Clinical features and management of Meniere’s disease patients with drop attacks

Abstract

Purpose

The aims of the present study are to investigate the variations in clinical features, including medical history, hearing function, vestibular function, and degree of endolymphatic hydrops (EH), in Meniere's disease (MD) patients with and without drop attacks (DAs), and to examine the efficacy of intratympanic gentamicin (ITG) treatment in alleviating DAs.

Methods

In total, 177 unilateral definite MD patients, including 16 patients with DAs and 161 patients without DAs, were enrolled. The results of hearing test, vestibular-evoked myogenic potentials (VEMPs), and magnetic resonance imaging (MRI) were analyzed. Thirteen patients with DAs received a single ITG treatment and were followed up.

Results

The disease course of MD in the DA group was significantly longer than that in the control group (p = 0.007). MD patients with DAs had significantly greater hearing loss and worse EH than MD patients without DAs (p < 0.05). However, there was no between-group difference in vestibular function. In the study, 92.31% of refractory definite MD patients with DAs achieved satisfactory control of DAs after ITG treatment.

Conclusions

MD patients with DAs tend to suffer from severe hearing loss and a significant degree of EH in the inner ear. However, the vestibular function of MD patients with DAs may not be completely abolished, but be sensitive to stimulating signals. ITG treatment, which helps to decrease vestibular sensitivity, was an effective treatment to control DAs.

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Transoral laser microsurgery in early glottic cancer involving the anterior commissure

Abstract

Purpose

Treatment modalities for glottic cancer comprise surgery, (chemo-)radiation, and combined treatment options. Glottic cancer involving the anterior commissure (AC) requires special preoperative assessment and surgical skills, as it is commonly considered a risk factor for local recurrence. The aim of this study is to analyze the oncological effectiveness of transoral laser microsurgery (TLM) in the early glottic cancer involving the AC.

Methods

We retrospectively analyzed the data of all patients with primary, early staged (T1–2) glottic squamous cell carcinoma who were treated between 2004 and 2014. Patients were preferably treated by TLM (rather than open surgical techniques) if appropriated transoral exposure of the endolarynx was ensured. Voice outcomes were not assessed.

Results

186 patients with early glottic cancer were included, 143 were treated by TLM and 43 by other therapy modalities [OT open surgical techniques (n = 32) or primary (chemo-)radiation (n = 11)], respectively. In 84 patients (59%) of the TLM cohort, the AC was involved (OT cohort n = 29 (73%), p = 0.143). The 1-, 3-, and 5-year local control rates after TLM were 91%, 86%, and 81% in patients without AC infiltration and 84%, 74%, and 70% in patients with AC infiltration, respectively, showing no statistical difference (p = 0.180). The 5-year disease-free survival and laryngeal preservation rate (LPR) did not differ with regard to AC infiltration (p = 0.215 and p = 0.261). Comparing the treatment modalities, the 5-year LPR was 90% for TLM and 83% for OT regardless of infiltration of the AC (p = 0,653 and p = 0.267, respectively).

Conclusion

TLM is an effective surgical treatment for early glottic cancer with AC involvement in patients with adequate transoral laryngeal exposure.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2R2B1iR

Clinical features and management of Meniere’s disease patients with drop attacks

Abstract

Purpose

The aims of the present study are to investigate the variations in clinical features, including medical history, hearing function, vestibular function, and degree of endolymphatic hydrops (EH), in Meniere's disease (MD) patients with and without drop attacks (DAs), and to examine the efficacy of intratympanic gentamicin (ITG) treatment in alleviating DAs.

Methods

In total, 177 unilateral definite MD patients, including 16 patients with DAs and 161 patients without DAs, were enrolled. The results of hearing test, vestibular-evoked myogenic potentials (VEMPs), and magnetic resonance imaging (MRI) were analyzed. Thirteen patients with DAs received a single ITG treatment and were followed up.

Results

The disease course of MD in the DA group was significantly longer than that in the control group (p = 0.007). MD patients with DAs had significantly greater hearing loss and worse EH than MD patients without DAs (p < 0.05). However, there was no between-group difference in vestibular function. In the study, 92.31% of refractory definite MD patients with DAs achieved satisfactory control of DAs after ITG treatment.

Conclusions

MD patients with DAs tend to suffer from severe hearing loss and a significant degree of EH in the inner ear. However, the vestibular function of MD patients with DAs may not be completely abolished, but be sensitive to stimulating signals. ITG treatment, which helps to decrease vestibular sensitivity, was an effective treatment to control DAs.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BShlUr

Transoral laser microsurgery in early glottic cancer involving the anterior commissure

Abstract

Purpose

Treatment modalities for glottic cancer comprise surgery, (chemo-)radiation, and combined treatment options. Glottic cancer involving the anterior commissure (AC) requires special preoperative assessment and surgical skills, as it is commonly considered a risk factor for local recurrence. The aim of this study is to analyze the oncological effectiveness of transoral laser microsurgery (TLM) in the early glottic cancer involving the AC.

Methods

We retrospectively analyzed the data of all patients with primary, early staged (T1–2) glottic squamous cell carcinoma who were treated between 2004 and 2014. Patients were preferably treated by TLM (rather than open surgical techniques) if appropriated transoral exposure of the endolarynx was ensured. Voice outcomes were not assessed.

Results

186 patients with early glottic cancer were included, 143 were treated by TLM and 43 by other therapy modalities [OT open surgical techniques (n = 32) or primary (chemo-)radiation (n = 11)], respectively. In 84 patients (59%) of the TLM cohort, the AC was involved (OT cohort n = 29 (73%), p = 0.143). The 1-, 3-, and 5-year local control rates after TLM were 91%, 86%, and 81% in patients without AC infiltration and 84%, 74%, and 70% in patients with AC infiltration, respectively, showing no statistical difference (p = 0.180). The 5-year disease-free survival and laryngeal preservation rate (LPR) did not differ with regard to AC infiltration (p = 0.215 and p = 0.261). Comparing the treatment modalities, the 5-year LPR was 90% for TLM and 83% for OT regardless of infiltration of the AC (p = 0,653 and p = 0.267, respectively).

Conclusion

TLM is an effective surgical treatment for early glottic cancer with AC involvement in patients with adequate transoral laryngeal exposure.

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High-Variability Sentence Recognition in Long-Term Cochlear Implant Users: Associations With Rapid Phonological Coding and Executive Functioning

Objectives: The objective of the present study was to determine whether long-term cochlear implant (CI) users would show greater variability in rapid phonological coding skills and greater reliance on slow-effortful compensatory executive functioning (EF) skills than normal-hearing (NH) peers on perceptually challenging high-variability sentence recognition tasks. We tested the following three hypotheses: First, CI users would show lower scores on sentence recognition tests involving high speaker and dialect variability than NH controls, even after adjusting for poorer sentence recognition performance by CI users on a conventional low-variability sentence recognition test. Second, variability in fast-automatic rapid phonological coding skills would be more strongly associated with performance on high-variability sentence recognition tasks for CI users than NH peers. Third, compensatory EF strategies would be more strongly associated with performance on high-variability sentence recognition tasks for CI users than NH peers. Design: Two groups of children, adolescents, and young adults aged 9 to 29 years participated in this cross-sectional study: 49 long-term CI users (≥7 years) and 56 NH controls. All participants were tested on measures of rapid phonological coding (Children's Test of Nonword Repetition), conventional sentence recognition (Harvard Sentence Recognition Test), and two novel high-variability sentence recognition tests that varied the indexical attributes of speech (Perceptually Robust English Sentence Test Open-set test and Perceptually Robust English Sentence Test Open-set test-Foreign Accented English test). Measures of EF included verbal working memory (WM), spatial WM, controlled cognitive fluency, and inhibition concentration. Results: CI users scored lower than NH peers on both tests of high-variability sentence recognition even after conventional sentence recognition skills were statistically controlled. Correlations between rapid phonological coding and high-variability sentence recognition scores were stronger for the CI sample than for the NH sample even after basic sentence perception skills were statistically controlled. Scatterplots revealed different ranges and slopes for the relationship between rapid phonological coding skills and high-variability sentence recognition performance in CI users and NH peers. Although no statistically significant correlations between EF strategies and sentence recognition were found in the CI or NH sample after use of a conservative Bonferroni-type correction, medium to high effect sizes for correlations between verbal WM and sentence recognition in the CI sample suggest that further investigation of this relationship is needed. Conclusions: These findings provide converging support for neurocognitive models that propose two channels for speech-language processing: a fast-automatic channel that predominates whenever possible and a compensatory slow-effortful processing channel that is activated during perceptually-challenging speech processing tasks that are not fully managed by the fast-automatic channel (ease of language understanding, framework for understanding effortful listening, and auditory neurocognitive model). CI users showed significantly poorer performance on measures of high-variability sentence recognition than NH peers, even after simple sentence recognition was controlled. Nonword repetition scores showed almost no overlap between CI and NH samples, and correlations between nonword repetition scores and high-variability sentence recognition were consistent with greater reliance on engagement of fast-automatic phonological coding for high-variability sentence recognition in the CI sample than in the NH sample. Further investigation of the verbal WM–sentence recognition relationship in CI users is recommended. Assessment of fast-automatic phonological processing and slow-effortful EF skills may provide a better understanding of speech perception outcomes in CI users in the clinical setting. ACKNOWLEDGMENTS: The authors thank Shirley Henning and Bethany Colson for administering the speech, language, and neurocognitive tests and Allison Ditmars for coordinating the study. The authors also thank Luis Hernandez for his help and assistance with data analysis connected with the speech production measures. This research was funded by National Institutes of Health-National Institute on Deafness and Other Communication Disorders (NIH-NIDCD) R01DC015257 (to W.G.K. and D.B.P.) and NIH-NIDCD R01DC009581 (to D.B.P.). Portions of this article were presented at the American Cochlear Implant Alliance CI2018 Emerging Issues Symposium on March 8, 2018, in Washington DC, (by W.G.K.) and the Cognitive Neuroscience Society 25th Annual Meeting on March 27, 2018, in Boston, MA, (by G.N.L.S.). G.N.L.S. analyzed the data, wrote the first draft of the paper, and provided critical revisions to subsequent drafts. D.B.P. conceptualized the study, designed the experiments, and provided critical revisions to all drafts of the article. W.G.K. conceptualized the study, designed the experiments, analyzed the data, wrote sections of the article, and provided critical revisions to the article. G.N.L.S., D.B.P., and W.G.K. gave final approval of the paper before submission. W.G.K. is a paid consultant for Shire Pharmaceuticals and the Indiana Hemophilia and Thrombosis Center. Address for correspondence: Gretchen N.L. Smith, Cognitive Neuroscience Laboratory, Shirley Ryan AbilityLab, 355 East Erie Street, Chicago, IL 60611, USA. E-mail: gsmith02@sralab.org Received May 14, 2018; accepted November 6, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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High-Variability Sentence Recognition in Long-Term Cochlear Implant Users: Associations With Rapid Phonological Coding and Executive Functioning

