Prokinetics prescribing in paediatrics: evidence on cisapride, domperidone, and metoclopramide.

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Prokinetics prescribing in paediatrics: evidence on cisapride, domperidone, and metoclopramide.

J Pediatr Gastroenterol Nutr. 2015 Apr;60(4):508-14

Authors: Mt-Isa S, Tomlin S, Sutcliffe A, Underwood M, Williamson P, Croft NM, Ashby D

Abstract
OBJECTIVES: Domperidone and metoclopramide are prokinetics commonly prescribed off-label to infants and younger children in an attempt to treat gastro-oesophageal reflux symptoms. Another prokinetic drug, cisapride, was used but withdrawn in 2000 in the United Kingdom because of serious arrhythmic adverse events. Medicines and Healthcare Products Regulatory Agency issued safety warnings for domperidone in May 2012 and restricted its indications. We report here national primary care prescribing trends and safety signals of these drugs in children.
METHODS: We used data from the General Practice Research Database between 1990 and 2006 for children <18 years. Descriptive statistics and Poisson regressions were performed to characterise prescribing trends. We examined safety signals in nested case-control studies.
RESULTS: The proportion of children <2 years old being prescribed one of the medications doubled during the study period. Prescriptions of domperidone increased 10-fold, mainly following the withdrawal of cisapride in 2000. Prescriptions of metoclopramide did not change significantly. Despite the increase in prescriptions of domperidone, no new safety signals were identified.
CONCLUSIONS: These data showed dramatic changes in prescribing of cisapride and domperidone despite the lack of good-quality supporting evidence. It is possible that these prescribing trends were influenced by published guidelines. Even if produced without robust efficacy and safety evidence, published guidelines can influence clinicians and consequently affect prescribing. Therefore, improving the evidence base on prokinetics to inform future guidelines is vital. The lack of new safety signals during this period would support the development of suitable powered clinical studies.

PMID: 25825854 [PubMed - indexed for MEDLINE]

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Dangerous liaisons? Gastroesophageal reflux disease and organizing pneumonia.

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Dangerous liaisons? Gastroesophageal reflux disease and organizing pneumonia.

Respiration. 2015;89(3):192-4

Authors: Drakopanagiotakis F

PMID: 25720852 [PubMed - indexed for MEDLINE]

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Gastroesophageal reflux disease is a risk factor for severity of organizing pneumonia.

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Gastroesophageal reflux disease is a risk factor for severity of organizing pneumonia.

Respiration. 2015;89(2):119-26

Authors: Gaillet G, Favelle O, Guilleminault L, de Muret A, Lemarie E, Lecomte T, Marchand-Adam S, Diot P

Abstract
BACKGROUND: The link between organizing pneumonia (OP) and gastroesophageal reflux disease (GERD) is not well known. There is little evidence in the literature to establish a causal link between GERD and OP.
OBJECTIVES: The aim of the study was to assess the hypothesis that OP is more severe when it is associated with GERD and that it leads to more frequent relapses.
METHODS: In a retrospective study on 44 patients suffering from OP, we compared the clinical, radiological and histological characteristics of 2 groups, 1 composed of patients with GERD (n = 20) and the other of patients without GERD (n = 24).
RESULTS: The GERD group was distinguished by a higher number of patients with migratory alveolar opacities on chest radiography and thoracic computerized tomography (14/20 vs. 9/24; p = 0.03 and 18/20 vs. 13/24; p = 0.01), greater hypoxemia [60 (42-80) vs. 70 (51-112) mm Hg; p = 0.03], greater bronchoalveolar lavage cellularity [0.255 (0.1-1.8) vs. 0.150 (0.05-0.4) g/l; p = 0.035] and more frequent relapses (14/20 vs. 9/24; p = 0.03).
CONCLUSIONS: OP associated with GERD is more severe and results in more frequent relapses. Microinhalation of gastric secretions might induce lung inflammation leading to OP and relapse. We suggest that typical symptoms of GERD such as pyrosis should be investigated in OP.

PMID: 25633753 [PubMed - indexed for MEDLINE]

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Treatment of aneurysmal aberrant right subclavian artery with triple-barrel stent graft.

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Treatment of aneurysmal aberrant right subclavian artery with triple-barrel stent graft.

Ann Vasc Surg. 2015 Apr;29(3):595.e1-3

Authors: Schwein A, Georg Y, Ohana M, Delay C, Lejay A, Thaveau F, Chakfe N

Abstract
Aneurysmal evolution of an aberrant right subclavian artery (ARSA) is an operative indication. Endovascular treatment is a minimally invasive procedure, which offers good short-term and midterm results. We describe a case of a 9-cm diameter ARSA aneurysm in a symptomatic man, treated with the triple-barrel technique using a thoracic aortic stent graft combined with surgical and endovascular revascularization of the supra-aortic trunks. Postoperatively, the patient developed a type III endoleak which was covered. The triple-barrel technique has been a proposed treatment approach for complex aortic arch pathologies and remains a less invasive option when compared with open surgery.

PMID: 25596407 [PubMed - indexed for MEDLINE]

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Hyperplasia of the submucosal glands of the columnar-lined oesophagus.

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Hyperplasia of the submucosal glands of the columnar-lined oesophagus.

Histopathology. 2015 Apr;66(5):726-31

Authors: Lörinc E, Öberg S

Abstract
AIM: To evaluate the presence of multi-layered epithelium (ME) and to compare the distribution, size and morphology of the oesophageal submucosal glands (SMG) beneath reflux exposed metaplastic columnar mucosa with those of normal squamous epithelium in patients with columnar-lined oesophagus (CLO).
METHODS AND RESULTS: In eight oesophageal resection specimens, the SMG of the metaplastic segments were significantly larger than those in the squamous segments of patients with CLO (0.81 versus 0.56 mm(2) , P = <0.001). There was an accumulation of SMG close to the neosquamocolumnar junction (NSCJ), as indicated by a higher median frequency of SMG (0.080 SMG/mm) compared with that of the squamous (0.013 SMG/mm) and metaplastic segments (0.031 SMG/mm) (P = 0.022). The frequency of ME was significantly higher in the metaplastic compared with the normal squamous segments (1/158 mm and 1/341 mm, respectively, P = 0.028) and ME was found almost exclusively (96%) in direct connection with the excretory ducts of SMG.
CONCLUSIONS: Hyperplasia of SMG in the metaplastic segment, accumulation of SMG near the NSCJ, the presence of ME in connection with the excretory ducts of SMG and metaplasia are all reflux-induced morphological changes, possibly induced by stimulation of progenitors in the excretory ducts of the SMG.

PMID: 25382111 [PubMed - indexed for MEDLINE]

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Cytoprotective effects of hydrogen sulfide in novel rat models of non-erosive esophagitis.

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Cytoprotective effects of hydrogen sulfide in novel rat models of non-erosive esophagitis.

PLoS One. 2014;9(10):e110688

Authors: Zayachkivska O, Havryluk O, Hrycevych N, Bula N, Grushka O, Wallace JL

Abstract
Non-erosive esophagitis is a chronic inflammatory condition of the esophagus and is a form of gastroesophageal reflux disease. There are limited treatment options for non-erosive esophagitis, and it often progresses to Barrett's esophagus and esophageal carcinoma. Hydrogen sulfide has been demonstrated to be a critical mediator of gastric and intestinal mucosal protection and repair. However, roles for H2S in esophageal mucosal defence, inflammation and responses to injury have not been reported. We therefore examined the effects of endogenous and exogenous H2S in rat models of non-erosive esophagitis. Mild- and moderate-severity non-erosive esophagitis was induced in rats through supplementation of drinking water with fructose, plus or minus exposure to water-immersion stress. The effects of inhibitors of H2S synthesis or of an H2S donor on severity of esophagitis was then examined, along with changes in serum levels of a pro- and an anti-inflammatory cytokine (IL-17 and IL-10, respectively). Exposure to water-immersion stress after consumption of the fructose-supplemented water for 28 days resulted in submucosal esophageal edema and neutrophil infiltration and the development of lesions in the muscular lamina and basal cell hyperplasia. Inhibition of H2S synthesis resulted in significant exacerbation of inflammation and injury. Serum levels of IL-17 were significantly elevated, while serum IL-10 levels were reduced. Treatment with an H2S donor significantly reduced the severity of esophageal injury and inflammation and normalized the serum cytokine levels. The rat models used in this study provide novel tools for studying non-erosive esophagitis with a range of severity. H2S contributes significantly to mucosal defence in the esophagus, and H2S donors may have therapeutic value in treating esophageal inflammation and injury.

