Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Child Abuse Neglect: Mandatory Reporting for EMS Providers. What to took for, what to report and how.
EMS World. 2016 May;45(5):52-5
Authors: Concialdi M, Read S
PMID: 27337836 [PubMed - in process]
PART I. 7 Alternative EMS Careers. If you're tired of the 9-1-1 grind, opportunities abound for delivering nontraditional EMS.
EMS World. 2016 May;45(5):48-51
Authors: Rubin M
PMID: 27337835 [PubMed - in process]
The Assessment of IN PARAMEDIC PRACTICE. The alleviation of pain depends on the provider's ability to identify, measure and interpret it.
EMS World. 2016 May;45(5):40-7
Authors: Lord B
PMID: 27337834 [PubMed - in process]
FROM DEVASTATION TO DETERMINATION: The Heavy Burden of Pediatric Care in the field. Many EMS providers are suffering in silence from the toll of traumatic calls.
EMS World. 2016 May;45(5):36-9
Authors: Antevy P, Sobel R
PMID: 27337833 [PubMed - in process]
With some extra preparation, CPs are ideally suited to help this vulnerable population The Community Paramedic's Role in Treating Mental and Behavioral Health Patients. With some extra preparation, CPs are ideally suited to help this vulnerable population.
EMS World. 2016 May;45(5):33-4
Authors: Montera A
PMID: 27337832 [PubMed - in process]
BRINGING the STREETS to the Classroom. How supplementing classroom lectures with realistic simulation improves the EMS student's experience.
EMS World. 2016 May;45(5):26-30
Authors: Hooker D
PMID: 27337831 [PubMed - in process]
50 Pearls of Wisdom for New EMTs. Besides knowledge, a good EMT needs to be equipped with other things as well.
EMS World. 2016 May;45(5):23-5
Authors: Dick T
PMID: 27337830 [PubMed - in process]
The Secrets of a Successful Simulation Program. Technology and tools can improve the experience, but optimizing the benefit for training EMS providers requires a bit more.
EMS World. 2016 May;45(5):16-8, 20-2
Authors: Erich J
PMID: 27337829 [PubMed - in process]
Why You Need to Market Your Agency. When you're successful, your community needs to know.
EMS World. 2016 May;45(5):14
Authors: Ludwig G
PMID: 27337828 [PubMed - in process]
Powderful Distractions. Never let a chaotic scene cloud your judgment.
EMS World. 2016 May;45(5):12-3
Authors: Page D, Krost W
PMID: 27337827 [PubMed - in process]
Tetanus is caused by the tetanus neurotoxin (TeNT) and is one of the most dreaded diseases especially in the developing countries. The current vaccine against tetanus is based on an inactivated tetanus toxin, which is effective but has many drawbacks. In our previous study, we developed a recombinant tetanus vaccine based on protein TeNT-Hc, with clear advantages over the toxoid vaccine in terms of production, characterization, and homogeneity. In this study, the titers, growth extinction, and persistence of specific antibodies induced by the two types of vaccine in mice, rats, and cynomolgus monkeys were compared. The booster vaccination efficacy of the two types of vaccines at different time points and protection mechanism in animals were also compared. The recombinant tetanus vaccine induced persistent and better antibody titers and strengthened the immunity compared with the commercially available toxoid vaccine in animals. Our results provide a theoretical basis for the development of a safe and effective recombinant tetanus vaccine to enhance the immunity of adolescents and adults as a substitute for the current toxoid vaccine.
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2016-06-25T05-13-12Z
Source: International Journal of Livestock Research
Adakole Hyacinth Abu, Terzungwe Ahemen, Haaga E..
An experiment was conducted to investigate the effect of aqueous Gmelina arborea leaf extract on testicular morphometry, cauda epididymal sperm characteristics and organ weights of male rabbits. Thirty two (32) rabbit bucks, aged 9-11 weeks with an average weight of 1300g, were randomly allocated to four treatments comprising of varying concentrations (0, 200, 400 and 600ml of extract per liter of water) of Gmelina arborea leaf. Each treatment consisting of 8 animals per group was replicated 8 times with one animal per replicate. Animals were fed aqueous Gmelina arborea leaf extracts for a period of fourteen (14) weeks. At the end of the experimental trial, the bucks were sacrificed and testicular morphometry; caudal epididymal sperm characteristics and viscera organ weights were evaluated. The results showed significant (P
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Assessment of bariatric surgery efficacy on Obstructive Sleep Apnea (OSA).
Rev Port Pneumol (2006). 2016 Jun 20;
Authors: Quintas-Neves M, Preto J, Drummond M
Abstract
A worldwide rise in weight and obesity is taking place, associated with an increase in several comorbid conditions, such as Obstructive Sleep Apnea (OSA). Bariatric surgery is an effective treatment approach for obesity, with resultant improvement in obesity-related comorbidities. However, the relationship between this type of treatment and OSA is not well established. This systematic review aims to assess and characterize the impact that different types of bariatric surgery have on obese OSA patients. 22 articles with stated preoperative apnea-hypopnea index (AHI), apnea index (AI) or respiratory disturbance index (RDI) were analyzed in this review. A significant improvement in AHI/AI/RDI occurred after surgery, in addition to the foreseeable reduction in body mass index (BMI). Moreover, almost every study stated a postoperative reduction of the AHI to < 20/h and/or a >50% postoperative reduction of AHI, with few exceptions. The interventions with a combined malabsorptive and restrictive mechanism, like roux-en-Y gastric bypass (RYGB), were more efficacious in resolving and improving OSA than purely restrictive ones, like laparoscopic adjustable gastric banding (LAGB). In conclusion, bariatric surgery has a significant effect on OSA, leading to its resolution or improvement, in the majority of cases, at least in the short/medium term (1-2 years). However, the different results must be interpreted with caution as there are many potential biases resulting from heterogeneous inclusion criteria, duration of follow-up, diagnostic methodology and assessed variables.
PMID: 27339391 [PubMed - as supplied by publisher]
Review of controversies in management of non-benign meningioma.
J Clin Neurosci. 2016 Jun 20;
Authors: Paldor I, Awad M, Sufaro YZ, Kaye AH, Shoshan Y
Abstract
Meningiomas are one of the most common brain tumors. World Health Organisation (WHO) Grade II and Grade III meningiomas are grouped together as non-benign meningioma (NBM). There are several controversies surrounding NBM management, including the significance of extent of resection and the efficacy of post-operative radiation and drug treatment. We reviewed the literature to develop recommendations for management of NBM. The questions we sought to answer were: Does gross total resection (GTR) improve patient outcome? Is radiation therapy (RT) warranted after complete or after incomplete resection of NBM? What drug therapies have been proven to improve outcome in patients with NBM? We found that GTR improves outcome in WHO Grade II meningioma, and should be attempted whenever considered safe. GTR correlates less closely to outcome in Grade III meningioma compared to subtotal resection (STR). Extreme measures to completely resect Grade III meningioma are not warranted. RT following GTR of Grade II meningioma does not improve patient outcome, and may be reserved for recurrence. RT improves outcome following STR of Grade II meningioma. RT improves outcome after resection of Grade III meningioma. No drug therapy has been shown to improve outcome in NBM. This review elucidates recommendations for some of the controversies involving NBM.
