Background: National surveys are used to capture US health trends and set clinical guidelines, yet the sampling frame often includes those in non-institutional households, potentially missing those most vulnerable for poor health. Declining response rates in national surveys also represent a challenge, and existing inputs to survey weights have limitations. We compared mortality rates between those who respond to surveys and the general population over time. Methods: Survey respondents from twenty waves of the National Health Interview Survey from 1990 through 2009 who have been linked to death records through 31 December 2011 were included. For each cohort in the survey, we estimated their mortality rates along with that cohort's mortality rate in the census population using vital statistics records and differences were examined using Poisson models. Results: In all years, survey respondents had lower mortality rates compared with the general population, when data were both weighted and unweighted. Among men, survey respondents in the weighted sample had 0.86 (95% C.I. 0.853-0.868) times the mortality rate of the general population (among women, RR=0.887; 95% C.I. 0.879-0.895). Differences in mortality are evident along all points of the life course. Differences have remained relatively stable over time. Conclusion: Survey respondents have lower death rates than the general US population, suggesting that they are a systematically healthier source population. Incorporating non-household samples and revised weighting strategies to account for sample frame exclusion and non-response may allow for more rigorous estimation of the US population's health. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Παρασκευή 27 Οκτωβρίου 2017
Acquisition of Somatic NRAS Mutations in Central Nervous System Melanocytes: A Predisposing Risk Factor to Primary Melanoma of the Central Nervous System, a Frequently Forgotten Pitfall in Congenital Nevi.
Congenital melanocytic nevi (CMN) are benign melanocytic proliferations that are usually present at birth. A somatic mosaicism for an NRAS point mutation is responsible for the several phenotypic abnormalities that may be associated with congenital nevi. We report the case of a 7-year-old boy with a proliferative nodule (PN) arising in a Giant CMN completely excised and with several visceral and intraspinal melanoma metastases with no evidence of primary cutaneous melanoma. The careful analysis of the clinical, morphologic, and molecular features allowed the distinction of between the benign PN (BPN) and the melanoma. The BPN showed a characteristic comparative genomic hybridization pattern with gains or losses of whole chromosomes, whereas the melanoma displayed gains or losses involving complex partial chromosomal copy number gains or losses. Leptomeningeal melanocytes are more susceptible to transformation by oncogenic NRAS than cutaneous melanocytes, and central nervous system melanomas are more common than cutaneous melanomas in the setting of CMN. Thus, it has been recommended to characterize the congenital disease in patients with 2 CMN at birth, independently of size and site, with a single magnetic resonance imaging screening younger than the age of 1 year. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Pruritic Linear Eruption in a 53-Year-Old Woman: Challenge.
No abstract available
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Measuring Scholastic Production by Dermatopathologists Using the H-Index: A Cross-Sectional Study.
Academic advancement in dermatopathology requires evidence of scientific production. The H-index is a useful bibliometric for measuring scientific production because it weights both volume and impact of an individual's scholastic production. The H-index distribution among academic dermatopathologists is unknown. In this cross-sectional study of 299 dermatopathologists with academic appointments in North America, H-index, publication counts, and citation counts were retrieved from Thomas Reuters Web of Science. Analytic statistics were performed to identify best predictors of academic rank and cutoff points between academic ranks. The H-index was a superior predictor of overall academic rank than publication or citation counts. The median H-index for assistant, associate, and full professors was 4, 6, and 11, respectively. H-index cutoff scores of 8 and 10 favored associate and full professor rank, respectively. These data provide benchmarks for dermatopathologists to gauge their scientific productivity against that of their peers. Although advancement decisions will depend on a careful examination of the scope and impact of a candidate's work, assistant professors of dermatopathology with H-index scores of >7 and associate professors of dermatopathology with H-index scores of >9 may wish to consider application for promotion. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Ustekinumab treatment of pityriasis rubra pilaris: A report of five cases
Abstract
Pityriasis rubra pilaris (PRP) is a rare, chronic, inflammatory skin disease of unknown etiology. Patients refractory to conventional therapies have been treated successfully with biologic drugs such as anti-tumor necrosis factor agents. Recently, a role of the interleukin-23/T-helper 17 axis in PRP has been described. Our objective was to assess the effectiveness of ustekinumab in five patients with adult-onset PRP refractory to conventional therapies. In the present study, four patients had type I and one patient type II adult-onset PRP. They were treated with three s.c. doses of ustekinumab at weeks 0, 4 and 16. Clinical response was evaluated monthly during treatment up to a 15-month follow-up period. All patients promptly showed a decrease in erythema, follicular hyperkeratosis and scaling. After three injections, complete remission of skin lesions was achieved in four out of five cases and a significant clinical improvement was shown in one case. To the best of our knowledge, this is the largest case series reported on ustekinumab treatment in PRP. Our results, in addition to previous studies from other groups, suggest that ustekinumab may be a possible first-line treatment for PRP patients refractory to conventional therapies.
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Validation of equations for pleural effusion volume estimation by ultrasonography
Abstract
Purpose
To validate the accuracy of previously published equations that estimate pleural effusion volume using ultrasonography.
Methods
Only equations using simple measurements were tested. Three measurements were taken at the posterior axillary line for each case with effusion: lateral height of effusion (H), distance between collapsed lung and chest wall (C) and distance between lung and diaphragm (D). Cases whose effusion was aspirated to dryness were included and drained volume was recorded. Intra-class correlation coefficient (ICC) was used to determine the predictive accuracy of five equations against the actual volume of aspirated effusion.
Results
46 cases with effusion were included. The most accurate equation in predicting effusion volume was (H + D) × 70 (ICC 0.83). The simplest and yet accurate equation was H × 100 (ICC 0.79).
Conclusion
Pleural effusion height measured by ultrasonography gives a reasonable estimate of effusion volume. Incorporating distance between lung base and diaphragm into estimation improves accuracy from 79% with the first method to 83% with the latter.
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Unilateral rhinorrhoea: An atypical aetiology
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): C. Aussedat, C. Dorbeau, D. Bakhos
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Unilateral rhinorrhoea: An atypical aetiology
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): C. Aussedat, C. Dorbeau, D. Bakhos
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Liddle syndrome
Liddle syndrome: This is a rare, inherited form of high blood pressure (hypertension). It passes genetically from parent to child as an autosomal dominant inheritance. High blood pressure in Liddle syndrome can be severe and associated with low potassium, fatigue, and weakness. It is also called pseudoaldosteronism.
MedTerms (TM) is the Medical Dictionary of MedicineNet.com.
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Addressing complexity in health research, a big issue
The developing history of medicine has shown an increasingly close interaction between improvement of clinical practice and the progress of scientific knowledge. But there has always been the tension that while research must be focused on very specific questions in order to test sharply delineated hypotheses (the mosaic pieces), practice is often complex (the full mosaic of comprehensive integrated care [1]).
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Histomorphometric analyses of area fraction of different ratios of Bio-Oss® and bone prior to grafting procedures – An in vitro study to demonstrate a baseline
Abstract
Objective
The objective of this study was to estimate the area fraction of different ratios of Bio-Oss® and bone, prior to grafting in an in vitro model to demonstrate a histomorphometric baseline.
Methods
Bio-Oss® particles were mixed with autogenous bone from pig jaw in three different ratios (50:50, 80:20 and 100:0) and packed in rice paper in a standardized procedure. Histomorphometric analyses were performed in 25 specimens and 74 regions of interest. The area percentage of Bio-Oss®, bone, and non-mineralized tissue (NMT) were calculated. Results were reported as mean values and 95% confidence interval (CI).
Results
The mean area fraction of Bio-Oss® was 20.6% (CI: 18.2–23) in the 50:50 mixture, 33.6% (CI: 29.7–37.6) in the 80:20 mixture, and 43.4% (CI: 40.5–46.3) in the 100:0 mixture. The mean area fraction of NMT was 60.5% (CI: 57.9–63.1) in the 50:50 mixture, 59.6% (CI: 56.4–62.7) in the 80:20 mixture, and 56.6% (CI: 53.7–59.5) in the 100:0 mixture. The mean area fraction of bone was 18.9% (CI: 16.9–20.9) in the 50:50 mixture and 6.8% (CI: 5–8.6) in the 80:20 mixture.
Conclusion
There is a great difference in the clinically estimated percentage and the histomorphometrically evaluated percentage of Bio-Oss® at baseline, prior to grafting. The area fraction of different tissues presented in this study may be beneficial as guidance for histomorphometrical baseline calculations when different mixtures of Bio-Oss® and autogenous bone are used as grafting materials.
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Oxygen-Enriched Photosensitizer Medium with Red Blood Cells to Study Tissue Interaction of Photosensitization Reaction
Photomedicine and Laser Surgery , Vol. 0, No. 0.
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Related GPCRs couple differently to Gs: preassociation between G protein and 5-HT7 serotonin receptor reveals movement of G{alpha}s upon receptor activation [Research]
How GPCRs and G proteins interact is important for their biologic functions and their functions as pharmacologic targets. It is still an open question whether receptors and G proteins are preassembled in a complex or interact only after receptor activation. We compared the propensity of the two Gs-coupled serotonin (5-HT) receptors 5-HT4 and 5-HT7 to associate with G protein prior to agonist activation. Combining receptor-immobilized fluorescence recovery after photobleaching and fluorescence resonance energy transfer methodologies, we observed that 5-HT7 receptors markedly reduced the diffusion of both Gα and Gβ at the cell surface, which indicated 5-HT7 receptor preassociation with Gs. This is in sharp contrast to the 5-HT4 receptor for which the diffusion of Gαβ was not modified, and agonist activation brought together the receptor and G, which is consistent with interaction by collision coupling. Agonist activation of 5-HT7 dissociated G from the receptor, whereas Gαs underwent a rapid conformational change with respect to both G and the receptor, followed by a slower dissociation of G from both Gαs and the receptor. Taken together, these data demonstrate a different propensity among receptors to preassociate with G protein in the absence of ligand and reveals a rapid conformational change in Gαs upon activation by the receptor.—Andressen, K. W., Ulsund, A. H., Krobert, K. A., Lohse, M. J., Bünemann, M., Levy, F. O. Related GPCRs couple differently to Gs: preassociation between G protein and 5-HT7 serotonin receptor reveals movement of Gαs upon receptor activation.
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Substrate analog interaction with MCR-1 offers insight into the rising threat of the plasmid-mediated transferable colistin resistance [Research]
Colistin is considered a last-resort antibiotic against most gram-negative bacteria. Recent discoveries of a plasmid-mediated, transferable colistin-resistance gene (mcr-1) on all continents have heralded the imminent emergence of pan–drug-resistant superbacteria. The inner-membrane protein MCR-1 can catalyze the transfer of phosphoethanolamine (PEA) to lipid A, resulting in colistin resistance. However, little is known about the mechanism, and few drugs exist to address this issue. We present crystal structures revealing the MCR-1 catalytic domain (cMCR-1) as a monozinc metalloprotein with ethanolamine (ETA) and d-glucose, respectively, thus highlighting 2 possible substrate-binding pockets in the MCR-1–catalyzed PEA transfer reaction. Mutation of the residues involved in ETA and d-glucose binding impairs colistin resistance in recombinant Escherichia coli containing full-length MCR-1. Partial analogs of the substrate are used for cocrystallization with cMCR-1, providing valuable information about the family of PEA transferases. One of the analogs, ETA, causes clear inhibition of polymyxin B resistance, highlighting its potential for drug development. These data demonstrate the crucial role of the PEA- and lipid A–binding pockets and provide novel insights into the structure-based mechanisms, important drug-target hot spots, and a drug template for further drug development to combat the urgent, rising threat of MCR-1–mediated antibiotic resistance.—Wei, P., Song, G., Shi, M., Zhou, Y., Liu, Y., Lei, J., Chen, P., Yin, L. Substrate analog interaction with MCR-1 offers insight into the rising threat of the plasmid-mediated transferable colistin resistance.
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Phase relations in the Cu-O-Al2O3-SiO2 system at 1150°C and 1300°C in air
Publication date: December 2017
Source:Calphad, Volume 59
Author(s): Niko Hellstén, Pekka Taskinen
Phase equilibria of the Cu-O-Al2O3-SiO2 system are important in the processing of copper aluminosilicate glasses, mullite ceramics and in non-ferrous metallurgy. We experimentally investigated the phase equilibria of this system at 1150°C and 1300°C in air atmosphere using equilibration and quenching method. Chemical compositions of the liquid and solid phases in the quenched samples were determined by Electron Probe Microanalysis (EPMA). Based on the results, we constructed an isothermal section containing the liquidus contours of various primary phases at 1300°C. Comparison of these results with previous experimental work confirms that oxygen pressure affects phase stability and composition of the liquidus in this system. The experimental liquidus determined in this work disagrees by up to 50wt% with the calculated values of MTDATA 6.0 software and Mtox database version 8.2. Concentration of 'Cu2O′ in mullite ranged from 0.46wt% to 1.25wt%. The results of this work will enable improvement of thermodynamic descriptions for this system.
