Sutureless approach with vein grafts and mesenchymal stem cells in primary nerve repair: Functional and immunohistological results

Abstract

Purpose

The aim of this study was to define a sutureless peripheral nerve repair technique with a vein graft and bone marrow-derived stem cells (BMSC) and compare it to epineural repair.

Materials and methods

Thirty Wistar Albino rats were divided into five groups evenly. In the control group (C), epineural repair was performed. In the SV (suture + vein) and MSV (BMSC + suture + vein) groups, epineural repair was wrapped with a vein graft. In the V (vein) and MV (vein + BMSC) groups, sutureless repair using a vein graft was performed by taking sutures away from the regeneration site. Rats were evaluated with pinprick, toe spread tests and sciatic nerve index (SFI) at 4th, 8th, and 12th weeks. They were sacrificed at 12th week, repair sites were harvested and evaluated immunohistochemically.

Results

There was no difference in pinprick and toe spread tests between the groups at 12th week. The mean SFI was −76.5 ± 3.7, −65.2 ± 11.7, −46.2 ± 19.4, −68.8 ± 9.8, −56 ± 8.8 in the C, SV, MSV, V, MV groups, respectively. The MSV group showed significantly the best SFI results (P < .05). NF-H immunostaining scores were as C; 1 ± 0.18, SV; 2.5 ± 0.36, MSV; 4 ± 0.49, V; 1.56 ± 0.54, MV; 3 ± 0.39, whereas GAP-43 scores were as C; 1 ± 0.31, SV; 2.66 ± 0.56, MSV; 4.50 ± 0.23, V; 2 ± 0.23, MV; 3 ± 0.6. The best nerve regeneration according to immunostaining results was observed in the MSV group (P < .05). The mean fibrosis area was 221.5 ± 25.9, 101.6 ± 7.1, 121.3 ± 18.8, 150.3 ± 12.1, 152.4 ± 11.8 μm² in the above groups, respectively. SV and MSV groups showed the significantly less fibrosis area (P < .05).

Conclusion

Epineural suture repair combined with vein wrapping and BMSCs (MSV) showed the best SFI, GAP-43, and NF-H immunostaining results.

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Orbital Hobnail Hemangioma

A 64-year-old woman presented with a 1 year history of progressive left proptosis and "blurry vision." Imaging studies revealed a left superior orbital mass distorting the optic nerve and superior rectus muscle. Excisional biopsy established the diagnosis of hobnail hemangioma. This report describes the first case of an orbital hobnail hemangioma, a lesion that more commonly presents in the dermis. Accepted for publication January 29, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Paul D. Langer, M.D., F.A.C.S., Rutgers New Jersey Medical School, Doctors Office Center, Suite 6100, P.O. Box 1709, Newark, NJ 07101-1709. E-mail: planger@njms.rutgers.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Fibrous Histiocytoma of the Lacrimal Sac in an 11-Year-Old Male

Fibrous histiocytoma is a soft tissue tumor with cells resembling both fibroblasts and histiocytes. Occasionally in the orbit, they rarely arise in the lacrimal sac. Similar to prior cases described, the patient presented with symptoms of epiphora and a slowly enlarging mass inferior to the right medial canthus. Imaging demonstrated a circumscribed 1.2 cm × 1.1 cm × 1.1 cm mass within the lacrimal sac without surrounding bony destruction. Grossly, the tumor appeared homogenous and rubbery. Pathologic study results from the case demonstrated zones of hypercellularity and hypocellularity with a fibrous appearance, admixed with spindle cells and collections of foamy histiocytes. A diagnosis of benign fibrous histiocytoma was rendered, with the patient experiencing a complete resolution of symptoms at subsequent follow up. To the authors' knowledge, this is the first reported solitary case report of a fibrous histiocytoma of the lacrimal sac in a pediatric patient. Accepted for publication January 5, 2018. The authors have no financial or conflict of interest to disclose. Address correspondence and reprint requests to Joseph A. Santamaria, M.D., San Antonio Military Medical Center, San Antonio, TX 78234. E-mail: joesantam3@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Are oral mucosal nevi potential precursors for oral mucosal melanoma?

Publication date: Available online 28 February 2018
Source:Oral Oncology
Author(s): A. Thirumal Raj, Shankargouda Patil, Chandini Rajkumar




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Fractional CO 2 laser for genitourinary syndrome of menopause in breast cancer survivors: clinical, immunological, and microbiological aspects

Abstract

The composition of vaginal microbiome in menopause and cancer survivor women changes dramatically leading to genitourinary syndrome of menopause (GSM) in up to 7% of patients. Recent reports suggest that laser therapy may be valuable as a not hormonal therapeutic modality. The aim of the present study was to evaluate the effects of fractional CO₂ laser treatment on the vaginal secretory pathway of a large panel of immune mediators, usually implicated in tissue remodeling and inflammation, and on microbiome composition in postmenopausal breast cancer survivors. The Ion Torrent PGM platform and the Luminex Bio-Plex platform were used for microbiome and immune factor analysis. The significant reduction of clinical symptoms and the non-significant changes in vaginal microbiome support the efficacy and safety of laser treatment. Moreover, the high remodeling status in vaginal epithelium is demonstrated by the significant changes in inflammatory and modulatory cytokine patterns. Laser therapy can be used for the treatment of GSM symptoms and does not show any adverse effects. However, further studies will be needed to clarify its long-term efficacy and other effects.

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Immunomodulatory effect of Polypodium leucotomos (Anapsos) in child palatine tonsil model

Recurrent tonsillitis might reduce the immunological capability of fighting against the infection of tonsil tissue. Polypodium leucotomos (Anapsos) immunomodulating effect has been subject of research in the last years. The aim of this research is to test the in vitro immunomodulating capacity of Anapsos in a child palatine tonsil explants model.

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Mainstream school readiness skills of a group of young cochlear implant users

The aims of the study were to compare the mainstream school readiness skills of young cochlear implant (CI) users to that of a group of normal hearing (NH) children and assessed the inter-rater agreement between parents and teachers on school readiness skills of the CI children.

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Long term platinum-induced ototoxicity in pediatric patients

Platinum-based chemotherapy treatments are effective against a variety of pediatric malignancies. However, its use can lead to permanent hearing loss. The aim of this study was to evaluate the long-term effect of platinum chemotherapy on hearing and evaluate its progression.

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The use of laryngeal mask airway for adenoidectomy

Airway management during adenoidectomy is traditionally performed through endotracheal intubation (ETT). Laryngeal mask airway (LMA) may be less stimulating to the airway and allow for shorter overall operating room time. Previous studies report LMA use during adenotonsillectomy. There has been no prior evaluation of LMA use during adenoidectomy alone. In this study, we attempt to identify the rate and contributing factors of LMA failure during adenoidectomy.

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Superiorly-based turnover skin flap: Pediatric tracheocutaneous fistula closure

To present a novel superiorly-based turnover skin flap for the primary repair of pediatric tracheocutaneous fistula closure, and to determine the efficacy and safety of this tracheocutaneous fistula turnover flap primary closure technique.

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Bilateral congenital cholesteatoma: A case report and review of the literature

Congenital cholesteatoma (CC) occurs less commonly than acquired cholesteatoma (AC), and bilateral CC (BCC) is even more rare with only 38 such cases having been reported in the past 42 years. Because of the rarity of this condition, providers confronted with cases of BCC may find it difficult to treat while balancing complete removal of disease, optimal hearing outcomes, and minimized surgical burden in the pediatric patient. This review alerts physicians that BCC occurs, highlights past presentations and management strategies, describes the considerations in treatment and offers an algorithm helpful in the management of BCC.

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Nationwide readmissions after tonsillectomy among pediatric patients - United States

1) Investigate incidence and predictors of readmissions after tonsillectomy with or without adenoidectomy (T&A) in children.2) Identify factors that may predict readmission.

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Diagnosis and treatment of paradoxical vocal fold motion in infants

Paradoxical vocal fold motion (PVFM) is a disorder often misdiagnosed in children presenting with shortness of breath and stridor. In infants, little is known about the clinical course and best approach for treatment of PVFM. This retrospective study assesses the approach to treatment and outcomes for infants with PVFM.

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Reply to: Comments on “Breast augmentation together with intraoperative glandular transposition flap for prevention and correction of lower pole deformities”

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Dental and skeletal changes associated with long-term oral appliance use for obstructive sleep apnea: A systematic review and meta-analysis

An oral appliance (OA) is an effective treatment option for patients with obstructive sleep apnea (OSA), but dental and skeletal changes have been detected by many studies after long-term OA use. Better understanding of the long-term side effects may decrease discontinuation of OA use and assist clinicians to make informed decisions. Accordingly, a systematic review and meta-analysis were performed to evaluate the dental and skeletal changes associated with OAs designed to advance the mandible. The quality of the studies was determined by using the risk of bias assessment tool for non-randomized studies (RoBANS), and 12 studies were included in the meta-analysis.

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Asthma exacerbation prediction: recent insights

Purpose of review Asthma attacks are frequent in children with asthma and can lead to significant adverse outcomes including time off school, hospital admission and death. Identifying children at risk of an asthma attack affords the opportunity to prevent attacks and improve outcomes. Recent findings Clinical features, patient behaviours and characteristics, physiological factors, environmental data and biomarkers are all associated with asthma attacks and can be used in asthma exacerbation prediction models. Recent studies have better characterized children at risk of an attack: history of a severe exacerbation in the previous 12 months, poor adherence and current poor control are important features which should alert healthcare professionals to the need for remedial action. There is increasing interest in the use of biomarkers. A number of novel biomarkers, including patterns of volatile organic compounds in exhaled breath, show promise. Biomarkers are likely to be of greatest utility if measured frequently and combined with other measures. To date, most prediction models are based on epidemiological data and population-based risk. The use of digital technology affords the opportunity to collect large amounts of real-time data, including clinical and physiological measurements and combine these with environmental data to develop personal risk scores. These developments need to be matched by changes in clinical guidelines away from a focus on current asthma control and stepwise escalation in drug therapy towards inclusion of personal risk scores and tailored management strategies including nonpharmacological approaches. Summary There have been significant steps towards personalized prediction models of asthma attacks. The utility of such models needs to be tested in the ability not only to predict attacks but also to reduce them.

