Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00306932607174

Παρασκευή 10 Νοεμβρίου 2017

Vocal fold augmentation under local anesthesia using autologous fascia

Abstract

Vocal fold augmentation by injection of autologous fascia has been used since the 1990s with excellent safety record in 500 operations done under general anaesthesia. It is safe from risks arising from allergic or other foreign body adverse reactions. Fascia provides long-term augmentation and remains stable 3-10 years after injection.

Vocal fold augmentation under local anaesthesia is excellent alternative for those unfit for general anaesthesia, providing aid to fragile and weak persons with vocal fold paralysis. However, all of available synthetic materials resorb within 6-24 months.

Fascia injection under local anaesthesia provides the possibility for a long-term vocal fold medialization while avoiding risk of general anaesthesia. Fascia lata harvesting and processing is easily done (as shown in video) followed by injection into the vocal fold. The whole procedure is done under local anaesthesia. Procedure offers long-term vocal fold medialization, fine tuning the amount of the medialization by immediate feedback from the patient's voice. Operation time is one hour.

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Antı-β2 Glycoprotein I Antibodies in Children with Rheumatologic Disorders

Abstract

Anti-beta-2-glycoprotein I antibodies (anti-β2GPI) which are the main antiphospholipid antibodies that characterize the autoimmune "antiphospholipid syndrome" are pathogenic and are contributing to thrombosis. We aimed to evaluate the presence and the diagnostic importance of these antibodies in children with different rheumatologic diseases with or without thrombosis risk. A total of 100 children with different rheumatologic diseases evaluated retrospectively. The mean anti-β2GPI IgG (p = 0.108), IgA (p = 0.547), and IgM (p = 0.807) levels showed no statistically significant difference between different diagnosis groups. But anti-β2GPI IgA and IgM levels were higher in SLE patient group. The mean anti-β2GPI IgG (p = 0.375), IgA (p = 0.811), and IgM (p = 0.276) levels were not also showed difference between disease groups with/without predisposition to thrombosis even though concentrations were higher in thrombosis group. In children with rheumatological complaints, anti-β2GPI antibody measurements should not be the first diagnostic criteria if vasculitis is not thought as the primary defect underlying the clinical symptoms.

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Tailored resections in oral and oropharyngeal cancer using narrow band imaging

Publication date: Available online 10 November 2017
Source:American Journal of Otolaryngology
Author(s): Giancarlo Tirelli, Marco Piovesana, Alberto Vito Marcuzzo, Annalisa Gatto, Matteo Biasotto, Rossana Bussani, Lorenzo Zandonà, Fabiola Giudici, Francesca Boscolo Nata
PurposeIn a previous pilot study we observed that intra-operative narrow-band imaging (NBI) helps achieve clear superficial resection margins. The aim of this study was to verify if the use of intra-operative NBI can help to obtain tailored resections and if it is influenced by the lesion site, aspects not investigated in our previous study.Materials and methodsThe resection margins of 39 oral and 22 oropharyngeal squamous cell carcinomas were first set at 1.5cm from the macroscopic lesion boundary (white light, WL, tattoo). Then, the superficial tumor extension was more precisely defined with NBI, giving rise to three possible situations: NBI tattoo larger than the WL tattoo, NBI tattoo coinciding with the WL tattoo, or NBI tattoo smaller than the WL tattoo. For each of these situations the space comprised between the NBI and WL tattoos was defined "NBI positive", "NBI null", and "NBI negative", respectively. Resections were performed following the outer tattoo. The number of clear superficial resection margins, and the pathological response on the "NBI-positive" and the "NBI-negative" areas were recorded.ResultsWe obtained 80.3% negative superficial resection margins. NBI provided a more precise definition of superficial tumor extension in 43 patients. Sensitivity, specificity, positive and negative predictive values were 94.4%, 64%, 79.1% and 88.9%, respectively; a test of proportions demonstrated they were not influenced by tumor site.ConclusionsNBI could allow for real-time definition of superficial tumor extension with possible tailored resections and fewer positive superficial resection margins; it is not influenced by tumor site.

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Reconstruction of preauricular soft tissue defects using a superiorly based rotation advancement scalp flap - A novel approach to the surgical treatment of preauricular sinuses

Publication date: Available online 10 November 2017
Source:American Journal of Otolaryngology
Author(s): Bernard Tan, Lee Tee Sin, Ian Loh

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Prevalence of Diabetes Mellitus in People Clinically Diagnosed with Periodontitis: A Systematic Review and Meta-analysis of Epidemiologic Studies

Abstract

Objectives

Diabetes mellitus and periodontitis are complex chronic diseases with an established bidirectional relationship. This systematic review evaluated in subjects with professionally diagnosed periodontitis the prevalence and odds of having diabetes.

Methods

The MEDLINE-PubMed, CENTRAL and EMBASE databases were searched. Prevalence of diabetes mellitus among subjects with periodontitis were extracted or if possible calculated.

Results

From the 803 titles and abstracts that came out of the search, 29papers met the initial criteria.

Prevalence of diabetes was 9.4% among subjects with periodontitis and 12.8%among subjects without periodontitis. Based on sub-analysis, for subjects with periodontitis, the prevalence of diabetes was 6.5%when diabetes was self-reported, compared to 17.3%when diabetes was clinically assessed. The highest prevalence of diabetes among subjects with periodontitis was observed in studies originating from Asian countries(17.2%,n=16647) and the lowest in studies describing populations from Europe(4.3%(n=7858). The overall odds ratio for diabetes patients to be among subjects with periodontitis as compared to those without periodontitis was 2.59(95%CI[2.12;3.15]). A substantial variability in the definitions of periodontitis, combination of self-reported and clinically assessed diabetes, lack of confounding for diabetes control in included studies introduces estimation bias.

Conclusions

The overall prevalence and odds of having diabetes is higher within periodontitis populations compared to people without periodontitis. Self-reported diabetes underestimates the prevalence when compared to this condition assessed clinically. Geographical differences were observed: the highest diabetes prevalence among subjects with periodontitis was observed in studies conducted in Asia and the lowest in studies originating from Europe.

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New dental office opens in Carolina Forest

Ocean Bay Dental Care in Carolina Forest, a full-service family dental practice, is set to open on Nov. 30 in its new building on International Drive. The dental clinic will be operated by dentists Jesse Blair and John Steppe, and staffed to perform routine cleanings and fillings as well as cosmetic services, said a statement announcing the opening.

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Mini-implants and narrow diameter implants as mandibular overdenture retainers: A systematic review and meta-analysis of clinical and radiographic outcomes

Summary

This study reviews the clinical and radiographic outcomes of Mini-implants (MI) and Narrow Diameter Implants (NDI) as mandibular overdenture (MO) retainers. Six databases were consulted for clinical studies that evaluated implants with diameter ≤ 3.5 mm. Data on the MI and NDI for survival and success rate and peri-implant bone loss and were collected and submitted to meta-analysis. Thirty-six studies were included, 24 reporting MI performance and 12 describing NDI results. The MI group comprised data from 1 cross-sectional clinical study, 3 retrospective longitudinal (RL) clinical studies, 13 prospective longitudinal (PL) clinical studies and 7 randomized clinical trials (RCT) with follow-up periods ranging from 1 day to 7 years. Eight studies used conventional loading, thirteen used immediate loading, two studies used both loading types and one study did not report. The NDI group comprised data from 3 RL clinical studies, 6 PL clinical studies and 3 RCT with follow-up ranging from 6 months to 10 years. Ten studies used conventional loading, 1 study used immediate loading and 1 study did not report. The average survival rates of MI and NDI studies were 98% and 98%, respectively, while the average success rates were 93% and 96%, respectively. The average peri-implant bone loss after 12, 24, and 36 months was 0.89, 1.18, and 1.02 mm for MI and 0.18, 0.12, and -0.32 mm for NDI. Both MI and NDI showed adequate clinical behavior as overdenture retainers. The NDI showed a better long-term predictability to retain OM with most studies adopting conventional loading.

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Regeneration dynamics of mixed stands of Pinus pinaster Ait. and Pinus pinea L. in Central Spain

Abstract

The dynamics of mixed stands are more complex and less studied than those of monospecific stands. The objective of this work was to analyze the variables involved in seedling occurrence and seedling survival in mixed stands of Pinus pinaster and P. pinea in Mediterranean areas. From 2011 to 2016, regeneration of both species was monitored at two sites located in Central Spain. We installed 72 regeneration plots where seedling dynamics were monitored. All the trees in the study areas were measured and mapped. Additionally, we took hemispherical photographs in each regeneration plot. The average density of P. pinea seedlings over the study period was almost 20 times larger than that of P. pinaster. Our results indicate that the seedlings of both species grow under moderate light conditions. In addition, we found that the occurrence of seedlings of both species was related to the structure of the stand. P. pinea seedlings grew where the density and size of P. pinaster trees were low and where P. pinea trees provided moderately sheltered conditions, whereas the number of P. pinaster seedlings was related to under intermediate densities of P. pinaster trees. Furthermore, seedling survival was positively associated with age of the seedlings and negatively with the August average maximum temperature. The temporal continuity of mixed stands of P. pinea and P. pinaster in the study area is compromised by the observed lack of regeneration of P. pinaster.

