Incremental and infrequent hemodialysis: a new paradigm for both dialysis initiation and conservative management.

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Incremental and infrequent hemodialysis: a new paradigm for both dialysis initiation and conservative management.

Panminerva Med. 2017 Jun;59(2):188-196

Authors: Rhee CM, Ghahremani-Ghajar M, Obi Y, Kalantar-Zadeh K

Abstract
Registry or national dialysis data show that a sizeable proportion of contemporary dialysis patients have substantial levels of residual kidney function especially upon transitioning to dialysis therapy. However, among incident hemodialysis patients, the prevailing paradigm has been to initiate "full-dose" triweekly treatment schedules irrespective of native kidney function in most developed countries. Recognizing the benefits of residual kidney function upon the health and survival of dialysis patients, there has been growing interest in incremental hemodialysis, in which dialysis frequency and dose are tailored according to the degree of patients' residual kidney function. Infrequent hemodialysis can also be used for those who prefer a more conservative approach in managing uremia. Clinical practice guidelines support the use of twice-weekly hemodialysis among patients with adequate residual kidney function (renal urea clearance >3 mL/min/1.73 m2), and a growing body of evidence indicates that incremental hemodialysis is associated with better preservation of residual kidney function without adversely impacting survival. Nonetheless, incremental hemodialysis remains an underutilized approach in this population. In this review, we will discuss the history of the twice- versus triweekly hemodialysis schedules; current clinical practice guidelines regarding infrequent hemodialysis; emerging data on incremental treatment regimens and outcomes; and guidelines for the practical implementation of incremental and infrequent hemodialysis in the clinical setting.

PMID: 28090764 [PubMed - indexed for MEDLINE]

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Efficacy of brief behavioral counselling by allied health professionals to promote physical activity in people with peripheral arterial disease (BIPP): study protocol for a multi-center randomized controlled trial.

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Efficacy of brief behavioral counselling by allied health professionals to promote physical activity in people with peripheral arterial disease (BIPP): study protocol for a multi-center randomized controlled trial.

BMC Public Health. 2016 Nov 09;16(1):1148

Authors: Burton NW, Ademi Z, Best S, Fiatarone Singh MA, Jenkins JS, Lawson KD, Leicht AS, Mavros Y, Noble Y, Norman P, Norman R, Parmenter BJ, Pinchbeck J, Reid CM, Rowbotham SE, Yip L, Golledge J

Abstract
BACKGROUND: Physical activity is recommended for people with peripheral arterial disease (PAD), and can improve walking capacity and quality of life; and reduce pain, requirement for surgery and cardiovascular events. This trial will assess the efficacy of a brief behavioral counselling intervention delivered by allied health professionals to improve physical activity in people with PAD.
METHODS: This is a multi-center randomised controlled trial in four cities across Australia. Participants (N = 200) will be recruited from specialist vascular clinics, general practitioners and research databases and randomised to either the control or intervention group. Both groups will receive usual medical care, a written PAD management information sheet including advice to walk, and four individualised contacts from a protocol-trained allied health professional over 3 months (weeks 1, 2, 6, 12). The control group will receive four 15-min telephone calls with general discussion about PAD symptoms and health and wellbeing. The intervention group will receive behavioral counselling via two 1-h face-to-face sessions and two 15-min telephone calls. The counselling is based on the 5A framework and will promote interval walking for 3 × 40 min/week. Assessments will be conducted at baseline, and 4, 12 and 24 months by staff blinded to participant allocation. Objectively assessed outcomes include physical activity (primary), sedentary behavior, lower limb body function, walking capacity, cardiorespiratory fitness, event-based claudication index, vascular interventions, clinical events, cardiovascular function, circulating markers, and anthropometric measures. Self-reported outcomes include physical activity and sedentary behavior, walking ability, pain severity, and health-related quality of life. Data will be analysed using an intention-to-treat approach. An economic evaluation will assess whether embedding the intervention into routine care would likely be value for money. A cost-effectiveness analysis will estimate change in cost per change in activity indicators due to the intervention, and a cost-utility analysis will assess change in cost per quality-adjusted life year. A full uncertainty analysis will be undertaken, including a value of information analysis, to evaluate the economic case for further research.
DISCUSSION: This trial will evaluate the efficacy and cost-effectiveness of a brief behavioral counselling intervention for a common cardiovascular disease with significant burden.
TRIAL REGISTRATION: ACTRN 12614000592640 Australian New Zealand Clinical Trials Registry. Registration Date 4 June 2014.

PMID: 27829449 [PubMed - indexed for MEDLINE]

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Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection.

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Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection.

Surg Endosc. 2016 Nov;30(11):4809-4816

Authors: Ihnát P, Guňková P, Peteja M, Vávra P, Pelikán A, Zonča P

Abstract
BACKGROUND: Anastomotic leakage presents the most feared complication after low anterior resection (LAR). A proximal diversion of the gastrointestinal tract is recommended to avoid septic complications of anastomotic leakage. The aim of the present study was to evaluate the benefits and risks of diverting ileostomy (DI) created during laparoscopic LAR because of low rectal cancer.
METHODS: This was a retrospective clinical cohort study conducted to assess outcomes of laparoscopic LAR with/without DI in a single institution within a 6-year period.
RESULTS: In total, 151 patients were enrolled in the study (73 patients without DI, 78 patients with DI). There were no significant differences between both groups regarding demographic and clinical features. Overall 30-day morbidity rates were significantly lower in patients without DI (23.3 vs. 42.3 %, P = 0.013). Symptomatic anastomotic leakage occurred more frequently in patients without DI (9.6 vs. 2.5 %, P = 0.090); surgical intervention was needed in 6.8 % of patients without DI. Post-operative hospital stay was significantly longer in the group of patients with DI (11.3 ± 8.5 vs. 8.1 ± 6.9 days, P = 0.013). Stoma-related complications occurred in 42 of 78 (53.8 %) patients with DI; some patients had more than one complication. Acute surgery was needed in 9 patients (11.5 %) because of DI-related complications. Small bowel obstruction due to DI semi-rotation around its longitudinal axis was seen in 3 patients (3.8 %) and presents a distinct complication of DI laparoscopic construction. The mean interval between LAR and DI reversal was more than 8 months; only 19.2 % of patients were reversed without delay (≤4 months). Morbidity after DI reversal was 16.6 %; re-laparotomy was necessary in 2.5 % of patients.
CONCLUSIONS: The present study indicates that DI protects low rectal anastomosis from septic complications at a cost of many stoma-related complications, substantial risk of acute surgery necessity and long stoma periods coupled with decreased quality of life.

PMID: 26902615 [PubMed - indexed for MEDLINE]

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Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

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Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

Endoscopy. 2016 Oct;48(10):939-48

Authors: Spaander MC, Baron TH, Siersema PD, Fuccio L, Schumacher B, Escorsell À, Garcia-Pagán JC, Dumonceau JM, Conio M, de Ceglie A, Skowronek J, Nordsmark M, Seufferlein T, Van Gossum A, Hassan C, Repici A, Bruno MJ

Abstract
This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE), endorsed by the European Society for Radiotherapy and Oncology (ESTRO), the European Society of Digestive Endoscopy (ESDO), and the European Society for Clinical Nutrition and Metabolism (ESPEN). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations for malignant disease 1 ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliative treatment of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass (strong recommendation, high quality evidence). 2 For patients with longer life expectancy, ESGE recommends brachytherapy as a valid alternative or in addition to stenting in esophageal cancer patients with malignant dysphagia. Brachytherapy may provide a survival advantage and possibly a better quality of life compared to SEMS placement alone. (Strong recommendation, high quality evidence.) 3 ESGE recommends esophageal SEMS placement as the preferred treatment for sealing malignant tracheoesophageal or bronchoesophageal fistula (strong recommendation, low quality evidence). 4 ESGE does not recommend the use of concurrent external radiotherapy and esophageal stent treatment. SEMS placement is also not recommended as a bridge to surgery or prior to preoperative chemoradiotherapy. It is associated with a high incidence of adverse events and alternative satisfactory options such as placement of a feeding tube are available. (Strong recommendation, low quality evidence.) Main recommendations for benign disease 1 ESGE recommends against the use of self-expandable stents (SEMSs) as first-line therapy for the management of benign esophageal strictures because of the potential for adverse events, the availability of alternative therapies, and costs (strong recommendation, low quality evidence). 2 ESGE suggests consideration of temporary placement of SEMSs as therapy for refractory benign esophageal strictures (weak recommendation, moderate evidence). Stents should usually be removed at a maximum of 3 months (strong recommendation, weak quality evidence). 3 ESGE suggests that fully covered SEMSs be preferred over partially covered SEMSs for the treatment of refractory benign esophageal strictures, because of their lack of embedment and ease of removability (weak recommendation, low quality evidence). 4 For the removal of partially covered esophageal SEMSs that are embedded, ESGE recommends the stent-in-stent technique (strong recommendation, low quality evidence). 5 ESGE recommends that temporary stent placement can be considered for treating esophageal leaks, fistulas, and perforations. The optimal stenting duration remains unclear and should be individualized. (Strong recommendation, low quality evidence.) 6 ESGE recommends placement of a SEMS for the treatment of esophageal variceal bleeding refractory to medical, endoscopic, and/or radiological therapy, or as initial therapy for patients with massive esophageal variceal bleeding (strong recommendation, moderate quality evidence).

PMID: 27626318 [PubMed - indexed for MEDLINE]

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Health-related quality of life, rehabilitation and mortality in a nursing home population.

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Health-related quality of life, rehabilitation and mortality in a nursing home population.

