Report on the 1st European Tissue Repair Society Summer School, London 29th June - 1st July 2016

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Are the Insomnia Severity Index and Pittsburgh Sleep Quality Index valid outcome measures for Cognitive Behavioral Therapy for Insomnia? Inquiry from the perspective of response shifts and longitudinal measurement invariance in their Chinese versions

The purpose of this study was to examine whether the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) are valid outcome measures for Cognitive Behavioral Therapy for Insomnia (CBT-I). Specifically, we tested whether the factorial parameters of the ISI and the PSQI could remain invariant against CBT-I, which is a prerequisite to using their change scores as an unbiased measure of the treatment outcome of CBT-I.

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Are the Insomnia Severity Index and Pittsburgh Sleep Quality Index valid outcome measures for Cognitive Behavioral Therapy for Insomnia? Inquiry from the perspective of response shifts and longitudinal measurement invariance in their Chinese versions

The purpose of this study was to examine whether the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) are valid outcome measures for Cognitive Behavioral Therapy for Insomnia (CBT-I). Specifically, we tested whether the factorial parameters of the ISI and the PSQI could remain invariant against CBT-I, which is a prerequisite to using their change scores as an unbiased measure of the treatment outcome of CBT-I.

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Tumores primarios del espacio parafaríngeo

Publication date: May–June 2017
Source:Acta Otorrinolaringológica Española, Volume 68, Issue 3
Author(s): Gianluigi Grilli, Vanessa Suarez, María Gabriela Muñoz, María Costales, José Luis Llorente
Introducción y objetivosEl objetivo de este estudio es presentar nuestra experiencia en el diagnóstico y tratamiento de los tumores parafaríngeos.Pacientes y métodoRealizamos un estudio retrospectivo de 90 pacientes, diagnosticados y tratados quirúrgicamente de una tumoración parafaríngea entre 1984 y 2015. Fueron excluidos los pacientes cuyos tumores no eran primarios, sino que invadían esta región por contigüidad, los tumores originados en el lóbulo profundo de la parótida y las metástasis de otros tumores de cabeza y cuello.ResultadosEl 74% de las neoplasias del espacio parafaríngeo fueron de naturaleza benigna y el 26% maligna. Los adenomas pleomorfos fueron los tumores más frecuentes (27%), seguido por los paragangliomas (25%), un grupo de tumores de origen misceláneo de naturaleza maligna (16%), los tumores de origen neurogénico (12%), un grupo de tumores de origen misceláneo de naturaleza benigna (10%) y los tumores malignos de glándulas salivales (10%). El tratamiento fue quirúrgico en todos los casos. Se realizó un abordaje transcervical en 56 pacientes, un abordaje cervical-transparotídeo en 15 pacientes, un abordaje infratemporal tipo A en 13 pacientes, un abordaje transmandibular en 4 pacientes y en 2 casos un abordaje transoral. Las complicaciones más frecuentes fueron las derivadas de lesiones de estructuras nerviosas.ConclusionesLa mayoría de los tumores localizados en el espacio parafaríngeo son subsidiarios de ser tratados de forma quirúrgica con una baja tasa de complicaciones y recurrencias. El abordaje transcervical es el más utilizado.Introduction and objectivesThe aim of this study is to present our experience with the diagnostic and therapeutic approaches for parapharyngeal space tumours.Patients and methodThis study is a retrospective review of 90 patients diagnosed with tumours of the parapharyngeal space and treated surgically between 1984 and 2015. Patients whose tumours were not primary but invaded the parapharyngeal space expanding from another region, tumours originating in the deep lobe of the parotid gland and head and neck metastasis were excluded from this study.Results74% percent of the parapharyngeal space neoplasms were benign and 26% were malignant. Pleomorphic adenoma was the most common neoplasm (27%), followed by paragangliomas (25%), miscellaneous malignant tumours (16%), neurogenic tumours (12%), miscellaneous benign tumours (10%), and malignant salivary gland tumours (10%). The transcervical approach was used in 56 cases, cervical-transparotid approach in 15 cases, type A infratemporal fossa approach in 13 cases, transmandibular approach in 4 cases and transoral approach in 2 cases. The most common complications were those deriving from nervous injuries.ConclusionsMost parapharyngeal space tumours can be removed surgically with a low rate of complications and recurrence. The transcervical approach is the most frequently used.



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Tumores primarios del espacio parafaríngeo

Publication date: May–June 2017
Source:Acta Otorrinolaringológica Española, Volume 68, Issue 3
Author(s): Gianluigi Grilli, Vanessa Suarez, María Gabriela Muñoz, María Costales, José Luis Llorente
Introducción y objetivosEl objetivo de este estudio es presentar nuestra experiencia en el diagnóstico y tratamiento de los tumores parafaríngeos.Pacientes y métodoRealizamos un estudio retrospectivo de 90 pacientes, diagnosticados y tratados quirúrgicamente de una tumoración parafaríngea entre 1984 y 2015. Fueron excluidos los pacientes cuyos tumores no eran primarios, sino que invadían esta región por contigüidad, los tumores originados en el lóbulo profundo de la parótida y las metástasis de otros tumores de cabeza y cuello.ResultadosEl 74% de las neoplasias del espacio parafaríngeo fueron de naturaleza benigna y el 26% maligna. Los adenomas pleomorfos fueron los tumores más frecuentes (27%), seguido por los paragangliomas (25%), un grupo de tumores de origen misceláneo de naturaleza maligna (16%), los tumores de origen neurogénico (12%), un grupo de tumores de origen misceláneo de naturaleza benigna (10%) y los tumores malignos de glándulas salivales (10%). El tratamiento fue quirúrgico en todos los casos. Se realizó un abordaje transcervical en 56 pacientes, un abordaje cervical-transparotídeo en 15 pacientes, un abordaje infratemporal tipo A en 13 pacientes, un abordaje transmandibular en 4 pacientes y en 2 casos un abordaje transoral. Las complicaciones más frecuentes fueron las derivadas de lesiones de estructuras nerviosas.ConclusionesLa mayoría de los tumores localizados en el espacio parafaríngeo son subsidiarios de ser tratados de forma quirúrgica con una baja tasa de complicaciones y recurrencias. El abordaje transcervical es el más utilizado.Introduction and objectivesThe aim of this study is to present our experience with the diagnostic and therapeutic approaches for parapharyngeal space tumours.Patients and methodThis study is a retrospective review of 90 patients diagnosed with tumours of the parapharyngeal space and treated surgically between 1984 and 2015. Patients whose tumours were not primary but invaded the parapharyngeal space expanding from another region, tumours originating in the deep lobe of the parotid gland and head and neck metastasis were excluded from this study.Results74% percent of the parapharyngeal space neoplasms were benign and 26% were malignant. Pleomorphic adenoma was the most common neoplasm (27%), followed by paragangliomas (25%), miscellaneous malignant tumours (16%), neurogenic tumours (12%), miscellaneous benign tumours (10%), and malignant salivary gland tumours (10%). The transcervical approach was used in 56 cases, cervical-transparotid approach in 15 cases, type A infratemporal fossa approach in 13 cases, transmandibular approach in 4 cases and transoral approach in 2 cases. The most common complications were those deriving from nervous injuries.ConclusionsMost parapharyngeal space tumours can be removed surgically with a low rate of complications and recurrence. The transcervical approach is the most frequently used.



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Tumores primarios del espacio parafaríngeo

Publication date: May–June 2017
Source:Acta Otorrinolaringológica Española, Volume 68, Issue 3
Author(s): Gianluigi Grilli, Vanessa Suarez, María Gabriela Muñoz, María Costales, José Luis Llorente
Introducción y objetivosEl objetivo de este estudio es presentar nuestra experiencia en el diagnóstico y tratamiento de los tumores parafaríngeos.Pacientes y métodoRealizamos un estudio retrospectivo de 90 pacientes, diagnosticados y tratados quirúrgicamente de una tumoración parafaríngea entre 1984 y 2015. Fueron excluidos los pacientes cuyos tumores no eran primarios, sino que invadían esta región por contigüidad, los tumores originados en el lóbulo profundo de la parótida y las metástasis de otros tumores de cabeza y cuello.ResultadosEl 74% de las neoplasias del espacio parafaríngeo fueron de naturaleza benigna y el 26% maligna. Los adenomas pleomorfos fueron los tumores más frecuentes (27%), seguido por los paragangliomas (25%), un grupo de tumores de origen misceláneo de naturaleza maligna (16%), los tumores de origen neurogénico (12%), un grupo de tumores de origen misceláneo de naturaleza benigna (10%) y los tumores malignos de glándulas salivales (10%). El tratamiento fue quirúrgico en todos los casos. Se realizó un abordaje transcervical en 56 pacientes, un abordaje cervical-transparotídeo en 15 pacientes, un abordaje infratemporal tipo A en 13 pacientes, un abordaje transmandibular en 4 pacientes y en 2 casos un abordaje transoral. Las complicaciones más frecuentes fueron las derivadas de lesiones de estructuras nerviosas.ConclusionesLa mayoría de los tumores localizados en el espacio parafaríngeo son subsidiarios de ser tratados de forma quirúrgica con una baja tasa de complicaciones y recurrencias. El abordaje transcervical es el más utilizado.Introduction and objectivesThe aim of this study is to present our experience with the diagnostic and therapeutic approaches for parapharyngeal space tumours.Patients and methodThis study is a retrospective review of 90 patients diagnosed with tumours of the parapharyngeal space and treated surgically between 1984 and 2015. Patients whose tumours were not primary but invaded the parapharyngeal space expanding from another region, tumours originating in the deep lobe of the parotid gland and head and neck metastasis were excluded from this study.Results74% percent of the parapharyngeal space neoplasms were benign and 26% were malignant. Pleomorphic adenoma was the most common neoplasm (27%), followed by paragangliomas (25%), miscellaneous malignant tumours (16%), neurogenic tumours (12%), miscellaneous benign tumours (10%), and malignant salivary gland tumours (10%). The transcervical approach was used in 56 cases, cervical-transparotid approach in 15 cases, type A infratemporal fossa approach in 13 cases, transmandibular approach in 4 cases and transoral approach in 2 cases. The most common complications were those deriving from nervous injuries.ConclusionsMost parapharyngeal space tumours can be removed surgically with a low rate of complications and recurrence. The transcervical approach is the most frequently used.



