A retrospective review of the dermatologic manifestations of chronic arsenic poisoning in the Philippines

Abstract

Background

The Section of Dermatology of the University of the Philippines, Philippine General Hospital, reported a case of chronic arsenic poisoning from a community in Luzon island to the Department of Health resulting in the conduct of two health and environmental assessment missions in December 2014.

Objective

To describe the demographic profile and cutaneous manifestations of chronic arsenic poisoning among affected residents in Luzon, Philippines.

Methods

A review of the medical records of 116 residents screened during the health assessment missions in December 2014 was conducted.

Results

Among the 116 residents screened, 81 (70%) had clinically confirmed arsenic keratoses and hyperpigmentation. Among them, 52 were males and 29 were females with age range of 4–82 years. Two cases of squamous cell carcinoma in situ were detected through skin biopsy. High levels of arsenic in the tap water and topsoil supported the occurrence of an epidemic of chronic arsenic poisoning.

Conclusion

Specific dermatologic findings of arsenic keratoses and pigmentation were common among the residents screened. Significantly higher occurrence of arsenic keratoses was seen in adults.

http://ift.tt/2otd41G

Military Metaphors in Oncology: Let's Not Fight About This

Publication date: Available online 27 March 2017
Source:Practical Radiation Oncology
Author(s): Benjamin W. Corn




http://ift.tt/2ncZejF

Scalp-sparing total skin electron therapy in mycosis fungoides: Case report featuring a technique without lead

Publication date: Available online 27 March 2017
Source:Practical Radiation Oncology
Author(s): Chirayu G. Patel, George Ding, Austin Kirschner




http://ift.tt/2o597no

Data on graphical representation (CGR and FCGR) of bacterial and archaeal species from two Soda Lakes

Publication date: June 2017
Source:Data in Brief, Volume 12
Author(s): Bhagwan N. Rekadwad, Chandrahasya N. Khobragade
In this paper, we presented the datasets generated using Chose Game representation (CGR) and Choase Game Representation of Frequencies (FCGR) of bacterial and archaeal 16S rRNA sequences. The data in the form of graphical representations was yielded with the help of ENDMEMO tool. The computational representation of these data datasets is useful for studies and interpretation of microbial sequences. Based on a technique from chaotic dynamics, the method produces a picture of any gene (DNA and RNA) sequence which displays both local and global patterns. Eukaryotes and prokaryotes can be identified merely based on their generated visual representation/DNA structures.



http://ift.tt/2nd1ozE

Data for the effects of rLj-RGD3 on normal tissues of rats and its location in HeyA8 cells

Publication date: June 2017
Source:Data in Brief, Volume 12
Author(s): Yuanyuan Zheng, Jianmei Han, Yuping Wang, Qi Jiang, Yue Wang, Li Lv, Rong Xiao, Jihong Wang
Lj-RGD3 which contains three Arg-Gly-Asp (RGD) motifs was identified from the buccal glands of Lampetra japonica. In the present data article, acute toxicity of recombinant Lj-RGD3 (rLj-RGD3) was performed in Sprague Dawley (SD) rats. Tissue observation data of these SD rats treated with normal saline (NS) or rLj-RGD3 were shown. Furthermore, confocal microscope data were also shown to observe the location of FITC-labeled rLj-RGD3 in the ovarian cancer cells (HeyA8 cells). This paper contains data related to research concurrently published in "rLj-RGD3 induces apoptosis via the mitochondrial-dependent pathway and inhibits adhesion, migration and invasion of human HeyA8 cells via FAK pathway" (Q. Jiang, Q. Li, J. Han, M. Gou, Y. Zheng, B. Li, R. Xiao, J. Wang, 2017) [1].



http://ift.tt/2ncLUff

An atlas of paste fabrics and supplemental paste compositional data from late middle preclassic-period ceramics at the Maya site of Holtun, Guatemala

Publication date: June 2017
Source:Data in Brief, Volume 12
Author(s): Michael G. Callaghan, Daniel Pierce, Brigitte Kovacevich, Michael D. Glascock
This data article contains an atlas of paste fabrics and supplemental paste compositional data generated from Late Middle Preclassic-period ceramics at the Maya site of Holtun, Guatemala. The data include maps showing locations of archeological contexts, excavation profiles, photographs and photomicrographs of sherds and paste fabrics, and compositional data produced by Neutron Activation Analysis (NAA) at the Research Reactor, University of Missouri (MURR). The NAA data include a biplot and table of canonical discriminant analyses, Mahalonobis distance calculations, and Euclidian distance searches between the samples.



http://ift.tt/2mKXwtA

Characteristics of tree nut challenges in tree nut allergic and tree nut sensitized individuals

Publication date: Available online 27 March 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Christopher Couch, Tim Franxman, Matthew Greenhawt
BackgroundCharacteristics and outcomes of tree nut (TN) oral food challenges (OFCs) in patients with TN allergy or sensitization alone are poorly studied.ObjectiveTo determine the relation between TN sensitization levels and OFC outcomes.MethodsOpen TN OFCs performed from 2007 through 2015 at a referral center were analyzed to compare outcome based on skin prick test (SPT) wheal size, food-specific immunoglobulin E (sIgE), peanut co-allergy, and TN sensitization only vs TN allergy with sensitization to other TNs. Delayed OFC was defined as longer than 12 months from the time of an sIgE level lower than 2 kUA/L.ResultsOverall passage rate was 86% for 156 TN OFCs in 109 patients (54 almond, 28 cashew, 27 walnut, 18 hazelnut, 14 pecan, 13 pistachio, and 2 Brazil nut). Passage rates were 76% (n = 67) in patients with a history of TN allergy who were challenged to another TN to which they were sensitized and 91% (n = 65) in those with TN sensitization only (mean sIgE 1.53 kUA/L; range 0.35–9.14). Passage rates were 89% (n = 110 of 124) for a TN sIgE level lower than 2 kUA/L and 69% (11 of 16) for a TN sIgE level of at least 2 kUA/L. In 44 challenges in patients with peanut allergy and TN co-sensitization, the TN OFC passage rate was 96%. In 41 TN OFCs with a TN SPT wheal size of at least 3 mm, 61% passed, with a mean wheal size of 4.8 mm (range 3–11) in those passing vs 9 mm (range 3–20) in those failing.ConclusionTN challenges are frequently passed in patients with TN sensitization with or without a history of TN reactivity despite a TN SPT wheal of at least 3 mm or a TN sIgE level of at least 2 kUA/L. Nearly all patients with peanut allergy and TN co-sensitization passed the TN challenge, questioning the clinical relevance of "co-allergy."



http://ift.tt/2obG4LX

Two synchronous malignant tumors of the pancreas: a case report

Only a limited number of multiple synchronous primary malignancies of the pancreas have been reported in the medical literature. We report a case of two solid malignant tumors of the pancreas diagnosed preoper...

http://ift.tt/2mKU2ra

Editorial Board/Reviewing Committee

http://ift.tt/2osUDKb

Critical role of environmental factors in the pathogenesis of psoriasis

Abstract

Psoriasis is a common cutaneous disease with multifactorial etiology including genetic and non-genetic factors, such as drugs, smoking, drinking, diet, infection and mental stress. Now, the role of the interaction between environmental factors and genetics are considered to be a main factor in the pathogenesis of psoriasis. However, it is a challenge to explore the mechanisms how the environmental factors break the body balance to affect the onset and development of psoriasis. In this article, we review the pathogenesis of psoriasis and summarize numerous clinical data to reveal the association between environmental factors and psoriasis. In addition, we focus on the mechanisms of environmental risk factors impact on psoriasis and provide a series of potential treatments against environmental risk factors.

http://ift.tt/2nuU6Kl

NUT Midline Carcinoma of the Sublingual Gland: Clinical Presentation and Review

Abstract

NUT midline carcinoma (NMC) is a rare and aggressive disease encountered in the midline of the head and neck or mediastinum. Due to its sparse incidence and subtle pathologic features, we aim to increase knowledge and awareness for this pathologic entity. We present an exemplary case of a young, healthy male presenting with oral cavity pain and cervical lymphadenopathy. This patient was initially diagnosed with an unspecified, highly aggressive sublingual gland malignancy and underwent locoregional resection with free flap reconstruction however suffered a rapid local recurrence and widely extensive metastasis within just 1 month. After rigorous analysis, final pathologic diagnosis revealed a poorly differentiated carcinoma with evidence of squamous differentiation that eventually, post-mortem tested positive for NMC. Only one prior case of sublingual gland NMC has been previously reported as we discuss the literature regarding all sublingual gland malignancies as well as the pathologic features and treatment options for NMC. We recommend consideration of testing for the NUT proto-oncogene at the time of biopsy in the clinical setting of a poorly differentiated midline carcinoma, especially with squamous differentiation, of the head or neck in order to identify patients for clinical trial enrollment and appropriately counsel on the poor clinical prognosis. Improving clinician awareness is critical to increase diagnostic accuracy and need to study prospective treatment outcomes as the first step toward improving management of this difficult disease.

http://ift.tt/2o9RFuT

Intraoral Salivary Duct Cyst: Clinical and Histopathologic Features of 177 Cases

Abstract

The salivary duct cyst (SDC) is a reactive ductal ectasia most frequently seen in major salivary glands, and likely caused by obstruction. The aim of this study is to define the clinical and histopathologic spectrum of intraoral SDCs. Cases were retrieved from the archives of Harvard School of Dental Medicine/StrataDx, Inc. from January 2012 to August 2014. There were 177 cases of which 103 (58.2%) occurred in females, with a median age of 56 (range 2–95). Approximately half of cases (45.8%) presented in the area of the buccal mucosa, lower lip mucosa, or mandibular vestibule, and 23.2% presented in the floor of mouth. SDCs were lined at least focally by 1–2 layers of cuboidal/columnar epithelium in 85.3% of cases and showed varying degrees of metaplasia (oncocytic, mucous cell, squamous, ciliated, apocrine-like) in 68.4% of cases. Intraluminal mucous stasis was present in 41.8% of SDCs, incipient calcification was present within 4.5% of SDCs, and chronic obstructive sialadenitis was seen in 90.2% of cases. No cysts showed adenomatous ductal proliferations or true papillary structures with fibrovascular cores, although 41.2% exhibited reactive undulation of cyst lining. Thirty-nine 'papillary oncocytic cystadenoma-like' SDCs (22.0%) demonstrated complete oncocytic metaplasia and marked undulation. An additional seven such cysts (4.0%) had a 'Warthin tumor-like' lymphoplasmacytic infiltrate. Intraoral SDCs occur most commonly in the sixth decade of life in locations distinct from extravasation mucoceles, likely secondary to intraluminal obstruction. SDCs show diverse histopathology and certain phenotypic variants may be mistaken for papillary oncocytic cystadenoma or Warthin tumor.

http://ift.tt/2nF7w77

Solid Cell Nests and Cyst Heterogeneity in Thyroglosal Duct Cysts

http://ift.tt/2o9WVi8

Dermasence refining gel modulates pathogenetic factors of rosacea in vitro

Summary

Background

Over the counter cosmetics sold for local treatment of slight to moderate rosacea often state the claim of actively modulating rosacea pathogenesis. Factors involved in the pathogenesis of this common yet complex skin disorder include kallikrein-related peptidase 5 (KLK5), LL-37, as well as protease-activated receptor 2 (PAR2) and vascular endothelial growth factor (VEGF).

