High service temperature, self-mendable thermosets networked by isocyanurate rings

Publication date: 7 April 2017
Source:Polymer, Volume 114
Author(s): Lisha Zhang, Florian Julé, Henry A. Sodano
A new mending chemistry exhibiting stability at extreme temperatures and holding mechanical properties as well as mechanical stability comparable to widely used engineering plastics is reported here. This mendable thermoset polymer is synthesized using commodity reactants through the formation of an isocyanurate-oxazolidone network which exhibit a high service temperature as shown by their Tg of 270 °C and Td of 365 °C. We demonstrate that this network polymer is repeatedly self-mendable in the presence of a macroscopic crack, yielding considerable recovery of the polymer's strength after thermal annealing. This self-mending behavior is derived from a high density of mechano-responsive isocyanurate rings which are introduced as cross-links in the network. After mechanically initiated cycloreversion, the recovery of isocyanurate rings in a solid state is thermally initiated. This research is the first demonstration of an isocyanurate ring as a repairing moiety. We developed a new class of intrinsic self-mendable polymers withstanding high temperatures, which will greatly impact the application of thermoset polymers in the field of structural laminates and electronics packaging.

Graphical abstract

http://ift.tt/2n8QgHz

Segmented imidazolium ionenes: Solution rheology, thermomechanical properties, and electrospinning

Publication date: 7 April 2017
Source:Polymer, Volume 114
Author(s): Christian Schreiner, Alexander T. Bridge, Matthew T. Hunley, Timothy E. Long, Matthew D. Green
Segmented imidazolium ionenes with poly (tetramethylene oxide) (PTMO) soft segments and ionic, bis-imidazolium hard segments formed nonwoven fibrous mats upon electrospinning. The segmented imidazolium ionenes exhibited high thermal stability, excellent mechanical properties, and two glass transition temperatures indicative of microphase separation. Tensile analysis revealed strain-induced crystallization for ionenes with a 2 kg/mol PTMO soft segment and increased stress at break with increasing soft segment molecular weight. Solution rheology enabled the determination of solvent quality, overlap and entanglement concentrations, and the influence of ion content on solution properties. Fiber diameters for polymeric fibers electrospun from acetonitrile suggested solution polyelectrolyte behavior that was independent of the PTMO molecular weight. This work reports the successful electrospinning of segmented imidazolium-containing ionenes and an in-depth analysis of their thermomechanical and solution properties.

Graphical abstract

http://ift.tt/2n8SUg7

Cost-effective Alternative for Negative-pressure Wound Therapy

Background: Current predominantly used equipments for negative-pressure wound therapy (NPWT) are expensive. In current healthcare climate continually emphasizing cost containment, importance in developing more cost-effective alternatives cannot be understated. Previously, therapeutically equivalent methods of providing NPWT was demonstrated using just low-cost, universally available supplies, coined Gauze-SUCtion (GSUC). Here, we examine long-term potential financial savings of utilizing GSUC over commercialized products. Methods: A retrospective cost analysis was performed at the University of Chicago Medical Center between 1999 and 2014. All NPWT was provided via either GSUC or commercialized vacuum-assisted closure (VAC, KCI) device. Sum of all material component costs were reviewed to determine theoretical average daily cost. For the VAC group, recorded institutional spend to KCI was also reviewed to determine actual daily cost. In the GSUC group, this figure was extrapolated using similar ratios. Labor costs for each method were determined using analysis from prior study. Patient demographics, etiology, wound location, and treatment length were also reviewed. Results: Total of 35,871 days of NPWT was provided during the 15-year span. Theoretical average cost of VAC was $94.01/d versus $3.61/d for GSUC, whereas actual average was $111.18/d versus $4.26/d. Average labor cost was $20.11/dressing change versus $12.32. Combined, total cost of VAC therapy was estimated at $119,224 per every 1,000 days of therapy versus $9,188 for the GSUC. Conclusions: There is clear and significant cost savings from utilization of GSUC method of NPWT. Furthermore, the added advantage of being able to provide NPWT from universally accessible materials cannot be overstated.

http://ift.tt/2mraybC

Asian Facial Rejuvenation by Extended SMAS Facelift Technique

No abstract available

http://ift.tt/2m09eLv

Deceased Organ Donors With A History Of Increased Risk Behavior For The Transmission Of Blood-Borne Viral Infection: The Uk Experience.

Background: Deceased organ donors are routinely screened for behaviors that increase the risk of transmissible blood borne viral (BBV) infection, but the impact of this information on organ donation and transplant outcome is not well documented. Our aim was to establish the impact of such behavior on organ donation and utilization, as well transplant recipient outcomes. Methods: We identified all UK deceased organ donors from 2003-2015 with a disclosed history of increased risk behavior (IRB) including intravenous drug use (IVDU), imprisonment and increased risk sexual behavior. Results: Of 17 262 potential donors, 659 (3.8%) had IRB for BBV and 285 (1.7%) were seropositive for BBV, of whom half had a history of IRB (mostly IVDU (78.5%)). Of actual donors with IRB, 393 were seronegative for viral markers at time of donation. A history of recent IVDU was associated with fewer potential donors proceeding to become actual organ donors (64% vs. 75%, p=0.007). Donors with IRB provided 1091 organs for transplantation (624 kidneys and 467 other organs). Transplant outcome was similar in recipients of organs from donors with and without IRB. There were 3 cases of unexpected HCV transmission, all from an active IVDU donor who was HCV seronegative at time of donation, but was found to be viraemic on retrospective testing Conclusion: Donors with a history of IRB provide a valuable source of organs for transplantation with good transplant outcomes and there is scope for increasing the use of organs from such donors. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2mYnWXS

Mild Cognitive Impairment and Exposure to General Anesthesia for Surgeries and Procedures: A Population-Based Case-Control Study.

BACKGROUND: To examine whether exposure to general anesthesia for procedures at age >=40 years is associated with prevalent mild cognitive impairment (MCI) in the elderly. METHODS: A case-control study nested within a population-based cohort. Olmsted County, Minnesota, residents, aged 70-91 years, underwent baseline evaluations that included the Clinical Dementia Rating scale, a neurologic evaluation, and neuropsychologic testing. Individuals identified with MCI (cases) at enrollment were matched 1:2 on age, sex, education, and apolipoprotein genotype with participants who were cognitively normal at the time of the index visit. Medical records from age 40 years until the index visit were reviewed to determine exposures to general anesthesia. Conditional logistic regression, taking into account the matched set study design and adjusting for MCI risk factors, was used to assess whether exposure to anesthesia after the age of 40 years was associated with prevalent MCI. RESULTS: A total of 387 Mayo Clinic Study of Aging participants (219 males, 168 females) were diagnosed with MCI at enrollment with mean age of 81 +/- 5 years. Exposure to general anesthesia after the age of 40 years was not significantly associated with prevalent MCI when analyzed as a dichotomous variable (any versus none, adjusted odds ratio, 0.97 [95% confidence interval, 0.68-1.40]) or the number of exposures (odds ratio, 1.13 [0.74-1.72], 0.81 [0.53-1.22], and 1.03 [0.67-1.58] for 1, 2-3, and >=4 exposures, respectively, with no exposure as the reference). Similar results were obtained for exposure to anesthesia after the age of 60 years and during 5, 10, and 20 years before the first visit. CONCLUSIONS: Exposure to general anesthesia for procedures at age >=40 years was not associated with prevalent MCI in the elderly. (C) 2017 International Anesthesia Research Society

http://ift.tt/2n8G01K

Pulsed CO2 Laser Ablation of Superficial Basal Cell of Limbs and Trunk: A Comparative Randomized Clinical Trial With Cryotherapy and Surgical Ablation.

BACKGROUND: Pulsed CO2 laser is a treatment of superficial basal cell carcinoma (sBCC) although robust clinical evidence has not been reported so far. OBJECTIVE: The authors investigated efficacy, safety, time to wound healing, cosmetic outcome, patient satisfaction, and cost-effectiveness ratio of pulsed CO2 laser in comparison to cryotherapy and surgery. MATERIALS AND METHODS: BCCs of the trunk and extremities were randomized to one of the treatments. After 90 days, efficacy and cosmetic outcome were assessed. Patients recorded the time to complete healing of the wound and scored their overall satisfaction. RESULTS: Two hundred forty patients were randomized. After 3 months, complete remission (CR) rate with pulsed CO2 laser was 78.8%. This was significantly lower than surgery, whereas the CR rate with cryotherapy was not significantly different. Cosmetic result was better with surgery. High satisfaction was reported by 65.0% of patients treated with CO2 ablation. Time of wound healing was significantly shorter with CO2 laser. CONCLUSION: In comparison to cryotherapy, pulsed CO2 laser showed no statistically significant difference in efficacy, cosmetic outcome, and patient satisfaction. Time to healing was shorter; the cost and cost-effectiveness ratio were similar. Surgery had the greatest efficacy rate. The main limitation of this study was the short duration of follow-up (3 months). (C) 2017 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2nrhGpe

Mohs Micrographic Surgery as a Digit-Sparing Treatment for Aggressive Digital Papillary Adenocarcinoma.

No abstract available

http://ift.tt/2mYhdNC

Scrotal Melanoma: A Systematic Review of Presentation, Treatment, and Outcomes.

BACKGROUND: Primary male genital melanomas are rare. Of these, scrotal melanoma is the least common, and is unfortunately often detected late in the disease course. OBJECTIVE: To assess the clinical presentation, treatment modalities, and outcome of scrotal melanoma to aid clinician management. METHODS: Systematic literature review of PubMed, yielding 23 cases, of which 20 met the inclusion criteria. RESULTS: Although previously thought to have the best outcome of genitourinary melanomas, scrotal melanomas are associated with high mortality and late presentation. Scrotal melanoma presented as Stage I/II disease 18.75% of the time, Stage III 56.3% of the time, and Stage IV 25% of the time, whereas typical cutaneous melanoma presents as Stage I/II disease 84% of the time, Stage III 8% of the time, and Stage IV 4% of the time. Half of patients experienced recurrence of their disease. All patients who presented with metastases to distant organs died. LIMITATIONS: Small sample size. Few cases described a Breslow's depth making it difficult to draw conclusions on tumor thickness and survival outcome. CONCLUSION: Scrotal melanoma is rare, aggressive, and is often caught late in the disease course. The authors encourage dermatologists to educate patients and destigmatize genital lesions to increase the likelihood of earlier detection and better patient outcomes. (C) 2017 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2nrnrDd

Antimicrobial Prophylaxis for Full-Face Laser Resurfacing in Transplant Recipients.

No abstract available

http://ift.tt/2mYoNaW

Transplantation of In Vivo-Harvested Epidermal Cell Suspension for Acute Cutaneous Lupus Erythematosus-Induced Depigmentation.

No abstract available

http://ift.tt/2mYfFTF

Quality of Life With Ingrown Toenails: A Cross-Sectional Study.