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Gluteus medius muscle metastasis of squamous cell carcinoma of larynx: a rare case

Publication date: Available online 29 April 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Alperen Vural, Deniz Avcı, Sedat Çağlı, İmdat Yüce, Turan Arlı




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Gluteus medius muscle metastasis of squamous cell carcinoma of larynx: a rare case

Publication date: Available online 29 April 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Alperen Vural, Deniz Avcı, Sedat Çağlı, İmdat Yüce, Turan Arlı




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Temporal patterns of patient-reported trismus and associated mouth-opening distances in radiotherapy for head and neck cancer: A prospective cohort study

Abstract

Objectives

To identify temporal patterns of patient-reported trismus during the first year post-radiotherapy, and to study their associations with maximal interincisal opening distances (MIOs).

Design

Single institution case series.

Setting

University hospital ENT clinic.

Participants

One hundred ninety six subjects who received radiotherapy (RT) for head and neck cancer (HNC) with or without chemotherapy in 2007-2012 to total dose of 64.6/68 Gy in 38/34 fractions, respectively. All subjects were prospectively assessed for mouth-opening ability (Gothenburg Trismus Questionnaire (GTQ), and MIO) pre-RT and at 3, 6, and 12 months after RT.

Main outcome measures

Correlations between temporally robust GTQ-symptoms and MIO as given by Pearson's correlation coefficients (P_r); temporally robust GTQ-symptom domains as given by factor analysis; rates of trismus with respect to baseline by risk ratios (RRs).

Results

Four temporally robust domains were identified: Eating (3-7 symptoms), Jaw (3-7), Pain (2-5), and Quality of Life (QoL, 2-5), and included 2-3 persistent symptoms across all post- RT assessments. The median RR for a moderate/severe (>2/>3) cut-off was the highest for Jaw (3.7/3.6) and QoL (3.2/2.9). The median P_r between temporally robust symptoms and MIO post-radiotherapy was 0.25-0.35/0.34-0.43/0.24-0.31/0.34-0.50 for Eating/Jaw/Pain/QoL, respectively.

Conclusions

Mouth-opening distances in HNC patients post-RT can be understood in terms of associated patient-reported outcomes on trismus-related difficulties. Our data suggest that a reduction in MIO can be expected as patients communicate their mouth-opening status to interfere with private/social life, a clinical warning signal for emerging or worsening trismus as patients are being followed after RT.

This article is protected by copyright. All rights reserved.

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Patient injuries in operative rhinology during a ten-year period: Review of National Patient Insurance Charts

Abstract

Objectives

To assess factors contributing to patient injuries in operative rhinology.

Design

Data of the accepted patient injury claims involving operative rhinology, between the years 2001 and 2011, were obtained from the Finnish Patient Insurance Centre registry. Two senior otolaryngologists analysed and evaluated the injury mechanisms.

Main outcome measures

Analysis and classification of factors contributing to patient injuries.

Results

During the ten-year study period, there were 67 patient injuries in operative rhinology, comprising 36% of all patient injuries in otorhinolaryngologic surgery. The majority (78%) of patients were treated in university or central hospitals and almost all (90%) by fully trained otolaryngology specialists. The factors contributing to the injuries were errors in surgical technique, like lesions to the orbit, skull base and meninges, and adjacent nerves, as well as mistakes with removable packings left in situ. Nearly half of the patients had undergone endoscopic sinus surgery. One patient died because of bleeding from the intracranial artery. Fourteen patients (21%) needed a re-operation due to the injury.

Conclusions

Patient injuries in rhinology were caused by typical complications of common operations performed by otorhinolaryngology specialists. The increased volume of endoscopic sinus surgery was evident also in patient injuries.

This article is protected by copyright. All rights reserved.

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Temporal patterns of patient-reported trismus and associated mouth-opening distances in radiotherapy for head and neck cancer: A prospective cohort study

Abstract

Objectives

To identify temporal patterns of patient-reported trismus during the first year post-radiotherapy, and to study their associations with maximal interincisal opening distances (MIOs).

Design

Single institution case series.

Setting

University hospital ENT clinic.

Participants

One hundred ninety six subjects who received radiotherapy (RT) for head and neck cancer (HNC) with or without chemotherapy in 2007-2012 to total dose of 64.6/68 Gy in 38/34 fractions, respectively. All subjects were prospectively assessed for mouth-opening ability (Gothenburg Trismus Questionnaire (GTQ), and MIO) pre-RT and at 3, 6, and 12 months after RT.

Main outcome measures

Correlations between temporally robust GTQ-symptoms and MIO as given by Pearson's correlation coefficients (P_r); temporally robust GTQ-symptom domains as given by factor analysis; rates of trismus with respect to baseline by risk ratios (RRs).

Results

Four temporally robust domains were identified: Eating (3-7 symptoms), Jaw (3-7), Pain (2-5), and Quality of Life (QoL, 2-5), and included 2-3 persistent symptoms across all post- RT assessments. The median RR for a moderate/severe (>2/>3) cut-off was the highest for Jaw (3.7/3.6) and QoL (3.2/2.9). The median P_r between temporally robust symptoms and MIO post-radiotherapy was 0.25-0.35/0.34-0.43/0.24-0.31/0.34-0.50 for Eating/Jaw/Pain/QoL, respectively.

Conclusions

Mouth-opening distances in HNC patients post-RT can be understood in terms of associated patient-reported outcomes on trismus-related difficulties. Our data suggest that a reduction in MIO can be expected as patients communicate their mouth-opening status to interfere with private/social life, a clinical warning signal for emerging or worsening trismus as patients are being followed after RT.

This article is protected by copyright. All rights reserved.

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Patient injuries in operative rhinology during a ten-year period: Review of National Patient Insurance Charts

Abstract

Objectives

To assess factors contributing to patient injuries in operative rhinology.

Design

Data of the accepted patient injury claims involving operative rhinology, between the years 2001 and 2011, were obtained from the Finnish Patient Insurance Centre registry. Two senior otolaryngologists analysed and evaluated the injury mechanisms.

Main outcome measures

Analysis and classification of factors contributing to patient injuries.

Results

During the ten-year study period, there were 67 patient injuries in operative rhinology, comprising 36% of all patient injuries in otorhinolaryngologic surgery. The majority (78%) of patients were treated in university or central hospitals and almost all (90%) by fully trained otolaryngology specialists. The factors contributing to the injuries were errors in surgical technique, like lesions to the orbit, skull base and meninges, and adjacent nerves, as well as mistakes with removable packings left in situ. Nearly half of the patients had undergone endoscopic sinus surgery. One patient died because of bleeding from the intracranial artery. Fourteen patients (21%) needed a re-operation due to the injury.

Conclusions

Patient injuries in rhinology were caused by typical complications of common operations performed by otorhinolaryngology specialists. The increased volume of endoscopic sinus surgery was evident also in patient injuries.

This article is protected by copyright. All rights reserved.

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Temporal patterns of patient-reported trismus and associated mouth-opening distances in radiotherapy for head and neck cancer: A prospective cohort study

Abstract

Objectives

To identify temporal patterns of patient-reported trismus during the first year post-radiotherapy, and to study their associations with maximal interincisal opening distances (MIOs).

Design

Single institution case series.

Setting

University hospital ENT clinic.

Participants

One hundred ninety six subjects who received radiotherapy (RT) for head and neck cancer (HNC) with or without chemotherapy in 2007-2012 to total dose of 64.6/68 Gy in 38/34 fractions, respectively. All subjects were prospectively assessed for mouth-opening ability (Gothenburg Trismus Questionnaire (GTQ), and MIO) pre-RT and at 3, 6, and 12 months after RT.

Main outcome measures

Correlations between temporally robust GTQ-symptoms and MIO as given by Pearson's correlation coefficients (P_r); temporally robust GTQ-symptom domains as given by factor analysis; rates of trismus with respect to baseline by risk ratios (RRs).

Results

Four temporally robust domains were identified: Eating (3-7 symptoms), Jaw (3-7), Pain (2-5), and Quality of Life (QoL, 2-5), and included 2-3 persistent symptoms across all post- RT assessments. The median RR for a moderate/severe (>2/>3) cut-off was the highest for Jaw (3.7/3.6) and QoL (3.2/2.9). The median P_r between temporally robust symptoms and MIO post-radiotherapy was 0.25-0.35/0.34-0.43/0.24-0.31/0.34-0.50 for Eating/Jaw/Pain/QoL, respectively.

Conclusions

Mouth-opening distances in HNC patients post-RT can be understood in terms of associated patient-reported outcomes on trismus-related difficulties. Our data suggest that a reduction in MIO can be expected as patients communicate their mouth-opening status to interfere with private/social life, a clinical warning signal for emerging or worsening trismus as patients are being followed after RT.

This article is protected by copyright. All rights reserved.

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Patient injuries in operative rhinology during a ten-year period: Review of National Patient Insurance Charts

Abstract

Objectives

To assess factors contributing to patient injuries in operative rhinology.

Design

Data of the accepted patient injury claims involving operative rhinology, between the years 2001 and 2011, were obtained from the Finnish Patient Insurance Centre registry. Two senior otolaryngologists analysed and evaluated the injury mechanisms.

Main outcome measures

Analysis and classification of factors contributing to patient injuries.

