Autogenous Mandibular Bone Graft for Maxillary LeFort I Osteotomy Inter-positional Gap in Orthognathic Surgery: A Technique Case Series

Correction of maxillofacial skeletal dental deformities often includes surgical interventions in the maxilla and mandible. LeFort I maxillary osteotomies are performed to correct maxillary horizontal, vertical and transverse discrepancies. Repositioning of the maxilla creates an inter-positional gap in bone which may lead to psuedoarthrosis, instability, mobility, infection and eventual relapse. Grafting the inter-positional gap with bone creates mechanical stops to prevent relapse, provides a matrix for secondary ossification, accelerates bony union and inhibits soft tissue herniation.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Tw5zGZ

Buccal nerve dissection via an intraoral approach: correcting an error regarding buccal nerve blockade

The buccal nerve (BN) supplies sensation to the skin over the anterior part of the buccinator and the buccal mucosa, as well as the buccal gingivae corresponding to the second and third molar teeth. Some dental anatomy books show the main trunk of the BN coursing over the buccal shelf of the mandible, which leads to a significant misunderstanding of this anatomy. Therefore, this study aims to reveal the course of the BN on the retromolar area and establish new evidence based anatomy for appropriate buccal nerve blockade.

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

Mind the gaps: clinical trial concepts to address unanswered questions in aeroallergen immunotherapy. An NIAID/AHRQ Workshop

Study designs are presented that could be used to address basic questions in immunotherapy: efficacy of SLIT vs. SCIT, appropriate number of allergens for immunotherapy, dose and duration of SCIT, and SCIT as preventive therapy.

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

Mast cells within cellular networks

Mast cells are highly versatile in terms of their mode of activation by a host of stimuli and their ability to flexibly release a plethora of biologically highly active mediators. Within the immune system, mast cells can best be designated as an active nexus interlinking innate and adaptive immunity. Herein, we try to draw an arc from the initiation of acute inflammatory reactions to microbial pathogens to the development of adaptive immunity and allergies. This multifaceted nature of mast cells is made possible by the interaction with multiple cell types of immunological and non-immunological origin.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2D8FtmE

New graft manipulation strategies improved outcome of mismatched stem cell transplantation in children with primary immunodeficiencies

Mismatched stem cell transplantation is associated with high risk of graft loss, graft versus host disease (GvHD) and transplant related mortality (TRM). Alternative graft manipulation strategies have been employed over the last 11 years to reduce these risks.

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

Activation of Group 2 innate lymphoid cells after allergen challenge in asthmatics

This study is first to show ILC2 recruitment from the circulation to the lung in response to an allergic airway inflammation in humans, where they become locally activated to further promote type 2 inflammation.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2D6uutO

Mind the gaps: clinical trial concepts to address unanswered questions in aeroallergen immunotherapy. An NIAID/AHRQ Workshop

Study designs are presented that could be used to address basic questions in immunotherapy: efficacy of SLIT vs. SCIT, appropriate number of allergens for immunotherapy, dose and duration of SCIT, and SCIT as preventive therapy.

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

Mast cells within cellular networks

Mast cells are highly versatile in terms of their mode of activation by a host of stimuli and their ability to flexibly release a plethora of biologically highly active mediators. Within the immune system, mast cells can best be designated as an active nexus interlinking innate and adaptive immunity. Herein, we try to draw an arc from the initiation of acute inflammatory reactions to microbial pathogens to the development of adaptive immunity and allergies. This multifaceted nature of mast cells is made possible by the interaction with multiple cell types of immunological and non-immunological origin.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2D8FtmE

New graft manipulation strategies improved outcome of mismatched stem cell transplantation in children with primary immunodeficiencies

Mismatched stem cell transplantation is associated with high risk of graft loss, graft versus host disease (GvHD) and transplant related mortality (TRM). Alternative graft manipulation strategies have been employed over the last 11 years to reduce these risks.

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

Activation of Group 2 innate lymphoid cells after allergen challenge in asthmatics

This study is first to show ILC2 recruitment from the circulation to the lung in response to an allergic airway inflammation in humans, where they become locally activated to further promote type 2 inflammation.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2D6uutO

CT perfusion hypervolemia: brain ischemia or stroke mimic?

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DV7HCZ

CT perfusion hypervolemia: brain ischemia or stroke mimic?

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DV7HCZ

The efficacy and limitations of USI for diagnosing TMJ internal derangements

Abstract

Introduction

This study was conducted to determine the effectiveness of ultrasonographic imaging for diagnosing temporomandibular joint internal derangements.

Materials and methods

Ultrasonographic and magnetic resonance imaging scans of temporomandibular joints were obtained bilaterally in 55 patients who had temporomandibular joint disorders and who were diagnosed with temporomandibular joint internal derangements following a clinical examination. Diagnostic accuracy of ultrasonographic imaging was assessed considering magnetic resonance imaging as the gold standard method.

Results

When the results of ultrasonographic imaging and magnetic resonance imaging were compared, the diagnostic accuracy of ultrasonographic imaging was 0.81 for detecting TMJ disc displacement. The diagnostic accuracy of ultrasonographic imaging in detecting TMJ disc position was 0.81 in the closed-mouth position and 0.93 in the open-mouth position.

Conclusion

As a noninvasive and reproducible imaging method acquiring dynamic images, ultrasonographic imaging is a successful method in the evaluation of temporomandibular joint disc displacement.

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

The efficacy and limitations of USI for diagnosing TMJ internal derangements

Abstract

Introduction

This study was conducted to determine the effectiveness of ultrasonographic imaging for diagnosing temporomandibular joint internal derangements.

Materials and methods

Ultrasonographic and magnetic resonance imaging scans of temporomandibular joints were obtained bilaterally in 55 patients who had temporomandibular joint disorders and who were diagnosed with temporomandibular joint internal derangements following a clinical examination. Diagnostic accuracy of ultrasonographic imaging was assessed considering magnetic resonance imaging as the gold standard method.

Results

When the results of ultrasonographic imaging and magnetic resonance imaging were compared, the diagnostic accuracy of ultrasonographic imaging was 0.81 for detecting TMJ disc displacement. The diagnostic accuracy of ultrasonographic imaging in detecting TMJ disc position was 0.81 in the closed-mouth position and 0.93 in the open-mouth position.

Conclusion

As a noninvasive and reproducible imaging method acquiring dynamic images, ultrasonographic imaging is a successful method in the evaluation of temporomandibular joint disc displacement.

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

Cognitive predictors of sentence comprehension in children with and without developmental language disorder: Implications for assessment and treatment

. (Source: International Journal of Speech-Language Pathology)

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Detecting Bulbar Motor Involvement in ALS: Comparing speech and chewing tasks

. (Source: International Journal of Speech-Language Pathology)

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Quality of life in primary progressive aphasia: What do we know and what can we do next?

. (Source: Aphasiology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2S8MgXG

Cognitive predictors of sentence comprehension in children with and without developmental language disorder: Implications for assessment and treatment

. (Source: International Journal of Speech-Language Pathology)

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Detecting Bulbar Motor Involvement in ALS: Comparing speech and chewing tasks

. (Source: International Journal of Speech-Language Pathology)

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Quality of life in primary progressive aphasia: What do we know and what can we do next?

. (Source: Aphasiology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2S8MgXG

Levels of horse allergen Equ C 4 in dander and saliva from ten horse breeds

Abstract

Background

Horses are an important source of allergens, but the distribution of horse allergens is poorly understood. Five horse allergens have been identified, Equ c 1‐4 and 6. Equ c 4 seems to be an important allergen, with an IgE‐binding frequency of 77% in horse‐sensitized individuals.

Objectives

The aim of this study was to investigate levels of horse allergen Equ c 4 in dander, saliva and urine from ten horse breeds.

Method: The study population included 170 horses (87 mares, 27 stallions, 56 geldings) from ten breeds. Horse dander, saliva and urine samples were collected. Levels of horse allergen Equ c 4 were quantified using a two‐site sandwich ELISA (mAb 103 and 14G4) and were expressed as Equ c 4 U/μg protein.

Results

The horse allergen Equ c 4 was present in all dander and saliva samples from ten horse breeds, with high within‐breed and inter‐breed variations; GM values were 639 Equ c 4 U /μg protein (range 5 – 15264) for dander and 39.5 (4 – 263) for saliva. Equ c 4 was found in 19/21 urine samples. Adjusted for age, sex and changes over time, no differences between breeds could be seen in dander, while in saliva the North Swedish horse showed lower levels of Equ c 4 than any other breed. The levels of Equ c 4 protein in dander and saliva were significantly higher in samples from stallions compared to mares and geldings, independent of breed.

Conclusions & Clinical Relevance

The results show a high variability in allergen levels of Equ c 4 in dander and saliva both within and between breeds. Significantly higher levels were found in stallions compared to mares and geldings, independent of breed. Results suggest that none of the horse breeds studied can be recommended for individuals allergic to Equ c 4.

This article is protected by copyright. All rights reserved.

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

Levels of horse allergen Equ C 4 in dander and saliva from ten horse breeds

Abstract

Background

Horses are an important source of allergens, but the distribution of horse allergens is poorly understood. Five horse allergens have been identified, Equ c 1‐4 and 6. Equ c 4 seems to be an important allergen, with an IgE‐binding frequency of 77% in horse‐sensitized individuals.

Objectives

The aim of this study was to investigate levels of horse allergen Equ c 4 in dander, saliva and urine from ten horse breeds.

Method: The study population included 170 horses (87 mares, 27 stallions, 56 geldings) from ten breeds. Horse dander, saliva and urine samples were collected. Levels of horse allergen Equ c 4 were quantified using a two‐site sandwich ELISA (mAb 103 and 14G4) and were expressed as Equ c 4 U/μg protein.

Results

The horse allergen Equ c 4 was present in all dander and saliva samples from ten horse breeds, with high within‐breed and inter‐breed variations; GM values were 639 Equ c 4 U /μg protein (range 5 – 15264) for dander and 39.5 (4 – 263) for saliva. Equ c 4 was found in 19/21 urine samples. Adjusted for age, sex and changes over time, no differences between breeds could be seen in dander, while in saliva the North Swedish horse showed lower levels of Equ c 4 than any other breed. The levels of Equ c 4 protein in dander and saliva were significantly higher in samples from stallions compared to mares and geldings, independent of breed.

