18 F-FDG PET and high-resolution MRI co-registration for pre-surgical evaluation of patients with conventional MRI-negative refractory extra-temporal lobe epilepsy

Abstract

Purpose

Epilepsy that originates outside of the temporal lobe can present some of the most challenging problems for surgical therapy, especially for patients with conventional magnetic resonance imaging (MRI)-negative refractory extra-temporal lobe epilepsy (ETLE). This study aimed to evaluate the clinical value of pre-surgical ¹⁸F-fluoro-deoxy-glucose positron emission tomography (¹⁸F-FDG PET) and high-resolution MRI (HR-MRI) co-registration in patients with conventional MRI-negative refractory ETLE, and compare their surgical outcomes.

Methods

Sixty-seven patients with conventional MRI-negative refractory ETLE were prospectively included for pre-surgical ¹⁸F-FDG PET and HR-MRI examinations. Under the guidance of ¹⁸F-FDG PET and HR-MRI co-registration, HR-MRI images were re-read. Based on the image result changes from first reading to re-reading, patients were divided into three groups: Change-1 (lesions of subtle abnormality could be identified in re-read), Change-2 (non-specific abnormalities reported in the first reading were considered as lesions on HR-MRI re-read) and No-change. Post-surgical follow-ups were conducted for up to 59 months.

Results

Visual analysis of ¹⁸F-FDG PET showed focal or regional abnormality in 46 patients (68.6%), while the abnormal rate increased to 94.0% (P < 0.05) by co-registration. Of the 67 patients, 46.3% of them were identified as Change-1, and 11.9% as Change-2 after co-registration and HR-MRI re-read. Patients with Change-1 and -2 were more likely to be recommended to receive surgical resection (P < 0.001). In the 17 post-surgical patients, 88% had good outcomes, whereas 11.7% had poor outcomes during our study period.

Conclusion

Pre-surgical evaluation by co-registration of ¹⁸F-FDG PET and HR-MRI could improve the identification of the epileptogenic onset zone (EOZ), and may further guide the surgical decision-making and improve the outcome of the refractory ETLE with normal conventional MRI; therefore, it should be recommended as a standard procedure for pre-surgical evaluation of these patients.

https://ift.tt/2u5bvwb

Noradrenaline transporter availability on [ 11 C]MRB PET predicts weight loss success in highly obese adults

Abstract

Purpose

Although the mechanisms by which the central noradrenaline (NA) system influences appetite and controls energy balance are quite well understood, its relationship to changes in body weight remains largely unknown. The main goal of this study was to further clarify whether the brain NA system is a stable trait or whether it can be altered by dietary intervention.

Methods

We aimed to compare central NA transporter (NAT) availability in ten obese, otherwise healthy individuals with a body mass index (BMI) of 42.4 ± 3.7 kg/m² (age 34 ± 9 years, four women) and ten matched non-obese, healthy controls (BMI 23.9 ± 2.5 kg/m², age 33 ± 10 years, four women) who underwent PET with the NAT-selective radiotracer (S,S)-[¹¹C]O-methylreboxetine (MRB) before and 6 months after dietary intervention.

Results

MRI-based individual volume-of-interest analyses revealed an increase in binding potential (BP_ND) in the insula and the hippocampus of obese individuals, which correlated well with changes in BMI (−3.3 ± 5.3%; p = 0.03) following completion of the dietary intervention. Furthermore, voxel-wise regression analyses showed that lower BP_ND in these regions, but also in the midbrain and the prefrontal cortex, at baseline was associated with higher achieved weight loss (e.g., hippocampal area R² = 0.80; p < 0.0001). No changes were observed in non-obese controls.

Conclusion

These first longitudinal interventional data on NAT availability in highly obese individuals indicate that the central NA system is modifiable. Our findings suggest that NAT availability before intervention could help predict the amount and success of weight loss in obese individuals and help adjust treatment options individually by allowing prediction of the benefit of a dietary intervention.

https://ift.tt/2IVp1GZ

Surgical management of chronic genital lymphoedema

A 44-year-old man with a spinal cord injury was referred to a specialist urology service with a 7-year history of significant genital swelling. His condition had eluded diagnosis and was refractory to all previous treatments. The considerable swelling both impacted his quality of life and prevented the patient from adequately managing his neurogenic bladder. He was diagnosed with chronic idiopathic genital lymphoedema and underwent total scrotectomy, wide penile skin excision and split skin graft to the penile shaft. The patient made an excellent recovery. We present this unusual case with preoperative, intraoperative and postoperative images.

https://ift.tt/2IYmQlX

Case of hepatic portal venous gas in an infant with hypertrophic pyloric stenosis

Hepatic portal venous gas is the presence of gas within the portal vein and its branches. A 4-week-old male infant presented with 1-week history of non-bloody, non-bilious projectile emesis. Examination was significant for an olive-shaped mass in the abdomen. Bloodwork showed hypokalaemic metabolic alkalosis. Abdominal ultrasound and radiograph was significant for portal venous gas and did not meet radiographic criteria for pyloric stenosis. He underwent upper endoscopy, which showed a narrowed, hypertrophic pylorus. The child underwent pyloromyotomy with resolution of his emesis. Hepatic portal venous gas (HPVG) is very rare and can be seen in the setting of hypertrophic pyloric stenosis. It is believed that an increase in intraluminal dilation and pressure subsequently moves gas from the intestinal mucosa venous system and lymphatics into the portal veins. The presence of HPVG in a well-appearing patient can be benign and should not prompt further testing nor delay treatment.

https://ift.tt/2tXI8f7

CMV encephalitis in an immune-competent patient

After being admitted to hospital with atypical chest pain, a 61-year-old woman was noted to become lethargic and confused. She also developed global dysphasia. MRI was suggestive of encephalitis, and lumbar puncture was positive for cytomegalovirus (CMV) PCR. The patient was treated with intravenous ganciclovir and subsequent oral valganciclovir and she gradually made a reasonable recovery. While this infection is usually closely linked to immunosuppression, the patient was found to be HIV negative, and was not on any immunosuppressive therapy. Going through the patient's medical history revealed two possible risk factors which might have led to the development of CMV encephalitis: immunosuppression secondary to underlying poorly controlled diabetes mellitus; and previous admission to the intensive care unit which might have lead to CMV reactivation.

https://ift.tt/2KVUxGD

Laser treatment contributes to maintain membrane integrity in stem cells from human exfoliated deciduous teeth (shed) under nutritional deficit

Abstract

This study aimed to analyze the effects of laser irradiation on the membrane integrity and viability of stem cells from human exfoliated deciduous teeth (SHED) that were kept in serum starvation. Nutritional deficit was used to mimic the cellular stress conditions of SHED isolation for regenerative dental approaches, where laser therapy could be beneficial. SHED were cultured under serum starvation (MEMα + 1%FBS) for 1 or 24 h pre-irradiation (protocols A and B, respectively). Then, cells received low-level laser therapy (LLLT; 660 nm) at 2.5 J/cm² (0.10 W; groups I and V), 5.0 J/cm² (0.20 W; groups II and VI), 7.5 J/cm² (0.30 W; groups III and VII), or remained non-irradiated (groups IV and VIII). During irradiation, cells were maintained in 1% FBS (groups I–IV) or 10% FBS (normal culture conditions; groups V–VIII). Membrane integrity was evaluated by quantifying lactate dehydrogenase (LDH) release (immediately after irradiation), and cell viability was assessed by the MTT assay (24, 48, and 72 h post-irradiation). Serum starvation did not alter LDH release by non-irradiated SHED, while LDH release decreased significantly in groups irradiated in 1% FBS (I and III), but not in groups irradiated in 10% FBS (V–VII), regardless the pre-irradiation conditions (protocols A/B). Cell viability was significantly higher 24 h after irradiation, in most protocol A groups. In contrast, cell viability remained mostly unaltered in protocol B groups. LLLT contributed to maintain membrane integrity in SHED subjected to nutritional deficit before and during irradiation with 0.10 or 0.30 W. Short serum starvation before irradiation improved SHED viability at 24 h post-irradiation.

https://ift.tt/2lYu54E

Evaluating the effect of photobiomodulation with a 940-nm diode laser on post-operative pain in periodontal flap surgery

Abstract

The aim of this study was to evaluate the efficacy of low-power of 940-nm diode laser on post-operative pain after undisplaced flap surgery. This randomized clinical trial study was conducted using a split-mouth design. The study participants comprised 30 patients who needed periodontal flap surgery for periodontal pockets on the same tooth on both sides of the mandible. One side of the mandible was subjected to undisplaced flap surgery plus treatment with a 940-nm diode laser, and on the contralateral side, the surgery was conducted without applying the laser. Patients received anti-inflammatory medication and analgesics after surgery. The patients were asked to report the number of analgesics they took and the pain they experienced each night for 1 week using a visual analogue scale. An independent-sample t test was used to compare the results between the two groups. Patients reported less pain on days 2, 3, 4, 5, 6, and 7 after surgery in the laser-treated group (p < 0.05). Furthermore, fewer analgesics were used in this group on days 3, 4, 5, 6, and 7 following the surgery (p < 0.05). The 940-nm diode laser with the settings used in this study could significantly reduce pain and the number of analgesics taken by patients after undisplaced flap surgery.

https://ift.tt/2u6yKFh

Reclassification as NIFTP: a Retrospective Review in a Single Institution with an Emphasis on Workload

Abstract

The aim of this study was to determine the number of cases of papillary thyroid carcinoma (PTC) which could be reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in our institute over a 10-year period, document their clinical status and assess the number of slides that had to be reviewed per case to exclude NIFTP. The histopathology reports for thyroid resections for all papillary carcinoma over a 10-year period (2007–2016) were reviewed. Five hundred forty-five histopathology reports were reviewed, and 71 cases were identified as potential cases of NIFTP. Forty-nine (69%) cases had been referred from external departments and the slides were not available for review. Of the remaining 22 (31% of 71) cases, 5 were reclassified as NIFTP. The 17 cases that were not reclassified as NIFTP required review of 114 of 356 slides (median 5.5 slides per case) was required to exclude NIFTP. For the 5 NIFTP cases, 58 slides were reviewed (median 12 slides per case). We found that review of the histology reports alone was adequate for exclusion in most cases, e.g. classic PTC or EVPTC cases with documented lymphovascular invasion or capsular invasion. As a single exclusion criterion is required for exclusion from reclassification as NIFTP, this can be achieved efficiently. Two of the five patients received radioactive iodine [RAI] as per standard treatment at time of diagnosis, on the basis of tumour size. None have recurrent or metastatic disease with mean follow-up of 5.8 years.

https://ift.tt/2KQMZYY

New software and breast boundary landmarks to calculate breast volumes from 3D surface images

Abstract

Background

A method to accurately calculate breast volumes helps achieving a better breast surgery outcome. 3D surface imaging potentially allows these calculations in a harmless, quick, and practicable way. The calculated volume from a 3D surface image is dependent on the determined breast boundary and the method of chest wall simulation by software. Currently, there is no consensus on a robust set of breast boundary landmarks and validation studies on breast volume calculation software are scarce. The purposes of this study were to determine the robustness of newly introduced breast boundary landmarks and introduce and validate a new method to simulate a chest wall.

