Head and Neck Medicine by Alexandros G.Sfakianakis: OtoLaryngology New Articles

Πέμπτη 15 Οκτωβρίου 2015

OtoLaryngology New Articles

Körperstereotaxie und Lobektomie im randomisierten Vergleich beim NSCLC Stadium I – endlich Level-I-Evidenz?

Update zur kombinierten Radio-, Radiochemo- und alleinigen Chemotherapie bei der multimodalen Therapie des Nasopharynxkarzinoms – eine MAC-NPC-Metaanalyse

Using vowel trajectories for southern U.S. monophthongization

It is widely known that monophthongization of the diphthong /ɑɪ/ is a feature of Southern U.S. English (e.g., Labov, Ash, and Boberg 2006). However, most studies of this phenomenon only use two measurement points, one from the onset and one from the glide, typically around 25% and 75% of the token's duration. While informative about whether or not a particular vocoid is monophthongal, this type of measure does not permit distinguishing among differing types of monophthongal realizations. Research including varieties from the Southern US (cf. Thomas 2000) has found that the trajectory of the vocoid can differentiate social groups. In this investigation, I track the monophthongal realizations from 24 speakers (12 men, 12 women) from Northeast Tennessee, balanced for age and education. I measure each token at 10ms intervals for both F1 and F2 for the entire vocalic duration. Plotting these measures allows for visualization and comparison of the entire trajectory of the articulation. In preliminary work in this population, flatter trajectories inversely correlate with social factors such as age, education, and local attachment. More finely nuanced measures, such as the whole vocalic trajectory, can capture social variation that may be lost when only comparing a few measurement points.

Remote sensing for bottom inversion

The scenarios of interest for estimating bottom and sub-bottom physical properties now encompass both deep and shallow, or very shallow, coastal waters, for the deployment of renewable energy platforms (e.g., wind farms and wave/tidal energy plants). This new paradigm, together with the continuous requirement for reducing survey time (and cost), spinned out the concept of a distributed and reconfigurable seismic survey system composed of a fleet of autonomous underwater vehicles (AUV) carrying acoustic sensing arrays. Such system poses a number of technical as well as scientific challenges, among which that of sensor positioning for optimal bottom inversion performance in a given scenario. The present work addresses this issue through the eye of the sensor configuration that maximizes diversity and proposes sampling incoherence bounds for 1, 2, and 3D array systems. Random sampling is a concept that favors diversity and allows for the usage of low-complexity inversion schemes such as those based on compressed sensing. Simulations on realistic environments illustrate the proposed concept. [This work is part of project WiMUST—Widely Scalable Mobile Underwater Sonar Technology funded under program H2020 of the European Union.]

Using broadband acoustic signals and modal behavior to assess scales of ocean variability in shallow water waveguides

The sound speed fields of the continental shelf water column are anisotropic and have "fronts" related to propagating internal wave packets. The angle between a broadband acoustic signal's source–receiver propagation track and the propagating "fronts" affects its modal composition. If the temporal variability of the modal behavior of the acoustic signals are monitored in time and space, one might identify the fluid process that causes the changes to the sound speed field. In this paper, we first present a heuristic view of how the modal properties of broadband signals can be affected by the sound speed field variability caused by propagating internal wave packets. We then present three days of acoustic field data acquired on vertical and horizontal arrays placed in ~100 m of water about 20 km from the location of acoustic signal sources. Temporal changes in the received acoustic signal's modal composition will be compared to numerical simulations. The changes in modal composition will be correlated to internal wave induced variability in the horizontal refraction of the signals.

Vibration damping and isolation using negative stiffness structures

This work presents a novel class of engineered structures with significant promise to improve vibration damping treatments and isolation systems: negative stiffness (NS) elements. A mechanical system displaying negative stiffness is characterized by a loading state that requires a decreasing force level to increase the deformation of the system. Systems displaying NS will possess regions of negative curvature in their strain energy response as a function of deformation; hence, they are unstable when unconstrained. Analytical and experimental results will be presented demonstrating that NS systems comprised of buckled beams in parallel with positive stiffness springs can be used to construct quasi-zero stiffness vibration isolation systems, which provide high static but low dynamic stiffness for compact base isolation design. Transmissibility measurements of these same systems show that the nonlinearity of NS systems constructed from buckled beam structures enable tunable vibration isolation behavior and isolation from impact. Finally, modeling results will be presented demonstrating that sub-wavelength NS elements embedded in a viscoelastic material can be used to design vibration damping treatments with increased loss factor and minimally reduced stiffness to reduce the ringdown time for an impulsively loaded multi-layered beam. [Work supported by DARPA, ARO, and NSF.]

L + H* and H* pitch accents in Mandarin Chinese

In this study, we examine acoustic correlates of L + H* and H* pitch accents in Mandarin Chinese. In English, L + H* denotes "exclusiveness" and H* conveys "new" information. For example, L + H* A. Katie did not pet the cat, (Kellie did). H* B. Katie did not pet the cat (she pet the dog). Ten Mandarin speakers were asked to produce the English equivalent L + H* and H* pitch accents in Mandarin as in C and D: L + H* C. 咪妮没有摸猫，妞蒙摸了猫 MiNi meiyou mo mao, NiuMeng mo le mao. MiNi did not pet the cat, it is NiuMeng who petted the cat. H* D. 咪妮没有摸猫，咪妮也没有摸狗 MiNi meiyou mo mao, MiNi ye meiyou mo gou. MiNi did not pet the cat, and she did not pet the dog either. MiNi and NiuMeng were produced with all combinations of four Mandarin tones. Preliminary findings from one speaker suggest an interaction between tones and pitch accents such that pitch contour and pitch height of both types of pitch accents vary as a function of tones.

Solid-liner suppressor design, construction, and development

Noise in a fluid system can be treated with a prototypical liner-style suppressor, an expansion chamber which includes an internal annulus of syntactic foam. A syntactic foam liner consists of host material with hollow microspheres which collapse under pressure to add compliance to the suppressor. The liner effectively increases the transmission loss of the suppressor, or ratio between inlet and outlet acoustic energy. Currently, liner-style suppressors are not commercially available. This study will investigate the integration of solid liner material within suppressor shells while also analyzing the effect of flow-smoothing diffusors on the transmission loss of the suppressor. The diffusors function to center the liner within the device, while reducing the potential for turbulence-induced self-noise. The diffusor may also impact the longevity of the liner, by reducing mechanical erosion. The results of the study should provide additional insight to the commercial viability of the liner-style suppressor.

Managing property distribution errors in arrays of coupled resonators

Arrays of small attachments can be designed to draw mechanical energy from a primary structure in a manner far in excess of their proportional size. Earlier work has shown that slight variations or errors in the property distributions of arrays of coupled resonators can have a dramatic effect on the response of primary structure to an external force. This work investigates the use of an electro-mechanical approach to making small adjustments in the stiffness of the individual elements of the array to alter the response of the primary. The electro-mechanical coupling is achieved by way of laminated thin piezoactuators mounted on a fraction of the subordinate elements. The piezoactuators are electrically coupled to a switching network that changes the effective stiffness of the subordinate elements. This ability to adjust the stiffness distribution facilitates real time control of the rate at which the energy is transferred into the coupled array. This apparent damping can then be adjusted to draw or reject energy from specific frequency bands. The presentation will describe the underling theory, present numerical results, and some preliminary experimental results.

A comparison of the reflection coefficient predictions of two competing sediment acoustic models

Currently, there are several competing models that have been used to describe the acoustic properties of sandy sediments. These models include those that assume the sediment to behave as an acoustic fluid, a viscoelastic solid, and as a porous media following Biot theory. Perhaps the two most sophisticated acoustic models that have been applied to sand are the Viscous Grain Shearing (VGS) model of Buckingham and the Extended Biot (EB) model of Chotiros. While both of these models have been found to agree with measured sound speed dispersion and attenuation data, previous work has shown that the reflection coefficients predicted using these models disagree. In this work, the reflection coefficient predictions of the VGS and EB models will be compared for both the case of a homogeneous sand half-space and the case of a sand layer overlying a rock substrate. [Work supported by ONR, Ocean Acoustics.]

Algorithms for measuring periodicity in F0 tracking

Measuring periodicity is an important measurement in speech processing. It can be used in many areas, especially for tracking fundamental frequency (F0), typically referred to as pitch. This seemingly easy measurement is made difficult since even voiced sections of speech are only semi-periodic or periodic over short intervals. In this paper, four functions for measuring periodicity are compared for both time domain and frequency domain processing. They are autocorrelation, normalized cross correlation function, spectral harmonics correlation, and normalized spectral harmonics correlation. In some cases, these four functions behave very similarly to each other; however, there are advantages and disadvantages, depending on conditions. The functions were experimentally evaluated in an F0 tracking experiment based on the Keele database, which has "ground truth" for pitch.

Improving reliability of measurement algorithms in differentiated electroglottograph and audio signals

The purpose of this work was to develop an optimized algorithm for determining the closed quotient (CQ) measurements of the vocal folds of female singers. This study extends previous results which showed that the measurement algorithm for differentiated electroglottograph (dEGG) signals and differentiated audio (dAUDIO) signals gave moderately reliable results with a correlation coefficient of r = 0.79. Additional performance studies indicate that the reliability may be improved by combining the differential signals and modifying the measurement algorithm to reduce the amount of signal overlap. Preliminary results using the modified measurement algorithm yield a significant increase in the correlation coefficient (r = 0.83). This works contributes to the development of a computational framework for determining accurate and reliable measurements for characterizing register shifts through an octave in female singers using electroglottography.

Acoustic propagation in the Strait of Georgia

In recent years, there has been a proliferation of Ocean Observing Systems (OOS) along with a wide distribution of their associated data products. The collected data support scientific research, industry, and government organizations by providing long term measurements of biological, chemical, and physical properties of the ocean environment. However, the collection and distribution of underwater acoustic data poses a potential security risk for naval vessels operating in the vicinity of OOS. The Canadian Forces Maritime Experimental and Test Ranges (CFMETR) provide an underwater tracking facility for naval tests, and are approximately 50 km from hydrophones of the Victoria Experimental Network Under the Sea (VENUS) observatory. Under an existing CFMETR-VENUS agreement, data are diverted during certain naval tests. In order to minimize the frequency of these data diversions, a study is being conducted to investigate acoustic propagation in the Strait of Georgia. The results of acoustic modeling and measurement of transmission loss from CFMETR to VENUS will be presented. A software application called CAVEAT is also presented. The application was developed to integrate the transmission loss results along with other sonar parameters to enable operators at CFMETR to determine the risk of acoustic exposure.

Removable damping treatments for use in sheet metal fabrication

Many industrial fabrication processes on metallic structures generate a great deal of work place noise. For example, riveting and chiseling on light-weight, stiff aerospace structures such as fusalage components and flight surfaces subject the workpiece to repeated impacts and consequent noise generation. Many such structures may be lightly damped. Many damping treatments are targeted toward permanent installation on a structure, but if the treatments are considered to be removable, one has design freedoms including placement on a structure, as well as mass and damping means, that might not otherwise exist if the treatment had to remain in place. A shot-mass or particle-impact damper configured in an elastic, cellular array is shown to provide high loss factors and mass loading, which, along with ease of placement and removal, may provide significant reduction in component vibration during fabrication and consequent reduction in noise in the work place. The concept applied to an example aircraft panel when subjected to riveting operations yields more than 10 dB of noise reduction.

Using automatic alignment on child speech: Directions for improvement

Phonetic analysis is labor intensive, limiting the amount of data that can be considered. Automated techniques (e.g., forced alignment based on Automatic Speech Recognition, ASR) have recently emerged allowing for larger-scale analysis. While forced alignment can be accurate for adult speech (e.g., Yuan & Liberman, 2009), ASR techniques remain a challenge for child speech (Benzeghiba et al., 2007). We used a trainable forced aligner (Gorman et al., 2011) to examine the effect of four factors on alignment accuracy with child speech: (1) Datasets CHILDES (McWhinney, 2000):—Spontaneous speech (single child)—Picture naming (multiple children, Paidologos data); (2) Phonetic Transcription—Manual—Automatic—CMU dictionary (Weide, 1998); (3) Training data—Adult lab data—one dataset of child data—All child data—Child & adult lab data; (4) Segment—voiceless stops—voiceless sibilants—vowels Automatically generated alignments were compared to hand segmentations. While there were limits on accuracy, in general, better results were obtained with (1) picture naming, (2) manual phonetic transcription, (3) training data including child speech, and (4) voiceless stops. These four factors increase the utility of analyzing children's speech production using forced alignment, potentially allowing researchers to conduct larger-scale studies that would not otherwise be feasible.

Computationally efficient algorithm for Kirchhoff approximation

In order to simulate the target echoes scattered from submerged underwater objects, Kirchhoff approximation is widely used for high frequency region. Since Kirchhoff integration is based on integrating the contributions from discretized boundary elements, the computation can be time-consuming especially for broadband pulses. In this study, a numerically efficient method for generating the scattered signal in time domain based on convolution is proposed and tested. It is shown that the computational time can be reduced by an order of 10–100 in typical cases.

The acoustic complexity of keyboard percussion instruments. Part II: What we know and what we wish we knew Leigh Howard Stevens

Part II Resonating chamber shapes, their Q factor, their resultant musical character Resonating Chambers come in many shapes and sizes and largely determine the power, focus, and sustain of whatever the associated tone bar is coupled with it. The most basic box resonators are found on elementary education musical instruments such as Carl Orff tuned percussion instruments: demonstration of various tone bars resonating over box, rectangular, square and round tube resonators; demonstration of high and low Q systems responding to the same tone bar; demonstration of well-tuned, miss-tuned, and deliberately de-tuned partials on various tone bars; and questions from (and challenges to!) the audience.

The clarinet: Past, present, and future

The modern clarinet is the result of several hundreds of years of research and craftsmanship. This paper will discuss where the clarinet has been acoustically by studying some input impedance spectrum characteristics of historical instruments (the Baroque Chalumeau, 13-key, etc.). The paper will then present where we are at present—focusing on the same measurement information for a full Boehm system (multiple models of Bb clarinets) and a comparison of the modern French vs. German system clarinet. Finally, a few words will be given on the possible future of the instrument—where we are going, what are we doing to continue improving the instrument's quality and playability.

The acoustic complexity of keyboard percussion instruments. Part I: (What we know and what we wish we knew) Leigh Howard Stevens

Part I Introduction to tuned bars and resonators Keyboard Percussion Instruments include innumerable variations of marimbas, xylophones, vibraphones, and glockenspiels. The tone bars, made of wood, metal, or other materials, are often incapable of producing sufficient volume without the amplifying assistance of a resonating tube or chamber. Unfortunately, these two vibrating systems (bar and resonator) react in opposite directions to changes in temperature, decoupling from their ideal relationship with any rise or fall in temperature. Also, unlike string, brass, or woodwind instruments, where the overtones are produced "naturally" and "are what they are," the overtones of the bars of keyboard percussion instruments can be manipulated and controlled in the design and manufacturing process. For example, while both instruments have tone bars made of rosewood, the xylophone has the second partial tuned to an octave and a perfect fifth above the fundamental, while a marimba has the second partial tuned to a frequency two octaves above the fundamental. While we can identify and lower the frequency of many of the prominent partials contained in tone bars, their interdependence within the bar, and their coupling with a resonator provides a level of complexity for the designer and manufacturer, perhaps unrivaled in musical instrument manufacturing.

Signature calls predict foraging success in big brown bats (Eptesicus fuscus)

Animals foraging in the dark must simultaneously pursue prey, avoid collisions, and interact with conspecifics, making efficient non-visual communication essential. A variety of birds and mammals emit food-associated calls that inform, attract, or repel conspecifics. While echolocation by the insectivorous, aerial-hawking big brown bat (Eptesicus fuscus) has been studied extensively, communicative calls used by this species have received comparatively little research attention. We report on a rich repertoire of vocalizations produced by big brown bats in a large flight room equipped with synchronized high-speed stereo video and audio recording equipment. We also provide evidence that a specific social call, the "frequency-modulated bout" (FMB), which is emitted only by males, exclusively in a foraging context, and only when conspecifics are present, predicts the caller's foraging success and is individually distinct. Bats were studied individually and in pairs, while sex and experience with a foraging task were experimentally manipulated. Individuals emitting a higher number of FMBs showed greater prey capture success. Following FMB emission, inter-bat distance, diverging flight, and the other bat's distance to the prey increased. These findings highlight the importance of vocal communication for nocturnal animals mediating interactions in a fast-paced foraging setting.

Interpretations of the frequency difference autoproduct in multipath environments

When locating remote acoustic sources in a shallow ocean sound channel, the established array signal processing technique known as matched field processing (MFP) has shown much success. However, MFP is sensitive to mismatch between the modeled and actual environments, and may fail to localize acoustic sources in the presence of such mismatch, particularly at high frequencies. A recent nonlinear array signal processing technique, frequency difference MFP (Abadi et. al. 2012, Worthmann, et. al., under review), has shown some success in localizing high frequency sources by moving the replica calculations to a lower, out-of-band, difference frequency where the detrimental effects of environmental mismatch are less severe. To extract the requisite out-of-band difference frequency information from the measured signals, a quadratic product, termed the autoproduct, is formed from complex signal amplitudes separated by the difference frequency but still lying within the signal bandwidth. Through the use of simple multipath propagation environments, the nature of this autoproduct is explored, and the reasons that it provides out-of-band field information are presented. More complex propagation environments are simulated as well to demonstrate some of the expected and unexpected behaviors of the autoproduct. [Sponsored by the Office of Naval Research and the National Science Foundation.]

Stochastic-basis matched-field processing

Matched-field processing (MFP) suffers serious degradation due to environmental mismatch between received acoustic-field vectors and modeled replica vectors. Physical reasons for degradation include uncertainty caused by incomplete descriptions of the parameters and fields necessary for correct specification of the acoustic waveguide (i.e., environmental uncertainty), and system uncertainty associated with incomplete knowledge of the array configuration, source depth, etc. Recent research in the theory of stochastic-basis expansions (polynomial chaos) provides a mathematically consistent way of incorporating both types of uncertainty into MFP. Such expansions are used efficiently to construct replica matrices that steer high-rank subspaces capable of capturing signals with uncertain wavefronts. When combined with cross-spectral density matrices, stochastic-basis steering matrices enable the design of new processors with properties not previously evaluated in a MFP context. A maximum likelihood processor is developed which incorporates environmental uncertainty through polynomial chaos expansions. The processor can be written as a Frobenius product between an estimated cross-spectral density matrix and the inverse of a stochastic-basis replica matrix. This talk will outline the theoretical foundation of stochastic-basis MFP, and illustrate the method with some simulations. [Work supported by the Office of Naval Research.]