Conclusions & Clinical Relevance

The results show a high variability in allergen levels of Equ c 4 in dander and saliva both within and between breeds. Significantly higher levels were found in stallions compared to mares and geldings, independent of breed. Results suggest that none of the horse breeds studied can be recommended for individuals allergic to Equ c 4.

This article is protected by copyright. All rights reserved.

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

Innovation Amidst the Crisis: Health IT and the Opioid Abuse Epidemic | Part 1 – A Strategic Framework

Colin Konschak Dave Levin  By COLIN KONSCHAK, FACHE and DAVE LEVIN, MD The opioid crisis in the United States is having a devastating impact on individuals, their families, and the health care industry. This multi-part series will focus on the role technology can play in addressing this crisis. In this article, we propose a strategic framework for evaluating and pursuing technical solutions. Future articles will explore specific areas and solutions within this framework. A Full-Blown Crisis One of the authors recently had the opportunity to participate in a multi-stakeholder workshop in Cleveland, OH dedicated to finding new, collaborative approaches to addressing the nation's opioid abuse epidemic. While Ohio might be considered ground zero for this epidemic, the evidence is clear that...

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

Junk Science Exposed: New Study Purports to Show that E-Cigarettes Increase Heart Attack Risk

According to the headline of aUPInews story from last week, vaping has been linked to an increased risk of having a heart attack. This research finding was reported worldwide, including a scary headline in London'sSunday Express reading: " New research claimsvaping raises risk of deadly heart attacks and strokes. "This finding is profoundly important because if e-cigarette use does indeed increase heart attack risk, then the role of vaping in harm reduction comes into serious question.The news headline stems from a paper that is being presented this week at the American Stroke Association 'sInternational Stroke Conference in Hawaii.According to the news coverage, the researchers used cross-sectional data from the 2016 Behavioral Risk Factor Surveillance Survey (BRFSS) and found that ever...

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

Innovation Amidst the Crisis: Health IT and the Opioid Abuse Epidemic | Part 1 – A Strategic Framework

Colin Konschak Dave Levin  By COLIN KONSCHAK, FACHE and DAVE LEVIN, MD The opioid crisis in the United States is having a devastating impact on individuals, their families, and the health care industry. This multi-part series will focus on the role technology can play in addressing this crisis. In this article, we propose a strategic framework for evaluating and pursuing technical solutions. Future articles will explore specific areas and solutions within this framework. A Full-Blown Crisis One of the authors recently had the opportunity to participate in a multi-stakeholder workshop in Cleveland, OH dedicated to finding new, collaborative approaches to addressing the nation's opioid abuse epidemic. While Ohio might be considered ground zero for this epidemic, the evidence is clear that...

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

Junk Science Exposed: New Study Purports to Show that E-Cigarettes Increase Heart Attack Risk

According to the headline of aUPInews story from last week, vaping has been linked to an increased risk of having a heart attack. This research finding was reported worldwide, including a scary headline in London'sSunday Express reading: " New research claimsvaping raises risk of deadly heart attacks and strokes. "This finding is profoundly important because if e-cigarette use does indeed increase heart attack risk, then the role of vaping in harm reduction comes into serious question.The news headline stems from a paper that is being presented this week at the American Stroke Association 'sInternational Stroke Conference in Hawaii.According to the news coverage, the researchers used cross-sectional data from the 2016 Behavioral Risk Factor Surveillance Survey (BRFSS) and found that ever...

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

Automatic Nasopharyngeal Carcinoma Segmentation Using Fully Convolutional Networks with Auxiliary Paths on Dual-Modality PET-CT Images

Abstract

Nasopharyngeal carcinoma (NPC) is prevalent in certain areas, such as South China, Southeast Asia, and the Middle East. Radiation therapy is the most efficient means to treat this malignant tumor. Positron emission tomography–computed tomography (PET-CT) is a suitable imaging technique to assess this disease. However, the large amount of data produced by numerous patients causes traditional manual delineation of tumor contour, a basic step for radiotherapy, to become time-consuming and labor-intensive. Thus, the demand for automatic and credible segmentation methods to alleviate the workload of radiologists is increasing. This paper presents a method that uses fully convolutional networks with auxiliary paths to achieve automatic segmentation of NPC on PET-CT images. This work is the first to segment NPC using dual-modality PET-CT images. This technique is identical to what is used in clinical practice and offers considerable convenience for subsequent radiotherapy. The deep supervision introduced by auxiliary paths can explicitly guide the training of lower layers, thus enabling these layers to learn more representative features and improve the discriminative capability of the model. Results of threefold cross-validation with a mean dice score of 87.47% demonstrate the efficiency and robustness of the proposed method. The method remarkably outperforms state-of-the-art methods in NPC segmentation. We also validated by experiments that the registration process among different subjects and the auxiliary paths strategy are considerably useful techniques for learning discriminative features and improving segmentation performance.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2D9XSzq

Computer-Assisted Nuclear Atypia Scoring of Breast Cancer: a Preliminary Study

Abstract

Inter-pathologist agreement for nuclear atypia scoring of breast cancer is poor. To address this problem, previous studies suggested some criteria for describing the variations appearance of tumor cells relative to normal cells. However, these criteria were still assessed subjectively by pathologists. Previous studies used quantitative computer-extracted features for scoring. However, application of these tools is limited as further improvement in their accuracy is required. This study proposes COMPASS (COMputer-assisted analysis combined with Pathologist's ASSessment) for reproducible nuclear atypia scoring. COMPASS relies on both cytological criteria assessed subjectively by pathologists as well as computer-extracted textural features. Using machine learning, COMPASS combines these two sets of features and output nuclear atypia score. COMPASS's performance was evaluated using 300 images for which expert-consensus derived reference nuclear pleomorphism scores were available, and they were scanned by two scanners from different vendors. A personalized model was built for three pathologists who gave scores to six atypia-related criteria for each image. Leave-one-out cross validation (LOOCV) was used. COMPASS was trained and tested for each pathologist separately. Percentage agreement between COMPASS and the reference nuclear scores was 93.8%, 92.9%, and 93.1% for three pathologists. COMPASS's performance in nuclear grading was almost identical for both scanners, with Cohen's kappa ranging from 0.80 to 0.86 for different pathologists and different scanners. Independently, the images were also assessed by two experienced senior pathologists. Cohen's kappa of COMPASS was comparable to the Cohen's kappa for two senior pathologists (0.79 and 0.68).

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GbilI5

Automatic Nasopharyngeal Carcinoma Segmentation Using Fully Convolutional Networks with Auxiliary Paths on Dual-Modality PET-CT Images

Abstract

Nasopharyngeal carcinoma (NPC) is prevalent in certain areas, such as South China, Southeast Asia, and the Middle East. Radiation therapy is the most efficient means to treat this malignant tumor. Positron emission tomography–computed tomography (PET-CT) is a suitable imaging technique to assess this disease. However, the large amount of data produced by numerous patients causes traditional manual delineation of tumor contour, a basic step for radiotherapy, to become time-consuming and labor-intensive. Thus, the demand for automatic and credible segmentation methods to alleviate the workload of radiologists is increasing. This paper presents a method that uses fully convolutional networks with auxiliary paths to achieve automatic segmentation of NPC on PET-CT images. This work is the first to segment NPC using dual-modality PET-CT images. This technique is identical to what is used in clinical practice and offers considerable convenience for subsequent radiotherapy. The deep supervision introduced by auxiliary paths can explicitly guide the training of lower layers, thus enabling these layers to learn more representative features and improve the discriminative capability of the model. Results of threefold cross-validation with a mean dice score of 87.47% demonstrate the efficiency and robustness of the proposed method. The method remarkably outperforms state-of-the-art methods in NPC segmentation. We also validated by experiments that the registration process among different subjects and the auxiliary paths strategy are considerably useful techniques for learning discriminative features and improving segmentation performance.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2D9XSzq

Computer-Assisted Nuclear Atypia Scoring of Breast Cancer: a Preliminary Study

Abstract

Inter-pathologist agreement for nuclear atypia scoring of breast cancer is poor. To address this problem, previous studies suggested some criteria for describing the variations appearance of tumor cells relative to normal cells. However, these criteria were still assessed subjectively by pathologists. Previous studies used quantitative computer-extracted features for scoring. However, application of these tools is limited as further improvement in their accuracy is required. This study proposes COMPASS (COMputer-assisted analysis combined with Pathologist's ASSessment) for reproducible nuclear atypia scoring. COMPASS relies on both cytological criteria assessed subjectively by pathologists as well as computer-extracted textural features. Using machine learning, COMPASS combines these two sets of features and output nuclear atypia score. COMPASS's performance was evaluated using 300 images for which expert-consensus derived reference nuclear pleomorphism scores were available, and they were scanned by two scanners from different vendors. A personalized model was built for three pathologists who gave scores to six atypia-related criteria for each image. Leave-one-out cross validation (LOOCV) was used. COMPASS was trained and tested for each pathologist separately. Percentage agreement between COMPASS and the reference nuclear scores was 93.8%, 92.9%, and 93.1% for three pathologists. COMPASS's performance in nuclear grading was almost identical for both scanners, with Cohen's kappa ranging from 0.80 to 0.86 for different pathologists and different scanners. Independently, the images were also assessed by two experienced senior pathologists. Cohen's kappa of COMPASS was comparable to the Cohen's kappa for two senior pathologists (0.79 and 0.68).

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GbilI5

Longitudinal study of hearing loss and subjective cognitive function decline in men.

