Clinical predictors for satisfaction with incus vibroplasty: a preliminary study

Abstract

Objective

We aimed to evaluate the subjective satisfaction after incus vibroplasty and to determine predictive factors affecting patient satisfaction in sensorineural hearing loss.

Design

A retrospective review of audiological data and an additional survey about subjective satisfaction after surgery were performed in 14 patients who underwent incus vibroplasty surgery. A numeric rating scale reflecting the degree of satisfaction after incus vibroplasty, compared with experiences using a conventional hearing aid, was used. Patients who showed median or better satisfaction were deemed the highly satisfied (HS) group, and the others were deemed the less satisfied (LS) group. To find the predictive factors correlated with satisfaction for incus vibroplasty, comparative analysis between two groups was performed.

Results

We found that the numeric rating scale for satisfaction was variable, ranged from 0 to 10, and was negatively correlated with age at operation (p < 0.01). The HS group had a younger age (27.6 ± 22.2 years) and better preoperative air conduction threshold at 250 Hz (20.7 ± 7.9 dB) than the LS group (68.0 ± 9.7 years, 32.1 ± 10.7 dB). The LS group (13.6 ± 9.9 dB) showed a larger change of air–bone gap after surgery than the HS group (5.7 ± 6.7 dB) at 250 Hz (p = 0.12).

Conclusions

Age at operation and the preoperative air conduction threshold level at 250 Hz appear to be potential predictive factors for subjective satisfaction with incus vibroplasty. Furthermore, more conservative selection of candidates and caution during surgery, considering inevitable air–bone gap development postoperatively, may be necessary to achieve higher satisfaction for incus vibroplasty.

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Elevated parathyroid hormone levels after successful parathyroidectomy for primary hyperparathyroidism: a clinical review

Abstract

Introduction

Surgery for primary hyperparathyroidism (PHPT) is traditionally deemed to be successful if serum calcium levels return to normal 6 months after parathyroidectomy. Regular monitoring of serum calcium and parathyroid hormone (PTH) in the follow-up of patients after parathyroidectomy for PHPT has drawn attention to the presence of a normocalcemic group of patients with elevated PTH (NCePTH) during the post-operative period. The etiological factors and mechanisms underlying this condition, its consequences, and the possibility of treatment are the object of this study.

Materials and methods

We conducted an unlimited PubMed search updated on March 31, 2017, which yielded 1628 results. We selected 37 articles, 33 of which included cases of NCePTH in their series and 23 performed statistical studies to assess factors associated with NCePTH.

Results

The maximum mean prevalence of NCePTH in the various series was 23.5%, ranging from 3 to 46%. Many factors were associated with NCePTH. The most important were higher pre-operative PTH, low pre-operative 25 (OH) D3, lower pre-operative creatinine clearance and greater adenoma weight. The origin of NCePTH may be multifactorial, since several factors were implicated in the etiology. NCePTH does not seem to be related to an increase in PHPT recurrence, although this possibility should not be dismissed. Vitamin D deficiency should be corrected. Treatment with calcium supplements seems to be clearly beneficial.

Conclusion

The prevalence of NCePTH is high. The causes of secondary hyperparathyroidism should be investigated carefully. Patients require treatment and long-term follow-up.

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Q & M Dental sells medical aesthetic and laser unit for S$242,000

DENTAL clinic operator Q & M Dental Group Ltd on Monday said that its subsidiary Q & M Medical Group Singapore has entered into an agreement with Dr Felix Li Jingxiang on Nov 28, 2017, to dispose all of its shares in Q & M Medical Aesthetic & Laser Centre for a total consideration of S$242,000. A sum of S$50,000 has been paid on Dec 1, 2017, with the completion of the share disposal, while the remaining amount will be payable via monthly instalments of S$12,000 over a period of 16 months from the date of completion of the share disposal.

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Hereditary Hemorrhagic Telangiectasia

Hereditary hemorrhagic telangiectasia (HHT) describes the presenting manifestations of a disorder that is characterized by pathologic blood vessels. HHT is inherited as an autosomal dominant trait with variable penetrance. The abnormal vascular structures (dysplasias) can affect all the organs in the human body. The link between a physical stimulus and new lesion development has been established for mucosal trauma owing to nasal airflow turbulence, for ultraviolet exposure to the fingers, and for mechanical trauma to the dominant hand. The pressing question then is whether HHT treatment constitutes a stimulus that is sufficient to trigger new lesion development. (Source: Otolaryngologic clinics of North America)

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New Frontiers in Our Understanding of Lymphatic Malformations of the Head and Neck

This article summarizes the clinical and basic science research that will likely influence the future of HNLM assessment and treatment. (Source: Otolaryngologic clinics of North America)

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Contributors

SUJANA S. CHANDRASEKHAR, MD (Source: Otolaryngologic clinics of North America)

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Venous Malformations of the Head and Neck

This article discusses the natural history, diagnosis, and management of VMs. (Source: Otolaryngologic clinics of North America)

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Multidisciplinary Approach to Vascular Anomalies Maximizes Outcomes

The birth of a child is a glorious and simultaneously nerve-wracking event in every family. If this is the 1 in 22 children born with a vascular lesion of the head and neck (which is visible in every picture and to every visitor), the parents ' concerns multiply. Will my baby bleed? Will my baby stay deformed by this lesion? Is this the tip of the iceberg of other problems? Will my baby be forced to enter chronic medical/surgical care? These are some of the questions that race through the parents' brains, even as they marvel at the w ondrousness of new life. (Source: Otolaryngologic clinics of North America)

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Capillary Malformations (Portwine Stains) of the Head and Neck

Capillary malformations (CMs), also known as port-wine stains, are the most common type of congenital vascular malformations. Facial CM often occurs with a quasidermatomal distribution according to the sensory trigeminal nerve distribution. With time, these lesions darken progressively, and soft tissue hypertrophy, bony hypertrophy, and/or nodule formation can develop. Multiple treatments for CM have been reported. However, the mainstay and gold standard therapy for facial or aesthetically sensitive CM is still the pulsed dye laser treatment. In patients with associated soft tissue/bony hypertrophy, surgical management is helpful in restoring the normal anatomy and in re-establishing a symmetric contour. (Source: Otolaryngologic clinics of North America)

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Outcome Measurement for Vascular Malformations of the Head and Neck

This article describes outcome measurements for vascular malformations and initiatives to improve outcome reporting. (Source: Otolaryngologic clinics of North America)

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Arteriovenous Malformations of the Head and Neck

Extracranial arteriovenous malformations (AVMs) are complex vascular malformations to diagnose and treat. They are comprised of congenitally derived arteriovenous shunts with chronic vascular expansion, collateralization, and infiltration of local tissue. Their cause remains unclear, but new genetic and molecular clues are emerging. They may present at any age following an early quiescent period. Diagnosis is based on vascular staining, soft tissue expansion, progressive growth, warmth, and pulsations. Focal lesions can be cured, whereas diffuse AVMs demonstrate highly recidivistic disease. Multimodal therapy with staged interventions can improve treatment outcomes, increase treatment intervals, and control disease. Vigilant follow-up is critical. (Source: Otolaryngologic clinics of North ...

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Classification and Pathology of Congenital and Perinatal Vascular Anomalies of the Head and Neck

This article provides an overview of the features that distinguish the major types of congenital and perinatal vascular anomalies affecting the head and neck, and summarizes the diagnostic histopathologic criteria and nomenclature currently applied to these lesions. (Source: Otolaryngologic clinics of North America)

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Etiology and Genetics of Congenital Vascular Lesions

The detection of somatic, activating genetic mutations to underlie development of vascular tumors and malformations led to a better understanding of their pathophysiology. Proteins encoded by the detected mutated genes activate the two major signaling pathways, also involved in cancer: the RAS/MAPK/ERK pathway and/or the PI3K/AKT/mTOR pathway. This gives a strong basis for studies to repurpose cancer therapeutics to patients with vascular tumors and malformations. (Source: Otolaryngologic clinics of North America)

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Congenital Vascular Lesions of the Head and Neck

OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA (Source: Otolaryngologic clinics of North America)

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Imaging of Vascular Lesions of the Head and Neck

This article provides an overview of imaging findings of common and uncommon vascular lesions in the head and neck and showcases images highlighting imaging findings. Both hemangiomas and vascular malformations are covered. (Source: Otolaryngologic clinics of North America)

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Forthcoming Issues

Otosclerosis and Stapes Surgery (Source: Otolaryngologic clinics of North America)

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Congenital Vascular Tumors

Vascular tumors are benign neoplasms, which result from proliferating endothelial cells. These lesions present during infancy or childhood, may affect any location, and exhibit postnatal growth. Local complications include bleeding, tissue destruction, and pain whereas systemic sequelae include thrombocytopenia, congestive heart failure, and death. Vascular tumors should be differentiated from vascular malformations, which present at birth, have a quiescent endothelium, and grow in proportion to the child. Together, vascular tumors and malformations comprise the field of vascular anomalies. (Source: Otolaryngologic clinics of North America)

