Cellular phenotyping of chronic rhinosinusitis with nasal polyps.

Cellular phenotyping of chronic rhinosinusitis with nasal polyps.

Rhinology. 2016 Jan 9;

Authors: Lou H, Meng Y, Piao Y, Zhang N, Bachert C, Wang C, Zhang L

Abstract
BACKGROUND: Defining the phenotypes of chronic rhinosinusitis with nasal polyps (CRSwNP) with prognosis may lead to delivery of personalized treatment. This study aimed to identify cellular phenotypes of CRSwNP using cluster analysis and define an algorithm for different clusters associated with polyp recurrence.
METHODS: Overall, 366 patients with CRSwNP were enrolled in this retrospective analysis. Eighteen variables, including clinical characteristics and tissue/peripheral inflammatory cells assessments, were selected for factor analysis. Unsupervised cluster analysis was performed after variables reduction and standardization and differences in polyp recurrence during follow-up for a minimum of 24 months were analysed among clusters. Discriminant analysis was further used to develop a clinically useful algorithm for predicting clustering.
RESULTS: Five phenotypic clusters were identified. Clusters 1 and 2 were plasma cell-dominant and lymphocyte-dominant phenotypes, respectively. Cluster 3 revealed a mixed inflammatory pattern. Cluster 4 was characterized by infiltration of predominantly neutrophils. Cluster 5 was characterized by a marked tissue eosinophilia and highest recurrence rate of 98.5%. The clinical algorithm predicted clustering with 93.7% accuracy.
CONCLUSIONS: Chinese CRSwNP patients may be classified into five phenotypes with different polyp recurrence rates, based on the presence of predominantly plasma cells, lymphocytes, neutrophils, eosinophils or mixed inflammatory cells in polyps.

PMID: 26747641 [PubMed - as supplied by publisher]

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Three-dimensional analysis of the accuracy of optic and electromagnetic navigation systems using surface registration in live endoscopic sinus surgery.

Three-dimensional analysis of the accuracy of optic and electromagnetic navigation systems using surface registration in live endoscopic sinus surgery.

Rhinology. 2016 Jan 9;

Authors: Chang CM, Jaw FS, Lo WC, Fang KM, Cheng PW

Abstract
BACKGROUND: This study presents the first report in the same patients on the time efficiency of surface registration as well as the navigational accuracy using optic and electromagnetic tracking systems.
METHODS: Thirty patients with bilateral chronic paranasal pansinusitis underwent endoscopic sinus surgery. After surface registration, the surgeries were performed on one side using optic navigation guidance and on the other side using electromagnetic navigation guidance. The intraoperative measurements performed included the time taken for the surface registration and surgical procedure on each side, as well as the navigation errors at the different locations.
RESULTS: The time for surface registration was significantly longer in the optic navigation group than the electromagnetic group. A comparison of the navigation errors along the 3 axes showed that the deviation in the medial-lateral direction was significantly less than that in the anterior-posterior and cranial-caudal directions in the optic navigation group as well as the electromagnetic group.
CONCLUSIONS: The procedure for surface registration in both optic and electromagnetic guidance is efficient and convenient. The accuracy of both navigation systems is comparable and within acceptable ranges for clinical use. In addition, the best accuracy was measured in the medial-lateral direction compared with the other two axes.

PMID: 26747431 [PubMed - as supplied by publisher]

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Device Life of Two Generations of Provox Voice Prostheses.

Device Life of Two Generations of Provox Voice Prostheses.

Ann Otol Rhinol Laryngol. 2016 Jan 7;

Authors: Thylur DS, Villegas BC, Fisher LM, Sinha UK, Kokot N

Abstract
BACKGROUND: Tracheoesophageal voice prostheses are invaluable for speech rehabilitation in patients who have received total laryngectomy, but device failure impedes communication and creates psychosocial and financial burdens. This study compares the Provox 2 and Provox Vega voice prostheses on the parameter of device life.
METHODS: This was a retrospective observational study of 21 patients with 181 device replacements at an academic tertiary care medical center. Disparity in device life and factors that may influence device life were analyzed.
RESULTS: The mean device life for Provox 2, at 115.6 days (SE = 5.8), was longer than for Provox Vega, at 65.1 days (SE = 7.5) (P < .001).
CONCLUSIONS: Device longevity was greater for Provox 2 over Provox Vega. These results will facilitate the design of prospective studies to assess reasons for variations in device life between patients and device types.

PMID: 26747630 [PubMed - as supplied by publisher]

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Myeloperoxidase-Antineutrophil Cytoplasmic Antibody-Positive Otitis Media and Rhinosinusitis With Pathological Features of Immunoglobulin G4-Related Disease: A Case Report.

Myeloperoxidase-Antineutrophil Cytoplasmic Antibody-Positive Otitis Media and Rhinosinusitis With Pathological Features of Immunoglobulin G4-Related Disease: A Case Report.

Ann Otol Rhinol Laryngol. 2016 Jan 7;

Authors: Ohno K, Matsuda Y, Arai T, Sugihara T, Iga S, Kimura Y

Abstract
BACKGROUND: Immunoglobulin G4-related disease (IgG4-RD) and antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have different clinical and pathological features. However, differentiation between these 2 disorders is sometimes difficult.
OBJECTIVE: To report a case involving a patient with characteristics of both IgG4-RD and AAV.
METHODS: Case report with literature review.
RESULTS: We report a case of myeloperoxidase-ANCA-positive otitis media and rhinosinusitis with pathological features of IgG4-RD in a 73-year-old man. The patient was first clinically suspected to have granulomatosis with polyangiitis. All of the main characteristic pathological features of IgG4-RD were present: dense lymphoplasmacytic infiltration, increased numbers of IgG4-positive plasma cells, storiform-type fibrosis, and obliterative phlebitis.
CONCLUSIONS: The simultaneous presence of the characteristics of both IgG4-RD and AAV makes diagnosis and treatment difficult.

PMID: 26747629 [PubMed - as supplied by publisher]

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Book Review: A Century of Progress in Head & Neck Cancer.

Book Review: A Century of Progress in Head & Neck Cancer.

Ann Otol Rhinol Laryngol. 2016 Feb;125(2):177

Authors: Palma GL

PMID: 26747429 [PubMed - as supplied by publisher]

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Book Review: Facial Paralysis: A Comprehensive Rehabilitative Approach.

Book Review: Facial Paralysis: A Comprehensive Rehabilitative Approach.

Ann Otol Rhinol Laryngol. 2016 Feb;125(2):177

Authors: Free N

PMID: 26747428 [PubMed - as supplied by publisher]

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Experienced versus Inexperienced Interexaminer Reliability on Location and Classification of Myofascial Trigger Point Palpation to Diagnose Lateral Epicondylalgia: An Observational Cross-Sectional Study

The purpose was to evaluate the interexaminer reliability of experienced and inexperienced examiners on location and classification of myofascial trigger points (MTrPs) in two epicondylar muscles and the association between the MTrP found and the diagnosis of lateral epicondylalgia (LE). Fifty-two pianists (some suffered LE) voluntarily participated in the study. Three physiotherapists (one inexperienced in myofascial pain) examined, located, and marked MTrPs in the extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) muscles. Forearms were photographed and analyzed to establish the degree of agreement on MTrPs diagnosis. Data showed 81.73% and 77.88% of agreement on MTrP classification and 85.58% and 72.12% on MTrP location between the expert evaluators for ECRB and EDC, respectively. The agreement on MTrP classification between experienced and inexperienced examiners was 54.81% and 51.92% for ECRB and 50.00% and 55.77% for EDC. Also, agreement on MTrP location was 54.81% and 60.58% for ECRB and 48.08% and 48.08% for EDC. A strong association was found between presence of relevant MTrPs, LE diagnosis, and forearm pain when the examiners were experts. The analysis of location and classification of MTrPs in the epicondylar muscles through physical examination by experienced evaluators is reliable, reproducible, and suitable for diagnosing LE.

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Intraoral Digital Impressions for Virtual Occlusal Records: Section Quantity and Dimensions

The purpose of this study was to locate the 3D spatial position mandibular cast and determine its occlusal contacts in a novel way by using an intraoral scanner as part of the virtual occlusal record procedure. This study also analyzes the requirements in quantity and dimensions of the intraoral virtual occlusal record. The results showed that the best section combination consists of 2 lateral and frontal sections, the width of this section being that of 2 teeth (24 mm × 15 mm). This study concluded that this procedure was accurate enough to locate the mandibular cast on a virtual articulator. However, at least 2 sections of the virtual occlusal records were necessary, and the best results were obtained when the distance between these sections was maximum.

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Book Review: Facial Paralysis: A Comprehensive Rehabilitative Approach.