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Reduziertes Blickfeld infolge benigner Neubildung am Oberlid

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Tenosynovitis caused by Mycobacterium malmoense in two kidney transplant recipients and review of the literature

Abstract

We report two unrelated cases of tenosynovitis caused by Mycobacterium malmoense in kidney transplant recipients. Both patients received immunosuppression and were referred to our tertiary hospital because of persisting complaints lasting >6 months not responding to corticosteroids or surgery. The mycobacterial cultures were positive for the slow-growing M. malmoense after several weeks of incubation. The patient in Case 1 was treated with a combination of surgical debridement and antibiotics, whereas the patient in Case 2 was only treated surgically. Both cases illustrate the doctor's delay in diagnosing mycobacterial infections, and remind us that nontuberculous mycobacterial infections should be part of the differential diagnosis of tenosynovitis, especially in immunocompromised patients.

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Use of a hepatitis C virus (HCV) RNA-positive donor in a treated HCV RNA-negative liver transplant recipient

Abstract

The shortage of livers has led most transplant centers to use extended criteria donors. Hepatitis C virus (HCV) RNA-positive donors are typically not given to patients who have cleared HCV. A 64-year-old male with chronic hepatitis C, genotype 1b was listed for LT with hepatocellular carcinoma. While on the waiting list, the patient was treated with sofosbuvir, ledipasvir, and ribavirin and achieved an HCV RNA <15 IU/mL by week 10. At week 18 of a planned 24-week treatment course, the patient underwent deceased-donor LT and received an organ from an anti-HCV-positive donor. Treatment was stopped at LT. At week 3 post LT, HCV RNA was detectable and revealed a genotype 3 HCV infection, compatible with transplantation of an organ with established infection. With retreatment with sofosbuvir, daclatasvir, and ribavirin for 12 weeks, the patient achieved a sustained virologic response. This report highlights how antiviral therapies can be used to optimize the outcomes of HCV-infected transplant patients.

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Current Status and Future Directions in Colorectal Cancer

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Contrasting the relative importance of species sorting and dispersal limitation in shaping marine bacterial versus protist communities

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Phage mobility is a core determinant of phage–bacteria coexistence in biofilms

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Vox Populi, Vox Dei (The Voice of the People is the Voice of God)

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Issue Information

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South Africa tackles crime at sea with ship-spotting satellites

WEB_southafrica1.22977_GettyImages-17852

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Training Groups

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Editorial Board

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Letters From Our Readers.

Letters From Our Readers.

Angle Orthod. 2017 Nov;87(6):925

Authors: Hu X, Xu J

PMID: 29120244 [PubMed - in process]

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Letters From Our Readers.

Letters From Our Readers.

Angle Orthod. 2017 Nov;87(6):926

Authors: Koerich L, Lindauer SJ, Weissheimer A

PMID: 29120243 [PubMed - in process]

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EHASO: Lessons for the Future.

EHASO: Lessons for the Future.

Angle Orthod. 2017 Nov;87(6):924

Authors: Conley RS

PMID: 29120242 [PubMed - in process]

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Assessment of biologically aggressive, recurrent glandular odontogenic cysts for mastermind-like 2 (MAML2) rearrangements: histopathologic and fluorescent in situ hybridization (FISH) Findings in eleven cases.

Assessment of biologically aggressive, recurrent glandular odontogenic cysts for mastermind-like 2 (MAML2) rearrangements: histopathologic and fluorescent in situ hybridization (FISH) Findings in eleven cases.

J Oral Pathol Med. 2017 Nov 09;:

Authors: Greer RO, Eskendri J, Freedman P, Ahmadian M, Murakami-Walter A, Varella-Garcia M

Abstract
BACKGROUND: Glandular odontogenic cyst (GOC) demonstrates a significant predilection toward localized biologic aggressiveness and recurrence. GOC shares certain histopathologic features with intraosseous mucoepidermoid carcinoma (IMEC). The current investigation evaluates a group of recurrent, biologically aggressive GOCs to determine if any cases demonstrated unique histologic features or Mastermind - like2 (MAML2) rearrangements common to IMEC.
METHODS: Microscopic slides from eleven previously diagnosed GOGs were stained with hematoxylin and eosin and assessed by two study participants for ten classic histopathologic features required to establish a diagnosis of GOC. Cases were evaluated utilizing break-apart fluorescent in situ hybridization (FISH) analysis for the presence of MAML2 gene rearrangements. Clinical and demographic data on all patients were recorded.
RESULTS: The mean age for patients included in the study was 55.27 years with a range of 36 to 72 years. The most common presenting symptom was a jaw expansion and all cysts presented initially as a unilocular or multilocular radiolucency. CYSTS displayed a minimum of 6 of 10 histologic parameters necessary for a diagnosis of GOC. One case demonstrated MAML2 rearrangements by FISH. That case also showed marked ciliation of cyst lining epithelial cells and extensive mucous secreting goblet cell proliferation.
CONCLUSION: Findings in the current study are in concert with previous investigations, and although this study finds ONLY LIMITED molecular evidence to support the premise that recurrent biologically aggressive GOCs are a precursor to IMEC, detection of MAML2 rearrangements in one case suggests that such a theoretic transition, while rare, is possible. This article is protected by copyright. All rights reserved.

PMID: 29121421 [PubMed - as supplied by publisher]

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Fear of evaluation unpacked: day-to-day correlates of fear of negative and positive evaluation

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NRP2 and CD63 Are Host Factors for Lujo Virus Cell Entry.

NRP2 and CD63 Are Host Factors for Lujo Virus Cell Entry.

Cell Host Microbe. 2017 Nov 08;22(5):688-696.e5

Authors: Raaben M, Jae LT, Herbert AS, Kuehne AI, Stubbs SH, Chou YY, Blomen VA, Kirchhausen T, Dye JM, Brummelkamp TR, Whelan SP

Abstract
Arenaviruses cause fatal hemorrhagic disease in humans. Old World arenavirus glycoproteins (GPs) mainly engage α-dystroglycan as a cell-surface receptor, while New World arenaviruses hijack transferrin receptor. However, the Lujo virus (LUJV) GP does not cluster with New or Old World arenaviruses. Using a recombinant vesicular stomatitis virus containing LUJV GP as its sole attachment and fusion protein (VSV-LUJV), we demonstrate that infection is independent of known arenavirus receptor genes. A genome-wide haploid genetic screen identified the transmembrane protein neuropilin 2 (NRP2) and tetraspanin CD63 as factors for LUJV GP-mediated infection. LUJV GP binds the N-terminal domain of NRP2, while CD63 stimulates pH-activated LUJV GP-mediated membrane fusion. Overexpression of NRP2 or its N-terminal domain enhances VSV-LUJV infection, and cells lacking NRP2 are deficient in wild-type LUJV infection. These findings uncover this distinct set of host cell entry factors in LUJV infection and are attractive focus points for therapeutic intervention.

PMID: 29120745 [PubMed - in process]

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Hygiene practices in removable prosthodontics: A systematic review.

Hygiene practices in removable prosthodontics: A systematic review.

Int J Dent Hyg. 2017 Nov 09;:

Authors: Papadiochou S, Polyzois G

Abstract
OBJECTIVE: To systematically review the recent scientific evidence about the hygiene practices of removable prostheses relative to the effectiveness, colour and dimensional stability. This review aimed also to identify patients' attitudes and habits towards denture hygiene.
METHODS: Three electronic databases (MEDLINE/PubMed, Scopus and Cochrane Library) were screened, in English language, between January 1995 and December 2016. A supplementary hand search in the reference list of the identified articles was also performed. Controlled clinical trials (CCTs) involving patients with no clinical signs of denture stomatitis along with a comprehensive aim to assess the effectiveness of hygiene interventions and their impact on prosthesis colour and dimensional stability were eligible for inclusion.
RESULTS: Following a thorough screening of titles/abstracts/full texts and consideration of the defined inclusion criteria, 21 CCTs examined the effectiveness of the hygiene approaches, 3 evaluated the colour stability of dentures subjected to hygiene practices, 2 examined the dimensional stability of dentures following microwave disinfection and 30 studies registered patients' attitudes and habits towards denture hygiene.
CONCLUSIONS: Combined application of different hygiene interventions, including brushing or ultrasound vibration in conjunction with chemical agents, leads to more effective outcomes (reduction in denture biofilm percentage and/or number of microorganisms' colony-forming units). The dimensional stability seems to be unaltered, but the number of clinical trials was limited. Critical concentrations of cleansing solutions along with the duration of their implementation influence the serviceability of dentures regarding colour stability. Brushing represents the most commonly applied hygiene practice, while denture wearers' attitudes are not complied with the recommended guidelines considering the reported frequency of hygiene practices and the continuous denture wear.

PMID: 29120113 [PubMed - as supplied by publisher]

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Comparative Study of Fusogenic Activity of H1 and H5 Subtypes Influenza Virus Hemagglutinins.

Comparative Study of Fusogenic Activity of H1 and H5 Subtypes Influenza Virus Hemagglutinins.

