OtoLaryngology New Articles

Synchronous Ipsilateral Parotid Tumors with Cytologic–Histologic Correlation Abstract Synchronous ipsilateral tumor formation within a major salivary gland is a very rare event. In this case, a 54-year-old female tobacco smoker presented with a slowly enlarging left parotid gland. Computed tomography of the neck demonstrated a solid mass superficial to a cystic mass in the deep lobe of the gland. Ultrasound-guided fine needle aspiration yielded oncocytic cells, lymphoid cells, and granular debris along with rare cohesive groups of basaloid cells. Parotidectomy was performed, and the resected gland was found to contain two adjacent but distinct masses. One mass, a predominantly solid, well-circumscribed lesion composed of ribbons of double-layered oncocytic cells and a lymphoid stroma with germinal center formation, was a Warthin tumor. The other mass, a predominantly cystic lesion composed of cords and nests of basaloid cells with associated deposits of basement membrane-like material, was a basal cell adenoma of the membranous type. To our knowledge, this is the first reported case of synchronous Warthin tumor and basal cell adenoma of the parotid gland with cytologic–histologic correlation attributable to each tumor. Read More » Synchronous Ipsilateral Parotid Tumors with Cytologic–Histologic Correlation Abstract Synchronous ipsilateral tumor formation within a major salivary gland is a very rare event. In this case, a 54-year-old female tobacco smoker presented with a slowly enlarging left parotid gland. Computed tomography of the neck demonstrated a solid mass superficial to a cystic mass in the deep lobe of the gland. Ultrasound-guided fine needle aspiration yielded oncocytic cells, lymphoid cells, and granular debris along with rare cohesive groups of basaloid cells. Parotidectomy was performed, and the resected gland was found to contain two adjacent but distinct masses. One mass, a predominantly solid, well-circumscribed lesion composed of ribbons of double-layered oncocytic cells and a lymphoid stroma with germinal center formation, was a Warthin tumor. The other mass, a predominantly cystic lesion composed of cords and nests of basaloid cells with associated deposits of basement membrane-like material, was a basal cell adenoma of the membranous type. To our knowledge, this is the first reported case of synchronous Warthin tumor and basal cell adenoma of the parotid gland with cytologic–histologic correlation attributable to each tumor. Read More » Letter to the Editor: Examination of Potential Sex Influences. No abstract available Read More » Anaphylaxis exclusivity in a single Citrus species Publication date: Available online 6 October 2015 Source:Annals of Allergy, Asthma & Immunology Author(s): George Cai, Jason Kihyuk Lee Read More » Patient engagement: challenges and opportunities for physicians Publication date: Available online 6 October 2015 Source:Annals of Allergy, Asthma & Immunology Author(s): Meryl Bloomrosen, Cary Sennett Read More » Successful Hearing Preservation After Reimplantation of a Failed Hybrid Cochlear Implant. Objective: Superficial siderosis (SS) of the CNS is associated with cerebellar ataxia, sensorineural hearing loss, and pyramidal symptoms, which result from iron depositions on CNS surfaces. SS can produce bilateral vestibulopathy because the vestibulo-cochlear nerve is particularly vulnerable. To our knowledge, however, vestibular dysfunction in SS has not been reported thoroughly in the literature. Here, we describe a case of bilateral vestibulopathy, documented quantitatively by the video head impulse test (vHIT), in a patient with SS. Patient: A 60-year-old man presented with slowly progressing bilateral hearing loss, oscillopsia, and a severe gait disturbance that worsened in the dark. Intervention: After noticing deficits in the bedside head impulse test in all six semicircular canals, the patient underwent vHIT and brain MRI. Main Outcome Measure: MRI demonstrated a rim of hypointensities and signal losses in T2-weighted and gradient echo images around the cerebellum, brainstem, and vestibulo-cochlear nerve, which were compatible with an SS diagnosis. In addition, vHIT revealed reduced vestibule-ocular reflex (VOR) gains, and abnormal catch-up saccades (both covert and overt saccades) in all semicircular canals. Results: The vHIT showed impaired VOR gains that were 0.55, 0.59, and 0.45 in the horizontal, anterior, and posterior canal, respectively. Conclusion: SS may result in chronic bilateral vestibulopathy with SNHL. Bilateral vestibulopathy originated peripherally in our participant, without cerebellar dysfunctions such as those reported in the literature. vHIT findings have not been previously reported in patients with SS, and our study suggests that vHIT is a useful tool to document vestibular dysfunction. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company Read More » Fracture of the Manubrium of the Malleus. No abstract available Read More » Successful Hearing Preservation After Reimplantation of a Failed Hybrid Cochlear Implant. Objective: Superficial siderosis (SS) of the CNS is associated with cerebellar ataxia, sensorineural hearing loss, and pyramidal symptoms, which result from iron depositions on CNS surfaces. SS can produce bilateral vestibulopathy because the vestibulo-cochlear nerve is particularly vulnerable. To our knowledge, however, vestibular dysfunction in SS has not been reported thoroughly in the literature. Here, we describe a case of bilateral vestibulopathy, documented quantitatively by the video head impulse test (vHIT), in a patient with SS. Patient: A 60-year-old man presented with slowly progressing bilateral hearing loss, oscillopsia, and a severe gait disturbance that worsened in the dark. Intervention: After noticing deficits in the bedside head impulse test in all six semicircular canals, the patient underwent vHIT and brain MRI. Main Outcome Measure: MRI demonstrated a rim of hypointensities and signal losses in T2-weighted and gradient echo images around the cerebellum, brainstem, and vestibulo-cochlear nerve, which were compatible with an SS diagnosis. In addition, vHIT revealed reduced vestibule-ocular reflex (VOR) gains, and abnormal catch-up saccades (both covert and overt saccades) in all semicircular canals. Results: The vHIT showed impaired VOR gains that were 0.55, 0.59, and 0.45 in the horizontal, anterior, and posterior canal, respectively. Conclusion: SS may result in chronic bilateral vestibulopathy with SNHL. Bilateral vestibulopathy originated peripherally in our participant, without cerebellar dysfunctions such as those reported in the literature. vHIT findings have not been previously reported in patients with SS, and our study suggests that vHIT is a useful tool to document vestibular dysfunction. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company Read More » Fracture of the Manubrium of the Malleus. No abstract available Read More » Primary Vitreoretinal Lymphoma Masquerading as Refractory Retinitis Purpose: To report a case of a patient with primary vitreoretinal lymphoma masquerading as retinitis. Methods: Retrospective review of the patient's clinical, histopathological and imaging records. Results: Cytopathology was negative for malignancy, and preliminary polymerase chain reaction results supported the diagnosis of varicella zoster virus retinitis. Therefore, the patient was treated with antiviral therapy. However, under this treatment, the retinitis progressed. As a result, primary vitreoretinal lymphoma was suspected, and empirical treatment with intravitreal methotrexate injections was started. Under this treatment, the ocular features improved. Five months after initial ocular presentation and ocular resolution, the patient presented with central nervous system lymphoma. Conclusion: This case should raise the awareness of the variable clinical presentations, the challenging diagnosis and treatment of primary vitreoretinal lymphoma. All cases should be continuously systemically evaluated. Case Rep Ophthalmol 2015;6:345-350 Read More » Letter to the Editor: Examination of Potential Sex Influences. No abstract available Read More » Bony ankylosis of hydroxyapatite prostheses in the middle ear Ossiculoplasty is a commonly performed middle ear procedure. Ossicular chain reconstruction (OCR) prostheses should be made of a biocompatible material; one such common material is hydroxyapatite (HA). Read More » Letter to the editor Dear Editor, Read More » Cochlear changes in serous labyrinthitis associated with silent otitis media: A human temporal bone study To determine histopathologic findings in the cochlea of human temporal bones with serous labyrinthitis. Read More » Radiation-Induced Thyroid Cancer: Gender-Related Disease Characteristics and Survival Background: Radiation exposure is a well-known risk factor for well-differentiated thyroid cancer (WDTC). However, gender disparity in disease characteristics is not completely understood. The purpose of this study was to determine the behavior of radiation-induced thyroid cancer according to gender. Methods:Charts of all patients diagnosed with WDTC after radiation exposure between the years 1985 and 2013 in a tertiary referral center were retrieved. Results:Forty-three patients were reviewed, 29 females and 14 males. Mean age of exposure for women and men were 17.1 ± 19.5 and 15.5 ± 12.5 years, respectively (P = .78). Age at diagnosis were 47.5 ± 15.5 and 41.5 ± 15 years for women and men, respectively (P = .18). Mean disease-specific survival was 44.1 and 43.7 years for women and men, respectively (P = .50). Conclusions:Similar disease characteristics, tumor pathology, disease-free survival, and overall survival in both genders. In sporadic well-differentiated thyroid carcinoma, female gender is associated with better tumor behavior and prognosis. However, our results suggest that women are more affected by radiation than men and therefore have the same prognosis as men. Read More » Does your patient have an intact gag reflex? The Skinny Medic explains two techniques to determine if a patient has intact gag reflex before inserting an NPA or OPA. Read More » Pediatric simulation training: Tips to make it effective for medics By Aaron Dix Simulation allows paramedics to become more experienced with limited practical opportunities for pediatric care, like airway management, without inflicting patient harm. You never rise to the occasion; you always sink to your level of training. In emergency services, successful outcomes in the field do not result from raw talent or intellect, but from training. For example, there is ongoing debate about paramedics performing endotracheal intubation for a pediatric patient. The controversy is with the paramedic's ability to perform the procedure, not whether the procedure itself is beneficial [1]. Paramedics who intubate more often have better results than those paramedics who intubate less often, regardless of how long they have been in the field [2]. The educational value of simulation is independent of technology [3]. Simulation is immersing a participant into a realistic working environment to provide an enhanced educational experience. Realistic simulation environments, with or without high-fidelity mannequins, place participants under the stress that they might experience in real life. While high-fidelity medical simulators can certainly add to simulation training, the following simple tips will ensure an effective and realistic experience that will improve patient outcomes. 1. Establish learning objectives This is the least sexy step, but the most important and the most commonly disregarded. Instructors need to determine what particular aspects of provider care need to be improved. Do trauma scene times need to be reduced? Does there need to be greater adherence to asthma protocols? How about higher intubation success rates? Speak to your personnel, medical director, and pediatric emergency department physicians. What are their concerns? Once you have identified deficiencies, create learning objectives that can be measured. Do not limit the objective to just recognizing or diagnosing an illness. For example, an EMS organization wrote a scenario for a pediatric seizure patient without establishing objectives. Every medic that went through the scenario easily recognized that the infant was seizing and required a benzodiazepine. The facilitators never required the medics to determine the appropriate dose or to administer the medication. Later conversations revealed that the deficiency that prompted the scenario was paramedics inadvertently overdosing pediatric seizure patients, a concern that was never addressed during the scenario. Establishing objectives before designing the scenario would have given the medics the training that they actually needed. The objective for this scenario should have been: To assess paramedic competency to calculate the appropriate dose of a benzodiazepine utilizing a length-based pediatric treatment tape. 2. Realistic, call-based simulations Create realistic scenarios based upon actual calls whenever possible. Choose a call, read the patient care report, speak to the hospital, and determine what happened during the course of the patient's hospital stay. Using actual calls ensures realistic scenarios and provides an appreciable impact on the way providers relate to their training. 