No abstract available

http://ift.tt/2nr9Mwc

Reconstruction of a Combined Nose and Cheek Defect.

No abstract available

http://ift.tt/2nqVOKB

Submental Alopecia at Deoxycholic Acid Injection Site.

No abstract available

http://ift.tt/2mr4zU4

Down syndrome: Age-dependence of PiB binding in postmortem frontal cortex across the lifespan

Publication date: Available online 14 March 2017
Source:Neurobiology of Aging
Author(s): Harry LeVine, H. Peter Spielmann, Sergey Matveev, Francesca Macchiavello Cauvi, M. Paul Murphy, Tina L. Beckett, Katie McCarty, Ira T. Lott, Eric Doran, Frederick Schmitt, Elizabeth Head
Beta-amyloid (Aβ) deposition in brain accumulates as a function of age in people with Down syndrome (DS) with subsequent development into Alzheimer disease neuropathology, typically by 40 years of age. In vivo imaging using the Pittsburgh Compound B (PiB) ligand has facilitated studies linking Aβ, cognition, and dementia in DS. However, there are no studies of PiB binding across the lifespan in DS. The current study describes in vitro ³H-PiB binding in the frontal cortex of autopsy cases with DS compared to non-DS controls. Tissue from 64 cases included controls (N=25) and DS (N=39). In DS, ³H-PiB binding was significantly associated with age. After age 40 years in DS, ³H-PiB binding rose dramatically along with increasing individual variability. ³H-PiB binding correlated with the amount of Aβ42. Using fixed frontal tissue and fluorescent 6-CN-PiB, neuritic and cored plaques along with extensive cerebral amyloid angiopathy (CAA) showed 6-CN-PiB binding. These results suggest that cortical PiB binding as shown by positron emission tomography imaging reflects plaques and CAA in DS brain.



http://ift.tt/2nm8ntS

Intranasal insulin decreases circulating cortisol concentrations during early sleep in elderly humans

Publication date: Available online 14 March 2017
Source:Neurobiology of Aging
Author(s): Matthias Thienel, Ines Wilhelm, Christian Benedict, Jan Born, Manfred Hallschmid
Aging is associated with increases in hypothalamic-pituitary-adrenal (HPA) axis activity that can predispose to metabolic and cognitive impairments. We investigated in elderly and young subjects whether intranasal insulin administration to the human brain reduces early-sleep nadir concentrations of adrenocorticotropin (ACTH) and cortisol, i.e., indicators of baseline HPA axis activity. In within-subject comparisons, intranasal insulin (160 IU) or placebo was administered to 14 elderly (mean age 70.0 years) and 30 young (23.6 years) healthy subjects before bedtime. Sleep was polysomnographically assessed and blood samples were repeatedly collected. Elderly compared to young participants displayed increased early-sleep cortisol concentrations (P < 0.04) and reductions in slow wave and REM sleep (P < 0.001). Insulin administration reduced cortisol levels between 2300 h and 0020 h in the elderly (P = 0.03) but not young participants (P = 0.56; P = 0.003 for interaction). Findings indicate that central nervous insulin acts as an inhibitory signal in basal HPA axis activity regulation and suggest that intranasal insulin may normalize sleep-associated stress axis activity in older age.



http://ift.tt/2mqFRCE

Subcutaneous Histiocytoid Sweet Syndrome in a Patient With Relapsed Acute Myeloblastic Leukemia.

No abstract available

http://ift.tt/2mMfFWp

A Rapidly Growing Facial Mass: Answer.

No abstract available

http://ift.tt/2mr73ln

A Rapidly Growing Facial Mass: Challenge.

No abstract available

http://ift.tt/2mM2CEq

Depletion of Epidermal Langerhans Cells in the Skin Lesions of Pellagra Patients.

Pellagra is a nutrient deficiency disease caused by insufficient niacin levels. Recent studies have shown that numbers of epidermal Langerhans cells decreased in other diseases caused by nutritional deficiencies, including necrolytic migratory erythema and acrodermatitis enteropathica. Epidermal Langerhans cells are capable of modulating or even halting the inflammatory reaction. The aim of this study was to examine changes in the number of Langerhans cells and other dendritic cells, and maturation of epidermal Langerhans cells in the lesional and adjacent non-lesional skin in pellagra patients. Seven pellagra patients and 10 healthy individuals who served as controls were included. The number and distribution of dendritic cells and other cutaneous cells were examined by immunohistochemistry. Epidermal Langerhans cells decreased considerably in the skin lesions of pellagra patients, whereas other dendritic cells did not change. The decrease in the number of Langerhans cells was positively correlated with the histological severity of skin lesions. As the number of Langerhans cells was not reduced in the undisturbed neighboring skin, the depletion of epidermal Langerhans cells did not precede skin damage but was a cause of prolonged severe inflammation. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2mrcKQb

Bilateral and Symmetrical Linear Plaques on the Hands.

No abstract available

http://ift.tt/2mM5xwE

On Allusive Names for the Syphilitic Patient From the 16th to the 19th Century: The Role of Dermatopathology.

No abstract available

http://ift.tt/2mqSj5Y

Study of Selected BRCA1, BRCA2, and PIK3CA Mutations in Benign and Malignant Lesions of Anogenital Mammary-Like Glands.

Anogenital mammary-like glands (AGMLGs) are nowadays considered a normal component of the anogenital area. Lesions involving AGMLGs are histopathologically very similar to their mammary counterparts, but the information on molecular biological mechanisms in these vulvar/perianal tumors is scarce. Mutations in the PI3K-AKT cascade have been found in hidradenoma papilliferum. The authors studied selected BRCA1, BRCA2, and PIK3CA mutations in series of benign and malignant neoplasms thought to be associated with AGMLGs, including 9 cases of primary extramammary Paget disease, 3 different cases of mammary-type carcinoma (adenoid cystic like, tubulolobular, and invasive ductal like), and 5 cases of hidradenoma papilliferum. No BRCA mutation was detected, whereas 3 neoplasms yielded PIK3CA mutation, including extramammary Paget disease, mammary-type invasive ductal carcinoma, and tubulolobular carcinoma. Our study expands the spectrum of lesions of AGMLGs harboring mutations in genes encoding the PI3K-AKT cascade. Further studies of the whole BRCA1 and BRCA2 genes using a larger cohort are needed to clarify their role in the pathogenesis of AGMLG lesions. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2mMjzi5

Nonhealing Ulcerations of the Breast.

No abstract available

http://ift.tt/2mr3Y4F

Nonhealing Ulcerations of the Breast: Challenge.

No abstract available

http://ift.tt/2mMjAm9

Melanoma Manifesting as Tumoral Melanosis; Now You See It, Now You Don't.

No abstract available

http://ift.tt/2mqGBZi

Comparative study of autologous fat vs hyaluronic acid in correction of the nasolabial folds

Summary

Objective

In the article, comparison of the hyaluronic acid (HA) and autologous fat is conducted to evaluate the effectiveness and safety in correction of the nasolabial folds (NLFs).

Methods

From November 2012 to December 2015, a single-blinded, randomized study was conducted. Sixty-two patients were included in the study, and 57 of them completed the whole procedure. The patients were randomly allocated to receive the treatments of HA or fat in both NLFs. The Wrinkle Severity Rating Scale (WSRS) and Global Aesthetic Improvement Scale (GAIS) were used for assessment. Efficacy was assessed using two parameters: evaluation of final improvement by blinded evaluator and patient-self using photographs. The effectiveness endpoint was improvement of scores at 1, 3, 6, 9, and 12 months from baseline. The adverse events (AEs) were recorded.

Results

In the blinded evaluator scores for NLF in accordance with WSRS, there were no significant differences between the two methods within 9 months. A statistically significant difference between the lipoinjection and HA groups was found at 12-month follow-up period. Subjects' self-assessment was similar to the results seen for the evaluator scores. The difference of AEs between the HA and fat group was obvious in the early stage of recovery. In the later stage, the AEs of the HA and fat group were similar.

Conclusions

Both HA gel and autologous fat provide augmentation of NLFs. The magnitude and duration of NLF correction appear to be similarly effective and safe within a period.

http://ift.tt/2mqwaE7

Comparative study of autologous fat vs hyaluronic acid in correction of the nasolabial folds

Summary

Objective

In the article, comparison of the hyaluronic acid (HA) and autologous fat is conducted to evaluate the effectiveness and safety in correction of the nasolabial folds (NLFs).

Methods

From November 2012 to December 2015, a single-blinded, randomized study was conducted. Sixty-two patients were included in the study, and 57 of them completed the whole procedure. The patients were randomly allocated to receive the treatments of HA or fat in both NLFs. The Wrinkle Severity Rating Scale (WSRS) and Global Aesthetic Improvement Scale (GAIS) were used for assessment. Efficacy was assessed using two parameters: evaluation of final improvement by blinded evaluator and patient-self using photographs. The effectiveness endpoint was improvement of scores at 1, 3, 6, 9, and 12 months from baseline. The adverse events (AEs) were recorded.

Results

In the blinded evaluator scores for NLF in accordance with WSRS, there were no significant differences between the two methods within 9 months. A statistically significant difference between the lipoinjection and HA groups was found at 12-month follow-up period. Subjects' self-assessment was similar to the results seen for the evaluator scores. The difference of AEs between the HA and fat group was obvious in the early stage of recovery. In the later stage, the AEs of the HA and fat group were similar.