PMID: 27338209 [PubMed - as supplied by publisher]
Cytological features of NUT midline carcinoma arising in sino-nasal tract and parotid gland: Report of two new cases and review of the literature.
Diagn Cytopathol. 2016 Jun 24;
Authors: Klijanienko J, Le Tourneau C, Rodriguez J, Caly M, Theocharis S
Abstract
Nuclear Protein in Testis (NUT) Midline Carcinoma (NMC) represents a recently described, uncommon, high-grade and extremely lethal malignancy mainly occurring in children and young adults. Such tumors are genetically characterized by chromosomal rearrangements of the NUT gene. Cytological description of NUT carcinoma is limited and only seven cases were reported up to date. We show here another two cases studied cytologically with molecular and immunohistochemical confirmation. In both cases smears were hypercellular and composed of isolated or clustered small to medium-sized in size with roundish and oval shape cells. Nuclei were either regular or roundish containing dusty chromatin and prominent nucleoli. Mitotic figures were prominent. Cytoplasm was scant, strongly basophilic. Cell debris, necrosis, and apoptosis were also prominent. One of the cases was studied by FISH and the second case was studied by RT-PCR and BRD4-NUT translocation was found in both cases. Moreover, the clinical evolution was aggressive in both cases with rapid fatal clinical outcome. NUT carcinomas are an underdiagnosed entity which should be taken into consideration when poorly differentiated carcinomas was diagnosed in children or young adults. Cytology material may be successfully used for morphological and molecular diagnosis. Diagn. Cytopathol. 2016. © 2016 Wiley Periodicals, Inc.
PMID: 27338676 [PubMed - as supplied by publisher]
Paraneoplastic Dermatomyositis Associated with Metastatic Seminoma.
Case Rep Urol. 2016;2016:7050981
Authors: Yoshie H, Nakazawa R, Usuba W, Kudo H, Sato Y, Sasaki H, Chikaraishi T
Abstract
We report the first case in Japan of paraneoplastic dermatomyositis with pure seminoma, a tumor that extremely rarely accompanies dermatomyositis. The patient presented to the hospital with muscle weakness and erythema and was diagnosed with dermatomyositis from skin biopsy. Routine radiological screening revealed testicular tumor and massive lymph node metastases. We initially performed orchiectomy along with conventional immunotherapy. However, muscle weakness gradually worsened, and he eventually showed dysphagia and forced respiration and became bedridden. Although he seemed close to being too unstable to tolerate further treatment, we started carefully adjusted chemotherapy comprising 4 courses of etoposide plus cisplatin, which proved highly successful. Lymph node metastases completely disappeared and swallowing and respiration fully normalized after completing chemotherapy. We believe that this clinical success was due to our decision to initiate chemotherapy even in such a weak patient.
PMID: 27340589 [PubMed]
Therapeutic effect of acupuncture combining standard swallowing training for post-stroke dysphagia: A prospective cohort study.
Chin J Integr Med. 2016 Jul;22(7):525-31
Authors: Mao LY, Li LL, Mao ZN, Han YP, Zhang XL, Yao JX, Li M
Abstract
OBJECTIVE: To assess the therapeutic effect of acupuncture combining standard swallowing training for patients with dysphagia after stroke.
METHODS: A total of 105 consecutively admitted patients with post-stroke dysphagia in the Affiliated Hospital of Gansu University of Chinese Medicine were included: 50 patients from the Department of Neurology and Rehabilitation received standard swallowing training and acupuncture treatment (acupuncture group); 55 patients from the Department of Neurology received standard swallowing training only (control group). Participants in both groups received 5-day therapy per week for a 4-week period. The primary outcome measures included the scores of Videofluoroscopic Swallow Study (VFSS) and the Standardized Swallowing Assessment (SSA); the secondary outcome measure was the Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS), all of which were assessed before and after the 4-week treatment.
RESULTS: A total of 98 subjects completed the study (45 in the acupuncture group and 53 in the control group). Significant differences were seen in VFSS, SSA and RBHOMS scores in each group after 4-week treatment as compared with before treatment (P<0.01). Comparison between the groups after 4-week treatment showed that the VFSS P=0.007) and SSA scores (P=0.000) were more significantly improved in the acupuncture group than the control group. However, there was no statistical difference (P=0.710) between the acupuncture and the control groups in RBHOMS scores.
CONCLUSIONS: Acupuncture combined with the standard swallowing training was an effective therapy for post-stroke dysphagia, and acupuncture therapy is worth further investigation in the treatment of post-stroke dysphagia.
PMID: 27339160 [PubMed - in process]
Reduced postoperative pain scores and narcotic use favor per-oral endoscopic myotomy over laparoscopic Heller myotomy.
Surg Endosc. 2016 Jun 23;
Authors: Docimo S, Mathew A, Shope AJ, Winder JS, Haluck RS, Pauli EM
Abstract
INTRODUCTION: Per-oral endoscopic myotomy (POEM) is a less invasive therapy for achalasia with a shorter hospitalization but with similar short- and long-term outcomes as a laparoscopic Heller myotomy (LHM). Previous literature comparing POEM to LHM has focused primarily on postoperative outcome parameters such as complications, dysphagia scores and gastro-esophageal reflux severity. This study specifically compares postoperative pain following POEM to pain following LHM, the current gold-standard operation.
METHODS: A retrospective review of all patients undergoing POEM or LHM for achalasia was performed from 2006 to 2015. Data collection included demographics, comorbidities, length of stay (LOS) and pain scores (arrival to the recovery room, 1 h postoperative, average first 24 h and upon discharge). Statistical analysis was performed using Student's t test and Chi-square test.
RESULTS: Forty-four POEM patients and 122 LHM patients were identified. The average age (52.2 ± 20.75 vs 50.9 ± 17.89 years, p = 0.306) and BMI (28.1 ± 7.62 vs 27.6 ± 7.07 kg/m(2), p = 0.824) did not differ between the POEM and LHM groups, respectively; however, the American Society of Anesthesiology scores were higher in the POEM patients (2.43 ± 0.62 vs 2.11 ± 0.71, p = 0.011). There were no differences in rates of smoking, diabetes, cardiac disease or pulmonary disease. The average pain scores upon arrival to the recovery room and 1 h postoperatively were lower in the POEM group (2.3 ± 3.014 vs 3.61 ± 3 0.418, p = 0.025 and 2.2 ± 2.579 vs 3.46 ± 3.063, p = 0.034, respectively). There was no difference in the average pain score over the first 24 h (2.7 ± 2.067 vs 3.29 ± 1.980, p = 0.472) or at the time of discharge (1.6 ± 2.420 vs 2.09 ± 2.157, p = 0.0657) between the POEM and LHM groups. After standardizing opioid administration against 10 mg of oral morphine, the POEM group used significantly less narcotics that the LHM group (35.8 vs 101.8 mg, p < 0.001) while hospitalized. The average LOS for the POEM group was 31.2 h and 55.79 for the LHM group (p < 0.0001). At discharge, fewer POEM patients required a prescription for a narcotic analgesic (6.81 vs 92.4 %, p < 0.0001).
