An analysis of the literature addressing tonsillectomy knowledge gaps

Publication date: Available online 27 September 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Craig M. Cooper, Jake X. Checketts, Lacy Brame, Harrison Gray, Jaye Bea Downs, Matt Vassar

Abstract

Importance

The ability of clinical practice guidelines to improve patient outcomes depends on the quality of evidence that they are built upon. Research into tonsillectomy in children is lacking, and the gaps in evidence were identified by guideline authors.

Objective

The objective of this study is to evaluate the extent that new research is addressing the gaps identified in the AAO-HNS Tonsillectomy in Children Guideline.

Design

For each recommendation in the AAO-HNS guideline Tonsillectomy In Children, we created PICO (Participants, Intervention, Comparator, Outcome) questions and search strings. PubMed was searched to locate studies undertaken after the final literature search performed by the AAO-HNS work group. These studies were then extracted and analyzed.

Setting

This study is relevant to all invested in focusing otolaryngological research on questions which currently lack strong evidence.

Participants

Trials in tonsillectomy that started after the development of the AAO-HNS clinical practice guidelines.

Main Outcome Measures

The main outcome measures of this study is the extent to which tonsillectomy research is addressing the evidence gaps listed in the clinical practice guideline.

Results

Of the 2519 studies included in our sample, 276 (11%) were relevant to the 18 recommendations made within the Tonsillectomy in Pediatric Patients clinical practice guideline. All but one of the recommendations was met by at least one study.

Conclusions

and Relevance: Our findings indicate that knowledge gaps within the guideline at publication may have since been addressed and a guideline update may thus be warranted.

Level of Evidence

NA.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2DD8vxY

Estimating and accounting for the effect of MRI scanner changes on longitudinal whole-brain volume change measurements

Publication date: 1 January 2019

Source: NeuroImage, Volume 184

Author(s): Hyunwoo Lee, Kunio Nakamura, Sridar Narayanan, Robert A. Brown, Douglas L. Arnold, for the Alzheimer's Disease Neuroimaging Initiative

Abstract

Objective

Longitudinal MRI studies are often subjected to mid-study scanner changes, which may alter image characteristics such as contrast, signal-to-noise ratio, contrast-to-noise ratio, intensity non-uniformity and geometric distortion. Measuring brain volume loss under these conditions can render the results potentially unreliable across the timepoint of the change. Estimating and accounting for this effect may improve the reliability of estimates of brain atrophy rates.

Methods

We analyzed 237 subjects who were scanned at 1.5 T for the Alzheimer's Disease Neuroimaging Initiative (ADNI) study and were subject to intra-vendor or inter-vendor scanner changes during follow-up (up to 8 years). Sixty-three subjects scanned on GE Signa HDx and HDxt platforms were also subject to a T1-weighted sequence change from Magnetization Prepared Rapid Gradient Echo (MP-RAGE) to Fast Spoiled Gradient Echo with IR Preparation (IR-FSPGR), as part of the transition from ADNI-1 to ADNI-2/GO. Two-timepoint percentage brain volume changes (PBVCs) between the baseline "screening" and the follow-up scans were calculated using SIENA. A linear mixed-effects model with subject-specific random slopes and intercepts was applied to estimate the fixed effects of scanner hardware changes on the PBVC measures. The same model also included a term to estimate the fixed effects of the T1-weighted sequence change.

Results

Different hardware upgrade or change combinations led to different offsets in the PBVC (SE; p): Philips Intera to Siemens Avanto, −1.81% (0.30; p < 0.0001); GE Genesis Signa to Philips Intera, 0.99% (0.47, p = 0.042); GE Signa Excite to Signa HDx, 0.33% (0.095, p = 0.0005); GE Signa Excite to Signa HDxt, −0.023% (0.23, p = 0.92); GE Signa Excite to Signa HDx to Signa HDxt, 0.25% (0.095, p = 0.010) and 0.27% (0.16, p = 0.098), respectively; GE Signa HDx to Signa HDxt, −0.24% (0.25, p = 0.34); Siemens Symphony to Symphony TIM, −0.39% (0.16; p = 0.019). The sequence change from MP-RAGE to IR-SPGR was associated with an average −1.63% (0.12; p < 0.0001) change.

Conclusion

Inter-vendor scanner changes generally led to greater effects on PBVC measurements than did intra-vendor scanner upgrades. The effect of T1-weighted sequence change was comparable to that of the inter-vendor scanner changes. Inclusion of the corrective fixed-effects terms for the scanner hardware and T1-weighted sequence changes yielded better model goodness-of-fits, and thus, potentially more reliable estimates of whole-brain atrophy rates.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2xWKj3z

Estimating and accounting for the effect of MRI scanner changes on longitudinal whole-brain volume change measurements

Publication date: 1 January 2019

Source: NeuroImage, Volume 184

Author(s): Hyunwoo Lee, Kunio Nakamura, Sridar Narayanan, Robert A. Brown, Douglas L. Arnold, for the Alzheimer's Disease Neuroimaging Initiative

Abstract

Objective

Longitudinal MRI studies are often subjected to mid-study scanner changes, which may alter image characteristics such as contrast, signal-to-noise ratio, contrast-to-noise ratio, intensity non-uniformity and geometric distortion. Measuring brain volume loss under these conditions can render the results potentially unreliable across the timepoint of the change. Estimating and accounting for this effect may improve the reliability of estimates of brain atrophy rates.

Methods

We analyzed 237 subjects who were scanned at 1.5 T for the Alzheimer's Disease Neuroimaging Initiative (ADNI) study and were subject to intra-vendor or inter-vendor scanner changes during follow-up (up to 8 years). Sixty-three subjects scanned on GE Signa HDx and HDxt platforms were also subject to a T1-weighted sequence change from Magnetization Prepared Rapid Gradient Echo (MP-RAGE) to Fast Spoiled Gradient Echo with IR Preparation (IR-FSPGR), as part of the transition from ADNI-1 to ADNI-2/GO. Two-timepoint percentage brain volume changes (PBVCs) between the baseline "screening" and the follow-up scans were calculated using SIENA. A linear mixed-effects model with subject-specific random slopes and intercepts was applied to estimate the fixed effects of scanner hardware changes on the PBVC measures. The same model also included a term to estimate the fixed effects of the T1-weighted sequence change.

Results

Different hardware upgrade or change combinations led to different offsets in the PBVC (SE; p): Philips Intera to Siemens Avanto, −1.81% (0.30; p < 0.0001); GE Genesis Signa to Philips Intera, 0.99% (0.47, p = 0.042); GE Signa Excite to Signa HDx, 0.33% (0.095, p = 0.0005); GE Signa Excite to Signa HDxt, −0.023% (0.23, p = 0.92); GE Signa Excite to Signa HDx to Signa HDxt, 0.25% (0.095, p = 0.010) and 0.27% (0.16, p = 0.098), respectively; GE Signa HDx to Signa HDxt, −0.24% (0.25, p = 0.34); Siemens Symphony to Symphony TIM, −0.39% (0.16; p = 0.019). The sequence change from MP-RAGE to IR-SPGR was associated with an average −1.63% (0.12; p < 0.0001) change.

Conclusion

Inter-vendor scanner changes generally led to greater effects on PBVC measurements than did intra-vendor scanner upgrades. The effect of T1-weighted sequence change was comparable to that of the inter-vendor scanner changes. Inclusion of the corrective fixed-effects terms for the scanner hardware and T1-weighted sequence changes yielded better model goodness-of-fits, and thus, potentially more reliable estimates of whole-brain atrophy rates.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2xWKj3z

Increased responses of the reward circuitry to positive task feedback following acute stress in healthy controls but not in siblings of schizophrenia patients

Publication date: 1 January 2019

Source: NeuroImage, Volume 184

Author(s): J.M.C. van Leeuwen, M. Vink, M. Joëls, R.S. Kahn, E.J. Hermans, C.H. Vinkers

Abstract

Acute stress is known to affect the way we process rewards. For example, during, or directly after stress, activity within key brain areas of the reward circuitry is reduced when a reward is presented. Generally, the effects of stress on the brain are time-dependent, changing neural and cognitive processing in the aftermath of stress to aid recovery. Such a dynamic response to stress is important for resilience on the longer term. However, relatively little is known about reward processing during the recovery phase of stress and whether this is changed in individuals at increased risk for stress-related psychopathology.

Healthy male individuals (N = 40) and unaffected siblings of schizophrenia patients (N = 40) were randomized to either an acute stress task (Trier Social Stress Test) or a no-stress task. Neural responses during reward anticipation and reward feedback (monetary gain or no gain) were examined 50 min later using an fMRI monetary incentive delay task. The ventral striatum and orbitofrontal cortex (OFC) were used as predefined hypothesis-driven regions of interest.

Neural responses following stress differed between controls and siblings during reward feedback (group × stress interaction OFC p = 0.003, ventral striatum p = 0.031), showing increased ventral striatum and OFC responses following stress in healthy controls only. Exploratory analyses revealed that this effect was most pronounced during hit trials (compared to when a reward was omitted), and independent of monetary value. Stress did not affect subsequent reward processing in siblings of schizophrenia patients. We found no significant differences between controls and siblings in ventral striatum and OFC responses during reward anticipation following stress.

This study shows that ventral striatum and OFC responses to positive task feedback are increased in the aftermath of stress in healthy male controls, regardless of monetary value. This indicates a dynamic shift from previously reported reduced responses in the striatum and OFC to reward feedback directly after stress to increased responses to both reward and non-reward feedback during the recovery phase of stress. These increased neural responses following stress were absent in siblings of schizophrenia patients. Together, these findings indicate that stress recovery is affected in this at-risk group, particularly in responses to positive feedback following stress.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2OYeOxq

Increased responses of the reward circuitry to positive task feedback following acute stress in healthy controls but not in siblings of schizophrenia patients

Publication date: 1 January 2019

Source: NeuroImage, Volume 184

Author(s): J.M.C. van Leeuwen, M. Vink, M. Joëls, R.S. Kahn, E.J. Hermans, C.H. Vinkers

Abstract

Acute stress is known to affect the way we process rewards. For example, during, or directly after stress, activity within key brain areas of the reward circuitry is reduced when a reward is presented. Generally, the effects of stress on the brain are time-dependent, changing neural and cognitive processing in the aftermath of stress to aid recovery. Such a dynamic response to stress is important for resilience on the longer term. However, relatively little is known about reward processing during the recovery phase of stress and whether this is changed in individuals at increased risk for stress-related psychopathology.