Bull Exp Biol Med. 2017 Nov 09;:

Authors: Kononova AA, Cheresiz SV, Chechushkov AV, Razumova YV, Pokrovskii AG

Abstract
Influenza virus hemagglutinins are surface proteins responsible for fusion of the viral and cellular membranes. Their capacity to mediate membrane fusion (fusogenic activity) is studied by various methods, including the syncytium formation and pseudovirus transduction methods. We constructed plasmids coding for genes of three H1 and one H5 hemagglutinins and compared their fusogenic activities. Hemagglutinin capacity to induce syncytium formation did not always correlate with the transduction activity of the respective pseudoviruses. Hemagglutinin H5 exhibited high fusogenic activity in studies by both methods, however, two of the studied H1 hemagglutinins induced the formation of syncytia, but did not mediate pseudovirus transduction. This could be due to different capsid sizes of influenza virus and vesicular stomatitis virus, which determines their different permeability through the fusion pore.

PMID: 29119400 [PubMed - as supplied by publisher]

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Contribution of oxidative stress in acute intestinal mucositis induced by 5 fluorouracil (5-FU) and its pro-drug capecitabine in rats.

Contribution of oxidative stress in acute intestinal mucositis induced by 5 fluorouracil (5-FU) and its pro-drug capecitabine in rats.

Toxicol Mech Methods. 2017 Nov 08;:1-24

Authors: Rtibi K, Selmi S, Grami D, Amri M, Sebai H, Marzouki L

Abstract
This study was designed to examine the contribution of oxidative stress in gastrointestinal disorders after an intraperitoneal administration of 5-FU (100mg/kg b.w.) and capecitabine oral administration (500mg/kg b.w.). The animals were divided into three groups: Group A (NaCl, 10ml/kg b.w.) considered as control group, group B was intoxicated by 5-FU and the group of animals (group C) treated with capecitabine (CAP). To evaluate the secretory and enteropooling effects, we were used as a hypersecretion agent (MgSO4, 1ml/100g b.w.). The mucosal gastro-intestinal specimens were scraped and examined for biological markers of oxidative stress and intracellular mediators. These anticancer drugs caused many intestinal damages manifested by an elevation of fluid accumulation and imbalance in electrolytes secretion. Also, the intestinal tissues from treated rats showed a significant increase in malondialdehyde (MDA), protein carbonylation and H2O2 production. However, a significant depletion of enzymatic and non-enzymatic antioxidant, such as, glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT) and sulfhydryl groups (-SH). These effects were related with histopatological damage and a perturbation of intracellular mediators. As expected, these disturbances were observed in the group of rats poisoned by the MgSO4. Data suggest the contribution of oxidative stress in chemotherapy-induced many disorders in intestinal tract.

PMID: 29117755 [PubMed - as supplied by publisher]

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Probiotic Lactobacillus rhamnosus GG prevents alveolar bone loss in a mouse model of experimental periodontitis.

Probiotic Lactobacillus rhamnosus GG prevents alveolar bone loss in a mouse model of experimental periodontitis.

J Clin Periodontol. 2017 Nov 09;:

Authors: Gatej SM, Marino V, Bright R, Fitzsimmons TR, Gully N, Zilm P, Gibson RJ, Edwards S, Bartold PM

Abstract
AIM: This study investigated the role of Lactobacillus rhamnosus GG on bone loss and local and systemic inflammation in an in vivo mouse model of experimental periodontitis.
MATERIALS AND METHODS: Experimental periodontitis was induced in mice by oral inoculation with Porphyromonas gingivalis and Fusobacterium nucleatum over a period of 44 days. The probiotic LGG was administered via oral inoculation or oral gavage prior to, and during disease induction. The antimicrobial activity of LGG on the inoculum was also tested. Alveolar bone levels and gingival tissue changes were assessed using in vivo micro-computed tomography and histological analysis. Serum levels of mouse homologues for IL-8 were measured using multiplex assays.
RESULTS: Pre-treatment with probiotics either via oral gavage or via oral inoculation significantly reduced bone loss (p < 0.0001) and gingival inflammation (p < 0.0001) when compared with periodontitis group. Oral gavage treatment group had significantly less TRAP positive cells (p < 0.02) then periodontitis group. LGG showed no antimicrobial activity against Porphyromonas gingivalis and Fusobacterium nucleatum.
CONCLUSIONS: LGG effectively supresses bone loss in a mouse model of induced periodontitis irrespective of the mode of administration. This article is protected by copyright. All rights reserved.

PMID: 29121411 [PubMed - as supplied by publisher]

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Adaptive intelligent cascade control of a ball-riding robot for optimal balancing and station-keeping

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Associations between maternal lifestyle factors and neonatal body composition in the Screening for Pregnancy Endpoints (Cork) cohort study

Abstract

Background

Neonatal body composition likely mediates fetal influences on life long chronic disease risk. A better understanding of how maternal lifestyle is related to newborn body composition could thus inform intervention efforts.

Methods

Using Cork participant data (n = 1754) from the Screening for Pregnancy Endpoints (SCOPE) cohort study [ECM5(10)05/02/08], we estimated how pre-pregnancy body size, gestational weight gain, exercise, alcohol, smoking and diet were related to neonatal fat and fat-free mass, as well as length and gestational age at birth, using quantile regression. Maternal factors were measured by a trained research midwife at 15 gestational weeks, in addition to a 3rd trimester weight measurement used to calculate weight gain. Infant body composition was measured using air-displacement plethysmography.

Results

Healthy (versus excess) gestational weight gain was associated with lower median fat-free mass [−112 g, 95% confidence interval (CI): −47 to −176) and fat mass (−33 g, 95% CI: −1 to −65) in the offspring; and a 103 g decrease in the 95th centile of fat mass (95% CI: −33 to −174). Maternal normal weight status (versus obesity) was associated with lower median fat mass (−48 g, 95% CI: −12 to −84). At the highest centiles, fat mass was lower among infants of women who engaged in frequent moderate-intensity exercise early in the pregnancy (−92 g at the 95th centile, 95% CI: −168 to −16). Lastly, women who never smoked tended to have longer babies with more fat mass and fat-free mass. No other lifestyle factors were strongly related to infant body composition.

Conclusions

These results suggest that supporting healthy maternal lifestyles could reduce the risk of excess fat accumulation in the offspring, without adversely affecting fat-free mass development, length or gestational age.

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A two-step method for variable selection in the analysis of a case-cohort study

Abstract

Background

Accurate detection and estimation of true exposure-outcome associations is important in aetiological analysis; when there are multiple potential exposure variables of interest, methods for detecting the subset of variables most likely to have true associations with the outcome of interest are required. Case-cohort studies often collect data on a large number of variables which have not been measured in the entire cohort (e.g. panels of biomarkers). There is a lack of guidance on methods for variable selection in case-cohort studies.

Methods

We describe and explore the application of three variable selection methods to data from a case-cohort study. These are: (i) selecting variables based on their level of significance in univariable (i.e. one-at-a-time) Prentice-weighted Cox regression models; (ii) stepwise selection applied to Prentice-weighted Cox regression; and (iii) a two-step method which applies a Bayesian variable selection algorithm to obtain posterior probabilities of selection for each variable using multivariable logistic regression followed by effect estimation using Prentice-weighted Cox regression.

Results

Across nine different simulation scenarios, the two-step method demonstrated higher sensitivity and lower false discovery rate than the one-at-a-time and stepwise methods. In an application of the methods to data from the EPIC-InterAct case-cohort study, the two-step method identified an additional two fatty acids as being associated with incident type 2 diabetes, compared with the one-at-a-time and stepwise methods.

Conclusions

The two-step method enables more powerful and accurate detection of exposure-outcome associations in case-cohort studies. An R package is available to enable researchers to apply this method.

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Additive Manufacturing: A Comparative Analysis of Dimensional Accuracy and Skin Texture Reproduction of Auricular Prostheses Replicas

Abstract

Purpose

The use of computer-aided design/computer-aided manufacturing (CAD/CAM) and additive manufacturing in maxillofacial prosthetics has been widely acknowledged. Rapid prototyping can be considered for manufacturing of auricular prostheses. Therefore, so-called prostheses replicas can be fabricated by digital means. The objective of this study was to identify a superior additive manufacturing method to fabricate auricular prosthesis replicas (APRs) within a digital workflow.

Materials and Methods

Auricles of 23 healthy subjects (mean age of 37.8 years) were measured in vivo with respect to an anthropometrical protocol. Landmarks were volumized with fiducial balls for 3D scanning using a handheld structured light scanner. The 3D CAD dataset was postprocessed, and the same anthropometrical measurements were made in the CAD software with the digital lineal. Each CAD dataset was materialized using fused deposition modeling (FDM), selective laser sintering (SLS), and stereolithography (SL), constituting 53 APR samples. All distances between the landmarks were measured on the APRs. After the determination of the measurement error within the five data groups (in vivo, CAD, FDM, SLS, and SL), the mean values were compared using matched pairs method. To this, the in vivo and CAD dataset were set as references. Finally, the surface structure of the APRs was qualitatively evaluated with stereomicroscopy and profilometry to ascertain the level of skin detail reproduction.

