Nasolabial fold discontinuity during speech as a possible extended cleft phenotype.

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Nasolabial fold discontinuity during speech as a possible extended cleft phenotype.

Cleft Palate Craniofac J. 2013 Mar;50(2):201-6

Authors: Schmidt KL, Neiswanger K, Cohn E, Desensi R, Brandon C, Bardi K, Marazita ML

Abstract
Objective : This exploratory research sought to extend the cleft phenotype by identifying movement-related soft tissue appearance changes in the midfacial region in individuals with cleft lip/palate or those with genetic susceptibility to cleft lip/palate (unaffected relatives). The cleft phenotype (clinically identified orofacial cleft or subclinical orbicularis oris defect) was hypothesized to be associated with movement related appearance changes in the midfacial region, e.g., with furrowing and dimpling during speech. Design : Changes in the appearance of skin in the midfacial region, including a newly identified phenotypic feature, nasolabial fold (NLF) discontinuity, were described and compared across groups. Participants : Individuals with cleft lip (n  =  42), unaffected relatives of persons with a cleft (n  =  57) and healthy controls (n  =  41) were compared. Results : Frequencies of NLF discontinuity differed across cleft, relative, and control groups. NLF discontinuities were observed more frequently in individuals with a cleft phenotype (overt cleft or previously identified orbicularis oris muscle defect) than in those with no underlying muscular defect (Fisher exact test, P  =  .014). Conclusion : Results suggest that the appearance of facial soft tissue during movement of the midface is moderated at least in part by underlying cleft risk factors, indicating certain facial movements as candidate physical markers for extension of the cleft phenotype.

PMID: 22273627 [PubMed - indexed for MEDLINE]

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Using ultrasound to quantify tongue shape and movement characteristics.

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Using ultrasound to quantify tongue shape and movement characteristics.

Cleft Palate Craniofac J. 2013 Jan;50(1):76-81

Authors: Zharkova N

Abstract
Objective : Previous experimental studies have demonstrated abnormal lingual articulatory patterns characterizing cleft palate speech. Most articulatory information to date has been collected using electropalatography, which records the location and size of tongue-palate contact but not the tongue shape. The latter type of data can be provided by ultrasound. The present paper aims to describe ultrasound tongue imaging as a potential tool for quantitative analysis of tongue function in speakers with cleft palate. A description of the ultrasound technique as applied to analyzing tongue movements is given, followed by the requirements for quantitative analysis. Several measures are described, and example calculations are provided. Measures : Two measures aim to quantify overuse of tongue dorsum in cleft palate articulations. Crucially for potential clinical applications, these measures do not require head-to-transducer stabilization because both are based on a single tongue curve. The other three measures compare sets of tongue curves, with the aim to quantify the dynamics of tongue displacement, token-to-token variability in tongue position, and the extent of separation between tongue curves for different speech sounds. Conclusions : All measures can be used to compare tongue function in speakers with cleft palate before and after therapy, as well as to assess their performance against that in typical speakers and to help in selecting more effective treatments.

PMID: 22117937 [PubMed - indexed for MEDLINE]

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The impact of maxillary osteotomy on speech outcomes in cleft lip and palate: an evidence-based approach to evaluating the literature.

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The impact of maxillary osteotomy on speech outcomes in cleft lip and palate: an evidence-based approach to evaluating the literature.

Cleft Palate Craniofac J. 2013 Jan;50(1):25-39

Authors: Pereira V, Sell D, Tuomainen J

Abstract
Objective : To undertake a critical and systematic review of the literature on the impact of maxillary advancement on speech outcomes in order to identify current best evidence. Design and Main Outcome Measures : The following databases were searched: PubMed, CINAHL, and The Cochrane Controlled Trials Register. In addition, reference lists were hand searched for additional articles. Using a predefined framework and set criteria, evidence was evaluated using the assignment of levels of evidence (at least Level III on the evidence hierarchy), calculation of post-hoc power (≥ 0.8), effect size (Cohen's d ≥ 0.5), and adaptation of the parameters as set out by The Cochrane Collaboration. Results : Of the 40 studies identified, the majority (68%) fell within Level III.ii, representing cohort-type studies and a fifth (20%) within Level IV, the weakest form of evidence. Power and effect size calculations were only possible in 9 studies for different speech outcomes, and only seven studies met the set criteria for best evidence. Accordingly, current best evidence for articulation exists only for a noncleft population, is conflicting for resonance and nasalance, and is mixed for velopharyngeal function depending on which instrumental measure is used. Conclusions : There is an obvious need for further prospective research in the field with strong speech methodology such as the undertaking of interrater and intrarater reliability, adequate follow-up, and sufficient sample sizes based on a priori power analyses. Methodologic issues are discussed and recommendations made.

PMID: 22103908 [PubMed - indexed for MEDLINE]

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TSE Case Studies Associated with Japanese and Other Regulatory Authorities--Talk Transcript.

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TSE Case Studies Associated with Japanese and Other Regulatory Authorities--Talk Transcript.

PDA J Pharm Sci Technol. 2010 Sep-Oct;64(5):442-4

Authors: Potts BJ

PMID: 21502050 [PubMed - indexed for MEDLINE]

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Bachelor of Fine Arts (BFA) in Photography

IIP Edu Academy; Bachelor of Fine Arts (BFA) Photography is a dynamic 3-year program which provides candidates with a thorough grounding in the fields of Commercial, Fine Art and Documentary Photography. BFA degree in that the majority of the program consists of a practical studio component, as ...

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Functional evaluation in young patients undergoing orthopedical interceptive treatment.

Functional evaluation in young patients undergoing orthopedical interceptive treatment.

Minerva Stomatol. 2016 Apr 22;

Authors: Galbiati G, Maspero C, Giannini L, Tagliatesta C, Farronato G

Abstract
BACKGROUND: The aim of this study is to examining the activity of jaw muscles through electromyograph and electrognatograph in children with unilateral posterior cross-bite and functional lateral shift before and after rapid palatal expansion, and to find out a relationship between the results.
METHODS: The sample included 71 children (35 females and 36 males; range: 6-10 years) with unilateral posterior crossbite and functional mandibular lateral shift in mixed dentition. Superficial Electromiographic activity coming from the muscles areas (anterior temporalis and masseters) and electrognatographic exam were obtained before (T0) and after rapid palatal expansion (T1) and after a follow-up period of 6 months (T2).
RESULTS: A significant increase was found in the value of activity index between T0, T1 and T2 in all the analyzed muscles both in rest position and during the exercises of the different acquisitions, at the end of the active phase of the rapid palatal expansion.
CONCLUSION: The evaluation of EMG activity after rapid palatal expansion is important to confirm the adaptation of the neuromuscular system to the new occlusal condition. In this study, the muscular activity was increased after therapy producing important changes in muscular tone.

PMID: 27103150 [PubMed - as supplied by publisher]

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Comparative analysis of force degradation of latex orthodontic elastics of 5/16'' diameter: an in vitro study.

Comparative analysis of force degradation of latex orthodontic elastics of 5/16'' diameter: an in vitro study.

Minerva Stomatol. 2016 Apr 22;

Authors: Seibt S, Salmoria I, Cericato GO, Paranhos LR, Rosario HD, El Haje O

Abstract
BACKGROUND: this study aimed to analyze, six commercial brands of latex elastics regarding force degradation according to time, immediately and in time intervals of 12, 24, 48, and 72 hours.
METHODS: the elastics were stretched by three times their diameter, measured, immersed in artificial saliva at 37 °C, and stored in a glass container. Data obtained were described by mean parameters, standard deviation, degradation rate, and coefficient of variation and Tukey's post hoc test (p<0.05).
RESULTS: American OrthodonticsTM was the brand closest to prescription (94.70%), and UnidenTM was the one with the lowest performance (73.60%). By analyzing the total force degradation rate at the end of the experiment, it is noted that elastics from the OrthometricTM brand presented the highest rate (20.24%).
CONCLUSIONS: it is concluded that the latex elastics studied suffer great intensity variation of initial force, and the higher variation rate occurs in the first 12 hours.

