Head and Neck Diseases by Alexandros G.Sfakianakis: 11/09/16

Τετάρτη 9 Νοεμβρίου 2016

What vaccine product attributes do immunization program stakeholders value? Results from interviews in six low- and middle-income countries

Publication date: Available online 8 November 2016
Source:Vaccine
Author(s): Debra D. Kristensen, Kate Bartholomew, Shirley Villadiego, Kristina Lorenson
This study attempts to capture the opinions of stakeholders working in immunization programs in low- and middle-income countries to understand how vaccine products could be improved to better meet their needs and to obtain feedback on specific vaccine product attributes including the number of doses per container and ease of preparing a dose for administration. We also reviewed how procurement decisions are made within immunization programs. Semi-structured interviews were undertaken with 158 immunization stakeholders in Brazil, China, India, Peru, the Philippines, and Tanzania. Interviewees included national decision-makers and advisors involved in vaccine-purchasing decisions (n=30), national Expanded Programme on Immunization managers (n=6), and health and logistics personnel at national, subnational, and health-facility levels (n=122).Immunization stakeholders at all levels of the supply chain valued vaccine product attributes that prevent heat damage, decrease vaccine wastage, and simplify delivery. Minimizing the time required to prepare a dose is especially valued by those closest to the work of actually administering vaccines. Respondents appreciated the benefits of lower-multidose presentations on reducing wastage but seemed to prefer single-dose vials even more. They also expressed concern about the need for training and the potential for confusion and vial contamination if opened vials of liquid preservative-free vaccines are not handled properly. Procurement decision-making processes varied widely between countries, though most relied heavily on international agencies and vaccine manufacturers for information.

http://rss.sciencedirect.com/action/redirectFile?&zone=main&currentActivity=feed&usageType=outward&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%3F_ob%3DGatewayURL%26_origin%3DIRSSSEARCH%26_method%3DcitationSearch%26_piikey%3DS0264410X16309926%26_version%3D1%26md5%3De644dedd1626a78e48a49c6c2d59426e

Commentary on “Development of Collaterals to the Spinal Cord After Endovascular Stent Graft Repair of Thoracic Aneurysms”

Publication date: Available online 9 November 2016
Source:European Journal of Vascular and Endovascular Surgery
Author(s): E. Choke

http://rss.sciencedirect.com/action/redirectFile?&zone=main&currentActivity=feed&usageType=outward&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%3F_ob%3DGatewayURL%26_origin%3DIRSSSEARCH%26_method%3DcitationSearch%26_piikey%3DS1078588416305469%26_version%3D1%26md5%3Dd7f29e0b63316c34c1212a43dafc88d4

Functional coupling between frontoparietal and occipitotemporal pathways during action and perception

Publication date: Available online 9 November 2016
Source:Cortex
Author(s): R. Matthew Hutchison, Jason P. Gallivan
Several lines of evidence point to areas in the occipitotemporal pathway as being critical in the processes of visual perception and object recognition. Much less appreciated, however, is the role that this pathway plays in object-related processing for the purposes of visually guided action. Here, using functional MRI and functional connectivity measures, we examined interactions between areas in frontoparietal cortex (FPC) involved in grasping, reaching, eye movements, and tool use and areas in occipitotemporal cortex (OTC) involved in object-, face-, scene-, body-, tool-, and motion-related processing, both during the performance of sensorimotor and visual-perceptual tasks, as well as during passive fixation (resting-state). Cluster analysis of regional time course data identified correspondence in the patterns of FPC and OTC connectivity during the visual-perceptual tasks and rest that both tended to segregate regions along traditional dorsal/ventral pathway boundaries. During the sensorimotor tasks, however, we observed a notable separation in functional coupling between ventral-medial and ventral-lateral regions of OTC, with several of the latter areas often being clustered together with sensorimotor-defined areas in parietal cortex. These findings indicate that the functional coupling of ventral-lateral OTC areas to dorsal parietal and ventral-medial structures is flexible and task-dependent, and suggests that regions in lateral occipital cortex, in particular, may play an important role in mediating interactions between the dorsal and ventral pathways during tasks involving sensorimotor control.

http://rss.sciencedirect.com/action/redirectFile?&zone=main&currentActivity=feed&usageType=outward&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%3F_ob%3DGatewayURL%26_origin%3DIRSSSEARCH%26_method%3DcitationSearch%26_piikey%3DS0010945216303136%26_version%3D1%26md5%3Dea7ad1933a1f7f64b3cf11fc8da0c24b

Experimental research on laser interference micro/nano fabrication of hydrophobic modification of stent surface

Abstract

Coronary artery disease (CAD) has become one of the important causes of human death, and coronary stent implantation is one of the most effective methods for the treatment of CAD. But the current clinical treatment has a high long-term restenosis rate and is easy to form late stent thrombosis. In order to solve these problems, coronary artery stent surface was directly modified by laser interference lithography and the highly ordered concave structures were fabricated. The morphology and contact angle (CA) of the microstructure were measured with scanning electron microscopy (SEM) and CA system. The water repellent property of the stent was also evaluated by the method of contacting the water drop with the stent and then separating. The result showed that the close-packed concave structure with the period of about 12.194 μm can be fabricated on the stent surface under special parameters (laser energy density of 3.5 J/cm⁻², incident angles of 3°, exposure time of 80 s) by the three-beam laser interference of 1064 nm and the form structure has good water repellency with contact angle of 120°.

http://link.springer.com/10.1007/s10103-016-2105-6

Corrigendum to “Paradigm shift redefining molecular, metabolic and structural events in Alzheimer’s disease involves a proposed contribution by transition metals. Defined lengthy preclinical stage provides new hope to circumvent advancement of disease- and age-related neurodegeneration” [Med. Hypotheses 84 (2015) 460–469]