Healthy male individuals (N = 40) and unaffected siblings of schizophrenia patients (N = 40) were randomized to either an acute stress task (Trier Social Stress Test) or a no-stress task. Neural responses during reward anticipation and reward feedback (monetary gain or no gain) were examined 50 min later using an fMRI monetary incentive delay task. The ventral striatum and orbitofrontal cortex (OFC) were used as predefined hypothesis-driven regions of interest.

Neural responses following stress differed between controls and siblings during reward feedback (group × stress interaction OFC p = 0.003, ventral striatum p = 0.031), showing increased ventral striatum and OFC responses following stress in healthy controls only. Exploratory analyses revealed that this effect was most pronounced during hit trials (compared to when a reward was omitted), and independent of monetary value. Stress did not affect subsequent reward processing in siblings of schizophrenia patients. We found no significant differences between controls and siblings in ventral striatum and OFC responses during reward anticipation following stress.

This study shows that ventral striatum and OFC responses to positive task feedback are increased in the aftermath of stress in healthy male controls, regardless of monetary value. This indicates a dynamic shift from previously reported reduced responses in the striatum and OFC to reward feedback directly after stress to increased responses to both reward and non-reward feedback during the recovery phase of stress. These increased neural responses following stress were absent in siblings of schizophrenia patients. Together, these findings indicate that stress recovery is affected in this at-risk group, particularly in responses to positive feedback following stress.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2OYeOxq

Interactions between neural decision-making circuits predict long-term dietary treatment success in obesity

Publication date: 1 January 2019

Source: NeuroImage, Volume 184

Author(s): Martin Weygandt, Joachim Spranger, Verena Leupelt, Lukas Maurer, Thomas Bobbert, Knut Mai, John-Dylan Haynes

Abstract

Although dietary decision-making is regulated by multiple interacting neural controllers, their impact on dietary treatment success in obesity has only been investigated individually. Here, we used fMRI to test how well interactions between the Pavlovian system (automatically triggering urges of consumption after food cue exposure) and the goal-directed system (considering long-term consequences of food decisions) predict future dietary success achieved in 39 months. Activity of the Pavlovian system was measured with a cue-reactivity task by comparing perception of food versus control pictures, activity of the goal-directed system with a food-specific delay discounting paradigm. Both tasks were applied in 30 individuals with obesity up to five times: Before a 12-week diet, immediately thereafter, and at three annual follow-up visits. Brain activity was analyzed in two steps. In the first, we searched for areas involved in Pavlovian processes and goal-directed control across the 39-month study period with voxel-wise linear mixed-effects (LME) analyses. In the second, we computed network parameters reflecting the covariation of longitudinal voxel activity (i.e. principal components) in the regions identified in the first step and used them to predict body mass changes across the 39 months with LME models. Network analyses testing the link of dietary success with activity of the individual systems as reference found a moderate negative link to Pavlovian activity primarily in left hippocampus and a moderate positive association to goal-directed activity primarily in right inferior parietal gyrus. A cross-paradigm network analysis that integrated activity measured in both tasks revealed a strong positive link for interactions between visual Pavlovian areas and goal-directed decision-making regions mainly located in right insular cortex. We conclude that adaptation of food cue processing resources to goal-directed control activity is an important prerequisite of sustained dietary weight loss, presumably since the latter activity can modulate Pavlovian urges triggered by frequent cue exposure in everyday life.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2NK9xwZ

Interactions between neural decision-making circuits predict long-term dietary treatment success in obesity

Publication date: 1 January 2019

Source: NeuroImage, Volume 184

Author(s): Martin Weygandt, Joachim Spranger, Verena Leupelt, Lukas Maurer, Thomas Bobbert, Knut Mai, John-Dylan Haynes

Abstract

Although dietary decision-making is regulated by multiple interacting neural controllers, their impact on dietary treatment success in obesity has only been investigated individually. Here, we used fMRI to test how well interactions between the Pavlovian system (automatically triggering urges of consumption after food cue exposure) and the goal-directed system (considering long-term consequences of food decisions) predict future dietary success achieved in 39 months. Activity of the Pavlovian system was measured with a cue-reactivity task by comparing perception of food versus control pictures, activity of the goal-directed system with a food-specific delay discounting paradigm. Both tasks were applied in 30 individuals with obesity up to five times: Before a 12-week diet, immediately thereafter, and at three annual follow-up visits. Brain activity was analyzed in two steps. In the first, we searched for areas involved in Pavlovian processes and goal-directed control across the 39-month study period with voxel-wise linear mixed-effects (LME) analyses. In the second, we computed network parameters reflecting the covariation of longitudinal voxel activity (i.e. principal components) in the regions identified in the first step and used them to predict body mass changes across the 39 months with LME models. Network analyses testing the link of dietary success with activity of the individual systems as reference found a moderate negative link to Pavlovian activity primarily in left hippocampus and a moderate positive association to goal-directed activity primarily in right inferior parietal gyrus. A cross-paradigm network analysis that integrated activity measured in both tasks revealed a strong positive link for interactions between visual Pavlovian areas and goal-directed decision-making regions mainly located in right insular cortex. We conclude that adaptation of food cue processing resources to goal-directed control activity is an important prerequisite of sustained dietary weight loss, presumably since the latter activity can modulate Pavlovian urges triggered by frequent cue exposure in everyday life.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2NK9xwZ

P3b amplitude as a signature of cognitive decline in the older population: An EEG study enhanced by Functional Source Separation

Publication date: 1 January 2019

Source: NeuroImage, Volume 184

Author(s): Camillo Porcaro, Joshua Henk Balsters, Dante Mantini, Ian H. Robertson, Nicole Wenderoth

Abstract

With the greying population, it is increasingly necessary to establish robust and individualized markers of cognitive decline. This requires the combination of well-established neural mechanisms, and the development of increasingly sensitive methodologies. The P300 event-related potential (ERP) has been one of the most heavily investigated neural markers of attention and cognition, and studies have reliably shown that changes in the amplitude and latency of the P300 ERP index the process of aging. However, it is still not clear whether either the P3a or P3b sub-components additionally index levels of cognitive impairment. Here, we used a traditional visual three-stimulus oddball paradigm to investigate both the P3a and P3b ERP components in sixteen young and thirty-four healthy elderly individuals with varying degrees of cognitive ability. EEG data extraction was enhanced through the use of a novel signal processing method called Functional Source Separation (FSS) that increases signal-to-noise ratio by using a weighted sum of all electrodes rather than relying on a single, or a small sub-set, of EEG channels. Whilst clear differences in both the P3a and P3b ERPs were seen between young and elderly groups, only P3b amplitude differentiated older people with low memory performance relative to IQ from those with consistent memory and IQ. A machine learning analysis showed that P3b amplitude (derived from FSS analysis) could accurately categorise high and low performing elderly individuals (78% accuracy). A comparison of Bayes Factors found that differences in cognitive decline within the elderly group were 87 times more likely to be detected using FSS compared to the best performing single electrode (Cz). In conclusion, we propose that P3b amplitude could be a sensitive marker of early, age-independent, episodic memory dysfunction within a healthy older population. In addition, we advocate for the use of more advanced signal processing methods, such as FSS, for detecting subtle neural changes in clinical populations.

Graphical abstract

Topographic and functional behaviours differences between P3a and P3b: a comparison between channels and source space.

ERPs and topographic maps for the three groups (Young vs. HP vs. LP) on Cz and Fz channels and FS_P300. Top Panel (Functional Source Space) – Blue, magenta and red lines indicate FSP3a and green, cyan and brown lines indicate FSP3b for Young, HP and LP groups respectively. Last right column represents the superimposition of the P3a and P3b in the three groups. Bottom Panel (Channel Space) – Grey lines indicate the butterfly representation of all the EEG channels. Blue, magenta and red lines indicate CzP3a selected channel and green, cyan and brown lines indicate FzP3b selected channel for Young, HP and LP groups respectively. The black circle on the topographic map represent Cz and Fz channel positions.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2OVLTtP

P3b amplitude as a signature of cognitive decline in the older population: An EEG study enhanced by Functional Source Separation

Publication date: 1 January 2019

Source: NeuroImage, Volume 184

Author(s): Camillo Porcaro, Joshua Henk Balsters, Dante Mantini, Ian H. Robertson, Nicole Wenderoth

Abstract

With the greying population, it is increasingly necessary to establish robust and individualized markers of cognitive decline. This requires the combination of well-established neural mechanisms, and the development of increasingly sensitive methodologies. The P300 event-related potential (ERP) has been one of the most heavily investigated neural markers of attention and cognition, and studies have reliably shown that changes in the amplitude and latency of the P300 ERP index the process of aging. However, it is still not clear whether either the P3a or P3b sub-components additionally index levels of cognitive impairment. Here, we used a traditional visual three-stimulus oddball paradigm to investigate both the P3a and P3b ERP components in sixteen young and thirty-four healthy elderly individuals with varying degrees of cognitive ability. EEG data extraction was enhanced through the use of a novel signal processing method called Functional Source Separation (FSS) that increases signal-to-noise ratio by using a weighted sum of all electrodes rather than relying on a single, or a small sub-set, of EEG channels. Whilst clear differences in both the P3a and P3b ERPs were seen between young and elderly groups, only P3b amplitude differentiated older people with low memory performance relative to IQ from those with consistent memory and IQ. A machine learning analysis showed that P3b amplitude (derived from FSS analysis) could accurately categorise high and low performing elderly individuals (78% accuracy). A comparison of Bayes Factors found that differences in cognitive decline within the elderly group were 87 times more likely to be detected using FSS compared to the best performing single electrode (Cz). In conclusion, we propose that P3b amplitude could be a sensitive marker of early, age-independent, episodic memory dysfunction within a healthy older population. In addition, we advocate for the use of more advanced signal processing methods, such as FSS, for detecting subtle neural changes in clinical populations.

Graphical abstract

Topographic and functional behaviours differences between P3a and P3b: a comparison between channels and source space.