Neth J Med. 2016 Jul;74(6):247-56

Authors: Hartog LC, Landman GW, Cimzar-Sweelssen M, Knipscheer A, Groenier KH, Kleefstra N, Bilo HJ, van Hateren KJ

Abstract
BACKGROUND: Health-related quality of life (HRQOL) in nursing home residents is generally low. The purpose of this study was to investigate the associations between HRQOL and two clinically relevant outcome measures, all-cause mortality and successful rehabilitation, in a nursing home population.
METHODS: In an observational prospective cohort study in a nursing home population, HRQOL was assessed with the RAND-36. A total of 184 patients were included, 159 (86%) completed the RAND-36 and were included in the study. A Cox proportional hazard model was used to investigate the independent association between HRQOL, rehabilitation and mortality with adjustment for confounders. Risk prediction capabilities were assessed with Harrell's C statistics and the proportion of explained variance (R2).
RESULTS: The median age (interquartile range) was 79 (75-85) years. The health dimensions vitality (HR 0.88 (95% CI 0.77-0.99)) and mental health (HR 0.86 (95% CI 0.75-0.98)) were inversely associated and role functioningphysical (HR 1.08 (95%CI 1.02-1.15)) was positively associated with mortality. The Harrell's C value and the R2 were ≤ 0.02 and ≤ 0.03 higher in the adjusted models with the dimensions role functioning- physical, mental health or vitality compared with the models without these dimensions. None of the health dimensions or summary scales were related to successful rehabilitation.
CONCLUSION: HRQOL was significantly associated with mortality for three dimensions, but partly in opposite directions. Additional value of HRQOL in mortality prediction is very limited. There were no independent associations between HRQOL and successful rehabilitation. Although HRQOL is an important outcome, this study did not provide evidence for an association between HRQOL and successful rehabilitation.

PMID: 27571722 [PubMed - indexed for MEDLINE]

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Fifteen-year mortality of patients with asthma-COPD overlap syndrome.

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Fifteen-year mortality of patients with asthma-COPD overlap syndrome.

Eur J Intern Med. 2016 Oct;34:72-77

Authors: Sorino C, Pedone C, Scichilone N

Abstract
BACKGROUND: The coexistence of asthma and chronic obstructive pulmonary disease (asthma-COPD overlap syndrome: ACOS) is increasingly recognized but data about its prevalence and long-term mortality are needed.
METHODS: Prevalence of ACOS and 15-year mortality rates were assessed in 1065 subjects aged >65years, enrolled in the SA.R.A. study, with complete clinical, lung functional and follow-up data. Physical performance, disease-related disability, and health-related quality of life (HRQL) were also evaluated.
RESULTS: ACOS was found in 11.1% of subjects (29.4% of those previously diagnosed with COPD and 19.7% of those with asthma). ACOS was positively associated with impaired physical performance, functional ability, and HRQL. Individuals with ACOS had higher mortality rates than controls (7.17 per 100 person-years; mortality rate ratio: 1.83). After adjustment for the main confounders, the risk of all-cause mortality remained significantly increased in subjects with ACOS (HR: 1.82), COPD (HR: 2.12), and restriction (HR: 2.41), but not asthma.
CONCLUSIONS: Long-term prognosis of ACOS was similar to COPD, and worse than asthma and healthy controls. ACOS had a significant impact on physical performance, functional ability, and HRQL.

PMID: 27357368 [PubMed - indexed for MEDLINE]

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Design and rationale of a prospective, multi-institutional registry for patients with sinonasal malignancy.

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Design and rationale of a prospective, multi-institutional registry for patients with sinonasal malignancy.

Laryngoscope. 2016 Sep;126(9):1977-80

Authors: Beswick DM, Holsinger FC, Kaplan MJ, Fischbein NJ, Hara W, Colevas AD, Le QT, Berry GJ, Hwang PH

Abstract
OBJECTIVES/HYPOTHESIS: Assessment of patients with sinonasal malignancy is challenging due to the low disease incidence and diverse histopathology. The current literature is composed mainly of retrospective studies with heterogeneous cohorts, and the rarity of cases limits our understanding of disease characteristics and treatment outcomes. We describe the development of a prospective, multi-institutional registry that utilizes cloud-based computing to evaluate treatment outcomes in patients with sinonasal cancer.
METHODS: A web-based, secure database was built to prospectively capture longitudinal outcomes and quality-of-life (QoL) data in patients diagnosed with sinonasal malignancy. Demographics, tumor staging, and treatment outcomes data are being collected. The Sinonasal Outcome Test-22 and University of Washington Quality of Life Questionnaire are administered at presentation and at recurring intervals. To date, seven institutions are participating nationally.
CONCLUSION: This prospective, multi-institutional registry will provide novel oncological and QoL outcomes on patients with sinonasal malignancy to inform management decisions and disease prognostication. The application of cloud-based computing facilitates secure multi-institutional collaboration and may serve as a model for future registry development for the study of rare diseases in otolaryngology.
LEVEL OF EVIDENCE: 2C Laryngoscope, 126:1977-1980, 2016.

PMID: 27283472 [PubMed - indexed for MEDLINE]

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Digestive System Mixed Neuroendocrine-Non-Neuroendocrine Neoplasms

Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN) are a heterogeneous subgroup of rare neoplasms that represent about a third of all poorly differentiated neuroendocrine carcinomas (PDNEC). MiNEN combine a neuroendocrine component, usually a PDNEC, and a non-neuroendocrine component, generally an adenocarcinoma, both accounting for at least 30% of the neoplasm. MiNEN are classified as high-, intermediate-, or low-grade malignancies depending on the metastatic potential of the tumour components. High-grade malignant component should be considered even if it represents Neuroendocrinology

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Correction: Nonlinear Dynamics Forecasting of Obstructive Sleep Apnea Onsets.

Correction: Nonlinear Dynamics Forecasting of Obstructive Sleep Apnea Onsets.

PLoS One. 2017;12(8):e0183422

Authors: Le TQ, Bukkapatnam STS

Abstract
[This corrects the article DOI: 10.1371/journal.pone.0164406.].

PMID: 28797079 [PubMed - in process]

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Singing from North to South: latitudinal variation in timing of dawn singing under natural and artificial light conditions.

Singing from North to South: latitudinal variation in timing of dawn singing under natural and artificial light conditions.

J Anim Ecol. 2017 Aug 10;:

Authors: Da Silva A, Kempenaers B

Abstract
1. Animals breeding at northern latitudes experience drastic changes in daily light conditions during the breeding season with decreasing periods of darkness, whereas those living at lower latitudes are exposed to naturally dark nights throughout the year. Nowadays, many animals are also exposed to artificial night lighting (often referred to as light pollution). 2. Animals strongly rely on variation in light levels to time their daily and seasonal behaviour. Previous work on passerine birds showed that artificial night lighting leads to earlier onset of dawn song. However, these studies were carried out at intermediate latitudes with more limited seasonal changes in daylength, and we still lack an understanding of the impact of artificial night lighting in relation to variation in natural light conditions. 3. We investigated the influence of natural and artificial light conditions on the timing of dawn singing in five common songbird species in each of three regions in Europe that differed in natural variation in daylength (northern Finland, 65°N; southern Germany, 48°N; southern Spain, 37°N). In each region, we selected five peri-urban forest sites with and five without street lighting, and recorded dawn singing at the beginning of the local breeding season. 4. Our results show that the earliest natural singers, i.e., European robins (Erithacus rubecula) and common blackbirds (Turdus merula), started dawn singing earlier along with the natural increase in night brightness in Finland, with no additional effects of artificial night lighting. In contrast, the later singers, i.e., great tits (Parus major), blue tits (Cyanistes caeruleus), and chaffinches (Fringilla coelebs), showed similar onsets of dawn song relative to sunrise across the season and similar effects of artificial night lighting at all latitudes. 5. Artificial night lighting affected great tits, blue tits and chaffinches even in northern Finland where nights became very bright. Proximate factors such as differential light sensitivities may explain why early singers showed more plastic behavioural responses to naturally and artificially bright nights. The maintenance of rhythmicity in the late singers during bright northern nights and under artificial night lighting may also be an adaptive response to predation risk or costs of sleep loss. This article is protected by copyright. All rights reserved.

PMID: 28796893 [PubMed - as supplied by publisher]

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Inflammatory Tracheobronchitis Related to Ulcerative Colitis.

Inflammatory Tracheobronchitis Related to Ulcerative Colitis.

J Bronchology Interv Pulmonol. 2017 Aug 07;:

Authors: Dy RV, Xu B, Dhillon SS

PMID: 28796718 [PubMed - as supplied by publisher]

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Sleep Disorder Diagnosis During Pregnancy and Risk of Preterm Birth.

Sleep Disorder Diagnosis During Pregnancy and Risk of Preterm Birth.

Obstet Gynecol. 2017 Aug 04;:

Authors: Felder JN, Baer RJ, Rand L, Jelliffe-Pawlowski LL, Prather AA

Abstract
OBJECTIVE: To test the hypothesis that sleep disorder diagnosis would be associated with increased risk of preterm birth and to examine risk by gestational age, preterm birth type, and specific sleep disorder (insomnia, sleep apnea, movement disorder, and other).
METHODS: In this observational study, participants were from a cohort of nearly 3 million women in California between 2007 and 2012. Inclusion criteria were women with singleton neonates liveborn between 20 and 44 weeks of gestation without chromosomal abnormalities or major structural birth defects linked to a hospital discharge database maintained by the California Office of Statewide Health Planning and Development and without mental illness during pregnancy. Sleep disorder was defined based on International Classification of Diseases, 9th Revision, Clinical Modification diagnostic code (n=2,265). Propensity score matching was used to select a referent population at a one-to-one ratio. Odds of preterm birth were examined by gestational age (less than 34 weeks, 34-36 weeks, and less than 37 weeks of gestation) and type (spontaneous, indicated).
RESULTS: Prevalence of preterm birth (before 37 weeks of gestation) was 10.9% in the referent group compared with 14.6% among women with a recorded sleep disorder diagnosis. Compared with the referent group, odds (95% CI, P value, percentage) of preterm birth were 1.3 (1.0-1.7, P=.023, 14.1%) for insomnia and 1.5 (1.2-1.8, P<.001, 15.5%) for sleep apnea. Risk varied by gestational age and preterm birth type. Odds of preterm birth were not significantly increased for sleep-related movement disorders or other sleep disorders.
CONCLUSION: Insomnia and sleep apnea were associated with significantly increased risk of preterm birth. Considering the high prevalence of sleep disorders during pregnancy and availability of evidence-based nonpharmacologic interventions, current findings suggest that screening for severe presentations would be prudent.

