Association of benign paroxysmal positional vertigo with vitamin D deficiency: a systematic review and meta-analysis

Abstract

Background and objective

Benign paroxysmal positional vertigo (BPPV) is an idiopathic recurrent inner ear illness that is caused most often by an imbalance in the metabolism of calcium carbonate crystals (otoconia) inside the semicircular canals, in which the otoconia begin to circulate freely after being dislodged from the basic structure. The underlying etiology of this imbalance has not yet been well established; however, a few recent articles have revealed that vitamin D level abnormality in these patients might play a role. Therefore, we conducted the current systematic review analysis to explore potential associations of vitamin D level with the occurrence as well as the recurrence of BPPV disease.

Methods

A comprehensive literature search was conducted using different databases to retrieve all of the articles that have evaluated possible associations, irrespective of the study design. Then, we reported different vitamin D3 levels from BPPV groups and control groups to estimate the standardized mean difference (SMD) between the BPPV and control groups. We also calculated the effect size of each study under the random effects statistical model.

Results

Of the 703 studies that we identified, only 37 studies were found to be potential for our analysis, and of these, only seven met our predetermined criteria. Two meta-analyses were conducted with respect to the occurrence and the recurrence of BPPV. When the BPPV cases were compared to the controls (free of BPPV disease), there was an insignificant reduction in vitamin D level among the diseased groups (SMD = − 2.20; 95% CI − 6.66 to 2.26). In contrast, when the recurrent BPPV groups were compared with the non-recurrent BPPV groups, the statistical analysis showed significantly lower level of vitamin D among the recurrence BPPV groups (SMD = − 4.47; 95% CI − 7.55 to − 1.29).

Conclusion

Although a negative vitamin D imbalance has been reported among some BPPV patients, this review analysis failed to establish a relationship between the occurrence of BPPV and low vitamin D level. However, low vitamin D level was significantly evident among patients with recurrent episodes of BPPV.

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Investigation of ultra-low insertion speeds in an inelastic artificial cochlear model using custom-made cochlear implant electrodes

Abstract

Purpose

Latest research on cochlear implantations focuses on hearing preservation during insertion of the implant's electrode array by reducing insertion trauma. One parameter which may influence trauma is insertion speed. The objective of this study was to extend the range of examined insertion speeds to include ultra-low velocities, being lower than manually feasible, and investigate whether these reduce insertion forces.

Methods

24 custom-made cochlear implant test samples were fabricated and inserted into an artificial scala tympani model using 12 different insertion speeds while measuring the resulting insertion forces. Three commercially available slim straight electrode carriers were inserted using the same setup to analyze whether the results are comparable.

Results

Insertions of the test samples using high insertion speeds (2.0/2.8 mm/s) showed significantly higher insertion forces than insertions done with low insertion speeds (0.2 mm/s) or ultra-low insertion speeds (< 0.1 mm/s). The insertions with commercial slim straight electrode arrays showed significantly reduced insertion forces when using a low insertion speed as well.

Conclusions

Slow insertions showed significantly reduced insertion forces. Insertion speeds which are lower than manually feasible showed even lower insertion forces.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2OOrNVy

Association of benign paroxysmal positional vertigo with vitamin D deficiency: a systematic review and meta-analysis

Abstract

Background and objective

Benign paroxysmal positional vertigo (BPPV) is an idiopathic recurrent inner ear illness that is caused most often by an imbalance in the metabolism of calcium carbonate crystals (otoconia) inside the semicircular canals, in which the otoconia begin to circulate freely after being dislodged from the basic structure. The underlying etiology of this imbalance has not yet been well established; however, a few recent articles have revealed that vitamin D level abnormality in these patients might play a role. Therefore, we conducted the current systematic review analysis to explore potential associations of vitamin D level with the occurrence as well as the recurrence of BPPV disease.

Methods

A comprehensive literature search was conducted using different databases to retrieve all of the articles that have evaluated possible associations, irrespective of the study design. Then, we reported different vitamin D3 levels from BPPV groups and control groups to estimate the standardized mean difference (SMD) between the BPPV and control groups. We also calculated the effect size of each study under the random effects statistical model.

Results

Of the 703 studies that we identified, only 37 studies were found to be potential for our analysis, and of these, only seven met our predetermined criteria. Two meta-analyses were conducted with respect to the occurrence and the recurrence of BPPV. When the BPPV cases were compared to the controls (free of BPPV disease), there was an insignificant reduction in vitamin D level among the diseased groups (SMD = − 2.20; 95% CI − 6.66 to 2.26). In contrast, when the recurrent BPPV groups were compared with the non-recurrent BPPV groups, the statistical analysis showed significantly lower level of vitamin D among the recurrence BPPV groups (SMD = − 4.47; 95% CI − 7.55 to − 1.29).

Conclusion

Although a negative vitamin D imbalance has been reported among some BPPV patients, this review analysis failed to establish a relationship between the occurrence of BPPV and low vitamin D level. However, low vitamin D level was significantly evident among patients with recurrent episodes of BPPV.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Nvk5ej

Investigation of ultra-low insertion speeds in an inelastic artificial cochlear model using custom-made cochlear implant electrodes

Abstract

Purpose

Latest research on cochlear implantations focuses on hearing preservation during insertion of the implant's electrode array by reducing insertion trauma. One parameter which may influence trauma is insertion speed. The objective of this study was to extend the range of examined insertion speeds to include ultra-low velocities, being lower than manually feasible, and investigate whether these reduce insertion forces.

Methods

24 custom-made cochlear implant test samples were fabricated and inserted into an artificial scala tympani model using 12 different insertion speeds while measuring the resulting insertion forces. Three commercially available slim straight electrode carriers were inserted using the same setup to analyze whether the results are comparable.

Results

Insertions of the test samples using high insertion speeds (2.0/2.8 mm/s) showed significantly higher insertion forces than insertions done with low insertion speeds (0.2 mm/s) or ultra-low insertion speeds (< 0.1 mm/s). The insertions with commercial slim straight electrode arrays showed significantly reduced insertion forces when using a low insertion speed as well.

Conclusions

Slow insertions showed significantly reduced insertion forces. Insertion speeds which are lower than manually feasible showed even lower insertion forces.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2OOrNVy

Microsurgical Anatomy of Stapedius Muscle: Anatomy Revisited, Redefined with Potential Impact in Surgeries

Abstract

Stapedius muscle even though being the smallest skeletal muscle in human body, it has a major role in otology. As many of the distinguished books in otology missed to explain much about stapedius muscle, and also considering the need for the anatomy based visit to this small muscle we felt it was important to have a exercise like this. In the dissection hall of our institution we dissected 32 cadaveric temporal bones and delineated stapedius muscle as a part of PG teaching programme to have a clear idea of the anatomy of stapedius muscle, its origin, attachment, extension, size (all dimensions). Length of the stapedius muscle varied between 9 and 11 mm. Stapedial tendon measured about 2 mm. The muscle had a classical sickle shape with tendon looking like the handle of the sickle. It has a bulky belly with a maximum breadth of 2–3 mm. It was found to be medial to midportion of vertical limb of facial nerve. All of our temporal bones measured size varied from 9 to 11 mm in length excluding stapedial tendon. Stapedial tendon measured almost 2 mm. Muscle is classical sickle shaped with tendon acting like the handle of the sickle. It has a bulky tummy which forms the maximum breadth of 1–3 mm. Why to have a clear idea about the anatomy of stapedius muscle is that, unless the anatomy is clear there is chance of confusing the muscle with that of facial nerve while doing facial nerve grafting and also while drilling for facial nerve decompression in experienced hands may get confused and decompress the muscle. Stapedius muscle said to be the smallest muscle in the body, but its not as small as its been described. Detailed awareness of the anatomy of stapedius muscle is needed so as to avoid confusion while facial nerve grafting and while drilling.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Cxz1I2

Microsurgical Anatomy of Stapedius Muscle: Anatomy Revisited, Redefined with Potential Impact in Surgeries

Abstract

Stapedius muscle even though being the smallest skeletal muscle in human body, it has a major role in otology. As many of the distinguished books in otology missed to explain much about stapedius muscle, and also considering the need for the anatomy based visit to this small muscle we felt it was important to have a exercise like this. In the dissection hall of our institution we dissected 32 cadaveric temporal bones and delineated stapedius muscle as a part of PG teaching programme to have a clear idea of the anatomy of stapedius muscle, its origin, attachment, extension, size (all dimensions). Length of the stapedius muscle varied between 9 and 11 mm. Stapedial tendon measured about 2 mm. The muscle had a classical sickle shape with tendon looking like the handle of the sickle. It has a bulky belly with a maximum breadth of 2–3 mm. It was found to be medial to midportion of vertical limb of facial nerve. All of our temporal bones measured size varied from 9 to 11 mm in length excluding stapedial tendon. Stapedial tendon measured almost 2 mm. Muscle is classical sickle shaped with tendon acting like the handle of the sickle. It has a bulky tummy which forms the maximum breadth of 1–3 mm. Why to have a clear idea about the anatomy of stapedius muscle is that, unless the anatomy is clear there is chance of confusing the muscle with that of facial nerve while doing facial nerve grafting and also while drilling for facial nerve decompression in experienced hands may get confused and decompress the muscle. Stapedius muscle said to be the smallest muscle in the body, but its not as small as its been described. Detailed awareness of the anatomy of stapedius muscle is needed so as to avoid confusion while facial nerve grafting and while drilling.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Cxz1I2

Cortical auditory evoked potentials in cochlear implant listeners via single electrode stimulation in relation to speech perception

. (Source: International Journal of Audiology)

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Participants ’ experiences of an Internet-based cognitive behavioural therapy intervention for tinnitus

. (Source: International Journal of Audiology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2C6Kv4f

Cortical auditory evoked potentials in cochlear implant listeners via single electrode stimulation in relation to speech perception

. (Source: International Journal of Audiology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2CyTwE8

Participants ’ experiences of an Internet-based cognitive behavioural therapy intervention for tinnitus

. (Source: International Journal of Audiology)

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Assessment of myelination progression in subcortical white matter of children aged 6–48 months using T2-weighted imaging

Abstract

Purpose

This study aims to provide a screening scoring method by assessing the age-related change of subcortical white matter (WM) myelination via T2-weighted imaging (T2WI).

