Clinical management for T1 and T2 external auditory canal cancer

Publication date: Available online 21 February 2019

Source: Auris Nasus Larynx

Author(s): Hirotaka Shinomiya, Natsumi Uehara, Masanori Teshima, Akinori Kakigi, Naoki Otsuki, Ken-ichi Nibu

Abstract

Objective

The purpose of this study was to clarify the impact of superficial parotidectomy and postoperative radiotherapy (PORT) for the surgical treatment of early stage squamous cell carcinoma (SCC) in external auditory canal (EAC).

Materials and methods

Thirty-seven patients with T1 (n = 14) or T2 (n = 19) SCC in EAC treated between 2000 and 2016 at Kobe University Hospital were enrolled in this study. Thirty-three patients were operated with sleeve resection or lateral temporal bone resection.

Results

The 5-year overall survival and disease-specific survival rates were 95% and 100%, respectively. Surgical margin was positive in 4 patients, who were treated by PORT and have been alive without disease. Prophylactic superficial parotidectomy was simultaneously performed at the time of initial surgery in 15 patients, in whom no lymph node (LN) metastasis was observed. Among the other 22 patients, regional recurrence in parotid LN was observed in one patient, who was successfully salvaged by total parotidectomy. Potential parotid lymph node metastasis rates of T1 and T2 SCC in EAC was 0% (0/14) and 5% (1/19) respectively.

Conclusions

Complete resection without positive surgical margins is essential for the treatment of the patients with T1 and T2 ear cancers. Prophylactic superficial parotidectomy or neck dissection is not mandatory for T1 and T2 diseases, as long as precisely extent of disease is assessed preoperatively. PORT should be performed for the patients with positive surgical margins.

Levels of evidence: 4.

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Oral administration of an herbal medicine to prevent progressive hearing loss in a mouse model of diabetes

Publication date: Available online 22 February 2019

Source: Auris Nasus Larynx

Author(s): Takeshi Hori, Kazuma Sugahara, Junko Tsuda, Yoshinobu Hirose, Makoto Hashimoto, Yousuke Takemoto, Shunsuke Tarumoto, Hiroshi Yamashita

Abstract

Objective

Tsumura Suzuki Obese Diabetes (TSOD) mice exhibit early age-associated hearing loss. Histopathological analysis of these mice shows narrowing of capillaries in the stria vascularis and chronic reduction of blood flow in the cochlea. In this study, we investigated the effect of oral administration of a herbal medicine or calorie restriction on hearing in TSOD mice.

Methods

TSOD mice were divided into 4 groups: CR (calorie restriction), BF and DS (treated with the herbal medicines, Bofutsushosan and Daisaikoto, respectively), and the control group. Body weight, blood glucose levels, and auditory brainstem responses (ABRs) were measured. The cochleae were excised and evaluated histopathologically.

Results

Blood glucose levels were suppressed in the CR, BF, and DS groups. In addition, the elevation of ABR thresholds was inhibited in the CR, BF, and DS groups. Cochlear blood vessels remained wide in the three treatment groups compared with the control group. These results suggested that the administration of these herbal medicines improved glucose tolerance and yielded results similar to those on calorie restriction.

Conclusion

Oral administration of 2 herbal medicines can prevent hearing function disorder in a model mouse of diabetes. The results may clarify the possibility of clinical application.

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Clinical management for T1 and T2 external auditory canal cancer

Publication date: Available online 21 February 2019

Source: Auris Nasus Larynx

Author(s): Hirotaka Shinomiya, Natsumi Uehara, Masanori Teshima, Akinori Kakigi, Naoki Otsuki, Ken-ichi Nibu

Abstract

Objective

The purpose of this study was to clarify the impact of superficial parotidectomy and postoperative radiotherapy (PORT) for the surgical treatment of early stage squamous cell carcinoma (SCC) in external auditory canal (EAC).

Materials and methods

Thirty-seven patients with T1 (n = 14) or T2 (n = 19) SCC in EAC treated between 2000 and 2016 at Kobe University Hospital were enrolled in this study. Thirty-three patients were operated with sleeve resection or lateral temporal bone resection.

Results

The 5-year overall survival and disease-specific survival rates were 95% and 100%, respectively. Surgical margin was positive in 4 patients, who were treated by PORT and have been alive without disease. Prophylactic superficial parotidectomy was simultaneously performed at the time of initial surgery in 15 patients, in whom no lymph node (LN) metastasis was observed. Among the other 22 patients, regional recurrence in parotid LN was observed in one patient, who was successfully salvaged by total parotidectomy. Potential parotid lymph node metastasis rates of T1 and T2 SCC in EAC was 0% (0/14) and 5% (1/19) respectively.

Conclusions

Complete resection without positive surgical margins is essential for the treatment of the patients with T1 and T2 ear cancers. Prophylactic superficial parotidectomy or neck dissection is not mandatory for T1 and T2 diseases, as long as precisely extent of disease is assessed preoperatively. PORT should be performed for the patients with positive surgical margins.

Levels of evidence: 4.

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Headache Caused by Sinus Disease

Publication date: Available online 21 February 2019

Source: Neuroimaging Clinics of North America

Author(s): Claudia F.E. Kirsch

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Intracranial Hypotension and Cerebrospinal Fluid Leak

Publication date: Available online 21 February 2019

Source: Neuroimaging Clinics of North America

Author(s): Stephen M. Chan, Yosef G. Chodakiewitz, Marcel M. Maya, Wouter I. Schievink, Franklin G. Moser

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Headache Caused by Sinus Disease

Publication date: Available online 21 February 2019

Source: Neuroimaging Clinics of North America

Author(s): Claudia F.E. Kirsch

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Intracranial Hypotension and Cerebrospinal Fluid Leak

Publication date: Available online 21 February 2019

Source: Neuroimaging Clinics of North America

Author(s): Stephen M. Chan, Yosef G. Chodakiewitz, Marcel M. Maya, Wouter I. Schievink, Franklin G. Moser

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Asymptomatic right cheek nodule in a 65-year-old female

Publication date: Available online 21 February 2019

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

Author(s): Raj Thaker, Kevin C. Lee, Scott Peters, David Greenman, James R King

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Asymptomatic right cheek nodule in a 65-year-old female

Publication date: Available online 21 February 2019

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

Author(s): Raj Thaker, Kevin C. Lee, Scott Peters, David Greenman, James R King

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Allergen immunotherapy improves defective follicular regulatory T cells in patients with allergic rhinitis

Publication date: Available online 21 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Yin Yao, Zhi-Chao Wang, Nan Wang, Peng-Cheng Zhou, Cai-Ling Chen, Jia Song, Li Pan, Bo Liao, Xin-Hao Zhang, Yong-Shi Yang, Xiao-Yan Xu, Rong-Fei Zhu, Di Yu, Zheng Liu

Abstract

Background

The function of follicular regulatory T (Tfr) cells, especially in regulating IgE production in allergic diseases, is poorly understood.

Objective

To investigate the phenotype, function, and clinical relevance of Tfr cells in patients with allergic rhinitis (AR).

Methods

The phenotype and frequency of tonsillar and circulating Tfr cells were characterized by flow cytometry. The function of Tfr cells was examined in an assay by co-culturing with follicular helper T (Tfh) cells and B cells. The associations between the Tfr cells and the clinical features in AR patients before and after allergen immunotherapy (AIT) were analyzed.

Results

Tfr cells were detected in germinal centers of tonsils but, compared to non-AR subjects, the frequencies declined in AR patients allergic to house dust mites. Circulating Tfr cells in blood were phenotypically and numerically correlated with tonsillar Tfr cells and a reduction of circulating Tfr cells, but not total or CXCR5^- Treg cells, was noted in AR patients compared to healthy controls. Moreover, circulating Tfr cells in AR patients showed a specific defect in suppressing IgE production but were capable to suppress the production of other immunoglobulin types. We identified negative associations of circulating Tfr cell frequencies and function with antigen-specific IgE levels or disease severity in AR patients. After AIT, the frequencies and function of circulating Tfr cells were improved, which positively associated with disease remission.

Conclusion

The impairment of Tfr cells may contribute to aberrant IgE production in AR, and AIT improves defective Tfr cell function. Tfr cells may serve as a potential biomarker to monitor clinical response to AIT.

Graphical abstract

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Lack of Protein Prenylation Promotes Nlrp3 Inflammasome Assembly in Human Monocytes

Publication date: Available online 21 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Oliver P. Skinner, Julie Jurczyluk, Paul J. Baker, Seth L. Masters, Alicia Rios Wilks, Misaki S. Clearwater, Avril A.B. Robertson, Kate Schroder, Sam Mehr, Marcia A. Munoz, Michael J. Rogers

Summary

We demonstrate that blocking the mevalonate pathway and protein prenylation in human monocytes leads to enhanced activity of an NLRP3-dependent, but not Pyrin-dependent, inflammasome, suggesting a prominent role for NLRP3 in the pathogenesis of mevalonate kinase deficiency.

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Allergen immunotherapy improves defective follicular regulatory T cells in patients with allergic rhinitis

Publication date: Available online 21 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Yin Yao, Zhi-Chao Wang, Nan Wang, Peng-Cheng Zhou, Cai-Ling Chen, Jia Song, Li Pan, Bo Liao, Xin-Hao Zhang, Yong-Shi Yang, Xiao-Yan Xu, Rong-Fei Zhu, Di Yu, Zheng Liu

Abstract

Background

The function of follicular regulatory T (Tfr) cells, especially in regulating IgE production in allergic diseases, is poorly understood.

Objective

To investigate the phenotype, function, and clinical relevance of Tfr cells in patients with allergic rhinitis (AR).

Methods

The phenotype and frequency of tonsillar and circulating Tfr cells were characterized by flow cytometry. The function of Tfr cells was examined in an assay by co-culturing with follicular helper T (Tfh) cells and B cells. The associations between the Tfr cells and the clinical features in AR patients before and after allergen immunotherapy (AIT) were analyzed.

