OtoRhinoLaryngology by Alexandros G.Sfakianakis: Νοεμβρίου 2017

Πέμπτη 30 Νοεμβρίου 2017

Optimal gain control step sizes for bimodal stimulation.

Optimal gain control step sizes for bimodal stimulation.

Int J Audiol. 2017 Nov 24;:1-11

Authors: Spirrov D, van Dijk B, Francart T

Abstract
OBJECTIVE: Cochlear implants (CI) and hearing aids (HA) have a gain control that allows the bimodal user to change the loudness. Due to differences in dynamic range between CI and HA, an equal change of the gains of the two devices results in different changes in loudness. The objective was to relate and individualise the step sizes of the loudness controls to obtain a similar perceptual effect in the two ears.
DESIGN: We used loudness models parametrised for individual users to find a relation between the controls of the CI and the HA such that each step resulted in an equal change in loudness. We conducted loudness balancing experiments to validate the results.
STUDY SAMPLE: Eleven bimodal users of whom six were tested in a prior study.
RESULTS: The difference between the optimal gain from the loudness balancing procedure and actual gain was 3.3 dB when the new relation was applied. In contrast, the difference was 8 dB if equal step sized were applied at both sides.
CONCLUSION: We can relate the controls such that each step results in a similar loudness difference.

PMID: 29172895 [PubMed - as supplied by publisher]

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Use of beta blockers is associated with hearing loss.

Use of beta blockers is associated with hearing loss.

Int J Audiol. 2017 Nov 24;:1-8

Authors: Al-Ghamdi BS, Rohra DK, Abuharb GAI, Alkofide HA, AlRuwaili NS, Shoukri MM, Cahusac PMB

Abstract
OBJECTIVE: This study was conducted to investigate the hypothesis that patients using β-blockers will develop hearing loss.
DESIGN: A cross-sectional study.
STUDY SAMPLE: A total of 125 patients completed the study. A total of 63 patients were on β-blockers and 62 were not on β-blockers.
RESULTS: Carvedilol was significantly associated with hearing loss. Other beta-blockers including metoprolol and atenolol showed no association with hearing loss. Linear multiple regression analysis was run including variables of gender, age, ischaemic heart disease, cardiac failure/dilated cardiomyopathy, frusemide and carvedilol use as predictors for total hearing loss severity at all frequencies. Age and gender, as well as carvedilol, were found to be the only statistically significant predictors for hearing loss severity.
CONCLUSION: Chronic use of carvedilol was associated with significant hearing loss. This may need to be taken into account when prescribing the drug. Further randomised controlled studies with baseline audiometric hearing tests before starting treatment, and periodic follow-up tests, would provide a better assessment of the effect of carvedilol on hearing.

PMID: 29172846 [PubMed - as supplied by publisher]

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Detection and reaction thresholds for reverse alarms in noise with and without passive hearing protection.

Detection and reaction thresholds for reverse alarms in noise with and without passive hearing protection.

Int J Audiol. 2017 Nov 26;:1-10

Authors: Laroche C, Giguère C, Vaillancourt V, Roy K, Pageot LP, Nélisse H, Ellaham N, Nassrallah F

Abstract
OBJECTIVE: To measure masked detection and reaction thresholds for two reverse alarms (tonal and broadband) and compare results to available standards and psychoacoustic criteria for setting alarm levels.
DESIGN: Alarm detection and reaction thresholds were adaptively measured in 80-dBA background noises without hearing protection (Experiment 1), and with a passive earmuff-style hearing protection device (HPD) (Experiment 2).
STUDY SAMPLE: Twenty-four young adults with normal hearing in each experimental group.
RESULTS: Reverse alarms remained audible at levels well-below background noises [thresholds: -11 to -25 dB signal-to-noise ratio (SNR)], with and without the selected HPD. Detection was more influenced by alarm and noise type, while reaction was more susceptible to HPD use. HPD use resulted in lower detection thresholds by up to 2.5 dB compared to unprotected listening but increased reaction thresholds by 5-10 dB depending on the alarm.
CONCLUSIONS: Since noise type appears to have a more limited effect on reaction thresholds, adjusting alarms based on a global dBA method appears preferable to methods based on masked detection thresholds. However, while the >0 dB SNR recommended in ISO 9533 seems adequate for unprotected listening, an additional 5-10 dB may be warranted to elicit the same reaction when the selected HPD is used.

PMID: 29172790 [PubMed - as supplied by publisher]

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Examining the noisy life of the college musician: weeklong noise dosimetry of music and non-music activities.

Examining the noisy life of the college musician: weeklong noise dosimetry of music and non-music activities.

Int J Audiol. 2017 Nov 24;:1-8

Authors: Tufts JB, Skoe E

Abstract
OBJECTIVE: To examine the contribution of all daily activities, including non-music activities, to the overall noise exposure of college student musicians, and to compare their "noise lives" with those of non-musician college students.
DESIGN: Continuous week-long dosimetry measurements were collected on student musicians and non-musicians. During the measurement period, participants recorded their daily activities in journals.
STUDY SAMPLE: 22 musicians and 40 non-musicians, all students (aged 18-24 years) at the University of Connecticut.
RESULTS: On every day of the week, musicians experienced significantly higher average exposure levels than did non-musicians. Nearly half (47%) of the musicians' days exceeded a daily dose of 100%, compared with 10% of the non-musicians' days. When the exposure due to music activities was removed, musicians still led noisier lives, largely due to participation in noisier social activities. For some musicians, non-music activities contributed a larger share of their total weekly noise exposure than did their music activities.
CONCLUSIONS: Compared with their non-musician peers, college student musicians are at higher risk for noise-induced hearing loss (NIHL). On a weekly basis, non-music activities may pose a greater risk to some musicians than music activities. Thus, hearing health education for musicians should include information about the contribution of lifestyle factors outside of music to NIHL risk.

PMID: 29172785 [PubMed - as supplied by publisher]

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AHNS Series: Do you know your guidelines? Principles of treatment for locally advanced or unresectable head and neck squamous cell carcinoma.

AHNS Series: Do you know your guidelines? Principles of treatment for locally advanced or unresectable head and neck squamous cell carcinoma.