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‘Hidden’ occupational allergens such as additives

Purpose of review With the development of innovative technologies, new agents are continually introduced to the workplace. Some of these agents can act as hidden allergens whenever they are not declared in the product labels or whenever their health hazards are unknown. This review article focuses on the identification and description of unusual and/or hidden allergens recently incriminated in occupational diseases. Recent findings Occupational exposure is an important global health issue that can induce respiratory and cutaneous disorders, as well as life-threatening anaphylaxis. Apart from the classic forms of occupational exposure, reports have emerged from nonconventional or newly identified allergens or additives. These compounds are substances added to another in order to alter or improve the general quality or to counteract undesirable properties, and some of them may behave as potent and frequently hidden allergens. These highly uncommon and/or hidden allergens belong to several categories: foods, spices, cosmetics, insects, enzymes, chemicals, drugs, preservatives, and coloring agents, among others. Summary A high level of suspicion and awareness about the potential hidden allergens is necessary to ascertain the allergens implicated. It is of utmost importance to identify the specific eliciting agents of the occupational diseases in order to avoid strictly further exposure to them.

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Evidence establishing a link between prenatal and early-life stress and asthma development

Purpose of review The objective of this review is to provide an update on our evolving understanding of the effects of stress in pregnancy and during early development on the onset of asthma-related phenotypes across childhood, adolescence, and into early adulthood. Recent findings Accumulating evidence over the past 2 decades has established that prenatal and early-life psychological stress and stress correlates (e.g., maternal anxiety or depression) increase the risk for childhood respiratory disorders. Recent systematic reviews and meta-analyses including numerous prospective epidemiological and case–control studies substantiate a significant effect of prenatal stress and stress in early childhood on the development of wheeze, asthma, and other atopic-related disorders (eczema and allergic rhinitis), with many studies showing an exposure–response relationship. Offspring of both sexes are susceptible to perinatal stress, but effects differ. The impact of stress on child wheeze/asthma can also be modified by exposure timing. Moreover, coexposure to prenatal stress can enhance the effect of chemical stressors, such as prenatal traffic-related air pollution, on childhood respiratory disease risk. Understanding complex interactions among exposure dose, timing, child sex, and concurrent environmental exposures promises to more fully characterize stress effects and identify susceptible subgroups. Although the link between perinatal stress and childhood asthma-related phenotypes is now well established, pathways by which stress predisposes children to chronic respiratory disorders are not as well delineated. Mechanisms central to the pathophysiology of wheeze/asthma and lung growth and development overlap and involve a cascade of events that include disrupted immune, neuroendocrine, and autonomic function as well as oxidative stress. Altered homeostatic functioning of these integrated systems during development can enhance vulnerability to asthma and altered lung development. Summary Mechanistic studies that more comprehensively assess biomarkers reflecting alterations across interrelated stress response systems and associated regulatory processes, in both pregnant women and young children, could be highly informative. Leveraging high-throughput systems-wide technologies to include epigenomics (e.g., DNA methylation, microRNAs), transcriptomics, and microbiomics as well as integrated multiomics are needed to advance this field of science. Understanding stress-induced physiological changes occurring during vulnerable life periods that contribute to chronic respiratory disease risk could lead to the development of preventive strategies and novel therapeutic interventions.

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Update on metal-induced occupational lung disease

Purpose of review Occupational and environmental exposures to metals can result in multiple pulmonary conditions. This article will review recent epidemiologic and mechanistic studies that have enhanced our understanding of the association between particular lung diseases and exposure to specific metals. Recent findings Recent studies have broadened our understanding of the mechanisms of lung diseases such as CBD in established industries and drawn attention to conditions that may arise from exposure to metals such as indium in developing technologies. New diagnostic techniques such as elemental tissue analysis may help establish a diagnosis of metal-induced occupational lung disease. Electronic cigarette devices, environmental pollutants, and the growing use of nanoparticle-sized metals pose additional risks to workers and consumers. Summary Recognizing the risks of pulmonary disease in workers exposed to metals and performing a thorough occupational history and diagnostic work-up in patients with unexplained respiratory findings is necessary to promote understanding and prevention of metal-induced lung disease.

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Role of epigenetics in the development of childhood asthma

Purpose of review Epigenetic marks are emerging as mediators of genetics and the environment on complex disease phenotypes, including childhood asthma and allergy. Recent findings Epigenome-wide association studies over the past year have added to the growing body of evidence supporting significant associations of epigenetic regulation of gene expression and asthma and allergy. Studies in children have identified signatures of eosinophils in peripheral blood, Th2 cell transcription factors and cytokines in peripheral blood mononuclear cells, and epithelial dysfunction in the respiratory epithelium. Importantly, studies at birth have begun to decipher the contribution of epigenetic marks to asthma inception. Few studies have also begun to address the contribution of genetics and the environment to these associations. Summary Next generation of epigenome-wide association studies that will deal with confounders, study the influence of the genetics and environment, and incorporate multiple datasets to provide better interpretation of the findings are on the horizon. Identification of key epigenetic marks that are shaped by genetics and the environment, and impact transcription of specific genes will help us have a better understanding of etiology, heterogeneity and severity of asthma, and will also empower us to develop biologically driven therapeutics and biomarkers for secondary prevention of this disease.

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Health surveillance for occupational asthma

Purpose of review The outcome for workers with occupational asthma is improved for those with an earlier diagnosis. Health surveillance at work is in principle designed to identify such cases, so that the risks to the individual worker, and coworkers, can be reduced. There is recent evidence to suggest that the uptake and quality of such surveillance could be improved. This review has assessed current approaches to health surveillance for occupational asthma. Recent findings The article covers a review of the utility of questionnaires, lung function testing, immunological investigations, and other tests, including exhaled nitric oxide, sputum eosinophilia, and exhaled breath condensate specifically in the context of workplace-based health surveillance. Summary Questionnaires remain a key component of respiratory health surveillance, although maybe limited by both sensitivity and specificity for early occupational asthma. The role of lung function testing is debated, although is recommended for higher level health surveillance. Various examples of immunological testing in health surveillance are discussed, but more evidence is needed in many specific areas before more general recommendations can be made. Evidence is discussed in relation to the utility of newer approaches such as exhaled nitric oxide, sputum eosinophilia, and exhaled breath condensate.

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Editorial introductions

No abstract available

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The emerging spectrum of exposure-related bronchiolitis

Purpose of review Exposure-related bronchiolitis is increasingly recognized as an important but challenging clinical diagnosis. Acute and chronic inhalational exposures are associated with variable clinical presentations and a spectrum of histopathologic abnormalities affecting the small airways. This review provides an overview of the histologic patterns and occupational settings for exposure-related bronchiolitis, along with recent advances in disease diagnosis and management. Recent findings The entire histopathologic spectrum of bronchiolitis (constrictive, obliterative, proliferative, lymphocytic, respiratory) has been reported in exposure-related bronchiolitis. Recent studies have shown that lung clearance index testing and impulse oscillometry are more sensitive than spirometry in detecting small airways abnormalities and may augment the diagnosis of occupational bronchiolitis. Prognosis in indolent occupational bronchiolitis appears more favorable than some other types of bronchiolitis but is variable depending on the extent of bronchiolar inflammation and the stage of disease at which exposure removal occurs. Summary No specific histopathologic pattern of bronchiolitis is pathognomonic for occupational bronchiolitis as one or more histologic patterns may be present. A high index of suspicion is needed for exposure and disease recognition. Recent advances that may aid in diagnosis include transbronchial cryobiopsy, lung clearance index testing, and impulse oscillometry, although further research is needed.

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Assessing the impact of air pollution on childhood asthma morbidity: how, when, and what to do

Purpose of review Exposure to air pollutants is linked with poor asthma control in children and represents a potentially modifiable risk factor for impaired lung function, rescue medication use, and increased asthma-related healthcare utilization. Identification of the most relevant pollutants to asthma as well as susceptibility factors and strategies to reduce exposure are needed to improve child health. Recent findings The current available literature supports the association between pollutants and negative asthma outcomes. Ethnicity, socioeconomic status, and presence of certain gene polymorphisms may impact susceptibility to the negative health effects of air pollution. Improved air quality standards were associated with better asthma outcomes. Summary The link between air pollution and pediatric asthma morbidity is supported by the recent relevant literature. Continued efforts are needed to identify the most vulnerable populations and develop strategies to reduce exposures and improve air quality.

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Biomarkers and asthma management: analysis and potential applications

Purpose of review Asthma features a high degree of heterogeneity in both pathophysiology and therapeutic response, resulting in many asthma patients being treated inadequately. Biomarkers indicative of underlying pathological processes could be used to identify disease subtypes, determine prognosis and to predict or monitor treatment response. However, the newly identified as well as more established biomarkers have different applications and limitations. Recent findings Conventional markers for type 2-high asthma, such as blood eosinophils, fraction of exhaled nitric oxide, serum IgE and periostin, feature limited sensitivity and specificity despite their significant correlations. More distinctive models have been developed by combining biomarkers and/or using omics techniques. Recently, a model with a positive predictive value of 100% for identification of type 2-high asthma based on a combination of minimally invasive biomarkers was developed. Summary Individualisation of asthma treatment regimens on the basis of biomarkers is necessary to improve asthma control. However, the suboptimal properties of currently available conventional biomarkers limit its clinical utility. Newly identified biomarkers and models based on combinations and/or omics analysis must be validated and standardised before they can be routinely applied in clinical practice. The development of robust biomarkers will allow development of more efficacious precision medicine-based treatment approaches for asthma.