CONCLUSION: POEM demonstrated significantly less postoperative pain upon arrival to the recovery room and 1 h postoperatively. To achieve similar pain scores during the first 24 h and at discharge, LHM patients required more narcotic analgesic administration. Despite a significantly shorter LOS, fewer POEM patients require a prescription for narcotic analgesics compared to LHM. POEM is a less painful procedure for achalasia than LHM, permitting earlier hospital discharge with little need for home narcotic use.
PMID: 27338580 [PubMed - as supplied by publisher]
The Nature of Exposure Drives Transmission of Nipah Viruses from Malaysia and Bangladesh in Ferrets.
PLoS Negl Trop Dis. 2016 Jun;10(6):e0004775
Authors: Clayton BA, Middleton D, Arkinstall R, Frazer L, Wang LF, Marsh GA
Abstract
Person-to-person transmission is a key feature of human Nipah virus outbreaks in Bangladesh. In contrast, in an outbreak of Nipah virus in Malaysia, people acquired infections from pigs. It is not known whether this important epidemiological difference is driven primarily by differences between NiV Bangladesh (NiV-BD) and Malaysia (NiV-MY) at a virus level, or by environmental or host factors. In a time course study, ferrets were oronasally exposed to equivalent doses of NiV-BD or NiV-MY. More rapid onset of productive infection and higher levels of virus replication in respiratory tract tissues were seen for NiV-BD compared to NiV-MY, corroborating our previous report of increased oral shedding of NiV-BD in ferrets and suggesting a contributory mechanism for increased NiV-BD transmission between people compared to NiV-MY. However, we recognize that transmission occurs within a social and environmental framework that may have an important and differentiating role in NiV transmission rates. With this in mind, ferret-to-ferret transmission of NiV-BD and NiV-MY was assessed under differing viral exposure conditions. Transmission was not identified for either virus when naïve ferrets were cohoused with experimentally-infected animals. In contrast, all naïve ferrets developed acute infection following assisted and direct exposure to oronasal fluid from animals that were shedding either NiV-BD or NiV-MY. Our findings for ferrets indicate that, although NiV-BD may be shed at higher levels than NiV-MY, transmission risk may be equivalently low under exposure conditions provided by cohabitation alone. In contrast, active transfer of infected bodily fluids consistently results in transmission, regardless of the virus strain. These observations suggest that the risk of NiV transmission is underpinned by social and environmental factors, and will have practical implications for managing transmission risk during outbreaks of human disease.
PMID: 27341030 [PubMed - as supplied by publisher]
A molecular epidemiological study of human respiratory syncytial virus in Croatia, 2011-2014.
Infect Genet Evol. 2016 Jun 20;
Authors: Slovic A, Ivancic-Jelecki J, Ljubin-Sternak S, Galinović GM, Forcic D
Abstract
Human respiratory syncytial virus (HRSV) causes common respiratory tract infections in infants, young children and the elderly. The diversity of HRSV strains circulating in Croatia was investigated throughout a period of four consecutive years from March 2011-March 2014. The analysis was based on sequences from the second hypervariable region of the G gene. A predominance of HRSV group A was observed in the first three years of the study, while group B became slightly predominant during the first few months of 2014. Overall, 76% of viruses belonged to group A including the genotypes NA1, ON1 and GA5. NA1 was by far the most common genotype within group A in 2011-2013; however, only ON1 and a few GA5 viruses were detected in the first three months of 2014. The majority of group B strains were of genotype BA9 (97%), and a few BA10 genotypes were detected. BA9 had the highest substitution rate of all the detected genotypes, followed by ON1. Multiple analyses showed that HRSV group A strains were more diverse than group B strains. Gly at residue 232 (previously described to be specific for ON1) was also detected in three NA1 strains, which were phylogenetically placed on separate branches within the NA1 genotype. For all genotypes, the diversity was higher at the amino acid level than at the nucleotide level, although positive selection of mutations was shown for only a few sites using four different methods of codon-based analysis of selective pressure. More codons were predicted to be negatively selected. The complexity of the HRSV pools present during each epidemic peak was determined and compared to previous epidemiological data. In addition to presenting genetic versatility of HRSV in this geographic region, the collected sequences provide data for further geographical and temporal comparative analyses of HRSV and its evolutionary pathways.
PMID: 27340014 [PubMed - as supplied by publisher]
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Mycoplasma hyopneumoniae management in gilts.
Vet Rec. 2016 Jan 30;178(5):122-3
Authors: Pieters M, Fano E
PMID: 26823313 [PubMed - indexed for MEDLINE]
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Phylogenetic Exploration of Nosocomial Transmission Chains of 2009 Influenza A/H1N1 among Children Admitted at Red Cross War Memorial Children's Hospital, Cape Town, South Africa in 2011.
PLoS One. 2015;10(11):e0141744
Authors: Valley-Omar Z, Nindo F, Mudau M, Hsiao M, Martin DP
Abstract
Traditional modes of investigating influenza nosocomial transmission have entailed a combination of confirmatory molecular diagnostic testing and epidemiological investigation. Common hospital-acquired infections like influenza require a discerning ability to distinguish between viral isolates to accurately identify patient transmission chains. We assessed whether influenza hemagglutinin sequence phylogenies can be used to enrich epidemiological data when investigating the extent of nosocomial transmission over a four-month period within a paediatric Hospital in Cape Town South Africa. Possible transmission chains/channels were initially determined through basic patient admission data combined with Maximum likelihood and time-scaled Bayesian phylogenetic analyses. These analyses suggested that most instances of potential hospital-acquired infections resulted from multiple introductions of Influenza A into the hospital, which included instances where virus hemagglutinin sequences were identical between different patients. Furthermore, a general inability to establish epidemiological transmission linkage of patients/viral isolates implied that identified isolates could have originated from asymptomatic hospital patients, visitors or hospital staff. In contrast, a traditional epidemiological investigation that used no viral phylogenetic analyses, based on patient co-admission into specific wards during a particular time-frame, suggested that multiple hospital acquired infection instances may have stemmed from a limited number of identifiable index viral isolates/patients. This traditional epidemiological analysis by itself could incorrectly suggest linkage between unrelated cases, underestimate the number of unique infections and may overlook the possible diffuse nature of hospital transmission, which was suggested by sequencing data to be caused by multiple unique introductions of influenza A isolates into individual hospital wards. We have demonstrated a functional role for viral sequence data in nosocomial transmission investigation through its ability to enrich traditional, non-molecular observational epidemiological investigation by teasing out possible transmission pathways and working toward more accurately enumerating the number of possible transmission events.
PMID: 26565994 [PubMed - indexed for MEDLINE]
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Historical evolution of human anthrax from occupational disease to potentially global threat as bioweapon.