Methods

Sixteen subjects who underwent a unilateral simple mastectomy were included. In addition to the natural skin fold of the breast, the sternomanubrial joint, the transition of the pectoral muscle curve into the breast curvature, and the midaxillary line were used as landmarks to indicate the breast boundary. The intra- and interrater variability of these landmarks was tested. Furthermore, new chest wall simulation software was validated on the breastless chest side of the subjects.

Results

The intra- and interrater variability of the three breast boundary markers was small (mean 3.5–6.7 mm), and no significant difference was found between the intra- and interrater variability (p = 0.08, p = 0.06, and p = 0.10). The mean volume error of the most accurately simulated chest wall was 4.6 ± 37 ml.

Conclusion

The newly introduced landmarks showed to be robust and our new chest wall simulation algorithm showed accurate results.

Level of Evidence: Level IV, diagnostic study.

https://ift.tt/2IXdib0

18 F-NaF and 18 F-FDG as molecular probes in the evaluation of atherosclerosis

Abstract

The early detection of atherosclerotic disease is vital to the effective prevention and management of life-threatening cardiovascular events such as myocardial infarctions and cerebrovascular accidents. Given the potential for positron emission tomography (PET) to visualize atherosclerosis earlier in the disease process than anatomic imaging modalities such as computed tomography (CT), this application of PET imaging has been the focus of intense scientific inquiry. Although ¹⁸F-FDG has historically been the most widely studied PET radiotracer in this domain, there is a growing body of evidence that ¹⁸F-NaF holds significant diagnostic and prognostic value as well. In this article, we review the existing literature on the application of ¹⁸F-FDG and ¹⁸F-NaF as PET probes in atherosclerosis and present the findings of original animal and human studies that have examined how well ¹⁸F-NaF uptake correlates with vascular calcification and cardiovascular risk.

https://ift.tt/2KxyQR8

Transcriptomics and metabonomics analyses of maternal DEHP exposure on male offspring

Abstract

The objectives of this study were to evaluate the effect of maternal Di-2-ethylhexyl phthalate (DEHP) exposure on male offspring and to explore the mechanism of changes with the metabolic alterations and differential genes. Pregnant female Sprague-Dawley (SD) rats were intragastrically administered with 600 mg/kg body weight of DEHP or corn oil (CON) throughout pregnancy and lactation. The growth of male offspring was investigated until 14 weeks old, the indices of blood were detected, and mechanism was studied using metabonomics and transcriptomics. Compared with the CON group, body weight, body length, food intake, body fat weight, Lee's index, organ coefficient, blood lipids, and oral glucose tolerance test (OGTT) of male offspring were not significantly changed in maternal DEHP group. However, serum biochemical indexes such as alanine transaminase (ALT), total protein (TP), albumin (ALB), blood urea nitrogen (BUN), and creatinine (CREA) were markedly reduced in maternal DEHP group (p < 0.05). In addition, insulin level was elevated and catalase (CAT) level was decreased notably in maternal DEHP group compared with the CON group (p < 0.05). Furthermore, thyroxine (T₄) level was lower and thyroid stimulating hormone (TSH) level was higher in maternal DEHP group (p < 0.05). Metabonomics revealed seven principal metabolites were identified, including increased L-allothreonine, creatine, uric acid, retinyl ester, L-palmitoylcarnitine, and decreased glycocholic acid and LysoPC (18:3). Transcriptomics displayed 35 differential genes were involved in the mechanism of maternal DEHP exposure. Therefore, this research confirms the effect of a certain dose of maternal DEHP exposure on male offspring and understands exactly the mechanism of these changes with metabonomics and transcriptomics.

https://ift.tt/2lZ5D34

Comparison of rabies virus protection by single chain and leucine zipper Fv fragments cocktail derived from a monoclonal antibody cocktail

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Hualong Xi, Xiangyu Meng, Tiejun Gu, Zhuang Li, Yue Cheng, Qing Sun, Kaixin Zhang, Wei Kong, Yongge Wu

Abstract

Monoclonal antibodies (MAbs) are a unique and attractive class of biologics and are potential substitutes for post-exposure rabies prophylaxis. The safety, tolerance, and broad neutralization efficiency of a MAb cocktail called CL184, composed of the antibodies CR4098 and CR57, was confirmed in a phase I clinical trial. We have prepared a series of single-chain Fv fragments (scFvs) and leucine zipper Fv fragments (zipFvs) from CR57 and CR4098. In this study, we selected and formed scFv and zipFv cocktails and compared their protective effects against the rabies virus. Mice and hamster challenge models demonstrated the improved protection of the zipFv cocktail compared with scFv cocktail, because of its stronger affinity. The results indicate that zipFv production is a promising novel method for the genetic engineering of antibody fragments and improving affinity through systematic screening may be important when designing small molecule antibodies against RV.

https://ift.tt/2u822mH

Definition, Classification and Diagnosis of Diabetes Mellitus

Exp Clin Endocrinol Diabetes 2018; 126: 406-410
DOI: 10.1055/a-0584-6223

Aim of recommendations like this one issued by the German Diabetes Association is to provide the GP and diabetologist and his team with information he needs for his daily practice. These recommendations are updated annually. They are written by a group of experts, but they are not evidence based guidelines. This specific recommendation for diabetes diagnosis briefly describes the diabetes types and the different options for diagnosis. Also the caveats and the practical procedure are presented.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

https://ift.tt/2uazt8a

Practical Recommendations for Glucose Measurement, Glucose Monitoring and Glucose Control in Patients with Type 1 or Type 2 Diabetes in Germany

Exp Clin Endocrinol Diabetes 2018; 126: 411-428
DOI: 10.1055/a-0586-5302

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

https://ift.tt/2lY6D7B

A Case-only Genome-Wide Association Study on Gene-Sex Interaction in Allergic Rhinitis

Publication date: Available online 5 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Afsaneh Mohammadnejad, Charlotte Brasch-Andersen, Weilong Li, Annette Haagerup, Jan Baumbach, Qihua Tan

https://ift.tt/2ze5nXr

Targeting IgE in allergic disease

Pascal Gasser | Alexander Eggel

https://ift.tt/2KMRvba

Impulse oscillometry in the assessment of children's lung function

Publication date: Available online 5 July 2018

Source: Allergologia et Immunopathologia

Author(s): P.P. de Oliveira Jorge, J.H.P. de Lima, D.C. Chong e Silva, D. Medeiros, D. Solé, G.F. Wandalsen

Abstract

Purpose

To review available evidence in the literature on impulse oscillometry in the assessment of lung function in children with respiratory diseases, especially asthma.

Data collection

Research in the Medline, PubMed, and Lilacs databases, with the keywords forced oscillation, impulse oscillometry, asthma and impulse oscillometry.

Results

The Impulse Oscillometry System (IOS) allows the measurement of resistance and reactance of airways and is used as a diagnostic resource. A significant association between the findings of the IOS and those of spirometry is observed. In asthma, the IOS has already been used to assess the bronchodilator response and the therapeutic response to different drugs and has shown to be a sensitive technique to evaluate disease control. There are limitations to this assessment, such as children with attention deficit and in some cases it is difficult to interpret the results from a clinical point of view.

Conclusion

The IOS is a useful tool for the measurement of the lung function of children. It is an easy test, although its interpretation is not straightforward.

https://ift.tt/2tYikj3

An Integrated model of Alopecia Areata biomarkers highlights both Th1/Th2 up-regulation

Publication date: Available online 5 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Teresa Song, Ana B. Pavel, Huei-Chi Wen, Kunal Malik, Yeriel Estrada, Juana Gonzalez, Peter Hashim, John Nia, Danielle Baum, Grace Kimmel, Giselle K. Singer, James G. Krueger, Emma Guttman-Yassky

https://ift.tt/2KydHX7

Treating insect bite hypersensitivity (IBH) in horses by active vaccination against Interleukin-5

Publication date: Available online 5 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Albert Y. Wu, Sanjiv Sur, J. Andrew Grant

https://ift.tt/2KRLVku

Urinary PGDM, a prostaglandin D2 metabolite, is a novel biomarker for objectively detecting allergic reactions of food allergy

Publication date: Available online 5 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Shinichiro Inagaki, Shingo Maeda, Masami Narita, Tatsuro Nakamura, Tatsuo Shimosawa, Takahisa Murata, Yukihiro Ohya

https://ift.tt/2KQDmJV

Outcome of domino hematopoietic stem cell transplantation in humans – an international case series

Publication date: Available online 5 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Mirjam E. Belderbos, Andrew R. Gennery, Christopher C. Dvorak, Henric-Jan Blok, Dirk-Jan Eikema, Juliana M.F. Silva, Paul Veys, Bénédicte Neven, Rebecca Buckley, Theresa Cole, Morton J. Cowan, W. Scott Goebel, Manfred Hoenig, Caroline Y. Kuo, E. Richard Stiehm, Robert Wynn, Marc Bierings, Inborn Errors Working Party of the EBMT and the PIDTC

https://ift.tt/2KTzNzA

The Eye’s Mind – visual imagination, neuroscience and the humanities

Publication date: Available online 5 July 2018

Source: Cortex

Author(s): Adam Zeman, Matthew MacKisack, John Onians

https://ift.tt/2KSBv4b

Alternative scenarios for ecological urbanizations using ENVI-met model

Abstract

Natural areas are quickly degraded by opening new settlement and industrial areas in order to meet the increasing demand of the growing population. Concreting, modification of land surfaces, complex urban structures, and depressed urban environments contribute to the formation of an Urban Heat Island (UHI). In this study, the outdoor measurements, meteorological parameters related to the thermal indices such as humidity, temperature, wind velocity, and direction for 24 h measurements, were evaluated. The ENVI-met micro-scale model was performed for evaluating alternative scenarios for winter and summer on thermal comfort for better urban environments. Meteorological parameters together with vegetation characteristics were analyzed for making possible scenarios in botanical garden_, auto industrial area_, city center, and rural open area. The average of the vegetated simulations of the botanical garden was about 2.2 °C cooler than this of the mean of current situation in the city center. Based upon the average of all stations, it was determined that the temperature increased 1.4 °C with the simulation of both wooded areas in winter. However, the mean temperature of all stations with coniferous plants was 1.2 °C cooler, in summer. It was concluded that deciduous plants in city center produced more positive results than coniferous plants in winter. In general, it can be said that afforestation in cold climatic regions provides great advantages for both summer and winter and positively affects outdoor thermal comfort. However, it needs further measurement and further research in this regard.