Methods

This study retrospectively recruited 109 children aged 6–48 months without abnormalities on MRI. Based on Parazzini's study, we developed a modified T2WI-based method to assess subcortical WM myelination (frontal, temporal, parietal, occipital lobes, and insula) by scoring WM's signal changes. Inter- and intra-observer agreements were evaluated by Bland-Altman plot. Age-related changes of myelination score were explored by locally weighted scatterplot smoothing (LOESS), linear regression, and Spearman correlation coefficients (r). Relationships between diffusion tensor imaging (DTI) metrics and total myelination score were investigated to further validate practicability of the scoring method by tract-based spatial statistics (TBSS).

Results

This method showed good intra-observer (mean difference = 0.18, SD = 0.95) and inter-observer agreements (mean difference = − 0.06, SD = 1.01). The LOESS and linear regression results indicated that myelination proceeded in two phases: a period of rapid growth (6–20 months; slope = 0.561) and one of slower growth (21–48 months; slope = 0.097). Significant correlations between myelination score and age were observed in whole subcortical WM (r = 0.945; P < 0.001) and all regional subcortical WM (r_{_mean} = 0.819, range, 0.664–0.928; P < 0.001). TBSS found significant correlations of WM-DTI metrics with myelination score during the range of 6–20 months, while no significant correlation was observed in 21–48 months.

Conclusion

The modified T2WI-based screening scoring method is easily feasible to assess myelination progression of subcortical WM, especially suitable for children aged 6–20 months. It may show potential in identifying individual developmental abnormalities by scoring assessment in the future clinical practice.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2C3kimR

Assessment of myelination progression in subcortical white matter of children aged 6–48 months using T2-weighted imaging

Abstract

Purpose

This study aims to provide a screening scoring method by assessing the age-related change of subcortical white matter (WM) myelination via T2-weighted imaging (T2WI).

Methods

This study retrospectively recruited 109 children aged 6–48 months without abnormalities on MRI. Based on Parazzini's study, we developed a modified T2WI-based method to assess subcortical WM myelination (frontal, temporal, parietal, occipital lobes, and insula) by scoring WM's signal changes. Inter- and intra-observer agreements were evaluated by Bland-Altman plot. Age-related changes of myelination score were explored by locally weighted scatterplot smoothing (LOESS), linear regression, and Spearman correlation coefficients (r). Relationships between diffusion tensor imaging (DTI) metrics and total myelination score were investigated to further validate practicability of the scoring method by tract-based spatial statistics (TBSS).

Results

This method showed good intra-observer (mean difference = 0.18, SD = 0.95) and inter-observer agreements (mean difference = − 0.06, SD = 1.01). The LOESS and linear regression results indicated that myelination proceeded in two phases: a period of rapid growth (6–20 months; slope = 0.561) and one of slower growth (21–48 months; slope = 0.097). Significant correlations between myelination score and age were observed in whole subcortical WM (r = 0.945; P < 0.001) and all regional subcortical WM (r_{_mean} = 0.819, range, 0.664–0.928; P < 0.001). TBSS found significant correlations of WM-DTI metrics with myelination score during the range of 6–20 months, while no significant correlation was observed in 21–48 months.

Conclusion

The modified T2WI-based screening scoring method is easily feasible to assess myelination progression of subcortical WM, especially suitable for children aged 6–20 months. It may show potential in identifying individual developmental abnormalities by scoring assessment in the future clinical practice.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2C3kimR

Comparison of an indirect impression scanning system and two direct intraoral scanning systems in vivo

Abstract

Objectives

This in vivo study aimed to compare the marginal discrepancies of zirconia copings manufactured on the basis of two direct intraoral scanning systems and the indirect digitization of a conventional impression.

Materials and methods

A total of 63 teeth in 23 patients were prepared to receive full-coverage crowns. Subsequently, these teeth were intraorally scanned using CEREC AC Omnicam and Cara TRIOS and a conventional impression was taken with the scannable PVS Flexitime Fast & Scan. The conventional impression was then extraorally digitized using a D700 laboratory scanner. The zirconia copings were manufactured on the basis of the resulting datasets. Silicone replicas of the copings were produced and sectioned for the measurement of the marginal discrepancy under a digital microscope.

Results

The statistical analysis showed no significant differences between the two intraoral scanners, the CEREC AC Omnicam (86.09 μm ± 61.46 μm) and the Cara TRIOS (88.95 μm ± 54.46 μm). However, the discrepancies of the zirconia copings obtained from the laboratory scans of conventional impressions (143.29 μm ± 100.71 μm) showed significant differences. Both intraoral scanners achieved a marginal discrepancy below 100 μm, whereas the laboratory scan exhibited considerably higher values.

Conclusions

The intraoral scanners tested allow for the production of single-tooth-restorations with an adequate marginal fit, whereas the production of restorations on the basis of the scan of a conventional impression led to vast marginal gaps.

Clinical relevance

The method of digitizing a conventional impression using a laboratory scanner seemed to have reached its limits in the clinical environment.

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Are dairy products containing probiotics beneficial for oral health? A systematic review and meta-analysis

Abstract

Objectives

To evaluate the effect of probiotic containing in dairy products on oral and salivary parameters.

Material and methods

Electronic searches were performed based on the PICO criteria. Randomized controlled trials in adults/children (P) in which dairy products containing probiotics (I) were compared to controls (C) for establishment of oral health (O) were included. Risk of bias and data extraction were performed. The meta-analysis evaluated the influence of probiotics on Streptococcus mutans (SM), Lactobacillus spp. (LB), and yeast counts, plaque index, and salivary pH. Random or fixed effect models were used, and heterogeneity was tested.

Results

Thirty-two studies were included in the qualitative synthesis, and 24 in the meta-analysis. For dichotomous results, individuals who consumed probiotics exhibited decreased scores in SM concentrations (RD 0.15 [0.02, 0.28] p = 0.03, I² = 70%), but no change was observed for LB (RD 0.10 [− 0.03, 0.23] p = 0.13, I² = 94%), or yeast levels (RD 0.05 [− 0.02, 0.12] p = 0.7, I² = 48%). For continuous analysis, both probiotic and control groups presented similar results for SM and LB (MD − 0.55 [− 1.16, 0.07] p = 0.08, I² = 62%, and RD 0.10 [− 0.03, 0.23] p = 0.13, I² = 94%, respectively). The consumption of probiotics increased salivary pH (MD 0.20 [0.04, 0.35] p = 0.01, I² = 46%) and plaque index (MD 0.38 [0.11, 0.65] p = 0.005, I² = 0%). The probiotic milk reduced SM (MD − 0.59 [− 0.96, − 0.22] p = 0.002, I² = 0%), and the probiotic yogurt decreased LB counts (RD 0.35 [0.19, 0.51] p < 0.0001, I² = 0%).

Conclusions

In general, dairy probiotics were effective in reducing SM, increasing salivary pH, and promoting a higher plaque index. Liquid matrices, such as milk and yogurt, seem to be more effective in reducing SM and LB levels.

Clinical relevance

Consumption of dairy products containing probiotics could be a supporting method in caries prevention.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2OgnfIf

Comparison of an indirect impression scanning system and two direct intraoral scanning systems in vivo

Abstract

Objectives

This in vivo study aimed to compare the marginal discrepancies of zirconia copings manufactured on the basis of two direct intraoral scanning systems and the indirect digitization of a conventional impression.

Materials and methods

A total of 63 teeth in 23 patients were prepared to receive full-coverage crowns. Subsequently, these teeth were intraorally scanned using CEREC AC Omnicam and Cara TRIOS and a conventional impression was taken with the scannable PVS Flexitime Fast & Scan. The conventional impression was then extraorally digitized using a D700 laboratory scanner. The zirconia copings were manufactured on the basis of the resulting datasets. Silicone replicas of the copings were produced and sectioned for the measurement of the marginal discrepancy under a digital microscope.

Results

The statistical analysis showed no significant differences between the two intraoral scanners, the CEREC AC Omnicam (86.09 μm ± 61.46 μm) and the Cara TRIOS (88.95 μm ± 54.46 μm). However, the discrepancies of the zirconia copings obtained from the laboratory scans of conventional impressions (143.29 μm ± 100.71 μm) showed significant differences. Both intraoral scanners achieved a marginal discrepancy below 100 μm, whereas the laboratory scan exhibited considerably higher values.