Results

Tfr cells were detected in germinal centers of tonsils but, compared to non-AR subjects, the frequencies declined in AR patients allergic to house dust mites. Circulating Tfr cells in blood were phenotypically and numerically correlated with tonsillar Tfr cells and a reduction of circulating Tfr cells, but not total or CXCR5^- Treg cells, was noted in AR patients compared to healthy controls. Moreover, circulating Tfr cells in AR patients showed a specific defect in suppressing IgE production but were capable to suppress the production of other immunoglobulin types. We identified negative associations of circulating Tfr cell frequencies and function with antigen-specific IgE levels or disease severity in AR patients. After AIT, the frequencies and function of circulating Tfr cells were improved, which positively associated with disease remission.

Conclusion

The impairment of Tfr cells may contribute to aberrant IgE production in AR, and AIT improves defective Tfr cell function. Tfr cells may serve as a potential biomarker to monitor clinical response to AIT.

Graphical abstract

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Lack of Protein Prenylation Promotes Nlrp3 Inflammasome Assembly in Human Monocytes

Publication date: Available online 21 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Oliver P. Skinner, Julie Jurczyluk, Paul J. Baker, Seth L. Masters, Alicia Rios Wilks, Misaki S. Clearwater, Avril A.B. Robertson, Kate Schroder, Sam Mehr, Marcia A. Munoz, Michael J. Rogers

Summary

We demonstrate that blocking the mevalonate pathway and protein prenylation in human monocytes leads to enhanced activity of an NLRP3-dependent, but not Pyrin-dependent, inflammasome, suggesting a prominent role for NLRP3 in the pathogenesis of mevalonate kinase deficiency.

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Comparison of PET/MRI with Multiparametric MRI in Diagnosis of Primary Prostate Cancer: A Meta-analysis

Publication date: Available online 21 February 2019

Source: European Journal of Radiology

Author(s): Mou Li, Zixing Huang, Haopeng Yu, Yi Wang, Yongchang Zhang, Bin Song

Abstract

Objective

This meta-analysis aimed to compare the diagnostic performance of positron emission tomography (PET)/MRI using various radiotracers with multiparametric (mp) MRI for detection of primary prostate cancer (PCa).

Methods

A systematic literature search up to January 2019 was performed to identify studies that evaluated the diagnostic value of PET/MRI and mpMRI for detection of PCa in the same patient cohorts and had sufficient data to construct 2 × 2 contingency tables for true-positive (TP), false-positive (FP), false-negative (FN), and true-negative (TN) results. The quality of each study was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool, and pooled sensitivity (SEN) and specificity (SPE) were calculated. Summary receiver operating characteristic (ROC) curves and area under the curves (AUCs) were used to compare the performances of PET/MRI and mpMRI.

Results

We identified 9 eligible studies that included a total of 353 patients. PET/MRI had a SEN of 0.783 (95% CI, 0.758–0.807) and a SPE of 0.899 (95% CI, 0.879–0.917), and mpMRI had a SEN of 0.603 (95% CI, 0.574–0.631) and a SPE of 0.887 (95% CI, 0.866–0.906). PET/MRI had a higher AUC than mpMRI (0.9311, 95% CI, 0.8990–0.9632vs. 0.8403, 95% CI, 0.7864–0.8942; P =  0.0036). There was no notable publication bias, but there was medium heterogeneity in outcomes. The meta-regression analysis showed the major potential cause of heterogeneity was the use of region-based rather than lesion-based analysis.

Conclusion

PET/MRI has very good diagnostic performance and outperforms mpMRI for the diagnosis of primary PCa.

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Comparison of PET/MRI with Multiparametric MRI in Diagnosis of Primary Prostate Cancer: A Meta-analysis

Publication date: Available online 21 February 2019

Source: European Journal of Radiology

Author(s): Mou Li, Zixing Huang, Haopeng Yu, Yi Wang, Yongchang Zhang, Bin Song

Abstract

Objective

This meta-analysis aimed to compare the diagnostic performance of positron emission tomography (PET)/MRI using various radiotracers with multiparametric (mp) MRI for detection of primary prostate cancer (PCa).

Methods

A systematic literature search up to January 2019 was performed to identify studies that evaluated the diagnostic value of PET/MRI and mpMRI for detection of PCa in the same patient cohorts and had sufficient data to construct 2 × 2 contingency tables for true-positive (TP), false-positive (FP), false-negative (FN), and true-negative (TN) results. The quality of each study was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool, and pooled sensitivity (SEN) and specificity (SPE) were calculated. Summary receiver operating characteristic (ROC) curves and area under the curves (AUCs) were used to compare the performances of PET/MRI and mpMRI.

Results

We identified 9 eligible studies that included a total of 353 patients. PET/MRI had a SEN of 0.783 (95% CI, 0.758–0.807) and a SPE of 0.899 (95% CI, 0.879–0.917), and mpMRI had a SEN of 0.603 (95% CI, 0.574–0.631) and a SPE of 0.887 (95% CI, 0.866–0.906). PET/MRI had a higher AUC than mpMRI (0.9311, 95% CI, 0.8990–0.9632vs. 0.8403, 95% CI, 0.7864–0.8942; P =  0.0036). There was no notable publication bias, but there was medium heterogeneity in outcomes. The meta-regression analysis showed the major potential cause of heterogeneity was the use of region-based rather than lesion-based analysis.

Conclusion

PET/MRI has very good diagnostic performance and outperforms mpMRI for the diagnosis of primary PCa.

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Issue Information

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Issue Information

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Hearing Loss in Pediatric Septo-Optic Dysplasia.

CONCLUSIONS:: Hearing loss was found in nearly 11% of SOD children, and SNHL was identified as (63%) the predominant form of loss. To our knowledge, this is the first retrospective review of hearing loss in a pediatric SOD cohort and the first to report of cochlear nerve deficiency and atresia/microtia in this population. Based on these findings, early identification of hearing loss with imaging when appropriate and treatment of otitis in this population is recommended. PMID: 30781969 [PubMed - as supplied by publisher] (Source: The Annals of Otology, Rhinology, and Laryngology)

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Hearing Loss in Pediatric Septo-Optic Dysplasia.

CONCLUSIONS:: Hearing loss was found in nearly 11% of SOD children, and SNHL was identified as (63%) the predominant form of loss. To our knowledge, this is the first retrospective review of hearing loss in a pediatric SOD cohort and the first to report of cochlear nerve deficiency and atresia/microtia in this population. Based on these findings, early identification of hearing loss with imaging when appropriate and treatment of otitis in this population is recommended. PMID: 30781969 [PubMed - as supplied by publisher] (Source: The Annals of Otology, Rhinology, and Laryngology)

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Simultaneous occurrence of benign and malignant tumours in the ipsilateral parotid gland—retrospective study

Publication date: Available online 22 February 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): H. Lu, W. Xu, Y. Zhu, L. Liu, S. Liu, W. Yang

Abstract

The simultaneous occurrence of benign and malignant tumours in the ipsilateral parotid gland is extremely rare. The cases of five patients with synchronous multiple parotid gland tumours consisting of diverse combinations of benign and malignant histological types are presented here. In addition, all published cases of this entity identified in the PubMed, Embase, and Web of Science databases up to January 2018 were reviewed. It is concluded that clinical vigilance should be raised when multifocal tumours are indicated by imaging examinations, in the presence of unmovable, painful, and rapid growth or symptoms of facial nerve palsy. In such cases, resected specimens should be sectioned meticulously, especially for tiny lesions, during histopathological sampling. Based on the possibility of the co-existence of benign and malignant neoplasms, it is necessary for clinicians to pay attention to this entity in order to have a favourable outcome.

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Simultaneous occurrence of benign and malignant tumours in the ipsilateral parotid gland—retrospective study

Publication date: Available online 22 February 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): H. Lu, W. Xu, Y. Zhu, L. Liu, S. Liu, W. Yang

Abstract

The simultaneous occurrence of benign and malignant tumours in the ipsilateral parotid gland is extremely rare. The cases of five patients with synchronous multiple parotid gland tumours consisting of diverse combinations of benign and malignant histological types are presented here. In addition, all published cases of this entity identified in the PubMed, Embase, and Web of Science databases up to January 2018 were reviewed. It is concluded that clinical vigilance should be raised when multifocal tumours are indicated by imaging examinations, in the presence of unmovable, painful, and rapid growth or symptoms of facial nerve palsy. In such cases, resected specimens should be sectioned meticulously, especially for tiny lesions, during histopathological sampling. Based on the possibility of the co-existence of benign and malignant neoplasms, it is necessary for clinicians to pay attention to this entity in order to have a favourable outcome.

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Understanding quit patterns from a randomized clinical trial: Latent classes, predictors, and long-term abstinence

Publication date: Available online 21 February 2019

Source: Addictive Behaviors

Author(s): Lorra Garey, Kara Manning, Danielle E. McCarthy, Matthew W. Gallagher, Justin M. Shepherd, Michael F. Orr, Norman B. Schmidt, Blaz Rodic, Michael J. Zvolensky

Abstract

Objective

Tobacco dependence treatment is recognized as a dynamic, chronic process comprised of several specific phases. Of these phases, the Cessation phase is the most critical as it has demonstrated the strongest relation to quit success. Yet, little is understood about smoking trajectories during this period. The current study aimed to address gaps in the smoking research literature and advance understanding of the dynamic quit process unique to completing an integrated smoking treatment by evaluating quit behavior during the Cessation phase.

Method

Two hundred and sixty-seven treatment seeking smokers enrolled in a clinical trial to evaluate the efficacy of a novel, integrated smoking cessation treatment (46.1% male; M_age = 39.25, SD = 13.70) were included in the present study. Repeated-measure latent class analysis was employed to evaluate quit patterns from quit day through day 14 post-quit.