https://ift.tt/2m0c19X

Sleep Disturbances and Their Impact in Pediatric Cystic Fibrosis

Cystic fibrosis is a chronic, life-shortening illness that affects multiple systems and results in frequent respiratory infections, chronic cough, fat malabsorption and malnutrition. Poor sleep is often reported by patients with cystic fibrosis. Although objective data to explain these complaints have been limited, they do show poor sleep efficiency and frequent arousals. Abnormalities in gas-exchange are also observed during sleep in patients with cystic fibrosis. The potential impact of these abnormalities in sleep on health and quality of life remains largely unstudied.

https://ift.tt/2NxEaSC

A Case-only Genome-Wide Association Study on Gene-Sex Interaction in Allergic Rhinitis

Allergic rhinitis (AR) is a condition with a significant impact on patient's quality of life. Sex differences in the prevalence and clinical presentation of rhinitis have been reported in multiple studies. Additionally, it has comorbidities with asthma, atopic dermatitis, rhinosinusitis, otitis media, anosmia, nasal polyps and lower airway infection. As a complex phenotype, AR is affected by both genetic and environmental factors. Recent literature has focused on difference in the genomic architecture of asthma for the two sexes by considering gene-sex interaction, whereas AR has been neglected.

https://ift.tt/2IWCTRo

Internal dose of particles in the elderly—modeling based on aerosol measurements

Abstract

The paper presents an integrated methodology that combines experimental and modeling techniques and links exposure to airborne particulate matter (PM) with internal dose in the respiratory system and burden in adjacent tissues over a period of time. The methodology is used to estimate doses in the respiratory systems of elders that reside in 10 elderly care centers (ECCs) in the metropolitan area of Lisbon. Measurements of PM were performed in the ECCs and combined with a time-budget survey for the occupants. This information served as input to the first model that estimated particle doses in the different regions of the respiratory tract of the elderly, and then a second model was used to calculate particle build-up in the alveolar region, the interstitium and the hilar lymph nodes of the elders over a 5-year exposure period. It was found that in 5 years of continuous exposure to the average particle concentration measured over all ECCs, 258 mg of all particles are deposited on the surface of the alveoli of which 79.6% are cleared, 18.8% are retained in the alveolar region, 1.5% translocate to the hilar lymph nodes, and 0.1% are transferred to the interstitium.

https://ift.tt/2NvhEcY

Comment on “Guidelines of care for the management of basal cell carcinoma”

https://ift.tt/2KCa6qS

Reply to Comment on “Guidelines of Care for the Management of Basal Cell Carcinoma”

https://ift.tt/2KP932R

Skin Confident: A skin health and acne educational intervention to improve Acne Quality of Life measures in adolescents

https://ift.tt/2KC9XDQ

Atypical Fibroxanthoma: Systematic Review and Meta-analysis of Treatment with Mohs Micrographic Surgery or Excision

The two treatment modalities most commonly used for AFX are wide local excision (WLE) and Mohs micrographic surgery (MMS). Mohs micrographic surgery (MMS) is associated with a lower local recurrence rate than WLE. MMS should be considered for treatment of AFX, especially in anatomically sensitive areas and in immunosuppressed patients.

https://ift.tt/2IUXu8M

Human Acellular Dermis Increases Surgical Site Infection and Overall Complication Profile When Compared with Submuscular Breast Reconstruction: An Updated Meta-Analysis Incorporating New Products

Human acellular dermal matrix (HADM) is an increasingly used adjunct to breast reconstruction. Previous meta-analysis demonstrate increased risks of complications, but these studies represent largely represent one product. The purpose of this study is to stratify outcomes based on a meta-analysis of complications incorporating all new studies after 2012 and their associated new human-based products.

https://ift.tt/2zeKR90

Contribution of Eisenia andrei earthworms in pathogen reduction during vermicomposting

Abstract

Vermicomposting is a process of degradation of biowaste which involves complex interactions between earthworms and microorganisms. This process lacks a thermophilic stage and thus, the possible presence of pathogens poses a potential health hazard. To assess the contribution of earthworms during the selective reduction of various pathogens, apple pomace substrate was artificially inoculated with Escherichia coli, Salmonella spp., thermotolerant coliform bacteria, and Enterococci. The artificial bacterial load did not influence the weight, reproduction, or intestinal enzymatic activity of the earthworms, but it caused reversible histological changes to the epithelial layer and chloragogen tissue of their intestines. The reduction of pathogenic Enterococci and E. coli from the substrate was accelerated by earthworms (63-fold, 77-fold, and 840-fold for Enterococci and 6-fold, 36-fold, and 7-fold for E. coli inoculated substrates after 2, 4, and 6 weeks, respectively). Moreover, the rapid elimination of Salmonella spp. was supported by the upregulated expression of two pattern recognition receptors which bind lipopolysaccharide, coelomic cytolytic factor, and lipopolysaccharide-binding protein. Further, the microbiomes of the intestine and the composting substrate differed significantly.

Graphical abstract

https://ift.tt/2MSKXoO

Stable carbon and nitrogen isotopic composition of PM 10 over Indo-Gangetic Plains (IGP), adjoining regions and Indo-Himalayan Range (IHR) during a winter 2014 campaign

Abstract

For source identification, a field campaign involving simultaneous sampling of particulate matter (PM₁₀) was conducted at eight sampling sites in the Indian mainland during winter 2014. The sampling sites include Delhi (upper IGP), Lucknow (middle IGP), and Kolkata (lower IGP) in the Indo-Gangetic Plains (IGP); Mohal-Kullu and Darjeeling in the Indo-Himalayan Range (IHR). In addition, Ajmer, located upwind of the IGP in NW-India and Giridih and Bhubaneswar, in the downwind to the IGP has also been chosen. To characterize the sources of the ambient PM₁₀, stable isotope ratios of carbon (δ¹³C_TC) and nitrogen (δ¹⁵N_TN) for the total carbon (TC) and total nitrogen (TN) fractions have been considered. Ancillary chemical parameters, such as organic carbon (OC), elemental carbon (EC), and water-soluble ionic components (WSIC) mass concentrations are also presented in this paper. There was very small variation in the daily average δ¹³C_TC ratios (− 24.8 to − 25.9‰) among the sites. Comparison with end-member stable C isotopic signatures of major typical sources suggests that the PM₁₀ at the sites was mainly from fossil fuel and biofuel and biomass combustion. Daily average δ¹⁵N_TN ratios were not observed to vary much between sites either (8.3 to 11.0‰), and the low δ¹⁵N_TN levels also indicate substantial contributions from biofuel and biomass burning of primarily C3 andC4 plant matter.

Graphical abstract

Scatter plot of the average (± 1 standard deviation (SD)) δ¹³C_TC (‰) compared to δ¹⁵N_TN (‰) at the sampling sites.

https://ift.tt/2KMPoDX

Novel magnetic ion-imprinted polymer: an efficient polymeric nanocomposite for selective separation and determination of Pb ions in aqueous media

Abstract

A novel ion-imprinted polymer (IIP) toward Pb(II) recognition was synthesized on the surface of magnetic multi-walled carbon nanotubes (magnetic MWCNTs). In order to prepare magnetic functionalized-MWCNT/IIP (magnetic f-MWCNT/IIP), copolymerization of methylenebisacrylamide (MBAm) and acrylamide (AM) in the presence of dithizone-Pb(II) complex was carried out on the surface of the magnetic f-MWCNTs. Selectivity of the new synthesized sorbent toward Pb(II) and the influence of a variety of foreign ions on the recognition, preconcentration, and removal of Pb(II) were evaluated using adsorption experiments in aqueous solution. The synthesized sorbent exhibited a good affinity with high adsorption capacity (Q = 80.81 mg/g) and an excellent selectivity toward Pb(II) in comparison with other common cations including alkaline, alkaline earth, and transition metals such as Na⁺, K⁺, Mg²⁺, Ca²⁺, Cd²⁺, and Ni²⁺. The parameters such as adsorption and desorption time, adsorption capacity, effect of the sorbent mass, eluent type, concentration and volume, and also pH of the solutions were investigated. The result demonstrated that the proposed sorbent provided a fast removal and higher maximum binding capacity compared to other reported synthesized sorbents. The characteristics of the magnetic f-MWCNT/IIP were analyzed using Fourier transform infrared spectroscopy (FT-IR), scanning electron microscopy (SEM), X-ray diffraction (XRD), energy-dispersive spectroscopy (EDS), vibrating sample magnetometer (VSM), and elemental analysis (EA).

Graphical abstract

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https://ift.tt/2MPtvBq

A rare case of seven siblings with Waardenburg syndrome: a case report

Waardenburg syndrome is a group of rare genetic conditions. It is determined by the absence of melanocytes from the eyes, hair, and skin. There are four types of Waardenburg syndrome with specific criteria to ...

https://ift.tt/2KOUfS8

Bilateral septic arthritis of the sternoclavicular joint complicating infective endocarditis: a case report

Septic arthritis is an infectious disease that commonly affects weight-bearing or proximal joints such as the knee and the hip. The sternoclavicular joint is an unusual site of this entity. It usually occurs i...

https://ift.tt/2MS5CJt

Frequency of CD4+ and CD8+ T cells in Iranian chronic rhinosinusitis patients

Chronic Rhinosinusitis (CRS) is a persistent inflammatory disease affecting paranasal sinuses. CRS is categorized into two distinct subgroups defined as CRS with nasal polyps (CRSwNP) and CRS without nasal pol...

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Discretized Modeling of Motionless Printing Based on Retarded Bending Motion and Deposition Control of Electrically Driven Jet

3D Printing and Additive Manufacturing, Ahead of Print.