PMID: 27103149 [PubMed - as supplied by publisher]

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Tooth discoloration induced by calcium-silicate based materials: a literature review.

Tooth discoloration induced by calcium-silicate based materials: a literature review.

Minerva Stomatol. 2016 Apr 22;

Authors: Mohebbi P, Tour Savadkouhi S

Abstract
AIM: Endodontic therapy may not focus only on biological and functional aspects, but should take esthetic considerations into account as well. It is common knowledge that calcium-silicate based materials may cause discoloration and thus impair the esthetic outcome of the treated tooth. The purpose of this review is to summarize the existing knowledge on the discoloration potential of these materials used for endodontic procedures.
METHODS: A comprehensive literature search covering the period from 2000 to 2015 was conducted on Pubmed and Google Scholar, using different keyword combinations including 'tooth', 'color', 'discoloration', 'staining', 'endodontic', 'root canal', 'calcium silicate', 'MTA', 'portland cement', 'Endocem' and 'biodentine'. Any relevant literature in the English language was considered for inclusion. In addition, previous review articles were hand-searched, and reference lists from endodontic textbooks were also reviewed. Articles were excluded if only single clinical reports or conference reports were included or if the topic was not related to the subject.
CONCLUSION: For a wide range of these materials currently available in the market, only scarce or no evidence exist regarding their discoloration potential. The need for further research in this field and development of non-staining calcium silicate based materials is evident.

PMID: 27103148 [PubMed - as supplied by publisher]

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The Effect of Temperature on Umami Taste.

The Effect of Temperature on Umami Taste.

Chem Senses. 2016 Apr 20;

Authors: Green BG, Alvarado C, Andrew K, Nachtigal D

Abstract
The effect of temperature on umami taste has not been previously studied in humans. Reported here are 3 experiments in which umami taste was measured for monopotassium glutamate (MPG) and monosodium glutamate (MSG) at solution temperatures between 10 and 37 °C. Experiment 1 showed that for subjects sensitive to MPG on the tongue tip, 1) cooling reduced umami intensity whether sampled with the tongue tip or in the whole mouth, but 2) had no effect on the rate of umami adaptation on the tongue tip. Experiment 2 showed that temperature had similar effects on the umami taste of MSG and MPG on the tongue tip but not in the whole mouth, and that contrary to umami taste, cooling to 10 °C increased rather than decreased the salty taste of both stimuli. Experiment 3 was designed to investigate the contribution of the hT1R1-hT1R3 glutamate receptor to the cooling effect on umami taste by using the T1R3 inhibitor lactisole. However, lactisole failed to block the umami taste of MPG at any temperature, which supports prior evidence that lactisole does not block umami taste for all ligands of the hT1R1-hT1R3 receptor. We conclude that temperature can affect sensitivity to the umami and salty tastes of glutamates, but in opposite directions, and that the magnitude of these effects can vary across stimuli and modes of tasting (i.e., whole mouth vs. tongue tip exposures).

PMID: 27102813 [PubMed - as supplied by publisher]

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Cardiac Myeloid Sarcoma - Multimodality Radiologic Imaging Features and Pathologic Correlation.

Cardiac Myeloid Sarcoma - Multimodality Radiologic Imaging Features and Pathologic Correlation.

Am J Med. 2016 Apr 18;

Authors: Dörfel D, Häntschel M, Federmann B, Haen S, Fend F, Müller II, Salih HR, Vogel W, Kanz L, Horger M

PMID: 27103046 [PubMed - as supplied by publisher]

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Cardiomyopathy in Duchenne Muscular Dystrophy: Current Value of Clinical, Electrophysiological and Imaging Findings in Children and Teenagers.

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Cardiomyopathy in Duchenne Muscular Dystrophy: Current Value of Clinical, Electrophysiological and Imaging Findings in Children and Teenagers.

Klin Padiatr. 2015 Jul;227(4):225-31

Authors: Dittrich S, Tuerk M, Haaker G, Greim V, Buchholz A, Burkhardt B, Fujak A, Trollmann R, Schmid A, Schroeder R

Abstract
BACKGROUND: Progressive cardiomyopathy (CMP) is one main cause of death in DMD. This cross-sectional assessment of different cardiac diagnostic procedures focusses on preterm diagnosis of cardiac dysfunction.
PATIENTS: 39 male DMD patients aged 6-20 years were included. 6 patients were still ambulatory, 21 patients received corticosteroid therapy.
METHODS: All patients were investigated by ECG, Holter ECG and heart rate variability (HRV), B-type natriuretic peptide (BNP), echocardiography (TTE), tissue Doppler Imaging (TD) and magnetic resonance imaging (MRI) with Late Gadolinium enhancement (LE) and segmental wall motion analysis (WMA).
RESULTS: 56% of the patients showed repolarization abnormalities and 76% altered HRV. Subnormal ventricular function was found in 25% by TTE and in 34% by MRI. TD differed from normal controls only in the apical septum. In MRI 89% of the patients showed different distribution and intensity of LE and WM restriction. The extent of LE was less in patients after steroid treatment (p<0.05).
DISCUSSION: MRI with segmental LE- and WM-analysis seems to be superior to TTE and TD in exploring regional distribution and severity of damage of the myocardium. ECG and HRV abnormalities are common in DMD-patients but not tightly predictive for segmental and global left ventricular dysfunction. Targeted treatment of CMP in DMD needs prospective evaluation.
CONCLUSION: A timely cardiac MRI is the most sensitive investigation for the identification of early myocardial changes in DMD which is a prerequisite for early interventions and therapeutic strategies.

PMID: 26058601 [PubMed - indexed for MEDLINE]

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How Many Temporomandibular Joint Total Joint Alloplastic Implants Will Be Placed in the United States in 2030?

Publication date: Available online 23 April 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Uvoh Onoriobe, Michael Miloro, Cortino Sukotjo, Louis G. Mercuri, Anthony Lotesto, Ransome Eke
PurposeThe purpose of this study is to provide a statistical projection of the number of alloplastic temporomandibular joint total joint replacements (TMJ TJR) that will be performed in the United States (USA) through the year 2030.Materials and MethodsThe Program Directors of all 101 Commission on Dental Accreditation (CODA) accredited oral and maxillofacial surgery (OMS) training programs in the USA were surveyed on-line using a questionnaire developed using Redcap (Chicago, IL) over a 6-week period (February 2015 – March 2016). The questionnaire included 19 questions related to each program's temporomandibular joint disorders (TMD) and TMJ TJR curricula as well as clinical experience. In addition, members of the American Society of TMJ Surgeons (ASTMJS) were surveyed on-line using Redcap and via direct survey forms. In addition, requests for the total number of TMJ TJR devices produced and implanted during the same time period were made to the three manufacturers of FDA-approved TMJ TJR devices in the USA.ResultsThe response rate amongst Program Directors was 52.5%, and the total number of TMJ TJR devices implanted at OMS programs in 2005 was 412. This total increased by 38% to 572 in 2014. Statistically, this projects an increase of 58% over the next 15 years to 902 TMJ TJR surgeries by 2030 (95% prediction limits: 768, 1,037). The total number TMJ TJR devices distributed by one manufacturer increased from 430 in the year 2000, to 1,004 in 2014 (133%). Using these data, statistically over the next 15 years the number of TMJ TJR devices distributed by this company is projected be 1,658 (95% prediction limits: 1,380, 1,935).ConclusionsThe data presented in this study demonstrates an increasing demand for the use of TMJ TJR devices in the management of end-stage TMD to the year 2030.



