“A cost and clinical effectiveness analysis among moist wound healing dressings versus traditional methods in home care patients with pressure ulcers - A randomized controlled trial”

Abstract

The aim of the study was a cost and clinical effectiveness analysis between moist wound healing dressings and gauze in a homecare set up for the treatment of stage III and IV pressure ulcers up to complete healing. In addition we assessed the overall economic burden on the Healthcare System. Treatment method for each patient was chosen randomly by using sealed opaque envelopes. The authors monitored the healing progress and recorded treatment costs without interfering with the treatment process. The healing progress was estimated by using surface measurement transparent films. To estimate treatment costs, the authors took into account labour costs, cost of dressings, as well the cost of other materials such as cleansing gauzes, normal saline, syringes, examination gloves, antiseptics and adhesive tape. The patient group under treatment with moist wound healing dressings consisted of 27 men and 20 women aged 75.1±8,6 and had an average ulcer surface of 43.5 ±30.70 cm²; the patient group under treatment with gauze comprised 25 men and 23 women aged 77.02±8.02 and had an average ulcer surface 41.52±29.41 cm² (p=0.25, 95% CI, Student's t test). The average healing time for the moist wound healing dressings group' was 85.56±52.09 days, while 121.4±52.21 days for the 'gauze group' (p=0.0001, 95% CI, Student's t test). The dressing change frequency per patient was reduced in the 'moist wound healing dressings group', 49.5±29.61, compared to a dressing change frequency per patient of 222.6±101.86 for the 'gauze group' (p=0.0001, 95% CI, Student's t test). The use of moist wound healing dressings had a lower total treatment cost of 1,351€per patient compared to, the use of gauzes (3,888€). This article is protected by copyright. All rights reserved.

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“A cost and clinical effectiveness analysis among moist wound healing dressings versus traditional methods in home care patients with pressure ulcers - A randomized controlled trial”

Abstract

The aim of the study was a cost and clinical effectiveness analysis between moist wound healing dressings and gauze in a homecare set up for the treatment of stage III and IV pressure ulcers up to complete healing. In addition we assessed the overall economic burden on the Healthcare System. Treatment method for each patient was chosen randomly by using sealed opaque envelopes. The authors monitored the healing progress and recorded treatment costs without interfering with the treatment process. The healing progress was estimated by using surface measurement transparent films. To estimate treatment costs, the authors took into account labour costs, cost of dressings, as well the cost of other materials such as cleansing gauzes, normal saline, syringes, examination gloves, antiseptics and adhesive tape. The patient group under treatment with moist wound healing dressings consisted of 27 men and 20 women aged 75.1±8,6 and had an average ulcer surface of 43.5 ±30.70 cm²; the patient group under treatment with gauze comprised 25 men and 23 women aged 77.02±8.02 and had an average ulcer surface 41.52±29.41 cm² (p=0.25, 95% CI, Student's t test). The average healing time for the moist wound healing dressings group' was 85.56±52.09 days, while 121.4±52.21 days for the 'gauze group' (p=0.0001, 95% CI, Student's t test). The dressing change frequency per patient was reduced in the 'moist wound healing dressings group', 49.5±29.61, compared to a dressing change frequency per patient of 222.6±101.86 for the 'gauze group' (p=0.0001, 95% CI, Student's t test). The use of moist wound healing dressings had a lower total treatment cost of 1,351€per patient compared to, the use of gauzes (3,888€). This article is protected by copyright. All rights reserved.

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Harnessing Fc receptor biology in the design of therapeutic antibodies

Peter Sondermann | David E Szymkowski

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Adoptive transfer of osteoclast-expanded natural killer cells for immunotherapy targeting cancer stem-like cells in humanized mice

Abstract

Based on data obtained from oral, pancreatic and lung cancers, glioblastoma, and melanoma, we have established that natural killer (NK) cells target cancer stem-like cells (CSCs). CSCs displaying low MHC class I, CD54, and PD-L1 are killed by cytotoxic NK cells and are differentiated by split anergized NK cells through both membrane bound and secreted forms of TNF-α and IFN-γ. NK cells select and differentiate both healthy and transformed stem-like cells, resulting in target cell maturation and shaping of their microenvironment. In our recent studies, we have observed that oral, pancreatic, and melanoma CSCs were capable of forming large tumors in humanized bone marrow, liver, thymus (hu-BLT) mice with fully reconstituted human immune system. In addition, major human immune subsets including NK cells, T cells, B cells, and monocytes were present in the spleen, bone marrow, peripheral blood, and tumor microenvironment. Similar to our previously published in vitro data, CSCs differentiated with split anergized NK cells prior to implantation in mice formed smaller tumors. Intravenous injection of functionally potent osteoclast-expanded NK cells inhibited tumor growth through differentiation of CSCs in humanized mice. In this review, we present current approaches, advances, and existing limitations in studying interactions of the immune system with the tumor, in particular NK cells with CSCs, using in vivo preclinical hu-BLT mouse model. In addition, we discuss the use of osteoclast-expanded NK cells in targeting cancer stem-like tumors in humanized mice—a strategy that provides a much-needed platform to develop effective cancer immunotherapies.

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Hearing performance as a predictor of postural recovery in cochlear implant users

Publication date: Available online 31 March 2016
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Mario Edwin Greters, Roseli Saraiva Moreira Bittar, Signe S. Grasel, Jeanne Oiticica, Ricardo Ferreira Bento
ObjectiveThis study aimed to evaluate if hearing performance is a predictor of postural control in cochlear implant (CI) users at least six months after surgery.MethodsCross-sectional study including (CI) recipients with post-lingual deafness and controls who were divided into the following groups: nine CI users with good hearing performance (G+), five CI users with poor hearing performance (G−), and seven controls (CG). For each patient, computerized dynamic posturography (CDP) tests, a sensory organization test (SOT), and an adaptation test (ADT) were applied as dual task performance, with first test (FT) and re-test (RT) on the same day, including a 40–60min interval between them to evaluate the short-term learning ability on postural recovery strategies. The results of the groups were compared.ResultsComparing the dual task performance on CDP and the weighted average between all test conditions, the G+ group showed better performance on RT in SOT4, SOT5, SOT6, and CS, which was not observed for G− and CG. The G− group had significantly lower levels of short-term learning ability than the other two groups in SOT5 (p=0.021), SOT6 (p=0.025), and CS (p=0.031).ConclusionThe CI users with good hearing performance had a higher index of postural recovery when compared to CI users with poor hearing performance.



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Outcome of different facial nerve reconstruction techniques

Publication date: Available online 31 March 2016
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Aboshanif Mohamed, Eigo Omi, Kohei Honda, Shinsuke Suzuki, Kazuo Ishikawa
IntroductionThere is no technique of facial nerve reconstruction that guarantees facial function recovery up to grade III.ObjectiveTo evaluate the efficacy and safety of different facial nerve reconstruction techniques.MethodsFacial nerve reconstruction was performed in 22 patients (facial nerve interpositional graft in 11 patients and hypoglossal-facial nerve transfer in another 11 patients). All patients had facial function House-Brackmann (HB) grade VI, either caused by trauma or after resection of a tumor. All patients were submitted to a primary nerve reconstruction except 7 patients, where late reconstruction was performed two weeks to four months after the initial surgery. The follow-up period was at least two years.ResultsFor facial nerve interpositional graft technique, we achieved facial function HB grade III in eight patients and grade IV in three patients. Synkinesis was found in eight patients, and facial contracture with synkinesis was found in two patients. In regards to hypoglossal-facial nerve transfer using different modifications, we achieved facial function HB grade III in nine patients and grade IV in two patients. Facial contracture, synkinesis and tongue atrophy were found in three patients, and synkinesis was found in five patients. However, those who had primary direct facial-hypoglossal end-to-side anastomosis showed the best result without any neurological deficit.ConclusionAmong various reanimation techniques, when indicated, direct end-to-side facial-hypoglossal anastomosis through epineural suturing is the most effective technique with excellent outcomes for facial reanimation and preservation of tongue movement, particularly when performed as a primary technique.



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Induced Loudness Reduction and Enhancement in Acoustic and Electric Hearing

Abstract

The loudness of a tone can be reduced by preceding it with a more intense tone. This effect, known as induced loudness reduction (ILR), has been reported to last for several seconds. The underlying neural mechanisms are unknown. One possible contributor to the effect involves changes in cochlear gain via the medial olivocochlear (MOC) efferents. Since cochlear implants (CIs) bypass the cochlea, investigating whether and how CI users experience ILR should help provide a better understanding of the underlying mechanisms. In the present study, ILR was examined in both normal-hearing listeners and CI users by examining the effects of an intense precursor (50 or 500 ms) on the loudness of a 50-ms target, as judged by comparing it to a spectrally remote 50-ms comparison sound. The interstimulus interval (ISI) between the precursor and the target was varied between 10 and 1000 ms to estimate the time course of ILR. In general, the patterns of results from the CI users were similar to those found in the normal-hearing listeners. However, in the short-precursor short-ISI condition, an enhancement in the loudness of target was observed in CI subjects that was not present in the normal-hearing listeners, consistent with the effects of an additional attenuation present in the normal-hearing listeners but not in the CI users. The results suggest that the MOC may play a role but that it is not the only source of these loudness context effects.

