Role of Frailty and Comorbidity in Determination of Operability for Patients With Oral and Oropharyngeal Squamous Cell Carcinoma

Abstract

Purpose of Review

To review the role of frailty and comorbidities in determining operability and associated outcomes in patients with oral and oropharyngeal squamous cell carcinoma.

Recent Findings

Frailty and comorbidity have been linked to multiple adverse outcome measures including risk of mortality, surgical complications, length of stay, intensity of care needs, discharge disposition, risk of readmission, and cost of healthcare delivery. There are diverse objective and validated measures of comorbidity and frailty. Addition of comorbidity and objective frailty measurements has been demonstrated to improve predictive power of nomograms and clinical staging systems for patients with oral and oropharyngeal squamous cell carcinoma. The use of predictive tools that assess frailty may contribute to shared decision making, realistic expectations, and facilitation of appropriate level of care. While emerging literature supports the role of prehabilitation, there is paucity of data in support of such interventions for patients afflicted by oral and oropharyngeal cancer.

Summary

Frailty assesses operability beyond anatomic resectability and incorporates key determinants of physical, nutritional, and cognitive well-being. Objective measurements of frailty predict meaningful outcomes following surgery for cancers of the oral cavity and oropharynx. This paper suggests that clinicians should objectively and routinely assess frailty, which may facilitate patient counseling, improved risk stratification, informed decision making, and further research to elucidate relationship of frailty with outcomes in head and neck specific populations.

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Role of Frailty and Comorbidity in Determination of Operability for Patients With Oral and Oropharyngeal Squamous Cell Carcinoma

Abstract

Purpose of Review

To review the role of frailty and comorbidities in determining operability and associated outcomes in patients with oral and oropharyngeal squamous cell carcinoma.

Recent Findings

Frailty and comorbidity have been linked to multiple adverse outcome measures including risk of mortality, surgical complications, length of stay, intensity of care needs, discharge disposition, risk of readmission, and cost of healthcare delivery. There are diverse objective and validated measures of comorbidity and frailty. Addition of comorbidity and objective frailty measurements has been demonstrated to improve predictive power of nomograms and clinical staging systems for patients with oral and oropharyngeal squamous cell carcinoma. The use of predictive tools that assess frailty may contribute to shared decision making, realistic expectations, and facilitation of appropriate level of care. While emerging literature supports the role of prehabilitation, there is paucity of data in support of such interventions for patients afflicted by oral and oropharyngeal cancer.

Summary

Frailty assesses operability beyond anatomic resectability and incorporates key determinants of physical, nutritional, and cognitive well-being. Objective measurements of frailty predict meaningful outcomes following surgery for cancers of the oral cavity and oropharynx. This paper suggests that clinicians should objectively and routinely assess frailty, which may facilitate patient counseling, improved risk stratification, informed decision making, and further research to elucidate relationship of frailty with outcomes in head and neck specific populations.

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

Biosynthesis of silver nanoparticle using extract of Zea mays (corn flour) and investigation of its cytotoxicity effect and radical scavenging potential

Publication date: Available online 17 January 2019Source: Journal of Photochemistry and Photobiology B: BiologyAuthor(s): T. Rajkumar, Andras Sapi, Gitishree Das, Trishna Debnath, AbuZar Ansari, Jayanta Kumar PatraAbstractSilver nanoparticles (AgNPs) possesses a number of exceptional pharmaceutical properties and applications as compared with other types of metallic nanoparticles. Currently, AgNPs was biosynthesized using aqueous extract of Zea mays L. (corn flour) powder. Further, the effect of concentration of reagents, extract, temperature and time of synthesis was also studied along with the cytotoxicity and radical scavenging potential. UV–vis spectra of AgNPs gave a surface plasmon resonance at ~420 nm. The absorption peak became sharp with the increase in time. AgNPs with monodi...

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Experiences of people with severe aphasia and spouses attending an Interdisciplinary Community Aphasia Group.

CONCLUSIONS: The Interdisciplinary Community Aphasia Group model has overall acceptability for people with chronic, severe aphasia and their spouses, and can be adapted to ensure feasibility in clinical practice. Ongoing research is required to best tailor community groups for people with aphasia and significant others, and to reinforce the need for their proliferation. Implications for rehabilitation People with aphasia and their spouses can benefit from a wide range of programming, including participation in meaningful and accessible non-verbal activitiesAn interdisciplinary staff team can contribute positively to member experience and impacts, with peer staff offering valuable mentoring roles. Various aspects of member identity and life narrative impact on community aphasia group partic...

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

“Sinus Headache”: Diagnosis and Dilemma?? An Analytical and Prospective Study

Abstract

To evaluate the type, location, severity of headache and their relation to various nasal and sinus related pathological conditions. All the patients presenting with acute and chronic sinus and nasal infections along with headache were included in the study. The diagnostic confirmation was done with clinical along with radiological and endoscopic evaluation. Various parameters categorized accordingly. Chronic rhinosinusitis/chronic recurrent rhinosinusitis are the most common nasal condition seen in oto-rhino-laryngology OPD which has enormous economic burden and significant morbidity on general population. The headache is the commonest associated symptom which is needed to be given attention. The location, variation, pattern of the headache can guide us towards the correct diagnosis.

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Slips of the tongue in the Seoul Korean Corpus of spontaneous speech

Publication date: Available online 17 January 2019Source: LinguaAuthor(s): Jeong-Im Han, Jeahyuk Oh, Joo-Yeon KimAbstractAlthough speech errors have served as the primary source of evidence for how the language production system works, there is a lack of studies on naturalistic slips of the tongue in Korean. The present study had two main goals: first, we introduced a new collection of slips produced by native speakers of Korean in a naturalistic setting and provided a general description of their main error patterns. The speech errors were drawn from a corpus of Korean conversations transcribed from tape recordings (Seoul Corpus; Yun et al., 2015), and classified according to the nature of the errors and the type of linguistic units with which each error type occurs. These findings were t...

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Computational study of necrotic areas in rat liver tissue treated with photodynamic therapy

ConclusionsIncreasing light fluence rate appears to be a more productive method than increasing photosensitizer concentration for inducing necrosis, especially in larger tumors. Finally, our results show that high φ values are necessary in order to maintain clinically applicable irradiation times. (Source: Journal of Photochemistry and Photobiology B: Biology)

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Biosynthesis of silver nanoparticle using extract of Zea mays (corn flour) and investigation of its cytotoxicity effect and radical scavenging potential

Publication date: Available online 17 January 2019Source: Journal of Photochemistry and Photobiology B: BiologyAuthor(s): T. Rajkumar, Andras Sapi, Gitishree Das, Trishna Debnath, AbuZar Ansari, Jayanta Kumar PatraAbstractSilver nanoparticles (AgNPs) possesses a number of exceptional pharmaceutical properties and applications as compared with other types of metallic nanoparticles. Currently, AgNPs was biosynthesized using aqueous extract of Zea mays L. (corn flour) powder. Further, the effect of concentration of reagents, extract, temperature and time of synthesis was also studied along with the cytotoxicity and radical scavenging potential. UV–vis spectra of AgNPs gave a surface plasmon resonance at ~420 nm. The absorption peak became sharp with the increase in time. AgNPs with monodi...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2MjhW6B

Experiences of people with severe aphasia and spouses attending an Interdisciplinary Community Aphasia Group.

CONCLUSIONS: The Interdisciplinary Community Aphasia Group model has overall acceptability for people with chronic, severe aphasia and their spouses, and can be adapted to ensure feasibility in clinical practice. Ongoing research is required to best tailor community groups for people with aphasia and significant others, and to reinforce the need for their proliferation. Implications for rehabilitation People with aphasia and their spouses can benefit from a wide range of programming, including participation in meaningful and accessible non-verbal activitiesAn interdisciplinary staff team can contribute positively to member experience and impacts, with peer staff offering valuable mentoring roles. Various aspects of member identity and life narrative impact on community aphasia group partic...

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

“Sinus Headache”: Diagnosis and Dilemma?? An Analytical and Prospective Study

Abstract

To evaluate the type, location, severity of headache and their relation to various nasal and sinus related pathological conditions. All the patients presenting with acute and chronic sinus and nasal infections along with headache were included in the study. The diagnostic confirmation was done with clinical along with radiological and endoscopic evaluation. Various parameters categorized accordingly. Chronic rhinosinusitis/chronic recurrent rhinosinusitis are the most common nasal condition seen in oto-rhino-laryngology OPD which has enormous economic burden and significant morbidity on general population. The headache is the commonest associated symptom which is needed to be given attention. The location, variation, pattern of the headache can guide us towards the correct diagnosis.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RCF8Cv

Role of Frailty and Comorbidity in Determination of Operability for Patients With Oral and Oropharyngeal Squamous Cell Carcinoma

Abstract

Purpose of Review

To review the role of frailty and comorbidities in determining operability and associated outcomes in patients with oral and oropharyngeal squamous cell carcinoma.

Recent Findings

Frailty and comorbidity have been linked to multiple adverse outcome measures including risk of mortality, surgical complications, length of stay, intensity of care needs, discharge disposition, risk of readmission, and cost of healthcare delivery. There are diverse objective and validated measures of comorbidity and frailty. Addition of comorbidity and objective frailty measurements has been demonstrated to improve predictive power of nomograms and clinical staging systems for patients with oral and oropharyngeal squamous cell carcinoma. The use of predictive tools that assess frailty may contribute to shared decision making, realistic expectations, and facilitation of appropriate level of care. While emerging literature supports the role of prehabilitation, there is paucity of data in support of such interventions for patients afflicted by oral and oropharyngeal cancer.

Summary

Frailty assesses operability beyond anatomic resectability and incorporates key determinants of physical, nutritional, and cognitive well-being. Objective measurements of frailty predict meaningful outcomes following surgery for cancers of the oral cavity and oropharynx. This paper suggests that clinicians should objectively and routinely assess frailty, which may facilitate patient counseling, improved risk stratification, informed decision making, and further research to elucidate relationship of frailty with outcomes in head and neck specific populations.