3. No do-overs Do not stop the scenario when a medic starts to do poorly. The point of simulation is creating a realistic work environment, there's no pause button in reality. Force the participant to think critically and recover from their poor performance. 4. Assess and treat Far too often facilitators allow participants to talk their way through a scenario. Make the participants speak to the patient, assess, and whenever possible, actually perform procedures. It is extraordinarily easy for a medic to recognize and treat croup when they are given a patient with a seal-like barking cough and a fever, but it is not that easy to actually assess a pediatric patient in respiratory distress. Furthermore, providers can have difficulty differentiating between respiratory distress and respiratory failure which can lead to under treatment. 5. Debrief after the scenario Allow the participants to self-recognize the positives and the negatives of their simulation performance. Many times participants will identify their own mistakes, which makes learning and retention more effective than when a facilitator points out every mistake. Even if the scenario went well, reiterate the learning objectives; sometimes things go well by accident. 6. Manual patient mode is OK If you have a high-fidelity mannequin and do not know how to program scenarios run the simulator in healthy patient mode and change the vital signs manually during the simulation. Most pediatric high-fidelity simulators have the ability to show cyanosis and differing respiratory patterns such as retractions and see-saw breathing, which can be programed on the fly. As the scope of practice for EMS providers continues to expand, it is imperative that EMS educators provide effective and realistic simulation training to ensure clinical competence; especially with the relatively low volume of pediatric patients. About the author Aaron Dix is the operations director for the Greenville Healthcare Simulation Center. He has an MBA in healthcare management, is a nationally certified EMS educator, and has 20 years of EMS experience. Prior to becoming operations director, he was the training coordinator for the largest and busiest EMS system in South Carolina managing the education of over 500 EMTs, paramedics, and firefighters to include simulation training. In addition to his duties at the simulation center, he remains a practicing paramedic with Anderson County EMS, Clear Spring Fire Rescue, and is an active member of the Emergency Medical Services for Children Advisory Council in South Carolina. References 1. Hansen, M., Lambert, W., Guise, J., Warden, C. R., Mann, N. C., & Wang, H. (2015). Out-of-hospital pediatric airway management in the United States. Resuscitation, 90104-110. doi:10.1016/j.resuscitation.2015.02.018 2. Wang, H. E., Balasubramani, G. K., Cook, L. J., Lave, J. R., & Yealy, D. M. (2010). Out-of-Hospital Endotracheal Intubation Experience and Patient Outcomes. Annals of Emergency Medicine, 55(6), 527–537.e6. doi:10.1016/j.annemergmed.2009.12.020 3. Lateef, F. (2010). Simulation-based learning: Just like the real thing. Journal of Emergencies, Trauma and Shock, 3(4), 348–352. doi:10.4103/0974-2700.70743 Read More » Anaphylaxis exclusivity in a single species Unique to the field of food allergies is the high degree of nuanced knowledge required to investigate and determine a diagnosis. This article, with the patient's consent, presents knowledge particular to citrus allergies that may be critical for properly assessing symptomatic patients. Because citrus allergies are among the top 20 food allergies, it is important that physicians familiarize themselves with the intricacies involved. Read More » Patient engagement: challenges and opportunities for physicians Despite recent moderation of health care cost inflation,1 there is ongoing demand for strategies to achieve high-quality, accessible, and efficient health care in the United States. These strategies are introducing profound changes to a health care system needing to assure care coordination and collaboration across the health care team. For people with chronic illnesses, the team is increasingly multidisciplinary, including physicians, nurses, managers, clinical pharmacists, respiratory therapists, nutritionists, and behavioral health providers. Read More » Acquired Hearing Loss in Children Hearing loss is the most common congenital sensory impairment. According to National Health and Nutrition Examination Survey data from 2001 to 2008, 20.3% of subjects aged greater than or equal to 12 had unilateral or bilateral hearing loss. The World Health Organization notes that, worldwide, there are 360 million people with disabling hearing loss, with 50% preventable. Although many hearing losses are acquired, many others are manifestations of preexisting conditions. The purpose of a pediatric hearing evaluation is to identify the degree and type of hearing loss and etiology and to outline a comprehensive strategy that supports language and social development and communication. Read More » The Child with Hearing Loss Perhaps no other field in Otolaryngology has expanded as rapidly as the evaluation and management of hearing loss in children. From safer and higher-resolution imaging techniques to more focused genetic analyses, the old ratio of congenital sensorineural hearing loss, 25-25-50, idiopathic-acquired-genetic, is rapidly changing as many idiopathic causes for hearing loss are being elucidated, and many specific causes of genetic hearing loss have been discovered. With the widespread mandate of newborn hearing screening in every state, children with hearing loss are being identified earlier, and ideally, diagnosed by 3 months of age with intervention by 6 months of age. Read More » Letter from the Guest Editor: Imaging of the Jaw Why do radiologists find imaging of the jaw and teeth difficult and intimidating? A large part of the reason is because dental professionals traditionally did this imaging in their office using plane radiographs. As a result, radiologists were never involved or trained in this area, making it foreign to them. Read More » Voice Needs and Voice Demands of Professional Newsreaders in Southern India Newsreaders are elite vocal professionals who are highly dependent on their voice quality to meet professional commitments. Globally, the voice needs and demands of newsreaders could vary depending on technology and cultural variations. This study documents voice demands, voice needs, and vocal and nonvocal habits of professional newsreaders in Chennai, southern India through a questionnaire-based interview. Read More » Acromegaly Presenting With Bilateral Vocal Cord Immobility: Case Report and Review of the Literature To present a case of bilateral vocal cord immobility (BVCI) in a patient with acromegaly and review the current literature describing this presentation. Read More » Adaptation and Validation of the Voice Handicap Index (VHI)-30 into Serbian To evaluate the internal consistency, test-retest reliability, and clinical validity of the Serbian version of the self-administered Voice Handicap Index (VHI)-30. Read More » Who Wrote This Clinical Practice Guideline? The American Academy of Otolaryngology—Head and Neck Surgery Foundation clinical practice guidelines address a variety of otolaryngologic diseases and/or procedures. It may seem reasonable to create these guidelines by assembling a team of expert clinicians familiar with the pertinent clinical issues and the available evidence, with debate and eventual agreement leading to recommendations. However, trustworthy clinical practice guidelines are in fact created via a defined process to assemble a guideline development group composed of diverse stakeholders: clinician generalists and specialists, content experts, methodologists, physicians and nonphysicians, patients, and advocates. Such a guideline development group can create a valuable and trusted guideline for clinicians and affected patients. Read More » Audiometric Outcomes in Pediatric Temporal Bone Trauma Objective To characterize pediatric temporal bone trauma, focusing on audiometric outcomes. Study DesignCase series with chart review. SettingTertiary care children's hospital. Subjects and MethodsCases were reviewed of children (<18 years) presenting over a 3-year period with computed tomography–proven temporal bone fracture and audiology examination. All scans were read by a neuroradiologist and reviewed by a pediatric otolaryngologist. Demographics, fracture pattern, and audiometric data were recorded. ResultsFifty-eight patients (60 fractures) met inclusion criteria. The majority (93%) were otic capsule–sparing fractures. The types and severity of hearing loss were significantly different between the 2 fracture patterns. Based on pure-tone average, all otic capsule–violating fractures had abnormal initial audiograms; 75% of these losses were severe. Approximately half (54%) of otic capsule–sparing fractures had abnormal initial audiograms; a majority were mild losses (85%). All classifiable losses in otic capsule–violating cases were of mixed type, whereas the majority (75%) of losses in otic capsule–sparing cases were conductive. Regardless of classification, 72% of patients with otic capsule–sparing fractures and initially abnormal audiograms improved to normal levels at a mean of 48 days posttrauma; this increased to 83% when only conductive losses were considered. ConclusionsHearing loss type and severity differ in otic capsule–sparing and otic capsule–violating temporal bone fractures. A majority of children with otic capsule–sparing fractures and associated hearing loss improve to normal levels in about 6 weeks, especially if the original loss is classified as solely conductive. Children who do not improve within this time frame may warrant early investigation into surgically correctable causes. Read More » Office Insertion of Tympanostomy Tubes without Anesthesia in Young Children Read More » Impact of Diabetes Mellitus on Head and Neck Cancer Patients Undergoing Surgery Objective The impact of diabetes mellitus (DM) on surgical outcomes and cost of care for patients undergoing surgery for head and neck cancer (HNCA) is not well established. We used the Nationwide Inpatient Sample to analyze the postoperative impact of DM on HNCA patients. Study DesignPopulation-based inpatient registry analysis. SettingAcademic medical center. Subjects and MethodsDischarge data from the Nationwide Inpatient Sample were analyzed for patients undergoing HNCA surgery from 2002 to 2010. Patient demographics, comorbidities, length of stay, hospital charges, and postoperative complications were compared between HNCA patients with and without DM. ResultsOf 31,075 patients, 4029 patients (13.0%) had a DM diagnosis. DM patients were older (65.7 ± 10.8 vs 61.1 ± 14.1 years old; P < .001), had more preexisting comorbidities, had longer hospitalizations, and incurred greater hospital charges. Compared with the non-DM cohort, DM patients experienced significantly higher rates of postoperative infections (2.6% vs 2.1%, P = .025), cardiac events (9.0% vs 4.3%, P < .001), pulmonary edema/failure (6.6% vs 5.7%, P = .023), acute renal failure (3.3% vs 1.5%, P < .001), and urinary tract infections (2.8 % vs 2.1%, P = .005). No differences in surgical wound healing rates were observed (0.1 vs 0.1, P = .794). On multivariate logistic regression corrected for age and race, DM patients had greater odds of postoperative infections (1.382, P = .007), cardiac events (1.893, P < .001), and acute renal failure (2.023, P < .001). ConclusionsDM is associated with greater length of stay and hospital charges among HNCA patients. DM patients have significantly greater rates of postoperative complications, including postoperative infections, cardiac events, and acute renal failure. Read More » Lateral inhibition in the somatosensory cortex during and between migraine without aura attacks: Correlations with thalamocortical activity and clinical features Background We