Δευτέρα 29 Φεβρουαρίου 2016

Brain Injury Alters Volatile Metabolome

Chemical signals arising from body secretions and excretions communicate information about health status as have been reported in a range of animal models of disease. A potential common pathway for diseases to alter chemical signals is via activation of immune function—which is known to be intimately involved in modulation of chemical signals in several species. Based on our prior findings that both immunization and inflammation alter volatile body odors, we hypothesized that injury accompanied by inflammation might correspondingly modify the volatile metabolome to create a signature endophenotype. In particular, we investigated alteration of the volatile metabolome as a result of traumatic brain injury. Here, we demonstrate that mice could be trained in a behavioral assay to discriminate mouse models subjected to lateral fluid percussion injury from appropriate surgical sham controls on the basis of volatile urinary metabolites. Chemical analyses of the urine samples similarly demonstrated that brain injury altered urine volatile profiles. Behavioral and chemical analyses further indicated that alteration of the volatile metabolome induced by brain injury and alteration resulting from lipopolysaccharide-associated inflammation were not synonymous. Monitoring of alterations in the volatile metabolome may be a useful tool for rapid brain trauma diagnosis and for monitoring recovery.



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Symptom: Right-Sided Tinnitus

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Mental Well-Being Tightly Linked to Hearing Health

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Beyond Hearing Loss: Self-Management in Audiological Practice

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Complementary Factors in Processing

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Management of Psychosocial Challenges Posed by Communication Breakdowns

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Manufacturers News

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Risk factors for Barrett’s esophagus

ABSTRACT

Barrett's esophagus (BE) is a well-recognized precursor for esophageal adenocarcinoma (EAC) and is defined as ≥1 cm segment of salmon colored mucosa extending above the gastroesophageal junction into the tubular esophagus with biopsy confirmation of metaplastic replacement of the normal squamous epithelium by intestinal-type columnar epithelium. The incidence of both BE and EAC has been increasing over the past few decades. As a result, preventing the development of BE by identifying and understanding its modifiable and non-modifiable risk factors may help reduce the incidence of EAC. Over the recent past, a tremendous amount of progress has been made towards improving our knowledge of risk factors and pathogenesis of BE. This article reviews the evidence for the various risk factors for development of BE. This article is protected by copyright. All rights reserved.



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Compressive sensing with a spherical microphone array

A wave expansion method is proposed in this work, based on measurements with a spherical microphone array, and formulated in the framework provided by Compressive Sensing. The method promotes sparse solutions via ℓ1-norm minimization, so that the measured data are represented by few basis functions. This results in fine spatial resolution and accuracy. This publication covers the theoretical background of the method, including experimental results that illustrate some of the fundamental differences with the "conventional" least-squares approach. The proposed methodology is relevant for source localization, sound field reconstruction, and sound fieldanalysis.



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Differential Group Delay of the Frequency Following Response Measured Vertically and Horizontally

Abstract

The frequency following response (FFR) arises from the sustained neural activity of a population of neurons that are phase locked to periodic acoustic stimuli. Determining the source of the FFR noninvasively may be useful for understanding the function of phase locking in the auditory pathway to the temporal envelope and fine structure of sounds. The current study compared the FFR recorded with a horizontally aligned (mastoid-to-mastoid) electrode montage and a vertically aligned (forehead-to-neck) electrode montage. Unlike previous studies, envelope and fine structure latencies were derived simultaneously from the same narrowband stimuli to minimize differences in cochlear delay. Stimuli were five amplitude-modulated tones centered at 576 Hz, each with a different modulation rate, resulting in different side-band frequencies across stimulus conditions. Changes in response phase across modulation frequency and side-band frequency (group delay) were used to determine the latency of the FFR reflecting phase locking to the envelope and temporal fine structure, respectively. For the FFR reflecting phase locking to the temporal fine structure, the horizontal montage had a shorter group delay than the vertical montage, suggesting an earlier generation source within the auditory pathway. For the FFR reflecting phase locking to the envelope, group delay was longer than that for the fine structure FFR, and no significant difference in group delay was found between montages. However, it is possible that multiple sources of FFR (including the cochlear microphonic) were recorded by each montage, complicating interpretations of the group delay.



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Compressive sensing with a spherical microphone array

cm_sbs_024_plain.png

A wave expansion method is proposed in this work, based on measurements with a spherical microphone array, and formulated in the framework provided by Compressive Sensing. The method promotes sparse solutions via ℓ1-norm minimization, so that the measured data are represented by few basis functions. This results in fine spatial resolution and accuracy. This publication covers the theoretical background of the method, including experimental results that illustrate some of the fundamental differences with the "conventional" least-squares approach. The proposed methodology is relevant for source localization, sound field reconstruction, and sound fieldanalysis.



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Pulse-spreading harmonic complex as an alternative carrier for vocoder simulations of cochlear implantsa)

cm_sbs_024_plain.png

Noise- and sine-carrier vocoders are often used to acoustically simulate the information transmitted by a cochlear implant(CI). However, sine-waves fail to mimic the broad spread of excitation produced by a CI and noise-bands contain intrinsic modulations that are absent in CIs. The present study proposes pulse-spreading harmonic complexes (PSHCs) as an alternative acoustic carrier in vocoders. Sentence-in-noise recognition was measured in 12 normal-hearing subjects for noise-, sine-, and PSHC-vocoders. Consistent with the amount of intrinsic modulations present in each vocoder condition, the average speech reception threshold obtained with the PSHC-vocoder was higher than with sine-vocoding but lower than with noise-vocoding.



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Language learning and brain reorganization in a 3.5-year-old child with left perinatal stroke revealed using structural and functional connectivity.

Language learning and brain reorganization in a 3.5-year-old child with left perinatal stroke revealed using structural and functional connectivity.

Cortex. 2016 Feb 4;77:95-118

Authors: François C, Ripollés P, Bosch L, Garcia-Alix A, Muchart J, Sierpowska J, Fons C, Solé J, Rebollo M, Gaitán H, Rodriguez-Fornells A

Abstract
Brain imaging methods have contributed to shed light on the possible mechanisms of recovery and cortical reorganization after early brain insult. The idea that a functional left hemisphere is crucial for achieving a normalized pattern of language development after left perinatal stroke is still under debate. We report the case of a 3.5-year-old boy born at term with a perinatal ischemic stroke of the left middle cerebral artery, affecting mainly the supramarginal gyrus, superior parietal and insular cortex extending to the precentral and postcentral gyri. Neurocognitive development was assessed at 25 and 42 months of age. Language outcomes were more extensively evaluated at the latter age with measures on receptive vocabulary, phonological whole-word production and linguistic complexity in spontaneous speech. Word learning abilities were assessed using a fast-mapping task to assess immediate and delayed recall of newly mapped words. Functional and structural imaging data as well as a measure of intrinsic connectivity were also acquired. While cognitive, motor and language levels from the Bayley Scales fell within the average range at 25 months, language scores were below at 42 months. Receptive vocabulary fell within normal limits but whole word production was delayed and the child had limited spontaneous speech. Critically, the child showed clear difficulties in both the immediate and delayed recall of the novel words, significantly differing from an age-matched control group. Neuroimaging data revealed spared classical cortical language areas but an affected left dorsal white-matter pathway together with right lateralized functional activations. In the framework of the model for Social Communication and Language Development, these data confirm the important role of the left arcuate fasciculus in understanding and producing morpho-syntactic elements in sentences beyond two word combinations and, most importantly, in learning novel word-referent associations, a building block of language acquisition.

PMID: 26922507 [PubMed - as supplied by publisher]



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Jackson's Parrot: Samuel Beckett, Aphasic Speech Automatisms, and Psychosomatic Language.

Jackson's Parrot: Samuel Beckett, Aphasic Speech Automatisms, and Psychosomatic Language.

J Med Humanit. 2016 Feb 27;

Authors: Salisbury L, Code C

Abstract
This article explores the relationship between automatic and involuntary language in the work of Samuel Beckett and late nineteenth-century neurological conceptions of language that emerged from aphasiology. Using the work of John Hughlings Jackson alongside contemporary neuroscientific research, we explore the significance of the lexical and affective symmetries between Beckett's compulsive and profoundly embodied language and aphasic speech automatisms. The interdisciplinary work in this article explores the paradox of how and why Beckett was able to search out a longed-for language of feeling that might disarticulate the classical bond between the language, intention, rationality and the human, in forms of expression that seem automatic and "readymade".

PMID: 26922435 [PubMed - as supplied by publisher]



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Κυριακή 28 Φεβρουαρίου 2016

The Influence of Cognitive Factors on Outcomes with Frequency Lowering

 IntroductionSince frequency lowering technology has become commercially available in modern digital hearing aids, researchers have set out to determine what benefits this technology could provide hearing-impaired patients. There is an abundance

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Understanding and Treating Severe and Profound Hearing Loss

Oticon has a history of creating excellent solutions for patients with severe-to-profound hearing loss. With the release of Oticon Dynamo, Sensei Super Power, and the Plus Power products in our performance line categories, we have again raised the ba

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Effects of benzalkonium chloride on histamine H1 receptor mRNA expression in nasal epithelial cells

To better understand the causes of the exacerbation of rhinitis medicamentosa (RM) induced by oxymetazoline (OMZ) or benzalkonium chloride (BKC), we examined the impact of pretreatment with OMZ or BKC on cultured human nasal epithelial cells. We also examined the effect of mometasone furoate (MF) on the cultured human nasal epithelial cells treated with OMZ or BKC.