ERPs and topographic maps for the three groups (Young vs. HP vs. LP) on Cz and Fz channels and FS_P300. Top Panel (Functional Source Space) – Blue, magenta and red lines indicate FSP3a and green, cyan and brown lines indicate FSP3b for Young, HP and LP groups respectively. Last right column represents the superimposition of the P3a and P3b in the three groups. Bottom Panel (Channel Space) – Grey lines indicate the butterfly representation of all the EEG channels. Blue, magenta and red lines indicate CzP3a selected channel and green, cyan and brown lines indicate FzP3b selected channel for Young, HP and LP groups respectively. The black circle on the topographic map represent Cz and Fz channel positions.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2OVLTtP

Fast and robust quantification of liquid inside thin fibrous porous materials with single-sided NMR

Publication date: Available online 27 September 2018

Source: Magnetic Resonance Imaging

Author(s): Behzad Mohebbi, Jan Claussen, Bernhard Blümich

Abstract

Single-sided NMR with the NMR-MOUSE is employed for the characterization of fluids in fibrous and open foam materials. One of the key aspects of this study is the quantification of the fluid amount. To this end critical information was provided by a relaxation study. Using 2 mM/L of a Gd³⁺ relaxation agent the repetition time could be shortened to 250 ms, improving the correlation coefficient between liquid amount and signal amplitude from R² = 0.893 to R² = 0.982. To assess reproducibility and instrument precision, calibration experiments were repeated several times and their variation investigated. The results showed that the device is highly precise and robust with a standard deviation for liquid quantification of less than 1%.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2zCyhi0

Fast and robust quantification of liquid inside thin fibrous porous materials with single-sided NMR

Publication date: Available online 27 September 2018

Source: Magnetic Resonance Imaging

Author(s): Behzad Mohebbi, Jan Claussen, Bernhard Blümich

Abstract

Single-sided NMR with the NMR-MOUSE is employed for the characterization of fluids in fibrous and open foam materials. One of the key aspects of this study is the quantification of the fluid amount. To this end critical information was provided by a relaxation study. Using 2 mM/L of a Gd³⁺ relaxation agent the repetition time could be shortened to 250 ms, improving the correlation coefficient between liquid amount and signal amplitude from R² = 0.893 to R² = 0.982. To assess reproducibility and instrument precision, calibration experiments were repeated several times and their variation investigated. The results showed that the device is highly precise and robust with a standard deviation for liquid quantification of less than 1%.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2zCyhi0

18 F-FDG Metabolic Tumor Volume: Association with Short- and Long-Term Feeding Tube Use in Head and Neck IMRT

Abstract

The purpose of this study was to investigate whether the metabolic tumor volume (MTV) of head and neck primary tumors may be a significant prognostic factor for feeding tube (FT) use and FT dependence. Seventy-nine patients with evaluable primary tumors, pre-therapy FDG-PET scans, treated with definitive intensity-modulated radiotherapy (IMRT) (± concurrent chemotherapy) for head and neck mucosal cancers were included. MTV was quantified and recorded for the primary lesion using a minimum standardized uptake value (SUV) threshold of 2.0. Patients were recommended prophylactic FT and followed up by a dietician for at least eight weeks of post-radiotherapy. Associations between MTV, dose to swallowing organs at risk, FT use, and FT dependence were analyzed. MTV was positively correlated with gross tumor volume (GTV) (r = 0.7357; p < 0.0001). MTVs larger than 17 cc were associated with higher rates of FT use (87.8% vs. 69.5%, p = 0.0067) and FT dependence at six weeks (76.7% vs. 41.7%, p = 0.0024) and six months (25.0% vs. 8.7%, p = 0.0088). Increasing MTV was associated with increasing mean dose to the oral cavity (p = < 0.0001), tongue base (p = 0.0009), and superior (SPCM) (p = 0.0001) and middle pharyngeal constrictor muscles (MPCM) (p = 0.0005). Increasing MTV was associated with increasing maximum dose to oral cavity (p = 0.0028), tongue base (p = 0.0056), SPCM (p = 0.0037), and MPCM (p = 0.0085). Pre-treatment MTV is a reproducible parameter that can be generated at or prior to a pre-treatment Multidisciplinary Tumor Board and may expedite decisions regarding placement of prophylactic FTs. Prospective evaluation in larger series is required to determine whether MTV is a more useful prognostic variable for FT use than clinical T-classification.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2R6LGpa

18 F-FDG Metabolic Tumor Volume: Association with Short- and Long-Term Feeding Tube Use in Head and Neck IMRT

Abstract

The purpose of this study was to investigate whether the metabolic tumor volume (MTV) of head and neck primary tumors may be a significant prognostic factor for feeding tube (FT) use and FT dependence. Seventy-nine patients with evaluable primary tumors, pre-therapy FDG-PET scans, treated with definitive intensity-modulated radiotherapy (IMRT) (± concurrent chemotherapy) for head and neck mucosal cancers were included. MTV was quantified and recorded for the primary lesion using a minimum standardized uptake value (SUV) threshold of 2.0. Patients were recommended prophylactic FT and followed up by a dietician for at least eight weeks of post-radiotherapy. Associations between MTV, dose to swallowing organs at risk, FT use, and FT dependence were analyzed. MTV was positively correlated with gross tumor volume (GTV) (r = 0.7357; p < 0.0001). MTVs larger than 17 cc were associated with higher rates of FT use (87.8% vs. 69.5%, p = 0.0067) and FT dependence at six weeks (76.7% vs. 41.7%, p = 0.0024) and six months (25.0% vs. 8.7%, p = 0.0088). Increasing MTV was associated with increasing mean dose to the oral cavity (p = < 0.0001), tongue base (p = 0.0009), and superior (SPCM) (p = 0.0001) and middle pharyngeal constrictor muscles (MPCM) (p = 0.0005). Increasing MTV was associated with increasing maximum dose to oral cavity (p = 0.0028), tongue base (p = 0.0056), SPCM (p = 0.0037), and MPCM (p = 0.0085). Pre-treatment MTV is a reproducible parameter that can be generated at or prior to a pre-treatment Multidisciplinary Tumor Board and may expedite decisions regarding placement of prophylactic FTs. Prospective evaluation in larger series is required to determine whether MTV is a more useful prognostic variable for FT use than clinical T-classification.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2R6LGpa

Taurine administration prevents the intestine from the damage induced by beta-lactoglobulin sensitization in a murine model of food allergy

Publication date: Available online 27 September 2018

Source: Allergologia et Immunopathologia

Author(s): S. Aïnad-Tabet, H. Grar, A. Haddi, H. Negaoui, A. Guermat, O. Kheroua, D. Saïdi

Abstract

Background

Allergy to cow's milk proteins has often been associated with dysfunction of the intestinal mucosa caused by chronic inflammation in infants. This study evaluated the protective effect of taurine on intestinal damage induced by beta-lactoglobulin (β-Lg) in Balb/c mice used as an animal model of allergy to cow's milk proteins.

Methods

Balb/c mice were treated with taurine administered orally by gavage (3 mmol/kg/day) or intraperitoneally (100 mg/kg/day) for two weeks, then sensitized intraperitoneally with β-Lg. The electrophysiological parameters: active ion transport of chloride (Short-circuit current: Isc) and the passive ion permeability (Conductance: G) were measured ex vivo in Ussing chamber by intestine challenge with β-Lg. Histological study was used to assess gut inflammation. Serum levels of TNF-α and IL-6 were measured. Serum IgG and IgE anti-β-Lg were determined by ELISA.

Results

Compared with sensitized mice, β-Lg challenge of intestinal epithelium of taurine-pre-treated mice in Ussing chamber did not influence the intensity of Isc, nor produce any changes in the G, reflecting a reduction in the secretory response and epithelial permeability. Histological and morphometric analysis showed that taurine reduced the intestinal damage and limited intestine retraction caused by β-Lg sensitization. No statistically significant difference in the serum levels of TNF-α or IL-6 was found after oral or intraperitoneal administration of taurine. Treatment with taurine significantly decreased the IgG (p < 0.001) and IgE anti β-Lg levels (p < 0.05).

Conclusions

These results have for the first time provided evidence that pre-treatment with taurine appears to prevent intestinal damage induced by β-Lg.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Oi8Wlr

Taurine administration prevents the intestine from the damage induced by beta-lactoglobulin sensitization in a murine model of food allergy

Publication date: Available online 27 September 2018

Source: Allergologia et Immunopathologia

Author(s): S. Aïnad-Tabet, H. Grar, A. Haddi, H. Negaoui, A. Guermat, O. Kheroua, D. Saïdi

Abstract

Background

Allergy to cow's milk proteins has often been associated with dysfunction of the intestinal mucosa caused by chronic inflammation in infants. This study evaluated the protective effect of taurine on intestinal damage induced by beta-lactoglobulin (β-Lg) in Balb/c mice used as an animal model of allergy to cow's milk proteins.

Methods

Balb/c mice were treated with taurine administered orally by gavage (3 mmol/kg/day) or intraperitoneally (100 mg/kg/day) for two weeks, then sensitized intraperitoneally with β-Lg. The electrophysiological parameters: active ion transport of chloride (Short-circuit current: Isc) and the passive ion permeability (Conductance: G) were measured ex vivo in Ussing chamber by intestine challenge with β-Lg. Histological study was used to assess gut inflammation. Serum levels of TNF-α and IL-6 were measured. Serum IgG and IgE anti-β-Lg were determined by ELISA.

Results

Compared with sensitized mice, β-Lg challenge of intestinal epithelium of taurine-pre-treated mice in Ussing chamber did not influence the intensity of Isc, nor produce any changes in the G, reflecting a reduction in the secretory response and epithelial permeability. Histological and morphometric analysis showed that taurine reduced the intestinal damage and limited intestine retraction caused by β-Lg sensitization. No statistically significant difference in the serum levels of TNF-α or IL-6 was found after oral or intraperitoneal administration of taurine. Treatment with taurine significantly decreased the IgG (p < 0.001) and IgE anti β-Lg levels (p < 0.05).

Conclusions

These results have for the first time provided evidence that pre-treatment with taurine appears to prevent intestinal damage induced by β-Lg.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Oi8Wlr

Relationship Between Tube Voltage and Physical Image Quality of Pulmonary Nodules on Chest Radiographs Obtained Using the Bone-Suppression Technique

Publication date: Available online 28 September 2018

Source: Academic Radiology

Author(s): Satoshi Takagi, Tatsuya Yaegashi, Masayori Ishikawa

Rationale and Objectives

Image quality of chest radiographs is affected by tube voltage. This study aimed to clarify the relationship between tube voltage and physical image quality of pulmonary nodules on bone-suppressed chest radiographs.

Materials and Methods

An anthropomorphic chest phantom and a spherical simulated nodule, with a 12-mm diameter and approximately +100 Hounsfield units were used. The lung field of the phantom was divided into three areas, based on the overlap with the ribs in the chest radiograph. Ten positions of the simulated nodule were defined in each area. One hundred and twenty chest radiographs were acquired using four tube voltages (70 kVp, 90 kVp, 110 kVp, and 130 kVp) for a total of 30 nodule positions and were processed to create bone-suppressed images. Differences in contrast and contrast-to-noise ratio (CNR) were analyzed for all pairs of the four tube voltages using a two-sided Wilcoxon signed-rank test.