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Six Degrees of Auditory Spatial Separation

Abstract

The location of a sound is derived computationally from acoustical cues rather than being inherent in the topography of the input signal, as in vision. Since Lord Rayleigh, the descriptions of that representation have swung between "labeled line" and "opponent process" models. Employing a simple variant of a two-point separation judgment using concurrent speech sounds, we found that spatial discrimination thresholds changed nonmonotonically as a function of the overall separation. Rather than increasing with separation, spatial discrimination thresholds first declined as two-point separation increased before reaching a turning point and increasing thereafter with further separation. This "dipper" function, with a minimum at 6 ° of separation, was seen for regions around the midline as well as for more lateral regions (30 and 45 °). The discrimination thresholds for the binaural localization cues were linear over the same range, so these cannot explain the shape of these functions. These data and a simple computational model indicate that the perception of auditory space involves a local code or multichannel mapping emerging subsequent to the binaural cue coding.

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Harnessing Fc receptor biology in the design of therapeutic antibodies

Peter Sondermann | David E Szymkowski

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Adoptive transfer of osteoclast-expanded natural killer cells for immunotherapy targeting cancer stem-like cells in humanized mice

Abstract

Based on data obtained from oral, pancreatic and lung cancers, glioblastoma, and melanoma, we have established that natural killer (NK) cells target cancer stem-like cells (CSCs). CSCs displaying low MHC class I, CD54, and PD-L1 are killed by cytotoxic NK cells and are differentiated by split anergized NK cells through both membrane bound and secreted forms of TNF-α and IFN-γ. NK cells select and differentiate both healthy and transformed stem-like cells, resulting in target cell maturation and shaping of their microenvironment. In our recent studies, we have observed that oral, pancreatic, and melanoma CSCs were capable of forming large tumors in humanized bone marrow, liver, thymus (hu-BLT) mice with fully reconstituted human immune system. In addition, major human immune subsets including NK cells, T cells, B cells, and monocytes were present in the spleen, bone marrow, peripheral blood, and tumor microenvironment. Similar to our previously published in vitro data, CSCs differentiated with split anergized NK cells prior to implantation in mice formed smaller tumors. Intravenous injection of functionally potent osteoclast-expanded NK cells inhibited tumor growth through differentiation of CSCs in humanized mice. In this review, we present current approaches, advances, and existing limitations in studying interactions of the immune system with the tumor, in particular NK cells with CSCs, using in vivo preclinical hu-BLT mouse model. In addition, we discuss the use of osteoclast-expanded NK cells in targeting cancer stem-like tumors in humanized mice—a strategy that provides a much-needed platform to develop effective cancer immunotherapies.

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Hearing performance as a predictor of postural recovery in cochlear implant users

Publication date: Available online 31 March 2016
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Mario Edwin Greters, Roseli Saraiva Moreira Bittar, Signe S. Grasel, Jeanne Oiticica, Ricardo Ferreira Bento
ObjectiveThis study aimed to evaluate if hearing performance is a predictor of postural control in cochlear implant (CI) users at least six months after surgery.MethodsCross-sectional study including (CI) recipients with post-lingual deafness and controls who were divided into the following groups: nine CI users with good hearing performance (G+), five CI users with poor hearing performance (G−), and seven controls (CG). For each patient, computerized dynamic posturography (CDP) tests, a sensory organization test (SOT), and an adaptation test (ADT) were applied as dual task performance, with first test (FT) and re-test (RT) on the same day, including a 40–60min interval between them to evaluate the short-term learning ability on postural recovery strategies. The results of the groups were compared.ResultsComparing the dual task performance on CDP and the weighted average between all test conditions, the G+ group showed better performance on RT in SOT4, SOT5, SOT6, and CS, which was not observed for G− and CG. The G− group had significantly lower levels of short-term learning ability than the other two groups in SOT5 (p=0.021), SOT6 (p=0.025), and CS (p=0.031).ConclusionThe CI users with good hearing performance had a higher index of postural recovery when compared to CI users with poor hearing performance.



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Outcome of different facial nerve reconstruction techniques

Publication date: Available online 31 March 2016
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Aboshanif Mohamed, Eigo Omi, Kohei Honda, Shinsuke Suzuki, Kazuo Ishikawa
IntroductionThere is no technique of facial nerve reconstruction that guarantees facial function recovery up to grade III.ObjectiveTo evaluate the efficacy and safety of different facial nerve reconstruction techniques.MethodsFacial nerve reconstruction was performed in 22 patients (facial nerve interpositional graft in 11 patients and hypoglossal-facial nerve transfer in another 11 patients). All patients had facial function House-Brackmann (HB) grade VI, either caused by trauma or after resection of a tumor. All patients were submitted to a primary nerve reconstruction except 7 patients, where late reconstruction was performed two weeks to four months after the initial surgery. The follow-up period was at least two years.ResultsFor facial nerve interpositional graft technique, we achieved facial function HB grade III in eight patients and grade IV in three patients. Synkinesis was found in eight patients, and facial contracture with synkinesis was found in two patients. In regards to hypoglossal-facial nerve transfer using different modifications, we achieved facial function HB grade III in nine patients and grade IV in two patients. Facial contracture, synkinesis and tongue atrophy were found in three patients, and synkinesis was found in five patients. However, those who had primary direct facial-hypoglossal end-to-side anastomosis showed the best result without any neurological deficit.ConclusionAmong various reanimation techniques, when indicated, direct end-to-side facial-hypoglossal anastomosis through epineural suturing is the most effective technique with excellent outcomes for facial reanimation and preservation of tongue movement, particularly when performed as a primary technique.



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Induced Loudness Reduction and Enhancement in Acoustic and Electric Hearing

Abstract

The loudness of a tone can be reduced by preceding it with a more intense tone. This effect, known as induced loudness reduction (ILR), has been reported to last for several seconds. The underlying neural mechanisms are unknown. One possible contributor to the effect involves changes in cochlear gain via the medial olivocochlear (MOC) efferents. Since cochlear implants (CIs) bypass the cochlea, investigating whether and how CI users experience ILR should help provide a better understanding of the underlying mechanisms. In the present study, ILR was examined in both normal-hearing listeners and CI users by examining the effects of an intense precursor (50 or 500 ms) on the loudness of a 50-ms target, as judged by comparing it to a spectrally remote 50-ms comparison sound. The interstimulus interval (ISI) between the precursor and the target was varied between 10 and 1000 ms to estimate the time course of ILR. In general, the patterns of results from the CI users were similar to those found in the normal-hearing listeners. However, in the short-precursor short-ISI condition, an enhancement in the loudness of target was observed in CI subjects that was not present in the normal-hearing listeners, consistent with the effects of an additional attenuation present in the normal-hearing listeners but not in the CI users. The results suggest that the MOC may play a role but that it is not the only source of these loudness context effects.

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Six Degrees of Auditory Spatial Separation

Abstract

The location of a sound is derived computationally from acoustical cues rather than being inherent in the topography of the input signal, as in vision. Since Lord Rayleigh, the descriptions of that representation have swung between "labeled line" and "opponent process" models. Employing a simple variant of a two-point separation judgment using concurrent speech sounds, we found that spatial discrimination thresholds changed nonmonotonically as a function of the overall separation. Rather than increasing with separation, spatial discrimination thresholds first declined as two-point separation increased before reaching a turning point and increasing thereafter with further separation. This "dipper" function, with a minimum at 6 ° of separation, was seen for regions around the midline as well as for more lateral regions (30 and 45 °). The discrimination thresholds for the binaural localization cues were linear over the same range, so these cannot explain the shape of these functions. These data and a simple computational model indicate that the perception of auditory space involves a local code or multichannel mapping emerging subsequent to the binaural cue coding.

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Induced Loudness Reduction and Enhancement in Acoustic and Electric Hearing

Abstract

The loudness of a tone can be reduced by preceding it with a more intense tone. This effect, known as induced loudness reduction (ILR), has been reported to last for several seconds. The underlying neural mechanisms are unknown. One possible contributor to the effect involves changes in cochlear gain via the medial olivocochlear (MOC) efferents. Since cochlear implants (CIs) bypass the cochlea, investigating whether and how CI users experience ILR should help provide a better understanding of the underlying mechanisms. In the present study, ILR was examined in both normal-hearing listeners and CI users by examining the effects of an intense precursor (50 or 500 ms) on the loudness of a 50-ms target, as judged by comparing it to a spectrally remote 50-ms comparison sound. The interstimulus interval (ISI) between the precursor and the target was varied between 10 and 1000 ms to estimate the time course of ILR. In general, the patterns of results from the CI users were similar to those found in the normal-hearing listeners. However, in the short-precursor short-ISI condition, an enhancement in the loudness of target was observed in CI subjects that was not present in the normal-hearing listeners, consistent with the effects of an additional attenuation present in the normal-hearing listeners but not in the CI users. The results suggest that the MOC may play a role but that it is not the only source of these loudness context effects.

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Six Degrees of Auditory Spatial Separation

Abstract

The location of a sound is derived computationally from acoustical cues rather than being inherent in the topography of the input signal, as in vision. Since Lord Rayleigh, the descriptions of that representation have swung between "labeled line" and "opponent process" models. Employing a simple variant of a two-point separation judgment using concurrent speech sounds, we found that spatial discrimination thresholds changed nonmonotonically as a function of the overall separation. Rather than increasing with separation, spatial discrimination thresholds first declined as two-point separation increased before reaching a turning point and increasing thereafter with further separation. This "dipper" function, with a minimum at 6 ° of separation, was seen for regions around the midline as well as for more lateral regions (30 and 45 °). The discrimination thresholds for the binaural localization cues were linear over the same range, so these cannot explain the shape of these functions. These data and a simple computational model indicate that the perception of auditory space involves a local code or multichannel mapping emerging subsequent to the binaural cue coding.

