Somatic memory and gain increase as preconditions for tinnitus: insights from congenital deafness.

Somatic memory and gain increase as preconditions for tinnitus: insights from congenital deafness.

Hear Res. 2015 Dec 21;

Authors: Eggermont JJ, Kral A

Abstract
Tinnitus is the conscious perception of sound heard in the absence of physical sound sources internal or external to the body. The characterization of tinnitus by its spectrum reflects the missing frequencies originally represented in the hearing loss, i.e., partially or completely deafferented, region. The tinnitus percept, despite a total hearing loss, may thus be dependent on the persisting existence of a somatic memory for the "lost" frequencies. Somatic memory in this context is the reference for phantom sensations attributed to missing sensory surfaces or parts thereof. This raises the question whether tinnitus can exist in congenital deafness, were somatic representations have not been formed. We review the development of tonotopic maps in altricial and precocial animals evidence for a lack of tinnitus in congenital deafness and the effects of cochlear implants on the formation of tonotopic maps in the congenitally deaf. The latter relates to the emergence of tinnitus in these subjects. The reviewed material is consistent with the hypothesis that tinnitus requires an established and actively used somatotopic map that leads to a corresponding somatic memory. The absence of such experience explains the absence of tinnitus in congenital bilateral and unilateral deafness.

PMID: 26719143 [PubMed - as supplied by publisher]

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Revision Transcervical Medialization Laryngoplasty for Unilateral Vocal Fold Paralysis.

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Revision Transcervical Medialization Laryngoplasty for Unilateral Vocal Fold Paralysis.

Otolaryngol Head Neck Surg. 2015 Oct;153(4):593-8

Authors: Parker NP, Barbu AM, Hillman RE, Zeitels SM, Burns JA

Abstract
OBJECTIVE: To identify patterns of failure following transcervical medialization laryngoplasty for unilateral vocal fold paralysis and describe indications and revision techniques for optimal vocal outcomes.
STUDY DESIGN: Case series with chart review.
SETTING: Tertiary care center.
SUBJECTS AND METHODS: Thirty-nine consecutive patients between January 2005 and April 2014 undergoing transcervical revision of failed primary medialization laryngoplasty were identified. Demographics, etiology, stroboscopic assessment, and surgical techniques were recorded. Patient self-assessment using the Voice-Related Quality-of-Life (VRQOL) questionnaire and objective acoustic and aerodynamic assessments performed pre- and postoperatively were analyzed using t tests for paired comparisons.
RESULTS: Thirty-nine patients underwent 48 transcervical revision surgeries. Median follow-up was 14.6 months from time of final revision surgery. Indications included anterior glottic incompetence (38/48, 79%), posterior glottic incompetence (20/48, 42%), glottic overclosure (8/48, 17%), and/or decreased phonatory pliability (12/48, 25%). A combination of findings was present in 21 (44%) surgeries. Revision techniques included either anterior augmentation, arytenopexy, and cricothyroid subluxation (alone or in combination) in 46 of 48 (96%) patients or partial implant removal alone in 2 patients. Seven patients (18%) required multiple revisions. A complete set of voice parameters was available for 22 patients, and statistically significant improvements included VRQOL scores, fundamental frequency in females, jitter, noise-to-harmonic ratio, and mean airflow rate.
CONCLUSION: Patterns of failure in patients with suboptimal phonatory function after transcervical medialization laryngoplasty included persistent glottic incompetence, glottic overclosure, and decreased vocal fold pliability. Revision transcervical medialization surgery, guided by individualized consideration of vocal fold position and surface pliability, can improve phonatory outcomes.

PMID: 25968059 [PubMed - indexed for MEDLINE]

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From the Editor: An Introduction to the JSLHR Supplement on Implementation Science.

From the Editor: An Introduction to the JSLHR Supplement on Implementation Science.

J Speech Lang Hear Res. 2015 Dec 1;58(6):1717-1718

Authors: Paul R

Abstract
Purpose: The JSLHR Supplement on Implementation Science is aimed at providing discussion and examples of research in implementation science, the study of methods designed to promote the incorporation of research findings into clinical practice.
Methods: Practitioners in the language science area were invited to submit articles that address their experience with various aspects of implementation science.
Results: Six articles from several research groups comprise this supplement.
Conclusions: Implementation science is an aspect of intervention research that merits consideration by communication disorders scientists. More extensive practice of implementation science will improve uptake of evidence-based practice in the clinical community.

PMID: 26720409 [PubMed - as supplied by publisher]

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Modality-specific processing precedes amodal linguistic processing during L2 sign language acquisition: A longitudinal study.

Modality-specific processing precedes amodal linguistic processing during L2 sign language acquisition: A longitudinal study.

Cortex. 2015 Dec 1;75:56-67

Authors: Williams JT, Darcy I, Newman SD

Abstract
The present study tracked activation pattern differences in response to sign language processing by late hearing second language learners of American Sign Language. Learners were scanned before the start of their language courses. They were scanned again after their first semester of instruction and their second, for a total of 10 months of instruction. The study aimed to characterize modality-specific to modality-general processing throughout the acquisition of sign language. Results indicated that before the acquisition of sign language, neural substrates related to modality-specific processing were present. After approximately 45 h of instruction, the learners transitioned into processing signs on a phonological basis (e.g., supramarginal gyrus, putamen). After one more semester of input, learners transitioned once more to a lexico-semantic processing stage (e.g., left inferior frontal gyrus) at which language control mechanisms (e.g., left caudate, cingulate gyrus) were activated. During these transitional steps right hemispheric recruitment was observed, with increasing left-lateralization, which is similar to other native signers and L2 learners of spoken language; however, specialization for sign language processing with activation in the inferior parietal lobule (i.e., angular gyrus), even for late learners, was observed. As such, the present study is the first to track L2 acquisition of sign language learners in order to characterize modality-independent and modality-specific mechanisms for bilingual language processing.

PMID: 26720258 [PubMed - as supplied by publisher]

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Comparisons of Longitudinal Trajectories of Social Competence: Parent Ratings of Children With Cochlear Implants Versus Hearing Peers.

Comparisons of Longitudinal Trajectories of Social Competence: Parent Ratings of Children With Cochlear Implants Versus Hearing Peers.

Otol Neurotol. 2015 Dec 18;

Authors: Hoffman MF, Cejas I, Quittner AL, CDaCI Investigative Team

Abstract
OBJECTIVE: To evaluate the longitudinal effects of cochlear implantation (CIs) on young, deaf children's social competence over 5 years of implant use and compare their social skills to those of same-aged, hearing peers.
STUDY DESIGN: Prospective, longitudinal between- and within-subjects design, with assessments completed 3 times over 5 years.
SETTING: This study was conducted at 6 cochlear implant centers and two preschools that enrolled both CI and hearing children.
PATIENTS: Parents of 132 children with CIs and 67 age-matched hearing controls completed the study measures. Children were between 5 and 9 years of age at the first time point.
INTERVENTIONS: Cochlear implantation and speech-language therapy.
MAIN OUTCOME MEASURES: Three subscales were drawn from 2 standardized measures of behavioral and social functioning, the Behavioral Assessment Scale for Children (Adaptability, Social Skills) and the Social Skills Rating System (Social Skills). A latent social competence variable was created using multiple subscales, which was modeled over time.
RESULTS: Parent data indicated that children with CIs were delayed in comparison to their hearing peers on the social competence latent variable across all time points. Further, there was minimal evidence of "catch-up" growth over this 5-year period.
CONCLUSION: Children with CIs continued to experience delays in social competence after several years of implant use. Despite documented gains in oral language, deficits in social competence remained. To date, no interventions for children with CIs have targeted these social and behavioral skills. Thus, interventions that address the functioning of the "whole child" following cochlear implantation are needed.

PMID: 26719958 [PubMed - as supplied by publisher]

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Spatial Language and the Embedded Listener Model in Parents' Input to Children.

Spatial Language and the Embedded Listener Model in Parents' Input to Children.

Cogn Sci. 2015 Dec 31;

Authors: Ferrara K, Silva M, Wilson C, Landau B

Abstract
Language is a collaborative act: To communicate successfully, speakers must generate utterances that are not only semantically valid but also sensitive to the knowledge state of the listener. Such sensitivity could reflect the use of an "embedded listener model," where speakers choose utterances on the basis of an internal model of the listener's conceptual and linguistic knowledge. In this study, we ask whether parents' spatial descriptions incorporate an embedded listener model that reflects their children's understanding of spatial relations and spatial terms. Adults described the positions of targets in spatial arrays to their children or to the adult experimenter. Arrays were designed so that targets could not be identified unless spatial relationships within the array were encoded and described. Parents of 3-4-year-old children encoded relationships in ways that were well-matched to their children's level of spatial language. These encodings differed from those of the same relationships in speech to the adult experimenter (Experiment 1). In contrast, parents of individuals with severe spatial impairments (Williams syndrome) did not show clear evidence of sensitivity to their children's level of spatial language (Experiment 2). The results provide evidence for an embedded listener model in the domain of spatial language and indicate conditions under which the ability to model listener knowledge may be more challenging.

PMID: 26717804 [PubMed - as supplied by publisher]

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Feeling addressed! The role of body orientation and co-speech gesture in social communication.

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Feeling addressed! The role of body orientation and co-speech gesture in social communication.

