Interaural Pitch-Discrimination Range Effects for Bilateral and Single-Sided-Deafness Cochlear-Implant Users

Abstract

By allowing bilateral access to sound, bilateral cochlear implants (BI-CIs) or unilateral CIs for individuals with single-sided deafness (SSD; i.e., normal or near-normal hearing in one ear) can improve sound localization and speech understanding in noise. Spatial hearing in the horizontal plane is primarily conveyed by interaural time and level differences computed from neurons in the superior olivary complex that receive frequency-matched inputs. Because BI-CIs and SSD-CIs do not necessarily convey frequency-matched information, it is critical to understand how to align the inputs to CI users. Previous studies show that interaural pitch discrimination for SSD-CI listeners is highly susceptible to contextual biases, questioning its utility for establishing interaural frequency alignment. Here, we replicate this finding for SSD-CI listeners and show that these biases also extend to BI-CI listeners. To assess the testing-range bias, three ranges of comparison electrodes (BI-CI) or pure-tone frequencies (SSD-CI) were tested: full range, apical/lower half, or basal/upper half. To assess the reference bias, the reference electrode was either held fixed throughout a testing block or randomly chosen from three electrodes (basal end, middle, or apical end of the array). Results showed no effect of reference electrode randomization, but a large testing range bias; changing the center of the testing-rage shifted the pitch match by an average 63 % (BI-CI) or 43 % (SSD-CI) of the change magnitude. This bias diminished pitch-match accuracy, with a change in reference electrode shifting the pitch match only an average 34 % (BI-CI) or 40 % (SSD-CI) of the expected amount. Because these effects extended to the relatively more symmetric BI-CI listeners, the results suggest that the bias cannot be attributed to interaural asymmetry. Unless the range effect can be minimized or accounted for, a pitch-discrimination task will produce interaural place-of-stimulation estimates that are highly influenced by the conditions tested, rather than reflecting a true interaural place-pitch comparison.

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

Neural ITD Sensitivity and Temporal Coding with Cochlear Implants in an Animal Model of Early-Onset Deafness

Abstract

Users of cochlear implant (CI) face challenges in everyday situations such as understanding conversations in noise, even with CIs in both ears. These challenges are related to difficulties with tasks that require fine temporal processing such as discrimination of pulse rates or interaural time differences (ITD), a major cue for sound localization. The degradation in temporal processing and ITD sensitivity are especially acute in those who lost hearing in early childhood. Here, we characterized temporal coding and ITD sensitivity of single neurons in a novel animal model of early-onset deafness. Rabbits were deafened as neonates and deprived of auditory stimulation until they reached adult age when single-unit recordings from the auditory midbrain were made chronically using an unanesthetized preparation. The results are compared to measurements from adult-deafened rabbits with normal auditory development to understand the effect of early-onset deafness on neural temporal coding and ITD sensitivity. Neurons in the inferior colliculus (IC) of early-deafened rabbits were less likely to show sustained, excitatory responses to pulse train stimulation and more likely to show suppressive responses compared to neurons in adult-deaf animals. Fewer neurons showed synchronized responses to pulse trains at any rate in the early-deaf group. In addition, fewer neurons showed significant ITD sensitivity in their overall firing rate in the early-deaf group compared to adult-deaf animals. Neural ITD discrimination thresholds in the early-deaf group were poorer than thresholds in adult-deaf group, especially at high pulse rates. The overall degradation in neural ITD sensitivity is consistent with the difficulties encountered by human CI users with early-onset hearing loss. These results lay the groundwork for investigating whether the degradations in temporal coding and ITD sensitivity observed in early-deaf animals can be reversed by appropriate CI stimulation during development.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2LZaI7I

Conventional audiometry, extended high-frequency audiometry, and DPOAEs in youth recreational firearm users

. (Source: International Journal of Audiology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SQ1A7G

Validation of clinical techniques for verification of uniform attenuation earplugs

. (Source: International Journal of Audiology)

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

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AB4y9j

Evaluation of the psychometric properties of the social isolation measure (SIM) in adults with hearing loss

. (Source: International Journal of Audiology)

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

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

ConclusionsMost 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. (Source: European Archives of Oto-Rhino-Laryngology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ALvVO7

Ontogeny of auditory brainstem responses in the bat, Phyllostomus discolor.

Authors: Linnenschmidt M, Wiegrebe L Abstract Hearing is the primary sensory modality in bats, but its development is poorly studied. For newborns, hearing appears essential in maintaining contact with their mothers and to develop echolocation abilities. Here we measured auditory brainstem responses (ABRs) to clicks and narrowband tone pips covering a large frequency range (5-90 kHz) in juveniles (p7 to p200) and adults of the bat, Phyllostomus discolor. Tone-pip audiograms show that juveniles at p7 are already quite responsive, not only below 20 kHz but up to 90 kHz. Hearing sensitivity increases further until about p14 and is then refined, possibly correlated with growth and differentiation of the animals' outer ears. ABR amplitudes decrease within the first 3-4 months, inv...

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

Interaural Pitch-Discrimination Range Effects for Bilateral and Single-Sided-Deafness Cochlear-Implant Users

Abstract

By allowing bilateral access to sound, bilateral cochlear implants (BI-CIs) or unilateral CIs for individuals with single-sided deafness (SSD; i.e., normal or near-normal hearing in one ear) can improve sound localization and speech understanding in noise. Spatial hearing in the horizontal plane is primarily conveyed by interaural time and level differences computed from neurons in the superior olivary complex that receive frequency-matched inputs. Because BI-CIs and SSD-CIs do not necessarily convey frequency-matched information, it is critical to understand how to align the inputs to CI users. Previous studies show that interaural pitch discrimination for SSD-CI listeners is highly susceptible to contextual biases, questioning its utility for establishing interaural frequency alignment. Here, we replicate this finding for SSD-CI listeners and show that these biases also extend to BI-CI listeners. To assess the testing-range bias, three ranges of comparison electrodes (BI-CI) or pure-tone frequencies (SSD-CI) were tested: full range, apical/lower half, or basal/upper half. To assess the reference bias, the reference electrode was either held fixed throughout a testing block or randomly chosen from three electrodes (basal end, middle, or apical end of the array). Results showed no effect of reference electrode randomization, but a large testing range bias; changing the center of the testing-rage shifted the pitch match by an average 63 % (BI-CI) or 43 % (SSD-CI) of the change magnitude. This bias diminished pitch-match accuracy, with a change in reference electrode shifting the pitch match only an average 34 % (BI-CI) or 40 % (SSD-CI) of the expected amount. Because these effects extended to the relatively more symmetric BI-CI listeners, the results suggest that the bias cannot be attributed to interaural asymmetry. Unless the range effect can be minimized or accounted for, a pitch-discrimination task will produce interaural place-of-stimulation estimates that are highly influenced by the conditions tested, rather than reflecting a true interaural place-pitch comparison.

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

Neural ITD Sensitivity and Temporal Coding with Cochlear Implants in an Animal Model of Early-Onset Deafness

Abstract

Users of cochlear implant (CI) face challenges in everyday situations such as understanding conversations in noise, even with CIs in both ears. These challenges are related to difficulties with tasks that require fine temporal processing such as discrimination of pulse rates or interaural time differences (ITD), a major cue for sound localization. The degradation in temporal processing and ITD sensitivity are especially acute in those who lost hearing in early childhood. Here, we characterized temporal coding and ITD sensitivity of single neurons in a novel animal model of early-onset deafness. Rabbits were deafened as neonates and deprived of auditory stimulation until they reached adult age when single-unit recordings from the auditory midbrain were made chronically using an unanesthetized preparation. The results are compared to measurements from adult-deafened rabbits with normal auditory development to understand the effect of early-onset deafness on neural temporal coding and ITD sensitivity. Neurons in the inferior colliculus (IC) of early-deafened rabbits were less likely to show sustained, excitatory responses to pulse train stimulation and more likely to show suppressive responses compared to neurons in adult-deaf animals. Fewer neurons showed synchronized responses to pulse trains at any rate in the early-deaf group. In addition, fewer neurons showed significant ITD sensitivity in their overall firing rate in the early-deaf group compared to adult-deaf animals. Neural ITD discrimination thresholds in the early-deaf group were poorer than thresholds in adult-deaf group, especially at high pulse rates. The overall degradation in neural ITD sensitivity is consistent with the difficulties encountered by human CI users with early-onset hearing loss. These results lay the groundwork for investigating whether the degradations in temporal coding and ITD sensitivity observed in early-deaf animals can be reversed by appropriate CI stimulation during development.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2LZaI7I

Conventional audiometry, extended high-frequency audiometry, and DPOAEs in youth recreational firearm users

. (Source: International Journal of Audiology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SQ1A7G

Validation of clinical techniques for verification of uniform attenuation earplugs

. (Source: International Journal of Audiology)

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

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AB4y9j

Evaluation of the psychometric properties of the social isolation measure (SIM) in adults with hearing loss

. (Source: International Journal of Audiology)

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

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

ConclusionsMost 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. (Source: European Archives of Oto-Rhino-Laryngology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ALvVO7

Ontogeny of auditory brainstem responses in the bat, Phyllostomus discolor.

Authors: Linnenschmidt M, Wiegrebe L Abstract Hearing is the primary sensory modality in bats, but its development is poorly studied. For newborns, hearing appears essential in maintaining contact with their mothers and to develop echolocation abilities. Here we measured auditory brainstem responses (ABRs) to clicks and narrowband tone pips covering a large frequency range (5-90 kHz) in juveniles (p7 to p200) and adults of the bat, Phyllostomus discolor. Tone-pip audiograms show that juveniles at p7 are already quite responsive, not only below 20 kHz but up to 90 kHz. Hearing sensitivity increases further until about p14 and is then refined, possibly correlated with growth and differentiation of the animals' outer ears. ABR amplitudes decrease within the first 3-4 months, inv...