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Anti-ADAM17 monoclonal antibody MEDI3622 increases IFNγ production by human NK cells in the presence of antibody-bound tumor cells

Abstract

Several clinically successful tumor-targeting mAbs induce NK cell effector functions. Human NK cells exclusively recognize tumor-bound IgG by the FcR CD16A (FcγRIIIA). Unlike other NK cell activating receptors, the cell surface density of CD16A can be rapidly downregulated in a cis manner by the metalloproteinase ADAM17 following NK cell stimulation in various manners. CD16A downregulation takes place in cancer patients and this may affect the efficacy of tumor-targeting mAbs. We examined the effects of MEDI3622, a human mAb and potent ADAM17 inhibitor, on NK cell activation by antibody-bound tumor cells. MEDI3622 effectively blocked ADAM17 function in NK cells and caused a marked increase in their production of IFNγ. This was observed for NK cells exposed to different tumor cell lines and therapeutic antibodies, and over a range of effector/target ratios. The augmented release of IFNγ by NK cells was reversed by a function-blocking CD16A mAb. In addition, NK92 cells, a human NK cell line that lacks endogenous FcγRs, expressing a recombinant non-cleavable version of CD16A released significantly higher levels of IFNγ than NK92 cells expressing equivalent levels of wildtype CD16A. Taken together, our data show that MEDI3622 enhances the release of IFNγ by NK cells engaging antibody-bound tumor cells by blocking the shedding of CD16A. These findings support ADAM17 as a dynamic inhibitory checkpoint of the potent activating receptor CD16A, which can be targeted by MEDI3622 to potentially increase the efficacy of anti-tumor therapeutic antibodies.

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Do Aesthetic Average Nasal Parameters Matter For Rhinoplasty in India?

Abstract

Nose morphology and facial features depend on ethnicity, gender and environmental conditions. Nasal parameters for rhinoplasty are well defined in the European and American population. Though rhinoplasty is a common cosmetic surgery in India, till now, there is no dedicated study delineating the parameters for the Indian Rhinoplasty. The aim of this study is to determine and delineate the anthropometric measurements of the Indian male and female noses and to propose the nasal parameters for Indian rhinoplasty. To determine the aesthetically pleasing nasal anthropometric parameters in Indian males and females and to put forth the parameters for Indian Rhinoplasty. This anthropometric study included a volunteer sample of 221 young, good-looking Indian males and females aged 18–25 years with Indian parents and no history of previous surgery or trauma to the nose. Standardized frontal, lateral and basal photographs of the noses along with the reference scale were taken, and 11 standard anthropometric measurements of the nose were determined. The sample size selected was such that it included representative population from the north south east and west zones of India. All the nasal measurements for the Indian women and men were found to be significantly different from the other European standards. In our study, we measured the nasal average values of the good looking, young Indian males and females and compared with the results of the nasal parameters of the other populations found in the literature. This study is the first one to propose the aesthetic average nasal parameters for corrective rhinoplasty in Indian population. Level of Evidence IV.

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Ectopic Cervical Thymus in an Infant with Normal Orthotopic Thymus: Role of Imaging in Diagnosis and Management

Abstract

Ectopic cervical thymus (ECT) is a rare cause of solid cervical mass in the pediatric age group. The location of the mass along the path of thymic descent (thymopharyngeal duct), sonographic echo pattern and MR signal intensity identical to that of normal orthotopic thymus in the anterior mediastinum help us in making a confident diagnosis. To the best of our knowledge only nine cases have been reported in infants in the literature. We present a case of ECT presenting as a right upper neck mass in a 2 month old child.

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Comparing the Establishment of Operation Space Between High Position and Low Position in Endoscopic Thyroid Surgery

Conditions:   Thyroid Cancer;   Endoscopy
Interventions:   Procedure: high position space group;   Procedure: low position space group
Sponsor:   Fujian Medical University
Recruiting

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Comparing the Establishment of Operation Space Between High Position and Low Position in Endoscopic Thyroid Surgery

Conditions:   Thyroid Cancer;   Endoscopy
Interventions:   Procedure: high position space group;   Procedure: low position space group
Sponsor:   Fujian Medical University
Recruiting

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Comparative study of the physicochemical and photocatalytic properties of water-soluble polymer-capped TiO 2 nanoparticles

Abstract

TiO₂ shows great potential as ideal and powerful photocatalyst to degrade and eliminate harmful organic pollutants from waste water. It is desirable to prepare anatase TiO₂ with good aqueous solubility and photocatalytic activity for water decontamination. In this paper, water-soluble TiO₂ nanoparticles were successfully prepared using polytetramethylene ether glycol (PTMG), poly(ethylene glycol) (PEG), and poly(propylene glycol) (PPG) as stabilizers. The anatase phase of TiO₂ was well controlled by introduction of HCl in the reaction system. The results showed that all the polymer-capped TiO₂ were well dissolved in water and their aqueous solutions could maintain stable for more than 2 months. The photocatalytic activities of polymer-capped TiO₂ were evaluated by monitoring the degradation of Rhodamine B (RhB) with Degussa P25 as a control. The results showed that all the polymer-capped TiO₂ presented better photocatalytic activity than that of Degussa P25. PTMG capped TiO₂ exhibited the longest average lifetime of charge carriers, indicating the lowest charge recombination rate. Thus, PTMG capped TiO₂ presented the best photocatalytic activity. In summary, PTMG, PEG, and PPG can be used as stabilizers to prepare water-soluble TiO₂. PTMG is an ideal stabilizer for the synthesis of water-soluble TiO₂ with good photocatalytic activity.

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Laryngeal chondrosarcoma

Norman J. Chan, MD; Christopher Fundakowski, MD; Ahmed M.S. Soliman, MD

About 80% of laryngeal chondrosarcomas have calcifications that can be seen on CT, but MRI can help to determine extralaryngeal extension.

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Antibiotics, steroids, and combination therapy in chronic rhinosinusitis without nasal polyps in adults

Yuan F. Liu, MD; Clare M. Richardson, MD; Stewart H. Bernard, MD; Christopher A. Church, MD; Kristin A. Seiberling, MD

Abstract

Despite a lack of robust data regarding their efficacy, oral antibiotics and steroids remain two of the most common treatments for chronic rhinosinusitis without nasal polyps (CRSsNP). We sought to objectively compare the efficacy of antibiotics and steroids, independently and in combination, for the initial treatment of CRSsNP. To that end, we conducted a retrospective chart review of 100 patients-51 men and 49 women, age 20 to 85 years (mean: 50)-who were treated for CRSsNP from January 2010 through January 2015. Of this group, 17 patients were treated with an antibiotic only, 28 with a steroid only, and 55 with both agents. All patients underwent computed tomography (CT) before and after treatment, and we compared the three groups' pre- and post-treatment Lund-Mackay CT scores, symptom scores, and rates of surgery. The average time between the pre- and post-treatment visits was 4.4 weeks. The mean Lund-Mackay CT score for the entire study population was significantly lower after treatment than at baseline (6.3 vs. 9.1; p < 0.001); however, there were no significant differences among the three groups in either pre- or post-treatment scores. Symptom scores were significantly better in the combination therapy group than in the two monotherapy groups (p < 0.001). In all, 40 of the 100 patients underwent surgery; the difference in surgery rates among the three groups was not statistically significant (p = 0.884). Surgery was performed on 9 of the 52 (17.3%) patients who either were followed for at least 1 year or who had had surgery within the first year postoperatively; again, there were no significant differences among the three groups (p = 0.578). We conclude that although the Lund-Mackay CT scores decreased significantly in the antibiotic, steroid, and combination therapy groups, no one regimen was superior to any other for treating CRSsNP in our study.

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Hemifacial spasm secondary to middle ear cholesteatoma

Maheep Sohal, MD; Nicholas Karter, MD; Marc Eisen, MD, PhD

Abstract

Hemifacial spasm is a peripheral myoclonus of the VIIth cranial nerve that is characterized by paroxysmal contraction of the muscles of facial expression. It exists in both primary and secondary forms. In rare cases, hemifacial spasm is caused by middle ear pathology. We describe the case of a 90-year-old man with recurrent cholesteatoma and tympanic segment fallopian canal dehiscence manifesting as right-sided hemifacial spasm. His history was significant for a right-sided tympanomastoidectomy for cholesteatoma 6 years earlier. Computed tomographic angiography performed to look for vascular compression of the facial nerve demonstrated a right middle ear opacification. Middle ear exploration revealed a completely dehiscent tympanic segment with cholesteatoma abutting the facial nerve. The overlying keratin debris and matrix were carefully dissected off, and facial nerve function was preserved. The final diagnosis was hemifacial spasm. During 14 months of postoperative follow-up, the patient experienced no further facial spasm.

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Histopathologic evaluation of Ecballium elaterium applied to nasal mucosa in a rat rhinosinusitis model

Can Mehmet Eti, MD; Yusuf Vayisoglu, MD; Berkan Kardas, MD; Rabia Bozdogan Arpaci, MD; Elif Sahin Horasan, MD; Arzu Kanik, PhD; Neslihan Eti, MD; Serap Yalin, BScPhm; Derya Umit Talas, MD

Abstract

This study aimed to evaluate the antimicrobial effects of the medicinal plant Ecballium elaterium, which is topically applied as a traditional medicine for the treatment of rhinosinusitis. Pure and extract forms of E elaterium were applied to the nasal cavity of rats for the treatment of Streptococcus-pneumoniae -induced rhinosinusitis. The nasal mucosa, soft palate, and trachea of the rats were harvested in the first hour, third day, and third week for histopathologic evaluation. This experiment revealed the anti-inflammatory effects of E elaterium and showed that it reduced fibrosis. The anti-inflammatory effect of all forms of E elaterium was found to reach its maximum level on the third day, decreasing by the third week. We also observed that the pure form of E elaterium caused severe epithelium loss in the first hour after application. The mechanism of the anti-inflammatory effect of different levels of extract forms needs to be further analyzed with different doses and duration of treatment.

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Balloon eustachian tuboplasty and the tragedy of the commons

Brian J. McKinnon, MD, MBA, MPH, FACS

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Intradermal nevus of external auditory canal revisited

Pei-Hsuan Wu, MD; Hsin-Chien Chen, MD, PhD

Intradermal nevus, a subtype of melanocytic nevus, occurs relatively rarely in the external auditory canal.

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An inverted papilloma arising from the middle turbinate and extending to the maxillary sinus ostium

Jae Hoon Lee, MD

Inverted papillomas have been reported to have a high propensity for recurrence, and they are associated with squamous cell carcinoma.