Hum Brain Mapp. 2015 May;36(5):1925-36

Authors: Nagels A, Kircher T, Steines M, Straube B

Abstract
During face-to-face communication, body orientation and coverbal gestures influence how information is conveyed. The neural pathways underpinning the comprehension of such nonverbal social cues in everyday interaction are to some part still unknown. During fMRI data acquisition, 37 participants were presented with video clips showing an actor speaking short sentences. The actor produced speech-associated iconic gestures (IC) or no gestures (NG) while he was visible either from an egocentric (ego) or from an allocentric (allo) position. Participants were asked to indicate via button press whether they felt addressed or not. We found a significant interaction of body orientation and gesture in addressment evaluations, indicating that participants evaluated IC-ego conditions as most addressing. The anterior cingulate cortex (ACC) and left fusiform gyrus were stronger activated for egocentric versus allocentric actor position in gesture context. Activation increase in the ACC for IC-ego>IC-allo further correlated positively with increased addressment ratings in the egocentric gesture condition. Gesture-related activation increase in the supplementary motor area, left inferior frontal gyrus and right insula correlated positively with gesture-related increase of addressment evaluations in the egocentric context. Results indicate that gesture use and body-orientation contribute to the feeling of being addressed and together influence neural processing in brain regions involved in motor simulation, empathy and mentalizing.

PMID: 25640962 [PubMed - indexed for MEDLINE]

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Does parental experience of the diagnosis and intervention process differ for children with auditory neuropathy?

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Does parental experience of the diagnosis and intervention process differ for children with auditory neuropathy?

Int J Pediatr Otorhinolaryngol. 2014 Dec;78(12):2210-5

Authors: Stroebel D, Swanepoel de W

Abstract
OBJECTIVES: This study compared parental experience of the audiological diagnosis and intervention process in children with auditory neuropathy spectrum disorder and sensory neural hearing loss.
METHODS: A matched group survey was used with parents of children with auditory neuropathy spectrum disorder (ANSD) matched with a control group of parents and children with sensorineural hearing loss (SNHL). The two groups were matched in terms of the child's gender, age, amplifications used, social background and utilisation of private or public health care sectors. An interview questionnaire, consisting of 45 questions in six categories (1. biographic information, 2. experiences of audiological diagnosis, 3. hearing aid benefit, 4. parental experience of the rehabilitation decision making process, 5. parental needs for emotional support and 6. parental needs for information) using a 5-point Likert scale for categories 2-7, was administered by the same audiologist.
RESULTS: Children with ANSD experienced a significantly longer waiting period from diagnosis to hearing aid fitting (p=0.025) and/or cochlear implantation (p=0.036). Parents of children with ANSD reported significantly different experiences of the diagnostic process (p=0.001) with poorer understanding of the diagnosis and reporting insufficient time allowed for asking questions. During the rehabilitation decision-making process 47% of parents with ANSD children (vs. 0% of parents with SNHL children) reported receiving conflicting information. Parents of children with ANSD were also less likely to recommend hearing aids to other parents. Information needs were similar between groups.
CONCLUSIONS: Parents of children with ANSD have different experiences and greater uncertainty during the diagnostic and rehabilitation process. Providing regular consultation and structured timelines through the diagnostic process and decision-making process may facilitate this process with less uncertainty.

PMID: 25458162 [PubMed - indexed for MEDLINE]

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Disability correlates in Canadian Armed Forces Regular Force Veterans.

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Disability correlates in Canadian Armed Forces Regular Force Veterans.

Disabil Rehabil. 2015;37(10):884-91

Authors: Thompson JM, Pranger T, Sweet J, VanTil L, McColl MA, Besemann M, Shubaly C, Pedlar D

Abstract
PURPOSE: This study was undertaken to inform disability mitigation for military veterans by identifying personal, environmental, and health factors associated with activity limitations.
METHOD: A sample of 3154 Canadian Armed Forces Regular Force Veterans who were released during 1998-2007 participated in the 2010 Survey on Transition to Civilian Life. Associations between personal and environmental factors, health conditions and activity limitations were explored using ordinal logistic regression.
RESULTS: The prevalence of activity reduction in life domains was higher than the Canadian general population (49% versus 21%), as was needing assistance with at least one activity of daily living (17% versus 5%). Prior to adjusting for health conditions, disability odds were elevated for increased age, females, non-degree post-secondary graduation, low income, junior non-commissioned members, deployment, low social support, low mastery, high life stress, and weak sense of community belonging. Reduced odds were found for private/recruit ranks. Disability odds were highest for chronic pain (10.9), any mental health condition (2.7), and musculoskeletal conditions (2.6), and there was a synergistic additive effect of physical and mental health co-occurrence.
CONCLUSIONS: Disability, measured as activity limitation, was associated with a range of personal and environmental factors and health conditions, indicating multifactorial and multidisciplinary approaches to disability mitigation.

PMID: 25203768 [PubMed - indexed for MEDLINE]

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Disability in post-earthquake Haiti: prevalence and inequality in access to services.

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Disability in post-earthquake Haiti: prevalence and inequality in access to services.

Disabil Rehabil. 2015;37(12):1082-9

Authors: Danquah L, Polack S, Brus A, Mactaggart I, Houdon CP, Senia P, Gallien P, Kuper H

Abstract
PURPOSE: To assess the prevalence of disability and service needs in post-earthquake Haiti, and to compare the inclusion and living conditions of people with disabilities to those without disabilities.
METHODS: A population-based prevalence survey of disability was undertaken in 2012 in Port-au-Prince region, which was at the centre of the earthquake in 2010. Sixty clusters of 50 people aged 5 + years were selected with probability proportionate to size sampling and screened for disability (Washington Group short set questionnaire). A case-control study was undertaken, nested within the survey, matching cases to controls by age, gender and cluster. There was additional case finding to identify further children with disabilities. Information was collected on: socioeconomic status, education, livelihood, health, activities, participation and barriers.
RESULTS: The prevalence of disability was 4.1% (3.4-4.7%) across 3132 eligible individuals. The earthquake was the second leading cause of disability. Disability was more common with increasing age, but unrelated to poverty. Large gaps existed in access of services for people with disabilities. Adults with disabilities were less likely to be literate or work and more likely to visit health services than adults without disabilities. Children with disabilities were less likely to be currently enrolled at school compared to controls. Children and adults with disabilities reported more activity limitations and participation restriction.
CONCLUSION: Further focus is needed to improve inclusion of people with disabilities in post-earthquake Haiti to ensure that their rights are fulfilled.
IMPLICATIONS FOR REHABILITATION: Almost one in six households in this region of Haiti included a person with a disability, and the earthquake was the second leading cause of disability. Fewer than half of people who reported needing medical rehabilitation had received this service. The leading reported barriers to the uptake of health services included financial constraints (50%) and difficulties with transport (40%). People with disabilities did not participate equally in education or employment and had poorer access to health care.

PMID: 25178862 [PubMed - indexed for MEDLINE]

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The 6-minute walk distance cannot be accurately assessed at home in people with COPD.

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The 6-minute walk distance cannot be accurately assessed at home in people with COPD.

Disabil Rehabil. 2015;37(12):1102-6

Authors: Holland AE, Rasekaba T, Fiore JF, Burge AT, Lee AL

Abstract
PURPOSE: The 6-minute walk test (6MWT) is commonly used to measure exercise capacity in COPD, but it is unclear if this test is accurate when performed at home. This study aimed to determine whether exercise capacity can be accurately assessed at home using the 6MWT in COPD.
METHODS: A total of 19 participants with stable COPD (mean [SD] FEV1/FVC 52[13]) undertook the 6MWT at home and at the hospital, in random order, with two tests performed on each occasion. Hospital tests were conducted on a 30-metre walking track whilst home tests (indoor or outdoor) were conducted using the longest available track. Agreement for 6-minute walk distance (6MWD) was examined using the Bland and Altman method.
RESULTS: The track length at home was mean [SD] of 17[9] m. The home 6MWD was shorter than the hospital 6MWD (mean 30 m shorter, limits of agreement -167 to 102 m). For the home tests, a shorter track length was associated with a greater reduction in 6MWD (rs = 0.59, p = 0.01), but not an increased number of turns (rs = -0.41, p = 0.08).
CONCLUSIONS: The 6MWD underestimates exercise capacity when conducted at home in COPD. Alternative tests suitable for the home environment should be considered if a comprehensive assessment is to be performed at home.
IMPLICATIONS FOR REHABILITATION: The 6-minute walk test is commonly used to assess change in exercise capacity following pulmonary rehabilitation in patients with chronic obstructive pulmonary disease, and may be conducted on varying track lengths, indoors or outdoors. When conducted at home, the 6-minute walk test underestimates exercise capacity in chronic obstructive pulmonary disease, due to a shorter track length available in the home environment. This suggests that results from 6-minute walk tests performed at home environment cannot be directly compared to results from centre-based tests.

PMID: 25176002 [PubMed - indexed for MEDLINE]

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Predicting sickness impact profile at six months after stroke: further results from the European multi-center CERISE study.

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Predicting sickness impact profile at six months after stroke: further results from the European multi-center CERISE study.

Disabil Rehabil. 2015;37(11):942-50

Authors: Stummer C, Verheyden G, Putman K, Jenni W, Schupp W, De Wit L

Abstract
PURPOSE: To develop prognostic models and equations for predicting participation at six months after stroke.
METHODS: This European prospective cohort study recruited 532 consecutive patients from four rehabilitation centers. Participation was assessed at six months after stroke with the Sickness Impact Profile (SIP), which consists of a physical, psychosocial and independent dimension. Twenty-six independent variables on admission to the rehabilitation center and 13 additional variables measured at two months post stroke were included in the analysis. A multiple logistic regression analysis was conducted predicting good participation (SIP < 20%). Sensitivity, specificity, positive and negative predictive values were calculated.
RESULTS: The prognostic models for the three dimensions provided independent predictors containing demographics, complications, diagnostic, and disability measures. Sensitivity ranged from 64-84%, specificity 66-85%, positive predictive value 70-78%, and negative predictive value 76-87%. Barthel Index on admission, Euroqol Health State at two months and Caregiver Strain Index at two months were retained in all prediction models.
CONCLUSIONS: A combination of variables was found in the prognostic models of the three dimensions of the SIP at six months after stroke. Already from the early beginning of stroke rehabilitation it seems important to focus on personal activities of daily living as well as caregivers' strain.
IMPLICATIONS FOR REHABILITATION: Prognostic factors predicting participation, measured by the three dimensions of the Sickness Impact Profile at six months post stroke include demographic variables, post-stroke complications, diagnostic parameters and disability measures. Significant prognostic variables for all three dimensions of the Sickness Impact Profile were a higher Barthel Index score on admission to the rehabilitation center, a higher Euroqol Health State score at two months post stroke and a lower Caregiver Strain Index score at two months post stroke. Early stroke therapy should therefore further emphasize rehabilitation of personal activities of daily living such as mobility, walking, feeding, dressing, and toilet use, as well as considering strategies to reduce caregiver strain such as giving support, providing information and training carers.

