An Evaluation of Different Bridging Techniques for Short Nerve Gaps

Background: In this study, we investigated sensory and motor outcomes for different bridging techniques for short nerve gaps. Material and Methods: This study was conducted in the Postdoctoral Department of Burns, Plastic, and Reconstructive Surgery of our institution from August 2014 to May 2017. All patients with posttraumatic short nerve gaps of 3 cm or less of median, ulnar, and/or both in forearm and wrists were included in the study. Patients with known causes of neuropathies were excluded. Groups 1, 2, 3, and 4 included 9 patients each, and the nerve gap was managed with reverse sural nerve autograft, inside-out vein conduit autograft, reverse sural nerve with covering inside-out vein autograft, and inside-out great saphenous vein autograft filled with denervated gastrocnemius skeletal muscle autograft, respectively. All the patients were followed-up and examined for sensory and motor recovery with a 2-point discrimination test (2PD) at finger tips in the distribution of reconstructed nerves and medical research council scale (MRCS) for muscle power innervated by the reconstructed nerves. The 2PD and MRCS muscles were compared between the groups using SPSS version 23 through 1-way analysis of variance. Results: All the patients in each group recovered either completely or partially. The 2PD and MRCS muscle power means were compared between the groups. On comparing the mean 2PD and mean MRCS muscle power were compared between the groups using 1-way analysis of variance test. All the groups have been found statistically comparable in spite of the apparent clinical difference. Conclusions: Although the nerve autograft is the criterion standard for managing the nerve gaps, the vein conduit is a viable alternative to nerve autograft for bridging the nerve gaps 3 cm or less, whereas filled conduit needs more study. However, more patients need to be studied to complete a relevant statistical study.

http://ift.tt/2id60Ve

Use of Fat Grafts in Facial Reconstruction on the Wounded Soldiers From the First World War (WWI) by Hippolyte Morestin (1869–1919)

Introduction: During the Great War of 1914 to 1918, spectacular progress was made in the field of facial reconstruction. The sheer number and severity of facial lesions inflicted during the fighting obliged French and German surgeons to take a close interest in the treatment of patients wounded in such a manner. As head surgeon of the fifth division "blessés de la face" at the hospital of Val-de-Grace, Hippolyte Morestin was responsible for one of the largest surgical departments specializing in facial surgery and reconstruction during the war. During his time of service, he developed various surgical techniques such as autoplasties using cartilaginous and adipose grafts to reconstruct tissue defects. This study focuses primarily on the adipose graft techniques and their aesthetic outcome used by Morestin during and in the aftermath of World War I. Methods: This is a historical descriptive study. Our research is based on documents available at the museum and archives of the Val-de-Grace Army Health Service (hospital activity reports, pre- and postoperative patient photographs, newspaper clippings, documented accounts of ward nurses, wax anatomy models). Thirty-four clinical cases published by Hippolyte Morestin dealing with facial reconstruction during the World War I were studied. Results: Fat was mainly used to fill craniofacial substance losses after carrying out often complex reconstructions. The surgical technique is well documented and subdivided into 3 succeeding procedures. Most of the time, the grafts were of autologous origin but sometimes heterologous samples were used. Although the primary objective was to increase volume, an improved quality of skin healing and better skin flexibility were observed. The fat thus allowed the filling of substance losses, and its positive effects on scarring were noticed even before the regenerative properties of the stem cells present in body fat were discovered. Conclusions: Hippolyte Morestin can be named one of the pioneers of facial reconstruction. A retroperspective analysis of his work with adipose grafts proves interesting because even though not being the first to apply this technique, he contributed, by means of experimentation and reproduction to proving it an innovative and useful method in facial reconstruction. It was not until the 1990s that adipose grafts were again applied under the name of lipostructure. Nowadays, they are commonly used in cosmetic and restorative surgery.

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Response to the letter to the editor: “Understanding the impact of preservation methods on the integrity and functionality of placental allografts”

No abstract available

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Microsurgery Fellowship at St Vincent's Hospital, Sydney, Australia: The Ultimate Hidden Gem

No abstract available

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Significance of the Lateral Thoracic Artery in Pectoralis Major Musculocutaneous Flap Reconstruction: Quantitative Assessment of Blood Circulation Using Indocyanine Green Angiography

Abstract: Free tissue transfer is the preferred reconstruction option in most major head and neck reconstructions. The pectoralis major muscle musculocutaneous (PMMC) flap is commonly used in salvage of necrotic free flaps and is the first choice for patients who are not candidates for free flaps. The lateral thoracic artery (LTA), which is thought to contribute to blood perfusion of the inferior and lateral mammary area, is not preserved in a conventionally harvested PMMC flap. With regard to blood supply, it has been suggested that the LTA should be preserved, in addition to the pectoral branch of the thoracoacromial artery, when a skin island is designed in the lower chest to attain a pedicle length sufficient for head and neck reconstruction. However, an effect on hemodynamic improvement using the LTA has not been shown quantitatively. In this study, we examined 8 patients with oral cancer who underwent reconstruction procedures with a bipedicle PMMC flap that included the LTA, in addition to the thoracoacromial artery. Intraoperative indocyanine green angiography was performed to examine circulation to the PMMC flap with or without LTA clamping after harvesting. After image processing, data were analyzed using a new quantitative perfusion assessment system with parameters that we recently established for assessment of peripheral arterial disease of the lower limbs. All patients had good clinical courses with whole-flap survival, no vascular insufficiency of the skin island, and no fistula formation. Intraoperative indocyanine green angiography showed an increased inflow rate into the skin island in an LTA-declamped condition in all cases, implying that the preserved LTA increased the blood supply to skin islands in the pectoralis major muscle. We conclude that preserving the LTA in a PMMC flap can increase blood perfusion and stabilize the vascularity of the flap, making the reconstruction more effective and reliable than with use of a conventionally harvested flap. Therefore, it is worthwhile to preserve the LTA as a major contributor to a lateral and distal PMMC flap.

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Gluteal Augmentation With Intramuscular Implants in Patients With Human Immunodeficiency Virus With Lipoatrophy Related to the Use of Antiretroviral Therapy

Introduction: Lipodystrophy syndrome associated with highly active antiretroviral therapy (HAART) may lead to low self-esteem and poor compliance with the drug treatment on patients infected with human immunodeficiency virus (HIV), which is a matter of concern for the health system. The aim of this study was to evaluate patients with HIV submitted to gluteal augmentation with intramuscular silicone implants to correct gluteal lipoatrophy related to the use of HAART. Methods: This is a retrospective evaluation of 10 patients submitted to gluteal augmentation with intramuscular silicone implant for correction of gluteal lipoatrophy related to the use of HAART, operated between 2012 and 2015. Postoperative complications and the degree of patient's satisfaction were analyzed. Results: There were 3 postoperative complications including 1 case of surgical wound dehiscence and 2 cases of seroma. Six months after surgery, 8 patients had an excellent degree of satisfaction, and 2 patients had a good degree of satisfaction related to the procedure. Although this intervention does not offer functional advantages, it improves the body contour, increases patients' self-esteem, and helps them to accept their body image. These advantages can lead to higher compliance with prolonged HAART. Conclusions: Gluteal augmentation with intramuscular silicone implant can be a viable option to treat patients with HIV with gluteal lipoatrophy related to the use of HAART. The patients were satisfied with the outcomes of the procedure, and there were only minor self-limited postoperative complications.

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Reverse Distal Transverse Palmar Arch in Distal Digital Replantation

Background: Refinements in microsurgery have made distal finger replantation an established technique with high success rates and good functional and aesthetic outcomes. However, it still represents a technically demanding procedure due to the small vessel caliber and frequent lack of vessel length, requiring the use of interpositional venous grafts in some instances. We describe a new technique for anastomosis in fingertip replantation, whereby the need for venous grafts is eliminated. Methods: Applying the reverse distal transverse palmar arch technique, 11 cases of distal digital replantation were performed between January 2011 and July 2016. The described procedure was used for arterial anastomosis in 10 cases and arteriovenous shunting for venous drainage in 1 case. A retrospective case review was conducted. The technical description and clinical outcome evaluations are presented. Results: Ten of the 11 replanted digits survived, corresponding to an overall success rate of 91%. One replant failed due to venous insufficiency. Blood transfusions were not required for any of the patients. Follow-up (range, 1.5–5 months) revealed near-normal range of motion and good aesthetic results. All of the replanted digits developed protective sensation. The average length of hospital admission was 5 days. All patients were satisfied with the results and were able to return to their previous work. Conclusions: The use of the reverse distal transverse palmar arch is a novel and reliable technique in distal digital replantation when an increase in vessel length is required, allowing for a tension-free arterial repair without the need for vein grafts.

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Does the Sequence of Tattooing and Nipple Reconstruction Affect Nipple Projection?

Background: In nipple reconstruction, the maintenance of adequate projection is one of the most important and challenging aspects. However, no reports have evaluated whether tattooing after nipple reconstruction affects nipple projection. This study aimed to test our hypothesis that tattooing after reconstruction adversely affects nipple projection. Method: Between September 2001 and July 2009, 384 nipples were reconstructed using the modified top hat technique after breast reconstruction with a transverse rectus abdominis musculocutaneous flap. Of these, 320 were reconstructed before tattooing, and 64 were reconstructed after tattooing. Projection at 6 months and 1 year was compared with that measured immediately after the operation, and projection was compared between the nipples reconstructed after tattooing and those reconstructed before tattooing. Results: After 6 months, the mean loss of projection was 52.5% in the tattoo-after group and 55.1% in the tattoo-before group. After 1 year, it was 59.2% in the tattoo-after group and 58.6% in the tattoo-before group. There were no significant differences between the groups regarding the sequence of the procedures. The additional tattoo and retattoo rate was 20% in the tattoo-before group and 1% in the tattoo-after group. Conclusions: These findings showed that the sequence of nipple reconstruction and tattooing had no significant effect on the projection of the reconstructed nipple. It is easier to tattoo homogeneously before nipple reconstruction because of the flat surface but more difficult to make a smooth areolar peripheral margin and circular areolar shape when reconstructing the nipple. The sequence of tattooing and nipple reconstruction can be determined according to esthetic and clinical considerations.