PMID: 25333941 [PubMed - indexed for MEDLINE]

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Outcomes at one-year post anastomosis from a national cohort of infants with oesophageal atresia.

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Outcomes at one-year post anastomosis from a national cohort of infants with oesophageal atresia.

PLoS One. 2014;9(8):e106149

Authors: Allin B, Knight M, Johnson P, Burge D, BAPS-CASS

Abstract
BACKGROUND AND AIMS: We aimed to provide a contemporaneous assessment of outcomes at one-year post oesophageal atresia/tracheoesophageal fistula (OA-TOF) repair, focussing particularly on post-operative complications. It is generally accepted that oesophageal stricture is the most common complication and causes significant morbidity. We also aimed to assess the efficacy of prophylactic anti-reflux medication (PARM) in reducing stricture formation.
METHOD: A prospective, multi-centre cohort study of all infants live-born with oesophageal atresia in the United Kingdom and Ireland in 2008/9 was performed, recording clinical management and outcomes at one year. The effect of PARM on stricture formation in infants with the type-c anomaly was assessed using logistic regression analysis.
RESULTS: 151 infants were live-born with oesophageal atresia in the defined reporting period, 126 of whom had the type-c anomaly. One-year follow-up information was returned for 105 infants (70%); the mortality rate was 8.6% (95% CI 4.7-14.3%). Post-operative complications included anastomotic leak (5.4%), recurrent fistula (3.3%) and oesophageal stricture (39%). Seventy-six (60%) of those with type-c anomaly were alive at one-year with returned follow-up, 57(75%) of whom had received PARM. Of these, 24 (42%) developed a stricture, compared to 4 (21%) of those who had not received PARM (adjusted odds ratio 2.60, 95% CI 0.71-9.46, p = 0.147).
CONCLUSIONS: This study provides a benchmark for current outcomes and complication rates following OA-TOF repair, with oesophageal stricture causing significant morbidity. The use of PARM appeared ineffective in preventing strictures. This study creates enough doubt about the efficacy of PARM in preventing stricture formation to warrant further investigation of its use with a randomised controlled trial.

PMID: 25153838 [PubMed - indexed for MEDLINE]

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A distinct variant of papillary thyroid carcinoma indicating familial adenomatous polyposis (FAP): a case report and brief review.

A distinct variant of papillary thyroid carcinoma indicating familial adenomatous polyposis (FAP): a case report and brief review.

BMC Res Notes. 2015;8(1):795

Authors: Liyanapathirana N, Seneviratne SA, Samarasekera DN

Abstract
BACKGROUND: Familial adenomatous polyposis (FAP) is an autosomal dominantly inherited intestinal polyposis syndrome with an incidence of about 1/8300 births and accounts for about 1 % of all colorectal cancers. It has a spectrum of extra-intestinal manifestations including thyroid carcinoma which occur in 1-2 % of affected. The cribriform morular variant (CMV) is a rare but distinct histological subtype of papillary thyroid carcinoma (PTC) associated with FAP. Most of the reported cases describe the above entity in the background of well-established FAP. We report a case where both entities presenting simultaneously in a previously undiagnosed patient with FAP without a family history of polyposis.
CASE PRESENTATION: A 24 year old Asian female presented to the surgical clinic with a goitre of eight months duration and recent onset of altered bowel habits with features of anaemia. She was previously healthy and there was no family history of adenomatous polyposis, colorectal carcinoma or thyroid neoplasms. Colonoscopy revealed large bowel polyposis and fine needle aspiration of thyroid revealed a smear suspicious for malignancy. She underwent total thyroidectomy which revealed CMV PTC. Histology was characterized by a prominent cribriform pattern of growth with interspersed cell clusters arranged as morules along with papillary structures which are the key features of this subtype.
CONCLUSION: Diagnosis of CMV warrants ruling out of underlying FAP, irrespective of family history or gastrointestinal symptoms.

PMID: 26681171 [PubMed - in process]

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Neuroendocrine Tumor of the Pancreas as a Unique Manifestation of Cowden Syndrome: a Case Report.

Neuroendocrine Tumor of the Pancreas as a Unique Manifestation of Cowden Syndrome: a Case Report.

J Clin Endocrinol Metab. 2015 Dec 17;:jc20153684

Authors: Neychev V, Sadowski SM, Jack Z, Allgaeuer M, Kilian K, Meltzer P, Kebebew E

Abstract
CONTEXT: Germline mutations in the phosphatase and tensin homolog (PTEN) tumor suppressor gene are found in the majority of patients with Cowden syndrome (CS), who have an increased risk of breast, thyroid and endometrial cancer. According to our current understanding of genetic changes in the PTEN gene and the resultant phenotypic features of CS, pancreatic neuroendocrine tumors (NETs) are not considered part of the clinical spectrum of CS.
CASE DESCRIPTION: We report a unique case of an advanced NET of the pancreas in a patient with CS. The germline DNA sequencing confirmed the clinical diagnosis of CS and revealed a PTEN mutation c.697C→T (p.R233*) causing a premature stop codon in exon 7. The tumor DNA sequencing showed no LOH or any copy number changes, and no other deleterious genetic alterations including those commonly mutated in sporadic pancreatic NETs; MEN1, ATRX, DAXX, TP53, and genes involved in the mTOR pathway. In addition, the high-throughput transcriptome analyzed by RNA-seq did not reveal any missed genetic alterations, aberrant splicing variants, gene fusions or gene expression alterations. The IHC staining of the tumor for PTEN revealed an abnormal, uniformly strong cytoplasmic staining of tumor cells with virtually absent nuclear staining.
CONCLUSION: The results from genetic testing and histopathological techniques used to confirm CS diagnosis and characterize this unusual tumor tempted us to believe that in this case the pancreatic NET was not a sporadic malignancy that occurred by coincidence, but rather represented a new entity in the spectrum of malignancies associated with CS.

PMID: 26678657 [PubMed - as supplied by publisher]

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Mortality in Individuals Treated with Glucose Lowering Agents: a Large, Controlled Cohort Study.

Mortality in Individuals Treated with Glucose Lowering Agents: a Large, Controlled Cohort Study.

