The Bare Necessities: Uncovering Essential and Condition‐Critical Genes with Transposon Sequencing

Summary

Querying gene function in bacteria has been greatly accelerated by the advent of transposon sequencing (Tn‐seq) technologies (related Tn‐seq strategies are known as TraDIS, INSeq, RB‐TnSeq and HITS). Pooled populations of transposon mutants are cultured in an environment and next‐generation sequencing tools are used to determine areas of the genome that are important for bacterial fitness. In this review we provide an overview of Tn‐seq methodologies and discuss how Tn‐seq has been applied, or could be applied, to the study of oral microbiology. These applications include studying the essential genome as a means to rationally design therapeutic agents. Tn‐seq has also contributed to our understanding of well‐studied biological processes in oral bacteria. Other important applications include in vivo pathogenesis studies and use of Tn‐seq to probe the molecular basis of microbial interactions. We also highlight recent advancements in techniques that act in synergy with Tn‐seq such as CRISPR interference and microfluidic chip platforms.

This article is protected by copyright. All rights reserved.

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The Bare Necessities: Uncovering Essential and Condition‐Critical Genes with Transposon Sequencing

Summary

Querying gene function in bacteria has been greatly accelerated by the advent of transposon sequencing (Tn‐seq) technologies (related Tn‐seq strategies are known as TraDIS, INSeq, RB‐TnSeq and HITS). Pooled populations of transposon mutants are cultured in an environment and next‐generation sequencing tools are used to determine areas of the genome that are important for bacterial fitness. In this review we provide an overview of Tn‐seq methodologies and discuss how Tn‐seq has been applied, or could be applied, to the study of oral microbiology. These applications include studying the essential genome as a means to rationally design therapeutic agents. Tn‐seq has also contributed to our understanding of well‐studied biological processes in oral bacteria. Other important applications include in vivo pathogenesis studies and use of Tn‐seq to probe the molecular basis of microbial interactions. We also highlight recent advancements in techniques that act in synergy with Tn‐seq such as CRISPR interference and microfluidic chip platforms.

This article is protected by copyright. All rights reserved.

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K-Means Clustering Optimizing Deep Stacked Sparse Autoencoder

Abstract

Because of the large structure and long training time, the development cycle of the common depth model is prolonged. How to speed up training is a problem deserving of study. In order to accelerate training, K-means clustering optimizing deep stacked sparse autoencoder (K-means sparse SAE) is presented in this paper. First, the input features are divided into K small subsets by K-means clustering, then each subset is input into corresponding autoencoder model for training, which only has fewer nodes in the hidden layer than traditional models. After training, each autoencoder's trained weights and biases is merged to obtain the next layer's input features by feedforward network. The above steps are repeated till the softmax layer, then fine-tuning is carried out. Using MNIST-Rotation datasets to train the network that has three hidden layers and each layer has 800 nodes, the improved model has higher classification accuracy and shorter training time when K = 10. With K increasing, the training time is reduced to almost the same as the fine-tuning time but the recognition ability is descended. Compared with the recently stacked denoising sparse autoencoder, the recognition accuracy is improved by 1%, not only the noise factor is not selected but also the training speed is significantly increased. The trained filters from the improved model is also used to train convolutional autoencoder, and it performs better than traditional models. We find that pre-training stage doesn't need large samples simultaneously, and small samples parallel training reduces the probability of falling into the local minimum.

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K-Means Clustering Optimizing Deep Stacked Sparse Autoencoder

Abstract

Because of the large structure and long training time, the development cycle of the common depth model is prolonged. How to speed up training is a problem deserving of study. In order to accelerate training, K-means clustering optimizing deep stacked sparse autoencoder (K-means sparse SAE) is presented in this paper. First, the input features are divided into K small subsets by K-means clustering, then each subset is input into corresponding autoencoder model for training, which only has fewer nodes in the hidden layer than traditional models. After training, each autoencoder's trained weights and biases is merged to obtain the next layer's input features by feedforward network. The above steps are repeated till the softmax layer, then fine-tuning is carried out. Using MNIST-Rotation datasets to train the network that has three hidden layers and each layer has 800 nodes, the improved model has higher classification accuracy and shorter training time when K = 10. With K increasing, the training time is reduced to almost the same as the fine-tuning time but the recognition ability is descended. Compared with the recently stacked denoising sparse autoencoder, the recognition accuracy is improved by 1%, not only the noise factor is not selected but also the training speed is significantly increased. The trained filters from the improved model is also used to train convolutional autoencoder, and it performs better than traditional models. We find that pre-training stage doesn't need large samples simultaneously, and small samples parallel training reduces the probability of falling into the local minimum.

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Impacts of a shared book-reading intervention for Italian-speaking children with developmental language disorder.

CONCLUSIONS & IMPLICATIONS: The present parent-based SBR intervention for Italian-speaking preschoolers with DLD showed effects, albeit modest, on both maternal and child communicative behaviours. The results suggest that extralinguistic strategies may be implemented successfully by parents and may be effective in enhancing children's engagement and language production in the short term. Further investigations are needed that provide a longer intervention period and examine the joint impact of therapist- and parent-based intervention for children with DLD. PMID: 30729644 [PubMed - as supplied by publisher] (Source: International Journal of Language and Communication Disorders)

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Impacts of a shared book-reading intervention for Italian-speaking children with developmental language disorder.

CONCLUSIONS & IMPLICATIONS: The present parent-based SBR intervention for Italian-speaking preschoolers with DLD showed effects, albeit modest, on both maternal and child communicative behaviours. The results suggest that extralinguistic strategies may be implemented successfully by parents and may be effective in enhancing children's engagement and language production in the short term. Further investigations are needed that provide a longer intervention period and examine the joint impact of therapist- and parent-based intervention for children with DLD. PMID: 30729644 [PubMed - as supplied by publisher] (Source: International Journal of Language and Communication Disorders)

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Three-dimensional skeletal changes after early proportional condylectomy for condylar hyperplasia

The purpose of this study was to evaluate volumetric and dentoskeletal changes in 21 patients with active unilateral condylar hyperplasia (AUCH) after proportional condylectomy. A split-mouth design was used: control group healthy joints (HS, healthy side) and test group affected joints (AS, affected side) (21 per group). Cone beam tomography scans were obtained at T0 (preoperative), T1 (10days after the intervention), and T2 (approximately 12 months post-surgery). The condylar unit volume (CUV), articular cavity volume (ACV), and dentoalveolar units (DAUs) were measured.

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Learning condyle repositioning during orthognathic surgery with a surgical navigation system

Condyle repositioning during bilateral sagittal splint osteotomy (BSSO) is a challenging step for the inexperienced surgeon. We aimed to demonstrate the benefit of navigation for learning the condyle repositioning. We treated 100 patients who underwent a BSSO. A trainee performed the condyle repositioning of one side in two phases. In the first one, the trainee positioned without watching the screen of the Orthopilot Navigation system (ONS). In the second one, the trainee could use the ONS to replace the condyle.

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Learning condyle repositioning during orthognathic surgery with a surgical navigation system

Condyle repositioning during bilateral sagittal splint osteotomy (BSSO) is a challenging step for the inexperienced surgeon. We aimed to demonstrate the benefit of navigation for learning the condyle repositioning. We treated 100 patients who underwent a BSSO. A trainee performed the condyle repositioning of one side in two phases. In the first one, the trainee positioned without watching the screen of the Orthopilot Navigation system (ONS). In the second one, the trainee could use the ONS to replace the condyle.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Gzg34K

Three-dimensional skeletal changes after early proportional condylectomy for condylar hyperplasia

The purpose of this study was to evaluate volumetric and dentoskeletal changes in 21 patients with active unilateral condylar hyperplasia (AUCH) after proportional condylectomy. A split-mouth design was used: control group healthy joints (HS, healthy side) and test group affected joints (AS, affected side) (21 per group). Cone beam tomography scans were obtained at T0 (preoperative), T1 (10days after the intervention), and T2 (approximately 12 months post-surgery). The condylar unit volume (CUV), articular cavity volume (ACV), and dentoalveolar units (DAUs) were measured.

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Management of velopharyngeal insufficiency by modified Furlow palatoplasty with pharyngeal flap: a retrospective outcome review

The surgical approach for the correction of residual velopharyngeal insufficiency requiring secondary surgery at Chang Gung Memorial Hospital is the modified Furlow palatoplasty with pharyngeal flap (mFP-PF). The aim of this study was to describe the mFP-PF technique and to determine the results obtained with regard to improvements in velopharyngeal function in patients undergoing this surgery. This retrospective analysis included 58 non-syndromic patients treated during the period 1992–2015 who complained of hypernasal speech after primary cleft palate repair and failed postoperative speech therapy.

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Management of velopharyngeal insufficiency by modified Furlow palatoplasty with pharyngeal flap: a retrospective outcome review

The surgical approach for the correction of residual velopharyngeal insufficiency requiring secondary surgery at Chang Gung Memorial Hospital is the modified Furlow palatoplasty with pharyngeal flap (mFP-PF). The aim of this study was to describe the mFP-PF technique and to determine the results obtained with regard to improvements in velopharyngeal function in patients undergoing this surgery. This retrospective analysis included 58 non-syndromic patients treated during the period 1992–2015 who complained of hypernasal speech after primary cleft palate repair and failed postoperative speech therapy.

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Role of mammary serine protease inhibitor on the inflammatory response in oral lichen planus

Abstract

Objectives

Oral lichen planus (OLP) is a chronic inflammatory condition with an unclear pathological mechanism. IκB kinase α (IKKα)‐regulated mammary serine protease inhibitor (MASPIN) has been shown to mediate inflammation, particularly in cancers. Here, we explored the expression of MASPIN in OLP and its role in the inflammatory response.

Materials and Methods

Immunohistochemistry staining and reverse transcription‐polymerase chain reaction assays were used to detect the subcellular localisation and expression of MASPIN and IKKα in OLP and healthy control tissues. Levels of the inflammatory factors were compared with enzyme‐linked immunosorbent assays. MASPIN and IKKα were overexpressed and silenced, respectively, in an inflammation model of human oral keratinocytes (HOKs) stimulated with lipopolysaccharide (LPS).