Results

In the area not overlapping with ribs, a statistically significant difference was observed only in contrast between tube voltage of 70 kVp and 90 kVp (p = 0.01). In the area overlapping with one or two ribs, the contrast and CNR tended to be higher at a lower tube voltage. In particular, the p values between the contrast at 70 kVp and that at the other three tube voltage settings were less than 0.01.

Conclusion

For a relatively dense nodule, the contrast and CNR in the bone-suppressed chest radiograph were significantly improved with lower tube voltage in the lung field overlapping with the ribs.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2OVXPvP

Relationship Between Tube Voltage and Physical Image Quality of Pulmonary Nodules on Chest Radiographs Obtained Using the Bone-Suppression Technique

Publication date: Available online 28 September 2018

Source: Academic Radiology

Author(s): Satoshi Takagi, Tatsuya Yaegashi, Masayori Ishikawa

Rationale and Objectives

Image quality of chest radiographs is affected by tube voltage. This study aimed to clarify the relationship between tube voltage and physical image quality of pulmonary nodules on bone-suppressed chest radiographs.

Materials and Methods

An anthropomorphic chest phantom and a spherical simulated nodule, with a 12-mm diameter and approximately +100 Hounsfield units were used. The lung field of the phantom was divided into three areas, based on the overlap with the ribs in the chest radiograph. Ten positions of the simulated nodule were defined in each area. One hundred and twenty chest radiographs were acquired using four tube voltages (70 kVp, 90 kVp, 110 kVp, and 130 kVp) for a total of 30 nodule positions and were processed to create bone-suppressed images. Differences in contrast and contrast-to-noise ratio (CNR) were analyzed for all pairs of the four tube voltages using a two-sided Wilcoxon signed-rank test.

Results

In the area not overlapping with ribs, a statistically significant difference was observed only in contrast between tube voltage of 70 kVp and 90 kVp (p = 0.01). In the area overlapping with one or two ribs, the contrast and CNR tended to be higher at a lower tube voltage. In particular, the p values between the contrast at 70 kVp and that at the other three tube voltage settings were less than 0.01.

Conclusion

For a relatively dense nodule, the contrast and CNR in the bone-suppressed chest radiograph were significantly improved with lower tube voltage in the lung field overlapping with the ribs.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2OVXPvP

Can Realistic Liver Tissue Surrogates Accurately Quantify the Impact of Reduced-kV Imaging on Attenuation and Contrast of Parenchyma and Lesions?

Publication date: Available online 28 September 2018

Source: Academic Radiology

Author(s): Andre Euler, Justin Solomon, Paul F. FitzGerald, Ehsan Samei, Rendon C. Nelson

Rationale and Objectives

To assess if a liquid tissue surrogate for the liver (LTSL) can emulate contrast-enhanced liver parenchyma and lesions and quantify the impact of reduced-kV imaging as a function of lesion contrast, phase of enhancement, and phantom size.

Materials and Methods

First, CT attenuation of LTSL- and water-iodine solutions were measured as a function of iodine concentration and tube potential. For each solution, the iodine concentration was determined to emulate liver parenchyma at 120kV. CT attenuation for both solutions was predicted for different tube potentials and compared to published patient data. Second, liver parenchyma in late arterial phase (LA: +92 HU at 120 kV) and portal venous phase (PV: +112 HU at 120 kV) was emulated using LTSL-iodine and a two-size phantom. Fourteen setups of hyper- and hypoattenuating lesions (lesion-to-parenchyma contrast (C_LP) = −50 to +50HU) were created. Each combination of C_LP, phase, and size was imaged at 80, 100, 120, and 140kV at constant radiation dose. CT attenuation, C_LP, and lesion-to-parenchyma contrast-to-noise ratio (CNR_LP) were assessed and compared to a theoretical model.

Results

LTSL-iodine more accurately emulated the CT attenuation of liver parenchyma across different tube potentials compared to water-iodine solutions. The theoretical model was confirmed by the empirical measurements using LTSL-iodine solutions: attenuation, C_LP, and CNR_LP increased when the tube potential decreased (p < 0.001). This trend was independent of lesion contrast, phase, and size. The absolute improvement in C_LP and CNR_LP, however, was inversely related to the magnitude of C_LP at 140kV.

Conclusion

LTSL accurately emulated the energy-dependent CT attenuation characteristics of contrast-enhanced liver parenchyma and lesions. The relative improvement in C_LP and CNR_LP by applying reduced-kV imaging was independent of lesion contrast, phase, and size while the absolute improvement decreased for low-contrast lesions.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2xKUybT

Can Realistic Liver Tissue Surrogates Accurately Quantify the Impact of Reduced-kV Imaging on Attenuation and Contrast of Parenchyma and Lesions?

Publication date: Available online 28 September 2018

Source: Academic Radiology

Author(s): Andre Euler, Justin Solomon, Paul F. FitzGerald, Ehsan Samei, Rendon C. Nelson

Rationale and Objectives

To assess if a liquid tissue surrogate for the liver (LTSL) can emulate contrast-enhanced liver parenchyma and lesions and quantify the impact of reduced-kV imaging as a function of lesion contrast, phase of enhancement, and phantom size.

Materials and Methods

First, CT attenuation of LTSL- and water-iodine solutions were measured as a function of iodine concentration and tube potential. For each solution, the iodine concentration was determined to emulate liver parenchyma at 120kV. CT attenuation for both solutions was predicted for different tube potentials and compared to published patient data. Second, liver parenchyma in late arterial phase (LA: +92 HU at 120 kV) and portal venous phase (PV: +112 HU at 120 kV) was emulated using LTSL-iodine and a two-size phantom. Fourteen setups of hyper- and hypoattenuating lesions (lesion-to-parenchyma contrast (C_LP) = −50 to +50HU) were created. Each combination of C_LP, phase, and size was imaged at 80, 100, 120, and 140kV at constant radiation dose. CT attenuation, C_LP, and lesion-to-parenchyma contrast-to-noise ratio (CNR_LP) were assessed and compared to a theoretical model.

Results

LTSL-iodine more accurately emulated the CT attenuation of liver parenchyma across different tube potentials compared to water-iodine solutions. The theoretical model was confirmed by the empirical measurements using LTSL-iodine solutions: attenuation, C_LP, and CNR_LP increased when the tube potential decreased (p < 0.001). This trend was independent of lesion contrast, phase, and size. The absolute improvement in C_LP and CNR_LP, however, was inversely related to the magnitude of C_LP at 140kV.

Conclusion

LTSL accurately emulated the energy-dependent CT attenuation characteristics of contrast-enhanced liver parenchyma and lesions. The relative improvement in C_LP and CNR_LP by applying reduced-kV imaging was independent of lesion contrast, phase, and size while the absolute improvement decreased for low-contrast lesions.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2xKUybT

Ultrafast Dynamic Contrast-Enhanced Breast MRI: Kinetic Curve Assessment Using Empirical Mathematical Model Validated with Histological Microvessel Density

Publication date: Available online 28 September 2018

Source: Academic Radiology

Author(s): Naoko Mori, Hiroyuki Abe, Shunji Mugikura, Chiaki Takasawa, Satoko Sato, Minoru Miyashita, Yu Mori, Federico D. Pineda, Gregory S. Karczmar, Hajime Tamura, Shoki Takahashi, Kei Takase

Rationale and Objectives

To evaluate whether parameters from empirical mathematical model (EMM) for ultrafast dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) correlate with histological microvessel density (MVD) in invasive breast cancer.

Materials and Methods

Ninety-eight consecutive patients with invasive breast cancer underwent an institutional review board-approved ultrafast DCE-MRI including a pre- and 18 postcontrast whole breast ultrafast scans (3 seconds) followed by four standard scans (60 seconds) using a 3T system. Region of interest was placed within each lesion where the highest signal increase was observed on ultrafast DCE-MRI, and the increase rate of enhancement was calculated as follows: ΔS = (SIpost − SIpre)/SIpre. The kinetic curve obtained from ultrafast DCE-MRI was analyzed using a truncated EMM: ΔS(t) = A(1 − e^−αt), where A is the upper limit of the signal intensity, α (min⁻¹) is the rate of signal increase. The initial slope of the kinetic curve is given by Aα. Initial area under curve (AUC30) and time of initial enhancement was calculated. From the standard DCE-MRI, the initial enhancement rate (IER) and the signal enhancement ratio (SER) were calculated as follows: IER = (SIearly − SIpre)/SIpre, SER = (SIearly − SIpre)/(SIdelayed − SIpre). The parameters were compared to MVD obtained from surgical specimens.

Results

A, α, Aα, AUC30, and time of initial enhancement significantly correlated with MVD (r = 0.29, 0.40, 0.51, 0.43, and −0.32 with p = 0.0027, p < 0.0001, p < 0.0001, p < 0.0001, and p = 0.0012, respectively), whereas IER and SER from standard DCE-MRI did not.

Conclusion

The parameters of the EMM, especially the initial slope or Aα, for ultrafast DCE-MRI correlated with MVD in invasive breast cancer.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2OXnMev

Ultrafast Dynamic Contrast-Enhanced Breast MRI: Kinetic Curve Assessment Using Empirical Mathematical Model Validated with Histological Microvessel Density

Publication date: Available online 28 September 2018

Source: Academic Radiology

Author(s): Naoko Mori, Hiroyuki Abe, Shunji Mugikura, Chiaki Takasawa, Satoko Sato, Minoru Miyashita, Yu Mori, Federico D. Pineda, Gregory S. Karczmar, Hajime Tamura, Shoki Takahashi, Kei Takase

Rationale and Objectives

To evaluate whether parameters from empirical mathematical model (EMM) for ultrafast dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) correlate with histological microvessel density (MVD) in invasive breast cancer.

Materials and Methods

Ninety-eight consecutive patients with invasive breast cancer underwent an institutional review board-approved ultrafast DCE-MRI including a pre- and 18 postcontrast whole breast ultrafast scans (3 seconds) followed by four standard scans (60 seconds) using a 3T system. Region of interest was placed within each lesion where the highest signal increase was observed on ultrafast DCE-MRI, and the increase rate of enhancement was calculated as follows: ΔS = (SIpost − SIpre)/SIpre. The kinetic curve obtained from ultrafast DCE-MRI was analyzed using a truncated EMM: ΔS(t) = A(1 − e^−αt), where A is the upper limit of the signal intensity, α (min⁻¹) is the rate of signal increase. The initial slope of the kinetic curve is given by Aα. Initial area under curve (AUC30) and time of initial enhancement was calculated. From the standard DCE-MRI, the initial enhancement rate (IER) and the signal enhancement ratio (SER) were calculated as follows: IER = (SIearly − SIpre)/SIpre, SER = (SIearly − SIpre)/(SIdelayed − SIpre). The parameters were compared to MVD obtained from surgical specimens.