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Successful application of endoscopic modified medial maxillectomy to orbital floor trapdoor fracture in a pediatric patient

Publication date: Available online 27 February 2016
Source:Auris Nasus Larynx
Author(s): Yasunori Matsuda, Hiroshi Sakaida, Masayoshi Kobayashi, Kazuhiko Takeuchi
Although surgical treatment of orbital floor fractures can be performed by many different approaches, the application of endoscopic modified medial maxillectomy (EMMM) for this condition has rarely been described in the literature. We report on a case of a 7-year-old boy with a trapdoor orbital floor fracture successfully treated with the application of EMMM. The patient suffered trauma to the right orbit floor and the inferior rectus was entrapped at the orbital floor. Initially, surgical repair via endoscopic endonasal approach was attempted. However, we were unable to adequately access the orbital floor through the maxillary ostium. Therefore, an alternative route of access to the orbital floor was established by EMMM. With sufficient visualization and operating space, the involved orbital content was completely released from the entrapment site and reduced into the orbit. To facilitate wound healing, the orbital floor was supported with a water-inflated urethral balloon catheter for 8 days. At follow-up 8 months later, there was no gaze restriction or complications associated with the EMMM. This case illustrates the efficacy and safety of EMMM in endoscopic endonasal repair of orbital floor fracture, particularly for cases with a narrow nasal cavity such as in pediatric patients.



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Cohort Profile: Nausea and vomiting during pregnancy genetics consortium (NVP Genetics Consortium).

Cohort Profile: Nausea and vomiting during pregnancy genetics consortium (NVP Genetics Consortium).

Int J Epidemiol. 2016 Feb 26;

Authors: Colodro-Conde L, Cross SM, Lind PA, Painter JN, Gunst A, Jern P, Johansson A, Lund Maegbaek M, Munk-Olsen T, Nyholt DR, Ordoñana JR, Paternoster L, Sánchez-Romera JF, Wright MJ, Medland SE

PMID: 26921609 [PubMed - as supplied by publisher]



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A new familial case of microdeletion syndrome 10p15.3.

A new familial case of microdeletion syndrome 10p15.3.

Eur J Med Genet. 2016 Feb 24;

Authors: Eggert M, Müller S, Heinrich U, Mehraein Y

Abstract
In 2012 a small terminal deletion in the short arm of chromosome 10 in the region 10p15.3 was reported as a novel microdeletion syndrome. By now 21 patients, including a single familial case, have been reported. Characteristic findings comprise variable cognitive impairment or developmental delay, disorder of speech development, as well as various dysmorphic signs. We here report on a new patient, an eight year old girl, with a microdeletion syndrome 10p15.3. She is a foster child showing intellectual deficits, disorder of speech development, behavioral problems, congenital heart defect, and several dysmorphic signs. The same microdeletion was subsequently found in the six year old maternal half-sister, showing very similar developmental and cognitive issues, including major speech impairment. The mother has not obtained a school degree. She was described as being a dissocial person with severe alcohol abuse and showing minor cognitive disability. Thus inheritance of the microdeletion from a probably symptomatic mother can be assumed. The patients presented here add up to the as yet small number of reported cases of microdeletion 10p15.3 and thereby might help to establish a more comprehensive clinical spectrum of this rather newly discovered syndrome.

PMID: 26921531 [PubMed - as supplied by publisher]



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The association between systemic sclerosis disease manifestations and esophageal high-resolution manometry parameters.

The association between systemic sclerosis disease manifestations and esophageal high-resolution manometry parameters.

Neurogastroenterol Motil. 2016 Feb 27;

Authors: Kimmel JN, Carlson DA, Hinchcliff M, Carns MA, Aren KA, Lee J, Pandolfino JE

Abstract
BACKGROUND: We aimed to evaluate the associations between systemic sclerosis (SSc)-related systemic manifestations and esophageal function using high-resolution manometry (HRM).
METHODS: Patients with SSc that had undergone HRM between 1/2004 and 9/2014 were identified and HRMs were analyzed according to the Chicago Classification. Clinical characteristics were identified via retrospective chart review and compared among motility diagnoses while adjusting for age, gender, race, and SSc-disease duration.
KEY RESULTS: Seventy-nine patients (85% female, ages 25-77) were included. Clinical characteristics were compared between patients with absent contractility (AC, n = 40), ineffective esophageal motility (IEM; n = 15), and normal motility (n = 19); the five remaining patients met criteria for other motility diagnoses. Groups differed in severity of skin involvement measured by the modified Rodnan skin score (0-51): AC (adjusted mean 12.6), IEM (4.4), normal (4.3), p = 0.043. Pulmonary function tests [percent predicted FVC and DLCO) were lower in AC (adjusted mean, FVC: 70.3, DLCO 51.1), than IEM (FVC: 92.0; DLCO: 76.9) and normal motility (FVC: 80.0; DLCO: 67.2), p values 0.057 (FVC) and 0.007 (DLCO). Groups did not differ by SSc-disease duration, autoantibodies, or reported symptoms of dysphagia or reflux.
CONCLUSIONS & INFERENCES: In patients with SSc, absent esophageal contractility on HRM was associated with increased skin disease severity and worse lung function. Obtaining HRM to identify SSc patients with more severe esophageal dysfunction could be considered to enable implementation of management strategies in patients potentially at risk for increased morbidity and mortality.

PMID: 26921101 [PubMed - as supplied by publisher]



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Beyond what the eye can see.

Beyond what the eye can see.

Surv Ophthalmol. 2016 Feb 24;

Authors: Ahmad KE, Fraser CL, Sue CM, Barton JJ

Abstract
A 45 year old woman presented with acute sequential optic neuropathy resulting in bilateral complete blindness. No significant visual recovery occurred. Past medical history was relevant for severe pre-eclampsia with resultant renal failure, diabetes mellitus, and sudden bilateral hearing loss when she was. There was a family history of diabetes mellitus in her mother. Testing for common causes of bilateral optic neuropathy did not reveal a diagnosis for her illness. The maternal history of diabetes, and personal history of diabetes and deafness prompted testing for mitochondrial disease. The three primary mitochondrial DNA mutations responsible for Leber Hereditary Optic Neuropathy (LHON), but the patient was subsequently found to have a disease causing mitochondrial DNA mutation, m.13513G>A. The case illustrates the importance of early testing for mitochondrial disease, and demonstrates that LHON like presentations may be missed if testing is limited to the three primary mutations.

PMID: 26921807 [PubMed - as supplied by publisher]



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Validity and repeatability of three in-shoe pressure measurement systems

Publication date: Available online 28 February 2016
Source:Gait & Posture
Author(s): Carina Price, Daniel Parker, Christopher Nester
In-shoe pressure measurement devices are used in research and clinic to quantify plantar foot pressures. Various devices are available, differing in size, sensor number and type; therefore accuracy and repeatability. Three devices (Medilogic, Tekscan and Pedar) were examined in a 2 day x 3 trial design, quantifying insole response to regional and whole insole loading. The whole insole protocol applied an even pressure (50-600kPa) to the insole surface for 0-30seconds in the Novel TruBlue™ device. The regional protocol utilised cylinders with contact surfaces of 3.14 and 15.9cm2 to apply pressures of 50 and 200kPa. The validity (% difference and Root Mean Square Error: RMSE) and repeatability (Intra-Class Correlation Coefficient: ICC) of the applied pressures (whole insole) and contact area (regional) were outcome variables. Validity of the Pedar system was highest (RMSE 2.6kPa; difference 3.9%), with the Medilogic (RMSE 27.0kPa; difference 13.4%) and Tekscan (RMSE 27.0kPa; difference 5.9%) systems displaying reduced validity. The average and peak pressures demonstrated high between-day repeatability for all three systems and each insole size (ICC≥0.859). The regional contact area % difference ranged from -97 to +249%, but the ICC demonstrated medium to high between-day repeatability (ICC≥0.797). Due to the varying responses of the systems, the choice of an appropriate pressure measurement device must be based on the loading characteristics and the outcome variables sought. Medilogic and Tekscan were most effective between 200-300kPa; Pedar performed well across all pressures. Contact area was less precise, but relatively repeatable for all systems.



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HEI-OC1 Cells as a Model for Investigating Drug Cytotoxicity

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Publication date: Available online 27 February 2016
Source:Hearing Research
Author(s): Gilda Kalinec, Pru Thein, Channy Park, Federico Kalinec
The House Ear Institute–Organ of Corti 1 (HEI-OC1) is one of the few, and arguable the most used, mouse auditory cell line available for research purposes. Originally proposed as an in vitro system for screening of ototoxic drugs, it has been used to investigate, among other topics, apoptotic pathways, autophagy and senescence, mechanism of cell protection, inflammatory responses, cell differentiation, effects of hypoxia, oxidative and endoplasmic reticulum stress, and expression of molecular channels and receptors. However, the use of different techniques with different goals resulted in apparent contradictions on the actual response of these cells to some specific treatments. We have now performed studies to characterize the actual response of HEI-OC1 cells to a battery of commonly used pharmacological drugs. We evaluated cell toxicity, apoptosis, viability, proliferation, senescence and autophagy in response to APAP (acetaminophen), cisplatin, dexamethasone, gentamicin, penicillin, neomycin, streptomycin, and tobramycin, at five different doses and two time-points (24 and 48 hours), by flow cytometry techniques and caspase 3/7, MTT, Cytotoxicity, BrdU, Beclin1, LC3 and SA-β-galactosidase assays. We also used HEK-293 and HeLa cells to compare some of the responses of these cells with those of HEI-OC1. Our results indicate that every cell line responds to the each drug in a different way, with HEI-OC1 cells showing a distinctive sensitivity to at least one of the mechanisms under study. Altogether, our results suggest that the HEI-OC1 might be a useful model to investigate biological responses associated with auditory cells, including auditory sensory cells, but a careful approach would be necessary at the time of evaluating drug effects.



