ACAAI: School District'Risks Children's Lives' by Not Stocking Epinephrine

(MedPage Today) -- Weatherford, Texas, board votes to use OTC Benadryl instead (Source: MedPage Today Allergy)

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ACAAI: School District'Risks Children's Lives' by Not Stocking Epinephrine

(MedPage Today) -- Weatherford, Texas, board votes to use OTC Benadryl instead (Source: MedPage Today Allergy)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2M3ZY81

The Significant Correlation Between the Density of the Cochlea Otic Capsule and Spine in Hearing Loss Patients

This study aimed to analyzes the correlation between the density of the cochlea otic capsule and the ear bone towards the femur and spine density in patients with reduction in bone density. This was a cross-sectional observational type analytic retrospective study analyzing 30 samples of patients with a reduction in bone density that have HRCT Mastoid examination results during 2017 at RSSA Malang 's osteoporosis polyclinic. From 30 samples, most were female with an age range of 51–60 years old. The average femur, spine, ear bone and cochlea otic capsule of the osteoporosis group was lower than the osteopenia group. The spine density was significantly correlated with the otic capsule den sity. There was a positive significant correlation between the spine density towards the otic caps...

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The Significant Correlation Between the Density of the Cochlea Otic Capsule and Spine in Hearing Loss Patients

This study aimed to analyzes the correlation between the density of the cochlea otic capsule and the ear bone towards the femur and spine density in patients with reduction in bone density. This was a cross-sectional observational type analytic retrospective study analyzing 30 samples of patients with a reduction in bone density that have HRCT Mastoid examination results during 2017 at RSSA Malang 's osteoporosis polyclinic. From 30 samples, most were female with an age range of 51–60 years old. The average femur, spine, ear bone and cochlea otic capsule of the osteoporosis group was lower than the osteopenia group. The spine density was significantly correlated with the otic capsule den sity. There was a positive significant correlation between the spine density towards the otic caps...

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Daily Aspirin May Curb COPD Exacerbations Daily Aspirin May Curb COPD Exacerbations

Daily aspirin use appears to reduce the risk of exacerbations and have other beneficial effects in patients with chronic obstructive pulmonary disease (COPD), according to an observational study.Reuters Health Information (Source: Medscape Allergy Headlines)

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U.S. Kids Often Get Inappropriate Antibiotics in the ED U.S. Kids Often Get Inappropriate Antibiotics in the ED

In U.S. emergency departments (EDs), especially non-pediatric EDs, children often receive antibiotics inappropriately, a retrospective study suggests.Reuters Health Information (Source: Medscape Allergy Headlines)

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Daily Aspirin May Curb COPD Exacerbations Daily Aspirin May Curb COPD Exacerbations

Daily aspirin use appears to reduce the risk of exacerbations and have other beneficial effects in patients with chronic obstructive pulmonary disease (COPD), according to an observational study.Reuters Health Information (Source: Medscape Allergy Headlines)

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U.S. Kids Often Get Inappropriate Antibiotics in the ED U.S. Kids Often Get Inappropriate Antibiotics in the ED

In U.S. emergency departments (EDs), especially non-pediatric EDs, children often receive antibiotics inappropriately, a retrospective study suggests.Reuters Health Information (Source: Medscape Allergy Headlines)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sife86

The Significant Correlation Between the Density of the Cochlea Otic Capsule and Spine in Hearing Loss Patients

Abstract

Osteoporosis and osteopenia are systemic disorders that affect all bones. Osteoporosis in the ear bone and cochlea otic capsule contribute to the occurrence of conduction and sensorineural deaf. The osteoporosis prevalence in RSSA is 38%; meanwhile hearing interference in osteoporosis patients is 66.67%. The femur and spine DXA are the golden standard to calculate the bone mineral density. The temporal bone density can be measured with CT scan using the Hounsfield Unit units. There is a hypothesis that the femur bone mass density can illustrate the temporal bone density. This study aimed to analyzes the correlation between the density of the cochlea otic capsule and the ear bone towards the femur and spine density in patients with reduction in bone density. This was a cross-sectional observational type analytic retrospective study analyzing 30 samples of patients with a reduction in bone density that have HRCT Mastoid examination results during 2017 at RSSA Malang's osteoporosis polyclinic. From 30 samples, most were female with an age range of 51–60 years old. The average femur, spine, ear bone and cochlea otic capsule of the osteoporosis group was lower than the osteopenia group. The spine density was significantly correlated with the otic capsule density. There was a positive significant correlation between the spine density towards the otic capsule density. The lower the spine density, the lower the otic capsule became.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2VJ3UiP

The Significant Correlation Between the Density of the Cochlea Otic Capsule and Spine in Hearing Loss Patients

Abstract

Osteoporosis and osteopenia are systemic disorders that affect all bones. Osteoporosis in the ear bone and cochlea otic capsule contribute to the occurrence of conduction and sensorineural deaf. The osteoporosis prevalence in RSSA is 38%; meanwhile hearing interference in osteoporosis patients is 66.67%. The femur and spine DXA are the golden standard to calculate the bone mineral density. The temporal bone density can be measured with CT scan using the Hounsfield Unit units. There is a hypothesis that the femur bone mass density can illustrate the temporal bone density. This study aimed to analyzes the correlation between the density of the cochlea otic capsule and the ear bone towards the femur and spine density in patients with reduction in bone density. This was a cross-sectional observational type analytic retrospective study analyzing 30 samples of patients with a reduction in bone density that have HRCT Mastoid examination results during 2017 at RSSA Malang's osteoporosis polyclinic. From 30 samples, most were female with an age range of 51–60 years old. The average femur, spine, ear bone and cochlea otic capsule of the osteoporosis group was lower than the osteopenia group. The spine density was significantly correlated with the otic capsule density. There was a positive significant correlation between the spine density towards the otic capsule density. The lower the spine density, the lower the otic capsule became.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2VJ3UiP

The Effect of Endoscopic Endonasal Transsphenoidal Skull Base Surgery on Cochlear Function

In conclusion, it is found that bone drilling in ETSS procedure has a negative effect on cochlear function in the early period. This is the first study to evaluate the degree of noise-induced cochlear damage in patients who were gone under ETSS procedure. [...] Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Journal of Neurological Surgery Part B: Skull Base)

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Increased eosinophil uptake in the lungs of obese patients with asthma —to correct for obesity compare to obese controls

We read with great interest the study by Farahi et  al1 reporting that single photon emission computed tomography/computed tomography imaging using radiolabeled eosinophils could be used to quantify eosinophil uptake from the blood to the lungs. We agree with the proposal that bronchial eosinophil count and sputum eosinophil count are not correlate d. Bronchial biopsies are currently the golden standard to investigate bronchial eosinophilic inflammation. However, a bronchial biopsy is an invasive procedure, which makes the noninvasive method from Farahi et al more interesting. (Source: Journal of Allergy and Clinical Immunology)

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Indirect treatment comparison of asthma biologics fraught with methodology issues

We read with interest the article by Busse et  al1 that evaluated the relative efficacies of benralizumab 30 mg, mepolizumab 100 mg, and reslizumab 3 mg/kg through an indirect treatment comparison (ITC). After careful consideration, we have concluded the methodology was lacking, and, therefore, the results and conclusions may not be robust or replicable. (Source: Journal of Allergy and Clinical Immunology)

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Reply

We thank Huisstede et  al1 for their interest in our publication and their comments. Like the authors we agree wholeheartedly that weight reduction is key to improving asthma control and quality of life in obese patients, and that bariatric surgery is one treatment option to help achieve this. However, access to bariatr ic surgery varies between countries. In the United Kingdom, this option is available only for those patients who have a body mass index (BMI) range of 35 to 40 together with additional medical problems such as type 2 diabetes or high blood pressure proven to be improved by marked weight loss, or a B MI of more than 40. (Source: Journal of Allergy and Clinical Immunology)

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Reply

Bourdin and Molinari1 suggest that methodological issues may have impacted the robustness and replicability of results described in our article2 that evaluated the relative efficacy of mepolizumab, benralizumab, and reslizumab through an indirect treatment comparison using the Bucher method.3 Specifically, the authors propose that matching-adjusted indirect comparison (MAIC),4 which was recently used in a study by Bourdin et  al,5 is more appropriate for accounting for differences in effect modifiers between studies. (Source: Journal of Allergy and Clinical Immunology)

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Omalizumab effectiveness in asthma-COPD overlap: Post hoc analysis of PROSPERO

Asthma and chronic obstructive pulmonary disease (COPD) overlap (ACO), defined as the coexistence of clinical features of asthma and COPD, is common.1,2 Although ACO is heterogeneous, common subphenotypes of ACO include those with asthma who are older than 40  years with a history of smoking and/or those who have persistent, progressive, and partially reversible airflow limitation.2 (Source: Journal of Allergy and Clinical Immunology)

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

Atopic eczema and major cardiovascular outcomes: A systematic review and meta-analysis of population-based studies

Atopic eczema is a common inflammatory skin disease. Various inflammatory conditions have been linked to cardiovascular disease, a major cause of global mortality and morbidity. (Source: Journal of Allergy and Clinical Immunology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2VKUV0r

Increased eosinophil uptake in the lungs of obese patients with asthma —to correct for obesity compare to obese controls

We read with great interest the study by Farahi et  al1 reporting that single photon emission computed tomography/computed tomography imaging using radiolabeled eosinophils could be used to quantify eosinophil uptake from the blood to the lungs. We agree with the proposal that bronchial eosinophil count and sputum eosinophil count are not correlate d. Bronchial biopsies are currently the golden standard to investigate bronchial eosinophilic inflammation. However, a bronchial biopsy is an invasive procedure, which makes the noninvasive method from Farahi et al more interesting. (Source: Journal of Allergy and Clinical Immunology)

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

Indirect treatment comparison of asthma biologics fraught with methodology issues

We read with interest the article by Busse et  al1 that evaluated the relative efficacies of benralizumab 30 mg, mepolizumab 100 mg, and reslizumab 3 mg/kg through an indirect treatment comparison (ITC). After careful consideration, we have concluded the methodology was lacking, and, therefore, the results and conclusions may not be robust or replicable. (Source: Journal of Allergy and Clinical Immunology)