Results

MASPIN expression was down‐regulated, whereas IKKα expression was up‐regulated in OLP tissues (P < 0.01). The levels of tumour necrosis factor‐alpha and interleukin‐6 in OLP tissues were increased compared to those of healthy controls (P < 0.01). MASPIN overexpression in LPS‐stimulated HOK cells inhibited the levels of IKKα and the secretion of inflammatory cytokines. By contrast, IKKα silencing promoted the expression of MASPIN and inhibited the secretion of inflammatory cytokines.

Conclusion

Both MASPIN and IKKα are involved in the inflammatory process of OLP, suggesting potential therapeutic targets.

This article is protected by copyright. All rights reserved.

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Role of mammary serine protease inhibitor on the inflammatory response in oral lichen planus

Abstract

Objectives

Oral lichen planus (OLP) is a chronic inflammatory condition with an unclear pathological mechanism. IκB kinase α (IKKα)‐regulated mammary serine protease inhibitor (MASPIN) has been shown to mediate inflammation, particularly in cancers. Here, we explored the expression of MASPIN in OLP and its role in the inflammatory response.

Materials and Methods

Immunohistochemistry staining and reverse transcription‐polymerase chain reaction assays were used to detect the subcellular localisation and expression of MASPIN and IKKα in OLP and healthy control tissues. Levels of the inflammatory factors were compared with enzyme‐linked immunosorbent assays. MASPIN and IKKα were overexpressed and silenced, respectively, in an inflammation model of human oral keratinocytes (HOKs) stimulated with lipopolysaccharide (LPS).

Results

MASPIN expression was down‐regulated, whereas IKKα expression was up‐regulated in OLP tissues (P < 0.01). The levels of tumour necrosis factor‐alpha and interleukin‐6 in OLP tissues were increased compared to those of healthy controls (P < 0.01). MASPIN overexpression in LPS‐stimulated HOK cells inhibited the levels of IKKα and the secretion of inflammatory cytokines. By contrast, IKKα silencing promoted the expression of MASPIN and inhibited the secretion of inflammatory cytokines.

Conclusion

Both MASPIN and IKKα are involved in the inflammatory process of OLP, suggesting potential therapeutic targets.

This article is protected by copyright. All rights reserved.

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A strategy for high‐dimensional multivariable analysis classifies childhood asthma phenotypes from genetic, immunological and environmental factors

Abstract

Background

Associations between childhood asthma phenotypes and genetic, immunological and environmental factors have been previously established. Yet, strategies to integrate high‐dimensional risk factors from multiple distinct data sets, and thereby increase the statistical power of analyses, have been hampered by a preponderance of missing data and lack of methods to accommodate them.

Methods

We assembled questionnaire, diagnostic, genotype, microarray, RT‐qPCR, flow cytometry and cytokine data (referred to as data modalities) to use as input factors for a classifier that could distinguish healthy children, mild‐to‐moderate allergic asthmatics and non‐allergic asthmatics. Based on data from 260 German children aged 4‐14 from our university outpatient clinic, we built a novel multi‐level prediction approach for asthma outcome which could deal with a present complex missing data structure.

Results

The optimal learning method was boosting based on all data sets, achieving an area‐underneath‐the‐receiver‐operating‐characteristic curve (AUC) for three classes of phenotypes of 0.81 (95%‐confidence interval (CI): 0.65‐0.94) using leave‐one‐out cross‐validation. Besides improving the AUC, our integrative multi‐level learning approach led to tighter CIs than using smaller complete predictor data sets (AUC=0.82[0.66‐0.94] for boosting). The most important variables for classifying childhood asthma phenotypes comprised novel identified genes, namely PKN2 (protein kinase N2), PTK2 (protein tyrosine kinase 2), and ALPP (alkaline phosphatase, placental).

Conclusion

Our combination of several data modalities using a novel strategy improved classification of childhood asthma phenotypes but requires validation in external populations. The generic approach is applicable to other multi‐level data‐based risk prediction settings, which typically suffer from incomplete data.

This article is protected by copyright. All rights reserved.

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Follow‐up, 18 months off HDM immunotherapy, of a randomized controlled study on the primary prevention of atopy

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Delayed drug hypersensitivity to bortezomib: desensitization and tolerance to its analogue carfilzomib

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Septocutaneous perforator mapping and clinical applications of the medial arm flap

The medial arm flap has a long history but remains underused despite providing multiple advantages. We reviewed our experience with using the medial arm flap in order to clarify the distribution of septocutaneous perforators and its relationship with pedicled flap design.

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Digital Model Simulation Technology for Ear Reconstruction of Microtia with Craniofacial Asymmetry

Craniofacial asymmetry is often observed in microtia patients, duing to the accompanied craniofacial microsomia deformity, such as mandibular dysplasia and/or depression of the mastoid region, which makes it difficult to obtain symmetrical results in ear reconstruction [1]. In the process of reconstruction, both ear location and framework fabrication are interfered by the asymmetry. Mandibular hypoplasia and the heterotopic residual ear can not be regarded as an appropriate locating reference, which poses difficulties to the surgeon when determining the location for the reconstructed ear.

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Post mastectomy upper limb lymphedema: combined vascularized lymph node transfer and scar release with fat graft expedites surgical and patients’ related outcomes. a retrospective comparative study

Lymphedema resulting from breast cancer treatment is a chronic condition which can significantly compromise quality of life. Several works have documented the efficacy of vascularized lymph node flap transfer (VLNT) for the treatment of advanced stage lymphedema. Given that the axillary scar may contribute to the patient's existing lymphedema, authors assumed that combining VLNT and scar release with fat graft could be an effective strategy of treatment. The purpose of this study is to compare the efficacy in limb's circumference reduction and health-related quality of life between a combined strategy, namely VLN and axillary scar release with fat grafting, and just VLN transfer for patients' affected by post mastectomy upper limb lymphedema.

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Carbon dioxide laser treatment in burn-related scarring: a prospective randomised controlled trial

To investigate the effect of ablative fractional CO2 laser (AFCO2L) on burns scar appearance and dermal architecture at 6 weeks and up to 3-years post-treatment.

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

“SCARLESS REVERSE UMBILICOPLASTY”: A NEW TECHNIQUE OF UMBILICAL TRANSPOSITION IN ABDOMNOPLASTY

The navel plays a major role in the aesthetics of the abdomen. A navel which is abnormally shaped, malpositioned or has evident scarring may compromise the outcome of an otherwise well executed full abdominoplasty. The aim of the technique in question is to recreate a navel that looks natural, with no visible scar and properly positioned.

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

Revisiting the reconstructive surgery framework: the reconstruction supermarket

Plastic and reconstructive surgeons apply a variety of techniques throughout the body with analogies having evolved to provide a conceptual framework for the selection of techniques. Well-known examples include: the reconstructive ladder with increasingly complex rungs, the reconstructive elevator where the surgeon moves directly to the most suitable reconstruction, the reconstructive toolbox, and the reconstructive triangle.1,2 Extended models have been proposed to incorporate developments such as negative pressure wound therapy, and include the extended ladder,3 the reconstructive solar system,4 and the reconstructive clockwork.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UJVcj0

A strategy for high‐dimensional multivariable analysis classifies childhood asthma phenotypes from genetic, immunological and environmental factors

Abstract

Background

Associations between childhood asthma phenotypes and genetic, immunological and environmental factors have been previously established. Yet, strategies to integrate high‐dimensional risk factors from multiple distinct data sets, and thereby increase the statistical power of analyses, have been hampered by a preponderance of missing data and lack of methods to accommodate them.

Methods

We assembled questionnaire, diagnostic, genotype, microarray, RT‐qPCR, flow cytometry and cytokine data (referred to as data modalities) to use as input factors for a classifier that could distinguish healthy children, mild‐to‐moderate allergic asthmatics and non‐allergic asthmatics. Based on data from 260 German children aged 4‐14 from our university outpatient clinic, we built a novel multi‐level prediction approach for asthma outcome which could deal with a present complex missing data structure.

Results

The optimal learning method was boosting based on all data sets, achieving an area‐underneath‐the‐receiver‐operating‐characteristic curve (AUC) for three classes of phenotypes of 0.81 (95%‐confidence interval (CI): 0.65‐0.94) using leave‐one‐out cross‐validation. Besides improving the AUC, our integrative multi‐level learning approach led to tighter CIs than using smaller complete predictor data sets (AUC=0.82[0.66‐0.94] for boosting). The most important variables for classifying childhood asthma phenotypes comprised novel identified genes, namely PKN2 (protein kinase N2), PTK2 (protein tyrosine kinase 2), and ALPP (alkaline phosphatase, placental).

Conclusion

Our combination of several data modalities using a novel strategy improved classification of childhood asthma phenotypes but requires validation in external populations. The generic approach is applicable to other multi‐level data‐based risk prediction settings, which typically suffer from incomplete data.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TG0Gvf

Follow‐up, 18 months off HDM immunotherapy, of a randomized controlled study on the primary prevention of atopy

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

Delayed drug hypersensitivity to bortezomib: desensitization and tolerance to its analogue carfilzomib

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TGdD8i

Septocutaneous perforator mapping and clinical applications of the medial arm flap

The medial arm flap has a long history but remains underused despite providing multiple advantages. We reviewed our experience with using the medial arm flap in order to clarify the distribution of septocutaneous perforators and its relationship with pedicled flap design.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tdU4bH

Digital Model Simulation Technology for Ear Reconstruction of Microtia with Craniofacial Asymmetry

Craniofacial asymmetry is often observed in microtia patients, duing to the accompanied craniofacial microsomia deformity, such as mandibular dysplasia and/or depression of the mastoid region, which makes it difficult to obtain symmetrical results in ear reconstruction [1]. In the process of reconstruction, both ear location and framework fabrication are interfered by the asymmetry. Mandibular hypoplasia and the heterotopic residual ear can not be regarded as an appropriate locating reference, which poses difficulties to the surgeon when determining the location for the reconstructed ear.

