OtoLaryngology New Articles

Tuning to Binaural Cues in Human Auditory Cortex Abstract Interaural level and time differences (ILD and ITD), the primary binaural cues for sound localization in azimuth, are known to modulate the tuned responses of neurons in mammalian auditory cortex (AC). The majority of these neurons respond best to cue values that favor the contralateral ear, such that contralateral bias is evident in the overall population response and thereby expected in population-level functional imaging data. Human neuroimaging studies, however, have not consistently found contralaterally biased binaural response patterns. Here, we used functional magnetic resonance imaging (fMRI) to parametrically measure ILD and ITD tuning in human AC. For ILD, contralateral tuning was observed, using both univariate and multivoxel analyses, in posterior superior temporal gyrus (pSTG) in both hemispheres. Response-ILD functions were U-shaped, revealing responsiveness to both contralateral and—to a lesser degree—ipsilateral ILD values, consistent with rate coding by unequal populations of contralaterally and ipsilaterally tuned neurons. In contrast, for ITD, univariate analyses showed modest contralateral tuning only in left pSTG, characterized by a monotonic response-ITD function. A multivoxel classifier, however, revealed ITD coding in both hemispheres. Although sensitivity to ILD and ITD was distributed in similar AC regions, the differently shaped response functions and different response patterns across hemispheres suggest that basic ILD and ITD processes are not fully integrated in human AC. The results support opponent-channel theories of ILD but not necessarily ITD coding, the latter of which may involve multiple types of representation that differ across hemispheres. Read More » Satzung der Rudolf-Virchow-Stiftung für Pathologie Read More » Sleep-disordered breathing following mandibular setback: a systematic review of the literature Abstract Introduction A mandibular setback reduces space in the pharyngeal airway, and it has been suggested that it might induce sleep-disordered breathing. Objectives An evidence-based literature review was conducted to identify the effect of mandibular setback on the respiratory function during sleep. Methods The authors performed a systematic review of pertinent literature published up to 2014. A structured search of literature was performed, with predefined criteria. A survey of the PubMed, ScienceDirect, and Cochrane database was performed. A manual search of oral and maxillofacial surgery-related journals was accomplished. Potentially relevant studies then had their full-text publication reviewed. Results A total of 1,780 publications were evaluated, through which nine papers (seven case series and two case–control studies) were selected for the final review. No evidence of sleep disorder after six months was related in 223 patients. In one study, two patients developed obstructive sleep apnea syndrome after surgery, and in another two studies, seven patients presented an increase of obstructive apneas/hypopneas events and oxygen desaturation index. Most of the patients analyzed were young and thin. Conclusion There was no evidence of postoperative sleep apnea syndrome after a mandibular setback surgery. However, one should always consider a potential reduction of the upper airway space during the treatment plan. Obese patients and those submitted to large amounts of mandibular setbacks present a higher chance to develop obstructive sleep apnea syndrome. Read More » ROS-mediated activation of JNK/p38 contributes partially to the pro-apoptotic effect of ajoene on cells of lung adenocarcinoma Abstract Ajoene, a garlic-derived organosulfur compound, exerts anti-tumorigenic effect against various cancers. However, little is known about the biological effect of ajoene on lung adenocarcinoma, an aggressive malignancy with dismal prognosis. We investigated the biological effect of ajoene on lung adenocarcinoma and the underlying pathway. Lung adenocarcinoma cells A549, NCI-H1373, and NCI-H1395, along with the noncancerous lung bronchus cells BEAS-2B, were used. MTT test showed that ajoene (25 μM) reduces viability of lung adenocarcinoma cells but not the noncancerous BEAS-2B cells. Bromodeoxyuridine incorporation assay revealed that ajoene inhibits proliferation of lung adenocarcinoma cells. Treatment of lung adenocarcinoma cells with ajoene enhances apoptosis and ROS generation in a time- and dose-dependent fashion. Abrogation of caspase activation by zVAD-fmk completely prevents the ajoene-induced apoptosis; whereas block of ROS generation by N-acetylcysteine partly abolishes the ajoene-induced apoptosis. ROS-mediated induction of apoptosis contributes partially to the anti-tumorigenic property of ajoene observed, a phenomenon also confirmed by xenograft tumor study. Mitogen activated protein kinases (MAPKs), pivots of ROS-mediated signaling pathway, are activated upon ajoene treatment; Jun-N-terminal kinase (JNK)/p38 activations are required for signaling pathway underlying the ajoene-induced apoptosis. Our results suggest that ROS-mediated activation of JNK/p38 contributes partially to the pro-apoptotic action of ajoene on cells of lung adenocarcinoma. Ajoene may be a promising chemotherapeutic agent for lung adenocarcinoma. Read More » Salivary adenoid cystic carcinoma in Denmark 1990–2005: Outcome and independent prognostic factors including the benefit of radiotherapy. Results of the Danish Head and Neck Cancer Group (DAHANCA) In Denmark there are around 60 new cases of salivary gland carcinoma per year with a corresponding incidence of 1.1 per 100,000 inhabitants per year, and 25% of these are adenoid cystic carcinomas (ACC) [1]. Read More » Salivary adenoid cystic carcinoma in Denmark 1990–2005: Outcome and independent prognostic factors including the benefit of radiotherapy. Results of the Danish Head and Neck Cancer Group (DAHANCA) In Denmark there are around 60 new cases of salivary gland carcinoma per year with a corresponding incidence of 1.1 per 100,000 inhabitants per year, and 25% of these are adenoid cystic carcinomas (ACC) [1]. Read More » Translating preclinical hopes into clinical reality for children with ependymoma Read More » The Role of Radiotherapy in the Treatment of Small-Cell Lung Cancer Opinion Statement The standard therapy for limited disease small cell lung cancer (LD-SCLC) is concurrent chemoradiotherapy and prophylactic cranial irradiation (PCI) for those who achieve complete remission (CR) or good partial response (PR) with initial therapy. On the other hand, the standard therapy for extensive disease (ED-SCLC) is chemotherapy only. After the two phase III study conducted by Slotman et al., PCI with/without thoracic radiotherapy (TRT) is also recommended in the treatment of ED-SCLC. However, a Japanese phase III study failed to confirm the benefit of PCI for patients with ED-SCLC. All studies have demonstrated the effectiveness of PCI for preventing brain metastasis, but PCI seems to have a limited influence on OS. In the 2014 edition of the Guidelines for the Treatment of Lung Cancer from the Japan Lung Cancer Society (JLCS), use of PCI for patients with ED-SCLC has been changed from "recommended" to "not recommended". Appropriate selection of patients for PCI with/without TRT is very important. It is hoped that the characteristics of patients for whom PCI with/without TRT should be considered or avoided will be better defined in the future. Read More » Ceiling effects of sedatives should be considered in the management of chronic insomnia To the Editor: Read More » The advent of continuous positive airway pressure (CPAP) provided a near-universally effective treatment... The advent of continuous positive airway pressure (CPAP) provided a near-universally effective treatment modality for different types of sleep disordered breathing (SDB) and created an impetus for the widespread recognition and treatment of countless patients with SDB. Unfortunately, the success of this simple and effective treatment [1] may have slowed the drive for basic and translational research into the mechanism, phenotypes, and consequences of SDB. The availability of this effective treatment provided the incentive to clinicians to oversimplify their diagnostic and therapeutical approach. Read More » Annual longitudinal survey at up to five time points reveals reciprocal effects of bedtime delay and depression/anxiety in adolescents • We investigate the relationship between sleep and mental health in adolescents.• Multipoint observation data of up-to five years is employed.• Longitudinal changes in bedtime and depression/anxiety are correlated.• Bedtime and depression/anxiety have reciprocal effects the following year.• Preventing late bedtime may improve mental health in adolescents. Read More » Response to robert vetrugno's commentary I would like to thank Dr Vetrugno for his thoughtful and thought-provoking comments regarding the letter "Opioid-induced hyperalgesia and dopamine-induced augmentation in an intractable and refractory case of RLS" [1]. His suggestion to the RLS/WED community to probe deeper into an understanding of RLS/WED in general and RLS/WED-augmentation in particular is timely. The main purpose of my communication is to direct attention to the RLS community about the real existence of opioid-induced hyperalgesia (OIH) in some RLS/WED patients, especially when many RLS patients are increasingly being treated with opioids. Read More » Predictors of Posterior Glottic Stenosis: A Multi-Institutional Case-Control Study Objective: To assess intrinsic and extrinsic risk factors in the development of posterior glottic stenosis (PGS) in intubated patients. Methods:Patients diagnosed with PGS between September 2012 and May 2014 at 3 tertiary care university hospitals were included. Patient demographics, comorbidities, duration of intubation, endotracheal tube (ETT) size, and indication for intubation were recorded. Patients with PGS were compared to control patients represented by patients intubated in intensive care units (ICU). Results:Thirty-six PGS patients were identified. After exclusion, 28 PGS patients (14 male, 14 female) and 112 (65 male, 47 female) controls were studied. Multivariate analysis demonstrated ischemia (P < .05), diabetes (P < .01), and length of intubation (P < .01) were significant risk factors for the development of PGS. Fourteen of 14 (100%) males were intubated with a size 8 or larger ETT compared to 47 of 65 (72.3%) male controls (P < .05). Posterior glottic stenosis (P < .01), length of intubation (P < .001), and obstructive sleep apnea (P < .05) were significant risk factors for tracheostomy. Conclusion:Duration of intubation, ischemia, diabetes mellitus, and large ETT size (8 or greater) in males were significant risk factors for the development of PGS. Reducing the use of size 8 ETTs and earlier planned tracheostomy in high-risk patients may reduce the incidence of PGS and improve ICU safety. Read More » Office-Based Subglottic Evaluation in Children With Risk of Subglottic Hemangioma Purpose: Children with V3 cutaneous infantile hemangiomas (IH) and PHACE syndrome have a high incidence for airway hemangioma, 29% and 52%, respectively. Therefore, a clinical evaluation for these high-risk children is essential. We report our experience with in-office lower airway evaluation (OLAE) in these high-risk children. Results:Since 2003, 5 children with IH of the V3 cutaneous distribution and 3 children with PHACE syndrome underwent OLAE. Average age of presentation was 2.75 months. Two children had stridor at initial evaluation, and 1 child had subglottic hemangioma. This child was evaluated serially with OLAE to monitor disease progression and treatment response. A total of 10 upper tracheoscopies were performed on the 8 patients without respiratory complications. Conclusion:An airway evaluation is essential to evaluate and manage this high-risk population. Typically, operative endoscopy requires general anesthesia. However, in these high-risk children, we have performed OLAE without sedation to evaluate the trachea. High-speed recording and playback is essential in this method. Our series demonstrates that awake OLAE is possible and may be a safe technique to evaluate and monitor disease progression in these high-risk patients. These patients avoided general anesthesia and delay in diagnosis and did not incur any complications during or after OLAE. Read More » Speech Recognition in Noise by Younger and Older Adults: Effects of Age, Hearing Loss, and Temporal Resolution Objectives: Purpose of the present study is to evaluate the effects of aging on temporal resolution and speech understanding in noise. Methods:Twenty-seven young and 33 older normal hearing adults participated in this study. Temporal resolution was investigated using the Gaps in Noise (GIN) test. Understanding sentences in noise was investigated using a Dutch sentences (LIST) test. Results:Results demonstrated that older adults have significantly worse temporal resolution scores and significantly greater difficulty understanding sentences in noise than younger adults. In the group of older adults, the ability to understand sentences in noise correlated with hearing and age. A stepwise regression analysis showed that age was the best predictor for the speech in noise results. However, temporal resolution correlated with hearing, not with age. Results from the GIN test did not correlate with the results from the LIST test. Conclusions:The present study shows that with advancing age, both temporal resolution and speech understanding in noise significantly diminish. Temporal resolution correlates with hearing, not age, while speech understanding correlates more with age than hearing. These results could have implications for the outcome of auditory prostheses in older adults, as both diminished temporal resolution and speech understanding have to be taken into account. Read More » 15TH INTERNATIONAL THYROID CONGRESS PROGRAM AND MEETING ABSTRACTS Thyroid Oct 2015, Vol. 25, No. S1: P-1-A-337. Read More » Future Research in Graves' Orbitopathy: from Priority Setting to Trial Design Through Patient and Public Involvement Thyroid , Vol. 0, No. 0. Read More » Thyroid Dysfunction in Patients with Metastatic Carcinoma Treated with Sunitinib: Is Thyroid Autoimmunity Involved? Thyroid , Vol. 0, No. 0. Read More » Abstract Author Index Thyroid Oct 2015, Vol. 25, No. S1: A-338-A355. Read More » Standardization of Free Thyroxine and Harmonization of Thyrotropin Measurements: A Request for Input from Endocrinologists and Other Physicians Thyroid , Vol. 0, No. 0. Read More » International Thyroid Congress Short Call Abstracts Thyroid Oct 2015, Vol. 25, No. S1: A-356-A-383. Read More » Short Call Abstract Author Index Thyroid Oct 2015, Vol. 25, No. S1: A-384-A-386. Read More » Activation of colo-rectal high-threshold afferent nerves by Interleukin-2 is tetrodotoxin-sensitive and upregulated in a mouse model of chronic visceral