studied lateral inhibition in the somatosensory cortex of migraineurs during and between attacks, and searched for correlations with thalamocortical activity and clinical features. Participants and methodsSomatosensory evoked potentials (SSEP) were obtained by electrical stimulation of the right median (M) or ulnar (U) nerves at the wrist or by simultaneous stimulation of both nerves (MU) in 41 migraine without aura patients, 24 between (MO), 17 during attacks, and in 17 healthy volunteers (HVs). We determined the percentage of lateral inhibition of the N20–P25 component by using the formula [(100)–MU/(M + U)*100]. We also studied high-frequency oscillations (HFOs) reflecting thalamocortical activation. ResultsIn migraine, both lateral inhibition (MO 27.9% vs HVs 40.2%; p = 0.009) and thalamocortical activity (MO 0.5 vs HVs 0.7; p = 0.02) were reduced between attacks, but not during. In MO patients, the percentage of lateral inhibition negatively correlated with days elapsed since the last migraine attack (r = –0.510, p = 0.01), monthly attack duration (r = –0.469, p = 0.02) and severity (r = –0.443, p = 0.03), but positively with thalamocortical activity (r = –0.463, p = 0.02). ConclusionsWe hypothesize that abnormal migraine cycle-dependent dynamics of connectivity between subcortical and cortical excitation/inhibition networks may contribute to clinical features of MO and recurrence of attacks. Read More » Prevalence of primary headache disorders diagnosed according to ICHD-3 beta in three different social groups Background The aim of our study was to estimate the one-year prevalence of primary headache disorders in three different social groups using the third edition beta of the International Classification of Headache Disorders (ICHD-3 beta). Material and methodsThe study population included a total of 3124 participants: 1042 students (719 females, 323 males, mean age 20.6, age range 17–40), 1075 workers (146 females, 929 males, mean age 40.4, age range 21–67) and 1007 blood donors (484 females, 523 males, mean age 34.1, age range 18–64). We used a semi-structured, validated face-to-face interview. ResultsThe age-adjusted one-year prevalence of migraine in females was significantly higher (p < 0.001) in students (41.9%) than in workers (19.2%) and blood donors (18.7%). Age-adjusted prevalence of migraine among males did not differ among the three groups: 4.5% in students, 4.9% in workers and 4.5% in blood donors. Age-adjusted prevalence of tension-type headache (TTH) among females was almost the same in students and blood donors (68.8% and 66.7%) but female workers had a lower prevalence of TTH (57%). Age-adjusted prevalence of TTH among males did not differ significantly between students and blood donors (55.8% and 58.1%) but male workers had a significantly lower (p < 0.001) prevalence of TTH (30.7%). The prevalence of chronic headache in students (TTH and/or migraine) was 3% and of probable medication-overuse headache 3%, significantly more than in workers and blood donors. ConclusionHeadache prevalence was high and differed markedly among the three social groups. It is important that headache epidemiology also focus on socially defined groups in order to target future preventive efforts. Read More » Seventy Years of Asthma in Italy: Age, Period and Cohort Effects on Incidence and Remission of Self-Reported Asthma from 1940 to 2010 by Giancarlo Pesce, Francesca Locatelli, Isa Cerveri, Massimiliano Bugiani, Pietro Pirina, Ane Johannessen, Simone Accordini, Maria Elisabetta Zanolin, Giuseppe Verlato, Roberto de Marco Background It is well known that asthma prevalence has been increasing all over the world in the last decades. However, few data are available on temporal trends of incidence and remission of asthma. Objective To evaluate the rates of asthma incidence and remission in Italy from 1940 to 2010. Methods The subjects were randomly sampled from the general Italian population between 1991 and 2010 in the three population-based multicentre studies: ECRHS, ISAYA, and GEIRD. Individual information on the history of asthma (age at onset, age at the last attack, use of drugs for asthma control, co-presence of hay-fever) was collected on 35,495 subjects aged 20–84 and born between 1925–1989. Temporal changes in rates of asthma incidence and remission in relation to age, birth cohort and calendar period (APC) were modelled using Poisson regression and APC models. Results The average yearly rate of asthma incidence was 2.6/1000 (3,297 new cases among 1,263,885 person-years). The incidence rates have been linearly increasing, with a percentage increase of +3.9% (95%CI: 3.1–4.5), from 1940 up to the year 1995, when the rates begun to level off. The stabilization of asthma incidence was mainly due to a decrease in the rates of atopic asthma after 1995, while non-atopic asthma has continued to increase. The overall rate of remission was 43.2/1000person-years, and it did not vary significantly across generations, but was associated with atopy, age at asthma onset and duration of the disease. Conclusions After 50 years of a continuous upward trend, the rates of asthma incidence underwent a substantial stabilization in the late 90s. Despite remarkable improvements in the treatment of asthma, the rate of remission did not change significantly in the last seventy years. Some caveats are required in interpreting our results, given that our estimates are based on self-reported events that could be affected by the recall bias. Read More » Regulatory effect of TLR3 signaling on staphylococcal enterotoxin-induced IL-5, IL-13, IL-17A and IFN-γ production in chronic rhinosinusitis with nasal polyps Publication date: Available online 6 October 2015 Source:Allergology International Author(s): Mitsuhiro Okano, Tazuko Fujiwara, Shin Kariya, Takaya Higaki, Sei-ichiro Makihara, Takenori Haruna, Yasuyuki Noyama, Takahisa Koyama, Ryotaro Omichi, Yorihisa Orita, Kentaro Miki, Kengo Kanai, Kazunori Nishizaki BackgroundToll-like receptor 3 (TLR3) is expressed in upper airways, however, little is known regarding whether Toll-like receptor 3 (TLR3) signals exert a regulatory effect on the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP), especially on eosinophilic inflammation. We sought to investigate the effect of Poly(IC), the ligand for TLR3, on cytokine production by dispersed nasal polyp cells (DNPCs).MethodsDNPCs were pretreated with or without Poly(IC), and were then cultured in the presence or absence of staphylococcal enterotoxin B (SEB), following which the levels of IL-5, IL-10, IL-13, IL-17A and interferon (IFN)-γ in the supernatant were measured. To determine the involvement of IL-10 and cyclooxygenase in Poly(IC)-mediated signaling, DNPCs were treated with anti-IL-10 monoclonal antibody and diclofenac, the cyclooxygenase inhibitor, respectively. Poly(IC)-induced prostaglandin E2 (PGE2) production was also determined.ResultsExposure to Poly(IC) induced a significant production of IL-10, but not of IL-5, IL-13, IL-17A or IFN-γ by DNPCs. Pretreatment with Poly(IC) dose-dependently inhibited SEB-induced IL-5, IL-13 and IL-17A, but not IFN-γ production. Neutralization of IL-10 significantly abrogated the inhibitory effect of Poly(IC). Treatment with diclofenac also abrogated the inhibitory effect of Poly(IC) on SEB-induced IL-5 and IL-13 production. However, unlike exposure of diclofenac-treated DNPCs to lipopolysaccharide, the ligand for TLR4, exposure of these cells to Poly(IC) did not enhance IL-5 or IL-13 production. Poly(IC) did not significantly increase PGE2 production by DNPCs.ConclusionsThese results suggest that TLR3 signaling regulates eosinophilia-associated cytokine production in CRSwNP, at least in part, via IL-10 production. Read More » HMGB1 enhances the protumoral activities of M2 macrophages by a RAGE-dependent mechanism Abstract The monocyte-macrophage lineage shows a high degree of diversity and plasticity. Once they infiltrate tissues, they may acquire two main functional phenotypes, being known as the classically activated type 1 macrophages (M1) and the alternative activated type 2 macrophages (M2). The M1 phenotype can be induced by bacterial products and interferon-γ and exerts a cytotoxic effect on cancer cells. Conversely, the alternatively activated M2 phenotype is induced by Il-4/IL13 and promotes tumor cell growth and vascularization. Although receptor for advanced glycation end-products (RAGE) engagement in M1 macrophages has been reported by several groups to promote inflammation, nothing is known about the functionality of RAGE in M2 macrophages. In the current study, we demonstrate that RAGE is equally expressed in both macrophage phenotypes and that RAGE activation by high-mobility group protein box1 (HMGB1) promotes protumoral activities of M2 macrophages. MKN45 cells co-cultured with M2 macrophages treated with HMGB1 at different times displayed higher invasive abilities. Additionally, conditioned medium from HMGB1-treated M2 macrophages promotes angiogenesis in vitro. RAGE-targeting knockdown abrogates these activities. Overall, the present findings suggest that HMGB1 may contribute, by a RAGE-dependent mechanism, to the protumoral activities of the M2 phenotype. Read More » Overexpression of Rab5a promotes hepatocellular carcinoma cell proliferation and invasion via FAK signaling pathway Abstract Rab5a was reported to be overexpressed in human malignancy and associated with the malignant phenotype. To data, its expression pattern and biological function in hepatocellular carcinoma (HCC) have not been studied. We analyzed Rab5a protein expression in 98 cases of HCC tissues and four HCC cell lines. We found that Rab5a expression was upregulated in HCC tissues and cell lines. Rab5a overexpression correlated with TNM stage and nodal metastasis (p < 0.05). To confirm the biological function of Rab5a in HCC cell lines, Rab5a siRNA was employed in SK-Hep-1 cell line and plasmid transfection was performed in Huh7 cell line. CCK-8 assay showed that Rab5a depletion blocked cell growth rate while Rab5a overexpression facilitated proliferation. Transwell and migration assay showed that Rab5a positively regulated cell invasion and migration. To explore the molecular mechanism underlying the biological effects of Rab5a, we checked several signaling pathways and found that Rab5a overexpression upregulated cyclin D1, cyclin E expression, FAK (Tyr397), and AKT (Ser473) phosphorylation. Blockage of FAK using inhibitor PF573228 abolished the role of Rab5a on cyclin D1. In conclusion, Rab5a is overexpressed in human HCC and contributes to cancer cell proliferation and invasion through regulation of FAK and AKT signaling. Read More » Overexpression of acylglycerol kinase is associated with poorer prognosis and lymph node metastasis in nasopharyngeal carcinoma Abstract Acylglycerol kinase (AGK) has been reported to promote a malignant phenotype and enhance the development of cancer stem cells. However, the clinical value of AGK in cancer remains unclear. This study aimed to investigate the expression and clinicopathological significance of AGK in nasopharyngeal carcinoma (NPC). AGK was significantly upregulated in NPC cell lines and clinical specimens as indicated by real-time PCR and Western blotting. Among the AGK-positive cases, 52/114 (45.6 %) of the archived human NPC specimens expressed high levels of AGK. High expression of AGK was associated with significantly shorter overall and disease-free survival (P < 0.001 and P = 0.002; log-rank test) and was an independent prognostic factor for overall survival (P = 0.041; multivariate Cox analysis). High AGK expression was associated with lymph node metastasis (P < 0.001; chi-squared test) and was an independent predicted factor for lymph node metastasis in NPC (P = 0.032; multivariate logistic analysis). AGK is overexpressed and associated with disease progression and lymph node metastasis in NPC. AGK has potential as a novel prognostic factor for overall survival in NPC. Read More » Differential function and regulation of orphan nuclear receptor TR3 isoforms in endothelial cells Abstract TR3 has been reported to be an excellent target for angiogenesis therapies. We reported three TR3 transcript variant messenger RNAs (mRNAs) are expressed in human umbilical vein endothelial cell (HUVEC) and are differentially regulated by vascular endothelial growth factor (VEGF). TR3 transcript variant 1 (TR3-TV1) and variant 2 (TR3-TV2) encoding the same TR3 isoform 1 protein (TR3-iso1) that was named TR3 has been extensively studied. However, the function of TR3 isoform 2 protein (TR3-iso2) encoded by TR3 transcript variant 3 (TR3-TV3) is still not known. Here, we clone and express the novel TR3-iso2 protein and