J Clin Endocrinol Metab. 2015 Dec 17;:jc20153184

Authors: Claesen M, Gillard P, De Smet F, Callens M, De Moor B, Mathieu C

Abstract
CONTEXT: Several observational studies and meta-analyses have reported increased mortality of patients taking sulfonylurea and insulin. The impact of patient profiles and concomitant therapies often remains unclear.
OBJECTIVE: To quantify survival of patients after starting glucose-lowering agents (GLAs) and compare it to control subjects, matched for risk profiles and concomitant therapies.
DESIGN: Retrospective controlled cohort study.
SETTING: The study is based on health expenditure records of the largest Belgian health mutual insurer, covering over 4.4 million people.
PATIENTS: 115,896 patients starting metformin, sulfonylurea or insulin (alone or in combination) between January 2003 and December 2007. Control subjects without GLA therapy were matched for age, gender, history of cardiovascular events and therapy with antihypertensives, statins and blood platelet aggregation inhibitors.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE: 5-year survival after start of GLA.
RESULTS: Profiles of patients using different GLAs varied, with patients on sulfonylurea being oldest and patients on insulin having more frequently a history of cardiovascular disease. Excess mortality differed across GLA therapies compared to matched controls without GLAs, even after adjusting for observable characteristics. Only metformin monotherapy was not associated with increased 5-year mortality compared to matched controls, while individuals on combination of sulfonylurea and insulin had highest mortality risks. Age and concomitant use of statins strongly affect survival.
CONCLUSIONS: Differences exist in 5-year survival of patients on GLA, at least partly driven by the risk profile of the individuals themselves. Metformin use was associated with lowest 5-year mortality risk and statins dramatically lowered 5-year mortality throughout all cohorts.

PMID: 26678656 [PubMed - as supplied by publisher]

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C-reactive protein as a new prognostic factor for survival in patients with pancreatic neuroendocrine neoplasia.

C-reactive protein as a new prognostic factor for survival in patients with pancreatic neuroendocrine neoplasia.

J Clin Endocrinol Metab. 2015 Dec 17;:jc20153114

Authors: Wiese D, Kampe K, Waldmann J, Heverhagen AE, Bartsch DK, Fendrich V

Abstract
CONTEXT: Patients with pancreatic neuroendocrine neoplasia (pNEN) show great variability in prognosis and treatment response. Additional prognostic markers might help in individual therapeutic decision making.
OBJECTIVE: To investigate the association between preoperative plasma levels of C-reactive protein (CRP) and overall survival (OS) in pNEN.
DESIGN: Single-center, retrospective analysis of long-term prospective patient-database.
SETTING: Tertiary referral center.
PATIENTS: All 149 patients with sporadic pNENs were eligible for retrospective analysis.
MAIN OUTCOME MEASURE: Cumulative overall survival, compared between patients with elevated and normal CRP levels.
RESULTS: Median OS for patients with elevated CRP levels was 1093 days (SE: 1261, 95%-CI: 0 - 3565), compared to 6859 days (SE: 1252, 95%-CI: 4405 - 9313) for patients with normal CRP levels. Log rank test showed a significant correlation between CRP and OS (P<0.001). In univariate Cox regression, patients with elevated CRP levels had a significantly higher hazard ratio for death (3.27; 95%-CI 1.74 - 6.16; P<0.001). This finding persisted after multivariable adjustment. Furthermore, OS was associated with presence of liver metastases (hazard ratio 3.17; 95%-CI 1.88 - 5.35; P<0.001), incomplete resection (R1/R2-Status; hazard ratio 3.99; 95%-CI 2.16 - 7.35; P<0.001) and Ki-67 percentage (hazard ratio 5.05; 95%-CI 2.17 - 11.76; P<0.001).
CONCLUSION: CRP is an independent prognostic marker in patients with pNEN. Pretreatment CRP measurements should be considered for incorporation into prospective studies of outcome in patients with pNENs and clinical trials of systemic therapies for these tumours.

PMID: 26678655 [PubMed - as supplied by publisher]

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The SPANK Block: A Selective Sensory, Single-Injection Solution for Posterior Pain After Total Knee Arthroplasty.

The SPANK Block: A Selective Sensory, Single-Injection Solution for Posterior Pain After Total Knee Arthroplasty.

Reg Anesth Pain Med. 2016 Jan-Feb;41(1):118-9

Authors: Kardash KJ, Noel GP

PMID: 26678763 [PubMed - in process]

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Revising the 2012 American Society of Regional Anesthesia and Pain Medicine Checklist for Local Anesthetic Systemic Toxicity: A Call to Resolve Ambiguity in Clinical Implementation.

Revising the 2012 American Society of Regional Anesthesia and Pain Medicine Checklist for Local Anesthetic Systemic Toxicity: A Call to Resolve Ambiguity in Clinical Implementation.

Reg Anesth Pain Med. 2016 Jan-Feb;41(1):117-8

Authors: Thompson BM

PMID: 26678762 [PubMed - in process]

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Block Performance and Risk Factors for Nerve Injury.

Block Performance and Risk Factors for Nerve Injury.

Reg Anesth Pain Med. 2016 Jan-Feb;41(1):117

Authors: Nelson T

PMID: 26678761 [PubMed - in process]

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Creating, and Protecting, the American Society of Regional Anesthesia and Pain Medicine's Intellectual Property.

Creating, and Protecting, the American Society of Regional Anesthesia and Pain Medicine's Intellectual Property.

Reg Anesth Pain Med. 2016 Jan-Feb;41(1):3-4

Authors: Neal JM, Stengel A, Huntoon MA

PMID: 26678760 [PubMed - in process]

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Local Anesthetic Systemic Toxicity (LAST): Not Gone, Hopefully Not Forgotten.

Local Anesthetic Systemic Toxicity (LAST): Not Gone, Hopefully Not Forgotten.

Reg Anesth Pain Med. 2016 Jan-Feb;41(1):1-2

Authors: Weinberg G, Barron G

PMID: 26678759 [PubMed - in process]

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Bone-impacted fibular free flap: Long-term dental implant success and complications compared to traditional fibular free tissue transfer.

Bone-impacted fibular free flap: Long-term dental implant success and complications compared to traditional fibular free tissue transfer.

Head Neck. 2015 Dec 17;

Authors: Barber BR, Dziegelewski PT, Chuka R, O'Connell D, Harris JR, Seikaly H

Abstract
BACKGROUND: The purpose of this study was to compare complications and dental implant success between the bone-impacted fibula free flap (BIFFF) and the traditional fibular free flap used in mandibular and midface reconstruction.
METHODS: Retrospective review of all patients undergoing BIFFF or traditional fibular free flap reconstruction from 2001 to 2009 was undertaken. Complications related to the BIFFF and traditional fibular free flap site of reconstruction were compared. Dental implant success rates for each type of flap were compared at 1-year intervals for 5 years.
RESULTS: One hundred fourteen patients underwent 81 BIFFFs and 35 traditional fibular free flaps. No significant difference in complications between BIFFF (20.9%) and traditional fibular free flap (25.7%) reconstruction was observed. Logistic regression analysis revealed only the site as a predictor of both single and multiple complications. At 5 years postimplantation, dental implant success rates were 95.5% and 77.1% for BIFFF and traditional fibular free flap, respectively (p = .006).
CONCLUSION: BIFFF reconstruction is a novel surgical technique that may improve long-term dental implant success rates with no additional risk of complications. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26681661 [PubMed - as supplied by publisher]

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Effect of training frequency on the learning curve on the da Vinci Skills Simulator.

Effect of training frequency on the learning curve on the da Vinci Skills Simulator.

Head Neck. 2015 Dec 17;

Authors: Walliczek U, Förtsch A, Dworschak P, Teymoortash A, Mandapathil M, Werner J, Güldner C

Abstract
BACKGROUND: The purpose of this study was to evaluate the effect of training on the performance outcome with the da Vinci Skills Simulator.
METHODS: Forty novices were enrolled in a prospective training curriculum. Participants were separated into 2 groups. Group 1 performed 4 training sessions and group 2 had 2 training sessions over a 4-week period. Five exercises were performed 3 times consecutively. On the last training day, a new exercise was added.
RESULTS: A significant skills gain from the first to the final practice day in overall performance, time to complete, and economy of motion was seen for both groups. Group 1 had a significantly better outcome in overall performance, time to complete, and economy of motion in all exercises. There was no significant difference found regarding the new exercise in group 1 versus group 2 in nearly all parameters.
CONCLUSION: Longer time distances between training sessions are assumed to play a secondary role, whereas total repetition frequency is crucial for improvement of technical performance. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26681572 [PubMed - as supplied by publisher]

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PRISM: Phase 2 trial with panitumumab monotherapy as second-line treatment in patients with recurrent or metastatic squamous cell carcinoma of the head and neck.

