Micromotion of implant-abutment interfaces (IAI) after loading: correlation of finite element analysis with in vitro performances

Abstract

Micromotion between IAI affects long-term survival rate of dental implants. The use of practical implants for mechanical test is costly. Finite element analysis (FEA) could test the micron level deformation changes, but whether it reflects the in vitro mechanical performances remains unknown. This study aims to investigate the correlation between IAI micromotion of FEA and in vitro performances. The two-step–two-component FEA method was used to test the relative deformation between IAI for three implant designs (M1, M2, and M3) during torque loading and cyclic oblique loading. The micromotion was divided into directions that perpendicular to (x-axis) and parallel to (y-axis) IAI. In vitro experiments on the micromotion relevant performance of IAI microleakage (tested by toluidine blue releasing with a spectrometer) and IAI locked condition (tested by abutment removal force tests after detaching the central screws) were also conducted for the identical implant systems (G1, G2, and G3). One-way ANOVA and Pearson's correlation tests were performed for data analysis. FEA illustrated that the three implant systems performed different micromotion patterns. Significant differences were found in the IAI microleakage and removal force among the groups. Positive correlations were found between FEA and in vitro outcomes. Therefore, the two-step–two-component FEA method is an appropriate method to evaluate the IAI micromotion after loading.

Graphical abstract

The correspondence of IAI micromotion between FEA analysis and in vitro performances.

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Models for optimally controlling varicella and herpes zoster by varicella vaccination: a comparative study

Abstract

The introduction of mass vaccination against Varicella-Zoster-Virus (VZV) is being delayed in many European countries mainly because of the "fear" of a subsequent boom in natural herpes zoster (HZ) incidence in the first decades after the initiation of vaccination, caused by the expected decline in the protective effect of natural immunity boosting due to reduced virus circulation. Optimal control theory has proven to be a successful tool in understanding ways to curtail the spread of infectious diseases by devising the optimal disease intervention strategies. In this paper, we describe how a reduced 'toy' model can extract the essentials of the dynamics of the VZV transmission and reactivation in case of the study of optimal paths of varicella immunization programs. Results obtained using different optimization approaches are compared with the ones of a more realistic age-structured model. The reduced model shows some unreliable predictions in regards of model time scales about herpes zoster dynamic; nevertheless, it is able to reproduce the main qualitative dynamic of the more realistic model to the different optimization problems, while requiring a minimal number of parameters to be identified.

Graphical abstract

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Light-absorbing impurities in snow of the Indian Western Himalayas: impact on snow albedo, radiative forcing, and enhanced melting

Abstract

Seasonal snow cover in the Himalayas acts as source of fresh water for several Asian rivers such as Indus, Ganges, Brahmaputra, and Yangtze. Early loss of seasonal snow exposes the ice layer of the glaciers directly to sunlight, consequently leading to their ablation and alterations in discharge of glacier-fed rivers. Therefore, any alteration in the melting rate of the Himalayan snow pack can significantly affect the ecological balance in the region. Besides global warming, enhanced melting of snow, caused by light-absorbing impurities (LAIs) such as dust and elemental carbon (EC), has also been recognized as prominent cause of enhanced melting of snow in the Himalayas of China and Nepal. However, in light of vast area of the Himalayas and persistent emissions from India, studies, emphasizing the potential of LAIs to substantially affect the snow radiation budget of snow cover in IWHs, are still scanty. Therefore, in this study, field campaigns were made on three glaciers, i.e., Hamta, Beas Kund, and Deo Tibba, in IWHs to collect snow samples for estimation of LAIs. Snow of the studied glaciers was observed to be contaminated with 13.02 to 74.57 ng/g of EC and 32.14 to 216.54 μg/g of dust. Albedo simulations done using SNow and ICe Aerosol Radiation (SNICAR) model indicated that besides the changes caused by increased grain size, EC and dust, cumulatively induced 0.60 to 32.65% reduction in albedo of snow. Further assessment, constrained by measurements, illustrated that radiative forcing (RF), of 1.8 to 80 W/m², was instigated due to enhanced thermal absorption of snow. Ten hours of daily mean RFs in this range could correspond to 3 to 9.65 mm/d of snow melt and contribute significantly in reducing the seasonal snow cover in IWHs. Considering the consequences of LAIs-induced snow melt and lack of in situ observations in the IWHs, the outcomes of this study could assist researchers and policy makers in developing efficient climate models and framing mitigation measures, respectively.

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UBC-Nepal Expedition: Cerebrovascular Responses to Exercise in Sherpa Children Residing at High Altitude

High Altitude Medicine &Biology, Ahead of Print.


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A Systematic Review of Radiofrequency Treatment of the Ankle for the Management of Chronic Foot and Ankle Pain

Abstract

Background

Chronic pain of the lower extremity remains challenging to manage. Radiofrequency treatment applies heat to nerve fibers with the goal of mitigating chronic pain conditions. The clinical efficacy has not yet been adequately established for pathologies of the ankle and foot. In this review paper, we report the use and efficacy of radiofrequency treatment applied to foot and ankle pain.

Recent Findings

PubMed and the Cochrane Controlled Trials Register were searched (final search 30 March 2018) using the MeSH terms "radiofrequency ablation," "neurolysis," "radiofrequency therapy," "pain syndrome," "analgesia," "plantar heel pain," "plantar fascitis," and "chronic pain" in the English literature. Of the 23 papers screened, 18 were further investigated for relevance. Our final search methodology yielded 15 studies that investigated the use of radiofrequency treatment at the ankle. Of these 15 studies, there were three randomized control trials, four prospective studies, three retrospective studies, and five case reports. The quality of selected publications was assessed using the Cochrane risk of bias instrument.

Summary

The evidence from our studies suggests that radiofrequency treatment can be used safely for the management foot and ankle pain. The technique (continuous vs pulsatile), temperature, location of treatment, and duration of administration need more thorough evaluation. Randomized control trials are needed to establish the efficacy and safety profile of radiofrequency ablation and its long-term benefits in patients with chronic pain of the foot and ankle.

Conclusion

The evidence from our studies suggests that radiofrequency treatment can be used safely for the management foot and ankle pain. The technique (continuous vs pulsatile), temperature, location of treatment, and duration of administration need more thorough evaluation. Randomized control trials are needed to establish the efficacy and safety profile of radiofrequency ablation and its long-term benefits in patients with chronic pain of the foot and ankle.

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Adherence to Behavioral Therapy for Migraine: Knowledge to Date, Mechanisms for Assessing Adherence, and Methods for Improving Adherence

Abstract

Purpose of Review

In other disease states, adherence to behavioral therapies has gained attention, with a greater amount of studies discussing, defining, and optimizing adherence. For example, a meta-analysis formally discussed adherence in 25 studies of CBT for 11 different disorders, with only 6 of the 25 omitting addressing or defining adherence. Many studies have discussed the use of text messages, graph-based adherence rates, and email/telephone reminders to improve adherence. This paper examined the available literature regarding adherence to behavioral therapy for migraine as well as adherence to similar therapies in other disease states. The goal of this research is to apply lessons learned from adherence to behavioral therapy for other diseases in better understanding how we can improve adherence to behavioral therapy for migraine.

Recent Findings

Treatment for migraine typically includes both pharmacologic and non-pharmacologic therapies, including progressive muscle relaxation (PMR), cognitive behavioral therapy (CBT), and biofeedback. Behavioral therapies have been shown to significantly reduce headache frequency and intensity, but high attrition rates and suboptimal adherence can undermine their efficacy. Traditionally, adherence to behavioral therapy has been defined by self-report, including paper headache diaries and assignments. In person attendance has also been employed as a method of defining and monitoring adherence. With the advent of personal electronics, measurements of adherence have shifted to include electronic-based methods such as computer-based programs and mobile-based therapies. Furthermore, some studies have taken advantage of electronic methods such as email reminders, push notifications, and other mobile-based reminders to optimize adherence. The JITA-I, a novel method of engaging individual patient adherence, has also been suggested as a possible method to improve adherence by tailoring engagement with a mobile health app-based on patient input. These novel methods may be utilized in behavioral therapy for migraine for further optimizing adherence.

Summary

Few intervention studies to date have addressed the optimal ways to impact adherence to migraine behavioral therapy. Further research is required regarding adherence with behavioral therapies, specifically via mobile health interventions to better understand how to define and improve adherence via this novel forum. Once we are able to understand optimal methods of tracking adherence, we will be better equipped to understand the role of adherence in shaping outcomes for behavioral therapy in migraine.

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The Status of Pain Research in Academia and how We Are Doing in the United States

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Imaging of Carotid Dissection

Abstract

Purpose of Review

Here, we describe the four primary imaging modalities for identification of carotid artery dissection, advantages, limitations, and clinical considerations. In addition, imaging characteristics of carotid dissection associated with each modality will be described.

Recent Findings

Recent advances in etiopathogenesis describe the genetic factors implicated in cervical artery dissection. MRI/MRA (magnetic resonance angiography) with fat suppression is regarded as the best initial screening test to detect dissection. Advances in magnetic resonance imaging for the diagnosis of dissection include the use of susceptibility-weighted imaging (SWI) for the detection of intramural hematoma and multisection motion-sensitized driven equilibrium (MSDE), which causes phase dispersion of blood spin using a magnetic field to suppress blood flow signal and obtain 3D T1- or T2*-weighted images. Digital subtraction angiography (DSA) remains the gold standard for identifying and characterizing carotid artery dissections.

Summary

Carotid artery dissection is the result of a tear in the intimal layer of the carotid artery. This leads to a "double lumen" sign comprised of the true vessel lumen and the false lumen created by the tear. The most common presentation of carotid artery dissection is cranial and/or cervical pain ipsilateral to the dissection. However, severe neurological sequelae such as embolic ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage can also result from carotid artery dissection. Carotid artery dissection can be identified by a variety of different imaging modalities including computed tomographic angiography (CTA), MRI, carotid duplex imaging (CDI), and digital subtraction angiography (DSA).