hypersensitivity Abstract Background Chronic visceral pain is a defining feature of irritable bowel syndrome (IBS). IBS patients often show alterations in innate and adaptive immune function which may contribute to symptoms. Immune mediators are known to modulate the activity of viscero-sensory afferent nerves, but the focus has been on the innate immune system. Interleukin-2 (IL-2) is primarily associated with adaptive immune responses but its effects on colo-rectal afferent function in health or disease are unknown. Methods Myeloperoxidase (MPO) activity determined the extent of inflammation in health, acute trinitrobenzene-sulfonic acid (TNBS) colitis, and in our post-TNBS colitis model of chronic visceral hypersensitivity (CVH). The functional effects of IL-2 on high-threshold colo-rectal afferents and the expression of IL-2R and NaV1.7 mRNA in colo-rectal dorsal root ganglia (DRG) neurons were compared between healthy and CVH mice. Key Results MPO activity was increased during acute colitis, but subsided to levels comparable to health in CVH mice. IL-2 caused direct excitation of colo-rectal afferents that was blocked by tetrodotoxin. IL-2 did not affect afferent mechanosensitivity in health or CVH. However, an increased proportion of afferents responded directly to IL-2 in CVH mice compared with controls (73% vs 33%; p < 0.05), and the abundance of IL-2R and NaV1.7 mRNA was increased 3.5- and 2-fold (p < 0.001 for both) in colo-rectal DRG neurons. Conclusions & Inferences IL-2, an immune mediator from the adaptive arm of the immune response, affects colo-rectal afferent function, indicating these effects are not restricted to innate immune mediators. Colo-rectal afferent sensitivity to IL-2 is increased long after healing from inflammation. Figure 4 details chemosensitive response to IL-2, and shows that it is blocked in the presence of Tetrodotoxin. Read More » Excessive coupling of the salience network with intrinsic neurocognitive brain networks during rectal distension in adolescents with irritable bowel syndrome: a preliminary report Abstract Background The neural network mechanisms underlying visceral hypersensitivity in irritable bowel syndrome (IBS) are incompletely understood. It has been proposed that an intrinsic salience network plays an important role in chronic pain and IBS symptoms. Using neuroimaging, we examined brain responses to rectal distension in adolescent IBS patients, focusing on determining the alteration of salience network integrity in IBS and its functional implications in current theoretical frameworks. We hypothesized that (i) brain responses to visceral stimulation in adolescents are similar to those in adults, and (ii) IBS is associated with an altered salience network interaction with other neurocognitive networks, particularly the default mode network (DMN) and executive control network (ECN), as predicted by the theoretical models. Methods Irritable bowel syndrome patients and controls received subliminal and liminal rectal distension during imaging. Stimulus-induced brain activations were determined. Salience network integrity was evaluated by the functional connectivity of its seed regions activated by rectal distension in the insular and cingulate cortices. Key Results Compared with controls, IBS patients demonstrated greater activation to rectal distension in neural structures of the homeostatic afferent and emotional arousal networks, especially the anterior cingulate and insular cortices. Greater brain responses to liminal vs subliminal distension were observed in both groups. Particularly, IBS is uniquely associated with an excessive coupling of the salience network with the DMN and ECN in their key frontal and parietal node areas. Conclusions & Inferences Our study provided consistent evidence supporting the theoretical predictions of altered salience network functioning as a neuropathological mechanism of IBS symptoms. We examined, using neuroimaging, the brain responses to subliminal and liminal rectal distension in adolescent IBS patients. IBS is uniquely associated with an excessive coupling of the salience network with the DMN and ECN in their key frontal and parietal node areas. Our study provided supporting evidence to the theoretical predictions of altered salience network functioning as a neuropathological mechanism of IBS symptoms. Read More » Psychological factors selectively upregulate rectal pain perception in hypersensitive patients with irritable bowel syndrome Abstract Background Visceral hypersensitivity and psychological symptoms are frequent features in irritable bowel syndrome (IBS). Exploring mechanistic pathways leading to visceral hypersensitivity is of importance to direct future studies and treatment options. In this study, we evaluated the contribution of psychological factors to the perception of painful and non-painful rectal sensations in hyper- vs normosensitive IBS patients. Methods We included 138 IBS patients (Rome II criteria) who underwent an ascending method of limited rectal balloon distension paradigm. At the end of each distension step, subjects rated the perceived intensity of non-painful ('unpleasantness') and painful rectal sensations on visual analog scales. Sensitivity status was determined based on pain thresholds. Anxiety, depression and somatization were assessed by questionnaires. Mixed models were used to test the relationship between sensitivity status, psychological variables, and pain & unpleasantness ratings upon increasing distension. Key Results Hypersensitive IBS patients had lower sensory thresholds for pain, first perception, urge to defecate, and discomfort (p < 0.0001). Upon increasing distension, they rated both painful and non-painful sensations as more intense than normosensitive patients (p < 0.0001). Psychological factors were associated with higher pain ratings during distension in hypersensitive (p < 0.006–0.0001), but not in normosensitive patients. Anxiety, but not depression or somatization, was associated with increased intensity ratings of non-painful sensations (p < 0.001), independent of sensitivity status. Conclusions & Inferences Hypersensitive IBS patients are characterized by increased perception of pain, but also of non-painful sensations. Psychological factors increase the perception of painful sensations in hypersensitive patients only, whereas non-painful visceral sensations were exaggerated in anxious patients regardless of the sensitivity status. Psychological distress is associated with increased rectal pain perception in hypersensitive, but not normosensitive, IBS patients. Anxiety, but not depression or somatization, is associated with augmented perception of non-painful rectal sensations in all IBS patients. Read More » Comparative bactericidal activity of four fluoroquinolones against Pseudomonas aeruginosa isolated from chronic suppurative otitis media Abstract Background The aim of the present study was to evaluate the bactericidal activity of four new fluoroquinolones against current isolates of Pseudomonas aeruginosa from the patients with chronic suppurative otitis media (CSOM). Methods We examined bactericidal activity of four types of fluoroquinolones, garenoxacin (GRNX), levofloxacin (LVFX), ciprofloxacin (CPFX) and sitafloxacin (STFX) against current isolates of P. aeruginosa (50 strains). Results STFX exhibited the most potent activity of both MIC50 and MIC90, followed by CPFX, LVFX, and GRNX. The number of GRNX-resistant strains was significantly greater than those of LVFX, CPFX, and STFX (P < 0.05). Conclusion STFX showed the most potent activity against P. aeruginosa for recent pathogens recovered from CSOM as compared with the others, suggesting that the clinical application of topical STFX would be useful to prevent the emergence of resistant mutants of P. aeruginosa. Read More » Comparison of Perioperative Outcomes between the Supraclavicular Artery Island Flap and Fasciocutaneous Free Flap Objective Outcomes of the supraclavicular artery island flap (SCAIF) have not been extensively studied in comparison with free tissue transfer (FTT) flaps for head and neck reconstruction. We hypothesize that the pedicled SCAIF has decreased operating room time, length of stay, time to wound healing of recipient site, complications, and hospital charges as compared with FTT. Study DesignCase series with chart review. SettingTertiary care teaching hospital. Subjects and MethodsMedical records were reviewed for patients who underwent SCAIF (n = 45) or FTT (n = 28) reconstruction between 2011 and 2013. ResultsTotal operating room time was significantly lower for the SCAIF group vs the FTT group (6.7 vs 8.1 hours, P = .002). Procedural time was 5.7 hours for the SCAIF group, as compared with 7.2 hours for FTT group (P = .0015). Mean area for SCAIF donor site was 63.89 cm2 vs 81.8 cm2 for the radial forearm free flap group (P = .015). There was no significant difference in mean length of stay between SCAIF (8.8 days) and FTT (11 days, P = .12). Mean length of time to wound healing of the recipient site was similar in the SCAIF group vs the FTT group (17.3 vs 22.1 days, P = .071). Ratio of total hospital charges for SCAIF were 32% lower than that of FTT (P = .0001). ConclusionThis is among the first studies to compare SCAIF with FTT in a large cohort analysis. We find decreased operating room times for SCAIF vs FTT, with similar length of stay and wound healing. Other outcomes between SCAIF and FTT were also comparable. Read More » 3D stereophotogrammetry in upper extremity lymphedema: an accurate diagnostic method Upper extremity lymphedema is a problem that is frequently seen after breast cancer treatment. Current diagnostic methods in volume measurement of the upper extremities are cumbersome or time consuming. The purpose of this study was to assess the validity and reliability of 3D stereophotogrammetry for volume measurements in upper extremity lymphedema. Read More » Clinical Results of a Percutaneous Technique for Trigger Digit Release Using a 25-Gauge Hypodermic Needle Combined with Corticosteroid Infiltration Clinical results of a technique of percutaneous needle trigger digit release (PNTDR) using a 25-gauge needle with corticosteroid infiltration are reported. This prospective study assessed 52 digits that underwent PNTDR. Results were compared with control group who had the only administration of steroid injection. Patients underwent PNTDR were divided into diabetic and nondiabetic groups and assessed postoperatively after 1 week, and after 1, 2, 3, and 6 months. The Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire and Visual Analog Scale (VAS) score for pain were completed pre and postoperatively. Read More » Comment RE: Dynamic reconstruction of complex abdominal wall defects with the pedicled innervated vastus lateralis and anterolateral thigh PIVA flap We read with interest the article by Vranckx et al. describing a pedicled, innervated vastus lateralis and anterolateral thigh (PIVA) flap technique for reconstruction of recurrent, previously infected, abdominal wall defects. Abdominal wall reconstruction can be challenging, particularly in patients with a history of multiple infections, stomata or multiple previous surgeries and attempts – with or without mesh and component separation - for hernia repair. The authors acknowledge their patient cohort of 15 is small and mention their lack of a control group for comparison. Read More » Reply: "Composite Orbital Reconstruction Using the Vascularized Segmentalized Osteo-Fascio-Cutaneous Fibula Flap" In the manuscript titled "Composite Orbital Reconstruction Using the Vascularized Segmentalized Osteo-Fascio-Cutaneous Fibula Flap" (1) The authors describe their experience using a free vascularized fibula flap for the reconstruction of the orbit. The authors correctly describe the functional and esthetic concerns in this patient population and correctly identify the surgical technique of the free fibula flap. Read More » Modified 'Mustardé' Suture Technique: Novel way of inserting mattress sutures to create the antihelical fold A variety of techniques have been described since the 19th century to correct prominent ears (1, 2). The two main approaches to otoplasty involve either scoring or suture based techniques (3, 4). The use of mattress sutures to create the antihelical fold in children with soft cartilage was put forward by Mustardé in 1963 (5). We present a simple alteration of this technique where hypodermic needles are used to aid accurate suture placement, to create a smooth, more natural antihelical fold. This method has been used for many years by the senior author (DM). Read More » The efficacy assessment of a self-administered immunotherapy protocol Background We previously reported the safety of a self-administered subcutaneous immunotherapy (SCIT) protocol. Here we report the results of the retrospective efficacy trial of the United Allergy Service (UAS) self-administered SCIT protocol. We hypothesized that by utilizing a slow SCIT buildup phase, designed to attain recommended allergen concentrations on a cumulative basis, efficacious outcomes and clinical relevance would be achieved. Methods We enrolled 60 SCIT patients and 56 control patients. The study contrasted baseline and treatment period combined symptom plus medication scores (CSMS) as the primary outcome measure and rhinoconjunctivitis quality of life questionnaire (RQLQ) scores as the secondary study outcome measure. Changes in pollen counts were also examined with regard to effects on these efficacy parameters. Results The treatment group showed significantly improved CSMS (standardized mean difference [SMD]: −1.57; 95% confidence interval [CI], −1.97 to −1.18; p < 0.001) and RQLQ (SMD: −0.91; 95% CI, −1.23 to −0.59; p < 0.001). These treatment group outcome measures were respectively improved by 33% and 29% compared to baseline and greater than 40% in comparison to the control group (p < 0.0001). Significant results were also shown when examining these outcome measures with regards to either monotherapy or poly-allergen SCIT. Furthermore, a comparison to recent meta-analyses of SCIT studies showed equivalent efficacy and clinical relevance. Assessment of pollen counts during the baseline and treatment periods further corroborated the efficacy of the UAS SCIT protocol. Conclusion These efficacy results, and our previous safety results, show that a carefully designed and implemented self-administered SCIT protocol is efficacious and safe. Read More » Dental Office DIY Cleanup TIP In 2013 I visited with Dr John Viviano in Mississauga ON. I noticed an interesting device hanging on the wall that he used for easy cleanup of acrylic material from working with sleep apnea oral appliances. I was really impressed by the simplicity of the device and I asked Dr Viviano to share with us this interesting tip. SIMPLE TIP FOR A CLEAN WORK AREA The outcome of brainstorming can be truly amazing; even when it's unplanned.  