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Induced Loudness Reduction and Enhancement in Acoustic and Electric Hearing

Abstract

The loudness of a tone can be reduced by preceding it with a more intense tone. This effect, known as induced loudness reduction (ILR), has been reported to last for several seconds. The underlying neural mechanisms are unknown. One possible contributor to the effect involves changes in cochlear gain via the medial olivocochlear (MOC) efferents. Since cochlear implants (CIs) bypass the cochlea, investigating whether and how CI users experience ILR should help provide a better understanding of the underlying mechanisms. In the present study, ILR was examined in both normal-hearing listeners and CI users by examining the effects of an intense precursor (50 or 500 ms) on the loudness of a 50-ms target, as judged by comparing it to a spectrally remote 50-ms comparison sound. The interstimulus interval (ISI) between the precursor and the target was varied between 10 and 1000 ms to estimate the time course of ILR. In general, the patterns of results from the CI users were similar to those found in the normal-hearing listeners. However, in the short-precursor short-ISI condition, an enhancement in the loudness of target was observed in CI subjects that was not present in the normal-hearing listeners, consistent with the effects of an additional attenuation present in the normal-hearing listeners but not in the CI users. The results suggest that the MOC may play a role but that it is not the only source of these loudness context effects.

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Six Degrees of Auditory Spatial Separation

Abstract

The location of a sound is derived computationally from acoustical cues rather than being inherent in the topography of the input signal, as in vision. Since Lord Rayleigh, the descriptions of that representation have swung between "labeled line" and "opponent process" models. Employing a simple variant of a two-point separation judgment using concurrent speech sounds, we found that spatial discrimination thresholds changed nonmonotonically as a function of the overall separation. Rather than increasing with separation, spatial discrimination thresholds first declined as two-point separation increased before reaching a turning point and increasing thereafter with further separation. This "dipper" function, with a minimum at 6 ° of separation, was seen for regions around the midline as well as for more lateral regions (30 and 45 °). The discrimination thresholds for the binaural localization cues were linear over the same range, so these cannot explain the shape of these functions. These data and a simple computational model indicate that the perception of auditory space involves a local code or multichannel mapping emerging subsequent to the binaural cue coding.

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Pediatric desmoid fibromatosis of the parapharyngeal space: A case report and review of literature

Desmoid fibromatosis, or aggressive fibromatosis, is a benign but locally infiltrative fibroblastic neoplasm arising from fascial or musculoaponeurotic tissues. Although lacking metastatic potential, head and neck fibromatosis can have significant functional or cosmetic morbidities. 7%–15% of all desmoid tumors are seen in the head and neck region, 57% of which occur in the pediatric population. The incidence of pediatric desmoid tumor peaks around age 8. Treatment of choice is complete surgical resection; however, local recurrence is common.

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Adenoid cystic carcinoma of the external ear: a population based study

To determine the incidence of adenoid cystic carcinoma of the external ear in the United States, and to evaluate the clinical characteristics and survival outcomes associated with the disease.

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Technically unresectable recurrent oral cancers: Is NACT the answer?

Surgical excision of loco-regionally recurrent head and neck cancers is associated with a median disease free survival of 17.9months [1]. The utility of surgical excision is limited to stage I–II patients; only very few of recurrent head and neck cancer patients can undergo resection [2]. When surgical salvage is not possible, re-irradiation is the next option. However, patients with locally advanced technically unresectable disease (T4a and T4b) are unlikely to be candidates for re-irradiation.

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Hammer sound elicited tinnitus in car body repair worker cured by stapedial tenotomy – A case report

Abnormal auditory sensations or tinnitus caused by abnormal middle ear muscle contraction are extremely rare and uncomfortable for patients. A 67-year-old man who performed paint and body work for cars presented at our hospital with complaint of an audible and annoying abnormal sound that was synchronous with the striking of his hammer against the metal of the car body during his work. The patient reported that the sound was audible of left ear with a split-second delay after his hammer struck the metal.

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The effect of orthognathic surgery on the lip lines while smiling in skeletal class III patients with facial asymmetry

Abstract

Background

The aim of this study was to examine the relationship between improvements in lip asymmetry at rest and while smiling after orthognathic surgery in patients with skeletal class III malocclusion.

Methods

This study included 21 patients with skeletal class III malocclusion and facial asymmetry. We used preoperative and postoperative CT data and photographs to measure the vertical distance of the lips when smiling. The photographs were calibrated based on these distances and the CT image. We compared preoperative and postoperative results with the t test and correlations between measurements at rest and when smiling by regression analyses.

Results

There were significant correlations between the postoperative changes in canting of the mouth corners at rest, canting of the canines, canting of the first molars, the slope of the line connecting the canines, and the slope of the line connecting first molars. The magnitude of the postoperative lip line improvement while smiling was not significantly correlated with changes in the canting and slopes of the canines, molars, and lip lines at rest.

Conclusions

It remains difficult to predict lip line changes while smiling compared with at rest after orthognathic surgery in patients with mandibular prognathism, accompanied by facial asymmetry.

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Frequency of bone graft in implant surgery

Abstract

Background

Implant surgery has become popular with the advance of surgical techniques such as sinus lifting, guided bone regeneration, and block bone graft. However, there were no data about the frequency of bone graft during implant surgery. The purpose of this study was to report the frequency and types of bone graft depending on dental implant patients' profile to complement the database regarding implant surgery.

Methods

The implant operations had been performed from January 2006 to October 2014. The upper and lower jaws were divided into six sextants. A total of 792 sextants were included in this study. Patient information including sex, age, sites, bone graft, and types of bone were investigated.

Results

A total of 1512 implants had been placed. Male and female sextants were 421 and 371, respectively (M:F = 1:0.88). Average age was 54.3 (ranging from 20 to 88 years old). Implants were placed in the posterior maxilla (322 sextants, 40.7 %), posterior mandible (286 sextants, 36.1 %), anterior maxilla (127 sextants, 16.1 %), and anterior mandible (57 sextants, 7.2 %). Bone graft was performed in 50.3 % of the sextants. Among the bone grafted sites, sinus lifting with lateral approach (22.1 %) and guided bone regeneration (22.7 %) were performed most frequently.

Conclusions

Bone graft in implant surgery was necessary to augment defects. More than half of the sextants needed bone graft for implant installation.

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Oral medicine in academia

Publication date: Available online 31 March 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Crispian Scully




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A Technique for the Treatment of Oral-Antral Fistulae Resulting from Medication-Related Osteonecrosis of the Maxilla: The Combined Buccal Fat Pad Flap and Radical Sinusotomy

Publication date: Available online 31 March 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): James C. Melville, Ramzey Tursun, Jonathan W. Shum, Simon Young, Issa A. Hanna, Robert E. Marx
ObjectiveBisphosphonates and monoclonal antibodies directed at osteoclastic function are frequently used to treat postmenopausal and corticosteroid induced osteoporosis. They are also used in the treatment of certain metastatic malignancies. However osteonecrosis of the jaw has been reported following intravenous, subcutaneous or oral use.1 More than 12 million Americans and another 20 million are thought to be taking a bisphosphonate worldwide.2 Increasingly exposed bone with oral-antral fistulae has been known to occur as a specific presentation of what is now termed as medication related osteonecrosis of the jaws with a specific ICD-10 code.3 Oral-antral communications caused by Bisphosphonate concomitant with a secondary sinusitis represents a unique treatment challenge for the oral and maxillofacial surgeon. The purpose of this article is to demonstrate a simple but effective technique to treat oral-antral communications caused by MRONJ.Study DesignWith the review and approval of the University of Miami IRB, we identified 23 patients who underwent this surgical procedure.ResultsWe report a 100% resolution of the ONJ and sinusitis with re-pneumatization.ConclusionsThe buccal fat pad and radical sinustomy can be used as an effective and predictable technique for the resolution of Oral-antral fistulas due to MRONJ



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MicroRNAs in Oral lichen Planus and potential miRNA-mRNA pathogenesis with essential cytokines: A Review

Publication date: Available online 31 March 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Hui Ma, Yuanqin Wu, Huamei Yang, Jiajia Liu, Hongxia Dan, Xin Zeng, Yu Zhou, Lu Jiang, Qianming Chen
Oral lichen planus (OLP) is a potentially premalignant condition with an unknown pathogenesis. Immune and inflammatory factors are thought to play important roles in the development of OLP, and cytokines, such as interferon (IFN)-γ and tumor necrosis factor (TNF)-α, can act as critical players in the immunopathogenesis of OLP. MicroRNAs (miRNAs) are closely correlated with cytokines in various inflammation-related diseases. In patients with OLP, miRNA-146a and miRNA-155 are increased in peripheral blood mononuclear cells, and numerous miRNAs have been shown to exhibit altered expression profiles in lesions. While the miRNA-mRNA network is thought to be involved in the development of OLP, in-depth studies are lacking. Here, we summarize current data on the mechanisms of action of miRNAs regulating typical cytokines in OLP, including interleukin (IL)-10, IL-17, IL-22, IFN-γ, and TNF-α, to study the genetic basis of the pathogenesis of OLP and to provide prospects of therapy.



