Editorial Board/Reviewing Committee

Publication date: March 2019

Source: International Journal of Oral and Maxillofacial Surgery, Volume 48, Issue 3

Author(s):

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Nasal soft tissue changes after two different approaches for surgically assisted rapid maxillary expansion

Publication date: Available online 11 February 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): Y. Fındık, T. Baykul, T. Yazıcı

Abstract

The aim of the study was to evaluate the nasal soft tissue changes in patients who underwent surgically assisted rapid maxillary expansion (SARME) using two different surgical approaches. Thirty-two patients were included in the study, and divided into two groups according to the type of surgical approach: in group A (n = 17), SARME performed with standard Le Fort I circumvestibular approach with alar base cinch and anterior nasal spine (ANS) exposure; and in group B (n = 15) operations were performed with the same standard Le Fort I circumvestibular approach with only alar base cinch. Measurements of height and width of the philtrum, nasal and subnasal width, and columella width were taken from three-dimensional facial images obtained before surgery (T1), after the distraction phase (T2) and 6 months postoperatively (T3). The mean maxillary expansion was 7.3 ± 0.7 mm for group A and 7.5 ± 1.5 mm for group B, without any significant difference between groups (P = 0.59). Both groups presented an increase in all vaules in T2 and T3. The approach used in group A resulted in smaller changes in the columella width. The results of the present study show that there is no need for intraoperative releasing of the soft tissues around the anterior nasal spine during SARME if columella width is sufficient. However, further randomized studies based on large patient groups are needed before final conclusions on this topic can be reached.

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Extension patterns of vestibular schwannomas towards the middle ear: three new cases and review of the literature

Abstract

Objective

Middle ear extension of vestibular schwannomas is not a common occurrence, and only a few cases have been described so far in past publications. We report three new cases of vestibular schwannomas extending to the middle ear and reviewed the literature to specify the patterns of such an extension.

Materials and methods

We analysed databases of previously published articles to search for additional cases of middle ear extension of vestibular schwannomas and compared them to the cases we have documented. Extension patterns of the tumours were analysed, especially focusing on the extension through the round and oval windows.

Results and conclusion

Middle ear vestibular schwannomas are uncommon tumours and only 13 cases have been published so far. The vestibular schwannoma (internal auditory canal or intralabyrinthine) has to invade the labyrinth first (complete invasion in 88% of the cases, n = 14), before reaching the middle ear. In the majority of cases (69%, n = 11/16), internal auditory canal vestibular schwannomas or intralabyrinthine schwannomas extended in the middle ear though the round window.

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The anatomical and radiological evaluation of the Vidian canal on cone-beam computed tomography images

Abstract

Introduction

The aim of this study is to explore the anatomy of the Vidian nerve to elucidate the appropriate surgical approach based on preoperative cone-beam computed tomography (CBCT) images.

Materials and methods

The Vidian canal and its surrounding structures were morphometrically evaluated retrospectively in CBCT images of 400 cases by the Planmeca Romexis program. The types of the Vidian canal were determined and seven parameters were measured from the images.

Results

Three types of the Vidian canal according to the relationship with the sphenoid bone were found as follows: the Vidian canal totally protruded into the sphenoid sinus (19.75%), partially protruded into sphenoid sinus (44.37%) and embedded inside bony tissue of the body of sphenoid bone (35.87%). The position of the Vidian canal was medial (34.62%), on the same line (55.12%) and lateral (10.25%) to the medial plate of the pterygoid process. The distance between the Vidian canal and the vomerine crest, the mid-sagittal plane, the round foramen, the palatovaginal canal, and the superior wall of the sphenoid sinus, the length of the Vidian canal and the angle between the Vidian canal and the sagittal plane was found to be 16.69 ± 2.14, 13.80 ± 2.00, 8.88 ± 1.60, 5.83 ± 1.37, 23.98 ± 2.68, 13.29 ± 1.71 mm and 25.78° ± 3.68° in males, 14.62 ± 1.66, 11.43 ± 1.28, 8.51 ± 1.63, 5.78 ± 0.57, 22.37 ± 2.07, 12.91 ± 1.26 mm and 23.43° ± 3.07° in females, respectively.

Conclusions

Our results may assist with proper treatment for surgical procedures around the Vidian canal with a high success rate and minimal complications. Therefore, the results obtained in this study contribute to the literature.

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Post-contrast 3D-FLAIR in idiopathic sudden sensorineural hearing loss

Abstract

Purpose

Our study investigated correlations between clinical characteristics, particularly hearing recovery, interval time between onset and three-dimensional fluid attenuation inversion recovery magnetic resonance imaging (3D-FLAIR MRI), and the signal intensity of post-contrast 3D-FLAIR MRI in patients with idiopathic sudden sensorineural hearing loss (SSNHL).

Methods

The study enrolled 100 SSNHL patients. The signal intensities and asymmetry ratios of the inner ear structures, including the cochleae, vestibules and vestibulocochlear nerve, were evaluated and calculated. The relationships between the clinical characteristics and MRI findings were assessed.

Results

After intravenous gadolinium (Gd) injection, 3D-FLAIR revealed high signal intensities in 65 patients. The corrected asymmetry ratios of cochlea correlated closely with interval time between onset and MRI. The asymmetry ratios of the inner ear structures were significantly lower in patients with final complete to partial hearing recovery. The corrected asymmetry ratios of the inner ear structures correlated with initial/final pure tone audiometry (PTA) and hearing recovery in the affected ear. Notably, it was shown that the corrected asymmetry ratios identified a poor prognosis for hearing recovery, with a sensitivity and specificity of 67.9% and 75.0% in the cochlea, 83.3% and 75.0% in the vestibule, and 52.4% and 81.2% in the vestibulocochlear nerve, respectively.

Conclusions

Post-contrast 3D-FLAIR after intravenous Gd injection in SSNHL can be used to assess the permeability of the blood–labyrinth and blood–nerve barriers. The asymmetry ratios of the inner ear structures may identify patients with poor prognosis for hearing recovery. Signal characteristics are closely related to interval time between onset and MRI.

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

Extension patterns of vestibular schwannomas towards the middle ear: three new cases and review of the literature

Abstract

Objective

Middle ear extension of vestibular schwannomas is not a common occurrence, and only a few cases have been described so far in past publications. We report three new cases of vestibular schwannomas extending to the middle ear and reviewed the literature to specify the patterns of such an extension.

Materials and methods

We analysed databases of previously published articles to search for additional cases of middle ear extension of vestibular schwannomas and compared them to the cases we have documented. Extension patterns of the tumours were analysed, especially focusing on the extension through the round and oval windows.

Results and conclusion

Middle ear vestibular schwannomas are uncommon tumours and only 13 cases have been published so far. The vestibular schwannoma (internal auditory canal or intralabyrinthine) has to invade the labyrinth first (complete invasion in 88% of the cases, n = 14), before reaching the middle ear. In the majority of cases (69%, n = 11/16), internal auditory canal vestibular schwannomas or intralabyrinthine schwannomas extended in the middle ear though the round window.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2E5NLxh

The anatomical and radiological evaluation of the Vidian canal on cone-beam computed tomography images

Abstract

Introduction

The aim of this study is to explore the anatomy of the Vidian nerve to elucidate the appropriate surgical approach based on preoperative cone-beam computed tomography (CBCT) images.

Materials and methods

The Vidian canal and its surrounding structures were morphometrically evaluated retrospectively in CBCT images of 400 cases by the Planmeca Romexis program. The types of the Vidian canal were determined and seven parameters were measured from the images.

Results

Three types of the Vidian canal according to the relationship with the sphenoid bone were found as follows: the Vidian canal totally protruded into the sphenoid sinus (19.75%), partially protruded into sphenoid sinus (44.37%) and embedded inside bony tissue of the body of sphenoid bone (35.87%). The position of the Vidian canal was medial (34.62%), on the same line (55.12%) and lateral (10.25%) to the medial plate of the pterygoid process. The distance between the Vidian canal and the vomerine crest, the mid-sagittal plane, the round foramen, the palatovaginal canal, and the superior wall of the sphenoid sinus, the length of the Vidian canal and the angle between the Vidian canal and the sagittal plane was found to be 16.69 ± 2.14, 13.80 ± 2.00, 8.88 ± 1.60, 5.83 ± 1.37, 23.98 ± 2.68, 13.29 ± 1.71 mm and 25.78° ± 3.68° in males, 14.62 ± 1.66, 11.43 ± 1.28, 8.51 ± 1.63, 5.78 ± 0.57, 22.37 ± 2.07, 12.91 ± 1.26 mm and 23.43° ± 3.07° in females, respectively.

Conclusions

Our results may assist with proper treatment for surgical procedures around the Vidian canal with a high success rate and minimal complications. Therefore, the results obtained in this study contribute to the literature.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BxwJ9H

Post-contrast 3D-FLAIR in idiopathic sudden sensorineural hearing loss

Abstract

Purpose

Our study investigated correlations between clinical characteristics, particularly hearing recovery, interval time between onset and three-dimensional fluid attenuation inversion recovery magnetic resonance imaging (3D-FLAIR MRI), and the signal intensity of post-contrast 3D-FLAIR MRI in patients with idiopathic sudden sensorineural hearing loss (SSNHL).

Methods

The study enrolled 100 SSNHL patients. The signal intensities and asymmetry ratios of the inner ear structures, including the cochleae, vestibules and vestibulocochlear nerve, were evaluated and calculated. The relationships between the clinical characteristics and MRI findings were assessed.

Results

After intravenous gadolinium (Gd) injection, 3D-FLAIR revealed high signal intensities in 65 patients. The corrected asymmetry ratios of cochlea correlated closely with interval time between onset and MRI. The asymmetry ratios of the inner ear structures were significantly lower in patients with final complete to partial hearing recovery. The corrected asymmetry ratios of the inner ear structures correlated with initial/final pure tone audiometry (PTA) and hearing recovery in the affected ear. Notably, it was shown that the corrected asymmetry ratios identified a poor prognosis for hearing recovery, with a sensitivity and specificity of 67.9% and 75.0% in the cochlea, 83.3% and 75.0% in the vestibule, and 52.4% and 81.2% in the vestibulocochlear nerve, respectively.