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

Millions of Americans incorrectly think they have food allergies

New research suggests many adults who think they have a food allergy actually have an intolerance (Source: Health News: CBSNews.com)

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

Millions of Americans incorrectly think they have food allergies

New research suggests many adults who think they have a food allergy actually have an intolerance (Source: Health News: CBSNews.com)

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

Evaluation of low-level diode laser irradiation and various irrigant solutions on the biological response of stem cells from exfoliated deciduous teeth

This study aimed to evaluate cytotoxic effects and the apoptosis of Gallium-Aluminum-Arsenide (GaAlAs) diode laser irradiation, sodium hypochlorite (NaOCl), ozonated water and ethylene diamine tetraacetic acid (EDTA) on stem cells from human exfoliated deciduous teeth (SHEDs). Cells were exposed to EDTA (5%, 8.5%, 17%), NaOCl (1%, 2.5%, 5%) ozonated water (5, 10, 20 μg/ml) and GaAlAs diode laser irradiation (energy densities of 0.5, 1, 1.5 j/cm2). Culture medium included D-MEM, supplemented with 15% foetal bovine serum, 1% l-glutamine, 1% penicillin-streptomycin, 1% gentamycin, amphotericin-B and served as control group. The prepared irrigants were added to the relevant wells and incubated with the cells at 37 °C for 5, 10 and 15 min. The cells in the laser group were also incuba...

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TC7R6Z

Implementing aphasia recommendations in the acute setting: speech-language pathologists ’ perspectives of a behaviour change intervention

. (Source: Aphasiology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CWc1RU

Changes in the Excitability of Corticobulbar Projections Due to Intraoral Cooling with Ice

AbstractThe aim of this study was to assess the effects of ice applied to the oral cavity on the excitability of corticobulbar projections to the swallowing muscles. The subjects were 8 healthy adult volunteers (mean age 29.0  ± 4.9 years). Motor-evoked potentials (MEPs) were recorded from the suprahyoid muscle complex using surface electrodes. Two blocks of 20 MEPs with a test stimulus intensity of 120% of the resting motor threshold were recorded at rest (baseline). Subjects then underwent 5-min thermal stimulation by either of 3 different types: (1) "ice-stick inside mouth," (2) "ice-stick on neck," and (3) "room temperature inside mouth." Blocks of 20 MEPs were then recorded immediately and at 5-min intervals for the following 15 min. There was a significant difference...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ADSl3s

Evaluation of low-level diode laser irradiation and various irrigant solutions on the biological response of stem cells from exfoliated deciduous teeth

This study aimed to evaluate cytotoxic effects and the apoptosis of Gallium-Aluminum-Arsenide (GaAlAs) diode laser irradiation, sodium hypochlorite (NaOCl), ozonated water and ethylene diamine tetraacetic acid (EDTA) on stem cells from human exfoliated deciduous teeth (SHEDs). Cells were exposed to EDTA (5%, 8.5%, 17%), NaOCl (1%, 2.5%, 5%) ozonated water (5, 10, 20 μg/ml) and GaAlAs diode laser irradiation (energy densities of 0.5, 1, 1.5 j/cm2). Culture medium included D-MEM, supplemented with 15% foetal bovine serum, 1% l-glutamine, 1% penicillin-streptomycin, 1% gentamycin, amphotericin-B and served as control group. The prepared irrigants were added to the relevant wells and incubated with the cells at 37 °C for 5, 10 and 15 min. The cells in the laser group were also incuba...

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

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TC7R6Z

Implementing aphasia recommendations in the acute setting: speech-language pathologists ’ perspectives of a behaviour change intervention

. (Source: Aphasiology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CWc1RU

Changes in the Excitability of Corticobulbar Projections Due to Intraoral Cooling with Ice

AbstractThe aim of this study was to assess the effects of ice applied to the oral cavity on the excitability of corticobulbar projections to the swallowing muscles. The subjects were 8 healthy adult volunteers (mean age 29.0  ± 4.9 years). Motor-evoked potentials (MEPs) were recorded from the suprahyoid muscle complex using surface electrodes. Two blocks of 20 MEPs with a test stimulus intensity of 120% of the resting motor threshold were recorded at rest (baseline). Subjects then underwent 5-min thermal stimulation by either of 3 different types: (1) "ice-stick inside mouth," (2) "ice-stick on neck," and (3) "room temperature inside mouth." Blocks of 20 MEPs were then recorded immediately and at 5-min intervals for the following 15 min. There was a significant difference...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ADSl3s

Changes in the Excitability of Corticobulbar Projections Due to Intraoral Cooling with Ice

AbstractThe aim of this study was to assess the effects of ice applied to the oral cavity on the excitability of corticobulbar projections to the swallowing muscles. The subjects were 8 healthy adult volunteers (mean age 29.0  ± 4.9 years). Motor-evoked potentials (MEPs) were recorded from the suprahyoid muscle complex using surface electrodes. Two blocks of 20 MEPs with a test stimulus intensity of 120% of the resting motor threshold were recorded at rest (baseline). Subjects then underwent 5-min thermal stimulation by either of 3 different types: (1) "ice-stick inside mouth," (2) "ice-stick on neck," and (3) "room temperature inside mouth." Blocks of 20 MEPs were then recorded immediately and at 5-min intervals for the following 15 min. There was a significant difference...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ADSl3s

Changes in the Excitability of Corticobulbar Projections Due to Intraoral Cooling with Ice

AbstractThe aim of this study was to assess the effects of ice applied to the oral cavity on the excitability of corticobulbar projections to the swallowing muscles. The subjects were 8 healthy adult volunteers (mean age 29.0  ± 4.9 years). Motor-evoked potentials (MEPs) were recorded from the suprahyoid muscle complex using surface electrodes. Two blocks of 20 MEPs with a test stimulus intensity of 120% of the resting motor threshold were recorded at rest (baseline). Subjects then underwent 5-min thermal stimulation by either of 3 different types: (1) "ice-stick inside mouth," (2) "ice-stick on neck," and (3) "room temperature inside mouth." Blocks of 20 MEPs were then recorded immediately and at 5-min intervals for the following 15 min. There was a significant difference...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ADSl3s

Health Care Digest: How federal shutdown hits one company, a JPM19 roundup — and more

A special edition of the Health Care Digest during the ongoing 37th annual J.P. Morgan Healthcare Conference going on in San Francisco. Aimmune Therapeutics Inc. CEO Jayson Dallas started his presentation Monday at the 37th annual J.P. Morgan Healthcare Conference describing the company as "a 2019 story." That may be more true than even Dallas knows. The Brisbane company (NASDAQ: AIMT) is on the cusp of a breakthrough in th e treatment of peanut allergy. It looks to win Food and Drug Administration… (Source: bizjournals.com Health Care:Biotechnology headlines)

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

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

Study estimates millions in U.S. wrongly believe they have food allergies

A study published Friday in JAMA Network Open estimates nearly 19 percent of adults think they have food allergies, but less than 11 percent actually do. Researchers say allergy testing is crucial for those who may need to protect themselves by avoiding certain foods and getting prescriptions for EpiPens. Dr. Tania Elliott, an allergist with NYU Langone Health, joins "CBS This Morning" to discuss the findings. (Source: Health News: CBSNews.com)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2H2gN4p

Food Allergies Common in U.S. Adults Food Allergies Common in U.S. Adults

More than 10 percent of American adults are allergic to at least one food, a new study suggests.Reuters Health Information (Source: Medscape Medical News Headlines)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Fg4sI9

Health Care Digest: How federal shutdown hits one company, a JPM19 roundup — and more

A special edition of the Health Care Digest during the ongoing 37th annual J.P. Morgan Healthcare Conference going on in San Francisco. Aimmune Therapeutics Inc. CEO Jayson Dallas started his presentation Monday at the 37th annual J.P. Morgan Healthcare Conference describing the company as "a 2019 story." That may be more true than even Dallas knows. The Brisbane company (NASDAQ: AIMT) is on the cusp of a breakthrough in th e treatment of peanut allergy. It looks to win Food and Drug Administration… (Source: bizjournals.com Health Care:Biotechnology headlines)

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

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

Study estimates millions in U.S. wrongly believe they have food allergies

A study published Friday in JAMA Network Open estimates nearly 19 percent of adults think they have food allergies, but less than 11 percent actually do. Researchers say allergy testing is crucial for those who may need to protect themselves by avoiding certain foods and getting prescriptions for EpiPens. Dr. Tania Elliott, an allergist with NYU Langone Health, joins "CBS This Morning" to discuss the findings. (Source: Health News: CBSNews.com)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2H2gN4p

Food Allergies Common in U.S. Adults Food Allergies Common in U.S. Adults

More than 10 percent of American adults are allergic to at least one food, a new study suggests.Reuters Health Information (Source: Medscape Medical News Headlines)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Fg4sI9

Cochlear implants for children and adults with severe to profound deafness (part review of TA166)

National Institute for Health and Care Excellence - Hundreds more people with severe to profound deafness are expected to be eligible for cochlear implants each year, due to this updated NICE guidance. The update comes after a review of the definition of severe to profound deafness which is used to identify if a cochlear implant might be appropriate.UpdatePress release (Source: Health Management Specialist Library)

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CY2Osf

Hearing Loss Linked to Dementia, Other Health Issues

The New York Times recently reported on several studies indicating a relationship between untreated hearing loss and other heath issues. The article also questions why most health insurance companies—including Medicare—do not typically cover hearing aids when studies show that health care costs are much higher when hearing loss goes uncorrected. Related health care risks found in these and other studies include dementia, depression, injuries resulting from balance issues, and cardiovascular diseases. The two studies showed increased risk for medical comorbidities and higher health care cost data for people with untreated hearing loss. One study demonstrated a 50-percent increased risk in dementia for those with hearing loss and a 40-percent increased risk of depression. The seco...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sdQTA9

Cochlear implants for children and adults with severe to profound deafness (part review of TA166)

National Institute for Health and Care Excellence - Hundreds more people with severe to profound deafness are expected to be eligible for cochlear implants each year, due to this updated NICE guidance. The update comes after a review of the definition of severe to profound deafness which is used to identify if a cochlear implant might be appropriate.UpdatePress release (Source: Health Management Specialist Library)

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

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CY2Osf

Hearing Loss Linked to Dementia, Other Health Issues

The New York Times recently reported on several studies indicating a relationship between untreated hearing loss and other heath issues. The article also questions why most health insurance companies—including Medicare—do not typically cover hearing aids when studies show that health care costs are much higher when hearing loss goes uncorrected. Related health care risks found in these and other studies include dementia, depression, injuries resulting from balance issues, and cardiovascular diseases. The two studies showed increased risk for medical comorbidities and higher health care cost data for people with untreated hearing loss. One study demonstrated a 50-percent increased risk in dementia for those with hearing loss and a 40-percent increased risk of depression. The seco...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sdQTA9

Health Care Digest: How federal shutdown hits one company, a JPM19 roundup — and more