Objective

The objective was to prove the modulating effect of the cosmetic skin care agent Dermasence Refining Gel (DRG) on factors involved in rosacea pathogenesis.

Methods

We analyzed the effect of DRG on the expression of KLK5, LL-37, PAR2, and VEGF in an in vitro skin model of human reconstituted epidermis.

Results

The expression of CAMP (LL-37 gene, fold change −4.19 [±0.11]), VEGFA (fold change −2.55 [±0.12]) and PAR2 (−1.33 [±0.12]) was reduced, KLK5 expression increased (fold change 2.06 (±0.08)) after 18 h of treatment with DRG in comparison to treatment with the matrix gel only. The reduction in CAMP expression was significant (P<.01). The protein expression of all four inflammatory markers was markedly reduced after 18 hours of DRG treatment in comparison to baseline (0 hour), by measure of fluorescence intensity.

Conclusion

We show evidence explaining the anti-inflammatory effect of Dermasence Refining Gel in rosacea pathogenesis in vitro. The adjunctive use of DRG in mild to moderate rosacea as a topical cosmetic seems medically reasonable.

http://ift.tt/2o4LRpC

Review in peeling complications

Summary

Chemical peeling, a procedure wherein a chemical agent is applied to the skin to cause controlled destruction followed by regeneration and remodeling, is a dynamic tool for the treatment of acne, pigmentation issues, and photoaging [Journal of cutaneous and aesthetic surgery vol. 5 (2012) 254–260]. The results and complications are related to the depth of the procedure, with deeper peels producing more marked results and higher rates of complications. Complications are more likely with darker skin types, certain peeling agents, and sun exposure after treatment [Journal of cutaneous and aesthetic surgery vol. 5 (2012) 254–260]. They can range from minor irritations and uneven pigmentation to permanent scarring. In extremely uncommon cases, the complications can be life-threatening. This knowledge is essential to prevent, reduce, and eliminate the occurrence of complications [Cirurgia dermatológica em consultório. São Paulo: Atheneu; 2009]. Swelling, pain, persistent erythema, pruritus, allergic reactions, folliculitis/acne, infection, herpes recurrence, hypopigmentation and hyperpigmentation, demarcation lines, and scarring are some of the complications that will be discussed in this article. The first step in preventing complications is to identify the patients at risk. By doing so, complications can be anticipated, prevented, and, if they still occur, treated as early as possible.

http://ift.tt/2nbhCbK

Dermasence refining gel modulates pathogenetic factors of rosacea in vitro

Summary

Background

Over the counter cosmetics sold for local treatment of slight to moderate rosacea often state the claim of actively modulating rosacea pathogenesis. Factors involved in the pathogenesis of this common yet complex skin disorder include kallikrein-related peptidase 5 (KLK5), LL-37, as well as protease-activated receptor 2 (PAR2) and vascular endothelial growth factor (VEGF).

Objective

The objective was to prove the modulating effect of the cosmetic skin care agent Dermasence Refining Gel (DRG) on factors involved in rosacea pathogenesis.

Methods

We analyzed the effect of DRG on the expression of KLK5, LL-37, PAR2, and VEGF in an in vitro skin model of human reconstituted epidermis.

Results

The expression of CAMP (LL-37 gene, fold change −4.19 [±0.11]), VEGFA (fold change −2.55 [±0.12]) and PAR2 (−1.33 [±0.12]) was reduced, KLK5 expression increased (fold change 2.06 (±0.08)) after 18 h of treatment with DRG in comparison to treatment with the matrix gel only. The reduction in CAMP expression was significant (P<.01). The protein expression of all four inflammatory markers was markedly reduced after 18 hours of DRG treatment in comparison to baseline (0 hour), by measure of fluorescence intensity.

Conclusion

We show evidence explaining the anti-inflammatory effect of Dermasence Refining Gel in rosacea pathogenesis in vitro. The adjunctive use of DRG in mild to moderate rosacea as a topical cosmetic seems medically reasonable.

http://ift.tt/2o4LRpC

Review in peeling complications

Summary

Chemical peeling, a procedure wherein a chemical agent is applied to the skin to cause controlled destruction followed by regeneration and remodeling, is a dynamic tool for the treatment of acne, pigmentation issues, and photoaging [Journal of cutaneous and aesthetic surgery vol. 5 (2012) 254–260]. The results and complications are related to the depth of the procedure, with deeper peels producing more marked results and higher rates of complications. Complications are more likely with darker skin types, certain peeling agents, and sun exposure after treatment [Journal of cutaneous and aesthetic surgery vol. 5 (2012) 254–260]. They can range from minor irritations and uneven pigmentation to permanent scarring. In extremely uncommon cases, the complications can be life-threatening. This knowledge is essential to prevent, reduce, and eliminate the occurrence of complications [Cirurgia dermatológica em consultório. São Paulo: Atheneu; 2009]. Swelling, pain, persistent erythema, pruritus, allergic reactions, folliculitis/acne, infection, herpes recurrence, hypopigmentation and hyperpigmentation, demarcation lines, and scarring are some of the complications that will be discussed in this article. The first step in preventing complications is to identify the patients at risk. By doing so, complications can be anticipated, prevented, and, if they still occur, treated as early as possible.

http://ift.tt/2nbhCbK

Microstructure and electrochemical corrosion behavior of extruded Mg–Al–Pb–La alloy as anode for seawater-activated battery

Publication date: 15 June 2017
Source:Materials & Design, Volume 124
Author(s): Yinchun Shi, Chaoqun Peng, Yan Feng, Richu Wang, Naiguang Wang
A seawater-activated battery is a disposable reserve battery that is specifically designed to pollute less due to the absence or relatively less use of heavy metals. Mg–Al–Pb–La alloy is a typical anode material that is used in high-power seawater-activated batteries. In this study, we use microstructure characterization to demonstrate that hot extrusion refines the grains of the alloy and leads to the formation of banded structures composed of the lamellar β-Al11La3 and lump AlMn phases. Our electrochemical measurements reveal that the extruded Mg–Al–Pb–La alloy is a promising anode material that exhibits excellent discharge activity and high anodic efficiency at a large current density. Moreover, we also examine the correlation between the grain orientation induced by extrusion and the electrochemical corrosion behavior of Mg–Al–Pb–La alloy. We believe that our results can significantly contribute to the development of seawater-activated batteries.

Graphical abstract

http://ift.tt/2nuX29T

Constrained groove pressing and subsequent annealing of Al-Mn-Si alloy: Microstructure evolutions, crystallographic transformations, mechanical properties, electrical conductivity and corrosion resistance

Publication date: 15 June 2017
Source:Materials & Design, Volume 124
Author(s): Hesam Pouraliakbar, Mohammad Reza Jandaghi, Gholamreza Khalaj
Al-Mn-Si specimens were severe plastic deformed (SPDed) through constrained groove pressing (CGP) by εeff=1.16, 232, and 3.48. CGPed sheets were subsequently annealed at 150, 250 and 350°C to investigate complementary treatment route on macro- and microscale properties of heavily strained alloy. Microstructure evolutions in deformed and post-annealed states along with their associated mechanisms such as recovery, recrystallization and strain induced grain boundary migration (SIGBM) were studied and analyzed. SIGBM as an indication for inhomogeneous grain growth was traced by transformations in grains' aspect ratio. Microanalysis of crystallographic characteristics by means of X-ray diffraction (XRD) patterns revealed that (111) planes were the main crystallographic index in CGPed and annealed alloys since preservation up to 350°C had amplified the (200) and deteriorated the intensity of (311) planes. Dislocation density measurements implied the dynamic recovery occurrence in CGP (εeff=2.32) which had affected mechanical characteristics, electrical conductivity and corrosion resistance of the utilized alloy. Mechanical properties through tension and hardness tests had been examined since the maximum YS, UTS, and hardness of 118MPa and 141MPa, 52Hv obtained for CGPed specimen (εeff=3.48) compared with annealed alloy with the values of 85MPa and 112MPa, and 29Hv, respectively.

Graphical abstract

http://ift.tt/2nuUxUL

Molecular dynamics study of the reinforcement effect of graphene in multilayered polymer nanocomposites

Publication date: 15 June 2017
Source:Materials & Design, Volume 124
Author(s): A.R. Alian, M.A.N. Dewapriya, S.A. Meguid
We conducted comprehensive molecular dynamics simulations of the nanoindentation of graphene reinforced composites to study the effect of graphene as a reinforcement and coating material. Three different cases are considered: (i) single and multilayered graphene layers used to coat a polyethylene (PE) substrate, (ii) graphene layers embedded into a PE block forming a multilayered system, and (iii) graphene layers randomly embedded into a PE block forming a nanocomposite. The study focused on the reinforcement mechanism and the fracture behaviour associated with increasing the number of graphene coating layers, changing interlayer spacing distance, orienting graphene-PE layers with respect to the indentation direction, and changing graphene dispersion in the composite. The results of our study reveal that the indentation resistance of a single-layer graphene coated PE is fourteen-fold the indentation resistance of pure PE. They also indicate that the indentation resistance of the multi-layered embedded graphene arrangement can be effectively controlled by appropriately selecting the separation distance between the graphene layers. They further show the strong influence of the orientation and the arrangement of graphene layers on the mechanical response of the nanocomposite. These findings are useful in designing graphene-based nanocomposites with tenable performance.

Graphical abstract

http://ift.tt/2nuHRgS

Fabricating protective epoxy-silica/CeO2 films for steel: Correlating physical barrier properties with material content

Publication date: 15 June 2017
Source:Materials & Design, Volume 124
Author(s): Ubong Eduok, Omar Faye, Ahmed Tiamiyu, Jerzy Szpunar
Upon the numerous researches on material protection, less attention has been drawn to the in-depth studies of the failure mechanisms accompanying modified organic coating formulations and their inherent barrier properties. In our present study, the mechanism for failed barrier properties of a new epoxy-silica polymer coating designed to anchor CeO2 pigments has been proposed while also investigating the impact of content leaching on the microstructure of coated metal substrate. By deploying a rare earth content in CeO2 pigments within its sol-gel network, we have observed improved protection against steel corrosion in an aerated corrosive medium by electrochemical impedance spectroscopy. Though protective performance increased with CeO2 content, beyond 1wt% concentration, the coating network becomes saturated with inorganic pigments thereby widening conducting paths for the flow of ionic currents towards the metal surface via the coating. These excess CeO2 contents tend to assume uneven distribution patterns within the sol-gel network leading to coating disbonding. The failed protective abilities of this modified sol-gel type coating design has been linked with particulate leaching upon prolonged exposure; evidence of this assertion has been established by SEM analyses though AFM evidence also reveals significant coating disbonding without these pigments.