Conclusions

Post-contrast 3D-FLAIR after intravenous Gd injection in SSNHL can be used to assess the permeability of the blood–labyrinth and blood–nerve barriers. The asymmetry ratios of the inner ear structures may identify patients with poor prognosis for hearing recovery. Signal characteristics are closely related to interval time between onset and MRI.

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Information for Readers

Publication date: March 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 3

Author(s):

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Society Page

Publication date: March 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 3

Author(s):

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2N067T2

Table of Contents

Publication date: March 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 3

Author(s):

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Vitamin D status modifies the response to indoor particulate matter in obese urban children with asthma

Publication date: Available online 11 February 2019

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

Author(s): Sonali Bose, Gregory B. Diette, Han Woo, Kirsten Koehler, Karina Romero, Ana M. Rule, Barbara Detrick, Emily Brigham, Meredith C. McCormack, Nadia N. Hansel

Abstract

Background

Indoor fine particulate air pollution (PM_2.5) is linked to asthma morbidity; however, whether vitamin D status influences individual susceptibility to airborne exposures is unclear.

Objective

We aimed to determine if vitamin D modifies effects of indoor PM_2.5 upon asthma symptoms in urban children.

Methods

120 children aged 5-12 years with physician-diagnosed asthma were evaluated at baseline and every 3 months for 9 months. Indoor PM_2.5, serum 25-hydroxy vitamin D (25-OH D) levels and asthma symptoms were simultaneously assessed at each time point. Adjusting for confounders, generalized estimating equations assessed 3-way interaction effects of 25-OH D, obesity and PM upon asthma symptoms.

Results

Children were of mean (SD) age 9.7 (2.2) years, 36% were obese, and 95% self-reported black race. Mean (SD) PM_2.5 indoor exposure was 38.2 (42.9) μg/m³ and 25-OH D was 19.1 (7.5) ng/ml. Three-way interaction models demonstrated significantly greater PM_2.5-associated effects on daytime asthma symptoms only among obese children with low 25-OH D levels (OR_PM2.5=1.26,p =0.049 at vitamin D=15.5 ng/ml, increasingly stronger PM effects at levels<15.5 ng/ml). In homes with increased PM_2.5, higher 25-OH D was associated with decreased symptom odds (e.g., OR_{Vitamin D} = 0.87; p=0.049 at PM_2.5 = 52.5 μg/m³, increasingly protective effects >52.5 μg/m³) among obese children.

Conclusion

Among obese urban children with asthma, low individual 25-OH vitamin D enhanced adverse respiratory effects associated with indoor PM_2.5. In high PM_2.5 environments, 25-OH D was protective against asthma symptoms. Optimizing vitamin D status in children may help reduce asthma morbidity driven by indoor air pollution.

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The role of early life food sensitization in adolescent lung function: Results from two birth cohort studies

Publication date: Available online 11 February 2019

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

Author(s): Shatha Alduraywish, Agnes Luzak, Caroline Lodge, Fahad Aldakheel, Bircan Erbas, Katrina Allen, Melanie Matheson, Lyle Gurrin, Joachim Heinrich, Irina Lehmann, Andrea von Berg, Marie Standl, Michael Abramson, Holger Schulz, Adrian Lowe, Shyamali Dharmage

Abstract

Background

It is unclear whether early life food sensitization (as opposed to aeroallergen sensitization) is associated with subsequent poor lung function.

Objectives

We investigated the associations between food sensitization in the first two years of life and lung function at 12 to 18 years and whether these observed associations are mediated through aeroallergen sensitization or asthma.

Methods

We used data from a high-risk cohort (MACS) and a population-based (LISAplus) cohort. Food sensitization was assessed at 6, 12 and 24-months in MACS and 24-months in LISAplus. Lung function was evaluated by spirometry at 12 and 18 years in MACS and 15 years in LISAplus. Linear regression models were used to estimate the association with sensitization (food and/or aeroallergen) while adjusting for potential confounders.

Results

Sensitization to food without aeroallergen at 6 months was associated with reduced FEV₁ at both 12 years (-153 ml; 95%CI=-256ml, -51ml) and 18 years (-206 ml; 95%CI=-347ml, -65ml) in MACS. Similar results were observed for sensitization measured at 12 months but not at 24 months. Early life asthma (but not aeroallergen sensitization) partially mediated these associations. Both cohorts showed that only aeroallergen sensitization at 24 months but not food sensitization was associated with lower adolescent lung function.

Conclusion

This study showed that food sensitization at 6 and 12 months was associated with reduced FEV₁ in adolescence. Our finding that this link is not completely mediated by either subsequent asthma or aeroallergen sensitization is novel and suggests that early food sensitization itself can be used to identify high-risk groups for poor lung health.

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Modified oral enteric-coated budesonide regimens to treat pediatric eosinophilic gastroenteritis, a single center experience

Publication date: Available online 11 February 2019

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

Author(s): Katie Kennedy, Amanda B. Muir, Andrew Grossman, Terri Brown-Whitehorn, Antonella Cianferoni, Jonathan M. Spergel, Glenn T. Furuta, Benjamin J. Wilkins, Michele Shuker, Melanie A. Ruffner

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Anaphylactic shock to meropenem with ertapenem tolerance: a case report

Publication date: Available online 11 February 2019

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

Author(s): Johana Gil-Serrano, Victoria Cardona, Olga Luengo, Mar Guilarte, Anna Sala-Cunill, Paula Galvan-Blasco, Moises Labrador-Horrillo

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Reduced Akkermansia muciniphila and Faecalibacterium prausnitzii levels in the gut microbiota of children with allergic asthma

Publication date: Available online 11 February 2019

Source: Allergologia et Immunopathologia

Author(s): M. Demirci, H.B. Tokman, H.K. Uysal, S. Demiryas, A. Karakullukcu, S. Saribas, H. Cokugras, B.S. Kocazeybek

Abstract

Introduction and objectives

The amounts of Akkermansia muciniphila and Faecalibacterium prausnitzii in gut microbiota are reduced in patients with allergic diseases compared to healthy controls. We aimed to quantify levels of A. muciniphila and F. prausnitzii amounts using real-time quantitative PCR (qPCR) in the gut microbiota of children with allergic asthma and in healthy controls.

Materials and methods

In total, 92 children between the ages of three and eight who were diagnosed with asthma and 88 healthy children were included in the study and bacterial DNA was isolated from the stool samples using the stool DNA isolation Kit. qPCR assays were studied with the microbial DNA qPCR Kit for A. muciniphila and microbial DNA qPCR Kit for F. prausnitzii.

Results

Both bacterial species showed a reduction in the patient group compared to healthy controls. A. muciniphila and F. prausnitzii were found to be 5.45 ± 0.004, 6.74 ± 0.01 and 5.71 ± 0.002, 7.28 ± 0.009 in the stool samples of the asthma and healthy control groups, respectively.

Conclusions

F. prausnitzii and A. muciniphila may have induced anti-inflammatory cytokine IL-10 and prevented the secretion of pro-inflammatory cytokines like IL-12. These findings suggest that A. muciniphila and F. prausnitzii may suppress inflammation through its secreted metabolites.

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Society Page

Publication date: March 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 3

Author(s):

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2N067T2

Table of Contents

Publication date: March 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 3

Author(s):

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SQ15xI

Vitamin D status modifies the response to indoor particulate matter in obese urban children with asthma

Publication date: Available online 11 February 2019

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

Author(s): Sonali Bose, Gregory B. Diette, Han Woo, Kirsten Koehler, Karina Romero, Ana M. Rule, Barbara Detrick, Emily Brigham, Meredith C. McCormack, Nadia N. Hansel

Abstract

Background

Indoor fine particulate air pollution (PM_2.5) is linked to asthma morbidity; however, whether vitamin D status influences individual susceptibility to airborne exposures is unclear.

Objective

We aimed to determine if vitamin D modifies effects of indoor PM_2.5 upon asthma symptoms in urban children.

Methods

120 children aged 5-12 years with physician-diagnosed asthma were evaluated at baseline and every 3 months for 9 months. Indoor PM_2.5, serum 25-hydroxy vitamin D (25-OH D) levels and asthma symptoms were simultaneously assessed at each time point. Adjusting for confounders, generalized estimating equations assessed 3-way interaction effects of 25-OH D, obesity and PM upon asthma symptoms.

Results

Children were of mean (SD) age 9.7 (2.2) years, 36% were obese, and 95% self-reported black race. Mean (SD) PM_2.5 indoor exposure was 38.2 (42.9) μg/m³ and 25-OH D was 19.1 (7.5) ng/ml. Three-way interaction models demonstrated significantly greater PM_2.5-associated effects on daytime asthma symptoms only among obese children with low 25-OH D levels (OR_PM2.5=1.26,p =0.049 at vitamin D=15.5 ng/ml, increasingly stronger PM effects at levels<15.5 ng/ml). In homes with increased PM_2.5, higher 25-OH D was associated with decreased symptom odds (e.g., OR_{Vitamin D} = 0.87; p=0.049 at PM_2.5 = 52.5 μg/m³, increasingly protective effects >52.5 μg/m³) among obese children.

Conclusion

Among obese urban children with asthma, low individual 25-OH vitamin D enhanced adverse respiratory effects associated with indoor PM_2.5. In high PM_2.5 environments, 25-OH D was protective against asthma symptoms. Optimizing vitamin D status in children may help reduce asthma morbidity driven by indoor air pollution.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tgO8yJ

The role of early life food sensitization in adolescent lung function: Results from two birth cohort studies

Publication date: Available online 11 February 2019

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

Author(s): Shatha Alduraywish, Agnes Luzak, Caroline Lodge, Fahad Aldakheel, Bircan Erbas, Katrina Allen, Melanie Matheson, Lyle Gurrin, Joachim Heinrich, Irina Lehmann, Andrea von Berg, Marie Standl, Michael Abramson, Holger Schulz, Adrian Lowe, Shyamali Dharmage

Abstract

Background

It is unclear whether early life food sensitization (as opposed to aeroallergen sensitization) is associated with subsequent poor lung function.

Objectives

We investigated the associations between food sensitization in the first two years of life and lung function at 12 to 18 years and whether these observed associations are mediated through aeroallergen sensitization or asthma.