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Asthma in inner city children: recent insights United States

Purpose of review Children living in US inner cities experience disparate burdens of asthma, especially in severity, impairment, exacerbations, and morbidity. Investigations seeking to better understand the factors and mechanisms underlying asthma prevalence, severity, and exacerbation in children living in these communities can lead to interventions that can narrow asthma disparities and potentially benefit all children with asthma. This update will focus on recent (i.e. late 2016–2017) advances in the understanding of asthma in US inner city children. Recent findings Studies published in the past year expand understanding of asthma prevalence, severity, exacerbation, and the outcomes of guidelines-based management of these at-risk children, including: asthma phenotypes in US inner city children that are severe and difficult-to-control; key environmental determinants and mechanisms underlying asthma severity and exacerbations (e.g. allergy-mediated exacerbation susceptibility to rhinovirus); the importance of schools as a place for provocative exposures (e.g. mouse allergen, nitrogen dioxide) as well as a place where asthma care and outcomes can be improved; and the development and validation of clinically useful indices for gauging asthma severity and predicting exacerbations. Summary These recent studies provide a trove of actionable findings that can improve asthma care and outcomes for these at-risk children.

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Development of allergic sensitization and its relevance to paediatric asthma

Purpose of review The purpose of this review is to summarize the recent evidence on the distinct atopic phenotypes and their relationship with childhood asthma. We start by considering definitions and phenotypic classification of atopy and then review evidence on its association with asthma in children. Recent findings It is now well recognized that both asthma and atopy are complex entities encompassing various different sub-groups that also differ in the way they interconnect. The lack of gold standards for diagnostic markers of atopy and asthma further adds to the existing complexity over diagnostic accuracy and definitions. Although recent statistical phenotyping studies contributed significantly to our understanding of these heterogeneous disorders, translating these findings into meaningful information and effective therapies requires further work on understanding underpinning biological mechanisms. Summary The disaggregation of allergic sensitization may help predict how the allergic disease is likely to progress. One of the important questions is how best to incorporate tests for the assessment of allergic sensitization into diagnostic algorithms for asthma, both in terms of confirming asthma diagnosis, and the assessment of future risk.

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Precision medicine in the treatment of primary immunodeficiency diseases

Purpose of the review Since the 1990s with the advances in molecular biology, a number of genetic defects have been described. The International Union of Immunological Sciences has recently updated the classification of genetic defects associated with primary immune deficiencies that now number 354. With the ever-expanding list of new monogenic disorders and a better understanding of the immunobiology and function of these defective genes, new therapies have emerged particularly aimed at the autoimmune and inflammatory conditions that plague these patients. Recent findings Immune deficiencies associated with gain-of-function (GOF) mutations are a potential category for targeted therapies to control the GOF activities of the mutated gene. In addition to the increased susceptibility to infections these patients have autoimmune and inflammatory diseases that are difficult to control with conventional therapies. The dysregulated immune functions of the activated phospholipase-3-kinase δ syndrome, cytotoxic T lymphocyte-associated antigen-4 haploinsufficiency, lipopolysaccharide-responsive beige-like anchor deficiency, the GOF mutations of signal transducer and activator of transcription 1 and 3 immune deficiencies will be reviewed. The targeted therapies for each of these immune deficiencies using small molecule kinase inhibitors and fusion protein biologic modifiers will be described. Summary In this review, we explore the recent advances in precision medicine treatment of several primary immunodeficiency syndromes in which immune dysregulation is a key feature. Understanding the immunobiology associated with these GOF mutations has led to the use of biologic therapies to better control the associated autoimmune and inflammatory manifestations.

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Hypereosinophilic syndrome presenting acutely with neurologic signs

A 70-year-old white male with a longstanding history of allergic rhinitis and nasal polyposis, and relatively recent onset of chronic cough one year prior, presented to the hospital for one-week duration of neurologic complaints including chronic and worsening neck pain, bilateral upper extremity weakness, difficulty gripping objects, blurry vision, confusion, change in gait, and difficulty with initiation of urination. His medical history also included essential hypertension, dyslipidemia, gastroesophageal reflux, and shingles.

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Displacement of the Recurrent Laryngeal Nerve in Patients with Recurrent Goiter Undergoing Redo Thyroid Surgery

Thyroid reoperations are surgically challenging because of scarring and disturbances in the anatomy of the recurrent laryngeal nerve (RLN). This study was conducted on 49 patients who underwent redo surgery. 61 RLNs were identified and completely exposed. Their functional integrity was evaluated using intraoperative nerve monitoring (IONM). Indications for secondary surgery, anatomical changes secondary to recurrent goiter mass and prior surgery, and results of IONM were studied. Frequent indications for redo surgery were multinodular goiter (MNG) in 19 (38.8%) and results of cytology in 14 (28.5%) patients. The mean time interval between primary and redo thyroid surgery was 23.4 years. We laterally approached 41 (67.2%) thyroid lobes between the sternocleidomastoid and sternohyoid muscles. 16 (26.2%) RLNs were found to be adherent to the lateral surface of the corresponding thyroid lobe. The functional integrity of all RLNs was confirmed by IONM. The remnant thyroid tissue can then lead to goiter recurrence requiring secondary surgery after a long period of time. The indications for redo surgery were similar to primary cases. Lateral displacement of the RLN which is adherent to the lateral surface of recurrent goiter mass is common anatomic variation. Thyroid reoperations based on awareness of anatomical disturbances can be performed safely by an experienced surgeon with support of ancillary electrophysiological technology.

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A case-control study of Drug-Induced Sleep Endoscopy (DISE) in pediatric population: A proposal for indications

To evaluate whether and when Drug-Induced Sleep Endoscopy (DISE) changes diagnosis and treatment plan in pediatric Obstructive Sleep Apnoea Syndrome (OSAS) with the aim to identify specific subgroups of patients for whom DISE should be especially considered.

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Surgical management of children presenting with surgical-needed tracheal stenosis

The purpose of this work was to assess epidemiological aspects, surgical approach, morbidity and mortality rates of patients presenting with tracheal stenosis requiring surgery, and the evolution of surgical techniques over the last years.

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3 tesla MRI assisted detection of compression points in ulnar neuropathy at the elbow in correlation with intraoperative findings

Releasing the ulnar nerve from all entrapments is the primary objective of every surgical method in ulnar neuropathy at the elbow (UNE). The aim of this retrospective diagnostic study was to validate preoperative 3 Tesla MRI results by comparing the MRI findings with the intraoperative aspects during endoscopic-assisted or open surgery.

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‘Investigation of the activation of temporalis and masseter muscles in voluntary and spontaneous smile production.’

Masticatory muscles or their nerve supply are options for facial reanimation surgery but their ability to create spontaneous smile has been questioned. This study assessed the percentage of healthy adults who activate temporalis and masseter during voluntary and spontaneous smile.

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Orthotopic transfer of vascularized groin lymph node flap in the treatment of breast cancer-related lymphedema: clinical results, lymphoscintigraphy findings and proposed mechanism

Vascularized lymph node transfer (VLNT) has become more popular in treating secondary lymphedema. However, the mechanism has not been clearly elucidated.The purpose of this study were (1) to evaluate the outcome of vascularized groin lymph node (VGLN) transfer using axilla as a recipient site in patients with breast cancer-related lymphedema (BCRL) and (2) to provide radiological evidence of lymphangiogenesis in VLNT.

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Outcome of Head and Neck Squamous Cell Cancers in Low-Resource Settings

Head and neck squamous cell carcinomas (HNSCCs) are amongst the most common cancers in certain parts of the world. Low-income and low middle- income countries make up 65% of newly diagnosed HNSCC cases annually and account for about 75% of HNSCC global mortality. These countries also suffer from a significant shortage of skilled labor, equipment, and health facilities. This article discusses the burden of HNSCCs in developing countries and the differences in outcomes compared with developed countries.

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Are oral mucosal nevi potential precursors for oral mucosal melanoma?

The origin of oral mucosal melanoma remains controversial with oral mucosal nevi being hypothesized to be a possible precursor. The hypotheses can be supported by the characteristics shared by the nevus cells and the melanoma cells including spindle-shaped, lack of dendritic processes, lack of contact inhibition and inability to transfer the melanosomes to the keratinocytes [1].

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Outcome of Head and Neck Squamous Cell Cancers in Low-Resource Settings

Head and neck squamous cell carcinomas (HNSCCs) are amongst the most common cancers in certain parts of the world. Low-income and low middle- income countries make up 65% of newly diagnosed HNSCC cases annually and account for about 75% of HNSCC global mortality. These countries also suffer from a significant shortage of skilled labor, equipment, and health facilities. This article discusses the burden of HNSCCs in developing countries and the differences in outcomes compared with developed countries.

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In vitro outlook of gold nanoparticles in photo-thermal therapy: a literature review

Abstract

Hyperthermia is an anti-cancer treatment in which the temperature of the malignant tumor is increased more than other adjacent normal tissues. Microwave, ultrasound, laser, and radiofrequency sources have been used for hyperthermia of cancerous tissues. In the past decade, near-infrared (NIR) laser for cancer therapy, known as photo-thermal therapy (PTT), was expanded in which the photo-sensitizer agent converts the light photon energy to heat. The heat following PTT can destroy cancer cells. There are some photo-sensitizer agents which have been used for PTT; however, owing to recent advances in nanotechnology, noble metal nanoparticles like gold (Au) nanoparticles (GNPs) have been used successfully in PTT. GNPs have some desirable specifications, including simple and controlled synthesis, small size, high level of biocompatibility, and surface plasmon resonance (SPR). The SPR effect of the GNPs increases the radiative properties like absorption and scattering; therefore, they can be used in PTT. In this article, we reviewed recent in vitro studies of PTT using GNPs in literature. At first, we focus on the physical properties of GNPs, their interaction with infrared radiation, and physical parameters governing the interaction of infrared radiation with the GNPs. Then, we review the passive and active targeting of GNPs using the different coating to induce the thermal damage in cancer cells using low-level laser PPT. The GNPs' cellular internalization into cancer cells is a challenge which is consequently considered. In this review, we also summarize the results of synergistic cancer therapy studies on the combination of radiation therapy as a routine cancer treatment and PTT: in which significant improvement occurs in treatment efficacy.