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Effect of sternal wire twisting on sternotomy closure rigidity
Abstract
Introduction
Wire twisting is the commonest method of median sternotomy closure. However, wire twisting weakens the wire and fracture may occur at the base of the twisted portion. We investigated how wire twisting affects the physical characteristics of sternotomy closure since rigid fixation promotes quicker primary bone healing.
Methodology
The maximum strength and rigidity of wire closure were tested in a steel sternal model, with varying number of twists, ranging from none to ten twists. Pearson correlation coefficient was used to investigate the relationship between the number of twists versus the maximum closure strength and rigidity. Regression analysis was used to relate closure rigidity with test load and number of wire twists.
Results
Maximum rigidity occurred at two-twists, and decreased from three to ten-twists. Pearson correlation coefficient showed a strong relationship between the number of twists versus maximum closure strength (r = 0.833, p = 0.003) and rigidity (r = 0.819, p = 0.004). The regression model identified load (p < 0.001) and number of twists as significant (p < 0.001), explaining 88.9% of the total variance in displacement. The maximum strength of all twisted closures far exceeded the threshold for wire cutting through bone; suggesting that maximum closure strength is clinically not an important parameter as closure rigidity.
Conclusions
In order to maximize rigidity in the wound closure and optimize primary bone healing, the optimal number of wire twists should be kept low. Excessive number of twists should be avoided as this weakens the closure and increases the amount of foreign material in the wound, theoretically increasing the risk of wound sepsis.
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Haemophilus parasuis CpxRA two-component system confers bacterial tolerance to environmental stresses and macrolide resistance
Source:Microbiological Research
Author(s): Qi Cao, Fenfen Feng, Huan Wang, Xiaojuan Xu, Huanchun Chen, Xuwang Cai, Xiangru Wang
Haemophilus parasuis is an opportunistic pathogen localized in the upper respiratory tracts of pigs, its infection begins from bacterial survival under complex conditions, like hyperosmosis, oxidative stress, phagocytosis, and sometimes antibiotics as well. The two-component signal transduction (TCST) system serves as a common stimulus-response mechanism that allows microbes to sense and respond to diverse environmental conditions via a series of phosphorylation reactions. In this study, we investigated the role of TCST system CpxRA in H. parasuis in response to different environmental stimuli by constructing the ΔcpxA and ΔcpxR single deletion mutants as well as the ΔcpxRA double deletion mutant from H. parasuis serotype 4 isolate JS0135. We demonstrated that H. parasuis TCST system CpxRA confers bacterial tolerance to stresses and bactericidal antibiotics. The CpxR was found to play essential roles in mediating oxidative stress, osmotic stresses and alkaline pH stress tolerance, as well as macrolide resistance (i.e. erythromycin), but the CpxA deletion did not decrease bacterial resistance to abovementioned stresses. Moreover, we found via RT-qPCR approach that HAPS_RS00160 and HAPS_RS09425, both encoding multidrug efflux pumps, were significantly decreased in erythromycin challenged ΔcpxR and ΔcpxRA mutants compared with wild-type strain JS0135. These findings characterize the role of the TCST system CpxRA in H. parasuis conferring stress response tolerance and bactericidal resistance, which will deepen our understanding of the pathogenic mechanism in H. parasuis.
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Structural and Functional Effects of Cytochrome b5 Interactions with Human Cytochrome P450 Enzymes [Enzymology]
The small heme-containing protein cytochrome b5 can facilitate, inhibit, or have no effect on cytochrome P450 catalysis, often in a P450-dependent and substrate-dependent manner that is not well understood. Herein solution NMR was used to identify b5 residues interacting with different human drug-metabolizing P450 enzymes. NMR results revealed that P450 enzymes bound to either b5 α4-5 (CYP2A6 and CYP2E1) or this region and α2-3 (CYP2D6 and CYP3A4) and suggested variation in the affinity for b5. Mutations of key b5 residues suggest that not only are different b5 surfaces responsible for binding different P450 enzymes, but that these different complexes are relevant to the observed effects on P450 catalysis.
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HIV-1 Vpr protein directly loads Helicase-like transcription factor (HLTF) onto the CRL4-DCAF1 E3 ubiquitin ligase [Protein Synthesis and Degradation]
The Vpr protein is an accessory virulence factor of HIV-1 that facilitates infection in immune cells. Cellular functions of Vpr are tied to its interaction with DCAF1, a substrate receptor component of the CRL4 E3 ubiquitin ligase. Recent proteomic approaches suggested that Vpr degrades HLTF DNA helicase in a proteasome-dependent manner by redirecting the CRL4-DCAF1 E3 ligase. However, the precise molecular mechanism of Vprdependent HLTF depletion is not known. Here, using in vitro reconstitution assays, we show that Vpr mediates polyubiquitination of HLTF, by directly loading it onto the C-terminal WD40 domain of DCAF1 in complex with the CRL4 E3 ubiquitin ligase. Mutational analyses suggest that Vpr interacts with DNA binding residues in the Nterminal HIRAN domain of HLTF in a manner similar to the recruitment of another target, Uracil DNA glycosylase (UNG2), to the CRL4-DCAF1 E3 by Vpr. Strikingly, Vpr also engages a second, adjacent region, which connects the HIRAN and ATPase/helicase domains. Thus, our findings reveal that Vpr utilizes common as well as distinctive interfaces to recruit multiple post-replication DNA repair proteins to the CRL4- DCAF1 E3 ligase for ubiquitin-dependent proteasomal degradation.
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Interferon Regulatory Factor 5 (IRF5) suppresses Hepatitis C Virus (HCV) Replication and HCV-Associated Hepatocellular Carcinoma [Cell Biology]
Hepatitis C virus (HCV) infection is a major risk factor for the development of chronic liver disease. The disease typically progresses from chronic HCV to fibrosis, cirrhosis, hepatocellular carcinoma (HCC), and death. Chronic inflammation associated with HCV infection is implicated in cirrhosis and HCC, but the molecular players and signaling pathways contributing to these processes remain largely unknown. Interferon regulatory factor 5 (IRF5) is a molecule of interest in HCV-associated HCC because it has critical roles in virus-, Tolllike receptor (TLR)-, and interferon (IFN)- induced signaling pathways. IRF5 is also a tumor suppressor, and its expression is dysregulated in several human cancers. Here, we present first evidence that IRF5 expression and signaling are modulated during HCV infection. Using HCV infection of human hepatocytes and cells with autonomously replicating HCV RNA, we found that levels of IRF5 mRNA and protein expression were downregulated. Of note, reporter assays indicated that IRF5 re-expression inhibited HCV protein translation and RNA replication. Gene expression analysis revealed significant differences in the expression of cancer pathway mediators and autophagy proteins rather than in cytokines between IRF5- and empty vector-transfected HCV replicon cells. IRF5 reexpression induced apoptosis via loss in mitochondrial membrane potential, downregulated autophagy, and inhibited hepatocyte cell migration/invasion. Analysis of clinical HCC specimens support a pathologic role for IRF5 in HCV-induced HCC, as IRF5 expression was down-regulated in livers from HCV-positive versus HCV-negative HCC patients or healthy donor livers. These results identify IRF5 as an important suppressor of HCV replication and HCC pathogenesis.
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Ablation of the riboflavin-binding protein retbindin reduces flavin levels and leads to progressive and dose-dependent degeneration of rods and cones [Metabolism]
The interface between the neural retina and the retinal pigment epithelium (RPE) is critical for several processes, including visual pigment regeneration and retinal attachment to the RPE. One of its most important functions is the exchange of metabolites between the photoreceptors and RPE because photoreceptor cells have very high energy demands, largely satisfied by oxidative metabolism. The riboflavin (RF) cofactors, flavin adenine dinucleotide (FAD) and flavin mononucleotide (FMN) are two key cofactors involved in oxidative metabolism. We have previously shown that retbindin is a photoreceptor-specific RF-binding protein exclusively expressed in the rods and present in the inter-photoreceptor matrix at the interface between the RPE and photoreceptor outer segments. Here, we show that retbindin ablation in mice causes a retinal phenotype characterized by time- and dose-dependent declines in rod and cone photoreceptor functions as early as 120 days of age. While minor retinal ultrastructural defects were observed at all ages examined, a significant decline occurred in photoreceptor nuclei at 240 days of age (~36.8% rods and ~19.9% cones). Interestingly, significant reductions in FAD and FMN levels were observed before the onset of degeneration (~46.1% FAD and ~45% FMN). These findings suggest that the reduced levels of these flavins result in the disruption of intracellular mechanisms, leading to photoreceptor cell death. Altogether, our results suggest that retbindin is a key player in the acquisition and retention of flavins in the neural retina, warranting future investigation into retbindin s role in photoreceptor cell death in models of retinal degenerative disorders.
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The palmitoyltransferase ZDHHC20 enhances interferon-induced transmembrane protein 3 (IFITM3) palmitoylation and antiviral activity [Microbiology]
Interferon-induced transmembrane protein 3 (IFITM3) is a cellular endosome- and lysosome-localized protein that restricts numerous virus infections. IFITM3 is activated by palmitoylation, a lipid posttranslational modification. Palmitoylation of proteins is primarily mediated by zinc finger DHHC domain-containing palmitoyltransferases (ZDHHCs), but which members of this enzyme family can modify IFITM3 is not known. Here, we screened a library of human cell lines individually lacking ZDHHCs 1-24, and found that IFITM3 palmitoylation and its inhibition of influenza virus infection remained strong in the absence of any single ZDHHC, suggesting functional redundancy of these enzymes in the IFITM3-mediated antiviral response. In an overexpression screen with 23 mammalian ZDHHCs, we unexpectedly observed that more than half of the ZDHHCs were capable of increasing IFITM3 palmitoylation, with ZDHHCs 3, 7, 15, and 20 having the greatest effect. Among these four enzymes, ZDHHC20 uniquely increased IFITM3 antiviral activity when both proteins were overexpressed. ZDHHC20 co-localized extensively with IFITM3 at lysosomes, unlike ZDHHCs 3, 7, and 15, which showed a defined perinuclear localization pattern, suggesting that the location at which IFITM3 is palmitoylated may influence its activity. Unlike knockout of individual ZDHHCs, siRNA-mediated knockdown of both ZDHHC3 and ZDHHC7 in ZDHHC20 knockout cells decreased endogenous IFITM3 palmitoylation. Overall, our results demonstrate that multiple ZDHHCs can palmitoylate IFITM3 to ensure a robust antiviral response, and that ZDHHC20 may serve as a particularly useful tool for understanding and enhancing IFITM3 activity.
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A pivotal role for a conserved bulky residue at the {alpha}1-helix of the {alpha}I integrin domain in ligand binding [Signal Transduction]
The ligand-binding βI and αI domains of integrin are the best-studied von Willebrand factor A (VWA) domains undergoing significant conformational changes for affinity regulation. In both βI and αI domains, the α1- and α7-helixes work in concert to shift the metal-ion-dependent-adhesion-site between the resting and active states. An absolutely conserved Gly in the middle of the α1-helix of βI helps maintain the resting βI conformation, while the homologous position in the αI α1-helix contains a conserved Phe. A functional role of this Phe is structurally unpredictable. Using αLβ2 integrin as a model, we found that the residue volume at the Phe position in the α1-helix is critical for αLβ2 activation since trimming the Phe by small amino acid substitutions abolished αLβ2 binding with soluble and immobilized intercellular-cell adhesion-molecule 1. Similar results were obtained for αMβ2 integrin. Our experimental and molecular dynamics simulation data suggested that the bulky Phe acts as a pawl that stabilizes the downward ratchet-like movement of β6-α7 loop and α7-helix, required for high-affinity ligand binding. This mechanism may apply to other VWA domains undergoing large conformational changes. We further demonstrated that the conformational crosstalk between αL αI and β2 βI could be uncoupled since the β2 extension and headpiece opening could occur independently of the αI activation. Reciprocally, the αI activation does not inevitably lead to the conformational changes of the β2 subunit. Such loose linkage between the αI and βI is attributed to the αI flexibility and could accommodate the αLβ2-mediated rolling adhesion of leukocytes.
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GKI Foods LLC Issues Allergy Alert On Undeclared Milk In Dark Chocolate Products
These products may contain an undeclared milk allergen. People who have an allergy or severe sensitivity to milk allergen run the risk of serious or life threatening allergic reaction if they consume these products.
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Reducing unnecessary chest X-rays, antibiotics and bronchodilators through implementation of the NICE bronchiolitis guideline
Abstract
Chest X-rays (CXR), antibiotics and inhaled/nebulized therapy are overused in bronchiolitis, despite evidence-based guidelines suggesting supportive management only. This study investigates the effect of the implementation of the NICE bronchiolitis guideline in a secondary paediatric unit in England. We present a quality improvement project with a completed audit cycle (winter 2014–2015 and 2015–2016) pre- and post-implementation of the NICE bronchiolitis guideline. The educational intervention included sessions for raising awareness of appropriate and inappropriate management of bronchiolitis for both clinicians and nursing staff. As a result, the number of chest radiographs reduced fivefold (from 20 to 4% of patients, absolute reduction 16%), antibiotics reduced more than threefold (from 22 to 6% of patients, absolute reduction 16%) and inhaled/nebulised treatment up to twofold (from 30 to 16%, absolute reduction 14%). Overall NICE guideline compliance rose from 28 to 63%.
