BJD Snippet

http://ift.tt/2sv2Dk3

Clinical efficacy of utilizing Ultrapulse CO2 combined with fractional CO2 laser for the treatment of hypertrophic scars in Asians—A prospective clinical evaluation

Summary

Background and Objective

Hypertrophic scarring is seen regularly. Tissue penetration of laser energy into hypertrophic scars using computer defaults from some lasers may be insufficient and penetration not enough. We have developed a treatment with an interrupted laser "drilling" by the Ultrapulse CO₂ (Manual Fractional Technology, MFT) and, a second pass, with fractional CO₂. The MFT with fractional CO₂ lasers to treat hypertrophic scars is evaluated.

Study Design/Materials and Methods

A total of 158 patients with hypertrophic scars had three sessions of MFT with fractional CO₂ laser at 3-month intervals. Evaluations made before and 6 months after the 3rd treatment: (1) the Vancouver Scar Scale (VSS), (2) the University of North Carolina (UNC) Scar Scale, and (3) a survey of patient satisfaction.

Results

All data were analyzed using a t-test before and after treatment. The VSS score decreased from 9.35 to 3.12 (P<.0001), and the UNC Scar Scale score decreased from 8.03 to 1.62 (P<.0001). The overall satisfaction rate was 92%. No long-term complications occurred in the clinical trial.

Conclusion

The interrupted laser drilling by MFT and a fractional CO2 laser had profound effects on the hypertrophic scars treated. It works by increasing the penetration depth of the CO₂ laser in the scar tissue, exerting more precise effects on the hypertrophic scars. MFT combined with fractional CO₂ laser has the potential to be a major advance in the treatment of hypertrophic scars.

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Issue Information - TOC

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JCD Editorial – June, 2017

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Familial hypocalciuric hypercalcemia type 1 due to a novel homozygous mutation of the calcium-sensing receptor gene

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Distally Based Medial Hemisoleus Muscle Flap: Anatomic and Angiographic Study of 18 Lower Limbs

Background: The distally based medial hemisoleus (MHS) flap was found useful for repairing soft-tissue defects of the lower third of the leg; however, its reliability is controversial. We used a combination of static and dynamic techniques to investigate the vascular supply of distally based MHS muscle flaps to better establish their use in repair of lower-third leg defects. Methods: We performed an anatomic study of 18 cadaver legs. For 6 legs, we performed dynamic angiography, which allowed for obtaining MHS muscle radiographs after pulsed injection of contrast medium in distal pedicles. Results: The mean length of MHS muscle was 25.4 cm, the mean width was 6.9 cm, and the mean surface area was 87.5 cm2. A mean of 3 distal posterior tibial vascular pedicles was directly connected to this medial subunit. These pedicles were present in all 18 cadaver legs. We observed complete opacification of the 6 MHS muscles through distal pedicles. Radiography revealed opacification of a vascular path from 1 distal pedicle to 1 proximal vascular pedicle of the MHS muscle. The mean level of this main distal pedicle was 14.5 cm to the tip of the medial malleolus. The level was at 38.2%, on average, from the bottom of the entire tibia. Conclusions: The distally based MHS muscle flap has constant blood supply, so it could be a useful flap to repair soft-tissue defects of the lower third of the leg. Moreover, knowledge of the average location of the main distal pedicle can help in increasing the use of the distally based MHS flap.

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The Impact of Medical Students on Bilateral Reduction Mammoplasty Procedure Time

Background: Exposure to the plastic surgery department is an important experience for medical students interested in the field. However, the impact of medical students in the plastic surgery operating room has not been previously examined. The aim of this study is to understand whether the presence of medical students impacted overall procedure time and postoperative complications for bilateral reduction mammoplasties. Materials and Methods: A retrospective review was performed on all patients who underwent bilateral reduction mammoplasty from January 2010 to December 2015. Procedures were divided into operations with medical students present and operations without medical students present. Patient average operation time and average procedure time were analyzed. A 2-tailed t-test was used to compare times with statistical significance set at P less than 0.05. A multivariate regression analysis was performed to control for potential confounders. Results: A total of 157 patients underwent bilateral reduction mammoplasties. Seventy-five of these cases had at least 1 medical student present; 82 of these cases had no medical student present. Patient information was not statistically different between groups. The average total operative time was 150.32 minutes, and the average procedure time (skin-incision to skin-closure) was 109.15 minutes. The total operative time was significantly longer in procedures with medical students: 158.25 minutes versus 143.06 minutes in procedures without medical students (P = 0.013). However, the total procedure time was not significantly longer: 113.95 minutes with medical students versus 104.75 minutes without medical students (P = 0.096). There were no differences in perioperative complications and multivariate regression analysis showed no statistically significant confounders for the duration of surgery.

http://ift.tt/2tpnGki

A Meta-analysis of Studies Comparing Outcomes of Diverse Acellular Dermal Matrices for Implant-Based Breast Reconstruction

Background: The current diversity of the available acellular dermal matrix (ADM) materials for implant-based breast reconstruction raises the issue of whether there are any differences in postoperative outcomes according to the kind of ADM used. The present meta-analysis aimed to investigate whether choice of ADM products can affect outcomes. Methods: Studies that used multiple kinds of ADM products for implant-based breast reconstruction and compared outcomes between them were searched. Outcomes of interest were rates of postoperative complications: infection, seroma, mastectomy flap necrosis, reconstruction failure, and overall complications. Results: A total of 17 studies met the selection criteria. There was only 1 randomized controlled trial, and the other 16 studies had retrospective designs. Comparison of FlexHD, DermaMatrix, and ready-to-use AlloDerm with freeze-dried AlloDerm was conducted in multiple studies and could be meta-analyzed, in which 12 studies participated. In the meta-analysis comparing FlexHD and freeze-dried AlloDerm, using the results of 6 studies, both products showed similar pooled risks for all kinds of complications. When comparing DermaMatrix and freeze-dried AlloDerm with the results from 4 studies, there were also no differences between the pooled risks of complications of the two. Similarly, the meta-analysis of 4 studies comparing ready-to-use and freeze-dried AlloDerm demonstrated that the pooled risks for the complications did not differ. Conclusions: This meta-analysis demonstrates that the 3 recently invented, human cadaveric skin–based products of FlexHD, DermaMatrix, and ready-to-use AlloDerm have similar risks of complications compared with those of freeze-dried AlloDerm, which has been used for longer. However, as most studies had low levels of evidence, further investigations are needed.

http://ift.tt/2tp8rbq

Book Review: Flaps and Reconstructive Surgery Second Edition

No abstract available

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Vertical Rectus Abdominis Myocutaneous Versus Alternative Flaps for Perineal Repair After Abdominoperineal Excision of the Rectum in the Era of Laparoscopic Surgery

Aims: Plastic surgical reconstruction of the perineum is often required after abdominoperineal excision of the rectum. Options for this reconstruction include a vertical rectus abdominis myocutaneous (VRAM) flap, gluteal fasciocutaneous flap, and gracilis myocutaneous flap. Although the VRAM flap is well established at most centers, less experience exists with the gluteal and gracilis flaps. In the era of laparoscopic colorectal resection, plastic surgeons are being forced to use gluteal and gracilis flaps because the VRAM flap must be tunnelled intra-abdominally requiring laparotomy. We therefore aimed to systematically review the evidence comparing VRAM, gluteal, and gracilis flaps. Methods: A comprehensive, structured literature search was conducted using Medline, Google Scholar, and Science Direct. Studies included were randomized control trials and observational studies documenting complication rates associated with the VRAM, gluteal, or gracilis flap. Results: Eleven studies meeting all inclusion and exclusion criteria were identified. When meta-analyzed, the overall rate of any perineal wound or flap complication among VRAM patients (35.8%) was significantly lower than gluteal flap (43.7%) and gracilis flap patients (52.9%) (P = 0.041). Conclusions: The VRAM flap is well established for perineal reconstruction, and this study suggests that it may be superior to the gluteal and gracilis flaps in terms perineal wound and flap complication rates. This should be taken into account when weighing up the risks and benefits of a laparoscopic approach to abdominoperineal excision of the rectum. Large studies making direct comparisons between the flap options should be conducted.

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Predictors for Frey Syndrome Development After Parotidectomy

Background: Frey syndrome is a common complication after parotidectomy. The aim of this study is to investigate potential predictors for development of Frey syndrome and explore their implications in additional prophylactic procedures. To the best of our knowledge, this is the first study to address these issues. Methods: A computer search was performed to identify all patients who received parotidectomy from January 2009 to December 2011 in Queen Mary Hospital, Hong Kong. Individual case notes were reviewed to retrieve details for analysis. Results: A total of 155 parotidectomies were identified. Tumor size was the only statistically significant clinical predictor (Frey group: 43.5 ± 38.4 mm vs No Frey group: 33.1 ± 27.5 mm; P = 0.018). Disease pathology, type of resection, and previous treatments such as radiotherapy or parotidectomy did not appear to be associated with development of Frey syndrome. Post hoc analysis of our data showed that Frey incidence nearly doubled in patients with tumor size of 4 cm or greater (33%) compared to those with tumors that sized less than 4 cm (18%). Conclusions: Frey syndrome is common after parotidectomy. Tumor size is the only statistically significant predictor of its development. Routine preventive interventions, for example, use of acellular dermal matrix, dermofat graft or muscle flaps to prevent Frey syndrome, should be considered for high risk patients.

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Investigating the Effect of Korean Red Ginseng on the Viability of Random-Pattern Skin Flaps in Rats

Objective: This experimental study investigated the efficacy of Korean Red Ginseng (KRG) extract in reducing the partial losses of random flaps. Method: Forty Wistar Albino rats were randomly distributed into 4 groups as (A) control group, (B) stress group, (C) oral KRG group, and (D) intraperitoneal KRG group. The modified McFarlane flap of 9 × 3 cm with a caudal pedicle was harvested from the back of the rats in all the groups. Korean Red Ginseng was administered to groups C and D at standard doses for 10 days. After 10 days, the flaps were removed in all groups and were examined macroscopically, histopathologically, histochemically, and biochemically. The results were statistically analyzed and compared among the groups. Results: The flap necrosis rates were significantly lower in groups C and D compared with groups A and B (P

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A Systematized Strategy in Corrective Rhinoplasty for the Asian Deviated Nose

Background: A deviated nose is a common deformity encountered in rhinoplasty. Over the past several decades, a variety of rhinoplasty techniques have been described focusing on the classification of bony and cartilaginous deviation. Nevertheless, corrective rhinoplasty is still a challenging procedure even for experienced surgeons because of the high recurrence rate of deviation. In attempt to reduce the recurrence rate, the author systematized the complex procedures by using a single technique regardless of the classification of a deviation. Materials and Methods: Forty patients who underwent corrective rhinoplasty between June 2009 and December 2014 were reviewed retrospectively. All the patients were operated using 4 main surgical procedures: anterior approach septal correction, unilateral osteotomy, and medialization of the deviated complex to the contralateral intact side, and dorsal augmentation with a dermofat graft. Assessment of improvement was based on photo standardization. The degree of nasal deviation, nasofrontal angle, tip projection-to-nasal length ratio, vertical line of the upper lip-to-tip projection ratio, and columellar-labial angle were measured. Results: Preoperative and postoperative anthropometric measurements revealed that the mean degree of deviation changed from 10.19° to 3.43° (P