We were standing around in my new office that was being preped for treating Sleep Disordered Breathing and I simply stated, "I hate the acrylic that ends up all over my shirt after Simple low cost acrylic dust vacuum for the dental office adjusting these Sleep appliances". One of the installers suggested, "you should consider a household central vacuum system that can be purchased at any Home Improvement store". The handyman on site followed up with "you could build a shelf at the height of your choosing". Someone else said, "yes, and you could use the toe-kick attachment they use for sweeping into for homes". I followed up with "I know exactly the guy to build the shelf to my specs (the cabinet maker)".  See the end product in the picture; it works great! ……Too bad life issues weren't all so easily resolved. Maybe we don't brainstorm enough… John Viviano DDS has a practice limited to sleep disordered breathing in Mississauga, ON Canada Read More » Epinephrine auto-injector prescriptions to food-allergic patients in primary care in The Netherlands Background: The knowledge of general practitioner(s) (GPs) regarding food allergy and anaphylaxis and practices in the prescription of epinephrine auto-injector(s) (EAIs) among GPs has previously only been studied using questionnaires and hypothetical cases. Therefore, there are currently no data as to whether or not GPs prescribe EAIs to high risk food-allergic patients presenting to primary care practices. The aim of this study was therefore to describe and evaluate practice in EAI prescription by GPs to food-allergic patients in The Netherlands. Methods: Patients aged 12–23 years who consulted their GP for allergic symptoms were identified in a primary care database. Patients were classified as probably or unlikely to be food-allergic. A risk factor assessment was done to identify probably food-allergic patients at high risk for anaphylaxis to assess the need for an EAI. Results: One hundred forty-eight out of 1015 patients consulted their GP for allergic symptoms due to food. Eighty patients were excluded from analysis because of incomplete records. Thirty-four patients were classified as probably food-allergic. Twenty-seven of them were considered high risk patients and candidates for an EAI. Importantly, only 10 of them had actually been prescribed an EAI by their GP. Conclusions: This study shows that high risk food-allergic patients that visit their GPs are often not prescribed an EAI. Thus, previously identified low rates of EAI ownership may be partly due to GPs not prescribing this medication to patients for whom it would be appropriate to do so. These data suggest that there is a need for improvement of the quality of care for high risk food-allergic patients in primary care. Read More » Sleep-disordered breathing following mandibular setback: a systematic review of the literature Abstract Introduction A mandibular setback reduces space in the pharyngeal airway, and it has been suggested that it might induce sleep-disordered breathing. Objectives An evidence-based literature review was conducted to identify the effect of mandibular setback on the respiratory function during sleep. Methods The authors performed a systematic review of pertinent literature published up to 2014. A structured search of literature was performed, with predefined criteria. A survey of the PubMed, ScienceDirect, and Cochrane database was performed. A manual search of oral and maxillofacial surgery-related journals was accomplished. Potentially relevant studies then had their full-text publication reviewed. Results A total of 1,780 publications were evaluated, through which nine papers (seven case series and two case–control studies) were selected for the final review. No evidence of sleep disorder after six months was related in 223 patients. In one study, two patients developed obstructive sleep apnea syndrome after surgery, and in another two studies, seven patients presented an increase of obstructive apneas/hypopneas events and oxygen desaturation index. Most of the patients analyzed were young and thin. Conclusion There was no evidence of postoperative sleep apnea syndrome after a mandibular setback surgery. However, one should always consider a potential reduction of the upper airway space during the treatment plan. Obese patients and those submitted to large amounts of mandibular setbacks present a higher chance to develop obstructive sleep apnea syndrome. Read More » The latissimus dorsi-groin-lymph node compound flap: A comprehensive technique with three features including skin coverage, restoration of motor function, and prevention of upper limb lymphedema Reconstruction of complex upper extremity defects requires a need for multiple tissue components. The supercharged latissimus dorsi (LD)-groin compound flap is an option that can provide a large skin paddle with simultaneous functional muscle transfer. It is necessary to supercharge the flap with the superficial circumflex iliac pedicle to ensure the viability of its groin extension. In this report, we present a case of a supercharged LD-groin flap in combination with vascularized inguinal lymph nodes, which was used for upper limb reconstruction in a young male patient, following excision of high-grade liposarcoma. Resection resulted in a 28 cm × 15 cm skin defect extending from the upper arm to the proximal forearm, also involving the triceps muscle, a segment of the ulnar nerve and the axillary lymph nodes. Restoration of triceps function was achieved with transfer of the innervated LD muscle. Part of the ulnar nerve was resected and repaired with sural nerve grafts. Post-operatively, the flap survived fully with no partial necrosis, and no complications at both the recipient and donor sites. At 1-year follow up, the patient had a well-healed wound with good elbow extension (against resistance), no tumor recurrence, and no signs of lymphedema. We believe this comprehensive approach may represent a valuable technique, for not only the oncological reconstruction of upper extremity, but also for the prevention of lymphedema. © 2015 Wiley Periodicals, Inc. Microsurgery, 2015. Read More » Sleep Apnea Dentistry is a Great Choice Dentists like you make thousands of choices during your career. From dental school days to how you shape your retirement plan, you get to decide how you want to do things.  While these days the new graduate may not have as many career paths as one might have a few decades ago,  the mix of services the involved dentist gets to pick from is ever expanding. Dental Sleep Medicine is the closest thing to practicing medicine any non-oral surgeon dentist will get.  More and more dentists every day are taking up the challenge of helping their patients breathe better during sleep.  Membership in the American Academy of Dental Sleep Medicine has grown by double digits each year, the calendar is crowded with courses in how to make oral appliances, dentists are finding the rewards that come with this area of practice stimulating and whole office teams are being reshaped to learn new skills. So is this right for you?  I'm going to assume that since you have found your way to Sleep Scholar, you are at least interested in this field.  Perhaps you have begun making appliances after some basic education.  Maybe you seek that first opportunity for helping a person live longer.  It's possible you are intimidated by the breadth of knowledge required and want assurance that you know enough to help. Over the years of my practice, I have been the extremely fortunate recipient of hundreds of hours of expert instruction, well-founded advice, and individual coaching by dentists and others I'm happy to have had as mentors along the way. A passion for passing along the wisdom learned  has created chances to meet with other individual dentists, study clubs, dental institutes, regional and national dental meetings to share what I've assimilated. Sleep Scholar is a new venture for me to offer what I've learned, engage with interested parties, and facilitate improvement in the practice of dental sleep medicine.  While I've had years of experience and read more articles than I could count, the fact I am most sure of is that I don't come close to 'knowing everything' and the second point I will always make is that almost everyone knows something I don't, with many people knowing much that I look forward to hearing about.  Still, I've found it quite valuable over the years to gather up a group of interested people and create an environment where we learn from each other.  I can claim some skills in helping folks accept what they do know, share it with others, and in the process gain confidence to put that knowledge to action, gaining wisdom along the way. Perhaps you will find the upcoming essays helpful.  I pledge to stay committed to present clinically oriented information that is based on the ever-growing body of published evidence.  We can't practice medicine without applying what we know to the individual patient sitting with us, so the artistry lies in taking that evidence and distilling it down to choosing an action for one person.  Therein lies the beauty of being a doctor – evidence supports how we choose to apply our skills. Shall we learn together? Read More » The Editor takes a closer look at some of this month's articles Read More » Forthcoming Meetings Read More » What makes children outgrow food allergy? Read More » Accuracy of fine-needle aspiration cytology in the diagnosis of breast cancer a single-center retrospective study from Turkey with cytohistological correlation in 733 cases Background The triple test, i.e., cytology combined with clinical and radiological findings, is the goal for accurate assessment of palpable breast lesions. Because of the limitations of fine-needle aspiration cytology (FNAC), its utility has somewhat decreased nationwide. We have been using a combination of physical examination, radiological modalities, and FNAC for the diagnosis of palpable/nonpalpable breast mass lesions for the last 23 years. Our institutional experience of the last 10 years is presented here, using FNAC of breast lesions along with an analysis of the diagnostic accuracy. Methods 4956 breast aspirates in 4860 cases were collected from the computer database of Haydarpasa Numune Education and Research Hospital in Istanbul, Turkey. Most of the FNACs were performed under ultrasound guidance and FNAC procedures were performed by radiologists and pathologists who used 22 gauge needles. Cytological diagnoses were classified as "unsatisfactory", "benign", "malignant", "atypical/probably benign", "atypical/probably malignant", and "atypical/NOS" (not otherwise specified) and were compared to the histopathological diagnoses obtained from core needle biopsy, lumpectomy or mastectomy to give an assessment of the diagnostic performance of FNAC in 733 aspirates. Results The sensitivity, specificity, accuracy, positive and negative predictive value, false positive, and false negative rates of FNAC were 98.02, 90.58, 95.97, 96.48, 94.54, 2.6, and 1.4%, respectively. Conclusions This study once again shows that FNAC is a reliable method for the initial evaluation and diagnosis of breast masses. In case of any suspicious conditions, FNAC, and core biopsy are considered complementary to one another. Diagn. Cytopathol. 2015. © 2015 Wiley Periodicals, Inc. Read More » Primary CNS plasmablastic lymphoma in an HIV/EBV negative patient: A case report Read More » Afirma GEC and thyroid lesions: An institutional experience Background Thyroid fine-needle aspiration (FNA) is used to assess appropriate management of nodular thyroid lesions safely, but Bethesda category III (atypia of undetermined significance/follicular lesion of undetermined significance) and category IV (follicular neoplasm/suspicious for follicular neoplasm) lesions are problematic. This study aimed to evaluate the Afirma Gene Expression Classifier (GEC) results for lesions in those categories. Methods Medical records of patients with thyroid FNA and GEC results were obtained from archived material. Results were compared to thyroidectomy histologic diagnoses. Results Among 66 patients with FNA results (47 women and 19 men aged 26–89 years [mean, 59.4 years]), surgical reports were available for 38. Afirma GEC results were "nondiagnostic" for 10 of 66 (15.2%), "benign" for 22 (33.3%), and "suspicious" for 34 (51.5%). Surgical diagnosis was available for 38 of 66 patients (57.6%); GEC results for 6 (15.8%) of these were "nondiagnostic," 27 (71.0%) were "suspicious," and 5 (13.2%) were "benign." One of 6 (16.7%) samples with "nondiagnostic" results, 1 of 5 (20%) with "benign" results, and 15 of 27 (55.6%) with "suspicious" results were malignant on histology. Papillary carcinoma was the most common tumor type (15 of 38; 39.5%). Conclusions Afirma GEC results minimize the number of unnecessary operations. Afirma GEC testing may be reserved for FNAs with a category III diagnosis on follow-up cytologic examination. We recommend a conservative approach for "suspicious" Afirma GEC results if Hürthle cells are seen with FNA. Diagn. Cytopathol. 2015. © 2015 Wiley Periodicals, Inc. Read More » Immunoisolation of pancreatic epithelial cells from endoscopic ultrasound-guided fine needle aspirates with magnetic beads for downstream molecular application Background Evaluation of pancreatic mass is routinely performed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). However, molecular analyses of the tumor cells on FNA samples are limited by the significant cellular heterogeneity. The goal of the current study is to evaluate a magnetic immunoconcentration technique in isolating pancreatic epithelial cells from needle aspirates, and to demonstrate that the isolated cells could be utilized for molecular analysis. Methods Pancreatic EUS–FNA specimens were processed and stored at −80°C. Based on the cytopathological diagnosis, 17 adenocarcinoma, 3 lymphoproliferative, and 3 benign cases were retrieved from the collection for further analyses. Epithelial cells were isolated using antihuman epithelial cell specific antibody-bound magnetic beads, and the isolated cellular component was confirmed cytologically. Genomic DNA was extracted, quantitated, and evaluated with methylation-specific PCR for cyclin D2 in 8 adenocarcinoma cases. Results After optimization, malignant epithelial cells were successfully isolated from all adenocarcinoma cases. Normal pancreatic ductal cells were isolated from three benign cases. No cells were retrieved after immunomagnetic isolation in all three lymphoproliferative cases.  DNA yields were 5–2646 ng, with a mean of 357 ng. Methylation-specific PCR for cyclin D2 on the 8 carcinoma cases showed methylated state at the promoter region, demonstrating feasible evaluation of the methylation status. Conclusion The magnetic immunoconcentration of pancreatic EUS–FNA specimen described here is a practical method of isolating pancreatic epithelial cells from needle aspirates. Isolated cells were sufficient for performing subsequent molecular analysis. Diagn. Cytopathol. 