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Severity and presence of atherosclerosis’ signs within the segments of internal carotid artery: The CBCT’s contribution

Publication date: Available online 31 March 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Spyros Damaskos, Heraldo L.D. da Silveira, Erwin W.R. Berkhout
ObjectivesThis study aims to assess the distribution and interrelation of the presence of calcifications along the course of the internal carotid artery (ICA), by cone beam CT (CBCT), and to associate the severity of their depiction with the allocation within the segments of ICA, gender and age.Study Design161 CBCTs with intracranial calcifications were evaluated on their allocation and severity within the segments of ICA using a documented visual scale.ResultsCalcifications were detected along the petrous (C2-11.8%), lacerum (C3-23.6%), cavernous (C4-92.5%), and ophthalmic-clinoid (C5/C6-65.8%) segments. Friedman test showed significant difference in the severity distribution among these segments; the highest degree was found in the C4 segment (P<0.05). Wilcoxon signed-rank test showed no significant difference between calcifications on the right or left side or, between severities within C1 (extracranial) and C5/C6 segments. Chi-square test showed that the severity and allocation of calcifications are not influenced by gender; it also showed that their severity increases with age (P<0.05).ConclusionsIn the cohort studied the incidence of calcifications increases throughout the C1, C5/C6, and C4 segments. More severe calcifications were found at the C4, C1, and C5/C6 segments in decreasing order, yet increasing with age, regardless of gender.



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The patients’ perspective on the impact of sentinel node biopsy in oral cancer treatment

Publication date: Available online 31 March 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Géke B. Flach, Irma M. Verdonck-de Leeuw, Birgit I. Witte, W. Martin C. Klop, Robert J.J. van Es, Kees-Pieter Schepman, Remco de Bree
IntroductionAssessment of the impact of a SNB-based strategy in cT1/T2N0 oral cancer on the course of health related quality of life, psychological distress and shoulder disability. And evaluation of the patients' perspective on neck management strategies.Patients and methodsFifty-two patients (39 SNB-, 13 SNB+) completed the EORTC QLQ-C30, QLQ-H&N35, HADS, IES and SDQ at baseline, after SNB diagnosis and at 6 months follow-up. Objective shoulder measurements were performed after 2 years and interviews were taken after 4.5 months follow-up.ResultsAll scores of the questionnaires were not significantly different between SNB- and SNB+ patients. Objective shoulder functioning was similar. Most patients preferred a SNB-based strategy to an END strategy.ConclusionThe impact of a SNB-based strategy in cT1/T2N0 oral cancer patients is comparable for SNB- and SNB+ patients in terms of HRQoL, psychological distress and shoulder functioning. Most patients preferred a SNB-based strategy to an END strategy.



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T follicular helper cells, T follicular regulatory cells and autoimmunity

CD4⁺ T follicular helper (Tfh) cells are recognized as a distinct T-cell subset, which provides help for germinal center (GC) formation, B-cell development and affinity maturation, and immunoglobulin class switching, as an indispensable part of adaptive immunity. Tfh cell differentiation depends on various factors including cell-surface molecule interactions, extracellular cytokines and multiple transcription factors, with B-cell lymphoma 6 (Bcl-6) being the master regulator. T follicular regulatory (Tfr) cells are also located in the GC and share phenotypic characteristics with Tfh cells and regulatory T cells, but function as negative regulators of GC responses. Dysregulation of either Tfh or Tfr cells is linked to the pathogenesis of autoimmune diseases such as systemic lupus erythematosus. This review covers the basic Tfh and Tfr biology including their differentiation and function, and their close relationship with autoimmune diseases.

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Induced Loudness Reduction and Enhancement in Acoustic and Electric Hearing

Abstract

The loudness of a tone can be reduced by preceding it with a more intense tone. This effect, known as induced loudness reduction (ILR), has been reported to last for several seconds. The underlying neural mechanisms are unknown. One possible contributor to the effect involves changes in cochlear gain via the medial olivocochlear (MOC) efferents. Since cochlear implants (CIs) bypass the cochlea, investigating whether and how CI users experience ILR should help provide a better understanding of the underlying mechanisms. In the present study, ILR was examined in both normal-hearing listeners and CI users by examining the effects of an intense precursor (50 or 500 ms) on the loudness of a 50-ms target, as judged by comparing it to a spectrally remote 50-ms comparison sound. The interstimulus interval (ISI) between the precursor and the target was varied between 10 and 1000 ms to estimate the time course of ILR. In general, the patterns of results from the CI users were similar to those found in the normal-hearing listeners. However, in the short-precursor short-ISI condition, an enhancement in the loudness of target was observed in CI subjects that was not present in the normal-hearing listeners, consistent with the effects of an additional attenuation present in the normal-hearing listeners but not in the CI users. The results suggest that the MOC may play a role but that it is not the only source of these loudness context effects.

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Six Degrees of Auditory Spatial Separation

Abstract

The location of a sound is derived computationally from acoustical cues rather than being inherent in the topography of the input signal, as in vision. Since Lord Rayleigh, the descriptions of that representation have swung between "labeled line" and "opponent process" models. Employing a simple variant of a two-point separation judgment using concurrent speech sounds, we found that spatial discrimination thresholds changed nonmonotonically as a function of the overall separation. Rather than increasing with separation, spatial discrimination thresholds first declined as two-point separation increased before reaching a turning point and increasing thereafter with further separation. This "dipper" function, with a minimum at 6 ° of separation, was seen for regions around the midline as well as for more lateral regions (30 and 45 °). The discrimination thresholds for the binaural localization cues were linear over the same range, so these cannot explain the shape of these functions. These data and a simple computational model indicate that the perception of auditory space involves a local code or multichannel mapping emerging subsequent to the binaural cue coding.

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Pediatric desmoid fibromatosis of the parapharyngeal space: A case report and review of literature

Desmoid fibromatosis, or aggressive fibromatosis, is a benign but locally infiltrative fibroblastic neoplasm arising from fascial or musculoaponeurotic tissues. Although lacking metastatic potential, head and neck fibromatosis can have significant functional or cosmetic morbidities. 7%–15% of all desmoid tumors are seen in the head and neck region, 57% of which occur in the pediatric population. The incidence of pediatric desmoid tumor peaks around age 8. Treatment of choice is complete surgical resection; however, local recurrence is common.

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Adenoid cystic carcinoma of the external ear: a population based study

To determine the incidence of adenoid cystic carcinoma of the external ear in the United States, and to evaluate the clinical characteristics and survival outcomes associated with the disease.

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Technically unresectable recurrent oral cancers: Is NACT the answer?

Surgical excision of loco-regionally recurrent head and neck cancers is associated with a median disease free survival of 17.9months [1]. The utility of surgical excision is limited to stage I–II patients; only very few of recurrent head and neck cancer patients can undergo resection [2]. When surgical salvage is not possible, re-irradiation is the next option. However, patients with locally advanced technically unresectable disease (T4a and T4b) are unlikely to be candidates for re-irradiation.

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Hammer sound elicited tinnitus in car body repair worker cured by stapedial tenotomy – A case report

Abnormal auditory sensations or tinnitus caused by abnormal middle ear muscle contraction are extremely rare and uncomfortable for patients. A 67-year-old man who performed paint and body work for cars presented at our hospital with complaint of an audible and annoying abnormal sound that was synchronous with the striking of his hammer against the metal of the car body during his work. The patient reported that the sound was audible of left ear with a split-second delay after his hammer struck the metal.

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The effect of orthognathic surgery on the lip lines while smiling in skeletal class III patients with facial asymmetry

Abstract

Background

The aim of this study was to examine the relationship between improvements in lip asymmetry at rest and while smiling after orthognathic surgery in patients with skeletal class III malocclusion.

Methods

This study included 21 patients with skeletal class III malocclusion and facial asymmetry. We used preoperative and postoperative CT data and photographs to measure the vertical distance of the lips when smiling. The photographs were calibrated based on these distances and the CT image. We compared preoperative and postoperative results with the t test and correlations between measurements at rest and when smiling by regression analyses.

Results

There were significant correlations between the postoperative changes in canting of the mouth corners at rest, canting of the canines, canting of the first molars, the slope of the line connecting the canines, and the slope of the line connecting first molars. The magnitude of the postoperative lip line improvement while smiling was not significantly correlated with changes in the canting and slopes of the canines, molars, and lip lines at rest.

Conclusions

It remains difficult to predict lip line changes while smiling compared with at rest after orthognathic surgery in patients with mandibular prognathism, accompanied by facial asymmetry.

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Frequency of bone graft in implant surgery

Abstract

Background

Implant surgery has become popular with the advance of surgical techniques such as sinus lifting, guided bone regeneration, and block bone graft. However, there were no data about the frequency of bone graft during implant surgery. The purpose of this study was to report the frequency and types of bone graft depending on dental implant patients' profile to complement the database regarding implant surgery.

Methods

The implant operations had been performed from January 2006 to October 2014. The upper and lower jaws were divided into six sextants. A total of 792 sextants were included in this study. Patient information including sex, age, sites, bone graft, and types of bone were investigated.

Results

A total of 1512 implants had been placed. Male and female sextants were 421 and 371, respectively (M:F = 1:0.88). Average age was 54.3 (ranging from 20 to 88 years old). Implants were placed in the posterior maxilla (322 sextants, 40.7 %), posterior mandible (286 sextants, 36.1 %), anterior maxilla (127 sextants, 16.1 %), and anterior mandible (57 sextants, 7.2 %). Bone graft was performed in 50.3 % of the sextants. Among the bone grafted sites, sinus lifting with lateral approach (22.1 %) and guided bone regeneration (22.7 %) were performed most frequently.

Conclusions

Bone graft in implant surgery was necessary to augment defects. More than half of the sextants needed bone graft for implant installation.