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PGY∞

No abstract available

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Complications After Reduction Mammaplasty: A Comparison of Wise Pattern/Inferior Pedicle and Vertical Scar/Superomedial Pedicle

Abstract: Reduction mammaplasty is a commonly-performed procedure among plastic surgeons. Although several methods exist, the Wise pattern/inferior pedicle (IP) technique is the most widely used. The vertical scar/superomedial pedicle (SP) technique has gained acceptance for its shorter scar and more durable projection results, but some hesitation remains with its use in larger volume reductions. The incidence of complications in 124 consecutively performed breast reductions (246 breasts) at a single institution using either the Wise pattern/IP technique or vertical scar/SP technique, as well as risk factors associated with them, was determined. Patient demographics, comorbidities, intraoperative details, and major and minor complications were assessed. Ninety (72.6%) patients underwent SP, and 39 patients had IP reductions. Minor infections and wound dehiscence were the most common complications (11 each [8.9%]), followed by minor nonoperative hematomas, 10 (8.1%) and fat necrosis, 7 (5.6%). The mean weight of resected tissue per breast was 692 g. No nipple loss, major complications or reexplorations occurred. Obese, diabetic patients were more likely to undergo IP compared with SP reductions. After adjustment in a multivariate analysis, there was no significant difference in complication rates between the 2 methods (IP vs SP: odds ratio, 2.65; 95% confidence interval, 0.85–8.27; P = 0.09). The results were similar after the analysis was restricted to patients with mean weight of resected tissue per breast greater than 1000 g. There was no significant difference in complications between IP and SP reduction, suggesting that the SP method is a safe alternative to the IP technique, even in macromastia patients undergoing large-volume reductions.

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Microcirculatory Effects of Botulinum Toxin A in the Rat: Acute and Chronic Vasodilation

Background: Botulinum toxin-A (BTX) has numerous cosmetic and therapeutic applications. Our previous studies have found that BTX augments pedicled flap survival through both vasodilatory effects and attenuation of the inflammatory response to ischemia in the rat. This study examines the effect of chronic BTX on microcirculatory vascular tone and its response to acute topical vasodilators in muscle flaps. Methods: The spinotrapezius muscle of Sprague-Dawley rats underwent a single 2-week pretreatment of 0.2 mL saline either with (n = 5) or without (n = 5) 2u BTX. After surgical elevation, an arcade arteriole was observed using a video caliper device. Vessel diameter was measured at 30-second intervals after sequential superfusion of nitroglycerin (100 and 200 μg/mL), multiple concentrations of lidocaine, and a combination of adenosine (10 μM) and nitroprusside (10 μM) to induce maximum dilation. Results: Baseline and dilation diameters were expressed as ratios of pharmacologically induced maximum dilation, whereas percent dilation was defined as the change in diameter over baseline diameter. We found a significant increase in resting diameter with BTX pretreatment (P = 0.0028). Compared with the control group, mean baseline diameter was 15% greater, and percent dilation was 25% less in BTX-pretreated flaps. There was no significant relationship between BTX pretreatment and dilation diameter (P = 0.2895) after adjusting for the effect of acute vasodilators. Conclusions: Pretreatment with BTX may induce the arteriolar resting diameter to be closer to their maximum potential diameter. Additionally, BTX does not display a synergistic effect with topical vasodilators on vasodilation.

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Long-Term Follow-Up of Flap Prefabrication in Facial Reconstruction

Background: Flap prefabrication is to turn a random flap into an axial flap by transferring a vascular pedicle. Methods: In the past 13 years, we have prefabricated 20 flaps in 20 patients by the superficial temporal artery and its concomitant veins. Typically, a 50- to 800-mL tissue expander was implanted in the donor site. After flap maturation, the prefabricated flap was raised and transferred locally to cover the large defect on the face. All the cases were followed up regularly. Results: The patients' age were between 3 and 27 years, the size of the flaps were between 3.5 × 5.5 cm2 and 13 × 15 cm2, the superficial temporal artery length was between 10 and 15 cm. All flaps were transferred successfully: 10 of the flaps had venous congestion, partial epidermis exfoliation and flap necrosis occurred in 4 flaps. All cases were followed up for at least 1 year, the longest follow-up period was 9 years. Long-term follow-up results showed the prefabricated flap survived in good condition and had a satisfactory outcome. Conclusions: Because flap prefabrication is practical, and long-term follow-ups have proved its preferable characters and stability, it is a fine method for large area facial reconstructions.

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De Novo Upper Extremity Lymphedema After Elective Hand Surgery in Breast Cancer Survivors

Background: The safety of elective hand surgery in breast cancer (BC) survivors is controversial because of concerns of developing upper extremity lymphedema. This study aimed to evaluate the risk of developing lymphedema after elective hand surgery among patients that underwent ipsilateral axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB), and/or radiation therapy (RT). Method: A retrospective cohort of BC patients treated with ALND, SLNB, and/or RT was identified (1997–2012). Patients with subsequent ipsilateral elective hand surgery were included if greater than 1 year of follow-up and no preexisting lymphedema. The primary outcome was lymphedema after hand surgery. Comparisons between patients with and without lymphedema were made to identify potential lymphedema risk factors. Dichotomous and continuous variables were compared with Fisher exact and Student t tests, respectively. Results: The analysis included 103 patients, of which 4 (3.8%) had documented lymphedema after hand surgery. Lymphedema developed early and was self-limited. Lymphedema was not related to age and type of hand surgery. Tourniquet time was longer in the nonlymphedema group. The lymphedema group all received adjuvant chemotherapy and RT with either ALND or SLNB. Patients with lymphedema had a shorter interval between hand surgery and completion of BC surgery (2.1 vs 6.2 years) and RT (2.0 vs 3.3 years). Conclusions: Lymphedema is uncommon after elective hand surgery among survivors and was not associated with tourniquet use. The combination of adjuvant therapies and axillary procedures and a short temporal relationship of these to hand surgery may increase lymphedema risk.

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The Combined Transverse Upper Gracilis and Profunda Artery Perforator Flap for Breast Reconstruction—Letter to the Editor

No abstract available

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Lateral Crural Reinforcement in Secondary Cleft Lip Nasal Deformity Through a Combined Lateral Crural Turn-over Flap and Strut Graft

Background: Secondary cleft lip nasal deformity is a complex deformity, and the variety of recommended techniques used to correct this deformity attests to it. Much of the nasal deformity can be attributed to an abnormal lower lateral cartilage. This study presents our experience with applying a lateral crural turnover flap with a sandwiched strut graft in adjunct with other procedures to correct unilateral secondary cleft lip nasal deformity. Methods: A retrospective review was conducted of 20 cases of unilateral cleft lip patients undergoing secondary rhinoplasty with lateral crural turnover flap with strut graft. Nostril base augmentation, columellar strut, suture techniques, and alar base reduction were performed as needed. Anthropometric analysis and subjective grading of the postoperative results were performed to evaluate the effect of the procedure on nostril symmetry. Results: At long-term follow-up of 1 year, the symmetry for cleft side and noncleft side nostril height, width, and angulation of long axis of nostril improved after surgery. Subjective evaluation revealed improved results for all patients. Conclusions: The lateral crural turnover flap with sandwiched strut graft is a useful technique for reinforcing, repositioning, and reshaping the lower lateral cartilage in cleft lip patients with hyperconcave lateral crus and hypoplastic pyriform margin. Combined with other techniques, the nostril is increased in height, decreased in width, and thus satisfactory symmetry is obtained.

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Can We Preserve the Urethral Plate in Proximal Hypospadias Repair?

Purpose: To know the limits of the preservation of the urethral plate in the correction of the curvature associated with proximal hypospadias. Methods: From January 2002 to January 2015, we treated 224 patients of proximal hypospadias. In 182 cases, we used of the lateral pictures taken during the successive saline erection tests to measure the correction obtained after each stage. Results: The analysis of the lateral pictures taken at the successive saline erection tests clearly demonstrated that release of the skin and dartos fascia provides an important correction of the chordee. This correction is complete of all curvature lower than 45 degrees and in 3 fourths of cases for curvatures between 45 and 90 degrees. However, for angles 90 degree and more, the release of the skin and dartos fascia was insufficient in more than 73.7% of cases. And the mobilization of the urethral plate with resection of the underlying fibrous tissue realized gives a very low correction of the chordee (0–20 degrees). Conclusions: The essential factor responsible of curvature associated with proximal hypopsadias is the fibrosis tissue present on the ventral side of the penis. However, in the severe forms, a short urethral plate must be transected to obtain a complete correction of the chordee.

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Aesthetic Reconstruction of the Frontotemporal Region: The Extended A-T Plasty, A Workhorse Revisited

Background: A-T plasty has long been a workhorse for defects located around the eyebrow or in the upper and lower lip. It allows like-with-like reconstruction with placement of the scars in natural creases or subunit junctions. In this article, the authors describe their refined technique to specifically address moderate to large size defects of the frontotemporal, preauricular, and zygomatic regions. Materials and Methods: Thirty consecutive patients underwent reconstruction with the extended A-T plasty at our institution after skin cancer excision. Mean age at surgery was 63 years (range, 39–87 years). Mean defect size was 5.2 × 4.7 cm. The defects were located in the frontotemporal (13), upper preauricular (10), and zygomatic (7) facial subunits. Results: Mean operative time was 65 minutes. Three (10%) patients suffered from delayed healing at the T junction, with no impairment in the long-term follow-up. All the other flaps healed uneventfully with optimal long-term cosmetic and functional restoration. Follow-up ranged from 3 months to 3 years (mean, 19 months). Conclusions: The basic principles of the A-T plasty were applied to design large advancement-rotation flaps incorporating frontotemporal and preauricular cervicofacial skin. The resulting extended A-T plasty proved to be a simple, reliable, and reproducible technique to resurface, in a "like with like" fashion, moderate to large defects located in the frontotemporal, preauricular and zygomatic facial subunits.

http://ift.tt/2srsWXK

Estimating Implant Volume and Mastectomy-Specimen Volume by Measuring Breast Volume With a 3-Dimensional Scanner

Objectives: Conventional 2-stage expander-implant breast reconstruction is frequently performed. However, direct to implant reconstruction should be considered if indicated and if circumstances allow. One difficulty in breast reconstruction postmastectomy is selection of the appropriate implant size prior to surgery. The ability to estimate implant volume and mastectomy-specimen volume from the preoperative breast volume using a 3-dimensional (3D) scanner would greatly facilitate reconstruction. We investigated the relation between preoperative breast volume, mastectomy-specimen volume, and implant volume. Materials and Methods: Forty-eight women who underwent 2-stage expander-implant reconstruction between April 2014 and September 2015 were included in this study. A 3D scanner (Kinect V1; Microsoft Corporation, Redmond, Wash) was used for measuring preoperative breast volume. We evaluated the relation of the measured preoperative breast volume, the mastectomy-specimen volume, and the implant volume using the Pearson correlation coefficient. Results and Conclusions: A strong correlation existed between preoperative breast volume, mastectomy-specimen volume, and implant volume. The following formulae were calculated: Mastectomy-specimen volume (mL) = 1.01 × preoperative breast volume (mL) + 9.91 Implant volume (mL) = 0.90 × preoperative breast volume (mL) + 65.42 Implant volume (mL) = 0.68 × mastectomy-specimen volume (mL) + 68.26 This study shows that preoperative breast volume, as measured by a 3D Kinect scanner, can provide useful assistance in the preoperative choice of implant size.

