Helicobacter pylori infection alters gastric and tongue coating microbial communities

Abstract

Objective

Infection with Helicobacter pylori (H pylori), especially cytotoxin‐associated gene A‐positive (CagA+) strains, has been associated with various gastrointestinal and extragastric diseases. The aim of this study was to characterize H pylori‐induced alterations in the gastric and tongue coating microbiota and evaluate their potential impacts on human health.

Design

The gastric mucosa and tongue coating specimens were collected from 80 patients with chronic gastritis, and microbiota profiles were generated by 16S rRNA gene sequencing. Samples were grouped as H pylori negative (n = 32), CagA‐negative H pylori infection (n = 13), and CagA‐positive H pylori infection (n=35). The comparison of bacterial relative abundance was made using a generalized linear model. Functional profiling of microbial communities was predicted with PICRUSt and BugBase. Microbial correlation networks were produced by utilizing SparCC method.

Results

Significant alterations of the gastric microbiota were found in the H pylori+/CagA+ samples, represented by a decrease in bacterial diversity, a reduced abundance of Roseburia, and increased abundances of Helicobacter and Haemophilus genera. At the community level, functions involved in biofilm forming, mobile element content, and facultative anaerobiosis were significantly decreased in gastric microbiome of the H pylori+ subjects. The presence of CagA gene was linked to an increased proportion of Gram‐negative bacteria in the stomach, thereby contributing to an upregulation of lipopolysaccharide (LPS) biosynthesis. The number of bacterial interactions was greatly reduced in networks of both tongue coating and gastric microbiota of the H pylori+/CagA+ subject, and the cooperative bacterial interactions dominated the tongue coating microbiome.

Conclusions

Infection with H pylori strains possessing CagA may increase the risk of various diseases, by upregulating LPS biosynthesis in the stomach and weakening the defense of oral microbiota against microorganisms with pathogenic potential.

http://bit.ly/2GeFpWh

Computer Algorithms in Assessment of Obstructive Sleep Apnoea Syndrome and Its Application in Estimating Prevalence of Sleep Related Disorders in Population

Abstract

The incorporation of telemedicine and artificial intelligence for early screening and assessment of severity of life-style disorders has a great potential for better assessment in a busy outpatient clinic and thereby curtail down the related morbidities. A computer based algorithm based upon standardized questionnaire (from established assessment tools) is designed to assess the risk of obstructive sleep apnoea syndrome (OSAS). In addition the incorporation of basic screening questions of anamnesis help in suggesting a probable diagnosis of sleep related disorder as well. The overall data at our center has been analyzed to establish the existing pattern of sleep related disorders. Of 850 healthy subjects screened, prevalence of snoring was 20.47% while OSAS was seen in 4.20% (N = 25) in males and 2.64% (N = 8) in females. The parasomnia was most prevalent (14.71%), followed by insomnia (10.24%), periodic leg movement (6.59%), bruxism (1.65%) and narcolepsy (0.59%). Hypertension, laryngopharyngeal reflux and obesity were the common co-morbidities in OSAS while family history of hypertension and diabetes were common in snorers. A significant association with OSA was seen with diabetes mellitus, neck circumference and nasal obstruction, while, obesity and apnoeic episodes were more significantly associated with OSA than snorers. Increased waist to hip ratio was appreciated in both the OSAS and snorers. The algorithm based online assessment is likely to diagnose the occult clinical cases as well as assess the risk of OSAS. In routine outpatient clinic, a clinician may better assess the patient morbidity with a comprehensive availability of symptoms and moreover enhance the post-treatment compliance. In addition a smartphone based computerized assessment for general population may be designed for other lifestyle disorders as well.

http://bit.ly/2Diq1UP

Papillary Thyroid Carcinoma with Cervical Lymph Node Metastasis Arising from Lingual Thyroid

Abstract

Although lingual thyroid is the most common site for ectopic thyroid gland but carcinomas originating from lingual thyroid are extremely rare, accounting only for 1% of all ectopic thyroids. Here we represent a young female with a bleeding mass at the base of her tongue and review the diagnostic approach towards papillary thyroid carcinoma of lingual thyroid. The surgical treatment and follow up are discussed. A combination of radiological studies and histological evaluation should be deployed to investigate suspicious lingual thyroids. The perspective of diagnostic and therapeutic approaches for carcinomas of lingual thyroid is the same as orthotopic thyroid tissue.

http://bit.ly/2SfYfmv

Clinicopathological and Radiological Study of Thyroid Swelling

Abstract

Thyroid swelling is the most common swelling among the endocrine disorder. It can affect any age group. USG neck will help to diagnose the solid and cystic lesions. The treatment is surgical excision. FNAC is a good diagnostic tool to minimize the incidence of thyroidectomy. FNAC is cost effective, reliable and OPD procedure. Final diagnosis can only be made by HPE postoperatively. The aim of this study is to find out the relative occurrence of various pathological conditions presenting as midline thyroid swellings and clinicopathological and radiological examination of the thyroid swellings. A one and half year prospective study which was carried out from October 2016 to April 2018 in ENT department of MMIMSR, Mullana, Ambala. Informed written consent was taken from all the patients. A complete clinical, radiological, cytological an HP Examination was done. Total 50 patients were included in the study. Complete clinical data of the patient was gathered from medical records. The maximum number of patients in present study was found in an age group of 31–40 years (34%). There was female predominance with female to male ratio of 7.3:1. Most of the patients belonged to rural background i.e. 42 (84%) patients. Most of the patients present with Left sided neck swelling i.e. 18 (36%) patients. Ultrasound revealed that non neoplastic lesions were present in 44 (88%) patients and 6 (12%) patients had neoplastic lesions. FNAC showed that non neoplastic lesions were present in 38 (76%) patients and 12 (24%) patients had neoplastic lesions. On HPE, non neoplastic and neoplastic lesions were present in 36 (72%) and 14 (28%) patients respectively. Colloid goiter was the most common among the non neoplastic lesions in 29 (58%) patients. Papillary carcinoma was the most common malignant disease in 4 (8%) patients. Thyroid swelling was most commonly seen during the 3rd and 4th decade of life, with a female preponderance. Most common benign thyroid swelling is Colloid goiter and papillary carcinoma was the most common malignant disease. Histopathology is considered as a gold standard.

http://bit.ly/2Dka7tj

Transcervical excision of a giant mediastinal parathyroid adenoma

http://bit.ly/2SyZc8F

One month of nitrous oxide abuse causing acute vitamin B 12 deficiency with severe neuropsychiatric symptoms

A 21-year-old university student studying abroad in the USA presented to the emergency department with double vision, lower extremity weakness with difficulty ambulating and other neuropsychiatric symptoms. MRI of the brain and spinal cord were normal. Vitamin B₁₂ was 78 pg/mL (58 pmol/L, reference 211–911 pg/mL). The patient had been using nitrous oxide capsules used for whipped cream recharging, which she obtained from other students, a few times daily for a month for the purpose of anxiety relief. The patient was not a vegan or vegetarian. The patient was treated with intramuscular vitamin B₁₂ repletion with partial resolution of neurologic symptoms and discharged on vitamin B₁₂ supplementation.

http://bit.ly/2SyZ9tv

Review and Classification Update: Unilateral condylar hyperplasia

Unilateral condylar hyperplasia is characterised by slow progressive growth of the different parts of mandible, the aetiology of which is still unclear. It is a self-limiting condition mostly seen between the age of 11–30 years causing facial asymmetry and its progression ceases after a certain time. In literature until now very few cases have been reported and every case that is being reported adds to its features or the aetiology. Previously, it has been classified into two types that is, hemimandibular hyperplasia and hemimandibular elongation. Here, we report a similar case with a few features distinct from those reported earlier.

http://bit.ly/2SED5gU

Paraduodenal inflammatory pseudotumor masquerading as malignancy

A 30-year-old woman presented with severe abdominal pain and abdominal distension. CT demonstrated two intra-abdominal masses, one involving the left lateral segment of the liver and the other adjacent to the duodenum. Initial biopsies were consistent with focal nodular hyperplasia of the liver and non-specific lymphocytic infiltrate in the paraduodenal mass. Due to persistent symptoms, the patient underwent laparoscopic resection of the paraduodenal mass. Final pathology was consistent with an inflammatory pseudotumour and the patient's symptoms subsequently resolved.

http://bit.ly/2MTUSLU

Prolonged neonatal hyperbilirubinaemia in a case of congenital hypopituitarism

http://bit.ly/2MZ4dCk

Lipoma arborescens: a rare cause of clicking in the knee

Lipoma arborescens (LA) is a rare condition with synovial membrane lipomatous proliferation. It most commonly affects the knee joint, in the suprapatellar pouch. It can present as a painful knee with an effusion. Diagnosis is via MRI demonstrating a synovial mass with frond-like appearance, and histology showing mature adipose cells, with an overlying synovial membrane. Treatment options include non-operative measures with analgesia, or operative intervention to resect the lesion. We describe a unique case of LA present in the anterolateral knee joint, presenting with persistent painful clicking in the knee. The patient underwent an open total resection of the lesion, with resolution of symptoms.

http://bit.ly/2MVLKGz

Endocarditis following IUD insertion in a patient with tetralogy of Fallot

The role of antibiotic prophylaxis for prevention of infective endocarditis is unknown. Endocarditis prophylaxis is recommended for certain high-risk individuals prior to dental procedures. To our knowledge, this is the first case reported in the literature of a patient with complex congenital heart disease developing endocarditis in the period immediately following otherwise uncomplicated intrauterine device insertion.

http://bit.ly/2SyZ6hj

Orbital floor fracture with periorbital haematoma

http://bit.ly/2MTMVX6

More than meets the eye

We report an extremely rare case of a hybrid tumour of the maxillary sinus. A 51-year-old man presented with a 6-week history of nasal congestion and epiphora. Radiological imaging demonstrated a maxillary sinus tumour, with extensive local invasion. Surgical excision included maxillectomy, left eye exenteration and free flap closure. Histology of the excised specimen showed a rare hybrid tumour containing adenoid cystic carcinoma, salivary duct carcinoma, epithelial-myoepithelial carcinoma and basal cell adenoma. Hybrid tumours are very rare tumour entities which are composed of at least two distinct tumour types. Each tumour entity conforms with a defined tumour type. The tumour entities of a hybrid tumour are not separated but have an identical origin within a definite topographical area. Diagnosis and appropriate management requires high index of suspicion, pathological endeavour to look for a more aggressive accompanying tumour and adequate oncological treatment according to the highest grade of tumour.

http://bit.ly/2MZ4dlO

Spontaneous intracranial hypotension associated with pachymeningeal enhancement in a patient with systemic lupus erythematosus (SLE): an extremely rare presenting feature

A 16-years-old girl presented to our institution with history of severe bilateral headache for 5 days associated with vomiting. She also had fever for 2 months without any localising symptoms and skin lesions for 1 month. Examination revealed erythematous rash over bridge of nose and ear lobes, ulcer over hard palate and tenderness of small joints of both hands. Systemic examination was unremarkable except for bilateral papilloedema. Investigations revealed anaemia, leucopenia and elevated erythrocyte sedimentation rate. Cranial imaging revealed diffuse pachymeningeal enhancement with subdural effusion. Lumbar puncture revealed no abnormal findings in cerebrospinal fluid except low opening pressure. Antinuclear antibody was 4+ with anti-Sm antibody positive. She was diagnosed to have spontaneous intracranial hypotension associated with pachymeningeal enhancement secondary to systemic lupus erythematosus. She showed dramatic improvement with steroid and azathioprine therapy. She continues to be asymptomatic after 2 years of follow-up.