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Orthognathic Considerations of Vascular Malformations

Vascular malformations affect the craniofacial skeleton in many ways, depending on the type of the lesion and its location. The lesions may exert a mass effect and cause thinning or thickening of the bone or cause expansion from direct bony infiltration. Orthognathic surgery can be used to correct any malocclusion or open bite deformities after the soft tissues are addressed. (Source: Otolaryngologic clinics of North America)

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Infantile Hemangiomas in the Head and Neck Region

Infantile hemangiomas (IHs) are benign vascular tumors of infancy most common in the region of the head and neck. Infantile hemangiomas are common; but they are extremely heterogeneous and cause a range of complications depending on their morphology, size, or location. Medical interventions for high-risk patients include topical and systemic therapies, including oral propranolol, which has revolutionized the management of IHs over the past recent years. In the following article, the authors aim to provide a review of the natural history, pathology, complications, syndromes, and medical management of infantile hemangioma. (Source: Otolaryngologic clinics of North America)

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Psychosocial Impact of Vascular Anomalies on Children and Their Families

Vascular anomalies are divided into tumors and malformations based on their clinical and cytologic attributes. Vascular malformations are further subcategorized as low-flow lymphatic, venous, capillary, or mixed lesions and as high-flow arteriovenous malformations. Treatment is reserved for vascular anomalies that are symptomatic or cosmetically disfiguring, and surgical and nonsurgical treatment options are widely varied with variable outcomes. (Source: Otolaryngologic clinics of North America)

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The Role of Surgery in the Management of Infantile Hemangiomas

Surgery for the management of infantile hemangiomas has become commonplace. Surgical technique articles are plentiful; however, little has been written about the timing of surgery. Knowledge of the biology of the tumors, data from developmental psychology, and the utility of facial reconstruction provide guidelines for timing of surgical intervention. (Source: Otolaryngologic clinics of North America)

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Congenital Vascular Lesions of the Head and Neck

The number of physicians interested in the treatment of vascular anomalies has grown exponentially over the last several decades from a mere handful in the mid 1980s to several thousand today. Every year, hundreds of peer-reviewed articles are published in this field. Some of the most interesting articles have shed light on the underlying genetic and molecular bases of some of these conditions. This has led to the development of at least one group of medical therapies for some vascular lesions. (Source: Otolaryngologic clinics of North America)

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The Surgical Management of Infantile Hemangiomas

The surgical management of facial infantile hemangiomas presents a unique challenge. The aim of the surgeon should be to remove the hemangioma and to restore normal facial features. Each of the facial zones has its own special features and challenges. The surgeon should remember that the child started out with normal anatomy and that as the hemangioma proliferated, it displaced and thinned these normal structures and in many cases, expanded adjacent tissue. Hemangiomas do not as a rule, invade adjacent tissues as they proliferate. These facts will help in planning the various surgical approaches. (Source: Otolaryngologic clinics of North America)

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Clinical predictors of chronic rhinosinusitis: do the Canadian clinical practice guidelines for acute and chronic rhinosinusitis predict CT-confirmation of disease?

The diagnosis of chronic rhinosinusitis (CRS) based on clinical presentation alone remains challenging. To improve the accuracy of clinical diagnosis, the Canadian Rhinosinusitis Guidelines recommend the use o...

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Community pharmacists—Leaders for antibiotic stewardship in respiratory tract infection

Summary

What is known and objective

Hospital-based pharmacists are established antibiotic stewards, but the potential for community pharmacists is largely untapped. This commentary explores the potential leadership role of the community pharmacist in antibiotic stewardship using upper respiratory tract infection (URTI) as an example.

Comment

Community pharmacists are well placed for antibiotic stewardship, possessing the capability (knowledge of medicines), opportunity (contact with prescribers and patients) and inherent commitment. Providing further motivation with information on patient education has great potential to change patient behaviour with respect to consulting a healthcare professional for an antibiotic prescription. A Global Respiratory Infection Partnership pharmacy-led educational initiative was shown to have a positive impact and can promote appropriate self-management of URTI and reduce levels of inappropriate antibiotic use.

What is new and conclusion

Community pharmacists are ideally placed as antibiotic stewards to lead the quest to contain the threat of antibiotic resistance.

This commentary explores the potential leadership role of community pharmacists in antibiotic stewardship. They have the capability (knowledge of medicines), opportunity (contact with both prescribers and patients), and inherent commitment to rational use of medicines. Providing community pharmacists with further motivation (training/information) has great potential to change patient behaviour, and community pharmacists are ideally placed as antibiotic stewards to lead the quest to contain the threat of antibiotic resistance.

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Rare cause of complicated prosthetic valve endocarditis

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Sound of music—or is it noise in OR?

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CME Accreditation Page

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Psychosocial Impact of Vascular Anomalies on Children and Their Families

Vascular anomalies are divided into tumors and malformations based on their clinical and cytologic attributes. Vascular malformations are further subcategorized as low-flow lymphatic, venous, capillary, or mixed lesions and as high-flow arteriovenous malformations. Treatment is reserved for vascular anomalies that are symptomatic or cosmetically disfiguring, and surgical and nonsurgical treatment options are widely varied with variable outcomes.

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Forthcoming Issues

Otosclerosis and Stapes Surgery

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Congenital Vascular Lesions of the Head and Neck

The number of physicians interested in the treatment of vascular anomalies has grown exponentially over the last several decades from a mere handful in the mid 1980s to several thousand today. Every year, hundreds of peer-reviewed articles are published in this field. Some of the most interesting articles have shed light on the underlying genetic and molecular bases of some of these conditions. This has led to the development of at least one group of medical therapies for some vascular lesions.

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Contents

Sujana S. Chandrasekhar

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Orthognathic Considerations of Vascular Malformations

Vascular malformations affect the craniofacial skeleton in many ways, depending on the type of the lesion and its location. The lesions may exert a mass effect and cause thinning or thickening of the bone or cause expansion from direct bony infiltration. Orthognathic surgery can be used to correct any malocclusion or open bite deformities after the soft tissues are addressed.

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Contributors

SUJANA S. CHANDRASEKHAR, MD

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Multidisciplinary Approach to Vascular Anomalies Maximizes Outcomes

The birth of a child is a glorious and simultaneously nerve-wracking event in every family. If this is the 1 in 22 children born with a vascular lesion of the head and neck (which is visible in every picture and to every visitor), the parents' concerns multiply. Will my baby bleed? Will my baby stay deformed by this lesion? Is this the tip of the iceberg of other problems? Will my baby be forced to enter chronic medical/surgical care? These are some of the questions that race through the parents' brains, even as they marvel at the wondrousness of new life.

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Copyright

Elsevier

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Classification and Pathology of Congenital and Perinatal Vascular Anomalies of the Head and Neck

Accurate histopathologic description in correlation with clinical and radiological evaluation is required for treatment of vascular anomalies, both neoplastic and malformative. It is important to examine current clinical, histologic, and immunophenotypical features that distinguish the major types of congenital and perinatal vascular anomalies affecting the head and neck. General discussions of pathogenesis and molecular diagnosis must also be taken into account. This article provides an overview of the features that distinguish the major types of congenital and perinatal vascular anomalies affecting the head and neck, and summarizes the diagnostic histopathologic criteria and nomenclature currently applied to these lesions.

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Congenital Vascular Lesions of the Head and Neck

OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA

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Hereditary Hemorrhagic Telangiectasia

Hereditary hemorrhagic telangiectasia (HHT) describes the presenting manifestations of a disorder that is characterized by pathologic blood vessels. HHT is inherited as an autosomal dominant trait with variable penetrance. The abnormal vascular structures (dysplasias) can affect all the organs in the human body. The link between a physical stimulus and new lesion development has been established for mucosal trauma owing to nasal airflow turbulence, for ultraviolet exposure to the fingers, and for mechanical trauma to the dominant hand. The pressing question then is whether HHT treatment constitutes a stimulus that is sufficient to trigger new lesion development.

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Outcome Measurement for Vascular Malformations of the Head and Neck

Vascular malformations are congenital anomalies of the vascular and/or lymphatic system that affect the head and neck region. The most common treatment options are sclerotherapy, laser therapy, surgery, and embolization. Because vascular malformations are variable in type, size, extent, and location, it is a challenge to select methods for evaluation of treatment outcome. Without standardized outcome reporting, it is difficult to compare and combine scientific evidence to support therapeutic decision making. Standardized collection and reporting of outcome data are the first steps toward a fair comparison between treatments. This article describes outcome measurements for vascular malformations and initiatives to improve outcome reporting.

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The Surgical Management of Infantile Hemangiomas

The surgical management of facial infantile hemangiomas presents a unique challenge. The aim of the surgeon should be to remove the hemangioma and to restore normal facial features. Each of the facial zones has its own special features and challenges. The surgeon should remember that the child started out with normal anatomy and that as the hemangioma proliferated, it displaced and thinned these normal structures and in many cases, expanded adjacent tissue. Hemangiomas do not as a rule, invade adjacent tissues as they proliferate. These facts will help in planning the various surgical approaches.