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Pediatric Lower Extremity Lawn Mower Injuries and Reconstruction: Retrospective 10-Year Review at a Level 1 Trauma Center

Introduction: From 2004 to 2013, there were 9341 lawn mower injuries in children under 20 years old. The incidence of lawn mower injuries in children has not decreased since 1990 despite implementation of various different prevention strategies. In this report, the authors review the results of pediatric lawn mower–related lower-extremity injuries treated at a tertiary care referral center as well as review the overall literature. Methods: A retrospective review was performed at a level 1 trauma center over a 10-year period (2005–2015). Patients younger than 18 years who presented to the emergency room with lower extremity lawn mower injuries were included. Results: Of the 27 patients with lower-extremity lawn mower injuries during this period, the mean age at injury was 5.5 years and Injury Severity Score was 7.2. Most (85%) patients were boys and the predominant type of mower causing injury was a riding lawn mower (96%). Injury occurred in patients who were bystanders in 78%, passengers in 11%, and operators in 11%. Mean length of stay was 12.2 days, and mean time to reconstruction was 7.9 days. Mean number of surgical procedures per patient was 4.1. Amputations occurred in 15 (56%) cases with the most common level of amputation being distal to the metatarsophalangeal joint (67%). Reconstructive procedures ranged from direct closure (41%) to free tissue transfer (7%). Major complications included infection (7%), wound dehiscence (11%), and delayed wound healing (15%). Mean follow up was 23.6 months and 100% of the patients were ambulatory after injury. The subgroup of patients with the most severe injuries, highest number of amputations, and need for overall surgical procedures were patients aged 2 to 5 years. A review of the literature also showed consistent findings. Conclusions: This study demonstrates the danger and morbidity that lawn mowers present to the pediatric population, particularly children aged 2 to 5 years. Every rung of the so-called reconstructive ladder is used in caring for these children. Increased public awareness is insufficient to decrease the incidence of these injuries. These products should have additional warning labels and meet updated changes to the design of lawn mowers to prevent these mutilating injuries successfully.

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The Classic Pitanguy Technique and Its Modifications in Mammaplasty: Ten Years of Experiences

Background: Mammaplasty surgery has been modified in the past few years, as plastic surgeons worked to improve and maintain the breast shape and especially the "bottoming out" of the gland. The classic Pitanguy's technique has been shown to be an anatomically safe technique in the management of the breast. However, as first described, cannot be applied in gigantomastia or in severe breast ptosis cases or in cases of dense breast parenchyma or for a long-lasting breast lift result. Using 2 different modifications, the Pitanguy technique can be applied for breasts of all sizes and for all cases of breast ptosis. Methods: A retrospective study of 140 patients who underwent the Pitanguy method and its 2 modifications was performed. The first modification consists of dissecting the upper pole of the breast vertically to the fascia of the pectoralis major muscle and laterally to the nac. The medial flap is then advanced superiorly, rotated 90 degrees, and sutured to point A, whereas the lateral flap is placed below the medial one. The second modification describes an inferior chest wall-based flap for achieving a desirable shape that can be maintained over a long period. The inferior flap is based only in the thoracic wall vasculature, completely detached from surrounding structures, maintaining a good volume. The upper flap of the breast covers the inferior flap. Results: The follow-up included 140 patients and the follow-up period ranged from 1 to 10 years. Five patients were operated on less than 4 months ago and were not involved in this study. All patients gained natural-shaped breasts, and they were pleased with the results. Serious complications, including flap necrosis, were avoided because caution was used to preserve the internal mammary perforators while performing the Pitanguy's technique and its 2 modifications. Conclusions: The classic Pitanguy technique and its 2 modifications provide a versatile, well-vascularized pedicle that allows elevation of the nipple areola complex at the desired height. Using these 2 modifications, the Pitanguy's technique can be applied for breasts of all sizes and for all cases of breast ptosis.

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Identification of Risk Factors in Lymphatic Surgeries for Melanoma: A National Surgical Quality Improvement Program Review

Introduction: Sentinel lymph node biopsy (SLNB) and lymphadenectomy (LAD) are commonly performed in the staging and care of patients with malignant melanoma. These procedures are accompanied by complications that may result in hospital readmission, negatively affecting patient outcomes and potentially affecting surgical procedure reimbursement. The National Surgical Quality Improvement Program (NSQIP) database offers a large data set allowing physicians to evaluate 30-day readmission for surgical complications. We used this database to explore predictors of 30-day hospital readmission for SLNB and LAD in the axillary, cervical, and inguinal regions. Methods: Data from the years 2005 to 2014 of the American College of Surgeons NSQIP database were used. Cohorts were constructed according to International Classification of Diseases, Ninth Revision, classification and current procedural terminology codes. The outcome of 30-day return to hospital was defined as patients who were readmitted to the hospital or the operating room within 30 days. Multiple logistic regression results are presented for a prespecified set of predictors and predictors that were significant on univariate logistic regression analysis. Odds ratios and confidence intervals were calculated using maximum likelihood estimates, along with Wald test P values. Results: A total of 3006 patients were included. Of those, 151 (5.0%) returned to the hospital. Among 1235 LAD patients, 65 (5.3%) returned; among 1771 SLNB patients, 86 (4.9%) returned. Smoking was a predictor of hospital readmission for overall SLNB and for cervical SLNB on multivariate analysis. Age was a significant predictor for cervical and inguinal LAD. Hypertension was significant for cervical LAD. Diabetes, preoperative hematocrit, and male sex were predictors for inguinal SLNB. There were no significant predictors for axillary SLNB and axillary LAD, as well as overall LAD procedures. Conclusions: This is the first and largest study using American College of Surgeons NSQIP to examine 30-day readmission after SLNB and LAD for melanoma in 3 commonly operated anatomical regions. We have found several significant risk factors associated with hospital readmission, which are now being used as a quality measure for hospital performance and reimbursement, that may help surgeons optimize patient selection for SLNB and LAD.

http://ift.tt/2gMoxrl

Sweet Syndrome After Bilateral Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Case Report

Abstract: We describe a case of Sweet's Syndrome after bilateral deep inferior epigastric perforator flap breast reconstruction in a patient with ductal carcinoma of the left breast.

http://ift.tt/2gKL4og

The Boreds

No abstract available

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Analysis of Mechanical Behavior of Dermal Fibroblasts Obtained From Various Anatomical Sites in Humans

Purpose: Facial skin fibroblasts imposed with cyclic stretch at 10% magnitude display considerable mechanotransduction properties and biochemical reactions in our previous study. However, it is poorly understood how these shared traits are fully parallel to the common features across all fibroblasts derived from different skin-based anatomical regions in response to cyclic stretch stimulation. Thus, the purpose of this study was to evaluate the effects of various cyclic stretches on fibroblasts derived from multiple anatomical skin sites of human bodies, and the optimal stretch magnitude was defined based on the changes to cell mechanical behavior. Methods: Fibroblasts from skin areas of the scalp, anterior chest, suprapubic, axilla, and planta were cultured and characterized in vitro. Cyclic stretch at 0%, 5%, 10%, 15%, and 20% magnitudes was imposed at a loading frequency of 0.1 Hz for 48 hours, and thereafter, the mechanical behavior and biochemical reaction of the dermal fibroblasts were analyzed. Results: Dermal fibroblasts from various anatomical sites preconditioned with varying cyclic stretch led to an evident increase in the cell proliferation ability, the expression of integrin β1 and p130 Crk-associated substrate messenger RNA and protein, and the productions of type I collagen and transforming growth factor β1, most importantly in a strain magnitude-dependent manner with the peak appearing in the range of 10% to 15% magnitude cyclic stretch. Conclusions: These findings may facilitate the subsequent studies on the conversion of normal skin fibroblasts into hypertrophic scar cells, which should be considered in an interpretation of the mechanisms of hypertrophic scarring and skin mechanics.

http://ift.tt/2id5LJO

Free Lateral Digital Flap for Reconstruction of the Fingers

Background: The region between the proximal interphalangeal (PIP) and the metacarpophalangeal (MP) creases has greater laxity than other regions in the fingers, allowing for primary closure of the donor site. We postulated if we could consistently locate perforators from the region between the PIP and the MP crease on the radial side of the middle and ring fingers, on which a scar would be less conspicuous than one on the radial side of the index finger, these regions would be ideal donor sites for digital reconstruction using very small flaps. Methods: In 20 fingers (10 middle fingers and 10 ring fingers) from 5 volunteers, perforators from the radial proper digital artery were visualized between the PIP and the MP creases using ultrasonography. Based on this information, and to evaluate its feasibility, a free lateral digital flap was used for reconstruction of small digital defects in 3 cases. Results: Of the 20 fingers, 19 had at least 1 digital artery perforator (DAP) arising from the radial proper digital artery between the PIP and MP creases. The average distance from the PIP crease to the DAP was 9.0 mm. The average diameter of the DAP was 0.37 mm. In all clinical cases, flaps survived completely with pleasing cosmesis. There were no donor site complications. Conclusions: With their consistent anatomy and relatively low donor site morbidity, free lateral digital flaps from the radial side of the middle or ring fingers may be a reliable option for reconstruction of the volar surface of the digits.

http://ift.tt/2idNDjd

Acute-Onset Quadriplegia With Recovery After High-Voltage Electrical Injury

Abstract: Although uncommon, electrical injuries are associated with significant morbidity and mortality. There have been several reports of neurological sequelae secondary to electrical injury; however, the neurophysiology is still not completely understood. These neurological complications pose the greatest risk for permanent disability. We present a case of acute-onset quadriplegia after high-voltage electrical injury without radiographic evidence. Two months after the injury, the patient went on to regain partial sensorimotor function. Only a few case reports in the literature exist describing neurological recovery after electrical burn-induced quadriplegia. These cases are reviewed.

http://ift.tt/2icy3nY

The Use of Bilayered Fascia Lata With an Interpositional Omental Flap for Autologous Repair of Contaminated Abdominal Fascial Defects

Introduction: Contaminated abdominal fascial defects, such as those seen in enterocutaneous fistula, or wound dehiscence with mesh exposure, are a significant source of morbidity and present unique reconstructive challenges. We present our technique of using the fascia lata, augmented with an interpositional omental flap, for complete autologous reconstruction of contaminated fascial defects, and the postoperative results of 3 cases. Methods: Three patients with contaminated abdominal defects underwent wound debridement/fistula resection and immediate reconstruction with fascia lata and omentum flap. Defect size ranged from 15 × 8 cm (120 cm2) to 25 × 12 cm (300 cm2). The fascia lata graft was inset using an underlay technique, and the omentum was tunneled through a subcostal slit in the semilunar line to augment the vascularity of the subcutaneous plane and protect the graft. Skin coverage was achieved by undermining and direct closure or local myocutaneous flaps. Results: Three patients underwent abdominal wall reconstruction with our technique. The median follow-up was 12 months. There were no recurrent infections, fistulae, or herniae. All patients experienced full functional recovery with return to independent activities of daily living by 6 months postoperatively. Conclusions: Since the use of synthetic material is contraindicated in contaminated abdominal fascial defects. We propose that our combination of fascia lata and an interpositional omental flap is a useful technique for the reconstruction of these challenging defects.

http://ift.tt/2id5FSs

Lesions Associated With Calcium Gluconate Extravasation: Presentation of 5 Clinical Cases and Analysis of Cases Published

Introduction: Calcium gluconate extravasation is a process, which, while not common, occurs more frequently in neonatal intensive care units. The aim of this study is to present a number of cases of calcium gluconate extravasation, which have occurred in our hospital, and to carry out a review of those clinical cases published in the literature to obtain relevant epidemiological data. Methods: Data were gathered on the medical histories of 5 patients who presented lesions secondary to calcium gluconate extravasation in our center. A review of the literature was also performed to include clinical cases of calcium gluconate extravasation already published. Results: Data were collected on 60 cases published in 37 articles. Most patients (55%) were neonates. The average age of these neonates was 8 days. The commonest location of injuries was the back of the hand and wrist (42%). The 2 most frequent symptoms were the appearance of erythema (65%) and swelling/edema (48%) followed by the appearance of skin necrosis (47%), indurated skin (33%), and yellow-white plaques or papules (33%). Most cases are cured within a period of 3 to 6 months. Fifty percent of patients required surgery, and in 13% of cases, skin grafts were performed. The most frequent histological finding was the presence of calcium deposits. Other histological findings described were the presence of necrosis, lymphohistiocytic infíltrate, and granulomas. Most histological findings were located in the dermis. Most x-rays showing calcium deposits had been performed at 3 to 4 weeks. Conclusions: Calcium gluconate extravasation is a process, which, although infrequent, is associated with serious skin and soft-tissue lesions, mainly affecting infants. Further studies are needed to determine possible specific procedures to be carried out in these cases.