Methods

We used data from a high-risk cohort (MACS) and a population-based (LISAplus) cohort. Food sensitization was assessed at 6, 12 and 24-months in MACS and 24-months in LISAplus. Lung function was evaluated by spirometry at 12 and 18 years in MACS and 15 years in LISAplus. Linear regression models were used to estimate the association with sensitization (food and/or aeroallergen) while adjusting for potential confounders.

Results

Sensitization to food without aeroallergen at 6 months was associated with reduced FEV₁ at both 12 years (-153 ml; 95%CI=-256ml, -51ml) and 18 years (-206 ml; 95%CI=-347ml, -65ml) in MACS. Similar results were observed for sensitization measured at 12 months but not at 24 months. Early life asthma (but not aeroallergen sensitization) partially mediated these associations. Both cohorts showed that only aeroallergen sensitization at 24 months but not food sensitization was associated with lower adolescent lung function.

Conclusion

This study showed that food sensitization at 6 and 12 months was associated with reduced FEV₁ in adolescence. Our finding that this link is not completely mediated by either subsequent asthma or aeroallergen sensitization is novel and suggests that early food sensitization itself can be used to identify high-risk groups for poor lung health.

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

Modified oral enteric-coated budesonide regimens to treat pediatric eosinophilic gastroenteritis, a single center experience

Publication date: Available online 11 February 2019

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

Author(s): Katie Kennedy, Amanda B. Muir, Andrew Grossman, Terri Brown-Whitehorn, Antonella Cianferoni, Jonathan M. Spergel, Glenn T. Furuta, Benjamin J. Wilkins, Michele Shuker, Melanie A. Ruffner

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

Comparative Study Between Microscopic and Endoscopic Tympanoplasty Type I

In conclusion permeatal endo scopic tympanoplasty can be considered as a good alternative to the conventional microscopic tympanoplasty. (Source: Indian Journal of Otolaryngology and Head and Neck Surgery)

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Standardisation of Tinnitus Handicap Inventory in Hindi

AbstractTinnitus is defined as perception of sound in ear continuously without presence of any external stimuli. It is mainly due to the activity within central nervous system without any mechanical or vibratory activity that stimulates the cochlea. It is purely subjective phenomenon that cannot be measured by the any physical scale. Tinnitus handicap inventory is very useful tool to measure the severity of impact of tinnitus on person 's life. There is lack of questionnaire in Hindi and this work will help a lot in future. The English THI was translated to Hindi by person expert in both English and Hindi. The translated THI was given to 40 people with Hindi as mother tongue for rechecking the words. The final THI (Hindi) was us ed in assessment of severity in 100 tinnitus patient. The o...

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

Comparative Study Between Microscopic and Endoscopic Tympanoplasty Type I

In conclusion permeatal endo scopic tympanoplasty can be considered as a good alternative to the conventional microscopic tympanoplasty. (Source: Indian Journal of Otolaryngology and Head and Neck Surgery)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DtT08o

Standardisation of Tinnitus Handicap Inventory in Hindi

AbstractTinnitus is defined as perception of sound in ear continuously without presence of any external stimuli. It is mainly due to the activity within central nervous system without any mechanical or vibratory activity that stimulates the cochlea. It is purely subjective phenomenon that cannot be measured by the any physical scale. Tinnitus handicap inventory is very useful tool to measure the severity of impact of tinnitus on person 's life. There is lack of questionnaire in Hindi and this work will help a lot in future. The English THI was translated to Hindi by person expert in both English and Hindi. The translated THI was given to 40 people with Hindi as mother tongue for rechecking the words. The final THI (Hindi) was us ed in assessment of severity in 100 tinnitus patient. The o...

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

Depleted uranium assessment and natural radioactivity monitoring in North West of Iraq over a decade since the last Gulf War

Publication date: May 2019

Source: Journal of Environmental Radioactivity, Volume 201

Author(s): E. Salama, S.U. El-kameesy, Rawaa Elrawi

Abstract

For the sake of completeness of the surveillance process concerning the spread of depleted uranium (DU) in the Arabian Gulf region, we have applied a simple gamma spectroscopy technique to evaluate its content in Al Jolan, Nazzal and Askari districts in Al Fallujah area, Iraq for the first time and after more than one decade. The measurements were carried out along the lines of the wars that have been witnessed in Iraq last period and expected to be the region of impact of residuals of a large quantity of DU. The observed radionuclides are ⁴ K and other naturally occurring radioactive members of uranium and thorium series. The obtained results show that, the average specific activity concentrations of ²²⁶Ra, ²³²Th, ⁴ K, ²¹⁰Pb ²³⁸U and ²³⁵U in different soil samples collected from Al Fallujah area, Iraq in range of 20.09 ± 4.0 to 21.94 ± 2.4, 11.51 ± 2.3 to 11.75 ± 3.2, 96.53 ± 8.0 to 112.13 ± 49.8, 19.98 ± 4.6 to 20.76 ± 4.8, 25.4 ± 3.9 to 26.1 ± 6.0 and 1.28 ± 0.18 to 1.34 ± 0.21 respectively. The obtained values of Ra_eq for all the investigated samples are less than the recommended limit of 370 Bq kg⁻¹ and those for H_ex are less than one. These results have been compared with the previous works and the world mean values specified by the UNSCEAR reports. The mean ratio of ²³⁸U/²³⁵U activity in all cases is about the natural value (21.73) which is less than its value in case of DU (76.92). The present obtained results of DU levels show that although a large amount of DU was released in Iraq during the Gulf wars, the tested samples are DU free. This may be attributed to the reduction of DU from the soil surface by wind or sandstorms and the downward leaching process.

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Direct analysis of 210Pb in drinking water by liquid scintillation counting after sulfate precipitation

Publication date: May 2019

Source: Journal of Environmental Radioactivity, Volume 201

Author(s): Yadong Wang, Yan Ma, Xiongxin Dai

Abstract

Lead-210 in drinking water can be rapidly determined by liquid scintillation counting (LSC) using a new sulfate precipitation method. In this method, ²¹⁰Pb was first preconcentrated from water using iron hydroxide co-precipitation followed by sulfate precipitation to decontaminate most of non-alkaline earth elements. The Pb in the sulfate precipitate was then dissolved in strong alkaline solution, while alkaline earth elements (Sr, Ba, Ra) were separated as the sulfate/carbonate precipitate. To optimize the method, the influences of different acids and sulfate concentration on sulfate precipitation as well as the effects of pH, the added SO₄²⁻/CO₃²⁻ concentrations and the Sr/Ba contents in the sulfate precipitate on the dissolution of PbSO₄ were studied. In addition, X-ray fluorescence (XRF) analysis was applied for rapid determination of the chemical recovery and triple-to-double coincidence ratio (TDCR) quench correction curve for counting of ²¹⁰Pb by LSC was established. The method was validated using 5 L of tap water samples and minimum detectable activity concentration (MDC) of ∼0.016 Bq·L⁻¹ was achieved, which is sufficiently sensitive to meet the guidance level of 0.1 Bq·L⁻¹ for ²¹⁰Pb in drinking water as recommended by the World Health Organization (WHO).

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Natural radioactivity of thermal springs and related precipitates in Gellért Hill area, Buda Thermal Karst, Hungary

Publication date: May 2019

Source: Journal of Environmental Radioactivity, Volume 201

Author(s): Petra Kovács-Bodor, Katalin Csondor, Anita Erőss, Dénes Szieberth, Ágnes Freiler-Nagy, Ákos Horváth, Árpád Bihari, Judit Mádl-Szőnyi

Abstract

The elevated radioactivity of the thermal waters of Buda Thermal Karst (BTK), Hungary is known and studied since the beginning of the 20th century. In the recent studies, the anomalous ²²²Rn/²²⁶Ra ratios have drawn the attention to the existence of local ²²²Rn source. Biogeochemical precipitates (i.e. biofilms) in spring caves were found to have high adsorption capacity, accumulating e.g. ²²⁶Ra. Biogeochemical precipitates are ubiquitous in the thermal springs of BTK, occurring in different amount and colours (dark grey, brown, red, white), and have different microbial communities and elemental composition. The detailed investigation of the radioactivity of spring waters highlighted the different ²²⁶Ra and ²²²Rn activity concentrations. The present study aimed to survey the radioactivity of the thermal springs of Gellért Hill area, together with the biogeochemical precipitates and air above the water level, and to assess the evolution of the radioactivity of known-aged precipitates, formed during in situ experiments. We found that the basic physicochemical parameters of the spring waters (field parameters, major ions) do not affect the adsorption capacity of biogeochemical precipitates. It was revealed by the conducted in situ experiments, that the flow conditions influence the evolution rate of precipitates, so their adsorption capacity. The ²²²Rn activity concentrations of spring waters are dependent on the area of the water surface, volume of air space above the water level, ventilation of the caves/channels and presence of calcite layer on the water surface. The latter has a blocking effect on degassing.

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Depleted uranium assessment and natural radioactivity monitoring in North West of Iraq over a decade since the last Gulf War

Publication date: May 2019

Source: Journal of Environmental Radioactivity, Volume 201

Author(s): E. Salama, S.U. El-kameesy, Rawaa Elrawi

Abstract

For the sake of completeness of the surveillance process concerning the spread of depleted uranium (DU) in the Arabian Gulf region, we have applied a simple gamma spectroscopy technique to evaluate its content in Al Jolan, Nazzal and Askari districts in Al Fallujah area, Iraq for the first time and after more than one decade. The measurements were carried out along the lines of the wars that have been witnessed in Iraq last period and expected to be the region of impact of residuals of a large quantity of DU. The observed radionuclides are ⁴ K and other naturally occurring radioactive members of uranium and thorium series. The obtained results show that, the average specific activity concentrations of ²²⁶Ra, ²³²Th, ⁴ K, ²¹⁰Pb ²³⁸U and ²³⁵U in different soil samples collected from Al Fallujah area, Iraq in range of 20.09 ± 4.0 to 21.94 ± 2.4, 11.51 ± 2.3 to 11.75 ± 3.2, 96.53 ± 8.0 to 112.13 ± 49.8, 19.98 ± 4.6 to 20.76 ± 4.8, 25.4 ± 3.9 to 26.1 ± 6.0 and 1.28 ± 0.18 to 1.34 ± 0.21 respectively. The obtained values of Ra_eq for all the investigated samples are less than the recommended limit of 370 Bq kg⁻¹ and those for H_ex are less than one. These results have been compared with the previous works and the world mean values specified by the UNSCEAR reports. The mean ratio of ²³⁸U/²³⁵U activity in all cases is about the natural value (21.73) which is less than its value in case of DU (76.92). The present obtained results of DU levels show that although a large amount of DU was released in Iraq during the Gulf wars, the tested samples are DU free. This may be attributed to the reduction of DU from the soil surface by wind or sandstorms and the downward leaching process.