We examined the relation between self-reported hearing loss, hearing aid use, and risk of subjective cognitive function (SCF) decline. METHODS: We conducted an 8-year (2008-2016) longitudinal study of 10,107 men aged ≥62 years who reported their hearing status in 2006 and had no subjective cognitive concerns in 2008. Change in SCF scores was assessed by a 6-item questionnaire, and subjective decline was defined as new report of at least one SCF concern during follow-up. RESULTS: Hearing loss was associated with higher risk of SCF decline. Compared with no hearing loss, the multivariable-adjusted relative risk (95% CI) of incident SCF decline was 1.30 (1.18, 1.42), 1.42 (1.26, 1.61), and 1.54 (1.22, 1.96) among men with mild, moderate, and severe hearing loss (no hearing aids), ...

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

Longitudinal study of hearing loss and subjective cognitive function decline in men.

We examined the relation between self-reported hearing loss, hearing aid use, and risk of subjective cognitive function (SCF) decline. METHODS: We conducted an 8-year (2008-2016) longitudinal study of 10,107 men aged ≥62 years who reported their hearing status in 2006 and had no subjective cognitive concerns in 2008. Change in SCF scores was assessed by a 6-item questionnaire, and subjective decline was defined as new report of at least one SCF concern during follow-up. RESULTS: Hearing loss was associated with higher risk of SCF decline. Compared with no hearing loss, the multivariable-adjusted relative risk (95% CI) of incident SCF decline was 1.30 (1.18, 1.42), 1.42 (1.26, 1.61), and 1.54 (1.22, 1.96) among men with mild, moderate, and severe hearing loss (no hearing aids), ...

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

A deep convolutional neural network for the diagnosis of thyroid nodules on ultrasound

Abstract

Background

We designed a deep convolutional neural network (CNN) to diagnose thyroid malignancy on ultrasound (US) and compared the diagnostic performance of CNN with that of experienced radiologists.

Methods

Between May 2012 and February 2015, 589 thyroid nodules in 519 patients were diagnosed as benign or malignant by surgical excision. Experienced radiologists retrospectively reviewed the US of the thyroid nodules in a test set. CNNs were trained and tested using retrospective data of 439 and 150 US images, respectively. Diagnostic performances were compared between the two groups.

Results

Of the 589 thyroid nodules, 396 were malignant and 193 were benign. The area under the curve (AUC) for diagnosing thyroid malignancy was 0.805‐0.860 for radiologists. The AUCs for diagnosing thyroid malignancy for the three CNNs were 0.845, 0.835, and 0.850. There was no significant difference in AUC between radiologists and CNNs.

Conclusions

CNNs showed comparable diagnostic performance compared to experienced radiologists in differentiating thyroid malignancy on US.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BdGWI7

A deep convolutional neural network for the diagnosis of thyroid nodules on ultrasound

Abstract

Background

We designed a deep convolutional neural network (CNN) to diagnose thyroid malignancy on ultrasound (US) and compared the diagnostic performance of CNN with that of experienced radiologists.

Methods

Between May 2012 and February 2015, 589 thyroid nodules in 519 patients were diagnosed as benign or malignant by surgical excision. Experienced radiologists retrospectively reviewed the US of the thyroid nodules in a test set. CNNs were trained and tested using retrospective data of 439 and 150 US images, respectively. Diagnostic performances were compared between the two groups.

Results

Of the 589 thyroid nodules, 396 were malignant and 193 were benign. The area under the curve (AUC) for diagnosing thyroid malignancy was 0.805‐0.860 for radiologists. The AUCs for diagnosing thyroid malignancy for the three CNNs were 0.845, 0.835, and 0.850. There was no significant difference in AUC between radiologists and CNNs.

Conclusions

CNNs showed comparable diagnostic performance compared to experienced radiologists in differentiating thyroid malignancy on US.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BdGWI7

Crossed cerebellar diaschisis

Clinical presentation: Frequent seizures, altered sensorium. 

MRI brain shows marked left hemi Atrophy, ex vacuo dilatation of left lateral ventricle owing to volume loss. Left cerebral hemisphere show multifocal patchy areas of cortical T2 hyper intensities without diffusion restriction. Associated Atrophy of left deep grey nuclei, changes of distal Wallerian degeneration involving left cerebral peduncle of mid brain, Pons.

Imaging diagnosis: Sequel of encephalitis / rasmussen encephalitis.

Right cerebellar hemisphere show marked atrophy can attributed to associated contralateral cerebellar diaschisis. 

Crossed cerebellar diaschisis

Refers to supra tentorial lesion leading to depressed function, metabolism and perfusion of contra lateral cerebellar hemisphere which is connected via white matter tracts.
Interruption of this cortico-ponto-cerebellar white matter tracts which then results in deafferentation and hypometabolism of the contralateral cerebellar hemisphere.

Classically seen following cerebral infarction, although it can be a sequel of any significant supratentorial lesion like bleed, encephalitis as in our case. The same phenomenon can also occur in thalamus called ipsilateral thalamic diaschisis, occurring after an ipsilateral middle cerebral artery territory infarction.

CT or MRI perfusion performed during an acute stroke may show a contralateral cerebellar hypo perfusion. In chronic stages volume loss involving contralateral cerebellar hemisphere.

Clinically other than the neurological deficits associated with the contra lateral supra tentorial lesion, the condition is generally asymptomatic. No treatment apart from management of the supratentorial insult.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2G8s7KR

Crossed cerebellar diaschisis

Clinical presentation: Frequent seizures, altered sensorium. 

MRI brain shows marked left hemi Atrophy, ex vacuo dilatation of left lateral ventricle owing to volume loss. Left cerebral hemisphere show multifocal patchy areas of cortical T2 hyper intensities without diffusion restriction. Associated Atrophy of left deep grey nuclei, changes of distal Wallerian degeneration involving left cerebral peduncle of mid brain, Pons.

Imaging diagnosis: Sequel of encephalitis / rasmussen encephalitis.

Right cerebellar hemisphere show marked atrophy can attributed to associated contralateral cerebellar diaschisis. 

Crossed cerebellar diaschisis

Refers to supra tentorial lesion leading to depressed function, metabolism and perfusion of contra lateral cerebellar hemisphere which is connected via white matter tracts.
Interruption of this cortico-ponto-cerebellar white matter tracts which then results in deafferentation and hypometabolism of the contralateral cerebellar hemisphere.

Classically seen following cerebral infarction, although it can be a sequel of any significant supratentorial lesion like bleed, encephalitis as in our case. The same phenomenon can also occur in thalamus called ipsilateral thalamic diaschisis, occurring after an ipsilateral middle cerebral artery territory infarction.

CT or MRI perfusion performed during an acute stroke may show a contralateral cerebellar hypo perfusion. In chronic stages volume loss involving contralateral cerebellar hemisphere.

Clinically other than the neurological deficits associated with the contra lateral supra tentorial lesion, the condition is generally asymptomatic. No treatment apart from management of the supratentorial insult.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2G8s7KR

Stepwise approach towards adoption of allergen immunotherapy for allergic rhinitis and asthma patients in daily practice in Belgium: a BelSACI-Abeforcal-EUFOREA statement

Allergic rhinitis (AR) affects 23–30% of the European population with equal prevalence reported in Belgium. Despite guidelines on the correct use of effective treatment, up to 40% of AR patients remain uncontr...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Sur9hO

Stepwise approach towards adoption of allergen immunotherapy for allergic rhinitis and asthma patients in daily practice in Belgium: a BelSACI-Abeforcal-EUFOREA statement

Allergic rhinitis (AR) affects 23–30% of the European population with equal prevalence reported in Belgium. Despite guidelines on the correct use of effective treatment, up to 40% of AR patients remain uncontr...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Sur9hO

Cone beam computed tomography evaluation of staged lateral ridge augmentation using platelet rich fibrin or resorbable collagen membranes in a randomized controlled clinical trial

Abstract

Objectives

To evaluate the volumetric changes following lateral alveolar ridge augmentation using autogenous bone graft covered by either a platelet rich fibrin membrane (test group) or an inorganic bovine bone substitute and a resorbable collagen barrier membrane (control group).

Material and methods

A total of 27 partially edentulous patients (test n=14, control n=13) with the indication for lateral bone block augmentation were included in this randomized, controlled clinical trial. Cone beam computed tomography (CBCT) examination was performed prior to grafting and 2 weeks and 6 months after grafting. The volumetric changes between the various examinations times were evaluated by planimetric measurements on two‐dimensional CBCT images of the grafted regions.

Results

The mean bone volumetric loss in the test group was 14.7%, SD± 8.9%, while the mean bone volume loss in the control group was 17.8%, SD± 13.3%. This difference was not significant (P=0.48). A total of ten patients were operated in the incisor and canine region with a mean bone volume loss of 23.41% SD, ±10.87%, while 17 patients were operated in the premolar region with at mean bone volume loss of 11.89% SD ±9.05%. This difference was significant (P=0.01).

Conclusion

The test and control group demonstrated no overall difference in volumetric bone changes of the augmented bone at the 6‐month follow‐up. The second major finding revealed a significantly larger amount of bone resorption in the incisor and canine region than in the premolar region of the maxilla, particularly in the control group.

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Cone beam computed tomography evaluation of staged lateral ridge augmentation using platelet rich fibrin or resorbable collagen membranes in a randomized controlled clinical trial

Abstract

Objectives

To evaluate the volumetric changes following lateral alveolar ridge augmentation using autogenous bone graft covered by either a platelet rich fibrin membrane (test group) or an inorganic bovine bone substitute and a resorbable collagen barrier membrane (control group).

Material and methods

A total of 27 partially edentulous patients (test n=14, control n=13) with the indication for lateral bone block augmentation were included in this randomized, controlled clinical trial. Cone beam computed tomography (CBCT) examination was performed prior to grafting and 2 weeks and 6 months after grafting. The volumetric changes between the various examinations times were evaluated by planimetric measurements on two‐dimensional CBCT images of the grafted regions.

Results

The mean bone volumetric loss in the test group was 14.7%, SD± 8.9%, while the mean bone volume loss in the control group was 17.8%, SD± 13.3%. This difference was not significant (P=0.48). A total of ten patients were operated in the incisor and canine region with a mean bone volume loss of 23.41% SD, ±10.87%, while 17 patients were operated in the premolar region with at mean bone volume loss of 11.89% SD ±9.05%. This difference was significant (P=0.01).