Book Review: Facial Paralysis: A Comprehensive Rehabilitative Approach.

Ann Otol Rhinol Laryngol. 2016 Feb;125(2):177

Authors: Free N

PMID: 26747428 [PubMed - as supplied by publisher]

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Laser-evoked cortical responses in freely-moving rats reflect the activation of C-fibre afferent pathways.

Laser-evoked cortical responses in freely-moving rats reflect the activation of C-fibre afferent pathways.

Neuroimage. 2015 Dec 30;

Authors: Xia XL, Peng WW, Iannetti GD, Hu L

Abstract
The limited success of translating basic animal findings into effective clinical treatments of pain can be partly ascribed to the use of sub-optimal models. Murine models of pain often consist in recording (1) threshold responses (like the tail-flick reflex) elicited by (2) non-nociceptive specific input in (3) anaesthetized animals. The direct cortical recording of laser-evoked potentials (LEPs) elicited by stimuli of graded energies in freely-moving rodents avoids these three important pitfalls, and has thus the potential of improving such translation. Murine LEPs are classically reported to consist of two distinct components, reflecting the activity of Aδ- and C-fibre afferent pathways. However, we have recently demonstrated that the so-called "Aδ-LEPs" in fact reflect the activation of the auditory system by laser-generated ultrasounds. Here we used ongoing white noise to avoid the confound represented by the early auditory response, and thereby comprehensively characterized the physiological properties of C-fibre LEPs recorded directly from the exposed surface of the rat brain. Stimulus-response functions indicated that response amplitude is positively related to the stimulus energy, as well as to nocifensive behavioral score. When displayed using average reference, murine LEPs consist of three distinct deflections, whose polarity, order, and topography are surprisingly similar to human LEPs. The scalp topography of the early N1 wave is somatotopically-organized, likely reflecting the activity of the primary somatosensory cortex, while topographies of the later N2 and P2 waves are more centrally distributed. These results indicate that recording LEPs in freely-moving rats is a valid model to improve the translation of animal results to human physiology and pathophysiology.

PMID: 26747747 [PubMed - as supplied by publisher]

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Head and Neck Schwannomas: 20-Year Experience of a Single Institution Excluding Cutaneous and Acoustic Sites.

Head and Neck Schwannomas: 20-Year Experience of a Single Institution Excluding Cutaneous and Acoustic Sites.

Head Neck Pathol. 2016 Jan 8;

Authors: Butler RT, Patel RM, McHugh JB

Abstract
While head and neck sites comprise the most common location of schwannomas, clinicopathologic data regarding those tumors occurring in non-acoustic and non-cutaneous locations are relatively sparse. In this study, therefore, we sought to examine retrospectively the clinical and pathologic features of head and neck schwannomas excised at our institution over a 20-year period. During this period, we identified a total cohort of 85 patients, which included 36 males (42.4 %) and 49 females with average age of 41.3 years, the majority of which presented asymptomatically with a mass. Localized symptoms were, however, associated with all of the schwannomas that arose in the oral cavity and larynx, while tumors within or adjacent to bone were often associated with neurologic complaints (7 of 15 such tumors [46.7 %]). Clinical follow-up data was available in 86.4 % of all cases and demonstrated no recurrences or mortality. Pathologically, the microscopic features were characteristic of those well-described for schwannomas in other sites, including alternating Antoni A and B areas and the presence of degenerative changes. Tumor encapsulation, however, was variable and was completely absent in schwannomas of the nasal cavity, paranasal sinuses, and larynx. Additionally, a significant minority of the tumors (28.2 %) exhibited foci that resembled neurofibroma. Non-acoustic, non-cutaneous schwannomas of the head and neck appear to have clinicopathologic features similar to their soft tissue counterparts with some subsite variation in presentation and/or microscopic features.

PMID: 26747460 [PubMed - as supplied by publisher]

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[Current methods for modelling voice production].

[Current methods for modelling voice production].

HNO. 2016 Jan 8;

Authors: Döllinger M, Kniesburges S, Kaltenbacher M, Echternach M

Abstract
BACKGROUND: Many details of the phonatory process are not yet fully understood. Besides observational research, scientists have long since been trying to explain the physical fundamentals of voicing using simulations. This approach is commonly called modeling. However, the knowledge gained often failed to find its way to professionals working with the voice, such as singing teachers, voice therapists, and voice coaches, and sometimes also to otorhinolaryngologists and phoniatricians. The reason for this is that scientific publications on this topic mostly contain very detailed mathematical and physical descriptions, which are often hard to understand.
OBJECTIVE: A simplified presentation and explanation of current methods for modeling the phonatory process, which have contributed greatly to uncovering and understanding the relationships involved in voicing during recent years.
METHODS: The presented methods cover a wide spectrum, ranging from numerically rather simple to mathematically highly complex models. Experimental models are based on self-oscillating silicon or static vocal folds. Cadaver models have the advantage of being representative of the natural phonation process.
RESULTS: An overview of different kinds of models is given to show the diversity of modeling approaches without going into mathematical or physical details.
CONCLUSION: Numerical and experimental models for simulating the phonatory process enable causalities and correlations to be uncovered, which can be used in the future to adapt conservative and surgical voice therapies, or even to suggest entire new treatment strategies.

PMID: 26746639 [PubMed - as supplied by publisher]

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Evaluating the Need for Daily Image Guidance in Head and Neck Cancers Treated with Helical Tomotherapy: A Retrospective Analysis of a Large Number of Daily Imaging-based Corrections.

Evaluating the Need for Daily Image Guidance in Head and Neck Cancers Treated with Helical Tomotherapy: A Retrospective Analysis of a Large Number of Daily Imaging-based Corrections.

Clin Oncol (R Coll Radiol). 2015 Dec 30;

Authors: Saha A, Mallick I, Das P, Shrimali RK, Achari R, Chatterjee S

Abstract
AIMS: Clinical implementation of image-guided intensity-modulated radiotherapy is rapidly evolving. Helical tomotherapy treatment delivery involves daily imaging before intensity-modulated radiotherapy delivery. This can be a time consuming resource-intensive process, which may not be essential in head and neck radiotherapy, where effective immobilisation is possible. This study aimed to evaluate whether an offline protocol implementing the shifts derived from the first few fractions can be an acceptable alternative to daily imaging for helical tomotherapy.
MATERIALS AND METHODS: We retrospectively analysed the set-up data of 2858 fractions of 100 head and neck cancer patients who were treated with daily online image guidance. Using summary data from all treatment fractions, we calculated the systematic error (∑) and random error (σ) in each of the three axes, i.e. mediolateral (x), craniocaudal (y), anteroposterior (z). We also calculated the translational vector of each fraction of individual patients. We then simulated two no-action-level offline protocols where set-up errors of the first three (protocol F3) or five fractions (protocol F5) were averaged and implemented for the remaining fractions. The residual errors in each axis for these fractions were determined together with the residual ∑ and σ. Planning target volume (PTV) margins using the van Herk formula were generated based on the uncorrected errors as well as for the F3 and F5 protocols. For each scenario, we tabulated the number of fractions where the residual errors were more than 5 mm (our default PTV margin). We also tried to evaluate whether errors tended to differ based on intent (radical or adjuvant), anatomical subsite or weight loss during treatment.
RESULTS: Analysis from this large dataset revealed that in the tomotherapy platform, the highest set-up errors were in the anteroposterior (z) axis. The global mean was 5.4 mm posterior shift, which can be partly attributed to couch sag on this system. Uncorrected set-up errors resulted in systematic and random errors of ∑x,y,z of 1.8, 1.7 and 2 mm and σx,y,z of 1.7, 1.5 and 1.9 mm, with a required PTV margin in x, y, z axes of 5.7, 5.3 and 6.2 mm. Implementing average shifts from the first three or five fractions resulted in a substantial reduction in the residual systematic errors, whereas random errors remained constant. The PTV margins required for the residual errors after three and five fraction corrections were 3.8, 3.4 and 5.1 mm for F3 and 3.3, 2.9, 4.8 mm for F5. The proportions of fractions where there was >5 mm residual error were 1.6%, 1.1%, 2.9% in x, y and z axes in the F3 protocol and 1.5%, 0.8% and 2.6% with the F5 protocol. Although there was no difference in residual shifts > 5 mm, there was a statistically higher chance of residual errors > 3 mm larynx/hypopharynx subsites versus other sites. In patients who had more than 5% weight loss, there was no significant increase in residual errors with the F5 protocol and the required PTV margin was within our default PTV margins expansion.
CONCLUSIONS: Correction of systematic errors by implementing average shifts from the first five fractions enables us to safely avoid daily imaging in this retrospective analysis. If this is validated in a prospective group it could lead to implementation of a resource sparing image-guided radiotherapy protocol both in terms of time and imaging dose. Patients with larynx/hypopharynx subsites may require more careful evaluation and daily online matching.