PMID: 25170786 [PubMed - indexed for MEDLINE]

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Bridging the goal intention-action gap in rehabilitation: a study of if-then implementation intentions in neurorehabilitation.

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Bridging the goal intention-action gap in rehabilitation: a study of if-then implementation intentions in neurorehabilitation.

Disabil Rehabil. 2015;37(12):1073-81

Authors: Kersten P, McPherson KM, Kayes NM, Theadom A, McCambridge A

Abstract
PURPOSE: To test the feasibility and acceptability of an implementation intention strategy (if-then plans) increasingly used in health psychology to bridge the goal intention-action gap in rehabilitation with people with neurological conditions who are experiencing difficulties with mobility.
METHODS: Twenty people with multiple sclerosis (MS) and stroke, randomised to an experimental and control group, set up to three mobility related goals with a physiotherapist. The experimental group also formulated if-then plans for every goal.
DATA COLLECTION: Focus groups and interviews with participants and therapists; Patient Activation Measure (PAM), 10-m walk test, Rivermead Mobility Index, self-efficacy, subjective health status, quality of life.
RESULTS: Qualitative data highlighted one main theme: Rehabilitation in context, encapsulating the usefulness of the if-then strategy in thinking about the patient in the context of complexity, the usefulness of home-based rehabilitation, and the perceived need for a few more sessions. Changes in walking speed were in the expected direction for both groups; PAM scores improved over 3 months in both groups.
CONCLUSION: If-then plans were feasible and acceptable in bridging the goal intention-action gap in rehabilitation with people with MS and stroke, who are experiencing difficulties with mobility. This approach can now be adapted and trialled further in a definitive study.
IMPLICATIONS FOR REHABILITATION: Goal planning in rehabilitation necessitates specific strategies that help people engage in goal-related tasks. If-then plans aim to support people to deal more effectively with self-regulatory problems that might undermine goal striving and have been found to be effective in health promotion and health behaviour change. This feasibility study with people with a stroke and multiple sclerosis has demonstrated that if-then plans are feasible and acceptable to patients and physiotherapists in supporting goal-directed behaviour.

PMID: 25163832 [PubMed - indexed for MEDLINE]

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Implementing a novel dance intervention in rehabilitation: perceived barriers and facilitators.

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Implementing a novel dance intervention in rehabilitation: perceived barriers and facilitators.

Disabil Rehabil. 2015;37(12):1066-72

Authors: Demers M, Thomas A, Wittich W, McKinley P

Abstract
PURPOSE: To identify clinicians' perceptions regarding the facilitators and barriers to the use of dance in rehabilitation.
METHODS: This study used a qualitative descriptive design. Three focus groups were conducted with clinicians across three purposively selected rehabilitation centers. Data were analyzed using thematic content analysis.
RESULTS: Fourteen allied health-care professionals (six occupational therapists, six physical therapists, and two social workers) with previous dance experience participated in this study. Four main themes emerged from the analysis representing the personal and organizational factors influencing on the implementation of dance interventions: (1) Clinician's dance experience and training, (2) Interest and personal beliefs towards using dance as a potential intervention, (3) Support from the organization of the institution, and (4) Available resources. Although each site was different, the main factors acting as barriers and facilitators were similar for all three sites.
CONCLUSION: The identification of the barriers and facilitators to implementing dance in rehabilitation is the first step to support the translation of knowledge about dance. A tailored approach designed for clinicians and managers should address the main barriers to knowledge use about dance, as a potential rehabilitation modality for individuals with disabilities.
IMPLICATIONS FOR REHABILITATION: Personal and organizational factors can act simultaneously as barriers and facilitators to the implementation of a dance intervention. Lack of time for professional development and lack of support from the organization are the main barriers to the uptake of knowledge about dance in rehabilitation. A knowledge translation strategy addressing the barriers to knowledge use is helpful for clinicians and managers facilitating the implementation of dance in rehabilitation settings.

PMID: 25163831 [PubMed - indexed for MEDLINE]

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Separation from supported employment: a retrospective chart review study.

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Separation from supported employment: a retrospective chart review study.

Disabil Rehabil. 2015;37(12):1055-9

Authors: West M, Targett P, Wehman P, Cifu G, Davis J

Abstract
PURPOSE: The objective of this study was to examine job separations from supported employment (SE). The aim was to identify the types and nature of separations and precipitating events leading to the separation.
METHODS: A retrospective chart review methodology was utilized. The study was conducted in a metropolitan area in the Southeast United States by a university-based SE program. Participants were 47 SE clients who had been placed into and separated from 67 jobs. Using a coding form, information regarding the type of separation and issues that preceded the separation were recorded. Data were aggregated using descriptive statistics.
RESULTS: The largest number of separations was due to termination, followed by resignation and mutual consent of the employer and employee. The mean number of issues leading to the separation was 2.2, ranging from one to five. Only eight positive issues were found (compared to 116 negative and 20 neutral), the most prevalent being entry into an educational or training program. Common negative issues included poor work performance, attendance and punctuality problems, conflicts with the supervisor, and social and behavioral issues.
CONCLUSIONS: The findings of this study illustrate the need to address job retention issues during the job development process, finding the most appropriate person-job fit and workplace culture for each client. The findings also support the need for vigilant and regular communication between the SE program and employers to intervene quickly when problems arise.
IMPLICATIONS FOR REHABILITATION: Separation from Supported Employment (SE) SE is an evidence-based employment practice that has been shown effective across multiple disability groups. Studying job separations can provide valuable information for improving service. Locating the best person-job fit, as well as frequent contract with employers, can help prevent unnecessary job loss.

PMID: 25162839 [PubMed - indexed for MEDLINE]

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The therapeutic relationship in telephone-delivered support for people undertaking rehabilitation: a mixed-methods interaction analysis.

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The therapeutic relationship in telephone-delivered support for people undertaking rehabilitation: a mixed-methods interaction analysis.

Disabil Rehabil. 2015;37(12):1060-5

Authors: Muller I, Kirby S, Yardley L

Abstract
PURPOSE: The aim of this study was to identify communication features that may affect the development of the therapeutic relationship during telephone support sessions for people undertaking self-directed therapy.
METHODS: Recorded telephone support sessions of 61 people with chronic dizziness were analysed for communication behaviour using the Roter Interaction Analysis System (RIAS). Working alliance was assessed and was correlated with the RIAS to determine whether communication behaviour affected the therapeutic relationship. Thematic qualitative analysis of support sessions was then carried out to explore the content of sessions with high or low levels of person-centredness.
RESULTS: The level of person-centredness was related to the therapeutic relationship. High person-centred sessions were more likely to address concerns and include therapist reassurances about the safety of the treatment and its side effects.
CONCLUSION: It is possible for rehabilitation therapists to build a strong therapeutic relationship very quickly and over the telephone. Person-centred communication is important for the development of the therapeutic relationship during telephone-delivered support. This research suggests how person-centred communicative behaviours, such as reassurance, encouragement and approval could be incorporated into practice.
IMPLICATIONS FOR REHABILITATION: Person-centred communication is important for the development of a strong therapeutic relationship during support for self-directed rehabilitation. It is possible for rehabilitation therapists to build a strong therapeutic relationship very quickly and over the telephone. Positive communication behaviours such as encouragement, approval, reassurance of safety, and responsiveness to participant cues aid the therapeutic relationship.

PMID: 25156569 [PubMed - indexed for MEDLINE]

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Establishing the reliability and concurrent validity of physical performance tests using virtual reality equipment for community-dwelling healthy elders.

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Establishing the reliability and concurrent validity of physical performance tests using virtual reality equipment for community-dwelling healthy elders.

Disabil Rehabil. 2015;37(12):1097-101

Authors: Griswold D, Rockwell K, Killa C, Maurer M, Landgraff N, Learman K

Abstract
PURPOSE: The aim of this study was to determine the reliability and concurrent validity of commonly used physical performance tests using the OmniVR Virtual Rehabilitation System for healthy community-dwelling elders.
METHOD: Participants (N = 40) were recruited by the authors and were screened for eligibility. The initial method of measurement was randomized to either virtual reality (VR) or clinically based measures (CM). Physical performance tests included the five times sit to stand, Timed Up and Go (TUG), Forward Functional Reach (FFR) and 30-s stand test. A random number generator determined the testing order. The test-re-test reliability for the VR and CM was determined. Furthermore, concurrent validity was determined using a Pearson product moment correlation (Pearson r).
RESULTS: The VR demonstrated excellent reliability for 5 × STS intraclass correlation coefficient (ICC) = 0.931(3,1), FFR ICC = 0.846(3,1) and the TUG ICC = 0.944(3,1). The concurrent validity data for the VR and CM (ICC 3, k) were moderate for FFR ICC = 0.682, excellent 5 × STS ICC = 0.889 and excellent for the TUG ICC = 0.878. The concurrent validity of the 30-s stand test was good ICC = 0.735(3,1).
CONCLUSIONS: This study supports the use of VR equipment for measuring physical performance tests in the clinic for healthy community-dwelling elders.
IMPLICATIONS FOR REHABILITATION: Virtual reality equipment is not only used to treat balance impairments but it is also used to measure and determine physical impairments through the use of physical performance tests. Virtual reality equipment is a reliable and valid tool for collecting physical performance data for the 5 × STS, FFR, TUG and 30-s stand test for healthy community-dwelling elders.

PMID: 25151998 [PubMed - indexed for MEDLINE]

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Post-concussion return to play and return to school guidelines for children and youth: a scoping methodology.