Graphical abstract

http://ift.tt/2nuHT8u

Effect of alkaline hydrolysis on cyclization reaction of PAN nanofibers

Publication date: 15 June 2017
Source:Materials & Design, Volume 124
Author(s): So Yeon Jin, Min Hee Kim, Young Gyu Jeong, Young Il Yoon, Won Ho Park
Polyacrylonitrile (PAN) nanofibers were prepared via electrospinning, and the PAN nanofibers were then subjected to alkaline hydrolysis with different treatment times. The alkaline hydrolysis behavior of the PAN nanofibers was investigated with ATR-IR and XPS analyses. The results indicate that the nitrile (CN) groups of PAN were converted into amide (CONH2) and carboxylic (COOH) groups. The effect of the alkaline hydrolysis on the cyclization of the PAN nanofibers was then investigated using ATR-IR, DSC, and TGA analyses. The functional groups introduced through the hydrolysis of PAN initiated the cyclization reaction at a faster rate, and thus the exothermic cyclization temperature shifted to a lower temperature. In addition, the extent of the stabilization reaction (EOS) of the hydrolyzed PAN nanofibers was higher than that of the PAN nanofibers. It was conclusively demonstrated that the alkaline hydrolysis was effective in improving the cyclization efficiency of the PAN nanofibers.

Graphical abstract

http://ift.tt/2nuX15P

Effect of beam offset on microstructure and mechanical properties of dissimilar electron beam welded high temperature titanium alloys

Publication date: 15 June 2017
Source:Materials & Design, Volume 124
Author(s): V. Esfahani Yeganeh, Peijie Li
Electron beam welding was used to join dissimilar Ti55 to TA15 titanium alloys. The aim of this study was to investigate the effect of the beam offset on microstructure and mechanical properties of the welded joints. Microstructural characterization was investigated by optical microscopy, scanning electron microscopy and X-ray diffraction. Tensile test was conducted at room temperature and 550°C. Results indicated that the fusion zone consisted of martensite α′ and acicular α. Heat affected zone (HAZ) in both Ti55 and TA15 sides consisted of two regions; Low temperature HAZ (LT-HAZ) was composed of primary α, secondary α and prior β and high temperature HAZ (HT-HAZ) was composed of martensite α′ and acicular α. The hardness of fusion zone was lower than HAZ of both Ti55 and TA15 alloy. Energy-dispersive spectroscopy was applied to display microstructure evolution inside the fusion zone. Tensile results showed that offsetting the beam position towards Ti55 alloy led to higher values of joint strength. Beam offsetting towards TA15 alloy lowered the hardness and strength of welded joints. Increasing the beam offset to the values >0.3mm towards Ti55 or TA15 resulted in premature fracture due to increasing the possibility of porosity formation inside the weld metal.

Graphical abstract

http://ift.tt/2nuN73U

Effect of a Zn interlayer on dissimilar FSSW of Al and Cu

Publication date: 15 June 2017
Source:Materials & Design, Volume 124
Author(s): A. Boucherit, M.-N. Avettand-Fènoël, R. Taillard
The present paper focuses on the role played by a Zn interlayer in the improvement of the mechanical behavior of Al-Cu Friction Stir Spot Welds. An unusual configuration of lap joint with Cu at the top surface as well as rather thick plates was considered. The effects of the tool plunge depth exceeding or not the top plate thickness and of various Zn layer thicknesses on the microstructure and mechanical properties of the joint were investigated. Zn at once hampers the formation of the deleterious Al4Cu9 compound while favoring the τ′ phase precipitation. Over the range considered in this study, the Zn layer thickness presents no obvious effect on the shear lap tensile properties. At last, various ways of welding improvement are proposed.

Graphical abstract

http://ift.tt/2nuZi0B

Tuning the plasticity of Ni-Mo solid solution in Ni-based superalloys by ab initio calculations

Publication date: 15 June 2017
Source:Materials & Design, Volume 124
Author(s): Wenyue Zhao, Wei Li, Zhimei Sun, Shengkai Gong, Levente Vitos
The generalized stacking fault energies of face centered cubic Ni-Mo solid solutions are calculated using the exact muffin-tin orbital method in combination with coherent potential approximation. The alloying of Mo in Ni is found to decrease the intrinsic stacking fault energy of the solid solution from 150mJ/m² (pure Ni) to 50mJ/m² (17.5at.% Mo) almost linearly. At the same time, the unstable stacking fault energy (the unstable twin fault energy) of the Ni-based solid solution increases (decreases) in a small extent with increasing Mo concentration. Three different twinnability measures are adopted and all indicate a substantially enhanced twinning mechanism in Ni-Mo solid solutions with increasing concentration of Mo. The weaker Ni-Ni bonding at high Mo concentrations is considered to be the main mechanism behind the disclosed phenomena. Segregation of Mo to the fault plane is proved to have strong effect on the generalized stacking fault energy of Ni-based solid solution.

Graphical abstract

http://ift.tt/2nv6t9d

Propofol-induced irreversible hair depigmentation: a case report

http://ift.tt/2mKWcaf

Programmed death-ligand 1 and its soluble form are highly expressed in nasal natural killer/T-cell lymphoma: a potential rationale for immunotherapy

Abstract

Nasal natural killer/T-cell lymphoma (NNKTL) is an aggressive neoplasm with poor therapeutic responses and prognosis. The programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) pathway plays an important role in immune evasion of tumor cells through T-cell exhaustion. The aim of the present study was to examine the expression of PD-L1 and PD-1 molecules in NNKTL. We detected the expression of PD-L1 in biopsy samples from all of the NNKTL patients studied. PD-L1 was found on both malignant cells and tumor-infiltrating macrophages, while PD-1-positive mononuclear cells infiltrated the tumor tissues in 36% of patients. Most significantly, soluble PD-L1 (sPD-L1) was present in sera of NNKTL patients at higher levels as compared to healthy individuals and the levels of serum sPD-L1 in patients positively correlated with the expression of PD-L1 in lymphoma cells of tumor tissues. In addition, the high-sPD-L1 group of patients showed significantly worse prognosis than the low-sPD-L1 group. Furthermore, we confirmed that membrane and soluble PD-L1 was expressed on the surface and in the culture supernatant, respectively, of NNKTL cell lines. The expression of PD-L1 was observed in tumor tissues and sera from a murine xenograft model inoculated with an NNKTL cell line. Our results suggest that sPD-L1 could be a prognostic predictor for NNKTL and open up the possibility of immunotherapy of this lymphoma using PD-1/PD-L1 axis inhibitors.

http://ift.tt/2nGuY3Q

Two synchronous malignant tumors of the pancreas: a case report

Only a limited number of multiple synchronous primary malignancies of the pancreas have been reported in the medical literature. We report a case of two solid malignant tumors of the pancreas diagnosed preoper...

http://ift.tt/2mKU2ra

TSHR/IGF-1R Cross-Talk, not IGF-1R Stimulating Antibodies, Mediates Graves' Ophthalmopathy Pathogenesis

Thyroid , Vol. 0, No. 0.


http://ift.tt/2nGAWSm

TSHR/IGF-1R Cross-Talk, not IGF-1R Stimulating Antibodies, Mediates Graves' Ophthalmopathy Pathogenesis

Thyroid , Vol. 0, No. 0.


http://ift.tt/2nGAWSm

Corrigendum to

The authors regret < that the dosage of amoxicillin was unclear in the original version of the article. The correct dosage is '2 capsules of amoxicillin 875mg orally' instead of '2g amoxicillin 875mg orally'>.

http://ift.tt/2nbka9U

Chemocauterization of second branchial cleft fistula using trichloroacetic acid: A preliminary report

Although second branchial cleft fistula (BCF) can be well treated with surgical excision, neck scarring is unavoidable. We previously reported chemocauterization with trichloroacetic acid (TCA) to close various fistulas. Here, we report chemocauterization of a second BCF without a consequent incision scar.

http://ift.tt/2o0gyfi

Sialendoscopic removal of fish bone-induced sialoliths in the duct of the submandibular gland

Obstructive sialadenitis of the submandibular gland is commonly caused by sialoliths, but more rarely by foreign body-induced sialoliths. Here, we report minimally invasive sialendoscopic removal of fish bone-induced sialoliths in the duct of the submandibular gland. A 43-year-old woman presented with recurrent swelling of the right submandibular gland at other hospital. Computed tomography (CT) showed an 8-mm linear calcification in the posterior part of Wharton's duct. The lesion was deemed difficult to remove and she was followed up.

http://ift.tt/2npnpfG

Chemocauterization of second branchial cleft fistula using trichloroacetic acid: A preliminary report

Although second branchial cleft fistula (BCF) can be well treated with surgical excision, neck scarring is unavoidable. We previously reported chemocauterization with trichloroacetic acid (TCA) to close various fistulas. Here, we report chemocauterization of a second BCF without a consequent incision scar.

http://ift.tt/2o0gyfi

Sialendoscopic removal of fish bone-induced sialoliths in the duct of the submandibular gland

Obstructive sialadenitis of the submandibular gland is commonly caused by sialoliths, but more rarely by foreign body-induced sialoliths. Here, we report minimally invasive sialendoscopic removal of fish bone-induced sialoliths in the duct of the submandibular gland. A 43-year-old woman presented with recurrent swelling of the right submandibular gland at other hospital. Computed tomography (CT) showed an 8-mm linear calcification in the posterior part of Wharton's duct. The lesion was deemed difficult to remove and she was followed up.

http://ift.tt/2npnpfG

Comparison of the adult three-dimensional craniofacial features of patients with unilateral craniofacial microsomia with and without early mandible distraction

This study was conducted to analyze the long-term facial growth of patients with craniofacial microsomia (CFM) after early mandible distraction osteogenesis (DO), and compared adult three-dimensional (3D) craniofacial features of patients with and without early mandibular DO for Pruzansky grade II deformities. The study included 20 patients: 9 with early mandible DO (the DO group) and 11 without previous treatment (the NDO group). Longitudinal radiographs were measured for growth changes after DO.

http://ift.tt/2nuxqd3

Evaluation of hyaluronic matrix efficacy in sinus augmentation: a randomized-controlled histomorphometric and micro–computed tomography analysis

The objective of the present study was to test the hypothesis that the addition of hyaluronic acid–based matrix to collagenated heterologous bone graft for sinus augmentation would enhance bone formation compared to collagenated heterologous bone graft alone in the early healing period, by micro−computed tomography and histomorphometry. Thirteen systemically healthy patients requiring bilateral two-stage maxillary sinus augmentation (residual crest height≤4mm) were enrolled in this split-mouth prospective randomized controlled study.

http://ift.tt/2ncatZO

Circulating Soluble IL-6 Receptor Concentration and Visceral Adipocyte Size Are Related to Insulin Resistance in Taiwanese Adults with Morbid Obesity

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


http://ift.tt/2ncrrad

The Influence of Epicardial Fat and Nonalcoholic Fatty Liver Disease on Heart Rate Recovery in Metabolic Syndrome

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


http://ift.tt/2mKKufG

Circulating Zbed3 Levels in Subjects With and Without Metabolic Syndrome

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


http://ift.tt/2ncurDG

High Prevalence of Vitamin D Deficiency and Correlation of Serum Vitamin D with Cardiovascular Risk in Patients with Metabolic Syndrome

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


http://ift.tt/2nGoVfo

Idiopathic intracranial hypertension: Contemporary review and implications for the otolaryngologist

Objectives

1) Review controversies pertaining to the pathophysiology, diagnosis, and treatment of idiopathic intracranial hypertension. 2) Discuss the evolving role of otolaryngologists in managing this disease and related disorders.

