Cortical processing of speech in individuals with auditory neuropathy spectrum disorder

Abstract

Objective

Auditory neuropathy spectrum disorder (ANSD) is a condition where cochlear amplification function (involving outer hair cells) is normal but neural conduction in the auditory pathway is disordered. This study was done to investigate the cortical representation of speech in individuals with ANSD and to compare it with the individuals with normal hearing.

Design

Forty-five participants including 21 individuals with ANSD and 24 individuals with normal hearing were considered for the study. Individuals with ANSD had hearing thresholds ranging from normal hearing to moderate hearing loss. Auditory cortical evoked potentials—through odd ball paradigm—were recorded using 64 electrodes placed on the scalp for /ba/-/da/ stimulus. Onset cortical responses were also recorded in repetitive paradigm using /da/ stimuli. Sensitivity and reaction time required to identify the oddball stimuli were also obtained.

Result

Behavioural results indicated that individuals in ANSD group had significantly lower sensitivity and longer reaction times compared to individuals with normal hearing sensitivity. Reliable P300 could be elicited in both the groups. However, a significant difference in scalp topographies was observed between the two groups in both repetitive and oddball paradigms. Source localization using local auto regressive analyses revealed that activations were more diffuses in individuals with ANSD when compared to individuals with normal hearing sensitivity.

Conclusion

Results indicated that the brain networks and regions activated in individuals with ANSD during detection and discrimination of speech sounds are different from normal hearing individuals. In general, normal hearing individuals showed more focused activations while in individuals with ANSD activations were diffused.

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Vaccine options for influenza: thinking small

Bert Schepens | Dorien De Vlieger | Xavier Saelens

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Ion channelopathies of the immune system

Martin Vaeth | Stefan Feske

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Modulation of innate and adaptive immunity by P2X ion channels

Francesco Di Virgilio | Alba Clara Sarti | Fabio Grassi

https://ift.tt/2H7cwex

Three-dimensional evaluation of mandibular asymmetry: a new classification and three-dimensional cephalometric analysis

Publication date: Available online 8 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M.Y. Leung, Y.Y. Leung
Mandibular asymmetry is common among orthognathic patients and exhibits great variation. The aim of this study was to propose a new classification of mandibular asymmetry by anatomical regions; namely R (ramus), B (mandibular body) and C (chin), in conjunction with a corresponding 'RBC' three-dimensional (3D) cephalometric analysis. The cone beam computed tomography data of 65 patients with mandibular asymmetry was retrieved to perform the RBC 3D cephalometric analysis and to investigate the characteristics of mandibular asymmetry. It was found that the more posteriorly in mandible, the more pronounced was the vertical asymmetry. Significant transverse asymmetry was only noted in mandibular body. Both mandibular body and chin were significantly asymmetric in length. Seven significant morphologic predictors of menton deviation were identified, namely lower dental midline shift, difference in ramus height, difference in chin length, difference in body length, body height on contralateral side, coronoid height on deviated side and body width on contralateral side, confirming the complex nature of mandibular asymmetry. This simple and concise classification allows comprehensive assessment of mandible morphology by anatomical regions which also facilitates diagnosis, treatment planning and communication in both clinical and research settings.



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A novel digital workflow to manufacture personalized three-dimensional-printed hollow surgical obturators after maxillectomy

Publication date: Available online 7 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J. Kortes, H. Dehnad, A.N.T. Kotte, W.M.M. Fennis, A.J.W.P. Rosenberg
Partial or complete resection of the maxilla during tumour surgery causes oronasal defects, leading to oral-maxillofacial dysfunction, for which the surgical obturator (SO) is an important treatment option. Traditional manufacturing of SOs is complex, time-consuming, and often results in inadequate fit and function. This technical note describes a novel digital workflow to design and manufacture a three-dimensional (3D)-printed hollow SO. Registered computed tomography and magnetic resonance imaging images are used for gross tumour delineation. The produced RTStruct set is exported as a stereolitography (STL) file and merged with a 3D model of the dental status. Based on these merged files, a personalized and hollow digital SO design is created, and 3D printed. Due to the proper fit of the prefabricated SO, a soft silicone lining material can be used during surgery to adapt the prosthesis to the oronasal defect, instead of putty materials that are not suitable for this purpose. An STL file of this final SO is created during surgery, based on a scan of the relined SO. The digital workflow results in a SO weight reduction, an increased fit, an up-to-date digital SO copy, and overall easier clinical handling.