New bone formation induced by surface strontium modified ceramic bone graft substitute

Abstract

Objectives

This study assessed the effect of surface strontium ion (Sr) modification on the osteogenic activity of an osteoconductive ceramic bone graft substitute with the hope of using the bone healing effect of Sr for potential application in periodontal and maxillofacial regenerative surgery.

Materials and methods

A simple wet chemical treatment was employed to deliver Sr to the surface of particulate porcine bone graft. The osteogenic activity of surface Sr-modified bone substitute was compared in vitro and in vivo with that of unmodified ceramic bone, other clinically available synthetic bone or osteoinductive allograft bone.

Results

The resultant bone substitute showed the formation of Sr-containing microstructured surface layer along with the formation of additional nanostructures and displayed sustained Sr release. Sr modification promoted the osteogenic differentiation of bipotential ST2 stem cells. Sr-modified bone substitute increased the amount of newly formed bone at early healing period in calvarial defect of rabbits.

Conclusions

These results suggest that the surface Sr modification by wet chemical treatment is a promising approach to enhance the early bone healing capacity of osteoconductive ceramic bone substitutes.

Text as a Supplement to Speech in Young and Older Adults.

Objective: The purpose of this experiment was to quantify the contribution of visual text to auditory speech recognition in background noise. Specifically, the authors tested the hypothesis that partially accurate visual text from an automatic speech recognizer could be used successfully to supplement speech understanding in difficult listening conditions in older adults, with normal or impaired hearing. The working hypotheses were based on what is known regarding audiovisual speech perception in the elderly from speechreading literature. We hypothesized that (1) combining auditory and visual text information will result in improved recognition accuracy compared with auditory or visual text information alone; (2) benefit from supplementing speech with visual text (auditory and visual enhancement) in young adults will be greater than that in older adults; and (3) individual differences in performance on perceptual measures would be associated with cognitive abilities. Design: Fifteen young adults with normal hearing, 15 older adults with normal hearing, and 15 older adults with hearing loss participated in this study. All participants completed sentence recognition tasks in auditory-only, text-only, and combined auditory-text conditions. The auditory sentence stimuli were spectrally shaped to restore audibility for the older participants with impaired hearing. All participants also completed various cognitive measures, including measures of working memory, processing speed, verbal comprehension, perceptual and cognitive speed, processing efficiency, inhibition, and the ability to form wholes from parts. Group effects were examined for each of the perceptual and cognitive measures. Audiovisual benefit was calculated relative to performance on auditory- and visual-text only conditions. Finally, the relationship between perceptual measures and other independent measures were examined using principal-component factor analyses, followed by regression analyses. Results: Both young and older adults performed similarly on 9 out of 10 perceptual measures (auditory, visual, and combined measures). Combining degraded speech with partially correct text from an automatic speech recognizer improved the understanding of speech in both young and older adults, relative to both auditory- and text-only performance. In all subjects, cognition emerged as a key predictor for a general speech-text integration ability. Conclusions: These results suggest that neither age nor hearing loss affected the ability of subjects to benefit from text when used to support speech, after ensuring audibility through spectral shaping. These results also suggest that the benefit obtained by supplementing auditory input with partially accurate text is modulated by cognitive ability, specifically lexical and verbal skills. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.
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Solitary Plasmacytoma in the Internal Auditory Canal and Cerebellopontine Angle Mimicking Meningioma.

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Solitary Plasmacytoma in the Internal Auditory Canal and Cerebellopontine Angle Mimicking Meningioma.

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DNA methylation and detection of cervical cancer and precancerous lesions using molecular methods

Abstract

Cervical cancer is the third most common cancer disease affecting the female population, and a key factor in the development of the disease is the human papillomavirus infection (HPV). The disease is also impacted by epigenetic changes such as DNA methylation, which causes activation or exclusion of certain genes. The aim of our review is to summarize and compare the most common molecular methods for detection of methylated promoter regions in biomarkers occurring in cervical carcinoma and also show the importance of connections of HR-HPV testing with methylation analysis in patients with cervical intraepithelial neoplasia. Insight into genetic and epigenetic alterations associated with cervical cancer development can offer opportunities for the molecular biomarkers that can be useful for screening, diagnosis, and also as new ways of treatment of cervical cancer precursor lesions.

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Esculin and its oligomer fractions inhibit adhesion and migration of U87 glioblastoma cells and in vitro angiogenesis

Abstract

Cancer metastasis is the major cause of cancer-related death. Chemoprevention is defined as the use of natural or synthetic substances to prevent cancer formation or cancer progress. In the present study, we investigate the antitumor activity of esculin and its oligomer fractions in U87 glioblastoma cells. We showed that esculin and its oligomers reduced U87 cell growth in a dose dependent manner. They also inhibited cell adhesion to collagen IV and vitronectin by interfering with the function of their respective receptors α2β1 and αvβ5 integrins. Furthermore, the tested samples were able to reduce migration of U87 cells towards another extracellular matrix fibronectin. Moreover, esculin and its oligomer fractions inhibited in vitro angiogenesis of endothelial cells (HMEC-1). In summary, our data provide the first evidence that esculin and its oligomer fractions are able to reduce adhesion, migration of glioblastoma cells and in vitro angiogenesis. Esculin and its oligomers may thus exert multi-target functions against cancer cells.

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Text as a Supplement to Speech in Young and Older Adults.

A cavitation threshold for transient signals applied to laboratory-scale sparker-induced pulses

The phenomenon known as cavitation can occur when a volume of liquid is subjected to a pressure that falls below a "cavitation threshold". Following this cavitation inception, a rupturing of the fluid or rapid growth of microbubbles occurs. The cavitation threshold is typically thought to be equal to the vapor pressure of the fluid; however, laboratory experiments involving underwater high-amplitude sparker-induced pulses have demonstrated that this is not necessarily the case. This presentation introduces a generalized threshold for transient acoustic pulses based on previous work of a threshold for constant-frequency transient signals. The output of this transient cavitation threshold will be compared against simulation and experiment.

Disentangling the contribution of pitch and duration cues in first and second language perception of the Mandarin neutral tone

Most L1 and L2 Standard Mandarin (SM) perception tests focus on the four lexical tones. However, none take into account the neutral tone (NT) for L2 speakers, and few do for L1 speakers (e.g., Yang, 2010). Pitch onset aside, the relatively short duration of NT syllables is assumed to be their primary perceptual cue (Lin and Yan, 1980). This study tested which perceptual cues are used by L1 and L2 groups. To this end, 9 L1 and 9 L2 learners (L1 British English) participated in a five-way alternative forced-choice tone identification task. Three minimal pair disyllabic tokens containing NT were used as stimuli. Syllables carrying NT were manipulated in PRAAT using steps of 30, 50, 70, and 100% manipulation for pitch and/or duration. Pitch was progressively manipulated to mimic that of a lexical tone, while duration progressively approached that of a lexical tone in second syllable position. This study found that L2s rely primarily on duration to identify NT, while L1s rely primarily on pitch. This expands previous studies showing that duration interferes with L2 SM tone perception (Blicher et al., 1991; Chang, 2011). By contextualizing this finding, new models are proposed for L2 SM tone perception and acquisition.

Improved multiple focusing with adaptive time-reversal mirror in the ocean

The linearly constrained minimum variance (LCMV) method in adaptive signal processing is designed in such a way that it attempts to minimize the output power subject to constraints on the look directions. This adaptive method has been applied to time-reversal mirror (TRM) for simultaneous multiple focusing and its efficiency has been verified by [Kim et al., J. Acoust. Soc. Am. 109 (5), 1817–1825 (2001)]. However, the norm of the weighting vector ‖w‖ that satisfies the constraints tends to become very large when two probe sources (PS) are close to each other. It causes prominent spatial sidelobes as the weighting vector w is back-propagated in TR focusing. In this study, a relationship between ‖w‖ and PS locations is illustrated, and LCMV method is partially reformulated to calculate the weighting vector w which satisfies new constraint responses, so that sidelobes are significantly suppressed. The proposed method for improved adaptive time-reversal mirror for stable simultaneous multiple focusing is verified using numerical simulations and experimental data.

The effect of elastic point contact: theory and experiment

It has recently been pointed out that nearfield deformation in the neighborhood of an elastic point contact can have significant phenomenological effects, producing shifts of resonance frequencies and serving as a source of loss. In order to take these effects into account, it is necessary to employ three dimensional elasticity theory, precluding the use of lower dimensional dynamic models, for example, plate elements in a finite element analysis (FEA) computation. This is a very significant limitation because the frequency response of many large complex structures can only be predicted using such models. We propose here a theoretical modeling approach that resolves this problem and enables the use of lower dimensional models in the analysis of such systems. We have found the predictions of the model to be in good agreement with experimental measurements in the cases we have examined so far, translational and cantilever resonators. Research funded by the Office of Naval Research.

Accent and fluency in third language acquisition

This paper examined the influence of L2 on L3 accent and fluency. Target participants were native speakers of Chinese who have studied English as an L2 prior to beginning their study of Japanese as L3. Participants were recorded in L2 and L3, and their speech samples were rated by expert judges of respective language. The judges were asked to rate each speaker based on foreign accentedness and overall fluency. The results from English and Japanese were analyzed using correlation analysis. The result of the correlation analysis showed a positive correlation between accent in L2 and L3, which suggests that, regarding foreign accentedness, the better a speaker performs in L2, the better they also perform in L3. The correlation between L2 and L3 in terms of fluency did not reach significance, mostly due to the fact that fluency rating in English was done mildly by the judges. The result nevertheless showed a clear trend toward positive correlation between the two languages. This study contributes to the area of Third Language Acquisition by supporting the idea that L3 acquisition is qualitatively different from L2 acquisition, and phonological acquisition in L3 is influenced not only by the learner's L1 but also their L2.

Acoustical Society of America Silver Medal in Speech Communication: John J. Ohala

The Silver Medal is presented to individuals, without age limitation, for contributions to the advancement of science, engineering, or human welfare through the application of acoustic principles, or through research accomplishment in acoustics.

Wireless underwater acoustic beamforming using chip-scale atomic clock timers

Obtaining the directionality of the sound field is typically performed using a cabled array of hydrophones, connected to a central data collection device. The cable introduces vulnerability wherein an electrical break in the line or dragging by currents or anchors may render the array inoperable. An underwater wireless beamforming system, which transmits time and recorded low-frequency sounds using directional high-frequency acoustic communications between elements, is presented here. Each element is contained in a standalone housing that contains batteries, amplifiers, signal conditioning hardware and a field-programmable gate array (FPGA)-based signal processing computer. Low-frequency sounds are recorded at a sampling rate of 2 kHz, then transmitted using binary phase-shift-key (BPSK) encoding at a center frequency of 750 kHz. Inter-element spacing estimates are facilitated by the time-stamped high-frequency signals. System timing is controlled by a Symmetricom® SA.45s chip-scale atomic clock (CSAC) embedded in each unit, connected to the FPGA. In addition, a CSAC output waveform is divided and modified to form the high-frequency multiplier waveform for the BPSK signal. The elements were deployed in shallow water offshore of Panama City, FL, in August 2015. [This work was supported by the Office of Naval Research.]

Acoustical Society of America Distinguished Service Citation: Paul D. Schomer

The Distinguished Service Citation is awarded to a present or former member of the Society in recognition of outstanding service to the Society.

Acoustical Society of America Silver Medal in Signal Processing in Acoustics: Brian G. Ferguson

Railway vibration and noise reduction using particle impact dampers

Rolling noise is becoming a increasing concern for residential areas near railways. Rail vibration caused by moving loads of a train and corrugations generates noise. This study presented a particle impact dampers and its application to reduction of the rolling noise. The particle impact dampers to efficiently reduce the vibration were designed and verified using simplified models of a railway. To verify the particle impact damper performance, the vibration of a simplified railway attached with particle impact dampers was measured. The effects of different clearances and mass ratio of the damper to the railway was investigated. The numerical predictions of finite element model of impacting dampers were proposed and verified to the measured results to find the vibration reduction mechanism.

Numerical hybrid TMM-modal finite element method prediction of the vibroacoustic of sandwich panels with add-on damping

This paper discusses the numerical modeling of the vibroacoustic response of sandwich-composite panels with add-on damping, under a diffuse acoustic field (DAF) excitation. A modal synthesis approach is used for the calculation of the structural response and the Rayleigh's integral is used for the acoustic response. Since the panel has a viscoelastic core, a methodology is presented to handle efficiently the modeling of the frequency depended properties of the viscoelastic layer. A hybrid TMM-modal FEM method is used to predict the acoustic response at high frequency, using the equivalent damping of panel which are calculated from strain energies. Next, a parameters study on the effect of the viscoelastic layer location is presented. In particular, three locations are compared: within the Honeycomb core, within the skins and added to the skin with a constraining layer. The effects of the excitation type on the vibration and acoustic response are also discussed. Key words: Sandwich NIDA, Modal FEM method, TMM method, viscoelastic damping, acoustic response, equivalent properties.

Perception and production abilities of question vs. statement intonation patterns in young deaf children with early cochlear implantation

Little research exists studying production and perception of prosody in early-implanted children with cochlear implants (CIs). Because of limited F0 information conveyed by CIs, there is particular interest in the impact of CIs on intonation perception and production. The aim of the present study was to describe and compare the ability of hearing (HC) and implanted (IC) children to perceive and produce distinctions between question vs. statement intonation patterns. Nine HC and 9 IC between 38 and 58 months of age participated in the study. All IC received their first implant prior to 15 months and had no other identified medical or developmental problems besides hearing loss. To determine the children's ability to perceive rising and falling intonation, an imitation task was used. Results showed no significant difference in perception between the groups (p = .09). Intonation production was examined by eliciting yes–no questions and statements during a play-based task. Production measures included mean, range, and slope of F0. While F0 range was significantly greater for IC than for HC (p = .015), no other measure was found to be significantly different between the two groups. Overall, early-implanted deaf children with CIs appear to develop intonation comparable to their hearing peers.

Acoustical activity of lithium niobate crystals

Acoustical activity in Lithium Niobate crystals was investigated by method of Bragg light diffraction. Transverse acoustic waves were excited in the range of 0.4–1.6 GHz using quartz piezoelectric plates. LiNbO3 samples were oriented at small angles to the axis Z in the crystallographic plane (010). Specific rotation of the polarization plane of transverse waves was determined from the dependence of the intensity of the diffracted light of the distance from the piezoelectric transducer along the acoustic wave propagation. The observed large specific rotation of the polarization plane of the acoustic waves can be used in devices controlling the intensity of light by the phenomenon of acoustical activity. Components of the imaginary part of the generalized Christoffel tensor taking into account the spatial dispersion have been determined also. It is shown that in crystals of class 3m the imaginary components of the Christoffel tensor for all the directions in the symmetry plane (100) are zero.

How do L1 and L2 influence on the acquisition of L3 (English) stress pattern

In this research, we investigated the acquisition of English stress by trilingual speakers (Kazakh/Russian (L1)-Russian/Kazakh (L2)-English (L3). Stress in Kazakh, as a Turkic language, is on the final position (Johnson, 1998) and was cued by fundamental frequency (Kirghner, cited from Kondibaeva, 2010). However, in Russian, stress was cued by duration and intensity (Hamilton, 1980; Kuznetsova, 2006). In this research, we used two different trilingual groups in which the Kazakh-Russian-English trilingual group has Kazakh as a dominant language and first language; on the other hand, the Russian-Kazakh-English trilingual group has Russian as a dominant language with the advanced level of Kazakh. However, both groups have high level of English (IELTS = 6.5 and above). All participants from both groups produced the noun-verb stress pattern words in sentences. In the production of ten female speakers from each group, average fundamental frequency, duration, average intensity, and first and second formant frequencies for vowels were collected in the stressed and unstressed syllables. The result showed that for Russian-Kazakh-English speakers, duration and intensity are stronger cues than F0. Kazakh-Russian-English trilinguals used all parameters, but duration was strongly associated with final lengthening. The results will be discussed in terms of L1/L2 transfer into the acquisition of L3.

A single equation for predicting required ocean and seismic acoustic fiber optic sensor response

In the past decade, requirements have evolved for systems of ocean bottom and seismic downhole acoustic sensors with high dynamic range, wider bandwidths, and which will operate reliably for a decade or more in high-pressure-high-temperature environments. As seismic and acoustic survey spatial resolution, operating depth, and range requirements have increased, higher sensor string counts have been required to provide the needed improvements in target definition. Fiber optic sensors and telemetry systems are being developed which allow HPHT operation, without vulnerable electrical telemetry in the "wet" end of the system, and which can reliably transmit high-sensor count string outputs which are 10's of km from the processor. This paper introduces a modified version of the SONAR equation which allows straight forward estimation of the required fiber optic acoustic sensor response, early in the system design stage, and allows the system engineer to define and optimize sensor response requirements and help minimize system performance risks.

Foreign accentedness of English sentences spoken by Japanese EFL learners and Japanese teachers of English: A first report

This study reports the results of a foreign-accented-rating experiment that investigate the foreign accentedness of spoken English sentences by two Japanese groups, Japanese EFL learners and Japanese teachers of English. This study aims first to investigate whether spoken English sentences by Japanese teachers of English are judged less foreign-accented than those by Japanese EFL learners, and second to investigate whether American-English listeners rate spoken English sentences by Japanese speakers more severely than Japanese listeners do. The stimuli were five sentences adopted from Flege, Munro, and McKay (1995) spoken by 33 Japanese EFL learners and 33 Japanese teachers of English. Ten American-English speakers and ten Japanese speakers were asked to rate the stimuli presented visually and auditorily by clicking along a line on the computer screen for their ratings. The participants' original responses were converted to 10 scales and were submitted to the analyses. The results showed that spoken English sentences by Japanese teachers of English were rated significantly less Japanese-accented than those by Japanese EFL learners. The results further revealed that as in the previous studies, the American-English speakers rated spoken English sentences by two Japanese groups significantly more severely than Japanese speakers. [Work supported by JSPS.]

Deep ocean vector sensor array performance metrics

Recent work in passive sonar has drawn interest in the potential for vertical line arrays (VLAs) deployed below the critical depth—the depth inthe deep ocean at which the sound speed below the channel axis reaches the sound speed near the surface. Such arrays can take advantage of propagation via the reliable acoustic path (RAP), which has been shown to improve thesignal-to-noise ratio (SNR) of received signals from sources at or near the surface at moderate ranges. The potential of these deep ocean VLAs hasspawned further interest in the design of vector sensor VLAs that would allow azimuthal rejection and additional array gain over conventional pressure sensor VLAs. This work will present simulation results that explore and quantify the performance of such vector sensor VLAs deployed in thedeep ocean in terms of surface area coverage, detection probability, andoperational lifetime. The potential use of these deep ocean vector sensorarrays to estimate source depth using the depth-harmonic interferencebetween direct and surface-reflected acoustic arrivals will also be discussed.

Acoustical Society of America Distinguished Service Citation: Allan D. Pierce

The Distinguished Service Citation is awarded to a present or former member of the Society in recognition of outstanding service to the Society.