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Direct analysis of 210Pb in drinking water by liquid scintillation counting after sulfate precipitation

Publication date: May 2019

Source: Journal of Environmental Radioactivity, Volume 201

Author(s): Yadong Wang, Yan Ma, Xiongxin Dai

Abstract

Lead-210 in drinking water can be rapidly determined by liquid scintillation counting (LSC) using a new sulfate precipitation method. In this method, ²¹⁰Pb was first preconcentrated from water using iron hydroxide co-precipitation followed by sulfate precipitation to decontaminate most of non-alkaline earth elements. The Pb in the sulfate precipitate was then dissolved in strong alkaline solution, while alkaline earth elements (Sr, Ba, Ra) were separated as the sulfate/carbonate precipitate. To optimize the method, the influences of different acids and sulfate concentration on sulfate precipitation as well as the effects of pH, the added SO₄²⁻/CO₃²⁻ concentrations and the Sr/Ba contents in the sulfate precipitate on the dissolution of PbSO₄ were studied. In addition, X-ray fluorescence (XRF) analysis was applied for rapid determination of the chemical recovery and triple-to-double coincidence ratio (TDCR) quench correction curve for counting of ²¹⁰Pb by LSC was established. The method was validated using 5 L of tap water samples and minimum detectable activity concentration (MDC) of ∼0.016 Bq·L⁻¹ was achieved, which is sufficiently sensitive to meet the guidance level of 0.1 Bq·L⁻¹ for ²¹⁰Pb in drinking water as recommended by the World Health Organization (WHO).

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Natural radioactivity of thermal springs and related precipitates in Gellért Hill area, Buda Thermal Karst, Hungary

Publication date: May 2019

Source: Journal of Environmental Radioactivity, Volume 201

Author(s): Petra Kovács-Bodor, Katalin Csondor, Anita Erőss, Dénes Szieberth, Ágnes Freiler-Nagy, Ákos Horváth, Árpád Bihari, Judit Mádl-Szőnyi

Abstract

The elevated radioactivity of the thermal waters of Buda Thermal Karst (BTK), Hungary is known and studied since the beginning of the 20th century. In the recent studies, the anomalous ²²²Rn/²²⁶Ra ratios have drawn the attention to the existence of local ²²²Rn source. Biogeochemical precipitates (i.e. biofilms) in spring caves were found to have high adsorption capacity, accumulating e.g. ²²⁶Ra. Biogeochemical precipitates are ubiquitous in the thermal springs of BTK, occurring in different amount and colours (dark grey, brown, red, white), and have different microbial communities and elemental composition. The detailed investigation of the radioactivity of spring waters highlighted the different ²²⁶Ra and ²²²Rn activity concentrations. The present study aimed to survey the radioactivity of the thermal springs of Gellért Hill area, together with the biogeochemical precipitates and air above the water level, and to assess the evolution of the radioactivity of known-aged precipitates, formed during in situ experiments. We found that the basic physicochemical parameters of the spring waters (field parameters, major ions) do not affect the adsorption capacity of biogeochemical precipitates. It was revealed by the conducted in situ experiments, that the flow conditions influence the evolution rate of precipitates, so their adsorption capacity. The ²²²Rn activity concentrations of spring waters are dependent on the area of the water surface, volume of air space above the water level, ventilation of the caves/channels and presence of calcite layer on the water surface. The latter has a blocking effect on degassing.

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Standardisation of Tinnitus Handicap Inventory in Hindi

Abstract

Tinnitus is defined as perception of sound in ear continuously without presence of any external stimuli. It is mainly due to the activity within central nervous system without any mechanical or vibratory activity that stimulates the cochlea. It is purely subjective phenomenon that cannot be measured by the any physical scale. Tinnitus handicap inventory is very useful tool to measure the severity of impact of tinnitus on person's life. There is lack of questionnaire in Hindi and this work will help a lot in future. The English THI was translated to Hindi by person expert in both English and Hindi. The translated THI was given to 40 people with Hindi as mother tongue for rechecking the words. The final THI (Hindi) was used in assessment of severity in 100 tinnitus patient. The observed data was analysed by using Microsoft excel. Reliability of THI Hindi was high (Pearson correlation .98, test and retest method), factor analysis indicated that TH1 Hindi has unified. The THI Hindi version is reliable. THI Hindi can be used to assessment of severity of tinnitus in Hindi speaking population.

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Editorial Board/Reviewing Committee

(Source: International Journal of Oral and Maxillofacial Surgery)

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Does postoperative orbital volume predict postoperative globe malposition after blow-out fracture reconstruction? A 6-month clinical follow-up study

ConclusionGMP was present in large and combined orbital fractures. Clinically detectable postoperative GMP occurred despite satisfactory orbital reconstruction and overcorrection. Mild GMP, however, is not significant for the patient. (Source: Oral and Maxillofacial Surgery)

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Editorial Board/Reviewing Committee

(Source: International Journal of Oral and Maxillofacial Surgery)

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Does postoperative orbital volume predict postoperative globe malposition after blow-out fracture reconstruction? A 6-month clinical follow-up study

ConclusionGMP was present in large and combined orbital fractures. Clinically detectable postoperative GMP occurred despite satisfactory orbital reconstruction and overcorrection. Mild GMP, however, is not significant for the patient. (Source: Oral and Maxillofacial Surgery)

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Asymmetric cavernous sinus enlargement: a novel finding in Sturge–Weber syndrome

Abstract

Purpose

Enlargement of deep cerebral veins and choroid plexus engorgement are frequently reported in Sturge–Weber syndrome. We aim to describe cavernous sinus involvement in patients with this syndrome and to identify possible clinical-neuroimaging correlations.

Methods

Sixty patients with Sturge–Weber syndrome (31 females, mean age 4.5 years) and 120 age/sex-matched controls were included in this retrospective study. We performed a visual analysis to identify patients with asymmetric cavernous sinus enlargement. Then, we measured on axial T2WI the left (A), right (B), and bilateral (LL) transverse diameters of the cavernous sinus. We calculated the module of the difference |A-B| and the cavernous sinus asymmetry index as the ratio |A-B|/LL. Differences among groups were assessed by Mann–Whitney U and Kruskal–Wallis tests. Clinicoradiological associations were evaluated by Fisher exact test.

Results

We found seven subjects (11.6%) with asymmetric CS enlargement. The |A-B| and cavernous sinus asymmetry index were higher in patients with asymmetric CS enlargement compared with controls and patients without visible CS abnormalities (p_B < 0.05). Asymmetric CS enlargement was always ipsilateral to facial port-wine stains (7/7), and, when present, to leptomeningeal vascular malformations (4/7). It was significantly associated with ipsilateral bone marrow changes (p = 0.013) and dilated veins (p = 0.002). Together with brain atrophy and deep venous dilatation, this sign was associated with neurological deficits (p < 0.05).

Conclusions

We expanded the spectrum of venous abnormalities in SWS, showing the presence of asymmetric cavernous sinus enlargement in more than one tenth of patients, likely related to increased venous drainage.

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A functional gene expression analysis in epithelial sinonasal cancer: Biology and clinical relevance behind three histological subtypes

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Loris De Cecco, Mara Serena Serafini, Carla Facco, Roberta Granata, Ester Orlandi, Carlo Fallai, Lisa Licitra, Edoardo Marchesi, Federica Perrone, Silvana Pilotti, Pasquale Quattrone, Cesare Piazza, Fausto Sessa, Mario Turri-Zanoni, Paolo Battaglia, Paolo Castelnuovo, Paolo Antognoni, Silvana Canevari, Paolo Bossi

Abstract

Epithelial sinonasal cancers (SNCs) are rare diseases with overlapping morphological features and a dismal prognosis. We aimed to investigate the expression differences among the histological subtypes for discerning their molecular characteristics.

We selected 47 SNCs: (i) 21 nonkeratinizing squamous cell carcinomas (NKSCCs), (ii) 13 sinonasal neuroendocrine cancers (SNECs), and (iii) 13 sinonasal undifferentiated cancers (SNUCs). Gene expression profiling was performed by DASL (cDNA-mediated annealing, selection, extension, and ligation) microarray analysis with internal validation by quantitative RT-PCR (RT-qPCR). Relevant molecular patterns were uncovered by sparse partial-least squares discriminant analysis (sPLS-DA), microenvironment cell type (xCell), CIBERSORT, and gene set enrichment (GSEA) analyses.

The first two sPLS-DA components stratified samples by histological subtypes. xCell highlighted increased expression of immune components (CD8⁺ effector memory cells, in SNUC) and "other cells": keratinocytes and neurons in NKSCC and SNEC, respectively. Pathway enrichment was observed in NKSCC (six gene sets, proliferation related), SNEC (one gene set, pancreatic β-cells), and SNUC (twenty gene sets, some of them immune-system related). Major neuroendocrine involvement was observed in all the SNEC samples.

Our high-throughput analysis revealed a good diagnostic ability to differentiate NKSCC, SNEC, and SNUC, but indicated that the neuroendocrine pathway, typical and pathognomonic of SNEC is also present at lower expression levels in the other two histological subtypes. The different and specific profiles may be exploited for elucidating their biology and could help to identify prognostic and therapeutic opportunities.

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Associations between pre-, post-, and peri-operative variables and health resource use following surgery for head and neck cancer

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Hoda Badr, Maximiliano Sobrero, Joshua Chen, Tamar Kotz, Eric Genden, Andrew G. Sikora, Brett Miles

Abstract

Objective

We examined associations between pre-, post-, and peri-operative variables and health resource use in head and neck cancer patients.