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Human Audiometric Thresholds do not Predict Specific Cellular Damage in the Inner Ear

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Publication date: Available online 27 February 2016
Source:Hearing Research
Author(s): Lukas D. Landegger, Demetri Psaltis, Konstantina M. Stankovic
IntroductionAs otology enters the field of gene therapy and human studies commence, the question arises whether audiograms – the current gold standard for the evaluation of hearing function – can consistently predict cellular damage within the human inner ear and thus should be used to define inclusion criteria for trials. Current assumptions rely on the analysis of small groups of human temporal bones post mortem or from psychophysical identification of cochlear "dead regions" in vivo, but a comprehensive study assessing the correlation between audiometric thresholds and cellular damage within the cochlea is lacking.MethodsA total of 131 human temporal bones from 85 adult individuals (ages 19-92 years, median 69 years) with sensorineural hearing loss due to various etiologies were analyzed. Cytocochleograms – which quantify loss of hair cells, neurons, and strial atrophy along the length of the cochlea – were compared with subjects' latest available audiometric tests prior to death (time range 5 hours to 22 years, median 24 months). The Greenwood function and the equivalent rectangular bandwidth were used to infer, from cytocochleograms, cochlear locations corresponding to frequencies tested in clinical audiograms. Correlation between audiometric thresholds at clinically tested frequencies and cell type-specific damage in those frequency regions was examined by calculating Spearman's correlation coefficients.ResultsSimilar audiometric profiles reflected widely different cellular damage in the cochlea. In our diverse group of patients, audiometric thresholds tended to be more influenced by hair cell loss than by neuronal loss or strial atrophy. Spearman's correlation coefficient across frequencies was at most 0.7 and often below 0.5, with 1.0 indicating perfect correlation.ConclusionsAudiometric thresholds do not predict specific cellular damage in the human inner ear. Our study highlights the need for better non- or minimally-invasive tools, such as cochlear endoscopy, to establish cellular-level diagnosis and thereby guide therapy and monitor response to treatment.



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Σάββατο 27 Φεβρουαρίου 2016

Perception of professional ethics by Iranian occupational therapists working with children

Ethics are related to the structure and culture of the society. In addition to specialized ethics for every profession, individuals

also hold their own personal beliefs and values. This study aimed to investigate Iranian occupational therapists' perception of

ethical practice when working with children. For this purpose, qualitative content analysis was used and semi-structured

interviews were conducted with ten occupational therapists in their convenient place and time. Each interview was transcribed

and double-checked by the research team. Units of meaning were extracted from each transcription and then coded and

categorized accordingly.

The main categories of ethical practice when working with children included personal attributes, responsibility toward clients,

and professional responsibility. Personal attributes included four subcategories: veracity, altruism, empathy, and competence.

Responsibility toward clients consisted of six subcategories: equality, autonomy, respect for clients, confidentiality,

beneficence, and non-maleficence. Professional responsibility included three subcategories: fidelity, development of

professional knowledge, and promotion and growth of the profession. Findings of this study indicated that in Iran, occupational

therapists' perception of autonomy, beneficence, non-maleficence, fidelity and competence is different from Western countries,

which may be due to a lower knowledge of ethics and other factors such as culture. The results of this study may be used to

develop ethical codes for Iranian occupational therapists both during training and on the job.



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A Review of Ferdous al-Hekma fil-Tibb by Ali ibn Raban Tabari

T Ferdous al-Hekma (Paradise of Wisdom) is one of the oldest medical texts in the Islamic world written in Arabic in 850 AD

by Ali ibn Raban Tabari. He was a Persian physician who moved from Tabaristan (Mazandaran province of modern day Iran) to

Samarra during the reign of the Abbasid Caliph al-Mutawakkil (847-861 AD).

We studied the book of Ferdous al-Hekma fil-Tibb, in an attempt to comprehend its general outlook on diseases of different

organs, their classifications and the associated signs and symptoms.

The book is one of the earliest medical pandects of the period of translation, adaptation and expansion of knowledge in the

Islamic world during the 9

th

century AD. Tabari was mainly influenced by Hippocrates, Galen and Aristotle, as well as his

contemporaries Johanna ibn Massavieh and Hunayn ibn Ishaq. The book is written in thirty chapters in a total number of 308

 

subtitles. In each part there is an introduction to the symptomatology, followed by organ specific diseases and therapeutic

 

recommendations.

 

Symptoms and physical signs of different diseases are vividly described in Ferdous al-Hekma, and some of them are even

 

understandable for contemporary medical students.

 

 



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Moral distress and perception of futile care in intensive care nurses

Special characteristics of care environments have always presented nurses with some challenges. One particular situation is

futile care, which is frequently accompanied by countless moral and legal challenges. The dominant atmosphere in futile care

may cause moral distress to nurses and lead to a sense of guilt, pain, suffering, job dissatisfaction, and eventually cause nurses

to leave the job. This descriptive-analytical study attempted to investigate the relationship between futile care and moral distress

in intensive care nurses. Study subjects were 300 nurses in intensive care units in Kerman, Iran and were selected by

convenience sampling based on inclusion criteria. Study tools included Corley's 21-item questionnaire on moral distress and a

researcher-made 17-item questionnaire on futile care. Data analysis was performed using SPSS version 16 and suitable

analytical and descriptive tests.

The results showed a significantly positive relationship between moral distress and futile care (

P

= 0.03, r = 0.4). Based on the

obtained results, futile care can create conditions that may lead to moral distress in nurses and therefore strategies should be

 

devised to prevent these conditions. Moreover, distress in nurses should be identified by periodical counseling so that it can be

 

managed more efficiently.

 

 



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Chorasmia Medical School from the beginning until the Mongol invasion

In research on the history of medicine, less attention is paid to the subject of historical geography. Considering the importance of this subject in the history of science, this paper discusses one of the most important science centers in the world. This outstanding medical research center was located in Gorganch city, Chorasmia area, in the Eastern part of the Islamic. Chorasmia medical school was one of the important Iranian medical schools before the Mongols' attack. Its history (305-1231 A.D.) can be divided into three eras; Ale Iraq, Ale Ma'mun, and era of the Khwarazmian dynasty. This geographical area in the Northeast of Iran has escaped the notice of researchers in recent studies. The presence of great Persian physicians and scientists throughout history in this area indicates its scientific importance. The present article focuses on Chorasmia Medical School since its establishment until the Mongols' attack.

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Professionalism in residents of physical medicine and rehabilitation in Iran

Professionalism is the foundation of trust on which the doctor-patient relationship is built. This study was performed to measure

professionalism in Iranian physical medicine and rehabilitation residents as a baseline assessment tool for future studies.

This was a descriptive study. The Persian version of the American Board of Internal Medicine (ABIM) questionnaire was

distributed among all the second and third-year residents of the medical state universities of Iran (n=43). Data were summarized

as mean (SD), and independent samples t-test was used for comparison of means between genders, and also between the second

and third-year residents.

Forty questionnaires were analyzed. The mean (± SD) age of respondents was 29.95 (± 2.37) years. The mean score (SD) for the

overall score was 115.15 (± 17.36) out of 150, and the mean score (± SD) for all items was 7.67 (± 1.15) out of 10. The

respondents averaged 5.88 (± 1.69) for items forming the 'excellence' factor, 7.98 (± 1.48) for items in 'altruism/respect' and

8.92 (± 1.26) for items in the 'honor/integrity' subscale.

These data may serve as a baseline for future research in this field. The lowest score pertained to excellence, which needs more

focus in future studies.



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Ethical challenges in the neonatal intensive care units: perceptions of physicians and nurses; an Iranian experience

The challenging nature of neonatal medicine today is intensified by modern advances in intensive care and

treatment of sicker neonates. These developments have caused numerous ethical issues and conflicts in ethical

decision-making. The present study surveyed the challenges and dilemmas from the viewpoint of the neonatal

intensive care personnel in the teaching hospitals of Tehran University of Medical Sciences (TUMS) in the capital of

Iran.

In this comparative cross-sectional study conducted between March 2013 and February 2014, the physicians' and

nurses' perceptions of the ethical issues in neonatal intensive care units were compared. The physicians and

nurses of the study hospitals were requested to complete a 36-item questionnaire after initial accommodations.

The study samples consisted of 284 physicians (36%) and nurses (64%). Content validity and internal consistency

calculations were used to examine the psychometric properties of the questionnaire. Data were analyzed by

Pearson's correlation, t-test, ANOVA, and linear regression using SPSS v. 22.

Respecting patients' rights and interactions with parents were perceived as the most challenging aspects of

neonatal care. There were significant differences between sexes in the domains of the perceived challenges.

According to the linear regression model, the perceived score would be reduced 0.33 per each year on the job.

The results of our study showed that the most challenging issues were related to patients' rights, interactions with

parents, communication and cooperation, and end of life considerations respectively. It can be concluded,

therefore, that more attention should be paid to these issues in educational programs and ethics committees of

hospitals.



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Moral self-concept and moral sensitivity in Iranian nurses

Nurses are often faced with serious situations that require high levels of legal and ethical knowledge, and should therefore be

sensitive to the moral issues in their profession in the decision making process. Some studies have investigated nurses' moral

self-concept as an effective factor in moral sensitivity, but there is not sufficient evidence to support this. The purpose of this

study was to determine the correlation between moral sensitivity and moral self-concept in nurses employed in the teaching

hospitals in Zahedan, Iran.