Conclusions

The intraoral scanners tested allow for the production of single-tooth-restorations with an adequate marginal fit, whereas the production of restorations on the basis of the scan of a conventional impression led to vast marginal gaps.

Clinical relevance

The method of digitizing a conventional impression using a laboratory scanner seemed to have reached its limits in the clinical environment.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2ymYKhx

Are dairy products containing probiotics beneficial for oral health? A systematic review and meta-analysis

Abstract

Objectives

To evaluate the effect of probiotic containing in dairy products on oral and salivary parameters.

Material and methods

Electronic searches were performed based on the PICO criteria. Randomized controlled trials in adults/children (P) in which dairy products containing probiotics (I) were compared to controls (C) for establishment of oral health (O) were included. Risk of bias and data extraction were performed. The meta-analysis evaluated the influence of probiotics on Streptococcus mutans (SM), Lactobacillus spp. (LB), and yeast counts, plaque index, and salivary pH. Random or fixed effect models were used, and heterogeneity was tested.

Results

Thirty-two studies were included in the qualitative synthesis, and 24 in the meta-analysis. For dichotomous results, individuals who consumed probiotics exhibited decreased scores in SM concentrations (RD 0.15 [0.02, 0.28] p = 0.03, I² = 70%), but no change was observed for LB (RD 0.10 [− 0.03, 0.23] p = 0.13, I² = 94%), or yeast levels (RD 0.05 [− 0.02, 0.12] p = 0.7, I² = 48%). For continuous analysis, both probiotic and control groups presented similar results for SM and LB (MD − 0.55 [− 1.16, 0.07] p = 0.08, I² = 62%, and RD 0.10 [− 0.03, 0.23] p = 0.13, I² = 94%, respectively). The consumption of probiotics increased salivary pH (MD 0.20 [0.04, 0.35] p = 0.01, I² = 46%) and plaque index (MD 0.38 [0.11, 0.65] p = 0.005, I² = 0%). The probiotic milk reduced SM (MD − 0.59 [− 0.96, − 0.22] p = 0.002, I² = 0%), and the probiotic yogurt decreased LB counts (RD 0.35 [0.19, 0.51] p < 0.0001, I² = 0%).

Conclusions

In general, dairy probiotics were effective in reducing SM, increasing salivary pH, and promoting a higher plaque index. Liquid matrices, such as milk and yogurt, seem to be more effective in reducing SM and LB levels.

Clinical relevance

Consumption of dairy products containing probiotics could be a supporting method in caries prevention.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2OgnfIf

Gender-Related Facial Surgical Goals

Facial plast Surg 2018; 34: 474-479
DOI: 10.1055/s-0038-1670648

In the last several years, there has been an increasing demand for surgical facial feminization or masculinization to treat the gender dysphoric patient. However, while aesthetic ideals for facial rejuvenation are well described and taught, there is a relative paucity of literature on how to achieve a feminine or masculine morphology. It is thus becoming increasingly important for facial plastic surgeons to understand patient goals regarding facial feminization or masculinization, and to have a systematic approach for analyzing the female and male face.
[...]

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

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

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Achieving Ideal Facial Appearance

Facial plast Surg 2018; 34: 431-432
DOI: 10.1055/s-0038-1668573

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

Article in Thieme eJournals:
Table of contents  |  Full text

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Enhanced Contouring of Local Flaps

Facial plast Surg 2018; 34: 433-442
DOI: 10.1055/s-0038-1668572

Scars and flaps represent a disruption of the normal skin contour, shape, and texture. Successful reconstruction of facial defects with local flaps requires prior planning to choose the correct reconstructive method. However, thorough preoperative planning should include consideration of adjunctive procedures to improve expected postoperative results as well as potential procedures to improve less-than-ideal results. Approaching facial reconstruction holistically allows the surgeon to soberly assess his/her reconstructive results and attain outstanding appearance.
[...]

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

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

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Correction of the Crooked Nose

Facial plast Surg 2018; 34: 488-496
DOI: 10.1055/s-0038-1672142

Successful management of the crooked nose can be a formidable task and requires a systematic approach that begins with an understanding of the patients' aesthetic desires, expectations, and functional symptoms. Dividing the nose into thirds and organizing a plan to correct each region individually can simplify the preoperative planning. There are two broad philosophical strategies of surgical management: engineering (reconstructive) and artistic (camouflaging). While the camouflaging technique is helpful for minor asymmetries, protrusions, and depressions, the engineering approach is best for more extreme corrections. The surgeon must be skilled in both approaches as either one or a combination of the two may yield the best results. Once corrected, postoperative care is essential to obtain optimal outcomes.
[...]

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

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

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Widened Dorsum: Bony and Cartilaginous Contributions

Facial plast Surg 2018; 34: 443-447
DOI: 10.1055/s-0038-1669989

Creation of a pleasing dorsal nasal profile in the anterior and lateral views requires proper analysis and planning to determine the required series of steps to accomplish the desired outcome. The widened nasal dorsum is a common esthetic complaint of the patient seeking rhinoplasty. Often patients seek an unrealistic result that, if accomplished, would leave them with a restricted nasal vault and nasal airway compromise. Nasal function must be balanced with the patient and surgeon's desire to narrow the nasal dorsum. Various techniques are used to control the width of the upper third, or bony vault, and middle third, or cartilaginous vault.
[...]

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

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

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Surgical and Nonsurgical Techniques in Forehead Rejuvenation

Facial plast Surg 2018; 34: 466-473
DOI: 10.1055/s-0038-1669990

The periorbital and forehead regions are among the most expressive parts of the face. A thorough understanding of the complex facial anatomy and aesthetic norms are essential when evaluating and treating a patient for facial brow rejuvenation. Not only will knowledge of the anatomy enhance facial injection and surgical outcomes, but will also diminish potential complications. Combining nonsurgical and surgical techniques, including laser and skin rejuvenation, can yield the most natural and effective aesthetic brow improvements.
[...]

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

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

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Facial Scar Improvement Procedures

Facial plast Surg 2018; 34: 448-457
DOI: 10.1055/s-0038-1669400

Scars are a natural part of dermal healing following lacerations, incisions, or tissue loss. The ideal scar is narrow, flat, level with surrounding tissue, and difficult for the untrained eye to see due to color match and placement parallel to relaxed skin tension lines; however, scarring that is dyspigmented, hypertrophied, widened, contracted, or atrophic can be aesthetically displeasing or causing functional limitations. When the scar has unfavorable characteristics, scar revision is often indicated and the cosmetic surgeon must be knowledgeable of the minimally invasive as well as surgical techniques to improve aesthetics, reduced reoccurrence, or correct functional limitations.
[...]

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

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

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Correction of the Lower Face and Neck

Facial plast Surg 2018; 34: 480-487
DOI: 10.1055/s-0038-1672128

Rejuvenation of the lower face and neck strives to reverse signs of aging while optimizing the patient's natural anatomy. Common features of an aesthetically pleasing lower face include a well-defined and appropriately balanced mandible and an acute cervicomental angle. Correction of the aging lower face and neck is accomplished through multiple surgical interventions, performed either alone or in combination. Determination of appropriate procedures is based on individual anatomic pathology. Intimate knowledge of facial anatomy and the complexity of the aging process is paramount to achieve a natural and aesthetic result. Thorough patient evaluation and counseling should precede any intervention. Specifically, the surgeon should be cognizant of the patient's skeletal structure, soft tissue distribution, muscular anatomy, and skin quality. Appropriate postoperative care and management of complications are vital to success.
[...]

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

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

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Ideal Facial Relationships and Goals

Facial plast Surg 2018; 34: 458-465
DOI: 10.1055/s-0038-1669401

Analysis of the face is an essential component of facial plastic surgery. In training, we are taught standards and ideals based on neoclassical models of beauty from Greek and Roman art and architecture. In practice, we encounter a wide range of variation in patient desires and perceptions of beauty. Our goals seem to be ever shifting, yet our education has provided us with a foundation from which to draw ideals of beauty. Plastic surgeons must synthesize classical ideas of beauty with patient desires, cultural nuances, and ethnic considerations all the while maintaining a natural appearance and result. This article gives an overview of classical models of facial proportions and relationships, while also discussing unique ethnic and cultural considerations which may influence the goal for the individual patient.
[...]

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

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

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PnUndB

Selecting the Best Eyelid Techniques

Facial plast Surg 2018; 34: 497-504
DOI: 10.1055/s-0038-1672148

The periorbital region is a focal point on the face. Dermatochalasis, fat herniation, blepharoptosis, brow ptosis, deep tear troughs, and malar fat pad descent are all age-related changes that occur around the eyes, and successful rejuvenation involves addressing all of these changes. Restoring a youthful, vibrant appearance to the eyes and periorbital areas can often only be accomplished with a combination of surgical and nonsurgical interventions. Facial plastic surgeons should have a comprehensive knowledge of all of these options and their applications to ensure good patient outcomes and satisfaction.
[...]