Conclusions

Both HA gel and autologous fat provide augmentation of NLFs. The magnitude and duration of NLF correction appear to be similarly effective and safe within a period.

http://ift.tt/2mqwaE7

The effect of desflurane versus propofol anesthesia on postoperative delirium in elderly obese patients undergoing total knee replacement: A randomized, controlled, double-blinded clinical trial

The goal of this study was to investigate the incidence of delirium, wake-up times and early post-operative cognitive decline in one hundred obese elderly patients undergoing total knee arthroplasty.

http://ift.tt/2nlYPPG

Successful tracheal intubation with the McGRATH™ MAC during chest compression in a difficult airway patient

We report a case of successful tracheal intubation with the McGRATH™ MAC (McGRATH; Aircraft Medical Ltd., U.K.) videolaryngoscope during chest compression in a difficult airway patient.

http://ift.tt/2nDacyB

Hands-on Anleitung für Larynxoperationen in örtlicher Betäubung mittels flexibler Endoskopie und Darstellung am Bildschirm

Laryngo-Rhino-Otol 2017; 96: 83-85
DOI: 10.1055/s-0042-124659

© Georg Thieme Verlag KG Stuttgart · New York

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Das neue Zweitmeinungsverfahren

Laryngo-Rhino-Otol 2017; 96: 118-119
DOI: 10.1055/s-0042-108311

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Das neue Zweitmeinungsverfahren

Laryngo-Rhino-Otol 2017; 96: 118-119
DOI: 10.1055/s-0042-108311

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Partielle Obliteration von Ohr-Radikalhöhlen

Laryngo-Rhino-Otol 2017; 96: 80-82
DOI: 10.1055/s-0042-122481

Die moderne operative Therapie des Mittelohrcholesteatoms hat sich von der früheren, fast dogmatischen Anwendung entweder der 2-Wege Technik oder der Radikalhöhlenoperation zu einer individualisierten Technik gewandelt, in Kenntnis der Pathomechanik (Entwicklung des Cholesteatoms aus einer Retraktionstasche) und den vielfältigen zuverlässigen Einsatzmöglichkeiten einer Knorpelrekonstruktion der Gehörgangswände. In der modernen Ohrchirurgie kommt daher in der Mehrzahl die sogenannte Verfolgungstechnik (die transmeatale Exposition des Cholesteatomsackes ohne zwingende Mastoidektomie mit anschließender Rekonstruktion der Gehörgangswand durch Knorpelplatten) zum Einsatz. Nur in seltenen Fällen ist noch die sogenannte 2-Wege Technik (mit Mastoidektomie) oder die Anlage einer Radikalhöhle erforderlich. Auch hier hat ein Umdenken stattgefunden in Anbetracht der unerträglich hohen Rezidivraten bei der 2-Wege Technik: Sowohl die hohe Zahl der Residualcholesteatome (typischerweise im Schatten der stehengelassenen hinteren Gehörgangswand) als auch die rekurrenten Rezidive (Einsenken einer neuen Retraktion in die vormals ausgebohrte Mastoidhöhle) lassen dieses Verfahren nur noch für sehr gut pneumatisierte und mit reizloser, gasproduzierender Schleimhaut ausgekleidete Mittelohren als erfolgsversprechend erscheinen. Bei der klassischen Radikalhöhlentechnik besteht trotz ihrer geringeren Rezidivrate als großer Nachteil das chronische Ohrenlaufen aufgrund der ständig feuchten Höhle. Ursächlich und schon lange bekannt ist das ungünstige Belüftungsverhältnis der hautausgekleideten großen Höhle (zu kleine Öffnung des Gehörgangs im Verhältnis zum großen Höhenvolumen). Eine stabile Verkleinerung der Höhle mit deutlicher Verringerung der Rezidivrate ist mit körpereigenem Knochenmehl und lückenloser Knorpelplattenabdeckung (aus dem Cavum conchae) möglich. In dem Video wird das Prinzip der Knochenmehl- und Knorpelplattenobliteration mit unserer in Dresden entwickelten Technik dargestellt und es werden einige Tipps zur Erzielung einer stabilen Höhle gegeben.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Partielle Obliteration von Ohr-Radikalhöhlen

Laryngo-Rhino-Otol 2017; 96: 80-82
DOI: 10.1055/s-0042-122481

Die moderne operative Therapie des Mittelohrcholesteatoms hat sich von der früheren, fast dogmatischen Anwendung entweder der 2-Wege Technik oder der Radikalhöhlenoperation zu einer individualisierten Technik gewandelt, in Kenntnis der Pathomechanik (Entwicklung des Cholesteatoms aus einer Retraktionstasche) und den vielfältigen zuverlässigen Einsatzmöglichkeiten einer Knorpelrekonstruktion der Gehörgangswände. In der modernen Ohrchirurgie kommt daher in der Mehrzahl die sogenannte Verfolgungstechnik (die transmeatale Exposition des Cholesteatomsackes ohne zwingende Mastoidektomie mit anschließender Rekonstruktion der Gehörgangswand durch Knorpelplatten) zum Einsatz. Nur in seltenen Fällen ist noch die sogenannte 2-Wege Technik (mit Mastoidektomie) oder die Anlage einer Radikalhöhle erforderlich. Auch hier hat ein Umdenken stattgefunden in Anbetracht der unerträglich hohen Rezidivraten bei der 2-Wege Technik: Sowohl die hohe Zahl der Residualcholesteatome (typischerweise im Schatten der stehengelassenen hinteren Gehörgangswand) als auch die rekurrenten Rezidive (Einsenken einer neuen Retraktion in die vormals ausgebohrte Mastoidhöhle) lassen dieses Verfahren nur noch für sehr gut pneumatisierte und mit reizloser, gasproduzierender Schleimhaut ausgekleidete Mittelohren als erfolgsversprechend erscheinen. Bei der klassischen Radikalhöhlentechnik besteht trotz ihrer geringeren Rezidivrate als großer Nachteil das chronische Ohrenlaufen aufgrund der ständig feuchten Höhle. Ursächlich und schon lange bekannt ist das ungünstige Belüftungsverhältnis der hautausgekleideten großen Höhle (zu kleine Öffnung des Gehörgangs im Verhältnis zum großen Höhenvolumen). Eine stabile Verkleinerung der Höhle mit deutlicher Verringerung der Rezidivrate ist mit körpereigenem Knochenmehl und lückenloser Knorpelplattenabdeckung (aus dem Cavum conchae) möglich. In dem Video wird das Prinzip der Knochenmehl- und Knorpelplattenobliteration mit unserer in Dresden entwickelten Technik dargestellt und es werden einige Tipps zur Erzielung einer stabilen Höhle gegeben.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Dank an die Gutachter

Laryngo-Rhino-Otol 2017; 96: 88-88
DOI: 10.1055/s-0043-101974

© Georg Thieme Verlag KG Stuttgart · New York

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Dank an die Gutachter

Laryngo-Rhino-Otol 2017; 96: 88-88
DOI: 10.1055/s-0043-101974

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2mY52QT

Hands-on Anleitung für Larynxoperationen in örtlicher Betäubung mittels flexibler Endoskopie und Darstellung am Bildschirm

Laryngo-Rhino-Otol 2017; 96: 83-85
DOI: 10.1055/s-0042-124659

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2mHDKMo

Schädelbasischirurgie

Laryngo-Rhino-Otol 2017; 96: 88-88
DOI: 10.1055/s-0042-121758

© Georg Thieme Verlag KG Stuttgart · New York

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Leserbrief – Rubrik CME-Fortbildung

Laryngo-Rhino-Otol 2017; 96: 86-87
DOI: 10.1055/s-0042-115162

© Georg Thieme Verlag KG Stuttgart · New York

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http://ift.tt/2nD6Dsl

Schädelbasischirurgie

Laryngo-Rhino-Otol 2017; 96: 88-88
DOI: 10.1055/s-0042-121758

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Die saisonale und perenniale allergische Rhinokonjunktivitis

Laryngo-Rhino-Otol 2017; 96: 89-97
DOI: 10.1055/s-0043-101391

Sowohl bei der saisonalen allergischen Konjunktivitis (seasonal allergic conjunctivitis, SAC) und ganzjährigen allergischen Konjunktivitis (perennial allergic conjunctivitis, PAC) als auch bei der intermittierenden und persistierenden Rhinitis handelt es sich umweit verbreitete Krankheitsbilder, die in der Mehrzahl der Fälle gemeinsam auftreten und daher zumeist unter dem Oberbegriff der allergischen Rhinokonjunktivitis zusammengefasst werden. SAC und PAC zusammen machen als die 2 akuten Formen mehr als 90% der Gesamtzahl aller Fälle von allergischer Konjunktivitis aus. Verglichen mit den chronischen Formen verlaufen sie harmloser, bekommen jedoch aufgrund der Häufigkeit und sowie des nachgewiesenen Einflusses auf die Lebensqualität der Patienten klinische und sozioökonomische Relevanz. Auslöser der der allergischen Rhinokonjunktivitis zugrunde liegenden IgE-vermittelten Typ-1-Hypersensitivitätsreaktion sind zumeist Aeroallergene. Pathognomonisches Symptom ist Juckreiz. Okulär zeigen sich zudem Chemosis, Bindehautinjektion, wässrige Sekretion sowie Lidschwellungen. HNO-ärztlich finden sich zumeist gesteigerte Nasensekretion, retronasaler Schleimfluss und Niesen. Durch Behinderung der Nasenatmung können Schlaf- und Konzentrationsstörungen auftreten. Therapeutisch können neben der Vermeidung der Allergenexposition durch Modifikation von Umweltfaktoren bei milden Formen von SAC und PAC Tränenersatzmittel eingesetzt werden. Topische Antihistaminika eignen sich insbesondere zur Linderung der akuten Symptomatik. Topische Mastzellstabilisatoren hingegen zeigen einen längerfristigen Effekt. Dual wirksame Kombinationen aus Antihistaminikum und Mastzellstabilisator vereinen gute Wirksamkeit und Anwenderfreundlichkeit. Lokale Steroide sollten bei SAC und PAC zurückhaltend und zeitlich begrenzt angewendet werden. Im Falle einer langfristigen Anwendung antiallergischer Lokalmedikation wird die Verwendung unkonservierter Präparate empfohlen. Die HNO-ärztlich häufig in Kombination mit Antihistaminika angewendeten intranasalen Steroide zeigen bei Verwendung moderner Präparate ein günstiges Nebenwirkungsprofil. Zusammenfassend stellt die allergische Rhinokonjunktivitis ein häufiges und nach korrekter Diagnosestellung gut therapierbares Krankheitsbild dar. Durch gezielte Behandlung kann innerhalb kurzer Zeit eine deutliche Verbesserung der Lebensqualität der betroffenen Patienten erreicht werden.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Leserbrief – Rubrik CME-Fortbildung