PMID: 28796676 [PubMed - as supplied by publisher]

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Cine MRI of Tracheal Dynamics in Healthy Volunteers and Patients With Tracheobronchomalacia.

Cine MRI of Tracheal Dynamics in Healthy Volunteers and Patients With Tracheobronchomalacia.

AJR Am J Roentgenol. 2017 Aug 10;:1-5

Authors: Ciet P, Boiselle PM, Heidinger B, Andrinopoulou ER, O'Donnel C, Alsop DC, Litmanovich DE

Abstract
OBJECTIVE: Bronchoscopy and MDCT are routinely used to assess tracheobronchomalacia (TBM). Recently, dynamic MRI (cine MRI) has been proposed as a radiation-free alternative to MDCT. In this study, we tested cine MRI assessment of airway dynamics during various breathing conditions and compared cine MRI and MDCT measurements in healthy volunteers and patients with suspected TBM.
CONCLUSION: Cine MRI was found to be a technically feasible alternative to MDCT for assessing central airway dynamics.

PMID: 28796542 [PubMed - as supplied by publisher]

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Oxygen Therapy for Interstitial Lung Disease: Physicians' Perceptions and Experiences.

Oxygen Therapy for Interstitial Lung Disease: Physicians' Perceptions and Experiences.

Ann Am Thorac Soc. 2017 Aug 10;:

Authors: Khor YH, Goh NS, McDonald CF, Holland AE

Abstract
RATIONALE: Domiciliary oxygen therapy (DOT) is commonly prescribed for patients with interstitial lung disease (ILD) and hypoxaemia, although evidence supporting benefit is limited.
OBJECTIVES: The aim of this study was to explore perspectives of respiratory physicians about DOT in patients with ILD.
METHODS: A qualitative study was undertaken with 26 respiratory physicians from Australia. Interviews were transcribed verbatim and coded independently by two investigators. Themes were established by consensus.
RESULTS: Physicians reported symptomatic relief as the main indication for prescribing DOT in ILD. Concerns were raised regarding the applicability of current clinical guidelines for DOT to ILD. Compared to patients with other lung diseases, there was a lower threshold for DOT prescription for patients with ILD. Physicians perceived patients with ILD complied better with recommended DOT prescription. There was significant variation in infrastructure for oxygen assessment and prescription, patient support and equipment provision amongst institutions and states. Various patients' attitudes and experiences towards DOT were reported, but notable was physicians' perception of significant anxiety in most patients using DOT due to social stigma and concerns that DOT signified end-stage disease.
CONCLUSIONS: Oxygen therapy was primarily prescribed for symptomatic management in patients with ILD. Education provision and supports regarding DOT varied significantly.

PMID: 28796538 [PubMed - as supplied by publisher]

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Role of Leptin in Obstructive Sleep Apnea.

Role of Leptin in Obstructive Sleep Apnea.

Ann Am Thorac Soc. 2017 Aug 10;:

Authors: Imayama I, Prasad B

Abstract
Leptin is a peptide hormone mainly produced in white adipose tissue. It is known to regulate energy homeostasis, inflammation, metabolism, and sympathetic nerve activity. Increasing evidence suggests it has a role in ventilatory function and upper airway obstruction. Leptin levels correlate positively with measurements of adiposity and can potentially provide important insights into the pathophysiology of diseases associated with obesity. Obesity is a strong risk factor for obstructive sleep apnea, a disease characterized by periodic upper airway occlusion during sleep. The neuromuscular activity that maintains upper airway patency during sleep and the anatomy of upper airway are key factors involved in its pathogenesis. Experimental studies using animal models of a low leptin state such as leptin deficiency have shown that leptin regulates sleep architecture, upper airway patency, ventilatory function, and hypercapnic ventilatory response. However, findings from human studies do not consistently support the data from the animal models. The effect of leptin on the pathophysiology of obstructive sleep apnea is being investigated, but the results of studies have been confounded by its diurnal variation and the short-term effects of feeding, adiposity, age, and gender. Improved study design and methods of assessing functional leptin levels, specifically its central versus peripheral effects, will improve our understanding of the role of leptin in sleep apnea.

PMID: 28796527 [PubMed - as supplied by publisher]

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Association of adiponectin level and obstructive sleep apnea prevalence in obese subjects.

Association of adiponectin level and obstructive sleep apnea prevalence in obese subjects.

Medicine (Baltimore). 2017 Aug;96(32):e7784

Authors: Zeng F, Wang X, Hu W, Wang L

Abstract
Obstructive sleep apnea (OSA) is prevalent in obese subjects. Plasma adiponectin level in obese subjects is decreased. Whether reduced adiponectin level is associated with OSA is unknown. Participants without a previous diagnosis of OSA or who have not been treated with continuous positive airway pressure were enrolled and parameters of interest were collected. Polysomnography was performed to evaluate the presence of OSA and the severity of OSA as indexed by the apnea-hypopnea index (AHI). Between-group differences were analyzed. Pearson correlation analysis was used to evaluate the association between body mass index (BMI) with plasma levels of adiponectin and C-reactive protein (CRP) and AHI; and the association between plasma adiponectin level with CRP and AHI was also evaluated. Logistic regression analysis was conducted to evaluate the association between per 1-SD standardized decrease of plasma adiponectin level and the prevalence of OSA using stepwise adjustment models. A total of 486 participants were enrolled and the mean BMI was 26.9 ± 6.2 kg/m with obesity prevalence of 28%; and the mean AHI was 12.6 ± 8.9 per sleep hour with OSA prevalence of 42%. The mean adiponectin level was 18.4 ± 10.6 μg/mL. Compared with the nonobese group, participants in the obese group had higher BMI, neck girth, waist circumference, and AHI (P < .05 for all comparisons). The prevalence of OSA (51% vs 37%) and the proportion of moderate OSA (49% vs 42%) were also significantly higher, while adiponectin level (14.6 ± 8.7 μg/mL vs 20.7 ± 10.5 μg/mL) was significantly lower. In the obese group, plasma adiponectin level was decreased gradually with the increasing severity of OSA, which was not observed in the nonobese group. BMI was negatively correlated with adiponectin while positively correlated with CRP and AHI; and adiponectin was negatively correlated with both CRP and AHI. After adjusted for covariates including BMI and waist circumference, adiponectin remained significantly associated with OSA prevalence with odds ratio of 1.20 (95% confidence interval 1.12-1.65). In summary, our preliminary study suggests that in obese subjects, plasma adiponectin level is associated with the prevalence of OSA.

PMID: 28796077 [PubMed - in process]

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Resistance training does not alter same-day sleep architecture in institutionalized older adults.

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Resistance training does not alter same-day sleep architecture in institutionalized older adults.

J Sleep Res. 2017 Aug 10;:

Authors: Herrick JE, Puri S, Richards KC

Abstract
Sleep disturbance is a common symptom in institutionalized older adults that reduces their quality of life and may contribute to progression of cognitive impairment. While we found that a 7-week combination of resistance training, walking and social activity significantly improved sleep in institutionalized older adults compared with a usual care control group, no one to our knowledge has determined the acute effects of resistance training on same-day sleep in this population. Given the effort required to promote exercise adherence in institutionalized older adults and to obtain a positive training effect, understanding of the acute effects of resistance training on same-day sleep architecture should be elucidated, especially with respect to unintended consequences. This secondary data analysis assessed if resistance training altered the same-day sleep architecture in institutionalized older adults. Forty-three participants (age 81.5 ± 8.1 years, male = 17, female = 26) had two attended overnight polysomnography tests in their rooms for sleep architecture analysis; one polysomnography with same-day resistance training, one without any resistance training. Resistance training consisted of chest and leg press exercises (three sets, eight repetitions, 80% predicted one-repetition maximum). There were no significant changes in sleep architecture between either polysomnography nights; sleep efficiency (P = 0.71), time in non-rapid eye movement stages (P = 0.50), time in rapid eye movement stages (P = 0.14), time awake (P = 0.56), time until sleep onset (P = 0.47), total sleep stage shifts (P = 0.65) or rapid eye movement sleep stage latency (P = 0.57). Our results show no acute same-day effects of resistance training on sleep architecture in institutionalized older adults. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT00888706.

PMID: 28795452 [PubMed - as supplied by publisher]

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Upper airway surgery for obstructive sleep apnea reduces blood pressure.

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Upper airway surgery for obstructive sleep apnea reduces blood pressure.

Laryngoscope. 2017 Aug 10;:

Authors: Pang KP, Pang EB, Pang KA, Vicini C, Chan YH, Rotenberg BW

Abstract
OBJECTIVES/HYPOTHESIS: To evaluate if upper airway surgery reduces blood pressure in patients with obstructive sleep apnea (OSA).
STUDY DESIGN: Prospective series.
METHODS: A prospective series of 112 consecutive OSA patients with hypertension (HTN). All patients were > 18 years old, respiratory disturbance index >5, all levels of apnea-hypopnea index (AHI), with a history of HTN treated with medication for at least 6 months. Surgical procedures included septoplasty, turbinate reduction, palate surgery, and tongue base reduction.
RESULTS: There were 92 men and 20 women, with a mean age of 48.6 years, mean body mass index (BMI) was 27.5 (range, 19.7-34.7). Mean follow-up was 16.1 months. The mean preoperative AHI was 32.6 (range, 1.2-104), with the mean lowest oxygen saturation (LSAT) of 79.9% (range, 52%-93%). The mean adjusted preoperative and postoperative systolic blood pressure (SBP) was reduced from 146 ± 15.3 mm Hg to 122 ± 12.5 mm Hg (P < .001), and diastolic blood pressure (DBP) was reduced from 91 ± 10.2 mm Hg to 76 ± 7.8 mm Hg (P < .001). There was a decrease in overall BMI from 27.5 ± 3.6 to 25.5 ± 3.0 (P < .001); however, based on multivariate analysis, the reduction in SBP and DBP was not affected by this BMI reduction. Fifty-eight patients (51.8%) did not require their antihypertensive after surgery. There was poor correlation noted between HTN with AHI, LSAT, and oxygen duration <90%.
CONCLUSIONS: Upper airway surgery does reduce SBP and DBP in patients with OSA.
LEVEL OF EVIDENCE: 4. Laryngoscope, 2017.