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

Reply

We thank Huisstede et  al1 for their interest in our publication and their comments. Like the authors we agree wholeheartedly that weight reduction is key to improving asthma control and quality of life in obese patients, and that bariatric surgery is one treatment option to help achieve this. However, access to bariatr ic surgery varies between countries. In the United Kingdom, this option is available only for those patients who have a body mass index (BMI) range of 35 to 40 together with additional medical problems such as type 2 diabetes or high blood pressure proven to be improved by marked weight loss, or a B MI of more than 40. (Source: Journal of Allergy and Clinical Immunology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2QAfn0x

Reply

Bourdin and Molinari1 suggest that methodological issues may have impacted the robustness and replicability of results described in our article2 that evaluated the relative efficacy of mepolizumab, benralizumab, and reslizumab through an indirect treatment comparison using the Bucher method.3 Specifically, the authors propose that matching-adjusted indirect comparison (MAIC),4 which was recently used in a study by Bourdin et  al,5 is more appropriate for accounting for differences in effect modifiers between studies. (Source: Journal of Allergy and Clinical Immunology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2VJ8nlJ

Omalizumab effectiveness in asthma-COPD overlap: Post hoc analysis of PROSPERO

Asthma and chronic obstructive pulmonary disease (COPD) overlap (ACO), defined as the coexistence of clinical features of asthma and COPD, is common.1,2 Although ACO is heterogeneous, common subphenotypes of ACO include those with asthma who are older than 40  years with a history of smoking and/or those who have persistent, progressive, and partially reversible airflow limitation.2 (Source: Journal of Allergy and Clinical Immunology)

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

Atopic eczema and major cardiovascular outcomes: A systematic review and meta-analysis of population-based studies

Atopic eczema is a common inflammatory skin disease. Various inflammatory conditions have been linked to cardiovascular disease, a major cause of global mortality and morbidity. (Source: Journal of Allergy and Clinical Immunology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2VKUV0r

UCLA researchers correct genetic mutation that causes IPEX, a life-threatening autoimmune syndrome

UCLA researchers led by Dr. Donald Kohn have created a method for modifying blood stem cells to reverse the genetic mutation that causes a life-threatening autoimmune syndrome called IPEX. The gene therapy, which was tested in mice, is similar to the technique Kohn has used to cure patients with another immune disease, severe combined immune deficiency, or SCID, also known as bubble baby disease.The workis described in a study published in the journal Cell Stem Cell.IPEX is caused by a mutation that prevents a gene called FoxP3 from making a protein needed for blood stem cells to produce immune cells called regulatory T cells. Regulatory T cells keep the body 's immune system in check; without them, the immune system attacks the body's own tissues and organs, which is known as autoimmu...

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CeUKS9

Metabolism as a driver of immune response

(Source: ScienceNOW)

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

Unmasking an agent of inflammatory anemia

(Source: ScienceNOW)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CaVg3I

An evolutionary perspective on immunometabolism

Metabolism is at the core of all biological functions. Anabolic metabolism uses building blocks that are either derived from nutrients or synthesized de novo to produce the biological infrastructure, whereas catabolic metabolism generates energy to fuel all biological processes. Distinct metabolic programs are required to support different biological functions. Thus, recent studies have revealed how signals regulating cell quiescence, proliferation, and differentiation also induce the appropriate metabolic programs. In particular, a wealth of new studies in the field of immunometabolism has unveiled many examples of the connection among metabolism, cell fate decisions, and organismal physiology. We discuss these findings under a unifying framework derived from the evolutionary and ecologic...

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

UCLA researchers correct genetic mutation that causes IPEX, a life-threatening autoimmune syndrome

UCLA researchers led by Dr. Donald Kohn have created a method for modifying blood stem cells to reverse the genetic mutation that causes a life-threatening autoimmune syndrome called IPEX. The gene therapy, which was tested in mice, is similar to the technique Kohn has used to cure patients with another immune disease, severe combined immune deficiency, or SCID, also known as bubble baby disease.The workis described in a study published in the journal Cell Stem Cell.IPEX is caused by a mutation that prevents a gene called FoxP3 from making a protein needed for blood stem cells to produce immune cells called regulatory T cells. Regulatory T cells keep the body 's immune system in check; without them, the immune system attacks the body's own tissues and organs, which is known as autoimmu...

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CeUKS9

Metabolism as a driver of immune response

(Source: ScienceNOW)

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

Unmasking an agent of inflammatory anemia

(Source: ScienceNOW)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CaVg3I

An evolutionary perspective on immunometabolism

Metabolism is at the core of all biological functions. Anabolic metabolism uses building blocks that are either derived from nutrients or synthesized de novo to produce the biological infrastructure, whereas catabolic metabolism generates energy to fuel all biological processes. Distinct metabolic programs are required to support different biological functions. Thus, recent studies have revealed how signals regulating cell quiescence, proliferation, and differentiation also induce the appropriate metabolic programs. In particular, a wealth of new studies in the field of immunometabolism has unveiled many examples of the connection among metabolism, cell fate decisions, and organismal physiology. We discuss these findings under a unifying framework derived from the evolutionary and ecologic...

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

Chronic TLR7 and TLR9 signaling drives anemia via differentiation of specialized hemophagocytes

Cytopenias are an important clinical problem associated with inflammatory disease and infection. We show that specialized phagocytes that internalize red blood cells develop in Toll-like receptor 7 (TLR7)–driven inflammation. TLR7 signaling caused the development of inflammatory hemophagocytes (iHPCs), which resemble splenic red pulp macrophages but are a distinct population derived from Ly6Chi monocytes. iHPCs were responsible for anemia and thrombocytopenia in TLR7-overexpressing mice, which have a macrophage activation syndrome (MAS)–like disease. Interferon regulatory factor 5 (IRF5), associated with MAS, participated in TLR7-driven iHPC differentiation. We also found iHPCs during experimental malarial anemia, in which they required endosomal TLR and MyD88 signaling for dif...

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

Metabolism as a driver of immune response

(Source: ScienceNOW)

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

Unmasking an agent of inflammatory anemia

(Source: ScienceNOW)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CaVg3I

An evolutionary perspective on immunometabolism

Metabolism is at the core of all biological functions. Anabolic metabolism uses building blocks that are either derived from nutrients or synthesized de novo to produce the biological infrastructure, whereas catabolic metabolism generates energy to fuel all biological processes. Distinct metabolic programs are required to support different biological functions. Thus, recent studies have revealed how signals regulating cell quiescence, proliferation, and differentiation also induce the appropriate metabolic programs. In particular, a wealth of new studies in the field of immunometabolism has unveiled many examples of the connection among metabolism, cell fate decisions, and organismal physiology. We discuss these findings under a unifying framework derived from the evolutionary and ecologic...

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

Chronic TLR7 and TLR9 signaling drives anemia via differentiation of specialized hemophagocytes

Cytopenias are an important clinical problem associated with inflammatory disease and infection. We show that specialized phagocytes that internalize red blood cells develop in Toll-like receptor 7 (TLR7)–driven inflammation. TLR7 signaling caused the development of inflammatory hemophagocytes (iHPCs), which resemble splenic red pulp macrophages but are a distinct population derived from Ly6Chi monocytes. iHPCs were responsible for anemia and thrombocytopenia in TLR7-overexpressing mice, which have a macrophage activation syndrome (MAS)–like disease. Interferon regulatory factor 5 (IRF5), associated with MAS, participated in TLR7-driven iHPC differentiation. We also found iHPCs during experimental malarial anemia, in which they required endosomal TLR and MyD88 signaling for dif...

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

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

UCLA researchers correct genetic mutation that causes IPEX, a life-threatening autoimmune syndrome

UCLA researchers led by Dr. Donald Kohn have created a method for modifying blood stem cells to reverse the genetic mutation that causes a life-threatening autoimmune syndrome called IPEX. The gene therapy, which was tested in mice, is similar to the technique Kohn has used to cure patients with another immune disease, severe combined immune deficiency, or SCID, also known as bubble baby disease.The workis described in a study published in the journal Cell Stem Cell.IPEX is caused by a mutation that prevents a gene called FoxP3 from making a protein needed for blood stem cells to produce immune cells called regulatory T cells. Regulatory T cells keep the body 's immune system in check; without them, the immune system attacks the body's own tissues and organs, which is known as autoimmu...

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

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CeUKS9

Metabolism as a driver of immune response

(Source: ScienceNOW)

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

Unmasking an agent of inflammatory anemia

(Source: ScienceNOW)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CaVg3I

Chronic TLR7 and TLR9 signaling drives anemia via differentiation of specialized hemophagocytes

Cytopenias are an important clinical problem associated with inflammatory disease and infection. We show that specialized phagocytes that internalize red blood cells develop in Toll-like receptor 7 (TLR7)–driven inflammation. TLR7 signaling caused the development of inflammatory hemophagocytes (iHPCs), which resemble splenic red pulp macrophages but are a distinct population derived from Ly6Chi monocytes. iHPCs were responsible for anemia and thrombocytopenia in TLR7-overexpressing mice, which have a macrophage activation syndrome (MAS)–like disease. Interferon regulatory factor 5 (IRF5), associated with MAS, participated in TLR7-driven iHPC differentiation. We also found iHPCs during experimental malarial anemia, in which they required endosomal TLR and MyD88 signaling for dif...

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

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

Defect-oriented reconstruction after transoral robotic surgery for oropharyngeal cancer: a case series and review of the literature.

Related Articles

Defect-oriented reconstruction after transoral robotic surgery for oropharyngeal cancer: a case series and review of the literature.