Publication date: Available online 8 November 2016
Source:Medical Hypotheses
Author(s): Franco Cavaleri

http://rss.sciencedirect.com/action/redirectFile?&zone=main&currentActivity=feed&usageType=outward&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%3F_ob%3DGatewayURL%26_origin%3DIRSSSEARCH%26_method%3DcitationSearch%26_piikey%3DS0306987716307757%26_version%3D1%26md5%3D23720b9ddbb5fe2d9868f8afa0907b3c

Cervical spine disorders and its association with tinnitus: The “TRIPLE” hypothesis

Publication date: Available online 9 November 2016
Source:Medical Hypotheses
Author(s): Bressi Federica, Manuele Casale, Papalia Rocco, Moffa Antonio, Di Martino Alberto, Miccinilli Sandra, Salvinelli Fabrizio, Denaro Vincenzo, Sterzi Silvia
Subjective Tinnitus and cervical spine disorders (CSD) are among the most common complaints encountered by physicians. Although the relationship between tinnitus and CSD has attracted great interest during the past several years, the pathogenesis of tinnitus induced by CSD remains unclear. Conceivably, CSD could trigger a somatosensory pathway-induced disinhibition of dorsal cochlear nucleus (DCN) activity in the auditory pathway; furthermore, CSD can cause inner ear blood impairment induced by vertebral arteries hemodynamic alterations and trigeminal irritation. In genetically -predisposed CSD patients with reduced serotoninergic tone, signals from chronically stimulated DCNs could activate specific cortical neuronal networks and plastic neural changes resulting in tinnitus. Therefore, an early specific tailored CSD treatments and/or boosting serotoninergic activity may be required to prevent the creation of 'tinnitus memory circuits' in CSD patients.

http://rss.sciencedirect.com/action/redirectFile?&zone=main&currentActivity=feed&usageType=outward&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%3F_ob%3DGatewayURL%26_origin%3DIRSSSEARCH%26_method%3DcitationSearch%26_piikey%3DS0306987716306399%26_version%3D1%26md5%3D4bcea18509de28c5ddd4df147a305f9f

Age equivalence in the benefit of repetition for speech understanding

Although repetition is the most commonly used conversational repair strategy, little is known about its relative effectiveness among listeners spanning the adult age range. The purpose of this study was to identify differences in how younger, middle-aged, and older adults were able to use immediate repetition to improve speech recognition in the presence of different kinds of maskers. Results suggest that all groups received approximately the same amount of benefit from repetition. Repetition benefit was largest when the masker was fluctuating noise and smallest when it was competing speech.

http://scitation.aip.org/content/asa/journal/jasa/140/5/10.1121/1.4966586?TRACK=RSS

Differences in outcome for cervical cancer patients treated with or without brachytherapy

Publication date: Available online 9 November 2016
Source:Brachytherapy
Author(s): Johannes Karlsson, Ann-Charlotte Dreifaldt, Louise Bohr Mordhorst, Bengt Sorbe
PurposeTo compare the clinical outcome of cervical cancer patients treated with primary radiotherapy with and without the addition of brachytherapy.Methods and MaterialsIn all, 220 patients with cervical cancer stage I–IV treated between 1993 and 2009 were included. Three or five 6.0 Gy fractions of brachytherapy were given in addition to the external beam radiotherapy to 134 patients, whereas 86 patients received external beam radiotherapy alone (EBRTA). In the EBRTA group, the patients received external boost instead of brachytherapy with a total dose to the tumor of 64–72 Gy.ResultsThe 5-year overall survival and cancer-specific survival rates of the complete series were 42.5% and 55.5%, respectively. The rates of primary complete remission, 5-year cancer-specific survival, and recurrence were 92.5%, 68.5%, and 31.3% for the brachytherapy group vs. 73.3%, 35.4%, and 37.2% for the EBRTA group. The survival (all types) of the patients receiving brachytherapy was significantly (p < 0.0001) better than for the patients treated with external boost, but the difference was most pronounced in FIGO stage II tumors. Higher FIGO stage, nonsquamous cell carcinoma histology, treatment with EBRTA, and lower total equal 2-Gy (EQD2) external dose were significantly associated with poorer survival, lower rate of remission, and higher recurrence rate in multivariate models.ConclusionsPrimary tumor remission rate, recurrence rate, and all types of survival rates were improved in the brachytherapy group. Brachytherapy is important to achieve sufficient doses to the periphery and central part of the tumor and should always be considered in treatment of cervical carcinomas.

http://rss.sciencedirect.com/action/redirectFile?&zone=main&currentActivity=feed&usageType=outward&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%3F_ob%3DGatewayURL%26_origin%3DIRSSSEARCH%26_method%3DcitationSearch%26_piikey%3DS1538472116305554%26_version%3D1%26md5%3Df0dc9a34476897d4fe1e6cbd02ec4bb7

Case Report of a Child after Hematopoietic Cell Transplantation with Acute Aspergillus Tracheobronchitis as a Cause for Respiratory Failure

Rapid respiratory failure due to invasive mycosis of the airways is an uncommon presentation of Aspergillus infection, even in immunocompromised patients, and very few pediatric cases have been reported. Patients with Aspergillus tracheobronchitis present with nonspecific symptoms, and radiologic studies are often noninformative, leading to a delay in diagnosis. Prompt initiation of adequate antifungal therapies is of utmost importance to improve outcome. We report the case of a 9-year-old girl with chronic myelogenous leukemia who developed respiratory distress 41 days after hematopoietic cell transplantation and rapidly deteriorated despite multiple interventions and treatment modalities.

http://www.hindawi.com/journals/cripe/2016/9676234/

Local pulsatile PTH delivery regenerates bone defects via enhanced bone remodeling in a cell-free scaffold