2015. © 2015 Wiley Periodicals, Inc. Read More » Crystalloid granuloma with amylase crystalloids in submandibular gland cytology Read More » Clinical and microbiological importance of Leptothrix vaginalis on Pap smear reports Read More » Strong periodic acid-schiff reaction in hypervacuolated blastic plasmacytoid dendritic cell neoplasm Read More » Prenatal Low Dosage Dioxin (TCDD) Exposure Impairs Cochlear Function Resulting in Auditory Neuropathy Publication date: Available online 14 October 2015 Source:Hearing Research Author(s): Theresa M. Safe, Anne E. Luebke 2,3,7,8-tetrachorodibenzo-p-dioxin (TCDD), a ubiquitous and persistent environmental contaminant, is a potent teratogen. Whereas developmental TCDD toxicity is mediated by the aryl hydrocarbon receptor (AhR), the normal function of the AhR is poorly understood. We tested whether dioxin exposure during a critical period of hair cell development disrupts cochlear function in three mouse strains, (C57BL6, BalbC, and CBA) that contain high affinity AhR-b alleles. C57BL/6, BalbC, and CBA dams were exposed to 500 ng/kg TCDD or olive oil (vehicle) on embryonic day 12 by gavage. Cochlear function was analyzed at 1.5 months of age by measuring 1) auditory brainstem response (ABRs) to tone pips from 5.6 to 30 kHz, and 2) distortion-product otoacoustic emissions (DPOAEs) evoked by primaries with f2 at the same frequency values. Cochlear threshold sensitivity following TCDD exposure was significantly elevated in both female and male mice in the C57BL/6 strain, carrying the Ahb-1 allele, but not significantly elevated in the BalbC or CBA strains, carrying the Ahb-2 allele. These ABR threshold deficits in mice carrying the Ahb-1 allele parallels the cleft palate incidence to higher TCDD exposures, suggesting that ABR testing could serve as a sensitive indicator of TCDD toxicity in at-risk children. Moreover, DPOAEs were not affected following TCDD exposure in any of the mouse strains, suggesting that following TCDD exposure mice with the Ahb-1 allele exhibit a mild auditory neuropathy. The causes of many auditory neuropathies are unknown, yet a developmental exposure to dioxin may be a risk factor for this condition. Graphical abstract Read More » Prenatal Low Dosage Dioxin (TCDD) Exposure Impairs Cochlear Function Resulting in Auditory Neuropathy Publication date: Available online 14 October 2015 Source:Hearing Research Author(s): Theresa M. Safe, Anne E. Luebke 2,3,7,8-tetrachorodibenzo-p-dioxin (TCDD), a ubiquitous and persistent environmental contaminant, is a potent teratogen. Whereas developmental TCDD toxicity is mediated by the aryl hydrocarbon receptor (AhR), the normal function of the AhR is poorly understood. We tested whether dioxin exposure during a critical period of hair cell development disrupts cochlear function in three mouse strains, (C57BL6, BalbC, and CBA) that contain high affinity AhR-b alleles. C57BL/6, BalbC, and CBA dams were exposed to 500 ng/kg TCDD or olive oil (vehicle) on embryonic day 12 by gavage. Cochlear function was analyzed at 1.5 months of age by measuring 1) auditory brainstem response (ABRs) to tone pips from 5.6 to 30 kHz, and 2) distortion-product otoacoustic emissions (DPOAEs) evoked by primaries with f2 at the same frequency values. Cochlear threshold sensitivity following TCDD exposure was significantly elevated in both female and male mice in the C57BL/6 strain, carrying the Ahb-1 allele, but not significantly elevated in the BalbC or CBA strains, carrying the Ahb-2 allele. These ABR threshold deficits in mice carrying the Ahb-1 allele parallels the cleft palate incidence to higher TCDD exposures, suggesting that ABR testing could serve as a sensitive indicator of TCDD toxicity in at-risk children. Moreover, DPOAEs were not affected following TCDD exposure in any of the mouse strains, suggesting that following TCDD exposure mice with the Ahb-1 allele exhibit a mild auditory neuropathy. The causes of many auditory neuropathies are unknown, yet a developmental exposure to dioxin may be a risk factor for this condition. Graphical abstract Read More » Tuning to Binaural Cues in Human Auditory Cortex Abstract Interaural level and time differences (ILD and ITD), the primary binaural cues for sound localization in azimuth, are known to modulate the tuned responses of neurons in mammalian auditory cortex (AC). The majority of these neurons respond best to cue values that favor the contralateral ear, such that contralateral bias is evident in the overall population response and thereby expected in population-level functional imaging data. Human neuroimaging studies, however, have not consistently found contralaterally biased binaural response patterns. Here, we used functional magnetic resonance imaging (fMRI) to parametrically measure ILD and ITD tuning in human AC. For ILD, contralateral tuning was observed, using both univariate and multivoxel analyses, in posterior superior temporal gyrus (pSTG) in both hemispheres. Response-ILD functions were U-shaped, revealing responsiveness to both contralateral and—to a lesser degree—ipsilateral ILD values, consistent with rate coding by unequal populations of contralaterally and ipsilaterally tuned neurons. In contrast, for ITD, univariate analyses showed modest contralateral tuning only in left pSTG, characterized by a monotonic response-ITD function. A multivoxel classifier, however, revealed ITD coding in both hemispheres. Although sensitivity to ILD and ITD was distributed in similar AC regions, the differently shaped response functions and different response patterns across hemispheres suggest that basic ILD and ITD processes are not fully integrated in human AC. The results support opponent-channel theories of ILD but not necessarily ITD coding, the latter of which may involve multiple types of representation that differ across hemispheres. Read More » Botulinum toxin treatment of false vocal folds in adductor spasmodic dysphonia: Functional outcomes Objectives/Hypothesis Supraglottic injection of botulinum toxin (Botox) has been described as an effective treatment for adductor spasmodic dysphonia (ADSD). Anecdotal evidence suggests that the patients have little to no breathiness after injection, but no formal longitudinal studies have been carried out to date. The purpose of this study was to examine the voice outcomes in patients with ADSD after supraglottic Botox injection. Study Design Retrospective case series. Methods Patients with ADSD who were treated with supraglottic Botox injections completed a qualitative self-evaluation of voice function after injection using the percentage of normal function (PNF) scale, a validated, quantitative scale from 0% (no function) to 100% (normal function). Posttreatment voice improvement after injection was determined using a Voice Handicap Index-10 (VHI-10) questionnaire. Results A total of 198 supraglottic injections were performed between July 2011 and October 2014. Twenty-five questionnaires were completed. Mean postinjection PNF was 95.0% ± 8.4% and was significantly increased from the preinjection mean PNF (62.5%) ± 22.6% (P < 0.001). The mean best VHI-10 for all injections was 7.23. In 19 of 25 patients (76%), there was no reduction in PNF in the early postinjection period. In the remaining six patients (24%), the decline in mean vocal function was 9.2%. Conclusions Supraglottic Botox injection is an effective treatment for ADSD. Postinjection voice is significantly improved, and the majority of patients do not experience breathy voice/decline in vocal function after injection. Level of Evidence 4. Laryngoscope, 2015 Read More » Sinus irrigations before and after surgery—Visualization through computational fluid dynamics simulations Objectives/Hypothesis Topical sinus irrigations play a critical role in the management of sinonasal disease, and the improvement in irrigant penetration into the sinuses postoperatively greatly contributes to the success of endoscopic sinus surgery. Prior investigations on postoperative sinus irrigations have been mostly limited to cadaver studies, which are labor intensive and do not capture the full dynamics of the flows. A pilot study was conducted to investigate the impact of surgery on sinus irrigation through computational fluid dynamics (CFD) simulations. Study Design Retrospective computational study. Methods Pre- and postoperative computed tomography (CT) scans were obtained on a patient who underwent standard endoscopic surgeries for all sinuses, including a Draf III frontal sinusotomy. CT-based pre- and postoperative CFD models then simulated irrigations of 120 mL saline per nostril at 12 mL/s (typical of Sinugator) and 60 mL/s (SinusRinse Bottle), in two head positions: face parallel and at a 45° angle to the ground. Results Overall, surgery most significantly improved frontal sinus irrigation, but surprisingly resulted in less maxillary and ethmoid sinuses penetration. This may due to the partial removal of the septum during the Draf III, causing most fluid to exit prematurely across the resected septum. Higher flow rate slightly improved ethmoid sinus irrigation, but resulted in less preoperative contralateral maxillary sinus penetration. Conclusions CFD modeling of sinonasal irrigations is a novel technique for evaluating irrigant penetration of individual sinus cavities. It may prove useful in determining the optimal degree of surgery or the ideal irrigation strategy to allow for maximal and targeted sinus irrigant penetration. Level of Evidence NA Laryngoscope, 2015 Read More » Safety and effectiveness of the Vibrant Soundbridge in treating conductive and mixed hearing loss: A systematic review Objectives/Hypothesis For many years, the therapeutic approach for conductive and/or mixed hearing loss has consisted of middle ear surgery with replacement of defect ossicles, and if possible the application of a hearing aid. Advances in technology have led to the introduction of electronmagnetic active implantable devices such as the Vibrant Soundbridge (VSB). With its various coupling techniques for different pathophysiological situations in the middle ear, the VSB offers greater improvement in the hearing performance of affected persons. Data Source PubMed, OvidSP (MEDLINE), EMBASE (DIMDI), the National Institue for Health research (NIHR) Centre for Reviews and Dissemination (including the National Health Service Economic Evaluation Database, Database of Abstracts of Reviews of Effects, and Health Technology Assessment), and the Cochrane Library were searched to identify articles published between January 2006 and April 2014 that evaluated the safety and effectiveness of the VSB in comparison to no intervention, bone conduction hearing implants (BCHI), and middle ear surgery plus hearing aids for adults and children with conductive or mixed hearing loss. Methods Study selection and data extraction was carried out by multiple reviewers. Study quality was assessed using the Oxford Centre for Evidence-Based Medicine levels of evidence (2011); and a checklist available from the Evidence Analysis Library, Academy of Nutrition and Diabetics. Results Thirty-six publications were identified: 19 on VSB outcomes in 294 individuals, 13 on BCHI outcomes in 666 individuals, and four on middle ear surgery plus hearing aid outcomes in 43 individuals. Two systematic reviews were also identified. Heterogeneous outcome measures made it difficult to summarize data. In general, the VSB proved to be safe and effective when compared to no intervention and BCHI, and provided more and consistent hearing gain compared to middle ear surgery plus conventional hearing aids. Conclusion As demonstrated in the literature, the VSB as an active device offers an effective alternative for patients with various middle ear pathologies, particularly with mixed hearing loss and failed previous tympanoplasties when classical ossiculoplasty could not provide enough functional gain. This new strategy in hearing rehabilitation has led to an improved quality of hearing and life. Laryngoscope, 2015 Read More » Surgical management of lateral skull base defects Objectives/Hypothesis We sought to analyze key factors that influence the management of lateral skull base defects and implement an algorithm to improve outcomes of reconstruction. Study Design Retrospective chart review. Setting Single tertiary academic referral center. Methods Adults who underwent temporal bone resection were included. Variables included tumor characteristics, ablative procedure, reconstructive method, and wound complications. Results Seventy-one patients were studied. Lateral temporal bone resection was performed in 55 patients (77%), subtotal temporal bone resection in 14 (20%), and total petrosectomy in two (3%). Primary closure was achieved in 46 patients (35%), with rotational muscle flaps in 21 (46%). The pectoralis major myocutaneous flap (PMMF) was used in nine patients (13%) without major complications. Single-stage free tissue transfer was undertaken in 10 patients (14%) with no flap failures. Primary closure was achieved in 16 of 32 of previously untreated cases (50%) compared to nine of 39 cases of previously treated disease (23%) (P = 0.03). Pedicled or free flaps were used in 18 of 39 cases of previously treated disease (46%) compared to three of 32 previously untreated cases (9%) (P < 0.001). Pedicled or free flaps were used in 13 of 22 cases (59%) in which partial or total auriculectomy was performed, whereas primary closure was achieved in 39 of 49 cases (80%) in which the pinna was preserved (P < 0.001). Conclusion Advanced tumors that require adjuvant therapy, revision cases for recurrent disease, and cases involving auriculectomy warrant free flap or PMMF reconstruction, with the latter preferred in poor free flap candidates. Level of Evidence 4. Laryngoscope, 2015 Read More » Pediatric laryngotracheal reconstruction with tissue-engineered cartilage in a rabbit model Objectives/Hypothesis To develop an effective rabbit model of in vitro- and in vivo-derived tissue-engineered cartilage for laryngotracheal reconstruction (LTR). Study Design 1) Determination of the optimal scaffold 1% hyaluronic acid (HA), 2% HA, and polyglycolic acid (PGA) and in vitro culture time course using a pilot study of 4 by 4-mm in vitro-derived constructs analyzed on a static culture versus zero-gravity bioreactor for 4, 8, and 12 weeks, with determination of compressive modulus and histology as outcome measures. 2) Three-stage survival rabbit experiment utilizing autologous auricular chondrocytes seeded in scaffolds, either 1% HA or PGA. The constructs were cultured for the determined in vitro time period and then cultured in vivo for 12 weeks. Fifteen LTRs were performed using HA cartilage constructs, and one was performed with a PGA construct. All remaining specimens and the final reconstructed larynx underwent mechanical testing, histology, and glycosaminoglycan (GAG) content determination, and then were compared to cricoid control specimens (n = 13) and control LTR using autologous thyroid cartilage (n = 18). Methods 1) One rabbit underwent an auricular punch biopsy, and its chondrocytes were isolated and expanded and then encapsulated in eight 4 by 4-mm discs of 1% HA, 2% HA, PGA either in rotary bioreactor or static culture for 4, 8, and 12 weeks, respectively, with determination of compressive modulus, GAG content, and histology. 