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Use of ultrasonic scalpel and monopolar electrocautery for skin incisions in neck dissection: a prospective randomized trial

Abstract

Purpose

Ultrasonic scalpel (UC) and monopolar electrocautery (ME) are standard equipment for soft tissue surgery. The aim of the present study was to compare intraoperative and postoperative patterns of patients using either UC or ME for skin incisions in neck dissection.

Material and methods

In a prospective randomized study of 30 patients, the thermal effects of UC (n = 15) and ME (n = 15) were examined using real-time infrared thermographic imaging. Additionally, tissue damage was evaluated histopathologically. The other measured variables were operation and bleeding time, postoperative pain score (only neck incision area), in-patient time, and complications.

Results

UC significantly reduces the thermal effects, compared to ME (p < 0.001). The mean depth of tissue damage (i.e., necrosis) was 272.7 μm for UC and 284.7 μm for ME with no significant difference (p = 0.285). From the third postoperative day, patients treated using UC had noticeably less pain in the neck incision area (t3 p = 0.010; t4 p < 0.001; t5 p < 0.005). Cutting time was reduced for ME by 36.1 s (p < 0.001) and the bleeding time was decreased by 40.9 s for UC (p < 0.001). The total preparation time was the same (p = 0.402). When comparing in-patient time (p = 0.723), as well as complications, no significant differences were seen.

Conclusion

UC results in less postoperative pain and less bleeding in the neck incision area. Accordingly, UC is superior to ME for skin incisions in neck dissection.

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Development of Velopharyngeal Closure for Vocalization During the First 2 Years of Life

Purpose

The vocalizations of young infants often sound nasalized, suggesting that the velopharynx is open during the 1st few months of life. Whereas acoustic and perceptual studies seemed to support the idea that the velopharynx closes for vocalization by about 4 months of age, an aeromechanical study contradicted this (Thom, Hoit, Hixon, & Smith, 2006). Thus, the current large-scale investigation was undertaken to determine when the velopharynx closes for speech production by following infants during their first 2 years of life.

Method

This longitudinal study used nasal ram pressure to determine the status of the velopharynx (open or closed) during spontaneous speech production in 92 participants (46 male, 46 female) studied monthly from age 4 to 24 months.

Results

The velopharynx was closed during at least 90% of the utterances by 19 months, though there was substantial variability across participants. When considered by sound category, the velopharynx was closed from most to least often during production of oral obstruents, approximants, vowels (only), and glottal obstruents. No sex effects were observed.

Conclusion

Velopharyngeal closure for spontaneous speech production can be considered complete by 19 months, but closure occurs earlier for speech sounds with higher oral pressure demands.

http://ift.tt/2GSvnpU

Targeting Complex Sentences in Older School Children With Specific Language Impairment: Results From an Early-Phase Treatment Study

Purpose

This study investigated the effects of a complex sentence treatment at 2 dosage levels on language performance of 30 school-age children ages 10–14 years with specific language impairment.

Method

Three types of complex sentences (adverbial, object complement, relative) were taught in sequence in once or twice weekly dosage conditions. Outcome measures included sentence probes administered at baseline, treatment, and posttreatment phases and comparisons of pre–post performance on oral and written language tests and tasks. Relationships between pretest variables and treatment outcomes were also explored.

Results

Treatment was effective at improving performance on the sentence probes for the majority of participants; however, results differed by sentence type, with the largest effect sizes for adverbial and relative clauses. Significant and clinically meaningful pre–post treatment gains were found on a comprehensive oral language test, but not on reading and writing measures. There was no treatment advantage for the higher dosage group. Several significant correlations indicated a relationship between lower pretest scores and higher outcome measures.

Conclusions

Results suggest that a focused intervention can produce improvements in complex sentence productions of older school children with language impairment. Future research should explore ways to maximize gains and extend impact to natural language contexts.

Supplemental Material

https://doi.org/10.23641/asha.5923318

http://ift.tt/2F9WK1z

Vocalization Subsystem Responses to a Temporarily Induced Unilateral Vocal Fold Paralysis

Purpose

The purpose of this study is to quantify the interactions of the 3 vocalization subsystems of respiration, phonation, and resonance before, during, and after a perturbation to the larynx (temporarily induced unilateral vocal fold paralysis) in 10 vocally healthy participants. Using dynamic systems theory as a guide, we hypothesized that data groupings would emerge revealing context-dependent patterns in the relationships of variables representing the 3 vocalization subsystems. We also hypothesized that group data would mask important individual variability important to understanding the relationships among the vocalization subsystems.

Method

A perturbation paradigm was used to obtain respiratory kinematic, aerodynamic, and acoustic formant measures from 10 healthy participants (8 women, 2 men) with normal voices. Group and individual data were analyzed to provide a multilevel analysis of the data. A 3-dimensional state space model was constructed to demonstrate the interactive relationships among the 3 subsystems before, during, and after perturbation.

Results

During perturbation, group data revealed that lung volume initiations and terminations were lower, with longer respiratory excursions; airflow rates increased while subglottic pressures were maintained. Acoustic formant measures indicated that the spacing between the upper formants decreased (F3–F5), whereas the spacing between F1 and F2 increased. State space modeling revealed the changing directionality and interactions among the 3 subsystems.

Conclusions

Group data alone masked important variability necessary to understand the unique relationships among the 3 subsystems. Multilevel analysis permitted a richer understanding of the individual differences in phonatory regulation and permitted subgroup analysis. Dynamic systems theory may be a useful heuristic to model the interactive relationships among vocalization subsystems.

Supplemental Material

https://doi.org/10.23641/asha.5913532

http://ift.tt/2GRpGIS

A Pilot Study to Investigate the Relationship Between Interaural Differences in Temporal Bone Anatomy and Normal Variations in Caloric Asymmetry

Purpose

This study assesses interaural differences in temporal bone anatomy in subjects with normal caloric findings.

Method

Eligible patients included those referred to the Duke University Medical Center otology clinic complaining of dizziness, with a head computed tomography scan and caloric stimulation results within normal ranges (inter-ear difference ≤ 10% or < 25% unilateral weakness). Three-dimensional reconstructions of computed tomography scans in 11 patients were used to calculate the surface area and volume of lateral semicircular canals (LSCCs), mastoid airspaces, mastoid bones, and internal auditory canal diameter and circumference. Percent differences in interaural temporal bone anatomy (i.e., left-to-right asymmetry) were analyzed and correlated with warm caloric inter-ear difference (WCD) and clinically indicated caloric predictor asymmetry.

Results

A multivariate model predicting WCD from 9 interaural anatomic variables demonstrated a Pearson's coefficient of 0.999. A similarly constructed model of the clinically indicated caloric predictor demonstrated a Pearson's coefficient of 0.999. The univariate correlation was strongest for WCD versus Proctor internal auditory canal diameter (r = 0.476; p = .139) and WCD versus lateral semicircular canal surface-area-to-volume ratio (r = −0.474; p = .141).

Conclusions

This pilot study provides multivariate models that predict caloric asymmetry in subjects without vestibular pathologic findings per caloric testing, based on interaural differences across variables of the temporal bone anatomy.

Supplemental Material

https://doi.org/10.23641/asha.5895988

http://ift.tt/2F1wLuc

A Cross-Sectional Study on the Hearing Threshold Levels Among People in Qinling, Qinghai, and Nanjing, China

Purpose

This study aimed to investigate the hearing threshold among different age groups, genders, and geographic areas in China to provide some insight into the appropriate clinical interventions for hearing loss.

Method

Using a systematic random sampling technique, 562 participants from Qinling, Qinghai, and Nanjing were included. Participants in the same area were divided into 3 groups according to their age. Pure-tone audiometric thresholds were measured at octave and interoctave frequencies of 0.125–16 kHz for each subject.

Results

There were significant differences in auditory thresholds at nearly all frequencies among young, middle-aged, and elderly people, and hearing thresholds increased with increasing age. People generally had the best hearing ability in Nanjing, better hearing ability in Qinghai, and the worst hearing ability in Qinling. Significant differences in hearing thresholds were found between males and females at several frequencies in Qinling.

Conclusion

People living in the rural area of Qinling in China had higher hearing threshold levels, particularly males, and hearing thresholds increased with age.

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Study Finds Gaps in Hearing Specialist Referrals and Hearing Aid Use

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More than 40 million adults in the United States have reported having hearing problems from minor hearing issues to deafness. Despite this prevalence, there are considerable low specialist referrals. A new study found a disproportion between self-reported cases of hearing loss and those who received medical evaluation and treatment recommendations, such as auditory rehabilitative options and amplification, including hearing aids and cochlear implants (CI).

Researchers performed a cross-sectional analysis of data collected from 239.6 million adult respondents, who provided answers to the hearing module questions in the 2014 National Health Interview Survey. The study participants were 51.8 percent women and 48.2 percent men, with an average age of 47 years.

About 95.5 percent of the participants reported functional hearing or the ability to hear either normal voice or whispering, 3.4 percent can only hear shouting, and 1.1 percent could not hear shouting. Also, 16.8 percent of the respondents noted that their hearing was less than "excellent/good," ranging from "a little trouble hearing" to "being deaf." Of these, 12.9 million had never seen a clinician for hearing problems and 11.1 million had never had their hearing tested.

The study also reports that out of the 48.8 million who visited a physician for hearing-related problems in the five years prior to the study, about 60 percent were referred to specialists: 15.9 million were referred to otolaryngologists and 13.3 million to audiologists. About 2.8 million adult respondents reported they could not hear shouting (not appreciating shouting). Of these, about 148,000 were recommended getting a CI but only 22.1 percent received it.

