Oral health status and its determinants among opiate dependents: a cross-sectional study

Abstract

Background

In addition to numerous general health problems, drug dependents manifest various oral health disorders. Our aim was to investigate the oral health status and its determinants among in-treatment opiate dependents.

Methods

As part of a comprehensive cross-sectional survey on opiate dependents admitted to methadone maintenance centers in Tehran, Iran, we conducted a clinical study in two centers from different socioeconomic areas. A trained dentist conducted face to face interviews and clinical oral examinations based on World Health Organization (WHO) criteria for Decayed, Missing, Filled Teeth (DMFT) index and Community Periodontal Index (CPI) on volunteer patients. Student's t-test, Mann-Whitney U, Kruskal Wallis, and Chi² tests, in addition to linear and logistic regression models served for statistical analysis (p < 0.05).

Results

A total of 217 patients (98% men), with a mean age of 43.6 years (SD 12.3) participated in the study. Opium was the main drug of abuse reported by 70% of the participants followed by crystalline heroin (22%). Of the participants, 24.4% were totally edentulous. The mean DMFT score of participants was 20.3 (SD 7.8). Missing teeth comprised the main part of the index followed by decayed and filled teeth. Older patients (p < 0.001) and the patients with a lower socioeconomic status (p = 0.01) had higher DMFT scores. None of the dentate patients had a healthy periodontium. Maximum CPI mostly consisted of shallow pockets (66%) followed by calculus in 15%, deep pockets in 11%, and bleeding in 8% of the participants. Older participants (p = 0.02) and those who started drug abuse at a younger age (p = 0.01) were more likely to develop periodontal pockets.

Conclusions

Opiate dependents had a poor oral health status in terms of the dentition status and periodontal health. Missing teeth comprised the main part of their dental caries history and none had a healthy periodontium. Oral health care should be integrated into the package of general health services available in treatment centers.

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NMR-based analysis of shear strength of weakly expansive clay in sodium chloride solution

Publication date: Available online 7 January 2019

Source: Magnetic Resonance Imaging

Author(s): Haihao Yu, De'an Sun, Huihui Tian

Abstract

A series of direct shear and nuclear magnetic resonance (NMR) tests were performed on a compacted weakly expansive clay saturated by sodium chloride (NaCl) solutions with different concentrations to study the effect of NaCl solution on the shear strength and its mechanism. Results from the direct shear tests show that the shear strength decreases slightly with increasing the NaCl solution concentration when the concentration is less than 1.0 mol/L. The results of NMR tests show that the smaller transverse relaxation times (T₂) of specimens saturated by NaCl solutions with concentrations of 0.5 and 1.0 mol/L are less than that of the specimen saturated by deionized water. This means that the amount of smaller pores in the specimens saturated by deionized water is greater than that in specimens by NaCl solutions. That is, the specimen saturated by deionized water is denser than those by NaCl solutions under the same vertical pressure, and thus the shear strength of weakly expensive clay decreases with increasing the NaCl solution concentration.

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Slow component apparent diffusion coefficient for prostate cancer: Comparison and correlation with pharmacokinetic evaluation from dynamic contrast-enhanced MR imaging

Publication date: Available online 7 January 2019

Source: Magnetic Resonance Imaging

Author(s): Akio Ogura, Fumie Maeda, Seiji Yahata, Daisuke Koyama, Fumiya Tsunoda, Norio Hayashi, Syunichi Motegi, Kenichiro Yamamura

Abstract

Purpose

Dynamic contrast enhancement (DCE)-MRI has high diagnostic performance of prostate cancer. However, it is preferable to avoid the use of MRI contrast media. A study reported that the diagnosability of the wash-in index of DCE-MRI was equivalent to the intravoxel incoherent motion of the diffusion weighted image.

The purpose of this study was to examine the correlation between the slow component apparent diffusion coefficient (ADC) and the wash-out index of the DCE.

Materials and methods

Thirty-eight patients diagnosed with prostate cancer by biopsy were enrolled in this study. The fast and slow component ADCs of the DWI were calculated for 76 points of the tumor and the contralateral normal parts. Furthermore, the wash-in and wash-out indices of the DCE-MRI were calculated. The correlations for each calculated index were compared.

Results

There was a significant difference between the tumor and the contralateral normal parts for both fast (p = 0.03) and slow component (p < 0.01) ADCs. In addition, the slow component ADC was correlated with the wash-out index (r = 0.64).

Conclusion

The slow component ADC was correlated with the wash-out index, and may, therefore, be a suitable substitute for DCE-MRI.

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Authors' awareness of concepts in the authorship

Publication date: Available online 6 January 2019

Source: Journal of Oral Biology and Craniofacial Research

Author(s): Beuy Joob, Viroj Wiwanitkit

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What Are The Potential Complications of a Tracheostomy?

Discussion In the past, indications for tracheostomy were often because of infection, but today are more often due to need for chronic airway support and/or ventilation. Many more children and infants are having tracheostomies placed. Decannulation rates for these children are low due to concomitant complex chronic disease such as neurological, pulmonary and congenital heart diseases. Co-morbidies are common with 3-4 being average, and frequently also including chronic technology such as gastrostomy tubes or ventriculoperitoneal shunts. Approximately 8% of children do not survive the hospitalization where the tracheostomy is placed. It is believe this is not specifically due to the tracheostomy, but is secondary to underlying medical conditions. About 15-20% of children with tracheostomies...

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What Are The Potential Complications of a Tracheostomy?

Discussion In the past, indications for tracheostomy were often because of infection, but today are more often due to need for chronic airway support and/or ventilation. Many more children and infants are having tracheostomies placed. Decannulation rates for these children are low due to concomitant complex chronic disease such as neurological, pulmonary and congenital heart diseases. Co-morbidies are common with 3-4 being average, and frequently also including chronic technology such as gastrostomy tubes or ventriculoperitoneal shunts. Approximately 8% of children do not survive the hospitalization where the tracheostomy is placed. It is believe this is not specifically due to the tracheostomy, but is secondary to underlying medical conditions. About 15-20% of children with tracheostomies...

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Broncho‐Vaxom® (OM‐85 BV) soluble components stimulate sinonasal innate immunity

Background

Broncho‐Vaxom® (OM‐85 BV) is an extract of infectious respiratory bacteria that is used as an immunostimulant outside of the United States for the prevention and treatment of bronchitis and rhinosinusitis. Prior studies have shown that use of OM‐85 BV is associated with reduction in frequency of respiratory infection and decreased duration of antibiotic usage. However, the effects of OM‐85 BV on respiratory mucosal innate immunity are unknown.

Methods

Human sinonasal epithelial cells were grown at an air‐liquid interface (ALI). Ciliary beat frequency (CBF) and nitric oxide (NO) production in response to stimulation with OM‐85 BV was measured in vitro. Pharmacologic inhibitors of bitter taste receptor (T2R) signaling were used to determine if this pathway was taste‐receptor–mediated.

Results

Apical application of OM‐85 BV resulted in an NO‐mediated increase in CBF (p < 0.05) and increased NO production (p < 0.0001) when compared to saline‐stimulated control cultures. ALI pretreatment with taste receptor pathway inhibitors blocked OM‐85 BV–induced increases in NO.

Conclusion

OM‐85 BV has ciliostimulatory and immunogenic properties that may be partially responsible for its observed efficacy as a respiratory therapeutic. These responses were NO‐dependent and consistent with T2R activation. Further work is necessary to elucidate specific component‐receptor signaling relationships.

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Broncho‐Vaxom® (OM‐85 BV) soluble components stimulate sinonasal innate immunity

Background

Broncho‐Vaxom® (OM‐85 BV) is an extract of infectious respiratory bacteria that is used as an immunostimulant outside of the United States for the prevention and treatment of bronchitis and rhinosinusitis. Prior studies have shown that use of OM‐85 BV is associated with reduction in frequency of respiratory infection and decreased duration of antibiotic usage. However, the effects of OM‐85 BV on respiratory mucosal innate immunity are unknown.

Methods

Human sinonasal epithelial cells were grown at an air‐liquid interface (ALI). Ciliary beat frequency (CBF) and nitric oxide (NO) production in response to stimulation with OM‐85 BV was measured in vitro. Pharmacologic inhibitors of bitter taste receptor (T2R) signaling were used to determine if this pathway was taste‐receptor–mediated.

Results

Apical application of OM‐85 BV resulted in an NO‐mediated increase in CBF (p < 0.05) and increased NO production (p < 0.0001) when compared to saline‐stimulated control cultures. ALI pretreatment with taste receptor pathway inhibitors blocked OM‐85 BV–induced increases in NO.

Conclusion

OM‐85 BV has ciliostimulatory and immunogenic properties that may be partially responsible for its observed efficacy as a respiratory therapeutic. These responses were NO‐dependent and consistent with T2R activation. Further work is necessary to elucidate specific component‐receptor signaling relationships.

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Biexponential T1ρ relaxation mapping of human knee menisci

Background

Measuring T_1ρ in the knee menisci can potentially be used as noninvasive biomarkers in detecting early‐stage osteoarthritis (OA).

Purpose

To demonstrate the feasibility of biexponential T_1ρ relaxation mapping of human knee menisci.

Study Type

Prospective.

Population

Eight healthy volunteers with no known inflammation, trauma, or pain in the knee and three symptomatic subjects with early knee OA.

Field Strength/Sequence

Customized Turbo‐FLASH sequence to acquire 3D‐T_1ρ‐weighted images on a 3 T MRI scanner.

Assessment

T_1ρ relaxation values were assessed in 11 meniscal regions of interest (ROIs) using monoexponential and biexponential models.

Statistical Tests

Nonparametric rank‐sum tests, Kruskal–Wallis test, and coefficient of variation.

Results

The mean monoexponential T_1ρ relaxation in the lateral menisci were 28.05 ± 4.2 msec and 37.06 ± 10.64 msec for healthy subjects and early knee OA patients, respectively, while the short and long components were 8.07 ± 0.5 msec and 72.35 ± 3.2 msec for healthy subjects and 2.63 ± 2.99 msec and 55.27 ± 24.76 msec for early knee OA patients, respectively. The mean monoexponential T_1ρ relaxation in the medial menisci were 34.30 ± 3.8 msec and 37.26 ± 11.38 msec for healthy and OA patients, respectively, while the short and long components were 7.76 ± 0.7 msec and 72.19 ± 4.2 msec for healthy subjects and 3.06 ± 3.24 msec and 55.27 ± 24.59 msec for OA patients, respectively. Statistically significant (P ≤ 0.05) differences were observed in the monoexponential relaxation between some of the ROIs. The T_1ρ,short was significantly lower (P = 0.02) in the patients than controls. The rmsCV% ranges were 1.51–16.6%, 3.59–14.3%, and 4.91–15.6% for T_1ρ‐mono, T_1ρ‐short, and T_1ρ‐long, respectively.