Laryngo-Rhino-Otol 2017; 96: 86-87
DOI: 10.1055/s-0042-115162

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2nD6Dsl

Implantierbare Knochenleitungs- und aktive Mittelohrhörsysteme

Laryngo-Rhino-Otol 2017; 96: 120-129
DOI: 10.1055/s-0042-122477

Bei audiologischen und/oder anatomischen Limitationen in der Versorgung mit konventionellen Hörgeräten können moderne teil- oder vollimplantierbare Hörsysteme in ausgewählten Fällen die Versorgungsmöglichkeiten komplettieren. Es konnte gezeigt werden, dass sich für eine Vielzahl an Patienten Verbesserungen im Tragekomfort, im Sprachverständnis und somit der Lebensqualität erzielen lassen.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  CME online  |  Full text

http://ift.tt/2mY50bJ

Die saisonale und perenniale allergische Rhinokonjunktivitis

Laryngo-Rhino-Otol 2017; 96: 89-97
DOI: 10.1055/s-0043-101391

Sowohl bei der saisonalen allergischen Konjunktivitis (seasonal allergic conjunctivitis, SAC) und ganzjährigen allergischen Konjunktivitis (perennial allergic conjunctivitis, PAC) als auch bei der intermittierenden und persistierenden Rhinitis handelt es sich umweit verbreitete Krankheitsbilder, die in der Mehrzahl der Fälle gemeinsam auftreten und daher zumeist unter dem Oberbegriff der allergischen Rhinokonjunktivitis zusammengefasst werden. SAC und PAC zusammen machen als die 2 akuten Formen mehr als 90% der Gesamtzahl aller Fälle von allergischer Konjunktivitis aus. Verglichen mit den chronischen Formen verlaufen sie harmloser, bekommen jedoch aufgrund der Häufigkeit und sowie des nachgewiesenen Einflusses auf die Lebensqualität der Patienten klinische und sozioökonomische Relevanz. Auslöser der der allergischen Rhinokonjunktivitis zugrunde liegenden IgE-vermittelten Typ-1-Hypersensitivitätsreaktion sind zumeist Aeroallergene. Pathognomonisches Symptom ist Juckreiz. Okulär zeigen sich zudem Chemosis, Bindehautinjektion, wässrige Sekretion sowie Lidschwellungen. HNO-ärztlich finden sich zumeist gesteigerte Nasensekretion, retronasaler Schleimfluss und Niesen. Durch Behinderung der Nasenatmung können Schlaf- und Konzentrationsstörungen auftreten. Therapeutisch können neben der Vermeidung der Allergenexposition durch Modifikation von Umweltfaktoren bei milden Formen von SAC und PAC Tränenersatzmittel eingesetzt werden. Topische Antihistaminika eignen sich insbesondere zur Linderung der akuten Symptomatik. Topische Mastzellstabilisatoren hingegen zeigen einen längerfristigen Effekt. Dual wirksame Kombinationen aus Antihistaminikum und Mastzellstabilisator vereinen gute Wirksamkeit und Anwenderfreundlichkeit. Lokale Steroide sollten bei SAC und PAC zurückhaltend und zeitlich begrenzt angewendet werden. Im Falle einer langfristigen Anwendung antiallergischer Lokalmedikation wird die Verwendung unkonservierter Präparate empfohlen. Die HNO-ärztlich häufig in Kombination mit Antihistaminika angewendeten intranasalen Steroide zeigen bei Verwendung moderner Präparate ein günstiges Nebenwirkungsprofil. Zusammenfassend stellt die allergische Rhinokonjunktivitis ein häufiges und nach korrekter Diagnosestellung gut therapierbares Krankheitsbild dar. Durch gezielte Behandlung kann innerhalb kurzer Zeit eine deutliche Verbesserung der Lebensqualität der betroffenen Patienten erreicht werden.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Fragen für die Facharztprüfung

Laryngo-Rhino-Otol 2017; 96: 130-131
DOI: 10.1055/s-0042-122478

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2nD9Fgk

Implantierbare Knochenleitungs- und aktive Mittelohrhörsysteme

Laryngo-Rhino-Otol 2017; 96: 120-129
DOI: 10.1055/s-0042-122477

Bei audiologischen und/oder anatomischen Limitationen in der Versorgung mit konventionellen Hörgeräten können moderne teil- oder vollimplantierbare Hörsysteme in ausgewählten Fällen die Versorgungsmöglichkeiten komplettieren. Es konnte gezeigt werden, dass sich für eine Vielzahl an Patienten Verbesserungen im Tragekomfort, im Sprachverständnis und somit der Lebensqualität erzielen lassen.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  CME online  |  Full text

http://ift.tt/2mY50bJ

Schwere Epistaxis stoppen: Klinischer Behandlungspfad zahlt sich aus

Laryngo-Rhino-Otol 2017; 96: 78-79
DOI: 10.1055/s-0043-101083

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2n8uZ0m

Fragen für die Facharztprüfung

Laryngo-Rhino-Otol 2017; 96: 130-131
DOI: 10.1055/s-0042-122478

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Schwere Epistaxis stoppen: Klinischer Behandlungspfad zahlt sich aus

Laryngo-Rhino-Otol 2017; 96: 78-79
DOI: 10.1055/s-0043-101083

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Effect of high laser output on the central bronchi and pulmonary artery

Abstract

A diode-pump Nd:YAG high-power laser (wavelength 1320 nm, power 100 W) is routinely used to surgically remove lung metastases. Even pulmonary lesions in central locations are resectable via this method, yet it also carries a potential risk of damaging the larger bronchi and vessels in the vicinity. Studies investigating the safety of using high-power lasers are lacking. We therefore aimed to examine the direct effects of a 100-watt laser on the bronchi and pulmonary artery at a standard working velocity. From freshly slaughtered pigs, we isolated cylindrical specimens of the trachea, the main and lobar bronchi, and the central pulmonary artery from the both lungs. These specimens were fixed consecutively in rows behind each other on a Styrofoam surface in the laboratory. The laser's handle was clamped into a hydraulic feed unit so that the laser was focused at constant distance perpendicular to the tissue and would move at 10 mm/s over the specimens. The Nd:YAG Laser LIMAX® 120 functioned at a consistent power of 100 W during all the experiments. The lasered specimens were examined macroscopically and histologically for tissue damage. None of the trachea or bronchial walls were perforated. Compared to the pulmonary parenchyma, we observed no vaporization effects—only minor superficial coagulation (with a mean depth of 2.1 ± 0.8 mm). This finding was histologically confirmed in each specimen, which revealed mild superficial coagulation and no damage to the cartilage. In the presence of a residual peribronchial fatty tissue, the laser effect was even attenuated. The pulmonary arteries presented no lumen openings whatsoever, merely a discrete trace of coagulation. The vessel wall revealed increased vacuolization without alteration of the remaining vessel wall. In conclusion, laser resection at 100 W of the central lung areas is safe with respect to airways and blood vessels and the laser output does not need to be reduced when treating these areas.

http://ift.tt/2moawAf

GreenLight laser photoselective vaporization of the prostate for treatment of benign prostate hyperplasia/lower urinary tract symptoms in patients with different post-void residual urine

Abstract

The purpose of this study is to assess the safety and efficacy of GreenLight laser photoselective vaporization of the prostate (PVP) for the treatment of benign prostate hyperplasia/lower urinary tract symptoms (BPH/LUTS) in patients with different post-void residual urine (PVR). BPH/LUTS patients treated with PVP from January 2014 to January 2016 were enrolled in the present study. All patients were divided into PVR > 50, 50 ≤ PVR < 400, and PVR ≥ 400 ml groups, and standard general and urological methods for BPH/LUTS were carried out. PVP surgery was performed, and the follow-up outcome was investigated 6 months after surgery. A total of 429 patients were included, and there were no significant differences in comorbid diseases or habits among the three groups. The maximum urinary flow rate (Qmax) differed significantly among the groups (P < 0.001), while patients in the PVR < 50 ml group had higher maximum detrusor pressure (Pdet.max) level than the other two groups (P < 0.001). Patients in 50 ≤ PVR < 400 (P < 0.001) and PVR ≥ 400 (P < 0.001) ml groups were more likely to develop detrusor underactivity than those in the PVR < 50 ml group. All patients were treated with PVP, and there were no severe complications requiring rehospitalization or reoperation except nine designed re-treatments. Follow-up data of 387 patients were available. Significant improvement in outcome parameters (International Prostate Symptom Score [IPSS], Qmax, and PVR) was observed in comparison with baseline measurements for the three groups. PVP significantly improved the IPSS, Qmax, and PVR in patients with different PVR; PVP is a safe and effective procedure for BPH/LUTS patients.

http://ift.tt/2n63k0e

The association between Nd:YAG laser and desensitizing dentifrices for the treatment of dentin hypersensitivity

Abstract

This study aims to evaluate the association between Nd:YAG laser (with and without a photoabsorber) and two desensitizing dentifrices containing 15% NovaMin or 8% arginine, as potential treatments for dentin hypersensitivity (DH). DH was simulated by EDTA application for 2 min. Specimens were then analyzed with an environmental scanning electron microscope (ESEM) to ensure open dentin tubules (ODT), counted by using ImageJ software. Specimens were randomized into eight groups (n = 10): Laser (L), Laser+Photoabsorber (LP), Arginine (A), Arginine+Laser (AL), Arginine+Laser+Photoabsorber (ALP), NovaMin (N), NovaMin+Laser (NL), and NovaMin+Laser+Photoabsorber (NLP). Laser irradiation was performed with 1 W, 100 mJ, 10 Hz, ≅85 J/cm²; 4 irradiations of 10 s each, with 10 s intervals between them. After treatment, specimens were again analyzed by ESEM and submitted to erosive/abrasive cycling for 5 days. A final ESEM analysis was performed. Data were analyzed with two-way repeated measure ANOVA and Tukey tests (α = 0.05). After treatment, groups N, NL, and NLP presented the lower number of ODT, but they did not different from LP, ALP, and AL. Group A presented the highest number of ODT and it did not differ from group L. Groups L, AL, ALP, and LP presented intermediate results, without differing from each other. After cycling, group A presented the highest number of ODT and did not differ significantly from the other groups, except NLP. None of the associations tested presented better tubule occlusion than NovaMin by itself. Arginine was the only treatment that presented improved tubule occlusion when associated with Nd:YAG laser.

http://ift.tt/2n5V93U

Can a teacher-reported indicator be used for population monitoring of oral language skills at school entry?

.


http://ift.tt/2lYKuIG

Evidence for the treatment of co-occurring stuttering and speech sound disorder: A clinical case series

.


http://ift.tt/2mHB3dB

Familiarity Speeds Up Visual Short-Term Memory Consolidation.

Author: Xie, Weizhen; Zhang, Weiwei

DOI: 10.1037/xhp0000355

Publication Date: POST AUTHOR CORRECTIONS, 13 March 2017

http://ift.tt/2lYIJuX

Abstract Feature Codes: The Building Blocks of the Implicit Learning System.

Author: Eberhardt, Katharina; Esser, Sarah; Haider, Hilde

DOI: 10.1037/xhp0000380

Publication Date: POST AUTHOR CORRECTIONS, 13 March 2017

http://ift.tt/2mHgTjY

Cerebral Hemodynamics During Scene Viewing: Hemispheric Lateralization Predicts Temporal Gaze Behavior Associated With Distinct Modes of Visual Processing.

Author: Mills, Mark; Alwatban, Mohammed; Hage, Benjamin; Barney, Erin; Truemper, Edward J.; Bashford, Gregory R.; Dodd, Michael D.

DOI: 10.1037/xhp0000357

Publication Date: POST AUTHOR CORRECTIONS, 13 March 2017

http://ift.tt/2lYr5Hz

Beyond Scene Gist: Objects Guide Search More Than Scene Background.

Author: Koehler, Kathryn; Eckstein, Miguel P.

DOI: 10.1037/xhp0000363

Publication Date: POST AUTHOR CORRECTIONS, 13 March 2017

http://ift.tt/2mHgsWN

Pushing Typists Back on the Learning Curve: Memory Chunking Improves Retrieval of Prior Typing Episodes.

Author: Yamaguchi, Motonori; Randle, James M.; Wilson, Thomas L.; Logan, Gordon D.