Conclusion

The test and control group demonstrated no overall difference in volumetric bone changes of the augmented bone at the 6‐month follow‐up. The second major finding revealed a significantly larger amount of bone resorption in the incisor and canine region than in the premolar region of the maxilla, particularly in the control group.

This article is protected by copyright. All rights reserved.

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Health-related quality of life assessment for patients with advanced or metastatic renal cell carcinoma treated with a tyrosine kinase inhibitor using electronic patient-reported outcomes in daily clinical practice (QUANARIE trial): study protocol

Two main therapies, pazopanib and sunitinib, are used in the first-line setting for metastatic renal cell carcinoma (mRCC). These two tyrosine kinase inhibitors (TKI) are equally effective in terms of survival...

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Health-related quality of life assessment for patients with advanced or metastatic renal cell carcinoma treated with a tyrosine kinase inhibitor using electronic patient-reported outcomes in daily clinical practice (QUANARIE trial): study protocol

Two main therapies, pazopanib and sunitinib, are used in the first-line setting for metastatic renal cell carcinoma (mRCC). These two tyrosine kinase inhibitors (TKI) are equally effective in terms of survival...

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Treatment of oral cancers during pregnancy: a case-based discussion

Malignancies occur in approximately 1:1000 pregnancies; the most common being breast (46%) and hematological (18%) malignancies. Oral cancers account for only 2% of all cancers in pregnant women, and there are...

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Pressure induced tissue resection in the larynx: A preliminary canine study

Objectives

The application of laser (light amplification by stimulated emission of radiation) energy in the larynx relies on thermal injury. The impact of this injury on adjacent tissue can be undesirable. Attempts have been made to limit the extent and range of injury to adjacent tissue. The O‐Pel Surgical System (Precise Light Surgical, Inc., Campbell, CA), a new technology, utilizes kinetic energy through Pressure Induced Tissue Resection (PITR) (Precise Light Surgical, Inc.) to cut tissue, theoretically eliminating injury to adjacent tissue. The purpose of this study was to evaluate the PSL in canine vocal folds.

Methods

Four dogs underwent PITR incisions (4 mJ pulses at 200 Hz) on their vocal folds, through mucosa into the muscle. The animals were sacrificed at days 0, 3, 7, and 21 days postsurgery. The larynges were harvested and histology was performed with hematoxylin and eosin, Masson trichrome, and Verhoeff‐van Gieson.

Results

At day 0, focal denudation of the epithelium and coagulation necrosis in the lamina propria and adjacent connective tissue are noted. On days 3 and 7, an inflammatory infiltrate of neutrophils is seen within the lamina propria and surrounding connective tissue with minimal edema and early deposition of collagen. At day 21, the mucosa is completely regenerated with the area of previous PITR into the muscle replaced with thick bundles of collagen.

Conclusion

The unique PITR characteristics offer a potentially unique cutting technology for laryngeal microsurgery. The current canine study suggests appropriate and rapid healing. With refinements of the tip size of the probe and adjustment of energy, PITR will likely be an appropriate alternate to traditional lasers in laryngeal surgery.

Level of Evidence

NA. Laryngoscope, 2019

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Treatment of oral cancers during pregnancy: a case-based discussion

Malignancies occur in approximately 1:1000 pregnancies; the most common being breast (46%) and hematological (18%) malignancies. Oral cancers account for only 2% of all cancers in pregnant women, and there are...

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Pressure induced tissue resection in the larynx: A preliminary canine study

Objectives

The application of laser (light amplification by stimulated emission of radiation) energy in the larynx relies on thermal injury. The impact of this injury on adjacent tissue can be undesirable. Attempts have been made to limit the extent and range of injury to adjacent tissue. The O‐Pel Surgical System (Precise Light Surgical, Inc., Campbell, CA), a new technology, utilizes kinetic energy through Pressure Induced Tissue Resection (PITR) (Precise Light Surgical, Inc.) to cut tissue, theoretically eliminating injury to adjacent tissue. The purpose of this study was to evaluate the PSL in canine vocal folds.

Methods

Four dogs underwent PITR incisions (4 mJ pulses at 200 Hz) on their vocal folds, through mucosa into the muscle. The animals were sacrificed at days 0, 3, 7, and 21 days postsurgery. The larynges were harvested and histology was performed with hematoxylin and eosin, Masson trichrome, and Verhoeff‐van Gieson.

Results

At day 0, focal denudation of the epithelium and coagulation necrosis in the lamina propria and adjacent connective tissue are noted. On days 3 and 7, an inflammatory infiltrate of neutrophils is seen within the lamina propria and surrounding connective tissue with minimal edema and early deposition of collagen. At day 21, the mucosa is completely regenerated with the area of previous PITR into the muscle replaced with thick bundles of collagen.

Conclusion

The unique PITR characteristics offer a potentially unique cutting technology for laryngeal microsurgery. The current canine study suggests appropriate and rapid healing. With refinements of the tip size of the probe and adjustment of energy, PITR will likely be an appropriate alternate to traditional lasers in laryngeal surgery.

Level of Evidence

NA. Laryngoscope, 2019

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Nephrogenic Systemic Fibrosis: A Review of History, Pathophysiology, and Current Guidelines

Abstract

Purpose of Review

Nephrogenic systemic fibrosis (NSF) is a rare systemic disease with a high mortality. The purpose of this review is to provide clinicians with guidance regarding safe administration of GBCAs to patients with renal disease.

Summary

Development of NSF has been linked to the administration of gadolinium-based contrast agents (GBCAs) in patients with renal disease. Due to the wide variety of available GBCAs and recommendations regarding safe administration of these agents, it can be difficult for clinicians to choose the best GBCA for this patient population.

Recent Findings

Although the current ACR guidelines have virtually eliminated the risk of NSF, future research may lead to the development of alternative contrast agents for patients at risk of NSF who require contrast-enhanced MRIs.

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State-of-the-Art Imaging in Cardiac Oncology

Abstract

Purpose of Review

Imaging modalities play an important role in the diagnosis and management of cardiotoxicity and cardiac tumors. In this review, we provide an overview of the imaging modalities that are relevant to the field of cardio-oncology.

Recent Findings

Cardiac magnetic resonance provides comprehensive tissue characterization in the assessment of cardiac tumors and cardiomyopathy. The combination of positron emission tomography/computed tomography offers improved localization of lesions, staging, targeting of biopsy and therapy, and greater confidence in interpretation.

Summary

Overall, cardiac imaging plays a critical role in the assessment and management of cardiac tumors either for surgical planning or for initiation of appropriate cancer therapies. For certain higher risk cancer patients and survivors, routine surveillance with cardiac imaging may be warranted so appropriate interventions can be instituted to stabilize or even improve the cardiac dysfunction.

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Intravascular Ultrasound in the Creation of Transjugular Intrahepatic Portosystemic Shunts: Review of the Literature and Future Directions

Abstract

Purpose of Review

Transjugular intrahepatic portosystemic shunt (TIPS) placement is a well-established interventional radiology procedure for treating sequelae of portal hypertension involving shunting portal blood flow to the hepatic vein bypassing the liver through a stent graft. Creating a TIPS can be a complex and radiation-intensive procedure due to the technically challenging step of cannulating the portal vein from the hepatic vein. As this is the most unpredictable step in TIPS creation, multiple techniques have been described for visualizing the portal vein to facilitate its access. The use of intravascular ultrasound (IVUS) has gained significant interest over the last few years due to reports of improved procedural metrics such as shortened procedural time and radiation dose. The purpose of this article is to review the literature and detail technical advances utilizing IVUS in TIPS creation.

Recent Findings

Intravascular ultrasound has been shown to be a safe and reproducible means of real-time image guidance for TIPS creation. The use of IVUS has been associated with improved procedural metrics including a decreased number of intrahepatic needle passes, shorter portal vein access times, decreased contrast usage, and a decrease in radiation dose.

Summary

Due to technical advances and real-time portal vein visualization using IVUS, TIPS creation at our institution has dramatically changed. Our institutional practice has nearly completed shifted to the sole use of IVUS for portal vein access in TIPS creation due to significantly improved procedural metrics including radiation dose and contrast usage.

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Nephrogenic Systemic Fibrosis: A Review of History, Pathophysiology, and Current Guidelines

Abstract

Purpose of Review

Nephrogenic systemic fibrosis (NSF) is a rare systemic disease with a high mortality. The purpose of this review is to provide clinicians with guidance regarding safe administration of GBCAs to patients with renal disease.

Summary

Development of NSF has been linked to the administration of gadolinium-based contrast agents (GBCAs) in patients with renal disease. Due to the wide variety of available GBCAs and recommendations regarding safe administration of these agents, it can be difficult for clinicians to choose the best GBCA for this patient population.

Recent Findings

Although the current ACR guidelines have virtually eliminated the risk of NSF, future research may lead to the development of alternative contrast agents for patients at risk of NSF who require contrast-enhanced MRIs.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2G9VQDh

State-of-the-Art Imaging in Cardiac Oncology

Abstract

Purpose of Review

Imaging modalities play an important role in the diagnosis and management of cardiotoxicity and cardiac tumors. In this review, we provide an overview of the imaging modalities that are relevant to the field of cardio-oncology.

Recent Findings

Cardiac magnetic resonance provides comprehensive tissue characterization in the assessment of cardiac tumors and cardiomyopathy. The combination of positron emission tomography/computed tomography offers improved localization of lesions, staging, targeting of biopsy and therapy, and greater confidence in interpretation.

Summary

Overall, cardiac imaging plays a critical role in the assessment and management of cardiac tumors either for surgical planning or for initiation of appropriate cancer therapies. For certain higher risk cancer patients and survivors, routine surveillance with cardiac imaging may be warranted so appropriate interventions can be instituted to stabilize or even improve the cardiac dysfunction.