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The Management of Vascular Malformations of the Airway

Vascular malformations may affect nearly all aspects of the upper airway. Each type of malformation has a characteristic pattern of disease. These lesions may be focal or diffuse, and require directed management strategies. Physicians treating these entities should have a high level of suspicion to consider airway evaluation even in the absence of overt symptoms. However, cutaneous head and neck venous malformations or other lesions affecting the lips, oral cavity, or tongue can herald the presence of coexisting airway lesions. A multidisciplinary approach is critical in achieving comprehensive treatment.

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Infantile Hemangiomas in the Head and Neck Region

Infantile hemangiomas (IHs) are benign vascular tumors of infancy most common in the region of the head and neck. Infantile hemangiomas are common; but they are extremely heterogeneous and cause a range of complications depending on their morphology, size, or location. Medical interventions for high-risk patients include topical and systemic therapies, including oral propranolol, which has revolutionized the management of IHs over the past recent years. In the following article, the authors aim to provide a review of the natural history, pathology, complications, syndromes, and medical management of infantile hemangioma.

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Multidisciplinary Approach to the Management of Lymphatic Malformations of the Head and Neck

Lymphatic malformations (LMs) occur in 2.8 to 5 per 100,000 live births. Most involve the head and neck and they are equally common in men and women. They are developmental anomalies of unknown cause, although recent evidence suggests that an upregulation of the mammalian target of rapamycin (mTOR) pathway may be a causal factor leading to the overproduction of abnormal lymph vessels. These vessels are likely dilated lymphatic sacs sequestered from the lymphatic and venous systems. This overproduction results in the accumulation of lymph in dilated cystic spaces, which in turn results in the clinical features of an LM.

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The Role of Surgery in the Management of Infantile Hemangiomas

Surgery for the management of infantile hemangiomas has become commonplace. Surgical technique articles are plentiful; however, little has been written about the timing of surgery. Knowledge of the biology of the tumors, data from developmental psychology, and the utility of facial reconstruction provide guidelines for timing of surgical intervention.

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Congenital Vascular Tumors

Vascular tumors are benign neoplasms, which result from proliferating endothelial cells. These lesions present during infancy or childhood, may affect any location, and exhibit postnatal growth. Local complications include bleeding, tissue destruction, and pain whereas systemic sequelae include thrombocytopenia, congestive heart failure, and death. Vascular tumors should be differentiated from vascular malformations, which present at birth, have a quiescent endothelium, and grow in proportion to the child. Together, vascular tumors and malformations comprise the field of vascular anomalies.

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Etiology and Genetics of Congenital Vascular Lesions

The detection of somatic, activating genetic mutations to underlie development of vascular tumors and malformations led to a better understanding of their pathophysiology. Proteins encoded by the detected mutated genes activate the two major signaling pathways, also involved in cancer: the RAS/MAPK/ERK pathway and/or the PI3K/AKT/mTOR pathway. This gives a strong basis for studies to repurpose cancer therapeutics to patients with vascular tumors and malformations.

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Usefulness of our proposed olfactory scoring system during endoscopic sinus surgery in patients with chronic rhinosinusitis

Abstract

Introduction

The primary aim of the current study was to examine the usefulness of our proposed olfactory scoring system in chronic rhinosinusitis (CRS) patients with olfactory disorders (n = 213) receiving endoscopic sinus surgery (ESS).

Materials and methods

Analyzed patients were divided into two groups: an eosinophilic CRS (ECRS) group (n = 153); and a non-ECRS group (n = 60). The T&T recognition threshold test was used to evaluate olfaction at baseline and at 3 and 12 months after ESS. Patients with mean recognition threshold < 2.0 at 3 or 12 months or with a decrease of ≥ 1.0 as compared with baseline were defined as showing clinical improvement. We scored mucosal conditions as normal (0 points), edema (1 point), and polyp (2 points) at the canopy of olfactory cleft (OC), middle and superior turbinates, superior nasal meatus, and sphenoethmoidal recess during ESS. The total score of OCs (SOCs) was calculated (range 0–20 points). We compared SOCs between ECRS and non-ECRS groups. Factors related to olfactory improvement were also investigated using uni- and multivariate analyses.

Results

SOCs in the ECRS and non-ECRS groups showed significant correlations with mean recognition thresholds at baseline and at 3 and 12 months. In the multivariate analysis for predicting improvement of mean recognition threshold, lower SOCs were significantly associated with olfactory improvement factors at 3 and 12 months postoperatively in the ECRS group.

Conclusion

SOCs appears promising for estimating olfactory prognosis after ESS in CRS patients.

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Sialendoscopy in treating pediatric salivary gland disorders: a systematic review

Abstract

Objective

The primary aim of this study is to conduct a systematic review in order to evaluate the use of sialendoscopy in treating pediatric salivary gland disorders.

Methods

Eligible articles were identified through a comprehensive search of electronic databases. Using predefined inclusion criteria, published articles on sialendoscopy in children were selected and reviewed.

Results

17 articles including 323 pediatric patients and 424 salivary glands managed by sialendoscopy were identified. The most common salivary gland disorder affected was the parotid (83% of cases), followed by the submandibular gland (16.5% of cases). Juvenile recurrent parotitis (68.9%) was the most frequent diagnosis followed by sialolithiasis (14.7%). The most common complication was ductal perforation. During a pooled mean follow-up time of 18.3 months, recurrences were reported in 14.5% of patients mostly in patients diagnosed with juvenile recurrent parotitis.

Conclusion

Sialendoscopy is a minimally invasive diagnostic and therapeutic tool for inflammatory salivary gland disorders in pediatric patients. Based on the current review, sialendoscopy can be successfully implemented in cases of pediatric salivary gland disorders.

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Reply to the letter “Laryngopharyngeal reflux disease in the elderly”

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The outcome of cochlear implantation among children with genetic syndromes

Abstract

Objective

To assess the outcome and efficacy of cochlear implantation in children with genetic syndromes.

Method

Study design: case–control study.

Setting

A cochlear implantation tertiary referral center.

Patients

All pediatric cochlear implantation recipients with Waardenburg syndrome, Usher syndrome, Dandy–Walker syndrome, or albinism. A control group was appropriately matched to the syndromic group with regard to age at implantation and duration of device use.

Intervention

Cochlear implantation.

Main outcome measures

Subjects' auditory abilities, speech intelligibility, and pure tone thresholds were compared between the syndromic and non-syndromic group.

Results

A total of 25 subjects (13 syndromic and 12 non-syndromic) participated in the study. Neither auditory ability nor speech intelligibility scores differed significantly by group. The final PTA of both the groups showed normal-to-mild hearing loss: 26 dB HL in the syndromic group and 23 dB HL for the control group.

Conclusions

Cochlear implant recipients with genetic syndromes achieved similar levels auditory perception and speech intelligibility as their peers with a genetic syndrome. The presence of any of the genetic syndromes described herein should not be a contraindication to cochlear implant provision, as it would have a positive impact on the patients' sensory perception and lifestyle.

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Prognostic value of the lymph node ratio in oropharyngeal carcinoma stratified for HPV-status

Abstract

Objective

Lymph node ratio (LNR) was shown to be a prognostic factor in laryngeal and oral cavity primaries. The purpose of this study was to investigate the impact of the lymph node ratio in oropharyngeal squamous cell carcinoma (OPSCC) with a high incidence of HPV-related disease. Therefore, the role of LNR was evaluated as an additional predictive parameter to the 8th edition of AJCC TNM staging system.

Methods

From December 2009 to August 2015, patients diagnosed with primary oropharyngeal squamous cell carcinoma were prospectively enrolled. After tumor resection with uni- or bilateral neck dissection, patients with ≥ 1 nodal metastasis (pN+) were eligible for a retrospective LNR analysis.

Results

137 patients underwent tumor resection with uni- or bilateral neck dissection. The proportion of HPV-associated disease was 42%. Most patients (n = 96; 70%) presented with involved neck nodes. In p16-positive OPSCC, the rate of pN + cases was significantly increased compared to p16-negative OPSCC (86% vs. 58%, p = 0.007). Patients with LNR ≤ 10% had a significant better overall survival (OS) and disease-specific survival (DSS). However, when stratified for p16-status, LNR ≤ 10% had a significant impact on OS only for HPV-associated tumors (p = 0.027), whereas LNR of ≤ 10% was not a significant predictor for better OS in p16-negative OPSCC (p = 0.143).

Conclusion

The LNR with a cut-off value of 10% serves as an additional prognostic parameter in HPV-related OPSCC and may help to improve risk stratification in combination with the revised AJCC 8th edition TNM classification.

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Reply to the Letter to the Editor concerning “Combined microscopic/endoscopic management of petrous apex lesions”

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Cathodal transcranial direct-current stimulation over right posterior parietal cortex enhances human temporal discrimination ability

Time perception associated with durations from 1 s to several minutes involves activity in the right posterior parietal cortex (rPPC). It is unclear whether altering the activity of the rPPC affects an individ...

