Condition: Pregnancy Intervention: Sponsor: Chinese University of Hong Kong Recruiting (Source: ClinicalTrials.gov)
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Condition: Drug Allergy Intervention: Sponsor: University Hospital, Montpellier Not yet recruiting (Source: ClinicalTrials.gov)
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Condition: Human Immunodeficiency Virus (HIV) Intervention: Biological: VRC-HIVRGP096-00-VP Sponsor: National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)
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Condition: Lassa Virus Infection Intervention: Sponsor: National Institute of Allergy and Infectious Diseases (NIAID) Not yet recruiting (Source: ClinicalTrials.gov)
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Conditions: Rheumatoid Arthritis; Tocilizumab Intervention: Drug: Tocilizumab Sponsors: Tel-Aviv Sourasky Medical Center; Amsterdam Rheumatology and Immunology Center Recruiting (Source: ClinicalTrials.gov)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Cy1jRk
Conditions: Allergic Rhinoconjunctivitis to Birch Pollen; With an Apple Oral Allergic Syndrome (OAS) to Apple; With a Positive Skin Prick Test to Birch Pollen Intervention: Drug: ILT-101 ld-(IL2) Sponsors: Assistance Publique - Hôpitaux de Paris; Iltoo Pharma Not yet recruiting (Source: ClinicalTrials.gov)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Tf9ZSh
Condition: Pregnancy Intervention: Sponsor: Chinese University of Hong Kong Recruiting (Source: ClinicalTrials.gov)
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Condition: Drug Allergy Intervention: Sponsor: University Hospital, Montpellier Not yet recruiting (Source: ClinicalTrials.gov)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Tbje5E
Condition: Human Immunodeficiency Virus (HIV) Intervention: Biological: VRC-HIVRGP096-00-VP Sponsor: National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CAJocV
Condition: Lassa Virus Infection Intervention: Sponsor: National Institute of Allergy and Infectious Diseases (NIAID) Not yet recruiting (Source: ClinicalTrials.gov)
MedWorm Message: If you are looking to buy something in the January Sales please visit TheJanuarySales.com for a directory of all the best sales in the UK. Any income gained via affiliate links keeps MedWorm running.
Conditions: Rheumatoid Arthritis; Tocilizumab Intervention: Drug: Tocilizumab Sponsors: Tel-Aviv Sourasky Medical Center; Amsterdam Rheumatology and Immunology Center Recruiting (Source: ClinicalTrials.gov)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Cy1jRk
Conditions: Allergic Rhinoconjunctivitis to Birch Pollen; With an Apple Oral Allergic Syndrome (OAS) to Apple; With a Positive Skin Prick Test to Birch Pollen Intervention: Drug: ILT-101 ld-(IL2) Sponsors: Assistance Publique - Hôpitaux de Paris; Iltoo Pharma Not yet recruiting (Source: ClinicalTrials.gov)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Tf9ZSh
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Abstracts XVIII NATIONAL CONGRESS - VII INTERNATIONAL SPANISH SOCIETY OF GERODONTOLOGY, SORIA, SPAIN, 7 - 9 JUNE 2018.
Med Oral Patol Oral Cir Bucal. 2018 Dec 24;23(Suppl2):S1-S56
Authors:
PMID: 30582745 [PubMed - in process]
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Abstracts XLVI Annual Meeting of the Dentistry Studies Center Valencia, Spain 14-16 June 2018.
Med Oral Patol Oral Cir Bucal. 2018 Dec 24;23(Suppl1):S1-S36
Authors:
PMID: 30581187 [PubMed - in process]
| Related Articles |
Abstracts XVIII NATIONAL CONGRESS - VII INTERNATIONAL SPANISH SOCIETY OF GERODONTOLOGY, SORIA, SPAIN, 7 - 9 JUNE 2018.
Med Oral Patol Oral Cir Bucal. 2018 Dec 24;23(Suppl2):S1-S56
Authors:
PMID: 30582745 [PubMed - in process]
| Related Articles |
Abstracts XLVI Annual Meeting of the Dentistry Studies Center Valencia, Spain 14-16 June 2018.
Med Oral Patol Oral Cir Bucal. 2018 Dec 24;23(Suppl1):S1-S36
Authors:
PMID: 30581187 [PubMed - in process]
CONCLUSIONS: Vaccination coverage in patients with cochlear implant is lower than expected. Close collaboration between Otolaryngology departments and the Vaccination Units is proposed as the main strategy for improvement. PMID: 30579509 [PubMed - as supplied by publisher] (Source: Acta Otorrinolaringologica Espanola)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2LAPblg
CONCLUSIONS: Vaccination coverage in patients with cochlear implant is lower than expected. Close collaboration between Otolaryngology departments and the Vaccination Units is proposed as the main strategy for improvement. PMID: 30579509 [PubMed - as supplied by publisher] (Source: Acta Otorrinolaringologica Espanola)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2LAPblg
Publication date: Available online 24 December 2018
Source: Journal of Medical Imaging and Radiation Sciences
Author(s): Haley Clark, Fred Cao, Carson Leong, Eric Berthelet
Patients requiring treatment for second cancer incidences present unique radiotherapy plan development challenges. Historical dose delivered to organs at risk must be accounted for to properly estimate lifetime toxicity risks, but historical dose delivered to the region now occupied by tumours does not contribute to the prescription dose. Treatment planning systems permit inclusion of a base plan but do not provide the ability to manipulate it. We present a technique, dose cropping, which incorporates organ-at-risk dose history into the base plan while selectively excising dose history to diseased tissues now occupied by tumours. A retrospective plan comparison is performed to assess the effectiveness of dose cropping.
Nine patients who received a second course of radiotherapy for cancers of the head-and-neck were replanned using the proposed technique. Clinical second courses and replans were compared on the basis of conformity index, heterogeneity index, maximum point dose, tissue control probability (TCP), normal tissue complication probability (NTCP), and whether the planning guidelines could be met by the treatment planning system. Replan constraints and guidelines followed the clinical treatment. In addition, a tissue recovery model was incorporated, applied to both clinical and replan courses, and compared to estimate the relevance of the dose cropping technique in such regimes.
Replans had reduced organ-at-risk maximum point doses (5 Gy for spinal cord, 4 Gy for brainstem), NTCP (2.9% median reduction), and were able to more consistently achieve the V95% > 98% coverage target regardless of the tissue recovery model. At the same time, replans using the dose cropping technique were statistically indistinguishable from clinical second courses on the basis of plan conformity, heterogeneity, or TCP (P > .31 in all cases).
Dosimetric history cropping is a valuable and widely applicable technique for second cancer radiotherapy planning. It also provides a natural means to incorporate tissue recovery models, biologically effective dose conversion, and NTCP and TCP model evaluation.
L'élaboration d'un plan de radiothérapie pour des patients qui doivent être traités pour un deuxième cancer peut comporter des difficultés uniques. Il faut notamment tenir compte des doses administrées antérieurement aux organes à risque pour estimer correctement les risques de toxicité à vie. Toutefois, la dose administrée précédemment à l'emplacement actuel des tumeurs ne contribue pas à la dose prescrite. Les systèmes de planification des traitements permettent d'inclure un plan de base, mais ils ne permettent pas de le manipuler. Nous présentons une technique, le « dose cropping » (ou « l'élagage de dose »), qui permet d'intégrer au plan de base l'historique de la dose administrée aux organes à risque tout en retirant de façon sélective l'historique de la dose administrée aux tissus atteints à l'emplacement actuel des tumeurs. Une comparaison rétrospective des plans a été réalisée afin d'évaluer l'efficacité de cette technique.
À l'aide de la technique proposée, nous avons recréé les plans de neuf patients ayant reçu une deuxième série de traitements de radiothérapie pour des cancers de la tête et du cou. Les deuxièmes séries de traitements cliniques et les nouveaux plans ont été comparés en fonction des aspects suivants: l'indice de conformité, l'indice d'hétérogénéité, le point de dose maximale, la probabilité de contrôle des tissus, la probabilité de complication aux tissus sains et la capacité du système de planification des traitements à respecter les lignes directrices. Les contraintes et les lignes directrices de la replanification suivaient le traitement clinique. De plus, un modèle de récupération cellulaire du tissu a été intégré au système, appliqué à la série de traitements clinique et à la replanification, puis comparé dans le but d'estimer la pertinence de la technique de « dose cropping » dans de tels régimes.
La replanification a entraîné la diminution du point de la dose maximale pour les organes à risque (5 Gy pour la colonne vertébrale et 4 Gy pour le tronc cérébral), de la probabilité de complication aux tissus sains (une diminution de la médiane de 2,9%), et nous a permis d'atteindre plus fréquemment la cible de couverture de V95% > 98%, et ce, quel que soit le modèle de récupération employé. Par ailleurs, les nouveaux plans qui utilisaient la technique de « dose cropping » étaient identiques d'un point de vue statistiquement significatif aux deuxièmes séries de traitements cliniques pour ce qui est de la conformité du plan, de l'hétérogénéité et de la probabilité de contrôle des tissus (p>0,31 dans tous les cas).