PRISM: Phase 2 trial with panitumumab monotherapy as second-line treatment in patients with recurrent or metastatic squamous cell carcinoma of the head and neck.

Head Neck. 2015 Dec 17;

Authors: Rischin D, Spigel DR, Adkins D, Wein R, Arnold S, Singhal N, Lee O, Murugappan S

Abstract
BACKGROUND: Panitumumab Regimen In Second-line Monotherapy of Head and Neck Cancer (PRISM) trial evaluated the safety and efficacy of panitumumab as second-line monotherapy in patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN).
METHODS: This was an open-label, single-arm, multicenter trial that enrolled patients with progressive disease or intolerance to first-line systemic chemotherapy for recurrent or metastatic SCCHN. Patients received panitumumab 9 mg/kg Q3W. The primary endpoint was overall response rate; secondary endpoints included disease control rate, overall survival (OS), progression-free survival (PFS), and safety.
RESULTS: The overall response rate was 4% (2 of 51 patients) and the disease control rate was 39% (20 of 51 patients). Median PFS was 1.4 months (95% confidence interval [CI] = 1.3-2.4 months). Median OS was 5.1 months (95% CI = 4.3-8.3 months). The most common adverse events were rash/dermatitis acneiform (69%), fatigue (33%), dry skin (21%), and hypomagnesemia (21%). There was one treatment-related death (angioedema).
CONCLUSION: Panitumumab monotherapy had limited activity in previously treated patients with recurrent or metastatic SCCHN. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26681429 [PubMed - as supplied by publisher]

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Tumor volume as a predictor of survival in human papillomavirus-positive oropharyngeal cancer.

Tumor volume as a predictor of survival in human papillomavirus-positive oropharyngeal cancer.

Head Neck. 2015 Dec 17;

Authors: Davis KS, Lim CM, Clump DA, Heron DE, Ohr JP, Kim S, Duvvuri U, Johnson JT, Ferris RL

Abstract
BACKGROUND: Increasing evidence exists that tumor volume may be a superior prognostic model than traditional TNM staging. It has been observed that oropharyngeal squamous cell carcinoma (oropharyngeal SCC) in the setting of human papillomavirus (HPV) positivity have a greater propensity for cystic nodal metastases, and, thus, presumably larger volume with relatively smaller primary tumors. The influence of HPV status on the predictive value of tumor volume is unknown.
METHODS: Fifty-three patients with HPV-positive oropharyngeal SCC were treated with definitive chemotherapy and intensity-modulated radiotherapy (IMRT).
RESULTS: The estimated 2-year overall survival (OS) and disease-free survival (DFS) was 92.2% and 83.6%, respectively. Nodal classification did not predict OS (p = .096) or DFS (p = .170). Similarly, T classification did not predict OS (p = .057) or DFS (p = .309). Lower nodal volume was associated with greater DFS (p = .001).
CONCLUSION: Nodal tumor volume was found to be predictive of DFS. DFS was best predicted by nodal gross tumor volume (GTV) at 24 months. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26681273 [PubMed - as supplied by publisher]

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Lateral bracing of the tongue during the onset phase of alveolar stops: an EPG study.

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Lateral bracing of the tongue during the onset phase of alveolar stops: an EPG study.

Clin Linguist Phon. 2015 Mar;29(3):236-45

Authors: Lee A, Gibbon FE, Oebels J

Abstract
Although raising the sides of the tongue to form a seal with the palate and upper teeth--lateral bracing--plays a key role in controlling airflow direction, providing overall tongue stability and building up oral pressure during alveolar consonant production, details of this articulatory gesture remain poorly understood. This study examined the dynamics of lateral bracing during the onset of alveolar stops /t/, /d/, /n/ produced by 15 typical English-speaking adults using electropalatography. Percent tongue palate contact in the lateral regions over a 150-ms period from the preceding schwa to stop closure was measured. Rapid rising of the sides of the tongue from the back towards the front during the 50-ms period before closure was observed, with oral stops showing significantly more contact than nasal stops. This feature corresponds to well-documented formant transitions detectable from acoustic analysis. Possible explanations for increased contact for oral stops and clinical implications are discussed.

PMID: 25495013 [PubMed - indexed for MEDLINE]

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Effects of aging on the neuromagnetic mismatch detection to speech sounds.

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Effects of aging on the neuromagnetic mismatch detection to speech sounds.

Biol Psychol. 2015 Jan;104:48-55

Authors: Cheng CH, Baillet S, Hsiao FJ, Lin YY

Abstract
The ability to discriminate speech sounds is crucial for higher language functions in humans. However, it remains unclear whether physiological aging affects the functional integrity of pre-attentive phonological discrimination. The neuromagnetic cortical responses during automatic change detection of speech sounds (/ba/versus/da/) were recorded in 24 young and 21 aged male adults. We used minimum norm estimate of source reconstruction to characterize the spatiotemporal dynamics of magnetic mismatch responses (MMNm). Distributed activations to phonetic changes were identified in the temporal, frontal and parietal regions. Compared to younger participants, elderly volunteers exhibited a significant reduction of cortical responses to phonetic-MMNm, except for the left orbitofrontal cortex and anterior inferior temporal gyrus. However, among the identified regions of interest, we did not observe significant between-group differences in the hemispheric asymmetry of phonetic-MMNm. Conclusively, our results suggest an altered phonetic processing at the perceptual level during physiological aging.

PMID: 25451380 [PubMed - indexed for MEDLINE]

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Perceived articulatory precision in patients with Parkinson's disease after deep brain stimulation of subthalamic nucleus and caudal zona incerta.

Related Articles

Perceived articulatory precision in patients with Parkinson's disease after deep brain stimulation of subthalamic nucleus and caudal zona incerta.

Clin Linguist Phon. 2015 Feb;29(2):150-66

Authors: Eklund E, Qvist J, Sandström L, Viklund F, Van Doorn J, Karlsson F

Abstract
The effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) and caudal zona incerta (cZi) on speech articulation in patients with Parkinson's disease (PD) was investigated. Read speech samples were collected from nine patients with STN-DBS and 10 with cZi-DBS. The recordings were made pre-operatively and 12 months post-operatively with stimulator on and off (on medication). Blinded, randomised, repeated perceptual assessments were performed on words and isolated fricatives extracted from the recordings to assess (1) overall articulatory quality ratings, (2) frequency of occurrence of misarticulation patterns and (3) fricative production. Statistically significant worsening of articulatory measures on- compared with off-stimulation occurred in the cZi-DBS group, with deteriorated articulatory precision ratings, increased presence of misarticulations (predominately altered realisations of plosives and fricatives) and a reduced accuracy in fricative production. A similar, but not significant, trend was found for the STN-DBS group.

PMID: 25333411 [PubMed - indexed for MEDLINE]

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Optic nerve sheath diameters in healthy adults measured by computer tomography.

Optic nerve sheath diameters in healthy adults measured by computer tomography.