Objectives: The objective of the present study was to determine whether long-term cochlear implant (CI) users would show greater variability in rapid phonological coding skills and greater reliance on slow-effortful compensatory executive functioning (EF) skills than normal-hearing (NH) peers on perceptually challenging high-variability sentence recognition tasks. We tested the following three hypotheses: First, CI users would show lower scores on sentence recognition tests involving high speaker and dialect variability than NH controls, even after adjusting for poorer sentence recognition performance by CI users on a conventional low-variability sentence recognition test. Second, variability in fast-automatic rapid phonological coding skills would be more strongly associated with performance on high-variability sentence recognition tasks for CI users than NH peers. Third, compensatory EF strategies would be more strongly associated with performance on high-variability sentence recognition tasks for CI users than NH peers. Design: Two groups of children, adolescents, and young adults aged 9 to 29 years participated in this cross-sectional study: 49 long-term CI users (≥7 years) and 56 NH controls. All participants were tested on measures of rapid phonological coding (Children's Test of Nonword Repetition), conventional sentence recognition (Harvard Sentence Recognition Test), and two novel high-variability sentence recognition tests that varied the indexical attributes of speech (Perceptually Robust English Sentence Test Open-set test and Perceptually Robust English Sentence Test Open-set test-Foreign Accented English test). Measures of EF included verbal working memory (WM), spatial WM, controlled cognitive fluency, and inhibition concentration. Results: CI users scored lower than NH peers on both tests of high-variability sentence recognition even after conventional sentence recognition skills were statistically controlled. Correlations between rapid phonological coding and high-variability sentence recognition scores were stronger for the CI sample than for the NH sample even after basic sentence perception skills were statistically controlled. Scatterplots revealed different ranges and slopes for the relationship between rapid phonological coding skills and high-variability sentence recognition performance in CI users and NH peers. Although no statistically significant correlations between EF strategies and sentence recognition were found in the CI or NH sample after use of a conservative Bonferroni-type correction, medium to high effect sizes for correlations between verbal WM and sentence recognition in the CI sample suggest that further investigation of this relationship is needed. Conclusions: These findings provide converging support for neurocognitive models that propose two channels for speech-language processing: a fast-automatic channel that predominates whenever possible and a compensatory slow-effortful processing channel that is activated during perceptually-challenging speech processing tasks that are not fully managed by the fast-automatic channel (ease of language understanding, framework for understanding effortful listening, and auditory neurocognitive model). CI users showed significantly poorer performance on measures of high-variability sentence recognition than NH peers, even after simple sentence recognition was controlled. Nonword repetition scores showed almost no overlap between CI and NH samples, and correlations between nonword repetition scores and high-variability sentence recognition were consistent with greater reliance on engagement of fast-automatic phonological coding for high-variability sentence recognition in the CI sample than in the NH sample. Further investigation of the verbal WM–sentence recognition relationship in CI users is recommended. Assessment of fast-automatic phonological processing and slow-effortful EF skills may provide a better understanding of speech perception outcomes in CI users in the clinical setting. ACKNOWLEDGMENTS: The authors thank Shirley Henning and Bethany Colson for administering the speech, language, and neurocognitive tests and Allison Ditmars for coordinating the study. The authors also thank Luis Hernandez for his help and assistance with data analysis connected with the speech production measures. This research was funded by National Institutes of Health-National Institute on Deafness and Other Communication Disorders (NIH-NIDCD) R01DC015257 (to W.G.K. and D.B.P.) and NIH-NIDCD R01DC009581 (to D.B.P.). Portions of this article were presented at the American Cochlear Implant Alliance CI2018 Emerging Issues Symposium on March 8, 2018, in Washington DC, (by W.G.K.) and the Cognitive Neuroscience Society 25th Annual Meeting on March 27, 2018, in Boston, MA, (by G.N.L.S.). G.N.L.S. analyzed the data, wrote the first draft of the paper, and provided critical revisions to subsequent drafts. D.B.P. conceptualized the study, designed the experiments, and provided critical revisions to all drafts of the article. W.G.K. conceptualized the study, designed the experiments, analyzed the data, wrote sections of the article, and provided critical revisions to the article. G.N.L.S., D.B.P., and W.G.K. gave final approval of the paper before submission. W.G.K. is a paid consultant for Shire Pharmaceuticals and the Indiana Hemophilia and Thrombosis Center. Address for correspondence: Gretchen N.L. Smith, Cognitive Neuroscience Laboratory, Shirley Ryan AbilityLab, 355 East Erie Street, Chicago, IL 60611, USA. E-mail: gsmith02@sralab.org Received May 14, 2018; accepted November 6, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Therapeutic breast reduction—are doctors and patients satisfied ?

Abstract

Background

Therapeutic breast reduction (TBR) is an oncoplastic technique that applies breast reduction principles for oncologic purposes. Given that TBR indications have expanded, the purpose of this study is to ascertain the aesthetic outcome of this procedure, and determine how it may be influenced by different surgical techniques and postoperative radiotherapy.

Methods

A non-randomized cohort study was performed, including breast cancer female patients who underwent breast conserving surgery with TBR. The primary outcome was the esthetic result of the reconstruction, evaluated by both plastic surgeons and patients, at least 12 months after surgery.

Results

The aesthetic assessment was made in 42 patients. Overall, the clear majority of patients classified the outcome as good or perfect (95.2%), with less than 5% considering the outcome as mediocre. As for plastic surgeons, 83.3% were considered perfect/good outcomes, with 16.7% mediocre results. There were no poor results, neither for the patient nor the surgeon. There were no statistically significant associations between the esthetic result and tumor location nor its relation to the skin-resection pattern.

Conclusion

Aesthetic outcomes with this technique are promising, even when there is the need for technical modifications and despite the need for adjuvant radiotherapy, making it valuable for tumors in all locations.

Level of Evidence: Level III, risk / prognostic study.

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Forehead biconvexity enhancement with fat grafting

Abstract

Background

Frontal biconvexity is a key criterion for an attractive forehead. Fat injection as an effective, safe and reliable method for soft tissue augmentation could be used to enhance forehead contour. We report our experience with combined platelet-rich plasma (PRP) and fat grafting to create or restore frontal biconvexity and to reduce wrinkles.

Methods

Fifty-seven females and 4 males (mean age, 40.2 years) underwent the combined PRP and fat injection. Fat mixed with PRP on the ratio of 5:1 was injected in small aliquots in the space between the dermis and underlying frontalis muscle. Patient satisfaction with the cosmetic result was evaluated by a questionnaire using pre- and postoperative photos and a four-point grading scale.

Results

All patients who underwent three injection sessions (n = 5) evaluated the esthetic result as excellent. In patients who had two injection sessions (n = 36), 36% evaluated the result as excellent, 50% as good, and the remaining 5 as moderate. In patients who had a single injection session (n = 15), 27% evaluated the result as excellent, 40% as good, and the remaining 5 as moderate. Concerning frontal wrinkles, 25 of 34 (73.5%) patients reported good improvement and the remaining 9 (26.5%) reported moderate improvement.

Conclusion

Fat injection combined with PRP should be considered as an effective tool to improve forehead biconvexity.

Level of evidence: Level IV, therapeutic study.

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Therapeutic breast reduction—are doctors and patients satisfied ?

Abstract

Background

Therapeutic breast reduction (TBR) is an oncoplastic technique that applies breast reduction principles for oncologic purposes. Given that TBR indications have expanded, the purpose of this study is to ascertain the aesthetic outcome of this procedure, and determine how it may be influenced by different surgical techniques and postoperative radiotherapy.

Methods

A non-randomized cohort study was performed, including breast cancer female patients who underwent breast conserving surgery with TBR. The primary outcome was the esthetic result of the reconstruction, evaluated by both plastic surgeons and patients, at least 12 months after surgery.

Results

The aesthetic assessment was made in 42 patients. Overall, the clear majority of patients classified the outcome as good or perfect (95.2%), with less than 5% considering the outcome as mediocre. As for plastic surgeons, 83.3% were considered perfect/good outcomes, with 16.7% mediocre results. There were no poor results, neither for the patient nor the surgeon. There were no statistically significant associations between the esthetic result and tumor location nor its relation to the skin-resection pattern.

Conclusion

Aesthetic outcomes with this technique are promising, even when there is the need for technical modifications and despite the need for adjuvant radiotherapy, making it valuable for tumors in all locations.

Level of Evidence: Level III, risk / prognostic study.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Qhb8Xh

Forehead biconvexity enhancement with fat grafting

Abstract

Background

Frontal biconvexity is a key criterion for an attractive forehead. Fat injection as an effective, safe and reliable method for soft tissue augmentation could be used to enhance forehead contour. We report our experience with combined platelet-rich plasma (PRP) and fat grafting to create or restore frontal biconvexity and to reduce wrinkles.

Methods

Fifty-seven females and 4 males (mean age, 40.2 years) underwent the combined PRP and fat injection. Fat mixed with PRP on the ratio of 5:1 was injected in small aliquots in the space between the dermis and underlying frontalis muscle. Patient satisfaction with the cosmetic result was evaluated by a questionnaire using pre- and postoperative photos and a four-point grading scale.

Results

All patients who underwent three injection sessions (n = 5) evaluated the esthetic result as excellent. In patients who had two injection sessions (n = 36), 36% evaluated the result as excellent, 50% as good, and the remaining 5 as moderate. In patients who had a single injection session (n = 15), 27% evaluated the result as excellent, 40% as good, and the remaining 5 as moderate. Concerning frontal wrinkles, 25 of 34 (73.5%) patients reported good improvement and the remaining 9 (26.5%) reported moderate improvement.