PMID: 26746002 [PubMed - as supplied by publisher]

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Altered expression and signalling of EP2 receptor in nasal polyps of AERD patients: role in inflammation and remodelling.

Altered expression and signalling of EP2 receptor in nasal polyps of AERD patients: role in inflammation and remodelling.

Rhinology. 2016 Jan 9;

Authors: Machado-Carvalho L, Torres R, Perez-Gonzalez M, Alobid I, Mullol J, Pujols L, Roca-Ferrer J, Picado C

Abstract
BACKGROUND: Down-regulation of the E-prostanoid (EP)2 receptor has been reported in aspirin exacerbated respiratory disease (AERD). We aimed to evaluate the expression and activation of EP receptors in AERD and their role in prostaglandin (PG) E2 signalling.
METHODS: Samples were obtained from nasal mucosa of control subjects (NM-C, n=7) and from nasal polyps of AERD patients (NP-AERD, n=7). Expression of EP1-4 was assessed at baseline. Fibroblasts were stimulated with receptor agonists to measure cAMP levels, cell proliferation and granulocyte-macrophage colony-stimulating factor (GM-CSF) release.
RESULTS: NM-C and NP-AERD samples and fibroblasts expressed EP2, EP3 and EP4 at baseline. Lower expression of EP2 and higher expression of EP4 was observed in NP-AERD compared with NM-C. Stimulation with PGE2 and butaprost caused a higher increase in cAMP in NM-C than in NP-AERD. On the contrary, CAY10598 produced a higher production of cAMP in NP-AERD compared with NM-C. The anti-proliferative effect of PGE2 and butaprost was lower in NP-AERD than in NM-C fibroblasts. Similarly, the capacity of PGE2 and butaprost to inhibit GM-CSF release was lower in NP-AERD than in NM-C.
CONCLUSIONS: The altered expression of EP2 in AERD may contribute to reduce the capacity of PGE2 to mediate anti-proliferative and anti-inflammatory effects.

PMID: 26747755 [PubMed - as supplied by publisher]

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Cellular phenotyping of chronic rhinosinusitis with nasal polyps.

Cellular phenotyping of chronic rhinosinusitis with nasal polyps.

Rhinology. 2016 Jan 9;

Authors: Lou H, Meng Y, Piao Y, Zhang N, Bachert C, Wang C, Zhang L

Abstract
BACKGROUND: Defining the phenotypes of chronic rhinosinusitis with nasal polyps (CRSwNP) with prognosis may lead to delivery of personalized treatment. This study aimed to identify cellular phenotypes of CRSwNP using cluster analysis and define an algorithm for different clusters associated with polyp recurrence.
METHODS: Overall, 366 patients with CRSwNP were enrolled in this retrospective analysis. Eighteen variables, including clinical characteristics and tissue/peripheral inflammatory cells assessments, were selected for factor analysis. Unsupervised cluster analysis was performed after variables reduction and standardization and differences in polyp recurrence during follow-up for a minimum of 24 months were analysed among clusters. Discriminant analysis was further used to develop a clinically useful algorithm for predicting clustering.
RESULTS: Five phenotypic clusters were identified. Clusters 1 and 2 were plasma cell-dominant and lymphocyte-dominant phenotypes, respectively. Cluster 3 revealed a mixed inflammatory pattern. Cluster 4 was characterized by infiltration of predominantly neutrophils. Cluster 5 was characterized by a marked tissue eosinophilia and highest recurrence rate of 98.5%. The clinical algorithm predicted clustering with 93.7% accuracy.
CONCLUSIONS: Chinese CRSwNP patients may be classified into five phenotypes with different polyp recurrence rates, based on the presence of predominantly plasma cells, lymphocytes, neutrophils, eosinophils or mixed inflammatory cells in polyps.

PMID: 26747641 [PubMed - as supplied by publisher]

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Three-dimensional analysis of the accuracy of optic and electromagnetic navigation systems using surface registration in live endoscopic sinus surgery.

Three-dimensional analysis of the accuracy of optic and electromagnetic navigation systems using surface registration in live endoscopic sinus surgery.

Rhinology. 2016 Jan 9;

Authors: Chang CM, Jaw FS, Lo WC, Fang KM, Cheng PW

Abstract
BACKGROUND: This study presents the first report in the same patients on the time efficiency of surface registration as well as the navigational accuracy using optic and electromagnetic tracking systems.
METHODS: Thirty patients with bilateral chronic paranasal pansinusitis underwent endoscopic sinus surgery. After surface registration, the surgeries were performed on one side using optic navigation guidance and on the other side using electromagnetic navigation guidance. The intraoperative measurements performed included the time taken for the surface registration and surgical procedure on each side, as well as the navigation errors at the different locations.
RESULTS: The time for surface registration was significantly longer in the optic navigation group than the electromagnetic group. A comparison of the navigation errors along the 3 axes showed that the deviation in the medial-lateral direction was significantly less than that in the anterior-posterior and cranial-caudal directions in the optic navigation group as well as the electromagnetic group.
CONCLUSIONS: The procedure for surface registration in both optic and electromagnetic guidance is efficient and convenient. The accuracy of both navigation systems is comparable and within acceptable ranges for clinical use. In addition, the best accuracy was measured in the medial-lateral direction compared with the other two axes.

PMID: 26747431 [PubMed - as supplied by publisher]

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Device Life of Two Generations of Provox Voice Prostheses.

Device Life of Two Generations of Provox Voice Prostheses.

Ann Otol Rhinol Laryngol. 2016 Jan 7;

Authors: Thylur DS, Villegas BC, Fisher LM, Sinha UK, Kokot N

Abstract
BACKGROUND: Tracheoesophageal voice prostheses are invaluable for speech rehabilitation in patients who have received total laryngectomy, but device failure impedes communication and creates psychosocial and financial burdens. This study compares the Provox 2 and Provox Vega voice prostheses on the parameter of device life.
METHODS: This was a retrospective observational study of 21 patients with 181 device replacements at an academic tertiary care medical center. Disparity in device life and factors that may influence device life were analyzed.
RESULTS: The mean device life for Provox 2, at 115.6 days (SE = 5.8), was longer than for Provox Vega, at 65.1 days (SE = 7.5) (P < .001).
CONCLUSIONS: Device longevity was greater for Provox 2 over Provox Vega. These results will facilitate the design of prospective studies to assess reasons for variations in device life between patients and device types.

PMID: 26747630 [PubMed - as supplied by publisher]

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Myeloperoxidase-Antineutrophil Cytoplasmic Antibody-Positive Otitis Media and Rhinosinusitis With Pathological Features of Immunoglobulin G4-Related Disease: A Case Report.

Myeloperoxidase-Antineutrophil Cytoplasmic Antibody-Positive Otitis Media and Rhinosinusitis With Pathological Features of Immunoglobulin G4-Related Disease: A Case Report.

Ann Otol Rhinol Laryngol. 2016 Jan 7;

Authors: Ohno K, Matsuda Y, Arai T, Sugihara T, Iga S, Kimura Y

Abstract
BACKGROUND: Immunoglobulin G4-related disease (IgG4-RD) and antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have different clinical and pathological features. However, differentiation between these 2 disorders is sometimes difficult.
OBJECTIVE: To report a case involving a patient with characteristics of both IgG4-RD and AAV.
METHODS: Case report with literature review.
RESULTS: We report a case of myeloperoxidase-ANCA-positive otitis media and rhinosinusitis with pathological features of IgG4-RD in a 73-year-old man. The patient was first clinically suspected to have granulomatosis with polyangiitis. All of the main characteristic pathological features of IgG4-RD were present: dense lymphoplasmacytic infiltration, increased numbers of IgG4-positive plasma cells, storiform-type fibrosis, and obliterative phlebitis.
CONCLUSIONS: The simultaneous presence of the characteristics of both IgG4-RD and AAV makes diagnosis and treatment difficult.

PMID: 26747629 [PubMed - as supplied by publisher]

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Book Review: A Century of Progress in Head & Neck Cancer.

Book Review: A Century of Progress in Head & Neck Cancer.

Ann Otol Rhinol Laryngol. 2016 Feb;125(2):177

Authors: Palma GL

PMID: 26747429 [PubMed - as supplied by publisher]

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Book Review: Facial Paralysis: A Comprehensive Rehabilitative Approach.

Book Review: Facial Paralysis: A Comprehensive Rehabilitative Approach.