Methods

Patients (N = 183) who were seen for a pre-surgical consult between January 2012 and December 2014 completed surveys that assessed medical history, a patient-reported outcome measure (PROM) of dysphagia, and quality of life (QOL). After surgery, peri-operative (e.g., tracheostomy, feeding tube) and post-operative (e.g., complications) variables were abstracted from patients' medical records.

Results

Multivariate regression models using backward elimination showed that pre-surgical University of Washington Quality of Life (UW-QOL) Inventory and M.D. Anderson Dysphagia Inventory (MDADI) composite scores, documented surgical complications, and having a tracheostomy, were all significant predictors of hospital length of stay, explaining 57% of the total variance (F(5, 160) = 18.71, p < .001). Male gender, psychiatric history, and lower pre-surgical MDADI scores significantly predicted thirty-day unplanned readmissions (30dUR). Pre-surgical MDADI composite scores also significantly predicted emergencey department (ED) visits within 30 days of initial hospital discharge (p = .02).

Conclusions

Assessment of PROMs and QOL in the pre-surgical setting may assist providers in identifying patients at risk for prolonged LOS and increased health resource use after hospital discharge.

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Asymmetric cavernous sinus enlargement: a novel finding in Sturge–Weber syndrome

Abstract

Purpose

Enlargement of deep cerebral veins and choroid plexus engorgement are frequently reported in Sturge–Weber syndrome. We aim to describe cavernous sinus involvement in patients with this syndrome and to identify possible clinical-neuroimaging correlations.

Methods

Sixty patients with Sturge–Weber syndrome (31 females, mean age 4.5 years) and 120 age/sex-matched controls were included in this retrospective study. We performed a visual analysis to identify patients with asymmetric cavernous sinus enlargement. Then, we measured on axial T2WI the left (A), right (B), and bilateral (LL) transverse diameters of the cavernous sinus. We calculated the module of the difference |A-B| and the cavernous sinus asymmetry index as the ratio |A-B|/LL. Differences among groups were assessed by Mann–Whitney U and Kruskal–Wallis tests. Clinicoradiological associations were evaluated by Fisher exact test.

Results

We found seven subjects (11.6%) with asymmetric CS enlargement. The |A-B| and cavernous sinus asymmetry index were higher in patients with asymmetric CS enlargement compared with controls and patients without visible CS abnormalities (p_B < 0.05). Asymmetric CS enlargement was always ipsilateral to facial port-wine stains (7/7), and, when present, to leptomeningeal vascular malformations (4/7). It was significantly associated with ipsilateral bone marrow changes (p = 0.013) and dilated veins (p = 0.002). Together with brain atrophy and deep venous dilatation, this sign was associated with neurological deficits (p < 0.05).

Conclusions

We expanded the spectrum of venous abnormalities in SWS, showing the presence of asymmetric cavernous sinus enlargement in more than one tenth of patients, likely related to increased venous drainage.

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A functional gene expression analysis in epithelial sinonasal cancer: Biology and clinical relevance behind three histological subtypes

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Loris De Cecco, Mara Serena Serafini, Carla Facco, Roberta Granata, Ester Orlandi, Carlo Fallai, Lisa Licitra, Edoardo Marchesi, Federica Perrone, Silvana Pilotti, Pasquale Quattrone, Cesare Piazza, Fausto Sessa, Mario Turri-Zanoni, Paolo Battaglia, Paolo Castelnuovo, Paolo Antognoni, Silvana Canevari, Paolo Bossi

Abstract

Epithelial sinonasal cancers (SNCs) are rare diseases with overlapping morphological features and a dismal prognosis. We aimed to investigate the expression differences among the histological subtypes for discerning their molecular characteristics.

We selected 47 SNCs: (i) 21 nonkeratinizing squamous cell carcinomas (NKSCCs), (ii) 13 sinonasal neuroendocrine cancers (SNECs), and (iii) 13 sinonasal undifferentiated cancers (SNUCs). Gene expression profiling was performed by DASL (cDNA-mediated annealing, selection, extension, and ligation) microarray analysis with internal validation by quantitative RT-PCR (RT-qPCR). Relevant molecular patterns were uncovered by sparse partial-least squares discriminant analysis (sPLS-DA), microenvironment cell type (xCell), CIBERSORT, and gene set enrichment (GSEA) analyses.

The first two sPLS-DA components stratified samples by histological subtypes. xCell highlighted increased expression of immune components (CD8⁺ effector memory cells, in SNUC) and "other cells": keratinocytes and neurons in NKSCC and SNEC, respectively. Pathway enrichment was observed in NKSCC (six gene sets, proliferation related), SNEC (one gene set, pancreatic β-cells), and SNUC (twenty gene sets, some of them immune-system related). Major neuroendocrine involvement was observed in all the SNEC samples.

Our high-throughput analysis revealed a good diagnostic ability to differentiate NKSCC, SNEC, and SNUC, but indicated that the neuroendocrine pathway, typical and pathognomonic of SNEC is also present at lower expression levels in the other two histological subtypes. The different and specific profiles may be exploited for elucidating their biology and could help to identify prognostic and therapeutic opportunities.

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Associations between pre-, post-, and peri-operative variables and health resource use following surgery for head and neck cancer

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Hoda Badr, Maximiliano Sobrero, Joshua Chen, Tamar Kotz, Eric Genden, Andrew G. Sikora, Brett Miles

Abstract

Objective

We examined associations between pre-, post-, and peri-operative variables and health resource use in head and neck cancer patients.

Methods

Patients (N = 183) who were seen for a pre-surgical consult between January 2012 and December 2014 completed surveys that assessed medical history, a patient-reported outcome measure (PROM) of dysphagia, and quality of life (QOL). After surgery, peri-operative (e.g., tracheostomy, feeding tube) and post-operative (e.g., complications) variables were abstracted from patients' medical records.

Results

Multivariate regression models using backward elimination showed that pre-surgical University of Washington Quality of Life (UW-QOL) Inventory and M.D. Anderson Dysphagia Inventory (MDADI) composite scores, documented surgical complications, and having a tracheostomy, were all significant predictors of hospital length of stay, explaining 57% of the total variance (F(5, 160) = 18.71, p < .001). Male gender, psychiatric history, and lower pre-surgical MDADI scores significantly predicted thirty-day unplanned readmissions (30dUR). Pre-surgical MDADI composite scores also significantly predicted emergencey department (ED) visits within 30 days of initial hospital discharge (p = .02).

Conclusions

Assessment of PROMs and QOL in the pre-surgical setting may assist providers in identifying patients at risk for prolonged LOS and increased health resource use after hospital discharge.

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Broad Immunglobulin G Repertoire in Chronic Rhinosinusitis with Nasal Polyps regulates pro-inflammatory IgE responses

Publication date: Available online 11 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Mohamed H. Shamji, Irene Thomsen, Janice Layhadi, Jasper Kappen, Gabriële Holtappels, Umit Sahiner, Amy Switzer, Stephen R. Durham, Oliver Pabst, Claus Bachert

Abstract

Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) is often characterized by local production of polyclonal IgE-idiotypes. Whilst tissue IgE concentrations can be in the range of several thousand kU/L, the regulatory mechanisms by which IgE-mediated inflammation is controlled in the nasal polyps is not well understood.

Objective

We sought to determine whether locally induced IgG antibodies in the nasal polyps can inhibit IgE-mediated pro-allergic response.

Methods

Nasal polyp homogenates were collected from grass pollen allergics with CRSwNP and non-allergic controls. IgE levels were measured by ISAC. IgE-containing nasal polyp homogenates, with/without IgG depletion, were evaluated for their capacity to promote IgE-facilitated allergen presentation, basophil activation and histamine release. Local IgE and IgG repertoires were evaluated by Immunoglobulin 454 sequencing.

Results

We show that IgG plays a key role in controlling IgE-mediated inflammatory responses in nasal polyps. Depletion of IgG from nasal homogenates resulted in an increase in CD23-mediated IgE-facilitated allergen binding to B cells (IgE-FAB), but also enhanced FcεRI-mediated allergen driven basophil activation and histamine release. A similar response was observed in relation to specific IgE antibodies to Staphylococcus aureus (SE-IgE). The capacity of IgG in nasal polyps to limit IgE-mediated inflammation is based on the fact that IgG repertoires widely share the antigen targets with the IgE repertoires, in both allergic and non-allergic subjects.

Conclusion

Polyclonal IgE idiotypes in CRSwNP are functional, promote IgE-mediated pro-allergic inflammation and are partially antagonized by corresponding IgG-idiotypes. This is most likely due to the fact that IgE and IgG clonotypes are widely shared in nasal polyps.

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Broad Immunglobulin G Repertoire in Chronic Rhinosinusitis with Nasal Polyps regulates pro-inflammatory IgE responses

Publication date: Available online 11 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Mohamed H. Shamji, Irene Thomsen, Janice Layhadi, Jasper Kappen, Gabriële Holtappels, Umit Sahiner, Amy Switzer, Stephen R. Durham, Oliver Pabst, Claus Bachert

Abstract

Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) is often characterized by local production of polyclonal IgE-idiotypes. Whilst tissue IgE concentrations can be in the range of several thousand kU/L, the regulatory mechanisms by which IgE-mediated inflammation is controlled in the nasal polyps is not well understood.

Objective

We sought to determine whether locally induced IgG antibodies in the nasal polyps can inhibit IgE-mediated pro-allergic response.

Methods

Nasal polyp homogenates were collected from grass pollen allergics with CRSwNP and non-allergic controls. IgE levels were measured by ISAC. IgE-containing nasal polyp homogenates, with/without IgG depletion, were evaluated for their capacity to promote IgE-facilitated allergen presentation, basophil activation and histamine release. Local IgE and IgG repertoires were evaluated by Immunoglobulin 454 sequencing.

Results

We show that IgG plays a key role in controlling IgE-mediated inflammatory responses in nasal polyps. Depletion of IgG from nasal homogenates resulted in an increase in CD23-mediated IgE-facilitated allergen binding to B cells (IgE-FAB), but also enhanced FcεRI-mediated allergen driven basophil activation and histamine release. A similar response was observed in relation to specific IgE antibodies to Staphylococcus aureus (SE-IgE). The capacity of IgG in nasal polyps to limit IgE-mediated inflammation is based on the fact that IgG repertoires widely share the antigen targets with the IgE repertoires, in both allergic and non-allergic subjects.