Data Sources

Primary literature review, Centers for Disease Control and Prevention website, International Classification of Headache Disorders, Second Edition.

Methods

A comprehensive review of the primary literature was performed from 1990 to 2016 utilizing keywords idiopathic intracranial hypertension, pseudotumor cerebri, benign intracranial hypertension, spontaneous cerebrospinal fluid leak, and encephalocele. Articles were included at the discretion of the authors based on novel and/or historical contributions to the literature.

Results

The incidence of idiopathic intracranial hypertension is increasing along with the obesity epidemic. Undiagnosed patients may present to otolaryngologists with pulsatile tinnitus, dizziness, sleep apnea, and spontaneous cerebrospinal fluid leaks. Although diagnosis is predicated upon imaging findings and lumbar puncture, radiographic signs including empty sella, optic nerve dilation, and globe flattening may suggest the diagnosis. The most effective intervention is weight loss combined with acetazolamide. Surgery is reserved for severe or refractory symptoms and can be highly morbid. Otolaryngologists are increasingly responsible for managing a number of secondary disorders including cerebrospinal fluid rhinorrhea and otorrhea. Failure to manage intracranial hypertension may lead to adverse surgical outcomes.

Conclusions

The knowledge base for idiopathic intracranial hypertension has greatly expanded over the past 25 years. This disease is associated with a number of conditions directly relevant to otolaryngologists. A keen understanding of this disorder and its management may optimize outcomes in a growing number of patients. Laryngoscope, 2017

http://ift.tt/2nGhi8O

Audiovestibular symptoms as predictors of prolonged sports-related concussion among NCAA athletes

Objective

We looked to determine the rates of audiovestibular symptoms following sports-related concussions among collegiate athletes. Further, we assessed the correlation between these symptoms and the time to return to participation in athletic activity.

Study Design

Retrospective analysis of the National Collegiate Athletic Association Injury Surveillance System (NCAA-ISS).

Methods

The NCAA-ISS was queried from 2009 through 2014 for seven men's sports and eight women's sports across divisions 1, 2, and 3. Injuries resulting in concussions were analyzed for audiovestibular symptoms, duration of symptoms, and return to participation times.

Results

From 2009 to 2014, there were 1,647 recorded sports-related concussions, with athletes reporting dizziness (68.2%), imbalance (35.8%), disorientation (31.4%), noise sensitivity (29.9%), and tinnitus (8.5%). Concussion symptoms resolved within 1 day (17.1%), within 2 to 7 days (50.0%), within 8 to 30 days (25.9%), or persisted over 1 month (7.0%). Return to participation occurred within 1 week (38.3%), within 1 month (53.0%), or over 1 month (8.7%). Using Mann-Whitney U testing, overall symptom duration and return to competition time were significantly increased when any of these symptoms were present (P < 0.05). Duration of concussion symptom correlated with dizziness (P = 0.043) and noise sensitivity (P = 0.000), whereas return to participation times correlated with imbalance (P = 0.011) and noise sensitivity (P = 0.000). Dizziness and imbalance (odds ratio: 4.15, confidence interval: 3.20–5.38, P < 0.001) were the two symptoms with the strongest association.

Conclusion

Audiovestibular symptoms are common complaints among collegiate athletes sustaining concussions. Dizziness and noise sensitivity correlated with the duration of concussive symptoms, whereas imbalance and noise sensitivity was correlated with prolonged return to competition time.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2nGmI3L

Idiopathic intracranial hypertension: Contemporary review and implications for the otolaryngologist

Objectives

1) Review controversies pertaining to the pathophysiology, diagnosis, and treatment of idiopathic intracranial hypertension. 2) Discuss the evolving role of otolaryngologists in managing this disease and related disorders.

Data Sources

Primary literature review, Centers for Disease Control and Prevention website, International Classification of Headache Disorders, Second Edition.

Methods

A comprehensive review of the primary literature was performed from 1990 to 2016 utilizing keywords idiopathic intracranial hypertension, pseudotumor cerebri, benign intracranial hypertension, spontaneous cerebrospinal fluid leak, and encephalocele. Articles were included at the discretion of the authors based on novel and/or historical contributions to the literature.

Results

The incidence of idiopathic intracranial hypertension is increasing along with the obesity epidemic. Undiagnosed patients may present to otolaryngologists with pulsatile tinnitus, dizziness, sleep apnea, and spontaneous cerebrospinal fluid leaks. Although diagnosis is predicated upon imaging findings and lumbar puncture, radiographic signs including empty sella, optic nerve dilation, and globe flattening may suggest the diagnosis. The most effective intervention is weight loss combined with acetazolamide. Surgery is reserved for severe or refractory symptoms and can be highly morbid. Otolaryngologists are increasingly responsible for managing a number of secondary disorders including cerebrospinal fluid rhinorrhea and otorrhea. Failure to manage intracranial hypertension may lead to adverse surgical outcomes.

Conclusions

The knowledge base for idiopathic intracranial hypertension has greatly expanded over the past 25 years. This disease is associated with a number of conditions directly relevant to otolaryngologists. A keen understanding of this disorder and its management may optimize outcomes in a growing number of patients. Laryngoscope, 2017

http://ift.tt/2nGhi8O

Onset of bell's palsy in late pregnancy and early puerperium is associated with worse long-term outcomes

Introduction

The incidence of Bell's palsy (BP) is elevated in the late phases of pregnancy. Controversy exists as to whether pregnancy is a risk factor for worse outcomes in BP, and whether such outcomes are the result of factors intrinsic to pregnancy or the tendency to withhold medical therapy in this cohort.

Methods

Long-term facial function outcomes in cases of pregnancy-associated BP (PABP) were compared against outcomes in cases affecting nonpregnant adult women of child-bearing age by a blinded expert using the electronic clinician-graded facial function scale (eFACE) facial grading system.

Results

Fifty-one pregnancy-associated cases and 58 nonpregnancy-associated cases were included. Among patients who received early corticosteroid therapy, significantly worse static, synkinesis, and composite facial function eFACE scores were demonstrated among cases of PABP compared to nonpregnancy-associated cases (static median = 86 vs. 92.5, P = 0.005; synkinesis median = 79 vs. 86, P = 0.007; composite median = 78 vs. 84, P = 0.023). Among those not treated with corticosteroids, significantly worse dynamic and composite facial function eFACE scores were demonstrated in cases of PABP compared to those for nonpregnancy-associated cases (dynamic median = 74 vs. 92.5, P = 0.038; composite median = 73 vs. 86.5, P = 0.038). A trend toward improved outcomes was demonstrated within both groups for those treated with corticosteroids compared to those who were not.

Conclusion

In comparison to cases unrelated to pregnancy, late-term PABP is associated with worse long-term outcomes to a degree that cannot solely be explained by differences in medical therapy.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2np38Xv

Real-time continuous image-guided surgery: Preclinical investigation in glossectomy

Objectives/Hypothesis

To develop, validate, and study the efficacy of an intraoperative real-time continuous image-guided surgery (RTC-IGS) system for glossectomy.

Study Design

Prospective study.

Methods

We created a RTC-IGS system and surgical simulator for glossectomy, enabling definition of a surgical target preoperatively, real-time cautery tracking, and display of a surgical plan intraoperatively. System performance was evaluated by a group of otolaryngology residents, fellows, medical students, and staff under a reproducible setting by using realistic tongue phantoms. Evaluators were grouped into a senior and a junior group based on surgical experience, and guided and unguided tumor resections were performed. National Aeronautics and Space Administration Task Load Index (NASA-TLX) scores and a Likert scale were used to measure workloads and impressions of the system, respectively. Efficacy was studied by comparing surgical accuracy, time, collateral damage, and workload between RTC-IGS and non-navigated resections.

Results

The senior group performed more accurately (80.9% ± 3.7% vs. 75.2% ± 5.5%, P = .28), required less time (5.0 ± 1.3 minutes vs. 7.3 ± 1.2 minutes, P = .17), and experienced lower workload (43 ± 2.0 vs. 64.4 ± 1.3 NASA-TLX score, P = .08), suggesting a trend of construct validity. Impressions were favorable, with participants reporting the system is a valuable practice tool (4.0/5 ± 0.3) and increases confidence (3.9/5 ± 0.4). Use of RTC-IGS improved both groups' accuracy, with the junior group improving from 64.4% ± 5.4% to 75.2% ± 5.5% (P = .01) and the senior group improving from 76.1% ± 4.5% to 80.9% ± 3.7% (P = .16).

Conclusions

We created an RTC-IGS system and surgical simulator and demonstrated a trend of construct validity. Our navigated simulator allows junior trainees to practice glossectomies outside the operating room. In all evaluators, navigation assistance resulted in increased surgical accuracy.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2nGoUIr

Laryngoscopic and stroboscopic signs in the diagnosis of vocal fold paresis

Objectives/Hypothesis

To identify strobolaryngoscopic findings significant in the diagnosis of paresis.

Study Design

Retrospective cohort study.

Methods

Fellowship-trained laryngologists reviewed 34 videostroboscopic examinations (24 with paresis, eight without paresis, two repeat). They indicated presence or absence of paresis, including side and type, degree of confidence in diagnosis, and ranked clinical findings that influenced diagnosis by order of importance. Fleiss's κ was used to assess inter-rater agreement for paresis presence, side, and type. Clinical findings compelling in diagnosis were tabulated and described. Confidence levels for side and type were compared by analysis of variance/Kruskal-Wallis tests and post hoc pairwise comparisons.