Publication date: January 2017
Source:Biomaterials, Volume 114
Author(s): Ming Dang, Amy J. Koh, Xiaobing Jin, Laurie K. McCauley, Peter X. Ma
Parathyroid hormone (PTH) is currently the only FDA-approved anabolic drug to treat osteoporosis, and is systemically administered through daily injections. A new local pulsatile PTH delivery device was developed from biodegradable polymers to expand the application of PTH from systemic treatment to spatially controlled local bone defect regeneration in this work. This is the first time that local pulsatile PTH delivery has been demonstrated to promote bone regeneration via enhanced bone remodeling. The biodegradable delivery device was designed to locally deliver PTH in a preprogrammed pulsatile manner. The PTH delivery was utilized to facilitate the regeneration of a bone defect spatially defined with a cell-free biomimetic nanofibrous (NF) scaffold. The local pulsatile PTH delivery (daily pulse for 21 days) not only promoted the regeneration of a critical-sized bone defect with negligible systemic side effects in a mouse model, but also advantageously achieved higher quality regenerated bone than the standard systemic PTH injection. These results demonstrate a promising and novel pulsatile PTH delivery device for spatially defined local bone regeneration.

http://rss.sciencedirect.com/action/redirectFile?&zone=main&currentActivity=feed&usageType=outward&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%3F_ob%3DGatewayURL%26_origin%3DIRSSSEARCH%26_method%3DcitationSearch%26_piikey%3DS0142961216305993%26_version%3D1%26md5%3Dea74ede1a28463f5346243f73136a341

Whole-Neck Computed Tomography Perfusion Scan in Imaging Patients With Head and Neck Tumors

Conditions: Head and Neck Neoplasm; Malignant Head and Neck Neoplasm
Intervention: Radiation: Computed Tomography Perfusion Imaging
Sponsors: University of Southern California; National Cancer Institute (NCI)
Recruiting - verified November 2016

https://clinicaltrials.gov/ct2/show/NCT02960308?term=HEAD+AND+NECK&recr=Open&lup_s=10%2F26%2F2016&lup_d=14&show_rss=Y&sel_rss=mod14

Life-threatening Wunderlich's syndrome with concurrent clopidogrel use

Spontaneous non-traumatic renal haemorrhage, or Wunderlich's syndrome, is a rare but potentially life-threatening event. We present the case of a 63-year-old man on clopidogrel who became haemodynamically unstable as a result of this condition. Angioembolisation revealed the unusual finding of active bleeding from multiple distinct subsegmental renal vessels, for which haemostasis was successfully achieved by coil placement. The patient remains well and with near-normal renal function on follow-up.

http://casereports.bmj.com/cgi/content/short/2016/nov08_2/bcr2016216171?rss=1

hTERT Immunotherapy Alone or in Combination With IL-12 DNA Followed by Electroporation in Adults With Solid Tumors at High Risk of Relapse

Conditions: Breast Cancer; Lung Cancer; Pancreatic Cancer; Head and Neck Cancer; Ovarian Cancer; ColoRectal Cancer; Gastric Cancer; Esophageal Cancer; HepatoCellular Carcinoma
Interventions: Biological: INO-1400; Biological: INO-9012
Sponsors: Inovio Pharmaceuticals; University of Pennsylvania; University of North Carolina; Thomas Jefferson University; University of Pittsburgh; Wayne State University; Mayo Clinic
Recruiting - verified November 2016

https://clinicaltrials.gov/ct2/show/NCT02960594?term=HEAD+AND+NECK&recr=Open&lup_s=10%2F26%2F2016&lup_d=14&show_rss=Y&sel_rss=mod14

Q fever hepatitis and endocarditis in the context of haemochromatosis

Hereditary haemochromatosis is associated with increased susceptibility to some infections. We report here a case of Q fever in a patient with coexistent haemochromatosis. The literature is reviewed in regard to the effect of haemochromatosis on susceptibility to infectious disease in general and Q fever in particular. Although there is documented increased risk in these patients for some infectious conditions, a specific association with Q fever has not been previously reported. The present report raises the possibility of such a clinically relevant connection.

http://casereports.bmj.com/cgi/content/short/2016/nov08_2/bcr2016215214?rss=1

A Phase II Trial to Compare Efficacy and Safety of CRT VS Neo-CRT in Patients Who Achieved CCR for Esophageal Cancer

Conditions: Stage II Esophageal Cancer; Stage III Esophageal Cancer
Interventions: Radiation: Definitive Radiochemotherapy; Procedure: Neoadjuvant Radiochemotherapy
Sponsor: Tianjin Medical University Cancer Institute and Hospital
Recruiting - verified October 2016

https://clinicaltrials.gov/ct2/show/NCT02959385?term=HEAD+AND+NECK&recr=Open&lup_s=10%2F26%2F2016&lup_d=14&show_rss=Y&sel_rss=mod14

Acute aortic dissection in postpartum

Description

A Caucasian woman aged 35 years, with no relevant personal history or history of drug abuse and an uneventful pregnancy, presented in the emergency room (ER) at 34 weeks of gestation, with preterm premature rupture of membranes. On physical examination, she had elevated blood pressure and bilateral peripheral oedema. An extensive blood panel was performed, providing the diagnosis of pre-eclampsia. Four hours after admission, she had a vaginal delivery and, 36 hours later, discharged herself against medical advice. A few hours later, she returned to the ER, reporting of severe thoracic pain of sudden onset, sweating and nausea. Her vitals were within normal range, and peripheral pulses were present and symmetrical.