Results

During the ten-year study period, there were 67 patient injuries in operative rhinology, comprising 36% of all patient injuries in otorhinolaryngologic surgery. The majority (78%) of patients were treated in university or central hospitals and almost all (90%) by fully trained otolaryngology specialists. The factors contributing to the injuries were errors in surgical technique, like lesions to the orbit, skull base and meninges, and adjacent nerves, as well as mistakes with removable packings left in situ. Nearly half of the patients had undergone endoscopic sinus surgery. One patient died because of bleeding from the intracranial artery. Fourteen patients (21%) needed a re-operation due to the injury.

Conclusions

Patient injuries in rhinology were caused by typical complications of common operations performed by otorhinolaryngology specialists. The increased volume of endoscopic sinus surgery was evident also in patient injuries.

This article is protected by copyright. All rights reserved.

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Studying the association between methylene tetrahdrofolate reductase (MTHFR) 677 gene polymorphism, cardiovascular risk and lichen planus

Abstract

Background

There is a reported relation between hyperhomocysteinemia and lichen planus (LP). An increase in homocysteine (Hcy) and the risk of cardiovascular disease (CVD) in patients with methylenetetrahydrofolate reductase (MTHFR) mutation has been described

Objective

To detect MTHFR (C677T) gene polymorphism, and to find its association with CVD risk, Hcy and folic acid levels in patients with LP

Methods

This hospital-based case-control study included 110 patients with LP; 70 with cutaneous LP (CLP) and 40 with oral LP (OLP). 120 age and sex matched healthy subjects were used as controls. Three ml venous blood sample was taken for detection of MTHFR gene polymorphism by PCR-RFLP technique and for measurement of the lipid profile. Hcy and folic acid were measured by ELISA. Hypertension was evaluated

Results

There were significantly higher prevalence of hypertension with higher Hcy, triglycerides and cholesterol levels and lower folic acid and HDL levels among patients' groups. Hypertension with higher Hcy and cholesterol levels together with lower folic acid and HDL levels have been found in OLP when compared to CLP. Patients showed a significant higher percentage of the MTHFR 677 TT genotype (P=0.003) and of the MTHFR 677 T allele (P=0.042) compared to controls. Moreover, there was higher a prevalence of MTHFR 677 T allele in patients with CLP.

Conclusion

MTHFR 677 gene polymorphism may be a risk factor for the development of the LP, and to predispose these patients to higher risk of CVD.

This article is protected by copyright. All rights reserved.

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Development of a financially viable model for the management of mandibular fractures as day cases in a level 1 major trauma centre

Publication date: Available online 29 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): J. Haq, J. Olding, S. Chegini, C. Huppa, R. Bentley, K. Fan
There is a subgroup of patients with mandibular fractures who could safely and effectively be managed in an outpatient day-care unit. Suitability depends on medical, social, and operative factors, and identification of the correct criteria will govern management after that in the emergency department. Reduced use of beds would lead to less money being spent on emergency treatment, and increased capacity for elective surgery. The aims of this study were to identify a group of patients with mandibular fractures whose duration of operation and period of recovery would be suitable for treatment in the day-care unit, and to evaluate the potential financial benefits. Inpatients were assessed for day surgery using medical, social, and surgical criteria. Each patient's suitability for discharge was assessed two, three, and five hours postoperatively. A financial feasibility study was made retrospectively on a larger sample of patients with mandibular fractures. The discharge criteria from the day-care unit were fully met by 26/40 patients at five hours postoperatively, mean (range) duration of operation was 145 (40–285) minutes, and mean (SD) Mandibular Injury Severity Score was 13 (3), range 7–20. When all the criteria were combined (n=100), 12 of the patients were suitable for day care. With 24 bed-day savings/100 patients, potential earnings would increase to around £80 000/year at this hospital. In conclusion, we have identified a group of patients who were suitable for management of mandibular fractures in the day-care unit. Considerable cost savings are anticipated.



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Use of couplers for vascular anastomoses in 601 free flaps for reconstruction of defects of the head and neck: technique and two-year retrospective clinical study

Publication date: Available online 29 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A. Assoumane, L. Wang, K. Liu, Z.-J. Shang
We describe our experience with the use of 854 couplers for venous or arterial anastomoses, or both, in 601 free flaps for reconstruction of defects of the head and neck. We reviewed 601 patients who had had free flaps (with the microvascular anastomoses being made with couplers in 519) between July 2013 and December 2015. Personal details, and clinical data including the site of the defect, the tumour excised, the types of flaps, the size of the couplers, the method of anastomosis (venous or arterial) in which the coupler was used, and postoperative complications were recorded. There were 417 men (69%) and 184 women (31%), mean (range) age 53 (13–91) years. Four types of flaps were used: anterolateral thigh flap (n=232), radial forearm flap (n=223), fibula free flap (n=78), and iliac crest flap (n=68). The sizes of couplers ranged from 1–4mm, most being 2mm (n=158), followed by 1.5mm (n=122). The recipient vessels used included a single vein (n=348), two veins (n=406), and both vein and artery (n=100). The overall success rate was 99%, and eight patients required resuture, which was successful in each case. This retrospective study shows that a coupler is easy to use, and is a reliable and time-saving technique for microvascular anastomosis. However, the disadvantage is the cost of the instrument, which in less developed countries will limit its use.



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Haplotypes of the RANK and OPG genes are associated with chronic arthralgia in individuals with and without temporomandibular disorders

Publication date: Available online 29 April 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): L.L. Bonato, V. Quinelato, R. Borojevic, A.R. Vieira, A. Modesto, J.M. Granjeiro, R. Tesch, P.L. Casado
The aim of this study was to evaluate the association between genetic polymorphisms and the comorbid presence of chronic systemic arthralgia in patients with articular temporomandibular disorders (TMD). Subjects were evaluated for the presence of TMD and asked about the presence of chronic joint pain. Four groups were included in the study: articular TMD and systemic arthralgia (n=85), no articular TMD and systemic arthralgia (n=82), articular TMD and no systemic arthralgia (n=21), no articular TMD and no systemic arthralgia (control, n=72). A total of 14 single nucleotide polymorphisms in the OPG, RANK, and RANKL genes were investigated. In the statistical analysis, a P-value of <0.05 was considered significant. For the OPG gene, an association was observed between the group with chronic arthralgia and joint TMD and the control group (P=0.04). There was also a tendency towards an association of the haplotype CGCCAA with an increased risk of developing chronic joint pain, even in the absence of TMD (P=0.06). For the RANK gene, the AGTGC haplotype was associated with the lowest risk of presenting chronic joint pain in individuals without TMD (P=0.03). This study supports the hypothesis that changes in the OPG and RANK genes influence the presence of chronic joint pain in individuals with and without TMD.



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speech and language; +21 new citations

21 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

speech and language

These pubmed results were generated on 2017/04/30

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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The reliability of the Adelaide in-shoe foot model

Publication date: July 2017
Source:Gait & Posture, Volume 56
Author(s): Chris Bishop, Susan Hillier, Dominic Thewlis
Understanding the biomechanics of the foot is essential for many areas of research and clinical practice such as orthotic interventions and footwear development. Despite the widespread attention paid to the biomechanics of the foot during gait, what largely remains unknown is how the foot moves inside the shoe. This study investigated the reliability of the Adelaide In-Shoe Foot Model, which was designed to quantify in-shoe foot kinematics and kinetics during walking. Intra-rater reliability was assessed in 30 participants over five walking trials whilst wearing shoes during two data collection sessions, separated by one week. Sufficient reliability for use was interpreted as a coefficient of multiple correlation and intra-class correlation coefficient of >0.61. Inter-rater reliability was investigated separately in a second sample of 10 adults by two researchers with experience in applying markers for the purpose of motion analysis. The results indicated good consistency in waveform estimation for most kinematic and kinetic data, as well as good inter-and intra-rater reliability. The exception is the peak medial ground reaction force, the minimum abduction angle and the peak abduction/adduction external hindfoot joint moments which resulted in less than acceptable repeatability. Based on our results, the Adelaide in-shoe foot model can be used with confidence for 24 commonly measured biomechanical variables during shod walking.



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The reliability of the Adelaide in-shoe foot model

Publication date: July 2017
Source:Gait & Posture, Volume 56
Author(s): Chris Bishop, Susan Hillier, Dominic Thewlis
Understanding the biomechanics of the foot is essential for many areas of research and clinical practice such as orthotic interventions and footwear development. Despite the widespread attention paid to the biomechanics of the foot during gait, what largely remains unknown is how the foot moves inside the shoe. This study investigated the reliability of the Adelaide In-Shoe Foot Model, which was designed to quantify in-shoe foot kinematics and kinetics during walking. Intra-rater reliability was assessed in 30 participants over five walking trials whilst wearing shoes during two data collection sessions, separated by one week. Sufficient reliability for use was interpreted as a coefficient of multiple correlation and intra-class correlation coefficient of >0.61. Inter-rater reliability was investigated separately in a second sample of 10 adults by two researchers with experience in applying markers for the purpose of motion analysis. The results indicated good consistency in waveform estimation for most kinematic and kinetic data, as well as good inter-and intra-rater reliability. The exception is the peak medial ground reaction force, the minimum abduction angle and the peak abduction/adduction external hindfoot joint moments which resulted in less than acceptable repeatability. Based on our results, the Adelaide in-shoe foot model can be used with confidence for 24 commonly measured biomechanical variables during shod walking.