http://bit.ly/2SyYZ5n

Complete recovery in Wernickes encephalopathy complicating hyperemesis gravidarum

Wernicke's encephalopathy (WE) is an uncommon neurological complication in pregnancies complicated with hyperemesis due to thiamine deficiency. In women with hyperemesis, inadvertent glucose administration prior to thiamine supplementation triggers the development of neurological manifestations. Delay in the diagnosis can lead to maternal morbidity, and in one-third of cases may lead to persistence of some neurological deficit. With early recognition and thiamine supplementation, complete recovery is reported. We report a case of WE complicating a case of triplet pregnancy with hyperemesis gravidarum, which highlights the importance of early recognition and treatment, resulting in complete recovery as in the index case.

http://bit.ly/2MZ4chK

Computer Algorithms in Assessment of Obstructive Sleep Apnoea Syndrome and Its Application in Estimating Prevalence of Sleep Related Disorders in Population

Abstract

The incorporation of telemedicine and artificial intelligence for early screening and assessment of severity of life-style disorders has a great potential for better assessment in a busy outpatient clinic and thereby curtail down the related morbidities. A computer based algorithm based upon standardized questionnaire (from established assessment tools) is designed to assess the risk of obstructive sleep apnoea syndrome (OSAS). In addition the incorporation of basic screening questions of anamnesis help in suggesting a probable diagnosis of sleep related disorder as well. The overall data at our center has been analyzed to establish the existing pattern of sleep related disorders. Of 850 healthy subjects screened, prevalence of snoring was 20.47% while OSAS was seen in 4.20% (N = 25) in males and 2.64% (N = 8) in females. The parasomnia was most prevalent (14.71%), followed by insomnia (10.24%), periodic leg movement (6.59%), bruxism (1.65%) and narcolepsy (0.59%). Hypertension, laryngopharyngeal reflux and obesity were the common co-morbidities in OSAS while family history of hypertension and diabetes were common in snorers. A significant association with OSA was seen with diabetes mellitus, neck circumference and nasal obstruction, while, obesity and apnoeic episodes were more significantly associated with OSA than snorers. Increased waist to hip ratio was appreciated in both the OSAS and snorers. The algorithm based online assessment is likely to diagnose the occult clinical cases as well as assess the risk of OSAS. In routine outpatient clinic, a clinician may better assess the patient morbidity with a comprehensive availability of symptoms and moreover enhance the post-treatment compliance. In addition a smartphone based computerized assessment for general population may be designed for other lifestyle disorders as well.

http://bit.ly/2Diq1UP

Papillary Thyroid Carcinoma with Cervical Lymph Node Metastasis Arising from Lingual Thyroid

Abstract

Although lingual thyroid is the most common site for ectopic thyroid gland but carcinomas originating from lingual thyroid are extremely rare, accounting only for 1% of all ectopic thyroids. Here we represent a young female with a bleeding mass at the base of her tongue and review the diagnostic approach towards papillary thyroid carcinoma of lingual thyroid. The surgical treatment and follow up are discussed. A combination of radiological studies and histological evaluation should be deployed to investigate suspicious lingual thyroids. The perspective of diagnostic and therapeutic approaches for carcinomas of lingual thyroid is the same as orthotopic thyroid tissue.

http://bit.ly/2SfYfmv

Clinicopathological and Radiological Study of Thyroid Swelling

Abstract

Thyroid swelling is the most common swelling among the endocrine disorder. It can affect any age group. USG neck will help to diagnose the solid and cystic lesions. The treatment is surgical excision. FNAC is a good diagnostic tool to minimize the incidence of thyroidectomy. FNAC is cost effective, reliable and OPD procedure. Final diagnosis can only be made by HPE postoperatively. The aim of this study is to find out the relative occurrence of various pathological conditions presenting as midline thyroid swellings and clinicopathological and radiological examination of the thyroid swellings. A one and half year prospective study which was carried out from October 2016 to April 2018 in ENT department of MMIMSR, Mullana, Ambala. Informed written consent was taken from all the patients. A complete clinical, radiological, cytological an HP Examination was done. Total 50 patients were included in the study. Complete clinical data of the patient was gathered from medical records. The maximum number of patients in present study was found in an age group of 31–40 years (34%). There was female predominance with female to male ratio of 7.3:1. Most of the patients belonged to rural background i.e. 42 (84%) patients. Most of the patients present with Left sided neck swelling i.e. 18 (36%) patients. Ultrasound revealed that non neoplastic lesions were present in 44 (88%) patients and 6 (12%) patients had neoplastic lesions. FNAC showed that non neoplastic lesions were present in 38 (76%) patients and 12 (24%) patients had neoplastic lesions. On HPE, non neoplastic and neoplastic lesions were present in 36 (72%) and 14 (28%) patients respectively. Colloid goiter was the most common among the non neoplastic lesions in 29 (58%) patients. Papillary carcinoma was the most common malignant disease in 4 (8%) patients. Thyroid swelling was most commonly seen during the 3rd and 4th decade of life, with a female preponderance. Most common benign thyroid swelling is Colloid goiter and papillary carcinoma was the most common malignant disease. Histopathology is considered as a gold standard.

http://bit.ly/2Dka7tj

Systematic review and meta-analysis on the association between phthalates exposure and insulin resistance

Abstract

This study aims to provide an overview of human studies on the association of exposure to phthalates and insulin resistance. We systematically searched human studies available until 15 January 2018.We conducted a literature search in Scopus, ISI Web of Science, PubMed, Google Scholar, and Cochrane Collaboration. We used the following keywords to identify relevant articles: "phthalate", "phthalate ester", "metabolic syndrome", "insulin resistance", "glucose intolerance", and "diabetes". For analyzing data, we conducted meta-analysis using the Stata software. We appraised each study to examine the sources of heterogeneity, including difference in clinical outcomes and exposure measurements. To determine the robustness and whether some of the factors have the highest impact on the results of the present meta-analysis, several sensitivity analyses were conducted. Sensitivity analysis showed that by removing studies with the highest weight and age groups, no change was observed in heterogeneity. Moreover, with excluding the study conducted in Europe, the results remained unchanged and constant. In addition, the funnel plot and Egger's tests were executed to access publication bias. Both the funnel plots and Egger's test did not show any evidence of publication bias (P = 0.31). In the random effects meta-analysis of all studies (n = 8), the pooled correlation coefficient between phthalate exposure and HOMA-IR was 0.10 (95% CI; 0.07–0.12, P < 0.001), with significant heterogeneity (P < 0.001, I² = 85.5%). Our findings revealed positive association between exposure to phthalate metabolites and increased HOMA-IR; this association remained significant even after adjusting the analysis for multiple confounding variables.

http://bit.ly/2SffxA5

A call for mentorship in otolaryngology

http://bit.ly/2MTfmo0

Laryngeal and vocal alterations after thyroidectomy

Abstract Introduction: Dysphonia is a common symptom after thyroidectomy. Objective: To analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy. Methods: Prospective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months). Results: Among the 151 patients (130 women; 21 men). Type of surgery: lobectomy + isthmectomy n = 40, total thyroidectomy n = 88, thyroidectomy + lymph node dissection n = 23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (lobectomy + isthmectomy n = 6; total thyroidectomy n = 17; thyroidectomy + lymph node dissection n = 9) and 2 superior laryngeal nerve (lobectomy + isthmectomy n = 1; Total thyroidectomy + lymph node dissection n = 1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n = 76; palsy n = 13), thyroiditis (n = 8; palsy n = 0), and carcinoma (n = 67; palsy n = 21). Conclusion: Vocal symptoms, reported by 27.8% of the patients on the 1st post decreased to 7% in 6 months. In the acoustic analysis, f0 and APQ were decreased. Transient paralysis of the vocal folds secondary to recurrent and superior laryngeal nerve injury occurred in, respectively, 21% and 1.3% of the patients, decreasing to 6.6% and 0% after 6 months.

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Resumo Introdução: A disfonia é um sintoma comum após a tireoidectomia. Objetivo: Analisar os sintomas vocais, auditivo-perceptivos e acústica vocal, videolaringoscopia, procedimento cirúrgico e achados histopatológicos em pacientes submetidos à tireoidectomia. Método: Estudo prospectivo. Pacientes submetidos à tireoidectomia foram avaliados da seguinte forma: anamnese, laringoscopia e avaliações vocais acústicas. Momentos: pré-operatório, 1ª avaliação pós (15 dias), 2ª avaliação pós (1 mês), 3ª avaliação pós (3 meses) e 4ª avaliação pós-operatória (6 meses). Resultados: Dos 151 pacientes, 130 eram mulheres e 21, homens. Tipos de cirurgia: lobectomia + istmectomia n = 40, tireoidectomia total n = 88, tireoidectomia + dissecção de linfonodo n = 23. Sintomas vocais foram relatados por 42 pacientes na 1ª avaliação pós-operatória (27,8%), reduzidos para 7,2% após 6 meses. Na análise acústica, f0 e APQ estavam diminuídos nas mulheres. As videolaringoscopias mostraram que 144 pacientes (95,3%) tiveram exames normais no momento pré-operatório. Paralisia das cordas vocais foi diagnosticada em 34 pacientes na 1ª avaliação pós-operatória, 32 do nervo laríngeo recorrente (lobectomia + istmectomia - n = 6; tireoidectomia total - n = 17; tireoidectomia total + dissecção de linfonodos - n = 9) e 2 do nervo laríngeo superior (lobectomia + istmectomia - n = 1; tireoidectomia total + dissecção de linfonodos - n = 1). Após 6 meses, 10 pacientes persistiram com paralisia do nervo laríngeo recorrente (6,6%). Histopatologia e correlação com paralisia das cordas vocais: bócio coloide nodular (n = 76; paralisia n = 13), tireoidite (n = 8; paralisia n = 0) e carcinoma (n = 67; paralisia n = 21). Conclusão: Os sintomas vocais, relatados por 27,8% dos pacientes na 1ª avaliação pós-operatória, diminuíram para 7% em 6 meses. Na análise acústica, f0 e APQ diminuíram. A paralisia transitória de cordas vocais secundária à lesão do nervo laríngeo recorrente e nervo laríngeo superior ocorreu, respectivamente, em 21% e 1,3% dos pacientes, reduziu-se para 6,6% e 0% após 6 meses.

http://bit.ly/2SvJTxB

Downregulation of Notch4 - a prognostic marker in distinguishing oral verrucous carcinoma from oral squamous cell carcinoma

Abstract Introduction: Oral verrucous carcinoma is a special form of well-differentiated squamous cell carcinoma which possesses specific clinical, morphologic and cytokinetic features that differ from other types of oral cancers and hence diagnosis requires immense experience in histopathology. Hence it is certainly important to distinguish such a lesion from other oral tumors as treatment strategies vary widely between them. Objective: In search of a critical diagnostic marker in distinguishing oral verrucous carcinoma from oral squamous cell carcinoma, Notch4 receptor, one of the key regulatory molecules of the Notch signaling family has been aberrantly activated in the progression of several types of tumors. However its function in oral verrucous carcinoma remains unexplored. Thus the present study aims in determining the differential expression pattern of Notch4 in oral verrucous carcinoma and oral squamous cell carcinoma. Methods: Ten patients reported positive for oral cancer (5 patients with oral verrucous carcinoma and 5 patients with oral squamous cell carcinoma). Five normal tissue samples were also obtained and evaluated for clinicopathological parameters and immunohistochemistry, western blotting and real time polymerase chain reaction for Notch4 expression. Results: Our results reveal that the expression of Notch4 was considerably high in oral squamous cell carcinoma lesions compared to normal tissue, whereas in oral verrucous carcinoma, irrespective of the clinicopathological features, complete regulação descendente of Notch4 was observed. Conclusions: These preliminary findings strongly support the fact that Notch4 is downregulated in oral verrucous carcinoma and could be considered as a suitable prognostic marker in distinguishing oral verrucous carcinoma from oral squamous cell carcinoma. This distinguishing marker can help in improving therapeutic options in patients diagnosed with oral verrucous carcinoma.