Suspecting a pulmonary embolism, a thoracic CT was performed (figures 1–3), showing 'extensive dissection of the ascending aorta, extending from the aortic root to the origin of the celiac artery. No aneurism is...

http://casereports.bmj.com/cgi/content/short/2016/nov08_2/bcr2016218236?rss=1

Aneurysmal wall imaging in a case of cortical superficial siderosis and multiple unruptured aneurysms

We report a case of interhemispheric and bifrontal cortical superficial siderosis in association with two intracranial aneurysms. The patient had no clinical history suggestive of aneurysm rupture, no feature of amyloid angiopathy or other apparent etiology for cortical siderosis. We performed high resolution brain MRI with dark blood T1 sequences before and after IV contrast injection. An anterior communicating aneurysm showed partial wall enhancement on the posterior wall whereas a left posterior communicating aneurysm did not. In the light of recent reports of the association of wall enhancement with unstable aneurysms, we considered wall enhancement to be a marker of inflammation and remodeling of the aneurysm wall, resulting in chronic hemorrhagic suffusion in the subarachnoid spaces. To our knowledge, this is the first report offering proof for a possible link between apparently unruptured aneurysms and cortical siderosis.

http://casereports.bmj.com/cgi/content/short/2016/nov08_2/bcr2016012680?rss=1

Whole-Neck Computed Tomography Perfusion Scan in Imaging Patients With Head and Neck Tumors

hTERT Immunotherapy Alone or in Combination With IL-12 DNA Followed by Electroporation in Adults With Solid Tumors at High Risk of Relapse

A Phase II Trial to Compare Efficacy and Safety of CRT VS Neo-CRT in Patients Who Achieved CCR for Esophageal Cancer

Refractory Obstructive Sleep Apnea in a Patient with Diffuse Idiopathic Skeletal Hyperostosis

Diffuse Idiopathic Skeletal Hyperostosis (DISH) can cause ossification of ligaments and may affect the spine. We report a case of obstructive sleep apnea in a patient with significant upper airway narrowing secondary to cervical DISH. This patient had an initial apnea-hypopnea index (AHI) of 145 events/hour and was treated with uvulopalatopharyngoplasty, genial tubercle advancement, hyoid suspension, septoplasty, inferior turbinoplasties, and radiofrequency ablations to the tongue base which reduced his AHI to 40 events/hour. He redeveloped symptoms, was started on positive airway pressure (PAP) therapy, and later underwent a maxillomandibular advancement which improved his AHI to 16.3 events/hour. A few years later his AHI was 100.4 events/hour. His disease has gradually progressed over time and he was restarted on PAP therapy. Despite PAP titration, years of using PAP therapy, and being 100 percent compliant for the past three months (average daily use of 7.6 hours/night), he has an AHI of 5.1 events/hour and has persistent hypersomnia with an Epworth Sleep Scale questionnaire score of 18/24. At this time he is pending further hypersomnia work-up. DISH patients require prolonged follow-up to monitor the progression of disease, and they may require unconventional measures for adequate treatment of obstructive sleep apnea.

http://www.hindawi.com/journals/criot/2016/4906863/

Refractory Obstructive Sleep Apnea in a Patient with Diffuse Idiopathic Skeletal Hyperostosis

Bone-Anchored Titanium Implants in Patients with Auricular Defects: Three Years and 27 Patients’ Experience

Different surgical solutions have been proposed for reconstruction of the auricle following loss of the pinna through traumatic injury or neoplastic disease or in patients with congenital defects. Surgical treatment may involve the insertion of an autogenous rib cartilage framework or the use of a porous polymer material inserted into an expanded postauricular flap. Reconstruction with rib cartilage has yielded good results but requires more than one surgical step, and adverse events can occur both at the donor and at the acceptor site; cases of prosthesis rejection have also been described following application of the polymeric prosthesis. The use of a titanium, dowel-retained silicone prosthetic pinna, fixed to the temporal bone, has recently been proposed. This useful surgical approach is indicated particularly after resection of the pinna caused by neoplastic disease or in traumatic auricular injury. Osseointegrated titanium implants used in 27 patients in this study provided them with a safe, reliable, adhesive-free method of anchoring the auricular prostheses. The prostheses allowed recovery of normal physical appearance and all the patients reported that they were completely satisfied with the outcome of the surgical reconstruction. No surgical complications, implant failures, or prosthetic failures were encountered over six months to three years.

http://www.hindawi.com/journals/ijoto/2016/9872048/

The P Value Problem in Otolaryngology: Shifting to Effect Sizes and Confidence Intervals

There is a lack of reporting effect sizes and confidence intervals in the current biomedical literature. The objective of this article is to present a discussion of the recent paradigm shift encouraging the use of reporting effect sizes and confidence intervals. Although P values help to inform us about whether an effect exists due to chance, effect sizes inform us about the magnitude of the effect (clinical significance), and confidence intervals inform us about the range of plausible estimates for the general population mean (precision). Reporting effect sizes and confidence intervals is a necessary addition to the biomedical literature, and these concepts are reviewed in this article.

http://oto.sagepub.com/cgi/content/abstract/0194599816677735v1?rss=1

A New Theory for Menieres Disease: Detached Saccular Otoconia

Ménière's disease is an inner ear disorder characterized by vertigo attacks, fluctuating and progressive hearing loss, tinnitus, and aural fullness in the affected ear. The pathophysiology of Ménière's disease remains elusive. Theories so far are anatomical variation in the size or position of the endolymphatic sac and duct, viral inflammation or autoimmune involvement of the sac, or a genetically determined abnormality of endolymph control. Animal studies on blocking the ductus reuniens and endolymphatic duct have produced hydrops in the cochlea, saccule, and utricle. Cone beam computed tomography images show a similar pattern with apparent obstruction of the ductus reuniens, saccular duct, and endolymphatic sinus. New studies documenting the age of onset of Ménière's disease show a pattern similar to benign paroxysmal positional vertigo, raising the possibility that the fundamental cause of Ménière's disease might be detached saccular otoconia.

http://oto.sagepub.com/cgi/content/abstract/0194599816675843v1?rss=1

The Effect of Vestibular Rehabilitation in Patients with Menieres Disease: A Systematic Review

Objective

To systematically review the evidence on the effect of vestibular rehabilitation in patients with Ménière's disease (MD) on balance and dizziness-related quality of life.