Le « dose cropping » est une technique intéressante qui peut être appliquée facilement à la planification des traitements de radiothérapies d'un deuxième cancer. Elle fournit également une manière aisée de tenir compte des modèles de récupération du tissu, de la conversion de la dose efficace d'un point de vue biologique et de l'évaluation des modèles de la probabilité de complication aux tissus sains (NTCP) et de la probabilité de contrôle tumoral (TCP).
Publication date: Available online 24 December 2018
Source: Journal of Medical Imaging and Radiation Sciences
Author(s): Haley Clark, Fred Cao, Carson Leong, Eric Berthelet
Patients requiring treatment for second cancer incidences present unique radiotherapy plan development challenges. Historical dose delivered to organs at risk must be accounted for to properly estimate lifetime toxicity risks, but historical dose delivered to the region now occupied by tumours does not contribute to the prescription dose. Treatment planning systems permit inclusion of a base plan but do not provide the ability to manipulate it. We present a technique, dose cropping, which incorporates organ-at-risk dose history into the base plan while selectively excising dose history to diseased tissues now occupied by tumours. A retrospective plan comparison is performed to assess the effectiveness of dose cropping.
Nine patients who received a second course of radiotherapy for cancers of the head-and-neck were replanned using the proposed technique. Clinical second courses and replans were compared on the basis of conformity index, heterogeneity index, maximum point dose, tissue control probability (TCP), normal tissue complication probability (NTCP), and whether the planning guidelines could be met by the treatment planning system. Replan constraints and guidelines followed the clinical treatment. In addition, a tissue recovery model was incorporated, applied to both clinical and replan courses, and compared to estimate the relevance of the dose cropping technique in such regimes.
Replans had reduced organ-at-risk maximum point doses (5 Gy for spinal cord, 4 Gy for brainstem), NTCP (2.9% median reduction), and were able to more consistently achieve the V95% > 98% coverage target regardless of the tissue recovery model. At the same time, replans using the dose cropping technique were statistically indistinguishable from clinical second courses on the basis of plan conformity, heterogeneity, or TCP (P > .31 in all cases).
Dosimetric history cropping is a valuable and widely applicable technique for second cancer radiotherapy planning. It also provides a natural means to incorporate tissue recovery models, biologically effective dose conversion, and NTCP and TCP model evaluation.
L'élaboration d'un plan de radiothérapie pour des patients qui doivent être traités pour un deuxième cancer peut comporter des difficultés uniques. Il faut notamment tenir compte des doses administrées antérieurement aux organes à risque pour estimer correctement les risques de toxicité à vie. Toutefois, la dose administrée précédemment à l'emplacement actuel des tumeurs ne contribue pas à la dose prescrite. Les systèmes de planification des traitements permettent d'inclure un plan de base, mais ils ne permettent pas de le manipuler. Nous présentons une technique, le « dose cropping » (ou « l'élagage de dose »), qui permet d'intégrer au plan de base l'historique de la dose administrée aux organes à risque tout en retirant de façon sélective l'historique de la dose administrée aux tissus atteints à l'emplacement actuel des tumeurs. Une comparaison rétrospective des plans a été réalisée afin d'évaluer l'efficacité de cette technique.
À l'aide de la technique proposée, nous avons recréé les plans de neuf patients ayant reçu une deuxième série de traitements de radiothérapie pour des cancers de la tête et du cou. Les deuxièmes séries de traitements cliniques et les nouveaux plans ont été comparés en fonction des aspects suivants: l'indice de conformité, l'indice d'hétérogénéité, le point de dose maximale, la probabilité de contrôle des tissus, la probabilité de complication aux tissus sains et la capacité du système de planification des traitements à respecter les lignes directrices. Les contraintes et les lignes directrices de la replanification suivaient le traitement clinique. De plus, un modèle de récupération cellulaire du tissu a été intégré au système, appliqué à la série de traitements clinique et à la replanification, puis comparé dans le but d'estimer la pertinence de la technique de « dose cropping » dans de tels régimes.
La replanification a entraîné la diminution du point de la dose maximale pour les organes à risque (5 Gy pour la colonne vertébrale et 4 Gy pour le tronc cérébral), de la probabilité de complication aux tissus sains (une diminution de la médiane de 2,9%), et nous a permis d'atteindre plus fréquemment la cible de couverture de V95% > 98%, et ce, quel que soit le modèle de récupération employé. Par ailleurs, les nouveaux plans qui utilisaient la technique de « dose cropping » étaient identiques d'un point de vue statistiquement significatif aux deuxièmes séries de traitements cliniques pour ce qui est de la conformité du plan, de l'hétérogénéité et de la probabilité de contrôle des tissus (p>0,31 dans tous les cas).
Le « dose cropping » est une technique intéressante qui peut être appliquée facilement à la planification des traitements de radiothérapies d'un deuxième cancer. Elle fournit également une manière aisée de tenir compte des modèles de récupération du tissu, de la conversion de la dose efficace d'un point de vue biologique et de l'évaluation des modèles de la probabilité de complication aux tissus sains (NTCP) et de la probabilité de contrôle tumoral (TCP).
Focusing on Swedish and Norwegian cohorts of community‐dwelling older adults between age 65 and 70, this study aimed to identify predictors of the prevalence and incident cases of daytime and night‐time xerostomia. It was hypothesized that the prevalence increases with increasing age and is higher in women than in men and that the prevalence of persistent xerostomia and the 5‐yr‐incident cases are higher in people with consistent use of medication and need for health care. Of the Norwegian participants who completed the 2007 survey (age 65 yr), 70% (n = 2,947) participated in 2012. Individuals participating in both 2007 and 2012 constituted the Swedish panel (80%, n = 4,862). The prevalence of xerostomia was higher in women than in men and increased from age 65 to age 70, most markedly in the Swedish cohort. The risk of persistent xerostomia was greatest for participants with consistent use of medication (OR = 1.3) and contact with a physician (OR = 2.3). The risk of incident cases of xerostomia during daytime was greatest for participants with recent and consistent use of medication and recent contact with a physician. Dental professionals should identify patients with xerostomia, emphasize early prevention, and alleviate oral symptoms in collaboration with physicians.
Publication date: Available online 24 December 2018
Source: Acta Otorrinolaringológica Española
Author(s): Fabián Alzate Amaya, Liliana Invencio da Costa, Mercedes Álvarez-Buylla Blanco
Publication date: Available online 24 December 2018
Source: Acta Otorrinolaringológica Española
Author(s): Miguel Mayo-Yáñez, Jaime Villares-Soriano
Focusing on Swedish and Norwegian cohorts of community‐dwelling older adults between age 65 and 70, this study aimed to identify predictors of the prevalence and incident cases of daytime and night‐time xerostomia. It was hypothesized that the prevalence increases with increasing age and is higher in women than in men and that the prevalence of persistent xerostomia and the 5‐yr‐incident cases are higher in people with consistent use of medication and need for health care. Of the Norwegian participants who completed the 2007 survey (age 65 yr), 70% (n = 2,947) participated in 2012. Individuals participating in both 2007 and 2012 constituted the Swedish panel (80%, n = 4,862). The prevalence of xerostomia was higher in women than in men and increased from age 65 to age 70, most markedly in the Swedish cohort. The risk of persistent xerostomia was greatest for participants with consistent use of medication (OR = 1.3) and contact with a physician (OR = 2.3). The risk of incident cases of xerostomia during daytime was greatest for participants with recent and consistent use of medication and recent contact with a physician. Dental professionals should identify patients with xerostomia, emphasize early prevention, and alleviate oral symptoms in collaboration with physicians.
Publication date: Available online 24 December 2018
Source: Acta Otorrinolaringológica Española
Author(s): Fabián Alzate Amaya, Liliana Invencio da Costa, Mercedes Álvarez-Buylla Blanco
Publication date: Available online 24 December 2018
Source: Acta Otorrinolaringológica Española
Author(s): Miguel Mayo-Yáñez, Jaime Villares-Soriano
Publication date: Available online 25 December 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Carol J. MacArthur, Gary Nesbit
To review simultaneous intra-operative sclerotherapy (IOS) with immediate surgical resection for the treatment of cervicofacial venous malformations (VMs) at a single institution. While pre-operative sclerotherapy (POS) has been reported in the literature, simultaneous intra-operative sclerotherapy and surgery in the operating room has not.
The database from the Hemangioma and Vascular Birthmarks Clinic was reviewed. All patients in both groups had biopsy-proven VMs.
IOS was used in 11 surgical patients with average age 17 years. Sclerotherapy was performed with sodium tetradecyl sulfate 3%, absolute alcohol or bleomycin. Immediately after IOS, and under the same anesthetic, all patients had either complete resection or debulking of the VMs. Eight patients had complete resolution of their VM and 3 had improvement. Average duration of the combined procedures done under a single anesthetic was 121 minutes.