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

Role of Frailty and Comorbidity in Determination of Operability for Patients With Oral and Oropharyngeal Squamous Cell Carcinoma

Abstract

Purpose of Review

To review the role of frailty and comorbidities in determining operability and associated outcomes in patients with oral and oropharyngeal squamous cell carcinoma.

Recent Findings

Frailty and comorbidity have been linked to multiple adverse outcome measures including risk of mortality, surgical complications, length of stay, intensity of care needs, discharge disposition, risk of readmission, and cost of healthcare delivery. There are diverse objective and validated measures of comorbidity and frailty. Addition of comorbidity and objective frailty measurements has been demonstrated to improve predictive power of nomograms and clinical staging systems for patients with oral and oropharyngeal squamous cell carcinoma. The use of predictive tools that assess frailty may contribute to shared decision making, realistic expectations, and facilitation of appropriate level of care. While emerging literature supports the role of prehabilitation, there is paucity of data in support of such interventions for patients afflicted by oral and oropharyngeal cancer.

Summary

Frailty assesses operability beyond anatomic resectability and incorporates key determinants of physical, nutritional, and cognitive well-being. Objective measurements of frailty predict meaningful outcomes following surgery for cancers of the oral cavity and oropharynx. This paper suggests that clinicians should objectively and routinely assess frailty, which may facilitate patient counseling, improved risk stratification, informed decision making, and further research to elucidate relationship of frailty with outcomes in head and neck specific populations.

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

Good News for Children With Autism

Several recent news items tell of new resources for children with autism spectrum disorder (ASD). From entertainment to health care to advocacy, these three articles offer something positive for families and caregivers. This is a welcome trend, with reports indicating a rise in prevalence of children diagnosed with ASD, as well as growing concerns about young adults with ASD finding jobs and learning life skills. Video games. Experiences enjoyed by most children can overwhelm those on the spectrum. Now—along with theme parks including quiet rooms, airlines offering programs to help prepare children for travel, retailers offering autism-friendly shopping days and museums giving tours for children with special needs—the popular video game Minecraft has a version for children with ASD...

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

Good News for Children With Autism

Several recent news items tell of new resources for children with autism spectrum disorder (ASD). From entertainment to health care to advocacy, these three articles offer something positive for families and caregivers. This is a welcome trend, with reports indicating a rise in prevalence of children diagnosed with ASD, as well as growing concerns about young adults with ASD finding jobs and learning life skills. Video games. Experiences enjoyed by most children can overwhelm those on the spectrum. Now—along with theme parks including quiet rooms, airlines offering programs to help prepare children for travel, retailers offering autism-friendly shopping days and museums giving tours for children with special needs—the popular video game Minecraft has a version for children with ASD...

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

Good News for Children With Autism

Several recent news items tell of new resources for children with autism spectrum disorder (ASD). From entertainment to health care to advocacy, these three articles offer something positive for families and caregivers. This is a welcome trend, with reports indicating a rise in prevalence of children diagnosed with ASD, as well as growing concerns about young adults with ASD finding jobs and learning life skills. Video games. Experiences enjoyed by most children can overwhelm those on the spectrum. Now—along with theme parks including quiet rooms, airlines offering programs to help prepare children for travel, retailers offering autism-friendly shopping days and museums giving tours for children with special needs—the popular video game Minecraft has a version for children with ASD...

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

Good News for Children With Autism

Several recent news items tell of new resources for children with autism spectrum disorder (ASD). From entertainment to health care to advocacy, these three articles offer something positive for families and caregivers. This is a welcome trend, with reports indicating a rise in prevalence of children diagnosed with ASD, as well as growing concerns about young adults with ASD finding jobs and learning life skills. Video games. Experiences enjoyed by most children can overwhelm those on the spectrum. Now—along with theme parks including quiet rooms, airlines offering programs to help prepare children for travel, retailers offering autism-friendly shopping days and museums giving tours for children with special needs—the popular video game Minecraft has a version for children with ASD...

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

Effects of Vaginal Seeding on Infants' Body Mass Index and Allergy Risk for Caesarean-delivered Children

Conditions:   Overweight and Obesity;   Allergy Intervention:   Procedure: Vaginal seeding Sponsors:   Peking University;   National Natural Science Foundation of China;   Liuyang Maternal and Child Health Care Hospital Recruiting (Source: ClinicalTrials.gov)

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A Randomized Experiment of Malaria Diagnostic Testing and Conditional Subsidies to Target ACTs in the Retail Sector: the TESTsmART Trial Aim 1

Conditions:   Malaria;   Febrile Illness Interventions:   Other: Conditional ACT subsidy, Arm 1 levels;   Other: Conditional ACT subsidy, Arm 2 levels;   Other: Conditional ACT subsidy, Arm 3 levels;   Other: Conditional ACT subsidy, Arm 4 levels Sponsors:   Duke University;   National Institute of Allergy and Infectious Diseases (NIAID);   Moi University;   Clinton Health Access Initiative, Nigeria Not yet recruiting (Source: ClinicalTrials.gov)

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Chinese herbal medicine bi min fang for allergic rhinitis: protocol for a double-blind, double-dummy, randomized controlled trial

This study will be the first to explore the mechanism of action of Chinese herbal medicine on the gut microbiota in AR.Trial registrationChinese Clinical Trial Registry,ChiCTR-IPR-17010970. Registered on 23 March 2017. (Source: Trials)

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Effects of Vaginal Seeding on Infants' Body Mass Index and Allergy Risk for Caesarean-delivered Children

Conditions:   Overweight and Obesity;   Allergy Intervention:   Procedure: Vaginal seeding Sponsors:   Peking University;   National Natural Science Foundation of China;   Liuyang Maternal and Child Health Care Hospital Recruiting (Source: ClinicalTrials.gov)

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2U0mCka

A Randomized Experiment of Malaria Diagnostic Testing and Conditional Subsidies to Target ACTs in the Retail Sector: the TESTsmART Trial Aim 1

Conditions:   Malaria;   Febrile Illness Interventions:   Other: Conditional ACT subsidy, Arm 1 levels;   Other: Conditional ACT subsidy, Arm 2 levels;   Other: Conditional ACT subsidy, Arm 3 levels;   Other: Conditional ACT subsidy, Arm 4 levels Sponsors:   Duke University;   National Institute of Allergy and Infectious Diseases (NIAID);   Moi University;   Clinton Health Access Initiative, Nigeria Not yet recruiting (Source: ClinicalTrials.gov)

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

Chinese herbal medicine bi min fang for allergic rhinitis: protocol for a double-blind, double-dummy, randomized controlled trial

This study will be the first to explore the mechanism of action of Chinese herbal medicine on the gut microbiota in AR.Trial registrationChinese Clinical Trial Registry,ChiCTR-IPR-17010970. Registered on 23 March 2017. (Source: Trials)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TUQ7UC

Evolution in the management of oropharyngeal squamous cell carcinoma: systematic review of outcomes over the last 25 years

The treatment of oropharyngeal squamous cell carcinoma (SCC) has evolved over the last 25years, from open surgery to combined chemoradiotherapy, and now to the development of minimally invasive procedures, but evidence for the best treatment is lacking. We therefore did a systematic search of the MEDLINE database for studies published between 1992 and 2017 that reported oncological or functional outcomes, or both. Predefined inclusion and exclusion criteria were used for screening and selection, and 45 studies were chosen. (Source: The British Journal of Oral and Maxillofacial Surgery)

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Incision to the sagittal temporalis tendon to optimise access to the ramus

Since Trauner and Obwegeser1 developed the intraoral sagittal ramus split osteotomy in 1953 it has become a mainstay of orthognathic surgery. The techniques have evolved over many years, with Dal Pont2 adding the advancement and rotation of the lower horizontal cut to the buccal cortex (with a vertical cut between the first and second molars) and Hunsuck3 shortening the lingual cut. The approach and access have, however, remained largely the same. All three techniques require access to the ramus and tunneling of the lingual pterygomandibular space. (Source: The British Journal of Oral and Maxillofacial Surgery)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2W4SFkP

Evaluating societal outcomes of orthognathic surgery: an innovative application of the Social Return on Investment methodology to patients after orthognathic treatment

Outcomes after orthognathic treatment are complex, and include improvements to mental and physical health, and psychosocial adjustments. The Social Return on Investment (SROI), a framework that is recognised by the government, explores the wider social value of interventions, but has not yet, to our knowledge, been used to measure the value of surgical procedures. To test its feasibility in a surgical setting and to begin to understand the wider nature of the changes experienced by patients after orthognathic surgery, we designed a pilot study that focused on the first two stages of the six-stage model. (Source: The British Journal of Oral and Maxillofacial Surgery)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2QXg8AP

Referrals for head and neck cancer in England and The Netherlands: an international qualitative study of the views of secondary-care surgical specialists

One-year survival after head and neck cancer in England has been reported to be worse than that in Europe, despite five-year conditional survival being similar, which implies that patients present later in England. One country with better rates is The Netherlands. There are many possible causes, one of which may be the system of referral from primary to secondary care. We have compared the views of secondary care specialists in the two countries about their systems for referral, and identified aspects that might have an impact on outcomes. (Source: The British Journal of Oral and Maxillofacial Surgery)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2W0cB8C

Evolution in the management of oropharyngeal squamous cell carcinoma: systematic review of outcomes over the last 25 years

The treatment of oropharyngeal squamous cell carcinoma (SCC) has evolved over the last 25years, from open surgery to combined chemoradiotherapy, and now to the development of minimally invasive procedures, but evidence for the best treatment is lacking. We therefore did a systematic search of the MEDLINE database for studies published between 1992 and 2017 that reported oncological or functional outcomes, or both. Predefined inclusion and exclusion criteria were used for screening and selection, and 45 studies were chosen. (Source: The British Journal of Oral and Maxillofacial Surgery)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2QVyP84

Incision to the sagittal temporalis tendon to optimise access to the ramus

Since Trauner and Obwegeser1 developed the intraoral sagittal ramus split osteotomy in 1953 it has become a mainstay of orthognathic surgery. The techniques have evolved over many years, with Dal Pont2 adding the advancement and rotation of the lower horizontal cut to the buccal cortex (with a vertical cut between the first and second molars) and Hunsuck3 shortening the lingual cut. The approach and access have, however, remained largely the same. All three techniques require access to the ramus and tunneling of the lingual pterygomandibular space. (Source: The British Journal of Oral and Maxillofacial Surgery)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2W4SFkP