Related Articles

Post-concussion return to play and return to school guidelines for children and youth: a scoping methodology.

Disabil Rehabil. 2015;37(12):1107-12

Authors: DeMatteo C, McCauley D, Stazyk K, Harper J, Adamich J, Randall S, Missiuna C

Abstract
PURPOSE: The objective of this study was to identify and describe management strategies to ensure safe return to activity (RTA) and return to school (RTS) of children with mild traumatic brain injury (MTBI) and determine whether they are evidence-based.
METHODS: A scoping methodology was conducted using research published between 1990 and 2013, gray literature and clinical expertise. Once the data had been charted, an expert panel of physicians and clinicians was consulted to inform and validate study findings. An analytical and thematic framework was used to examine the study findings.
RESULTS: A total of 400 potentially relevant published articles, 100 websites and 24 iPad Applications were found. Ten articles and three web-based resources met inclusion criteria and were included in the final review. Nine articles recommended a more conservative approach to RTA, as well as identified a step-wise or severity-oriented approach. General recommendations were also found regarding safe RTS. One study recommended a stepwise RTS protocol for children.
CONCLUSIONS: This scoping methodology determined that the most comprehensive guidelines for management are focused on adults. Evidence concerning prolonged recovery patterns in children and the impact of concussion on the developing brain suggests that pediatric-specific guidelines are needed for RTA and RTS after MTBI/concussion.
IMPLICATIONS FOR REHABILITATION: Although concussion in children is an increasing concern, it has been determined that the most comprehensive guidelines for management are focused on adults. These guidelines are primarily consensus-based and are not proven fact through quality research. Evidence concerning prolonged recovery patterns in youth and the impact of concussion on the developing brain suggest that pediatric guidelines should be more conservative than for adults. Therefore, pediatric-specific guidelines need to be developed for return to activity and return to school after MTBI/concussion.

PMID: 25144831 [PubMed - indexed for MEDLINE]

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Determination of the minimal clinically important difference on the Australian therapy outcome measures for occupational therapy (AusTOMs-OT).

Related Articles

Determination of the minimal clinically important difference on the Australian therapy outcome measures for occupational therapy (AusTOMs-OT).

Disabil Rehabil. 2015;37(11):997-1003

Authors: Unsworth CA, Coulson M, Swinton L, Cole H, Sarigiannis M

Abstract
PURPOSE: Outcome measures must be responsive to change (able to show statistically significant change) and must also produce information on the degree of change that is clinically significant, or the minimal clinically important difference (MCID). This research sought to establish the MCID for four domains of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT).
METHODS: Using a criterion approach, 30 international clinicians were surveyed about their perceptions of the MCID for AusTOMs-OT. Second, using a distribution-based approach, the MCID was calculated as half of the standard deviation (SD) of the AusTOMs-OT raw scores for a sample of 787 clients.
RESULTS: Just over half the clinicians surveyed indicated that a one-point change represented the MCID for AusTOMs-OT for three domains, and 0.5-point change showed MCID for the final domain. The data analysed for the distribution-based calculation indicated that the half SD ranged from 0.51 to 0.61.
CONCLUSION: Using both criterion and distribution-based approaches, this research empirically demonstrated that a change on the four domains of the AusTOMs-OT of between 0.51 and 1 point shows MCID. Considering these findings, and for ease of clinical interpretation, it is recommended that a one-point shift be adopted as the MCID across all domains.
IMPLICATIONS FOR REHABILITATION: The AusTOMs-OT have been previously shown to be valid and reliable outcome measures for use with all client groups across all settings including rehabilitation. So that rehabilitation professionals can interpret outcomes data from AusTOMs-OT, information must be available on the degree of change that is clinically significant (also referred to as the minimal clinically important difference or MCID). Using empirical calculations as well as clinician opinion, it is recommended that a one-point shift be used as the minimal clinically important difference for the AusTOMs-OT.

PMID: 25144830 [PubMed - indexed for MEDLINE]

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Observation Versus Embolization in Patients with Blunt Splenic Injury After Trauma: A Propensity Score Analysis.

Observation Versus Embolization in Patients with Blunt Splenic Injury After Trauma: A Propensity Score Analysis.

World J Surg. 2015 Dec 30;

Authors: Olthof DC, Joosse P, Bossuyt PM, de Rooij PP, Leenen LP, Wendt KW, Bloemers FW, Goslings JC

Abstract
BACKGROUND: Non-operative management (NOM) is the standard of care in hemodynamically stable patients with blunt splenic injury after trauma. Splenic artery embolization (SAE) is reported to increase observation success rate. Studies demonstrating improved splenic salvage rates with SAE primarily compared SAE with historical controls. The aim of this study was to investigate whether SAE improves success rate compared to observation alone in contemporaneous patients with blunt splenic injury.
METHODS: We included adult patients with blunt splenic injury admitted to five Level 1 Trauma Centers between January 2009 and December 2012 and selected for NOM. Successful treatment was defined as splenic salvage and no splenic re-intervention. We calculated propensity scores, expressing the probability of undergoing SAE, using multivariable logistic regression and created five strata based on the quintiles of the propensity score distribution. A weighted relative risk (RR) was calculated across strata to express the chances of success with SAE.
RESULTS: Two hundred and six patients were included in the study. Treatment was successful in 180 patients: 134/146 (92 %) patients treated with observation and 48/57 (84 %) patients treated with SAE. The weighted RR for success with SAE was 1.17 (0.94-1.45); for complications, the weighted RR was 0.71 (0.41-1.22). The mean number of transfused blood products was 4.4 (SD 9.9) in the observation group versus 9.1 (SD 17.2) in the SAE group.
CONCLUSIONS: After correction for confounders with propensity score stratification technique, there was no significant difference between embolization and observation alone with regard to successful treatment in patients with blunt splenic injury after trauma.

PMID: 26718838 [PubMed - as supplied by publisher]

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Thanks to Reviewers 2015

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A study to investigate and compare the physicomechanical properties of experimental and commercial temporary crown and bridge materials

Publication date: Available online 31 December 2015
Source:Dental Materials
Author(s): Bana Abdulmohsen, Sandra Parker, Michael Braden, Mangala P. Patel
ObjectivesTo develop two experimental temporary crown and bridge materials with improved physicomechanical properties.MethodsCommercial materials: Trim (TR, monomethacrylate, Bosworth) and Quicktemp2 (QT, dimethacrylate, Schottlander). Experimental materials: isobutyl methacrylate/poly(ethyl methacrylate) (IBMA/PEM) and n-butyl methacrylate/PEM (nBMA/PEM), both monomethacrylates. For water absorption/desorption studies rectangular samples (40mm×10mm×1mm) of each material were prepared, immersed in deionized water (DW, control) and artificial saliva (AS), and weighed at regular time intervals. %solubility and diffusion coefficients (D) for uptake/loss processes were calculated and compared with theoretical predictions. Polymerization exotherm (cylindrical samples 10mm×18mm) and flexural moduli were measured (three point bending; rectangular samples 80mm×10mm×4mm, dry and after 9 days storage in DW). The data were compared statistically.ResultsQT and nBMA/PEM had lower %equilibrium uptakes/loss in DW (0.68%/0.884% and 0.64%/0.895% respectively). QT had the lowest water absorption/desorption D (P<0.05) compared to the three monomethacrylates, in DW and AS. %solubility for all systems showed no differences in DW (P>0.05), but a difference for QT in AS (P<0.05). QT reached its maximum temperature rapidly (∼2min; 3 monomethacrylates ∼7–13min). The commercial materials exhibited high peak temperatures (∼51°C, P<0.05; experimental materials ∼43°C). QT had a higher flexural modulus (∼4GPa; 3 monomethacrylates ∼0.7–1GPa) for dry and wet samples. The moduli for commercial materials reduced significantly after immersion in DW; there was no difference between the dry and wet experimental materials samples (P>0.05).SignificanceThe experimental materials merit further studies since they presented with lower setting exotherms, and contained no phthalate plasticizer, thus being less of a risk to patients.



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Confocal laser scanning microscopy and area-scale analysis used to quantify enamel surface textural changes from citric acid demineralization and salivary remineralization in vitro

Publication date: Available online 31 December 2015
Source:Dental Materials
Author(s): R.S. Austin, C.L. Giusca, G. Macaulay, R. Moazzez, D.W. Bartlett
ObjectivesThis paper investigates the application of confocal laser scanning microscopy to determine the effect of acid-mediated erosive enamel wear on the micro-texture of polished human enamel in vitro.MethodsTwenty polished enamel samples were prepared and subjected to a citric acid erosion and pooled human saliva remineralization model. Enamel surface microhardness was measured using a Knoop hardness tester, which confirmed that an early enamel erosion lesion was formed which was then subsequently completely remineralized. A confocal laser scanning microscope was used to capture high-resolution images of the enamel surfaces undergoing demineralization and remineralization. Area-scale analysis was used to identify the optimal feature size following which the surface texture was determined using the 3D (areal) texture parameter Sa.ResultsThe Sa successfully characterized the enamel erosion and remineralization for the polished enamel samples (P<0.001).SignificanceAreal surface texture characterization of the surface events occurring during enamel demineralization and remineralization requires optical imaging instrumentation with lateral resolution <2.5μm, applied in combination with appropriate filtering in order to remove unwanted waviness and roughness. These techniques will facilitate the development of novel methods for measuring early enamel erosion lesions in natural enamel surfaces in vivo.



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Bilateral renal lymphoangiomatosis.

Bilateral renal lymphoangiomatosis.