Results

Results supported a four-class solution: Consistent Quitters, Non-Quitters, Relapsers, and Delayed Quitters. Predictors of class membership included age, number of prior quit attempts, motivation to quit smoking, and quit day smoking urges. Moreover, class membership was significantly associated with 6-month abstinence.

Conclusion

Results suggest that there are four relevant classes of quit behavior, each with specific predictor variables including age, motivation to quit, smoking urges, and number of quit attempts, and that these classes relate to long-term abstinence. These results have the potential to inform manualized smoking cessation treatment interventions based on relevant subgroups of quit behavior.

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Using electronic audience response technology to track e-cigarette habits among college freshmen

Publication date: Available online 21 February 2019

Source: Addictive Behaviors

Author(s): Jessica L. Bourdon, Linda C. Hancock

Abstract

Purpose

The use of e-cigarette devices, specifically JUUL, is on the rise on college campuses. Traditional means of collecting and analyzing research may not be fast enough for health professionals to effectively assess, plan, and implement effective prevention/intervention strategies.

Procedures

In August 2018, during incoming student orientation sessions at seven different college campuses, data on a specific e-cigarette, JUUL. Data on use and knowledge of JUUL, as well as traditional cigarette use, was collected via immediate electronic audience response devices. Analyses included calculating descriptive statistics for questions of interest.

Results

Because response on each item was optional and anonymous, participation on specific questions varied and the total sample size for the questions of interest ranged from 1940 to 2027 students. Mean daily use rates were 13.7% (11.6–18.0%) for JUUL and 1.7% (1.3–2.5%) for cigarettes. Most students (67.3%) knew that JUUL always contained nicotine (38.4–84.5%), although 30.1% believed that it just contained nicotine and/or flavored vapor (15.5–50.0%), and 2.1% thought it was flavored vapor only (0.0–5.9%).

Conclusions

This study reports the highest daily use of e-cigarettes among college students in the literature to date, with past-month e-cigarette use and daily cigarette use on par with previous estimates. Findings also highlight the knowledge gaps that some users have about JUUL specifically. In order for college health educators and professionals to best help students, adoption of methods that allow for more rapid assessment of e-cigarette trends is needed. This will help campuses more effectively address this issue, closing the research-to-practice gap in college health.

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Understanding quit patterns from a randomized clinical trial: Latent classes, predictors, and long-term abstinence

Publication date: Available online 21 February 2019

Source: Addictive Behaviors

Author(s): Lorra Garey, Kara Manning, Danielle E. McCarthy, Matthew W. Gallagher, Justin M. Shepherd, Michael F. Orr, Norman B. Schmidt, Blaz Rodic, Michael J. Zvolensky

Abstract

Objective

Tobacco dependence treatment is recognized as a dynamic, chronic process comprised of several specific phases. Of these phases, the Cessation phase is the most critical as it has demonstrated the strongest relation to quit success. Yet, little is understood about smoking trajectories during this period. The current study aimed to address gaps in the smoking research literature and advance understanding of the dynamic quit process unique to completing an integrated smoking treatment by evaluating quit behavior during the Cessation phase.

Method

Two hundred and sixty-seven treatment seeking smokers enrolled in a clinical trial to evaluate the efficacy of a novel, integrated smoking cessation treatment (46.1% male; M_age = 39.25, SD = 13.70) were included in the present study. Repeated-measure latent class analysis was employed to evaluate quit patterns from quit day through day 14 post-quit.

Results

Results supported a four-class solution: Consistent Quitters, Non-Quitters, Relapsers, and Delayed Quitters. Predictors of class membership included age, number of prior quit attempts, motivation to quit smoking, and quit day smoking urges. Moreover, class membership was significantly associated with 6-month abstinence.

Conclusion

Results suggest that there are four relevant classes of quit behavior, each with specific predictor variables including age, motivation to quit, smoking urges, and number of quit attempts, and that these classes relate to long-term abstinence. These results have the potential to inform manualized smoking cessation treatment interventions based on relevant subgroups of quit behavior.

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Using electronic audience response technology to track e-cigarette habits among college freshmen

Publication date: Available online 21 February 2019

Source: Addictive Behaviors

Author(s): Jessica L. Bourdon, Linda C. Hancock

Abstract

Purpose

The use of e-cigarette devices, specifically JUUL, is on the rise on college campuses. Traditional means of collecting and analyzing research may not be fast enough for health professionals to effectively assess, plan, and implement effective prevention/intervention strategies.

Procedures

In August 2018, during incoming student orientation sessions at seven different college campuses, data on a specific e-cigarette, JUUL. Data on use and knowledge of JUUL, as well as traditional cigarette use, was collected via immediate electronic audience response devices. Analyses included calculating descriptive statistics for questions of interest.

Results

Because response on each item was optional and anonymous, participation on specific questions varied and the total sample size for the questions of interest ranged from 1940 to 2027 students. Mean daily use rates were 13.7% (11.6–18.0%) for JUUL and 1.7% (1.3–2.5%) for cigarettes. Most students (67.3%) knew that JUUL always contained nicotine (38.4–84.5%), although 30.1% believed that it just contained nicotine and/or flavored vapor (15.5–50.0%), and 2.1% thought it was flavored vapor only (0.0–5.9%).

Conclusions

This study reports the highest daily use of e-cigarettes among college students in the literature to date, with past-month e-cigarette use and daily cigarette use on par with previous estimates. Findings also highlight the knowledge gaps that some users have about JUUL specifically. In order for college health educators and professionals to best help students, adoption of methods that allow for more rapid assessment of e-cigarette trends is needed. This will help campuses more effectively address this issue, closing the research-to-practice gap in college health.

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Reproducibility of multi-shell diffusion tractography on traveling subjects: A multicenter study prospective

Publication date: Available online 21 February 2019

Source: Magnetic Resonance Imaging

Author(s): Qiqi Tong, Hongjian He, Ting Gong, Chen Li, Peipeng Liang, Tianyi Qian, Yi Sun, Qiuping Ding, Kuncheng Li, Jianhui Zhong

Abstract

Reproducibility of multicenter diffusion magnetic resonance imaging has drawn more attention recently due to rapidly increasing need for large-size brain imaging studies. Advanced multi-shell diffusion models are recommended for their potentials to provide variety of physio-pathological information. While previous studies have investigated the consistency of single-shell diffusion acquisition from various hardware and protocols, a well-controlled study with multi-shell acquisition would be necessary to understand the inherent factors of reproducibility from new complexity of such acquisition protocol. In this study, three traveling subjects were scanned at eight imaging centers equipped with the same type of scanners using the same multi-shell diffusion imaging protocol. Track density imaging and structure connectomes were investigated in local-scale distribution and in distal-scale connectivity, respectively. With evaluations of the coefficient of variation and the intra-class correlation coefficient, our results indicated: 1) similar to single-shell schemes, the intra-center reproducibility of multi-shell is higher than inter-center; 2) multi-shell schemes produce higher reproducibility and precision among centers compared to the single-shell schemes; and 3) in addition to the diffusion schemes, image quality and the presence of complex fiber structure could also associated with multicenter reproducibility.

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Reproducibility of multi-shell diffusion tractography on traveling subjects: A multicenter study prospective

Publication date: Available online 21 February 2019

Source: Magnetic Resonance Imaging

Author(s): Qiqi Tong, Hongjian He, Ting Gong, Chen Li, Peipeng Liang, Tianyi Qian, Yi Sun, Qiuping Ding, Kuncheng Li, Jianhui Zhong

Abstract

Reproducibility of multicenter diffusion magnetic resonance imaging has drawn more attention recently due to rapidly increasing need for large-size brain imaging studies. Advanced multi-shell diffusion models are recommended for their potentials to provide variety of physio-pathological information. While previous studies have investigated the consistency of single-shell diffusion acquisition from various hardware and protocols, a well-controlled study with multi-shell acquisition would be necessary to understand the inherent factors of reproducibility from new complexity of such acquisition protocol. In this study, three traveling subjects were scanned at eight imaging centers equipped with the same type of scanners using the same multi-shell diffusion imaging protocol. Track density imaging and structure connectomes were investigated in local-scale distribution and in distal-scale connectivity, respectively. With evaluations of the coefficient of variation and the intra-class correlation coefficient, our results indicated: 1) similar to single-shell schemes, the intra-center reproducibility of multi-shell is higher than inter-center; 2) multi-shell schemes produce higher reproducibility and precision among centers compared to the single-shell schemes; and 3) in addition to the diffusion schemes, image quality and the presence of complex fiber structure could also associated with multicenter reproducibility.

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Pre-target alpha power predicts the speed of cued target discrimination

Publication date: 1 April 2019

Source: NeuroImage, Volume 189

Author(s): Nathan M. Petro, Nina N. Thigpen, Steven Garcia, Maeve R. Boylan, Andreas Keil

Abstract

The human visual system selects information from dense and complex streams of spatiotemporal input. This selection process is aided by prior knowledge of the features, location, and temporal proximity of an upcoming stimulus. In the laboratory, this knowledge is often conveyed by cues, preceding a task-relevant target stimulus. Response speed in cued selection tasks varies within and across participants and is often thought to index efficient selection of a cued feature, location, or moment in time. The present study used a reverse correlation approach to identify neural predictors of efficient target discrimination: Participants identified the orientation of a sinusoidal grating, which was presented in one hemifield following the presentation of bilateral visual cues that carried temporal but not spatial information about the target. Across different analytic approaches, faster target responses were predicted by larger alpha power preceding the target. These results suggest that heightened pre-target alpha power during a cue period may index a state that is beneficial for subsequent target processing. Our findings are broadly consistent with models that emphasize capacity sharing across time, as well as models that link alpha oscillations to temporal predictions regarding upcoming events.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2T8GV29

Decoding the meaning of unconsciously processed words using fMRI-based MVPA

Publication date: Available online 21 February 2019

Source: NeuroImage

Author(s): Usman Ayub Sheikh, Manuel Carreiras, David Soto

Abstract

Does the human brain elicit patterns of activity associated with the meaning of words in the absence of conscious awareness? Do such non-conscious semantic representations generalize across languages? This study aimed to address these questions using fMRI-based multivariate pattern analysis (MVPA) in a masked word paradigm. Animal and non-animal words were visually presented in two different languages (i.e. Spanish and Basque). Words were presented very briefly and were masked. On each trial, participants identified the semantic category and provided a visibility rating of the word. A support vector machine (SVM) was used to decode word category from multivoxel patterns of BOLD responses in seven canonical semantic regions of a left-lateralized network that were prespecified based on a previous meta-analysis. We show that the semantic category of non-conscious words (i.e. associated with null visual experience and chance-level discrimination performance) can be significantly decoded from BOLD response patterns. For Spanish, such discriminative patterns of BOLD responses were consistently found in inferior parietal lobe, dorsomedial prefrontal cortex, inferior frontal gyrus and posterior cingulate gyrus. While for Basque, these were found in ventromedial temporal lobe and posterior cingulate gyrus. All of the areas identified have previously been associated with semantic processing in studies involving animals-tools and animals-artifacts contrasts. In conscious trials, such patterns were found to be distributed over all seven regions of the semantic network in both Spanish and Basque. However, we found no evidence of across-language generalization. These results demonstrate that even in the absence of conscious awareness and lack of behavioural sensitivity to the words, putative semantic brain areas carry information related to the meanings of the words. The generalization of semantic representations across languages, however, may require deeper conscious semantic access.