Conclusion

Polyclonal IgE idiotypes in CRSwNP are functional, promote IgE-mediated pro-allergic inflammation and are partially antagonized by corresponding IgG-idiotypes. This is most likely due to the fact that IgE and IgG clonotypes are widely shared in nasal polyps.

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Measures of Listening Effort Are Multidimensional

Objectives: Listening effort can be defined as the cognitive resources required to perform a listening task. The literature on listening effort is as confusing as it is voluminous: measures of listening effort rarely correlate with each other and sometimes result in contradictory findings. Here, we directly compared simultaneously recorded multimodal measures of listening effort. After establishing the reliability of the measures, we investigated validity by quantifying correlations between measures and then grouping-related measures through factor analysis. Design: One hundred and sixteen participants with audiometric thresholds ranging from normal to severe hearing loss took part in the study (age range: 55 to 85 years old, 50.3% male). We simultaneously measured pupil size, electroencephalographic alpha power, skin conductance, and self-report listening effort. One self-report measure of fatigue was also included. The signal to noise ratio (SNR) was adjusted at 71% criterion performance using sequences of 3 digits. The main listening task involved correct recall of a random digit from a sequence of six presented at a SNR where performance was around 82 to 93%. Test–retest reliability of the measures was established by retesting 30 participants 7 days after the initial session. Results: With the exception of skin conductance and the self-report measure of fatigue, interclass correlation coefficients (ICC) revealed good test–retest reliability (minimum ICC: 0.71). Weak or nonsignificant correlations were identified between measures. Factor analysis, using only the reliable measures, revealed four underlying dimensions: factor 1 included SNR, hearing level, baseline alpha power, and performance accuracy; factor 2 included pupillometry; factor 3 included alpha power (during speech presentation and during retention); factor 4 included self-reported listening effort and baseline alpha power. Conclusions: The good ICC suggests that poor test reliability is not the reason for the lack of correlation between measures. We have demonstrated that measures traditionally used as indicators of listening effort tap into multiple underlying dimensions. We therefore propose that there is no "gold standard" measure of listening effort and that different measures of listening effort should not be used interchangeably. When choosing method(s) to measure listening effort, the nature of the task and aspects of increased listening demands that are of interest should be taken into account. The findings of this study provide a framework for understanding and interpreting listening effort measures. ACKNOWLEDGMENTS: We thank Dr. Andrew Dimitrijevic for assistance in developing the research protocol. We also thank Dr. Mohammad Sobuh, Dr. Emanuele Perugia, and Dr. Garreth Prendergast for their assistance in the data analysis. The study was supported by the Manchester University Hospitals NHS Foundation Trust. All authors contributed to the conception and design of the study, analysis and interpretation of the data, and writing of the manuscript. The authors have no conflicts of interest to disclose. Received August 31, 2017; accepted November 28, 2018. Address for correspondence: Sara Alhanbali, Department of Hearing and Speech Sciences, Faculty of Rehabilitation Sciences, University of Jordan, Amman, Jordan. E-mail: alhanbalisara@yahoo.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Measures of Listening Effort Are Multidimensional

Objectives: Listening effort can be defined as the cognitive resources required to perform a listening task. The literature on listening effort is as confusing as it is voluminous: measures of listening effort rarely correlate with each other and sometimes result in contradictory findings. Here, we directly compared simultaneously recorded multimodal measures of listening effort. After establishing the reliability of the measures, we investigated validity by quantifying correlations between measures and then grouping-related measures through factor analysis. Design: One hundred and sixteen participants with audiometric thresholds ranging from normal to severe hearing loss took part in the study (age range: 55 to 85 years old, 50.3% male). We simultaneously measured pupil size, electroencephalographic alpha power, skin conductance, and self-report listening effort. One self-report measure of fatigue was also included. The signal to noise ratio (SNR) was adjusted at 71% criterion performance using sequences of 3 digits. The main listening task involved correct recall of a random digit from a sequence of six presented at a SNR where performance was around 82 to 93%. Test–retest reliability of the measures was established by retesting 30 participants 7 days after the initial session. Results: With the exception of skin conductance and the self-report measure of fatigue, interclass correlation coefficients (ICC) revealed good test–retest reliability (minimum ICC: 0.71). Weak or nonsignificant correlations were identified between measures. Factor analysis, using only the reliable measures, revealed four underlying dimensions: factor 1 included SNR, hearing level, baseline alpha power, and performance accuracy; factor 2 included pupillometry; factor 3 included alpha power (during speech presentation and during retention); factor 4 included self-reported listening effort and baseline alpha power. Conclusions: The good ICC suggests that poor test reliability is not the reason for the lack of correlation between measures. We have demonstrated that measures traditionally used as indicators of listening effort tap into multiple underlying dimensions. We therefore propose that there is no "gold standard" measure of listening effort and that different measures of listening effort should not be used interchangeably. When choosing method(s) to measure listening effort, the nature of the task and aspects of increased listening demands that are of interest should be taken into account. The findings of this study provide a framework for understanding and interpreting listening effort measures. ACKNOWLEDGMENTS: We thank Dr. Andrew Dimitrijevic for assistance in developing the research protocol. We also thank Dr. Mohammad Sobuh, Dr. Emanuele Perugia, and Dr. Garreth Prendergast for their assistance in the data analysis. The study was supported by the Manchester University Hospitals NHS Foundation Trust. All authors contributed to the conception and design of the study, analysis and interpretation of the data, and writing of the manuscript. The authors have no conflicts of interest to disclose. Received August 31, 2017; accepted November 28, 2018. Address for correspondence: Sara Alhanbali, Department of Hearing and Speech Sciences, Faculty of Rehabilitation Sciences, University of Jordan, Amman, Jordan. E-mail: alhanbalisara@yahoo.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Preventing Burnout in the Face of Growing Patient Volumes In a Busy Outpatient CT Suite: A Technologist Perspective

Publication date: Available online 11 February 2019

Source: Current Problems in Diagnostic Radiology

Author(s): Sharon Mohammed, Andrew B Rosenkrantz, Michael P Recht

Abstract

CT technologists, like radiologists, are at risk of increased stress and burnout due to ever increasing clinical and workload demands. To mitigate these issues, radiology facilities need to be prepared to actively address and resolve issues that impact the technologist satisfaction. At our institution, a Process Improvement Committee was formed to identify and alleviate workplace stressors faced by CT technologists. As a result of the initiative, our CT department has evolved into a technologist driven department in which experienced and effective technologists play a large role in fostering efficient and patient-centered care, while feeling empowered to function as leaders in their work environment. In this article, a senior CT technologist provides a first-hand account of the process changes from the technologist's perspective, focusing on strategies for establishing a supportive system that allows technologists to thrive in providing patient-centered care even in the busiest of clinical contexts.

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The Evolving Role of Osteopathic Physicians in Diagnostic Radiology

Publication date: Available online 11 February 2019

Source: Current Problems in Diagnostic Radiology

Author(s): Cory M. Pfeifer

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Providing Compassionate Care for the Elderly Patient in Radiology

Publication date: Available online 11 February 2019

Source: Current Problems in Diagnostic Radiology

Author(s): Sharon Mohammed, Andrew B. Rosenkrantz

Abstract

The increasing age of the U.S. population is increasing the demand for healthcare services for elderly patients. However, elderly patients, particularly those over the age of 75, may encounter unique challenges when seeking healthcare services, including radiological imaging. Radiology practices need to recognize the needs of this cohort and develop strategies to provide elderly patients with compassionate, high quality care. In this article, we highlight obstacles that elderly patients may face in undergoing imaging examinations, and approaches that radiology practices may take in addressing these.

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Preventing Burnout in the Face of Growing Patient Volumes In a Busy Outpatient CT Suite: A Technologist Perspective

Publication date: Available online 11 February 2019

Source: Current Problems in Diagnostic Radiology

Author(s): Sharon Mohammed, Andrew B Rosenkrantz, Michael P Recht

Abstract

CT technologists, like radiologists, are at risk of increased stress and burnout due to ever increasing clinical and workload demands. To mitigate these issues, radiology facilities need to be prepared to actively address and resolve issues that impact the technologist satisfaction. At our institution, a Process Improvement Committee was formed to identify and alleviate workplace stressors faced by CT technologists. As a result of the initiative, our CT department has evolved into a technologist driven department in which experienced and effective technologists play a large role in fostering efficient and patient-centered care, while feeling empowered to function as leaders in their work environment. In this article, a senior CT technologist provides a first-hand account of the process changes from the technologist's perspective, focusing on strategies for establishing a supportive system that allows technologists to thrive in providing patient-centered care even in the busiest of clinical contexts.

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

The Evolving Role of Osteopathic Physicians in Diagnostic Radiology

Publication date: Available online 11 February 2019

Source: Current Problems in Diagnostic Radiology

Author(s): Cory M. Pfeifer

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

Providing Compassionate Care for the Elderly Patient in Radiology

Publication date: Available online 11 February 2019

Source: Current Problems in Diagnostic Radiology

Author(s): Sharon Mohammed, Andrew B. Rosenkrantz

Abstract

The increasing age of the U.S. population is increasing the demand for healthcare services for elderly patients. However, elderly patients, particularly those over the age of 75, may encounter unique challenges when seeking healthcare services, including radiological imaging. Radiology practices need to recognize the needs of this cohort and develop strategies to provide elderly patients with compassionate, high quality care. In this article, we highlight obstacles that elderly patients may face in undergoing imaging examinations, and approaches that radiology practices may take in addressing these.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Ss7DmN

The microRNA-375 as a potentially promising biomarker to predict the prognosis of patients with head and neck or esophageal squamous cell carcinoma: a meta-analysis

Abstract

Background

The prognostic value of microRNA-375 (miR-375) expression in squamous cell carcinoma (SCC) had been reported in the previous studies; however, the results remain inconsistent. This study was performed to investigate the prognostic significance of miR-375 expression in SCC based on all eligible evidences.