Int J Surg Case Rep. 2015 Dec 7;19:66-68

Authors: Raed A, Sultan A, Bader AM

Abstract
INTRODUCTION: Renal lymphangiomatosis is a rare congenital benign disease of renal lymphatic system, here we are presenting a very rare form of disease which is bilateral form.
PRESENTATION OF THE CASE: A young adult presented to our clinic after being referred from primary care clinic with intermittent bilateral flank pain and no other symptoms after extensive radiological investigations diagnosis has been made and confirmed by radiological finding of disease. Active treatment usually preserved for complex cases and for the complications of the disease but in our patient as needed analgesia worked well in controlling his intermittent pain and his wish not to pursue any intervention. The vague presentation with initial imaging rising suspicion of renal tumor or complex renal cyst might cause psychological street on the patient, which our patient had, but reassurance after extensive radiological work up relive that's stress.
DISCUSSION: Although it is very rare disease to be bilateral but wide variety of other differential diagnoses make importance of disease recognition and accurate diagnosis is the key.
CONCLUSION: Renal lymphangiomatosis is a rare benign disease of renal lymphatic, which usually affect one side, but bilateral form is very rare form, which may raise the suspicions of genetic form of renal malignancy. Accurate diagnosis requires work up to role out malignant and other renal tumor, which require active surgical management.

PMID: 26719997 [PubMed - as supplied by publisher]

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Unilateral lower limb lymphedema resulting from a heart surgery performed 50 years prior.

Unilateral lower limb lymphedema resulting from a heart surgery performed 50 years prior.

Int J Surg Case Rep. 2015 Dec 17;19:63-65

Authors: Onoda S, Miura Y, Sugiyama N

Abstract
INTRODUCTION: Lymphedema is classified into two main types: secondary lymphedema accompanied by lymph node excision surgery or radiotherapy; and idiopathic lymphedema. Here we experienced a very rare case of lymphatic edema resulting from cardiac surgery that the patient underwent 50 years previously.
PRESENTATION OF CASE: A 62-year-old woman experienced progressive unilateral lower leg lymphedema for recent years. After undergoing cardiac surgery at another hospital at the age of 12 years, she gradually developed left lower leg edema. The cause of the edema was unclear and it remained untreated. Her edema symptoms gradually worsened in recent years, so she consulted the plastic surgery division of our hospital.
DISCUSSSION: Perhaps the lymphatic structures of affected individuals differ prior to disease onset. If the mechanism of lymphatic edema outbreak is elucidated, patients needing conservative and surgical therapy might be more easily identified. Knowing the outbreak mechanism of lymphatic edema would definitely ease the investigation of an unconventional case like this one. Conservative treatments for lymphedema, such as self-massage and compression therapy using garments, were immediately started. With these treatments, the leg volume and edema symptoms reduced.
CONCLUSION: The research on the cause of this case may be important step for elucidating the source of secondary lymphatic edema.

PMID: 26719996 [PubMed - as supplied by publisher]

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Primary aorto-enteric fistula.

Primary aorto-enteric fistula.

Int J Surg Case Rep. 2015 Dec 17;19:60-62

Authors: Gordon AC, Agarwal M

Abstract
INTRODUCTION: Primary aorto-enteric fistula (PAEF) is a life threatening, spontaneous erosion and communication of the aorta and intestinal tract. Unlike secondary AEF, which occur following aortic surgery, they are extremely rare. The low clinical suspicion and difficulty in obtaining a definitive diagnosis make for a dismal prognosis.
CASE PRESENTATION: A literature review highlighted aetiology which included gallstone erosion, carcinoma of the pancreas and duodenal diverticulum. With written consent, we present the case of a 59 year old female, brought to the hospital following an episode of haematemesis and later found to have an AEF, secondary to metastatic retroperitoneal carcinoma - an extremely rare aetiology.
DISCUSSION: There is far less literature on primary AEF when compared to secondary AEF. Furthermore, there is a variation in aetiology. Identifying the presence of a 'herald' bleed appears to be significant.
CONCLUSION: Aorto-enteric fistulae must always be considered as a potential diagnosis in the setting of an acute upper GI haemorrhage with no apparent cause.

PMID: 26719995 [PubMed - as supplied by publisher]

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Efficacy of cervical and ocular vestibular-evoked myogenic potentials in evaluation of benign paroxysmal positional vertigo of posterior semicircular canal.

Efficacy of cervical and ocular vestibular-evoked myogenic potentials in evaluation of benign paroxysmal positional vertigo of posterior semicircular canal.

Eur Arch Otorhinolaryngol. 2015 Dec 30;

Authors: Singh NK, Apeksha K

Abstract
Benign paroxysmal positional vertigo (BPPV) constitutes a major proportion of the population with peripheral vestibulopathies. Although the freely floating otoconia within the semicircular canals is responsible for the symptoms of BPPV, the source of the otoconia debris is mainly believed to be the otolith organs. Therefore, the pathology in either or both the otolith organs appears a logical proposition. Cervical and ocular vestibular-evoked myogenic potentials (cVEMP and oVEMP), being the tests for functional integrity of the otolith organs, appear promising for investigating otolith involvement in BPPV. While recent evidences are suggestive of equivocal findings for cVEMP, there are only a few studies on oVEMP. Additionally, both these potentials have never been explored in the same set of individuals with BPPV. Therefore, the present study aimed to evaluate the functional integrity of the otolith organs through cVEMP and oVEMP in individuals with posterior canal BPPV. Thirty-one individuals with unilateral posterior canal BPPV and 31 age- and gender-matched healthy controls underwent 500 Hz tone-burst-evoked cVEMP and oVEMP. The results demonstrated no significant group difference on any of the cVEMP parameters (p > 0.05). A similar trend was noticed for the latency-related parameters of oVEMP. However, the peak-to-peak amplitude was significantly smaller in the affected ears of individuals with BPPV than their unaffected ears and the ears of healthy controls (p < 0.05). The BPPV group showed significantly higher inter-aural amplitude difference ratio than the healthy controls (p < 0.05). Further, the sensitivity and specificity of oVEMP were also found to be far superior to those of cVEMP. Thus, the outcome of the present study revealed involvement of utricle rather than saccule in posterior canal BPPV, and therefore, oVEMP appears to be better suited to clinical investigation than cVEMP in individuals with posterior canal BPPV.

PMID: 26718546 [PubMed - as supplied by publisher]

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Localization techniques for guided surgical excision of non-palpable breast lesions.

Localization techniques for guided surgical excision of non-palpable breast lesions.

Cochrane Database Syst Rev. 2015 Dec 31;12:CD009206

Authors: Chan BK, Wiseberg-Firtell JA, Jois RH, Jensen K, Audisio RA

Abstract
BACKGROUND: Breast cancer is the most common form of cancer and the second leading cause of death amongst women in Europe. Amongst five invasive cancers per 1000 women detected in screening, 2.7 were < 15 mm in diameter; and others reported that over one third of excised breast lesions were clinically occult. The challenge is to accurately locate small non-palpable lesions intraoperatively for optimal therapeutic outcome. A secondary important goal is to remove the smallest amount possible of healthy glandular tissue for optimal cosmesis. Currently the most widely adopted approach (80% in one survey) in guided breast-conserving surgery for excising non-palpable breast lesions is wire-guided localization (WGL). With the clinical setting shifting towards earlier non-palpable breast lesions being detected through screening, we investigated whether the current standard in assisting surgical excision of these lesions, WGL, yields the best therapeutic outcome for women with breast cancer.
OBJECTIVES: To assess the therapeutic outcomes of any new form of guided surgical intervention for non-palpable breast lesions against wire-guided localization, the current gold standard.
SEARCH METHODS: We searched the Cochrane Breast Cancer Group's (CBCG) Specialized Register, MEDLINE (via PubMed), the Cochrane Central Register of Controlled Trials (CENTRAL), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal from the earliest available date up to 30 March 2015. We also handsearched recent conference proceedings and sought information from experts in the field.
SELECTION CRITERIA: Two review authors, BC and RJ, independently screened by title and abstract the studies we had identified through the search strategy; when this was inconclusive, they examined the full-text article for inclusion. We resolved any discrepancies regarding eligibility by discussion with a third review author, RA.
DATA COLLECTION AND ANALYSIS: Three review authors, BC, JW, and RJ, independently extracted data using a standardized data sheet. We performed all analyses using Review Manager (RevMan) or the R meta package, and in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. We reported results via a graphical assessment using forest plots showing the study estimates. We considered and discussed additional subgroup and sensitivity analyses.
MAIN RESULTS: We identified 11 randomized controlled trials (RCTs) that met the inclusion criteria of this Cochrane review and included eight trials in the meta-analyses. Six RCTs compared radioguided occult lesion localization (ROLL) versus WGL, and two RCTs compared radioactive iodine ((125)I) seed localization (RSL) versus WGL. Of the three remaining trials, one RCT compared cryo-assisted techniques (CAL) versus WGL, one compared intraoperative ultrasound-guided lumpectomy (IOUS) versus WGL, and one compared modified ROLL technique in combination with methylene dye (RCML) versus WGL. Of the trials we included in the meta-analysis, there were a total of 1273 participants with non-palpable breast lesions (627 participants (WGL); 443 participants (ROLL); and 203 participants (RSL)). The participant population varied considerably between included trials, which included participants with both non-palpable benign and malignant lesions, and varied in defining clear margins. The included trials did not report any long-term outcomes.In general, the outcomes of WGL, ROLL and RSL were comparable.ROLL demonstrated favourable results in successful localization (risk ratio (RR) 0.60, 95% confidence interval (CI) 0.16 to 2.28; 869 participants; six trials), positive excision margins (RR 0.74, 95% CI 0.42 to 1.29; 517 participants; five trials), and re-operation rates (RR 0.51, 95% CI 0.21 to 1.23; 583 participants; four trials) versus WGL, but none were statistically significant. WGL was significantly superior to RSL in successfully localizing non-palpable lesions (RR 3.85, 95% CI 1.21 to 12.19; 402 participants; two trials). However, for successful excision, ROLL and RSL have comparable outcomes versus WGL (ROLL versus WGL: RR 1.00, 95% CI 0.99 to 1.01; 871 participants; six trials; RSL versus WGL: RR 1.00, 95% CI 0.99 to 1.01; 402 participants; two trials). These findings were similar in that RSL demonstrated favourable results over WGL in positive tumour margins (RR 0.67, 95% CI 0.43 to 1.06; 366 participants; two trials), and re-operation rates (RR 0.80, 95% CI 0.48 to 1.32; 305 participants; one trial) but neither reached statistical significance. In contrast, WGL had fewer postoperative complications to both ROLL (RR 1.18, 95% CI 0.71 to 1.98; 642 participants; four trials) and RSL (RR 1.51, 95% CI 0.75 to 3.03; 305 participants; one trial), although this was also not statistically significant.The overall quality of evidence was good. The main risk of bias amongst included studies consisted of incomplete data sets, selective reporting, and allocation concealment. Interpretation and applicability of this meta-analysis was hindered by the mixed indication of diagnostic versus therapeutic purposes when undertaking WGL, ROLL, or RSL, leading to a high level of mixed pathology in numerous trials. Other limitations include underpowered studies, lack of data in standardized format for meta-analysis, lack of complete data amongst the trials, and absence of long-term data.
AUTHORS' CONCLUSIONS: Owing to a lack of trials in certain localization techniques, we could only draw conclusions about ROLL and RSL versus WGL. There is no clear evidence to support one guided technique for surgically excising a non-palpable breast lesion over another. Results from this Cochrane review support the continued use of WGL as a safe and tested technique that allows for flexibility in selected cases when faced with extensive microcalcification. ROLL and RSL could be offered to patients as a comparable replacement for WGL as they are equally reliable. Other techniques such as IOUS, RCML, and CAL are of academic interest, but recommendation for routine use in the clinical environment and oncological outcomes require further validation. The results of this Cochrane review also stress the need for more fully powered RCTs to evaluate the best technique according to the comprehensive criteria described, with a more consistent and standardized approach in outcome reporting.