Conclusion: Implementation of the NICE bronchiolitis guideline supported by a simple educational intervention can effectively reduce the number of inappropriate chest radiographs and antibiotic prescribing in bronchiolitis, and enhance compliance with the NICE guideline.
| What is Known: • Bronchiolitis management in paediatric units in the UK is variable, with poor evidence for existing guidance. Best available evidence was compiled into the NICE guideline, aiming to standardize care. • Some evidence exists for the effectiveness of quality improvement approaches to improve the management of bronchiolitis. |
| What is New: • NICE guidance can be effectively applied to a department using simple educational tools. • Effective NICE implementation reduces the rates of unnecessary chest radiograph and antibiotic administration for patients admitted with bronchiolitis in District General Hospitals. |
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Regenerative Effects of Basic Fibroblast Growth Factor on Restoration of Thyroarytenoid Muscle Atrophy Caused by Recurrent Laryngeal Nerve Transection
Vocal fold atrophy following unilateral vocal fold paralysis is caused by atrophy of the thyroarytenoid (TA) muscle and remains a challenge. Medialization procedures are popular treatment options; however, hoarseness often remains due to the reduction in mass or tension of the TA muscle. Therefore, in addition to medialization procedures, TA muscle reinnervation is desirable. In vivo studies have shown the potential for basic fibroblast growth factor (bFGF) to affect muscular and nerve regeneration.
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Cross-cultural Adaptation and Validation of the Italian Version of the Vocal Tract Discomfort Scale (I-VTD)
To evaluate the reliability and validity of the Italian version of the VTD scale (I-VTD scale).
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Combined Vocal Exercises for Rehabilitation After Supracricoid Laryngectomy: Evaluation of Different Execution Times
The supracricoid partial laryngectomy allows the preservation of laryngeal functions with good local cancer control.
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Virtual Presurgical Planning Optimizes the Outcome for a Patient with Ameloblastoma
By the time 31-year-old Marcus King saw Ron Karni, MD, and Kunal Jain, MD, the ameloblastoma encompassed the majority of... Read the full article...from ! ORL Sfakianakis via paythelady.61 on Inoreader http://ift.tt/2yaXLnm
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Dr. Amber Luong Recognized for Clinical Excellence by UTHealth’s Women Faculty Forum
Amber Luong, MD, PhD, associate professor of otorhinolaryngology and research director for the department, has been recognized with the 2017... Read the full article...from ! ORL Sfakianakis via paythelady.61 on Inoreader http://ift.tt/2yatchR
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Dr. William Yao Selected Faculty Member of the Year by ORL Residents
Each year, the faculty of the Department of Otorhinolaryngology-Head and Neck Surgery at McGovern Medical School at UTHealth recognizes an... Read the full article...from ! ORL Sfakianakis via paythelady.61 on Inoreader http://ift.tt/2yb2XYp
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Dr. Soham Roy, Dr. William Yao and Dr. Ibrahim Alava Receive Dean’s Teaching Excellence Awards
Soham Roy, MD, FACS, FAAP, Ibrahim "Trey" Alava, MD, and William Yao, MD, have been recognized with McGovern Medical School... Read the full article...from ! ORL Sfakianakis via paythelady.61 on Inoreader http://ift.tt/2yat3uP
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Development of a portable blood salvage and autotransfusion technology to enhance survivability of personnel requiring major medical interventions in austere or military environments
Introduction
Uncontrolled haemorrhage is the leading cause of death on the battlefield, and two-thirds of these deaths result from non-compressible haemorrhage. Blood salvage and autotransfusion represent an alternative to conventional blood transfusion techniques for austere environments, potentially providing blood to the casualty at point of injury. The aim of this paper is to describe the design, development and initial proof-of-concept testing of a portable blood salvage and autotransfusion technology to enhance survivability of personnel requiring major medical interventions in austere or military environments.
MethodA manually operable, dual-headed pump was developed that removes blood from site of injury to a collection reservoir (upper pump) and back to casualty (lower pump). Theoretical flow rate calculations determined pump configuration and a three-dimensionally printed peristaltic pump was manufactured. Flow rates were tested with fresh bovine blood under laboratory conditions representative of the predicted clinical environment.
ResultsMathematical modelling suggested flow rates of 3.6 L/min and 0.57 L/min for upper and lower pumps. Using fresh bovine blood, flow rates produced were 2.67 L/min and 0.43 L/min. To mimic expected battlefield conditions, upper suction pump flow rate was calculated using a blood/air mixture.
ConclusionThe authors believe that this technology can potentially enhance survivability for casualties in austere and deployed military settings through autotransfusion and cell concentration. It reduces negative effects of blood donation on the conventional donor pool, and potentially negates the logistical constraints associated with allogenic transfusions.
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Quantitative assessment of the learning curve for cleft lip repair using LC-CUSUM
The first step in cleft lip repair is the precise positioning of anatomical landmarks and tracing of the incisions on the patient's lip at the beginning of the procedure. The aim of this study was to evaluate progress made in learning cleft lip repair tracing using a quantitative assessment of learning curves: LC-CUSUM (learning curve – cumulative sum). Eight surgical residents were enrolled and asked to trace lip repair incisions on five cases of unilateral left cleft lip over 5 consecutive weeks.
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Clinics combine doctor, dentist in one location
Sometimes it feels like a parent's job is taxi driver, shuttling kids from one appointment to the next. But what if you could combine appointments -- such as doctor and dental -- into one? At St. Anthony North Health Campus, everything looked normal about Elena Thomas' 18-month checkup until the very end, when she and her mother, Shawn Thomas, walked out of the doctor's office and down the hall to the next appointment with the dental hygienist.
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Acquired Vascular Tumors of the Head and Neck
Vascular neoplasms of the head and neck present with a wide spectrum of signs and symptoms. Diagnosis requires a high index of suspicion and is usually made after tumors are large enough to be visually apparent or cause symptoms. This article discusses the most common acquired benign and malignant vascular tumors, with an emphasis on their evaluation and treatment.
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Somatosensory function is impaired in patients with idiopathic REM sleep behaviour disorder
Idiopathic REM sleep behaviour disorder (iRBD) has been recognised as a significant biomarker for developing a neurodegenerative alpha-synucleinopathy, why iRBD is considered to be a prodromal state for alpha-synucleinopathies including Parkinson's disease (PD). Many patients with PD suffer from complaints of pain and present impaired somatosensory function. We hypothesized that pain perception and somatosensory function could be altered already in a preclinical stage of PD including iRBD. Hence, the objective of this study was to investigate pain perception and somatosensory function in patients with iRBD.
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Arabic translation and validation of SNOT-22
Samy Elwany, Ahmed Atef, Ahmed A Ibrahim, Ahmed S Ismail, Wael K Hussein, Ahmed S Youssef, Mohamed Elwany, Remon Bazak
The Egyptian Journal of Otolaryngology 2017 33(4):611-615
Objective The objective of the study was to translate the Sino-Nasal Outcome Test 22 (SNOT-22) into Arabic and to check its reliability and validity in Arabic-speaking patients. Patients and methods The study included 178 patients with confirmed chronic rhinosinusitis (CRS) and 95 asymptomatic individuals as a control group. All participants completed the Arabic SNOT-22 (A-SNOT-22) questionnaire. The scores of the two groups were compared for validity analysis. Eighty-two patients completed the questionnaire twice, 1 week apart, for test-to-test reliability analysis. The A-SNOT-22 scores of 60 CRS patients were correlated with Lund–Mackay scores for criterion validity analysis. The preoperative and postoperative scores of 73 patients were compared for responsiveness analysis. Results All participants completed the questionnaire with no or minimal assistance. Internal consistency (α=0.90) and test-to-test reliability (intraclass correlation=0.78) were good. The differences between the scores of CRS patients and asymptomatic individuals were significant (P<0.005). There was a positive moderate correlation between A-SNOT-22 and Lund–Mackay scores. Preoperative A-SNOT-22 scores were significantly higher than postoperative scores. Conclusion A-SNOT-22 questionnaire is a reliable and valid outcome measure for CRS patients. The questionnaire is responsive to changes in the state of the disease and is recommended for clinical practice and outcome research.
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The Egyptian Journal of Otolaryngology 2017 33(4):611-615
Objective The objective of the study was to translate the Sino-Nasal Outcome Test 22 (SNOT-22) into Arabic and to check its reliability and validity in Arabic-speaking patients. Patients and methods The study included 178 patients with confirmed chronic rhinosinusitis (CRS) and 95 asymptomatic individuals as a control group. All participants completed the Arabic SNOT-22 (A-SNOT-22) questionnaire. The scores of the two groups were compared for validity analysis. Eighty-two patients completed the questionnaire twice, 1 week apart, for test-to-test reliability analysis. The A-SNOT-22 scores of 60 CRS patients were correlated with Lund–Mackay scores for criterion validity analysis. The preoperative and postoperative scores of 73 patients were compared for responsiveness analysis. Results All participants completed the questionnaire with no or minimal assistance. Internal consistency (α=0.90) and test-to-test reliability (intraclass correlation=0.78) were good. The differences between the scores of CRS patients and asymptomatic individuals were significant (P<0.005). There was a positive moderate correlation between A-SNOT-22 and Lund–Mackay scores. Preoperative A-SNOT-22 scores were significantly higher than postoperative scores. Conclusion A-SNOT-22 questionnaire is a reliable and valid outcome measure for CRS patients. The questionnaire is responsive to changes in the state of the disease and is recommended for clinical practice and outcome research.
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Safety and efficacy of pediatric functional endoscopic sinus surgery for the treatment of pediatric chronic rhinosinusitis
Hossam Elsisi
The Egyptian Journal of Otolaryngology 2017 33(4):616-622
Objective: The objective of this article is to evaluate the effectiveness and safety of pediatric endoscopic sinus surgery for the treatment of pediatric chronic rhinosinusitis (CRS). Patients and methods: This study was of a retrospective observational clinical type and was carried in the tertiary referral center. A total of 90 patients with CRS refractory to medical treatment and operated with endoscopic sinus surgery were included in this study. Computed tomography scan of the nose and paranasal sinuses was done for all patients. Sinonasal outcome test-20 German adapted version was used for preoperative and postoperative symptoms evaluation. Results Among these 90 children, there were 62 males and 28 females, with mean age of 12.5 (7–16) years. A total of 84 (93.3%) patients had CRS without nasal polyps, and CRS with nasal polyps was present in the remaining six (6.7%) patients. Nasal obstruction and purulent nasal discharge were the most reported symptoms. The follow-up period ranged from 6 months to 5 years, with a mean of 3.7 years. The overall success of the procedure was 68.8%. The most significant improvement was noticed by patients with nasal obstruction and purulent nasal discharge (90.3 and 88.8%). The least improvement occurred in patients with hyposmia (36.3%). Conclusion Functional endoscopic sinus surgery is a safe and effective procedure in children. Proper preoperative selection of patients is mandatory. Limited surgical intervention is needed in children with control of the disease and preservation of the nasal mucosa. Second-look operation may be needed in some cases. Follow-up is essential for success of the procedure.
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The Egyptian Journal of Otolaryngology 2017 33(4):616-622
Objective: The objective of this article is to evaluate the effectiveness and safety of pediatric endoscopic sinus surgery for the treatment of pediatric chronic rhinosinusitis (CRS). Patients and methods: This study was of a retrospective observational clinical type and was carried in the tertiary referral center. A total of 90 patients with CRS refractory to medical treatment and operated with endoscopic sinus surgery were included in this study. Computed tomography scan of the nose and paranasal sinuses was done for all patients. Sinonasal outcome test-20 German adapted version was used for preoperative and postoperative symptoms evaluation. Results Among these 90 children, there were 62 males and 28 females, with mean age of 12.5 (7–16) years. A total of 84 (93.3%) patients had CRS without nasal polyps, and CRS with nasal polyps was present in the remaining six (6.7%) patients. Nasal obstruction and purulent nasal discharge were the most reported symptoms. The follow-up period ranged from 6 months to 5 years, with a mean of 3.7 years. The overall success of the procedure was 68.8%. The most significant improvement was noticed by patients with nasal obstruction and purulent nasal discharge (90.3 and 88.8%). The least improvement occurred in patients with hyposmia (36.3%). Conclusion Functional endoscopic sinus surgery is a safe and effective procedure in children. Proper preoperative selection of patients is mandatory. Limited surgical intervention is needed in children with control of the disease and preservation of the nasal mucosa. Second-look operation may be needed in some cases. Follow-up is essential for success of the procedure.