Results

The anthropometrical approach showed drawbacks in measuring the protrusion of the ear's helix. The measurement error within all groups of measurements was calculated between 0.20 and 0.28 mm, implying a high reproducibility. The lowest mean differences of 53 produced APRs were found in FDM (0.43%) followed by SLS (0.54%) and SL (0.59%)––compared to in vivo, and again in FDM (0.20%) followed by SL (0.36%) and SLS (0.39%)––compared to CAD. None of these values exceed the threshold of clinical relevance (1.5%); however, the qualitative evaluation revealed slight shortcomings in skin reproduction for all methods: reproduction of skin details exceeding 0.192 mm in depth was feasible.

Conclusion

FDM showed the superior dimensional accuracy and best skin surface reproduction. Moreover, digital acquisition and CAD postprocessing seem to play a more important role in the outcome than the additive manufacturing method used.

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Fear of evaluation unpacked: day-to-day correlates of fear of negative and positive evaluation

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A Simple Method for Quantification of Five Urinary Porphyrins, Porphobilinogen and 5-Aminolevulinic Acid, Using Liquid Chromatography Tandem Mass Spectrometry

Abstract

Analysis of porphyrins and 5-aminolevulinic acid (ALA), porphobilinogen (PBG) in physiological liquids is required for diagnosis and follow-up of porphyrias. High performance liquid chromatography (HPLC) and liquid chromatography tandem mass spectrometry (LC–MS) methods with higher specificity and sensitivity have been developed. The major disadvantage of those methods is that they require longer extraction times due to their matrix effects. The present study suggests a simple, fast, sensitive, and specific assay for determination of Coproporphyrin, 5-carboxylporphyrin, 6-carboxylporphyrin, 7-carboxylporphyrin, Uroporphyrin I and ALA, PBG in urine sample by direct injection without sample pre-treatment using LC–MS. For the purposes of the present study LC–MS device was set to multiple reaction monitoring (MRM) and positive ion mode. Porphyrins and ALA, porphobilinogen were characterized by their MS/MS product ion, spectra. ALA, PBG and 5 porphyrins were detected simultaneously. Limit of detection for Coproporphyrin, 5-carboxylporphyrin, 6-carboxylporphyrin, 7-carboxylporphyrin, Uroporphyrin I were 2 nmol/L, where it was 5 μmol/L for ALA and 2 μmol/L for porphobilinogen. The present study suggests that the present method is very effective compared to many other available methods for it does not require pre-treatment, provides simultaneous results of ALA, PBG and 5 porphyrins quantitatively in a shorter span of time, and has suitable sensitivity and selectivity. LC–MS technique was used clinically for the determination of urine porphyrin levels.

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High occurrence of osteoarthritic histopathological features unaccounted for by traditional scoring systems in lateral femoral condyles from total knee arthroplasty patients with varus alignment

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Local dentist offering free dental care for vets

Calderon-Melendez is fourth generation military man and the patriarch of a family of five, but like many veterans, he can't get dental coverage through the Department of Veterans Affairs. "To get a cleaning, even with three insurances, it's an outrageous expense and not everyone qualifies," said Calderon-Melendez.

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Extra-territorial movements differ between territory holders and subordinates in a large, monogamous rodent

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Limited evidence of declining growth among moisture-limited black and white spruce in interior Alaska

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Folded fabric tunes rock deformation and failure mode in the upper crust

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The nature of ancient Egyptian copper-containing carbon inks is revealed by synchrotron radiation based X-ray microscopy

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Captive bottlenose dolphins and killer whales harbor a species-specific skin microbiota that varies among individuals

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Molecular speciation and transformation of soil legacy phosphorus with and without long-term phosphorus fertilization: Insights from bulk and microprobe spectroscopy

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Rapid and selective surface functionalization of the membrane for high efficiency oil-water separation via an atmospheric pressure plasma process

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Stable Isotopes Reveal Rapid Enamel Elongation (Amelogenesis) Rates for the Early Cretaceous Iguanodontian Dinosaur Lanzhousaurus magnidens

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Early diverging lineages within Cryptomycota and Chytridiomycota dominate the fungal communities in ice-covered lakes of the McMurdo Dry Valleys, Antarctica

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Effects of elevated CO2 on fine root biomass are reduced by aridity but enhanced by soil nitrogen: A global assessment

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Urban Seismology: on the origin of earth vibrations within a city

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Climate induced human demographic and cultural change in northern Europe during the mid-Holocene

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Atomistic Structure of Mineral Nano-aggregates from Simulated Compaction and Dewatering

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The Habitats Humans Provide: Factors affecting the diversity and composition of arthropods in houses

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Prediction of human prenatal exposure to bisphenol A and bisphenol A glucuronide from an ovine semi-physiological toxicokinetic model

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Hearing Preservation Cochlear Implantation: a Review of Audiologic Benefits, Surgical Success Rates, and Variables That Impact Success

Abstract

Purpose of Review

The objectives of this review are as follows: (1) examine the audiologic benefits of hearing preservation, (2) review rates of successful hearing preservation, and (3) analyze variables that impact hearing preservation success.

Recent Findings

Hearing preservation has been shown to confer the following audiologic benefits: better speech understanding in complex listening environments, superior sound localization, and improved music appreciation. There is a notable lack of standardized criteria for reporting of hearing preservation outcomes—this leads to considerable heterogeneity across studies. Rates of functional (i.e., aidable) hearing preservation generally range between 50 and 90%. Studies demonstrate higher preservation rates and more durable hearing outcomes with shorter, straight electrode arrays.

Summary

With advances in CI technology and surgical techniques, residual hearing can be preserved after CI surgery in the majority of patients. Cochlear implant recipients with preserved hearing demonstrate better speech understanding, sound localization, and improved music appreciation.

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Safety, pharmacokinetics and pharmacodynamics of single rising doses of BI 655064, an antagonistic anti-CD40 antibody in healthy subjects: a potential novel treatment for autoimmune diseases

Abstract

Purpose

The CD40–CD40L pathway is a promising treatment target for autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus and lupus nephritis. The safety, pharmacokinetics and pharmacodynamics of BI 655064, a novel humanised antagonistic anti-CD40 monoclonal antibody, were investigated in this first-in-human trial.

Methods

Healthy male subjects (n = 72) were randomised 3:1, within each BI 655064 dose group, to single intravenous (IV; 0.2–120 mg) or subcutaneous (SC; 40–120 mg) doses of BI 655064 or placebo. Safety, plasma exposure, CD40 receptor occupancy and CD40L-induced CD54 upregulation were assessed over 12 weeks.

Results

Adverse events (AEs) were reported in 43% of subjects (n = 31). Frequency and intensity of AEs were generally similar between BI 655064 and placebo and showed no dose relationship. The most frequent AEs were headache and nasopharyngitis. One mild rash and one local reaction occurred with SC BI 655064; two serious AEs were reported, both judged unrelated to BI 655064. Pharmacokinetic evaluation demonstrated a more than proportional increase in plasma exposure relative to BI 655064 dose, with a terminal half-life between 4 h and 4 days IV and approximately 5 days SC; doses ≥ 20 mg IV and 120 mg SC showed > 90% CD40 receptor occupancy and inhibition of CD54 upregulation, which lasted 7 days in the 120 mg IV and SC groups.

Conclusions

Single doses up to 120 mg BI 655064 IV and SC were well tolerated and showed a high potential to block the CD40–CD40L pathway, supporting further clinical development of BI 655064 in patients with autoimmune disease.

Trial registration

ClinicalTrials.gov Identifier: NCT01510782

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Hearing Preservation Cochlear Implantation: a Review of Audiologic Benefits, Surgical Success Rates, and Variables That Impact Success

Abstract

Purpose of Review

Recent Findings

Summary

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Identification of 16q21 as a modifier of nonsyndromic orofacial cleft phenotypes

ABSTRACT

Orofacial clefts (OFCs) are common, complex birth defects with extremely heterogeneous phenotypic presentations. Two common subtypes—cleft lip alone (CL) and CL plus cleft palate (CLP)—are typically grouped into a single phenotype for genetic analysis (i.e., CL with or without cleft palate, CL/P). However, mounting evidence suggests there may be unique underlying pathophysiology and/or genetic modifiers influencing expression of these two phenotypes. To this end, we performed a genome-wide scan for genetic modifiers by directly comparing 450 CL cases with 1,692 CLP cases from 18 recruitment sites across 13 countries from North America, Central or South America, Asia, Europe, and Africa. We identified a region on 16q21 that is strongly associated with different cleft type (P = 5.611 × 10⁻⁸). We also identified significant evidence of gene–gene interactions between this modifier locus and two recognized CL/P risk loci: 8q21 and 9q22 (FOXE1) (P = 0.012 and 0.023, respectively). Single nucleotide polymorphism (SNPs) in the 16q21 modifier locus demonstrated significant association with CL over CLP. The marker alleles on 16q21 that increased risk for CL were found at highest frequencies among individuals with a family history of CL (P = 0.003). Our results demonstrate the existence of modifiers for which type of OFC develops and suggest plausible elements responsible for phenotypic heterogeneity, further elucidating the complex genetic architecture of OFCs.