Environ Int. 2015 Dec;85:133-46
Authors: D'Amelio E, Gentile B, Lista F, D'Amelio R
Abstract
PURPOSE: Anthrax is caused by Bacillus anthracis, which can naturally infect livestock, wildlife and occupationally exposed humans. However, for its resistance due to spore formation, ease of dissemination, persistence in the environment and high virulence, B. anthracis has been considered the most serious bioterrorism agent for a long time. During the last century anthrax evolved from limited natural disease to potentially global threat if used as bioweapon. Several factors may mitigate the consequences of an anthrax attack, including 1. the capability to promptly recognize and manage the illness and its public health consequences; 2. the limitation of secondary contamination risk through an appropriate decontamination; and 3. the evolution of genotyping methods (for microbes characterization at high resolution level) that can influence the course and/or focus of investigations, impacting the response of the government to an attack.
METHODS: A PubMed search has been done using the key words "bioterrorism anthrax".
RESULTS: Over one thousand papers have been screened and the most significant examined to present a comprehensive literature review in order to discuss the current knowledge and strategies in preparedness for a possible deliberate release of B. anthracis spores and to indicate the most current and complete documents in which to deepen.
CONCLUSIONS: The comprehensive analysis of the two most relevant unnatural anthrax release events, Sverdlovsk in the former Soviet Union (1979) and the contaminated letters in the USA (2001), shows that inhalational anthrax may easily and cheaply be spread resulting in serious consequences. The damage caused by an anthrax attack can be limited if public health organization, first responders, researchers and investigators will be able to promptly manage anthrax cases and use new technologies for decontamination methods and in forensic microbiology.
PMID: 26386727 [PubMed - indexed for MEDLINE]
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Synthetic cannabinoids as a cause for black carbonaceous bronchoalveolar lavage.
BMJ Case Rep. 2015;2015
Authors: Biswas A, Patel V, Jantz M, Mehta HJ
PMID: 26220985 [PubMed - indexed for MEDLINE]
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Cutaneous Cryptococcus: marker for disseminated infection.
BMJ Case Rep. 2015;2015
Authors: Srivastava GN, Tilak R, Yadav J, Bansal M
Abstract
Cryptococcosis is an infection caused by the encapsulated yeast, Cryptococcus neoformans, a dimorphic fungus recovered from pigeon excreta, soil, dust and human skin. After a primary infection in the lungs, the disease can disseminate via a haematogenous route to various organs, including the central nervous system and skin, in susceptible individuals. Cryptococcosis can present with a variety of skin and soft tissue manifestations including acneiform lesions, purpura, vesicles, nodules, abscesses, ulcers, granulomas, pustules, draining sinuses and cellulitis. We present a case of a young man with HIV infection who developed molluscum-like cutaneous lesions secondary to pulmonary cryptococcosis. The diagnosis was confirmed by Indian ink preparation of the cutaneous lesions. Primary cutaneous infection occurs rarely due to direct inoculation. Cutaneous lesions are usually secondary and act as a key marker of disseminated infection, especially in patients with impaired cell-mediated immunity, such as those infected with HIV, solid-organ transplant recipients, and those on chronic corticosteroid therapy.
PMID: 26199299 [PubMed - indexed for MEDLINE]
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A novel inhaled multi-pronged attack against respiratory bacteria.
Eur J Pharm Sci. 2015 Apr 5;70:37-44
Authors: Lee SH, Teo J, Heng D, Zhao Y, Ng WK, Chan HK, Tan LT, Tan RB
Abstract
Airway mucus hypersecretion is a common clinical feature of many severe respiratory diseases, and when complicated by a recalcitrant bacterial infection, the whole treatment regimen thereby becomes more challenging and protracted. The accumulation of thickened mucus secretions in the lower airways provides a nutrient-rich breeding ground for bacteria that promotes their growth and limits the ease of effective eradication. Unfortunately, no direct-inhaled dry powder formulation to treat these respiratory mucoid infections more effectively is available commercially. This work therefore seeks to develop a highly-efficacious ternary dry powder inhaler (DPI) formulation (ciprofloxacin hydrochloride (CIP), gatifloxacin hydrochloride (GAT) and ambroxol hydrochloride (AMB)) capable of delivering a novel multi-pronged attack (synergy, quorum quenching and mucociliary clearance) on Pseudomonas aeruginosa, a common respiratory bacteria found in mucoid infections. The powders were prepared via spray drying, evaluated on their aerosol performance via a multi-stage liquid impinger (MSLI) and tested for their efficacies in bacteria-spiked artificial sputum medium (ASM). The optimized particles were of respirable-size (d50 of ∼1.61±0.03μm) and slightly corrugated. When dispersed via an Aerolizer® inhaler at 60L/min, the powder showed concomitant in vitro deposition, minimal capsule, device and throat retention, and highly promising and uniform fine particle fractions (of the loaded dose) of ∼64-69%, which was a vast improvement over the singly-delivered actives. Favourably, when tested on bacteria-spiked ASM, the optimized ternary formulation (with AMB) was more effective at killing bacteria (i.e. faster rate of killing) than just the synergistic antibiotics alone (binary formulation; without AMB). In conclusion, a ternary antibiotic-(non-antibiotic) DPI formulation involving a unique multi-pronged attack mechanism was successfully pioneered and optimized for mucoid infections.
PMID: 25612805 [PubMed - indexed for MEDLINE]
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Intrapleural Antimicrobial Irrigation for Postpneumonectomy Empyema in Patients With Lung Cancer.
J Pharm Pract. 2015 Oct;28(5):469-72
Authors: Torbic H, Glasser N, Rostas SE, Alquwaizani M, Hacobian G
Abstract
PURPOSE: Postpneumonectomy empyema (PPE) is a possible complication after a pneumonectomy in patients with lung cancer. The use of intrapleural (IP) antibiotic irrigation to treat infections in the pleural space may be indicated after systemic antimicrobial therapy, and drainage of the pleural space has been insufficient.
METHODS: Adult patients ≥18 years old who received IP antibiotic irrigation between 2006 and 2011 were included. Demographic data, past medical history, surgical procedure, systemic antibiotics, and culture data were collected. Additionally, the IP antibiotic administered, the dose, and how it was prepared and administered were collected.
RESULTS: A total of 18 patients were evaluated in this retrospective descriptive analysis. The majority of patients underwent an extrapleural pneumonectomy (EPP; 72%). Most patients received systemic antibiotics before IP antibiotic administration (95%). Vancomycin was the most common antibiotic used for both systemic therapy (100%) and IP irrigation (94%). The median number of IP antibiotic doses received per patient was 5.5 (interquartile range [IQR] 1-9). Recurrence of PPE within 6 months of initial PPE resolution occurred in 28% of patients. Intrapleural antibiotic irrigation was well tolerated in all patients.
CONCLUSION: Vancomycin is most commonly used for IP antibiotic irrigation at our institution after patients have undergone a thoracic surgery, which was most commonly an EPP.
PMID: 25107425 [PubMed - indexed for MEDLINE]
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Improving Antibiotic De-Escalation in Suspected Ventilator-Associated Pneumonia: An Observational Study With a Pharmacist-Driven Intervention.
