Publication date: December 2016
Source:Research in Developmental Disabilities, Volume 59
Author(s): Inmaculada Baixauli, Carla Colomer, Belén Roselló, Ana Miranda
BackgroundThe aim of this meta-analysis was to analyze the narrative performance of children and adolescents with high-functioning Autism Spectrum Disorders (ASD) in terms of microstructure, macrostructure and internal state language.MethodA systematic literature search yielded 24 studies that met the predetermined inclusion criteria. Effect sizes for each study were calculated for eight variables and analyzed using a random effects model. Intellectual ability, age and type of narrative were considered as potential moderators.ResultsResults revealed that the children with ASD performed significantly worse than their peers on all the variables considered.ConclusionsFindings are discussed taking into account the main explanatory psychological autism theories. Implications for intervention and orientations for future research are suggested.
http://ift.tt/2cQSHro
Σάββατο 17 Σεπτεμβρίου 2016
Narratives of children with high-functioning autism spectrum disorder: A meta-analysis
p16 expression as a prognostic and predictive marker in high-grade localized osteosarcoma of the extremities: an analysis of 357 cases
Publication date: December 2016
Source:Human Pathology, Volume 58
Author(s): Alberto Righi, Marco Gambarotti, Marta Sbaraglia, Andrea Sisto, Stefano Ferrari, Angelo P. Dei Tos, Piero Picci
The potential prognostic and predictive value of p16 in high-grade localized osteosarcoma of the extremities has been recently investigated in small series of cases, and the results from different studies were somewhat controversial. A retrospective immunohistochemical analysis of p16 expression was performed in a series of 357 patients, included in different neoadjuvant chemotherapy protocols from 1986 to 2010, to explore its potential prognostic and predictive value. Immunohistochemistry was performed with a commercially available p16 monoclonal mouse antibody. Follow-up data were available in all cases with a median of 120 months. Positivity for p16 was detected in 70.6% (252/357) of cases. The p16 expression did not differ by age, sex, tumor site, histologic subtype, tumor volume, surgical margin, serum alkaline phosphatase levels, and lactate dehydrogenase levels. In the different chemotherapy protocols included, the incidence of p16 expression was similar. The absence of p16 expression was significantly associated with an adverse disease-free survival (P=.04) and overall survival (P=.05) when compared with the presence of p16 expression. At the multivariate Cox regression analysis, p16 expression lost its prognostic significance. Multivariate logistic regression analysis showed that as p16 expression was the only statistically significant parameter to predict the pathological response to neoadjuvant chemotherapy treatment with an odds ratio of 3.025 (P<.001) for "good" chemotherapy response. Our data indicate that the negative expression of p16 is associated with a reduced rate of good response to primary chemotherapy and to a worse probability of survival, although it was not confirmed as an independent prognostic biomarker after multivariate analysis.
http://ift.tt/2cQSrIO
Adaptation and Compensation of Vestibular Responses Following Superior Canal Dehiscence Surgery
Objective: To describe vestibulo-ocular function and compensatory mechanisms in the immediate postoperative period after superior canal dehiscence surgery. Study Design: Prospective longitudinal study. Setting: Tertiary medical center. Patients: Five patients who underwent plugging of superior semicircular canal via middle cranial fossa approach. Interventions: Bedside quantitative video head impulse testing (vHIT). Main Outcome Measures: Dynamic measures of vestibulo-ocular reflex (VOR) function including VOR gain and compensatory saccades during vHIT. Results: Mean VOR gain of the ipsilateral superior semicircular canal (SC) decreased from 0.71 ± 0.1 preoperatively to 0.28 ± 0.07 on postoperative day (POD) 2–4 (p = 0.0031), consistent with plugging. There was also a significant immediate postoperative decrease of VOR gain for the other ipsilateral canals (posterior canal (PC) from gain 0.91 ± 0.33 down to 0.55 ± 0.14, p = 0.040; horizontal canal (HC) from 0.81 ± 0.08 down to 0.54 ± 0.19, p = 0.038). On PODs 1–2, compensatory saccades after testing the plugged SC occurred exclusively after the head stopped moving (overt) with latency of 186.2 ms ± 19.9 ms. By POD 7 saccade latency decreased to 141.0 ± 17.5 ms (p = 0.032), and saccades were occurring during the vertical head rotation (covert saccades). Follow-up >40 days was consistent with previous findings in that mean SC gain remained low. HC gain recovered fully, but some cases did not have full recovery of PC gain. Conclusion: When the SC is plugged surgically, early quantitative vHIT demonstrates significantly reduced VOR gain for all of the ipsilateral canals. Possible mechanisms include labyrinthine inflammation and loss of perilymph at the time of surgery. Full recovery is typical for the horizontal canal but not always for the PC. Evidence of central compensation occurred by the elicitation of compensatory saccades and by reducing their latencies within the first week after surgery.http://ift.tt/2ce9iTa
What Could Posturography Tell Us About Balance Problems in Parkinson's Disease?
Objective: Impaired balance in patients with Parkinson's disease (PD) leads to loss of balance and frequent falls. Computerized dynamic posturography allows the assessment of stance tasks whereas mobile posturography analyzes the balance in free-field conditions, where falls among PD patients commonly occur (e.g. sitting down or standing up). The aim of the present study is to assess postural stability in PD patients with both techniques. Study Design: Prospective study. Setting: University Hospitals, ambulatory care (outpatient clinic). Patients: Thirty-three patients diagnosed with idiopathic PD. Intervention: Balance assessment. Main Outcome Measures: Dizziness handicap inventory (DHI), activities-specific balance confidence scale (ABC), composite score of sensory organization test (SOT), results of free-field body sway analysis (standard balance deficit test (SBDT)), or geriatric SBDT. Results: PD patients showed a significantly higher sway in the roll direction in almost all of the SBDT conditions. Also, pathological sway compared with normative values was more prominent in complex tasks. There is a significant correlation between the different objective variables of the postural study (SOT and SBDT) and the ABC, but not with the DHI. Finally, the percentage of PD patients with a pathological score in SOT-composite score was 54.5% whereas in SBDT-composite score it was significantly higher (93.9%). Conclusion: Mobile posturography is more accurate in depicting the reality of balance impairment in PD patients than platform posturography. Also, ABC relates better than DHI to the significant psychological consequences of balance impairments. An increased lateral trunk sway seems to be a key factor of postural instability in PD patients.http://ift.tt/2cgaqun
Role of STAT1 and Oxidative Stress in Gentamicin-Induced Hair Cell Death in Organ of Corti
Rationale: Oxidative stress plays a critical role in gentamicin-induced hair cell death. Previous work has implicated the cytoplasmic transcription factor signal transducer and activator of transcription 1 (STAT1) as a potential mediator of drug-induced ototoxicity, but role in aminoglycosides is largely unknown. This study investigated aminoglycosides-induced cell death, exploring contributions of reactive oxygen species and STAT1 pathway in injury and protection. Methods: Neonatal murine organ of Corti explants from 2 to 3 day postnatal pups (n = 96) were treated with gentamicin at (4 μM, 50 μM) for 4 to 72 hours, with/without protectants. Effects on STAT1 pathway and gentamicin-induced hair cell death were measured with 50 μM Epigallocatechin gallate (EGCG, a STAT1 inhibitor) and all-trans retinoic acid (atRA, a STAT1 activator). Hair cell morphology was evaluated and hair cell loss was quantified with cytocochleograms. Mitochondrial membrane potential was assayed and superoxide generation and suppression was measured with dihydroethidium (DHE) staining. Results: Co-administration of 50 μM EGCG conferred protection from 4 μM gentamicin toxicity (p http://ift.tt/2ceacyW
Music-induced Hearing Loss in Children, Adolescents, and Young Adults: A Systematic Review and Meta-analysis