http://ift.tt/2srhqeP

Electronic Cigarettes Are as Toxic to Skin Flap Survival as Tobacco Cigarettes

Purpose: Electronic cigarettes (e-cigarettes) have become increasingly popular. However, information about the health risks associated with e-cigarette use is sparse. Currently, no published studies examine the effects of chronic e-cigarette exposure on microcirculation or perfusion. Using a rat skin flap model, we examined the toxic microcirculatory effects e-cigarettes may have in comparison with tobacco cigarettes. Methods: Fifty-eight rats were randomized to either exposure to room air, tobacco cigarette smoke, medium-nicotine content (1.2%) e-cigarette vapor, or a high-nicotine content (2.4%) e-cigarette vapor. After 4 weeks of exposure, a random pattern, 3 × 9 cm skin flap was elevated on the dorsum of the rats. At 5 weeks, flap survival was evaluated quantitatively, and the rats were euthanized. Plasma was collected for nicotine and cotinine analysis, and flap tissues were harvested for histopathological analysis. Results: Evaluation of the dorsal skin flaps demonstrated significantly increased necrosis in the vapor and tobacco groups. The average necrosis within the groups was as follows: control 19.23%, high-dose vapor 28.61%, medium-dose vapor 35.93%, and tobacco cigarette 30.15%. Although the e-cigarette and tobacco cigarette groups did not differ significantly, each individual group had significantly more necrosis than the control group (P

http://ift.tt/2sriWO8

Evaluating the Use of Tissue Oximetry to Decrease Intensive Unit Monitoring for Free Flap Breast Reconstruction

Background: Postoperative free flap care has historically required intensive monitoring for 24 hours in an intensive care unit. Continuous monitoring with tissue oximetry has allowed earlier detection of vascular compromise, decreasing flap loss and improving salvage. This study aims to identify whether a fast-track postoperative paradigm can be safely used with tissue oximetry to decrease intensive monitoring and costs. Materials and Methods: All consecutive microsurgical breast reconstructions performed at a single institution were reviewed (2008–2014) and cases requiring return to the operating room were identified. Data evaluated included patient demographics, the take back time course, and complications of flap loss and salvage. A cost-benefit analysis was performed to analyse the utility of a postoperative intensive monitoring setting. Results: There were 900 flaps performed and 32 required an unplanned return to the operating room. There were 16 flaps that required a reexploration within the first 24 hours; the standard length of intensive unit monitoring. After 4 hours, there were 7 flaps (44%) detected by tissue oximetry for reexploration. After 15 hours of intensive monitoring postoperatively, cost analysis revealed that the majority (15/16; 94%) of failing flaps had been identified and the cost of identifying each subsequent failing flap exceeded the cost of another hour of intensive monitoring. Conclusions: The postoperative paradigm for microsurgical flaps has historically required intensive unit monitoring. Using tissue oximetry, a fast-track pathway can reduce time spent in an intensive monitoring setting from 24 to 15 hours with significant cost savings and minimal risk of missing a failing free flap.

http://ift.tt/2srju6u

Effect of primary recrystallization microstructure on abnormal growth of Goss grains in a twin-roll cast grain-oriented electrical steel

Publication date: 5 October 2017
Source:Materials & Design, Volume 131
Author(s): Hong-Yu Song, Hai-Tao Liu, John J. Jonas, Guo-Dong Wang
Various primary recrystallization microstructures and textures were produced in a twin-roll cast grain-oriented electrical steel by employing different routes. The relationship between the primary recrystallization microstructure and texture and the abnormal growth of secondary Goss grains was investigated. The results show that the cold rolling reductions have a significant influence on secondary recrystallization by changing the primary recrystallization microstructure. Sheet processed by single-stage cold rolling with 88.3% reduction displayed the poorest secondary recrystallization microstructure as it contained many small equiaxed grains. By contrast, the employment of two-stage cold rolling markedly improved the secondary recrystallization microstructure. In the case of two moderate reductions of 65.2% and 66.3%, dense deformation substructures formed during both the first and second cold rolling, leading to a homogeneous primary recrystallization microstructure together with a strong γ-fiber texture. In this way, a suitable secondary recrystallization microstructure consisting of large Goss grains was produced. In the case of the inappropriate reductions, many large λ- and α-grains in the primary recrystallization matrix blocked the growth of secondary Goss grains along the transverse direction, resulting in a poor secondary recrystallization microstructure.

Graphical abstract

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Organic aerogel-impregnated low-density carbon/carbon composites: Preparation, properties and response under simulated atmospheric re-entry conditions

Publication date: 5 October 2017
Source:Materials & Design, Volume 131
Author(s): Chonghai Wang, Xiangyu Jin, Haiming Cheng, Changqing Hong, Xinghong Zhang
A novel lightweight organic aerogel-impregnated low-density carbon/carbon (C/C) composite was produced through vacuum impregnation using carbon-bonded carbon fibre (CBCF) as substrate and resorcinol-furfural (RF) aerogel as infiltrant. Microstructural analysis showed that fibres in CBCF were uniformly coated with a thin layer of aerogels, acting as the supporting skeletons, to strengthen the aerogel matrix. The as prepared RF-C/C possessed low densities between 0.26 and 0.37g/cm³, relatively high compressive strength, ranging from 0.45 to 3.27MPa, and low thermal conductivities of 0.105 to 0.350W/(mK) at room temperature. Furthermore, good thermal ablative and insulative properties (recession rates as low as 0.082mm/s and internal temperature peaks below 90°C at 38mm in-depth position as the surface temperature exceeded 2000°C) under an atmospheric re-entry condition. From mentioned above, RF-C/C present huge application prospects in heat preservation and thermal protection field, especially in energy-saving and aerospace.

Graphical abstract

http://ift.tt/2sCyrDj

Microstructure evolution and thermostability of bondline based on Cu@Sn core-shell structured microparticles under high-temperature conditions

Publication date: 5 October 2017
Source:Materials & Design, Volume 131
Author(s): Tianqi Hu, Hongtao Chen, Mingyu Li, Chunqing Wang
Cu@Sn core-shell structured particles with different coating layer thicknesses were fabricated and used as bonding materials. The microstructure evolution and thermostability of the bondline were studied under high-temperature conditions; the minimum thickness of the Sn coating layer required to consume all the inner Cu cores when forming ε-Cu3Sn was determined; and the accompanying volume shrinkage was verified. The phase transformation pathway for particles with a thin Sn coating layer was Cu6Sn5→ε-Cu3Sn→δ-Cu41Sn11→γ-phase→β-phase upon heating to 600°C. Thermal instability occurs at 520°C and 586°C due to the formation of the Cu-rich phases. High-temperature shearing tests were conducted at 500°C and 550°C to verify the existence of a critical point for brittle rupture and tough rupture at approximately 520°C. For particles with a thick Sn coating layer, the outer Sn shell completely consumes the inner Cu core when forming a ε-Cu3Sn intermetallic phase, and no other Cu-rich phases formed when heating to 600°C.

Graphical abstract

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Defect induced magnetism and super spin glass state in reactive ion beam deposited nano-structured AlN thin films

Publication date: 5 October 2017
Source:Materials & Design, Volume 131
Author(s): Shilpam Sharma, E.P. Amaladass, Awadhesh Mani
Defect induced magnetism is reported in undoped aluminium nitride thin films deposited using reactive ion beam sputtering of aluminium in nitrogen plasma. The films have been deposited on silicon substrate at different temperatures. Existence of the defects in the films has been verified using room temperature photo-luminescence measurements. Owing to nano-crystalline nature of the films, super-magnetic ground states have been observed. A cross-over from super paramagnetic to super spin glass state has been observed as the grain density increases. Detailed magnetisation measurements along with AC susceptibility measurements have been used to determine the ground states in these AlN thin films.

Graphical abstract

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Mixed-mode (I/II) interlaminar fracture of glued-laminated timber

Publication date: 5 October 2017
Source:Materials & Design, Volume 131
Author(s): Yanhua Zhao, Zheng Li, Bohan Xu
Mixed-mode bending (MMB) tests, together with double cantilever beam (DCB) and end-notched flexure (ENF) tests were conducted on Mongolian Scots pine to investigate the initial interlaminar fracture toughness of glued-laminated timber (glulam) under various mixed mode I/II conditions. By changing the loading lever location, a wide range of apparent ratios between mode I and mode II fracture were covered for MMB tests. Using the recorded critical load, interlaminar fracture toughness in terms of energy release rate was determined using compliance combination method (CCM), where the influence of growth ring orientations of adjacent laminae of glulam was highlighted. The results reveal the initial interlaminar fracture toughness was influenced by the growth ring orientation when mode II fracture component is larger. And an empirical power criterion was proven to be applicable to the mixed mode I/II interlaminar fracture toughness envelope of glulam.

Graphical abstract

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Effect of gels containing chlorhexidine or epigallocatechin-3-gallate on the protein composition of the acquired enamel pellicle

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Cíntia Maria de Souza-e-Silva, Talita Mendes da Silva Ventura, Luiza de Pau, la Silva Cassiano, Aline de Lima Leite, Marília Afonso Rabelo Buzalaf
ObjectiveThis study evaluated changes in protein profile of the acquired enamel pellicle (AEP) formed in vivo, after application of gels containing chlorhexidine or EGCG and further challenge with citric acid.DesignAEP was formed in 9 volunteers for 2h and then treated with one of the following gels: placebo, 400μM EGCG or 0.012% chlorhexidine. A thin layer of gel was applied and after 1min the excess was removed. One hour after gel application, the AEP was collected from the buccal surface (upper and lower jaw) of one of the sides with filter paper dipped in 3% citric acid. On the other side, erosive challenge was performed through gentle application of 1% citric acid (pH 2.5) for 20s (using a pipette) followed by washing with deionized water. The AEP was collected as mentioned before. Proteomic analysis was performed through liquid chromatography-electrospray ionization tandem mass spectrometry (LC-ESI–MS/MS). The MS/MS spectra obtained were compared with human protein databases (SWISS-PROT). Label-free quantitation was done using the PLGS software.ResultsIn total, 223 proteins were identified. After treatment with EGCG and CHX gels, proteins with potential functions to protect against caries and erosion such as PRPs, calcium-bind proteins and Statherin were increased. When EGCG and CHX-treated AEPs were challenged with citric acid, there was increase in cystatins and Profilin-1.ConclusionCHX- and EGCG-treated AEPs, submitted to challenge with citric acid or not, had remarkable changes in their proteomic profiles.



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Multiuse of Disposable Microsurgical Instruments as a Cost-Efficient Alternative for Training and Research

Summary: Microsurgery demands significant preclinical training, often hampered by the high costs of the required microsurgery instruments. We hypothesized that recently available disposable microsurgery instruments provide sufficient quality and significantly reduced costs. In a comparative analysis with standard reusable instruments, participants performed equally with both instrument sets and recommended the disposable instruments for microsurgery training and research applications.