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Impact of Abdominal Lipectomy on Post-Sleeve Gastrectomy Surgery Weight Loss

Background: Abdominal lipectomy after bariatric surgery is recommended because of residual excess skin resulting in difficulty with maintaining hygiene, recurrent infections, and functional impairment, interfering with daily activities. There is a dearth of literature examining weight loss outcomes in patients undergoing abdominal lipectomy post sleeve gastrectomy (SG). The purpose of this study was to examine whether post-SG patients who received abdominal lipectomy achieved greater percent excess weight loss (%EWL) than post-SG patients who did not receive abdominal lipectomy. Methods: Retrospective study of patients who underwent minimally invasive SG at the University of Illinois Hospital and Health Sciences System from March 2008 to June 2015 was conducted. The cohort was divided into 2 groups: patients who underwent abdominal lipectomy after SG (PS-SG) and patients who underwent SG alone (SG). Demographics, comorbidities, and %EWL were examined. Results: Twenty-nine patients were included in the PS-SG group versus 287 patients in the SG group. Significant differences were found in %EWL at 24 (P

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Chemotherapy Extravasation Management: 21-Year Experience

Abstract: Chemotherapy extravasation may result in serious damage to patients, with irreversible local injures and disability. Evidence-based standardization on extravasation management is lacking and many institutions do not practice adequate procedures to prevent the severer damages. Our aim was to explore the prevention and treatment of extravasation injuries, proposing a standard therapeutic protocol together with a review of the literature. From January 1994 to December 2015, 545 cases were reviewed (age range, 5–87 years; 282 men and 263 women). Our therapeutic protocol consisted of local infiltration of saline solution and topical occlusive applications of corticosteroids. The infiltrations were administrated 3 to 6 times a week depending on damage severity. Our protocol allowed us to prevent ulceration in 373 cases. Only 27 patients required surgery (escarectomy, skin graft, regional, and free flap). Numerous treatments have been proposed in literature. The antidotes have been discussed controversially and are not considered standard methods for treatment, especially when polychemotherapy is administrated and the identification of the responsible drug is not possible. We proposed the use of saline solution injection to dilute rapidly the drug, thus reducing its local toxic effects. This method is easy to use and always reproducible even when the drug is not known or when it is administrated in combination with other drugs. It is possible to perform it in ambulatory regimen, and, overall, it represents a standard method.

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Should you wash your hair everyday?

For some people, frequent washing can damage hair and cause a dry, itchy scalp. How often should you wash your hair with shampoo?

http://ift.tt/2gS26oh

Should you wash your hair everyday?

For some people, frequent washing can damage hair and cause a dry, itchy scalp. How often should you wash your hair with shampoo?

http://ift.tt/2gS26oh

Editorial Board/Reviewing Committee

http://ift.tt/2gKeFhv

Identification and management of inverted or everted edges of traumatic tympanic membrane perforations

Publication date: Available online 28 October 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Zhengcai Lou, Zi-Han Lou
IntroductionMost of traumatic tympanic membrane perforations have inverted or everted edges, however, the effects of inverted and everted edges on the spontaneous healing of the eardrum remain controversial.ObjectiveWe investigated the influence of inverted or everted edges on the spontaneous healing of traumatic tympanic membrane perforations.MethodsThe clinical records of patients with a traumatic tympanic membrane perforations who met the study criteria were retrieved and categorized into two groups, based on whether the eardrum was inverted or everted. The features along the edge of each inverted or everted eardrum were described using 30° and 70° endoscopes.ResultsIn total, 196 patients (196 ears) met the inclusion criteria; of these, 148 had inverted or everted eardrums while 48 did not. Of the 148 patients with inverted or everted eardrums, the perforation edges were everted in 77 patients, inverted in 44 patients, drooping in 17 patients, and both inverted and everted in 10 patients. The perforation shape was triangular in 18.9% of patients, sector-shaped in 11.5%, kidney-shaped in 14.2%, ovoid in 20.3%, and irregularly shaped in 35.1% of patients. The difference was not significant between the with and without inverted/everted eardrum edges groups in terms of the closure rate or closure time. Similarly, the difference was not significant between the with and without edge approximation groups in terms of the closure rate or closure time at the end of the 12-month follow-up period.ConclusionThis study suggests that endoscopic inspection can clearly identify inverted/everted eardrum edges using 30° and 70° endoscopes. The edge is glossy in inverted/everted eardrums, whereas the edge is rough and irregular in non-inverted/everted cases. The inverted/everted eardrums gradually became necrotic, but this did not affect the healing process. Additionally, edge approximation did not improve the healing outcome of traumatic tympanic membrane perforations.



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Comparison between chloral hydrate and propofol-ketamine as sedation regimens for pediatric auditory brainstem response testing

Publication date: Available online 28 October 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Kamal Abulebda, Vinit J. Patel, Sheikh S. Ahmed, Alvaro J. Tori, Riad Lutfi, Samer Abu-Sultaneh
IntroductionThe use of diagnostic auditory brainstem response testing under sedation is currently the "gold standard" in infants and young children who are not developmentally capable of completing the test.ObjectiveThe aim of the study is to compare a propofol-ketamine regimen to an oral chloral hydrate regimen for sedating children undergoing auditory brainstem response testing.MethodsPatients between 4 months and 6 years who required sedation for auditory brainstem response testing were included in this retrospective study. Drugs doses, adverse effects, sedation times, and the effectiveness of the sedative regimens were reviewed.Results73 patients underwent oral chloral hydrate sedation, while 117 received propofol-ketamine sedation. 12% of the patients in the chloral hydrate group failed to achieve desired sedation level. The average procedure, recovery and total nursing times were significantly lower in the propofol-ketamine group. Propofol-ketamine group experienced higher incidence of transient hypoxemia.ConclusionBoth sedation regimens can be successfully used for sedating children undergoing auditory brainstem response testing. While deep sedation using propofol-ketamine regimen offers more efficiency than moderate sedation using chloral hydrate, it does carry a higher incidence of transient hypoxemia, which warrants the use of a highly skilled team trained in pediatric cardio-respiratory monitoring and airway management.



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Carbon nanotubes physicochemical properties influence the overall cellular behavior and fate

Publication date: Available online 28 October 2017
Source:NanoImpact
Author(s): Reem Eldawud, Alixandra Wagner, Chenbo Dong, Todd Stueckle, Yon Rojanasakul, Cerasela Zoica Dinu
The unique properties of single walled carbon nanotubes (SWCNTs) make them viable candidates for versatile implementation in the next generation of biomedical devices for targeted delivery of chemotherapeutic agents or cellular-sensing probes. Such implementation requires user-tailored changes in SWCNT's physicochemical characteristics to allow for efficient cellular integration while maintaining nanotubes' functionality. However, isolated reports showed that user-tailoring could induce deleterious effects in exposed cells, from decrease in cellular proliferation, to changes in cellular adhesion, generation of reactive oxygen species or phenotypical variations, just to name a few. Before full implementation of SWCNTs is achieved, their toxicological profiles need to be mechanistically correlated with their physicochemical properties to determine how the induced cellular fate is related to the exposure conditions or samples' characteristics. Our study provides a comprehensive analysis of the synergistic cyto- and genotoxic effects resulted from short-term exposure of human lung epithelial cells to pristine (as manufactured) and user-tailored SWCNTs, as a function of their physicochemical properties. Specifically, through a systematic approach we are correlating the nanotube uptake and nanotube-induced cellular changes to the sample's physicochemical characteristics (e.g., metal impurities, length, agglomerate size, surface area, dispersion, and surface functionalization). By identifying changes in active hallmarks involved in cell-cell connections and maintaining epithelial layer integrity, we also determine the role that short-term exposure to SWCNTs plays in the overall cellular fate and cellular transformation. Lastly, we assess cellular structure-function relationships to identify non-apoptotic pathways induced by SWCNTs exposure that could however lead to changes in cellular behavior and cellular transformation. Our results show that the degree of cell transformation is a function of the physicochemical properties of the SWCNT, with the nanotube with higher length, higher metal content and larger agglomerate size reducing cell viability to a larger extent. Such changes in cell viability are also complemented by changes in cell structure, cycle and cell-cell interactions, all responsible for maintaining cell fate.

Graphical abstract

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Editorial Board/Title Page

Publication date: November 2017
Source:Cortex, Volume 96





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The blind mind: No sensory visual imagery in aphantasia

Publication date: Available online 28 October 2017
Source:Cortex
Author(s): Rebecca Keogh, Joel Pearson
For most people the use of visual imagery is pervasive in daily life, but for a small group of people the experience of visual imagery is entirely unknown. Research based on subjective phenomenology indicates that otherwise healthy people can completely lack the experience of visual imagery, a condition now referred to as aphantasia. As congenital aphantasia has thus far been based on subjective reports, it remains unclear whether participants are really unable to imagine visually, or if they have very poor metacognition - they have images in their mind, but are blind to them. Here we measured sensory imagery in subjectively self-diagnosed aphantasics, using the binocular rivalry paradigm, as well as measuring their self-rated object and spatial imagery with multiple questionnaires (VVIQ, SUIS and OSIQ). Unlike, the general population, experimentally naive aphantasics showed almost no imagery-based rivalry priming. Aphantasic participants' self-rated visual object imagery was significantly below average, however their spatial imagery scores were above average. These data suggest that aphantasia is a condition involving a lack of sensory and phenomenal imagery, and not a lack of metacognition. The possible underlying neurological cause of aphantasia are discussed as well as future research directions.



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Cover Figure

Publication date: November 2017
Source:Cortex, Volume 96





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Nonfatal air embolism complicating percutaneous CT-guided lung biopsy and VATS marking: Four cases from a single institution

Publication date: March–April 2018
Source:Clinical Imaging, Volume 48
Author(s): Rika Yoshida, Takeshi Yoshizako, Megumi Nakamura, Shinji Ando, Mitsunari Maruyama, Minako Maruyama, Yoshikazu Takinami, Yukihisa Tamaki, Tomonori Nakamura, Hajime Kitagaki
Systemic air emboli occur as a rare complication of percutaneous needle biopsy of the lung and video-assisted thoracoscopic surgery (VATS) marking.Here we present four cases of systemic air emboli from single institution and the imaging findings and embolism' kinetics using contrast-enhanced media during VATS color marking with indocyanine green. We suggest that early detection using routine whole-lung CT is required for asymptomatic patients with abnormal air. If abnormal air is found, we should keep the patient to the appropriate posture in order to prevent moving the air until it dissipates. Early detection of abnormal air can prevent severe complications.