Conclusion

Fat injection combined with PRP should be considered as an effective tool to improve forehead biconvexity.

Level of evidence: Level IV, therapeutic study.

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Bloodpool SPECT as part of bone SPECT/CT in painful total knee arthroplasty (TKA): validation and potential biomarker of prosthesis biomechanics

Abstract

Purpose

To compare bloodpool SPECT with planar imaging in bone SPECT/CT of painful total knee arthroplasty (TKA) with respect to inter-rater agreement, confidence, prosthesis outcome, and biomechanical functioning.

Methods

Retrospective study of bloodpool SPECT and planar control images. Four raters used the validated Bruderholz scheme and a 5-point scale to grade uptake. Inter-rater agreement and overall confidence scores were calculated. Variable cluster analysis was performed to identify patterns of uptake, and associations between patterns and prosthesis outcome and biomechanical functioning were examined.

Results

In all, 55 knees in 43 patients were analyzed (median follow-up 17 months; revision rate 21.8%). SPECT significantly improved inter-rater agreement in 24% of regions (all P < 0.05) and overall confidence by 20% (P < 0.001). Regional uptake cluster analysis showed improved antero-posterior separation with SPECT, and distinct patterns associated with prosthesis survival in lateral femoral (P = 0.041) and medial tibial (P < 0.001) regions. The prognostic value of SPECT outperformed planar imaging for tibial (P < 0.001), patellar (P = 0.009), and synovial (P = 0.040) assessment. Internal femoral malrotation resulted in increased uptake in posteromedial (P = 0.042) and anterolateral (P = 0.016) femoral, and lateral patellar (P = 0.011) regions. Internal tibial malrotation increased uptake in posterolateral (P = 0.026) and posteromedial tibial (P = 0.005), and medial patellar regions (P = 0.004). Bloodpool SPECT improved the prognostic value of late-phase SPECT/CT for the assessment of the medial tibial region.

Conclusions

Bloodpool SPECT outperforms planar assessment of painful TKAs and the identification of distinct uptake patterns make it a potentially clinically relevant biomarker of prosthesis survival and biomechanical functioning.

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Bloodpool SPECT as part of bone SPECT/CT in painful total knee arthroplasty (TKA): validation and potential biomarker of prosthesis biomechanics

Abstract

Purpose

To compare bloodpool SPECT with planar imaging in bone SPECT/CT of painful total knee arthroplasty (TKA) with respect to inter-rater agreement, confidence, prosthesis outcome, and biomechanical functioning.

Methods

Retrospective study of bloodpool SPECT and planar control images. Four raters used the validated Bruderholz scheme and a 5-point scale to grade uptake. Inter-rater agreement and overall confidence scores were calculated. Variable cluster analysis was performed to identify patterns of uptake, and associations between patterns and prosthesis outcome and biomechanical functioning were examined.

Results

In all, 55 knees in 43 patients were analyzed (median follow-up 17 months; revision rate 21.8%). SPECT significantly improved inter-rater agreement in 24% of regions (all P < 0.05) and overall confidence by 20% (P < 0.001). Regional uptake cluster analysis showed improved antero-posterior separation with SPECT, and distinct patterns associated with prosthesis survival in lateral femoral (P = 0.041) and medial tibial (P < 0.001) regions. The prognostic value of SPECT outperformed planar imaging for tibial (P < 0.001), patellar (P = 0.009), and synovial (P = 0.040) assessment. Internal femoral malrotation resulted in increased uptake in posteromedial (P = 0.042) and anterolateral (P = 0.016) femoral, and lateral patellar (P = 0.011) regions. Internal tibial malrotation increased uptake in posterolateral (P = 0.026) and posteromedial tibial (P = 0.005), and medial patellar regions (P = 0.004). Bloodpool SPECT improved the prognostic value of late-phase SPECT/CT for the assessment of the medial tibial region.

Conclusions

Bloodpool SPECT outperforms planar assessment of painful TKAs and the identification of distinct uptake patterns make it a potentially clinically relevant biomarker of prosthesis survival and biomechanical functioning.

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Does cartilage tympanoplasty impair hearing in patients with normal preoperative hearing? A comparison of different techniques

Abstract

Objectives

To evaluate and compare functional outcomes of tympanoplasty procedures with temporalis fascia and four different types of cartilage grafts in chronic otitis media (COM) cases with normal preoperative hearing levels.

Methods

Records of patients who underwent type 1 tympanoplasty for non-complicated COM in a tertiary medical center between January 2010 and January 2017 were reviewed. Patients with central or marginal and dry perforations of the tympanic membrane, normal middle ear mucosa, intact ossicular chain and patients with a preoperative pure tone average (PTA) level of 25 dB or less and a word recognition score (WRS) of 88% or greater were included in the study. Graft success rates, preoperative and postoperative functional outcomes, and anatomical results were analyzed.

Results

One hundred and forty-four patients who met the inclusion criteria were evaluated in the study. PTA and Air-bone gap (ABG) levels decreased significantly both in TF and CG groups after the surgery (p = 0.001). Similarly, WRS scores increased significantly in both groups (p = 0.001). There was not a significant difference in terms of PTA increase, WRS increase, and ABG closure levels between cartilage and TF groups. Increase in PTA, closure in ABG, and increase in WRS levels were compared among TF, WsCCG, MCG, PCG, and CPIG groups. The increase in PTA levels was also found to be significantly superior in the TF group (p = 0,023). However, the multivariate analysis showed no significant difference for increase in WRS, closure in ABG and increase in PTA levels according to graft type (p = 0.285; p = 0.461; p = 0.106, respectively) and gender (p = 0.487; p = 0.811; p = 0.756, respectively).

Conclusion

In COM cases with normal preoperative hearing, both TF and cartilage lead to superb functional and anatomical outcomes. There was not a significant difference in terms of PTA increase, WRS increase and ABG closure levels between cartilage and TF groups. The graft success rate of cartilage was found to be superior to TF, but there was not a statistically significant difference. Different types of cartilage grafts can be used in cases with normal preoperative hearing without the concern of hearing impairment.

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Does cartilage tympanoplasty impair hearing in patients with normal preoperative hearing? A comparison of different techniques

Abstract

Objectives

To evaluate and compare functional outcomes of tympanoplasty procedures with temporalis fascia and four different types of cartilage grafts in chronic otitis media (COM) cases with normal preoperative hearing levels.

Methods

Records of patients who underwent type 1 tympanoplasty for non-complicated COM in a tertiary medical center between January 2010 and January 2017 were reviewed. Patients with central or marginal and dry perforations of the tympanic membrane, normal middle ear mucosa, intact ossicular chain and patients with a preoperative pure tone average (PTA) level of 25 dB or less and a word recognition score (WRS) of 88% or greater were included in the study. Graft success rates, preoperative and postoperative functional outcomes, and anatomical results were analyzed.

Results

One hundred and forty-four patients who met the inclusion criteria were evaluated in the study. PTA and Air-bone gap (ABG) levels decreased significantly both in TF and CG groups after the surgery (p = 0.001). Similarly, WRS scores increased significantly in both groups (p = 0.001). There was not a significant difference in terms of PTA increase, WRS increase, and ABG closure levels between cartilage and TF groups. Increase in PTA, closure in ABG, and increase in WRS levels were compared among TF, WsCCG, MCG, PCG, and CPIG groups. The increase in PTA levels was also found to be significantly superior in the TF group (p = 0,023). However, the multivariate analysis showed no significant difference for increase in WRS, closure in ABG and increase in PTA levels according to graft type (p = 0.285; p = 0.461; p = 0.106, respectively) and gender (p = 0.487; p = 0.811; p = 0.756, respectively).

Conclusion

In COM cases with normal preoperative hearing, both TF and cartilage lead to superb functional and anatomical outcomes. There was not a significant difference in terms of PTA increase, WRS increase and ABG closure levels between cartilage and TF groups. The graft success rate of cartilage was found to be superior to TF, but there was not a statistically significant difference. Different types of cartilage grafts can be used in cases with normal preoperative hearing without the concern of hearing impairment.

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Editorial Board/Reviewing Committee

(Source: International Journal of Oral and Maxillofacial Surgery)

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Retraction notice to “A Safe and Accurate Method to Perform Esthetic Mandibular Contouring Surgery for Far Eastern Asians” [International Journal of Oral and Maxillofacial Surgery 46 (2017) 578–581]

This article has been retracted after the discovery that the authors had falsely claimed to have ethical approval of the Institutional Review Board of Cathay General Hospital. The surgery conducted in this research was carried out at a private practise not affiliated with Cathay Hospital and without the IRB Committee 's knowledge. (Source: International Journal of Oral and Maxillofacial Surgery)

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Retraction notice to “Dexamethasone injection into the pterygomandibular space in lower third molar surgery” [International Journal of Oral and Maxillofacial Surgery 46 (2017) 899–904]

The article duplicates significant parts of a paper that had already appeared in J Dent Anesth Pain Med. 2016 Jun;16(2):95 –102. http://bit.ly/2Qf8YHW. One of the conditions of submission of a paper for publication is that authors declare explicitly that the paper has not been previously published and is not under consideration for publication elsewhere. Re-use of any data should be appropriately cited. As such this article represents a misuse of the scientific publishing system. (Source: International Journal of Oral and Maxillofacial Surgery)

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Cranial nerve injuries in Le Fort I osteotomy: a systematic review

The aim of this systematic review was to describe the anatomical and surgical factors related to cranial nerve injuries in Le Fort I osteotomy. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO). Two independent reviewers performed an unrestricted electronic database search in the MEDLINE/PubMed, LILACS, Scopus, Web of Science, and Cochrane databases up to and including August 2018. Thirty-two articles were selected for data extraction and synthesis: 30 studies were identified in the main search and two by a manual search. (Source: International Journal of Oral and Maxillofacial Surgery)

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Surgically assisted rapid maxillary expansion with bone-borne versus tooth-borne distraction appliances —a systematic review

The objective was to test the hypothesis of no difference in skeletal and dental arch expansion and relapse after surgically assisted rapid maxillary expansion with a bone-borne compared with a tooth-borne appliance. The PubMed, Embase (Ovid), Cochrane Library, and Google Scholar databases were searched in combination with a hand-search of relevant journals up until December 2017. No language restriction was applied. Two short-term randomized controlled trials with a low risk of bias fulfilled the inclusion criteria. (Source: International Journal of Oral and Maxillofacial Surgery)