Data Sources

A literature search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Web of Science, and CINAHL databases.

Review Methods

Articles were reviewed by 2 independent authors and data were compiled in tables for analysis regarding balance (ie, posturography) and dizziness-specific quality of life in patients with MD. A comprehensive search was performed up to November 2015. Studies on relevance and methodological quality were assessed by means of the Cochrane risk of bias tool. For outcome on balance and quality of life, we calculated mean differences and their 95% confidence intervals.

Results

A total of 986 unique studies were retrieved. Five studies, including a total of 498 patients, fulfilled the eligibility criteria, including 2 randomized controlled trials and 3 prospective cohort studies. There was no study with a low risk of bias. We found inconsistent evidence for the effect of vestibular rehabilitation on balance and dizziness-related quality of life.

Conclusion

Based on the low quality of the selected studies, it is inconclusive whether there is a positive effect of vestibular rehabilitation in patients with MD on balance and dizziness-related quality of life.

http://oto.sagepub.com/cgi/content/abstract/0194599816678386v1?rss=1

Evaluation of a Web-Based Module and an Otoscopy Simulator in Teaching Ear Disease

Objective

To determine which teaching method—otoscopy simulation (OS), web-based module (WM), or standard classroom instruction (SI)—produced the best improvement in the diagnosis of middle/external ear pathologies and the development of otoscopy clinical skills.

Study Design

Prospective randomized controlled nonclinical trial.

Setting

Preclerkship undergraduate medical education.

Subjects and Methods

Fifty-four medical students (first year, 26; second year, 28) were randomized to receive 1 of the 3 interventions: OS, WM, or SI. All students underwent baseline testing of diagnostic accuracy (25 ear pathologies) and otoscopy skills. Immediately following each intervention and 3 months later, testing was repeated.

Results

Baseline scores for diagnostic accuracy and otoscopy skills did not differ across intervention groups. Immediately postintervention, all groups showed an improvement in diagnostic accuracy (P < .001). OS scored significantly higher than SI (P < .001), as did WM (P = .003). At 3-month follow-up, all groups continued to demonstrate improved diagnostic accuracy as compared with baseline. Again, OS showed improvement over SI (P = .031). For otoscopy clinical skills, only OS improved immediately postintervention (P < .001). OS had significantly higher scores than WM and SI (P < .001). At 3-month follow-up, OS again showed improvement over WM (P < .001) and SI (P = .009).

Conclusion

All groups showed an improvement in diagnostic accuracy immediately postintervention, with the largest increases coming from OS and WM. Otoscopy clinical skills increased and were retained only in OS. Preclerkship medical student acquisition and retention of otolaryngology diagnostic skills can be greatly improved through web-based teaching modules and otoscopy simulation.

http://oto.sagepub.com/cgi/content/abstract/0194599816677697v1?rss=1

Association between Laryngeal Pepsin Levels and the Presence of Vocal Fold Polyps

Objective

To determine whether pepsin, the main component of refluxed gastric contents, is significantly associated with vocal fold polyps and to evaluate the diagnostic value of pepsin in vocal fold polyps' tissues.

Study Design

Cross-sectional study.

Setting

Nanfang Hospital of Southern Medical University.

Subjects and Methods

The study included 32 patients with vocal fold polyps and 16 healthy controls between 2011 and 2012. Reflux symptom index and reflux finding score assessments, 24-hour combined multichannel intraluminal impedance and pH monitoring, and biopsy of the vocal fold polyp tissues or posterior laryngeal mucosa (healthy controls) for immunohistochemical pepsin staining were performed.

Results

The expression of pepsin was significantly higher in patients with vocal fold polyps than in controls (28/32, 75% vs 5/16, 31.25%; P < .001). The pepsin levels were significantly positively correlated with upright position pharyngeal acid reflux and esophageal reflux parameters adjusted by age. Based on pepsin staining data, the sensitivity and negative predictive values of 24-hour pH monitoring, the reflux symptom index, and the reflux finding score were 70% to 84.62%, whereas their specificity and positive predictive values were relatively low (20%-31.58%).

Conclusion

Pepsin reflux may be a risk factor for vocal fold polyps formation. In addition, pepsin immunohistochemical analysis of polyp biopsy samples appears to be a more sensitive and effective test for diagnosing laryngopharyngeal reflux than the reflux symptom index, the reflux finding score, and 24-hour pH monitoring in a clinical setting.

http://oto.sagepub.com/cgi/content/abstract/0194599816676471v1?rss=1

Head and Neck Cancer: Underfunded and Understudied?

Despite a considerable expansion in our therapeutic repertoire for management of other malignancies, mortality from head and neck cancer (HNC) has not significantly improved in recent decades. Upon normalizing National Institutes of Health–awarded R01 and R01-equivalent grants by incidence, thyroid cancer ($214) and HNC ($1329) received the fewest funding dollars. Upon adjusting funding totals by mortality, HNC was 7th out of 9 cancers evaluated ($6138). These findings highlight HNC as an underfunded disease versus other cancers. As data detailing grant applications (including unsuccessful grants) are not publicly available, it is not clear if these disparities stem from fewer applications or fewer opportunities. Our hope is that this commentary will spur further investigation into strategies to increase HNC inquiry and funding for trainees as well as early-stage and established investigators.

http://oto.sagepub.com/cgi/content/abstract/0194599816674672v1?rss=1

Corrigendum

http://oto.sagepub.com/cgi/reprint/0194599816679126v1?rss=1

Geographic Variation in Use of Vestibular Testing among Medicare Beneficiaries

Objective

There is a lack of consensus regarding the indications for vestibular testing in the evaluation of dizziness and balance disorders. Geographic variation in health services utilization is associated with lack of consensus. To understand the variation in current practice, we investigated the patterns of use of vestibular testing and diagnosis codes for dizziness and balance disorders among individuals ≥65 years of age across different regions of the United States.