Data Conclusion

Our results showed that in all ROIs, T_1ρ relaxation times of outer zones (red zones) were less than inner zones (white zones). Monoexponential T_1ρ was increased in medial, lateral, and body menisci of early OA while the biexponential numbers were decreased in early OA patients.

Level of Evidence: 2

Technical Efficacy Stage: 1

J. Magn. Reson. Imaging 2019.

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Biexponential T1ρ relaxation mapping of human knee menisci

Background

Measuring T_1ρ in the knee menisci can potentially be used as noninvasive biomarkers in detecting early‐stage osteoarthritis (OA).

Purpose

To demonstrate the feasibility of biexponential T_1ρ relaxation mapping of human knee menisci.

Study Type

Prospective.

Population

Eight healthy volunteers with no known inflammation, trauma, or pain in the knee and three symptomatic subjects with early knee OA.

Field Strength/Sequence

Customized Turbo‐FLASH sequence to acquire 3D‐T_1ρ‐weighted images on a 3 T MRI scanner.

Assessment

T_1ρ relaxation values were assessed in 11 meniscal regions of interest (ROIs) using monoexponential and biexponential models.

Statistical Tests

Nonparametric rank‐sum tests, Kruskal–Wallis test, and coefficient of variation.

Results

The mean monoexponential T_1ρ relaxation in the lateral menisci were 28.05 ± 4.2 msec and 37.06 ± 10.64 msec for healthy subjects and early knee OA patients, respectively, while the short and long components were 8.07 ± 0.5 msec and 72.35 ± 3.2 msec for healthy subjects and 2.63 ± 2.99 msec and 55.27 ± 24.76 msec for early knee OA patients, respectively. The mean monoexponential T_1ρ relaxation in the medial menisci were 34.30 ± 3.8 msec and 37.26 ± 11.38 msec for healthy and OA patients, respectively, while the short and long components were 7.76 ± 0.7 msec and 72.19 ± 4.2 msec for healthy subjects and 3.06 ± 3.24 msec and 55.27 ± 24.59 msec for OA patients, respectively. Statistically significant (P ≤ 0.05) differences were observed in the monoexponential relaxation between some of the ROIs. The T_1ρ,short was significantly lower (P = 0.02) in the patients than controls. The rmsCV% ranges were 1.51–16.6%, 3.59–14.3%, and 4.91–15.6% for T_1ρ‐mono, T_1ρ‐short, and T_1ρ‐long, respectively.

Data Conclusion

Our results showed that in all ROIs, T_1ρ relaxation times of outer zones (red zones) were less than inner zones (white zones). Monoexponential T_1ρ was increased in medial, lateral, and body menisci of early OA while the biexponential numbers were decreased in early OA patients.

Level of Evidence: 2

Technical Efficacy Stage: 1

J. Magn. Reson. Imaging 2019.

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CO2 laser ‘Ablation Suction’ technique for treatment of laryngeal recurrent respiratory papillomatosis

Abstract

Recurrent respiratory papillomatosis (RRP) is a histologically benign condition predominantly caused by human papillomavirus types 6 and 11 which most commonly affects the larynx. There is a bimodal age distribution with two peaks of onset, 'Juvenile onset RRP' (JORRP) occurring before the age of 5, and 'Adult onset' occurring between the second and fourth decades. The incidence in the US has been estimated at 4.3 per 100,000 children and 1.8 per 100,00 adults.

This article is protected by copyright. All rights reserved.

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CO2 laser ‘Ablation Suction’ technique for treatment of laryngeal recurrent respiratory papillomatosis

Abstract

Recurrent respiratory papillomatosis (RRP) is a histologically benign condition predominantly caused by human papillomavirus types 6 and 11 which most commonly affects the larynx. There is a bimodal age distribution with two peaks of onset, 'Juvenile onset RRP' (JORRP) occurring before the age of 5, and 'Adult onset' occurring between the second and fourth decades. The incidence in the US has been estimated at 4.3 per 100,000 children and 1.8 per 100,00 adults.

This article is protected by copyright. All rights reserved.

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An anatomical study of vascular communications between anterior tibial and peroneal osseosomes and its clinical application in proximal hemiarthroplasty of radiocarpal joint following tumor excision

Abstract

Background

There are speculations that the proximal third fibular osseosomes, supplied by the anterior tibial vessels cannot be reliably recruited on the peroneal vessels supplying fibular diaphyseal osseosomes. Anatomical study by the authors eschewed this speculation and paved way for an evidence-based surgery. Cadaveric dissection, dye injection, and radiological studies revealed existence of a reliable anastomotic musculoperiosteal vessel between these two osseosomes that could effectively recruit the proximal fibular osseosomes on the peroneal vessels. Also, operative tips and tricks for safeguarding these anastomotic vessels were defined by the cadaveric study. Aesthetic and functional outcomes were assessed in five clinical cases, where the fibular heads were harvested reliably on the peroneal pedicle and stable wrist joints were reconstructed following oncological excisions.

Methods

Based on the evidence from the anatomical study, five clinical cases (three males and two females) affected by stage III GCT (giant cell tumor) of distal radius underwent microvascular fibular head hemiarthroplasty following tumor excision. Average follow-up of the patients was 18 months.

Results

At the end of follow-up period, all patients had an average MSTS (Musculoskeletal Tumor Society) score of 23. Scores ranged from 21 to 25. Patients had good functional outcomes with 69% average mobility in the reconstructed wrist when compared with the opposite normal wrist. Aesthesis of the reconstructed wrists were acceptable.

Conclusion

The cadaveric study demonstrated concrete anatomical evidence of existence of an anastomotic musculoperiosteal vessel between anterior tibial and peroneal fibular osseosomes in all the specimens. Clinical study validated the safety of the vascularized proximal fibular hemiarthroplasty on peroneal pedicle. It may be a reliable method for reconstruction of the radiocarpal joint in the post-GCT distal radius excision with good aesthetic and functional outcomes.

Level of Evidence: Level V, therapeutic study

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An anatomical study of vascular communications between anterior tibial and peroneal osseosomes and its clinical application in proximal hemiarthroplasty of radiocarpal joint following tumor excision

Abstract

Background

There are speculations that the proximal third fibular osseosomes, supplied by the anterior tibial vessels cannot be reliably recruited on the peroneal vessels supplying fibular diaphyseal osseosomes. Anatomical study by the authors eschewed this speculation and paved way for an evidence-based surgery. Cadaveric dissection, dye injection, and radiological studies revealed existence of a reliable anastomotic musculoperiosteal vessel between these two osseosomes that could effectively recruit the proximal fibular osseosomes on the peroneal vessels. Also, operative tips and tricks for safeguarding these anastomotic vessels were defined by the cadaveric study. Aesthetic and functional outcomes were assessed in five clinical cases, where the fibular heads were harvested reliably on the peroneal pedicle and stable wrist joints were reconstructed following oncological excisions.

Methods

Based on the evidence from the anatomical study, five clinical cases (three males and two females) affected by stage III GCT (giant cell tumor) of distal radius underwent microvascular fibular head hemiarthroplasty following tumor excision. Average follow-up of the patients was 18 months.

Results

At the end of follow-up period, all patients had an average MSTS (Musculoskeletal Tumor Society) score of 23. Scores ranged from 21 to 25. Patients had good functional outcomes with 69% average mobility in the reconstructed wrist when compared with the opposite normal wrist. Aesthesis of the reconstructed wrists were acceptable.

Conclusion

The cadaveric study demonstrated concrete anatomical evidence of existence of an anastomotic musculoperiosteal vessel between anterior tibial and peroneal fibular osseosomes in all the specimens. Clinical study validated the safety of the vascularized proximal fibular hemiarthroplasty on peroneal pedicle. It may be a reliable method for reconstruction of the radiocarpal joint in the post-GCT distal radius excision with good aesthetic and functional outcomes.

Level of Evidence: Level V, therapeutic study

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Disruption of the Obligatory Swallowing Sequence in Patients with Wallenberg Syndrome

Abstract

Although the sequence of events involved in swallowing varies among healthy adults, healthy adults demonstrate some consistent patterns, including opening of the upper esophageal sphincter (UES) prior to maximum laryngeal elevation (LE). Previous animal studies suggested that swallowing is regulated by a neuronal network in the medulla, and lateral medullary infarction, or Wallenberg syndrome, frequently causes dysphagia. This retrospective, observational, multicenter study aimed to determine if the sequence of swallowing events was disturbed in patients with Wallenberg syndrome compared with previously published reference data for healthy adults. The study subjects included 35 patients with Wallenberg syndrome admitted to three hospitals in Japan from 1/4/2009 to 31/3/2017. Sixteen timing events, including maximum LE and UES opening, and the intervals between events were measured. If the sequence of events was the same as in healthy adults, the interval value was positive, and if the sequence of events was opposite to that in healthy adults, the value was negative. The median interval from UES opening to maximum LE was − 0.02 s (range − 0.80 to 0.89, 95% CI − 0.14 to 0.10). About half of the Wallenberg cases showed negative values indicating that the sequence was reversed. These results suggest that lateral medullary infarction impairs the sequence of swallowing events.

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Disruption of the Obligatory Swallowing Sequence in Patients with Wallenberg Syndrome

Abstract

Although the sequence of events involved in swallowing varies among healthy adults, healthy adults demonstrate some consistent patterns, including opening of the upper esophageal sphincter (UES) prior to maximum laryngeal elevation (LE). Previous animal studies suggested that swallowing is regulated by a neuronal network in the medulla, and lateral medullary infarction, or Wallenberg syndrome, frequently causes dysphagia. This retrospective, observational, multicenter study aimed to determine if the sequence of swallowing events was disturbed in patients with Wallenberg syndrome compared with previously published reference data for healthy adults. The study subjects included 35 patients with Wallenberg syndrome admitted to three hospitals in Japan from 1/4/2009 to 31/3/2017. Sixteen timing events, including maximum LE and UES opening, and the intervals between events were measured. If the sequence of events was the same as in healthy adults, the interval value was positive, and if the sequence of events was opposite to that in healthy adults, the value was negative. The median interval from UES opening to maximum LE was − 0.02 s (range − 0.80 to 0.89, 95% CI − 0.14 to 0.10). About half of the Wallenberg cases showed negative values indicating that the sequence was reversed. These results suggest that lateral medullary infarction impairs the sequence of swallowing events.