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Mitochondrial specific photodynamic therapy by rare-earth nanoparticles mediated near-infrared graphene quantum dots

Publication date: January 2018
Source:Biomaterials, Volume 153
Author(s): Dandan Zhang, Liewei Wen, Ru Huang, Huanhuan Wang, Xianglong Hu, Da Xing
Photodynamic therapy (PDT) has been proposed in cancer treatment for decades, but its clinical translation is significantly impeded by the low yield of ROS, poor tissue penetration depth of most current photosensitizers, and short lifetime of ROS. These limitations directly affect the therapeutic effect of PDT in cancer therapy. Here we proposed a new strategy by collaboratively integrating rare-earth doped upconversion nanoparticles (UCNP) with graphene quantum dot (GQD) for highly efficacious PDT, based on the merits of UCNP, which can emit UV–vis light under near-infrared light (NIR) excitation, and GQD, which can produce ¹O2 efficiently. For GQD-decorated UCNP nanoparticles (UCNP-GQD), the emission light from UCNP can further excite GQD with prominent ¹O2 generation for NIR-triggered PDT. Furthermore, a hydrophilic rhodamine derivative, TRITC, is covalently tethered to afford the resultant UCNP-GQD/TRITC, possessing distinct mitochondrial targeting property. Thus mitochondrial specific PDT with in-situ¹O2 burst in mitochondria induces sharp decrease of mitochondrial membrane potential, which initiates the tumor cell apoptosis irreversibly. Importantly, in vivo experiments demonstrate the tumor inhibition of mitochondrial targeting UCNP-GQD/TRITC with improved therapeutic efficiency compared with non-targeting UCNP-GQD. The proposed strategy highlights the advantages of precision organelles-specific PDT in cancer therapy.



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Macrophages as a potential tumor-microenvironment target for noninvasive imaging of early response to anticancer therapy

Publication date: January 2018
Source:Biomaterials, Volume 152
Author(s): Qizhen Cao, Xinrui Yan, Kai Chen, Qian Huang, Marites P. Melancon, Gabriel Lopez, Zhen Cheng, Chun Li
As a result of therapy-induced apoptosis, peripheral blood monocytes are recruited to tumors, where they become tumor-associated macrophages (TAMs). To date, few studies have investigated noninvasive molecular imaging for assessment of macrophage infiltration in response to therapy-induced apoptosis. Here, noninvasive assessment of changes in tumor accumulation of TAMs was proposed as a new way to measure early tumor response to anticancer therapy. Three different nanoparticles, QD710-Dendron quantum dots (QD710-D), Ferumoxytol, and PG-Gd-NIR813, were used for near-infrared fluorescence imaging, T2-weighted magnetic resonance imaging, and dual optical/T1-weighted MR imaging, respectively, in the MDA-MB-435 tumor model. Treatment with Abraxane induced tumor apoptosis and infiltrating macrophages. In spite of markedly different physicochemical properties among the nanoparticles, in vivo imaging revealed increased uptake of all three nanoparticles in Abraxane-treated tumors compared with untreated tumors. Moreover, imaging visualized increased uptake of QD710-D in MDA-MB-435 tumors but not in drug-resistant MDA-MB-435R tumors grown in the mice treated with Abraxane. Our results suggest that infiltration of macrophages due to chemotherapy-induced apoptosis was partially responsible for increased nanoparticle uptake in treated tumors. Noninvasive imaging techniques in conjunction with systemic administration of imageable nanoparticles that are taken up by macrophages are a potentially useful tool for assessing early treatment response.



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Dual modal ultra-bright nanodots with aggregation-induced emission and gadolinium-chelation for vascular integrity and leakage detection

Publication date: January 2018
Source:Biomaterials, Volume 152
Author(s): Guangxue Feng, Jackson Liang Yao Li, Carla Claser, Akhila Balachander, Yingrou Tan, Chi Ching Goh, Immanuel Weng Han Kwok, Laurent Rénia, Ben Zhong Tang, Lai Guan Ng, Bin Liu
The study of blood brain barrier (BBB) functions is important for neurological disorder research. However, the lack of suitable tools and methods has hampered the progress of this field. Herein, we present a hybrid nanodot strategy, termed AIE-Gd dots, comprising of a fluorogen with aggregation-induced emission (AIE) characteristics as the core to provide bright and stable fluorescence for optical imaging, and gadolinium (Gd) for accurate quantification of vascular leakage via inductively-coupled plasma mass spectrometry (ICP-MS). In this report, we demonstrate that AIE-Gd dots enable direct visualization of brain vascular networks under resting condition, and that they form localized punctate aggregates and accumulate in the brain tissue during experimental cerebral malaria, indicative of hemorrhage and BBB malfunction. With its superior detection sensitivity and multimodality, we hereby propose that AIE-Gd dots can serve as a better alternative to Evans blue for visualization and quantification of changes in brain barrier functions.



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Porous composite scaffold incorporating osteogenic phytomolecule icariin for promoting skeletal regeneration in challenging osteonecrotic bone in rabbits

Publication date: January 2018
Source:Biomaterials, Volume 153
Author(s): Yuxiao Lai, Huijuan Cao, Xinluan Wang, Shukui Chen, Ming Zhang, Nan Wang, Zhihong Yao, Yi Dai, Xinhui Xie, Peng Zhang, Xinsheng Yao, Ling Qin
Steroid-associated osteonecrosis (SAON) often requires surgical core decompression (CD) in the early stage for removal of necrotic bone to facilitate repair where bone grafts are needed for filling bone defect and avoiding subsequent joint collapse. In this study, we developed a bioactive composite scaffold incorporated with icariin, a unique phytomolecule that can provide structural and mechanical support and facilitate bone regeneration to fill into bone defects after surgical CD in established SAON rabbit model. An innovative low-temperature 3D printing technology was used to fabricate the poly (lactic-co-glycolic acid)/β-calcium phosphate/icariin (PLGA/TCP/Icariin, PTI) scaffold. The cytocompatibility of the PTI scaffold was tested in vitro, and the osteogenesis properties of PTI scaffolds were assessed in vivo in the SAON rabbit models. Our results showed that the fabricated PTI scaffold had a well-designed biomimic structure that was precisely printed to provide increased mechanical support and stable icariin release from the scaffold for bone regeneration. Furthermore, our in vivo study indicated that the PTI scaffold could enhanced the mechanical properties of new bone tissues and improved angiogenesis within the implanted region in SAON rabbit model than those of PLGA/TCP (PT) scaffold. The underlying osteoblastic mechanism was investigated using MC3T3-E1 cells in vitro and revealed that icariin could facilitate MC3T3-E1 cells ingrowth into the PTI scaffold and regulate osteoblastic differentiation. The PTI scaffold exhibited superior biodegradability, biocompatibility, and osteogenic capability compared with those of PT scaffold. In summary, the PTI composite scaffold which incorporated bioactive phyto-compounds is a promising potential strategy for bone tissue engineering and regeneration in patients with challenging SAON.

Graphical abstract

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The treatment of a pregnant HIV positive patient with cryptococcal meningitis in Malawi. Case report and review of treatment options

Publication date: Available online 28 October 2017
Source:Medical Mycology Case Reports
Author(s): Philip D. Bright, Duncan Lupiya, Joep J. van Oosterhout, Amy Chen, Thomas S. Harrison, Adrienne K. Chan
This case reports cryptococcal meningitis in an HIV positive woman on antiretroviral therapy, presenting with left middle cerebral artery stroke at 30 weeks gestation. The patient had well-controlled HIV (CD4 count over 200 cells/mL). The immunosuppressive effects of the pregnancy likely contributed to the development of cryptococcal disease. The patient was successfully treated with two weeks of amphotericin B followed by fluconazole, delivered a healthy baby, but remained with a permanent severe neurological deficit.



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Sporotrichosis by Sporothrix schenckii senso stricto with itraconazole resistance and terbinafine sensitivity observed in vitro and in vivo: case report

Publication date: Available online 28 October 2017
Source:Medical Mycology Case Reports
Author(s): Rodrigo Vettorato, Daiane Heidrich, Fernanda Fraga, Amanda Carvalho Ribeiro, Danielle Machado Pagani, Carina Timotheo, Tais Guarienti Amaro, Gerson Vettorato, Maria Lúcia Scroferneker
We report a case of a patient with lymphocutaneous sporotrichosis in the right upper limb. The fungus was identified as Sporothrix schenckii senso stricto by calmodulin gene sequencing. The initial treatment was itraconazole (200mg/day), but in vitro antifungal susceptibility demonstrated high resistant to this and another six antifungals, with exception to terbinafine. The lesions did not regress with itraconazole treatment. Thus, 500mg/day of terbinafine was prescribed and clinical cure was obtained after four months



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Monogenic lupus: it's all new!

Patricia Costa-Reis | Kathleen E Sullivan

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Chemical affinity of 10-methacryloyloxydecyl dihydrogen phosphate to dental zirconia: Effects of molecular structure and solvents

Publication date: Available online 14 October 2017
Source:Dental Materials
Author(s): Ying Chen, Zhicen Lu, Mengke Qian, Huaiqin Zhang, Chen Chen, Haifeng Xie, Franklin R. Tay
ObjectivesTo examine whether solvents and changing the molecular structure of 10-Methacryloyloxydecyl dihydrogen phosphate (10-MDP) affect its chemical affinity to Yttria-stabilized tetragonal zirconia polycrystals (Y-TZP).MethodsThe present work investigated the chemical affinity between Y-TZP and 10-MDP dissolved in different solvents (acetone/ethanol/water or mixture) using X-ray photoelectron spectroscopy, Fourier-transform infrared spectroscopy, and thermodynamic calculations. Shear bond strength (SBS) tests were used to evaluate the influence of different solvents on 10-MDP bonding. In addition, several phosphate ester monomer variants were created by changing the 10-MDP molecular structure. Changes included extending/shortening the spacer chain-length, and installing hydroxyl or carboxyl groups as side chains at different positions along the spacer chain. The thermodynamic parameters of the complexes formed between the 10-MDP variants and tetragonal zirconia were evaluated.ResultsThe acquired data indicated that solvent is necessary for the formation of Zr–O–P bonds between 10-MDP and Y-TZP. Solvents affected the chemical affinity of 10-MDP to Y-TZP; acetone facilitated the best bonding, followed by ethanol. Changing the molecular structure of 10-MDP affected its chemical affinity to Y-TZP. The variants 15-MPDP, 12-MDDP, 6-hydroxyl-10-MDP and 6-carboxy-10-MDP all exhibited higher thermodynamic stability than 10-MDP when coordinated with tetragonal zirconia. In contrast, 2-MEP, 5-MPP, 10-hydroxyl-MDP, 10-carboxy-MDP, 5,6-dihydroxyl-10-MDP and 5,6-dicarboxy-10-MDP exhibited lower thermodynamic stability.Significance10-MDP coordinates with zirconia through dissociating in solvents. Changing the molecular structure of 10-MDP theoretically affects its chemical affinity to Y-TZP.