This cross-sectional descriptive study aimed to study the relationship between moral self-concept and moral sensitivity in nurses

employed in the teaching hospitals affiliated with Zahedan University of Medical Sciences. Chang's Moral Self-Concept

Questionnaire and Lutzen's Moral Sensitivity Questionnaire were used for data collection. Data analysis was performed using

SPSS software version 17.

A total of 188 nurses participated in this study. The results showed that there was a positive and significant relationship between

moral self-concept and moral sensitivity (

P

< 0.05).

Based on our findings, an individual's attention to moral issues can lead to greater sensitivity and result in morally responsible

 

behavior at the time of decision making. Consequently, promotion of moral self-concept through personal effort or education

 

can increase moral sensitivity, which in turn leads to behavioral manifestations of ethical knowledge.

 

 



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Surveying the attitudes of transsexual patients referring to Tehran Institute of Psychiatry toward doctors’ empathy, Iran, 2011-2012

Physicians' knowledge of therapy and counseling stands among the most important issues in the viewpoints of clients who refer to psychiatric centers. Transsexual patients are very important in this regard. The goal of this research is to study their attitude toward doctors' empathy.

A group of transsexual patients who referred to the Tehran Institute of Psychiatry, Iran, answered the Jefferson Scale of Empathy. The relationship of the patients' age, gender, education level, and lifestyle with their attitude was measured.

This study was conducted on 40 patients, including 16 women (40%) and 24 men (60%). In terms of education, 8 patients had a degree below high school diploma (20%), 9 had high school diploma (22.5%), and 23 patients were university students or of higher education level (57.5%). Among these patients, 6 were unemployed (15%), 10 were students (25%), and the rest were employed. Moreover, 8 participants lived alone (20%), 5 lived with their friends (12.5%), and 27 lived with their family (67.5%). Gender had no influence on the average score of the questionnaires, yet level of education had some influence. Lifestyle also had a significant influence on the patients' attitude. On the other hand, patients whose problems began before the age of 12 had lower score than others.

Experienced psychologists in referential centers can express greater levels of empathy to specific diseases and this trend is very effective on the patients' cooperation level. In order to create an effective relationship between physicians and patients, the efficiency of the health system and increasing satisfaction of specific patients should be considered.

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Developing an ethical guideline for clinical teaching in Tehran University ofMedical Sciences

Clinical education is an essential part of medical trainees' education process, and curriculum planners agree that it should be

based on ethical standards and principles in the medical field. Nevertheless, no explained and codified criteria have been

developed for ethics in clinical teaching. This study was aimed to develop an ethical guideline for medical students and teachers

as the first and most important step in respecting patients' rights in educational centers.

The initial draft included the codes of ethics in clinical education and was developed based on library studies. Subsequently, it

was improved through a qualitative study using semi-structured interviews and focus group sessions with medical students,

patients, and medical teachers in educational hospitals affiliated to Tehran University of Medical Sciences. The improved draft

was reviewed and validated by a medical expert panel to prepare the final draft.

The codes derived from this study included patients' choices and rights in purely educational procedures, and special

considerations for a) obtaining informed consent for educational procedures; b) performing procedures on deceased persons,

patients under anesthesia and those lacking decision making capacity; c) educational visual recordings of the patients; and d)

safety monitoring in clinical education.

The guideline developed in this study incorporates codes of ethics into clinical training. Therefore, in addition to providing

efficient education, the interests of patients and their rights are respected, and the ethical sensitivity of learners in primacy of

patients' best interests will be preserved and enhanced.



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Development of a scale for the evaluation of patients’ rights prerequisites at educational hospitals in Iran: a study using the Delphi technique

The patients' rights status is one of the essential elements in defining norms related to the concept of clinical governance system. In addition, the patients' rights status is an important index for quality of care offered in the health care system. However, the lack of a coherent instrument makes it difficult to evaluate patients' rights status in hospitals and clinics. The aim of this study was to develop an instrument for the evaluation of patients' rights prerequisites at educational hospitals in Iran.

This study was conducted using the modified Delphi technique. In this study, 36 experts in the fields of law, medicine, and professional ethics were participated. The panel of experts participated in 3 rounds. First, experts were asked to judge some pre-identified items, and then, excluded items were judged again in the second round. At the end of the third round, all of the agreed items were included in the final list to form an evaluative scale on practice of patients' rights.

Experts were asked to judge a total 171 items in 3 rounds. Around 31% (n = 53) of items obtained the panel's approval to be included in the final version of the scale. The experts' opinions were collected using face-to-face interviews and electronic email during a 6-month period of data collection from October 2013 to February 2014. This study developed a 53-item scale for evaluation of patients' rights prerequisites in educational hospitals in Iran. This scale was developed in 7 areas of commitments including university education, research, supervision, process management, physical structure, organizational policy, and human resources management.

This study developed an evaluative scale to assess the practice of patients' rights in educational hospitals. The items in the final version of this scale were obtained from a consensus of experts and the instrument can be used to evaluate the context and prerequisites for practice of patients' rights in Iranian educational hospitals.

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Patients’ lived experiences regarding maintaining dignity

Preservation of dignity is frequently emphasized as a basic patient's right in national and international nursing codes of ethics

and is indeed the essence and core of nursing care. It is therefore essential to explore the concept based on patients' lived

experiences in order to maintain and respect their dignity and consequently improve the quality of health services and patient

satisfaction. The present study aimed to discover the lived experiences of Iranian patients regarding maintaining their dignity at

the bedside.

This qualitative study was conducted using an interpretive phenomenological approach. A total of 14 participants (9 women and

5 men) were purposefully selected, and data were collected through individual, semi-structured and deep interviews. The

recorded interviews were transcribed and analyzed by the Diekelman, Allen and Tanner approach.

The findings of this study revealed three main themes and related subthemes regarding the meaning of preserving patients'

dignity. The first main theme was "exigency of preserving the innate human dignity" and comprised two subthemes: "respect

for the intrinsic equality of all humans" and "treating the patient as a valued person, not an object". The second theme was

"service based on love and kindness" and included two subthemes: 'being with the patient" and "inspiring the sense of being

accepted and loved". The third main theme emerged as "dignifying and transcendental professional service" and consisted of

two subthemes: "professional commitment to uphold patients' rights" and "enlightened practice".

This study revealed that the concept of maintaining patients' dignity is related to health providers' duty to preserve patients'

dignity and also their moral obligation to manifest the human love that is in their own as well as their patients' nature. In

conclusion, if nurses reflect on the transcendental nature of nursing care, they will value and prize their everyday bedside

nursing practice and will utilize their capacities to be more human as well.



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A complementary response to the article “breaching confidentiality: medical mandatory reporting laws in Iran”

The article is Commentary and has no abstract

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Polymorphous low-grade adenocarcinoma: A Danish national study

Publication date: April 2016
Source:Oral Oncology, Volume 55
Author(s): Mohammad Talal Elhakim, Helle Breinholt, Christian Godballe, Lisbeth Juhler Andersen, Hanne Primdahl, Claus A. Kristensen, Kristine Bjørndal
ObjectivesTo present a national series of polymorphous low-grade adenocarcinoma (PLGA) patients, including survival rates and an analysis of prognostic factors.Materials and methodsBy merging three Danish nationwide registries, 73 patients diagnosed with PLGA from 1990 to 2005 were identified. Histological slides were reviewed and data concerning demographics, tumour site, clinical stage, treatment profiles and follow-up were retrieved. Survival estimates and prognostic factors were evaluated by comparing Kaplan–Meier plots using the Mantel–Haenszel log-rank test.ResultsOf the 73 patients, 47 (64%) were female. Median age was 58years. The most common location was the palate (73%). Median latency was five months. Recurrence was seen in 13% of patients. Overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS) rates after 10years were 73%, 99% and 83%, respectively. Univariate analyses suggested that free resection margins significantly improve RFS.ConclusionPLGA usually has an excellent survival outcome even in cases of advanced stage disease and locoregional recurrence. Primary choice of treatment should be complete surgical excision. Although there is no convincing evidence for the efficacy of adjuvant radiotherapy, it should still be considered, particularly in cases of involved resection margins and advanced stage disease. Late recurrences are common and respond well to salvage therapy.



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RNA in-situ hybridization is a practical and effective method for determining HPV status of oropharyngeal squamous cell carcinoma including discordant cases that are p16 positive by immunohistochemistry but HPV negative by DNA in-situ hybridization

Publication date: April 2016
Source:Oral Oncology, Volume 55
Author(s): Lisa M. Rooper, Manoj Gandhi, Justin A. Bishop, William H. Westra
ObjectivesEvaluation of human papillomavirus (HPV) status in oropharyngeal squamous cell carcinoma (OPSCC) has become increasingly important for prognostication and clinical trial enrollment. This assessment is confounded in OPSCCs that are p16 positive by immunohistochemistry (IHC) but HPV negative by DNA in situ hybridization (DISH). This study evaluates whether E6/E7 mRNA in situ hybridization (RISH) can detect transcriptionally active HPV in these problematic cases.Materials and methodsEighty-two head and neck squamous cell carcinoma cases that had previously undergone p16 IHC and HPV DISH were evaluated with two RISH platforms and a second-generation DISH probe. The study included 21 p16+/DISH+ concordant cases, 19 p16−/DISH− concordant cases, and 42 p16+/DISH− discordant cases.ResultsRISH identified E6/E7 mRNA in 37 (88%) p16+/DISH− cases, 21 (100%) p16+/DISH+ cases, and 0 (0%) p16−/DISH− cases. RISH signals were clearly visible at low to medium magnification in 97% of positive cases, facilitating almost-perfect inter-observer reproducibility. The performance of the manual and automated RISH platforms were equivalent (kappa=0.915). Only 29% of carcinomas that demonstrated E6/E7 mRNA transcriptional activity were positive using the 2nd generation DISH probe.ConclusionsHPV RISH is a highly sensitive and specific platform that can clarify the HPV status of those perplexing OPSCCs that are p16 positive by IHC but HPV negative by DISH. Moreover, it is easy to interpret, readily adaptable to the clinical laboratory, and provides direct evidence of HPV transcriptional activity. E6/E7 RISH should be considered as a first-line platform for determination of HPV status in OPSCCs.