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Repair of Occipital Bone Defects in Neurofibromatosis Type 1 by Means of CAD/CAM Prefabricated Titanium Plates

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1608699

Certain skeletal defects may develop in neurofibromatosis type 1 (NF1), a common tumor-suppressor syndrome, such as cranial lesions confined to the lambdoid suture region. Here, we report on the repair of osseous defects of occipital bone in a NF1 patient with history of skull trauma and tumorous hemorrhage. Computer-aided design and computer-aided manufacturing (CAD/CAM)-assisted devices were applied to safely close the bone defects. The variable phenotype of NF1 in the occipital skull region is discussed and a brief review is presented on NF1-related therapies for tumors and malformations of the occipitoparietal skull region.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Metastasierung kutaner Plattenepithelkarzinome im HNO-Bereich

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-122745

Hintergrund Kutane Plattenepithelkarzinome können lymphogen sowohl nach intraparotideal, als auch nach zervikal metastasieren. Prognostisch scheinen sich gemäß mehreren Studien die beiden Metastasierungswege zu unterscheiden. Wir möchten mit klinikeigenen Daten das Metastasierungsverhalten hinsichtlich der Prognose untersuchen. Material und Methoden In die retrospektive Studie aufgenommen wurden 29 Kaukasier mit einem Plattenepithelkarzinom der Haut im Kopf-Halsbereich, welche sich zwischen 2004 und 2016 an unserer Hals-Nasen-Ohren-Klinik vorgestellt haben. Bei allen Patienten wurde eine Tumorresektion mit Neck dissection durchgeführt. Sowohl das präoperative Staging, wie auch die Nachsorge erfolgten mittels Ultraschall oder Computertomographie (konventionell oder PET Scan). Die Patienten wurden nach Metastasierungsverhalten eingeteilt und die entsprechenden Überlebensraten wurden ermittelt. Ergebnisse 11 Patienten hatten zervikale Metastasen, 4 Patienten parotideale Metastasen, 5 Patienten hatten beides. Bei 9 Patienten wurde eine prophylaktische Neck dissection bei cN0 durchgeführt. Ein lokoregionäres Tumorrezidiv trat in insgesamt 24 % der Fälle auf, davon waren alle mit einer zervikalen Metastasierung assoziiert. Die 5-Jahres Überlebensrate betrug in diesen Fällen 71 %. Im Gegensatz dazu betrug diese bei alleiniger parotidealer Metastasierung 100 %. Im Rahmen der prophylaktischen Neck dissection wurden in einem Fall okkulte Metastasen diagnostiziert. Schlussfolgerungen Eine zervikale Metastasierung geht im Gegensatz zu einer alleinigen parotidealen Metastasierung mit einer schlechteren Prognose einher. Die Überlebensrate nach chirurgischer Therapie, sowie gegebenenfalls zusätzlichen adjuvanten Radiotherapie ist insgesamt gut (79 %). Die Rolle einer prophylaktischen Neck dissection bei cN0 und entsprechenden Risikofaktoren ist nicht abschließend geklärt.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Dentist accused of killing mistress son plotted her murder

Dentist accused of killing his mistress's 19-month-old son is now charged with 'plotting from prison to have HER murdered so she couldn't testify against him' Dentist Bert Franklin was accused of killing his mistress's 19-month-old son, and now he's accused of plotting to kill her from behind bars An Oklahoma dentist accused of causing fatal skull fractures to his mistress's 19-month-old son was charged Monday in a new felony case- with conspiring to have her killed so she couldn't testify against him. Bert Franklin, 36, was set to face trial Monday in the death of his mistress Roxanne Lewis's son, Lincoln Von Henry Lewis.

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"Endoscopic assisted treatment combined with transoral and transbuccal approach of mandibular subcondylar fractures”

Introduction: Endoscopic treatment of maxillofacial fractures is a different way of performing open reduction internal fixation. In this study, we present a case series of mandibular subcondylar fractures performed with the combination of endoscopic transoral and transbuccal approaches to evaluate the results.Material and Method: 16 patients with mandibular condylar fractures were preoperatively assessed for risk and underwent open reduction internal fixation with endoscope assisted transoral approach.

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What Factors Necessitate Removal of Retained Ballistic Fragments in the Head and Neck?

In the United States, firearm violence is a significant healthcare burden. According to the Center for Disease Control, an estimated 100,000 firearm injuries are treated annually in the United States and approximately one third of these injuries result in fatalities i ii. Media attention has recently been placed on gun violence in the United States and resulting gun control discussions. The head and neck encompasses a smaller percentage of victims of gunshot wounds; however, the consequences can be more severe.

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Central xanthoma of the mandible associated with hyperlipidemia: A rare presentation

Xanthoma is a common, self-limiting cutaneous lesion of non-Langerhans cell, lipid-laden foamy histiocytes that is often concomitant with hyperlipidemia. The intraosseous counterpart is rarely encountered and typically presents as a painless, expansile osteolytic process in the context of hyperlipidemia or normolipidemia. Only a scant number of gnathic xanthomas have been reported in the otolaryngologic literature. We report the clinical, laboratory, radiographic, histopathologic, immunohistochemical, and ultrastructural studies of a mandibular lesion discovered in an asymptomatic 16-year-old male, and associated with 2 previously unreported comorbidities, namely hyperlipidemia and vitamin D deficiency.

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Hyalinizing clear cell carcinoma of salivary gland origin in the head and neck: clinical and histopathological analysis

Hyalinizing clear cell carcinoma (HCCC) is an extremely rare neoplasm of salivary gland origin with a low-grade indolent nature. It is difficult to distinguish from other malignant salivary gland tumours. Clinical outcomes following surgery are generally reported as good. The aim of this study was to further determine the features of HCCC. This study was approved by Medical ethics review of affiliated hospital of jiangsu university. Fourteen new cases of HCCC are reported. The clinical and histopathological data of these 14 cases were analysed alongside those of 141 cases identified in a systematic review of the literature (up to 2016).

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Usefulness of our proposed olfactory scoring system during endoscopic sinus surgery in patients with chronic rhinosinusitis

Abstract

Introduction

The primary aim of the current study was to examine the usefulness of our proposed olfactory scoring system in chronic rhinosinusitis (CRS) patients with olfactory disorders (n = 213) receiving endoscopic sinus surgery (ESS).

Materials and methods

Analyzed patients were divided into two groups: an eosinophilic CRS (ECRS) group (n = 153); and a non-ECRS group (n = 60). The T&T recognition threshold test was used to evaluate olfaction at baseline and at 3 and 12 months after ESS. Patients with mean recognition threshold < 2.0 at 3 or 12 months or with a decrease of ≥ 1.0 as compared with baseline were defined as showing clinical improvement. We scored mucosal conditions as normal (0 points), edema (1 point), and polyp (2 points) at the canopy of olfactory cleft (OC), middle and superior turbinates, superior nasal meatus, and sphenoethmoidal recess during ESS. The total score of OCs (SOCs) was calculated (range 0–20 points). We compared SOCs between ECRS and non-ECRS groups. Factors related to olfactory improvement were also investigated using uni- and multivariate analyses.

Results

SOCs in the ECRS and non-ECRS groups showed significant correlations with mean recognition thresholds at baseline and at 3 and 12 months. In the multivariate analysis for predicting improvement of mean recognition threshold, lower SOCs were significantly associated with olfactory improvement factors at 3 and 12 months postoperatively in the ECRS group.

Conclusion

SOCs appears promising for estimating olfactory prognosis after ESS in CRS patients.

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Sialendoscopy in treating pediatric salivary gland disorders: a systematic review

Abstract

Objective

The primary aim of this study is to conduct a systematic review in order to evaluate the use of sialendoscopy in treating pediatric salivary gland disorders.

Methods

Eligible articles were identified through a comprehensive search of electronic databases. Using predefined inclusion criteria, published articles on sialendoscopy in children were selected and reviewed.

Results

17 articles including 323 pediatric patients and 424 salivary glands managed by sialendoscopy were identified. The most common salivary gland disorder affected was the parotid (83% of cases), followed by the submandibular gland (16.5% of cases). Juvenile recurrent parotitis (68.9%) was the most frequent diagnosis followed by sialolithiasis (14.7%). The most common complication was ductal perforation. During a pooled mean follow-up time of 18.3 months, recurrences were reported in 14.5% of patients mostly in patients diagnosed with juvenile recurrent parotitis.

Conclusion

Sialendoscopy is a minimally invasive diagnostic and therapeutic tool for inflammatory salivary gland disorders in pediatric patients. Based on the current review, sialendoscopy can be successfully implemented in cases of pediatric salivary gland disorders.

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Reply to the letter “Laryngopharyngeal reflux disease in the elderly”

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The outcome of cochlear implantation among children with genetic syndromes

Abstract

Objective

To assess the outcome and efficacy of cochlear implantation in children with genetic syndromes.

Method

Study design: case–control study.