Results

Thirty-one laryngologists completed the review. Inter-rater agreement on presence or absence of paresis was fair at 0.334 (Fleiss's κ). Fourteen examinations were diagnosed with paresis by >70% of raters and considered strong paresis-candidate exams. Diagnosis of paresis side and type were inconsistent, although with statistically significant differences in confidence ratings (unilateral vs. bilateral, recurrent laryngeal nerve [RLN] vs. superior laryngeal nerve [SLN], RLN vs. mixed RLN/SLN). Laryngoscopic and stroboscopic findings with the strongest association with paresis were vocal fold motion anomalies, vocal fold degeneration, glottic insufficiency, and mucosal wave anomalies.

Conclusions

Most laryngologists use strobolaryngoscopy for diagnosis of paresis. Although certain clinical findings were found to be associated with diagnosis, most commonly vocal fold motion anomalies, these varied among raters, especially when determining sidedness and nerve involvement. Future studies should expand the discussion and consideration of strobolaryngoscopic factors and adjunct functional and objective measures to develop a heuristic algorithm for diagnosis of paresis.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2nperio

Nerve transection repair using laser-activated chitosan in a rat model

Objectives/Hypothesis

Cranial nerve transection during head and neck surgery is conventionally repaired with microsuture. Previous studies have demonstrated recovery with laser nerve welding (LNW), a novel alternative to microsuture. LNW has been reported to have poorer tensile strength, however. Laser-activated chitosan, an adhesive biopolymer, may promote nerve recovery while enhancing the tensile strength of the repair. Using a rat posterior tibial nerve injury model, we compared four different methods of nerve repair in this pilot study.

Study Design

Animal study.

Design

Animals underwent unilateral posterior tibial nerve transection. The injury was repaired by potassium titanyl phosphate (KTP) laser alone (n = 20), KTP + chitosan (n = 12), microsuture + chitosan (n = 12), and chitosan alone (n = 14). Weekly walking tracks were conducted to measure functional recovery (FR). Tensile strength (TS) was measured at 6 weeks.

Results

At 6 weeks, KTP laser alone had the best recovery (FR = 93.4% ± 8.3%). Microsuture + chitosan, KTP + chitosan, and chitosan alone all showed good FR (87.4% ± 13.5%, 84.6% ± 13.0%, and 84.1% ± 10.0%, respectively). One-way analysis of variance was performed (F(3,56) = 2.6, P = .061). A TS threshold of 3.8 N was selected as a control mean recovery. Three groups—KTP alone, KTP + chitosan, and microsuture + chitosan—were found to meet threshold 60% (95% confidence interval [CI]: 23.1%-88.3%), 75% (95% CI: 46.8%-91.1%), and 100% (95% CI: 75.8%-100.0%), respectively.

Conclusions

In the posterior tibial nerve model, all repair methods promoted nerve recovery. Laser-activated chitosan as a biopolymer anchor provided good TS and appears to be a novel alternative to microsuture. This repair method may have surgical utility following cranial nerve injury during head and neck surgery.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2npd5UI

Audiovestibular symptoms as predictors of prolonged sports-related concussion among NCAA athletes

Objective

We looked to determine the rates of audiovestibular symptoms following sports-related concussions among collegiate athletes. Further, we assessed the correlation between these symptoms and the time to return to participation in athletic activity.

Study Design

Retrospective analysis of the National Collegiate Athletic Association Injury Surveillance System (NCAA-ISS).

Methods

The NCAA-ISS was queried from 2009 through 2014 for seven men's sports and eight women's sports across divisions 1, 2, and 3. Injuries resulting in concussions were analyzed for audiovestibular symptoms, duration of symptoms, and return to participation times.

Results

From 2009 to 2014, there were 1,647 recorded sports-related concussions, with athletes reporting dizziness (68.2%), imbalance (35.8%), disorientation (31.4%), noise sensitivity (29.9%), and tinnitus (8.5%). Concussion symptoms resolved within 1 day (17.1%), within 2 to 7 days (50.0%), within 8 to 30 days (25.9%), or persisted over 1 month (7.0%). Return to participation occurred within 1 week (38.3%), within 1 month (53.0%), or over 1 month (8.7%). Using Mann-Whitney U testing, overall symptom duration and return to competition time were significantly increased when any of these symptoms were present (P < 0.05). Duration of concussion symptom correlated with dizziness (P = 0.043) and noise sensitivity (P = 0.000), whereas return to participation times correlated with imbalance (P = 0.011) and noise sensitivity (P = 0.000). Dizziness and imbalance (odds ratio: 4.15, confidence interval: 3.20–5.38, P < 0.001) were the two symptoms with the strongest association.

Conclusion

Audiovestibular symptoms are common complaints among collegiate athletes sustaining concussions. Dizziness and noise sensitivity correlated with the duration of concussive symptoms, whereas imbalance and noise sensitivity was correlated with prolonged return to competition time.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2nGmI3L

Real-time continuous image-guided surgery: Preclinical investigation in glossectomy

Objectives/Hypothesis

To develop, validate, and study the efficacy of an intraoperative real-time continuous image-guided surgery (RTC-IGS) system for glossectomy.

Study Design

Prospective study.

Methods

We created a RTC-IGS system and surgical simulator for glossectomy, enabling definition of a surgical target preoperatively, real-time cautery tracking, and display of a surgical plan intraoperatively. System performance was evaluated by a group of otolaryngology residents, fellows, medical students, and staff under a reproducible setting by using realistic tongue phantoms. Evaluators were grouped into a senior and a junior group based on surgical experience, and guided and unguided tumor resections were performed. National Aeronautics and Space Administration Task Load Index (NASA-TLX) scores and a Likert scale were used to measure workloads and impressions of the system, respectively. Efficacy was studied by comparing surgical accuracy, time, collateral damage, and workload between RTC-IGS and non-navigated resections.

Results

The senior group performed more accurately (80.9% ± 3.7% vs. 75.2% ± 5.5%, P = .28), required less time (5.0 ± 1.3 minutes vs. 7.3 ± 1.2 minutes, P = .17), and experienced lower workload (43 ± 2.0 vs. 64.4 ± 1.3 NASA-TLX score, P = .08), suggesting a trend of construct validity. Impressions were favorable, with participants reporting the system is a valuable practice tool (4.0/5 ± 0.3) and increases confidence (3.9/5 ± 0.4). Use of RTC-IGS improved both groups' accuracy, with the junior group improving from 64.4% ± 5.4% to 75.2% ± 5.5% (P = .01) and the senior group improving from 76.1% ± 4.5% to 80.9% ± 3.7% (P = .16).

Conclusions

We created an RTC-IGS system and surgical simulator and demonstrated a trend of construct validity. Our navigated simulator allows junior trainees to practice glossectomies outside the operating room. In all evaluators, navigation assistance resulted in increased surgical accuracy.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2nGoUIr

Laryngoscopic and stroboscopic signs in the diagnosis of vocal fold paresis

Objectives/Hypothesis

To identify strobolaryngoscopic findings significant in the diagnosis of paresis.

Study Design

Retrospective cohort study.

Methods

Fellowship-trained laryngologists reviewed 34 videostroboscopic examinations (24 with paresis, eight without paresis, two repeat). They indicated presence or absence of paresis, including side and type, degree of confidence in diagnosis, and ranked clinical findings that influenced diagnosis by order of importance. Fleiss's κ was used to assess inter-rater agreement for paresis presence, side, and type. Clinical findings compelling in diagnosis were tabulated and described. Confidence levels for side and type were compared by analysis of variance/Kruskal-Wallis tests and post hoc pairwise comparisons.

Results

Thirty-one laryngologists completed the review. Inter-rater agreement on presence or absence of paresis was fair at 0.334 (Fleiss's κ). Fourteen examinations were diagnosed with paresis by >70% of raters and considered strong paresis-candidate exams. Diagnosis of paresis side and type were inconsistent, although with statistically significant differences in confidence ratings (unilateral vs. bilateral, recurrent laryngeal nerve [RLN] vs. superior laryngeal nerve [SLN], RLN vs. mixed RLN/SLN). Laryngoscopic and stroboscopic findings with the strongest association with paresis were vocal fold motion anomalies, vocal fold degeneration, glottic insufficiency, and mucosal wave anomalies.

Conclusions

Most laryngologists use strobolaryngoscopy for diagnosis of paresis. Although certain clinical findings were found to be associated with diagnosis, most commonly vocal fold motion anomalies, these varied among raters, especially when determining sidedness and nerve involvement. Future studies should expand the discussion and consideration of strobolaryngoscopic factors and adjunct functional and objective measures to develop a heuristic algorithm for diagnosis of paresis.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2nperio

Onset of bell's palsy in late pregnancy and early puerperium is associated with worse long-term outcomes

Introduction

The incidence of Bell's palsy (BP) is elevated in the late phases of pregnancy. Controversy exists as to whether pregnancy is a risk factor for worse outcomes in BP, and whether such outcomes are the result of factors intrinsic to pregnancy or the tendency to withhold medical therapy in this cohort.

Methods

Long-term facial function outcomes in cases of pregnancy-associated BP (PABP) were compared against outcomes in cases affecting nonpregnant adult women of child-bearing age by a blinded expert using the electronic clinician-graded facial function scale (eFACE) facial grading system.

Results

Fifty-one pregnancy-associated cases and 58 nonpregnancy-associated cases were included. Among patients who received early corticosteroid therapy, significantly worse static, synkinesis, and composite facial function eFACE scores were demonstrated among cases of PABP compared to nonpregnancy-associated cases (static median = 86 vs. 92.5, P = 0.005; synkinesis median = 79 vs. 86, P = 0.007; composite median = 78 vs. 84, P = 0.023). Among those not treated with corticosteroids, significantly worse dynamic and composite facial function eFACE scores were demonstrated in cases of PABP compared to those for nonpregnancy-associated cases (dynamic median = 74 vs. 92.5, P = 0.038; composite median = 73 vs. 86.5, P = 0.038). A trend toward improved outcomes was demonstrated within both groups for those treated with corticosteroids compared to those who were not.

Conclusion

In comparison to cases unrelated to pregnancy, late-term PABP is associated with worse long-term outcomes to a degree that cannot solely be explained by differences in medical therapy.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2np38Xv

The state of academic sleep surgery: A survey of United States residency and fellowship programs

Objectives/Hypothesis

Our objectives were to describe otolaryngology residency programs' experience in and attitudes toward sleep surgery, and describe current otolaryngology sleep fellowships and their impact on future academic practice.

Study Design

E-mail survey.

Methods

A survey was e-mailed to program directors of 106 Accreditation Council for Graduate Medical Education-accredited otolaryngology residencies assessing resident sleep medicine experience, program satisfaction, and impact of sleep faculty. A separate survey was sent to directors of the seven sleep medicine otolaryngology fellowships. Frequency of graduates pursuing academic careers was examined.