find that expression of TR3-iso2, in contrast to TR3-iso1, inhibits endothelial cell proliferation induced by VEGF-A, histamine, and phorbol-12-myristate-13-acetate (PMA). The differential function of TR3-iso2 correlates with the down-regulation of cyclin D1. However, TR3-iso2 plays similar roles in endothelial cell migration and monolayer permeability as TR3-iso1. We further demonstrate that several intracellular signaling pathways are involved in histamine-induced TR3 transcript variants, including histamine receptor H1-mediated phospholipase C (PLC)/calcium /calcineurin/protein kinase C (PKC)/protein kinase D (PKD) pathway and ERK pathway, as well as histamine receptor H3-mediated PKC-ERK pathway. Further, expressions of TR3-TV1, TR3-TV2, and TR3-TV3 by VEGF and histamine are regulated by different promoters, but not by their mRNA stability. Read More » miR-137 acts as a tumor suppressor in astrocytoma by targeting RASGRF1 Abstract Astrocytoma is one of the most common primary central nervous system tumors and has both high mortality and a poor 5-year survival rate. MicroRNAs (miRNAs) play important roles in carcinogenesis by acting on multiple signaling pathways. Although we have demonstrated that miR-137 is downregulated in astrocytoma tissues, the role of miR-137 in astrocytoma still remains unknown. In the present study, we aimed to investigate the function of miR-137 and its possible target genes in astrocytoma. miR-137 was significantly downregulated in astrocytoma tissues, and its expression level was inversely correlated with the clinical stage. Restoring miR-137 was able to dramatically inhibit cell proliferation, migration, and invasion and enhance apoptosis in vitro, whereas silencing its expression inhibited these processes. By overexpressing or inhibiting miR-137 in cancer cells, we experimentally confirmed that miR-137 directly recognized the 3′-UTR (3′-untranslated region) of the RASGRF1 (Ras protein-specific guanine nucleotide-releasing factor 1) transcript and regulated RASGRF1 expression. Furthermore, an inverse correlation was observed between miR-137 levels and RASGRF1 protein levels, but not mRNA levels, in astrocytoma samples. The silencing of RASGRF1 resulted in similar effects to miR-137 restoration in cancer cells. Finally, overexpression of RASGRF1 rescued the inhibitory effects of miR-137. Taken together, our results indicate that miR-137 acts as a tumor suppressor in astrocytoma by targeting RASGRF1. These findings suggest that miR-137 may serve as a novel therapeutic target in astrocytoma treatment. Read More » Alpha-linolenic acid regulates Cox2/VEGF/MAP kinase pathway and decreases the expression of HPV oncoproteins E6/E7 through restoration of p53 and Rb expression in human cervical cancer cell lines Abstract Cervical cancer represents the largest cause of mortality in women worldwide. In our previous report, we have shown how alpha-linolenic acid (ALA), an omega-3 fatty acid, regulated the growth of cervical cancer cells. The present study aimed to explore mechanistic details for the anticancer activity of ALA in cervical cancer cell lines, SiHa and HeLa. ALA significantly modulated the growth kinetics of the cells and reduced cell migration with concomitant decrease in the expression of VEGF, MMP-2, and MMP-9 proteins. Besides this, ALA significantly decreased the expression of phosphorylated p38, pERK1/2, c-JUN, NFκB, and COX2, proteins. Most importantly, ALA reduced the expression of HPV onco-proteins E6 and E7, resulting into restoration of expression of tumor suppressor proteins, p53 and Rb. These results suggested that ALA could be explored for its therapeutic potential in cervical cancer. Read More » Mitteilungen der Deutschen Gesellschaft für Pathologie Read More » Mitteilungen der Österreichischen Gesellschaft für Pathologie/Österreichischen Abteilung der IAP Read More » Recombinant Mal d 1 facilitates sublingual challenge tests of birch pollen-allergic patients with apple allergy Abstract It is still unclear whether allergen-specific immunotherapy (AIT) with birch pollen improves birch pollen-related food allergy. One reason for this may be the lack of standardized tests to assess clinical reactions to birch pollen-related foods, e.g. apple. We tested the applicability of recombinant (r) Mal d 1, the Bet v 1-homolog in apple, for oral challenge tests. Increasing concentrations of rMal d 1 in 0.9% NaCl were sublingually administered to 72 birch pollen-allergic patients with apple allergy. The dose of 1.6 μg induced oral allergy syndromes in 26.4%, 3.2 μg in 15.3%, 6.3 μg in 27.8%, 12.5 μg in 8.3%, 25 μg in 11.1% and 50 μg in 4.2% of the patients. No severe reactions occurred. None of the patients reacted to 0.9% NaCl alone. Sublingual administration of 50 μg of rMal d 1 induced no reactions in three non-allergic individuals. Our approach allows straight forward, dose-defined sublingual challenge tests in a high number of birch pollen-allergic patients that inter alia can be applied to evaluate the therapeutic efficacy of birch pollen-AIT on birch pollen-related food allergy. This article is protected by copyright. All rights reserved. Read More » Latest developments in Allergic Rhinitis in Allergy for Clinicians and Researchers Abstract Research efforts in allergic rhinitis has always been intense. Over the past 3 years, numerous breakthroughs in basic science and clinical research have been made, augmenting our understanding of this condition that afflicts a significant proportion of the global population. New epidemiological findings, novel insights into the molecular and cellular mechanisms of allergy, enhancement of current developmental theories, new concepts of the goals and endpoints of management, latest therapeutic modalities that includes the harnessing of information technology and big data are some areas where important advances were made. We attempt to bring you a summary of the key research advances made in the field of allergic rhinitis from 2013 to 2015. This article is protected by copyright. All rights reserved. Read More » Update on food allergy Abstract Food allergies are a global health issue with increasing prevalence. Allergic reactions can range from mild local symptoms to severe anaphylactic reactions. Immense progress has been made in diagnostic tools such as component-resolved diagnostics and its impact on risk stratification as well as in therapeutic approaches including biologicals. However, a cure for food allergy has not yet been achieved and patients and their families are forced to alter eating habits and social engagements, impacting their quality of life. New technologies and improved in vitro and in vivo models will advance our knowledge of the pathogenesis of food allergies and multicenter - multinational cohort studies will elucidate interactions between genetic background, lifestyle, and environmental factors. This review focuses on new insights and developments in the field of food allergy and summarizes recently published articles. This article is protected by copyright. All rights reserved. Read More » Innovative Surgical Sciences: A New Open Access Journal Available from De Gruyter Read More » Anatomy and development of the cardiac lymphatic vasculature: Its role in and injury and disease Abstract Lymphatic vessels are present throughout the entire body in all mammals and function to regulate tissue fluid balance, lipid transport and survey the immune system. Despite the presence of an extensive lymphatic plexus within the heart, until recently the importance of the cardiac lymphatic vasculature and its origins were unknown. Several studies have described the basic anatomy of the developing cardiac lymphatic vasculature and more recently the detailed development of the murine cardiac lymphatics has been documented, with important insight into their cellular sources during embryogenesis. In this review we initially describe the development of systemic lymphatic vasculature, to provide the background for a comparative description of the spatiotemporal development of the cardiac lymphatic vessels, including detail of both canonical, typically venous, and non-canonical (haemogenic endothelium) cellular sources. Subsequently, we address the response of the cardiac lymphatic network to myocardial infarction (heart attack) and the therapeutic potential of targeting cardiac lymphangiogenesis. This article is protected by copyright. All rights reserved. Read More » Evaluation of the safety and efficacy of the picosecond alexandrite laser with specialized lens array for treatment of the photoaging décolletage Background Fractionated lasers are routinely used to treat the characteristic cutaneous signs of photoaging. In this study, we evaluate the use of picosecond pulse duration combined with a diffractive lens array for treatment of photodamage of the décolletage. Methods Twenty subjects with Fitzpatrick skin types I–IV were enrolled in a prospective open-label trial evaluating the efficacy of the 755 nm picosecond pulsed alexandrite laser with diffractive lens array for treatment of photodamage to the décolletage. Each subject received a series of four laser treatments at 3 week intervals. Follow up evaluation was performed 1 and 3 months later by a masked investigator and consisted of assessment of dyspigmentation, erythema, keratosis, texture, and rhytides on a standardized 5 point scale; global aesthetic improvement 5 point scale; and investigator and subject satisfaction questionnaire. Adverse events and treatment discomfort was also assessed. Results Statistically significant improvement in dyspigmentation, keratosis, and skin texture were observed at both 1 and 3 month follow up intervals (P < 0.05). rhytides initially demonstrated significant improvement at the 1 month time point, but this significance was not maintained at 3 months (P = 0.08). There was no statistically significant improvement noted in erythema. The majority of subjects were satisfied, with a mean rating of 2.8/6 (one being extremely satisfied and six being extremely dissatisfied). Subject pain was 3.6/10. Conclusion The 755 nm picosecond pulsed alexandrite laser with diffractive lens array can be an effective option for rejuvenation of the photodamaged décolletage. Lasers Surg. Med. © 2015 Wiley Periodicals, Inc. Read More » Seventy Years of Asthma in Italy: Age, Period and Cohort Effects on Incidence and Remission of Self-Reported Asthma from 1940 to 2010 by Giancarlo Pesce, Francesca Locatelli, Isa Cerveri, Massimiliano Bugiani, Pietro Pirina, Ane Johannessen, Simone Accordini, Maria Elisabetta Zanolin, Giuseppe Verlato, Roberto de Marco Background It is well known that asthma prevalence has been increasing all over the world in the last decades. However, few data are available on temporal trends of incidence and remission of asthma. Objective To evaluate the rates of asthma incidence and remission in Italy from 1940 to 2010. Methods The subjects were randomly sampled from the general Italian population between 1991 and 2010 in the three population-based multicentre studies: ECRHS, ISAYA, and GEIRD. Individual information on the history of asthma (age at onset, age at the last attack, use of drugs for asthma control, co-presence of hay-fever) was collected on 35,495 subjects aged 20–84 and born between 1925–1989. Temporal changes in rates of asthma incidence and remission in relation to age, birth cohort and calendar period (APC) were modelled using Poisson regression and APC models. Results The average yearly rate of asthma incidence was 2.6/1000 (3,297 new cases among 1,263,885 person-years). The incidence rates have been linearly increasing, with a percentage increase of +3.9% (95%CI: 3.1–4.5), from 1940 up to the year 1995, when the rates begun to level off. The stabilization of asthma incidence was mainly due to a decrease in the rates of atopic asthma after 1995, while non-atopic asthma has continued to increase. The overall rate of remission was 43.2/1000person-years, and it did not vary significantly across generations, but was associated with atopy, age at asthma onset and duration of the disease. Conclusions After 50 years of a continuous upward trend, the rates of asthma incidence underwent a substantial stabilization in the late 90s. Despite remarkable improvements in the treatment of asthma, the rate of remission did not change significantly in the last seventy years. Some caveats are required in interpreting our results, given that our estimates are based on self-reported events that could be affected by the recall bias. Read More » Variability in the implementation of voicing in American English obstruents Publication date: January 2016 Source:Journal of Phonetics, Volume 54 Author(s): Lisa