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

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

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2y9hFxg

Rejuvenation of the Midface

Facial plast Surg 2018; 34: 505-523
DOI: 10.1055/s-0038-1672161

In this article, the interested reader will learn when and how to apply different techniques on their patients, with the goal of safe, effective, natural looking, and long-lasting midface rejuvenation.
[...]

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

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

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PojxsD

Gender-Related Facial Surgical Goals

Facial plast Surg 2018; 34: 474-479
DOI: 10.1055/s-0038-1670648

In the last several years, there has been an increasing demand for surgical facial feminization or masculinization to treat the gender dysphoric patient. However, while aesthetic ideals for facial rejuvenation are well described and taught, there is a relative paucity of literature on how to achieve a feminine or masculine morphology. It is thus becoming increasingly important for facial plastic surgeons to understand patient goals regarding facial feminization or masculinization, and to have a systematic approach for analyzing the female and male face.
[...]

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

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

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PnUnKD

Achieving Ideal Facial Appearance

Facial plast Surg 2018; 34: 431-432
DOI: 10.1055/s-0038-1668573

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

Article in Thieme eJournals:
Table of contents  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2y9hUIG

Correction of the Crooked Nose

Facial plast Surg 2018; 34: 488-496
DOI: 10.1055/s-0038-1672142

Successful management of the crooked nose can be a formidable task and requires a systematic approach that begins with an understanding of the patients' aesthetic desires, expectations, and functional symptoms. Dividing the nose into thirds and organizing a plan to correct each region individually can simplify the preoperative planning. There are two broad philosophical strategies of surgical management: engineering (reconstructive) and artistic (camouflaging). While the camouflaging technique is helpful for minor asymmetries, protrusions, and depressions, the engineering approach is best for more extreme corrections. The surgeon must be skilled in both approaches as either one or a combination of the two may yield the best results. Once corrected, postoperative care is essential to obtain optimal outcomes.
[...]

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

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

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Widened Dorsum: Bony and Cartilaginous Contributions

Facial plast Surg 2018; 34: 443-447
DOI: 10.1055/s-0038-1669989

Creation of a pleasing dorsal nasal profile in the anterior and lateral views requires proper analysis and planning to determine the required series of steps to accomplish the desired outcome. The widened nasal dorsum is a common esthetic complaint of the patient seeking rhinoplasty. Often patients seek an unrealistic result that, if accomplished, would leave them with a restricted nasal vault and nasal airway compromise. Nasal function must be balanced with the patient and surgeon's desire to narrow the nasal dorsum. Various techniques are used to control the width of the upper third, or bony vault, and middle third, or cartilaginous vault.
[...]

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

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

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Surgical and Nonsurgical Techniques in Forehead Rejuvenation

Facial plast Surg 2018; 34: 466-473
DOI: 10.1055/s-0038-1669990

The periorbital and forehead regions are among the most expressive parts of the face. A thorough understanding of the complex facial anatomy and aesthetic norms are essential when evaluating and treating a patient for facial brow rejuvenation. Not only will knowledge of the anatomy enhance facial injection and surgical outcomes, but will also diminish potential complications. Combining nonsurgical and surgical techniques, including laser and skin rejuvenation, can yield the most natural and effective aesthetic brow improvements.
[...]

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

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

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Facial Scar Improvement Procedures

Facial plast Surg 2018; 34: 448-457
DOI: 10.1055/s-0038-1669400

Scars are a natural part of dermal healing following lacerations, incisions, or tissue loss. The ideal scar is narrow, flat, level with surrounding tissue, and difficult for the untrained eye to see due to color match and placement parallel to relaxed skin tension lines; however, scarring that is dyspigmented, hypertrophied, widened, contracted, or atrophic can be aesthetically displeasing or causing functional limitations. When the scar has unfavorable characteristics, scar revision is often indicated and the cosmetic surgeon must be knowledgeable of the minimally invasive as well as surgical techniques to improve aesthetics, reduced reoccurrence, or correct functional limitations.
[...]

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

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

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Pp6TcS

Correction of the Lower Face and Neck

Facial plast Surg 2018; 34: 480-487
DOI: 10.1055/s-0038-1672128

Rejuvenation of the lower face and neck strives to reverse signs of aging while optimizing the patient's natural anatomy. Common features of an aesthetically pleasing lower face include a well-defined and appropriately balanced mandible and an acute cervicomental angle. Correction of the aging lower face and neck is accomplished through multiple surgical interventions, performed either alone or in combination. Determination of appropriate procedures is based on individual anatomic pathology. Intimate knowledge of facial anatomy and the complexity of the aging process is paramount to achieve a natural and aesthetic result. Thorough patient evaluation and counseling should precede any intervention. Specifically, the surgeon should be cognizant of the patient's skeletal structure, soft tissue distribution, muscular anatomy, and skin quality. Appropriate postoperative care and management of complications are vital to success.
[...]

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

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

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2y9hIJs

Ideal Facial Relationships and Goals

Facial plast Surg 2018; 34: 458-465
DOI: 10.1055/s-0038-1669401

Analysis of the face is an essential component of facial plastic surgery. In training, we are taught standards and ideals based on neoclassical models of beauty from Greek and Roman art and architecture. In practice, we encounter a wide range of variation in patient desires and perceptions of beauty. Our goals seem to be ever shifting, yet our education has provided us with a foundation from which to draw ideals of beauty. Plastic surgeons must synthesize classical ideas of beauty with patient desires, cultural nuances, and ethnic considerations all the while maintaining a natural appearance and result. This article gives an overview of classical models of facial proportions and relationships, while also discussing unique ethnic and cultural considerations which may influence the goal for the individual patient.
[...]

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

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

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PnUndB

Selecting the Best Eyelid Techniques

Facial plast Surg 2018; 34: 497-504
DOI: 10.1055/s-0038-1672148

The periorbital region is a focal point on the face. Dermatochalasis, fat herniation, blepharoptosis, brow ptosis, deep tear troughs, and malar fat pad descent are all age-related changes that occur around the eyes, and successful rejuvenation involves addressing all of these changes. Restoring a youthful, vibrant appearance to the eyes and periorbital areas can often only be accomplished with a combination of surgical and nonsurgical interventions. Facial plastic surgeons should have a comprehensive knowledge of all of these options and their applications to ensure good patient outcomes and satisfaction.
[...]

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

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

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2y9hFxg

Rejuvenation of the Midface

Facial plast Surg 2018; 34: 505-523
DOI: 10.1055/s-0038-1672161

In this article, the interested reader will learn when and how to apply different techniques on their patients, with the goal of safe, effective, natural looking, and long-lasting midface rejuvenation.
[...]

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

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

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PojxsD

COPD Triple Tx Reduced Exacerbations in Nonreversible Patients

(MedPage Today) -- Improvements in lung function, QoL also seen in IMPACT analysis (Source: MedPage Today Allergy)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2EjCgVd

COPD Triple Tx Reduced Exacerbations in Nonreversible Patients

(MedPage Today) -- Improvements in lung function, QoL also seen in IMPACT analysis (Source: MedPage Today Allergy)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2EjCgVd

N.C. Man Dies from Allergic Reaction to Fire Ant Bite

  FRANKLINTON, N.C. (WTVD) -- A Franklinton family is warning others after the death of a father and husband. Floyd Edwards died September 28 after his family said he had an allergic reaction following a fire ant bite. "There ain't no telling how many times he got bit by fire ants," said Carlton Curtis, Edwards's son. Curtis, his brother, and Edwards were clearing out a trailer on their 45-acre property when he began having problems. "All of a sudden he says - 'Carlton, something's in my throat,'" Curtis said. Edwards drank some water, and then returned to working. Shortly after, he came back to the house still struggling. "I sat him down in the recliner right here - and I said, 'Floyd don't try to talk, just try to breathe. That's all you need to be worried a...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PsjqfG

N.C. Man Dies from Allergic Reaction to Fire Ant Bite

  FRANKLINTON, N.C. (WTVD) -- A Franklinton family is warning others after the death of a father and husband. Floyd Edwards died September 28 after his family said he had an allergic reaction following a fire ant bite. "There ain't no telling how many times he got bit by fire ants," said Carlton Curtis, Edwards's son. Curtis, his brother, and Edwards were clearing out a trailer on their 45-acre property when he began having problems. "All of a sudden he says - 'Carlton, something's in my throat,'" Curtis said. Edwards drank some water, and then returned to working. Shortly after, he came back to the house still struggling. "I sat him down in the recliner right here - and I said, 'Floyd don't try to talk, just try to breathe. That's all you need to be worried a...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PsjqfG

FDA Allows Sales of First Self-Fitting Hearing Aid FDA Allows Sales of First Self-Fitting Hearing Aid

The FDA has approved the sale of the first hearing aid that users can buy, fit, and use themselves without the help of an expert.WebMD Health News (Source: Medscape Medical News Headlines)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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Self-Fitting Hearing Aid Receives Nod from FDA