Objective: Exposure to loud music has increased significantly because of the current development of personal music players and mobile phones. The aim of this study was to provide an overview of music-induced hearing loss and its symptoms in children. Data Sources: The search was performed in the databases Embase, Medline (OvidSP), Web-of-science, Scopus, Cinahl, Cochrane, PubMed publisher, and Google Scholar. Only articles written in English were included. Study Selection: Articles describing hearing levels and music exposure in children were used, published from 1990 until April 2015. Data Extraction: The quality of the studies was assessed on reporting, validity, power, and the quality of audiometric testing. Data Synthesis: Data of each publication was extracted into spreadsheet software and analyzed using best evidence synthesis. Conclusion: The prevalence of increased hearing levels (>15 dB HL) was 9.6%, and high-frequency hearing loss was found in 9.3%. The average hearing thresholds were 4.79 dB HL at low frequencies (0.5, 1, and 2 kHz) and 9.54 dB HL at high frequencies (3, 4, and 6 kHz). Most studies reported no significant association between pure-tone air thresholds and exposure to loud music. However, significant changes in hearing thresholds and otoacoustic emissions, and a high tinnitus prevalence suggest an association between music exposure and hearing loss in children.http://ift.tt/2ceahmu
Intracranial Pressure and Promontory Vibration With Soft Tissue Stimulation in Cadaveric Human Whole Heads
Hypothesis: Intracranial pressure and skull vibrations are correlated and depend on the stimulation position and frequency. Background: A hearing sensation can be elicited by vibratory stimulation on the skin covered skull, or by stimulation on soft tissue such as the neck. It is not fully understood whether different stimulation sites induce the skull vibrations responsible for the perception or whether other transmission pathways are dominant. The aim of this study was to assess the correlation between intracranial pressure and skull vibration measured on the promontory for stimulation to different sites on the head. Methods: Measurements were performed on four human cadaver heads. A bone conduction hearing aid was held in place with a 5-Newton steel headband at four locations (mastoid, forehead, eye, and neck). While stimulating in the frequency range of 0.3 to 10 kHz, acceleration of the cochlear promontory was measured with a Laser Doppler Vibrometer, and intracranial pressure at the center of the head with a hydrophone. Results: Promontory acceleration and intracranial pressure was measurable for all stimulation sites. The ratios were comparable between all stimulation sites for frequencies below 2 kHz. Conclusion: These findings indicate that both promontory acceleration and intracranial pressure are involved for stimulation on the sites investigated. The transmission pathway of sound energy is comparable for the four stimulation sites.http://ift.tt/2ceatlt
Outer Hair Cell Molecular Protein, Prestin, as a Serum Biomarker for Hearing Loss: Proof of Concept
Hypothesis: At present there are no serum biomarkers available to monitor cochlear health in those at risk of hearing loss. Outer hair cells (OHCs) play an important role in cochlear function and are one of the cellular elements most vulnerable to damage, such as acoustic trauma. We hypothesized that an OHC-specific protein can serve as a biomarker for OHC damage in circulation. Methods: After assessing auditory function, rats were exposed to intense octave band noise for 2 to 3 hours. Auditory function was assessed 14 days after trauma. Blood samples were collected and prestin concentration was measured using enzyme-linked immunosorbent assay. Results: Circulating prestin was detectable in all control and noise-exposed animals. At 14 days after trauma, however, noise-exposed rats demonstrated statistically significant decrease in prestin concentrations compared with control animals. Conclusion: This work, for the first time, provides proof of concept that an otologic serum biomarker level can change after acoustic trauma and hearing loss. Our approach represents an entirely novel strategy in hearing diagnostics and has both research and clinical potential. Further work is needed to map out the temporal course of change in serum prestin concentrations after inner ear trauma, better define the relationship of serological and functional changes, and explore application to other etiologies of hearing loss (e.g., ototoxins).http://ift.tt/2ceardD
Postoperative Complications and Readmission Rates Following Surgery for Cerebellopontine Angle Schwannomas
Objective: To investigate the 30-day postoperative complication, readmission, and reoperation rates following surgery for cerebellopontine angle (CPA) schwannomas. Study Design: Cross-sectional analysis. Setting: National surgical quality improvement program dataset (NSQIP) 2009 through 2013. Patients: All surgical cases with an International Classification of Diseases, 9th edition, Clinical Modification (ICD-9-CM) diagnosis code of 225.1, benign neoplasms of cranial nerves, and one of the following current procedural terminology (CPT) codes, were included: 61616, 61526, 61530, and 61520. Intervention(s): Surgical resection as indicated by the CPT codes above. Main Outcome Measure(s): Demographics, comorbidities, 30-day postoperative complications, readmission rate, and reoperation rate. Results: Overall, 404 cases were identified, of which 42.6% were men. The average age was 51 years. Comorbidities were present in 45.3%. NSQIP-tracked complications occurred in 9.7% of patients. Most common complications were wound infections including surgical-site infection and wound dehiscence (11 patients, 2.7%), sepsis (10 patients, 2.5%), blood loss (nine patients, 2.2%), and deep vein thrombosis (DVT; seven patients, 1.7%). Mortality occurred in four patients (1.0%). The complication rate was statistically higher in patients with comorbidities versus those without (10.2% versus 4.1%, p = 0.04). Patients with complications were more likely to undergo reoperation (2.5% with versus 4.1% without, p = 0.001). Unplanned readmissions occurred in 41 cases (10.1%) and reoperations occurred in 23 patients (5.7%). Conclusions: Most common NSQIP-tracked complications in excision of CPA neoplasms are infections, sepsis, blood loss, and deep vein thrombosis (DVT). Further, investigation of patients with unplanned readmission and reoperation are warranted. Neurotologists need to take an active role in the data to be gathered in the NSQIP database as it relates to vestibular schwannomas.http://ift.tt/2ce8YUo
Applying Neurotrophins to the Round Window Rescues Auditory Function and Reduces Inner Hair Cell Synaptopathy After Noise-induced Hearing Loss
Hypothesis: Applying neurotrophins to the round window immediately after a single noise exposure will prevent noise-induced hidden hearing loss. Background: Loud noise can eliminate neural connections between inner hair cells and their afferent neurons (thereby diminishing sound perception) without causing a detectable change on audiogram. This phenomenon is termed hidden hearing loss. Methods: Guinea pigs were exposed for 2 hours to 4 to 8 kHz noise at either 95 or 105 dB SPL. Immediately afterward a 4 μl bolus of neurotrophins (brain-derived neurotrophic factor 1 μg/μl, and neurotrophin-3 1 μg/μl) was delivered to the round window of one ear, and saline to the other. Auditory brainstem responses to pure-tone pips were acquired preoperatively, and at 1 and 2 weeks' postexposure. Cochleae were removed and whole mounted for immunohistochemical analysis, with presynaptic ribbons of inner hair cells and associated postsynaptic glutamatergic AMPA receptors identified using CtBP2 and GluA2 antibodies respectively. Results: After exposure to 105 dB noise, threshold did not change, but the amplitude growth of the auditory brainstem response was significantly reduced in control ears in response to 16 and 32 kHz tones. The amplitude growth was also reduced neurotrophin ears, but to a lesser degree and the reduction was not significant. Similar results were obtained from control ears exposed to 95 dB, but amplitude growth recovered in neurotrophin-treated ears, this reaching statistical significance in response to 16 kHz tones. There were significantly more presynaptic ribbons, postsynaptic glutamate receptors, and colocalized ribbons after neurotrophin treatment. Conclusion: A single dose of neurotrophins delivered to the round window reduced synaptopathy and recovered high-frequency hearing in ears exposed to 95 dB noise. These findings suggest that hidden hearing loss may be reduced by providing trophic support to the cochlea after injury.http://ift.tt/2ce99Pu
Hyperostotic En Plaque Meningioma Mimicking Fibrous Dysplasia of the Temporal Bone
No abstract availablehttp://ift.tt/2cea0Qp
The Underlying Mechanism of Preventing Facial Nerve Stimulation by Triphasic Pulse Stimulation in Cochlear Implant Users Assessed With Objective Measure