Int J Ophthalmol. 2015;8(6):1240-4

Authors: Vaiman M, Abuita R, Bekerman I

Abstract
AIM: To measure optic nerve sheath diameters (ONSD) in different locations by computer tomography (CT) and to recommend the best location for cases when ONSD is used for intracranial pressure monitoring.
METHODS: In a prospective cohort study, CT data of 300 healthy adults were analyzed (600 eyes). In all cases, the CT investigation was performed at the Emergency Department because of the various conditions that proved not to be connected with ophthalmological or neurological pathology. The ONSD were measured at 3 mm and 8 mm distance from the globe, and 3 mm from the anterior opening of the optic canal. The correlation analysis was performed with gender, age, and ethnic background.
RESULTS: The right/left ONSD are 4.94±1.51/5.17±1.34 mm at 3 mm, 4.35±0.76/4.45±0.62 mm at 8 mm from the globe, and 3.55±0.82/3.65±0.7 mm at 3 mm from the optic canal. No significant differences correlated with gender of the patients, their age, and ethnic background were found.
CONCLUSION: In healthy persons, the ONSD varies from 5.17±1.34 mm to 3.55±0.82 mm in different locations within the intraorbital space. The most stable results with lesser standard deviation can be obtained if it is measured 8-10 mm from the globe.

PMID: 26682181 [PubMed]

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The Prevalence of High-Riding Jugular Bulb in Patients with Suspected Endolymphatic Hydrops.

The Prevalence of High-Riding Jugular Bulb in Patients with Suspected Endolymphatic Hydrops.

J Neurol Surg B Skull Base. 2015 Dec;76(6):471-4

Authors: Brook CD, Buch K, Kaufmann M, Sakai O, Devaiah AK

Abstract
Background To determine the prevalence of a high-riding jugular bulb (HRJB) in the endolymphatic hydrops population. Methods This was a retrospective chart and radiology review of patients seen at a tertiary care medical center. Patients were identified using the International Classification of Diseases, 9th edition, code 386.xx (Meniere disease-unspecified), and were required to have undergone an imaging study that included views of the jugular bulb that were available for review. A radiologist then evaluated all of the imaging studies for evidence of HRJB or inner ear dehiscence with a jugular bulb abnormality. Results The prevalence of a HRJB in all endolymphatic hydrops patients was 9.0% (7 of 78), and it was 4.5% (7 of 156) in all ears. The prevalence of HRJB ipsilateral to an ear with endolymphatic hydrops was 4.6% (4 of 88 ears); it was 4.4% (3 of 68 ears) in ears without endolymphatic hydrops. The incidence of inner ear dehiscence with a HRJB was 1.3% (1 of 78). Electrocochleography results were not correlated with jugular bulb volume. Discussion The results of this study indicate that a small subset of patients treated for endolymphatic hydrops patients have a HRJB. Overall, these results suggest that HRJB does not play a major role in endolymphatic hydrops, although it may play a role in a few isolated patients.

PMID: 26682126 [PubMed]

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Variability of the Middle Meningeal Artery Subject to the Shape of Skull.

Variability of the Middle Meningeal Artery Subject to the Shape of Skull.

J Neurol Surg B Skull Base. 2015 Dec;76(6):451-8

Authors: Kornieieva M, Hadidy A, Zhuravlova I

Abstract
Objectives Endovascular embolization of the middle meningeal artery (MMA) is currently considered one of the basic methods to treat acute bleeding and a posttraumatic aneurysm. The present research correlates the morphological characteristics of the MMA with individual skull shape. Design A prospective cohort study. Setting Hospital of University of Jordan (Amman, Jordan) from 2012 to 2013. Participants A total of 50 patients without known vascular pathology in the carotid system underwent routine magnetic resonance angiography examination of the head and neck. Main Outcome Measures The length and outer diameter of extracranial, intraosseous, and intracranial segments of the MMA were measured in patients with dolichocephalic, mesocephalic, and brachycephalic types of skulls. Results The brachycephalic patients have the most inauspicious anatomical precondition for endovascular intervention of the MMA due to the narrowest lumen of the vessel, high probability of a tortuous extracranial part, and pronounced inflexion at the transmission of the intraosseous segment to the intracranial one. Conclusions The morphological characteristics of the MMA have a close correlation with individual skull shape.

PMID: 26682123 [PubMed]

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The Reverse-Flow Facial Artery Buccinator Flap for Skull Base Reconstruction: Key Anatomical and Technical Considerations.

The Reverse-Flow Facial Artery Buccinator Flap for Skull Base Reconstruction: Key Anatomical and Technical Considerations.

J Neurol Surg B Skull Base. 2015 Dec;76(6):432-9

Authors: Farzal Z, Lemos-Rodriguez AM, Rawal RB, Overton LJ, Sreenath SB, Patel MR, Zanation AM

Abstract
Objective To highlight key anatomical and technical considerations for facial artery identification, and harvest and transposition of the facial artery buccinator (FAB) flap to facilitate its future use in anterior skull base reconstruction. Only a few studies have evaluated the reverse-flow FAB flap for skull base defects. Design Eight FAB flaps were raised in four cadaveric heads and divided into thirds; the facial artery's course at the superior and inferior borders of the flap was measured noting in which incisional third of the flap it laid. The flap's reach to the anterior cranial fossa, sella turcica, clival recess, and contralateral cribriform plate were studied. A clinical case and operative video are also presented. Results The facial artery had a near vertical course and stayed with the middle (⅝) or posterior third (⅜) of the flap in the inferior and superior incisions. Seven of eight flaps covered the sellar/planar regions. Only four of eight flaps covered the contralateral cribriform region. Lastly, none reached the middle third of the clivus. Conclusions The FAB flap requires an understanding of the facial artery's course, generally seen in the middle third of the flap, and is an appropriate alternative for sellar/planar and ipsilateral cribriform defects.

PMID: 26682122 [PubMed]

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Optimization of chitosan nanoparticles for colon tumors using experimental design methodology.

Optimization of chitosan nanoparticles for colon tumors using experimental design methodology.

Artif Cells Nanomed Biotechnol. 2015 Dec 17;:1-10

Authors: Jain A, Jain SK

Abstract
Purpose Colon-specific drug delivery systems (CDDS) can improve the bio-availability of drugs through the oral route. A novel formulation for oral administration using ligand coupled chitosan nanoparticles bearing 5-Flurouracil (5FU) encapsulated in enteric coated pellets has been investigated for CDDS. Method The effect of polymer concentration, drug concentration, stirring time and stirring speed on the encapsulation efficiency, and size of nanoparticles were evaluated. The best (or optimum) formulation was obtained by response surface methodology. Using the experimental data, analysis of variance has been carried out to evolve linear empirical models. Using a new methodology, polynomial models have been evolved and the parametric analysis has been carried out. In order to target nanoparticles to the hyaluronic acid (HA) receptors present on colon tumors, HA coupled nanoparticles were tested for their efficacy in vivo. The HA coupled nanoparticles were encapsulated in pellets and were enteric coated to release the drug in the colon. Results Drug release studies under conditions of mimicking stomach to colon transit have shown that the drug was protected from being released in the physiological environment of the stomach and small intestine. The relatively high local drug concentration with prolonged exposure time provides a potential to enhance anti-tumor efficacy with low systemic toxicity for the treatment of colon cancer. Conclusions Conclusively, HA coupled nanoparticles can be considered as the potential candidate for targeted drug delivery and are anticipated to be promising in the treatment of colorectal cancer.

PMID: 26678861 [PubMed - as supplied by publisher]

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[Fertility sparing treatment in women affected by cervical cancer larger than 2cm].

[Fertility sparing treatment in women affected by cervical cancer larger than 2cm].