Study Design

Cross-sectional study.

Setting

Medicare administrative claims data.

Subjects and Methods

Using the Summarized Denominator file, a sample of the US population linked to the Surveillance, Epidemiology, and End Results (SEER)–Medicare files (years 2000-2010), we identified persons who were ≥65 years of age. We used multivariable analyses to determine the factors associated with vestibular testing and diagnoses.

Results

Of the 231,984 eligible Medicare beneficiaries, 27% were diagnosed with dizziness and balance disorders. Patterns of use of vestibular tests (eye movement recording for spontaneous nystagmus, caloric testing, and rotary chair testing) varied significantly by geographic region. Rotary chair test utilization varied most. We found significant geographic variation in vestibular testing and diagnoses after controlling for age, sex, race, Medicaid participation, and rurality.

Conclusions

There may be opportunities to improve the consistency and efficiency of care for dizziness and balance disorders. It will be important to define appropriate levels of vestibular diagnostic testing and which tests add sufficient value to justify the costs. Further work is needed to better characterize the causes and consequences of variation in vestibular test utilization.

http://oto.sagepub.com/cgi/content/abstract/0194599816676450v1?rss=1

Bone-Anchored Titanium Implants in Patients with Auricular Defects: Three Years and 27 Patients’ Experience

The P Value Problem in Otolaryngology: Shifting to Effect Sizes and Confidence Intervals

http://oto.sagepub.com/cgi/content/abstract/0194599816677735v1?rss=1

A New Theory for Menieres Disease: Detached Saccular Otoconia

http://oto.sagepub.com/cgi/content/abstract/0194599816675843v1?rss=1

The Effect of Vestibular Rehabilitation in Patients with Menieres Disease: A Systematic Review

Objective

To systematically review the evidence on the effect of vestibular rehabilitation in patients with Ménière's disease (MD) on balance and dizziness-related quality of life.

Data Sources

A literature search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Web of Science, and CINAHL databases.

Review Methods

Results

Conclusion

http://oto.sagepub.com/cgi/content/abstract/0194599816678386v1?rss=1

Evaluation of a Web-Based Module and an Otoscopy Simulator in Teaching Ear Disease

Objective

Study Design

Prospective randomized controlled nonclinical trial.

Setting

Preclerkship undergraduate medical education.

Subjects and Methods

Results

Conclusion

http://oto.sagepub.com/cgi/content/abstract/0194599816677697v1?rss=1

Association between Laryngeal Pepsin Levels and the Presence of Vocal Fold Polyps

Objective

Study Design

Cross-sectional study.

Setting

Nanfang Hospital of Southern Medical University.

Subjects and Methods

Results

Conclusion

http://oto.sagepub.com/cgi/content/abstract/0194599816676471v1?rss=1

Head and Neck Cancer: Underfunded and Understudied?

http://oto.sagepub.com/cgi/content/abstract/0194599816674672v1?rss=1

Corrigendum

http://oto.sagepub.com/cgi/reprint/0194599816679126v1?rss=1

Geographic Variation in Use of Vestibular Testing among Medicare Beneficiaries

Objective

Study Design

Cross-sectional study.

Setting

Medicare administrative claims data.

Subjects and Methods

Results

Conclusions

http://oto.sagepub.com/cgi/content/abstract/0194599816676450v1?rss=1

Age at menarche and risk of developing migraine or non-migraine headaches by young adulthood: A prospective cohort study

Importance

Migraine is a highly prevalent and disabling primary headache disorder that is two to three times more prevalent in young women. Among females, there is a steep increase in incidence from puberty to young adulthood, but the mechanisms for the increase are unknown.

Objective

To determine if age of menarche is a risk factor for developing migraine headache vs. non-migraine headache by young adulthood.

Design

A prospective cohort study, The Growing Up Today Study (GUTS), of adolescents who have been followed since 1996, when they were nine, to 14 years of age. Headache questions were included on the 2007 and 2010 surveys.

Setting

Youth from across the United States who are offspring of women participating in the Nurses' Health Study II.

Participants

6112 female participants who had provided data on headache symptoms, age at menarche and family history of migraine and were followed through 2007 or 2010 were included in this analysis.

Main outcomes

Migraine or non-migraine headache.

Results

Many females had a history of headaches, with approximately equal numbers reporting symptoms consistent with migraine (29.7%) and non-migraine headaches (25.3%). We found that, independent of age and family history of migraine, each one-year delay in onset of menarche decrease the odds of migraine by 7% (odds ratio (OR) = 0.93, 95% confidence interval (CI) 0.89–0.97), but was not related to non-migraine headaches.

Conclusions and relevance

The findings of this study suggest that early puberty increases the risk of developing migraines by young adulthood. As such, the study emphasizes the need for understanding the pathophysiological links between puberty and developmental changes that occur in the brain during that period and the mechanisms of onset of the migraine disease and its trajectory.

http://cep.sagepub.com/cgi/content/abstract/0333102416677999v1?rss=1

Psychosocial factors associated with migraine and tension-type headache in medical students

Background

In our previous study of workers, blood donors and medical students, students stood out with a higher 1-year prevalence of migraine (28%) and tension-type headache (TTH) (74%). General factors associated with headache were common for all groups except low physical activity. The hypothesis of this study was therefore that a number of psychosocial factors relating to the personal sphere would better explain the high prevalence of migraine and TTH in students.