Acta Otorhinolaryngol Ital. 2018 Dec;38(6):569-574

Authors: Meccariello G, Montevecchi F, Sgarzani R, Vicini C

Abstract
Transoral robotic surgery (TORS) is a fascinating new technique that has been shown to be a safe and feasible treatment for selected oropharyngeal cancers. Furthermore, TORS might offer some advantages in selected locoregionally advanced cancers. Thus, the patient selection is the keypoint for the useful application of TORS. However, the reconstruction of large oropharyngeal defects is challenging due to the restoration of velopharyngeal competency and swallowing. Moreover, the absence of mandibular splitting increases the difficulties faced by reconstructive surgeons. The paradigm for oropharyngeal reconstruction has undergone changes paralleling reflecting the overall change in the trend of the treatment alternatives over the last few decades. Flap choice and harvesting should be tailored to obtain significant advantages both in functional terms and for easy insetting. In this review, we analyse the strengths and weaknesses of the various flaps used in TORS framework with particular regards on our preliminary experience.

PMID: 30623902 [PubMed - in process]

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Surgical outcomes of tympanoplasty using a sterile acellular dermal allograft: a prospective randomised controlled study.

Related Articles

Surgical outcomes of tympanoplasty using a sterile acellular dermal allograft: a prospective randomised controlled study.

Acta Otorhinolaryngol Ital. 2018 Dec;38(6):554-562

Authors: Lee JM, Seo YJ, Shim DB, Lee HJ, Kim SH

Abstract
Acellular human dermal allografts have been shown to be effective for soft-tissue implantation. We compared treatment outcomes of tympanoplasty using tragal perichondrium and acellular human dermal allograft (MegaDerm®). In a prospective randomised controlled study, 60 patients scheduled to undergo tympanoplasty were randomly assigned to the autologous tragal perichondrium group (n = 33) or acellular human dermal allograft group (n = 27). Postoperative hearing gain, graft success rate at 1 and 6 months and operation times were compared between groups. Graft success rate, defined as the complete closure of tympanic membrane perforation, did not show any significant intergroup difference (75.8% vs 85.2%, p = 0.519). Air conduction thresholds and air-bone gaps showed significant improvements in both groups; from 38.7 ± 15.9 dB to 30.2 ± 15.6 dB (p < 0.001) and from 17.8 ± 7.3 dB to 11.5 ± 7.0 (p = 0.001) in the autologous tragal perichondrium group, and from 30.4 ± 12.2 dB to 24.5 ± 13.0 dB (p = 0.006) and from 14.3 ± 5.1 dB to 7.6 ± 4.6 dB (p < 0.001) in the acellular human dermal allograft group. The amount of hearing gain (p = 0.31) and closure of air-bone gap (p = 0.863) were not meaningfully different between groups. The mean operation time was significantly lower in the acellular human dermal allograft group (35.2 min vs 27.4 min, p = 0.039). In this prospective randomised controlled study, acellular human dermal allograft was shown to be an effective alternative to tragal perichondrium, with similar graft success rates and postoperative hearing results, but with reduced operation times.

PMID: 30623901 [PubMed - in process]

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Otologic manifestations of Susac syndrome.

Related Articles

Otologic manifestations of Susac syndrome.

Acta Otorhinolaryngol Ital. 2018 Dec;38(6):544-553

Authors: Patel VA, Dunklebarger M, Zacharia TT, Isildak H

Abstract
Susac syndrome, a rare autoimmune disorder first described as a classic triad (encephalopathy, branch retinal artery occlusion, and sensorineural hearing loss) in 1979 by renowned physician John O. Susac, has been an advancing area of clinical interest and scientific research over the last several decades. This comprehensive review aims to succinctly highlight the breadth and detail of this enigmatic disease, with a primary focus on otologic manifestations. Topics discussed include epidemiology, pathophysiology, clinical manifestations, differential diagnoses, classification schema, laboratory investigations, characteristic audiometric findings, high-yield radiographic imaging, temporal bone histopathology, treatment strategies and overall prognosis.

PMID: 30623900 [PubMed - in process]

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SMyC8N

Speech perception in noise by young sequential bilingual children.

Related Articles

Speech perception in noise by young sequential bilingual children.

Acta Otorhinolaryngol Ital. 2018 Dec;38(6):536-543

Authors: Bovo R, Lovo E, Astolfi L, Montino S, Franchella S, Gallo S, Prodi N, Borsetto D, Trevisi P

Abstract
The objective of this study was to ascertain the effects of competitive noise on second language perception skills of sequentially bilingual children and to compare the results with those relating to matched monolingual peers. Fifteen bilingual immigrant children (aged 6-10 years) (BL) learning through their second language (L2), which was Italian, were matched with 15 peers who only spoke Italian (IO). All immigrant children had arrived in Italy and were exposed to L2 after their 4th year of life. The speech-to-noise ratio (SNR) needed to obtain 50% intelligibility - the speech reception threshold (SRT) - for Italian words was measured against the Italian version of ICRA noise, using an adaptive method. Moreover, presentation of phrases against a contralateral continuous discourse (informational masking) was carried out to exclude possible biases due to differences in memory, attention, or other central auditory processing disorders between groups. The SNR was -2.7 dB (SD 1.7; range: -5.5 to + 0.9) for the BL group and -5.3 dB (SD 2.3; range: -8.8 to -0.9) for the IO group (p < 0.01). With contralateral continuous discourse presentation the SNR were -32.8 dB (SD 2.4; range: -36.1 to -28.2) for the BL group and -27.8 dB (SD 2.1; range: -31.7 to -24.1) for the OI group (p < 0.01). Even sequential bilingual individuals exposed to L2 at 4 years old had worse speech perception in noise than their matched IO peers. On the other hand, the BL group demonstrated superior divided attention skills in tests with competitive contralateral discourse (p < 0.01).

PMID: 30623899 [PubMed - in process]

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Septoplasty: is it possible to identify potential "predictors" of surgical success?

Related Articles

Septoplasty: is it possible to identify potential "predictors" of surgical success?

Acta Otorhinolaryngol Ital. 2018 Dec;38(6):528-535

Authors: Cantone E, Ricciardiello F, Oliva F, De Corso E, Iengo M

Abstract
Septoplasty is one of the most frequent surgical procedures performed by otolaryngologists. Despite successful surgical correction, many patients are not satisfied with their outcomes. So far, in clinical practice there is no consensus of opinion about the reliability of objective measurements of nasal patency and the correlation between objective measurements and subjective nasal patency symptoms. This study aims to assess the reasons for patient dissatisfaction after septoplasty and optimise pre-operative diagnostic management to predict surgical outcomes. We analysed 494 patients undergoing septoplasties with turbinoplasty by subjective Nasal Obstruction Symptom Evaluation questionnaire (NOSE) and objective active anterior rhinomanometric measurements before surgery and after 6 months. In our series, 17% had postoperative septal re-displacement; all patients had an anterior deviations at baseline. We found that the type of septal deviation, anterior vs posterior, was a significant predictor of postoperative functional improvement, whereas demographic characteristics as age, gender and smoke habit were not. Our data suggest that the anterior segment of the nasal septum was the most critical area for nasal airway resistance and more difficult to manage because it is likely to re-displace vs the posterior one and for this reason it represents a negative predictor of postoperative satisfaction.

PMID: 30623898 [PubMed - in process]

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Clinical characteristics of patients with granulomatosis with polyangiitis and microscopic polyangiitis in ENT practice: a comparative analysis.

Related Articles

Clinical characteristics of patients with granulomatosis with polyangiitis and microscopic polyangiitis in ENT practice: a comparative analysis.

Acta Otorhinolaryngol Ital. 2018 Dec;38(6):517-527

Authors: Wojciechowska J, KręCicki T

Abstract
ENT manifestations are commonly observed in patients with small vessel vasculitis (SVV). The main aim of this study was to analyse and present the clinicopathological characteristics of individuals with SVV emphasising otorhinolaryngological symptoms. This study evaluated 64 patients, 41 with granulomatosis with polyangiitis (GPA) and 23 with microscopic polyangiitis (MPA). Herein, we compare the clinicopathologic features of GPA and MPA. The average age at diagnosis was 50.2 and 56.2 years, for GPA and MPA, respectively. 57 patients (89%) were antineutrophil cytoplasmic antibody (ANCA) positive, 34 (59.6%) for anti-proteinase 3 (PR3)-ANCA and 21 (36.8%) for myeloperoxidase (MPO)-ANCA. 7 patients (10.9%) were ANCA negative. The most commonly affected organs were lungs (76.56%), ear, nose, throat (ENT) (75%) and kidneys (73.44%). ENT disorders mainly appeared as chronic rhinosinusitis and epistaxis and preceded SVV diagnosis by an average 14.4 months. In the majority of patients, ENT disorders were the first symptoms of SVV and preceded its systemic transformation. Pulmonary, ENT and nervous manifestations were more common in GPA, whereas the prevalence of renal, gastrointestinal, cutaneous, cardiovascular and ocular disorders was higher in MPA. The results of our study emphasise the high prevalence of ENT symptoms in patients with SVV, especially in those with GPA. We highlight the significant role of the otorhinolaryngologist in early SVV diagnosis and management. Any patient with persistent ENT symptoms or ENT dysfunctions not responding to standard otorhinolaryngological treatment should be precisely and rapidly evaluated for the presence of systemic dysfunctions (especially renal and pulmonary). Realising the differences and similarities between GPA and MPA is crucial in undelayed SVV diagnosis and proper treatment.

PMID: 30623897 [PubMed - in process]

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The supraclavicular artery island flap (SCAIF) in head and neck reconstruction: an Italian multi-institutional experience.

Related Articles

The supraclavicular artery island flap (SCAIF) in head and neck reconstruction: an Italian multi-institutional experience.