Graphical abstract

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Editorial Board

Publication date: November 2017
Source:Dental Materials, Volume 33, Issue 11





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Zirconia-incorporated zinc oxide eugenol has improved mechanical properties and cytocompatibility with human dental pulp stem cells

Publication date: Available online 14 October 2017
Source:Dental Materials
Author(s): Soo Kyung Jun, Hae-Won Kim, Hae-Hyoung Lee, Jung-Hwan Lee
ObjectiveZinc oxide eugenol (ZOE) is widely used as a therapeutic dental restorative material. However, ZOE has poor mechanical properties and high cytotoxicity toward human dental pulp stem cells (hDPSCs) due to the release of Zn ions. In this study, zirconia-incorporated ZOE (ZZrOE) was developed to reduce the cytotoxicity and improve the mechanical properties of ZOE with sustained therapeutic effects on inflamed hDPSCs in terms of inflammatory gene expression levels compared with those of the original material.MethodsAfter the setting time and mechanical properties of ZZrOE incorporating varying amounts of zirconia (0, 5, 10, and 20wt% in powder) were characterized, the surface morphology and composition of the resulting ZZrOE materials were investigated. The ions and chemicals released into the cell culture medium from ZOE and ZZrOE (3cm²/mL) were measured by inductively coupled plasma atomic emission spectroscopy and gas chromatography, respectively. After testing cytotoxicity against hDPSCs using the above extracts, the therapeutic effects on lipopolysaccharide-inflamed hDPSCs in terms of compromising the upregulation of inflammatory response-related mRNA expression were tested using real-time PCR.ResultsZZrOE 20% exhibited increased compressive strength (∼45%), 3-point flexural strength (∼150%) and hardness (∼75%), as well as a similar setting time (∼90%), compared with those of ZOE. After the rough surface of ZZrOE was observed, significantly fewer released Zn ions and eugenol (∼40% of that from ZOE) were detected in ZZrOE 20%. ZZrOE showed less cytotoxicity because of the lower amount of Zn ions released from ZOE while showing sustained inhibition of inflammatory marker (e.g., interleukin 1β, 6 and 8) mRNA levels.SignificanceThe improved mechanical properties and cytocompatibility, as well as the sustained therapeutic effects on inflamed hDPSCs, were investigated in ZZrOE compared with those of ZOE. Therefore, ZZrOE has the potential to be used as an alternative to ZOE as a dental restorative material.

Graphical abstract

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3D printed versus conventionally cured provisional crown and bridge dental materials

Publication date: Available online 27 October 2017
Source:Dental Materials
Author(s): Anthony Tahayeri, MaryCatherine Morgan, Ana P. Fugolin, Despoina Bompolaki, Avathamsa Athirasala, Carmem S. Pfeifer, Jack L. Ferracane, Luiz E. Bertassoni
ObjectivesTo optimize the 3D printing of a dental material for provisional crown and bridge restorations using a low-cost stereolithography 3D printer; and compare its mechanical properties against conventionally cured provisional dental materials.MethodsSamples were 3D printed (25×2×2mm) using a commercial printable resin (NextDent C&B Vertex Dental) in a FormLabs1+ stereolithography 3D printer. The printing accuracy of printed bars was determined by comparing the width, length and thickness of samples for different printer settings (printing orientation and resin color) versus the set dimensions of CAD designs. The degree of conversion of the resin was measured with FTIR, and both the elastic modulus and peak stress of 3D printed bars was determined using a 3-point being test for different printing layer thicknesses. The results were compared to those for two conventionally cured provisional materials (Integrity^®, Dentsply; and Jet^®, Lang Dental Inc.).ResultsSamples printed at 90° orientation and in a white resin color setting was chosen as the most optimal combination of printing parameters, due to the comparatively higher printing accuracy (up to 22% error), reproducibility and material usage. There was no direct correlation between printing layer thickness and elastic modulus or peak stress. 3D printed samples had comparable modulus to Jet^®, but significantly lower than Integrity^®. Peak stress for 3D printed samples was comparable to Integrity^®, and significantly higher than Jet^®. The degree of conversion of 3D printed samples also appeared higher than that of Integrity^® or Jet^®.SignificanceOur results suggest that a 3D printable provisional restorative material allows for sufficient mechanical properties for intraoral use, despite the limited 3D printing accuracy of the printing system of choice.



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Incorporation of antibacterial agent derived deep eutectic solvent into an active dental composite

Publication date: Available online 23 October 2017
Source:Dental Materials
Author(s): Jing Wang, Xiaoqing Dong, Qingsong Yu, Sheila N. Baker, Hao Li, Nathaniel E. Larm, Gary A. Baker, Liang Chen, Jingwen Tan, Meng Chen
ObjectiveTo incorporate an antibacterial agent derived deep eutectic solvent (DES) into a dental resin composite, and investigate the resulting mechanical properties and antibacterial effects.MethodThe DES was derived from benzalkonium chloride (BC) and acrylic acid (AA) and was incorporated into the dental resin composite through rapid mixing. A three-point bending test was employed to measure the flexural strength of the composite. An agar diffusion test was used to investigate antibacterial activity. Artificial (accelerated) aging was undertaken by immersing the composites in buffer solutions at an elevated temperature for up to 4 weeks. UV–vis spectrophotometry and NMR analysis were conducted to study BC release from the composite. Finally, the biocompatibility of the composite materials was evaluated using osteoblast cell culture for 7 days. Results were compared to those of a control composite which contained no BC.ResultThe DES-incorporated composite (DES-C) displayed higher flexural strength than a similar BC-incorporated composite BC (BC-C) for the same level of BC. The inclusion of BC conferred antibacterial activity to both BC-containing composites, although BC-C produced larger inhibition halos than DES-C at the same loading of BC. Control composites which contained no BC showed negligible antibacterial activity. After artificial aging, the DES-C composite showed better maintenance of the mechanical properties of the control compared with BC-C, although a decrease was observed during the three-point bending test, particularly upon storage at elevated temperatures. No BC release was detected in the aged solutions of DES-C, whereas the BC-C showed a linear increase in BC release with storage time. Significantly, cell viability results indicated that DES-C has better biocompatibility than BC-C.SignificanceThe incorporation of a BC-based DES into a dental resin composite provides a new strategy to develop antibacterial dental materials with better biocompatibility and longer effective lifetimes without sacrificing the intrinsic mechanical properties of the composite structure.

Graphical abstract

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Corrosion behavior of titanium in response to sulfides produced by Porphyromonas gingivalis

Publication date: Available online 20 October 2017
Source:Dental Materials
Author(s): Rino Harada, Eitoyo Kokubu, Hideaki Kinoshita, Masao Yoshinari, Kazuyuki Ishihara, Eiji Kawada, Shinji Takemoto
ObjectiveTo investigate the effects of sulfides produced by Porphyromonas gingivalis (P. gingivalis) on the corrosion behavior of titanium.MethodsCommercially pure titanium disks were mirror-polished and immersed in culture medium (BHI), spent medium after culturing P. gingivalis (BHI-S), and culture medium with P. gingivalis (BHI-P), and incubated aerobically at 37°C for 3–14 days. Titanium corrosion was evaluated through surface observation (using scanning electron microscope: SEM), color change (ΔE*ab), glossiness (Gs(20°)), chemical composition and state (using X-ray photoelectron spectroscopy: XPS), and titanium release.ResultsΔE*ab and Gs(20°) did not significantly differ among specimens placed in test mediums for the study duration (p>0.05). SEM images of specimens showed no signs of localized or overall corrosion. XPS analysis indicated showed clear titanium metal state peaks on all specimens in addition to sulfide and sulfate on BHI-S and BHI-P specimens. Valency fraction of titanium decomposed from Ti2p spectrum of BHI-S and BHI-P specimens indicated no progression of oxidation. No significant levels of titanium release were found regardless of the mediums' sulfide content. Results suggested that sulfides produced by P. gingivalis attached on the surface of titanium specimens but did not cause titanium corrosion over the immersion period of 14 days.SignificanceIt is imperative for dental practitioners to be aware of any elements which may influence the clinical success of titanium implants.

Graphical abstract

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Cuspal flexure of composite-restored typodont teeth and correlation with polymerization shrinkage values

Publication date: Available online 20 October 2017
Source:Dental Materials
Author(s): Taylor Enochs, Anne E. Hill, Cassandra E. Worley, Crisnicaw Veríssimo, Daranee Tantbirojn, Antheunis Versluis
ObjectiveThe relationship between post-gel shrinkage, total shrinkage, and cuspal flexure was examined. Cuspal flexure was measured on restored typodont teeth, which offered a standardized tooth shape for comparison of shrinkage stress effects among restorative composites.MethodsSix restorative composites were compared (Filtek LS, Venus Flowable, Tetric EvoCeram, Filtek Flowable, Esthet-X, and Filtek Supreme). Total shrinkage was determined from changes in projected surface area before and after polymerization (n=10). Post-gel shrinkage was determined with a biaxial strain gauge that measured strain development during polymerization (n=10). Cuspal flexure was determined using typodont maxillary second premolars with standard MOD slot preparation (n=10). Flexure was determined by comparing the three-dimensionally scanned cuspal surfaces before and after restoration. Restoration bonding to the typodont cavity was achieved by sandblasting and adhesive application. Bond integrity was verified by measuring dye penetration. Results were analyzed using ANOVA and Student–Newman–Keuls post hoc test (significance level 0.05). Pearson was used for correlations.ResultsTotal and post-gel shrinkage were significant different for all composites (t-test; P<0.001). Depending on the composite, only 9–41% of the total shrinkage was recorded as post-gel shrinkage. Bond integrity of restored typodont teeth was 96–99%. Cuspal flexure correlated strongly with post-gel shrinkage, but there was no correlation with total shrinkage.SignificanceCuspal flexure of restored typodont teeth showed the effect of shrinkage stress caused by polymerizing composite restorations, ensuring standardization while maintaining the effects of tooth/cavity geometry. Post-gel shrinkage gave a good indication to screen composites for the stress they may generate; total shrinkage had no direct correlation with stress.