Evaluating societal outcomes of orthognathic surgery: an innovative application of the Social Return on Investment methodology to patients after orthognathic treatment

Outcomes after orthognathic treatment are complex, and include improvements to mental and physical health, and psychosocial adjustments. The Social Return on Investment (SROI), a framework that is recognised by the government, explores the wider social value of interventions, but has not yet, to our knowledge, been used to measure the value of surgical procedures. To test its feasibility in a surgical setting and to begin to understand the wider nature of the changes experienced by patients after orthognathic surgery, we designed a pilot study that focused on the first two stages of the six-stage model. (Source: The British Journal of Oral and Maxillofacial Surgery)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2QXg8AP

Referrals for head and neck cancer in England and The Netherlands: an international qualitative study of the views of secondary-care surgical specialists

One-year survival after head and neck cancer in England has been reported to be worse than that in Europe, despite five-year conditional survival being similar, which implies that patients present later in England. One country with better rates is The Netherlands. There are many possible causes, one of which may be the system of referral from primary to secondary care. We have compared the views of secondary care specialists in the two countries about their systems for referral, and identified aspects that might have an impact on outcomes. (Source: The British Journal of Oral and Maxillofacial Surgery)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2W0cB8C

A Systematic Review and Meta-Analysis of Methods for Reducing Local Anesthetic Injection Pain Among Patients Undergoing Periocular Surgery

Purpose: Various factors help minimize pain during the injection of local anesthetic. The majority of current evidence involves nonspecific injection sites. The objective of this review was to provide a comprehensive summary of all existing evidence for methods used to reduce injection pain specifically in the context of periocular procedures. Methods: A literature search of the MEDLINE, EMBASE, and Scopus databases was conducted to identify all relevant experimental and observational studies from 1946 to 2018. Studies were included of patients undergoing periocular surgery under subcutaneous local anesthesia whereby outcomes were reported following a specific intervention intended to help reduce pain. Risk of bias was assessed using recognized tools. A subgroup meta-analysis was performed to indirectly compare pooled intervention-versus-control differences for various pain reduction interventions. Results: Following the review of 2089 search results, 23 articles representing 1135 patients were included. The methods assessed in the studies included choice of anesthetic agent, buffering, warming, dilution, needle type, administration of an inhalational anesthetic, application of topical anesthetics, iontophoresis, skin cooling with ice, tactile distraction with vibration, and decreasing the rate of injection. Conclusions: Methods demonstrating best efficacy included solution modification (buffering, dilution, warming), skin cooling with ice, vibration, transconjunctival topical anesthetic before injection, and decreased rate of injection. Further study is warranted for modification of equipment factors, topical anesthetics, and strategies to reduce pain because of anesthetic infiltration. Accepted for publication July 8, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Mišo Gostimir, M.D., Ivey Eye Institute, Western University, 268 Grosvenor Street, London, ON N6A 4V2, Canada. E-mail: mgostimi@uwo.ca © 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Optic Nerve Sheath Meningocele With Optic Disc Pit: A Rare Finding

No abstract available

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2HhT1BC

Regulatory cells in the skin: pathophysiological role and potential targets for anti-inflammatory therapies

Inflammation is a fundamental defence mechanism to protect the body from danger, which becomes potentially harmful if it turns chronic. Therapeutic strategies aimed at specifically blocking pro-inflammatory signals - particularly cytokines such as interleukin-4, interleukin-6, interleukin-13, interleukin-17A or tumour necrosis factor α - have substantially improved our ability to effectively and safely treat chronic inflammatory diseases. Much less efforts have been made to better understand the role of potential anti-inflammatory mechanisms. (Source: Journal of Allergy and Clinical Immunology)

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Novel Proteasome Assembly Chaperone mutations in PSMG2/PAC2, cause the autoinflammatory interferonopathy, CANDLE/PRAAS4

Chronic Atypical Neutrophilic Dermatosis with Lipodystrophy and Elevated temperature (CANDLE) is a rare autoinflammatory interferonopathy caused by additive loss-of-function mutations in proteasome genes. Mutations in the proteasome chaperone, PSMG2/PAC2 are a novel cause of CANDLE. (Source: Journal of Allergy and Clinical Immunology)

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Systemic Antibody Responses to Gut Commensal Bacteria: How and Why Do I Know You?

(Source: Journal of Allergy and Clinical Immunology)

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

A Systematic Review and Meta-Analysis of Methods for Reducing Local Anesthetic Injection Pain Among Patients Undergoing Periocular Surgery

Purpose: Various factors help minimize pain during the injection of local anesthetic. The majority of current evidence involves nonspecific injection sites. The objective of this review was to provide a comprehensive summary of all existing evidence for methods used to reduce injection pain specifically in the context of periocular procedures. Methods: A literature search of the MEDLINE, EMBASE, and Scopus databases was conducted to identify all relevant experimental and observational studies from 1946 to 2018. Studies were included of patients undergoing periocular surgery under subcutaneous local anesthesia whereby outcomes were reported following a specific intervention intended to help reduce pain. Risk of bias was assessed using recognized tools. A subgroup meta-analysis was performed to indirectly compare pooled intervention-versus-control differences for various pain reduction interventions. Results: Following the review of 2089 search results, 23 articles representing 1135 patients were included. The methods assessed in the studies included choice of anesthetic agent, buffering, warming, dilution, needle type, administration of an inhalational anesthetic, application of topical anesthetics, iontophoresis, skin cooling with ice, tactile distraction with vibration, and decreasing the rate of injection. Conclusions: Methods demonstrating best efficacy included solution modification (buffering, dilution, warming), skin cooling with ice, vibration, transconjunctival topical anesthetic before injection, and decreased rate of injection. Further study is warranted for modification of equipment factors, topical anesthetics, and strategies to reduce pain because of anesthetic infiltration. Accepted for publication July 8, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Mišo Gostimir, M.D., Ivey Eye Institute, Western University, 268 Grosvenor Street, London, ON N6A 4V2, Canada. E-mail: mgostimi@uwo.ca © 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RYEw9C

Optic Nerve Sheath Meningocele With Optic Disc Pit: A Rare Finding

No abstract available

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2HhT1BC

Regulatory cells in the skin: pathophysiological role and potential targets for anti-inflammatory therapies

Inflammation is a fundamental defence mechanism to protect the body from danger, which becomes potentially harmful if it turns chronic. Therapeutic strategies aimed at specifically blocking pro-inflammatory signals - particularly cytokines such as interleukin-4, interleukin-6, interleukin-13, interleukin-17A or tumour necrosis factor α - have substantially improved our ability to effectively and safely treat chronic inflammatory diseases. Much less efforts have been made to better understand the role of potential anti-inflammatory mechanisms. (Source: Journal of Allergy and Clinical Immunology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2R1vCnD

Novel Proteasome Assembly Chaperone mutations in PSMG2/PAC2, cause the autoinflammatory interferonopathy, CANDLE/PRAAS4

Chronic Atypical Neutrophilic Dermatosis with Lipodystrophy and Elevated temperature (CANDLE) is a rare autoinflammatory interferonopathy caused by additive loss-of-function mutations in proteasome genes. Mutations in the proteasome chaperone, PSMG2/PAC2 are a novel cause of CANDLE. (Source: Journal of Allergy and Clinical Immunology)

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Systemic Antibody Responses to Gut Commensal Bacteria: How and Why Do I Know You?

(Source: Journal of Allergy and Clinical Immunology)

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

Impact of cochlear tonotopy on electrically evoked compound action potentials (ECAPs).

CONCLUSIONS AND SIGNIFICANCE: tNRTs differ depending on electrode type and location inside the cochlea. This should be considered pre implantation when choosing the electrode array type and post-implantation when mapping the CI program. PMID: 30652918 [PubMed - as supplied by publisher] (Source: Acta Oto-Laryngologica)

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Impact of cochlear tonotopy on electrically evoked compound action potentials (ECAPs).

CONCLUSIONS AND SIGNIFICANCE: tNRTs differ depending on electrode type and location inside the cochlea. This should be considered pre implantation when choosing the electrode array type and post-implantation when mapping the CI program. PMID: 30652918 [PubMed - as supplied by publisher] (Source: Acta Oto-Laryngologica)

MedWorm Message: If you are looking to buy something in the January Sales please visit TheJanuarySales.com for a directory of all the best sales in the UK. Any income gained via affiliate links keeps MedWorm running.

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Role of the Human Papillomavirus in Malignant Transformation of Oral Leukoplakia Distinct from Oropharyngeal Squamous Cell Carcinoma: A Study of 76 Patients with Internal-Control Specimens.