Setting

A cochlear implantation tertiary referral center.

Patients

All pediatric cochlear implantation recipients with Waardenburg syndrome, Usher syndrome, Dandy–Walker syndrome, or albinism. A control group was appropriately matched to the syndromic group with regard to age at implantation and duration of device use.

Intervention

Cochlear implantation.

Main outcome measures

Subjects' auditory abilities, speech intelligibility, and pure tone thresholds were compared between the syndromic and non-syndromic group.

Results

A total of 25 subjects (13 syndromic and 12 non-syndromic) participated in the study. Neither auditory ability nor speech intelligibility scores differed significantly by group. The final PTA of both the groups showed normal-to-mild hearing loss: 26 dB HL in the syndromic group and 23 dB HL for the control group.

Conclusions

Cochlear implant recipients with genetic syndromes achieved similar levels auditory perception and speech intelligibility as their peers with a genetic syndrome. The presence of any of the genetic syndromes described herein should not be a contraindication to cochlear implant provision, as it would have a positive impact on the patients' sensory perception and lifestyle.

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Prognostic value of the lymph node ratio in oropharyngeal carcinoma stratified for HPV-status

Abstract

Objective

Lymph node ratio (LNR) was shown to be a prognostic factor in laryngeal and oral cavity primaries. The purpose of this study was to investigate the impact of the lymph node ratio in oropharyngeal squamous cell carcinoma (OPSCC) with a high incidence of HPV-related disease. Therefore, the role of LNR was evaluated as an additional predictive parameter to the 8th edition of AJCC TNM staging system.

Methods

From December 2009 to August 2015, patients diagnosed with primary oropharyngeal squamous cell carcinoma were prospectively enrolled. After tumor resection with uni- or bilateral neck dissection, patients with ≥ 1 nodal metastasis (pN+) were eligible for a retrospective LNR analysis.

Results

137 patients underwent tumor resection with uni- or bilateral neck dissection. The proportion of HPV-associated disease was 42%. Most patients (n = 96; 70%) presented with involved neck nodes. In p16-positive OPSCC, the rate of pN + cases was significantly increased compared to p16-negative OPSCC (86% vs. 58%, p = 0.007). Patients with LNR ≤ 10% had a significant better overall survival (OS) and disease-specific survival (DSS). However, when stratified for p16-status, LNR ≤ 10% had a significant impact on OS only for HPV-associated tumors (p = 0.027), whereas LNR of ≤ 10% was not a significant predictor for better OS in p16-negative OPSCC (p = 0.143).

Conclusion

The LNR with a cut-off value of 10% serves as an additional prognostic parameter in HPV-related OPSCC and may help to improve risk stratification in combination with the revised AJCC 8th edition TNM classification.

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Reply to the Letter to the Editor concerning “Combined microscopic/endoscopic management of petrous apex lesions”

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Diagnostic and treatment effects of sialendoscopy for patients with swelling of the parotid gland when sialoliths are undetected with computed tomography

Between August 2009 and May 2016, 74 patients underwent sialoendoscopic surgery. 32 patients had parotid gland disease and 9 patients had intermittent swelling of the parotid gland and sialoliths were not detected with CT imaging. 4 patients were diagnosed with idiopathic Stensen's duct stenosis. Sialendoscopy directly confirmed Stensen's duct stenosis in 2 patients. However, the sialendoscope was unable to be inserted in the other 2 patients, who had stenosis of the orifice of the Stensen's duct.

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Using multilevel models to evaluate the influence of contextual factors on HIV/AIDS, STIs, and risky sexual behavior in sub-Saharan Africa: a systematic review

To describe the use of multilevel models (MLMs) in evaluating the influence of contextual factors on HIV/AIDS, sexually transmitted infections (STIs), and risky sexual behavior (RSB) in sub-Saharan Africa.

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MultIethNic Study of BrEast ARterial Calcium Gradation and CardioVAscular Disease (MINERVA): cohort recruitment and baseline characteristics

MultIethNic Study of BrEast ARterial Calcium Gradation and CardioVAscular Disease (MINERVA) was designed to answer the question of whether a novel continuous breast arterial calcification (BAC) mass score improves cardiovascular risk stratification among asymptomatic post-menopausal women. This article describes recruitment and baseline characteristics.

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Can we identify older people most vulnerable to living in cold homes during winter?

Living in a cold home increases the risk of dying in winter, especially in older people. However, it is unclear which individual factors predict whether older people are living in cold homes.

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Stigma as a barrier to healthcare utilization among men who have sex with men and female sex workers in Burkina Faso

To examine the prevalence and correlates of perceived healthcare stigma among female sex workers (FSW) and men who have sex with men (MSM), including other stigma types, suicidal ideation, and participation in social activities.

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Between-trial heterogeneity in meta-analyses may be partially explained by reported design characteristics

We investigated the associations between risk of bias judgments from Cochrane reviews for sequence generation, allocation concealment and blinding and between-trial heterogeneity.

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Specific agreement on ordinal and multiple nominal outcomes can be calculated for more than two raters

The concept of specific agreement has been proposed for dichotomous outcomes for two and more raters. We aim to extend this concept for variables with more than two ordinal or nominal categories and more than two raters.

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Patient handed A 12,500 out of court settlement by North Shields dentist

Verne Road Dental Practice, in North Shields, has not admitted liability for problems endured by Louise Forster but has offered her a A 12,500 payout A patient has been handed a 12,500 in an out of court settlement by a North Shields dental firm. Louise Forster, 32, was paid the compensation out of court by Verne Road Dental Practice, North Shields, in July 2017.

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'Rudolph the Red-Nosed Reindeer' Mysteries, Explained

Learn why generations of young TV viewers grew up perplexed by the odd behavior of a character named Yukon Cornelius in the "Rudolph the Red-Nosed Reindeer" Christmas special. The one-hour animated TV special "Rudolph the Red-Nosed Reindeer" debuted more than 50 years ago, yet remains a Christmas season viewing tradition for many American families despite - or perhaps because of - its dated visual effects and its old-fashioned storytelling methods.

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Relationship between body mass and ambulatory blood pressure: comparison with office blood pressure measurement and effect of treatment

Relationship between body mass and ambulatory blood pressure: comparison with office blood pressure measurement and effect of treatment

Relationship between body mass and ambulatory blood pressure: comparison with office blood pressure measurement and effect of treatment, Published online: 04 December 2017; doi:10.1038/s41371-017-0021-2

Relationship between body mass and ambulatory blood pressure: comparison with office blood pressure measurement and effect of treatment

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Clinical pathologic conference: diffuse papillomatous lesions of the gingiva with posterolateral neck skin tags.

Clinical pathologic conference: diffuse papillomatous lesions of the gingiva with posterolateral neck skin tags.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Nov 06;:

Authors: Lin SI, Mort JR, Hinchey PM, Lewis JS, Zwerner J

PMID: 29195813 [PubMed - as supplied by publisher]

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Effects of a single condylar neck fracture without condylar cartilage injury on traumatic heterotopic ossification around the temporomandibular joint in mice.

Effects of a single condylar neck fracture without condylar cartilage injury on traumatic heterotopic ossification around the temporomandibular joint in mice.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Nov 06;:

Authors: Ouyang N, Zhu X, Li H, Lin Y, Shi J, Dai J, Shen G

Abstract
OBJECTIVES: In this study, we tried to explore the effects of a single condylar neck fracture without condylar cartilage injury during the pathogenesis process of traumatic heterotopic ossification around the temporomandibular joint (THO-TMJ).
STUDY DESIGN: One-month-old C57 BL/6 J male mice were divided into 2 groups. In group 1, condylar cartilage was partially removed in the right joint to induce THO. In group 2, a single fracture on the condylar neck was created using small scissors. The condylar head was repositioned to its original place if any displacement occurred. The phenotypes were observed using gross observation, micro-computed tomography, and histologic examination.
RESULTS: The results showed obvious hyperplasia in the right condyle in group 1, with ectopic bones and cartilage in the periarticular region. In group 2, the surface of condyle was smooth, but the size of the right condylar head became smaller.
CONCLUSIONS: Taking these findings together, we concluded that it is condylar cartilage injury, and not a single condylar neck fracture without condylar cartilage injury, that contributes to the development of THO-TMJ.

PMID: 29195812 [PubMed - as supplied by publisher]

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A new stem sarcopterygian illuminates patterns of character evolution in early bony fishes

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Phase 1 and pharmacokinetic study of LY3007113, a p38 MAPK inhibitor, in patients with advanced cancer.

Phase 1 and pharmacokinetic study of LY3007113, a p38 MAPK inhibitor, in patients with advanced cancer.