PMID: 28795409 [PubMed - as supplied by publisher]

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Integrated Imaginative Distention Therapy to Cope with Fatigue. DIMMI SI Study: The First Randomized Controlled Trial in Multiple Sclerosis.

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Integrated Imaginative Distention Therapy to Cope with Fatigue. DIMMI SI Study: The First Randomized Controlled Trial in Multiple Sclerosis.

Neurol Ther. 2017 Aug 09;:

Authors: Sgoifo A, Bignamini A, La Mantia L, Celani MG, Parietti P, Ceriani MA, Marazzi MR, Proserpio P, Nobili L, Protti A, Agostoni EC

Abstract
INTRODUCTION: Fatigue is a frequent, disabling, and difficult to treat symptom in neurological disease and in other stress-related conditions; Integrated Imaginative Distention (IID) is a therapy combining muscular and imaginative relaxation, feasible also in disabled subjects; the DIMMI SI trial was planned to evaluate IID efficacy on fatigue.
METHODS: The design was a parallel, randomised 1:1 (intervention:waiting list), controlled, open-label trial. Participants were persons with multiple sclerosis (pwMS), persons with insomnia (pwINS), and health professionals (HP) as conditions related to fatigue and stress. The primary outcome was the post-intervention change of fatigue; secondary outcomes were changes in insomnia, stress, and quality of life (QoL). Eight IID weekly training group sessions were delivered by a skilled psychotherapist. The study lasted 12 months.
RESULTS: One hundred and forty-four subjects were enrolled, 48 for each condition. The mean change in Modified Fatigue Impact Scale (MFIS) score among exposed was 7.7 [95% CI 1.1, 14.4] (P = 0.023) in pwMS; 7.1 [1.9, 12.3] (P = 0.007) among pwINS, and 11.3 [4.3, 18.2] among HP (P = 0.002). At the last follow-up, the benefit was confirmed on physical fatigue for pwMS, on total fatigue for pwINS and HP.
CONCLUSIONS: DIMMI SI is the first randomized controlled trial evaluating the efficacy of IID on fatigue. IID resulted a complementary intervention to reduce fatigue in stress-related conditions, in both health and disease status. NCT02290990ClinicalTrials.gov.

PMID: 28795383 [PubMed - as supplied by publisher]

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Leptocarpus disjunctus prolongs sleeping time and increases nonrapid eye movement sleep with additional anxiolytic capacity.

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Leptocarpus disjunctus prolongs sleeping time and increases nonrapid eye movement sleep with additional anxiolytic capacity.

J Adv Pharm Technol Res. 2017 Jul-Sep;8(3):97-101

Authors: Damjuti W, Fuangfoo T, Palanuvej C, Li T, Ruangrungsi N

Abstract
Leptocarpus disjunctus Mast. (Restionaceae) is an edible plant which has indigenous warnings regarding its side effects which can manifest as dizziness. This study investigated hypnotic and anxiolytic properties using several animal models. Anxiolytic activities were evaluated using locomotor determination by elevated plus-maze test, open-field test, and rotarod performance test. Hypnotic activities were performed using pentobarbital sodium-induced sleeping time test. Sleep architecture and quality were obtained from sleep-wake analysis and nonrapid eye movement (NREM) delta activity using electroencephalography. An ethanolic extract of L. disjunctus indicated effective potencies for hypnotic test, locomotor activities, and sleep-wake analysis. Ethanolic extract showed a dose relationship with sleeping time for pentobarbital-induced sleeping time test (P < 0.01) and also an antagonistic effect on shortening in sleep time induced by flumazenil. The consort significantly decreased locomotor activities among animals undergoing elevated plus-maze test, open-field test, and rotarod performance test, whereas sleep-wake analysis showed that sleeping time and NREM sleep increased. Ethanolic extract of L. disjunctus was shown to be anxiolytic, with the possibly of benzodiazepine-like hypnotic activity.

PMID: 28795023 [PubMed]

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Symptom correlates of cerebral blood flow following acute concussion.

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Symptom correlates of cerebral blood flow following acute concussion.

Neuroimage Clin. 2017;16:234-239

Authors: Churchill NW, Hutchison MG, Graham SJ, Schweizer TA

Abstract
Concussion is associated with significant symptoms within hours to days post-injury, including disturbances in physical function, cognition, sleep and emotion. However, little is known about how subjective impairments correlate with objective measures of cerebrovascular function following brain injury. This study examined the relationship between symptoms and cerebral blood flow (CBF) in individuals following sport-related concussion. Seventy university level athletes had CBF measured using Arterial Spin Labelling (ASL), including 35 with acute concussion and 35 matched controls and their symptoms were assessed using the Sport Concussion Assessment Tool 3 (SCAT3). For concussed athletes, greater total symptom severity was associated with elevated posterior cortical CBF, although mean CBF was not significantly different from matched controls (p = 0.46). Examining symptom clusters, athletes reporting greater cognitive symptoms also had lower frontal and subcortical CBF, relative to athletes with greater somatic symptoms. The "cognitive" and "somatic" subgroups also exhibited significant differences in CBF relative to controls (p ≤ 0.026). This study demonstrates objective CBF correlates of symptoms in recently concussed athletes and shows that specific symptom clusters may have distinct patterns of altered CBF, significantly extending our understanding of the neurobiology of concussion and traumatic brain injury.

PMID: 28794982 [PubMed - in process]

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RAI1 Overexpression Promotes Altered Circadian Gene Expression and Dyssomnia in Potocki-Lupski Syndrome.

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RAI1 Overexpression Promotes Altered Circadian Gene Expression and Dyssomnia in Potocki-Lupski Syndrome.

J Pediatr Genet. 2017 Sep;6(3):155-164

Authors: Mullegama SV, Alaimo JT, Fountain MD, Burns B, Balog AH, Chen L, Elsea SH

Abstract
Retinoic acid induced 1 ( RAI1 ) encodes a dosage-sensitive gene that when haploinsufficient results in Smith-Magenis syndrome (SMS) and when overexpressed results in Potocki-Lupski syndrome (PTLS). Phenotypic and molecular evidence illustrates that haploinsufficiency of RAI1 disrupts circadian rhythm through the dysregulation of the master circadian regulator, circadian locomotor output cycles kaput ( CLOCK) , and other core circadian components, contributing to prominent sleep disturbances in SMS. However, the phenotypic and molecular characterization of sleep features in PTLS has not been elucidated. Using the Pittsburgh Sleep Quality Index (PSQI), caregivers of 15 school-aged children with PTLS reported difficulties in initiating sleep. Indeed, more than 70% of individuals manifested moderate to severe sleep latency, as defined by the PSQI. Moreover, these individuals manifested difficulties in sleep maintenance, with middle of the night and early morning awakenings. When assessing daytime sleepiness through the Epworth Sleepiness Scale, approximately 21% of the individuals manifested excessive daytime somnolence. This indicates that mild dyssomnia characterizes the majority of the sleep phenotype, with occasionally problematic daytime somnolence, a phenotype different than that expressed by individuals with SMS, where daytime sleepiness is a chronic problem. Gene expression analysis of the core circadian machinery in the hypothalamus of the PTLS mouse model ( Rai1 -Tg) found significant dysregulation of the transcriptional activators, Clock and Arntl , and the transcriptional repressors, Per1-3 and Cry1/2 , during both light and dark phases. These findings suggest a partial loss of circadian entrainment typically evoked by environmental photic cues. Examination of circadian clock gene expression in the Rai1- Tg mouse heart, liver, and kidney found unchanged expression of Clock and most of its downstream targets during both light and dark phases, suggesting an asynchronized circadian rhythm. Furthermore, examination of circadian gene expression in synchronized PTLS lymphoblasts revealed reduced transcripts of the Period ( PER1-3 ) family and normal expression of CRY1/2 . The finding that central circadian gene expression was altered while many peripheral circadian components were intact suggests a tissue-specific circadian uncoupling of the circadian machinery due to Rai1 overexpression. Overall, our results demonstrate that overexpression of RAI1 results in sleep deficiencies in individuals with PTLS due to a lack of properly regulated circadian machinery gene expression and highlight the importance of evaluating sleep concerns in individuals with PTLS.

PMID: 28794907 [PubMed]

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Monitoring respiration and oxygen saturation in patients during the first night after elective bariatric surgery: A cohort study.

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Monitoring respiration and oxygen saturation in patients during the first night after elective bariatric surgery: A cohort study.

F1000Res. 2017;6:735

Authors: Wickerts L, Forsberg S, Bouvier F, Jakobsson J

Abstract
BACKGROUND: Obstructive sleep apnoea and obese hypoventilation is not uncommon in patients with obesity. Residuals effect from surgery/anaesthesia and opioid analgesics may worsen respiration during the first nights after bariatric surgery. The aim of this observational study was to monitor respiration on the first postoperative night following elective bariatric surgery.
METHODS: This observational study aimed to determine the incidence and severity of hypo/apnea. Oxygen desaturation was analysed by continuous respiratory monitoring.
RESULTS: 45 patients were monitored with portable polygraphy equipment (Embletta, ResMed) during the first postoperative night at the general ward following elective laparoscopic bariatric surgery. Mean SpO2 was 93%; 10 patients had a mean SpO2 of less than 92% and 4 of less than 90%. The lowest mean SpO2 was 87%. There were 16 patients with a nadir SpO2 of less than 85%, lowest nadir SpO2 being 63%. An Apnoea Hypo/apnea Index (AHI) > 5 was found in 2 patients only (AHI 10 and 6), and an Oxygen Desaturation index (ODI) > 5 was found in 3 patients (24, 10 and 6, respectively). 3 patients had more prolonged (> 30 seconds) apnoea with nadir SpO2 81%, 83% and 86%.
CONCLUSIONS: A low mean SpO2 and short episodes of desaturation were not uncommon during the first postoperative night following elective bariatric surgery in patients without history of night time breathing disturbance. AHI and/or ODI of more than 5 were only rarely seen. Night-time respiration monitoring provided sparse additional information. Thus, it seems reasonable to have low risk patients at general ward already in their first night after bariatric surgery.