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Brachial plexus paralysis after thoracoscopic esophagectomy for esophageal cancer in the prone position: A thought-provoking case report of an unexpected complication.

Related Articles

Brachial plexus paralysis after thoracoscopic esophagectomy for esophageal cancer in the prone position: A thought-provoking case report of an unexpected complication.

Int J Surg Case Rep. 2019 Jan 09;55:11-14

Authors: Aisu Y, Hori T, Kato S, Ando Y, Yasukawa D, Kimura Y, Takamatsu Y, Kitano T, Kadokawa Y

Abstract
INTRODUCTION: During prone esophagectomy, placement of a port in the third intercostal space for upper mediastinal dissection requires adequate axillary expansion. To facilitate this, the right arm is elevated cranially and simultaneously turned outward. Brachial plexus paralysis associated with esophagectomy in the prone position has not been documented.
PRESENTATION OF CASE: A 58-year-old man diagnosed with middle intrathoracic esophageal cancer was referred to our department. Thoracoscopic esophagectomy in the prone position was performed following neoadjuvant chemotherapy. After surgery, he complained of difficulty moving his right arm. Physical examination revealed perceptual dysfunction and movement disorder in the territory of cervical spinal nerve 6. Magnetic resonance imaging indicated the injury in the right posterior cord of the brachial plexus at the costoclavicular space. Therefore, we diagnosed the patient with right brachial plexus injury caused by the intraoperative position. The postoperative course was uneventful other than the brachial plexus paralysis, and he was discharged on postoperative day 23. He underwent continuous rehabilitation as an outpatient, and the right brachial plexus paralysis had completely disappeared by 2 months after surgery.
DISCUSSION: This is the first case of brachial plexus injury during thoracoscopic esophagectomy in the prone position. In prone esophagectomy, managing the patient's position, especially the head and arm positions, is so important to avoid brachial plexus injury due to intraoperative positioning.
CONCLUSION: The clinicians should consider managing the patient's position with anatomical familiarity to avoid brachial plexus injury due to intraoperative positioning.

PMID: 30654315 [PubMed - as supplied by publisher]

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Prognostic significance of the presence of tertiary Gleason grade 5 in robot-assisted radical prostatectomy specimens in Japanese patients with clinically localized prostate cancer.

Related Articles

Prognostic significance of the presence of tertiary Gleason grade 5 in robot-assisted radical prostatectomy specimens in Japanese patients with clinically localized prostate cancer.

Jpn J Clin Oncol. 2019 Jan 11;:

Authors: Kamoda N, Ohori M, Hirasawa Y, Inoue R, Hashimoto T, Satake N, Gondo T, Nakagami Y, Nagao T, Ohno Y

Abstract
Background: The aim of this study was to study the prognostic significance of tertiary Gleason grade (TGG) 5 in patients with clinically localized prostate cancer treated with robot-assisted radical prostatectomy (RARP).
Methods: A total of 600 Japanese patients who underwent RARP for clinical stage T1-3N0M0 prostate cancer were evaluated. TGG5 was evaluated according to the International Society of Urological Pathology criterion. Cox hazard regression was used to evaluate the prognostic significance of prostate-specific antigen and pathological features in RARP specimens.
Results: Of the 600 RARP specimens, 92 (15%) had TGG5. TGG5 component was found in 30 (10%) of 287 cases with Gleason score (GS) 3 + 4, 55 (37%) of 149 cases with GS 4 + 3 and 7 (17%) of 40 cases with GS 4 + 4. There were no significant differences in pathological stage and surgical margin status between GS 3 + 4 with and without TGG5, as well as between GS 4 + 4 with and without TGG5. Of the 600 patients, 92 (15%) patients had biochemical recurrence (BCR) after surgery, with a median follow-up period of 42 (3-104) months. There were no differences in 5-year BCR-free survival rates between patients with GS 3 + 4 with and without TGG5 (92 vs. 100%, P = 0.16), as well as between patients with GS 4 + 3 with and without TGG5 (79 vs. 71%, P = 0.30). Similarly, there were no differences in 3-year BCRFS rates between patients with GS 4 + 4 with and without TGG5 (80 vs. 71%, P = 0.38).
Conclusions: In our population, the presence of TGG5 in RARP specimens had no strong impact on pathological and prognostic outcomes.

PMID: 30649377 [PubMed - as supplied by publisher]

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Solitary fibrous tumor of the lumbar spine resembling schwannoma: a case report and review of the literature.

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Solitary fibrous tumor of the lumbar spine resembling schwannoma: a case report and review of the literature.

World Neurosurg. 2019 Jan 14;:

Authors: Zhang YW, Xiao Q, Zeng JH, Deng L

Abstract
BACKGROUND: Solitary fibrous tumors (SFTs) are rare tumors derived from mesenchymal tissues. Notably, despite the widespread reports of SFT in various parts of the body, it is extremely rare in spine, especially the lumbosacral spine, with only four previously reported cases.
CASE PRESENTATION: We present a 40-year-old Chinese man who suffered from low back and right leg pain for 11 years. Lumbar spine MRI indicated a dumbbell-shaped mass at the right L4 vertebra. After the first surgical resection, the tumor was diagnosed as schwannoma pathologically. Three years later, he presented with low back pain, numbness in both legs, and defecation incontinence. Imaging examination suggested tumor recurrence. The pathology of the second surgical specimen revealed features of SFT. So far, the patient has recovered well through the second extended resection and postoperative radiotherapy.
CONCLUSION: To our knowledge, this is the fifth reported case of lumbar spine SFT, and its diagnosis is a difficult challenge. However, accurate diagnosis and complete resection of SFT in the suspected patients could extend life or improve quality of life.

PMID: 30654157 [PubMed - as supplied by publisher]

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Tracheobronchopathia Osteochondroplastica: A Case Report Illustrating the Importance of Multilevel Workup Clinical, Endoscopic and Histological Assessment in Diagnosis of an Uncommon Disease.

Related Articles

Tracheobronchopathia Osteochondroplastica: A Case Report Illustrating the Importance of Multilevel Workup Clinical, Endoscopic and Histological Assessment in Diagnosis of an Uncommon Disease.

Am J Case Rep. 2019 Jan 18;20:74-77

Authors: Riva G, Girolami I, Luchini C, Villanova M, Valotto G, Cima L, Carella R, Riva M, Fraggetta F, Novelli L, Eccher A

Abstract
BACKGROUND Tracheobronchopathia osteochondroplastica (TO) is a rare idiopathic disease with a stable course, which involves the lumen of the tracheobronchial tree. Clinical manifestations at time of presentation may differ, typically including hoarseness, persistent and/or productive cough, hemoptyses, and dyspnea. There are no well-established guidelines for diagnostic workup and treatment. Our aim here is to present a paradigmatic case of TO together with a concise survey of the most important clinical, radiological, and histological criteria. CASE REPORT We report a case of a 62-year-old non-smoker male with persisting cough and no prior history of respiratory disease. Chest radiography (RX) and computed tomography (CT) were unremarkable. Given the persistence of symptoms, the patient underwent bronchoscopic examination, which revealed protruding sessile nodules into the tracheal lumen, with cobblestone appearance. Histopathological examination of biopsies taken during bronchoscopy showed cartilaginous and osseous submucosal nodules consistent with the diagnosis of TO. CONCLUSIONS TO is not always an easily recognized disease, and a multidisciplinary team work is often required for diagnosis, with particular importance of endoscopic-pathological correlation.

PMID: 30655500 [PubMed - in process]

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Future Oncology; +91 new citations

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

Future Oncology

These pubmed results were generated on 2019/01/19

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

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Influence of the Ratio of C2-C7 Cobb angle to T1 Slope on the Cervical Alignment After Laminoplasty.

Related Articles

Influence of the Ratio of C2-C7 Cobb angle to T1 Slope on the Cervical Alignment After Laminoplasty.

World Neurosurg. 2019 Jan 14;:

Authors: Li XY, Kong C, Sun XY, Lu SB, Guo MC, Ding JZ, Yang YM

Abstract
PURPOSE: To assess the relationship between the ratio of C2-C7 Cobb angle to T1 slope (CL/T1S) and cervical alignment changes after laminoplasty.
METHODS: 78 consecutive patients with cervical myelopathy who underwent laminoplasty were enrolled. All patients with preoperative and follow-up cervical spine lateral x-ray images available for review were recruited in this study. Imaging data included C2-C7 Cobb angle, T1 slope, cervical sagittal vertical axis (cSVA). All patients were classified into low ratio group (bottom 25% of CL/T1S), fair ratio group (middle 50% of CL/T1S), and high ratio group (top 25% of CL/T1S) according to CL/T1S ratio. The recovery rate was calculated based on the Japanese orthopedic Association score.
RESULTS: The preoperative C2-C7 Cobb angle had significant correlations with the T1 slope (r=0.528). Kyphotic alignment changes in the group with high ratio of CL/T1S was greater than that of the other two groups (p < 0.001). The incidence of postoperative kyphosis in the group with low ratio of CL/T1S was higher than that of the other two groups (p < 0.001). There was no postoperative kyphosis in the fair ratio group. The surgical outcome in low CL/T1S ratio group and high CL/T1S ratio group was poorer than that in fair CL/T1S ratio group (p = 0.005).
CONCLUSIONS: The cervical alignment was kept well in mid-range CL/T1S ratio group after laminoplasty. Patients with a high CL/T1S ratio were more likely to present with kyphotic alignment change. Patients with a low CL/T1S ratio were more likely to exhibit postoperative kyphosis.