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The incidence of revision adenoidectomy: A comparison of four surgical techniques over a 10-year period

Nipun Bhandari, MPH; Debra M. Don, MD; Jeffrey A. Koempel, MD, MBA

Abstract

Approximately 130,000 adenoidectomies are performed each year in the United States. Few studies have examined adenoid regrowth and the incidence of revision surgery or have compared four different surgical instruments commonly used for adenoid surgery within the same institution. This study aimed to determine the incidence of revision adenoidectomy after the use of microdebrider, Coblation, suction cautery, and curette instruments over a 10-year period at a single major tertiary children's center in the United States. A retrospective chart review was performed for all patients who underwent primary and/or revision adenoidectomy at the Children's Hospital Los Angeles (CHLA) between August 2004 and August 2014. During the 10-year study period, a microdebrider was used in 212 cases, Coblation in 382, suction cautery in 1,926, and curette in 3,139 adenoidectomies. The percentages of revision adenoidectomy were 1.42% (3 patients) for microdebrider, 0.79% (3 patients) for Coblation, 0.36% (7 patients) for suction cautery, and 0.03% (1 patient) for curette. The cumulative incidence of revision adenoidectomy for initial surgeries performed at CHLA was 0.2% for the 10-year study period. Pearson chi-square analysis showed statistically significant differences between the surgical techniques (p < 0.0001). In conclusion, regrowth of adenoid tissue requiring revision surgery occurs very infrequently irrespective of the instrument used for the primary procedure, and the most common indication for revision adenoidectomy is to improve eustachian tube dysfunction rather than nasal obstruction due to adenoid hypertrophy.

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Low-grade sinonasal sarcoma with neural and myogenic features

Neil G. Hockstein, MD; Peter E. Dross, MD; Shoheb Farooqui, MD; Ian N. Wilhelm, MD

The distinction between bony destruction versus erosion is important because they suggest different pathologic entities.

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Endoscopic surgery for primary sinonasal malignancies: Treatment outcomes and prognostic factors

Yan Huang, MD; Qian-hui Qiu, MD, PhD; Shui-xing Zhang, MD, PhD

Abstract

We retrospectively reviewed the cases of 85 patients with primary sinonasal malignancies who had undergone endoscopic surgery with curative intent achieved by "regional resection." Our goal was to assess the efficacy of endoscopic surgical treatment vis-à-vis traditional open surgery. Kaplan-Meier data analysis revealed that the 1-, 3-, and 5-year disease-specific survival rates were 82, 60, and 49%, respectively. Multivariate Cox model survival analysis revealed that male sex, certain pathologic types of cancer (i.e., undifferentiated carcinoma, olfactory neuroblastoma, and rhabdomyosarcoma), and T3/T4 category negatively impacted survival (adjusted hazard ratios: 3.601, 0.012, 0.287, 0.068, and 0.339, respectively; p < 0.05 for all). We also performed a separate analysis of 47 patients who had category T3 or T4 cancer to determine if the type of surgical approach is a prognostic factor. For this, we identified 20 new patients who had undergone open resection, and we compared them to 27 of our endoscopically treated patients who had similar clinical characteristics. We found that the type of surgical approach did not appear to be a prognostic factor (p > 0.10), although those patients who had undergone endoscopic resection had significantly shorter hospital stays (p < 0.001). We conclude that patients with primary sinonasal malignancies who are treated with endoscopic surgery have acceptable survival rates and therefore endoscopic surgery is justified in the hands of highly experienced surgeons in selected cases.

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Ultrasound-guided left lateral transversus abdominis plane block combined with rectus sheath block in peritoneal dialysis catheter placement

Abstract

This study assessed the utility of ultrasound-guided lateral transversus abdominis plane (TAP) block combined with rectus sheath (RS) block for peritoneal dialysis catheter placement surgery. Thirty consecutive patients with end-stage renal disease scheduled to have peritoneal dialysis catheter placement received a left lateral TAP block combined with RS block performed under ultrasound guidance. The TAP and RS blocks were, respectively, conducted with 15 ml of 0.5% ropivacaine and 10 ml of 0.5% ropivacaine. Pain intensity was evaluated by verbal rating scale during operation, and the degree of patient and surgeon satisfaction was qualified by a categorical scale. Twenty-nine patients received successful blocks without any other adjuvant anesthetic drugs. One patient required rescue analgesia with lidocaine infiltration. No complications related to regional anesthesia were noted. Ultrasound-guided left lateral TAP block combined with RS block can serve as the primary anesthetic modality for peritoneal dialysis catheter placement surgery.

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Radiation-induced acute toxicities after image-guided intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy for patients with spinal metastases (IRON-1 trial)

Abstract

Purpose

Radiation therapy (RT) provides an important treatment approach in the palliative care of vertebral metastases, but radiation-induced toxicities in patients with advanced disease and low performance status can have substantial implications for quality of life. Herein, we prospectively compared toxicity profiles of intensity-modulated radiotherapy (IMRT) vs. conventional three-dimensional conformal radiotherapy (3DCRT).

Methods

This was a prospective randomized monocentric explorative pilot trial to compare radiation-induced toxicity between IMRT and 3DCRT for patients with spinal metastases. A total of 60 patients were randomized between November 2016 and May 2017. In both cohorts, RT was delivered in 10 fractions of 3 Gy each. The primary endpoint was radiation-induced toxicity at 3 months.

Results

Median follow-up was 4.3 months. Two patients suffered from grade 3 acute toxicities in the IMRT arm, along with 1 patient in the 3DCRT group. At 12 weeks after treatment (t2), 1 patient reported grade 3 toxicity in the IMRT arm vs. 4 patients in the 3DCRT group. No grade 4 or 5 adverse events occurred in either group. In the IMRT arm, the most common side effects by the end of irradiation (t1) were grade 1–2 xerostomia and nausea in 8 patients each (29.6%), and dyspnea in 7 patients (25.9%). In the 3DCRT group, the most frequent adverse events (t1) were similar: grade 1–2 xerostomia (n = 10, 35.7%), esophagitis (n = 10, 35.8%), nausea (n = 10, 35.8%), and dyspnea (n = 5, 17.9%).

Conclusion

This is the first randomized trial to evaluate radiation-induced toxicities after IMRT versus 3DCRT in patients with vertebral metastases. This trial demonstrated an additional improvement for IMRT in terms of acute side effects, although longer follow-up is required to further ascertain other endpoints.

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Close Margins and Adjuvant Radiotherapy in Acinic Cell Carcinoma of the Parotid Gland

This case series evaluates the oncologic outcomes of patients with acinic cell carcinoma of the parotid gland and the results of adjuvant therapy for those with close (≤1-mm) margins.

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Multiple-Flap Reconstruction of Head and Neck Defects

The goals of head and neck reconstruction of cancer-related defects are to restore speech, swallowing, and cosmesis and maximize patient quality of life. During the past 2 decades, our ability to achieve these goals with free, pedicled, and local tissue transfer alone or in combination has steadily improved. The reconstructive surgeon now has a robust armamentarium with an array of tissue choices, including bone, muscle, viscera, skin (thick, thin, hair bearing, and color match to facial skin). In addition, there has been an expansion of recipient vessels, which allows an increased range of options for patients in whom prior therapy has failed and who present for head and neck reconstruction. These advances have changed the way that we think about the various components of the head and neck and increased the number of creative choices to restore form and function and minimize morbidity.

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Trend Toward the Use of Transcutaneous Osseointegrated Hearing Devices in Pediatric Patients

Transcutaneous osseointegrated hearing implants, instead of percutaneous implants, are increasingly becoming the choice of surgeons when considering osseointegrated hearing aids in children. Transcutaneous implants use a magnet under the skin coupled with a magnet on the processor, whereas percutaneous implants have an abutment through the skin to which the processor connects. For aural atresia and maximum conductive hearing loss, surgeons and patients have multiple options for hearing rehabilitation, including canalplasty and an osseointegrated hearing aid. Pediatric otolaryngologists seem to be choosing the transcutaneous devices because they present fewer complications and less wound care, which is better tolerated by pediatric patients. Most studies into osseointegrated hearing aids have focused on adult outcomes, and data in the pediatric population are lacking, especially information related to newer transcutaneous, rather than percutaneous, devices. Previous studies have shown a complication rate of more than 50% for pediatric patients with percutaneous implants, with most of the complications related to soft-tissue infections or growth. These studies have shown high rates of parental satisfaction with percutaneous devices but low compliance rates, indicating that satisfaction scores may be misleading.

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Transcutaneous Osseointegrated Implants for Pediatric Patients With Atresia

This case series describes the processes, advantages, and outcomes of transcutaneous osseointegrated implantation for pediatric patients with aural atresia.

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Outcomes in Head and Neck Resections That Require Multiple-Flap Reconstructions

This systematic review characterizes the outcomes of large-scale head and neck resections that require multiple-flap reconstructions.

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Analysis of dysphagia in advanced-stage head-and-neck cancer patients: impact on quality of life and development of a preventive swallowing treatment

Abstract

Objectives

Swallowing and voice dysfunctions are common side effects following head-and-neck squamous-cell carcinoma (HNSCC) treatment. Our aim was to analyze the relationships between quality of life, swallowing, and phonatory problems in patients with an advanced-stage HNSCC and to prospectively evaluate the effects of a prophylactic swallowing program.

Methods

First, we retrospectively studied 60 advanced HNSCC patients treated with exclusive or adjuvant radiotherapy/chemoradiotherapy (RT/CRT). Subjects were classified according to general and clinical–therapeutic features. Outcome measures included EORTC QLQ-C30, EORTC QLQ-H&N35, Dysphagia Handicap Index (DHI), M.D.Anderson Dysphagia Inventory (MDADI), and Voice Handicap Index (VHI). Then, we conducted a prospective evaluation of a prophylactic swallowing counselling in 12 consecutive advanced-stage HNSCC patients by a two-arm case–control analysis. These patients were treated with exclusive or adjuvant RT/CRT.

Results

71% of the retrospective population studied reported swallowing dysfunction as a major side effect. No differences were detected in the severity of dysphagia or dysphonia according to type of treatment or staging of the primary tumour, while hypopharyngeal and laryngeal cancer patients showed significantly better swallowing ability and better QoL compared to oral cavity and oropharyngeal localisation (p < 0.05). In addition, a relevant correlation between swallowing and voice problems emerged (p < 0.05). In the prospective part, while no statistical correlation was evident before the start of RT/CRT in the experimental group compared to the control one, the former showed better performances at MDADI (p = 0.006) and DHI (p = 0.002) test 3 months after its end.

Conclusion

Dysphagia is both an acute-and-long-term side effect which greatly affects QoL of HNSCC patients undergoing multimodality treatment. Our data show that a prophylactic swallowing program could actually produce a beneficial effect on patients' outcomes.

Level of evidence

1b and 2b.