DOI: 10.1037/xlm0000385

Publication Date: POST AUTHOR CORRECTIONS, 13 March 2017

http://ift.tt/2mLvJaE

Eye Movements in Implicit Artificial Grammar Learning.

Author: Silva, Susana; Inacio, Filomena; Folia, Vasiliki; Petersson, Karl Magnus

DOI: 10.1037/xlm0000350

Publication Date: POST AUTHOR CORRECTIONS, 13 March 2017

http://ift.tt/2mqCLz6

Comparing Theories of Reference-Dependent Choice.

Author: Bhatia, Sudeep

DOI: 10.1037/xlm0000384

Publication Date: POST AUTHOR CORRECTIONS, 13 March 2017

http://ift.tt/2mLC7ig

Predictors of Verb-Mediated Anticipatory Eye Movements in the Visual World.

Author: Hintz, Florian; Meyer, Antje S.; Huettig, Falk

DOI: 10.1037/xlm0000388

Publication Date: POST AUTHOR CORRECTIONS, 13 March 2017

http://ift.tt/2mqnoqC

Distinguishing Discrete and Gradient Category Structure in Language: Insights From Verb-Particle Constructions.

Author: Brehm, Laurel; Goldrick, Matthew

DOI: 10.1037/xlm0000390

Publication Date: POST AUTHOR CORRECTIONS, 13 March 2017

http://ift.tt/2mLATDX

How Performance-Contingent Reward Prospect Modulates Cognitive Control: Increased Cue Maintenance at the Cost of Decreased Flexibility.

Author: Hefer, Carmen; Dreisbach, Gesine

DOI: 10.1037/xlm0000397

Publication Date: POST AUTHOR CORRECTIONS, 13 March 2017

http://ift.tt/2mqw2VV

Disentangling the Effects of Advisor Consensus and Advice Proximity.

Author: Wanzel, Stella K.; Schultze, Thomas; Schulz-Hardt, Stefan

DOI: 10.1037/xlm0000396

Publication Date: POST AUTHOR CORRECTIONS, 13 March 2017

http://ift.tt/2mLCJo7

Tumor cells interact with red blood cells via galectin-4 - a short report

Abstract

Background

The ability of tumor cells to invade and metastasize is relevant to the process of cancer progression and, as such, it represents an obstacle to cancer cure. So far, limited information is available on interactions between circulating tumor cells and blood cells. It is well-documented that galectin-4 is upregulated in many types of tumor cells and is involved in metastasis. Here, we address the hypothesis that tumor cells may interact with red blood cells (RBCs) via galectin-4.

Methods

High galectin-4 expressing colon, normal pancreatic and pancreatic cancer-derived cell lines (n = 5) were incubated with peripheral blood cells from different donors. Their interactions and associated proteins were examined by immunostaining and live cell imaging.

Results

We found that (endogenous or exogenous) galectin-4 expressing tumor cells interact directly with RBCs. We also observed an accumulation of galectin-4 and human blood group antigens at the contact sites between these cells. By comparing the number of RBCs attaching to each tumor cell, we found that cells with high pre-incubation expression levels of galectin-4 attached significantly more RBCs than those with low expression levels (p < 1 × 10⁻⁷). Conversely, we found that RBC attachment induces galectin-4 expression in tumor cells.

Conclusions

From our data we conclude that tumor cells directly interact with red blood cells via galectin-4.

http://ift.tt/2mpRUjs

Increasing Calcium Level Limits Schwann Cell Numbers In Vitro following Peripheral Nerve Injury

J reconstr Microsurg
DOI: 10.1055/s-0037-1599836

Background After peripheral nerve injury, there is an increase in calcium concentration in the injured nerves. Our previous publications have shown that increase in calcium concentration correlated well with degree of nerve injury and that local infusion of calcitonin has a beneficial effect on nerve recovery. Schwann cells play a pivotal role in regeneration and recovery. We aim to examine cultured Schwann cell survivals in various concentrations of calcium-containing growth media and the effect of calcitonin in such media. Methods To establish baseline in postinjury state, crush injury was induced in male Sprague-Dawley rats' sciatic nerves. Extra- and intraneural calcium concentrations were measured. To study Schwann cell survival, uninjured sciatic nerve segment was harvested and cultured in media containing various amounts of calcium. To study the effect of calcitonin, nerve harvest and culture were done in four additional media: (1) normal control, (2) normal control with calcitonin, (3) high calcium medium, and (4) high calcium medium with calcitonin. Schwann cells were studied and analyzed under fluorescent conditions. Results With increasing calcium concentration, there was a significant decrease in the number of Schwann cells. For the experimental groups, in which calcitonin had been added to the growth medium, there were similar amounts of Schwann cells present in both high and low calcium-containing medium. Conclusion Schwann cells are sensitive to increasing calcium concentration. Calcitonin counteracts the detrimental effects of high calcium on Schwann cell survival. This can have significant future clinical implications for patients with peripheral nerve injuries.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Transoral robotic surgery with radial forearm free flap reconstruction: case control analysis

Abstract

Background

The resection of large oropharyngeal tumors traditionally involves a lip-splitting mandibulotomy for adequate margin visualization and free flap reconstruction of the surgical defect. Transoral robotic surgery (TORS) has emerged as a technique that can resect large and complex oropharyngeal tumors, avoiding a lip-splitting approach. The aim of this study is to compare the lip-splitting mandibulotomy approach versus TORS for the management of advanced stage oropharyngeal carcinomas.

Methods

Prospectively collected data from 18 patients with advanced stage oropharyngeal squamous cell carcinoma (OPSCC) who received TORS with radial forearm free flap reconstruction (RFFF) was compared to a matched cohort of 39 patients who received a lip-splitting mandibulotomy and RFFF. Patients were matched for stage, p16 positivity, smoking, age and gender. Length of hospital stay (LOHS), tracheostomy decanulation time, operative time, surgical margin status, and post-operative complications were compared between groups.

Results

Patients who received TORS with RFFF had a significantly lower mean LOHS, compared to patients who were treated by lip-splitting mandibulotomy and RFFF (14.4 vs 19.7 days, p = 0.03). No significant differences were seen between groups in terms of operative time, tracheostomy decannulation time, margin positivity and post-operative complications.

Conclusion

TORS with radial forearm free flap reconstruction is a safe, effective and cost-saving alternative to the lip-splitting mandibulotomy approach for the treatment of advanced stage OPSCC.

http://ift.tt/2mLd277

Transoral robotic surgery with radial forearm free flap reconstruction: case control analysis

Abstract

Background

The resection of large oropharyngeal tumors traditionally involves a lip-splitting mandibulotomy for adequate margin visualization and free flap reconstruction of the surgical defect. Transoral robotic surgery (TORS) has emerged as a technique that can resect large and complex oropharyngeal tumors, avoiding a lip-splitting approach. The aim of this study is to compare the lip-splitting mandibulotomy approach versus TORS for the management of advanced stage oropharyngeal carcinomas.

Methods

Prospectively collected data from 18 patients with advanced stage oropharyngeal squamous cell carcinoma (OPSCC) who received TORS with radial forearm free flap reconstruction (RFFF) was compared to a matched cohort of 39 patients who received a lip-splitting mandibulotomy and RFFF. Patients were matched for stage, p16 positivity, smoking, age and gender. Length of hospital stay (LOHS), tracheostomy decanulation time, operative time, surgical margin status, and post-operative complications were compared between groups.

Results

Patients who received TORS with RFFF had a significantly lower mean LOHS, compared to patients who were treated by lip-splitting mandibulotomy and RFFF (14.4 vs 19.7 days, p = 0.03). No significant differences were seen between groups in terms of operative time, tracheostomy decannulation time, margin positivity and post-operative complications.

Conclusion

TORS with radial forearm free flap reconstruction is a safe, effective and cost-saving alternative to the lip-splitting mandibulotomy approach for the treatment of advanced stage OPSCC.

http://ift.tt/2mLd277

Tissue-Engineered Larynx: Future Applications in Laryngeal Cancer

Abstract

Purpose of Review

This article reviews the latest developments in tissue engineering for the larynx with a specific focus on the treatment of laryngeal cancer.

Recent Findings

Challenges in tissue engineering a total larynx can be divided into scaffold design, methods of re-mucosalization, and how to restore laryngeal function. The literature described a range of methods to deliver a laryngeal scaffold including examples of synthetic, biomimetic, and biological scaffolds. Methods to regenerate laryngeal mucosa can be divided into examples that use a biological dressing and those that engineer a new mucosal layer de novo. Studies aiming to restore laryngeal function have been reported, but to date, the optimum method for achieving this as part of a total laryngeal transplant is yet to be determined.

Summary

There is great potential for tissue engineering to improve the treatments available for laryngeal cancer within the next 10 years. A number of challenges exist however and advances in restoring function must keep pace with developments in scaffold design.

http://ift.tt/2nqyZ9Z

Tissue-Engineered Larynx: Future Applications in Laryngeal Cancer

Abstract

Purpose of Review

This article reviews the latest developments in tissue engineering for the larynx with a specific focus on the treatment of laryngeal cancer.

Recent Findings

Challenges in tissue engineering a total larynx can be divided into scaffold design, methods of re-mucosalization, and how to restore laryngeal function. The literature described a range of methods to deliver a laryngeal scaffold including examples of synthetic, biomimetic, and biological scaffolds. Methods to regenerate laryngeal mucosa can be divided into examples that use a biological dressing and those that engineer a new mucosal layer de novo. Studies aiming to restore laryngeal function have been reported, but to date, the optimum method for achieving this as part of a total laryngeal transplant is yet to be determined.

Summary

There is great potential for tissue engineering to improve the treatments available for laryngeal cancer within the next 10 years. A number of challenges exist however and advances in restoring function must keep pace with developments in scaffold design.

http://ift.tt/2nqyZ9Z

The effect of caudal extension graft on nostril in rhinoplasty

Abstract

Background

Caudal extension graft technique is a versatile technique in rhinoplasty providing good tip support and maintaining tip projection. In this study, we evaluated the clinical outcomes of this technique and performed anthropometric analysis of nostril shape from the basal view.

Methods

Thirty-two patients undergoing caudal extension graft technique were identified from December 2011 to July 2016. Patients with a minimum of 12 month follow-up were included. Quantitative analysis was performed on standard pre- and postoperative photos.

Results

Nasal tip protrusion and columellar width were increased significantly (p value < 0.001), while apex angle was decreased significantly (p value <0.001). Caudal extension graft placement resulted in a non-significant decrease in nostril size on the side of graft placement. There was no significant change in columellar length or nostril width.

Conclusions

Caudal extension graft technique is a versatile and reliable technique for addressing poor tip support and setting tip projection. Disadvantages of caudal extension graft include asymmetric nostrils and over projection in cases where projection reduction is needed. We showed that while there is a significant increase in columellar width, there is no significant increase in nostril asymmetry.