Acta Otorhinolaryngol Ital. 2018 Dec;38(6):497-503

Authors: Giordano L, Di Santo D, Bondi S, Marchi F, Occhini A, Bertino G, Grammatica A, Parrinello G, Peretti G, Benazzo M, Nicolai P, Bussi M

Abstract
The supraclavicular artery island flap (SCAIF) is a thin and pliable pedicled flap that is easy and quick to harvest. Thanks to its particular features and high reliability, it is best indicated for the elderly or most fragile patients. SCAIF is very versatile, as it can be used for reconstruction of oral cavity, oropharynx, hypopharynx, facial and cervical skin and tracheostomal defects. We began using this flap in four Italian tertiary referral centres, with several indications, both as first treatment and as salvage surgery. The aim of the study was to demonstrate the easy reproducibility of the flap among four different centres. A series of 28 patients underwent head and neck reconstructions with SCAIF with no recorded complications during flap harvesting. After the very first cases, harvesting time was approximately 45 minutes; 24 patients had successful flap integration at the recipient site, while the remaining 4 suffered from partial flap necrosis, two of whom needed revision surgery. Other minor complications were reported at the recipient site, always at the most distal and most delicate portion of the flap. Donor site was always closed primarily, with only three cases of partial suture dehiscence. We only selected the most fragile patients for SCAIF reconstruction, such as the elderly or those with one or more comorbidities; for this reason, we reported some serious systemic complications and one intraoperative death. SCAIF is an easy reproducible flap, with multiple possible indications. Its use as an alternative to free flaps in the head and neck region is nowadays under discussion. Its use should be encouraged among head and neck surgeons thanks to its various advantages.

PMID: 30623895 [PubMed - in process]

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Facial pain: sinus or not?

Related Articles

Facial pain: sinus or not?

Acta Otorhinolaryngol Ital. 2018 Dec;38(6):485-496

Authors: De Corso E, Kar M, Cantone E, Lucidi D, Settimi S, Mele D, Salvati A, Muluk NB, Paludetti G, Cingi C

Abstract
Facial pain remains a diagnostic and therapeutic challenge for both clinicians and patients. In clinical practice, patients suffering from facial pain generally undergo multiple repeated consultations with different specialists and receive various treatments, including surgery. Many patients, as well as their primary care physicians, mistakenly attribute their pain as being due to rhinosinusitis when this is not the case. It is important to exclude non-sinus-related causes of facial pain before considering sinus surgery to avoid inappropriate treatment. Unfortunately, a significant proportion of patients have persistent facial pain after endoscopic sinus surgery (ESS) due to erroneous considerations on aetiology of facial pain by physicians. It should be taken into account that neurological and sinus diseases may share overlapping symptoms, but they frequently co-exist as comorbidities. The aim of this review was to clarify the diagnostic criteria of facial pain in order to improve discrimination between sinogenic and non-sinogenic facial pain and provide some clinical and diagnostic criteria that may help clinicians in addressing differential diagnosis.

PMID: 30623894 [PubMed - in process]

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Defect-oriented reconstruction after transoral robotic surgery for oropharyngeal cancer: a case series and review of the literature.

Related Articles

Defect-oriented reconstruction after transoral robotic surgery for oropharyngeal cancer: a case series and review of the literature.

Acta Otorhinolaryngol Ital. 2018 Dec;38(6):569-574

Authors: Meccariello G, Montevecchi F, Sgarzani R, Vicini C

Abstract
Transoral robotic surgery (TORS) is a fascinating new technique that has been shown to be a safe and feasible treatment for selected oropharyngeal cancers. Furthermore, TORS might offer some advantages in selected locoregionally advanced cancers. Thus, the patient selection is the keypoint for the useful application of TORS. However, the reconstruction of large oropharyngeal defects is challenging due to the restoration of velopharyngeal competency and swallowing. Moreover, the absence of mandibular splitting increases the difficulties faced by reconstructive surgeons. The paradigm for oropharyngeal reconstruction has undergone changes paralleling reflecting the overall change in the trend of the treatment alternatives over the last few decades. Flap choice and harvesting should be tailored to obtain significant advantages both in functional terms and for easy insetting. In this review, we analyse the strengths and weaknesses of the various flaps used in TORS framework with particular regards on our preliminary experience.

PMID: 30623902 [PubMed - in process]

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Otologic manifestations of Susac syndrome.

Related Articles

Otologic manifestations of Susac syndrome.

Acta Otorhinolaryngol Ital. 2018 Dec;38(6):544-553

Authors: Patel VA, Dunklebarger M, Zacharia TT, Isildak H

Abstract
Susac syndrome, a rare autoimmune disorder first described as a classic triad (encephalopathy, branch retinal artery occlusion, and sensorineural hearing loss) in 1979 by renowned physician John O. Susac, has been an advancing area of clinical interest and scientific research over the last several decades. This comprehensive review aims to succinctly highlight the breadth and detail of this enigmatic disease, with a primary focus on otologic manifestations. Topics discussed include epidemiology, pathophysiology, clinical manifestations, differential diagnoses, classification schema, laboratory investigations, characteristic audiometric findings, high-yield radiographic imaging, temporal bone histopathology, treatment strategies and overall prognosis.

PMID: 30623900 [PubMed - in process]

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Speech perception in noise by young sequential bilingual children.

Related Articles

Speech perception in noise by young sequential bilingual children.

Acta Otorhinolaryngol Ital. 2018 Dec;38(6):536-543

Authors: Bovo R, Lovo E, Astolfi L, Montino S, Franchella S, Gallo S, Prodi N, Borsetto D, Trevisi P

Abstract
The objective of this study was to ascertain the effects of competitive noise on second language perception skills of sequentially bilingual children and to compare the results with those relating to matched monolingual peers. Fifteen bilingual immigrant children (aged 6-10 years) (BL) learning through their second language (L2), which was Italian, were matched with 15 peers who only spoke Italian (IO). All immigrant children had arrived in Italy and were exposed to L2 after their 4th year of life. The speech-to-noise ratio (SNR) needed to obtain 50% intelligibility - the speech reception threshold (SRT) - for Italian words was measured against the Italian version of ICRA noise, using an adaptive method. Moreover, presentation of phrases against a contralateral continuous discourse (informational masking) was carried out to exclude possible biases due to differences in memory, attention, or other central auditory processing disorders between groups. The SNR was -2.7 dB (SD 1.7; range: -5.5 to + 0.9) for the BL group and -5.3 dB (SD 2.3; range: -8.8 to -0.9) for the IO group (p < 0.01). With contralateral continuous discourse presentation the SNR were -32.8 dB (SD 2.4; range: -36.1 to -28.2) for the BL group and -27.8 dB (SD 2.1; range: -31.7 to -24.1) for the OI group (p < 0.01). Even sequential bilingual individuals exposed to L2 at 4 years old had worse speech perception in noise than their matched IO peers. On the other hand, the BL group demonstrated superior divided attention skills in tests with competitive contralateral discourse (p < 0.01).

PMID: 30623899 [PubMed - in process]

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Septoplasty: is it possible to identify potential "predictors" of surgical success?

Related Articles

Septoplasty: is it possible to identify potential "predictors" of surgical success?

Acta Otorhinolaryngol Ital. 2018 Dec;38(6):528-535

Authors: Cantone E, Ricciardiello F, Oliva F, De Corso E, Iengo M

Abstract
Septoplasty is one of the most frequent surgical procedures performed by otolaryngologists. Despite successful surgical correction, many patients are not satisfied with their outcomes. So far, in clinical practice there is no consensus of opinion about the reliability of objective measurements of nasal patency and the correlation between objective measurements and subjective nasal patency symptoms. This study aims to assess the reasons for patient dissatisfaction after septoplasty and optimise pre-operative diagnostic management to predict surgical outcomes. We analysed 494 patients undergoing septoplasties with turbinoplasty by subjective Nasal Obstruction Symptom Evaluation questionnaire (NOSE) and objective active anterior rhinomanometric measurements before surgery and after 6 months. In our series, 17% had postoperative septal re-displacement; all patients had an anterior deviations at baseline. We found that the type of septal deviation, anterior vs posterior, was a significant predictor of postoperative functional improvement, whereas demographic characteristics as age, gender and smoke habit were not. Our data suggest that the anterior segment of the nasal septum was the most critical area for nasal airway resistance and more difficult to manage because it is likely to re-displace vs the posterior one and for this reason it represents a negative predictor of postoperative satisfaction.

PMID: 30623898 [PubMed - in process]

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Clinical characteristics of patients with granulomatosis with polyangiitis and microscopic polyangiitis in ENT practice: a comparative analysis.

Related Articles

Clinical characteristics of patients with granulomatosis with polyangiitis and microscopic polyangiitis in ENT practice: a comparative analysis.

Acta Otorhinolaryngol Ital. 2018 Dec;38(6):517-527

Authors: Wojciechowska J, KręCicki T

Abstract
ENT manifestations are commonly observed in patients with small vessel vasculitis (SVV). The main aim of this study was to analyse and present the clinicopathological characteristics of individuals with SVV emphasising otorhinolaryngological symptoms. This study evaluated 64 patients, 41 with granulomatosis with polyangiitis (GPA) and 23 with microscopic polyangiitis (MPA). Herein, we compare the clinicopathologic features of GPA and MPA. The average age at diagnosis was 50.2 and 56.2 years, for GPA and MPA, respectively. 57 patients (89%) were antineutrophil cytoplasmic antibody (ANCA) positive, 34 (59.6%) for anti-proteinase 3 (PR3)-ANCA and 21 (36.8%) for myeloperoxidase (MPO)-ANCA. 7 patients (10.9%) were ANCA negative. The most commonly affected organs were lungs (76.56%), ear, nose, throat (ENT) (75%) and kidneys (73.44%). ENT disorders mainly appeared as chronic rhinosinusitis and epistaxis and preceded SVV diagnosis by an average 14.4 months. In the majority of patients, ENT disorders were the first symptoms of SVV and preceded its systemic transformation. Pulmonary, ENT and nervous manifestations were more common in GPA, whereas the prevalence of renal, gastrointestinal, cutaneous, cardiovascular and ocular disorders was higher in MPA. The results of our study emphasise the high prevalence of ENT symptoms in patients with SVV, especially in those with GPA. We highlight the significant role of the otorhinolaryngologist in early SVV diagnosis and management. Any patient with persistent ENT symptoms or ENT dysfunctions not responding to standard otorhinolaryngological treatment should be precisely and rapidly evaluated for the presence of systemic dysfunctions (especially renal and pulmonary). Realising the differences and similarities between GPA and MPA is crucial in undelayed SVV diagnosis and proper treatment.