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Collagenous matrix supported by a 3D-printed scaffold for osteogenic differentiation of dental pulp cells

Publication date: Available online 18 October 2017
Source:Dental Materials
Author(s): Farahnaz Fahimipour, Erfan Dashtimoghadam, Morteza Rasoulianboroujeni, Mostafa Yazdimamaghani, Kimia Khoshroo, Mohammadreza Tahriri, Amir Yadegari, Jose A. Gonzalez, Daryoosh Vashaee, Douglas C. Lobner, Tahereh S. Jafarzadeh Kashi, Lobat Tayebi
ObjectiveA systematic characterization of hybrid scaffolds, fabricated based on combinatorial additive manufacturing technique and freeze-drying method, is presented as a new platform for osteoblastic differentiation of dental pulp cells (DPCs).MethodsThe scaffolds were consisted of a collagenous matrix embedded in a 3D-printed beta-tricalcium phosphate (β-TCP) as the mineral phase. The developed construct design was intended to achieve mechanical robustness owing to 3D-printed β-TCP scaffold, and biologically active 3D cell culture matrix pertaining to the Collagen extracellular matrix. The β-TCP precursor formulations were investigated for their flow-ability at various temperatures, which optimized for fabrication of 3D printed scaffolds with interconnected porosity. The hybrid constructs were characterized by 3D laser scanning microscopy, X-ray diffraction, Fourier transform infrared spectroscopy, and compressive strength testing.ResultsThe in vitro characterization of scaffolds revealed that the hybrid β-TCP/Collagen constructs offer superior DPCs proliferation and alkaline phosphatase (ALP) activity compared to the 3D-printed β-TCP scaffold over three weeks. Moreover, it was found that the incorporation of TCP into the Collagen matrix improves the ALP activity.SignificanceThe presented results converge to suggest the developed 3D-printed β-TCP/Collagen hybrid constructs as a new platform for osteoblastic differentiation of DPCs for craniomaxillofacial bone regeneration.

Graphical abstract

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Zirconia surface modification by a novel zirconia bonding system and its adhesion mechanism

Publication date: Available online 16 October 2017
Source:Dental Materials
Author(s): Takahiro Murakami, Shinji Takemoto, Norihiro Nishiyama, Masahiro Aida
ObjectiveBonding to zirconia has been of great interest over the last 10–15 years. The aim of this study was to develop a zirconia bonding system and clarify its adhesion mechanism.MethodsA zirconia primer was prepared using tetra-n-propoxy zirconium (TPZr) and water. A silane primer was also prepared using γ-methacryloyloxypropyltrimethoxysilane (γ-MPS) and hydrochloric acid. After the zirconia primer was applied to the oxidized zirconia surface, the silane primer was applied to the ZrO2-functionalized layer and the resin cement was applied to the silane-modified layer. Ceramic Primer II was used as a typical MDP-based ceramic primer. Shear bond strengths were measured using a universal testing machine. To clarify the enhancing mechanism of the zirconia bonding system, X-ray photoelectron spectroscopy (XPS) analyses were performed.ResultsThe zirconia bond strength was affected by the surface wettability of zirconia, and the compositions of TPZr and water utilized in the zirconia primer. When the zirconia primer, consisting of 10μL TPZr and 13μL water, was applied to the zirconia surface that had been oxidized by H2O2 above 10%, the maximum bond strength of 8.2MPa was obtained. The mechanism of the zirconia bonding system was established as follows: the hydrolyzed zirconium species formed a more reactive ZrO2-functionalized layer on the oxidized zirconia surface, and the hydrolyzed γ-MPS species adsorbed on that layer introduces a chemical bonding to the resin.SignificanceThe novel zirconia bonding system enhanced the bonding performance of the resin, and showed a greater bond strength than an MDP-based ceramic primer.



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Cytotoxicity and DNA double-strand breaks in human gingival fibroblasts exposed to eluates of dental composites

Publication date: Available online 15 October 2017
Source:Dental Materials
Author(s): Yang Yang, Franz-Xaver Reichl, Jianwei Shi, Xiuli He, Reinhard Hickel, Christof Högg
ObjectivePreviously, single composite components were used to study cytotoxicity and induction of DNA double-strand breaks (DNA-DSBs) of dental composite resins. In the present study, cytotoxicity and induction of DNA-DSBs in human gingival fibroblasts (HGFs) were investigated with dental composite eluates consisting of multiple components. The eluates were qualified and quantified.MethodsThe composites Esthet.X^® HD, Venus^®, X-tra fil^®, CLEARFIL™ AP-X, Admira^® Fusion and QuiXfil^® were polymerized and immersed into Dulbecco's modified Eagle's medium (DMEM) for 72h. Subsequently, HGFs were incubated with the corresponding composite eluates. The cell viability of HGFs was obtained from an XTT assay. DNA-DSBs were determined using a γ-H2AX assay. The qualification and quantification of eluates were performed by gas chromatography/mass spectrometry (GC/MS).ResultsHGFs exposed to the eluates of all investigated composites showed no significant loss of cell viability, compared to negative control. Significant DNA-DSBs induction could be found in HGFs exposed to the eluates of Esthet.X^® HD (0.43±0.05 foci/cell) and Venus^® (0.39±0.04 foci/cell), compared to control (0.22±0.03 foci/cell). A total of 12 substances were detected from the investigated composite eluates. Five of them were methacrylates: tetraethyleneglycol dimethacrylate (TEGDMA), 2-hydroxyethyl methacrylate (HEMA), hydroxypropyl methacrylate (HPMA), ethyleneglycol dimethacrylate (EGDMA) and trimethylolpropane trimethacrylate (TMPTMA). The highest concentration of HEMA (110.5μM), HPMA (86.08μM) and TMPTMA (4.50μM) was detected in the eluates of QuiXfil^®. The highest concentration of TEGDMA was 1080μM in Venus^® eluates and the highest concentration of EGDMA was 3.18μM in Esthet.X^® HD eluates.SignificanceSignificant DNA-DSBs induction can be found in HGFs exposed to the eluates of Esthet.X^® HD and Venus^®. The interactive effects among released (co)monomers and additives may influence the cytotoxicity and induction of DNA-DSBs, compared to exposure with single composite component.



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Bioactivity and fluoride release of strontium and fluoride modified Biodentine

Publication date: Available online 15 October 2017
Source:Dental Materials
Author(s): Hazel O. Simila, Natalia Karpukhina, Robert G. Hill
Biodentine™ is a novel tricalcium silicate based material used both as a coronal dentine replacement and in pulp therapy. Its multiple use in sealing perforations, pulp capping and as a temporary restoration arises from its ability to promote dentine formation and to confer an excellent marginal seal. However, there is still room for improvement of this cement as it lacks the anticariogenic effect typically conferred by fluoride ion release as seen in glass ionomer cement based dental materials. Therefore, this study was conducted to investigate the impact of bioactive glass addition to Biodentine™.Objectivewas to compare the apatite formation capacity, specificity of the apatite type formed and fluoride ion release by Biodentine™ cements that have been modified by three different compositions of bioactive glasses.MethodsHigh fluoride, high strontium and high fluoride plus strontium containing bioactive glasses were synthesized, incorporated into Biodentine™ powder and four types of cements prepared. These cements were immersed in phosphate buffered saline solution and incubated for a period of 3 and 24h, 3, 7 and 14 days. Fourier transform infra-red spectroscopy, X-ray diffraction, magic angle spinning nuclear magnetic resonance and fluoride ion release studies were performed.ResultsBioactive glass addition to Biodentine™ led to pronounced formation of apatite. Where the bioactive glass contained fluoride, fluorapatite and fluoride ion release were demonstrated.SignificanceEliciting fluorapatite formation and fluoride ion release from Biodentine™ is an important development as fluoride is known to have antibacterial and anticariogenic effects.



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Instrument-assisted soft tissue mobilization increases myofascial trigger point pain threshold

Publication date: Available online 28 October 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Dawn T. Gulick
BackgroundA myofascial trigger point (MTrP) has been defined as a hyperirritable, palpable nodule in a skeletal muscle. The signs and symptoms of a MTrP include muscle pain, weakness, and dysfunction. MTrPs are common problems associated with soft tissue pathology. Having an intervention to decrease MTrP pain can be clinically valuable.PurposeTo determine if a series of six instrument-assisted soft tissue mobilization (IASTM) treatments rendered over three weeks would influence the pressure pain threshold (PPT) of a myofascial trigger point (MTrP).MethodsRandomized, control trial of healthy individuals (n = 29) with MTrPs in the upper trapezius muscle. The intervention was six IASTM treatments rendered over three weeks. Each treatment included 1 min of sweeping with the GT-1/HG-2 (handle bar), 1 min of swivel with the knob of the GT-1/HG-2 directly over the MTrP, 2 min of fanning with the GT-4/HG-8 (convex single bevel), and concluded with 1 min of sweeping with GT-1/HG-2.The outcome measure used a dolorimeter to compare PPT before and after three weeks in both the treatment and control groups.ResultsPaired t-test for PPT pre-test and post-test of the control and treatment groups were p = 0.42159 and p = 0.00003, respectively. A one-way ANOVA of the control and IASTM groups revealed a statistically significant difference (p < 0.0001). The power calculation was greater than 0.99.ConclusionsA 5-min intervention using three IASTM techniques can effectively increase the PPT of a MTrP in six treatments over a three-week period of time.



http://ift.tt/2z0VLx9

Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee

In 2002, the National Rosacea Society assembled an expert committee to develop the first standard classification of rosacea. This original classification was intended to be updated as scientific knowledge and clinical experience increased. Over the last 15 years, significant new insights into rosacea's pathogenesis and pathophysiology have emerged, and the disorder is now widely addressed in clinical practice. Growing knowledge of rosacea's pathophysiology has established that a consistent multivariate disease process underlies the various clinical manifestations of this disorder, and the clinical significance of each of these elements is increasing as more is understood.

http://ift.tt/2iHtsOa

Sleep disturbance in children with moderate/severe atopic dermatitis: A case-control study

Sleep is disturbed in 60% of children with atopic dermatitis (AD).

http://ift.tt/2zfd8vh

Evidence-based update on rosacea comorbidities and their common physiologic pathways

Rosacea is a common chronic inflammatory disease affecting the facial skin whose etiology and pathophysiology are the subject of much investigation. Risk factors include genetic and environmental elements that may predispose individuals to localized inflammation and abnormal neurovascular responses to stimuli. Recent studies have introduced an array of systemic rosacea comorbidities, such as inflammatory bowel disease and neurologic conditions, that can be challenging to synthesize. We critically review the current data behind reported rosacea comorbidities and identify and highlight underrecognized physiologic mediators shared among rosacea and associated comorbidities.

http://ift.tt/2zf269t

Quantitative analysis of facial soft tissue perfusion during hypotensive anesthesia using laser-assisted indocyanine green fluorescence angiography

The aim of this study was to quantitatively evaluate the efficacy of induced hypotensive anesthesia in decreasing facial soft tissue perfusion during orthognathic surgery using laser-assisted indocyanine green fluorescence angiography. This retrospective study involved the evaluation of 16 patients who underwent orthognathic surgery. Data collection included facial tissue perfusion of the bilateral cheeks and chin at normotension and with pharmacologically induced hypotensive anesthesia. There were statistically significant differences in the facial tissue perfusion at normal and depressed levels of blood pressure (P<0.001).

http://ift.tt/2idFWcz

Treatment of lower lip pits in Van der Woude syndrome: a systematic review

The presence of lower lip pits in individuals with Van der Woude syndrome (VWS) may cause discomfort due to saliva secretion. Furthermore, one of the main complaints in relation to lip pits is poor aesthetics, which often affects quality of life. The aim of this systematic review was to identify the best technique for the surgical removal of lower lip pits in terms of aesthetic and functional characteristics. A search of the PubMed, Embase, Web of Science, Science Direct, and Scopus databases was performed on December 27, 2016, which retrieved 88 records without duplicates.