Head Neck. 2017 Nov 24;:

Authors: Fulcher CD, Haigentz M, Ow TJ, Education Committee of the American Head and Neck Society (AHNS)

Abstract
This article is a continuation of the "Do You Know Your Guidelines" series, initiated by the Education committee of the American Head and Neck Society. Treatment guidelines for advanced head and neck squamous cell carcinoma are reviewed here, including the critical roles of radiotherapy, chemotherapy, and the recent application of immunotherapy agents. We will be limiting this discussion to include cancers of the oral cavity, oropharynx, hypopharynx, and larynx. It should be noted that much of the article pertains to human papillomavirus (HPV)-negative oropharyngeal cancer where applicable, as HPV-positive oropharyngeal squamous cell carcinoma carries a different natural history, different prognosis, and now different staging criteria. Additionally, the article will not include information on nasopharyngeal or sinus cancers, as these latter topics are covered in separate "Do you know your guidelines?" installments and these diagnoses carry somewhat different approaches to diagnosis and management that diverge from the focus of this article.

PMID: 29171929 [PubMed - as supplied by publisher]

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Right-Ear Advantage for Speech-in-Noise Recognition in Patients with Nonlateralized Tinnitus and Normal Hearing Sensitivity.

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Right-Ear Advantage for Speech-in-Noise Recognition in Patients with Nonlateralized Tinnitus and Normal Hearing Sensitivity.

J Assoc Res Otolaryngol. 2017 Nov 27;:

Authors: Tai Y, Husain FT

Abstract
Despite having normal hearing sensitivity, patients with chronic tinnitus may experience more difficulty recognizing speech in adverse listening conditions as compared to controls. However, the association between the characteristics of tinnitus (severity and loudness) and speech recognition remains unclear. In this study, the Quick Speech-in-Noise test (QuickSIN) was conducted monaurally on 14 patients with bilateral tinnitus and 14 age- and hearing-matched adults to determine the relation between tinnitus characteristics and speech understanding. Further, Tinnitus Handicap Inventory (THI), tinnitus loudness magnitude estimation, and loudness matching were obtained to better characterize the perceptual and psychological aspects of tinnitus. The patients reported low THI scores, with most participants in the slight handicap category. Significant between-group differences in speech-in-noise performance were only found at the 5-dB signal-to-noise ratio (SNR) condition. The tinnitus group performed significantly worse in the left ear than in the right ear, even though bilateral tinnitus percept and symmetrical thresholds were reported in all patients. This between-ear difference is likely influenced by a right-ear advantage for speech sounds, as factors related to testing order and fatigue were ruled out. Additionally, significant correlations found between SNR loss in the left ear and tinnitus loudness matching suggest that perceptual factors related to tinnitus had an effect on speech-in-noise performance, pointing to a possible interaction between peripheral and cognitive factors in chronic tinnitus. Further studies, that take into account both hearing and cognitive abilities of patients, are needed to better parse out the effect of tinnitus in the absence of hearing impairment.

PMID: 29181615 [PubMed - as supplied by publisher]

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Weak Middle-Ear-Muscle Reflex in Humans with Noise-Induced Tinnitus and Normal Hearing May Reflect Cochlear Synaptopathy.

Weak Middle-Ear-Muscle Reflex in Humans with Noise-Induced Tinnitus and Normal Hearing May Reflect Cochlear Synaptopathy.

eNeuro. 2017 Nov-Dec;4(6):

Authors: Wojtczak M, Beim JA, Oxenham AJ

Abstract
Chronic tinnitus is a prevalent hearing disorder, and yet no successful treatments or objective diagnostic tests are currently available. The aim of this study was to investigate the relationship between the presence of tinnitus and the strength of the middle-ear-muscle reflex (MEMR) in humans with normal and near-normal hearing. Clicks were used as test stimuli to obtain a wideband measure of the effect of reflex activation on ear-canal sound pressure. The reflex was elicited using a contralateral broadband noise. The results show that the reflex strength is significantly reduced in individuals with noise-induced continuous tinnitus and normal or near-normal audiometric thresholds compared with no-tinnitus controls. Due to a shallower growth of the reflex strength in the tinnitus group, the difference between the two groups increased with increasing elicitor level. No significant difference in the effect of tinnitus on the strength of the middle-ear muscle reflex was found between males and females. The weaker reflex could not be accounted for by differences in audiometric hearing thresholds between the tinnitus and control groups. Similarity between our findings in humans and the findings of a reduced middle-ear muscle reflex in noise-exposed animals suggests that noise-induced tinnitus in individuals with clinically normal hearing may be a consequence of cochlear synaptopathy, a loss of synaptic connections between inner hair cells (IHCs) in the cochlea and auditory-nerve (AN) fibers that has been termed hidden hearing loss.

PMID: 29181442 [PubMed - in process]

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Biomechanical Analysis of Dance for Parkinson's Disease: A Paradoxical Case Study of Balance and Gait Effects?

Biomechanical Analysis of Dance for Parkinson's Disease: A Paradoxical Case Study of Balance and Gait Effects?

Explore (NY). 2017 Nov - Dec;13(6):409-413

Authors: Sowalsky KL, Sonke J, Altmann LJP, Almeida L, Hass CJ

Abstract
OBJECTIVES: This study aimed to measure the effects of a dance training program on subjective and objective balance and gait measures in a person with Parkinson's disease.
DESIGN AND SETTING: The participant was measured via clinical scales and biomechanical balance and gait analyses pre- and post-16 weeks of dance participation at the University Center for Arts in Medicine. The dance program consisted of 75 minute sessions three days a week.
RESULTS: Improved clinical scales included the Schwab and England scale (+10%), falls efficacy scale (-11 points), six-minute walk (+15.54m), and timed up and go (1.38s). Balance measures during three conditions (eyes open, eyes closed, and narrow stance) all demonstrated an increase (24-112%) in center of pressure path length, velocity (anteroposterior and mediolateral), sway area, and approximate entropy (anteroposterior and mediolateral). Spatiotemporal gait parameters improved during forward walking: velocity (+0.12m/s), cadence (+3.89steps/min), double support time (-2.02%), stride length (+0.07m), stride time (-0.03s), and backward walking: single support (+3.47%), double support (-7.0%), swing time (+3.4%), and stance time (-3.4%).
CONCLUSIONS: Classic interpretation of the above measures may indicate a detriment in biomechanical balance effects concomitant with an improvement in gait. Alternative explanations explored suggest this paradox to be illusory.

PMID: 29179887 [PubMed - in process]

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Outcomes of bacterial meningitis in children.

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Outcomes of bacterial meningitis in children.