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Oral medicine in academia

Publication date: Available online 31 March 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Crispian Scully




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A Technique for the Treatment of Oral-Antral Fistulae Resulting from Medication-Related Osteonecrosis of the Maxilla: The Combined Buccal Fat Pad Flap and Radical Sinusotomy

Publication date: Available online 31 March 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): James C. Melville, Ramzey Tursun, Jonathan W. Shum, Simon Young, Issa A. Hanna, Robert E. Marx
ObjectiveBisphosphonates and monoclonal antibodies directed at osteoclastic function are frequently used to treat postmenopausal and corticosteroid induced osteoporosis. They are also used in the treatment of certain metastatic malignancies. However osteonecrosis of the jaw has been reported following intravenous, subcutaneous or oral use.1 More than 12 million Americans and another 20 million are thought to be taking a bisphosphonate worldwide.2 Increasingly exposed bone with oral-antral fistulae has been known to occur as a specific presentation of what is now termed as medication related osteonecrosis of the jaws with a specific ICD-10 code.3 Oral-antral communications caused by Bisphosphonate concomitant with a secondary sinusitis represents a unique treatment challenge for the oral and maxillofacial surgeon. The purpose of this article is to demonstrate a simple but effective technique to treat oral-antral communications caused by MRONJ.Study DesignWith the review and approval of the University of Miami IRB, we identified 23 patients who underwent this surgical procedure.ResultsWe report a 100% resolution of the ONJ and sinusitis with re-pneumatization.ConclusionsThe buccal fat pad and radical sinustomy can be used as an effective and predictable technique for the resolution of Oral-antral fistulas due to MRONJ



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MicroRNAs in Oral lichen Planus and potential miRNA-mRNA pathogenesis with essential cytokines: A Review

Publication date: Available online 31 March 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Hui Ma, Yuanqin Wu, Huamei Yang, Jiajia Liu, Hongxia Dan, Xin Zeng, Yu Zhou, Lu Jiang, Qianming Chen
Oral lichen planus (OLP) is a potentially premalignant condition with an unknown pathogenesis. Immune and inflammatory factors are thought to play important roles in the development of OLP, and cytokines, such as interferon (IFN)-γ and tumor necrosis factor (TNF)-α, can act as critical players in the immunopathogenesis of OLP. MicroRNAs (miRNAs) are closely correlated with cytokines in various inflammation-related diseases. In patients with OLP, miRNA-146a and miRNA-155 are increased in peripheral blood mononuclear cells, and numerous miRNAs have been shown to exhibit altered expression profiles in lesions. While the miRNA-mRNA network is thought to be involved in the development of OLP, in-depth studies are lacking. Here, we summarize current data on the mechanisms of action of miRNAs regulating typical cytokines in OLP, including interleukin (IL)-10, IL-17, IL-22, IFN-γ, and TNF-α, to study the genetic basis of the pathogenesis of OLP and to provide prospects of therapy.



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Severity and presence of atherosclerosis’ signs within the segments of internal carotid artery: The CBCT’s contribution

Publication date: Available online 31 March 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Spyros Damaskos, Heraldo L.D. da Silveira, Erwin W.R. Berkhout
ObjectivesThis study aims to assess the distribution and interrelation of the presence of calcifications along the course of the internal carotid artery (ICA), by cone beam CT (CBCT), and to associate the severity of their depiction with the allocation within the segments of ICA, gender and age.Study Design161 CBCTs with intracranial calcifications were evaluated on their allocation and severity within the segments of ICA using a documented visual scale.ResultsCalcifications were detected along the petrous (C2-11.8%), lacerum (C3-23.6%), cavernous (C4-92.5%), and ophthalmic-clinoid (C5/C6-65.8%) segments. Friedman test showed significant difference in the severity distribution among these segments; the highest degree was found in the C4 segment (P<0.05). Wilcoxon signed-rank test showed no significant difference between calcifications on the right or left side or, between severities within C1 (extracranial) and C5/C6 segments. Chi-square test showed that the severity and allocation of calcifications are not influenced by gender; it also showed that their severity increases with age (P<0.05).ConclusionsIn the cohort studied the incidence of calcifications increases throughout the C1, C5/C6, and C4 segments. More severe calcifications were found at the C4, C1, and C5/C6 segments in decreasing order, yet increasing with age, regardless of gender.



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The patients’ perspective on the impact of sentinel node biopsy in oral cancer treatment

Publication date: Available online 31 March 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Géke B. Flach, Irma M. Verdonck-de Leeuw, Birgit I. Witte, W. Martin C. Klop, Robert J.J. van Es, Kees-Pieter Schepman, Remco de Bree
IntroductionAssessment of the impact of a SNB-based strategy in cT1/T2N0 oral cancer on the course of health related quality of life, psychological distress and shoulder disability. And evaluation of the patients' perspective on neck management strategies.Patients and methodsFifty-two patients (39 SNB-, 13 SNB+) completed the EORTC QLQ-C30, QLQ-H&N35, HADS, IES and SDQ at baseline, after SNB diagnosis and at 6 months follow-up. Objective shoulder measurements were performed after 2 years and interviews were taken after 4.5 months follow-up.ResultsAll scores of the questionnaires were not significantly different between SNB- and SNB+ patients. Objective shoulder functioning was similar. Most patients preferred a SNB-based strategy to an END strategy.ConclusionThe impact of a SNB-based strategy in cT1/T2N0 oral cancer patients is comparable for SNB- and SNB+ patients in terms of HRQoL, psychological distress and shoulder functioning. Most patients preferred a SNB-based strategy to an END strategy.



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T follicular helper cells, T follicular regulatory cells and autoimmunity

CD4⁺ T follicular helper (Tfh) cells are recognized as a distinct T-cell subset, which provides help for germinal center (GC) formation, B-cell development and affinity maturation, and immunoglobulin class switching, as an indispensable part of adaptive immunity. Tfh cell differentiation depends on various factors including cell-surface molecule interactions, extracellular cytokines and multiple transcription factors, with B-cell lymphoma 6 (Bcl-6) being the master regulator. T follicular regulatory (Tfr) cells are also located in the GC and share phenotypic characteristics with Tfh cells and regulatory T cells, but function as negative regulators of GC responses. Dysregulation of either Tfh or Tfr cells is linked to the pathogenesis of autoimmune diseases such as systemic lupus erythematosus. This review covers the basic Tfh and Tfr biology including their differentiation and function, and their close relationship with autoimmune diseases.

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Cover

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Subscriptions

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Therapeutic potential of regulatory cytokines that target B cells

Autoreactive B cells play a crucial role in the pathogenesis of autoimmune diseases by producing auto-antibodies and presenting antigens. Regulatory cytokines that simultaneously suppress multiple pathways have the potential to control autoreactive B cells. The generally inhibitory cytokine IL-10 may have a stimulatory effect on human B-cell survival and antibody production. TGF-β family cytokines can decrease or increase antibody production and can suppress B-cell proliferation and differentiation. In contrast to TGF-β1, which induces extensive fibrosis, TGF-β3 and bone morphogenetic protein 6 (BMP-6)/BMP-7 induce non-scarring wound healing and counteract tissue fibrosis. Therefore, TGF-β3 and BMP-6/BMP-7 may be clinically applicable as therapeutic cytokines that target B cells. Recent progress in protein engineering may enable us to generate novel biologic therapies based on TGF-β family cytokines.

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Table of Contents

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CD4+ T-cell subsets in inflammatory diseases: beyond the Th1/Th2 paradigm

CD4⁺ T cells are crucial for directing appropriate immune responses during host defense and for the pathogenesis of inflammatory diseases. In addition to the classical biphasic model of differentiation of T-helper 1 (T_h1) and T_h2 cells, unexpected increases in the numbers of CD4⁺ T-cell subsets, including T_h17, T_h9, T follicular-helper (T_fh) and T-regulatory (T_reg) cells, have been recognized. In the present review, we focus on how these various T-helper cell subsets contribute to the pathogenesis of immune-mediated inflammatory diseases. In particular, we focus on multiple sclerosis, psoriasis and asthma as typical model diseases in which multiple T-helper cell subsets have recently been suggested to play a role. We will also discuss various unique sub-populations of T-helper cells that have been identified. First, we will introduce the heterogeneous T-helper cell subsets, which are classified by their simultaneous expression of multiple key transcription factors. We will also introduce different kinds of memory-type T_h2 cells, which are involved in the pathogenesis of chronic type-2 immune-related diseases. Finally, we will discuss the molecular mechanisms underlying the generation of the plasticity and heterogeneity of T-helper cell subsets. The latest progress in the study of T-helper cell subsets has forced us to reconsider the etiology of immune-mediated inflammatory diseases beyond the model based on the T_h1/T_h2 balance. To this end, we propose another model—the pathogenic T-helper population disease-induction model—as a possible mechanism for the induction and/or persistence of immune-mediated inflammatory diseases.

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Introduction: Autoimmunity Special Issue

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Acoustic Shock by Nail Gun

No abstract available

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Manufacturers News

No abstract available

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3D Games for Tuning and Learning About Hearing Aids

No abstract available

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PCAST Ignites Debate Among Hearing Health Professionals

No abstract available

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Symptom: Asymmetric Hearing Loss

No abstract available

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Best Practices for Effective Patient Interaction

No abstract available

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Hearing Loss Risk Factors for Cystic Fibrosis Patients

No abstract available

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Ethiopian Surgical Camps a Win for Surgeons and Patients

No abstract available

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Conditioned Play Audiometry: It Should Be All Fun and Games

No abstract available

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Throw Out the Caregiver

No abstract available

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Acoustic Shock by Nail Gun

No abstract available

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Manufacturers News

No abstract available

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AAA Releases Guidance for Hearing Loss from Zika Virus

The American Academy of Audiology (AAA) released a statement regarding the Zika virus outbreak and its potential impact on hearing health.

The Academy said it hearing loss due to the disease could occur at birth or acquired later.