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Resumo Introdução: O carcinoma verrucoso de cavidade oral é uma forma especial de carcinoma de células escamosas bem diferenciada que tem características clínicas, morfológicas e citocinéticas específicas que diferem de outros tipos de cânceres orais. Por essa razão, o diagnóstico requer grande experiência em histopatologia. Portanto, é certamente importante distingui-lo de outros tumores orais, pois as respectivas estratégias de tratamento variam muito. Objetivo: Em busca de um marcador de diagnóstico crítico na distinção entre o carcinoma verrucoso e o carcinoma de células escamosas de cavidade oral, o receptor Notch4, uma das principais moléculas reguladoras da família de sinalizadores Notch, foi ativado de maneira anormal na progressão de vários tipos de tumores. No entanto, sua função no carcinoma verrucoso permanece inexplorada. Assim, o presente estudo tem como objetivo determinar o padrão de expressão diferencial de Notch4 no carcinoma verrucoso e de células escamosas de cavidade oral. Método: Dez pacientes tiveram resultado positivo para câncer oral (cinco pacientes com carcinoma verrucoso e cinco pacientes com carcinoma de células escamosas) e cinco amostras normais foram também obtidas. Além da avaliação dos parâmetros clínico-patológicos, foram feitos análise imuno-histoquímica, Western Blot e reação de polimerase em cadeia em tempo real para a expressão de Notch4. Resultados: Nossos resultados revelam que a expressão de Notch4 foi consideravelmente alta em carcinomas de células escamosas em comparação com os tecidos normais, enquanto que no carcinoma verrucoso, independentemente das características clínico-patológicas, observou-se regulação descendente completa de Notch4. Conclusão: Esses achados preliminares apoiam fortemente o fato de que Notch4 estava regulado para baixo no carcinoma verrucoso oral e poderia ser considerado um marcador prognóstico adequado para distinguir entre carcinoma verrucoso e carcinoma de células escamosas de cavidade oral. Esse marcador distintivo pode ajudar a melhorar as opções terapêuticas em pacientes com diagnóstico de carcinoma verrucoso oral.

http://bit.ly/2MTffJ6

Identification and management of inverted or everted edges of traumatic tympanic membrane perforations

Abstract Introduction: Most of traumatic tympanic membrane perforations have inverted or everted edges, however, the effects of inverted and everted edges on the spontaneous healing of the eardrum remain controversial. Objective: We investigated the influence of inverted or everted edges on the spontaneous healing of traumatic tympanic membrane perforations. Methods: The clinical records of patients with a traumatic tympanic membrane perforations who met the study criteria were retrieved and categorized into two groups, based on whether the eardrum was inverted or everted. The features along the edge of each inverted or everted eardrum were described using 30º and 70º endoscopes. Results: In total, 196 patients (196 ears) met the inclusion criteria; of these, 148 had inverted or everted eardrums while 48 did not. Of the 148 patients with inverted or everted eardrums, the perforation edges were everted in 77 patients, inverted in 44 patients, drooping in 17 patients, and both inverted and everted in 10 patients. The perforation shape was triangular in 18.9% of patients, sector-shaped in 11.5%, kidney-shaped in 14.2%, ovoid in 20.3%, and irregularly shaped in 35.1% of patients. The difference was not significant between the with and without inverted/everted eardrum edges groups in terms of the closure rate or closure time. Similarly, the difference was not significant between the with and without edge approximation groups in terms of the closure rate or closure time at the end of the 12-month follow-up period. Conclusion: This study suggests that endoscopic inspection can clearly identify inverted/everted eardrum edges using 30º and 70º endoscopes. The edge is glossy in inverted/everted eardrums, whereas the edge is rough and irregular in non-inverted/everted cases. The inverted/everted eardrums gradually became necrotic, but this did not affect the healing process. Additionally, edge approximation did not improve the healing outcome of traumatic tympanic membrane perforations.

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Resumo Introdução: A maioria das perfurações de membrana timpânica traumáticas apresenta bordas invertidas ou evertidas; no entanto, os efeitos dessas configurações sobre a cicatrização espontânea do tímpano continuam a ser uma questão controversa. Objetivo: Investigar a influência de bordas invertidas ou evertidas sobre a cicatrização espontânea de perfurações traumáticas de membrana timpânica. Método: Os prontuários clínicos de pacientes com perfuração traumática de membrana timpânica que preencheram os critérios do estudo foram recuperados e categorizados em dois grupos, baseados na configuração invertida ou evertida das bordas da membrana timpânica. As características de configuração da borda de cada membrana foram descritas com o uso de endoscópios de 30º e 70º. Resultados: No total, 196 pacientes (196 orelhas) preencheram os critérios de inclusão; desses, 148 apresentavam bordas de membranas timpânicas invertidas ou evertidas, enquanto 48 não. Dos 148 pacientes, as bordas da perfuração estavam evertidas em 77 pacientes, invertidas em 44 pacientes, caídas em 17 pacientes e ambas invertidas e evertidas em 10 pacientes. O formato da perfuração era triangular em 18,9% dos pacientes, em forma de fatia de pizza em 11,5%, em forma de rim em 14,2%, ovoide em 20,3% e de forma irregular em 35,1% dos pacientes. A diferença não foi significante entre os grupos com e sem membrana timpânica invertida/evertida em termos de taxa ou tempo de fechamento. Da mesma forma, a diferença não foi significativa entre os grupos com e sem aproximação das bordas em termos de taxa de fechamento ou tempo de fechamento no fim do período de seguimento de 12 meses. Conclusões: Este estudo sugere que a avaliação com endoscópios de 30º e 70º pode identificar claramente as bordas invertidas/evertidas das perfurações de membranas timpânicas. A borda da perfuração timpânica em casos invertidos/evertidos é brilhante, enquanto a borda é áspera e irregular em casos não invertidos/evertidos. O rebordo timpânico invertido/evertido gradualmente torna-se necrótico, mas isso não afetou o processo de cicatrização. Além disso, a aproximação das bordas não melhorou o resultado da cicatrização.

http://bit.ly/2SAPNNQ

A predictive model to distinguish malignant and benign thyroid nodules based on age, gender and ultrasonographic features

Abstract Introduction: A discussion in literature about a standardized decision support tool for the management of thyroid nodules remains. Objective: The purpose of this study was to create a statistical prediction model for thyroid nodules management. Methods: Two hundred and four benign and 57 malignant thyroid nodules were selected for a retrospective study. The variables age, gender and ultrasonographic features were examined using univariate and multivariate models. A statistical formula was used to calculate the risk of cancer of each case. Results: In multivariate analysis, irregular shape, absence of halo, lower mean age, homogeneous echotexture, microcalcifications and solid content were associated with cancer. After applying the formula, 20 cases (7.6%) with a calculated risk for malignancy ≤3.0% were found, all of them benign. Setting the calculated risk in ≥80%, 21 (8.0%) cases were selected, and in 85.7% of them cancer was confirmed in histopathology. Internal accuracy of the prediction formula was 92.5%. Conclusions: The prediction formula reached high accuracy and may be an alternative to other decision support tools for thyroid nodule management.

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Resumo Introdução: Persiste na literatura uma discussão sobre uma ferramenta padronizada de apoio à decisão para o manejo de nódulos tireoidianos. Objetivo: Criar um modelo de previsão estatística para o manejo de nódulos tireoidianos. Método: Foram selecionados 204 casos de nódulos tireoidianos benignos e 57 malignos para o estudo retrospectivo. As variáveis idade, sexo e características ultrassonográficas foram analisadas com modelos univariados e multivariados. Uma fórmula estatística foi usada para calcular o risco de câncer de cada caso. Resultados: Na análise multivariada, a forma irregular, a ausência de halo, menor idadesubp média, ecotextura homogênea, microcalcificações e conteúdo sólido foram associadas ao câncer. Após a aplicação da fórmula, foram encontrados 20 casos (7,6%) com risco calculado de malignidade ≤ 3,0%, todos benignos. Definiu-se o risco calculado em ≥ 80%, 21 casos (8,0%) foram selecionados e em 85,7% deles o câncer foi confirmado pela histopatologia. A precisão interna da fórmula de previsão foi de 92,5%. Conclusões: A fórmula de previsão alcançou alta precisão e pode ser uma opção para outras ferramentas de apoio à decisão para o manejo de nódulos da tireoide.

http://bit.ly/2MUWLbj

Comparison between chloral hydrate and propofol-ketamine as sedation regimens for pediatric auditory brainstem response testing

Abstract Introduction: The use of diagnostic auditory brainstem response testing under sedation is currently the "gold standard" in infants and young children who are not developmentally capable of completing the test. Objective: The aim of the study is to compare a propofol-ketamine regimen to an oral chloral hydrate regimen for sedating children undergoing auditory brainstem response testing. Methods: Patients between 4 months and 6 years who required sedation for auditory brainstem response testing were included in this retrospective study. Drugs doses, adverse effects, sedation times, and the effectiveness of the sedative regimens were reviewed. Results: 73 patients underwent oral chloral hydrate sedation, while 117 received propofol-ketamine sedation. 12% of the patients in the chloral hydrate group failed to achieve desired sedation level. The average procedure, recovery and total nursing times were significantly lower in the propofol-ketamine group. Propofol-ketamine group experienced higher incidence of transient hypoxemia. Conclusion: Both sedation regimens can be successfully used for sedating children undergoing auditory brainstem response testing. While deep sedation using propofol-ketamine regimen offers more efficiency than moderate sedation using chloral hydrate, it does carry a higher incidence of transient hypoxemia, which warrants the use of a highly skilled team trained in pediatric cardio-respiratory monitoring and airway management.