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Successful management of functional aphonia using a modified voice therapy technique: a case series
Aboloyoun I Ali, Marglani Osama, Elmorsy A Soha, El Kholy M Rasha, Farooq U Mian
The Egyptian Journal of Otolaryngology 2017 33(4):679-684
Objective The aim of the present study was to report the experience of a tertiary-care center in Makkah, Saudi Arabia in managing cases of functional aphonia. Study settings and design A case series study was conducted at the Phoniatrics Outpatient Clinics of King Abdullah Medical City in Holy Makkah, Saudi Arabia. Materials and methods Cases with functional aphonia managed by modified voice therapy technique in the period from March 2011 to January 2016 at the Phoniatrics Outpatient Clinics were recruited. Management consisted of auditory perceptual assessment, acoustic analysis, laryngeal examination, and voice handicap index measurement. All these parameters were recorded for each case before and after management. Statistical analysis Data were analyzed using statistical package for the social sciences version 16, and data were subjected to descriptive as well as inferential analyses. Results A total of 15 patients with functional aphonia were managed. One female patient had an exceptionally long period of aphonia, and her case is presented separately. The success rate of the procedure used for management was 100%. Conclusion Using the nonphonatory function of vocal folds in a modified manner by experienced therapists leads to recovery of voice regardless of the period of aphonia.
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The Egyptian Journal of Otolaryngology 2017 33(4):679-684
Objective The aim of the present study was to report the experience of a tertiary-care center in Makkah, Saudi Arabia in managing cases of functional aphonia. Study settings and design A case series study was conducted at the Phoniatrics Outpatient Clinics of King Abdullah Medical City in Holy Makkah, Saudi Arabia. Materials and methods Cases with functional aphonia managed by modified voice therapy technique in the period from March 2011 to January 2016 at the Phoniatrics Outpatient Clinics were recruited. Management consisted of auditory perceptual assessment, acoustic analysis, laryngeal examination, and voice handicap index measurement. All these parameters were recorded for each case before and after management. Statistical analysis Data were analyzed using statistical package for the social sciences version 16, and data were subjected to descriptive as well as inferential analyses. Results A total of 15 patients with functional aphonia were managed. One female patient had an exceptionally long period of aphonia, and her case is presented separately. The success rate of the procedure used for management was 100%. Conclusion Using the nonphonatory function of vocal folds in a modified manner by experienced therapists leads to recovery of voice regardless of the period of aphonia.
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Current microbiological pattern and role of respiratory syncytial virus infection in children with acute otitis media in South Jeddah
Sherif K Mohamed, Heba G Hassan
The Egyptian Journal of Otolaryngology 2017 33(4):623-625
Introduction Otitis media is one of the most commonly encountered pediatric ENT diseases. Antibiotic resistance is increasing partly because of their overuse and largely because of changing microbiological strains leading to the disease. In this study, we aimed to determine the current microbiological pattern of the disease in children. Participants and methods Ear discharges of 200 children with acute otitis media between 6 and 14 years of age were microbiologically examined. Results Virus-only infection was positive in 13% of patients, 30% were only bacterial (48% of which is Proteus mirabilis), and 57% had combined viral and bacterial infections. Conclusion Changing trends in microbiological patterns warrant further researches to achieve better prevention and treatment.
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The Egyptian Journal of Otolaryngology 2017 33(4):623-625
Introduction Otitis media is one of the most commonly encountered pediatric ENT diseases. Antibiotic resistance is increasing partly because of their overuse and largely because of changing microbiological strains leading to the disease. In this study, we aimed to determine the current microbiological pattern of the disease in children. Participants and methods Ear discharges of 200 children with acute otitis media between 6 and 14 years of age were microbiologically examined. Results Virus-only infection was positive in 13% of patients, 30% were only bacterial (48% of which is Proteus mirabilis), and 57% had combined viral and bacterial infections. Conclusion Changing trends in microbiological patterns warrant further researches to achieve better prevention and treatment.
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The relationship between visual–motor integration and handwriting skills in Arabic-speaking Egyptian children at the age of 4–6 years
Tamer Abou-El-Saad, Omayma Afsah, Hemmat Baz, Walaa Shaaban
The Egyptian Journal of Otolaryngology 2017 33(4):663-669
Background Handwriting is a complex perceptual-motor skill that is dependent on the maturation and integration of a number of cognitive, perceptual, and motor skills. Aim To examine the relationship between visual–motor skills and handwriting skills (HS) in Arabic-speaking Egyptian children at the age of 4–6 years. Patients and methods Overall, 200 typically developing kindergarten and primary school Arabic-speaking children, in the age range of 4–6 years, were tested using a constructed battery for assessment of both visual–motor integration (VMI) and HS. Results and conclusion Performance on both VMI and HS tasks improved with age. Moreover, the older the child was, the lesser the duration for completion of the tasks. Copying lines was found to be the best predictor of copying letters, copying words, and copying numbers. Reliability and validity of the designed VMI and HS assessment battery proved to be excellent. VMI is an important prerequisite for Arabic HS.
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The Egyptian Journal of Otolaryngology 2017 33(4):663-669
Background Handwriting is a complex perceptual-motor skill that is dependent on the maturation and integration of a number of cognitive, perceptual, and motor skills. Aim To examine the relationship between visual–motor skills and handwriting skills (HS) in Arabic-speaking Egyptian children at the age of 4–6 years. Patients and methods Overall, 200 typically developing kindergarten and primary school Arabic-speaking children, in the age range of 4–6 years, were tested using a constructed battery for assessment of both visual–motor integration (VMI) and HS. Results and conclusion Performance on both VMI and HS tasks improved with age. Moreover, the older the child was, the lesser the duration for completion of the tasks. Copying lines was found to be the best predictor of copying letters, copying words, and copying numbers. Reliability and validity of the designed VMI and HS assessment battery proved to be excellent. VMI is an important prerequisite for Arabic HS.
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Formaldehyde-treated temporofascial graft versus cartilage graft in repairing failed tympanic membrane grafting
Mostafa O Ramadan, Ahmad A.A Abd-Algaleel, Rowaa A Ahmad
The Egyptian Journal of Otolaryngology 2017 33(4):626-630
Aim The aim of this study was to compare the anatomical and functional outcomes of grafting the tympanic membrane (TM) − that is, previously failed grafting − by two graft materials: the first was formaldehyde-treated temporalis fascia graft (FTFG) and the second was tragal cartilage composite graft. Graft-take, hearing results, and complications were compared. Patients and methods The present study included 36 patients with chronic suppurative otitis media with recurrent TM perforation. Nineteen patients received tragal cartilage graft, and 17 patients received the FTFG. For each patient, history taking and complete general and ENT examinations were performed. Graft-take, preoperative and postoperative pure tone average, air–bone gap, and tympanometry scores were calculated and compared. Statistical analysis Data entry and data analysis were carried out using statistical package for social science version 19. Results and conclusion The present study showed that for repairing TM grafting, cartilage graft and FTFG were comparable in both graft-take and hearing results. The FTFG reflected the true configuration of tympanometry. It can be used in cases where the cartilage graft is previously consumed.
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The Egyptian Journal of Otolaryngology 2017 33(4):626-630
Aim The aim of this study was to compare the anatomical and functional outcomes of grafting the tympanic membrane (TM) − that is, previously failed grafting − by two graft materials: the first was formaldehyde-treated temporalis fascia graft (FTFG) and the second was tragal cartilage composite graft. Graft-take, hearing results, and complications were compared. Patients and methods The present study included 36 patients with chronic suppurative otitis media with recurrent TM perforation. Nineteen patients received tragal cartilage graft, and 17 patients received the FTFG. For each patient, history taking and complete general and ENT examinations were performed. Graft-take, preoperative and postoperative pure tone average, air–bone gap, and tympanometry scores were calculated and compared. Statistical analysis Data entry and data analysis were carried out using statistical package for social science version 19. Results and conclusion The present study showed that for repairing TM grafting, cartilage graft and FTFG were comparable in both graft-take and hearing results. The FTFG reflected the true configuration of tympanometry. It can be used in cases where the cartilage graft is previously consumed.
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Lipoma of parotid: a case report
Ripon M Chowdhury, Dev Roy, Sanjib K Pattari
The Egyptian Journal of Otolaryngology 2017 33(4):691-693
Lipomas are common benign soft tissue neoplasm, but they seldom occur in head and neck regions compared to other sites. Fine needle aspiration cytology (FNAC) accompanied with Computed tomography (CT) scan and Magnetic Resonance Imaging (MRI) determines its diagnosis preoperatively. In symptomatic cases, surgery remains the treatment of choice but requires an experienced surgeon because of possible damage to the facial nerve and its branches. The authors have discussed a rare case of lipoma, involving the deep and superficial lobe of parotid of a 42-year-old female patient with emphasis on its characteristics, preoperative diagnostic methods and its surgery. This case report shows MRI's to be potent diagnostic tool for Lipoma of the parotid, by means of which a surgical procedure could be planned while maintaining function and aesthetics.
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The Egyptian Journal of Otolaryngology 2017 33(4):691-693
Lipomas are common benign soft tissue neoplasm, but they seldom occur in head and neck regions compared to other sites. Fine needle aspiration cytology (FNAC) accompanied with Computed tomography (CT) scan and Magnetic Resonance Imaging (MRI) determines its diagnosis preoperatively. In symptomatic cases, surgery remains the treatment of choice but requires an experienced surgeon because of possible damage to the facial nerve and its branches. The authors have discussed a rare case of lipoma, involving the deep and superficial lobe of parotid of a 42-year-old female patient with emphasis on its characteristics, preoperative diagnostic methods and its surgery. This case report shows MRI's to be potent diagnostic tool for Lipoma of the parotid, by means of which a surgical procedure could be planned while maintaining function and aesthetics.
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The effect of direct application of dexamethasone on the round window membrane in patients with sudden sensorineural hearing loss
Fatthi A Abdel Baki, Ahmed A Omran, Samir I Asal, Khaled M Hassan
The Egyptian Journal of Otolaryngology 2017 33(4):631-636
Objective The aim of this study was to test the effect of direct application of dexamethasone on the round window (RW) after its adequate exposure following a transcanal approach in patients with sudden sensorineural hearing loss (SSNHL). Study design This investigation was designed to be a prospective cohort study. Patients and methods This study included eighteen adult patients with SSNHL who attended our outpatient clinic at Alexandria Main University Hospital between 1 July 2015 and 1 July 2016. Under general anesthesia the small tympanomeatal flap was elevated to visualize the RW. If it was fully exposed, dexamethasone (4 mg/ml) was applied directly over a piece of gel foam; if not fully exposed the overhang was removed first and then dexamethasone was applied. After 2 weeks, a repeat audiogram was taken in all patients in order to evaluate the efficacy of the treatment on their hearing ability. Results Post-treatment assessment revealed 50% of patients with variable levels of improvement, whereas 50% did not respond to the given treatment. Of the patients showing improvement, 16.7% had normal hearing levels restored. Thus, direct application of dexamethasone on the RW membrane after its adequate exposure may reverse the hearing deficits in a few patients with SSNHL. Conclusion There is a definitive improvement in hearing in patients with SSNHL on direct application of dexamethasone on the RW membrane after its adequate exposure in patients.
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The Egyptian Journal of Otolaryngology 2017 33(4):631-636
Objective The aim of this study was to test the effect of direct application of dexamethasone on the round window (RW) after its adequate exposure following a transcanal approach in patients with sudden sensorineural hearing loss (SSNHL). Study design This investigation was designed to be a prospective cohort study. Patients and methods This study included eighteen adult patients with SSNHL who attended our outpatient clinic at Alexandria Main University Hospital between 1 July 2015 and 1 July 2016. Under general anesthesia the small tympanomeatal flap was elevated to visualize the RW. If it was fully exposed, dexamethasone (4 mg/ml) was applied directly over a piece of gel foam; if not fully exposed the overhang was removed first and then dexamethasone was applied. After 2 weeks, a repeat audiogram was taken in all patients in order to evaluate the efficacy of the treatment on their hearing ability. Results Post-treatment assessment revealed 50% of patients with variable levels of improvement, whereas 50% did not respond to the given treatment. Of the patients showing improvement, 16.7% had normal hearing levels restored. Thus, direct application of dexamethasone on the RW membrane after its adequate exposure may reverse the hearing deficits in a few patients with SSNHL. Conclusion There is a definitive improvement in hearing in patients with SSNHL on direct application of dexamethasone on the RW membrane after its adequate exposure in patients.
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Complex auditory brainstem response in normal-hearing adults using binaural versus monaural speech stimuli
Abeir Osman Dabbous, Rabab Ahmed Koura, Mona Mohamed Hamdy
The Egyptian Journal of Otolaryngology 2017 33(4):656-662
Background Binaural hearing refers to the ability of the auditory system to integrate sounds reaching both ears. The complex auditory brainstem response (cABR) to the /da/ synthetic syllable gives information about time-locked response that is either transient or sustained depending on the periodic or nonperiodic characteristics of the stimulus. Objective This is a preliminary research that was performed to study the binaural interaction component of cABR in normal-hearing adults. Patients and methods This study included 20 normal-hearing adults, whose age ranged from 15 to 60 years, with a mean age of 29.30±12.52 years. CABR was conducted for all patients. The stimulus used was the syllable [da] (40 ms), presented first monaurally (left and right) and then binaurally through TDH headphones, in alternating polarity at 80 dBnHL. binaural interaction component (BIC) was then computed by subtracting the binaural waveform from the sum of the two monaural responses. Results The mean right amplitudes were smaller than binaural amplitudes for waves V, A, C, D, E, and F. However, this difference was statistically significant at D, E, and F waves only. The mean left amplitudes were smaller than binaural amplitudes for waves V, A, C, D, and E only. In addition, this difference was statistically significant. The mean binaural amplitudes were smaller than the summed right+left amplitudes for waves V, A, C, D, E, F, and O. There was no statistically significant difference among the mean latencies of responses recorded from right, left, or binaural for all cABR waves. Conclusion BICs reflecting binaural process can be obtained for ABR using speech stimuli comparing the binaural and summed monaural recorded responses. We recommend assessing the BIC on a large scale to obtain normative data, for comparison with patients with known auditory processing capabilities (shown by behavioural tests) to see how well the data can be used as an index of binaural process.