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Editorial Board/Reviewing Committee

(Source: International Journal of Oral and Maxillofacial Surgery)

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Retraction notice to “A Safe and Accurate Method to Perform Esthetic Mandibular Contouring Surgery for Far Eastern Asians” [International Journal of Oral and Maxillofacial Surgery 46 (2017) 578–581]

This article has been retracted after the discovery that the authors had falsely claimed to have ethical approval of the Institutional Review Board of Cathay General Hospital. The surgery conducted in this research was carried out at a private practise not affiliated with Cathay Hospital and without the IRB Committee 's knowledge. (Source: International Journal of Oral and Maxillofacial Surgery)

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Retraction notice to “Dexamethasone injection into the pterygomandibular space in lower third molar surgery” [International Journal of Oral and Maxillofacial Surgery 46 (2017) 899–904]

The article duplicates significant parts of a paper that had already appeared in J Dent Anesth Pain Med. 2016 Jun;16(2):95 –102. http://bit.ly/2Qf8YHW. One of the conditions of submission of a paper for publication is that authors declare explicitly that the paper has not been previously published and is not under consideration for publication elsewhere. Re-use of any data should be appropriately cited. As such this article represents a misuse of the scientific publishing system. (Source: International Journal of Oral and Maxillofacial Surgery)

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Cranial nerve injuries in Le Fort I osteotomy: a systematic review

The aim of this systematic review was to describe the anatomical and surgical factors related to cranial nerve injuries in Le Fort I osteotomy. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO). Two independent reviewers performed an unrestricted electronic database search in the MEDLINE/PubMed, LILACS, Scopus, Web of Science, and Cochrane databases up to and including August 2018. Thirty-two articles were selected for data extraction and synthesis: 30 studies were identified in the main search and two by a manual search. (Source: International Journal of Oral and Maxillofacial Surgery)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Vp6Gti

Surgically assisted rapid maxillary expansion with bone-borne versus tooth-borne distraction appliances —a systematic review

The objective was to test the hypothesis of no difference in skeletal and dental arch expansion and relapse after surgically assisted rapid maxillary expansion with a bone-borne compared with a tooth-borne appliance. The PubMed, Embase (Ovid), Cochrane Library, and Google Scholar databases were searched in combination with a hand-search of relevant journals up until December 2017. No language restriction was applied. Two short-term randomized controlled trials with a low risk of bias fulfilled the inclusion criteria. (Source: International Journal of Oral and Maxillofacial Surgery)

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Arch of cricoid cartilage anatomical variation: morphological and radiological aspects

Abstract

The cricoid cartilage serves as an anatomical reference for several surgical procedures for access to the airway. Additionally, it serves as an attachment point for muscles that move the vocal folds. We present a case where the cricoid cartilage arch is divided into distinct superior and inferior arches, with a fibrous membrane between them. We did not find any similar description to this case in the literature, which makes it unique to date. This type of variation is important knowledge for clinicians and surgeons during airway management in the anterior neck region. The presence of this variation could induce an error during a palpation of the thyroid and cricoid cartilages, realized in clinical examination and surgical or emergency procedures.

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Arch of cricoid cartilage anatomical variation: morphological and radiological aspects

Abstract

The cricoid cartilage serves as an anatomical reference for several surgical procedures for access to the airway. Additionally, it serves as an attachment point for muscles that move the vocal folds. We present a case where the cricoid cartilage arch is divided into distinct superior and inferior arches, with a fibrous membrane between them. We did not find any similar description to this case in the literature, which makes it unique to date. This type of variation is important knowledge for clinicians and surgeons during airway management in the anterior neck region. The presence of this variation could induce an error during a palpation of the thyroid and cricoid cartilages, realized in clinical examination and surgical or emergency procedures.

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Heat shock protein 70 is induced by pepsin via MAPK signaling in human nasal epithelial cells

Abstract

Background

Recent studies have shown that laryngopharyngeal reflux is associated with chronic rhinosinusitis. Pepsin may be a key factor involved in the injury of nasal mucosal epithelial cells, but the pathogenesis remains unclear. We are to investigate whether a mitogen-activated protein kinase (MAPK) pathway regulates heat shock protein 70 (HSP70) expression in primary cultures of human nasal epithelial cells (HNEpCs) in response to pepsin stimulation.

Methods

HSP70 protein expression levels in HNEpCs were estimated by Western blot analysis after treatment with pepsin. MAPK pathway activity levels were also evaluated to elucidate the mechanism underlying the effects of pepsin on HSP70 in HNEpCs. Inhibitors of signaling pathways were used to determine the contribution of MAPKs in HSP70 response after pepsin stimulation. Cellular apoptosis and cell viability in HNEpCs after treatment with pepsin were measured.

Results

The expression of HSP70 increased after stimulation with pepsin and decreased after the removal of pepsin. Pepsin induced activation of p38, extracellular signal-regulated kinase 1/2, and c-Jun N-terminal kinase (JNK) 1/2. Inhibition of JNK1/2 reduced HSP70 expression in HNEpCs. The apoptosis in HNEpCs at 12 h after treatment with pepsin at pH 7.0 increased significantly when compared with the control and pH 7.0 groups. Cell viability decreased following exposure to pepsin at pH 7.0.

Conclusion

Pepsin, even under neutral pH 7.0, increases the expression of HSP70 in HNEpCs by activating the JNK/MAPK signaling pathway. Increased HSP70 may be the protective mechanism when pepsin presents in the other parts of the body.

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Heat shock protein 70 is induced by pepsin via MAPK signaling in human nasal epithelial cells

Abstract

Background

Recent studies have shown that laryngopharyngeal reflux is associated with chronic rhinosinusitis. Pepsin may be a key factor involved in the injury of nasal mucosal epithelial cells, but the pathogenesis remains unclear. We are to investigate whether a mitogen-activated protein kinase (MAPK) pathway regulates heat shock protein 70 (HSP70) expression in primary cultures of human nasal epithelial cells (HNEpCs) in response to pepsin stimulation.

Methods

HSP70 protein expression levels in HNEpCs were estimated by Western blot analysis after treatment with pepsin. MAPK pathway activity levels were also evaluated to elucidate the mechanism underlying the effects of pepsin on HSP70 in HNEpCs. Inhibitors of signaling pathways were used to determine the contribution of MAPKs in HSP70 response after pepsin stimulation. Cellular apoptosis and cell viability in HNEpCs after treatment with pepsin were measured.

Results

The expression of HSP70 increased after stimulation with pepsin and decreased after the removal of pepsin. Pepsin induced activation of p38, extracellular signal-regulated kinase 1/2, and c-Jun N-terminal kinase (JNK) 1/2. Inhibition of JNK1/2 reduced HSP70 expression in HNEpCs. The apoptosis in HNEpCs at 12 h after treatment with pepsin at pH 7.0 increased significantly when compared with the control and pH 7.0 groups. Cell viability decreased following exposure to pepsin at pH 7.0.

Conclusion

Pepsin, even under neutral pH 7.0, increases the expression of HSP70 in HNEpCs by activating the JNK/MAPK signaling pathway. Increased HSP70 may be the protective mechanism when pepsin presents in the other parts of the body.

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Oral medicine psychiatric liaison clinic: study of 1202 patients attending over an 18-year period

Patients with orofacial pain and discomfort often suffer from psychiatric disorders. However, few studies involving a large sample have examined the diagnostic results of patients with orofacial pain or discomfort in relation to psychiatric disorders. The purpose of this study was to summarize and clarify the characteristics and demographic data of 1202 patients attending the psychiatric liaison clinic at Aichi Gakuin University Hospital. Psychiatric diagnosis was performed by psychiatrists for all patients, based on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition.

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Oral medicine psychiatric liaison clinic: study of 1202 patients attending over an 18-year period

Patients with orofacial pain and discomfort often suffer from psychiatric disorders. However, few studies involving a large sample have examined the diagnostic results of patients with orofacial pain or discomfort in relation to psychiatric disorders. The purpose of this study was to summarize and clarify the characteristics and demographic data of 1202 patients attending the psychiatric liaison clinic at Aichi Gakuin University Hospital. Psychiatric diagnosis was performed by psychiatrists for all patients, based on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition.

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Expression of C-type lectin receptor mRNA in otitis media with effusion and chronic otitis media with and without cholesteatoma

C-type lectin receptors (CLRs) are a family of pattern recognition receptors (PRPs). The expression of CLRs has been analyzed in other diseases but has not yet been compared in patients with otitis media with effusion (OME), chronic otitis media (COM) and COM with cholesteatoma (Chole OM). This study therefore evaluated the levels of expression of mRNAs encoding Dectin-1, MR1, MR2, DC-SIGN, Syk, Card-9, Bcl-10, Malt-1, Src, DEC-205, Tim-3, Trem-1, and DAP-12 in patients with OME, COM, and Chole OM.

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Expression of C-type lectin receptor mRNA in otitis media with effusion and chronic otitis media with and without cholesteatoma

C-type lectin receptors (CLRs) are a family of pattern recognition receptors (PRPs). The expression of CLRs has been analyzed in other diseases but has not yet been compared in patients with otitis media with effusion (OME), chronic otitis media (COM) and COM with cholesteatoma (Chole OM). This study therefore evaluated the levels of expression of mRNAs encoding Dectin-1, MR1, MR2, DC-SIGN, Syk, Card-9, Bcl-10, Malt-1, Src, DEC-205, Tim-3, Trem-1, and DAP-12 in patients with OME, COM, and Chole OM.

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Reply

We read Akiyama's correspondence1 on our findings2 with interest. The concept of the autoinflammatory keratinization diseases (AIKDs) is intriguing. We are glad to join the discussion as to whether this umbrella term could include early-onset generalized pustular psoriasis (GPP) without psoriasis vulgaris (PV) concurrence (GPP without PV). The definition of AIKD includes 4 criteria3 (Table I). We agree that criteria 1 and 3 are clearly met in early-onset GPP without PV. The inflammation site is the epidermis and dermis.