Level of Evidence: Level IV, risk/prognostic study.

http://ift.tt/2mH3Lex

A phase 1 study of gemcitabine/nab-paclitaxel/S-1 (GAS) combination neoadjuvant chemotherapy for patients with locally advanced pancreatic adenocarcinoma

Abstract

Purpose

To determine a recommended dose for a biweekly combination neoadjuvant chemotherapy including gemcitabine, nab-paclitaxel, and S-1 (GAS) for patients with locally advanced pancreatic ductal adenocarcinoma (LAPC).

Methods

Patients with borderline resectable or unresectable LAPC without distant metastasis were eligible for this study. The planned dosages of gemcitabine (mg/m², day 1), nab-paclitaxel (mg/m², day 1), and S-1 (mg/day, days 1–7) were 800/100/60–100 at level 1, and 1000/125/60–100 at level 2. The treatment cycle was repeated every 2 weeks, and patients were assessed for resectability and response to the treatment after 6 cycles. This study was registered with UMIN Clinical Trial Registry (UMIN000016630).

Results

We enrolled 16 patients with LAPC in this study. At dose level 1, one of 8 patients experienced dose-limiting toxicity (DLT). One of the next 8 patients also experienced DLT at dose level 2. Based on these results, level 2 was considered the recommended dose for this regimen. Pancreatectomy with curative intent could be performed in 13 of the 16 patients. R0 resection was performed in 12 of 13 patients.

Conclusion

In conclusion, recommended doses for a biweekly GAS chemotherapy regimen were determined as nab-paclitaxel: 125 mg/m², gemcitabine: 1000 mg/m² on day 1, S-1: <1.25 m², 60 mg; 1.25–1.5 m², 80 mg; >1.5 m², 100 mg twice a day on days 1–7. GAS chemotherapy showed good preliminary efficacy with mild toxicity in this study, and warrants a further phase 2 trial to investigate the efficacy of the GAS regimen for LAPC.

http://ift.tt/2nlg0AJ

Thyroglossal Duct Cyst Carcinomas in Pediatric Patients: Report of Two Cases with a Comprehensive Literature Review

Abstract

Thyroglossal duct cyst (TGDC) carcinomas are rarely encountered in the pediatric population. The clinical behavior of these tumors in the pediatric setting is unclear and management is not well defined. Two cases of pediatric thyroglossal duct cyst carcinoma were identified in a review of all thyroglossal duct cysts diagnosed over a ten year period. These two cases were analyzed along with 57 cases of thyroglossal duct cyst carcinoma affecting patients less than 21 years of age compiled from the English literature. Fifty-nine patients (36 females, 23 males) aged 6–20 years (mean 15.0 years) were identified. All presented with an anterior midline neck mass, which was typically mobile and non-tender. The average tumor size was 2.6 cm. Histologically, all tumors were papillary thyroid carcinomas arising in a background of a thyroglossal duct cyst. The tumors exhibited a papillary, follicular, or mixed architecture with classical papillary thyroid carcinoma nuclear features. Soft tissue extension was present in 16 cases. All patients were managed surgically with a Sistrunk procedure, with additional thyroidectomy performed in 29 patients, combined with a lymph node dissection (n = 15), or a Sistrunk and lymph node dissection (n = 5). All patients were stage I at presentation, with 11 showing lymph node metastases. Postoperative radioactive iodine was employed in 20 patients. A papillary carcinoma of the thyroid gland was reported in four of the patients who had concurrent/subsequent thyroidectomies. Recurrences were reported in four patients, with distant metastases in one patient, who died of disease (13 months). Follow up data was available for 45 patients, with an overall mean follow-up of 54.5 months. All patients were alive, with the exception of one who died with disease. TGDC carcinomas in pediatric patients is associated with a good overall prognosis, best managed by Sistrunk procedure alone, with selected lymph node dissection if clinically indicated.

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Evaluation of Hearing Sensitivity in Young Adults With Normal Hearing Using a 40-Hz Auditory Steady-State Response With CE-Chirp

Purpose

The present study aimed to measure hearing sensitivity in young adults with normal hearing using a 40-Hz auditory steady-state response with CE-Chirp and to evaluate the speed and accuracy of this method.

Method

Twelve young adults (1 man, 11 women; mean age = 22.1 ± 3.1 years) each completed two auditory steady-state response measurement sessions with CE-Chirp. The difference score was calculated at each of the four pure-tone frequencies. The measurement time and residual noise level in all stimulus levels were also determined.

Results

The difference scores across the 4 frequencies ranged within ±10 dB (1st: 58% to 71%, 2nd: 54% to 79%), within 20 dB (1st: 79% to 96%, 2nd: 79% to 100%), and ≥ 30 dB (1st: 4% to 17%, 2nd: 0% to 17%). The measurement times for both ears were approximately 20 min in both sessions. There was a significant correlation between the measurement time and the mean residual noise level for pooled frequencies in all stimulus levels (p = .0001249, r = .70). The measurement time was reduced by approximately 50% from conventional auditory steady-state response measurement.

Conclusion

The results of this preliminary study support the use of this technology as a rapid and accurate method for behavioral auditory threshold evaluation.

http://ift.tt/2nC7REe

Considerations for Pediatric Cochlear Implant Recipients With Unilateral or Asymmetric Hearing Loss: Assessment, Device Fitting, and Habilitation

Purpose

The purpose of this clinical report is to present case studies of children who are nontraditional candidates for cochlear implantation because they have significant residual hearing in 1 ear and to describe outcomes and considerations for their audiological management and habilitation.

Method

Case information is presented for 5 children with profound hearing loss in 1 ear and normal or mild-to-moderate hearing loss in the opposite ear and who have undergone unilateral cochlear implantation. Pre- and postoperative assessments were performed per typical clinic routines with modifications described. Postimplant habilitation was customized for each recipient using a combination of traditional methods, newer technologies, and commercial materials.

Results

The 5 children included in this report are consistent users of their cochlear implants and demonstrate speech recognition in the implanted ear when isolated from the better hearing ear.

Conclusions

Candidacy criteria for cochlear implantation are evolving. Children with single-sided deafness or asymmetric hearing loss who have traditionally not been considered candidates for cochlear implantation should be evaluated on a case-by-case basis. Audiological management of these recipients is not vastly different compared with children who are traditional cochlear implant recipients. Assessment and habilitation techniques must be modified to isolate the implanted ear to obtain accurate results and to provide meaningful therapeutic intervention.

http://ift.tt/2n7yc07

Service Delivery to Children With Mild Hearing Loss: Current Practice Patterns and Parent Perceptions

Purpose

This study investigates clinical practice patterns and parent perception of intervention for children with mild hearing loss (HL).

Method

Ages at and delays between service delivery steps (first diagnostic evaluation, confirmation of HL, hearing aid [HA] fitting, entry into early intervention) were investigated for 113 children with mild HL. Comparisons were made to children with moderate-to-severe HL. Parents of children with mild HL reported reasons for delays and their perceptions of intervention and amplification for their children.

Results

Seventy-four percent of children with mild HL were identified through the newborn hearing screen; 26% were identified later due to passing or not receiving a newborn hearing screen. Ninety-four percent of children with mild HL were fit with HAs, albeit at significantly later ages than children with moderate-to-severe HL. Most parents indicated that their children benefited from HA use, but some parents expressed ambivalence toward the amount of benefit.

Conclusions

Audiologists appear to be moving toward regularly providing amplification for children with mild HL. However, delays in HA fittings indicate that further educating professionals and parents about the benefits of early amplification and intervention is warranted to encourage timely fitting and consistent use of HAs.

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Molekular-allergologische Aspekte der allergenspezifischen Immuntherapie

Zusammenfassung

Die allergenspezifische Immuntherapie (SIT) erreicht keine 100 %ige Wirksamkeit, und auch für das Therapieversagen gibt es keinen verlässlichen Marker. Die Fortschritte in der molekularen Allergologie in den letzten Jahren erlauben inzwischen jedoch eine deutlich verbesserte Charakterisierung der Patienten durch molekular-allergologisch basierte Analyseverfahren (molekulare Phänotypisierung). So können Major- und Minorallergene identifiziert werden, und es bilden sich vereinzelt neben den Markerallergenen für die Schwere einer allergischen Reaktion krankheits- sowie therapieprädiktive Markerallergene bzw. Sensibilisierungsmuster heraus.

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Abdominale Papeln bei einem Patienten mit Psoriasis vulgaris und Tinea manuum

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Building Evidence Implicating Novel Cardiovascular Biomarkers in Obstructive Sleep Apnea

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Circulating Anti-Coatomer Protein Complex Subunit Epsilon (COPE) Autoantibodies as a Potential Biomarker for Cardiovascular and Cerebrovascular Events in Patients with Obstructive Sleep Apnea

Study Objectives:

Although moderate to severe obstructive sleep apnea (OSA) is an independent risk factor for severe arteriosclerotic diseases such as cardiovascular disease (CVD) and stroke, the development of atherosclerosis-related diseases cannot yet be predicted in patients with OSA. In a pilot study, we identified autoantibodies against the coatomer protein complex, subunit epsilon [circulating anti-coatomer protein complex subunit epsilon autoantibody (COPE-Ab)], a cytosolic complex that mediates protein transport in the Golgi compartment, as a potential novel biomarker of atherosclerosis. This study aimed to evaluate whether COPE-Ab levels had an association with cardiovascular and cerebrovascular events in patients with OSA.

Methods:

Eighty-two adult patients with a diagnosis of OSA via polysomnography and 64 healthy donors were studied. Serum COPE-Ab levels were measured using an amplified luminescence proximity homogeneous assay. Then, clinical factors related to atherosclerosis were evaluated with respect to COPE-Ab levels.

Results:

Significant differences in COPE-Ab levels were observed in terms of OSA severity. COPE-Ab levels were significantly higher in patients with OSA and also CVD and/or stroke, hypertension, and a high body mass index. Univariate and multivariate logistic regression analyses of patients with OSA identified elevated COPE-Ab level as a significant predictor of CVD and/or stroke.

Conclusions:

An elevated COPE-Ab level may be a potential predictor of the risks of cardiovascular and cerebrovascular events in patients with OSA. Therefore, patients with higher COPE-Ab levels may require more careful and intensive treatment.

Commentary:

A commentary on this article appears in this issue on page 361.

Citation:

Matsumura T, Terada J, Kinoshita T, Sakurai Y, Yahaba M, Ema R, Amata A, Sakao S, Nagashima K, Tatsumi K, Hiwasa T. Circulating anti-coatomer protein complex subunit epsilon (COPE) autoantibodies as a potential biomarker for cardiovascular and cerebrovascular events in patients with obstructive sleep apnea. J Clin Sleep Med. 2017;13(3):393–400.