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An anatomical study of vascular communications between anterior tibial and peroneal osseosomes and its clinical application in proximal hemiarthroplasty of radiocarpal joint following tumor excision

Abstract

Background

There are speculations that the proximal third fibular osseosomes, supplied by the anterior tibial vessels cannot be reliably recruited on the peroneal vessels supplying fibular diaphyseal osseosomes. Anatomical study by the authors eschewed this speculation and paved way for an evidence-based surgery. Cadaveric dissection, dye injection, and radiological studies revealed existence of a reliable anastomotic musculoperiosteal vessel between these two osseosomes that could effectively recruit the proximal fibular osseosomes on the peroneal vessels. Also, operative tips and tricks for safeguarding these anastomotic vessels were defined by the cadaveric study. Aesthetic and functional outcomes were assessed in five clinical cases, where the fibular heads were harvested reliably on the peroneal pedicle and stable wrist joints were reconstructed following oncological excisions.

Methods

Based on the evidence from the anatomical study, five clinical cases (three males and two females) affected by stage III GCT (giant cell tumor) of distal radius underwent microvascular fibular head hemiarthroplasty following tumor excision. Average follow-up of the patients was 18 months.

Results

At the end of follow-up period, all patients had an average MSTS (Musculoskeletal Tumor Society) score of 23. Scores ranged from 21 to 25. Patients had good functional outcomes with 69% average mobility in the reconstructed wrist when compared with the opposite normal wrist. Aesthesis of the reconstructed wrists were acceptable.

Conclusion

The cadaveric study demonstrated concrete anatomical evidence of existence of an anastomotic musculoperiosteal vessel between anterior tibial and peroneal fibular osseosomes in all the specimens. Clinical study validated the safety of the vascularized proximal fibular hemiarthroplasty on peroneal pedicle. It may be a reliable method for reconstruction of the radiocarpal joint in the post-GCT distal radius excision with good aesthetic and functional outcomes.

Level of Evidence: Level V, therapeutic study

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An anatomical study of vascular communications between anterior tibial and peroneal osseosomes and its clinical application in proximal hemiarthroplasty of radiocarpal joint following tumor excision

Abstract

Background

There are speculations that the proximal third fibular osseosomes, supplied by the anterior tibial vessels cannot be reliably recruited on the peroneal vessels supplying fibular diaphyseal osseosomes. Anatomical study by the authors eschewed this speculation and paved way for an evidence-based surgery. Cadaveric dissection, dye injection, and radiological studies revealed existence of a reliable anastomotic musculoperiosteal vessel between these two osseosomes that could effectively recruit the proximal fibular osseosomes on the peroneal vessels. Also, operative tips and tricks for safeguarding these anastomotic vessels were defined by the cadaveric study. Aesthetic and functional outcomes were assessed in five clinical cases, where the fibular heads were harvested reliably on the peroneal pedicle and stable wrist joints were reconstructed following oncological excisions.

Methods

Based on the evidence from the anatomical study, five clinical cases (three males and two females) affected by stage III GCT (giant cell tumor) of distal radius underwent microvascular fibular head hemiarthroplasty following tumor excision. Average follow-up of the patients was 18 months.

Results

At the end of follow-up period, all patients had an average MSTS (Musculoskeletal Tumor Society) score of 23. Scores ranged from 21 to 25. Patients had good functional outcomes with 69% average mobility in the reconstructed wrist when compared with the opposite normal wrist. Aesthesis of the reconstructed wrists were acceptable.

Conclusion

The cadaveric study demonstrated concrete anatomical evidence of existence of an anastomotic musculoperiosteal vessel between anterior tibial and peroneal fibular osseosomes in all the specimens. Clinical study validated the safety of the vascularized proximal fibular hemiarthroplasty on peroneal pedicle. It may be a reliable method for reconstruction of the radiocarpal joint in the post-GCT distal radius excision with good aesthetic and functional outcomes.

Level of Evidence: Level V, therapeutic study

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Bayesian model with application to a study of dental caries

Abstract

Background

Dental caries are a significant public health problem. It is a disease with multifactorial causes. In Sub-Sahara Africa, Ethiopia is one of the countries with a high record of dental caries. This study was to determine the risk factors affecting dental caries using both Bayesian and classical approaches.

Methods

The study design was a retrospective cohort study in the period of March 2009 to March 2013 dental caries patients Hawassa Haik Poly Higher Clinic. The Bayesian logistic regression procedure was adapted to make inference about the parameters of a logistic regression model. The purpose of this method was generating the posterior distribution of the unknown parameters given both the data and some prior density for the unknown parameters.

Results

From this study the prevalence of natural dental caries was 87% and non-natural dental caries were 13%. The age group of 18–25 was higher prevalence of dental caries than the other age groups. From Bayesian logistic regression, we found out that rural patients, do not clean their teeth, patients from SNNPR and age group 18–25 are statistically significant. The finding from the Bayesian statistics approach is getting popular in data analysis than classical statistics because the technique is more robust and precise.

Conclusions

Bayesian approach was found to be better than classical method as the value of the standard errors in Bayesian approaches is smaller than that of classical logistic regression. The Bayesian credible interval is smaller than the length of the confidence interval for all significant risk factors. Age, sex, place of residence, region and habit of cleaning teeth was found to have a significant effect on dental caries patients.

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Bayesian model with application to a study of dental caries

Abstract

Background

Dental caries are a significant public health problem. It is a disease with multifactorial causes. In Sub-Sahara Africa, Ethiopia is one of the countries with a high record of dental caries. This study was to determine the risk factors affecting dental caries using both Bayesian and classical approaches.

Methods

The study design was a retrospective cohort study in the period of March 2009 to March 2013 dental caries patients Hawassa Haik Poly Higher Clinic. The Bayesian logistic regression procedure was adapted to make inference about the parameters of a logistic regression model. The purpose of this method was generating the posterior distribution of the unknown parameters given both the data and some prior density for the unknown parameters.

Results

From this study the prevalence of natural dental caries was 87% and non-natural dental caries were 13%. The age group of 18–25 was higher prevalence of dental caries than the other age groups. From Bayesian logistic regression, we found out that rural patients, do not clean their teeth, patients from SNNPR and age group 18–25 are statistically significant. The finding from the Bayesian statistics approach is getting popular in data analysis than classical statistics because the technique is more robust and precise.

Conclusions

Bayesian approach was found to be better than classical method as the value of the standard errors in Bayesian approaches is smaller than that of classical logistic regression. The Bayesian credible interval is smaller than the length of the confidence interval for all significant risk factors. Age, sex, place of residence, region and habit of cleaning teeth was found to have a significant effect on dental caries patients.

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Editorial

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Editorial

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Testing the diagnostic accuracy of [18F]FDG-PET in discriminating spinal- and bulbar-onset amyotrophic lateral sclerosis

Abstract

Purpose

The role for [18F]FDG-PET in supporting amyotrophic lateral sclerosis (ALS) diagnosis is not fully established. In this study, we aim at evaluating [18F]FDG-PET hypo- and hyper-metabolism patterns in spinal- and bulbar-onset ALS cases, at the single-subject level, testing the diagnostic value in discriminating the two conditions, and the correlations with core clinical symptoms severity.

Methods

We included 95 probable-ALS patients with [18F]FDG-PET scan and clinical follow-up. [18F]FDG-PET images were analyzed with an optimized voxel-based-SPM method. The resulting single-subject SPM-t maps were used to: (a) assess brain regional hypo- and hyper-metabolism; (b) evaluate the accuracy of regional hypo- and hyper metabolism in discriminating spinal vs. bulbar-onset ALS; (c) perform correlation analysis with motor symptoms severity, as measured by ALS-FRS-R.

Results

Primary motor cortex showed the most frequent hypo-metabolism in both spinal-onset (∼57%) and bulbar-onset (∼64%) ALS; hyper-metabolism was prevalent in the cerebellum in both spinal-onset (∼56.5%) and bulbar-onset (∼55.7%) ALS, and in the occipital cortex in bulbar-onset (∼62.5%) ALS. Regional hypo- and hyper-metabolism yielded a very low accuracy (AUC < 0.63) in discriminating spinal- vs. bulbar-onset ALS, as obtained from single-subject SPM-t-maps. Severity of motor symptoms correlated with hypo-metabolism in sensorimotor cortex in spinal-onset ALS, and with cerebellar hyper-metabolism in bulbar-onset ALS.

Conclusions

The high variability in regional hypo- and hyper-metabolism patterns, likely reflecting the heterogeneous pathology and clinical phenotypes, limits the diagnostic potential of [18F]FDG-PET in discriminating spinal and bulbar onset patients.

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Testing the diagnostic accuracy of [18F]FDG-PET in discriminating spinal- and bulbar-onset amyotrophic lateral sclerosis

Abstract

Purpose

The role for [18F]FDG-PET in supporting amyotrophic lateral sclerosis (ALS) diagnosis is not fully established. In this study, we aim at evaluating [18F]FDG-PET hypo- and hyper-metabolism patterns in spinal- and bulbar-onset ALS cases, at the single-subject level, testing the diagnostic value in discriminating the two conditions, and the correlations with core clinical symptoms severity.

Methods

We included 95 probable-ALS patients with [18F]FDG-PET scan and clinical follow-up. [18F]FDG-PET images were analyzed with an optimized voxel-based-SPM method. The resulting single-subject SPM-t maps were used to: (a) assess brain regional hypo- and hyper-metabolism; (b) evaluate the accuracy of regional hypo- and hyper metabolism in discriminating spinal vs. bulbar-onset ALS; (c) perform correlation analysis with motor symptoms severity, as measured by ALS-FRS-R.