The POS approach was used for 6 surgical patients with average age 7 years. Sclerotherapy agents used were absolute alcohol or sodium tetradecyl sulfate 3%. All patients underwent complete resection of the VM 24-72 hours after sclerotherapy under a separate surgical session. Five patients experienced complete resolution of their VM and one has had further sclerotherapy for recurrent disease. Interventional Radiology suite sclerotherapy times were on average 70 minutes. Surgical times were on average 142 minutes. Total combined anesthesia times for the two procedures added together were 212 min. Treatment time was significantly shorter in the IOS group (p=0.0015).
Simultaneous IOS at the time of surgical resection has been successful in our hands. IOS has the advantage of a single procedure and decreased cost to the patient. In the era of reducing pediatric exposure to anesthesia, this approach is especially attractive in the pediatric population. As well, at approximately $100/minute cost to the patient to be in either the Interventional Radiology Suite or in the operating room, the reduced length of the procedures seen in the IOS approach results in lower overall cost to the patient.
Publication date: Available online 25 December 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Carol J. MacArthur, Gary Nesbit
To review simultaneous intra-operative sclerotherapy (IOS) with immediate surgical resection for the treatment of cervicofacial venous malformations (VMs) at a single institution. While pre-operative sclerotherapy (POS) has been reported in the literature, simultaneous intra-operative sclerotherapy and surgery in the operating room has not.
The database from the Hemangioma and Vascular Birthmarks Clinic was reviewed. All patients in both groups had biopsy-proven VMs.
IOS was used in 11 surgical patients with average age 17 years. Sclerotherapy was performed with sodium tetradecyl sulfate 3%, absolute alcohol or bleomycin. Immediately after IOS, and under the same anesthetic, all patients had either complete resection or debulking of the VMs. Eight patients had complete resolution of their VM and 3 had improvement. Average duration of the combined procedures done under a single anesthetic was 121 minutes.
The POS approach was used for 6 surgical patients with average age 7 years. Sclerotherapy agents used were absolute alcohol or sodium tetradecyl sulfate 3%. All patients underwent complete resection of the VM 24-72 hours after sclerotherapy under a separate surgical session. Five patients experienced complete resolution of their VM and one has had further sclerotherapy for recurrent disease. Interventional Radiology suite sclerotherapy times were on average 70 minutes. Surgical times were on average 142 minutes. Total combined anesthesia times for the two procedures added together were 212 min. Treatment time was significantly shorter in the IOS group (p=0.0015).
Simultaneous IOS at the time of surgical resection has been successful in our hands. IOS has the advantage of a single procedure and decreased cost to the patient. In the era of reducing pediatric exposure to anesthesia, this approach is especially attractive in the pediatric population. As well, at approximately $100/minute cost to the patient to be in either the Interventional Radiology Suite or in the operating room, the reduced length of the procedures seen in the IOS approach results in lower overall cost to the patient.
CONCLUSIONS: The number of ARE is an important predictor of the diagnosis of food allergy, although less than we would have imagined. The number of ARE could be used to increase the predictability of the diagnostic tests currently in use, to define clinical prediction rules alternative to OFC and easy to use in clinical practice. PMID: 30573320 [PubMed - as supplied by publisher] (Source: Allergologia et Immunopathologia)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SljPlo
CONCLUSIONS: This is the first study in Japan to show that PTB, but not LBW or SGA, was significantly positively associated with childhood wheeze and asthma. PMID: 30573321 [PubMed - as supplied by publisher] (Source: Allergologia et Immunopathologia)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AeQ8LT
CONCLUSIONS: The results of our study are placed alongside others already present in the literature and concerning other methods of processing CM proteins and help to reduce the dietary restrictions of the majority of children with systemic IgE-CMA. PMID: 30573322 [PubMed - as supplied by publisher] (Source: Allergologia et Immunopathologia)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SjMiIn
CONCLUSIONS: The number of ARE is an important predictor of the diagnosis of food allergy, although less than we would have imagined. The number of ARE could be used to increase the predictability of the diagnostic tests currently in use, to define clinical prediction rules alternative to OFC and easy to use in clinical practice. PMID: 30573320 [PubMed - as supplied by publisher] (Source: Allergologia et Immunopathologia)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SljPlo
CONCLUSIONS: This is the first study in Japan to show that PTB, but not LBW or SGA, was significantly positively associated with childhood wheeze and asthma. PMID: 30573321 [PubMed - as supplied by publisher] (Source: Allergologia et Immunopathologia)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AeQ8LT
CONCLUSIONS: The results of our study are placed alongside others already present in the literature and concerning other methods of processing CM proteins and help to reduce the dietary restrictions of the majority of children with systemic IgE-CMA. PMID: 30573322 [PubMed - as supplied by publisher] (Source: Allergologia et Immunopathologia)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SjMiIn
Publication date: Available online 24 December 2018
Source: Archives of Oral Biology
Author(s): Kun Wang, Xuedong Zhou, Wei Li, Linglin Zhang
Saliva contains a large number of proteins that play various crucial roles to maintain the oral health and tooth integrity. This oral fluid is proposed to be one of the most important host factors, serving as a special medium for monitoring aspects of microorganisms, diet and host susceptibility involved in the caries process. Extensive salivary proteomic and peptidomic studies have resulted in considerable advances in the field of biomarkers discovery for dental caries. These salivary biomarkers may be exploited for the prediction, diagnosis, prognosis and treatment of dental caries, many of which could also provide the potential templates for bioactive peptides used for the biomimetic management of dental caries, rather than repairing caries lesions with artificial materials. A comprehensive understanding of the biological function of salivary proteins as well as their derived biomimetic peptides with promising potential against dental caries has been long awaited. This review overviewed a collection of current literature and addressed the majority of different functions of salivary proteins and peptides with their potential as functional biomarkers for caries risk assessment and clinical prospects for the anti-caries application.
Publication date: March 2019
Source: NeuroImage, Volume 188
Author(s): Ethan M. McCormick, Kathleen M. Gates, Eva H. Telzer
Theories of adolescent neurodevelopment have largely focused on group-level descriptions of neural changes that help explain increases in risk behavior that are stereotypical of the teen years. However, because these models are concerned with describing the "average" individual, they can fail to account for important individual or within-group variability. New methodological developments now offer the possibility of accounting for both group trends and individual differences within the same modeling framework. Here we apply GIMME, a model-based approach which uses both group and individual-level information to construct functional connectivity maps, to investigate risky behavior and neural changes across development. Adolescents (N = 30, Mage = 13.22), young adults (N = 23, Mage = 19.19), and adults (N = 31, Mage = 43.93) completed a risky decision-making task during an fMRI scan, and functional networks were constructed for each individual. We took two subgrouping approaches: 1) a confirmatory approach where we searched for functional connections that distinguished between our a priori age categories, and 2) an exploratory approach where we allowed an unsupervised algorithm to sort individuals freely. Contrary to expectations, we show that age is not the most influence contributing to network configurations. The implications for developmental theories and methodologies are discussed.
Publication date: March 2019
Source: NeuroImage, Volume 188
Author(s): Lauri Tuominen, Emily Boeke, Stephanie DeCross, Rick PF. Wolthusen, Shahin Nasr, Mohammed Milad, Mark Vangel, Roger Tootell, Daphne Holt
The generalization of conditioned fear responses has been shown to decrease as a function of perceptual similarity. However, generalization may also extend beyond the perceptual discrimination threshold, ostensibly due to contributions from processes other than perception. Currently the neural mechanisms that mediate perceptual and non-perceptual aspects of fear generalization are unclear.
To investigate this question, we conducted a Pavlovian fear conditioning and generalization experiment, collecting functional magnetic resonance imaging (fMRI), skin conductance and explicit shock likelihood ratings, in 37 healthy subjects. Face stimuli were initially paired (CS+) or not paired (CS) with an electrical shock. During the generalization phase, responses were measured to the CS+, CS
and a range of CS + -to
CS
morphs (generalization stimuli), selected for each participant based on that participant's discrimination ability.
Across multiple measurements, we found that fear generalization responses were limited to stimuli that could not be distinguished from the CS + stimulus, thus following a gradient closely linked to perceptual discriminability. These measurements, which were correlated with one another, included skin conductance responses, behavioral ratings, and fMRI responses of anterior insula and superior frontal gyrus. In contrast, responses in areas of the default network, including the posterior cingulate gyrus, angular gyrus and hippocampus, showed a negative generalization function extending to stimuli that were more likely to be distinguished from the CS+. In addition, the generalization gradients of the anterior insula and the behavioral ratings showed some evidence for extension beyond perceptual limits. Taken together, these results suggest that distinct brain areas are involved in perceptual and non-perceptual components of fear generalization.
