Achieving ventricular rate control using metoprolol in beta-blocker naïve patients versus patients on chronic beta-blocker therapy

Publication date: Available online 7 January 2016
Source:The American Journal of Emergency Medicine
Author(s): Patricia Kuang, Nathan D. Mah, Cassie A. Barton, Andrea J. Miura, Laura R. Tanas, Ran Ran
Study ObjectiveTo evaluate the difference in ventricular rate control using an intravenous (IV) metoprolol regimen commonly used in clinical practice in patients receiving chronic beta-blocker therapy compared to patients considered beta-blocker naïve admitted to the emergency department (ED) for atrial fibrillation (AF) with rapid ventricular rate (RVR).MethodsA single-center retrospective cohort study of adult ED patients who were admitted with a rapid ventricular rate of 120 beats per minute (bpm) or greater and treated with IV metoprolol was performed. Rate control was defined as either a decrease in ventricular rate to less than 100 bpm or a 20% decrease in heart rate to less than 120 bpm after metoprolol administration. Patient demographics, differences in length of stay and adverse events were recorded.ResultsA total of 398 patients were included in the study, with 79.4% (n=316) receiving chronic beta-blocker therapy. Patients considered to be beta-blocker naïve were more likely to achieve successful rate control with IV metoprolol compared to patients on chronic beta-blocker therapy (56.1% versus 42.4%, p = 0.03). Beta-blocker naïve status was associated with a shorter length of stay in comparison to patients receiving chronic beta-blocker therapy (1.79 days versus 2.64 days, p <0.01).ConclusionIntravenous metoprolol for the treatment of AF with RVR was associated with a higher treatment response in patients considered beta-blocker naïve compared to patients receiving chronic beta-blocker therapy.

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Physical exercise modulates the homeostasis of human regulatory T cells

A sedentary lifestyle increases the risk for various medical conditions, whereas regular physical activity (PA) has been shown to promote health and reduce the risk of developing chronic disorders such as cardiovascular disease and cancer, which are prevalent in industrialized countries.1 The cellular and molecular mechanisms by which PA mediates its beneficial effects are poorly understood. Because a common etiologic factor for many noncommunicable diseases of affluence is persistent sterile inflammation, PA could exert part of its effects by dampening chronic low-grade inflammation.

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Big atria, little P-waves: unexpected mismatch between chamber volume and electrocardiogram signal in “false” atrial-fibrillation

Publication date: Available online 7 January 2016
Source:The American Journal of Emergency Medicine
Author(s): Giuseppe Carpagnano, Riccardo Ieva, Michele Correale, Matteo Di Biase, Natale Daniele Brunetti

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Chromosomal microarray provides enhanced targetable gene aberration detection when paired with next generation sequencing panel in profiling lung and colorectal tumors

Publication date: Available online 6 January 2016
Source:Cancer Genetics
Author(s): S Mukherjee, Z Ma, S Wheeler, M Sathanoori, C Coldren, JL Prescott, N Kozyr, M Bouzyk, M Correll, H Ho, P Chandra, PA Lennon
Development of targeted therapies based on specific genomic alterations have altered the treatment and management of lung and colorectal cancers. Chromosomal microarray (CMA) has allowed identification of copy number variations (CNVs) in lung and colorectal cancers in great detail, and Next-Generation Sequencing (NGS) is used extensively to analyze the genome of cancers for molecular subtyping and use of molecularly guided therapies. The main objective of this study was to evaluate the utility of combining CMA and NGS for a comprehensive genomic assessment of lung and colorectal adenocarcinomas, especially for detecting drug targets. We compared results from NGS and CMA data from 60 lung and 51 colorectal tumors. From CMA analysis, 33% were amplified, 89% showed gains, 75% showed losses and 41% demonstrated loss of heterozygosity; pathogenic variants were identified in 81% of colon and 67% lung specimens through NGS. KRAS mutations commonly occurred with loss in TP53 and there was significant loss of BRCA1 and NF1 among male patients with lung cancer. For clinically actionable targets, 23% had targetable CNVs when no pathogenic variants were detected by NGS. The data thus indicates that combining the two approaches provides significant benefit in a routine clinical setting not available by NGS alone.

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Effects of platelet-rich plasma in association with bone grafts in maxillary sinus augmentation: a systematic review and meta-analysis

This systematic review evaluated the effect on bone formation and implant survival of combining platelet-rich plasma (PRP) with bone grafts in maxillary augmentation. A comprehensive review of articles listed in the PubMed/MEDLINE, Embase, and Cochrane Library databases covering the period January 2000 to January 2015 was performed. The meta-analysis was based on bone formation for which the mean difference (MD, in millimetres) was calculated. Implant survival was assessed as a dichotomous outcome and evaluated using the risk ratio (RR) with 95% confidence interval (CI).

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Prospective, Randomized, Double Blind Controlled Trial Comparing Vapocoolant Spray versus Placebo Spray in Adults Undergoing Venipuncture

Publication date: Available online 7 January 2016
Source:The American Journal of Emergency Medicine
Author(s): Sharon E. Mace
IntroductionTopical anesthetics are used to decrease procedural pain such as venipuncture. Advantages of vapocoolants include rapid onset, ease of application, low cost, and lack of associated pain of injection and other needle stick-related risks. We hypothesized that the pain of venipuncture would be reduced by at least 1.8 points on a 10-point numerical rating scale after application of a vapocoolant compared with placebo.MethodsWe conducted a prospective, randomized, double blind controlled trial of vapocoolant versus placebo spray in 100 adults (ages 18 – 80) requiring venipuncture in a hospital emergency department or observation unit. The primary efficacy outcome was the difference in pain scores immediately after venipuncture, measured on a 10-point verbal numeric rating scale from 0 (none) to worst Rodriguez and Jordan (2002) . Safety outcomes included local adverse effects (edema, erythema, blanching) and changes in vital signs.ResultsPatient characteristics and venipuncture procedure were not significantly different for the two groups. The median (inter-quartile range) pain of venipuncture was 3 (1.2-5) in the placebo group and 1 (0-3) in the vapocoolant group, P < 0.001. Skin checklist revealed vapocoolant: minimal blanching 4%, minimal erythema 18% which resolved within 5 minutes; placebo: no visible skin changes. Photographs at 5-10 minutes revealed no visible skin changes in any patient. Complaints were two: "very wet and cold on skin" (placebo) and "felt burning on skin" (vapocoolant).ConclusionThe vapocoolant significantly decreased venipuncture pain in adults compared with placebo and was well tolerated with minor side effects that resolved quickly. There were no significant differences in VS and no visible skin changes documented at the site by photographs taken within 5-10 minutes post spray/venipuncture.