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Πέμπτη 9 Νοεμβρίου 2017

Differences in medication adherence are associated with beliefs about medicines in asthma and COPD

Adherence to medication is crucial for achieving treatment control in chronic obstructive lung diseases. This study refers to the "necessity-concerns framework" and examines the associations between beliefs a...

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Vocal assessment of addicts on methadone therapy via the RBH scale and objective acoustic parameters

Publication date: Available online 10 November 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Veljko Mirkov, Slobodan M. Mitrović
IntroductionA large number of people around the world struggle daily to become free of their addiction to illegal psychoactive substances. In order to create an atmosphere of improved supervision, established communication and improved quality of life for drug addicts, centers have been set up to provide methadone as a substitute.ObjectiveThe aim of the research was to assess the vocal features of drug addicts on methadone therapy via subjective and objective parameters, to ascertain if vocal damage has occurred and to determine whether subjective and objective acoustic vocal parameters are related, and how.MethodsThe research included 34 adults of both genders who were undergoing methadone treatment. A subjective vocal evaluation assessed voice pitch and clarity, while the subjective acoustic analysis utilized the Roughness-Breathiness-Hoarseness scale of roughness-breathiness-hoarseness. Objective acoustic analysis was conducted after recording and analyzing an uninterrupted vocal /a/ of at least three seconds duration, using the "GllotisController" software.ResultsThe subjective acoustic analysis using the Roughness-Breathiness-Hoarseness scale showed pathological values in 52.9% male and 47% female participants. The average values of the roughness-breathiness-hoarseness for the entire sample were 0.91, 0.38 and 0.50, respectively. Lower roughness was associated with a higher fundamental frequency (f0) and lower jitter and shimmer values (p<0.05). There was a statistically significant correlation between breathiness, jitter (p<0.01) and shimmer (p<0.05), and between hoarseness and jitter (p<0.01).ConclusionA statistically significant correlation was found between the two subjective vocal assessments, voice clarity and pitch, and Roughness-Breathiness-Hoarseness scale, and the parameters of the objective acoustic vocal assessment.

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The protective effects of whortleberry extract against cisplatin-induced ototoxicity in rats

Publication date: Available online 10 November 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Doğukan Özdemir, Abdulkadir Özgür, Yıldıray Kalkan, Suat Terzi, Levent Tümkaya, Adnan Yılmaz, Metin Çeliker, Engin Dursun
IntroductionCisplatin is one of the main chemotherapeutic agents used for the treatment of many types of cancer. However, ototoxicity, one of the most serious side effects of cisplatin, restricts its usage.ObjectiveWe aimed to investigate the protective effects of whortleberry extract against cisplatin-induced ototoxicity by evaluating hearing and histopathological cochlear damage and by measuring the biochemical parameters affected byoxidative stress.MethodsForty-eight male rats were included in the study after performing Distortion Product Otoacoustic Emission test to confirm that their hearing levels were normal. The rats were randomly divided into six groups: the control group, the sham group, and, which received only whortleberry extract, only cisplatin, cisplatin+100mg whortleberry extract, cisplatin+200mg whortleberry extract, respectively. Audiologic investigation was performed by performing the Distortion Product Otoacoustic Emission test at the beginning and at the eighth day of the study. Cardiac blood samples were collected for biochemical analysis, and the rats were sacrificed to obtain cochlear histopathological specimens on the eighth day.ResultsThe results revealed that whortleberry protects hearing against cisplatin-induced ototoxicity independent of the dose. However, high doses of whortleberry extract are needed to prevent histopathological degeneration and oxidative stress.ConclusionThe results obtained in this study show that whortleberry extract has a protective effect against cisplatin-induced ototoxicity.

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An unconventional approach to dental health that works

One of the greatest fears for most people is a trip to the dentist, especially if they know there is work to be done. The grinding, pulling, smells, and needles are not exactly a situation that drums up warm and cozy feelings.

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Treating periodontitis to prevent heart disease – evidence unclear

Only 1 trial at high risk of bias was included in this recent update of a 2014 Cochrane review of periodontal therapy for preventing cardiovascular disease (CVD) providing insufficient evidence to support or refute whether periodontal therapy can prevent the recurrence of CVD in the long term in patients with chronic periodontitis.

The post Treating periodontitis to prevent heart disease – evidence unclear appeared first on National Elf Service.

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Effect of Home Bleaching on the Translucency of CAD/CAM Systems

Abstract

Purpose

To evaluate the effect of a home bleaching agent (Opalescence PF) on the translucency of CAD/CAM ceramic systems.

Materials and Methods

The 28 sintered ceramic specimens (IPS Empress CAD and IPS e.max CAD; 15 mm long, 10 mm wide, 1 mm thick) were divided into two subgroups as control and bleaching groups (n = 7). Carbamide peroxide (CP), 16%, home bleaching agent was applied onto the surface of each specimen for 6 hours per day for 7 days. A spectrophotometer (VITA Easyshade Advance) was used to measure the CIE L^*a^* b^* coordinates and the reflectance value (Y) of the specimens on white and black backgrounds. The translucency parameter (TP), contrast ratio (CR), and opalescence parameter (OP) of the specimens were calculated. The data were statistically analyzed using Kolmogorov–Smirnov, one-way ANOVA, Tukey's test, and Pearson's correlation.

Results

Statistically significant differences in the TP values after 16% CP bleaching treatment were observed (p ˂ 0.05); however, no significant differences were found in the OP and CR values after the surface treatment (p ˃ 0.05).

Conclusions

According to our study, patients who have all-ceramic restorations in their mouths should be careful when using home bleaching agents, because whitening agents can affect the translucency of all-ceramic restorations such as e.max CAD and Empress CAD.

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Environmental microbiology: Geographic coordinates guide natural product discovery

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Nuclear IGF-1R predicts chemotherapy and targeted therapy resistance in metastatic colorectal cancer

Nuclear IGF-1R predicts chemotherapy and targeted therapy resistance in metastatic colorectal cancer

Nuclear IGF-1R predicts chemotherapy and targeted therapy resistance in metastatic colorectal cancer, Published online: 09 November 2017; doi:10.1038/bjc.2017.279

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Combining DNA damaging therapeutics with immunotherapy: more haste, less speed

Combining DNA damaging therapeutics with immunotherapy: more haste, less speed

Combining DNA damaging therapeutics with immunotherapy: more haste, less speed, Published online: 09 November 2017; doi:10.1038/bjc.2017.376

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Neutrophils: driving progression and poor prognosis in hepatocellular carcinoma?

Neutrophils: driving progression and poor prognosis in hepatocellular carcinoma?

Neutrophils: driving progression and poor prognosis in hepatocellular carcinoma?, Published online: 09 November 2017; doi:10.1038/bjc.2017.386

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BPIFB1 (LPLUNC1) inhibits migration and invasion of nasopharyngeal carcinoma by interacting with VTN and VIM

BPIFB1 (LPLUNC1) inhibits migration and invasion of nasopharyngeal carcinoma by interacting with VTN and VIM

BPIFB1 (LPLUNC1) inhibits migration and invasion of nasopharyngeal carcinoma by interacting with VTN and VIM, Published online: 09 November 2017; doi:10.1038/bjc.2017.385

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Favourable prognostic role of histological regression in stage III positive sentinel lymph node melanoma patients

Favourable prognostic role of histological regression in stage III positive sentinel lymph node melanoma patients

Favourable prognostic role of histological regression in stage III positive sentinel lymph node melanoma patients, Published online: 09 November 2017; doi:10.1038/bjc.2017.397

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IGF-1R: SUMO-ing its weight in chemoresistant colorectal cancer

IGF-1R: SUMO-ing its weight in chemoresistant colorectal cancer

IGF-1R: SUMO-ing its weight in chemoresistant colorectal cancer, Published online: 09 November 2017; doi:10.1038/bjc.2017.377

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A new panel of pancreatic cancer biomarkers discovered using a mass spectrometry-based pipeline

A new panel of pancreatic cancer biomarkers discovered using a mass spectrometry-based pipeline

A new panel of pancreatic cancer biomarkers discovered using a mass spectrometry-based pipeline, Published online: 09 November 2017; doi:10.1038/bjc.2017.365

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Tumour-infiltrating inflammatory and immune cells in patients with extrahepatic cholangiocarcinoma

Tumour-infiltrating inflammatory and immune cells in patients with extrahepatic cholangiocarcinoma

Tumour-infiltrating inflammatory and immune cells in patients with extrahepatic cholangiocarcinoma, Published online: 09 November 2017; doi:10.1038/bjc.2017.401

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The Contribution of Surface Electromyographic Assessment for Defining the Stage of Peripheral Facial Paralysis: Flaccid or Sequelae Stage

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1607335

Introduction Surface electromyographic activity may not be symmetric, even in subjects with no facial paralysis history. Objective To evaluate the contribution of the index of electromyographic (IEMG) activity in the identification of the two extremes of the facial paralysis course. Methods Thirty-four subjects with unilateral peripheral facial paralysis were selected. A control group was composed of volunteers without a history of facial paralysis. The electromyographic assessment of the facial muscle was performed by placing surface electrodes during movements of the forehead, eyes and lips using MIOTEC equipment, such as the MIOTOOL (Miotec, Porto Alegre, Brazil) software. The electromyographic activity was also recorded in other channels during the primary activity to identify the presence of synkinesis. The statistical analysis was performed using the Statistical Package for Social Sciences for Macintosh (SPSS Inc, Chicago, IL, USA). The IEMG activity was obtained from the division of the electromyographic activity root mean square (RMS) values on both sides. Results There was a statistically significant difference among the groups in all the analyzed indexes. The ocular-oral synkinesis in all patients must be correctly identified (with 100% sensitivity and specificity) using an IEMG activity of 1.62 as a cutoff point. The oral-ocular synkinesis must be correctly identified (93.3% sensitivity and 95.9% specificity) using the IEMG activity of 1.79 as a cutoff point. Conclusion The IEMG activity is below the normal scores in patients in the flaccid stage, whereas patients in the sequelae stage can either show normal values or values above or below the normal scores. The IEMG activity was shown to have high sensitivity and specificity in the identification of synkinesis.
[...]

Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

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

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Vocal Symptoms and Associated Risk Factors between Male and Female University Teachers

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1606604

Introduction Many recent studies on teachers warn of the adverse effects that voice problems have on work performance. However, only a few of these studies included university teachers. Objective To compare the vocal symptoms and risk factors between male and female university teachers in a private institution within the city of São Paulo. Methods In a cross-sectional survey, a voice self-evaluation form prepared by the Ministry of Labor in Brazil was administered to 846 university teachers at a private institution in the city of São Paulo. Results The percentage of hoarseness, vocal tract discomfort, neck pain and foreign body sensation was significantly higher in female than in male subjects. A significantly higher percentage of males participated in other professional activities in addition to teaching, reported working in a calm environment compared with working in a moderately or severely tense and stressful environment, and rated themselves as calm, slightly stressed and anxious or moderately stressed and anxious rather than very stressed and anxious. A significantly higher percentage of females spent most of their time teaching compared with performing other professional activities, and rated themselves as chatty or impulsive. Conclusion Among university teachers, a significantly higher percentage of females than males reported hoarseness, vocal tract discomfort, neck pain and foreign body sensation. Some risk factors related to work organization, workplace environment, voice care and quality of life variables were related to this higher prevalence in females.
[...]

Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

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

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Efficacy of Drainless Total Thyroidectomy in Intrathyroidal Lesions of Thyroid

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1606183

Introduction There is difference of opinion about the placement of the drain in thyroid surgeries, and, to the best of our knowledge, the efficacy of drainless total thyroidectomy regarding various parameters of thyroid lesions has not been well-established. Objective To report our experience with drainless total thyroidectomy, and to define an appropriate patient population for its performance. Methods This is a retrospective case analysis of the patients who underwent total thyroidectomy for intrathyroidal lesions with or without central neck dissection in a tertiary referral hospital (number = 74). The patients, who had undergone total thyroidectomy without any drain insertion, were analyzed, and the relationships among various parameters of thyroid lesions were noted in relation to seroma and hematoma formation. Results Seroma formation was noted only in 5 out of 74 patents (6.75%). All of the seromas that occurred were observed in patients with thyroid lesions < 4 cm, and 4 out of 5 seromas were observed in patients with a malignant pathology. There was no statistically significant difference in seroma formation between patients younger or older than 50 years of age.The nature of the lesion, whether benign or malignant, did not affect the formation of seroma. Of interest is the fact that none of the 10 patients who had central neck dissection performed as part of their treatment developed seroma. Conclusions Drainless total thyroidectomy is safe across all age groups for patients harboring either benign or malignant thyroid pathologies. However, caution is to be observed in opting for drainless total thyroidectomy in patients with large lesions (> 5 cm)
[...]

Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

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

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Changing Trends in the Treatment of Mandibular Fracture

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1606645

Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Article in Thieme eJournals:
Table of contents | open access Full text

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Evaluation of the Facial Recess and Cochlea on the Temporal Bone of Stillbirths regarding the Percutaneous Cochlear Implant

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1606612

Introduction The literature shows that there are anatomical changes on the temporal bone anatomy during the first four years of life in children. Therefore, we decided to evaluate the temporal bone anatomy regarding the cochlear implant surgery in stillbirths between 32 and 40 weeks of gestational age using computed tomography to simulate the trajectory of the drill to the scala timpani avoiding vital structures. Objectives To measure the distances of the simulated trajectory to the facial recess, cochlea, ossicular chain and tympanic membrane, while performing the minimally invasive cochlear implant technique, using the Improvise imaging software (Vanderbilt University, Nashville, TN, US). Methods An experimental study with 9 stillbirth specimens, with gestational ages ranging between 32 and 40 weeks, undergoing tomographic evaluation with individualization and reconstruction of the labyrinth, facial nerve, ossicular chain, tympanic membrane and cochlea followed by drill path definition to the scala tympani. Improvise was used for the computed tomography (CT) evaluation and for the reconstruction of the structures and trajectory of the drill. Results Range of the distance of the trajectory to the facial nerve: 0.58 to 1.71 mm. to the ossicular chain: 0.38 to 1.49 mm; to the tympanic membrane: 0.85 to 1.96 mm; total range of the distance of the trajectory: 5.92 to 12.65 mm. Conclusion The measurements of the relationship between the drill and the anatomical structures of the middle ear and the simulation of the trajectory showed that the middle ear cavity at 32 weeks was big enough for surgical procedures such as cochlear implants. Although cochlear implantation at birth is not an indication yet, this study shows that the technique may be an option in the future.
[...]

Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

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

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Papillary Thyroid Carcinoma within Thyroglossal Duct Cyst: Case Series and Literature Review

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1606277

Introduction Thyroglossal duct cyst (TGDC) is the most common congenital anomaly of the neck, and approximately 7% of all the adult population presents it. Ectopic thyroid tissue is found in the thyroglossal duct cyst wall in up to 65% of cases. This thyroid tissue has the potential to develop some type of malignancy, the most common of which is the papillary carcinoma of the thyroid. There are just over 270 cases of thyroglossal duct cyst malignancy reported in the literature. Objectives We aimed to study our population of patients in order to identify cases with thyroglossal duct cyst malignancy. Methods A retrospective chart review was conducted in the section of otolaryngology/head and neck surgery at a hospital in Karachi, Pakistan, from January of 2004 to December of 2014 on patients with the diagnosis of thyroglossal duct cyst. Results Fifty-eight patients were diagnosed with TGDC, two of whom also presented with thyroglossal duct cyst carcinoma. Both patients revealed papillary thyroid carcinoma on histopathology. Case 1 had an open biopsy before undergoing definitive surgery. Both patients underwent subsequent total thyroidectomy after Sistrunk procedure, and case 2 had selective neck dissection revealing lymph node metastasis. Conclusion Thyroglossal duct cyst carcinoma is a rare finding that comes as a surprise to both the patient and the surgeon. We report 2 out of 58 cases diagnosed with thyroglossal duct cyst carcinoma.
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An Analysis of Anatomic Variations of the Sphenoid Sinus and Its Relationship to the Internal Carotid Artery

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1607336

Introduction The sphenoid sinus (SS) has a high variability; its anatomical relations and variations must be well understood prior to the expanded endoscopic surgery (EES) at the skull base via the endonasal transsphenoidal approach. A feared complication is injury to the internal carotid artery (ICA). Objective To evaluate the anatomic variations of the SS and its relationship to the ICA using computed tomography (CT). Methods Cross-sectional retrospective study. Analysis of 90 patients' CT scans on axial, coronal and sagittal planes with 1 mm slices, evaluating lateral and posterior extensions of pneumatization of the SS, deviation of the sphenoid septum, presence of septations and their relationship to the parasellar and paraclival segments of the internal carotid artery (psICA and pcICA, respectively). Results The association between the protrusions of the psICA and the pcICA was statistically significant (p < 0.001), as was the association between the lateral extension of pneumatization of the SS and the protrusion of the psICA (p = 0.014). The presence of the posterior extension of pneumatization of the SS and protrusion of the pcICA occurred in 46% of the cases. Deviation of the sphenoid septum in the direction of the pcICA was present in 14% and dehiscence of the pcICA was seen in 3.6% of the cases. Conclusion Using the CT scan to recognize the type of extensions of pneumatization of the SS, the deviation of the sphenoid septum, and the presence of septations is beneficial to identify accurately the ICA and to reduce the risk of injury to it.
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Probable Association of Hearing Loss, Hypertension and Diabetes Mellitus in the Elderly