Results

Primary motor cortex showed the most frequent hypo-metabolism in both spinal-onset (∼57%) and bulbar-onset (∼64%) ALS; hyper-metabolism was prevalent in the cerebellum in both spinal-onset (∼56.5%) and bulbar-onset (∼55.7%) ALS, and in the occipital cortex in bulbar-onset (∼62.5%) ALS. Regional hypo- and hyper-metabolism yielded a very low accuracy (AUC < 0.63) in discriminating spinal- vs. bulbar-onset ALS, as obtained from single-subject SPM-t-maps. Severity of motor symptoms correlated with hypo-metabolism in sensorimotor cortex in spinal-onset ALS, and with cerebellar hyper-metabolism in bulbar-onset ALS.

Conclusions

The high variability in regional hypo- and hyper-metabolism patterns, likely reflecting the heterogeneous pathology and clinical phenotypes, limits the diagnostic potential of [18F]FDG-PET in discriminating spinal and bulbar onset patients.

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Procedural Recommendations for Lymphoscintigraphy in the Diagnosis of Peripheral Lymphedema: the Genoa Protocol

Abstract

Introduction

Lymphoscintigraphy is the gold standard for imaging in the diagnosis of peripheral lymphedema. However, there are no clear guidelines to standardize usage across centers, and as such, large variability exists. The aim of this perspectives paper is to draw upon the knowledge and extensive experience of lymphoscintigraphy here in Genoa, Italy, from our center of excellence in the assessment and treatment of lymphatic disorders for over 30 years to provide general guidelines for nuclear medicine specialists.

Method

The authors describe the technical characteristics of lymphoscintigraphy in patients with limb swelling. Radioactive tracers, dosage, administration sites, and the rationale for a two-compartment protocol with the inclusion of subfascial lymphatic vessels are all given in detail.

Results

Examples of lymphoscintigraphic investigations with various subgroups of patients are discussed. The concept of a transport index (TI) for semi-quantitative analysis of normal/pathological lymphatic flow is introduced. Different concepts of injection techniques are outlined.

Discussion

It is past time that lymphoscintigraphy in the diagnosis of lymphatic disorders becomes standardized. This represents our first attempt to outline a clear protocol and delineate the relevant points for lymphoscintigraphy in this patient population.

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Procedural Recommendations for Lymphoscintigraphy in the Diagnosis of Peripheral Lymphedema: the Genoa Protocol

Abstract

Introduction

Lymphoscintigraphy is the gold standard for imaging in the diagnosis of peripheral lymphedema. However, there are no clear guidelines to standardize usage across centers, and as such, large variability exists. The aim of this perspectives paper is to draw upon the knowledge and extensive experience of lymphoscintigraphy here in Genoa, Italy, from our center of excellence in the assessment and treatment of lymphatic disorders for over 30 years to provide general guidelines for nuclear medicine specialists.

Method

The authors describe the technical characteristics of lymphoscintigraphy in patients with limb swelling. Radioactive tracers, dosage, administration sites, and the rationale for a two-compartment protocol with the inclusion of subfascial lymphatic vessels are all given in detail.

Results

Examples of lymphoscintigraphic investigations with various subgroups of patients are discussed. The concept of a transport index (TI) for semi-quantitative analysis of normal/pathological lymphatic flow is introduced. Different concepts of injection techniques are outlined.

Discussion

It is past time that lymphoscintigraphy in the diagnosis of lymphatic disorders becomes standardized. This represents our first attempt to outline a clear protocol and delineate the relevant points for lymphoscintigraphy in this patient population.

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Mechanical stress induced S100A7 expression in human dental pulp cells to augment osteoclast differentiation

Abstract

Objectives

Mechanical injury of dental pulp leads to root resorption by osteoclasts/odontoclasts. S100 proteins have been demonstrated to be involved in inflammatory processes and bone remodeling. This study aimed to investigate the effect of mechanical stress on S100A7 expression by human dental pulp cells (HDPCs) and the effect of S100A7 proteins on osteoclast differentiation.

Materials and Methods

Isolated HDPCs were stimulated with compressive loading (2 and 6 hours), or shear loading (2, 6 and 16 hours). S100 mRNA expression and S100A7 protein levels were determined by real‐time PCR and ELISA, respectively. Osteoclast differentiation was analyzed using primary human monocytes. The differentiation and activity of osteoclasts was examined by TRAcP staining and dentine resorption. In addition, the expression of S100A7 was analyzed in pulp tissues obtained from orthodontically treated teeth.

Results

Compressive and shear mechanical stress significantly upregulated both mRNA and protein level of S100A7. Dental pulp tissues from orthodontically treated teeth exhibited higher S100A7 mRNA levels compared to non‐treated control teeth. S100A7 promoted osteoclast differentiation by primary human monocytes. Moreover, S100A7 significantly enhanced dentine resorption by these cells.

Conclusions

Mechanical stress induced expression of S100A7 by human dental pulp cells and this may promote root resorption by inducing osteoclast differentiation and activity.

This article is protected by copyright. All rights reserved.

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Understanding the pathophysiology behind chairside diagnostics and genetic testing for IL‐1 and IL‐6

Abstract

In order for chairside diagnostic testing to make an impact on dental therapy, practitioners require a better understanding of genetic mutations contributing to the pathophysiology of periodontal disease. Commensal and pathogenic bacterial colonization in oral cavity tissues produces a cascade of proinflammatory signaling pathways ultimately detrimental to host tissues. Resolving inflammation is a multifactorial process involving the downregulation of proinflammatory cytokines while allowing commensal bacterial levels to return to normal. Because of the complicated nature of commensal bacteria and oral health homeostasis, the emphasis of dental therapy should place renewed focus on limiting destructive inflammation rather than solely eliminating bacteria. Salivary diagnostics are an easy, non‐invasive way to assess inflammatory markers. Inflammatory cytokine levels can help determine the subclinical health of a patient, showing the transition from health to gingivitis, or periodontitis, prior to clinical presentation. Single nucleotide polymorphism mutations can aid in determining increased risk of developing periodontitis. Taken together, and alongside regular clinical evaluations, chairside diagnostics help individualize treatment plans to slow, or halt, the progression of disease ‐ before tissue destruction can take place. While more studies are needed analyzing specific mutations across periodontal categories, chairside diagnostics present an exciting adjunct to improve patient care.

This article is protected by copyright. All rights reserved.

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Global incidence and profile of ameloblastoma: a systematic review and meta‐analysis

Abstract

Objectives

To evaluate the global incidence of ameloblastoma and to provide a profile of ameloblastoma patients.

Material and Methods

A systematic review and meta‐analysis was conducted. Searches were performed in PubMed, Embase, SCOPUS, and Web of Science for articles published from 1969 to 2018 for the global incidence and from 1995 to 2018 for the profile of ameloblastoma patients.

Results

Seven studies on the incidence rate of ameloblastoma were included in the meta‐analysis. These studies only covered Europe, Africa, and Australia. The pooled incidence rate was 0.92 per million person‐years (95% CI: 0.57‐1.49), with significant heterogeneity between studies.

Forty‐two articles provided profile data of 6446 ameloblastoma patients. Mean age was 34 years and the peak age incidence in the third decade of life. In Europe and North America, ameloblastoma mostly occurred at an older age when compared to Africa and South America. A slight male preference (53%) was found, and the mandible appeared to be the preferred site. The most common type of ameloblastoma was multicystic. The histopathologic patterns were mostly follicular and plexiform.

Conclusions

This is the first study assessing the global incidence of ameloblastoma. The pooled incidence rate was determined to be 0.92 per million person‐years.

This article is protected by copyright. All rights reserved.

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6‐months Clinical Outcomes of Non‐Surgical Periodontal Treatment with Antibiotics on Apoptosis Markers in Aggressive Periodontitis

Abstract

Objective

Extrinsic and intrinsic pathways of apoptosis are involved in generalized aggressive periodontitis (GAgP). The aim of this study was to evaluate 6‐month clinical outcomes relative to apoptosis of one‐stage full‐mouth disinfection (OSFMD) and systemic antibiotics (SA) in the treatment of GAgP.

Methods

Twenty‐six patients with GAgP were included in this prospective follow‐up intervention study. Gingival crevicular fluid (GCF) was collected from patients at baseline, and 3 and 6 months after periodontal therapy, which consisted of OSFMD and SA (amoxicillin and metronidazole, 500 mg each for 7 days). The levels of p53, caspase‐3, TNF‐α, TRAIL, IL‐1β and IL‐10 in GCF were measured via ELISA.

Results

Periodontal parameters were improved at 3 and 6 months compared to baseline (p<0.05). P53 was decreased up to 6 months (p<0.05). TRAIL, TNF‐α and IL‐10 were similar at baseline, 3 and 6 months. Caspase‐3 and IL‐1β were decreased at 3 months (p<0.05), but similar at 6 months compared to baseline (p>0.05).

Conclusion

Although OSFMD plus SA improve clinical periodontal parameters up to 6 months, this treatment protocol differentially regulates the apoptotic markers caspase‐3 at 3 months and p53 at 6 months without influencing TRAIL in GCF.

This article is protected by copyright. All rights reserved.

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Mechanical stress induced S100A7 expression in human dental pulp cells to augment osteoclast differentiation

Abstract

Objectives

Mechanical injury of dental pulp leads to root resorption by osteoclasts/odontoclasts. S100 proteins have been demonstrated to be involved in inflammatory processes and bone remodeling. This study aimed to investigate the effect of mechanical stress on S100A7 expression by human dental pulp cells (HDPCs) and the effect of S100A7 proteins on osteoclast differentiation.

Materials and Methods

Isolated HDPCs were stimulated with compressive loading (2 and 6 hours), or shear loading (2, 6 and 16 hours). S100 mRNA expression and S100A7 protein levels were determined by real‐time PCR and ELISA, respectively. Osteoclast differentiation was analyzed using primary human monocytes. The differentiation and activity of osteoclasts was examined by TRAcP staining and dentine resorption. In addition, the expression of S100A7 was analyzed in pulp tissues obtained from orthodontically treated teeth.

Results

Compressive and shear mechanical stress significantly upregulated both mRNA and protein level of S100A7. Dental pulp tissues from orthodontically treated teeth exhibited higher S100A7 mRNA levels compared to non‐treated control teeth. S100A7 promoted osteoclast differentiation by primary human monocytes. Moreover, S100A7 significantly enhanced dentine resorption by these cells.

Conclusions

Mechanical stress induced expression of S100A7 by human dental pulp cells and this may promote root resorption by inducing osteoclast differentiation and activity.

This article is protected by copyright. All rights reserved.