Hypothesis: Triphasic pulse stimulation prevents from facial nerve stimulation (FNS) because of a different electromyographic input–output function compared with biphasic pulse stimulation. Background: FNS is sometimes observed in cochlear implant users as an unwanted side effect of electrical stimulation of the auditory nerve. The common stimulation applied in current cochlear implant consists of biphasic pulse patterns. Two common clinical remedies to prevent unpleasant FNS caused by activation of certain electrodes are to expand their pulse phase duration or simply deactivate them. Unfortunately, in some patients these methods do not provide sufficient FNS prevention. In these patients triphasic pulse can prevent from FNS. The underlying mechanism is yet unclear. Methods: Electromyographic (EMG) recordings of muscles innervated by the facial nerve (musculi orbicularis ori and oculi) were applied to quantitatively assess the effects on FNS. Triphasic and biphasic fitting maps were compared in four subjects with severe FNS. Based on the recordings, a model is presented which intends to explain the beneficial effects of triphasic pulse application. Results: Triphasic stimulation provided by fitting of an OPUS 2 speech processor device. For three patients, EMG was successfully recorded depending on stimulation level up to uncomfortable and intolerable FNS stimulation as upper boarder. The obtained EMG recordings demonstrated high individual variability. However, a difference between the input–output function for biphasic and triphasic pulse stimulation was visually observable. Compared with standard biphasic stimulation, triphasic pulses require higher stimulation levels to elicit an equal amount of FNS, as reflected by EMG amplitudes. In addition, we assume a steeper slope of the input–output function for biphasic pulse stimulation compared with triphasic pulse stimulation. Conclusion: Triphasic pulse stimulation prevents from FNS because of a smaller gradient of EMG input–output function compared with biphasic pulse stimulation. The underlying mechanism can be modeled by differences in spatiotemporal spread of the electrical field.http://ift.tt/2cea7eU
Long-term Hearing Preservation Outcomes After Cochlear Implantation for Electric-Acoustic Stimulation
Objective: This study reviewed outcomes of hearing preservation (HP) surgery in a cochlear implant patient population, with clinical follow-up results up to 11 years after implantation. Study Design: Retrospective case review. Setting: Tertiary referral university hospital. Patients: Ninety six patients (103 ears) with partial deafness who underwent HP surgery at the University Hospital Frankfurt since 1999 were included. Electrode carriers were Cochlear Slim Straight, MED-EL Standard, Medium, Flex20, and Flex24. Intervention: Cochlear implantation using the HP surgery technique with either the cochleostomy or round window approach. Main Outcome Measures: Pure-tone averages for low frequencies (125 Hz, 250 Hz, 500 Hz, PTAlow) and speech perception scores of the Freiburg monosyllable and number tests in quiet. PTAlow shifts were used to evaluate HP as complete for ≤10 dB, partial between 10 and 30 dB, and minimal for ≥30 dB. Time intervals were: preoperative, postoperative, after 12 months, and long-term (>24 months, mean 51.4 months, range 2–11 years). Impacts of electrode design and surgical approach were analyzed. Results: Postoperatively (n = 103), HP was complete in 32 (31.1%), partial in 49 (47.6%), minimal in 14 (13.6%), and loss of hearing occurred in 8 cases (7.8%). After 12 months (n = 81), HP was complete in 22 (27.2%), partial in 33 (40.7%), minimal in 11 (13.6%), and loss of hearing occurred in 7 additional cases. For long-term outcomes (n = 62) HP was complete in 7 (11.3%), partial in 24 (38.7%), minimal in 9 (14.5%), and loss of hearing occurred in 7 additional cases (total 22/103, 21.4%). Cases with residual hearing who could utilize acoustic amplification (i.e., PTAlow http://ift.tt/2ceadmu
Cochlear Implants in Adults: Effects of Age and Duration of Deafness on Speech Recognition
Objective: Unexplained outcome variability exists among adults with cochlear implants (CIs). Two significant predictors are age and duration of deafness, with older patients and those with longer durations of deafness generally demonstrating poorer speech recognition. However, these factors are often highly correlated. Thus, it is unclear whether poorer outcomes should be attributed primarily to age-related declines or to the experience of auditory deprivation. Our aim was to examine the effects of aging and duration of hearing loss on outcomes for postlingually deaf adults with CIs. Study Design: Retrospective review of adults who received CIs from 1983 to 2014. Setting: Tertiary adult CI program. Patients: Sixty-four adult patients with postlingual hearing loss beginning after age 12 years, full electrode insertion, normal cochlear anatomy, and availability of postoperative outcome measures. Intervention: Cochlear implantation with 12 months or greater of device use. Main Outcome Measures: Postoperative pure-tone averages (0.5, 1, 2, and 3 kHz) and recognition of words in sentences (Hearing in Noise Test and AzBio). Results: Age at postoperative testing had a negative partial correlation with AzBio scores, when controlling for duration of deafness, whereas duration of deafness had a positive partial correlation with AzBio scores, when controlling for age. No other effects were identified. Conclusion: Older age at testing was associated with poorer recognition of words in difficult sentences, suggesting that cognitive aging may negatively impact CI outcomes. Further studies are needed to examine how a long duration of auditory deprivation affects CI outcomes.http://ift.tt/2ceap5v
Calcium Homeostasis During Attack and Remission in Patients With Idiopathic Benign Paroxysmal Positional Vertigo
Objective: To evaluate changes in calcium metabolism in patients with idiopathic benign paroxysmal positional vertigo (BPPV) on initial presentation and at the follow-up visit. Subjects and Methods: The study comprised a total of 31 patients aged greater than 18 years who presented at the otorhinolaryngology outpatient clinic of our hospital, newly diagnosed as idiopathic BPPV based on the history compatible with BPPV and positive provocative maneuver (either Dix-Hallpike or Roll test). The first blood sample was obtained on the day of initial presentation when the patient was found to have active unilateral BPPV. After 6 months, a blood sample was again drawn in accordance with the procedure. Blood samples were analyzed for data on 25-hydroxyvitamin D (25(OH)-D), total calcium, parathormone and ionized calcium on initial presentation, and at the follow-up visit. Results: The patients comprised 20 (64.5%) women and 11 (35.5%) men with a mean age of 49.78 years (range, 23–75 years). During an attack a higher prevalence of decreased serum Vitamin D is less than 20 ng/ml, was determined (93.5% versus 38.7%). There were statistical differences between the Vitamin D values, parathormone, and corrected by pH ionized calcium in both periods (p http://ift.tt/2cea2HX
Cone Beam CT Versus Multislice CT: Radiologic Diagnostic Agreement in the Postoperative Assessment of Cochlear Implantation
Objective: To evaluate the diagnostic concordance between multislice computed tomography (MSCT) and cone beam computed tomography (CBCT) in the early postoperative assessment of patients after cochlear implantation. Study Design: Prospective, randomized, single-center, interventional, pilot study on the diagnostic performance of a medical device. Setting: Tertiary referral center. Patients: Patients aged over 18 years requiring a computed tomographic (CT) scan after cochlear implant surgery. Interventions: Nine patients were implanted with electrode arrays from three different manufacturers, including one bilateral. High-resolution MSCT and CBCT were then performed, and two experienced radiologists blinded to the imaging modality evaluated the randomized images, twice. Main Outcome Measures: Concordance between MSCT and CBCT for assessing the scalar position (tympani or vestibuli) of the electrodes. Secondary outcome measures were also studied: length of the intracochlear electrode array, percentage of implanted cochlea, number of intracochlear electrodes, and radiation doses. Results: There was a good agreement between both CT scanners in determining the scalar position and estimating the number of implanted electrodes and percentage of implanted cochlea. CBCT had a lower radiation exposure. Conclusions: The CBCT appears to be a useful tool for postoperative assessment of cochlear implanted adult patients and is comparable to the conventional scanner in determining the scalar position, with lower radiation exposure.http://ift.tt/2ceayWq
Real Incidence of Vestibular Schwannoma? Estimations From a National Registry