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The effectiveness of earmuffs on the physiologic and behavioral stability in preterm infants

Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Nasrin Khalesi, Nastaran Khosravi, Azadeh Ranjbar, Zahra Godarzi, Alireza Karimi
BackgroundThe use of earmuffs can protect preterm infants against negative effects of high noise levels in the neonatal intensive care unit. This study was aimed at assessing the effectiveness of the earmuffs on the physiologic and behavioral responses in preterm infants.MethodsA crossed over controlled trial was conducted at Aliasghar Hospital (Tehran, Iran) in 2014. Thirty-six preterm infants cared in closed incubators, 18 cases wore a pair of silicon earmuffs in the first day and the others were worn it at the second day. During 2 consecutive days, all subjects were observed as their own controls (without earmuffs). Physiologic (body temperature, heart rate, respiratory rate, systolic, diastolic pressures, arterial Oxygen Saturation) and behavioral responses (according to the Anderson behavioral state scoring system) were assessed every 2 h for 8 h long during daytime for two consecutive days.ResultsThe application of earmuffs could decrease the rate of the heart and respiratory while could increase the amount of oxygen saturation (p < 0.05). The results also showed that the preterm infants with earmuffs had lower ABSS score and a better light sleep compared to those without earmuffs (2.38 ± 0.47 versus 4.8 ± 0.97, p < 0.05).ConclusionThe results indicated that using the earmuffs reduces the level of noise in NICUs following by improving the preterm neonates' physiological stability and behavioral states of ABSS.



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The effectiveness of earmuffs on the physiologic and behavioral stability in preterm infants

Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Nasrin Khalesi, Nastaran Khosravi, Azadeh Ranjbar, Zahra Godarzi, Alireza Karimi
BackgroundThe use of earmuffs can protect preterm infants against negative effects of high noise levels in the neonatal intensive care unit. This study was aimed at assessing the effectiveness of the earmuffs on the physiologic and behavioral responses in preterm infants.MethodsA crossed over controlled trial was conducted at Aliasghar Hospital (Tehran, Iran) in 2014. Thirty-six preterm infants cared in closed incubators, 18 cases wore a pair of silicon earmuffs in the first day and the others were worn it at the second day. During 2 consecutive days, all subjects were observed as their own controls (without earmuffs). Physiologic (body temperature, heart rate, respiratory rate, systolic, diastolic pressures, arterial Oxygen Saturation) and behavioral responses (according to the Anderson behavioral state scoring system) were assessed every 2 h for 8 h long during daytime for two consecutive days.ResultsThe application of earmuffs could decrease the rate of the heart and respiratory while could increase the amount of oxygen saturation (p < 0.05). The results also showed that the preterm infants with earmuffs had lower ABSS score and a better light sleep compared to those without earmuffs (2.38 ± 0.47 versus 4.8 ± 0.97, p < 0.05).ConclusionThe results indicated that using the earmuffs reduces the level of noise in NICUs following by improving the preterm neonates' physiological stability and behavioral states of ABSS.



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The effectiveness of earmuffs on the physiologic and behavioral stability in preterm infants

Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Nasrin Khalesi, Nastaran Khosravi, Azadeh Ranjbar, Zahra Godarzi, Alireza Karimi
BackgroundThe use of earmuffs can protect preterm infants against negative effects of high noise levels in the neonatal intensive care unit. This study was aimed at assessing the effectiveness of the earmuffs on the physiologic and behavioral responses in preterm infants.MethodsA crossed over controlled trial was conducted at Aliasghar Hospital (Tehran, Iran) in 2014. Thirty-six preterm infants cared in closed incubators, 18 cases wore a pair of silicon earmuffs in the first day and the others were worn it at the second day. During 2 consecutive days, all subjects were observed as their own controls (without earmuffs). Physiologic (body temperature, heart rate, respiratory rate, systolic, diastolic pressures, arterial Oxygen Saturation) and behavioral responses (according to the Anderson behavioral state scoring system) were assessed every 2 h for 8 h long during daytime for two consecutive days.ResultsThe application of earmuffs could decrease the rate of the heart and respiratory while could increase the amount of oxygen saturation (p < 0.05). The results also showed that the preterm infants with earmuffs had lower ABSS score and a better light sleep compared to those without earmuffs (2.38 ± 0.47 versus 4.8 ± 0.97, p < 0.05).ConclusionThe results indicated that using the earmuffs reduces the level of noise in NICUs following by improving the preterm neonates' physiological stability and behavioral states of ABSS.



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Banhasasim-Tang Treatment Reduces the Severity of Esophageal Mucosal Ulcer on Chronic Acid Reflux Esophagitis in Rats.

Related Articles

Banhasasim-Tang Treatment Reduces the Severity of Esophageal Mucosal Ulcer on Chronic Acid Reflux Esophagitis in Rats.

Biomed Res Int. 2017;2017:7157212

Authors: Shin MR, Seo BI, Son CG, Roh SS, An HJ

Abstract
The present study was conducted to evaluate both antioxidant and anti-inflammatory activity of Banhasasim-tang (BHSST) on chronic acid reflux esophagitis (CRE) model. Rat CRE model was established operatively and then treated with BHSST (1 g/kg body weight per day) for 15 days Esophageal pathological changes were analyzed using macroscopic examination and hematoxylin/eosin staining. The antioxidant and inflammatory protein levels were determined using Western blotting. The administration of BHSST significantly reduced both the overexpression of serum reactive oxygen species (ROS) and an excessive formation of thiobarbituric acid-reactive substances (TBARS) in esophagus tissue. Thus, the severity of esophageal ulcer was lower in BHSST treated rats than control rats on the gross and histological evaluation. Nuclear factor-erythroid 2-related factor 2 (Nrf2) led to the upregulation of antioxidant enzyme including SOD, GPx-1/2, and HO-1 by binding to antioxidant response element (ARE). Moreover, BHSST administration markedly reduced the expression of inflammatory proteins through mitogen-activated protein kinase- (MAPK-) related signaling pathways and decreased significantly the protein expressions of inflammatory mediators and cytokines by inhibition of nuclear factor-kappa B (NF-κB) activation. Taken together, these results support the fact that BHSST administration can suppress the development of esophageal mucosal ulcer via regulating inflammation through the activation of the antioxidant pathway.

PMID: 28349065 [PubMed - indexed for MEDLINE]

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Incidental Finding of Oleothorax.

Related Articles

Incidental Finding of Oleothorax.

N Engl J Med. 2017 Mar 23;376(12):e21

Authors: Koratala A, Bhatti V

PMID: 28328345 [PubMed - indexed for MEDLINE]

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Asymptomatic medial vocal fold hemorrhagic polyp.

Related Articles

Asymptomatic medial vocal fold hemorrhagic polyp.

Ear Nose Throat J. 2016 Jun;95(6):210

Authors: Kantarcioglu OE, Rutt AL, Sataloff RT

PMID: 27304436 [PubMed - indexed for MEDLINE]

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Poorly Controlled Congenital Hypothyroidism due to an Underlying Allgrove Syndrome.

Related Articles

Poorly Controlled Congenital Hypothyroidism due to an Underlying Allgrove Syndrome.

Horm Res Paediatr. 2016;86(6):420-424

Authors: van Tellingen V, Finken MJ, Israëls J, Hendriks YM, Kamp GA, van Santen HM

Abstract
BACKGROUND: Congenital hypothyroidism of thyroidal origin (CHT) is a common disorder in pediatric endocrinology practices, which can be difficult to manage. Elevated thyrotropin (TSH) concentrations are in the great majority of cases explained by poor compliance to levothyroxine therapy.
METHODS: Case description.
RESULTS: We present a boy with CHT, with 2 heterozygous mutations in the TSH receptor gene, who showed persistently elevated TSH concentrations and psychomotor retardation, initially misinterpreted as malcompliance. At the age of 4 years, he was diagnosed with adrenal insufficiency, wherefore a broad diagnostic search was initiated. After the start of glucocorticoid replacement therapy, his TSH normalized and the levothyroxine could be lowered. At the age of 6 years, his TSH increased again, this time caused by malabsorption of levothyroxine due to esophageal achalasia. In retrospect, alacrima was also present and the diagnosis of Allgrove syndrome was genetically confirmed. The CHT was considered a separate disease entity.
CONCLUSIONS: In case of persistently elevated TSH levels in children with CHT, causes other than noncompliance must be considered. Second, in establishing the cause of adrenal insufficiency, specific symptoms, such as alacrima, are easily overlooked. Third, Allgrove syndrome is a rare disorder, in which diagnostic delay can lead to potentially life-threatening complications.

PMID: 27255745 [PubMed - indexed for MEDLINE]

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Cervical disc herniation causing difficulty swallowing.

Related Articles

Cervical disc herniation causing difficulty swallowing.

Ear Nose Throat J. 2016 Apr-May;95(4-5):148

Authors: Cheng SY, Lee JC

PMID: 27140012 [PubMed - indexed for MEDLINE]

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Diagnostic accuracy of the clinical feeding evaluation in detecting aspiration in children: a systematic review.

Related Articles

Diagnostic accuracy of the clinical feeding evaluation in detecting aspiration in children: a systematic review.

Dev Med Child Neurol. 2016 Jun;58(6):541-53

Authors: Calvo I, Conway A, Henriques F, Walshe M

Abstract
The aim of this systematic review is to determine the diagnostic accuracy of clinical feeding evaluation (CFE) compared to instrumental assessments in detecting oropharyngeal aspiration (OPA) in children. This is important to support clinical decision-making and to provide safe, cost-effective, higher quality care. All published and unpublished studies in all languages assessing the diagnostic accuracy of CFE compared to videofluoroscopic swallowing study (VFSS) and/or fibre-optic endoscopic examination of swallowing (FEES) in detecting OPA in paediatric populations were sought. Databases were searched from inception to April 2015. Grey literature, citations, and references were also searched. Two independent reviewers extracted and analysed data. Accuracy estimates were calculated. Research reports were translated into English as required. Six studies examining the diagnostic accuracy of CFE using VFSS and/or FEES were eligible for inclusion. Sample sizes, populations studied, and CFE characteristics varied widely. The overall methodological quality of the studies, assessed with QUADAS-2, was considered 'low'. Results suggested that CFEs trialling liquid consistencies might provide better accuracy estimates than CFEs trialling solids exclusively. This systematic review highlights the critical lack of evidence on the accuracy of CFE in detecting OPA in children. Larger well-designed primary diagnostic test accuracy studies in this area are needed to inform dysphagia assessment in paediatrics.