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

Understanding the pathophysiology behind chairside diagnostics and genetic testing for IL‐1 and IL‐6

Abstract

In order for chairside diagnostic testing to make an impact on dental therapy, practitioners require a better understanding of genetic mutations contributing to the pathophysiology of periodontal disease. Commensal and pathogenic bacterial colonization in oral cavity tissues produces a cascade of proinflammatory signaling pathways ultimately detrimental to host tissues. Resolving inflammation is a multifactorial process involving the downregulation of proinflammatory cytokines while allowing commensal bacterial levels to return to normal. Because of the complicated nature of commensal bacteria and oral health homeostasis, the emphasis of dental therapy should place renewed focus on limiting destructive inflammation rather than solely eliminating bacteria. Salivary diagnostics are an easy, non‐invasive way to assess inflammatory markers. Inflammatory cytokine levels can help determine the subclinical health of a patient, showing the transition from health to gingivitis, or periodontitis, prior to clinical presentation. Single nucleotide polymorphism mutations can aid in determining increased risk of developing periodontitis. Taken together, and alongside regular clinical evaluations, chairside diagnostics help individualize treatment plans to slow, or halt, the progression of disease ‐ before tissue destruction can take place. While more studies are needed analyzing specific mutations across periodontal categories, chairside diagnostics present an exciting adjunct to improve patient care.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sej95L

Global incidence and profile of ameloblastoma: a systematic review and meta‐analysis

Abstract

Objectives

To evaluate the global incidence of ameloblastoma and to provide a profile of ameloblastoma patients.

Material and Methods

A systematic review and meta‐analysis was conducted. Searches were performed in PubMed, Embase, SCOPUS, and Web of Science for articles published from 1969 to 2018 for the global incidence and from 1995 to 2018 for the profile of ameloblastoma patients.

Results

Seven studies on the incidence rate of ameloblastoma were included in the meta‐analysis. These studies only covered Europe, Africa, and Australia. The pooled incidence rate was 0.92 per million person‐years (95% CI: 0.57‐1.49), with significant heterogeneity between studies.

Forty‐two articles provided profile data of 6446 ameloblastoma patients. Mean age was 34 years and the peak age incidence in the third decade of life. In Europe and North America, ameloblastoma mostly occurred at an older age when compared to Africa and South America. A slight male preference (53%) was found, and the mandible appeared to be the preferred site. The most common type of ameloblastoma was multicystic. The histopathologic patterns were mostly follicular and plexiform.

Conclusions

This is the first study assessing the global incidence of ameloblastoma. The pooled incidence rate was determined to be 0.92 per million person‐years.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2M1S533

6‐months Clinical Outcomes of Non‐Surgical Periodontal Treatment with Antibiotics on Apoptosis Markers in Aggressive Periodontitis

Abstract

Objective

Extrinsic and intrinsic pathways of apoptosis are involved in generalized aggressive periodontitis (GAgP). The aim of this study was to evaluate 6‐month clinical outcomes relative to apoptosis of one‐stage full‐mouth disinfection (OSFMD) and systemic antibiotics (SA) in the treatment of GAgP.

Methods

Twenty‐six patients with GAgP were included in this prospective follow‐up intervention study. Gingival crevicular fluid (GCF) was collected from patients at baseline, and 3 and 6 months after periodontal therapy, which consisted of OSFMD and SA (amoxicillin and metronidazole, 500 mg each for 7 days). The levels of p53, caspase‐3, TNF‐α, TRAIL, IL‐1β and IL‐10 in GCF were measured via ELISA.

Results

Periodontal parameters were improved at 3 and 6 months compared to baseline (p<0.05). P53 was decreased up to 6 months (p<0.05). TRAIL, TNF‐α and IL‐10 were similar at baseline, 3 and 6 months. Caspase‐3 and IL‐1β were decreased at 3 months (p<0.05), but similar at 6 months compared to baseline (p>0.05).

Conclusion

Although OSFMD plus SA improve clinical periodontal parameters up to 6 months, this treatment protocol differentially regulates the apoptotic markers caspase‐3 at 3 months and p53 at 6 months without influencing TRAIL in GCF.

This article is protected by copyright. All rights reserved.

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Exploring Disease Immunogenicity and the Immunological Effects of Hypomethylating Agents in Acute Myeloid Leukemia

Condition:   Acute Myeloid Leukemia Intervention:   Genetic: Immunogenic profile Sponsor:   Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori Not yet recruiting (Source: ClinicalTrials.gov)

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Clinical and Immunological Long-term Follow-up of Patients With Pemphigus Included in the " RITUXIMAB 3 " Trial

Condition:   Autoimmune Diseases Interventions:   Drug: Rituximab;   Drug: corticosteroids'therapy Sponsor:   University Hospital, Rouen Not yet recruiting (Source: ClinicalTrials.gov)

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Intestinal Microbiota on Allergy, Growth and Development

Condition:   Pregnancy Intervention:   Sponsor:   Chinese University of Hong Kong Recruiting (Source: ClinicalTrials.gov)

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Multiple Drug Hypersensitivity Syndrome

Condition:   Drug Allergy Intervention:   Sponsor:   University Hospital, Montpellier Not yet recruiting (Source: ClinicalTrials.gov)

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Dose, Safety, Tolerability, and Immunogenicity of an HIV-1 Vaccine, VRC-HIVRGP096-00-VP, With Alum in Healthy Adults < TAB >

Condition:   Human Immunodeficiency Virus (HIV) Intervention:   Biological: VRC-HIVRGP096-00-VP Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)

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Prevalence and Incidence of Lassa Virus Infection in Southern Mali

Condition:   Lassa Virus Infection Intervention:   Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Not yet recruiting (Source: ClinicalTrials.gov)

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Exploring Disease Immunogenicity and the Immunological Effects of Hypomethylating Agents in Acute Myeloid Leukemia

Condition:   Acute Myeloid Leukemia Intervention:   Genetic: Immunogenic profile Sponsor:   Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori Not yet recruiting (Source: ClinicalTrials.gov)

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Clinical and Immunological Long-term Follow-up of Patients With Pemphigus Included in the " RITUXIMAB 3 " Trial

Condition:   Autoimmune Diseases Interventions:   Drug: Rituximab;   Drug: corticosteroids'therapy Sponsor:   University Hospital, Rouen Not yet recruiting (Source: ClinicalTrials.gov)

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Intestinal Microbiota on Allergy, Growth and Development

Condition:   Pregnancy Intervention:   Sponsor:   Chinese University of Hong Kong Recruiting (Source: ClinicalTrials.gov)

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Multiple Drug Hypersensitivity Syndrome

Condition:   Drug Allergy Intervention:   Sponsor:   University Hospital, Montpellier Not yet recruiting (Source: ClinicalTrials.gov)

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Dose, Safety, Tolerability, and Immunogenicity of an HIV-1 Vaccine, VRC-HIVRGP096-00-VP, With Alum in Healthy Adults < TAB >

Condition:   Human Immunodeficiency Virus (HIV) Intervention:   Biological: VRC-HIVRGP096-00-VP Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)

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Prevalence and Incidence of Lassa Virus Infection in Southern Mali

Condition:   Lassa Virus Infection Intervention:   Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Not yet recruiting (Source: ClinicalTrials.gov)

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The Ability of Conditioned Media From Stem Cells to Repair Vocal Fold Injuries

Objective

This study investigated the ability of hypoxia‐induced 25‐fold concentrated conditioned media (hCM) from human nasal inferior turbinate‐derived mesenchymal stem cells (hTMSC) to repair injured vocal folds during the early phase of the wound‐healing process.

Methods

The vocal fold was injured in Sprague‐Dawley rats. Next, hCM from hTMSC (the hCM group) or hTMSC (the hTMSC group) were injected into the injured vocal folds. As a control, saline (the phosphate‐buffered saline group) or 25‐fold concentrated media (the media group) was injected in the same manner. The vocal folds were harvested for quantitative real‐time polymerase chain reaction (PCR) at 1 week and 2 weeks after injury. Histologic evaluation was performed at 3 weeks postinjury.

Results

In the hCM group at 1 week after injury, PCR showed that the genes encoding hyaluronan synthase (HAS), HAS 1, and HAS 2 were significantly upregulated compared to the media and normal groups. The gene encoding procollagen III was significantly downregulated compared to the media group. Nearly identical results were obtained for the hTMSC group at 1 week after injury. Histological examination showed that the hCM group was similar to or better than the hTMSC group in collagen deposition and hyaluronic acid production.

Conclusion

The injection of hCM into injured vocal folds produced antifibrotic effects in the early phase of wound healing. These effects were equivalent to those produced by the injection of hTMSC. These results provide a foundation for the future clinical use of hCM for vocal fold regeneration.

Level of Evidence

NA. Laryngoscope, 2018

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Preoperative quality‐of‐life measures predict acute postoperative pain in endoscopic sinus surgery

Objectives

Recent increases in opioid‐related mortality have prompted a critical evaluation of postoperative pain management across all specialties. However, successfully limiting narcotic overprescription requires perioperative identification of patients who are at risk for high postoperative pain. Unfortunately, quality data to guide practice patterns are lacking. We therefore prospectively investigated several possible predictive factors of postoperative pain after endoscopic sinus surgery (ESS).

Methods

Sixty‐four consecutive patients undergoing ESS were enrolled. Baseline 22‐item SinoNasal Outcomes Test (SNOT‐22) and Short‐Form 8 (SF‐8) scores were obtained. Pain scores were collected postoperatively using a numeric rating scale. Spearman correlations and univariate linear regression models were used to investigate relationships between postoperative pain, patient factors, and SNOT‐22/SF‐8 domain scores. Multivariate linear regression was then performed to control for potential confounding variables.

Results

Day‐of‐surgery pain scores were significantly correlated with the SF‐8 role‐physical domain (Rs = 0.32, P = 0.04). Whereas SF‐8 pain scores were initially nonsignificant, at postoperative day 3 (POD3) the preoperative SF‐8 pain score became correlated with self‐reported pain (Rs = 0.39, P = 0.02). SNOT‐22 total and subdomain scores were not associated with pain scores at any time point. Multivariate linear regression modelling identified baseline SF‐8 role‐physical and pain scores, smoking status, and undergoing a modified Lothrop procedure as significant independent predictors of POD3 pain (adjusted R² = 0.359, P < 0.0001).