PMID: 28794858 [PubMed]

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Water-filtered infrared-A (wIRA) overcomes swallowing disorders and hypersalivation - a case report.

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Water-filtered infrared-A (wIRA) overcomes swallowing disorders and hypersalivation - a case report.

Ger Med Sci. 2017;15:Doc11

Authors: Hoffmann G

Abstract
Case description: A patient with a Barrett oesophageal carcinoma and a resection of the oesophagus with gastric pull-up developed swallowing disorders 6 years and 2 months after the operation. Within 1 year and 7 months two recurrences of the tumor at the anastomosis were found and treated with combined chemoradiotherapy or chemotherapy respectively. 7 years and 9 months after the operation local tumor masses and destruction were present with no ability to orally drink or eat (full feeding by jejunal PEG tube): quality of life was poor, as saliva and mucus were very viscous (pulling filaments) and could not be swallowed and had to be spat out throughout the day and night resulting in short periods of sleep (awaking from the necessity to spit out). In total the situation was interpreted more as a problem related to a feeling of choking (with food or fluid) in the sense of a functional dysphagia rather than as a swallowing disorder from a structural stenosis. At that time acetylcysteine (2 times 200 mg per day, given via the PEG tube) and irradiation with water-filtered infrared-A (wIRA), a special form of heat radiation, of the ventral part of the neck and the thorax were added to the therapy. Within 1 day with acetylcysteine saliva and mucus became less viscous. Within 2 days with wIRA (one day with 4 to 5 hours with irradiation with wIRA at home) salivation decreased markedly and quality of life clearly improved: For the first time the patient slept without interruption and without the need for sleep-inducing medication. After 5 days with wIRA the patient could eat his first soft dumpling although drinking of fluids was still not possible. After 2½ weeks with wIRA the patient could eat his first minced schnitzel (escalope). Following the commencement of wIRA (with typically approximately 90-150 minutes irradiation with wIRA per day) the patient had 8 months with good quality of life with only small amounts of liquid saliva and mucus and without the necessity to spit out. During this period the patient was able to sleep during the night. Discussion: The main physiological effects of water-filtered infrared-A (wIRA) are: wIRA increases tissue temperature, tissue oxygen partial pressure and tissue perfusion markedly. The five main clinical effects of wIRA are: wIRA decreases pain, inflammation and exudation/hypersecretion, and promotes infection defense and regeneration, all in a cross-indication manner. Therefore there is a wide range of indications for wIRA. The effects of wIRA are based on both its thermal effects (relying on transfer of heat energy) and thermic effects (temperature-dependent effects, occurring together with temperature changes) as well as on non-thermal and temperature-independent effects like direct effects on cells, cell structures or cell substances. Conclusion: Besides in a variety of other indications for wIRA, in cases of swallowing disorders (functional dysphagia) and hypersalivation or hypersecretion of mucus the use of wIRA should be considered as part of the treatment regime for improving a patient's quality of life.

PMID: 28794695 [PubMed - in process]

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Resident wellness: institutional trends over 10 years since 2003.

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Resident wellness: institutional trends over 10 years since 2003.

Adv Med Educ Pract. 2017;8:513-523

Authors: Choi D, Cedfeldt A, Flores C, Irish K, Brunett P, Girard D

Abstract
BACKGROUND: The surveys in this study were carried out at the Graduate Medical Education Division at Oregon Health & Science University (OHSU). OHSU implemented two significant wellness initiatives: a wellness program in 2004, and a policy allowing 4 half-days off each academic year to pursue personal or family health care needs in 2010. This study provides a secondary data analysis of five cross-sectional surveys of career satisfaction of resident and fellow trainees.
METHODS: All trainees were surveyed five times over a 10-year period using anonymous, cross-sectional web-based survey instruments. Surveys included questions about career satisfaction, perceived stress, sleep hours, burnout, and related factors.
RESULTS: This represents 10 years of accumulated responses from over 2,200 residents with results showing continual improvement in their career satisfaction. Response rates ranged from 56% to 72%. During the study period, there was a significant positive change in overall resident career satisfaction, with little change in factors traditionally considered to be predictive of overall career satisfaction such as sleep hours or perceived stress level. In addition, our data support that availability of time for personal tasks could positively impact the overall training experience.
CONCLUSION: We postulate that the improvements in satisfaction relate to two major institutional innovations designed to promote resident wellness.

PMID: 28794665 [PubMed]

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Bronchial thermoplasty: implementing best practice in the era of cost containment.

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Bronchial thermoplasty: implementing best practice in the era of cost containment.

J Asthma Allergy. 2017;10:225-230

Authors: Tan LD, Kenyon N, Yoneda KY, Louie S

Abstract
Increasing dependence on advanced technologies in the 21st century has created a dilemma between the practice and business of medicine. From information technology to robotic surgery, new technologies have expanded treatment possibilities and have potentially improved patient outcomes and safety. Simultaneously, their escalating costs limit access for certain patients and health care facilities. Nevertheless, medical decisions should not simply be based on cost. Input from physicians and other health care specialists as well as adherence to best practice position statements, are vital to implementing truly cost-effective strategies in medicine. Bronchial thermoplasty (BT), a US Food and Drug Administration approved bronchoscopy procedure in difficult-to-control persistent asthma, is a prime example of a new technology facing cost and implementation challenges. We discuss the specific indications and contraindications for BT and review recent real-world experiences that can provide the foundation for building a comprehensive asthma program that provides BT for difficult-to-control asthma patients who fail national guideline treatment recommendations after an adequate clinical trial of one. We also offer insight into the barriers to implementing a successful BT program and strategies for overcoming them.

PMID: 28794646 [PubMed]

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Illusory limb movements activate different brain networks than imposed limb movements: an ALE meta-analysis

Abstract

Proprioceptive information allows us to perform smooth coordinated movements by constantly updating us with knowledge of the position of our limbs in space. How this information is combined and processed to form conscious perceptions of limb position is still relatively unknown. Several functional neuroimaging studies have attempted to tease out the brain areas responsible for proprioceptive processing in the human brain. Yet there still exists some disagreement in the specific brain regions involved. In order to consolidate the current knowledge in the field, we performed a systematic review of the literature and an activation likelihood estimation (ALE) meta-analysis of functional neuroimaging studies of proprioception. We identified 12 studies that used a proprioceptive stimulus of the upper extremity for ALE analysis (n = 141 participants). Two types of stimuli (illusion of movement induced through muscle tendon vibration and passive/imposed movements) were found to be most commonly used to probe proprioceptive networks in the brain. ALE analysis of these two stimulus types revealed that both were associated with activation in the left precentral, postcentral, and anterior cingulate gyri. Interestingly, different patterns of activation were also observed between illusions of movement and imposed movement. In the left hemisphere, imposed movements resulted in activations that were more inferior in the post-central gyrus. In the right hemisphere, imposed movements resulted in two clusters of activation in the inferior aspect of the precentral gyrus and the hand area of the post-central gyrus, while illusions of movement resulted in a single cluster of activation in the inferior parietal lobule. These results suggest that illusions of movement without limb displacement may activate different brain areas compared with actual limb displacement. Careful consideration should be made in future studies when selecting a proprioceptive stimulus to probe these brain networks.

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Prospective changes in neural alcohol cue reactivity in at-risk adolescents

Abstract

Adolescence represents an ideal time for elucidating the etiology of cue reactivity profiles. This study examined the influence of three risk factors consistently associated with heavy adolescent drinking on alcohol cue reactivity. Youth were first assessed while still naïve to alcohol (12–14 years old) and followed after transitioning into alcohol use (17–21 years old). The effects of family history of substance use disorder, sex, and history of early of dating (i.e., before 14 years of age) on BOLD response contrast to alcohol picture cues were examined in a linear mixed model, controlling for age and alcohol use patterns at follow-up. Activation to alcohol picture cues differed as a function of risk factor and time. At baseline, family history positive youth showed greater activation to alcohol cues than family history negative peers in the right middle occipital and anterior cingulate gyri. Youth with a history of early-dating showed greater activation to alcohol cues, compared to non-early daters, in the left anterior cingulate/white matter region. Girls showed greater activation to alcohol than boys at baseline in left middle frontal gyrus. At follow-up, after drinking started, patterns reversed for each risk factor. These results indicate that even prior to initiating alcohol use, adolescents showed differences in activation to alcohol cues based on their family history, dating history, and sex.

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Terence John Cain

bmj;358/aug11_3/j3851/FAF1faTerence John Cain ("Terry") carried out his early orthopaedic training in and around Manchester and his senior registrar rotation in Leeds. In 1979 he was appointed...

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Feedback: Gem-studded power pants to put a sparkle in your life

But there's one thing they can't help with. Plus: 1-tonne kangaroos roaming the West Country, a place to get a very cold beer, and a farewell to Daedalus

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Differential effects of amnion and chorion membrane extracts on osteoblast-like cells due to the different growth factor composition of the extracts.

Differential effects of amnion and chorion membrane extracts on osteoblast-like cells due to the different growth factor composition of the extracts.