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

Post mastectomy upper limb lymphedema: combined vascularized lymph node transfer and scar release with fat graft expedites surgical and patients’ related outcomes. a retrospective comparative study

Lymphedema resulting from breast cancer treatment is a chronic condition which can significantly compromise quality of life. Several works have documented the efficacy of vascularized lymph node flap transfer (VLNT) for the treatment of advanced stage lymphedema. Given that the axillary scar may contribute to the patient's existing lymphedema, authors assumed that combining VLNT and scar release with fat graft could be an effective strategy of treatment. The purpose of this study is to compare the efficacy in limb's circumference reduction and health-related quality of life between a combined strategy, namely VLN and axillary scar release with fat grafting, and just VLN transfer for patients' affected by post mastectomy upper limb lymphedema.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tdU23z

Carbon dioxide laser treatment in burn-related scarring: a prospective randomised controlled trial

To investigate the effect of ablative fractional CO2 laser (AFCO2L) on burns scar appearance and dermal architecture at 6 weeks and up to 3-years post-treatment.

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

“SCARLESS REVERSE UMBILICOPLASTY”: A NEW TECHNIQUE OF UMBILICAL TRANSPOSITION IN ABDOMNOPLASTY

The navel plays a major role in the aesthetics of the abdomen. A navel which is abnormally shaped, malpositioned or has evident scarring may compromise the outcome of an otherwise well executed full abdominoplasty. The aim of the technique in question is to recreate a navel that looks natural, with no visible scar and properly positioned.

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

Revisiting the reconstructive surgery framework: the reconstruction supermarket

Plastic and reconstructive surgeons apply a variety of techniques throughout the body with analogies having evolved to provide a conceptual framework for the selection of techniques. Well-known examples include: the reconstructive ladder with increasingly complex rungs, the reconstructive elevator where the surgeon moves directly to the most suitable reconstruction, the reconstructive toolbox, and the reconstructive triangle.1,2 Extended models have been proposed to incorporate developments such as negative pressure wound therapy, and include the extended ladder,3 the reconstructive solar system,4 and the reconstructive clockwork.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UJVcj0

Examining adjuvant radiation dose in head and neck squamous cell carcinoma

Abstract

Background

Compare adjuvant radiation dose trends and outcomes in head and neck squamous cell carcinoma (HNSCC).

Methods

Nonmetastatic HNSCCs treated between 2004 and 2014 with primary site surgery, lymph node dissection, and adjuvant radiation were identified in the National Cancer Database. Standard dose radiation (SD‐RT) was defined as an equivalent dose in 2 Gy (EQD2) ≥56.64 and ≤60 Gy and high‐dose radiation (HD‐RT) as an EQD2 >60 and <70 Gy.

Results

HD‐RT was given to 46% of the 15 836 HNSCC patients managed with adjuvant radiation. When adjusted for poor prognostic factors, HD‐RT was associated with increased mortality (HR1.09; 95%CI 1.02‐1.16). In nonoropharynx or human papillomavirus‐negative oropharynx primary that had positive margins, ≥5 positive lymph nodes, and/or extranodal extension, HD‐RT was still not associated with improved survival (HR 1.01, 95% CI 0.91‐1.12).

Conclusions

There was no survival benefit from postoperative dose escalation above EQD2 60 Gy even in a high‐risk cohort.

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Dynamic changes in chemosensitivity immune predictors in patients with hypopharyngeal cancer treated with induction chemotherapy

Abstract

Background

There are currently no data predicting chemosensitivity of induction chemotherapy (ICT) for hypopharyngeal squamous cell carcinomas (SCC).

Methods

Associations between immune cells and overall response (OR) to ICT and changes in immune cells during ICT were observed in 40 patients with hypopharyngeal SCC undergoing ICT.

Results

CD4⁺ and CD8⁺ T‐cell and regulatory T‐cell (Treg) frequencies reached diagnostic accuracy for OR to ICT. OR rate was significantly higher in CD4⁺‐high T cell, CD8⁺‐high T cell, and low Treg groups. A transient reduction in Tregs and increases in Tregs in the non‐OR and OR groups were observed during the course of ICT. Conversely, increases in CD8⁺ T cells and reductions in CD8⁺ T cells in the non‐OR and OR groups were observed.

Conclusion

High CD4⁺ T‐cell, high CD8⁺ T‐cell, and low Treg frequencies can be predictors for high efficacy of ICT in patients with hypopharyngeal SCC.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2MXh1sF

Postoperative radiation performed at the same surgical facility associated with improved overall survival in oral cavity squamous cell carcinoma

Abstract

Background

The purpose of this analysis is to evaluate whether postoperative radiotherapy (PORT) at the same facility as surgery portends to better survival outcomes compared to PORT given at a different facility.

Methods

Patients underwent upfront surgery at the National Cancer Database reporting facility followed by PORT. PORT was coded as performed at either the same facility or at a different facility as surgery.

Results

A total of 10 832 patients were selected. Five‐year overall survival (OS) was higher in patients undergoing PORT at the same facility: 52.5% vs 48.4% (P < 0.001). PORT performed at the same facility was associated with improved OS under multivariate (HR, 0.92; P = 0.01) and propensity score matched (hazard ratio, 0.90; P = 0.004) analyses.

Conclusions

OS was better among patients with head and neck cancer who received PORT at the same facility as surgery.

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The role of age in treatment‐related adverse events in patients with head and neck cancer: A systematic review

Abstract

Head and neck squamous cell carcinoma (HNSCC) is often diagnosed in advanced stage and therefore requires aggressive, multimodal treatment. Elderly patients are often excluded from standard therapy regimens purely based on age. This clinical review aims to collect all published data in the literature on treatment modality selection in elderly patients and on age‐related adverse events following treatment of HNSCC. We performed a literature search for articles on the treatment of HNSCC in elderly patients. Most of the articles were retrospective studies with the consequent limitations. It can be concluded that age is not an absolute contraindication for intensive treatment and comorbidity is an important predictor of outcome, but not the only one. Despite the existence of multiple tools for pretreatment evaluation, there are not consistent data on their use.

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Outcomes and cost implications of microvascular reconstructions of the head and neck

Abstract

Background

Critical review of current head and neck reconstructive practices as related to free flap donor sites and their impact on clinical outcomes and cost.

Methods

Retrospective multicenter review of free tissue transfer reconstruction of head and neck defects (n = 1315). Variables reviewed: defect, indication, T classification, operative duration, and complications. A convenience sample was selected for analysis of overall (operative and inpatient admission) charges per hospitalization (n = 400).

Results

Mean charges of hospitalization by donor tissue: radial forearm free flap (RFFF) $127 636 (n = 183), osteocutaneous RFFF (OCRFFF) $125 456 (n = 70), anterior lateral thigh $133 781 (n = 54), fibula $140 747 (n = 42), latissimus $208 890 (n = 24), rectus $169 637 (n = 18), scapula $128 712 (n = 4), and ulna $110 716 (n = 5; P = .16). Mean operative times for malignant lesions stratified by T classification: 6.9 hours (±25 minutes) for T1, 7.0 hours (±16 minutes) for T2, 7.3 hours (±17 minutes) for T3, and 7.8 hours (±11 minutes) for T4 (P < .0001). Complications correlated with differences in mean charges: minor surgical ($123 720), medical ($216 387), and major surgical ($169 821; P < .001). Operations for advanced malignant lesions had higher mean charges: T1 lesions ($106 506) compared to T2/T3 lesions ($133 080; P = .03) and T4 lesions ($142 183; P = .02). On multivariate analysis, the length of stay, operative duration, and type a postoperative complication were factors affecting overall charges for the hospitalization (P < .018).

Conclusion

Conclusion: The RFFF and OCRFFF had the lowest complication rates, length of hospitalization, duration of operation, and mean charges of hospitalization. Advanced stage malignant disease correlated with increased hospitalization length, operative time, and complication rates resulting in higher hospitalization charges.

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Examining adjuvant radiation dose in head and neck squamous cell carcinoma

Abstract

Background

Compare adjuvant radiation dose trends and outcomes in head and neck squamous cell carcinoma (HNSCC).

Methods

Nonmetastatic HNSCCs treated between 2004 and 2014 with primary site surgery, lymph node dissection, and adjuvant radiation were identified in the National Cancer Database. Standard dose radiation (SD‐RT) was defined as an equivalent dose in 2 Gy (EQD2) ≥56.64 and ≤60 Gy and high‐dose radiation (HD‐RT) as an EQD2 >60 and <70 Gy.

Results

HD‐RT was given to 46% of the 15 836 HNSCC patients managed with adjuvant radiation. When adjusted for poor prognostic factors, HD‐RT was associated with increased mortality (HR1.09; 95%CI 1.02‐1.16). In nonoropharynx or human papillomavirus‐negative oropharynx primary that had positive margins, ≥5 positive lymph nodes, and/or extranodal extension, HD‐RT was still not associated with improved survival (HR 1.01, 95% CI 0.91‐1.12).

Conclusions

There was no survival benefit from postoperative dose escalation above EQD2 60 Gy even in a high‐risk cohort.

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Dynamic changes in chemosensitivity immune predictors in patients with hypopharyngeal cancer treated with induction chemotherapy

Abstract

Background

There are currently no data predicting chemosensitivity of induction chemotherapy (ICT) for hypopharyngeal squamous cell carcinomas (SCC).

Methods

Associations between immune cells and overall response (OR) to ICT and changes in immune cells during ICT were observed in 40 patients with hypopharyngeal SCC undergoing ICT.

Results

CD4⁺ and CD8⁺ T‐cell and regulatory T‐cell (Treg) frequencies reached diagnostic accuracy for OR to ICT. OR rate was significantly higher in CD4⁺‐high T cell, CD8⁺‐high T cell, and low Treg groups. A transient reduction in Tregs and increases in Tregs in the non‐OR and OR groups were observed during the course of ICT. Conversely, increases in CD8⁺ T cells and reductions in CD8⁺ T cells in the non‐OR and OR groups were observed.

Conclusion

High CD4⁺ T‐cell, high CD8⁺ T‐cell, and low Treg frequencies can be predictors for high efficacy of ICT in patients with hypopharyngeal SCC.