PMID: 30623897 [PubMed - in process]

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Aspiration: diagnostic contributions from bedside swallowing evaluation and endoscopy.

Related Articles

Aspiration: diagnostic contributions from bedside swallowing evaluation and endoscopy.

Acta Otorhinolaryngol Ital. 2018 Dec;38(6):511-516

Authors: Farneti D, Turroni V, Genovese E

Abstract
The aim of this study was to identify which characteristics, collected by bedside swallowing evaluation (BSE) and fiberoptic endoscopic evaluation of swallowing (FEES), are a risk or a protective factor for aspiration. This retrospective study included data on 1577 consecutive patients, collected by BSE and FEES. Bivariate analysis was performed to verify the association of each variable with aspiration (Chi-Square test). The variables associated with aspiration were entered into a multivariate logistic model to quantify this association. Several variables were significantly associated (p < 0.05) with aspiration; cooperation, sensation, laryngeal elevation and direct therapy were found to be protective factors against aspiration. The regression model identified the most variables related with aspiration, among which tracheotomy, material pooling and spillage. Patients able to perform dry swallows were 77% less likely to aspirate (protective factor). Several variables are involved in protection of airways during swallowing. Their interaction, in patients with swallowing disorders, offers the clinician the best means of interpreting BSE and FEES.

PMID: 30623896 [PubMed - in process]

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The supraclavicular artery island flap (SCAIF) in head and neck reconstruction: an Italian multi-institutional experience.

Related Articles

The supraclavicular artery island flap (SCAIF) in head and neck reconstruction: an Italian multi-institutional experience.

Acta Otorhinolaryngol Ital. 2018 Dec;38(6):497-503

Authors: Giordano L, Di Santo D, Bondi S, Marchi F, Occhini A, Bertino G, Grammatica A, Parrinello G, Peretti G, Benazzo M, Nicolai P, Bussi M

Abstract
The supraclavicular artery island flap (SCAIF) is a thin and pliable pedicled flap that is easy and quick to harvest. Thanks to its particular features and high reliability, it is best indicated for the elderly or most fragile patients. SCAIF is very versatile, as it can be used for reconstruction of oral cavity, oropharynx, hypopharynx, facial and cervical skin and tracheostomal defects. We began using this flap in four Italian tertiary referral centres, with several indications, both as first treatment and as salvage surgery. The aim of the study was to demonstrate the easy reproducibility of the flap among four different centres. A series of 28 patients underwent head and neck reconstructions with SCAIF with no recorded complications during flap harvesting. After the very first cases, harvesting time was approximately 45 minutes; 24 patients had successful flap integration at the recipient site, while the remaining 4 suffered from partial flap necrosis, two of whom needed revision surgery. Other minor complications were reported at the recipient site, always at the most distal and most delicate portion of the flap. Donor site was always closed primarily, with only three cases of partial suture dehiscence. We only selected the most fragile patients for SCAIF reconstruction, such as the elderly or those with one or more comorbidities; for this reason, we reported some serious systemic complications and one intraoperative death. SCAIF is an easy reproducible flap, with multiple possible indications. Its use as an alternative to free flaps in the head and neck region is nowadays under discussion. Its use should be encouraged among head and neck surgeons thanks to its various advantages.

PMID: 30623895 [PubMed - in process]

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Facial pain: sinus or not?

Related Articles

Facial pain: sinus or not?

Acta Otorhinolaryngol Ital. 2018 Dec;38(6):485-496

Authors: De Corso E, Kar M, Cantone E, Lucidi D, Settimi S, Mele D, Salvati A, Muluk NB, Paludetti G, Cingi C

Abstract
Facial pain remains a diagnostic and therapeutic challenge for both clinicians and patients. In clinical practice, patients suffering from facial pain generally undergo multiple repeated consultations with different specialists and receive various treatments, including surgery. Many patients, as well as their primary care physicians, mistakenly attribute their pain as being due to rhinosinusitis when this is not the case. It is important to exclude non-sinus-related causes of facial pain before considering sinus surgery to avoid inappropriate treatment. Unfortunately, a significant proportion of patients have persistent facial pain after endoscopic sinus surgery (ESS) due to erroneous considerations on aetiology of facial pain by physicians. It should be taken into account that neurological and sinus diseases may share overlapping symptoms, but they frequently co-exist as comorbidities. The aim of this review was to clarify the diagnostic criteria of facial pain in order to improve discrimination between sinogenic and non-sinogenic facial pain and provide some clinical and diagnostic criteria that may help clinicians in addressing differential diagnosis.

PMID: 30623894 [PubMed - in process]

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Retroperitoneal fibrosis and its relationship to IgG 4 diseases

(Source: Notes from Dr. RW)

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Retroperitoneal fibrosis and its relationship to IgG 4 diseases

(Source: Notes from Dr. RW)

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Resting-State Functional Connectivity of the Middle Frontal Gyrus Can Predict Language Lateralization in Patients with Brain Tumors [FUNCTIONAL]

BACKGROUND AND PURPOSE:

A recent study using task-based fMRI demonstrated that the middle frontal gyrus is comparable with Broca's area in its ability to determine language laterality using a measure of verbal fluency. This study investigated whether the middle frontal gyrus can be used as an indicator for language-hemispheric dominance in patients with brain tumors using task-free resting-state fMRI. We hypothesized that no significant difference in language lateralization would occur between the middle frontal gyrus and Broca area and that the middle frontal gyrus can serve as a simple and reliable means of measuring language laterality.

MATERIALS AND METHODS:

Using resting-state fMRI, we compared the middle frontal gyrus with the Broca area in 51 patients with glial neoplasms for voxel activation, the language laterality index, and the effect of tumor grade on the laterality index. The laterality index derived by resting-state fMRI and task-based fMRI was compared in a subset of 40 patients.

RESULTS:

Voxel activations in the left middle frontal gyrus and left Broca area were positively correlated (r = 0.47, P < .001). Positive correlations were seen between the laterality index of the Broca area and middle frontal gyrus regions (r = 0.56, P < .0005). Twenty-seven of 40 patients (67.5%) showed concordance of the laterality index based on the Broca area using resting-state fMRI and the laterality index based on a language task. Thirty of 40 patients (75%) showed concordance of the laterality index based on the middle frontal gyrus using resting-state fMRI and the laterality index based on a language task.

CONCLUSIONS:

The middle frontal gyrus is comparable with the Broca area in its ability to determine hemispheric dominance for language using resting-state fMRI. Our results suggest the addition of resting-state fMRI of the middle frontal gyrus to the list of noninvasive modalities that could be used in patients with gliomas to evaluate hemispheric dominance of language before tumor resection. In patients who cannot participate in traditional task-based fMRI, resting-state fMRI offers a task-free alternate to presurgically map the eloquent cortex.

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Maternal-Fetal Medicine Specialists Should Manage Patients Requiring Fetal MRI of the Central Nervous System [LETTERS]

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Improving the Quality of Synthetic FLAIR Images with Deep Learning Using a Conditional Generative Adversarial Network for Pixel-by-Pixel Image Translation [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Synthetic FLAIR images are of lower quality than conventional FLAIR images. Here, we aimed to improve the synthetic FLAIR image quality using deep learning with pixel-by-pixel translation through conditional generative adversarial network training.

MATERIALS AND METHODS:

Forty patients with MS were prospectively included and scanned (3T) to acquire synthetic MR imaging and conventional FLAIR images. Synthetic FLAIR images were created with the SyMRI software. Acquired data were divided into 30 training and 10 test datasets. A conditional generative adversarial network was trained to generate improved FLAIR images from raw synthetic MR imaging data using conventional FLAIR images as targets. The peak signal-to-noise ratio, normalized root mean square error, and the Dice index of MS lesion maps were calculated for synthetic and deep learning FLAIR images against conventional FLAIR images, respectively. Lesion conspicuity and the existence of artifacts were visually assessed.

RESULTS:

The peak signal-to-noise ratio and normalized root mean square error were significantly higher and lower, respectively, in generated-versus-synthetic FLAIR images in aggregate intracranial tissues and all tissue segments (all P < .001). The Dice index of lesion maps and visual lesion conspicuity were comparable between generated and synthetic FLAIR images (P = 1 and .59, respectively). Generated FLAIR images showed fewer granular artifacts (P = .003) and swelling artifacts (in all cases) than synthetic FLAIR images.

CONCLUSIONS:

Using deep learning, we improved the synthetic FLAIR image quality by generating FLAIR images that have contrast closer to that of conventional FLAIR images and fewer granular and swelling artifacts, while preserving the lesion contrast.

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Treatment Response Prediction of Nasopharyngeal Carcinoma Based on Histogram Analysis of Diffusional Kurtosis Imaging [HEAD & NECK]

BACKGROUND AND PURPOSE:

The prediction of treatment response is important in planning and modifying the chemoradiation therapy regimen. This study aimed to explore the quantitative histogram indices for treatment-response prediction of nasopharyngeal carcinoma based on diffusional kurtosis imaging compared with a standard ADC value (ADC_standard).

MATERIALS AND METHODS:

Thirty-six patients with an initial diagnosis of locoregionally advanced nasopharyngeal carcinoma and diffusional kurtosis imaging acquisitions before and after neoadjuvant chemotherapy were enrolled. Patients were divided into respond-versus-nonrespond groups after neoadjuvant chemotherapy and residual-versus-nonresidual groups after radiation therapy. Histogram parameters of diffusional kurtosis imaging–derived parameters (ADC, ADC coefficient corrected by the non-Gaussain model [D], apparent kurtosis coefficient without a unit [K]) were calculated. The ADC_standard was calculated on the basis of intravoxel incoherent movement data. The intraclass correlation coefficient, Kolmogorov-Smirnov test, Student t test or Mann-Whitney U test, and receiver operating characteristic analysis were performed.