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DOES fixation METHOD EFFECTS temporomandibular joints after mandibular advancement?

Publication date: Available online 7 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Erdogan Utku Ureturk, Aysegul Apaydin
PurposeSagittal split ramus osteotomy (SSRO) is a standard procedure in which miniplates and screws are used to achieve stabilization. Although the titanium plate and screw fixation system is stable, resorbable fixation systems are also used. There is currently no consensus on the ideal fixation technique for SSRO procedures and its effect on the condyle. We aimed to evaluate the stress distribution on temporomandibular joints (TMJ).MethodsA 3D finite element model of a hemimandible was designed and 5 mm advancement was simulated on a computer model. Four different fixation techniques were applied: inverted-L shaped bicortical screws, L-shaped bicortical screws, miniplate with monocortical screws, and miniplate with monocortical screws and bicortical screw. Computer models were prepared twice for resorbable and titanium material. Load of 600N and muscle forces were applied. In the finite element analysis, computer models simulated and analyzed stress distribution of bone, fixation materials and condyle.ResultsBicortical screws increase the total stress on TMJ, and the stress is located more on the posterior part than the anterior. Miniplates decrease the stress, and the forces are located more on the anterior aspect of the TMJ.ConclusionAccording to our analysis, the use of bicortical screws increases the stress amount on the condyle. For the patients with a tendency toward temporomandibular disorders, using miniplate fixation techniques may decrease the forces around the condyle. These findings should be useful for oral surgeons when deciding on the most appropriate fixation technique in patients with a tendency toward temporomandibular joint disorders.



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Comparison of functional outcomes after total thyroidectomy and completion thyroidectomy: Hypoparathyroidism and postoperative complications

This study aimed to investigate differences in functional outcomes of postoperative complications and hypoparathyroidism between patients who underwent completion thyroidectomy (CT) after thyroid lobectomy or total thyroidectomy (TT) as an initial treatment.

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Surgical outcomes in the treatment of temporal bone cerebrospinal fluid leak: A systematic review

Temporal bone cerebrospinal fluid (CSF) leakage may have acquired or spontaneous origin. Acquired temporal bony defects typically comprise traumatic injuries, iatrogenic causes, chronic otitis media with or without cholesteatoma, irradiation, neoplastic invasion of the skull base [1]. Concerning the etiology of spontaneous temporal CSF leaks some authors suggest that small bony defects of the middle fossa tegmen originating from imperfect embryologic development may progressively expand with constant CSF pressure [2].

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Genetic variation and systemic lupus erythematosus: A field synopsis and systematic meta-analysis

Publication date: Available online 7 April 2018
Source:Autoimmunity Reviews
Author(s): Dong Yeon Jeong, Sang Woo Lee, Young Ha Park, Ji Hoon Choi, Young Wook Kwon, Gabin Moon, Michael Eisenhut, Andreas Kronbichler, Jae Il Shin
Systemic lupus erythematosus (SLE) is a multi-systemic severe autoimmune disease which results from the irreversible loss of self-tolerance and impaired molecular responses, especially an altered interferon signature. We synthesized all meta-analyses reporting a genetic association of SLE, and further investigated their validity to discover false positive results under Bayesian methods. We executed a PubMed search to extract the respective results regarding gene polymorphisms of SLE, published until June 30th 2017 and selected a single result per genetic variant among duplicates. Among 133 significant genotype comparisons, 45 (34%) were found noteworthy under both false positive report probability (FPRP) and Bayesian false discovery probability (BFDP). From the meta-analysis of genome-wide association studies (GWAS), we could confirm that all significant comparisons were noteworthy under both Bayesian approaches. Both approaches may be advantageous for determining whether the reported associations is genuine, especially for interpreting results from observational studies instead of GWAS whose significance was determined in a more strict manner. When determining results from GWAS with a p-value ranging between 0.05 and 5 × 10⁻⁸, other statistical approaches, rather than single standard significance may be beneficial. Taking into account these considerations, a proportion of meta-analyses claimed statistical significance, but these results need to be interpreted with caution.