PMID: 26862075 [PubMed - indexed for MEDLINE]

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[Lower esophageal muscular ring: A rare cause of dysphagia].

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[Lower esophageal muscular ring: A rare cause of dysphagia].

Gastroenterol Hepatol. 2015 Oct;38(8):493-5

Authors: Barrientos Delgado A, Martínez Tirado MP, del Moral Martínez M, Moreno Madrid F, Casado Caballero FJ

PMID: 25224761 [PubMed - indexed for MEDLINE]

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Delayed lower cranial neuropathy after oropharyngeal intensity-modulated radiotherapy: A cohort analysis and literature review.

Related Articles

Delayed lower cranial neuropathy after oropharyngeal intensity-modulated radiotherapy: A cohort analysis and literature review.

Head Neck. 2017 Apr 28;:

Authors: Hutcheson KA, Yuk M, Hubbard R, Gunn GB, Fuller CD, Lai SY, Lin H, Garden AS, Rosenthal DI, Hanna EY, Kies MS, Lewin JS

Abstract
BACKGROUND: The purpose of this study was to examine swallowing-related lower cranial nerve palsy (LCNP) in oropharyngeal cancer (OPC) survivors after intensity-modulated radiotherapy (IMRT).
METHODS: Patients treated with definitive IMRT (66-72 Gy) were pooled from institutional trial databases. Prospective analyses on parent trials included videofluoroscopy, clinical LCNP examination, and questionnaires pre-IMRT, 6 months post-IMRT, 12 months post-IMRT, and 24 months post-IMRT. Time-to-event and incidence of LCNP was estimated with competing risk methods. Literature review (1977-2015) summarized published LCNP outcomes.
RESULTS: Three of 59 oropharyngeal cancer survivors with a minimum 2-year follow-up developed hypoglossal palsy ipsilateral to the index tumor (median latency 6.7 years; range 4.6-7.6 years). At a median of 5.7 years, cumulative incidence of LCNP was 5%. LCNP preceded progressive dysphagia in all cases. Published studies found median incidence of radiation-associated LCNP was 10.5% after NPC, but no OPC cancer-specific estimate.
CONCLUSION: Although uncommon, the potential for late LCNP preceding swallowing deterioration highlights the importance of long-term functional surveillance in OPC survivorship.

PMID: 28452175 [PubMed - as supplied by publisher]

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Consistency stability of water thickened with maltodextrin, xanthan gum and potassium chloride.

Related Articles

Consistency stability of water thickened with maltodextrin, xanthan gum and potassium chloride.

J Texture Stud. 2017 Apr 27;:

Authors: Alves DC, Alves NA, Dantas RO

Abstract
Thickened water used for hydration of patients with dysphagia and airway aspiration may change its consistency after preparation. The objective of this investigation was to evaluate the consistency stability of water thickened with maltodextrin, xanthan gum and potassium chloride using the method developed by the International Dysphagia Diet Standardization Initiative (IDDSI). The IDDSI flow test consists of placing 10 ml of liquid inside a graduated syringe and measuring how much volume remains after a flow duration of 10 seconds. Pure and thickened water was tested with 1.2 g (nectar), 2.4 g (honey) and 3.6 g (pudding) of food thickener in 100 ml of water. Each consistency was measured at 8AM ten times immediately after preparation, and hourly for 12 hours (from 8AM to 8PM), and every 24 hours for 96 hours, always at 8AM. With the thin liquid, nothing was left in the syringe at 10 seconds (zero), with the consistency nectar, the volume remaining was 5.43(0.64)ml (level 2, mildly thick), with the consistency of honey, 8.14(0.57)ml remained (level 3, moderately thick) and with the consistency pudding 9.48(0.07)ml (level 3, moderately thick). There was a small increase in consistency after 10 hours of the preparation. The consistency changed after 24 hours in preparations with mildly thick consistency (level 2) and after 48 hours with the moderately thick consistency (level 3). In conclusion, there was good stability of the thickened water at least during a 12-hour period. This article is protected by copyright. All rights reserved.

PMID: 28452158 [PubMed - as supplied by publisher]

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The relationship between manometric subtype and outcomes of surgical treatment for patients with achalasia : Achalasia: manometric subtypes.

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The relationship between manometric subtype and outcomes of surgical treatment for patients with achalasia : Achalasia: manometric subtypes.

Surg Endosc. 2017 Apr 27;:

Authors: Crespin OM, Tatum RP, Xiao K, Martin AV, Khandelwal S, Pellegrini CA, Oelschlager BK

Abstract
BACKGROUND: The Chicago Classification describes three distinct subtypes of achalasia and it appears to be a promising tool in predicting results of treatment with standard Heller Myotomy. The aim of this study is to analyze the outcomes of surgical treatment for achalasia using an extended Heller myotomy for each subtype and to identify additional parameters that may predict the success of therapy.
METHODS: 72 consecutive patients with achalasia were evaluated at the University of Washington between 2008 and 2013. Symptom duration, patient age, and the degree of esophageal dilation (stage 1-3) as assessed by radiography were determined. We defined treatment failure as no improvement in symptoms and/or need for a second therapy within 1 year. Long-term follow-up data of 25 patients were available in the form of a survey evaluating overall satisfaction with the operation.
RESULTS: The distribution of patients according to subtype included 13 with type I, 54 with type II, and 5 with type III. All of the type I patients had some degree of esophageal dilation on radiography, whereas no dilation was found in the type III group. All patients underwent uneventful laparoscopic-extended Heller myotomy. Two patients were classified as failures, including one with type I and one with type II achalasia; however, further investigation revealed the cause of both failures to be the development of peptic stricture. Only one of the 25 patients with long-term follow-up reported dissatisfaction with the treatment result and indicated persistent chest pain without dysphagia.
CONCLUSIONS: Laparoscopic-extended Heller myotomy is a highly successful treatment for patients with achalasia and outcomes do not appear to vary significantly according to the manometric subtype. Failures may result from reflux in patients who develop esophagitis or stricture. Chest pain is not always responsive to esophagogastric myotomy despite relief of dysphagia.

PMID: 28451814 [PubMed - as supplied by publisher]

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Dysphagia Rates after Anterior Cervical Diskectomy and Fusion: A Systematic Review and Meta-Analysis.

Related Articles

Dysphagia Rates after Anterior Cervical Diskectomy and Fusion: A Systematic Review and Meta-Analysis.

Global Spine J. 2017 Feb;7(1):95-103

Authors: Shriver MF, Lewis DJ, Kshettry VR, Rosenbaum BP, Benzel EC, Mroz TE

Abstract
STUDY DESIGN:  Systematic review and meta-analysis.
OBJECTIVE: Anterior cervical diskectomy and fusion (ACDF) is an effective surgical option for patients with cervical radiculopathy, myelopathy, or deformity. Although ACDF is generally safe, dysphagia is a common complication. Despite its high incidence, prolonged postoperative dysphagia is poorly understood; its etiology remains relatively unknown, and its risk factors are widely debated.
METHODS: We searched MEDLINE, Scopus, Web of Science, and Embase for studies reporting complications for cervical diskectomy with plating. We recorded dysphagia events from all included studies and calculated effect summary values, 95% confidence intervals (CIs), Q values, and I(2) values.
RESULTS: Of the 7,780 retrieved articles, 14 met inclusion criteria. The overall dysphagia rate was 8.5% (95% CI 5.7 to 11.3%). The rate of moderate or severe dysphagia was 4.4% (0.4 to 8.4%). Follow-up times of <12, 12 to 24, and >24 months reported rates of 19.9% (6.0 to 33.7%), 7.0% (5.2 to 8.7%), and 7.6% (1.4 to 13.8%), respectively. Studies utilizing the Bazaz Dysphagia Score resulted in an increase in dysphagia diagnosis relative to studies with no outlined criteria (19.8%, 5.9 to 33.7% and 6.9%, 3.7 to 10.0%, respectively), indicating that the criteria used for dysphagia identification are critical. There was no difference in dysphagia rate with the use of autograft versus allograft.
CONCLUSIONS: This review represents a comprehensive estimation of the actual incidence of dysphagia across a heterogeneous group of surgeons, patients, and criteria. The classification scheme for dysphagia varied significantly within the literature. To ensure its diagnosis and identification, we recommend the use of a standardized, well-outlined method for dysphagia diagnosis.

PMID: 28451514 [PubMed - in process]

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Evaluation of Adverse Events in Total Disc Replacement: A Meta-Analysis of FDA Summary of Safety and Effectiveness Data.

Related Articles

Evaluation of Adverse Events in Total Disc Replacement: A Meta-Analysis of FDA Summary of Safety and Effectiveness Data.

Global Spine J. 2017 Apr;7(1 Suppl):76S-83S

Authors: Anderson PA, Nassr A, Currier BL, Sebastian AS, Arnold PM, Fehlings MG, Mroz TE, Riew KD

Abstract
STUDY DESIGN: Systematic review and meta-analysis.
OBJECTIVES: The safety of new technology such as cervical total disc replacement (TDR) is of paramount importance and is best evaluated in randomized clinical trials (RCT). We compared complication risks of TDR to fusion using data from Investigational Device Exemptions.
METHODS: A systematic review of FDA Summary of Safety and Effectiveness reports of the 8 approved cervical TDRs was performed. These were all randomized controlled trials comparing anterior cervical discectomy and fusion (ACDF) to TDR. Important outcome variables were dysphagia, wound infection, neurologic injuries, heterotopic ossification, death, and secondary surgeries. A random effects model was selected a priori. Data on adverse events was abstracted and analyzed by calculating relative risk of ACDF to TDR by meta-analysis techniques.
RESULTS: The study included 3027 patients with 1377 randomized to ACDF and 1652 to TDR. No statistical differences were present between the 2 groups in dysphagia/dysphonia, hardware related, heterotopic ossification, death, and overall neurologic adverse events and incidence of neurologic deterioration. The relative risk of wound-related problems ACDF to TDR was 0.76 (95% confidence interval [CI] = 0.59, 0.98) favoring ACDF, which was statistically significant, but these were minor and never required a second surgical procedure for deep wound infection. The relative risk of ACDF to TDR in surgical-related neurologic events and secondary surgeries was 1.62 (95% CI = 1.04, 2.53) and 1.79 (95% CI = 1.17, 2.74), both favoring TDR.
CONCLUSIONS: Cervical TDR appears to be as safe as or safer than ACDF at 2-year follow-up.