This study sought to investigate the role of human papillomaviruses (HPV) in oral leukoplakia (OLK) carcinogenesis, with the oral cavity as the site of interest.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Dl54tI

Synthesis of Ag-Ho, Ag-Sm, Ag-Zn, Ag-Cu, Ag-Cs, Ag-Zr, Ag-Er, Ag-Y and Ag-Co metal organic nanoparticles for UV-Vis-NIR wide-range bio-tissue imaging

Photochem. Photobiol. Sci., 2019, Accepted Manuscript
DOI: 10.1039/C8PP00493E, Paper

Ye Wu, Yingcheng Lin, Jian Xu
Development of materials for fluorescence imaging with wide optical range is important for clinical applications. In this work, a solution synthesis method was used for making Ag-Ho, Ag-Sm, Ag-Zn, Ag-Cu...
The content of this RSS Feed (c) The Royal Society of Chemistry

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://rsc.li/2Ct5dtB

Comparison of pre-oxygenation using spontaneous breathing through face mask and high-flow nasal oxygen: A prospective randomised crossover controlled study in healthy volunteers

BACKGROUND High-flow nasal oxygen (HFNO) therapy has been proposed for pre-oxygenation before intubation, but the end-tidal fraction of oxygen (ETO2) obtained remains unknown. OBJECTIVE(S) To compare the ETO2 following a 3 min pre-oxygenation with HFNO and face mask. SETTING Operating room in a primary university hospital. DESIGN A prospective, randomised crossover study. PARTICIPANTS Fifty healthy volunteers. INTERVENTIONS Participants were randomly pre-oxygenated through spontaneous breathing 100% oxygen in a face mask and with HFNO (mouth closed, heated and humidified gas flow at 60 l min–1). In the face mask group, the ETO2 was measured continuously. In the HFNO group, the nasal cannula was quickly exchanged with a face mask while the subject held their breath at end inspiration and the ETO2 was measured after a deep expiration. The protocol ended when ETO2 reached 90% or otherwise at 6 min. MAIN OUTCOME MEASURES The primary endpoint was the ETO2 after 3 min of pre-oxygenation. Secondary endpoints were the proportion of participants with an ETO2 at least 90% and the time until the ETO2 at least 90%. RESULTS The ETO2 after 3 min of pre-oxygenation was 89 (2) % and 77 (12) % in the face mask and HFNO groups [difference 12% (95% confidence interval, 95% CI: 8 to 15]; P 

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FEaz9t

Central venous-to-arterial PCO2 difference, arteriovenous oxygen content and outcome after adult cardiac surgery with cardiopulmonary bypass: A prospective observational study

BACKGROUND Rapid identification and treatment of tissue hypoxia reaching anaerobiosis (dysoxia) may reduce organ failure and the occurrence of major postoperative complications (MPC) after cardiac surgery. The predictive ability of PCO2-based dysoxia biomarkers, central venous-to-arterial PCO2 difference (ΔPCO2) and ΔPCO2 to arteriovenous oxygen content difference ratio, is poorly studied in this setting. OBJECTIVES We evaluated the ability of PCO2-based tissue dysoxia biomarkers, blood lactate concentration and central venous oxygen saturation measured 2 h after admission to the ICU as predictors of MPC. DESIGN A prospective, observational cohort study. SETTING Single-centre, academic hospital cardiovascular ICU. PATIENTS We included adult patients undergoing cardiac surgery with cardiopulmonary bypass and measured dysoxia biomarkers at ICU admission, and after 2, 6 and 24 h. MAIN OUTCOME MEASURES The primary endpoint was MPC, a composite of cardiac and noncardiac MPC evaluated in the 48 h following surgery. After univariate analysis of MPC covariates including dysoxia biomarkers measured at 2 h, multivariate logistic regression analyses were performed to identify the association of these biomarkers with MPC for confounders. Areas under the receiver operating characteristic curves were determined for biomarkers which remained independently associated with MPC. RESULTS MPC occurred in 56.5% of the 308 patients analysed. ΔPCO2, blood lactate concentration and central venous oxygen saturation measured at 2 h, but not ΔPCO2 to arteriovenous oxygen content difference ratio, were significantly associated with MPC. However, only ΔPCO2 was independently associated with MPC after multivariate analysis. The areas under the receiver operating characteristic curves of ΔPCO2 measured at 2 h for MPC prediction was 0.64 (95% CI 0.57 to 0.70, P 

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FI7Hr6

Programmed intermittent bolus infusion versus continuous infusion of 0.2% levobupivacaine after ultrasound-guided thoracic paravertebral block for video-assisted thoracoscopic surgery: A randomised controlled trial

BACKGROUND The analgesic benefits of programmed intermittent bolus infusion for thoracic paravertebral block remain unknown. OBJECTIVE The aim of this study was to compare the analgesia from intermittent bolus infusion with that of a continuous infusion after thoracic paravertebral block. DESIGN A randomised controlled study. SETTING A single centre between December 2016 and November 2017. Seventy patients scheduled for video-assisted thoracoscopic surgery were included in the study. INTERVENTION(S) Patients were randomly assigned to receive 0.2% levobupivacaine via continuous infusion (5 ml h−1, continuous group) or programmed intermittent bolus infusion (15 ml every 3 h, bolus group) after an initial 15-ml bolus injection of 0.2% levobupivacaine. MAIN OUTCOME MEASURES The main outcome was the amount of rescue fentanyl (per kg of body weight) consumed within 24 h after surgery. Secondary outcomes were postoperative pain scores, plasma levobupivacaine concentrations and the number of dermatomes anaesthetised. RESULTS There was no significant difference between the continuous and bolus groups in the postoperative consumption of fentanyl (median [interquartile range] 5.5 [4 to 9.5] μg kg−1 versus 6 [3.5 to 9] μg kg−1 respectively, P = 0.45) and postoperative pain scores within 24 h. At 20 h after initiating the infusions, there was no statistically significant difference between the two groups in terms of the plasma levobupivacaine concentration. The number of dermatomes anaesthetised to pinprick and cold testing was significantly greater in the bolus group. CONCLUSION Our findings suggest that postoperative pain and opioid usage are similar with either programmed intermittent bolus infusion or continuous infusion after thoracic paravertebral block. Programmed intermittent bolus infusion provides a wider sensory blockade and could benefit patients requiring a wider extent of anaesthesia. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN-CTR; URL: http://umin.ac.jp/ctr/, ID: UMIN000023378). Correspondence to Dr. Yasuko Taketa, Department of Anesthesiology and Critical Care, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama-City, Ehime 790-0024, Japan. E-mail: suko1231@yahoo.co.jp © 2019 European Society of Anaesthesiology

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Pre-operative ultrasonographic evaluation of inferior vena cava collapsibility index and caval aorta index as new predictors for hypotension after induction of spinal anaesthesia: A prospective observational study

BACKGROUND Hypotension after spinal anaesthesia is a common side effect that may be harmful. Patients' susceptibility to intra-operative hypotension can be affected by many pre-operative factors. OBJECTIVES The current study aimed to evaluate the efficacy of both pre-operative inferior vena cava collapsibility index (IVCCI) and inferior vena cava to aorta diameter (IVC : Ao) index for predicting postspinal anaesthesia hypotension (PSAH). DESIGN Prospective observational blinded study. SETTING Operating room from June 2017 to February 2018. PATIENTS One hundred adult patients of both sexes, American Society of Anesthesiologists' physical status 1 or 2 scheduled for elective surgery under spinal anaesthesia were included in this study. INTERVENTIONS Patients received spinal anaesthesia performed at the level of L3 to 4 or L4 to 5 intervertebral space with the patient in the sitting position then placed in the supine position immediately after neuraxial block and kept supine throughout the study period (30 min). IVCCI and IVC : Ao index were assessed pre-operatively. Baseline noninvasive blood pressure was recorded before administration of spinal anaesthesia then every minute after spinal blockade for 30 min. MAIN OUTCOME MEASURES The primary outcome was to evaluate the predictive values of both IVCCI and IVC : Ao index for detecting PSAH and the secondary outcomes were to compare the predictive values of both IVCCI and IVC : Ao index and to detect other clinical predictors for PSAH using logistic regression analysis. RESULTS Forty-five patients developed PSAH (45%). IVCCI was significantly higher in patients who developed PSAH than in patients who did not, while IVC : Ao index was significantly lower in patients who developed PSAH than in patients who did not. Hypotension after induction of spinal anaesthesia was defined as an absolute value of SBP less than 90 mmHg, a decrease in SBP more than 30% of the baseline value or an absolute value of arterial blood pressure less than 60 mmHg. Logistic regression analysis revealed that IVCCI and IVC : Ao index were good predictors of the occurrence of PSAH. Receiver operating characteristic curve analysis showed that IVC : Ao index had a sensitivity of 96%, a specificity of 88%, and an accuracy of 95% to predict PSAH at a cut-off point less than 1.2. IVCCI had a sensitivity of 84%, a specificity of 77%, and an accuracy of 84% to predict PSAH at a cut-off point more than 44.7%. CONCLUSION Pre-operative IVCCI and IVC : Ao index are good predictors of the occurrence of PSAH. However, IVC : Ao index is a more powerful predictor than IVCCI. TRIAL REGISTRATION This study evaluate accuracy of two diagnostic methods for the occurrence of postspinal anaesthesia hypotension, so not a clinical trial as no intervention is present and no outcome of intervention is measured. Correspondence to Dr Eman Ramadan Salama, MD, Anaesthesia and Surgical ICU, Tanta University Hospital, Tanta, Egypt Tel: +20 1277886405; fax: +20 402231671; e-mail: dr.ers1975@yahoo.com © 2019 European Society of Anaesthesiology

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

Role of the Human Papillomavirus in Malignant Transformation of Oral Leukoplakia Distinct from Oropharyngeal Squamous Cell Carcinoma: A Study of 76 Patients with Internal-Control Specimens.

This study sought to investigate the role of human papillomaviruses (HPV) in oral leukoplakia (OLK) carcinogenesis, with the oral cavity as the site of interest.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Dl54tI

Synthesis of Ag-Ho, Ag-Sm, Ag-Zn, Ag-Cu, Ag-Cs, Ag-Zr, Ag-Er, Ag-Y and Ag-Co metal organic nanoparticles for UV-Vis-NIR wide-range bio-tissue imaging

Photochem. Photobiol. Sci., 2019, Accepted Manuscript
DOI: 10.1039/C8PP00493E, Paper

Ye Wu, Yingcheng Lin, Jian Xu
Development of materials for fluorescence imaging with wide optical range is important for clinical applications. In this work, a solution synthesis method was used for making Ag-Ho, Ag-Sm, Ag-Zn, Ag-Cu...
The content of this RSS Feed (c) The Royal Society of Chemistry

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://rsc.li/2Ct5dtB

Comparison of pre-oxygenation using spontaneous breathing through face mask and high-flow nasal oxygen: A prospective randomised crossover controlled study in healthy volunteers