Davidson Previous research has shown that in languages like English, the implementation of voicing in voiced obstruents is affected by linguistic factors such as utterance position, stress, and the adjacent sound. The goal of the current study is to extend previous findings in two ways: (1) investigate the production of voicing in connected read speech instead of in isolation/carrier sentences, and (2) understand the implementation of partial voicing by examining where in the constriction voicing appears or dies out. The current study examines the voicing of stops and fricatives in the connected read speech of 37 speakers. Results confirm that phrase position, word position, lexical stress, and the manner and voicing of the adjacent sound condition the prevalence of voicing, but they have different effects on stops and fricatives. The analysis of where voicing is realized in the constriction interval shows that bleed from a preceding sonorant is common, but voicing beginning partway through the constriction interval (i.e., negative voice onset time) is much rarer. The acoustic, articulatory, and aerodynamic sources of the patterns of phonation found in connected speech are discussed. Read More » Accounting for variability in North American English /ɹ/: Evidence from children's articulation Publication date: January 2016 Source:Journal of Phonetics, Volume 54 Author(s): Lyra Magloughlin This acoustic and articulatory pilot study examines the North American English /ɹ/ productions of English-speaking children during acquisition, and compares their early- and later-stage productions with /ɹ/ allophony patterns reported in previous studies with adults. Ultrasound imaging is used to investigate the articulatory behavior of four children, aged 3–6 years, during production of familiar lexical items containing prevocalic, post-vocalic, and syllabic /ɹ/. Shape analysis of the tongue is conducted using a technique that is highly robust against rotational and translational differences from token to token. Participants exhibited behaviors that are consistent with adults' in previous studies, showing both intra- and inter-speaker variability, and similar patterns of allophony based on syllable position, consonant place of articulation, and vowel quality. For three participants, variable behavior occurred prevocalically, in contexts where adults tend to exhibit the greatest amount of allophonic variation. Variable behavior during acquisition of an articulatorily complex speech sound provides a plausible explanation for the variability that has been previously reported with adults. If a child's dominant strategy for reaching adult-like targets proves ineffective in certain contexts, that may motivate exploratory behavior that could lead to a stable alternative strategy in those contexts over time. Participants' later-stage productions mirror allophony patterns observed with adults in previous studies. The current research adds to the literature on children's articulatory behavior during acquisition, and to the body of accumulated knowledge on North American English /ɹ/. Read More » Heritability and confirmation of genetic association studies for childhood asthma in twins Abstract Background Although the genetics of asthma has been extensively studied using both quantitative and molecular genetic analysis methods, both approaches lack studies specific to the childhood phenotype and including other allergic diseases. This study aimed to give specific estimates for the heritability of childhood asthma and other allergic diseases, to attempt to replicate findings from genome-wide association studies (GWAS) for childhood asthma and to test the same variants against other allergic diseases. Methods In a cohort of 25,306 Swedish twins aged 9 or 12, data on asthma were available from parental interviews and population-based registers. The interviews also inquired about wheeze, hay fever, eczema and food allergy. Through structural equation modeling, the heritability of all phenotypes was calculated. A subset of 10,075 twins was genotyped for 16 single nucleotide polymorphisms (SNPs) selected from previous GWAS; these were first tested for association with asthma and significant findings also against the other allergic diseases. Results The heritability of any childhood asthma was 0.82 (95% CI 0.79-0.85). For the other allergic diseases the range was approximately 0.60-0.80. Associations for six SNPs with asthma were replicated, including rs2305480 in the GSDMB gene (OR 0.80, 95% CI 0.74-0.86, p= 1.5*10-8; other significant associations all below p=3.5*10-4). Of these, only rs3771180 in IL1RL1 was associated with any other allergic disease (for hay fever, OR 0.64, 95%CI 0.53-0.77, p=2.5*10-6). Conclusion Asthma and allergic diseases of childhood are highly heritable, and these high-risk genetic variants associated specifically with childhood asthma, except for one SNP shared with hay fever. This article is protected by copyright. All rights reserved. Read More » Development and evaluation of the Turkish matrix sentence test 10.3109/14992027.2015.1074735<br/>Melanie A. Zokoll Read More » Influence of the renal lower pole anatomy and mid-renal-zone classification in successful approach to the calices during flexible ureteroscopy Abstract Purpuse The aim of this paper is to analyze if the anatomy type of the collector system (CS) limits the accessibility of flexible ureteroscopy (FUR) in the lower pole. Methods We analyzed the pyelographies of 51 patients submitted to FUR and divided the CS into four groups: A1—kidney midzone (KM) drained by minor calices (Mc) that are dependent on the superior or on the inferior caliceal groups; A2—KM drained by crossed calices; B1—KM drained by a major caliceal group independent both of the superior and inferior groups, and B2—KM drained by Mc entering directly into the renal pelvis. We studied the number of calices, the angle between the lower infundibulum and renal pelvis, and the angle between the lower infundibulum and the inferior Mc. With the use of a flexible ureteroscope, the access attempt was made to all of lower pole calices. Averages were statistically compared using the ANOVA and Unpaired T test (p < 0.05). Results We found 14 kidneys of A1 (27.45 %); 4 of A2 (7.84 %); 17 of B1 (33.33 %); and 16 of B2 (31.37 %). The LIP was >90° in 31 kidneys (60.78 %) and between 61° and 90° in 20 kidneys (39.22 %). We did not find angles smaller than 60°. The group A1 presented 48 Mc and the UF was able to access 42 (87.5 %); the group A2 had 11 Mc and the UF was able to access 7 (63.64 %); the group B1 had 48 Mc and the UF was able to access 41 (85.42 %) and in group B2 we observed 41 Mc and the UF could access 35 (85.36 %). There was no statistical difference in the accessibility between the groups (p = 0.2610). Conclusions Collecting system with kidney midzone drained by crossed calices presented the lower accessibility rate during FUR. Read More » Die Rechtsprechung des Bundesgerichtshofs im Jahr 2014 zur Aufklärung Read More » Endoskopie in der MKG-Chirurgie Read More » Einsatz endoskopiegestützter Verfahren bei der Versorgung von Collum- und Orbitabodenfrakturen Zusammenfassung Hintergrund Endoskopisch assistierte Verfahren werden u. a. bei Verletzungen der Stirnhöhle, des Jochbogens, der Orbita und des Collums angewendet. Sie können helfen, eine exakte anatomische Reposition und eine Mikroplattenfixation zu erreichen. Durch den Einsatz des Endoskops lässt sich die Qualität der Versorgung direkt kontrollieren und damit insgesamt verbessern. Vor allem bei der operativen Behandlung der Gelenkfortsatzfrakturen können dabei wichtige nervale Strukturen geschont und oftmals sichtbare Narben verhindert werden. Ebenso kann die Endoskopie Möglichkeiten eröffnen, nur schwer zu erreichende Raumforderungen minimal-invasiv zu entfernen. Methoden Der vorliegende Beitrag beschreibt die endoskopische Versorgung von Gelenkfortsatz- und Orbitabodenfrakturen und zeigt Möglichkeiten auf, Raumforderungen oder Fremdköper am Gelenk endoskopiegestützt von enoral zu resezieren. Read More » Risk of anaphylaxis after vaccination in children and adults Publication date: Available online 6 October 2015 Source:Journal of Allergy and Clinical Immunology Author(s): Michael M. McNeil, Eric S. Weintraub, Jonathan Duffy, Lakshmi Sukumaran, Steven J. Jacobsen, Nicola P. Klein, Simon J. Hambidge, Grace M. Lee, Lisa A. Jackson, Stephanie A. Irving, Jennifer P. King, Elyse O. Kharbanda, Robert A. Bednarczyk, Frank DeStefano BackgroundAnaphylaxis is a potentially life-threatening allergic reaction. The risk of anaphylaxis after vaccination has not been well described in adults or with newer vaccines in children.ObjectiveWe sought to estimate the incidence of anaphylaxis after vaccines and describe the demographic and clinical characteristics of confirmed cases of anaphylaxis.MethodsUsing health care data from the Vaccine Safety Datalink, we determined rates of anaphylaxis after vaccination in children and adults. We first identified all patients with a vaccination record from January 2009 through December 2011 and used diagnostic and procedure codes to identify potential anaphylaxis cases. Medical records of potential cases were reviewed. Confirmed cases met the Brighton Collaboration definition for anaphylaxis and had to be determined to be vaccine triggered. We calculated the incidence of anaphylaxis after all vaccines combined and for selected individual vaccines.ResultsWe identified 33 confirmed vaccine-triggered anaphylaxis cases that occurred after 25,173,965 vaccine doses. The rate of anaphylaxis was 1.31 (95% CI, 0.90-1.84) per million vaccine doses. The incidence did not vary significantly by age, and there was a nonsignificant female predominance. Vaccine-specific rates included 1.35 (95% CI, 0.65-2.47) per million doses for inactivated trivalent influenza vaccine (10 cases, 7,434,628 doses given alone) and 1.83 (95% CI, 0.22-6.63) per million doses for inactivated monovalent influenza vaccine (2 cases, 1,090,279 doses given alone). The onset of symptoms among cases was within 30 minutes (8 cases), 30 to less than 120 minutes (8 cases), 2 to less than 4 hours (10 cases), 4 to 8 hours (2 cases), the next day (1 case), and not documented (4 cases).ConclusionAnaphylaxis after vaccination is rare in all age groups. Despite its rarity, anaphylaxis is a potentially life-threatening medical emergency that vaccine providers need to be prepared to treat. Read More » Raloxifene Inhibits NF-kB Pathway and Potentiates Anti-Tumour Activity of Cisplatin with Simultaneous Reduction in its Nephrotoxictiy Abstract Cisplatin induced nephrotoxicity is the chief obstacle in the use of cisplatin as chemotherapeutic agent. However, it remains as most widely employed anticancer agent to treat various solid tumours like head-neck, testicular, ovarian and mammary gland cancer. Raloxifene is claimed to be potent anti-inflammatory as well as anti-cancer agent. The present study was carried out to explore the effect of pre-treatment of raloxifene on cisplatin induced nephrotoxicity and its anti-tumour activity in 7, 12 dimethyl benz [a] anthracene induced mammary tumour in animal model. Renal damage was accessed by measuring serum level of creatinine, blood urea nitrogen and albumin whereas systemic inflammation was accessed by measuring level of pro-inflammatory cytokines like tumour necrosis factor alpha (TNF-α), interleukin 6 (IL-6), interleukin 10 (IL-10) and nuclear factor kappa B (NFκB). Moreover, assessment of tumour reduction was done by measuring tumour volume and percentage tumour reduction. A single dose of cisplatin (7.5 mg/kg) resulted in significant increase in serum creatinine, blood urea nitrogen, NF-kB, TNF-α and IL-6 levels along with decrease in albumin and IL-10 levels. However, there were no significant changes in raloxifene (8 mg/kg) treated group. Pre-treatment of raloxifene (8 mg/kg) caused marked decrease in serum creatinine, blood urea nitrogen, TNF-α and IL-6 levels whereas increase in albumin and IL-10 levels. However, pre-treatment of raloxifene showed maximum tumour reduction as compared to cisplatin and raloxifene treated groups. The present study demonstrates that raloxifene potentiates anti-tumour activity of cisplatin with simultaneous reduction in its nephrotoxicity, and this effect is attributed to its direct anti-inflammatory activity. Read More » Voice Needs and Voice Demands of Professional Newsreaders in Southern India Publication date: Available online 6 October 2015 Source:Journal of Voice Author(s): Nishanthi Gunasekaran, Prakash Boominathan, Jayashree Seethapathy ObjectivesNewsreaders are elite vocal professionals who are highly dependent on their voice quality