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Emergence of long-term surviving patients with the introduction of Cetuximab in recurrent/metastatic disease of squamous cell carcinoma of head and neck

Publication date: Available online 28 February 2016
Source:Oral Oncology
Author(s): Jenniffer Linares, Antonio Rullan, Miren Taberna, Silvia Vazquez, Ricard Mesia




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Towards a pragmatic human migraine model for drug testing: 2. Isosorbide-5-mononitrate in healthy individuals

Background

A model for the testing of novel anti-migraine drugs should preferably use healthy volunteers for ease of recruiting. Isosorbide-5-mononitrate (5-ISMN) provokes headache in healthy volunteers with some migraine features such as pulsating pain quality and aggravation by physical activity. Therefore, this headache might respond to sumatriptan, a requirement for validation of any model. The hypothesis of the present study was that sumatriptan is effective in 5-ISMN-induced headache in healthy individuals.

Methods

In a double-blind, randomised, crossover design, 30 healthy volunteers of both sexes received 5-ISMN 60 mg on two separate days, each day followed by oral self-administered placebo or sumatriptan 50 mg. Headache response and accompanying symptoms were registered in a questionnaire by the participants themselves.

Results

5-ISMN induced a reproducible headache in all 30 participants. The headache had several migraine-like features in all participants and 20 individuals developed a migraine-like attack. Median peak headache score was 5 on both experimental days (p = 1.00). There was no reduction, but instead an increase in headache intensity 2 hours after sumatriptan (p = 0.003). Difference in area under the headache score curve (AUC) 0–4 hours between sumatriptan and placebo was not significant (p = 0.30).

Conclusion

5-ISMN is a very powerful inducer of migraine-like headache in healthy individuals but the headache does not respond to sumatriptan. The model is not useful for future drug testing.



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May headache triggered by odors be regarded as a differentiating factor between migraine and other primary headaches?

Objectives

The objective of this article is to characterize olfactory stimulation as a trigger of headaches attacks and differentiation between migraine and other primary headaches.

Participants and methods

The study was prospective and experimental, with comparison of groups. A total of 158 volunteers (73 men and 85 women) were diagnosed with primary headaches, according to the criteria of the International Classification of Headache Disorders, Third Edition (beta version) (ICHD-3β). The study was conducted by two examiners; one of them was assigned to diagnose the presence and type of primary headache, while the other was responsible for exposing the volunteers to odor and recording the effects of this exposure.

Results

Of the 158 volunteers with headache, there were 72 (45.6%) cases of migraine and 86 (54.4%) with other primary headaches. In both groups, there were differences in headache characteristics (2 = 4.132; p = 0.046). Headache attacks (25/72; 34.7%) and nausea (5/72; 6.9%) were triggered by odor only in patients with migraine, corresponding to 19.0% (30/158) of the sample, but in none with other primary headaches (2 = 43.78; p < 0.001). Headache occurred more often associated with nausea (p = 0.146) and bilateral location (p = 0.002) in migraineurs who had headache triggered by odor. Headache was triggered after 118 ± 24.6 min and nausea after 72.8 ± 84.7 min of exposure to odor.

Conclusions

The odor triggered headache attacks or nausea only in migraineurs. Therefore, headache triggered by odors may be considered a factor of differentiation between migraine and other primary headaches and this trigger seems very specific of migraine.



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Questionnaires that screen for multiple SLEEP disorders

The goal of this review was to identify, describe, and evaluate the existing multiple sleep disorders screening questionnaires for their comprehensiveness, brevity, and psychometric quality. A systematic review was conducted using Medline/PubMed, Cumulative Index to Nursing & Allied Health Literature, Health and Psychosocial Instruments and the "grey literature". Search terms were "sleep disorders, screening, questionnaires, and psychometrics". The scope of the search was limited to English language articles for adult age groups from 1989 through 2015.

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The effects of bilingualism on conflict monitoring, cognitive control, and garden-path recovery.

The effects of bilingualism on conflict monitoring, cognitive control, and garden-path recovery.

Cognition. 2016 Feb 23;150:213-231

Authors: Teubner-Rhodes SE, Mishler A, Corbett R, Andreu L, Sanz-Torrent M, Trueswell JC, Novick JM

Abstract
Bilinguals demonstrate benefits on non-linguistic tasks requiring cognitive control-the regulation of mental activity to resolve information-conflict during processing. This "bilingual advantage" has been attributed to the consistent management of two languages, yet it remains unknown if these benefits extend to sentence processing. In monolinguals, cognitive control helps detect and revise misinterpretations of sentence meaning. Here, we test if the bilingual advantage extends to parsing and interpretation by comparing bilinguals' and monolinguals' syntactic ambiguity resolution before and after practicing N-back, a non-syntactic cognitive-control task. Bilinguals outperformed monolinguals on a high-conflict but not a no-conflict version of N-back and on sentence comprehension, indicating that the advantage extends to language interpretation. Gains on N-back conflict trials also predicted comprehension improvements for ambiguous sentences, suggesting that the bilingual advantage emerges across tasks tapping shared cognitive-control procedures. Because the overall task benefits were observed for conflict and non-conflict trials, bilinguals' advantage may reflect increased cognitive flexibility.

PMID: 26918741 [PubMed - as supplied by publisher]



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A new experimental paradigm to study children's processing of their parent's unscripted language input.

A new experimental paradigm to study children's processing of their parent's unscripted language input.

J Mem Lang. 2016 Jun 1;88:104-116

Authors: Arunachalam S

Abstract
This paper introduces a new experimental paradigm for studying children's real-time language processing of their parents' unscripted speech. Focusing on children's processing of referential expressions, or the phrases that parents used to label particular objects, we engaged dyads in a game in which parents labeled one of several objects displayed on a screen, and the child was to quickly identify it as their eye gaze was tracked. There were two conditions; one included a competitor object (e.g., the target was a striped umbrella and the display also included an umbrella with polka dots), while the other one did not (e.g., only one umbrella was present). The results revealed evidence of children's incremental processing of their parents' referential expressions. They also showed faster processing of postnominally-modified as compared to prenominally-modified referential expressions. Parents tended to produce postnominally-modified referential expressions in the more difficult experimental condition in which there was a competitor object, suggesting either that these expressions are also easier for them to produce, or that they accommodate their children by producing more easily processed expressions. We discuss the potential of this paradigm for advancing theories of the relationship between child-directed language input and children's language processing.

PMID: 26917862 [PubMed - as supplied by publisher]



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Atypical speech lateralization in adults with developmental coordination disorder demonstrated using functional transcranial Doppler ultrasound.

Atypical speech lateralization in adults with developmental coordination disorder demonstrated using functional transcranial Doppler ultrasound.

J Neuropsychol. 2016 Feb 25;

Authors: Hodgson JC, Hudson JM

Abstract
Research using clinical populations to explore the relationship between hemispheric speech lateralization and handedness has focused on individuals with speech and language disorders, such as dyslexia or specific language impairment (SLI). Such work reveals atypical patterns of cerebral lateralization and handedness in these groups compared to controls. There are few studies that examine this relationship in people with motor coordination impairments but without speech or reading deficits, which is a surprising omission given the prevalence of theories suggesting a common neural network underlying both functions. We use an emerging imaging technique in cognitive neuroscience; functional transcranial Doppler (fTCD) ultrasound, to assess whether individuals with developmental coordination disorder (DCD) display reduced left-hemisphere lateralization for speech production compared to control participants. Twelve adult control participants and 12 adults with DCD, but no other developmental/cognitive impairments, performed a word-generation task whilst undergoing fTCD imaging to establish a hemispheric lateralization index for speech production. All participants also completed an electronic peg-moving task to determine hand skill. As predicted, the DCD group showed a significantly reduced left lateralization pattern for the speech production task compared to controls. Performance on the motor skill task showed a clear preference for the dominant hand across both groups; however, the DCD group mean movement times were significantly higher for the non-dominant hand. This is the first study of its kind to assess hand skill and speech lateralization in DCD. The results reveal a reduced leftwards asymmetry for speech and a slower motor performance. This fits alongside previous work showing atypical cerebral lateralization in DCD for other cognitive processes (e.g., executive function and short-term memory) and thus speaks to debates on theories of the links between motor control and language production.

PMID: 26917045 [PubMed - as supplied by publisher]



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Do children with social communication disorder have explicit knowledge of pragmatic rules they break? A comparison of conversational pragmatic ability and metapragmatic awareness.

Do children with social communication disorder have explicit knowledge of pragmatic rules they break? A comparison of conversational pragmatic ability and metapragmatic awareness.