Methods

Relevant studies were identified by searching PubMed, Embace, Medline, Cochrane Library, and China Biology Medicine disk. Survival outcome including overall survival (OS) and other survival outcomes were used as the primary endpoint to evaluate the prognostic outcome of patients with SCC. All statistical analyses were performed in RevMan software version 5.3 and STATA software version 14.1. Furthermore, the quality of included studies was assessed by The Newcastle–Ottawa Scale.

Results

In total, 13 studies, including 1340 patients, met the inclusion criteria for our meta-analysis. The pooled analysis results indicated that downregulation of miR-375 significantly predicted poor OS (HR 1.58, 95% CI 1.34–1.88, P < 0.001). Downregulated miR-375 was also correlated with the other survival outcomes. Subgroup analysis based on tumor type found that lower expression of miR-375 was significantly related with poor OS in patients with esophageal squamous cell carcinoma (ESCC) (HR 1.58, 95% CI 1.29–1.94, P < 0.001) and head and neck squamous cell carcinoma (HNSCC) (HR 1.59, 95% CI 1.16–2.18, P = 0.004).

Conclusions

This meta-analysis demonstrated that the downexpression of miR-375 was significantly correlated with poor OS in patients with SCCs and indicated the potential clinical use of miR-375 as a molecular biomarker, particularly in assessing prognosis for patients with ESCC and HNSCC.

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Low-dose spinal anesthesia for cesarean section to prevent spinal-induced hypotension

Purpose of review Low-dose combined spinal epidural (CSE) anesthesia is a common technique to anesthetize women for cesarean section. It is used to reduce the incidence of hypotension while providing excellent anesthetic conditions. Recent findings Low spinal doses produce effective anesthesia but of limited duration. Therefore, an epidural catheter (and thus CSE) is required to guarantee pain-free surgery. Recent work confirmed that lower spinal doses can reduce significantly hypotension. Summary Low-dose CSE is a valuable strategy to anesthetize pregnant women for cesarean section but requires attention and training. Correspondence to Marc Van de Velde, MD, PhD, EDRA, Professor, Department of Cardiovascular Sciences, Chair, Department of Anaesthesiology, Herestraat 49, B - 3000 Leuven, Belgium. E-mail: marc.vandevelde@uzleuven.be Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Time-efficient, goal-directed, and evidence-based teaching in the ICU

Purpose of review Teaching in the stressful, high-acuity environment of the ICU is challenging. The intensivist-educator must use teaching strategies that are both effective and time-efficient, as well as evidence-based approaches to the ICU curriculum. This review provides an overview of pertinent educational theories and their implications on educational practices, a selection of effective teaching techniques, and a review on feedback. Recent findings Evidence supports the role of conceptual frameworks in providing the educator with a key perspective to obtain a deeper understanding of the factors contributing to an effective and goal-directed education in the ICU. The role of simulation training for technical and nontechnical skills acquisition is growing. Feedback is difficult to provide, but critical to facilitate learner success; frameworks, and approaches are becoming more standardized. Summary Direct teaching should be goal-oriented, sequential, and adjusted to the level of the learner. The ICU curriculum should optimize cognitive load, reduce stress that is unrelated to the activity, include resilience training, and help trainees deal with stressful clinical situations better. Simulation is a powerful tool to promote technical and nontechnical skills. Providing feedback is essential and a skill that can be taught and enhanced with structure, prompts, and tools. Correspondence to Marek Brzezinski, MD, PhD, VA Medical Center, Anesthesiology Service (129), 4150 Clement Street, San Francisco, CA 94121, USA. Tel: +1 415 750 2069; e-mail: marek.brzezinski@ucsf.edu Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Both non-surgical dental treatment and extractions increase the risk of medication-related osteonecrosis of the jaw: case-control study

Abstract

Objectives

Medication-related osteonecrosis of the jaws (MRONJ) is a serious condition whose risk factors remain unclear. The aim of this study is to investigate the role of oral health and of dental treatment in the development of MRONJ.

Materials and methods

A case-control study was conducted in Brisbane, Australia. Hospital records were used to identify incident cases of MRONJ between January 2010 and March 2017. Cases were individually matched to up to 3 controls according to age, sex, primary disease, and type of antiresorptive therapy. Demographic data, medical histories and public dental records were collected. Associations between oral health, dental treatment, and MRONJ were investigated using conditional logistic regression.

Results

Overall, 44 cases were identified and matched to 115 controls (total sample = 159). Only one-third of patients received a dental examination in the year prior to commencing antiresorptive therapy (27% of cases and 34% of controls). After adjusting for potentially confounding variables, non-surgical dental treatment (OR = 6.3; 95% CI = 2.1, 19.1; p < 0.001) and dental extractions (OR = 8.0; 95% CI = 3.0, 21.0, p < 0.001) were significantly associated with development of MRONJ.

Conclusions

Current levels of preventative dental care are insufficient to eliminate the need for dental treatment and extractions during antiresorptive therapy, and the consequent increase in risk of MRONJ.

Clinical relevance

Optimizing the health of the oral cavity and ongoing preventative dental care must be a priority for patients prior to the initiation of antiresorptive medications.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SN74mY

Low-dose spinal anesthesia for cesarean section to prevent spinal-induced hypotension

Purpose of review Low-dose combined spinal epidural (CSE) anesthesia is a common technique to anesthetize women for cesarean section. It is used to reduce the incidence of hypotension while providing excellent anesthetic conditions. Recent findings Low spinal doses produce effective anesthesia but of limited duration. Therefore, an epidural catheter (and thus CSE) is required to guarantee pain-free surgery. Recent work confirmed that lower spinal doses can reduce significantly hypotension. Summary Low-dose CSE is a valuable strategy to anesthetize pregnant women for cesarean section but requires attention and training. Correspondence to Marc Van de Velde, MD, PhD, EDRA, Professor, Department of Cardiovascular Sciences, Chair, Department of Anaesthesiology, Herestraat 49, B - 3000 Leuven, Belgium. E-mail: marc.vandevelde@uzleuven.be Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Time-efficient, goal-directed, and evidence-based teaching in the ICU

Purpose of review Teaching in the stressful, high-acuity environment of the ICU is challenging. The intensivist-educator must use teaching strategies that are both effective and time-efficient, as well as evidence-based approaches to the ICU curriculum. This review provides an overview of pertinent educational theories and their implications on educational practices, a selection of effective teaching techniques, and a review on feedback. Recent findings Evidence supports the role of conceptual frameworks in providing the educator with a key perspective to obtain a deeper understanding of the factors contributing to an effective and goal-directed education in the ICU. The role of simulation training for technical and nontechnical skills acquisition is growing. Feedback is difficult to provide, but critical to facilitate learner success; frameworks, and approaches are becoming more standardized. Summary Direct teaching should be goal-oriented, sequential, and adjusted to the level of the learner. The ICU curriculum should optimize cognitive load, reduce stress that is unrelated to the activity, include resilience training, and help trainees deal with stressful clinical situations better. Simulation is a powerful tool to promote technical and nontechnical skills. Providing feedback is essential and a skill that can be taught and enhanced with structure, prompts, and tools. Correspondence to Marek Brzezinski, MD, PhD, VA Medical Center, Anesthesiology Service (129), 4150 Clement Street, San Francisco, CA 94121, USA. Tel: +1 415 750 2069; e-mail: marek.brzezinski@ucsf.edu Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SPw2m1

Both non-surgical dental treatment and extractions increase the risk of medication-related osteonecrosis of the jaw: case-control study

Abstract

Objectives

Medication-related osteonecrosis of the jaws (MRONJ) is a serious condition whose risk factors remain unclear. The aim of this study is to investigate the role of oral health and of dental treatment in the development of MRONJ.

Materials and methods

A case-control study was conducted in Brisbane, Australia. Hospital records were used to identify incident cases of MRONJ between January 2010 and March 2017. Cases were individually matched to up to 3 controls according to age, sex, primary disease, and type of antiresorptive therapy. Demographic data, medical histories and public dental records were collected. Associations between oral health, dental treatment, and MRONJ were investigated using conditional logistic regression.

Results

Overall, 44 cases were identified and matched to 115 controls (total sample = 159). Only one-third of patients received a dental examination in the year prior to commencing antiresorptive therapy (27% of cases and 34% of controls). After adjusting for potentially confounding variables, non-surgical dental treatment (OR = 6.3; 95% CI = 2.1, 19.1; p < 0.001) and dental extractions (OR = 8.0; 95% CI = 3.0, 21.0, p < 0.001) were significantly associated with development of MRONJ.

Conclusions

Current levels of preventative dental care are insufficient to eliminate the need for dental treatment and extractions during antiresorptive therapy, and the consequent increase in risk of MRONJ.

Clinical relevance

Optimizing the health of the oral cavity and ongoing preventative dental care must be a priority for patients prior to the initiation of antiresorptive medications.

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Does postoperative orbital volume predict postoperative globe malposition after blow-out fracture reconstruction? A 6-month clinical follow-up study

Abstract

Purpose

The aim of this study was to investigate the relationship between intraorbital volume change caused by orbital fracture and globe malposition (GMP) in blow-out fracture patients undergoing surgery and to clarify the significance of different radiologically detected predictors associated with GMP.

Patients and methods

A 6-month prospective follow-up study of unilateral isolated orbital fractures was designed and implemented. The main outcome variable was GMP (present or absent); the secondary outcome was orientation of GMP (horizontal or vertical). The primary predictor variable was postoperative orbital volume difference determined as the difference between the fractured and non-fractured orbit (measured in milliliter and analyzed in milliliter and percentages). The explanatory variables were gender, age, treatment delay from trauma to surgery, fracture site, horizontal depth of the fracture, fracture area, maximum vertical dislocation of the fracture, and preoperative volume difference.

Results

A total of 15 patients fulfilled the inclusion criteria and were followed for 6 months from a larger cohort. GMP was detected in 6/15 patients (40.0%). GMP was more often present in large (≥ 2.5 cm²) fractures (55.6%), in combined orbital fractures (50.0%), and in fractures with preoperative volume difference ≥ 2.5 ml (62.5%) regardless of the postoperative volume correction. Postoperatively, patients with and without GMP displayed overcorrection of orbital volume; 4.15% corresponded to 1.15 ml (with GMP) and 7.6% corresponded to 1.9 ml (without GMP).