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Immediate Regrafting of the Split Thickness Skin Graft Donor Site Assists Healing

Background: Delayed or even lack of healing of a split-thickness skin graft (STSG) donor site is a potential problem with elderly patients or those with poor wound healing capabilities. A proactive solution that may minimize this risk is to regraft that donor site using otherwise discarded skin graft remnants. Methods: A prospective, nonrandomized, consecutive study was designed to compare the time to healing of the commonly used anterior thigh STSG donor site in patients who had routine dressings (n = 113) versus those with comorbidities known to adversely affect wound healing and had planned regrafting (n = 204). Those comorbidities included age (≥65 years), diabetes mellitus, peripheral vascular disease, chronic renal disease, and chronic steroid use. Results: The average number of comorbidities in the regrafted subgroup versus those not regrafted was 1.41 and 0.31, respectively. This was considered to be a significant difference (P

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The influence of antidepressants on restless legs syndrome and periodic limb movements: A systematic review

Restless legs syndrome is commonly co-morbid with medical conditions that are treated with antidepressant medications, such as depression, anxiety, fibromyalgia, and chronic insomnia disorder. Evidence from case reports and cross-sectional studies suggests that antidepressants may induce or worsen restless legs syndrome and increase periodic limb movements. We undertook a systematic review of the literature to identify and collate all prospective studies that measured restless legs syndrome symptoms and/or periodic limb movements following the introduction of an antidepressant.

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Sleep quality during pregnancy: A meta-analysis

Women's sleep quality has been reported to change during pregnancy; prevalence estimates of poor sleep quality during pregnancy vary widely. To further understand the observed variation of findings, we conducted a meta-analysis to quantify the prevalence of poor sleep quality during pregnancy. Articles (N = 24) that reported prevalence of poor sleep quality as captured by the Pittsburgh sleep quality index (PSQI) ≥ 5 were included, with a total of 11,002 participants contributing data. PubMed, PsycINFO, and Web of Science databases were systematically searched.

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Comparison of G protein sequences of South African street rabies viruses showing distinct progression of the disease in a mouse model of experimental rabies

Publication date: Available online 13 June 2017
Source:Microbes and Infection
Author(s): Wonhyo Seo, Alexandre Servat, Florence Cliquet, Jenkins Akinbowale, Christophe Prehaud, Monique Lafon, Claude Sabeta
Rabies is a fatal zoonotic disease and infections generally lead to a fatal encephalomyelitis in both humans and animals. In South Africa, domestic (dogs) and the wildlife (yellow mongoose) host species maintain the canid and mongoose rabies variants respectively. In this study, pathogenicity differences of South African canid and mongoose rabies viruses were investigated in a murine model, by assessing the progression of clinical signs and survivorship. Comparison of glycoprotein gene sequences revealed amino acid differences that may underpin the observed pathogenicity differences. Cumulatively, our results suggest that the canid rabies virus may be more neurovirulent in mice than the mongoose rabies variant.



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Histologic features of chronic cutaneous lupus erythematosus of the scalp using horizontal sectioning: Emphasis on follicular findings

Chronic cutaneous lupus erythematosus (CCLE) often affects the scalp resulting in scarring alopecia. While histopathologic findings of CCLE have been well described, there is little written on the morphologic changes to the hair follicles in this condition.

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Skin-infiltrating, interleukin-22–producing T cells differentiate pediatric psoriasis from adult psoriasis

Evidence from adult psoriasis studies implicates an imbalance between regulatory and effector T cells, particularly TH-17–producing T cells, in the pathogenesis of psoriasis. Little is known about the immunopathology of psoriasis in children.

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Quality of Life and Dysphagia Following Palliative Stenting in Esophageal Cancer

Condition:   Esophageal Cancer
Intervention:  
Sponsor:   Centre hospitalier de l'Université de Montréal (CHUM)
Recruiting - verified June 2017

http://ift.tt/2sqYv3X

Reply

The correspondence letter delineates a dichotomy between the common paradigm of asthma inception in susceptible individuals being due to epithelial junctional complex dysfunction as assessed by albumin concentrations in the airway lumen (discussed in Löser et al1) and reported findings of unchanged or decreased epithelial permeability in patients measured by clearance of aerosolized radiolabeled diethylenetriaminepentaacetic acid. Whether epithelial barrier dysfunction is a basic feature of asthma and allergic rhinitis and whether albumin concentrations measured in the airways correlate with epithelial permeability is a matter of debate.

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Reply

We have read with interest the response of Rajput et al1 regarding our article.2 Their suggestion to replace skin prick testing and peanut specific IgE (sIgE) by sIgE to Ara h 2 as routine screening test for peanut allergy in children is in line with our findings and previously published literature reporting high diagnostic accuracy of sIgE to Ara h 2.2-7 However, we would like to comment on a few critical aspects.

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Allergy testing in predicting outcome of open food challenge to peanut

We read with interest the report by van Erp et al1 showing that in 81 Swedish children with suspected peanut allergy, 0.1 and 5.0 kUA/L Ara h2 cutoff values correctly predicted the outcome in 62% of children undergoing peanut double-blind placebo-controlled food challenge, and with the addition of basophil activation test Ara h 2 and 6 80% were correctly predicted. They proposed a flowchart for the diagnosis of peanut allergy. Clinicians managing peanut and other food allergies need diagnostic tools that are accurate, but also simple and readily available.

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Epithelial perviousness in allergic airways disease

Löser et al1 infer that increased airway surface albumin in their mouse model of asthma reflects defect epithelial integrity. A defect epithelial barrier in asthma, letting through allergens and other inhaled disease-inducing factors, is an established paradigm.2 However, 2 aspects seem forgotten: (1) The asymmetry of the epithelial barrier operating such that microvascular-epithelial exudation of plasma macromolecules occurs without increased passage of molecules in the opposite direction. (2) Late 1900 work demonstrating that bronchial epithelial permeability in asthma is not increased.

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Quality of Life and Dysphagia Following Palliative Stenting in Esophageal Cancer

Condition:   Esophageal Cancer
Intervention:  
Sponsor:   Centre hospitalier de l'Université de Montréal (CHUM)
Recruiting - verified June 2017

http://ift.tt/2sqYv3X

Erratum to: Early gastric adenocarcinoma arising within foveolar-type dysplasia in a patient with Muir-Torre variant Lynch syndrome

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Squamous cell carcinoma of the retromolar trigone: Treatment outcomes

Squamous cell carcinoma (SCC) of the retromolar trigone is uncommon, accounting for 1.4% of all oral cancer cases in Japan. Few studies have examined the optimal treatment for this cancer. The aim of this study was to evaluate the outcome of treatment for primary SCC of the retromolar area.

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Undifferentiated sarcoma of the sphenoid sinus

Paranasal sinuses sarcomas are rare and no treatments have been established. We report a young-adult case of sphenoid sinus sarcoma treated by carbon-ion radiotherapy. The patient presented with progressive left-sided visual impairment. A tumor was then identified and partial resection by transnasal approach was performed. The resected mass showed typical morphology of mesenchymal tumor, and morphological and molecular analyses ruled out a predominant-differentiation phenotype. The pathological diagnosis was undifferentiated sarcoma.

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A case grafted with polyglycolic acid sheets and fibrin glue for protection after temporary resection of a metastatic cervical skin tumor

The aim of this case report was to evaluate the usefulness of a grafting with polyglycolic acid sheet and a fibrin glue spray (PGA sheet grafting) after resection of a cervical skin tumor. A 61-year-old woman presented with left cervical skin tumor resistance to chemo-radiotherapy. She had been undergoing multimodal therapy for ovarian serous papillary adenocarcinoma for the previous six years. Although she had a poor general condition and a cervical skin tumor of 9cm in diameter, which was painful and easy bleeding, had offensive smell, she hoped to return to her job.

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Squamous cell carcinoma of the retromolar trigone: Treatment outcomes

Squamous cell carcinoma (SCC) of the retromolar trigone is uncommon, accounting for 1.4% of all oral cancer cases in Japan. Few studies have examined the optimal treatment for this cancer. The aim of this study was to evaluate the outcome of treatment for primary SCC of the retromolar area.

http://ift.tt/2sC3kaW

Undifferentiated sarcoma of the sphenoid sinus

Paranasal sinuses sarcomas are rare and no treatments have been established. We report a young-adult case of sphenoid sinus sarcoma treated by carbon-ion radiotherapy. The patient presented with progressive left-sided visual impairment. A tumor was then identified and partial resection by transnasal approach was performed. The resected mass showed typical morphology of mesenchymal tumor, and morphological and molecular analyses ruled out a predominant-differentiation phenotype. The pathological diagnosis was undifferentiated sarcoma.

http://ift.tt/2rjkshW

A case grafted with polyglycolic acid sheets and fibrin glue for protection after temporary resection of a metastatic cervical skin tumor

The aim of this case report was to evaluate the usefulness of a grafting with polyglycolic acid sheet and a fibrin glue spray (PGA sheet grafting) after resection of a cervical skin tumor. A 61-year-old woman presented with left cervical skin tumor resistance to chemo-radiotherapy. She had been undergoing multimodal therapy for ovarian serous papillary adenocarcinoma for the previous six years. Although she had a poor general condition and a cervical skin tumor of 9cm in diameter, which was painful and easy bleeding, had offensive smell, she hoped to return to her job.

http://ift.tt/2sBINn6

Three-dimensional scanning electron microscopy of maxillofacial biomaterials

Recent studies have used conventional scanning electron microscopy (SEM), micro-computed tomography (μCT), and synchrotron-based X-ray tomographic microscopy (SRXTM) to visualise and characterise maxillofacial biomaterials.1,2 We report a method of 3-dimensional scanning electron microscopy (3D-SEM) to visualise maxillofacial biomaterials.

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Inspiring a career in oral and maxillofacial surgery: a first-degree medical student’s perspective

When a person is considering a career in oral and maxillofacial surgery (OMFS) the need for both medical and dental qualifications can be discouraging. The long training is daunting, and may not seem worthwhile to students who have not experienced the specialty first hand. In 2015, 76% of medical students reported no exposure to OMFS, and 82% of those who had, attributed it to extra-curricular activities.1 These figures starkly outline the need to expose students to OMFS and highlight its absence from the undergraduate curriculum.

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Simultaneous, congenital, mucocoele of the Blandin-Nühn glands and teratoma of the tongue: early management and follow up at one year

Mucocoele of the Blandin-Nühn glands and teratomas of the tongue are rare in newborn babies. We present what is to our knowledge the first documented case of both at the same time, and describe management and follow up over 12 months after the birth. Prenatal diagnosis defined the treatment plan during delivery to establish an airway for the baby promptly. A normal delivery is possible if the cyst is anterior, and can be punctured during delivery. Delayed excision reduces the possibility of oedema and obstruction of the airway, ensures complete resection, avoids recurrence, and confirms the diagnosis.

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The outcomes of endoscopic management in young children with subglottic stenosis

Subglottic stenosis (SGS) is a common cause of obstructed airway in children, and the treatment of pediatric SGS, especially congenital SGS, remains a challenge for the otolaryngologist.

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Pediatric Langerhans cell histiocytosis of the lateral skull base

Describe the presentation, imaging characteristics, management, and outcomes of pediatric patients with Langerhans cell histiocytosis (LCH) of the temporal bone.