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Early-onset generalized pustular psoriasis is representative of autoinflammatory keratinization diseases

I read with great interest the article titled "Clinical and genetic differences between pustular psoriasis subtypes" by Twelves et al.1 The authors studied a large number of patients with pustular psoriasis, including those with generalized pustular psoriasis (GPP), palmoplantar pustulosis (PPP), and acrodermatitis continua of Hallopeau (ACH), clinically and genetically. They revealed significant clinical and genetic differences between PPP and GPP.1

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Reply

We read Akiyama's correspondence1 on our findings2 with interest. The concept of the autoinflammatory keratinization diseases (AIKDs) is intriguing. We are glad to join the discussion as to whether this umbrella term could include early-onset generalized pustular psoriasis (GPP) without psoriasis vulgaris (PV) concurrence (GPP without PV). The definition of AIKD includes 4 criteria3 (Table I). We agree that criteria 1 and 3 are clearly met in early-onset GPP without PV. The inflammation site is the epidermis and dermis.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BT45iv

Early-onset generalized pustular psoriasis is representative of autoinflammatory keratinization diseases

I read with great interest the article titled "Clinical and genetic differences between pustular psoriasis subtypes" by Twelves et al.1 The authors studied a large number of patients with pustular psoriasis, including those with generalized pustular psoriasis (GPP), palmoplantar pustulosis (PPP), and acrodermatitis continua of Hallopeau (ACH), clinically and genetically. They revealed significant clinical and genetic differences between PPP and GPP.1

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Learning to localize a broadband tonal complex signal with advanced hearing protectors and TCAPS: the effectiveness of training on open-ear vs. device-occluded performance

. (Source: International Journal of Audiology)

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Learning to localize a broadband tonal complex signal with advanced hearing protectors and TCAPS: the effectiveness of training on open-ear vs. device-occluded performance

. (Source: International Journal of Audiology)

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Optimizing the cumulative cisplatin dose during radiotherapy in nasopharyngeal carcinoma: Dose-effect analysis for a large cohort

Publication date: February 2019

Source: Oral Oncology, Volume 89

Author(s): Liang Peng, Cheng Xu, Yu-Pei Chen, Rui Guo, Yan-Ping Mao, Ying Sun, Jun Ma, Ling-Long Tang

Abstract

Objectives

Definitive concurrent chemoradiotherapy (CCRT) is the standard treatment for locoregionally advanced nasopharyngeal carcinoma (NPC). The cumulative cisplatin dose (CCD) during radiotherapy is an important prognostic factor; however, the optimal CCD is undetermined.

Materials and methods

In this retrospective analysis, patients with locoregionally advanced NPC treated with single-agent cisplatin-based CCRT or RT alone from 2009 through 2015 were identified. CCD was entered into a multivariate Cox regression model as a continuous variable using natural cubic splines to allow for a nonlinear relationship between CCD and outcomes. The primary endpoint was overall survival, and the secondary endpoints were locoregional relapse‐free survival and distant metastasis‐free survival.

Results

A total of 2 924 patients were included in our study, with a median CCD of 160 mg/m² (range, 0–300 mg/m²). As the CCD increased, the risk of death remained steady until 180 mg/m², then decreased sharply until 250 mg/m², and then increased until 300 mg/m². The optimal CCD of 230–270 mg/m² was associated with the lowest risk of death and disease relapse. However, the CCD had less prognostic value for disease control, especially for distant control among high-risk patients (N2–3 or T4).

Conclusions

A CCD dose of 230–270 mg/m² (240 mg/m² is recommended) is optimal for patients with locoregionally advanced NPC, especially for those at low risk (T1–3 and N0–1). For high-risk patients (N2–3 or T4), additional chemotherapy should be administered before or after CCRT.

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Letter to the Editor about the Article: “Performance of different imaging techniques in the diagnosis of head and neck cancer mandibular invasion: A systematic review and meta-analysis”

Publication date: Available online 1 January 2019

Source: Oral Oncology

Author(s): Rama Jayaraj, Chellan Kumarasamy

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Optimizing the cumulative cisplatin dose during radiotherapy in nasopharyngeal carcinoma: Dose-effect analysis for a large cohort

Publication date: February 2019

Source: Oral Oncology, Volume 89

Author(s): Liang Peng, Cheng Xu, Yu-Pei Chen, Rui Guo, Yan-Ping Mao, Ying Sun, Jun Ma, Ling-Long Tang

Abstract

Objectives

Definitive concurrent chemoradiotherapy (CCRT) is the standard treatment for locoregionally advanced nasopharyngeal carcinoma (NPC). The cumulative cisplatin dose (CCD) during radiotherapy is an important prognostic factor; however, the optimal CCD is undetermined.

Materials and methods

In this retrospective analysis, patients with locoregionally advanced NPC treated with single-agent cisplatin-based CCRT or RT alone from 2009 through 2015 were identified. CCD was entered into a multivariate Cox regression model as a continuous variable using natural cubic splines to allow for a nonlinear relationship between CCD and outcomes. The primary endpoint was overall survival, and the secondary endpoints were locoregional relapse‐free survival and distant metastasis‐free survival.

Results

A total of 2 924 patients were included in our study, with a median CCD of 160 mg/m² (range, 0–300 mg/m²). As the CCD increased, the risk of death remained steady until 180 mg/m², then decreased sharply until 250 mg/m², and then increased until 300 mg/m². The optimal CCD of 230–270 mg/m² was associated with the lowest risk of death and disease relapse. However, the CCD had less prognostic value for disease control, especially for distant control among high-risk patients (N2–3 or T4).

Conclusions

A CCD dose of 230–270 mg/m² (240 mg/m² is recommended) is optimal for patients with locoregionally advanced NPC, especially for those at low risk (T1–3 and N0–1). For high-risk patients (N2–3 or T4), additional chemotherapy should be administered before or after CCRT.

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Letter to the Editor about the Article: “Performance of different imaging techniques in the diagnosis of head and neck cancer mandibular invasion: A systematic review and meta-analysis”

Publication date: Available online 1 January 2019

Source: Oral Oncology

Author(s): Rama Jayaraj, Chellan Kumarasamy

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Jorge Henao-Mejia Explores the Immune System ’s Controls

By tying together his understanding of the microbiome and nucleic acids, the UPenn immunologist is decoding the underlying causes of inflammation and disease. (Source: The Scientist)

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T-cell Tracker: A Profile of Wendy Havran

By uncovering novel properties of a unique population of T cells, the Scripps Research Institute immunologist has helped to redefine the immune cells, uncovering their role in wound healing. (Source: The Scientist)

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Jorge Henao-Mejia Explores the Immune System ’s Controls

By tying together his understanding of the microbiome and nucleic acids, the UPenn immunologist is decoding the underlying causes of inflammation and disease. (Source: The Scientist)

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T-cell Tracker: A Profile of Wendy Havran

By uncovering novel properties of a unique population of T cells, the Scripps Research Institute immunologist has helped to redefine the immune cells, uncovering their role in wound healing. (Source: The Scientist)

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Jorge Henao-Mejia Explores the Immune System ’s Controls

By tying together his understanding of the microbiome and nucleic acids, the UPenn immunologist is decoding the underlying causes of inflammation and disease. (Source: The Scientist)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BSodBf

T-cell Tracker: A Profile of Wendy Havran

By uncovering novel properties of a unique population of T cells, the Scripps Research Institute immunologist has helped to redefine the immune cells, uncovering their role in wound healing. (Source: The Scientist)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2R21woQ

Jorge Henao-Mejia Explores the Immune System ’s Controls

By tying together his understanding of the microbiome and nucleic acids, the UPenn immunologist is decoding the underlying causes of inflammation and disease. (Source: The Scientist)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BSodBf

T-cell Tracker: A Profile of Wendy Havran

By uncovering novel properties of a unique population of T cells, the Scripps Research Institute immunologist has helped to redefine the immune cells, uncovering their role in wound healing. (Source: The Scientist)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2R21woQ

Osteoarthritis of the TMJ and increase of the horizontal condylar angle. A longitudinal study

Publication date: Available online 31 December 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Peggy P. Lee, Alexander R. Stanton, Austin E Schumacher, Edmond Truelove, Lars G. Hollender

Abstract

Objective

Our previous study of patients with unilateral TMJ osteoarthritis (OA) showed that the affected joints had greater horizontal condylar angle (HCA) than contralateral unaffected joints. However, it was unclear whether the HCA changes preceded or were the result of OA changes. The aim of this study was to investigate the relationship between HCA and OA progression in a longitudinal study.

Study Design

127 subjects (with and without TMJ disorders) completed baseline and follow up examinations (average time to follow-up 7.9 years). Generalized Estimating Equation models were used to account for correlation of observations within the same patients.

Results

(1) HCA was greater in OA-affected than in unaffected joints (p=0.04). (2) Increased HCA at follow up was associated with change in joint status from no OA to OA. (p=0.001). (3) Baseline HCA value alone did not predict future OA diagnosis. (4) All OA changes in fossa/articular eminence morphology, and some combinations of condylar changes, were associated with a greater HCA. (5) OA diagnosis was associated with pain during maximum opening (p=0.005) and pain history (p=0.002). (6) Aging alone was not correlated with increased HCA.

Conclusions

Clinical progression of OA preceded increases in HCA. HCA alone did not predict OA development.

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Evaluation of different soft-tissue simulating materials in pixel intensity values in cone beam computed tomography

Publication date: Available online 31 December 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Gustavo Machado Santaella, Maria Augusta Portella Guedes Visconti, Karina Lopes Devito, Francisco Carlos Groppo, Francisco Haiter-Neto, Luciana Asprino

ABSTRACT

Objective

This study aimed to evaluate different materials as soft tissue simulators and the influence of soft tissues in CBCT.

Study Design

Images were acquired of five piglet heads with intact soft-tissues, stripped tissues, and with the use of different soft tissue simulators, following the same acquisition protocol. Four different materials were tested, individually or in combination: acrylic, water, utility wax and expanded polystyrene (EPS). Pixel intensity values of eight quadrangular regions were obtained, being upper and lower teeth and alveolar bone. The mean values were used for comparison by analysis of variance (α=5%).

Results

No differences were observed for groups "No Material", "EPS", "Acrylic" and "EPS and Wax" for the lower anterior and posterior teeth, and upper posterior tooth and anterior and posterior bone, and groups "No Material", "EPS", and "EPS and Wax" for the lower posterior bone. All groups showed statistical differences for the lower anterior bone and upper anterior tooth.