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Sleep Quality in an Adult American Indian Community Sample

Study Objectives:

Epidemiological studies have found that insufficient sleep (< 7 h/night) is more common among American Indians/Alaska Natives (AI/AN). In this study we sought to identify specific demographic, clinical, and cultural factors that may be associated with reduced sleep quality in an American Indian community sample.

Methods:

Information on demography along with personal medical, psychiatric, and drinking history was obtained using the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA). Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI).

Results:

The adult participants (n = 386, 54% women) had a mean ± standard deviation age of 31.35 ± 14.4 y. Higher degrees of AI ancestry, but not cultural identification, being older than 30 y, and having a high school diploma all were factors predictive of having a short sleep duration (< 6 h). The global score on the PSQI was significantly higher in those participants with a lifetime diagnosis of substance use disorders, anxiety disorders, and affective disorders. Alcohol use disorders and affective disorders were significant predictors of sleep latency whereas anxiety and affective disorders were correlated with waking more often in the night/early morning. Nicotine dependence was associated with having trouble breathing, and alcohol use disorders and anxiety disorders with bad dreams.

Conclusions:

Alcohol use disorders are associated with poorer quality of sleep in this population and substance use disorders were associated with different aspects of sleep than anxiety and depressive disorders. These findings add to the understanding of the interactions between sleep and substance use, anxiety, and affective disorders in an understudied and underserved population.

Citation:

Ehlers CL, Wills DN, Lau P, Gilder DA. Sleep quality in an adult American Indian community sample. J Clin Sleep Med. 2017;13(3):385–391.

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Performance of Remotely Controlled Mandibular Protrusion Sleep Studies for Prediction of Oral Appliance Treatment Response

Study Objectives:

Mandibular protrusion during sleep monitoring has been proposed as a method to predict oral appliance treatment outcome.

A commercial remotely controlled mandibular protrusion (RCMP) device has become available for this purpose with predictive accuracy demonstrated in an initial study. Our aim was to validate this RCMP method for oral appliance treatment outcome prediction in a clinical sleep laboratory setting.

Methods:

Forty-two obstructive sleep apnea (OSA) patients (apnea-hypopnea index [AHI] > 10 events/h) were recruited to undergo a RCMP sleep study before commencing oral appliance treatment. The RCMP study was used to make a prediction of treatment "Success" or "Failure" based on a rule of ≤ 1 respiratory event per 5 min supine rapid eye movement sleep. Oral appliance treatment response was verified by polysomonography and defined as treatment AHI < 10 events/h with 50% reduction.

Results:

Participants were on average middle-aged (57.1 ± 11.6 y) and overweight (29.6 ± 4.5 kg/m²) with baseline AHI 31.5 ± 20.5 events/h, 39% severe OSA (AHI > 30 events/h). Two participants (5%) were not able to tolerate the RCMP study. Oral appliance treatment outcome was verified in 33 participants (RCMP results: "Success" n = 10, "Failure" n = 15, "Inconclusive" n = 8). In those with a treatment outcome prediction (n = 25) the diagnostic characteristics of the RCMP test were sensitivity 81.8%, specificity 92.9%, positive predictive value 90%, and negative predictive value 86.7% (n = 3 misclassified).

Conclusions:

The RCMP device was well tolerated by patients and successfully used to perform mandibular protrusion sleep studies in our sleep laboratory. The RCMP sleep study showed good accuracy as a prediction technique for oral appliance treatment outcome, although there was a high rate of inconclusive tests.

Citation:

Sutherland K, Ngiam J, Cistulli PA. Performance of remotely controlled mandibular protrusion sleep studies for prediction of oral appliance treatment response. J Clin Sleep Med. 2017;13(3):411–417.

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Is it Time for Immunotherapy Trials in Narcolepsy?

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The Effect of OSA Therapy on Glucose Metabolism: It's All about CPAP Adherence!

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F-Wave Duration as a Specific and Sensitive Tool for the Diagnosis of Restless Legs Syndrome/Willis-Ekbom Disease

Study Objectives:

Restless legs syndrome, also known as Willis-Ekbom disease (RLS/WED), is a frequent condition, though its pathophysiology is not completely understood. The diagnosis of RLS/WED relies on clinical criteria, and the only instrumental tool, the suggested immobilization test, may lead to equivocal results. Recently, neurophysiological parameters related to F-wave duration have been proposed as a diagnostic aid. The aim of this study is to assess and compare the diagnostic values of these parameters in diagnosis of RLS/WED.

Methods:

Fifteen women affected by primary RLS/WED and 17 age- and sex- matched healthy subjects. A complete electroneurographic evaluation, including nerve conduction studies (NCS), cutaneous silent period (CSP), and F-wave parameters, namely amplitude, F-wave duration (FWD), and the ratio between FWD and duration of the corresponding compound muscle action potential (FWD/CMAPD).

Results:

No subject showed alterations of the NCS. However, FWD and FWD/CMAPD of both upper and lower limbs were significantly longer in patients than controls. Tibial FWD/CMAPD best discriminated RLS/WED patients from controls. A cutoff of 2.06 yielded a sensitivity of 69.2%, a specificity of 94.1%, a positive predictive power of 90%, and a negative predictive power of 80% (area under the curve = 0.817; 95% confidence interval = 0.674–0.959). The combination of ulnar or tibial FWD/CMAPD increases the sensitivity (85.7%) while slightly decreasing the specificity (87.5%, positive predictive value: 85.7%, negative predictive value: 87.5%).

Conclusions:

Lower limb FWD/CMAPD ratio may represent a supportive diagnostic tool, especially in cases of evening lower leg discomfort of unclear interpretation.

Citation:

Congiu P, Fantini ML, Milioli G, Tacconi P, Figorilli M, Gioi G, Pereira B, Marrosu F, Parrino L, Puligheddu M. F-wave duration as a specific and sensitive tool for the diagnosis of restless legs syndrome/Willis-Ekbom disease. J Clin Sleep Med. 2017;13(3):369–375.

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Relationship of Sleep Duration with Sociodemographic Characteristics, Lifestyle, Mental Health, and Chronic Diseases in a Large Chinese Adult Population

Study Objectives:

Pattern of sleep duration and its correlates have rarely been reported in China. This study examined the sleep duration and its relationship with sociodemographic variables, lifestyle, mental health, and chronic diseases in a large Chinese adult population.

Methods:

This cross-sectional study used multistage stratified cluster sampling. A total of 17,320 participants from Jilin province were selected and interviewed using standardized assessment tools. Basic socio-demographic and clinical data were collected. Sleep duration was classified as short (< 7 h per day), long (> 9 h per day) and medium sleep (7–9 h per day).

Results:

The mean age of the sample was 42.60 ± 10.60 y, with 51.4% being female. The mean sleep duration was 7.31 ± 1.44 h. Short and long sleepers accounted for 30.9% and 6.9% of the sample, respectively. Multinomial logistic regression analysis revealed that older age, current smoking, irregular meal pattern, lack of physical exercise, poor mental health, and chronic diseases or multimorbidity were positively associated with short sleep. Being married and living in rural areas were, however, negatively associated with short sleep. In addition, living in rural area, current smoking, current alcohol use and lack of physical exercise were positively associated with long sleep, while older age and lower education were negatively associated with long sleep.

Conclusion:

Given the high frequency of short sleep and its negative effect on health, health professionals should pay more attention to sleep patterns in general health care. Nationwide epidemiologic surveys in China are needed to further explore the relationship between sleep duration and health.

Citation:

Wang S, Li B, Wu Y, Ungvari GS, Ng CH, Fu Y, Kou C, Yu Y, Sun HQ, Xiang YT. Relationship of sleep duration with sociodemographic characteristics, lifestyle, mental health and chronic diseases in a large Chinese adult population. J Clin Sleep Med. 2017;13(3):377–384.

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A Single Arm Pilot Trial of Brief Cognitive Behavioral Therapy for Insomnia in Adolescents with Physical and Psychiatric Comorbidities

Study Objectives:

The majority of adolescents with chronic insomnia have physical health or psychiatric comorbidities; insomnia is also associated with greater negative daytime symptoms (e.g., depressive symptoms) and reduced overall health-related quality of life (HRQOL). However, to date, there has been limited attention to treatment of insomnia in this population. The purpose of this study was to determine the preliminary efficacy of a brief cognitive behavioral therapy for insomnia (CBT-I) intervention on sleep, psychological symptoms, and HRQOL outcomes in adolescents with insomnia and co-occurring physical or psychiatric comorbidities.

Methods:

We conducted a single arm pilot trial in which 40 youth (mean age = 14.93, standard deviation = 1.89) with insomnia and physical or psychiatric comorbidities (e.g., depression, chronic pain, anxiety, gastrointestinal problems) received CBT-I in four individual treatment sessions over 4 to 6 w. Adolescents completed 7 days of wrist actigraphy and self-report measures of insomnia, sleep quality and behaviors, psychological symptoms, and HRQOL outcomes at pretreatment, immediate posttreatment, and 3-mo follow-up.

Results:

CBT-I was associated with improvements in self-reported measures of sleep including insomnia symptoms, sleep quality, sleep hygiene, pre-sleep arousal, and sleep onset latency. Psychological symptoms and HRQOL also improved. Effects were generally sustained at 3-mo follow-up.

Conclusions:

CBT-I may be efficacious for adolescents with co-occurring physical and mental health comorbidities; future randomized controlled trials are needed to test the effect of CBT-I on sleep, psychological symptoms, and HRQOL and to evaluate maintenance of treatment effects over longer time periods.

Citation:

Palermo TM, Beals-Erickson S, Bromberg M, Law E, Chen M. A single arm pilot trial of brief cognitive-behavioral therapy for insomnia in adolescents with physical and psychiatric comorbidities. J Clin Sleep Med. 2017;13(3):401–410.

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Listening to the Patient Voice in Narcolepsy: Diagnostic Delay, Disease Burden, and Treatment Efficacy

Study Objectives:

Describe common symptoms, comorbidities, functional limitations, and treatment responsiveness among patients with narcolepsy. Investigate the effect of pediatric onset of narcolepsy symptoms on time to diagnosis of narcolepsy and presence of comorbid depression.

Methods:

Cross-sectional survey of 1,699 people in the United States with self-reported diagnosis of narcolepsy. We utilized mixed-methods data analyses to report study findings.

Results:

Most participants reported receiving a diagnosis of narcolepsy more than 1 y after symptom onset. We found that the strongest predictor of this delayed diagnosis was pediatric onset of symptoms (odds ratio = 2.4, p < 0.0005). Depression was the most common comorbidity but we detected no association with pediatric onset of narcolepsy symptoms. Overall, participants reported that fatigue and cognitive difficulties were their most burdensome symptoms in addition to sleepiness and cataplexy. The majority of participants reported residual daytime fatigue and/or sleepiness despite treatment. Most participants reported they could not perform at work or school as well as they would like because of narcolepsy symptoms.