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Should rheumatoid factor (RF) (and antinuclear antibodies (ANA)) become routinary screening test for morbidities in the general population?

Publication date: Available online 8 April 2018
Source:Autoimmunity Reviews
Author(s): Gianfranco Ferraccioli, Stefano Alivernini, Barbara Tolusso, Elisa Gremese




https://ift.tt/2EuNrVJ

Three-dimensional evaluation of mandibular asymmetry: a new classification and three-dimensional cephalometric analysis

Mandibular asymmetry is common among orthognathic patients and exhibits great variation. The aim of this study was to propose a new classification of mandibular asymmetry by anatomical regions; namely R (ramus), B (mandibular body) and C (chin), in conjunction with a corresponding 'RBC' three-dimensional (3D) cephalometric analysis. The cone beam computed tomography data of 65 patients with mandibular asymmetry was retrieved to perform the RBC 3D cephalometric analysis and to investigate the characteristics of mandibular asymmetry.

https://ift.tt/2IBvDuy

Endoscope-assisted nasal dermoid excision with an open rhinoplasty approach

Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Devon M. Livingstone, James Brookes, Warren K. Yunker
Congenital midline nasal masses have been traditionally excised through rhinotomies and bicoronal incisions. These approaches are disfiguring and potentially morbid, leading pediatric otolaryngologists to seek out less invasive, endoscopic-assisted approaches. Here we present a nasal dermoid excised with a minimally invasive, endoscopic assisted open rhinoplasty approach. The preoperative workup as well as perioperative steps for excision are documented, with the hope that this will assist other practitioners with this approach. An endoscopic open rhinoplasty technique affords excellent visualisation, with a superior cosmetic outcome. A preoperative MRI is essential to ensure the lesion is amenable to this approach.



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What you should not miss from the systematic reviews and meta-analyses on allergen-specific immunotherapy in 2017

Purpose of review Allergen immunotherapy (AIT) is a well recognized and extensively studied therapeutic intervention for some allergic diseases. Every year new systematic reviews and meta-analysis provide the most powerful source of evidence to orient decision making on prevention or efficacy of AIT. We here discuss systematic reviews and meta-analyses on AIT (published January 2017 to February 2018). Recent findings We identified 4 systematic reviews and 10 meta-analyses. Subcutaneous and sublingual AIT (SCIT/SLIT) significantly reduced the development of asthma in children–adolescents with moderate/severe allergic rhinitis, but evidence for a short-term, preventive effect for new allergic sensitizations was nonconclusive. SCIT/SLIT proved to significantly improve symptom and medication scores versus placebo or active comparators in respiratory allergy, with various effect sizes. Oral immunotherapy for IgE-mediated food allergy resulted in substantial benefit in desensitization rates. Data on venom AIT and latex AIT, although limited in quantity and quality, respectively, suggest a large and discrete beneficial effect. Summary Although current evidence extracted from meta-analyses and systematic reviews support AIT as an effective, relatively safe, and well tolerated alternative for some allergic diseases, heterogeneity and some methodological inconsistencies represent matters of concern as they may affect the validity and applicability of their results, especially in the context of individual, real-life settings. Correspondence to Désirée Larenas-Linnemann, MD, Hospital Medica Sur, Torre 2-602, Colonia Toriello-Guerra, Delegación Tlalpan, 14050 Mexico city, Mexico. Tel: +52 1 55 85095950; fax: +52 55 51712248; e-mail: marlar1@prodigy.net.mx Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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How to actively treat food allergy

Purpose of review In the last years, food allergy treatment is moving away from food avoidance to interventional treatments. We review here the recent developments on immunotherapy with food allergens. Recent findings Oral immunotherapy remains the best studied form of food immunotherapy. In 2017, further evidence has been added to its efficacy. Its mechanisms of action are under scrutiny. To reduce its side effects, studies have been dedicated to the simultaneous use of biologics, in particular omalizumab. Among the other forms of food immunotherapy that are being developed, the epicutaneous application of food allergens is promising. Summary The immunologic trajectories of the development of food tolerance may be intercepted by different forms of food immunotherapy. Research efforts aim to make these therapies feasible at the clinical level. Correspondence to Valentina Pecora, MD, PhD, Allergy Department, Pediatric Hospital Bambino Gesù – Piazza di Sant'Onofrio 4, Vatican City, Rome 00100, Italy. Tel: +39 46 6859 4777; fax: +39 46 6859 2020; e-mail: valentina.pecora@opbg.net Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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How to manage food dependent exercise induced anaphylaxis (FDEIA)