2) Sixteen rabbits underwent ear punch biopsy; chondrocytes were isolated and expanded. The cells were seeded in 13 by 5 by 2.25-mm UV photopolymerized 1% HA (w/w) or calcium alginate encapsulated synthetic PGA (13 × 5 × 2 mm); the constructs were then incubated in vitro for 12 weeks (the optimal time period determined above in paragraph 1) on a shaker. One HA and one PGA construct from each animal was tested mechanically and histologically, and the remaining eight (4 HA and 4 PGA) were implanted in the neck. After 12 weeks in vivo, the most optimal-appearing HA construct was used as a graft for LTR in 15 rabbits and PGA in one rabbit. The seven remaining specimens underwent hematoxylin and eosin, Safranin O, GAG content determination, and flexural modulus testing. At 12 weeks postoperative, the animals were euthanized and underwent endoscopy. The larynges underwent mechanical and histological testing. All animals that died underwent postmortem examination, including gross and microhistological analysis of the reconstructed airway. Results Thirteen of the 15 rabbits that underwent LTR with HA in vitro- and in vivo-derived tissue-engineered cartilage constructs survived. The 1% HA specimens had the highest modulus and GAG after 12 weeks in vitro. The HA constructs became well integrated in the airway, supported respiration for the 12 weeks, and were histologically and mechanically similar to autologous cartilage. Conclusions The engineering of in vitro- and in vivo-derived cartilage with HA is a novel approach for laryngotracheal reconstruction. The data suggests that the in vitro- and in vivo-derived tissue-engineered approaches may offer a promising alternative to current strategies used in pediatric airway reconstruction, as well as other head and neck applications. Level of Evidence NA. Laryngoscope, 2015 Read More » Repair of the foramen of Huschke using an extended endaural approach Read More » The prognostic value of electroneurography of Bell's palsy at the orbicularis oculi versus nasolabial fold Objectives/Hypothesis We compared the prognostic value of different placements measured by electroneurography (ENoG) in Bell's palsy, especially among patients with poor results on ENoG. Study Design Retrospective study using electrodiagnostic data and medical chart review from August 2006 to June 2013 was performed of patients who were diagnosed with Bell's palsy. Methods We included 81 patients treated from August 2006 to June 2013. Initial and final facial function was established clinically by the House-Brackmann scale. Final state of facial palsy was estimated after 6 months from onset of facial palsy. Patients with less than 10% of ENoG response (more than 90% degeneration) were divided into three groups according to ENoG response by electrode placement as follows: group A, ENoG for orbicularis oculi (oculi) ≥ 10% and ENoG for nasolabial fold (NLF) < 10%; group B, ENoG (oculi) < 10% and ENoG (NLF) ≥ 10%; and group C, ENoG (oculi) < 10% and ENoG (NLF) < 10%. Results There were no differences in demographic data among the three groups in terms of age, gender, initial paralysis, and days from the onset to ENoG. The complete/nearly complete recovery rates were the following: group A, 49.9%; group B, 75%; group C, 32%. The overall incomplete recovery rate in groups A and C was significantly worse than group B, and group C was the worst (P < 0.05). Conclusion The results suggest that ENoG of the NLF has more prognostic value in the outcomes of Bell's palsy than ENoG of the oculi, with poorest results in patients with the NLF < 10%. Level of Evidence 4. Laryngoscope, 2015 Read More » Endoscope-assisted approach to excision of branchial cleft cysts Objectives/Hypothesis The purpose of this study is to describe an endoscope-assisted surgical technique for the excision of branchial cleft cysts and compare it to the standard approach. Study Design Retrospective case series review. Methods Twenty-seven cases described as branchial cleft excisions performed by a single surgeon at one academic medical center were identified between 2007 and 2014. Twenty-five cases (8 endoscopic, 17 standard approach) were included in the study. Cases were excluded if final pathology was malignant. Patient charts were reviewed, and two techniques were compared through analysis of incision size, operative time, and surgical outcomes. Results This study showed that the length of incision required for the endoscopic approach (mean = 2.13 ± 0.23) was significantly less than that of the standard approach (mean = 4.10 ± 1.46, P = 0.008) despite the fact that there was no significant difference in cyst size between the two groups (P = 0.09). The other variables examined, including operative time and surgical outcomes, were not significantly different between the two groups. Conclusion This transcervical endoscope-assisted approach to branchial cleft cyst excision is a viable option for uncomplicated cases. It provides better cosmetic results than the standard approach and does not negatively affect outcomes, increase operative time, or result in recurrence. Level of Evidence 4. Laryngoscope, 2015 Read More » On the costs and benefits of repeating a nonspatial feature in an exogenous spatial cuing paradigm Abstract Recent research using the Posner cuing paradigm to explore inhibition of return seems to suggest that repetition of a nonspatial feature modulates cue-related facilitatory and inhibitory aftereffects differently in detection and discrimination tasks. Because the cues were unrelated to the final response in the detection task but parallel to (not orthogonal with) the final response in the discrimination task, it is unclear whether the different patterns of results were caused by the complexity of the decision (detection vs. discrimination) or by the task relevance of the feature that might or might not repeat from cue to target. Using a paradigm modeled on previous work, in Experiment 1 (detection task) and 2 (discrimination task) we replicated the previous patterns: No early feature repetition benefit but reduced IOR for feature mismatch trials in the detection task; and large early feature repetition benefit but no effect of feature match upon the later IOR in the discrimination task. In Experiment 3 (discrimination task), we used an "orthogonal-cuing" method: the feature (color) that could repeat or not from cue to target was not on the dimension being discriminated (shape). The pattern of results was very similar to what is observed in detection tasks. These results demonstrate that it is not the task but the task relevance of the repeating feature that modulates facilitation and inhibition effects. The findings are generally consistent with a habituation account of the inhibitory aftereffects of orienting but do not rule out the contribution of other mechanisms. Read More » Fixation Not Required: Characterizing Oculomotor Attention Capture for Looming Stimuli Abstract A stimulus moving toward us, such as a ball being thrown in our direction or a vehicle braking suddenly in front of ours, often represents a stimulus that requires a rapid response. Using a visual search task in which target and distractor items were systematically associated with a looming object, we explored whether this sort of looming motion captures attention, the nature of such capture using eye movement measures (overt/covert), and the extent to which such capture effects are more closely tied to motion onset or the motion itself. We replicated previous findings indicating that looming motion induces response time benefits and costs during visual search Lin, Franconeri, & Enns(Psychological Science 19(7): 686–693, 2008). These differences in response times were independent of fixation, indicating that these capture effects did not necessitate overt attentional shifts to a looming object for search benefits or costs to occur. Interestingly, we found no differences in capture benefits and costs associated with differences in looming motion type. Combined, our results suggest that capture effects associated with looming motion are more likely subserved by covert attentional mechanisms rather than overt mechanisms, and attention capture for looming motion is likely related to motion itself rather than the onset of motion. Read More » The effects of simulated vision impairments on the cone of gaze Abstract Detecting the gaze direction of others is critical for many social interactions. We explored factors that may make the perception of mutual gaze more difficult, including the degradation of the stimulus and simulated vision impairment. To what extent do these factors affect the complex assessment of mutual gaze? Using an interactive virtual head whose eye direction could be manipulated by the subject, we conducted two experiments to assess the effects of simulated vision impairments on mutual gaze. Healthy subjects had to demarcate the center and the edges of the cone of gaze—that is, the range of gaze directions that are accepted for mutual gaze. When vision was impaired by adding a semitransparent white contrast reduction mask to the display (Exp. 1), judgments became more variable and more influenced by the head direction (indicative of a compensation strategy). When refractive blur was added (Exp. 1), the gaze cone shrank from 12.9° (no blur) to 11.3° (3-diopter lens), which cannot be explained by a low-level process but might reflect a tightening of the criterion for mutual gaze as a response to the increased uncertainty. However, the overall effects of the impairments were relatively modest. Elderly subjects (Exp. 2) produced more variability but did not differ qualitatively from the younger subjects. In the face of artificial vision impairments, compensation mechanisms and criterion changes allow us to perform better in mutual gaze perception than would be predicted by a simple extrapolation from the losses in basic visual acuity and contrast sensitivity. Read More » Visual search is influenced by 3D spatial layout Abstract Many activities necessitate the deployment of attention to specific distances and directions in our three-dimensional (3D) environment. However, most research on how attention is deployed is conducted with two dimensional (2D) computer displays, leaving a large gap in our understanding about the deployment of attention in 3D space. We report how each of four parameters of 3D visual space influence visual search: 3D display volume, distance in depth, number of depth planes, and relative target position in depth. Using a search task, we find that visual search performance depends on 3D volume, relative target position in depth, and number of depth planes. Our results demonstrate an asymmetrical preference for targets in the front of a display unique to 3D search and show that arranging items into more depth planes reduces search efficiency. Consistent with research using 2D displays, we found slower response times to find targets in displays with larger 3D volumes compared with smaller 3D volumes. Finally, in contrast to the importance of target depth relative to other distractors, target depth relative to the fixation point did not affect response times or search efficiency. Read More » Gender identification from high-pass filtered vowel segments: The use of high-frequency energy Abstract The purpose of this study was to examine the use of high-frequency information for making gender identity judgments from high-pass filtered vowel segments produced by adult speakers. Specifically, the effect of removing lower-frequency spectral detail (i.e., F3 and below) from vowel segments via high-pass filtering was evaluated. Thirty listeners (ages 18–35) with normal hearing participated in the experiment. A within-subjects design was used to measure gender identification for six 250-ms vowel segments (/æ/, /ɪ /, /ɝ/, /ʌ/, /ɔ/, and /u/), produced by ten male and ten female speakers. The results of this experiment demonstrated that despite the removal of low-frequency spectral detail, the listeners were accurate in identifying speaker gender from the vowel segments, and did so with performance significantly above chance. The removal of low-frequency spectral detail reduced gender identification by approximately 16 % relative to unfiltered vowel segments. Classification results using linear discriminant function analyses followed the perceptual data, using spectral and temporal representations derived from the high-pass filtered segments. Cumulatively, these findings indicate that normal-hearing listeners are able to make accurate perceptual judgments regarding speaker gender from vowel segments with low-frequency spectral detail removed via high-pass filtering. Therefore, it is reasonable to suggest the presence of perceptual cues related to gender identity in the high-frequency region of naturally produced vowel signals. Implications of these findings and possible mechanisms for performing the gender identification task from high-pass filtered stimuli are discussed. Read More » Contralateral delay activity tracks the influence of Gestalt grouping principles on active visual working memory representations Abstract Recent studies have demonstrated that factors influencing perception, such as Gestalt grouping cues, can influence the storage of information in visual working memory (VWM). In some cases, stationary cues, such as stimulus similarity, lead to superior VWM performance. However, the neural correlates underlying these benefits to VWM performance remain unclear. One neural index, the contralateral delay activity (CDA), is an event-related potential that shows increased amplitude according to the number of items held in VWM and asymptotes at an individual's VWM capacity limit. Here, we applied the CDA to determine whether previously reported behavioral benefits supplied by similarity, proximity, and uniform connectedness were reflected as a neural savings such that the CDA amplitude was reduced when these cues were present. We implemented VWM change-detection tasks with arrays including similarity and proximity (Experiment 1); uniform connectedness (Experiments 2a and 2b); and similarity/proximity and uniform connectedness (Experiment 3). The results indicated that when there was a behavioral benefit to VWM, this was echoed by a reduction in CDA amplitude, which suggests more efficient processing. However, not all perceptual grouping cues provided a VWM benefit in the same measure (e.g., accuracy) or of the same magnitude. We also found unexpected interactions between cues. We observed a mixed bag of effects, suggesting that these powerful perceptual grouping benefits are not as predictable in VWM. The current findings indicate that when grouping cues produce behavioral