BACKGROUND High-flow nasal oxygen (HFNO) therapy has been proposed for pre-oxygenation before intubation, but the end-tidal fraction of oxygen (ETO2) obtained remains unknown. OBJECTIVE(S) To compare the ETO2 following a 3 min pre-oxygenation with HFNO and face mask. SETTING Operating room in a primary university hospital. DESIGN A prospective, randomised crossover study. PARTICIPANTS Fifty healthy volunteers. INTERVENTIONS Participants were randomly pre-oxygenated through spontaneous breathing 100% oxygen in a face mask and with HFNO (mouth closed, heated and humidified gas flow at 60 l min–1). In the face mask group, the ETO2 was measured continuously. In the HFNO group, the nasal cannula was quickly exchanged with a face mask while the subject held their breath at end inspiration and the ETO2 was measured after a deep expiration. The protocol ended when ETO2 reached 90% or otherwise at 6 min. MAIN OUTCOME MEASURES The primary endpoint was the ETO2 after 3 min of pre-oxygenation. Secondary endpoints were the proportion of participants with an ETO2 at least 90% and the time until the ETO2 at least 90%. RESULTS The ETO2 after 3 min of pre-oxygenation was 89 (2) % and 77 (12) % in the face mask and HFNO groups [difference 12% (95% confidence interval, 95% CI: 8 to 15]; P 

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FEaz9t

Central venous-to-arterial PCO2 difference, arteriovenous oxygen content and outcome after adult cardiac surgery with cardiopulmonary bypass: A prospective observational study

BACKGROUND Rapid identification and treatment of tissue hypoxia reaching anaerobiosis (dysoxia) may reduce organ failure and the occurrence of major postoperative complications (MPC) after cardiac surgery. The predictive ability of PCO2-based dysoxia biomarkers, central venous-to-arterial PCO2 difference (ΔPCO2) and ΔPCO2 to arteriovenous oxygen content difference ratio, is poorly studied in this setting. OBJECTIVES We evaluated the ability of PCO2-based tissue dysoxia biomarkers, blood lactate concentration and central venous oxygen saturation measured 2 h after admission to the ICU as predictors of MPC. DESIGN A prospective, observational cohort study. SETTING Single-centre, academic hospital cardiovascular ICU. PATIENTS We included adult patients undergoing cardiac surgery with cardiopulmonary bypass and measured dysoxia biomarkers at ICU admission, and after 2, 6 and 24 h. MAIN OUTCOME MEASURES The primary endpoint was MPC, a composite of cardiac and noncardiac MPC evaluated in the 48 h following surgery. After univariate analysis of MPC covariates including dysoxia biomarkers measured at 2 h, multivariate logistic regression analyses were performed to identify the association of these biomarkers with MPC for confounders. Areas under the receiver operating characteristic curves were determined for biomarkers which remained independently associated with MPC. RESULTS MPC occurred in 56.5% of the 308 patients analysed. ΔPCO2, blood lactate concentration and central venous oxygen saturation measured at 2 h, but not ΔPCO2 to arteriovenous oxygen content difference ratio, were significantly associated with MPC. However, only ΔPCO2 was independently associated with MPC after multivariate analysis. The areas under the receiver operating characteristic curves of ΔPCO2 measured at 2 h for MPC prediction was 0.64 (95% CI 0.57 to 0.70, P 

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FI7Hr6

Programmed intermittent bolus infusion versus continuous infusion of 0.2% levobupivacaine after ultrasound-guided thoracic paravertebral block for video-assisted thoracoscopic surgery: A randomised controlled trial

BACKGROUND The analgesic benefits of programmed intermittent bolus infusion for thoracic paravertebral block remain unknown. OBJECTIVE The aim of this study was to compare the analgesia from intermittent bolus infusion with that of a continuous infusion after thoracic paravertebral block. DESIGN A randomised controlled study. SETTING A single centre between December 2016 and November 2017. Seventy patients scheduled for video-assisted thoracoscopic surgery were included in the study. INTERVENTION(S) Patients were randomly assigned to receive 0.2% levobupivacaine via continuous infusion (5 ml h−1, continuous group) or programmed intermittent bolus infusion (15 ml every 3 h, bolus group) after an initial 15-ml bolus injection of 0.2% levobupivacaine. MAIN OUTCOME MEASURES The main outcome was the amount of rescue fentanyl (per kg of body weight) consumed within 24 h after surgery. Secondary outcomes were postoperative pain scores, plasma levobupivacaine concentrations and the number of dermatomes anaesthetised. RESULTS There was no significant difference between the continuous and bolus groups in the postoperative consumption of fentanyl (median [interquartile range] 5.5 [4 to 9.5] μg kg−1 versus 6 [3.5 to 9] μg kg−1 respectively, P = 0.45) and postoperative pain scores within 24 h. At 20 h after initiating the infusions, there was no statistically significant difference between the two groups in terms of the plasma levobupivacaine concentration. The number of dermatomes anaesthetised to pinprick and cold testing was significantly greater in the bolus group. CONCLUSION Our findings suggest that postoperative pain and opioid usage are similar with either programmed intermittent bolus infusion or continuous infusion after thoracic paravertebral block. Programmed intermittent bolus infusion provides a wider sensory blockade and could benefit patients requiring a wider extent of anaesthesia. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN-CTR; URL: http://umin.ac.jp/ctr/, ID: UMIN000023378). Correspondence to Dr. Yasuko Taketa, Department of Anesthesiology and Critical Care, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama-City, Ehime 790-0024, Japan. E-mail: suko1231@yahoo.co.jp © 2019 European Society of Anaesthesiology

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Fzh4Kw

Pre-operative ultrasonographic evaluation of inferior vena cava collapsibility index and caval aorta index as new predictors for hypotension after induction of spinal anaesthesia: A prospective observational study

BACKGROUND Hypotension after spinal anaesthesia is a common side effect that may be harmful. Patients' susceptibility to intra-operative hypotension can be affected by many pre-operative factors. OBJECTIVES The current study aimed to evaluate the efficacy of both pre-operative inferior vena cava collapsibility index (IVCCI) and inferior vena cava to aorta diameter (IVC : Ao) index for predicting postspinal anaesthesia hypotension (PSAH). DESIGN Prospective observational blinded study. SETTING Operating room from June 2017 to February 2018. PATIENTS One hundred adult patients of both sexes, American Society of Anesthesiologists' physical status 1 or 2 scheduled for elective surgery under spinal anaesthesia were included in this study. INTERVENTIONS Patients received spinal anaesthesia performed at the level of L3 to 4 or L4 to 5 intervertebral space with the patient in the sitting position then placed in the supine position immediately after neuraxial block and kept supine throughout the study period (30 min). IVCCI and IVC : Ao index were assessed pre-operatively. Baseline noninvasive blood pressure was recorded before administration of spinal anaesthesia then every minute after spinal blockade for 30 min. MAIN OUTCOME MEASURES The primary outcome was to evaluate the predictive values of both IVCCI and IVC : Ao index for detecting PSAH and the secondary outcomes were to compare the predictive values of both IVCCI and IVC : Ao index and to detect other clinical predictors for PSAH using logistic regression analysis. RESULTS Forty-five patients developed PSAH (45%). IVCCI was significantly higher in patients who developed PSAH than in patients who did not, while IVC : Ao index was significantly lower in patients who developed PSAH than in patients who did not. Hypotension after induction of spinal anaesthesia was defined as an absolute value of SBP less than 90 mmHg, a decrease in SBP more than 30% of the baseline value or an absolute value of arterial blood pressure less than 60 mmHg. Logistic regression analysis revealed that IVCCI and IVC : Ao index were good predictors of the occurrence of PSAH. Receiver operating characteristic curve analysis showed that IVC : Ao index had a sensitivity of 96%, a specificity of 88%, and an accuracy of 95% to predict PSAH at a cut-off point less than 1.2. IVCCI had a sensitivity of 84%, a specificity of 77%, and an accuracy of 84% to predict PSAH at a cut-off point more than 44.7%. CONCLUSION Pre-operative IVCCI and IVC : Ao index are good predictors of the occurrence of PSAH. However, IVC : Ao index is a more powerful predictor than IVCCI. TRIAL REGISTRATION This study evaluate accuracy of two diagnostic methods for the occurrence of postspinal anaesthesia hypotension, so not a clinical trial as no intervention is present and no outcome of intervention is measured. Correspondence to Dr Eman Ramadan Salama, MD, Anaesthesia and Surgical ICU, Tanta University Hospital, Tanta, Egypt Tel: +20 1277886405; fax: +20 402231671; e-mail: dr.ers1975@yahoo.com © 2019 European Society of Anaesthesiology

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Respiratory and Airway Considerations in Obstetric Patients

Abstract

Purpose of Review

The purpose of this article is to provide the current evidences on respiratory and airway medicine in the obstetric population.

Recent Findings

The prevalence of obstructive sleep apnea (OSA) among pregnant women is increasing. Upper body elevation improves respiratory mechanics in parturients and reduces the risk of postpartum OSA. Clinically significant respiratory depression from neuraxial opioid administration, compared to parenteral, is extremely rare.

The incidence of failed tracheal intubation in obstetric patients is higher than that in non-obstetric patients and it has been unchanged recently. The first obstetric-specific guidelines for the management of difficult airway were published in 2015.

The incidence of serious aspiration in obstetric patients is low and has been decreasing. Interventions to reduce aspiration at cesarean delivery recommended by recently published guidelines and clinical studies will be discussed. Supplemental oxygen during uncomplicated delivery, either cesarean or vaginal, has been controversial.

Summary

Understanding the changes in airway anatomy and respiratory physiology related to pregnancy, and adherence to evidence-based guidelines are essential in taking care of obstetric patients. Recently published scholarly articles and clinical guidelines relevant to respiratory physiology and airway management in obstetric anesthesia will be presented.

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

Anesthetic Considerations in the Care of the Parturient with Obesity

Abstract

Purpose of Review

The goal of this review is to summarize recent findings on the physiologic alterations posed by maternal obesity and implications for the anesthetic care of mother and infant.

Recent Findings

Obesity is rising nationally and globally. Many studies show associations between excess weight during pregnancy with increased morbidity and mortality. Parturients with obesity are at a higher risk of endocrine, cardiac, pulmonary, and post-operative complications. A neuraxial catheter is recommended given the higher risk of an operative delivery. Consultation by an obstetric anesthesiologist is helpful for patient education and planning.

Summary

Maternal mortality is the highest in the USA compared to other high-income countries. Understanding the association between obesity and maternal morbidity and mortality is critically important. The obstetric anesthesiologist can improve care by understanding not only the patient's medical needs, but also anticipating complications and having appropriate equipment available. Multi-disciplinary care optimizes outcomes.