Med Mal Infect. 2016 Jun;46(4):177-87

Authors: Briand C, Levy C, Baumie F, Joao L, Béchet S, Carbonnelle E, Grimprel E, Cohen R, Gaudelus J, de Pontual L

Abstract
OBJECTIVE: Pediatricians are well aware of the immediate risks of bacterial meningitis in children. However, the long-term outcome of the disease has not been extensively studied. We aimed: (i) to evaluate the duration and quality of the long-term follow-up of children diagnosed with bacterial meningitis in a general pediatric department, (ii) to estimate the incidence of sequelae at the various stages of follow-up, and (iii) to compare our data with that of other studies.
METHODS: We conducted a retrospective study and included 34 children (3 months-15 years) who had been hospitalized for bacterial meningitis in the pediatric department of a University Hospital between January 1st, 2001 and December 31st, 2013.
RESULTS: Overall, 32% of patients presented with sequelae and 15% with seizures. Only one patient presented with hearing loss, but 23.5% of patients did not have any hearing test performed. Seven patients had a neuropsychological assessment performed and no severe neuropsychological sequela was observed in this group. The average follow-up duration increased during the study period (from 23 to 49months). The long-term follow-up modalities observed in other studies were highly variable. Assessing the incidence and severity of sequelae was therefore difficult.
CONCLUSION: A standardized follow-up should be implemented by way of a national surveillance network of children presenting with bacterial meningitis.

PMID: 27020729 [PubMed - indexed for MEDLINE]

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Deep neck infections: review of 263 cases.

Deep neck infections: review of 263 cases.

Otolaryngol Pol. 2017 Oct 30;71(5):37-42

Authors: Adoviča A, Veidere L, Ronis M, Sumeraga G

Abstract
OBJECTIVES: In patients hospitalized due to deep neck infections (DNIs), to investigate the association between demographic parameters, etiology, and localization of abscesses and/or phlegmons, complications, comorbidities, treatment, and bacterial cultures.
METHODS: We analyzed data of 263 patients that were hospitalized from January 1, 2012, to December 31, 2015, due to deep neck space phlegmons and/or abscesses. We performed statistical analysis with the SPSS 22.0 software; statistical significance was set p<0.05.
RESULTS: Among the analyzed patients, dental infections were the most frequent, followed by acute phlegmonous pharyngitis. Submandibular space abscesses or phlegmons of the neck were the most frequent complications of these infections. Re-operation was performed in 19.8% of cases, and complications developed in 11% (mostly airway obstruction). DNI complications were less common in smokers than in non-smokers (OR=0.038, p=0.025).
DISCUSSION: In our study, dental infections accounted for 70.6% of DNI cases. Thus, our study explains why odontogenic DNIs are the most common DNI type studied in the literature. Poor oral health and odontogenic infections should not be underestimated because they can lead to uncommon but lethal diseases such as descending necrotizing mediastinitis, which requires aggressive surgical treatment and is associated with a mortality rate of 10%-40% despite treatment. The complication developed in 11.4% of cases. In conclusion, oral health and hygiene contribute to DNI development.

PMID: 29154249 [PubMed - in process]

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Optimal gain control step sizes for bimodal stimulation.

Optimal gain control step sizes for bimodal stimulation.

Int J Audiol. 2017 Nov 24;:1-11

Authors: Spirrov D, van Dijk B, Francart T

PMID: 29172895 [PubMed - as supplied by publisher]

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Use of beta blockers is associated with hearing loss.

Use of beta blockers is associated with hearing loss.

Int J Audiol. 2017 Nov 24;:1-8

Authors: Al-Ghamdi BS, Rohra DK, Abuharb GAI, Alkofide HA, AlRuwaili NS, Shoukri MM, Cahusac PMB

PMID: 29172846 [PubMed - as supplied by publisher]

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Detection and reaction thresholds for reverse alarms in noise with and without passive hearing protection.

Detection and reaction thresholds for reverse alarms in noise with and without passive hearing protection.

Int J Audiol. 2017 Nov 26;:1-10

Authors: Laroche C, Giguère C, Vaillancourt V, Roy K, Pageot LP, Nélisse H, Ellaham N, Nassrallah F

PMID: 29172790 [PubMed - as supplied by publisher]

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Examining the noisy life of the college musician: weeklong noise dosimetry of music and non-music activities.

Examining the noisy life of the college musician: weeklong noise dosimetry of music and non-music activities.

Int J Audiol. 2017 Nov 24;:1-8

Authors: Tufts JB, Skoe E

PMID: 29172785 [PubMed - as supplied by publisher]

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Diagnostic role of cone beam computed tomography for the position of straight array.

Diagnostic role of cone beam computed tomography for the position of straight array.

Acta Otolaryngol. 2017 Nov 26;:1-7

Authors: An SY, An CH, Lee KY, Jang JH, Choung YH, Lee SH

Abstract
OBJECTIVE: To assess the usefulness of cone beam computed tomography (CBCT) for characterizing electrode insertion and evaluate the influence of electrode insertion status on post-cochlear implantation (CI) outcomes.
DESIGN: Twenty-six ears with post-CI CBCT scans were included. The devices were MED-EL Flex28 (n = 21) and Nucleus slim straight (n = 5). The parameters including cochlear duct length (CDL), insertion depth angle (IDA), insertion length of electrode (IL), and cochlear coverage (CC) were analyzed and compared with aided pure-tone threshold (PTA) with implant in free field, and open-set sentence score.
RESULTS: The mean CDL was 36.8 ± 1.4 mm. Electrode array was dislocated into scala tympani in two ears. The mean IL and IDA were 26.5 ± 1.9 mm and 541.4 ± 70.2°. The mean linear CC (IL/CDL, 0.73 ± 0.06) was larger than the mean angular CC (IDA/900, 0.60 ± 0.08). The CBCT parameters showed correlation one another. While the aided pure-tone threshold was correlated with IL and IDA, there were no significant correlations in the open-set sentence score. For the postlingually deaf patients with single electrode (Flex 28), the sentence score had no significant correlation and the aided PTA was positively correlated with IL (R = 0.517, p = .028).
CONCLUSIONS: This study validated the CBCT evaluating the electrode array position. The CBCT could be helpful for the preoperative selection of the optimal array and prediction of the CC.

PMID: 29172857 [PubMed - as supplied by publisher]

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Ectonucleotidase CD39 expression in regional metastases in head and neck cancer.

Ectonucleotidase CD39 expression in regional metastases in head and neck cancer.