"It is difficult to determine the exact contributing factors with the data presented in this study," Hossein Mahboubi, MD, MPH, study lead author, told The Hearing Journal about the possible contributing factors for this gap. "However, it is likely a multi-factorial process with lack of access, lack of awareness, and financial aspects playing the major roles."

"The low CI utilization rate is also likely multi-factorial. Need for surgical implantation and possible comorbid conditions or patient preference/compliance may influence candidacy and financial constraints may also play a role. Future studies are required to further characterize these associations and investigate the contributing factors," said Mahboubi on the main issues deterring patients from getting a cochlear implant.

The study noted that improved awareness of the importance of referrals to otolaryngologists and audiologists as well as auditory rehabilitative options among clinicians may improve hearing loss care.

"I believe there needs to be an effort, most appropriately led by otolaryngologists and audiologists, to increase awareness of physicians and the community about hearing loss, its common prevalence, and consequences if left untreated," Mahboubi added.

Published: 2/28/2018 8:48:00 AM

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IDEAL IMPLANT® Structured Breast Implants: Core Study Results at 6 Years

Background: The structured breast implant utilizes different technology than saline or silicone gel implants, making it a third type of implant. FDA and Health Canada granted approval in November 2014. This implant is filled with saline, but has an internal structure consisting of a series of nested shells that support the upper pole when upright and control fluid movement. It combines certain key features and benefits of saline and silicone gel implants. Like saline, the filler is only saline, which women like for peace of mind in case of rupture/deflation. Like silicone gel, it has a natural feel, but without risk of silent rupture and FDA-recommended MRI scans - women can simply look in the mirror and know their implants are intact. Methods: This US trial enrolled 502 women: 399 primary augmentations and 103 replacements of existing augmentation implants. Investigators were 45 ABPS certified plastic surgeons at 35 sites. Of the 502 women enrolled, 438 (87.3%) completed 6-year follow-up visits, a higher percentage than other Core breast implant trials. Results: At 6 years, patient satisfaction was 89.7% for primary and 91.6% for replacement augmentations; surgeon satisfaction was 92.6% for primary and 94.0% for replacement. Kaplan-Meier adverse event rates were: Baker class III & IV capsule contracture – 5.7% for primary, 11.5% for replacement; rupture/deflation – 1.8% for primary, 4.7% for replacement. Conclusion: 6-year results from 438 women show the structured breast implant has high patient and surgeon satisfaction, a low rate of capsule contracture and a low rate of rupture/deflation. Financial Disclosure Statement: Ideal Implant Incorporated designed and funded the study. The authors received research support for conducting this study. Gregg Anigian is an Ideal Implant Incorporated stockholder. Presented in part at: Plastic Surgery The Meeting (ASPS) 2017 in Orlando, Florida. This trial is registered under the name "Core Study of the Safety and Effectiveness of IDEAL IMPLANT® Saline-filled Breast Implants," ClinicalTrials.gov identification number NCT00858052 (http://ift.tt/2oFzXR1) The study was approved by a central investigational review board (RCRC IRB, now Salus IRB, Austin, TX). Corresponding author: Larry S. Nichter, M.D., Pacific Center for Plastic Surgery, 3991 MacArthur Boulevard Suite 320, Newport Beach, CA 92660 USA lnichter@gmail.com ©2018American Society of Plastic Surgeons

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Radiculomegaly: a case report of this rare dental finding with review of the associated oculo-facio-cardio-dental syndrome

Publication date: Available online 28 February 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Molly Housley Smith, Donald M. Cohen, Indraneel Bhattacharyya, Nadim M. Islam, Deeba Kashtwari
Background: Radiculomegaly, or root gigantism, is a rare dental abnormality with important clinical implications. It is highly specific for oculo-facio-cardio-dental syndrome (OFCD), which places dentists at the forefront of diagnosis for this syndrome. Only one case of non-syndromic radiculomegaly has been reported in the literature since the description of OFCD in 1996. We present the second confirmed, non-syndromic/non-familial case and review the literature for dental treatments in patients with this dental finding. Methods: A review of the English-language literature was performed within PubMed for patients with radiculomegaly or OFCD. Teeth affected by radiculomegaly, gender, oro-dental findings, presence of OFCD syndrome, and dental treatment methods were recorded. Results: Sixty-seven cases of radiculomegaly and 92 OFCD cases were found in the literature. Only one confirmed case of non-syndromic/non-familial radiculomegaly existed prior to our report. Ten cases reported dental treatment or treatment plan details, and even fewer detailed the specific methods. Conclusions: Because dental anomalies, especially radiculomegaly, are a primary feature of OFCD, dentists should be aware of the clinical and radiographic features. Radiculomegaly poses a distinct challenge to dentists, and reports of dental therapy provided to these patients are sparse. Early diagnosis of the syndrome may prevent dental challenges and improve prognosis.



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Validity of fish, birds and mammals as surrogates for amphibians and reptiles in pesticide toxicity assessment

Abstract

Amphibians and reptiles are the two most endangered groups of vertebrates. Environmental pollution by pesticides is recognised as one of the major factors threatening populations of these groups. However, the effects of pesticides on amphibians and reptiles have been studied for few substances, which is partly related to the fact that these animals are not included in the mandatory toxicity testing conducted as part of environmental risk assessments of pesticides. Whether risks of pesticides to amphibians and reptiles are addressed by surrogate taxa used in risk assessment is currently under debate. In order to develop a scientifically sound and robust risk assessment scheme, information needs to be gathered to examine whether fish, birds and mammals are valid surrogates for amphibians and reptiles. We updated a systematic review of scientific literature that was recently published compiling toxicity data on amphibians and reptiles. The outcome of this review was analysed with the purposes to (1) compare endpoints from amphibians and reptiles with the available information from fish, birds and mammals, and (2) develop species sensitivity distributions (SSDs) for those substances tested in at least six amphibian species (no substances were found tested in at least six reptile species) to identify a candidate amphibian model species to be used as surrogate in risk assessment. A positive correlation was found between toxicity recorded on fish and amphibians, the former revealing, in general, to be more sensitive than the latter to waterborne pollutants. In the terrestrial environment, although birds and mammals were more sensitive than amphibians and reptiles to at least 60% of tested substances, just a few weak significant correlations were observed. As a general rule, homoeothermic vertebrates are not good surrogates for reptiles and terrestrial amphibians in pesticide risk assessment. However, some chemical-dependent trends were detected, with pyrethroids and organochlorine insecticides being more toxic to amphibians or reptiles than to birds or mammals. These trends could ultimately help in decisions about protection provided by surrogate taxa for specific groups of substances, and also to determine when risk assessment of pesticides needs to pay special consideration to amphibians and reptiles. The outcome of this review reflects that there is still much information needed to reduce uncertainties and extract relevant conclusions on the overall protection of amphibians and reptiles by surrogate vertebrates.

from ORL via alkiviadis.1961 on Inoreader http://ift.tt/2GQROfq

The Influence of Hearing Aid Gain on Gap-Detection Thresholds for Children and Adults With Hearing Loss

Objectives: The objective of this experiment was to examine the contributions of audibility to the ability to perceive a gap in noise for children and adults. Sensorineural hearing loss (SNHL) in adulthood is associated with a deficit in gap detection. It is well known that reduced audibility in adult listeners with SNHL contributes to this deficit; however, it is unclear the extent to which hearing aid amplification can restore gap-detection thresholds, and the effect of childhood SNHL on gap-detection thresholds have not been described. For adults, it was hypothesized that restoring the dynamic range of hearing for listeners with SNHL would lead to approximately normal gap-detection thresholds. Children with normal hearing (NH) exhibit poorer gap-detection thresholds than adults. Because of their hearing loss, children with SNHL have less auditory experience than their peers with NH. Yet, it is unknown the extent to which auditory experience impacts their ability to perceive gaps in noise. Even with the provision of amplification, it was hypothesized that children with SNHL would show a deficit in gap detection, relative to their peers with normal hearing, because of reduced auditory experience. Design: The ability to detect a silent interval in noise was tested by adapting the stimulus level required for detection of gap durations between 3 and 20 ms for adults and children with and without SNHL. Stimulus-level thresholds were measured for participants with SNHL without amplification and with two prescriptive procedures—the adult and child versions of the desired sensation level i/o program—using a hearing aid simulator. The child version better restored the normal dynamic range than the adult version. Adults and children with NH were tested without amplification. Results: When fitted using the procedure that best restored the dynamic range, adults with SNHL had stimulus-level thresholds similar to those of adults with normal hearing. Compared to the children with NH, the children with SNHL required a higher stimulus level to detect a 5-ms gap, despite having used the procedure that better restored the normal dynamic range of hearing. Otherwise, the two groups of children had similar stimulus-level thresholds. Conclusion: These findings suggest that apparent deficits in temporal resolution, as measured using stimulus-level thresholds for the detection of gaps, are dependent on age and audibility. These novel results indicate that childhood SNHL may impair temporal resolution as measured by stimulus-level thresholds for the detection of a gap in noise. This work has implications for understanding the effects of amplification on the ability to perceive temporal cues in speech. ACKNOWLEDGMENTS: We thank Alex Baker, Brianna Byllesby, Evan Cordrey, and Clairissa Mollak for help in data collection and analysis. M. B. designed and performed experiments, analyzed data, and wrote the paper. All authors discussed analysis and implications and commented on the manuscript at all stages. This research was funded by grants R01 DC013591 (to R. M.), F32 DC12709 (to M. B.), P20 GM109023 (to M. B. and W. J.), and P30 DC4662 from the National Institutes of Health (NIH). Presented at the International Hearing Aid Research Conference, Lake Tahoe, Nevada, August 13, 2016. The authors have no conflicts of interest to disclose. Address for correspondence: Marc Brennan, University of Nebraska-Lincoln, 274 Barkley Center, Lincoln, NE 68583, USA. E-mail: marc.brennan@unl.edu Received February 21, 2017; accepted December 28, 2017. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Adult Cranioplasty Reconstruction With Customized Cranial Implants: Preferred Technique, Timing, and Biomaterials