Ann Otol Rhinol Laryngol. 2016 Feb;125(2):177

Authors: Free N

PMID: 26747428 [PubMed - as supplied by publisher]

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Experienced versus Inexperienced Interexaminer Reliability on Location and Classification of Myofascial Trigger Point Palpation to Diagnose Lateral Epicondylalgia: An Observational Cross-Sectional Study

The purpose was to evaluate the interexaminer reliability of experienced and inexperienced examiners on location and classification of myofascial trigger points (MTrPs) in two epicondylar muscles and the association between the MTrP found and the diagnosis of lateral epicondylalgia (LE). Fifty-two pianists (some suffered LE) voluntarily participated in the study. Three physiotherapists (one inexperienced in myofascial pain) examined, located, and marked MTrPs in the extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) muscles. Forearms were photographed and analyzed to establish the degree of agreement on MTrPs diagnosis. Data showed 81.73% and 77.88% of agreement on MTrP classification and 85.58% and 72.12% on MTrP location between the expert evaluators for ECRB and EDC, respectively. The agreement on MTrP classification between experienced and inexperienced examiners was 54.81% and 51.92% for ECRB and 50.00% and 55.77% for EDC. Also, agreement on MTrP location was 54.81% and 60.58% for ECRB and 48.08% and 48.08% for EDC. A strong association was found between presence of relevant MTrPs, LE diagnosis, and forearm pain when the examiners were experts. The analysis of location and classification of MTrPs in the epicondylar muscles through physical examination by experienced evaluators is reliable, reproducible, and suitable for diagnosing LE.

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Intraoral Digital Impressions for Virtual Occlusal Records: Section Quantity and Dimensions

The purpose of this study was to locate the 3D spatial position mandibular cast and determine its occlusal contacts in a novel way by using an intraoral scanner as part of the virtual occlusal record procedure. This study also analyzes the requirements in quantity and dimensions of the intraoral virtual occlusal record. The results showed that the best section combination consists of 2 lateral and frontal sections, the width of this section being that of 2 teeth (24 mm × 15 mm). This study concluded that this procedure was accurate enough to locate the mandibular cast on a virtual articulator. However, at least 2 sections of the virtual occlusal records were necessary, and the best results were obtained when the distance between these sections was maximum.

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Book Review: Facial Paralysis: A Comprehensive Rehabilitative Approach.

Book Review: Facial Paralysis: A Comprehensive Rehabilitative Approach.

Ann Otol Rhinol Laryngol. 2016 Feb;125(2):177

Authors: Free N

PMID: 26747428 [PubMed - as supplied by publisher]

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Laser-evoked cortical responses in freely-moving rats reflect the activation of C-fibre afferent pathways.

Laser-evoked cortical responses in freely-moving rats reflect the activation of C-fibre afferent pathways.

Neuroimage. 2015 Dec 30;

Authors: Xia XL, Peng WW, Iannetti GD, Hu L

Abstract
The limited success of translating basic animal findings into effective clinical treatments of pain can be partly ascribed to the use of sub-optimal models. Murine models of pain often consist in recording (1) threshold responses (like the tail-flick reflex) elicited by (2) non-nociceptive specific input in (3) anaesthetized animals. The direct cortical recording of laser-evoked potentials (LEPs) elicited by stimuli of graded energies in freely-moving rodents avoids these three important pitfalls, and has thus the potential of improving such translation. Murine LEPs are classically reported to consist of two distinct components, reflecting the activity of Aδ- and C-fibre afferent pathways. However, we have recently demonstrated that the so-called "Aδ-LEPs" in fact reflect the activation of the auditory system by laser-generated ultrasounds. Here we used ongoing white noise to avoid the confound represented by the early auditory response, and thereby comprehensively characterized the physiological properties of C-fibre LEPs recorded directly from the exposed surface of the rat brain. Stimulus-response functions indicated that response amplitude is positively related to the stimulus energy, as well as to nocifensive behavioral score. When displayed using average reference, murine LEPs consist of three distinct deflections, whose polarity, order, and topography are surprisingly similar to human LEPs. The scalp topography of the early N1 wave is somatotopically-organized, likely reflecting the activity of the primary somatosensory cortex, while topographies of the later N2 and P2 waves are more centrally distributed. These results indicate that recording LEPs in freely-moving rats is a valid model to improve the translation of animal results to human physiology and pathophysiology.

PMID: 26747747 [PubMed - as supplied by publisher]

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The development of a framework for high-quality, sustainable and accessible rural private therapy under the Australian National Disability Insurance Scheme.

The development of a framework for high-quality, sustainable and accessible rural private therapy under the Australian National Disability Insurance Scheme.

Disabil Rehabil. 2016 Jan 8;:1-13

Authors: Dew A, Barton R, Ragen J, Bulkeley K, Iljadica A, Chedid R, Brentnall J, Bundy A, Lincoln M, Gallego G, Veitch C

Abstract
Purpose The Australian National Disability Insurance Scheme (NDIS) will provide people with individual funding with which to purchase services such as therapy from private providers. This study developed a framework to support rural private therapists to meet the anticipated increase in demand. Method The study consisted of three stages utilizing focus groups, interviews and an online expert panel. Participants included private therapists delivering services in rural New South Wales (n = 28), disability service users (n = 9) and key representatives from a range of relevant consumer and service organizations (n = 16). We conducted a thematic analysis of focus groups and interview data and developed a draft framework which was subsequently refined based on feedback from stakeholders. Results The framework highlights the need for a 'rural-proofed' policy context in which service users, therapists and communities engage collaboratively in a therapy pathway. This collaborative engagement is supported by enablers, including networks, resources and processes which are influenced by the drivers of time, cost, opportunity and motivation. Conclusions The framework identifies factors that will facilitate delivery of high-quality, sustainable, individualized private therapy services for people with a disability in rural Australia under the NDIS and emphasizes the need to reconceptualize the nature of private therapy service delivery. Implications for Rehabilitation Rural private therapists need upskilling to work with individuals with disability who have individual funding such as that provided by the Australian National Disability Insurance Scheme. Therapists working in rural communities need to consider alternative ways of delivering therapy to individuals with disability beyond the traditional one-on-one therapy models. Rural private therapists need support to work collaboratively with individuals with disability and the local community. Rural private therapists should harness locally available and broader networks, resources and processes to meet the needs and goals of individuals with disability.

PMID: 26747789 [PubMed - as supplied by publisher]

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Paralympism, Paralympic values and disability sport: a conceptual and ethical critique.

Paralympism, Paralympic values and disability sport: a conceptual and ethical critique.

Disabil Rehabil. 2016 Jan 8;:1-9

Authors: McNamee MJ

Abstract
PURPOSE: This paper explores the conceptual content of Paralympism. It exists by exploring the nascent normative framework that the International Paralympic Committee (IPC) has begun to construct around its constituent sports. The IPC sets out four values: Courage, Determination, Inspiration and Equality.
METHOD: Drawing on philosophical ethical methods it offers a critical evaluation of the four values that comprise the IPC position.
CONCLUSION: While courage is undoubtedly a moral virtue, there is more than one conception that might inform Paralympism with either/both active and passive content. It is argued that Determination is an instrumental character trait that is not necessarily ethically praiseworthy. While potentially inspiring, the efforts and abilities of Paralympic athletes need not depend on the reception of spectators whom they have no control over. Finally, being an important ethical idea, it is neither clear what kind of equality is aimed for nor how it would be operationalized within sports with respect to access to expensive technology that is often the precondition of Paralympic sporting success. It is concluded that the Paralympic movement has not yet invested sufficient intellectual effort to articulate its ethical basis, and while these four values may have something to do with Paralympism, they are insufficient to articulate the concept. Implications for Rehabilitation Athletes with disabilities are governed by a range of normative frameworks that affect their preparation for and participation in the Paralympic games and associated events. Medical models often espouse a conception of biostatistical normality that derogates persons with disabilities, yet in elite sports abnormalities in structure and function can be highly valued. There is a lack of clarity about the ethical goals for those assisting Paralympic athletes. Governing bodies in disability sports, such as the International Paralympic Committee need to more critically and coherently spell out their ethical vision for Paralympic sports, which should guide athletes and rehabilitation professionals to behave in ways that would command the general public's admiration. Paralympism, Paralympic values and disability sport: a conceptual and ethical critique.

PMID: 26747693 [PubMed - as supplied by publisher]

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The Purdue Pegboard test: normative data for older adults with low vision.

The Purdue Pegboard test: normative data for older adults with low vision.