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Efficacy of an eccentric osteopathic manipulation treatment in somatic tinnitus

Manu Goyal, Sorabh Sharma, Nitish Baisakhiya, Kanu Goyal

Indian Journal of Otology 2017 23(2):125-127

Tinnitus is the ringing in the ears heard by the patients in the absence of external sounds. The potential causes for the tinnitus could be the vascular, temporal bone dysfunction, inflammation in the ear, idiopathic, muscular spasms of the middle ear and palatal muscles, functional impairment of the eustachian tube, functional disorders of the jaw, and cervical spine. The author reported a 30-year-old female case who presented with the complaint of buzzing and hissing in the right ear accompanied by the stiffness in the head and neck. Patient had no past medical and surgical history of any ear problem. On otoscopic examination of the tympanic membrane by otolaryngologist no abnormality was detected. In the present case, the diagnosis was made as somatic tinnitus accompanied by reduced cranial sacral motion. The craniosacral osteopathic manipulation was performed which remains the only choice in such cases. In follow-up of 1 month, patient was doing well and is asymptomatic.

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Investigating a patient of vertigo: Where do we stand today?

Chetana Naik

Indian Journal of Otology 2017 23(2):63-66



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To study the anatomy of tympanomastoid segment of facial nerve and its variations in human cadaveric temporal bone

Nitika Gupta, Rohan Gupta, IP Singh, Sunil Kotwal, Anil Suri, Sunanda Raina

Indian Journal of Otology 2017 23(2):108-112

Introduction: The facial nerve is one of the most significant and vulnerable structures in the temporal bone. Its dysfunction affects both voluntary and voluntary motion leading to noticeable disfigurement and emotional distress to those suffering from it. Iatrogenic facial paralysis is known to be a feared complication of ear surgery, and its incidence is reported to be 0.6–3.6% in all otologic surgical procedures, which increases to 4–10% in revision cases. Objective: The aim of this study is to study the anatomical aspects of tympanomastoid segment of the facial nerve. Materials and Methods: Thirty wet human cadaveric temporal bones were dissected in the temporal bone dissection laboratory in the Department of ENT, Government Medical College, Jammu. The length of the tympanomastoid segment of the facial nerve, its relationship with important bony landmarks, and the presence of any anomaly or variation in its course were studied. Observations and Results: The mean length of the tympanic segment of the facial nerve was 10.44±1.428 mm while that of the mastoid segment was 13.33±2.202 mm. The angle formed between the tympanic and mastoid segments of the facial nerve varied between 95°and 120°with the mean angle being 104.66°±7.760°.

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Screening of auditory acuity in patients with type 2 diabetes mellitus

Netra A Pathak, Vidya V Rokade, Kiran J Shinde

Indian Journal of Otology 2017 23(2):67-70

Diabetes mellitus (DM) is a multifunctional metabolic disorder affecting almost all the systems of the body. There is a strong relation between DM and hearing. The three main theories of pathogenesis of hearing impairment in patients with diabetes are microangiopathy, neuropathy, and combination of both. Even though studies have proved the occurrence of sensorineural hearing loss in DM, disagreement still exists among some about their relation. Material and Methods: This study was a prospective design. Aim: The present study aimed (1) to focus on and evaluate the interrelation between Type 2 DM and hearing loss; (2) to screen the degree of auditory acuity in patients with Type 2 DM using pure tone audiometry; and (3) to analyze the effect of age, glycemic status (fasting blood sugar and postprandial blood sugar), glycemic control (glycosylated hemoglobin), and duration of Type 2 diabetes on auditory acuity. Results: In the present study, it was found that the patients with Type 2 diabetes had a higher hearing threshold than the healthy controls. The patients with diabetes showed significant high-frequency, bilateral, mild-to-moderate SNHL. Conclusion: The glycemic status had significant correlation with hearing loss may be explained by diabetic microangiopathy of the inner ear, and the hearing was affected in both sexes equally.

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Effect of postauricular sulcus incision for myringoplasty on auricle protrusion: 5 years' experience

Mohammad Waheed El-Anwar, Ahmed Shaker ElAassar

Indian Journal of Otology 2017 23(2):71-73

Objective: The objective of this study was to investigate the effect of postauricular incision (sulcus incision) during myringoplasty using conchal perichondrial graft with or without conchal cartilage on the ear protrusion. Patients and Methods: A prospective study was conducted on 243 patients who underwent myringoplasty using small postauricular sulcus incision. The distances from postauricular area to the lateral aspects of helical rim and ear lobule at three different levels and the maximum ear protrusion were measured pre- and post-operatively. Results: There were no statistically significant differences between the measures of the auricle position preoperatively and 2 weeks, 1 month, and 3 months postoperatively. Conclusion: There was no effect of the short postauricular sulcus incisions for myringoplasty on the ear position. It does not affect or annoy the glasses wearers with highly satisfactory cosmetic results without reported persistent complications.

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Evaluation of the myringosclerotic tympanic membrane with wideband tympanometry

Suat Terzi, Abdulkadir Özgür, Zerrin Özergin Coşkun, Özlem Çelebi Erdivanlı, Metin Çeliker, Münir Demirci, Engin Dursun

Indian Journal of Otology 2017 23(2):117-120

Objective: The purpose of this study is to evaluate the effects of myringosclerosis (MS) localized to the tympanic membrane (TM) on the mechano-acoustics of hearing using wideband tympanometry (WBT). Materials and Methods: In this prospective case-controlled study, 86 ears of 54 patients who were found to have MS localized to the TM were compared to 40 healthy eardrums in 20 patients. Thirty-seven ears which had a MS ratio to the whole TM of <25% were classified as Group 1, 33 ears with a ratio of 25–50% were classified as Group 2, and 16 ears with a ratio of >50% were classified as Group 3. Peak acoustic compliance, resonant frequency (RF), and frequency-specific absorbance results of WBT were compared among the MS groups and the control group. Results: When the amplitudes of peak acoustic compliance of the MS groups and control group were compared, the MS groups were found to have lower amplitudes, and the difference was statistically significant (P < 0.05). There was no difference in frequency-specific absorbance values (250, 500, 1000, 2000, 4000, 8000, and 375–2000 Hz averaged absorbance) among the groups (P > 0.05). The RF of Groups 1, 2, and 3 were 1062, 1154, and 1166 Hz, respectively, and the RF of the control group was 1077 Hz. There was no significant difference among the groups with regard to resonant frequencies. Conclusion: This study showed that although MS localized to the TM decreased the amplitude of peak acoustic compliance of the tympanogram, it did not affect the RF or the wideband acoustic absorbance.

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Vestibular dysfunction in children with sensorineural hearing loss: A cross-sectional study

Poonam Raj, Atul Gupta

Indian Journal of Otology 2017 23(2):74-77

Introduction: The cochlea and vestibule are anatomically and functionally related to each other and any dysfunction in each or both of them may result in vestibular functional derangement and subsequent deficit in the function of balance. This is especially true in children where the two systems are still evolving. Vestibular dysfunction has been reported in approximately 20-70 % of children with hearing loss of different causes. This study was aimed to detect and evaluate the prevalence of vestibular dysfunction in children with SNHL. Methods and Materials: Vestibular function assessment was done with monothermal warm air caloric test on 50 children less than 12 years of age with bilateral severe to profound SNHL. Recordings were made using a head band camera on SYNAPSYS Ulmer VNG software. "Monothermal Caloric Asymmetry" (MCA) was depicted in the recording software as unilateral weakness. MCA of >15 % was taken as evidence of canal paresis. Results: The mean age of the children was 5.48 years. Of the 48 children who successfully completed the test, 09 children had vestibular dysfunction indicative of canal paresis. Prevalence was 18.75 % with 95% CI (7.3, 30.2). Correlation between compensated vestibular function results with age and severity of SNHL was not significant. Conclusions: Children with SNHL should be evaluated for occult compensated vestibular dysfunction. It may also be relevant in the context of any further vestibular pathology the child may develop and should be kept in mind when surgical procedures like cochlear implantation are being contemplated.

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Effect of inter-stimulus interval on the acoustic change complex elicited with tone-complex and speech stimuli

Mohan Kumar Kalaiah, Anjali Jude, Vinaya Palora Malayil

Indian Journal of Otology 2017 23(2):83-88

Background: Acoustic change complex (ACC) is an auditory-evoked cortical potential elicited for a change in the physical properties of the sound. It can be elicited for a change in frequency, amplitude, or periodicity in the ongoing speech and nonspeech stimuli. Earlier investigations have established a significant effect of stimulus-related factors on the cortical auditory-evoked potentials. However, investigations to understand the effects of stimulus factors on the ACC are rare. Purpose: This study aimed to investigate the effect of inter-stimulus interval (ISI) between the stimuli on the ACC elicited for speech and tone-complex stimuli. Research Design: This is a cross-sectional study. Method: A total of 12 young adults aged between 18 and 22 years with normal hearing in both ears participated in the study. The ACC was elicited using a consonant-vowel syllable/sa/and frequency-changing tone-complex. Tone-complex had an onset frequency of 1000 Hz and changed its frequency to 2000 Hz at 120 ms after the onset. Both stimuli had a total duration of 350 ms and changed their characteristics at 120 ms after the onset. The stimulus was presented monaurally with ISIs of 500, 1000, 1500, and 2000 ms, and the ACC was recorded from Cz to Fz. Results: The present study showed a significant effect of ISI on peak latencies and peak-to-peak amplitudes. Shorter ISI was found to elicit peaks with smaller amplitude and slightly longer latency, whereas longer ISI elicited peaks with larger amplitude and shorter latency. Further, the amplitude of response for tone-complex was larger than response for syllable/sa/. Conclusions: ISI is one of the stimulus-related factors which significantly affects the ACC. Longer ISIs (≥1500 ms) should be used to elicit the ACC.

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Glomus tympanicum: A radiological dilemma

A Karunagaran, VJ Niranjana Bharathi, Anand Karthikeyan

Indian Journal of Otology 2017 23(2):131-133

Glomus tumors are non chromaffin paraganglionomas, a vascular tumor arising in the middle ear, presents with tinnitus and aural block with radiological supportive findings. Diagnosis is made easy by the radiological investigations. Even in this modern era, the role played by clinical examination is vital and as we present in this case report, played an important role in management of the disease.

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Nitinol piston versus conventional teflon piston in the management of otosclerosis: A comparative study

Poonam Raj, Atul Gupta, Ruchika Mittal

Indian Journal of Otology 2017 23(2):78-82

Introduction: Otosclerosis is a primary metabolic localized disease characterized by conductive deafness. The mainstay of treatment of this condition remains surgical. Several techniques and approaches are commonly used with largely excellent results. A newly developed piston made of Nitinol has the property of crimping by heat activation rather than manually. This study, carried out at a tertiary care centre of the armed forces, proposed to evaluate the efficacy and complications of the Nitinol Smart piston in comparison to the conventional pistons currently being used. Methods and Materials: 50 patients of otosclerosis were evaluated with Pure tone audiometry and randomized into test and control groups of 25 each. The control group underwent stapedotomy by the conventional Teflon piston and in the test group Nitinol smart pistons were used. Pure tone Audiometry for hearing thresholds and AB gap was performed at 06 weeks after surgery and repeated at 06 months, 01 year and 02 years after surgery. Results: Results show an almost identical outcome in terms of improvement of hearing thresholds with the two kinds of prosthesis used with the 'Smart' piston showing marginally better results. There was no significant difference in the postoperative ABG (P < .23) or ABG closure (P < .09). Conclusion: The nitinol piston prosthesis represents the latest advancement in stapes prosthesis design in that incorporates heat-sensitive crimping to preclude the technically difficult step of manual crimping. It is at least as effective as a standard prosthesis in closing the ABG in patients with otosclerosis.