RESULTS:

Most of the parameters had good-to-excellent consistency (intraclass correlation coefficient = 0.675–0.998). The pre-ADC_standard, pre-ADC (10th, 25th, 50th percentiles), pre-D (10th, 25th, 50th percentiles), and pre-K_50th were significantly different between the respond and nonrespond groups, while the pre-ADC_10th, pre-K_90th, post-ADC_50th, post-K_75th, post-K_90th, and the percentage change of parameters before and after neoadjuvant chemotherapy (ADC_50th%) were significantly different between the residual and nonresidual groups (all P < .05). Receiver operating characteristic analysis indicated that setting pre-D_50th = 0.875 x 10^–3mm²/s as the cutoff value could result in optimal diagnostic performance for neoadjuvant chemotherapy response prediction (area under the curve = 0.814, sensitivity = 0.70, specificity = 0.92), while the post-K_90th = 1.035 (area under the curve = 0.829, sensitivity = 0.78, specificity = 0.72), andADC_50th% = 0.253 (area under the curve = 0.833, sensitivity = 0.94, specificity = 0.72) were optimal for radiation therapy response prediction.

CONCLUSIONS:

Histogram analysis of diffusional kurtosis imaging may potentially predict the neoadjuvant chemotherapy and short-term radiation therapy response in locoregionally advanced nasopharyngeal carcinoma, therefore providing evidence for modification of the treatment regimen.

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Resting-State Functional Connectivity of the Middle Frontal Gyrus Can Predict Language Lateralization in Patients with Brain Tumors [FUNCTIONAL]

BACKGROUND AND PURPOSE:

A recent study using task-based fMRI demonstrated that the middle frontal gyrus is comparable with Broca's area in its ability to determine language laterality using a measure of verbal fluency. This study investigated whether the middle frontal gyrus can be used as an indicator for language-hemispheric dominance in patients with brain tumors using task-free resting-state fMRI. We hypothesized that no significant difference in language lateralization would occur between the middle frontal gyrus and Broca area and that the middle frontal gyrus can serve as a simple and reliable means of measuring language laterality.

MATERIALS AND METHODS:

Using resting-state fMRI, we compared the middle frontal gyrus with the Broca area in 51 patients with glial neoplasms for voxel activation, the language laterality index, and the effect of tumor grade on the laterality index. The laterality index derived by resting-state fMRI and task-based fMRI was compared in a subset of 40 patients.

RESULTS:

Voxel activations in the left middle frontal gyrus and left Broca area were positively correlated (r = 0.47, P < .001). Positive correlations were seen between the laterality index of the Broca area and middle frontal gyrus regions (r = 0.56, P < .0005). Twenty-seven of 40 patients (67.5%) showed concordance of the laterality index based on the Broca area using resting-state fMRI and the laterality index based on a language task. Thirty of 40 patients (75%) showed concordance of the laterality index based on the middle frontal gyrus using resting-state fMRI and the laterality index based on a language task.

CONCLUSIONS:

The middle frontal gyrus is comparable with the Broca area in its ability to determine hemispheric dominance for language using resting-state fMRI. Our results suggest the addition of resting-state fMRI of the middle frontal gyrus to the list of noninvasive modalities that could be used in patients with gliomas to evaluate hemispheric dominance of language before tumor resection. In patients who cannot participate in traditional task-based fMRI, resting-state fMRI offers a task-free alternate to presurgically map the eloquent cortex.

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Maternal-Fetal Medicine Specialists Should Manage Patients Requiring Fetal MRI of the Central Nervous System [LETTERS]

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Improving the Quality of Synthetic FLAIR Images with Deep Learning Using a Conditional Generative Adversarial Network for Pixel-by-Pixel Image Translation [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Synthetic FLAIR images are of lower quality than conventional FLAIR images. Here, we aimed to improve the synthetic FLAIR image quality using deep learning with pixel-by-pixel translation through conditional generative adversarial network training.

MATERIALS AND METHODS:

Forty patients with MS were prospectively included and scanned (3T) to acquire synthetic MR imaging and conventional FLAIR images. Synthetic FLAIR images were created with the SyMRI software. Acquired data were divided into 30 training and 10 test datasets. A conditional generative adversarial network was trained to generate improved FLAIR images from raw synthetic MR imaging data using conventional FLAIR images as targets. The peak signal-to-noise ratio, normalized root mean square error, and the Dice index of MS lesion maps were calculated for synthetic and deep learning FLAIR images against conventional FLAIR images, respectively. Lesion conspicuity and the existence of artifacts were visually assessed.

RESULTS:

The peak signal-to-noise ratio and normalized root mean square error were significantly higher and lower, respectively, in generated-versus-synthetic FLAIR images in aggregate intracranial tissues and all tissue segments (all P < .001). The Dice index of lesion maps and visual lesion conspicuity were comparable between generated and synthetic FLAIR images (P = 1 and .59, respectively). Generated FLAIR images showed fewer granular artifacts (P = .003) and swelling artifacts (in all cases) than synthetic FLAIR images.

CONCLUSIONS:

Using deep learning, we improved the synthetic FLAIR image quality by generating FLAIR images that have contrast closer to that of conventional FLAIR images and fewer granular and swelling artifacts, while preserving the lesion contrast.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2H7oarn

Treatment Response Prediction of Nasopharyngeal Carcinoma Based on Histogram Analysis of Diffusional Kurtosis Imaging [HEAD & NECK]

BACKGROUND AND PURPOSE:

The prediction of treatment response is important in planning and modifying the chemoradiation therapy regimen. This study aimed to explore the quantitative histogram indices for treatment-response prediction of nasopharyngeal carcinoma based on diffusional kurtosis imaging compared with a standard ADC value (ADC_standard).

MATERIALS AND METHODS:

Thirty-six patients with an initial diagnosis of locoregionally advanced nasopharyngeal carcinoma and diffusional kurtosis imaging acquisitions before and after neoadjuvant chemotherapy were enrolled. Patients were divided into respond-versus-nonrespond groups after neoadjuvant chemotherapy and residual-versus-nonresidual groups after radiation therapy. Histogram parameters of diffusional kurtosis imaging–derived parameters (ADC, ADC coefficient corrected by the non-Gaussain model [D], apparent kurtosis coefficient without a unit [K]) were calculated. The ADC_standard was calculated on the basis of intravoxel incoherent movement data. The intraclass correlation coefficient, Kolmogorov-Smirnov test, Student t test or Mann-Whitney U test, and receiver operating characteristic analysis were performed.

RESULTS:

Most of the parameters had good-to-excellent consistency (intraclass correlation coefficient = 0.675–0.998). The pre-ADC_standard, pre-ADC (10th, 25th, 50th percentiles), pre-D (10th, 25th, 50th percentiles), and pre-K_50th were significantly different between the respond and nonrespond groups, while the pre-ADC_10th, pre-K_90th, post-ADC_50th, post-K_75th, post-K_90th, and the percentage change of parameters before and after neoadjuvant chemotherapy (ADC_50th%) were significantly different between the residual and nonresidual groups (all P < .05). Receiver operating characteristic analysis indicated that setting pre-D_50th = 0.875 x 10^–3mm²/s as the cutoff value could result in optimal diagnostic performance for neoadjuvant chemotherapy response prediction (area under the curve = 0.814, sensitivity = 0.70, specificity = 0.92), while the post-K_90th = 1.035 (area under the curve = 0.829, sensitivity = 0.78, specificity = 0.72), andADC_50th% = 0.253 (area under the curve = 0.833, sensitivity = 0.94, specificity = 0.72) were optimal for radiation therapy response prediction.

CONCLUSIONS:

Histogram analysis of diffusional kurtosis imaging may potentially predict the neoadjuvant chemotherapy and short-term radiation therapy response in locoregionally advanced nasopharyngeal carcinoma, therefore providing evidence for modification of the treatment regimen.

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Hearing Aid Upkeep Often Out of Reach for the Poor

Title: Hearing Aid Upkeep Often Out of Reach for the PoorCategory: Health NewsCreated: 1/8/2019 12:00:00 AMLast Editorial Review: 1/9/2019 12:00:00 AM (Source: MedicineNet Hearing General)

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Hearing Aid Upkeep Often Out of Reach for the Poor

Title: Hearing Aid Upkeep Often Out of Reach for the PoorCategory: Health NewsCreated: 1/8/2019 12:00:00 AMLast Editorial Review: 1/9/2019 12:00:00 AM (Source: MedicineNet Hearing General)

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Using phenol for treating pilonidal sinus: a systematic review and meta-analysis

Abstract

Pilonidal sinus is an acquired disease that affects the natal cleft. Phenolization is a common conservative treatment approach due to its robust antiseptic effects. The aim of this study is to systematically review and evaluate the quality of the controlled clinical trials that investigated the effectiveness of phenol, as a standalone or an adjunct treatment, compared to surgical intervention in reducing sinus recurrence rate and hospitalization period. Four electronic databases were searched (MEDLINE (PubMed), Scopus, Web of Science, Cochrane) from inception to October 2018. The retrieved studies were screened by two independent reviewers. The risk of bias was assessed using the Jadad tool. Meta-analysis was conducted to examine recurrence rate and hospital stay using random effect model while I2 test was used to assess heterogeneity. Five studies were eligible for qualitative and quantitative assessment; 228 patients were treated with phenolization (45.6%) and 272 patients were treated with surgery (54.4%). Phenolization reduces the Likelihood of hospital stay after the procedure by 96–100% compared to surgery. For recurrence rate, the pooled analysis showed no significant difference between phenol and surgery treatment. However, 33.33% of cases did not recur after multi applications of crystallized phenol. Phenolization of patients with pilonidal sinuses is significantly associated with less hospitalization compared to surgical intervention. However, both approaches have a comparable recurrence rate and complications.