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Resumo Introdução: O uso de testes diagnósticos de potencial evocado auditivo de tronco encefálico sob sedação é atualmente o padrão-ouro em lactentes e crianças pequenas que não têm desenvolvimento suficiente para realizar o exame. Objetivo: O objetivo do estudo foi comparar a sedação de crianças submetidas a testes de potencial evocado auditivo de tronco encefálico com propofol-quetamina e com hidrato de cloral por via oral. Método: Pacientes entre 4 meses e 6 anos de idade que necessitaram de sedação para a realização do potencial evocado auditivo de tronco encefálico foram incluídos nesse estudo retrospectivo. Foram revisadas as doses dos medicamentos, os efeitos adversos, os tempos de sedação e a eficácia das formas de sedação. Resultados: 73 pacientes foram submetidos à sedação oral com hidrato de cloral, enquanto 117 receberam sedação com propofol-quetamina; 12% dos pacientes do grupo hidrato de cloral não alcançaram o nível desejado de sedação. Os tempos médios de procedimento, recuperação e o tempo total de cuidados de enfermagem foram significativamente menores no grupo propofol-quetamina, entretanto este grupo experimentou maior incidência de hipoxemia transitória. Conclusão: Ambos os regimes de sedação podem ser utilizados com sucesso para sedar crianças para realização do exame de potencial evocado de tronco encefálico. Embora a sedação profunda com propofol e quetamina ofereça mais eficiência do que a sedação moderada com hidrato de cloral, ela apresenta maior incidência de hipoxemia transitória, o que requer uma equipe altamente qualificada, treinada em monitoramento cardiorrespiratório pediátrico e manejo de vias aéreas.

http://bit.ly/2SDTN00

The first postoperative-stimulated serum thyroglobulin is a prognostic factor for thyroid microcarcinomas

Abstract Introduction: Endogenous thyroid-stimulating hormone-stimulated thyroglobulin collected after total thyroidectomy is a useful predictor of better prognosis in patients with differentiated thyroid carcinomas in general, but studies with microcarcinomas are scarce. Objective: To assess whether the first postoperative stimulated thyroglobulin measurement is a prognostic factor in patients with microcarcinoma. Methods: The medical data of 150 differentiated thyroid carcinoma patients were studied retrospectively, and 54 (36%) cases with microcarcinoma were selected. The first postoperative stimulated thyroglobulin (1st stimulated thyroglobulin), measured after thyroidectomy, initial presentation data, and microcarcinomas treatment were assessed regarding outcome. Worse prognosis was defined as neoplasm persistence/recurrence. Results: Persistence/recurrence occurred in 27.8% of the cases. These patients were identified according to the following parameters: receiving more than one 131iodine dose (100% vs. 0%; p < 0.0001); accumulated 131iodine dose (232.14 ± 99.09 vs. 144 ± 33.61 mCi; p < 0.0001); presented active disease in the last assessment (53.3% vs. 0%; p < 0.0001); follow-up time (103.07 ± 61.27 vs. 66.85 ± 70.14 months; p = 0.019); and 1st stimulated thyroglobulin (19.01 ± 44.18 vs. 2.19 ± 2.54 ng/dL; p < 0.0001). After multivariate logistic regression, only the 1stSTg [odds ratio = 1.242; 95% confidence interval: 1.022-1.509; p = 0.029] and follow-up time (odds ratio = 1.027; 95% confidence interval: 1.007-1.048; p = 0.007) were independent predictors of risk of persistence/recurrence. The cutoff point of 1.6 ng/dL for the 1st stimulated thyroglobulin was significantly associated with disease persistence/recurrence [area under the curve = 0.713 (p = 0.019)]. Conclusion: The first stimulated thyroglobulin predicted disease persistence/recurrence in patients with microcarcinoma.

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Resumo Introdução: A tireoglobulina estimulada pelo hormônio tireoestimulante endógeno coletada após tireoidectomia total é um preditor útil de melhor prognóstico em pacientes com carcinomas diferenciados de tireoide em geral, mas os estudos com microcarcinomas são escassos. Objetivo: Avaliar se a primeira medida pós-operatória de tireoglobulina estimulada é um fator prognóstico em pacientes com microcarcinoma. Método: Os dados clínicos de 150 pacientes com carcinoma diferenciado de tireoide foram estudados retrospectivamente e 54 (36%) casos com microcarcinoma foram selecionados. A primeira dosagem de tireoglobulina estimulada (1a TgE) pós-operatória, medida após a tireoidectomia, os dados da apresentação inicial e tratamento do microcarcinoma foram avaliados quanto ao resultado. O pior prognóstico foi definido como a persistência/recorrência da neoplasia. Resultados: A persistência/recorrência ocorreu em 27,8% dos casos. Esses pacientes foram identificados de acordo com os seguintes parâmetros: receberam mais de uma dose de iodo131 (100% vs. 0%; p < 0,0001); dose acumulada de iodo131 (232,14 ± 99,09 vs. 144 ± 33,61 mCi; p < 0,0001); apresentou doença ativa na última avaliação (53,3% vs. 0%; p < 0,0001); tempo de seguimento (103,07 ± 61,27 vs. 66,85 ± 70,14 meses; p = 0,019); e 1ªTgE (19,01 ± 44,18 vs. 2,19 ± 2,54 ng/dL; p < 0,0001). Após a regressão logística multivariada, apenas a 1ª TgE [odds ratio = 1.242; intervalo de confiança de 95%: 1,022-1,509; p = 0,029] e tempo de seguimento (odds ratio = 1,027; intervalo de confiança de 95%: 1,007-1,048; p = 0,007) foram preditores independentes de risco de persistência/recorrência. O ponto de corte de 1,6 ng/dL para a 1a TgE foi significativamente associado à persistência/recidiva da doença [área abaixo da curva = 0,713 (p = 0,019)]. Conclusão: A 1ª dosagem sérica de tireoglobulina estimulada previu a persistência/recorrência da doença em pacientes com microcarcinoma.

http://bit.ly/2MTfxzG

Does the reduction of inferior turbinate affect lower airway functions?

Abstract Introduction: Although the nose and lungs are separate organs, numerous studies have reported that the entire respiratory system can be considered as a single anatomical and functional unit. The upper and lower airways affect each other either directly or through reflex mechanisms. Objective: In this study, we aimed to evaluate the effects of the radiofrequency ablation of persistent inferior turbinate hypertrophy on nasal and pulmonary function. Methods: Twenty-seven patients with bilateral persistent inferior turbinate hypertrophy without septal deviation were included in this study. All of the patients were evaluated using anterior rhinoscopy, nasal endoscopy, acoustic rhinometry, a visual analogue scale, and flow-sensitive spirometry on the day before and 4 months after the radiofrequency ablation procedure. Results: The post-ablation measurements revealed that the inferior turbinate ablation caused an increase in the mean cross-sectional area and volume of the nose, as well as in the forced expiratory volume in 1 s, forced vital capacity, and peak expiratory flow of the patients. These differences between the pre- and post-ablation results were statistically significant. The post-ablation visual analogue scale scores were lower when compared with the pre-ablation scores, and this difference was also statistically significant. Conclusion: This study demonstrated that the widening of the nasal passage after the reduction of the inferior turbinate size had a favorable effect on the pulmonary function tests.

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Resumo Introdução: Embora o nariz e os pulmões sejam órgãos separados, numerosos estudos relataram que todo o sistema respiratório pode ser considerado como uma única unidade anatômica e funcional. As vias aéreas superiores e inferiores afetam uma à outra diretamente ou através de mecanismos reflexos. Objetivo: Avaliar os efeitos da ablação por radiofrequência em conchas nasais inferiores com hipertrofia persistente sobre a função nasal e pulmonar. Método: Foram incluídos neste estudo 27 pacientes com hipertrofia persistente bilateral de conchas inferiores sem desvio septal. Todos os pacientes foram avaliados com rinoscopia anterior, endoscopia nasal, rinometria acústica, escala visual analógica e espirometria sensível ao fluxo no dia anterior e quatro meses após o procedimento de ablação por radiofrequência. Resultados: As medidas pós-ablação demonstraram que a ablação das conchas nasais inferiores resultou em um aumento da área transversal média e do volume do nariz, bem como do volume expiratório forçado em um segundo, da capacidade vital forçada e do fluxo expiratório máximo dos pacientes. Essas diferenças entre os resultados pré e pós-ablação foram estatisticamente significantes. Os escores da escala visual analógica pós-ablação foram menores quando comparados com os escores pré-ablação e essa diferença também foi estatisticamente significante. Conclusão: O alargamento da passagem nasal após a redução do tamanho das conchas nasais inferiores teve efeito favorável nos testes de função pulmonar.

http://bit.ly/2SEqM4g

Vocal assessment of addicts on methadone therapy via the RBH scale and objective acoustic parameters

Abstract Introduction: A large number of people around the world struggle daily to become free of their addiction to illegal psychoactive substances. In order to create an atmosphere of improved supervision, established communication and improved quality of life for drug addicts, centers have been set up to provide methadone as a substitute. Objective: The aim of the research was to assess the vocal features of drug addicts on methadone therapy via subjective and objective parameters, to ascertain if vocal damage has occurred and to determine whether subjective and objective acoustic vocal parameters are related, and how. Methods: The research included 34 adults of both genders who were undergoing methadone treatment. A subjective vocal evaluation assessed voice pitch and clarity, while the subjective acoustic analysis utilized the Roughness-Breathiness-Hoarseness scale of roughness-breathiness-hoarseness. Objective acoustic analysis was conducted after recording and analyzing an uninterrupted vocal /a/ of at least three seconds duration, using the "GllotisController" software. Results: The subjective acoustic analysis using the Roughness-Breathiness-Hoarseness scale showed pathological values in 52.9% male and 47% female participants. The average values of the roughness-breathiness-hoarseness for the entire sample were 0.91, 0.38 and 0.50, respectively. Lower roughness was associated with a higher fundamental frequency (f0) and lower jitter and shimmer values (p < 0.05). There was a statistically significant correlation between breathiness, jitter (p < 0.01) and shimmer (p < 0.05), and between hoarseness and jitter (p < 0.01). Conclusion: A statistically significant correlation was found between the two subjective vocal assessments, voice clarity and pitch, and Roughness-Breathiness-Hoarseness scale, and the parameters of the objective acoustic vocal assessment.

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Resumo Introdução: Um grande número de pessoas em todo o mundo luta diariamente para livrar-se de seu vício em substâncias psicoativas ilegais. Com o objetivo de criar uma atmosfera de supervisão melhorada, comunicação estabelecida e melhora da qualidade de vida para drogaditos, foram criados centros que fornecem a substância substitutiva metadona. Objetivo: Avaliar a voz de drogaditos que recebem terapia com metadona através de parâmetros subjetivos e objetivos, para determinar o eventual dano à voz, bem como determinar se os parâmetros vocais acústicos subjetivos e objetivos estão interligados e como isso ocorre. Método: A pesquisa incluiu 34 participantes, usuários de terapia com metadona, de ambos os sexos. A avaliação vocal subjetiva consistiu na avaliação do tom (pitch) e clareza da voz, enquanto a análise acústica subjetiva consistiu no uso da escala RSA, de rugosidade, soprosidade e aspereza. A análise acústica objetiva foi realizada após a gravação e análise da vocalização ininterrupta de /a/ com duração de no mínimo três segundos, com o software GllotisController. Resultados: A análise acústica subjetiva utilizando a escala RSA mostrou valores patológicos em 52,9% de homens e 47% em mulheres. Os valores médios dos parâmetros rugosidade, soprosidade e aspereza para toda a amostra foram 0,91, 0,38 e 0,50, respectivamente. O parâmetro rugosidade mais baixo esteve associado a valores mais altos de frequência fundamental (f0) e menor jitter e o shimmer (p < 0,05). Entre o parâmetro soprosidade e o jitter (p < 0,01) e o shimmer (p < 0,05) houve uma correlação estatisticamente significante, bem como entre o parâmetro aspereza e o jitter (p < 0,01). Conclusão: Foi encontrada uma correlação estatisticamente significante entre a avaliação vocal subjetiva da clareza e do tom (pitch) da voz e os parâmetros da avaliação vocal acústica objetiva, bem como os parâmetros da análise vocal acústica subjetiva utilizando a escala de rugosidade, soprosidade e aspereza e os parâmetros acústicos objetivos.

http://bit.ly/2MTeWxW

The protective effects of whortleberry extract against cisplatin-induced ototoxicity in rats

Abstract Introduction: Cisplatin is one of the main chemotherapeutic agents used for the treatment of many types of cancer. However, ototoxicity, one of the most serious side effects of cisplatin, restricts its usage. Objective: We aimed to investigate the protective effects of whortleberry extract against cisplatin-induced ototoxicity by evaluating hearing and histopathological cochlear damage and by measuring the biochemical parameters affected byoxidative stress. Methods: Forty-eight male rats were included in the study after performing Distortion Product Otoacoustic Emission test to confirm that their hearing levels were normal. The rats were randomly divided into six groups: the control group, the sham group, and, which received only whortleberry extract, only cisplatin, cisplatin + 100 mg whortleberry extract, cisplatin + 200 mg whortleberry extract, respectively. Audiologic investigation was performed by performing the Distortion Product Otoacoustic Emission test at the beginning and at the eighth day of the study. Cardiac blood samples were collected for biochemical analysis, and the rats were sacrificed to obtain cochlear histopathological specimens on the eighth day. Results: The results revealed that whortleberry protects hearing against cisplatin-induced ototoxicity independent of the dose. However, high doses of whortleberry extract are needed to prevent histopathological degeneration and oxidative stress. Conclusion: The results obtained in this study show that whortleberry extract has a protective effect against cisplatin-induced ototoxicity.