A special edition of the Health Care Digest during the ongoing 37th annual J.P. Morgan Healthcare Conference going on in San Francisco. Aimmune Therapeutics Inc. CEO Jayson Dallas started his presentation Monday at the 37th annual J.P. Morgan Healthcare Conference describing the company as "a 2019 story." That may be more true than even Dallas knows. The Brisbane company (NASDAQ: AIMT) is on the cusp of a breakthrough in th e treatment of peanut allergy. It looks to win Food and Drug Administration… (Source: bizjournals.com Health Care:Biotechnology headlines)

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

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

Study estimates millions in U.S. wrongly believe they have food allergies

A study published Friday in JAMA Network Open estimates nearly 19 percent of adults think they have food allergies, but less than 11 percent actually do. Researchers say allergy testing is crucial for those who may need to protect themselves by avoiding certain foods and getting prescriptions for EpiPens. Dr. Tania Elliott, an allergist with NYU Langone Health, joins "CBS This Morning" to discuss the findings. (Source: Health News: CBSNews.com)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2H2gN4p

Food Allergies Common in U.S. Adults Food Allergies Common in U.S. Adults

More than 10 percent of American adults are allergic to at least one food, a new study suggests.Reuters Health Information (Source: Medscape Medical News Headlines)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Fg4sI9

Health Care Digest: How federal shutdown hits one company, a JPM19 roundup — and more

A special edition of the Health Care Digest during the ongoing 37th annual J.P. Morgan Healthcare Conference going on in San Francisco. Aimmune Therapeutics Inc. CEO Jayson Dallas started his presentation Monday at the 37th annual J.P. Morgan Healthcare Conference describing the company as "a 2019 story." That may be more true than even Dallas knows. The Brisbane company (NASDAQ: AIMT) is on the cusp of a breakthrough in th e treatment of peanut allergy. It looks to win Food and Drug Administration… (Source: bizjournals.com Health Care:Biotechnology headlines)

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

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

Study estimates millions in U.S. wrongly believe they have food allergies

A study published Friday in JAMA Network Open estimates nearly 19 percent of adults think they have food allergies, but less than 11 percent actually do. Researchers say allergy testing is crucial for those who may need to protect themselves by avoiding certain foods and getting prescriptions for EpiPens. Dr. Tania Elliott, an allergist with NYU Langone Health, joins "CBS This Morning" to discuss the findings. (Source: Health News: CBSNews.com)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2H2gN4p

Food Allergies Common in U.S. Adults Food Allergies Common in U.S. Adults

More than 10 percent of American adults are allergic to at least one food, a new study suggests.Reuters Health Information (Source: Medscape Medical News Headlines)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Fg4sI9

Unusual presentation of gouty tophus in the liver with subsequent appearance in the same site of HCC: a correlate diagnosis? Case report

Although gout is a common disease, the presence of gouty tophi outside joints is rare and in literature, there is to date only one report of hepatic tophaceous nodule. We would like to highlight here the diffi...

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

Automatic thyroid nodule recognition and diagnosis in ultrasound imaging with the YOLOv2 neural network

In this study, images of 2450 benign thyroid nodules and 2557 malignant thyroid nodules were collected and labeled, and an automatic image recognition and diagnosis system was established by deep learning usin...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Ff6Puy

Living donor liver transplantation with two-stage hepatectomy for patients with isolated, irresectable colorectal liver—the LIVER-T(W)O-HEAL study

Colorectal cancer is the third most common malignancy worldwide. The occurrence of liver metastases worsens the prognosis of the patient significantly if the tumor burden is not resectable.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FiMNi6

Unusual presentation of gouty tophus in the liver with subsequent appearance in the same site of HCC: a correlate diagnosis? Case report

Although gout is a common disease, the presence of gouty tophi outside joints is rare and in literature, there is to date only one report of hepatic tophaceous nodule. We would like to highlight here the diffi...

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

Automatic thyroid nodule recognition and diagnosis in ultrasound imaging with the YOLOv2 neural network

In this study, images of 2450 benign thyroid nodules and 2557 malignant thyroid nodules were collected and labeled, and an automatic image recognition and diagnosis system was established by deep learning usin...

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Living donor liver transplantation with two-stage hepatectomy for patients with isolated, irresectable colorectal liver—the LIVER-T(W)O-HEAL study

Colorectal cancer is the third most common malignancy worldwide. The occurrence of liver metastases worsens the prognosis of the patient significantly if the tumor burden is not resectable.

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Preliminary findings on cryptocurrency trading among regular gamblers: A new risk for problem gambling?

Publication date: Available online 8 January 2019

Source: Addictive Behaviors

Author(s): Devin J. Mills, Lia Nower

Abstract

Cryptocurrencies are emerging digital currencies that allow anonymity in accessing various risk-taking activities through the Internet (e.g., drugs, gambling). However, given conceptual links to high-risk stocks, the present study sought to assess the association between trading cryptocurrencies and problem gambling. Data was collected through a cross-sectional online survey. Advertisement for the survey was posted on Amazon's Mechanical Turk. Participants were adults who had gambled at least monthly in the past year (N = 876; 58.33% male; M = 33.74 years, SD = 9.73). Participants completed the Problem Gambling Severity Index, Patient Health Questionnaire (2-item version), and Generalized Anxiety Disorder scale (2-item version). Trading cryptocurrencies is strongly associated with problem gambling severity (r = 0.53, p < .001). Results from a linear regression with backwards elimination revealed that sports betting, daily fantasy sports, high-risk stock trading, and problem gambling severity contribute to trading cryptocurrencies more frequently in the past year, whereas gambling in on-land casinos contributed to less cryptocurrency trading. Finally, trading cryptocurrencies overlapped strongly with trading high-risk stocks. Moreover, gamblers who engaged in both forms of trading reported greater problem gambling and depression and anxiety symptoms relative to those trading either cryptocurrencies or high-risk stocks, but not both. The present results suggest that trading cryptocurrencies may be appealing to gamblers that are exhibiting greater problem gambling severity. Future research should begin to include cryptocurrency trading in screening, assessment, and treatment protocols, particularly with regular gamblers.

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Preliminary findings on cryptocurrency trading among regular gamblers: A new risk for problem gambling?

Publication date: Available online 8 January 2019

Source: Addictive Behaviors

Author(s): Devin J. Mills, Lia Nower

Abstract

Cryptocurrencies are emerging digital currencies that allow anonymity in accessing various risk-taking activities through the Internet (e.g., drugs, gambling). However, given conceptual links to high-risk stocks, the present study sought to assess the association between trading cryptocurrencies and problem gambling. Data was collected through a cross-sectional online survey. Advertisement for the survey was posted on Amazon's Mechanical Turk. Participants were adults who had gambled at least monthly in the past year (N = 876; 58.33% male; M = 33.74 years, SD = 9.73). Participants completed the Problem Gambling Severity Index, Patient Health Questionnaire (2-item version), and Generalized Anxiety Disorder scale (2-item version). Trading cryptocurrencies is strongly associated with problem gambling severity (r = 0.53, p < .001). Results from a linear regression with backwards elimination revealed that sports betting, daily fantasy sports, high-risk stock trading, and problem gambling severity contribute to trading cryptocurrencies more frequently in the past year, whereas gambling in on-land casinos contributed to less cryptocurrency trading. Finally, trading cryptocurrencies overlapped strongly with trading high-risk stocks. Moreover, gamblers who engaged in both forms of trading reported greater problem gambling and depression and anxiety symptoms relative to those trading either cryptocurrencies or high-risk stocks, but not both. The present results suggest that trading cryptocurrencies may be appealing to gamblers that are exhibiting greater problem gambling severity. Future research should begin to include cryptocurrency trading in screening, assessment, and treatment protocols, particularly with regular gamblers.

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Extended field of view magnetic resonance imaging for suspected osteomyelitis in very young children: is it useful?

Abstract

Background

Osteomyelitis is a challenging diagnosis for clinicians, particularly in very young children. At our institution, the magnetic resonance imaging (MRI) protocol in suspected osteomyelitis for children 5 years of age or younger includes a large field of imaging regardless of the clinical site of concern.

Objective

To determine if extended field of view (FOV) MRI contributes important information in young children with suspected osteomyelitis.

Materials and methods

A retrospective study was performed including children 5 years of age or younger with suspected osteomyelitis from January 2011 to September 2015. All children underwent coronal fluid-sensitive MRI from neck to feet. Focused imaging was performed as necessary on abnormal sites depicted on survey imaging. Two radiologists reviewed the imaging findings, which were compared to the clinical outcome.

Results

We studied 51 children with a mean age of 2.2 years (range: 21 days-5.5 years); 53% were boys. Osteomyelitis was depicted by MRI in 20 subjects (39.2%). Survey coronal fluid-sensitive imaging was accomplished by adding a single fluid-sensitive series in 1 child, 2 series in 31 children, 3 series in 16 children and 4 series in 3 children. Survey imaging added a median total time of 6:51 min to the examination (range: 2.29–20.54 min). Extended FOV imaging added important information in 11/51 subjects (21.6%), in 6 cases (11.8%) of infection and in 5 cases (9.8%) by suggesting alternative diagnoses.

Conclusion

The addition of extended FOV MRI in young children with suspected osteomyelitis added important clinical information in 21.6% of patients while only adding a median of 6:51 min to the examination. It is our experience that in children ≤5 years of age with suspected osteomyelitis, extended FOV imaging adds important information and may result in changes in management.

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Extended field of view magnetic resonance imaging for suspected osteomyelitis in very young children: is it useful?

Abstract

Background

Osteomyelitis is a challenging diagnosis for clinicians, particularly in very young children. At our institution, the magnetic resonance imaging (MRI) protocol in suspected osteomyelitis for children 5 years of age or younger includes a large field of imaging regardless of the clinical site of concern.

Objective

To determine if extended field of view (FOV) MRI contributes important information in young children with suspected osteomyelitis.

Materials and methods

A retrospective study was performed including children 5 years of age or younger with suspected osteomyelitis from January 2011 to September 2015. All children underwent coronal fluid-sensitive MRI from neck to feet. Focused imaging was performed as necessary on abnormal sites depicted on survey imaging. Two radiologists reviewed the imaging findings, which were compared to the clinical outcome.