Acta Otolaryngol. 2017 Nov 26;:1-5

Authors: Mandapathil M, Boduc M, Roessler M, Güldner C, Walliczek-Dworschak U, Mandic R

Abstract
INTRODUCTION: CD39 is the rate-limiting enzyme in the generation of immunosuppressive adenosine and its expression and activity are significant in tumor progression. Squamous cell carcinoma of the head and neck (HNSCC) shows an overall poor prognosis due to high local recurrence rates and early metastatic spread.
MATERIAL AND METHODS: Primary tumor specimens and lymph node specimens harvested during neck dissection of 65 patients with a diagnosis of HNSCC were subjected to immunohistochemical and H-score analysis of CD39 expression. Demographics, histopathology and subsequent outcome were analyzed.
RESULTS: The primary cancer was squamous cell carcinoma in all patients (male/female 55:10). H-score for CD39 expression in the primary lesion and metastatic lymph nodes was significantly higher in advanced compared to early stages with no significant differences among different tumor locations. High intratumoral and intrametastatic CD39 expression was associated with an inferior patients' overall survival at a mean follow-up of 83.4 months (6-204 months).
CONCLUSION: CD39 expression in HNSCC correlated positively with tumor stage and appears to predict poor prognosis. Therefore, CD39 expression in primary lesions and metastatic lymph nodes seems to identify patients at high risk in HNSCC of all tumor sites. Immunotherapeutic approaches targeting CD39 might be promising for this patient population.

PMID: 29172836 [PubMed - as supplied by publisher]

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A prognostic scoring system using inflammatory response biomarkers in oral cavity squamous cell carcinoma patients who underwent surgery-based treatment.

A prognostic scoring system using inflammatory response biomarkers in oral cavity squamous cell carcinoma patients who underwent surgery-based treatment.

Acta Otolaryngol. 2017 Nov 23;:1-6

Authors: Park YM, Oh KH, Cho JG, Baek SK, Kwon SY, Jung KY, Woo JS

Abstract
BACKGROUND: The aim of this study was to evaluate the effectiveness of a scoring system based on the lymphocyte-to-monocyte ratio, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio for predicting disease-specific survival of oral cancer patients treated by surgery.
METHODS: From January 2007 to December 2016, we retrospectively analyzed data from 69 oral cancer patients who received surgery.
RESULTS: Lymphocyte-to-monocyte ratio was significantly associated with T classification, N classification, and pathologic stage. Neutrophil-to-lymphocyte ratio was significantly associated with T classification and pathologic stage. Platelet-to-lymphocyte ratio was significantly associated with N classification and pathologic stage. In multivariate analysis, only a higher score on this scoring system was significantly associated with poorer disease-specific survival.
CONCLUSIONS: We found that the prognostic score system based on these three values was significantly associated with disease-specific survival of oral cancer patients who received surgery, indicating that the prognostic scoring system was effective in indirectly predicting systemic inflammatory response.

PMID: 29168424 [PubMed - as supplied by publisher]

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Presenting symptoms and clinical findings in HPV-positive and HPV-negative oropharyngeal cancer patients.

Presenting symptoms and clinical findings in HPV-positive and HPV-negative oropharyngeal cancer patients.

Acta Otolaryngol. 2017 Nov 21;:1-6

Authors: Carpén T, Sjöblom A, Lundberg M, Haglund C, Markkola A, Syrjänen S, Tarkkanen J, Mäkitie A, Hagström J, Mattila P

Abstract
OBJECTIVES: Oropharyngeal squamous cell carcinoma (OPSCC) is divided in two different disease entities depending on HPV involvement. We investigated differences in presenting symptoms and clinical findings in patients with HPV-positive and -negative OPSCC tumors.
METHODS: Altogether 118 consecutive patients diagnosed with primary OPSCC between 2012 and 2014 at the Helsinki University Hospital were included. HPV-status of the tumors was assessed by PCR detection of HPV DNA and immunostaining with p16-INK4a antibody.
RESULTS: Fifty-one (47.7%) of the patients had HPV-positive and 56 (52.3%) HPV-negative tumors. Forty-nine (49/51, 96.1%) of the HPV+ tumors were also p16+ showing high concordance. The most common presenting symptom among HPV+/p16+ patients was a neck mass (53.1%), whereas any sort of pain in the head and neck area was more frequently related to the HPV-/p16- (60.0%) group. HPV+/p16+ tumors had a tendency to locate in the tonsillar complex and more likely had already spread into regional lymph nodes compared with HPV-/p16- tumors. Smoking and alcohol consumption were significantly more common among HPV+/p16+ patients but also rather common among HPV-/p16- patients.
CONCLUSIONS: This analysis of symptoms and signs confirm that OPSCC can be dichotomized in two distinct disease entities as defined by HPV status.

PMID: 29161981 [PubMed - as supplied by publisher]

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Foam pad of appropriate thickness can improve diagnostic value of foam posturography in detecting postural instability.

Foam pad of appropriate thickness can improve diagnostic value of foam posturography in detecting postural instability.

Acta Otolaryngol. 2017 Nov 21;:1-6

Authors: Liu B, Leng Y, Zhou R, Liu J, Liu D, Liu J, Zhang SL, Kong WJ

Abstract
OBJECTIVE: The present study investigated the effect of foam thickness on postural stability in patients with unilateral vestibular hypofunction (UVH) during foam posturography.
METHODS: Static and foam posturography were performed in 33 patients (UVH group) and 30 healthy subjects (control group) with eyes open (EO) and closed (EC) on firm surface and on 1-5 foam pad(s). Sway velocity (SV) of center of pressure, standing time before falling (STBF) and falls reaction were recorded and analyzed.
RESULTS: (1) SVs had an increasing tendency in both groups as the foam pads were added under EO and EC conditions. (2) STBFs, only in UVH group with EC, decreased with foam thickness increasing. (3) Significant differences in SV were found between the control and UVH group with EO (except for standing on firm surface, on 1 and 2 foam pad(s)) and with EC (all surface conditions). (4) Receiver operating characteristic curve analysis showed that the SV could better reflect the difference in postural stability between the two groups while standing on the 4 foam pads with EC.
CONCLUSION: Our study showed that diagnostic value of foam posturography in detecting postural instability might be enhanced by using foam pad of right thickness.

PMID: 29161921 [PubMed - as supplied by publisher]

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Temporal variability in sung productions of adolescents who stutter.

Temporal variability in sung productions of adolescents who stutter.