PMID: 30654159 [PubMed - as supplied by publisher]

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Highly Active Antiretroviral Therapy and Gamma Knife Radiosurgery for the Treatment of AIDS-Related Primary Central Nervous System Lymphoma: A Case Report.

Related Articles

Highly Active Antiretroviral Therapy and Gamma Knife Radiosurgery for the Treatment of AIDS-Related Primary Central Nervous System Lymphoma: A Case Report.

World Neurosurg. 2019 Jan 14;:

Authors: Alvarez-Pinzon AM, Valerio JE, Swedberg HN, Elwasila SM, Wolf A, Alonso Pena JR

Abstract
A 66-year-old male presented with acute cephalalgia, disorientation, and lethargy. The patient was evaluated in the ER and admitted with probable hydrocephalus. Brain-MRI revealed multiple nonspecific brain lesions, predominantly involving the right temporal lobe, which on biopsy proved a diagnosis of Primary Central Nervous System Lymphoma (PCNSL). Subsequent laboratory studies demonstrated active HIV infection with a CD4 count of 21 cells/ microliter and HIV viral load (VL) of greater than 400,000 copies/milliliter. The patient was eventually initiated on highly active antiretroviral therapy (HAART). He declined palliative whole-brain radiotherapy (WBRT) but was amenable to Gamma Knife Radiosurgery (GKRS) for treatment of right temporal brain lesions. Three months later, the patient's neurological symptoms improved; similarly, his CD4 count increased to 176 cells/mL and his HIV VL was less than 90 copies/mL. By 12-month follow-up, patient was asymptomatic and at 36-months, Brain MRI demonstrated total remission (CR) without new brain lesions. The gold standard treatment of newly diagnosed PCNSL remains high-dose chemotherapy in conjunction with palliative WBRT, however there may be a role for novel, combined approaches utilizing chemotherapy, HAART, and GKRS to positively impact survival rates of PCNSL related to AIDS.

PMID: 30654158 [PubMed - as supplied by publisher]

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Deep Brain Stimulation for Memory Modulation: A New Frontier.

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Deep Brain Stimulation for Memory Modulation: A New Frontier.

World Neurosurg. 2019 Jan 14;:

Authors: Khan IS, D'Agostino EN, Calnan DR, Lee JE, Aronson JP

PMID: 30654156 [PubMed - as supplied by publisher]

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A Comprehensive Meta-Analysis for Bypass Surgery in Adult Moyamoya.

Related Articles

A Comprehensive Meta-Analysis for Bypass Surgery in Adult Moyamoya.

World Neurosurg. 2019 Jan 14;:

Authors: Yan Y, Li Y, Huang L, Zhang S

PMID: 30654155 [PubMed - as supplied by publisher]

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Radiation exposure reduction in ultrasound-guided transforaminal percutaneous endoscopic lumbar discectomy for lumbar disc herniation: a randomized, controlled trial.

Related Articles

Radiation exposure reduction in ultrasound-guided transforaminal percutaneous endoscopic lumbar discectomy for lumbar disc herniation: a randomized, controlled trial.

World Neurosurg. 2019 Jan 12;:

Authors: Wu RH, Deng DH, Huang XQ, Shi CL, Liao XQ

Abstract
BACKGROUND: Transforaminal percutaneous endoscopic lumbar discectomy (TF-PELD) is a minimally invasive technique with high radiation exposure. The purpose of this study was to compare radiation exposure of ultrasound-guided TF-PELD with fluoroscopy-guided TF-PELD.
METHODS: In this prospective randomized controlled clinical trial, 60 patients with lumbar disc herniation were enrolled and randomly assigned to two groups (30 cases in each group): ultrasound-guided group or fluoroscopy-guided group. The radiation exposure, fluoroscopy time and visual analog scale score were recorded. Meanwhile, the number of possible operations per year within the yearly occupational exposure limit (OEL) were calculated. We also recorded the adverse events to evaluate the safety of ultrasound-guided TF-PELD.
RESULTS: In 30 patients from ultrasound-guided group, the lumbar disc structure were clearly visible under ultrasound guidance. The effective dose to surgeons and radiation dose to patients was 1.7±0.4 and 25.2±4.9 μSv in the ultrasound-guided group, and 9.0±2.5 and 127.4±27.1 μSv in fluoroscopy-guided group (p<0.05), respectively. The fluoroscopy time was 2.6± 0.5 s in the ultrasound-guided group and 127.3±29.5 s in the fluoroscopy-guided group (p<0.05). A surgeon with shielding devices could perform 5,556 cases per year in the fluoroscopy-guided group before exceeding the OEL for the whole-body radiation, while 29,412 cases in the ultrasound-guided group. No difference between groups was detected in postoperative VAS score (p>0.58). No serious adverse event was found in all patients.
CONCLUSION: Ultrasound-guided TF-PELD could decrease radiation exposure to surgeons and patients, without serious adverse events. It seems to be an acceptable alternative to fluoroscopy-guided TF-PELD.

PMID: 30648611 [PubMed - as supplied by publisher]

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Posterior percutaneous full-endoscopic cervical laminectomy and decompression for cervical stenosis with myelopathy: a technical note.

Related Articles

Posterior percutaneous full-endoscopic cervical laminectomy and decompression for cervical stenosis with myelopathy: a technical note.

World Neurosurg. 2019 Jan 12;:

Authors: Lin Y, Rao S, Li Y, Zhao S, Chen B

Abstract
PURPOSE: Cervical stenosis with myelopathy caused by ossification of the ligamentum flavum is relatively rare, and surgical treatment is the preferred option. Previous surgical procedures usually require assisted internal fixation, while some problems may occur, such as large trauma, intraoperative bleeding, wound infection and internal fixation failure. The aim of this paper is to introduce a new minimally invasive surgical procedure for the treatment of upper cervical spinal stenosis complicated with myelopathy.
METHODS AND RESULTS: A 56-year-old male patient with cervical myelopathy (C2-3) caused by calcification of the ligamentum flavum underwent posterior percutaneous full-endoscopic cervical laminectomy and decompression (PECLD) and achieved a good clinical efficacy. A surgical incision just 1 cm in size was made, and there was little bleeding during the operation. The patient was hospitalized for 2 days and returned to work after 4 weeks. The patient's postoperative recovery of neurological function was significantly improved, the pain was obviously reduced, and the quality of life was remarkably improved. No intra- or postoperative surgical complications were encountered.
CONCLUSIONS: PECLD is an effective method for treating cervical stenosis associated with myelopathy due to ossification of the ligamentum flavum. It has the advantages of smaller trauma, less bleeding, shorter postoperative hospital stays and faster recovery. Taken together, this minimally technique can be considered as a good alternative to traditional open surgery.

PMID: 30648610 [PubMed - as supplied by publisher]

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Corrigendum to 'Reoperation for Symptomatic Nonunions in Atlantoaxial (C1-C2) Fusions with and without Bone Morphogenetic Protein: A Cohort of 108 Patients with >2 Years Follow-Up' [World Neurosurgery 121 (2019) e458-e466].

Related Articles

Corrigendum to 'Reoperation for Symptomatic Nonunions in Atlantoaxial (C1-C2) Fusions with and without Bone Morphogenetic Protein: A Cohort of 108 Patients with >2 Years Follow-Up' [World Neurosurgery 121 (2019) e458-e466].

World Neurosurg. 2019 Jan 11;:

Authors: Guppy KH, Lee DJ, Harris J, Brara HS

PMID: 30642744 [PubMed - as supplied by publisher]

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Endovascular and Microsurgical Aneurysm Training in a Chicken Thigh and Leg Pulsatile Model.

Related Articles

Endovascular and Microsurgical Aneurysm Training in a Chicken Thigh and Leg Pulsatile Model.

World Neurosurg. 2019 Jan 11;:

Authors: Tanweer O, Mureb MC, Pacione D, Sen R, Jafar JJ, Riina HA, Huang PP

Abstract
BACKGROUND: Neurovascular training models include animal models, synthetics, or computer simulation. In vivo models are expensive and require significant resources. Synthetic/computer models do not reflect the elasticity of fresh vessels. We describe an endovascular and microsurgical training model using a chicken thigh/leg.
METHODS: 20 chicken thigh/leg models were obtained. Angiography was utilized to understand the anatomy. Proximal cannulation with a 5-French catheter was achieved and connected to a hemostatic valve with a pump to simulate pulsatile flow. Aneurysms were created at the thigh-leg junction. For clipping training, 3 types of aneurysms were created to reproduce anatomy seen in middle cerebral, anterior communicating and posterior communicating aneurysms.
RESULTS: The average cost per specimen from was $1.70 ± 0.30. The diameter of the proximal femoral artery (PFA) was 2.4 mm ± 0.2 mm. The length from the PFA to the aneurysm was 9.5 cm ± 0.7 cm. Distal catheterization was successful in all cases (n=6). Successful deployment of coils and a stent was achieved under fluoroscopic guidance. Gross over-sizing of coils and other mistakes led to aneurysm rupture. Each examiner performed an exploration of the pulsatile aneurysm, application and reapplication of a variety of clips and then final inspection of branching vessels to confirm patency.
CONCLUSIONS: The chicken thigh/leg model provides training opportunities in microsurgical suturing, endovascular techniques for aneurysm obliteration, and microsurgical reconstruction of aneurysms. It combines affordability, time efficiency and reproducibility. Further studies measuring improvement in technical aneurysm management and comparison to other training models are warranted.

PMID: 30641239 [PubMed - as supplied by publisher]

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Elongated conus medullaris, sacral agenesis and scoliosis- a case report of a patient with trisomy 19q and monosomy 7q.

Related Articles

Elongated conus medullaris, sacral agenesis and scoliosis- a case report of a patient with trisomy 19q and monosomy 7q.