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New drug may overcome treatment resistance in a high-risk children’s cancer

Paediatric oncologists from The Children's Hospital of Philadelphia (CHOP) have reported their latest results in devising new treatments for stubbornly deadly forms of the childhood cancer neuroblastoma. Building on their previous experiences in treating…

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Study shows statins could be effective against small cell lung cancer

In a recent study, researchers at Cancer Treatment Centers of America (CTCA) at Western Regional Medical Center (Western), in collaboration with international colleagues, found that statins could be an effective therapeutic against metastatic small cell…

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Being overweight or obese could cause around 700,000 new UK cancers by 2035 https://t.co/0kSxaBGEYK

Being overweight or obese could cause around 700,000 new UK cancers by 2035 https://t.co/0kSxaBGEYK

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Physical exercise modulates the homeostasis of human regulatory T cells

A sedentary lifestyle increases the risk for various medical conditions, whereas regular physical activity (PA) has been shown to promote health and reduce the risk of developing chronic disorders such as cardiovascular disease and cancer, which are prevalent in industrialized countries.1 The cellular and molecular mechanisms by which PA mediates its beneficial effects are poorly understood. Because a common etiologic factor for many noncommunicable diseases of affluence is persistent sterile inflammation, PA could exert part of its effects by dampening chronic low-grade inflammation.

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Effect of intranasal steroids on rhinosinusitis after radiotherapy for nasopharyngeal carcinoma: clinical study

Research Articles
S Feng, Y Fan, Z Liang, G Yang, Z Liao, L Guo
The Journal of Laryngology Otology, FirstView Article(s), 7 pages

Abstract

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Tracheal agenesis, a frightening scenario

Rapid Communication
H Mohammed, K West, J Bewick, M Wickstead
The Journal of Laryngology Otology, FirstView Article(s), 4 pages

Abstract

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ENT and airways in the emergency department: national survey of junior doctors’ knowledge and skills

Research Articles
K L Whitcroft, B Moss, A Mcrae
The Journal of Laryngology Otology, FirstView Article(s), 7 pages

Abstract

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Somatic arousal and sleepiness/fatigue among patients with sleep-disordered breathing

Abstract

Objectives

In a large clinical sample, we tested the hypothesis that levels of sleepiness and fatigue among upper airway resistance syndrome (UARS) patients are correlated with levels of somatic arousal (SA; reflecting the sympathetic nervous system component of the stress response). We also tested the correlations of post-treatment change in these three parameters, and we extended the investigation to obstructive sleep apnea/hypopnea (OSA/H) patients.

Methods

From 5 years of patient data, we obtained scores on the body sensation questionnaire (BSQ), measuring the level of SA, the fatigue severity scale (FSS), and Epworth sleepiness scale (ESS) for 152 consecutive UARS patients and 150 consecutive OSA/H patients. For each group, we correlated the FSS and ESS scores with the BSQ scores. Among the 45 UARS patients and 49 OSA/H patients treated with nasal CPAP who provided post-treatment data, we correlated change in FSS and ESS scores with change in BSQ scores.

Results

Scores on the BSQ, FSS, and ESS for UARS patients and OSA/H patients were comparable. In both UARS and OSA/H patients, both the FSS and ESS scores were positively correlated with the BSQ score. Nasal CPAP use decreased all three questionnaire scores in both patient groups. In the pooled data, changes in FSS were significantly correlated with changes in BSQ.

Conclusions

Our findings confirm our preliminary observations that sleepiness and fatigue among UARS patients are correlated with their level of SA and suggest that the same is true for OSA/H patients. The decrease of SA following treatment suggests that SDB is a cause of SA among patients with UARS and OSA/H.

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Clinical diagnostics and therapy monitoring in the congenital disorders of glycosylation

Abstract

Abnormal protein glycosylation is observed in many common disorders like cancer, inflammation, Alzheimer's disease and diabetes. However, the actual use of this information in clinical diagnostics is still very limited. Information is usually derived from analysis of total serum N-glycan profiling methods, whereas the current use of glycoprotein biomarkers in the clinical setting is commonly based on protein levels. It can be envisioned that combining protein levels and their glycan isoforms would increase specificity for early diagnosis and therapy monitoring. To establish diagnostic assays, based on the mass spectrometric analysis of protein-specific glycosylation abnormalities, still many technical improvements have to be made. In addition, clinical validation is equally important as well as an understanding of the genetic and environmental factors that determine the protein-specific glycosylation abnormalities. Important lessons can be learned from the group of monogenic disorders in the glycosylation pathway, the Congenital Disorders of Glycosylation (CDG). Now that more and more genetic defects are being unraveled, we start to learn how genetic factors influence glycomics profiles of individual and total serum proteins. Although only in its initial stages, such studies suggest the importance to establish diagnostic assays for protein-specific glycosylation profiling, and the need to look beyond the single glycoprotein diagnostic test. Here, we review progress in and lessons from genetic disease, and review the increasing opportunities of mass spectrometry to analyze protein glycosylation in the clinical diagnostic setting. Furthermore, we will discuss the possibilities to expand current CDG diagnostics and how this can be used to approach glycoprotein biomarkers for more common diseases.

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What results to disclose, when, and who decides? Healthcare professionals’ views on prenatal chromosomal microarray analysis

Abstract

Objectives

This study explored the views of healthcare-professionals (HCPs) in the UK about what information should be disclosed; when; and whether women/parents should be given a choice as to what they wish to know.

Methods

Q-methodology was used to assess the views of forty HCPs (genetic healthcare professionals, fetal medicine experts, lab-scientists).