Publication date: Available online 24 December 2018
Source: Archives of Oral Biology
Author(s): Kun Wang, Xuedong Zhou, Wei Li, Linglin Zhang
Saliva contains a large number of proteins that play various crucial roles to maintain the oral health and tooth integrity. This oral fluid is proposed to be one of the most important host factors, serving as a special medium for monitoring aspects of microorganisms, diet and host susceptibility involved in the caries process. Extensive salivary proteomic and peptidomic studies have resulted in considerable advances in the field of biomarkers discovery for dental caries. These salivary biomarkers may be exploited for the prediction, diagnosis, prognosis and treatment of dental caries, many of which could also provide the potential templates for bioactive peptides used for the biomimetic management of dental caries, rather than repairing caries lesions with artificial materials. A comprehensive understanding of the biological function of salivary proteins as well as their derived biomimetic peptides with promising potential against dental caries has been long awaited. This review overviewed a collection of current literature and addressed the majority of different functions of salivary proteins and peptides with their potential as functional biomarkers for caries risk assessment and clinical prospects for the anti-caries application.
Publication date: March 2019
Source: NeuroImage, Volume 188
Author(s): Ethan M. McCormick, Kathleen M. Gates, Eva H. Telzer
Theories of adolescent neurodevelopment have largely focused on group-level descriptions of neural changes that help explain increases in risk behavior that are stereotypical of the teen years. However, because these models are concerned with describing the "average" individual, they can fail to account for important individual or within-group variability. New methodological developments now offer the possibility of accounting for both group trends and individual differences within the same modeling framework. Here we apply GIMME, a model-based approach which uses both group and individual-level information to construct functional connectivity maps, to investigate risky behavior and neural changes across development. Adolescents (N = 30, Mage = 13.22), young adults (N = 23, Mage = 19.19), and adults (N = 31, Mage = 43.93) completed a risky decision-making task during an fMRI scan, and functional networks were constructed for each individual. We took two subgrouping approaches: 1) a confirmatory approach where we searched for functional connections that distinguished between our a priori age categories, and 2) an exploratory approach where we allowed an unsupervised algorithm to sort individuals freely. Contrary to expectations, we show that age is not the most influence contributing to network configurations. The implications for developmental theories and methodologies are discussed.
Publication date: March 2019
Source: NeuroImage, Volume 188
Author(s): Lauri Tuominen, Emily Boeke, Stephanie DeCross, Rick PF. Wolthusen, Shahin Nasr, Mohammed Milad, Mark Vangel, Roger Tootell, Daphne Holt
The generalization of conditioned fear responses has been shown to decrease as a function of perceptual similarity. However, generalization may also extend beyond the perceptual discrimination threshold, ostensibly due to contributions from processes other than perception. Currently the neural mechanisms that mediate perceptual and non-perceptual aspects of fear generalization are unclear.
To investigate this question, we conducted a Pavlovian fear conditioning and generalization experiment, collecting functional magnetic resonance imaging (fMRI), skin conductance and explicit shock likelihood ratings, in 37 healthy subjects. Face stimuli were initially paired (CS+) or not paired (CS) with an electrical shock. During the generalization phase, responses were measured to the CS+, CS
and a range of CS + -to
CS
morphs (generalization stimuli), selected for each participant based on that participant's discrimination ability.
Across multiple measurements, we found that fear generalization responses were limited to stimuli that could not be distinguished from the CS + stimulus, thus following a gradient closely linked to perceptual discriminability. These measurements, which were correlated with one another, included skin conductance responses, behavioral ratings, and fMRI responses of anterior insula and superior frontal gyrus. In contrast, responses in areas of the default network, including the posterior cingulate gyrus, angular gyrus and hippocampus, showed a negative generalization function extending to stimuli that were more likely to be distinguished from the CS+. In addition, the generalization gradients of the anterior insula and the behavioral ratings showed some evidence for extension beyond perceptual limits. Taken together, these results suggest that distinct brain areas are involved in perceptual and non-perceptual components of fear generalization.
Publication date: Available online 24 December 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): F. Marín-Conde, L. Castellanos-Cosano, J. Pachón-Ibañez, M.A. Serrera-Figallo, J.L. Gutiérrez-Pérez, D. Torres-Lagares
The objective of this study was to assess the effectiveness of photobiomodulation with low-level laser therapy (LLLT) as a preventive and therapeutic procedure for the treatment of oral and oropharyngeal mucositis caused by radio-chemotherapy in patients diagnosed with oral squamous cell carcinoma (SCC). An experimental, prospective, double-blind, randomized controlled study was conducted involving patients diagnosed with oral SCC undergoing oncological treatment. The variables analyzed included grade, appearance, and remission of mucositis. A final sample of 26 patients was included: 11 (42.3%) in the study group and 15 (57.7%) in the control group; their average age was 60.89 ± 9.99 years. Statistically significant differences between the groups were observed from week 5 of oncological treatment; 72.7% of the laser group showed normal mucosa (mucositis grade 0), while in the control group, 20.0% showed grade 0 mucositis and 40.0% showed grade 2 mucositis (P < 0.01). No statistically significant difference between the groups was found regarding the application or use of medication throughout the study period (P > 0.05). The tolerance evaluation did not show any statistically significant difference between the groups regarding the occurrence of side effects or adverse events during the trial (P > 0.05). Photobiomodulation with LLLT reduces the incidence and severity of mucositis in patients treated with radiotherapy ± chemotherapy.
Publication date: Available online 24 December 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): F. Marín-Conde, L. Castellanos-Cosano, J. Pachón-Ibañez, M.A. Serrera-Figallo, J.L. Gutiérrez-Pérez, D. Torres-Lagares
The objective of this study was to assess the effectiveness of photobiomodulation with low-level laser therapy (LLLT) as a preventive and therapeutic procedure for the treatment of oral and oropharyngeal mucositis caused by radio-chemotherapy in patients diagnosed with oral squamous cell carcinoma (SCC). An experimental, prospective, double-blind, randomized controlled study was conducted involving patients diagnosed with oral SCC undergoing oncological treatment. The variables analyzed included grade, appearance, and remission of mucositis. A final sample of 26 patients was included: 11 (42.3%) in the study group and 15 (57.7%) in the control group; their average age was 60.89 ± 9.99 years. Statistically significant differences between the groups were observed from week 5 of oncological treatment; 72.7% of the laser group showed normal mucosa (mucositis grade 0), while in the control group, 20.0% showed grade 0 mucositis and 40.0% showed grade 2 mucositis (P < 0.01). No statistically significant difference between the groups was found regarding the application or use of medication throughout the study period (P > 0.05). The tolerance evaluation did not show any statistically significant difference between the groups regarding the occurrence of side effects or adverse events during the trial (P > 0.05). Photobiomodulation with LLLT reduces the incidence and severity of mucositis in patients treated with radiotherapy ± chemotherapy.
Publication date: Available online 25 December 2018
Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
Author(s): Shoya Mizuno, Kenichi Kurita, Koki Imaoka, Hiroyuki Hanai, Yoshihito Matsui, Yoshiko Katayama, Masahito Maeda, Atsushi Nakayama, Takefumi Negoro, Kozo Tanida
We evaluated maxillary growth outcomes of our modification of a two-stage palatoplasty algorithm (the Zurich University protocol) for the treatment of complete unilateral cleft lip, alveolus, and palate (UCLP) that allows for maxillary growth by delaying alveolar and hard palate closure with bone grafting until age 8 years or older.
We obtained measurements from lateral cephalograms taken at age 6 years for 46 consecutive patients and compared them between the two-stage group and children without UCLP (non-cleft group) and children with UCLP historically treated with push-back palatoplasty. Values related to facial growth were compared between the three groups and by sex. Profilograms were compared between the two-stage and non-cleft groups.
Sella-nasion distance, sella-nasion-point A angle, and sella-nasion-point B angle were significantly smaller in the two-stage group than in the non-cleft group among boys but were not significantly different among girls. Profilograms showed that these smaller values reflected a smaller skull size. However, in the two-stage group, the point A-nasion-point B angle (∠ANB) was 2 standard deviations (SDs) less than the mean in 3 patients (6.5%) and 1 SD less in 10 patients (21.7%), reflecting poor maxilla-mandibular relationships. Compared with the push-back group, the two-stage group showed better maxillary growth in all measured values.
Postoperative maxillary growth was acceptable and better with two-stage palatoplasty than with push-back palatoplasty. However, about 30% of two-stage patients had worse ∠ANB, indicating the need for careful follow-up and analysis of maxillary growth when the child reaches adulthood.
Publication date: Available online 25 December 2018
Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
Author(s): Shoya Mizuno, Kenichi Kurita, Koki Imaoka, Hiroyuki Hanai, Yoshihito Matsui, Yoshiko Katayama, Masahito Maeda, Atsushi Nakayama, Takefumi Negoro, Kozo Tanida
We evaluated maxillary growth outcomes of our modification of a two-stage palatoplasty algorithm (the Zurich University protocol) for the treatment of complete unilateral cleft lip, alveolus, and palate (UCLP) that allows for maxillary growth by delaying alveolar and hard palate closure with bone grafting until age 8 years or older.