Extending the distributed-basis transition matrix for acoustic target scattering to highly oblate elastic objects in free-field

In previously presented work, a variant of Waterman's transition (T) matrix utilizing an ansatz for problematic outgoing basis functions in standard formulations was proposed and demonstrated to improve the stability of free-field acoustic scattering calculations for elongated axisymmetric elastic objects. The ansatz replaced the basis causing instability with a non-local basis consisting of low-order spherical functions made into a complete set by distributing the functions along the axis within the object. Unfortunately, as pointed out by Doicu, et al. [Acoustic & Electromagnetic Scattering Analysis Using Discrete Sources, Academic Press, London, 2000], these bases are not as useful for expanding surface fields on oblate axisymmetric shapes. However, they suggested an alternative basis for such shapes in the form of low-order spherical functions made complete by analytically continuing them into a complex plane of the axial coordinate of the object and distributing them along the imaginary axis of this axial coordinate. This presentation will show how this alternative performs in our T-matrix formulation for highly oblate axisymmetric objects, discuss sources of residual noise, and suggest ways to remediate the noise for such shapes. [Work supported by ONR.]

Two strategies for distinguishing ngã and sắc tones in Northern Vietnamese

The six tones of Northern Vietnamese involve F0 and phonation properties. We examine the acoustic manifestation of two rising tones usually characterized as having distinct phonation (ngã = creaky and sắc = modal) in 1584 vowels produced by 9 Hanoi speakers (88 real three word compounds, 8 target vowels /a/, /i/, /u/ with sắc and ngã in first two syllables). Based on measurements of F0, energy, duration, and phonation properties (spectral tilt, CPP, and HNR), we observed two strategies for producing the two tones: (a) both F0 and phonation differences, where creaky voice appeared in >78% of the ngã tones (N = 7); (b) only F0 difference, where creaky voice appeared in tones (N = 2). Classification of the data into the two tones with Binary Logistic Regression Analyses confirmed the distinct behaviors. In the first strategy, the main property distinguishing ngã from sắc is HNR (84%), but F0 was also very successful (75%). In the second strategy, F0 was the only significant property (90%). Given that there were no age, gender, or educational differences, we suggest that the patterns may be due to (i) a regional dialectal difference or (ii) a change in progress in Vietnamese.

Narrow Band Imaging: A Tool for Endoscopic Examination of Patients With Laryngeal Papillomatosis

Objectives:
Narrow band imaging (NBI) is supposed to be a technique for a better visualization of vessel structures in superficial tissue as it selects the wavelengths of hemoglobin. It was hypothesized that, in the regular follow-up examination of patients with recurrent laryngeal papillomatosis, NBI enables a better detection of laryngeal papillomatosis in contrast to normal white light endoscopy.
Methods:Eleven patients, 10 with a known recurrent papillomatosis (8 with a relapse, 2 without) and 1 with a primary diagnosis of papillomatosis, were examined with normal white light and NBI endoscopy. Twenty-six video sequences (11 white, 11 NBI, 4 doubled for validity) were generated and randomly presented to 20 otolaryngologists who rated the videos in terms of lesions seen and number of lesions identified. Results were compared with the histopathologic findings of microlaryngoscopy.
Results:Detection of papillomatosis and the correct number of lesions identified were more accurate with NBI than with normal white light endoscopy. There was a significantly higher probability of detecting laryngeal papillomata with NBI.
Conclusions:NBI endoscopy enables a more accurate detection of laryngeal papillomatosis than white light endoscopy.

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Six-Year Experience With Endoscopic Thyroidectomy: Outcomes and Safety Profile

Background:
Though minimally invasive video-assisted thyroidectomy (MIVAT) offers many advantages over traditional thyroid surgery, its adoption in North America has been limited. This study analyzes the largest series of MIVAT in North America to explore its safety.
Methods:A prospectively maintained database of all patients undergoing thyroid surgery by a single surgeon from 2003 to 2011 at an academic tertiary care medical center was evaluated. Demographic information, surgical and pathologic data, and postoperative outcomes were analyzed.
Results:Beginning in 2005, a total of 260 MIVATs were performed during the study period. Outpatient surgery was accomplished in 234 MIVATs (90%). MIVAT patients were predominantly young (46.8 ± 14.8 years vs 52.4 ± 14.6 years for conventional thyroidectomy) and female (88.5% vs 75.5% for conventional thyroidectomy). There were no cases of permanent hypoparathyroidism or permanent recurrent laryngeal nerve dysfunction. Observed complications included transient recurrent laryngeal nerve dysfunction (n = 10; 3.8%), cellulitis (n = 1; 0.4%), and temporary hypocalcemia (n = 6; 2.3%). The overall complication rate for MIVAT (6.5%) was lower than the overall complication rate in conventional thyroidectomy (18.5%, P < .0001).
Conclusion:MIVAT can be performed safely with a low complication profile in a high-volume practice. The safety of MIVAT represented by this experience supports broader adoption across surgical practices.

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Harmonic Scalpel and Electrothermal Bipolar Vessel Sealing System in Head and Neck Surgery: A Prospective Study on Tissue Heating and Histological Damage on Nerves

Objectives:
Define and compare the thermal nerve injury caused by 3 different vessel sealing and dissection devices: the harmonic scalpel (HS), the electrothermal bipolar vessel sealing system (EBVS), and the bipolar electrosurgery unit (BE).
Methods:First we recorded the heating variations in pig tissue caused by a BE unit, HS, and EBVS after an activation for 5, 10, and 15 seconds at minimum and at maximum power. In the second part, we evaluated the histological damage caused by HS and EBVS on 20 in vivo human nerves, 10 per device. The 2 scalpels were placed and activated at 3 different distances from the nerve (1, 3, and 5 mm). The extension and the degree of the nerve lesion was then calculated.
Results:The instrument determining the highest rise in temperature was the BE unit, followed by HS and then EBVS. Comparison between the extension and degree of nerve injury caused by the 2 scalpels showed no statistically significant differences. Based on these evaluations, we established a relative safety limit at 3 mm and an absolute safety limit at 5 mm for both scalpels.
Conclusions:Our data suggest EBVS and HS can be considered valid and safe devices for ENT surgery.

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Short-term Peripheral Auditory Effects of Cranial Irradiation: A Mouse Model

Objectives:
Assess postcranial irradiation: (1) short-term threshold shift, (2) short-term peripheral auditory histopathology, and (3) the mouse as an experimental model.
Methods:Adult mice were exposed to single-dose radiation of 10 to 60 Gy. Pre- and post-irradiation (baseline, 2-8 days) audiometric brainstem response data were recorded with analysis of cochlear ultrastructure.
Results:Significant threshold shift occurred at all test frequencies in mice exposed to ≥20 Gy at 4 to 6 days post-irradiation. Ultrastructurally in Rosenthal's canal and the spiral lamina, neuronal density and extracellular matrix decreased dramatically. There was overall preservation of hair cells, stria vascularis, and vasculature. No difference within Gy group was noted in the frequency or severity of pathology along the length of the cochlea.
Conclusions:The initial impact of radiation in the first week post-exposure focuses on spiral ganglion cell bodies and peripheral projections, resulting in significant threshold shift for irradiation dosages ≥20 Gy. This study demonstrates that the mouse is a viable model for study of short-term peripheral auditory effects using single-dose cranial irradiation. Additionally, with access to a precise animal irradiator, the mouse may be used as an experimental model for a fractionated irradiation dosage of 10 Gy, simulating stereotactic therapeutic cranial irradiation.

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Treatment Selection for T3/T4a Laryngeal Cancer: Chemoradiation Versus Primary Surgery

Objective:
We report the treatment outcomes, including organ preservation, for patients with locally advanced (T3/T4a) laryngeal cancer receiving both surgical and nonsurgical approaches. We hypothesize that selection of treatment protocols aimed to optimize organ preservation does not compromise survival provided careful selection is done through the process of multidisciplinary treatment planning.
Methods:Patients with T3-4a laryngeal squamous cell cancer were evaluated and recommended for primary treatment with total or partial laryngectomy (37 patients) or chemoradiotherapy (34 patients). Treatment outcomes were compared between the 2 cohorts. In addition, the laryngeal preservation rate and laryngoesophageal dysfunction-free survival (LEDFS) were determined for the chemoradiation group.
Results:The 5-year overall survival rate for patients with T3 lesions was 41% and 40% for the surgical and nonsurgical groups, respectively, and for T4 lesions it was 54% and 53%, respectively. For the chemoradiation group, the rate of overall laryngeal preservation was 79%. LEDFS at 2 years was 40% for T3 lesions and 33% for T4 lesions.
Conclusion:Through careful selection, some patients with locally advanced laryngeal cancer can be offered chemoradiation (organ preservation) without compromising survival. However, the patients selected to receive chemoradiation have a high rate of laryngeal and esophageal dysfunction.

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Average Ambulatory Measures of Sound Pressure Level, Fundamental Frequency, and Vocal Dose Do Not Differ Between Adult Females With Phonotraumatic Lesions and Matched Control Subjects

Objectives:
Clinical management of phonotraumatic vocal fold lesions (nodules, polyps) is based largely on assumptions that abnormalities in habitual levels of sound pressure level (SPL), fundamental frequency (f0), and/or amount of voice use play a major role in lesion development and chronic persistence. This study used ambulatory voice monitoring to evaluate if significant differences in voice use exist between patients with phonotraumatic lesions and normal matched controls.
Methods:Subjects were 70 adult females: 35 with vocal fold nodules or polyps and 35 age-, sex-, and occupation-matched normal individuals. Weeklong summary statistics of voice use were computed from anterior neck surface acceleration recorded using a smartphone-based ambulatory voice monitor.
Results:Paired t tests and Kolmogorov-Smirnov tests resulted in no statistically significant differences between patients and matched controls regarding average measures of SPL, f0, vocal dose measures, and voicing/voice rest periods. Paired t tests comparing f0 variability between the groups resulted in statistically significant differences with moderate effect sizes.
Conclusions:Individuals with phonotraumatic lesions did not exhibit differences in average ambulatory measures of vocal behavior when compared with matched controls. More refined characterizations of underlying phonatory mechanisms and other potentially contributing causes are warranted to better understand risk factors associated with phonotraumatic lesions.

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The Mayo Clinic Arizona Spasmodic Dysphonia Experience: A Demographic Analysis of 718 Patients

Objective:
Analyze demographic data collected over a 25-year experience of 718 patients with spasmodic dysphonia (SD) who have been treated with botulinum toxin-A (BoNT-A) and compare our data with previously published studies.
Methods:Seven hundred eighteen patients with SD were treated with 6621 BoNT-A injections at Mayo Clinic Arizona between 1989 and 2014. All patients were treated by the same physician team. Background demographic data for each patient were recorded.
Results:Of 718 patients, 557 patients were female (77.6%). Six hundred sixty of 718 (91.8%) patients had adductor SD (AdSD), and 58 of 718 (8.1%) patients had abductor SD (AbSD). Average age of onset was 51 years. Of 718 patients, 378 (52.6%) had vocal tremor (VT); VT was present in 54.4% of AdSD patients and 32.1% of AbSD patients. Thirty-seven of 718 (5.2%) patients had other dystonias, including cervical dystonia (2.3%), blepharospasm (1.4%), limb dystonia (1.1%), and oromandibular dystonia (0.3%). A positive family history of SD was present in only 6 of 718 patients (0.8%) and of other dystonias in 11 of 718 patients (1.5%).
Conclusions:Spasmodic dysphonia is a chronic and potentially disabling focal laryngeal dystonia. The Mayo Clinic Arizona SD experience compares to prior reports and reveals a female preponderance, onset in middle age, infrequent hereditary pattern, high co-occurrence of VT, and low co-occurrence of other dystonias.

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Microbial Flora and Antibiotic Resistance in Peritonsillar Abscesses in Upstate New York

Objectives:
To identify the common bacteria in recent peritonsillar abscesses and the prevalence of antibiotic resistance and compare both between adults and children.
Methods:This is a retrospective chart review at a single academic institution of patients who underwent either incision and drainage or tonsillectomy for a peritonsillar abscess between 2002 and 2012 (n = 69). Medical records were reviewed for cultures, comorbidities, and drainage procedures.
Results:Cultures obtained from 62.32% of peritonsillar abscesses were polymicrobial, and 34.78% were monomicrobial. The most common pathogens were β-hemolytic Streptococcus (31.88%), α-hemolytic Streptococcus (21.74%), Neisseria (14.49%), and Streptococcus milleri (13.04%). Group A β-hemolytic streptococcus was more common in children and Streptococcus milleri was more common in adults. Alpha-hemolytic streptococcus was resistant to clindamycin (6.67%) and erythromycin (6.67%). Streptococcus milleri was resistant to clindamycin (11.11%) and erythromycin (11.11%). Staphylococcus was resistant to penicillin (37.5%), oxacillin (25%), erythromycin (25%), and clindamycin (12.5%).
Conclusions:β- and α-hemolytic Streptococci, Neisseria, and Streptococcus milleri are the most common pathogens. Streptococcus milleri is more common in adults, and β-hemolytic streptococcus is more common in children. Resistance to clindamycin and erythromycin is common in Streptococci and Staphylococci, and penicillin resistance is common in Staphylococci.

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Otolaryngology Consult Carts: Maximizing Patient Care, Surgeon Efficiency, and Cost Containment

Objective:
The objective of this study was to develop an otolaryngology consult cart system to ensure prompt delivery to the bedside of all the unique equipment and medications required for emergent and urgent otolaryngology consults.
Method:An otolaryngology practice responsible for emergency room and hospital consult coverage sought to create a cart containing all equipment, medications, and supplies for otolaryngology consults. Meetings with hospital administration and emergency room, nursing, pharmacy, central processing, and operating room staff were held to develop a system for the emergent delivery of the cart to the needed location, sterilization and restocking of equipment between uses, and appropriate billing of supplies.
Results:Two months were required from conception to implementation. All equipment was purchased new, including flexible scopes and headlights. The cart is sterilized, restocked, and maintained by central processing after each use. The equipment is available to handle all airway emergencies as well as all common otolaryngology consults and is delivered bedside in less than 5 minutes.
Conclusion:The development of a self-contained otolaryngology consult cart requires coordination with a wide variety of hospital departments. This system, while requiring initial monetary and time investment, has resulted in improved patient care, cost containment, and surgeon convenience.

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Local Synthesis of Pepsin in Barrett's Esophagus and the Role of Pepsin in Esophageal Adenocarcinoma

Objective:
Despite widespread use of proton pump inhibitors (PPIs), the incidence of esophageal adenocarcinoma (EAC) continues to rise. PPIs reduce reflux acidity, but only transiently inactivate gastric enzymes. Nonacid reflux, specifically nonacid pepsin, contributes to carcinogenesis in the larynx. Given the carcinogenic potential of pepsin and inefficacy of PPIs to prevent EAC, the presence and effect of pepsin in the esophagus should be investigated.
Methods:Normal and Barrett's biopsies from 8 Barrett's esophagus patients were collected for pepsin analysis via Western blot and reverse transcriptase-polymerase chain reaction (RT-PCR). Human esophageal cells cultured from healthy patients were treated with pepsin (0.01-1 mg/mL; 1-20 hours), acid (pH 4) ± pepsin (5 minutes); real-time RT-PCR, ELISA, and cell migration were assayed.
Results:Pepsin was detected in all 8 Barrett's and 4 of 8 adjacent normal specimens. Pepsinogen mRNA was observed in 22 Barrett's, but not in normal adjacent samples. Pepsin induced PTSG2 (COX-2) and IL-1β expression and cell migration in vitro.
Conclusions:Pepsin is synthesized by metaplastic, Barrett's esophageal mucosa. Nonacid pepsin increases metrics of tumorigenicity in esophageal epithelial cells in vitro. These findings implicate refluxed and locally synthesized pepsin in development and progression of EAC and, in part, explain the inefficacy of PPIs in the prevention of EAC.

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Quantification of Trapezius Muscle Innervation During Neck Dissections: Cervical Plexus Versus the Spinal Accessory Nerve

Objectives:
Despite increasing use of selective, nerve-sparing surgical techniques during neck dissections, the reported rate of postoperative paralysis of the trapezius muscle is still high. The aim of the study is to measure and compare motor inflow to the trapezius muscle, in order to better understand the peripheral neuroanatomy.
Methods:Intraoperative nerve monitoring (electroneurography) in patients undergoing routine neck dissection (n = 18). The innervation of the 3 functional parts of the trapezius muscle was mapped and quantified through compound muscle action potentials.
Results:In 18/18 (100%) of the patients, the spinal accessory nerve (SAN) innervated all parts of the trapezius muscle. In 7/18 (39%) of the patients, an active motor branch from the cervical plexus was detected, equally distributed to all functional parts of the trapezius muscle, at levels comparable to the SAN.
Conclusions:Compared to the SAN, branches from cervical plexus provide a significant amount of neural input to all parts of the trapezius muscle. Intraoperative nerve monitoring can be used in routine neck dissections to detect these branches, which may be important following surgical injury to the SAN.

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Woven Coronary Arteries: A detailed review

ABSTRACT

A woven coronary artery is a rare congenital vascular variation that involves the separation of the artery into several thin channels, which later merge distally to form a single lumen. This mesh of intertwining small vessels may occur anywhere along the vessel and may be present in multiple coronaries. Although generally a benign incidental finding, there have been reported cases of associated ischemia, thrombus and atherosclerotic plaque formation and complications with cardiac intervention procedures. In this review, we have analyzed and compiled all the reported data pertaining to woven coronary arteries and highlighted its relevance to clinical practice. This article is protected by copyright. All rights reserved.

The subdiaphragmatic part of the phrenic nerve – morphometry and connections to autonomic ganglia

Abstract

Few anatomical textbooks offer much information concerning the anatomy and distribution of the phrenic nerve inferior to the diaphragm. The aim of this study was to identify the subdiaphragmatic distribution of the phrenic nerve, the presence of phrenic ganglia, and possible connections to the celiac plexus. One hundred and thirty formalin-fixed adult cadavers were studied. The right phrenic nerve was found inferior to the diaphragm in 98% with 49.1% displaying a right phrenic ganglion. In 22.8% there was an additional smaller ganglion (right accessory phrenic ganglion). The remaining 50.9% had no grossly identifiable right phrenic ganglion. Most (65.5% of specimens) exhibited plexiform communications with the celiac ganglion, aorticorenal ganglion, and suprarenal gland. The left phrenic nerve inferior to the diaphragm was observed in 60% of specimens with 19% containing a left phrenic ganglion. No accessory left phrenic ganglia were observed. The left phrenic ganglion exhibited plexiform communications to several ganglia in 71.4% of specimens. Histologically, the right phrenic and left phrenic ganglia contained large soma concentrated in their peripheries. Both phrenic nerves and ganglia were closely related to the diaphragmatic crura. Surgically, sutures to approximate the crura for repair of hiatal hernias must be placed above the ganglia in order to avoid iatrogenic injuries to the autonomic supply to the diaphragm and abdomen. These findings could also provide a better understanding of the anatomy and distribution of the fibers of that autonomic supply. This article is protected by copyright. All rights reserved.