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Postoperative radiation performed at the same surgical facility associated with improved overall survival in oral cavity squamous cell carcinoma

Abstract

Background

The purpose of this analysis is to evaluate whether postoperative radiotherapy (PORT) at the same facility as surgery portends to better survival outcomes compared to PORT given at a different facility.

Methods

Patients underwent upfront surgery at the National Cancer Database reporting facility followed by PORT. PORT was coded as performed at either the same facility or at a different facility as surgery.

Results

A total of 10 832 patients were selected. Five‐year overall survival (OS) was higher in patients undergoing PORT at the same facility: 52.5% vs 48.4% (P < 0.001). PORT performed at the same facility was associated with improved OS under multivariate (HR, 0.92; P = 0.01) and propensity score matched (hazard ratio, 0.90; P = 0.004) analyses.

Conclusions

OS was better among patients with head and neck cancer who received PORT at the same facility as surgery.

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The role of age in treatment‐related adverse events in patients with head and neck cancer: A systematic review

Abstract

Head and neck squamous cell carcinoma (HNSCC) is often diagnosed in advanced stage and therefore requires aggressive, multimodal treatment. Elderly patients are often excluded from standard therapy regimens purely based on age. This clinical review aims to collect all published data in the literature on treatment modality selection in elderly patients and on age‐related adverse events following treatment of HNSCC. We performed a literature search for articles on the treatment of HNSCC in elderly patients. Most of the articles were retrospective studies with the consequent limitations. It can be concluded that age is not an absolute contraindication for intensive treatment and comorbidity is an important predictor of outcome, but not the only one. Despite the existence of multiple tools for pretreatment evaluation, there are not consistent data on their use.

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Outcomes and cost implications of microvascular reconstructions of the head and neck

Abstract

Background

Critical review of current head and neck reconstructive practices as related to free flap donor sites and their impact on clinical outcomes and cost.

Methods

Retrospective multicenter review of free tissue transfer reconstruction of head and neck defects (n = 1315). Variables reviewed: defect, indication, T classification, operative duration, and complications. A convenience sample was selected for analysis of overall (operative and inpatient admission) charges per hospitalization (n = 400).

Results

Mean charges of hospitalization by donor tissue: radial forearm free flap (RFFF) $127 636 (n = 183), osteocutaneous RFFF (OCRFFF) $125 456 (n = 70), anterior lateral thigh $133 781 (n = 54), fibula $140 747 (n = 42), latissimus $208 890 (n = 24), rectus $169 637 (n = 18), scapula $128 712 (n = 4), and ulna $110 716 (n = 5; P = .16). Mean operative times for malignant lesions stratified by T classification: 6.9 hours (±25 minutes) for T1, 7.0 hours (±16 minutes) for T2, 7.3 hours (±17 minutes) for T3, and 7.8 hours (±11 minutes) for T4 (P < .0001). Complications correlated with differences in mean charges: minor surgical ($123 720), medical ($216 387), and major surgical ($169 821; P < .001). Operations for advanced malignant lesions had higher mean charges: T1 lesions ($106 506) compared to T2/T3 lesions ($133 080; P = .03) and T4 lesions ($142 183; P = .02). On multivariate analysis, the length of stay, operative duration, and type a postoperative complication were factors affecting overall charges for the hospitalization (P < .018).

Conclusion

Conclusion: The RFFF and OCRFFF had the lowest complication rates, length of hospitalization, duration of operation, and mean charges of hospitalization. Advanced stage malignant disease correlated with increased hospitalization length, operative time, and complication rates resulting in higher hospitalization charges.

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Realization and representation of Nepali laryngeal contrasts: Voiced aspirates and laryngeal realism

In this study we push laryngeal realist theory in a new direction – to segments proposed to be specified for both [voice] and [spread] features – a combination which poses challenges to the current diagnostics. To do so, we analyze acoustic data from Nepali, an Indic (a.k.a. Indo-Aryan) language with a single class of stops described as both voiced and aspirated. We apply the same criteria and diagnostics used in laryngeal realism. We find support for the proposed representation, with a caveat that the [voice] feature appears 'stronger' than [spread]. (Source: Journal of Phonetics)

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Do Children Recall Numbers as Generic? A Strong Test of the Generics-As-Default Hypothesis

. (Source: Language Learning and Development)

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Exploring participation experiences of youth who use AAC in social media settings: impact of an e-mentoring intervention.

Authors: Grace E, Raghavendra P, McMillan JM, Gunson JS Abstract The contribution of cross-age peer e-mentoring on reported experiences of participation during online conversations using social media was explored in this pre-experimental study. Young people (n = 4, aged 13; 4-18;3 [years; months]) who used augmentative and alternative communication (AAC) participated in an e-mentoring intervention. Two mentors who also used AAC had regular conversations with the participants via Facebook 1 , email, or Skype 2 . It was predicted that the mentoring support would contribute to experiences of participation in online conversations outside of the e-mentoring intervention. Reported experiences of participation in online conversations with communication partners other than the mentor w...

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Loudness Trumps Pitch in Politeness Judgments: Evidence from Korean Deferential Speech.

Authors: Idemaru K, Winter B, Brown L, Oh GE Abstract Social meaning is not conveyed through words alone, but also through how words are produced phonetically. This paper investigates the role of loudness and pitch in determining the perception of politeness-related judgments in Korean. It has been proposed that high pitch is universally associated with polite or deferential social meanings. In contrast to this, Experiment 1 examined the perceptual effect of pitch and found no effect. Experiment 2 tested the effect of loudness, and found that listeners associate quieter speech with deference. Finally, Experiment 3 investigated the simultaneous effects of loudness and pitch, and found again that loudness had a consistent effect, whereas pitch only had a weak effect. Analyses of indi...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RO7x3P

Realization and representation of Nepali laryngeal contrasts: Voiced aspirates and laryngeal realism

In this study we push laryngeal realist theory in a new direction – to segments proposed to be specified for both [voice] and [spread] features – a combination which poses challenges to the current diagnostics. To do so, we analyze acoustic data from Nepali, an Indic (a.k.a. Indo-Aryan) language with a single class of stops described as both voiced and aspirated. We apply the same criteria and diagnostics used in laryngeal realism. We find support for the proposed representation, with a caveat that the [voice] feature appears 'stronger' than [spread]. (Source: Journal of Phonetics)

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

Do Children Recall Numbers as Generic? A Strong Test of the Generics-As-Default Hypothesis

. (Source: Language Learning and Development)

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

Exploring participation experiences of youth who use AAC in social media settings: impact of an e-mentoring intervention.

Authors: Grace E, Raghavendra P, McMillan JM, Gunson JS Abstract The contribution of cross-age peer e-mentoring on reported experiences of participation during online conversations using social media was explored in this pre-experimental study. Young people (n = 4, aged 13; 4-18;3 [years; months]) who used augmentative and alternative communication (AAC) participated in an e-mentoring intervention. Two mentors who also used AAC had regular conversations with the participants via Facebook 1 , email, or Skype 2 . It was predicted that the mentoring support would contribute to experiences of participation in online conversations outside of the e-mentoring intervention. Reported experiences of participation in online conversations with communication partners other than the mentor w...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2WV88V5

Loudness Trumps Pitch in Politeness Judgments: Evidence from Korean Deferential Speech.

Authors: Idemaru K, Winter B, Brown L, Oh GE Abstract Social meaning is not conveyed through words alone, but also through how words are produced phonetically. This paper investigates the role of loudness and pitch in determining the perception of politeness-related judgments in Korean. It has been proposed that high pitch is universally associated with polite or deferential social meanings. In contrast to this, Experiment 1 examined the perceptual effect of pitch and found no effect. Experiment 2 tested the effect of loudness, and found that listeners associate quieter speech with deference. Finally, Experiment 3 investigated the simultaneous effects of loudness and pitch, and found again that loudness had a consistent effect, whereas pitch only had a weak effect. Analyses of indi...

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Dental injuries in patients associated with fracture of facial bones

ConclusionDifferent types of tooth injuries associated with facial bone fracture found more in females and maxillary teeth. (Source: Oral and Maxillofacial Surgery)

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Assessing Gait Stability before and after Cochlear Implantation.

Authors: Kaczmarczyk K, Błażkiewicz M, Wiszomirska I, Pietrasik K, Zdrodowska A, Wit A, Barton G, Skarżyński H Abstract Background: It is known that cochlear implantation may alter the inner ear and induce vestibular disorders. Research Question: How does cochlear implantation influence gait stability? Material and Methods. An experimental group of twenty-one subjects scheduled for cochlear implantation underwent gait testing twice, on the day before cochlear implantation (BCI) and three months after cochlear implantation (ACI), using a motion capture system. A control group of 30 age-matched healthy individuals were also tested. Results: In the experimental group, the gait stability ratio (GSR) was found to improve in 17 subjects after implantation, by an average of 6%...

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Robotic cochlear implantation: feasibility of a multiport approach in an ex vivo model

ConclusionsElectrode insertion through a robotic three-port approach is feasible. Drill tunnels through the facial recess for the electrode and endoscope allow for optimized insertion angles and sufficient visualization. Through a retrofacial tunnel effective manipulation for sealing is possible. (Source: European Archives of Oto-Rhino-Laryngology)

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Changes in Maxillary Sinus Volume and It ’s Walls Thickness Due to Chronic Rhinosinusitis: A Prospective Study

AbstractThis is a prospective observational cross sectional study comprising of 57 patients who were having symptoms of chronic rhinosinusitis which were evaluated with the help of computed tomography scan (coronal and axial sections) to measure the thickness of all walls of maxillary sinus and it 's volume. Computed tomographic imaging of sinonasal region has become the gold standard in the evaluation of patients with chronic sinusitis. The maxillary sinus is pyramidal in shape with lateral wall of nose forming its base and its apex is directed towards zygomatic process. All three dimensio ns of the maxillary sinus were measured and the volume of each maxillary sinus was also calculated. Hyperostosis of maxillary sinus tended to increase maxillary sinus walls thickness which ultimately ...