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Effect of mastoid pneumatization on myringoplasty success: A radiological study

Hazem Saeed Amer, Mohammad Waheed El-Anwar, Mohammad Abdelhady, Ghada Abdulmonaem, Khaled Mohammad Elgerby

Indian Journal of Otology 2017 23(2):104-107

Objectives: The objective of the study was to evaluate the effect of mastoid pneumatization on myringoplasty success. Patients and Methods: Forty-two adult patients with dry central tympanic membrane perforation scheduled for myringoplasty were included in the study. Computed tomography (CT) scans of the temporal bone coronal and axial cuts were done 1–2 days before surgery. The patients were evaluated on the basis of postoperative graft taking. Results: Success rate was 85.7% while failure rate was 14.3%. The mean longitudinal diameter of the mastoid was found to be 2.35 cm in succeeded cases and 1.43 cm in failed cases with near significant difference (P = 0.0636). The mean transverse diameter was 1.44 cm in succeeded cases and 0.83 cm in failed cases with a significant difference (P = 0.0476). The mean depth of the mastoid was 0.4 in both succeeded and failed cases. The mean total mastoid volume was 2.832 ml in succeeded cases and 1.13 ml in failed cases with nonsignificant difference (P = 0.1218). The mean mastoid surface area was 516.9 cm2 in succeeded cases and 448.5 cm2 in failed cases with a significant difference (P = 0.0087). Conclusions: Success rate of myringoplasty is higher in patients with chronic suppurative otitis media (CSOM) having large mastoid system than those having small one. Preoperative CT scans in patients with CSOM undergoing myringoplasty are advisable.

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Effect of duration of diabetes mellitus on hearing threshold among type 2 diabetics

Stephen Semen Yikawe, Kufre Robert Iseh, Anas Ahmad Sabir, Joseph Hassan Solomon, Caleb Manya, Nasiru Aliyu

Indian Journal of Otology 2017 23(2):113-116

Background: Diabetes mellitus (DM) is a syndrome of chronic hyperglycemia due to relative insulin deficiency or resistance. The risk of complications of diabetes has been observed to increase as a function of the duration of hyperglycemia. Objective: The objective of this study is to determine the effect of duration of DM on hearing thresholds among type 2 diabetics. Methodology: This was a cross-sectional descriptive study conducted between October 2015 and May 2016 in Usmanu Danfodiyo University Teaching Hospital Sokoto among type 2 diabetic patients attending the Endocrine Clinic of the hospital. Patients had their blood sugar and hearing thresholds measured. Results: A total of 170 type 2 diabetics were recruited into the study, out of which 98 (57.6%) were females and 72 (42.4%) were males. The mean age was 46.49±10.02 years. One hundred and twenty-two (71.8%) had elevated hearing thresholds. The mean duration of diabetes among participants was 7.81±5.34 years, with durations ranging from <1 year to 30 years. The mean pure tone average increased with increase in duration of diabetes (P < 0.001). Simple linear regression showed that increase in duration of diabetes was positively related with hearing threshold (P < 0.0001). For every year increase in duration of type 2 DM, a 1.036 dB HL increase in pure tone average is to be expected. Conclusion: This study demonstrated a relationship between duration of diabetes and hearing threshold. It has shown that as the duration of hyperglycemia increased, the hearing threshold among participants also increased.

http://ift.tt/2sr1WYo

Test-retest reliability of contralateral suppression of acoustic middle ear muscle reflex

Sandeep Maruthy, G Nike Gnanateja, M Shamantha, M Nayana

Indian Journal of Otology 2017 23(2):89-93

Background and Objective: The role of efferent system in auditory perception is very important. To assess this, a reliable measure of efferent functioning is necessary. The efferent suppression of otoacoustic emission lacks good test-retest reliability, and there is a need to look for the reliability of other measures of efferent auditory functioning. The current study evaluated the test-retest reliability of contralateral suppression of acoustically evoked middle ear muscle reflexes (MEMR). Method: Nineteen normal hearing adults in the age range of 18–24 years participated in the study. A Repeated measures design was used to establish the reliability of the contralateral suppression of MEMR. Measurements were spaced 1 h and 1 day apart. Results: The results showed acceptable test-retest reliability of contralateral suppression of acoustically evoked MEMR in terms of its Cronbach's alpha. However, inspection of the individual data did not support the impression to call it a reliable tool to assess efferent auditory functioning. The findings of the study are discussed in light of its clinical utility. Conclusion: Contralateral suppression of acoustically evoked MEMR has questionable reliability to be used as a clinical tool.

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Enterococcus brain abscess with lateral sinus thrombophlebitis as a complication of chronic otitis media

Manu Malhotra, Shubhankur Gupta, Saurabh Varshney, Poonam Joshi, Rashmi Malhotra

Indian Journal of Otology 2017 23(2):121-124

With widespread use of antibiotics, the occurrence of brain abscess and lateral sinus thrombosis together is rare these days, especially with enterococcus as the causative organism. We here present a case of pediatric case of brain abscess and lateral sinus thrombosis which developed an additional complication of postoperative cerebrospinal fluid leakage. The case was successfully treated by excision of the abscess, canal wall down mastoidectomy with partial obliteration of cavity, and Type III tympanoplasty with umbrella graft.

http://ift.tt/2sqV1hH

Effects of ethnicity and gender on the middle ear function in Asian adults

Aw Cheu Lih, Mohd Normani Zakaria, Ridwan Afif Mohamad, Mohd Fadzil Nor Rashid

Indian Journal of Otology 2017 23(2):94-97

Introduction: Tympanometry is a standard clinical test to measure the middle ear function objectively. Ethnicity and gender may affect tympanometric results, and specific normative data are required for diagnosing middle ear disorders accurately. Aim: This study aimed to determine the effects of ethnicity (Malay vs. Chinese) and gender on tympanometric results among Asian adults. Materials and Methods: A total of 72 young adults aged 20–25 years participated in this comparative study. They comprised two ethnic groups: Malay (n = 31 [14 males and 17 females]) and Chinese (n = 41 [20 males and 21 females]) participants. All participants fulfilled the inclusion criteria (no history of ear and hearing difficulties and normal findings in routine audiological assessments) and underwent a standard 226 Hz tympanometric testing. Tympanometric parameters including static admittance (SA), ear canal volume (ECV), tympanometric peak pressure (TPP), and tympanometric width (TW) were recorded from each participant. Results: No significant differences in all tympanometric parameters were found between Chinese and Malay participants (P > 0.05). However, statistically higher SA and ECV values were noted in males than in females (P < 0.05). No gender effect was observed in TPP and TW (P > 0.05). Conclusions: For a more accurate middle ear evaluation in Malay and Chinese young adults, gender-specific tympanometric normative data derived from this study are recommended.

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Migrated guidewire: An unusual cause for recurrent aural polyps

Kong Yew Liew, Aun Wee Chong

Indian Journal of Otology 2017 23(2):128-130

Aural polyps are secondary to multiple ear pathologies, most commonly inflammatory or cholesteatoma related. Here, we present a rare case of recurrent aural polyps caused by guidewire migration into the middle ear with serious systemic complications and our attempts at removal.

http://ift.tt/2sqvsgH

Comparison of performance across transcranial contralateral routing of signal, trimmer digital and digital bone-anchored hearing implant (with headbands) in children with unilateral hearing loss

N Devi, Suma Chatni, K. J. S. Ramadevi, D Baba Fakruddin

Indian Journal of Otology 2017 23(2):98-103

Background: Children with unilateral hearing loss (UHL) of severe profound degree find it challenging to locate a sound source and to comprehend speech in the presence of noise, like in classrooms. The objectives of the present study were to compare the available rehabilitative options for children with UHL and arrive at a probably appropriate option. Methods: Fifteen children with unilateral severe sensorineural or profound hearing loss participated in the study. The sound field thresholds, speech perception in the presence of noise and in quiet were assessed with the digitally programmable bone-anchored hearing implant (BAHI), the trimmer digital BAHI and the transcranial contralateral routing of signal (T-CROS). Results: BAHI and T-CROS both provide significant benefit for the children with UHL. However, the children performed better with the BAHIs than the T-CROS both in quiet and noise in most of the measures. It was also noted that the digitally programmable and the trimmer digital BAHI both gave similar performance. Conclusions: BAHI was a better option in both quiet and noise than the T-CROS as a rehabilitation option for children with UHL. The current study helps in prioritizing the rehabilitation options while considering trial and also helps in narrowing down at the appropriate rehabilitative option for the children with UHL.

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Erratum: Influence of channel and channelfree™ processing technology on the vocal parameters in hearing-impaired individuals

Indian Journal of Otology 2017 23(2):134-134



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Cysteine-rich whey protein isolate (Immunocal®) ameliorates deficits in the GFAP.HMOX1 mouse model of schizophrenia

Publication date: September 2017
Source:Free Radical Biology and Medicine, Volume 110
Author(s): Wei Song, Ayda Tavitian, Marisa Cressatti, Carmela Galindez, Adrienne Liberman, Hyman M. Schipper
Schizophrenia is a neuropsychiatric disorder that features neural oxidative stress and glutathione (GSH) deficits. Oxidative stress is augmented in brain tissue of GFAP.HMOX1 transgenic mice which exhibit schizophrenia-relevant characteristics. The whey protein isolate, Immunocal® serves as a GSH precursor upon oral administration. In this study, we treated GFAP.HMOX1 transgenic mice daily with either Immunocal (33mg/ml drinking water) or equivalent concentrations of casein (control) between the ages of 5 and 6.5 months. Immunocal attenuated many of the behavioral, neurochemical and redox abnormalities observed in GFAP.HMOX1 mice. In addition to restoring GSH homeostasis in the CNS of the transgenic mice, the whey protein isolate augmented GSH reserves in the brains of wild-type animals. These results demonstrate that consumption of whey protein isolate augments GSH stores and antioxidant defenses in the healthy and diseased mammalian brain. Whey protein isolate supplementation (Immunocal) may constitute a safe and effective modality for the management of schizophrenia, an unmet clinical imperative.

Graphical abstract

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Pituitary stem cell regulation: who is pulling the strings?