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Intravascular Ultrasound in the Creation of Transjugular Intrahepatic Portosystemic Shunts: Review of the Literature and Future Directions

Abstract

Purpose of Review

Transjugular intrahepatic portosystemic shunt (TIPS) placement is a well-established interventional radiology procedure for treating sequelae of portal hypertension involving shunting portal blood flow to the hepatic vein bypassing the liver through a stent graft. Creating a TIPS can be a complex and radiation-intensive procedure due to the technically challenging step of cannulating the portal vein from the hepatic vein. As this is the most unpredictable step in TIPS creation, multiple techniques have been described for visualizing the portal vein to facilitate its access. The use of intravascular ultrasound (IVUS) has gained significant interest over the last few years due to reports of improved procedural metrics such as shortened procedural time and radiation dose. The purpose of this article is to review the literature and detail technical advances utilizing IVUS in TIPS creation.

Recent Findings

Intravascular ultrasound has been shown to be a safe and reproducible means of real-time image guidance for TIPS creation. The use of IVUS has been associated with improved procedural metrics including a decreased number of intrahepatic needle passes, shorter portal vein access times, decreased contrast usage, and a decrease in radiation dose.

Summary

Due to technical advances and real-time portal vein visualization using IVUS, TIPS creation at our institution has dramatically changed. Our institutional practice has nearly completed shifted to the sole use of IVUS for portal vein access in TIPS creation due to significantly improved procedural metrics including radiation dose and contrast usage.

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A methodological approach to standardize and control the quality of the position and alignment of lamina implants on two-dimensional radiographs

Abstract

Objectives

We sought to validate a new method to detect the degree of correlation between simulated and real tilted blade implants as they appear on a single two-dimensional radiograph.

Methods

The angular correction factor (CF^) was defined as the coupling of two subsequent angle transformations, a set of five angular values describing the theoretical radiographic appearance of the blade implant: (1) three consecutive rotations about the axes of the blade ( \(\varphi\) , θ, and ψ, standing for pitch, roll, and yaw, respectively) to represent the polarization directions; (2) a two-dimensional projection defined by two angles (λ and \(\phi\) , respectively, longitude and latitude) to represent the vector of the X-ray beam intersecting the detector plate. Data of patients who received fixed prostheses supported by blade-form implants were employed to calculate a dimensional correction factor (CF°), a specific length through the major axis. The simulation of a distorted radiograph of a blade positioned in space was compared with the real radiograph. Differences in the angular measurements served as an initial test to assess the effectiveness of the method.

Results

In the acquired sets of periapical radiographs, mean misalignments of + 3.58° in longitude and − 0.04° in latitude were registered. The following variations were detected during the accuracy testing: the absolute error was 0.1 ± 7.5° for angle \(\varphi\) ; 2.4 ± 6.7° for angle θ; − 1.0 ± 3.7° for angle ψ; 4.5 ± 8.6° for angle λ; and 2.0 ± 9.3° for angle \(\phi\) . The linear dependence between CF° and CF^ was estimated by a robust linear regression: slope + 0.991, intercept + 0.007, and adjusted R² 0.992.

Conclusions

This a posteriori analysis introduces the explicit trigonometric equations of the theoretical standard (CF^) used to describe the blade implant radiographic position and misalignment on two-dimensional radiographs.

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A methodological approach to standardize and control the quality of the position and alignment of lamina implants on two-dimensional radiographs

Abstract

Objectives

We sought to validate a new method to detect the degree of correlation between simulated and real tilted blade implants as they appear on a single two-dimensional radiograph.

Methods

The angular correction factor (CF^) was defined as the coupling of two subsequent angle transformations, a set of five angular values describing the theoretical radiographic appearance of the blade implant: (1) three consecutive rotations about the axes of the blade ( \(\varphi\) , θ, and ψ, standing for pitch, roll, and yaw, respectively) to represent the polarization directions; (2) a two-dimensional projection defined by two angles (λ and \(\phi\) , respectively, longitude and latitude) to represent the vector of the X-ray beam intersecting the detector plate. Data of patients who received fixed prostheses supported by blade-form implants were employed to calculate a dimensional correction factor (CF°), a specific length through the major axis. The simulation of a distorted radiograph of a blade positioned in space was compared with the real radiograph. Differences in the angular measurements served as an initial test to assess the effectiveness of the method.

Results

In the acquired sets of periapical radiographs, mean misalignments of + 3.58° in longitude and − 0.04° in latitude were registered. The following variations were detected during the accuracy testing: the absolute error was 0.1 ± 7.5° for angle \(\varphi\) ; 2.4 ± 6.7° for angle θ; − 1.0 ± 3.7° for angle ψ; 4.5 ± 8.6° for angle λ; and 2.0 ± 9.3° for angle \(\phi\) . The linear dependence between CF° and CF^ was estimated by a robust linear regression: slope + 0.991, intercept + 0.007, and adjusted R² 0.992.

Conclusions

This a posteriori analysis introduces the explicit trigonometric equations of the theoretical standard (CF^) used to describe the blade implant radiographic position and misalignment on two-dimensional radiographs.

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Cognitive hearing science and ease of language understanding

. (Source: International Journal of Audiology)

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The effect of delayed auditory feedback (DAF) and frequency altered feedback (FAF) on speech production: cochlear implanted versus normal hearing individuals.

Authors: Taitelbaum-Swead R, Avivi M, Gueta B, Fostick L Abstract Normal auditory feedback contributes to moment-to-moment control of speech production. Effects of auditory feedback's absence on hearing-impaired individuals are widely documented, but auditory perturbation has not been investigated. Our objective was to evaluate the effect of delayed auditory feedback (DAF) and frequency altered feedback (FAF) on speech production among prelingual cochlear implant (CI) users and normal hearing (NH) individuals, to evaluate CI users' reliance on auditory feedback. Twenty young adults (10 CI, 10 NH), without developmental and cognitive impairments, participated in the study. Under variable auditory feedback conditions, speech production (spontaneous or reading aloud) was measured usin...

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Cognitive hearing science and ease of language understanding

. (Source: International Journal of Audiology)

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The effect of delayed auditory feedback (DAF) and frequency altered feedback (FAF) on speech production: cochlear implanted versus normal hearing individuals.

Authors: Taitelbaum-Swead R, Avivi M, Gueta B, Fostick L Abstract Normal auditory feedback contributes to moment-to-moment control of speech production. Effects of auditory feedback's absence on hearing-impaired individuals are widely documented, but auditory perturbation has not been investigated. Our objective was to evaluate the effect of delayed auditory feedback (DAF) and frequency altered feedback (FAF) on speech production among prelingual cochlear implant (CI) users and normal hearing (NH) individuals, to evaluate CI users' reliance on auditory feedback. Twenty young adults (10 CI, 10 NH), without developmental and cognitive impairments, participated in the study. Under variable auditory feedback conditions, speech production (spontaneous or reading aloud) was measured usin...

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Development of CT-based methods for longitudinal analyses of paranasal sinus osteitis in granulomatosis with polyangiitis

Abstract

Background

Even though progressive rhinosinusitis with osteitis is a major clinical problem in granulomatosis with polyangiitis (GPA), there are no studies on how GPA-related osteitis develops over time, and no quantitative methods for longitudinal assessment.

Here, we aimed to identify simple and robust CT-based methods for capture and quantification of time-dependent changes in GPA-related paranasal sinus osteitis and compare performance of the methods under study in a largely unselected GPA cohort.

Methods

GPA patients (n = 121) with ≥3 paranasal CT scans obtained ≥12 months apart and control patients not having GPA or rhinosinusitis (n = 15) were analysed by: (i) Global osteitis scoring scale (GOSS), originally developed for chronic rhinosinusitis; (ii) Paranasal sinus volume by manual segmentation; (iii) Mean maxillary and sphenoid diameter normalised to landmark distances (i.e. diameter ratio measurement, DRM).

Results

Time-dependent changes in GPA-related osteitis were equally well measured by the simple DRM and the labour-intensive volume method while GOSS missed ongoing changes in cases with extensive osteitis. GOSS at last CT combined with DRM identified three distinct patient groups: (i) The no osteitis group, who had no osteitis and no change in DRM from baseline CT to last CT (45/121 GPA patients and 15/15 disease controls); (ii) Stable osteitis group, with presence of osteitis, but no change in DRM across time (31 GPA); (iii) Progressive osteitis, defined by declining DRM (45 GPA).

Conclusions

We suggest DRM and GOSS as complementary methods for capturing, classifying and quantifying time-dependent changes in GPA-related osteitis.

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Development of CT-based methods for longitudinal analyses of paranasal sinus osteitis in granulomatosis with polyangiitis

Abstract

Background

Even though progressive rhinosinusitis with osteitis is a major clinical problem in granulomatosis with polyangiitis (GPA), there are no studies on how GPA-related osteitis develops over time, and no quantitative methods for longitudinal assessment.

Here, we aimed to identify simple and robust CT-based methods for capture and quantification of time-dependent changes in GPA-related paranasal sinus osteitis and compare performance of the methods under study in a largely unselected GPA cohort.

Methods

GPA patients (n = 121) with ≥3 paranasal CT scans obtained ≥12 months apart and control patients not having GPA or rhinosinusitis (n = 15) were analysed by: (i) Global osteitis scoring scale (GOSS), originally developed for chronic rhinosinusitis; (ii) Paranasal sinus volume by manual segmentation; (iii) Mean maxillary and sphenoid diameter normalised to landmark distances (i.e. diameter ratio measurement, DRM).

Results

Time-dependent changes in GPA-related osteitis were equally well measured by the simple DRM and the labour-intensive volume method while GOSS missed ongoing changes in cases with extensive osteitis. GOSS at last CT combined with DRM identified three distinct patient groups: (i) The no osteitis group, who had no osteitis and no change in DRM from baseline CT to last CT (45/121 GPA patients and 15/15 disease controls); (ii) Stable osteitis group, with presence of osteitis, but no change in DRM across time (31 GPA); (iii) Progressive osteitis, defined by declining DRM (45 GPA).

Conclusions

We suggest DRM and GOSS as complementary methods for capturing, classifying and quantifying time-dependent changes in GPA-related osteitis.