PMID: 26718728 [PubMed - as supplied by publisher]

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Clinical efficacy of computed tomography-guided iodine-125 seed implantation therapy in patients with advanced spinal metastatic tumors.

Clinical efficacy of computed tomography-guided iodine-125 seed implantation therapy in patients with advanced spinal metastatic tumors.

Onco Targets Ther. 2016;9:7-12

Authors: Zhang L, Lu J, Wang Z, Cheng Y, Teng G, Chen K

Abstract
OBJECTIVE: The purpose of this study was to examine the safety and clinical efficacy of computed tomography (CT)-guided radioactive iodine-125 ((125)I) seed implantation treatment in patients with spinal metastatic tumors.
METHODS: We retrospectively analyzed 20 cases of spinal metastatic tumors, including nine men and eleven women aged 50-79 years (mean age: 61.1 years). We used treatment planning system (TPS) to construct three-dimensional images of the spinal metastatic tumors and to determine what number and dose rate distribution to use for the (125)I seeds. The matched peripheral dose of the (125)I seed implantation was 90-130 Gy. Twenty-four spinal metastatic tumors were treated by CT-guided radioactive (125)I seed implantation. A median of 19 (range: 4-43) (125)I seeds were implanted.
RESULTS: Twenty cases were followed for a median of 15.3 months (range: 7-32 months). The rate of pain relief was 95%. The median control time for all of the patients was 12.5 months. The 3-, 6-, and 12-month cumulative local control rates were 100%, 95%, and 60%, respectively. The median survival time for all of the patients was 16 months. The cumulative 6- and 12-month survival rates were 100% and 78.81%, respectively. No major complications were observed. No (125)I seeds were lost or migrated to other tissues or organs.
CONCLUSION: CT-guided radioactive (125)I seed implantation is a safe, effective, and minimally invasive method for the treatment of patients with spinal metastatic tumors. It is a possible alternative therapy for the treatment of spinal metastases.

PMID: 26719712 [PubMed]

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Sudden cardiac arrest as a presentation of Brugada syndrome unmasked by thyroid storm.

Sudden cardiac arrest as a presentation of Brugada syndrome unmasked by thyroid storm.

BMJ Case Rep. 2015;2015

Authors: Korte AK, Derde L, van Wijk J, Tjan DH

Abstract
An 18-year-old man suffered a sudden cardiac arrest with ventricular fibrillation and was successfully resuscitated. He had neither a medical nor family history of cardiac disease/sudden death, but was known to have Graves' disease, for which he was treated with radioactive iodine. Recently, block-and-replacement therapy had been discontinued to evaluate thyroid functioning. On admission, thyroid hormone levels were markedly elevated, suggesting thyroid storm due to residual Graves' disease. The patient was treated with propylthiouracil, hydrocortisone and Lugol solution. ECG showed repolarisation patterns suggestive of an underlying type 1 Brugada syndrome (BS). These findings were confirmed by an additional ajmaline test. An implantable cardioverter defibrillator was implanted to prevent future arrhythmias. The patient underwent total thyroidectomy 9 months later and recovered completely. To the best of our knowledge, this is the first reported case of a sudden cardiac arrest as a presentation of BS unmasked by thyroid storm.

PMID: 26718704 [PubMed - in process]

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Gliofibroma: Report of Four Cases and Review of the Literature.

Gliofibroma: Report of Four Cases and Review of the Literature.

Fetal Pediatr Pathol. 2015 Dec 31;:1-12

Authors: Jones MC, Díaz V, D'Agustini M, Altamirano E, Baglieri N, Drut R

Abstract
Gliofibroma is a relatively rare variant of a mixed glial-fibrous tumor more frequent in children than in adults. It has been reported to appear all along the neuraxis, with predilection for the midline. Its evolution is usually benign, although few examples have shown either multiple sites of involvement or leptomeningeal dissemination. Some authors regard it as part of the desmoplastic astrocytoma spectrum. We report here four examples of this rare condition which exemplify its histological patterns and biological behavior, and provide a review of the literature. Even though this tumor is commonly regarded as heterogeneous and with variable course, our literature review points to a set of clinical and pathological traits that are constant, such as age, location and gross and histological characteristics, as well as a predictable evolution. Currently, this tumor is not included in the WHO Classification of CNS tumors.

PMID: 26720861 [PubMed - as supplied by publisher]

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Validation of Clinicoradiological Criteria for the Diagnosis of Cerebral Amyloid Angiopathy-Related Inflammation.

Validation of Clinicoradiological Criteria for the Diagnosis of Cerebral Amyloid Angiopathy-Related Inflammation.

JAMA Neurol. 2015 Dec 28;:1-6

Authors: Auriel E, Charidimou A, Gurol ME, Ni J, Van Etten ES, Martinez-Ramirez S, Boulouis G, Piazza F, DiFrancesco JC, Frosch MP, Pontes-Neto OV, Shoamanesh A, Reijmer Y, Vashkevich A, Ayres AM, Schwab KM, Viswanathan A, Greenberg SM

Abstract
Importance: Cerebral amyloid angiopathy-related inflammation (CAA-ri) is an important diagnosis to reach in clinical practice because many patients with the disease respond to immunosuppressive therapy. Reliable noninvasive diagnostic criteria for CAA-ri would allow some patients to avoid the risk of brain biopsy.
Objective: To test the sensitivity and specificity of clinical and neuroimaging-based criteria for CAA-ri.
Design, Setting, and Participants: We modified the previously proposed clinicoradiological criteria and retrospectively analyzed clinical medical records and magnetic resonance imaging fluid-attenuated inversion recovery and gradient-echo scans obtained from individuals with CAA-ri and noninflammatory CAA. At 2 referral centers between October 1, 1995, and May 31, 2013, and between January 1, 2009, and December 31, 2011, participants included 17 individuals with pathologically confirmed CAA-ri and 37 control group members with pathologically confirmed noninflammatory CAA. The control group was further divided into those with past lobar intracerebral hemorrhage (ICH) (n = 21) and those with cerebral microbleeds only and no history of ICH (n = 16). The dates of our analysis were September 1, 2012, to August 31, 2015.
Main Outcomes and Measures: The sensitivity and specificity of prespecified criteria for probable CAA-ri (requiring asymmetric white matter hyperintensities extending to the subcortical white matter) and possible CAA-ri (not requiring the white matter hyperintensities to be asymmetric).
Results: The 17 patients in the CAA-ri group were a mean (SD) of 68 (8) years and 8 (47%) were women. In the CAA-ri group, 14 of 17 (82%) met the criteria for both probable and possible CAA-ri. In the control group having noninflammatory CAA with lobar ICH, 1 of 21 (5%) met the criteria for possible CAA-ri, and none met the criteria for probable CAA-ri. In the control group having noninflammatory CAA with no ICH, 11 of 16 (69%) met the criteria for possible CAA-ri, and 1 of 16 (6%) met the criteria for probable CAA-ri. These findings yielded a sensitivity and specificity of 82% and 97%, respectively, for the probable criteria and a sensitivity and specificity of 82% and 68%, respectively, for the possible criteria.
Conclusions and Relevance: Our data suggest that a reliable diagnosis of CAA-ri can be reached from basic clinical and magnetic resonance imaging information alone, with good sensitivity and excellent specificity.

PMID: 26720093 [PubMed - as supplied by publisher]

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Air pollution, a rising environmental risk factor for cognition, neuroinflammation and neurodegeneration: The clinical impact on children and beyond.

Air pollution, a rising environmental risk factor for cognition, neuroinflammation and neurodegeneration: The clinical impact on children and beyond.