Invest New Drugs. 2017 Dec 01;:

Authors: Goldman JW, Rosen LS, Tolcher AW, Papadopoulos K, Beeram M, Shi P, Pitou C, Bell R, Kulanthaivel P, Zhang X, Fink A, Chan EM, Shahir A, Farrington D, Patnaik A

Abstract
Background The signaling protein p38 mitogen-activated protein kinase (MAPK) regulates the tumor cell microenvironment, modulating cell survival, migration, and invasion. This phase 1 study evaluated the safety of p38 MAPK inhibitor LY3007113 in patients with advanced cancer to establish a recommended phase 2 dose. Methods In part A (dose escalation), LY3007113 was administered orally every 12 h (Q12H) at doses ranging from 20 mg to 200 mg daily on a 28-day cycle until the maximum tolerated dose (MTD) was reached. In part B (dose confirmation), patients received MTD. Safety, pharmacokinetics, pharmacodynamics, and tumor response data were evaluated. Results MTD was 30 mg Q12H. The most frequent treatment-related adverse events (>10%) were tremor, rash, stomatitis, increased blood creatine phosphokinase, and fatigue. Grade ≥ 3 treatment-related adverse events included upper gastrointestinal haemorrhage and increased hepatic enzyme, both occurring at 40 mg Q12H and considered dose-limiting toxicities. LY3007113 exhibited an approximately dose-proportional increase in exposure and time-independent pharmacokinetics after repeated dosing. Maximal inhibition (80%) of primary biomarker MAPK-activated protein kinase 2 in peripheral blood mononuclear cells was not reached, and sustained minimal inhibition (60%) was not maintained for 6 h after dosing to achieve a biologically effective dose (BED). The best overall response in part B was stable disease in 3 of 27 patients. Conclusions The recommended phase 2 dosage of LY3007113 was 30 mg Q12H. Three patients continued treatment after the first radiographic assessment, and the BED was not achieved. Further clinical development of this compound is not planned as toxicity precluded achieving a biologically effective dose.

PMID: 29196957 [PubMed - as supplied by publisher]

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Risk of disability pension in first and second generation immigrants: the role of age and region of birth in a prospective population-based study from Sweden

In several countries, immigrants have higher disability pension (DP) rates than natives. Reasons for this are poorly understood. The aim of this study was to investigate if the risk of diagnosis-specific DP di...

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Trajectories of body mass index among Canadian seniors and associated mortality risk

This study aims to characterize the heterogeneity in BMI trajectories and evaluate how different BMI trajectories predict mortality risk in Canadian seniors.

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Seroprevalence of toxoplasmosis and risk factors of Toxoplasma gondii infection among pregnant women in Sri Lanka: a cross sectional study

Toxoplasma gondii is an intracellular protozoan infecting humans and animals. Infection in adults usually causes mild disease but greater importance lies in preventing transplacental t...

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Das Cochleaimplantat in der sozialgerichtlichen Rechtsprechung

Zusammenfassung

Hintergrund

Da sich die Indikation für eine CI-Versorgung erweitert hat („Single-Sided Deafness" [SSD], elektrisch akustische Stimulation [EAS], bilaterale Versorgung, Versorgung bei sehr langer Taubheit) und daher zunehmend mehr Patienten für eine solche Versorgung infrage kommen, kommt es auch immer öfter zu Auseinandersetzungen mit den Kostenträgern hinsichtlich der Frage, ob die Kosten für die Operation und die Nachsorgekosten durch die Krankenversicherungen getragen werden müssen.

Zielsetzung/Fragestellung

Dieser Artikel gibt einen Überblick über Urteile der deutschen Sozialgerichte. Es wurde untersucht, ob und in welchen Fällen es für den einzelnen Patienten empfehlenswert ist, den Klageweg zu beschreiten, und mit welcher Verfahrensdauer gerechnet werden muss.

Material und Methoden

Ausgewertet wurden die beiden größten kommerziellen juristischen Datenbanken sowie die durch die Sozialgerichtsbarkeit veröffentlichten Urteile. Als Suchparameter dienten verschiedene Kombinationen aus den Begriffen „Cochlear", „Cochlea", „Implant" und „Implantat". Drei Entscheidungen wurden durch direkte Anforderung beim entscheidenden Gericht erlangt, eine weitere in einem Artikel aufgeführt. Die besprochenen Entscheidungen ergingen im Zeitraum 2003 bis 2017.

Ergebnisse

Insgesamt wurden 12 Entscheidungen gefunden. Die Hauptsacheentscheidungen gingen bis auf einen Fall alle zugunsten der Patienten aus. Bei dem Verfahren, in dem die Klägerin nicht Recht bekam, handelte es sich um einen Ausnahmesachverhalt. Ein Kläger unterlag zwar im Verfahren auf einstweiligen Rechtsschutz, in der Hauptsache erkannte die Krankenversicherung seinen Anspruch auf eine CI-Versorgung jedoch an. Die Verfahren dauerten zwischen 1;8 Jahren und 9;5 Jahren.

Schlussfolgerung

Trotz des zeitlichen Aufwands lohnt sich die Beschreitung des Rechtswegs. Das grundsätzlich kostenfreie sozialgerichtliche Verfahren führt in den meisten Fällen dazu, dass die gesetzlichen Krankenversicherungen zur Tragung der Kosten für ein CI verpflichtet werden.

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Archaeologists uneasy as Trump shrinks Bears Ears monument lands

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A comparison of tumour size measurements with palpation, ultrasound and mammography in male breast cancer: first results of the prospective register study

Abstract

Purpose

Precise presurgical diagnosis of tumour size is essential for adequate treatment of male breast cancer (MBC). This study is aimed to compare the accuracy of clinical measurement (CE), ultrasound (US) and mammography (MG) for preoperative estimation of tumour size.

Methods

This study was conducted as a prospective, multicentre register study. One hundred and twenty-nine male patients with invasive breast cancer were included. CE, US and MG were performed in 107, 110 and 75 patients, respectively, and the estimated tumour size was compared with the histopathological (HP) tumour size.

Results

All methods tended to underestimate the HP tumour size. None of the methods were significantly more accurate than the others in determining the maximal tumour diameter. The sensitivity within 5 mm tolerance for US was 65.5%, which was better than for MG (61.3%) and CE (56.6%). In the group of patients with pT2 tumours, MG showed significantly better accuracy than US. The measurements obtained with each method were significantly correlated with the HP measurements. The highest correlation coefficient was observed for MG (0.788), followed by US (0.741) and CE (0.671).

Conclusions

Our data demonstrate that MG and US have similar accuracy with regard to tumour size estimation. US assessment showed the highest sensitivity in determining tumour size, followed by MG and CE. However, MG demonstrated a significant advantage for estimating the real tumour size for pT2 tumours compared to US or CE.

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Five years’ follow-up of dental fear and anxiety, experience of dental care and oral health behaviour in Swedish preterm and full-term adolescents

Abstract

Background

There is rising concern about how preterm birth affects long-term health later in life. The various effects that preterm birth have on developmental outcomes, cognitive profiles and medical health may also affect levels of cooperation in the dental care situation in addition to general oral health and other oral health-related habits. Oral health is an integral part of one's general health and well-being; however, less is known about how prematurity affects oral health and other related areas such as dental care, and including dental fear and anxiety (DFA) in individuals during adolescence and adulthood. This is considered of special interest to study, as preterm children during the preschool and school period were reported to have behavioural problems during dental treatments and less than favourable oral hygiene.

Methods

A questionnaire was used of self-report design and structured into behavioural aspects relating to dental treatment, oral health-related factors, and medical health. This questionnaire at 17–19 years of age was a follow-up from 12 to 14 years of age and considered a predictor for planning future dental care for this group of patients. The 145 participating adolescents were all preterm, born between 23 and 32 weeks of gestation and 140 full-term controls, born ≥37 weeks of gestation.

Results

Dental fear and anxiety, oral health behaviour, and intake of sweets and sugary drinks of 17–19-year old adolescents born preterm was comparable to that of the full-term control group. Medical health problems as well as the intake of sweets and sugary drinks increased from the time of early adolescence to late adolescence in both groups.

Conclusions

Preterm as well as full-term adolescents between 17 and 19 years of age are satisfied with their dental care and display low prevalence of dental fear and anxiety (DFA). The findings in this study indicate that adolescents born very preterm and extremely preterm are well prepared for transition to dental care in adult life with expectations of being able to take responsibility for their oral health.

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Parasite and dental clinic major efforts during United for Kids...

Judy Hamilton of Springdale poses with a young boy in the Dominican Republic while visiting as part of the United for Kids Foundation. - Submitted SPRINGDALE, NL - With education efforts continually ongoing in the Dominican Republic, the United for Kids Foundation also helps families get healthy.

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FullContour CAD Design Services

The online social blog and network from LMT Communications dedicated exclusively for members of the Dental Laboratory industry. Join free to learn more about FullContour CAD Design Services and other services.

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Impact of Sweden's asylum age assessment tests revealed

The results of medical age assessments on asylum seekers who arrived in Sweden as unaccompanied minors show that many were older than they claimed. The national forensic medicine agency began carrying out the checks earlier this year after doubts were raised over whether all those who were being processed as minors were in fact underage.