Disabil Rehabil Assist Technol. 2016 Jan 8;:1-8

Authors: Wittich W, Nadon C

Abstract
Purpose The usability of assistive technologies depends, in part, on the user's ability to manipulate the device. In the context of aging and visual impairment, the visibility of any device and its components becomes crucial, and often users rely on tactile information in order to overcome visibility barriers. The purpose of this study was to establish performance norms for older adults with low vision on a common measure of manual dexterity: the Purdue Pegboard Test. Method The Purdue Pegboard was completed visually with the dominant, non-dominant and both hands by 134 older adults (age 60-97) with various levels of low vision, ranging from 20/30 to 20/604 in the better eye. Results Scores decreased significantly as age increased. In addition, performance using the dominant hand was generally best. Compared to previously published values, scores were lower than the norms for healthy older adults as well as those for younger visually impaired individuals. Conclusions The present values for older adults with low vision add to the already existing standards and allow for comparison among future studies with this population. Systematic examination of manual dexterity in low vision clients will enable rehabilitation specialists to make more informed recommendations in terms of usable low-vision devices. Implications for rehabilitation Older adults with visual impairment often rely on tactile cues when using assistive devices. The Purdue Pegboard provides a systematic evaluation of manual dexterity, whereby age norms exist for older adults and for visually impaired younger adults. We present normative data on the Purdue Pegboard test for older adults with low vision in order to facilitate comparison of performance. Systematic evaluation of manual dexterity will inform whether some assistive devices are suitable for older adults with a visual impairment.

PMID: 26746872 [PubMed - as supplied by publisher]

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Envisioning future cognitive telerehabilitation technologies: a co-design process with clinicians.

Envisioning future cognitive telerehabilitation technologies: a co-design process with clinicians.

Disabil Rehabil Assist Technol. 2016 Jan 8;:1-18

Authors: How TV, Hwang AS, Green RE, Mihailidis A

Abstract
Purpose Cognitive telerehabilitation is the concept of delivering cognitive assessment, feedback, or therapeutic intervention at a distance through technology. With the increase of mobile devices, wearable sensors, and novel human-computer interfaces, new possibilities are emerging to expand the cognitive telerehabilitation paradigm. This research aims to: (1) explore design opportunities and considerations when applying emergent pervasive computing technologies to cognitive telerehabilitation and (2) develop a generative co-design process for use with rehabilitation clinicians. Methods We conducted a custom co-design process that used design cards, probes, and design sessions with traumatic brain injury (TBI) clinicians. All field notes and transcripts were analyzed qualitatively. Results Potential opportunities for TBI cognitive telerehabilitation exist in the areas of communication competency, executive functioning, emotional regulation, energy management, assessment, and skill training. Designers of TBI cognitive telerehabilitation technologies should consider how technologies are adapted to a patient's physical/cognitive/emotional state, their changing rehabilitation trajectory, and their surrounding life context (e.g. social considerations). Clinicians were receptive to our co-design approach. Conclusion Pervasive computing offers new opportunities for life-situated cognitive telerehabilitation. Convivial design methods, such as this co-design process, are a helpful way to explore new design opportunities and an important space for further methodological development. Implications for Rehabilitation Designers of rehabilitation technologies should consider how to extend current design methods in order to facilitate the creative contribution of rehabilitation stakeholders. This co-design approach enables a fuller participation from rehabilitation clinicians at the front-end of design. Pervasive computing has the potential to: extend the duration and intensity of cognitive telerehabilitation training (including the delivery of 'booster' sessions or maintenance therapies); provide assessment and treatment in the context of a traumatic brain injury (TBI) patient's everyday life (thereby enhancing generalization); and permit time-sensitive interventions. Long-term use of pervasive computing for TBI cognitive telerehabilitation should take into account a patient's changing recovery trajectory, their meaningful goals, and their journey from loss to redefinition.

PMID: 26746683 [PubMed - as supplied by publisher]

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Isolated Intramedullary Spinal Rosai-Dorfman Disease: A Case Report and Literature Review.

Isolated Intramedullary Spinal Rosai-Dorfman Disease: A Case Report and Literature Review.

World Neurosurg. 2015 Dec 31;

Authors: Huang BY, Liu HL, Yu CJ

Abstract
Rosai-Dorfman disease (RDD) is a rare histioproliferative disorder that only occasionally involves the central nervous system (CNS). We presented the diagnosis and treatment of an exceedingly rare case of isolated intramedullary spinal RDD which was previously reported for only 3 times. Moreover, it was for the first time that intramedullary spinal RDD was described in child. The patient was treated by total surgical resection and experienced no recurrence during the 12-months follow-up. Histopathological examination showed a characteristic emperipolesis, the lymphocytes were engulfed in the S-100-protein-positive histiocytes with negative expression of CD1a. Preoperative diagnosis of spinal RDD is still challenging because the lesion is usually a dura-based lesion that mimics a meningioma. Surgical resection is an effective treatment and radiotherapy, steroid and chemotherapy has not demonstrated reliable therapeutic efficiency.

PMID: 26748178 [PubMed - as supplied by publisher]

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Delayed Migration of Fractured K-wire Causing Vertebral Artery Invagination Following Anterior Atlantoaxial Fixation: A Case Report.

Delayed Migration of Fractured K-wire Causing Vertebral Artery Invagination Following Anterior Atlantoaxial Fixation: A Case Report.

World Neurosurg. 2015 Dec 31;

Authors: Hafez A, Ibrahim T, Raj R, Antinheimo J, Siironen J, Hernesniemi J

Abstract
Most of attention during spinal surgery, when using wires and screws, is going to avoid injuries of the critical structures (nerves and vessels). When these wires are broken during surgery, the most important point is to take them out safely or, if it is impossible, to leaf them in secure place and follow the patient closely. Migrations broken k-wire is well known in literature. However, to the best of our knowledge, migration fractured K-wire during anterior atlantoaxial fixation of cervical spine is not reported in the literature. We report a case in which a fractured k-wire has been imbedded in the lateral mass of C1 for three years and then migrated to endanger the dominant right vertebral artery. By using posterior approach and drilling right part of posterior arch of C1 we manage to secure the vertebral artery. The broken k-wire was successfully extracted away. In our case, with optimal follow-up, the burred wire inside hard bone has been moved in delayed fashion to come out of the bone and grooving the dominant vertebral artery. Our recommendation is to investigate the k-wire in every attempt of using it and to try as much as we can when to take it out immediately.

PMID: 26748177 [PubMed - as supplied by publisher]

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The development of a framework for high-quality, sustainable and accessible rural private therapy under the Australian National Disability Insurance Scheme.

The development of a framework for high-quality, sustainable and accessible rural private therapy under the Australian National Disability Insurance Scheme.

Disabil Rehabil. 2016 Jan 8;:1-13

Authors: Dew A, Barton R, Ragen J, Bulkeley K, Iljadica A, Chedid R, Brentnall J, Bundy A, Lincoln M, Gallego G, Veitch C

Abstract
Purpose The Australian National Disability Insurance Scheme (NDIS) will provide people with individual funding with which to purchase services such as therapy from private providers. This study developed a framework to support rural private therapists to meet the anticipated increase in demand. Method The study consisted of three stages utilizing focus groups, interviews and an online expert panel. Participants included private therapists delivering services in rural New South Wales (n = 28), disability service users (n = 9) and key representatives from a range of relevant consumer and service organizations (n = 16). We conducted a thematic analysis of focus groups and interview data and developed a draft framework which was subsequently refined based on feedback from stakeholders. Results The framework highlights the need for a 'rural-proofed' policy context in which service users, therapists and communities engage collaboratively in a therapy pathway. This collaborative engagement is supported by enablers, including networks, resources and processes which are influenced by the drivers of time, cost, opportunity and motivation. Conclusions The framework identifies factors that will facilitate delivery of high-quality, sustainable, individualized private therapy services for people with a disability in rural Australia under the NDIS and emphasizes the need to reconceptualize the nature of private therapy service delivery. Implications for Rehabilitation Rural private therapists need upskilling to work with individuals with disability who have individual funding such as that provided by the Australian National Disability Insurance Scheme. Therapists working in rural communities need to consider alternative ways of delivering therapy to individuals with disability beyond the traditional one-on-one therapy models. Rural private therapists need support to work collaboratively with individuals with disability and the local community. Rural private therapists should harness locally available and broader networks, resources and processes to meet the needs and goals of individuals with disability.

PMID: 26747789 [PubMed - as supplied by publisher]

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Paralympism, Paralympic values and disability sport: a conceptual and ethical critique.

Paralympism, Paralympic values and disability sport: a conceptual and ethical critique.