Methods

The study population consisted of 1042 students (719 females, 323 males, mean age 20.6, range 17–40). Headache diagnoses and associated factors were identified by direct professional semi-structured interview. We also interviewed about the following psychosocial factors: dissatisfaction with study, dissatisfaction with family life, dissatisfaction for personal reasons, bad financial situation, overwork, stress, not enough sleep, insomnia, depressed mood, anxiety, irritability, tendency towards conflicts and not being married. We report psychosocial factors associated with headache according to diagnosis and sex using univariate and multivariate logistic regression analyses.

Results

Several factors were significantly associated with migraine and TTH in the univariate analysis. In the multivariate analysis, two psychosocial factors were statistically significantly associated with migraine in all students: irritability (OR 2.2, 95% CI 1.4–3.6) and overwork (OR 2.2, 95% CI 1.4–3.5). Insomnia (2.7, 95% CI 1.1–6.9) and depressed mood (OR 2.1, 95% CI 1.1–4.2) were associated with migraine only in females. Two psychosocial factors were associated with TTH: dissatisfaction with study in males (OR 2.0, 95% CI 1.0–3.8) and depressed mood in females (OR 1.8, 95% CI 1.0–3.5).

Conclusion

Psychosocial factors from the personal sphere showed significant association with migraine and TTH in students. Such factors should therefore be major targets for preventive efforts to reduce the prevalence of primary headache disorders in students.

http://cep.sagepub.com/cgi/content/abstract/0333102416678389v1?rss=1

Reversible cerebral vasoconstriction syndrome (RCVS) and headache attributed to aeroplane travel (AH): Does a link exist?

http://cep.sagepub.com/cgi/reprint/0333102416677967v1?rss=1

A novel SCN1A mutation identified in a Chinese family with familial hemiplegic migraine: A case report

Background

Familial hemiplegic migraine (FHM) is a rare type of migraine with aura that is characterized by transient hemiparesis. Mutations in three genes (CACNA1A, ATP1A2, and SCN1A) have been found to cause FHM. Among these, nine SCN1A gene mutations were reported to cause familial hemiplegic migraine type 3 (FHM3). However, none of them was reported in China.

Method

The clinical manifestations of a Chinese FHM family were recorded and all coding exons and flanking intronic regions of the CACNA1A, ATP1A2, and SCN1A genes were tested for mutations.

Results

All FHM patients in the investigated family have typical hemiplegic migraine attacks characteristic of FHM. We identified a novel mutation (p.Leu1670Trp) of the SCN1A gene. The affected amino acid is highly conserved across different species and therefore likely plays an important role in SCN1A gene function.

Conclusion

The identification of a novel mutation in the SCN1A gene in the Chinese population may further aid in the understanding of FHM genetics.

http://cep.sagepub.com/cgi/content/abstract/0333102416677049v1?rss=1

Does the rectus capitis posterior minor muscle contribute to the pathogenesis of chronic headache?

http://cep.sagepub.com/cgi/reprint/0333102416664795v1?rss=1

A Rare Case Report of Thoracic Ectopia Cordis: An Obstetrician’s Point of View in Multidisciplinary Approach

Ectopia cordis is a rare congenital anomaly associated with the heart positioned outside of the thoracic cavity either partially or completely. It can be associated with other congenital abnormalities. Overall, the prognosis for infants with ectopia cordis is very poor but depends greatly on the type and severity of ectopia cordis and intracardiac and associated malformations. We present one case of a fetus with prenatally diagnosed thoracic ectopia cordis with intracardiac defects and omphalocele, all the abnormalities seen in pentalogy of Cantrell except a diaphragmatic defect. Considering poor prognosis for fetus, conservative management of prenatal care has been chosen. At the 42nd gestational week, during the active stage of labor, due to fetal distress, cesarean section was performed at a tertiary level hospital. The condition of the infant was impairing rapidly and the newborn succumbed within 24 hours. We discuss the perinatal care concerning this rare anomaly.

http://www.hindawi.com/journals/cripe/2016/5097059/

Contribution Of Cholesterol And Oxysterols To The Pathophysiology Of Parkinson's Disease

Publication date: Available online 9 November 2016
Source:Free Radical Biology and Medicine
Author(s): Margaux Doria, Lucie Maugest, Thibault Moreau, Gérard Lizard, Anne Vejux
Neurodegenerative diseases are a major public health issue worldwide. Some countries, including France, have engaged in research into the causes of Parkinson's disease, Alzheimer's disease, and multiple sclerosis and the management of these patients. It should lead to a better understanding of the mechanisms leading to these diseases including the possible involvement of lipids in their pathogenesis. Parkinson's disease is a progressive neurodegenerative disorder characterized by the loss of dopaminergic neurons in the substantia nigra and the accumulation of α-synuclein (Lewy bodies). Several in vivo studies have shown a relationship between the lipid profile [cholesterol, oxidized cholesterol products (oxysterols) formed either enzymatically or by auto-oxidation], the use of drugs regulating cholesterol levels, and the development of Parkinson's disease. Several oxysterols are present in the brain and could play a role in the development of this disease, particularly in the accumulation of α-synuclein, and through various side effects, such as oxidation, inflammation, and cell death. Consequently, in Parkinson's disease, some oxysterols could contribute to the pathophysiology of the disease and constitute potential biomarkers or therapeutic targets.