Objective: To identify incidence of vestibular schwannoma (VS) in The Netherlands. Determining incidence of VS poses considerable challenges given the lack of complete epidemiologic data. Study Design: Retrospective patient review. Setting: Tertiary referral center. Patients: Patients with VS in The Netherlands. Data on patients with VS during 2001 to 2012 were obtained from The Netherlands Cancer Registry (NCR). Notification to the NCR is primarily pathology-based, but additional sources are used, including databases from hospital registrations and radiology departments. In addition, VS incidence estimations for the Leiden region were made; since these data are considered most complete, it was anticipated that estimates calculated from this region approximated the true incidence of VS in The Netherlands. Intervention(s): Magnetic resonance imaging (MRI). Main Outcome Measure(s): Incidence of VS. Results: From 2001 to 2012, a total of 3,663 patients of VS were registered. One thousand forty patients (28.4%) were pathologically confirmed, the majority only had a clinical diagnosis (n = 2623, 71.6%). Incidence increased from 10.3 per one million inhabitants (European Standardized Rate, ESR) to 15.5. Considerable variation in incidence rates was observed across regions, ranging from 12.0 to 24.9 per million over the total period. In the Leiden region, incidence was estimated at 25.5 per million during 2005 to 2007, and 33.2 per million during 2009 to 2012. In this region, the ratio of clinical versus histopathological diagnoses rose from 1.4 to 6.7. Conclusions: Completeness of the registration of VS varies across regions in The Netherlands. Incidence estimates obtained from regions with the highest rates are higher than those reported by previous studies.http://ift.tt/2cea2HT
Air-Bone Gaps Contribute to Functional Hearing Preservation in Cochlear Implantation
Objective: To examine the incidence and effect of postoperative air-bone gaps in subjects who received cochlear implants for the purpose of hearing preservation. Study Design: Prospective, multicenter, nonrandomized, repeated measures within subject design. Setting: Ten tertiary care institutions. Patients: Fifty adults participating in a multicenter clinical trial of the Cochlear Nucleus Hybrid implant system. Intervention(s): Cochlear implantation with Hybrid L24 electrode. Audiometric testing including air and bone conductive thresholds and tympanometry preoperatively and at multiple time points postoperatively for 1 year. Main Outcome Measure(s): Average air-bone gaps (ABG) and percentage of patients with ABGs (≥15 dB HL) measured for each time point for 1 year postoperatively at 250, 500, and 1000 Hz. Correlation of tympanograms and ABGs. Results: The mean ABGs at 250, 500, and 1000 Hz increased postoperatively (p 60% of patients at 250 Hz, in >38% at 500 Hz, and in >50% at 1000 Hz in those with residual hearing. No significant relationships were found between abnormal tympanograms and ABG. Conclusion: The incidence of ABGs postoperatively is higher than previously expected and does not correlate to abnormalities on tympanometry. ABGs can adversely affect the fitting of postoperative residual hearing and associated functional benefit. Additionally, intraoperative strategies should be used to potentially reduce ABGs, and bone conduction thresholds should be measured postoperatively.http://ift.tt/2cea4Qa
The Clinical Behavior of Asymptomatic Incidental Vestibular Schwannomas Is Similar to That of Symptomatic Tumors
Background: The clinical behavior of asymptomatic incidentally diagnosed vestibular schwannoma (VS) remains undefined. Specifically, it is unknown whether these tumors represent a more indolent biological variant. Such information would be beneficial toward patient counseling regarding treatment strategy and surveillance intervals during observation. Study Design: Case series with matched cohort. Setting: Single tertiary academic referral center. Patients: All patients with asymptomatic incidentally diagnosed VS who were evaluated between January 2000 and December 2015 were analyzed. Only cases where imaging was obtained for unrelated indications in patients with symmetrical or normal hearing and lack of any attributable symptoms were included. A separate VS reference cohort composed of patients with typical symptomatology, matched according to tumor size, age and sex, was used for comparison. Main Outcome Measures: Growth, symptom progression, treatment. Results: A total of 38 incidental VS were evaluated, representing approximately 1.6% of all VS evaluated during this time. There was a statistically significant increase in the rate of incidental tumor diagnosis over time. Estimated survival free of tumor growth or treatment (95% CI; number still at risk) at 1, 3, and 5 years after diagnosis was 89% (77–100; 22), 74% (57–95; 13), and 54% (35–84; 4), respectively. The median growth rate for the 11 patients with tumor growth was 1.3 mm/year. Time to growth or treatment (p = 0.18), growth rate (p = 0.60), and rate of audiometric decline was not statistically significantly different between incidentally discovered and symptomatic reference groups. Conclusion: The frequency of asymptomatic, incidentally diagnosed VS is rising. These data demonstrate that the clinical behavior of asymptomatic incidental VS is not different than that of age-, sex-, and size-matched symptomatic VS. Thus, if initial observation is undertaken, patients with asymptomatic incidental tumors still require long-term magnetic resonance imaging surveillance performed at regular time intervals.http://ift.tt/2cea96e
Massive Tension Pneumocephalus Following Cochlear Implant Surgery
Objective: To report clinical presentation, management and outcomes of a rare complication of cochlear implant surgery. Patient: A 68-year-old man, affected by profound bilateral deafness because of superficial cerebral hemosiderosis, presented to Authors' Department 8 days after cochlear implant surgery with vomiting, fever, and mental confusion. Brain computed tomographic (CT) scan showed a massive collection of intracranial air from an osteodural defect in the right tegmen mastoideum because of repeated nose blowing in the postoperative period. Intervention: A multilayer reconstruction of the tegmen with obliteration of the mastoid cavity using abdominal subcutaneous adipose tissue was performed, preserving the cochlear implant in place. Main Outcome and Results: Following surgery the patient showed rapid neurological improvement and CT scan performed 2 days later showed complete resolution of the intracranial air collection. He is currently using the cochlear implant with open set performances. Conclusion: Pneumocephalus is a rare complication of cochlear implant surgery. In patients with severe neurological signs following cochlear implantation (CI), pneumocephalus should be suspected. Drilling of mastoid air cells may expose dura mater and positive high pressure events may break meningeal layers and force air into the cranial cavity.http://ift.tt/2ce8Xji
Asthma quality of life and control after sinus surgery in patients with chronic rhinosinusitis
Abstract
Background
Patients with chronic rhinosinusitis (CRS) often have comorbid asthma. Prior studies have not examined the impact of CRS or endoscopic sinus surgery (ESS) upon asthma quality-of-life (QOL) and asthma control using validated outcome metrics.
Methods
Patients with CRS, both with and without polyps, and comorbid asthma completed the Mini-Asthma QOL Questionnaire (miniAQLQ) and Asthma Control Test (ACT) at baseline and 6 months postoperatively as part of a multi-institutional, prospective study.
Results
Baseline metrics were available on 86 patients. Patients undergoing ESS reported improved miniAQLQ (0.5 [SD±1.1], 95%CI: 0.2-0.7; p=0.002) and ACT scores (1.3 [±4.1], 95%CI: 0.2-2.4; p=0.025). Uncontrolled baseline asthma (ACT<20) was present in 51% of patients undergoing ESS. In uncontrolled patients, ESS resulted in a minimal clinically important difference 57% of the time for miniAQLQ scores (>0.5 points) and 50% of the time for ACT scores (>3.0 points). After adjustment with linear regression, baseline miniAQLQ scores were worse in patients with comorbid allergy (p=0.045) and chronic obstructive pulmonary disease (COPD; p=0.015). Adjusted baseline ACT scores were worse in patients with COPD (p=0.004). Covariates associated with changes in miniAQLQ scores after ESS were preoperative corticosteroid dependency (p=0.011) and change in total SNOT-22 score (p=0.010). Covariate associated with significantly less improvement in ACT scores was obstructive sleep apnea (p=0.016).
Conclusions
Patients with CRS often present with uncontrolled asthma, and ESS improves both miniAQLQ and ACT. Approximately half of patients with uncontrolled asthma improve after ESS, yet there are few CRS-specific factors associated with asthma QOL or control or ESS outcomes.
This article is protected by copyright. All rights reserved.
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Allergy testing in children with persistent asthma: Comparison of four diagnostic methods
Abstract
Background
Multiple allergic sensitizations are common in persistent childhood asthma, and thorough assessment of allergy is crucial for optimal care of these children. Microarray testing offers opportunities for improved sIgE characterization, which has been projected to be useful in the management of multi-sensitized patients.