http://ift.tt/2zdAYra

Hyperlipidemia-induced hepassocin in the liver contributes to insulin resistance in skeletal muscle

Publication date: Available online 28 October 2017
Source:Molecular and Cellular Endocrinology
Author(s): Tae Woo Jung, Yoon Hee Chung, Hyoung-Chun Kim, A.M.Abd El-Aty, Ji Hoon Jeong
Hepassocin (HPS) has recently been identified as a novel hepatokine that causes hepatic steatosis. However, the role of HPS in the development of insulin resistance in skeletal muscle under obesity remains unclear. The effect of hyperlipidemia on hepatic HPS expression was evaluated in primary hepatocytes and liver of mice. HPS-mediated signal pathways were explored using small interfering (si) RNAs of specific genes or inhibitors. We found that treatment of primary hepatocytes with palmitate could induce HPS expression through C/EBPβ-mediated transcriptional activation. Furthermore, increased HPS expression was observed in the liver of high fat diet (HFD)-fed or tunicamycin-treated mice. Pretreatment with 4-phenylbutyrate (4-BPA) (an endoplasmic reticulum (ER) stress inhibitor) and suppression of p38 by siRNA abrogated the effect of palmitate on HPS expression in primary hepatocytes. Treatment of differentiated C2C12 cells with recombinant HPS caused c-Jun N-terminal kinase (JNK) phosphorylation and impairment of insulin sensitivity in a dose-dependent manner. siRNA-mediated suppression of JNK reduced the effect of HPS on insulin signaling. Furthermore, the suppression of epidermal growth factor receptor (EGFR) by siRNA mitigated both HPS-induced JNK phosphorylation and insulin resistance. In addition, HPS did not affect inflammation and ER stress in differentiated C2C12 cells. In conclusion, we elucidated that ER stress induced by palmitate could increase the expression of HPS in hepatocytes and further contribute to the development of insulin resistance in skeletal muscle via EGFR/JNK-mediated pathway. Taken together, we suggest that HPS could be a therapeutic target for obesity-linked insulin resistance.

Graphical abstract

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Activin over-expression in the testis of mice lacking the inhibin α-subunit gene is associated with androgen deficiency and regression of the male reproductive tract

Publication date: Available online 28 October 2017
Source:Molecular and Cellular Endocrinology
Author(s): Rukmali Wijayarathna, David M. de Kretser, Andreas Meinhardt, Ralf Middendorff, Helen Ludlow, Nigel P. Groome, Kate A. Loveland, Mark P. Hedger
Regionalised interaction of the activins, follistatin and inhibin was investigated in the male reproductive tract of mice lacking the inhibin α-subunit (Inha^−/-). Serum and intratesticular activin B, although not activin A and follistatin, were increased in Inha^−/- mice at 25 days of age, but all three proteins were elevated at 56 days. None of these proteins were altered within the epididymis and vas deferens at either age. At 25 days, histology of the epididymis and vas deferens was similar to wild-type. At 56 days, the testis contained extensive somatic cell tumours, leading to Leydig cell regression and testosterone deficiency. The epididymis and vas deferens showed epithelial regression and increased prominence of the interstitial stroma. Immunoregulatory and fibrotic gene expression in the epididymis and vas deferens were unchanged. Thus, absence of the inhibin α-subunit has marginal effects on activins in the epididymis and vas deferens, and regression of these tissues is associated with androgen deficiency.



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Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS)

Cerebellar ataxia with neuropathy and bilateral vestibular areflexia syndrome (CANVAS) is a novel ataxic disorder consisting of the triad of cerebellar impairment, bilateral vestibular hypofunction, and a somatosensory deficit. We report the first Japanese case of CANVAS. The patient is a 68-year-old Japanese male. He was referred to our university for further evaluation of progressive gait disturbance and ataxia. He exhibited horizontal gaze-evoked nystagmus and sensory deficit. Nerve conduction studies showed sensory neuronopathy.

http://ift.tt/2z0LRvy

A rare case of bilateral vagus nerve schwanomatosis

Schwanomatosis is the third most common form of neurofibromatosis. Schwanomatosis affecting the vagus nerve is particularly rare. In this report, we describe an extremely rare case bilateral vagus nerve schwanomatosis in a 45-year-old male patient. The patient initially presented with bilateral neck tumors and hoarseness arising after thoracic surgery. We performed left neck surgery in order to diagnose and resect the remaining tumors followed by laryngeal framework surgery to improve vocal cord closure and symptoms of hoarseness.

http://ift.tt/2yVVLNc

Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS)

Cerebellar ataxia with neuropathy and bilateral vestibular areflexia syndrome (CANVAS) is a novel ataxic disorder consisting of the triad of cerebellar impairment, bilateral vestibular hypofunction, and a somatosensory deficit. We report the first Japanese case of CANVAS. The patient is a 68-year-old Japanese male. He was referred to our university for further evaluation of progressive gait disturbance and ataxia. He exhibited horizontal gaze-evoked nystagmus and sensory deficit. Nerve conduction studies showed sensory neuronopathy.

http://ift.tt/2z0LRvy

A rare case of bilateral vagus nerve schwanomatosis

Schwanomatosis is the third most common form of neurofibromatosis. Schwanomatosis affecting the vagus nerve is particularly rare. In this report, we describe an extremely rare case bilateral vagus nerve schwanomatosis in a 45-year-old male patient. The patient initially presented with bilateral neck tumors and hoarseness arising after thoracic surgery. We performed left neck surgery in order to diagnose and resect the remaining tumors followed by laryngeal framework surgery to improve vocal cord closure and symptoms of hoarseness.

http://ift.tt/2yVVLNc

Morphology and Outcomes of Total Endovascular Treatment of Type B Aortic Dissection with Aberrant Right Subclavian Artery

Publication date: Available online 28 October 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Min Zhou, Xueqin Bai, Yong Ding, Yonggang Wang, Changpo Lin, Dong Yan, Zhenyu Shi, Weiguo Fu
ObjectivesTo characterize the morphology of type B aortic dissection with aberrant right subclavian artery (ARSA) and present early and midterm outcomes of total endovascular treatment for affected patients.MethodsFrom January 2010 to December 2015, patients with ARSA and type B aortic dissection treated with total endovascular techniques were enrolled. The angle of the aortic arch was measured on pre-operative CTA. Sixty age and gender matched normal aortic arch patients with type B aortic dissection served as controls. Primary outcomes were technical success, 30 day mortality, and late survival. Secondary outcomes included in hospital morbidity, re-intervention rate, and patency of the subclavian artery.ResultsA total of 13 patients (8 men, 5 women; mean age 58 years) were included. The mean angle of the aortic arch in patients with ARSA was significantly smaller than in normal aortic arch patients (117.2° ± 10.8° vs. 124.2° ± 9.4°, respectively; p = .024). Simple thoracic endovascular aortic repair (TEVAR) and TEVAR plus a parallel graft technique were performed in six and seven patients, respectively. Primary technique success was achieved in 11 of the 13 (84.6%) patients. A bird beak configuration occurred significantly more frequently in patients with ARSA than in normal aortic arch patients (91.7% vs. 48.3%, respectively; p = .035). The median follow-up time was 36 months. One patient received a secondary procedure because of a new onset entry tear at the distal end of the stent graft. No posterior circulation stroke, permanent spinal cord ischaemia, or ischaemia of the upper arm was observed.ConclusionsType B aortic dissection with ARSA was associated with a steep aortic arch. Total endovascular treatment for these patients was feasible and safe. Stent grafts with better flexibility and appropriate extension of the proximal landing zone with a parallel graft technique are suggested based on the observed outcomes.



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Determinants of Acute Kidney Injury and Renal Function Decline After Endovascular Abdominal Aortic Aneurysm Repair

Publication date: Available online 27 October 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Randolph G. Statius van Eps, Banne Nemeth, Ronne T.A. Mairuhu, Jan J. Wever, Hugo T.C. Veger, Hans van Overhagen, Lukas C. van Dijk, Bob Knippenberg
Objective/BackgroundEndovascular aneurysm repair (EVAR) may be associated with renal injury and more insight is needed into potential risk factors. The aim was to identify clinical, anatomical, and peri-procedural parameters as potential risk factors for the occurrence of acute kidney injury (AKI) and to evaluate chronic kidney disease (CKD) after EVAR.MethodsA cohort of 212 consecutive patients who underwent elective EVAR for abdominal aortic aneurysm from January 2009 to October 2016 was included. A subgroup of 149 patients with 2 years follow-up was compared with a set of 135 non-operated aneurysm patients with smaller aneurysms (similar cardiovascular risk profile) to assess CKD. Primary outcomes were AKI (Acute Kidney Injury Network criteria) and CKD measured by estimated glomerular filtration rate (Kidney Disease Improving Global Outcomes guidelines). For AKI, candidate risk factors were identified by univariate and multivariate logistic regression analysis; for chronic renal function decline, risk factors were identified using Cox regression analysis.ResultsAKI occurred in 30 patients (15%). On multivariate analysis, the use of angiotensin II blocker (odds ratio [OR] 4.08, 95% confidence interval [CI] 1.38–12.07) and peri-operative complications (OR 3.12, 95% CI 1.20–8.10) were independent risk factors for AKI, whereas statin use was a protective factor (OR 0.19, 95% CI 0.07–0.52). EVAR resulted in a significant increase (23.5%) in the occurrence of CKD compared with the control group (6.7%; p <.001). On univariate and multivariate Cox regression the risk factors: aortic neck diameter (per mm increase) (hazard ratio [HR] 1.13, 95% CI 1.02–1.25), renal artery stenosis >50% (HR 2.24, 95% CI 1.05–4.79), and the occurrence of AKI (HR 2.19, 95% CI 0.99–4.85) were significant predictors of CKD.ConclusionThis study identified use of angiotensin II blockers and peri-operative complications as risk factors for AKI. In addition, the problem of renal function decline after EVAR is highlighted, which indicates that prolonged protective measures (e.g., in those patients at high risk) over time are needed to improve patient outcomes.