Introduction: Complex cranial defects requiring delayed reconstruction present numerous challenges. Delayed cranioplasties accompany frequent complications approaching an incidence of 35 to 40%. Therefore, the authors sought to collate their experience in hopes of sharing their perspective on several topics including technique, timing, and preferred biomaterials. Methods: The authors' 5-year consecutive experience over 430 customized cranial implants is described herein. Since its inception in 2012, the authors' team has employed the pericranial-onlay cranioplasty technique instead of the standard epidural approach. Optimal timing for cranioplasty is determined using objective criteria such as scalp healing and parenchymal edema, close collaboration with neuroplastic surgery, conversion from autologous bone to sterile implant in instances of questionable viability/storage, and the first-line use of solid poly(methylmethacrylate) implants for uncomplicated, delayed cases, first-line porous polyethylene (MEDPOR) implants for single-stage cranioplasty, and first-line polyether-ether-ketone implants for cases with short notice. Furthermore, the use of the pterional design algorithm with temporal bulking for all customized implants has helped to correct and/or prevent temporal hollowing deformities. Results: The authors' team has observed a three-fold reduction in reported complications as compared with the existing literature, with a major complication rate of 11%. The multidisciplinary center has provided an optimal stage for synergy and improved outcomes versus standard cranioplasty techniques. Conclusion: Secondary cranial reconstruction, or cranioplasty, can be challenging due to numerous reasons. These best practices, developed in collaboration with neuroplastic surgery and neurosurgery, appear to encompass the largest published experience to date. The authors find this approach to be both safe and reliable. Address correspondence and reprint requests to Chad Gordon, DO, FACS, Associate Professor of Plastic Surgery and Neurosurgery, Johns Hopkins University School of Medicine, 601 N. Caroline St, JHOC 8th floor, Baltimore, MD 21287; E-mail: cgordon@jhmi.edu Received 15 November, 2017 Accepted 22 December, 2017 CG is a consultant for Stryker Craniomaxillofacial (CMF) and Longeviti Neuro Solutions. The authors report no conflicts of interest. AW and GFS should be considered co-first authors. This paper was supported in part by a research grant received from Stryker Craniomaxillofacial (Kalamazoo, MI), which was reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. © 2018 by Mutaz B. Habal, MD.

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Pain Management for Nonsyndromic Craniosynostosis: Adequate Analgesia in a Pediatric Cohort?

Background: Postoperative pain following open craniosynostosis repair has not been studied extensively and is sometimes thought to be inconsequential. The purpose of this study was to assess postoperative pain in this pediatric population. Methods: We performed a retrospective chart review of patients (n = 54) undergoing primary open craniosynostosis repair from 2010 to 2016. Demographics, length of stay (LOS), pain scores, emesis events, and perioperative analgesics were reviewed. Multivariable regression models were designed to assess for independent predictors of LOS and emesis. Results: A high proportion had moderate to severe pain on postoperative day 0 (56.5%) and day 1 (60.9%). Opioid administered in postoperative period was 1.40 mg/kg/d in morphine milligram equivalent (MME) (±1.07 mg/kg/d MME). Majority of patients transitioned to enteral opioids on postoperative day 1 (24.5%) or day 2 (49.1%). Ketorolac was administered to 11.1% (n = 6). Emesis was documented in 50% of patients. LOS revealed a positive association with age (P = 0.006), weight (P = 0.009), and day of transition to enteral opioids (P 

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Maxillary Hypoplasia With Congenital Oligodontia Treated by Maxillary Distraction Osteogenesis

It is known that congenitally missing teeth can often cause differences in craniofacial morphology; however, there are few reported cases of orthognathic surgical treatment for these patients. Herein, the authors report a rare case of maxillary hypoplasia with congenital oligodontia treated by maxillary distraction osteogenesis with internal device. A 17-year-old male presenting with multiple tooth agenesis and maxillary recession was referred to our hospital for orthognathic surgical treatment. Preoperative simulation surgery was performed using Full-Color 3-dimensional salt model. After surgery, improvement in maxillary recession and occlusal stability was observed. This report demonstrates the advantages of the method used herein, which includes reduction in operating time with increase in the safety of the procedure. Address correspondence and reprint requests to Sayaka Mishima, DDS, Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan; E-mail: sayakams@kuhp.kyoto-u.ac.jp Received 5 April, 2017 Accepted 5 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Simple Technique for Reducing the Buccal Fat Pad During Mandibular Orthognathic Surgery

Sagittal split ramus osteotomy and intraoral vertical ramus osteotomy are commonly performed for the correction of jaw deformities. However, during mandibular orthognathic surgeries such as sagittal split ramus osteotomy and intraoral vertical ramus osteotomy , the authors sometimes encounter exposure of the buccal fat pad (BFP), which decreases the surgical field. The exposed BFP makes it difficult to perform these operations, may result in unexpected complications, and may increase the operation time. Therefore, the authors herein describe a simple, safe, and convenient technique for reducing the volume of the exposed BFP during mandibular orthognathic surgery using an electric knife in the coagulation mode. Address correspondence and reprint requests to Yoko Kawase-Koga, DDS, PhD, Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Tokyo 160-0023, Japan; E-mail: kogay@tokyo-med.ac.jp Received 28 September, 2017 Accepted 5 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Evaluation of the Olfactory Function With the “Sniffin’ Sticks” Test After Endoscopic Transsphenoidal Pituitary Surgery

The aim of this study was to evaluate the olfactory function of patients who had undergone endoscopic transsphenoidal pituitary surgery. In this prospective study, the "Sniffin' Sticks" test was performed between June 2016 and April 2017 at Izmir Katip Celebi University Ataturk Training and Research Hospital. Thirty patients who were scheduled to undergo endoscopic transsphenoidal pituitary surgery were evaluated preoperatively and 8 weeks postoperatively using the Sniffin' Sticks test battery for olfactory function, odor threshold, smell discrimination, and odor identification. The patients were evaluated preoperatively by an otolaryngologist. The patients' demographic data and olfactory functions were analyzed with a t test and Wilcoxon-labeled sequential test. The study group comprised 14 women (46.7%) and 16 men (53.3%) patients. The mean age of the patients was 37.50 ± 9.43 years (range: 16–53 years). We found a significant difference in the preoperative and postoperative values of the odor recognition test (P = 0.017); however, there was no significant difference between the preoperative and postoperative odor threshold values (P = 0.172) and odor discrimination values (P = 0.624). The threshold discrimination identification test scores were not significant (P = 0.110). The olfactory function of patients who were normosmic preoperatively was not affected postoperatively. This study shows that the endoscopic transsphenoidal technique for pituitary surgery without nasal flap has no negative effect on the olfactory function. Address correspondence and reprint requests to Ceren Kizmazoglu, MD, Department of Neurosurgery, Dokuz Eylul University School of Medicine, 35340 Balçova, Izmir, Turkey; E-mail: ceren.kizmazoglu@gmail.com Received 17 October, 2017 Accepted 3 January, 2018 The authors have no conflicts of interest to disclose. © 2018 by Mutaz B. Habal, MD.

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Frontal Mucocele Extended Orbita and Endoscopic Marsupialization Technique

Mucocele is benign, slow-growing, mucous-filled cystic lesions that arise in the paranasal sinuses. It causes progressive distension of the bony walls and induces compressive symptoms. Surgical treatment of paranasal sinus mucoceles includes endoscopic approach or external approach. The authors report a patient of frontal mucocele who presented with a history of progressive unilateral protrusion. Computed tomography scan revealed a large mucocele of the frontal sinus with orbital extension on the same side. He was successfully treated with endoscopic marsupialization without any serious complications. Address correspondence and reprint requests to Banu Atalay Erdogan, MD, Department of Otolaryngology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, 34890 Cevizli, Kartal, Istanbul, Turkey; E-mail: banuatalay81@gmail.com Received 24 October, 2017 Accepted 5 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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A Reduction Technique for Depressed Medial Maxillary Fractures

The authors developed a technique for reducing the fractured segment by introducing an elevator through the accessory maxillary ostium (AMO). Through an upper gingivolabial vestibular incision, the fractured segments were exposed. In cases where no cleft was available for inserting the elevator, the blunt end of a Cottle elevator was inserted into the AMO via a nasal approach. The curved blunt end of a Cottle elevator was inserted into the middle meatus and the AMO was felt at the medial wall of the maxillary sinus. With gentle pressure, the tip was pushed into the maxillary sinus, and then pushed forward about 2 cm. An upward force was applied until the depressed segment was reduced to its original position. Through a gingivolabial vestibular incision, alignment of the reduced segments could be seen. Miniplate fixation can be applied. If the reduced segments are stable or too many segments are present, the fracture can be stabilized using tissue glue. The authors propose that in medial maxillary fractures where no cleft for the elevator is available, the fractured segment can be mobilized by introducing an elevator through the AMO. Address correspondence and reprint requests to Kun Hwang, MD, PhD, Department of Plastic Surgery, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon 400-711, Korea; E-mail: jokerhg@inha.ac.kr Received 30 November, 2017 Accepted 5 January, 2018 This study was supported by a grant from National Research Foundation of Korea (NRF-2017R1A2B4005787). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Unilateral Orticochea Pharyngoplasty for Unilateral Velopharyngeal Dysfunction: Long-Term Outcomes Data