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

Development of Intensive Care in Low-Resource Regions

Abstract

Purpose of review

Since their introduction almost a century ago, intensive care units have become an essential part of the health care system. Although the majority are found in the high-income countries, access to intensive care in the low-income countries has improved. The purpose of this review is to report on the current state of intensive care in resource-limited settings.

Recent Findings

Lack of basic health care resources still poses a specific challenge to the development and sustainability of health care. In addition, adequate funding, human resource training, and equipment specific to the specialty of critical care pose an even larger setback to the development of critical care in low-resource-limited settings.

Summary

Deaths potentially preventable with access to critical care as presented by data from the global disease burden analysis in 2004 are approximately 70% of all recorded deaths in low-income countries. This reflects the large burden of critical illness in low-income countries. Efforts to increase access to hospitals and intensive care for all critically ill patients should grow to match these needs.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FB0wlg

Respiratory and Airway Considerations in Obstetric Patients

Abstract

Purpose of Review

The purpose of this article is to provide the current evidences on respiratory and airway medicine in the obstetric population.

Recent Findings

The prevalence of obstructive sleep apnea (OSA) among pregnant women is increasing. Upper body elevation improves respiratory mechanics in parturients and reduces the risk of postpartum OSA. Clinically significant respiratory depression from neuraxial opioid administration, compared to parenteral, is extremely rare.

The incidence of failed tracheal intubation in obstetric patients is higher than that in non-obstetric patients and it has been unchanged recently. The first obstetric-specific guidelines for the management of difficult airway were published in 2015.

The incidence of serious aspiration in obstetric patients is low and has been decreasing. Interventions to reduce aspiration at cesarean delivery recommended by recently published guidelines and clinical studies will be discussed. Supplemental oxygen during uncomplicated delivery, either cesarean or vaginal, has been controversial.

Summary

Understanding the changes in airway anatomy and respiratory physiology related to pregnancy, and adherence to evidence-based guidelines are essential in taking care of obstetric patients. Recently published scholarly articles and clinical guidelines relevant to respiratory physiology and airway management in obstetric anesthesia will be presented.

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

Anesthetic Considerations in the Care of the Parturient with Obesity

Abstract

Purpose of Review

The goal of this review is to summarize recent findings on the physiologic alterations posed by maternal obesity and implications for the anesthetic care of mother and infant.

Recent Findings

Obesity is rising nationally and globally. Many studies show associations between excess weight during pregnancy with increased morbidity and mortality. Parturients with obesity are at a higher risk of endocrine, cardiac, pulmonary, and post-operative complications. A neuraxial catheter is recommended given the higher risk of an operative delivery. Consultation by an obstetric anesthesiologist is helpful for patient education and planning.

Summary

Maternal mortality is the highest in the USA compared to other high-income countries. Understanding the association between obesity and maternal morbidity and mortality is critically important. The obstetric anesthesiologist can improve care by understanding not only the patient's medical needs, but also anticipating complications and having appropriate equipment available. Multi-disciplinary care optimizes outcomes.

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

Development of Intensive Care in Low-Resource Regions

Abstract

Purpose of review

Since their introduction almost a century ago, intensive care units have become an essential part of the health care system. Although the majority are found in the high-income countries, access to intensive care in the low-income countries has improved. The purpose of this review is to report on the current state of intensive care in resource-limited settings.

Recent Findings

Lack of basic health care resources still poses a specific challenge to the development and sustainability of health care. In addition, adequate funding, human resource training, and equipment specific to the specialty of critical care pose an even larger setback to the development of critical care in low-resource-limited settings.

Summary

Deaths potentially preventable with access to critical care as presented by data from the global disease burden analysis in 2004 are approximately 70% of all recorded deaths in low-income countries. This reflects the large burden of critical illness in low-income countries. Efforts to increase access to hospitals and intensive care for all critically ill patients should grow to match these needs.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FB0wlg

Systemic Antibody Responses to Gut Commensal Bacteria: How and Why Do I Know You?

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

Novel Proteasome Assembly Chaperone mutations in PSMG2/PAC2, cause the autoinflammatory interferonopathy, CANDLE/PRAAS4

Chronic Atypical Neutrophilic Dermatosis with Lipodystrophy and Elevated temperature (CANDLE) is a rare autoinflammatory interferonopathy caused by additive loss-of-function mutations in proteasome genes. Mutations in the proteasome chaperone, PSMG2/PAC2 are a novel cause of CANDLE.

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

Regulatory cells in the skin: pathophysiological role and potential targets for anti-inflammatory therapies

Inflammation is a fundamental defence mechanism to protect the body from danger, which becomes potentially harmful if it turns chronic. Therapeutic strategies aimed at specifically blocking pro-inflammatory signals - particularly cytokines such as interleukin-4, interleukin-6, interleukin-13, interleukin-17A or tumour necrosis factor α - have substantially improved our ability to effectively and safely treat chronic inflammatory diseases. Much less efforts have been made to better understand the role of potential anti-inflammatory mechanisms.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CtZV0Y

Systemic Antibody Responses to Gut Commensal Bacteria: How and Why Do I Know You?

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

Novel Proteasome Assembly Chaperone mutations in PSMG2/PAC2, cause the autoinflammatory interferonopathy, CANDLE/PRAAS4

Chronic Atypical Neutrophilic Dermatosis with Lipodystrophy and Elevated temperature (CANDLE) is a rare autoinflammatory interferonopathy caused by additive loss-of-function mutations in proteasome genes. Mutations in the proteasome chaperone, PSMG2/PAC2 are a novel cause of CANDLE.

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

Regulatory cells in the skin: pathophysiological role and potential targets for anti-inflammatory therapies

Inflammation is a fundamental defence mechanism to protect the body from danger, which becomes potentially harmful if it turns chronic. Therapeutic strategies aimed at specifically blocking pro-inflammatory signals - particularly cytokines such as interleukin-4, interleukin-6, interleukin-13, interleukin-17A or tumour necrosis factor α - have substantially improved our ability to effectively and safely treat chronic inflammatory diseases. Much less efforts have been made to better understand the role of potential anti-inflammatory mechanisms.

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Skin Cancer Associated Genodermatoses: A Literature Review.

Authors: Schierbeck J, Vestergaard T, Bygum A Abstract Skin cancer has become the most common type of cancer worldwide as a result of environmental exposure and medical treatments. A small group of patients are genetically predisposed to skin cancer and this article is intended as a diagnostic tool when encountering patients with multiple skin cancer lesions. The disorders are described with clinical characteristics, genetics and management. The most common syndromes associated with basal cell carcinoma are: Gorlin-Goltz syndrome, Rombo syndrome, and Bazex-Dupré-Christol syndrome. Multiple squamous cell carcinomas can be related to: xeroderma pigmentosum, Ferguson-Smith, Muir-Torre syndrome, Mibelli-type, porokeratosis, keratitis-ichthyosis-deafness syndrome, Rothmund-Thomson synd...

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Tonsillectomy plus steroid pulse therapy is the most effective treatment in adult patients with C-Grade I IgA nephropathy, and the weight of the extracted palatine tonsils and Yamamoto scale have no significant correlation with the effects of this treatment

We studied patients who underwent tonsillectomy plus steroid pulse therapy (TSP) for immunoglobulin A nephropathy (IgAN), in order to investigate the clinical factors associated with a positive response to this treatment.

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Skin Cancer Associated Genodermatoses: A Literature Review.

Authors: Schierbeck J, Vestergaard T, Bygum A Abstract Skin cancer has become the most common type of cancer worldwide as a result of environmental exposure and medical treatments. A small group of patients are genetically predisposed to skin cancer and this article is intended as a diagnostic tool when encountering patients with multiple skin cancer lesions. The disorders are described with clinical characteristics, genetics and management. The most common syndromes associated with basal cell carcinoma are: Gorlin-Goltz syndrome, Rombo syndrome, and Bazex-Dupré-Christol syndrome. Multiple squamous cell carcinomas can be related to: xeroderma pigmentosum, Ferguson-Smith, Muir-Torre syndrome, Mibelli-type, porokeratosis, keratitis-ichthyosis-deafness syndrome, Rothmund-Thomson synd...

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

Tonsillectomy plus steroid pulse therapy is the most effective treatment in adult patients with C-Grade I IgA nephropathy, and the weight of the extracted palatine tonsils and Yamamoto scale have no significant correlation with the effects of this treatment

We studied patients who underwent tonsillectomy plus steroid pulse therapy (TSP) for immunoglobulin A nephropathy (IgAN), in order to investigate the clinical factors associated with a positive response to this treatment.

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

A Mysterious Company Claims to Sell Sneeze-Filled Tissues for $80. Is It Real?

The package appeared one day, unbidden, on the desk of a TIME writer. Inside was a slick white box that housed a petri dish sealed with gold tape. In the dish was a crumpled tissue—and inside the tissue were, allegedly, the germs of a sick person who had sneezed into it. Vaev Tissue, the only product of a new startup based in Los Angeles, costs $79.99, according to the company's website. Its sole purpose is to give the user a cold virus. "We believe using a tissue that carries a human sneeze is safer than needles or pills," read the note that came with the product, written by the founder of the company. Wipe your nose with the sullied tissue, and you'll "get sick on your own terms." But a few questions lingered, like a runny nose that won't ...

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Contaminated Umbilical Cord Blood-Derived Stem Cell Products Contaminated Umbilical Cord Blood-Derived Stem Cell Products

This investigation highlights the serious potential risks to patients of stem cell therapies administered for unapproved and unproven uses other than hematopoietic or immunologic reconstitution.Morbidity & Mortality Weekly Report (Source: Medscape Today Headlines)

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A Mysterious Company Claims to Sell Sneeze-Filled Tissues for $80. Is It Real?

The package appeared one day, unbidden, on the desk of a TIME writer. Inside was a slick white box that housed a petri dish sealed with gold tape. In the dish was a crumpled tissue—and inside the tissue were, allegedly, the germs of a sick person who had sneezed into it. Vaev Tissue, the only product of a new startup based in Los Angeles, costs $79.99, according to the company's website. Its sole purpose is to give the user a cold virus. "We believe using a tissue that carries a human sneeze is safer than needles or pills," read the note that came with the product, written by the founder of the company. Wipe your nose with the sullied tissue, and you'll "get sick on your own terms." But a few questions lingered, like a runny nose that won't ...