PMID: 28451497 [PubMed - in process]

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[Costal metastasis revealing esophageal squamous cell carcinoma].

Related Articles

[Costal metastasis revealing esophageal squamous cell carcinoma].

Pan Afr Med J. 2017;26:23

Authors: Gueye MN, Diouf G, Dia D, Boye A, Fall T, Diémé JL, Ba O, Mbengue M

Abstract
Esophageal cancer is associated with poor prognosis. Its severity is linked to delayed diagnosis which is most often made once a cancer has metastasized, in Africa. Costal metastases are rare. We report a case of a 38-year old Senegalese patient with squamous cell carcinoma of the lower esophagus with lytic metastases to the ribs. Mrs. TD, aged 38, was admitted with painful swelling in right hemithorax associated with weight loss. The patient also reported mechanical dysphagia evolving during 4 months which had not motivated consultation. Clinical examination showed a poor general condition, a hard, sensitive swelling measuring 3 cm along its longer axis, located on the anterolateral surface of the right hemithorax at the level of the 5(th)rib. Biological examinations showed normocytic normochromic anemia with hemoglobin level of 9.4 g/dl, non-specific biological inflammatory syndrome, and hypercalcemia (corrected calcium = 107 mg/l. Oesogastroduodenal endoscopy showed a ulcerative, budding, stenotic lesion 32 cm from the dental arches. Anatomopathological examination of the biopsies revealed moderately differentiated squamous cell carcinoma. In addition to oesophageal tumor, thoracoabdominal-pelvic computed tomography showed bone lysis involving the anterior arch of the 5(th) rib, carcinomatous pulmonary nodules and bilateral pleural effusion. Pleural fluid aspiration through an exploratory needle showed serohematic fluid and the cytological examination of this fluid objectified carcinomatous cells. The diagnosis of squamous cell carcinoma of the lower esophagus with rib, pleural and pulmonary metastases was retained and palliative treatment was initiated. The evolution was marked by the death of the patient 3 months after gastrostomy, within a context of respiratory distress. The originality of this observation is related to the atypical seat of metastases of this cancer of the esophagus as well as the risk factors of this tumor. Cancer of the esophagus in young adults is a major problem in Africa. The challenge is to determine its risk factors in order to prevent its occurrence.

PMID: 28451002 [PubMed - in process]

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Banhasasim-Tang Treatment Reduces the Severity of Esophageal Mucosal Ulcer on Chronic Acid Reflux Esophagitis in Rats.

Related Articles

Banhasasim-Tang Treatment Reduces the Severity of Esophageal Mucosal Ulcer on Chronic Acid Reflux Esophagitis in Rats.

Biomed Res Int. 2017;2017:7157212

Authors: Shin MR, Seo BI, Son CG, Roh SS, An HJ

Abstract
The present study was conducted to evaluate both antioxidant and anti-inflammatory activity of Banhasasim-tang (BHSST) on chronic acid reflux esophagitis (CRE) model. Rat CRE model was established operatively and then treated with BHSST (1 g/kg body weight per day) for 15 days Esophageal pathological changes were analyzed using macroscopic examination and hematoxylin/eosin staining. The antioxidant and inflammatory protein levels were determined using Western blotting. The administration of BHSST significantly reduced both the overexpression of serum reactive oxygen species (ROS) and an excessive formation of thiobarbituric acid-reactive substances (TBARS) in esophagus tissue. Thus, the severity of esophageal ulcer was lower in BHSST treated rats than control rats on the gross and histological evaluation. Nuclear factor-erythroid 2-related factor 2 (Nrf2) led to the upregulation of antioxidant enzyme including SOD, GPx-1/2, and HO-1 by binding to antioxidant response element (ARE). Moreover, BHSST administration markedly reduced the expression of inflammatory proteins through mitogen-activated protein kinase- (MAPK-) related signaling pathways and decreased significantly the protein expressions of inflammatory mediators and cytokines by inhibition of nuclear factor-kappa B (NF-κB) activation. Taken together, these results support the fact that BHSST administration can suppress the development of esophageal mucosal ulcer via regulating inflammation through the activation of the antioxidant pathway.

PMID: 28349065 [PubMed - indexed for MEDLINE]

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Incidental Finding of Oleothorax.

Related Articles

Incidental Finding of Oleothorax.

N Engl J Med. 2017 Mar 23;376(12):e21

Authors: Koratala A, Bhatti V

PMID: 28328345 [PubMed - indexed for MEDLINE]

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Asymptomatic medial vocal fold hemorrhagic polyp.

Related Articles

Asymptomatic medial vocal fold hemorrhagic polyp.

Ear Nose Throat J. 2016 Jun;95(6):210

Authors: Kantarcioglu OE, Rutt AL, Sataloff RT

PMID: 27304436 [PubMed - indexed for MEDLINE]

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Poorly Controlled Congenital Hypothyroidism due to an Underlying Allgrove Syndrome.

Related Articles

Poorly Controlled Congenital Hypothyroidism due to an Underlying Allgrove Syndrome.

Horm Res Paediatr. 2016;86(6):420-424

Authors: van Tellingen V, Finken MJ, Israëls J, Hendriks YM, Kamp GA, van Santen HM

Abstract
BACKGROUND: Congenital hypothyroidism of thyroidal origin (CHT) is a common disorder in pediatric endocrinology practices, which can be difficult to manage. Elevated thyrotropin (TSH) concentrations are in the great majority of cases explained by poor compliance to levothyroxine therapy.
METHODS: Case description.
RESULTS: We present a boy with CHT, with 2 heterozygous mutations in the TSH receptor gene, who showed persistently elevated TSH concentrations and psychomotor retardation, initially misinterpreted as malcompliance. At the age of 4 years, he was diagnosed with adrenal insufficiency, wherefore a broad diagnostic search was initiated. After the start of glucocorticoid replacement therapy, his TSH normalized and the levothyroxine could be lowered. At the age of 6 years, his TSH increased again, this time caused by malabsorption of levothyroxine due to esophageal achalasia. In retrospect, alacrima was also present and the diagnosis of Allgrove syndrome was genetically confirmed. The CHT was considered a separate disease entity.
CONCLUSIONS: In case of persistently elevated TSH levels in children with CHT, causes other than noncompliance must be considered. Second, in establishing the cause of adrenal insufficiency, specific symptoms, such as alacrima, are easily overlooked. Third, Allgrove syndrome is a rare disorder, in which diagnostic delay can lead to potentially life-threatening complications.

PMID: 27255745 [PubMed - indexed for MEDLINE]

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Cervical disc herniation causing difficulty swallowing.

Related Articles

Cervical disc herniation causing difficulty swallowing.

Ear Nose Throat J. 2016 Apr-May;95(4-5):148

Authors: Cheng SY, Lee JC

PMID: 27140012 [PubMed - indexed for MEDLINE]

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Distal sensory to distal motor nerve anastomosis can protect lower extremity muscle atrophy in a murine model

Abstract

Background

Delayed reinnervation of denervated motor neuron has irreversible consequences. We introduced distal motor to distal sensory anastomosis (DDSA) as a practical, time-saving method to protect injured motor neurons and its target tissues.

Methods

Two experimental groups of Wistar rats were studied. In DDSA group, the distal end of the tibial sensory nerve of the left leg was anastomosed to the distal common peroneal nerve. The same nerves were dissected without anastomosis in the control group. Four months later, visual functional assessment of sciatic nerves was performed, and histological structures of the nerves and muscles and ultra-structure of nerves were evaluated.

Results

Significant enhancement was seen in intermediate toe spread factor in DDSA group (P < 0.05), but toe spread factor and subsequently sciatic statistic index demonstrated no significant improvement. The surgical procedures resulted in an ipsilateral rehabilitation in DDSA group with statistically significant (P < 0.05) improvement in muscle weight and myelinated axon count. Light and electron microscopy evaluations of the histological specimen showed obvious prevention of nerve and muscle tissues degeneration following anastomosis.

Conclusions

Overall, DDSA showed a peripheral nerve could repair, survive, and protect target tissues from degeneration without connection to their cell bodies and central nervous system. Some possible explanations for these positive results could be the restorative role of electrochemical signaling directly from the skin sensory nerve receptors and stimulation of Schwann cell to convert to its regenerative phenotype.

Level of Evidence: Not ratable.