Int J Lang Commun Disord. 2016 Feb 24;

Authors: Lockton E, Adams C, Collins A

Abstract
BACKGROUND: Children who have social communication disorder (CwSCD) demonstrate persistent difficulties with language pragmatics in conversations and other verbal interactions. Speech-language interventions for these children often include promotion of metapragmatic awareness (MPA); that is, the ability to identify explicitly and reflect upon pragmatic rules (MP explicitation). Improved MPA is assumed to support increased self-monitoring and generalization of pragmatic knowledge. Evidence to support this as a mechanism of intervention depends upon the identification of a systematic relationship between MPA and use of pragmatic rules in conversational behaviour.
AIMS: To explore whether there is a relationship between MPA and conversational pragmatic ability in CwSCD. Further, it is asked whether CwSCD can demonstrate MPA for the pragmatic rules they themselves violate in conversation.
METHODS & PROCEDURES: Thirty-nine CwSCD (aged 6;1-10;7 years), recruited from NHS speech and language therapy caseloads across the North West of England and South East Scotland, completed (1) a novel task, the Assessment of Metapragmatics (AMP), in which they identified and described a series of pragmatic errors depicted in scripted films; responses on this task were categorized into levels of MP explicitation; and (2) the Targeted Observation of Pragmatics in Children's Conversations (TOPICC), a semi-structured conversation-elicitation task from which 12 aspects of pragmatics were coded for presence of impairment. Regression analysis was used to explore the interaction between scores on the two tasks.
OUTCOMES & RESULTS: Expressive language score was a significant predictor of TOPICC score. However, AMP score, when added into the regression model, did not explain a significant amount of unique variance in TOPICC score. Over half of CwSCD demonstrated moderate or marked impairment in one or two pragmatic behaviours on TOPICC. For just over half of the occasions where a child showed moderate/marked impairment of a pragmatic rule on TOPICC did the same child demonstrate MPA for the same pragmatic rule on AMP. On 25% of occasions they demonstrated the most sophisticated level of MP explicitation.
CONCLUSIONS & IMPLICATIONS: Findings indicate that some CwSCD have an awareness of the pragmatic rules they themselves violate in conversation. This finding suggests that, for some CwSCD, it may be beneficial for speech and language therapy to focus on improving motivation for use and better understanding of the impact of one's own pragmatic performance on others, rather than solely teaching awareness of pragmatic rules that are already understood but not used.

PMID: 26916221 [PubMed - as supplied by publisher]



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Hearing loss and cognition in the Busselton Baby Boomer cohort: An epidemiological study.

Hearing loss and cognition in the Busselton Baby Boomer cohort: An epidemiological study.

Laryngoscope. 2016 Feb 24;

Authors: Bucks RS, Dunlop PD, Taljaard DS, Brennan-Jones CG, Hunter M, Wesnes K, Eikelboom RH

Abstract
OBJECTIVES/HYPOTHESIS: To determine the relationship between peripheral hearing loss (HL) in baby boomers (better-ear measure) and cognitive function, taking into account the impact of depression or cognitive reserve on this relationship and exploring binaural hearing.
STUDY DESIGN: A prospective, epidemiology study.
METHODS: Data from 1,969 participants aged 45 to 66 years were collected in the Busselton Healthy Ageing Study. Participants were assessed using pure-tone air-conduction thresholds at octave frequencies (250; 500; 1,000; 2,000; 4,000; and 8,000 Hz). Hearing loss was grouped using 1) pure-tone averages across 4 frequencies (500 to 4000Hz) in the better ear (BE4FA) or 2) latent profile analysis (LPA) using all thresholds from both ears. Cognition was tested with the Cognitive Drug Research System, verbal fluency, and National Adult Reading Test (premorbid-IQ). Regression was used to determine the impact of HL relative to no HL on age and education-adjusted cognition, controlling for mood, sex, and premorbid-IQ.
RESULTS: According to BE4FA, 4.7% had mild (26-40 dB) HL; 0.8% had moderate (41-60 dB) HL; and 0.3% had severe (61-80 dB) HL. Based on the LPA, 20.5% had high-frequency HL; 7.8% had mid- to high-frequency HL; and 1.9% had significant HL across all frequencies. The HL group was not a predictor of cognitive performance in any domain using BE4FA and explained just 0.5% and 0.4% of variance in continuity-of-attention and speed-of-memory retrieval using LPA. Critically, those with the worst hearing did not differ cognitively from those with the best.
CONCLUSION: Hearing loss is not an important determinant of contemporaneous attention, memory, or executive function in middle-aged adults once age, education, depression, cognitive reserve, and sex are controlled.
LEVEL OF EVIDENCE: 2a. Laryngoscope, 2016.

PMID: 26915472 [PubMed - as supplied by publisher]



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Small groups, big gains: efficacy of a tier 2 phonological awareness intervention with preschoolers with early literacy deficits.

http:--pubs.asha.org-images-b_pubmed_ful Related Articles

Small groups, big gains: efficacy of a tier 2 phonological awareness intervention with preschoolers with early literacy deficits.

Am J Speech Lang Pathol. 2015 May;24(2):189-205

Authors: Kruse LG, Spencer TD, Olszewski A, Goldstein H

Abstract
PURPOSE: The purpose of the present study was to evaluate the efficacy of a phonological awareness (PA) intervention, designed for Tier 2 instruction in a Response to Intervention (RTI) model, delivered to small groups of preschoolers.
METHOD: A multiple-baseline design across participants was used to evaluate the efficacy of the intervention on low-income preschool children's PA skills. A trained interventionist delivered small group sessions 3 to 4 days a week and ensured children received frequent opportunities to respond and contingent feedback. Participants received 28 to 36 lessons that lasted about 10 min each and focused on PA and alphabet knowledge. Initiation of intervention was staggered across 3 triads, and 7 children completed the study.
RESULTS: The intervention produced consistent gains on weekly progress monitoring assessments of the primary outcome measure for first sound identification (First Sound Fluency). Most children also demonstrated gains on other measures of PA and alphabet knowledge.
CONCLUSIONS: Results provide support for the application of a small group intervention consistent with an RTI framework and document the potential benefits of the intervention to learners who need early literacy instruction beyond the core curriculum.

PMID: 25835770 [PubMed - indexed for MEDLINE]



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Decoding skills in children with language impairment: contributions of phonological processing and classroom experiences.

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Decoding skills in children with language impairment: contributions of phonological processing and classroom experiences.

Am J Speech Lang Pathol. 2015 May;24(2):177-88

Authors: Tambyraja SR, Farquharson K, Logan JA, Justice LM

Abstract
PURPOSE: Children with language impairment (LI) often demonstrate difficulties with word decoding. Research suggests that child-level (i.e., phonological processing) and environmental-level (i.e., classroom quality) factors both contribute to decoding skills in typically developing children. The present study examined the extent to which these same factors influence the decoding skills of children with LI, and the extent to which classroom quality moderates the relationship between phonological processing and decoding.
METHOD: Kindergarten and first-grade children with LI (n = 198) were assessed on measures of phonological processing and decoding twice throughout the academic year. Live classroom observations were conducted to assess classroom quality with respect to emotional support and instructional support.
RESULTS: Hierarchical regression analyses revealed that of the 3 phonological processing variables included, only phonological awareness significantly predicted spring decoding outcomes when controlling for children's age and previous decoding ability. One aspect of classroom quality (emotional support) was also predictive of decoding, but there was no significant interaction between classroom quality and phonological processing.
CONCLUSIONS: This study provides further evidence that phonological awareness is an important skill to assess in children with LI and that high-quality classroom environments can be positively associated with children's decoding outcomes.

PMID: 25835599 [PubMed - indexed for MEDLINE]



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What's on Your Mind? Conversation Topics Chosen by People With Degenerative Cognitive-Linguistic Disorders for Communication Boards.

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What's on Your Mind? Conversation Topics Chosen by People With Degenerative Cognitive-Linguistic Disorders for Communication Boards.

Am J Speech Lang Pathol. 2015 May;24(2):272-80

Authors: Fried-Oken M, Daniels D, Ettinger O, Mooney A, Noethe G, Rowland C

Abstract
PURPOSE: Conversational topics chosen by a group of adults with degenerative cognitive-linguistic disorders for personalized communication board development were examined. The patient-generated themes commonly selected are presented to guide treatment planning and communication board development.
METHOD: Communication boards were created for 109 adults as part of a larger research project. One autobiographical topic that each participant would enjoy discussing multiple times was represented on each communication board with 16 pictures and word labels. For this review, topics were collapsed into general themes through a consensus process and examined by gender and age.
RESULTS: Sixty unique conversational topics were identified from 109 participants and collapsed into 9 general themes: Hobbies, Family, Travel, Work, Home/Places I've Lived, Sports/Fitness, Religion, Animals, and World War II. Age and gender produced variations in themes chosen, though no significance in rank orders was found across groups.
CONCLUSIONS: Topics selected by adults with degenerative cognitive-linguistic disorders for communication boards resemble common conversational adult themes and do not center around basic needs or medical issues. Differences in gender and age for topic selection tend to be based on traditional roles. These general themes should be used when creating personalized communication boards for those who benefit from conversational aids.

PMID: 25835511 [PubMed - indexed for MEDLINE]



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Constraint-induced aphasia therapy versus intensive semantic treatment in fluent aphasia.

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Constraint-induced aphasia therapy versus intensive semantic treatment in fluent aphasia.