"Much like cytomeglovirus and other pathologies, it is crucially important to identify hearing loss through infant hearing screening or preschool and school-aged screening programs for all infants and children who may be at high risk for hearing loss as a consequence of Zika virus disease," AAA said in a press release.

The concern of potential risks is targeted for the infants born of mothers who were or could be during pregnancy. 

Learn more about the Zika virus: http://ift.tt/1lX0TJ3 

Published: 3/30/2016 2:05:00 PM

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AAA Releases Guidance for Hearing Loss from Zika Virus

The American Academy of Audiology (AAA) released a statement regarding the Zika virus outbreak and its potential impact on hearing health.

The Academy said it hearing loss due to the disease could occur at birth or acquired later.

"Much like cytomeglovirus and other pathologies, it is crucially important to identify hearing loss through infant hearing screening or preschool and school-aged screening programs for all infants and children who may be at high risk for hearing loss as a consequence of Zika virus disease," AAA said in a press release.

The concern of potential risks is targeted for the infants born of mothers who were or could be during pregnancy. 

Learn more about the Zika virus: http://ift.tt/1lX0TJ3 

Published: 3/30/2016 2:05:00 PM

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Response to Letter : Psychometric properties of the Tinnitus Functional Index (TFI): Assessment in a UK research volunteer population

Publication date: Available online 30 March 2016
Source:Hearing Research
Author(s): Kathryn Fackrell, Deborah A. Hall, Johanna G. Barry, Derek J. Hoare




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Response to Letter : Psychometric properties of the Tinnitus Functional Index (TFI): Assessment in a UK research volunteer population

Publication date: Available online 30 March 2016
Source:Hearing Research
Author(s): Kathryn Fackrell, Deborah A. Hall, Johanna G. Barry, Derek J. Hoare




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Scanning Electron Microscopic Examination of the Extracellular Matrix in the Decellularized Mouse and Human Cochlea

Abstract

Decellularized tissues have been used to investigate the extracellular matrix (ECM) in a number of different tissues and species. Santi and Johnson JARO 14:3-15 (2013) first described the decellularized inner ear in the mouse, rat, and human using scanning thin-sheet laser imaging microscopy (sTSLIM). The purpose of the present investigation is to examine decellularized cochleas in the mouse and human at higher resolution using scanning electron microscopy (SEM). Fresh cochleas were harvested and decellularized using detergent extraction methods. Following decellularization, the ECM of the bone, basilar membrane, spiral limbus, and ligament remained, and all of the cells were removed from the cochlea. A number of similarities and differences in the ECM of the mouse and human were observed. A novel, spirally directed structure was present on the basilar membrane and is located at the border between Hensen and Boettcher cells. These septa-like structures formed a single row in the mouse and multiple rows in the human. The basal lamina of the stria vascularis capillaries was present and appeared thicker in the human compared with the mouse. In the mouse, numerous openings beneath the spiral prominence that previously housed the root processes of the external sulcus cells were observed but in the human there was only a single row of openings. These and other anatomical differences in the ECM between the mouse and human may reflect functional differences and/or be due to aging; however, decellularized cochleas provide a new way to examine the cochlear ECM and reveal new observations.

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Scanning Electron Microscopic Examination of the Extracellular Matrix in the Decellularized Mouse and Human Cochlea

Abstract

Decellularized tissues have been used to investigate the extracellular matrix (ECM) in a number of different tissues and species. Santi and Johnson JARO 14:3-15 (2013) first described the decellularized inner ear in the mouse, rat, and human using scanning thin-sheet laser imaging microscopy (sTSLIM). The purpose of the present investigation is to examine decellularized cochleas in the mouse and human at higher resolution using scanning electron microscopy (SEM). Fresh cochleas were harvested and decellularized using detergent extraction methods. Following decellularization, the ECM of the bone, basilar membrane, spiral limbus, and ligament remained, and all of the cells were removed from the cochlea. A number of similarities and differences in the ECM of the mouse and human were observed. A novel, spirally directed structure was present on the basilar membrane and is located at the border between Hensen and Boettcher cells. These septa-like structures formed a single row in the mouse and multiple rows in the human. The basal lamina of the stria vascularis capillaries was present and appeared thicker in the human compared with the mouse. In the mouse, numerous openings beneath the spiral prominence that previously housed the root processes of the external sulcus cells were observed but in the human there was only a single row of openings. These and other anatomical differences in the ECM between the mouse and human may reflect functional differences and/or be due to aging; however, decellularized cochleas provide a new way to examine the cochlear ECM and reveal new observations.

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Is there a need for non-drug treatments in headaches?

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Is there a need for non-drug treatments in headaches?

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Is there a need for non-drug treatments in headaches?

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Spontaneous rupture of an internal laryngocele after neck dissection: a rare complication

We present a rare, and to the best of our knowledge, previously unreported complication of the spontaneous rupture of an internal laryngocele after a routine neck dissection for metastatic squamous cell carcinoma. While this caused some diagnostic confusion, the patient was managed conservatively with no further complications.

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Developing a Registry for Thyroid Incidentalomas: Lessons Learned and the Path Forward

Thyroid , Vol. 0, No. 0.


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Spontaneous rupture of an internal laryngocele after neck dissection: a rare complication

We present a rare, and to the best of our knowledge, previously unreported complication of the spontaneous rupture of an internal laryngocele after a routine neck dissection for metastatic squamous cell carcinoma. While this caused some diagnostic confusion, the patient was managed conservatively with no further complications.

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Spontaneous rupture of an internal laryngocele after neck dissection: a rare complication

We present a rare, and to the best of our knowledge, previously unreported complication of the spontaneous rupture of an internal laryngocele after a routine neck dissection for metastatic squamous cell carcinoma. While this caused some diagnostic confusion, the patient was managed conservatively with no further complications.

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Developing a Registry for Thyroid Incidentalomas: Lessons Learned and the Path Forward

Thyroid , Vol. 0, No. 0.


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Developing a Registry for Thyroid Incidentalomas: Lessons Learned and the Path Forward

Thyroid , Vol. 0, No. 0.


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Spontaneous rupture of an internal laryngocele after neck dissection: a rare complication

Publication date: Available online 30 March 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Eirini Zagkou, Thomas Aldridge, Peyman Alam, Peter A. Brennan
We present a rare, and to the best of our knowledge, previously unreported complication of the spontaneous rupture of an internal laryngocele after a routine neck dissection for metastatic squamous cell carcinoma. While this caused some diagnostic confusion, the patient was managed conservatively with no further complications.



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Endoskopische Revisionschirurgie des Nasenrückens

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The Inflammatory Response in Psoriasis: a Comprehensive Review

Abstract

Psoriasis is a chronic inflammatory autoimmune disease characterized by an excessively aberrant hyperproliferation of keratinocytes. The pathogenesis of psoriasis is complex and the exact mechanism remains elusive. However, psoriasis is thought to result from a combination of genetic, epigenetic, and environmental influences. Recent studies have identified that epigenetic factors including dysregulated DNA methylation levels, abnormal histone modification and microRNAs expressions are involved in the development of psoriasis. The interplay of immune cells and cytokines is another critical factor in the pathogenesis of psoriasis. These factors or pathways include Th1/Th2 homeostasis, the Th17/Treg balance and the IL-23/Th17 axis. Th17 is believed particularly important in psoriasis due to its pro-inflammatory effects and its involvement in an integrated inflammatory loop with dendritic cells and keratinocytes, contributing to an overproduction of antimicrobial peptides, inflammatory cytokines, and chemokines that leads to amplification of the immune response. In addition, other pathways and signaling molecules have been found to be involved, including Th9, Th22, regulatory T cells, γδ T cells, CD8⁺ T cells, and their related cytokines. Understanding the pathogenesis of psoriasis will allow us to develop increasingly efficient targeted treatment by blocking relevant inflammatory signaling pathways and molecules. There is no cure for psoriasis at the present time, and much of the treatment involves managing the symptoms. The biologics, while lacking the adverse effects associated with some of the traditional medications such as corticosteroids and methotrexate, have their own set of side effects, which may include reactivation of latent infections. Significant challenges remain in developing safe and efficacious novel targeted therapies that depend on a better understanding of the immunological dysfunction in psoriasis.

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Spontaneous rupture of an internal laryngocele after neck dissection: a rare complication

Publication date: Available online 30 March 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Eirini Zagkou, Thomas Aldridge, Peyman Alam, Peter A. Brennan
We present a rare, and to the best of our knowledge, previously unreported complication of the spontaneous rupture of an internal laryngocele after a routine neck dissection for metastatic squamous cell carcinoma. While this caused some diagnostic confusion, the patient was managed conservatively with no further complications.



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via IFTTT

Spontaneous rupture of an internal laryngocele after neck dissection: a rare complication

Publication date: Available online 30 March 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Eirini Zagkou, Thomas Aldridge, Peyman Alam, Peter A. Brennan
We present a rare, and to the best of our knowledge, previously unreported complication of the spontaneous rupture of an internal laryngocele after a routine neck dissection for metastatic squamous cell carcinoma. While this caused some diagnostic confusion, the patient was managed conservatively with no further complications.