PLoS One. 2017;12(8):e0182716

Authors: Go YY, Kim SE, Cho GJ, Chae SW, Song JJ

Abstract
Human amniotic membrane extracts contain numerous growth factors and bioactive substances. However, osteogenic effects of amnion and chorion membrane extracts (AME and CME, respectively) on osteoblasts are unclear. In this study, we explored the ability of AME and CME to promote the osteogenic differentiation of osteoblast-like MG-63 cells. MG-63 cells were cultured in osteogenic induction medium (OIM) with or without exogenous AME and CME. CME enhanced the osteogenic differentiation of MG-63 cells compared with AME, as indicated by increased mineralization; alkaline phosphatase activity; and mRNA expression of osteogenic marker genes encoding integrin-binding sialoprotein (IBSP), RUNX2, OSTERIX, and osteocalcin (OCN). Interestingly, AME and CME contained different combinations of osteogenesis-related growth factors, including basic fibroblast growth factor (bFGF), transforming growth factor beta-1 (TGFβ-1), and epidermal growth factor (EGF), which differentially regulated the osteogenic differentiation of MG-63 cells. bFGF and TGFβ-1 present in CME positively regulated the osteogenic differentiation of MG-63 cells, whereas EGF present in AME negatively regulated the differentiation of MG-63 cells. Moreover, exogenous treatment of EGF antagonized CME-induced mineralization of extracellular matrix on MG-63 cells. We compared the osteogenic efficacy of CME with that of BMP2, bFGF, and TGFβ-1 alone or their combinations. We observed that CME greatly enhanced osteogenesis by providing a conductive environment for the differentiation of MG-63 cells. Together, our results indicated that human AME and CME exerted differential effects on osteogenesis because of the presence of different compositions of growth factors. In addition, our results highlighted a new possible strategy of using CME as a biocompatible therapeutic material for bone regeneration.

PMID: 28797129 [PubMed - in process]

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Teaching Quality Improvement and Patient Safety in Residency Education: Strategies for Meaningful Resident Quality and Safety Initiatives.

Teaching Quality Improvement and Patient Safety in Residency Education: Strategies for Meaningful Resident Quality and Safety Initiatives.

JAMA Otolaryngol Head Neck Surg. 2017 Aug 10;:

Authors: Morrison RJ, Bowe SN, Brenner MJ

PMID: 28796866 [PubMed - as supplied by publisher]

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Congenital cutaneous lymphadenoma.

Congenital cutaneous lymphadenoma.

J Cutan Pathol. 2017 Aug 10;:

Authors: Fernandez-Flores A, Nicklaus-Wollenteit I, Sathishkumar D, Diba V, Richard B, Carr R, Moss C, Nagy A, Ogboli M, Colmenero I

Abstract
Cutaneous lymphadenoma is an uncommon benign neoplasm often considered to be an adamantinoid variant of trichoblastoma. Lesions present in both sexes, between 14 and 87 years of age, and are mainly located on the head and neck. Cases in children are rare and there is only one previous case of a congenital lymphadenoma. An 8-year-old Asian girl presented with a congenital lesion on her forehead comprising four pink papules, the largest 5 mm in diameter. Microscopy revealed a well circumscribed tumor within the dermis and subcutis comprising well demarcated epithelial lobules of basaloid and clear cells with subtle peripheral palisading, growing in a collagenous stroma but lacking retraction artefact. A relatively dense accompanying predominantly lymphocytic inflammatory cell infiltrate including both T-cells (CD3+) and B-cells (CD20+) permeated the nodules and spilled into the stroma. CD68+ histiocytes and CD1a+ Langerhans cells were moderately numerous. This is the second case of congenital lymphadenoma which -in spite of its rarity in childhood- widens the diagnostic possibilities of cutaneous lymphoepithelial tumors in children.

PMID: 28796320 [PubMed - as supplied by publisher]

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The Effect of Functional Mandibular Shift on the Muscle Spindle Systems in Head-Neck Muscles and the Related Neurotransmitter Histamine.

The Effect of Functional Mandibular Shift on the Muscle Spindle Systems in Head-Neck Muscles and the Related Neurotransmitter Histamine.

J Craniofac Surg. 2017 Aug 08;:

Authors: Du BL, Li JN, Guo HM, Li S, Liu B

Abstract
The aim of this study is to explore the effects of abnormal occlusion and functional recovery caused by functional mandible deviation on the head and neck muscles and muscle spindle sensory-motor system by electrophysiological response and endogenous monoamine neurotransmitters' distribution in the nucleus of the spinal tract. Seven-week-old male Wistar rats were randomly divided into 7 groups: normal control group, 2W experimental control group, 2W functional mandible deviation group, 2W functional mandible deviation recovery group, 4W experimental control group, 4W functional mandible deviation group, 4W functional mandible deviation recovery group. Chewing muscles, digastric muscle, splenius, and trapezius muscle spindles electrophysiological response activities at the opening and closing state were recorded. And then the chewing muscles, digastric, splenius, trapezius, and neck trigeminal nucleus were taken for histidine decarboxylase (HDC) detection by high performance liquid chromatography (HPLC), immunofluorescence, and real-time polymerase chain reaction (RT-PCR). Histamine receptor proteins in the neck nucleus of the spinal tract were also examined by immunofluorescence and RT-PCR. Electromyography activity of chewing muscles, digastric, and splenius muscle was significantly asymmetric; the abnormal muscle electromyography activity was mainly detected at the ipsilateral side. After functional mandibular deviation, muscle sensitivity on the ipsilateral sides of the chewing muscle and splenius decreased, muscle excitement weakened, modulation depth decreased, and the muscle spindle afferent impulses of excitation transmission speed slowed down. Changes for digastric muscle electrical activity were contrary. The functions recovered at different extents after removing the deflector. However, trapezius in all the experimental groups and recovery groups exhibited bilateral symmetry electrophysiological responses, and no significant difference compared with the control group. After functional mandibular deviation, HDC protein and mRNA levels on the ipsilateral sides of the chewing muscle and splenius increased significantly. HDC level changes for digastric muscle were contrary. After the removal of the mandibular position deflector, HDC protein and mRNA levels decreased on the ipsilateral sides of the chewing muscle and splenius while they increased in the digastric muscle. The difference of histamine decarboxylase content in the bilateral trapezius in each experimental group was small. After functional mandibular deviation, the temporomandibular joint mechanical receptors not only caused the fusimotor fiber hypoallergenic fatigue slow response on the ipsilateral sides of splenius, but also increased the injury neurotransmitter histamine release. The authors' results further support the opinion that the temporomandibular joint receptors may be involved in the mechanical theory of the head and neck muscles nervous system regulation.

PMID: 28796107 [PubMed - as supplied by publisher]

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Use of the Ipsilateral Anteromedial Thigh Flap for Immediate Rescue of Nonviable Anterolateral Thigh Flaps in Head and Neck Cancer Reconstruction.

Use of the Ipsilateral Anteromedial Thigh Flap for Immediate Rescue of Nonviable Anterolateral Thigh Flaps in Head and Neck Cancer Reconstruction.

J Craniofac Surg. 2017 Aug 08;:

Authors: Cheng HT, Tian JY, Hsu YC, Chen HH, Chang SC

Abstract
BACKGROUND: It is not always possible to use the anatomically variable free anterolateral thigh (ALT) flap for reconstructive surgery. An anteromedial thigh (AMT) flap serves as a good alternative, and shares the same vascular pedicle as the ALT flap.
METHODS: Of 698 reconstructions performed in 2006 to 2013 following head and neck tumor ablation surgery, ALT flaps were used in 653 patients. Eighteen free AMT flaps were harvested to replace variant nonviable ALT flaps.
RESULTS: The lack of a sizable perforator in the ALT flap territory was the main reason for changing the reconstruction plan. Anteromedial thigh flap size ranged from 10 × 4 to 30 × 8 cm. The flap survival rate was 100%. The follow-up period ranged from 3 to 56 months.
CONCLUSION: During head and neck reconstruction, when no sizable perforator is available during harvest of the ALT flap, successful reconstruction can be achieved using the ipsilateral AMT flap without additional donor-site morbidity.

PMID: 28796101 [PubMed - as supplied by publisher]

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Radiotherapy and Smoking History Are Significant Independent Predictors for Osteosynthesis-Associated Late Complications in Vascular Free Fibula Reconstruction of Mandible.

Radiotherapy and Smoking History Are Significant Independent Predictors for Osteosynthesis-Associated Late Complications in Vascular Free Fibula Reconstruction of Mandible.

J Craniofac Surg. 2017 Aug 08;:

Authors: Chen Y, Wu J, Gokavarapu S, Shen Q, Ji T

Abstract
BACKGROUND: The vascular fibula flap is an ideal choice for function and appearance reconstruction of mandible. Despite the high success rate, "late complications" such as Ti plate exposure and local infection related to osteosynthesis are not uncommon.
PATIENTS AND METHOD: A retrospective cohort of patients who received vascular fibula reconstruction for mandible from January 2011 to December 2013 from the Department of Oral and Maxillofacial Oncology in a tertiary hospital were charted: clinical, pathological, and therapeutic factors were analyzed for late complications in univariate and multivariate analyses.
RESULTS: One hundred forty-two patients were finally analyzed with median follow-up time of 47 months; 19 of them had "late complications," which occurred at a median of 8 months. Preoperative or postoperative radiotherapy (P = 0.02), type of Ti plate (P = 0.019), and the disease characteristics (P = 0.02) were significant factors on univariate. Cox regression suggested postoperative radiation (P = 0.009) and smoking history (P = 0.037) were independent significant factors for late complications. Secondary reconstruction (P = 0.069) and preoperative radiotherapy (P = 0.086) were borderline significant.
CONCLUSION: Postoperative radiation and smoking history are associated with late complications. Mini Ti plate should be less used. Patients with risk factors need to be observed for at least 6 to 16 months before further management.

PMID: 28796099 [PubMed - as supplied by publisher]

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Intracanalicular Vestibular Schwannomas: Initial Clinical Manifestation, Imaging Classification, and Risk Stratification for Management Proposal.

Intracanalicular Vestibular Schwannomas: Initial Clinical Manifestation, Imaging Classification, and Risk Stratification for Management Proposal.