A newly-approved device could change the way patients manage their hearing loss. Last week, FDA greenlit the Bose Hearing Aid, which is called the first such technology that doesnât require the assistance of an audiologist or healthcare providers. The hearing aid was developed by Framingham, MA-based Bose Corp., and is intended to amplify sounds for individuals 18-years or older with perceived mild to moderate hearing impairment (hearing loss.) âHearing loss is a significant public health issue, especially as individuals age,â Malvina Eydelman, M.D., director of the Division of Ophthalmic, and Ear, Nose and Throat Devices at the FDA's Center for Devices and Radiological Health, said in a release. âTodayâ...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2y4NuHm

FDA Allows Sales of First Self-Fitting Hearing Aid FDA Allows Sales of First Self-Fitting Hearing Aid

The FDA has approved the sale of the first hearing aid that users can buy, fit, and use themselves without the help of an expert.WebMD Health News (Source: Medscape Medical News Headlines)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PmT5zz

Self-Fitting Hearing Aid Receives Nod from FDA

A newly-approved device could change the way patients manage their hearing loss. Last week, FDA greenlit the Bose Hearing Aid, which is called the first such technology that doesnât require the assistance of an audiologist or healthcare providers. The hearing aid was developed by Framingham, MA-based Bose Corp., and is intended to amplify sounds for individuals 18-years or older with perceived mild to moderate hearing impairment (hearing loss.) âHearing loss is a significant public health issue, especially as individuals age,â Malvina Eydelman, M.D., director of the Division of Ophthalmic, and Ear, Nose and Throat Devices at the FDA's Center for Devices and Radiological Health, said in a release. âTodayâ...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2y4NuHm

FDA Allows Sales of First Self-Fitting Hearing Aid FDA Allows Sales of First Self-Fitting Hearing Aid

The FDA has approved the sale of the first hearing aid that users can buy, fit, and use themselves without the help of an expert.WebMD Health News (Source: Medscape Medical News Headlines)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PmT5zz

Self-Fitting Hearing Aid Receives Nod from FDA

A newly-approved device could change the way patients manage their hearing loss. Last week, FDA greenlit the Bose Hearing Aid, which is called the first such technology that doesnât require the assistance of an audiologist or healthcare providers. The hearing aid was developed by Framingham, MA-based Bose Corp., and is intended to amplify sounds for individuals 18-years or older with perceived mild to moderate hearing impairment (hearing loss.) âHearing loss is a significant public health issue, especially as individuals age,â Malvina Eydelman, M.D., director of the Division of Ophthalmic, and Ear, Nose and Throat Devices at the FDA's Center for Devices and Radiological Health, said in a release. âTodayâ...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2y4NuHm

FDA Allows Sales of First Self-Fitting Hearing Aid FDA Allows Sales of First Self-Fitting Hearing Aid

The FDA has approved the sale of the first hearing aid that users can buy, fit, and use themselves without the help of an expert.WebMD Health News (Source: Medscape Medical News Headlines)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PmT5zz

Self-Fitting Hearing Aid Receives Nod from FDA

A newly-approved device could change the way patients manage their hearing loss. Last week, FDA greenlit the Bose Hearing Aid, which is called the first such technology that doesnât require the assistance of an audiologist or healthcare providers. The hearing aid was developed by Framingham, MA-based Bose Corp., and is intended to amplify sounds for individuals 18-years or older with perceived mild to moderate hearing impairment (hearing loss.) âHearing loss is a significant public health issue, especially as individuals age,â Malvina Eydelman, M.D., director of the Division of Ophthalmic, and Ear, Nose and Throat Devices at the FDA's Center for Devices and Radiological Health, said in a release. âTodayâ...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2y4NuHm

FDA Approves Revcovi for Adenosine Deaminase SCID FDA Approves Revcovi for Adenosine Deaminase SCID

The US Food and Drug Administration has approved elapegademase-lvlr for the treatment of adults and children with adenosine deaminase severe combined immune deficiency.FDA Approvals (Source: Medscape Medical News Headlines)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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COPD Triple Tx Reduced Exacerbations in Nonreversible Patients

(MedPage Today) -- Improvements in lung function, QoL also seen in IMPACT analysis (Source: MedPage Today Allergy)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2EjCgVd

N.C. Man Dies from Allergic Reaction to Fire Ant Bite

  FRANKLINTON, N.C. (WTVD) -- A Franklinton family is warning others after the death of a father and husband. Floyd Edwards died September 28 after his family said he had an allergic reaction following a fire ant bite. "There ain't no telling how many times he got bit by fire ants," said Carlton Curtis, Edwards's son. Curtis, his brother, and Edwards were clearing out a trailer on their 45-acre property when he began having problems. "All of a sudden he says - 'Carlton, something's in my throat,'" Curtis said. Edwards drank some water, and then returned to working. Shortly after, he came back to the house still struggling. "I sat him down in the recliner right here - and I said, 'Floyd don't try to talk, just try to breathe. That's all you need to be worried a...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PsjqfG

FDA Approves Revcovi for Adenosine Deaminase SCID FDA Approves Revcovi for Adenosine Deaminase SCID

The US Food and Drug Administration has approved elapegademase-lvlr for the treatment of adults and children with adenosine deaminase severe combined immune deficiency.FDA Approvals (Source: Medscape Medical News Headlines)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2RAJfLV

COPD Triple Tx Reduced Exacerbations in Nonreversible Patients

(MedPage Today) -- Improvements in lung function, QoL also seen in IMPACT analysis (Source: MedPage Today Allergy)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2EjCgVd

N.C. Man Dies from Allergic Reaction to Fire Ant Bite

  FRANKLINTON, N.C. (WTVD) -- A Franklinton family is warning others after the death of a father and husband. Floyd Edwards died September 28 after his family said he had an allergic reaction following a fire ant bite. "There ain't no telling how many times he got bit by fire ants," said Carlton Curtis, Edwards's son. Curtis, his brother, and Edwards were clearing out a trailer on their 45-acre property when he began having problems. "All of a sudden he says - 'Carlton, something's in my throat,'" Curtis said. Edwards drank some water, and then returned to working. Shortly after, he came back to the house still struggling. "I sat him down in the recliner right here - and I said, 'Floyd don't try to talk, just try to breathe. That's all you need to be worried a...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PsjqfG

FDA Approves Revcovi for Adenosine Deaminase SCID FDA Approves Revcovi for Adenosine Deaminase SCID

The US Food and Drug Administration has approved elapegademase-lvlr for the treatment of adults and children with adenosine deaminase severe combined immune deficiency.FDA Approvals (Source: Medscape Medical News Headlines)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2RAJfLV

COPD Triple Tx Reduced Exacerbations in Nonreversible Patients

(MedPage Today) -- Improvements in lung function, QoL also seen in IMPACT analysis (Source: MedPage Today Allergy)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2EjCgVd

FDA Approves Revcovi for Adenosine Deaminase SCID FDA Approves Revcovi for Adenosine Deaminase SCID

The US Food and Drug Administration has approved elapegademase-lvlr for the treatment of adults and children with adenosine deaminase severe combined immune deficiency.FDA Approvals (Source: Medscape Medical News Headlines)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2RAJfLV

COPD Triple Tx Reduced Exacerbations in Nonreversible Patients

(MedPage Today) -- Improvements in lung function, QoL also seen in IMPACT analysis (Source: MedPage Today Allergy)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2EjCgVd

TWiV 511: Accessory found guilty in DC

Ned Landau joins the TWiV team to discuss restriction of HIV replication by SAMHD1, and a viral antagonist that can be used to produce a dendritic cell vaccine. Hosts: Vincent Racaniello, Dickson Despommier, Alan Dove, Rich Condit, and Brianne Barker Guest: Ned Landau Become a patron of TWiV! Links for this episode Support Viruses Gordon Conference TWiV #124 September 2008 SAMHD1 restricts HIV-1 replication (Nature) SAMHD1 restricts diverse retroviruses (Retrovirology) Vpx degradation of SAMHD1 independent of uncoating (J Virol) Transduction of myeloid cells with Vpx vector (Gene Ther) Letters read on TWiV 511 Timestamps by Jolene. Thanks! Weekly Science Picks Brianne- Online Immunology Course Alan- Bacteria Builder Rich- 2018 Ig Nobel Prizes Dickson- Between Fear and Hope Ned - HUSH...

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TWiV 511: Accessory found guilty in DC

Ned Landau joins the TWiV team to discuss restriction of HIV replication by SAMHD1, and a viral antagonist that can be used to produce a dendritic cell vaccine. Hosts: Vincent Racaniello, Dickson Despommier, Alan Dove, Rich Condit, and Brianne Barker Guest: Ned Landau Become a patron of TWiV! Links for this episode Support Viruses Gordon Conference TWiV #124 September 2008 SAMHD1 restricts HIV-1 replication (Nature) SAMHD1 restricts diverse retroviruses (Retrovirology) Vpx degradation of SAMHD1 independent of uncoating (J Virol) Transduction of myeloid cells with Vpx vector (Gene Ther) Letters read on TWiV 511 Timestamps by Jolene. Thanks! Weekly Science Picks Brianne- Online Immunology Course Alan- Bacteria Builder Rich- 2018 Ig Nobel Prizes Dickson- Between Fear and Hope Ned - HUSH...