Bull Cancer. 2015 Dec 8;

Authors: Estevez JP, Hequet D, Dubot C, Fourchotte V, De La Motte Rouge T, Becette V, Rouzier R

Abstract
OBJECTIVE: We report our experience on fertility sparing treatment in young women affected by cervical cancer of more than 2cm.
METHODS: Between July 2012 and February 2014, five patients presenting cervical tumors larger than 2cm (IB1>2cm) (23-35) and wishing to preserve fertility have been treated at our institution. Laparoscopic pelvic and para-aortic lymphadenectomy was performed for all patients. When lymph nodes were free of disease, patients had neoadjuvant chemotherapy followed by surgical conservative treatment.
RESULTS: Four patients underwent a cisplatin based neoadjuvant chemotherapy before conservative surgery: radical trachelectomy or simple trachelectomy. One patient with nodal involvement underwent a 3cycle chemotherapy followed by concurrent radiochemotherapy. Hematologic toxicity grade 3 was observed in one patient leading to a change of chemotherapy. Two patients showed complete disappearance of tumor and two a partial response to neoadjuvant treatment. After a mean follow up of 20.5months (14-33), no relapse was observed. To date, no pregnancy was obtained.
CONCLUSION: Lymph node staging followed by neoadjuvant chemotherapy and radical trachelectomy seems to be a promising treatment scheme for patients with cervical tumors IB1>2cm pN0 seeking parenthood.

PMID: 26681641 [PubMed - as supplied by publisher]

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[Qualitative and collaborative research with cancer patients. Experience narratives of treatments for peritoneal carcinomatosis].

[Qualitative and collaborative research with cancer patients. Experience narratives of treatments for peritoneal carcinomatosis].

Bull Cancer. 2015 Dec 8;

Authors: Durif-Bruckert C, Guilloux R, Guïoux A, Lasserre E, Goffette J, Régnier V

Abstract
This CORCAN study is concerned with the way patients hospitalised for peritoneal carcinosis perceive surgical treatment and hyperthermic intraperitoneal chemotherapy (HIPEC).
OBJECTIVES: (1) To identify and analyse, using concepts of social representation and accounts of the illness, characteristics of the way this treatment is experienced; (2) to inform doctors and healthcare workers about patients' representations, with a view to adjusting the treatment, the care and the information given to patients.
METHODOLOGY: Fifty-eight directive and nondirective interviews were conducted longitudinally with 21 patients (13 women and 7 men) hospitalised for treatment by cell killing and HIPEC.
RESULTS: Five important elements of concern were raised and discussed by the patients at different stages of the disease, then reported and discussed with the doctors and healthcare workers. These were patients' experiences of: the hyperthermic intraperitoneal chemotherapy (HIPEC), randomisation, intensive care, the effects of surgery on the digestive system, reorganising their diet, and returning home.

PMID: 26681640 [PubMed - as supplied by publisher]

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[In Process Citation].

[In Process Citation].

Bull Cancer. 2015 Dec;102(12):961

Authors: La rédaction

PMID: 26679035 [PubMed - in process]

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The Pipeline Embolization Device: Long-term outcome data flows in.

The Pipeline Embolization Device: Long-term outcome data flows in.

World Neurosurg. 2015 Dec 8;

Authors: McDowell MM, Feroze RA, Ducruet AF

PMID: 26679263 [PubMed - as supplied by publisher]

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SEEG, Happy Anniversary!

SEEG, Happy Anniversary!

World Neurosurg. 2015 Dec 8;

Authors: Cardinale F, González-Martínez J, Lo Russo G

PMID: 26679262 [PubMed - as supplied by publisher]

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Epistemology and Brain Arteriovenous Malformations.

Epistemology and Brain Arteriovenous Malformations.

World Neurosurg. 2015 Dec 8;

Authors: Ecker R

PMID: 26679261 [PubMed - as supplied by publisher]

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Primary intracranial epidermoid carcinoma with diffuse leptomeningeal carcinomatosis: Report of two cases.

Primary intracranial epidermoid carcinoma with diffuse leptomeningeal carcinomatosis: Report of two cases.

World Neurosurg. 2015 Dec 8;

Authors: Raheja A, Eli IM, Bowers CA, Palmer CA, Couldwell WT

Abstract
BACKGROUND: Malignant degeneration of epidermoid cyst (EC) with accompanying leptomeningeal carcinomatosis (LC) at presentation is extremely rare. We add two cases to the literature, including the first case of primary brainstem involvement with simultaneous diffuse LC, and discuss clinical and radiological cues to differentiate benign and malignant epidermoid tumors for early diagnosis.
CASE DESCRIPTION: A 54-year-old woman presented with recurrent aseptic meningitis and hydrocephalus. Imaging revealed a pre- and parapontine extra-axial EC with an intra-axial brainstem ring-enhancing cystic lesion, diffuse leptomeningeal enhancement, and intradural extramedullary nodular deposits throughout the spine. Surgical decompression of the cysts confirmed the diagnosis of invasive primary squamous cell carcinoma (SCC) of the brainstem and benign epidermoid tumor of the cerebellopontine cistern. The second patient was a 37-year-old woman with extensive left-sided cranial neuropathies. Imaging revealed pre- and parapontine enhancing and non-enhancing deposits along multiple cranial nerves and diffuse leptomeningeal nodular enhancement in the thoracolumbar spine. A biopsy confirmed the diagnosis of infiltrative poorly differentiated carcinoma adjacent to a benign EC. Both patients had systemic screening to rule out metastatic disease.
CONCLUSIONS: These cases illustrate that a high index of clinical suspicion is necessary for early diagnosis of disseminated disease in cases of recurrent episodes of aseptic meningitis. In cases of primary benign EC, aggressive resection should be attempted to reduce the risk of malignant degeneration. Separate biopsy from the enhancing portion of the tumor is used to rule out an underlying coexisting malignancy. Multimodal management carries the best prognosis for primary intracranial SCC with LC.

PMID: 26679260 [PubMed - as supplied by publisher]

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Flow diverters for Treatment of Intracranial Aneurysms: Technical and Clinical Updates.

Flow diverters for Treatment of Intracranial Aneurysms: Technical and Clinical Updates.

World Neurosurg. 2015 Dec 8;

Authors: Amuluru K, Al-Mufti F, Singh PI, Prestigiacomo C, Gandhi C

PMID: 26679259 [PubMed - as supplied by publisher]

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Neuroinflammation after Subarachnoid Hemorrhage: A consolidated theory?

Neuroinflammation after Subarachnoid Hemorrhage: A consolidated theory?

World Neurosurg. 2015 Dec 8;

Authors: Welling LC, Welling MS, Teixeira MJ, Figueiredo EG

PMID: 26679258 [PubMed - as supplied by publisher]

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Evaluation of a wireless audio streaming accessory to improve mobile telephone performance of cochlear implant users.

Evaluation of a wireless audio streaming accessory to improve mobile telephone performance of cochlear implant users.

Int J Audiol. 2016 Feb;55(2):75-82

Authors: Wolfe J, Morais Duke M, Schafer E, Cire G, Menapace C, O'Neill L

Abstract
OBJECTIVE: The objective of this study was to evaluate the potential improvement in word recognition in quiet and in noise obtained with use of a Bluetooth-compatible wireless hearing assistance technology (HAT) relative to the acoustic mobile telephone condition (e.g. the mobile telephone receiver held to the microphone of the sound processor).
DESIGN: A two-way repeated measures design was used to evaluate differences in telephone word recognition obtained in quiet and in competing noise in the acoustic mobile telephone condition compared to performance obtained with use of the CI sound processor and a telephone HAT.
STUDY SAMPLE: Sixteen adult users of Nucleus cochlear implants and the Nucleus 6 sound processor were included in this study.
RESULTS: Word recognition over the mobile telephone in quiet and in noise was significantly better with use of the wireless HAT compared to performance in the acoustic mobile telephone condition. Word recognition over the mobile telephone was better in quiet when compared to performance in noise.
CONCLUSIONS: The results of this study indicate that use of a wireless HAT improves word recognition over the mobile telephone in quiet and in noise relative to performance in the acoustic mobile telephone condition for a group of adult cochlear implant recipients.

PMID: 26681229 [PubMed - in process]

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Dietary habits and hearing.

Related Articles

Dietary habits and hearing.