Am J Speech Lang Pathol. 2015 May;24(2):281-94

Authors: Wilssens I, Vandenborre D, van Dun K, Verhoeven J, Visch-Brink E, Mariën P

Abstract
OBJECTIVE: The authors compared the effectiveness of 2 intensive therapy methods: Constraint-Induced Aphasia Therapy (CIAT; Pulvermüller et al., 2001) and semantic therapy (BOX; Visch-Brink & Bajema, 2001).
METHOD: Nine patients with chronic fluent aphasia participated in a therapy program to establish behavioral treatment outcomes. Participants were randomly assigned to one of two groups (CIAT or BOX).
RESULTS: Intensive therapy significantly improved verbal communication. However, BOX treatment showed a more pronounced improvement on two communication-namely, a standardized assessment for verbal communication, the Amsterdam Nijmegen Everyday Language Test (Blomert, Koster, & Kean, 1995), and a subjective rating scale, the Communicative Effectiveness Index (Lomas et al., 1989). All participants significantly improved on one (or more) subtests of the Aachen Aphasia Test (Graetz, de Bleser, & Willmes, 1992), an impairment-focused assessment. There was a treatment-specific effect. BOX treatment had a significant effect on language comprehension and semantics, whereas CIAT treatment affected language production and phonology.
CONCLUSION: The findings indicate that in patients with fluent aphasia, (a) intensive treatment has a significant effect on language and verbal communication, (b) intensive therapy results in selective treatment effects, and (c) an intensive semantic treatment shows a more striking mean improvement on verbal communication in comparison with communication-based CIAT treatment.

PMID: 25765602 [PubMed - indexed for MEDLINE]



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Language exposure in bilingual toddlers: performance on nonword repetition and lexical tasks.

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Language exposure in bilingual toddlers: performance on nonword repetition and lexical tasks.

Am J Speech Lang Pathol. 2015 May;24(2):126-38

Authors: Brandeker M, Thordardottir E

Abstract
PURPOSE: The amount of language exposure is correlated with bilingual lexical development, but findings are mixed on how exposure relates to nonword repetition (NWR), a complex skill involving both short-term processing and long-term vocabulary knowledge. We extend previous work to a younger age group by investigating the role of exposure on NWR versus vocabulary, along with the effect of item construction and scoring.
METHOD: Sixty typically developing children (ages 2;5-3;6[years;months]) were assessed for NWR and receptive and expressive vocabulary. Participants ranged in amount of previous exposure to English and French from 0% to 100% and were tested in both languages if able to participate, even with very limited exposure (28 completed testing in both languages, 11 completed testing in English only, 21 completed testing in French only).
RESULTS: Correlational analyses showed moderate to strong associations between the amount of exposure and vocabulary in that language, whereas the relationship of exposure with NWR was weak or nonsignificant, depending on scoring method. NWR correlated with vocabulary in English only. Performance on NWR was affected by nonword length but unaffected by wordlikeness.
CONCLUSIONS: NWR and vocabulary were differently related to language exposure. The underlying mechanisms of NWR at this age appeared mainly reliant on short-term processes, in contrast to long-term vocabulary knowledge.

PMID: 25675009 [PubMed - indexed for MEDLINE]



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The efficacy of recasts in language intervention: a systematic review and meta-analysis.

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The efficacy of recasts in language intervention: a systematic review and meta-analysis.

Am J Speech Lang Pathol. 2015 May;24(2):237-55

Authors: Cleave PL, Becker SD, Curran MK, Van Horne AJ, Fey ME

Abstract
PURPOSE: This systematic review and meta-analysis critically evaluated the research evidence on the effectiveness of conversational recasts in grammatical development for children with language impairments.
METHOD: Two different but complementary reviews were conducted and then integrated. Systematic searches of the literature resulted in 35 articles for the systematic review. Studies that employed a wide variety of study designs were involved, but all examined interventions where recasts were the key component. The meta-analysis only included studies that allowed the calculation of effect sizes, but it did include package interventions in which recasts were a major part. Fourteen studies were included, 7 of which were also in the systematic review. Studies were grouped according to research phase and were rated for quality.
RESULTS: Study quality and thus strength of evidence varied substantially. Nevertheless, across all phases, the vast majority of studies provided support for the use of recasts. Meta-analyses found average effect sizes of .96 for proximal measures and .76 for distal measures, reflecting a positive benefit of about 0.75 to 1.00 standard deviation.
CONCLUSION: The available evidence is limited, but it is supportive of the use of recasts in grammatical intervention. Critical features of recasts in grammatical interventions are discussed.

PMID: 25654306 [PubMed - indexed for MEDLINE]



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Less-aggressive surgical management and long-term outcomes of jugular foramen paragangliomas: a neurosurgical perspective.

Less-aggressive surgical management and long-term outcomes of jugular foramen paragangliomas: a neurosurgical perspective.

J Neurosurg. 2016 Feb 26;:1-12

Authors: Li D, Zeng XJ, Hao SY, Wang L, Tang J, Xiao XR, Meng GL, Jia GJ, Zhang LW, Wu Z, Zhang JT

Abstract
OBJECTIVE The aim of this study was to analyze the neurological functional outcome and recurrent risks in surgically treated jugular foramen paragangliomas (JFPs) and to propose an individualized therapeutic strategy. METHODS Clinical charts and radiological information were reviewed retrospectively in 51 consecutive cases of JFPs. Less-aggressive surgical interventions were adopted with the goal of preserving neurovascular structures. Scheduled follow-up was performed. RESULTS The mean age of the patients in the cases reviewed was 41.6 years, and the group included 27 females (52.9%). The mean preoperative Karnofsky Performance Scale (KPS) score was 78.4. The mean lesion size was 3.8 cm. Forty-three cases (84.3%) were Fisch Type D, including 37 cases (72.5%) of Type Di1 and Di2. Thirty-seven cases (72.5%) were Glasscock-Jackson Type III-IV. Gross-total resection and subtotal resection were achieved in 26 (51.0%) and 22 (43.1%) cases, respectively. Surgical morbidities occurred in 23 patients (45.1%), without surgery-related mortality after the first operation. The mean postoperative KPS scores at discharge, 3 months, 1 year, and most recent evaluation were 71.8, 77.2, 83.2, and 79.6, respectively. The mean follow-up duration was 85.7 months. The tumor recurrence/regrowth (R/R) rate was 11.8%. Compared with preoperative status, swallowing function improved or stabilized in 96.1% and facial function improved or stabilized in 94.1% of patients. A House-Brackmann scale Grade I/II was achieved in 43 patients (84.3%). Overall neurological status improved or stabilized in 90.0% of patients. Pathological mitosis (HR 10.640, p = 0.009) was the most significant risk for tumor R/R. A 1-year increase in age (OR 1.115, p = 0.037) and preoperative KPS score < 80 (OR 11.071, p = 0.018) indicated a risk for recent poor neurological function (KPS < 80). Overall R/R-free survival, symptom progression-free survival, and overall survival at 15 years were 78.9%, 86.8%, and 80.6%, respectively. CONCLUSIONS Surgical outcomes for JFPs were acceptable using a less-aggressive surgical strategy. Most patients could adapt to surgical morbidities and carry out normal life activities. Preserving neurological function was a priority, and maximal decompression with or without radiotherapy was desirable to preserve a patient's quality of life when radical resection was not warranted. Early surgery plus preoperative devascularization was proposed, and radiotherapy was mandatory for lesions with pathological mitosis.

PMID: 26918473 [PubMed - as supplied by publisher]



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Real enough: using virtual public speaking environments to evoke feelings and behaviors targeted in stuttering assessment and treatment.

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Real enough: using virtual public speaking environments to evoke feelings and behaviors targeted in stuttering assessment and treatment.

Am J Speech Lang Pathol. 2015 May;24(2):139-49

Authors: Brundage SB, Hancock AB

Abstract
PURPOSE: Virtual reality environments (VREs) are computer-generated, 3-dimensional worlds that allow users to experience situations similar to those encountered in the real world. The purpose of this study was to investigate VREs for potential use in assessing and treating persons who stutter (PWS) by determining the extent to which PWS's affective, behavioral, and cognitive measures in a VRE correlate with those same measures in a similar live environment.
METHOD: Ten PWS delivered speeches-first to a live audience and, on another day, to 2 virtual audiences (neutral and challenging audiences). Participants completed standard tests of communication apprehension and confidence prior to each condition, and frequency of stuttering was measured during each speech.
RESULTS: Correlational analyses revealed significant, positive correlations between virtual and live conditions for affective and cognitive measures as well as for frequency of stuttering.
CONCLUSIONS: These findings suggest that virtual public speaking environments engender affective, behavioral, and cognitive reactions in PWS that correspond to those experienced in the real world. Therefore, the authentic, safe, and controlled environments provided by VREs may be useful for stuttering assessment and treatment.

PMID: 25569429 [PubMed - indexed for MEDLINE]



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Effective Treatment of Symptomatic Lower Esophageal (Schatzki) Rings With Acid Suppression Therapy: Confirmed on Barium Esophagography.

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Effective Treatment of Symptomatic Lower Esophageal (Schatzki) Rings With Acid Suppression Therapy: Confirmed on Barium Esophagography.

AJR Am J Roentgenol. 2015 Dec;205(6):1182-7

Authors: Novak SH, Shortsleeve MJ, Kantrowitz PA

Abstract
OBJECTIVE: Symptomatic lower esophageal (Schatzki) rings are one of the most common causes of dysphagia and esophageal food impaction. Although these rings are often diagnosed fluoroscopically, patients are typically referred for dilation procedures performed by a gastroenterologist. Because these procedures are invasive and carry risks, including esophageal perforation, an alternative treatment option is needed. Although recent research has shown the effectiveness of acid suppression medications used in addition to dilation procedures, our objective was to evaluate the effectiveness of treatment with acid suppression medication alone.
MATERIALS AND METHODS: We retrospectively evaluated a cohort of nine patients who underwent barium esophagography at our institution to determine the ability to pass a 13-mm barium tablet and to identify a change in the lumen diameter of the lower esophageal rings after treatment with an oral proton pump inhibitor medication.
RESULTS: The median ring diameter was 10 mm (range, 8-15 mm) before treatment and 15 mm (range, 13-25 mm) after treatment, a statistically significant difference (p = 0.008). The median tablet passage score was 2 before treatment (with tablet passage paused briefly) and 1 after treatment (with the tablet passing through the esophagus easily without stopping), which was also a statistically significant difference (p = 0.02).
CONCLUSION: Significant improvements in both the ring lumen diameter and the ability to pass a tablet through the esophagus indicate that acid suppression medication is an effective alternative to the use of dilation procedures for the treatment of Schatzki rings.