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

Age-related differences in reallocating cognitive resources when dealing with interruptions

Publication date: Available online 21 February 2019

Source: NeuroImage

Author(s): Stefan Arnau, Edmund Wascher, Kristina Küper

Abstract

The ability to perform at a high level, even when the task at hand is interrupted by an unrelated secondary task, is central to human information processing. Executive control processes, in particular the reallocation of attentional resources, are crucial for coping with interruptions. Although the age-related decline in cognitive control functions is well described, the consequences of such changes for the ability to deal with interruptions are as of yet unclear. In the present study, we examined behavioral performance as well as electrophysiological parameters associated with executive control processes in older and younger participants using a nested task design: In one third of all trials, an ongoing working memory task was interrupted by a math task. We found that the impact of interruptions on primary task performance was more severe in the older age group. In the EEG, older adults showed stronger frontal midline theta activation and fronto-parietal connectivity in the theta range in response to the cue indicating the relevant attentional set. Younger participants, on the other hand, showed distinct and specific increases in cognitive control as indexed by frontal midline theta in response to the stimulus signaling an upcoming interruption. Overall, the results reveal strategic differences between the age groups, as older participants seem to prioritize the primary task more strongly. The data furthermore indicate that the combination of a rapid succession of events and the decreased ability to shift executive resources renders older adults' performance particularly vulnerable to the occurrence of interruptions.

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Response time as a proxy of ongoing mental state: A combined fMRI and pupillometry study in Generalized Anxiety Disorder

Publication date: Available online 21 February 2019

Source: NeuroImage

Author(s): Elena Makovac, Sabrina Fagioli, David R. Watson, Frances Meeten, Jonathan Smallwood, Hugo D. Critchley, Cristina Ottaviani

Abstract

In Generalized Anxiety Disorder (GAD), fluctuations in ongoing thoughts (i.e., mind-wandering) often take the form of rigid and intrusive perseverative cognition, such as worry. Here, we sought to characterise the neural correlates of mind-wandering and perseverative cognition, alongside autonomic nervous system indices of central arousal, notably pupil dilation. We implemented a protocol incorporating the dynamic delivery of thought-probes within a functional neuroimaging task. Sixteen individuals with GAD and sixteen matched healthy controls (HC) underwent functional magnetic resonance imaging with concomitant pupillometry. Participants performed a series of low-demand tracking tasks, responding to occasional changes in a target stimulus. Such a task is typically accompanied by self-generated, off-task thinking. Thought-probes were triggered based on an individual's response time (RT) when responding to the change in the target. Subjective reports showed that long RT predicted off-task thinking/mind-wandering. Moreover, long RT and mind-wandering were also associated with larger pupil diameter. This effect was exaggerated in GAD patients during perseverative cognition. Within brain, during both pre-target periods and target events, there were distinct neural correlates for mind-wandering (e.g., anterior cingulate and paracingulate activation at target onset) and perseverative cognition (e.g., opposite patterns of activation in posterior cingulate and cerebellum at target onset in HC and GAD). Results suggest that not only attention systems but also sensory-motor cortices are important during off-task states. Interestingly, changes across the 'default mode network' also tracked fluctuations in pupillary size. Autonomic expression in pupillary changes mirror brain activation patterns that occur during different forms of repetitive thinking.

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

Real-time fMRI neurofeedback training to improve eating behavior by self-regulation of the dorsolateral prefrontal cortex: A randomized controlled trial in overweight and obese subjects

Publication date: Available online 21 February 2019

Source: NeuroImage

Author(s): Simon H. Kohl, Ralf Veit, Maartje S. Spetter, Astrid Günther, Andriani Rina, Michael Lührs, Niels Birbaumer, Hubert Preissl, Manfred Hallschmid

Abstract

Obesity is associated with altered responses to food stimuli in prefrontal brain networks that mediate inhibitory control of ingestive behavior. In particular, activity of the dorsolateral prefrontal cortex (dlPFC) is reduced in obese compared to normal-weight subjects and has been linked to the success of weight-loss dietary interventions. In a randomized controlled trial in overweight/obese subjects, we investigated the effect on eating behavior of volitional up-regulation of dlPFC activity via real-time functional magnetic resonance imaging (fMRI) neurofeedback training.

Thirty-eight overweight or obese subjects (BMI 25–40 kg/m²) took part in fMRI neurofeedback training with the aim of increasing activity of the left dlPFC (dlPFC group; n = 17) or of the visual cortex (VC/control group; n = 21). Participants were blinded to group assignment. The training session took place on a single day and included three training runs of six trials of up-regulation and passive viewing. Food appraisal and snack intake were assessed at screening, after training, and in a follow-up session four weeks later.

Participants of both groups succeeded in up-regulating activity of the targeted brain area. However, participants of the control group also showed increased left dlPFC activity during up-regulation. Functional connectivity between dlPFC and ventromedial PFC, an area that processes food value, was generally increased during up-regulation compared to passive viewing. At follow-up compared to baseline, both groups rated pictures of high-, but not low-calorie foods as less palatable and chose them less frequently. Actual snack intake remained unchanged but palatability and choice ratings for chocolate cookies decreased after training.

We demonstrate that one session of fMRI neurofeedback training enables individuals with increased body weight to up-regulate activity of the left dlPFC. Behavioral effects were observed in both groups, which might have been due to dlPFC co-activation in the control group and, in addition, unspecific training effects. Improved dlPFC-vmPFC functional connectivity furthermore suggested enhanced food intake-related control mechanisms. Neurofeedback training might support therapeutic strategies aiming at improved self-control in obesity, although the respective contribution of area-specific mechanisms and general regulation effects is in need of further investigation.

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Prospective clinical study of bilateral balanced occlusion (BBO) versus canine-guided occlusion (CGO) in complete denture wearers

Abstract

Objectives

Previous studies have often discussed occlusal concepts for complete dentures without formulating a recommendation. Various options are available, the most common ones being canine-guided occlusion (CGO) and bilateral balanced occlusion (BBO). We designed a prospective randomized study to compare these two schemes with the goal of formulating a recommendation.

Materials and methods

Forty patients could be evaluated. In a crossover design, they were randomized to a CGO>BBO group and a BBO>CGO group, each starting out by wearing their dentures with the first occlusal scheme for 3 months, followed by a first investigator- and patient-centered assessment. Then, each patient was transitioned to the other occlusal scheme by replacing the denture setup in the dental laboratory, followed by another 3 months of intraoral use and a second assessment. Wilcoxon–Mann–Whitney and marginal homogeneity tests were used for statistical analysis.

Results

All statistically significant differences favored the CGO concept. Based on patient ratings, the CGO>BBO group preferred its esthetics (p = 0.02) and the BBO>CGO group its mandibular retention (p = 0.05), phonetics (p = 0.03), and masticatory function (p = 0.01). Based on investigator assessments, maxillary denture retention was found to significantly improve among the BBO>CGO patients after transition to CGO (p = 0.01).

Conclusions

Within the limitations of this study, canine guidance can be recommended as a comfortable alternative to bilateral balanced occlusion for complete dentures.

Clinical relevance

This recommendation can reduce the time requirements for the fabrication of complete dentures in dental laboratories.

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

Do dental bleaching agents induce genetic damage on oral mucosa cells?