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What big planets have in common with failed stars

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Genetic engineering in nonhuman primates for human disease modeling

Genetic engineering in nonhuman primates for human disease modeling

Genetic engineering in nonhuman primates for human disease modeling, Published online: 04 December 2017; doi:10.1038/s10038-017-0351-5

Genetic engineering in nonhuman primates for human disease modeling

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Zentrale und periphere Aspekte der Lärmschwerhörigkeit

Zusammenfassung

Lärm stellt in den entwickelten Industrieländern ein großes sozioökonomisches Problem dar. Für die Behandlung der durch die Lärmschwerhörigkeit auftretenden audiologischen Phänomene ist ein vertieftes Verständnis der zugrunde liegenden Schädigungsmechanismen peripherer und zentraler Anteile der Hörbahn notwendig. Die mechanische Schädigung, die Ischämie, die Exzitotoxizität sowie die auditorische Synaptopathie stellen die wesentlichen lärminduzierten Schädigungsprozesse in der Cochlea dar. Neben cochleären pathologischen Veränderungen treten jedoch auch zentralnervöse Schädigungen infolge der Lärmexposition auf. Aufgrund der Überstimulation kommt es sehr frühzeitig zum Zellverlust im Versorgungsgebiet des N. cochlearis. Der spätere Zellverlust in höheren auditorischen Kerngebieten ist im Gegensatz dazu auf die sensorische Deprivation zurückzuführen. Insgesamt wird dem strukturellen Verlust durch eine Modulation der Spontanaktivität im Sinne der Netzwerkhomöostase entgegenreguliert. Dennoch nimmt sehr wahrscheinlich die Verarbeitungsgüte durch die lärminduzierten neuroplastischen Veränderungen ab. Die Lärmschwerhörigkeit ist somit durch eine Reihe von peripheren und zentralen Veränderungen gekennzeichnet, die bisher nur teilweise einer Therapie zugänglich sind. Besonders im Hinblick auf die auditorische Synaptopathie und die zentralen Verarbeitungsdefizite werden neue therapeutische Ansätze benötigt, um audiologische Phänomene wie Tinnitus, Hyperakusis oder schlechtes Diskriminationsvermögen effektiv behandeln zu können.

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Clinical predictors of chronic rhinosinusitis: do the Canadian clinical practice guidelines for acute and chronic rhinosinusitis predict CT-confirmation of disease?

Abstract

Background

The diagnosis of chronic rhinosinusitis (CRS) based on clinical presentation alone remains challenging. To improve the accuracy of clinical diagnosis, the Canadian Rhinosinusitis Guidelines recommend the use of specific symptom and endoscopic criteria. Our study objective was to determine whether symptom and endoscopic criteria, as defined by the Canadian Rhinosinusitis Guidelines, accurately predict CT-confirmed CRS diagnosis.

Methods

A retrospective cohort study of 126 patients who underwent CT sinuses based on clinical suspicion of possible CRS. The presence of symptom and endoscopic criteria, as defined by the Canadian Rhinosinusitis Guidelines, were compared between patients with and without a CT-confirmed CRS diagnosis using two-tailed Fisher's exact tests. Positive predictive values and likelihood ratios were determined for each symptom and endoscopic finding.

Results

Overall, 56.3% of patients had a CT-confirmed diagnosis of CRS. With the exception of nasal polyps, none of the symptom or endoscopic criteria had a statistically significant correlation with positive CT sinuses. For symptom criteria, positive predictive values ranged from 52.4% to 63.4%; likelihood ratios ranged from 0.85 to 1.34. For endoscopic criteria, positive predictive values and likelihood ratios were 71.4% and 1.94 (edema); 63.0% and 1.32 (discharge); and 92.9% and 10.1 (nasal polyps). 35.2% of patients with CT-confirmed CRS had normal endoscopic exams.

Conclusion

The Canadian Rhinosinusitis Guidelines' symptom and endoscopic criteria for CRS, with the exception of nasal polyps on endoscopy, do not accurately predict CT-confirmed disease. In addition, a normal endoscopic exam does not rule out CRS.

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An Interesting Case of Wasted Healthcare Dollars

 

 

Recently I was reading an article on Propublica.com.  The article stated a mother was offered the chance to have her 5 year old daughter's ears pierced while she was under general anesthesia for another procedure.  The mom thought that was a nice offer by the surgeon and agreed, only to receive a bill for $1877 from the hospital for the procedure which was not covered by insurance.

 

From the article:

 

Only months later did O'Neill discover her cost for this extracurricular work: $1,877.86 for "operating room services" related to the ear piercing — a fee her insurer was unwilling to pay.

At first, O'Neill assumed the bill was a mistake. Her daughter hadn't needed her ears pierced, and O'Neill would never have agreed to it if she'd known the cost. She complained in phone calls and in writing.

The hospital wouldn't budge. In fact, O'Neill said it dug in, telling her to pay up or it would send the bill to collections. The situation was "absurd," she said.

"There are a lot of things we'd pay extra for a doctor to do," she said. "This is not one of them."

Kelley and the hospital declined to comment to ProPublica about the ear piercing.

Surgical ear piercings are rare, according to the Health Care Cost Institute, a nonprofit that maintains a database of commercial health insurance claims. The institute could only find a few dozen possible cases a year in its vast cache of billing data. But O'Neill's case is a vivid example of health care waste known as overuse.

Now I will be the first to admit that overcharges occur in hospitals routinely.  The part of the whole article that I found mildly amusing is… the procedure the 5 year old was in for?  A simple lingual frenectomy.  Now perhaps there is more to the story as far as management goes.  Perhaps the child is very frightened & difficult to control without general.  Perhaps there is more to this than meets the eye.  However, if this was a routine lingual frenectomy, that could have been done in my office with a few drops of local, no bleeding, no scalpel, no sutures, no post-op pain.  I would have done this with a laser.  I do it all the time.  So, in my opinion, the entire reason the child was in the hospital could have potentially been not necessary… potentially.  I don't know all the facts.

However, if you are considering a similar procedure for your child, consult a dentist before going to a hospital.

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Effect of global warming on willingness to pay for uninterrupted electricity supply in European nations

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The significance of relationships

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The ecological importance of intraspecific variation

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A model for ‘sustainable’ US beef production

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Grows well in sun and warmth — and shade and cold

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Heterogeneous delivery of silicate and metal to the Earth by large planetesimals

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Dynamics of the global meridional ice flow of Europa’s icy shell

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Foraging constraints reverse the scaling of activity time in carnivores

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Open discussion of negative emissions is urgently needed

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Social polymorphism is favoured by the co-evolution of dispersal with social behaviour

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The beef with sustainability

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Attractive force on atoms due to blackbody radiation

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Large emissions from floodplain trees close the Amazon methane budget

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Local loss and spatial homogenization of plant diversity reduce ecosystem multifunctionality

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Subsurface iceberg melt key to Greenland fjord freshwater budget

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Constraints on the spin evolution of young planetary-mass companions

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Substantial large-scale feedbacks between natural aerosols and climate

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Genetic engineering in nonhuman primates for human disease modeling

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Relationship between body mass and ambulatory blood pressure: comparison with office blood pressure measurement and effect of treatment

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Contemporary adaptations of Greek tragedy: auteurship and directorial visions

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Relapsing Ipsilateral Vestibular Neuritis

In 2013, a 70-year-old male was admitted with an acute episode of vertigo, nausea, and vomiting with duration of one day. The patient's background included prehypertension, vitiligo, left ventricular hypertrophy, and Sjögren's syndrome. He denied any previous episode of vertigo or migraine manifestations. Neither hearing loss nor tinnitus or otorrhea was detected at the time of evaluation. No neurological symptoms were found. There was a left-beating spontaneous nystagmus Grade 3. The patient could stand still and walk on his own with some help without falling. Day 1 vHIT showed a significant reduction in VOR gain and refixation saccades after head impulses were delivered in the planes of the right anterior and horizontal semicircular canals. MRI showed no significant findings. He was treated with steroids. A vHIT performed 14 days later showed recovery of gains and no refixation saccades. In 2015, the patient had a new episode of acute vertigo. The clinical examination was similar, and the vHIT revealed a new drop of right superior and lateral canal gains. Cervical and ocular VEMPs were performed, and no significant asymmetry was detected. Serum PCR for herpes viruses resulted negative. Contrast MRI was performed without relevant brain findings.

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Antiangiogenic therapies in urogenital malignancies

Summary

The use of antiangiogenic agents in cancer therapy has become an attractive target in oncological research. However, concerning the uro-oncological field, current guidelines only recommend the use of antiangiogenic agents in metastatic renal cell cancer. Yet in recent years, several approaches for sequential treatment with angiogenesis inhibitors in other urogenital malignancies apart from renal cell cancer are ongoing. Thus, the present review article aims to provide an overview about clinical studies with antiangiogenic agents in prostate-, bladder-, testicular-, as well as penile cancer patients. For this, a literature search was conducted using Medline; moreover we performed a systematic review of data presented at this year's important urooncological meetings. Preliminary data revealed that there are several promising studies ongoing in prostate-, bladder-, testicular-, as well as penile cancer; however, larger studies should be conducted to optimize the use of antiangiogenic agents in clinical practice.