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Enhanced Antibody Production in Clever-1/Stabilin-1 –Deficient Mice

Johannes Dunkel, Miro Viitala, Marika Karikoski, Pia Rantakari, Reetta Virtakoivu, Kati Elima, Maija Hollm én, Sirpa Jalkanen, Marko Salmi (Source: Frontiers in Immunology)

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Bacterial Vaccine Antigen Discovery in the Reverse Vaccinology 2.0 Era: Progress and Challenges

Fadil A. Bidmos, Sara Siris, Camilla A. Gladstone, Paul R. Langford (Source: Frontiers in Immunology)

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Long Pentraxin-3 Modulates the Angiogenic Activity of Fibroblast Growth Factor-2

Marco Presta, Eleonora Foglio, Ander Churruca Schuind, Roberto Ronca (Source: Frontiers in Immunology)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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Ficolin-1 and Ficolin-3 Plasma Levels Are Altered in HIV and HIV/HCV Coinfected Patients From Southern Brazil

Maria Regina Tizzot, K árita Cláudia Freitas Lidani, Fabiana Antunes Andrade, Hellen Weinschutz Mendes, Marcia Holsbach Beltrame, Edna Reiche, Steffen Thiel, Jens C. Jensenius, Iara J. de Messias-Reason (Source: Frontiers in Immunology)

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Compromised DNA Repair and Signalling in Human Granulocytes

In previous studies, we showed impaired DNA repair in human monocytes. Here, we addressed the question of whether human neutrophilic granulocytes that arise from the same precursor as monocytes exhibit a similar phenotype and are impaired in repairing their DNA. We show that neutrophilic granulocytes isolated from peripheral blood display a lack of the same repair proteins that are missing in monocytes and do not show repair of their DNA when damaged by ionising radiation (IR) or chemical ROS. Contrary to T cells, we observed no decline in the number of single-strand breaks following γ-radiation. Also, granulocytes did not show γH2AX foci formation while T cells and peripheral blood lymphocytes (PBL) responded. In comparison to PBL, XRCC1, PARP-1 and ligase III were not expressed and the...

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Improved patient adherence to subcutaneous allergen immunotherapy using a modified rush immunotherapy protocol

Despite the efficacy of allergen immunotherapy (AIT), studies demonstrate low compliance rates.1 Adherence during build-up is especially challenging for patients. Rush immunotherapy (RIT) provides a faster method to reach maintenance dose, eliminating several months of build-up, potentially leading to higher patient adherence and accelerated symptom control. Few studies have directly compared the compliance rates of RIT schedules vs conventional schedules in patients from the same office.2 Safety and increased frequency of reaction rate continue to be primary concerns of RIT. (Source: Annals of Allergy, Asthma and Immunology)

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Anaphylaxis After Anal Intercourse With Tolerance By Vaginal Route

Anaphylaxis induced by coitus is an uncommon phenomenon 1, 2. The true prevalence is unknown, but it is believed to affect up to 40,000 women in the United States 3. The clinical features may vary in severity from mild immediate reactions as vaginal itching after coitus to systemic reactions such as systemic urticaria or even anaphylactic shock 1. The main agent involved in the few reported cases is seminal fluid, although cases of hypersensitivity to other agents such as latex, spermicidal agents, foods, drugs or lubricants have been reported. (Source: Annals of Allergy, Asthma and Immunology)

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Enhanced Antibody Production in Clever-1/Stabilin-1 –Deficient Mice

Johannes Dunkel, Miro Viitala, Marika Karikoski, Pia Rantakari, Reetta Virtakoivu, Kati Elima, Maija Hollm én, Sirpa Jalkanen, Marko Salmi (Source: Frontiers in Immunology)

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Bacterial Vaccine Antigen Discovery in the Reverse Vaccinology 2.0 Era: Progress and Challenges

Fadil A. Bidmos, Sara Siris, Camilla A. Gladstone, Paul R. Langford (Source: Frontiers in Immunology)

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Long Pentraxin-3 Modulates the Angiogenic Activity of Fibroblast Growth Factor-2

Marco Presta, Eleonora Foglio, Ander Churruca Schuind, Roberto Ronca (Source: Frontiers in Immunology)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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Ficolin-1 and Ficolin-3 Plasma Levels Are Altered in HIV and HIV/HCV Coinfected Patients From Southern Brazil

Maria Regina Tizzot, K árita Cláudia Freitas Lidani, Fabiana Antunes Andrade, Hellen Weinschutz Mendes, Marcia Holsbach Beltrame, Edna Reiche, Steffen Thiel, Jens C. Jensenius, Iara J. de Messias-Reason (Source: Frontiers in Immunology)

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Compromised DNA Repair and Signalling in Human Granulocytes

In previous studies, we showed impaired DNA repair in human monocytes. Here, we addressed the question of whether human neutrophilic granulocytes that arise from the same precursor as monocytes exhibit a similar phenotype and are impaired in repairing their DNA. We show that neutrophilic granulocytes isolated from peripheral blood display a lack of the same repair proteins that are missing in monocytes and do not show repair of their DNA when damaged by ionising radiation (IR) or chemical ROS. Contrary to T cells, we observed no decline in the number of single-strand breaks following γ-radiation. Also, granulocytes did not show γH2AX foci formation while T cells and peripheral blood lymphocytes (PBL) responded. In comparison to PBL, XRCC1, PARP-1 and ligase III were not expressed and the...

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Anaphylaxis After Anal Intercourse With Tolerance By Vaginal Route

Anaphylaxis induced by coitus is an uncommon phenomenon 1, 2. The true prevalence is unknown, but it is believed to affect up to 40,000 women in the United States 3. The clinical features may vary in severity from mild immediate reactions as vaginal itching after coitus to systemic reactions such as systemic urticaria or even anaphylactic shock 1. The main agent involved in the few reported cases is seminal fluid, although cases of hypersensitivity to other agents such as latex, spermicidal agents, foods, drugs or lubricants have been reported. (Source: Annals of Allergy, Asthma and Immunology)

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Chemical Approaches for the Enhancement of 5-Aminolevulinic Acid-Based Photodynamic Therapy and Photodiagnosis

Photochem. Photobiol. Sci., 2018, Accepted Manuscript
DOI: 10.1039/C8PP00362A, Perspective

Open Access

  This article is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported Licence.

Kunal M Tewari, Ian M Eggleston
The administration of 5-aminolevulinic acid (ALA) to generate enhanced intracellular levels of endogenous porphyrins is currently one of the most important approaches for photodynamic therapy (PDT) and photodiagnosis. Despite the...
The content of this RSS Feed (c) The Royal Society of Chemistry

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Chemical Approaches for the Enhancement of 5-Aminolevulinic Acid-Based Photodynamic Therapy and Photodiagnosis

Photochem. Photobiol. Sci., 2018, Accepted Manuscript
DOI: 10.1039/C8PP00362A, Perspective

Open Access

  This article is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported Licence.

Kunal M Tewari, Ian M Eggleston
The administration of 5-aminolevulinic acid (ALA) to generate enhanced intracellular levels of endogenous porphyrins is currently one of the most important approaches for photodynamic therapy (PDT) and photodiagnosis. Despite the...
The content of this RSS Feed (c) The Royal Society of Chemistry

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Apparent Diffusion Coefficient Levels and Neurodevelopmental Outcome in Fetuses with Brain MR Imaging White Matter Hyperintense Signal [PEDIATRICS]

BACKGROUND AND PURPOSE:

One of the perplexing findings of fetal brain MR imaging is white matter T2 hyperintense signal. The aims of our study were initially to determine the main etiologies associated with white matter T2 hyperintense signal, then to examine whether the different etiologies have different ADC values, and, last, to assess the association of white matter T2 hyperintense signal with developmental outcome.

MATERIALS AND METHODS:

This was a prospective cohort study of 44 MR imaging scans of fetal brains obtained for suspected brain pathologies at a tertiary medical center during 2011–2015. Clinical data were collected from electronic medical charts. ADC values were measured and averaged in the frontal, parietal, occipital, and temporal lobes. Neurodevelopmental assessments were performed with the Vineland Adaptive Behavior Scales II.

RESULTS:

Half of the cases of MRI hyperintense T2 signal of the fetal brain were associated with congenital cytomegalovirus infection. The other half were mainly idiopathic. Thus, the study group was divided to subgroups positive and negative for cytomegalovirus. Both groups had hyperintense signal in the temporal lobe. The group positive for cytomegalovirus had involvement of the parietal lobe. Only this group had increased ADC values in the temporal and parietal lobes. There was no association between the neurodevelopment outcome and the etiologies or ADC values.

CONCLUSIONS:

T2 hyperintense signal in fetal brain MRI associated with positive cytomegalovirus infection has increased ADC values in the temporal and parietal lobes, suggestive of brain edema in these areas. However, the association between this finding and neurodevelopment outcome requires further evaluation.

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Correlation between Human Papillomavirus Status and Quantitative MR Imaging Parameters including Diffusion-Weighted Imaging and Texture Features in Oropharyngeal Carcinoma [HEAD & NECK]

BACKGROUND AND PURPOSE:

The incidence of Oropharyngeal Squampus Cell Carcinoma (OPSCC) cases is increasing especially in the Western countries due to the spreading of human papilloma virus (HPV) infection. Radiological investigations, MRI in particular, are used in the daily clinical practice to stage OPSCC. The aim of this study was to investigate the association of quantitative MR imaging features including diffusion-weighted imaging and human papillomavirus status in oropharyngeal squamous cell carcinoma.