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2VdU1bU

Pre-target alpha power predicts the speed of cued target discrimination

Publication date: 1 April 2019

Source: NeuroImage, Volume 189

Author(s): Nathan M. Petro, Nina N. Thigpen, Steven Garcia, Maeve R. Boylan, Andreas Keil

Abstract

The human visual system selects information from dense and complex streams of spatiotemporal input. This selection process is aided by prior knowledge of the features, location, and temporal proximity of an upcoming stimulus. In the laboratory, this knowledge is often conveyed by cues, preceding a task-relevant target stimulus. Response speed in cued selection tasks varies within and across participants and is often thought to index efficient selection of a cued feature, location, or moment in time. The present study used a reverse correlation approach to identify neural predictors of efficient target discrimination: Participants identified the orientation of a sinusoidal grating, which was presented in one hemifield following the presentation of bilateral visual cues that carried temporal but not spatial information about the target. Across different analytic approaches, faster target responses were predicted by larger alpha power preceding the target. These results suggest that heightened pre-target alpha power during a cue period may index a state that is beneficial for subsequent target processing. Our findings are broadly consistent with models that emphasize capacity sharing across time, as well as models that link alpha oscillations to temporal predictions regarding upcoming events.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2T8GV29

Decoding the meaning of unconsciously processed words using fMRI-based MVPA

Publication date: Available online 21 February 2019

Source: NeuroImage

Author(s): Usman Ayub Sheikh, Manuel Carreiras, David Soto

Abstract

Does the human brain elicit patterns of activity associated with the meaning of words in the absence of conscious awareness? Do such non-conscious semantic representations generalize across languages? This study aimed to address these questions using fMRI-based multivariate pattern analysis (MVPA) in a masked word paradigm. Animal and non-animal words were visually presented in two different languages (i.e. Spanish and Basque). Words were presented very briefly and were masked. On each trial, participants identified the semantic category and provided a visibility rating of the word. A support vector machine (SVM) was used to decode word category from multivoxel patterns of BOLD responses in seven canonical semantic regions of a left-lateralized network that were prespecified based on a previous meta-analysis. We show that the semantic category of non-conscious words (i.e. associated with null visual experience and chance-level discrimination performance) can be significantly decoded from BOLD response patterns. For Spanish, such discriminative patterns of BOLD responses were consistently found in inferior parietal lobe, dorsomedial prefrontal cortex, inferior frontal gyrus and posterior cingulate gyrus. While for Basque, these were found in ventromedial temporal lobe and posterior cingulate gyrus. All of the areas identified have previously been associated with semantic processing in studies involving animals-tools and animals-artifacts contrasts. In conscious trials, such patterns were found to be distributed over all seven regions of the semantic network in both Spanish and Basque. However, we found no evidence of across-language generalization. These results demonstrate that even in the absence of conscious awareness and lack of behavioural sensitivity to the words, putative semantic brain areas carry information related to the meanings of the words. The generalization of semantic representations across languages, however, may require deeper conscious semantic access.

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

Age-related differences in reallocating cognitive resources when dealing with interruptions

Publication date: Available online 21 February 2019

Source: NeuroImage

Author(s): Stefan Arnau, Edmund Wascher, Kristina Küper

Abstract

The ability to perform at a high level, even when the task at hand is interrupted by an unrelated secondary task, is central to human information processing. Executive control processes, in particular the reallocation of attentional resources, are crucial for coping with interruptions. Although the age-related decline in cognitive control functions is well described, the consequences of such changes for the ability to deal with interruptions are as of yet unclear. In the present study, we examined behavioral performance as well as electrophysiological parameters associated with executive control processes in older and younger participants using a nested task design: In one third of all trials, an ongoing working memory task was interrupted by a math task. We found that the impact of interruptions on primary task performance was more severe in the older age group. In the EEG, older adults showed stronger frontal midline theta activation and fronto-parietal connectivity in the theta range in response to the cue indicating the relevant attentional set. Younger participants, on the other hand, showed distinct and specific increases in cognitive control as indexed by frontal midline theta in response to the stimulus signaling an upcoming interruption. Overall, the results reveal strategic differences between the age groups, as older participants seem to prioritize the primary task more strongly. The data furthermore indicate that the combination of a rapid succession of events and the decreased ability to shift executive resources renders older adults' performance particularly vulnerable to the occurrence of interruptions.

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

Response time as a proxy of ongoing mental state: A combined fMRI and pupillometry study in Generalized Anxiety Disorder

Publication date: Available online 21 February 2019

Source: NeuroImage

Author(s): Elena Makovac, Sabrina Fagioli, David R. Watson, Frances Meeten, Jonathan Smallwood, Hugo D. Critchley, Cristina Ottaviani

Abstract

In Generalized Anxiety Disorder (GAD), fluctuations in ongoing thoughts (i.e., mind-wandering) often take the form of rigid and intrusive perseverative cognition, such as worry. Here, we sought to characterise the neural correlates of mind-wandering and perseverative cognition, alongside autonomic nervous system indices of central arousal, notably pupil dilation. We implemented a protocol incorporating the dynamic delivery of thought-probes within a functional neuroimaging task. Sixteen individuals with GAD and sixteen matched healthy controls (HC) underwent functional magnetic resonance imaging with concomitant pupillometry. Participants performed a series of low-demand tracking tasks, responding to occasional changes in a target stimulus. Such a task is typically accompanied by self-generated, off-task thinking. Thought-probes were triggered based on an individual's response time (RT) when responding to the change in the target. Subjective reports showed that long RT predicted off-task thinking/mind-wandering. Moreover, long RT and mind-wandering were also associated with larger pupil diameter. This effect was exaggerated in GAD patients during perseverative cognition. Within brain, during both pre-target periods and target events, there were distinct neural correlates for mind-wandering (e.g., anterior cingulate and paracingulate activation at target onset) and perseverative cognition (e.g., opposite patterns of activation in posterior cingulate and cerebellum at target onset in HC and GAD). Results suggest that not only attention systems but also sensory-motor cortices are important during off-task states. Interestingly, changes across the 'default mode network' also tracked fluctuations in pupillary size. Autonomic expression in pupillary changes mirror brain activation patterns that occur during different forms of repetitive thinking.

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

Real-time fMRI neurofeedback training to improve eating behavior by self-regulation of the dorsolateral prefrontal cortex: A randomized controlled trial in overweight and obese subjects

Publication date: Available online 21 February 2019

Source: NeuroImage

Author(s): Simon H. Kohl, Ralf Veit, Maartje S. Spetter, Astrid Günther, Andriani Rina, Michael Lührs, Niels Birbaumer, Hubert Preissl, Manfred Hallschmid

Abstract

Obesity is associated with altered responses to food stimuli in prefrontal brain networks that mediate inhibitory control of ingestive behavior. In particular, activity of the dorsolateral prefrontal cortex (dlPFC) is reduced in obese compared to normal-weight subjects and has been linked to the success of weight-loss dietary interventions. In a randomized controlled trial in overweight/obese subjects, we investigated the effect on eating behavior of volitional up-regulation of dlPFC activity via real-time functional magnetic resonance imaging (fMRI) neurofeedback training.

Thirty-eight overweight or obese subjects (BMI 25–40 kg/m²) took part in fMRI neurofeedback training with the aim of increasing activity of the left dlPFC (dlPFC group; n = 17) or of the visual cortex (VC/control group; n = 21). Participants were blinded to group assignment. The training session took place on a single day and included three training runs of six trials of up-regulation and passive viewing. Food appraisal and snack intake were assessed at screening, after training, and in a follow-up session four weeks later.

Participants of both groups succeeded in up-regulating activity of the targeted brain area. However, participants of the control group also showed increased left dlPFC activity during up-regulation. Functional connectivity between dlPFC and ventromedial PFC, an area that processes food value, was generally increased during up-regulation compared to passive viewing. At follow-up compared to baseline, both groups rated pictures of high-, but not low-calorie foods as less palatable and chose them less frequently. Actual snack intake remained unchanged but palatability and choice ratings for chocolate cookies decreased after training.

We demonstrate that one session of fMRI neurofeedback training enables individuals with increased body weight to up-regulate activity of the left dlPFC. Behavioral effects were observed in both groups, which might have been due to dlPFC co-activation in the control group and, in addition, unspecific training effects. Improved dlPFC-vmPFC functional connectivity furthermore suggested enhanced food intake-related control mechanisms. Neurofeedback training might support therapeutic strategies aiming at improved self-control in obesity, although the respective contribution of area-specific mechanisms and general regulation effects is in need of further investigation.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Tgikc5

Prospective clinical study of bilateral balanced occlusion (BBO) versus canine-guided occlusion (CGO) in complete denture wearers

Abstract

Objectives

Previous studies have often discussed occlusal concepts for complete dentures without formulating a recommendation. Various options are available, the most common ones being canine-guided occlusion (CGO) and bilateral balanced occlusion (BBO). We designed a prospective randomized study to compare these two schemes with the goal of formulating a recommendation.

Materials and methods

Forty patients could be evaluated. In a crossover design, they were randomized to a CGO>BBO group and a BBO>CGO group, each starting out by wearing their dentures with the first occlusal scheme for 3 months, followed by a first investigator- and patient-centered assessment. Then, each patient was transitioned to the other occlusal scheme by replacing the denture setup in the dental laboratory, followed by another 3 months of intraoral use and a second assessment. Wilcoxon–Mann–Whitney and marginal homogeneity tests were used for statistical analysis.

Results

All statistically significant differences favored the CGO concept. Based on patient ratings, the CGO>BBO group preferred its esthetics (p = 0.02) and the BBO>CGO group its mandibular retention (p = 0.05), phonetics (p = 0.03), and masticatory function (p = 0.01). Based on investigator assessments, maxillary denture retention was found to significantly improve among the BBO>CGO patients after transition to CGO (p = 0.01).

Conclusions

Within the limitations of this study, canine guidance can be recommended as a comfortable alternative to bilateral balanced occlusion for complete dentures.

Clinical relevance

This recommendation can reduce the time requirements for the fabrication of complete dentures in dental laboratories.

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

Do dental bleaching agents induce genetic damage on oral mucosa cells?

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2VdU1bU

“Return to play” after facial injuries: is it time for a consensus view?

Publication date: Available online 22 February 2019

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): M.J. Fardy

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Prevalence of pneumatization of the articular eminence and glenoid fossa viewed on cone-beam computed tomography examinations in a Turkish sample

Abstract

Objective

The aim of this study is to evaluate the prevalence of the pneumatization of the articular eminence and glenoid fossa (PAT and PGF, respectively) using cone-beam computed tomography (CBCT).

Methods

CBCT images of 1000 patients (511 females and 489 males) representing 2000 regions of interest (the glenoid fossa and articular eminence of each patient) were examined retrospectively with regard to age, gender, laterality, and type of pneumatization. The mean age of the female patients was 39.66 and that of males was 39.79. Suitable images from patients aged 16 years and over found in the archives of CBCT images were included in the study. The data were assessed using IBM SPSS 20 and statistical comparisons between two categorical variables were conducted using Chi square tests.

Results

It was observed that 14.7% of the patients had PAT and 47.1% had PGF. There was no significant difference in PAT and PGF prevalence between ages, age ranges, and gender in our study (p > 0.5).