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via IFTTT

Endoskopische Revisionschirurgie des Nasenrückens

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Endoskopische Revisionschirurgie des Nasenrückens

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The Inflammatory Response in Psoriasis: a Comprehensive Review

Abstract

Psoriasis is a chronic inflammatory autoimmune disease characterized by an excessively aberrant hyperproliferation of keratinocytes. The pathogenesis of psoriasis is complex and the exact mechanism remains elusive. However, psoriasis is thought to result from a combination of genetic, epigenetic, and environmental influences. Recent studies have identified that epigenetic factors including dysregulated DNA methylation levels, abnormal histone modification and microRNAs expressions are involved in the development of psoriasis. The interplay of immune cells and cytokines is another critical factor in the pathogenesis of psoriasis. These factors or pathways include Th1/Th2 homeostasis, the Th17/Treg balance and the IL-23/Th17 axis. Th17 is believed particularly important in psoriasis due to its pro-inflammatory effects and its involvement in an integrated inflammatory loop with dendritic cells and keratinocytes, contributing to an overproduction of antimicrobial peptides, inflammatory cytokines, and chemokines that leads to amplification of the immune response. In addition, other pathways and signaling molecules have been found to be involved, including Th9, Th22, regulatory T cells, γδ T cells, CD8⁺ T cells, and their related cytokines. Understanding the pathogenesis of psoriasis will allow us to develop increasingly efficient targeted treatment by blocking relevant inflammatory signaling pathways and molecules. There is no cure for psoriasis at the present time, and much of the treatment involves managing the symptoms. The biologics, while lacking the adverse effects associated with some of the traditional medications such as corticosteroids and methotrexate, have their own set of side effects, which may include reactivation of latent infections. Significant challenges remain in developing safe and efficacious novel targeted therapies that depend on a better understanding of the immunological dysfunction in psoriasis.

from #ENT via xlomafota13 on Inoreader http://ift.tt/1UVvpBP
via IFTTT

The Inflammatory Response in Psoriasis: a Comprehensive Review

Abstract

Psoriasis is a chronic inflammatory autoimmune disease characterized by an excessively aberrant hyperproliferation of keratinocytes. The pathogenesis of psoriasis is complex and the exact mechanism remains elusive. However, psoriasis is thought to result from a combination of genetic, epigenetic, and environmental influences. Recent studies have identified that epigenetic factors including dysregulated DNA methylation levels, abnormal histone modification and microRNAs expressions are involved in the development of psoriasis. The interplay of immune cells and cytokines is another critical factor in the pathogenesis of psoriasis. These factors or pathways include Th1/Th2 homeostasis, the Th17/Treg balance and the IL-23/Th17 axis. Th17 is believed particularly important in psoriasis due to its pro-inflammatory effects and its involvement in an integrated inflammatory loop with dendritic cells and keratinocytes, contributing to an overproduction of antimicrobial peptides, inflammatory cytokines, and chemokines that leads to amplification of the immune response. In addition, other pathways and signaling molecules have been found to be involved, including Th9, Th22, regulatory T cells, γδ T cells, CD8⁺ T cells, and their related cytokines. Understanding the pathogenesis of psoriasis will allow us to develop increasingly efficient targeted treatment by blocking relevant inflammatory signaling pathways and molecules. There is no cure for psoriasis at the present time, and much of the treatment involves managing the symptoms. The biologics, while lacking the adverse effects associated with some of the traditional medications such as corticosteroids and methotrexate, have their own set of side effects, which may include reactivation of latent infections. Significant challenges remain in developing safe and efficacious novel targeted therapies that depend on a better understanding of the immunological dysfunction in psoriasis.

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Scanning Electron Microscopic Examination of the Extracellular Matrix in the Decellularized Mouse and Human Cochlea

Abstract

Decellularized tissues have been used to investigate the extracellular matrix (ECM) in a number of different tissues and species. Santi and Johnson JARO 14:3-15 (2013) first described the decellularized inner ear in the mouse, rat, and human using scanning thin-sheet laser imaging microscopy (sTSLIM). The purpose of the present investigation is to examine decellularized cochleas in the mouse and human at higher resolution using scanning electron microscopy (SEM). Fresh cochleas were harvested and decellularized using detergent extraction methods. Following decellularization, the ECM of the bone, basilar membrane, spiral limbus, and ligament remained, and all of the cells were removed from the cochlea. A number of similarities and differences in the ECM of the mouse and human were observed. A novel, spirally directed structure was present on the basilar membrane and is located at the border between Hensen and Boettcher cells. These septa-like structures formed a single row in the mouse and multiple rows in the human. The basal lamina of the stria vascularis capillaries was present and appeared thicker in the human compared with the mouse. In the mouse, numerous openings beneath the spiral prominence that previously housed the root processes of the external sulcus cells were observed but in the human there was only a single row of openings. These and other anatomical differences in the ECM between the mouse and human may reflect functional differences and/or be due to aging; however, decellularized cochleas provide a new way to examine the cochlear ECM and reveal new observations.

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Scanning Electron Microscopic Examination of the Extracellular Matrix in the Decellularized Mouse and Human Cochlea

Abstract

Decellularized tissues have been used to investigate the extracellular matrix (ECM) in a number of different tissues and species. Santi and Johnson JARO 14:3-15 (2013) first described the decellularized inner ear in the mouse, rat, and human using scanning thin-sheet laser imaging microscopy (sTSLIM). The purpose of the present investigation is to examine decellularized cochleas in the mouse and human at higher resolution using scanning electron microscopy (SEM). Fresh cochleas were harvested and decellularized using detergent extraction methods. Following decellularization, the ECM of the bone, basilar membrane, spiral limbus, and ligament remained, and all of the cells were removed from the cochlea. A number of similarities and differences in the ECM of the mouse and human were observed. A novel, spirally directed structure was present on the basilar membrane and is located at the border between Hensen and Boettcher cells. These septa-like structures formed a single row in the mouse and multiple rows in the human. The basal lamina of the stria vascularis capillaries was present and appeared thicker in the human compared with the mouse. In the mouse, numerous openings beneath the spiral prominence that previously housed the root processes of the external sulcus cells were observed but in the human there was only a single row of openings. These and other anatomical differences in the ECM between the mouse and human may reflect functional differences and/or be due to aging; however, decellularized cochleas provide a new way to examine the cochlear ECM and reveal new observations.

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Distraction Osteogenesis for Management of Severe OSA in Pierre Robin Sequence: An Approach to Elude Tracheostomy in Infants

Abstract

Background

Severe obstructive sleep apnoea (OSA) is a life threatening condition associated with Pierre Robin sequence (PRS) due to mandibular micrognathia and glossoptosis. Often these patients require tracheostomy at an early age which has high morbidity. Distraction osteogenesis (DO) is an accepted method of treatment for patients with hypoplastic mandible to achieve mandibular lengthening without need for a bone graft. It has also been used in respiratory distressed neonates and infants to avoid tracheostomy.

Case report

An eight month old baby, a diagnosed case of PRS with severe OSA and recurrent episodes of aspiration pneumonia and on nasogastric tube feeding since birth was referred to us for evaluation and possibility of therapeutic augmentation of the mandible by DO. After a thorough clinico-radiological assessment the child was operated for bilateral extraoral placement of horizontal corpus distractor. A total distraction of 12 mm was carried out and consolidation of callus was monitored by USG. Postoperatively the patient was followed up for 12 months. Presently she has normal respiratory and feeding function without any episode of aspiration pneumonia.

Conclusion

Mandibular corpus DO is a safe and effective technique that can be applied to predictably relieve severe upper airway obstruction in selected PRS cases. In order to avoid the limitations of alternative surgical procedures and the tracheostomy-associated morbidity, DO should be considered among the routine treatment modalities.

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Early Postoperative Malignant Subcutaneous Emphysema: Report and Review

Abstract

Background

Subcutaneous emphysema is defined as presence of air or gas in subcutaneous tissue layer. It may be localized or generalized due to various aetiological factors. Although SE and pneumomediastinum are self-limiting conditions, life-threatening complications may develop. Escape of air into both pleural cavity causing bilateral pneumothorax and tension pneumothorax can be termed as malignant emphysema.

Purpose

To report a case of malignant generalized subcutaneous emphysema in early postoperative phase following palatoplasty.

Case Report

A 25 year old female patient was operated for closure of residual oronasal communication using an anteriorly based tongue flap. The patient was reversed from general anesthesia and shifted to the post-operative room with the endotracheal tube in situ. Sudden swelling of the face and periorbital area was noticed which spread all over the body. A diagnosis of malignant post-operative subcutaneous emphysema was made and the patient was shifted back to the operation theatre. She was managed successfully by bilateral tube thoracotomy and tracheostomy.

Conclusion

Close observation of the patient in early postoperative stage having endotracheal tube in situ is crucial to avoid such complication. Regardless of aetiology, early recognition of the clinical features of tension pneumothorax and timely intervention are necessary for the survival of the patient.

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Enhanced recovery after surgery (ERAS) pathways in autologous breast reconstruction: a systematic review

Abstract

Enhanced recovery after surgery (ERAS) pathways aim to achieve earlier recovery and reduced hospital length-of-stay (LOS) by providing multi-modal perioperative care. The tenets of ERAS pathways include pre-operative optimisation, prevention of surgical complications, reduction of physiological stress response to surgery and rehabilitation to normal function. To date, ERAS protocols have gained broad acceptance by many surgical specialities. Contemporary literature has identified decreased LOS, improved quality of care and reduced healthcare expenditures. We aimed to systematically review the current literature and assess the current state of ERAS in autologous breast reconstruction. A systematic review of MEDLINE, EMBASE, ScienceDirect, Cochrane Libraries and Web of Science databases in October 2015 was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Articles pertaining to the use of ERAS in plastic and reconstructive surgery were included for analysis. Review articles, conference proceedings and correspondence were excluded from the assessment. Five hundred fifty-seven articles were identified, of which three suitable articles were included for assessment. Of these, one series outlined the learning curve associated with ERAS pathways and two series were comparative in nature. Meta-analytical analysis was not possible do to insufficient data and heterogeneity in outcome measures. In two of these comparative series, there was no statistical difference in rates of systemic infective (OR 0.91, 95 % CI 0.29 to 2.80, p = 0.86), total flap loss (OR 1.09, 95 % CI 0.37 to 3.19, p = 0.87), partial flap loss (OR 1.64, 95 % CI 0.66 to 4.10, p = 0.29) or wound infection (OR 1.38, 95 % CI 0.78 to 2.34, p = 0.29). LOS was significantly reduced in the ERAS group in both comparative studies from 7.4 to 6.2 days (p < 0.001) and 6.6 to 3.9 days (p < 0.001), respectively. ERAS pathways in breast reconstruction appear to consistently reduce LOS. From the available literature there were no significant detrimental effects on patient care following the implementation of ERAS pathways. Further research is required to definitively determine safety in the assessed cohort and to determine reductions in healthcare-related expenditures.