Results

We studied 51 children with a mean age of 2.2 years (range: 21 days-5.5 years); 53% were boys. Osteomyelitis was depicted by MRI in 20 subjects (39.2%). Survey coronal fluid-sensitive imaging was accomplished by adding a single fluid-sensitive series in 1 child, 2 series in 31 children, 3 series in 16 children and 4 series in 3 children. Survey imaging added a median total time of 6:51 min to the examination (range: 2.29–20.54 min). Extended FOV imaging added important information in 11/51 subjects (21.6%), in 6 cases (11.8%) of infection and in 5 cases (9.8%) by suggesting alternative diagnoses.

Conclusion

The addition of extended FOV MRI in young children with suspected osteomyelitis added important clinical information in 21.6% of patients while only adding a median of 6:51 min to the examination. It is our experience that in children ≤5 years of age with suspected osteomyelitis, extended FOV imaging adds important information and may result in changes in management.

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Diffusion-weighted imaging of the dentate nucleus after repeated application of gadolinium-based contrast agents in multiple sclerosis

Publication date: Available online 7 January 2019

Source: Magnetic Resonance Imaging

Author(s): Philipp Eisele, Kristina Szabo, Anne Ebert, Alexander Radbruch, Michael Platten, Stefan O. Schoenberg, Achim Gass

Abstract

Objective

Over the last years several studies reported an increased signal intensity (SI) of the dentate nucleus (DN) on unenhanced T1-weighted images after repeated application of gadolinium-based contrast agents (GBCAs), suggesting gadolinium deposition. The aim of this study was to investigate with diffusion-weighted MRI possible tissue abnormalities of the DN in multiple sclerosis (MS) patients.

Material and methods

We retrospectively identified seventeen patients with at least six contrast-enhanced MRI examinations by using the linear GBCA gadopentate dimeglumine and twenty-three patients with the exclusive use of the macrocyclic contrast agent gadoterate meglumine followed by another 3 Tesla MRI scan including unenhanced T1-weighted and diffusion-weighted images.

Results

In the linear GBCA group, we found significant differences of the DN-to-pons SI ratio on unenhanced T1-weighted images (1.13 ± 0.05) when compared to the macrocyclic GBCA group (0.97 ± 0.03; p < 0.001). However, we found no significant differences between apparent diffusion coefficient (ADC) values of the DN in both groups (linear GBCA group: 0.82 ± 0.04 × 10⁻³ mm/s²; marcocyclic GBCA group: 0.79 ± 0.04 × 10⁻³ mm/s²; p = 0.15).

Conclusions

Our results do not suggest that there is any difference in ADC values in the T1-hyperintense DN, which does not indicate a difference in tissue integrity between patients exposed to macrocyclic or linear GBCAs.

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Using functional magnetic resonance imaging to evaluate an acute allograft rejection model in rats

Publication date: Available online 7 January 2019

Source: Magnetic Resonance Imaging

Author(s): Song Zeng, Lu Liang, Qiang Zhang, Yue Xu, Hao Tang, Zijian Zhang, Xiaodong Zhang, Tao Jiang, Xiaopeng Hu

Abstract

Purpose

To assess the longitudinal changes of allograft pathophysiology by intravoxel incoherent motion (IVIM) and blood oxygen level-dependent (BOLD) MRI in a rat model of acute renal allograft rejection.

Materials and methods

Acute rejection (AR) was induced by transplantation of Dark Agouti donor kidneys into Lewis recipients (n = 18). A Lewis-Lewis rat syngeneically transplanted (sTX) model served as the control (n = 6). Acute tubular necrosis (n = 6) and acute calcineurin inhibitor toxicity (n = 6) groups were established using Lewis rats. MRI was performed on postoperative day (POD) 1, 4 and 7 in the allogeneically transplanted (aTX) group and on POD4 in the other groups. Histological evaluation and PCR were performed.

Results

After the allogenic transplantation, all MRI parameters of allograft further decreased until POD7, and the D and ADC values in the cortex were significantly lower than that in the sTX group (1.03 ± 0.09 vs 1.52 ± 0.09 × 10⁻³ mm²/s, P_adj < 0.05; 1.21 ± 0.03 vs 1.78 ± 0.07 × 10⁻³ mm²/s, P_adj < 0.05). The D*, f and R2* values of the aTX group in the cortex and medulla were significantly lower than those in the sTX group on POD7 (cortex, D*: 25.60 ± 4.78 vs 69.32 ± 9.79 × 10⁻³ mm²/s, P_adj < 0.05; f: 7.84 ± 1.83 vs 20.34 ± 3.08%, P_adj < 0.05; R2*: 16.61 ± 4.18 vs 31.48 ± 6.43 1/s, P_adj < 0.05; medulla, D*: 13.59 ± 6.08 vs 62.75 ± 9.20 × 10⁻³ mm²/s, P_adj < 0.05; f: 7.46 ± 1.62 vs 14.68 ± 2.05%, P_adj < 0.05; R2*: 21.59 ± 3.45 vs 39.53 ± 4.34 1/s, P_adj < 0.05). AR grafts presented serve interstitial inflammation, tubulitis and infiltration of T-lymphocytes and macrophages. The MRI parameters, including D, ADC, D*, f and R2*, were significantly correlated with the histological changes, cell infiltration and inflammatory cytokine mRNA levels.

Conclusions

IVIM coupled with BOLD MRI allows longitudinal assessment of allograft diffusion, perfusion and oxygen consumption impairment caused by acute renal allograft rejection in rat model.

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Diffusion-weighted imaging of the dentate nucleus after repeated application of gadolinium-based contrast agents in multiple sclerosis

Publication date: Available online 7 January 2019

Source: Magnetic Resonance Imaging

Author(s): Philipp Eisele, Kristina Szabo, Anne Ebert, Alexander Radbruch, Michael Platten, Stefan O. Schoenberg, Achim Gass

Abstract

Objective

Over the last years several studies reported an increased signal intensity (SI) of the dentate nucleus (DN) on unenhanced T1-weighted images after repeated application of gadolinium-based contrast agents (GBCAs), suggesting gadolinium deposition. The aim of this study was to investigate with diffusion-weighted MRI possible tissue abnormalities of the DN in multiple sclerosis (MS) patients.

Material and methods

We retrospectively identified seventeen patients with at least six contrast-enhanced MRI examinations by using the linear GBCA gadopentate dimeglumine and twenty-three patients with the exclusive use of the macrocyclic contrast agent gadoterate meglumine followed by another 3 Tesla MRI scan including unenhanced T1-weighted and diffusion-weighted images.

Results

In the linear GBCA group, we found significant differences of the DN-to-pons SI ratio on unenhanced T1-weighted images (1.13 ± 0.05) when compared to the macrocyclic GBCA group (0.97 ± 0.03; p < 0.001). However, we found no significant differences between apparent diffusion coefficient (ADC) values of the DN in both groups (linear GBCA group: 0.82 ± 0.04 × 10⁻³ mm/s²; marcocyclic GBCA group: 0.79 ± 0.04 × 10⁻³ mm/s²; p = 0.15).

Conclusions

Our results do not suggest that there is any difference in ADC values in the T1-hyperintense DN, which does not indicate a difference in tissue integrity between patients exposed to macrocyclic or linear GBCAs.

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Using functional magnetic resonance imaging to evaluate an acute allograft rejection model in rats

Publication date: Available online 7 January 2019

Source: Magnetic Resonance Imaging

Author(s): Song Zeng, Lu Liang, Qiang Zhang, Yue Xu, Hao Tang, Zijian Zhang, Xiaodong Zhang, Tao Jiang, Xiaopeng Hu

Abstract

Purpose

To assess the longitudinal changes of allograft pathophysiology by intravoxel incoherent motion (IVIM) and blood oxygen level-dependent (BOLD) MRI in a rat model of acute renal allograft rejection.

Materials and methods

Acute rejection (AR) was induced by transplantation of Dark Agouti donor kidneys into Lewis recipients (n = 18). A Lewis-Lewis rat syngeneically transplanted (sTX) model served as the control (n = 6). Acute tubular necrosis (n = 6) and acute calcineurin inhibitor toxicity (n = 6) groups were established using Lewis rats. MRI was performed on postoperative day (POD) 1, 4 and 7 in the allogeneically transplanted (aTX) group and on POD4 in the other groups. Histological evaluation and PCR were performed.

Results

After the allogenic transplantation, all MRI parameters of allograft further decreased until POD7, and the D and ADC values in the cortex were significantly lower than that in the sTX group (1.03 ± 0.09 vs 1.52 ± 0.09 × 10⁻³ mm²/s, P_adj < 0.05; 1.21 ± 0.03 vs 1.78 ± 0.07 × 10⁻³ mm²/s, P_adj < 0.05). The D*, f and R2* values of the aTX group in the cortex and medulla were significantly lower than those in the sTX group on POD7 (cortex, D*: 25.60 ± 4.78 vs 69.32 ± 9.79 × 10⁻³ mm²/s, P_adj < 0.05; f: 7.84 ± 1.83 vs 20.34 ± 3.08%, P_adj < 0.05; R2*: 16.61 ± 4.18 vs 31.48 ± 6.43 1/s, P_adj < 0.05; medulla, D*: 13.59 ± 6.08 vs 62.75 ± 9.20 × 10⁻³ mm²/s, P_adj < 0.05; f: 7.46 ± 1.62 vs 14.68 ± 2.05%, P_adj < 0.05; R2*: 21.59 ± 3.45 vs 39.53 ± 4.34 1/s, P_adj < 0.05). AR grafts presented serve interstitial inflammation, tubulitis and infiltration of T-lymphocytes and macrophages. The MRI parameters, including D, ADC, D*, f and R2*, were significantly correlated with the histological changes, cell infiltration and inflammatory cytokine mRNA levels.

Conclusions

IVIM coupled with BOLD MRI allows longitudinal assessment of allograft diffusion, perfusion and oxygen consumption impairment caused by acute renal allograft rejection in rat model.

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Impact of different restorative treatments for deep caries lesion in primary teeth (CEPECO 1) – study protocol for a noninferiority randomized clinical trial

Abstract

Background

Due to the lack of evidence to determine the best treatment for deep cavitated caries lesions in primary molars, the search for an effective restorative technique, which results in a minimal discomfort to patients, and reduce the time needed for the treatment, becomes relevant. The objective of this randomized clinical trial was to evaluate if high-viscosity glass ionomer cement (HVGIC) restorations is noninferior to restoration with calcium hydroxide cement associated with HVGIC for treatment of deep lesions in primary molars, as well as the impact of the treatments on cost and discomfort of the patient.