Int J Audiol. 2015 Feb;54 Suppl 1:S53-6

Authors: Rosenhall U, Idrizbegovic E, Hederstierna C, Rothenberg E

Abstract
UNLABELLED: Abstract Objective: Study groups from three age cohorts of 70-75 year-olds were investigated to search for possible correlations between dietary habits and auditory function.
DESIGN: A cross-sectional, epidemiological study.
STUDY SAMPLE: A total number of 524 people (275 women, 249 men) were recruited from three age cohorts. The study sample was representative of the general population. All participants answered a diet history and were tested with pure-tone audiometry. Eleven categories of food consumption were related to pure-tone averages of low-mid frequency hearing, and high frequency hearing.
RESULTS: Two consistent correlations between diet and hearing were observed. One was a correlation between good hearing and a high consumption of fish in the male group. The other was a correlation between poor high frequency hearing and a high consumption of food rich in low molecular carbohydrates in both genders; a larger effect size was seen in females.
CONCLUSIONS: The study indicates that diet is important for aural health in aging. According to this study fish is beneficial to hearing, whereas consumption of "junk food", rich in low molecular carbohydrates, is detrimental. Other correlations, e.g. between high consumption of antioxidants, were not demonstrated here, but cannot be excluded.

PMID: 25549171 [PubMed - indexed for MEDLINE]

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Lifelong occupational exposures and hearing loss among elderly Latino Americans aged 65-75 years.

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Lifelong occupational exposures and hearing loss among elderly Latino Americans aged 65-75 years.

Int J Audiol. 2015 Feb;54 Suppl 1:S57-64

Authors: Hong O, Chin DL, Kerr MJ

Abstract
OBJECTIVE: The purpose of this study is to determine the relationship between occupational exposures and hearing among elderly Latino Americans.
DESIGN: A descriptive, correlational design used for this secondary analysis with the data from the Sacramento Area Latino Study of Aging (SALSA).
STUDY SAMPLE: A total of 547 older adults were included.
RESULTS: A majority of participants (58%) reported occupational exposures to loud noise and/or ototoxic chemicals. About 65% and over 90% showed hearing loss at low and high frequencies, respectively. Participants with occupational exposure to loud noise and/or ototoxic chemicals were, significantly, two times more likely to have hearing loss at high frequencies compared to those without exposure (OR = 2.29; 95% CI: 1.17 = 4.51, p = .016), after controlling for other risk factors of hearing loss such as age, gender, household income, current smoking, and diabetes. However, lifelong occupational exposure was not significantly associated with hearing loss at low frequencies (OR = 1.43; 95% CI: 0.94 = 2.18, p = .094).
CONCLUSION: Lifelong occupational exposure to loud noise and/or ototoxic chemicals was significantly associated with hearing loss among elderly Latino Americans. Healthy work life through protection from harmful auditory effects of occupational exposures to noise and chemicals will have a positive impact on better hearing in later life.

PMID: 25549170 [PubMed - indexed for MEDLINE]

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The interaction of hearing loss and level-dependent hearing protection on speech recognition in noise.

Related Articles

The interaction of hearing loss and level-dependent hearing protection on speech recognition in noise.

Int J Audiol. 2015 Feb;54 Suppl 1:S9-S18

Authors: Giguère C, Laroche C, Vaillancourt V

Abstract
OBJECTIVES: To determine the effects of different control settings of level-dependent hearing protectors on speech recognition performance in interaction with hearing loss.
DESIGN: Controlled laboratory experiment with two level-dependent devices (Peltor® PowerCom Plus™ and Nacre QuietPro®) in two military noises.
STUDY SAMPLE: Word recognition scores were collected in protected and unprotected conditions for 45 participants grouped into four hearing profile categories ranging from within normal limits to moderate-to-severe hearing loss.
RESULTS: When the level-dependent mode was switched off to simulate conventional hearing protection, there were large differences across hearing profile categories regarding the effects of wearing the devices on speech recognition in noise; participants with normal hearing showed little effect while participants in the most hearing-impaired category showed large decrements in scores compared to unprotected listening. Activating the level-dependent mode of the devices produced large speech recognition benefits over the passive mode at both low and high gain pass-through settings. The category of participants with the most impaired hearing benefitted the most from the level-dependent mode.
CONCLUSIONS: The findings indicate that level-dependent hearing protection circuitry can provide substantial benefits in speech recognition performance in noise, compared to conventional passive protection, for individuals covering a wide range of hearing losses.

PMID: 25549169 [PubMed - indexed for MEDLINE]

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Does tinnitus, hearing asymmetry, or hearing loss predispose to occupational injury risk?

Related Articles

Does tinnitus, hearing asymmetry, or hearing loss predispose to occupational injury risk?

Int J Audiol. 2015 Feb;54 Suppl 1:S30-6

Authors: Cantley LF, Galusha D, Cullen MR, Dixon-Ernst C, Tessier-Sherman B, Slade MD, Rabinowitz PM, Neitzel RL

Abstract
OBJECTIVE: To determine the relative contributions of tinnitus, asymmetrical hearing loss, low frequency hearing loss (pure tone average of 0.5, 1, 2, 3 kHz; PTA.5123), or high frequency hearing loss (pure tone average of 4, 6 kHz; PTA46), to acute injury risk among a cohort of production and maintenance workers at six aluminum manufacturing plants, adjusting for ambient noise exposure and other recognized predictors of injury risk.
DESIGN: Retrospective analysis.
STUDY SAMPLE: The study considered 9920 workers employed during 2003 to 2008. The cohort consisted of 8818 workers (89%) whose complete records were available.
RESULTS: Adjusting for noise exposure and other recognized injury predictors, a 25% increased acute injury risk was observed among workers with a history of tinnitus in conjunction with high-frequency hearing loss (PTA46). Low frequency hearing loss may be associated with minor, yet less serious, injury risk. We did not find evidence that asymmetry contributes to injury risk.
CONCLUSION: These results provide evidence that tinnitus, combined with high-frequency hearing loss, may pose an important safety threat to workers, especially those who work in high-noise exposed environments. These at risk workers may require careful examination of their communication and hearing protection needs.

PMID: 25549168 [PubMed - indexed for MEDLINE]

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Short-term music-induced hearing loss after sound exposure to discotheque music: the effectiveness of a break in reducing temporary threshold shift.

Related Articles

Short-term music-induced hearing loss after sound exposure to discotheque music: the effectiveness of a break in reducing temporary threshold shift.

Int J Audiol. 2015 Feb;54 Suppl 1:S46-52

Authors: Helleman HW, Dreschler WA

Abstract
OBJECTIVE: To investigate the effect of a break in music exposure on temporary threshold shifts.
DESIGN: A cross-over design where subjects are exposed to dance music for either two hours consecutively, or exposed to two hours of dance music with a one-hour break in between. Outcome measure was the change in hearing threshold, measured in 1-dB steps at different time points after ending the music.
STUDY SAMPLE: Eighteen normal-hearing subjects participated in this study.
RESULTS: Changes in pure-tone threshold were observed in both conditions and were similar, regardless of the break. Threshold shifts could be averaged for 1000, 2000, and 4000 Hz. The shift immediately after the ending of the music was 1.7 dB for right ears, and 3.4 dB for left ears. The difference between left and right ears was significant. One hour after the exposure, right ears were recovered to baseline conditions whereas left ears showed a small but clinically irrelevant remaining shift of approximately 1 dB.
CONCLUSIONS: The advice to use chill-out zones is still valid, because this helps to reduce the duration to the exposure. This study does not provide evidence that a rest period gives an additional reduction of temporary threshold shifts.

PMID: 25549167 [PubMed - indexed for MEDLINE]

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Effects of user training with electronically-modulated sound transmission hearing protectors and the open ear on horizontal localization ability.

Related Articles

Effects of user training with electronically-modulated sound transmission hearing protectors and the open ear on horizontal localization ability.