J Commun Disord. 2016 Jul-Aug;62:101-14

Authors: Falk S, Maslow E, Thum G, Hoole P

Abstract
UNLABELLED: Singing has long been used as a technique to enhance and reeducate temporal aspects of articulation in speech disorders. In the present study, differences in temporal structure of sung versus spoken speech were investigated in stuttering. In particular, the question was examined if singing helps to reduce VOT variability of voiceless plosives, which would indicate enhanced temporal coordination of oral and laryngeal processes. Eight German adolescents who stutter and eight typically fluent peers repeatedly spoke and sang a simple German congratulation formula in which a disyllabic target word (e.g., /'ki:ta/) was repeated five times. Every trial, the first syllable of the word was varied starting equally often with one of the three voiceless German stops /p/, /t/, /k/. Acoustic analyses showed that mean VOT and stop gap duration reduced during singing compared to speaking while mean vowel and utterance duration was prolonged in singing in both groups. Importantly, adolescents who stutter significantly reduced VOT variability (measured as the Coefficient of Variation) during sung productions compared to speaking in word-initial stressed positions while the control group showed a slight increase in VOT variability. However, in unstressed syllables, VOT variability increased in both adolescents who do and do not stutter from speech to song. In addition, vowel and utterance durational variability decreased in both groups, yet, adolescents who stutter were still more variable in utterance duration independent of the form of vocalization. These findings shed new light on how singing alters temporal structure and in particular, the coordination of laryngeal-oral timing in stuttering. Future perspectives for investigating how rhythmic aspects could aid the management of fluent speech in stuttering are discussed.
LEARNING OUTCOMES: Readers will be able to describe (1) current perspectives on singing and its effects on articulation and fluency in stuttering and (2) acoustic parameters such as VOT variability which indicate the efficiency of control and coordination of laryngeal-oral movements. They will understand and be able to discuss (3) how singing reduces temporal variability in the productions of adolescents who do and do not stutter and 4) how this is linked to altered articulatory patterns in singing as well as to its rhythmic structure.

PMID: 27323225 [PubMed - indexed for MEDLINE]

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Evaluation of 1,25-dihydroxyvitamin D3 Pathway in Patients with Chronic Urticaria.

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Evaluation of 1,25-dihydroxyvitamin D3 Pathway in Patients with Chronic Urticaria.

QJM. 2017 Nov 20;:

Authors: Nasiri-Kalmarzi R, Abdi M, Hosseini J, Babaei E, Mokarizadeh A, Vahabzadeh Z

Abstract
BACKGROUND: Previous studies showed the role of vitamin D (Vit D) on the progression of chronic urticaria. To the best of our knowledge, there are no other results regarding the contribution of single nucleotide polymorphisms (SNPs) in the vitamin D receptor (VDR) and vitamin D binding protein (VDBP) genes in Chronic Urticaria (CU).
AIM: In the present study, we investigated the Vit pathway and the association between VDR and VDBP gene polymorphisms and CU risk in Iranian population.
METHODS: All participating individuals in the present study were evaluated for serum Vit D and VDBP concentration VDR rs1544410 and rs2228570 and VDBP rs7041using a polymerase chain reaction⍰restriction fragment length polymorphism (PCR-RFLP) analysis. The associations of studied analytes and 3 SNPs with clinical and laboratory outcomes were investigated in CU patients.
RESULTS: Patients with CU showed lower Vit D compared to controls (19.26 ± 1.26 vs. 31.72 ± 7.14 ng/ml, p value=0.006). There was a significant correlation between vitamin D levels and urticaria activity score. Serum VDBP was significantly higher in CU patients than controls (1317.3 ± 183.71 vs. 395.77 ± 12.96 µg/mL, p value < 0.0001) and had a positive correlation to progression of CU. The A allele of this polymorphism might be a potential risk factor for progression of CU (OR = 4.3434, 95%CI = (1.7331 to 10.8852), Z statistic= 3.133, p value=0.0017).
CONCLUSION: In Summary, this study demonstrated that change in Vit D pathway in the level of gene or protein may be a risk factor for progression of CU.

PMID: 29165650 [PubMed - as supplied by publisher]

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The burden of hip fractures - why aren't we better at prevention?

The burden of hip fractures - why aren't we better at prevention?

QJM. 2017 Nov 20;:

Authors: Schattner A

PMID: 29165606 [PubMed - as supplied by publisher]

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Paget-Schroetter Syndrome.

Paget-Schroetter Syndrome.

QJM. 2017 Nov 17;:

Authors: Jonathan F, Medina F, Formiga F, Huerta J, Arbe G, Charte A

PMID: 29161439 [PubMed - as supplied by publisher]

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Response to letter to editor from Dr O.M.P. Jolobe.

Response to letter to editor from Dr O.M.P. Jolobe.

QJM. 2017 Oct 30;:

Authors: Matsuura H, Yamaji Y

PMID: 29161438 [PubMed - as supplied by publisher]

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Clinical Neuropathology; +25 new citations

25 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

Clinical Neuropathology

These pubmed results were generated on 2017/11/30

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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Cardiophrenic lymph node resection in advanced ovarian cancer: surgical outcomes, pre- and postoperative imaging.

Cardiophrenic lymph node resection in advanced ovarian cancer: surgical outcomes, pre- and postoperative imaging.

Acta Oncol. 2017 Nov 28;:1-5

Authors: Salehi S, Mohammar R, Suzuki C, Joneborg U, Hjerpe E, Torbrand C, Falconer H

Abstract
OBJECTIVE: To evaluate the accuracy of preoperative imaging in the diagnosis of cardiophrenic lymph node (CPLN) metastases and to report perioperative outcomes after resection of CPLN at the time of cytoreductive surgery for advanced epithelial ovarian cancer (EOC). Furthermore, to assess clearance of CPLN by postoperative imaging.
METHODS: All women with stage IIIC/IV EOC subjected to surgery at our institution from January 2014 to October 2016 were retrospectively identified from a database. Among these, women subjected to CPLN resection during surgery were identified. Pre- and postoperative computed tomography (CT) scans, pathology reports, surgical approach and outcomes were reviewed.
RESULTS: One hundred and eighty women with stage IIIC/IV EOC subjected to surgery with curative intent were identified. Twenty-four (13%) of these women underwent CPLN resection. All had CT imaging suggestive of CPLN metastases. 20/24 (83%) had confirmed metastases upon final pathology. CPLN resection was associated with longer operation time, more often advanced upper abdominal surgery and more postoperative complications but there was no difference in days from surgery to initiation of chemotherapy. Postoperative CT was still indicative of CPLN metastases in 13/22 (59%) women despite resection with confirmative pathology.
CONCLUSIONS: Resection of CPLN metastases is highly feasible without considerable added morbidity. Concern regarding surgical clearance is raised since postoperative imaging was indicative of metastases in the majority of women. The prognostic significance of stage IV disease based exclusively on CPLN metastases is unclear and any survival benefit from the procedure is yet to be determined.

PMID: 29182048 [PubMed - as supplied by publisher]

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Intrinsic subtypes and benefit from postmastectomy radiotherapy in node-positive premenopausal breast cancer patients who received adjuvant chemotherapy - results from two independent randomized trials.

Intrinsic subtypes and benefit from postmastectomy radiotherapy in node-positive premenopausal breast cancer patients who received adjuvant chemotherapy - results from two independent randomized trials.