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Dental injuries in patients associated with fracture of facial bones

ConclusionDifferent types of tooth injuries associated with facial bone fracture found more in females and maxillary teeth. (Source: Oral and Maxillofacial Surgery)

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

Assessing Gait Stability before and after Cochlear Implantation.

Authors: Kaczmarczyk K, Błażkiewicz M, Wiszomirska I, Pietrasik K, Zdrodowska A, Wit A, Barton G, Skarżyński H Abstract Background: It is known that cochlear implantation may alter the inner ear and induce vestibular disorders. Research Question: How does cochlear implantation influence gait stability? Material and Methods. An experimental group of twenty-one subjects scheduled for cochlear implantation underwent gait testing twice, on the day before cochlear implantation (BCI) and three months after cochlear implantation (ACI), using a motion capture system. A control group of 30 age-matched healthy individuals were also tested. Results: In the experimental group, the gait stability ratio (GSR) was found to improve in 17 subjects after implantation, by an average of 6%...

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

Robotic cochlear implantation: feasibility of a multiport approach in an ex vivo model

ConclusionsElectrode insertion through a robotic three-port approach is feasible. Drill tunnels through the facial recess for the electrode and endoscope allow for optimized insertion angles and sufficient visualization. Through a retrofacial tunnel effective manipulation for sealing is possible. (Source: European Archives of Oto-Rhino-Laryngology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SDoz9d

Changes in Maxillary Sinus Volume and It ’s Walls Thickness Due to Chronic Rhinosinusitis: A Prospective Study

AbstractThis is a prospective observational cross sectional study comprising of 57 patients who were having symptoms of chronic rhinosinusitis which were evaluated with the help of computed tomography scan (coronal and axial sections) to measure the thickness of all walls of maxillary sinus and it 's volume. Computed tomographic imaging of sinonasal region has become the gold standard in the evaluation of patients with chronic sinusitis. The maxillary sinus is pyramidal in shape with lateral wall of nose forming its base and its apex is directed towards zygomatic process. All three dimensio ns of the maxillary sinus were measured and the volume of each maxillary sinus was also calculated. Hyperostosis of maxillary sinus tended to increase maxillary sinus walls thickness which ultimately ...

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

Radiographic scoring methods in rheumatoid arthritis and psoriatic arthritis

Abstract

Structural changes of bone and cartilage are the hallmarks of rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Radiography can help in making diagnosis and in differentiating PsA and RA from other articular diseases. Radiography is still considered the preferred imaging method to assess disease progression, reflecting cumulative damage over time. The presence of bone erosions in RA is as an indicator of irreversible articular damage. Radiographic features of PsA are characteristic and differ from those observed in RA, especially in the distribution of affected joints and in the presence of destructive changes and bone proliferation at the same time. Semiquantitative scoring methods are designed to measure the degree of radiographically detectable joint damage and of changes over time. Several radiographic scoring methods that had been developed originally for RA have been adopted for the use in PsA. This review discusses the use of conventional radiography for diagnosing and detecting early structural changes in RA and PsA and providing a historical overview of commonly used scoring methods.

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Radiographic scoring methods in rheumatoid arthritis and psoriatic arthritis

Abstract

Structural changes of bone and cartilage are the hallmarks of rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Radiography can help in making diagnosis and in differentiating PsA and RA from other articular diseases. Radiography is still considered the preferred imaging method to assess disease progression, reflecting cumulative damage over time. The presence of bone erosions in RA is as an indicator of irreversible articular damage. Radiographic features of PsA are characteristic and differ from those observed in RA, especially in the distribution of affected joints and in the presence of destructive changes and bone proliferation at the same time. Semiquantitative scoring methods are designed to measure the degree of radiographically detectable joint damage and of changes over time. Several radiographic scoring methods that had been developed originally for RA have been adopted for the use in PsA. This review discusses the use of conventional radiography for diagnosing and detecting early structural changes in RA and PsA and providing a historical overview of commonly used scoring methods.

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Robotic cochlear implantation: feasibility of a multiport approach in an ex vivo model

Abstract

Purpose

A recent clinical trial has shown the feasibility of robotic cochlear implantation. The electrode was inserted through the robotically drilled tunnel and an additional access through the external auditory canal was created to provide for means of visualization and manipulation. To obviate the need for this additional access, the utilization of multiple robotically drilled tunnels targeting the round window has been proposed. The objective of this study was to assess the feasibility of electrode insertion through a robotic multiport approach.

Methods

In four ex vivo human head specimens (left side), four trajectories through the facial recess (2x) and the retrofacial and suprameatal region were planned and robotically drilled. Optimal three-port configurations were determined for each specimen by analyzing combinations of three of the four trajectories, where the three trajectories were used for the electrode, endoscopic visualization and manipulative assistance. Finally, electrode insertions were conducted through the optimal configurations.

Results

The electrodes could successfully be inserted, and the procedure sufficiently visualized through the facial recess drill tunnels in all specimens. Effective manipulative assistance for sealing the round window could be provided through the retrofacial tunnel.

Conclusions

Electrode insertion through a robotic three-port approach is feasible. Drill tunnels through the facial recess for the electrode and endoscope allow for optimized insertion angles and sufficient visualization. Through a retrofacial tunnel effective manipulation for sealing is possible.

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

Robotic cochlear implantation: feasibility of a multiport approach in an ex vivo model

Abstract

Purpose

A recent clinical trial has shown the feasibility of robotic cochlear implantation. The electrode was inserted through the robotically drilled tunnel and an additional access through the external auditory canal was created to provide for means of visualization and manipulation. To obviate the need for this additional access, the utilization of multiple robotically drilled tunnels targeting the round window has been proposed. The objective of this study was to assess the feasibility of electrode insertion through a robotic multiport approach.

Methods

In four ex vivo human head specimens (left side), four trajectories through the facial recess (2x) and the retrofacial and suprameatal region were planned and robotically drilled. Optimal three-port configurations were determined for each specimen by analyzing combinations of three of the four trajectories, where the three trajectories were used for the electrode, endoscopic visualization and manipulative assistance. Finally, electrode insertions were conducted through the optimal configurations.

Results

The electrodes could successfully be inserted, and the procedure sufficiently visualized through the facial recess drill tunnels in all specimens. Effective manipulative assistance for sealing the round window could be provided through the retrofacial tunnel.

Conclusions

Electrode insertion through a robotic three-port approach is feasible. Drill tunnels through the facial recess for the electrode and endoscope allow for optimized insertion angles and sufficient visualization. Through a retrofacial tunnel effective manipulation for sealing is possible.

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Cochlear ablation in neonatal rats disrupts inhibitory transmission in the medial nucleus of the trapezoid body

Publication date: Available online 8 February 2019Source: Neuroscience LettersAuthor(s): Bohdana Hruskova, Johana Trojanova, Michaela Kralikova, Adolf Melichar, Stepanka Suchankova, Jolana Bartosova, Jana Svobodova Burianova, Jiri Popelar, Josef Syka, Rostislav TurecekAbstractInhibitory circuits in the auditory brainstem undergo multiple postnatal changes that are both activity-dependent and activity-independent. We tested to see if the shift from GABA- to glycinergic transmission, which occurs in the rat medial nucleus of the trapezoid body (MNTB) around the onset of hearing, depends on sound-evoked neuronal activity. We prevented the activity by bilateral cochlear ablations in early postnatal rats and studied ionotropic GABA and glycine receptors in MNTB neurons after hearing onset. The ...

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Long-term Conductive Auditory Deprivation During Early Development Causes Irreversible Hearing Impairment and Cochlear Synaptic Disruption

In this study, a mouse model of conductive auditory deprivation (CAD) was achieved using external auditory canal closure on postnatal day 12, which marks the onset of external ear canal opening. Short-term (2 weeks) and long-term (6 weeks) deprivations involving external ear canal closure were conducted. Mice were examined immediately, 4 weeks, and 8 weeks after deprivation. Short-term deprivation induced reversible auditory brainstem response (ABR) threshold and latencies of ABR wave I, whereas long-term deprivation caused irreversible ABR thresholds and latencies of ABR wave I. Complete recovery of ribbon synapses and latencies of ABR wave I were observed in the short-term group. In contrast, we observed irreversible ABR thresholds, latencies of ABR wave I, and quantity of ribbon synapse...

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Cochlear ablation in neonatal rats disrupts inhibitory transmission in the medial nucleus of the trapezoid body

Publication date: Available online 8 February 2019Source: Neuroscience LettersAuthor(s): Bohdana Hruskova, Johana Trojanova, Michaela Kralikova, Adolf Melichar, Stepanka Suchankova, Jolana Bartosova, Jana Svobodova Burianova, Jiri Popelar, Josef Syka, Rostislav TurecekAbstractInhibitory circuits in the auditory brainstem undergo multiple postnatal changes that are both activity-dependent and activity-independent. We tested to see if the shift from GABA- to glycinergic transmission, which occurs in the rat medial nucleus of the trapezoid body (MNTB) around the onset of hearing, depends on sound-evoked neuronal activity. We prevented the activity by bilateral cochlear ablations in early postnatal rats and studied ionotropic GABA and glycine receptors in MNTB neurons after hearing onset. The ...

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

Long-term Conductive Auditory Deprivation During Early Development Causes Irreversible Hearing Impairment and Cochlear Synaptic Disruption

In this study, a mouse model of conductive auditory deprivation (CAD) was achieved using external auditory canal closure on postnatal day 12, which marks the onset of external ear canal opening. Short-term (2 weeks) and long-term (6 weeks) deprivations involving external ear canal closure were conducted. Mice were examined immediately, 4 weeks, and 8 weeks after deprivation. Short-term deprivation induced reversible auditory brainstem response (ABR) threshold and latencies of ABR wave I, whereas long-term deprivation caused irreversible ABR thresholds and latencies of ABR wave I. Complete recovery of ribbon synapses and latencies of ABR wave I were observed in the short-term group. In contrast, we observed irreversible ABR thresholds, latencies of ABR wave I, and quantity of ribbon synapse...