Comprehensive Review of the Anatomy and Physiology of Male Ejaculation: Premature Ejaculation Is Not a Disease

Abstract

Human semen contains spermatozoa secreted by the testes and a mixture of components produced by the bulbo-urethral and Littre (paraurethral) glands, prostate, seminal vesicles, ampulla and epididymis. Ejaculation is used as a synonym for the external ejection of semen, but it comprises two phases: emission and expulsion. As semen collects in the prostatic urethra, the rapid preorgasmic distension of the urethral bulb is pathognomonic of impeding orgasm, and the man experiences a sensation that ejaculation is inevitable (in women, emission is the only phase of orgasm). The semen is propelled along the penile urethra mainly by the bulbocavernosus muscle. With Kegel exercises, it is possible to train the perineal muscles. Immediately after the expulsion phase the male enters a refractory period, a recovery time during which further orgasm or ejaculation is physiologically impossible. Age affects the recovery time: as a man grows older, the refractory period increases. Sexual medicine experts consider premature ejaculation only in the case of vaginal intercourse, but vaginal orgasm has no scientific basis, so the duration of intercourse is not important for a woman's orgasm. The key to female orgasm are the female erectile organs; vaginal orgasm, G-spot, G-spot amplification, clitoral bulbs, clitoris-urethra-vaginal complex, internal clitoris and female ejaculation are terms without scientific basis. Female sexual dysfunctions are popular because they are based on something that does not exist, i.e. the vaginal orgasm. The physiology of ejaculation and orgasm is not impaired in premature ejaculation: it is not a disease, and non-coital sexual acts after male ejaculation can be used to produce orgasm in women. Teenagers and men can understand their sexual responses by masturbation and learn ejaculatory control with the stop-start method and the squeeze technique. Premature ejaculation must not be classified as a male sexual dysfunction. It has become the center of a multimillion dollar business: is premature ejaculation - and female sexual dysfunction - an illness constructed by sexual medicine experts under the influence of drug companies? This article is protected by copyright. All rights reserved.

Charcot-Marie-Tooth 1A: a narrative review with clinical and anatomical perspectives

ABSTRACT

Charcot-Marie-Tooth 1A (CMT1A) is regarded as the most common hereditary peripheral neurodegenerative disorder. This narrative review highlights perspectives around the historically well-established and characteristic anatomical manifestations of CMT1A seen in the feet, legs and hands, in addition to a clinical diagnosis that may be confirmed by electrophysiology, genetic or molecular markers together with the presence of a typical family history. A less well-known perspective is the potential for systemic manifestation and wider complication. The condition is characterised by a progressive clinical picture with unmistakable anatomical and neurological features that have been described since the late 19th century. There remains no cure although supportive, rehabilitative and surgical regimes may provide helpful management or amelioration of symptoms. Most recently, the emergence of a pleotherapeutic approach suggests distinct promise. Future research focused on a detailed elucidation of the underlying molecular mechanisms underpinning myelin and axonal function may eventually hold the key to successful treatment of CMT1A. Genetic modification would potentially present a cure. This article is protected by copyright. All rights reserved.

A systematic review of the oral and craniofacial manifestations of cri du chat syndrome

ABSTRACT

INTRODUCTION: Cri du chat syndrome is an autosomal disorder. Because it affects few people in the population it is considered a rare disease, yet it is one of the most common autosomal chromosomal syndromes in humans. It entails pathognomonic alterations that affect the craniofacial and oral anatomy of patients. The aim of this study is to review these craniofacial and oral abnormalities in patients with Cri du chat syndrome.

MATERIALS AND METHODS: The PubMed Medline database was searched using two different strategies. First, we used "Dentistry" and "Cri du chat" as keywords; second, we used "Cri du chat" and "craniofacial".

RESULTS: Seven articles in which the main orofacial and cranio-skeletal characteristics of patients with Cri du chat syndrome were described were selected according to the inclusion and exclusion criteria.

CONCLUSION: Cri du Chat syndrome entails pathognomonic characteristics in the craniofacial area (epicanthus, short philtrum and wide nasal bridge), the oral area (mandibular retrognathism and anterior open bite) and the cranial region (alterations at the cranial base angle and a small upper airway). However, more studies on larger samples are needed to specify the orofacial and craniofacial characteristics of patients with Cri du chat syndrome more accurately. This article is protected by copyright. All rights reserved.

Volumetric analysis of the diagonal band of Broca in patients with schizophrenia and affective disorders: A post-mortem study

Abstract

The human diagonal band of Broca is connected to other parts of the limbic system, such as the hippocampus, that are involved in the pathology of schizophrenia. This study aimed to characterize the volume and anterior-to-posterior distance of the human diagonal band of Broca (vertical limb) from post-mortem brains obtained from three groups: healthy control subjects (N = 17), patients with schizophrenia (N = 26), and patients with affective disorders (N = 12). There were no significant differences in the volume or anterior-to-posterior distance in the patients with schizophrenia or affective disorders compared with the healthy control subjects. To date, this is the first post-mortem investigation measuring the volume and the anterior-to-posterior distance of the diagonal band of Broca (vertical limb) in patients with schizophrenia or affective disorders compared with healthy control subjects. This article is protected by copyright. All rights reserved.

Der Einsatz der perkutanen Dilatationstracheotomie im Rahmen der Kopf-Hals-Tumorchirurgie

Laryngo-Rhino-Otol
DOI: 10.1055/s-0035-1555915
Hintergrund: Im Rahmen der chirurgischen Therapie von Kopf-Hals-Tumoren stellt die peri- und postoperative Atemwegssicherung eine klinisch relevante, anspruchsvolle Aufgabe dar. Meistens wird ein epithelisiertes Tracheostoma angelegt. Der Stellenwert der perkutanen Dilatationstracheotomie (PDT) in Kombination mit tumorchirurgischen Eingriffen des Kopf-Hals-Bereiches ist bisher nicht geklärt. Material und Methoden: Im Zeitraum von Dezember 2002 bis Oktober 2007 wurden an der Universitätsklinik für HNO-Heilkunde, Kopf- und Halschirurgie, Halle, 58 Patienten im Rahmen einer Tumoroperation mit einer PDT nach Ciaglia oder Fantoni versorgt. Es erfolgte eine retrospektive, pseudonymisierte Untersuchung der Patientendaten. Bei einer follow-up-Untersuchung wurden die Folgezustände nach PDT untersucht. Ergebnisse: Der Median für die durchschnittliche Trachealkanülenliegedauer lag bei 12 Tagen. Bei 25 (43%) Patienten kam es zu keinen dokumentierten Komplikationen nach PDT. Zu den schwerwiegenden Komplikationen gehörten ein Pneumothorax bei 2 Patienten (3,4%), 9 Blutungen (15,5%) und 1 Infektion (1,7%). Nach dem Auftreten von Tracheostoma-Metastasen nach Fantoni-Tracheotomie wurde dieses Verfahren nicht mehr angewandt. In der Nachuntersuchung von 33 Patienten wurden keine Trachealstenosen oder schwerwiegende Langzeitkomplikationen festgestellt. Schlussfolgerungen: Die perkutane Dilatationstracheotomie nach Ciaglia mit begleitender Bronchoskopie ist, unter Beachtung der Indikationen und Kontraindikationen, ein sicheres und komplikationsarmes Verfahren zur peri- und postoperativen Atemwegssicherung bei Tumorpatienten des Kopf-Hals-Bereiches. Längerfristige Komplikationen und Problemen nach PDT sind nicht zu erwarten. Die Fantonimethode ist wegen der schweren Spätkomplikationen hierfür nicht geeignet.
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© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text

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Hyaluronan in Human Vocal Folds in Smokers and Nonsmokers—A Histochemical Study

To study the hyaluronan occurrence in human vocal folds, with special regards to gender and smoking and to discuss the implications of findings.
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Supraglottic Airway Devices and Effect on Voice—Comparison of LMA Proseal and i-gel: Double-Blind Randomized Clinical Trial

Laryngeal mask airway (LMA) is an important alternative to endotracheal intubation for all professional voice users undergoing surgery. However, dysphonia is a known complication of LMA Proseal (PLMA) use. The i-gel airway (IGA) provides adequate airway seal without the need for an inflatable cuff. Hence, it helps to minimize the risk of tissue compression. This study compares effect of PLMA and IGA on voice at 24th hour after anesthesia.
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Correlation Between Clinical Diagnosis and Pathological Diagnosis in Laryngeal Lesions

To evaluate the degree of agreement between the clinical and the pathological diagnosis in patients undergoing laryngeal microsurgery due to epithelial or edematous lesions of the vocal folds.
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Interrater Reliability in Analysis of Laryngoscopic Features for Unilateral Vocal Fold Paresis

The diagnosis of paresis in patients with vocal fold motion impairment remains a challenge. In particular, laryngoscopy examination may result in significant disagreement in diagnosis among providers. We hypothesize that systematically evaluating for a standard set of clinical parameters will increase the diagnostic concordance among providers.
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A Simple Approach to Facilitate the Use of Microdebrider for Treatment of Fibrous Gynaecomastia

The microdebrider is well known amongst the ENT surgeons for their functional endoscopic sinus surgery1. This is a powered rotatory shaving instrument attached to a continuous suction device. We have previously described the use of the microdebrider in patients with fibrous gynaecomastia to avoid the need for a peri-areolar incision for removal of the breast tissue2.
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Immediate two-stage nipple reconstruction with a local mastectomy flap following secondary autologous breast reconstruction

Due to the inevitable postoperative shrinkage, an initial hypercorrection is emphasized in nipple reconstruction with a random skin flap. However, the breast shape will be damaged if an excessively large flap is raised on the surface of the breast mound. In the manuscript, we report a technique for immediate two-stage nipple reconstruction with a local mastectomy flap during the secondary breast reconstruction. From February 2011 to March 2014, 33 patients underwent breast reconstruction and immediate two-stage nipple reconstructions.
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Use of the Anterolateral Thigh Flap for Reconstruction of the Pediatric Anophthalmic Orbit

Children with acquired anophthalmia pose unique reconstructive challenges. With implant-based reconstruction, the current standard of care, there is a tendency toward intraorbital and adnexal tissue contraction and an increasing volume discrepancy with orbital growth, producing enophthalmos, eyelid retraction, and difficulty retaining an ocular prosthesis. We describe a novel technique for secondary reconstruction of the pediatric anophthalmic orbit using a small free anterolateral thigh (ALT) flap.
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Vein of foramen caecum: imaging findings

Abstract

Vein of foramen caecum has been classically described as a vein that connects nasal mucosa to the superior sagittal sinus in classic anatomy textbooks. However, its existence is controversial in literature. Herein, we demonstrated computed tomography and contrast enhanced magnetic resonance imaging findings of a tubular vascular structure extending to nasal mucosa and superior sagittal sinus.

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Targeting Quality Improvement in Clinical Practice Guidelines

Clinical practice guidelines provide key action statements targeted at quality improvements. Areas of potential quality improvement can be identified by exploring known contributors to cognitive errors. Three common contributors to medical error and reduced quality care are (1) the complexity of modern medicine, (2) the tendency to apply cause and effect to random associations, and (3) our bias to our first intuition. Future authors of clinical practice guidelines should consider these 3 influences when deciding how to best provide guidance to improve patient care.

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A Systematic Review of Eligibility and Outcomes in Tinnitus Trials: Reassessment of Tinnitus Guideline

Objective
To analyze existing tinnitus treatment trials with regard to eligibility criteria, outcome measures, study quality, and external validity and to recognize the effect of patient demographics, symptom duration, severity, and otologic comorbidity on research findings to help practitioners apply them to patient encounters.
Data SourcesSystematic literature search conducted by an information specialist for development of the American Academy of Otolaryngology—Head and Neck Surgery Foundation's tinnitus clinical practice guideline.
Review MethodsArticles were assessed for eligibility with the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-analyses) and data extracted by 2 independent investigators. Studies were assessed for methodological quality, inclusion and exclusion criteria, patient demographics, and outcome measures.
ResultsA total of 147 randomized trials met inclusion criteria. Nearly all studies took place in a specialist setting. More than 50% did not explicitly define tinnitus, and 44% used a subjective severity threshold, such as "severely disturbing." Fifty-four percent required symptom duration of at least 6 months for study eligibility, and up to 33% excluded patients with "organic" hearing loss or otologic conditions. Mean age was 52.2 years, and median follow-up was 3 months. Only 20% had a low risk of bias.
ConclusionRandomized trials of tinnitus interventions are most applicable to older adults with tinnitus lasting ≥6 months who are evaluated in specialty settings. High risk of bias, short follow-up, and outcome reporting raise concerns about the validity of findings and may influence how clinicians apply trial results to individual patients and establish treatment expectations, thus demonstrating the need for further quality research in this field.

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Randomized Controlled Trial Assessing the Feasibility of Shortened Fasts in Intubated ICU Patients Undergoing Tracheotomy

Objective
American Society of Anesthesiology guidelines recommend preoperative fasts of 6 hours after light snacks and 8 hours after large meals. These guidelines were designed for healthy patients undergoing elective procedures but are often applied to intubated intensive care unit (ICU) patients. ICU patients undergoing routine procedures may be subjected to unnecessary prolonged fasts. This study tests whether shorter fasts allow for better nutrition delivery and patient outcomes without increasing the risk.
Study DesignRandomized blinded controlled trial.
SettingTertiary academic medical center.
SubjectsICU patients undergoing bedside tracheotomy.
MethodsIntubated ICU patients who were receiving enteral feeding and for whom bedside tracheotomy was indicated were enrolled prospectively and randomly allocated to 2 parallel preoperative fasting regimens: a 6-hour fast (control) and a 45-minute fast (intervention). Patients were assessed for aspiration, caloric delivery, metabolic markers, and infectious and noninfectious complications.
ResultsTwenty-four patients were enrolled and randomized. There were no complications related to the procedure. There were no cases of intraoperative aspiration identified. There was a single postoperative pneumonia in the control group. Median (interquartile range) length of fast and caloric delivery were significantly different between the control group and the shortened fast group: 22 hours (18, 34) vs 14 hours (5, 25; P < .001) and 429 kcal (57, 1125) vs 1050 kcal (825, 1410; P = .01), respectively.
ConclusionsShortening preoperative fasts in intubated ICU patients allowed for better caloric delivery in the preoperative period.

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On the way to understanding migraine

Self-reported neck and shoulder pain in adolescents is associated with episodic and chronic migraine

Aim
The aim of this study was to verify the association between self-reported neck/shoulder pain and migraine and to compare findings of chronic and episodic migraine in adolescents.
MethodsIn this cross-sectional study, 601 secondary-school students filled in questionnaires about headache appearance, type and frequency, neck and shoulder pain and lifestyle factors.
ResultsThe adjusted strength of the association between reported neck and shoulder pain and migraine (assessed in multinomial regression models) increased with the frequency of migraine: less than once a week (OR = 1.40; 95% CI = (0.85–2.30)), weekly (OR = 2.14; 95% CI = (1.42–3.24)), and at least 15 days/month (OR = 7.27; 95% CI = (3.42–15.44)).
ConclusionIn adolescents the association between self-reported neck and shoulder pain and migraine is most pronounced in migraine with a high attack frequency.

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Years of potential life lost for brain and CNS tumors relative to other cancers in adults in the United States, 2010

Background
Years of potential life lost (YPLL) complement incidence and survival rates by measuring how much a patient's life is likely to be shortened by his or her cancer. In this study, we examine the impact of death due to brain and other central nervous system (CNS) tumors compared to other common cancers in adults by investigating the YPLL of adults in the United States.
MethodsMortality and life table data were obtained from the Centers for Disease Control and Prevention's National Center for Health Statistics Vital Statistics Data for 2010. The study population included individuals aged 20 years or older at death who died from one of the selected cancers. YPLL was calculated by taking an individual's age at death and finding the corresponding expected remaining years of life using life table data.
ResultsThe cancers with the greatest mean YPLL were other malignant CNS tumors (20.65), malignant brain tumors (19.93), and pancreatic cancer (15.13) for males and malignant brain tumors (20.31), breast cancer (18.78), and other malignant CNS tumors (18.36) for females. For both sexes, non-Hispanic whites had the lowest YPLL, followed by non-Hispanic blacks, and Hispanics.
ConclusionMalignant brain and other CNS tumors have the greatest mean YPLL, thereby reflecting their short survival time post diagnosis. These findings will hopefully motivate more research into mitigating the impact of these debilitating tumors.

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Current status and future directions of anti-angiogenic therapy for gliomas

Molecular targets for the pathological vasculature are the vascular endothelial growth factor (VEGF)/VEGF receptor axis, integrins, angiopoietins, and platelet-derived growth factor receptor (PDGFR), as well as several intracellular or downstream effectors like protein kinase C beta and mammalian target of rapamycin (mTOR). Besides hypoxic damage or tumor cell starvation, preclinical models imply vessel independent tumor regression and suggest differential effects of anti-angiogenic treatments on tumorous and nontumorous precursor cells or the immune system. Despite compelling preclinical data and positive data in other cancers, the outcomes of clinical trials with anti-angiogenic agents in gliomas by and large have been disappointing and include VEGF blockage with bevacizumab, integrin inhibition with cilengitide, VEGF receptor inhibition with sunitinib or cediranib, PDGFR inhibition with imatinib or dasatinib, protein kinase C inhibition with enzastaurin, and mTOR inhibition with sirolimus, everolimus, or temsirolimus. Importantly, there is a lack of real understanding for this negative data. Anti-angiogenic therapies have stimulated the development of standardized imaging assessment and the integration of functional MRI sequences into daily practice. Here, we delineate directions in the identification of molecularly or image-based defined subgroups, anti-angiogenic cotreatment for immunotherapy, and the potential of ongoing trials or modified targets to change the game.

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Lithium prevents rat steroid-related osteonecrosis of the femoral head by β-catenin activation

Abstract

This study explored the use of lithium to prevent rat steroid-related osteonecrosis of the femoral head (ONFH) through the modulation of the β-catenin pathway. ONFH was induced by methylprednisolone combined with lipopolysaccharide, and serum lipids were analyzed. ONFH was detected by hematoxylin–eosin staining. Micro-CT-based angiography and bone scanning were performed to analyze vessels and bone structure, respectively. Immunohistochemical staining for peroxisome proliferator-activated receptor gamma (PPARγ), bone morphogenetic protein-2 (BMP-2), and vascular endothelial growth factor (VEGF) was analyzed. Protein levels of phospho-glycogen synthase kinase-3β at Tyr-216 (p-Tyr²¹⁶ GSK-3β), total glycogen synthase kinase-3β (GSK-3β) and β-catenin, as well as mRNA levels of GSK-3β and β-catenin in femoral heads, were assessed. The rate of empty bone lacunae in the femoral heads was lower in the lithium and control groups than in the model group. The lithium group showed preventive effects against steroid-related vessel loss by micro-CT-based angiography and VEGF staining. Lithium treatment improved hyperlipidemia and reduced PPARγ expression. Moreover, lithium improved steroid-related bone loss in micro-CT bone scans and BMP-2 staining analyses. Furthermore, local β-catenin was reduced in steroid-related ONFH, and lithium treatment increased β-catenin expression while reducing p-Tyr²¹⁶ GSK-3β levels. The local β-catenin pathway was inhibited during steroid-related ONFH. Lithium may enhance angiogenesis and stabilize osteogenic/adipogenic homeostasis during steroid-related ONFH in rats by activating the β-catenin pathway.