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Using phenol for treating pilonidal sinus: a systematic review and meta-analysis

Abstract

Pilonidal sinus is an acquired disease that affects the natal cleft. Phenolization is a common conservative treatment approach due to its robust antiseptic effects. The aim of this study is to systematically review and evaluate the quality of the controlled clinical trials that investigated the effectiveness of phenol, as a standalone or an adjunct treatment, compared to surgical intervention in reducing sinus recurrence rate and hospitalization period. Four electronic databases were searched (MEDLINE (PubMed), Scopus, Web of Science, Cochrane) from inception to October 2018. The retrieved studies were screened by two independent reviewers. The risk of bias was assessed using the Jadad tool. Meta-analysis was conducted to examine recurrence rate and hospital stay using random effect model while I2 test was used to assess heterogeneity. Five studies were eligible for qualitative and quantitative assessment; 228 patients were treated with phenolization (45.6%) and 272 patients were treated with surgery (54.4%). Phenolization reduces the Likelihood of hospital stay after the procedure by 96–100% compared to surgery. For recurrence rate, the pooled analysis showed no significant difference between phenol and surgery treatment. However, 33.33% of cases did not recur after multi applications of crystallized phenol. Phenolization of patients with pilonidal sinuses is significantly associated with less hospitalization compared to surgical intervention. However, both approaches have a comparable recurrence rate and complications.

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Using phenol for treating pilonidal sinus: a systematic review and meta-analysis

Abstract

Pilonidal sinus is an acquired disease that affects the natal cleft. Phenolization is a common conservative treatment approach due to its robust antiseptic effects. The aim of this study is to systematically review and evaluate the quality of the controlled clinical trials that investigated the effectiveness of phenol, as a standalone or an adjunct treatment, compared to surgical intervention in reducing sinus recurrence rate and hospitalization period. Four electronic databases were searched (MEDLINE (PubMed), Scopus, Web of Science, Cochrane) from inception to October 2018. The retrieved studies were screened by two independent reviewers. The risk of bias was assessed using the Jadad tool. Meta-analysis was conducted to examine recurrence rate and hospital stay using random effect model while I2 test was used to assess heterogeneity. Five studies were eligible for qualitative and quantitative assessment; 228 patients were treated with phenolization (45.6%) and 272 patients were treated with surgery (54.4%). Phenolization reduces the Likelihood of hospital stay after the procedure by 96–100% compared to surgery. For recurrence rate, the pooled analysis showed no significant difference between phenol and surgery treatment. However, 33.33% of cases did not recur after multi applications of crystallized phenol. Phenolization of patients with pilonidal sinuses is significantly associated with less hospitalization compared to surgical intervention. However, both approaches have a comparable recurrence rate and complications.

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Using phenol for treating pilonidal sinus: a systematic review and meta-analysis

Abstract

Pilonidal sinus is an acquired disease that affects the natal cleft. Phenolization is a common conservative treatment approach due to its robust antiseptic effects. The aim of this study is to systematically review and evaluate the quality of the controlled clinical trials that investigated the effectiveness of phenol, as a standalone or an adjunct treatment, compared to surgical intervention in reducing sinus recurrence rate and hospitalization period. Four electronic databases were searched (MEDLINE (PubMed), Scopus, Web of Science, Cochrane) from inception to October 2018. The retrieved studies were screened by two independent reviewers. The risk of bias was assessed using the Jadad tool. Meta-analysis was conducted to examine recurrence rate and hospital stay using random effect model while I2 test was used to assess heterogeneity. Five studies were eligible for qualitative and quantitative assessment; 228 patients were treated with phenolization (45.6%) and 272 patients were treated with surgery (54.4%). Phenolization reduces the Likelihood of hospital stay after the procedure by 96–100% compared to surgery. For recurrence rate, the pooled analysis showed no significant difference between phenol and surgery treatment. However, 33.33% of cases did not recur after multi applications of crystallized phenol. Phenolization of patients with pilonidal sinuses is significantly associated with less hospitalization compared to surgical intervention. However, both approaches have a comparable recurrence rate and complications.

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11 C-choline PET/CT predicts survival in prostate cancer patients with PSA < 1 NG/ml

Abstract

Purpose

The main drawback of ¹¹C-choline PET/CT for restaging prostate cancer (PCa) patients with biochemical failure is the relatively low positive detection rate for prostate specific antigen (PSA) < 1 ng/ml. This study assessed whether ¹¹C-choline PET/CT predicts survival in PCa patients with PSA < 1 ng/ml.

Methods

This retrospective study included 210 PCa patients treated with radical prostatectomy who underwent ¹¹C-choline PET/CT from December 1, 2004 to July 31, 2007 due to biochemical failure. PCa-specific survival was estimated using Kaplan–Meier curves. Cox regression analysis was used to evaluate the association between clinicopathologic variables and PCa-specific survival. PCa-specific survival was computed as the interval from radical prostatectomy to PCa-specific death.

Results

Median follow-up after radical prostatectomy was 6.9 years (95% confidence interval, CI, 2.0–14.5 years). ¹¹C-choline PET/CT was positive in 20.5% of patients. Median PCa-specific survival was 13.4 years (95% CI, 9.9–16.8 years) in patients with positive ¹¹C-choline PET/CT, and it was not achieved in patients with negative ¹¹C-choline PET/CT (log-rank, chi-square = 15.0, P < 0.001). Ten-year survival probabilities for patients with negative ¹¹C-choline PET/CT and for patients with positive ¹¹C-choline PET/CT were 86.0% (95% CI: 80.7%–91.3%) and 63.6% (95% CI: 54.5–72.7%). At multivariate analysis, only ¹¹C-choline PET/CT significantly predicted PCa-specific survival (hazard ratio = 2.54, 95% CI, 1.05–6.13, P = 0.038). Patients with pathological ¹¹C-choline uptake in the prostatic bed or in pelvic lymph nodes had longer PCa-specific survival in comparison to patients with pathological tracer uptake in the skeleton (log-rank: chi-square = 27.4, P < 0.001).

Conclusion

Despite the relatively low positive detection rate for PSA < 1 ng/ml, positive ¹¹C-choline PET/CT predicts PCa-specific survival in this low PSA range. As long as more sensitive radiotracers, such as ⁶⁸Ga-PSMA-11, do not become more widely available, these results might support a broader use of radiolabeled choline in restaging PCa for PSA < 1 ng/ml.

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Automatic Vertebrae Localization and Identification by Combining Deep SSAE Contextual Features and Structured Regression Forest

Abstract

Automatic vertebrae localization and identification in medical computed tomography (CT) scans is of great value for computer-aided spine diseases diagnosis. In order to overcome the disadvantages of the approaches employing hand-crafted, low-level features and based on field-of-view priori assumption of spine structure, an automatic method is proposed to localize and identify vertebrae by combining deep stacked sparse autoencoder (SSAE) contextual features and structured regression forest (SRF). The method employs SSAE to learn image deep contextual features instead of hand-crafted ones by building larger-range input samples to improve their contextual discrimination ability. In the localization and identification stage, it incorporates the SRF model to achieve whole spine localization, then screens those vertebrae within the image, thus relieves the assumption that the part of spine in the field of image is visible. In the end, the output distribution of SRF and spine CT scans properties are assembled to develop a two-stage progressive refining strategy, where the mean-shift kernel density estimation and Otsu method instead of Markov random field (MRF) are adopted to reduce model complexity and refine vertebrae localization results. Extensive evaluation was performed on a challenging data set of 98 spine CT scans. Compared with the hidden Markov model and the method based on convolutional neural network (CNN), the proposed approach could effectively and automatically locate and identify spinal targets in CT scans, and achieve higher localization accuracy, low model complexity, and no need for any assumptions about visual field in CT scans.

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Automatic Vertebrae Localization and Identification by Combining Deep SSAE Contextual Features and Structured Regression Forest

Abstract

Automatic vertebrae localization and identification in medical computed tomography (CT) scans is of great value for computer-aided spine diseases diagnosis. In order to overcome the disadvantages of the approaches employing hand-crafted, low-level features and based on field-of-view priori assumption of spine structure, an automatic method is proposed to localize and identify vertebrae by combining deep stacked sparse autoencoder (SSAE) contextual features and structured regression forest (SRF). The method employs SSAE to learn image deep contextual features instead of hand-crafted ones by building larger-range input samples to improve their contextual discrimination ability. In the localization and identification stage, it incorporates the SRF model to achieve whole spine localization, then screens those vertebrae within the image, thus relieves the assumption that the part of spine in the field of image is visible. In the end, the output distribution of SRF and spine CT scans properties are assembled to develop a two-stage progressive refining strategy, where the mean-shift kernel density estimation and Otsu method instead of Markov random field (MRF) are adopted to reduce model complexity and refine vertebrae localization results. Extensive evaluation was performed on a challenging data set of 98 spine CT scans. Compared with the hidden Markov model and the method based on convolutional neural network (CNN), the proposed approach could effectively and automatically locate and identify spinal targets in CT scans, and achieve higher localization accuracy, low model complexity, and no need for any assumptions about visual field in CT scans.

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Prescription Opioids May Raise Pneumonia Risk

(Source: Pulmonary Medicine News - Doctors Lounge)

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

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The science is clear: with HIV, undetectable equals untransmittable

(NIH/National Institute of Allergy and Infectious Diseases) An overwhelming body of clinical evidence has firmly established the HIV Undetectable = Untransmittable (U=U) concept as scientifically sound. U=U means that people living with HIV who achieve and maintain an undetectable viral load -- the amount of HIV in the blood -- by taking and adhering to antiretroviral therapy (ART) as prescribed cannot sexually transmit the virus to others. NIAID officials review the scientific evidence underlying U=U and discuss implications of widespread acceptance of the message. (Source: EurekAlert! - Infectious and Emerging Diseases)

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E - Cigarette Aerosol Exposure Tied to Asthma Symptoms

Findings seen among youth reporting asthma diagnosis, secondhand exposure to e - cigarette aerosols (Source: Pulmonary Medicine News - Doctors Lounge)

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E - Cigarette Aerosol Exposure Tied to Asthma Symptoms

Findings seen among youth reporting asthma diagnosis, secondhand exposure to e - cigarette aerosols (Source: Pulmonary Medicine News - Doctors Lounge)

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Risk scores for predicting dysphagia in critically ill patients after cardiac surgery

Abstract

Background

This study aimed at developing and validating a scoring model to stratify critically ill patients after cardiac surgery based on risk for dysphagia, a common but often neglected complication.