World Neurosurg. 2019 Jan 11;:

Authors: Graul I, Zippelius T, Hölzl A, Strube P

Abstract
BACKGROUND: Both progression of scoliosis following completion of growth, and the combination of low mental retardationand the conspicuous sagittal clinical and radiographic abnormalities suggest a secondary genesis of the scoliosis according to a genetic aberration.
CASE DISCRIPTION: In the outpatient department, an 18-year-old girl presents with scoliosis and mild mental retardation. Radiography findings demonstrate a sacral agenesis and the consecutively performed MRI a conus depression. Due to the symptom constellation, a genetic syndrome was suspected. Genetic diagnostics revealed a trisomy 19q and monosomy 7q. Usually, deletions of the subtelomer 7q show a phenotype with growth retardation, facial anomalies and intellectual deficit, trisomy of the subtelomer 19q growth retardation, atypical ears, short neck and intellectual deficit with delayed development. The further clinical radiological and neurological examination showed no evidence of a tethered cord syndrome. The correction of scoliosis was carried out under intraoperative neurophysiological monitoring without neurologic complications.
CONCLUSIONS: In the presence of dysplastic sacral changes and accompanying elongated conus medullaris in patients with scoliosis, it is always necessary to think of rare chromosome aberrations and to initiate appropriate diagnostics before surgery. The intraoperative neurophysiological monitoring is strongly recommended, due to a morphologically not fully-excludable tethered cord syndrome.

PMID: 30641238 [PubMed - as supplied by publisher]

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A Two-Year Cost Analysis of Maximum Non-Operative Treatments in Patients with Cervical Stenosis that Ultimately Required Surgery.

Related Articles

A Two-Year Cost Analysis of Maximum Non-Operative Treatments in Patients with Cervical Stenosis that Ultimately Required Surgery.

World Neurosurg. 2019 Jan 11;:

Authors: Davison MA, Desai SA, Lilly DT, Vuong VD, Moreno J, Bagley C, Adogwa O

PMID: 30641237 [PubMed - as supplied by publisher]

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National Patterns of Care in the Management of WHO Grade II and III Spinal Ependymomas.

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National Patterns of Care in the Management of WHO Grade II and III Spinal Ependymomas.

World Neurosurg. 2019 Jan 11;:

Authors: Yeboa DN, Liao KP, Guadagnolo BA, Rao G, Bishop A, Chung C, Li J, Tatsui CE, Rhines LD, Ferguson S, Paulino AC, Ghia AJ

Abstract
BACKGROUND: Spinal ependymomas are rare with an incidence of 1 per 100,000. Given the paucity of data for higher grade II and III disease, the management and patterns of care require further investigation.
METHODS: Our study of 1,345 patients with higher grade spinal ependymoma utilized chi-square tests, simple and multivariable logistic regression models to assess demographic and clinical factors associated with therapy. Kaplan Meier and log-rank test were used to assess overall survival (OS).
RESULTS: The majority of grade II patients received surgery alone (81.1%) in comparison to 36.8% of grade III. Approximately 60% percent of grade III ependymomas received radiotherapy(RT) versus 15.3% of grade II (P< 0.001). Patients ≤20 miles from a facility were more likely to receive RT (P<0.001) than those living further away. On multivariable logistic regression, grade (grade III: OR 8.6, P<0.001) and facility distance were significantly associated with receipt of RT (P<0.0001). The 5 and 10-year OS rates were 94.7%/ 85.1% for patients with grade II disease and 58.2%/46.4% for grade III disease (P<0.0001). OS rates were highest at facilities treating an average of 15 patients over 10 years, corresponding to the top 81st percentile in volume. The 10-year OS rates were 92.6% at facilities treating at least 15 patients and 88.0% at facilities treating 6-14 patients.
CONCLUSIONS: Approximately 40% of grade III ependymomas do not receive immediate adjuvant therapy which may be related to distance from a facility. Patients with this rare tumor may benefit from multidisciplinary care at facilities with a larger volume.

PMID: 30641236 [PubMed - as supplied by publisher]

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Dural Sandwich Technique for Hemicraniectomy and Benefits During Cranioplasty.

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Dural Sandwich Technique for Hemicraniectomy and Benefits During Cranioplasty.

World Neurosurg. 2019 Jan 11;:

Authors: Nguyen KD, Reddy V, Rahimi SY

Abstract
OBJECT: Hemicraniectomy is a commonly performed neurosurgical procedure used in the setting of medically refractory malignant intracranial hypertension. Complications from cranioplasty following hemicraniectomy can be significant, including infection and wound issues. Difficulty with scar tissue during exposure for cranioplasty can be challenging and can lead to prolonged surgical time and increased bleeding. We describe a surgical technique, termed the "dural sandwich", that could provide a significant benefit during cranioplasty as compared to traditional single-layered dural closure.
METHODS: A retrospective analysis was conducted that included 14 patients who underwent a hemicraniectomy procedure over a four-year period. Seven patients were identified who received a cranioplasty following dural sandwich technique during craniectomy. They were compared to a similar patient group of seven patients who received cranioplasty following conventional hemicraniectomy with single-layered dural closure. Surgical time, estimated blood loss, and complication rates were compared between the two groups. Analysis of variance measures was performed to assess for statistically significant differences in blood loss and operative time between the dural sandwich and control groups. Statistical significance was defined as p < 0.05.
RESULTS: Mean estimated blood loss was 82.1 mL in the dural sandwich craniectomy group versus 150 mL in the conventional hemicraniectomy group (p < 0.05). Mean estimated surgical time was 91.7 minutes in the dural sandwich craniectomy group versus 127.5 minutes in the conventional craniectomy group (p < 0.05). There was no evidence of neurologic deterioration, cerebral spinal fluid leak, or post-operative hematoma requiring evacuation in either group. In the conventional craniectomy group, a single report of a wound infection was noted that was treated conservatively with antibiotics.
CONCLUSION: By layering bovine pericardium above and below the dura during initial hemicraniectomy, an artificial plane is created that improves ease of exposure during cranioplasty. This technique could reduce surgical time and blood loss during subsequent cranioplasty, and potentially reduce recovery time and postoperative complications.

PMID: 30641235 [PubMed - as supplied by publisher]

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A Combined Extradural-Intradural Technique for an En-Bloc Anterior Petrosectomy: A Cadaveric Feasibility Study.

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A Combined Extradural-Intradural Technique for an En-Bloc Anterior Petrosectomy: A Cadaveric Feasibility Study.

World Neurosurg. 2019 Jan 09;:

Authors: Dones F, Kournoutas I, Vigo V, Di Bonaventura R, Raygor K, El-Sayed IH, Abla AA, Rubio RR

Abstract
INTRODUCTION: The anterior petrosectomy approach is among the most popular for exposure of the petroclival region. However, the complexity of the anatomy, drilling time, and risk of injury to neurovascular structures make this procedure especially challenging.
OBJECTIVE: Our study proposes a novel combined extradural-intradural technique for an en-bloc anterior petrosectomy-or one-piece Kawase(OPK)-while also charting the landmarks that define its surgical boundaries.
METHODS: The approach was performed on fourteen embalmed specimens. The OPK approach consists of three extradural drilling steps, followed by incision of the dura and skeletonization of the superior petrosal sinus, and culminates with two intradural drilling steps. The bone piece was then en-bloc removed and its maximum antero-posterior(AP), supero-inferior(SI) and medio-lateral(ML) lengths were recorded. Linear distances between main neurovascular landmarks were also measured using a stereotactic navigation system.
RESULTS: Mean measurements were 17.6±2.6 mm for the AP distance, 10.5±2.3 mm for the SI distance and 9.5±2.6 mm for ML distance. The medial linear distance from the mandibular nerve/greater superficial petrosal nerve to the internal carotid artery was 6.8± 1.3mm, to the facial hiatus was 11.6± 2.2mm and to the lateral internal acoustic canal (IAC) was 17.9± 1.8mm. The average distance from porus trigeminus to medial IAC was 19.4 mm.
CONCLUSION: Advantages of this technique include: wide exposure of the petroclival region, extensive visualization of critical structures via extradural and intradural corridors, and the minimization of bone drilling which may reduce heat damage. Clinical application of the illustrated technique will be required to test its reliability in different pathology subsets.

PMID: 30639606 [PubMed - as supplied by publisher]

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Preoperative Diffusion Tensor Imaging : A landmark modality for predicting the outcome and characterization of supratentorial intra-axial brain tumours.

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Preoperative Diffusion Tensor Imaging : A landmark modality for predicting the outcome and characterization of supratentorial intra-axial brain tumours.

World Neurosurg. 2019 Jan 09;:

Authors: Khan KA, Jain SK, Sinha VD, Sinha J

Abstract
BACKGROUND AND AIM: In view of few large prospective studies available on the role of preoperative diffusion tensor imaging(DTI), and the potential of DTI in revealing tumour and white matter tracts relationship, we studied the role of 'preoperative DTI' in planning safe surgical corridor, predicting the neurological and surgical outcome and tumour characterization in supratentorial intra-axial brain tumours.
METHODOLOGY: We included 128 cases. Preoperative neurological status and tumour volume was assessed. MRI based surgical plan was decided and reviewed for changes after DTI ( site of corticotomy or limit of resection ) by senior faculty of neurosurgery and neuroradiologist. Tracts were divided as displaced, infiltrated and disrupted .Postoperative neurological and surgical outcome was assessed along with evaluation of association of DTI with tumour type.
RESULTS: DTI based change in surgical corridor was seen in 60 (47%) patients. 66 patients harbored Low grade gliomas( LGGs), 48 had High grade gliomas( HGGs) and 14 had metastastic lesions. Resectibility ( maximum safe resection )was found higher in patients with displaced fibers and lesser in those with disrupted/infiltrated fibers, which was statistically significant. Fewer patients had neurological deterioration in displaced category (7.1%) as compared to disrupted/infiltrated (13.9%). Although no significant association could be established between neurological outcome and fiber type. Displaced fibers were mainly associated with LGG( 71%) whereas disrupted/infiltrated fibers mainly with HGG(66%) and this correlation was significant.
CONCLUSION: Preoperative DTI is a landmark tool for planning safe surgical corridor and predicting the tumour type along with neurological and surgical outcome of patients.