Acta Oncol. 2017 Nov 25;:1-6

Authors: Laurberg T, Tramm T, Nielsen T, Alsner J, Nord S, Myhre S, Sørlie T, Leung S, Fan C, Perou C, Gelmon K, Overgaard J, Voduc D, Prat A, Cheang MCU

Abstract
BACKGROUND: The study of the intrinsic molecular subtypes of breast cancer has revealed differences among them in terms of prognosis and response to chemotherapy and endocrine therapy. However, the ability of intrinsic subtypes to predict benefit from adjuvant radiotherapy has only been examined in few studies.
METHODS: Gene expression-based intrinsic subtyping was performed in 228 breast tumors collected from two independent post-mastectomy clinical trials (British Columbia and the Danish Breast Cancer Cooperative Group 82b trials), where pre-menopausal patients with node-positive disease were randomized to adjuvant radiotherapy or not. All patients received adjuvant chemotherapy and a subgroup of patients underwent ovarian ablation. Tumors were classified into intrinsic subtypes: Luminal A, Luminal B, HER2-enriched, Basal-like and Normal-like using the research-based PAM50 classifier.
RESULTS: In the British Columbia study, patients treated with radiation had an overall significant lower incidence of locoregional recurrence compared to the controls. For Luminal A tumors the risk of loco-regional recurrence was low and was further lowered by adjuvant radiation. These findings were validated in the DBCG 82b study. The individual data from the two cohorts were merged, the hazard ratio (HR) for loco-regional recurrence associated with giving radiation was 0.34 (0.19 to 0.61) overall and 0.12 (0.03 to 0.52) for Luminal A tumors.
CONCLUSIONS: In both postmastectomy trials, patients with Luminal A tumors turned out to have a significant lower incidence of loco-regional recurrence when randomized to adjuvant radiotherapy, leaving no indication to omit postmastectomy adjuvant radiation in pre-menopausal high-risk patients with Luminal A tumors. It was not possible to evaluate the effect of radiotherapy among the other subtypes because of limited sample sizes.

PMID: 29172851 [PubMed - as supplied by publisher]

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A systematic review of targeted agents for non-small cell lung cancer.

A systematic review of targeted agents for non-small cell lung cancer.

Acta Oncol. 2017 Nov 25;:1-11

Authors: Vestergaard HH, Christensen MR, Lassen UN

Abstract
BACKGROUND: advanced-stage non-small cell lung cancer (NSCLC) is characterized by having limited treatment options and thus a poor prognosis. However, new treatment options, in the form of targeted agents (TA), have emerged during recent years. This systematic review aims to provide an overview of the accessible literature in PubMed evaluating TA used on NSCLC patients, and the resulting survival outcomes.
METHOD: this systematic literature review was conducted by reviewing all relevant literature in PubMed. Six separate searches were performed: Three searches where controlled entry terms were used and three free text searches. Furthermore, other relevant publications were included manually. A total of seventy-two studies met the search criteria and were thus further analyzed and evaluated.
RESULTS: In the included studies, various TAs and their effect on different molecular targets have been evaluated. Clinical responses vary considerably among the different genetic aberrations. The majority of studies evaluated TA for epidermal growth factor receptor (EGFR) mutations and TA for echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) rearrangements. Studies regarding the use of TA for Rat sarcoma (RAS), rapidly accelerated fibrosarcoma (RAF), ROS proto-oncogene 1 (ROS1) rearrangement, Receptor tyrosine-protein kinase erbB-2 (ERBB2), Phosphatidylinositol 3-kinase (PIK3CA)/v-akt murine thymoma viral oncogene homolog; protein kinase B(AKT)/Phosphatase and tensin homolog deleted on chromosome 10(PTEN), The mammalian target of rapamycin (mTOR), and Mesenchymal-epithelial transition factor (MET) were included as well. In general, studies comparing treatment outcomes in EGFR-mutated patients and EML4-ALK (ALK) rearranged patients after use of either TA or standard chemotherapy, present significant better results after TA.
CONCLUSIONS: This systematic review provides an overview of available literature in PubMed regarding NSCLC and TA. Included studies point toward that TA appears to be a promising therapeutic tool in treating NSCLC patients and use of TA is expected to result in improved treatment outcomes.

PMID: 29172833 [PubMed - as supplied by publisher]

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Interleukin-6 as one of the potential mediators of immune-related adverse events in non-small cell lung cancer patients treated with immune checkpoint blockade: evidence from a case report.

Interleukin-6 as one of the potential mediators of immune-related adverse events in non-small cell lung cancer patients treated with immune checkpoint blockade: evidence from a case report.

Acta Oncol. 2017 Nov 24;:1-4

Authors: Naqash AR, Yang LV, Sanderlin EJ, Atwell DC, Walker PR

PMID: 29171332 [PubMed - as supplied by publisher]

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Obstructive and restrictive pulmonary dysfunction in long-term lymphoma survivors after high-dose therapy with autologous stem cell transplantation.

Obstructive and restrictive pulmonary dysfunction in long-term lymphoma survivors after high-dose therapy with autologous stem cell transplantation.

Acta Oncol. 2017 Nov 24;:1-9

Authors: Stenehjem JS, Smeland KB, Murbraech K, Holte H, Kvaløy SO, Wethal T, Kiserud CE, Samersaw-Lund MB

Abstract
BACKGROUND: Obstructive and restrictive dysfunction in long-term lymphoma survivors (LSs) after high-dose therapy with autologous stem-cell transplantation (HDT-ASCT) has not been addressed systematically previously.
MATERIAL AND METHODS: LSs treated in Norway 1987-2008 with HDT-ASCT who performed spirometry, measurement of static lung volumes and echocardiography 2012-2014 at either Oslo or St. Olavs University Hospitals was eligible. Smoking data were recorded by questionnaire. Treatment data were collected from medical records or hospital databases. Factors associated with obstructive and restrictive impairments (dichotomous outcomes) were examined by Poisson regression. Linear regression with the margins post-estimation command was used to derive adjusted mean values of forced expiratory volume in 1 s (FEV1). We used the normative reference data recommended by the European Respiratory Society for calculating percent predicted values.
RESULTS: A total of 226 LSs were studied, of whom 11.5 and 5.8% had obstructive and restrictive impairment, respectively. For women and men, mean FEV1 was 2.31 and 3.34 l corresponding to 11.4%- and 11.1%-points below that predicted from norms, respectively. In multivariable regression analyses, cumulative doxorubicin dose (400-775 mg/m2) and current smoking were associated with increased risk of obstructive impairment, and chest RT (>13-66 Gy) was associated with increased risk of restrictive impairment. Currently smoking LSs within the highest doxorubicin category (400-775 mg/m2), had the lowest adjusted mean FEV1.
CONCLUSIONS: Despite intensive cancer treatment, our analysis showed modest reductions in obstructive parameters among long-term LSs after HDT-ASCT compared to normative reference data. To limit obstructive impairments in LSs after HDT-ASCT, we suggest that targeted smoking-cessation advice is directed towards patients who have received high cumulative doses of doxorubicin.