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Resumo Introdução: A cisplatina é um dos principais agentes quimioterápicos utilizados para o tratamento de muitos tipos de câncer. No entanto, a ototoxicidade, um dos efeitos colaterais mais graves da cisplatina, restringe seu uso. Objetivo: Nosso objetivo foi investigar os efeitos protetores do extrato de uva-do-monte contra a ototoxicidade induzida por cisplatina, avaliar o dano auditivo e histopatológico coclear e medir os parâmetros bioquímicos afetados pelo estresse oxidativo. Método: Foram incluídos no estudo 48 ratos machos após teste de emissão otoacústica evocada por produto de distorção para confirmar que seus níveis de audição eram normais. Os ratos foram divididos aleatoriamente em seis grupos: o grupo controle, o grupo simulado, o que recebeu apenas extrato de uva-do-monte, o que recebeu apenas cisplatina, o que recebeu cisplatina + 100 mg de extrato de uva-do-monte e o que recebeu cisplatina + 200 mg de extrato de uva-do-monte, respectivamente. A investigação audiológica foi feita através do teste de emissão otoacústica de produto de distorção no início e no oitavo dia do estudo. As amostras de sangue cardíaco foram coletadas para análise bioquímica e os ratos foram sacrificados para obtenção de espécimes histopatológicos cocleares no oitavo dia. Resultados: Os resultados revelaram que o extrato de uva-do-monte protege a audição contra a ototoxicidade induzida por cisplatina, independentemente da dose. No entanto, são necessárias doses elevadas do extrato para evitar a degeneração histopatológica e o estresse oxidativo. Conclusão: Os resultados obtidos neste estudo mostram que o extrato de uva-do-monte tem um efeito protetor contra a ototoxicidade induzida por cisplatina.

http://bit.ly/2SEqGcU

Hypoparathyroidism: what is the best calcium carbonate supplementation intake form?

Abstract Introduction: In hypoparathyroidism, calcium supplementation using calcium carbonate is necessary for the hypocalcemia control. The best calcium carbonate intake form is unknown, be it associated with feeding, juice or in fasting. Objective: The objective was to evaluate the calcium, phosphorus and calcium × phosphorus product serum levels of hypoparathyroidism women after total thyroidectomy, following calcium carbonate intake in three different forms. Methods: A crossover study was carried out with patients presenting definitive hypoparathyroidism, assessed in different situations (fasting, with water, orange juice, breakfast with a one-week washout). Through the review of clinical data records of tertiary hospital patients from 1994 to 2010, 12 adult women (18-50 years old) were identified and diagnosed with definitive post-thyroidectomy hypoparathyroidism. The laboratory results of calcium and phosphorus serum levels dosed before and every 30 min were assessed, for 5 h, after calcium carbonate intake (elementary calcium 500 mg). Results: The maximum peak average values for calcium, phosphorus and calcium × phosphorus product were 8.63 mg/dL (water), 8.77 mg/dL (orange juice) and 8.95 mg/dL (breakfast); 4.04 mg/dL (water), 4.03 mg/dL (orange juice) and 4.12 mg/dL (breakfast); 34.3 mg2/dL2 (water), 35.8 mg2/dL2 (orange juice) and 34.5 mg2/dL2 (breakfast), respectively, and the area under the curve 2433 mg/dL min (water), 2577 mg/dL min (orange juice) and 2506 mg/dL min (breakfast), 1203 mg/dL min (water), 1052 mg/dL min (orange juice) and 1128 mg/dL min (breakfast), respectively. There was no significant difference among the three different tests (p > 0.05). Conclusion: The calcium, phosphorus and calcium × phosphorus product serum levels evolved in a similar fashion in the three calcium carbonate intake forms.

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Resumo Introdução: No hipoparatireoidismo, a suplementação de cálcio com carbonato de cálcio é necessária para o controle da hipocalcemia. A melhor forma de ingestão de carbonato de cálcio ainda é desconhecida, seja concomitante com alimentação, no suco ou em jejum. Objetivo: Avaliar os níveis séricos de cálcio, fósforo e produto cálcio-fósforo em mulheres pós-tireoidectomia por hipoparatireoidismo, após a ingestão de carbonato de cálcio em três formas diferentes. Método: Foi realizado um estudo cruzado em pacientes com hipoparatireoidismo definitivo, avaliados em diferentes situações (em jejum, com água, suco de laranja, café da manhã, após washout de uma semana). A revisão dos prontuários dos pacientes de um hospital terciário de 1994 a 2010 identificou 12 mulheres adultas (18-50 anos), diagnosticadas com hipoparatireoidismo definitivo pós-tireoidectomia. Os resultados laboratoriais dos níveis séricos de cálcio e fósforo foram mensurados antes e a cada 30 minutos durante 5 horas, após a ingestão de carbonato de cálcio (cálcio elementar 500 mg). Resultados: Os valores de pico máximo médio de cálcio, fósforo e produto cálcio-fósforo foram 8,63 mg/dL (água), 8,77 mg/dL (suco de laranja) e 8,95 mg/dL (café da manhã); 4,04 mg/dL (água), 4,03 mg/dL (suco de laranja) e 4,12 mg/dL (café da manhã); 34,3 mg2/dL2 (água), 35,8 mg2/dL2 (suco de laranja) e 34,5 mg2/dL2 (café da manhã), respectivamente, e a área sob a curva foi 2.433 mg/dL.min. (água), 2.577 mg/dL.min. (suco de laranja) e 2.506 mg/dL.min. (café da manhã), 1.203 mg/dL.min. (água), 1.052 mg/dL.min. (suco de laranja) e 1.128 mg/dL.min. (café da manhã), respectivamente. Não houve diferença significante entre os três diferentes testes (p > 0,05). Conclusão: Os níveis séricos de cálcio, fósforo e produto cálcio-fósforo evoluíram de forma semelhante nas três formas de ingestão de carbonato de cálcio.

http://bit.ly/2MTePT2

Evaluation of postoperative patient satisfaction after covering the nasal dorsum with upper lateral cartilage: "upper lateral closing"

Abstract Introduction: Following nasal hump removal during septorhinoplasty, the middle vault should be reconstructed to avoid functional and esthetic problems. Middle vault reconstruction, however, may result in widening of the middle vault and may need a camouflage graft to cover dorsal irregularities. Objective: To present the results of reconstructing the middle vault with a technique that covers the nasal dorsum with upper lateral cartilage, from the viewpoint of patient satisfaction. Methods: Retrospective study of patients who underwent septorhinoplasty that included nasal dorsum closure with upper lateral cartilage from December 1, 2014 to January 31, 2016. Those with postoperative follow-up of less than 3 months were excluded. The final study group included 39 patients. The same surgeon performed all septorhinoplasties. The dorsum was closed using an "upper lateral closing" technique that approximated upper lateral cartilages to each other over the septum. Postoperative patient satisfaction was determined using a visual analog scale and the rhinoplasty outcomes evaluation questionnaire. The questionnaire evaluates patient esthetic and functional satisfaction with the operated nose. High scores indicate improved esthetic results. Results: No dorsal irregularities were seen at postoperative follow-up evaluation of the patients. For esthetic nasal appearance, the median visual analogue scale scores was 86%, and the mean for the questionnaire was 77.03%. Conclusion: The natural dome-shaped anatomy of the nasal dorsum was achieved by approximating the upper lateral cartilages to each other. Closing the dorsum with this technique also covers any dorsal irregularities and results in a smooth dorsum. Patients expressed satisfaction with the esthetic and functional aspects of the smooth, attractive nasal dorsum.

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Resumo Introdução: Após a remoção da giba nasal durante a rinosseptoplastia, a abóbada deve ser reconstruída para evitar problemas funcionais e estéticos. A reconstrução da abóboda entretanto, pode resultar em alargamento dorsal e pode necessitar de um enxerto para camuflar irregularidades dorsais. Objetivo: Avaliar a satisfação dos pacientes com os resultados da reconstrução da abóboda com uma técnica que utiliza a cartilagem lateral superior para recobrir o dorso nasal. Método: Estudo retrospectivo de pacientes submetidos a rinosseptoplastia, que incluiu fechamento do dorso nasal com cartilagem lateral superior, realizado de 1º de dezembro de 2014 a 31 de janeiro de 2016. Foram excluídos aqueles com acompanhamento pós-operatório de menos de 3 meses. O grupo final do estudo incluiu 39 pacientes. O mesmo cirurgião realizou todas as rinosseptoplastias. O dorso foi fechado com uma técnica de "fechamento lateral superior" que aproxima as cartilagens laterais superiores de cada lado sobre o septo. A satisfação pós-operatória dos pacientes foi determinada através de uma escala visual analógica e o questionário Rhinoplasty Outcomes Evaluation. O questionário avalia a satisfação estética e funcional do paciente com o nariz. Escores altos indicam percepção de melhoria estética. Resultados: Não foram observadas irregularidades dorsais na avaliação pós-operatória de seguimento dos pacientes. Em relação à aparência nasal estética, o escore médio da escala visual analógica foi 86% e o escore médio do questionário foi 77,03%. Conclusões: A anatomia natural em forma de domo do dorso nasal foi conseguida através da aproximação das cartilagens laterais superiores entre si. O fechamento do dorso com essa técnica também abrange todas as irregularidades dorsais e resulta em um dorso liso. Os pacientes expressaram satisfação com os aspectos estéticos e funcionais do dorso nasal liso e atraente.

http://bit.ly/2SzHkuf

Long-term follow-up of tonsillectomy efficacy in children with PFAPA syndrome

Abstract Introduction: The role of tonsillectomy in the periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome, is controversial. Although some studies reported high success rates with tonsillectomy, further investigations are needed with larger numbers of patients. Objective: To seek the long-term outcomes of tonsillectomy in periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome. Methods: Case series; multi-center study. The study comprised 23 patients with periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome who underwent surgery (tonsillectomy with or without adenoidectomy) between January 2009 and November 2014. Results: 21 (91%) of 23 patients had complete resolution immediately after surgery. One patient had an attack 24 h after surgery, but has had no further attacks. One patient had three attacks with various intervals, and complete remission was observed after 3 months. Conclusions: Tonsillectomy is a good option for the treatment of periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome.