benefits, there is a parallel reduction in the neural resources required to maintain grouped items within VWM. Read More » Selective visual scaling of time-scale processes facilitates broadband learning of isometric force frequency tracking Abstract The experiment investigated the effect of selectively augmenting faster time scales of visual feedback information on the learning and transfer of continuous isometric force tracking tasks to test the generality of the self-organization of 1/f properties of force output. Three experimental groups tracked an irregular target pattern either under a standard fixed gain condition or with selectively enhancement in the visual feedback display of intermediate (4–8 Hz) or high (8–12 Hz) frequency components of the force output. All groups reduced tracking error over practice, with the error lowest in the intermediate scaling condition followed by the high scaling and fixed gain conditions, respectively. Selective visual scaling induced persistent changes across the frequency spectrum, with the strongest effect in the intermediate scaling condition and positive transfer to novel feedback displays. The findings reveal an interdependence of the timescales in the learning and transfer of isometric force output frequency structures consistent with 1/f process models of the time scales of motor output variability. Read More » Mapping the spatiotemporal dynamics of interference between two visual targets Abstract A major thread of visual cognition has been to explore the characteristics of the attention system by presenting two targets and observing how well they can both be reported as a function of their temporal and spatial separation. This method has illuminated effects such as the attentional blink, the attentional dwell time, competitive interference, sparing temporal order errors, and localized attentional interference. However, these different effects are typically explored separately, using quite distinct experimental paradigms. In an effort to consolidate our understanding of these various effects into a more comprehensive theory of attention, we present a new method for measuring spatial gradients of interference at different temporal separations between two targets without creating specific expectations about target location. The observed data support theories that there are multiple sources of interference within the visual system. A theoretical model is proposed that illustrates how three distinct forms of interference could arise through the processes of identifying, attending, and encoding visual targets. Read More » Gait transition dynamics are modulated by concurrent cognitive activity Abstract In tasks with two categorically distinct behavioral possibilities a person beginning with one option will typically switch to the other at a higher value of a control parameter in an ascending (increasing) sequence than in a descending (decreasing) sequence. For example, the switch from walking to running on an accelerating treadmill occurs at a higher speed than the switch from running to walking on a decelerating treadmill. The reported research posed the question of whether this variant of behavioral hysteresis was affected by concurrent cognitive activity. Participants walked or ran on a treadmill with a constant acceleration or deceleration while counting backwards by sevens or ones, or not counting. The degree of hysteresis, the difference between walk-to-run and run-to-walk transition speeds, increased with cognitive difficulty. Specifically, the increased hysteresis was shown to be due to lower run-to-walk transition speeds for the more difficult concurrent cognitive tasks. These results support the hypothesis that cognitive load occupies attentional resources that contribute to triggering human gait transitions. Read More » Capture by colour: Evidence for dimension-specific singleton capture Abstract Previous work on attentional capture has shown the attentional system to be quite flexible in the stimulus properties it can be set to respond to. Several different attentional "modes" have been identified. Feature search mode allows attention to be set for specific features of a target (e.g., red). Singleton detection mode sets attention to respond to any discrepant item ("singleton") in the display. Relational search sets attention for the relative properties of the target in relation to the distractors (e.g., redder, larger). Recently, a new attentional mode was proposed that sets attention to respond to any singleton within a particular feature dimension (e.g., colour; Folk & Anderson, 2010). We tested this proposal against the predictions of previously established attentional modes. In a spatial cueing paradigm, participants searched for a colour target that was randomly either red or green. The nature of the attentional control setting was probed by presenting an irrelevant singleton cue prior to the target display and assessing whether it attracted attention. In all experiments, the cues were red, green, blue, or a white stimulus rapidly rotated (motion cue). The results of three experiments support the existence of a "colour singleton set," finding that all colour cues captured attention strongly, while motion cues captured attention only weakly or not at all. Notably, we also found that capture by motion cues in search for colour targets was moderated by their frequency; rare motion cues captured attention (weakly), while frequent motion cues did not. Read More » Strength of object representation: its key role in object-based attention for determining the competition result between Gestalt and top-down objects Abstract It was found in previous studies that two types of objects (rectangles formed according to the Gestalt principle and Chinese words formed in a top-down fashion) can both induce an object-based effect. The aim of the present study was to investigate how the strength of an object representation affects the result of the competition between these two types of objects based on research carried out by Liu, Wang and Zhou [(2011) Acta Psychologica, 138(3), 397–404]. In Experiment 1, the rectangles were filled with two different colors to increase the strength of Gestalt object representation, and we found that the object effect changed significantly for the different stimulus types. Experiment 2 used Chinese words with various familiarities to manipulate the strength of the top-down object representation. As a result, the object-based effect induced by rectangles was observed only when the Chinese word familiarity was low. These results suggest that the strength of object representation determines the result of competition between different types of objects. Read More » Attentional cartography: mapping the distribution of attention across time and space Abstract Decades of research have shown that the orienting of attention follows a reliable pattern of facilitation and then inhibition following a peripheral cue. However, the literature lacks a high-resolution spatiotemporal map of this pattern. Moreover, the use of visual placeholders to highlight potential stimulus locations is inconsistent. This is puzzling, given attention's well-known predilection for objects. In this article, we remedy these outstanding issues with a large-scale investigation charting the spatiotemporal distribution of attention. Participants detected targets presented at 121 possible locations 100, 200, 400, or 800 ms following an uninformative peripheral cue. The cued locations were presented with or without placeholders. With placeholders, the classic pattern of early facilitation and late inhibition was observed for targets appearing within the placeholders, and the spread of inhibition was severely limited to within the placeholders. Without placeholders, we observed inhibition shortly after cue presentation, upsetting the famously reliable effect of facilitation following a cue. Moreover, inhibition spread from the cued location, unlike when placeholders were present. This investigation has produced an eminently detailed spatiotemporal map of attentional orienting and illustrated the consequences of placeholder stimuli, with surprising results. Read More » The time course of explicit and implicit categorization Abstract Contemporary theory in cognitive neuroscience distinguishes, among the processes and utilities that serve categorization, explicit and implicit systems of category learning that learn, respectively, category rules by active hypothesis testing or adaptive behaviors by association and reinforcement. Little is known about the time course of categorization within these systems. Accordingly, the present experiments contrasted tasks that fostered explicit categorization (because they had a one-dimensional, rule-based solution) or implicit categorization (because they had a two-dimensional, information-integration solution). In Experiment 1, participants learned categories under unspeeded or speeded conditions. In Experiment 2, they applied previously trained category knowledge under unspeeded or speeded conditions. Speeded conditions selectively impaired implicit category learning and implicit mature categorization. These results illuminate the processing dynamics of explicit/implicit categorization. Read More » Simple reaction time to the onset of time-varying sounds Abstract Although auditory simple reaction time (RT) is usually defined as the time elapsing between the onset of a stimulus and a recorded reaction, a sound cannot be specified by a single point in time. Therefore, the present work investigates how the period of time immediately after onset affects RT. By varying the stimulus duration between 10 and 500 msec, this critical duration was determined to fall between 32 and 40 milliseconds for a 1-kHz pure tone at 70 dB SPL. In a second experiment, the role of the buildup was further investigated by varying the rise time and its shape. The increment in RT for extending the rise time by a factor of ten was about 7 to 8 msec. There was no statistically significant difference in RT between a Gaussian and linear rise shape. A third experiment varied the modulation frequency and point of onset of amplitude-modulated tones, producing onsets at different initial levels with differently rapid increase or decrease immediately afterwards. The results of all three experiments results were explained very well by a straightforward extension of the parallel grains model (Miller and Ulrich Cogn. Psychol. 46, 101–151, 2003), a probabilistic race model employing many parallel channels. The extension of the model to time-varying sounds made the activation of such a grain depend on intensity as a function of time rather than a constant level. A second approach by mechanisms known from loudness produced less accurate predictions. Read More » Strategic top-down control versus attentional bias by previous reward history Abstract Rewards modify performance so that attentional priority is given to stimuli associated with a higher probability of reward. A stimulus associated with reward attracts attention even when it is no longer relevant. In this study, we explored whether or not strategic top-down control can be employed to overcome the attentional bias from a recent reward–stimulus association. Four groups of 12 participants completed a spatial-cueing task involving two phases, in which the cue associated with the target location changed from Phase 1 to Phase 2. Attentional-bias effects toward a previously rewarded cue were demonstrated when the rewarded cue from Phase 1 interfered with the orienting toward a nonrewarded but valid cue in Phase 2. Associating the Phase 2 cue with a higher reward than had been used in Phase 1 resulted in a rapid orientation of attention to the new cue. These findings suggest that pathologies characterized by maladaptive attentional biases (e.g., addiction) may be counteracted by treatments that manipulate motivation by enhancing the subjective relevance of rewards that are less harmful. Read More » Modulation of spatial attention by goals, statistical learning, and monetary reward Abstract This study documented the relative strength of task goals, visual statistical learning, and monetary reward in guiding spatial attention. Using a difficult T-among-L search task, we cued spatial attention to one visual quadrant by (i) instructing people to prioritize it (goal-driven attention), (ii) placing the target frequently there (location probability learning), or (iii) associating that quadrant with greater monetary gain (reward-based attention). Results showed that successful goal-driven attention exerted the strongest influence on search RT. Incidental location probability learning yielded a smaller though still robust effect. Incidental reward learning produced negligible guidance for spatial attention. The 95 % confidence intervals of the three effects were largely nonoverlapping. To understand these results, we simulated the role of location repetition priming in probability cuing and reward learning. Repetition priming underestimated the strength of location probability cuing, suggesting that probability cuing involved long-term statistical learning of how to shift attention. Repetition priming provided a reasonable account for the negligible effect of reward on spatial attention. We propose a multiple-systems view of spatial attention that includes task goals, search habit, and priming as primary drivers of top-down attention. Read More » Immunohistochemical expression of alpha-smooth muscle actin and glucocorticoid and calcitonin receptors in central giant-cell lesions Background Central giant-cell lesions (CGCLs) are reactive lesions that consist histologically of spindle-shaped stromal cells, (fibroblasts and myofibroblasts) loosely arranged in a fibrous stroma, multinucleated giant cells and mononuclear cells with haemorrhagic areas. This study identified the immunoexpression of alpha-smooth muscle actin in spindle-shaped stromal cells, and glucocorticoid and calcitonin receptors in multinucleated giant cells and mononuclear cells. Their association with the clinical and radiographic characteristics of these lesions was identified. Methods Thirty-five cases of CGCLs were studied. Expression of alpha-smooth muscle actin, glucocorticoid and calcitonin was evaluated by immunohistochemistry. The labelling index was 100 times the quotient of the number of positive cells divided by the total number of cells of each type. Logistic regression analysis was applied. Results Alpha-smooth muscle actin was positive (54%) for spindle stromal cells (myofibroblasts). A significant association was observed with root resorption (P = 0.004) and cortical bone destruction (P = 0.024). Glucocorticoid immunoexpression was positive for 99% of the giant cells and 86.7% of the mononuclear cells. Glucocorticoid immunoexpression in the mononuclear cells was associated with root resorption (P = 0.031). A longer evolution time was associated with lower immunoexpression of glucocorticoid (OR 12.4: P = 