We obtained measurements from lateral cephalograms taken at age 6 years for 46 consecutive patients and compared them between the two-stage group and children without UCLP (non-cleft group) and children with UCLP historically treated with push-back palatoplasty. Values related to facial growth were compared between the three groups and by sex. Profilograms were compared between the two-stage and non-cleft groups.
Sella-nasion distance, sella-nasion-point A angle, and sella-nasion-point B angle were significantly smaller in the two-stage group than in the non-cleft group among boys but were not significantly different among girls. Profilograms showed that these smaller values reflected a smaller skull size. However, in the two-stage group, the point A-nasion-point B angle (∠ANB) was 2 standard deviations (SDs) less than the mean in 3 patients (6.5%) and 1 SD less in 10 patients (21.7%), reflecting poor maxilla-mandibular relationships. Compared with the push-back group, the two-stage group showed better maxillary growth in all measured values.
Postoperative maxillary growth was acceptable and better with two-stage palatoplasty than with push-back palatoplasty. However, about 30% of two-stage patients had worse ∠ANB, indicating the need for careful follow-up and analysis of maxillary growth when the child reaches adulthood.
Publication date: Available online 24 December 2018
Source: European Journal of Radiology
Author(s): Bieke De Roo, Nele Stichelbaut, Pieter Hoste, Koenraad Verstraete, Klaus Bacher
This study aims to evaluate the radiation exposure to patients undergoing an abdominopelvic or a chest and abdominopelvic (trunk) CT examination and to assess compliance to imaging referral guidelines.
To this end, 357 standard abdominopelvic and trunk CT scans were collected from 8 Belgian institutions in 2011 and 2015. Effective dose (E) and collective dose were calculated using CT dose descriptors (CTDIvol and DLP), which were obtained from dose reports generated by the CT scanner. Subsequently, these CT requests were compared against the national referral guidelines to assess compliance. Population estimates for dose and compliance were obtained using multilevel linear regression and generalized estimating equation models.
Between 2011 and 2015, a significant decrease of 28% in CTDIvol and DLP was found for abdominopelvic CT. The corresponding E decreased by 27%, and the collective dose by 23%. For trunk CT, a non-significant decrease of 6% was found in CTDIvol and a significant decrease of 14% in both DLP and E. However, the collective dose of trunk examinations increased by 39%. In 2011, 24% of the abdominopelvic examinations were not compliant with the guidelines, whereas this percentage dropped to 17% in 2015. Non-justified examinations accounted for 8% and 12% of all trunk CT scans in 2011 and 2015, respectively.
Between 2011 and 2015, there was a decrease in dose for patients undergoing abdominopelvic or trunk CT in Belgium. However, a fraction of the estimated doses are linked to unnecessary CT examinations, which should be avoided.
Publication date: Available online 24 December 2018
Source: European Journal of Radiology
Author(s): Bieke De Roo, Nele Stichelbaut, Pieter Hoste, Koenraad Verstraete, Klaus Bacher
This study aims to evaluate the radiation exposure to patients undergoing an abdominopelvic or a chest and abdominopelvic (trunk) CT examination and to assess compliance to imaging referral guidelines.
To this end, 357 standard abdominopelvic and trunk CT scans were collected from 8 Belgian institutions in 2011 and 2015. Effective dose (E) and collective dose were calculated using CT dose descriptors (CTDIvol and DLP), which were obtained from dose reports generated by the CT scanner. Subsequently, these CT requests were compared against the national referral guidelines to assess compliance. Population estimates for dose and compliance were obtained using multilevel linear regression and generalized estimating equation models.
Between 2011 and 2015, a significant decrease of 28% in CTDIvol and DLP was found for abdominopelvic CT. The corresponding E decreased by 27%, and the collective dose by 23%. For trunk CT, a non-significant decrease of 6% was found in CTDIvol and a significant decrease of 14% in both DLP and E. However, the collective dose of trunk examinations increased by 39%. In 2011, 24% of the abdominopelvic examinations were not compliant with the guidelines, whereas this percentage dropped to 17% in 2015. Non-justified examinations accounted for 8% and 12% of all trunk CT scans in 2011 and 2015, respectively.
Between 2011 and 2015, there was a decrease in dose for patients undergoing abdominopelvic or trunk CT in Belgium. However, a fraction of the estimated doses are linked to unnecessary CT examinations, which should be avoided.
In this study, we aim to determine the frequency of adherence to National Comprehensive Cancer Network follow‐up guidelines in a population of head and neck cancer patients who received curative treatment. We will also assess the impact of race, ethnicity, socioeconomic status, and treatment setting on utilization of follow‐up care.
This study included patients with biopsy‐proven, nonmetastatic oropharyngeal or laryngeal cancer treated with radiotherapy between January 1, 2014, and June 30, 2016, at a safety‐net hospital or adjacent private academic hospital. Components of follow‐up care analyzed included an appointment with a surgeon or radiation oncologist within 3 months and posttreatment imaging of the primary site within 6 months. Univariable and multivariable analyses were conducted using a logistic regression model to estimate odds ratios and corresponding 95% confidence intervals.
Two hundred and thirty‐four patients were included in this study. Of those, 88.8% received posttreatment imaging of the primary site within 6 months; 88.5% attended a follow‐up appointment with a radiation oncologist within 3 months; and 71.1% of patients attended a follow‐up appointment with a surgeon within 3 months. On multivariable analysis, private academic hospital treatment versus safety‐net hospital treatment was associated with increased utilization of both surgical and radiation oncology follow‐up. Non‐Hispanic black (NHB) patients, Hispanic patients, and those with a low socioeconomic status were also less likely to receive follow‐up.
Safety‐net hospital treatment, socioeconomic status, Hispanic ethnicity, and NHB race were associated with decreased follow‐up service utilization. Quality improvement initiatives are needed to reduce these disparities.
2b. Laryngoscope, 2018
Opioid‐related deaths in the United States have increased 200% since 2000, in part due to prescription diversion from patients who had a surgical procedure. The purpose of this study was to characterize provider prescription patterns and assess patient‐reported opioid use after endoscopic sinus surgery (ESS).
Retrospective chart review.
Patients who underwent ESS between May 2017 and May 2018 were included. Opioid prescription, operative details, and postoperative opioid use data were extracted. The Massachusetts Prescription Awareness Tool (MassPAT) was queried to determine if patients filled their prescription.
One hundred fifty‐five patients were included. Nearly all patients received an opioid prescription (94.8%). An average of 15.6 tablets was prescribed per patient. Among 116 patients with MassPAT data, 91.4% filled their prescription. Among 67 patients who reported the number of tablets they had used at the time of first follow‐up appointment, 73.1% reported taking no opioids. Mean number of tablets prescribed was significantly greater among patients who underwent primary versus revision surgery (16.5 vs. 13.5, P = .0111) and those who had splints placed (21.5 vs. 15.1, P = .0037). Predictors of opioid use included concurrent turbinate reduction (58.3% vs. 14.3%, P < .0001) and concurrent septoplasty (45.5% vs. 21.6%, P = .039).
Nearly all patients who underwent ESS were prescribed an opioid, and nearly all patients filled their prescription. However, the vast majority of patients did not require any opioid medication for postoperative pain control. As the opioid epidemic continues to persist, these findings have immediate relevance to current prescribing patterns and pain management practices.
4 Laryngoscope, 2018
Peritonsillar abscess (PTA) is a common infectious complication of pharyngeal infection managed by otolaryngologists and emergency room physicians. Streptococcus and Fusobacterium (e.g., Fusobacterium necrophorum, FN) species are commonly isolated pathogens. The aim of this study was to determine the implication of culture results on abscess recurrence following drainage.
Single‐institution retrospective review of patients treated at the University of Michigan between 2000 and 2017. Demographic and clinical outcome data were analyzed, including treatment details, culture data, and recurrence.
One hundred fifty‐six of the 990 patients in our study developed recurrence of their abscess (16%). The age ranges most susceptible to recurrence included adolescent (22.9%) and young adult groups (17.1%). Recurrent patients were more likely to have experienced acute progression of symptoms (79% vs. 71%, P = 0.03), trismus (67% vs. 55%, P = 0.006), voice changes (65% vs. 57%, P = 0.04), and dysphagia (72% vs. 61%, P = 0.01) compared to nonrecurrent patients. They were also more likely to have clinical lymphadenopathy noted on initial examination (67% vs. 56%, P = 0.009). Culture data was sent for 852 patients (86%). The presence of FN was significantly more prevalent in the recurrent group (P < 0.0001).
There is a high observed prevalence of FN species within PTA aspirates in the recurrent PTA population. PTA aspirate should be sent for anaerobic growth to screen for Fusobacterium species. In addition, follow‐up and lower threshold for subsequent tonsillectomy should be considered in this at‐risk group.
3. Laryngoscope, 2018
Voice outcomes following medialization laryngoplasty (ML) for unilateral vocal fold paralysis (UVFP) were compared to those who underwent ML plus arytenoid adduction (AA) (ML+AA).