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Titanium-silver alloys miniplates for mandibular fixation-In vitro and in vivo study

Publication date: Available online 23 April 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Jung-Hwan Lee, Jae-Sung Kwon, Seung-Kyun Moon, Soo-Hyuk Uhm, Byung-Ho Choi, Uk-Hyon Joo, Kwang-Mahn Kim, Kyoung-Nam Kim
PurposeTitanium (Ti) alloys have received significant attention as materials for oral and maxillofacial surgery, which requires high mechanical strength, osteosynthesis and biocompatibility. The objective was to implant miniplates fabricated from commercially pure Ti (CP Ti) and newly developed Ti-Ag alloy in fractured mandibles of adult dogs after preliminary mechanical and biological characterization.MethodsThe surface characteristics, biocompatibility, and pre-osteoblast adhesion and proliferation of CP Ti (grade 3) and Ti-Ag (2 at% of Ag) alloys were evaluated. Next, the bending strength of six- and eight-hole miniplates fabricated from CP Ti and Ti-Ag was compared according to ISO 9585. Six-hole miniplates were implanted for 12 weeks in fractured mandibles of adult dogs. The silver ion concentration in each alloy and implanted bone block with soft tissue was measured by inductively coupled plasma mass spectroscopy after euthanasia according to ISO 10993-12.ResultsPrecipitated Ag was detected in Ti-Ag by alpha- and beta-phase Ti in X-ray powder diffraction. The biocompatibility with pre-osteoblasts of Ti-Ag and CP Ti was comparable in terms of cytotoxicity, cell adhesion and proliferation (P > .05). Ti-Ag miniplates had up to threefold greater bending strength than CP Ti miniplates (P < .05). An in vivo study showed that CP Ti and Ti-Ag miniplates had comparable soft and hard tissue regeneration ability (P > .05). Silver ions were detected in Ti-Ag alloys and applied mandible blocks.ConclusionThe results of this study suggest that Ti-Ag alloys can be used to produce miniplates with high mechanical properties, considerable biocompatibility and osteosynthesis ability and silver ion-release properties. Further studies, including preclinical investigations, are required to enable clinical usage of Ti-Ag bone plates.

Graphical abstract

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Piezotome-Rhinoplasty reduces post-surgical morbidity and enhances patient satisfaction: a multidisciplinary clinical study

Publication date: Available online 23 April 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Troedhan Angelo
PurposeExperimental and clinical studies in various fields of oral and maxillofacial surgery suggest the use of piezotomes to reduce post-surgical morbidity and enhance healing. The aim of the study was to investigate if rhinoplasty-surgery with piezotomes might decrease post-surgical morbidity and increase overall patient satisfaction when compared to rhinoplasty with traditional instruments and protocols.MethodsIn this prospective clinical study patients of the departments for cosmetic surgery, ENT and specialty-ambulance for maxillofacial surgery, scheduled for cosmetic reductive rhinoplasty, underwent rhinoplasty with traditional instruments or the ultrasonic surgical device "piezotome". Before rhinoplasty all patients were evaluated by Rhinoplasty Outcome Evaluation (ROE), staged for ecchymosis and edema (EE) and pain (D) on the 7^th day after surgery and six months after surgery again evaluated by ROE-score. Female and male patients were aged between 24 and 57yrs and had to be free of functional impairments of nose-breathing. Data were anonymized and evaluated with SPSS 22.0 (one-way ANOVA, Games-Howell post-hoc-test for primary and secondary outcome evaluation, Leven-Test of equal variances, t-test and Pearson-Correlation of primary and secondary outcome evaluation).Results108 patients (51 females and 12 males) were fully documented by EE/D-staging and ROE and underwent cosmetic rhinoplasty at a department of plastic and reconstructive surgery, an ENT-department, and a specialty ambulance for maxillofacial surgery. 16 female and 5 male patients –fully documented - received a piezotome-rhinoplasty. Statistic evaluation verified no significant differences between the three surgical disciplines when a rhinoplasty was performed with traditional instruments (p>0,7), but demonstrated the use of ultrasonic surgical instruments to improve immediate post-surgical morbidity EE and D significantly (P<0,05) as well as ROE after 6 months (P<0,05). Correlation of EE and D with ROE showed a significant difference (P≤0,01) in favor of the piezotome.ConclusionThe use of ultrasonic surgical devices in reductive rhinoplasty decreases post-surgical morbidity and increase patient overall satisfaction significantly. The results of the study suggest piezotomes to be the surgical instrument of choice not only for oral surgical procedures but also for cosmetic surgery on facial bones.

Graphical abstract

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Report of two cases of oropharyngeal injury with the use of video laryngoscopy techniques

Publication date: Available online 23 April 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Bradford Huffman, Suvikram Puri, Henry Heyman, Vikas Kumar, Solon Kao
While the trend toward video laryngoscopy and away from direct laryngoscopy may be associated with a greater likelihood of successful intubation, appropriate training is necessary to prevent injuries. We present two instances of operator error which resulted in penetrating injury to the soft palate as well as a review of the literature.



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Is there a Difference in Cost between Standard and Virtual Surgical Planning for Orthognathic Surgery?

Publication date: Available online 22 April 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Cory M. Resnick, Gino Inverso, Mariusz Wrzosek, Bonnie L. Padwa, Leonard B. Kaban, Zachary S. Peacock
PurposeVirtual surgical planning (VSP) and three-dimensional (3D) printing of surgical splints are becoming the standard of care for orthognathic surgery, but costs have not been thoroughly evaluated. The purpose of this study was to compare the cost of VSP and 3D printing of splints ("VSP") versus two-dimensional cephalometric evaluation, model surgery, and manual splint fabrication ("standard planning").Materials and MethodsThis is a retrospective cohort study including patients planned for bimaxillary surgery from January 2014 to January 2015 at Massachusetts General Hospital. Subjects were divided into 3 groups by case type: symmetric, nonsegmental (Group 1), asymmetric (Group 2) and segmental (Group 3). All cases underwent both VSP and standard planning with times for all activities recorded. The primary and secondary predictor variables were method of treatment planning and case type, respectively. Time-driven activity-based micro-costing analysis was used to quantify the differences in cost. Results were analyzed using a paired t-test and ANOVA.ResultsThe sample included 43 subjects (19 Group 1, 17 Group 2, and 7 Group 3). The average times and costs for VSP were 194±14.1 minutes and $2765.94, and for standard planning were 540.9±99.5 minutes and $3519.18. The average times and costs for VSP for the simple group were 188±17.8 minutes and $2,700.52, and for standard planning were 524.4 ± 86.1 minutes and $3,380.17. The average times and costs for the asymmetric group were 187.4±10.9 minutes and $2,713.69 for VSP and 556.1±94.1 minutes and $3,640.00 for standard planning. For the segmental group, the average times and costs were 208.8±13.5 minutes and $2,883.62 for VSP and 542.3±118.4 minutes and $3,537.37 for standard planning. All time and cost differences were statistically significant (p < 0.001).ConclusionThe results of this study indicate that VSP for bimaxillary orthognathic surgery utilizes significantly less time and is less expensive than standard planning for the 3 types of cases analyzed.



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Is Alloplastic TMJ Reconstruction a viable option in the Surgical Management of Adult Idiopathic Condylar Resorption Patients?