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Análisis de supervivencia libre de recaída audiométrica en pacientes con hipoacusia inmunomediada tratados exclusivamente con corticoides

Publication date: July–August 2018

Source: Acta Otorrinolaringológica Española, Volume 69, Issue 4

Author(s): Nieves Mata-Castro, Raimon García-Chilleron, Javier Gavilanes-Plasencia, Rafael Ramírez-Camacho, Alfredo García-Fernández, José Ramón García-Berrocal

Resumen

Objetivo

Describir los resultados en términos de supervivencia libre de recaída audiométrica y el ritmo de recaída en pacientes con hipoacusia inmunomediada tratados exclusivamente con corticoides.

Método

Estudio retrospectivo de pacientes, con recaídas audiométricas, en seguimiento desde 1995 hasta 2014, en 2 centros de la Comunidad de Madrid.

Resultados

Se evaluaron 31 pacientes con una media de edad de 48,52 años (14,67 DE) de los cuales el 61,3% fueron mujeres. La mayoría de las hipoacusias fueron fluctuantes (48,4%). Solo el 16,1% de los pacientes presentaban enfermedad autoinmune sistémica. Existe una correlación positiva moderada entre ser mujer y presentar afectación sistémica (coeficiente de correlación de Spearman = 0,356). La tasa relativa de incidencia de recaída en el primer año en nuestra serie fue de 2,01 recaídas/año con un IC95% (1,32-2,92). El tiempo de supervivencia medio del evento (recaída audiométrica) fue de 5,25 meses (DE 0,756). Con el análisis multivariante, la única variable que consiguió significación estadística fue la edad, con una hazard ratio de 1,032 (IC95%; 1,001-1,063, p = 0,043)

Conclusiones

La enfermedad inmunomediada del oído interno es una enfermedad crónica con recaídas. La mitad de los pacientes tratados exclusivamente con corticoides recaen antes de los 6 meses de seguimiento. Además, si un paciente no ha presentado recaída, tiene más riesgo de recaer cada año que pasa. El análisis de la supervivencia libre de recaída audiométrica permitirá comparar el efecto de tratamientos futuros y su capacidad para reducir el ritmo de recaídas.

Abstract

Objective

To describe the results in terms of audiometric relapse-free survival and relapse rate in immunomediated hearing loss patients treated exclusively with corticosteroids.

Method

Retrospective study of patients with audiometric relapses, monitored from 1995 to 2014, in two centres of the Community of Madrid.

Results

We evaluated 31 patients with a mean age of 48.52 years (14.67 SD), of which 61.3% were women. Most hearing loss was fluctuating (48.4%). Only 16.1% of patients had systemic autoimmune disease. There is a moderate positive correlation between the sex variable and the systemic involvement variable (Spearman's correlation coefficient = 0.356): specifically, between being female and systemic disease. The relative incidence rate of relapse in the first year was 2.01 relapses/year with a 95% CI (1.32 to 2.92). The mean survival time of the event (audiometric relapse) was 5.25 months (SD 0.756). With multivariate analysis, the only variable that achieved statistical significance was age, with a hazard ratio of 1.032 (95% CI; 1.001-1.063, P = .043).

Conclusions

Immune-mediated disease of the inner ear is a chronic disease with relapses. Half of the patients with immunomediated hearing loss treated exclusively with corticosteroids relapse before 6 months of follow-up. In addition, if a patient has not relapsed, they are more likely to relapse as each year passes. Analysis of the of audiometric relapse- free survival will enable the effect of future treatments to be compared and their capacity to reduce the rhythm of relapses.

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Recomendaciones sobre el uso de la neuromonitorización en cirugía de tiroides y paratiroides

Publication date: July–August 2018

Source: Acta Otorrinolaringológica Española, Volume 69, Issue 4

Author(s): José Luis Pardal-Refoyo, Pablo Parente-Arias, Marta María Arroyo-Domingo, Juan Manuel Maza-Solano, José Granell-Navarro, Jesús María Martínez-Salazar, Ramón Moreno-Luna, Elvylins Vargas-Yglesias

Resumen

Introducción

La cirugía de tiroides y paratiroides (CTPT) se asocia a riesgo de lesión del nervio laríngeo recurrente, nervio laríngeo superior y cambios en la voz. La neuromonitorización intraoperatoria (NMIO), intermitente o continua, en CTPT evalúa el estado funcional de los nervios laríngeos y se utiliza progresivamente con más frecuencia. Esto obliga a adoptar puntos de acuerdo en los aspectos más controvertidos.

Objetivo

Elaborar un documento de ayuda para orientar en la utilización de la NMIO en CTPT.

Método

Consenso en grupo de trabajo mediante revisión sistemática y método Delphi.

Resultados

Se identificaron 7 secciones sobre las que se establecieron puntos de acuerdo: indicaciones, equipo, técnica (parámetros de programación y registro), conducta en pérdida de señal, laringoscopia, voz e implicaciones legales.

Conclusiones

La NMIO ayuda en la localización e identificación del nervio laríngeo recurrente, ayuda durante su disección, informa sobre su estado funcional al finalizar la cirugía y permite tomar decisiones en caso de pérdida de señal en el primer lado operado en una tiroidectomía bilateral programada o si había parálisis contralateral previa. La precisión de la NMIO depende de variables como la técnica realizada, la tecnología utilizada y la formación para la correcta ejecución de la técnica e interpretación de la señal. El documento presentado es un punto de inicio para futuros acuerdos en CTPT en cada una de las secciones de consenso.

Abstract

Introduction

Thyroid and parathyroid surgery (TPTS) is associated with risk of injury to the recurrent laryngeal nerve, superior laryngeal nerve and voice changes. Intraoperative neuromonitoring (IONM), intermittent or continuous, evaluates the functional state of the laryngeal nerves and is being increasingly used. This means that points of consensus on the most controversial aspects are necessary.

Objective

To develop a support document for guidance on the use of IONM in TPTS.

Method

Work group consensus through systematic review and the Delphi method.

Results

Seven sections were identified on which points of consensus were identified: indications, equipment, technique (programming and registration parameters), behaviour on loss of signal, laryngoscopy, voice and legal implications.

Conclusions

IONM helps in the location and identification of the recurrent laryngeal nerve, helps during its dissection, reports on its functional status at the end of surgery and enables decision-making in the event of loss of signal in the first operated side in a scheduled bilateral thyroidectomy or previous contralateral paralysis. The accuracy of IONM depends on variables such as accomplished technique, technology and training in the correct execution of the technique and interpretation of the signal. This document is a starting point for future agreements on TPTS in each of the sections of consensus.

https://ift.tt/2zdIFP1

Evaluación de la capacidad formativa del libro del residente de Otorrinolaringología español (FORMIR) como portafolio electrónico

Publication date: July–August 2018

Source: Acta Otorrinolaringológica Española, Volume 69, Issue 4

Author(s): Juan Manuel Maza Solano, Gustavo Benavente Bermudo, Francisco José Estrada Molina, Jesús Ambrosiani Fernández, Serafín Sánchez Gómez

Resumen

Introducción y objetivos

Evaluar la capacidad formativa del libro del residente español como portafolio electrónico para alcanzar los objetivos de aprendizaje de los MIR de Otorrinolaringología (ORL).

Métodos

Se realizó una investigación cualitativa multimétodo de características tranversal, temporal y de orientación retrospectiva sobre los MIR de ORL mediante un cuestionario estructurado y una entrevista semiestructurada, sobre la aplicación informática web FORMIR.

Resultados

Participaron el 56,5% de los MIR de ORL de alguno de los 63 hospitales españoles acreditados para impartir formación en ORL entre 2009 y 2012. Los resultados obtenidos demostraron que los MIR de ORL que utilizaban el portafolio electrónico eran capaces de autoguiar mejor su aprendizaje, conocían mejor sus objetivos de aprendizaje, cumplían más eficientemente el programa de formación, identificaban más claramente las causas de sus carencias en el aprendizaje y consideraban que FORMIR como portafolio electrónico constituía una herramienta formativa idónea para sustituir al libro del residente en formato papel.

Conclusiones

Los MIR de ORL apreciaban de forma muy relevante las prestaciones formativas de FORMIR como portafolio electrónico, especialmente su interfaz, el feedback numérico y automático sobre la adquisición de competencias, su capacidad de almacenamiento de evidencias y su capacidad de visualizarse como logbook de la Unión Europea de Médicos Especialistas o como un curriculum vitae estándar. Este feedback automático facilita el aprendizaje autoguiado. Todo esto hace de FORMIR una herramienta formativa y evaluativa que supera las prestaciones y aceptación de instrumentos similares puestos a disposición de los residentes, que no dudan en proponerlo como el libro del residente más idóneo para facilitar su formación especializada.

Abstract

Background

and objectives We have evaluated the training capacity of the Spanish resident training book as an electronic portfolio to achieve the learning objectives of otorhinolaryngology (ENT) residents.

Methods

A multi-method qualitative investigation with transversal characteristics, temporal and retrospective guidance was performed on Spanish ENT residents using a structured questionnaire, a semi-structured interview, and a computer application on the FORMIR website.

Results

A 56.5% of ENT-residents specialising in one of the 63 accredited Spanish hospitals between 2009-2012 participated in the study. The results obtained show that the ENT residents who used the e-portfolio were better able to implement self-guided study, were more aware of their learning objectives, fulfilled the training programme more efficiently, identified the causes of learning gaps more clearly, and considered FORMIR in e-portfolio format to be an ideal training tool to replace the resident training book in paper format.

Conclusions

The ENT residents greatly appreciated the training benefits of FORMIR as an e-portfolio, especially its simple and intuitive interface, the ease and comfort with which they could record their activities, the automatic and numeric feedback on the acquisition of their competencies (which facilitates self-guided learning), its storage capacity for evidence, and its ability to be used as UEMS logbook as well as a standard curriculum vitae. All these features make FORMIR a training and evaluation tool that outperforms similar instruments available to ENT residents. They do not hesitate to identify it as the ideal resident training book for facilitating their specialised training.

https://ift.tt/2MRaqPv

Recidiva de carcinoma nasosinusal relacionado con el virus del papiloma humano con características similares al adenoide quístico

Publication date: Available online 22 June 2018

Source: Acta Otorrinolaringológica Española

Author(s): Andrés Felipe Sáenz González, Eduardo Morera Serna, Adriana Marcela Quintero Duarte, Rafael Ramos Asensio

https://ift.tt/2MOrENq

Manejo del absceso de la glándula tiroides

Publication date: Available online 9 June 2018

Source: Acta Otorrinolaringológica Española

Author(s): Javier García Callejo, Jaume Redondo Martínez, Miguel Civera, José Verdú Colomina, Verónica Pellicer Zoghbi, M. Paz Martínez Beneyto

Resumen

Introducción

La enfermedad supurativa de la glándula tiroides-absceso de tiroides o tiroiditis supurativa aguda– supone una infrecuente situación clínica. Presentamos nuestra experiencia en los casos asistidos durante 41 años.