Purpose of review In recent years, the number of reports on food-dependent exercise-induced anaphylaxis (FDEIA) has been increasing. This review aims to describe the standard management of FDEIA including provocation tests and identify the issues that remain unclear. Recent findings Provocation tests with aspirin for FDEIA enable us to confirm the definitive diagnosis and to make differential diagnosis. In some cases, FDEIA symptoms can be induced by aspirin and the causative food without exercise. Exercise may only be an augmenting factor of FDEIA, similar to aspirin or alcohol. Summary The mechanisms of FDEIA development remain unclear. It has been suggested that in FDEIA, exercise lowers the threshold of a food allergy. Further research is needed to elucidate the mechanism of FDEIA and to establish strategies for effective disease management. Correspondence to Tomoyuki Asaumi, Department of Pediatrics, Sagamihara National Hospital, 18-1, Sakuradai, Minami-ku, Sagamihara, Kanagawa 252-0392, Japan. Tel: +81 42 742 8311; fax: +81 42 742 5314; e-mail: ocean19oranges@yahoo.co.jp Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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A Randomized Comparison Between Interscalene and Small-Volume Supraclavicular Blocks for Arthroscopic Shoulder Surgery

Background and Objectives This randomized trial compared ultrasound (US)–guided interscalene block (ISB) and small-volume supraclavicular block (SCB) for arthroscopic shoulder surgery. We hypothesized that SCB would provide equivalent analgesia to ISB 30 minutes after surgery without the risk of hemidiaphragmatic paralysis (HDP). Methods All patients received an US-guided intermediate cervical plexus block. In the ISB group, US-guided ISB was performed with 20 mL of levobupivacaine 0.5% and epinephrine 5 μg/mL. In the SCB group, US-guided SCB was carried out using 20 mL of the same local anesthetic agent: 3 and 17 mL were deposited at the "corner pocket" (ie, intersection of the first rib and subclavian artery) and posterolateral to the brachial plexus, respectively. A blinded investigator assessed ISBs and SCBs every 5 minutes until 30 minutes using a composite scale that encompassed the sensory function of the supraclavicular nerves, the sensorimotor function of the axillary nerve, and the motor function of the suprascapular nerve. We considered the blocks complete if, at 30 minutes, a composite score equal or superior to 6 points (out of 8 points) was achieved. Thus, onset time was defined as the time required to reach a minimal composite score of 6 points. The blinded investigator also assessed the presence of HDP at 30 minutes with US. Subsequently, all patients underwent general anesthesia. Postoperatively, a blinded investigator recorded pain scores at rest at 0.5, 1, 2, 3, 6, 12, and 24 hours. Patient satisfaction at 24 hours, consumption of intraoperative and postoperative narcotics, and opioid-related adverse effects were also tabulated. Results Both groups displayed equivalent postoperative pain scores at 0.5, 1, 2, 3, 6, 12, and 24 hours. Interscalene blocks resulted in a higher incidence of HDP (95% vs 9%; P

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Effective Dose of Intravenous Dexmedetomidine to Prolong the Analgesic Duration of Interscalene Brachial Plexus Block: A Single-Center, Prospective, Double-Blind, Randomized Controlled Trial