Publication date: Available online 23 April 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Pushkar Mehra, Mohammed Nadershah, Radhika Chigurupati
PurposeIdiopathic condylar resorption (ICR) presents diagnostic and therapeutic challenges to practitioners due to the rarity of the condition, progressive deformity, and simultaneous involvement of skeletal, occlusal and articular disorders. The objective of this study is to report our clinical outcomes following prosthetic replacement of the TMJ for management of ICR.Patients and MethodsA retrospective analysis of ICR patients managed by bilateral TMJ total joint replacement and concomitant mandibular advancement with or without maxillary surgery was performed using data gathered from medical records. The primary treatment outcomes of interest were: 1) Correction of anterior open bite malocclusion, 2) Mandibular advancement and, 3) Increase in posterior facial height. Secondary outcomes included subjective assessment of pain, dietary restrictions, and functional disability and objective evaluations of TMJ sounds, occlusal relationship, mandibular range of motion, cranial nerve VII injury, and objectionable scarring. Radiographs were used to measure surgical change and relapse.ResultsTwenty-one patients met the inclusion criteria for this retrospective study. The average patient age was 25.6 years (range: 22 - 32 years) and mean follow-up was 6.2 years (range: 5 - 12 years). The mean mandibular advancement at Point B was 24.3 mm and mean occlusal plane change was - 10.2 degrees. Sixteen patients (76%) underwent maxillary orthognathic surgery for posterior down grafting with rigid fixation and grafting. Long-term follow-up revealed excellent stability of surgical movements with a decrease in TMJ and myofacial pain, headaches, and dietary restrictions.ConclusionsICR patients can be effectively treated using TMJ total joint prostheses with maxillary orthognathic surgery when indicated for correction of the associated dentofacial deformity. Use of alloplastic joint prostheses allows for execution of large mandibular advancements in a predictable and accurate manner with a significant reduction in TMJ dysfunction symptoms.



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Postoperative Bleeding Following Dental Extractions in Patients Anticoagulated with Warfarin

Publication date: Available online 22 April 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Anthony Febbo, Andrew Cheng, Brian Stein, Alastair Goss, Paul Sambrook
PurposeThe practising dentist must frequently advise on the risks involved with dental extractions in the anticoagulated patient. We aimed to assess the risk of bleeding in a large heterogeneous cohort of patients on warfarin treated by practitioners in training (dental students and junior staff in a teaching hospital).MethodsA retrospective case-control study of 439 anticoagulated cases on warfarin (1022 extractions) and 439 matched controls (1049 extractions). Patients with INR<2.2 had no specific measures, INR 2.2-4 sutured and tranexamic acid mouthwash, INR>4 no extraction. Bayesian methods were used to estimate posterior probabilities of bleeding.ResultsCases were 63% male, 25% were over 80, 40% had an INR<2.2 and 9% had an INR>3. Nine cases bled 0-10 days postoperatively, with one requiring admission and transfusion. Significant predictors of bleeding were INR and number of extractions (p<0.001 for both). There were no events of bleeding in controls or cases with an INR<2.2 (95% credible interval (CrI) for difference -0.7-1.6%). The posterior mean of bleeding was 1% (CrI 0.1-2.6%) for INR<2.2, 2.3% (CrI 0.9-4.5%) for INR 2.2-3 and 8.4% (CrI 3.5-15%) for INR>3.ConclusionUnselected anticoagulated patients with an INR<2.2 have a similar risk of bleeding to control patients. The risk is about 1/40 in those with an INR 2.2-3 while the risk in patients with an INR>3 is about 1 in 11.



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Response to the Parkland 12-Minute Checklist Tracheostomy

Publication date: Available online 22 April 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Neeraj Panchal, Michael Zide




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Morbidity and Mortality Rates after Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea

Publication date: Available online 21 April 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Luis A. Passeri, James G. Choi, Leonard B. Kaban, Edward T. Lahey
PurposeTo compare morbidity and mortality rates in obstructive sleep apnea (OSA) versus dentofacial deformity (DFD) patients undergoing equivalent maxillofacial surgical procedures.Patients and MethodsPatients with OSA who underwent maxillomandibular advancement with genial advancement (MMA), at Massachusetts General Hospital Department of Oral and Maxillofacial Surgery, from December 2002 to June 2011, were matched to patients with DFD undergoing similar maxillofacial procedures during the same time period. They were compared with regards to demographic variables, medical comorbidities, perioperative management, intraoperative, early and late postoperative complications and mortality.ResultsA study group of 28 patients with OSA and a control group of 26 patients with DFD were compared. The patients with OSA were older (41.9±12.5 vs. 21.7±8.6years), had a higher ASA classification (2.0±0.5 vs. 1.3±0.6) and BMI (29.6±4.7 vs. 23.0±3.1kg/m²). They also had a greater number of medical comorbidities (2.4±2.3 vs. 0.7±1.0). More OSA than DFD patients had complications (28, 100% vs.19, 73%, p=0.003) and the total number of complications in the OSA group was higher (108 vs. 33, p<0.001). In the OSA group, 13.9% and in the DFD group 3.0% of the complications were classified as major. The absolute risk of a complication for the OSA group was 3.9 vs . 1.3 for the DFD group. The relative risk of complications in OSA compared to DFD was 3.0. No difference in mortality was found.ConclusionsOSA patients were older, had more comorbidities and ultimately had a greater number of early, late, minor and major complications than those in the DFD group. The incidence of mortality in both groups was zero. MMA appears to be a safe procedure with regards to mortality but OSA patients should be counseled preoperatively regarding the relative increased risk of complications.



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Biomechanical Effects of Novel Osteotomy Approaches on Mandibular Expansion: A 3D Finite Element Analysis

Publication date: Available online 21 April 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Pradeep Singh, Chao Wang, Deepal Haresh Ajmera, Shui Sheng Xiao, Jinlin Song, Zeng Ling
IntroductionSurgically assisted mandibular arch expansion has proven to be an effective treatment modality in alleviating constriction and crowding issues. However, only mandibular symphyseal distraction osteogenesis has been in favor for the purpose of mandibular arch expansion. Besides, there is no relevant study to compare the biomechanical response of different osteotomy designs on mandibular expansion. Therefore, this study is aimed to evaluate the effect of different osteotomy approaches and modes of loading on the expansion of adult mandible using biomechanics.Materials ad MethodsTo address the research purpose, a total of 9 Finite Element models including two novel osteotomy designs were simulated. Stress, strain and displacement of crown, root and bone were calculated and compared under different osteotomy approaches and loading conditions.ResultsThe biomechanical response envisaged by the FE models in terms of displacement on X axis, was consistent from anterior to posterior teeth with parasymphyseal step osteotomy and hybrid mode of force application. In addition, the amount of displacement predicted by parasymphyseal step osteotomy with hybrid mode was more, compared to other models.ConclusionIn conclusion, the results of our study suggest, parasymphyseal step osteotomy with hybrid mode to be a viable treatment option for true bony expansion in adult mandible.



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The medico-legal value of consensus statements

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Pediatric Radiology Continuing Medical Education Activity

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Ultrasound and MR imaging findings in prenatal diagnosis of craniosynostosis syndromes

Abstract

Background

Craniosynostosis syndromes are uncommonly encountered in the prenatal period. Identification is challenging but important for family counseling and perinatal management.

Objective

This series examines prenatal findings in craniosynostosis syndromes, comparing the complementary roles of US and MRI and emphasizing clues easily missed in the second trimester.

Materials and methods

Six prenatal cases evaluated from 2002 through 2011 were retrospectively reviewed. Referral history, gestational age, and sonographic and MRI findings were reviewed by three pediatric radiologists. Abnormalities of the calvarium, hands, feet, face, airway and central nervous system were compared between modalities.

Results

The diagnosis was Apert syndrome in three, Pfeiffer syndrome in two and Carpenter syndrome in one. The gestational age at evaluation ranged from 21 to 33 weeks. All six were evaluated by MRI and US, with two undergoing repeat evaluation in the third trimester, yielding a total of eight MRIs and US exams. The referral history suggested cloverleaf skull in two cases but did not suggest craniosynostosis syndrome in any case. In four, the referral suggested central nervous system (CNS) findings that were not confirmed by MRI; additional CNS findings were discovered in the remaining two. In four cases, developing turricephaly resulted in a characteristic "lampshade" contour of the fetal head. Hypertelorism and proptosis were present in five, with proptosis better appreciated by MRI. Digit abnormalities were present in all, seen equally well by MRI and US. Lung abnormalities in the second trimester in one fetus resolved by the third trimester.