Conclusions:

This study provides unique insight into the narcolepsy disease experience. The study quantifies the problem of diagnostic delay for narcolepsy patients in the United States and highlights that symptoms are more likely to be missed if they develop before 18 y of age. These results suggest that narcolepsy awareness efforts should be aimed at parents, pediatric health care providers, school professionals, and children/adolescents themselves. Disease burden is high because of problems with fatigue, cognition, and persistence of residual symptoms despite treatment.

Citation:

Maski K, Steinhart E, Williams D, Scammell T, Flygare J, McCleary K, Gow M. Listening to the patient voice in narcolepsy: diagnostic delay, disease burden and treatment efficacy. J Clin Sleep Med. 2017;13(3):419–425.

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Using the Berlin Questionnaire to Predict Obstructive Sleep Apnea in the General Population

Study Objectives:

The Berlin questionnaire is a self-administered questionnaire that was developed to identify subjects with obstructive sleep apnea (OSA) in primary care settings. This study evaluated the performance of the questionnaire to predict OSA in the general population.

Methods:

A sample of 242 subjects in a population-based cohort completed a home-based sleep study with an Embletta device (type 3 monitor). Subjects completed the Berlin questionnaire on the evening just prior to the sleep study. The sleep studies were manually scored according to the 2012 American Academy of Sleep Medicine (AASM) criteria.

Results:

The prevalence of moderate-to-severe and severe OSA defined as apnea-hypopnea index (AHI) of ≥ 15 and ≥ 30 was 28.1% and 10.7%, respectively. Seventy-nine subjects (32.6%) were classified as high risk according to the Berlin questionnaire. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of the questionnaire to predict an AHI ≥ 15 was 58.8%, 77.6%, 82.9%, and 50.6%, respectively. The area under the receiving operator characteristic (ROC) curve for moderate-to-severe OSA was 0.682. When used to predict an AHI ≥ 30, the sensitivity of the questionnaire increased to 76.9% with a small drop in specificity to 72.7%. The corresponding NPV, PPV, and area under the ROC curve of the questionnaire to predict severe OSA were 96.3%, 25.3%, and 0.748, respectively.

Conclusions:

The Berlin questionnaire may have utility in the general population setting as a screening tool for OSA in view of its good sensitivity and high NPV in ruling out severe OSA.

Citation:

Tan A, Yin JD, Tan LW, van Dam RM, Cheung YY, Lee CH. Using the Berlin questionnaire to predict obstructive sleep apnea in the general population. J Clin Sleep Med. 2017;13(3):427–432.

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Ambulatory Blood Pressure Monitoring in Chinese Patients with Obstructive Sleep Apnea

Study Objectives:

Nocturnal blood pressure (BP) dipping in patients with obstructive sleep apnea (OSA) has not yet been well investigated in Chinese patients, in whom the relationship of OSA and body mass index (BMI) is weaker than that in Caucasians. The aim of this study was to evaluate the BP profile, and the relationships between nocturnal BP and the severity of OSA, in Chinese patients.

Methods:

Consecutive Chinese adult outpatients with suspected OSA had overnight polysomnography (PSG), office BP, and 24-h ambulatory BP monitoring (ABPM). The apnea-hypopnea index (AHI) and nocturnal oxygen saturation level were recorded, and BP patterns were classified based on the ABPM.

Results:

Fifty-six subjects (40 male and 16 female, 48.59 ± 13.27 y) were evaluated. There were 14 patients with mild OSA (25.0%, AHI: 10.56 ± 3.42 events/h), 16 with moderate OSA (28.6%, AHI: 23.536 ± 3.42 events/h) and 26 with severe OSA (46.4%, AHI: 51.52 ± 3.42 events/h). There were 18 dippers (32.1%), 27 non-dippers (48.2%), and 11 reverse dippers (19.6%). As OSA severity increased, non-dipping also increased. A total of 67.9% of the OSA patients showed overall hypertension on ABPM, 57.1% had daytime hypertension only, and 73.2% had nighttime hypertension.

Conclusions:

OSA severity is associated with 24-h BP profiles in a population with only mild increases in BMI. These results can influence clinical practice, OSA management, and hypertension treatment policies.

Citation:

Ma Y, Sun S, Peng CK, Fang Y, Thomas RJ. Ambulatory blood pressure monitoring in Chinese patients with obstructive sleep apnea. J Clin Sleep Med. 2017;13(3):433–439.

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Intravenous Immunoglobulin Therapy in Pediatric Narcolepsy: A Nonrandomized, Open-Label, Controlled, Longitudinal Observational Study

Study Objectives:

Previous case reports of intravenous immunoglobulins (IVIg) in pediatric narcolepsy have shown contradictory results.

Methods:

This was a nonrandomized, open-label, controlled, longitudinal observational study of IVIg use in pediatric narcolepsy with retrospective data collection from medical files obtained from a single pediatric national reference center for the treatment of narcolepsy in France. Of 56 consecutively referred patients with narcolepsy, 24 received IVIg (3 infusions administered at 1-mo intervals) in addition to standard care (psychostimulants and/or anticataplectic agents), and 32 continued on standard care alone (controls).

Results:

For two patients in each group, medical files were unavailable. Of the 22 IVIg patients, all had cerebrospinal fluid (CSF) hypocretin ≤ 110 pg/mL and were HLA-DQB1*06:02 positive. Of the 30 control patients, 29 were HLA-DQB1*06:02 positive and of those with available CSF measurements, all 12 had hypocretin ≤ 110 pg/mL. Compared with control patients, IVIg patients had shorter disease duration, shorter latency to sleep onset, and more had received H1N1 vaccination. Mean (standard deviation) follow-up length was 2.4 (1.1) y in the IVIg group and 3.9 (1.7) y in controls. In multivariate-adjusted linear mixed-effects analyses of change from baseline in Ullanlinna Narcolepsy Scale (UNS) scores, high baseline UNS, but not IVIg treatment, was associated with a reduction in narcolepsy symptoms. On time-to-event analysis, among patients with high baseline UNS scores, control patients achieved a UNS score < 14 (indicating remission) less rapidly than IVIg patients (adjusted hazard ratio 0.18; 95% confidence interval: 95% confidence interval: 0.03, 0.95; p = 0.043). Shorter or longer disease duration did not influence treatment response in any analysis.

Conclusions:

Overall, narcolepsy symptoms were not significantly reduced by IVIg. However, in patients with high baseline symptoms, a subset of IVIg-treated patients achieved remission more rapidly than control patients.

Commentary:

A commentary on this article appears in this issue on page 363.

Citation:

Lecendreux M, Berthier J, Corny J, Bourdon O, Dossier C, Delclaux C. Intravenous immunoglobulin therapy in pediatric narcolepsy: a nonrandomized, open-label, controlled, longitudinal observational study. J Clin Sleep Med. 2017;13(3):441–453.

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VAMONOS (Veterans Affairs' Metabolism, Obstructed and Non-Obstructed Sleep) Study: Effects of CPAP Therapy on Glucose Metabolism in Patients with Obstructive Sleep Apnea

Study Objectives:

Obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) are prevalent disorders that pose increased risk of cardiovascular disease and death. The objective of this study was to clarify if continuous positive airway pressure (CPAP) therapy for OSA affects T2DM control and emergence.

Methods:

Point-of-care, comparative effectiveness study; cross-sectional and longitudinal analyses.

Results:

Our cohort included 928 consecutive patients; 13% were women; 36% were Caucasians and 61% African-Americans. OSA was diagnosed in approximately 738 patients and CPAP was initiated in 718 patients; median duration of therapy was 5 mo (25% to 75% interquartile range [IQR] 3–14). Patients with OSA used CPAP therapy for a median duration of 4.8 h, 34.5% of the nights. Adherence to CPAP was prespecified as follows: good (≥ 70% nights and ≥ 4 h/night), excellent (≥ 80% nights and ≥ 6 h/night) or outstanding (≥ 90% of nights and 8 h/night). Based on objective data, good, excellent, and outstanding compliance were found in only 30%, 20%, and 6%, respectively. Three percent of subjects without CPAP follow-up and less than 4% of those nonadherent to CPAP therapy (based on the established criteria) developed incident T2DM. Incident T2DM developed in only 0.8% of those with good compliance and in none (0%) of those in the excellent and outstanding groups. During follow-up, median weight change was +0.3 kg (IQR −1.8 to 2.7).

Conclusions:

We found that an outstanding compliance to CPAP reduced fasting blood glucose in patients with OSA. Longitudinally, higher levels of therapeutic adherence may affect the rate of incident impaired fasting glucose, prediabetes, and T2DM, despite the observed weight gains.

Commentary:

A commentary on this article appears in this issue on page 365.

Citation:

Ioachimescu OC, Anthony Jr J, Constantin T, Ciavatta MM, McCarver K, Sweeney ME. VAMONOS (Veterans Affairs' Metabolism, Obstructed and Non-Obstructed Sleep) study: effects of CPAP therapy on glucose metabolism in patients with obstructive sleep apnea. J Clin Sleep Med. 2017;13(3):455–466.

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Impact of Obstructive Sleep Apnea and Its Treatments on Partners: A Literature Review

Study Objectives:

Many adults sleep with a significant other; thus, sleep disorder symptoms and treatments of one partner are likely to impact the other partner's health. A literature review was conducted to examine the impact of obstructive sleep apnea (OSA) and OSA treatments on partner-assessed sleep and daytime functioning and partner involvement in OSA treatment.

Methods:

MEDLINE, EMBASE, and CINAHL searches yielded 38 pertinent quantitative and qualitative studies that described sleep and/or daytime functioning assessed in partners of patients with untreated OSA, sleep and/or daytime functioning assessed in partners who were referred for OSA treatment, including continuous positive airway pressure (CPAP) therapy, oral appliance (OA), or surgery, and/or associations between partner involvement and OSA treatment use.

Results:

The majority of studies found untreated OSA to have a negative impact on partners' objective and subjective sleep and daytime functioning, in particular mood, quality of life, and relationship quality. Improvements in partner-assessed sleep quality were reported for CPAP, OA, and surgery. Conflicting results were reported for partners' mood, quality of life, daytime sleepiness, and relationship quality. Perceived partner support was associated with greater CPAP use.

Conclusions:

Symptoms associated with OSA can negatively impact partners' sleep and daytime functioning. Treatment of OSA with CPAP, OA, or surgery can have health benefits for not only patients but also partners. Collaborative partner involvement may be a useful strategy for interventions promoting CPAP adherence.

Citation:

Luyster FS. Impact of obstructive sleep apnea and its treatments on partners: a literature review. J Clin Sleep Med. 2017;13(3):467–477.

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Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

Introduction:

This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults.

Methods:

The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations.

Recommendations:

The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources.

Good Practice Statements:

Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation.

Recommendations:

1. We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG)

2. We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG)

3. We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG)

4. We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG)

5. We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK)

6. We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK)

Citation:

Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(3):479–504.

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