J Pharm Pract. 2015 Oct;28(5):457-61
Authors: Oxman DA, Adams CD, Deluke G, Philbrook L, Ireland P, Mitani A, Panizales C, Frendl G, Rogers SO
Abstract
BACKGROUND: Recommendations for treatment of ventilator-associated pneumonia (VAP) emphasize early empiric broad-spectrum antibiotics. However, appropriate antibiotic de-escalation is also critical for optimal patient care.
MATERIALS AND METHODS: We examined how often intensivists in our institution appropriately de-escalated antibiotics in cases of suspected VAP, and whether decision support by intensive care unit pharmacists could improve rates of antibiotic targeting and early antibiotic discontinuation in low-risk patients.
MAIN RESULTS: A total of 92 (observation phase = 50; intervention phase = 42) patients with suspected VAP were identified. During the observation phase, 39 cases yielded positive sputum cultures, but in only 23 (59%) were antibiotics targeted to culture results. This rate improved during the intervention phase when 29 (91%) of 32 cases with positive cultures were targeted (P value .003). There were 48 cases in which the risk of pneumonia was considered low. Of the 26 low-risk cases in the observation phase, 5 (19%) had antibiotics discontinued early versus 5 (23%) of the 22 cases in the intervention phase.
CONCLUSIONS: Decision support by clinical pharmacists significantly improved rates of appropriate antibiotic targeting in cases of culture-positive suspected VAP but did not have a significant effect on early antibiotic discontinuation in patients at low risk of true pneumonia.
PMID: 24651641 [PubMed - indexed for MEDLINE]
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EEG entropy measures indicate decrease of cortical information processing in Disorders of Consciousness.
Clin Neurophysiol. 2016 Feb;127(2):1419-27
Authors: Thul A, Lechinger J, Donis J, Michitsch G, Pichler G, Kochs EF, Jordan D, Ilg R, Schabus M
Abstract
OBJECTIVE: Clinical assessments that rely on behavioral responses to differentiate Disorders of Consciousness are at times inapt because of some patients' motor disabilities. To objectify patients' conditions of reduced consciousness the present study evaluated the use of electroencephalography to measure residual brain activity.
METHODS: We analyzed entropy values of 18 scalp EEG channels of 15 severely brain-damaged patients with clinically diagnosed Minimally-Conscious-State (MCS) or Unresponsive-Wakefulness-Syndrome (UWS) and compared the results to a sample of 24 control subjects. Permutation entropy (PeEn) and symbolic transfer entropy (STEn), reflecting information processes in the EEG, were calculated for all subjects. Participants were tested on a modified active own-name paradigm to identify correlates of active instruction following.
RESULTS: PeEn showed reduced local information content in the EEG in patients, that was most pronounced in UWS. STEn analysis revealed altered directed information flow in the EEG of patients, indicating impaired feed-backward connectivity. Responses to auditory stimulation yielded differences in entropy measures, indicating reduced information processing in MCS and UWS.
CONCLUSIONS: Local EEG information content and information flow are affected in Disorders of Consciousness. This suggests local cortical information capacity and feedback information transfer as neural correlates of consciousness.
SIGNIFICANCE: The utilized EEG entropy analyses were able to relate to patient groups with different Disorders of Consciousness.
PMID: 26480834 [PubMed - indexed for MEDLINE]
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Deep Brain Stimulation of Heschl Gyrus: Implantation Technique, Intraoperative Localization, and Effects of Stimulation.
Neurosurgery. 2015 Dec;77(6):940-7
Authors: Donovan C, Sweet J, Eccher M, Megerian C, Semaan M, Murray G, Miller J
Abstract
BACKGROUND: Tinnitus is a source of considerable morbidity, and neuromodulation has been shown to be a potential treatment option. However, the location of the primary auditory cortex within Heschl gyrus in the temporal operculum presents challenges for targeting and electrode implantation.
OBJECTIVE: To determine whether anatomic targeting with intraoperative verification using evoked potentials can be used to implant electrodes directly into the Heschl gyrus (HG).
METHODS: Nine patients undergoing stereo-electroencephalogram evaluation for epilepsy were enrolled. HG was directly targeted on volumetric magnetic resonance imaging, and framed stereotaxy was used to implant an electrode parallel to the axis of the gyrus by using an oblique anterolateral-posteromedial trajectory. Intraoperative evoked potentials from auditory stimuli were recorded from multiple electrode contacts. Postoperatively, stimulation of each electrode was performed and participants were asked to describe the percept. Audiometric analysis was performed for 2 participants during subthreshold stimulation.
RESULTS: Sounds presented to the contralateral and ipsilateral ears produced evoked potentials in HG electrodes in all participants intraoperatively. Stimulation produced a reproducible sensation of sound in all participants with perceived volume proportional to amplitude. Four participants reported distinct sounds when different electrodes were stimulated, with more medial contacts producing tones perceived as higher in pitch. Stimulation was not associated with adverse audiometric effects. There were no complications of electrode implantation.
CONCLUSION: Direct anatomic targeting with physiological verification can be used to implant electrodes directly into primary auditory cortex. If deep brain stimulation proves effective for intractable tinnitus, this technique may be useful to assist with electrode implantation.
ABBREVIATIONS: DBS, deep brain stimulatorEEG, electroencephalographyHG, Heschl gyrus.
PMID: 26280116 [PubMed - indexed for MEDLINE]
Survival and quality of life in oropharyngeal cancer patients treated with primary chemoradiation after salivary gland transfer.
J Laryngol Otol. 2016 Jun 24;:1-8
Authors: Morand GB, Madana J, Da Silva SD, Roskies M, Sultanem K, Black MJ, Mlynarek AM, Hier MP
Abstract
OBJECTIVES: Salivary gland transfer surgery can reduce xerostomia in oropharyngeal squamous cell carcinoma patients undergoing primary chemoradiation. A potential drawback of salivary gland transfer is the treatment delay associated with the surgery, and its complications. This study aimed to determine whether the treatment delay affects patient survival and to evaluate patient quality of life after salivary gland transfer.
METHODS: A retrospective analysis of 138 patients (salivary gland transfer group, n = 58; non-salivary gland transfer group, n = 80) was performed. Patient survival was compared between these groups using multivariate analysis. Salivary gland transfer patients were further evaluated for surgical complications and for quality of life using the head and neck module of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire.
RESULTS: Salivary gland transfer and non-salivary gland transfer patients had comparable baseline clinical characteristics. Salivary gland transfer patients experienced a median treatment delay of 16.5 days before chemoradiation (p = 0.035). Multivariate analysis showed that this did not, however, correspond to a survival disadvantage (p = 0.24 and p = 0.97 for disease-free and disease-specific survival, respectively). A very low complication rate was reported for the salivary gland transfer group (1.7 per cent). Questionnaire scores for the item 'xerostomia' were very low in salivary gland transfer patients.
CONCLUSION: The treatment delay associated with salivary gland transfer surgery does not negatively affect patient survival. Oropharyngeal squamous cell patients have an excellent quality of life after salivary gland transfer.
PMID: 27339712 [PubMed - as supplied by publisher]
Rhinoseptoplasty in children.