to meet professional commitments. Globally, the voice needs and demands of newsreaders could vary depending on technology and cultural variations. This study documents voice demands, voice needs, and vocal and nonvocal habits of professional newsreaders in Chennai, southern India through a questionnaire-based interview.Study designProspective, case–control study design.MethodsForty-seven professional newsreaders and 47 non-newsreaders participated in the questionnaire-based interview that elicited information relevant to their profession and voice use.ResultsMajority of the newsreaders were not formally trained for newsreading. A significantly larger percentage of female newsreaders felt their jobs to be vocally demanding. Most newsreaders also had other full-time jobs that required a lot of speaking. Ninety-four percent of newsreaders consciously altered their voices while rendering news, and majority of them reported their voices to have changed considerably since they began newsreading. When compared with non-newsreaders, a significantly larger number of newsreaders were aware of voice problems, and many experienced some type of vocal technical difficulties. Seventy-seven percent of newsreaders took active measures to conserve their voice as opposed to non-newsreaders. Majority reported that sitting upright and erect while reading news helped produce the best vocal output for newsreading.ConclusionsThe findings on voice needs and vocal and nonvocal habits among newsreaders in Chennai, India, provide valuable first-time information from this part of the world. These have potential application for voice professionals, voice trainers, and prospective aspirant newsreaders in developing strategies for voice care and in preventing voice problems. Read More » Voice Needs and Voice Demands of Professional Newsreaders in Southern India Publication date: Available online 6 October 2015 Source:Journal of Voice Author(s): Nishanthi Gunasekaran, Prakash Boominathan, Jayashree Seethapathy ObjectivesNewsreaders are elite vocal professionals who are highly dependent on their voice quality to meet professional commitments. Globally, the voice needs and demands of newsreaders could vary depending on technology and cultural variations. This study documents voice demands, voice needs, and vocal and nonvocal habits of professional newsreaders in Chennai, southern India through a questionnaire-based interview.Study designProspective, case–control study design.MethodsForty-seven professional newsreaders and 47 non-newsreaders participated in the questionnaire-based interview that elicited information relevant to their profession and voice use.ResultsMajority of the newsreaders were not formally trained for newsreading. A significantly larger percentage of female newsreaders felt their jobs to be vocally demanding. Most newsreaders also had other full-time jobs that required a lot of speaking. Ninety-four percent of newsreaders consciously altered their voices while rendering news, and majority of them reported their voices to have changed considerably since they began newsreading. When compared with non-newsreaders, a significantly larger number of newsreaders were aware of voice problems, and many experienced some type of vocal technical difficulties. Seventy-seven percent of newsreaders took active measures to conserve their voice as opposed to non-newsreaders. Majority reported that sitting upright and erect while reading news helped produce the best vocal output for newsreading.ConclusionsThe findings on voice needs and vocal and nonvocal habits among newsreaders in Chennai, India, provide valuable first-time information from this part of the world. These have potential application for voice professionals, voice trainers, and prospective aspirant newsreaders in developing strategies for voice care and in preventing voice problems. Read More » Up-regulation of Bpifb1 expression in the parotid glands of non-obese diabetic mice Abstract Objective To define the increased mRNA expression of Bpifb1, a member of the bactericidal/permeability-increasing protein family, in parotid acinar cells from non-obese diabetic (NOD) mice, an animal model for Sjögren's syndrome. Materials And Methods Parotid acinar cells were prepared from female NOD (NOD/ShiJcl) mice with or without diabetes, as well as from control (C57BL/6JJcl) mice. Total RNA and homogenate were prepared from the parotid acinar cells. Embryonic cDNA from a Mouse MTC™ Panel I kit was used. The expression of Bpifb1 was determined by cDNA microarray analysis, RT-PCR, real-time PCR, northern blotting and in situ hybridization. Results The expression of Bpifb1 mRNA was high in parotid acinar cells from diabetic and non-diabetic NOD mice at 5 to 50 weeks of age. Acinar cells in the C57BL/6 mice had a low expression of Bpifb1 mRNA at an age >8 weeks, but had a relatively high expression in the foetus and infantile stages. Conclusions Bpifb1 mRNA is up-regulated in parotid acinar cells in NOD mice, but its expression is not related to the onset of diabetes. These findings suggest that high expression levels of Bpifb1 might predict disease traits before the onset of autoimmunity. This article is protected by copyright. All rights reserved. Read More » Health-related quality-of-life changes due to high-dose-rate brachytherapy, low-dose-rate brachytherapy, or intensity-modulated radiation therapy for prostate cancer Publication date: Available online 6 October 2015 Source:Brachytherapy Author(s): Tobin J. Strom, Alex A. Cruz, Nick B. Figura, Kushagra Shrinath, Kevin Nethers, Eric A. Mellon, Daniel C. Fernandez, Amarjit S. Saini, Dylan C. Hunt, Randy V. Heysek, Richard B. Wilder PurposeTo compare urinary, bowel, and sexual health-related quality-of-life (HRQOL) changes due to high-dose-rate (HDR) brachytherapy, low-dose-rate (LDR) brachytherapy, or intensity-modulated radiation therapy (IMRT) monotherapy for prostate cancer.Methods and MaterialsBetween January 2002 and September 2013, 413 low-risk or favorable intermediate-risk prostate cancer patients were treated with HDR brachytherapy monotherapy to 2700–2800 cGy in two fractions (n = 85), iodine-125 LDR brachytherapy monotherapy to 14,500 cGy in one fraction (n = 249), or IMRT monotherapy to 7400–8100 cGy in 37–45 fractions (n = 79) without pelvic lymph node irradiation. No androgen deprivation therapy was given. Patients used an international prostate symptoms score questionnaire, an expanded prostate cancer index composite-26 bowel questionnaire, and a sexual health inventory for men questionnaire to assess their urinary, bowel, and sexual HRQOL, respectively, pretreatment and at 1, 3, 6, 9, 12, and 18 months posttreatment.ResultsMedian follow-up was 32 months. HDR brachytherapy and IMRT patients had significantly less deterioration in their urinary HRQOL than LDR brachytherapy patients at 1 and 3 months after irradiation. The only significant decrease in bowel HRQOL between the groups was seen 18 months after treatment, at which point IMRT patients had a slight, but significant, deterioration in their bowel HRQOL compared with HDR and LDR brachytherapy patients. HDR brachytherapy patients had worse sexual HRQOL than both LDR brachytherapy and IMRT patients after treatment.ConclusionsIMRT and HDR brachytherapy cause less severe acute worsening of urinary HRQOL than LDR brachytherapy. However, IMRT causes a slight, but significant, worsening of bowel HRQOL compared with HDR and LDR brachytherapy. Read More » Thin Versus Thick Description: Analyzing Representations of People and Their Life Worlds in the Literature of Communication Sciences and Disorders Purpose Evidence-based practice relies on clinicians to translate research evidence for individual clients. This study, the initial phase of a broader research project, examines the textual resources of such translations by analyzing how people with acquired cognitive-communication disorders (ACCD) and their life worlds have been represented in Communication Sciences and Disorders (CSD) research articles. Method Using textual analysis, we completed a categorical analysis of 6,059 articles published between 1936 and 2012, coding for genre, population, and any evidence of thick representations of people and their life worlds, and a discourse analysis of representations used in 56 ACCD research articles, identifying thin and thick representations in 4 domains (derived from the International Classification of Functioning, Disability, and Health) and across article sections. Results The categorical analysis identified a higher percentage of ACCD articles with some evidence of thick representation (30%) compared with all CSD articles (12%) sampled. However, discourse analysis of ACCD research articles found that thick representations were quite limited; 34/56 articles had thin representational profiles, 19/56 had mixed profiles, and 3/56 had thick profiles. Conclusions These findings document the dominance of thin representations in the CSD literature, which we suggest makes translational work more difficult. How clinicians translate such evidence will be addressed in the next research phase, an interview study of speech-language pathologists. Read More » Epithelial–Mesenchymal Transition Protein Expression in Basal Cell Adenomas and Basal Cell Adenocarcinomas Abstract Basal cell adenomas and basal cell adenocarcinomas show marked histomorphologic similarity and are separated microscopically primarily by the invasive characteristics of the adenocarcinomas. We wished to explore potential differences in the expression of epithelial–mesenchymal transition associated proteins in these two tumor types. A tissue microarray was constructed utilizing 29 basal cell adenomas and 16 basal cell adenocarcinomas. Immunohistochemical expression of E-cadherin, beta-catenin, Twist 1 and vimentin were investigated. Both tumors expressed all proteins in a relatively similar manner. Nuclear beta-catenin was essentially limited to the abluminal cell populations in both tumor types. E-cadherin was limited largely to luminal locations but was more prevalent in the adenocarcinomas as compared to the adenomas. Primarily abluminal expression for vimentin was seen, sometimes present in an apical dot-like pattern. Distinct populations of cellular expression of these four markers of epithelial mesenchymal transition were present but were similar in locations in both tumors with no patterns discerned to separate basal cell adenoma from basal cell adenocarcinoma. Given these findings, the mechanisms by which basal cell adenocarcinoma is able to invade while its counterpart, basal cell adenoma can not, may be more complex than in other tumor types. Read More » Epithelial–Mesenchymal Transition Protein Expression in Basal Cell Adenomas and Basal Cell Adenocarcinomas Abstract Basal cell adenomas and basal cell adenocarcinomas show marked histomorphologic similarity and are separated microscopically primarily by the invasive characteristics of the adenocarcinomas. We wished to explore potential differences in the expression of epithelial–mesenchymal transition associated proteins in these two tumor types. A tissue microarray was constructed utilizing 29 basal cell adenomas and 16 basal cell adenocarcinomas. Immunohistochemical expression of E-cadherin, beta-catenin, Twist 1 and vimentin were investigated. Both tumors expressed all proteins in a relatively similar manner. Nuclear beta-catenin was essentially limited to the abluminal cell populations in both tumor types. E-cadherin was limited largely to luminal locations but was more prevalent in the adenocarcinomas as compared to the adenomas. Primarily abluminal expression for vimentin was seen, sometimes present in an apical dot-like pattern. Distinct populations of cellular expression of these four markers of epithelial mesenchymal transition were present but were similar in locations in both tumors with no patterns discerned to separate basal cell adenoma from basal cell adenocarcinoma. Given these findings, the mechanisms by which basal cell adenocarcinoma is able to invade while its counterpart, basal cell adenoma can not, may be more complex than in other tumor types. Read More » Predicting Outcomes After Glioma Surgery: Model Behavior Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Author(s): Randy L. Jensen Read More » Cranioplasty and Ventriculoperitoneal Shunt Placement after Decompressive Craniectomy: Staged Surgery Is Associated with Fewer Postoperative Complications Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Author(s): Patrick Schuss, Valeri Borger, Ági Güresir, Hartmut Vatter, Erdem Güresir ObjectiveDecompressive craniectomy (DC) requires later cranioplasty (CP) in survivors. However, if additional