Conclusion

Baseline patient‐reported global quality‐of‐life measures are associated with postoperative pain after ESS. Large multicenter studies are necessary to validate these findings and investigate additional factors associated with postoperative pain following ESS.

Level of Evidence

2c Laryngoscope, 2019

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Control of speech and voice in cochlear implant patients

Objective

Hearing plays an important role in the learning and production of speech, but the benefits of cochlear implantation for such vocal control are unclear. Here, we present a perspective and review of recent work on the control of speech and voice following cochlear implantation. We further discuss insights provided on the mechanisms of normal vocal control and implications for future rehabilitative approaches.

Data Sources

Peer‐reviewed articles on speech and voice production in cochlear implant patients were identified from PUBMED. Relevant articles were supplemented with selected publications describing normal vocal control mechanisms and behaviors.

Review Methods

Publications that discussed speech and voice outcomes following cochlear implantation were chosen, with a focus on those presenting measurements of specific speech or voice parameters.

Results

Recent studies demonstrate that hearing restoration by cochlear implantation has significant effects on many aspects of voice and speech production. These include changes in vocal pitch and loudness, as well as improved control of both vowels and consonants. Despite these improvements, however, the speech of many implant recipients remains abnormal as compared to normal hearing individuals. Such differences likely result from the impoverished auditory feedback provided by the implant.

Conclusions

Cochlear implants provide valuable insights into the role of hearing in vocal production. Although implants improve vocal production for most patients, there remains considerable room for future study and therapeutic improvement. Laryngoscope, 2019

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Chronic opioid use in patients undergoing treatment for oropharyngeal cancer

Objectives/Hypothesis

Head and neck cancer pain is a prevalent problem, and the current opioid crisis has highlighted concerns raised in chronic pain management. This study assessed the characteristics of opioid use in patients undergoing treatment for oropharynx cancer and identified risk factors associated with chronic opioid use.

Study Design

Retrospective cohort study.

Methods

A study was conducted of 198 eligible patients who underwent radiotherapy as part of their treatment for oropharynx cancer at a single institution from 2012 to 2017. p16/human papillomavirus (HPV) status was determined by pathology report review. Opioid use was recorded. Statistical analysis was performed to assess risk factors for chronic opioid use and effect on overall survival.

Results

The average age was 62 years, and the mean follow‐up was 38 months. Eighty‐three percent of patients had stage III/IV disease, and 73% received chemoradiotherapy. Sixty‐nine percent were HPV/p16 positive. Fifty‐seven (29%) patients had preexisting chronic pain conditions. Chronic opioid use was observed in 53% of the patients. Age ≤ 62 years (P < .0001), history of depression (P = .0356), p16 negative status (P = .0097), opioid use at pretreatment visit (P = .0021), and presence of a preexisting chronic pain condition at time of diagnosis (P = .0181) were associated with chronic opioid use using univariate analysis. On multivariate analysis, T stage and anxiety/depression were associated with chronic opioid use. Overall survival was worse for patients who had chronic opioid use, but was not significant when recurrence was taken into consideration.

Conclusions

More than 50% of the patients treated for oropharynx squamous cell carcinoma in this cohort were chronic opioid users after treatment. Identifying patients at greatest risk for chronic opioid use prior to treatment may help with long‐term pain management in this patient population.

Level of Evidence

4 Laryngoscope, 2019

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Lubricin/proteoglycan 4 detected in vocal folds of humans and five other mammals

Objectives/Hypothesis

Lubricin/proteoglycan‐4 (PRG4) lubricates connective tissues such as joints and tendon sheaths, enabling them to better withstand shearing and frictional forces during motion. We wondered whether PRG4 might play a role in phonation, as normal vocal folds withstand repetitive, high‐velocity deformations remarkably well. As a first step, we tested whether PRG4 is expressed in vocal folds.

Study Design

Laboratory study.

Methods

Anatomical and molecular methods were applied to 47 larynges from humans, macaque (Macaca fascicularis), canines, pigs, calves, and rats. Immunohistochemistry (IHC), Western blot, and quantitative real‐time polymerase chain reaction (qRT‐PCR) methods were used to test for the presence of PRG4.

Results

In all species, the true vocal fold lamina propria (TVF‐LP) was positive for PRG4 by IHC, whereas immunoreactivity of the false vocal fold was weak or absent, depending on the species. Human TVF‐LP was strongly stained across all layers. Immunoreactivity was seen variably on the vocal fold surface and within the vocal fold epithelium, in the conus elasticus and thyroglottic ligament, and at the tip of vocal process. Western blots of four humans and six pigs demonstrated immunoreactivity at appropriate molecular weight. qRT‐PCR of pig tissues confirmed PRG4 mRNA expression, which was highest in the TVF‐LP.

Conclusions

PRG4 was found in phonatory tissues of six mammals. We suggest it might act as a lubricant within the lamina propria and possibly on the vocal fold surface, limiting phonation‐related damage to vocal fold extracellular matrix and epithelium, and enhancing vocal efficiency by reducing internal friction (viscosity) within the vocal fold.

Level of Evidence

NA Laryngoscope, 2018

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Efficacy of a selective imaging paradigm prior to pediatric cochlear implantation

Objectives/Hypothesis

There is no consensus on the necessary preoperative imaging in children being evaluated for cochlear implantation (CI). Dual‐imaging protocols that implement both magnetic resonance imaging (MRI) and high resolution computed tomography (HRCT) create diagnostic redundancy in the face of potentially unnecessary radiation and anaesthetic exposure. The objectives of the current study were to examine the efficacy of an MRI‐predominant with selective HRCT imaging protocol.

Study Design

Retrospective review.

Methods

The protocol was implemented over a 4‐year period, during which HRCT was obtained in addition to MRI only if specific risk factors on clinical assessment were identified or if imaging findings in need of further evaluation were detected on initial MRI evaluation. Retrospective review of operative reports and prospective review of imaging were performed; anesthetic exposure and costing information were also obtained.

Results

Of the 240 patients who underwent assessment, seven (2.9%) had combined HRCT and MRI performed concurrently based on initial clinical assessment, 15 (6.3%) underwent HRCT based on imaging anomalies found on MRI, and MRI alone was ordered for the remaining 218 (90.1%). All patients were implanted without complication. Overall, radiation exposure, general anesthesia (GA), and healthcare costs were reduced.

Conclusions

MRI alone can be used in the vast majority of cases for preoperative evaluation of pediatric CI candidates resulting in a significant reduction in healthcare costs, radiation, and GA exposure in children. The additional need for HRCT occurs in a small proportion and can be predicted up front on clinical assessment or on initial MRI.

Level of Evidence

4 Laryngoscope, 2019

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Sphenopalatine artery surgery for refractory idiopathic epistaxis: Systematic review and meta‐analysis

Objectives

Epistaxis, especially posterior epistaxis, is occasionally refractory to treatment. In these cases, sphenopalatine artery surgeries, including cauterization and ligation, are required. Previous reports have demonstrated treatment results for these procedures but failed to provide high‐level evidence. The aim of this study was to quantify the rates of failure and perioperative complications of these procedures by using a meta‐analysis technique.

Methods

We systematically searched electronic databases and identified articles regarding epistaxis, sphenopalatine artery ligation, or cauterization. Pooled rebleeding and complication rates were calculated by using a random effects model.

Results

A total of 896 cases of sphenopalatine ligation or cauterization for epistaxis were analyzed. Pooled rebleeding rates for the entire cohort, cauterization group, and ligation group were 13.4% (95% confidence interval [CI] 10.0–17.8, P < 0.001), 7.2% (95% CI 4.6–11.0, P < 0.001), and 15.1% (95% CI 9.8–22.5, P < 0.001), respectively. Pooled perioperative complication rates for the entire cohort, cauterization group, and ligation group were 8.7% (95% CI 4.9–15.1, P < 0.001), 10.2% (95% CI 3.8–24.5, P < 0.001), and 6.4% (95% CI 1.8–20.9, P < 0.001), respectively.

Conclusion

Overall, sphenopalatine surgery for refractory epistaxis is an effective method because of its low rates of failure and complications. Cauterization is more effective than ligation, whereas complications are comparable between the two procedures. Laryngoscope, 2018

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The Ability of Conditioned Media From Stem Cells to Repair Vocal Fold Injuries

Objective

This study investigated the ability of hypoxia‐induced 25‐fold concentrated conditioned media (hCM) from human nasal inferior turbinate‐derived mesenchymal stem cells (hTMSC) to repair injured vocal folds during the early phase of the wound‐healing process.

Methods

The vocal fold was injured in Sprague‐Dawley rats. Next, hCM from hTMSC (the hCM group) or hTMSC (the hTMSC group) were injected into the injured vocal folds. As a control, saline (the phosphate‐buffered saline group) or 25‐fold concentrated media (the media group) was injected in the same manner. The vocal folds were harvested for quantitative real‐time polymerase chain reaction (PCR) at 1 week and 2 weeks after injury. Histologic evaluation was performed at 3 weeks postinjury.

Results

In the hCM group at 1 week after injury, PCR showed that the genes encoding hyaluronan synthase (HAS), HAS 1, and HAS 2 were significantly upregulated compared to the media and normal groups. The gene encoding procollagen III was significantly downregulated compared to the media group. Nearly identical results were obtained for the hTMSC group at 1 week after injury. Histological examination showed that the hCM group was similar to or better than the hTMSC group in collagen deposition and hyaluronic acid production.

Conclusion

The injection of hCM into injured vocal folds produced antifibrotic effects in the early phase of wound healing. These effects were equivalent to those produced by the injection of hTMSC. These results provide a foundation for the future clinical use of hCM for vocal fold regeneration.

Level of Evidence

NA. Laryngoscope, 2018

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Preoperative quality‐of‐life measures predict acute postoperative pain in endoscopic sinus surgery

Objectives

Recent increases in opioid‐related mortality have prompted a critical evaluation of postoperative pain management across all specialties. However, successfully limiting narcotic overprescription requires perioperative identification of patients who are at risk for high postoperative pain. Unfortunately, quality data to guide practice patterns are lacking. We therefore prospectively investigated several possible predictive factors of postoperative pain after endoscopic sinus surgery (ESS).