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2T4xOMM

Contaminated Umbilical Cord Blood-Derived Stem Cell Products Contaminated Umbilical Cord Blood-Derived Stem Cell Products

This investigation highlights the serious potential risks to patients of stem cell therapies administered for unapproved and unproven uses other than hematopoietic or immunologic reconstitution.Morbidity & Mortality Weekly Report (Source: Medscape Today Headlines)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2HlL6mA

A Mysterious Company Claims to Sell Sneeze-Filled Tissues for $80. Is It Real?

The package appeared one day, unbidden, on the desk of a TIME writer. Inside was a slick white box that housed a petri dish sealed with gold tape. In the dish was a crumpled tissue—and inside the tissue were, allegedly, the germs of a sick person who had sneezed into it. Vaev Tissue, the only product of a new startup based in Los Angeles, costs $79.99, according to the company's website. Its sole purpose is to give the user a cold virus. "We believe using a tissue that carries a human sneeze is safer than needles or pills," read the note that came with the product, written by the founder of the company. Wipe your nose with the sullied tissue, and you'll "get sick on your own terms." But a few questions lingered, like a runny nose that won't ...

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2T4xOMM

Contaminated Umbilical Cord Blood-Derived Stem Cell Products Contaminated Umbilical Cord Blood-Derived Stem Cell Products

This investigation highlights the serious potential risks to patients of stem cell therapies administered for unapproved and unproven uses other than hematopoietic or immunologic reconstitution.Morbidity & Mortality Weekly Report (Source: Medscape Today Headlines)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2HlL6mA

A Mysterious Company Claims to Sell Sneeze-Filled Tissues for $80. Is It Real?

The package appeared one day, unbidden, on the desk of a TIME writer. Inside was a slick white box that housed a petri dish sealed with gold tape. In the dish was a crumpled tissue—and inside the tissue were, allegedly, the germs of a sick person who had sneezed into it. Vaev Tissue, the only product of a new startup based in Los Angeles, costs $79.99, according to the company's website. Its sole purpose is to give the user a cold virus. "We believe using a tissue that carries a human sneeze is safer than needles or pills," read the note that came with the product, written by the founder of the company. Wipe your nose with the sullied tissue, and you'll "get sick on your own terms." But a few questions lingered, like a runny nose that won't ...

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2T4xOMM

Contaminated Umbilical Cord Blood-Derived Stem Cell Products Contaminated Umbilical Cord Blood-Derived Stem Cell Products

This investigation highlights the serious potential risks to patients of stem cell therapies administered for unapproved and unproven uses other than hematopoietic or immunologic reconstitution.Morbidity & Mortality Weekly Report (Source: Medscape Today Headlines)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2HlL6mA

Transcranial direct current stimulation in post-stroke aphasia rehabilitation: a systematic review

ConclusionEvidence from published peer reviewed literature is effective for post stroke aphasia rehabilitation at the chronic stages. tDCS devices are easy to use, safe and inexpensive. They can be used in routine clinical practice by speech therapists for aphasia rehabilitation. However, further studies should investigate the effectiveness in the sub-acute post-stroke phase and determine the effect of the lesion for precisely identifying the targeted brain areas. We discuss crucial challenges for future studies. (Source: Annals of Physical and Rehabilitation Medicine)

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Challenges and opportunities in augmentative and alternative communication: Research and technology development to enhance communication and participation for individuals with complex communication needs.

Authors: Light J, McNaughton D, Beukelman D, Fager SK, Fried-Oken M, Jakobs T, Jakobs E Abstract The field of augmentative and alternative communication (AAC) has witnessed significant changes since its inception. AAC services are now considered for a much greater number of individuals with complex communication needs and there are many more AAC options available as communication supports, including a proliferation of technologies. The scope and options for communication within society have increased substantially to include a wide array of digital and social media. Individuals with complex communication needs have increased expectations for participation and engagement across a full range of environments-education, employment, family, healthcare, and community living. Despite thes...

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Designing effective AAC displays for individuals with developmental or acquired disabilities: State of the science and future research directions.

Authors: Light J, Wilkinson KM, Thiessen A, Beukelman DR, Fager SK Abstract This paper reviews research on the impact of AAC display variables on visual attention and performance of children with developmental disabilities and adults with acquired conditions, and considers implications for designing effective visual scene displays (VSDs) or grids. When using VSDs with children with developmental disabilities or adults with acquired conditions, research supports the use of personalized photo VSDs that include familiar people engaged in meaningful activities, with navigation bars with thumbnail VSDs, located adjacent to the main VSD. Adults with acquired conditions seem to benefit from the inclusion of text boxes adjacent to the scene. Emerging evidence supports the use of motion to ...

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Vocal characteristics of 5-year-old children: proposed normative values based on a French-speaking population †.

CONCLUSIONS: The lack of gender differences - other than for NHR on the vowel [a] - led us to propose mixed norms for 5-year-old boys and girls combined. IMPLICATIONS: These normative data will allow clinicians to compare children's voice assessments to specific references in order to enhance diagnostic accuracy and measure therapy outcomes. PMID: 30648500 [PubMed - as supplied by publisher] (Source: Logopedics, Phoniatrics, Vocology.)

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New and emerging AAC technology supports for children with complex communication needs and their communication partners: State of the science and future research directions.

Authors: Light J, McNaughton D, Caron J Abstract This paper discusses recent research and development with a specific focus on selected new and emerging research-based augmentative and alternative communication (AAC) technologies that are developmentally appropriate and responsive to the individual interests, needs, and skills of children with developmental disabilities, their families, peers, and other communication partners. Specifically, this paper reviews the state of the science and future directions related to recent research and development of AAC technologies as supports to (a) enhance language learning, (b) facilitate social interaction, (c) improve literacy skills, (d) increase participation in society, and (e) teach interaction strategies to communication partners. P...

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

Effects of regional dialect on oral-nasal balance and nasality perception.

This study explored cross-dialectal differences in the production of oral-nasal balance and the perception of nasality, with special emphasis on Inland North (IN) and Midland (M) dialects in the USA. Twenty-six adults representing the IN (n = 15) and M (n = 11) dialects participated in the study. Oral-nasal balance characteristics and nasality perception were compared between dialects using mean nasalance of various speech stimuli, measured via nasometry, and perceptual ratings of nasality of synthetic vowel stimuli, measured using direct magnitude estimation (DME). Despite similar mean nasalance scores between two regional dialects for standardized passage readings and sustained vowels, IN and M groups significantly differed in their perceptual ratings of nasality, with the DMEs of IN l...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CtO7M0

Transcranial direct current stimulation in post-stroke aphasia rehabilitation: a systematic review

ConclusionEvidence from published peer reviewed literature is effective for post stroke aphasia rehabilitation at the chronic stages. tDCS devices are easy to use, safe and inexpensive. They can be used in routine clinical practice by speech therapists for aphasia rehabilitation. However, further studies should investigate the effectiveness in the sub-acute post-stroke phase and determine the effect of the lesion for precisely identifying the targeted brain areas. We discuss crucial challenges for future studies. (Source: Annals of Physical and Rehabilitation Medicine)

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RxV7lr

Challenges and opportunities in augmentative and alternative communication: Research and technology development to enhance communication and participation for individuals with complex communication needs.

Authors: Light J, McNaughton D, Beukelman D, Fager SK, Fried-Oken M, Jakobs T, Jakobs E Abstract The field of augmentative and alternative communication (AAC) has witnessed significant changes since its inception. AAC services are now considered for a much greater number of individuals with complex communication needs and there are many more AAC options available as communication supports, including a proliferation of technologies. The scope and options for communication within society have increased substantially to include a wide array of digital and social media. Individuals with complex communication needs have increased expectations for participation and engagement across a full range of environments-education, employment, family, healthcare, and community living. Despite thes...

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

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Cs1zQx

Designing effective AAC displays for individuals with developmental or acquired disabilities: State of the science and future research directions.

Authors: Light J, Wilkinson KM, Thiessen A, Beukelman DR, Fager SK Abstract This paper reviews research on the impact of AAC display variables on visual attention and performance of children with developmental disabilities and adults with acquired conditions, and considers implications for designing effective visual scene displays (VSDs) or grids. When using VSDs with children with developmental disabilities or adults with acquired conditions, research supports the use of personalized photo VSDs that include familiar people engaged in meaningful activities, with navigation bars with thumbnail VSDs, located adjacent to the main VSD. Adults with acquired conditions seem to benefit from the inclusion of text boxes adjacent to the scene. Emerging evidence supports the use of motion to ...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RxUZ5r

Vocal characteristics of 5-year-old children: proposed normative values based on a French-speaking population †.

CONCLUSIONS: The lack of gender differences - other than for NHR on the vowel [a] - led us to propose mixed norms for 5-year-old boys and girls combined. IMPLICATIONS: These normative data will allow clinicians to compare children's voice assessments to specific references in order to enhance diagnostic accuracy and measure therapy outcomes. PMID: 30648500 [PubMed - as supplied by publisher] (Source: Logopedics, Phoniatrics, Vocology.)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CxIf4k

New and emerging AAC technology supports for children with complex communication needs and their communication partners: State of the science and future research directions.

Authors: Light J, McNaughton D, Caron J Abstract This paper discusses recent research and development with a specific focus on selected new and emerging research-based augmentative and alternative communication (AAC) technologies that are developmentally appropriate and responsive to the individual interests, needs, and skills of children with developmental disabilities, their families, peers, and other communication partners. Specifically, this paper reviews the state of the science and future directions related to recent research and development of AAC technologies as supports to (a) enhance language learning, (b) facilitate social interaction, (c) improve literacy skills, (d) increase participation in society, and (e) teach interaction strategies to communication partners. P...

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

Effects of regional dialect on oral-nasal balance and nasality perception.