Conclusion

Expanded polystyrene 2 cm thick, with or without Utility Wax 1 cm thick, was effective for most regions, followed by acrylic 0.5 cm. The soft-tissues were not of great influence for most regions. Water was not an effective material for any of the regions.

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Comparison of FASN and COX-2 immunoexpression between embryonal, benign and malignant odontogenic tissues

Publication date: Available online 31 December 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Celeste Sánchez-Romero, Adalberto Mosqueda-Taylor, Wilson Delgado-Azañero, Oslei Paes de Almeida, Ronell Bologna-Molina

ABSTRACT

Objectives

To analyze the immunohistochemical expression of fatty acid synthase (FASN) and cyclooxygenase-2 (COX‑2) in tooth germ (TG), ameloblastoma (AM), ameloblastic carcinoma (AC), ameloblastic fibroma (AF) and ameloblastic fibrosarcoma (AFS).

Study design

Immunohistochemistry for FASN and COX-2 was performed in 10 TG, 44 AM, 10 AC, 9 AF and 5 AFS specimens. The results were analyzed using the immunoreactive score (IRS) and Kruskal-Wallis test followed by Dunn's post-test.

Results

Most TG were strongly positive for FASN, while COX-2 was weak or negative. All AM and AC expressed both proteins. In AF, FASN and COX-2 were variably expressed in the epithelium and negative in the mesenchyme. In AFS, FASN was strongly positive in the malignant mesenchyme and variable in the epithelium; COX-2 was focal or weak in both components. FASN showed significant differences in the following comparisons: TG vs AC, AM vs AC, and AF vs AFS. Differences in COX-2 were significant when comparing TG with AM, AC and AF.

Conclusion

The results suggest that FASN and COX-2 overexpression may have a role in the pathogenesis of AM and AC¸ while in AFS, only FASN seems to be involved. Further studies are necessary to clarify these mechanisms and their clinical implications.

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Post-processing of all Zirconia Restorations in Digital Dental Radiographs: a Quality Assurance Predicament

Publication date: Available online 31 December 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Allison Buchanan, Amelia Orta, Sajitha Kalathingal

Abstract

Objectives

To describe a quality assurance issue, producing non-diagnostic high contrast radiographs, when imaging teeth restored with all zirconia crowns on bitewing radiographs.

Methods

All zirconia crowns were imaged with DIGORA Optime Photostimulable Phosphor (PSP) plates (Soredex/Orion Corp., Helsinki, Finland). To assess differences in software processing, the PSP plates were scanned into third party software as well as directly into the twain and native software provided by the manufacturer. Gamma correction, histogram stretch, and scanner resolution settings were adjusted. Vertical bitewings were acquired to increase anatomical coverage.

Results

Scanning into third party software or directly into the twain and native software did not improve contrast. Shifting the lower limit of the histogram stretch to 3 with a gamma correction of 2 resolved the problem. Neither scanner resolution setting nor vertical bitewings improved contrast.

Conclusions

The high contrast non-diagnostic radiographs result from imaging software not effectively displaying the available grey scale. The software processing error appears to be initiated by the high attenuation characteristics of zirconia. Consequently, radiographs with a high zirconia crown to normal anatomy ratio are particularly susceptible.

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Regulation of Wnt/β-catenin pathway may be related to Regγ in benign epithelial odontogenic lesions

Publication date: Available online 31 December 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Hellen Bandeira de Pontes Santos, Hianne Cristinne de Morais Medeiros, Rodrigo Porpino Mafra, Márcia Cristina da Costa Miguel, Hébel Cavalcanti Galvão, Lélia Batista de Souza

ABSTRACT

OBJECTIVES

This study analyzed and compared the immunoexpression of Regγ, Wnt-1 and β-catenin in ameloblastomas, adenomatoid odontogenic tumors (AOTs), and odontogenic keratocysts (OKCs).

STUDY DESIGN

Thirty solid ameloblastomas, 20 AOTs, and 30 OKCs were selected for analysis of the immunoexpression of Regγ, Wnt-1, and β-catenin. Each case was semi-quantitatively evaluated in the epithelial component and in their different cellular compartments (membrane, cytoplasm and nucleus).

RESULTS

Ameloblastomas displayed higher cytoplasmic and nuclear Regγ expression in comparison to AOTs and OKCs, as well as higher membrane and cytoplasmic Wnt-1 expression (p < 0.05). β-catenin membrane expression was higher in OKCs compared to ameloblastomas and AOTs (p < 0.05). Nuclear β-catenin expression was higher in ameloblastomas and AOTs than in OKCs (p < 0.05). Cytoplasmic and nuclear Regγ expression in AOTs were positively correlated with nuclear β-catenin expression (p < 0.05).

CONCLUSION

The marked expression of Regγ, Wnt-1, and β-catenin suggests the participation of these proteins in the pathogenesis of the studied lesions. The greater expression of Regγ, Wnt-1, and nuclear β-catenin in ameloblastomas may be related to their more aggressive behavior. Pro-tumor effects of nuclear β-catenin may be counterbalanced by inhibitory pathways in AOTs, justifying their low aggressiveness.

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Case report of epithelioid osteoblastoma of the mandible: findings on PET/CT and review of the literature

Publication date: Available online 31 December 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Akram Al-Ibraheem, Basel Yacoub, Andrew Barakat, Mohamad Yasser Dergham, Gilbert Maroun, Hussam Haddad, Alaa Saleh, Nabil Khoury, Mukbil Hourani, Mohamad B. Haidar

Abstract

Epithelioid osteoblastoma is a clinically aggressive subtype of osteoblastoma that favors the mandible and maxilla. Its histological features lie on a spectrum between conventional osteoblastoma and low grade osteosarcoma, thus making it difficult at times to confirm the diagnosis. It is known to have a high risk of recurrence after surgical resection but it is a benign entity and lacks the propensity to metastasize. To our knowledge, there is no published literature on findings of epithelioid osteoblastoma on positron emission tomography/computed tomography (PET/CT). We report a case of a 25-year-old male patient presenting with epithelioid osteoblastoma of the mandible. The lesion exhibited significantly increased FDG uptake on PET/CT with an SUVmax value of 5.5. PET/CT is not specific in differentiating between malignant and benign bone lesions, but may be necessary to rule out distant lesions when a confirmed diagnosis of epithelioid osteoblastoma cannot be obtained by histological examination.

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Changes of the condylar position after modified disc repositioning: a retrospective study based on magnetic resonance imaging

Publication date: Available online 31 December 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Xu-Zhuo Chen, Ya-Ting Qiu, Shan-Yong Zhang, Ji-Si Zheng, Chi Yang

Abstract

Objective

This study aims to explain the malocclusion after unilateral open disc repositioning surgery from the changes of condylar position.

Study Design

Patients treated with unilaterally modified TMJ disc repositioning were reviewed. All subjects had pre and immediately postoperative magnetic resonance imaging (MRI). The occlusion was checked, and the changes of the joint space and condylar position were measured in MRI. The paired t test was used for analysis.

Results

Thirty-two subjects were included in the final analysis. The incidences of the posterior open bite in the affected side were 100%, 87.5%, 71.9%, 9.4%, 3.1%, and 3.1% at 0, 3, 7 days, 3, 6 months, and the last follow-up after surgery. The mean distances of the condylar movements were 2.67 and 0.32 mm in the affected and normal joints. There were significant differences for the anterior (P=0.03), superior (P<0.001), and posterior (P<0.001) joint spaces of the affected joints in MRI.

Conclusions

The joint spaces significantly increased postoperatively, in addition to the changes of the condylar position in anterior and inferior movements, leading to the posterior open bite, most of which will be recovered 3 months after surgery. It is concluded that disc repositioning results in a stable occlusion over time when done unilaterally.

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Osteoarthritis of the TMJ and increase of the horizontal condylar angle. A longitudinal study

Publication date: Available online 31 December 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Peggy P. Lee, Alexander R. Stanton, Austin E Schumacher, Edmond Truelove, Lars G. Hollender

Abstract

Objective

Our previous study of patients with unilateral TMJ osteoarthritis (OA) showed that the affected joints had greater horizontal condylar angle (HCA) than contralateral unaffected joints. However, it was unclear whether the HCA changes preceded or were the result of OA changes. The aim of this study was to investigate the relationship between HCA and OA progression in a longitudinal study.

Study Design

127 subjects (with and without TMJ disorders) completed baseline and follow up examinations (average time to follow-up 7.9 years). Generalized Estimating Equation models were used to account for correlation of observations within the same patients.

Results

(1) HCA was greater in OA-affected than in unaffected joints (p=0.04). (2) Increased HCA at follow up was associated with change in joint status from no OA to OA. (p=0.001). (3) Baseline HCA value alone did not predict future OA diagnosis. (4) All OA changes in fossa/articular eminence morphology, and some combinations of condylar changes, were associated with a greater HCA. (5) OA diagnosis was associated with pain during maximum opening (p=0.005) and pain history (p=0.002). (6) Aging alone was not correlated with increased HCA.

Conclusions

Clinical progression of OA preceded increases in HCA. HCA alone did not predict OA development.

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Evaluation of different soft-tissue simulating materials in pixel intensity values in cone beam computed tomography

Publication date: Available online 31 December 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Gustavo Machado Santaella, Maria Augusta Portella Guedes Visconti, Karina Lopes Devito, Francisco Carlos Groppo, Francisco Haiter-Neto, Luciana Asprino

ABSTRACT

Objective

This study aimed to evaluate different materials as soft tissue simulators and the influence of soft tissues in CBCT.

Study Design

Images were acquired of five piglet heads with intact soft-tissues, stripped tissues, and with the use of different soft tissue simulators, following the same acquisition protocol. Four different materials were tested, individually or in combination: acrylic, water, utility wax and expanded polystyrene (EPS). Pixel intensity values of eight quadrangular regions were obtained, being upper and lower teeth and alveolar bone. The mean values were used for comparison by analysis of variance (α=5%).

Results

No differences were observed for groups "No Material", "EPS", "Acrylic" and "EPS and Wax" for the lower anterior and posterior teeth, and upper posterior tooth and anterior and posterior bone, and groups "No Material", "EPS", and "EPS and Wax" for the lower posterior bone. All groups showed statistical differences for the lower anterior bone and upper anterior tooth.