Methods

A non-inferiority randomized clinical trial with two parallels arms (1:1) will be conducted. Children with 4 to 8 years will be selected at Clinic of Pediatric Dentistry at Ibirapuera University. 108 teeth will be randomized into two groups: (1) Calcium hydroxide cement associated with HVGIC and (2) HVGIC restoration. Primary outcome will be considered the pulp vitality and to be evaluated after 6, 12, 18 and 24 months by two calibrated examiners. Survival of restorations will also be evaluated in the equal intervals. The duration of dentals treatment and the cost of all materials used will be considered for estimating of cost-efficacy of each treatment. Individual discomfort will be measured after each dental procedure using the Wong-Baker's Facial Scale. For the primary outcome, Kaplan-Meier survival and the long-rank test will be used to comparison between the groups. Cox regression will be performed to assess the influence of variables on the outcome. For all analyzes, the significance level is set at 5%.

Discussion

Based on the philosophy of ART, our hypothesis is that the HVGIC restoration is a possible approach to restore the deep caries lesion with pulp vitality without the use of rubber dam and anesthesia.

Trial registration

Clinicaltrials.gov registration NCT02903979. Registered on June 9th 2016.

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Impact of different restorative treatments for deep caries lesion in primary teeth (CEPECO 1) – study protocol for a noninferiority randomized clinical trial

Abstract

Background

Due to the lack of evidence to determine the best treatment for deep cavitated caries lesions in primary molars, the search for an effective restorative technique, which results in a minimal discomfort to patients, and reduce the time needed for the treatment, becomes relevant. The objective of this randomized clinical trial was to evaluate if high-viscosity glass ionomer cement (HVGIC) restorations is noninferior to restoration with calcium hydroxide cement associated with HVGIC for treatment of deep lesions in primary molars, as well as the impact of the treatments on cost and discomfort of the patient.

Methods

A non-inferiority randomized clinical trial with two parallels arms (1:1) will be conducted. Children with 4 to 8 years will be selected at Clinic of Pediatric Dentistry at Ibirapuera University. 108 teeth will be randomized into two groups: (1) Calcium hydroxide cement associated with HVGIC and (2) HVGIC restoration. Primary outcome will be considered the pulp vitality and to be evaluated after 6, 12, 18 and 24 months by two calibrated examiners. Survival of restorations will also be evaluated in the equal intervals. The duration of dentals treatment and the cost of all materials used will be considered for estimating of cost-efficacy of each treatment. Individual discomfort will be measured after each dental procedure using the Wong-Baker's Facial Scale. For the primary outcome, Kaplan-Meier survival and the long-rank test will be used to comparison between the groups. Cox regression will be performed to assess the influence of variables on the outcome. For all analyzes, the significance level is set at 5%.

Discussion

Based on the philosophy of ART, our hypothesis is that the HVGIC restoration is a possible approach to restore the deep caries lesion with pulp vitality without the use of rubber dam and anesthesia.

Trial registration

Clinicaltrials.gov registration NCT02903979. Registered on June 9th 2016.

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A Proof of Concept, Window Trial of the IMmunological Effects of AveLumab and Aspirin in Triple-Negative Breast Cancer

Condition:   Breast Cancer Interventions:   Drug: Avelumab;   Drug: Aspirin;   Drug: Lansoprazole (Proton Pump Inhibitor) Sponsors:   The Christie NHS Foundation Trust;   University of Manchester Not yet recruiting (Source: ClinicalTrials.gov)

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A Proof of Concept, Window Trial of the IMmunological Effects of AveLumab and Aspirin in Triple-Negative Breast Cancer

Condition:   Breast Cancer Interventions:   Drug: Avelumab;   Drug: Aspirin;   Drug: Lansoprazole (Proton Pump Inhibitor) Sponsors:   The Christie NHS Foundation Trust;   University of Manchester Not yet recruiting (Source: ClinicalTrials.gov)

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Recurrent Sinonasal CD34-Negative Malignant Solitary Fibrous Tumor Diagnosed on STAT6 Immunohistochemistry and NAB2-STAT6 Fusion

Abstract

A spectrum of mesenchymal neoplasms occur in the sinonasal region. One of these is solitary fibrous tumor (SFT), a translocation-associated neoplasm characterized by NAB2-STAT6 gene fusion. Sinonasal SFTs characteristically display CD34 immunopositivity, which aids in diagnosis. However, a small proportion of SFTs may be negative for CD34, making diagnosis difficult. The availability of STAT6 immunohistochemistry (IHC) has helped to overcome this. Malignant SFTs, characterized by increased cellularity and mitoses > 4 per ten high power fields, are extremely unusual in the sinonasal region, with only ten such cases reported to date. We report a case of a CD34-negative malignant SFT that was diagnosed using STAT6 IHC and confirmed by demonstrating NAB2 ex 4-STAT6 ex 2 fusion, and recurred 8 months after complete excision, to highlight the aggressive nature of this tumor.

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Recurrent Sinonasal CD34-Negative Malignant Solitary Fibrous Tumor Diagnosed on STAT6 Immunohistochemistry and NAB2-STAT6 Fusion

Abstract

A spectrum of mesenchymal neoplasms occur in the sinonasal region. One of these is solitary fibrous tumor (SFT), a translocation-associated neoplasm characterized by NAB2-STAT6 gene fusion. Sinonasal SFTs characteristically display CD34 immunopositivity, which aids in diagnosis. However, a small proportion of SFTs may be negative for CD34, making diagnosis difficult. The availability of STAT6 immunohistochemistry (IHC) has helped to overcome this. Malignant SFTs, characterized by increased cellularity and mitoses > 4 per ten high power fields, are extremely unusual in the sinonasal region, with only ten such cases reported to date. We report a case of a CD34-negative malignant SFT that was diagnosed using STAT6 IHC and confirmed by demonstrating NAB2 ex 4-STAT6 ex 2 fusion, and recurred 8 months after complete excision, to highlight the aggressive nature of this tumor.

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Perceived helpfulness of treatments for myofascial TMD as a function of comorbid widespread pain

Abstract

Objective

This study examined whether patients with myofascial temporomandibular disorder (mTMD) comorbid with fibromyalgia (FM) receive different treatments or respond differently to these treatments than mTMD-only patients.

Materials and methods

A total of 125 mTMD+ women were enrolled (26 FM+ and 98 FM−). mTMD and FM were assessed via clinical research examinations. Treatment histories and self-reported treatment-related improvement were obtained via interview.

Results

The top 3 most common treatments reported were oral appliances (59%), physical therapy (54%), and jaw exercises at home (34%). Use of alternative medicine was reported more frequently among FM+ women, but self-reported improvement did not differ by comorbid FM. Physical therapy was as likely reported by FM status but self-reported improvement scores trended higher for FM+ women.

Conclusions

Oral appliances were as likely to be reported by FM comorbid as FM− women. Oral appliances did not outperform self-management treatments on self-reported improvement of facial pain.

Clinical relevance

Results support the use of self-management as first-line treatment for mTMD and potential utility of inquiring about widespread pain for treatment planning.

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Perceived helpfulness of treatments for myofascial TMD as a function of comorbid widespread pain

Abstract

Objective

This study examined whether patients with myofascial temporomandibular disorder (mTMD) comorbid with fibromyalgia (FM) receive different treatments or respond differently to these treatments than mTMD-only patients.

Materials and methods

A total of 125 mTMD+ women were enrolled (26 FM+ and 98 FM−). mTMD and FM were assessed via clinical research examinations. Treatment histories and self-reported treatment-related improvement were obtained via interview.

Results

The top 3 most common treatments reported were oral appliances (59%), physical therapy (54%), and jaw exercises at home (34%). Use of alternative medicine was reported more frequently among FM+ women, but self-reported improvement did not differ by comorbid FM. Physical therapy was as likely reported by FM status but self-reported improvement scores trended higher for FM+ women.

Conclusions

Oral appliances were as likely to be reported by FM comorbid as FM− women. Oral appliances did not outperform self-management treatments on self-reported improvement of facial pain.

Clinical relevance

Results support the use of self-management as first-line treatment for mTMD and potential utility of inquiring about widespread pain for treatment planning.

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Contrast-enhanced magnetic resonance imaging of facial nerve swelling in patients with severe Ramsay Hunt syndrome

Publication date: Available online 7 January 2019

Source: Auris Nasus Larynx

Author(s): Toshiya Minakata, Akira Inagaki, Shinji Sekiya, Shingo Murakami

Abstract

Objective

In Ramsay Hunt syndrome, contrast enhancement of magnetic resonance (MR) imaging seen in the affected facial nerve in the majority of cases, but its clinical significance has not been well investigated to date. The aim of this study was to elucidate the clinical significance of this imaging sign by quantitively investigating the correlation between the signal increase and swelling of the facial nerve. We also investigated the temporal change in this sign and its correlation with recovery.

Methods

We retrospectively evaluated swelling of the facial nerve in 16 patients with severe Ramsay Hunt syndrome who underwent both contrast-enhanced magnetic resonance imaging and facial nerve decompression surgery via a transmastoid approach alone or in combination with a middle cranial approach. All the patients had a Yanagihara score of ≤8 points and facial nerve degeneration of ≥90% confirmed by either a nerve excitability test or electroneurography. Swelling of the facial nerve was evaluated intraoperatively using a 4-point grading system.

Results

A significant correlation was observed between contrast enhancement on T1-weighted images and facial nerve swelling in the labyrinthine segment, geniculate ganglion, and pyramidal segment (P = 0.030, P = 0.018, and P = 0.037, respectively). Furthermore, the contrast enhancement increased significantly as more time elapsed after the onset of facial palsy (mean ± standard error, 14.7 ± 2.3 days, range, 5–42 days) in the geniculate ganglion and pyramidal segment (correlation coefficient, 0.546 and 0.689, P = 0.022 and P = 0.002, respectively). Patients with good recovery (Yanagihara score of ≥36) showed significantly lower contrast enhancement in the tympanic and mastoid segments (P = 0.021 and 0.020, respectively) than those who with poor recovery.

Conclusion

In particular segments of the facial nerve, contrast enhancement on T1-weighted image correlated with facial nerve swelling and recovery. These observations underscore the clinical significance of contrast enhancement on T1-weighted images in patients with Ramsay Hunt syndrome.