Objective
The aim of this study was to investigate the accuracy and information obtained by two microarray platforms applied on a well-characterized pediatric asthma cohort.
Methods
Seventy-one (71) children were recruited from a nationwide Swedish study on severe childhood asthma. Severe (n = 40) and controlled (n = 31) asthmatics were assessed for allergic sensitization by two microarray systems (Microtest and ISAC) and by two standard diagnostic methods (ImmunoCAP and skin prick test). Data on clinical history, physical examination, spirometry, asthma control test and doctor's diagnosis were collected. Results from the four diagnostic methods were analyzed and compared.
Results
A high prevalence of allergic sensitization was observed in this cohort. The pairwise concordance between two methods was 90-92% independently of methods compared. The sensitivity of the four methods against doctor's diagnosis was 0.77-0.88, and the specificity was 0.97-0.99. Microarray methods provided new information in 47% of the sensitized children in comparison to results obtained by standard diagnostic methods.
Conclusion
The high prevalence of food and respiratory sensitization supports the clinical guideline recommendation that allergies should be evaluated in all children with suspected asthma. The microarray platforms studied here demonstrated acceptable accuracy and provided refined IgE characterization in 47% of the patients compared to standard extract-based methods.
This article is protected by copyright. All rights reserved.
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Work stress and satisfaction in relation to personality profiles in a sample of Dutch anaesthesiologists: A questionnaire survey.
http://ift.tt/2cEiaDV
Incidence and severity of chronic pain after caesarean section: A systematic review with meta-analysis.
http://ift.tt/2cRhRsx
Impact of age on anaesthesiologists' competence: A narrative review.
http://ift.tt/2cRhv5l
Modelling of the optimal bupivacaine dose for spinal anaesthesia in ambulatory surgery based on data from systematic review.
http://ift.tt/2cEj4jH
T cell subpopulations in juvenile idiopathic arthritis and their modifications after biotherapies
Source:Autoimmunity Reviews
Author(s): Laura Maggi, Lorenzo Cosmi, Gabriele Simonini, Francesco Annunziato, Rolando Cimaz
Inflammatory T cells are thought to be central to the pathogenesis of juvenileidiopathicarthritis. In particular, recentevidencehasunderlined the importance of a balance between Th17 and Tregcells. Severalmechanismshave come to light that control thisreciprocalrelationship.Moreover, ithasbeenshownthat in certainconditions Th17 cells can shifttoward a non classic Th1 phenotype. Anti-rheumaticbiologictherapiesmayinterfere with thesemechanisms and re-establish immune tolerance.
http://ift.tt/2cxSpWA
The industrial food additive microbial transglutaminase, mimics the tissue transglutaminase and is immunogenic in celiac disease patients
Source:Autoimmunity Reviews
Author(s): T. Matthias, P. Jeremias, S. Neidhöfer, A. Lerner
Microbial transglutaminase (mTg) is capable of cross-linking numerous molecules. It is a family member of human tissue transglutaminase (tTg), involved in CD. Despite declarations of mTg industrial use safety, direct evidence for immunogenicity of the enzyme is lacking.The serological activity of mTg, tTg, gliadin complexed mTg (mTg neo-epitope) and gliadin complexed tTg (tTg neo-epitope) were studied in: 95 pediatric celiac patients (CD), 99 normal children (NC) 79 normal adults (NA) and 45 children with nonspecific abdominal pain (AP). Sera were tested by ELISAs, detecting IgA, IgG or both IgA and IgG (check): AESKULISA® tTg (tTg), AESKULISA® tTg New Generation (tTg neo-epitope (tTg-neo)), microbial transglutaminase (mTg) and mTg neo-epitope (mTg-neo). Marsh criteria were used for the degree of intestinal injury. Parallel, mTg and tTg neo-epitopes were purified by asymmetric field flow fractionation, confirmed by multi light scattering and SDS-page, and analyzed on the adult CD and controls group by competition ELISAs.No sequence homology but active site similarity were detected on alignment of the 2 Tgs. Comparing pediatric CD patients with the 2 normal groups: mTg-neo IgA, IgG and IgA+IgG antibody activities exceed the comparable mTg ones (p<0.0001). All mTg-neo and tTg-neo levels were higher (p<0.001). tTg IgA and IgG+IgA were higher than mTg IgA and IgA+IgG (p<0.0001). The levels of tTg-neo IgA/IgG were higher than tTg IgA/IgG (p<0.0001). The sequential antibody activities reflecting best the increased intestinal damage were: tTg-neo check>tTg-neo IgA≥mTg-neo IgG>tTg-neo IgG>mTg-neo check > mTg-neo IgA. Taken together, tTg-neo check, tTg-neo IgA and mTg-neo IgG correlated best with intestinal pathology (r2=0.6454, r2=0.6165,r2=0.5633 p<0.0001, p<0.0001, p<0.0001, respectively). Purified mTg-neo IgG and IgA showed an increased immunoreactivity compared to single mTg and gliadin (p<0.001) but similar immunoreactivity to the tTg-neo IgG and IgA ELISA. Using a competition ELISA, the mTg neo-epitopes and tTg neo-epitopes have identical outcomes in CD sera both showing a decrease in optical density of 55±6%, (p<0.0002).mTg is immunogenic in children with CD and by complexing to gliadin its immunogenicity is enhanced. Anti-mTg-neo-epitope IgG antibodies correlate with intestinal damage to a comparable degree as anti-tTg-neo IgA. mTg and tTg display a comparable immunopotent epitope. mTg-neo IgG is a new marker for CD. Further studies are needed to explore the pathogenic potential of anti-mTg antibodies in CD.
http://ift.tt/2cwsKkg
Statin-associated autoimmune myopathy: A distinct new IFL pattern can increase the rate of HMGCR antibody detection by clinical laboratories
Source:Autoimmunity Reviews
Author(s): M Alvarado-Cardenas, A Marin, MA Martínez, L Martínez, I Pinal-Fernandez, M Labrador-Horrillo, E Balada, X Mundet-Tuduri, L Gonzalez-Mera, J Casademont, E Martínez Acebes, PJ Moreno, C Juarez, JM Grau-Junyent, R Pujol-Borrell, A Selva-O'Callaghan
Background and objectiveStatin-associated autoimmune myopathy (SAAM) with anti-HMGCR antibodies has recently been described. Several specific immunoassays are in use to detect HMGCR antibodies. In the course of systematic autoantibody screening we recognized a new distinct IFL staining pattern on rat liver sections that regularly coincided with anti-HMGCR antibodies. In this study we investigated whether this new IFL pattern is specifically associated to statin-associated autoimmune myopathy and corresponds to anti-HMGCR antibodies.Patients and methodsTwenty-three patients positive for anti-HMGCR antibodies (14 diagnosed with SAAM) were investigated for anti-HMGCR antibodies by two ELISA assays and confirmed by immmunoblot. HMGCR associated liver IFL pattern (HALIP) was detected by indirect IFL and the reactivity against HMGCR was confirmed by immunoabsorption using purified human HMGCR antigen. 90 patients with other autoimmune diseases and 45 non-autoimmune statin treated patients were studied as controls.Results21 out of 23 (91%) anti-HMGCR positive patients were HALIP positive. The staining was completely and specifically removed by immunoabsorption with human purified HMGCR. None of the control sera from autoimmune patients or non-autoimmune statin treated subjects was positive for HALIP. Statistical concordance between HALIP and anti-HMGCR antibody specific tests was 98.7%, kappa 0.95.ConclusionsA new and distinct IFL staining pattern (HALIP) is associated to HMGCR associated myopathy. Absorption and concordance studies indicate that the antigen recognized in the liver by HALIP is HMGCR or a closely related protein. Awareness of this new pattern can help to detect HMGCR autoantibodies in statin treated patients tested for autoimmune serology.