Conclusions

It is important to evaluate the pneumatic cells in the articular eminence and glenoid fossa regions before surgery. It was also found that CBCT is more helpful in detecting pneumatization than plain film.

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“Return to play” after facial injuries: is it time for a consensus view?

Publication date: Available online 22 February 2019

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): M.J. Fardy

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First case of skin allergy to pregabalin with positive patch tests

A 51‐year‐old female patient was treated with Pregabalin (Lyrica) 25 mg/day for 3 weeks and 75 mg/day during a 4th week). After a month of treatment, a maculopular rash developed in the nape, neck, ears, arms knees and ankles which improved after the withdrawal of the drug and administration of deflazacort 30 mg for 5 days.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2U4KzYc

First case of skin allergy to pregabalin with positive patch tests

A 51‐year‐old female patient was treated with Pregabalin (Lyrica) 25 mg/day for 3 weeks and 75 mg/day during a 4th week). After a month of treatment, a maculopular rash developed in the nape, neck, ears, arms knees and ankles which improved after the withdrawal of the drug and administration of deflazacort 30 mg for 5 days.

This article is protected by copyright. All rights reserved.

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Implementation of the European Laryngological Society classification for pediatric benign laryngotracheal stenosis: a multicentric study

Abstract

Purpose

The European Laryngological Society (ELS) has published a revised classification for benign laryngotracheal stenosis (LTS), based on their degree, longitudinal extension, and associated comorbidities. We retrospectively applied this classification to pediatric patients treated in four referral centers to assess its reliability in predicting surgical outcomes.

Methods

We included 191 pediatric LTS patients treated by segmental resection, restaged according to the degree of stenosis (I–IV according to Myer–Cotton grading system), number of subsites involved ("a" to "d" for 1–4 subsites among supraglottis, glottis, subglottis and trachea), and presence of systemic comorbidity ("+" sign). We analyzed the ability of this scoring system in predicting the rates of decannulation and complications, as well as the number of re-treatments.

Results

The mean decannulation rate was 88%; a higher rate was observed in patients without comorbidities (95.7% vs. 78.1%, p < 0.001), with two or fewer vs. three or four subsites involved (89% vs. 72%, p < 0.01), and in those with an ELS score of IIIa+ or less vs. patients with IIIb or more (96% vs. 82%, p < 0.001). Surgical complications were not dependent on the degree of stenosis, but rather on the number of affected subsites (p < 0.05), as well as on the presence of associated comorbidities (RR 7.5, p < 0.01). The number of re-treatments was dependent on length of resection (p < 0.05), stage according to the revised ELS classification (p < 0.001), and presence of surgical complications (RR 17, p < 0.001).

Conclusions

The revised ELS classification system is easy to apply in everyday practice and offers a sound contribution in the decision-making process.

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

Implementation of the European Laryngological Society classification for pediatric benign laryngotracheal stenosis: a multicentric study

Abstract

Purpose

The European Laryngological Society (ELS) has published a revised classification for benign laryngotracheal stenosis (LTS), based on their degree, longitudinal extension, and associated comorbidities. We retrospectively applied this classification to pediatric patients treated in four referral centers to assess its reliability in predicting surgical outcomes.

Methods

We included 191 pediatric LTS patients treated by segmental resection, restaged according to the degree of stenosis (I–IV according to Myer–Cotton grading system), number of subsites involved ("a" to "d" for 1–4 subsites among supraglottis, glottis, subglottis and trachea), and presence of systemic comorbidity ("+" sign). We analyzed the ability of this scoring system in predicting the rates of decannulation and complications, as well as the number of re-treatments.

Results

The mean decannulation rate was 88%; a higher rate was observed in patients without comorbidities (95.7% vs. 78.1%, p < 0.001), with two or fewer vs. three or four subsites involved (89% vs. 72%, p < 0.01), and in those with an ELS score of IIIa+ or less vs. patients with IIIb or more (96% vs. 82%, p < 0.001). Surgical complications were not dependent on the degree of stenosis, but rather on the number of affected subsites (p < 0.05), as well as on the presence of associated comorbidities (RR 7.5, p < 0.01). The number of re-treatments was dependent on length of resection (p < 0.05), stage according to the revised ELS classification (p < 0.001), and presence of surgical complications (RR 17, p < 0.001).

Conclusions

The revised ELS classification system is easy to apply in everyday practice and offers a sound contribution in the decision-making process.

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An integrated in utero MR method for assessing structural brain abnormalities and measuring intracranial volumes in fetuses with congenital heart disease: results of a prospective case-control feasibility study

Abstract

Purpose

To refine methods that assess structural brain abnormalities and calculate intracranial volumes in fetuses with congenital heart diseases (CHD) using in utero MR (iuMR) imaging. Our secondary objective was to assess the prevalence of brain abnormalities in this high-risk cohort and compare the brain volumes with normative values.

Methods

We performed iuMR on 16 pregnant women carrying a fetus with CHD and gestational age ≥ 28-week gestation and no brain abnormality on ultrasonography. All cases had fetal echocardiography by a pediatric cardiologist. Structural brain abnormalities on iuMR were recorded. Intracranial volumes were made from 3D FIESTA acquisitions following manual segmentation and the use of 3D Slicer software and were compared with normal fetuses. Z scores were calculated, and regression analyses were performed to look for differences between the normal and CHD fetuses.

Results

Successful 2D and 3D volume imaging was obtained in all 16 cases within a 30-min scan. Despite normal ultrasonography, 5/16 fetuses (31%) had structural brain abnormalities detected by iuMR (3 with ventriculomegaly, 2 with vermian hypoplasia). Brain volume, extra-axial volume, and total intracranial volume were statistically significantly reduced, while ventricular volumes were increased in the CHD cohort.

Conclusion

We have shown that it is possible to perform detailed 2D and 3D studies using iuMR that allow thorough investigation of all intracranial compartments in fetuses with CHD in a clinically appropriate scan time. Those fetuses have a high risk of structural brain abnormalities and smaller brain volumes even when brain ultrasonography is normal.

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T Cells in Severe Childhood Asthma

Abstract

Severe asthma in children is a debilitating condition that accounts for a disproportionately large health and economic burden of asthma. Reasons for the lack of a response to standard anti‐inflammatory therapies remain enigmatic. Work in the last decade has shed new light on the heterogeneous nature of asthma, and the varied immunopathologies of severe disease, which are leading to new treatment approaches for the individual patient. However, most studies to date that explored the immune landscape of the inflamed lower airways have focused on adults. T cells are pivotal to the inception and persistence of inflammatory processes in the diseased lungs, despite a contemporary shift in focus to immune events at the epithelial barrier. This article outlines current knowledge on the types of T cells and related cell types that are implicated in severe asthma. The potential for environmental exposures and other inflammatory cues to condition the immune environment of the lung in early life to favor pathogenic T cells and steroid resistance is discussed. The contributions of T cells and their cytokines to inflammatory processes and treatment resistance are also considered, with an emphasis on new observations in children that argue against conventional type 1 and type 2 T‐cell paradigms. Finally, the ability for new technologies to revolutionize our understanding of T cells in severe childhood asthma, and to guide future treatment strategies that could mitigate this disease, is highlighted.

This article is protected by copyright. All rights reserved.

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The Impact of a GP‐led Community Paediatric Allergy Clinic: A Service Evaluation

Abstract

Background

The NHS is not meeting the nation's allergy needs. There are insufficient allergy specialists, with variable care across the country. General Practitioners (GPs) are lacking in allergy training. London's Whittington Hospital created a GP with Special Interest (GPwSI) community paediatric allergy clinic, running alongside pre‐existing hospital clinics, to address local unmet needs, aiming to provide equity for patients, improve patient experience and decrease secondary care burden.

Objectives

To establish whether improvements have occurred within the service by introducing a GPwSI‐led community paediatric allergy clinic alongside providing GP education and referral pathways. This study asks: 1: Have allergy‐related hospital attendances decreased with the provision of the community service? 2: Are patients seen in the appropriate clinic? 3: What proportion of patients require GPwSI follow‐up? 4: Is there good patient satisfaction? 5: Have allergy clinic waiting times changed?

Methods

Numbers of allergy‐related hospital attendances and waiting times in 2013, 2014 and 2016 were assessed. Data was analysed regarding proportions of patients requiring GPwSI follow‐up or referral from the GPwSI community clinic to hospital. Patient satisfaction was assessed.

Results

Since introducing the GPwSI community service the burden on secondary care has decreased, with reduced hospital attendances for allergy clinic patients, although waiting times have increased. In 2013, 65% of allergy clinic patients attended other hospital services for allergy‐related complaints prior to their first allergy clinic appointment. This was reduced to 27.3% (community) and 36.9% (hospital) in 2014 and maintained in 2016 (27.5% community and 37.5% hospital), p<0.01. Patient satisfaction in the hospital and community clinics is very high.

Clinical Relevance

This integrated, multidisciplinary paediatric allergy service could provide a model to improve the unmet allergy need both in the UK and beyond. This GPwSI model could also be applied to other chronic diseases in both adults and children, improving care beyond allergy.

This article is protected by copyright. All rights reserved.

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T Cells in Severe Childhood Asthma

Abstract

Severe asthma in children is a debilitating condition that accounts for a disproportionately large health and economic burden of asthma. Reasons for the lack of a response to standard anti‐inflammatory therapies remain enigmatic. Work in the last decade has shed new light on the heterogeneous nature of asthma, and the varied immunopathologies of severe disease, which are leading to new treatment approaches for the individual patient. However, most studies to date that explored the immune landscape of the inflamed lower airways have focused on adults. T cells are pivotal to the inception and persistence of inflammatory processes in the diseased lungs, despite a contemporary shift in focus to immune events at the epithelial barrier. This article outlines current knowledge on the types of T cells and related cell types that are implicated in severe asthma. The potential for environmental exposures and other inflammatory cues to condition the immune environment of the lung in early life to favor pathogenic T cells and steroid resistance is discussed. The contributions of T cells and their cytokines to inflammatory processes and treatment resistance are also considered, with an emphasis on new observations in children that argue against conventional type 1 and type 2 T‐cell paradigms. Finally, the ability for new technologies to revolutionize our understanding of T cells in severe childhood asthma, and to guide future treatment strategies that could mitigate this disease, is highlighted.