MATERIALS AND METHODS:

We retrospectively analyzed 59 patients with untreated histologically proved T2–T4 oropharyngeal squamous cell carcinoma. Human papillomavirus status was determined by viral DNA detection on tissue samples. MR imaging protocol included T2-weighted, contrast-enhanced T1-weighted (volumetric interpolated brain examination), and DWI sequences. Parametric maps of apparent diffusion coefficient were obtained from DWI sequences. Texture analysis was performed on T2 and volumetric-interpolated brain examination sequences and on ADC maps. Differences in quantitative MR imaging features between tumors positive and negative for human papillomavirus and among subgroups of patients stratified by smoking status were tested using the nonparametric Mann-Whitney U test; the false discovery rate was controlled using the Benjamini-Hochberg correction; and a predictive model for human papillomavirus status was built using multivariable logistic regression.

RESULTS:

Twenty-eight patients had human papillomavirus-positive oropharyngeal squamous cell carcinoma, while 31 patients had human papillomavirus-negative oropharyngeal squamous cell carcinoma. Tumors positive for human papillomavirus had a significantly lower mean ADC compared with those negative for it (median, 850.87 versus median, 1033.68; P < .001). Texture features had a lower discriminatory power for human papillomavirus status. Skewness on volumetric interpolated brain examination sequences was significantly higher in the subgroup of patients positive for human papillomavirus and smokers (P = .003). A predictive model based on smoking status and mean ADC yielded a sensitivity of 83.3% and specificity 92.6% in classifying human papillomavirus status.

CONCLUSIONS:

ADC is significantly lower in oropharyngeal squamous cell carcinoma positive for human papillomavirus compared with oropharyngeal squamous cell carcinoma negative for it. ADC and smoking status allowed noninvasive prediction of human papillomavirus status with a good accuracy. These results should be validated and further investigated on larger prospective studies.

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Thrombus Permeability on Dynamic CTA Predicts Good Outcome after Reperfusion Therapy [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Thrombus permeability assessed on conventional CTA is associated with neurologic outcome in patients with acute ischemic stroke. We aimed to investigate whether dynamic CTA can improve the accuracy of thrombus permeability assessment and its predictive value for outcome.

MATERIALS AND METHODS:

We reviewed consecutive patients with acute ischemic stroke who had occlusion of the M1 segment of the middle artery cerebral artery and underwent pretreatment perfusion CT. Thrombus permeability, determined by thrombus attenuation increase (TAI), was assessed on 26-phase dynamic CTA derived from perfusion CT. TAI_max was defined as the maximum TAI among phases; TAI_peak, as TAI of peak arterial phase; TAI_con, as TAI on phase 13. Good outcome was defined as a 3-month mRS score of ≤2.

RESULTS:

One hundred four patients were enrolled in the final analysis. The median TAI_max, TAI_peak, and TAI_con were 30.1 HU (interquartile range, 13.0–50.2 HU), 9.5 HU (interquartile range, –1.6–28.7 HU), and 6.6 HU (interquartile range, –5.1–24.4 HU), respectively. Multivariable regression analyses showed that TAI_max (OR = 1.027; 95% CI, 1.007–1.048; P = .008), TAI_peak (OR = 1.029; 95% CI, 1.005–1.054; P = .020), and TAI_con (OR = 1.026; 95% CI, 1.002–1.051; P = .037) were independently associated with good outcome. The areas under the ROC curve of TAI_max, TAI_peak, and TAI_con in predicting good outcome were 0.734, 0.701, and 0.658, respectively.

CONCLUSIONS:

Thrombus permeability assessed on dynamic CTA could be a better predictor of outcome after reperfusion therapy than that assessed on conventional single-phase CTA.

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Quality-Control Assessment to Improve the Accuracy of Dynamic Contrast-Enhanced MR Imaging Perfusion [LETTERS]

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MR Imaging of the Facial Nerve through the Temporal Bone at 3T with a Noncontrast Ultrashort Echo Time Sequence [HEAD & NECK]

SUMMARY:

The pointwise encoding time reduction with radial acquisition (PETRA) ultrashort echo time MR imaging sequence at 3T enables visualization of the facial nerve from the brain stem, through the temporal bone, to the stylomastoid foramen without intravenous contrast. Use of the PETRA sequence, or other ultrashort echo time sequences, should be considered in the MR imaging evaluation of certain skull base tumors and perhaps other facial nerve and temporal bone pathologies.

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Spinal Imaging Findings of Open Spinal Dysraphisms on Fetal and Postnatal MRI [SPINE]

BACKGROUND AND PURPOSE:

Fetal MRI has become a valuable tool in the evaluation of open spinal dysraphisms making studies comparing prenatal and postnatal MRI findings increasingly important. Our aim was to determine the accuracy of predicting the level of the spinal dysraphic defect of open spinal dysraphisms on fetal MR imaging and to report additional findings observed when comparing fetal and postnatal MR imaging of the spine in this population.

MATERIALS AND METHODS:

A single-center retrospective analysis was performed of fetal MRIs with open spinal dysraphisms from 2004 through 2016 with available diagnostic postnatal spine MR imaging. Images were reviewed by 2 board-certified fellowship-trained pediatric neuroradiologists. Corresponding clinical/operative reports were reviewed.

RESULTS:

One hundred nineteen fetal MRIs of open spinal dysraphisms were included. The level of the osseous defect between fetal and postnatal MR imaging was concordant in 42.9% (51/119) of cases and was 1 level different in 39% (47/119) of cases. On postnatal MR imaging, type II split cord malformation was seen in 8.4% (10/119) of cases, with only 50% (5/10) of these cases identified prospectively on fetal MR imaging. Syrinx was noted in 3% (4/119) of prenatal studies, all cervical, all confirmed on postnatal MR imaging.

CONCLUSIONS:

Fetal MR imaging is accurate in detecting the level of the spinal dysraphic defect, which has an impact on prenatal counseling, neurologic outcomes, and eligibility for fetal surgery. In addition, fetal MR imaging is limited in its ability to detect split cord malformations in patients with open spinal dysraphisms. Although rare, fetal MR imaging has a high specificity for detection of cervical spinal cord syrinx.

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Vertebroplasty: Expectation or Evidence-Based Interventional Radiology? [LETTERS]

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Altered brain functional network in children with type 1 Gaucher disease: a longitudinal graph theory-based study

Abstract

Purpose

Previous studies have investigated the brain structural abnormalities in children with type I Gaucher disease (GD). The purpose of our study is to investigate the topological efficiency of the brain functional network in children with type 1 GD.

Methods

Twenty-two children diagnosed with type 1 GD and 22 sex- and age-matched healthy controls (HCs) underwent resting-state functional MRI (rs-fMRI) examination. For longitudinal study, the GD patients underwent rs-fMRI examination again after 4.6 years. Graph theoretical analysis was used to assess the brain network topological properties at the global and regional levels.

Results

Compared with the HCs, the children with type 1 GD showed a decreased efficiency in functional segregation with a decreased γ (normalized clustering coefficient). In addition, the balance between functional segregation and integration was disrupted with decreased small-worldness (σ). At the regional level, the children with type 1 GD showed significantly decreased nodal degree and efficiency in the right precentral gyrus (PreCG.R) and left postcentral gyrus (PoCG.L). The significantly altered γ, σ, and nodal degree in the PreCG.R and PoCG.L were negatively correlated with the disease duration. No significant alterations in the global and regional topological properties were identified in these patients over time.

Conclusion

Compared with that of the HCs, the efficiency of the brain functional network in the children with type 1 GD was disrupted, and regional involvement was located in motor- and sensory-related regions. The efficiency of the brain functional network in these patients remained stable over time.

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Integrating 3D Rotational Angiography into Gamma Knife Planning [INTERVENTIONAL]

SUMMARY:

3D rotational angiography provides remarkable spatial resolution for cerebrovascular disorders; however, it cannot be integrated directly into gamma knife planning due to the discrepancy of DICOM "tag" information, and most physicians still cannot benefit from 3D rotational angiography. Here, we describe a simple and easy technique to enable the integration of 3D rotational angiography.

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Reply: [LETTERS]

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The Diagnostic Value of Diffusion-Weighted Imaging in Differentiating Metastatic Lymph Nodes of Head and Neck Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis [HEAD & NECK]

BACKGROUND:

Accurate lymph node staging is crucial for proper treatment planning for metastasis in patients with head and neck squamous cell carcinoma.

PURPOSE:

Our aim was to evaluate the diagnostic performance of DWI for differentiating metastatic cervical lymph nodes from benign cervical lymph nodes in patients with head and neck squamous cell carcinoma and to identify optimal cutoff values for ADC.

DATA SOURCES:

A computerized literature search was performed to identify relevant original articles in Ovid MEDLINE and EMBASE.

STUDY SELECTION:

Studies evaluating the diagnostic performance of DWI for differentiating metastatic cervical lymph nodes from benign cervical lymph nodes were selected.

DATA ANALYSIS:

Diagnostic meta-analysis was conducted with a bivariate random-effects model, and a hierarchical summary receiver operating characteristic curve was obtained. Meta-regression was also performed.