Single institution retrospective review of patients with UVFP undergoing ML and ML+AA (2009–2017). Demographic information and history of laryngeal procedures were collected. Preoperative and postoperative Voice Handicap Index‐10 (VHI‐10) and Consensus Perceptual Auditory Evaluation of Voice (CAPE‐V) were assessed.
Of 236 patients, 119 met study criteria. Of those, 70 (59%) underwent ML and 49 (41%) underwent ML+AA. Significant differences between groups at baseline were found for age at time of thyroplasty (P = 0.046), VHI‐10 scores (P < 0.001), and CAPE‐V scores (P = 0.007). Baseline VHI‐10 scores for ML+AA (28 ± 7) were greater than those for ML alone (24 ± 7). At 12 months, overall VHI‐10 scores improved compared to baseline for both groups (ML+AA = 9 ± 7, ML = 16 ± 9); however, there was greater improvement for the ML+AA group compared to ML group (P = 0.001). CAPE‐V scores at 3 or 12 months improved, but differences between the groups were not statistically significant once controlled for covariates.
Based on current findings, patients who undergo ML+AA likely have greater voice handicap at baseline compared to those undergoing ML alone. Patients selected for ML+AA improve as much or more than those who underwent ML alone. This highlights the importance of appropriate selection of candidates for AA.
4. Laryngoscope, 2018
Although no clear guidelines exist, protocols in the treatment of spasmodic dysphonia (SD) vary among physicians. Previously published work comes from relatively few centers.
A descriptive survey among experts (laryngologists who practice Botulinum toxin injections for SD).
An online 58‐item survey was sent to all otolaryngologists who self‐identify as laryngologists on the American Academy of Otolaryngology–Head and Neck Surgery website. Items surveyed included botulinum toxin injection technique, laterality, and dosage.
An 80% response rate was achieved (70 completed the survey). Participants collectively reported treating >4,000 SD patients in the past year (mean, 71 ± 68 patients/laryngologist). Eighty‐seven percent perform injections exclusively in the office; the remainder both in the office and operating room. For adductor SD injections, 88% use electromyographic (EMG) guidance alone via cricothyroid approach. The remainder use anatomical landmarks alone (9%) or EMG with endoscopic guidance (3%). Sitting is the preferred patient position (70%; supine, 30%). A substantial majority (87%) begin with bilateral injections (starting dosage mode, 1.25 units/side). For abductor SD injections, 67% use EMG guidance alone and 31% use endoscopic guidance with or without EMG. Sitting is the preferred patient position (84%; supine, 16%). The preferred approach is anterior‐translaryngeal (51%), followed by lateral‐retrolaryngeal with rotation (34%). A considerable majority (79%) begin with unilateral injections (starting dosage mode, 5 units). When deciding on initial dosage, the most influential factor was balancing patients' desire/needs, followed by patients' frailty and risk of aspiration. The typical planned interval between injections is 3 to 4 months.
Laryngologists follow fairly uniform protocols in the treatment of SD with some important and previously unpublished differences. This study documents areas of agreement and discordance among laryngologists in the United States for the treatment of SD.
4 Laryngoscope, 2018
This study aimed to investigate the risk of postoperative recurrent laryngeal nerve paralysis (RLNP) with and without the use of intraoperative nerve monitoring (IONM) during thyroid cancer surgery.
Retrospective cohort study.
This study utilized a nationwide claims database in Japan. Patients who underwent thyroid cancer surgery with and without IONM were included, and postoperative RLNP incidence was compared.
The study included 5,804 patients. Multivariable logistic regression analysis revealed that use of IONM was not associated with increased RLNP risk (odds ratio: 1.15; 95% confidence interval: 0.67‐1.96). There was no significant effect on RLNP prevention when stratified by tumor or nodal classification. Rather, the patients who had T4 or N1b classifications who received IONM had higher incidences of RLNP.
Use of IONM did not significantly reduce the risk of RLNP. The results for the T4 and N1b populations may be explained by indication bias or unmeasured confounders.
NA Laryngoscope, 2018
Serial intralesional steroid injection (SILSI) has recently been proposed as an effective scar‐modifying therapy for subglottic stenosis (SGS). We aimed to explore the systemic absorption of steroid following SILSI and to characterize the magnitude and chronicity of any effect observed. Specifically, we aimed to show that any effect resolves prior to the next intralesional injection.
Prospective, observational pilot study.
Patients were injected intralesionally with 40 to 200 mg triamcinolone. Serum cortisol, as well as white cell counts and inflammatory markers were measured at day 0 (baseline), 1, 7, and 28. Salivary cortisol was measured at baseline and for 7 consecutive days following injection.
Six patients with idiopathic SGS were recruited. At baseline, serum cortisol measured 284.0 ± 61.4 nmol/L and fell significantly to 15.5 ± 4.3 nmol/L 1 day following triamcinolone injection (P = .03). At day 7, serum steroid levels showed significant recovery to 221.8 ± 78.9 nmol/L (P = .03) and further rose to 279.5 ± 29.9 nmol/L at 28 days (P = .07). Salivary cortisol exhibited a similar pattern with significant recovery by day 6 (P = .04) and suggestion of exponential clearance of triamcinolone systemically. White cell counts were also affected by systemic absorption of exogenous steroid. No significant change in inflammatory markers was observed.
Our findings demonstrate systemic absorption of steroid following SILSI, with acute hypothalamic–pituitary–adrenal (HPA) axis suppression. However, normalization of HPA axis function by day 7 suggests that although acute steroid side effects should be discussed with patients, no cumulative systemic steroid side effect would occur with serial injections.
2 Laryngoscope, 2018
Overnight hospitalization is routinely advocated following type I thyroplasty (TP) because of concerns for airway compromise. Hospitalization increases cost and patient inconvenience, and may not necessarily be appropriate. This study evaluated complications following surgery and identified predictors for same to assess which patients benefit most from hospitalization.
Retrospective chart review.
A study was conducted on patients who underwent TP with or without arytenoid repositioning procedures between June 2008 and March 2017. The demographic data of the subjects, characteristics, etiology of glottic insufficiency, interventions performed, and subsequent complications were evaluated.
Of 147 patients reviewed, 100 underwent TP alone, 41 underwent TP with arytenoid adduction, and six patients underwent TP with adduction arytenopexy. Iatrogenic vocal fold paralysis was the most common indication. Major complications, which included transient airway compromise and hematoma requiring reoperation, occurred in 7% of patients. Revision surgery and thyroplasty combined with arytenoid repositioning maneuvers were associated with increased risk of major complications.
In general, TP is a safe procedure, with a major complication rate that is lower than that of outpatient thyroidectomy. Overnight hospitalization should be considered in patients undergoing revision surgery and in those requiring concurrent arytenoid repositioning procedures.
4 Laryngoscope, 2018
To compare the effect of lateral head rotation to lateral head and trunk rotation on upper airway patency during drug‐induced sleep endoscopy (DISE) in nonpositional obstructive sleep apnea (OSA) patients (NPP) and positional OSA patients (PP).
Prospective cohort study.
In total 92 patients were included. Seventy‐five patients were male (82%) with a mean age of 47.2 ± 11.3 years, a body mass index of 27.0 ± 3.3 kg/m2, and a median apnea–hypopnea index of 16.7 per hour (8.7, 26,5). Of all patients, 75% were PP. Lateral head rotation and lateral head and trunk rotation findings are similar in NPP at each possible level of obstruction, with exception of the oropharynx but not in PP. In PP, lateral head rotation and both lateral head and trunk observations were different at every possible obstruction site.
The effect of lateral head rotation and lateral head and trunk rotation on upper airway patency during DISE is significantly different in PP. In NPP, similar results regarding the degree of upper airway obstruction were found at the level of the velum, tongue base, and epiglottis.
2B Laryngoscope, 2018
In this study, we aim to determine the frequency of adherence to National Comprehensive Cancer Network follow‐up guidelines in a population of head and neck cancer patients who received curative treatment. We will also assess the impact of race, ethnicity, socioeconomic status, and treatment setting on utilization of follow‐up care.
This study included patients with biopsy‐proven, nonmetastatic oropharyngeal or laryngeal cancer treated with radiotherapy between January 1, 2014, and June 30, 2016, at a safety‐net hospital or adjacent private academic hospital. Components of follow‐up care analyzed included an appointment with a surgeon or radiation oncologist within 3 months and posttreatment imaging of the primary site within 6 months. Univariable and multivariable analyses were conducted using a logistic regression model to estimate odds ratios and corresponding 95% confidence intervals.
Two hundred and thirty‐four patients were included in this study. Of those, 88.8% received posttreatment imaging of the primary site within 6 months; 88.5% attended a follow‐up appointment with a radiation oncologist within 3 months; and 71.1% of patients attended a follow‐up appointment with a surgeon within 3 months. On multivariable analysis, private academic hospital treatment versus safety‐net hospital treatment was associated with increased utilization of both surgical and radiation oncology follow‐up. Non‐Hispanic black (NHB) patients, Hispanic patients, and those with a low socioeconomic status were also less likely to receive follow‐up.