This study explored cross-dialectal differences in the production of oral-nasal balance and the perception of nasality, with special emphasis on Inland North (IN) and Midland (M) dialects in the USA. Twenty-six adults representing the IN (n = 15) and M (n = 11) dialects participated in the study. Oral-nasal balance characteristics and nasality perception were compared between dialects using mean nasalance of various speech stimuli, measured via nasometry, and perceptual ratings of nasality of synthetic vowel stimuli, measured using direct magnitude estimation (DME). Despite similar mean nasalance scores between two regional dialects for standardized passage readings and sustained vowels, IN and M groups significantly differed in their perceptual ratings of nasality, with the DMEs of IN l...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CtO7M0

Tuberous Breast Deformity Correction: 12-Years Experience

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Tuberous Breast Deformity Correction: 12-Years Experience

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Issue Information

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Author Guidelines

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Issue Information

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Author Guidelines

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Tuberous Breast Deformity Correction: 12-Years Experience

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Tuberous Breast Deformity Correction: 12-Years Experience

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Ewing ’s Sarcoma of the Sinonasal Tract: A Report of Two Challenging Cases

We present these cases due to the rarity of the disease and the difficulty o f diagnosis. (Source: Indian Journal of Otolaryngology and Head and Neck Surgery)

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Ewing ’s Sarcoma of the Sinonasal Tract: A Report of Two Challenging Cases

We present these cases due to the rarity of the disease and the difficulty o f diagnosis. (Source: Indian Journal of Otolaryngology and Head and Neck Surgery)

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Perioperative pain management for general and plastic surgery

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Perioperative pain management for general and plastic surgery

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Diversity of the Oral Microbiome Between Dentate and Edentulous Individuals

Abstract

Background

Measurement of saliva microbes is promoted as a way to detect oral and systemic disease, yet there is a multitude of factors that affect the oral microbiome. The salivary microbiome is influenced by oral biofilm of shedding (epithelial) and non‐shedding (tooth) surfaces.

Methods

To gauge the ability of salivary microbial analytics to distinguish between edentulous and dentate oral conditions, we looked for differences in the saliva microbiome of subjects with and without teeth. 52 dentate and 49 edentulous subjects provided stimulated saliva samples. 16S rRNA gene sequencing, QIIME‐based data processing, and statistical analysis was done using several different analytical approaches to detect differences in the salivary microbiome between the two groups.

Results

Bacteria diversity was lower in the edentulous group. Remarkably, all 31 of the most significant differences in taxa were deficits that occur in the edentulous group. As one might expect many of these taxa are attributed to dental plaque and gingival sulcus associated bacteria.

Conclusion

In sum, the measurement of 16S rRNA genes in the bacteria of the saliva can be used to reproducibly measure differences in the oral microbiome that occur with edentulism, mainly the lack of tooth and tooth related structures.

This article is protected by copyright. All rights reserved.

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Diversity of the Oral Microbiome Between Dentate and Edentulous Individuals

Abstract

Background

Measurement of saliva microbes is promoted as a way to detect oral and systemic disease, yet there is a multitude of factors that affect the oral microbiome. The salivary microbiome is influenced by oral biofilm of shedding (epithelial) and non‐shedding (tooth) surfaces.

Methods

To gauge the ability of salivary microbial analytics to distinguish between edentulous and dentate oral conditions, we looked for differences in the saliva microbiome of subjects with and without teeth. 52 dentate and 49 edentulous subjects provided stimulated saliva samples. 16S rRNA gene sequencing, QIIME‐based data processing, and statistical analysis was done using several different analytical approaches to detect differences in the salivary microbiome between the two groups.

Results

Bacteria diversity was lower in the edentulous group. Remarkably, all 31 of the most significant differences in taxa were deficits that occur in the edentulous group. As one might expect many of these taxa are attributed to dental plaque and gingival sulcus associated bacteria.

Conclusion

In sum, the measurement of 16S rRNA genes in the bacteria of the saliva can be used to reproducibly measure differences in the oral microbiome that occur with edentulism, mainly the lack of tooth and tooth related structures.

This article is protected by copyright. All rights reserved.

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A Randomized Pilot Trial of a School‐Based Psychoeducational Intervention for Children with Asthma

Abstract

Background

Asthma is a common childhood illness with high morbidity and mortality among minority and socioeconomically disadvantaged children. Disparities are not fully accounted for by differences in asthma prevalence, highlighting a need for interventions targeting factors associated with poorer asthma control. One such factor is psychological stress.

Objective

Here, we examine the feasibility and acceptability of "I Can Cope (ICC)," a school‐based stress management and coping intervention for children with asthma.

Methods

A parallel randomized pilot trial was conducted. One hundred and four low income children (mean age 10 years; 54% male; 70% African American) with persistent asthma were recruited from 12 urban schools and randomized to: (1) ICC or one of two control conditions: (2) "Open Airways for Schools (OAS)" – an asthma education intervention or (3) no treatment.

Results

71% of eligible children participated in the study, with a dropout rate of 12%. ICC was rated as highly acceptable by participating children and parents. Preliminary efficacy data suggest that when compared with no treatment, ICC resulted in decreased symptoms of depression, perceived stress, and child‐reported symptoms of asthma, and improvements in sleep quality and child‐reported asthma control. There were no intervention‐related changes in objective measures of asthma morbidity. The magnitude of intervention effects on psychological function did not differ between the ICC and OAS groups.

Conclusions

Results support the feasibility and acceptability of utilizing school‐based interventions to access hard to reach children with asthma. Preliminary findings offer support for future, large‐scale efficacy studies of school‐based interventions designed to target multiple factors that contribute to asthma disparities.

This article is protected by copyright. All rights reserved.

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Longitudinal analysis to better characterize Asthma‐COPD Overlap Syndrome (ACOS): Findings from an adult asthma cohort in Korea (COREA)

Abstract

Background

Asthma‐chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS), which has received much attention, has not been unanimously defined.

Objective

In this study, we tried to demonstrate that longitudinally defined ACOS is more useful in the real‐world than blending patients with asthma and COPD.

Methods

The study patients had undergone two consecutive pulmonary function tests measured at least 3 months apart (n = 1,889). We selected the patients who had positive bronchodilator response or methacholine provocation tests (n = 959). Next, we defined ACOS as a patient with a persistent airflow obstruction [forced expiratory volume in 1 sec (FEV1)/forced vital capacity < 0.7] that was identified twice consecutively by an interval of at least 3 months (n = 228).

Results

The proportions of patients who were older, male, and smokers were significantly higher, and baseline lung function was lower in patients with ACOS. In the longitudinal analysis, the mean change in lung function was high, and a greater decline in FEV1 was observed in patients with ACOS. In addition, we compared ACOS and severe asthma, and we also performed a cluster analysis and compared the results with our definition of ACOS. According to our definition, ACOS is an independent subtype with distinctive characteristics. Finally, a genome‐wide association study (GWAS) was performed to identify genetic variations associated with ACOS, but no significant single nucleotide polymorphisms were identified.

Conclusion

Our findings suggest that ACOS should be defined longitudinally and considered as an independent subgroup distinguished by inherited environmental factors rather than as a genetically distinct independent group.

This article is protected by copyright. All rights reserved.

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Identification and characterization of a naïve CD8+ T‐cell repertoire for benzylpenicillin

Abstract

Background

Beta‐lactams allergy is the most commonly reported drug allergy and constitutes an important health problem. We previously showed the pre‐existence of a naïve CD4+ T‐cell repertoire for benzylpenicillin (BP) coupled to human serum albumin (HSA) but little is known about the naïve CD8+ T‐cell repertoire specific for BP.

Objective

The purpose of this work was to identify naïve CD8+ T cells specific for BP and to explore mechanisms dictating their activation.

Methods

Co‐cultures were established with naïve CD8+ T cells and autologous dendritic cells (DCs) loaded with HSA‐BP or free BP. T cells were restimulated once a week with autologous DCs loaded with HSA‐BP or BP. The specific CD8+ T cell response was measured using an IFN‐γ ELISpot assay.

Results

When using free BP, we were able to detect a naïve CD8+ T‐cell repertoire for BP in the 6 out of 7 tested healthy donors. However, our results showed that HSA‐BP was recognized by naïve CD8+ T cells in only one donor out of five tested healthy donors. Using free BP, we evidenced its binding to cellular proteins in DCs that was concentration dependent and was correlated with BP‐specific CD8+ T‐cell activation. Moreover, the BP‐specific CD8+ T‐cell response was MHC class I dependent and required intracellular processing and proteasome activity.

Conclusion and clinical relevance

This work showed the existence of a naïve CD8+ T‐cell repertoire for BP when DCs were treated with free BP suggesting that patients could be immunized by haptenated peptides from cellular proteins generated in antigen‐presenting cells.

This article is protected by copyright. All rights reserved.

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Validation of childhood asthma predictive tools: a systematic review

Abstract

Background

There is uncertainty about the clinical usefulness of currently available asthma predictive tools. Validation of predictive tools in different populations and clinical settings is an essential requirement for the assessment of their predictive performance, reproducibility and generalizability. We aimed to critically appraise asthma predictive tools which have been validated in external studies.

Methods

We searched MEDLINE and EMBASE (1946‐2017) for all available childhood asthma prediction models and focused on externally validated predictive tools alongside the studies in which they were originally developed. We excluded non‐English and non‐original studies. PROSPERO registration number is CRD42016035727.

Results

From 946 screened papers, 8 were included in the review. Statistical approaches for creation of prediction tools included chisquare tests, logistic regression models and the least absolute shrinkage and selection operator. Predictive models were developed and validated in general and high‐risk populations. Only three prediction tools were externally validated: the Asthma Predictive Index, the PIAMA, and the Leicester asthma prediction tool. A variety of predictors has been tested, but no studies examined the same combination. There was heterogeneity in definition of the primary outcome among development and validation studies, and no objective measurements were used for asthma diagnosis. The performance of tools varied at different ages of outcome assessment. We observed a discrepancy between the development and validation studies in the tools' predictive performance in terms of sensitivity and positive predictive values.

Conclusions

Validated asthma predictive tools, reviewed in this paper, provided poor predictive accuracy with performance variation in sensitivity and positive predictive value.

This article is protected by copyright. All rights reserved.

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