DATA SYNTHESIS:

Nine studies with 337 patients were included. In all studies, ADC values derived from metastatic lymph nodes were significantly lower than ADC values derived from benign lymph nodes. The median ADC cutoff value was 0.965 x 10^–3 mm²/s. The pooled sensitivity and specificity for the diagnostic performance of DWI in differentiating metastatic lymph nodes from benign lymph nodes were 90% (95% CI, 84%–94%) and 88% (95% CI, 80%–93%), respectively. In the meta-regression, sensitivity was significantly higher in the studies using a 3-mm slice thickness (93% [95% CI, 88%–98%]) than in studies using a slice thickness of >3 mm (86% [95% CI, 77%–95%], P < .01).

LIMITATIONS:

A small number of studies were included in our meta-analysis.

CONCLUSIONS:

DWI demonstrated high diagnostic performance for differentiating metastatic lymph nodes from benign lymph nodes in patients with head and neck squamous cell carcinoma, and the median ADC cutoff value was 0.965 x 10^–3 mm²/s. A 3-mm DWI slice thickness can provide a slight improvement in sensitivity.

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[other]

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Multidelay Arterial Spin-Labeling MRI in Neonates and Infants: Cerebral Perfusion Changes during Brain Maturation [PEDIATRICS]

BACKGROUND AND PURPOSE:

Arterial spin-labeling with multiple postlabeling delays can correct transit times. We tried to evaluate CBF in neonates and infants using multidelay arterial spin-labeling.

MATERIALS AND METHODS:

Multidelay arterial spin-labeling was applied to 13 preterm neonates (mean postmenstrual age, 34.9 weeks), 13 term-equivalent-age neonates (mean postmenstrual age, 39.2 weeks), and 6 infants (mean postmenstrual age, 57.8 weeks). Transit time–corrected CBF in the caudate, thalamus, frontal GM, occipital GM, frontal WM, and occipital WM was measured, and relative CBF compared with the whole-brain CBF was calculated. Inter- and intragroup comparisons were performed among the 3 age groups. A correlation and nonlinear regression analysis were performed between postmenstrual age and CBF.

RESULTS:

Intergroup comparisons showed significantly higher whole-brain CBF in infants (38.3 mL/100 g/min) compared with preterm (15.5 mL/100 g/min) and term-equivalent-age (18.3 mL/100 g/min) neonates (P < .001). In the intragroup comparison, all 3 groups showed significantly higher relative CBF values in the occipital WM (63.6%–90.3%) compared with the frontal WM (46.3%–73.9%). In term-equivalent-age neonates, the occipital GM (120.8%) had significantly higher relative CBF values than the frontal GM (103.5%). There was a significant negative correlation between postmenstrual age and the relative CBF of the thalamus (r = – 0.449, P = .010). There were significant positive relationships between postmenstrual age and the relative CBF of the frontal WM (R² = 0.298, P = .001) and occipital WM (R² = 0.452, P < .001).

CONCLUSIONS:

Multidelay arterial spin-labeling with transit time–corrected CBF showed developmental changes and regional differences of CBF in neonates and infants.

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Imaging of Clival Hypoplasia in CHARGE Syndrome and Hypothesis for Development: A Case-Control Study [PEDIATRICS]

BACKGROUND AND PURPOSE:

We present the largest case series to date on basiocciput abnormalities in CHARGE syndrome (Coloboma of the eye, Heart defects, Atresia of the choanae, Retardation of growth and/or development, Genital and/or urinary abnormalities, and Ear abnormalities and/or deafness). We aimed to show that basiocciput abnormalities are common and may aid in diagnosis. We furthermore explored whether clivus size correlates with the type of chromodomain-helicase-DNA binding protein 7 gene (CHD7) mutation, which causes CHARGE syndrome, and with clinical criteria according to Blake et al and Verloes.

MATERIALS AND METHODS:

We retrospectively analyzed the clivus of 23 patients with CHARGE syndrome with CHD7 mutations on MR imaging or CT. We recorded the size of the clivus, the Welcher angle, basilar invagination, and Chiari I malformations. We compared the clival size and Welcher angle of patients with CHARGE syndrome with those of 72 age-matched controls. Additionally, we tested for correlations between clivus size and mutation type or clinical criteria.

RESULTS:

Eighty-seven percent of the patients with CHARGE syndrome had an abnormal clivus; 61% had a clivus >2.5 SD smaller than that of age-matched controls. An abnormally large Welcher angle was observed in 35%. Basiocciput hypoplasia was found in 70%, and basilar invagination, in 29%. None of the patients had a Chiari I malformation. At the group level, patients with CHARGE syndrome had a smaller clivus and larger Welcher angle than controls. No significant correlation between clivus size and mutation type or clinical criteria was found.

CONCLUSIONS:

Most patients with CHARGE syndrome have an abnormal clivus. This suggests that clivus abnormalities may be used as an additional diagnostic tool. Our results provide evidence that CHD7, which is expressed in the presomitic mesoderm during somitogenesis, plays an important role in the formation of the clivus.

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Comparison of Advanced Imaging Resources, Radiology Workforce, and Payment Methodologies between the United States and Canada [research-article]

SUMMARY:

The purpose of this Practice Perspectives was to review the United States and Canadian approaches to health care access and payment for advanced imaging. The historical background, governmental role, workforce, coding, payment, radiologic challenges, cost, resource intensity, and overall outcomes in longevity are reviewed.

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Clinical Value of Hybrid TOF-PET/MR Imaging-Based Multiparametric Imaging in Localizing Seizure Focus in Patients with MRI-Negative Temporal Lobe Epilepsy [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Temporal lobe epilepsy is the most common type of epilepsy. Early surgical treatment is superior to prolonged medical therapy in refractory temporal lobe epilepsy. Successful surgical operations depend on the correct localization of the epileptogenic zone. This study aimed to evaluate the clinical value of hybrid TOF-PET/MR imaging–based multiparametric imaging in localizing the epileptogenic zone in patients with MR imaging-negative for temporal lobe epilepsy.

MATERIALS AND METHODS:

Twenty patients with MR imaging-negative temporal lobe epilepsy who underwent preoperative evaluation and 10 healthy controls were scanned using PET/MR imaging with simultaneous acquisition of PET and arterial spin-labeling. On the basis of the standardized uptake value and cerebral blood flow, receiver operating characteristic analysis and a logistic regression model were used to evaluate the predictive value for the localization. Statistical analyses were performed using statistical parametric mapping. The values of the standardized uptake value and cerebral blood flow, as well as the asymmetries of metabolism and perfusion, were compared between the 2 groups. Histopathologic findings were used as the criterion standard.

RESULTS:

Complete concordance was noted in lateralization and localization among the PET, arterial spin-labeling, and histopathologic findings in 12/20 patients based on visual assessment. Concordance with histopathologic findings was also obtained for the remaining 8 patients based on the complementary PET and arterial spin-labeling information. Receiver operating characteristic analysis showed that the sensitivity and specificity of PET, arterial spin-labeling, and combined PET and arterial spin-labeling were 100% and 81.8%, 83.3% and 54.5%, and 100% and 90.9%, respectively. When we compared the metabolic abnormalities in patients with those in healthy controls, hypometabolism was detected in the middle temporal gyrus (P < .001). Metabolism and perfusion asymmetries were also located in the temporal lobe (P < .001).

CONCLUSIONS:

PET/MR imaging–based multiparametric imaging involving arterial spin-labeling may increase the clinical value of localizing the epileptogenic zone by providing concordant and complementary information in patients with MR imaging-negative temporal lobe epilepsy.

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Apparent Diffusion Coefficient Levels and Neurodevelopmental Outcome in Fetuses with Brain MR Imaging White Matter Hyperintense Signal [PEDIATRICS]

BACKGROUND AND PURPOSE:

One of the perplexing findings of fetal brain MR imaging is white matter T2 hyperintense signal. The aims of our study were initially to determine the main etiologies associated with white matter T2 hyperintense signal, then to examine whether the different etiologies have different ADC values, and, last, to assess the association of white matter T2 hyperintense signal with developmental outcome.

MATERIALS AND METHODS:

This was a prospective cohort study of 44 MR imaging scans of fetal brains obtained for suspected brain pathologies at a tertiary medical center during 2011–2015. Clinical data were collected from electronic medical charts. ADC values were measured and averaged in the frontal, parietal, occipital, and temporal lobes. Neurodevelopmental assessments were performed with the Vineland Adaptive Behavior Scales II.

RESULTS:

Half of the cases of MRI hyperintense T2 signal of the fetal brain were associated with congenital cytomegalovirus infection. The other half were mainly idiopathic. Thus, the study group was divided to subgroups positive and negative for cytomegalovirus. Both groups had hyperintense signal in the temporal lobe. The group positive for cytomegalovirus had involvement of the parietal lobe. Only this group had increased ADC values in the temporal and parietal lobes. There was no association between the neurodevelopment outcome and the etiologies or ADC values.

CONCLUSIONS:

T2 hyperintense signal in fetal brain MRI associated with positive cytomegalovirus infection has increased ADC values in the temporal and parietal lobes, suggestive of brain edema in these areas. However, the association between this finding and neurodevelopment outcome requires further evaluation.

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