http://ift.tt/2cxUoKi
Plant materials for gastrointestinal diseases used in Chawang District, Nakhon Si Thammarat Province, Thailand
Publication date: 24 December 2016
Source:Journal of Ethnopharmacology, Volume 194
Author(s): Oratai Neamsuvan, Thanchanok Phumchareon, Wanisa Bunphan, Wayanan Kaosaeng
Ethnopharmacological relevanceIn Thailand, gastrointestinal diseases have occurred since the past, consequently healers know well how to use herbs for treatment. Currently, some groups of Thai people continue to be interested in treating diseases by herbs. Therefore, the aims of this study were to (1) compile a list of species of medicinal plants and their source, (2) document the diseases treated and their frequency of citation, (3) record the parts used, methods of preparation and route of administration of traditional medicines, and (4) compare the folk knowledge to that in other relevant reports.Materials and methodsTen folk healers were included in the study. Semi-structured interviews were used to compile data, namely plant parts used, preparation, route of administration and properties. The data were analyzed by interpretation and descriptive statistics.ResultsSixty-two species in 28 families were identified. The most used plants (11 species) were grouped in Zingiberaceae. The highest level of relative frequency of citation (RFC) was found in Zingiber officinale Roscoe (1.0). Most plants were applied for treating constipation. Powder was the most common preparation form of folk drug. A total of 174 use lists were recorded, however, more than two thirds were reported as new uses in this study.ConclusionA literature review revealed that the remaining 37 species for pharmacological activities and 42 species for toxicity should be further studied to validate the folk use of these medicinal resource.
Graphical abstract
http://ift.tt/2d1IFaf
Ginsenosides attenuate d-galactose- and AlCl3-inducedspatial memory impairment by restoring the dysfunction of the neurotransmitter systems in the rat model of Alzheimer's disease
Publication date: 24 December 2016
Source:Journal of Ethnopharmacology, Volume 194
Author(s): Yan Zhang, Zifeng Pi, Fengrui Song, Zhiqiang Liu
Ethnopharmacological relevancePanax ginseng C.A.Mey. is a traditional Chinese herbal medicine, which has been used to treat Alzheimer's disease (AD) for thousands of years. Ginsenoside is one of the major compounds found in P. ginseng. This study aimed to explore the attenuation of spatial memory impairment by ginsenosides and its correlation with restoring the dysfunction of the neurotransmitter systems in AD model rats to understand the mechanism underlying the anti-AD effect of P. ginseng.Materials and methodsIn this study, the AD model was established by combining d-galactose (d-gal) with AlCl3 (Al) for 60 days. From day 30, the ginsenosides group was intragastrically administered with ginsenosides for 30 days. The ethology of rats was tested through the Morris water maze test(MWM). Histopathological changes in the hippocampus of rats were observed through hematoxylin and eosin staining. The expressions of amyloid β peptide (Aβ) and phospho-tau (p-tau) in the hippocampus and cortex of rats were detected by immunohistochemistry. A liquid chromatography–mass spectrometry assay was used to measure neurotransmitter concentrations in the hippocampus, cortex, and blood.ResultsGinsenosides could significantly decrease the escape latency time and the average latency time in the place navigation test and increase the times of crossing the platform area, the percentage of residence time, and the distance in the original platform quadrant in the spatial probe test. Ginsenosides could repair the damage of the hippocampus and reduce the expressions of Aβ and p-tau. Ginsenosides could also increase γ-aminobutyric acid, acetylcholine, and dopamine levels and decrease glutamate and aspartic acid levels in the hippocampus and cortex and increase glycine and serotonin levels in the blood.ConclusionsAfter effectively administrated, ginsenosides attenuate d-gal- and Al-induced spatial memory impairment. The possible mechanism of the beneficial effect is restoring the dysfunction of various neurotransmitters.
Graphical abstract
http://ift.tt/2d1Jjo4
The antioxidant transcription factor Nrf2 contributes to the protective effect of mild thermotolerance (40°C) against heat shock-induced apoptosis
Source:Free Radical Biology and Medicine, Volume 99
Author(s): Audrey Glory, Diana A. Averill-Bates
The exposure of cells to low doses of stress induces adaptive survival responses that protect cells against subsequent exposure to toxic stress. The ability of cells to resist subsequent toxic stress following exposure to low dose heat stress at 40°C is known as mild thermotolerance. Mild thermotolerance involves increased expression of heat shock proteins and antioxidants, but the initiating factors in this response are not understood. This study aims to understand the role of the Nrf2 antioxidant pathway in acquisition of mild thermotolerance at 40°C, and secondly, whether the Nrf2 pathway could be involved in the protective effect of thermotolerance against heat-shock (42°C)-induced apoptosis. During cell preconditioning at 40°C, protein expression of the Nrf2 transcription factor increased after 15–60min. In addition, levels of the Nrf2 targets MnSOD, catalase, heme oxygenase-1, glutamate cysteine ligase and Hsp70 increased at 40°C. Levels of these Nrf2 targets were enhanced by Nrf2 activator oltipraz and decreased by shRNA targeting Nrf2. Levels of pro-oxidants increased after 30–60min at 40°C. Pro-oxidant levels were decreased by oltipraz and increased by knockdown of Nrf2. Increased Nrf2 expression and catalase activity at 40°C were inhibited by the antioxidant PEG-catalase and by p53 inhibitor pifithrin-α. These results suggest that mild thermotolerance (40°C) increases cellular pro-oxidant levels, which in turn activate Nrf2 and its target genes. Moreover, Nrf2 contributes to the protective effect of thermotolerance against heat-shock (42°C)-induced apoptosis, because Nrf2 activation by oltipraz enhanced thermotolerance, whereas Nrf2 knockdown partly reversed thermotolerance. Improved knowledge about the different protective mechanisms that mild thermotolerance can activate is crucial for the potential use of this adaptive survival response to treat stress-related diseases.
http://ift.tt/2cwm59T
Sensitive detection and estimation of cell-derived peroxynitrite fluxes using fluorescein-boronate
Source:Free Radical Biology and Medicine
Author(s): Natalia Rios, Lucía Piacenza, Madia Trujillo, Alejandra Martínez, Verónica Demicheli, Carolina Prolo, María Noel Álvarez, Gloria V. López, Rafael Radi
The specific and sensitive detection of peroxynitrite (ONOO‒/ONOOH) in biological systems is a great challenge due to its high reactivity towards several biomolecules. Herein, we validated the advantages of using fluorescein-boronate (Fl-B) as a highly sensitive fluorescent probe for the direct detection of peroxynitrite under biologically-relevant conditions in two different cell models. The synthesis of Fl-B was achieved by a very simply two-step conversion synthetic route with high purity (> 99 %) and overall yield (∼ 42%). Reactivity analysis of Fl-B with relevant biological oxidants including hydrogen peroxide (H2O2), hypochlorous acid (HOCl) and peroxynitrite were performed. The rate constant for the reaction of peroxynitrite with Fl-B was 1.7 x 106 M-1s-1, a million times faster than the rate constant measured for H2O2 (k = 1.7 M-1s-1) and 2,700 faster than HOCl (6.2 x 102 M-1s-1) at 37° C and pH 7.4. The reaction of Fl-B with peroxynitrite was significant even in the presence of physiological concentrations of CO2, a well-known peroxynitrite reactant. Experimental and simulated kinetic analyses confirm that the main oxidation process of Fl-B takes place with peroxynitrite itself via a direct bimolecular reaction and not with peroxynitrite-derived radicals. Fl-B was successfully applied for the detection of endogenously- generated peroxynitrite by endothelial cells and in macrophage-phagocyted parasites. Moreover, the generated data allowed estimating the actual intracellular flux of peroxynitrite. For instance, ionomycin-stimulated endothelial cells generated peroxynitrite at a rate of ∼ 0.1 μM s-1, while immunostimulated macrophages do so in the order of ∼ 1 μM s-1 inside T. cruzi-infected phagosomes. Fl-B revealed not to be toxic in concentrations up to 1 mM for 24 h. Cellular peroxynitrite detection was achieved by conventional laboratory fluorescence-based methods including flow cytometry and epi-fluorescence microscopy. Fl-B was shown to be more sensitive than the coumarin boronate due to a higher molar absorption coefficient and quantum yield. Overall, our results show that Fl-B is a kinetically selective and highly sensitive probe for the direct detection of cell-derived peroxynitrite.
http://ift.tt/2cxNPHM
Lichen Nitidus of the Eyelids.