Disabil Rehabil. 2016 Jan 8;:1-9

Authors: McNamee MJ

Abstract
PURPOSE: This paper explores the conceptual content of Paralympism. It exists by exploring the nascent normative framework that the International Paralympic Committee (IPC) has begun to construct around its constituent sports. The IPC sets out four values: Courage, Determination, Inspiration and Equality.
METHOD: Drawing on philosophical ethical methods it offers a critical evaluation of the four values that comprise the IPC position.
CONCLUSION: While courage is undoubtedly a moral virtue, there is more than one conception that might inform Paralympism with either/both active and passive content. It is argued that Determination is an instrumental character trait that is not necessarily ethically praiseworthy. While potentially inspiring, the efforts and abilities of Paralympic athletes need not depend on the reception of spectators whom they have no control over. Finally, being an important ethical idea, it is neither clear what kind of equality is aimed for nor how it would be operationalized within sports with respect to access to expensive technology that is often the precondition of Paralympic sporting success. It is concluded that the Paralympic movement has not yet invested sufficient intellectual effort to articulate its ethical basis, and while these four values may have something to do with Paralympism, they are insufficient to articulate the concept. Implications for Rehabilitation Athletes with disabilities are governed by a range of normative frameworks that affect their preparation for and participation in the Paralympic games and associated events. Medical models often espouse a conception of biostatistical normality that derogates persons with disabilities, yet in elite sports abnormalities in structure and function can be highly valued. There is a lack of clarity about the ethical goals for those assisting Paralympic athletes. Governing bodies in disability sports, such as the International Paralympic Committee need to more critically and coherently spell out their ethical vision for Paralympic sports, which should guide athletes and rehabilitation professionals to behave in ways that would command the general public's admiration. Paralympism, Paralympic values and disability sport: a conceptual and ethical critique.

PMID: 26747693 [PubMed - as supplied by publisher]

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The Purdue Pegboard test: normative data for older adults with low vision.

The Purdue Pegboard test: normative data for older adults with low vision.

Disabil Rehabil Assist Technol. 2016 Jan 8;:1-8

Authors: Wittich W, Nadon C

Abstract
Purpose The usability of assistive technologies depends, in part, on the user's ability to manipulate the device. In the context of aging and visual impairment, the visibility of any device and its components becomes crucial, and often users rely on tactile information in order to overcome visibility barriers. The purpose of this study was to establish performance norms for older adults with low vision on a common measure of manual dexterity: the Purdue Pegboard Test. Method The Purdue Pegboard was completed visually with the dominant, non-dominant and both hands by 134 older adults (age 60-97) with various levels of low vision, ranging from 20/30 to 20/604 in the better eye. Results Scores decreased significantly as age increased. In addition, performance using the dominant hand was generally best. Compared to previously published values, scores were lower than the norms for healthy older adults as well as those for younger visually impaired individuals. Conclusions The present values for older adults with low vision add to the already existing standards and allow for comparison among future studies with this population. Systematic examination of manual dexterity in low vision clients will enable rehabilitation specialists to make more informed recommendations in terms of usable low-vision devices. Implications for rehabilitation Older adults with visual impairment often rely on tactile cues when using assistive devices. The Purdue Pegboard provides a systematic evaluation of manual dexterity, whereby age norms exist for older adults and for visually impaired younger adults. We present normative data on the Purdue Pegboard test for older adults with low vision in order to facilitate comparison of performance. Systematic evaluation of manual dexterity will inform whether some assistive devices are suitable for older adults with a visual impairment.

PMID: 26746872 [PubMed - as supplied by publisher]

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Envisioning future cognitive telerehabilitation technologies: a co-design process with clinicians.

Envisioning future cognitive telerehabilitation technologies: a co-design process with clinicians.

Disabil Rehabil Assist Technol. 2016 Jan 8;:1-18

Authors: How TV, Hwang AS, Green RE, Mihailidis A

Abstract
Purpose Cognitive telerehabilitation is the concept of delivering cognitive assessment, feedback, or therapeutic intervention at a distance through technology. With the increase of mobile devices, wearable sensors, and novel human-computer interfaces, new possibilities are emerging to expand the cognitive telerehabilitation paradigm. This research aims to: (1) explore design opportunities and considerations when applying emergent pervasive computing technologies to cognitive telerehabilitation and (2) develop a generative co-design process for use with rehabilitation clinicians. Methods We conducted a custom co-design process that used design cards, probes, and design sessions with traumatic brain injury (TBI) clinicians. All field notes and transcripts were analyzed qualitatively. Results Potential opportunities for TBI cognitive telerehabilitation exist in the areas of communication competency, executive functioning, emotional regulation, energy management, assessment, and skill training. Designers of TBI cognitive telerehabilitation technologies should consider how technologies are adapted to a patient's physical/cognitive/emotional state, their changing rehabilitation trajectory, and their surrounding life context (e.g. social considerations). Clinicians were receptive to our co-design approach. Conclusion Pervasive computing offers new opportunities for life-situated cognitive telerehabilitation. Convivial design methods, such as this co-design process, are a helpful way to explore new design opportunities and an important space for further methodological development. Implications for Rehabilitation Designers of rehabilitation technologies should consider how to extend current design methods in order to facilitate the creative contribution of rehabilitation stakeholders. This co-design approach enables a fuller participation from rehabilitation clinicians at the front-end of design. Pervasive computing has the potential to: extend the duration and intensity of cognitive telerehabilitation training (including the delivery of 'booster' sessions or maintenance therapies); provide assessment and treatment in the context of a traumatic brain injury (TBI) patient's everyday life (thereby enhancing generalization); and permit time-sensitive interventions. Long-term use of pervasive computing for TBI cognitive telerehabilitation should take into account a patient's changing recovery trajectory, their meaningful goals, and their journey from loss to redefinition.

PMID: 26746683 [PubMed - as supplied by publisher]

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Isolated Intramedullary Spinal Rosai-Dorfman Disease: A Case Report and Literature Review.

Isolated Intramedullary Spinal Rosai-Dorfman Disease: A Case Report and Literature Review.

World Neurosurg. 2015 Dec 31;

Authors: Huang BY, Liu HL, Yu CJ

Abstract
Rosai-Dorfman disease (RDD) is a rare histioproliferative disorder that only occasionally involves the central nervous system (CNS). We presented the diagnosis and treatment of an exceedingly rare case of isolated intramedullary spinal RDD which was previously reported for only 3 times. Moreover, it was for the first time that intramedullary spinal RDD was described in child. The patient was treated by total surgical resection and experienced no recurrence during the 12-months follow-up. Histopathological examination showed a characteristic emperipolesis, the lymphocytes were engulfed in the S-100-protein-positive histiocytes with negative expression of CD1a. Preoperative diagnosis of spinal RDD is still challenging because the lesion is usually a dura-based lesion that mimics a meningioma. Surgical resection is an effective treatment and radiotherapy, steroid and chemotherapy has not demonstrated reliable therapeutic efficiency.

PMID: 26748178 [PubMed - as supplied by publisher]

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Delayed Migration of Fractured K-wire Causing Vertebral Artery Invagination Following Anterior Atlantoaxial Fixation: A Case Report.

Delayed Migration of Fractured K-wire Causing Vertebral Artery Invagination Following Anterior Atlantoaxial Fixation: A Case Report.

World Neurosurg. 2015 Dec 31;

Authors: Hafez A, Ibrahim T, Raj R, Antinheimo J, Siironen J, Hernesniemi J

Abstract
Most of attention during spinal surgery, when using wires and screws, is going to avoid injuries of the critical structures (nerves and vessels). When these wires are broken during surgery, the most important point is to take them out safely or, if it is impossible, to leaf them in secure place and follow the patient closely. Migrations broken k-wire is well known in literature. However, to the best of our knowledge, migration fractured K-wire during anterior atlantoaxial fixation of cervical spine is not reported in the literature. We report a case in which a fractured k-wire has been imbedded in the lateral mass of C1 for three years and then migrated to endanger the dominant right vertebral artery. By using posterior approach and drilling right part of posterior arch of C1 we manage to secure the vertebral artery. The broken k-wire was successfully extracted away. In our case, with optimal follow-up, the burred wire inside hard bone has been moved in delayed fashion to come out of the bone and grooving the dominant vertebral artery. Our recommendation is to investigate the k-wire in every attempt of using it and to try as much as we can when to take it out immediately.

PMID: 26748177 [PubMed - as supplied by publisher]

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Parametric digital subtraction angiography imaging for the objective grading of collateral flow in acute middle cerebral artery occlusion.

Parametric digital subtraction angiography imaging for the objective grading of collateral flow in acute middle cerebral artery occlusion.