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Contrast-enhanced magnetic resonance imaging of facial nerve swelling in patients with severe Ramsay Hunt syndrome

Publication date: Available online 7 January 2019

Source: Auris Nasus Larynx

Author(s): Toshiya Minakata, Akira Inagaki, Shinji Sekiya, Shingo Murakami

Abstract

Objective

In Ramsay Hunt syndrome, contrast enhancement of magnetic resonance (MR) imaging seen in the affected facial nerve in the majority of cases, but its clinical significance has not been well investigated to date. The aim of this study was to elucidate the clinical significance of this imaging sign by quantitively investigating the correlation between the signal increase and swelling of the facial nerve. We also investigated the temporal change in this sign and its correlation with recovery.

Methods

We retrospectively evaluated swelling of the facial nerve in 16 patients with severe Ramsay Hunt syndrome who underwent both contrast-enhanced magnetic resonance imaging and facial nerve decompression surgery via a transmastoid approach alone or in combination with a middle cranial approach. All the patients had a Yanagihara score of ≤8 points and facial nerve degeneration of ≥90% confirmed by either a nerve excitability test or electroneurography. Swelling of the facial nerve was evaluated intraoperatively using a 4-point grading system.

Results

A significant correlation was observed between contrast enhancement on T1-weighted images and facial nerve swelling in the labyrinthine segment, geniculate ganglion, and pyramidal segment (P = 0.030, P = 0.018, and P = 0.037, respectively). Furthermore, the contrast enhancement increased significantly as more time elapsed after the onset of facial palsy (mean ± standard error, 14.7 ± 2.3 days, range, 5–42 days) in the geniculate ganglion and pyramidal segment (correlation coefficient, 0.546 and 0.689, P = 0.022 and P = 0.002, respectively). Patients with good recovery (Yanagihara score of ≥36) showed significantly lower contrast enhancement in the tympanic and mastoid segments (P = 0.021 and 0.020, respectively) than those who with poor recovery.

Conclusion

In particular segments of the facial nerve, contrast enhancement on T1-weighted image correlated with facial nerve swelling and recovery. These observations underscore the clinical significance of contrast enhancement on T1-weighted images in patients with Ramsay Hunt syndrome.

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Analysis of Various Factors and Techniques to Improve Outcome of Surgical Management of 243 Cases of CSF Rhinorrhea

Abstract

Cerebrospinal fluid (CSF) rhinorrhea occurs when there is a communication between subarachnoid space and sinonasal mucosa due to meningeal, osseous and mucosal defects in the cranial base leading to discharge of CSF from the nose. The risk of developing meningitis after CSF rhinorrhea may vary from 5.6 (Leech and Paterson in Lancet 1:1013–1016, 1973) to 60% (Eljarnel and Foy in Br J Neurosurg 5:275–279, 1991). Hence surgical management of CSF rhinorrhea is highly recommended. Transnasal endoscopic approach first described by Wigand in 1981, has been proven to be the approach of choice in comparison to intracranial and external nasal approach (Jones and Becker in Br Med J 322:122–123, 2001) in most cases. The next defining milestone was the pedicled naso septal vascularized flap described by Hadad et al. (Laryngoscope 116(10):1882–1886, 2006), which could be used to manage large defects. In the present study we assessed 243 cases of CSF rhinorrhea managed by transnasal endoscopic approach. We compared the various factors associated with CSF rhinorrhea and the correlation with the outcome of the surgical treatment. We also analyzed the different sites and techniques of surgical repair and have certain recommendations to improve the surgical outcome. The commonest cause of CSF leak was spontaneous (54.32%) and the commonest site was cribriform plate (43.24%). Patients presented most commonly with watery nasal discharge (82.3%). CT scan with cisternography or MR cisternography is the gold standard to identify the suspected site of leak. Out of 243 patients, 77.77% were operated using free grafts and 22.22% by flap repair. Results are comparable. Hence we would advise simple conservative technique with free grafts to reduce morbidity and shorten the postoperative recovery.

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Analysis of Various Factors and Techniques to Improve Outcome of Surgical Management of 243 Cases of CSF Rhinorrhea

Abstract

Cerebrospinal fluid (CSF) rhinorrhea occurs when there is a communication between subarachnoid space and sinonasal mucosa due to meningeal, osseous and mucosal defects in the cranial base leading to discharge of CSF from the nose. The risk of developing meningitis after CSF rhinorrhea may vary from 5.6 (Leech and Paterson in Lancet 1:1013–1016, 1973) to 60% (Eljarnel and Foy in Br J Neurosurg 5:275–279, 1991). Hence surgical management of CSF rhinorrhea is highly recommended. Transnasal endoscopic approach first described by Wigand in 1981, has been proven to be the approach of choice in comparison to intracranial and external nasal approach (Jones and Becker in Br Med J 322:122–123, 2001) in most cases. The next defining milestone was the pedicled naso septal vascularized flap described by Hadad et al. (Laryngoscope 116(10):1882–1886, 2006), which could be used to manage large defects. In the present study we assessed 243 cases of CSF rhinorrhea managed by transnasal endoscopic approach. We compared the various factors associated with CSF rhinorrhea and the correlation with the outcome of the surgical treatment. We also analyzed the different sites and techniques of surgical repair and have certain recommendations to improve the surgical outcome. The commonest cause of CSF leak was spontaneous (54.32%) and the commonest site was cribriform plate (43.24%). Patients presented most commonly with watery nasal discharge (82.3%). CT scan with cisternography or MR cisternography is the gold standard to identify the suspected site of leak. Out of 243 patients, 77.77% were operated using free grafts and 22.22% by flap repair. Results are comparable. Hence we would advise simple conservative technique with free grafts to reduce morbidity and shorten the postoperative recovery.

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Is a Bone Marrow Biopsy Optional or Essential in the Evaluation of the Patient with a Suspected Mast Cell Disorder?

Publication date: Available online 8 January 2019

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Paul A. Greenberger, Dean D. Metcalfe

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Is a Bone Marrow Biopsy Optional or Essential in the Evaluation of the Patient with a Suspected Mast Cell Disorder?

Publication date: Available online 8 January 2019

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Paul A. Greenberger, Dean D. Metcalfe

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MRI features suggestive of gadolinium retention do not correlate with Expanded Disability Status Scale worsening in Multiple Sclerosis

Abstract

Purpose

Different studies showed correlations between gadolinium-based contrast agent (GBCA) administrations and dentate nucleus (DN) T1-weighted hyperintensity. The clinical impact of gadolinium retention, however, is still largely unknown. The aim of this study was to investigate relations between MRI and clinical disability in relapsing–remitting multiple sclerosis (RR-MS) patients.

Methods

In this retrospective study, clinical data were obtained from 74 RR-MS patients at baseline and after a mean follow-up time of 3.6 years, including the expanded disability status scale (EDSS) score and its change (ΔEDSS). Patients were considered showing clinical worsening if they score a ΔEDSS ≥ 1 (for baseline EDSS ≤ 5.5) or ΔEDSS ≥ 0.5 (for baseline EDSS > 5.5). From the MRI data, the presence of bilateral DN hyperintensity was recorded along with the calculation of longitudinal relaxation rate (R1) maps.

Results

Patients with DN hyperintensity showed similar ΔEDSS change compared to those without visible changes on T1-weighted images (p = 0.32). Similarly, no DN-R1 difference was found comparing stable patients with those showing a significant clinical worsening (p = 0.54). Finally, no significant effect of DN-R1 values explained the variance in ΔEDSS (p = 0.76), thus suggesting their independence from the clinical outcome.

Conclusions

MS patients with DN hyperintensity show similar EDSS changes compared to subjects without DN high-signal intensity. Furthermore, mean DN-R1 values of patients with significant clinical worsening were comparable to those of stable subjects and were unrelated to clinical disability. Taken together, these findings suggest that gadolinium retention in the brain of MS patients does not affect their clinical worsening, expressed by the EDSS change.

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MRI features suggestive of gadolinium retention do not correlate with Expanded Disability Status Scale worsening in Multiple Sclerosis

Abstract

Purpose

Different studies showed correlations between gadolinium-based contrast agent (GBCA) administrations and dentate nucleus (DN) T1-weighted hyperintensity. The clinical impact of gadolinium retention, however, is still largely unknown. The aim of this study was to investigate relations between MRI and clinical disability in relapsing–remitting multiple sclerosis (RR-MS) patients.

Methods

In this retrospective study, clinical data were obtained from 74 RR-MS patients at baseline and after a mean follow-up time of 3.6 years, including the expanded disability status scale (EDSS) score and its change (ΔEDSS). Patients were considered showing clinical worsening if they score a ΔEDSS ≥ 1 (for baseline EDSS ≤ 5.5) or ΔEDSS ≥ 0.5 (for baseline EDSS > 5.5). From the MRI data, the presence of bilateral DN hyperintensity was recorded along with the calculation of longitudinal relaxation rate (R1) maps.

Results

Patients with DN hyperintensity showed similar ΔEDSS change compared to those without visible changes on T1-weighted images (p = 0.32). Similarly, no DN-R1 difference was found comparing stable patients with those showing a significant clinical worsening (p = 0.54). Finally, no significant effect of DN-R1 values explained the variance in ΔEDSS (p = 0.76), thus suggesting their independence from the clinical outcome.

Conclusions

MS patients with DN hyperintensity show similar EDSS changes compared to subjects without DN high-signal intensity. Furthermore, mean DN-R1 values of patients with significant clinical worsening were comparable to those of stable subjects and were unrelated to clinical disability. Taken together, these findings suggest that gadolinium retention in the brain of MS patients does not affect their clinical worsening, expressed by the EDSS change.

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Artificial intelligence, machine learning, and the human interface in medicine: Is there a sweet spot for oral and maxillofacial radiology?

Publication date: Available online 8 January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Aditya Tadinada

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Artificial intelligence, machine learning, and the human interface in medicine: Is there a sweet spot for oral and maxillofacial radiology?

Publication date: Available online 8 January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Aditya Tadinada

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The role of immediate versus secondary removal of the odontogenic focus in treatment of deep head and neck space infections. A retrospective analysis of 248 patients

Abstract

Objectives

Aim of this study was to investigate conditions and predisposing factors for head and neck infection progress regarding the length of stay (LOS) in hospital, with special emphasis on the time of removal of the odontogenic infection focus.