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Acupuncture at heterotopic acupoints facilitates distal colonic motility via activating M3 receptors and somatic afferent C-fibers in normal, constipated, or diarrhoeic rats

Abstract

Background

Previous studies have demonstrated the efficacy of somatic stimulation for patients with gastrointestinal motility disorders. However, little effort has been made to investigate the effects of acupuncture on colonic motility, particularly in pathological conditions. The precise mechanism employed in the regulation of acupuncture on colonic motility still remains unclear.

Methods

We assessed the effect of acupuncture at heterotopic acupoints on distal colonic motility using a warm-water-filled manometric balloon inserted 5–6 cm into the rectum of anesthetized normal rats or rats with diarrhea or constipation. Choline chloride, 4-DAMP, cobra venom and capsaicin were separately applied to investigate the role of M₃ receptors in the regulation of distal colonic motility by acupuncture at heterotopic acupoints, and whether Aδ- and/or C-fibers are required for triggering distal colonic motility by acupuncture.

Key Results

Acupuncture at heterotopic acupoints increased distal colonic motility not only in normal rats but also in rats with constipation or diarrhea. M₃ receptors play an important role in the facilitation of distal colonic motility triggered by acupuncture at heterotopic acupoints. Afferent nerve Aδ- and C-fibers mediate the transduction of the acupuncture signal and C-fibers are essential for enhancing the effect of acupuncture at the heterotopic acupoint on distal colonic motility.

Conclusions & Inferences

Our results reveal that acupuncture at heterotopic acupoints increases distal colonic motility regardless of normal or pathological conditions via predominately activating C-fibers of somatic afferent nerve and M₃ receptors.

Little effort has previously been made to investigate the effects of acupuncture on distal colonic motility, particularly in pathological conditions, and the precise mechanism employed in the regulation of acupuncture on colonic motility. In this study, our results reveal that acupuncture at heterotopic acupoints increases distal colonic motility not only in normal rats but also in rats with constipation or diarrhea via predominately activating C-fibers of somatic afferent nerve and M3 receptors.

Angiosarcoma of the Head and Neck

Introduction
Angiosarcoma of the head and neck is a rare vascular sarcoma associated with high rates of local recurrence and distant metastasis and a poor prognosis.
ObjectiveWe describe our experience treating patients with angiosarcoma of the head and neck to evaluate the outcomes, patterns of failure, and current treatments.
MethodsWe identified six patients with angiosarcoma of the head and neck and treated at our institution between 2000 and 2013. We compared our results to the literature from 1979 to 2013.
ResultsMean follow-up was 42 months. Local recurrence rate was 50% with diseasespecific survival and 2-year disease-free survival rates of 33.3 and 20%, respectively. Prognostic factors included tumor size > 5 cm and surgical margin status, with no correlation between histologic grade and survival. Combined-modality therapy was only used for aggressive tumors with positive surgical margins but is suggested to improve local control and overall survival.
ConclusionsOur data series supports that angiosarcoma of the head and neck has a high rate of recurrence and is associated with a poor prognosis, despite current combined-modality therapy. The study highlights the importance of attaining negative margins during surgical resection, the utility of adjuvant therapies, as well as the need for continued research in developing new management strategies.

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Hearing Aid Use and Adherence to Treatment in a Publicly-Funded Health Service from the City of São Paulo, Brazil

Introduction
Periodic follow-up appointments are important to ensure long-term effectiveness of rehabilitation with hearing aids. However, not all users are able to maintain adherence to recommendations prescribed during the fitting process and some do not attend those appointments, which compromises the effectiveness of treatment.
ObjectiveCompare hearing aid use after 1 year between subjects who did not attend a follow-up evaluation appointment at a publicly-funded health service (nonattenders) and those who attended the appointment (attenders). Reasons for nonuse of hearing aids and unscheduled appointments were also analyzed.
MethodsProspective observational cross-sectional study. Nonattenders and attenders in a follow-up evaluation appointment were interviewed by telephone about hearing aid use, reasons for nonuse, and unscheduled appointments.
ResultsThe nonattenders group consisted of 108 subjects and the attenders group had 200 subjects; in both groups, most users kept bilateral use but the nonuse rate was higher in nonattenders. The main reason for nonuse of hearing aids among nonattenders was health problems; fitting problems was the main reason for nonuse in the attenders group. Health problems and issues like unavailable companion and transportation difficulties were the reasons for unscheduled follow-up appointments.
ConclusionNonattenders had a greater nonuse rate and were more likely to abandon hearing aid use. Measures to increase hearing aid use and adherence to prescribed recommendations are also necessary to ensure long-termeffectiveness of rehabilitation with hearing aids.

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Rhinosinusal Polyposis and Inverted Papilloma: A Morphometric Comparative Study

Introduction
Nasal obstruction is one of the main rhinologic complaints, and two diseases must be investigated as differential diagnosis: rhinosinusal polyposis and inverted papilloma. Using traditionalmethods, the differential diagnosis between these diseases may be difficult. The morphometric study may be a useful tool for differential diagnosis and to define prognosis.
ObjectiveCalculate the morphometric values of rhinosinusal polyposis and inverted papilloma and compare the average of variables obtained between the groups.
MethodsThe nasal mucus of 10 patients who had surgery in the Department of Otorhinolaryngology and Surgery of Head and Neck was studied; 5 had rhinosinusal polyposis and 5 had inverted papilloma. After the capture and print of corresponding data of each slide, the largest and smallest diameters of the nuclei were measured and the morphometric variables were calculated: average diameter, perimeter, ratio between largest and smallest diameter, volume, area, ratio of volume to area, form coefficient, contour index, and eccentricity.
ResultsWe found a significant difference (p < 0.05) between the two groups in the following morphometric variables: largest diameter, smallest diameter, average diameter, volume, area, perimeter, and ratio of volume to area, indicating that these parameters can be useful in diagnostic differentiation between these diseases.
ConclusionWe founded morphometric variables higher in patients with inverted papilloma, which can be related to the neoplastic origin of the inverted papilloma. The analysis of nuclear parameters is an instrument of great value in the differential diagnosis between rhinosinusal polyposis and inverted papilloma.

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Ambient Noise in Emergency Rooms and Its Health Hazards

Introduction
The occupational risk due to high levels of noise in the hospital environment has been recognized, and the National Agency of Sanitary Surveillance of the Ministry of Health recommends evaluation and control of noise in hospital areas.
ObjectivesTo assess the sound environment in the emergency ward of a general trauma reference hospital in the city of Curitiba, Parana State, Brazil.
MethodsIn this descriptive study, noise levels were assessed on mornings, afternoons, and evenings using an integrating Bruel & Kjaer (Denmark) calibrated sound levelmeter, type 2230. Ten indoor points in the emergency ward were assessed; the helicopter as well as several available pieces of equipment in the ward were assessed individually.
ResultsNoise levels in sound pressure level ambiance [dBA] ranged from 56.6 to 68.8. The afternoon period was the noisiest. The helicopter at 119 dBA and the cast saw at 90 dBA were the noisiest equipment, and the lowest noise level found was the activated oximeter at 61.0 dBA.
ConclusionIn all assessed points, noise levels were above the comfort levels recommended by the Brazilian Association of Technical Standards (1987), which may harm users' and professionals' health as well as influence professional performance in the emergency ward. Sound pressure levels of the helicopter and cast saw reach high hearing hazard levels, requiring professionals to use individual protection equipment, and point to the need for creation and implementation of effective control measures of noise levels in emergency wards.

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Venous Thromboembolism-Incidence of Deep Venous Thrombosis and Pulmonary Embolism in Patients with Head and Neck Cancer: A Tertiary Care Experience in Pakistan

Introduction
Although venous thromboembolism (VTE) is seen with morbidity and mortality in various surgical specialties, scarce data are available in the head and neck surgery domain.
ObjectiveWe aim to determine the incidence of VTE in patients receiving surgery for head and neck cancer.
MethodsFour hundred thirteen patients who underwent head and neck surgery procedures between 2005 and 2013 were reviewed retrospectively. All patients with head and neck surgery had received thromboprophylaxis (i.e., compression stockings and subcutaneous heparin). Patient demographics, operating time, and length of hospital stay were analyzed. The incidence of symptomatic deep venous thrombosis (DVT) and pulmonary embolism (PE) during the initial postoperative hospitalization was assessed.
ResultsTwelve patients were identified who developed VTE. Three patients developed DVT, and nine developed PE. The incidence of DVT and PE was 0.72 and 2.17%, respectively. Interestingly, all of these patients had undergone excision of extensive head and neck cancers accompanied by a reconstructive procedure. Patients who developed PE had a longer hospital stay compared with those who only had DVT. There were overall three mortalities in the nine patients who developed PE.
ConclusionAlthough VTE has a low incidence, it is a known complication of extensive head and neck surgeries with life-threatening outcomes. We recommend early mobilization and physiotherapy with the possible aid from appropriate mechanical and pharmacologic thromboprophylaxis.

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Relationship between Otolaryngologic Complaints and Systemic Comorbidities Observed in a Group of Hearing Aid Users

Introduction
Optimization of the selection, adaptation, and benefit of hearing aids is necessary to characterize and manage hearing loss, user expectations, otolaryngologic symptoms, and systemic comorbidities.
ObjectiveTo compare the occurrence of otologic complaints, systemic diseases, and effective use of hearing aids in men and women with deafness.
MethodsPatients from a Unified Health System-accredited hearing health service, who reported problems in adapting to their hearing aids, were evaluated by a physician and audiologist. An anamnesis, ENT evaluation, and audiological evaluation were performed.
ResultsDuring the data collection period, 278 subjects came in for follow-up visits; of these, 61 (21%) reported otologic or operational problems with their equipment. The most prevalent type of hearing loss was basocochlear, a characteristic of presbycusis, in both men and women; the most frequently reported comorbidities were hypercholesterolemia (more significant in women) and hypertension (more significant in men). Fourteen subjects reported using their device discontinuously, with no significant difference between genders; the reasons for discontinuation of use were itching and ringing, with more complaints from women.
ConclusionThe incidence of systemic and audiological complaints is high in this population. These patients should be evaluated thoroughly, as resolutions of these complaints can contribute to improving the quality of life and assist in the process of hearing aid fitting.

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Study of the Hearing Threshold of Dance Teachers

Introduction
High sound pressure levels can cause hearing loss, beginning at high frequencies.
ObjectiveTo analyze the hearing thresholds of dance teachers.
MethodsThis study had a cross-sectional, observational, prospective, and descriptive design. Conventional and high-frequency hearing evaluations were performed with dance teachers and subjects in the control group.
ResultsIn all, 64 individuals were assessed, 32 in the research group and 32 in the control group. Results showed that individuals in the research group had hearing loss at frequencies between 4 and 8 kHz, but no significant difference was found between groups. Frequency analysis showed that individuals in the control group had higher thresholds than individuals in the research group at the frequency of 0.25 kHz. In the control group, men showed higher thresholds than women at the frequency of 9 kHz.
ConclusionA low prevalence of hearing loss was found, with no difference between teachers and subjects fromthe control group. No difference was found for hearing thresholds at high frequencies between groups. Results have been partially affected by sex.

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Study of the Hearing Threshold of Dance Teachers

Hearing Aid Use and Adherence to Treatment in a Publicly-Funded Health Service from the City of São Paulo, Brazil

Reflux Laryngitis: Correlation between the Symptoms Findings and Indirect Laryngoscopy

Introduction
The indirect laryngoscopy has an important role in the characterization of reflux laryngitis. Although many findings are nonspecific, some strongly suggest that the inflammation is the cause of reflux.
ObjectiveThe aim of this study was to evaluate the correlation between reflux symptoms and the findings of indirect laryngoscopy.
MethodsWe evaluated 27 patients with symptoms of pharyngolaryngeal reflux disease.
ResultsLaryngoscopy demonstrated in all patients the presence of hypertrophy of the posterior commissure and laryngeal edema. The most frequent symptoms were the presence of dry cough and foreign body sensation.
ConclusionThere was a correlation between the findings at laryngoscopy and symptoms of reflux.

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Voice Outcome after Gore-Tex Medialization Thyroplasty

Introduction
Although medialization thyroplasty utilizing Gore-Tex (Gore and Associates, Newark, Delaware, United States) has been discussed in the literature, few reports have assessed voice quality afterward, and they did not use a full assessment protocol.
ObjectiveTo assess the improvement in voice quality after medialization thyroplasty utilizing Gore-Tex in patients with glottic insufficiency of variable etiology.
MethodsEleven patients with glottic insufficiency of different etiologies that failed compensation were operated by type 1 thyroplasty utilizing Gore-Tex. Pre- and postoperative (1 week, 3 months, and 6 months) voice assessment was done and statistical analysis was performed on the results.
ResultsIn all postoperative assessments, there was significant improvement in the grade of dysphonia (p < 0.004) and highly significant reduction in the size of glottic gap and prolongation of maximum phonation time (p < 0.0001). The difference in voice parameters in the early (1 week) and the late (3 and 6months) postoperative period was not significant. None of the patients developed stridor or shortness of breath necessitating tracheotomy, and there was no implant extrusion in any patient during the study period.
ConclusionGore-Tex medialization provides reliable results for both subjective and objective voice parameters. It leads to a satisfactory restoration of voice whatever the etiology of glottic incompetence is. This technique is relatively easy and does not lead to major complications. Further studies with larger number of patients andmore extended periods of follow-up are still required to assess the long-term results of the technique regarding voice quality and implant extrusion.

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Venous Thromboembolism-Incidence of Deep Venous Thrombosis and Pulmonary Embolism in Patients with Head and Neck Cancer: A Tertiary Care Experience in Pakistan

Relationship between Otolaryngologic Complaints and Systemic Comorbidities Observed in a Group of Hearing Aid Users

Ambient Noise in Emergency Rooms and Its Health Hazards

The Effects of Unilateral Adaptation of Hearing Aids on Symptoms of Depression and Social Activity Constraints of Elderly

Introduction
Hearing loss is one of the most common problems in the elderly population. Besides compromising oral communication, it directly affects social relations and prevents elderly patients from living actively in society, possibly leading to the onset of depression or other conditions. Objective To analyze the effects of unilateral adaptation of hearing aids on symptoms of depression and the social activity constraints of elderly subjects with hearing impairment.
MethodsThe sample consisted of elderly subjects with hearing loss who did not use hearing aids. Data were collected in two phases. Initially, all participants underwent an audiological assessment and answered the Hearing Handicap Inventory for Elderly (summarized version) and the Geriatric Depression Scale. All subjects participated in the selection and hearing aid adaptation processes and became monaural hearing aid users. After 30 days of hearing aid use, they were assessed with the same instruments. The results of the questionnaires before and after hearing aid adaptation were compared.
ResultsThe sample consisted of 13 individuals, between 60 and 90 years old (mean 72.85 ± 11.05 years). Data analysis showed that there was significant improvement in social activity constraints (p < 0.001) and in symptoms of depression (p = 0.031). Conclusion Results show that, in the sample studied, unilateral hearing aid adaptation reduced social activity constraints and depression symptoms.

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Angiosarcoma of the Head and Neck

Effectiveness of a Vestibular Rehabilitation Protocol to Improve the Health-Related Quality of Life and Postural Balance in Patients with Vertigo

Introduction
Dizziness can be characterized as a balance disorder that causes discomfort, leading to several functional limitations. Currently, vestibular rehabilitation has been highlighted as a possible treatment.
ObjectiveAnalyze the effects of completing a vestibular rehabilitation treatment protocol on quality of life and postural balance in patients with vestibular complaints, as well as to compare these effects between the patients taking or not taking antivertigo drugs.
MethodsA nonrandomized controlled trial was performed with 20 patients previously diagnosed with vestibular diseases. Information regarding vertigo symptoms, quality of life as assessed through the Dizziness Handicap Inventory, visual analog scale of dizziness, and stabilometry using force platform was collected. Patients were treated for 12 weeks by a customprotocol. The sample was divided into two groups according to the use (medicated group, n = 9) or not (control group, n = 11) of antivertigo drugs.
ResultsThere was improvement in quality of life (p < 0.001) and intensity of dizziness (p = 0.003) with the intervention. An improvement of postural balance was observed through functional tests. However, no statistically significant difference was noted in stabilometry. When both groups were compared, no statistically significant differences between the variations of the variables analyzed were found in the re-evaluation session.
ConclusionQuality of life and postural balance are improved with intervention. However, this improvement is not associated with pharmacologic treatment.

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Rhinosinusal Polyposis and Inverted Papilloma: A Morphometric Comparative Study

Transient Evoked and Distortion Product Otoacoustic Emissions in a Group of Neonates

Introduction
The most commonly used method in neonatal hearing screening programs is transient evoked otoacoustic emissions in the first stage of the process. There are few studies comparing transient evoked otoacoustic emissions with distortion product, but some authors have investigated the issue.
ObjectiveTo correlate the results of transient evoked and distortion product otoacoustic emissions in a Brazilian maternity hospital.
MethodsThis is a cross-sectional, comparative, and prospective study. The study included 579 newborns, ranging from 6 to 54 days of age, born in a low-risk maternity hospital and assessed for hearing loss. All neonates underwent hearing screening by transient evoked and distortion product otoacoustic emissions. The results were analyzed using the Spearman correlation test to relate the two procedures.
ResultsThe pass index on transient evoked otoacoustic emissions was 95% and on distortion product otoacoustic emissions was 91%. The comparison of the two procedures showed that 91% of neonates passed on both procedures, 4.5% passed only on transient evoked otoacoustic emissions, 0.5% passed only on distortion product otoacoustic emissions, and 4% failed on both procedures. The inferential analysis showed a significant strong positive relationship between the two procedures.
ConclusionThe failure rate was higher in distortion product otoacoustic emissions when compared with transient evoked; however, there was correlation between the results of the procedures.