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The Egyptian Journal of Otolaryngology 2017 33(4):656-662
Background Binaural hearing refers to the ability of the auditory system to integrate sounds reaching both ears. The complex auditory brainstem response (cABR) to the /da/ synthetic syllable gives information about time-locked response that is either transient or sustained depending on the periodic or nonperiodic characteristics of the stimulus. Objective This is a preliminary research that was performed to study the binaural interaction component of cABR in normal-hearing adults. Patients and methods This study included 20 normal-hearing adults, whose age ranged from 15 to 60 years, with a mean age of 29.30±12.52 years. CABR was conducted for all patients. The stimulus used was the syllable [da] (40 ms), presented first monaurally (left and right) and then binaurally through TDH headphones, in alternating polarity at 80 dBnHL. binaural interaction component (BIC) was then computed by subtracting the binaural waveform from the sum of the two monaural responses. Results The mean right amplitudes were smaller than binaural amplitudes for waves V, A, C, D, E, and F. However, this difference was statistically significant at D, E, and F waves only. The mean left amplitudes were smaller than binaural amplitudes for waves V, A, C, D, and E only. In addition, this difference was statistically significant. The mean binaural amplitudes were smaller than the summed right+left amplitudes for waves V, A, C, D, E, F, and O. There was no statistically significant difference among the mean latencies of responses recorded from right, left, or binaural for all cABR waves. Conclusion BICs reflecting binaural process can be obtained for ABR using speech stimuli comparing the binaural and summed monaural recorded responses. We recommend assessing the BIC on a large scale to obtain normative data, for comparison with patients with known auditory processing capabilities (shown by behavioural tests) to see how well the data can be used as an index of binaural process.
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The effect of L-thyroxine hormone therapy on hearing loss in hypothyroid patients
Mohammed M Hussein, Samir I Asal, Tarek M Salem, Ahmed M Mohammed
The Egyptian Journal of Otolaryngology 2017 33(4):637-644
Objective The aim of this work was to study whether or not the hearing loss encountered in some hypothyroid patients can be improved with L-thyroxine hormone therapy, as other symptoms of hypothyroidism. Study design The study design was a prospective cohort one. Patients and methods This study included 30 patients of either sex who were proved to be in a hypothyroid state with an additional symptom of hearing impairment. The study was carried out in Alexandria Main University Hospital and was conducted in a prospective manner. All selected patients were proved to be in a hypothyroid state in the Endocrinology Department. Moreover, their symptom of hearing impairment was confirmed by thorough audiological examination supplemented by pure-tone audiometry plus tympanometry that was carried out in the ENT Department and the associate Audiology Unit. L-thyroxine treatment for hypothyroidism was initiated in all cases for 6 months to maintain a state of euthyroidism. At the end of 6 months, a repeat audiogram and tympanometry were performed in all patients in order to evaluate the efficacy of the said treatment protocol on the hearing in these patients. Cases proved to have hearing impairment irrelevant to the hypothyroid condition were excluded. Informed consent was compulsory for recruitment in this study. Results Post-treatment assessment revealed that variable improvement was achieved in 48% of ears, whereas 52% did not respond to the given treatment, with the impairment remaining nearly the same as it was before. Of the improved ears, in 15% of ears hearing levels were restored to normal hearing levels. Thereby, adherence to replacement therapy may reverse the hearing deficits in a few number of hypothyroid patients. Conclusion There is a definitive improvement in hearing with the use of L-thyroxine treatment of hypothyroid patients with hearing impairment.
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The Egyptian Journal of Otolaryngology 2017 33(4):637-644
Objective The aim of this work was to study whether or not the hearing loss encountered in some hypothyroid patients can be improved with L-thyroxine hormone therapy, as other symptoms of hypothyroidism. Study design The study design was a prospective cohort one. Patients and methods This study included 30 patients of either sex who were proved to be in a hypothyroid state with an additional symptom of hearing impairment. The study was carried out in Alexandria Main University Hospital and was conducted in a prospective manner. All selected patients were proved to be in a hypothyroid state in the Endocrinology Department. Moreover, their symptom of hearing impairment was confirmed by thorough audiological examination supplemented by pure-tone audiometry plus tympanometry that was carried out in the ENT Department and the associate Audiology Unit. L-thyroxine treatment for hypothyroidism was initiated in all cases for 6 months to maintain a state of euthyroidism. At the end of 6 months, a repeat audiogram and tympanometry were performed in all patients in order to evaluate the efficacy of the said treatment protocol on the hearing in these patients. Cases proved to have hearing impairment irrelevant to the hypothyroid condition were excluded. Informed consent was compulsory for recruitment in this study. Results Post-treatment assessment revealed that variable improvement was achieved in 48% of ears, whereas 52% did not respond to the given treatment, with the impairment remaining nearly the same as it was before. Of the improved ears, in 15% of ears hearing levels were restored to normal hearing levels. Thereby, adherence to replacement therapy may reverse the hearing deficits in a few number of hypothyroid patients. Conclusion There is a definitive improvement in hearing with the use of L-thyroxine treatment of hypothyroid patients with hearing impairment.
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Correlation between stuttering severity and pragmatic development in Egyptian children who stutter
Sabah Mohammed Hassan, Yossra Abdel Naby Sallam, Mona Sameeh Khodeir, Ola Shaaban Mahmoud
The Egyptian Journal of Otolaryngology 2017 33(4):670-678
Background Few studies have been carried out concerning the relation between stuttering behaviors and language pragmatics in children who stutter (CWS). The correlation between stuttering severity and pragmatic development in CWS is scarce in the literature so far. Aim This research aimed to study the relationship between stuttering severity and pragmatic language development in the Egyptian Arabic-speaking CWS. Patients and methods This study is an analytical cross-sectional study carried out at the Phoniatrics Clinics of El-Demerdash Hospital (Ain Shams University) and El-Zahraa Hospital (Al Azhar University). A total of 60 Egyptian CWS in the age range between 4 years 1 day and 9 years 11 months 31 days were selected conveniently based on inclusion and exclusion criteria. Selected children underwent the Ain Shams assessment protocol for fluency disorders, including assessment of stuttering severity by Bloodstein (BLS) classification and the Stuttering Severity Instrument for Children and Adults − Arabic version (ASSI). The standardized Egyptian Arabic Pragmatic Language Test has been used to assess the pragmatic language development. Pearson's correlation coefficient has been used to correlate the total pragmatic language age and degree of stuttering severity by BLS classification and the ASSI. Results Upon application of the Egyptian Arabic Pragmatic Language Test, all the participating children had no pragmatic language delay. They had scores either at and/or above their fifth percentiles in all the test items except in the paralinguistic aspect. There was no statistically significant correlation between grades of BLS classification or ASSI and the total pragmatic language age. Conclusion CWS had no pragmatic language delay except in the paralinguistic aspects.
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The Egyptian Journal of Otolaryngology 2017 33(4):670-678
Background Few studies have been carried out concerning the relation between stuttering behaviors and language pragmatics in children who stutter (CWS). The correlation between stuttering severity and pragmatic development in CWS is scarce in the literature so far. Aim This research aimed to study the relationship between stuttering severity and pragmatic language development in the Egyptian Arabic-speaking CWS. Patients and methods This study is an analytical cross-sectional study carried out at the Phoniatrics Clinics of El-Demerdash Hospital (Ain Shams University) and El-Zahraa Hospital (Al Azhar University). A total of 60 Egyptian CWS in the age range between 4 years 1 day and 9 years 11 months 31 days were selected conveniently based on inclusion and exclusion criteria. Selected children underwent the Ain Shams assessment protocol for fluency disorders, including assessment of stuttering severity by Bloodstein (BLS) classification and the Stuttering Severity Instrument for Children and Adults − Arabic version (ASSI). The standardized Egyptian Arabic Pragmatic Language Test has been used to assess the pragmatic language development. Pearson's correlation coefficient has been used to correlate the total pragmatic language age and degree of stuttering severity by BLS classification and the ASSI. Results Upon application of the Egyptian Arabic Pragmatic Language Test, all the participating children had no pragmatic language delay. They had scores either at and/or above their fifth percentiles in all the test items except in the paralinguistic aspect. There was no statistically significant correlation between grades of BLS classification or ASSI and the total pragmatic language age. Conclusion CWS had no pragmatic language delay except in the paralinguistic aspects.
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Visual vestibular mismatch: is it a vestibular disorder?
Nadia Kamal, Hesham Taha, Rasha H El-Kabarity, Dina Housni
The Egyptian Journal of Otolaryngology 2017 33(4):645-649
Background Visual vestibular mismatch (VVM) is a group of symptoms rather than a disease. All are exaggerated by introducing any visual conflict. For such reason, there is no adequate tools to investigate or to diagnose and limited research studies were done to explore such group of people. Aim To identify VVM disorder among dizzy patients and to study the vestibular function in them. Patients and methods This study was conducted on 30 patients suffering from VVM (out of 153 patients) who were selected by a questionnaire modified by the authors based on the original questionnaire. All patients were subjected to objective testing including: full neuro-otological history, office vestibular tests including dynamic visual test (DVA), modified clinical test of sensory integration of balance (MCTSIB), Fukuda stepping test, functional reach test, videonystagmography and vestibular evoked myogenic potentials (VEMPs). Results VVM symptomatology was found in 19 patients (subjectively by Mallison questionnaire) and reached 30 patients using a modified questionnaire. 23.33% patients had abnormal Fukuda test, 26.6% had abnormal functional reach test, while 97.6% of patients had abnormal MCTSIB test scores and 50% had abnormal DVA test scores. Abnormal cervical VEMP test results were present in 50% of cases, while only 10% suffered from videonystagmography abnormalities reflecting minor affection of semicircular canals as compared with the saccule. Conclusion This study showed that VVM is a fairly common complain among the dizzy population and it can be easily picked up using a simple questionnaire. Office tests as DVA and MCTSIB were highly sensitive tests for VVM patients but more research is needed to find the correlations between these tests and VVM. The study pointed out to the importance of cervical VEMP test to be routinely enrolled in testing of patients with suggestive symptoms of VVM. Further researches should be conducted for knowing the underlying cause and the exact role of saccule in VVM.
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The Egyptian Journal of Otolaryngology 2017 33(4):645-649
Background Visual vestibular mismatch (VVM) is a group of symptoms rather than a disease. All are exaggerated by introducing any visual conflict. For such reason, there is no adequate tools to investigate or to diagnose and limited research studies were done to explore such group of people. Aim To identify VVM disorder among dizzy patients and to study the vestibular function in them. Patients and methods This study was conducted on 30 patients suffering from VVM (out of 153 patients) who were selected by a questionnaire modified by the authors based on the original questionnaire. All patients were subjected to objective testing including: full neuro-otological history, office vestibular tests including dynamic visual test (DVA), modified clinical test of sensory integration of balance (MCTSIB), Fukuda stepping test, functional reach test, videonystagmography and vestibular evoked myogenic potentials (VEMPs). Results VVM symptomatology was found in 19 patients (subjectively by Mallison questionnaire) and reached 30 patients using a modified questionnaire. 23.33% patients had abnormal Fukuda test, 26.6% had abnormal functional reach test, while 97.6% of patients had abnormal MCTSIB test scores and 50% had abnormal DVA test scores. Abnormal cervical VEMP test results were present in 50% of cases, while only 10% suffered from videonystagmography abnormalities reflecting minor affection of semicircular canals as compared with the saccule. Conclusion This study showed that VVM is a fairly common complain among the dizzy population and it can be easily picked up using a simple questionnaire. Office tests as DVA and MCTSIB were highly sensitive tests for VVM patients but more research is needed to find the correlations between these tests and VVM. The study pointed out to the importance of cervical VEMP test to be routinely enrolled in testing of patients with suggestive symptoms of VVM. Further researches should be conducted for knowing the underlying cause and the exact role of saccule in VVM.