Results

A, α, Aα, AUC30, and time of initial enhancement significantly correlated with MVD (r = 0.29, 0.40, 0.51, 0.43, and −0.32 with p = 0.0027, p < 0.0001, p < 0.0001, p < 0.0001, and p = 0.0012, respectively), whereas IER and SER from standard DCE-MRI did not.

Conclusion

The parameters of the EMM, especially the initial slope or Aα, for ultrafast DCE-MRI correlated with MVD in invasive breast cancer.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2OXnMev

A Comparison of Two Hyperpolarized 129Xe MRI Ventilation Quantification Pipelines: The Effect of Signal to Noise Ratio

Publication date: Available online 27 September 2018

Source: Academic Radiology

Author(s): Mu He, Wei Zha, Fei Tan, Leith Rankine, Sean Fain, Bastiaan Driehuys

Rationale

Hyperpolarized ¹²⁹Xe MRI enables quantitative evaluation of regional ventilation. To this end, multiple classifiers have been proposed to determine ventilation defect percentage (VDP) as well as other cluster populations. However, consensus has not yet been reached regarding which of these methods to deploy for multicenter clinical trials. Here, we compare two published classification techniques–linear-binning and adaptive K-means–to establish their limits of agreement and their robustness against reduced signal-to-noise ratio (SNR).

Methods

A total of 29 subjects (age: 38.4 ± 19.0 years) were retrospectively identified for inter-method comparison. For each ¹²⁹Xe ventilation image, 7 images with reduced SNR were generated with equal decrements relative to the native SNR. All 8 sets of images were then analyzed using both methods independently to classify all lung voxels into four clusters: VDP, low-, medium-, and high-ventilation-percentage (LVP, MVP and HVP). For each cluster, the percentage of the lung it comprised was compared between the two methods, as well as how these values persisted as SNR was degraded.

Results

The limits of agreement for calculating VDP were [+0.2%, +4.0%] with a +1.5% bias for binning relative to K-means. However, the inter-method agreement for the other clusters was moderate, with biases of −5.7%, 8.1%, and −4.0% for LVP, MVP, and HVP, respectively. As SNR decreased below ∼4, both methods began reporting values that deviated substantially from the native image. By requiring VDP to remain within ≤1.8% of that calculated from the native image, the minimum tolerable SNR values were 2.4 ± 1.0 for the linear-binning, and 3.5 ± 1.5 for the K-means.

Conclusions

Both methods agree well in quantifying VDP, but agreement for LVP and MVP remains variable. We suggest a required SNR threshold be two standard deviations above the minimum value of 3.5 ± 1.5 for robust determination of VDP, suggesting a minimum SNR of 6.6. However, robust quantification of the ventilated clusters required an SNR of 13.4.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2xK9gjr

A Comparison of Two Hyperpolarized 129Xe MRI Ventilation Quantification Pipelines: The Effect of Signal to Noise Ratio

Publication date: Available online 27 September 2018

Source: Academic Radiology

Author(s): Mu He, Wei Zha, Fei Tan, Leith Rankine, Sean Fain, Bastiaan Driehuys

Rationale

Hyperpolarized ¹²⁹Xe MRI enables quantitative evaluation of regional ventilation. To this end, multiple classifiers have been proposed to determine ventilation defect percentage (VDP) as well as other cluster populations. However, consensus has not yet been reached regarding which of these methods to deploy for multicenter clinical trials. Here, we compare two published classification techniques–linear-binning and adaptive K-means–to establish their limits of agreement and their robustness against reduced signal-to-noise ratio (SNR).

Methods

A total of 29 subjects (age: 38.4 ± 19.0 years) were retrospectively identified for inter-method comparison. For each ¹²⁹Xe ventilation image, 7 images with reduced SNR were generated with equal decrements relative to the native SNR. All 8 sets of images were then analyzed using both methods independently to classify all lung voxels into four clusters: VDP, low-, medium-, and high-ventilation-percentage (LVP, MVP and HVP). For each cluster, the percentage of the lung it comprised was compared between the two methods, as well as how these values persisted as SNR was degraded.

Results

The limits of agreement for calculating VDP were [+0.2%, +4.0%] with a +1.5% bias for binning relative to K-means. However, the inter-method agreement for the other clusters was moderate, with biases of −5.7%, 8.1%, and −4.0% for LVP, MVP, and HVP, respectively. As SNR decreased below ∼4, both methods began reporting values that deviated substantially from the native image. By requiring VDP to remain within ≤1.8% of that calculated from the native image, the minimum tolerable SNR values were 2.4 ± 1.0 for the linear-binning, and 3.5 ± 1.5 for the K-means.

Conclusions

Both methods agree well in quantifying VDP, but agreement for LVP and MVP remains variable. We suggest a required SNR threshold be two standard deviations above the minimum value of 3.5 ± 1.5 for robust determination of VDP, suggesting a minimum SNR of 6.6. However, robust quantification of the ventilated clusters required an SNR of 13.4.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2xK9gjr

Danger-Associated Molecular Patterns (DAMPs): the Derivatives and Triggers of Inflammation

Abstract

Purpose of Review

Allergen is an umbrella term for irritants of diverse origin. Along with other offenders such as pathogens, mutagens, xenobiotics, and pollutants, allergens can be grouped as inflammatory agents. Danger-associated molecular patterns (DAMPs) are altered metabolism products of necrotic or stressed cells, which are deemed as alarm signals by the innate immune system. Like inflammation, DAMPs play a role in correcting the altered physiological state, but in excess, they can be lethal due to their signal transduction roles. In a vicious loop, inflammatory agents are DAMP generators and DAMPs create a pro-inflammatory state. Only a handful of DAMPs such as uric acid, mtDNA, extracellular ATP, HSPs, amyloid β, S100, HMGB1, and ECM proteins have been studied till now. A large number of DAMPs are still obscure, in need to be unveiled. The identification and functional characterization of those DAMPs in inflammation pathways can be insightful.

Recent Findings

As inflammation and immune activation have been implicated in almost all pathologies, studies on them have been intensified in recent times. Consequently, the pathologic mechanisms of various DAMPs have emerged. Following PRR ligation, the activation of inflammasome, MAPK, and NF-kB is some of the common pathways.

Summary

The limited number of recognized DAMPs are only a fraction of the vast array of other DAMPs. In fact, any misplaced or abnormal level of metabolite can be a DAMP. Sophisticated analysis studies can reveal the full profile of the DAMPs. Lowering the level of DAMPs is useful therapeutic intervention but certainly not as effective as avoiding the DAMP generators, i.e., the inflammatory agents. So, rather than mitigating DAMPs, efforts should be focused on the elimination of inflammatory agents.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2DEjrvz

Family blames mislabeled food for death of 15-year-old with sesame allergy

Teenager died after eating a Pret a Manger sandwich, her family says. (Source: ABC News: Health)

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 https://ift.tt/2OVUFrX

Danger-Associated Molecular Patterns (DAMPs): the Derivatives and Triggers of Inflammation

Abstract

Purpose of Review

Allergen is an umbrella term for irritants of diverse origin. Along with other offenders such as pathogens, mutagens, xenobiotics, and pollutants, allergens can be grouped as inflammatory agents. Danger-associated molecular patterns (DAMPs) are altered metabolism products of necrotic or stressed cells, which are deemed as alarm signals by the innate immune system. Like inflammation, DAMPs play a role in correcting the altered physiological state, but in excess, they can be lethal due to their signal transduction roles. In a vicious loop, inflammatory agents are DAMP generators and DAMPs create a pro-inflammatory state. Only a handful of DAMPs such as uric acid, mtDNA, extracellular ATP, HSPs, amyloid β, S100, HMGB1, and ECM proteins have been studied till now. A large number of DAMPs are still obscure, in need to be unveiled. The identification and functional characterization of those DAMPs in inflammation pathways can be insightful.

Recent Findings

As inflammation and immune activation have been implicated in almost all pathologies, studies on them have been intensified in recent times. Consequently, the pathologic mechanisms of various DAMPs have emerged. Following PRR ligation, the activation of inflammasome, MAPK, and NF-kB is some of the common pathways.

Summary

The limited number of recognized DAMPs are only a fraction of the vast array of other DAMPs. In fact, any misplaced or abnormal level of metabolite can be a DAMP. Sophisticated analysis studies can reveal the full profile of the DAMPs. Lowering the level of DAMPs is useful therapeutic intervention but certainly not as effective as avoiding the DAMP generators, i.e., the inflammatory agents. So, rather than mitigating DAMPs, efforts should be focused on the elimination of inflammatory agents.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2DEjrvz

Family blames mislabeled food for death of 15-year-old with sesame allergy

Teenager died after eating a Pret a Manger sandwich, her family says. (Source: ABC News: Health)

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 https://ift.tt/2OVUFrX

Magnetic resonance imaging of muscle injury in elite American football players: predictors for return to play and performance: Authors

Publication date: Available online 27 September 2018

Source: European Journal of Radiology

Author(s): Manickam Kumaravel, Pritish Bawa, Naoki Murai

Abstract

Muscle injury accounts for about one-third of total sports-related injuries. The lower limb muscles have one of the highest predisposition for injury in high-level professional athletic sports, such as the National Football League. The commonest group of muscles injured among football players include the hamstrings, followed by the quadriceps. Muscle injuries lead to significant time, off the field and affect return to play. Sports physicians and teams have been keen on assessing such injuries and also relying on multiple tools to safely return the player back to the field. MRI plays a key role in evaluation, follow-up, and assessment for return to play (RTP). In this review, we will discuss details of muscle anatomy, incidence of muscle injuries, injury mechanisms, and use of MRI in assessment, grading, follow-up and in predicting the natural course of muscle injuries in the high-end athletic players. While the use of MRI is clear in diagnosis, and for follow up of muscle injuries, there is some limitation in its ability to predict RTP, based on current MRI classification systems. Footballers who have clinical injuries without MRI evidence of significant muscle injury (grade 0 and 1) have a shorter period of RTP. Injuries classified as high grade (3 and 4) on MRI do not correlate well with time to RTP. Further trials are required to improve the capability of MRI in its prediction of RTP.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2QiNYR1