Braz J Otorhinolaryngol. 2016 May 31;
Authors: Maniglia CP, Maniglia JV
Abstract
INTRODUCTION: Untreated septal and/or nasal pyramid deviation in children should be corrected as soon as possible, because they can result in esthetic or functional problems years later.
OBJECTIVE: To report the surgical experience in treating children with nasal septum and/or nasal pyramid deviation.
METHODS: Review of medical records of 202 children, 124 (61.4%) males and 78 (38.6%) females, between 4 and 16 years of age (M=11 years) who underwent rhinoplasty and/or septoplasty in a Pediatric Otolaryngology Service of the Dept. of Otolaryngology and Head and Neck Surgery between January 1994 and January 2010.
RESULTS: Septoplasty performed in 157 cases (77.7%); rhinoseptoplasty in 23 cases (11.4%), and rhinoplasty in 22 cases (10.9%).
CONCLUSION: Nasal changes should be corrected in children, in order to provide harmonious growth, and prevent severe sequelae found in mouth breathers.
PMID: 27339699 [PubMed - as supplied by publisher]
Publication date: Available online 24 June 2016
Source:Gait & Posture
Author(s): Jennifer A. Nichols, Koren E. Roach, Niccolo M. Fiorentino, Andrew E. Anderson
Evidence suggests that the tibiotalar and subtalar joints provide near six degree-of-freedom (DOF) motion. Yet, kinematic models frequently assume one DOF at each of these joints. In this study, we quantified the accuracy of kinematic models to predict joint angles at the tibiotalar and subtalar joints from skin-marker data. Models included 1 or 3 DOF at each joint. Ten asymptomatic subjects, screened for deformities, performed 1.0m/s treadmill walking and a balanced, single-leg heel-rise. Tibiotalar and subtalar joint angles calculated by inverse kinematics for the 1 and 3 DOF models were compared to those measured directly in vivo using dual-fluoroscopy. Results demonstrated that, for each activity, the average error in tibiotalar joint angles predicted by the 1 DOF model were significantly smaller than those predicted by the 3 DOF model for inversion/eversion and internal/external rotation. In contrast, neither model consistently demonstrated smaller errors when predicting subtalar joint angles. Additionally, neither model could accurately predict discrete angles for the tibiotalar and subtalar joints on a per-subject basis. Differences between model predictions and dual-fluoroscopy measurements were highly variable across subjects, with joint angle errors in at least one rotation direction surpassing 10° for 9 out of 10 subjects. Our results suggest that both the 1 and 3 DOF models can predict trends in tibiotalar joint angles on a limited basis. However, as currently implemented, neither model can predict discrete tibiotalar or subtalar joint angles for individual subjects. Inclusion of subject-specific attributes may improve the accuracy of these models.
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Publication date: Available online 24 June 2016
Source:Gait & Posture
Author(s): Jesse V. Jacobs
Stairways are a common location for falls, and they result in a disproportionate risk of death or severe injury. Stairway falls are a significant problem across the lifespan and are often coincident with risky behaviors during stair use. The mechanics of successful stair negotiation for healthy young and older adults have been well described. These studies imply that current stair design does not offer an optimal universal design to meet the needs of older adults or people with health conditions. In addition, impaired stair negotiation associates with more than impaired strength, including functional impairments of cognitive load, sensory function and central motor coordination. Identification of behavioral strategies or stairway environments that assist or hinder recovery from a loss of balance on stairs remains incomplete. Therefore, future studies should investigate the mechanisms of balance recovery on stairs as well as the effectiveness of environmental interventions to mitigate stairway falls and injuries. Potential areas for evaluation may include modifying stair dimensions, surfaces, handrails, visual cues, and removing distractors of attention. Studies should also evaluate combinatorial interventions on person-related factors, such as behavioral interventions to decrease risky behaviors during stair use as well as interventions on cognitive, sensory, and motor functions relevant to stair use. Moreover, future studies should take advantage of new technologies to record stair use outside the laboratory in order to identify people or locations at risk for stairway falls. Such studies would inform the potential for broad-spectrum programs that decrease the risk of stairway falls and injuries.
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Listeners' identification and evaluation of Korean idiomatic utterances produced by persons with left- or right-hemisphere damage.
Clin Linguist Phon. 2016 Jun 24;:1-19
Authors: Yang SY, Sidtis D, Yang SN
Abstract
This study investigates the effects of left- (LHD) or right-hemisphere damage (RHD) on the production of matched idiomatic or literal expressions by examining healthy listeners' abilities to identify, evaluate and perceptually characterize the utterances. Native speakers of Korean with LHD or RHD and healthy controls (HCs) produced six ditropically ambiguous (idiomatic or literal) sentences in an elicitation and a repetition task. Healthy listeners identified the sentence types and indicated how well each utterance represented the intended meaning. Perceptual ratings of voice quality were performed by expert listeners. The results indicate a negative effect of RHD on listeners' identification and goodness ratings of utterance type. Repetition yielded better speech exemplars than elicitation. Sentence type was associated with selected voice qualities. These findings support previous reports of prosodic information serving to signal idiomatic versus literal meanings as well as a right-hemisphere involvement in formulaic language and the dual process model of language.
PMID: 27341552 [PubMed - as supplied by publisher]
I can see what you are saying: Auditory labels reduce visual search times.
Acta Psychol (Amst). 2016 Jun 21;170:19-31
Authors: Cho KW
Abstract
The present study explored the self-directed-speech effect, the finding that relative to silent reading of a label (e.g., DOG), saying it aloud reduces visual search reaction times (RTs) for locating a target picture among distractors. Experiment 1 examined whether this effect is due to a confound in the differences in the number of cues in self-directed speech (two) vs. silent reading (one) and tested whether self-articulation is required for the effect. The results showed that self-articulation is not required and that merely hearing the auditory label reduces visual search RTs relative to silent reading. This finding also rules out the number of cues confound. Experiment 2 examined whether hearing an auditory label activates more prototypical features of the label's referent and whether the auditory-label benefit is moderated by the target's imagery concordance (the degree to which the target picture matches the mental picture that is activated by a written label for the target). When the target imagery concordance was high, RTs following the presentation of a high prototypicality picture or auditory cue were comparable and shorter than RTs following a visual label or low prototypicality picture cue. However, when the target imagery concordance was low, RTs following an auditory cue were shorter than the comparable RTs following the picture cues and visual-label cue. The results suggest that an auditory label activates both prototypical and atypical features of a concept and can facilitate visual search RTs even when compared to picture primes.
PMID: 27341509 [PubMed - as supplied by publisher]
Wh- questions and passive sentences in non-fluent variant PPA and semantic variant PPA: Longitudinal findings of an anagram production task.