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Optimal needle length for epinephrine prefilled syringe in children

Publication date: Available online 29 April 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Wiparat Manuyakorn, Buntita Bamrungchaowkasem, Nichanan Ruangwattanapaisarn, Wasu Kamchaisatian, Suwat Benjaponpitak




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Successful management of hereditary angioedema during pregnancy in a patient with heterozygous MTHFR mutation

Publication date: Available online 29 April 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Inmaculada Martinez Saguer, Carmen Escuriola Ettingshausen




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Effects of acute morning and evening exercise on subjective and objective sleep quality in older individuals with insomnia

Publication date: June 2017
Source:Sleep Medicine, Volume 34
Author(s): Yuko Morita, Taeko Sasai-Sakuma, Yuichi Inoue
ObjectivesThe aims of this study were to compare the effects of acute morning or evening exercise on nocturnal sleep in individuals with two subjective insomnia symptoms: difficulty in initiating sleep (DIS), and early morning awakening (EMA), separately for the first vs the second halves of the night.MethodsOlder individuals (55–65 years old) with DIS (N = 15) or EMA (N = 15) and age- and sex-matched controls (N = 13) participated in this non-randomized crossover study. Participants were assigned to two exercise conditions (morning exercise and evening exercise) in counterbalanced order following the baseline condition with a two-week interval between conditions. A single session of aerobic step exercise was performed during each exercise condition. Nocturnal polysomnography was carried out to evaluate objective sleep quality. Patient global impression of change scale scores for nocturnal sleep were obtained to subjectively evaluate the different groups.ResultsAcute physical exercise did not improve subjective sleep quality. Morning exercise decreased the number of stage shifts over the whole night. The arousal index and the number of stage shifts were decreased especially during the second half of the night in all groups. Furthermore, morning exercise decreased the number of wake stages during the second half of the night in the DIS group, but not in the EMA group.ConclusionsAcute morning exercise can improve nocturnal sleep quality in individuals with difficulty initiating sleep, especially during the later part of the night.



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Effects of acute morning and evening exercise on subjective and objective sleep quality in older individuals with insomnia

Publication date: June 2017
Source:Sleep Medicine, Volume 34
Author(s): Yuko Morita, Taeko Sasai-Sakuma, Yuichi Inoue
ObjectivesThe aims of this study were to compare the effects of acute morning or evening exercise on nocturnal sleep in individuals with two subjective insomnia symptoms: difficulty in initiating sleep (DIS), and early morning awakening (EMA), separately for the first vs the second halves of the night.MethodsOlder individuals (55–65 years old) with DIS (N = 15) or EMA (N = 15) and age- and sex-matched controls (N = 13) participated in this non-randomized crossover study. Participants were assigned to two exercise conditions (morning exercise and evening exercise) in counterbalanced order following the baseline condition with a two-week interval between conditions. A single session of aerobic step exercise was performed during each exercise condition. Nocturnal polysomnography was carried out to evaluate objective sleep quality. Patient global impression of change scale scores for nocturnal sleep were obtained to subjectively evaluate the different groups.ResultsAcute physical exercise did not improve subjective sleep quality. Morning exercise decreased the number of stage shifts over the whole night. The arousal index and the number of stage shifts were decreased especially during the second half of the night in all groups. Furthermore, morning exercise decreased the number of wake stages during the second half of the night in the DIS group, but not in the EMA group.ConclusionsAcute morning exercise can improve nocturnal sleep quality in individuals with difficulty initiating sleep, especially during the later part of the night.



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The Effect of Ventilating Tubes in Young Children with Recurrent Acute Otitis Media: an Update of the Literature

Abstract

Purpose of Review

Ventilating tube treatment (VT) is a common surgical procedure in preschool children. Twenty to fifty percent of children treated with VT suffer from recurrent acute otitis media (RAOM). The aim of this review is to update current knowledge on the topic.

Recent Findings

There is still controversy regarding the use of VT for children with RAOM. So far, only six randomized trials have been published. From the limited data pool, it seems that children with RAOM treated with VT experienced less time with acute otitis media and experienced less recurrence compared to controls. However, no difference in quality of life was found between subgroups in one trial.

Summary

Children with RAOM seem to benefit from VT on objective parameters, especially if middle ear effusion is present in between acute episodes. There is a need for more high quality evidence on the subjective domains such as disease severity and quality of life.

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Guidelines for the Treatment of Acute Otitis Media: Why Are There Worldwide Differences?

Abstract

Purpose of Review

This study aims to review differences between acute otitis media (AOM) diagnosis and treatment guidelines from different countries, with regards to the aspects of diagnostic criteria and methods, supplementary tests, treatment options, recommended first-, second-, and third-line antibiotics, non-antibiotic treatment options, and preventive means and measures.

Recent Findings

Tympanic membrane (TM) bulging, opacity, and presence of middle ear fluid are the pillars for diagnosis, as marginal/uncertain cases are not accepted anymore. Guidelines from developed countries offer the use of pneumatic otoscopy and tympanometry to aid diagnosis. Withholding antibiotic therapy and a "watchful waiting" in mild-moderate cases are preferred in settings where follow-up visits are both possible and attainable, mostly in developed countries. While amoxicillin is mostly accepted as the first-line antibiotic therapy, options for second- and third-line antibiotics vary, according to local bacteriology and antimicrobial susceptibility data and costs. Other treatments, such as complementary and alternative medicine, steroids, or anti-histamines, are either rejected or ignored. Reduction of known risk factors and call for vaccinations (influenza, pneumococcal conjugate vaccine) are encouraged mostly in developed countries, where such immunizations have been implemented in National Immunization Programs.

Summary

Despite regional differences, AOM guidelines worldwide share common grounds on various matters concerning diagnosis and management: diagnosis based on TM findings observed on otoscopy and/or pneumatic otoscopy or tympanometry, "watchful waiting" approach in appropriate cases, oral analgesic treatment using ibuprofen/paracetamol, reduction of risk factors, and preventive measures to reduce AOM.

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The Effect of Ventilating Tubes in Young Children with Recurrent Acute Otitis Media: an Update of the Literature

Abstract

Purpose of Review

Ventilating tube treatment (VT) is a common surgical procedure in preschool children. Twenty to fifty percent of children treated with VT suffer from recurrent acute otitis media (RAOM). The aim of this review is to update current knowledge on the topic.

Recent Findings

There is still controversy regarding the use of VT for children with RAOM. So far, only six randomized trials have been published. From the limited data pool, it seems that children with RAOM treated with VT experienced less time with acute otitis media and experienced less recurrence compared to controls. However, no difference in quality of life was found between subgroups in one trial.

Summary

Children with RAOM seem to benefit from VT on objective parameters, especially if middle ear effusion is present in between acute episodes. There is a need for more high quality evidence on the subjective domains such as disease severity and quality of life.

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Guidelines for the Treatment of Acute Otitis Media: Why Are There Worldwide Differences?

Abstract

Purpose of Review

This study aims to review differences between acute otitis media (AOM) diagnosis and treatment guidelines from different countries, with regards to the aspects of diagnostic criteria and methods, supplementary tests, treatment options, recommended first-, second-, and third-line antibiotics, non-antibiotic treatment options, and preventive means and measures.

Recent Findings

Tympanic membrane (TM) bulging, opacity, and presence of middle ear fluid are the pillars for diagnosis, as marginal/uncertain cases are not accepted anymore. Guidelines from developed countries offer the use of pneumatic otoscopy and tympanometry to aid diagnosis. Withholding antibiotic therapy and a "watchful waiting" in mild-moderate cases are preferred in settings where follow-up visits are both possible and attainable, mostly in developed countries. While amoxicillin is mostly accepted as the first-line antibiotic therapy, options for second- and third-line antibiotics vary, according to local bacteriology and antimicrobial susceptibility data and costs. Other treatments, such as complementary and alternative medicine, steroids, or anti-histamines, are either rejected or ignored. Reduction of known risk factors and call for vaccinations (influenza, pneumococcal conjugate vaccine) are encouraged mostly in developed countries, where such immunizations have been implemented in National Immunization Programs.

Summary

Despite regional differences, AOM guidelines worldwide share common grounds on various matters concerning diagnosis and management: diagnosis based on TM findings observed on otoscopy and/or pneumatic otoscopy or tympanometry, "watchful waiting" approach in appropriate cases, oral analgesic treatment using ibuprofen/paracetamol, reduction of risk factors, and preventive measures to reduce AOM.

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Singing Lessons for Respiratory Health: A Literature Review

Publication date: Available online 29 April 2017
Source:Journal of Voice
Author(s): Rachel B. Goldenberg
ObjectiveSeveral studies have explored the role of music and singing as a treatment for respiratory symptoms. The objective of this paper was to review the current body of literature in regard to the use of singing as both a physiological and a psychological therapy for respiratory disease and assess the role the singing teacher might play in this treatment.Study DesignThis is a literature review, discussion of results and directions for further research.MethodMultiple databases were searched using keywords such as "respiratory," "physiotherapy," and "pulmonary" in conjunction with "singing." Studies that met selection criteria were summarized and analyzed.ResultsSeventeen studies pertaining to multiple conditions including chronic obstructive pulmonary disease, asthma, cystic fibrosis, cancer, Parkinson disease, quadriplegia, and multiple sclerosis were analyzed. All studies reported trends of positive physical and/or quality of life outcomes after a series of singing lessons, regardless of statistical significance. Several noted improvements in maximum expiratory pressure and overall breathing technique. Many studies included open-ended interviews revealing participants' perception of singing as an effective therapy that was fun, improved mood, taught breathing and breath control, was a good exercise for the lungs, and had improved physical functioning.ConclusionsSinging can be used as an adjunctive treatment for respiratory disease, with the best results occurring after long-term study. Group lessons and a strong teacher relationship feed the need for social interaction and support, which can facilitate treatment compliance. Further research is warranted.



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Infant-directed speech in English and Spanish: Assessments of monolingual and bilingual caregiver VOT

Publication date: July 2017
Source:Journal of Phonetics, Volume 63
Author(s): Melanie S. Fish, Adrián García-Sierra, Nairán Ramírez-Esparza, Patricia K. Kuhl
It has been shown that monolingual caregivers exaggerate acoustic speech cues in infant-directed speech (IDS), but less is known about the characteristics of IDS in late second-language (L2) bilingual caregivers. Furthermore, there is inconsistency in the literature regarding voice onset time (VOT) of stop consonants in IDS. The present study explores VOT of English and Spanish stops in English monolingual and Spanish-dominant bilingual caregivers, in infant- versus adult-directed speech registers. Both monolinguals and bilinguals exaggerate VOT in IDS; however, different patterns are noted across consonant type and language context. Also, bilinguals produced English stops with Spanish-like and English-like properties, depending upon their L2-proficiency. The characteristics of late-L2 Spanish–English bilingual IDS may create a complex phonetic environment for infants, which may in turn affect the perception and later production of stop consonants in dual language-learning infants.