Material and methods

A 3-year retrospective study reviewed hospital records of 248 subjects who were treated under inpatient conditions with severe odontogenic infections who received surgical incisions, drainage, and intravenous (IV) antibiotics. Outcomes measured included age, gender, involved fascial spaces, LOS, number of infected spaces, antibiotics administered, and comorbidities. We precisely recorded the time between abscess incision and focus extraction.

Results

Removal of infection focus (tooth) in the same stay (1 stay, n = 106; group 1; mean 6.5 days ± 3) showed significantly higher (p = 0.042) LOS than extraction in a second stay (2 stays, n = 46; group 2; 5.3 ± 3.1). Group 3 patients showed infection after removal of teeth in outpatient management (1 stay ex-op, n = 96) and presented significantly lower LOS (5.6 ± 2.5) compared to group 1 (p = 0.0216). LOS of group 3 to group 2 patients showed no significance (p = 0.668). Infection expansion and diabetes showed a significant increase of LOS.

Conclusion

Simultaneous removal of infection focus and abscess incision leads to the lowest LOS. If tooth extraction is performed after incision, subsequent focus extraction performed in a second stay shows lower overall-LOS than extraction at the same stay at later stage.

Clinical relevance

Multiple factors tend to increase the LOS of patients with severe head and neck infections of odontogenic origin. Our data reveals the role of removal of odontogenic focus and additionally ranks further parameters that influence the LOS. Based on our findings, decisions regarding the surgical treatment can be recommended.

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The role of immediate versus secondary removal of the odontogenic focus in treatment of deep head and neck space infections. A retrospective analysis of 248 patients

Abstract

Objectives

Aim of this study was to investigate conditions and predisposing factors for head and neck infection progress regarding the length of stay (LOS) in hospital, with special emphasis on the time of removal of the odontogenic infection focus.

Material and methods

A 3-year retrospective study reviewed hospital records of 248 subjects who were treated under inpatient conditions with severe odontogenic infections who received surgical incisions, drainage, and intravenous (IV) antibiotics. Outcomes measured included age, gender, involved fascial spaces, LOS, number of infected spaces, antibiotics administered, and comorbidities. We precisely recorded the time between abscess incision and focus extraction.

Results

Removal of infection focus (tooth) in the same stay (1 stay, n = 106; group 1; mean 6.5 days ± 3) showed significantly higher (p = 0.042) LOS than extraction in a second stay (2 stays, n = 46; group 2; 5.3 ± 3.1). Group 3 patients showed infection after removal of teeth in outpatient management (1 stay ex-op, n = 96) and presented significantly lower LOS (5.6 ± 2.5) compared to group 1 (p = 0.0216). LOS of group 3 to group 2 patients showed no significance (p = 0.668). Infection expansion and diabetes showed a significant increase of LOS.

Conclusion

Simultaneous removal of infection focus and abscess incision leads to the lowest LOS. If tooth extraction is performed after incision, subsequent focus extraction performed in a second stay shows lower overall-LOS than extraction at the same stay at later stage.

Clinical relevance

Multiple factors tend to increase the LOS of patients with severe head and neck infections of odontogenic origin. Our data reveals the role of removal of odontogenic focus and additionally ranks further parameters that influence the LOS. Based on our findings, decisions regarding the surgical treatment can be recommended.

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Point of care creatinine testing in diagnostic imaging: A feasibility study within the outpatient computed tomography setting

Publication date: Available online 8 January 2019

Source: European Journal of Radiology

Author(s): Beverly Snaith, Martine A. Harris, Bethany Shinkins, Michael Messenger, Andrew Lewington, Marieke Jordaan, Nicholas Spencer

Abstract

Introduction

Although the risks associated with iodinated contrast administration are acknowledged to be very low, screening of kidney function prior to administration is still standard practice in many hospitals. This study has evaluated the feasibility of implementing a screening form in conjunction with point of care (PoC) creatinine testing as a method to manage the risks of post contrast acute kidney injury (PC-AKI) within the CT imaging pathway.

Method

Over an eight-week period 300 adult outpatients attending a UK CT department for contrast-enhanced scans were approached. Participants completed a screening questionnaire for co-morbidities linked to kidney dysfunction and consented to have a PoC and laboratory creatinine tests. Comparison was made against with previous baseline blood tests obtained within the preceding 3 months, as required by the study site. Participants were also invited to attend for follow up PoC and laboratory bloods tests at 48-72 hours.

Results

14 patients (4.7%) had a scan-day eGFR below 45mL/min/1.73m2, all identified through screening. The majority of patients (n=281/300; 93.7%) fell in the same risk category based on previous and scan-day blood results. Six PoC test failures were recorded on the scan day. The constant error between the Abbott i-STAT PoC scan-day measurements and the laboratory scan-day measurements was -3.71 (95% CI: -6.41 to -0.50). Five patients had an elevated creatinine (≥25%) post contrast administration, but no instances of PC-AKI (≥50%) were identified.

Conclusion

PoC creatinine testing is a practical method of ensuring renal function and is feasible in the radiology environment.

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Prediction of EGFR Mutations by Conventional CT-Features in Advanced Pulmonary Adenocarcinoma

Publication date: Available online 7 January 2019

Source: European Journal of Radiology

Author(s): Yanqing Chen, Yang Yang, Longbai Ma, Huiyuan Zhu, Tienan Feng, Sen Jiang, Youyong Wei, Tingting Wang, Xiwen Sun

Abstract

Objective

This study assessed the ability of conventional computed tomography (CT) features (including primary tumors, metastatic lesions, lymph nodes, and emphysema) to predict epidermal growth factor receptor (EGFR) mutations in advanced pulmonary adenocarcinoma.

Methods

Patients who were diagnosed with advanced pulmonary adenocarcinoma between January 2017 and August 2017 and had undergone a chest CT and EGFR mutation testing were enrolled in this retrospective study. Qualitative and quantitative CT-features and clinical characteristics evaluated in this study included: primary tumor location, size, and morphology (including degree of lobulation, density, calcification, cavitation, vacuole sign, and air bronchogram), size and distribution of lung and pleural metastatic nodules, size and status of hilar and mediastinal lymph nodes, emphysema, organs with distant metastasis, and patient age, sex, and smoking history.

Results

Of 201 patients, 107 (53.23%) were EGFR-mutation positive. The multivariate logistic regression indicated that EGFR mutations were significantly associated with smaller lymph nodes, a lower percentage of deep lobulation of the primary tumor and partial fusion of lymph nodes, and absence of emphysema. The area under the curve of logistic regression model for predicting EGFR mutations was 0.898.

Conclusions

Conventional CT-features, including emphysema, degree of primary tumor lobulation, and lymph node size and status, help to predict the presence or absence of EGFR mutations in advanced pulmonary adenocarcinoma. Additionally, these same CT-features demonstrated that the CT manifestations of the EGFR mutant group were of relatively lower malignancy and less invasive as compared to the wild-type EGFR group.

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Meta-analysis of ultrasound for cervical lymph nodes in papillary thyroid cancer: diagnosis of central and lateral compartment nodal metastases

Publication date: Available online 7 January 2019

Source: European Journal of Radiology

Author(s): Hengqiang Zhao, Hehe Li

Abstract

Purpose

To evaluate the performance of preoperative ultrasound in the diagnosis of cervical lymph nodes metastases (CLNM) of papillary thyroid cancer (PTC) and its value in assisting cervical lymph node dissection (CLND).

Methods

PubMed, EMBASE and Cochrane Library databases were searched to identify relevant studies up to Sep. 2017. Overall sensitivity, specificity, and diagnostic odds ratio (DOR) were used to assess the diagnostic efficacy of ultrasound in detecting central and lateral CLNM of PTC.

Results

Nineteen studies comprising 4014 patients were included in the meta-analysis. The pooled sensitivity, specificity, DOR and area under curve (AUC) of ultrasound in detecting central CLNM were 0.33 (95% confidence interval (95% CI): 0.31–0.35), 0.93 (95% CI: 0.92–0.94), 5.63 (95% CI: 3.50–9.04), and 0.69, respectively; and lateral CLNM were 0.70 (95% CI: 0.68–0.72), 0.84 (95% CI: 0.82–0.85), 18.7 (95% CI: 10.3–33.9) and 0.88, respectively. We found that the rate of central CLNM of PTC was 48.0%, and 36.2% of the dissected lymph nodes were metastatic, meanwhile, the rate of lateral CLNM of PTC was 59.2%, and 46.6% of the dissected lymph nodes were metastatic in the meta-analysis.

Conclusions

Preoperative ultrasound demonstrates poor sensitivity in the diagnosis of central CLNM, and good diagnostic efficacy for lateral CLNM of PTC. Prophylactic central CLND is recommended to PTC patients due to the high incidence of central CLNM and low diagnostic efficacy of ultrasound.

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Point of care creatinine testing in diagnostic imaging: A feasibility study within the outpatient computed tomography setting

Publication date: Available online 8 January 2019

Source: European Journal of Radiology

Author(s): Beverly Snaith, Martine A. Harris, Bethany Shinkins, Michael Messenger, Andrew Lewington, Marieke Jordaan, Nicholas Spencer

Abstract

Introduction

Although the risks associated with iodinated contrast administration are acknowledged to be very low, screening of kidney function prior to administration is still standard practice in many hospitals. This study has evaluated the feasibility of implementing a screening form in conjunction with point of care (PoC) creatinine testing as a method to manage the risks of post contrast acute kidney injury (PC-AKI) within the CT imaging pathway.

Method

Over an eight-week period 300 adult outpatients attending a UK CT department for contrast-enhanced scans were approached. Participants completed a screening questionnaire for co-morbidities linked to kidney dysfunction and consented to have a PoC and laboratory creatinine tests. Comparison was made against with previous baseline blood tests obtained within the preceding 3 months, as required by the study site. Participants were also invited to attend for follow up PoC and laboratory bloods tests at 48-72 hours.

Results

14 patients (4.7%) had a scan-day eGFR below 45mL/min/1.73m2, all identified through screening. The majority of patients (n=281/300; 93.7%) fell in the same risk category based on previous and scan-day blood results. Six PoC test failures were recorded on the scan day. The constant error between the Abbott i-STAT PoC scan-day measurements and the laboratory scan-day measurements was -3.71 (95% CI: -6.41 to -0.50). Five patients had an elevated creatinine (≥25%) post contrast administration, but no instances of PC-AKI (≥50%) were identified.