Conclusion

Expanded polystyrene 2 cm thick, with or without Utility Wax 1 cm thick, was effective for most regions, followed by acrylic 0.5 cm. The soft-tissues were not of great influence for most regions. Water was not an effective material for any of the regions.

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Comparison of FASN and COX-2 immunoexpression between embryonal, benign and malignant odontogenic tissues

Publication date: Available online 31 December 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Celeste Sánchez-Romero, Adalberto Mosqueda-Taylor, Wilson Delgado-Azañero, Oslei Paes de Almeida, Ronell Bologna-Molina

ABSTRACT

Objectives

To analyze the immunohistochemical expression of fatty acid synthase (FASN) and cyclooxygenase-2 (COX‑2) in tooth germ (TG), ameloblastoma (AM), ameloblastic carcinoma (AC), ameloblastic fibroma (AF) and ameloblastic fibrosarcoma (AFS).

Study design

Immunohistochemistry for FASN and COX-2 was performed in 10 TG, 44 AM, 10 AC, 9 AF and 5 AFS specimens. The results were analyzed using the immunoreactive score (IRS) and Kruskal-Wallis test followed by Dunn's post-test.

Results

Most TG were strongly positive for FASN, while COX-2 was weak or negative. All AM and AC expressed both proteins. In AF, FASN and COX-2 were variably expressed in the epithelium and negative in the mesenchyme. In AFS, FASN was strongly positive in the malignant mesenchyme and variable in the epithelium; COX-2 was focal or weak in both components. FASN showed significant differences in the following comparisons: TG vs AC, AM vs AC, and AF vs AFS. Differences in COX-2 were significant when comparing TG with AM, AC and AF.

Conclusion

The results suggest that FASN and COX-2 overexpression may have a role in the pathogenesis of AM and AC¸ while in AFS, only FASN seems to be involved. Further studies are necessary to clarify these mechanisms and their clinical implications.

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Post-processing of all Zirconia Restorations in Digital Dental Radiographs: a Quality Assurance Predicament

Publication date: Available online 31 December 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Allison Buchanan, Amelia Orta, Sajitha Kalathingal

Abstract

Objectives

To describe a quality assurance issue, producing non-diagnostic high contrast radiographs, when imaging teeth restored with all zirconia crowns on bitewing radiographs.

Methods

All zirconia crowns were imaged with DIGORA Optime Photostimulable Phosphor (PSP) plates (Soredex/Orion Corp., Helsinki, Finland). To assess differences in software processing, the PSP plates were scanned into third party software as well as directly into the twain and native software provided by the manufacturer. Gamma correction, histogram stretch, and scanner resolution settings were adjusted. Vertical bitewings were acquired to increase anatomical coverage.

Results

Scanning into third party software or directly into the twain and native software did not improve contrast. Shifting the lower limit of the histogram stretch to 3 with a gamma correction of 2 resolved the problem. Neither scanner resolution setting nor vertical bitewings improved contrast.

Conclusions

The high contrast non-diagnostic radiographs result from imaging software not effectively displaying the available grey scale. The software processing error appears to be initiated by the high attenuation characteristics of zirconia. Consequently, radiographs with a high zirconia crown to normal anatomy ratio are particularly susceptible.

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Regulation of Wnt/β-catenin pathway may be related to Regγ in benign epithelial odontogenic lesions

Publication date: Available online 31 December 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Hellen Bandeira de Pontes Santos, Hianne Cristinne de Morais Medeiros, Rodrigo Porpino Mafra, Márcia Cristina da Costa Miguel, Hébel Cavalcanti Galvão, Lélia Batista de Souza

ABSTRACT

OBJECTIVES

This study analyzed and compared the immunoexpression of Regγ, Wnt-1 and β-catenin in ameloblastomas, adenomatoid odontogenic tumors (AOTs), and odontogenic keratocysts (OKCs).

STUDY DESIGN

Thirty solid ameloblastomas, 20 AOTs, and 30 OKCs were selected for analysis of the immunoexpression of Regγ, Wnt-1, and β-catenin. Each case was semi-quantitatively evaluated in the epithelial component and in their different cellular compartments (membrane, cytoplasm and nucleus).

RESULTS

Ameloblastomas displayed higher cytoplasmic and nuclear Regγ expression in comparison to AOTs and OKCs, as well as higher membrane and cytoplasmic Wnt-1 expression (p < 0.05). β-catenin membrane expression was higher in OKCs compared to ameloblastomas and AOTs (p < 0.05). Nuclear β-catenin expression was higher in ameloblastomas and AOTs than in OKCs (p < 0.05). Cytoplasmic and nuclear Regγ expression in AOTs were positively correlated with nuclear β-catenin expression (p < 0.05).

CONCLUSION

The marked expression of Regγ, Wnt-1, and β-catenin suggests the participation of these proteins in the pathogenesis of the studied lesions. The greater expression of Regγ, Wnt-1, and nuclear β-catenin in ameloblastomas may be related to their more aggressive behavior. Pro-tumor effects of nuclear β-catenin may be counterbalanced by inhibitory pathways in AOTs, justifying their low aggressiveness.

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Case report of epithelioid osteoblastoma of the mandible: findings on PET/CT and review of the literature

Publication date: Available online 31 December 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Akram Al-Ibraheem, Basel Yacoub, Andrew Barakat, Mohamad Yasser Dergham, Gilbert Maroun, Hussam Haddad, Alaa Saleh, Nabil Khoury, Mukbil Hourani, Mohamad B. Haidar

Abstract

Epithelioid osteoblastoma is a clinically aggressive subtype of osteoblastoma that favors the mandible and maxilla. Its histological features lie on a spectrum between conventional osteoblastoma and low grade osteosarcoma, thus making it difficult at times to confirm the diagnosis. It is known to have a high risk of recurrence after surgical resection but it is a benign entity and lacks the propensity to metastasize. To our knowledge, there is no published literature on findings of epithelioid osteoblastoma on positron emission tomography/computed tomography (PET/CT). We report a case of a 25-year-old male patient presenting with epithelioid osteoblastoma of the mandible. The lesion exhibited significantly increased FDG uptake on PET/CT with an SUVmax value of 5.5. PET/CT is not specific in differentiating between malignant and benign bone lesions, but may be necessary to rule out distant lesions when a confirmed diagnosis of epithelioid osteoblastoma cannot be obtained by histological examination.

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Changes of the condylar position after modified disc repositioning: a retrospective study based on magnetic resonance imaging

Publication date: Available online 31 December 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Xu-Zhuo Chen, Ya-Ting Qiu, Shan-Yong Zhang, Ji-Si Zheng, Chi Yang

Abstract

Objective

This study aims to explain the malocclusion after unilateral open disc repositioning surgery from the changes of condylar position.

Study Design

Patients treated with unilaterally modified TMJ disc repositioning were reviewed. All subjects had pre and immediately postoperative magnetic resonance imaging (MRI). The occlusion was checked, and the changes of the joint space and condylar position were measured in MRI. The paired t test was used for analysis.

Results

Thirty-two subjects were included in the final analysis. The incidences of the posterior open bite in the affected side were 100%, 87.5%, 71.9%, 9.4%, 3.1%, and 3.1% at 0, 3, 7 days, 3, 6 months, and the last follow-up after surgery. The mean distances of the condylar movements were 2.67 and 0.32 mm in the affected and normal joints. There were significant differences for the anterior (P=0.03), superior (P<0.001), and posterior (P<0.001) joint spaces of the affected joints in MRI.

Conclusions

The joint spaces significantly increased postoperatively, in addition to the changes of the condylar position in anterior and inferior movements, leading to the posterior open bite, most of which will be recovered 3 months after surgery. It is concluded that disc repositioning results in a stable occlusion over time when done unilaterally.

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Factors associated with masticatory performance and swallowing threshold according to dental formula development

Publication date: Available online 31 December 2018

Source: Archives of Oral Biology

Author(s): Tomohiro Takeshima, Yuko Fujita, Kenshi Maki

Abstract

Objective

The aims of the present study were to the determine changes in, and factors related to, masticatory performance and swallowing threshold according to dental formula development.

Methods

A total of 120 subjects, ranging in age from 4 to 19, and 21 to 29 years, were included in the present study. Grip strength and maximum occlusal force were measured in all subjects. Masticatory performance and swallowing threshold (including the number of chewing cycles and chewing time), were determined according to the concentration of dissolved glucose obtained from gummy jellies. The 12-item General Health Questionnaire (GHQ-12) was used to assess mental health status in participants 21 to 29 years of age.

Results

In the primary dentition, masticatory performance and glucose concentration before swallowing were the lowest in all dentition groups. Masticatory performance was the highest in subjects 21 to 29 years of age. In children with mixed and permanent dentition, glucose concentration levels before swallowing were similar to those in individuals aged 21 to 29 years. Multiple regression analysis revealed that maximum occlusal force was significantly and positively correlated with glucose concentration before swallowing in children, and the GHQ-12 score was significantly and negatively correlated with glucose concentration before swallowing in young adults.

Conclusions

Changes in swallowing threshold did not coincide with masticatory performance according to dental formula stage. Maximum occlusal force was the variable most strongly associated with swallowing threshold in children, while in young adults, better mental health status was closely associated with a higher swallowing threshold.

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Factors associated with masticatory performance and swallowing threshold according to dental formula development

Publication date: Available online 31 December 2018

Source: Archives of Oral Biology

Author(s): Tomohiro Takeshima, Yuko Fujita, Kenshi Maki

Abstract

Objective

The aims of the present study were to the determine changes in, and factors related to, masticatory performance and swallowing threshold according to dental formula development.

Methods

A total of 120 subjects, ranging in age from 4 to 19, and 21 to 29 years, were included in the present study. Grip strength and maximum occlusal force were measured in all subjects. Masticatory performance and swallowing threshold (including the number of chewing cycles and chewing time), were determined according to the concentration of dissolved glucose obtained from gummy jellies. The 12-item General Health Questionnaire (GHQ-12) was used to assess mental health status in participants 21 to 29 years of age.