Cogn Neuropsychol. 2016 Jun 24;:1-14
Authors: Cupit J, Graham NL, Leonard C, Tang-Wai D, Black SE, Rochon E
Abstract
Using an anagram task, we investigated longitudinal syntactic production by individuals with semantic variant primary progressive aphasia (svPPA) and non-fluent variant PPA (nfvPPA), compared to controls. The accuracy of the production of active and passive, and reversible and non-reversible sentences, as well as of wh- questions was compared across the three groups. Results showed a different pattern of syntactic impairment across the two patient groups. The nfvPPA group showed difficulty with wh- questions at Time 1 and impairment with the passive structure approximately one year later, at Time 2. Surprisingly, the svPPA group also showed difficulty with wh- questions from Time 1, but still no difficulty on passive sentences, two years later, at Time 3. Neither group had difficulty with reversibility. The results of the nfvPPA patients were as expected, and the results of the svPPA patients suggest that this group may exhibit a greater syntactic impairment than is typically recognized.
PMID: 27341394 [PubMed - as supplied by publisher]
Constraint Induced Aphasia Therapy: Volunteer-led, unconstrained and less intense delivery can be effective.
NeuroRehabilitation. 2016 Jun 23;
Authors: Nickels L, Osborne A
Abstract
BACKGROUND: Constraint Induced Aphasia Therapy (CIAT) has been shown to be effective in the treatment of aphasia, but clinicians have expressed concern regarding how far CIAT was practical to implement in clinical practice.
OBJECTIVE: To determine whether CIAT delivered in a less-intense, lower dose, reduced constraint and volunteer-led format could produce positive outcomes in people with chronic aphasia.
METHODS: Two groups were run, each with two people with chronic aphasia. Treatment involved a standard CIAT card-exchange game, supplemented by a home activity. Spoken language was required for responses but alternative modalities of communication were also permitted. Each group was led by a trained volunteer, lasted 90 minutes and was delivered twice a week for four weeks.
RESULTS: Three of the four participants showed significant improvements in target word retrieval following treatment. No significant improvements were observed for untreated stimuli or language tasks. Two participants showed increases in the elaboration of their responses, and the same two showed increased in frequency with which they engaged in communication activities.
CONCLUSIONS: Clear gains in performance were observed for the majority of people with aphasia who participated in a less intense format, considerably lower dose and less constrained form of CIAT led by trained volunteers. This suggests that this 'clinically realistic' service delivery model for CIAT should be added to the clinical repertoire of speech pathologists.
PMID: 27341364 [PubMed - as supplied by publisher]
The impact of group therapy on word retrieval in people with chronic aphasia.
NeuroRehabilitation. 2016 Jun 23;
Authors: Nickels L, McDonald B, Mason C
Abstract
BACKGROUND: Traditional group-based aphasia intervention has been shown to benefit people with aphasia in a variety of ways. However, despite the prevalence of anomia and the impact it has for communication, there has been little investigation as to whether these interventions improve word retrieval.
OBJECTIVE: This study aimed to determine the effects on word retrieval of a 'traditional' out-patient group intervention.
METHODS: A 6-week group therapy programme focused on current-affairs topics with facilitator-led discussion and language tasks. Half the topics received a supplementary, self-directed, anomia home programme. Using a single case experimental design, replicated across three participants, we examined the effectiveness of the group, and the group+home programme, in facilitating word retrieval in picture naming and connected speech.
RESULTS: The participants showed a pattern of improved picture naming over the course of the study for the treated topics which was not evident for the untreated control topics. However, it was difficult to attribute this improvement unequivocally to the treatment.
CONCLUSIONS: While participants felt that the group was beneficial, there was little clear evidence for treatment-related gains in word retrieval. 'Traditional' group treatment has many positive features, but clinicians need to be cautious regarding the extent of impairment-related gains that can be expected, which seem small at best.
PMID: 27341363 [PubMed - as supplied by publisher]
Restoring one's language edifice: A case study of long-term effects of intensive aphasia therapy employing cognitive modifiability strategies.
NeuroRehabilitation. 2016 Jun 23;
Authors: Anaki D, Goldenberg R, Devisheim H, Rosenfelder D, Falik L, Harif I
Abstract
NG is an architect who suffered a left occipital-parietal hemorrhage cerebral vascular accident (CVA) in 2000, resulting in aphasia of Wernicke and conduction types. He was characterized with fluent paraphasic speech, decreased repetition, and impaired object naming. Comprehension was relatively preserved but reading and writing were severely compromised, as well as his auditory working memory. Despite a grim prognosis he underwent intensive aphasia therapy, lasting from 2001 to 2010, at the Center for Cognitive Rehabilitation of the Brain Injured at the Feuerstein Institute. The tailored-made interventions, applied in NG's therapy, were based upon the implementation of the principles of the Structural Mediated Learning Experience (MLE) and the Feuerstein Instrumental Enrichment (FIE) Program, to optimize his rehabilitation. As a result NG improved in most of his impaired linguistic capacities, attested by the results of neuropsychological and linguistic assessments performed throughout the years. More importantly, he was able to manage again his daily functions at a high level, and to resume his occupational role as an architect, a role which he holds to this day.
PMID: 27341358 [PubMed - as supplied by publisher]
Cochlear Implantation in a Patient with Kabuki Syndrome.
J Int Adv Otol. 2016 Apr;12(1):129-131
Authors: Vesseur A, Cillessen E, Mylanus E
Abstract
Criteria for cochlear implants are expanding and now include children with disabilities in addition to hearing loss, such as those with Kabuki syndrome (KS). This case report describes language outcomes and changes in the quality of life of a female child with KS after cochlear implantation. The subject had a profound progressive sensorineural hearing loss, cognitive impairments, and other disabilities and communicated using vocalized sounds and the Dutch Sign Language. After cochlear implantation at an age of nine years and three months, the patient displayed no progress in speech production and minimal progress in receptive language development, but she had an increased awareness of the world and an increase in the quality of life.
PMID: 27341000 [PubMed - as supplied by publisher]
Preventive Audiology: Screening for Hearing Impairment in Children Having Recurrent URTI.
Indian J Otolaryngol Head Neck Surg. 2016 Jun;68(2):163-6
Authors: Sharma K, Pannu MS, Arora A, Sharma V
Abstract
A late detection of hearing impairment in children can affect speech and language development. Otitis media with effusion (OME) associated with risk factors like recurrent upper respiratory tract infections (URTI) is considered the most common cause of silent hearing impairment among children. So this study was carried out to screen such at risk children for hearing impairment. The study was conducted on 1000 children in the age group of 2-12 years who presented to the OPD of ENT and Pediatrics Department, Govt Medical College with the complaint of recurrent URTI. The children were screened by history taking, general physical examination and local ENT examination. This was followed by impedance audiometry and pure tone audiometry (PTA, wherever indicated). Children with discharging ears and perforated tympanic membrane (TM) were excluded from the study. The most common presenting complaint was nasal discharge (67.9 %), followed by mouth breathing (66.3 %) and snoring (65 %). Only 16.2 % cases actually complained of some hearing impairment on exploratory history indicating the silent nature of OME. On examination 52.65 % cases had a normal looking TM whereas 41.2 % had a dull retracted TM. Results of impedance audiometry showed Type A graph in 56.75 %, Type B in 33.4 % indicating OME and Type C in 9.85 % indicating Eustachian tube dysfunction. PTA showed a mild conductive hearing loss in 26.7 % cases. OME is quite prevalent in high risk children and incidence of OME resulting in silent hearing impairment is quite high especially in young children having recurrent URTI. Impedance audiometry has been proved to be an objective screening tool for the same with a diagnostic accuracy of 87 % and thus under preventive audiology, it has a definite role in young children having recurrent URTI.