Graphical abstract

http://rss.sciencedirect.com/action/redirectFile?&zone=main&currentActivity=feed&usageType=outward&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%3F_ob%3DGatewayURL%26_origin%3DIRSSSEARCH%26_method%3DcitationSearch%26_piikey%3DS0891584916304506%26_version%3D1%26md5%3D93031fcd35d22ce324b32892a5c230dd

Oxidative stress leads to reduction of plasmalogen serving as a novel biomarker for systemic lupus erythematosus

Publication date: Available online 9 November 2016
Source:Free Radical Biology and Medicine
Author(s): Changfeng Hu, Jia Zhou, Shasha Yang, Haichang Li, Chunyan Wang, Xiaoling Fang, Yongsheng Fan, Jida Zhang, Xianlin Han, Chengping Wen
Oxidative stress is elevated in systemic lupus erythematosus (SLE) patients, and associated extensively with SLE pathogenesis. However, no common indicators of oxidative stress are yet in routine clinical use because of their instability, nonspecificity, and non-representation of all SLE symptoms. Moreover, the method for reproducible analysis of reactive oxygen species is still lacking. Lipids and their metabolites are essential components of biological systems, many of which serve as molecular targets of oxidative stress and play crucial roles in signaling, inflammation, and immune responses. Thus, determining the changed levels of lipids and their metabolites may serve the needs for SLE research. In the pilot study, shotgun lipidomics of sera from 30 SLE patients and 30 controls was performed and revealed a marked reduction of ethanolamine plasmalogen (pPE) species from 85.03 ± 3.06 to 62.39 ± 4.34 nmol/mL serum in controls and patients, respectively, accompanying significant increases in lysoPE (LPE) content (~46mol%) and 4-hydroxynonenal (an indictor of oxidative stress) in patients. Representative proinflammatory cytokines were also determined, revealing significant elevation of IL-6, IL-10, and TNF-α in SLE patients. Multivariate and multiple regression analyses showed for the first time that significant correlation among the SLE disease activity index, IL-10 levels, and pPE content exists, providing insights into SLE pathogenesis. The study also indicates that the changes of pPE (molecular targets of oxidative stress) and their peroxidation products may serve as novel biomarkers for diagnosis of SLE

Graphical abstract

http://rss.sciencedirect.com/action/redirectFile?&zone=main&currentActivity=feed&usageType=outward&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%3F_ob%3DGatewayURL%26_origin%3DIRSSSEARCH%26_method%3DcitationSearch%26_piikey%3DS0891584916310309%26_version%3D1%26md5%3D2d98f04f3ab179f0b47ec1b65cf42c62

Lack of mutation of DICER1 and FOXL2 genes in microcystic stromal tumor of the ovary

Abstract

Microcystic stromal tumors (MCST), first described in 2009 by Irving et al., are rare ovarian neoplasms. The entity was introduced into the 2014 WHO classification of tumors of female reproductive organs in the group of sex cord-stromal tumors, which is rather heterogeneous. We studied three cases of ovarian tumor with the characteristic morphological features and immunohistochemical marker profiles of MCST. The three tumors showed micro, and macrocystic patterns with solid areas, and were composed of small round to spindle-shaped cells, without atypia. The tumors diffusely and strongly expressed CD10, FOXL2, and nuclear β-catenin, but without immmunoreactivity for hormone receptors, calretinin, or inhibin. Genome analyses showed no somatic mutation of exon 1 of the FOXL2 gene and of exons 24 and 25 of DICER1 gene, the latter not having been reported previously. The patients are well, without evidence of tumor progression 1 to 10 years after diagnosis.

The absence of FOXL2 and DICER1 gene mutation, along with strong FOXL2 immunoreactivity provides additional evidence to place MCST within pure gonadal stromal rather than sex cord ovarian tumors.

http://link.springer.com/10.1007/s00428-016-2038-2

Pilot study of FMC (5-fluorouracil, mitomycin C, and cisplatin) with radiotherapy for patients with anal cancer

Abstract

Objectives

Concurrent chemoradiotherapy (CRT) is the current standard of treatment for anal squamous carcinoma. However, local or metastatic recurrences remain significant after CRT with 5-fluorouracil (5-FU) and mitomycin C (MMC). Therefore, the present study evaluated the feasibility and efficacy of adding cisplatin to the classic CRT (5-FU, MMC, and radiotherapy).

Methods

Twenty patients with histologically confirmed squamous cell carcinoma of the anus without metastatic disease were enrolled at Kyungpook National University Medical Center (Daegu, Korea) between January 2005 and December 2014. The CRT comprised of two cycles of 5-FU 750 mg/m² days 1–4, MMC 10 mg/m² day 1, and cisplatin 60 mg/m² day 1 every 4 weeks and radiotherapy (59.6 Gy in 33 daily fractions). The primary endpoint was to determine the feasibility of FMC, while the secondary endpoints were the pathologic complete response (pCR) rate at 8 weeks following the completion of CRT, progression-free survival (PFS), and overall survival (OS).

Results

The treatment was generally well tolerated, and all patients received two cycles of FMC chemotherapy. Among the 20 patients, 17 were assessed for their pathologic response and 12 patients (70.6%) achieved pCR. The most common grade 3 or 4 hematologic toxicity was neutropenia (n = 3), while the most frequent severe non-hematologic toxicity was radiation dermatitis (n = 6, 30%). After a median follow-up duration of 45.5 months, the estimated 5-year PFS and overall survival rates were 88.9 and 88.1%, respectively.

Conclusion

CRT with two cycles of a FMC regimen was found to be feasible for patients with anal squamous carcinoma. Further study is warranted to evaluate the efficacy of CRT with a FMC regimen.

http://link.springer.com/10.1007/s00280-016-3185-5

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Τετάρτη 9 Νοεμβρίου 2016

Abstract

Graphical abstract

Graphical abstract

Abstract

Abstract

Objectives

Methods

Results

Conclusion

Αρχειοθήκη ιστολογίου