ventriculoperitoneal shunt (VPS) placement due to shunt-dependent hydrocephalus is necessary, the optimal timing of both procedures still remains controversial. We therefore analyzed our computerized database concerning the optimal timing of CP and VPS regarding postoperative complications.MethodsFrom 2009–2014, 41 cranioplasty procedures with simultaneous or staged VPS placement were performed at the authors' institution. Patients were stratified into two groups according to the time from CP to VPS ("simultaneous" and "staged"). Patient characteristics, timing of CP and VPS, as well as procedure-related complications, were assessed and analyzed.ResultsOverall CP and VPS were performed simultaneously in 41% and in staged fashion in 59% of the patients. The overall complication rate was 27%. Patients who underwent simultaneous CP and VPS suffered significantly more often from complications compared with patients who underwent staged CP and VPS procedures (47% vs. 12%; P = 0.03). Patients with simultaneous CP and VPS had a significantly higher rate of infectious postoperative complications compared with patients with staged procedures (P = 0.003). On multivariate analysis, simultaneous CP and VPS procedure was the only significant predictor of postoperative complication after CP and VPS (P = 0.03).ConclusionWe provide detailed data on surgical timing and complications for cranioplasty and ventriculoperitoneal shunt placement after DC. The present data suggest that patients who undergo staged CP and VPS procedures might benefit from a lower complication rate. This might influence future surgical decision making regarding optimal timing of CP and VPS placement. Read More » Patient Age, Hemorrhage Patterns, and Outcomes of Arteriovenous Malformation Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Author(s): Xianli Lv, Jie Liu, Xiulan Hu, Youxiang Li BackgroundThe angioarchitecture and presentation of arteriovenous malformations (AVMs) associated with AVM hemorrhage may vary with patient age. Our aim was to determine the influence of patient age at diagnosis on hemorrhage patterns and outcomes.MethodsA consecutive case series of 267 cases of ruptured AVMs was retrospectively analyzed. Hemorrhage patterns (intracerebral hemorrhage, subarachnoid hemorrhage, and intraventricular hemorrhage) were confirmed based on computed tomography imaging at initial diagnosis. Clinical outcomes were classified with a modified Rankin Score. These cases were analyzed with respect to age at diagnosis, hemorrhage patterns, Spetzler-Martin grades, and their clinical outcomes.ResultsDuring a mean 22.2 months follow-up time (range, 7 hours to 10 years), 212 cases (79.4%) were favorable (modified Rankin Score ≤2) and 55 cases (21.6%) were unfavorable (modified Rankin Score ≥3). The mean age was higher in patients with an unfavorable outcome at follow-up. In univariate analyses, different age groups were significantly associated with bleeding patterns (P = 0.022). Unfavorable outcome was associated with intracerebral hemorrhage (odds ratio, 0.330; 95% confidence interval, 0.142–0.768; P = 0.008) and evacuation of hematoma (odds ratio, 0.195; 95% confidence interval, 0.044–0.867; P = 0.025), whereas intraventricular hemorrhage, subarachnoid hemorrhage, and intraventricular drainage were significantly associated with a favorable outcome. Different age groups were not significantly associated with bleeding patterns, sex, and the location of the AVM, and Spetzler-Martin grades did not show a significant association with the severity of outcomes.ConclusionsDifferent age groups were significantly associated with bleeding patterns. Higher patient age, intracerebral hemorrhage, and evacuation of hematoma seem to be associated with an unfavorable outcome after AVM rupture. Read More » The Safety of Surgery in Elderly Patients with Primary and Recurrent Glioblastoma Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Author(s): Randy S. D'Amico, Michael B. Cloney, Adam M. Sonabend, Brad Zacharia, Matthew N. Nazarian, Fabio M. Iwamoto, Michael B. Sisti, Jeffrey N. Bruce, Guy M. McKhann BackgroundGlioblastoma (GBM) occurs more commonly in elderly patients. However, these patients are often excluded from clinical trials. The absence of solid evidence has resulted in a nihilistic view of GBM in the elderly and a traditionally conservative treatment approach. In particular, the safety of surgical resection for both primary and recurrent GBM is poorly understood in elderly patients.MethodsIn a retrospective cohort of patients aged ≥65 years, we examined selection for biopsy, surgical resection, and reoperation for recurrent disease. We also analyzed complication rates after initial resection and reoperation for recurrent disease. We identified 319 elderly patients with pathologically proven GBM who underwent a total of 274 craniotomies at our institution between 2000 and 2012. Events were reported according to the methods used in the Glioma Outcomes Project.ResultsThe overall rate of complications after resection was 21.9%, with a rate of neurological complications of 7.7%. The rates of neurological, regional, and systemic complications were not significantly different after initial craniotomy and reoperation for GBM in elderly patients. Reoperations were not associated with an increased risk of complications. Low cardiovascular risk, improved functional status, and hemispheric GBM were associated with selection for more aggressive surgical treatment. Younger age and improved functional status were associated with a reduced likelihood of complications.ConclusionsWe conclude that in select patients, age alone should not preclude the decision to pursue aggressive surgical management. Read More » Surgical Treatment of Middle Cerebral Artery Aneurysms Without Using Indocyanine Green Videoangiography Assistance: Retrospective Monocentric Study of 263 Clipped Aneurysms Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Author(s): Sabrina Hallout IntroductionMiddle cerebral artery (MCA) aneurysms represent 20% of intracranial aneurysms. Most (80%) of them are located on the sylvian bifurcation, the seat of hemodynamic turbulence flow. Morbidity and mortality related to surgery of MCA aneurysms are not negligible. MCA vascularization areas are important eloquence functional territorial of Brain tissue. Indocyanine green videoangiography assistance (ICG-VA) is an emergent tool for intraoperative assessment of aneurysmal occlusion and for checking a possible stenosant clip in vascular area. The purposes of this study were to evaluate the safety of clipping procedure in terms of morbidity, mortality, and efficiency of aneurysm occlusion without using ICG-VA, recurrence and bleeding/rebleeding at short and long terms, and angiographic and clinical follow-ups.Material and MethodsThis study is a monocentric retrospective study performed at Pitié-Salpêtrière-Charles Foix Hospital Center, reporting clinical and angiographic follow-up of consecutive patients treated for MCA aneurysms (ruptured and unruptured) by clipping procedures. From 2002–2012, 251 consecutive patients were admitted at the author's institution for treatment of 263 MCA aneurysms (163 ruptured and 100 unruptured). Procedure-related death and complications were systematically assessed without video-angiography availability. The degree of aneurysms exclusion was evaluated according to the Raymond-Roy scale after the procedure and at long-term angiographic follow-up (mean delay = 36 months).ResultsThe death rate related to aneurysmal exclusion procedure was 1.2%. The major complication rate related to surgery was 5.3%. Postprocedure, an aneurysm occlusion rate Raymond-Roy grade A or B was 95.6%. Neither recanalization controlled clipped aneurysms nor re-aneurysmal rupture was observed in the long-term clinical follow-up (mean time = 83.5 months). The institution's series of surgical outcomes reported 95.6% of complete exclusion and 4.5% incomplete procedures without ICG-VA. A clip of repositioning rate was estimated at 15% when ICG-VA was used.ConclusionSurgical management is relatively safe for patients, with an acceptable complication rate in the era when ICG-VA was not yet available. Indeed, the main source of procedural ischemia microsurgery is stenosant clip. To limit the occurrence of malposition, the author's center began using ICG-VA a few months ago and expects to reduce its rate of incomplete occlusion. Read More » Making Dissection Planes for Cranioplasty After Decompressive Craniectomy Easier Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Author(s): N. Scott Litofsky Read More » Neurosurgical Quality Metrics: Seeking the Right Question Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Author(s): James Richard Bean Quality of care measurement was a late addition to managed care. As a small specialty, neurosurgery quality of care metrics have a low priority for Medicare and other health care payers. Frequency of complications of glioma surgery derived from a large administrative database can be used as a quality measure, but the results may be inaccurate and inadequate. Prospective voluntary outcome registries offer a better alternative. Read More » The Expanding Spectrum of Disease Treated by the Transnasal, Transsphenoidal Microscopic and Endoscopic Anterior Skull Base Approach: A Single-Center Experience 2008–2015 Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Author(s): David J. Cote, Robert Wiemann, Timothy R. Smith, Ian F. Dunn, Ossama Al-Mefty, Edward R. Laws IntroductionThe transsphenoidal approach was initially developed in neurosurgical practice as an operative approach to the pituitary gland. The introduction of the operating endoscope has improved the versatility of the transsphenoidal approach, broadening the spectrum of lesions that can be treated effectively with this operative strategy.MethodsWe performed a retrospective review of all patients who underwent transnasal, transsphenoidal operations at Brigham and Women's Hospital from April 2008 to February 2015 and categorized each case by pathologic diagnosis.ResultsA total of 792 transnasal, transsphenoidal operations (512 endoscopic) were performed by 9 neurosurgeons for 33 pathologies over a 7-year period. Pituitary adenomas (535, 67.55%) were the most common impetus for a transsphenoidal operation. Others included Rathke cleft cysts (86, 10.86%), craniopharyngiomas (25, 3.16%), lympocytic hypophysitis/pituitary inflammation (21, 2.65%), arachnoid cysts (8, 1.01%), spindle cell oncocytoma (4, 0.51%), colloid cysts (4, 0.51%), and pituicytoma (2, 0.25%). Pituitary hyperplasia was treated in 9 cases (1.14%) and pituitary apoplexy in 7 (0.88%). Nineteen operations were undertaken for postoperative repairs (2.40%) and 3 for abscesses (0.38%). Other diseases treated transsphenoidally included chordomas (12, 1.52%), metastases (9, 1.14%), meningiomas (5, 0.63%), clival lesions (4, 0.51%), germinomas (3, 0.38%), granulomas (2, 0.25%), dermoid tumors (2, 0.25%), and 1 (0.13%) each of esthesioneuroblastoma, granular cell tumor, Wegener granulomatosis, olfactory neuroblastoma, glioneuronal tumor, chondromyxoid fibroma, epidermoid, meningoencephalocele, aneurysm, neuroendocrine carcinoma, chondrosarcoma, and lymphoma.ConclusionsAlthough initially devised in neurosurgical practice for tumors of the pituitary gland, developments in technology now make the transsphenoidal approach an effective operative strategy for a wide range of anterior skull base lesions. Read More » Role of Genetic Polymorphisms in Predicting Delayed Cerebral Ischemia and Radiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage: A Meta-Analysis Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Author(s): Pui Man Rosalind Lai, Rose Du ObjectiveThe pathophysiology on cerebral vasospasm and delayed cerebral ischemia (DCI) remains poorly understood. Much research has been dedicated to finding genetic loci associated with vasospasm and ischemia. We present a systematic review and meta-analysis to identify genetic polymorphisms associated with delayed ischemic neurologic deficit (DIND), radiographic infarction attributed to ischemia, and radiographic vasospasm.MethodsPubMed, the Cochrane Library, and Excerpta Medica dataBASE (EMBASE) databases were used to identify relevant studies published up to March 2015 containing the subject terms cerebral or intracranial vasospasm and DCI in combination with genetics, gene, polymorphism or marker. Meta-analyses were performed using a random-effects model to calculate summary odds ratio (ORs) and 95% confidence intervals for each respective gene.ResultsOf 269 articles initially identified, 20 studies with 1670 patients were included in our comprehensive review, including 