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Resumo Introdução: O papel da tonsilectomia na síndrome da febre periódica, estomatite aftosa, faringite e adenite é controverso. Embora alguns estudos tenham relatado altas taxas de sucesso com a tonsilectomia, são necessárias mais pesquisas com um número maior de pacientes. Objetivo: Avaliar os resultados em longo prazo da tonsilectomia na síndrome de febre periódica, estomatite aftosa, faringite e adenite. Método: Série de casos; estudo multicêntrico. O estudo avaliou 23 pacientes com síndrome de febre periódica, estomatite aftosa, faringite e adenite submetidos a cirurgia (tonsilectomia com ou sem adenoidectomia) entre janeiro de 2009 e novembro de 2014. Resultados: Dos 23 pacientes, 21 (91%) apresentaram resolução completa imediatamente após a cirurgia. Um paciente apresentou um episódio 24 horas após a cirurgia, mas sem recorrência posterior. Um paciente teve três episódios com vários intervalos e a remissão completa foi observada após 3 meses. Conclusões: A tonsilectomia é uma boa opção para o tratamento da síndrome de febre periódica, estomatite aftosa, faringite e adenite.

http://bit.ly/2MTaG1r

Nasal patency and otorhinolaryngologic-orofacial features in children

Abstract Introduction: Nasal obstruction is a common symptom in childhood, related to rhinitis and pharyngeal tonsil hypertrophy. In the presence of nasal obstruction, nasal patency may be reduced, and nasal breathing is replaced by mouth breathing. Orofacial and otorhinolaryngologic changes are related to this breathing mode. Objective evaluation of upper airways may be obtained through nasal patency measurement. Objective: To compare nasal patency and otorhinolaryngologic-orofacial features in children. Methods: One hundred and twenty three children, 6-12 year-old, and of both sexes underwent speech therapy evaluation, according to Orofacial Myofunctional Evaluation protocol, clinical and endoscopic otorhinolaryngologic examination and nasal patency measurement, using the absolute and predicted (%) peak nasal inspiratory flow values. Results: Lower values of absolute and estimated peak nasal inspiratory flow values were found in children with restless sleep (p = 0.006 and p = 0.002), nasal obstruction report (p = 0.027 and p = 0.023), runny nose (p = 0.004 and p = 0.012), unsystematic lip closure during mastication (p = 0.040 and p = 0.026), masticatory speed reduced (p = 0.006 and p = 0.008) and altered solid food swallowing (p = 0.006 and p = 0.001). Absolute peak nasal inspiratory flow was lower in children with pale inferior turbinate (p = 0.040), reduced hard palate width (p = 0.037) and altered speech (p = 0.004). Higher absolute values were found in children with increased tongue width (p = 0.027) and, higher absolute and predicted (%) in children with mild everted lip (p = 0.008 and p = 0.000). Conclusions: Nasal patency was lower in children with restless sleep, rhinitis signs and symptoms, hard palate width reduced and with changes in mastication, deglutition and speech functions. It is also emphasized that most of the children presented signs and symptom of allergic rhinitis.

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Resumo Introdução: A obstrução nasal é um sintoma comum na infância relacionado a rinite e hipertrofia das tonsilas faríngeas. Na presença de obstrução nasal, a patência nasal pode estar reduzida e a respiração nasal ser substituída por respiração oral. Alterações orofaciais e otorrinolaringológicas estão relacionadas a esse modo de respiração. A avaliação objetiva das vias aéreas superiores pode ser obtida através da medida da patência nasal. Objetivo: Comparar a patência nasal e características otorrinolaringológicas e orofaciais em crianças. Método: Foram submetidas 123 crianças de seis a 12 anos, de ambos os sexos, a avaliação fonoaudiológica, de acordo com o protocolo de avaliação Miofuncional Orofacial, exame clínico e endoscópico otorrinolaringológico e medição da patência nasal, com o uso do pico de fluxo inspiratório nasal em valores absolutos e valores estimados (% pico de fluxo inspiratório nasal). Resultados: Valores mais baixos de pico de fluxo inspiratório nasal e % pico de fluxo inspiratório nasal foram encontrados em crianças com sono agitado (p = 0,006 e p = 0,002), relato de obstrução nasal (p = 0,027 e p = 0,023), rinorreia (p = 0,004 e p = 0,012), fechamento não sistemático dos lábios durante a mastigação (p = 0,040 e p = 0,026), velocidade mastigatória reduzida (p = 0,006 e p = 0,008) e alteração da ingestão de alimentos sólidos (p = 0,006 e p = 0,001). O pico de fluxo inspiratório nasal foi menor em crianças com conchas inferiores pálidas (p = 0,040), redução da largura do palato duro (p = 0,037) e alterações da fala (p = 0,004). Valores maiores foram encontrados em crianças com largura da língua aumentada (p = 0,027). Valores maiores de pico de fluxo inspiratório nasal e % de pico de fluxo inspiratório nasal foram observados em crianças com lábio levemente evertido (p = 0,008 e p = 0,000). Conclusões: A patência nasal foi menor em crianças com sono agitado, sinais e sintomas de rinite, redução da largura do palato duro e alterações nas funções de mastigação, deglutição e fala. Enfatiza-se também que a maioria das crianças apresentava sinais e sintomas de rinite alérgica.

http://bit.ly/2SEqudG

Frequency of GJB2 mutations in patients with nonsyndromic hearing loss from an ethnically characterized Brazilian population

Abstract Introduction: In different parts of the world, mutations in the GJB2 gene are associated with nonsyndromic hearing loss, and the homozygous 35delG mutation (p.Gly12Valfs*2) is a major cause of hereditary hearing loss. However, the 35delG mutation is not equally prevalent across ethnicities, making it important to study other mutations, especially in multiethnic countries such as Brazil. Objective: This study aimed to identify different mutations in the GJB2 gene in patients with severe to profound nonsyndromic sensorineural hearing loss of putative genetic origin, and who were negative or heterozygote for the 35delG mutation. Methods: Observational study that analyzed 100 ethnically characterized Brazilian patients with nonsyndromic severe to profound sensorineural hearing loss, who were negative or heterozygote for the 35delG mutation. GJB2 mutations were detected by DNA-based sequencing in this population. Participants' ethnicities were identified as Latin European, Non-Latin European, Jewish, Native, Turkish, Afro-American, Asian and Others. Results: Sixteen participants were heterozygote for the 35delG mutation; 14 participants, including three 35delG heterozygote's, had nine different alterations in the GJB2 gene. One variant, p.Ser199Glnfs*9, detected in two participants, was previously unreported. Three variants were pathogenic (p.Trp172*, p.Val167Met, and p.Arg75Trp), two were non-pathogenic (p.Val27Ile and p.Ile196Thr), and three variants were indeterminate (p.Met34Thr, p.Arg127Leu, and p.Lys168Arg). Three cases of compound heterozygosity were detected: p.[(Gly12Valfs*2)];[(Trp172*)], p.[(Gly12Valfs*2)](;)[(Met34Thr)], and p.[(Gly12Valfs*2)(;)[(Ser199Glnfs*9)]). Conclusion: This study detected previously unclassified variants and one case of previously unreported compound heterozygosity.

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Resumo Introdução: Em diferentes partes do mundo, mutações do gene GJB2 estão associadas a perda auditiva não sindrômica e a mutação homozigótica 35delG (p.Gly12Valfs*2) é uma das principais causas de perda auditiva hereditária. No entanto, a mutação 35delG não é igualmente prevalente em todas as etnias, faz com que seja importante estudar outras mutações, especialmente em países multiétnicos, como o Brasil. Objetivo: Identificar diferentes mutações no gene GJB2 em pacientes com perda auditiva neurossensorial grave ou profunda não sindrômica de origem genética putativa e negativos ou heterozigotos para a mutação 35delG. Método: Estudo observacional que analisou 100 pacientes brasileiros caracterizados etnicamente, com perda auditiva neurossensorial grave ou profunda não sindrômica, negativos ou heterozigotos para a mutação 35delG. As mutações de GJB2 foram detectadas por sequenciamento baseado no DNA nessa população. As etnias dos participantes foram identificadas como latino-europeia, não latino-europeia, judaica, nativa, turca, negra, asiática e outras. Resultados: Dezesseis participantes eram heterozigotos para a mutação 35delG e 14, incluindo três heterozigotos para 35delG, apresentaram nove alterações no gene GJB2. Uma variante, p.Ser199Glnfs*9, detectada em dois participantes, não havia sido relatada anteriormente. Três variantes eram patogênicas (p.Trp172*, p.Val167Met, e p.Arg75Trp), duas não patogênicas (p.Val27Ile e p.Ile196Thr) e três indeterminadas (p.Met34Thr, p.Arg127Leu, e p.Lys168Arg). Três casos de heterozigosidade composta foram detectados: p.[(Gly12Valfs*2)];[(Trp172*)], p.[(Gly12Valfs*2)](;)[(Met34Thr)], e p.[(Gly12Valfs*2)(;)[(Ser199Glnfs*9)]). Conclusão: Este estudo detectou variantes não classificadas anteriormente e um caso de heterozigosidade composta ainda não relatada.

http://bit.ly/2MSguIu

Questionnaires and checklists for central auditory processing screening used in Brazil: a systematic review

Abstract Introduction: The action of listening involves a complex interaction between the peripheral and central auditory systems. Central auditory processing disorder can be described as any problem in one or more auditory abilities. Literature reports that behavioral questionnaires and checklists can be applied to screen individuals at risk for central auditory processing disorder. Objective: To identify and analyze in the national literature questionnaires and checklists for the screening of central auditory processing available in Brazil for the Portuguese language. Methods: The research was carried out in electronic databases and "gray literature". The search strategy was: "questionnaires OR surveys and questionnaires AND auditory OR hearing tests OR auditory perception AND Brazil". The research was carried out between June and August of 2017. Study selection followed inclusion and exclusion criteria. The criteria adopted included Brazilian studies, without date and design restriction, that were carried out, translated, adapted and/or validated to Brazilian Portuguese or European Portuguese, as tools for central auditory processing screening. International studies that were not adapted to the Portuguese language were excluded, as well as the ones that were not available in full. Results: A total of 3664 publications were found and seven articles were selected for this systematic review, according to the established criteria. Conclusions: There is scarce national literature for central auditory processing screening and the only tool validated to Brazilian Portuguese, published as a monograph, is the auditory processing domains questionnaire. It is suggested that new studies with greater methodological stringency related to the processes of tool adaptation and validation be developed and published in the usual scientific databases, aiming at greater diffusion and clinical applicability.

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Resumo Introdução: O ato de ouvir envolve uma complexa interação entre os sistemas auditivo periférico e central. O transtorno do processamento auditivo central pode ser descrito como qualquer alteração em uma ou mais habilidades auditivas. A literatura refere que questionários e checklists comportamentais podem ser aplicados para triagem de indivíduos em risco para o transtorno do processamento auditivo central. Objetivo: Identificar na literatura nacional e analisar questionários e checklists para triagem do processamento auditivo central disponíveis no Brasil para a língua portuguesa. Método: Pesquisa realizada em bases de dados eletrônicas e "literatura cinza". A estratégia de busca foi a seguinte: questionnaires OR surveys and questionnaires AND auditory OR hearing tests OR auditory perception AND Brazil. A pesquisa foi realizada de junho a agosto de 2017. A seleção dos estudos seguiu critérios de inclusão e exclusão. Os critérios adotados compreenderam estudos brasileiros, sem restrição de data e delineamento, que tenham sido elaborados, traduzidos, adaptados e/ou validados para o português brasileiro ou europeu, questionários e checklists como instrumentos para triagem do processamento auditivo central. Foram excluídos estudos internacionais não adaptados à língua portuguesa, bem como aqueles não disponíveis na íntegra. Resultados: Foram encontradas 3.664 publicações e sete trabalhos foram selecionados para esta revisão sistemática, conforme os critérios estabelecidos. Conclusões: Há escassa literatura nacional para triagem do processamento auditivo central e o único instrumento validado para o português brasileiro, publicado em formato de monografia, é o Auditory Processing Domains Questionnaire. Sugere-se que novos trabalhos com maior rigor metodológico nos processos de adaptação e validação dos instrumentos sejam desenvolvidos e publicados nas bases científicas usuais, com vistas à maior difusão e aplicabilidade clínica.

http://bit.ly/2SzHbXJ

Different clinical presentation of intralabyrinthine schwannomas - a systematic review

Abstract Introduction: Intralabyrinthine schwannoma is a rare, benign tumor that affects the most terminal portions of the vestibular and cochlear nerves. This tumor can be classified into 10 subtypes, according to its inner ear location. Objective: To carry out a comprehensive review of the most frequent auditory manifestations secondary to the intralabyrinthine schwannoma, describing the possible underlying pathophysiological mechanisms. Methods: Systematic review of the literature until October 2017 using the PubMed, Web of Science and Scopus databases. The inclusion criteria were clinical manifestations of the intralabyrinthine schwannoma. Three researchers independently assessed the articles and extracted relevant information. The description of a case of an intravestibular subtype intralabyrinthine schwannoma with multiple forms of clinical presentations was used as an example. Results: Twenty-seven studies met our inclusion criteria. The most common intralabyrinthine schwannoma subtype was the intracochlear, followed by the intravestibular type. All the cases demonstrated hearing loss, usually progressive hearing loss. Conclusion: The diagnosis of intralabyrinthine schwannomas is based on high-resolution magnetic resonance imaging and should be included in the differential diagnosis of patients with vestibulocochlear complaints. Although there are approximately 600 cases in the literature, we still lack a detailed description of the clinical evolution of the patients, correlating it with MRI findings of temporal bones and tumor subtype.