Level of evidence: Not ratable

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Asthma in Urban Children: Epidemiology, Environmental Risk Factors, and the Public Health Domain

Abstract

Asthma is the most commonly reported chronic condition of childhood in developed countries, with 6.5 million children affected in the USA. A disparate burden of childhood asthma is seen among socioeconomically disadvantaged youth, often concentrated in urban areas with high poverty rates. Host factors that predispose a child to asthma include atopy, male gender, parental history of asthma, and also race, ethnicity, and genetic and epigenetic susceptibilities. Environmental factors, such as improved hygiene, ambient air pollution, and early life exposures to microbes and aeroallergens, also influence the development of asthma. With greater than 90 % of time spent indoors, home exposures (such as cockroach, rodent, and indoor air pollution) are highly relevant for urban asthma. Morbidity reduction may require focused public health initiatives for environmental intervention in high priority risk groups and the addition of immune modulatory agents in children with poorly controlled disease.

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After Breast Reconstruction, 24 Hours of Antibiotics Is Enough

After breast reconstruction surgery, 24 hours of antibiotics to fight surgical sight infections is equivalent to an extended course, according to new research.
Reuters Health Information

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Scanning Electron Microscopic Examination of the Extracellular Matrix in the Decellularized Mouse and Human Cochlea

Abstract

Decellularized tissues have been used to investigate the extracellular matrix (ECM) in a number of different tissues and species. Santi and Johnson JARO 14:3-15 (2013) first described the decellularized inner ear in the mouse, rat, and human using scanning thin-sheet laser imaging microscopy (sTSLIM). The purpose of the present investigation is to examine decellularized cochleas in the mouse and human at higher resolution using scanning electron microscopy (SEM). Fresh cochleas were harvested and decellularized using detergent extraction methods. Following decellularization, the ECM of the bone, basilar membrane, spiral limbus, and ligament remained, and all of the cells were removed from the cochlea. A number of similarities and differences in the ECM of the mouse and human were observed. A novel, spirally directed structure was present on the basilar membrane and is located at the border between Hensen and Boettcher cells. These septa-like structures formed a single row in the mouse and multiple rows in the human. The basal lamina of the stria vascularis capillaries was present and appeared thicker in the human compared with the mouse. In the mouse, numerous openings beneath the spiral prominence that previously housed the root processes of the external sulcus cells were observed but in the human there was only a single row of openings. These and other anatomical differences in the ECM between the mouse and human may reflect functional differences and/or be due to aging; however, decellularized cochleas provide a new way to examine the cochlear ECM and reveal new observations.

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Distraction Osteogenesis for Management of Severe OSA in Pierre Robin Sequence: An Approach to Elude Tracheostomy in Infants

Abstract

Background

Severe obstructive sleep apnoea (OSA) is a life threatening condition associated with Pierre Robin sequence (PRS) due to mandibular micrognathia and glossoptosis. Often these patients require tracheostomy at an early age which has high morbidity. Distraction osteogenesis (DO) is an accepted method of treatment for patients with hypoplastic mandible to achieve mandibular lengthening without need for a bone graft. It has also been used in respiratory distressed neonates and infants to avoid tracheostomy.

Case report

An eight month old baby, a diagnosed case of PRS with severe OSA and recurrent episodes of aspiration pneumonia and on nasogastric tube feeding since birth was referred to us for evaluation and possibility of therapeutic augmentation of the mandible by DO. After a thorough clinico-radiological assessment the child was operated for bilateral extraoral placement of horizontal corpus distractor. A total distraction of 12 mm was carried out and consolidation of callus was monitored by USG. Postoperatively the patient was followed up for 12 months. Presently she has normal respiratory and feeding function without any episode of aspiration pneumonia.

Conclusion

Mandibular corpus DO is a safe and effective technique that can be applied to predictably relieve severe upper airway obstruction in selected PRS cases. In order to avoid the limitations of alternative surgical procedures and the tracheostomy-associated morbidity, DO should be considered among the routine treatment modalities.

from #ENT via xlomafota13 on Inoreader http://ift.tt/1WYIPuA
via IFTTT

Early Postoperative Malignant Subcutaneous Emphysema: Report and Review

Abstract

Background

Subcutaneous emphysema is defined as presence of air or gas in subcutaneous tissue layer. It may be localized or generalized due to various aetiological factors. Although SE and pneumomediastinum are self-limiting conditions, life-threatening complications may develop. Escape of air into both pleural cavity causing bilateral pneumothorax and tension pneumothorax can be termed as malignant emphysema.

Purpose

To report a case of malignant generalized subcutaneous emphysema in early postoperative phase following palatoplasty.

Case Report

A 25 year old female patient was operated for closure of residual oronasal communication using an anteriorly based tongue flap. The patient was reversed from general anesthesia and shifted to the post-operative room with the endotracheal tube in situ. Sudden swelling of the face and periorbital area was noticed which spread all over the body. A diagnosis of malignant post-operative subcutaneous emphysema was made and the patient was shifted back to the operation theatre. She was managed successfully by bilateral tube thoracotomy and tracheostomy.

Conclusion

Close observation of the patient in early postoperative stage having endotracheal tube in situ is crucial to avoid such complication. Regardless of aetiology, early recognition of the clinical features of tension pneumothorax and timely intervention are necessary for the survival of the patient.

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Enhanced recovery after surgery (ERAS) pathways in autologous breast reconstruction: a systematic review

Abstract

Enhanced recovery after surgery (ERAS) pathways aim to achieve earlier recovery and reduced hospital length-of-stay (LOS) by providing multi-modal perioperative care. The tenets of ERAS pathways include pre-operative optimisation, prevention of surgical complications, reduction of physiological stress response to surgery and rehabilitation to normal function. To date, ERAS protocols have gained broad acceptance by many surgical specialities. Contemporary literature has identified decreased LOS, improved quality of care and reduced healthcare expenditures. We aimed to systematically review the current literature and assess the current state of ERAS in autologous breast reconstruction. A systematic review of MEDLINE, EMBASE, ScienceDirect, Cochrane Libraries and Web of Science databases in October 2015 was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Articles pertaining to the use of ERAS in plastic and reconstructive surgery were included for analysis. Review articles, conference proceedings and correspondence were excluded from the assessment. Five hundred fifty-seven articles were identified, of which three suitable articles were included for assessment. Of these, one series outlined the learning curve associated with ERAS pathways and two series were comparative in nature. Meta-analytical analysis was not possible do to insufficient data and heterogeneity in outcome measures. In two of these comparative series, there was no statistical difference in rates of systemic infective (OR 0.91, 95 % CI 0.29 to 2.80, p = 0.86), total flap loss (OR 1.09, 95 % CI 0.37 to 3.19, p = 0.87), partial flap loss (OR 1.64, 95 % CI 0.66 to 4.10, p = 0.29) or wound infection (OR 1.38, 95 % CI 0.78 to 2.34, p = 0.29). LOS was significantly reduced in the ERAS group in both comparative studies from 7.4 to 6.2 days (p < 0.001) and 6.6 to 3.9 days (p < 0.001), respectively. ERAS pathways in breast reconstruction appear to consistently reduce LOS. From the available literature there were no significant detrimental effects on patient care following the implementation of ERAS pathways. Further research is required to definitively determine safety in the assessed cohort and to determine reductions in healthcare-related expenditures.

Level of evidence: Not ratable

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Distraction Osteogenesis for Management of Severe OSA in Pierre Robin Sequence: An Approach to Elude Tracheostomy in Infants

Abstract

Background

Severe obstructive sleep apnoea (OSA) is a life threatening condition associated with Pierre Robin sequence (PRS) due to mandibular micrognathia and glossoptosis. Often these patients require tracheostomy at an early age which has high morbidity. Distraction osteogenesis (DO) is an accepted method of treatment for patients with hypoplastic mandible to achieve mandibular lengthening without need for a bone graft. It has also been used in respiratory distressed neonates and infants to avoid tracheostomy.

Case report

An eight month old baby, a diagnosed case of PRS with severe OSA and recurrent episodes of aspiration pneumonia and on nasogastric tube feeding since birth was referred to us for evaluation and possibility of therapeutic augmentation of the mandible by DO. After a thorough clinico-radiological assessment the child was operated for bilateral extraoral placement of horizontal corpus distractor. A total distraction of 12 mm was carried out and consolidation of callus was monitored by USG. Postoperatively the patient was followed up for 12 months. Presently she has normal respiratory and feeding function without any episode of aspiration pneumonia.

Conclusion

Mandibular corpus DO is a safe and effective technique that can be applied to predictably relieve severe upper airway obstruction in selected PRS cases. In order to avoid the limitations of alternative surgical procedures and the tracheostomy-associated morbidity, DO should be considered among the routine treatment modalities.

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