Int J Audiol. 2015 Feb;54 Suppl 1:S37-45

Authors: Casali JG, Robinette MB

Abstract
OBJECTIVE: To determine if training with electronically-modulated hearing protection (EMHP) and the open ear results in auditory learning on a horizontal localization task.
DESIGN: Baseline localization testing was conducted in three listening conditions (open-ear, in-the-ear (ITE) EMHP, and over-the-ear (OTE) EMHP). Participants then wore either an ITE or OTE EMHP for 12, almost daily, one-hour training sessions. After training was complete, participants again underwent localization testing in all three listening conditions. A computer with a custom software and hardware interface presented localization sounds and collected participant responses.
STUDY SAMPLE: Twelve participants were recruited from the student population at Virginia Tech. Audiometric requirements were 35 dBHL at 500, 1000, and 2000 Hz bilaterally, and 55 dBHL at 4000 Hz in at least one ear.
RESULTS: Pre-training localization performance with an ITE or OTE EMHP was worse than open-ear performance. After training with any given listening condition, including open-ear, performance in that listening condition improved, in part from a practice effect. However, post-training localization performance showed near equal performance between the open-ear and training EMHP. Auditory learning occurred for the training EMHP, but not for the non-training EMHP; that is, there was no significant training crossover effect between the ITE and the OTE devices.
CONCLUSION: It is evident from this study that auditory learning (improved horizontal localization performance) occurred with the EMHP for which training was performed. However, performance improvements found with the training EMHP were not realized in the non-training EMHP. Furthermore, localization performance in the open-ear condition also benefitted from training on the task.

PMID: 25549166 [PubMed - indexed for MEDLINE]

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To measure the impact of hearing protectors on the perception of speech in noise.

Related Articles

To measure the impact of hearing protectors on the perception of speech in noise.

Int J Audiol. 2015 Feb;54 Suppl 1:S3-8

Authors: Hiselius P, Edvall N, Reimers D

Abstract
OBJECTIVE: To propose and evaluate a new method for assessing the potential impact on speech intelligibility when wearing a hearing protection device (HPD) in a noisy environment.
DESIGN: The method is based on a self adaptive method for finding the speech reception threshold (SRT) using speech material from the Callsign acquisition test (CAT) presented at a constant level while adjusting the level of a background noise. A key point is to primarily examine the impact of the HPD; i.e. the difference between occluded and unoccluded SRTs, presented as the speech intelligibility impact level.
STUDY SAMPLE: A total of 31 test subjects.
RESULTS: The method is shown to be stable, with a minimum amount of learning effect, and capable of detecting differences between hearing protection devices. It is also shown that low-attenuation passive HPDs are likely to have a very small effect on speech intelligibility in noise, and that an electronic HPD with a level-dependant function has the potential to improve intelligibility.
CONCLUSIONS: The results are encouraging regarding the precision, repeatability, and applicability of the proposed method.

PMID: 25549165 [PubMed - indexed for MEDLINE]

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Stimulus and transducer effects on threshold.

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Stimulus and transducer effects on threshold.

Int J Audiol. 2015 Feb;54 Suppl 1:S19-29

Authors: Flamme GA, Geda K, McGregor KD, Wyllys K, Deiters KK, Murphy WJ, Stephenson MR

Abstract
OBJECTIVE: This study examined differences in thresholds obtained under Sennheiser HDA200 circumaural earphones using pure tone, equivalent rectangular noise bands, and 1/3 octave noise bands relative to thresholds obtained using Telephonics TDH-39P supra-aural earphones.
DESIGN: Thresholds were obtained via each transducer and stimulus condition six times within a 10-day period.
STUDY SAMPLE: Forty-nine adults were selected from a prior study to represent low, moderate, and high threshold reliability.
RESULTS: The results suggested that (1) only small adjustments were needed to reach equivalent TDH-39P thresholds, (2) pure-tone thresholds obtained with HDA200 circumaural earphones had reliability equal to or better than those obtained using TDH-39P earphones, (3) the reliability of noise-band thresholds improved with broader stimulus bandwidth and was either equal to or better than pure-tone thresholds, and (4) frequency-specificity declined with stimulus bandwidths greater than one equivalent rectangular band, which could complicate early detection of hearing changes that occur within a narrow frequency range.
CONCLUSIONS: These data suggest that circumaural earphones such as the HDA200 headphones provide better reliability for audiometric testing as compared to the TDH-39P earphones. These data support the use of noise bands, preferably ERB noises, as stimuli for audiometric monitoring.

PMID: 25549164 [PubMed - indexed for MEDLINE]

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Stop gambling with your hearing.

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Stop gambling with your hearing.

Int J Audiol. 2015 Feb;54 Suppl 1:S1-2

Authors: Murphy WJ, Grantham MA

PMID: 25530043 [PubMed - indexed for MEDLINE]

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Two rare cases of simultaneous Tessier number 3 cleft, contralateral cleft lip, and signs of amniotic band syndrome

Publication date: Available online 19 December 2015
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Yi Xu, Yue Mu, Renji Chen, Zongmei Zheng, Wenjing Zhang
The Tessier number 3 cleft is rare. In this paper, we report two extremely rare cases of simultaneous Tessier number 3 cleft, contralateral cleft lip, and signs of amniotic band syndrome. In the two cases, we confirmed that amniotic bands were the probable cause of the Tessier number 3 cleft, where swallowed fibrous strands of amniotic bands entangle a typical cleft lip and cause the more severe Tessier number 3 cleft. In this study, Z-plasty was performed for one case, and a straight-line method was used for the other. Postoperatively, the appearance of both patients was satisfactory, as expected. Consequently, treatment for the Tessier number 3 cleft should be designed individually based on the severity of deformity.



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miR expression profiling at diagnosis predicts relapse in pediatric precursor B-cell acute lymphoblastic leukemia

Our aim was to identify miRNAs that can predict risk of relapse in pediatric patients with acute lymphoblastic leukemia (ALL). Following high-throughput miRNA expression analysis (48 samples), five miRs were selected for further confirmation performed by real time quantitative PCR on a cohort of precursor B-cell ALL patients (n = 138). The results were correlated with clinical parameters and outcome. Low expression of miR-151-5p, and miR-451, and high expression of miR-1290 or a combination of all three predicted inferior relapse free survival (P = 0.007, 0.042, 0.025, and <0.0001, respectively). Cox regression analysis identified aberrant expression of the three miRs as an independent prognostic marker with a 10.5-fold increased risk of relapse (P = 0.041) in PCR-MRD non-high risk patients. Furthermore, following exclusion of patients harboring IKZF1 deletion, the aberrant expression of all three miRs could identify patients with a 24.5-fold increased risk to relapse (P < 0.0001). The prognostic relevance of the three miRNAs was evaluated in a non-BFM treated precursor B-cell ALL cohort (n = 33). A significant correlation between an aberrant expression of at least one of the three miRs and poor outcome was maintained (P < 0.0001). Our results identify an expression profile of miR-151-5p, miR-451, and miR-1290 as a novel biomarker for outcome in pediatric precursor B-cell ALL patients, regardless of treatment protocol. The use of these markers may lead to improved risk stratification at diagnosis and allow early therapeutic interventions in an attempt to improve survival of high risk patients. © 2015 Wiley Periodicals, Inc.

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SEOM clinical guidelines in metastatic breast cancer 2015

Abstract

Metastatic breast cancer is essentially an incurable disease. However, recent advances have resulted in a significant improvement of overall survival. The SEOM guidelines are intended to make evidence-based recommendations on how to manage patients with metastatic breast cancer to achieve the best patient outcomes based on a rational use of the currently available therapies. To assign a level of certainty and a grade of recommendation the United States Preventive Services Task Force guidelines methodology was selected as reference.

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