Lichen nitidus is a rare, idiopathic inflammatory condition that typically presents as small, flat-topped papules on the chest, abdomen, and upper extremities. The lesions are benign and often asymptomatic and self-resolve. The pediatric population is most often affected. The authors report a case of lichen nitidus presenting as isolated bilateral eyelid lesions increasing in number for several years. Eventual excision and antibiotic/steroid ointment prompted regression. (C) 2016 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
http://ift.tt/2ce7FEQ
http://ift.tt/2ce7FEQ
A Novel One-Stage Obstruction-Based Endoscopic Approach to Congenital Nasolacrimal Duct Obstruction.
Purpose: To report 10-year results of a 1-stage, obstruction-based, endoscopic approach in children with congenital nasolacrimal duct obstruction (CNLDO) with and without prior failed probing/intubation. Methods: In a retrospective study, children with primary CNLDO of >6 months old previously failed probing/intubation, acute dacryocystitis or dacryocele at any age, and at least 6 months follow up. Diagnosis was based on history of tearing and dye disappearance test. Excluded were patients with complete puncto-canalicular obstruction and craniofacial anomaly. Type of CNLDO was confirmed using endonasal endoscopic guided probing. An endoscopic probing was performed for membranous, intubation for incomplete complex, and dacryocystorhinostomy for complete complex CNLDO. They were followed at 1 week, 1, 3, and 6 months, and then after. Success was defined as no or occasional tearing related to noxious stimulus at least 6 months after the procedure. Results: There were 226 eyes (200 patients). Mean age was 26.72 months. Previous failed probing/intubation was in 34.1%. Inferior turbinate impaction in 73.5% and septal deviation in 2.7% were noted. Membranous CNLDO was found in 38.9%, incomplete complex in 57.9%, and complete complex in 3.1%. Mean time of tube removal was 11.9 weeks and last follow-up time was 24.3 months. There was no significant effect of any variables on the final success rates (probing: 96.5%, intubation: 95.4%, dacryocystorhinostomy: 100%). Conclusions: One-stage, obstruction-based endoscopic approach to CNLDO resulted in a high success rate for different types of CNLDO (membranous, incomplete complex, and complete complex). No variable significantly affected the success rates. (C) 2016 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
http://ift.tt/2cg4LVn
http://ift.tt/2cg4LVn
Rates of Positive Findings on Positron Emission Tomography and Bone Marrow Biopsy in Patients With Ocular Adnexal Lymphoma.
Purpose: The aim of this study was to determine rates of positive findings on positron emission tomography (PET) and bone marrow biopsy performed during staging workup for ocular adnexal lymphoma (OAL). Methods: A retrospective review of OAL patients was conducted. Demographics, primary versus secondary OAL, histologic subtype, and findings on PET and bone marrow biopsy performed as part of the initial staging workup for OAL were recorded. Results: The study included 119 patients with OAL. There were 85 primary and 34 secondary OALs. The main histologic subtypes of lymphoma were mucosa-associated lymphoid tissue (n = 61), follicular (n = 26), diffuse large B-cell (n = 17), and mantle cell (n = 10). Positive PET findings were seen in 42 of 68 patients (62%) with primary OAL and 19 of 24 (79%) with secondary OAL. Positive PET findings were seen in 24 of 47 patients (51%) with mucosa-associated lymphoid tissue, 13 of 17 (76%) with follicular, 14 of 15 (93%) with diffuse large B-cell, and 9 of 10 (90%) with mantle cell lymphoma. Positive findings on bone marrow biopsy were seen in 7 of 59 patients (12%) with mucosa-associated lymphoid tissue, 4 of 23 (17%) with follicular, 1 of 17 (6%) with diffuse large B-cell, and 2 of 9 (22%) with mantle cell lymphoma. Conclusions: Our findings suggest that a significant proportion of patients with primary and secondary OAL have positive findings on PET and bone marrow biopsy at initial diagnosis, suggesting a reasonable yield for these tests as part of the initial staging workup in patients with a new diagnosis of OAL. (C) 2016 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
http://ift.tt/2ce3sBe
http://ift.tt/2ce3sBe
Interactions between neurokinin B and kisspeptin in mediating estrogen feedback in healthy women
The Journal of Clinical Endocrinology &Metabolism, Early Release.
http://ift.tt/2ckO6hw
Diabetic Ketoacidosis without Diabetes
The Journal of Clinical Endocrinology &Metabolism, Early Release.
http://ift.tt/2cGK54v
Adhesion G-protein coupled receptor G1 (ADGRG1/GPR56) and pancreatic β-cell function
The Journal of Clinical Endocrinology &Metabolism, Early Release.
http://ift.tt/2ckNzwe
Impact of completion axillary lymph node dissection in patients with breast cancer and isolated tumour cells or micrometastases in sentinel nodes
Source:European Journal of Cancer, Volume 67
Author(s): G. Houvenaeghel, J.M. Boher, F. Reyal, M. Cohen, J.R. Garbay, J.M. Classe, R. Rouzier, S. Giard, C. Faure, H. Charitansky, C. Tunon de Lara, E. Daraï, D. Hudry, P. Azuar, P. Gimbergues, R. Villet, P. Sfumato, E. Lambaudie
BackgroundOmission of completion axillary lymph node dissection (ALND) is a standard practice in patients with breast cancer (BC) and negative sentinel nodes (SNs) but has shown insufficient evidence to be recommended in those with SN invasion.MethodsA retrospective analysis of a cohort of patients with BC and micrometastases (Mic) or isolated tumour cells (ITCs) in SN. Factors associated with ALND were identified, and patients with ALND were matched to patients without ALND. Overall survival (OS) and recurrence-free survival (RFS) were estimated in the overall population, in Mic and in ITC cohorts.FindingsAmong 2009 patients analysed, 1390 and 619 had Mic and ITC in SN, respectively. Factors significantly associated with ALND were SN status, histological type, age, number of SN harvested and absence of adjuvant chemotherapy. After a median follow-up of 60.4 months, ALND omission was independently associated with reduced OS (hazard ratio [HR] 2.41, 90 confidence interval [CI] 1.36–4.27, p = 0.0102), but not with increased RFS (HR 1.21, 90 CI 0.74–2.0, p = 0.52) in the overall population. In matched patients, the increased risk of death in case of ALND omission was found only in the Mic cohort (HR 2.88, 90 CI 1.46–5.69), not in the ITC cohort. The risk of recurrence was also significantly increased in the subgroup of matched Mic patients (HR 1.56, 90 CI 0.90–2.73).InterpretationA separate analysis of Mic and ITC groups, matched for the determinants of ALND, suggested that patients with Mic had increased recurrence rates and shorter OS when ALND was not performed. Our results are consistent with those of previous studies for patients with ITC but not for those with Mic. Randomised controlled clinical trials are still warranted to show with a high level of evidence if ALND can be safely omitted in patients with micrometastatic disease in SN.