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Language disorders in children with congenital hypothyroidism
Haitham M Mohamed, Efat Zaki, Adel Abdel Baki Abdall, Mohammed A Gomaa, Marwa M Abdel Wahab
The Egyptian Journal of Otolaryngology 2017 33(4):685-690
Introduction Congenital hypothyroidism (CH) represents one of the most common preventable causes of mental retardation. If fetal hypothyroidism develops, untoward effects may be shown in certain organ systems, including the central nervous system. CH may be associated with hearing and language impairment. It is possible that this impairment may worsen with delay of therapy. Problems in language, auditory processing, and reading may persist in hypothyroid children, particularly if their treatment with l-thyroxin is delayed into the third week of life. The aim of this study is to estimate the extent of language disorder and detect the factors influencing language acquisition in children with CH. Patients and methods This study included 60 children. The study group included 40 children who complained of CH. The age range of this group was 3–8 years. The children of the study group were divided according to the level of thyroid stimulating hormone (TSH) and T4 into two subgroups. The G1 subgroup included children with controlled CH and subgroup G2 included children with uncontrolled hypothyroidism. The results of the study group were compared with those of another group (control group), which included 20 children; both groups were matched for age and sex. The children of both groups were subjected to the protocol of language assessment. Results and conclusion The current study showed that the children with uncontrolled CH show delayed language, mental, social age, and intelligence quotient in comparison with children with controlled hypothyroidism and normal children. There is a need for the diagnosis and treatment of children with CH as soon as possible after birth, preferably no later than the second week of life. It is also important to screen hypothyroid children for hearing problems and to provide remediation in language and reading.
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The Egyptian Journal of Otolaryngology 2017 33(4):685-690
Introduction Congenital hypothyroidism (CH) represents one of the most common preventable causes of mental retardation. If fetal hypothyroidism develops, untoward effects may be shown in certain organ systems, including the central nervous system. CH may be associated with hearing and language impairment. It is possible that this impairment may worsen with delay of therapy. Problems in language, auditory processing, and reading may persist in hypothyroid children, particularly if their treatment with l-thyroxin is delayed into the third week of life. The aim of this study is to estimate the extent of language disorder and detect the factors influencing language acquisition in children with CH. Patients and methods This study included 60 children. The study group included 40 children who complained of CH. The age range of this group was 3–8 years. The children of the study group were divided according to the level of thyroid stimulating hormone (TSH) and T4 into two subgroups. The G1 subgroup included children with controlled CH and subgroup G2 included children with uncontrolled hypothyroidism. The results of the study group were compared with those of another group (control group), which included 20 children; both groups were matched for age and sex. The children of both groups were subjected to the protocol of language assessment. Results and conclusion The current study showed that the children with uncontrolled CH show delayed language, mental, social age, and intelligence quotient in comparison with children with controlled hypothyroidism and normal children. There is a need for the diagnosis and treatment of children with CH as soon as possible after birth, preferably no later than the second week of life. It is also important to screen hypothyroid children for hearing problems and to provide remediation in language and reading.
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Assessment of the audiovestibular system in patients with rheumatoid arthritis
Tarek M El Dessouky, Enas Abu El Khair, Rabab Ahmed Koura, Sara Ahmed El Sharkawy
The Egyptian Journal of Otolaryngology 2017 33(4):650-655
Objective This study was designed to assess hearing and vestibular function in patients with rheumatoid arthritis (RA) in comparison with a control group. In addition, we correlated these findings in disease activity and severity. Materials and methods Totally, 40 RA patients (35 women and five men) diagnosed according to the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria and 20 healthy controls (11 women and nine men), whose age ranged from 25 to 66 years with a mean age of 45.5±12.4 years, were included in the study. Each individuals was tested with pure tone audiometry. Mean values of air and bone conduction at each frequency and tympanometric values were calculated for the study groups. Videonystagmography (VNG) test including smooth pursuit, saccade, optokinetic tests, positioning tests, positional test, and water caloric tests was also carried out. Results The mean air conduction threshold values at high frequencies (4000 and 8000 Hz) in the RA group were lower than in the control group. The difference between mean air conduction threshold values of the control group and the RA group at high frequencies was statistically significant (P<0.05). There was no statistically significance between the two groups as regards speech reception threshold, speech discrimination (DIS), and tympanometric values (P>0.05). VNG testing revealed central abnormalities in 12 (30%) patients, peripheral abnormalities in nine (22.5%) patients, and mixed abnormalities in one (2.5%) patient. There was no association between VNG abnormalities in patients with RA and age, sex, duration of disease, accompanying vertigo complaint, and the laboratory findings (P>0.05). Conclusion There is an association between RA and audiovestibular system dysfunction regardless clinical and demographic situation of patients. We assume that the shearing and vestibular disturbances in RA are more prevalent than previously recognized. High-frequency hearing loss in RA patients could be an indicator of cochlear involvement.
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The Egyptian Journal of Otolaryngology 2017 33(4):650-655
Objective This study was designed to assess hearing and vestibular function in patients with rheumatoid arthritis (RA) in comparison with a control group. In addition, we correlated these findings in disease activity and severity. Materials and methods Totally, 40 RA patients (35 women and five men) diagnosed according to the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria and 20 healthy controls (11 women and nine men), whose age ranged from 25 to 66 years with a mean age of 45.5±12.4 years, were included in the study. Each individuals was tested with pure tone audiometry. Mean values of air and bone conduction at each frequency and tympanometric values were calculated for the study groups. Videonystagmography (VNG) test including smooth pursuit, saccade, optokinetic tests, positioning tests, positional test, and water caloric tests was also carried out. Results The mean air conduction threshold values at high frequencies (4000 and 8000 Hz) in the RA group were lower than in the control group. The difference between mean air conduction threshold values of the control group and the RA group at high frequencies was statistically significant (P<0.05). There was no statistically significance between the two groups as regards speech reception threshold, speech discrimination (DIS), and tympanometric values (P>0.05). VNG testing revealed central abnormalities in 12 (30%) patients, peripheral abnormalities in nine (22.5%) patients, and mixed abnormalities in one (2.5%) patient. There was no association between VNG abnormalities in patients with RA and age, sex, duration of disease, accompanying vertigo complaint, and the laboratory findings (P>0.05). Conclusion There is an association between RA and audiovestibular system dysfunction regardless clinical and demographic situation of patients. We assume that the shearing and vestibular disturbances in RA are more prevalent than previously recognized. High-frequency hearing loss in RA patients could be an indicator of cochlear involvement.
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Ameloblastic fibro-odontoma of the maxilla: a case report
Belal Alani, Muraja Aldoori, Amar Adham, Farag Ismail
The Egyptian Journal of Otolaryngology 2017 33(4):694-697
The ameloblastic fibro-odontoma is a rare benign odontogenic lesion defined as a tumor with the general features of ameloblastic fibroma but that also contains enamel and dentin. In this article the authors describe a case of a young male patient with ameloblastic fibro-odontoma of the maxilla and the management of such condition.
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The Egyptian Journal of Otolaryngology 2017 33(4):694-697
The ameloblastic fibro-odontoma is a rare benign odontogenic lesion defined as a tumor with the general features of ameloblastic fibroma but that also contains enamel and dentin. In this article the authors describe a case of a young male patient with ameloblastic fibro-odontoma of the maxilla and the management of such condition.
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Barosinusitis: Comprehensive review and proposed new classification system
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Evaluation of a new and simple classification for endoscopic sinus surgery
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The study of a possible correlation between serum levels of interleukin 17 and clinical severity in patients with allergic rhinitis
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Prenatal maternal depression related to allergic rhinoconjunctivitis in the first 5 years of life in children of the EDEN mother-child cohort study
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Characterization of T-cell subpopulations in patients with chronic rhinosinusitis with nasal polyposis
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A multicenter, prospective, noninterventional study in a Norwegian cohort of patients with moderate-to-severe allergic rhinitis treated with MP-AzeFlu
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Oral immunotherapy in children with IgE-mediated hen's egg allergy: Follow-ups at 2.5 and 7 years
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Long-term omalizumab use in the treatment of exercise-induced anaphylaxis
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Long-term follow-up of a patient with malignant transformation of inverted papilloma into sinonasal undifferentiated carcinoma
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Multiple doses of icatibant used during pregnancy
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An ergonomic assessment of operating table and surgical stool heights for seated otolaryngology procedures
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Acquired Vascular Tumors of the Head and Neck
Vascular neoplasms of the head and neck present with a wide spectrum of signs and symptoms. Diagnosis requires a high index of suspicion and is usually made after tumors are large enough to be visually apparent or cause symptoms. This article discusses the most common acquired benign and malignant vascular tumors, with an emphasis on their evaluation and treatment.
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Arabic translation and validation of SNOT-22
Samy Elwany, Ahmed Atef, Ahmed A Ibrahim, Ahmed S Ismail, Wael K Hussein, Ahmed S Youssef, Mohamed Elwany, Remon Bazak
The Egyptian Journal of Otolaryngology 2017 33(4):611-615
Objective The objective of the study was to translate the Sino-Nasal Outcome Test 22 (SNOT-22) into Arabic and to check its reliability and validity in Arabic-speaking patients. Patients and methods The study included 178 patients with confirmed chronic rhinosinusitis (CRS) and 95 asymptomatic individuals as a control group. All participants completed the Arabic SNOT-22 (A-SNOT-22) questionnaire. The scores of the two groups were compared for validity analysis. Eighty-two patients completed the questionnaire twice, 1 week apart, for test-to-test reliability analysis. The A-SNOT-22 scores of 60 CRS patients were correlated with Lund–Mackay scores for criterion validity analysis. The preoperative and postoperative scores of 73 patients were compared for responsiveness analysis. Results All participants completed the questionnaire with no or minimal assistance. Internal consistency (α=0.90) and test-to-test reliability (intraclass correlation=0.78) were good. The differences between the scores of CRS patients and asymptomatic individuals were significant (P<0.005). There was a positive moderate correlation between A-SNOT-22 and Lund–Mackay scores. Preoperative A-SNOT-22 scores were significantly higher than postoperative scores. Conclusion A-SNOT-22 questionnaire is a reliable and valid outcome measure for CRS patients. The questionnaire is responsive to changes in the state of the disease and is recommended for clinical practice and outcome research.
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The Egyptian Journal of Otolaryngology 2017 33(4):611-615
Objective The objective of the study was to translate the Sino-Nasal Outcome Test 22 (SNOT-22) into Arabic and to check its reliability and validity in Arabic-speaking patients. Patients and methods The study included 178 patients with confirmed chronic rhinosinusitis (CRS) and 95 asymptomatic individuals as a control group. All participants completed the Arabic SNOT-22 (A-SNOT-22) questionnaire. The scores of the two groups were compared for validity analysis. Eighty-two patients completed the questionnaire twice, 1 week apart, for test-to-test reliability analysis. The A-SNOT-22 scores of 60 CRS patients were correlated with Lund–Mackay scores for criterion validity analysis. The preoperative and postoperative scores of 73 patients were compared for responsiveness analysis. Results All participants completed the questionnaire with no or minimal assistance. Internal consistency (α=0.90) and test-to-test reliability (intraclass correlation=0.78) were good. The differences between the scores of CRS patients and asymptomatic individuals were significant (P<0.005). There was a positive moderate correlation between A-SNOT-22 and Lund–Mackay scores. Preoperative A-SNOT-22 scores were significantly higher than postoperative scores. Conclusion A-SNOT-22 questionnaire is a reliable and valid outcome measure for CRS patients. The questionnaire is responsive to changes in the state of the disease and is recommended for clinical practice and outcome research.
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Safety and efficacy of pediatric functional endoscopic sinus surgery for the treatment of pediatric chronic rhinosinusitis
Hossam Elsisi
The Egyptian Journal of Otolaryngology 2017 33(4):616-622
Objective: The objective of this article is to evaluate the effectiveness and safety of pediatric endoscopic sinus surgery for the treatment of pediatric chronic rhinosinusitis (CRS). Patients and methods: This study was of a retrospective observational clinical type and was carried in the tertiary referral center. A total of 90 patients with CRS refractory to medical treatment and operated with endoscopic sinus surgery were included in this study. Computed tomography scan of the nose and paranasal sinuses was done for all patients. Sinonasal outcome test-20 German adapted version was used for preoperative and postoperative symptoms evaluation. Results Among these 90 children, there were 62 males and 28 females, with mean age of 12.5 (7–16) years. A total of 84 (93.3%) patients had CRS without nasal polyps, and CRS with nasal polyps was present in the remaining six (6.7%) patients. Nasal obstruction and purulent nasal discharge were the most reported symptoms. The follow-up period ranged from 6 months to 5 years, with a mean of 3.7 years. The overall success of the procedure was 68.8%. The most significant improvement was noticed by patients with nasal obstruction and purulent nasal discharge (90.3 and 88.8%). The least improvement occurred in patients with hyposmia (36.3%). Conclusion Functional endoscopic sinus surgery is a safe and effective procedure in children. Proper preoperative selection of patients is mandatory. Limited surgical intervention is needed in children with control of the disease and preservation of the nasal mucosa. Second-look operation may be needed in some cases. Follow-up is essential for success of the procedure.