The pituitary gland plays a pivotal role in the endocrine system, steering fundamental processes of growth, metabolism, reproduction and coping with stress. The adult pituitary contains resident stem cells which are highly quiescent in homeostatic conditions. However, the cells show marked signs of activation during processes of increased cell remodeling in the gland, including maturation at neonatal age, adaptation to physiological demands, regeneration upon injury, and growth of local tumors. Although functions of pituitary stem cells are slowly but gradually uncovered, their regulation largely remains virgin territory. Since postnatal stem cells in general reiterate embryonic developmental pathways, attention is first being given to regulatory networks involved in pituitary embryogenesis. Here, we give an overview of the current knowledge on the NOTCH, WNT, epithelial-mesenchymal transition, SHH and Hippo pathways in the pituitary stem/progenitor cell compartment during various (activation) conditions from embryonic over neonatal to adult age. Most information comes from expression analyses of molecular components belonging to these networks, whereas functional extrapolation is still very limited. From this overview, it emerges that the 'big five' embryonic pathways are indeed reiterated in the stem cells of the 'lazy' homeostatic postnatal pituitary, further magnified en route to activation in more energetic, physiological and pathological remodeling conditions. Increasing the knowledge on the molecular players that pull the regulatory strings of the pituitary stem cells will not only provide further fundamental insight in postnatal pituitary homeostasis and activation, but also clues toward the development of regenerative ideas for improving treatment of pituitary deficiency and tumors.

http://ift.tt/2riNFJX

Structural Basis for CD4+ T Cell Epitope Dominance in Arbo-Flavivirus Envelope Proteins: A Meta-Analysis

Viral Immunology , Vol. 0, No. 0.


http://ift.tt/2rtsAk4

Coexisting Vocal Fold Polyps and Sulcus Vocalis: Coincidence or Coexistence? Characteristics of 14 Patients

The study aimed (1) to evaluate the prevalence of sulcus vocalis (SV) coexisting with vocal fold polyp (SV-VFP), and (2) to determine the effect of their coexistence on voice quality.

http://ift.tt/2sczIyd

Obese Asthmatics Have Decreased Surfactant Protein-A Levels: Mechanisms and Implications

SP-A secretion by epithelial cells is attenuated by TNF-α, a cytokine increased in obese asthmatics. SP-A plays an important role in resolving tissue eosinophilia, therefore obese asthmatics may have prolonged tissue eosinophilia due to significantly decreased SP-A levels.

http://ift.tt/2sqRiAW

The future of Allergy/Immunology: Promising Young Investigators

http://ift.tt/2toA848

Human mast cells present antigen to autologous CD4+ T Cells

Mast cells (MCs), the primary effector cell of the atopic response, participate in immune defense at host/environment interfaces, yet the mechanisms by which they interact with CD4+-T cells has been controversial.

http://ift.tt/2topnPb

Human mast cells as antigen-presenting cells: when is this role important in vivo?

http://ift.tt/2sqWBAn

Anti-FcγRIIB monoclonal antibody suppresses murine IgG-dependent anaphylaxis by Fc domain targeting of FcγRIII

The inhibitory receptor, FcγRIIB, is expressed on human and murine bone marrow-derived cells and limits inflammation by suppressing signaling through stimulatory receptors.

http://ift.tt/2toxhYV

Obesity’s Impact on Asthma Extends to Diagnostic Criteria

Obesity is associated with decreased sensitivity of blood eosinophils, IgE and FeNO in characterizing eosinophilia. Reliance on peripheral markers to make decisions regarding therapies targeting eosinophilia should therefore be approached with caution in obese asthma.

http://ift.tt/2sqUeNA

Endoscope-assisted Neurectomy and Inferior Alveolar Nerve Avulsion in Treating Trigeminal Neuralgia

To explore endoscope-assisted surgical treatment for idiopathic trigeminal neuralgia (TN), with neurectomy and avulsion of the inferior alveolar nerve (IAN), when patients are not willing to undergo intracranial procedures.

http://ift.tt/2sci1yR

Imiquimod-induced cutaneous lupus erythematosus with antinuclear antibodies showing a homogenous pattern

http://ift.tt/2tognd1

Lichen striatus following yellow fever vaccination in an adult woman

http://ift.tt/2sqAqdg

Development of a solid-phase extraction method with simple MEKC-UV analysis for simultaneous detection of indole metabolites in human urine after administration of indole dietary supplement

Publication date: 1 November 2017
Source:Talanta, Volume 174
Author(s): Apichai Phonchai, Prapin Wilairat, Rattikan Chantiwas
This work presents the development of a solid phase extraction method with simple MEKC-UV analysis for the simultaneous determination of indole-3-carbinol (I3C) and its metabolites (3, 3′-diindolylmethane (DIM), indole-3-carboxaldehyde (I3CAL), indole-3-acetonitrile (I3A)) in human urine after oral administration of an indole dietary supplement. Solid phase extraction (SPE) method was applied for the first time for simultaneous analysis of these indole metabolites. The MEKC separation method was developed in a previous work. Three commercial SPE cartridges, each with different sorbent materials, were investigated: Sep-Pak^® C18, Oasis^® HLB and Oasis^® WCX. The Sep-Pak^® C18 material provided the highest extraction recovery of 88–113% (n = 9), for the four target indole metabolites (I3C, DIM, I3CAL and I3A). The optimal washing and elution solutions were 40% methanol/water (v/v) and 100% methanol, respectively, and optimal elution volume was 2.0mL. The specificity of the proposed SPE method was evaluated with negative control urine samples (n = 10) from healthy volunteers who had not taken the dietary supplement or vegetables known to contain indole compounds. Linear calibration curves were in the range of 0.2–25μgmL⁻¹ (r² > 0.998) using diphenylamine (DPA) as the internal standard. Intra-day and inter-day precisions were 3.5–12.3%RSD and 2.7–14.1%RSD, respectively. Limits of detection and quantification were 0.05–0.10μgmL⁻¹ and 0.10–0.50μgmL⁻¹, respectively. The four target indole compounds were separated within only 5min by MEKC-UV analysis. Urine from 5 subjects who had taken a dietary supplement containing I3C and DIM were found to contain only the DIM metabolite at concentrations ranging from 0.10 to 0.35µgmL⁻¹. Accuracy of the proposed method based on the percentage recovery of spiked urine samples were 70–108%, 82–116%, 82–132% and 80–100% for I3C, I3CAL, I3A and DIM, respectively. The Sep-Pak^®C18 cartridge was highly effective in extraction and sample cleanup for the downstream simultaneous detection of urinary indole metabolites by MEKC-UV method.

Graphical abstract

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Ordered mesoporous silica film as a novel fiber coating for solid-phase microextraction

Publication date: 1 November 2017
Source:Talanta, Volume 174
Author(s): Hui Jiang, Jiansheng Li, Xingru Hu, Jinyou Shen, Xiuyun Sun, Weiqing Han, Lianjun Wang
Ordered mesoporous silica (OMS) film supported on anodized titanium wire was fabricated as a new solid phase microextraction (SPME) fiber for the extraction of chlorophenols (CPs) from aqueous media followed by the determination with gas chromatography flame ionization detection (GC-FID). The supported OMS film was prepared via a solvent evaporation-induced self-assembly approach (EISA) combined with dip-coating technology. Commonly used fragile fused silica fiber was replaced by anodized titanium wire. The coating materials were characterized by N2 adsorption-desorption, Fourier transform infrared spectroscopy (FT-IR), scanning electron microscopy (SEM) and thermogravimetric (TG) analysis. The N2 adsorption-desorption results show the OMS material has well-ordered mesostructure with uniform pore diameter. The SEM images verify that the OMS film was successfully grafted onto the surface of anodized titanium wire. The resultant method based on the OMS fiber exhibited wide linear ranges (0.2-200μgL⁻¹), low detection limits (0.03-0.12μgL⁻¹) and good repeatabilities (6.2–9.8% for one fiber, 8.9–13.2% for fiber-to-fiber). No significant change was observed after being subjected into high temperature or immersed in organic solvents. The new fiber was successfully applied to the extraction and determination of three CPs compounds in the natural water samples. Thus, the OMS fiber is a promising alternative to the commercial fiber as it is easily and inexpensively prepared with high extraction capacity and good stability.

Graphical abstract

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Imiquimod-induced cutaneous lupus erythematosus with antinuclear antibodies showing a homogenous pattern

http://ift.tt/2tognd1

Lichen striatus following yellow fever vaccination in an adult woman

http://ift.tt/2sqAqdg

Vocal palsy increases the risk of lower respiratory tract infection in low-risk low-morbidity patients undergoing thyroidectomy for benign disease: a big data analysis

Abstract

Objectives

Thyroidectomy is the commonest and most rapidly-growing operation which places normally-functioning laryngeal nerves at risk of injury. Laryngeal palsy is a major risk-factor for dysphonia, dysphagia, and less commonly, airway obstruction. We investigated the association between post-thyroidectomy vocal palsy and long-term risks of pneumonia and laryngeal failure.

Design

An N=near-all analysis of the English administrative dataset using a previously-validated informatics algorithm to identify young and otherwise low-risk patients undergoing thyroidectomy for benign disease. Information about age, sex, morbidities, social deprivation, and postoperative and late complications were derived.

Main Outcome Measures

Between 2004 and 2012, 43,515 patients between the ages of 20 and 69 who had no history of cancer, neurological, or respiratory disease underwent first-time elective total or hemithyroidectomy without concomitant or late neck dissection, parathyroidectomy, or laryngotracheal surgery for benign thyroid disease. Information about age, sex, morbidities, and in-hospital and late complications was recorded.

Results

Mean age at surgery was 46±12. There was a strong female preponderance (85%) and most patients (89%) had no recorded Charlson morbidities. Most patients (65%) underwent hemithyroidectomy. Late vocal palsy was recorded in 449 (1.03%) patients and its occurrence was an independent risk factor for emergency hospital readmission (n=7113; Hazard Ratio 1.52; 95% Confidence interval 1.21-1.91), hospitalisation for lower respiratory tract infection (n=944; HR 2.04; 95% CI 1.07-3.75), dysphagia (n=564; HR 3.47; 95% CI 1.57-7.65) and gastrostomy/tracheostomy placement (n=80; HR 20.8; 95% CI 2.5-171.2). Independent risk-factors for late vocal palsy were age, burden of morbidities, total thyroidectomy, and postoperative bleeding. Female sex and annual surgeon volume >30 were independently protective.

Conclusions

There is a significant association between post-thyroidectomy vocal palsy and long-term risks of hospital readmission, dysphagia, pneumonia, and gastrostomy/tracheostomy tube placement. This adds weight to the need, from a thyroid surgical perspective, to undertake universal post-thyroidectomy laryngeal surveillance with a focus on postoperative dysphagia and aspiration, and from a medical/respiratory perspective, to initiate investigations to identify occult vocal palsy in patients who present with pneumonia, who have a history of thyroid surgery.

This article is protected by copyright. All rights reserved.

http://ift.tt/2rtma4g

Vocal palsy increases the risk of lower respiratory tract infection in low-risk low-morbidity patients undergoing thyroidectomy for benign disease: a big data analysis

Abstract

Objectives

Thyroidectomy is the commonest and most rapidly-growing operation which places normally-functioning laryngeal nerves at risk of injury. Laryngeal palsy is a major risk-factor for dysphonia, dysphagia, and less commonly, airway obstruction. We investigated the association between post-thyroidectomy vocal palsy and long-term risks of pneumonia and laryngeal failure.

Design

An N=near-all analysis of the English administrative dataset using a previously-validated informatics algorithm to identify young and otherwise low-risk patients undergoing thyroidectomy for benign disease. Information about age, sex, morbidities, social deprivation, and postoperative and late complications were derived.

Main Outcome Measures

Between 2004 and 2012, 43,515 patients between the ages of 20 and 69 who had no history of cancer, neurological, or respiratory disease underwent first-time elective total or hemithyroidectomy without concomitant or late neck dissection, parathyroidectomy, or laryngotracheal surgery for benign thyroid disease. Information about age, sex, morbidities, and in-hospital and late complications was recorded.