Safety‐net hospital treatment, socioeconomic status, Hispanic ethnicity, and NHB race were associated with decreased follow‐up service utilization. Quality improvement initiatives are needed to reduce these disparities.
2b. Laryngoscope, 2018
Opioid‐related deaths in the United States have increased 200% since 2000, in part due to prescription diversion from patients who had a surgical procedure. The purpose of this study was to characterize provider prescription patterns and assess patient‐reported opioid use after endoscopic sinus surgery (ESS).
Retrospective chart review.
Patients who underwent ESS between May 2017 and May 2018 were included. Opioid prescription, operative details, and postoperative opioid use data were extracted. The Massachusetts Prescription Awareness Tool (MassPAT) was queried to determine if patients filled their prescription.
One hundred fifty‐five patients were included. Nearly all patients received an opioid prescription (94.8%). An average of 15.6 tablets was prescribed per patient. Among 116 patients with MassPAT data, 91.4% filled their prescription. Among 67 patients who reported the number of tablets they had used at the time of first follow‐up appointment, 73.1% reported taking no opioids. Mean number of tablets prescribed was significantly greater among patients who underwent primary versus revision surgery (16.5 vs. 13.5, P = .0111) and those who had splints placed (21.5 vs. 15.1, P = .0037). Predictors of opioid use included concurrent turbinate reduction (58.3% vs. 14.3%, P < .0001) and concurrent septoplasty (45.5% vs. 21.6%, P = .039).
Nearly all patients who underwent ESS were prescribed an opioid, and nearly all patients filled their prescription. However, the vast majority of patients did not require any opioid medication for postoperative pain control. As the opioid epidemic continues to persist, these findings have immediate relevance to current prescribing patterns and pain management practices.
4 Laryngoscope, 2018
Peritonsillar abscess (PTA) is a common infectious complication of pharyngeal infection managed by otolaryngologists and emergency room physicians. Streptococcus and Fusobacterium (e.g., Fusobacterium necrophorum, FN) species are commonly isolated pathogens. The aim of this study was to determine the implication of culture results on abscess recurrence following drainage.
Single‐institution retrospective review of patients treated at the University of Michigan between 2000 and 2017. Demographic and clinical outcome data were analyzed, including treatment details, culture data, and recurrence.
One hundred fifty‐six of the 990 patients in our study developed recurrence of their abscess (16%). The age ranges most susceptible to recurrence included adolescent (22.9%) and young adult groups (17.1%). Recurrent patients were more likely to have experienced acute progression of symptoms (79% vs. 71%, P = 0.03), trismus (67% vs. 55%, P = 0.006), voice changes (65% vs. 57%, P = 0.04), and dysphagia (72% vs. 61%, P = 0.01) compared to nonrecurrent patients. They were also more likely to have clinical lymphadenopathy noted on initial examination (67% vs. 56%, P = 0.009). Culture data was sent for 852 patients (86%). The presence of FN was significantly more prevalent in the recurrent group (P < 0.0001).
There is a high observed prevalence of FN species within PTA aspirates in the recurrent PTA population. PTA aspirate should be sent for anaerobic growth to screen for Fusobacterium species. In addition, follow‐up and lower threshold for subsequent tonsillectomy should be considered in this at‐risk group.
3. Laryngoscope, 2018
Voice outcomes following medialization laryngoplasty (ML) for unilateral vocal fold paralysis (UVFP) were compared to those who underwent ML plus arytenoid adduction (AA) (ML+AA).
Single institution retrospective review of patients with UVFP undergoing ML and ML+AA (2009–2017). Demographic information and history of laryngeal procedures were collected. Preoperative and postoperative Voice Handicap Index‐10 (VHI‐10) and Consensus Perceptual Auditory Evaluation of Voice (CAPE‐V) were assessed.
Of 236 patients, 119 met study criteria. Of those, 70 (59%) underwent ML and 49 (41%) underwent ML+AA. Significant differences between groups at baseline were found for age at time of thyroplasty (P = 0.046), VHI‐10 scores (P < 0.001), and CAPE‐V scores (P = 0.007). Baseline VHI‐10 scores for ML+AA (28 ± 7) were greater than those for ML alone (24 ± 7). At 12 months, overall VHI‐10 scores improved compared to baseline for both groups (ML+AA = 9 ± 7, ML = 16 ± 9); however, there was greater improvement for the ML+AA group compared to ML group (P = 0.001). CAPE‐V scores at 3 or 12 months improved, but differences between the groups were not statistically significant once controlled for covariates.
Based on current findings, patients who undergo ML+AA likely have greater voice handicap at baseline compared to those undergoing ML alone. Patients selected for ML+AA improve as much or more than those who underwent ML alone. This highlights the importance of appropriate selection of candidates for AA.
4. Laryngoscope, 2018
Although no clear guidelines exist, protocols in the treatment of spasmodic dysphonia (SD) vary among physicians. Previously published work comes from relatively few centers.
A descriptive survey among experts (laryngologists who practice Botulinum toxin injections for SD).
An online 58‐item survey was sent to all otolaryngologists who self‐identify as laryngologists on the American Academy of Otolaryngology–Head and Neck Surgery website. Items surveyed included botulinum toxin injection technique, laterality, and dosage.
An 80% response rate was achieved (70 completed the survey). Participants collectively reported treating >4,000 SD patients in the past year (mean, 71 ± 68 patients/laryngologist). Eighty‐seven percent perform injections exclusively in the office; the remainder both in the office and operating room. For adductor SD injections, 88% use electromyographic (EMG) guidance alone via cricothyroid approach. The remainder use anatomical landmarks alone (9%) or EMG with endoscopic guidance (3%). Sitting is the preferred patient position (70%; supine, 30%). A substantial majority (87%) begin with bilateral injections (starting dosage mode, 1.25 units/side). For abductor SD injections, 67% use EMG guidance alone and 31% use endoscopic guidance with or without EMG. Sitting is the preferred patient position (84%; supine, 16%). The preferred approach is anterior‐translaryngeal (51%), followed by lateral‐retrolaryngeal with rotation (34%). A considerable majority (79%) begin with unilateral injections (starting dosage mode, 5 units). When deciding on initial dosage, the most influential factor was balancing patients' desire/needs, followed by patients' frailty and risk of aspiration. The typical planned interval between injections is 3 to 4 months.
Laryngologists follow fairly uniform protocols in the treatment of SD with some important and previously unpublished differences. This study documents areas of agreement and discordance among laryngologists in the United States for the treatment of SD.
4 Laryngoscope, 2018
This study aimed to investigate the risk of postoperative recurrent laryngeal nerve paralysis (RLNP) with and without the use of intraoperative nerve monitoring (IONM) during thyroid cancer surgery.
Retrospective cohort study.
This study utilized a nationwide claims database in Japan. Patients who underwent thyroid cancer surgery with and without IONM were included, and postoperative RLNP incidence was compared.
The study included 5,804 patients. Multivariable logistic regression analysis revealed that use of IONM was not associated with increased RLNP risk (odds ratio: 1.15; 95% confidence interval: 0.67‐1.96). There was no significant effect on RLNP prevention when stratified by tumor or nodal classification. Rather, the patients who had T4 or N1b classifications who received IONM had higher incidences of RLNP.
Use of IONM did not significantly reduce the risk of RLNP. The results for the T4 and N1b populations may be explained by indication bias or unmeasured confounders.
NA Laryngoscope, 2018
Serial intralesional steroid injection (SILSI) has recently been proposed as an effective scar‐modifying therapy for subglottic stenosis (SGS). We aimed to explore the systemic absorption of steroid following SILSI and to characterize the magnitude and chronicity of any effect observed. Specifically, we aimed to show that any effect resolves prior to the next intralesional injection.
Prospective, observational pilot study.
Patients were injected intralesionally with 40 to 200 mg triamcinolone. Serum cortisol, as well as white cell counts and inflammatory markers were measured at day 0 (baseline), 1, 7, and 28. Salivary cortisol was measured at baseline and for 7 consecutive days following injection.
Six patients with idiopathic SGS were recruited. At baseline, serum cortisol measured 284.0 ± 61.4 nmol/L and fell significantly to 15.5 ± 4.3 nmol/L 1 day following triamcinolone injection (P = .03). At day 7, serum steroid levels showed significant recovery to 221.8 ± 78.9 nmol/L (P = .03) and further rose to 279.5 ± 29.9 nmol/L at 28 days (P = .07). Salivary cortisol exhibited a similar pattern with significant recovery by day 6 (P = .04) and suggestion of exponential clearance of triamcinolone systemically. White cell counts were also affected by systemic absorption of exogenous steroid. No significant change in inflammatory markers was observed.
Our findings demonstrate systemic absorption of steroid following SILSI, with acute hypothalamic–pituitary–adrenal (HPA) axis suppression. However, normalization of HPA axis function by day 7 suggests that although acute steroid side effects should be discussed with patients, no cumulative systemic steroid side effect would occur with serial injections.