Conclusion

Prenatal diagnosis of craniosynostosis syndromes is difficult prior to the third trimester. MRI and US have complementary roles in evaluation of these patients.

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No title Article type: Exposure

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Role of percutaneous abscess drainage in the management of young patients with Crohn disease

Abstract

Background

Intra-abdominal abscess is a common complication of Crohn disease in children. Prior studies, primarily in adults, have shown that percutaneous abscess drainage is a safe and effective treatment for this condition; however, the data regarding this procedure and indications in pediatric patients is limited.

Objective

Our aim was to determine the success rate of percutaneous abscess drainage for abscesses related to Crohn disease in pediatric patients with a focus on treatment endpoints that are relevant in the era of biological medical therapy.

Materials and methods

We retrospectively reviewed 25 cases of patients ages ≤20 years with Crohn disease who underwent percutaneous abscess drainage. Technical success was defined as catheter placement within the abscess with reduction in abscess size on post-treatment imaging. Clinical success was defined as (1) no surgery within 1 year of drainage or (2) surgical resection following drainage with no residual abscess at surgery or on preoperative imaging. Multiple clinical parameters were analyzed for association with treatment success or failure.

Results

All cases were classified as technical successes. Nineteen cases were classified as clinical successes (76%), including 7 patients (28%) who required no surgery within 1 year of percutaneous drainage and 12 patients (48%) who had elective bowel resection within 1 year. There was a statistically significant association between resumption of immunosuppressive therapy within 8 weeks of drainage and both clinical success (P < 0.01) and avoidance of surgery after 1 year (P < 0.01).

Conclusion

Percutaneous abscess drainage is an effective treatment for Crohn disease-related abscesses in pediatric patients. Early resumption of immunosuppressive therapy is statistically associated with both clinical success and avoidance of bowel resection, suggesting a role for percutaneous drainage in facilitating prompt initiation of medical therapy and preventing surgical bowel resection.

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Incidental mastoid opacification in children on MRI

Abstract

Background

The opacification the mastoid cavity is frequently reported by radiologists on cross-sectional imaging done for non-otological indications. It is well known that presence of fluid the mastoid does not amount to mastoiditis. This study seeks to provide an evidence-based confirmation of this known finding.

Objective

The purpose of our study was to determine the prevalence of mastoid opacification in children undergoing outpatient brain MRI examination.

Materials and methods

Our study included 515 outpatient children who had brain MRI for indications other than mastoiditis or otitis media from January 2014 to March 2014. Children with history of skull base trauma or radiation were excluded. The age range was 15 days to 18 years. The overall prevalence of mastoid opacification was determined using one sample proportion and exact 95% Clopper-Pearson confidence intervals. The prevalence of mastoid opacification was analyzed based on gender, age and presenting symptoms using chi-square test of association.

Results

One hundred ten children (21.4%) had mastoid opacification. Younger patients tended to have higher opacification rates with the prevalence in children younger than 1 year of age and between 1 and 2 years of age as high as 41.7% (20/48) and 47.5% (38/80), respectively.

Conclusion

The diagnosis of mastoiditis in children should not be based upon a radiologist's report of finding fluid or mucosal thickening in the mastoid air cells as incidental opacification the mastoid is seen frequently.

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Hermes

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Occupational stress among Swedish audiologists in clinical practice: Reasons for being stressed

10.3109/14992027.2016.1172119<br/>K. Jonas Brännström

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Development and psychometric evaluation of a health-related quality of life instrument for individuals with adult-onset hearing loss

10.3109/14992027.2016.1166397<br/>Carren J. Stika

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An updated checklist of mosquito species (Diptera: Culicidae) from Madagascar.

An updated checklist of mosquito species (Diptera: Culicidae) from Madagascar.

Parasite. 2016;23:20

Authors: Tantely ML, Le Goff G, Boyer S, Fontenille D

Abstract
An updated checklist of 235 mosquito species from Madagascar is presented. The number of species has increased considerably compared to previous checklists, particularly the last published in 2003 (178 species). This annotated checklist provides concise information on endemism, taxonomic position, developmental stages, larval habitats, distribution, behavior, and vector-borne diseases potentially transmitted. The 235 species belong to 14 genera: Aedeomyia (3 species), Aedes (35 species), Anopheles (26 species), Coquillettidia (3 species), Culex (at least 50 species), Eretmapodites (4 species), Ficalbia (2 species), Hodgesia (at least one species), Lutzia (one species), Mansonia (2 species), Mimomyia (22 species), Orthopodomyia (8 species), Toxorhynchites (6 species), and Uranotaenia (73 species). Due to non-deciphered species complexes, several species remain undescribed. The main remarkable characteristic of Malagasy mosquito fauna is the high biodiversity with 138 endemic species (59%). Presence and abundance of species, and their association, in a given location could be a bio-indicator of environmental particularities such as urban, rural, forested, deforested, and mountainous habitats. Finally, taking into account that Malagasy culicidian fauna includes 64 species (27%) with a known medical or veterinary interest in the world, knowledge of their biology and host preference summarized in this paper improves understanding of their involvement in pathogen transmission in Madagascar.

PMID: 27101839 [PubMed - as supplied by publisher]

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Mode of recording and modulation frequency effects of auditory steady state response thresholds.

Mode of recording and modulation frequency effects of auditory steady state response thresholds.

Braz J Otorhinolaryngol. 2016 Mar 29;

Authors: Jalaei B, Zakaria MN

Abstract
INTRODUCTION: The performance of auditory steady state response (ASSR) in threshold testing when recorded ipsilaterally and contralaterally, as well as at low and high modulation frequencies (MFs), has not been systematically studied.
OBJECTIVE: To verify the influences of mode of recording (ipsilateral vs. contralateral) and modulation frequency (40Hz vs. 90Hz) on ASSR thresholds.
METHODS: Fifteen female and 14 male subjects (aged 18-30 years) with normal hearing bilaterally were studied. Narrow-band CE-chirp(®) stimuli (centerd at 500, 1000, 2000, and 4000Hz) modulated at 40 and 90Hz MFs were presented to the participants' right ear. The ASSR thresholds were then recorded at each test frequency in both ipsilateral and contralateral channels.
RESULTS: Due to pronounced interaction effects between mode of recording and MF (p<0.05 by two-way repeated measures ANOVA), mean ASSR thresholds were then compared among four conditions (ipsi-40Hz, ipsi-90Hz, contra-40Hz, and contra-90Hz) using one-way repeated measures ANOVA. At the 500 and 1000Hz test frequencies, contra-40Hz condition produced the lowest mean ASSR thresholds. In contrast, at high frequencies (2000 and 4000Hz), ipsi-90Hz condition revealed the lowest mean ASSR thresholds. At most test frequencies, contra-90Hz produced the highest mean ASSR thresholds.
CONCLUSIONS: Based on the findings, the present study recommends two different protocols for an optimum threshold testing with ASSR, at least when testing young adults. This includes the use of contra-40Hz recording mode due to its promising performance in hearing threshold estimation.

PMID: 27102175 [PubMed - as supplied by publisher]

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Cisplatin induces stemness in ovarian cancer.

Cisplatin induces stemness in ovarian cancer.