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Resumo Introdução: Schwannoma intralabiríntico é um tumor benigno, raro, que afeta as porções mais terminais dos nervos vestibular e coclear. Este tumor pode ser classificado, de acordo com sua localização na orelha interna, em 10 subtipos. Objetivo: Realizar uma revisão abrangente das manifestações auditivas mais frequentes secundárias ao schwannoma intralabiríntico e descrever os possíveis mecanismos fisiopatológicos subjacentes. Método: Revisão sistemática da literatura até outubro de 2017 nas bases de dados PubMed, Web of Science e Scopus. O critério de inclusão foi manifestações clínicas do schwannoma intralabiríntico. Três pesquisadores avaliaram de forma independente os artigos e extraíram informações relevantes. Exemplificamos com a descrição de um caso de schwannoma intralabiríntico subtipo intravestibular com múltiplas formas de apresentações clínicas. Resultados: Vinte sete estudos contemplaram nossos critérios de inclusão. O subtipo do schwannoma intralabiríntico mais comum encontrado foi o intracoclear, seguido pelo intravestibular. Todos os casos apresentaram alteração auditiva, normalmente perda auditiva progressiva. Conclusão: O diagnóstico de schwannomas intralabirínticos baseia-se em exames de ressonância magnética de alta resolução e deve ser incluído no diagnóstico diferencial de pacientes com queixas vestibulococleares. Apesar de termos aproximadamente 600 casos na literatura, ainda nos falta descrição detalhada da evolução clínica dos pacientes em correlação com achados na ressonância magnética de ossos temporais e o subtipo tumoral.

http://bit.ly/2MTaEql

Cavernous hemangioma in unusual location: pterygopalatine fossa

Abstract Introduction: Intralabyrinthine schwannoma is a rare, benign tumor that affects the most terminal portions of the vestibular and cochlear nerves. This tumor can be classified into 10 subtypes, according to its inner ear location. Objective: To carry out a comprehensive review of the most frequent auditory manifestations secondary to the intralabyrinthine schwannoma, describing the possible underlying pathophysiological mechanisms. Methods: Systematic review of the literature until October 2017 using the PubMed, Web of Science and Scopus databases. The inclusion criteria were clinical manifestations of the intralabyrinthine schwannoma. Three researchers independently assessed the articles and extracted relevant information. The description of a case of an intravestibular subtype intralabyrinthine schwannoma with multiple forms of clinical presentations was used as an example. Results: Twenty-seven studies met our inclusion criteria. The most common intralabyrinthine schwannoma subtype was the intracochlear, followed by the intravestibular type. All the cases demonstrated hearing loss, usually progressive hearing loss. Conclusion: The diagnosis of intralabyrinthine schwannomas is based on high-resolution magnetic resonance imaging and should be included in the differential diagnosis of patients with vestibulocochlear complaints. Although there are approximately 600 cases in the literature, we still lack a detailed description of the clinical evolution of the patients, correlating it with MRI findings of temporal bones and tumor subtype.

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Resumo Introdução: Schwannoma intralabiríntico é um tumor benigno, raro, que afeta as porções mais terminais dos nervos vestibular e coclear. Este tumor pode ser classificado, de acordo com sua localização na orelha interna, em 10 subtipos. Objetivo: Realizar uma revisão abrangente das manifestações auditivas mais frequentes secundárias ao schwannoma intralabiríntico e descrever os possíveis mecanismos fisiopatológicos subjacentes. Método: Revisão sistemática da literatura até outubro de 2017 nas bases de dados PubMed, Web of Science e Scopus. O critério de inclusão foi manifestações clínicas do schwannoma intralabiríntico. Três pesquisadores avaliaram de forma independente os artigos e extraíram informações relevantes. Exemplificamos com a descrição de um caso de schwannoma intralabiríntico subtipo intravestibular com múltiplas formas de apresentações clínicas. Resultados: Vinte sete estudos contemplaram nossos critérios de inclusão. O subtipo do schwannoma intralabiríntico mais comum encontrado foi o intracoclear, seguido pelo intravestibular. Todos os casos apresentaram alteração auditiva, normalmente perda auditiva progressiva. Conclusão: O diagnóstico de schwannomas intralabirínticos baseia-se em exames de ressonância magnética de alta resolução e deve ser incluído no diagnóstico diferencial de pacientes com queixas vestibulococleares. Apesar de termos aproximadamente 600 casos na literatura, ainda nos falta descrição detalhada da evolução clínica dos pacientes em correlação com achados na ressonância magnética de ossos temporais e o subtipo tumoral.

http://bit.ly/2SEqkmA

Management of hyperacusis in children - two case reports

Abstract Introduction: Intralabyrinthine schwannoma is a rare, benign tumor that affects the most terminal portions of the vestibular and cochlear nerves. This tumor can be classified into 10 subtypes, according to its inner ear location. Objective: To carry out a comprehensive review of the most frequent auditory manifestations secondary to the intralabyrinthine schwannoma, describing the possible underlying pathophysiological mechanisms. Methods: Systematic review of the literature until October 2017 using the PubMed, Web of Science and Scopus databases. The inclusion criteria were clinical manifestations of the intralabyrinthine schwannoma. Three researchers independently assessed the articles and extracted relevant information. The description of a case of an intravestibular subtype intralabyrinthine schwannoma with multiple forms of clinical presentations was used as an example. Results: Twenty-seven studies met our inclusion criteria. The most common intralabyrinthine schwannoma subtype was the intracochlear, followed by the intravestibular type. All the cases demonstrated hearing loss, usually progressive hearing loss. Conclusion: The diagnosis of intralabyrinthine schwannomas is based on high-resolution magnetic resonance imaging and should be included in the differential diagnosis of patients with vestibulocochlear complaints. Although there are approximately 600 cases in the literature, we still lack a detailed description of the clinical evolution of the patients, correlating it with MRI findings of temporal bones and tumor subtype.

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Resumo Introdução: Schwannoma intralabiríntico é um tumor benigno, raro, que afeta as porções mais terminais dos nervos vestibular e coclear. Este tumor pode ser classificado, de acordo com sua localização na orelha interna, em 10 subtipos. Objetivo: Realizar uma revisão abrangente das manifestações auditivas mais frequentes secundárias ao schwannoma intralabiríntico e descrever os possíveis mecanismos fisiopatológicos subjacentes. Método: Revisão sistemática da literatura até outubro de 2017 nas bases de dados PubMed, Web of Science e Scopus. O critério de inclusão foi manifestações clínicas do schwannoma intralabiríntico. Três pesquisadores avaliaram de forma independente os artigos e extraíram informações relevantes. Exemplificamos com a descrição de um caso de schwannoma intralabiríntico subtipo intravestibular com múltiplas formas de apresentações clínicas. Resultados: Vinte sete estudos contemplaram nossos critérios de inclusão. O subtipo do schwannoma intralabiríntico mais comum encontrado foi o intracoclear, seguido pelo intravestibular. Todos os casos apresentaram alteração auditiva, normalmente perda auditiva progressiva. Conclusão: O diagnóstico de schwannomas intralabirínticos baseia-se em exames de ressonância magnética de alta resolução e deve ser incluído no diagnóstico diferencial de pacientes com queixas vestibulococleares. Apesar de termos aproximadamente 600 casos na literatura, ainda nos falta descrição detalhada da evolução clínica dos pacientes em correlação com achados na ressonância magnética de ossos temporais e o subtipo tumoral.

http://bit.ly/2MTgf01

Electromagnetic radiofrequency radiation with special reference to otorhinolaryngology and brain tumors

Abstract Introduction: Intralabyrinthine schwannoma is a rare, benign tumor that affects the most terminal portions of the vestibular and cochlear nerves. This tumor can be classified into 10 subtypes, according to its inner ear location. Objective: To carry out a comprehensive review of the most frequent auditory manifestations secondary to the intralabyrinthine schwannoma, describing the possible underlying pathophysiological mechanisms. Methods: Systematic review of the literature until October 2017 using the PubMed, Web of Science and Scopus databases. The inclusion criteria were clinical manifestations of the intralabyrinthine schwannoma. Three researchers independently assessed the articles and extracted relevant information. The description of a case of an intravestibular subtype intralabyrinthine schwannoma with multiple forms of clinical presentations was used as an example. Results: Twenty-seven studies met our inclusion criteria. The most common intralabyrinthine schwannoma subtype was the intracochlear, followed by the intravestibular type. All the cases demonstrated hearing loss, usually progressive hearing loss. Conclusion: The diagnosis of intralabyrinthine schwannomas is based on high-resolution magnetic resonance imaging and should be included in the differential diagnosis of patients with vestibulocochlear complaints. Although there are approximately 600 cases in the literature, we still lack a detailed description of the clinical evolution of the patients, correlating it with MRI findings of temporal bones and tumor subtype.