Rev Neurol (Paris). 2015 Dec 21;

Authors: Calderón-Garcidueñas L, Leray E, Heydarpour P, Torres-Jardón R, Reis J

Abstract
Air pollution (indoors and outdoors) is a major issue in public health as epidemiological studies have highlighted its numerous detrimental health consequences (notably, respiratory and cardiovascular pathological conditions). Over the past 15years, air pollution has also been considered a potent environmental risk factor for neurological diseases and neuropathology. This review examines the impact of air pollution on children's brain development and the clinical, cognitive, brain structural and metabolic consequences. Long-term potential consequences for adults' brains and the effects on multiple sclerosis (MS) are also discussed. One challenge is to assess the effects of lifetime exposures to outdoor and indoor environmental pollutants, including occupational exposures: how much, for how long and what type. Diffuse neuroinflammation, damage to the neurovascular unit, and the production of autoantibodies to neural and tight-junction proteins are worrisome findings in children chronically exposed to concentrations above the current standards for ozone and fine particulate matter (PM2.5), and may constitute significant risk factors for the development of Alzheimer's disease later in life. Finally, data supporting the role of air pollution as a risk factor for MS are reviewed, focusing on the effects of PM10 and nitrogen oxides.

PMID: 26718591 [PubMed - as supplied by publisher]

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Hard to Swallow: A Phenomenological Exploration of the Experience of Caring for Individuals With Myotonic Dystrophy and Dysphagia.

Hard to Swallow: A Phenomenological Exploration of the Experience of Caring for Individuals With Myotonic Dystrophy and Dysphagia.

J Neurosci Nurs. 2016 Feb;48(1):42-51

Authors: LaDonna KA, Koopman WJ, Ray SL, Venance SL

Abstract
PURPOSE: Myotonic dystrophy (DM1), a genetic, multisystemic disorder, is the most prevalent adult form of muscular dystrophy. Dysphagia is a common symptom that may be difficult to diagnose and treat and can be associated with increased morbidity and mortality. Preexisting cognitive impairment or apathy, both well described in the DM1 literature, may contribute to management challenges. Caregivers may become important for managing a family member's swallowing dysfunction. Although clinicians place great importance on swallowing difficulties, it is unknown how dysphagia impacts patients and their caregivers. Therefore, the purpose of this study was to explore the experiences of caregivers living with those with DM1and dysphagia.
METHODS: An interpretive phenomenological approach was used to study the lived experience of six caregivers for individuals with DM1 and dysphagia. Audio-taped semistructured interviews were used for data collection, and data were analyzed using van Manen's steps for phenomenological analysis.
FINDINGS: Despite the potential for dysphagia to cause morbidity and mortality in individuals with DM1, caregivers did not describe this as a problematic symptom. Instead, they highlighted more debilitating symptoms like fatigue or weakness and discussed the caregiving experience. Themes pertaining to participants' lived body, lived relationality, lived time, and lived space were identified.
CONCLUSIONS: Healthcare providers need to balance issues of clinical concern with those that are important for individuals and their family members. Assessments of caregiver knowledge and burden at each clinic visit may be warranted.

PMID: 26720320 [PubMed - as supplied by publisher]

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What to do when people with Parkinson's disease cannot take their usual oral medications.

What to do when people with Parkinson's disease cannot take their usual oral medications.

Pract Neurol. 2015 Dec 30;

Authors: Alty J, Robson J, Duggan-Carter P, Jamieson S

Abstract
People with Parkinson's disease have limited brain reserves of endogenous dopamine; thus, their medications must not be omitted or delayed as this may lead to a significant drop in brain dopamine levels. This has two main clinical consequences: first, a deterioration in disease control, with distressing symptoms such as tremor, pain, rigidity, dysphagia and immobility, and second, an increased risk of developing the life-threatening complication of neuroleptic malignant-like syndrome. Common reasons for people with Parkinson's disease being unable to take their oral medications are neurogenic dysphagia from progressive disease or concurrent illness, gastroenteritis, iatrogenic 'nil by mouth' status especially perioperatively, and impaired consciousness level. Here we outline alternative methods to give dopaminergic drugs in the acute setting to people with Parkinson's disease who cannot take their usual oral treatment, namely using dispersible preparations in thickened fluids, an enteral tube, a transdermal patch or subcutaneous injections.

PMID: 26719485 [PubMed - as supplied by publisher]

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[Severe edematous dermatomyositis].

[Severe edematous dermatomyositis].

Ann Dermatol Venereol. 2015 Dec 21;

Authors: Goussot R, Wettlé C, Le Coz C, Cribier B, Lipsker D

Abstract
INTRODUCTION: Edematous dermatomyositis is a rare entity with localized or generalized subcutaneous edema and only 21cases have been reported in the literature. It is considered to be a severe form of dermatomyositis which needs quick therapeutic decision. We report 2cases with difficult therapeutic decisions.
OBSERVATIONS: Two patients aged 23 and 80years were admitted in hospital for DM with typical cutaneous and muscular involvement without any sign of gravity and which have been treated by steroids: methylprednisolone bolus and prednisone. They both then developed severe edema of the upper limbs as well as worsening of the cutaneous and muscular symptoms with dysphagia. The addition of mycophenolate mofetil and intravenous immunoglobulin has permitted in the case of the first patient the disappearance of the cutaneous symptoms in particular the edema with restitution of the muscular force and withdrawal of the dysphagia and swallowing symptoms. The therapeutic failure for the second patient was due to a refusal of the treatment and a probable paraneoplastic context.
CONCLUSION: Subcutaneous edema localized or generalized must not be confused with periorbital erythematous edema, classically observed in DM, nor with DM with mucinosis. Potential marker of gravity, it is often associated to important muscular weakness and dysphagia. In this case, an aggressive treatment associating corticosteroids, immunosuppressive therapy and intravenous immunoglobulin is necessary.

PMID: 26718900 [PubMed - as supplied by publisher]

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Progression of Jackhammer Esophagus to Type II Achalasia.

Progression of Jackhammer Esophagus to Type II Achalasia.

J Neurogastroenterol Motil. 2016 Jan 31;22(1):153-6

Authors: Abdallah J, Fass R

Abstract
It has been suggested that patients with certain motility disorders may progress overtime to develop achalasia. We describe a 66 year-old woman who presented with dysphagia for solids and liquids for a period of 18 months. Her initial workup showed normal endoscopy and non-specific esophageal motility disorder on conventional manometry. Six months later, due to persistence of symptoms, the patient underwent a high resolution esophageal manometry (HREM) demonstrating jackhammer esophagus. The patient was treated with a high dose proton pump inhibitor but without resolution of her symptoms. During the last year, the patient reported repeated episodes of food regurgitation and a significant weight loss. A repeat HREM revealed type II achalasia. Multiple case reports, and only a few prospective studies have demonstrated progression from certain esophageal motility disorders to achalasia. However, this report is the first to describe a case of jackhammer esophagus progressing to type II achalasia.

PMID: 26717932 [PubMed]

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Effect of submental sensitive transcutaneous electrical stimulation on virtual lesions of the oropharyngeal cortex.

Effect of submental sensitive transcutaneous electrical stimulation on virtual lesions of the oropharyngeal cortex.

Ann Phys Rehabil Med. 2015 Dec 21;

Authors: Cugy E, Leroi AM, Kerouac-Laplante J, Dehail P, Joseph PA, Gerardin E, Marie JP, Verin É

Abstract
OBJECTIVE: The aim of this study was to assess the effect of submental sensitive transcutaneous electrical stimulation (SSTES) on pharyngeal cortical representation after the creation of an oropharyngeal cortical virtual lesion in healthy subjects.
METHODS: Motor-evoked potential amplitude of the mylohyoid muscles was measured with transcranial magnetic stimulation (TMS), the oropharyngeal cortex was mapped by cartography, and videofluoroscopic parameters of swallowing function were measured before and after SSTES (at the end of SSTES [0min] and at 30 and 60min), after the creation of a cortical virtual lesion (repetitive TMS, 1Hz, 20min on the dominant swallowing hemisphere).
RESULTS: Nine subjects completed the study. After 20min of SSTES, motor-evoked potential amplitude increased (P<0.05), as did swallow reaction time after repetitive TMS, as seen on videofluoroscopy, which was reversed after electrical stimulation. On cortical mapping, the number of points with a cortical response increased in the dominant lesioned hemisphere (P<0.05), remaining constant at 60min (P<0.05).
CONCLUSION: SSTES may be effective for producing cortical plasticity for mylohyoid muscles and reverses oropharyngeal cortical inhibition in healthy subjects. It could be a simple non-invasive way to treat post-stroke dysphagia.

PMID: 26717886 [PubMed - as supplied by publisher]

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The use of polyacrylate-polyalcohol copolymer hydrogel in the endoscopic treatment of primary vesicoureteral reflux in children.

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The use of polyacrylate-polyalcohol copolymer hydrogel in the endoscopic treatment of primary vesicoureteral reflux in children.

J Pediatr Surg. 2015 Mar;50(3):485-8

Authors: Corbetta JP, Bortagaray JI, Weller S, Ruiz J, Burek C, Sager C, Durán V, Lopez JC

Abstract
BACKGROUND/PURPOSE: It is still under discussion which is the best tissue augmenting substance for the endoscopic treatment of children with vesicoureteral reflux (VUR). We describe our preliminary experience (September 2009-November 2011) with polyacrylate-polyalcohol copolymer hydrogel (PPCH).
METHODS: This is an observational, descriptive, prospective study which included 81 female and male patients (age 1-14 years) diagnosed with unilateral (n=45) and bilateral (n=36) primary VUR comprising a total of 117 refluxing renal units (RRU). Complex cases were excluded from the study. All patients were clinically and radiologically evaluated and those who met the inclusion criteria were treated endoscopically with a single subureteral injection of PPCH by a single surgeon. 11 patients (13.5%) had a pathological 99mTc-DMSA before treatment. The volume of injected product was measured in all cases. Results were considered successful if 6months postinjection, conventional voiding cystourethrogram (VCUG) revealed VUR was cured (Grade 0). Follow-up ranged from 7 to 32months.
RESULTS: The overall resolution rate based on the number of RRUs studied was 92.3% (108/117). The mean injected volume of PPCH per patient was 0.6ml. One patient with obstructive anuria required vesicoureteral reimplantation. Other complications were persistent, self-limiting hematuria (n=2); lumbar pain (n=4) and urinary tract infection with normal VCUG (n=4).
CONCLUSIONS: Our short term data show PPCH provides a high level of reflux resolution in selected patients. Long term follow-up is required.