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Digitized evaluation of speech intelligibility using vowels in maxillectomy patients

Abstract

Background

Among the functional disabilities that patients face following maxillectomy, speech impairment is a major factor influencing quality of life. Proper rehabilitation of speech, which may include prosthodontic and surgical treatment and speech therapy, requires accurate evaluation of speech intelligibility (SI). A simple, less time-consuming yet accurate evaluation is desirable both for maxillectomy patients and the various clinicians providing maxillofacial treatment.

Objective

This study sought to determine the utility of digital acoustic analysis of vowels for the prediction of SI in maxillectomy patients, based on a comprehensive understanding of speech production in the vocal tract of maxillectomy patients and its perception.

Methods

Speech samples were collected from 33 male maxillectomy patients (mean age 57.4 years) in two conditions, without and with a maxillofacial prosthesis, and formant data for the vowels /a/, /e/, /i/, /o/, and /u/ were calculated based on linear predictive coding. The frequency range of formant 2 (F2) was determined by differences between the minimum and maximum frequency. An SI test was also conducted to reveal the relationship between SI score and F2 range. Statistical analyses were applied.

Results

F2 range and SI score were significantly different between the two conditions without and with a prosthesis (both p < 0.0001). F2 range was significantly correlated with SI score in both the conditions (Spearman's r = 0.843, p < 0.0001; r = 0.832, p < 0.0001, respectively).

Conclusion

These findings indicate that calculating the F2 range from 5 vowels has clinical utility for the prediction of SI after maxillectomy.

This article is protected by copyright. All rights reserved.

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The relationship between jaw-opening force and the cross-sectional area of the suprahyoid muscles in healthy elderly

Abstract

We conducted a clinical cross-sectional study to examine the relationship between jaw-opening force and the cross-sectional area of the suprahyoid muscles and whole skeletal muscle mass. Subjects were healthy 39 males and 51 females without dysphagia and sarcopenia, aged 65 years and older. Jaw-opening force was measured three times using a jaw-opening sthenometer; the maximal of these three was taken as the measurement value. The cross-sectional area of the geniohyoid and anterior belly of the digastric muscles was evaluated using ultrasonography. The skeletal muscle mass index, gait speed, and grip strength were evaluated according to the diagnostic criteria of the Asian Working Group for Sarcopenia. For each sex, a multiple regression analysis determined the factors that affect jaw-opening force. Jaw-opening force was associated with the cross-sectional area of the geniohyoid muscle in males (regression coefficient [β] = 0.441, 95% confidence interval [CI] = 14.28–56.09) and females (β = 0.28, 95% CI = 3.10–54.57). Furthermore, in females only, jaw-opening force was associated with the skeletal muscle mass index (β = 0.40, 95% CI = 3.67–17.81). In contrast, jaw-opening force was not associated with the cross-sectional area of the anterior belly of the digastric muscle in either sex. In healthy elderly males and females, jaw-opening force was positively associated with the cross-sectional area of the geniohyoid muscle. However, the jaw-opening force was positively associated with the skeletal muscle mass index only in females.

This article is protected by copyright. All rights reserved.

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Validation of the Pain Resilience Scale in Chinese-speaking patients with TMD pain

Abstract

To validate of the Pain Resilience Scale (PRS) for use in Chinese patients with temporomandibular disorders (TMD) pain. According to international guidelines, the original PRS was first translated and cross-culturally adapted to formulate the Chinese version of PRS (PRS-C). A total of 152 patients with TMD pain were recruited to complete series of questionnaires. Reliability of the PRS-C was investigated using internal consistency and test-retest reliability. Validity of the PRS-C was calculated using cross-cultural validity and convergent validity. Cross-cultural validity was evaluated by examining the confirmatory factor analysis (CFA). And convergent validity was examined through correlating the PRS-C scores with scores of two commonly used pain-related measures (the Connor-Davidson Resilience Scale (CD-RISC) and the Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD)). The PRS-C had a high internal consistency (Cronbach's alpha = 0.92) and good test-retest reliability ((intraclass correlation coefficient (ICC) = 0.81). The CFA supported a two-factor model for the PRS-C with acceptable fit to the data. The fit indices were Chi-Square/DF=2.21, GFI=0.91, TLI=0.97, CFI=0.98, RMSEA= 0.08. As regards convergent validity, the PRS-C evidenced moderate-to-good relationships with the CD-RISC and the TSK-TMD. The PRS-C shows good psychometric properties and could be considered as a reliable and valid measure to evaluate pain-related resilience in patients with TMD pain.

This article is protected by copyright. All rights reserved.

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Influence of removable prostheses on mastication in elderly subjects with rheumatoid arthritis Mastication in elders with rheumatoid arthritis

Abstract

Background

Rheumatoid arthritis (RA) is a prevalent disease in the elderly population, and it may affect the temporomandibular joint (TMJ) and the stomatognathic system

Objective

This study evaluated masticatory function in elderly patients with RA before and after oral rehabilitation with removable prostheses

Methods

Forty-five elders with partial or total edentulism who were using unsatisfactory removable prostheses were selected and assigned to three groups: RA with TMJ involvement, RA without TMJ involvement, and healthy controls. Masticatory function was assessed in terms of masticatory performance (MP) and maximum bite force (MBF). The former was determined by the sieving method and the latter was measured by pressure sensors placed in the bilateral molar regions. The variables were first evaluated in elderly subjects wearing unsatisfactory prostheses, and re-assessed after participants had received new removable prostheses. Comparisons between groups and among time points were performed with analysis of variance for repeated measures and the Tukey–Kramer test (P < 0.05).

Results

Comparison among groups showed decreased MP in elders with RA before new prosthesis insertion (P < 0.05). Irrespective of TMJ involvement, MP improved after treatment in subjects with RA. RA groups also showed decreased MBF (P < 0.05), which improved after new prosthesis insertion.

Conclusion

RA might impair masticatory function, and well-fitted removable prosthesis insertion might be very beneficial in elders with RA.

This article is protected by copyright. All rights reserved.

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Dental Consumables Market - Global Industry Insights, 2025

Dental Consumables Market, report categorizes the report by Consumables Type, End User and geography. It provides information about - Global Industry Insights, Trends, Outlook and Opportunity Analysis, 2017-2025 Dental consumables are specially created materials and are specifically designed according to the need in dental complications.

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Remote Area Medical providing medical services in Puerto Rico

Remote Area Medical opened up in Puerto Rico Sunday to begin providing medical services to those in need in that area. They will be offering services such as free dental services, eye exams, women's health exams and general health exams.

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Dentoskeletal and soft tissue changes in class II subdivision treatment with asymmetric extraction protocols

This study cephalometrically compared the dentoskeletal and soft tissue changes consequent to one and three-premolar extraction protocols of class II subdivision malocclusion treatment.

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Australia’s China policy of strategic ambiguity: navigating between big fish

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Determinants of variable resource use for multidisciplinary team meetings in cancer care

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Big Sugar is winning the lobbying battle vs. health

You can mess with Big Tobacco, Big Pharma and Big Oil. But don't dare mess with Big Sugar.

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Prenatal exposure to antipsychotic medication and use of primary health care system in childhood: a population-based cohort study in Denmark

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Validation of asthma recording in electronic health records: a systematic review

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Talking about our Bodies and their Parts in Warlpiri

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Temperature Dependence in Heterogeneous Nucleation with Application to the Direct Determination of Cluster Energy on Nearly Molecular Scale

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CO2 fixation in above-ground biomass of summer maize under different tillage and straw management treatments

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Increased pollinator service and reduced pollen limitation in the fixed dune populations of a desert shrub

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Water depth affects reproductive allocation and reproductive allometry in the submerged macrophyte Vallisneria natans

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Enhancement of eruption explosivity by heterogeneous bubble nucleation triggered by magma mingling

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Seismogenesis of dual subduction beneath Kanto, central Japan controlled by fluid release

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Characteristics of soil C:N ratio and δ13C in wheat-maize cropping system of the North China Plain and influences of the Yellow River

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Environmental DNA reveals tropical shark diversity in contrasting levels of anthropogenic impact

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Crystal plasticity as an indicator of the viscous-brittle transition in magmas

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The sensitivity and stability of bacterioplankton community structure to wind-wave turbulence in a large, shallow, eutrophic lake

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Constraints from the dehydration of antigorite on high-conductivity anomalies in subduction zones

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Enhanced thermal stability of organic solar cells comprising ternary D-D-A bulk-heterojunctions

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DNA metabarcoding data unveils invisible pollination networks

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Foraging and recruitment hotspot dynamics for the largest Atlantic loggerhead turtle rookery

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Cover Image

The cover image, by Christoph A. Ramseier et al., is based on the Epidemiology Natural history of periodontitis: Disease progression and tooth loss over 40 years, DOI: 10.1111/jcpe.12782. Photo Credit: Christoph A. Ramseier.

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