Methods

Data were prospectively collected and analyzed from January 2016 to June 2017 from 395 consecutive post cardiac surgery patients at the cardiac care unit (CCU) at a single center; 103 (26.1%) developed dysphagia. Univariate and multivariate logistic analyses were used to identify independent predictors for dysphagia. The survival nomogram was developed on the basis of a multivariable Cox model, which allowed us to obtain survival probability estimations. The predictive performance of the nomogram was verified for discrimination and calibration. Areas under receiver operating characteristic curve analysis were used to illustrate and evaluate the diagnostic performance of the novel model.

Results

The final novel scoring model, named SSG-OD, consists of three independent factors: gastric intubation (OR = 1.024, 95% CI 1.015–1.033), sedative drug use duration (OR = 1.031, 95% CI 1.001–1.063) and stroke or not (OR = 6.182, 95% CI 3.028–12.617). SSG-OD identified patients at risk for dysphagia with sensitivity of 68.5% and specificity of 89.0% (OR = 0.833, 95% CI: 0.782–0.884). The positive and negative likelihood ratios were 6.22 and 0.35.

Conclusions

The novel SSG-OD scoring system to risk stratify CCU patients for dysphagia is an easy-to-use bedside prognostication aid with good predictive performance and the potential to reduce aspiration incidence and accelerate recovery.

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The evaluation of a better intubation strategy when only the epiglottis is visible: a randomized, cross-over mannequin study

Abstract

Background

The Cormack-Lehane (C-L) grade III airway is considered to be a challenging airway to intubate and is associated with a poor intubation success rate. The purpose of this study was to investigate whether the holding position, shapes, bend angles of the endotracheal tube (ET) and the stylet-assisted lifting of the epiglottis could improve the success rate of intubation.

Methods

Thirty-two participants, 26 physicians, 2 residents, and 4 nurse practitioners, with 12.09 ± 5.38 years of work experience in the emergency department and more than 150 annual intubation events, were enrolled in this randomized, cross-over mannequin study. We investigated the effects of straight-to-cuff ET shapes with 35° and 50° bend angles, banana-shaped ET with longitudinal distances of 28 cm and 26 cm, two methods of holding the ET (either on the top or in the middle), and lifting or not the epiglottis, on the intubation duration, its success rate, and its subjective difficulty. The aim of the study is to provide optimized intubation strategies for difficult airway with C-L IIb or III grades, when the inlet of the trachea cannot be visualized.

Results

The two groups that lifted the epiglottis using the stylets, in bend angles of 35° and 50°, had the shortest duration of intubation (23.75 ± 14.24 s and 20.72 ± 6.90 s, hazard ratios 1.54 and 1.85 with 95% confidence intervals [95% CI] of 1.01–2.34 and 1.23–2.78, respectively) and a 100% success rate in intubations. In the survival analysis, lifting of the epiglottis was the only significant factor (p < 0.0001, 95% CI 1.34–2.11) associated with the success rate of intubation.

Conclusions

The use of the epiglottic lift as an adjunctive technique can facilitate the intubation and improve its success rate without increasing procedure difficulty, in C-L III airway, when only the epiglottis is seen.

Trial registration

ClinicalTrials Registry (https://clincaltrials.gov, identifier NCT03366311).

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Ethnic considerations in the upper lip bite test: the reliability and validity of the upper lip bite test in predicting difficult laryngoscopy in Koreans

Abstract

Background

Several methods have been used to predict difficult tracheal intubation. Among recently suggested methods, the upper lip bite test (ULBT) could serve as a good predictor. Soft tissue and skeletal hard tissue profiles are affected by many factors including ethnicity. We aimed to assess the clinical utility of the ULBT in Koreans while considering ethnic differences.

Methods

Three-hundred-forty-four Korean patients undergoing general anesthesia with orotracheal intubation were included. Preoperatively, we recorded the patient's Modified Mallampati (MMT) classification, ULBT ratings, and the Cormack–Lehane grade.

Results

The area under the receiver operating characteristic (ROC) curve (AUC) was lower for the ULBT than the MMT (95% confidence interval: 0.0697–0.191, p < 0.0001). The ULBT showed high accuracy (73.83%) and specificity (98.04%). On the other hand, the ULBT showed significantly lower sensitivity (4.49%). Only nine of 344 Korean patients could not bite their upper lip; among them, only three presented a difficult laryngoscopic view.

Conclusions

One factor related to the low sensitivity is the low incidence of a grade III ULBT in Koreans. In Asians, the scarcity of a grade III ULBT is explainable as a result of anteriorly displaced temporomandibular joints and redundant lip soft tissues. Despite its high specificity, the low sensitivity and AUC of the ULBT mean that the test results should be interpreted cautiously in Koreans. Ethnic differences should be considered when evaluating parameters related to soft tissues such as the ULBT.

Trial registration

ClinicalTrials.gov Identifier: NCT01908218, Date of registration JUL 2013.

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Repetition Reduction Revisited: The Prosody of Repeated Words in Papuan Malay.

Conclusions partially confirm previous work and challenge theories on how the prosody and information value of a word are related. PMID: 30618355 [PubMed - as supplied by publisher] (Source: Language and Speech)

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Risk scores for predicting dysphagia in critically ill patients after cardiac surgery

Abstract

Background

This study aimed at developing and validating a scoring model to stratify critically ill patients after cardiac surgery based on risk for dysphagia, a common but often neglected complication.

Methods

Data were prospectively collected and analyzed from January 2016 to June 2017 from 395 consecutive post cardiac surgery patients at the cardiac care unit (CCU) at a single center; 103 (26.1%) developed dysphagia. Univariate and multivariate logistic analyses were used to identify independent predictors for dysphagia. The survival nomogram was developed on the basis of a multivariable Cox model, which allowed us to obtain survival probability estimations. The predictive performance of the nomogram was verified for discrimination and calibration. Areas under receiver operating characteristic curve analysis were used to illustrate and evaluate the diagnostic performance of the novel model.

Results

The final novel scoring model, named SSG-OD, consists of three independent factors: gastric intubation (OR = 1.024, 95% CI 1.015–1.033), sedative drug use duration (OR = 1.031, 95% CI 1.001–1.063) and stroke or not (OR = 6.182, 95% CI 3.028–12.617). SSG-OD identified patients at risk for dysphagia with sensitivity of 68.5% and specificity of 89.0% (OR = 0.833, 95% CI: 0.782–0.884). The positive and negative likelihood ratios were 6.22 and 0.35.

Conclusions

The novel SSG-OD scoring system to risk stratify CCU patients for dysphagia is an easy-to-use bedside prognostication aid with good predictive performance and the potential to reduce aspiration incidence and accelerate recovery.

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Closing the gap – detection of clinically relevant von Willebrand disease in emergency settings through an improved algorithm based on rotational Thromboelastometry

Abstract

Background

Hemorrhage and blood loss are still among the main causes of preventable death. Global hemostatic assays are useful point-of-care test (POCT) devices to rapidly detect cumulative effects of plasma factors and platelets on coagulation. Thromboelastography (TEG) and Thromboelastometry (ROTEM) are established methods in many anesthesiological departments for guided hemostatic treatment. However, von Willebrand disease remains undetected by standard ROTEM, especially during emergency care, despite being the most prevalent congenital hemostatic disorder.

Methods

In our monocentric cohort pilot study we focused on hemostatic challenges associated with von Willebrand disease. Twenty-seven patients with suspected von Willebrand disease were included. We modified the routine ROTEM assay by adding a preincubation with ristocetin and commercially available plasma-derived von Willebrand factor to identify clinically relevant von Willebrand disease (VWD).

Results

Addition of von Willebrand factor to the ristocetin assay of a VWD type 3 patient restored the reaction of the whole blood probe to match the response of a healthy person. Our modified ROTEM assay with ristocetin (Ricotem) showed that all high responders (n = 7) had VWD. In the low responder group (n = 16) – 10 of 16 had VWD and in the normal responder group (n = 5), 2 of 5 had mild type 1 VWD.

Conclusions

This new modification of the standard ROTEM assay enables the detection of otherwise unnoticed critical von Willebrand disease based on alterations in clot formation and might serve as a novel approach to reliably assess severe VWD patients by platelet-mediated blood clotting in an emergency setting. We recommend incorporating this new VWD-focused screening tool into the current ROTEM-based management algorithm of acute microvascular bleeding.

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Ethnic considerations in the upper lip bite test: the reliability and validity of the upper lip bite test in predicting difficult laryngoscopy in Koreans

Abstract

Background

Several methods have been used to predict difficult tracheal intubation. Among recently suggested methods, the upper lip bite test (ULBT) could serve as a good predictor. Soft tissue and skeletal hard tissue profiles are affected by many factors including ethnicity. We aimed to assess the clinical utility of the ULBT in Koreans while considering ethnic differences.

Methods

Three-hundred-forty-four Korean patients undergoing general anesthesia with orotracheal intubation were included. Preoperatively, we recorded the patient's Modified Mallampati (MMT) classification, ULBT ratings, and the Cormack–Lehane grade.

Results

The area under the receiver operating characteristic (ROC) curve (AUC) was lower for the ULBT than the MMT (95% confidence interval: 0.0697–0.191, p < 0.0001). The ULBT showed high accuracy (73.83%) and specificity (98.04%). On the other hand, the ULBT showed significantly lower sensitivity (4.49%). Only nine of 344 Korean patients could not bite their upper lip; among them, only three presented a difficult laryngoscopic view.

Conclusions

One factor related to the low sensitivity is the low incidence of a grade III ULBT in Koreans. In Asians, the scarcity of a grade III ULBT is explainable as a result of anteriorly displaced temporomandibular joints and redundant lip soft tissues. Despite its high specificity, the low sensitivity and AUC of the ULBT mean that the test results should be interpreted cautiously in Koreans. Ethnic differences should be considered when evaluating parameters related to soft tissues such as the ULBT.

Trial registration

ClinicalTrials.gov Identifier: NCT01908218, Date of registration JUL 2013.

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