PMID: 29171324 [PubMed - as supplied by publisher]

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Breast conserving surgery versus mastectomy: overall and relative survival-a population based study by the Danish Breast Cancer Cooperative Group (DBCG).

Breast conserving surgery versus mastectomy: overall and relative survival-a population based study by the Danish Breast Cancer Cooperative Group (DBCG).

Acta Oncol. 2017 Nov 23;:1-7

Authors: Christiansen P, Carstensen SL, Ejlertsen B, Kroman N, Offersen B, Bodilsen A, Jensen MB

Abstract
BACKGROUND: Observational studies have pointed at a better survival after breast conserving surgery (BCS) compared with mastectomy. The aim of the present study was to evaluate whether this remains true when more extensive tumor characteristics and treatment data were included.
METHODS: The cohort included patients registered after primary surgery for early invasive breast cancer in the database of the Danish Breast Cancer Cooperative Group, in the period 1995-2012. The cohort was divided into three groups: (i) patients who primarily had a mastectomy, (ii) patients treated by BCS, and (iii) patients who primarily had BCS and then mastectomy [intention to treat (ITT) by BCS]. The association between overall mortality and standard mortality ratio (SMR) and risk factors was analyzed in univariate and multivariate Poisson regression models.
RESULTS: A total of 58,331 patients were included: 27,143 in the mastectomy group, 26,958 in the BCS group, and 4230 in the BCS-ITT group. After adjusting for patient and treatment characteristics, the relative risk (RR) was 1.20 (95% CI: 1.15-1.25) after mastectomy and 1.08 (95% CI: 1.01-1.15) after BCS first and then mastectomy, as compared to BCS. Statistically significant interactions were not observed for age, period of treatment, and nodal status, but patients with Charlson's Comorbidity Index (CCI) score 2+ had no increased mortality after mastectomy, as opposed to patients with CCI 0-1. Loco-regional radiation therapy (RT) in node positive patients did not reduce the increased risk associated with mastectomy [RR = 1.28 (95% CI 1.19-1.38)].
CONCLUSION: Patients assigned to BCS have a better survival than patients assigned to mastectomy. Residual confounding after adjustment for registered characteristics presumably explained the different outcomes, thus consistent with selection bias. Diversities in RT did not appear to explain the observed difference in survival after BCS and mastectomy.

PMID: 29168674 [PubMed - as supplied by publisher]

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The occurrence of fractures after adjuvant treatment of breast cancer: a DBCG register study.

The occurrence of fractures after adjuvant treatment of breast cancer: a DBCG register study.

Acta Oncol. 2017 Nov 23;:1-5

Authors: Kristensen B, Ejlertsen B, Jensen MB, Mouridsen HT, Danish Breast Cancer Cooperative Group

Abstract
BACKGROUND: Adjuvant treatment in breast cancer patients especially with aromatase inhibitors (AIs) has adverse effects on bone metabolism resulting in an increased occurrence of fractures. In order to demonstrate this occurrence, long-term follow-up studies are necessary. From several national registries in Denmark, it is possible to link data from different sources and analyze this issue.
METHODS: A study cohort of 68,842 breast cancer patients prospectively diagnosed and registered in the Danish Breast Cancer Cooperative Group's database during the period 1995-2012 formed the basis of the analysis. These data were matched with data on all types of fractures from the Danish National Patient Register and vital data from the Danish Civil Registration System.
RESULTS: After data cleaning 66,502 patients were available for analysis and 16,360 of these had incurred 20,341 fractures with 13,182 patients having just one fracture. These fractures were distributed over 214 specific fracture sites. An extended multivariable Cox regression model revealed significant association between the occurrence of fractures and age, menopause, Charlson comorbidity index (CCI) and endocrine therapy such that late menopause and tamoxifen treatment were associated with a lower occurrence and AI treatment, age and CCI were associated with a higher occurrence of fractures.
CONCLUSION: Before advising adjuvant therapy with AIs fragile patients with chronic diseases should receive special attention in order to reduce the incidence of fractures in this vulnerable group of patients.

PMID: 29168668 [PubMed - as supplied by publisher]

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Triple negative breast cancer - prognostic role of immune-related factors: a systematic review.

Triple negative breast cancer - prognostic role of immune-related factors: a systematic review.

Acta Oncol. 2017 Nov 23;:1-9

Authors: Stovgaard ES, Nielsen D, Hogdall E, Balslev E

Abstract
PURPOSE: Treatment of breast cancer has been increasingly successful in recent years with the advent of HER2-receptor targeted treatment and endocrine treatment. However, the triple negative subgroup of breast cancer (TNBC) (estrogen-, progesterone- and HER2-receptor negative) still lacks targeted treatment options. TNBC is a type of breast cancer that often affects younger women, and generally has a worse prognosis than other types of breast cancer. Recently, the complex role of the immune system in cancer growth, elimination and metastasis has been the object of increased attention. There is hope that a more detailed understanding of the intricate roles of the constituents of the immune system, will hold potential both as prognostic or predictive markers of cancer progression, but also as treatment targets for a wide range of tumors, including TNBC. The aim of this review is to provide an overview of the cellular immune microenvironment in TNBC, and to highlight areas in which TNBC may differ from other types of breast cancer.
MATERIAL AND METHODS: A search of PubMed was made using the terms 'triple negative breast cancer' and 'tumor infiltrating lymphocytes', 'CD8', 'CD4', 'B cells', 'natural killer cells', 'macrophages', myeloid derived suppressor cells', 'dendritic cells', 'immune check point inhibitor', 'CTLA-4' and 'PD-L1'.
RESULTS: We find that whilst factors such as TILs and certain subgroups of TILs (e.g., CD8 + and regulator T-cells) have been extensively researched, none of these markers are currently applicable to routine clinical practice. Also, TNBC differs from other types of breast cancer with regards to cellular composition of the immune infiltrate and PD-L1 expression, and the prognostic significance of these.
CONCLUSIONS: Immune-related factors have the potential as both prognostic and predictive biomarkers for new treatments targeting the immune system in breast cancer. However, multivariate analyses, taking other well-known factors into account, are required to determine the true value of these biomarkers. Also, differences between TNBC and other types of breast cancer may have implications for treatment and use of immune-related factors as biomarkers.