Results

Most participants agreed that variants of unknown clinical significance should not be disclosed. Participants were divided between those who considered variants of uncertain clinical significance helpful for parents and clinicians, and those who considered them harmful. Although recognising the potential disadvantages of disclosing risks for adult-onset conditions, participants thought it would be difficult to withhold such information once identified. Participants largely supported some parental involvement in determining which results should be returned. Most participants believed that information obtained via CMA testing in pregnancy should either be disclosed during pregnancy, or not at all.

Conclusion

HCPs taking part in the study largely believed that variants that will inform the management of the pregnancy, or are relevant to other family members, should be reported. Recent UK guidelines, published after this research was completed, reflect these opinions.

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Cleft characteristics and treatment outcomes in hemifacial microsomia compared to non-syndromic cleft lip/palate

The goal of this study was to describe the clinical characteristics and treatment outcomes of patients with hemifacial microsomia (HFM) and cleft lip/palate (CL/P), and to compare them to a historic cohort of patients with non-syndromic CL/P treated at the same centre. A retrospective review of patients with HFM and CL/P was performed; the main outcome measures assessed were cleft type/side, surgical outcome, midfacial retrusion, and speech. Twenty-six patients (13 male, 13 female; mean age 22.7±14.9, range 1–52 years) with cleft lip with/without cleft palate (CL±P) were identified: three with cleft lip (12%), two with cleft lip and alveolus and an intact secondary palate (8%), and 21 with cleft lip and palate (CLP) (81%; 15 unilateral and six bilateral).

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Treatment of exophthalmos and strabismus surgery in thyroid-associated orbitopathy

Endocrine orbitopathy (EO) can have important consequences, such as exophthalmos and restrictive strabismus. A retrospective study was performed of 35 patients with EO who underwent orbital decompression surgery and restrictive strabismus correction. Two surgical techniques for orbital decompression were analyzed: fat decompression by Olivari technique and three-wall bony expansion with fat decompression. Strabismus surgery was performed using adjustable or non-adjustable sutures under topical anaesthesia.

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Prehospital Indicators for Disaster Preparedness and Response: New York City Emergency Medical Services in Hurricane Sandy

Research Articles
Silas W. Smith, James Braun, Ian Portelli, Sidrah Malik, Glenn Asaeda, Elizabeth Lancet, Binhuan Wang, Ming Hu, David C. Lee, David J. Prezant, Lewis R. Goldfrank
Disaster Medicine and Public Health Preparedness, FirstView Article(s), 11 pages

Abstract

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Issue Information

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Effects of platelet-rich plasma in association with bone grafts in maxillary sinus augmentation: a systematic review and meta-analysis

This systematic review evaluated the effect on bone formation and implant survival of combining platelet-rich plasma (PRP) with bone grafts in maxillary augmentation. A comprehensive review of articles listed in the PubMed/MEDLINE, Embase, and Cochrane Library databases covering the period January 2000 to January 2015 was performed. The meta-analysis was based on bone formation for which the mean difference (MD, in millimetres) was calculated. Implant survival was assessed as a dichotomous outcome and evaluated using the risk ratio (RR) with 95% confidence interval (CI).

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Physical exercise modulates the homeostasis of human regulatory T cells

A sedentary lifestyle increases the risk for various medical conditions, whereas regular physical activity (PA) has been shown to promote health and reduce the risk of developing chronic disorders such as cardiovascular disease and cancer, which are prevalent in industrialized countries.1 The cellular and molecular mechanisms by which PA mediates its beneficial effects are poorly understood. Because a common etiologic factor for many noncommunicable diseases of affluence is persistent sterile inflammation, PA could exert part of its effects by dampening chronic low-grade inflammation.

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Sources of injustice among individuals with persistent pain following musculoskeletal injury

Abstract

Evidence supports the negative impact of perceived injustice on recovery following injury. However, little is known about sources that contribute to injustice perceptions in this context. Therefore, this study systematically investigated sources of injustice following painful musculoskeletal injury. Following completion of the Injustice Experiences Questionnaire (IEQ) and measures of pain, depression, and disability, participants completed a semi-structured interview to discuss reasons underlying their IEQ responses. On average, the sample was experiencing moderate levels of pain, depression, and disability, and clinically meaningful levels of perceived injustice. Participants frequently identified employers/colleagues, other drivers, insurers, healthcare providers, family, significant others, friends, and society as sources of injustice. Common reasons for identifying these sources included their contribution to the injury, inadequate assessment or treatment of pain, and punitive responses toward participants' pain expression. Sex- and injury-related differences emerged in the identification of injustice sources. Potential strategies for preventing perceived injustice following painful injury are discussed.

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Psychometric Properties of a Brief Instrument to Assess Perceptions of Injustice Associated with Debilitating Health and Mental Health Conditions

Abstract

The present study examined the psychometric properties of a shortened and simplified version of the Injustice Experience Questionnaire (IEQ). The instructional set of the original IEQ was modified to make it better suited to the context of debilitating health and mental health conditions that do not necessarily arise as a result of injury. The number of items was reduced from 12 to 5, and the response scale was simplified. The Injustice Experiences Questionnaire – Short Form (IEQ-SF) was administered to individuals diagnosed with a chronic musculoskeletal (MSK) condition (N = 88) or major depressive disorder (MDD) (N = 87). The internal consistency of the IEQ-SF was acceptable. The IEQ-SF was significantly correlated with measures of pain severity, depressive symptom severity and disability in both samples. Individuals with MDD scored higher on the IEQ-SF than individuals with MSK. The IEQ-SF was shown to be sensitive to treatment-related reductions in perceived injustice. Preliminary analyses suggest that the IEQ-SF is a reliable and valid measure of disability-related injustice perceptions associated with debilitating health and mental health conditions.

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Being overweight or obese could cause around 700,000 new UK cancers by 2035 https://t.co/0kSxaBGEYK

Being overweight or obese could cause around 700,000 new UK cancers by 2035 https://t.co/0kSxaBGEYK

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Perceived Injustice Predicts Intention to Litigate: Findings from a Spinal Cord Injury Sample

Abstract

The current study examined the association between perceived injustice (assessed by the Injustice Experiences Questionnaire) and intent to litigate in a sample of individuals who had recently suffered a spinal cord injury and were currently on an inpatient rehabilitation unit. Higher perception of injustice was associated with reported interest in litigation. In logistic regression analyses, perceived injustice uniquely differentiated between individuals who foresaw involvement in litigation versus those who did not, with the blame/unfairness factor of the Injustice Experiences Questionnaire emerging as more significant than the severity/irreparability of loss factor. Both anticipated litigation and higher perception of injustice were associated with greater attribution of responsibility for injury to other person(s) and reduced forgiveness across a number of domains. Finally, a receiver operating characteristic (ROC) curve analysis was conducted to identify IEQ score most associated with anticipated litigation. This study is the first to examine perception of injustice in a spinal cord injury sample or the association between perceived injustice and litigation intent. Results support the possibility that psychological appraisals of injury may have significant legal ramifications.