Conclusion

GMP was present in large and combined orbital fractures. Clinically detectable postoperative GMP occurred despite satisfactory orbital reconstruction and overcorrection. Mild GMP, however, is not significant for the patient.

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In Response to pH‐Neutralizing Esophageal Irrigations as a Novel Mitigation Strategy

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Does postoperative orbital volume predict postoperative globe malposition after blow-out fracture reconstruction? A 6-month clinical follow-up study

Abstract

Purpose

The aim of this study was to investigate the relationship between intraorbital volume change caused by orbital fracture and globe malposition (GMP) in blow-out fracture patients undergoing surgery and to clarify the significance of different radiologically detected predictors associated with GMP.

Patients and methods

A 6-month prospective follow-up study of unilateral isolated orbital fractures was designed and implemented. The main outcome variable was GMP (present or absent); the secondary outcome was orientation of GMP (horizontal or vertical). The primary predictor variable was postoperative orbital volume difference determined as the difference between the fractured and non-fractured orbit (measured in milliliter and analyzed in milliliter and percentages). The explanatory variables were gender, age, treatment delay from trauma to surgery, fracture site, horizontal depth of the fracture, fracture area, maximum vertical dislocation of the fracture, and preoperative volume difference.

Results

A total of 15 patients fulfilled the inclusion criteria and were followed for 6 months from a larger cohort. GMP was detected in 6/15 patients (40.0%). GMP was more often present in large (≥ 2.5 cm²) fractures (55.6%), in combined orbital fractures (50.0%), and in fractures with preoperative volume difference ≥ 2.5 ml (62.5%) regardless of the postoperative volume correction. Postoperatively, patients with and without GMP displayed overcorrection of orbital volume; 4.15% corresponded to 1.15 ml (with GMP) and 7.6% corresponded to 1.9 ml (without GMP).

Conclusion

GMP was present in large and combined orbital fractures. Clinically detectable postoperative GMP occurred despite satisfactory orbital reconstruction and overcorrection. Mild GMP, however, is not significant for the patient.

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Does postoperative orbital volume predict postoperative globe malposition after blow-out fracture reconstruction? A 6-month clinical follow-up study

Abstract

Purpose

The aim of this study was to investigate the relationship between intraorbital volume change caused by orbital fracture and globe malposition (GMP) in blow-out fracture patients undergoing surgery and to clarify the significance of different radiologically detected predictors associated with GMP.

Patients and methods

A 6-month prospective follow-up study of unilateral isolated orbital fractures was designed and implemented. The main outcome variable was GMP (present or absent); the secondary outcome was orientation of GMP (horizontal or vertical). The primary predictor variable was postoperative orbital volume difference determined as the difference between the fractured and non-fractured orbit (measured in milliliter and analyzed in milliliter and percentages). The explanatory variables were gender, age, treatment delay from trauma to surgery, fracture site, horizontal depth of the fracture, fracture area, maximum vertical dislocation of the fracture, and preoperative volume difference.

Results

A total of 15 patients fulfilled the inclusion criteria and were followed for 6 months from a larger cohort. GMP was detected in 6/15 patients (40.0%). GMP was more often present in large (≥ 2.5 cm²) fractures (55.6%), in combined orbital fractures (50.0%), and in fractures with preoperative volume difference ≥ 2.5 ml (62.5%) regardless of the postoperative volume correction. Postoperatively, patients with and without GMP displayed overcorrection of orbital volume; 4.15% corresponded to 1.15 ml (with GMP) and 7.6% corresponded to 1.9 ml (without GMP).

Conclusion

GMP was present in large and combined orbital fractures. Clinically detectable postoperative GMP occurred despite satisfactory orbital reconstruction and overcorrection. Mild GMP, however, is not significant for the patient.

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In Response to pH‐Neutralizing Esophageal Irrigations as a Novel Mitigation Strategy

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SN9K3W

Does postoperative orbital volume predict postoperative globe malposition after blow-out fracture reconstruction? A 6-month clinical follow-up study

Abstract

Purpose

The aim of this study was to investigate the relationship between intraorbital volume change caused by orbital fracture and globe malposition (GMP) in blow-out fracture patients undergoing surgery and to clarify the significance of different radiologically detected predictors associated with GMP.

Patients and methods

A 6-month prospective follow-up study of unilateral isolated orbital fractures was designed and implemented. The main outcome variable was GMP (present or absent); the secondary outcome was orientation of GMP (horizontal or vertical). The primary predictor variable was postoperative orbital volume difference determined as the difference between the fractured and non-fractured orbit (measured in milliliter and analyzed in milliliter and percentages). The explanatory variables were gender, age, treatment delay from trauma to surgery, fracture site, horizontal depth of the fracture, fracture area, maximum vertical dislocation of the fracture, and preoperative volume difference.

Results

A total of 15 patients fulfilled the inclusion criteria and were followed for 6 months from a larger cohort. GMP was detected in 6/15 patients (40.0%). GMP was more often present in large (≥ 2.5 cm²) fractures (55.6%), in combined orbital fractures (50.0%), and in fractures with preoperative volume difference ≥ 2.5 ml (62.5%) regardless of the postoperative volume correction. Postoperatively, patients with and without GMP displayed overcorrection of orbital volume; 4.15% corresponded to 1.15 ml (with GMP) and 7.6% corresponded to 1.9 ml (without GMP).

Conclusion

GMP was present in large and combined orbital fractures. Clinically detectable postoperative GMP occurred despite satisfactory orbital reconstruction and overcorrection. Mild GMP, however, is not significant for the patient.

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

Low-dose spinal anesthesia for cesarean section to prevent spinal-induced hypotension

Purpose of review Low-dose combined spinal epidural (CSE) anesthesia is a common technique to anesthetize women for cesarean section. It is used to reduce the incidence of hypotension while providing excellent anesthetic conditions. Recent findings Low spinal doses produce effective anesthesia but of limited duration. Therefore, an epidural catheter (and thus CSE) is required to guarantee pain-free surgery. Recent work confirmed that lower spinal doses can reduce significantly hypotension. Summary Low-dose CSE is a valuable strategy to anesthetize pregnant women for cesarean section but requires attention and training. Correspondence to Marc Van de Velde, MD, PhD, EDRA, Professor, Department of Cardiovascular Sciences, Chair, Department of Anaesthesiology, Herestraat 49, B - 3000 Leuven, Belgium. E-mail: marc.vandevelde@uzleuven.be Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Time-efficient, goal-directed, and evidence-based teaching in the ICU

Purpose of review Teaching in the stressful, high-acuity environment of the ICU is challenging. The intensivist-educator must use teaching strategies that are both effective and time-efficient, as well as evidence-based approaches to the ICU curriculum. This review provides an overview of pertinent educational theories and their implications on educational practices, a selection of effective teaching techniques, and a review on feedback. Recent findings Evidence supports the role of conceptual frameworks in providing the educator with a key perspective to obtain a deeper understanding of the factors contributing to an effective and goal-directed education in the ICU. The role of simulation training for technical and nontechnical skills acquisition is growing. Feedback is difficult to provide, but critical to facilitate learner success; frameworks, and approaches are becoming more standardized. Summary Direct teaching should be goal-oriented, sequential, and adjusted to the level of the learner. The ICU curriculum should optimize cognitive load, reduce stress that is unrelated to the activity, include resilience training, and help trainees deal with stressful clinical situations better. Simulation is a powerful tool to promote technical and nontechnical skills. Providing feedback is essential and a skill that can be taught and enhanced with structure, prompts, and tools. Correspondence to Marek Brzezinski, MD, PhD, VA Medical Center, Anesthesiology Service (129), 4150 Clement Street, San Francisco, CA 94121, USA. Tel: +1 415 750 2069; e-mail: marek.brzezinski@ucsf.edu Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SPw2m1

Low-dose spinal anesthesia for cesarean section to prevent spinal-induced hypotension

Purpose of review Low-dose combined spinal epidural (CSE) anesthesia is a common technique to anesthetize women for cesarean section. It is used to reduce the incidence of hypotension while providing excellent anesthetic conditions. Recent findings Low spinal doses produce effective anesthesia but of limited duration. Therefore, an epidural catheter (and thus CSE) is required to guarantee pain-free surgery. Recent work confirmed that lower spinal doses can reduce significantly hypotension. Summary Low-dose CSE is a valuable strategy to anesthetize pregnant women for cesarean section but requires attention and training. Correspondence to Marc Van de Velde, MD, PhD, EDRA, Professor, Department of Cardiovascular Sciences, Chair, Department of Anaesthesiology, Herestraat 49, B - 3000 Leuven, Belgium. E-mail: marc.vandevelde@uzleuven.be Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2N2BoVt

Time-efficient, goal-directed, and evidence-based teaching in the ICU

Purpose of review Teaching in the stressful, high-acuity environment of the ICU is challenging. The intensivist-educator must use teaching strategies that are both effective and time-efficient, as well as evidence-based approaches to the ICU curriculum. This review provides an overview of pertinent educational theories and their implications on educational practices, a selection of effective teaching techniques, and a review on feedback. Recent findings Evidence supports the role of conceptual frameworks in providing the educator with a key perspective to obtain a deeper understanding of the factors contributing to an effective and goal-directed education in the ICU. The role of simulation training for technical and nontechnical skills acquisition is growing. Feedback is difficult to provide, but critical to facilitate learner success; frameworks, and approaches are becoming more standardized. Summary Direct teaching should be goal-oriented, sequential, and adjusted to the level of the learner. The ICU curriculum should optimize cognitive load, reduce stress that is unrelated to the activity, include resilience training, and help trainees deal with stressful clinical situations better. Simulation is a powerful tool to promote technical and nontechnical skills. Providing feedback is essential and a skill that can be taught and enhanced with structure, prompts, and tools. Correspondence to Marek Brzezinski, MD, PhD, VA Medical Center, Anesthesiology Service (129), 4150 Clement Street, San Francisco, CA 94121, USA. Tel: +1 415 750 2069; e-mail: marek.brzezinski@ucsf.edu Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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