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Validation of the Thai version of the family reported outcome measure (FROM-16)© to assess the impact of disease on the partner or family members of patients with cancer

Cancer not only impairs a patient's physical and psychosocial functional behaviour, but also contributes to negative impact on family members' health related quality of life. Currently, there is an absence of ...

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Can physical activity compensate for low socioeconomic status with regard to poor self-rated health and low quality-of-life?

Both high socioeconomic status (SES) and high physical activity (PA) are associated with better self-rated health (SRH) and higher quality-of-life (QoL).

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Validation of the Thai version of the family reported outcome measure (FROM-16)© to assess the impact of disease on the partner or family members of patients with cancer

Cancer not only impairs a patient's physical and psychosocial functional behaviour, but also contributes to negative impact on family members' health related quality of life. Currently, there is an absence of ...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2E0riRX

Can physical activity compensate for low socioeconomic status with regard to poor self-rated health and low quality-of-life?

Both high socioeconomic status (SES) and high physical activity (PA) are associated with better self-rated health (SRH) and higher quality-of-life (QoL).

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Traitement des nécroses du tendon d’Achille sans reconstruction tendineuse : à propos de quatre cas

Publication date: Available online 8 February 2019

Source: Annales de Chirurgie Plastique Esthétique

Author(s): C. Monnerie, D. Le Nen, W. Hu, H. Letissier, N. Kerfant

Résumé

Introduction

La prise en charge des pertes de substances combinées du tendon d'Achille et de la peau est difficile. Il ne s'agit pourtant pas de situations exceptionnelles après chirurgie du tendon d'Achille. Les données de la littérature sont vastes et il n'existe actuellement pas de consensus quant à la technique de reconstruction du tendon.

Cas cliniques

Nous rapportons quatre cas de nécrose purulente du tendon d'Achille compliquant un peignage ou la suture d'une rupture tendineuse. Après parage de l'ensemble des tissus nécrotiques, la perte de substance a été couverte par un lambeau perforant fascio-cutané ou par une greffe de peau mince sans reconstruction du tendon sous-jacent.

Discussion et conclusion

Les résultats fonctionnels sont très satisfaisants avec de bonnes mobilités articulaires et une reprise de la marche sans boiterie pour tous les patients. La fibrose permet de reconstituer un véritable néotendon confirmé à l'IRM. Les avantages sont nombreux par rapport à d'autres méthodes : un seul temps opératoire est nécessaire, la gestion postopératoire est simple et elle permet d'éviter certaines difficultés techniques liées à la reconstruction tendineuse. Une plus large série serait nécessaire pour conforter ces résultats.

Summary

Introduction

Management of the combined loss of Achilles tendon and skin is difficult. However, these are not exceptional situations after Achilles tendon surgery. Data from the literature are extensive and there is currently no consensus on the technique of tendon reconstruction.

Case reports

We report four cases of purulent necrosis of the Achilles tendon complicating longitudinal incision or suturing of a tendon rupture. After debridement of necrotic tissue, the defect was covered either by a fasciocutaneous perforating flap or a thin skin graft without reconstruction of the underlying tendon.

Discussion and conclusion

The functional results are very satisfactory with good joint mobilities and a resumption of walking without lameness for all patients. Fibrosis can reconstitute a true neo-tendon confirmed on MRI. The advantages are many compared to other methods: a single operating time is necessary, the postoperative management is simple and it avoids certain technical difficulties related to tendon reconstruction. A larger series would be needed to support these results.

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Traitement des nécroses du tendon d’Achille sans reconstruction tendineuse : à propos de quatre cas

Publication date: Available online 8 February 2019

Source: Annales de Chirurgie Plastique Esthétique

Author(s): C. Monnerie, D. Le Nen, W. Hu, H. Letissier, N. Kerfant

Résumé

Introduction

La prise en charge des pertes de substances combinées du tendon d'Achille et de la peau est difficile. Il ne s'agit pourtant pas de situations exceptionnelles après chirurgie du tendon d'Achille. Les données de la littérature sont vastes et il n'existe actuellement pas de consensus quant à la technique de reconstruction du tendon.

Cas cliniques

Nous rapportons quatre cas de nécrose purulente du tendon d'Achille compliquant un peignage ou la suture d'une rupture tendineuse. Après parage de l'ensemble des tissus nécrotiques, la perte de substance a été couverte par un lambeau perforant fascio-cutané ou par une greffe de peau mince sans reconstruction du tendon sous-jacent.

Discussion et conclusion

Les résultats fonctionnels sont très satisfaisants avec de bonnes mobilités articulaires et une reprise de la marche sans boiterie pour tous les patients. La fibrose permet de reconstituer un véritable néotendon confirmé à l'IRM. Les avantages sont nombreux par rapport à d'autres méthodes : un seul temps opératoire est nécessaire, la gestion postopératoire est simple et elle permet d'éviter certaines difficultés techniques liées à la reconstruction tendineuse. Une plus large série serait nécessaire pour conforter ces résultats.

Summary

Introduction

Management of the combined loss of Achilles tendon and skin is difficult. However, these are not exceptional situations after Achilles tendon surgery. Data from the literature are extensive and there is currently no consensus on the technique of tendon reconstruction.

Case reports

We report four cases of purulent necrosis of the Achilles tendon complicating longitudinal incision or suturing of a tendon rupture. After debridement of necrotic tissue, the defect was covered either by a fasciocutaneous perforating flap or a thin skin graft without reconstruction of the underlying tendon.

Discussion and conclusion

The functional results are very satisfactory with good joint mobilities and a resumption of walking without lameness for all patients. Fibrosis can reconstitute a true neo-tendon confirmed on MRI. The advantages are many compared to other methods: a single operating time is necessary, the postoperative management is simple and it avoids certain technical difficulties related to tendon reconstruction. A larger series would be needed to support these results.

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Errors according to the number of registered markers used in navigation-assisted surgery of the mandible

The aim of this study was to evaluate the accuracy of navigation according to the number of markers in terms of target registration errors (TREs) at each anatomical location during the registration process of ...

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Errors according to the number of registered markers used in navigation-assisted surgery of the mandible

The aim of this study was to evaluate the accuracy of navigation according to the number of markers in terms of target registration errors (TREs) at each anatomical location during the registration process of ...

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Does procalcitonin have a role in the pathogenesis of nasal polyp?

Abstract

Purpose

The aim of this study is to investigate serum and tissue procalcitonin (PCT) levels in patients with nasal polyps.

Methods

The study was designed to be prospectively controlled and included 26 patients chronic rhinosinusitis with nasal polyp (CRSwNP) endoscopically diagnosed and as a control group 25 chronic rhinosinusitis without nasal polyp (CRSsNP). NP specimens, nasal mucosal tissue and venous blood samples of both groups were collected and PCT levels determined by Elisa method. The results were compared statistically.

Results

Serum PCT values were 1319.5 pg/mL in the NP group and 818.8 pg/mL in the control group. The difference between the groups was statistically significant (p = 0.0001). In the NP group, the average PCT value of the polyp tissue was 1521.5 pg/gr, while the mean PCT value of the control group in the nasal mucosa was 414.6 pg/gr. There was a statistically significant difference between the groups (p = 0.0001). The tissue cut-off value of PCT 750 was significant [area under curve 0.940 (0.863–1.00)]. Serum PCT 950 cut-off value was significant [area under curve 0.860 (0.748–0.972)] activity (CI: 95%).

Conclusions

This is the first study of its kind to objectively examine PCT in the polyp and serum of CRSwNP patients. PCT may serve as a diagnostic biomarker in nasal polyps.

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Does procalcitonin have a role in the pathogenesis of nasal polyp?

Abstract

Purpose

The aim of this study is to investigate serum and tissue procalcitonin (PCT) levels in patients with nasal polyps.

Methods

The study was designed to be prospectively controlled and included 26 patients chronic rhinosinusitis with nasal polyp (CRSwNP) endoscopically diagnosed and as a control group 25 chronic rhinosinusitis without nasal polyp (CRSsNP). NP specimens, nasal mucosal tissue and venous blood samples of both groups were collected and PCT levels determined by Elisa method. The results were compared statistically.

Results

Serum PCT values were 1319.5 pg/mL in the NP group and 818.8 pg/mL in the control group. The difference between the groups was statistically significant (p = 0.0001). In the NP group, the average PCT value of the polyp tissue was 1521.5 pg/gr, while the mean PCT value of the control group in the nasal mucosa was 414.6 pg/gr. There was a statistically significant difference between the groups (p = 0.0001). The tissue cut-off value of PCT 750 was significant [area under curve 0.940 (0.863–1.00)]. Serum PCT 950 cut-off value was significant [area under curve 0.860 (0.748–0.972)] activity (CI: 95%).

Conclusions

This is the first study of its kind to objectively examine PCT in the polyp and serum of CRSwNP patients. PCT may serve as a diagnostic biomarker in nasal polyps.

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Comment on “Nonsurgical Management of Medication-Related Osteonecrosis of the Jaws Using Local Wound Care” by Hadaya et al

Publication date: Available online 8 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Takako Nishida, Yoshinori Fujita, Yoshinari Myoken

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Comment on “Nonsurgical Management of Medication-Related Osteonecrosis of the Jaws Using Local Wound Care” by Hadaya et al

Publication date: Available online 8 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Takako Nishida, Yoshinori Fujita, Yoshinari Myoken

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Pediatric Tracheostomy First Tube Change: When is it Safe?

Publication date: Available online 8 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): R. Woods, L. Geyer, R. Mehanna, J. Russell

Abstract

Objectives

The first tracheostomy tube change is typically performed on days 5-7 post-operatively, however recent international consensus guidelines suggested that, with maturation sutures, days 3-5 is appropriate. We evaluate whether a first tube change on day 2 post-operatively is safe and effective.

Methods

We carried out a retrospective review of all patients undergoing tracheostomy between 2009 and 2018. Exclusion criteria were patients on whom the senior authors did not operate, operations done elsewhere, cases where maturation sutures were not used or a patient died prior to first tube change. We noted patient details, indication for tracheostomy, the need for long-term ventilation, timing of the first tube change, decannulation and need for surgical closure of persistent tracheocutaneous fistula.