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Functional Comorbidity Index in chronic rhinosinusitis

Background

The Functional Comorbidity Index is a promising tool to predict general health status and adjust for comorbidity confounding in outcomes studies of chronic conditions, but it has been tested as a predictor of general health status only in a sleep apnea cohort. We tested it in a chronic rhinosinusitis cohort with 2 objectives: (1) measure the association between the Functional Comorbidity Index (range, 0 to 18) and general health status (SF-36 Physical Component Score and Mental Component Score); and (2) test if the Functional Comorbidity Index is more strongly associated (a better predictor) than the well-known Charlson Comorbidity Index (range, 0 to 37) with these SF-36 outcome measures.

Methods

In a cross-sectional study of chronic rhinosinusitis patients, we obtained scores for the Functional Comorbidity Index, Charlson Comorbidity Index, and the SF-36. We calculated Spearman correlations and adjusted coefficients of determination (R²) using multiple linear regression, adjusted for demographic covariates. Bootstrapping generated R² distributions for statistical comparison.

Results

In the cohort (N = 97), the Functional Comorbidity Index scores (mean ± standard deviation: 2.2 ± 1.9) were more widely distributed than Charlson Comorbidity Index scores (0.6 ± 1.2). The Functional Comorbidity Index significantly correlated with the SF-36 Physical Component Score (−0.49, p < 0.001) and Mental Component Score (−0.37, p < 0.001). The Functional Comorbidity Index was a better predictor than the Charlson Comorbidity Index of SF-36 Physical Component Score (R² mean ± standard error: 0.21 ± 0.09 vs 0.15 ± 0.05; p < 0.001) and Mental Component Score (0.16 ± 0.10 vs 0.01 ± 0.06; p < 0.001).

Conclusion

The Functional Comorbidity Index is a more robust predictor of general health status than the Charlson Comorbidity Index in chronic rhinosinusitis patients.

Impact of postoperative endoscopy upon clinical outcomes after endoscopic sinus surgery

Background

After endoscopic sinus surgery (ESS), endoscopy is used to gauge surgical success and clinical outcomes. Prior studies have not examined this topic prospectively using validated outcome metrics across multiple institutions.

Methods

A multi-institutional, prospective study of patients with chronic rhinosinusitis (CRS) who underwent ESS completed the 22-item Sino-Nasal Outcome Test (SNOT-22), missed productivity, and medication usage questionnaires 6 months postoperatively. Lund-Kennedy endoscopy scoring (LKES) was performed with reviewers blinded to patient-reported data. A control cohort of non-CRS patients was recruited for comparison.

Results

Complete data was available on 183 CRS patients and 48 non-CRS control patients. Approximately 50% of patients achieve perfect or near perfect endoscopy (LKES 0 to 2) after ESS. Postoperative endoscopy correlated with total SNOT-22 scores (r = 0.278, p < 0.001), with the strongest correlations to rhinologic and extranasal subdomains in the nasal polyp cohort. Improved postoperative endoscopy was associated with decreased antibiotic and oral steroid usage, but had little association with missed productivity. Among patients who achieved near perfect postoperative endoscopy, those with nasal polyps had SNOT-22 scores that were similar to non-CRS control patients (mean SNOT-22 scores 17.7 and 16.3, respectively). However, CRS patients without nasal polyps remained more symptomatic than non-CRS controls and CRS with nasal polyps patients despite nearly perfect endoscopy (mean SNOT-22 score 21.6).

Conclusion

Postoperative endoscopy correlates with SNOT-22 and medication usage in CRS patients. Polyp patients who achieve near perfect endoscopy have similar symptoms to healthy controls; however, nonpolyp patients with near perfect endoscopy still have rhinologic and extranasal symptoms that are worse than healthy controls.

Reply to: In reference to: Medical therapy vs surgery for recurrent acute rhinosinusitis

Expression and function of the Scn5a-encoded voltage-gated sodium channel NaV1.5 in the rat jejunum

Abstract

Background

The SCN5A-encoded voltage-gated sodium channel Na_V1.5 is expressed in human jejunum and colon. Mutations in Na_V1.5 are associated with gastrointestinal motility disorders. The rat gastrointestinal tract expresses voltage-gated sodium channels, but their molecular identity and role in rat gastrointestinal electrophysiology are unknown.

Methods

The presence and distribution of Scn5a-encoded Na_V1.5 was examined by PCR, Western blotting and immunohistochemistry in rat jejunum. Freshly dissociated smooth muscle cells were examined by whole cell electrophysiology. Zinc finger nuclease was used to target Scn5a in rats. Lentiviral-mediated transduction with shRNA was used to target Scn5a in rat jejunum smooth muscle organotypic cultures. Organotypic cultures were examined by sharp electrode electrophysiology and RT-PCR.

Key Results

We found Na_V1.5 in rat jejunum and colon smooth muscle by Western blot. Immunohistochemistry using two other antibodies of different portions of Na_V1.5 revealed the presence of the ion channel in rat jejunum. Whole cell voltage-clamp in dissociated smooth muscle cells from rat jejunum showed fast activating and inactivating voltage-dependent inward current that was eliminated by Na⁺ replacement by NMDG⁺. Constitutive rat Scn5a knockout resulted in death in utero. Na_V1.5 shRNA delivered by lentivirus into rat jejunum smooth muscle organotypic culture resulted in 57% loss of Scn5a mRNA and several significant changes in slow waves, namely 40% decrease in peak amplitude, 30% decrease in half-width, and 7 mV hyperpolarization of the membrane potential at peak amplitude.

Conclusions & Inferences

Scn5a-encoded Na_V1.5 is expressed in rat gastrointestinal smooth muscle and it contributes to smooth muscle electrophysiology.

The voltage-gated Na⁺ channel Na_V1.5, encoded by the gene SCN5A, is expressed in human GI tract and is associated with functional GI disorders. Here we found that Scn5a is also expressed and functional in rat jejunal smooth muscle; knockdown of Scn5a expression with shRNA reduced the amplitude and half-widths of jejunal smooth muscle electrical slow waves. This study demonstrates a role for the voltage-gated mechanosensitive ion channel Na_V1.5 in normal gastrointestinal motility in the rat and establishes the rat as an important model for study of the Scn5a-encoded Na_V1.5 in gastrointestinal physiology and pathophysiology.

Methotrexate-associated lymphoproliferative disorder presenting as extranodal NK/T-cell lymphoma arising in the lungs

Patients having rheumatoid arthritis (RA) treated with methotrexate (MTX) are at an increased risk of developing lymphoproliferative disorder (LPD). Epstein–Barr virus (EBV) sometimes contributes to the development of MTX-associated LPD. Herein, we report the case of a 64-year-old Japanese woman with RA who showed complications of EBV-positive MTX-associated LPD. This case is exceedingly rare in that the LPD was confined to the lungs and its subclassification was extranodal NK/T-cell lymphoma. Only four cases of extranodal NK/T-cell lymphoma in the setting of MTX-associated LPD have ever been reported in the English language literature, only one of which was an extranasal NK/T-cell lymphoma, similar to our case. Extranasal NK/T-cell lymphomas show more aggressive behavior than nasal NK/T-cell lymphomas, possibly reflected by the considerable re-exacerbation of the lesions in only two months after the cessation of MTX in our case. However, the SMILE regimen (steroid, methotrexate, ifosfamide, l-asparaginase, and etoposide) was able to suppress tumor growth in this case.

Efficiency of Performing Pulmonary Procedures in a Shared Endoscopy Unit: Procedure Time, Turnaround Time, Delays, and Procedure Waiting Time

Background: The purpose of this study was to assess the efficiency of performing pulmonary procedures in the endoscopy unit in a large teaching hospital. Methods: A prospective study from May 20 to July 19, 2013, was designed. The main outcome measures were procedure delays and their reasons, duration of procedural steps starting from patient's arrival to endoscopy unit, turnaround time, total case durations, and procedure wait time. Results: A total of 65 procedures were observed. The most common procedure was BAL (61%) followed by TBLB (31%). Overall procedures for 35 (53.8%) of 65 patients were delayed by ≥30 minutes, 21/35 (60%) because of "spillover" of the gastrointestinal and surgical cases into the time block of pulmonary procedure. Time elapsed between end of pulmonary procedure and start of the next procedure was ≥30 minutes in 8/51 (16%) of cases. In 18/51 (35%) patients there was no next case in the room after completion of the pulmonary procedure. The average idle time of the room after the end of pulmonary procedure and start of next case or end of shift at 5:00 PM if no next case was 58±53 minutes. In 17/51 (33%) patients the room's idle time was >60 minutes. A total of 52.3% of patients had the wait time >2 days and 11% had it ≥6 days, reason in 15/21 (71%) being unavailability of the slot. Conclusions: Most pulmonary procedures were delayed due to spillover of the gastrointestinal and surgical cases into the block time allocated to pulmonary procedures. The most common reason for difficulty encountered in scheduling the pulmonary procedure was slot unavailability. This caused increased procedure waiting time. The strategies to reduce procedure delays and turnaround times, along with improved scheduling methods, may have a favorable impact on the volume of procedures performed in the unit thereby optimizing the existing resources.

Lateral Calcaneal Artery Flaps in Atherosclerosis: Cadaveric Study, Vascular Assessment and Clinical Applications

Background: Soft tissue defects of the lateral malleolus (LM) and Achilles tendon pose difficult reconstructive problems due to the bony prominence and limited local tissue available. The objectives were to study the anatomical landmarks of the lateral calcaneal artery (LCA) and patency of LCA in atherosclerotic patients. Methods: Part I: Thirty-four cadaveric feet were dissected to identify the LCA. The distance between the LCA and the most prominent point of the LM was measured horizontally (LCAa-LM), obliquely (LCAb-LM), and vertically (LCAc-LM). Part II: Thirty-two patients were divided in 2 groups as nonatherosclerotic and atherosclerotic groups. The LCA was assessed by both Doppler ultrasonography and computed tomographic angiography (CTA). Part III: Clinical applications were demonstrated. Results: Part I: Mean distances of LCAa-LM, LCAb-LM, and LCAc-LM were 24.76, 33.68, and 35.03 mm, respectively. The LCA originated 94.12% from the peroneal artery. Part II: Doppler ultrasonography detected the LCA at 90.62% and 87.50% in nonatherosclerotic and atherosclerotic groups, respectively, whereas 100.00% and 93.75%, respectively, were detected by CTA. No statistically significant difference was found in the patency of the LCA between nonatherosclerotic and atherosclerotic patients. Part III: Clinical applications were performed in atherosclerotic patients. Conclusions: The LM is a reliable point to identify the LCA, and the LCA flap can be raised safely in atherosclerotic patients. Preoperative CTA should be performed in severely atherosclerotic patients or cases of major lower extremity vascular injuries.

Salvage of Exposed Groin Vascular Grafts with Early Intervention Using Local Muscle Flaps

Background: Peripheral vascular surgery may be complicated by wound infection and potential graft exposure in the groin area. Muscle flap coverage of the graft has been promoted to address these wound complications. The authors present their findings regarding graft salvage rates and patient outcomes using local muscle flaps to address vascular graft complications of the groin. Methods: Data were obtained by retrospective cohort study of patients who underwent a local muscle flap procedure by a single surgeon following vascular graft complication in the groin. Results: Seventeen patients undergoing local muscle flap coverage of a vascular graft were reviewed. Six men and 9 women, 51–80 years old, were included in the study. Wound complications in the groin occurred anywhere from 3 days to 3.5 years following graft placement. Graft exposure was the most common presenting complication (14 of 17 patients). Muscle flap coverage occurred within 15 days of complication presentation in all patients (average, 6.4 days). Seven of the 15 patients experienced postoperative complications within 6 months of the procedure, most commonly wound dehiscence. However, analysis demonstrated that vascular grafts were successfully salvaged in 10 of the 17 patients (59%) over the course of follow-up (range, 104–1748 days). Average time to muscle flap coverage was 4.2 days in patients who retained the graft and 9.6 days in patients who ultimately lost their vascular graft. Conclusion: The authors demonstrate improved vascular graft salvage rate when local muscle flap procedure is performed early after initial wound complication presentation.

A Novel Treatment of Denuded Areas in Newborns: A Report of 2 Successful Cases

Summary: Covering denuded areas in the extremes of life is challenging for the plastic surgeon. In newborns, this becomes a greater challenge because of the immaturity of all of their systems, making any injury a potential risk for death. We present in this case report a successful treatment of 2 cases covered with cultured autologous keratinocytes. In this procedure, a small skin biopsy is taken from the retroauricular area and the keratinocytes are cultured. After 5 days, a membrane with the cells cultured is applied covering the denuded area. We find the autologous keratinocyte method a suitable option for the treatment of denuded areas in newborns, without causing any additional morbidity and in a very short period of time.

Development of Standardized Clinical Assessment and Management Plans (SCAMPs) in Plastic and Reconstructive Surgery

Background: With rising cost of healthcare, there is an urgent need for developing effective and economical streamlined care. In clinical situations with limited data or conflicting evidence-based data, there is significant institutional and individual practice variation. Quality improvement with the use of Standardized Clinical Assessment and Management Plans (SCAMPs) might be beneficial in such scenarios. The SCAMPs method has never before been reported to be utilized in plastic surgery. Methods: The topic of immediate breast reconstruction was identified as a possible SCAMPs project. The initial stages of SCAMPs development, including planning and implementation, were entered. The SCAMP Champion, along with the SCAMPs support team, developed targeted data statements. The SCAMP was then written and a decision-tree algorithm was built. Buy-in was obtained from the Division of Plastic Surgery and a SCAMPs data form was generated to collect data. Results: Decisions pertaining to "immediate implant-based breast reconstruction" were approved as an acceptable topic for SCAMPs development. Nine targeted data statements were made based on the clinical decision points within the SCAMP. The SCAMP algorithm, and the SDF, required multiple revisions. Ultimately, the SCAMP was effectively implemented with multiple iterations in data collection. Conclusions: Full execution of the SCAMP may allow better-defined selection criteria for this complex patient population. Deviations from the SCAMP may allow for improvement of the SCAMP and facilitate consensus within the Division. Iterative and adaptive quality improvement utilizing SCAMPs creates an opportunity to reduce cost by improving knowledge about best practice.

Trends in Immediate Postmastectomy Breast Reconstruction in the United Kingdom

Background: The study aimed to evaluate local and national trends in immediate breast reconstruction (IBR) using the national English administrative records, Hospital Episode Statistics. Our prediction was an increase in implant-only and free flap procedures and a decline in latissimus flap reconstructions. Methods: Data from an oncoplastic center were interrogated to derive numbers of implant-only, autologous latissimus dorsi (LD), LD-assisted, and autologous pedicled or free flap IBR procedures performed between 2004 and 2013. Similarly, Hospital Episode Statistics data were used to quantify national trends in these procedures from 1996 to 2012 using a curve fitting analysis. Results: National data suggest an increase in LD procedures between 1996 (n = 250) and 2002 (n = 958), a gradual rise until 2008 (n = 1398) followed by a decline until 2012 (n = 1090). As a percentage of total IBR, trends in LD flap reconstruction better fit a quadratic (R2 = 0.97) than a linear function (R2 = 0.63), confirming a proportional recent decline in LD flap procedures. Conversely, autologous (non-LD) flap reconstructions have increased (1996 = 0.44%; 2012 = 2.76%), whereas implant-only reconstructions have declined (1996 = 95.42%; 2012 = 84.92%). Locally, 70 implant-assisted LD procedures were performed in 2003 -2004, but only 2 were performed in 2012 to 2013. Conclusions: Implants are the most common IBR technique; autologous free flap procedures have increased, and pedicled LD flap procedures are in decline.

Multidetector-row Computed Tomographic Angiography in the Planning of the Local Perforator Flaps

Background: The perforator vessels are highly variable in number, localization types, hemodynamic specifications, and the anatomical interactions with other structures. For these reasons, the identification of the best perforator before the operation is very important for the choice of the main feed vessel and the design of the perforator flap. Methods: The authors retrospectively analyzed all cases in which multiple detector computed tomography (MDCT) with 3-dimensional (3D) image reconstruction was used in the preoperative planning in preparation for the reconstruction with local perforator flaps, which took place between July 2012 and December 2014 in the hospital. Results: A total of 24 people were examined and underwent operations with 26 reconstructions using local perforator flaps. All perforators, which were identified during the MDCT with 3D reconstruction examination, were located intraoperationally without any errors. Conclusions: The preoperative MDCT with 3D reconstruction investigations of the topographic anatomical specifics of the perforator vessel on which the formation of the flap feed pedicle is planned allow for the fast and precise identification of the perforation at the preoperative stage while minimizing the amount of injury caused to the perforator during the operation and decrease the operation time.

Applying a Dermal Regenerative Template in Management of Congenital Melanocytic Nevi of the Hand

Summary: Congenital melanocytic nevus of the hand in the pediatric population is an uncommon diagnosis. These lesions have malignant potential and can cause psychosocial effects from cosmetic deformity. Early surgical intervention is recommended in these cases. The literature suggests that full-thickness skin grafting is to be performed in the hand to maintain functionality and avoid contracture and scarring. This creates a large donor-site defect and increased risk of graft loss due to slow revascularization from graft thickness. In addition, for large defects, the full-thickness skin graft donor site would require a split-thickness graft. However, split-thickness skin grafting is avoided in the hand due to increased scarring and contracture and decreased range of motion despite decreased donor-site morbidity and better revascularization. We describe a novel reconstructive technique that uses a dermal regenerative template (Integra) with split-thickness grafting. Having performed in 2 pediatric patients, we demonstrate that aesthetic and functional outcomes are equivalent to full-thickness grafting while creating a superficial donor site and allowing for improved revascularization from decreased graft thickness.

The Reverse Superficial Sural Artery Flap Revisited for Complex Lower Extremity and Foot Reconstruction

Background: Soft-tissue defects of the distal lower extremity and foot present significant challenges to the reconstructive surgeon. The reverse superficial sural artery flap (RSSAF) is a popular option for many of these difficult wounds. Our initial experience with this flap at multiple institutions resulted in a 50% failure rate, mostly because of critical venous congestion. To overcome this, we have modified our operative technique, which has produced a more reliable flap. Methods: All patients reconstructed with an RSSAF between May 2002 and September 2013 were retrospectively reviewed. In response to a high rate of venous congestion in an early group of patients, we adopted a uniform change in operative technique for a late group of patients. A key modification was an increase in pedicle width to at least 4 cm. Outcomes of interest included postoperative complications and limb salvage rate. Results: Twenty-seven patients were reconstructed with an RSSAF (n = 12 for early group, n = 15 for late group). Salvage rate in the early group was 50% compared with 93% in the late group (P = 0.02). Postoperative complications (75% vs. 67%, P = 0.70) were similar between groups. Venous congestion that required leech therapy was 42% in the early group (n = 5) and 0% in the late group (P = 0.01). Conclusions: Venous congestion greatly impairs the survival of the RSSAF. A pedicle width of at least 4 cm is recommended to maintain venous drainage and preserve flap viability.