Otol Neurotol. 2017 Aug 08;:

Authors: Younes E, Montava M, Bachelard-Serra M, Jaloux L, Salburgo F, Lavieille JP

Abstract
INTRODUCTION: There is no consensus about the use of observation as a therapeutic modality for intracanalicular vestibular schwannoma (ICVS). The objective of this study was to describe tumor evolution, its correlation with initial size, stage of vestibular schwannoma, clinical presentation and to propose a risk classification for tumor growth with a therapeutic decision algorithm.
METHODS: Fifty-three patients with ICVS were followed prospectively from 2010 to 2015. The mean follow-up was 32 months. Patients underwent clinical examination, audiogram, magnetic resonance imaging at 6, 12, and then 12 months intervals within the first 5 years of initial diagnosis. We analyzed the patient's clinical course, audiologic changes, initial tumor location, and correlation of different parameters with ICVS growth.
RESULTS: Fourteen patients (26%) deteriorated their hearing level and 17 patients (27%) showed tumor growth during the follow-up period. Growth was noted during the first year of observation in 13 patients (76.5%). Considering initial presentation: tumor size, intracanalicular staging, and hearing level, patients with larger vestibular schwannoma, extension to the fundus regardless of tumor size, higher initial pure-tone average, and speech recognition test showed a significantly higher rate of tumor growth. ICVS evolution was not correlated with hearing deterioration with time.
DISCUSSION: We should consider observation a therapeutic modality. We valid the intrameatal staging as prognostic factor and propose a stratification of patients into low, moderate, or high risk for potential tumor growth to guide the initial management of ICVS.

PMID: 28796095 [PubMed - as supplied by publisher]

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Patulous Eustachian Tube Dysfunction: Patient Demographics and Comorbidities.

Patulous Eustachian Tube Dysfunction: Patient Demographics and Comorbidities.

Otol Neurotol. 2017 Aug 08;:

Authors: Ward BK, Ashry Y, Poe DS

Abstract
OBJECTIVE: The objective is to describe a large cohort of patients presenting with patulous Eustachian tube (pET) dysfunction.
STUDY DESIGN: Retrospective patient series.
SETTING: Tertiary referral center.
PATIENTS: All outpatient visits (2004-2016) that were assigned ICD9 code (381.7-Patulous Eustachian tube) were screened. Only patients with observed tympanic membrane movements during ipsilateral nasal breathing or acoustic reflex decay testing demonstrating transmitted nasal breathing were included (n = 190, n = 239 ears).
MAIN OUTCOME MEASURES: Demographics and nasopharyngoscopy/otomicroscopy findings by comorbidities.
RESULTS: The majority (54%) was female and mean age of symptom onset was 38.0 (SD 20.0) years. Common symptoms included voice autophony (93%), breath autophony (92%), aural fullness (57%), pulsatile tinnitus (17%), and crackling or rumbling sounds (14%). Symptoms increased in frequency and duration with time (65%), were exacerbated with exercise (27%), and improved with placing the head in a dependent position (65%), sniffing (28%), upper respiratory infection (8%), and ipsilateral internal jugular vein compression (12%). In 52% pET was bilateral. Common comorbidities include environmental allergy (49%), weight loss (35%), laryngopharyngeal reflux (33%), anxiety (31%), autoimmunity (13%), and neuromuscular disease (8%). Allergy and anxiety patients were younger and more likely to have tonic contraction of the tensor veli palatini on exam (p < 0.05, χ). Allergy patients also had relief with sniffing and tympanic membrane retraction (p < 0.01, χ). Weight loss patients reported mean loss of 19.7 kg (SD 23.1), and were older, more rapidly diagnosed, and more likely to have persistent symptoms (p < 0.05). Initially, all patients were treated medically, with 47% eventually electing surgical intervention.
CONCLUSION: pET is progressive, often bilateral, and possibly underdiagnosed. In this large series of pET, in addition to weight loss and chronic medical conditions, allergy and stress/anxiety were identified as novel risk factors. Most patients can be treated medically.

PMID: 28796094 [PubMed - as supplied by publisher]

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Duration of Eligibility Prior to Cochlear Implantation: Have We Made Any Progress?

Duration of Eligibility Prior to Cochlear Implantation: Have We Made Any Progress?

Otol Neurotol. 2017 Aug 08;:

Authors: Appelbaum EN, Yoo SS, Perera RA, Coelho DH

Abstract
OBJECTIVE: The objective is to determine if eligibility (as defined as the duration of severe to profound hearing loss before cochlear implantation [CI]) has changed over the 30 years since Food and Drug Administration approval.
DATA SOURCES: English-language, peer-reviewed articles, theses, and trial data available through PubMed and Cochrane Library databases up until and including May 31, 2016.
STUDY SELECTION: One thousand six unique articles were identified. Prospective studies that reported duration of severe/profound hearing loss before CI in adult patients were included. Retrospective studies, reviews, meta-analyses, articles reporting pediatric or mixed data, hybrid/electroacoustic CI, and articles from centers outside the United States were excluded. Seventy-one studies met inclusion criteria and were included for analysis.
DATA EXTRACTION: Contributing authors independently reviewed included studies for data validity and applicability.
DATA SYNTHESIS: Metaregression was used to assess the relationship between the year of publication and duration of hearing loss. To account for a possible age effect, a second model was estimated including mean age at the time of study as a covariate.
CONCLUSION: A positive association between study year and the duration of hearing loss before implantation was found showing a 0.28-year increase in the duration of hearing loss for every increasing study year. Contrary to conventional assumption, duration of eligibility for CI appears to be increasing. Though the reasons for this are not clear, current strategies to increase both awareness and access to CI seem to be falling short.

PMID: 28796093 [PubMed - as supplied by publisher]

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Jacobson's Nerve Schwannoma Presenting as a Middle Ear Mass Causing Pulsatile Tinnitus: A Case Report.

Jacobson's Nerve Schwannoma Presenting as a Middle Ear Mass Causing Pulsatile Tinnitus: A Case Report.

Otol Neurotol. 2017 Aug 08;:

Authors: Lin KF, Turk AT, Kim AH

PMID: 28796090 [PubMed - as supplied by publisher]

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The Effect of Citalopram Versus a Placebo on Central Auditory Processing in the Elderly.

The Effect of Citalopram Versus a Placebo on Central Auditory Processing in the Elderly.

Otol Neurotol. 2017 Aug 08;:

Authors: Polanski JF, Soares AD, Pereira LD, Cruz OLM

Abstract
OBJECTIVE: Evaluate the effects of therapy with citalopram on the central auditory processing in the elderly measured by central auditory tests.
STUDY DESIGN: Prospective, randomized, double-blind, placebo-controlled study.
SETTING: Tertiary referral center.
PATIENTS: Thirty-nine patients older than 60 years with normal hearing thresholds or symmetrical sensorineural hearing loss up to 70 dBHL, word-recognition score equal to or better than 70%, and diagnosed with central auditory processing disorders completed the study. They underwent the mini-mental state examination, as a way to screen those with the possibility of dementia; they also underwent the Beck depression inventory, for screening individuals with depression.
INTERVENTION: Citalopram 20 mg/d or placebo for 6 months.
MAIN OUTCOME MEASURE: The central auditory tests were applied to the selection of individuals with auditory processing disorders and repeated after 6 months' treatment. The tests were sound localization, speech in noise, dichotic digits test, pitch pattern sequence, duration pattern test, and gaps-in-noise.
RESULTS: Comparisons of central auditory tests pre- and posttreatment in groups showed: sound localization (p = 0.022), pitch pattern sequence humming (p = 0.110), pitch pattern sequence nomination (p = 0.355), duration pattern test humming (p = 0.801), duration pattern test nomination (p = 0.614), and gaps-in-noise (p = 0.230). Dichotic tests in right and left ears respectively: speech in noise (p = 0.949; p = 0.722), dichotic digits test (p = 0.943; p = 0.513).
CONCLUSION: There was no clinical effect with the use of citalopram in central auditory processing tests of the subjects.

PMID: 28796088 [PubMed - as supplied by publisher]

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Audiometric Outcomes Following Endoscopic Ossicular Chain Reconstruction.

Audiometric Outcomes Following Endoscopic Ossicular Chain Reconstruction.

Otol Neurotol. 2017 Aug 08;:

Authors: Yawn RJ, Hunter JB, O'Connell BP, Wanna GB, Killeen DE, Wick CC, Isaacson B, Rivas A

Abstract
OBJECTIVE: To evaluate the audiometric outcomes following endoscopic ossicular chain reconstruction (OCR).
STUDY DESIGN: Retrospective case series.
SETTING: Two tertiary referral centers.
PATIENTS: Sixty two ears with ossicular discontinuity.
INTERVENTION(S): Endoscopic and microscopic OCR in patients with ossicular discontinuity.
MAIN OUTCOME MEASURES: Bone and air pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS).
RESULTS: Sixty two ears were included for analysis. Patients that underwent ossiculoplasty were subdivided based on prosthesis type (total ossicular replacement prosthesis [TORP] and partial ossicular replacement prosthesis [PORP], primary and staged ossiculoplasties, and surgical approach [microscopic and total endoscopic]). Forty two ears required PORP reconstructions, while 20 ears required TORP reconstructions. The microscope was used to reconstruct the ossicular chain in 31 cases, while an exclusive endoscopic approach was used in the remaining 31 patients. Controlling for the prosthesis, there were no significant postoperative differences in bone PTA, air PTA, and ABG between primary and staged ossiculoplasties, or surgical approach.
CONCLUSIONS: Controlling for the type of prosthesis, there were no significant differences in hearing outcomes with respect to staged ossicular chain reconstruction or whether the endoscope or microscope was used for visualization. Thus, in this series, endoscopic OCR yields similar audiometric outcomes when compared with microscopic OCR.

PMID: 28796085 [PubMed - as supplied by publisher]

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Surgery With or Without Postoperative Radiation Therapy for Early-stage External Auditory Canal Squamous Cell Carcinoma: A Meta-analysis.

Surgery With or Without Postoperative Radiation Therapy for Early-stage External Auditory Canal Squamous Cell Carcinoma: A Meta-analysis.