PMID: 30639605 [PubMed - as supplied by publisher]

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Desmoid Tumor Presenting as a Typical Cervical Dumbbell Tumor:A Case Report and Literature Review.

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Desmoid Tumor Presenting as a Typical Cervical Dumbbell Tumor:A Case Report and Literature Review.

World Neurosurg. 2019 Jan 10;:

Authors: Luo N, He X, Li G, Liao Y, Tang Q, Ye R, Zhong D

Abstract
BACKGROUND: Dumbbell-shaped tumor is a type of the inner and outer cervical spinal canal tumor, and most of them are neurogenic tumors. Desmoid tumor is a rare tumor, and no case of them involving intervertebral foramen formed dumbbell-shaped in cervical spine have been reported before in English literature. Here we report a case of desmoid tumor arising in the cervical spine which is presented as typical dumbbell-shaped tumor.
CASE DESCRIPTION: A 47-year-old female was admitted to our department with a mass in her left neck. The tumor was initially thought to be a neurogenic cervical dumbbell tumor based on physical and radiological examination. Postoperative HE and immunohistochemical staining verified the diagnosis of a cervical dumbbell desmoid tumor, which had never been reported before. We report our experience and reviewed literature about desmoid tumor to share our experience and explore proper treatment option of such lesion.
CONCLUSION: Desmoid tumors in the head and neck may present as cervical dumbbell-shaped tumors. Before the treatment plan was undertaken, thorough examinations including surgical pathology were necessary.

PMID: 30639503 [PubMed - as supplied by publisher]

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A Reduced Exogenous Steroid Taper (REST) for postoperative brain tumor patients - a case-control study.

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A Reduced Exogenous Steroid Taper (REST) for postoperative brain tumor patients - a case-control study.

World Neurosurg. 2019 Jan 10;:

Authors: Breshears JD, Haddad AF, Viner J, Rau J, Sankaran S, McDermott MW

Abstract
BACKGROUND: Dexamethasone is a standard treatment for cerebral edema following brain tumor surgery. However its side effects can negatively impact the quality and safety of care provided to patients. Sparse evidence exists in the literature regarding postoperative steroid dosing to guide clinicians.
OBJECTIVE: To determine if a new reduced exogenous steroid taper (REST) protocol would effectively treat postoperative cerebral edema while reducing the incidence of steroid related side effects including diabetes, hypertension, and insomnia.
METHODS: A REST protocol (dexamethasone 38.5 mg tapered over 10 days) was instituted for postoperative brain tumor patients of a single surgeon. Historical controls treated with a high-dose taper (dexamethasone 117 mg taper over 17 days) were selected to match for baseline characteristics. Outcomes of new or worsened diabetes, hypertension, and insomnia; as well as length of stay (LOS) and 30-day readmission rates, were compared.
RESULTS: Twenty-five patients were included in each group. There were no significant differences in baseline characteristics. The REST group received a median of 34.5mg [interquartile range (IQR) 32mg-41mg] of dexamethasone, while controls received 43mg [IQR 16 - 91mg] (p = 0.04). There was a significant reduction in the incidence of new or worsened hypertension in the REST group (0%) compared to controls (20%, p = 0.02). No difference was seen in the rates of DM, insomnia, LOS, or 30-day readmission rates.
CONCLUSION: A reduced steroid taper following brain tumor surgery significantly reduced the incidence of hypertension without increasing LOS or 30-day re-admissions compared to controls treated with a high dose taper.

PMID: 30639502 [PubMed - as supplied by publisher]

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Glioblastoma Multiforme of the Conus Medullaris - Management Strategies and Complications.

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Glioblastoma Multiforme of the Conus Medullaris - Management Strategies and Complications.

World Neurosurg. 2019 Jan 10;:

Authors: Goodarzi A, Thaci B, Toussi A, Karnati T, Kim K, Fragoso R

Abstract
Primary spinal glioblastoma multiforme (GBM) of the conus medullaris is a rare and devastating pathology. Presenting symptoms commonly include progressive neurologic deficits in the lower extremities, bowel and bladder dysfunction, and low back pain. Histologically, these tumors have high-grade features similar to their intracranial counterparts, however, recent advancements in the field of molecular oncology are beginning to elucidate a unique molecular blueprint for these spinal gliomas. Given the lack of standardized treatment strategies, we present our institutional experience in treating a small series of patients suffering from conus medullaris GBM and review the literature on relevant molecular markers, management strategies, and complication avoidance for this malignant pathology.

PMID: 30639501 [PubMed - as supplied by publisher]

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Changes in oral health-related quality of life after three different strategies of implant therapy: a clinical trial

Abstract

This research aims to evaluate changes in Oral Health-related Quality of Life (OHQoL) by means of the Oral Impacts on Daily Performances (OIDP) of patients treated with three distinct implant strategies. This clinical trial consisted of an oral examination and a questionnaire-based interview carried out before and after the definitive prosthetic rehabilitation in a consecutive sample of patients requiring dental implants. According to the clinical diagnosis and patient preference, patients were assigned to the one of the following groups: the conventional group (CGCL; n = 40), where implants were inserted without guiding and conventionally loaded; to the guided surgery but conventional loading group (GSCL; n = 35); or to the guided surgery and immediate loading group (GSIL; n = 29). At baseline, the OHQoL was significantly greater among those assigned to CGCL (2.4 ± 1.3) than those assigned to GSCL (3.3 ± 1.3), which were both greater than those patients assigned to GSIL (4.6 ± 2.0). After implant therapy, the oral well-being was significantly better than at baseline, and patient satisfaction was greater when the implants were loaded immediately (8.7 ± 1.1) than if the prosthetic rehabilitation was delayed (8.3 ± 1.1). In the GSIL group, the effect size of the OIDP exceeded the threshold value of 0.8 for all of the OIDP domains and for the total OIDP score and patient satisfaction. A global improvement in the OHQoL scores and patient satisfaction was observed after implant therapy, but the change was markedly greater in the GSIL group.

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The accuracy and stability of the maxillary position after orthognathic surgery using a novel computer-aided surgical simulation system

Abstract

Background

Many reports have been published on orthognathic surgery (OGS) using computer-aided surgical simulation (CASS). The purpose of this study was to evaluate the accuracy of the maxillary repositioning and the stability of the maxilla in patients who underwent OGS using a newly developed CASS program, a customized osteotomy guide, and a customized miniplate.

Methods

Thirteen patients who underwent OGS from 2015 to 2017 were included. All patients underwent a bimaxillary operation. First, a skull-dentition hybrid 3D image was rendered by merging the cone beam computed tomography (CBCT) images with the dentition scan file. After virtual surgery (VS) using the FaceGide® program, patient-customized osteotomy guides and miniplates were then fabricated and used in the actual operation. To compare the VS with the actual surgery and postoperative skeletal changes, each reference point marked on the image was compared before the operation (T0) and three days (T1), four months (T2), and a year (T3) after the operation, and with the VS (Tv). The differences between ΔTv (Tv-T0) and ΔT1 (T1-T0) were statistically compared using tooth-based reference points. The superimposed images of Tv and T1 were also investigated at eight bone-based reference points. The differences between the reference points of the bone surface were examined to evaluate the stability of the miniplate on the maxilla over time.

Results

None of the patients experienced complications. There were no significant differences between the reference points based on the cusp tip between ΔTv and ΔT1 (p > 0.01). Additionally, there were no significant differences between the Tv and T1 values of the bone surface (p > 0.01). The mean difference in the bone surface between Tv and T1 was 1.01 ± 0.3 mm. Regarding the stability of the miniplate, there were no significant differences between the groups. The difference in the bone surface between T1 and T3 was − 0.37 ± 0.29 mm.

Conclusions

VS was performed using the FaceGide® program, and customized materials produced based on the VS were applied in actual OGS. The maxilla was repositioned in almost the same manner as in the VSP plan, and the maxillary position remained stable for a year.

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Salivary characteristics and dental caries experience in remote Indigenous children in Australia: a cross-sectional study

Abstract

Background

While associations between salivary characteristics and dental caries have been well studied, we are not aware of this being assessed in a remote Indigenous child population, where lifestyles may be different from urban children. Our aim was to assess associations between caries experience and putative biomarkers in saliva, accounting for oral hygiene and dietary habits.

Methods

Children attending schools in an Indigenous community in remote north Queensland, Australia were invited to an oral examination by qualified and calibrated examiners. Salivary flow rate, pH, buffering capacity and loads of mutans streptococci (MS), lactobacilli (LB) and yeasts were determined. Also, data on tooth brushing frequency and soft drinks consumption were obtained via a questionnaire. Caries experience was recorded by the International Caries Detection and Assessment System (ICDAS-II), and quantified as decayed, missing and filled surfaces. Relationships between the salivary variables and the cumulative caries experience (dmfs+DMFS) in the deciduous and permanent dentitions were examined by multivariate analyses to control the effect of confounders.

Results

The mean cumulative decayed (DS + ds), missing (MS + ms) and filled (FS + fs) surfaces were 3.64 (SD: 4.97), 1.08 (4.38) and 0.79 (1.84) respectively. Higher salivary MS and LB counts, low tooth brushing frequency and daily soft drink consumption were significantly related to greater caries experience. Caries experience was about twice in those with ≥10^5 CFU/ml saliva counts of MS (mean = 6.33, SD: 8.40 vs 3.11, 5.77) and LB (7.03, 7.49 vs 4.41, 8.00). In the fully-adjusted multivariate model, caries experience in those with higher counts of MS and LB were 51 and 52% more than those with lower counts.