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Modern Hearing Aids: Verification, Outcome Measures, and Follow-Up

No abstract available

http://ift.tt/2hivUr8

Improving the Efficiency of Speech-In-Noise Hearing Screening Tests

Objective: Speech-in-noise hearing screening tests have become increasingly popular. These tests follow an adaptive procedure with a fixed number of presentations to estimate the speech reception threshold. The speech reception threshold is compared with an established cutoff signal to noise ratio (SNR) for a pass result or refer result. A fixed SNR procedure was developed to improve the efficiency of speech-in-noise hearing screening tests. Design: The cutoff SNR is used for all presentations in the fixed-SNR procedure. After each response a reliable test result is given (pass/refer) or an extra stimulus is presented. The efficiency and pass/refer rates between the adaptive procedure and the fixed-SNR procedure were compared. Results: An average reduction of 67% in the number of presentations can be achieved (from 25 to an average of 8.3 presentations per test). Conclusions: The fixed-SNR procedure is superior in efficiency to the adaptive procedure while having nearly equal refer and pass rates.

http://ift.tt/2hihd7q

Hearing Threshold Shifts Among 11-to-35-Year-Olds With Early Hearing Impairment

No abstract available

http://ift.tt/2zNsjIc

Rotational and Collic Vestibular-Evoked Myogenic Potential Testing in Normal Developing Children and Children With Combined Attention Deficit/Hyperactivity Disorder

Objectives: Vestibular dysfunction in childhood can have a major effect on a child's developmental process. Balance function has been reported to be poorer in children with attention deficit and hyperactivity disorder (ADHD) than in their typically developing peers. Due to contradictory available evidence and the paucity of research on vestibular function specifically in children with combined ADHD (cADHD), we designed this aged-matched study to assess vestibular function in children with cADHD. Design: We enrolled 30 typically developing children (15 boys and 15 girls; mean age, 9 years 6 months; range, 7 to 12 years) and 33 children (19 boys and 14 girls; mean age, 9 years 0 months; range, 7 to 12 years) with cADHD diagnosed by our research psychiatrist. Typically developing controls were used to obtain normative data on vestibular testing and to examine the impact of age on the vestibular response parameters, and these results were compared with those of the cADHD group. All children underwent the sinusoidal harmonic acceleration subtype of the rotary chair test (0.01, 0.02, 0.08, 0.16, and 0.32 Hz) and the cervical vestibular-evoked myogenic potential (cVEMP) test. Results: At all five frequencies in the sinusoidal harmonic acceleration test, there was no significant correlation between age and any of the following rotary chair response parameters in typically developing children: vestibulo-ocular reflex (VOR) gain, phase, asymmetry, and fixation index. Furthermore, there was no significant correlation between age and any of the following cVEMP parameters for the right and left ears of control group: p1 and n1 latency, amplitude, threshold, and amplitude ratio. Significantly higher VOR gains were observed for children with cADHD at frequencies of 0.01 (p = 0.001), 0.08 (p

http://ift.tt/2zPahoW

Systemic Aminoglycosides-Induced Vestibulotoxicity in Humans

Objectives: This systematic review aimed to investigate the prevalence and characteristics of vestibular adverse effects of aminoglycoside (AG) therapy in humans and to analyze objective vestibular tests for the detection of AG-induced vestibulotoxicity. Design: PubMed, Cochrane Database, Web of Science, and reference lists of all included studies were screened by two independent researchers. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Studies were included according to preset inclusion criteria and reported outcomes of studies evaluating vestibular function using one or more objective vestibular function tests in adults and children after systemic AG administration. The methodological quality of each study was assessed using the quality assessment tool for quantitative studies. Interrater reliability was established using Cohen's Kappa. Results: Twenty-seven studies were included, with the vast majority showing AG-induced vestibulotoxic side effects, ranging from 0 to 60%. Most studies reported AG-induced abnormalities by caloric and rotatory testing, whereas only a few studies reported using video Head Impulse test and vestibular evoked myogenic potential testing. Conclusions: Because type I hair cells (particularly of the semicircular canals) are more susceptible to ototoxicity, video Head Impulse test and vestibular evoked myogenic potential testing seem more promising for the early detection of vestibulotoxicity than caloric and rotatory testing. Prospective studies using an extensive vestibular test battery are needed to further characterize the impact of AGs on the different vestibular end organs and to identify the most sensitive vestibular technique for the early detection of vestibulotoxicity.

http://ift.tt/2zPafNQ

Comparison of the Spectral-Temporally Modulated Ripple Test With the Arizona Biomedical Institute Sentence Test in Cochlear Implant Users

Objectives: Although speech perception is the gold standard for measuring cochlear implant (CI) users' performance, speech perception tests often require extensive adaptation to obtain accurate results, particularly after large changes in maps. Spectral ripple tests, which measure spectral resolution, are an alternate measure that has been shown to correlate with speech perception. A modified spectral ripple test, the spectral-temporally modulated ripple test (SMRT) has recently been developed, and the objective of this study was to compare speech perception and performance on the SMRT for a heterogeneous population of unilateral CI users, bilateral CI users, and bimodal users. Design: Twenty-five CI users (eight using unilateral CIs, nine using bilateral CIs, and eight using a CI and a hearing aid) were tested on the Arizona Biomedical Institute Sentence Test (AzBio) with a +8 dB signal to noise ratio, and on the SMRT. All participants were tested with their clinical programs. Results: There was a significant correlation between SMRT and AzBio performance. After a practice block, an improvement of one ripple per octave for SMRT corresponded to an improvement of 12.1% for AzBio. Additionally, there was no significant difference in slope or intercept between any of the CI populations. Conclusion: The results indicate that performance on the SMRT correlates with speech recognition in noise when measured across unilateral, bilateral, and bimodal CI populations. These results suggest that SMRT scores are strongly associated with speech recognition in noise ability in experienced CI users. Further studies should focus on increasing both the size and diversity of the tested participants, and on determining whether the SMRT technique can be used for early predictions of long-term speech scores, or for evaluating differences among different stimulation strategies or parameter settings.

http://ift.tt/2zPaeJM

Rehabilitation and Psychosocial Determinants of Cochlear Implant Outcomes in Older Adults

Objective: The cochlear implant (CI) has been shown to be associated with better hearing, cognitive abilities, and functional independence. There is variability however in how much benefit each recipient derives from his or her CI. This study's primary objective is to determine the effects of individual and environmental characteristics on CI outcomes. Design: Seventy-six adults who developed postlingual severe to profound hearing loss and received their first unilateral CI at 65 years and older were eligible for the study. Fifty-five patients were asked to participate and the 33 (60%) with complete data were classified as "group 1." The remaining patients were placed in "group 2." Primary outcomes included changes in quality of life and open-set speech perception scores. Independent variables included age, health status, trait emotional intelligence (EI), comfort with technology, and living arrangements. Survey outcomes and audiological measurements were collected prospectively at 12 months after surgery, whereas preoperative data were collected retrospectively. Comparisons between groups 1 and 2 were made. Wilcoxon signed rank test, Spearman correlations, Mann–Whitney tests, Chi-square tests, and linear regressions were performed only on group 1 data. Results: Having a CI was associated with improved quality of life and speech perception. Familiarity with electronic tablets was associated with increased 12-month postoperative AzBio gains when adjusted for preoperative AzBio scores (adjusted p = 0.019), but only marginally significant when a family-wise error correction was applied (p = 0.057). Furthermore, patients who lived with other people scored at least 20 points higher on the AzBio sentences than those who lived alone (adjusted p = 0.046). Finally, consultation with an auditory rehabilitation therapist was associated with higher self-reported quality of life (p = 0.035). Conclusion: This study suggests that in a cohort of older patients cochlear implantation is associated with a meaningful increase in both quality of life and speech perception. Furthermore, it suggests the potential importance of adjunct support and services, including the tailoring of CI rehabilitation sessions depending on the patient's familiarity with technology and living situation. Investment in rehabilitation and other services is associated with improvements in quality of life and may mitigate clinical, individual and social risk factors for poor communication outcome.

http://ift.tt/2zPad8G

Age-Related Differences in the Processing of Temporal Envelope and Spectral Cues in a Speech Segment

Objectives: As people age, they experience reduced temporal processing abilities. This results in poorer ability to understand speech, particularly for degraded input signals. Cochlear implants (CIs) convey speech information via the temporal envelopes of a spectrally degraded input signal. Because there is an increasing number of older CI users, there is a need to understand how temporal processing changes with age. Therefore, the goal of this study was to quantify age-related reduction in temporal processing abilities when attempting to discriminate words based on temporal envelope information from spectrally degraded signals. Design: Younger normal-hearing (YNH) and older normal-hearing (ONH) participants were presented a continuum of speech tokens that varied in silence duration between phonemes (0 to 60 ms in 10-ms steps), and were asked to identify whether the stimulus was perceived more as the word "dish" or "ditch." Stimuli were vocoded using tonal carriers. The number of channels (1, 2, 4, 8, 16, and unprocessed) and temporal envelope low-pass filter cutoff frequency (50 and 400 Hz) were systematically varied. Results: For the unprocessed conditions, the YNH participants perceived the word ditch for smaller silence durations than the ONH participants, indicating that aging affects temporal processing abilities. There was no difference in performance between the unprocessed and 16-channel, 400-Hz vocoded stimuli. Decreasing the number of spectral channels caused decreased ability to distinguish dish and ditch. Decreasing the envelope cutoff frequency also caused decreased ability to distinguish dish and ditch. The overall pattern of results revealed that reductions in spectral and temporal information had a relatively larger effect on the ONH participants compared with the YNH participants. Conclusions: Aging reduces the ability to utilize brief temporal cues in speech segments. Reducing spectral information—as occurs in a channel vocoder and in CI speech processing strategies—forces participants to use temporal envelope information; however, older participants are less capable of utilizing this information. These results suggest that providing as much spectral and temporal speech information as possible would benefit older CI users relatively more than younger CI users. In addition, the present findings help set expectations of clinical outcomes for speech understanding performance by adult CI users as a function of age.

http://ift.tt/2zPacBE

The Effect of Aging and Priming on Same/Different Judgments Between Text and Partially Masked Speech

Objectives: It is well known from previous research that when listeners are told what they are about to hear before a degraded or partially masked auditory signal is presented, the speech signal "pops out" of the background and becomes considerably more intelligible. The goal of this research was to explore whether this priming effect is as strong in older adults as in younger adults. Design: Fifty-six adults—28 older and 28 younger—listened to "nonsense" sentences spoken by a female talker in the presence of a 2-talker speech masker (also female) or a fluctuating speech-like noise masker at 5 signal-to-noise ratios. Just before, or just after, the auditory signal was presented, a typed caption was displayed on a computer screen. The caption sentence was either identical to the auditory sentence or differed by one key word. The subjects' task was to decide whether the caption and auditory messages were the same or different. Discrimination performance was reported in d'. The strength of the pop-out perception was inferred from the improvement in performance that was expected from the caption-before order of presentation. A subset of 12 subjects from each group made confidence judgments as they gave their responses, and also completed several cognitive tests. Results: Data showed a clear order effect for both subject groups and both maskers, with better same-different discrimination performance for the caption-before condition than the caption-after condition. However, for the two-talker masker, the younger adults obtained a larger and more consistent benefit from the caption-before order than the older adults across signal-to-noise ratios. Especially at the poorer signal-to-noise ratios, older subjects showed little evidence that they experienced the pop-out effect that is presumed to make the discrimination task easier. On average, older subjects also appeared to approach the task differently, being more reluctant than younger subjects to report that the captions and auditory sentences were the same. Correlation analyses indicated a significant negative association between age and priming benefit in the two-talker masker and nonsignificant associations between priming benefit in this masker and either high-frequency hearing loss or performance on the cognitive tasks. Conclusions: Previous studies have shown that older adults are at least as good, if not better, at exploiting context in speech recognition, as compared with younger adults. The current results are not in disagreement with those findings but suggest that, under some conditions, the automatic priming process that may contribute to benefits from context is not as strong in older as in younger adults.

http://ift.tt/2zPaaK2