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Activation of Group 2 innate lymphoid cells after allergen challenge in asthmatics

Publication date: Available online 4 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Carla Winkler, Thomas Hochdörfer, Elisabeth Israelsson, Annemarie Hasselberg, Anders Cavallin, Kristofer Thörn, Daniel Muthas, Shervin Shojaee, Katrin Lueer, Meike Mueller, Jenny Mjösberg, Outi Vaarala, Jens Hohlfeld, Katerina Pardali

Abstract

Background

Group 2 innate lymphoid cells (ILC2) are effective producers of IL-5 and IL-13 during allergic inflammation and bridge the innate and adaptive immune response. ILC2 are increased in asthmatics compared to healthy controls. So far human data describing their phenotype during acute allergic inflammation in the lung is incomplete.

Objectives

This study aims to characterize and compare blood- and lung-derived ILC2 before and after segmental allergen challenge in mild to moderate asthmatic individuals with high blood eosinophil levels (≥300/μl).

Methods

ILC2 were isolated from blood and bronchoalveolar lavage (BAL) before and after segmental allergen challenge. Cells were sorted by flow cytometry, cultured and analyzed for cytokine release or migration, and sequenced for RNA expression.

Results

ILC2 were nearly absent in the alveolar space under baseline conditions but increased significantly after allergen challenge (P < 0.05) , whilst at the same time ILC2 numbers in blood were reduced (P<0.05). Prostaglandin D₂ (PGD₂) and CXCL12 levels in BAL correlated with decreased ILC2 numbers in blood (P = 0.004, respective P = 0.024). After allergen challenge several genes promoting type 2 inflammation were higher expressed in BAL compared to blood ILC2, while blood ILC2 remain unactivated.

Conclusion

ILC2 accumulate at the site of allergic inflammation and are recruited from the blood. Their transcriptional and functional activation pattern promote type 2 inflammation.

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Activation of Group 2 innate lymphoid cells after allergen challenge in asthmatics

Publication date: Available online 4 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Carla Winkler, Thomas Hochdörfer, Elisabeth Israelsson, Annemarie Hasselberg, Anders Cavallin, Kristofer Thörn, Daniel Muthas, Shervin Shojaee, Katrin Lueer, Meike Mueller, Jenny Mjösberg, Outi Vaarala, Jens Hohlfeld, Katerina Pardali

Abstract

Background

Group 2 innate lymphoid cells (ILC2) are effective producers of IL-5 and IL-13 during allergic inflammation and bridge the innate and adaptive immune response. ILC2 are increased in asthmatics compared to healthy controls. So far human data describing their phenotype during acute allergic inflammation in the lung is incomplete.

Objectives

This study aims to characterize and compare blood- and lung-derived ILC2 before and after segmental allergen challenge in mild to moderate asthmatic individuals with high blood eosinophil levels (≥300/μl).

Methods

ILC2 were isolated from blood and bronchoalveolar lavage (BAL) before and after segmental allergen challenge. Cells were sorted by flow cytometry, cultured and analyzed for cytokine release or migration, and sequenced for RNA expression.

Results

ILC2 were nearly absent in the alveolar space under baseline conditions but increased significantly after allergen challenge (P < 0.05) , whilst at the same time ILC2 numbers in blood were reduced (P<0.05). Prostaglandin D₂ (PGD₂) and CXCL12 levels in BAL correlated with decreased ILC2 numbers in blood (P = 0.004, respective P = 0.024). After allergen challenge several genes promoting type 2 inflammation were higher expressed in BAL compared to blood ILC2, while blood ILC2 remain unactivated.

Conclusion

ILC2 accumulate at the site of allergic inflammation and are recruited from the blood. Their transcriptional and functional activation pattern promote type 2 inflammation.

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Current Update on Pediatric Body MR Imaging

Publication date: Available online 4 February 2019

Source: Magnetic Resonance Imaging Clinics of North America

Author(s): Edward Y. Lee

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Current Update on Pediatric Body MR Imaging

Publication date: Available online 4 February 2019

Source: Magnetic Resonance Imaging Clinics of North America

Author(s): Edward Y. Lee

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Delayed tine Displacement of a CASPER Carotid Artery Stent due to Styloid Process Compression

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Effect of High-fat Diet on Tracheal Responsiveness to Methacholine and Insulin Resistance Index in Ovalbumin-sensitized Male and Female Rats

Epidemiological and clinical studies have demonstrated a close association between obesity and asthma. The current study investigated the effect of high-fat diet on tracheal responsiveness to methacholine and insulin resistance in ovalbumin (OVA) sensitized male and female rats. The rats were divided into eight groups (n=6 per group): female with the normal diet (F+ND), male with the normal diet (M+ND), female OVA-sensitized with the normal diet (F+SND), male OVA-sensitized with the normal diet (M+SND), female with high-fat diet (F+HFD), male with high-fat diet (M+HFD), female OVA-sensitized with high-fat diet (F+SHFD), and male OVA-sensitized with high-fat diet (M+SHFD). All rats were fed for 8 weeks with high-fat diet or standard pelts, and for another 4 weeks, they were sensitized with OVA or saline. At the end of the study, the tracheal responsiveness to methacholine, serum insulin, and blood glucose levels was measured. Also, insulin resistance indexes were determined. OVA-sensitization and diet-induced obesity caused the curve of methacholine concentration response to shifting to the left. In addition, results indicated that the EC₅₀ (the effective concentration of methacholine generating 50% of peak response) in F+SHFD rats was statistically lower than M+SHFD group (p<0.05). Moreover, insulin resistance was higher in the F+SHFD than the M+SHFD group (p<0.001). These results suggest that insulin resistance and metabolic syndrome may be involved in the pathogenesis of obesity associated with OVA-sensitized rats condition, especially in female animals.

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Delayed tine Displacement of a CASPER Carotid Artery Stent due to Styloid Process Compression

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Effect of High-fat Diet on Tracheal Responsiveness to Methacholine and Insulin Resistance Index in Ovalbumin-sensitized Male and Female Rats

Epidemiological and clinical studies have demonstrated a close association between obesity and asthma. The current study investigated the effect of high-fat diet on tracheal responsiveness to methacholine and insulin resistance in ovalbumin (OVA) sensitized male and female rats. The rats were divided into eight groups (n=6 per group): female with the normal diet (F+ND), male with the normal diet (M+ND), female OVA-sensitized with the normal diet (F+SND), male OVA-sensitized with the normal diet (M+SND), female with high-fat diet (F+HFD), male with high-fat diet (M+HFD), female OVA-sensitized with high-fat diet (F+SHFD), and male OVA-sensitized with high-fat diet (M+SHFD). All rats were fed for 8 weeks with high-fat diet or standard pelts, and for another 4 weeks, they were sensitized with OVA or saline. At the end of the study, the tracheal responsiveness to methacholine, serum insulin, and blood glucose levels was measured. Also, insulin resistance indexes were determined. OVA-sensitization and diet-induced obesity caused the curve of methacholine concentration response to shifting to the left. In addition, results indicated that the EC₅₀ (the effective concentration of methacholine generating 50% of peak response) in F+SHFD rats was statistically lower than M+SHFD group (p<0.05). Moreover, insulin resistance was higher in the F+SHFD than the M+SHFD group (p<0.001). These results suggest that insulin resistance and metabolic syndrome may be involved in the pathogenesis of obesity associated with OVA-sensitized rats condition, especially in female animals.

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The protective role of ferulic acid against cisplatin-induced ototoxicity

Publication date: Available online 4 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Eu-Ri Jo, Cha Kyung Youn, Yonghyun Jun, Sung Il Cho

Abstract

Objectives

While cisplatin is an effective chemotherapeutic agent, it can cause irreversible hearing loss. Ototoxicity leads to dose reduction during the cisplatin chemotherapy and results in inadequate treatment of malignant tumors. This study aimed to investigate the protective effects of ferulic acid on cisplatin-induced ototoxicity.

Methods

House Ear Institute-Organ of Corti 1 (HEI-OC1) cells were exposed to 30 μM of cisplatin for 24 h with or without pretreatment with ferulic acid. Cell viability was determined using the WST assay. Apoptotic cells were identified using TUNEL assay. Western blot analysis was performed to examine the change in expression of cleaved caspase, cleaved poly-ADP-ribose polymerase (PARP), nuclear factor erythroid 2-related factor 2 (Nrf2), and catalase. Intracellular reactive oxygen species (ROS) were determined by flow cytometry. Real-time PCR analyses were performed to examine the mRNA levels of antioxidant enzymes including glutamate-cysteine ligase catalytic subunit (Gclc), glutathione peroxidase 2 (Gpx2), catalase, and superoxide dismutase 2 (SOD2). Phalloidin staining of the organ of Corti was performed to determine hair cell survival or degeneration.

Results

Pretreatment with ferulic acid before cisplatin exposure significantly increased cell viability, levels of antioxidant enzymes, and hair cell survival. In addition, pretreatment with ferulic acid significantly reduced apoptotic cells, levels of cleaved caspase, levels of cleaved PARP, and intracellular ROS production.

Conclusion

Our results demonstrated that ferulic acid inhibited cisplatin-induced cytotoxicity by preventing ROS formation and inducing the production of endogenous antioxidants and indicated that ferulic acid might be used as a protective agent against cisplatin-induced ototoxicity.

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Patient injuries in pediatric otorhinolaryngology

Publication date: Available online 3 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Johanna Nokso-Koivisto, Karin Blomgren, Leena-Maija Aaltonen, Lasse Lehtonen, Päivi Helmiö

Abstract

Objectives

Patient injuries in children can have lifelong effects on the patient and a marked impact on the whole family. The aim of this study was to identify the errors and incidents leading to patient injuries in pediatric otorhinolaryngology (ORL) by evaluating accepted patient injury claims.

Methods

The records of all accepted patient injury claims in ORL between 2001 and 2011 were searched from the nationwide Patient Insurance Centre registry. Pediatric injuries were reviewed and evaluated in detail, and factors contributing to injury were identified.

Results

In the 10-year study period, 17 (7.6%) of the 223 patient injuries occurred in children, and of these, 15 (88%) were considered operative care. The median age of the patients was 8 years (range 3 to 16 years). All operations were performed as daytime elective surgery and by a fully trained specialist in 93% of the cases. One-half of the cases were routine surgeries for common ORL diseases. The most common incidences were incomplete surgery, retained gauze or foreign body, injury to adjacent anatomic structure, and insufficient charts or instructions (each occurred in 3 cases). The most frequent consequence was burn (n=4). One child died because of post-tonsillectomy hemorrhage.