Oncotarget. 2016 Apr 20;

Authors: Wiechert A, Saygin C, Thiagarajan PS, Rao VS, Hale JS, Gupta N, Hitomi M, Nagaraj AB, DiFeo A, Lathia JD, Reizes O

Abstract
The mainstay of treatment for ovarian cancer is platinum-based cytotoxic chemotherapy. However, therapeutic resistance and recurrence is a common eventuality for nearly all ovarian cancer patients, resulting in poor median survival. Recurrence is postulated to be driven by a population of self-renewing, therapeutically resistant cancer stem cells (CSCs). A current limitation in CSC studies is the inability to interrogate their dynamic changes in real time. Here we utilized a GFP reporter driven by the NANOG-promoter to enrich and track ovarian CSCs. Using this approach, we identified a population of cells with CSC properties including enhanced expression of stem cell transcription factors, self-renewal, and tumor initiation. We also observed elevations in CSC properties in cisplatin-resistant ovarian cancer cells as compared to cisplatin-naïve ovarian cancer cells. CD49f, a marker for CSCs in other solid tumors, enriched CSCs in cisplatin-resistant and -naïve cells. NANOG-GFP enriched CSCs (GFP+ cells) were more resistant to cisplatin as compared to GFP-negative cells. Moreover, upon cisplatin treatment, the GFP signal intensity and NANOG expression increased in GFP-negative cells, indicating that cisplatin was able to induce the CSC state. Taken together, we describe a reporter-based strategy that allows for determination of the CSC state in real time and can be used to detect the induction of the CSC state upon cisplatin treatment. As cisplatin may provide an inductive stress for the stem cell state, future efforts should focus on combining cytotoxic chemotherapy with a CSC targeted therapy for greater clinical utility.

PMID: 27105520 [PubMed - as supplied by publisher]

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Risk of chemotherapy-induced amenorrhea in patients with breast cancer: a systematic review and meta-analysis.

Risk of chemotherapy-induced amenorrhea in patients with breast cancer: a systematic review and meta-analysis.

Acta Oncol. 2016 Apr 22;:1-7

Authors: Zavos A, Valachis A

Abstract
BACKGROUND: The aim of the study was to calculate the rate of chemotherapy-induced amenorrhea (CIA) after treatment with different adjuvant therapies in patients with breast cancer and to evaluate the risk factors for CIA based on the quality of evidence.
PATIENT AND METHODS: A search of PubMed and ISI Web of Science was performed. All published trials with female breast cancer patients who received adjuvant chemotherapy and presented data on the rate of CIA were considered eligible. The pooled rates of CIA were calculated by random effects model. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each potential risk factor for CIA by using the generic inverse weighted method.
RESULTS: We identified 580 potentially relevant studies, of which 75 were included in the analysis. Among 75 eligible studies, 19 different definitions of CIA have been used. The pooled rate of CIA was 55% (95% CI 50-60%) including 23 673 patients from 74 studies. The rate of CIA was increased by age with an estimate of 26% (95% CI 12-43%), 39% (95% CI 31-58%), and 77% (95% CI 71-83%) for women <35, 35-40, and >40 years old, respectively. Two risk factors were associated with the occurrence of CIA and were supported by strong level of evidence: older age (>40 years old), and the use of tamoxifen.
CONCLUSIONS: This meta-analysis summarized the updated evidence on the impact of different adjuvant treatment regimens for breast cancer in menstruation and could serve as a helpful guide for oncologists during the discussion with their patients on fertility issues before decision on adjuvant therapy is made. A uniform definition of CIA is essential in future studies to make the interpretation of results more reliable.

PMID: 27105082 [PubMed - as supplied by publisher]

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Script-theory virtual case: A novel tool for education and research.

Script-theory virtual case: A novel tool for education and research.

Med Teach. 2016 Apr 21;:1-9

Authors: Hayward J, Cheung A, Velji A, Altarejos J, Gill P, Scarfe A, Lewis M

Abstract
Context/Setting: The script theory of diagnostic reasoning proposes that clinicians evaluate cases in the context of an "illness script," iteratively testing internal hypotheses against new information eventually reaching a diagnosis. We present a novel tool for teaching diagnostic reasoning to undergraduate medical students based on an adaptation of script theory.
INTERVENTION: We developed a virtual patient case that used clinically authentic audio and video, interactive three-dimensional (3D) body images, and a simulated electronic medical record. Next, we used interactive slide bars to record respondents' likelihood estimates of diagnostic possibilities at various stages of the case. Responses were dynamically compared to data from expert clinicians and peers. Comparative frequency distributions were presented to the learner and final diagnostic likelihood estimates were analyzed. Detailed student feedback was collected.
OBSERVATIONS: Over two academic years, 322 students participated. Student diagnostic likelihood estimates were similar year to year, but were consistently different from expert clinician estimates. Student feedback was overwhelmingly positive: students found the case was novel, innovative, clinically authentic, and a valuable learning experience.
DISCUSSION: We demonstrate the successful implementation of a novel approach to teaching diagnostic reasoning. Future study may delineate reasoning processes associated with differences between novice and expert responses.

PMID: 27102980 [PubMed - as supplied by publisher]

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A national approach for automated collection of standardized and population-based radiation therapy data in Sweden.

A national approach for automated collection of standardized and population-based radiation therapy data in Sweden.

Radiother Oncol. 2016 Apr 18;

Authors: Nyholm T, Olsson C, Agrup M, Björk P, Björk-Eriksson T, Gagliardi G, Grinaker H, Gunnlaugsson A, Gustafsson A, Gustafsson M, Johansson B, Johnsson S, Karlsson M, Kristensen I, Nilsson P, Nyström L, Onjukka E, Reizenstein J, Skönevik J, Söderström K, Valdman A, Zackrisson B, Montelius A

Abstract
PURPOSE: To develop an infrastructure for structured and automated collection of interoperable radiation therapy (RT) data into a national clinical quality registry.
MATERIALS AND METHODS: The present study was initiated in 2012 with the participation of seven of the 15 hospital departments delivering RT in Sweden. A national RT nomenclature and a database for structured unified storage of RT data at each site (Medical Information Quality Archive, MIQA) have been developed. Aggregated data from the MIQA databases are sent to a national RT registry located on the same IT platform (INCA) as the national clinical cancer registries.
RESULTS: The suggested naming convention has to date been integrated into the clinical workflow at 12 of 15 sites, and MIQA is installed at six of these. Involvement of the remaining 3/15 RT departments is ongoing, and they are expected to be part of the infrastructure by 2016. RT data collection from ARIA®, Mosaiq®, Eclipse™, and Oncentra® is supported. Manual curation of RT-structure information is needed for approximately 10% of target volumes, but rarely for normal tissue structures, demonstrating a good compliance to the RT nomenclature. Aggregated dose/volume descriptors are calculated based on the information in MIQA and sent to INCA using a dedicated service (MIQA2INCA). Correct linkage of data for each patient to the clinical cancer registries on the INCA platform is assured by the unique Swedish personal identity number.
CONCLUSIONS: An infrastructure for structured and automated prospective collection of syntactically interoperable RT data into a national clinical quality registry for RT data is under implementation. Future developments include adapting MIQA to other treatment modalities (e.g. proton therapy and brachytherapy) and finding strategies to harmonize structure delineations. How the RT registry should comply with domain-specific ontologies such as the Radiation Oncology Ontology (ROO) is under discussion.

PMID: 27102842 [PubMed - as supplied by publisher]

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Both high and low levels of cellular Epstein-Barr virus DNA in blood identify failure after hematologic stem cell transplantation in conjunction with acute GVHD and type of conditioning.

Both high and low levels of cellular Epstein-Barr virus DNA in blood identify failure after hematologic stem cell transplantation in conjunction with acute GVHD and type of conditioning.