Conclusions

As with studies in other populations, childhood salivary counts of MS and LB were significantly associated with greater caries experience in this remote Indigenous community. To address the serious burden of oral disease, we are researching ways to promote a healthy oral environment by encouraging good dietary habits, and emphasising the importance of daily tooth brushing with a fluoridated toothpaste. Our ongoing longitudinal studies will indicate the success of measures employed to reduce the counts of bacteria closely associated with cariogenesis and their impact on caries increment.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR), No: ACTRN12615000693527; date of registration: 3rd July 2015.

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Oral health of 6–7 year-old children according to the Caries Assessment Spectrum and Treatment (CAST) index

Abstract

Background

The index of Caries Assessment Spectrum and Treatment (CAST) reveals a range of caries development from a non-cavitated status to advanced lesions. The aim of the present study was to explore the oral health status of 6- to 7-year-old children based on the CAST index in relation to oral health knowledge and background determinants.

Methods

A multi-stage cluster random sampling method was applied and after ethical clearance, clinical examination was performed (Kappa = 0.89). The status of caries and oral hygiene was recorded according to the CAST index and OHI-Simplified (OHI-S) index, respectively. A self-administered questionnaire was used to collect the data of parental knowledge of oral health. SPSS version 22.0 was used for data analysis and p-value less than 0.05 were considered significant.

Results

Seven hundred and thirty-nine children and their parents in 24 schools participated in this study (88%), of whom 48.6% were boys and the rest were girls. In permanent molars, a healthy status (code 0–2) was observed in 89.3–93.7% of the teeth. In primary molar teeth, dentinal lesions ranged from 25.3 to 31.2%, the prevalence of pulp involvement was between 2.9 and 10.5%, and less than 1% had abscess/fistula. Serious morbidity (codes 6 and 7) were more common in the first primary molars than the second ones. Multi-variable logistic regression analysis indicated that children with a low level of father's education were 2.45 times more likely to have a CAST score of 3 and higher (95% CI 1.35–4.46, p = 0.003) compared to children whose fathers had academic education. For each one-unit increment of OHI_S, the likelihood of a CAST score 3 and higher in primary dentition increased by 1.77 times (OR = 1.77; 95% CI 1.08–2.93, p = 0.02).

Conclusion

The consequences of dental caries including abscess and fistula were more prevalent in the first and second primary teeth. There was a significant correlation between a CAST score of 3 and higher with father's education (as an indicator of social rank) and oral hygiene status. The CAST index is a useful and practical index in epidemiological surveys.

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Caries prevalence and dental health of 8–12 year-old children in Damascus city in Syria during the Syrian Crisis; a cross-sectional epidemiological oral health survey

Abstract

Background

There was an immense need for studies evaluating the dental health status in Syrian children, especially under the current circumstances of the Syrian crisis. No contemporary data was available. The aim of this study was to assess the current dental health status in children aged 8 to 12 years in Damascus city.

Methods

The study was a cross-sectional epidemiological school-based oral health survey using stratified random cluster sampling. A total of 1500 children were clinically examined. For each child, personal information together with DMFT and dmft indices were recorded. Statistical analysis was undertaken to investigate the effects of different factors on caries prevalence. ANOVA, and Chi Square tests were both utilised.

Results

The caries prevalence for the whole city was at (79.1%). The mean DMFT was (2.03 ± 1.81) and the mean dmft was (2.47 ± 2.94). Of the DMFT index mean value, (91.14%) was for decayed and missing permanent teeth. Of the dmft index mean value, (89.1%) was for decayed and missing deciduous teeth. The most affected teeth were the permanent first molars (1.58 ± 1.51). There is a statistically significant relationship between the used indices means and the children's distribution as to the city's localities.

Conclusions

Dental caries was higher than expected. Health promotion programmes are essential and of critical importance in order to improve the dental health status.

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Predictive factors for tooth loss during supportive periodontal therapy in patients with severe periodontitis: a Japanese multicenter study

Abstract

Background

Supportive periodontal therapy (SPT) must take individual patient risk factors into account. We conducted a multicenter joint retrospective cohort study to investigate the value of modified periodontal risk assessment (MPRA) and therapy-resistant periodontitis (TRP) assessment as predictive factors for tooth loss due to periodontal disease in patients with severe periodontitis during SPT.

Methods

The subjects were 82 patients from 11 dental institutions who were diagnosed with severe periodontitis and continued SPT for at least 1 year (mean follow-up = 4.9 years) between 1981 and 2008. The outcome was tooth loss due to periodontal disease during SPT. The Cox proportional hazards model was used to analyze sex, age, diabetes status, smoking history, number of periodontal pockets measuring ≥6 mm, rate of bleeding on probing, bone loss/age ratio, number of teeth lost, MPRA, and TRP assessment as explanatory variables.

Results

Univariate analysis showed that loss of ≥8 teeth by the start of SPT [hazard ratio (HR) 2.86], MPRA score indicating moderate risk (HR 8.73) or high risk (HR 11.04), and TRP assessment as poor responsiveness to treatment (HR 2.79) were significantly associated with tooth loss (p < 0.05). In a model in which the explanatory variables of an association that was statistically significant were added simultaneously, the HR for poor responsiveness to treatment and ≥8 teeth lost was significant at 20.17 compared with patients whose TRP assessment indicated that they responded favorably to treatment and who had lost <8 teeth by the start of SPT.

Conclusion

MPRA and TRP assessment may be useful predictive factors for tooth loss due to periodontal disease during SPT in Japanese patients with severe periodontitis. Additionally, considering the number of teeth lost by the start of SPT in TRP assessment may improve its predictive accuracy.

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Caries experience and oral health-related quality of life (OHRQoL) of children and adolescents with cerebral palsy in a low-resource setting

Abstract

Background

Children with complex neurodevelopmental disabilities such as cerebral palsy (CP), have a higher risk of dental disease related at least in part to greater difficulties in performing and maintaining effective oral hygiene and oral care practices. However, to date, there are very few studies that have considered the impact of dental disease on the Oral Health-Related Quality of Life (OHRQoL) of children and adolescents with cerebral palsy. This study aimed to investigate the association between dental caries experience and oral health related quality of life (OHRQoL) among children and adolescents with cerebral palsy in a low-resource setting (Bangladesh).

Methods

A total of 90 children and adolescents with CP, 2–17 years old (median age 10 years; 37.8% female and 62.2% male) were randomly selected from the Bangladesh Cerebral Palsy Register (BCPR) The decayed, missing and filled teeth (dmft/DMFT) index was used to measure caries experience. Child Perceptions Questionnaire (CPQ) and Family Impact Scale (FIS) were used to assess oral health–related quality of life (OHRQoL). Binary logistic regression was used to investigate factors that may contribute to dental caries experience.

Results

Dental caries were observed among 55.6% of the participants. After adjusting for age and gender, binary logistic regression analysis showed that dental caries experience was significantly associated with those who had teeth/mouth pain (rate ratio 7.3; P = 0.02), food caught between teeth (rate ratio: 6.4; P = 0.02), difficulty in eating and drinking (rate ratio 5.9; p = 0.02) and those who felt frequently upset (rate ratio: 54.7; P = 0.02).

Conclusion

In this study, we found that children and adolescents with CP in a low-resource setting had high dental caries experience and that dental caries had a negative impact on OHRQoL amongst these participants and their parents/caregivers. Health care professionals should be aware of the importance of dental health and oral hygiene in this population. These findings highlight the need for oral health promotion programs for children and adolescents with CP in these settings to reduce pain and to improve quality of life.

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Dental caries status of Lisu preschool children in Yunnan Province, China: a cross-sectional study

Abstract

Background

Dental caries is still considered a major public health concern for human beings, especially minority groups and those living in disadvantaged communities. The Lisu is a minority group in China of more than 702,000 people located primarily in Yunnan Province. The present study was aimed at studying the status of dental caries status, as well as its risk factors, among Lisu children aged 5 years in Yunnan Province, China.

Methods

A multistage cluster sampling method was employed for participants' recruitment. Two calibrated dentists carried out the clinical examination with dental mirrors and CPI probes under an LED headlight. The dental caries experience was assessed by the dmft index. Oral hygiene status was evaluated using the visible plaque index (VPI). Information on the child's socio-demographic characteristics and oral health-related practices were collected using a parental questionnaire. A zero-inflated negative binomial regression (ZINB) was employed to analyse the associations between the dental caries status and the children's social-demographic status and their oral health–related behaviours.

Results

In all, 470 Lisu children aged 5 were invited, and 404 were examined. Their mean dmft (±SD) and caries prevalence were 5.6 ± 4.8 and 80%, respectively. Their mean VPI scores were 58% ± 21%. Lisu children who brushed their teeth at least once daily had higher dmft scores, and children from high-income families were more likely to have dental caries.

Conclusion

The prevalence of dental caries among Lisu children aged 5 years in Yunnan, China was high, and their caries status was severe, with a majority of carious teeth untreated. The dental caries experience of Lisu children aged 5 was related to their brushing frequency and families' economic backgrounds.

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Comparison of the salivary and dentinal microbiome of children with severe-early childhood caries to the salivary microbiome of caries-free children

Abstract

Background

The main objectives of this study were to describe and compare the microbiota of 1) deep dentinal lesions of deciduous teeth of children affected with severe early childhood caries (S-ECC) and 2) the unstimulated saliva of these children and 3) the unstimulated saliva of caries-free children, and to compare microbiota compositional differences and diversity of taxa in these sampled sites.