Results

93 patients were identified, of which 83 were included. The age range was 0-16 years, with the youngest day one of life and an overall mean age of 1.91 years. 59% of patients required long-term ventilation due to various co-morbidities. 26 patients (31%) underwent a first tube change on day 2 post-operatively. All these were uneventful and were irrespective of the patient's need for ventilation. Of the 42 patients who have subsequently been decannulated, 33 (79%) were noted to have a persistent tracheocutaneous fistula requiring surgical closure, four of whom needed revision closure.

Conclusions

This study shows that a first tube change on day 2 post-operatively is safe, facilitating earlier discharge from intensive care, allowing shorter length of sedation, earlier start to parent/carer training and wound assessment.

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The relationship between health-related quality of life and speech in patients with cleft palate

Publication date: Available online 8 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Laura Bruneel, Kim Bettens, Kristiane Van Lierde

Abstract

Introduction

In health-care, current efforts focus on providing patient-centered care. Specifically for patients with velopharyngeal insufficiency, and by extent patients with cleft palate, the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) questionnaire (Skirko et al., 2012; 2013) allows the clinician to map the impact of speech and swallowing difficulties on the patient's health-related quality of life (HRQoL). The current study evaluated the hypothesized association between this speech-related HRQoL measure and perceptually and instrumentally assessed speech variables, to provide evidence for the construct validity of the Dutch version of the VELO questionnaire.

Materials and methods

Thirty participants, twenty-five patients with cleft palate and five controls, were enrolled. Perceptual speech assessment was conducted following the recently developed Dutch outcome tool for perceptual speech assessment in patients with cleft palate. In addition, nasalance values and the Nasality Severity Index (NSI) 2.0 were determined. The relationship between these speech outcomes and the scores on the VELO parent report was determined using Spearman rank-order correlation coefficients.

Results

Moderate to strong correlations were found between the total score on the VELO parent report and five speech variables: the VPC-SUM score (r_s= -0.476), speech understandability (r_s= -0.657), passive CSC's (r_s= -0.654), speech acceptability (r_s= -0.591) and the need for C(L)P-related speech therapy (r_s= -0.711). Furthermore, these variables were associated with at least one subscale of the VELO questionnaire.

Discussion and conclusion:Correlations between speech outcomes and the Dutch version of the VELO questionnaire provide evidence for the construct validity of this version of the instrument. Furthermore, insights in these associations may lead the way to efficient therapy approaches, targeting speech features with the greatest impact on the patient's health-related quality of life.

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Radiologic Recognition of Cochlear Implant Magnet Displacement- A Case Report

Publication date: Available online 8 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Madison V. Epperson, Hayley L. Born, John Greinwald

Abstract

Despite various studies that have demonstrated risk of cochlear implant magnet displacement following MRI, minimal literature is available on radiologic recognition of magnet displacement. Current literature emphasizes the status and placement of the electrode component of the implant. This case report examines the consequences of a delay in radiologic diagnosis of a displaced magnet including hospital admission, unnecessary radiation, and prolonged patient discomfort. Additionally, it provides a framework for successful radiologic recognition of a displaced magnet, detailing specific imaging modalities and magnet characteristics that should be evaluated to expedite and facilitate radiologic recognition of displacement.

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The relationship between health-related quality of life and speech in patients with cleft palate

Publication date: Available online 8 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Laura Bruneel, Kim Bettens, Kristiane Van Lierde

Abstract

Introduction

In health-care, current efforts focus on providing patient-centered care. Specifically for patients with velopharyngeal insufficiency, and by extent patients with cleft palate, the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) questionnaire (Skirko et al., 2012; 2013) allows the clinician to map the impact of speech and swallowing difficulties on the patient's health-related quality of life (HRQoL). The current study evaluated the hypothesized association between this speech-related HRQoL measure and perceptually and instrumentally assessed speech variables, to provide evidence for the construct validity of the Dutch version of the VELO questionnaire.

Materials and methods

Thirty participants, twenty-five patients with cleft palate and five controls, were enrolled. Perceptual speech assessment was conducted following the recently developed Dutch outcome tool for perceptual speech assessment in patients with cleft palate. In addition, nasalance values and the Nasality Severity Index (NSI) 2.0 were determined. The relationship between these speech outcomes and the scores on the VELO parent report was determined using Spearman rank-order correlation coefficients.

Results

Moderate to strong correlations were found between the total score on the VELO parent report and five speech variables: the VPC-SUM score (r_s= -0.476), speech understandability (r_s= -0.657), passive CSC's (r_s= -0.654), speech acceptability (r_s= -0.591) and the need for C(L)P-related speech therapy (r_s= -0.711). Furthermore, these variables were associated with at least one subscale of the VELO questionnaire.

Discussion and conclusion:Correlations between speech outcomes and the Dutch version of the VELO questionnaire provide evidence for the construct validity of this version of the instrument. Furthermore, insights in these associations may lead the way to efficient therapy approaches, targeting speech features with the greatest impact on the patient's health-related quality of life.

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Genetic diversity of Streptococcus mutans serotype c isolated from white spot and cavitated caries lesions from schoolchildren

Publication date: Available online 8 February 2019

Source: Archives of Oral Biology

Author(s): Ramiro Javier Rincón-Rodríguez, Monica Tatiana Parada-Sanchez, Claudia María Bedoya-Correa, David Arboleda-Toro

Abstract

Objective

To determine the genetic diversity ofStreptococcus mutans (S. mutans) serotype c isolated from white spot and cavitated caries lesions of schoolchildren.

Methods

S. mutans isolates were obtained and identify by Polymerase Chain Reaction (PCR) from 28 schoolchildren. A total of 92 S. mutans isolates, identified as serotype c by PCR, were analyzed by pulsed field gel electrophoresis after digestion of genomic DNA with SmaI enzyme. 62 isolates were obtained from white spot and cavitated caries lesions of schoolchildren that presented both lesions simultaneously and 30 isolates were from saliva and biofilm samples of schoolchildren without dental caries. Cluster analyses were performed using the Dice coefficient of the BioNumerics software version 6.0.

Results

It was possible to determine the serotype in 190 isolates out of 255 isolates identified as S. mutans. Serotype c was the most frequent (n = 139), followed by serotype f (n = 31) and serotype e (n = 20). After analyzing the dendograms of the 92 serotype c isolates, this study identified three strains present in both types of lesions, two strains specific to the type of lesion: one strain from the white spot lesion and one strain from the cavitated caries lesion, and five strains specific to children with caries versus four strains for children without caries.

Conclusion

S. mutans serotype c genetic variability is similar in terms of the number of strains present according to the caries status and type of lesion.

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Radiologic Recognition of Cochlear Implant Magnet Displacement- A Case Report

Publication date: Available online 8 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Madison V. Epperson, Hayley L. Born, John Greinwald

Abstract

Despite various studies that have demonstrated risk of cochlear implant magnet displacement following MRI, minimal literature is available on radiologic recognition of magnet displacement. Current literature emphasizes the status and placement of the electrode component of the implant. This case report examines the consequences of a delay in radiologic diagnosis of a displaced magnet including hospital admission, unnecessary radiation, and prolonged patient discomfort. Additionally, it provides a framework for successful radiologic recognition of a displaced magnet, detailing specific imaging modalities and magnet characteristics that should be evaluated to expedite and facilitate radiologic recognition of displacement.

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Pediatric Tracheostomy First Tube Change: When is it Safe?

Publication date: Available online 8 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): R. Woods, L. Geyer, R. Mehanna, J. Russell

Abstract

Objectives

The first tracheostomy tube change is typically performed on days 5-7 post-operatively, however recent international consensus guidelines suggested that, with maturation sutures, days 3-5 is appropriate. We evaluate whether a first tube change on day 2 post-operatively is safe and effective.

Methods

We carried out a retrospective review of all patients undergoing tracheostomy between 2009 and 2018. Exclusion criteria were patients on whom the senior authors did not operate, operations done elsewhere, cases where maturation sutures were not used or a patient died prior to first tube change. We noted patient details, indication for tracheostomy, the need for long-term ventilation, timing of the first tube change, decannulation and need for surgical closure of persistent tracheocutaneous fistula.

Results

93 patients were identified, of which 83 were included. The age range was 0-16 years, with the youngest day one of life and an overall mean age of 1.91 years. 59% of patients required long-term ventilation due to various co-morbidities. 26 patients (31%) underwent a first tube change on day 2 post-operatively. All these were uneventful and were irrespective of the patient's need for ventilation. Of the 42 patients who have subsequently been decannulated, 33 (79%) were noted to have a persistent tracheocutaneous fistula requiring surgical closure, four of whom needed revision closure.

Conclusions

This study shows that a first tube change on day 2 post-operatively is safe, facilitating earlier discharge from intensive care, allowing shorter length of sedation, earlier start to parent/carer training and wound assessment.

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Genetic diversity of Streptococcus mutans serotype c isolated from white spot and cavitated caries lesions from schoolchildren

Publication date: Available online 8 February 2019

Source: Archives of Oral Biology

Author(s): Ramiro Javier Rincón-Rodríguez, Monica Tatiana Parada-Sanchez, Claudia María Bedoya-Correa, David Arboleda-Toro

Abstract

Objective

To determine the genetic diversity ofStreptococcus mutans (S. mutans) serotype c isolated from white spot and cavitated caries lesions of schoolchildren.

Methods

S. mutans isolates were obtained and identify by Polymerase Chain Reaction (PCR) from 28 schoolchildren. A total of 92 S. mutans isolates, identified as serotype c by PCR, were analyzed by pulsed field gel electrophoresis after digestion of genomic DNA with SmaI enzyme. 62 isolates were obtained from white spot and cavitated caries lesions of schoolchildren that presented both lesions simultaneously and 30 isolates were from saliva and biofilm samples of schoolchildren without dental caries. Cluster analyses were performed using the Dice coefficient of the BioNumerics software version 6.0.

Results

It was possible to determine the serotype in 190 isolates out of 255 isolates identified as S. mutans. Serotype c was the most frequent (n = 139), followed by serotype f (n = 31) and serotype e (n = 20). After analyzing the dendograms of the 92 serotype c isolates, this study identified three strains present in both types of lesions, two strains specific to the type of lesion: one strain from the white spot lesion and one strain from the cavitated caries lesion, and five strains specific to children with caries versus four strains for children without caries.