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1606644

Introduction The aging process causes changes in body structure in a continuous manner, and contributes to clinical disorders. Life expectancy is increasing, especially in developing countries. Objective To assess the prevalence of hearing loss and its possible association with hypertension and diabetes mellitus (DM) in the elderly. Methods A cross-sectional study with 519 elderly individuals aged over 60 years who underwent an audiological evaluation (pure tone audiometry), and answered a comorbidity questionnaire that included questions about age, gender, tinnitus and medical history, with data concerning DM. The dependent variable was the presence of hearing loss. The independent variables were age, gender, DM and hypertension. The variables were presented in absolute numbers and proportions, and enabled us to estimate the prevalence. The statistical analysis was performed through multiple logistic regression with 95% confidence intervals and values of p < 0.05 for the hearing loss and its associated factors. Results A total of 519 subjects of both genders with a median age of 69 years were evaluated, and the individuals who did not attend the audiometric test were excluded from the study, so the final sample was composed of 498 subjects. Sensorineural hearing loss was more prevalent (66.26%) of most frequently with bilateral hearing loss of 91.56% and 26.50% with mild degree. The statistical analysis showed that the variable DM was associated with the high frequency of hearing loss in the elderly, and according to the multiple logistic regression, the risk factors are independent of the hearing loss only for age and exposure to occupational noise. Conclusions There was a statistically significant difference between hearing loss at high frequencies and the risk factors, that is, age and DM.
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Outcomes of Automated Auditory Evoked Potential Performed in Different Settings and the Factors Associated with Referred Cases

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1607334

Introduction For the population with risk factors for hearing loss, the first option to assess the hearing status is the performance of the automated brainstem auditory evoked potential (BAEP) test because of its efficacy in identifying retrocochlear hearing loss. Objective To verify the outcomes of automated BAEP performed in different settings as well as the factors associated with the prevalence of hearing impairment. Methods Cross-sectional study conducted from October of 2014 to May of 2015. The sample consisted of 161 infants with at least one risk factor for hearing loss who underwent automated BAEP during the hospital stay or at the outpatient clinic. After 30 days, the altered cases were referred for BAEP diagnosis. Results One hundred and thirty-eight infants (86%) had a result of "pass" and 23 (14%) of "failure" in the automated BAEP. There was no statistically significant difference in the rate of "referred" results between examinations performed in different settings. The infants' ages did not influence the number of abnormal cases. All of the 23 infants who presented a "referred" result in the automated BAEP, unilateral or bilateral, were sent for BAEP diagnosis, and out of these, 9 (39%) remained with at least some degree of alteration. The average age of diagnosis was 2.7 months. Conclusion The results of the automated BAEP were similar when performed during hospitalization or after discharge. Neither the age at the examination nor the gender of the patient influenced the prevalence of hearing loss.
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Hyoid Bone Suspension as a Part of Multilevel Surgery for Obstructive Sleep Apnea Syndrome

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1607227

Introduction Since oropharyngeal surgery alone is often insufficient to treat obstructive sleep apnea (OSA), advances have been developed in hypopharyngeal surgery. Objective To assess hyoid suspension surgery as part of a multilevel OSA surgery, also including palatal surgery. Methods The study included patients with OSA symptoms with apnea hypopnea index (AHI) > 15. They were scheduled for hyoid suspension after a nasoendoscopy during Müller maneuver and drug induced sleep endoscopy (DISE). All patients had body mass index (BMI) < 35 kg/m2. Hyoidothyroidopexy combined with tonsillectomy and palatal suspension was performed in all cases. Results The mean AHI dropped significantly (p < 0.0001) from 68.4 ± 25.3 preoperatively to 25.6 ± 9.52 postoperatively. The mean lowest oxygen (O2) saturation level increased significantly from 66.8 ± 11.3 to 83.2 ± 2.86 (p < 0.0001). In addition, the snoring score significantly decreased (p < 0.0001) from a preoperative mean of 3.4 ± 0.54 to 2 ± 0.7 at 6 months postoperatively. In regard to the Epworth sleepiness scale (ESS), it showed significant improvements (p < 0.0001) as its mean diminished from 13.8 ± 5.4 preoperatively to 5.2 ± 1.6 postoperatively. Conclusion Hyoidothyroidopexy using absorbable suture seems to produce a good outcome in treating OSA. It could be effectively and safely combined with other palatal procedures in the multilevel surgery for OSA.
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Assessment of Pulmonary Function before and after Sinus Surgery in Lung Transplant Recipients

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1606600

Introduction The association between sinus and lung diseases is well known. However, there are scarce studies regarding the effects of sinus surgery on pulmonary function in lung transplant recipients. The present study describes our experience with sinus surgery in lung transplant recipients with chronic rhinosinusitis. Objectives To assess the impact of sinus surgery for chronic rhinosinusitis on pulmonary function and on inpatient hospitalization days due to lower respiratory tract infection in lung transplant recipients. Methods A retrospective study conducted between 2006 and 2012 on a sample of lung transplant recipients undergoing sinus surgery for chronic rhinosinusitis. Pulmonary function, measured by forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1), as well as inpatient hospitalization days due to lower respiratory tract infection, were compared 6 months before and 6 months after sinus surgery. Results The FEV1 values increased significantly, and the inpatient hospitalization days due to bronchopneumonia decreased significantly 6 months after sinus surgery. The preoperative and postoperative median FEV1 values were 2.35 and 2.68 respectively (p = 0.0056). The median number of inpatient hospitalization days due to bronchopneumonia 6 months before and 6 months after surgery were 32.82 and 5.41 respectively (p = 0.0013). Conclusion In this sample of lung transplant recipients with chronic rhinosinusitis, sinus surgery led to an improvement in pulmonary function and a decrease in inpatient hospitalization days due to bronchopneumonia.
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Otitis Externa in Secondary Care: A Change in Our Practice Following a Full Cycle Audit

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1606621

Introduction Patients presenting with otitis externa are a common thing in otolaryngology units. However, the practice has not been standardized due to a lack of consensus over the management of this condition in secondary care. The National Institute for Health and Care Excellence (NICE) guideline has been published targeting the general practitioners, but it may be relevant in cases of hospital first-time attenders. Objective To conduct an audit of the investigative and prescription practice for hospital first-time attenders in our department against the NICE guideline for otitis externa. Methods The case notes of the patients presenting with otitis externa were reviewed. The data collation included the performance of ear swabs and choice of eardrops. Results An initial audit showed that ear swabs were sent in 14 out of 19 cases, of which 11 grew either Pseudomonas aeruginosa or Staphylococcus aureus (organisms that are sensitive to empirical treatment). A re-audit showed higher adherence to NICE recommendations, with ear swabs sent in only 3 out of 25 cases. The initial audit also demonstrated Sofradex (Sanofi-Aventis, Paris, France) as the most popular empirical eardrop. Following our recommendation, the re-audit showed that Betnesol-N (GSK, Brentford, UK) was administered in 24 out of 25 cases. Conclusion We recommend Betnesol-N due to its cost-effectiveness. Ear swabs should be reserved for refractory cases only. Posters and email reminders are effective means of disseminating information within the hospital.
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Sudden Sensorineural Hearing Loss: Comparative Study of Different Treatment Modalities

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1605376

Introduction Idiopathic sudden sensorineural hearing loss (ISSNHL) is hearing loss of at least 30 dB in at least 3 contiguous frequencies within at least 72 hours. There are many different theories to explain it, and many different modalities are used for its management, such as: systemic steroids (SSs), intratympanic steroid injection (ITSI), hyperbaric oxygen therapy (HOT), antiviral drugs, and vasodilators or vasoactive substances. Objectives This study aims to evaluate the efficacy of the combination of the most common treatment modalities of ISSNHL and to compare the results if HOT was not one of the treatment modalities administered. Methods The study was conducted with 22 ISSNHL patients with ages ranging from 34 to 58 years. The patients were divided into 2 groups; group A included 11 patients managed by SSs, ITSI, antiviral therapy, and HOT simultaneously, and group B included 11 patients exposed to the aforementioned modalities, with the exception of HOT. Results After one month, all of the patients in group A showed total improvement in hearing in all frequencies, with pure tone average (PTA) of 18.1 ± 2.2, while in group B, 5/11 (45.5%) patients showed total improvement, and 6 /11 (54.5%) patients showed partial improvement, with a total mean PTA of 28.1 ± 8.7. Conclusion The early administration of HOT in combination with other clinically approved modalities (SSs, ITSI, antiviral therapy) provides better results than the administration of the same modalities, with the exception of HOT, in the treatment of ISSNHL.
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Applicability of Evoked Auditory Brainstem Responses with Complex Stimuli in Adults with Hearing Loss

Int Arch Otorhinolaryngol
DOI: 10.1055/s-0037-1605341

Introduction The use of the speech-evoked auditory brainstem response (ABR) shows how the brainstem operates up to the subcortex in a more complex manner than when the click-evoked ABR is used. Objective To study the applicability of the speech-evoked ABR in adults with hearing loss. Methods The sample was composed of a study group of 11 subjects, with ages ranging between 18 and 59 years, and auditory thresholds within normal standards, with loss of up to 65 dB at high frequencies or up to moderately severe symmetric sensorineural hearing loss. The sample underwent a basic audiological assessment, as well as speech-evoked ABR and click-evoked ABR, in which waves I, III and V, and V, A, C, D, E, F were respectively marked. The electrophysiological assessments were performed using the SmartEP device (Intelligent Hearing Systems, Miami, FL, US). Results For the speech-evoked ABR, the reference values were used in the identification and analysis of the study group. Those values found for the study group were: V = 8.56; A = 10.97; C = 21.33; D = 29.51; E = 37.93; F = 46.96; and O = 55.97. In the comparison between groups, the study group presented an increase in latency only in wave C. Conclusion The speech-evoked ABR can be performed in subjects with up to moderately severe hearing loss, and the test proved to be appropriate, because, unlike the click-evoked ABR, the former does not suffer influence of peripheral hearing loss.
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As we celebrate and honor those who made the ultimate sacrifice for our country, one veteran is thankful to find new peace following his struggles with crippling PTSD. But state-of-the-art technology being used at a dentists office in Wellington is helping him to cope with his symptoms.