World Neurosurg. 2015 Dec 31;

Authors: Wen W, Fang YB, Yang PF, Zhang YW, Wu YN, Shen H, Ge JJ, Xu Y, Hong B, Huang Q, Liu JM

Abstract
PURPOSE: To report the feasibility of parametric color coding digital subtraction angiography (DSA) in complementing traditional subjective way of leptomeningeal collateral assessment in acute middle cerebral artery (MCA) occlusions.
METHODS: Thirty-three consecutive acute MCA occlusion patients who received endovascular treatment were recruited for investigation. Eighteen from 33 consecutive patients were included. The target downstream territory (TDT) of MCA and reference point at terminal ICA of each patient was contoured by 5 raters independently based on 2D-DSA at anterior-posterior view. Two parameters of relative maximum density of TDT (rDensitymax) and peak time interval (ΔPT) between reference and TDT were extracted using parametric DSA analysis software. Inter-rater reliability was tested using intra-class correlation coefficients (ICC). Parameters with sufficient inter-rater reliability entered validity evaluation. Then the correlation test with the American Society of Interventional and Therapeutic Neuroradiology collateral grading (ACG) system and efficacy in predicting favorable clinical outcome was evaluated.
RESULTS: The ICC of rDensitymax and ΔPT were 0.983, 95% CI 0.968-0.993 and 0.831, 95% CI 0.705-0.923, respectively. The parameter rDensitymax shows strong correlation with ACG score (r of Spearman correlation test is 0.869, P＜0.001) and mRS at 3 months (partial correlation coefficient is 0.616, P=0.009) while ΔPT_average didn't. A cut-off point of 0.224 in rDensitymax predicted favorable clinical outcome with high sensitivity and specificity.
CONCLUSION: The relative maximum contrast density of MCA territory on 2D DSA measured by parametric imaging technique appears to be a simple and reliable metric for the assessment of leptomeningeal collaterals in acute MCA occlusion cases.

PMID: 26748176 [PubMed - as supplied by publisher]

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Craniotomy vs craniectomy for acute traumatic subdural hematoma in the United States: a national retrospective cohort analysis.

Craniotomy vs craniectomy for acute traumatic subdural hematoma in the United States: a national retrospective cohort analysis.

World Neurosurg. 2015 Dec 31;

Authors: Rush B, Rousseau J, Sekhon M, Griesdale D

PMID: 26748175 [PubMed - as supplied by publisher]

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Spontaneous regression of pineal lesions: Ghost tumor or pineal apoplexy?

Spontaneous regression of pineal lesions: Ghost tumor or pineal apoplexy?

World Neurosurg. 2015 Dec 31;

Authors: Mattogno PP, Frassanito P, Massimi L, Tamburrini G, Novello M, Lauriola L, Caldarelli M

Abstract
BACKGROUNDS: Pineal apoplexy (either hemorrhagic or ischemic) may complicate the course of a tumor at this site. This event is usually characterized by an acute clinical onset and requires emergency surgical management while the regression of the lesion is a much rarer outcome.
MATERIAL AND METHODS: Three cases of pineal vanishing tumors in the pediatric population are reported and the pertinent literature is reviewed.
RESULTS: In one case radiological findings were consistent with a diagnosis of pineal cyst, which became symptomatic after a spontaneous hemorrhage. This event may also explain its regression after the treatment of associated hydrocephalus. In the remaining two cases, neuroimaging examinations disclosed a solid tumor. One of them regressed after a surgical biopsy, probably because of an ischemic evolution, while the last one disappeared without any medical or surgical manipulation. Neither hemorrhage nor ischemia were noticed, thus the mechanism of regression remains controversial.
CONCLUSIONS: Vanishing tumors of the pineal region may occur in different circumstances, resulting from absence of any medical and surgical action to minor manipulation of the tumor to obtain a biopsy. This variety may reflect different underlying mechanisms, leading to hemorrhagic or ischemic change of the tumor and its subsequent regression, although radiological imaging may fail to document hemorrhage or ischemia.

PMID: 26748174 [PubMed - as supplied by publisher]

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Preoperative Predictors of Spinal Infection within the National Surgical Quality Inpatient Database.

Preoperative Predictors of Spinal Infection within the National Surgical Quality Inpatient Database.

World Neurosurg. 2015 Dec 31;

Authors: Lieber B, Han B, Strom RG, Mullin J, Frempong-Boadu AK, Agarwal N, Kazemi N, Tabbosha M

Abstract
BACKGROUND: Surgical-site infections (SSIs) are a major cause of morbidity and mortality, increasing the length and cost of hospitalization. In patients undergoing spine surgery, there is limited large-scale data on patient-specific risk factors for SSIs.
METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was reviewed for all spinal operations between 2006 and 2012. The rates of 30 day surgical site infections were calculated, and univariate analysis of selected preoperative risk factors was performed. Multivariate analysis was then used to identify independent predictors of SSIs.
RESULTS: 1110 of the 60179 patients (1.84%) had a postoperative wound infection. There were 527 (0.87%) deep and 590 (0.98%) superficial infections. Patients with infections had greater rates of sepsis, longer lengths of stay and more return visits to the operating room. Independent predictors of infection were female gender, inpatient status, insulin dependent diabetes, preoperative steroid use greater than 10 days, hematocrit less than 35, body mass index (BMI) greater than 30, wound class, ASA class, and operative duration.
CONCLUSIONS: Analysis of a large national patient database revealed many independent risk factors for SSIs after spinal surgery. Some of these risk factors can be modified preoperatively to reduce the risk of postoperative infection.

PMID: 26748173 [PubMed - as supplied by publisher]

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Vertebral Artery Transposition via an Extreme-Lateral Approach for Anterior Foramen Magnum Meningioma or Cranio-cervical Junction Tumors.

Vertebral Artery Transposition via an Extreme-Lateral Approach for Anterior Foramen Magnum Meningioma or Cranio-cervical Junction Tumors.

World Neurosurg. 2015 Dec 31;

Authors: Park HH, Lee KS, Hong CK

PMID: 26748172 [PubMed - as supplied by publisher]

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Comparison of Primary Spinal Central and Peripheral Primitive Neuroectodermal Tumors in Clinical and Imaging Characteristics and Long-term Outcome.

Comparison of Primary Spinal Central and Peripheral Primitive Neuroectodermal Tumors in Clinical and Imaging Characteristics and Long-term Outcome.

World Neurosurg. 2015 Dec 31;

Authors: Qi W, Deng X, Liu T, Hou Y, Yang C, Wu L, Fang J, Tong X, Yang J, Xu Y

Abstract
OBJECTIVE: Primary spinal primitive neuroectodermal tumors (PNETs) are extremely rare entities. The purpose of this study was to analyze the difference between primary spinal central PNETs (cPNETs) and peripheral PNETs (pPNETs) in clinical and imaging characteristics and outcomes.
METHODS: A consecutive series of 25 patients with primary spinal PNETs were enrolled. The diagnosis was cPNETs in 6 patients for negative CD99 expression and pPNETs in 19 patients for positive CD99 expression. Overall, gross total resection (GTR) was achieved in 12 patients, subtotal resection was conducted in 9 patients and partial resection was performed in 4 patients. Fourteen patients underwent postoperative chemotherapy and 16 patients underwent radiotherapy.
RESULTS: The age at diagnosis was significantly younger in the cPNET group (mean 12.8 years) than the pPNET group (mean 22.5 years) (p=0.040), and the two pathologies didn't show significant difference in prognosis. GTR (p=0.041), radiotherapy (p=0.008), and GTR with radiotherapy (p=0.009) were significant factors leading to a higher 2-year survival rate. Kaplan-Meier analysis showed that radiotherapy (p<0.001) and GTR with radiotherapy (p=0.040) could bring about a longer median survival time (MST). Among the different treatment modalities, patients who underwent GTR, chemotherapy and radiotherapy all together had the highest 1- (100.0%) and 2-year (71.4%) survival rates and the longest MST (32 months).
CONCLUSIONS: Patients with spinal cPNETs had a younger age compared to pPNETs. The prognosis of spinal cPNETs and pPNETs are poor and there was no significant difference. The most beneficial treatment modality is GTR combined with adjuvant radiotherapy and chemotherapy.

PMID: 26748171 [PubMed - as supplied by publisher]

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Acute Paraplegia after Aneurysmal SAH - A rare complication and the review of literature.

Acute Paraplegia after Aneurysmal SAH - A rare complication and the review of literature.

World Neurosurg. 2015 Dec 31;

Authors: Chiang YC, Lee CH, Chen WH, Tsuei YS

Abstract
Paraplegia following intracranial aneurysmal subarachnoid hemorrhage (SAH) is a rare condition and its pathogenesis is still unclear. We present a case of ruptured basilar dissecting aneurysm treated with the stent-assisted coiling procedure. Progressive weakness of the lower limbs developed within 5 days post-operatively. Spinal magnetic resonance image (MRI) showed SAH accumulation in the lumbosacral area. Emergency lumbar drainage was performed and the patient's symptoms improved dramatically. To the best of our knowledge, this is the first report to describe the successful treatment of paraplegia following intracranial aneurysmal SAH.