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Resumo Introdução: Schwannoma intralabiríntico é um tumor benigno, raro, que afeta as porções mais terminais dos nervos vestibular e coclear. Este tumor pode ser classificado, de acordo com sua localização na orelha interna, em 10 subtipos. Objetivo: Realizar uma revisão abrangente das manifestações auditivas mais frequentes secundárias ao schwannoma intralabiríntico e descrever os possíveis mecanismos fisiopatológicos subjacentes. Método: Revisão sistemática da literatura até outubro de 2017 nas bases de dados PubMed, Web of Science e Scopus. O critério de inclusão foi manifestações clínicas do schwannoma intralabiríntico. Três pesquisadores avaliaram de forma independente os artigos e extraíram informações relevantes. Exemplificamos com a descrição de um caso de schwannoma intralabiríntico subtipo intravestibular com múltiplas formas de apresentações clínicas. Resultados: Vinte sete estudos contemplaram nossos critérios de inclusão. O subtipo do schwannoma intralabiríntico mais comum encontrado foi o intracoclear, seguido pelo intravestibular. Todos os casos apresentaram alteração auditiva, normalmente perda auditiva progressiva. Conclusão: O diagnóstico de schwannomas intralabirínticos baseia-se em exames de ressonância magnética de alta resolução e deve ser incluído no diagnóstico diferencial de pacientes com queixas vestibulococleares. Apesar de termos aproximadamente 600 casos na literatura, ainda nos falta descrição detalhada da evolução clínica dos pacientes em correlação com achados na ressonância magnética de ossos temporais e o subtipo tumoral.

http://bit.ly/2SzH0f1

Preparation of montmorillonite grafted polyacrylic acid composite and study on its adsorption properties of lanthanum ions from aqueous solution

Abstract

Montmorillonite grafted polyacrylic acid composite (GNM) was prepared by using ultraviolet radiation grafting method in this work. The synthesized materials were characterized by XRF, SEM, FTIR, XRD, TG, and XPS. The experimental equilibrium data indicates that the adsorbent is suitable for the Langmuir model and belongs to the pseudo-second-order kinetic model. The entire adsorption process is spontaneous, endothermic, and chaotically enhanced by thermodynamic analysis. The maximum adsorption capacity of La(III) by GNM was 280.54 mg/g at 313.15 K. In addition, the regeneration experiment shows that the adsorbent has good reusability and stable desorption efficiency. This study demonstrates that GNM has high adsorption performance and La(III) adsorption and regeneration capabilities to solve the water pollution caused by rare earth ions and regeneration capabilities for La(III).

http://bit.ly/2DhLNIz

Root uptake of atenolol, sulfamethoxazole and carbamazepine, and their transformation in three soils and four plants

Abstract

Soils can be contaminated by pharmaceuticals. The aim of this study was to evaluate the impact of soil conditions (influencing sorption and persistence of pharmaceuticals in soils) and plant type on the root uptake of selected pharmaceuticals and their transformation in plant-soil systems. Four plants (lamb's lettuce, spinach, arugula, radish) planted in 3 soils were irrigated for 20 days (26) with water contaminated by one of 3 pharmaceuticals (carbamazepine, atenolol, sulfamethoxazole) or their mixture. The concentrations of pharmaceuticals and their metabolites in soils and plant tissues were evaluated after the harvest. Sulfamethoxazole and atenolol dissipated rapidly from soils. The larger concentrations of both compounds and an atenolol metabolite were found in roots than in leaves. Sulfamethoxazole metabolites were below the limits of quantifications. Carbamazepine was stable in soils, easily uptaken, accumulated, and metabolized in plant leaves. The efficiency of radish and arugula (both family Brassicaceae) in metabolizing was very low contrary to the high and moderate efficiencies of lamb's lettuce and spinach, respectively. Compounds' transformations mostly masked the soil impact on their accumulation in plant tissues. The negative relationships were found between the carbamazepine sorption coefficients and its concentrations in roots of radish, lamb's lettuce, and spinach.

http://bit.ly/2Sk0CEO

Extensor indicis opponensplasty: a modified evaluation system

Abstract

Background

Extensor indicis opponensplasty is the gold standard treatment for the restoration of opposition in individuals with median nerve injuries, and it has excellent outcomes. Most authors have used the Sundraraj and Mani scoring system, which considered a thumb reaching any fingertip as a good or excellent outcome. To refine the technique for extensor indicis opponensplasty, we propose an informative yet simple system to describe outcomes.

Methods

This study included 13 patients who underwent extensor indicis opponensplasty for median nerve injuries, with four isolated and nine combined. Six patients had triple insertions, and seven had single/double insertions. The patients were evaluated using the Sundraraj and Mani system and our proposed system for the primary outcome. Secondary outcomes included return to productivity and complications.

Results

We demonstrated that 92% of the patients achieved excellent results according to the Sundraraj and Mani system. We achieved pulp to little pulp (5A) in seven patients, tip to little pulp (5B) in two patients, pulp to ring pulp (4A) in one patient, tip to ring pulp (4B) in one patient, pulp to middle finger pulp (3A) in one patient, and fair opposition (1) in one patient. A 5A score was achieved in five patients with triple insertion.

Conclusions

The new system proposed in this study better facilitates the comparison of technical variations of opponensplasty.

Level of evidence:Level IV, therapeutic study.

http://bit.ly/2MSZ9iE

Endocytosis of CF in marginal cells of stria vascularis regulated by ROCK and MLCK signaling cascade, but not G-proteins

Objective The endocytosis of cationized feritin (CF) via a clathrin-mediated pathway is regulated by a signaling network. Marginal cells showed the active endocytosis of CF via a clathrin-mediated pathway. The internalization of receptors through this clathrin-mediated pathway is an important regulatory event in signal transduction. Numerous kinases are involved in endocytosis, and each endocytic route is subjected to high-order regulation by cellular signaling mechanisms. In this study, we investigated whether ROCK and MLCK signaling cascades and G-proteins regulate the endocytosis of CF in marginal cells of the stria vascularis.

http://bit.ly/2RN72a4

Combustion and emission characteristics for a marine low-speed diesel engine with high-pressure SCR system

Abstract

In order to avoid the production of sulfates and nitrates in marine diesel engines that burn sulfur-containing fuels, the operating temperature of their high-pressure selective catalytic reduction (HP-SCR) systems should be higher than 320 °C. For marine low-speed diesel engines, only the pre-turbine exhaust gas temperature can meet this requirement under specific conditions, with the main engine modulation method helping to increase the exhaust gas temperature. However, the main engine modulation method brings down the power output and fuel economy of the main engine and causes the matching problem of the turbine and the other devices with the main engine. The original engine model of the marine low-speed diesel engine and the high-pressure SCR system configuration model have been constructed using one-dimensional simulation software. In addition, the performance of the high-pressure SCR system under the conditions of low-sulfur and high-sulfur exhaust gas was thoroughly analyzed. Moreover, the two main engine modulation schemes of the scavenging bypass and the turbine exhaust bypass of the original engine matching with the high-pressure SCR system were studied. The study found that the weighted average value of the NOx under the condition of low-sulfur exhaust gas met with the requirement of the IMO Tier III regulations when the low-speed diesel engine was matched with the high-pressure SCR system. However, the weighted average value of the NOx under the condition of high-sulfur exhaust gas was slightly higher than that required by the IMO Tier III regulation. In addition, the optimal main engine modulation scheme for this low-speed diesel engine was clarified by comparing the effects of the scavenging bypass and the turbine exhaust bypass modulation on the exhaust performance, and the working performance of the original engine. With an opening of 0.4 of the CBV valve under 25% engine load, the weighted average NOx of the original exhaust gas was 3.38 g/(kW·h), the power had decreased by 0.7%, and the fuel consumption had increased by 1.0%. Furthermore, when the EGB valve opening was 0.3, the weighted average value of NOx was 3.31 g/(kW·h), the power had reduced by 2.4% and the fuel consumption had increased by 2.5%. Both modulation scheme methods made the exhaust performance of the original engine meet the requirements of the IMO Tier III emission regulations, but the scavenging bypass modulation scheme had less impact on the original engine's performance.

http://bit.ly/2TE4UmP

Enhanced performance of alkali-modified Bi 2 WO 6 /Bi 0.15 Ti 0.85 O 2 toward photocatalytic oxidation of HCHO under visible light

Abstract

Photocatalytic oxidation of formaldehyde (HCHO) is considered as one of the promising ways to resolve indoor air HCHO pollution. TiO₂ has been well known as the most extended application in photocatalysis due to its strong oxidizing ability and stability. Owing to high activity under visible light irradiation, TiO₂ and Bi₂O₃ doping mixed with Bi₂WO₆ was analyzed in this study. The formation of two kinds of heterojunction caused efficient charge separation, leading to the effective reduction in the recombination of photo-generated electron and hole. The special structure and enhanced performance of these catalysts were analyzed. For the first time, the loading of alkali salts was researched for photocatalytic oxidation. In order to understand the reaction mechanism of alkali salts enhanced effects, the catalysts were investigated by using BET, XRD, UV–Vis, FT-IR, SEM, and XPS. The results found more than 2 wt% of Na₂SO₄ loading and the mixed methods with different solutions were key factors affecting the performance of catalysts. Nearly 92% HCHO conversion could be completed over Bi₂WO₆/Bi_0.15Ti_0.85O₂ (Na₂SO₄), and the concentration of HCHO was only 0.07 mg/m³ for 24 h, which was below the limit of specification in China. The results also indicated that the solution mixing method was more favorable to increase the HCHO conversion due to decrease the size of Bi_0.15T_i0.85O₂ particles. The catalysts with Na₂SO₄ loading provided more surface-adsorbed oxygen that facilitated the desorption of CO₂ and markedly increased the photocatalytic oxidation of HCHO.

Graphical abstract

Plausible mechanism over W-Bi2WO6/ Bi0.15Ti0.85O2-Na2SO4 (1:4) catalysts

http://bit.ly/2BpZtky

Influence of the residence time of street trees and their soils on trace element contamination in Paris (France)

Abstract

With the actual increasing interest for urban soils, the evaluation of soil contamination by trace elements and the dynamics of this contamination appear mandatory to preserve plant and thereby human health. Street trees and the associated soil placed in pits located nearby roads could represent convenient indicators of urban and vehicle traffic influences on soils and plants. However, data on these soils remain scarce, many studies investigating park soils rather than street tree soils. Furthermore, trace elements could be one of the main factors causing the observed urban tree decline, while practitioners more and more question the possible reuse of these soils after the death of trees as well as tree litter collected in the streets. We evaluated the contamination in anthropogenic trace elements (TE), namely Zn, Pb, and Cd, of street trees (Tilia tomentosa) and their soils distributed all over Paris (France). Street tree soils are imported from rural areas at the plantation of each new tree so that tree age corresponds to the time of residence of the soil within an urban environment allowing the evaluation of temporal trends on TE concentration in soils and trees. The TE concentration revealed an important soil pollution, especially for the older soils (mean age of 80 years old). The consideration of the residence time of trees and soils in an urban environment evidenced an accumulation of Zn and Pb (ca. 4.5 mg kg⁻¹ year⁻¹ and 4 mg kg⁻¹ year⁻¹ for Zn and Pb, respectively). However, leaf concentrations in TE were low and indicate that soil-root transfer was not significant compared to the contamination by atmospheric deposition. These results underlined the necessity to deepen the evaluation of the recycling of urban soils or plants submitted to urban contamination.

http://bit.ly/2TDxJQi

Purification of water contaminated with Hg using horizontal subsurface constructed wetlands

Abstract

As a global pollutant, Hg (Hg) since the turn of the last century has received increased attention. Decreasing the emission of Hg into the food chain and the atmosphere is an effective way to reduce the Hg damage. The current study provided information about pilot-scale horizontal subsurface flow (HSSF) constructed wetlands (CWs) to remove different Hg species in polluted water. Synthetic wastewater was fed to two HSSF CWs, one was planted with Acorus calamus L and the other was unplanted as a control. The total Hg (THg), dissolved Hg (DHg), and particulate Hg (PHg) from five sites along the HSSF CWs were analyzed to describe the process of Hg removal. Results show that the CWs have high removal efficiency of Hg which is more than 90%. The removal efficiencies of THg and DHg from the unplanted CW were 92.1 ± 3.6% and 72.4 ± 13.1%, respectively. While, the removal efficiencies of THg and DHg in planted CW were 95.9 ± 7.5% and 94.9 ± 4.9%, which were higher than that in blank CW. The PHg was mainly removed in the first quarter of the CWs, which was also revealed by the partition coefficient K_d. To a certain extent, the effect of plants depends on the hydraulic retention time (HRT). The results in the current study show the potential of the HSSF-CWs for restoration from Hg-contaminated water.

http://bit.ly/2BA6vDx