Results

In the primary dentition, masticatory performance and glucose concentration before swallowing were the lowest in all dentition groups. Masticatory performance was the highest in subjects 21 to 29 years of age. In children with mixed and permanent dentition, glucose concentration levels before swallowing were similar to those in individuals aged 21 to 29 years. Multiple regression analysis revealed that maximum occlusal force was significantly and positively correlated with glucose concentration before swallowing in children, and the GHQ-12 score was significantly and negatively correlated with glucose concentration before swallowing in young adults.

Conclusions

Changes in swallowing threshold did not coincide with masticatory performance according to dental formula stage. Maximum occlusal force was the variable most strongly associated with swallowing threshold in children, while in young adults, better mental health status was closely associated with a higher swallowing threshold.

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To Batch, or Not to Batch, That is the Question: Screening Tomosynthesis Interpretation Methods

Publication date: Available online 31 December 2018

Source: Academic Radiology

Author(s): Sarah M. Friedewald

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To Batch, or Not to Batch, That is the Question: Screening Tomosynthesis Interpretation Methods

Publication date: Available online 31 December 2018

Source: Academic Radiology

Author(s): Sarah M. Friedewald

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The onset and post-onset auditory responses of cochlear nucleus neurons are modulated differently by cortical activation

Publication date: Available online 31 December 2018

Source: Hearing Research

Author(s): Xiuping Liu, Oliver Zhang, Jiyao Qi, Amber Chen, Kaili Hu, Jun Yan

Abstract

Auditory cortex exhibit a capacity of modulating the functions of subcortical auditory nuclei and even inner ear through descending pathways. The cochlear nucleus (CN), which acts as the gateway from the auditory periphery to the central auditory system, is also subjected to corticofugal modulation. Cortical modulation of subcortical nuclei is highly specific to the frequency tunings of cortical and subcortical neurons. It is unclear whether the high frequency-specificity of the cortical modulation of CN frequency tuning is implemented in the CN, in the auditory periphery, or in both. We analyzed the corticofugal effects on the frequency tuning, constructed from both onset (OS) and post-onset (pOS) response components of CN neurons in C57 mice. We found that the focal electrical stimulation of the primary auditory cortex (ES_AI) induced remarkable changes in the response magnitude, response latency and the frequency response curves of CN neurons. The changes in the pOS components were highly specific to the difference in BFs between the stimulated AI neurons and recorded CN neurons. The changes in the OS component mostly involved the augmentation of the auditory responses of CN neurons, while exhibiting far poorer frequency-specificity. Considering the large differences in the temporal response patterns and the tuning shapes between the auditory nerve and the CN, our data suggest that the CN intrinsic neural circuitry plays a critical role in the frequency specificity of corticofugal modulation. Cortical modulation of the inner ear mostly contributes to the augmentation of the AN inputs to the CN, around the BFs of stimulated AI neurons.

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The onset and post-onset auditory responses of cochlear nucleus neurons are modulated differently by cortical activation

Publication date: Available online 31 December 2018

Source: Hearing Research

Author(s): Xiuping Liu, Oliver Zhang, Jiyao Qi, Amber Chen, Kaili Hu, Jun Yan

Abstract

Auditory cortex exhibit a capacity of modulating the functions of subcortical auditory nuclei and even inner ear through descending pathways. The cochlear nucleus (CN), which acts as the gateway from the auditory periphery to the central auditory system, is also subjected to corticofugal modulation. Cortical modulation of subcortical nuclei is highly specific to the frequency tunings of cortical and subcortical neurons. It is unclear whether the high frequency-specificity of the cortical modulation of CN frequency tuning is implemented in the CN, in the auditory periphery, or in both. We analyzed the corticofugal effects on the frequency tuning, constructed from both onset (OS) and post-onset (pOS) response components of CN neurons in C57 mice. We found that the focal electrical stimulation of the primary auditory cortex (ES_AI) induced remarkable changes in the response magnitude, response latency and the frequency response curves of CN neurons. The changes in the pOS components were highly specific to the difference in BFs between the stimulated AI neurons and recorded CN neurons. The changes in the OS component mostly involved the augmentation of the auditory responses of CN neurons, while exhibiting far poorer frequency-specificity. Considering the large differences in the temporal response patterns and the tuning shapes between the auditory nerve and the CN, our data suggest that the CN intrinsic neural circuitry plays a critical role in the frequency specificity of corticofugal modulation. Cortical modulation of the inner ear mostly contributes to the augmentation of the AN inputs to the CN, around the BFs of stimulated AI neurons.

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Radiologists’ recommendations for additional imaging (RAI) in the inpatient setting

Abstract

Objective

The aim of our study was to measure the rate of radiologists' additional recommended imaging examinations (RAI) at a hospital-based inpatient setting and to estimate the influence on RAI of clinical variables.

Materials and methods

This retrospective study was approved by the institutional review board. Inpatients CT and US examinations interpreted by fifteen radiologists between October and December 2016 were studied. Information about RAI from radiology report texts was extracted manually. The analytic data set included the interpreting radiologists' years of experience, patient age, patient gender, radiologist gender, ordering service and "clinical question to be answered" as collected from the radiology request forms.

Results

Of the 1996 US and CT examinations performed between October and December 2016 in the inpatient setting, 34% (683 examinations) had a radiologists' RAI. The largest proportion of RAI was for chest CT, followed by PET-CT, abdominal CT and abdominal MRI. Patient age and gender had no impact on RAI. Radiologists' years of experience were inversely correlated to RAI. "Pneumonia" showed the highest rate of RAI due to follow-up of lung nodules.

Conclusion

A high percentage of RAI resulted from CT and US radiologists' reports. The largest proportion of RAI was for chest CT, followed by PET-CT, abdominal CT, and abdominal MRI. Radiologists' years of experience play an important role in the number of the requested RAI. Further studies with a larger cohort of radiologists are needed to confirm the role of radiologists' experience in RAI. Also, follow-up studies are warranted to assess the number of RAI that are actually acted upon by the referring physicians.

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Varicocele, conventional laparoscopic ligation versus occluding balloon embolization

Abstract

Introduction

Varicocele is a relatively complex pathology that affects the pampiniform plexus of veins in the spermatic cord. Modern treatment involves both urological/surgical and interventional procedures. Our objective is to compare outcomes of conventional laparoscopic ligation (LL) and occluding balloon embolization (OBE) a percutaneous interventional procedure.

Materials and methods

We treated retrospectively a total of 98 patients, divided in two cohorts; arm A with 48 and arm B with 50 patients. Arm A patients underwent LL, while arm B ones were treated in interventional radiology suite, via OBE method. No comorbidities were reported, especially scrotal ones. Hence, all patients have been asked to respect 3 and 6 months' follow-up, clinical examination and ultrasonography were performed. Age range of the entire sample: 15–45 years old, with average of 28 years. The study involved two European centers. We performed a comparative analysis (Fisher's test) of intra-operative time, hospitalization and patient's postoperative recovery time.

Results and limitations

Outcomes have been in line with the recent literature ones, allowing the occluding balloon embolization a small advantage for quicker operative average time, hospitalization needed and full recovery to normal activities for the patient. Main limitation was the unfeasibility of cost-effectiveness analysis due to national differences, limited sample and lack of complete semen analysis pre- and postoperative.

Conclusion

Both OBE and LL are safe and effective procedures in the treatment of varicocele, conceding OBE a slight advantage in terms of hospital stay and full recovery to normal activity of patients.

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Radiologists’ recommendations for additional imaging (RAI) in the inpatient setting

Abstract

Objective

The aim of our study was to measure the rate of radiologists' additional recommended imaging examinations (RAI) at a hospital-based inpatient setting and to estimate the influence on RAI of clinical variables.

Materials and methods

This retrospective study was approved by the institutional review board. Inpatients CT and US examinations interpreted by fifteen radiologists between October and December 2016 were studied. Information about RAI from radiology report texts was extracted manually. The analytic data set included the interpreting radiologists' years of experience, patient age, patient gender, radiologist gender, ordering service and "clinical question to be answered" as collected from the radiology request forms.

Results

Of the 1996 US and CT examinations performed between October and December 2016 in the inpatient setting, 34% (683 examinations) had a radiologists' RAI. The largest proportion of RAI was for chest CT, followed by PET-CT, abdominal CT and abdominal MRI. Patient age and gender had no impact on RAI. Radiologists' years of experience were inversely correlated to RAI. "Pneumonia" showed the highest rate of RAI due to follow-up of lung nodules.

Conclusion

A high percentage of RAI resulted from CT and US radiologists' reports. The largest proportion of RAI was for chest CT, followed by PET-CT, abdominal CT, and abdominal MRI. Radiologists' years of experience play an important role in the number of the requested RAI. Further studies with a larger cohort of radiologists are needed to confirm the role of radiologists' experience in RAI. Also, follow-up studies are warranted to assess the number of RAI that are actually acted upon by the referring physicians.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2F0yuP9

Varicocele, conventional laparoscopic ligation versus occluding balloon embolization

Abstract

Introduction

Varicocele is a relatively complex pathology that affects the pampiniform plexus of veins in the spermatic cord. Modern treatment involves both urological/surgical and interventional procedures. Our objective is to compare outcomes of conventional laparoscopic ligation (LL) and occluding balloon embolization (OBE) a percutaneous interventional procedure.

Materials and methods

We treated retrospectively a total of 98 patients, divided in two cohorts; arm A with 48 and arm B with 50 patients. Arm A patients underwent LL, while arm B ones were treated in interventional radiology suite, via OBE method. No comorbidities were reported, especially scrotal ones. Hence, all patients have been asked to respect 3 and 6 months' follow-up, clinical examination and ultrasonography were performed. Age range of the entire sample: 15–45 years old, with average of 28 years. The study involved two European centers. We performed a comparative analysis (Fisher's test) of intra-operative time, hospitalization and patient's postoperative recovery time.

Results and limitations

Outcomes have been in line with the recent literature ones, allowing the occluding balloon embolization a small advantage for quicker operative average time, hospitalization needed and full recovery to normal activities for the patient. Main limitation was the unfeasibility of cost-effectiveness analysis due to national differences, limited sample and lack of complete semen analysis pre- and postoperative.

Conclusion

Both OBE and LL are safe and effective procedures in the treatment of varicocele, conceding OBE a slight advantage in terms of hospital stay and full recovery to normal activity of patients.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2F1iLQM