0.047). Calcitonin immunoexpression was positive in 86% of the giant cells. Immunoexpression of calcitonin was associated with age (P = 0.040). Conclusions Myofibroblasts are important components of CGCLs, stromal cells and alpha-smooth muscle. Actin immunoexpression was associated with root and cortical bone resorption. Read More » Archaeology Through Computational Linguistics: Inscription Statistics Predict Excavation Sites of Indus Valley Artifacts Abstract Computational techniques comparing co-occurrences of city names in texts allow the relative longitudes and latitudes of cities to be estimated algorithmically. However, these techniques have not been applied to estimate the provenance of artifacts with unknown origins. Here, we estimate the geographic origin of artifacts from the Indus Valley Civilization, applying methods commonly used in cognitive science to the Indus script. We show that these methods can accurately predict the relative locations of archeological sites on the basis of artifacts of known provenance, and we further apply these techniques to determine the most probable excavation sites of four sealings of unknown provenance. These findings suggest that inscription statistics reflect historical interactions among locations in the Indus Valley region, and they illustrate how computational methods can help localize inscribed archeological artifacts of unknown origin. The success of this method offers opportunities for the cognitive sciences in general and for computational anthropology specifically. Read More » The Role of Radiotherapy in the Treatment of Small-Cell Lung Cancer Opinion Statement The standard therapy for limited disease small cell lung cancer (LD-SCLC) is concurrent chemoradiotherapy and prophylactic cranial irradiation (PCI) for those who achieve complete remission (CR) or good partial response (PR) with initial therapy. On the other hand, the standard therapy for extensive disease (ED-SCLC) is chemotherapy only. After the two phase III study conducted by Slotman et al., PCI with/without thoracic radiotherapy (TRT) is also recommended in the treatment of ED-SCLC. However, a Japanese phase III study failed to confirm the benefit of PCI for patients with ED-SCLC. All studies have demonstrated the effectiveness of PCI for preventing brain metastasis, but PCI seems to have a limited influence on OS. In the 2014 edition of the Guidelines for the Treatment of Lung Cancer from the Japan Lung Cancer Society (JLCS), use of PCI for patients with ED-SCLC has been changed from "recommended" to "not recommended". Appropriate selection of patients for PCI with/without TRT is very important. It is hoped that the characteristics of patients for whom PCI with/without TRT should be considered or avoided will be better defined in the future. Read More » Extra oral cause of restricted mouth opening in the oncology setting Publication date: Available online 13 October 2015 Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): P.S. Satheesh kumar Read More » Restricted mouth opening in chronic graft-versus-host disease Publication date: Available online 14 October 2015 Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): Yehuda Zadik Read More » Massive enlargement of the anterior mandible Publication date: Available online 13 October 2015 Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): Sasha J. Betz, Peter T. Green, Rachel N. Madden, George H. Blakey, Ricardo J. Padilla Read More » A biphasic sessile mass of the buccal mucosa Publication date: Available online 13 October 2015 Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): Tiffany M. Peters, Jose P. Zevallos, Brent A. Golden, Alice E. Curran Read More » Clinicopathological features, microvessel density and immunohistochemical expression of ICAM-1 and VEGF in 15 cases of secondary syphilis with oral manifestations Publication date: Available online 13 October 2015 Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): Fábio Ramôa Pires, Paulo José Souza da Silva, Renan Ferreira Natal, Fábio Abreu Alves, Clovis Antônio Lopes Pinto, Alícia Rumayor, Águida Maria Menezes Aguiar Miranda, Oslei Paes de Almeida Several studies have reported the clinical aspects of oral syphilis, but few papers have considered the involved immunoinflammatory mechanisms. Objective: to analyze the clinicopathological features and expression of immunoinflammatory and vascular proteins in oral secondary syphilis. Study Design: fifteen patients with oral secondary syphilis were included; histological features were analyzed using HE-stained histological slides and immunohistochemical reactions were performed against ICAM-1, VEGF and CD34. Results: lesions presented as multiple plaques and ulcers mostly located on the tongue, lips and palate. They were covered by a stratified epithelium of irregular thickness showing exocytosis associated with a subjacent plasma cell infiltrate arranged in perivascular and perineural patterns. ICAM-1 and VEGF were expressed on endothelial cells and leukocytes and microvessel density was similar on the superficial and deep regions of the connective tissue. Conclusion: expression of immunoinflammatory and vascular proteins was intense, suggesting their participation on the pathogenesis of oral secondary syphilis. Read More » Malignant sublingual gland tumors: demographics, prognostic factors, and treatment outcomes Publication date: Available online 13 October 2015 Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): Robert J. Lee, Elizabeth L. Tong, Riki Patel, Nihal Satyadev, Russell E. Christensen ObjectiveTo determine the demographics, prognostic factors, and optimal treatment modalities of patients diagnosed with malignant primary tumors of the sublingual gland.Materials and MethodsThe Surveillance, Epidemiology, and End Results (SEER) registry contains 210 patients diagnosed with sublingual gland tumors in the SEER database. Kaplan-Meier and multivariate Cox regression analysis were performed on age, sex, race, histologic subtype, stage, and treatment modality.ResultsKaplan-Meier analysis found an overall survival (OS) and disease-specific survival (DSS) at 5 years of 69% and 83% respectively. Multivariate analysis demonstrated that age, sex, stage, and surgery were predictors of OS, while stage was a predictor of DSS.ConclusionsHere we report, to our knowledge, the largest study to date investigating demographics, prognostic factors, and treatment modalities of patients diagnosed with primary malignant tumors of the sublingual gland. Increased age and stage correlated with decreased survival while female gender and surgical therapy correlated with increased survival in the overall population. Radiation therapy for patients diagnosed with adenoid cystic carcinoma in the sublingual gland was correlated with increased survival. Read More » Ameloblastic Carcinoma (Secondary Type) with Extensive Squamous Differentiation Areas and Dedifferentiated Regions Publication date: Available online 13 October 2015 Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): Felipe Paiva Fonseca, Oslei Paes de Almeida, Pablo Agustin Vargas, Fábio Gonçalves Júnior, Flávia Sirotheau Corrêa Pontes, Hélder Antônio Rebelo Pontes Ameloblastic carcinoma is rare, accounting for 1.5 to 2.0% of all odontogenic tumors. Few small series are available, but data upon its clinicopathological characteristics derive mainly from single case reports; therefore, description of new cases may help to better understand the biological characteristics of this rare odontogenic malignancy. In the current report we describe an ameloblastic carcinoma affecting a 27-year-old female patient that had a previous diagnosis of ameloblastoma seven years before. The carcinoma showed extensive areas of squamous differentiation resembling a primary intra-osseous squamous cell carcinoma, as well as areas of dedifferentiation, a poorly documented histological characteristic of ameloblastic carcinoma. This case provides new insights on the microscopic spectrum of ameloblastic carcinoma, permitting a critical discussion of the current WHO classification of this odontogenic tumor. Read More » Reciprocal measurement of acoustic feedback paths in hearing aids A reciprocal measurement procedure to measure the acoustic feedback path in hearing aids is investigated. The advantage of the reciprocal measurement compared to the direct measurement is a significantly reduced sound pressure in the ear. The direct and reciprocal measurements are compared using measurements on a dummy head with adjustable ear canals, different earmolds, and variations in the outer sound field. The results show that the reciprocal measurement procedure can be used to obtain plausible feedback paths, while reducing the sound pressure in the ear canal by 30 to 40 dB. Read More » Optimal design of modal beamformers for circular arrays An approach to optimal design of circular harmonics based modal beamformers for circular arrays is presented. Theoretical analysis shows the equivalence between the element-space and circular-harmonics-domain beamformers. By deriving the expression for the signal and noise covariance matrices, array manifold, and the array response in terms of the circular-harmonics-domain beamforming weights, the weights design problem is formulated as one of minimum variance distortionless response beamforming in the circular harmonics domain. It is found that the well-known phase-mode beamformer for circular arrays can be viewed as an ideal minimum variance distortionless response beamformer against the planarly isotropic noise in the circular harmonics domain. This interesting result is useful for analyzing and evaluating the performance of the phase-mode circular arrays. In this circular-harmonics-domain beamformer, additional constraints can be imposed to improve its robustness and control the sidelobes, which is important in practical applications. The developed approach can include both the delay-and-sum and phase-mode beamformers as special cases, which leads to very flexible designs. Simulation and experimental results show excellent performance of the proposed beamforming approach. Read More » Eigenvector pruning method for high resolution beamforming This paper introduces an eigenvector pruning algorithm for the estimation of the signal-plus-interference eigenspace, required as a preliminary step to subspace beamforming. The proposed method considers large-aperture passive array configurations operating in environments with multiple maneuvering targets in background noise, in which the available data for estimation of sample covariances and eigenvectors are limited. Based on statistical properties of scalar products between deterministic and complex random vectors, this work defines a statistically justified threshold to identify target-related features embedded in the sample eigenvectors, leading to an estimator for the signal-bearing eigenspace. It is shown that data projection into this signal subspace results in sharpening of beamforming outputs corresponding to closely spaced targets and provides better target separation compared to current subspace beamformers. In addition, the proposed threshold gives the user control over the worst-case scenario for the number of false detections by the beamformer. Simulated data are used to quantify the performance of the subspace estimator according to the distance between estimated and true signal subspaces. Beamforming resolution using the proposed method is analyzed with simulated data corresponding to a horizontal line array, as well as experimental data from the Shallow Water Array Performance experiment. Read More » The relationship between speech segment duration and vowel centralization in a group of older speakers This study examined the relationship between average vowel duration and spectral vowel quality across a group of 149 New Zealand English speakers aged 65 to 90 yr. The primary intent was to determine whether participants who had a natural tendency to speak slowly would also produce more spectrally distinct vowel segments. As a secondary aim, this study investigated whether advancing age exhibited a measurable effect on vowel quality and vowel durations within the group. In examining vowel quality, both flexible and static formant extraction points were compared. Two formant measurements, from selected [ɐ:], [ ], and [ ] vowels, were extracted from a standard passage and used to calculate two measurements of vowel space area (VSA) for each speaker. Average vowel duration was calculated from segments across the passage. The study found a statistically significant relationship between speakers' average vowel durations and VSA measurements indicating that, on average, speakers with slower speech rates produced more acoustically distinct speech segments. As expected, increases in average vowel duration were found with advancing age. However, speakers' formant values remained unchanged. It is suggested that the use of a habitually slower speaking rate may assist speakers in maintaining acoustically distinct vowels. Read More » Reciprocal measurement of acoustic feedback paths in hearing aids A reciprocal measurement procedure to measure the acoustic feedback path in hearing aids is investigated. The advantage of the reciprocal measurement compared to the direct measurement is a significantly reduced sound pressure in the ear. The direct and reciprocal measurements are compared using measurements on a dummy head with adjustable ear canals, different earmolds, and variations in the outer sound field. The results show that the reciprocal measurement procedure can be used to obtain plausible feedback paths, while reducing the sound pressure in the ear canal by 30 to 40 dB. Read More » Dosing intervals in intralymphatic immunotherapy Abstract Allergen-specific subcutaneous (SCIT) as well as sublingual (SLIT) immunotherapy both confer long-term protection against the highly prevalent IgE-mediated allergies, such as allergic rhino-conjunctivitis and asthma. Since both SCIT and SLIT are both very laborious and time-consuming treatments, we and others have investigated whether the immunotherapy could be enhanced by so-called intralymphatic immunotherapy (ILIT), which aims at improving treatment efficacy and safety and to reduce treatment duration, thereby making allergen immunotherapy (AIT) more patient friendly. In the original studies made by us (1, 2) and by Cardell et al (3), ILIT was administered three times with four week intervals. In 2013, Witten et al. questioned the efficacy of ILIT with grass pollen, based on the results of a clinical study of their in 38 adult hay-fever patients (4). While promising immunological changes such as increased IgG4 and Treg responses were observed, they concluded that the clinical outcome was at odds with that measured by us in 165 hay fever and 20 cat-dander allergic patients as well as in Cardell's study with 28 hay-fever patients. This article is protected by copyright. All rights reserved. Read More » Efficacy of electrical stimulation and exercise