Conclusion

PoC creatinine testing is a practical method of ensuring renal function and is feasible in the radiology environment.

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Prediction of EGFR Mutations by Conventional CT-Features in Advanced Pulmonary Adenocarcinoma

Publication date: Available online 7 January 2019

Source: European Journal of Radiology

Author(s): Yanqing Chen, Yang Yang, Longbai Ma, Huiyuan Zhu, Tienan Feng, Sen Jiang, Youyong Wei, Tingting Wang, Xiwen Sun

Abstract

Objective

This study assessed the ability of conventional computed tomography (CT) features (including primary tumors, metastatic lesions, lymph nodes, and emphysema) to predict epidermal growth factor receptor (EGFR) mutations in advanced pulmonary adenocarcinoma.

Methods

Patients who were diagnosed with advanced pulmonary adenocarcinoma between January 2017 and August 2017 and had undergone a chest CT and EGFR mutation testing were enrolled in this retrospective study. Qualitative and quantitative CT-features and clinical characteristics evaluated in this study included: primary tumor location, size, and morphology (including degree of lobulation, density, calcification, cavitation, vacuole sign, and air bronchogram), size and distribution of lung and pleural metastatic nodules, size and status of hilar and mediastinal lymph nodes, emphysema, organs with distant metastasis, and patient age, sex, and smoking history.

Results

Of 201 patients, 107 (53.23%) were EGFR-mutation positive. The multivariate logistic regression indicated that EGFR mutations were significantly associated with smaller lymph nodes, a lower percentage of deep lobulation of the primary tumor and partial fusion of lymph nodes, and absence of emphysema. The area under the curve of logistic regression model for predicting EGFR mutations was 0.898.

Conclusions

Conventional CT-features, including emphysema, degree of primary tumor lobulation, and lymph node size and status, help to predict the presence or absence of EGFR mutations in advanced pulmonary adenocarcinoma. Additionally, these same CT-features demonstrated that the CT manifestations of the EGFR mutant group were of relatively lower malignancy and less invasive as compared to the wild-type EGFR group.

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Meta-analysis of ultrasound for cervical lymph nodes in papillary thyroid cancer: diagnosis of central and lateral compartment nodal metastases

Publication date: Available online 7 January 2019

Source: European Journal of Radiology

Author(s): Hengqiang Zhao, Hehe Li

Abstract

Purpose

To evaluate the performance of preoperative ultrasound in the diagnosis of cervical lymph nodes metastases (CLNM) of papillary thyroid cancer (PTC) and its value in assisting cervical lymph node dissection (CLND).

Methods

PubMed, EMBASE and Cochrane Library databases were searched to identify relevant studies up to Sep. 2017. Overall sensitivity, specificity, and diagnostic odds ratio (DOR) were used to assess the diagnostic efficacy of ultrasound in detecting central and lateral CLNM of PTC.

Results

Nineteen studies comprising 4014 patients were included in the meta-analysis. The pooled sensitivity, specificity, DOR and area under curve (AUC) of ultrasound in detecting central CLNM were 0.33 (95% confidence interval (95% CI): 0.31–0.35), 0.93 (95% CI: 0.92–0.94), 5.63 (95% CI: 3.50–9.04), and 0.69, respectively; and lateral CLNM were 0.70 (95% CI: 0.68–0.72), 0.84 (95% CI: 0.82–0.85), 18.7 (95% CI: 10.3–33.9) and 0.88, respectively. We found that the rate of central CLNM of PTC was 48.0%, and 36.2% of the dissected lymph nodes were metastatic, meanwhile, the rate of lateral CLNM of PTC was 59.2%, and 46.6% of the dissected lymph nodes were metastatic in the meta-analysis.

Conclusions

Preoperative ultrasound demonstrates poor sensitivity in the diagnosis of central CLNM, and good diagnostic efficacy for lateral CLNM of PTC. Prophylactic central CLND is recommended to PTC patients due to the high incidence of central CLNM and low diagnostic efficacy of ultrasound.

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The Incidence of velopharyngeal insufficiency and oronasal fistula after primary palatal surgery with Sommerlad intravelar veloplasty: a retrospective study in Isfahan Cleft Care Team

Publication date: Available online 8 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Dorsa Mapar, Fatemeh Khanlar, Saba Sadeghi, Hossein Abdali, Mehrdad Memarzadeh, Heydar Ali Davari, Fatemeh Derakhshandeh

Abstract

Objectives

This study was designed to determine the incidence of velopharyngeal insufficiency (VPI), oronasal fistula development and facial grimace in patients seen by Isfahan Cleft Care Team (ICCT) after primary Sommerlad intravelar veloplasty (SIVV). Furthermore the association of gender, cleft type and age at primary surgery with the incidence of hypernasality and fistula is determined.

Methods

A group of 40 patients with history of cleft palate with or without cleft lip were identified from the records of ICCT between 2011 and 2014. The main outcome measures were the incidence of hypernasality and fistula after primary palate repair with SIVV. Speech recordings were analyzed by consensus by two speech therapists according to the Cleft Audit Protocol for Speech- Augmented (CAPS-A), (Kappa =82.4). Deciding whether or not to have a fistula was based on the oral examination videos.

Results

Severe and moderate hypernasality was observed in 42.5% of patients. Normal resonance and mild/borderline hypernasality was observed in 37.5% and 20% of patients, respectively. The frequency of fistulas was 17.5%. There was a significant association between hypernasality with cleft type and the age at primary surgery (p <0.05).

Conclusion

Significant progress has been made in the outcomes of the primary palate surgeries with the SIVV technique compared to the previous study in the ICCT.

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Reducing the Need for General Anesthesia in the Repair of Choanal Atresia with Steroid-Eluting Stents: A Case Series

Publication date: Available online 7 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Joseph B. Meleca, Samantha Anne, Brandon Hopkins

Abstract

Introduction

Choanal atresia (CA) is a rare pediatric congenital disorder resulting in upper airway obstruction and respiratory distress in the setting of obligate nasal breathing in infants. In 2016, a novel technique was reported in the literature utilizing drug-eluting stents to correct CA. However, 2 out of 3 patients in the study required a second operation under general anesthesia. The repeated visits to the operating room for evaluations and debridement under general anesthesia continues to be a concern for increased morbidity and mortality in infants undergoing repair of CA.

Methods

A case series of three (3) patients who underwent repair of CA. Outcomes were measured by post-operative, in-office flexible nasoendoscopy.

Results

Each patient was implanted with mometasone furoate drug-eluting stents at the conclusion of the operation. Post-operatively, patients were instructed to perform nasal saline rinses 3-4 times daily. Outpatient follow-up between 6-17 months showed patent nasal passages on nasal endoscopy. There were no post-operative complications. Moreover, patients only underwent a single episode of general anesthesia at time of initial repair.

Conclusions

In our study, we report successful outcomes using drugeluting stents for one-stage surgical correction of CA, therefore negating the need for children to undergo multiple subjections to general anesthetics.

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Can standard deviation of overnight pulse oximetry be used to screen childhood obstructive sleep apnea

Publication date: Available online 7 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Siriporn Warapongmanupong, Aroonwan Preutthipan

Abstract

Objectives

Pulse oximetry (PO) has been frequently used as an alternative test to polysomnography (PSG) in children. We conducted this study to determine which statistical parameters obtained from overnight PO monitoring would be most suitable and to evaluate its diagnostic performance.

Methods

We prospectively recruited children with snoring referred for PSG. Subjects were monitored with PO while performing PSG. Eight statistical parameters of SpO₂ data were analyzed to identify which had the best diagnostic performance as assessed by the area under the receiver-operating characteristic curve (AUC). To validate this parameter (which was found to be the standard deviation, SD) in a larger population, we retrospectively extracted raw data of SpO₂ from our previous PSG records, calculated the SD of each patient, and assessed its AUC.

Results

A total of 166 children were recruited in the first phase. SD of SpO₂ was found to have the largest AUC. In the second phase, raw data of 457 patients were extracted. SD of SpO₂ correlated well with the apnea/hypopnea index (AHI) (r=0.6, P<0.001). For diagnosis of moderate to severe obstructive sleep apnea (OSA) (AHI ≥5 events/h), AUC was 0.74. SD of SpO₂ ≥1.06 representing mean + 2SD of normal to mild OSA (AHI <5) provided 97% specificity and 92% positive predictive value. The positive likelihood ratio was 11.

Conclusion

Calculating the SD of SpO₂, which quantifies the amount of dispersion of SpO₂ values, is a useful initial investigation in childhood OSA. An SD ≥1.06 can predict moderate to severe OSA with confidence. This parameter is simple, practical, and readily accessible.

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Aural and nasal foreign bodies in children – Epidemiology and correlation with hyperkinetic disorders, developmental disorders and congenital malformations

Publication date: Available online 7 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Tobias Schuldt, Wilma Großmann, Nora M. Weiss, Atilla Ovari, Robert Mlynski, Sebastian P. Schraven

Abstract

Objectives

Foreign body incorporation in children is often a serious situation. Attention deficit hyperactivity disorder (ADHD) could be a risk factor for self-insertion of foreign bodies. Large cohort analyses are missing.

Methods

This was a retrospective analysis of patients' records from a health insurance company representing 2.19% of the German population and 1.75% of German children and adolescents. According to the International Classification of Diseases, children in the age range between 1 and 18 years have been screened for foreign bodies in ear, nasal sinus and nostrils as well as for hyperkinetic disorders (F90), disorders of psychological development (F80–F89), and congenital malformations, deformations and chromosomal abnormalities (Q00–Q99).

Results

In total, 12887 children (6609 male; 6278 female) have been treated in 16929 cases. The majority (n=10041 (77.9%)) presented with foreign body incorporation on a single occasion. On average, 1.31 cases of foreign body treatment were recorded per child; 14.1% of children with foreign body treatment (FBT) also had a record of hyperkinetic disorder, 52.7% had a disorder of psychological development, and 50.8% a congenital malformation. Mean occurrence of FBT was 174.8 days before the diagnosis of a hyperkinetic disorder but 517.2 days after the diagnosis of a psychological development disorder and 683.1 days after the diagnosis of a congenital malformation, deformation or chromosomal abnormality.

Conclusion

Patients with disorders of psychological development as well as children with congenital malformations are high-risk patients for nasal and aural foreign bodies. The prevalence of a hyperkinetic disorder in patients with FBT is much higher than in the normal population. ADHD is a risk factor for foreign bodies.

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