Results

Forty-six (43.4%) residency programs responded. Thirty-one (67.4%) have a faculty member with any time spent practicing sleep medicine or surgery. Nineteen (41.3%) have a faculty member with >50% dedicated sleep practice and/or who is board certified in sleep medicine. These programs were significantly more likely to respond "extremely" or "very" satisfied with resident sleep exposure than those without (P < .001). Most programs (69.6%) "strongly agreed" or "agreed" their program would benefit from a dedicated sleep surgeon; there was no significant difference in response rates between programs already with and those without dedicated sleep faculty. All fellowship directors responded. In the past 5 years these programs have trained 11 total fellows. Ten (90.9%) have remained in academic practice.

Conclusions

There is significantly increased satisfaction in resident sleep education at otolaryngology programs with dedicated sleep providers. Concurrently, there is strong program interest in sleep surgeons' involvement in resident training. Sleep fellowships are producing surgeons who pursue academic careers. This study provides support to training fellowship-specialized sleep surgeons and encouraging otolaryngology sleep faculty.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2npkymK

The state of academic sleep surgery: A survey of United States residency and fellowship programs

Objectives/Hypothesis

Our objectives were to describe otolaryngology residency programs' experience in and attitudes toward sleep surgery, and describe current otolaryngology sleep fellowships and their impact on future academic practice.

Study Design

E-mail survey.

Methods

A survey was e-mailed to program directors of 106 Accreditation Council for Graduate Medical Education-accredited otolaryngology residencies assessing resident sleep medicine experience, program satisfaction, and impact of sleep faculty. A separate survey was sent to directors of the seven sleep medicine otolaryngology fellowships. Frequency of graduates pursuing academic careers was examined.

Results

Forty-six (43.4%) residency programs responded. Thirty-one (67.4%) have a faculty member with any time spent practicing sleep medicine or surgery. Nineteen (41.3%) have a faculty member with >50% dedicated sleep practice and/or who is board certified in sleep medicine. These programs were significantly more likely to respond "extremely" or "very" satisfied with resident sleep exposure than those without (P < .001). Most programs (69.6%) "strongly agreed" or "agreed" their program would benefit from a dedicated sleep surgeon; there was no significant difference in response rates between programs already with and those without dedicated sleep faculty. All fellowship directors responded. In the past 5 years these programs have trained 11 total fellows. Ten (90.9%) have remained in academic practice.

Conclusions

There is significantly increased satisfaction in resident sleep education at otolaryngology programs with dedicated sleep providers. Concurrently, there is strong program interest in sleep surgeons' involvement in resident training. Sleep fellowships are producing surgeons who pursue academic careers. This study provides support to training fellowship-specialized sleep surgeons and encouraging otolaryngology sleep faculty.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2npkymK

Nerve transection repair using laser-activated chitosan in a rat model

Objectives/Hypothesis

Cranial nerve transection during head and neck surgery is conventionally repaired with microsuture. Previous studies have demonstrated recovery with laser nerve welding (LNW), a novel alternative to microsuture. LNW has been reported to have poorer tensile strength, however. Laser-activated chitosan, an adhesive biopolymer, may promote nerve recovery while enhancing the tensile strength of the repair. Using a rat posterior tibial nerve injury model, we compared four different methods of nerve repair in this pilot study.

Study Design

Animal study.

Design

Animals underwent unilateral posterior tibial nerve transection. The injury was repaired by potassium titanyl phosphate (KTP) laser alone (n = 20), KTP + chitosan (n = 12), microsuture + chitosan (n = 12), and chitosan alone (n = 14). Weekly walking tracks were conducted to measure functional recovery (FR). Tensile strength (TS) was measured at 6 weeks.

Results

At 6 weeks, KTP laser alone had the best recovery (FR = 93.4% ± 8.3%). Microsuture + chitosan, KTP + chitosan, and chitosan alone all showed good FR (87.4% ± 13.5%, 84.6% ± 13.0%, and 84.1% ± 10.0%, respectively). One-way analysis of variance was performed (F(3,56) = 2.6, P = .061). A TS threshold of 3.8 N was selected as a control mean recovery. Three groups—KTP alone, KTP + chitosan, and microsuture + chitosan—were found to meet threshold 60% (95% confidence interval [CI]: 23.1%-88.3%), 75% (95% CI: 46.8%-91.1%), and 100% (95% CI: 75.8%-100.0%), respectively.

Conclusions

In the posterior tibial nerve model, all repair methods promoted nerve recovery. Laser-activated chitosan as a biopolymer anchor provided good TS and appears to be a novel alternative to microsuture. This repair method may have surgical utility following cranial nerve injury during head and neck surgery.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2npd5UI

What additional treatment is indicated for oral cavity cancer with isolated perineural invasion?

http://ift.tt/2nGlB48

What additional treatment is indicated for oral cavity cancer with isolated perineural invasion?

http://ift.tt/2nGlB48

Assessment of frozen section margin analysis during olfactory neuroblastoma surgery

Objectives

1) assess the performance of the intraoperative frozen section procedure to correctly classify biopsies obtained during olfactory neuroblastoma (ONB) surgery; 2) define the relationship between posttest probabilities and pretest probabilities from frozen section analysis; and 3) review incorrectly classified specimens.

Study Design

Study of diagnostic accuracy.

Methods

We searched our institution's pathology database for patients who had ONB surgery between January 1, 2000 and November 16, 2012. We only included patients who had a definitive diagnosis of ONB prior to surgery and frozen sections obtained during surgery. All frozen sections in this study had corresponding permanent sections available to serve as a gold standard. This database was analyzed to obtain classification statistics. The confidence intervals for classification performance were obtained using the bootstrap sampling method. Confidence intervals for posttest probability curves were derived using the Taylor series expansion. Finally, we obtained and reviewed the slides from ambiguous or incorrect reads.

Results

A total of 459 specimens from 33 patients were analyzed. We found the following performance characteristics: sensitivity: 0.89 (0.81, 0.94); specificity: 0.96 (0.94, 0.98); accuracy: 0.95 (0.92, 0.96); likelihood ratio positive: 24.4 (14.5, 44.1); prevalence: 0.20 (0.17, 0.25); positive predictive value: 0.86 (0.78, 0.92); and negative predictive value: 0.97 (0.95, 0.99). Histopathologic review revealed that crush artifacts and inadequate specimen size were major sources of incorrect reads.

Conclusion

We found frozen section assessment of ONB specimens to be an excellent tool for the assessment of intraoperative margins.

Level of Evidence

NA. Laryngoscope, 2017

http://ift.tt/2npky6e

Assessment of frozen section margin analysis during olfactory neuroblastoma surgery

Objectives

1) assess the performance of the intraoperative frozen section procedure to correctly classify biopsies obtained during olfactory neuroblastoma (ONB) surgery; 2) define the relationship between posttest probabilities and pretest probabilities from frozen section analysis; and 3) review incorrectly classified specimens.

Study Design

Study of diagnostic accuracy.

Methods

We searched our institution's pathology database for patients who had ONB surgery between January 1, 2000 and November 16, 2012. We only included patients who had a definitive diagnosis of ONB prior to surgery and frozen sections obtained during surgery. All frozen sections in this study had corresponding permanent sections available to serve as a gold standard. This database was analyzed to obtain classification statistics. The confidence intervals for classification performance were obtained using the bootstrap sampling method. Confidence intervals for posttest probability curves were derived using the Taylor series expansion. Finally, we obtained and reviewed the slides from ambiguous or incorrect reads.

Results

A total of 459 specimens from 33 patients were analyzed. We found the following performance characteristics: sensitivity: 0.89 (0.81, 0.94); specificity: 0.96 (0.94, 0.98); accuracy: 0.95 (0.92, 0.96); likelihood ratio positive: 24.4 (14.5, 44.1); prevalence: 0.20 (0.17, 0.25); positive predictive value: 0.86 (0.78, 0.92); and negative predictive value: 0.97 (0.95, 0.99). Histopathologic review revealed that crush artifacts and inadequate specimen size were major sources of incorrect reads.

Conclusion

We found frozen section assessment of ONB specimens to be an excellent tool for the assessment of intraoperative margins.

Level of Evidence

NA. Laryngoscope, 2017

http://ift.tt/2npky6e

Sternohyoid muscles for reconstruction after thyroid cartilage anterior partial resection

http://ift.tt/2nGv7Ec

Endoscopic management of tissue-engineered tracheal graft stenosis in an ovine model

Objective

To evaluate the safety and efficacy of bronchoscopic interventions in the management of tissue-engineered tracheal graft (TETG) stenosis.

Study Design

Animal research study.

Methods

TETGs were constructed with seeded autologous bone marrow-derived mononuclear cells on a bioartificial graft. Eight sheep underwent tracheal resection and orthotopic implantation of this construct. Animals were monitored by bronchoscopy and fluoroscopy at 3 weeks, 6 weeks, 3 months, and 4 months. Bronchoscopic interventions, including dilation and stenting, were performed to manage graft stenosis. Postdilation measurements were obtained endoscopically and fluoroscopically.

Results

Seven dilations were performed in six animals. At the point of maximal stenosis, the lumen measured 44.6 ± 8.4 mm² predilation and 50.7 ± 14.1 postdilation by bronchoscopy (P = 0.3517). By fluoroscopic imaging, the airway was 55.9 ± 12.9 mm² predilation and 65.9 ± 22.4 mm² postdilation (P = 0.1303). Stents were placed 17 times in six animals. Pre- and poststenting lumen sizes were 62.8 ± 38.8 mm² and 80.1 ± 54.5 mm² by bronchoscopy (P = 0.6169) and 77.1 ± 38.9 mm² and 104 ± 60.7 mm² by fluoroscopy (P = 0.0825). Mortality after intervention was 67% with dilation and 0% with stenting (P = 0.0004). The average days between bronchoscopy were 8 ± 2 for the dilation group and 26 ± 17 in the stenting group (P = 0.05). One hundred percent of dilations and 29% of stent placements required urgent follow-up bronchoscopy (P = 0.05).

Conclusion

Dilation has limited efficacy for managing TETG stenosis, whereas stenting has a more lasting clinical effect.

Level of Evidence

NA. Laryngoscope, 2017

http://ift.tt/2npg0wF

Sternohyoid muscles for reconstruction after thyroid cartilage anterior partial resection

http://ift.tt/2nGv7Ec

Endoscopic management of tissue-engineered tracheal graft stenosis in an ovine model

Objective

To evaluate the safety and efficacy of bronchoscopic interventions in the management of tissue-engineered tracheal graft (TETG) stenosis.

Study Design

Animal research study.

Methods

TETGs were constructed with seeded autologous bone marrow-derived mononuclear cells on a bioartificial graft. Eight sheep underwent tracheal resection and orthotopic implantation of this construct. Animals were monitored by bronchoscopy and fluoroscopy at 3 weeks, 6 weeks, 3 months, and 4 months. Bronchoscopic interventions, including dilation and stenting, were performed to manage graft stenosis. Postdilation measurements were obtained endoscopically and fluoroscopically.