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The Egyptian Journal of Otolaryngology 2017 33(4):616-622
Objective: The objective of this article is to evaluate the effectiveness and safety of pediatric endoscopic sinus surgery for the treatment of pediatric chronic rhinosinusitis (CRS). Patients and methods: This study was of a retrospective observational clinical type and was carried in the tertiary referral center. A total of 90 patients with CRS refractory to medical treatment and operated with endoscopic sinus surgery were included in this study. Computed tomography scan of the nose and paranasal sinuses was done for all patients. Sinonasal outcome test-20 German adapted version was used for preoperative and postoperative symptoms evaluation. Results Among these 90 children, there were 62 males and 28 females, with mean age of 12.5 (7–16) years. A total of 84 (93.3%) patients had CRS without nasal polyps, and CRS with nasal polyps was present in the remaining six (6.7%) patients. Nasal obstruction and purulent nasal discharge were the most reported symptoms. The follow-up period ranged from 6 months to 5 years, with a mean of 3.7 years. The overall success of the procedure was 68.8%. The most significant improvement was noticed by patients with nasal obstruction and purulent nasal discharge (90.3 and 88.8%). The least improvement occurred in patients with hyposmia (36.3%). Conclusion Functional endoscopic sinus surgery is a safe and effective procedure in children. Proper preoperative selection of patients is mandatory. Limited surgical intervention is needed in children with control of the disease and preservation of the nasal mucosa. Second-look operation may be needed in some cases. Follow-up is essential for success of the procedure.
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Successful management of functional aphonia using a modified voice therapy technique: a case series
Aboloyoun I Ali, Marglani Osama, Elmorsy A Soha, El Kholy M Rasha, Farooq U Mian
The Egyptian Journal of Otolaryngology 2017 33(4):679-684
Objective The aim of the present study was to report the experience of a tertiary-care center in Makkah, Saudi Arabia in managing cases of functional aphonia. Study settings and design A case series study was conducted at the Phoniatrics Outpatient Clinics of King Abdullah Medical City in Holy Makkah, Saudi Arabia. Materials and methods Cases with functional aphonia managed by modified voice therapy technique in the period from March 2011 to January 2016 at the Phoniatrics Outpatient Clinics were recruited. Management consisted of auditory perceptual assessment, acoustic analysis, laryngeal examination, and voice handicap index measurement. All these parameters were recorded for each case before and after management. Statistical analysis Data were analyzed using statistical package for the social sciences version 16, and data were subjected to descriptive as well as inferential analyses. Results A total of 15 patients with functional aphonia were managed. One female patient had an exceptionally long period of aphonia, and her case is presented separately. The success rate of the procedure used for management was 100%. Conclusion Using the nonphonatory function of vocal folds in a modified manner by experienced therapists leads to recovery of voice regardless of the period of aphonia.
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The Egyptian Journal of Otolaryngology 2017 33(4):679-684
Objective The aim of the present study was to report the experience of a tertiary-care center in Makkah, Saudi Arabia in managing cases of functional aphonia. Study settings and design A case series study was conducted at the Phoniatrics Outpatient Clinics of King Abdullah Medical City in Holy Makkah, Saudi Arabia. Materials and methods Cases with functional aphonia managed by modified voice therapy technique in the period from March 2011 to January 2016 at the Phoniatrics Outpatient Clinics were recruited. Management consisted of auditory perceptual assessment, acoustic analysis, laryngeal examination, and voice handicap index measurement. All these parameters were recorded for each case before and after management. Statistical analysis Data were analyzed using statistical package for the social sciences version 16, and data were subjected to descriptive as well as inferential analyses. Results A total of 15 patients with functional aphonia were managed. One female patient had an exceptionally long period of aphonia, and her case is presented separately. The success rate of the procedure used for management was 100%. Conclusion Using the nonphonatory function of vocal folds in a modified manner by experienced therapists leads to recovery of voice regardless of the period of aphonia.
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Current microbiological pattern and role of respiratory syncytial virus infection in children with acute otitis media in South Jeddah
Sherif K Mohamed, Heba G Hassan
The Egyptian Journal of Otolaryngology 2017 33(4):623-625
Introduction Otitis media is one of the most commonly encountered pediatric ENT diseases. Antibiotic resistance is increasing partly because of their overuse and largely because of changing microbiological strains leading to the disease. In this study, we aimed to determine the current microbiological pattern of the disease in children. Participants and methods Ear discharges of 200 children with acute otitis media between 6 and 14 years of age were microbiologically examined. Results Virus-only infection was positive in 13% of patients, 30% were only bacterial (48% of which is Proteus mirabilis), and 57% had combined viral and bacterial infections. Conclusion Changing trends in microbiological patterns warrant further researches to achieve better prevention and treatment.
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The Egyptian Journal of Otolaryngology 2017 33(4):623-625
Introduction Otitis media is one of the most commonly encountered pediatric ENT diseases. Antibiotic resistance is increasing partly because of their overuse and largely because of changing microbiological strains leading to the disease. In this study, we aimed to determine the current microbiological pattern of the disease in children. Participants and methods Ear discharges of 200 children with acute otitis media between 6 and 14 years of age were microbiologically examined. Results Virus-only infection was positive in 13% of patients, 30% were only bacterial (48% of which is Proteus mirabilis), and 57% had combined viral and bacterial infections. Conclusion Changing trends in microbiological patterns warrant further researches to achieve better prevention and treatment.
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The relationship between visual–motor integration and handwriting skills in Arabic-speaking Egyptian children at the age of 4–6 years
Tamer Abou-El-Saad, Omayma Afsah, Hemmat Baz, Walaa Shaaban
The Egyptian Journal of Otolaryngology 2017 33(4):663-669
Background Handwriting is a complex perceptual-motor skill that is dependent on the maturation and integration of a number of cognitive, perceptual, and motor skills. Aim To examine the relationship between visual–motor skills and handwriting skills (HS) in Arabic-speaking Egyptian children at the age of 4–6 years. Patients and methods Overall, 200 typically developing kindergarten and primary school Arabic-speaking children, in the age range of 4–6 years, were tested using a constructed battery for assessment of both visual–motor integration (VMI) and HS. Results and conclusion Performance on both VMI and HS tasks improved with age. Moreover, the older the child was, the lesser the duration for completion of the tasks. Copying lines was found to be the best predictor of copying letters, copying words, and copying numbers. Reliability and validity of the designed VMI and HS assessment battery proved to be excellent. VMI is an important prerequisite for Arabic HS.
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The Egyptian Journal of Otolaryngology 2017 33(4):663-669
Background Handwriting is a complex perceptual-motor skill that is dependent on the maturation and integration of a number of cognitive, perceptual, and motor skills. Aim To examine the relationship between visual–motor skills and handwriting skills (HS) in Arabic-speaking Egyptian children at the age of 4–6 years. Patients and methods Overall, 200 typically developing kindergarten and primary school Arabic-speaking children, in the age range of 4–6 years, were tested using a constructed battery for assessment of both visual–motor integration (VMI) and HS. Results and conclusion Performance on both VMI and HS tasks improved with age. Moreover, the older the child was, the lesser the duration for completion of the tasks. Copying lines was found to be the best predictor of copying letters, copying words, and copying numbers. Reliability and validity of the designed VMI and HS assessment battery proved to be excellent. VMI is an important prerequisite for Arabic HS.
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Formaldehyde-treated temporofascial graft versus cartilage graft in repairing failed tympanic membrane grafting
Mostafa O Ramadan, Ahmad A.A Abd-Algaleel, Rowaa A Ahmad
The Egyptian Journal of Otolaryngology 2017 33(4):626-630
Aim The aim of this study was to compare the anatomical and functional outcomes of grafting the tympanic membrane (TM) − that is, previously failed grafting − by two graft materials: the first was formaldehyde-treated temporalis fascia graft (FTFG) and the second was tragal cartilage composite graft. Graft-take, hearing results, and complications were compared. Patients and methods The present study included 36 patients with chronic suppurative otitis media with recurrent TM perforation. Nineteen patients received tragal cartilage graft, and 17 patients received the FTFG. For each patient, history taking and complete general and ENT examinations were performed. Graft-take, preoperative and postoperative pure tone average, air–bone gap, and tympanometry scores were calculated and compared. Statistical analysis Data entry and data analysis were carried out using statistical package for social science version 19. Results and conclusion The present study showed that for repairing TM grafting, cartilage graft and FTFG were comparable in both graft-take and hearing results. The FTFG reflected the true configuration of tympanometry. It can be used in cases where the cartilage graft is previously consumed.
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The Egyptian Journal of Otolaryngology 2017 33(4):626-630
Aim The aim of this study was to compare the anatomical and functional outcomes of grafting the tympanic membrane (TM) − that is, previously failed grafting − by two graft materials: the first was formaldehyde-treated temporalis fascia graft (FTFG) and the second was tragal cartilage composite graft. Graft-take, hearing results, and complications were compared. Patients and methods The present study included 36 patients with chronic suppurative otitis media with recurrent TM perforation. Nineteen patients received tragal cartilage graft, and 17 patients received the FTFG. For each patient, history taking and complete general and ENT examinations were performed. Graft-take, preoperative and postoperative pure tone average, air–bone gap, and tympanometry scores were calculated and compared. Statistical analysis Data entry and data analysis were carried out using statistical package for social science version 19. Results and conclusion The present study showed that for repairing TM grafting, cartilage graft and FTFG were comparable in both graft-take and hearing results. The FTFG reflected the true configuration of tympanometry. It can be used in cases where the cartilage graft is previously consumed.
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Lipoma of parotid: a case report
Ripon M Chowdhury, Dev Roy, Sanjib K Pattari
The Egyptian Journal of Otolaryngology 2017 33(4):691-693
Lipomas are common benign soft tissue neoplasm, but they seldom occur in head and neck regions compared to other sites. Fine needle aspiration cytology (FNAC) accompanied with Computed tomography (CT) scan and Magnetic Resonance Imaging (MRI) determines its diagnosis preoperatively. In symptomatic cases, surgery remains the treatment of choice but requires an experienced surgeon because of possible damage to the facial nerve and its branches. The authors have discussed a rare case of lipoma, involving the deep and superficial lobe of parotid of a 42-year-old female patient with emphasis on its characteristics, preoperative diagnostic methods and its surgery. This case report shows MRI's to be potent diagnostic tool for Lipoma of the parotid, by means of which a surgical procedure could be planned while maintaining function and aesthetics.
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The Egyptian Journal of Otolaryngology 2017 33(4):691-693
Lipomas are common benign soft tissue neoplasm, but they seldom occur in head and neck regions compared to other sites. Fine needle aspiration cytology (FNAC) accompanied with Computed tomography (CT) scan and Magnetic Resonance Imaging (MRI) determines its diagnosis preoperatively. In symptomatic cases, surgery remains the treatment of choice but requires an experienced surgeon because of possible damage to the facial nerve and its branches. The authors have discussed a rare case of lipoma, involving the deep and superficial lobe of parotid of a 42-year-old female patient with emphasis on its characteristics, preoperative diagnostic methods and its surgery. This case report shows MRI's to be potent diagnostic tool for Lipoma of the parotid, by means of which a surgical procedure could be planned while maintaining function and aesthetics.
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The effect of direct application of dexamethasone on the round window membrane in patients with sudden sensorineural hearing loss
Fatthi A Abdel Baki, Ahmed A Omran, Samir I Asal, Khaled M Hassan
The Egyptian Journal of Otolaryngology 2017 33(4):631-636
Objective The aim of this study was to test the effect of direct application of dexamethasone on the round window (RW) after its adequate exposure following a transcanal approach in patients with sudden sensorineural hearing loss (SSNHL). Study design This investigation was designed to be a prospective cohort study. Patients and methods This study included eighteen adult patients with SSNHL who attended our outpatient clinic at Alexandria Main University Hospital between 1 July 2015 and 1 July 2016. Under general anesthesia the small tympanomeatal flap was elevated to visualize the RW. If it was fully exposed, dexamethasone (4 mg/ml) was applied directly over a piece of gel foam; if not fully exposed the overhang was removed first and then dexamethasone was applied. After 2 weeks, a repeat audiogram was taken in all patients in order to evaluate the efficacy of the treatment on their hearing ability. Results Post-treatment assessment revealed 50% of patients with variable levels of improvement, whereas 50% did not respond to the given treatment. Of the patients showing improvement, 16.7% had normal hearing levels restored. Thus, direct application of dexamethasone on the RW membrane after its adequate exposure may reverse the hearing deficits in a few patients with SSNHL. Conclusion There is a definitive improvement in hearing in patients with SSNHL on direct application of dexamethasone on the RW membrane after its adequate exposure in patients.
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The Egyptian Journal of Otolaryngology 2017 33(4):631-636
Objective The aim of this study was to test the effect of direct application of dexamethasone on the round window (RW) after its adequate exposure following a transcanal approach in patients with sudden sensorineural hearing loss (SSNHL). Study design This investigation was designed to be a prospective cohort study. Patients and methods This study included eighteen adult patients with SSNHL who attended our outpatient clinic at Alexandria Main University Hospital between 1 July 2015 and 1 July 2016. Under general anesthesia the small tympanomeatal flap was elevated to visualize the RW. If it was fully exposed, dexamethasone (4 mg/ml) was applied directly over a piece of gel foam; if not fully exposed the overhang was removed first and then dexamethasone was applied. After 2 weeks, a repeat audiogram was taken in all patients in order to evaluate the efficacy of the treatment on their hearing ability. Results Post-treatment assessment revealed 50% of patients with variable levels of improvement, whereas 50% did not respond to the given treatment. Of the patients showing improvement, 16.7% had normal hearing levels restored. Thus, direct application of dexamethasone on the RW membrane after its adequate exposure may reverse the hearing deficits in a few patients with SSNHL. Conclusion There is a definitive improvement in hearing in patients with SSNHL on direct application of dexamethasone on the RW membrane after its adequate exposure in patients.