27 polymorphisms in 11 genes. The following 6 polymorphisms in 3 genes were selected for subsequent meta-analyses: apolipoprotein E (ApoE2, E4); endothelial nitric oxide (eNOS T786C, VNTR intron 4 a/b, G894T); and haptoglobin (Hp) 1/2 phenotypes. The eNOS VNTR a allele was associated with DIND (a vs. b allele: OR 1.92 [1.31-2.81], padj = 0.008). The Hp 2-2 allele was associated with radiographic vasospasm (2-2 vs. 2-1 and 1-1: OR 3.86 [1.86-8.03], padj = 0.003) but did not reach significance for DIND.ConclusionsThis is the first systemic review and meta-analysis to study and evaluate the associations between genetic polymorphism with DCI and radiographic vasospasm independently. In our study, eNOS VNTR and Hp polymorphisms appear to have the strongest associations with DIND and radiographic vasospasm, respectively. Read More » Sex-Related Prognostic Predictors for Parkinson Disease Undergoing Subthalamic Stimulation Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Author(s): Shang-Ming Chiou BackgroundA few reports have addressed the sex-related efficacy of deep brain stimulation (DBS) in the subthalamic nucleus (STN) to treat advanced Parkinson disease (PD). The present study evaluates the sex-related prognostic factors for STN-DBS outcomes.MethodsSeventy-two consecutive patients (48 men and 24 women) were reviewed retrospectively. Changes in the Unified PD Rating Scale scores were compared between men and women in the 6-month drug-off/DBS-on state relative to the preoperative drug-off baseline. A multivariate linear regression model was used to identify the preoperative factors predictive of motor improvements after surgery.ResultsBefore surgery, the male and female patient groups were comparable in clinical severity, except the women were associated with slightly inferior cognition (P < 0.05) and a relatively better response to levodopa (LD) (P < 0.05) than the men. Both sexes showed similar clinical improvements after STN-DBS therapy. In men, preoperative lower LD requirement and higher motor dysfunction, particularly tremor (adjusted R2 = 0.613, P < 0.001), as well as greater improvement in tremor and rigidity after LD therapy (adjusted R2 = 0.232, P = 0.001) were favorable predictors of surgical outcomes. Women achieved a significant improvement if they performed well in activities of daily living even with higher baseline motor scores (adjusted R2 = 0.620, P < 0.001), or exhibited improvements in akinesia disability after preoperative LD therapy (adjusted R2 = 0.305, P = 0.003).ConclusionsSTN-DBS therapy is equally beneficial for both sexes. Sex-related differences exist with regard to favorable prognostic predictors for early surgical outcomes. Read More » Upcoming Events Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Read More » World Federation of Neurosurgical Societies Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Read More » Magnesium Lithospermate B Implicates 3′-5′-Cyclic Adenosine Monophosphate/Protein Kinase A Pathway and N-Methyl-d-Aspartate Receptors in an Experimental Traumatic Brain Injury Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Author(s): Chih-Zen Chang, Shu-Chuan Wu, Aij-Lie Kwan, Chih-Lung Lin ObjectiveDecreased 3′-5'-cyclic adenosine monophosphate (cAMP), protein kinase A (PKA), and increased N-methyl-d-aspartate (NMDA) related apoptosis were observed in traumatic brain injury (TBI). It is of interest to examine the effect of magnesium lithospermate B (MLB) on cAMP/PKA pathway and NMDAR in TBI.MethodsA rodent weight-drop TBI model was used. Administration of MLB was initiated 1 week before (precondition) and 24 hours later (reversal). Cortical homogenates were harvested to measure cAMP (enzyme-linked immunosorbent assay), soluble guanylyl cyclases, PKA and NMDA receptor-2β (Western blot). In addition, cAMP kinase antagonist and H-89 dihydrochloride hydrate were used to test MLB's effect on the cytoplasm cAMP/PKA pathway after TBI.ResultsMorphologically, vacuolated neuron and activated microglia were observed in the TBI groups but absent in the MLB preconditioning and healthy controls. Induced cAMP, soluble guanylyl cyclase α1, and PKA were observed in the MLB groups, when compared with the TBI group (P < 0.01) Administration of H-89 dihydrochloride hydrate reversed the effect of MLB on cortical PKA and NMDA-2β expression after TBI.ConclusionsThis study showed that MLB exerted an antioxidant effect on the enhancement of cytoplasm cAMP and PKA. This compound also decreased NMDA-2β levels, which may correspond to its neuroprotective effects. This finding lends credence to the presumption that MLB modulates the NMDA-2β neurotoxicity through a cAMP-dependent mechanism in the pathogenesis of TBI. Read More » Subscription Information Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Read More » Contents Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Read More » Member Societies Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Read More » Internal Pulse Generators in Deep Brain Stimulation: Rechargeable or Not? Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Author(s): Michele Rizzi, Giuseppe Messina, Federica Penner, Antonio D'Ammando, Francesco Muratorio, Angelo Franzini ObjectiveDeep brain stimulation (DBS) is a cost-effective strategy for the treatment of different neurologic disorders. However, DBS procedures are associated with high costs of implantation and replacement of the internal pulse generator (IPG). Different manufacturers propose the use of rechargeable IPGs. The objective of this study is to compare the implantation costs of nonrechargeable IPGs versus the estimated costs of rechargeable IPGs in different categories of patients to evaluate if an economic advantage for the health care system could be derived.MethodsThe study looked at 149 patients who underwent a surgical procedure for IPG replacement. In a hypothetical scenario, rechargeable IPGs were implanted instead of nonrechargeable IPGs at the time of DBS system implantation. Another scenario was outlined in a perspective period of time, corresponding to the patients' life expectancy. Costs were calculated, and inferential analysis was performed.ResultsA savings of €234,194, including the cost of management of complications, was calculated during a follow-up period of 7.9 years. In a comprehensive life expectancy period of 47 years, a savings of €5,918,188 would be obtained (P < 0.05). Long-term group data point out that a relevant savings would be expected from implantation of rechargeable IPGs in dystonic patients (P < 0.05) and patients with Parkinson disease (P < 0.05), and a savings is projected to occur in other categories of patients (P < 0.05).ConclusionsImplantation of rechargeable IPGs presents clinical advantages compared with nonrechargeable devices. A huge economic savings can be realized with the implantation of rechargeable IPGs in categories of patients implanted with IPGs for DBS. Read More » Editor's Choices Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Read More » Editorial Board Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Read More » Affective Symptoms and White Matter Changes in Brain Tumor Patients Publication date: October 2015 Source:World Neurosurgery, Volume 84, Issue 4 Author(s): Andre Richter, Cristoph M. Woernle, Niklaus Krayenbühl, Spyridon Kollias, David Bellut BackgroundAffective symptoms are frequent in patients with brain tumors. The origin of such symptoms is unknown; either focal brain injury or reactive emotional distress may be responsible. This cross-sectional pilot study linked depressive symptoms and anxiety to white matter integrity. The objective was to test the hypothesis of a relationship between tissue damage and brain function in patients with brain tumors and to provide a basis for further studies in this field.MethodsDiffusion tensor imaging was performed in 39 patients with newly diagnosed supratentorial primary brain tumor. Patients completed the Beck Depression Inventory, and examiners rated them on the Hamilton Depression Rating Scale (HDRS). State and trait anxiety were measured using the State-Trait Anxiety Inventory. Correlations between fractional anisotropy (FA) and psychological measures were assessed on the basis of regions of interest; the defined regions of interest corresponded to clearly specified white matter tracts.ResultsStatistical analysis revealed correlations between FA in the left internal capsule and scores on the HDRS, Beck Depression Inventory, and State-Trait Anxiety Inventory (P < 0.05). HDRS scores were also correlated with FA in the right medial uncinate fasciculus, and state anxiety scores were significantly correlated with FA in the left lateral and medial uncinate fasciculus (P < 0.05).ConclusionsOur results suggest that neurobiologic mechanisms related to the integrity of tissue in specific white matter tracts may influence affective symptoms in patients with brain tumors, and these mechanisms can be investigated with diffusion tensor imaging. However, prospective observational studies are needed to investigate further the links between brain structures and the severity of affective symptoms in this patient population. Read More » Effects of lip-closing training on maximum voluntary lip-closing force during lip pursing in healthy young adults Summary To investigate the effect of lip-closing training, the time-course of multidirectional lip-closing forces during training was evaluated. The subjects were healthy young adults with no systemic disease. Ten subjects each were allocated to the training and non-training (control) groups. The subjects were instructed to use a lip muscle strength fixation device (M Patakara) for lip-closing training. Regarding closing the upper and lower lips against this force for 3 min as one task, the subjects were instructed to perform three tasks a day for 4 weeks. The multidirectional lip-closing forces were measured before, during and after training every week. In the control group, the forces were measured under the same schedule without training. After the initiation of training, the total lip-closing force significantly increased at 3 and 4 weeks in the training group compared with that in the control group (P = 0·003 at 3 weeks, P < 0·001 at 4 weeks). After the completion of training, the force decreased from 1 week and no significant difference from the control group was noted. When the lip-closing force was evaluated by direction, significant increases in the upward and downward directions were noted in the training group compared with those in the control group (P = 0·034 at 3 weeks for upwards; P = 0·027 at 4 weeks for downwards). Quantitative analysis confirmed that lip-closing training enhanced the lip-closing force regionally. Read More » Remember 2 Things: Narcan administration by EMTs and paramedics Narcan distribution is widespread. In this episode of Remember 2 Things EMS1 columnist Steve Whitehead discusses Narcan administration routes, including the importance of titrating intranasal naloxone to achieve return of spontaneous breathing, and the likelihood that the affect of the opioids is longer than the action phase of naloxone. Learn more about the safety of intranasal naloxone administration ... Read More » Epithelial–Mesenchymal Transition Protein Expression in Basal Cell Adenomas and Basal Cell Adenocarcinomas Abstract Basal cell adenomas and basal cell adenocarcinomas show marked histomorphologic similarity and are separated microscopically primarily by the invasive characteristics of the adenocarcinomas. We wished to explore potential differences in the expression of epithelial–mesenchymal transition associated proteins in these two tumor types. A tissue microarray was constructed utilizing 29 basal cell adenomas and 16 basal cell adenocarcinomas. Immunohistochemical expression of E-cadherin, beta-catenin, Twist 1 and vimentin were investigated. Both tumors expressed all proteins in a relatively similar manner. Nuclear beta-catenin was essentially limited to the abluminal cell populations in both tumor types. E-cadherin was limited largely to luminal locations but was more prevalent in the adenocarcinomas as compared to the adenomas. Primarily abluminal expression for vimentin was seen, sometimes present in an apical dot-like pattern. Distinct populations of cellular expression of these four markers of epithelial mesenchymal transition were present but were similar in locations in both tumors with no patterns discerned to separate basal cell adenoma from basal cell adenocarcinoma. Given these findings, the mechanisms by which basal cell adenocarcinoma is able to invade while its counterpart, basal cell adenoma can not, may be more complex than in other tumor types. Read More »