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New drug may overcome treatment resistance in a high-risk children’s cancer

Paediatric oncologists from The Children's Hospital of Philadelphia (CHOP) have reported their latest results in devising new treatments for stubbornly deadly forms of the childhood cancer neuroblastoma. Building on their previous experiences in treating…

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Lung cancer clinical trial finds lung function without additional imaging

A newly NIH funded clinical trial (NCT02528942) by University of Colorado Cancer Center investigators and collaborators at Beaumont Health in Michigan and the University of Texas Medical Branch is evaluating a new method for pinpointing and sparing…

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Study shows statins could be effective against small cell lung cancer

In a recent study, researchers at Cancer Treatment Centers of America (CTCA) at Western Regional Medical Center (Western), in collaboration with international colleagues, found that statins could be an effective therapeutic against metastatic small cell…

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Sugar tax and screening: listen to the evidence

"Sugar, rum, and tobacco are commodities which are nowhere necessaries of life, which are become objects of almost universal consumption, and which are therefore extremely proper subjects of…

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Package architecture and component design for an implanted neural stimulator with closed loop control.

Package architecture and component design for an implanted neural stimulator with closed loop control.

Conf Proc IEEE Eng Med Biol Soc. 2015 Aug;2015:7825-7830

Authors: Bjune CK, Marinis TF, Brady JM, Moran J, Wheeler J, Sriram TS, Parks PD, Widge AS, Dougherty DD, Eskandar EN

Abstract
An implanted neural stimulator with closed loop control requires electrodes for stimulation pulses and recording neuron activity. Our system features arrays of 64 electrodes. Each electrode can be addressed through a cross bar switch, to enable it to be used for stimulation or recording. This electrode switch, a bank of low noise amplifiers with an integrated analog to digital converter, power conditioning electronics, and a communications and control gate array are co-located with the electrode array in a 14 millimeter diameter satellite package that is designed to be flush mounted in a skull burr hole. Our system features five satellite packages connected to a central hub processor-controller via ten conductor cables that terminate in a custom designed, miniaturized connector. The connector incorporates features of high reliability, military grade devices and utilizes three distinct seals to isolate the contacts from fluid permeation. The hub system is comprised of a connector header, hermetic electronics package, and rechargeable battery pack, which are mounted on and electrically interconnected by a flexible circuit board. The assembly is over molded with a compliant silicone rubber. The electronics package contains two antennas, a large coil, used for recharging the battery and a high bandwidth antenna that is used to download data and update software. The package is assembled from two machined alumina pieces, a flat base with brazed in, electrical feed through pins and a rectangular cover with rounded corners. Titanium seal rings are brazed onto these two pieces so that they can be sealed by laser welding. A third system antenna is incorporated in the flexible circuit board. It is used to communicate with an externally worn control package, which monitors the health of the system and allows both the user and clinician to control or modify various system function parameters.

PMID: 26738106 [PubMed - as supplied by publisher]

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Updates in anterior skull base reconstruction.

Updates in anterior skull base reconstruction.

Curr Opin Otolaryngol Head Neck Surg. 2016 Feb;24(1):75-82

Authors: Zuniga MG, Turner JH, Chandra RK

Abstract
PURPOSE OF REVIEW: This article summarizes the indications and surgical techniques for the reconstructions of anterior skull base defects.
RECENT FINDINGS: There is increasing popularity of the vascularized pedicled flaps in endoscopic skull base surgery for the successful reconstruction of anterior skull base defects, compared with the use of free-tissue grafts. The location and size of the defect as well as the rate of cerebrospinal fluid (CSF) flow are important considerations for selection of the most appropriate reconstructive approach. Recent literature provides evidence suggesting that pedicled flaps may be more effective for clival defects and high-flow CSF leaks, potentially reducing the incidence of postoperative CSF leaks. Although the nasoseptal flap (NSF) continues to be the mainstay of endoscopic skull base reconstruction, alternative vascularized flaps exist when the NSF is impractical or unavailable, and new surgical approaches continue to evolve.
SUMMARY: Vascularized pedicled flaps, and especially the NSF, have greatly reduced complications associated with endoscopic skull base surgery. Multiple considerations should be taken into account during closure of skull base defects, and several options are available to accommodate different needs.

PMID: 26735312 [PubMed - as supplied by publisher]

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Endoscopic Modified Transseptal Transsphenoidal Approach for Maximal Preservation of Sinonasal Quality of Life and Olfaction.

Endoscopic Modified Transseptal Transsphenoidal Approach for Maximal Preservation of Sinonasal Quality of Life and Olfaction.

World Neurosurg. 2015 Dec 27;

Authors: Hong SD, Nam DH, Kong DS, Kim HY, Chung SK, Dhong HJ

Abstract
OBJECTIVE: Patients experience significant postoperative sinonasal symptoms for the first few months after endoscopic transnasal transsphenoidal approach (ETN-TSA) surgery. We modified this technique by bypassing the nasal mucosa and approaching through the septum bilaterally. In this study, we analyze whether these technical modifications, which we have termed the endoscopic modified transseptal transsphenoidal approach (EMTS-TSA), decrease postoperative sinonasal morbidity after endoscopic TSA.
METHODS: We retrospectively reviewed a prospectively collected database. Patients who underwent endoscopic TSA from Dec 2012 to Jun 2014 were included. Thirty patients underwent ETN-TSA and 51 underwent EMTS-TSA. Sino-Nasal Outcome Test (SNOT)-20, anterior skull base (ASK) nasal inventory, and visual analogue scale (VAS) for subjective olfaction were evaluated before and 1 and 3 months after surgery. Cross Cultural Smell Identification Test (CC-SIT) was also measured before and 3 months after surgery.
RESULTS: There was a significant difference between the preoperative and 3 month VAS for olfaction in the ETN-TSA group (92.5 to 81.3; P = 0.002) but not the EMTS-TSA group (from 90.6 to 88.8; P = 0.403). There was no statistical difference in SNOT-20 or CC-SIT scores between two groups during follow-up. The EMTS-TSA group scored better than the ETN-TSA group in the ASK nasal inventory subdomain ("nasal discharge", "urge to blow" and "trouble breading) 1 month postoperatively.
CONCLUSIONS: EMTS-TSA could preserve almost all nasal mucosa, including the septum and turbinates. EMTS-TSA may be useful for preserving early postoperative olfactory function and some sinonasal quality of life. We believe that EMTS-TSA is a good endoscopic pituitary surgery option.