Oncotarget. 2016 Apr 19;

Authors: Li Q, Rane L, Poiret T, Zou J, Magalhaes I, Ahmed R, Du Z, Vudattu N, Meng Q, Gustafsson-Jernberg Å, Winiarski J, Ringdén O, Maeurer M, Remberger M, Ernberg I

Abstract
The level of Epstein-Barr virus DNA in blood has proven to be a biomarker with some predictive value in allogeneic hematopoietic stem cell transplantation patients (HSCT). We evaluated the impact of EBV load on survival of 51 patients (32M/19F, median age: 32 years, from < 1 to 68 years old), who had received HSCT for different types of malignancies (49 cases) or non-malignancies (2 cases). The overall survival [1]was compared between patients with extreme and moderate cell bound EBV DNA levels. Different sources of stem-cells (peripheral blood stem, n = 39; bone marrow, n = 9; or umbilical cord blood, n = 3) were used. Twenty patients received reduced-intensity conditioning regimen while the other 31 received myeloablative conditioning. Patients with high or very low level of cell bound EBV-DNA levels had a shorter OS than those with moderate EBV load: OS at 5 years was 67% vs 90% (p < 0.03). There was a conspicuous relationship between EBV load and the reconstitution dynamics of total and EBV-specific T cells, CD4+ and CD4- CD8- (double negative) T cells in the few patients where it was analyzed. This was not statistically significant. Two other factors were associated to early mortality in addition to high or low EBV load: acute GVHD II-IV (p < 0.02) and pre-transplant conditioning with total body irradiation (TBI) ≥6 Gy, (p < 0.03). All the patients meeting all three criteria died within two years after transplantation. This points to a subgroup of HSCT patients which deserve special attention with improvement of future, personalized treatment.

PMID: 27102298 [PubMed - as supplied by publisher]

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Current status of brachytherapy in Korea: a national survey of radiation oncologists.

Current status of brachytherapy in Korea: a national survey of radiation oncologists.

J Gynecol Oncol. 2016 Feb 3;:e33

Authors: Kim H, Kim JY, Kim J, Park W, Kim YS, Kim HJ, Kim YB

Abstract
OBJECTIVE: The aim of the present study was to acquire information on brachytherapy resources in Korea through a national survey of radiation oncologists.
METHODS: Between October 2014 and January 2015, a questionnaire on the current status of brachytherapy was distributed to all 86 radiation oncology departments in Korea. The questionnaire was divided into sections querying general information on human resources, brachytherapy equipment, and suggestions for future directions of brachytherapy policy in Korea.
RESULTS: The response rate of the survey was 88.3%. The average number of radiation oncologists per center was 2.3. At the time of survey, 28 centers (36.8%) provided brachytherapy to patients. Among the 28 brachytherapy centers, 15 (53.5%) were located in in the capital Seoul and its surrounding metropolitan areas. All brachytherapy centers had a high-dose rate system using ¹⁹²Ir (26 centers) or ⁶⁰Co (two centers). Among the 26 centers using ¹⁹²Ir sources, 11 treated fewer than 40 patients per year. In the two centers using ⁶⁰Co sources, the number of patients per year was 16 and 120, respectively. The most frequently cited difficulties in performing brachytherapy were cost related. A total of 21 centers had a plan to sustain the current brachytherapy system, and four centers noted plans to upgrade their brachytherapy system. Two centers stated that they were considering discontinuation of brachytherapy due to cost burdens of radioisotope source replacement.
CONCLUSION: The present study illustrated the current status of brachytherapy in Korea. Financial difficulties were the major barriers to the practice of brachytherapy.

PMID: 27102244 [PubMed - as supplied by publisher]

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Prospective Evaluation of the Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) for Prostate Cancer Detection.

Prospective Evaluation of the Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) for Prostate Cancer Detection.

J Urol. 2016 Apr 18;

Authors: Mertan FV, Greer MD, Shih JH, George AK, Kongnyuy M, Muthigi A, Merino MJ, Wood BJ, Pinto PA, Choyke PL, Turkbey B

Abstract
INTRODUCTION: and Objective: PI-RADSv2 was developed to standardize interpretation and reporting of multiparametric prostate MRI (mpMRI) and provide guidelines for biopsy of mpMRI findings. We prospectively evaluated the cancer detection rate (CDR) at each overall PI-RADSv2 score.
METHODS: This prospective study included 62 consecutive patients with 116 lesions who underwent multi-parametric prostate MRI at 3T with PI-RADSv2 evaluation and subsequent targeted MRI/TRUS fusion-guided biopsy (FgBx) and concurrent 12-core systematic prostate biopsy (SBx) between May-September 2015. Median patient age and PSA values were 65.5 years (range: 50.3-76.6) and 7.10 ng/mL (range: 0.47-863.0), respectively. Mean lesion size was 12.7mm overall. Lesion-based CDRs for all tumors and Gleason ≥3+4 tumors at each PI-RADSv2 score were calculated. Univariate analysis was performed to assess differences in CDR between PI-RADSv2 scores.
RESULTS: 116 lesions in 62 patients were evaluated prospectively (0 PI-RADS 1, 18 PI-RADS 2, 19 PI-RADS 3, 47 PI-RADS 4, 32 PI-RADS 5) and underwent FgBx and SBx. Histopathology revealed 55/116 (47.4%) cancers (17 Gleason 3+3, 16 Gleason 3+4, 6 Gleason 4+3, 12 Gleason 4+4, 3 Gleason 4+5, 1 Gleason 5+4). Based on targeted biopsy (Tbx) on a per lesion basis, the overall CDRs of PI-RADS 2, 3, 4 and 5 score for all tumors was 22.2%, 15.8%, 29.8% and 78.1% respectively. The CDR of PI-RADS 2, 3, 4, and 5 score for Gleason ≥3+4 tumors was 5.6%, 0%, 21.3%, and 75%, respectively. Differences in the CDR between overall PI-RADS 4 and 5 scores were significant (p<0.001 for both Gleason >3+3 and Gleason ≥3+4 cancers).
CONCLUSION: PI-RADS score of 5 had the highest prospective CDR (78%). PI-RADS score of 4 had only a 30% CDR which is lower than expected. Surprisingly, no or very few significant cancers were detected at a PI-RADS score of 3 (16%). This early prospective data suggests that current criteria results in a high false positive rate that lowers the CDR. Therefore, stricter criteria may be needed in the future to decrease false positives and increase the CDR for PI-RADS scores of 3, 4 and 5.

PMID: 27101772 [PubMed - as supplied by publisher]

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A Nomogram to Predict Recurrence and Survival of High-Risk Patients Undergoing Sublobar Resection for Lung Cancer: An Analysis of a Multicenter Prospective Study (ACOSOG Z4032).

A Nomogram to Predict Recurrence and Survival of High-Risk Patients Undergoing Sublobar Resection for Lung Cancer: An Analysis of a Multicenter Prospective Study (ACOSOG Z4032).

Ann Thorac Surg. 2016 Apr 19;

Authors: Kent MS, Mandrekar SJ, Landreneau R, Nichols F, Foster NR, DiPetrillo TA, Meyers B, Heron DE, Jones DR, Tan AD, Starnes S, Putnam JB, Fernando HC

Abstract
BACKGROUND: Individualized prediction of outcomes may help with therapy decisions for patients with non-small cell lung cancer. We developed a nomogram by analyzing 17 clinical factors and outcomes from a randomized study of sublobar resection for non-small cell lung cancer in high-risk operable patients. The study compared sublobar resection alone with sublobar resection with brachytherapy. There were no differences in primary and secondary outcomes between the study arms, and they were therefore combined for this analysis.
METHODS: The clinical factors of interest (considered as continuous variables) were assessed in a univariate Cox proportional hazards model for significance at the 0.10 level for their impact on overall survival (OS), local recurrence-free survival (LRFS), and any recurrence-free survival (RFS). The final multivariable model was developed using a stepwise model selection.
RESULTS: Of 212 patients, 173 had complete data on all 17 risk factors. Median follow-up was 4.94 years (range, 0.04 to 6.22). The 5-year OS, LRFS, and RFS were 58.4%, 53.2%, and 47.4%, respectively. Age, baseline percent diffusing capacity of lung for carbon monoxide, and maximum tumor diameter were significant predictors for OS, LRFS, and RFS in the multivariable model. Nomograms were subsequently developed for predicting 5-year OS, LRFS, and RFS.
CONCLUSIONS: Age, baseline percent diffusing capacity of lung for carbon monoxide, and maximum tumor diameter significantly predicted outcomes after sublobar resection. Such nomograms may be helpful for treatment planning in early stage non-small cell lung cancer and to guide future studies.