http://ift.tt/2cEnsRx
Neutrophil-to-lymphocyte ratio as a prognostic marker in locally advanced nasopharyngeal carcinoma: A pooled analysis of two randomised controlled trials
Source:European Journal of Cancer, Volume 67
Author(s): Melvin Lee Kiang Chua, Sze Huey Tan, Grace Kusumawidjaja, Ma Than Than Shwe, Shie Lee Cheah, Kam Weng Fong, Yoke Lim Soong, Joseph Tien Seng Wee, Terence Wee Kiat Tan
PurposeTo assess the prognostic value of neutrophil-to-lymphocyte ratio (NLR) in patients with International Union Against Cancer (UICC)–staged III/IVA,B nasopharyngeal carcinoma (NPC), who were enrolled into two randomised controlled trials of concurrent/adjuvant chemotherapy when added to radiotherapy (SQNP01), and induction chemotherapy when added to chemoradiotherapy (NCC0901).Material and methodsA post hoc analysis of pooled cohorts from SQNP01 (N = 221) and NCC0901 (N = 172) was performed. We employed a threshold of pre-treatment NLR = 3.0 (median) to stratify patients. Survival outcomes were compared using log-rank test. Multivariable Cox regression analyses were performed to assess association between NLR and overall survival (OS), disease-free survival (DFS), distant metastasis–free survival (DMFS), and locoregional recurrence–free survival (LRFS).ResultsHigh NLR (≥3.0) was associated with advanced T-status (p = 0.002), N-status (p = 0.002), overall UICC stage (p = 0.004), and high pre-treatment Epstein–Barr virus DNA titre (p = 0.001). High NLR was not associated with OS (0.94 [0.67–1.32], p = 0.7), DFS (0.98 [0.73–1.33], p = 0.9), DMFS (1.02 [0.66–1.57], p = 0.9), and LRFS (1.37 [0.84–2.22], p = 0.2) on univariable and multivariable analyses, while conventional clinical indices (T-status, N-status, and overall UICC stage) were prognostic of clinical outcomes. High NLR also did not predict for a treatment effect with the experimental arms in both trials.ConclusionOur pooled analyses that were confined to a homogenous patient population of locally advanced NPC do not suggest that NLR adds prognostic value to conventional clinical indices in identifying patients with unfavourable disease.
http://ift.tt/2d5kNhV
Beyond dilation: current concepts in endoscopic airway stenting and reconstruction.
Purpose of review: To discuss current modalities of endoscopic airway management beyond balloon dilation therapy. Recent findings: Advances continue to be made through technology and bioengineering with exciting potential in the pediatric airway. Smaller robots and instrumentation allow increased endoscopic surgical success. Biodegradable stents and bioengineered grafts are on the horizon for use in airway surgery. Dysphonia following airway reconstruction is of increasing recognition with new endoscopic treatments being performed. Supraglottoplasty is further recognized as a treatment for obstructive sleep apnea for laryngomalacia diagnosed on sleep endoscopy. Interarytenoid injection may be beneficial in the normal larynx for aspiration and dysphagia as well as diagnosing and treating type I laryngeal clefts. Summary: Endoscopic airway surgery continues to be a popular and effective method of treating the pediatric airway. Technological advances such as in robotics may have an increasing role in the future of endoscopic airway surgery in children. Bioengineered airway adjuncts including biodegradable airway stents look to be promising in the future treatment of airway stenosis. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2cVWO4b
http://ift.tt/2cVWO4b
Pharyngoesophageal diverticuli: diagnosis, incidence and management.
Purpose of review: Pharyngoesophageal diverticuli such as Zenker's diverticulum are relatively rare diseases that may have a significant impact on a patient's quality of life. Open surgical techniques have historically been the mainstay of treatment for Zenker's diverticuli and remain the preferred approach for many surgeons operating on Killian-Jamieson diverticuli (KJD) and pharyngoceles. However, advances in technology in recent decades have allowed for the development of successful endoscopic surgical techniques for the management of these conditions. Recent findings: Endoscopic management of Zenker's diverticulum with carbon dioxide laser-assisted diverticulotomy or endoscopic stapler-assisted diverticulostomy has gained wide acceptance in recent years. This is based on studies showing high rates of successful outcomes, low rates of complications and shorter operative time with an associated impact on overall cost and patient recovery. Endoscopic management of KJD and pharyngoceles has recently been described, but remains controversial with many surgeons preferring open surgical approaches for the ability to identify and protect the recurrent laryngeal nerve. Summary: Open and endoscopic techniques are accepted for the treatment of Zenker's diverticulum with open approaches remaining the traditional technique for management of non-Zenker's diverticulum. Further investigation of endoscopic approaches for management of KJD is necessary to assess safety and efficacy. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2cNeQsh
http://ift.tt/2cNeQsh
Associations between childhood height and morphologically different variants of melanoma in adulthood
Source:European Journal of Cancer, Volume 67
Author(s): Kathrine Damm Meyle, Michael Gamborg, Lisbet Rosenkrantz Hölmich, Jennifer Lyn Baker
Aim of the studyMelanoma subtypes have different aetiological characteristics. Child height is positively associated with adult melanoma; however, a clarification of associations with specific melanoma variants is necessary for an improved understanding of risk factors underlying the histologic entities. This study investigated associations between childhood height and future development of cutaneous melanoma variants.MethodA cohort study of 316,193 individuals from the Copenhagen School Health Records Register, with measured heights at ages 7–13 years who were born from 1930 to 1989. Melanoma cases were identified via linkage to the national Danish Cancer Registry and subdivided into subtypes. Cox proportional hazards regressions were performed.ResultsA total of 2223 cases of melanoma distributed as 60% superficial spreading melanoma (SSM), 27.5% melanoma not otherwise specified (NOS), 8.5% nodular melanoma (NM), and 2% lentigo maligna melanoma (LMM). The remaining rare melanoma forms were not analysed. Childhood height was positively and significantly associated with SSM, melanoma NOS, and NM, but not LMM, in adulthood. Per height z-score at age 13 years, the hazard ratios were 1.20 (95% confidence intervals [CI]: 1.13–1.27) for SSM, 1.19 (95% CI: 1.09–1.29) for melanoma NOS, and 1.21 (95% CI: 1.04–1.41) for NM. Further, growth patterns were linked to the melanoma variants with persistently tall children having an increased risk of developing SSM, melanoma NOS, or NM.ConclusionChildhood height is positively associated with the majority of the melanoma variants. These results suggest that the underlying processes contributing to childhood height and growth patterns interconnect early-life events with the predisposition to melanomagenesis in adulthood.
http://ift.tt/2d5nQX6
Pediatric sialendoscopy indications and outcomes.
Purpose of review: Chronic sialadenitis can affect patients of all age ranges and typically presents as recurrent or chronic painful swelling of the salivary glands. In children, the most common cause of sialadenitis is juvenile recurrent parotitis. Salivary stones, or sialolithiasis, are a much less common cause. Historically, for patients with chronic sialadenitis who failed conservative management, salivary gland removal was the standard treatment option. Recently, however, sialendoscopy has emerged as an effective gland-preserving procedure for sialadenitis evaluation and treatment in adults and children. The aim of this review is to discuss pediatric sialadenitis evaluation and treatment, including sialendoscopy indications, technique, and outcomes. Recent findings: Sialendoscopy is a well tolerated and effective treatment for sialadenitis Sialendoscopy and salivary duct irrigation have been shown to improve frequency and severity of sialadenitis episodes in patients with juvenile recurrent parotitis. Salivary stones are managed successfully with endoscopic and combined endoscopic-assisted open approaches. Minimally invasive approaches with sialendoscopy have improved the ability to preserve salivary glands in patients with recurrent sialadenitis. Summary: Sialendoscopy is a well tolerated and effective procedure for recurrent sialadenitis in children. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2cVVY7E
http://ift.tt/2cVVY7E
A review of postsurgical dysphagia in nonmalignant disease.
Purpose of review: This article reviews current literature regarding postsurgical dysphagia in nonmalignant disease examining the current recommendations, risk factors, and potential implications. Recent findings: Surgical interventions including anterior cervical spine surgery, thyroidectomy, laryngeal and pulmonary, cardiac, esophageal and fundoplication, gastric and bariatric, and posterior fossa surgeries are known to result in swallowing dysfunction. Postsurgical dysphagia may increase the length of hospitalization, overall cost, risk of pneumonia, and time to oral intake. There are limited prospective research studies examining postsurgical dysphagia and poorly understood causes. The results are unclear regarding severity, symptom type, duration, and treatment outcomes of postsurgical dysphagia. Summary: The life-changing and life-threatening nature of dysphagia make this an important factor to consider and discuss with patients and families. Both acute and late-onset dysphagia may become chronic if left untreated. Presurgery and postsurgery swallow studies should be considered for cervical spine, thyroid, lung, gastric, cardiac, and surgeries involving the cranial nerves. Future research should examine postsurgical dysphagia in a prospective manner using established and reliable methods of measurement to parse out causal factors and more accurate prevalence rates for each surgical intervention and population. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2cNeHVH
http://ift.tt/2cNeHVH
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