Materiales y métodos

Estudio longitudinal retrospectivo anotando características epidemiológicas, conducta diagnóstico-terapéutica y resultado clínico, detectando 14 casos –9 varones y 5 mujeres, entre 19 y 68 años, con una media de edad de 40,6 ± 15,4 años– con 22 episodios. En 2 pacientes la condición se había reproducido hasta en 4 ocasiones.

Resultados

Supusieron el 0,29% de todos los abscesos cervicales atendidos. La punción-aspiración fue efectuada en 13 de ellos para su tratamiento e identificación del agente causal. Los agentes más habitualmente implicados fueron Mycobacterium tuberculosis y Staphylococcus aureus. Se realizó un estudio de imagen mediante ecografía en 9 casos y de tomografía computarizada en 7. En 10 pacientes el tratamiento definitivo fue quirúrgico, efectuándose drenaje del absceso en 7 de ellos, tiroidectomía total en 4 y hemitiroidectomía en 2. Otros tratamientos admitidos fueron la antibioterapia sistémica o mediante irrigación intralesional y la esclerosis. Aunque en un caso la fase aguda comenzó con hipertiroidismo y tirotoxicosis, a los 6 meses del alta existió hipotiroidismo definitivo en 5 casos. Las opciones terapéuticas adoptadas consiguieron la curación en el 100% de los casos.

Conclusión

La supuración de la glándula tiroidea es una circunstancia extremadamente rara en el contexto de la enfermedad cervical, variando las opciones terapéuticas desde alternativas conservadoras al drenaje con tiroidectomía según los hallazgos microbiológicos y radiológicos.

Abstract

Background

Thyroid abscess or acute suppurative thyroiditis is an unusual clinical condition. We present our experience with cases attended over 41 years.

Materials and methods

A retrospective study was performed on these patients reviewing their epidemiological characteristics and the diagnostic and therapeutic manoeuvres chosen for them all, as well as their clinical outcome. A group of 9 males and 5 females was studied, with ages ranging from 19 to 68 (mean of 40.6 ± 15.4). These patients suffered 22 acute episodes, and 2 patients each had 4 episodes.

Results

Suppurative thyroiditis comprised 0.29% of the neck abscesses. Fine needle aspiration was performed in 13 cases to evacuate the collection and isolate the aetiological agent. Mycobacterium tuberculosis and Staphylococcus aureus were the most frequently identified. Nine patients underwent ultrasound and 7 computed tomography imaging studies. Surgery was the option for 10 patients, including drainage for 7, thyroidectomy for 4 and hemithyroidectomy for the remaining 2. Systemic or intralesional antibiotics and sclerosis of the gland were also carried out. Although one case presented with hyperthyroidism and thyrotoxicosis in the acute phase, definitive hypothyroidism was observed in 5 patients at 6 months following discharge. The rate of success was 100%.

Conclusion

Thyroid gland suppuration is a very infrequent circumstance in neck pathology, and the options for its treatment are varied, from conservative to invasive techniques according to the microbial and radiologic findings.

https://ift.tt/2u73d5W

Miringoplastia con injerto doble medial y lateral

Publication date: Available online 7 June 2018

Source: Acta Otorrinolaringológica Española

Author(s): Francisco Javier Olarieta Soto, Francisco Antolí-Candela Cano, Alejandro Harguindey Antolí-Candela

Resumen

Objetivos

Se describe la técnica quirúrgica del injerto doble medial y lateral de fascia autóloga, sus indicaciones y resultados.

Material y método

Se estudian las características preoperatorias y al año de la intervención de 100 casos intervenidos de miringoplastia con la técnica de injerto doble medial y lateral de fascia autóloga. Se analizan los resultados anatómicos y funcionales.

Resultados

Los resultados se valoran al año de la intervención. En el 95% de los casos conseguimos el cierre de la perforación. La incidencia de persistencia de las perforaciones es del 12,5% en los niños menores de 10 años y del 2,5% en niños mayores de 10 años y adultos. Las complicaciones son un 4% de perlas epiteliales con engrosamiento del neotímpano, un 1% de retracciones del neotímpano y un 3% de epitelitis que se resuelven con tratamiento médico tópico. La recuperación auditiva es del 85% de cierres del UDA medio a menos de 20 dB (el 38% a menos de 10 dB y el 47% entre 10 y 20 dB). Se analizan las posibles causas del cierre incompleto del UDA, posiblemente relacionados con fibrosis y esclerosis de los restos timpánicos y/o la cadena osicular.

Conclusiones

Se concluye que esta metodología nos proporciona los mejores resultados en comparación con otras que hemos utilizado y hemos relegado a situaciones muy específicas atendiendo al tamaño y localización de la perforación.

Abstract

Objectives

A surgical technique for a double medial and lateral overlay autologous fascia graft myringoplasty is described in this paper along with its indications and results.

Material and method

The presurgical and one year post surgery characteristics are analyzed for 100 cases with the double medial and lateral overlay autologous fascia graft technique. The anatomical and functional results are analyzed.

Results

The results are analyzed one year post surgery. The probabilities of obtaining a graft take using this methodology are 95%. The incidence of persistence of the perforations is 12.5% in children under 10 and 2.5% in children over ten years of age and adults. The complications are 4% of epithelial pearls with blunting of the neo-tympanum, 1% of retractions and 3% of epithelitis which is resolved with a topical medical treatment. The average residual air/bone gap is less than 20 dB in 85% of the cases. Less than 10 dB in 38%, and between 10 and 20 dB in 47%. The causes for incomplete closure of the gap are analyzed; possibly related to fibrosis and sclerosis of the tympanic remnants and/or the ossicular chain.

Conclusions

It is concluded that this methodology provides the best results in comparison with other methods we have used and have set aside for very specific situations related to the size and location of the perforation.

https://ift.tt/2tYSACZ

Manejo de los carcinomas diferenciados de tiroides

Publication date: Available online 5 June 2018

Source: Acta Otorrinolaringológica Española

Author(s): Laura Fernández-Vañes, José Luis Llorente, Patricia García-Cabo, Marta Menéndez, Daniel Pedregal, Juan Pablo Rodrigo, Fernando López

Resumen

Introducción y objetivos

El tratamiento principal de los carcinomas diferenciados de tiroides es la cirugía seguida de radioyodo. El propósito de este estudio es exponer nuestra experiencia en el manejo de estos tumores.

Material y método

Se presenta un estudio retrospectivo de los 55 pacientes intervenidos quirúrgicamente de un carcinoma diferenciado de tiroides en nuestro hospital entre los años 2007 y 2011.

Resultados

La edad media al diagnóstico fue de 49 años, con un predominio femenino (78% de los casos). El 78% de los pacientes se encontraban en fases iniciales (estadios i y ii). El diagnóstico histopatológico definitivo fue de carcinoma papilar en el 84% y folicular en el 16% restante. A todos, salvo a 2 pacientes (4%), se les realizó una tiroidectomía total, acompañada de linfadenectomía en el 58% de los casos. Un 9% de los pacientes presentó hipoparatiroidismo permanente y aunque un 18% sufrió parálisis recurrencial unilateral transitoria, un 40% de ellos se recuperó completamente a los 6 meses. Se administró radioyodo en el postoperatorio al 89% de los pacientes. Se produjo un 40% de recidivas, la mayor parte de las cuales (29% de los pacientes) se localizaron a nivel cervical. La supervivencia a los 5 años fue del 87%, siendo del 95% en el subtipo papilar y descendiendo al 56% en el folicular (p = 0,001).

Discusión/conclusiones

Los carcinomas diferenciados de tiroides son tumores con un pronóstico excelente tras un tratamiento quirúrgico adecuado previa valoración preoperatoria exhaustiva y seguimiento postoperatorio estricto debido a las tasas significativas de recidiva.

Abstract

Introduction and objectives

Radioiodine is the principal treatment for differentiated thyroid carcinomas. The aim of this study is to present our experience in the management of these tumours.

Material and method

We present a retrospective study of 55 patients operated for differentiated thyroid carcinoma in our hospital between 2007 and 2011.

Results

The mean age at time of diagnosis was 49 years, and females predominated (78% of cases). Seventy eight percent of the patients were in the initial stages (stages i and ii). The definitive histopathological diagnosis was papillary carcinoma in 84% and follicular carcinoma in the remaining 16%. All of the patients, with the exception of 2 (4%), underwent total thyroidectomy, with lymphadenectomy in 58% of cases. Nine percent of the patients had permanent hypoparathyroidism and although 18% suffered transitory unilateral paralysis, 40% of these female patients had completely recovered after 6 months. Eighty-nine percent of the patients were given radioiodine postoperatively. There was a recurrence rate of 40% most of which was at cervical level (29% of the patients). Survival at 5 years was 87%, 95% of the papillary subtype, falling to 56% of the follicular subtype (P = .001).

Discussion/conclusions

The prognosis for differentiated thyroid carcinomas is excellent after appropriate surgical treatment, thorough preoperative assessment,and strict postoperative follow-up due to the significant recurrence rates.

https://ift.tt/2zcSVH5

La audición en la enfermedad ósea de Paget

Publication date: Available online 5 June 2018

Source: Acta Otorrinolaringológica Española

Author(s): Emilio Amilibia Cabeza, Susana Holgado Pérez, Marta Pérez Grau, Carme Moragues Pastor, Francesc Roca-Ribas Serdà, Miquel Quer Agustí

Resumen

Introducción y objetivos

La enfermedad ósea de Paget (EOP) puede cursar con hipoacusia. Con el objetivo de cuantificar, caracterizar y determinar los factores de riesgo de hipoacusia en un grupo de pacientes con EOP se realiza el presente estudio.

Métodos

Se realizó un estudio observacional, transversal del tipo casos y controles que incluyó una cohorte de 76 sujetos con diagnóstico de EOP en el grupo caso y un grupo control de 134 sujetos. Se analiza la información clínica, demográfica y audiométrica de los sujetos incluidos.

Resultados

El análisis comparativo entre el grupo de sujetos con EOP y el grupo control determinó que el grupo caso presentaba un umbral medio auditivo mayor (39,51 dB) que el grupo control (37,28 dB) (p = 0,069) y que presentaba hipoacusia transmisiva con mayor frecuencia (22,76%) que el grupo control (12,05%) (p = 0,0062). El análisis de los factores de riesgo de hipoacusia determinó que la afectación craneal en la gammagrafía ósea, la edad y la HTA, entre otros, constituían factores de riesgo de mayor pérdida auditiva en la EOP.