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Removal of a Frontal Sinus Osteoma and Reconstruction by a Custom-Made Implant with Neuronavigation Assistance

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1607066

The authors report the surgical treatment of an extensive right frontal sinus osteoma assisted by neuronavigation and reconstruction by a hydroxyapatite custom-made implant. The patient presents with ptosis, hypoglobus, and proptosis of the right eye, without any visual impairment. Computed tomographic (CT) scan showed a very large bony mass involving right frontal sinus and displacing the orbital roof. A stereolithographic model–guided planning was carried out to obtain a practical simulation of the surgical operation and it was submitted to a new CT scan to acquire the reference point to realize the neuronavigation assistance, and to achieve the template to realize the hydroxyapatite custom-made implant. Intraoperatively, with the help of neuronavigation assistance, osteotomies were performed by piezoelectric device. The reconstruction was made using a hydroxyapatite custom-made implant. The procedure was damage free, the bony mass was excised, and the orbital roof was repaired without any adverse effects. Postsurgical CT scan and scintigraphy showed a good reconstruction and a good-quality osteoblasts activity on the borders of the implant. Osteoma is a benign slow-growing bone tumor, usually involving the frontal sinus. Navigational assistance offers a very important help to perform safe osteotomies. Hydroxyapatite custom-made implant seems to be an excellent reconstructive method.
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Thromboprophylaxis in Head and Neck Microvascular Reconstruction

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1607068

Head and neck patients undergoing microvascular reconstruction are at high risk for thromboembolism. While the prevention of thromboembolism has become an essential aspect of care, within the field of microsurgery, concern for anastomotic complications have hindered the creation of an accepted regimen. The aim of this review was to evaluate the risks and benefits of prophylactic agents for thromboprophylaxis. A literature search was conducted in MEDLINE, Cochrane Library, and PubMed/NCBI databases. Articles discussing thromboprophylaxis in otolaryngology, head and neck surgery, or microvascular reconstruction were considered in the review from the past 30 years. The majority of patients undergoing microvascular surgery have multiple risk factors for thrombus formation. Several consensus guidelines exist for the prophylaxis in patients who are critically ill, undergoing surgery, or with malignancy. Significant evidence supports the routine use of mechanical means, such as early mobilization and pneumatic compression along with subcutaneous heparin. Low-molecular-weight heparin is also frequently utilized, although results are largely divided. Data on aspirin remain equivocal. Studies on microvascular failure and flap loss have demonstrated little to no association with chemoprophylaxis. The evidence for postoperative thromboprophylaxis regimens in patients undergoing head and neck free tissue transfer is variable. Multiple studies have supported the use of unfractionated heparin or low-molecular-weight heparin. There appears to be an expert consensus for the combined use of mechanical prophylactic methods and chemical prophylaxis. Prospective randomized trials are required to validate the most effective combination of chemoprophylaxis agents.
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Pseudoaneurysm Following Endoscopic-Assisted Repair of Subcondylar Fracture

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1607064

Pseudoaneurysms are a known complication following facial trauma and orthognathic surgery. Few reports exist of this clinical entity following traditional open techniques of repair, and none have been associated with endoscopic-assisted open reduction and internal fixation (ORIF) of a subcondylar fracture. We present a case of a 33-year-old man who developed pseudoaneurysm after endoscopic-assisted ORIF as well as a review of the literature on this topic. While uncommon, this is a potential complication that should be recognized with the use of endoscopic-assisted repair of mandibular fractures.
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Traumatic Anterosuperior Dislocation of the Intact Mandibular Condyle into the Temporal Fossa

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1607067

Temporomandibular joint (TMJ) dislocation, or luxation, occurs when the condyle crosses the articular eminence in such a way that it does not return to its correct anatomical position, unless aided by a reduction in external forces for TMJ. The diagnosis of condylar luxation is clinical; however, image exams are important in classifying the types of condylar luxation and associated fractures. Displacement of the TMJ can occur due to either an exaggerated mouth opening or a forced opening and occasionally is associated with a high-impact trauma to the jaw, the latter being an extremely rare condition. Few cases of anterosuperior dislocation of the intact mandibular condyles into the temporal fossa (ADIMC) have been documented in medical literature, many of which are associated with craniofacial trauma. This study describes the case of an ADIMC of the left side combined with facial fractures, as well as the treatment performed. A review of cases found in the literature from 1969 to 2017 was conducted through a detailed bibliographical study.
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Cartilage Graft Donor Site Morbidity following Rhinoplasty and Nasal Reconstruction

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1607065

Although surgical techniques for rhinoplasty and nasal reconstruction are well established, prospective research on postoperative morbidity remains limited. The aim of this pilot study was to assess costal and auricular cartilage donor site pain and morbidity in patients undergoing rhinoplasty and nasal reconstruction. In this prospective cohort study, we enrolled 55 patients undergoing nasal surgery that required costal or auricular cartilage harvest from February 2015 through May 2016. Each patient was given a symptom-specific patient survey that assessed general pain, nasal pain, graft donor site pain, graft donor site itching, color variation, skin stiffness and thickness, and graft donor site appearance at 1, 4, and 12 weeks after surgery. Our patient group was 55% female (n = 30); the mean age was 47 years. Rib cartilage graft patients had significantly greater nasal pain than cartilage donor site pain. There was no significant difference in rib versus ear cartilage donor site pain. Nearly all patients reported that they were not at all concerned about their scar appearance or ear shape and appearance. No prior studies compare cartilage donor site morbidity in patients undergoing nasal surgery. Our findings challenge the conventional wisdom that utilizing auricular and costal cartilage results in high levels of donor site pain. Surgeons should have a low threshold to harvest rib or ear cartilage when it can improve surgical outcome.
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A Novel Approach for the Management and Prevention of Self-Induced Masticatory Lingual Trauma in the Neurologically Injured Patient

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1606300

Self-induced masticatory trauma is an unfortunate complication of a variety of neurologic disorders, including epileptic seizures, cerebral palsy, mental retardation, psychiatric disease, and brain trauma, in addition to other described etiologies. While single or occasional occurrences of tongue biting are relatively benign, recurrent self-injury can pose major issues and predispose a patient to chronic, severe complications. To prevent the complications associated with ongoing trauma to the tongue, steps must be taken to protect individuals from chronic self-injurious behavior. Often, these interventions cause significant morbidity to the patient, such as elective removal of the dentition or complications in gaining access to the oral cavity/airway associated with maxillomandibular fixation. In the neurologically impaired patient, immobilization of the jaws is frequently associated with higher rates of agitation, aspiration, or development of complicating infections of the gingival tissues. We report a case of self-induced masticatory trauma managed with the fabrication of a custom-fabricated oral appliance. This treatment modality successfully prevents the recurrence or incidence of self-induced masticatory trauma to the tongue. The benefits of this modality are that it allows access to the oral cavity, prevents immobilization of the jaws, has minimal to no morbidity, and is completely reversible.
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Figi’s Issues Recall Alert Due to Undeclared Allergen (Milk) in Dark Chocolate Gingersnaps

Figi's Companies, Inc of Marshfield, WI is recalling the following 2 products that are related to the GKI FOODS LLC Dark Chocolate Products recall because it may contain undeclared milk allergen. People who have an allergy or severe sensitivity to milk run the risk of serious or life- threatening allergic reaction if they consume these products.

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Osseointegrated Implants and Prosthetic Reconstruction Following Skull Base Surgery

Seminars in Plastic Surgery 2017; 31: 214-221
DOI: 10.1055/s-0037-1607201

Rehabilitation following ablative skull base surgery remains a challenging task, given the complexity of the anatomical region, despite the recent advances in reconstructive surgery. Remnant defects following resection of skull base tumors are often not amenable to primary closure. As such, numerous techniques have been described for reconstruction, including local rotational muscle flaps, pedicled flaps with skin paddle, or even free tissue transfer. However, not all patients are appropriate surgical candidates and therefore may instead benefit from nonsurgical options for functional and aesthetic restoration. Osseointegrated implants and biocompatible prostheses provide a viable alternative for such a patient population. The purpose of this review serves to highlight current options for prosthetic rehabilitation of skull base defects and describe their indications, advantages, and disadvantages.
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Αρχειοθήκη ιστολογίου

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Παρασκευή 10 Νοεμβρίου 2017

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Πέμπτη 9 Νοεμβρίου 2017

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