A unilateral deficit in velopharyngeal closure during speech production is an unusual presentation of velopharyngeal dysfunction (VPD) and few solutions have been described for this problem. This report details the long-term outcomes using this technique. We performed a retrospective chart review of all the patients who underwent a unilateral Orticochea pharyngoplasty for VPD. The authors identified 10 patients treated with 11 unilateral pharyngoplasty at a single tertiary care institutional setting. The mean age at repair was 8.6 years. The mean length of follow-up was 7.6 years. All the patients demonstrated improvement in velopharyngeal closure and speech resonance with 4 showing complete resolution of VPD. There were no revisions required or complications. One patient, after 10.7 years, required a unilateral procedure on the contralateral side which resulted in complete resolution of VPD postoperatively. Address correspondence and reprint requests to Arlen D. Denny, MD, FACS, Center for Craniofacial Disorders, P.O. Box 1997; MS C340, Milwaukee, WI 53201-1997; E-mail: adenny@chw.org Received 24 September, 2017 Accepted 7 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Ablation of Buccal Cancer and Functionality Buccal Reconstruction Using an Individuation Anterolateral Thigh Flap

The complex area for reconstruction of the head and the neck is the buccal because of difficult anatomy of this region. This article aimed to describe our individualized design for the reconstruction of the buccal using an different categories anterolateral thigh (ALT) flap. Ninety-four patients were involved in this study. Among 94cases, the number of using the musculocutaneous ALT flap was 57, using the fasciocutaneous ALT flap was 25, and using the thin ALT flap was 12. Postoperative vessel thrombosis occurred in 8 flaps, and required operative exploration in the perioperative period, 6 flaps were complete survival after the salvages, 2 flap was failure. The ALT flap represents a very good choice for the reconstruction of the complex defects at the cheek level. The flap can replace large volumes of tissues and the skin island is large and can be used both for the tegument reconstruction and for the oral mucosa reconstruction. Address correspondence and reprint requests to Dr. Guowen Sun, Department of Oral and Maxillofacial Surgery, Nangjing Stomatological Hospital,Medical School of Nanjing University,30 Zhongyang Road, Nanjing 210008, PR China; E-mail: guowensun@yahoo.com Received 3 September, 2017 Accepted 5 January, 2018 LZ and TZ contributed equally and should both be regarded as first authors. This research was supported by Jiangsu Provincial Special Program of Medical Science (BL2013005), Project of Health Department of Jiangsu province Nanjing science and technology development project (H201441), Nanjing science and technology development project (201503038) and Key project supported by Medical science and technology development Foundation Nanjing Department of Health (Ykk13150). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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A Rare Cause of Recurrent Cerebral Ischemia and Syncope: Eagle Syndrome

Eagle syndrome is defined as symptomatic elongation of the styloid process or calcification of the stylohyoid and stilomandibular ligament. The syndrome was described by WW Eagle in 1937. The styloid process is located between the internal and external carotid arteries and laterally in the tonsillar fossa. Patients with cerebrovascular ischemia causing syncope or hemiparesia due to Eagle syndrome are rarely published in the literature. The authors presented a patient with recurrent cerebrovascular attacks due to long styloid process. Address correspondence and reprint requests to Kemal Koray Bal, Resident Doctor, MD, Department of Otorhinolaryngology, Faculty of Medicine, University of Mersin, Mersin 33010, Turkey; E-mail: dr.kemalkoraybal@gmail.com Received 25 October, 2017 Accepted 7 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Nasolabial Morphology Following Nasoalveolar Molding in Infants With Unilateral Cleft Lip and Palate

Aim: The aim of the present study is to evaluate the effects of nasoalveolar molding (NAM) therapy on nasolabial morphology three dimensionally, and compare the nasolabial linear and surface distance measurements in infants with unilateral cleft lip and palate. Methods: Facial plaster casts of 42 infants with unilateral cleft lip and palate taken at the onset (pre-NAM) and finishing stage (post-NAM) of NAM were scanned with 3dMDface stereophotogrammetry system (3dMD, Atlanta, GA). Nineteen nasolabial linear and surface distance measurements were performed on three-dimensional images. In addition to standard descriptive statistical calculations (means and SDs), pre- and post-NAM measurements were evaluated by paired t test. Results: All measurements except lip gap, nostril floor width, and nostril diameter increased between pre-NAM and post-NAM. Nostril and lip height increased significantly on the cleft side (P 

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Postextraction Dental Implant in the Aesthetic Zone, Socket Shield Technique Versus Conventional Protocol

The aim of this randomized controlled trial was to evaluate the survival rate, the marginal bone level, and the aesthetic outcome; at 3 years' follow-up, of dental implants placed into a high-esthetic aesthetic zone by comparing 2 techniques of postextraction implant with immediate loading: the socket shied technique and the conventional insertion technique. Several clinical studies suggested that the avulsion of a dental element causes dimensional alterations of both soft and hard tissues at the postextractive site. To increase the aesthetic outcomes, the "socket-shield technique" has been proposed. This method involves maintaining the vestibular root portion and immediate insertion of the dental implant in close proximity to the root. Patients enrolled in this study were randomized to receive a postextraction implant in the aesthetic zone, either with the socket shied technique or with the conventional insertion technique. Implant survival, marginal bone level, and the pink aesthetic score were the outcomes evaluated. Implant survival rate was 100% in both the groups at 3 years. Implants inserted with the socket shield technique showed better values of both marginal bone level and pink aesthetic score (P 

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Does the Degree of the Mastoid Pneumatization Affect the Side of Bell Palsy?

Objective: The aim is to investigate the impact of degree of mastoid pneumatization on the affected side of Bell palsy (BP). Study Design: Retrospective study in tertiary academic hospital. Methods: In total, 52 patients who were diagnosed with as BP were included in the study. Each patient was staged using House–Brackmann (HB) staging system. All patients underwent temporal bone computed tomography imaging. House–Brackmann scores, side of the BP, and mastoid pneumatization of all of patients were evaluated in the present study. Results: Regarding the degree of the mastoid pneumatization, there were no significant differences between the affected side and the unaffected side (P = 0.439). The degree of the mastoid pneumatization of the affected side and the unaffected side did not differ between males and females (P = 0.918 for the affected side, P = 0.765 for the unaffected side, respectively). A negative correlation between the age and mastoid pneumatization of each side was found (P = 0.001, P = 0.025, respectively). There was no significant correlation between HB score and the degree of the mastoid pneumatization of each side (P = 0.789, P = 0.703). Conclusion: As a conclusion, the degree of the mastoid pneumatization is not one of the risk factors for BP. Further randomized studies with larger numbers of patients are needed to confirm these findings. Address correspondence and reprint requests to Dr Mustafa Çelik, MD, Bakirköy Dr Sadi Konuk Eğitim ve Araştirma Hastanesi, Zuhuratbaba Mah. Tevfik Sağlam Cad. No: 11, Bakirköy, 34147 Istanbul, Turkey; E-mail: dr.mcelik@yahoo.com Received 8 July, 2017 Accepted 1 December, 2017 The protocol for this study was approved by the hospital's local ethics committee (ethical committee number 2017/05/05). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Demystifying the “Triple Point: ” Technical Nuances of the Fronto-Orbital Advancement

Removal of the fronto-orbital bandeau is one of the most critical components for procedures designed to correct anomalies of the craniofacial skeleton and remodel the anterior calvarial vault. It is also used to improve exposure of the anterior cranial fossa. It is arguably one of the more difficult portions of some craniofacial procedures. While the technique for fronto-orbito-sphenoid osteotomy has been frequently described, it has only been minimally detailed. Separation of bone in this region remains challenging due to the bone thickness, adjacent vital structures, and limited direct visibility. The present paper describes the anatomy of this particular region, which the authors have termed the "triple point", to facilitate successful osteotomy and avoid potential injury. Address correspondence and reprint requests to Peter J. Taub, MD, FACS, Professor, Surgery, Pediatrics, Dentistry, and Neurosurgery; Professor, Medical Education; Program Director, Plastic and Reconstructive Surgery; Chief, Craniomaxillofacial Surgery, Icahn School of Medicine at Mount Sinai; Chief, Pediatric Plastic Surgery, Kravis Children's Hospital, 5 East 98th Street, New York, NY 10029; E-mail: Peter.taub@mountsinai.org Received 2 March, 2017 Accepted 30 June, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Replacement of the distorted dentition of the Cone Beam Computed Tomography (CBCT) scans for orthognathic surgery planning

Publication date: Available online 28 February 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Turki Almutairi, Kurt Naudi, Neil Nairn, Xiangyang Ju, John Whitters, Aashraf Ayoub
PurposeCBCT imaging does not record dental morphology accurately due to the scattering produced by metallic restorations and the reported magnification. The aim of this study was the development and the evaluation of a new method for the replacement of the distorted dentition of CBCT scans with 3D dental image captured by a digital intraoral camera.
Materials and MethodSix dried skulls with orthodontics brackets fixed on the teeth were used in this study. Three intra-oral markers made of dental stone were constructed and attached to orthodontics brackets. The skulls were CBCT scanned and occlusal surfaces were captured using TRIOS ^® 3D intraoral scanner. The digital intra-oral scan (IOS) was fused into the CBCT models. This produced a new composite digital model of the skull and dentition. The skulls were scanned again using the commercially accurate Laser Faro^® arm to produce the 3D model "gold standard" for the assessment of the accuracy of the developed method. This was assessed by measuring the distance between the occlusal surfaces of the new composite model and the "gold standard" 3D laser scanned modelResultsThe results showed the errors related to the superimposition of the intra-oral image on the CBCT to replace the distorted dentition were between 0.11 and 0.20 mm.ConclusionThe results of this study suggests that the dentition in the CBCT can be accurately replaced with the digital IOS captured by an intra-oral scanner to create a composite model which will improve the accuracy of the digital orthognathic surgical planning and the fabrication of an occlusal wafer.