for dysphagia in patients with head and neck cancer: A randomized clinical trial Abstract Background Neuromuscular electrical stimulation (NMES) is a highly sought after but poorly studied treatment for dysphagia among patients with head and neck cancer with dysphagia. This study investigated the efficacy of NMES in this patient population. Methods In this double-blinded, randomized controlled trial, 170 patients with head and neck cancer experiencing posttreatment dysphagia were randomized into active NMES + swallow exercise versus sham NMES + swallow exercise groups. Outcomes after a 12-week program included changes in fluoroscopy measures, diet, and quality of life. Results After the 12-week program, the active NMES group had significantly worse Penetration Aspiration Scale scores than the sham group. Both groups reported significantly better diet and quality of life. No other measures were significant. Conclusion NMES did not add benefit to traditional swallow exercises. Unfortunately, swallow exercises were not effective by themselves either. For patients with head and neck cancer with moderate to severe dysphagia caused by radiation therapy, current behavioral therapies are of limited help in reversing long-term dysphagia. © 2015 Wiley Periodicals, Head Neck, 2015 Read More » Endoscopic Treatment of Bronchial Carcinoids in Comparison to Surgical Resection: A Retrospective Study Background: Surgery is the gold standard of lung carcinoid treatment. However, bronchoscopic treatment may provide a complete cure in selected patients. The aim of the study was to review the results of laser treatment of bronchial carcinoids and to compare the outcome after laser resection against the outcome after surgical resection. Methods: Seventy-three patients, 29 men and 44 women, median age 53 years (range, 23 to 78 y), with bronchial carcinoids were treated by surgical resection (n=48) or endobronchial ablation (n=25). Bronchoscopic treatment was also performed in 5 of 48 surgical patients as a part of the surgical treatment strategy. Results: Among 25 patients treated endoscopically, 16 were successfully treated with laser, whereas 9 were operated subsequently. One major complication was registered, as an inadvertent ventilation caused a nonfatal fire of the bronchoscope during Nd:YAG laser procedure. Forty-eight patients underwent surgical resection. Most of the patients underwent lobectomy and bilobectomy (30 and 5 patients, respectively). Four of the patients were dead by the end of the study, 1 was treated with laser, and 3 treated with surgical resection. The overall survival was 94.5% in the surgical group and 94.4% in the group treated with endoscopic ablation (P=0.9). None of the 69 survivors had any sign of recurrence on computed tomographic scans and bronchoscopy by the end of the study. Conclusions: This is a retrospective study and no randomization has been performed. However, the results add evidence to the view that transbronchial laser treatment may be offered as a safe, stand-alone procedure in the treatment of typical carcinoid tumor in the central airways. Read More » Are stents beneficial in endoscopic choanal atresia repair of newborns and children? Case series of 11 patients Abstract Although commonly used, the use of stents after endonasal, endoscopic choanal atresia and choanal stenosis repair is not clearly defined yet. The aim of the present work was to report about our experience of choanal stent application. Excellent postoperative results can be achieved with both, stent- and non-stent surgical techniques. Choanal stents may be used in newborns in order to avoid immediate postoperative restenosis and subsequent potential live threatening complications. Due to possible stent associated complications, we do not recommend the application of choanal stents in older patients (> 1 year) with mild symptoms. This article is protected by copyright. All rights reserved. Read More » Integrating Language, Pragmatics, and Social Intervention in a Single-Subject Case Study of a Child With a Developmental Social Communication Disorder Purpose This clinical focus article presents an illustration of a complex communication intervention, the Social Communication Intervention Programme (SCIP), as delivered to a child who has a social communication disorder (SCD). The SCIP intervention combined language processing and pragmatic and social understanding therapies in a program of individualized therapy activities and in close liaison with families. Method The study used an enhanced AB single-subject design in which an 8-year-old child with an SCD participated in 20 therapy sessions with a specialist speech-language pathologist. A procedure of matching assessment findings to intervention choices was followed to construct an individualized treatment program. Examples of intervention content and the embedded structure of SCIP are illustrated. Observational and formal measurements of receptive and expressive language, conversation, and parent–teacher ratings of social communication were completed before therapy, after therapy, and at a 6-month follow-up session. Results Outcomes revealed change in total and receptive language scores but not in expressive language. Conversation showed marked improvement in responsiveness, appreciation of listener knowledge, turn taking, and adaptation of discourse style. Teacher-reported outcomes included improved classroom behavior and enhanced literacy skills. Parent-reported outcomes included improved verbal interactions with family members and personal narratives. Conclusions This clinical focus article demonstrates the complexity of needs in a child with an SCD and how these can be addressed in individualized intervention. Findings are discussed in relation to the essential nature of language support including pragmatic therapy for children with SCDs. Discussion of the role of formal and functional outcome measurement as well as the proximity of chosen outcomes to the intervention is included. Read More » Headache as a predictor for dementia: The HUNT Study Background: The impact of headache on dementia is largely unknown. This study examined the association between headache and dementia using data from a large population-based study. Methods: This population-based study used data from the Nord-Trøndelag Health Surveys performed in 1995–1997 (HUNT2) and 2006–2008 (HUNT3). The reference group (controls) was participants aged ≥55 years who answered the headache questions in HUNT2 and later participated in HUNT3 (n = 15,601). The association with headache status in HUNT2 was investigated in sample of confirmed non-demented elderly evaluated with psychometric tests after HUNT3 (n = 96), and HUNT2 participants later diagnosed with dementia during 1997–2011 (n = 746). The association with headache was evaluated by logistical regression with adjustment for age, gender, level of education, comorbidity, smoking, and anxiety and depression. Results: Any headache was more likely to be reported in HUNT2 among those who later were included in the dementia registry (OR 1.24; 95 % CI 1.04–1.49) compared to the reference group, but less likely among the confirmed non-demented individuals (OR 0.62; 95 % CI 0.39–0.98). This relationship was even stronger for non-migrainous headache, whereas such association was not found for migraine. Conclusions: Compared to the reference group, individuals with dementia were more likely to report non-previous migrainous headache in HUNT2, whereas a sample of confirmed non-demented were less likely to report previous non-migrainous headache. Read More » Stability of Word-Retrieval Errors With the AphasiaBank Stimuli Purpose This study examined the test–retest reliability of select measures of word-retrieval errors in narrative discourses of individuals with aphasia assessed with the AphasiaBank stimuli. Method Ten participants with aphasia were video recorded during 2 sessions producing narratives elicited with pictures. Discourses were transcribed and coded using AphasiaBank procedures, then analyzed for the stability of rates of phonological errors, semantic errors, false starts, time fillers, and repetitions per minute. Values for correlation coefficients and the minimal detectable change score were used to assess stability for research and clinical decision making. Results There was poor test–retest reliability when the discourses were analyzed by each narrative subgenre. When the narrative discourses were combined for analysis, several measures appeared to be sufficiently stable across sessions for use in group studies, and 1 could be adequately stable for making clinical decisions about an individual. Conclusions Because the short speech samples yielded by the subgenre narrative analyses demonstrated poor test–retest reliability, it is recommended that all of the picture-based narrative discourse tasks be combined for analysis of word-retrieval impairments when the AphasiaBank stimuli are used. However, the confidence intervals associated with the reliability coefficients obtained in this study suggest caution in using the measures if they are based on performance in a single session. More investigations of the test–retest reliability of measures used to study language impairment in discourse contexts are essential. Read More » Milk Flow Rates From Bottle Nipples Used for Feeding Infants Who Are Hospitalized Purpose This study tested the milk flow rates and variability in flow of currently available nipples used for bottle-feeding infants who are hospitalized. Method Clinicians in 3 countries were surveyed regarding nipples available to them for feeding infants who are hospitalized. Twenty-nine nipple types were identified, and 10 nipples of each type were tested by measuring the amount of infant formula expressed in 1 min using a breast pump. Mean milk flow rate (mL/min) and coefficient of variation were used to compare nipples within brand and within category (i.e., Slow, Standard, Premature). Results Flow rates varied widely between nipples, ranging from 2.10 mL/min for the Enfamil Cross-Cut to 85.34 mL/min for the Dr. Brown's Y-Cut Standard Neck. Variability of flow rates among nipples of the same type ranged from a coefficient of variation of 0.05 for Dr. Brown's Level 1 Standard- and Wide-Neck to 0.42 for the Enfamil Cross-Cut. Mean coefficient of variation by brand ranged from 0.08 for Dr. Brown's to 0.36 for Bionix. Conclusions Milk flow is an easily manipulated variable that may contribute to the degree of physiologic instability experienced by infants who are medically fragile during oral feeding. This study provides clinicians with information to guide appropriate selection of bottle nipples for feeding infants who are hospitalized. Read More » Editorial Read More » Psychological Traits of Female Patients Undergoing Cosmetic Surgery This comparative study of young, female, Chinese patients reports that self-esteem and self-efficacy mediate the negative effects of self-assessment on the decision to undergo facial cosmetic surgery. Read More » The International Advisory Board The JAMA Facial Plastic Surgery mission statement, appearing on the masthead of every issue, reads as follows: Read More » Patterns of Pediatric Mandible Fractures in the United States This database analysis of mandible fractures among children and adolescents reports that patients younger than 12 years and female patients tend to have condyle fractures caused more commonly by falls, while teenaged patients and male patients tend to have angle fractures caused by assault. Read More » 19th annual meeting of the scientific association of swiss radiation oncology (SASRO) Read More » Risk Estimation for Complications After Oral Cavity Cancer The authors of this retrospective case series describe their development and validation of a statistical tool to predict an individual patient's risk of developing a major complication after surgery for oral cavity cancer. Read More » Delayed Complications After Cochlear Implantation This systematic review describes the reported rates and types of delayed complications after cochlear implantation in adults and children. Read More » Elderly Woman With Left-Sided Acute Epistaxis An elderly woman presented with new-onset, left-sided acute epistaxis occurring multiple times per day, and noncontrast paranasal sinus CT showed a 1ovoid soft-tissue mass opacifying the posterior aspect of the left nasal vestibule. What is the diagnosis? Read More » Immediate and Short-Term Therapeutic Results Between Direction-Changing Positional Nystagmus with Short- and Long-Duration Groups. Objectives: Clinicians sometimes treat patients with relatively long-duration geotropic direction-changing positional nystagmus (DCPN), without latency. Recently, the concept of a "light cupula" in the lateral canal that reveals persistent geotropic DCPN has been introduced. In the present study, we investigated the immediate and short-term therapeutic findings in long-duration DCPN. Design: The authors prospectively compared the therapeutic efficacy of a canalith-repositioning procedure (CRP) in short- and long-duration geotropic DCPN. Results: In patients with long-duration DCPN, the authors found no immediate therapeutic effect, and the number of patients showing short-term effects (on the next day) was very low compared with the comparable figure among those with short-duration DCPN. In addition, no cases exhibited canal conversion after the CRP. Conclusion: Our results suggest that CRP is not useful in patients with long-duration geotropic DCPN, and the pathogenesis of long-duration geotropic DCPN may not originate from free-floating debris but from deflection of the cupula. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved. Read More » Immediate and Short-Term Therapeutic Results Between Direction-Changing Positional Nystagmus with Short- and Long-Duration Groups. Objectives: Clinicians sometimes treat patients with relatively long-duration geotropic direction-changing positional nystagmus (DCPN), without latency. Recently, the concept of a "light cupula" in the lateral canal that reveals persistent geotropic DCPN has been introduced. In the present study, we investigated the immediate and short-term therapeutic findings in long-duration DCPN. Design: The authors prospectively compared the therapeutic efficacy of a canalith-repositioning procedure (CRP) in short- and long-duration geotropic DCPN. Results: In patients with long-duration DCPN, the authors found no immediate therapeutic effect, and the number of patients showing short-term effects (on the next day) was very low compared with the comparable figure among those with short-duration DCPN. In addition, no cases exhibited canal conversion after the CRP. Conclusion: Our results suggest that CRP is not useful in patients with long-duration geotropic DCPN, and the pathogenesis of long-duration geotropic DCPN may not originate from free-floating debris but from deflection of the cupula. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved. Read More »