Conclusiones

Los sujetos con EOP presentaron una pérdida auditiva más severa y con mayor frecuencia de tipo transmisivo que el grupo control. Los sujetos con afectación de la calota craneal por EOP presentaron mayor pérdida auditiva que los sujetos sin afectación craneal. La afectación de la calota craneal por la EOP y la edad constituyeron factores de riesgo de hipoacusia.

Abstract

Introduction and objectives

Paget's disease of bone (PDB) may lead to hearing loss. The present study was conducted with the aim of measuring, characterizing and determining the risk factors for hearing loss in a group of subjects with PDB.

Methods

An observational, transversal, case-control study was conducted, a cohort of 76 subjects diagnosed with PDB in the case group and a control group of 134 subjects were included. Clinical, demographic and audiometric data were analysed.

Results

The comparative analysis between the subjects in the PDB group and the control group found that the case group showed higher hearing thresholds (39,51 dB) compared with the control group (37.28 dB) (P=.069) and presented a greater rate of conductive hearing loss (22.76%) than the control group (12.05%) (P=.0062). The study of risk factors for hearing loss found that skull involvement in bone scintigraphy, age and high blood pressure were risk factors for higher impairment in PDB.

Conclusions

The subjects with PDB showed more profound and a higher proportion of conductive hearing loss than the control group. The patients with PDB and skull involvement presented a more severe hearing loss compared with the subjects without skull involvement. Skull involvement and age were found to be risk factors for hearing loss.

https://ift.tt/2NrSqMB

Dehiscencia de la lámina papirácea del etmoides

Publication date: Available online 30 May 2018

Source: Acta Otorrinolaringológica Española

Author(s): Gabriel Huguet Llull, Marta Mesalles Ruiz, Xavier González Compta

https://ift.tt/2zcSNHB

Investigation on the relationship of dimensions of the maxillary sinus drainage system with the presence of sinusopathies: a cone beam computed tomography study

Publication date: October 2018

Source: Archives of Oral Biology, Volume 94

Author(s): Ana Beatriz Gomes de Carvalho, Andre Luiz Ferreira Costa, Acácio Fuziy, Afonso Celso Souza de Assis, José Ribamar Castro Veloso, Luiz Roberto Coutinho Manhães, Mauro Pedrine Santamaria, Sérgio Lucio Pereira de Castro Lopes

Abstract

Objective

This study sought to assess the relationship between the dimensions of the maxillary sinus drainage system with the content of sinuses.

Design

Three-hundred cone beam computed tomography images were selected from a database (105 males and 195 females). The images were assessed by a single investigator, trained and calibrated, performing image analysis. The length of the infundibulum and the ostium height in both maxillary sinuses were measured. The data were analyzed using Minitab 1, using 5% as a critical p-value.

Results

A significant gender difference was also found for presence in the normal content of sinus for females and presence of antral pseudocyst for males (p < 0.05). Subjects with normal content in the maxillary sinus present lower ostium height values. There were statistically significant with presence of and higher ostium height values and antral pseudocyst (p < 0.01).

Conclusion

The current study results demonstrated that some sinusopathies were significantly related to dimensions of maxillary sinus drainage.

https://ift.tt/2IWEbvX

Effects of far infrared radiation by isotropic high-density carbon on the human oral mucosa

Publication date: October 2018

Source: Archives of Oral Biology, Volume 94

Author(s): Isao Kimura, Toshiro Yamamoto, Koya Nakamura, Toshihiro Uenishi, Taku Asai, Masakazu Kita, Narisato Kanamura

Abstract

Objectives

Wound healing of the oral mucosal epithelium through the application of far infrared radiation emitted by isotropic high-density carbon was investigated in order to clarify the preventive and therapeutic effects of isotropic high-density carbon on oral mucosal injury.

Materials and methods

A carbon massager with an isotropic high-density carbon tip was used. Far infrared radiation was applied to the human buccal mucosal squamous cell carcinoma cell line, HO-1-N-1 using a carbon massager, and cell growth factors and heat shock protein levels were measured using real-time RT-PCR and ELISA. Far infrared radiation was applied to oral mucosal injury in SD rats over time using the carbon massager, and its effects were examined by HE staining and immunostaining. The immunostaining positive rate was measured and analyzed using image analysis software.

Results

Far infrared radiation induced stronger mRNA expression and higher HSP27 and HSP70 protein levels on real-time RT-PCR and ELISA than in the control group. The far infrared radiation of oral mucosal injury in rats induced strong positive reactions, and positive rates for Ki67, HSP27, and HSP70 were higher than those in the control group.

Conclusions

The treatment of oral mucosal injury with far infrared radiation emitted by isotropic high-density carbon appears to have promoted heat shock protein production and induced regenerative reactions more strongly than in the control group.

https://ift.tt/2KJmOmZ

The in vitro effects of CCN2 on odontoblast-like cells

Publication date: October 2018

Source: Archives of Oral Biology, Volume 94

Author(s): Youjing Qiu, Jia Tang, Takashi Saito

Abstract

Objective

To investigate the in vitro effects of CCN2 on odontoblast-like cells proliferation and differentiation.

Design

MDPC-23 cells were cultured in DMEM supplemented with 5% FBS. CCN2 was either added to culture media or coated onto culture polystyrene, addition or coating of dH2O was served as control. In the addition group, CCN2 (100 ng/mL) was added into culture media. In the coating group, CCN2 at the concentration of 1000 ng/mL was employed. Cell proliferation was performed using CCK-8 assay. Cell differentiation and mineralization were analyzed by ALPase activity assay, real time RT-PCR and alizarin red staining. One-way ANOVA with post-hoc tukey HSD test was used for statistical analysis.

Results

MDPC-23 cells exhibited robust proliferative activity upon exposure to either soluble or immobilized CCN2. ALP activity of cells cultured on CCN2-modified surface was continuously strengthened from day six (0.831 ± 0.024 units/μg protein versus 0.563 ± 0.006 units/μg protein of control) till day eight (1.035 ± 0.139 units/μg protein versus 0.704 ± 0.061 units/μg protein of control). Gene expression of BSP, OCN and OPN were promoted by soluble CCN2 after 48 h exposure. Moreover, gene expression of BSP, OCN, OPN, ALP, COL1 A1, Runx-2, DSPP and DMP-1 was significantly enhanced by immobilized CCN2. Finally, mineralization of MDPC-23 cells was accelerated by both soluble and immobilized CCN2 to different extent.

Conclusions

The findings indicate that CCN2 promoted proliferation, odontogenic gene expression and mineralization of MDPC-23 cells. It is proposed that CCN2 may be a promising adjunctive formula for dentin regeneration.

https://ift.tt/2IWMJCF

Effects of anterior tooth crown inclination on occlusal relationship—A study in three-dimensional reconstruction

Publication date: October 2018

Source: Archives of Oral Biology, Volume 94

Author(s): Feng Feng, Yifan Liu, Jingwen Chi, Yuqiao Wang, Bin Xing, Yucheng Wang, Wen Liu

Abstract

Objective

This study aims to analyze the relationship between the central incisor crown inclination and occlusal relationship via three-dimensional study.

Methods

Ten Chinese volunteers with normal occlusion were selected from physical examination of college students. Lateral cephalograms and CT scans were taken, and the CT data were imported into Simplant pro 11.04 to reconstruct three-dimensional model. In the three-dimensional model, every tooth was separated independently. The upper and lower central incisors were moved labial inclination(up) or lingual inclination(down) and then the upper and lower tooth were aligned based on the central incisor's position according to the principles of Andrew's six keys. Four groups were set up with different changes of central incisors. The upper and the lower arch were aligned again based on the moved central incisors. After every motion, the mesio-distal distances of upper and lower canines and first molars were recorded. All data were analyzed using t-test via SPSS19.0, and the significance level was set at 5%.

Results

The results showed that the mesio-distal distances of occlusal relationship were different from normal occlusal relations, when either upper incisor crown inclination or lower incisor crown inclination was changed, and both upper and lower incisor crown inclination were moved in same or opposite direction. According to the statistical analysis, there was no significant difference when the changes of U1-L1 were no more than 10° (P > 0.05). But there was statistically significant difference (P < 0.05) when changes of U1-L1 were more than 20°.

Conclusions

The incisor crown inclination has influence on the establishment of occlusal relationships. The bigger difference upper and lower incisor crown inclination has, the more deviations from the normal occlusal relationship exist.

https://ift.tt/2KJmGUx

The impact of dietary consistency on structural craniofacial components: Temporomandibular joint/condyle, condylar cartilage, alveolar bone and periodontal ligament. A systematic review and meta-analysis in experimental in vivo research

Publication date: October 2018

Source: Archives of Oral Biology, Volume 94

Author(s): Rolf Scheidegger, Despina Koletsi, Theodore Eliades

Abstract

Objective

The aim of this systematic review was to provide a comprehensive synthesis of available evidence evaluating the effect of dietary loading on temporomandibular joint/condyle, condylar cartilage, alveolar bone of the mandible and the periodontal ligament in healthy mice and rats.

Design

Medline via PubMed, EMBASE and Open Grey databases were searched for published and unpublished literature. Search terms included "mandiblular condyle", "alveolar bone", "temporomandibular joint", "condylar cartilage", "periodontal ligament", "rat", "mice". After data extraction, risk of bias (SYRCLE) and reporting quality (ARRIVE) were assessed. Random effects meta-analyses were performed for the outcomes of interest where applicable.

Results

A total of 33 relevant articles were considered in the systematic review, while only 6 studies were included in the quantitative synthesis. Risk of Bias in all studies was judged to be unclear to high overall, while reporting quality was suboptimal. Comparing soft to hard diet animals, significantly reduced anteroposterior condylar length (4 studies, weighted mean difference: −0.40 mm; 95% CI: −0.47, −0.32; p < 0.001) and width (4 studies, weighted mean difference: −0.043 mm; 95% CI: −0.51, −0.36; p < 0.001) were found in rats. Decreased anteroposterior condylar dimensions were detected for mice as well (2 studies, weighted mean difference: −0.049; 95% CI: −0.56, −0.43; p < 0.001).

Conclusions

Overall, there was strong evidence to suggest a significant effect of soft diet on reduced condylar dimensions in rodents; however, there is need for further high quality experimental studies to inform current knowledge on condylar cartilage, alveolar bone and periodontal ligament related outcomes.

https://ift.tt/2KUiRsr