Refined Method of Lipofilling following DIEP Breast Reconstruction: 3D Analysis of Graft Survival

Background: The deep inferior epigastric perforator (DIEP) flap technique gives good clinical results, but aesthetic surgical adjustments are often necessary. Lipofilling represents a good complementary method, but fat resorption within the few months after surgery limits its use. Recently, a new protocol was introduced and successfully evaluated on murine models. This study aims to evaluate this protocol following a DIEP procedure by three-dimensional analysis. Methods: Within a period of 4 months, every patient having undergone breast reconstruction with DIEP and who required a lipofilling adjustment was invited to take part in this study. All surgeries were performed using the Adip'sculpt disposable medical device MACROFILL (Laboratoires SEBBIN, Boissy-l'Aillerie, France). Fat resorption was analyzed using a three-dimensional photography system. Results: Twenty-three patients were included, with a total of 25 breasts operated on. Injections were carried out on irradiated breasts in 73% of cases, and average injection volume was 124 mL (SD = 39 mL), whereas average operating time was 68 minutes (44–96 minutes). At an average follow-up of 5 months (4–8 months), 70.9% of projection gain afforded by the lipofilling was still present. Conclusions: It is now clear that particular rules should be respected for an efficient lipofilling, particularly regarding aspiration cannula characteristics, vacuum used, and the necessity of washes and soft centrifugations. We demonstrate here that by following a specific protocol that addresses these precautions, while using material that is specifically adapted, a 70.9% fat survival rate can be achieved, even in the very unfavorable case of postirradiation DIEP breast reconstruction.

Pseudoangiomatous Stromal Hyperplasia: A Rare Cause of Idiopathic Gigantomastia

Summary: Gigantomastia remains a rare clinical diagnosis with significant physical and psychological impacts on patients. We present the case of a 40-year-old woman with idiopathic breast enlargement. Further histological analysis of the breast tissue revealed pseudoangiomatous stromal hyperplasia. This is the first reported case of diffuse breast enlargement resulting from pseudoangiomatous stromal hyperplasia.

Breast Reconstruction Using Contour Fenestrated AlloDerm: Does Improvement in Design Translate to Improved Outcomes?

Background: Acellular dermal matrices are used in implant-based breast reconstruction. The introduction of contour fenestrated AlloDerm (Life-Cell, Branchburg, N.J.) offers sterile processing, a crescent shape, and prefabricated fenestrations. However, any evidence comparing reconstructive outcomes between this newer generation acellular dermal matrices and earlier versions is lacking. Methods: Patients undergoing implant-based breast reconstruction from 2010 to 2014 were identified. Reconstructive outcomes were stratified by 4 types of implant coverage: aseptic AlloDerm, sterile "ready-to-use" AlloDerm, contour fenestrated AlloDerm, or total submuscular coverage. Outcomes were compared with significance set at P

St. Macrina, the Patron Saint of Modern Oncoplastic Surgery?

No abstract available

Combination of Mandibular Constriction and Intraoral Vertical Ramus Osteotomies for a Transverse Jaw Discrepancy

Background: The aim of the present study was to evaluate the treatment of patients developing a transverse jaw width discrepancy who exhibited class III malocclusion and/or facial asymmetry by a combination of mandibular constriction (MC) and intraoral vertical ramus osteotomies (IVROs). Subjects and methods: In a retrospective study, functional results, postoperative complications, and skeletal stability were analyzed for all the patients who had undergone MC and IVRO, with more than 2 years of follow-up. A mandibular midline osteotomy for constriction with lag screw technique and IVROs was used for MC and setback. Results: Sixteen patients were included in the present study. The average degree of MC was 6.34 mm. Both the occlusal relationship and facial appearance in all patients were significantly improved by the surgical orthodontic treatment, with no harmful clinical symptoms. In addition, our original MC using lag screw technique provided the most reliable results in terms of skeletal stability. Conclusions: This study showed that MC using lag screw technique gives a very stable mandibular width constriction, and the combination of MC and IVROs offers a promising treatment alternative for patients with mandibular prognathism developing a transverse jaw width discrepancy.

Usefulness of Simple-Designed Bilobed Flap for Reconstruction of Ischial Decubitus Ulcer

Summary: The pressure ulcer of the ischial region is often accompanied by complete paraplegia in patients with spinal cord injury and is attributable to the compression and breakdown of tissue arising from constant sitting. Characteristically, a pressure ulcer of this region is circular and deep. We recently reconstructed ischial decubitus ulcer of 8 patients using simple-designed bilobed flap. In all cases, the flap survived completely without any complication. Moreover, none of the patients in this group experienced any pressure ulcer relapse during the postoperative follow-up from 1 year 1 month to 9 years. In the vicinity of the ischial region, the buttock contains the most abundant amount of fatty tissue. Therefore, for our technique, we create the first flap in the buttock neighboring the defect and the second flap on the posterior thigh. Using this approach, it is possible to cover the skin or soft tissue defect of the ischial region with the flap from the buttock having a thickness large enough to bear the patient's weight during sitting. The first flap is arranged parallel to the gluteal sulcus, and the second flap from the thigh is moved to the first-flap donation site. This technique allows closure of the wound without producing tension along the suture line. The bilobed flap, which does not require the artery to be included in the flap, is applicable for patients with relapsing pressure ulcer having a history of surgery. Our flap operative procedure is particularly useful in the reconstruction of ischial decubitus ulcer.

Forequarter Replantation and the Lessons Learnt

Summary: The literature on major upper limb replantation, especially those proximal to the elbow, is inadequate. An 18-year-old man presented to us with a left forequarter amputation. A replantation was attempted with a view to salvaging function and avoiding prosthesis. The procedure was technically challenging with a number of issues not highlighted in previous reports, particularly bony stabilization. The procedure was initially successful, with good perfusion. However, with time, the limb showed sepsis and had to be abandoned. We report this case to add to the literature on replantation at the shoulder level in the hope that this procedure may be reported successfully in the future.

Saved by De-epithelialization: DIEP Flap Dermal Skin Regeneration Salvage after Mastectomy Skin Flap Loss

Background: Wound re-epithelialization has been traditionally described to occur from the dermal appendages of the wound edges. As such, the role of the dermal wound bed in re-epithelialization has been questioned. In a patient undergoing breast reconstruction with free tissue transfer, the buried portions of the free flap skin paddle could be either de-epithelialized or deskinned. In case of mastectomy skin flap loss, the role of de-epithelialized skin in wound healing has not been described before. Methods: We report a patient with bilateral mastectomies and bilateral deep inferior epigastric perforator flaps whose postoperative course was complicated by bilateral full-thickness mastectomy skin flap loss. Multiple debridements of nonviable skin resulted in exposure of previously buried de-epithelialized skin paddle of the deep inferior epigastric perforator flap. Results: Our study demonstrates self re-epithelialization of the dermal wound bed from the dermal appendages. We noticed multiple noncontiguous neoepidermal islands in the dermal wound bed, which did not communicate with the wound edges. Conclusions: In case of full-thickness mastectomy skin flap loss, deep vascular plexus present in the dermal bed of the underlying de-epithelialized skin paddle of the free flap converts an otherwise full-thickness wound to a partial-thickness wound. Our study demonstrates the self-epithelialization potential of the de-epithelialized dermal wound bed from the dermal appendages when exposed to air and in the presence of wound healing elements.

Preventable Sternocleidomastoid Muscular Atrophy after Neck Dissection

Background: Modified radical neck dissection (mRND) [preserving the sternocleidomastoid muscle (SCM) and the spinal accessory nerve] and supraomohyoid neck dissection have become common surgical procedures for treating head and neck cancer. Postoperative severe asymmetry of the neck and severe atrophy of the SCM, however, have been demonstrated. Methods: Using computed tomographic images, cross-sectional areas of the SCMs were measured in 99 patients with carcinoma of the oral cavity who underwent unilateral mRND or supraomohyoid neck dissection. An asymmetry index was used. Results: Innervation to the SCM was preserved in 91 patients. The spinal accessory nerve and the innervation were sacrificed in 3 patients; the innervation was repaired in 5 patients. Sacrifice of innervation to the SCM resulted in extremely severe asymmetry. Repair of the innervation prevented severe asymmetry in 40%. Preservation of the innervation prevented severe asymmetry in 75% at the middle portion of the neck and in 56% at the lower portion after mRND. Conclusion: Preserving innervation to the SCM and gentle handling of the nerve during neck dissection could prevent severe asymmetry after neck dissection.

Metastatic Invasive Sweat Gland Adenocarcinoma of the Hand with Upper Limb Amputation/Shoulder Reconstruction

Summary: A rare case of metastatic invasive sweat gland adenocarcinoma of hand in a 78-year-old woman is presented. From this analysis of the available literature, it seems that these rare primary tumors of the hand are aggressive tumors with little known about their biological behavior. Fluoropyrimidines, taxanes, and cisplatin have been reported to be active agents for metastatic sweat gland carcinomas. Further, these tumors have historically been considered radioresistant, but responses to radiation have been documented in the setting of recurrent disease, and the use of adjuvant radiotherapy has been advocated for tumors at high risk of local recurrence. We advocate an aggressive approach of high amputation and axillary lymph node dissection with adjuvant treatment using chemotherapy as the mainstay with close follow-up for metastases.

Simultaneous Bilateral Submental Lymph Node Flaps for Lower Limb Lymphedema Post Leg Charles Procedure

Summary: We summarize the case of a 59-year-old woman with left lower limb lymphedema for 4 years post hysterectomy, pelvic lymph node dissection, radiation therapy, and chemotherapy for endometrial cancer. She underwent the Charles procedure on her left leg 2 years before being referred to our hospital and developed several cellulitis episodes and progressive lymphedema affecting her left toes and thigh. Bilateral vascularized submental lymph node flaps were transferred to her left ankle and thigh, respectively. After a 5-month follow-up, the leg became softer and lighter without relapsing cellulites, and the circumferential reduction rates at 15 cm above knee, 15 cm below knee, and 10 cm above ankle were 23.3%, 50%, and 22.2%, respectively. The patient was satisfied with the functional recovery and discontinued use of compression garment postoperatively.

Recurrent Myoepithelioma Treated by Palatal and Piriform Apertural Approaches

Summary: Myoepithelioma is a rare, benign salivary neoplasm, most frequently located in the salivary gland; extrasalivary cases most commonly occur in the palate. This tumor is prone to recurrence. We present a case of recurrent myoepithelioma in the nasal cavity with a palatal fistula treated both by a palatal approach and a piriform apertural approach. The combination of these approaches widens the surgical space, allowing removal of the mass. It is important not only to excise the mass but also to allow for reconstruction.

The effects of noise on key workplace skills

This study explored the effect on memory and psychomotor performance of wideband noise (simulated in-cabin aircraft noise) at 75 dBA, which is similar to that experienced during the cruise phase of a commercial flight. The results from the tests were compared to the effects of a widely known and common metric on the same skills, namely, blood alcohol concentration (BAC). All 32 participants, half non-native English speakers, completed three different tests (recognition memory, working memory, and reaction time) presented in counterbalanced order, either in the presence of noise, with or without noise attenuation headphones, and without noise but with a BAC of 0.05 or 0.10. Simulated aircraft noise was found to affect recognition memory but not working memory or reaction time. These effects were more pronounced for non-native speakers and reflected performance similar to that for BAC of 0.05 or 0.10.

The precedence effect with increased lag level

When a pair of sounds arrive from different directions with a sufficiently short delay between them, listeners hear a perceptually fused image with a perceived location that is dominated by the first arriving sound. This is called the precedence effect. To test the limits of this phenomenon, 200-ms noise stimuli were presented over headphones to model a temporally overlapping direct sound (lead) with a single reflection (lag) at inter-stimulus intervals (ISIs) of 0–5 ms. Lag intensity exceeded that of the lead by 0–10 dB. Results for 16 listeners show that lateralization shifted from the position of the lead towards the lag as lag level increased. Response variability also increased with lag level. An oscillatory pattern emerged across ISIs as lag level increased, to a degree that varied greatly between listeners. Analysis of modeled binaural cues suggests that these oscillatory patterns are correlated with ILDs produced by the physical interference of lead and lag during the ongoing portion of the stimulus, especially in the 764-Hz frequency band. Different listeners apparently weighted cues from the onset versus ongoing portions of the stimulus differently, as evidenced by the varying degree of influence the ongoing ILD cues had on listeners' perceived lateralization.

On the use of evanescent plane waves for low-frequency energy transmission across material interfaces

The transmission of airborne sound into high-impedance media is of interest in several applications. For example, sonic booms in the atmosphere may impact marine life when incident on the ocean surface, or affect the integrity of existing structures when incident on the ground. Transmission across high impedance-difference interfaces is generally limited by reflection and refraction at the surface, and by the critical angle criterion. However, spatially decaying incident waves, i.e., inhomogeneous or evanescent plane waves, may transmit energy above the critical angle, unlike homogeneous plane waves. The introduction of a decaying component to the incident trace wavenumber creates a nonzero propagating component of the transmitted normal wavenumber, so energy can be transmitted across the interface. A model of evanescent plane waves and their transmission across fluid-fluid and fluid-solid interfaces is developed here. Results are presented for both air-water and air-solid interfaces. The effects of the incident wave parameters (including the frequency, decay rate, and incidence angle) and the interfacial properties are investigated. Conditions for which there is no reflection at the air-solid interface, due to impedance matching between the incident and transmitted waves, are also considered and are found to yield substantial transmission increases over homogeneous incident waves.

Audio-vocal responses elicited in adult cochlear implant users

Auditory deprivation experienced prior to receiving a cochlear implant could compromise neural connections that allow for modulation of vocalization using auditory feedback. In this report, pitch-shift stimuli were presented to adult cochlear implant users to test whether compensatory motor changes in vocal F0 could be elicited. In five of six participants, rapid adjustments in vocal F0 were detected following the stimuli, which resemble the cortically mediated pitch-shift responses observed in typical hearing individuals. These findings suggest that cochlear implants can convey vocal F0 shifts to the auditory pathway that might benefit audio-vocal monitoring.

Patients seek better access to homecare in a changing market

Change is traumatic. This is true regardless of whether the change is positive or negative. Getting married is traumatic; so is getting a divorce. Starting a new job is traumatic; so is getting fired. Anything that takes us out of our comfort zone is traumatic.
As an industry, we had a nice "run" from the late 70s until the first part of this century. We were lightly regulated; audits barely existed; competitive bidding certainly did not exist; the NSC was not particularly aggressive; the contractors were likewise not aggressive; and reimbursement rates were high. It was not terribly difficult to run a profitable DME company. There was enough money to provide great services to patients and to keep happy employees on board.
This has come to an end. Congress and CMS have forced a complete transformation of the industry. In many ways, has this been unfair? Sure. In many ways, has CMS been out of touch with reality? Of course. But this is what the government does. We have seen this movie play out in health care and non-health care industries alike.
We are having to "remake ourselves." But so have other industries. Think of Xerox. What immediately comes to mind are copiers. Well, Xerox has branched out into so many other areas that copiers are now an afterthought to Xerox. Polaroid and Kodak were icons in the photographic film arena. This arena is now extinct. The list goes on and on.
What is an absolute is that we have 78 million Baby Boomers who will live to be 85 years old, whose bodies will break down, and who will need DME. The demand for DME will be overwhelming. What is another absolute is that Medicare will not pay a whole lot and it will take a lot of effort to get paid by Medicare.
Can we as an industry meet the demand? Sure. Do we have to be creative regarding the products and services we offer? Absolutely. Do we have to work our tails off to produce only a small profit margin? Without question.
What gives me optimism is to see new players coming into the market. Medtrade used to be like a high school reunion. I knew everybody. I saw the same faces every year. This is no longer the case. During the past several Medtrades, I have not recognized most of the faces. They are new. I am seeing young, educated, entrepreneurial people coming into the market.
They are willing to take the market "as is….warts and all." What they see is the huge demand. And they have the confidence that they will be creative enough to meet the demand—and generate a profit in doing so. The "old timers" are burdened by knowing how "things used to be." That is truly a burden. The old timers need to force themselves to forget about the past and rethink everything.
Creative DME suppliers needs to think of themselves not as a traditional suppliers, but as a companies that sell products and provides services to help people have an enjoyable lifestyle. If the supplier can set itself apart from its competition, and find its own unique niche, then people will pay for the products and services. It may not be Medicare that is doing the paying. It may very well be the consumer that is more than happy to pay out of pocket.
I am a Baby Boomer. One day I will wake up and I will be 75 years old. When that happens, I will know that I will likely have about 10 more years left on this earth. Time will be my most valuable asset. I will not want to wait around for Medicare to agree to pay for something I want. Rather, I will pull out my Visa and pay for it. There are millions like me. We are the industry's future customers.
Jeffrey S. Baird, JD, is chairman of the Health Care Group at Brown & Fortunato PC, Amarillo, TX
The post The Home Care Industry Will Grow, But it Will Look Different appeared first on Sleep Diagnosis and Therapy.

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Audio-vocal responses elicited in adult cochlear implant users

Establishment of a xenograft model to explore the mechanism of bone destruction by human oral cancers and its application to analysis of role of RANKL

Background

The molecular mechanism underlying bone invasion caused by oral squamous cell carcinoma (OSCC) is not well understood. To elucidate the molecular mechanism, the development of more suitable xenograft models mimicking human mandibular bone destruction by OSCC has been required.

Materials and methods

Human OSCC cell lines, HSC3, HSC3-C1, and HSC3-R2, were injected in the periosteal region of the mandible in athymic mice, and the bone destruction was analyzed. Receptor activators of nuclear factor κ-B ligand (RANKL) mRNA and protein expression levels were measured in the OSCC cell lines. Antibody that specifically neutralizes mouse RANKL and human RANKL, respectively, was injected into HSC3-cell-transplanted mice.

Results

Transplantation of HSC3 cells induced mandibular bone destruction. Histological examination revealed numerous osteoclasts on the bone destruction surface. Fibroblastic cell intervention between the cancer nests and resorbing bone surface was observed in a similar fashion to those observed in human OSCC cases. The number of osteoclasts and fibroblasts was significantly correlated. Bone destruction induced by the transplantation of HSC3 cells was reduced by injection of an antibody that specifically neutralizes mouse RANKL. Transplantation of HSC3-R2 cells, which overexpresses RANKL, induced advanced bone destruction compared to that of HSC3-C1 cells, which only overexpress the empty vector.

Conclusions

We established a useful xenograft model for investigating the molecular mechanism underlying the bone destruction induced by OSCC in the jaw. This model will be used to investigate the precise roles of several cytokines synthesized by both cancer cells and fibroblastic cells in OSCC-associated bone destruction in the jaw.