PMID: 26732950 [PubMed - as supplied by publisher]

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[Epistaxis following skull trauma].

[Epistaxis following skull trauma].

Ned Tijdschr Geneeskd. 2015;159:A9352

Authors: Nooij RP, van Dijk JM, Groen RJ, Uyttenboogaart M, Eshghi OS, Kosten-Meijer AG

Abstract
BACKGROUND: Epistaxis is a common problem, which is usually benign in nature. In some cases, however, epistaxis is a symptom of a severe underlying condition.
CASE DESCRIPTION: A 20-year-old male was treated conservatively following head injury with craniofacial and base-of-skull fractures. Recurrent episodes of epistaxis occurred some weeks after treatment. Further investigation showed an extradural dissecting aneurysm of the left internal carotid artery (ICA), projecting into the sphenoid sinus. The aneurysm was treated endovascularly by placing a coil in the aneurism and a stent in the artery. On the basis of this case study we describe the diagnostics and treatment of patients with posttraumatic posterior epistaxis.
CONCLUSION: In cases if delayed epistaxis following head injury the physician should be alert for the possibility of trauma to the ICA. This is a potentially life-threatening situation that requires prompt treatment.

PMID: 26732210 [PubMed - in process]

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A brain-lesion pattern based algorithm for the diagnosis of posttraumatic olfactory loss.

A brain-lesion pattern based algorithm for the diagnosis of posttraumatic olfactory loss.

Rhinology. 2015 Dec 1;53(4):365-370

Authors: Lő Tsch J, Reither N, Bogdanov V, Hähner A, Ultsch A, Hill K, Hummel T

Abstract
BACKGROUND: Brain areas processing olfactory information exhibit functionally relevant morphological dynamics. This suggests the exploitation of anatomical information in the diagnosis of an olfactory dysfunction. Following previous identifications of olfactory eloquent areas such as the olfactory bulbs and tracts, we focused at a brain-morphology based algorithm for establishing the diagnosis of olfactory loss following brain injury.
METHODOLOGY: Forty-one patients with a history of head trauma dated back 40 ± 39 months, and additional 23 patients without head trauma, were assessed for damages in 11 olfaction-relevant brain areas using magnetic resonance imaging (MRI). Olfactory function was derived from the use of a standardized, reliable and validated olfactory test. An olfactory diagnostic algorithm was derived following classification and regression tree analysis of the brain lesion pattern.
RESULTS: Subjects were assigned to olfactory diagnoses of anosmia, hyposmia or normosmia. These diagnoses were predictable at an accuracy of 62.3 % from the degree of damage in the olfactory bulb and in the left temporal lobe pole. The main diagnosis algorithm addressed the presence of anosmia, which could be predicted from the degree of damage in these brain areas at an accuracy of 81.3 %.
CONCLUSIONS: We independently reproduced previously identified brain regions in which morphological damage is associated with olfactory loss. Based on this reproduction, an algorithm was developed for the diagnosis of anosmia from central-nervous damage. Thus, we introduce a morphological component to the olfactory diagnosis that specifically addresses clinical cases of olfactory loss following head trauma.

PMID: 26735133 [PubMed - as supplied by publisher]

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Follow-up of Thalidomide treatment in patients with Hereditary Haemorrhagic Telangiectasia.

Follow-up of Thalidomide treatment in patients with Hereditary Haemorrhagic Telangiectasia.

Rhinology. 2015 Dec 1;53(4):340-344

Authors: Hosman A, Westermann CJ, Snijder R, Disch F, Mummery CL, Mager JJ

Abstract
BACKGROUND: Patients with a hereditary vascular disorder called Rendu-Osler-Weber syndrome (Hereditary Haemorrhagic Telangiectasia, HHT) haemorrhage easily due to weak-walled vessels. Haemorrhage in lungs or brain can be fatal but patients suffer most from chronic and prolonged nosebleeds (epistaxis), the frequency and intensity of which increases with age. Several years ago, it was discovered serendipitously that the drug Thalidomide had beneficial effects on the disease symptoms in several of a small group of HHT patients: epistaxis and the incidence of anaemia were reduced and patients required fewer blood transfusions. In addition, they reported a better quality of life. However, Thalidomide has significant negative side effects, including neuropathy and fatigue.
METHODS: We followed up all HHT patients in the Netherlands who had been taking Thalidomide at the time the original study was completed to find out (i) how many had continued taking Thalidomide and for how long (ii) the nature and severity of any side-effects and (iii) whether side-effects had influenced their decision to continue taking Thalidomide.
RESULTS: Only a minority of patients had continued taking the drug despite its beneficial effects on their symptoms and that the side effects were the primary reason to stop.
CONCLUSION: Despite symptom reduction, alternative treatments are still necessary for epistaxis in HHT patients and a large-scale clinical trial is not justified although incidental use in the most severely affected patients can be considered.

PMID: 26735132 [PubMed - as supplied by publisher]

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A time-frequency respiration tracking system using non-contact bed sensors with harmonic artifact rejection.

A time-frequency respiration tracking system using non-contact bed sensors with harmonic artifact rejection.