This article is protected by copyright. All rights reserved.

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The Impact of a GP‐led Community Paediatric Allergy Clinic: A Service Evaluation

Abstract

Background

The NHS is not meeting the nation's allergy needs. There are insufficient allergy specialists, with variable care across the country. General Practitioners (GPs) are lacking in allergy training. London's Whittington Hospital created a GP with Special Interest (GPwSI) community paediatric allergy clinic, running alongside pre‐existing hospital clinics, to address local unmet needs, aiming to provide equity for patients, improve patient experience and decrease secondary care burden.

Objectives

To establish whether improvements have occurred within the service by introducing a GPwSI‐led community paediatric allergy clinic alongside providing GP education and referral pathways. This study asks: 1: Have allergy‐related hospital attendances decreased with the provision of the community service? 2: Are patients seen in the appropriate clinic? 3: What proportion of patients require GPwSI follow‐up? 4: Is there good patient satisfaction? 5: Have allergy clinic waiting times changed?

Methods

Numbers of allergy‐related hospital attendances and waiting times in 2013, 2014 and 2016 were assessed. Data was analysed regarding proportions of patients requiring GPwSI follow‐up or referral from the GPwSI community clinic to hospital. Patient satisfaction was assessed.

Results

Since introducing the GPwSI community service the burden on secondary care has decreased, with reduced hospital attendances for allergy clinic patients, although waiting times have increased. In 2013, 65% of allergy clinic patients attended other hospital services for allergy‐related complaints prior to their first allergy clinic appointment. This was reduced to 27.3% (community) and 36.9% (hospital) in 2014 and maintained in 2016 (27.5% community and 37.5% hospital), p<0.01. Patient satisfaction in the hospital and community clinics is very high.

Clinical Relevance

This integrated, multidisciplinary paediatric allergy service could provide a model to improve the unmet allergy need both in the UK and beyond. This GPwSI model could also be applied to other chronic diseases in both adults and children, improving care beyond allergy.

This article is protected by copyright. All rights reserved.

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Prevalence of MRI-Detected Ankle Injuries in Athletes in the Rio de Janeiro 2016 Summer Olympics

Publication date: Available online 21 February 2019

Source: Academic Radiology

Author(s): Rafael Heiss, Ali Guermazi, Mohamed Jarraya, Lars Engebretsen, Thilo Hotfiel, Pedram Parva, Frank W. Roemer

Objective

To describe the prevalence, severity, and location of ankle injuries as assessed on magnetic resonance imaging (MRI) in athletes participating in the Rio de Janeiro 2016 Summer Olympic Games.

Methods

We analyzed all ankle MRIs that were acquired for suspected injury as reported by the National Olympic Committee medical teams and the Organizing Committee medical staff during the Rio 2016 Summer Olympics. Diagnostic imaging was performed through the Olympic Village Polyclinic. Images were interpreted retrospectively according to standardized criteria.

Results

A total of 11,274 athletes participated in the Games, of which 89 (8.8%) were referred for an ankle MRI. Eighty-eight of the 89 (99%) had at least 1 abnormal finding, and some had as many as 27, for an average of 6.2 abnormalities per examination. Around one-fifth of all abnormal findings were considered pre-existing (21%) and 79% were assumed to be the result of an acute or subacute injury. The highest proportion of acute/subacute injuries per athlete occurred in ball sports (7.0 injuries per examination) and in the age group >30. Most pre-existing findings per athlete were identified in the group of others (no track and field or ball sports athletes) with 2.5 findings per examination and respectively in the age group >30 (1.7).

Conclusion

Our study demonstrated a high prevalence of acute and subacute, but also pre-existing injuries in Olympic athletes undergoing ankle MRI. Tendon injuries were the most common acute injuries, found mainly in ball sports athletes. Most pre-existing ankle injuries were identified at the ligaments.

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Prevalence of MRI-Detected Ankle Injuries in Athletes in the Rio de Janeiro 2016 Summer Olympics

Publication date: Available online 21 February 2019

Source: Academic Radiology

Author(s): Rafael Heiss, Ali Guermazi, Mohamed Jarraya, Lars Engebretsen, Thilo Hotfiel, Pedram Parva, Frank W. Roemer

Objective

To describe the prevalence, severity, and location of ankle injuries as assessed on magnetic resonance imaging (MRI) in athletes participating in the Rio de Janeiro 2016 Summer Olympic Games.

Methods

We analyzed all ankle MRIs that were acquired for suspected injury as reported by the National Olympic Committee medical teams and the Organizing Committee medical staff during the Rio 2016 Summer Olympics. Diagnostic imaging was performed through the Olympic Village Polyclinic. Images were interpreted retrospectively according to standardized criteria.

Results

A total of 11,274 athletes participated in the Games, of which 89 (8.8%) were referred for an ankle MRI. Eighty-eight of the 89 (99%) had at least 1 abnormal finding, and some had as many as 27, for an average of 6.2 abnormalities per examination. Around one-fifth of all abnormal findings were considered pre-existing (21%) and 79% were assumed to be the result of an acute or subacute injury. The highest proportion of acute/subacute injuries per athlete occurred in ball sports (7.0 injuries per examination) and in the age group >30. Most pre-existing findings per athlete were identified in the group of others (no track and field or ball sports athletes) with 2.5 findings per examination and respectively in the age group >30 (1.7).

Conclusion

Our study demonstrated a high prevalence of acute and subacute, but also pre-existing injuries in Olympic athletes undergoing ankle MRI. Tendon injuries were the most common acute injuries, found mainly in ball sports athletes. Most pre-existing ankle injuries were identified at the ligaments.

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IL‐10 mRNA levels in whole blood cells correlate with house dust mite allergen immunotherapy efficacy

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Paired acute‐baseline serum tryptase levels in perioperative anaphylaxis: an observational study 97/100

Abstract

Background

Anaphylaxis is recognized mainly through clinical criteria, which may lack specificity or relevance in the perioperative setting. The transient increase in serum tryptase has been proposed since 1989 as a diagnostic tool. Sampling for well‐defined acute and baseline determinations has been recommended. We assessed the performance of four proposed algorithms with tightly controlled time frames for tryptase sampling, their robustness with inadequate sampling times, and the possible use of mature tryptase determination.

Methods

A retrospective study was performed on 102 adult patients from the Aix‐Marseille University Hospitals who had experienced a perioperative hypersensitivity reaction clinically suggesting anaphylaxis. EAACI and ICON criteria were used to diagnose anaphylaxis. Mature and total serum tryptase levels were measured.

Results

Based on EAACI guidelines, clinical diagnostic criteria for anaphylaxis were found in 76 patients and lacking in 26. The most effective algorithm was the international consensus recommendation of 2012 that acute total tryptase levels should be greater than [(1.2xbaseline tryptase) + 2] μg/L to be considered a clinically‐significant rise. In our cohort, this algorithm achieved 94% PPV, 53% NPV, 75% sensitivity, 86% specificity, and a Youden's index value of 0.61. A detectable acute mature tryptase level showed lower sensitivity, particularly in patients with acute total tryptase levels lower than 16 μg/L. Acute tryptase levels varied as a function of the clinical severity of anaphylaxis.

Conclusion

Total tryptase levels in serum discriminated between non‐anaphylactic and anaphylactic events in a perioperative setting when acute and baseline levels were collected and analyzed by the consensus algorithm.

This article is protected by copyright. All rights reserved.

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Lung disease in STAT3‐Hyper‐IgE‐Syndrome requires intense therapy

Abstract

Background

Pulmonary complications are responsible for high morbidity and mortality rates in patients with the rare immunodeficiency disorder STAT3 hyper‐IgE syndrome (STAT3‐HIES). The aim of this study was to expand knowledge about lung disease in STAT3‐HIES.

Methods

The course of pulmonary disease, radiological and histopathological interrelations, therapeutic management, and the outcome of 14 STAT3‐HIES patients were assessed.

Results

The patients' quality of life was compromised most by pulmonary disease. All 14 patients showed first signs of lung disease at a median onset of 1.5 years of age. Lung function revealed a mixed obstructive‐restrictive impairment with reduced FEV1 and FVC in 75% of the patients. The severity of lung function impairment was associated with Aspergillus fumigatus infection and prior lung surgery. Severe lung tissue damage, with reduced numbers of ABCA3 positive type II pneumocytes, was observed in the histological assessment of two deceased patients. Imaging studies of all patients above 6 years of age showed severe airway and parenchyma destruction. Lung surgeries frequently led to complications, including fistula formation. Long‐term antifungal and antibacterial treatment proved to be beneficial, as were inhalation therapy, chest physiotherapy, and exercise. Regular immunoglobulin replacement therapy tended to stabilize lung function.

Conclusions

Due to its severity, pulmonary disease in STAT3‐HIES patients requires strict monitoring and intensive therapy.

This article is protected by copyright. All rights reserved.

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IL‐10 mRNA levels in whole blood cells correlate with house dust mite allergen immunotherapy efficacy

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

Paired acute‐baseline serum tryptase levels in perioperative anaphylaxis: an observational study 97/100

Abstract

Background

Anaphylaxis is recognized mainly through clinical criteria, which may lack specificity or relevance in the perioperative setting. The transient increase in serum tryptase has been proposed since 1989 as a diagnostic tool. Sampling for well‐defined acute and baseline determinations has been recommended. We assessed the performance of four proposed algorithms with tightly controlled time frames for tryptase sampling, their robustness with inadequate sampling times, and the possible use of mature tryptase determination.