Magnetic resonance imaging of muscle injury in elite American football players: predictors for return to play and performance: Authors

Publication date: Available online 27 September 2018

Source: European Journal of Radiology

Author(s): Manickam Kumaravel, Pritish Bawa, Naoki Murai

Abstract

Muscle injury accounts for about one-third of total sports-related injuries. The lower limb muscles have one of the highest predisposition for injury in high-level professional athletic sports, such as the National Football League. The commonest group of muscles injured among football players include the hamstrings, followed by the quadriceps. Muscle injuries lead to significant time, off the field and affect return to play. Sports physicians and teams have been keen on assessing such injuries and also relying on multiple tools to safely return the player back to the field. MRI plays a key role in evaluation, follow-up, and assessment for return to play (RTP). In this review, we will discuss details of muscle anatomy, incidence of muscle injuries, injury mechanisms, and use of MRI in assessment, grading, follow-up and in predicting the natural course of muscle injuries in the high-end athletic players. While the use of MRI is clear in diagnosis, and for follow up of muscle injuries, there is some limitation in its ability to predict RTP, based on current MRI classification systems. Footballers who have clinical injuries without MRI evidence of significant muscle injury (grade 0 and 1) have a shorter period of RTP. Injuries classified as high grade (3 and 4) on MRI do not correlate well with time to RTP. Further trials are required to improve the capability of MRI in its prediction of RTP.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2QiNYR1

Anesthesiology at the Cutting Edge

Publication date: Available online 27 September 2018

Source: Advances in Anesthesia

Author(s): Thomas M. McLoughlin, Laurence C. Torsher, Francis V. Salinas, Richard P. Dutton

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2QdAOo8

Anesthesiology at the Cutting Edge

Publication date: Available online 27 September 2018

Source: Advances in Anesthesia

Author(s): Thomas M. McLoughlin, Laurence C. Torsher, Francis V. Salinas, Richard P. Dutton

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2QdAOo8

Family blames mislabeled food for death of 15-year-old with sesame allergy

Teenager died after eating a Pret a Manger sandwich, her family says. (Source: ABC News: Health)

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 https://ift.tt/2OVUFrX

Family blames mislabeled food for death of 15-year-old with sesame allergy

Teenager died after eating a Pret a Manger sandwich, her family says. (Source: ABC News: Health)

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 https://ift.tt/2OVUFrX

Invasion of the mandible in gingivobuccal complex cancers: Histopathological analysis of routes of tumour entry and correlation with preoperative assessment

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): DA. Chaukar, M. Dandekar, S. Kane, S. Arya, N. Purandare, V. Rangarajan, AK. D'Cruz

Abstract

Objectives

To determine the most accurate imaging modality predicting mandibular invasion in gingivobuccal (GB) complex cancers. To determine patterns of invasion and routes of tumour entry into the mandible by detailed histopathologic analysis.

Material and methods

Prospective observational study of GB Complex cancers juxtaposed with the mandible clinically necessitating some form of mandibular resection. Orthopantomogram (OPG), Multi Detector Computed Tomography (MDCT), DENTA scan and Single Photon Emission Computed Tomography scan (SPECT) were performed after which the patient was subjected to surgery. Histopathological assessment was systematically performed with serial cuts of the mandibular segment.

Results

Of 70 patients, MDCT was the most accurate with area under curve (AUC) of 0.833. OPG, DENTA and SPECT had AUC of 0.714, 0.786 and 0.738 respectively. Mean calculated difference of involved height was −0.025 cm by MDCT (p value 0.87), −0.2 cm by OPG (p value 0.09) and 0.12 by DENTA scan (p value 0.41). Mean difference of involved length was −0.51 cm (p value 0.08) and −1.02 cm (p value 0.04) for MDCT and OPG respectively. 50% of tumour invasion was through the occlusal route while large tumours demonstrated multiple routes of entry.

Conclusion

-Gingivobuccal complex cancers are homogenous with respect to mandibular invasion, preferred route of tumour entry being the occlusal surface.

-Multidetector CT scan is fairly accurate in detecting mandibular involvement and predicting extent of involvement.

-Oncological safety can be achieved by positioning the bone cuts corresponding to the adjacent soft tissue margins in segmental mandibulectomy.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2NMaxAt

Invasion of the mandible in gingivobuccal complex cancers: Histopathological analysis of routes of tumour entry and correlation with preoperative assessment

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): DA. Chaukar, M. Dandekar, S. Kane, S. Arya, N. Purandare, V. Rangarajan, AK. D'Cruz

Abstract

Objectives

To determine the most accurate imaging modality predicting mandibular invasion in gingivobuccal (GB) complex cancers. To determine patterns of invasion and routes of tumour entry into the mandible by detailed histopathologic analysis.

Material and methods

Prospective observational study of GB Complex cancers juxtaposed with the mandible clinically necessitating some form of mandibular resection. Orthopantomogram (OPG), Multi Detector Computed Tomography (MDCT), DENTA scan and Single Photon Emission Computed Tomography scan (SPECT) were performed after which the patient was subjected to surgery. Histopathological assessment was systematically performed with serial cuts of the mandibular segment.

Results

Of 70 patients, MDCT was the most accurate with area under curve (AUC) of 0.833. OPG, DENTA and SPECT had AUC of 0.714, 0.786 and 0.738 respectively. Mean calculated difference of involved height was −0.025 cm by MDCT (p value 0.87), −0.2 cm by OPG (p value 0.09) and 0.12 by DENTA scan (p value 0.41). Mean difference of involved length was −0.51 cm (p value 0.08) and −1.02 cm (p value 0.04) for MDCT and OPG respectively. 50% of tumour invasion was through the occlusal route while large tumours demonstrated multiple routes of entry.

Conclusion

-Gingivobuccal complex cancers are homogenous with respect to mandibular invasion, preferred route of tumour entry being the occlusal surface.

-Multidetector CT scan is fairly accurate in detecting mandibular involvement and predicting extent of involvement.

-Oncological safety can be achieved by positioning the bone cuts corresponding to the adjacent soft tissue margins in segmental mandibulectomy.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2NMaxAt

Danger-Associated Molecular Patterns (DAMPs): the Derivatives and Triggers of Inflammation

Abstract

Purpose of Review

Allergen is an umbrella term for irritants of diverse origin. Along with other offenders such as pathogens, mutagens, xenobiotics, and pollutants, allergens can be grouped as inflammatory agents. Danger-associated molecular patterns (DAMPs) are altered metabolism products of necrotic or stressed cells, which are deemed as alarm signals by the innate immune system. Like inflammation, DAMPs play a role in correcting the altered physiological state, but in excess, they can be lethal due to their signal transduction roles. In a vicious loop, inflammatory agents are DAMP generators and DAMPs create a pro-inflammatory state. Only a handful of DAMPs such as uric acid, mtDNA, extracellular ATP, HSPs, amyloid β, S100, HMGB1, and ECM proteins have been studied till now. A large number of DAMPs are still obscure, in need to be unveiled. The identification and functional characterization of those DAMPs in inflammation pathways can be insightful.

Recent Findings

As inflammation and immune activation have been implicated in almost all pathologies, studies on them have been intensified in recent times. Consequently, the pathologic mechanisms of various DAMPs have emerged. Following PRR ligation, the activation of inflammasome, MAPK, and NF-kB is some of the common pathways.

Summary

The limited number of recognized DAMPs are only a fraction of the vast array of other DAMPs. In fact, any misplaced or abnormal level of metabolite can be a DAMP. Sophisticated analysis studies can reveal the full profile of the DAMPs. Lowering the level of DAMPs is useful therapeutic intervention but certainly not as effective as avoiding the DAMP generators, i.e., the inflammatory agents. So, rather than mitigating DAMPs, efforts should be focused on the elimination of inflammatory agents.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2DEjrvz

Danger-Associated Molecular Patterns (DAMPs): the Derivatives and Triggers of Inflammation

Abstract

Purpose of Review

Allergen is an umbrella term for irritants of diverse origin. Along with other offenders such as pathogens, mutagens, xenobiotics, and pollutants, allergens can be grouped as inflammatory agents. Danger-associated molecular patterns (DAMPs) are altered metabolism products of necrotic or stressed cells, which are deemed as alarm signals by the innate immune system. Like inflammation, DAMPs play a role in correcting the altered physiological state, but in excess, they can be lethal due to their signal transduction roles. In a vicious loop, inflammatory agents are DAMP generators and DAMPs create a pro-inflammatory state. Only a handful of DAMPs such as uric acid, mtDNA, extracellular ATP, HSPs, amyloid β, S100, HMGB1, and ECM proteins have been studied till now. A large number of DAMPs are still obscure, in need to be unveiled. The identification and functional characterization of those DAMPs in inflammation pathways can be insightful.

Recent Findings

As inflammation and immune activation have been implicated in almost all pathologies, studies on them have been intensified in recent times. Consequently, the pathologic mechanisms of various DAMPs have emerged. Following PRR ligation, the activation of inflammasome, MAPK, and NF-kB is some of the common pathways.

Summary

The limited number of recognized DAMPs are only a fraction of the vast array of other DAMPs. In fact, any misplaced or abnormal level of metabolite can be a DAMP. Sophisticated analysis studies can reveal the full profile of the DAMPs. Lowering the level of DAMPs is useful therapeutic intervention but certainly not as effective as avoiding the DAMP generators, i.e., the inflammatory agents. So, rather than mitigating DAMPs, efforts should be focused on the elimination of inflammatory agents.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2DEjrvz

Imaging of salivary gland pathology

Publication date: Available online 28 September 2018

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Gopi K. Nayak, Mari Hagiwara

ABSTRACT

The major salivary glands can be affected by a variety of acute or chronic, systemic, and neoplastic conditions. Several modalities can be used for salivary gland imaging, each with its own advantages and limitations. The article reviews the optimal imaging modality for different clinical scenarios, the typical imaging appearance of commonly encountered pathologies, and seeks to provide a framework for generating an appropriate differential diagnosis. Additionally, with regard to neoplastic conditions, the goals of the review are to highlight features suggestive of benign or low-grade lesions verses high grade malignancy, while recognizing the limitations of imaging in making specific histologic diagnoses.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2N1PtRv

Imaging of salivary gland pathology

Publication date: Available online 28 September 2018

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Gopi K. Nayak, Mari Hagiwara

ABSTRACT

The major salivary glands can be affected by a variety of acute or chronic, systemic, and neoplastic conditions. Several modalities can be used for salivary gland imaging, each with its own advantages and limitations. The article reviews the optimal imaging modality for different clinical scenarios, the typical imaging appearance of commonly encountered pathologies, and seeks to provide a framework for generating an appropriate differential diagnosis. Additionally, with regard to neoplastic conditions, the goals of the review are to highlight features suggestive of benign or low-grade lesions verses high grade malignancy, while recognizing the limitations of imaging in making specific histologic diagnoses.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2N1PtRv

Carotid Webs and Ischemic Stroke: Experiences in a Comprehensive Stroke Center

Publication date: Available online 28 September 2018

Source: Journal of Neuroradiology

Author(s): Payam Sajedi, Lydia Chelala, Joel Nunez-Gonalez, Carolyn Cronin, Steven Kittner, Jiachen Zhuo, Yang Zhang, Dheeraj Gandhi, Prashant Raghavan

Abstract

Background and Purpose

Carotid webs are intraluminal filling defects at the carotid bulb which are considered rare, though possibly underappreciated entities with recent studies demonstrating a likely casual association with ischemic stroke. The purpose of the study is to describe our recent experience with clinical and imaging manifestations of carotid webs.