Conf Proc IEEE Eng Med Biol Soc. 2015 Aug;2015:8111-8114

Authors: Beattie ZT, Jacobs PG, Riley TC, Hagen CC

Abstract
Sleep apnea is a breathing disorder that affects many individuals and has been associated with serious health conditions such as cardiovascular disease. Clinical diagnosis of sleep apnea requires that a patient spend the night in a sleep clinic while being wired up to numerous obtrusive sensors. We are developing a system that utilizes respiration rate and breathing amplitude inferred from non-contact bed sensors (i.e. load cells placed under bed supports) to detect sleep apnea. Multi-harmonic artifacts generated either biologically or as a result of the impulse response of the bed have made it challenging to track respiration rate and amplitude with high resolution in time. In this paper, we present an algorithm that can accurately track respiration on a second-by-second basis while removing noise harmonics. The algorithm is tested using data collected from 5 patients during overnight sleep studies. Respiration rate is compared with polysomnography estimations of respiration rate estimated by a technician following clinical standards. Results indicate that certain subjects exhibit a large harmonic component of their breathing signal that can be removed by our algorithm. When compared with technician transcribed respiration rates using polysomnography signals, we demonstrate improved accuracy of respiration rate tracking using harmonic artifact rejection (mean error: 0.18 breaths/minute) over tracking not using harmonic artifact rejection (mean error: -2.74 breaths/minute).

PMID: 26738176 [PubMed - as supplied by publisher]

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Horner syndrome in glandular fever: a case report.

Horner syndrome in glandular fever: a case report.

J Laryngol Otol. 2016 Jan 6;:1-3

Authors: West EV, Sheerin F, Bates JE

Abstract
OBJECTIVE: This study aimed to present and discuss the case of a patient with known glandular fever who presented with Horner syndrome.
CASE REPORT: A 35-year-old patient with known glandular fever developed acute unilateral Horner syndrome, a previously undescribed complication of this common illness. Magnetic resonance imaging and magnetic resonance angiography showed that enlarged intra-carotid sheath lymphoid tissue was likely to be the underlying cause of sympathetic nerve disruption. The case is described, the anatomy of the sympathetic chain is discussed and possible alternative pathophysiological mechanisms are reviewed.
CONCLUSION: This is the first report in the worldwide literature of Horner syndrome arising as a result of compression from enlarged lymph nodes in glandular fever.

PMID: 26732343 [PubMed - as supplied by publisher]

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Endoscopic dacryocystorhinostomy with and without silicone intubation: 4 years retrospective study.

Endoscopic dacryocystorhinostomy with and without silicone intubation: 4 years retrospective study.

Eur Arch Otorhinolaryngol. 2016 Jan 5;

Authors: Longari F, Dehgani Mobaraki P, Ricci AL, Lapenna R, Cagini C, Ricci G

Abstract
The objective of this study is to assess different outcomes between endoscopic dacryocystorhinostomy (En-DCR) with and without silicone intubation. We retrospectively analyzed 84 patients (89 procedures), suffering from chronic epiphora for primary acquired nasolacrimal duct obstruction, treated with En-DCR and divided into two groups depending on silicone stent intubation. The surgical outcomes were evaluated at 7 post-operative controls using Munk's score criteria. Functional success was defined as absence of epiphora, no further episodes of dacryocystitis, and a patent ostium after fluorescein irrigation. 45 En-DCR with stent and 44 En-DCR without stent were performed. Success rate after 18 months follow-up were, respectively, 82.2 % in the stent group and 88.6 % in the non-stent group (OR 0.59) with no statistical differences. The ostial size reduction has been reported in higher percentage in the stent group, mainly due to peristomal granuloma (OR 3.64), scar tissue formation (OR 2.25), and turbinoseptal synaechia (OR 1.76). The benefits of non-intubation are less patient discomfort, reduced surgical time and costs, simpler follow-up regimen and less intubation-associated complications. En-DCR without silicone stent intubation should be the first choice of procedure, stent intubation should be reserved in selected cases with poor local conditions pre and intra-operatively assessed.

PMID: 26732693 [PubMed - as supplied by publisher]

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A Complementary Affair

Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 57-year-old man presented to…

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Abrupt Relapse of ALK-Positive Lymphoma after Discontinuation of Crizotinib

To the Editor: Crizotinib has been shown to have therapeutic activity in relapsed and resistant ALK-positive lymphomas. Some patients receive treatment for more than 4 years without recurrence. We describe two cases of abrupt relapse in patients with ALK-positive anaplastic large-cell lymphoma…

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Quantifying spinal gait kinematics using an enhanced optical motion capture approach in adolescent idiopathic scoliosis

Publication date: February 2016
Source:Gait & Posture, Volume 44
Author(s): Stefan Schmid, Daniel Studer, Carol-Claudius Hasler, Jacqueline Romkes, William R. Taylor, Silvio Lorenzetti, Reinald Brunner
Background and purposeThe pathogenesis of adolescent idiopathic scoliosis (AIS) remains poorly understood. Previous research has indicated possible relationships between kinematics of the spine, pelvis and lower extremities during gait and the progression of AIS, but adequate evidence on spinal kinematics is lacking. The aim of this study was to provide a detailed assessment of spinal gait kinematics in AIS patients compared to asymptomatic controls.MethodsFourteen AIS patients and 15 asymptomatic controls were included. Through introducing a previously validated enhanced trunk marker set, sagittal and frontal spinal curvature angles as well as general trunk kinematics were measured during gait using a 12-camera Vicon motion capture system. Group comparisons were conducted using T-tests and relationships between kinematic parameters and severity of scoliosis (Cobb angle) were investigated using regression analyses.ResultsThe sagittal thoracic curvature angle in AIS patients showed on average 10.7° (4.2°, 17.3°) less kyphosis but 4.9° (2.3°, 7.6°) more range of motion (Cobb angle-dependent (R2=0.503)). In the frontal plane, thoracic and thoracolumbar/lumbar curvature angles indicated average lateral deviations in AIS patients. General trunk kinematics and spatio-temporal gait parameters, however, did not show any clinically relevant differences between the groups.ConclusionsThis demonstrates that the dynamic functionality of the scoliotic spine can be assessed using advanced non-invasive optical approaches and that these should become standard in clinical gait analysis. Furthermore, curvature angle data might be used to drive sophisticated computer simulation models in order to gain an insight into the dynamic loading behavior of the scoliotic spine during gait.