Methods

A retrospective study was performed on 102 adult patients from the Aix‐Marseille University Hospitals who had experienced a perioperative hypersensitivity reaction clinically suggesting anaphylaxis. EAACI and ICON criteria were used to diagnose anaphylaxis. Mature and total serum tryptase levels were measured.

Results

Based on EAACI guidelines, clinical diagnostic criteria for anaphylaxis were found in 76 patients and lacking in 26. The most effective algorithm was the international consensus recommendation of 2012 that acute total tryptase levels should be greater than [(1.2xbaseline tryptase) + 2] μg/L to be considered a clinically‐significant rise. In our cohort, this algorithm achieved 94% PPV, 53% NPV, 75% sensitivity, 86% specificity, and a Youden's index value of 0.61. A detectable acute mature tryptase level showed lower sensitivity, particularly in patients with acute total tryptase levels lower than 16 μg/L. Acute tryptase levels varied as a function of the clinical severity of anaphylaxis.

Conclusion

Total tryptase levels in serum discriminated between non‐anaphylactic and anaphylactic events in a perioperative setting when acute and baseline levels were collected and analyzed by the consensus algorithm.

This article is protected by copyright. All rights reserved.

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

Lung disease in STAT3‐Hyper‐IgE‐Syndrome requires intense therapy

Abstract

Background

Pulmonary complications are responsible for high morbidity and mortality rates in patients with the rare immunodeficiency disorder STAT3 hyper‐IgE syndrome (STAT3‐HIES). The aim of this study was to expand knowledge about lung disease in STAT3‐HIES.

Methods

The course of pulmonary disease, radiological and histopathological interrelations, therapeutic management, and the outcome of 14 STAT3‐HIES patients were assessed.

Results

The patients' quality of life was compromised most by pulmonary disease. All 14 patients showed first signs of lung disease at a median onset of 1.5 years of age. Lung function revealed a mixed obstructive‐restrictive impairment with reduced FEV1 and FVC in 75% of the patients. The severity of lung function impairment was associated with Aspergillus fumigatus infection and prior lung surgery. Severe lung tissue damage, with reduced numbers of ABCA3 positive type II pneumocytes, was observed in the histological assessment of two deceased patients. Imaging studies of all patients above 6 years of age showed severe airway and parenchyma destruction. Lung surgeries frequently led to complications, including fistula formation. Long‐term antifungal and antibacterial treatment proved to be beneficial, as were inhalation therapy, chest physiotherapy, and exercise. Regular immunoglobulin replacement therapy tended to stabilize lung function.

Conclusions

Due to its severity, pulmonary disease in STAT3‐HIES patients requires strict monitoring and intensive therapy.

This article is protected by copyright. All rights reserved.

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Pharmacologic Treatment of Insomnia in Children and Adolescents with Chronic Pain Conditions

Abstract

Purpose of Review

The purpose of this chapter is to provide a review and expert opinion supporting pharmacological treatments for insomnia in children and adolescents with chronic pain conditions.

Recent Findings

Insomnia as an independent disorder is defined as dissatisfaction with sleep quantity or quality, clinically significant distress or impairment in daytime functioning, and a specific time pattern of occurrence. Independent of the pathological context, insomnia is more frequent in adolescents than in children. The impact of insomnia on pediatric patients is quite profound, especially on those affected by chronic pain, where the prevalence of insomnia is significantly greater than in those without pain. Despite the intense effect of insomnia on physical, emotional, and cognitive health, as well as on the efficacy of interdisciplinary therapy, currently, there are no pharmacological guidelines for this population. Thus, the diagnosis and successful treatment of insomnia in children with chronic pain conditions often represent a significant challenge for clinicians.

Summary

The management of insomnia requires an interdisciplinary team that includes a physician, physiotherapist, and psychologist. Specific therapies for insomnia include sleep hygiene counseling, cognitive behavioral therapy, and pharmacological interventions. This review focuses exclusively on five successful pharmacological treatments for insomnia in children and adolescents with chronic pain conditions, and presents concepts and recommendations based on current medical evidence and the knowledge of medical experts in the field.

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When Children of the Anti-Vax Movement Want Immunizations: A Challenge for Pediatric Bioethics

by Craig Klugman, Ph.D. A teenager comes to a medical clinic and asks for an MMR vaccine. Although this particular vaccine is usually given at 12-15 months of age with a second dose at ages 4-6 years, this 16-year-old has never been vaccinated. His parents believe that vaccines cause autism* and are dangerous, therefore they have never vaccinated their children. In the age of the internet, the teen has done a lot of research and found that the science is conclusive: Vaccines are safe and beneficial (as long as you are not allergic to the ingredients).… (Source: blog.bioethics.net)

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

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

Pharmacologic Treatment of Insomnia in Children and Adolescents with Chronic Pain Conditions

Abstract

Purpose of Review

The purpose of this chapter is to provide a review and expert opinion supporting pharmacological treatments for insomnia in children and adolescents with chronic pain conditions.

Recent Findings

Insomnia as an independent disorder is defined as dissatisfaction with sleep quantity or quality, clinically significant distress or impairment in daytime functioning, and a specific time pattern of occurrence. Independent of the pathological context, insomnia is more frequent in adolescents than in children. The impact of insomnia on pediatric patients is quite profound, especially on those affected by chronic pain, where the prevalence of insomnia is significantly greater than in those without pain. Despite the intense effect of insomnia on physical, emotional, and cognitive health, as well as on the efficacy of interdisciplinary therapy, currently, there are no pharmacological guidelines for this population. Thus, the diagnosis and successful treatment of insomnia in children with chronic pain conditions often represent a significant challenge for clinicians.

Summary

The management of insomnia requires an interdisciplinary team that includes a physician, physiotherapist, and psychologist. Specific therapies for insomnia include sleep hygiene counseling, cognitive behavioral therapy, and pharmacological interventions. This review focuses exclusively on five successful pharmacological treatments for insomnia in children and adolescents with chronic pain conditions, and presents concepts and recommendations based on current medical evidence and the knowledge of medical experts in the field.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Td7mDO

When Children of the Anti-Vax Movement Want Immunizations: A Challenge for Pediatric Bioethics

by Craig Klugman, Ph.D. A teenager comes to a medical clinic and asks for an MMR vaccine. Although this particular vaccine is usually given at 12-15 months of age with a second dose at ages 4-6 years, this 16-year-old has never been vaccinated. His parents believe that vaccines cause autism* and are dangerous, therefore they have never vaccinated their children. In the age of the internet, the teen has done a lot of research and found that the science is conclusive: Vaccines are safe and beneficial (as long as you are not allergic to the ingredients).… (Source: blog.bioethics.net)

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

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Comparison of Bethesda cytopathology classification to surgical pathology across racial‐ethnic groups

Abstract

Background

The Bethesda System standardized the reporting of thyroid cytopathology and created categories to provide an estimation of a nodule's risk of malignancy. There are limited data describing their utility in different racial‐ethnic groups.

Methods

A retrospective chart review of thyroid fine‐needle aspirations (FNA) was performed within our health‐care systems. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPVs) were calculated for the total cohort, and racial‐ethnic groups.

Results

The sensitivity, specificity, PPV, and NPV of the entire cohort was 93%, 77%, 57%, and 97%. Among patients who underwent surgery, African Americans contained a high number of Bethesda II FNAs (63%) compared to Hispanics (48%) and whites (45%). The sensitivity, specificity, and NPV were comparable among groups, the PPV was lowest for African Americans (43%), followed by Hispanics (60%) and whites (69%).

Conclusions

The Bethesda system's predictive value may differ among racial‐ethnic groups.

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Comparison of Bethesda cytopathology classification to surgical pathology across racial‐ethnic groups

Abstract

Background

The Bethesda System standardized the reporting of thyroid cytopathology and created categories to provide an estimation of a nodule's risk of malignancy. There are limited data describing their utility in different racial‐ethnic groups.

Methods

A retrospective chart review of thyroid fine‐needle aspirations (FNA) was performed within our health‐care systems. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPVs) were calculated for the total cohort, and racial‐ethnic groups.

Results

The sensitivity, specificity, PPV, and NPV of the entire cohort was 93%, 77%, 57%, and 97%. Among patients who underwent surgery, African Americans contained a high number of Bethesda II FNAs (63%) compared to Hispanics (48%) and whites (45%). The sensitivity, specificity, and NPV were comparable among groups, the PPV was lowest for African Americans (43%), followed by Hispanics (60%) and whites (69%).

Conclusions

The Bethesda system's predictive value may differ among racial‐ethnic groups.

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Our experience of stapes superstructure and incudostapedial joint preservation in otosclerosis surgery

Abstract

Key points

•Preservation of the stapes anterior crus and incudostapedial joint can be considered an evolution of the stapedotomy technique, which itself has evolved from stapedectomy.

•This approach can be adopted as part of a 'reversal steps' stapedotomy.

•Removing the stapes superstructure is a surgical step associated with risk of footplate mobilization or fracture, and in selected cases may be avoided.

•We report an average hearing gain of 26dB when using this technique in 21 patients, compared to 28dB when using a conventional technique.

•Randomised studies would be necessary to demonstrate non‐inferiority of a stapes preservation stapedotomy technique.

This article is protected by copyright. All rights reserved.

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Our experience of stapes superstructure and incudostapedial joint preservation in otosclerosis surgery

Abstract

Key points

•Preservation of the stapes anterior crus and incudostapedial joint can be considered an evolution of the stapedotomy technique, which itself has evolved from stapedectomy.

•This approach can be adopted as part of a 'reversal steps' stapedotomy.

•Removing the stapes superstructure is a surgical step associated with risk of footplate mobilization or fracture, and in selected cases may be avoided.

•We report an average hearing gain of 26dB when using this technique in 21 patients, compared to 28dB when using a conventional technique.

•Randomised studies would be necessary to demonstrate non‐inferiority of a stapes preservation stapedotomy technique.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2T2d9fJ