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Editorial Board / Subscription Information

Publication date: May 2017
Source:Journal of Phonetics, Volume 62





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Gemination and degemination in English prefixation: Phonetic evidence for morphological organization

Publication date: May 2017
Source:Journal of Phonetics, Volume 62
Author(s): Sonia Ben Hedia, Ingo Plag
This paper addresses the problem of morpho-phonological variability and the role of phonetic detail in morphologically complex words by investigating the gemination behavior of the English prefixes un- and in-. Traditionally, it is assumed that un- geminates while in- degeminates, but empirical studies are rare and not conclusive. This paper presents the first study that uses data from natural speech (Switchboard Corpus, Godfrey and Holliman 1997). It is shown that both prefixes geminate, contra large parts of the literature. Furthermore, there is a difference in nasal duration between un-, negative in- and locative in-. The more segmentable the prefix the longer the nasal duration. The results challenge widely-shared assumptions in morphological theory, lexical phonology and models of speech production, and support models in which the strength of morphological boundaries may impact on the durational properties of complex words.



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Listeners respond to phoneme-specific spectral information when assessing speaker size from speech

Publication date: July 2017
Source:Journal of Phonetics, Volume 63
Author(s): Santiago Barreda
Spectral information in speech sounds varies as a function of linguistic content, as well as the vocal-tract length (VTL) of the speaker. It is usually considered that human listeners rely on VTL information when assessing apparent speaker-size. However, a recent experiment (Barreda, 2016) found that listeners respond to the specific spectral-content of speech sounds rather than simply responding to speaker VTL information. This results in biases towards identifying certain phonemes with larger speakers independently of VTL information. To investigate this, listeners were asked to judge relative speaker-size based on vowel pairs differing in vowel quality and/or apparent speaker VTL. Additionally, one group of listeners was asked to report relative-height differences, while another group was trained to report relative-VTL differences directly. Results indicate that both groups of listeners exhibited substantial biases towards associating certain phonemes with larger speakers. In addition, listeners showed substantial variation both in their sensitivity to specific acoustic cues, and in their general approach to speaker size estimation. For example, some listeners rely primarily on VTL cues while others rely heavily on phoneme-specific spectral information.



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The direct and indirect effects of the phonotactic constraints in the listener’s native language on the comprehension of reduced and unreduced word pronunciation variants in a foreign language

Publication date: May 2017
Source:Journal of Phonetics, Volume 62
Author(s): Mirjam Ernestus, Huib Kouwenhoven, Margot van Mulken
This study investigates how the comprehension of casual speech in foreign languages is affected by the phonotactic constraints in the listener's native language. Non-native listeners of English with different native languages heard short English phrases produced by native speakers of English or Spanish and they indicated whether these phrases included can or can't. Native Mandarin listeners especially tended to interpret can't as can. We interpret this result as a direct effect of the ban on word-final /nt/ in Mandarin. Both the native Mandarin and the native Spanish listeners did not take full advantage of the subsegmental information in the speech signal cueing reduced can't. This finding is probably an indirect effect of the phonotactic constraints in their native languages: these listeners have difficulties interpreting the subsegmental cues because these cues do not occur or have different functions in their native languages. Dutch resembles English in the phonotactic constraints relevant to the comprehension of can't, and native Dutch listeners showed similar patterns in their comprehension of native and non-native English to native English listeners. This result supports our conclusion that the major patterns in the comprehension results are driven by the phonotactic constraints in the listeners' native languages.



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An acoustic-articulatory study of bilingual vowel production: Advanced tongue root vowels in Twi and tense/lax vowels in Ghanaian English

Publication date: May 2017
Source:Journal of Phonetics, Volume 62
Author(s): Sam Kirkham, Claire Nance
This article investigates the acoustic and articulatory correlates of vowel contrasts in bilingual speakers. We analyse data from bilingual speakers of Twi (Akan) and Ghanaian English, with the aim of examining how the production of the advanced tongue root vowel contrast in Twi relates to the production of the tense/lax vowel contrast in Ghanaian English. These data are compared to tense/lax vowel data from monolingual British English speakers. The acoustic results show that Twi and Ghanaian English mainly rely on F1 for distinguishing [ATR] and [TENSE] vowels, whereas British English uses F1, F2, F3 and duration for the [TENSE] contrast. The ultrasound tongue imaging data show tongue root distinctions across all languages, while there are consistent tongue height distinctions in British English, no height distinctions in Ghanaian English, and small height distinctions for some vowels in Twi. Twi has the weakest correlation between F1 and tongue root advancement, which suggests that the [ATR] contrast may involve additional strategies for pharyngeal cavity expansion that are not present in [TENSE] vowels. In doing so, we show that bilinguals produce similar contrasts in similar ways across their two languages, but that language-specific differences also persist, which may reflect different articulatory goals in each language.



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Integrating the discreteness and continuity of intonational categories

Publication date: Available online 26 April 2017
Source:Journal of Phonetics
Author(s): Martine Grice, Simon Ritter, Henrik Niemann, Timo B. Roettger
It has already been observed that there is no one-to-one mapping between intonational categories and the pragmatic functions they are used to express. For instance, in German a particular pitch accent (L+H^∗) is often used to express contrastive (corrective) focus, but neither is the use of this pitch accent confined to this function nor is this the only pitch accent used to express it. In particular, there are considerable differences across speakers in the use of pitch accents and the functions they express. In this paper we look at the phonetic parameters that are characteristic of each of these pitch accents (f0 peak alignment, tonal onglide and target height) and observe a striking similarity across speakers: All speakers modulate each parameter in the same direction, e.g. the f0 peak is aligned later for contrastive focus than for narrow focus. Whereas for some speakers this is transcribed as two different pitch accents (L+H^∗ vs. H^∗), for others it is not, and the peak alignment is treated as phonetic variation within one accent type (H^∗). To capture both the differences and similarities in intonation, we therefore argue for an integrated analysis of the discrete phonological pitch accents and the modulation of continuous phonetic parameters that characterise them.



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Erratum to “An acoustic-articulatory study of bilingual vowel production: Advanced tongue root vowels in Twi and tense/lax vowels in Ghanaian English” [J. Phon. 62 (2017) 65–81]

Publication date: Available online 23 April 2017
Source:Journal of Phonetics
Author(s): Sam Kirkham, Claire Nance




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The phonetic specificity of competition: Contrastive hyperarticulation of voice onset time in conversational English

Publication date: Available online 23 March 2017
Source:Journal of Phonetics
Author(s): Noah Richard Nelson, Andrew Wedel
Competition between words in the lexicon is associated with hyperarticulation of phonetic properties in production. This correlation has been reported for metrics of competition varying in the phonetic specificity of the relationship between target and competitor (e.g., neighborhood density, onset competition, cue-specific minimal pairs). Sampling a systematic array of competition metrics, we tested their ability to predict voice onset times in both voiced and voiceless word-initial stops of conversational English. Linear mixed effects models were compared according to their corrected Akaike's Information Criterion (AICc) values. High-performing models were evaluated using evidence ratios, with the competition metrics of top-performing models tested for significance using nested model comparisons. Words with a minimal pair defined for initial stop voicing were contrastively hyperarticulated, with shorter voice onset times for voiced stops and longer voice onset times for voiceless stops. No other competition metric reliably predicted hyperarticulation for both stop types. These results suggest that contrastive hyperarticulation is phonetically specific, increasing the perceptual distance between target and competitor.



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Exertive modulation of speech and articulatory phasing

Publication date: Available online 21 March 2017
Source:Journal of Phonetics
Author(s): Sam Tilsen
An articulatory study was conducted to investigate whether fluctuations in exertive mechanisms (attention, effort, motivation, arousal, etc.) have a global effect on articulatory control systems. Participants in the experiment produced an articulatory pattern 400 times, attempting to do so as consistently as possible. Evidence for global exertive modulation was obtained in the form of widespread correlations between variables associated with biomechanically independent systems such as phonation, linguo-labial coordination, and head movement/posture. Analyses of movement timing autocorrelation showed evidence for random walk-like dynamics on short timescales and equilibrium dynamics on long timescales, along with evidence for low- and high-exertion states of production. An extension of the coupled oscillators model of articulatory coordination is presented to account for these phenomena.



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Letter to “Covered versus uncovered metal stents for malignant gastric outlet obstruction. Systematic review and metaanalysis” Dig Endosc doi 10.1111/den.12786

Abstract

We prospectively analyzed the clinical outcomes of 72 patients (2,3) and we came to similar conclusions. Conceptually, covered stents present the advantage to prevent tumor ingrowth within the stent, and, being more compliant, they could facilitate pyloric motility. However, they dislodge more easily, and distal migration of the stent can lead to serious consequences (4).

This article is protected by copyright. All rights reserved.

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Endoscopists should keep up with the current trends of antithrombotic therapy in other fields

Abstract

Endoscopy plays an important role in the clinical daily practice of diagnosis and treatment in gastrointestinal diseases. Aggressive endoscopists have been developing novel endoscopic procedures for various diseases that had been treated by surgery a few decades ago [1-3]. However, bleedings associated with endoscopic procedures are still inextricable complications and major concerns for endoscopists even though endoscopic procedures are less invasive compared to surgery. On the other hand, as the number of patients receiving antithrombotics is increasing in the clinical daily practice, endoscopists encounter more patients who require endoscopic procedures during antithrombotic therapy [4]. Antithrombotics decrease the risks of thromboembolism although they also increase the risks of gastrointestinal bleeding at the same time. From that standpoint, cessation during periendoscopic periods seems preferable although careless cessations of antithrombotics bring the unfortunate events of thromboembolism. Thus, the management of antithrombotics in such patients during periendoscopic period has remained a great dilemma for endoscopists.

This article is protected by copyright. All rights reserved.

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