PMID: 26748170 [PubMed - as supplied by publisher]

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Direct microsurgical embolectomy for acute occlusion of the internal carotid artery and middle cerebral artery.

Direct microsurgical embolectomy for acute occlusion of the internal carotid artery and middle cerebral artery.

World Neurosurg. 2015 Dec 31;

Authors: Hino A, Oka H, Hashimoto Y, Echigo T, Koseki H, Fujii A, Katsumori T, Shiomi N, Nozaki K, Arima H, Hashimoto N

PMID: 26748169 [PubMed - as supplied by publisher]

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Elevated Incidence of Hypovitaminosis D Among Patients Requiring Treatment for Cerebral Aneurysms.

Elevated Incidence of Hypovitaminosis D Among Patients Requiring Treatment for Cerebral Aneurysms.

World Neurosurg. 2015 Dec 31;

Authors: Guan J, Karsy M, Eli I, Bisson EF, McNally S, Taussky P, Park MS

PMID: 26748168 [PubMed - as supplied by publisher]

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Glioblastoma presenting with pure alexia and palinopsia involving the left inferior occipitotemporal gyrus and Visual Word Form Area evaluated with fMRI and DTI tractography.

Glioblastoma presenting with pure alexia and palinopsia involving the left inferior occipitotemporal gyrus and Visual Word Form Area evaluated with fMRI and DTI tractography.

World Neurosurg. 2015 Dec 31;

Authors: Huang M

PMID: 26748167 [PubMed - as supplied by publisher]

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Supplementary Motor Cortical Changes Explored by Resting-state Functional Connectivity in Brachial Plexus Injury.

Supplementary Motor Cortical Changes Explored by Resting-state Functional Connectivity in Brachial Plexus Injury.

World Neurosurg. 2015 Dec 30;

Authors: Lu Y, Liu H, Hua X, Xu WD, Xu JG, Gu YD

Abstract
OBJECTIVE: Brachial plexus injury is one of the most serious peripheral nerve injuries. However, clinical outcomes are generally unsatisfactory. It has been reported that cortical plasticity could influence the restoration of motor function. However, the neurological mechanism of BPI remains unclear, which provides a basis for further investigation. Supplementary motor area (SMA) plays an important role in the regulation of motor function. This study aims to explore SMA-whole brain functional connectivity after deafferentation of the brachial plexus.
METHODS: Sixteen BPI patients and eight healthy volunteers were recruited. The seed region was defined by a block-design fMRI program which used unilateral imaginary hand grasp motion as a task stimulus. Next, the ROI-wise functional connectivity between the predefined region and the other regions of the brain was calculated.
RESULTS: We discovered decreased ROI-wise functional connectivity between SMA and multiple brain regions including precuneus, posterior cingulum cortex and anterior cingulum cortex.
CONCLUSIONS: BPI patients showed weakened functional connectivity between hand-grasp related areas and SMA as well as multiple regions associated with motor processing or information integration A clear image of the functional status of the brain after deafferentation was provided. On the basis of this discovery, a relationship between changes in neural imaging measurements and clinical outcomes can be expected in future studies.

PMID: 26746337 [PubMed - as supplied by publisher]

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Neurofibromas of the phrenic nerve: a case report and review of the literature.

Neurofibromas of the phrenic nerve: a case report and review of the literature.

World Neurosurg. 2015 Dec 30;

Authors: Ghali MG, Srinivasan VM, Jea A, Slopis JM, McCutcheon IE

Abstract
Phrenic neurofibromas are a rare pathological entity, with nine cases described in the English literature. They may occur in conjunction with or independently of neurofibromatosis type 1 (NF1). Phrenic neurofibromas post distinct therapeutic challenges compared to the more common phrenic schwannoma. We describe here a 14 year-old male with neurofibroma of the left phrenic nerve presenting as dextroposition of the heart after paralysis of the left hemidiaphragm allowed herniation of abdominal contents into the left hemithorax and displaced of the heart. Surgical resection of the tumor followed by diaphragmatic plication was performed to assess its degree of malignancy, reduce abdominal herniation, and improve lung capacity. The operation markedly improved his hemidiaphragmatic elevation. The spectrum of management options ranges from conservative surveillance to open thoracic surgery. Functional preservation of the phrenic nerve is technically challenging, and although phrenic neurofibromas often present with absent function that cannot be recovered, surgical intervention can be fruitful in restoring lung capacity through diaphragmatic reconstruction.

PMID: 26746336 [PubMed - as supplied by publisher]

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Incidence of Headache Following Traumatic Brain Injury in China: A Large Prospective Study.

Incidence of Headache Following Traumatic Brain Injury in China: A Large Prospective Study.

World Neurosurg. 2015 Dec 30;

Authors: Xu H, Pi H, Ma L, Su X, Wang J

Abstract
BACKGROUND: There have yet to be any large scale studies in China on headaches following traumatic brain injury (TBI). We evaluate the incidence of headache following TBI and investigate risk factors and functional outcome in a large tertiary center with a high case load.
METHODS: 543 patients (82% male, 18% female) with a mean age of 48.4±18.6 years presenting with TBI were prospectively enrolled in this study between March 2011 and July 2013. Patient demographics, severity of TBI, incidence and classification of headache, and treatment information were collected during initial hospitalization and at 3, 6, and 12 months follow-up.
RESULTS: Of our 543 patients (82% male, 18% female) with a mean age of 48.4±18.6 years, 62% were injured in motor vehicle collisions and 27% in falls. The vast majority of patients (97%) were considered to have mild TBI. Follow-up rates at 3, 6, and 12 months were 91%, 75%, and 61%, respectively. Only 12% of patients reported pre-TBI headaches whereas 58% of respondents reported headache at 3 month follow-up, 54% at 6 month follow-up, and 49% at 1 year follow-up. No statistically significant correlations between age, sex, and/or TBI severity and posttraumatic headaches were observed.
CONCLUSION: We present the findings of the first study on headaches following TBI in China. Headaches were found to occur in the majority of TBI patients and persisted through the first year following injury. The incidence of posttraumatic headache observed here is comparable to previously published studies outside of China.

PMID: 26746335 [PubMed - as supplied by publisher]

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Venous thromboembolism prophylaxis in meningioma surgery - a population based comparative effectiveness study of routine mechanical prophylaxis with or without preoperative low molecular weight heparin.

Venous thromboembolism prophylaxis in meningioma surgery - a population based comparative effectiveness study of routine mechanical prophylaxis with or without preoperative low molecular weight heparin.

World Neurosurg. 2015 Dec 30;

Authors: Sjåvik K, Bartek J, Solheim O, Ingebrigtsen T, Gulati S, Sagberg LM, Förander P, Jakola AS

Abstract
OBJECT: Venous thromboembolism (VTE) is a serious complication after intracranial meningioma surgery. To what extent systemic prophylaxis with pharmacotherapy is beneficial with respect to VTE risk, or associated with increased risk of bleeding and postoperative hemorrhage, remains debated. The current study aimed to clarify the risk-benefit of prophylactic pharmacotherapy initiated the evening before craniotomy for meningioma.
METHODS: In a Scandinavian population-based cohort we conducted a retrospective review of 979 operations for intracranial meningioma between 2007 and 2013 at three neurosurgical centers with population-based referral. We compared two different treatment strategies analyzing frequencies of VTE and proportions of postoperative intracranial hematomas requiring surgery or intensified subsequent observation or care (ICU or other intensified observation and/or treatment). One neurosurgical center favored preoperative prophylaxis with low-molecular weight heparin (LMWH) ("LMWH routine group") in addition to mechanical prophylaxis, while two centers favored mechanical prophylaxis with LMWH only given as needed in cases of delayed mobilization ("LMWH as needed group").
RESULTS: In the LMWH routine group, VTE was diagnosed after 24/626 operations (3.9%), while VTE was diagnosed after 11/353 (3.1%) operations in the LMWH as needed group (p=0.56). Clinically relevant postoperative hematomas occurred after 57/626 operations (9.1%) in the LMWH routine group compared to 23/353 (6.5%) in the LMWH as needed group (p=0.16). Surgically evacuated postoperative hematomas occurred after 19/626 operations (3.0%) in the LMWH routine group compared to 8/353 operations (2.3%) in the LMWH as needed group (p=0.26).
CONCLUSION: There is no benefit of routine preoperative LMWH starting before intracranial meningioma surgery. Neither could we for primary outcomes detect a significant increase in clinically relevant postoperative hematomas secondary to this regimen. We suggest that "as-needed" perioperative administration of LMWH, reserved for patients with excess risk due to delayed mobilization, is effective and also appears to be the safest strategy.

PMID: 26746334 [PubMed - as supplied by publisher]

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