Results

Seven dilations were performed in six animals. At the point of maximal stenosis, the lumen measured 44.6 ± 8.4 mm² predilation and 50.7 ± 14.1 postdilation by bronchoscopy (P = 0.3517). By fluoroscopic imaging, the airway was 55.9 ± 12.9 mm² predilation and 65.9 ± 22.4 mm² postdilation (P = 0.1303). Stents were placed 17 times in six animals. Pre- and poststenting lumen sizes were 62.8 ± 38.8 mm² and 80.1 ± 54.5 mm² by bronchoscopy (P = 0.6169) and 77.1 ± 38.9 mm² and 104 ± 60.7 mm² by fluoroscopy (P = 0.0825). Mortality after intervention was 67% with dilation and 0% with stenting (P = 0.0004). The average days between bronchoscopy were 8 ± 2 for the dilation group and 26 ± 17 in the stenting group (P = 0.05). One hundred percent of dilations and 29% of stent placements required urgent follow-up bronchoscopy (P = 0.05).

Conclusion

Dilation has limited efficacy for managing TETG stenosis, whereas stenting has a more lasting clinical effect.

Level of Evidence

NA. Laryngoscope, 2017

http://ift.tt/2npg0wF

Periodic olfactory assessment in patients undergoing skull base surgery with preservation of the olfactory strip

Objectives/Hypothesis

Others have reported olfactory disturbances following endoscopic approaches to the skull base. However, there is a lack of consensus on the extent and duration of dysfunction. This study aimed to compare our results with previously published work and to validate the olfactory strip–sparing approach.

Study Design

Prospective study to assess olfaction in 50 patients scheduled to undergo resection of skull base tumors via extended endoscopic approaches.

Methods

Patients were divided into two groups. Group I had a nasoseptal flap (NSF), and group II included patients in whom rescue flaps were performed bilaterally. Olfactory outcomes were assessed using repeated University of Pennsylvania Smell Identification Test at baseline, 6 weeks, 3 months, and 6 months following surgery.

Results

Ultimately, 42 patients (seven group I and 35 group II) were available for assessment. Scores for group I were lower than at baseline at 6 weeks postoperatively (30.71 ± 5.5 vs. 24.5 ± 5.4; P = .05). However, by the third postoperative month the scores had improved to a level that was not significantly different from baseline (29.0 ± 3.7; P = .5). At 6 months, the score was 30.0 ± 3.9. Patients in group II showed no difference between their baseline and 6-week scores (31.5 ± 5.3 vs. 29.7 ± 5.9; P = .16). Six months postoperatively, the score was significantly higher (33.78 ± 3.6; P = .04).

Conclusions

Expanded endoscopic approaches to skull base tumors involving reconstruction with an NSF are associated with a short-term negative impact on olfaction. Olfaction does not seem to be affected by the surgical resection of pituitary adenomas associated with rescue flaps. Identification of the olfactory epithelium and meticulous harvesting of the NSF are critical to preserve olfaction.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2nGEgwv

Periodic olfactory assessment in patients undergoing skull base surgery with preservation of the olfactory strip

Objectives/Hypothesis

Others have reported olfactory disturbances following endoscopic approaches to the skull base. However, there is a lack of consensus on the extent and duration of dysfunction. This study aimed to compare our results with previously published work and to validate the olfactory strip–sparing approach.

Study Design

Prospective study to assess olfaction in 50 patients scheduled to undergo resection of skull base tumors via extended endoscopic approaches.

Methods

Patients were divided into two groups. Group I had a nasoseptal flap (NSF), and group II included patients in whom rescue flaps were performed bilaterally. Olfactory outcomes were assessed using repeated University of Pennsylvania Smell Identification Test at baseline, 6 weeks, 3 months, and 6 months following surgery.

Results

Ultimately, 42 patients (seven group I and 35 group II) were available for assessment. Scores for group I were lower than at baseline at 6 weeks postoperatively (30.71 ± 5.5 vs. 24.5 ± 5.4; P = .05). However, by the third postoperative month the scores had improved to a level that was not significantly different from baseline (29.0 ± 3.7; P = .5). At 6 months, the score was 30.0 ± 3.9. Patients in group II showed no difference between their baseline and 6-week scores (31.5 ± 5.3 vs. 29.7 ± 5.9; P = .16). Six months postoperatively, the score was significantly higher (33.78 ± 3.6; P = .04).

Conclusions

Expanded endoscopic approaches to skull base tumors involving reconstruction with an NSF are associated with a short-term negative impact on olfaction. Olfaction does not seem to be affected by the surgical resection of pituitary adenomas associated with rescue flaps. Identification of the olfactory epithelium and meticulous harvesting of the NSF are critical to preserve olfaction.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2nGEgwv

Subtotal petrosectomy: Surgical technique, indications, outcomes, and comprehensive review of literature

Objectives/Hypothesis

To describe the technique of subtotal petrosectomy (STP), to analyze the outcomes, and to review the literature

Study Design

A retrospective review.

Methods

Four hundred sixty cases of STP performed for various indications were included in the study, which was conducted at a quaternary referral center for otology and skull base surgery. Surgical and audiological parameters, and complications were evaluated. Our results were compared with the existing literature on the subject.

Results

Two hundred ninety-seven (64.6%) patients had been subjected to multiple surgeries before an STP was performed. The most common indication for STP was recurrent chronic otitis with or without cholesteatoma, with 165 (35.9%) patients. Difficult cases of cochlear implantation, temporal bone fractures, and class B3 tympanomastoid paragangliomas were the next most common indications, with 91 (19.8%), 43 (9.4%), and 38 (8.3%) cases, respectively. The median follow-up of the patient pool was 36 ± 19 months. Recidivism and postauricular wound fistula were the most common complications, seen in five (1.1%) patients each. This series of STP is the largest reported in the literature

Conclusions

STP is a very useful and safe surgical tool in the management of a variety of problematic situations in otology, as it offers the possibility of a definitive cure by offering radical clearance. This procedure can be combined safely with hearing implantation procedures.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2npbIp5

Subtotal petrosectomy: Surgical technique, indications, outcomes, and comprehensive review of literature

Objectives/Hypothesis

To describe the technique of subtotal petrosectomy (STP), to analyze the outcomes, and to review the literature

Study Design

A retrospective review.

Methods

Four hundred sixty cases of STP performed for various indications were included in the study, which was conducted at a quaternary referral center for otology and skull base surgery. Surgical and audiological parameters, and complications were evaluated. Our results were compared with the existing literature on the subject.

Results

Two hundred ninety-seven (64.6%) patients had been subjected to multiple surgeries before an STP was performed. The most common indication for STP was recurrent chronic otitis with or without cholesteatoma, with 165 (35.9%) patients. Difficult cases of cochlear implantation, temporal bone fractures, and class B3 tympanomastoid paragangliomas were the next most common indications, with 91 (19.8%), 43 (9.4%), and 38 (8.3%) cases, respectively. The median follow-up of the patient pool was 36 ± 19 months. Recidivism and postauricular wound fistula were the most common complications, seen in five (1.1%) patients each. This series of STP is the largest reported in the literature

Conclusions

STP is a very useful and safe surgical tool in the management of a variety of problematic situations in otology, as it offers the possibility of a definitive cure by offering radical clearance. This procedure can be combined safely with hearing implantation procedures.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2npbIp5

Defining surgical criteria for empty nose syndrome: Validation of the office-based cotton test and clinical interpretability of the validated Empty Nose Syndrome 6-Item Questionnaire

Objectives/Hypothesis

The validated Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) identifies empty nose syndrome (ENS) patients. The unvalidated cotton test assesses improvement in ENS-related symptoms. By first validating the cotton test using the ENS6Q, we define the minimal clinically important difference (MCID) score for the ENS6Q.

Study Design

Individual case–control study.

Methods

Fifteen patients diagnosed with ENS and 18 controls with non-ENS sinonasal conditions underwent office cotton placement. Both groups completed ENS6Q testing in three conditions—precotton, cotton in situ, and postcotton—to measure the reproducibility of ENS6Q scoring. Participants also completed a five-item transition scale ranging from "much better" to "much worse" to rate subjective changes in nasal breathing with and without cotton placement. Mean changes for each transition point, and the ENS6Q MCID, were then calculated.

Results

In the precotton condition, significant differences (P < .001) in all ENS6Q questions between ENS and controls were noted. With cotton in situ, nearly all prior ENS6Q differences normalized between ENS and control patients. For ENS patients, the changes in the mean differences between the precotton and cotton in situ conditions compared to postcotton versus cotton in situ conditions were insignificant among individuals. Including all 33 participants, the mean change in the ENS6Q between the parameters "a little better" and "about the same" was 4.25 (standard deviation [SD] = 5.79) and −2.00 (SD = 3.70), giving an MCID of 6.25.

Conclusions

Cotton testing is a validated office test to assess for ENS patients. Cotton testing also helped to determine the MCID of the ENS6Q, which is a 7-point change from the baseline ENS6Q score.

Level of Evidence

3b. Laryngoscope, 2017

http://ift.tt/2nGph5P

Defining surgical criteria for empty nose syndrome: Validation of the office-based cotton test and clinical interpretability of the validated Empty Nose Syndrome 6-Item Questionnaire

Objectives/Hypothesis

The validated Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) identifies empty nose syndrome (ENS) patients. The unvalidated cotton test assesses improvement in ENS-related symptoms. By first validating the cotton test using the ENS6Q, we define the minimal clinically important difference (MCID) score for the ENS6Q.

Study Design

Individual case–control study.

Methods

Fifteen patients diagnosed with ENS and 18 controls with non-ENS sinonasal conditions underwent office cotton placement. Both groups completed ENS6Q testing in three conditions—precotton, cotton in situ, and postcotton—to measure the reproducibility of ENS6Q scoring. Participants also completed a five-item transition scale ranging from "much better" to "much worse" to rate subjective changes in nasal breathing with and without cotton placement. Mean changes for each transition point, and the ENS6Q MCID, were then calculated.

Results

In the precotton condition, significant differences (P < .001) in all ENS6Q questions between ENS and controls were noted. With cotton in situ, nearly all prior ENS6Q differences normalized between ENS and control patients. For ENS patients, the changes in the mean differences between the precotton and cotton in situ conditions compared to postcotton versus cotton in situ conditions were insignificant among individuals. Including all 33 participants, the mean change in the ENS6Q between the parameters "a little better" and "about the same" was 4.25 (standard deviation [SD] = 5.79) and −2.00 (SD = 3.70), giving an MCID of 6.25.

Conclusions

Cotton testing is a validated office test to assess for ENS patients. Cotton testing also helped to determine the MCID of the ENS6Q, which is a 7-point change from the baseline ENS6Q score.

Level of Evidence

3b. Laryngoscope, 2017

http://ift.tt/2nGph5P

Hearing loss and speech perception in noise difficulties in Fanconi anemia

Objectives/Hypothesis

Fanconi anemia is a hereditary chromosomal instability disorder. Hearing loss and ear abnormalities are among the many manifestations reported in this disorder. In addition, Fanconi anemia patients often complain about hearing difficulties in situations with background noise (speech perception in noise difficulties). Our study aimed to describe the prevalence of hearing loss and speech perception in noise difficulties in Dutch Fanconi anemia patients.