Methods

Children with S-ECC and without S-ECC were recruited. The saliva of all children with and without S-ECC was sampled along with the deep dentinal microbiota from children affected by S-ECC. The salivary microbiota of children affected by S-ECC (n = 68) was compared to that of caries-free children (n = 70), by Illumina MiSeq sequencing of 16S rRNA amplicons. Finally, the caries microbiota of deep dentinal lesions of those children with S-ECC was investigated.

Results

Using two beta diversity metrics (Bray Curtis dissimilarity and UniFrac distance), the caries microbiota was found to be distinct from that of either of the saliva groups (caries-free & caries-active) when bacterial abundance was taken into account. However, when the comparison was made by measuring only presence and absence of bacterial taxa, all three microbiota types separated. While the alpha diversity of the caries microbiota was lowest, the diversity difference between the caries samples and saliva samples was statistically significant (p < 0.001). The major phyla of the caries active dentinal microbiota were Firmicutes (median abundance value 33.5%) and Bacteroidetes (23.2%), with Neisseria (10.3%) being the most abundant genus, followed by Prevotella (10%). The caries-active salivary microbiota was dominated by Proteobacteria (median abundance value 38.2%) and Bacteroidetes (27.8%) with the most abundant genus being Neisseria (16.3%), followed by Porphyromonas (9.5%). Caries microbiota samples were characterized by high relative abundance of Streptococcus mutans, Prevotella spp., Bifidobacterium and Scardovia spp.

Conclusions

Distinct differences between the caries microbiota and saliva microbiota were identified, with separation of both salivary groups (caries-active and caries-free) whereby rare taxa were highlighted. While the caries microbiota was less diverse than the salivary microbiota, the presence of these rare taxa could be the difference between health and disease in these children.

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Root canal morphology of permanent teeth in a Malaysian subpopulation using cone-beam computed tomography

Abstract

Background

To determine the root canal morphology of human permanent maxillary and mandibular teeth in a Malaysian subpopulation using cone-beam computed tomography (CBCT).

Methods

A total of 208 CBCT images were examined retrospectively. Prevalence of an extra root/canal and internal morphology based on Vertucci's classification were observed in human maxillary and mandibular permanent teeth. Variations in the external and internal morphology were compared in relation to gender and tooth side (left vs right) using Pearson Chi-square and Fisher's exact tests with significance level set at p < 0.05.

Results

In the maxillary arch, the prevalence of three canals were observed in 0.3% of first premolars and two canals in 46.5% of second premolars. Males displayed significantly higher prevalence of two canals in maxillary second premolars than females (p < 0.05). The prevalence of a second mesiobuccal canal in maxillary first and second molars were 36.3 and 8.5%, respectively. Males displayed significantly higher prevalence of a second mesiobuccal canal in maxillary second molars than females (p < 0.05). The prevalence of a second palatal canal in maxillary first and second molars were 0.9 and 0.6%, respectively. In the mandibular arch, the prevalence of two canals were observed in 5.1% of central incisors, 12.3% of lateral incisors, 6.1% of canines, 18.7% of first premolars and 0.5% of second premolars. The prevalence of a middle mesial canal, second distal canal and extra root (radix entomolaris) were detected in 1.9, 19.5 and 21.4% of mandibular first molars, respectively. The prevalence of a C-shaped canal was observed in 48.7% of mandibular second molars. Females displayed significantly higher prevalence of a C-shaped canal in the right mandibular second molars than males (p < 0.05). No other statistically significant differences in root anatomy and root canal morphology were observed in relation to gender and tooth side.

Conclusions

Wide variations in the root canal morphology exist among Malaysians. CBCT is a clinically useful tool in the identification of external and internal morphological variations in the human teeth.

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In vitro and in vivo cytotoxic activity and human serum albumin interaction for a methoxy-styryl-thiosemicarbazone

Summary

Thiosemicarbazone is a class of compounds with potential applications in medicine, presenting high capacity to inhibit the growth of cancer cells as well as low toxicity. Because of high interest in anticancer studies involving thiosemicarbazones as new chemotherapeutic agents, a synthetic thiosemicarbazone derivative, 4-N-(2′-methoxy-styryl)-thiosemicarbazone (MTSC) was evaluated in vivo against Ehrlich carcinoma in an animal model. In vivo results demonstrated that MTSC treatment induced the survival of mice and altered significantly the body weight of the surviving mice 12 days after tumor inoculation. Treatment with 30 mg/kg of MTSC exhibited effective cytotoxic activity with T/C values of 150.49% (1 dose) and 278% (2 doses). Its interaction with human serum albumin (HSA), which plays a crucial role in the biodistribution of a wide variety of ligands, was investigated by multiple spectroscopic techniques at 296 K, 303 K, and 310 K, as well as by theoretical calculations. The interaction between HSA and MTSC occurs via ground-state association in the subdomain IIA (Sudlow's site I). The binding is moderate (K_a ≈ 10⁴ M^–1), spontaneous, entropically, and enthalpically driven. Molecular docking results suggested hydrogen bonding and hydrophobic interactions as the main binding forces. Overall, the interaction HSA:MTSC could provide therapeutic benefits, improving its cytotoxic efficacy and tolerability.

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Acknowledgement of Reviewers 2018

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The cellular effects of novel triazine nitrogen mustards in glioblastoma LBC3, LN-18 and LN-229 cell lines

Summary

1,3,5-triazine is an important heterocyclic skeleton for mono, two or three 2-chloroethylamine groups. The study presented here provides novel information on cellular effects of 1,3,5-triazine with mono, two or three 2-chloroethylamine groups in glioblastoma LBC3, LN-18 and LN-229 cell lines. In our study, the most cytotoxic effect was observed in 1,3,5-triazine with three 2-chloroethylamine groups (12f compound). It has been demonstrated that 12f induce time- and dose-dependent cytotoxicity in all investigated glioma cell lines. Apart from that in glioblastoma cells, treated with 12f compound, we noticed strong induction of apoptosis. In conclusion, this research provides novel information concerning cellular effects of apoptosis in LBC3, LN-18 and LN-229 cell lines. Moreover, we suggest that 12f compound may be a candidate for further evaluation as an effective chemotherapeutic agent for human glioblastoma cells.

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Effects of Reverberation on the Relation Between Compression Speed and Working Memory for Speech-in-Noise Perception

Objectives: Previous study has suggested that when listening in modulated noise, individuals benefit from different wide dynamic range compression (WDRC) speeds depending on their working memory ability. Reverberation reduces the modulation depth of signals and may impact the relation between WDRC speed and working memory. The purpose of this study was to examine this relation across a range of reverberant conditions. Design: Twenty-eight older listeners with mild-to-moderate sensorineural hearing impairment were recruited in the present study. Individual working memory was measured using a Reading Span test. Sentences were combined with noise at two signal to noise ratios (2 and 5 dB SNR), and reverberation was simulated at a range of reverberation times (0.00, 0.75, 1.50, and 3.00 sec). Speech intelligibility was measured in listeners when listening to the sentences processed with simulated fast-acting and slow-acting WDRC conditions. Results: There was a significant relation between WDRC speed and working memory with minimal or no reverberation. Consistent with previous research, this relation was such that individuals with high working memory had higher speech intelligibility with fast-acting WDRC, and individuals with low working memory performed better with slow-acting WDRC. However, at longer reverberation times, there was no relation between WDRC speed and working memory. Conclusions: Consistent with previous studies, results suggest that there is an advantage of tailoring WDRC speed based on an individual's working memory under anechoic conditions. However, the present results further suggest that there may not be such a benefit in reverberant listening environments due to reduction in signal modulation. ACKNOWLEDGMENTS: The authors thank Tim Schoof for help with calibration, Laura Mathews and Melissa Sherman for assistance with participant recruitment, and Thomas Lunner for providing the Reading Span test. This research was funded by the National Institutes of Health Grants F31 DC015373 to P.R., R01 DC008168 to P.Z., and R01 DC006014 to P.S. The work presented in this manuscript represents an original contribution that has not been previously published or submitted for publication elsewhere. All authors contributed equally to this study. P.R. and P.S. collected and analyzed data and wrote the main article; P.Z. contributed to the study design and manuscript preparation. All authors discussed the results and implications and commented on the manuscript at all stages. The authors have no conflicts of interest to disclose. Address for correspondence: Pamela Souza, Department of Communication Sciences and Disorders, Northwestern University, 2240 E Campus Drive, Evanston, IL 60208, USA. E-mail: p-souza@northwestern.edu Received May 31, 2018; accepted November 26, 2018. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Use of Direct-Connect for Remote Speech-Perception Testing in Cochlear Implants

Objectives: Previous research has demonstrated the feasibility of programming cochlear implants (CIs) via telepractice. To effectively use telepractice in a comprehensive manner, all components of a clinical CI visit should be validated using remote technology. Speech-perception testing is important for monitoring outcomes with a CI, but it has yet to be validated for remote service delivery. The objective of this study, therefore, was to evaluate the feasibility of using direct audio input (DAI) as an alternative to traditional sound-booth speech-perception testing for serving people with CIs via telepractice. Specifically, our goal was to determine whether there was a significant difference in speech-perception scores between the remote DAI (telepractice) and the traditional (in-person) sound-booth conditions. Design: This study used a prospective, split-half-design to test speech perception in the remote DAI and in-person sound-booth conditions. Thirty-two adults and older children with CIs participated; all had a minimum of 6 months of experience with their device. Speech-perception tests included the consonant–nucleus–consonant (CNC) words, Hearing-in-Noise test (HINT) sentences, and Arizona Biomedical Institute at Arizona State University (AzBio) sentences. All three tests were administered at levels of 50 and 60 dBA in quiet. Sentence stimuli were also presented in 4-talker babble at signal to noise ratios (SNRs) of +10 and +5 dB for both the 50- and 60-dBA presentation levels. A repeated-measures analysis of variance was used to assess the effects of location (remote, in person), stimulus level (50, 60 dBA), and SNR (if applicable; quiet, +10, +5 dB) on each outcome measure (CNC, HINT, AzBio). Results: The results showed no significant effect of location for any of the tests administered (p > 0.1). There was no significant effect of presentation level for CNC words or phonemes (p > 0.2). There was, however, a significant effect of level (p