Otol Neurotol. 2017 Aug 08;:

Authors: Oya R, Takenaka Y, Takemura K, Ashida N, Shimizu K, Kitamura T, Yamamoto Y, Uno A

Abstract
OBJECTIVE: External auditory canal squamous cell carcinoma (EACSCC) is a rare disease with no standard treatment supported by high-level evidence. The aim of this study was to investigate EACSCC prognoses according to treatment modality and thus determine the optimal intervention for early-stage disease.
DATA SOURCES: PubMed, Scopus, and Ichushi-Web searches of the English and Japanese-language literature published between January 1, 2006 and December 31, 2016 were performed using the key words "external auditory canal cancer" and "temporal bone cancer."
STUDY SELECTION: Articles related to EACSCC that include the 5-year overall survival rate or individual patient data for histological types, follow-up periods, and final outcomes were enrolled.
DATA EXTRACTION: Sex, age, Moody's modified Pittsburgh stage, type of treatment modality, type of operation, follow-up period, and 5-year survival rates were extracted.
DATA SYNTHESIS: Twenty articles were used for the aggregate meta-analysis using a random-effects model, and 18 articles that reported 99 patients with early-stage EACSCC were used for the individual patient data meta-analysis.
CONCLUSION: The 5-year overall survival rate of early-stage EACSCC was 77%. Postoperative radiation therapy (PORT) was performed in 45% of stage I patients and 68% of stage II patients. Survival analysis of all patients showed no differences between the surgery-only and PORT groups; however, PORT exhibited a better prognosis than surgery alone among patients with stage I disease (p = 0.003, log-rank test). This result indicated that PORT can be the standard therapy for stages I and II EACSCC.

PMID: 28796084 [PubMed - as supplied by publisher]

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The First Reported Case of Primary Intestinal-type Adenocarcinoma of the Middle Ear and Review of the Literature.

The First Reported Case of Primary Intestinal-type Adenocarcinoma of the Middle Ear and Review of the Literature.

Otol Neurotol. 2017 Aug 08;:

Authors: Nader ME, Bell D, Ginsberg L, DeMonte F, Gunn GB, Gidley PW

Abstract
OBJECTIVE: Adenocarcinoma of the middle ear is a rare entity that must be distinguished from other adenomatous tumors of the temporal bone. We present the first patient of an intestinal-type adenocarcinoma originating from the middle ear.
PATIENTS: A 58-year-old woman presented with an 8-year history of left otorrhea. Her middle ear effusions were quite thick and gummy. She underwent eight sets of pressure-equalization tubes within 3 years. In 2011, her physical examination identified a middle ear mass, and she underwent mastoidectomy. A middle ear adenoma was resected. She underwent an additional three mastoidectomies for recurrence, with pathology from the 4th mastoidectomy revealing a diagnosis of adenocarcinoma. Imaging, at that time, showed an extensive temporal bone and Eustachian tube tumor.
INTERVENTIONS: She underwent a left subtotal temporal bone resection, parotidectomy, infratemporal fossa resection, dural resection, and microvascular free flap reconstruction followed by postoperative proton beam radiotherapy.
MAIN OUTCOME MEASURES: The final pathology report revealed intestinal-type adenocarcinoma.
RESULTS: Treatment was successful and the patient remains disease free 4 years later.
CONCLUSION: This is the first report of an intestinal-type adenocarcinoma of the middle ear and temporal bone. This patient also illustrates the difficulty of accurate histologic diagnosis of adenomatous tumors of the middle ear.

PMID: 28796082 [PubMed - as supplied by publisher]

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Strategies for Supporting Physician-Scientists in Faculty Roles: A Narrative Review With Key Informant Consultations.

Strategies for Supporting Physician-Scientists in Faculty Roles: A Narrative Review With Key Informant Consultations.

Acad Med. 2017 Aug 08;:

Authors: Lingard L, Zhang P, Strong M, Steele M, Yoo J, Lewis J

Abstract
PURPOSE: Physician-scientists are a population in decline globally. Solutions to reverse this decline often have focused on the training pipeline. Less attention has been paid to reducing attrition post training, when physician-scientists take up faculty roles. However, this period is a known time of vulnerability because of the pressures of clinical duties and the long timeline to securing independent research funding. This narrative review explored existing knowledge regarding how best to support physician-scientists for success in their faculty roles.
METHOD: The authors searched the Medline, Embase, ERIC, and Cochrane Library databases for articles published from 2000 to 2016 on this topic and interviewed key informants in 2015 to solicit their input on the review results.
RESULTS: The authors reviewed 78 articles and interviewed 16 key informants. From the literature, they developed a framework of organizational (facilitate mentorship, foster community, value the physician-scientist role, minimize financial barriers) and individual (develop professional and research skills) strategies for supporting physician-scientists. They also outlined key knowledge gaps representing topics either rarely or never addressed in the reviewed articles (percent research time, structural hypocrisy, objective assessment, group metrics, professional identity). The key informants confirmed the identified strategies and discussed how the gaps were particularly important and impactful.
CONCLUSIONS: This framework offers a basis for assessing an organization's existing support strategies, identifying outstanding needs, and developing targeted programming. The identified gaps require attention, as they threaten to undermine the benefits of existing support strategies.

PMID: 28795977 [PubMed - as supplied by publisher]

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Validation of the modified 4-tiered categorization system through comparison with the 5-tiered categorization system of the 2015 American Thyroid Association guidelines for classifying small thyroid nodules on ultrasound.

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Validation of the modified 4-tiered categorization system through comparison with the 5-tiered categorization system of the 2015 American Thyroid Association guidelines for classifying small thyroid nodules on ultrasound.

Head Neck. 2017 Aug 10;:

Authors: Lee JH, Han K, Kim EK, Moon HJ, Yoon JH, Park VY, Kwak JY

Abstract
BACKGROUND: The purpose of this study was to validate the modified 4-tiered categorization system and to compare stratification of malignancy risk in small thyroid nodules with the 2015 American Thyroid Association (ATA) management guidelines.
METHODS: From January 2015 to December 2015, 737 thyroid nodules measured ≥ 1 cm and <2 cm were included in this study. Each nodule was assigned a category with the ultrasonographic patterns described by the 2015 ATA guidelines.
RESULTS: On univariate analysis, there was no difference of malignancy risk between low suspicion and very low suspicion nodules (P = .584). Therefore, we suggested a modified 4-tiered categorization, which combines very low suspicion and low suspicion nodules into the "revised low suspicion" category. Specificity, positive predictive value (PPV) and accuracy were higher with the modified 4-tiered categorization system (P < .001 for all).
CONCLUSION: The modified 4-tiered categorization system allows more efficient management with better diagnostic performance than the 2015 ATA categorization system in small thyroid nodules.

PMID: 28795453 [PubMed - as supplied by publisher]

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News and Announcements.

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News and Announcements.

Otolaryngol Head Neck Surg. 1991 Jun;104(6):900-902

Authors:

PMID: 28791906 [PubMed]

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Book Review: Tinnltus Pathophysiology and Management Tinnltus Pathophysiology and Management edited by Kitahara Masaaki . 121 pages with illustrations. Igaku-Shoin , Tokyo , 1988 . $39.50 .

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Book Review: Tinnltus Pathophysiology and Management Tinnltus Pathophysiology and Management edited by Kitahara Masaaki . 121 pages with illustrations. Igaku-Shoin , Tokyo , 1988 . $39.50 .

Otolaryngol Head Neck Surg. 1991 Jun;104(6):899

Authors: Eisele DW, Norton SJ

PMID: 28791905 [PubMed]

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Book Review: Sicher and DuBruil's Oral Anatomy Sicher and DuBruil's Oral Anatomy by DuBrul E. Lloyd . 356 pages with illustrations. Ishiyaku EuroAmerica, Inc. , St. Louis , 1988 . $42.50 .

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Book Review: Sicher and DuBruil's Oral Anatomy Sicher and DuBruil's Oral Anatomy by DuBrul E. Lloyd . 356 pages with illustrations. Ishiyaku EuroAmerica, Inc. , St. Louis , 1988 . $42.50 .

Otolaryngol Head Neck Surg. 1991 Jun;104(6):898

Authors: Eisele DW

PMID: 28791904 [PubMed]

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Book Review: Rhinoplasty: Problems and Controversies Rhinoplasty: Problems and Controversies edited by Rees T.D. Baker D.C. , and Tabbal N. . 434 pages. C.V. Mosby Co. , St. Louis , 1988 . $80.00 .

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Book Review: Rhinoplasty: Problems and Controversies Rhinoplasty: Problems and Controversies edited by Rees T.D. Baker D.C. , and Tabbal N. . 434 pages. C.V. Mosby Co. , St. Louis , 1988 . $80.00 .

Otolaryngol Head Neck Surg. 1991 Jun;104(6):898

Authors: Eisele DW, Papel ID

PMID: 28791903 [PubMed]

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Book Review: Microsurgery of fie Skull Base Microsurgery of fie Skull Base by Fisch UGO , and Mattox Douglas . 670 pages with illustrations. Georg Thieme Verlag, Stuttgart , 1988 . $168.00 .

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Book Review: Microsurgery of fie Skull Base Microsurgery of fie Skull Base by Fisch UGO , and Mattox Douglas . 670 pages with illustrations. Georg Thieme Verlag, Stuttgart , 1988 . $168.00 .

Otolaryngol Head Neck Surg. 1991 Jun;104(6):897

Authors: Eisele DW, Willis R

PMID: 28791899 [PubMed]

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Book Review: Headache Headache by Raskin Neil Hugh , MD. 396 pages. 2nd ed . Churchill Livingstone, Inc. , New York , 1988 . $49.00.

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Book Review: Headache Headache by Raskin Neil Hugh , MD. 396 pages. 2nd ed . Churchill Livingstone, Inc. , New York , 1988 . $49.00.

Otolaryngol Head Neck Surg. 1991 Jun;104(6):895-896

Authors: Eisele DW, Pratt LW

PMID: 28791902 [PubMed]

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Book Review: Guide to Dental Problems for Physicians and Surgeons Guide to Dental Problems for Physicians and Surgeons edited by Thaller Seth R. and Montgomery William W. . 369 pages with illustrations. Williams & Wilkins, Baltimore , 1988 . $68.95 .

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Book Review: Guide to Dental Problems for Physicians and Surgeons Guide to Dental Problems for Physicians and Surgeons edited by Thaller Seth R. and Montgomery William W. . 369 pages with illustrations. Williams & Wilkins, Baltimore , 1988 . $68.95 .

Otolaryngol Head Neck Surg. 1991 Jun;104(6):895

Authors: Eisele DW, Medders RG

PMID: 28791901 [PubMed]

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