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Pesticides as risk factors for head and neck cancer: a review

Abstract

Humans may be exposed to pesticides such as fungicides, herbicides and insecticides, during occupational and non-occupational activities. Pesticides could be related to cancer development mainly because of their effects on the endocrine and immune systems and their cumulative effect. The present review evaluated in current literature evidence of an association between exposure to pesticides and the occurrence of head and neck cancer (HNC). A literature search for cohort studies was conducted in the PubMed, Web of science and Cochrane databases. Methodological quality of each study was rated with the Scottish Intercollegiate Guidelines Network (SIGN) checklist. One thousand one hundred thirty-two studies were identified. Thirty-two were included. Most of the studies found addressed occupational exposure to pesticides and were conducted in Europe and North America. Eleven high-quality studies were found. Most of them found no association between exposure to pesticides and increased risk of HNC. Two studies found some evidence of a positive association between pesticide (malathion and atrazine) exposure and thyroid cancer. The literature review does not support a clear evidence for association between pesticides exposure and HNC. Only limited evidence points to a positive association between exposure to some pesticides and thyroid cancer. Further standardized studies based on appropriate designs are required to clarify the effect of pesticides on the genesis of HNC, considering dose, length of exposure and type of pesticide.

This article is protected by copyright. All rights reserved.

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Pre- and postsynaptic ionotropic glutamate receptors in the auditory system of mammals

Publication date: Available online 28 February 2018
Source:Hearing Research
Author(s): Hideki Takago, Tomoko Oshima-Takago
The ionotropic glutamate receptors (iGluRs) concertedly mediate neurotransmission to convey, process, and integrate acoustic information along the auditory pathway. In order to ensure these challenging tasks, the iGluRs are variously expressed in auditory neurons in an age- and site-dependent manner. The subunit compositions of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs) and N-methyl-D-aspartate receptors (NMDARs) are altered with development, underlying the acceleration in kinetics of excitatory postsynaptic responses. AMPAR desensitization partly affects short-term synaptic plasticity upon repetitive stimuli in subsets of auditory neurons at a given period of maturation. NMDAR activation is required for long-term synaptic plasticity in a cerebellum-like microcircuit within the first auditory brainstem nucleus. Along with their postsynaptic functions, AMPARs and NMDARs fulfill essential roles in presynaptic modulation of auditory neurotransmission. Despite the expression of the kainate and delta receptors, their functions remain unknown. Here this review aims to discuss the diverse distribution and functions of pre- and postsynaptic iGluRs in the peripheral and central auditory systems.



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Monotherapy with a novel intervenolin derivative, AS-1934, is an effective treatment for Helicobacter pylori infection

Abstract

Background

Helicobacter pylori (H. pylori) infection causes various gastrointestinal diseases including gastric cancer. Hence, eradication of this infection could prevent these diseases. The most popular first-line treatment protocol to eradicate H. pylori is termed "triple therapy" and consists of a proton pump inhibitor (PPI), clarithromycin, and amoxicillin or metronidazole. However, the antibiotics used to treat H. pylori infection are hindered by the antibiotics-resistant bacteria and by their antimicrobial activity against intestinal bacteria, leading to side effects. Therefore, an alternative treatment with fewer adverse side effects is urgently required to improve the overall eradication rate of H. pylori.

Objective

The aim of this study was to assess the effectiveness and mechanism of action of an antitumor agent, intervenolin, and its derivatives as an agent for the treatment of H. pylori infection.

Results

We demonstrate that intervenolin, and its derivatives showed selective anti-H. pylori activity, including antibiotic-resistant strains, without any effect on intestinal bacteria. We showed that dihydroorotate dehydrogenase, a key enzyme for de novo pyrimidine biosynthesis, is a target and treatment with intervenolin or its derivatives decreased the protein and mRNA levels of H. pylori urease, which protects H. pylori against acidic conditions in the stomach. Using a mouse model of H. pylori infection, oral monotherapy with the intervenolin derivative AS-1934 had a stronger anti-H. pylori effect than the triple therapy commonly used worldwide to eradicate H. pylori.

Conclusion

AS-1934 has potential advantages over current treatment options for H. pylori infection.

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Clinical and Instrumental Evaluation of Late Dysphagia in Patients With Oropharynx and Nasopharynx Cancer, Candidates to Combined Radiochemotherapy With Intensity Modulated Technique (IMRT)

Conditions:   Cancer of Oropharynx;   Cancer of Nasopharynx
Intervention:  
Sponsor:   Azienda Ospedaliero, Universitaria Pisana
Recruiting

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Susceptibility of sodA- and sodB-deficient Escherichia coli mutant towards antimicrobial photodynamic inactivation via the type I-mechanism of action

Photochem. Photobiol. Sci., 2018, Advance Article
DOI: 10.1039/C7PP00370F, Paper

Pouriya Faraj Tabrizi, Sara Wennige, Mark Berneburg, Tim Maisch
In PACT existing defense mechanisms against ROS in bacteria might influence the susceptibility against T_I-PACT, while this was not the case using T_II-photosensitizers (TMPyP).
To cite this article before page numbers are assigned, use the DOI form of citation above.
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Boric acid as reference substance for ecotoxicity tests in tropical artificial soil

Abstract

Reference substances are recommended to evaluate the quality of laboratory test species and the reliability of ecotoxicity data. Boric acid (BA) has been recommended as reference substance in some standardized tests in OECD soil, but no data are available for Tropical Artificial Soil (TAS). For this purpose, avoidance tests with Eisenia andrei, lethality tests with E. andrei and Folsomia candida, and reproduction tests with E. andrei, Enchytraeus crypticus and F. candida were carried out in TAS (5% organic matter), following ISO guidelines, and compared between two laboratories. Collembolans were more sensitive than earthworms in lethality tests (LC₅₀ = 342 and > 1000 mg kg⁻¹, respectively). For both laboratories, the EC₅₀ values were similar for reproduction of oligochaeta species (165 mg kg⁻¹ for E. crypticus; 242 and 281 mg kg⁻¹ for E. andrei), but significantly different for reproduction of F. candida (96 and 198 mg kg⁻¹). Present results suggest that boric acid could replace the current pesticides recommended by ISO guidelines as reference substances on reproduction tests with soil invertebrates in TAS. Concerning avoidance tests, additional investigations should be performed with other substances that cause no neurotoxic effects on soil organisms.

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Orthotopic transfer of vascularized groin lymph node flap in the treatment of breast cancer-related lymphedema: clinical results, lymphoscintigraphy findings and proposed mechanism

Publication date: Available online 28 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Hin-Lun Liu, Suet-Ying Pang, Chung-Ching Lee, Melody Man-Kuen Wong, Hon-Ping Chung, Yu-Wai Chan
IntroductionVascularized lymph node transfer (VLNT) has become more popular in treating secondary lymphedema. However, the mechanism has not been clearly elucidated.The purpose of this study were (1) to evaluate the outcome of vascularized groin lymph node (VGLN) transfer using axilla as a recipient site in patients with breast cancer-related lymphedema (BCRL) and (2) to provide radiological evidence of lymphangiogenesis in VLNT.MethodsBetween August 2013 and June 2016, 30 consecutive patients with a mean age of 60 years underwent VGLN transfer for BCRL. A skinless VGLN flap nourished by the superficial circumflex iliac vessels was transferred to the axillary region of lymphedematous limb. The outcomes were assessed clinically with limb circumference measurement and radiologically with lymphoscintigraphy.ResultsAt a mean follow-up of 22.11 ± 7.83 months, 21 (70%) patients had reduction in limb circumference. The mean circumference reduction rate of the lymphedematous limb was 47.06 ± 27.92% (range, 0 to 100%).Eleven (37%) patients showed radiological improvement in post-operative lymphoscintigraphy that included 7 cases of faster contrast transport and 4 cases of visualization of transplanted lymph node.ConclusionPatients with BCRL can benefit from orthotopic VGLN transfer. Lymphangiogenesis is supported by the visualization of transplanted lymph node in post-operative lymphoscintigraphy.



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The international WAO/EAACI guideline for the management of hereditary angioedema – the 2017 revision and update

Hereditary Angioedema (HAE) is a rare and disabling disease. Early diagnosis and appropriate therapy are essential. This update and revision of the global guideline for HAE provides up-to-date consensus recomm...

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Vocalization Subsystem Responses to a Temporarily Induced Unilateral Vocal Fold Paralysis.

Vocalization Subsystem Responses to a Temporarily Induced Unilateral Vocal Fold Paralysis.

J Speech Lang Hear Res. 2018 Feb 27;:1-17

Authors: Croake DJ, Andreatta RD, Stemple JC

Abstract
Purpose: The purpose of this study is to quantify the interactions of the 3 vocalization subsystems of respiration, phonation, and resonance before, during, and after a perturbation to the larynx (temporarily induced unilateral vocal fold paralysis) in 10 vocally healthy participants. Using dynamic systems theory as a guide, we hypothesized that data groupings would emerge revealing context-dependent patterns in the relationships of variables representing the 3 vocalization subsystems. We also hypothesized that group data would mask important individual variability important to understanding the relationships among the vocalization subsystems.
Method: A perturbation paradigm was used to obtain respiratory kinematic, aerodynamic, and acoustic formant measures from 10 healthy participants (8 women, 2 men) with normal voices. Group and individual data were analyzed to provide a multilevel analysis of the data. A 3-dimensional state space model was constructed to demonstrate the interactive relationships among the 3 subsystems before, during, and after perturbation.
Results: During perturbation, group data revealed that lung volume initiations and terminations were lower, with longer respiratory excursions; airflow rates increased while subglottic pressures were maintained. Acoustic formant measures indicated that the spacing between the upper formants decreased (F3-F5), whereas the spacing between F1 and F2 increased. State space modeling revealed the changing directionality and interactions among the 3 subsystems.
Conclusions: Group data alone masked important variability necessary to understand the unique relationships among the 3 subsystems. Multilevel analysis permitted a richer understanding of the individual differences in phonatory regulation and permitted subgroup analysis. Dynamic systems theory may be a useful heuristic to model the interactive relationships among vocalization subsystems.
Supplemental Material: http://ift.tt/2ow2Z6y.

PMID: 29486490 [PubMed - as supplied by publisher]

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