Materials and Methods

A retrospective review of CTA neck studies in all adult patients presenting to our institution during the 19 month study interval was performed to determine the presence of carotid webs. Subsequent chart review of these patients with webs was performed to assess their clinical history and to obtain demographic detail.

Results

A total of 14 patients were identified with carotid webs in the study population. The mean age of patients with webs was 42.1 years (range 28-54), consisting mostly of African Americans (86%) and females (64%). Ten (71%) of web patients had a history of ischemic stroke, each ipsilateral to the side of web, and at least four of these patients had recurrent ischemic stroke.

Conclusions

We provide one of the largest sample sizes of webs gathered in a single study. Given its association with ischemic stroke, carotid webs should be assessed for in all patients presenting with ischemic stroke, especially younger African Americans.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Iogkqj

Carotid Webs and Ischemic Stroke: Experiences in a Comprehensive Stroke Center

Publication date: Available online 28 September 2018

Source: Journal of Neuroradiology

Author(s): Payam Sajedi, Lydia Chelala, Joel Nunez-Gonalez, Carolyn Cronin, Steven Kittner, Jiachen Zhuo, Yang Zhang, Dheeraj Gandhi, Prashant Raghavan

Abstract

Background and Purpose

Carotid webs are intraluminal filling defects at the carotid bulb which are considered rare, though possibly underappreciated entities with recent studies demonstrating a likely casual association with ischemic stroke. The purpose of the study is to describe our recent experience with clinical and imaging manifestations of carotid webs.

Materials and Methods

A retrospective review of CTA neck studies in all adult patients presenting to our institution during the 19 month study interval was performed to determine the presence of carotid webs. Subsequent chart review of these patients with webs was performed to assess their clinical history and to obtain demographic detail.

Results

A total of 14 patients were identified with carotid webs in the study population. The mean age of patients with webs was 42.1 years (range 28-54), consisting mostly of African Americans (86%) and females (64%). Ten (71%) of web patients had a history of ischemic stroke, each ipsilateral to the side of web, and at least four of these patients had recurrent ischemic stroke.

Conclusions

We provide one of the largest sample sizes of webs gathered in a single study. Given its association with ischemic stroke, carotid webs should be assessed for in all patients presenting with ischemic stroke, especially younger African Americans.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Iogkqj

Postoperative complications of male to female sex reassignment surgery: A 10-year French retrospective study

Publication date: Available online 27 September 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): S. Cristofari, B. Bertrand, S. Leuzzi, K. Rem, J. Rausky, M. Revol, M. Atlan, A. Stivala

Summary

In primary male to female (MTF) sex reassignment surgery (SRS), the most frequent postoperative functional complications using the penoscrotal skin technique remain neovaginal stenosis, urinary meatal stenosis and secondary revision surgery. We aimed to retrospectively analyze postoperative functional and anatomical complications, as well as secondary procedures required after MTF SRS by penile skin inversion. All patients operated on for MTF SRS, using the inverted technique, from June 2006 to July 2016, were retrospectively reviewed. The minimum follow-up was one year (five-years maximum follow-up). Soft postoperative dilationprotocol was prescribed until complete healing of the vagina. We did not prescribe long-term hard dilation systematically. Possible short-depth neovaginas were primarily treated with further temporary dilation using a hard bougie. Among the 189 included patients, we reported a 2.6% of rectovaginal wall perforations. In 37% of patients we had repeated compressive dressings and 15% of them required blood transfusions. Eighteen percent of patients presented with hematoma and 27% with early infectious complications. Delayed short-depth neovagina occurred in 21% of patients, requiring additional hard dilatation, with a 95.5% success rate. Total secondary vaginoplasty rate was 6.3% (4.7% skin graft and 3.7% bowel plasty). Secondary functional meatoplasty occurred in 1% of cases. Other secondary cosmetic surgery rates ranged between 3 to 20%. A low rate of secondary functional meatoplasty was showed after MTF SRS by penile skin inversion. Hard dilation was prescribed in case of healed short-depth vagina, with good efficiency in most of cases. Secondary vaginoplasty was required in cases of neovagina stenosis or persisting short-depth neovagina after failure of hard dilation protocol.

Résumé

Dans la chirurgie de réattribution sexuelle (SRS) primaire masculine à féminine, les complications fonctionnelles postopératoires les plus fréquentes utilisant la technique de la peau pénoscrotale restent la sténose néovaginale, la sténose urinaire et la reprise secondaire. Nous avons cherché à analyser rétrospectivement les complications fonctionnelles et anatomiques postopératoires, ainsi que les procédures secondaires requises après un SRS MTF par inversion de la peau du pénis. Tous les patients opérés pour le SRS MTF, en utilisant la technique inversée, de juin 2006 à juillet 2016, ont été revus rétrospectivement. Le suivi minimum était d'un an et le maximum était de cinq ans. Un protocole de dilatation postopératoire souple a été prescrit jusqu'à guérison complète du vagin. Nous n'avons pas prescrit une dilatation dure à long terme systématiquement. Les néovagins de faible profondeur possible ont été traités principalement avec une dilatation temporaire supplémentaire en utilisant une bougie dure. Parmi les 189 patients inclus, nous avons rapporté 2,6 % des perforations de la paroi rectovaginale. Chez 37 % des patients, nous avions des pansements compressifs répétés et 15 % d'entre eux nécessitaient des transfusions sanguines. Dix-huit pour cent des patients présentaient un hématome et 27 % présentaient des complications infectieuses précoces. Vingt et un pour cent des patients ont présenté un court néovagin en différée, nécessitant une dilatation dure supplémentaire, avec un taux de réussite de 95,5 %. Le taux de vaginoplastie secondaire totale était de 6,3 % (4,7 % de greffe de peau et 3,7 % de plastie intestinale). Une veinoplastie fonctionnelle secondaire est survenue dans 1 % des cas. Les autres taux de chirurgie esthétique secondaire se situaient entre 3 et 20 %. Un faible taux de meatoplastie fonctionnelle secondaire a été montré après MTF SRS par inversion de la peau du pénis. Une dilatation dure a été prescrite en cas de vagin guéri à faible profondeur, avec une bonne efficacité dans la plupart des cas. Une vaginoplastie secondaire a été nécessaire en cas de sténose à néovagin ou de néovagin à faible profondeur persistante après l'échec du protocole de dilatation dure.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2OVHYgI

Prélever un SIEP à la place d’un DIEP en reconstruction mammaire : note technique

Publication date: Available online 27 September 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): Q. Bettex, C. Jaloux, M. Abellan Lopez, D. Casanova, B. Bertrand, C. Philandrianos

Résumé

La reconstruction mammaire par lambeau abdominal a évolué vers une diminution des séquelles du site donneur depuis la description du lambeau perforant de DIEP (pour Deep Inferior Epigastrique Perforator). De même épaisseur et de même surface, le lambeau de SIEA (pour Superficial Inferior Epigstrique Artery) ne nécessite pas, pour son prélèvement, d'ouverture de la gaine abdominale ni de dissection au travers des muscles grands droits, minimisant encore les séquelles. Cependant, il est peu utilisé en raison de la variabilité de sa vascularisation et d'un taux d'échec plus élevé que le DIEP dans la littérature. Nous pensons qu'il est tout de même raisonnable, dans certains cas, de prélever un SIEA à la place d'un DIEP. Nous présentons une note technique expliquant notre stratégie opératoire permettant de prélever un SIEA de façon fiable lorsque le calibre des vaisseaux le permet.

Summary

Breast reconstruction by abdominal flap has evolved to ensure minimal donor-site morbidity with the description of Deep Inferior Epigastric artery Perforator flap (DIEP flap). Being of the same thickness and the same surface, the Superficial Inferior Epigastric Artery flap (SIEA flap) does not require, for it harvesting, to open the abdominal fascia or to dissect through the muscles minimizing again donor-site sequelae. However, it is little used because of the variability of its vascularization and a higher failure rate than the DIEP in the literature. We believe that it is reasonable, in some cases, to harvest a SIEA flap instead of DIEP flap in mammary reconstruction. We present a technical note explaining our operative strategy for reliably taking a SIEA when the caliber of the vessels allows.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2OhraUg

Postoperative complications of male to female sex reassignment surgery: A 10-year French retrospective study

Publication date: Available online 27 September 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): S. Cristofari, B. Bertrand, S. Leuzzi, K. Rem, J. Rausky, M. Revol, M. Atlan, A. Stivala

Summary

In primary male to female (MTF) sex reassignment surgery (SRS), the most frequent postoperative functional complications using the penoscrotal skin technique remain neovaginal stenosis, urinary meatal stenosis and secondary revision surgery. We aimed to retrospectively analyze postoperative functional and anatomical complications, as well as secondary procedures required after MTF SRS by penile skin inversion. All patients operated on for MTF SRS, using the inverted technique, from June 2006 to July 2016, were retrospectively reviewed. The minimum follow-up was one year (five-years maximum follow-up). Soft postoperative dilationprotocol was prescribed until complete healing of the vagina. We did not prescribe long-term hard dilation systematically. Possible short-depth neovaginas were primarily treated with further temporary dilation using a hard bougie. Among the 189 included patients, we reported a 2.6% of rectovaginal wall perforations. In 37% of patients we had repeated compressive dressings and 15% of them required blood transfusions. Eighteen percent of patients presented with hematoma and 27% with early infectious complications. Delayed short-depth neovagina occurred in 21% of patients, requiring additional hard dilatation, with a 95.5% success rate. Total secondary vaginoplasty rate was 6.3% (4.7% skin graft and 3.7% bowel plasty). Secondary functional meatoplasty occurred in 1% of cases. Other secondary cosmetic surgery rates ranged between 3 to 20%. A low rate of secondary functional meatoplasty was showed after MTF SRS by penile skin inversion. Hard dilation was prescribed in case of healed short-depth vagina, with good efficiency in most of cases. Secondary vaginoplasty was required in cases of neovagina stenosis or persisting short-depth neovagina after failure of hard dilation protocol.