PMID: 27101729 [PubMed - as supplied by publisher]

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Fatigue in the acute care and ambulatory setting.

Related Articles

Fatigue in the acute care and ambulatory setting.

J Pediatr Nurs. 2014 Jul-Aug;29(4):344-7

Authors: McCabe M, Patricia B

Abstract
Nurses commonly assess their patients for symptoms and intervene to ease any patient distress, yet children are seldom asked about feeling fatigued. The existing pediatric literature suggests that fatigue goes unrecognized and therefore untreated in children, particularly children experiencing stressful events, such as illness and/or hospitalization. In an effort to better understand the presence of the symptom in our environment we conducted a program specific point prevalence survey. Data were collected on nine inpatient and 11 outpatient units of a university affiliated tertiary care children's hospital. Overall, this sample reported higher levels of fatigue than published data from their healthy and chronically ill peers by total fatigue score and sub scores. This brief description of the symptom in our inpatient and ambulatory settings has provided information that will inform our nursing practice and drive future research.

PMID: 24650424 [PubMed - indexed for MEDLINE]

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My illness, myself: on the secrecy of shame.

Related Articles

My illness, myself: on the secrecy of shame.

Asian Pac J Cancer Prev. 2010;11 Suppl 1:59-62

Authors: Baider L

Abstract
Research has shown that the experience of being diagnosed with cancer has a negative psychosocial impact on patients and their families, often resulting in distress, and numerous practical and relationship challenges. Men with prostate cancer and their partners face special challenges. A range of symptoms that result from monitoring patients and side effects of treatment may reverse the quality of life and intimate relations between patient and partner. However, patients often are reluctant to bring up their distress about the symptoms, leading to an underestimation and reduction in optimal symptom control. As a result of their illness, chronically-ill male patients often experience elevated levels of stress, daily activities are often limited, they are frustrated about the unpredictable course of the illness and its symptoms, and are immersed in fears about their present and future social identity. Most of them avoid disclosure about their illness--when and where possible--and place great importance on sustaining a normal life. Factors related to limiting disclosure include men's low perceived need for support, fear of stigmatization, the need to minimize the threat of illness to aid coping, practical necessities in the workplace, and the desire to avoid burdening others. This paper contributes to an understanding of the complex issues of disclosure related to prostate cancer patients and raises issues about how best to be helpful, within their cultural and social framework. It also deals with feelings of shame, guilt and inadequacy as the cause--or consequence--of concealing the illness. The oral presentation will use a clinical example of secrecy and the subsequent conflicts and quandaries of a religious person diagnosed with advanced prostate cancer. Dilemmas of shame, disclosure and guilt will be the focus of the discussion.

PMID: 20590351 [PubMed - indexed for MEDLINE]

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Chronic nausea and vomiting: insights into underlying mechanisms

Abstract

Chronic nausea and vomiting are common and debilitating symptoms in adults. There are some fundamental problems that make our understanding of mechanisms difficult, diagnostic definitions of patient-cohorts being central. As there is no unifying mechanism with a direct link to chronic nausea or vomiting, it is most likely that several mechanisms interact, e.g., pylorus function and its relation to gastric emptying, or gastric sensory and motor function. In this mini-review, we highlight the roles and evidence for brain–gut interactions as well as gastrointestinal neurophysiologic, motor, sensory, and hormonal factors involved in the pathophysiology of chronic nausea and vomiting. There are factors not mentioned in the text, mostly as they are not well characterized in the setting of chronic symptoms or only in animal models.

Chronic nausea and vomiting of unknown cause are common and debilitating symptoms in adults. It is most likely that several pathophysiologic mechanisms interact. This mini-review highlight the evidence for some key factors involved.

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Gastric emptying and symptoms: functional dyspepsia versus gastroparesis

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Issue Information

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Erratum to: Robust adaptive synchronization of general dynamical networks with multiple delays and uncertainties

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Ion Transport in Nanostructured Phosphonated Block Copolymers Containing Ionic Liquids

The morphology and conductivity of poly(styrenephosphonate-b-methylbutylene) block copolymers containing ionic liquids are investigated. The block copolymers display a series of well-defined self-assembled morphologies, i.e., lamellae, gyroid, hexagonal cylinder (HEX), body-centered cubic, and A15 lattice, in the absence and presence of ionic liquids. The observation of an equilibrium A15 lattice for linear diblock copolymers, in contrast to a number of theoretical studies, is ascribed to the packing frustration accompanied by prevailing electrostatic interactions. The samples having the A15 lattice show a substantially higher morphology factors (0.83–0.96) than those with the HEX phases (0.42–0.69). This indicates the structural advantage of the A15 lattice with a well-defined 3D symmetry over the 2D HEX structure for constructing less tortuous ion-conduction pathways. This unprecedented study portends the rational design of nanostructured phosphonated polymer membranes with improved conductivity.

A series of well-defined self-assembled morphologies are developed from the phosphonated block copolymers upon the addition of ionic liquids. The elucidation of morphology-transport relationship reveals the structural advantage of the A15 lattice with a well-defined 3D symmetry over the 2D hexagonal cylinder morphology for the construction of less tortuous ion-conduction pathways.

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Biomedical Uses for 2D Materials Beyond Graphene: Current Advances and Challenges Ahead

Currently, a broad interdisciplinary research effort is pursued on biomedical applications of 2D materials (2DMs) beyond graphene, due to their unique physicochemical and electronic properties. The discovery of new 2DMs is driven by the diverse chemical compositions and tuneable characteristics offered. Researchers are increasingly attracted to exploit those as drug delivery systems, highly efficient photothermal modalities, multimodal therapeutics with non-invasive diagnostic capabilities, biosensing, and tissue engineering. A crucial limitation of some of the 2DMs is their moderate colloidal stability in aqueous media. In addition, the lack of suitable functionalisation strategies should encourage the exploration of novel chemical methodologies with that purpose. Moreover, the clinical translation of these emerging materials will require undertaking of fundamental research on biocompatibility, toxicology and biopersistence in the living body as well as in the environment. Here, a thorough account of the biomedical applications using 2DMs explored today is given.

Different classes of two-dimensional materials are emerging as biomaterial alternatives to graphene due to their unique physicochemical properties and their good biocompatibility. Currently, applications including anticancer therapeutics, multimodal bioimaging, cancer theranostics, biosensing, tissue engineering and antimicrobial coatings are explored. However, there are still several concerns and new challenges ahead of these materials before their translation into clinical use.

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A High-Performance WSe2/h-BN Photodetector using a Triphenylphosphine (PPh3)-Based n-Doping Technique

The effects of triphenylphosphine (PPh₃)-based n-doping and hexagonal boron nitride (h-BN) insertion on tungsten diselenide (WSe₂) photodetector are systematically studied, and a very high performance WSe₂/h-BN heterostucture-based photodetector is demonstrated with record photoresponsivity (1.27 × 10⁶ A W⁻¹) and temporal photoresponse (rising time: 2.8 ms, decaying time: 20.8 ms) under 520 nm wavelength and 5 pW power laser illumination.

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Erratum to: Neuroprotective Effect of the Endogenous Amine 1MeTIQ in an Animal Model of Parkinson’s Disease

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