2 Laryngoscope, 2018
Overnight hospitalization is routinely advocated following type I thyroplasty (TP) because of concerns for airway compromise. Hospitalization increases cost and patient inconvenience, and may not necessarily be appropriate. This study evaluated complications following surgery and identified predictors for same to assess which patients benefit most from hospitalization.
Retrospective chart review.
A study was conducted on patients who underwent TP with or without arytenoid repositioning procedures between June 2008 and March 2017. The demographic data of the subjects, characteristics, etiology of glottic insufficiency, interventions performed, and subsequent complications were evaluated.
Of 147 patients reviewed, 100 underwent TP alone, 41 underwent TP with arytenoid adduction, and six patients underwent TP with adduction arytenopexy. Iatrogenic vocal fold paralysis was the most common indication. Major complications, which included transient airway compromise and hematoma requiring reoperation, occurred in 7% of patients. Revision surgery and thyroplasty combined with arytenoid repositioning maneuvers were associated with increased risk of major complications.
In general, TP is a safe procedure, with a major complication rate that is lower than that of outpatient thyroidectomy. Overnight hospitalization should be considered in patients undergoing revision surgery and in those requiring concurrent arytenoid repositioning procedures.
4 Laryngoscope, 2018
To compare the effect of lateral head rotation to lateral head and trunk rotation on upper airway patency during drug‐induced sleep endoscopy (DISE) in nonpositional obstructive sleep apnea (OSA) patients (NPP) and positional OSA patients (PP).
Prospective cohort study.
In total 92 patients were included. Seventy‐five patients were male (82%) with a mean age of 47.2 ± 11.3 years, a body mass index of 27.0 ± 3.3 kg/m2, and a median apnea–hypopnea index of 16.7 per hour (8.7, 26,5). Of all patients, 75% were PP. Lateral head rotation and lateral head and trunk rotation findings are similar in NPP at each possible level of obstruction, with exception of the oropharynx but not in PP. In PP, lateral head rotation and both lateral head and trunk observations were different at every possible obstruction site.
The effect of lateral head rotation and lateral head and trunk rotation on upper airway patency during DISE is significantly different in PP. In NPP, similar results regarding the degree of upper airway obstruction were found at the level of the velum, tongue base, and epiglottis.
2B Laryngoscope, 2018
Updated Date: Dec 21, 2018 EST (Source: DailyMed Drug Label Updates)
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To assess periodontal awareness among laypersons, to characterise the very aware of periodontitis, and to disclose whether high awareness implies sufficient periodontal knowledge.
Subjects and methods: Cross‐sectional study on laypersons randomly selected by quota sampling from March 2015 to June 2016. The questionnaire of periodontal awareness included aspects of aetiology, risk factors, signs & symptoms, related risks, prevention, treatment, and related attitudes. It was applied by 12 interviewers in the community in each four province capitals, in a sort of pathfinder survey method.
A 43.3% response rate was obtained, and 3,553 people entered the study. "Very aware": 19.4%. "Aware": 42.7%. "Not aware": 37.9%. Age, oral self‐care, and educational achievements characterized those "very aware". Any additional degree beyond compulsory education halves the chances for being "not periodontally aware". Very aware people likely to have periodontitis were elder, less educated, with a smoking history and less knowledge of the disease. Gaps of knowledge among the "very aware" were identified in all aspects except for "prevention" and "treatment".
Very periodontally aware people were in their late 40s‐60s, followed sound oral care routines, and held a degree but elicited insufficient knowledge about aetiology, signs‐symptoms, related risks, or periodontal risk factors.
This article is protected by copyright. All rights reserved.
To assess periodontal awareness among laypersons, to characterise the very aware of periodontitis, and to disclose whether high awareness implies sufficient periodontal knowledge.
Subjects and methods: Cross‐sectional study on laypersons randomly selected by quota sampling from March 2015 to June 2016. The questionnaire of periodontal awareness included aspects of aetiology, risk factors, signs & symptoms, related risks, prevention, treatment, and related attitudes. It was applied by 12 interviewers in the community in each four province capitals, in a sort of pathfinder survey method.
A 43.3% response rate was obtained, and 3,553 people entered the study. "Very aware": 19.4%. "Aware": 42.7%. "Not aware": 37.9%. Age, oral self‐care, and educational achievements characterized those "very aware". Any additional degree beyond compulsory education halves the chances for being "not periodontally aware". Very aware people likely to have periodontitis were elder, less educated, with a smoking history and less knowledge of the disease. Gaps of knowledge among the "very aware" were identified in all aspects except for "prevention" and "treatment".
Very periodontally aware people were in their late 40s‐60s, followed sound oral care routines, and held a degree but elicited insufficient knowledge about aetiology, signs‐symptoms, related risks, or periodontal risk factors.
This article is protected by copyright. All rights reserved.
Quantitative susceptibility mapping (QSM) has recently been applied in humans to quantify the magnetic susceptibility of collagen fibrils in the articular cartilage.
To determine the ability of QSM to detect cartilage matrix degeneration between normal and early knee osteoarthritis (OA) patients.
Prospective.
Twenty‐four patients with knee OA and 24 age‐ and sex‐matched healthy controls.
3D gradient echo, T1 turbo spin echo, and proton density‐weighted (PDw) spectral attenuated inversion recovery (SPAIR) sequence at 3.0T.
Scan–rescan reproducibility of the susceptibility values in the cartilage was assessed in control subjects. Cartilage thickness, volume, mean, and standard deviation (SD) of susceptibility values of the cartilage compartments were compared between normal and OA patients. The relationship between magnetic susceptibility values and cartilage lesion grading based on MR images was studied.
The Wilcoxon Rank‐Sum test was used to compare cartilage thickness, volume, mean, and SD of susceptibility values between control subjects and OA patients. A Spearman rank correlation was performed to study the relationship between the mean and SD of susceptibility values and the cartilage thinning grades.
The SD of magnetic susceptibility values in the knee cartilage was significantly lower in OA patients compared with healthy controls, and it decreased with more severe MR grades of cartilage thinning degeneration. Significant correlations between the SD of susceptibility values and cartilage thinning grades were observed with R2 = 0.64 and P = 0.000, R2 = 0.47 and P = 0.002, R2 = 0.52 and P = 0.001, R2 = 0.42 and P = 0.0006, and R2 = 0.67 and P = 0.000 for medial femoral condyle (MFC), lateral femoral condyle (LFC), medial tibia (MT), lateral tibia (LT), and patella, respectively. No significant difference was found in cartilage volume (P = 0.17, P = 0.13, P = 0.20, P = 0.25, and P = 0.18 for MFC, LFC, MT, LT, and patella, respectively) and thickness (P = 0.31, P = 0.19, P = 0.16, P = 0.09, and P = 0.22 for MFC, LFC, MT, LT, and patella, respectively) between OA patients and healthy controls.
The variations of susceptibility values in the knee cartilage decrease with the degree of cartilage degeneration. QSM may be a sensitive indicator for alteration of the collagen network and shows potential to detect cartilage degeneration at early stage.
Level of Evidence: 2
Technical Efficacy: Stage 3
J. Magn. Reson. Imaging 2018.
Magnetic resonance elastography (MRE) has proven to be useful for assessing chronic liver disease. However, MRE images are acquired with breath‐holding (BH) to limit respiratory motion artifacts, which may be difficult in some patients.
To implement a respiratory‐triggered (RT) spin‐echo echo‐planar imaging (SE‐EPI) MRE technique and to validate its performance through comparison to a BH SE‐EPI MRE technique.
Prospective feasibility study.
Twenty‐three adult volunteers (18 without and 5 with liver disease).
1.5 T Philips Ingenia MR scanner; RT and BH SE‐EPI MRE sequences.
Four axial images were obtained through the middle of the liver with each technique. Liver stiffness measurements (in kPa) were made from elastograms, with 95% confidence maps overlaid, for both MRE sequences.
Liver stiffness measurements were compared using the paired t‐test (two‐sided). Absolute agreement between the two techniques was evaluated using Lin's concordance coefficient (rc). Bland–Altman analysis was used to assess the mean bias between the techniques and 95% limits of agreement, using BH MRE as the reference standard.
There was excellent agreement (rc = 0.98; 95% confidence interval: 0.96–0.99) between RT and BH SE‐EPI MRE. Mean (±SD) stiffness values from BH and RT SE‐EPI MRE techniques were 2.40 ± 1.15 kPa and 2.37 ± 1.06 kPa, respectively, with no significant difference (P = 0.54) and no significant bias (mean bias of +0.03 kPa; 95% limits of agreement: –0.39 to 0.45 kPa). Measurable regions of interest in the liver were slightly smaller with the RT technique (mean difference of 1.91 cm2; P = 0.04).
RT SE‐EPI MRE is feasible and yields comparable results to BH SE‐EPI MRE.
Level of Evidence: 1
Technical Efficacy: Stage 2
J. Magn. Reson. Imaging 2018.