Methods

Sixty‐four consecutive patients undergoing ESS were enrolled. Baseline 22‐item SinoNasal Outcomes Test (SNOT‐22) and Short‐Form 8 (SF‐8) scores were obtained. Pain scores were collected postoperatively using a numeric rating scale. Spearman correlations and univariate linear regression models were used to investigate relationships between postoperative pain, patient factors, and SNOT‐22/SF‐8 domain scores. Multivariate linear regression was then performed to control for potential confounding variables.

Results

Day‐of‐surgery pain scores were significantly correlated with the SF‐8 role‐physical domain (Rs = 0.32, P = 0.04). Whereas SF‐8 pain scores were initially nonsignificant, at postoperative day 3 (POD3) the preoperative SF‐8 pain score became correlated with self‐reported pain (Rs = 0.39, P = 0.02). SNOT‐22 total and subdomain scores were not associated with pain scores at any time point. Multivariate linear regression modelling identified baseline SF‐8 role‐physical and pain scores, smoking status, and undergoing a modified Lothrop procedure as significant independent predictors of POD3 pain (adjusted R² = 0.359, P < 0.0001).

Conclusion

Baseline patient‐reported global quality‐of‐life measures are associated with postoperative pain after ESS. Large multicenter studies are necessary to validate these findings and investigate additional factors associated with postoperative pain following ESS.

Level of Evidence

2c Laryngoscope, 2019

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Control of speech and voice in cochlear implant patients

Objective

Hearing plays an important role in the learning and production of speech, but the benefits of cochlear implantation for such vocal control are unclear. Here, we present a perspective and review of recent work on the control of speech and voice following cochlear implantation. We further discuss insights provided on the mechanisms of normal vocal control and implications for future rehabilitative approaches.

Data Sources

Peer‐reviewed articles on speech and voice production in cochlear implant patients were identified from PUBMED. Relevant articles were supplemented with selected publications describing normal vocal control mechanisms and behaviors.

Review Methods

Publications that discussed speech and voice outcomes following cochlear implantation were chosen, with a focus on those presenting measurements of specific speech or voice parameters.

Results

Recent studies demonstrate that hearing restoration by cochlear implantation has significant effects on many aspects of voice and speech production. These include changes in vocal pitch and loudness, as well as improved control of both vowels and consonants. Despite these improvements, however, the speech of many implant recipients remains abnormal as compared to normal hearing individuals. Such differences likely result from the impoverished auditory feedback provided by the implant.

Conclusions

Cochlear implants provide valuable insights into the role of hearing in vocal production. Although implants improve vocal production for most patients, there remains considerable room for future study and therapeutic improvement. Laryngoscope, 2019

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Chronic opioid use in patients undergoing treatment for oropharyngeal cancer

Objectives/Hypothesis

Head and neck cancer pain is a prevalent problem, and the current opioid crisis has highlighted concerns raised in chronic pain management. This study assessed the characteristics of opioid use in patients undergoing treatment for oropharynx cancer and identified risk factors associated with chronic opioid use.

Study Design

Retrospective cohort study.

Methods

A study was conducted of 198 eligible patients who underwent radiotherapy as part of their treatment for oropharynx cancer at a single institution from 2012 to 2017. p16/human papillomavirus (HPV) status was determined by pathology report review. Opioid use was recorded. Statistical analysis was performed to assess risk factors for chronic opioid use and effect on overall survival.

Results

The average age was 62 years, and the mean follow‐up was 38 months. Eighty‐three percent of patients had stage III/IV disease, and 73% received chemoradiotherapy. Sixty‐nine percent were HPV/p16 positive. Fifty‐seven (29%) patients had preexisting chronic pain conditions. Chronic opioid use was observed in 53% of the patients. Age ≤ 62 years (P < .0001), history of depression (P = .0356), p16 negative status (P = .0097), opioid use at pretreatment visit (P = .0021), and presence of a preexisting chronic pain condition at time of diagnosis (P = .0181) were associated with chronic opioid use using univariate analysis. On multivariate analysis, T stage and anxiety/depression were associated with chronic opioid use. Overall survival was worse for patients who had chronic opioid use, but was not significant when recurrence was taken into consideration.

Conclusions

More than 50% of the patients treated for oropharynx squamous cell carcinoma in this cohort were chronic opioid users after treatment. Identifying patients at greatest risk for chronic opioid use prior to treatment may help with long‐term pain management in this patient population.

Level of Evidence

4 Laryngoscope, 2019

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Lubricin/proteoglycan 4 detected in vocal folds of humans and five other mammals

Objectives/Hypothesis

Lubricin/proteoglycan‐4 (PRG4) lubricates connective tissues such as joints and tendon sheaths, enabling them to better withstand shearing and frictional forces during motion. We wondered whether PRG4 might play a role in phonation, as normal vocal folds withstand repetitive, high‐velocity deformations remarkably well. As a first step, we tested whether PRG4 is expressed in vocal folds.

Study Design

Laboratory study.

Methods

Anatomical and molecular methods were applied to 47 larynges from humans, macaque (Macaca fascicularis), canines, pigs, calves, and rats. Immunohistochemistry (IHC), Western blot, and quantitative real‐time polymerase chain reaction (qRT‐PCR) methods were used to test for the presence of PRG4.

Results

In all species, the true vocal fold lamina propria (TVF‐LP) was positive for PRG4 by IHC, whereas immunoreactivity of the false vocal fold was weak or absent, depending on the species. Human TVF‐LP was strongly stained across all layers. Immunoreactivity was seen variably on the vocal fold surface and within the vocal fold epithelium, in the conus elasticus and thyroglottic ligament, and at the tip of vocal process. Western blots of four humans and six pigs demonstrated immunoreactivity at appropriate molecular weight. qRT‐PCR of pig tissues confirmed PRG4 mRNA expression, which was highest in the TVF‐LP.

Conclusions

PRG4 was found in phonatory tissues of six mammals. We suggest it might act as a lubricant within the lamina propria and possibly on the vocal fold surface, limiting phonation‐related damage to vocal fold extracellular matrix and epithelium, and enhancing vocal efficiency by reducing internal friction (viscosity) within the vocal fold.

Level of Evidence

NA Laryngoscope, 2018

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Efficacy of a selective imaging paradigm prior to pediatric cochlear implantation

Objectives/Hypothesis

There is no consensus on the necessary preoperative imaging in children being evaluated for cochlear implantation (CI). Dual‐imaging protocols that implement both magnetic resonance imaging (MRI) and high resolution computed tomography (HRCT) create diagnostic redundancy in the face of potentially unnecessary radiation and anaesthetic exposure. The objectives of the current study were to examine the efficacy of an MRI‐predominant with selective HRCT imaging protocol.

Study Design

Retrospective review.

Methods

The protocol was implemented over a 4‐year period, during which HRCT was obtained in addition to MRI only if specific risk factors on clinical assessment were identified or if imaging findings in need of further evaluation were detected on initial MRI evaluation. Retrospective review of operative reports and prospective review of imaging were performed; anesthetic exposure and costing information were also obtained.

Results

Of the 240 patients who underwent assessment, seven (2.9%) had combined HRCT and MRI performed concurrently based on initial clinical assessment, 15 (6.3%) underwent HRCT based on imaging anomalies found on MRI, and MRI alone was ordered for the remaining 218 (90.1%). All patients were implanted without complication. Overall, radiation exposure, general anesthesia (GA), and healthcare costs were reduced.

Conclusions

MRI alone can be used in the vast majority of cases for preoperative evaluation of pediatric CI candidates resulting in a significant reduction in healthcare costs, radiation, and GA exposure in children. The additional need for HRCT occurs in a small proportion and can be predicted up front on clinical assessment or on initial MRI.

Level of Evidence

4 Laryngoscope, 2019

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Sphenopalatine artery surgery for refractory idiopathic epistaxis: Systematic review and meta‐analysis

Objectives

Epistaxis, especially posterior epistaxis, is occasionally refractory to treatment. In these cases, sphenopalatine artery surgeries, including cauterization and ligation, are required. Previous reports have demonstrated treatment results for these procedures but failed to provide high‐level evidence. The aim of this study was to quantify the rates of failure and perioperative complications of these procedures by using a meta‐analysis technique.

Methods

We systematically searched electronic databases and identified articles regarding epistaxis, sphenopalatine artery ligation, or cauterization. Pooled rebleeding and complication rates were calculated by using a random effects model.

Results

A total of 896 cases of sphenopalatine ligation or cauterization for epistaxis were analyzed. Pooled rebleeding rates for the entire cohort, cauterization group, and ligation group were 13.4% (95% confidence interval [CI] 10.0–17.8, P < 0.001), 7.2% (95% CI 4.6–11.0, P < 0.001), and 15.1% (95% CI 9.8–22.5, P < 0.001), respectively. Pooled perioperative complication rates for the entire cohort, cauterization group, and ligation group were 8.7% (95% CI 4.9–15.1, P < 0.001), 10.2% (95% CI 3.8–24.5, P < 0.001), and 6.4% (95% CI 1.8–20.9, P < 0.001), respectively.

Conclusion

Overall, sphenopalatine surgery for refractory epistaxis is an effective method because of its low rates of failure and complications. Cauterization is more effective than ligation, whereas complications are comparable between the two procedures. Laryngoscope, 2018

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Pediatric Radiology Continuing Medical Education Activity

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Pediatric Radiology Continuing Medical Education Activity

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Bilateral cochlear implantation is regarded as very beneficial: results from a worldwide survey by online questionnaire

Abstract

Purpose

Bilateral cochlear implant (CI) provision is now widely regarded as the most beneficial hearing intervention for acceptable candidates. This study sought to determine if a number of well-regarded hearing professionals at highly reputable clinics shared similar practices and beliefs regarding bilateral CI provision, use, and rehabilitation in children and adults.

Methods

An 11-question online questionnaire was created and distributed to all 27 clinics in the HEARRING group. Questions 1–5 asked for facts; questions 6–11 asked for opinions.

Results

20 completed questionnaires were returned. All 20 respondents reported that their clinics perform bilateral cochlear implantation in children; 18 do so in adults. Regarding the fact-based questions, bilateral CI provision is more commonly performed and more likely to be reimbursed in children than in adults. Children are also much more likely to be implanted simultaneously than are adults. Regarding the opinion-based questions, respondents gave broadly similar answers. Communication between the CIs and speech coding strategies specifically developed for bilateral CI users were regarded as the two future technologies that would most enhance the benefit of bilateral CI use.