Study Design

Retrospective chart review.

Methods

A retrospective chart review was conducted at a Dutch tertiary care center. All patients with Fanconi anemia at clinical follow-up in our hospital were included. Medical files were reviewed to collect data on hearing loss and speech perception in noise difficulties.

Results

In total, 49 Fanconi anemia patients were included. Audiograms were available in 29 patients and showed hearing loss in 16 patients (55%). Conductive hearing loss was present in 24.1%, sensorineural in 20.7%, and mixed in 10.3%. A speech in noise test was performed in 17 patients; speech perception in noise was subnormal in nine patients (52.9%) and abnormal in two patients (11.7%).

Conclusions

Hearing loss and speech perception in noise abnormalities are common in Fanconi anemia. Therefore, pure tone audiograms and speech in noise tests should be performed, preferably already at a young age, because hearing aids or assistive listening devices could be very valuable in developing language and communication skills.

Level of Evidence

4. Laryngoscope, 2016

http://ift.tt/2npn1h5

Hearing loss and speech perception in noise difficulties in Fanconi anemia

Objectives/Hypothesis

Fanconi anemia is a hereditary chromosomal instability disorder. Hearing loss and ear abnormalities are among the many manifestations reported in this disorder. In addition, Fanconi anemia patients often complain about hearing difficulties in situations with background noise (speech perception in noise difficulties). Our study aimed to describe the prevalence of hearing loss and speech perception in noise difficulties in Dutch Fanconi anemia patients.

Study Design

Retrospective chart review.

Methods

A retrospective chart review was conducted at a Dutch tertiary care center. All patients with Fanconi anemia at clinical follow-up in our hospital were included. Medical files were reviewed to collect data on hearing loss and speech perception in noise difficulties.

Results

In total, 49 Fanconi anemia patients were included. Audiograms were available in 29 patients and showed hearing loss in 16 patients (55%). Conductive hearing loss was present in 24.1%, sensorineural in 20.7%, and mixed in 10.3%. A speech in noise test was performed in 17 patients; speech perception in noise was subnormal in nine patients (52.9%) and abnormal in two patients (11.7%).

Conclusions

Hearing loss and speech perception in noise abnormalities are common in Fanconi anemia. Therefore, pure tone audiograms and speech in noise tests should be performed, preferably already at a young age, because hearing aids or assistive listening devices could be very valuable in developing language and communication skills.

Level of Evidence

4. Laryngoscope, 2016

http://ift.tt/2npn1h5

Insights Into the Role of Collagen in Vocal Fold Health and Disease

As one of the key fibrous proteins in the extracellular matrix, collagen plays a significant role in the structural and biomechanical characteristics of the vocal fold. Anchored fibrils of collagen create secure structural regions within the vocal folds and are strong enough to sustain vibratory impact and stretch during phonation. This contributes tensile strength, density, and organization to the vocal folds and influences health and pathogenesis. This review offers a comprehensive summary for a current understanding of collagen within normal vocal fold tissues throughout the life span as well as vocal pathology and wound repair.

http://ift.tt/2o0iDb5

Effect of Hormonal Replacement Therapy on Voice

This study aimed to investigate the effect of hormonal therapy (HRT) on voice in a group of menopausal women, taking into consideration body mass index (BMI) as a confounding factor and its potential role as a substitute for HRT.

http://ift.tt/2osLKAi

Increased vimentin in human {alpha} and {beta}-cells in type 2 diabetes

Type 2 diabetes (T2DM) is associated with pancreatic islet dysfunction. Loss of β-cell identity has been implicated via dedifferentiation or conversion to other pancreatic endocrine cell types. How these transitions contribute to the onset and progression of T2DM in vivo is unknown. The aims of this study were to determine the degree of epithelial-to-mesenchymal transition occurring in α and β cells in vivo and to relate this to diabetes-associated (patho)physiological conditions. The proportion of islet cells expressing the mesenchymal marker vimentin was determined by immunohistochemistry and quantitative morphometry in specimens of pancreas from human donors with (T2DM, n=28) and without diabetes (ND, n=38), and in non-human primates at different stages of the diabetic syndrome; normoglycaemic (ND, n=4), obese, hyperinsulinaemic (HI, n=4) and hyperglycaemic (DM, n=8). Vimentin co-localised more frequently with glucagon (α-cells) than with insulin (β-cells) in the human ND group (1.43% total α-cells, 0.98% total β-cells, median; p<0.05); these proportions were higher in T2DM than ND (median 4.53% α- , 2.53% β-cells; p<0.05). Vimentin-positive β-cells were not apoptotic, had reduced expression of Nkx6.1 and Pdx-1 and were not associated with islet amyloidosis or with bihormonal expression (insulin+glucagon). In non-human primates, vimentin-positive β-cell proportion was larger in the diabetic than the ND group (12.08% vs. 0.45%, respectively, p<0.05), whereas it was similar in ND and HI groups. In conclusion, islet cell expression of vimentin indicates a degree of plasticity and dedifferentiation with potential loss of cellular identity in diabetes. This could contribute to α- and β-cell dysfunction in T2DM

http://ift.tt/2nbew7z

Mineralocorticoid receptor mutations

Aldosterone and the mineralocorticoid receptor (MR) are key elements for maintaining fluid and electrolyte homeostasis as well as regulation of blood pressure. Loss of function mutations of the MR are responsible for renal pseudohypoaldosteronism type 1 (PHA1), a rare disease of mineralocorticoid resistance presenting in the newborn with weight loss, failure to thrive, vomiting and dehydration, associated with hyperkalemia and metabolic acidosis, despite extremely elevated levels of plasma renin and aldosterone. On the opposite, a MR gain of function mutation has been associated with a familial form of inherited mineralocorticoid hypertension exacerbated by pregnancy. In addition to rare variants, frequent functional single nucleotide polymorphisms of the MR are associated with salt sensitivity, blood pressure, stress response and depression in the general population. This review will summarize our knowledge on MR mutations in PHA1, reporting our experience on the genetic diagnosis in a large number of patients performed in the last 10 years at a national reference center for the disease. We will also discuss the influence of rare MR variants on blood pressure and salt sensitivity as well as on stress and cognitive functions in the general population.

http://ift.tt/2mKRklx

Hypophysectomy abolishes rhythms in rat thyroid hormones but not in the thyroid clock

The endocrine body rhythms including the hypothalamic-pituitary-thyroid axis seem to be regulated by the circadian timing system, and daily rhythmicity of circulating thyroid stimulating hormone (TSH) is well-established. The circadian rhythms are generated by endogenous clocks in the central brain oscillator located in the hypothalamic suprachiasmatic nucleus (SCN) as well as multiple peripheral clocks, but information on the existence and function of a thyroid clock is limited. The molecular machinery in all clock cells is composed of a number of clock genes and their gene products connected by autoregulatory feedback loops. Here we provide evidence for a thyroid clock in the rat by demonstrating 24 h antiphase oscillations for the mRNA of the canonical clock genes Per1 and Bmal1, which was unaffected by hypophysectomy. By immunostaining, we supported the existence of a core oscillator in the individual thyroid cells by demonstrating a daily cytoplasmatic-nuclear shuttling of PER1 protein. In normal rats, we found a significant daily rhythmicity in the circulating thyroid hormones preceded by a peak in TSH. In hypophysectomised rats, although the thyroid clock was not affected, the oscillations in circulating thyroid hormones were abolished and the levels markedly lowered. No daily oscillations in the expression of TSH receptor mRNA were observed in neither control rats nor hypophysectomised rats. Our findings indicate that the daily rhythm of thyroid hormone secretion is governed by SCN signalling via the rhythmic TSH secretion rather than by the local thyroid clock, which was still ticking after hypophysectomy.

http://ift.tt/2nb5RCl

Decrease in Ins+Glut2LO{beta}-cells with advancing age in mouse and human pancreas

The presence and location of resident pancreatic β-cell progenitors is controversial. A subpopulation of insulin-expressing but glucose transporter-2-low (Ins+Glut2LO) cells may represent multipotent pancreatic progenitors in adult mouse and human islets, and in mice are enriched in small, extra-islet β-cell clusters (<5 β-cells). Here, we sought to identify and compare the ontogeny of these cells in mouse and human pancreata throughout life. Mouse pancreata were collected at postnatal days (d) 7, 14, 21, 28, and at 3, 6, 12, and 18 months of age, and in the first 28 days after β-cell mass depletion following Streptozotocin (STZ) administration. Human pancreas samples were examined during fetal life (22-30 weeks gestation), infancy (0-1 year), childhood (2-9), adolescence (10-17), and adulthood (18-80). Tissues were analyzed by immunohistochemistry for the expression and location of insulin, glut2, and ki67. The proportion of β-cells within clusters relative to islets was higher in human pancreas than mouse at all ages examined, and decreased significantly at adolescence. In mice, the total number of Ins+Glut2LO cells decreased after 7 d, concurrent with the proportion of clusters. These cells were more abundant in clusters than islets in both species. A positive association existed between the appearance of new β-cells after STZ treatment of young mice, particularly in clusters and smaller islets, and an increased proportional presence of Ins+Glut2LO cells during early β-cell regeneration. These data suggest that Ins+Glut2LO cells are preferentially located within β-cell clusters throughout life in mouse and human pancreas, and may represent a source of β-cell plasticity.

http://ift.tt/2mKFSq1

Nongenomic effects via the mineralocorticoid receptor

The mineralocorticoid receptor (MR) belongs to the steroid hormone receptor family and classically functions as a ligand-dependent transcription factor. It is involved in water-electrolyte homeostasis and blood pressure regulation but independently from these effects also furthers inflammation, fibrosis, hypertrophy and remodeling in cardiovascular tissues. Next to genomic effects, aldosterone elicits very rapid actions within minutes that do not require transcription or translation and that occur both in classical MR epithelial target organs like kidney and colon but also in nonepithelial tissues with special pathophysiological relevance like heart and vasculature and adipose tissue. Most of these effects can be mediated by classical MR and its cross-talk with different signaling cascades. Near the plasma membrane the MR seems to be associated with caveolin and striatin and with receptor tyrosine kinases like EGFR, PDGFR and IGF1R and G protein-coupled receptors like AT1 and GPER1 which then mediate nongenomic aldosterone effects. GPER1 has also been named a putative novel MR. There is a close interaction and functional synergism between the genomic and the nongenomic signaling so that nongenomic signaling can lead to long-term effects and support genomic actions. Therefore, understanding nongenomic aldosterone/MR effects is of potential relevance for modulating genomic aldosterone effects and may provide additional targets for intervention.

http://ift.tt/2naYsCR