PMID: 26587923 [PubMed - indexed for MEDLINE]



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Which PPI?

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Which PPI?

Med Lett Drugs Ther. 2015 Jun 22;57(1471):91

Authors:

PMID: 26079763 [PubMed - indexed for MEDLINE]



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Effects of genetic correction on the differentiation of hair cell-like cells from iPSCs with MYO15A mutation.

Effects of genetic correction on the differentiation of hair cell-like cells from iPSCs with MYO15A mutation.

Cell Death Differ. 2016 Feb 26;

Authors: Chen JR, Tang ZH, Zheng J, Shi HS, Ding J, Qian XD, Zhang C, Chen JL, Wang CC, Li L, Chen JZ, Yin SK, Shao JZ, Huang TS, Chen P, Guan MX, Wang JF

Abstract
Deafness or hearing loss is a major issue in human health. Inner ear hair cells are the main sensory receptors responsible for hearing. Defects in hair cells are one of the major causes of deafness. A combination of induced pluripotent stem cell (iPSC) technology with genome-editing technology may provide an attractive cell-based strategy to regenerate hair cells and treat hereditary deafness in humans. Here, we report the generation of iPSCs from members of a Chinese family carrying MYO15A c.4642G>A and c.8374G>A mutations and the induction of hair cell-like cells from those iPSCs. The compound heterozygous MYO15A mutations resulted in abnormal morphology and dysfunction of the derived hair cell-like cells. We used a CRISPR/Cas9 approach to genetically correct the MYO15A mutation in the iPSCs and rescued the morphology and function of the derived hair cell-like cells. Our data demonstrate the feasibility of generating inner ear hair cells from human iPSCs and the functional rescue of gene mutation-based deafness by using genetic correction.Cell Death and Differentiation advance online publication, 26 February 2016; doi:10.1038/cdd.2016.16.

PMID: 26915297 [PubMed - as supplied by publisher]



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Feasibility of flexible endoscopic evaluation of swallowing in healthy dogs.

Feasibility of flexible endoscopic evaluation of swallowing in healthy dogs.

Am J Vet Res. 2016 Mar;77(3):294-299

Authors: Marks SL, Douthitt KL, Belafsky PC

Abstract
OBJECTIVE To assess feasibility of flexible endoscopic evaluation of swallowing (FEES) in awake dogs, determine whether specific variables associated with the oropharyngeal phase of swallowing can be recognized, and evaluate the safety and tolerability of FEES. ANIMALS 6 healthy client-owned large- and giant-breed adult dogs. PROCEDURES A topical anesthetic was applied to the nasal passage of each dog, and a fiberoptic endoscope was passed transnasally until the tip of the scope was positioned in the oropharynx. All dogs voluntarily drank colored water followed by consumption of a commercial canned diet and then a kibble diet mixed with food color. During each swallow, laryngeal and pharyngeal anatomic structures were evaluated and depth of bolus flow prior to the pharyngeal phase of swallowing was assessed. Evidence of bolus retention in the vallecula or pyriform sinuses and laryngeal penetration of the bolus were recorded. RESULTS FEES was completed without major adverse events and was tolerated well by all 6 dogs. Mild, self-limiting epistaxis was noted for 2 dogs. The nasopharynx, oropharynx, and hypopharynx were observed in all dogs; movement of food boluses through the esophagus was observed in 2 dogs, and food boluses in the stomach were visible in 1 dog. Pharyngeal and laryngeal function was considered physiologically normal in all dogs. CONCLUSIONS AND CLINICAL RELEVANCE FEES appeared to be a feasible diagnostic tool for use in large- and giant-breed dogs. Studies are warranted in dogs with oropharyngeal dysphagia to determine whether FEES can be tolerated and whether it can augment videofluoroscopy findings.

PMID: 26919601 [PubMed - as supplied by publisher]



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Variation in palliative care of esophageal cancer in clinical practice: factors associated with treatment decisions.

Variation in palliative care of esophageal cancer in clinical practice: factors associated with treatment decisions.

Dis Esophagus. 2016 Feb 26;

Authors: Opstelten JL, de Wijkerslooth LR, Leenders M, Bac DJ, Brink MA, Loffeld BC, Meijnen-Bult MJ, Minderhoud IM, Verhagen MA, van Oijen MG, Siersema PD

Abstract
Various treatments are available for the palliation of esophageal cancer, but the optimal therapeutic approach is unclear. This study aimed to assess the palliative treatment modalities used in patients with inoperable esophageal cancer and to identify factors associated with treatment decisions. A population-based, retrospective cohort study was conducted using data from the nationwide Netherlands Cancer Registry and medical records of seven participating hospitals. Patients diagnosed with stage III-IV inoperable esophageal or gastric cardia cancer in the central part of the Netherlands between 2001 and 2010 were included. Logistic regression analyses were performed to identify determinants of treatment choices. In total, 736 patients were initially treated with best supportive care (21%), stent placement (19%), chemotherapy (18%), external beam radiotherapy (EBRT) (16%), brachytherapy (6%), a combination of EBRT and brachytherapy (6%), a combination of chemotherapy and EBRT (5%) or another treatment (9%). The palliative approach varied for disease stage (P < 0.01) and hospital of diagnosis (P < 0.01). Independent factors affecting treatment decisions were age, degree of dysphagia, tumor histology, tumor localization, disease stage, and hospital of diagnosis. For example, patients diagnosed in one hospital were less likely to be treated with EBRT than with stent placement compared to patients in another hospital (odds ratio 0.20, 95% confidence interval 0.07-0.59). In conclusion, the initial palliative approach of patients with inoperable esophageal cancer varies widely and is not only associated with patient- and disease-related factors, but also with hospital of diagnosis. These findings suggest a lack of therapeutic guidance and highlight the need for more evidence on palliative care strategies for esophageal cancer.

PMID: 26919349 [PubMed - as supplied by publisher]



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Letter to the Editor: Reduction of early postoperative dysphagia via steroid use after anterior cervical surgery.

Letter to the Editor: Reduction of early postoperative dysphagia via steroid use after anterior cervical surgery.

J Neurosurg Spine. 2016 Feb 26;:1

Authors: Ramos-Zúñiga R, Saldaña-Koppel DA

PMID: 26918576 [PubMed - as supplied by publisher]



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Phase II study of erlotinib and docetaxel with concurrent intensity-modulated radiotherapy in locally advanced head and neck squamous cell carcinoma.

Phase II study of erlotinib and docetaxel with concurrent intensity-modulated radiotherapy in locally advanced head and neck squamous cell carcinoma.

Head Neck. 2016 Feb 26;

Authors: Yao M, Woods C, Lavertu P, Fu P, Gibson M, Rezaee R, Zender C, Wasman J, Sharma N, Machtay M, Savvides P

Abstract
BACKGROUND: The purpose of this study was to establish the efficacy and toxicities of concurrent erlotinib and docetaxel with intensity-modulated radiotherapy (IMRT) for locally advanced head and neck squamous cell carcinoma (HNSCC).
METHODS: Patients received daily erlotinib for 2 weeks, followed by daily IMRT with concurrent weekly docetaxel and daily erlotinib, followed by daily erlotinib for up to 2 years. The primary objective was disease-free survival (DFS). Secondary objectives included overall survival (OS), patterns of failure, and toxicities. Forty-three patients were recruited for this study.
RESULTS: With a median follow-up of 48.7 months, the 3-year DFS, OS, locoregional failure-free survival, and distant metastasis-free survival was 69.5%, 81%, 82.4%, and 83.7%, respectively. The most common grade III/IV local toxicities were dysphagia, dermatitis, and mucositis. Patients with p16-positive tumors had significantly better outcomes.
CONCLUSION: The regimen is tolerable and effective. It is worthy of further investigation in selected patients and may be useful in patients who cannot tolerate cisplatin. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26918562 [PubMed - as supplied by publisher]



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A Case of Laryngeal Cancer Associated with Dermatomyositis.

A Case of Laryngeal Cancer Associated with Dermatomyositis.

Clin Pract. 2015 Nov 5;5(4):818

Authors: Kusunoki T, Homma H, Kidokoro Y, Yanai A, Ikeda K, Wada R

Abstract
We experienced a rare case of laryngeal cancer associated with dermatomyositis. The patient was a 63-year-old male and Japanese. He was admitted to our department of Otorhinolaryngology with dysphagia for a day as a chief complaint. He became aware of hoarseness with bloody sputum and then face edema with redness a half year before. At first physical examination, he had bilateral eyelid edema with erythema, finger edema with keratinizing erythema and limb extensor erythema. Serous creatine phosphokinase was 850 IU/mL (normal range: 40-200 IU/mL). Later, he was referred to the rheumatology department and was diagnosed as having dermatomyositis. Fiberscopic examination revealed laryngeal cancer with left laryngeal palsy. We gave priority to the laryngeal treatment. As a result, the symptoms of dermatomyositis were improved.

PMID: 26918103 [PubMed]



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