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Age-related decline of gait variability in children with attention-deficit/hyperactivity disorder: Support for the maturational delay hypothesis in gait

Publication date: February 2016
Source:Gait & Posture, Volume 44
Author(s): Olivia Manicolo, Alexander Grob, Sakari Lemola, Priska Hagmann-von Arx
BackgroundPrevious findings showed a tendency toward higher gait variability in children with attention-deficit/hyperactivity disorder (ADHD) compared to controls. This study examined whether gait variability in children with ADHD eventually approaches normality with increasing age (delay hypothesis) or whether these gait alterations represent a persistent deviation from typical development (deviation hypothesis).MethodThis cross-sectional study compared 30 children with ADHD (25 boys; Mage=10 years 11 months, range 8–13 years; n=21 off medication, n=9 without medication) to 28 controls (25 boys; Mage=10 years 10 months, range 8–13 years). Gait parameters (i.e. velocity and variability in stride length and stride time) were assessed using an electronic walkway system (GAITRite) while children walked at their own pace.ResultsChildren with ADHD walked with significantly higher variability in stride time compared to controls. Age was negatively associated with gait variability in children with ADHD such that children with higher age walked with lower variability, whereas in controls there was no such association.ConclusionsChildren with ADHD displayed a less regular gait pattern than controls, indicated by their higher variability in stride time. The age-dependent decrease of gait variability in children with ADHD showed that gait performance became more regular with age and converged toward that of typically developing children. These results may reflect a maturational delay rather than a persistent deviation of gait regularity among children with ADHD compared to typically developing children.

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Does providing real-time augmented feedback affect the performance of repeated lower limb loading to exhaustion?

Publication date: February 2016
Source:Gait & Posture, Volume 44
Author(s): Amitabh Gupta, Ryan J. Hilliard, Kurt L. Mudie, Peter J. Clothier
IntroductionThis study aimed to determine whether real-time augmented feedback influenced performance of single-leg hopping to volitional exhaustion.MethodsTwenty-seven healthy, male participants performed single-leg hopping (2.2Hz) with (visual and tactile feedback for a target hop height) or without feedback on a force plate. Repeated measures ANOVA were used to determine differences in vertical stiffness (k), duration of flight (tf) and loading (tl) and vertical height displacement during flight (zf) and loading (zl). A Friedman 2-way ANOVA was performed to compare the percentage of trials between conditions that were maintained at 2.2Hz±5%. Correlations were performed to determine if the effects were similar when providing tactile or visual feedback synchronously with the audible cue.ResultsAugmented feedback resulted in maintenance of the tf, zf and zl between the start and end of the trials compared to hopping with no feedback (p<0.01). With or without feedback there was no change in tl and k from start to end. Without feedback, 21 of 27 participants maintained >70% of total hops at 2.2±5% Hz and this was significantly lower (p=0.01) with tactile (13/27) and visual (15/27) feedback. There was a strong correlation between tactile and visual feedback for duration of hopping cycle (Spearman's r=0.74, p≤0.01).ConclusionFeedback was detrimental to being able to maintain hopping cadence in some participants while other participants were able to achieve the cadence and target hop height. This indicates variability in the ability to use real-time augmented feedback effectively.

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Long term gait outcomes of surgically treated idiopathic toe walkers

Publication date: February 2016
Source:Gait & Posture, Volume 44
Author(s): Mark L. McMulkin, Andi B. Gordon, Bryan J. Tompkins, Paul M. Caskey, Glen O. Baird
Toe walking is a common gait deviation which in the absence of a known cause is termed idiopathic toe walking. Surgical treatment in the presence of a triceps surae contracture includes tendo-Achilles or gastrocnemius/soleus recession and has been shown to be effective in improving kinematic outcomes at a one year follow up. The purpose of this study was to assess longer term kinematic and kinetic outcomes of children with idiopathic toe walking treated surgically for gastrocnemius/soleus contractures. Eight subjects with a diagnosis of idiopathic toe walking who had surgical lengthening of the gastrocnemius/soleus and had previous motion analysis laboratory studies pre-operative and 1 year post-operative, returned for a motion analysis laboratory study greater than 5 years since surgery. Subjects completed lower extremity physical exam and 3-D computerized kinematics and kinetics. Significant improvements for mean pelvic tilt, peak dorsiflexion in stance and swing, and overall kinematics index at 1 year post-operative were maintained at 5 years post-operative. Kinetic variables of ankle moment and power were improved at 1 year and 5 years post-operative. On physical exam, dorsiflexion with knee extended was tighter from 1 to 5 year follow-up which did not correspond to the functional changes of gait. Idiopathic toe walkers who were treated surgically for triceps surae contractures showed significant improvements in key kinematic and kinetic gait analysis variables at 1 year post-operative that were maintained at 5 years post-operative. Overall, subjects were satisfied with outcomes of the surgery, unrestricted in activities, and reported minimal pain.

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Relationship between maximum isometric joint moment and functional task performance in patients with brachial plexus injury: A pilot study

Publication date: February 2016
Source:Gait & Posture, Volume 44
Author(s): Dustin L. Crouch, Anthony C. Santago, Johannes F. Plate, Zhongyu Li, Katherine R. Saul
We evaluated whether subjects with brachial plexus injury (BPI) adapted their movements to reduce the mechanical demand on their impaired upper extremity. In 6 subjects with unilateral BPI with C5 and C6 involvement, we measured bilateral maximum isometric shoulder and elbow strength, and computed joint kinematics and net muscle-generated joint moments during 7 unimanual functional tasks. Compared to the unimpaired extremity, maximum strength in shoulder abduction, extension, and external rotation was 60% (p=0.02), 49% (p=0.02), and 75% (p=0.02) lower, respectively, on the impaired side. Significant kinematic and kinetic differences were observed only when reaching to the back of the head. However, because of substantially reduced strength in their impaired upper extremities, subjects used a significantly higher percentage of their maximum strength during several tasks and along several directions of movement. The peak percentage of maximal strength subjects used across tasks was 32% (p=0.03) and 29% (p=0.03) more on their impaired side in shoulder extension and external rotation, respectively. Subjects had less reserve strength available for performing upper extremity tasks and, therefore, may be less adaptive to strength declines due to injury progression and normal aging. Quantitatively measuring maximal strength may help clinicians ensure that patients maintain sufficient upper extremity strength to preserve long-term functional ability.