Conclusions

Patient injuries in pediatric ORL are strongly related to surgery. Most injuries occurred after routine operations by a fully trained specialist. Clinicians should be aware of the most likely scenarios resulting in claims.

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The protective role of ferulic acid against cisplatin-induced ototoxicity

Publication date: Available online 4 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Eu-Ri Jo, Cha Kyung Youn, Yonghyun Jun, Sung Il Cho

Abstract

Objectives

While cisplatin is an effective chemotherapeutic agent, it can cause irreversible hearing loss. Ototoxicity leads to dose reduction during the cisplatin chemotherapy and results in inadequate treatment of malignant tumors. This study aimed to investigate the protective effects of ferulic acid on cisplatin-induced ototoxicity.

Methods

House Ear Institute-Organ of Corti 1 (HEI-OC1) cells were exposed to 30 μM of cisplatin for 24 h with or without pretreatment with ferulic acid. Cell viability was determined using the WST assay. Apoptotic cells were identified using TUNEL assay. Western blot analysis was performed to examine the change in expression of cleaved caspase, cleaved poly-ADP-ribose polymerase (PARP), nuclear factor erythroid 2-related factor 2 (Nrf2), and catalase. Intracellular reactive oxygen species (ROS) were determined by flow cytometry. Real-time PCR analyses were performed to examine the mRNA levels of antioxidant enzymes including glutamate-cysteine ligase catalytic subunit (Gclc), glutathione peroxidase 2 (Gpx2), catalase, and superoxide dismutase 2 (SOD2). Phalloidin staining of the organ of Corti was performed to determine hair cell survival or degeneration.

Results

Pretreatment with ferulic acid before cisplatin exposure significantly increased cell viability, levels of antioxidant enzymes, and hair cell survival. In addition, pretreatment with ferulic acid significantly reduced apoptotic cells, levels of cleaved caspase, levels of cleaved PARP, and intracellular ROS production.

Conclusion

Our results demonstrated that ferulic acid inhibited cisplatin-induced cytotoxicity by preventing ROS formation and inducing the production of endogenous antioxidants and indicated that ferulic acid might be used as a protective agent against cisplatin-induced ototoxicity.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DRpf2B

Patient injuries in pediatric otorhinolaryngology

Publication date: Available online 3 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Johanna Nokso-Koivisto, Karin Blomgren, Leena-Maija Aaltonen, Lasse Lehtonen, Päivi Helmiö

Abstract

Objectives

Patient injuries in children can have lifelong effects on the patient and a marked impact on the whole family. The aim of this study was to identify the errors and incidents leading to patient injuries in pediatric otorhinolaryngology (ORL) by evaluating accepted patient injury claims.

Methods

The records of all accepted patient injury claims in ORL between 2001 and 2011 were searched from the nationwide Patient Insurance Centre registry. Pediatric injuries were reviewed and evaluated in detail, and factors contributing to injury were identified.

Results

In the 10-year study period, 17 (7.6%) of the 223 patient injuries occurred in children, and of these, 15 (88%) were considered operative care. The median age of the patients was 8 years (range 3 to 16 years). All operations were performed as daytime elective surgery and by a fully trained specialist in 93% of the cases. One-half of the cases were routine surgeries for common ORL diseases. The most common incidences were incomplete surgery, retained gauze or foreign body, injury to adjacent anatomic structure, and insufficient charts or instructions (each occurred in 3 cases). The most frequent consequence was burn (n=4). One child died because of post-tonsillectomy hemorrhage.

Conclusions

Patient injuries in pediatric ORL are strongly related to surgery. Most injuries occurred after routine operations by a fully trained specialist. Clinicians should be aware of the most likely scenarios resulting in claims.

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Longitudinal assessment of heavy alcohol use and incapacitated sexual assault: A cross-lagged analysis

Publication date: Available online 4 February 2019

Source: Addictive Behaviors

Author(s): Alyssa L. Norris, Kate B. Carey, Jennifer L. Walsh, Robyn L. Shepardson, Michael P. Carey

Abstract

Researchers have argued there are bidirectional associations between heavy alcohol use and sexual assault; however, research in this area is inconclusive due to methodological differences, particularly in study design. The purpose of this study is to clarify the longitudinal associations between heavy alcohol use and incapacitated sexual assault among first-year college women, accounting for hypothesized autoregressive effects within each construct over their first year of college. A sample of 483 women completed regular surveys that assessed a range of health behaviors, including alcohol use and sexual behavior, during their first year of college. We used cross-lagged analyses to examine prospective associations between incapacitated sexual assault and heavy alcohol use (frequency of heavy episodic drinking and peak blood alcohol content). There were significant autoregressive effects, such that women who were engaging in heavier alcohol use as they entered college continued to be heavier alcohol users throughout their first year, and women with a history of assault at college entry were at greater risk for assault during their first year of college. There was a significant cross-lagged effect from precollege incapacitated assault to first-semester alcohol use after controlling for pre-college alcohol use. There were no significant cross-lag paths from alcohol use to subsequent incapacitated assault. Women with a history of incapacitated sexual assault engaged in heavier drinking during their transition to college, but heavy alcohol use did not predict subsequent assault risk.

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Longitudinal assessment of heavy alcohol use and incapacitated sexual assault: A cross-lagged analysis

Publication date: Available online 4 February 2019

Source: Addictive Behaviors

Author(s): Alyssa L. Norris, Kate B. Carey, Jennifer L. Walsh, Robyn L. Shepardson, Michael P. Carey

Abstract

Researchers have argued there are bidirectional associations between heavy alcohol use and sexual assault; however, research in this area is inconclusive due to methodological differences, particularly in study design. The purpose of this study is to clarify the longitudinal associations between heavy alcohol use and incapacitated sexual assault among first-year college women, accounting for hypothesized autoregressive effects within each construct over their first year of college. A sample of 483 women completed regular surveys that assessed a range of health behaviors, including alcohol use and sexual behavior, during their first year of college. We used cross-lagged analyses to examine prospective associations between incapacitated sexual assault and heavy alcohol use (frequency of heavy episodic drinking and peak blood alcohol content). There were significant autoregressive effects, such that women who were engaging in heavier alcohol use as they entered college continued to be heavier alcohol users throughout their first year, and women with a history of assault at college entry were at greater risk for assault during their first year of college. There was a significant cross-lagged effect from precollege incapacitated assault to first-semester alcohol use after controlling for pre-college alcohol use. There were no significant cross-lag paths from alcohol use to subsequent incapacitated assault. Women with a history of incapacitated sexual assault engaged in heavier drinking during their transition to college, but heavy alcohol use did not predict subsequent assault risk.

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Elevated diastolic wall shear stress in regurgitant semilunar valvular lesions

Background

Alterations in wall shear stress (WSS) assessed using 4D flow MRI have been shown to play a role in various vascular pathologies, such as bicuspid aortic valve aortopathy. Most studies have focused on systolic WSS, whereas altered diastolic hemodynamics in regurgitant semilunar valvular lesions have not so far been well characterized.

Purpose

To investigate diastolic WSS in aortic and pulmonary regurgitation.

Study Type

Retrospective data analysis.

Population

Thirty tetralogy of Fallot patients, 19 bicuspid aortic valve patients, 11 healthy volunteers.

Field Strength/Sequence

5 T, 3D time‐resolved phase‐contrast MRI with 3D velocity encoding.

Assessment

Estimation of WSS and its axial and circumferential vector components along cardiac cycle timeframes in the proximal main pulmonary artery in pulmonary regurgitation (PR) and in the proximal ascending aorta in aortic regurgitation (AR) as well as in healthy volunteers.

Statistical Tests

Wilcoxon matched pairs test was used for intra‐group comparisons and Mann–Whitney test for intergroup comparisons. Correlations were assessed using Spearman correlation.

Results

WSS along the entire cardiac cycle was higher in PR and AR in comparison with controls (mean WSS 0.381 ± 0.070 vs. 0.220 ± 0.018, P < 0.0001; 0.361 ± 0.099 vs. 0.212 ± 0.030, P < 0.0001; respectively). Peak diastolic WSS was significantly higher than the mean WSS in AR and PR (P < 0.0001–0.005). The severity of PR correlated with the peak diastolic axial WSS (Spearman's r _s  = 0.454, P = 0.018), whereas the severity of AR correlated with both peak systolic and diastolic tangential WSS (Spearman's r _s  = 0.458, P = 0.049; r _s  = 0.539, P = 0.017, respectively).

Data Conclusion

Elevated diastolic WSS is a component of the altered flow hemodynamics in AR and PR. This may give more insight into the pathophysiologic role of WSS in vascular remodeling in AR and PR.

Level of Evidence: 4

Technical Efficacy Stage: 1

J. MAGN. RESON. IMAGING 2019.

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Analysis of aortic pressure fields from 4D flow MRI in healthy volunteers: Associations with age and left ventricular remodeling

Background

Aging‐related arterial stiffness is associated with substantial changes in global and local arterial pressures. The subsequent early return of reflected pressure waves leads to an elevated left ventricular (LV) afterload and ultimately to a deleterious concentric LV remodeling.

Purpose

To compute aortic time‐resolved pressure fields of healthy subjects from 4D flow MRI and to define relevant pressure‐based markers while investigating their relationship with age, LV remodeling, as well as tonometric augmentation index (AIx) and pulse wave velocity (PWV).

Study Type

Retrospective.

Population

Forty‐seven healthy subjects (age: 49.5 ± 18 years, 24 women).

Field Strength/Sequence

3 T/4D flow MRI.

Assessment

Spatiotemporal pressure fields were computed by integrating velocity‐derived pressure gradients using Navier–Stokes equations, while assuming zero pressure at the sino‐tubular junction. To quantify aortic pressure spatiotemporal variations, we defined the following markers: 1) volumetric aortic pressure propagation rates ΔP _E1 /ΔV and ΔP _E2 /ΔV, representing variations of early and late systolic relative pressure peaks along the aorta, respectively, according to the cumulated aortic volume; 2) ΔA _PE1‐PE2 defined in four aortic regions as the absolute difference between early and late systolic relative pressure peaks amplitude.