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Correlates of Hearing Aid Use in UK Adults: Self-Reported Hearing Difficulties, Social Participation, Living Situation, Health, and Demographics

Objectives: Hearing impairment is ranked fifth globally for years lived with disability, yet hearing aid use is low among individuals with a hearing impairment. Identifying correlates of hearing aid use would be helpful in developing interventions to promote use. To date, however, no studies have investigated a wide range of variables, this has limited intervention development. The aim of the present study was to identify correlates of hearing aid use in adults in the United Kingdom with a hearing impairment. To address limitations in previous studies, we used a cross-sectional analysis to model a wide range of potential correlates simultaneously to provide better evidence to aid intervention development. Design: The research was conducted using the UK Biobank Resource. A cross-sectional analysis of hearing aid use was conducted on 18,730 participants aged 40 to 69 years old with poor hearing, based on performance on the Digit Triplet test. Results: Nine percent of adults with poor hearing in the cross-sectional sample reported using a hearing aid. The strongest correlate of hearing aid use was self-reported hearing difficulties (odds ratio [OR] = 110.69 [95% confidence interval {CI} = 65.12 to 188.16]). Individuals who were older were more likely to use a hearing aid: for each additional year of age, individuals were 5% more likely to use a hearing aid (95% CI = 1.04 to 1.06). People with tinnitus (OR = 1.43 [95% CI = 1.26 to 1.63]) and people with a chronic illness (OR = 1.97 [95% CI = 1.71 to 2.28]) were more likely to use a hearing aid. Those who reported an ethnic minority background (OR = 0.53 [95% CI = 0.39 to 0.72]) and those who lived alone (OR = 0.80 [95% CI = 0.68 to 0.94]) were less likely to use a hearing aid. Conclusions: Interventions to promote hearing aid use need to focus on addressing reasons for the perception of hearing difficulties and how to promote hearing aid use. Interventions to promote hearing aid use may need to target demographic groups that are particularly unlikely to use hearing aids, including younger adults, those who live alone and those from ethnic minority backgrounds. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal's Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: The research was funded by a doctoral studentship supported by Sonova. The study was supported by the NIHR Manchester Biomedical Research Centre and the NIHR Greater Manchester Patient Safety Translational Research Centre. C.S.S and P.D.D. analyzed the data; C.S.S. wrote the article; P.D.D., C.J.A., K.J.M., and G.S. provided critical revision. All authors discussed the results and implications and commented on the manuscript at all stages. This research was conducted using the UK Biobank Resource. The authors have no conflicts of interest to disclose. Address for correspondence: Chelsea S. Sawyer, University of Manchester, HCD office, Ellen Wilkinson Building, Oxford Road, Manchester M13 9PL. E-mail: chelsea.sawyer@manchester.ac.uk Received February 28, 2018; accepted November 19, 2018. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Complete Glottic Obstruction by an Unusual Foreign Body.

Related Articles

Complete Glottic Obstruction by an Unusual Foreign Body.

Otolaryngol Head Neck Surg. 2019 Jan 15;:194599818824298

Authors: Davis RJ, Stewart CM

PMID: 30645187 [PubMed - as supplied by publisher]

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Otolaryngology Resident Reviewer Development Program: Lessons Learned from Cohort 1.

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Otolaryngology Resident Reviewer Development Program: Lessons Learned from Cohort 1.

Otolaryngol Head Neck Surg. 2019 Jan 15;:194599818823725

Authors: Schmalbach CE

Abstract
OBJECTIVE: To implement a quality improvement project addressing the knowledge gap in the otolaryngology resident and fellow scientific peer review process.
METHODS: The creation of the Resident Reviewer Development Program, cohort 1 outcomes, and subsequent lessons learned from the inaugural class are outlined using the plan-do-study-act model. Interested otolaryngology residents were paired with seasoned reviewers and conducted a minimum of 3 mentored peer reviews followed by an independent review test if competency was determined.
RESULTS: Twenty-five residents (postgraduate years [PGYs] 2-5) were actively enrolled in cohort 1. At 24 months, 18 (72%) graduated, 6 remained actively enrolled, and 1 did not successfully complete the program. The median number of practice reviews prior to testing was 3 (range, 3-6). The median independent review score was 83 (overall journal mean = 78). Cohort 1 graduates continued on to review 130 articles with a mean score of 85. Five (28%) graduates achieved Star Reviewer status.
DISCUSSION: The inaugural cohort demonstrated that the PGY-3 and PGY-4 class is ideal for enrollment given that completion of the program could take up to 24 months. Three mentored reviews were identified as the ideal minimum requirement for education. The accelerated achievement of Star Reviewer status (28%) and mean postgraduation score of 85 demonstrate successful and sustainable outcome measures.
IMPLICATIONS FOR PRACTICE: With appropriate mentorship and administrative support, scientific peer review can be formally incorporated into an educational program. Lessons learned during the educational program are sustained long term as demonstrated by review scores and Star Reviewer status.

PMID: 30645154 [PubMed - as supplied by publisher]

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Unsolicited Patient Complaints among Otolaryngologists.

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Unsolicited Patient Complaints among Otolaryngologists.

Otolaryngol Head Neck Surg. 2019 Jan 15;:194599818823706

Authors: Nassiri AM, Pichert JW, Domenico HJ, Galloway MB, Cooper WO, Bennett ML

Abstract
OBJECTIVES: To analyze unsolicited patient complaints (UPCs) among otolaryngologists, identify risk factors for UPCs, and determine the impact of physician feedback on subsequent UPCs.
METHODS: This retrospective study reviewed UPCs associated with US otolaryngologists from 140 medical practices from 2014 to 2017. A subset of otolaryngologists with high UPCs received peer-comparative feedback and was monitored for changes.
RESULTS: The study included 29,778 physicians, of whom 548 were otolaryngologists. UPCs described concerns with treatment (45%), communication (19%), accessibility (18%), concern for patients and families (10%), and billing (8%). Twenty-nine (5.3%) otolaryngologists were associated with 848 of 3659 (23.2%) total UPCs. Male sex and graduation from a US medical school were statistically significantly associated with an increased number of UPCs ( P = .0070 and P = .0036, respectively). Twenty-nine otolaryngologists with UPCs at or above the 95th percentile received peer-comparative feedback. The intervention led to an overall decrease in the number of UPCs following intervention ( P = .049). Twenty otolaryngologists (69%) categorized as "responders" reduced the number of complaints an average of 45% in the first 2 years following intervention.
DISCUSSION: Physician demographic data can be used to identify otolaryngologists with a greater number of UPCs. Most commonly, UPCs expressed concern regarding treatment. Peer-delivered, comparative feedback can be effective in reducing UPCs in high-risk otolaryngologists.
IMPLICATIONS FOR PRACTICE: Systematic monitoring and respectful sharing of peer-comparative patient complaint data offers an intervention associated with UPCs and concomitant malpractice risk reduction. Collegial feedback over time increases the response rate, but a small proportion of physicians will require directive interventions.

PMID: 30642235 [PubMed - as supplied by publisher]

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Multicenter Interrater Reliability in the Endoscopic Assessment of Velopharyngeal Function Using a Video Instruction Tool.

Related Articles

Multicenter Interrater Reliability in the Endoscopic Assessment of Velopharyngeal Function Using a Video Instruction Tool.

Otolaryngol Head Neck Surg. 2019 Jan 15;:194599818822989

Authors: Miller C, Bly R, Cofer S, Dahl JP, de Serres L, Goudy S, Hartzell L, Jabbour N, Kacmarysnki D, Macarthur C, Messner A, Milczuk H, Rastatter J, Swibel Rosenthal LH, Scott A, Tollefson T, Woolley A, Zdanski C, Zopf DA, Sie K

Abstract
OBJECTIVE: Assess interrater agreement of endoscopic assessment of velopharyngeal (VP) function before and after viewing the video instruction tool (VIT). We hypothesized improvement in interrater agreement using the Golding-Kushner scale (GKS) after viewing the VIT.
STUDY DESIGN: Prospective study.
SETTING: Multi-institutional.
METHODS: Sixteen fellowship-trained pediatric otolaryngologists who treat velopharyngeal insufficiency (VPI) rated 50 video segments using the GKS before and after watching the VIT. Raters assessed gap size percentage and lateral pharyngeal wall (LPW), soft palate (SP), and posterior pharyngeal wall (PPW) movement. Intraclass correlation coefficient was estimated for these continuous measures. Raters also indicated the presence of a palatal notch, Passavant's ridge, and aberrant pulsations (categorical variables). Fleiss κ coefficient was used for categorical variables. Wilcoxon signed-rank test was performed on the difference between the pre/post individual video ratings.
RESULTS: Reliability improved for all continuous variables after watching the instructional video. The improvement was significant for PPW (0.22-0.30, P < .001), SP (left: 0.63-0.68, P < .001 and right: 0.64-0.68, P = .001), and LPW (left: 0.49-0.54, P = .01 and right: 0.49-0.54, P = .09) but not significant for gap size (0.65-0.69, P = .36). Among categorical variables, agreement on Passavant's ridge significantly improved (0.30-0.36, P = .03).
CONCLUSION: Exposure to a video instruction tool improves interrater agreement of endoscopic assessment of VP function. Significant improvement was observed in our primary end points, specifically posterior pharyngeal wall movement, soft palate movement, and lateral pharyngeal wall movement. There was less impact of the VIT on the interrater agreement of the categorical variables, palatal notch, Passavant's ridge, and aberrant pulsations.

PMID: 30642231 [PubMed - as supplied by publisher]

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