Follicular Thyroid Carcinoma Metastatic to the Kidney: Report of a Case with Cytohistologic Correlation

Here we report a case of a 45-year-old female who underwent thyroidectomy for thyroid cancer and presented 20 years later with a left renal mass. CT-guided core biopsy was performed, and imprints and histologic sections of the biopsy showed cells resembling thyroid follicular cells with a background containing colloid. Immunohistochemistry revealed positivity for thyroglobulin and thyroid transcription factor 1, consistent with metastatic follicular thyroid carcinoma (FTC). The patient later underwent radical nephrectomy; histologic sections of the resected tumor revealed an encapsulated lesion morphologically similar to the biopsy specimen. Thyroid metastases to the kidney are extremely rare and are often detected during postthyroidectomy surveillance by elevation in thyroid hormone levels, 131I scintigraphy, or 18F-fluorodeoxyglucose uptake in positron emission tomography studies. Treatment involves total thyroidectomy, resection of the metastatic foci, and 131I therapy. The differential diagnoses of renal metastasis of FTC include the encapsulated follicular variant of papillary thyroid carcinoma (PTC), which possesses some of the nuclear features seen in conventional PTC but may occasionally be indistinguishable from FTC in cytologic preparations, and renal lesions such as benign thyroidization of the kidney and thyroid-like follicular carcinoma of the kidney, which mimic FTC in histologic appearance but do not stain with thyroid markers.
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Adult hearing-aid users with cochlear dead regions restricted to high frequencies: Implications for amplification

10.3109/14992027.2015.1074294<br/>Anna Pepler
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Response to comments on "Reflectance confocal microscopy as a useful diagnostic tool for monitoring of skin containing vascularized allograft rejection: A Preliminary study on rats"

Perforators as recipients for free flap reconstruction of the inguinal and perineal region

Objective

Extensive defects of the perineal or inguinal area require well vascularized free flap coverage. This area has an abundance of perforating arteries and veins based on vessels from the femoral artery and internal iliac artery. We present our experience on the use of perforators as recipient vessels in reconstructing soft tissue defects of the perineal and inguinal area with free flaps.

Patients and Methods

From March 2012 to August 2014, 13 patients underwent free flap reconstruction for soft tissue defects of the inguinal or perineal area. Perforating arteries with diameters ranging from 0.7 to 1.2 mm were used as recipient arteries. Accompanying veins or neighboring superficial veins were secured as recipient veins.

Results

All flaps survived attached to a recipient perforator with a diameter ranging from 0.7 to 1.2 mm. These vessels were found in the inguinal or perineal areas, regions that are supplied by the superficial circumflex iliac vessels, superficial inferior epigastric vessels, superficial and deep external pudendal vessels, lateral and medial circumflex femoral vessels, and internal pudendal vessels. There were no cases of arterial insufficiency or venous congestion, flap necrosis, or infection. A single case of hematoma beneath the flap was treated by simple evacuation. There were no donor complications.

Conclusion

Using perforators as the recipient during free flap reconstruction of the inguinal and perinea area allows the surgeon to choose from a wider choice of vessels, and yields acceptable flap survival. © 2015 Wiley Periodicals, Inc. Microsurgery, 2015.

Depiction of differential etiologies of dwarfism by Il Veronese (1528–1588)

Brigida del Rio, "La Barbuda de Peñaranda" (1590): Juan Sánchez Cotán (1560–1627)

Comparative treatment planning study on sequential vs. simultaneous integrated boost in head and neck cancer patients

Abstract

Aim

The purpose of this work was to compare sequential (SeqB) versus simultaneous integrated boost (SIB) radiotherapy plans delivered with volumetric modulated arc therapy (VMAT) for patients with locally advanced squamous cell cancer of the head and neck (HNSCC).

Patients and methods

SeqB and SIB plans using VMAT for 10 HNSCC patients given definitive chemoradiation were generated and analysed for differences in dose distribution, coverage, conformity and homogeneity to the planning target volumes (PTV) 1–3 and sparing of organs at risk (OAR).

Results

The mean delineated volumes ± standard deviations were 137.7 ± 44.8, 351.3 ± 83.9 and 895.6 ± 120.5 cm³ for PTV1–3. The mean volumes encompassed by the corresponding 95 % isodoses were 281 (+ 110 %) ± 73.4, 712.2 (+ 115 %) ± 146.4 and 1381.1 (+ 54 %) ± 217.3 cm³ with SeqB and 138.2 (+ 7 %) ± 40.1, 380.4 (+ 11 %) ± 91.9 and 1057.3 (+ 21 %) ± 161.4 cm³ with SIB for PTV1–3, respectively. Both strategies achieved excellent PTV coverage. SeqB provided significantly better coverage of PTV1 and 3, worse conformity for PTV1–3 and a higher mean dose than prescribed (111–115 %) to PTV2 and 3 (p ≤ 0.007). Both strategies provided satisfactory OAR sparing.

Conclusion

This study showed significant dosimetric differences with potential clinical relevance between two VMAT boost strategies regarding coverage, conformity and dose to the PTVs. SIB might cause less toxicity. A clinical phase III/IV trial endorsed by the German Head and Neck Clinical Trials Group (IAG-KHT) will evaluate differences in acute/late toxicity as well as in locoregional recurrences between the two boost techniques.

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Weekly cisplatin and radiotherapy for low risk, locoregionally advanced human papillomavirus–positive oropharyngeal squamous cell carcinoma

Abstract

Background

There is interest in different treatment strategies, including deintensification in good prognosis human papillomavirus-positive (HPV(+)) oropharyngeal squamous cell carcinoma (SCC). We reviewed our experience with weekly cisplatin in low-risk, locoregionally advanced HPV(+) oropharyngeal SCC since late 2009.

Methods

Data from patients with low-risk HPV(+) oropharyngeal SCC treated with weekly cisplatin (40 mg/m²) and 70 Gy radiotherapy were collected. Low risk was defined as stage III to IV oropharyngeal SCC excluding T1-2N1, T4 or N3 disease, or N2b to N2c disease in patients with >10 pack-year smoking history.

Results

Of 31 patients, the median age was 56 years (range, 41–69 years). All patients completed 70 Gy radiotherapy within 51 days and 84% completed at least 5 cycles of cisplatin. Grade 3 mucositis occurred in 22 patients (71%) and grade 3 febrile neutropenia in 6 patients (19%). No patients required enteral feeding at 12 months. The median follow-up was 30 months (range, 21–57 months) with no recurrences or deaths.

Conclusion

Concurrent weekly cisplatin is relatively well-tolerated and associated with excellent disease control in low-risk, locoregionally advanced HPV(+) oropharyngeal SCC. © 2015 Wiley Periodicals, Inc. Head Neck, 2015

Age of onset of Recurrent Respiratory Papillomatosis: a distribution analysis

Abstract

Background

Distribution of age of onset of Recurrent Respiratory Papillomatosis (RRP) is generally described to be bimodal, with peaks at approximately at 5 years and 30 years. This assumption has never been scientifically confirmed and authors tend to refer to an article which does not describe distribution. Knowledge of the distribution of age of onset is important for virological and epidemiological comprehension. Objective of this study was to determine the distribution of age of onset of RRP in a large international sample.

Methods

Laryngologists from twelve European hospitals provided information for this cross-sectional study on date of birth and date of onset of all their RRP patients treated between 1998 and 2012. Centers which exclusively treated either juvenile onset or adult onset RRP patients, or were less accessible for one of these groups, were excluded to prevent skewness. A mixture model was implemented to describe distribution of age of onset. The best fitting model was selected using the Bayesian Information Criterion.

Results

Six hundred and thirty-nine patients were included in the analysis. Age of onset was described by a three component mixture distribution with lognormally distributed components. RRP starts at three median ages 7, 35 and 64 years.

Conclusions

Distribution of age of onset of RRP shows three peaks. In addition to the already adopted idea of age peaks at pediatric and adult age, there is an additional peak around the age of 64.

Comparison of effects of OSA treatment by MAD and by CPAP on cardiac autonomic function during daytime

Abstract

Purpose

The present study compared the effects of mandibular advancement therapy (MAD) with continuous positive airway pressure therapy (CPAP) on daytime cardiac autonomic modulation in a wide range of obstructive sleep apnea (OSA) patients under controlled conditions in a randomized, two-period crossover trial.

Methods

Forty OSA patients underwent treatment with MAD and with CPAP for 12 weeks each. At baseline and after each treatment period, patients were assessed by polysomnography as well as by a daytime cardiac autonomic function test that measured heart rate variability (HRV), continuous blood pressure (BP), and baroreceptor sensitivity (BRS) under conditions of spontaneous breathing, with breathing at 6, 12, and 15/min.

Results

Both CPAP and MAD therapy substantially eliminated apneas and hypopneas. CPAP had a greater effect. During daytime with all four conditions of controlled breathing, three-minute mean values of continuous diastolic BP were significantly reduced for both MAD and CPAP therapy. At the same time, selective increases due to therapy with MAD were found for HRV high frequency (HF) values. No changes were observed for BRS in either therapy mode.

Conclusions

These findings indicate that both MAD and CPAP result in similar beneficial changes in cardiac autonomic function during daytime, especially in blood pressure. CPAP is more effective than MAD in eliminating respiratory events.

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Utility of Tongue Stitch and Nasal Trumpet in the Immediate Post-operative Outcome of Cleft Palatoplasty.

Background: Post-operative airway obstruction is a feared complication following cleft palate repair.. The aim of this study is to evaluate the effectiveness of tongue stitches and nasal trumpets which have been used in an attempt to prevent this complication. Methods: An eight-year (2005-2013) retrospective review of palatoplasties performed at a tertiary care center was performed. Patients were divided into three groups: those with no airway protective measure, those with a tongue stitch only, and a group with nasal trumpet and tongue stitch. Recorded variables included sex, age, Veau classification and co-morbidities. Primary outcomes measured were post-operative respiratory distress, readmission and re-operative rates. Results: 58 patients underwent palatoplasties with no airway protective measure, 252 patients only had tongue stitch, and 87 had tongue stitch and nasal trumpet. There were no significant differences between groups with respect to co-morbidities except that Cleft lip was more prevalent in the no airway protection group than the other two groups (p =0.04). There was no significant difference in the incidence of re-intubation, ICU transfer, surgery related readmissions, or reoperations. Respiratory complications were significantly increased in the nasal trumpet group even after adjusting for age and weight. Length of stay was also significantly (p
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Posterior Component Separation with Transversus Abdominis Release: Technique, Utility, and Outcomes in Complex Abdominal Wall Reconstruction.

Background: Ventral hernia formation is a frequent and increasingly difficult problem. Non-midline hernias, parastomal hernias, hernias near bony landmarks, and recurrent ventral hernias (especially after anterior component separation) present particular challenges. Typical reconstructive techniques may struggle to reestablish abdominal domain and to create a lasting repair. Posterior component separation (PCS) with transversus abdominis release (TAR) is a novel technique that offers a durable solution to a variety of complex ventral hernias. Methods: PCS-TAR is carried out by incising the posterior rectus sheath and developing the retrorectus plane. In a modification of the Rives-Stoppa technique, the transversus abdominis is released medial to the linea semilunaris to expose a broad plane that extends from the central tendon of the diaphragm superiorly, to the space of Retzius inferiorly, and laterally to the retroperitoneum. This preserves the neurovascular bundles innervating the medial abdominal wall. Mesh is placed in a sublay fashion above the posterior layer. In an overwhelming majority of patients, the linea alba is reconstructed, creating a functional abdominal wall with wide mesh reinforcement. Results: PCS-TAR is reliable and durable, with a 5% recurrence rate at 2 years. Although wound complications occur with similar frequency to other techniques, they tend to be less severe, rarely requiring operative debridement. The technique is applicable to a broad range of hernias including midline, parastomal, flank, subcostal, and recurrent hernias after prior component separations. Conclusion: Posterior component separation is a versatile, easy-to-learn technique of hernia repair that offers a reliable, durable solution to complex abdominal wall reconstruction. (C)2015American Society of Plastic Surgeons
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CORE: A Novel Method for Assessing Procedure-Based Residency Training.

Background: Assessing operative skills in the OR remains challenging. Increasing ACGME documentation requirements are necessitating mechanisms capable of documenting trainee competence without hindering operative turnover. Therefore, we created a comprehensive electronic resource facilitating plastic surgery training program compliance with Next Accreditation System Milestones and ACGME-mandated changes. Methods: In 2013 we implemented the Comprehensive Observations of Resident Evolution (CORE), a web-based tool to assess plastic surgery residents. CORE comprises a rapid electronic assessment of resident OR performance completed after each surgery; a data dashboard displaying graphical summaries of resident progress by case, Milestone, or CPT code; and an electronic Milestones tracker (MileMarker(C)) enabling ongoing trainee assessments. Results: From January-October 31, 2014, nearly 1,300 Operative Entrustability Assessments (OEAs) were completed by 24 residents. Thirty-eight percent of residents reported more immediate feedback regarding operative performance. The OEA demonstrates construct validity, distinguishing novice from experienced residents. Individual case data identifies resident-specific operative strengths and weaknesses. Using OEA data, our first two Clinical Competency Committee reviews were 81% and 87% shorter than Milestones pilot test site reports (avg: 11.5 and 8 min. vs. 60 min. per resident, respectively). Conclusions: CORE is capable of capturing operative performance data on all OR cases by primary CPT code. It increases immediate attending/trainee feedback and assessment transparency, enables trainee self-monitoring, and informs end-of-rotation reviews, program-wide assessments, and tailoring of training to address specific needs. These features make CORE a valuable resource through which programs and trainees can track resident progress in real-time while maintaining compliance with evolving ACGME requirements. (C)2015American Society of Plastic Surgeons
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Expanding the Applications of the Profunda Artery Perforator Flap.

BACKGROUND: The profunda artery perforator (PAP) free flap has not gained traction for non-breast reconstruction, likely due to the presence of a proven workhorse in the anterolateral thigh (ALT) flap. We believe that the PAP flap offers similar coverage characteristics with the benefits of a medial donor site, a more consistent anatomy and relatively easy dissection. We review our indications, technique and outcomes in seven patients requiring eight free flap reconstructions. METHODS: The authors applied the use of the vertically oriented PAP flap to both lower extremity and head and neck reconstructions in which an ALT flap would normally be used. Details reviewed include soft tissue defect, perforator location, flap size, recipient vessel, and complications. RESULTS: Eight soft tissue defects were covered with a vertically oriented profunda artery perforator flap (VPAP) in seven patients. Six reconstructions were for distal lower extremity and two were for head and neck reconstruction, both trauma and oncologic reconstructions. Flap sizes ranged from 40-92cm2. The pedicle length ranged from 7 to 10cm. There were no partial or complete flap losses. One complication of seroma at the donor site requiring washout and closure was encountered. CONCLUSION: The profunda artery perforator flap is a safe and effective option for perforator-based free flap reconstruction with relative ease of harvest and an inconspicuous donor site. This flap offers an excellent alternative to the anterolateral thigh flap. In certain patient demographics, the PAP flap should be considered as a primary option. (C)2015American Society of Plastic Surgeons
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Treatment outcome of the transfacial Ti-Epiplating-System for total nasal defects.

Background: Malignant tumors are the most frequent reason for acquired defects of the nose. Bone-anchored craniofacial prostheses represent a secure, uncomplicated and cosmetically acceptable rehabilitative alternative to surgical reconstruction.The aim of our study was to determine a potential benefit of the Ti-Epiplating-System (Fa. Medicon, Tuttlingen, Germany)as a grouped implant system in the anatomical difficult nasal region with limited bone supply. Patients and Methods: Patients with complete nasal defects who received a transfacial Epiplatingbetween January 2009 and December 2013 for nasal prosthesis were included. The Epiplating titanium plates are specially adapted to the nasal region and were modified individually. Implant survival, periimplantitis, clinical course and risk factors for implant survival were assessed retrospectively including univariate statistics. Results: 53 patients were included into this study. At the time of last follow-up 96.2% (51/53) Epiplating systems were stable in situ. One titanium plate had to be renewed because of a traumatic accident and one plate had to be removed because of disease recurrence. Periimplantitis occured in 7.5% and could be treated successfully by either local or systemic antibiotic therapy without any loss of stability in bone anchorage. Only smoking significantly increased the risk of periimplantitis (p=0.013), whereas age, irradiation, chemotherapy or immunosuppression did not influence the therapy outcome. The median healing time of the Epiplating system was 3.6 months (SD= 2.7). Conclusion: The Epiplating is a safe and uncomplicated system for bone-anchored retention for nasal prostheses. Good aesthetic results can be achieved. (C)2015American Society of Plastic Surgeons
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Rolle der Zytopathologie in der Pathologie

Wer macht die gynäkologische Zytologie und wie?

Zusammenfassung

Seit 1971 haben Frauen in Deutschland ab dem 20. Lebensjahr die Möglichkeit, jährlich kostenfrei an einer gynäkologischen Vorsorgeuntersuchung teilzunehmen. Im Rahmen dieser Untersuchung wird ein Abstrich von der Cervix uteri entnommen. Der Gemeinsame Bundesausschuss (GBA) plant eine Änderung dieses Vorgehens dergestalt, dass die Teilnehmerinnen entweder wie bisher einen Zervixabstrich jährlich erhalten oder ab dem 30. Lebensjahr primär einen HPV-Test (humanes Papillomvirus) alle 5 Jahre, bei positivem Testausfall ergänzt durch eine zytologische Untersuchung als Triagemethode. Grundlage der Klassifikation des zytologischen Befundes bleibt die Münchner Nomenklatur in ihrer seit dem 01.01.2015 gültigen Form (MN III). Seit 2008 ist es zu erheblichen Veränderungen der Zahl zugelassener Einrichtungen und der Zahl zugelassener Zytologen gekommen. Erfreulicherweise hat die Zahl der Pathologen mit + 28,4 % deutlich zugenommen. Die Zahl der durchgeführten Untersuchungen ist nahezu gleich geblieben. Allerdings werden jetzt mehr Untersuchungen in größeren Labors durchgeführt.

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Klinische Bedeutung der Schilddrüsenzytologie

Zusammenfassung

Die zytologische Beurteilung der Feinnadelbiopsie (FNB) der Schilddrüse setzt eine enge Kommunikation von Klinikern und Zytopathologen voraus. Szintigraphie, Sonographie und klinisch-anamnestische Befunde sind zur klinischen Indikationsstellung für die Punktion unerlässlich; die Kenntnis dieser Befunde ist aber auch für den Pathologen zur abschließenden Interpretation des zytomorphologischen Befundes unerlässlich. Der vorliegende Übersichtsartikel beschreibt den gegenwärtigen Standard der Gewinnung, Verarbeitung und zytopathologischen Beurteilung von Schilddrüsenpunktaten. Molekularpathologischen Zusatzuntersuchungen am zytologischen Material kommt eine zunehmende Bedeutung bei der präzisen Befundkategorisierung zu.

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Cytology nomenclature and 2015 World Health Organization classification of lung cancer

The recommendations of the 2015 World Health Organization classification of lung tumors are examined and discussed in terms of cytologic diagnoses.

Αρχειοθήκη ιστολογίου

Πέμπτη 15 Οκτωβρίου 2015

OtoLaryngology New Articles

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