Statistical Tests

Linear regression, Wilcoxon rank sum test, Bland–Altman analysis, and intraclass correlation coefficients (ICC).

Results

Spatiotemporal variations of aortic pressure peaks were moderately to highly reproducible (ICC ≥0.50) and decreased significantly with age, in terms of absolute magnitude: ΔP _E1 /ΔV (r = 0.70, P < 0.005), ΔP _E2 /ΔV (r = –0.45, P < 0.005) and ΔA _PE1‐PE2 (|r| > 0.39, P < 0.005). ΔP _E1 /ΔV was associated with LV remodeling (r = 0.53, P < 0.001) and ascending aorta ΔA _PE1‐PE2 was associated with AIx (r = –0.59, P < 0.001). Both associations were independent of age and systolic blood pressures. Only weak associations were found between pressure indices and PWV (r ≤ 0.40).

Data Conclusion

4D flow MRI relative aortic pressures were consistent with physiological knowledge as demonstrated by their significant volumetric and temporal variations with age and their independent association with LV remodeling and augmentation index.

Level of Evidence 2

Technical Efficacy Stage 3

J. MAGN. RESON. IMAGING 2019.

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Elevated diastolic wall shear stress in regurgitant semilunar valvular lesions

Background

Alterations in wall shear stress (WSS) assessed using 4D flow MRI have been shown to play a role in various vascular pathologies, such as bicuspid aortic valve aortopathy. Most studies have focused on systolic WSS, whereas altered diastolic hemodynamics in regurgitant semilunar valvular lesions have not so far been well characterized.

Purpose

To investigate diastolic WSS in aortic and pulmonary regurgitation.

Study Type

Retrospective data analysis.

Population

Thirty tetralogy of Fallot patients, 19 bicuspid aortic valve patients, 11 healthy volunteers.

Field Strength/Sequence

5 T, 3D time‐resolved phase‐contrast MRI with 3D velocity encoding.

Assessment

Estimation of WSS and its axial and circumferential vector components along cardiac cycle timeframes in the proximal main pulmonary artery in pulmonary regurgitation (PR) and in the proximal ascending aorta in aortic regurgitation (AR) as well as in healthy volunteers.

Statistical Tests

Wilcoxon matched pairs test was used for intra‐group comparisons and Mann–Whitney test for intergroup comparisons. Correlations were assessed using Spearman correlation.

Results

WSS along the entire cardiac cycle was higher in PR and AR in comparison with controls (mean WSS 0.381 ± 0.070 vs. 0.220 ± 0.018, P < 0.0001; 0.361 ± 0.099 vs. 0.212 ± 0.030, P < 0.0001; respectively). Peak diastolic WSS was significantly higher than the mean WSS in AR and PR (P < 0.0001–0.005). The severity of PR correlated with the peak diastolic axial WSS (Spearman's r _s  = 0.454, P = 0.018), whereas the severity of AR correlated with both peak systolic and diastolic tangential WSS (Spearman's r _s  = 0.458, P = 0.049; r _s  = 0.539, P = 0.017, respectively).

Data Conclusion

Elevated diastolic WSS is a component of the altered flow hemodynamics in AR and PR. This may give more insight into the pathophysiologic role of WSS in vascular remodeling in AR and PR.

Level of Evidence: 4

Technical Efficacy Stage: 1

J. MAGN. RESON. IMAGING 2019.

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

Analysis of aortic pressure fields from 4D flow MRI in healthy volunteers: Associations with age and left ventricular remodeling

Background

Aging‐related arterial stiffness is associated with substantial changes in global and local arterial pressures. The subsequent early return of reflected pressure waves leads to an elevated left ventricular (LV) afterload and ultimately to a deleterious concentric LV remodeling.

Purpose

To compute aortic time‐resolved pressure fields of healthy subjects from 4D flow MRI and to define relevant pressure‐based markers while investigating their relationship with age, LV remodeling, as well as tonometric augmentation index (AIx) and pulse wave velocity (PWV).

Study Type

Retrospective.

Population

Forty‐seven healthy subjects (age: 49.5 ± 18 years, 24 women).

Field Strength/Sequence

3 T/4D flow MRI.

Assessment

Spatiotemporal pressure fields were computed by integrating velocity‐derived pressure gradients using Navier–Stokes equations, while assuming zero pressure at the sino‐tubular junction. To quantify aortic pressure spatiotemporal variations, we defined the following markers: 1) volumetric aortic pressure propagation rates ΔP _E1 /ΔV and ΔP _E2 /ΔV, representing variations of early and late systolic relative pressure peaks along the aorta, respectively, according to the cumulated aortic volume; 2) ΔA _PE1‐PE2 defined in four aortic regions as the absolute difference between early and late systolic relative pressure peaks amplitude.

Statistical Tests

Linear regression, Wilcoxon rank sum test, Bland–Altman analysis, and intraclass correlation coefficients (ICC).

Results

Spatiotemporal variations of aortic pressure peaks were moderately to highly reproducible (ICC ≥0.50) and decreased significantly with age, in terms of absolute magnitude: ΔP _E1 /ΔV (r = 0.70, P < 0.005), ΔP _E2 /ΔV (r = –0.45, P < 0.005) and ΔA _PE1‐PE2 (|r| > 0.39, P < 0.005). ΔP _E1 /ΔV was associated with LV remodeling (r = 0.53, P < 0.001) and ascending aorta ΔA _PE1‐PE2 was associated with AIx (r = –0.59, P < 0.001). Both associations were independent of age and systolic blood pressures. Only weak associations were found between pressure indices and PWV (r ≤ 0.40).

Data Conclusion

4D flow MRI relative aortic pressures were consistent with physiological knowledge as demonstrated by their significant volumetric and temporal variations with age and their independent association with LV remodeling and augmentation index.

Level of Evidence 2

Technical Efficacy Stage 3

J. MAGN. RESON. IMAGING 2019.

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Evaluation of the effect of teriparatide therapy on mandibular fracture healing in rats with medication-related osteonecrosis of the jaw

Abstract

Objective

The aim of this study was to evaluate the effect of teriparatide therapy on mandibular fracture healing in rats with medication-related osteonecrosis of the jaw (MRONJ).

Materials and methods

To induce MRONJ, a total of 120 rats received intravenous zoledronate 0.06 mg/kg once a week for 6 weeks and their right mandibular first molar was extracted. Eighty of 94 rats with MRONJ were randomly selected and underwent unilateral mandibular osteotomy to replicate a fracture. After surgery, the rats were randomly assigned to T (teriparatide-treated) and C (control) groups. Group T (n = 40) received subcutaneous injection of 2 μg/kg/day teriparatide and group C (n = 40) received the same volume of normal saline until sacrifice. Four and 8 weeks after surgery, 20 rats in each group were sacrificed. Fracture healing was scored using a histological grading system (1 to 10).

Results

In group C, at 4 weeks and 8 weeks post-fracture, fibrous and cartilaginous tissues and scant bone formation at the fracture site and lacunae without osteocyte in adjacent mandibular bone were seen. In group T, substantial amounts of new trabecular bone rimmed by osteoblasts and some areas of remodeled mature bone were seen. After 8 weeks, extensive replacement of trabecular bone with mature bone occurred. Except between C4 and C8 groups, the healing score was significantly different between all subgroups.

Conclusion

Teriparatide therapy successfully improved mandibular fracture healing in rats with MRONJ. However, this study was limited by the use of an animal model whose anatomy, physiology, and drug metabolism might be different from humans.

Clinical relevance

The present study showed that teriparatide therapy may be used adjunctive to surgery in the treatment of mandibular fractures in MRONJ patients.

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Evaluation of the effect of teriparatide therapy on mandibular fracture healing in rats with medication-related osteonecrosis of the jaw

Abstract

Objective

The aim of this study was to evaluate the effect of teriparatide therapy on mandibular fracture healing in rats with medication-related osteonecrosis of the jaw (MRONJ).

Materials and methods

To induce MRONJ, a total of 120 rats received intravenous zoledronate 0.06 mg/kg once a week for 6 weeks and their right mandibular first molar was extracted. Eighty of 94 rats with MRONJ were randomly selected and underwent unilateral mandibular osteotomy to replicate a fracture. After surgery, the rats were randomly assigned to T (teriparatide-treated) and C (control) groups. Group T (n = 40) received subcutaneous injection of 2 μg/kg/day teriparatide and group C (n = 40) received the same volume of normal saline until sacrifice. Four and 8 weeks after surgery, 20 rats in each group were sacrificed. Fracture healing was scored using a histological grading system (1 to 10).

Results

In group C, at 4 weeks and 8 weeks post-fracture, fibrous and cartilaginous tissues and scant bone formation at the fracture site and lacunae without osteocyte in adjacent mandibular bone were seen. In group T, substantial amounts of new trabecular bone rimmed by osteoblasts and some areas of remodeled mature bone were seen. After 8 weeks, extensive replacement of trabecular bone with mature bone occurred. Except between C4 and C8 groups, the healing score was significantly different between all subgroups.

Conclusion

Teriparatide therapy successfully improved mandibular fracture healing in rats with MRONJ. However, this study was limited by the use of an animal model whose anatomy, physiology, and drug metabolism might be different from humans.

Clinical relevance

The present study showed that teriparatide therapy may be used adjunctive to surgery in the treatment of mandibular fractures in MRONJ patients.

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Safety Study of Hepatitis E Vaccine (HEV239) in Healthy US Adult Population

Conditions:   Hepatitis E;   Immunisation Interventions:   Biological: HEV 239;   Other: Placebo Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Not yet recruiting (Source: ClinicalTrials.gov)

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Allergy UK Research and Development Nurse Project

Condition:   Allergy Intervention:   Other: Nurse Led Allergy Clinic Sponsors:   University of Edinburgh;   Allergy UK Recruiting (Source: ClinicalTrials.gov)

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