PMID: 25746713 [PubMed - indexed for MEDLINE]

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Upper and lower esophageal sphincter kinetics are modified during maturation: effect of pharyngeal stimulus in premature infants.

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Upper and lower esophageal sphincter kinetics are modified during maturation: effect of pharyngeal stimulus in premature infants.

Pediatr Res. 2015 Jan;77(1-1):99-106

Authors: Jadcherla SR, Shubert TR, Gulati IK, Jensen PS, Wei L, Shaker R

Abstract
BACKGROUND: We hypothesized that changes in proximal and distal esophageal sphincter kinetics evoked upon pharyngeal provocation undergo longitudinal maturation.
METHODS: Pharyngeal stimulation-induced reflexes were characterized using novel pharyngo-esophageal motility methods in 19 healthy premature neonates, studied at 34.7 ± 0.8 wk (time-1) and 39.3 ± 1.1 wk postmenstrual age (time-2). Graded volumes of air (290 infusions) and sterile water (172 infusions) were infused to define sensory-motor characteristics of upstream (pharyngeal reflexive swallow, PRS) and downstream (pharyngo-lower esophageal sphincter relaxation reflex, PLESRR) esophageal reflexes. Data displayed as mean ± SE.
RESULTS: Threshold volumes were similar with air and water for PRS and PLESRR at time-1 and time-2. Multiple PRS responses were noted with water stimulus and were different between the media (time-1 vs. air, P < 0.0001; time-2 vs. air, P = 0.0003). Dose-response relationships for water were significant (P < 0.01 for PRS and PLESRR time-1 and time-2), but not with air.
CONCLUSION: Significantly, the recruitment frequency of PRS and PLESRR increases with maturation, liquid is a superior medium for evoking such swallowing reflexes, and stimulus-response relationships for these reflexes are evident. These changes in aerodigestive protective reflexive activity may indicate differences in modulation of excitatory and inhibitory pathways during longitudinal postnatal maturation.

PMID: 25279989 [PubMed - indexed for MEDLINE]

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Health effects of changes in the structure of dietary macronutrients intake in western societies.

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Health effects of changes in the structure of dietary macronutrients intake in western societies.

Rocz Panstw Zakl Hig. 2015;66(2):97-105

Authors: Okręglicka K

Abstract
A Western-type diet, characterized by a significant share of highly processed and refined foods and high content of sugars, salt, fat and protein from red meat, has been recognized as an important factor contributing to the development of metabolic disorders and the obesity epidemic around the world. Excessive body fat causes metabolic pathologies, such as insulin resistance, type 2 diabetes, dyslipidemia, cardiovascular diseases, hypertension, non-alcoholic fatty liver disease and cancer. According to the World Health Organization 1.5 billion adults are overweight, nearly 500 million are obese and 220 million suffer from type 2 diabetes. The Western-type diet is also associated with an increased incidence of chronic kidney disease. It is known that a combination of nutrients typical for this diet contributes to impaired renal function, renal steatosis and inflammation, hypertension and dysfunctional renal hormonal regulation. The Western diet is also associated with a chronic inflammatory process that is involved in all stages of atherosclerosis development and is increasingly recognized as a universal mechanism of various chronic degenerative diseases, such as autoimmune diseases, some neoplasms or osteoporosis. The present article is focused on the results of the most recent research investigating the effects of dietary macronutrients and the type of fatty acids on selected mechanisms associated with the occurrence of the most common diet-related diseases.

PMID: 26024397 [PubMed - indexed for MEDLINE]

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Advances in mechanisms, diagnosis, and treatment of pernicious anemia.

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Advances in mechanisms, diagnosis, and treatment of pernicious anemia.

Discov Med. 2015 Mar;19(104):159-68

Authors: Rojas Hernandez CM, Oo TH

Abstract
Pernicious anemia (PA) is an entity initially described in 1849 as a condition that consisted of pallor, weakness, and progressive health decline. Since then several advances led to the conclusion that PA is an autoimmune disease characterized by the deficient absorption of dietary cobalamin. It is currently recognized as the most common cause of cobalamin deficiency worldwide. We hereby review the current understanding of the disease and its neurological, hematological, and biochemical manifestations with emphasis on the diagnostic approach, treatment, and monitoring strategies. We propose an algorithm for the diagnostic approach considering the current performance and limitations of the available diagnostic tools for evaluation of cobalamin status and the presence of autoimmune chronic atrophic gastritis (CAG). Patients with PA require lifelong treatment with cobalamin replacement therapy. The current widely available treatment can be provided through enteral or parenteral cobalamin supplements, with comparable efficacy and tolerability.

PMID: 25828519 [PubMed - indexed for MEDLINE]

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Efficacy of cervical and ocular vestibular-evoked myogenic potentials in evaluation of benign paroxysmal positional vertigo of posterior semicircular canal.

Efficacy of cervical and ocular vestibular-evoked myogenic potentials in evaluation of benign paroxysmal positional vertigo of posterior semicircular canal.

Eur Arch Otorhinolaryngol. 2015 Dec 30;

Authors: Singh NK, Apeksha K

Abstract
Benign paroxysmal positional vertigo (BPPV) constitutes a major proportion of the population with peripheral vestibulopathies. Although the freely floating otoconia within the semicircular canals is responsible for the symptoms of BPPV, the source of the otoconia debris is mainly believed to be the otolith organs. Therefore, the pathology in either or both the otolith organs appears a logical proposition. Cervical and ocular vestibular-evoked myogenic potentials (cVEMP and oVEMP), being the tests for functional integrity of the otolith organs, appear promising for investigating otolith involvement in BPPV. While recent evidences are suggestive of equivocal findings for cVEMP, there are only a few studies on oVEMP. Additionally, both these potentials have never been explored in the same set of individuals with BPPV. Therefore, the present study aimed to evaluate the functional integrity of the otolith organs through cVEMP and oVEMP in individuals with posterior canal BPPV. Thirty-one individuals with unilateral posterior canal BPPV and 31 age- and gender-matched healthy controls underwent 500 Hz tone-burst-evoked cVEMP and oVEMP. The results demonstrated no significant group difference on any of the cVEMP parameters (p > 0.05). A similar trend was noticed for the latency-related parameters of oVEMP. However, the peak-to-peak amplitude was significantly smaller in the affected ears of individuals with BPPV than their unaffected ears and the ears of healthy controls (p < 0.05). The BPPV group showed significantly higher inter-aural amplitude difference ratio than the healthy controls (p < 0.05). Further, the sensitivity and specificity of oVEMP were also found to be far superior to those of cVEMP. Thus, the outcome of the present study revealed involvement of utricle rather than saccule in posterior canal BPPV, and therefore, oVEMP appears to be better suited to clinical investigation than cVEMP in individuals with posterior canal BPPV.

PMID: 26718546 [PubMed - as supplied by publisher]

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Association Between β-Genus Human Papillomavirus and Cutaneous Squamous Cell Carcinoma in Immunocompetent Individuals-A Meta-analysis.

Association Between β-Genus Human Papillomavirus and Cutaneous Squamous Cell Carcinoma in Immunocompetent Individuals-A Meta-analysis.

JAMA Dermatol. 2015 Dec 30;

Authors: Chahoud J, Semaan A, Chen Y, Cao M, Rieber AG, Rady P, Tyring SK

Abstract
Importance: Existing epidemiological evidence remains controversial regarding the association between β-genus human papillomavirus (β-HPV) and cutaneous squamous cell carcinoma (cSCC) in immunocompetent individuals.
Objective: We aimed to clarify this association and evaluate type-specific β-HPV involvement.
Data Sources: We performed a systematic literature search of MEDLINE and EMBASE for studies in humans through June 18, 2014, with no restriction on publication date or language. The following search terms were used: "human papillomavirus" and "cutaneous squamous cell carcinoma or skin squamous cell carcinoma or cSCC or nonmelanoma skin neoplasms."
Study Selection: Articles were independently assessed by 2 reviewers. We only included case-control or cohort studies, in immunocompetent individuals, that calculated the odds ratio (OR) for cSCC associated with overall and type-specific β-HPV.
Data Extraction and Synthesis: We first assessed the heterogeneity among study-specific ORs using the Q statistic and I2 statistic. Then, we used the random-effects model to obtain the overall OR and its 95% CI for all studies as well as for each type of HPV. We also tested and corrected for publication bias by 3 funnel plot-based methods. The quality of each study was assessed with The Newcastle Ottowa scale.
Main Outcomes and Measures: Pooled ORs and 95% CIs for overall β-HPV and HPV types 5, 8, 15, 17, 20, 24, 36, and 38 association with skin biopsy proven cSCC.
Results: Seventy-nine articles were assessed for elligibility; 14 studies met inclusion criteria for the meta-analysis and included 3112 adult immunocompetent study participants with cSCC and 6020 controls. For all detection methods, the overall association between β-HPV and cSCC was significant with an adjusted pooled OR (95% CI) of 1.42 (1.18-1.72). As for the type-specific analysis, types 5, 8, 15, 17, 20, 24, 36, and 38 showed a significant association with adjusted pooled ORs (95% CIs) of 1.4 (1.18-1.66), 1.39 (1.16-1.66), 1.25 (1.04-1.50), 1.34 (1.19-1.52), 1.38(1.21-1.59), 1.26 (1.09-1.44), 1.23 (1.01-1.50) and 1.37 (1.13-1.67) respectively. Our subgroup analysis in studies using only serology for HPV detection showed a significant association between overall β-HPV and HPV subtypes 5, 8, 17, 20, 24, and 38 with an increased risk of cSCC development.
Conclusions and Relevance: This study serves as added evidence supporting β-HPV as a risk factor for cSCC in healthy individuals. The subgroup analysis highlights this significant association for HPV 5, 8, 17, 20, and 38, which may help to direct future prevention efforts.

PMID: 26720285 [PubMed - as supplied by publisher]

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