Background and Objectives Intravenous (IV) dexmedetomidine (DEX) is reported to prolong the analgesic duration after single-shot interscalene brachial plexus block (ISBPB). However, the effective analgesic dose of IV DEX remains undetermined. Therefore, we aimed to elucidate the clinically relevant dose of IV DEX to prolong the analgesic duration of ISBPB. Methods Seventy-two patients scheduled for arthroscopic shoulder surgery received ISBPB with 15 mL of 0.5% ropivacaine with 1:200,000 epinephrine and were randomly assigned to 1 of 4 groups (n = 18, each): (1) IV normal saline (control), (2) IV DEX 0.5 μg/kg (DEX 0.5), (3) IV DEX 1.0 μg/kg (DEX 1.0), and (4) IV DEX 2.0 μg/kg (DEX 2.0). The primary outcome was time to the first pain at surgical site. Results The median (interquartile range) duration of analgesia was significantly prolonged for the DEX 2.0 (874 minutes [727–1153 minutes]) compared with 656 minutes (590–751 minutes), 703 minutes (644–761 minutes), and 696 minutes (615–814 minutes) for the control, DEX 0.5 and DEX 1.0 groups, respectively (P = 0.001, P = 0.008, and P = 0.003, respectively). Postoperative cumulative IV morphine equivalent consumption at 24 hours was significantly lower in the DEX 2.0 compared with the control, DEX 0.5 and DEX 1.0 groups (P

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Perineural Versus Systemic Dexamethasone in Front-Foot Surgery Under Ankle Block: A Randomized Double-Blind Study

Background and Objectives Among the different adjuvants, dexamethasone is one of the most accepted to prolong the effect of local anesthetics. This study aims to determine the superiority of perineural over systemic dexamethasone administration after a single-shot ankle block in metatarsal osteotomy. Methods We performed a prospective, double-blind, randomized study. A total of 100 patients presenting for metatarsal osteotomy with an ankle block were randomized into 2 groups: 30 mL ropivacaine 0.375% + perineural dexamethasone 4 mg (1 mL) + 2.5 mL of systemic saline solution (PNDex group, n = 50) and 30 mL ropivacaine 0.375% + 1 mL of perineural saline solution + intravenous dexamethasone 10 mg (2.5 mL) (IVDex group, n = 50). The primary end point was the duration of analgesia defined as the time between the performance of the ankle block and the first administration of rescue analgesia with tramadol. Results Time period to first rescue analgesia with tramadol was similar in the IVDex group and the PNDex group. Data are expressed as mean (SD) or median (range). Duration of analgesia was 23.2 (9.5) hours in the IVDex group and 19 (8.2) hours in the PNDex group (P = 0.4). Consumption of tramadol during the first 48 hours was 0 mg (0–150 mg) in the IVDex group versus 0 mg (0–250 mg) in the PNDex group (P = 0.59). Four (8%) and 12 (24%) patients reported nausea or vomiting in the IVDex group and the PNDex group, respectively (P = 0.03). Conclusions In front-foot surgery, perineural and systemic administrations of dexamethasone are equivalent for postoperative pain relief when used as an adjuvant to ropivacaine ankle block. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT02904538. Address correspondence to: Philippe Marty, MD, Department of Anesthesia, Clinique Médipôle Garonne, 31036, Toulouse, France (e-mail: philippemarty@hotmail.com). Accepted for publication November 20, 2017. The authors declare no conflict of interest. Support was provided solely from institutional and department sources from Department of Anesthesiology, Clinique Médipôle Garonne, Toulouse, France. This work should be attributed to the Department of Anesthesiology, Clinique Médipôle Garonne, Toulouse, France. Authors' contributions: O.R., B.Basset, C.V., and M.C.M. performed all regional anesthesia. P.M. and F.F. wrote the manuscript. C.M., M.M., and M.C. participated in the design of the study. B.Bataille performed the statistical analysis. A.D. participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Practice Management: Successfully Guiding Your Group into the Future

Publication date: Available online 7 April 2018
Source:Anesthesiology Clinics
Author(s): Lee A. Fleisher




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Septate Uterus in a Girl with Rubinstein–Taybi Syndrome

Rubinstein–Taybi syndrome is an extremely rare plurimalformative condition that can affect any organ. However, reports regarding gynecological problems are unusual. We report the first case of a septate uterus in an adolescent with this syndrome, in agreement with the American Society for Reproductive Medicine (ASRM) and the Congenital Uterine Malformations by Expert (CUME) criteria for uterine septum. Additional studies are required to determine whether there is an increased frequency of müllerian duct anomalies with the condition. Our report extends the data on the clinical phenotype associated with Rubinstein–Taybi syndrome.

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