PMID: 27340630 [PubMed]
Prediction of Cochlear Implant Outcomes in Patients With Prelingual Deafness.
Clin Exp Otorhinolaryngol. 2016 Jun 25;
Authors: Kang DH, Lee MJ, Lee KY, Lee SH, Jang JH
Abstract
Objectives: To evaluate the factors that limit post-cochlear implantation (CI) speech perception in prelingually deaf children.
Methods: Patients with CI were divided into two groups according to Category of Auditory Performance (CAP) scores 3 years post-CI: the poor performance group (poor performance group, CAP scores≤4, n=41) and the good performance group (good performance group, CAP scores≥5, n=85). The distribution and contribution of the potential limiting factors related to post-CI speech perception was compared.
Results: Perinatal problems, inner ear anomalies, narrow bony cochlear nerve canal (BCNC), and intraoperative problems was significantly higher in the poor performance group than the good performance group (P=0.010, P=0.003, P=0.001, and P=0.045, respectively). The mean number of limiting factors was significantly higher in the poor performance group (1.98±1.04) than the good performance group (1.25±1.11, P=0.001). The odds ratios for perinatal problems and narrow bony cochlear nerve canal in the poor performance group in comparison with the good performance group were 4.878 (95% confidence interval, 0.067 to 0.625; P=0.005) and 4.785 (95% confidence interval, 0.045 to 0.972; P=0.046).
Conclusion: This study highlights the comprehensive prediction of speech perception after CI and provides otologic surgeons with useful information for individualized preoperative counseling of CI candidates.
PMID: 27337951 [PubMed - as supplied by publisher]
 | Related Articles |
Risk Factors for Sudden Cardiac Death Among Patients with Alcohol Dependence: A Nested Case-Control Study.
Alcohol Clin Exp Res. 2015 Sep;39(9):1797-804
Authors: Wu SI, Tsai SY, Huang MC, Stewart R, Kuo CJ, Chen CC
Abstract
BACKGROUND: Excessive alcohol consumption causes a broad range of health problems, including premature mortality and sudden cardiac death (SCD). We identified potential clinical characteristics and laboratory indices associated with SCD among patients with alcohol dependence.
METHODS: Patients with alcohol dependence (n = 2,793) admitted to a psychiatric center in northern Taiwan between 1985 and 2008 were linked with a national mortality database for causes of death. Of the 2,793 patients in the cohort, 67 cases died of SCD. The standardized mortality ratio (SMR) of SCD relative to the general population was calculated. Based on a nested case-control design, we selected a set of sex-, age-, and year-of-admission-matched two control subjects for each case derived from the cohort. We collated the clinical information through a standardized review of patients' medical records. Conditional logistic regressions were then conducted to explore potential exposures associated with SCD.
RESULTS: The sample had substantially higher SCD mortality (SMR 12.8) compared to the general population. After adjustments in the multivariate analyses for the clinical profiles at the index (earliest) admission, both abnormal electrocardiography (ECG) (adjusted risk ratio = 16.97, 95% confidence interval (CI) 1.60 to 179.58, p = 0.019) and elevated aspartate aminotransferase levels (adjusted risk ratio = 1.01, 95% CI 1.00 to 1.02, p = 0.046) were significantly associated with SCD.
CONCLUSIONS: This study raises the question of whether intensive follow-up of patients with elevated AST and abnormal ECG findings should be evaluated as a strategy to prevent SCD in patients with alcohol dependence.
PMID: 26207644 [PubMed - indexed for MEDLINE]
Spontaneous intracranial hypotension caused by cervical CSF fistulae mimicking subarachnoid haemorrhage - a case report.
Br J Neurosurg. 2016 Jun 24;:1-3
Authors: Eristavi A, Sabin I
Abstract
We describe an unusual and rarely documented site of SIH supported by clear radiological evidence: a case of spontaneous cerebrospinal fluid (CSF) fistulae involving the C7 and C8 nerve root sheaths, presenting with sudden onset headache and requiring surgical intervention to seal the leaks. Investigations confirmed the leaks and the typical MRI findings of meningeal enhancement, which were resolved after surgery.
PMID: 27341482 [PubMed - as supplied by publisher]
Spontaneous intracranial hypotension syndrome: contribution of radioisotope cisternography.
Rev Esp Med Nucl Imagen Mol. 2016 Jun 20;
Authors: Suárez JP, Domínguez ML, Gómez MA, Muñoz JL
Abstract
Spontaneous intracranial hypotension is a clinical syndrome caused by a loss of cerebrospinal fluid volume, usually secondary to leaking through structural defects of the spinal dura mater. Radioisotope cisternography (RC) can confirm the diagnosis of spontaneous intracranial hypotension, especially in doubtful or atypical case presentations. A retrospective study was conducted on 8 patients who underwent RC because spontaneous intracranial hypotension was suspected, and they presented with atypical clinical manifestations and/or inconclusive findings in other imaging techniques. RC detected paradural extravasation of cerebrospinal fluid in 7 patients. Moreover, there was indirect evidence of cerebrospinal fluid leaks in all 8 patients (early appearance of radioactivity in the bladder, soft tissue uptake of radioisotope and/or reduction in the amount of radiotracer in the brain at 24hours). RC had a significant impact on the diagnosis of 6 patients, and on the therapeutic management of 4 patients.
PMID: 27337940 [PubMed - as supplied by publisher]
An immunohistochemical study of cytokeratins distribution of the human adult male and female urethra.
Histol Histopathol. 2016 Jun 24;:11796
Authors: Herrera-Imbroda B, Aragón IM, Hierro MI, Álvarez M, Alaminos M, Campos A, Izeta A, Machuca J, Lara MF
Abstract
Surgical treatment of diseases affecting long urethral areas represents a challenge in urology. Recent developments of tissue-engineered urethral substitutes represent a hope for patients. However finding an ideal tissue source for urethral reconstruction first requires proper understanding of the native human urethra physiology and a deep knowledge of the histological and molecular features of the native human urethra. Here we present a comprehensive characterization of male and female urethra by histological, histochemical and immunohistochemical methods with a panel of 15 antibodies. The results demonstrated that the histology of the male and female urethra depend on the area where the sample is taken along its length. Proximal areas of male and female urethra have differential expression of the epithelial basal and suprabasal layer markers CK14 and CK10 which distinguished the prostatic/membranous and proximal female urethra from the bulbar/penile and distal female areas of the urethra. The distal male (penile) and female may be further divided by the distinct expression pattern of CK19. On the other hand, the expression of CK5/6 and CK19 also make a distinction of the proximal and distal female urethra. These results should facilitate a more informed selection of donor graft tissues for urethral replacement. Besides, novel bioengineered urethral tissue approaches should take into account the characterization of the different areas of the urethra presented in this work.
PMID: 27337975 [PubMed - as supplied by publisher]