Conclusions

Most clinics in the HEARRING group are very familiar with bilateral CI provision and hold similar opinions on its results and benefits. Hopefully the results described herein will lead to a greater acceptance and regular reimbursement of bilateral CI provision, especially in adults.

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Is there a relationship between Onodi cell and optic canal?

Abstract

Objectives

We investigated the relationship between Onodi cells and optic canal by paranasal sinus computed tomography (PNSCT).

Methods

In this retrospective study, 508 PNSCT (265 males and 243 females) was examined. Onodi cell presence, pneumatization types, optic canal types; and also sphenoid sinusitis and anterior clinoid process pneumatization were evaluated.

Results

The prevalence of Onodi cells was 21.2% of the patients. Onodi cells were observed 40.7% on the right side and 25.9% on the left side. In 33.4% of the patients, bilateral Onodi cells were present. Male/Female ratio was 24.5%/17.6%. Onodi cell types were detected as Type I > Type II > Type III bilaterally. There was a positive correlation between the right and left Onodi cell types (p < 0.05). Optic canal types were detected as Type IV > Type I > Type II > Type III. bilaterally. There was a positive correlation between right and left optic canal types. Onodi cell presence and ACP pneumatization were found as statistically significant (p < 0.05). In 65.5% of the patients, Onodi cells and ACP pneumatization were absent. ACP pneumatization was present in 35.4% of the cases. In nine cases, bilateral Onodi cells and ACP pneumatization were detected. Sphenoid sinusitis was detected in 11.4% of Type I and 13.8% of the Type II Onodi cells on the right side. On the left side, it was detected in 12.9% of the Type I and 19.0% of Type II Onodi cells.

Conclusion

Identification of Onodi cell is very important clinically because of its proximity to optic nerve canal. We concluded that type IV Onodi–optic canal relationship was the most common finding in our study. Onodi cell presence and their patterns of pneumatization must be evaluated on PNSCT preoperatively to avoid optic canal damage.

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Bilateral cochlear implantation is regarded as very beneficial: results from a worldwide survey by online questionnaire

Abstract

Purpose

Bilateral cochlear implant (CI) provision is now widely regarded as the most beneficial hearing intervention for acceptable candidates. This study sought to determine if a number of well-regarded hearing professionals at highly reputable clinics shared similar practices and beliefs regarding bilateral CI provision, use, and rehabilitation in children and adults.

Methods

An 11-question online questionnaire was created and distributed to all 27 clinics in the HEARRING group. Questions 1–5 asked for facts; questions 6–11 asked for opinions.

Results

20 completed questionnaires were returned. All 20 respondents reported that their clinics perform bilateral cochlear implantation in children; 18 do so in adults. Regarding the fact-based questions, bilateral CI provision is more commonly performed and more likely to be reimbursed in children than in adults. Children are also much more likely to be implanted simultaneously than are adults. Regarding the opinion-based questions, respondents gave broadly similar answers. Communication between the CIs and speech coding strategies specifically developed for bilateral CI users were regarded as the two future technologies that would most enhance the benefit of bilateral CI use.

Conclusions

Most clinics in the HEARRING group are very familiar with bilateral CI provision and hold similar opinions on its results and benefits. Hopefully the results described herein will lead to a greater acceptance and regular reimbursement of bilateral CI provision, especially in adults.

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

Is there a relationship between Onodi cell and optic canal?

Abstract

Objectives

We investigated the relationship between Onodi cells and optic canal by paranasal sinus computed tomography (PNSCT).

Methods

In this retrospective study, 508 PNSCT (265 males and 243 females) was examined. Onodi cell presence, pneumatization types, optic canal types; and also sphenoid sinusitis and anterior clinoid process pneumatization were evaluated.

Results

The prevalence of Onodi cells was 21.2% of the patients. Onodi cells were observed 40.7% on the right side and 25.9% on the left side. In 33.4% of the patients, bilateral Onodi cells were present. Male/Female ratio was 24.5%/17.6%. Onodi cell types were detected as Type I > Type II > Type III bilaterally. There was a positive correlation between the right and left Onodi cell types (p < 0.05). Optic canal types were detected as Type IV > Type I > Type II > Type III. bilaterally. There was a positive correlation between right and left optic canal types. Onodi cell presence and ACP pneumatization were found as statistically significant (p < 0.05). In 65.5% of the patients, Onodi cells and ACP pneumatization were absent. ACP pneumatization was present in 35.4% of the cases. In nine cases, bilateral Onodi cells and ACP pneumatization were detected. Sphenoid sinusitis was detected in 11.4% of Type I and 13.8% of the Type II Onodi cells on the right side. On the left side, it was detected in 12.9% of the Type I and 19.0% of Type II Onodi cells.

Conclusion

Identification of Onodi cell is very important clinically because of its proximity to optic nerve canal. We concluded that type IV Onodi–optic canal relationship was the most common finding in our study. Onodi cell presence and their patterns of pneumatization must be evaluated on PNSCT preoperatively to avoid optic canal damage.

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An unusual altered biodistribution of 18 F-FDG on PET/CT: diffuse perimuscular uptake in the setting of acute adrenal crisis

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An unusual altered biodistribution of 18 F-FDG on PET/CT: diffuse perimuscular uptake in the setting of acute adrenal crisis

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Can Food Allergies Be This Severe? Child Dies After Smell Of Fish Cooking

An 11-year-old reportedly smelled fish cooking in the house and then lost consciousness. (Source: Forbes.com Healthcare News)

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Can Food Allergies Be This Severe? Child Dies After Smell Of Fish Cooking

An 11-year-old reportedly smelled fish cooking in the house and then lost consciousness. (Source: Forbes.com Healthcare News)

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Improving the detection specificity of endogenous MRI for reactive oxygen species (ROS)

Background

The detection of tissue reactive oxygen species (ROS) using endogenous MRI methods has great potential applications in research and the clinic. We recently demonstrated that ROS produce a significant T₁‐shortening effect. However, T₁ or T₁‐weighted contrast is not specific, as there are many other factors that alter tissue T₁.

Purpose

To investigate whether the presence of ROS alters tissue environmental conditions such as the proton exchange rate (K _ex ) to improve the detection specificity of endogenous ROS MRI.

Study Type

Prospective.

Subjects/Phantom

The ROS‐producing phantoms consisted of fresh egg white treated with H₂O₂ and healthy mice injected with pro‐oxidative rotenone.

Field Strength/Sequence

T₁ mapping was performed based on fast spin‐echo sequence and K _ex was evaluated using chemical exchange saturation transfer (CEST) MRI with varied saturation power (QUESP) on a 9.4 T animal scanner.

Assessment

Phantom experiments were conducted to evaluate the overall K _ex of CEST‐expressing metabolites in fresh egg white treated with H₂O₂ of various concentrations (0, 0.025, 0.05, 0.1, and 0.25 v/v%). The egg white phantom continuously produced ROS for more than 3 hours. Various experiments were performed to rule out potential contributing factors to the observed K _ex changes. In addition, in vivo MRI study was conducted with a well‐established rotenone‐exposed mouse model.

Statistical Tests

Student's t‐test.

Results

Egg white phantoms treated with H₂O₂ of various concentrations showed a 26–85% increase in K _ex compared with controls. In addition, the K _ex of egg white is negligibly affected by other potential confounding factors, including paramagnetic contrast agents (<11%), oxygen (2.3%), and iron oxidation (<10%). Changes in temperature (<1°C) and pH (ΔpH <0.1) in H₂O₂‐treated egg white were also negligible. Results from the in vivo rotenone study were consistent with the phantom studies by showing reduced T₁ relaxation time (6%) and increased K _ex (9%) in rotenone‐treated mice.

Data Conclusion

We demonstrate that the specificity of endogenous ROS MRI can be improved with the aid of proton exchange rate mapping.

Level of Evidence: 2

Technical Efficacy Stage: 2

J. Magn. Reson. Imaging 2019.

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Nomograms for Cardiovascular Magnetic Resonance Measurements in the Pediatric Age Group: To Define the Normal and the Expected Abnormal Values in Corrected/Palliated Congenital Heart Disease: A Systematic Review

Our purpose is to provide an overview and to systematically review the strengths and limitations of studies on pediatric and adolescent normal values for cardiovascular MRI parameters. A literature search was performed within the National Library of Medicine using the following keywords: normal, reference values, cardiovascular magnetic resonance imaging, and children/pediatric. Eleven published studies evaluating cardiovascular MRI measurements in normal children were included in the present analysis. Our results revealed reasonable consistencies in the protocols employed for cardiovascular MRI. Inter‐ and intraobserver variability analyses were performed in most studies and generally showed acceptable reproducibility. However, several numerical and methodological limitations emerged. Besides small sample sizes (the largest study enrolled 114 subjects), data for some structures (pulmonary arteries, aortic arch) were limited, and neonates/infants were poorly represented (eg, only two studies). There was heterogeneity regarding measurement normalization (eg, for gender, age, or both), and data were mostly expressed as mean values, while z‐scores (commonly used in pediatric echocardiography) were rarely employed. Theoretically, a z‐score or a standard deviation of ±2 is considered pathological. Furthermore, differences among races and ethnic groups were not evaluated. In conclusion, our analyses revealed an important need for generation of pediatric and adolescent cardiovascular MRI nomograms built over a wide population of healthy children, using consistent methodologies and with consideration of potentially relevant confounders. More data on expected abnormal values in specific CHD populations (eg, univentricular hearts) also need to be defined.

Level of Evidence: 2

Technical Efficacy Stage: 3

J. Magn. Reson. Imaging 2019.

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Malignant peripheral nerve sheath tumor (MPNST) arising from angiosarcoma: a rare case report

Abstract

Purpose

An extremely rare case of divergent differentiation of a cutaneous angiosarcoma to a malignant peripheral nerve sheath tumor (MPNST) is presented.

Methods

A 62-year-old male patient presented with an angiosarcoma of the left buccal region, which was excised with wide surgical margins. Four months after the operation, the tumor recurred locally as a MPNST. The recurrent tumor was treated with surgical excision followed by postoperative radiotherapy. Four years later, the patient presented with solitary lung metastasis. The patient underwent upper right lobectomy.

Results

The patient is alive and disease-free 2 years after the lobectomy and 6 years after initial presentation.

Conclusions

Divergent differentiation of an angiosarcoma to a neurosarcoma supports the theory that cells of the neural crest capable of differentiating both to neuroectoderm and to mesenchyme give origin to these tumors.

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