Results

Mean age at surgery was 46±12. There was a strong female preponderance (85%) and most patients (89%) had no recorded Charlson morbidities. Most patients (65%) underwent hemithyroidectomy. Late vocal palsy was recorded in 449 (1.03%) patients and its occurrence was an independent risk factor for emergency hospital readmission (n=7113; Hazard Ratio 1.52; 95% Confidence interval 1.21-1.91), hospitalisation for lower respiratory tract infection (n=944; HR 2.04; 95% CI 1.07-3.75), dysphagia (n=564; HR 3.47; 95% CI 1.57-7.65) and gastrostomy/tracheostomy placement (n=80; HR 20.8; 95% CI 2.5-171.2). Independent risk-factors for late vocal palsy were age, burden of morbidities, total thyroidectomy, and postoperative bleeding. Female sex and annual surgeon volume >30 were independently protective.

Conclusions

There is a significant association between post-thyroidectomy vocal palsy and long-term risks of hospital readmission, dysphagia, pneumonia, and gastrostomy/tracheostomy tube placement. This adds weight to the need, from a thyroid surgical perspective, to undertake universal post-thyroidectomy laryngeal surveillance with a focus on postoperative dysphagia and aspiration, and from a medical/respiratory perspective, to initiate investigations to identify occult vocal palsy in patients who present with pneumonia, who have a history of thyroid surgery.

This article is protected by copyright. All rights reserved.

http://ift.tt/2rtma4g

Patterns of multimorbidity in people with severe or profound intellectual and motor disabilities

Publication date: August 2017
Source:Research in Developmental Disabilities, Volume 67
Author(s): E.A. van Timmeren, A. Waninge, H.M.J. van Schrojenstein Lantman-de, A.A.J. van der Putten, C.P. van der Schans
BackgroundPeople with severe or profound intellectual and motor disabilities (SPIMD) experience multimorbidity and have complex health needs. Multimorbidity increases mortality, decreases functioning, and negatively influences quality of life. Information regarding patterns of multimorbidity in people with SPIMD may lead to proactive prevention, specifically detection and treatment of physical health problems at an early stage and prevention of secondary complications.AimThe aim of this study was to explore patterns of multimorbidity in individuals with SPIMD.Methods and proceduresData from medical records and care plans on reported physical health problems of 99 adults with SPIMD were analysed. To explore the co-occurrence of physical health problems, cross tabulations and a 5-set Venn Diagram were used.Outcomes and resultsThe most common combination of two physical health problems comprise the most prevalent physical health problems, which included visual impairment, constipation, epilepsy, spasticity, and scoliosis. These five issues occurred as a multimorbidity combination in 37% of the participants. In 56% of the participants a multimorbidity combination of four health problems emerged, namely constipation, visual impairment, epilepsy, and spasticity.Conclusions and implicationsPeople experiencing SPIMD have interrelated health problems. As a consequence, a broad variety of potential interactions between physical health problems and their treatments may occur. Identifying multimorbidity patterns can provide guidance for accurate monitoring of persistent health problems and, early detection of secondary complications. However, the results require confirmation with larger samples in further studies.



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Exogenous deoxyribonuclease has a protective effect in a mouse model of sepsis

Publication date: September 2017
Source:Biomedicine & Pharmacotherapy, Volume 93
Author(s): Lucia Lauková, Barbora Konečná, Janka Bábíčková, Alexandra Wagnerová, Veronika Melišková, Barbora Vlková, Peter Celec
Sepsis is associated with the activation of white blood cells (WBCs) that leads to the production of extracellular traps. This process increases extracellular DNA (ecDNA) that can be recognized by the innate immune system and leads to inflammation. Previous studies have shown that by cleaving ecDNA deoxyribonuclease (DNase) prevents the antibacterial effects of extracellular traps, but also has beneficial effects in sepsis. The aim of our study was to analyze the effects of DNase on WBCs in vitro and on ecDNA in a mouse model of sepsis. Our results confirmed that DNase decreases ecDNA by 70% and prevents the antibacterial effects of WBCs in vitro. Sepsis was induced in mice by intraperitoneal injection of E. coli. DNase was subsequently administered intravenously. In comparison to untreated septic mice DNase treatment improved the survival of septic mice by 60%, reduced their weight loss as well as inflammatory markers. Increased plasma DNase activity led to ecDNA concentrations in plasma comparable with the control group. In conclusion, the study showed that intravenous DNase improves survival of septic mice by cleavage of ecDNA, especially of nuclear origin. Further mechanistic studies are needed to prove the potential of DNase in the treatment or prevention of septic complications.

Graphical abstract

http://ift.tt/2sCiM77

The role of apitoxin in alleviating propionic acid-induced neurobehavioral impairments in rat pups: The expression pattern of Reelin gene

Publication date: September 2017
Source:Biomedicine & Pharmacotherapy, Volume 93
Author(s): Maha H. Daghestani, Manar E. Selim, Yasmina M. Abd-Elhakim, Enas N. Said, Noura E. Abd El-Hameed, Samah R. Khalil, Osama S. El-Tawil
The efficacy of apitoxin (bee venom; BV) in ameliorating propionic acid (PPA) −induced neurobehavioral impacts was studied. Sixty rat pups were enrolled in a split litter design to six groups: a control group, a PPA-treated group, a BV-treated group, a BV/PPA protective group, a PPA/BV therapeutic group, and a BV/PPA/BV protective and therapeutic group. Exploratory, social, locomotor, and repetitive/stereotype-like activities were assessed and prosocial, empathy, and acquired behavior were evaluated. Levels of neurotransmitter including serotonin, dopamine, and gamma-aminobutyric acid (GABA) were determined and a quantitative analysis of Reelin gene expression was performed. PPA treatment induced several behavioral alterations, as reduced exploratory activity and social behaviors, increased repetitive/stereotypic behaviors, and hyperactivity. In addition, a marked decline of neurotransmitters and down-regulation of Reelin mRNA expression were observed. BV exhibited high efficiency in ameliorating the PPA-induced neurobehavioral alterations, particularly when applied both before and after PPA administration. Overall, the results implied that BV has merit as a candidate therapeutic treatment to alleviate PPA-induced neurobehavioral disorders.

Graphical abstract

http://ift.tt/2rjcnd9

Targeting proinflammatory cytokines, oxidative stress, TGF-β1 and STAT-3 by rosuvastatin and ubiquinone to ameliorate trastuzumab cardiotoxicity

Publication date: September 2017
Source:Biomedicine & Pharmacotherapy, Volume 93
Author(s): Ahmed M. Kabel, Abeer A. Elkhoely
The aim of this study was to assess the possible modulatory effects of rosuvastatin and/or ubiquinone on trastuzumab (TRZ)-induced cardiotoxicity in mice. One hundred and twenty mice were divided into six equal groups as follows: control group; TRZ group; TRZ+carboxymethyl cellulose group; TRZ+rosuvastatin group; TRZ+Ubiquinone group and TRZ+rosuvastatin+Ubiquinone group. Serum creatine kinase (CK-MB), lactate dehydrogenase (LDH), troponin I and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) were measured. Also, tissue malondialdehyde (MDA), catalase (CAT), glutathione peroxidase (GPx), interleukin 6 (IL-6), transforming growth factor beta 1 (TGF-β1) and signal transducers and activators of transcription-3 (STAT-3) were determined. Also, echocardiography was performed. Parts of the heart were subjected to histopathological, immunohistochemical and electron microscopic examination. Administration of rosuvastatin and/or ubiquinone to TRZ-treated mice induced significant increase in tissue GPx, CAT and STAT-3 with significant decrease in serum CK-MB, LDH, troponin I, NT-pro BNP, tissue MDA, TGF-β1 and IL-6 and improved the histopathological, immunohistochemical, echocardiographic and electron microscopic changes compared to the group that received TRZ alone. These changes were significant in rosuvastatin/ubiquinone combination group compared to the use of each of these drugs alone. In conclusion, rosuvastatin/ubiquinone combination may represent a new therapeutic modality to ameliorate TRZ-induced cardiotoxicity.

Graphical abstract

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Second generation H1 - antihistamines interaction with food and alcohol—A systematic review

Publication date: September 2017
Source:Biomedicine & Pharmacotherapy, Volume 93
Author(s): Paweł Paśko, Tomasz Rodacki, Renata Domagała-Rodacka, Krzysztof Palimonka, Monika Marcinkowska, Danuta Owczarek
Histamine is a mediator of many physiological processes. It plays an important role in modulating allergy reactions and immune system responses. H1 receptor is a therapeutic target for drugs applied in allergic diseases such as allergic rhinoconjunctivitis, urticarial, or atopic dermatitis. H1‐antihistamines display different chemical structures, pharmacokinetics and a potential for drug–drug and drug-food interactions. Drug-food interactions are known to reduce therapeutic effects of the medicine, as well as to induce a potent adverse drug reactions. Considering it all, a systematic review was conducted to investigate the importance of drug-food interaction for H1-antihistamine drugs. As non-sedating second generation H1-antihistamines remain to be drugs of choice in treating allergic conditions, the review has been focused on this particular class of medicines.The aim of this paper is to examine the evidence of food-drug and food-alcohol interactions for second generation H1-antihistamine drugs.A systematic literature queries were performed in the following databases: Medline (via PubMed), Cochrane Library, Embase and Web of Science (all from their inception date till October 2016). The queries covered nine specific names of second generation anthistamine drugs, namely bilastine, cetirizine, desloratadine, ebastine, fexofenadine, levocetirizine, loratadine, mizolastine, and rupatadine, in combinations with such terms as "food", "juice", "grapefruit", "fruits", "alcohol", "pharmacokinetics", and "meal". Additional publications were found by checking all the reference lists. Where none data on drug-food interaction could be found within the investigated databases, a specific drug prescribing information was used. 2326 publications were identified with the database queries. Articles were subjected to analysis by reviewing their title, abstract and full text; duplicated papers were removed. Having collected a complete set of data, a critical review was undertaken.For selected H1-antihistamines food, fruit juices or alcohol consumption may significantly impact the efficacy and safety of the therapy. This issue shall be well understood to educate patients properly, as it provides the major therapeutic element in allergic diseases.

Graphical abstract

http://ift.tt/2sBU1rq

Long noncoding RNA linc00462 promotes hepatocellular carcinoma progression

Publication date: September 2017
Source:Biomedicine & Pharmacotherapy, Volume 93
Author(s): JianDe Gong, XuFei Qi, Yi Zhang, YingCong Yu, XiZhou Lin, HongLiang Li, YiRen Hu
BackgroundHepatocellular carcinoma (HCC) represents one of the most common malignancies worldwide. In two pubic long noncoding RNA (lncRNA) profiling studies of HCC, linc00462 was consistently upregulated. We analyzed the clinical significance and biological role of linc00462 in HCC.MethodsWe performed quantitative real-time PCR analysis to determine the levels of linc00462 in HCC tissues from 49 patients. Functional analysis was performed in cell lines and in an animal model to support clinical findings.ResultsOur data showed that linc00462 was significantly upregulated in HCC tissues compared with matched normal tissues. The knockdown of linc00462 in HCC cells resulted in a much less aggressive oncogenic phenotype, and linc00462 downregulation contribute to the inactivation of the PI3K/AKT signaling pathway.Conclusionslinc00462 may be a potential therapeutic target in HCC.



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