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Nomogram predicting cause-specific mortality in patients with surgically resected stage I non-small cell lung cancer: a competing risk analysis
The objective of this study was to evaluate the probability of cause-specific death and other causes of death for patients who underwent surgery with stage I non-small cell lung cancer (NSCLC). We also built competing risk nomograms to predict prognosis for patients with NSCLC.
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Sequential CT Findings in Non-Small Cell Lung Cancer Patients Receiving Nivolumab
Nivolumab is a novel immunotherapy for non-small cell lung cancer (NSCLC). Patients that receive this treatment may show variable CT features on follow-up imaging. We identified patients with NSCLC who received Nivolumab and reviewed their pre- and post-treatment CT scans. We found variable patterns of findings in those who ultimately respond to treatment.
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Accuracy of the cobas® EGFR mutation assay in non-small cell lung cancer compared with three laboratory-developed tests
Rapid and precise mutation assays are essential to select lung cancer patients who may respond to treatment with epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors. Using the same specimens, the reliability of the cobas® EGFR assay was compared to three commonly used laboratory-developed tests (LDTs). High concordance rates and κ-coefficients were obtained between the cobas® EGFR assay and the LDTs.
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The Impact of Contract Research Organizations (CRO) Bureaucracy in Clinical Trial Conduction: a Model from Lung Cancer
Although CRO support is commonly included in clinical trials conduction, its hypothetical impact in term of timesaving and benefit has never been quantified. With this aim, we retrospectively analyzed 113 lung cancer trials to evaluate activation timelines and patients accrual according to CRO involvement. The exploratory results of our analysis suggest that bureaucratic procedures might require more time in the CRO-administered trials compared to sponsor-administered and CRO-free studies, which also result in a superior number of patients screening and enrollment.
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The significance of the PD-L1 expression in non-small cell lung cancer: Trenchant double swords as predictive and prognostic markers
Lung cancer is the leading cause of death due to cancer worldwide. Surgery, chemotherapy, and radiotherapy have been the standard treatment for lung cancer, and targeted molecular therapy has greatly improved the clinical course of patients with non-small cell lung cancer (NSCLC) harboring driver mutations, such as in epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) genes. Despite advances in such therapies, the prognosis of patients with NSCLC without driver oncogene mutations remains poor.
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Comparison of Single- and Three-Fraction Schedules of Stereotactic Body Radiation Therapy for Peripheral Early-Stage Non-Small Cell Lung Cancer
We compared the clinical outcome of single- and three-fraction stereotactic body radiation therapy schedules for early-stage non-small cell lung cancer (n=159). No statistical difference in clinical outcomes between these two regimens was observed, despite the single-fraction group that included more patients with worse performance status. This suggests a single-fraction regimen is a reasonable option.
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An Analysis of Factors Associated with In-Hospital Mortality in Lung Cancer Chemotherapy Patients with Neutropenia
Lung cancer, compared to other solid tumors, is associated with high mortality rates from febrile neutropenia. Risk factors associated with in-hospital mortality were identified and compared for patients with lung cancer and patients with other solid tumors.
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Lung toxicity in non-small cell lung cancer patients exposed to ALK inhibitors: report of a peculiar case and systematic review of the literature
Lung toxicity is a potential fatal effect involving non-small cell lung cancer (NSCLC) patients exposed to tyrosine kinase inhibitors (TKIs). Moving from our experience regarding a patient who developed lung toxicity while receiving two different anaplastic lymphoma kinase (ALK)-TKIs, we performed a systematic review to assess the epidemiologic magnitude and the clinical significance of such toxicity in NSCLC patients treated with ALK-TKIs.
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Improved Survival with Increased Time-To-Radiation (TTR) and Sequential Chemotherapy After Surgery for pN2 Non-Small Cell Lung Cancer
Currently, the ideal timing for post-operative radiotherapy (PORT) and chemotherapy is unknown in resected lung cancer. Using the National Cancer Database (NCDB), we reviewed 1,629 patients with resected pN2 NSCLC with margin-negative disease. We found that longer time-to-radiation (≥8 weeks) was associated with better survival. Also, sequential chemotherapy was associated with better survival compared to concurrent chemoradiotherapy.
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The Utility of Liquid-Biopsy by Improved PNA-LNA PCR Clamp Method for Detecting EGFR Mutation at The Initial Diagnosis of NSCLC: AN Observational Study of 190 Consecutive Cases in Clinical Practice.
We reviewed 190 consecutive, unselected patients who received a liquid-biopsy for detecting an EGFR mutation. The results indicated that not all patients should be candidates for liquid-biopsy at initial diagnosis, while some patients gain benefit from initial liquid-biopsy in clinical practice. This real-world data would supply useful information in discussing appropriate patients for liquid-biopsy.
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The Notch Pathway Inhibitor SAHM1 Abrogates the Hallmarks of Allergic Asthma
The Notch signaling pathway has been implicated in the pathogenesis of allergic airway inflammation. Targeting the active Notch transactivation complex by the cell-permeable, hydrocarbon-stapled synthetic peptide SAHM1 was results in genome-wide suppression of Notch-activated genes in leukemic cells and other models. However, efficacy of SAHM1 in allergic asthma models has remained unexplored.
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Methotrexate versus azathioprine in patients with atopic dermatitis: two years follow-up data
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Home freezers kill house dust mites
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MCPIP1 controls allergic airway inflammation by suppressing IL-5-producing Th2 cells through Notch/Gata3 pathway
Asthmatic and allergic inflammation is mediated by Th2 cytokines (IL-4, IL-5 and IL-13). Though we have learned much about how Th2 cells are differentiated, the Th2 checkpoint mechanisms remain elusive.
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Prenatal and Early Life Triclosan and Parabens Exposure and Allergic Outcomes
In cross-sectional studies, triclosan and parabens, ubiquitous ingredients in personal care and other products, are associated with allergic disease.
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Cat ownership, cat allergen exposure, and trajectories of sensitization and asthma throughout childhood
Exposure to cat and/or cat allergens can confer either an increase in risk, or protection, or will have no effect, depending on the age of the assessment, study design and the choice of study population.
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Association of Rhinovirus Species with Common Cold and Asthma Symptoms and Bacterial Pathogens
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Ruxolitinib partially reverses functional NK cell deficiency in patients with STAT1 gain-of-function mutations
Natural Killer (NK) cells are critical innate effector cells whose development is dependent on the JAK-STAT pathway. NK deficiency can result in severe or refractory viral infections. Patients with Signal Transducer and Activator of Transcription (STAT)1 gain of function (GOF) mutations have increased viral susceptibility.
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Economic evaluations of alcohol prevention interventions: is the evidence sufficient? A review of methodological challenges
Source:Health Policy
Author(s): Sarah R. Hill, Luke Vale, David Hunter, Emily Henderson, Yemi Oluboyede
Public health interventions have unique characteristics compared to health technologies, which present additional challenges for economic evaluation (EE). High quality EEs that are able to address the particular methodological challenges are important for public health decision-makers. In England, they are even more pertinent given the transition of public health responsibilities in 2013 from the National Health Service to local government authorities where new agents are shaping policy decisions.Addressing alcohol misuse is a globally prioritised public health issue. This article provides a systematic review of EE and priority-setting studies for interventions to prevent and reduce alcohol misuse published internationally over the past decade (2006–2016). This review appraises the EE and priority-setting evidence to establish whether it is sufficient to meet the informational needs of public health decision-makers.619 studies were identified via database searches. 7 additional studies were identified via hand searching journals, grey literature and reference lists. 27 met inclusion criteria. Methods identified included cost-utility analysis (18), cost-effectiveness analysis (6), cost-benefit analysis (CBA) (1), cost-consequence analysis (CBA) (1) and return-on-investment (1). The review identified a lack of consideration of methodological challenges associated with evaluating public health interventions and limited use of methods such as CBA and CCA which have been recommended as potentially useful for EE in public health. No studies using other specific priority-setting tools were identified.
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Phenotypic spectrum of Tessier facial cleft number 5
Craniofacial clefts are among the most disfiguring and rare congenital malformations of the face. The exact incidence remains unclear but it is estimated to be 1.43 to 4.85 per 100.000 live births (Kawamoto, 1976) or as more recently reported to be 1.5 to 6.0 live births (Moore, 1996). Among these, orbito-facial clefts constitute approximately 0.22% of the cases and there is consensus that Tessier cleft number 5 is the least common in this subgroup (Natsume et al., 1999).
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Novel Computer Vision Analysis of Nasal Shape in Children with Unilateral Cleft Lip
Optimization of treatment of the unilateral cleft lip nasal deformity (uCLND) is hampered by lack of objective means to assess initial severity and changes produced by treatment and growth. The purpose of this study was to develop automated 3D image analysis specific to the uCLND; assess the correlation of these measures to esthetic appraisal; measure changes that occur with treatment and differences amongst cleft types.
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Immunoprecipitation high-performance liquid chromatographic analysis of healing process in chronic suppurative osteomyelitis in the jaw
Chronic suppurative osteomyelitis (CSO) of the jaw is one of the most difficult infectious diseases to manage, because it causes progressive bony destruction and is associated with bacterial inhabitation of the sequestra. A combination of antibiotic therapy and surgical debridement is often used to treat CSO. Nevertheless, various systemic conditions can lead to life-threatening complications.
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Metabolic changes in tumor cells and tumor-associated macrophages: a mutual relationship
In order to adapt to the reduced availability of nutrients and oxygen in the tumor microenvironment and the increased requirements of energy and building blocks necessary for maintaining their high proliferation rate, malignant cells undergo metabolic changes that result in an increased production of lactate, nitric oxide, reactive oxygen species, prostaglandins and other byproducts of arachidonic acid metabolism that influence both the composition of the inflammatory microenvironment and the function of the tumor-associated macrophages (TAMs).
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N6L pseudopeptide interferes with nucleophosmin protein-protein interactions and sensitizes leukemic cells to chemotherapy
NPM1 is a multifunctional nucleolar protein implicated in several processes such as ribosome maturation and export, DNA damage response and apoptotic response to stress stimuli. The NPM1 gene is involved in human tumorigenesis and is found mutated in one third of acute myeloid leukemia patients, leading to the aberrant cytoplasmic localization of NPM1. Recent studies indicated that the N6L multivalent pseudopeptide, a synthetic ligand of cell–surface nucleolin, is also able to bind NPM1 with high affinity.
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Chemoprevention with isothiocyanates – from bench to bedside
Intake of isothiocyanates (ITCs), naturally occurring as hydrolization products from glucosinolates (GLSs) in brassicaceae, has, in epidemiological studies, been weakly to moderately inversely correlated with the risk of colorectal cancer, prostate cancer and lung cancer. Numerous preclinical studies demonstrate chemopreventive mode of actions of ITCs, mainly related to a.) detoxification (induction of phase II enzymes), b.) anti-inflammatory properties by down-regulation of NFkappaB activity, c.) cyclin-mediated cell cycle arrest and d.) epigenetic modulation by inhibition of histone deacetylase activity.
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The developmental transcription factor IRF6 attenuates ABCG2 gene expression and distinctively reverses stemness phenotype in nasoparyngeal carcinoma
Nasopharyngeal carcinoma (NPC), which originates from the nasopharynx, is highly prevalent in Southern China and Southeast Asia, and more than 90% of all NPCs are non-keratinizing undifferentiated cells or poorly differentiated squamous cells. Cancer stem cells (CSCs) are capable of self-renewal and have differentiation potential. These properties form the basis of cancer initiation, development, and radiochemoresistance. However, the molecular mechanisms underlying NPC CSC maintenance remain poorly understood.
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NRPa-308, a new neuropilin-1 antagonist, exerts in vitro anti-angiogenic and anti-proliferative effects and in vivo anti-cancer effects in a mouse xenograft model
Neuropilin-1 (NRP-1) is an extra-cellular receptor for the main Vascular Endothelial Growth Factor over-expressed in tumour tissues, VEGF-A165. Consequently, NRP-1 is involved in angiogenesis and in tumour growth, and its over-expression is related to a clinical poor prognosis. NRP-1 appears as a major target in oncology, which remains poorly exploited. Herein, we report a new series of 18 small-sized fully organic VEGF-A165/NRP-1 antagonists (NRPas). These compounds share an original scaffold, including two linkers (sulphonamide and amide) and three aromatic cores.
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Two-Dimensional Vanadium Carbide (MXene) as a High-Capacity Cathode Material for Rechargeable Aluminum Batteries
ACS Nano
DOI: 10.1021/acsnano.7b05350
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Highly Porous Silicon Embedded in a Ceramic Matrix: A Stable High-Capacity Electrode for Li-Ion Batteries
ACS Nano
DOI: 10.1021/acsnano.7b06031
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