Résumé

Dans la chirurgie de réattribution sexuelle (SRS) primaire masculine à féminine, les complications fonctionnelles postopératoires les plus fréquentes utilisant la technique de la peau pénoscrotale restent la sténose néovaginale, la sténose urinaire et la reprise secondaire. Nous avons cherché à analyser rétrospectivement les complications fonctionnelles et anatomiques postopératoires, ainsi que les procédures secondaires requises après un SRS MTF par inversion de la peau du pénis. Tous les patients opérés pour le SRS MTF, en utilisant la technique inversée, de juin 2006 à juillet 2016, ont été revus rétrospectivement. Le suivi minimum était d'un an et le maximum était de cinq ans. Un protocole de dilatation postopératoire souple a été prescrit jusqu'à guérison complète du vagin. Nous n'avons pas prescrit une dilatation dure à long terme systématiquement. Les néovagins de faible profondeur possible ont été traités principalement avec une dilatation temporaire supplémentaire en utilisant une bougie dure. Parmi les 189 patients inclus, nous avons rapporté 2,6 % des perforations de la paroi rectovaginale. Chez 37 % des patients, nous avions des pansements compressifs répétés et 15 % d'entre eux nécessitaient des transfusions sanguines. Dix-huit pour cent des patients présentaient un hématome et 27 % présentaient des complications infectieuses précoces. Vingt et un pour cent des patients ont présenté un court néovagin en différée, nécessitant une dilatation dure supplémentaire, avec un taux de réussite de 95,5 %. Le taux de vaginoplastie secondaire totale était de 6,3 % (4,7 % de greffe de peau et 3,7 % de plastie intestinale). Une veinoplastie fonctionnelle secondaire est survenue dans 1 % des cas. Les autres taux de chirurgie esthétique secondaire se situaient entre 3 et 20 %. Un faible taux de meatoplastie fonctionnelle secondaire a été montré après MTF SRS par inversion de la peau du pénis. Une dilatation dure a été prescrite en cas de vagin guéri à faible profondeur, avec une bonne efficacité dans la plupart des cas. Une vaginoplastie secondaire a été nécessaire en cas de sténose à néovagin ou de néovagin à faible profondeur persistante après l'échec du protocole de dilatation dure.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2OVHYgI

Prélever un SIEP à la place d’un DIEP en reconstruction mammaire : note technique

Publication date: Available online 27 September 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): Q. Bettex, C. Jaloux, M. Abellan Lopez, D. Casanova, B. Bertrand, C. Philandrianos

Résumé

La reconstruction mammaire par lambeau abdominal a évolué vers une diminution des séquelles du site donneur depuis la description du lambeau perforant de DIEP (pour Deep Inferior Epigastrique Perforator). De même épaisseur et de même surface, le lambeau de SIEA (pour Superficial Inferior Epigstrique Artery) ne nécessite pas, pour son prélèvement, d'ouverture de la gaine abdominale ni de dissection au travers des muscles grands droits, minimisant encore les séquelles. Cependant, il est peu utilisé en raison de la variabilité de sa vascularisation et d'un taux d'échec plus élevé que le DIEP dans la littérature. Nous pensons qu'il est tout de même raisonnable, dans certains cas, de prélever un SIEA à la place d'un DIEP. Nous présentons une note technique expliquant notre stratégie opératoire permettant de prélever un SIEA de façon fiable lorsque le calibre des vaisseaux le permet.

Summary

Breast reconstruction by abdominal flap has evolved to ensure minimal donor-site morbidity with the description of Deep Inferior Epigastric artery Perforator flap (DIEP flap). Being of the same thickness and the same surface, the Superficial Inferior Epigastric Artery flap (SIEA flap) does not require, for it harvesting, to open the abdominal fascia or to dissect through the muscles minimizing again donor-site sequelae. However, it is little used because of the variability of its vascularization and a higher failure rate than the DIEP in the literature. We believe that it is reasonable, in some cases, to harvest a SIEA flap instead of DIEP flap in mammary reconstruction. We present a technical note explaining our operative strategy for reliably taking a SIEA when the caliber of the vessels allows.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2OhraUg

Mechanical and hydrolytic degradation of an Ormocer®-based Bis-GMA-free resin composite

Abstract

Objectives

The aim of the study was to evaluate the mechanical stability of bisphenol A-glycidyl methacrylate (Bis-GMA) and Ormocer-based resin composites before and after water absorption and to examine water saturation.

Material and methods

Disc-shaped specimens of the Bis-GMA (Grandio SO, Voco) and the Ormocer-based (Admira Fusion, Voco) dental resin composites were produced, stored in water, and weighed after pre-determined times to measure the absorbed water. Bend bars were produced and stored for 24 h in dry conditions as well as in distilled water for 14 days or 60 days at 37 °C. The initial flexural strength (FS) under quasi-static loading and flexural fatigue strength (FFS) under cyclic loading were determined under 4-point bending. Fracture toughness (K_Ic) of both composites was measured using the single-edge-V-notch-beam (SEVNB) technique after the same storage conditions under 3-point bending.

Results

Within the first 14 days, storage conditions did not affect the initial FS of Grandio SO, while a significant drop in initial FS was observed for Admira Fusion after 2 weeks in water and most of the water was absorbed within this time. FFS for the Bis-GMA composite was not reduced before 2 months in water, whereas for the Ormocer®-based composite, there has been a significant decrease in strength after cyclic fatigue already at 2 weeks of water storage. K_Ic of Admira Fusion decreased significantly after both storage periods, while K_Ic of Grandio SO decreased only significantly after 2 weeks of water storage.

Conclusion

All mechanical properties of the Bis-GMA composite were superior to those of the Ormocer®-based material, except water sorption.

Clinical significance

Water storage seems to have a much more pronounced effect on the mechanical properties of Ormocer®-based dental composites in comparison to Bis-GMA-based composites.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2xJRblz

Mechanical and hydrolytic degradation of an Ormocer®-based Bis-GMA-free resin composite

Abstract

Objectives

The aim of the study was to evaluate the mechanical stability of bisphenol A-glycidyl methacrylate (Bis-GMA) and Ormocer-based resin composites before and after water absorption and to examine water saturation.

Material and methods

Disc-shaped specimens of the Bis-GMA (Grandio SO, Voco) and the Ormocer-based (Admira Fusion, Voco) dental resin composites were produced, stored in water, and weighed after pre-determined times to measure the absorbed water. Bend bars were produced and stored for 24 h in dry conditions as well as in distilled water for 14 days or 60 days at 37 °C. The initial flexural strength (FS) under quasi-static loading and flexural fatigue strength (FFS) under cyclic loading were determined under 4-point bending. Fracture toughness (K_Ic) of both composites was measured using the single-edge-V-notch-beam (SEVNB) technique after the same storage conditions under 3-point bending.

Results

Within the first 14 days, storage conditions did not affect the initial FS of Grandio SO, while a significant drop in initial FS was observed for Admira Fusion after 2 weeks in water and most of the water was absorbed within this time. FFS for the Bis-GMA composite was not reduced before 2 months in water, whereas for the Ormocer®-based composite, there has been a significant decrease in strength after cyclic fatigue already at 2 weeks of water storage. K_Ic of Admira Fusion decreased significantly after both storage periods, while K_Ic of Grandio SO decreased only significantly after 2 weeks of water storage.

Conclusion

All mechanical properties of the Bis-GMA composite were superior to those of the Ormocer®-based material, except water sorption.

Clinical significance

Water storage seems to have a much more pronounced effect on the mechanical properties of Ormocer®-based dental composites in comparison to Bis-GMA-based composites.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2xJRblz

Treatment of Vocal Cord Paralysis by Autologous Fat Injection: Our Experience with 41 Patients

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2zCUjkH

Treatment of Vocal Cord Paralysis by Autologous Fat Injection: Our Experience with 41 Patients

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2zCUjkH

A 20 year observational cohort of a 5 million patient population – tonsillectomy rates in the context of two national policy changes

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2N7oCTZ

Our Experience of Long Term Result of Tympanoplasty Using Areolar Tissue in 359 patients

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2zC4GW2

Our Experience of Long Term Result of Tympanoplasty Using Areolar Tissue in 359 patients

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2zC4GW2

Snoring sound energy as a potential biomarker for disease severity and surgical response in childhood obstructive sleep apnea: a pilot study

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2N7oEez

Snoring sound energy as a potential biomarker for disease severity and surgical response in childhood obstructive sleep apnea: a pilot study

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2N7oEez

The Sources of Essential Fatty Acids for Allergic and Cancer Patients; a Connection with Insight into Mammalian Target of Rapamycin: A Narrative Review

Conclusions: According to the concept of Traditional Iranian Medicine therapy, in contrast to Cold-nature oils, EFA supplementation with the sources of Hot-nature oilsis not suitable for the treatment of atopic and cancerous diseases. PMID: 30255691 [PubMed - in process] (Source: Asian Pacific Journal of Cancer Prevention)

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 https://ift.tt/2OhyPSp

The Sources of Essential Fatty Acids for Allergic and Cancer Patients; a Connection with Insight into Mammalian Target of Rapamycin: A Narrative Review

Conclusions: According to the concept of Traditional Iranian Medicine therapy, in contrast to Cold-nature oils, EFA supplementation with the sources of Hot-nature oilsis not suitable for the treatment of atopic and cancerous diseases. PMID: 30255691 [PubMed - in process] (Source: Asian Pacific Journal of Cancer Prevention)

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 https://ift.tt/2OhyPSp

43rd National AOMSI Conference

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2xZh0O6

43rd National AOMSI Conference

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2xZh0O6

Recent Developments and Highlights in rhinitis and allergen immunotherapy

Allergy, Volume 0, Issue ja, -Not available-.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Og8eoW

Recent Developments and Highlights in rhinitis and allergen immunotherapy

Allergy, Volume 0, Issue ja, -Not available-.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Og8eoW

Tender Nodules and Swollen Red Legs: Challenge

No abstract available

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2xT5aF3

Tender Nodules and Swollen Red Legs: Challenge

No abstract available

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2xT5aF3

43rd National AOMSI Conference

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2xZh0O6