Conclusion

S. mutans serotype c genetic variability is similar in terms of the number of strains present according to the caries status and type of lesion.

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Safety of tooth extraction in patients receiving direct oral anticoagulant treatment versus warfarin: a prospective observation study

Publication date: Available online 8 February 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): H. Yoshikawa, M. Yoshida, M. Yasaka, H. Yoshida, Y. Murasato, D. Fukunaga, A. Shintani, Y. Okada

Abstract

The aim of this study was to compare the safety of tooth extraction in patients receiving direct oral anticoagulants (DOACs) or warfarin without cessation of their antithrombotic treatment. This prospective observational study included 367 patients undergoing tooth extraction (119 receiving DOACs and 248 receiving warfarin). All extractions in DOAC patients were performed 6–7 h after taking DOACs in consideration of the half-life in blood under continued antithrombotic treatment. To examine the potential postoperative bleeding risk related to the time of extraction and the drug concentration of blood, activated partial thromboplastin time (APTT) in dabigatran and prothrombin time (PT) in rivaroxaban were measured three times after administration. A total of 390 tooth extractions were performed: 128 in the DOAC patients and 262 in warfarin patients. Postoperative bleeding occurred in four extractions (3.1%) in the DOAC group and in 23 (8.8%) in the warfarin group. There was no statistically significant difference between the two groups (odds ratio: 2.362, 95% confidence interval (CI) 0.819–6.815, p = 0.112). APTT and PT prolongation in almost all cases decreased with time after taking the medicine. Our findings suggest that interruption of DOAC therapy is not necessary for tooth extraction if the procedure is performed at least 6 h after the last dose.

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Safety of tooth extraction in patients receiving direct oral anticoagulant treatment versus warfarin: a prospective observation study

Publication date: Available online 8 February 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): H. Yoshikawa, M. Yoshida, M. Yasaka, H. Yoshida, Y. Murasato, D. Fukunaga, A. Shintani, Y. Okada

Abstract

The aim of this study was to compare the safety of tooth extraction in patients receiving direct oral anticoagulants (DOACs) or warfarin without cessation of their antithrombotic treatment. This prospective observational study included 367 patients undergoing tooth extraction (119 receiving DOACs and 248 receiving warfarin). All extractions in DOAC patients were performed 6–7 h after taking DOACs in consideration of the half-life in blood under continued antithrombotic treatment. To examine the potential postoperative bleeding risk related to the time of extraction and the drug concentration of blood, activated partial thromboplastin time (APTT) in dabigatran and prothrombin time (PT) in rivaroxaban were measured three times after administration. A total of 390 tooth extractions were performed: 128 in the DOAC patients and 262 in warfarin patients. Postoperative bleeding occurred in four extractions (3.1%) in the DOAC group and in 23 (8.8%) in the warfarin group. There was no statistically significant difference between the two groups (odds ratio: 2.362, 95% confidence interval (CI) 0.819–6.815, p = 0.112). APTT and PT prolongation in almost all cases decreased with time after taking the medicine. Our findings suggest that interruption of DOAC therapy is not necessary for tooth extraction if the procedure is performed at least 6 h after the last dose.

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Drop attacks, hydrops severity, and disease duration in hydropic ear disease (Menière’s)

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The SNOT-22 factorial structure in European patients with chronic rhinosinusitis: new clinical insights

Abstract

Purpose

The sino-nasal outcomes test-22 (SNOT-22) represents the reference questionnaire to assess patients with chronic rhinosinusitis (CRS). As weak correlations between objective CRS parameters and SNOT-22 total score have been observed, factor analyses have aimed to identify underlying factorial structures. However, ambiguous factor loadings and problematic item-domain assignments have resulted. Moreover, such factor analyses have mainly been performed in non-European CRS patients, while European data remain sparse. This study thus sought to address these issues.

Methods

Principal component analysis and confirmatory factor analysis were performed from SNOT-22 questionnaires completed by European CRS patients. Goodness of fit, internal consistencies, and factor loadings were calculated. Item-domain assignment was based on statistical grounds and clinical meaningfulness. Additionally, this study investigated correlations between SNOT-22 domains and external reference criteria, including Lund–Mackay score, Lund–Naclerio score and the brief symptom inventory 18 (BSI-18).

Results

One hundred and thirty-four European CRS patients were included. Principal component analysis proposed four SNOT-22 domains ("nasal symptoms", "otologic symptoms", "sleep symptoms", "emotional symptoms"), which explained 63.6% of variance. Observed item-domain-assignment differed from previously proposed item-domain assignments. All factor loadings were > 0.5, except "cough" (0.42) and "facial pain or pressure" (0.49). For confirmatory factor analysis, satisfactory goodness of fit (RMSEA = 0.66; CFI = 0.92; TLI = 0.90) and internal consistencies (Cronbach-α: total score = 0.93; domains = 0.75–0.91) were observed. Significant positive correlations were found between the "nasal symptoms" domain and both the Lund–Mackay score (r = 0.48; p < 0.001) and the Lund–Naclerio score (r = 0.27, p < 0.01). Significant positive correlations were also identified between "emotional symptoms" and BSI-18 total score (r = 0.64, p < 0.001).

Conclusions

Principal component analysis performed for SNOT-22 questionnaires completed by European CRS patients indicated a different item-domain-assignment than previously reported. Confirmatory factor analysis suggested acceptable and clinically plausible psychometric properties for the resulting factorial structure. Significant correlations between the "nasal symptoms" and the "emotional symptoms" domains were observed with objective CRS parameters. The resulting factorial structure with different item-domain assignments may thus be more suitable for European CRS patients.

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Drop attacks, hydrops severity, and disease duration in hydropic ear disease (Menière’s)

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The SNOT-22 factorial structure in European patients with chronic rhinosinusitis: new clinical insights

Abstract

Purpose

The sino-nasal outcomes test-22 (SNOT-22) represents the reference questionnaire to assess patients with chronic rhinosinusitis (CRS). As weak correlations between objective CRS parameters and SNOT-22 total score have been observed, factor analyses have aimed to identify underlying factorial structures. However, ambiguous factor loadings and problematic item-domain assignments have resulted. Moreover, such factor analyses have mainly been performed in non-European CRS patients, while European data remain sparse. This study thus sought to address these issues.

Methods

Principal component analysis and confirmatory factor analysis were performed from SNOT-22 questionnaires completed by European CRS patients. Goodness of fit, internal consistencies, and factor loadings were calculated. Item-domain assignment was based on statistical grounds and clinical meaningfulness. Additionally, this study investigated correlations between SNOT-22 domains and external reference criteria, including Lund–Mackay score, Lund–Naclerio score and the brief symptom inventory 18 (BSI-18).

Results

One hundred and thirty-four European CRS patients were included. Principal component analysis proposed four SNOT-22 domains ("nasal symptoms", "otologic symptoms", "sleep symptoms", "emotional symptoms"), which explained 63.6% of variance. Observed item-domain-assignment differed from previously proposed item-domain assignments. All factor loadings were > 0.5, except "cough" (0.42) and "facial pain or pressure" (0.49). For confirmatory factor analysis, satisfactory goodness of fit (RMSEA = 0.66; CFI = 0.92; TLI = 0.90) and internal consistencies (Cronbach-α: total score = 0.93; domains = 0.75–0.91) were observed. Significant positive correlations were found between the "nasal symptoms" domain and both the Lund–Mackay score (r = 0.48; p < 0.001) and the Lund–Naclerio score (r = 0.27, p < 0.01). Significant positive correlations were also identified between "emotional symptoms" and BSI-18 total score (r = 0.64, p < 0.001).

Conclusions

Principal component analysis performed for SNOT-22 questionnaires completed by European CRS patients indicated a different item-domain-assignment than previously reported. Confirmatory factor analysis suggested acceptable and clinically plausible psychometric properties for the resulting factorial structure. Significant correlations between the "nasal symptoms" and the "emotional symptoms" domains were observed with objective CRS parameters. The resulting factorial structure with different item-domain assignments may thus be more suitable for European CRS patients.

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MRI estimates of brown adipose tissue in children – Associations to adiposity, osteocalcin, and thigh muscle volume

Publication date: Available online 8 February 2019

Source: Magnetic Resonance Imaging

Author(s): Jonathan Andersson, Josefine Roswall, Emma Kjellberg, Håkan Ahlström, Jovanna Dahlgren, Joel Kullberg

Abstract

Context

Brown adipose tissue is of metabolic interest. The tissue is however poorly explored in children.

Methods

Sixty-three 7-year old subjects from the Swedish birth-cohort Halland Health and Growth Study were recruited. Care was taken to include both normal weight and overweight children, but the subjects were otherwise healthy. Only children born full term were included.

Water-fat separated whole-body MRI scans, anthropometric measurements, and measurements of fasting glucose and levels of energy homeostasis related hormones, including the insulin-sensitizer osteocalcin, were performed. The fat fraction (FF) and effective transverse relaxation time (T₂*) of suspected brown adipose tissue in the cervical-supraclavicular-axillary fat depot (sBAT) and the FFs of abdominal visceral (VAT) and subcutaneous adipose tissue (SAT) were measured. Volumes of sBAT, abdominal VAT and SAT, and thigh muscle volumes were measured.

Results

The FF in the sBAT depot was lower than in VAT and SAT for all children. In linear correlations including sex and age as explanatory variables, sBAT FF correlated positively with all measures of adiposity (p < 0.01), except for VAT FF and weight, positively with sBAT T₂* (p = 0.036), and negatively with osteocalcin (p = 0.017). When adding measures of adiposity as explanatory variables, sBAT FF also correlated negatively with thigh muscle volume (p < 0.01).

Conclusions

Whole-body water-fat MRI of children allows for measurements of sBAT. The FF of sBAT was lower than that of VAT and SAT, indicating presence of BAT. Future studies could confirm whether the observed correlations corresponds to a hormonally active BAT.

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