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Impaired synergic control of posture in Parkinson’s patients without postural instability

Publication date: February 2016
Source:Gait & Posture, Volume 44
Author(s): Ali Falaki, Xuemei Huang, Mechelle M. Lewis, Mark L. Latash
BackgroundPostural instability is one of most disabling motor symptoms in Parkinson's disease. Indices of multi-muscle synergies are new measurements of movement and postural stability.ObjectivesMulti-muscle synergies stabilizing vertical posture were studied in Parkinson's disease patients without clinical symptoms of postural instability (Hoehn-Yahr≤II) and age-matched controls. We tested the hypothesis that both synergy indices during quiet standing and synergy adjustments to self-triggered postural perturbations would be reduced in patients.MethodsEleven Parkinson's disease patients and 11 controls performed whole-body tasks while standing. Surface electromyography was used to quantify synergy indices stabilizing center of pressure shifts in the anterior–posterior direction during a load-release task.ResultsParkinson's disease patients showed a significantly lower percentage of variance in the muscle activation space accounted for by the first four principal components, significantly reduced synergy indices during steady state, and significantly reduced anticipatory synergy adjustments (a drop in the synergy index prior to the self-triggered unloading).ConclusionsThe study demonstrates for the first time that impaired synergic control in Parkinson's disease can be quantified in postural tasks, even in patients without clinical manifestations of postural instability. Synergy measurements may provide a biomarker sensitive for early problems with postural stability in Parkinson's disease.

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The reliability of local dynamic stability in walking while texting and performing an arithmetical problem

Publication date: February 2016
Source:Gait & Posture, Volume 44
Author(s): Dennis Hamacher, Daniel Hamacher, Alexander Törpel, Martin Krowicki, Fabian Herold, Lutz Schega
In the recent years, local dynamic stability of walking was frequently used to quantify motor control. Particularly, dual-task paradigms are used to assess a shift in gait control strategy to test walking in real life situations. Texting short messages while walking is a common motor-cognitive dual task of daily living. To able to monitor possible intervention effects on motor-cognitive dual-task performance, the test-retest reliability of the measure has to be evaluated. Since the reliability of the effects of cognitive tasks including texting while walking on local dynamic gait stability has not been assessed yet, this will be evaluated in the current study. Eleven young individuals were included. Gait data was registered twice (test-retest interval: seven days) using an inertial sensor fixed on the subjects' trunks in three conditions: normal walking, walking while texting a message and walking while reciting serials of 7. Short-term finite maximum Lyapunov Exponents were quantified to assess local dynamic stability. The test-retest reliability was calculated using intra-class correlation coefficients and Bland and Altman Plots (bias and limits of agreement). ICC values of the current study show that in normal walking and walking while texting, outcomes are comparable and indicate mostly good to excellent reliability. The reliability values were almost always the lowest in walking while reciting serials of 7. Local dynamic stability derived from kinematic data of walking while cell phone texting can be reliably collected and, in turn, be used as an outcome measure in clinical trials with repeated measures design.

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Manipulating walking path configuration influences gait variability and six-minute walk test outcomes in older and younger adults

Publication date: February 2016
Source:Gait & Posture, Volume 44
Author(s): C.T. Barnett, M. Bisele, J.S. Jackman, T. Rayne, N.C. Moore, J.L. Spalding, P. Richardson, B. Plummer
This study determined whether manipulations to walking path configuration influenced six-minute walk test (6MWT) outcomes and assessed how gait variability changes over the duration of the 6MWT in different walking path configurations. Healthy older (ODR) and younger (YNG) (n=24) adults completed familiarisation trials and five randomly ordered experimental trials of the 6MWT with walking configurations of; 5, 10 and 15m straight lines, a 6m by 3m rectangle (RECT), and a figure of eight (FIG8). Six-minute walk distance (6MWD) and walking speed (m.s−1) were recorded for all trials and the stride count recorded for experimental trials. Reflective markers were attached to the sacrum and feet with kinematic data recorded at 100Hz by a nine-camera motion capture system for 5m, 15m and FIG8 trials, in order to calculate variability in stride and step length, stride width, stride and step time and double limb support time. Walking speeds and 6MWD were greatest in the 15m and FIG8 experimental trials in both groups (p<0.01). Step length and stride width variability were consistent over the 6MWT duration but greater in the 5m trial vs. the 15m and FIG8 trials (p<0.05). Stride and step time and double limb support time variability all reduced between 10 and 30 strides (p<0.01). Stride and step time variability were greater in the 5m vs. 15m and FIG8 trials (p<0.01). Increasing uninterrupted gait and walking path length results in improved 6MWT outcomes and decreased gait variability in older and younger adults.

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Peri-implant bone loss clinical and radiographic evaluation around rough neck and microthread implants: a 5-year study

Abstract

Objective

To evaluate marginal bone loss over 5 years around microthreaded implants placed in the maxillary anterior/esthetic zone and immediate restored with non-occlusal loading.

Materials and methods

Seventy-one implants (with microthreads up to the platform-rough surface body and neck, internal connection and platform switching) were placed in healed bone in the maxillary arches of 30 men and 23 women (mean age 37.85 ± 7.09 years, range 27–60). All subjects had at least 3 mm of soft tissue to allow the establishment of adequate biologic width and to reduce bone resorption. Each patient received a provisional restoration immediately after implant placement with slight occlusal contact. Mesial and distal bone height was evaluated using digital radiography on the day following implant placement (baseline) and after 1, 2, 3, 4 and 5 years. Primary stability was measured with resonance frequency analysis.

Results

No implants failed, resulting in a cumulative survival rate of 100% after 3 years. Marginal bone loss from implant collar to bone crest measured at baseline (peri-implant bone defect at the fresh extraction socket) and after 5 years was 0.90 mm ± 0.26 mm. Mesial and distal site crestal bone loss ranged from 3.42 ± 1.2 mm at baseline to 3.51 ± 1.5 mm after 5 years and from 3.38 ± 0.9 mm at baseline to 3.49 ± 0.9 mm after 5 years, respectively (P = 0.086).

Conclusions

The results of this study showed limited implant crestal bone loss 0.90 mm ± 0.26 mm and 100% of implant survival rate at 5-year follow-up of immediate restored implants with rough surface neck and microthreads.

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