PMID: 29168430 [PubMed - as supplied by publisher]

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Axillary lymph node dissection in breast cancer patients after sentinel node biopsy.

Axillary lymph node dissection in breast cancer patients after sentinel node biopsy.

Acta Oncol. 2017 Nov 23;:1-4

Authors: Jessing C, Langhans L, Jensen MB, Talman ML, Tvedskov TF, Kroman N

PMID: 29168429 [PubMed - as supplied by publisher]

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Standardized assessment of tumor-infiltrating lymphocytes in breast cancer: an evaluation of inter-observer agreement between pathologists.

Standardized assessment of tumor-infiltrating lymphocytes in breast cancer: an evaluation of inter-observer agreement between pathologists.

Acta Oncol. 2017 Nov 23;:1-5

Authors: Tramm T, Di Caterino T, Jylling AB, Lelkaitis G, Lænkholm AV, Ragó P, Tabor TP, Talman MM, Vouza E, Scientific Committee of Pathology, Danish Breast Cancer Group (DBCG)

Abstract
INTRODUCTION: In breast cancer, there is a growing body of evidence that tumor-infiltrating lymphocytes (TILs) may have clinical utility and may be able to direct clinical decisions for subgroups of patients. Clinical utility is, however, not sufficient for warranting the implementation of a new biomarker in the routine practice, and evaluation of the analytical validity is needed, including testing the reproducibility of decentralized assessment of TILs. The aim of this study was to evaluate the inter-observer agreement of TILs assessment using a standardized method, as proposed by the International TILs Working Group 2014, applied to a cohort of breast cancers reflecting an average breast cancer population.
MATERIAL AND METHODS: Stromal TILs were assessed using full slide sections from 124 breast cancers with varying histology, malignancy grade and ER- and HER2 status. TILs were estimated by nine dedicated breast pathologists using scanned hematoxylin-eosin stainings. TILs results were categorized using various cutoffs, and the inter-observer agreement was evaluated using the intraclass coefficient (ICC), Kappa statistics as well as individual overall agreements with the median value of TILs.
RESULTS: Evaluation of TILs led to an ICC of 0.71 (95% CI: 0.65-0.77) corresponding to an acceptable agreement. Kappa values were in the range of 0.38-0.46 corresponding to a fair to moderate agreement. The individual agreements increased, when using only two categories ('high' vs. 'low' TILs) and a cutoff of 50-60%.
DISCUSSION: The results of the present study are in accordance with previous studies, and shows that the proposed methodology for standardized evaluation of TILs renders an acceptable inter-observer agreement. The findings, however, indicate that assessment of TILs needs further refinement, and is in support of the latest St. Gallen Consensus, that routine reporting of TILs for early breast cancer is not ready for implementation in a clinical setting.

PMID: 29168428 [PubMed - as supplied by publisher]

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Neoadjuvant letrozole for postmenopausal estrogen receptor-positive, HER2-negative breast cancer patients, a study from the Danish Breast Cancer Cooperative Group (DBCG).

Neoadjuvant letrozole for postmenopausal estrogen receptor-positive, HER2-negative breast cancer patients, a study from the Danish Breast Cancer Cooperative Group (DBCG).

Acta Oncol. 2017 Nov 23;:1-7

Authors: Skriver SK, Laenkholm AV, Rasmussen BB, Handler J, Grundtmann B, Tvedskov TF, Christiansen P, Knoop AS, Jensen MB, Ejlertsen B

Abstract
INTRODUCTION: Neoadjuvant endocrine treatment (NET) is a low-toxicity approach to achieve operability in locally advanced breast cancer, and to facilitate breast conservation in early breast cancer, particular in patients with highly estrogen receptor (ER) positive and HER2-negative disease. Here, we report the results obtained by neoadjuvant letrozole in patients with early breast cancer in a phase-II design.
MATERIAL AND METHODS: A total of 119 postmenopausal women with ER-positive, HER2-negative operable breast cancer were assigned to four months of neoadjuvant letrozole before definitive surgery. Sentinel node or diagnostic fine needle aspiration cytology procedure was performed prior to treatment and the women were assessed prior, at two months, and before surgery with clinical examination, mammography and ultrasonography. Surgical specimens were examined for pathological response. Primary outcome was pathological and clinical response.
RESULTS: The per protocol population consisted of 112 patients. Clinical response was evaluated in 109 patients and pathological response in 108. Overall a mean decrease in tumor size was 15% (p ≤ .0001). One patient had complete pathological response and 55% of patients had partial pathological response. ER at 100%, ductal subtype, tumor size below 2 cm and lymph node-negative status was significantly associated with a better response to NET and malignancy grade 3 with a poorer response to NET. One patient progressed during treatment and received neoadjuvant chemotherapy. Eight patients received adjuvant chemotherapy due to lack of response.
CONCLUSION: Neoadjuvant aromatase inhibitor therapy is an acceptable strategy in selected postmenopausal patients with ER-rich and HER2-negative early breast cancer with ductal histology and should be considered when chemotherapy either isn't indicated or feasible.

PMID: 29168427 [PubMed - as supplied by publisher]

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A Danish national effort of BRCA1/2 variant classification.

A Danish national effort of BRCA1/2 variant classification.

Acta Oncol. 2017 Nov 23;:1-3

Authors: Pedersen IS, Schmidt AY, Bertelsen B, Ernst A, Andersen CLT, Kruse T, Rossing M, Thomassen M

PMID: 29168416 [PubMed - as supplied by publisher]

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Mortality and recurrence rates among systemically untreated high risk breast cancer patients included in the DBCG 77 trials.

Mortality and recurrence rates among systemically untreated high risk breast cancer patients included in the DBCG 77 trials.

Acta Oncol. 2017 Nov 23;:1-6

Authors: Jensen MB, Nielsen TO, Knoop AS, Laenkholm AV, Balslev E, Ejlertsen B

Abstract
BACKGROUND: Following loco-regional treatment for early breast cancer accurate prognostication is essential for communicating benefits of systemic treatment. The aim of this study was to determine time to recurrence and long-term mortality rates in high risk patients according to patient characteristics and subtypes as assigned by immunohistochemistry panels.
PATIENTS AND METHODS: In November 1977 through January 1983, 2862 patients with tumors larger than 5 cm or positive axillary nodes were included in the DBCG 77 trials. Archival tumor tissue from patients randomly assigned to no systemic treatment was analyzed for ER, PR, Ki67, EGFR and HER2. Intrinsic subtypes were defined as follows: Luminal A, ER or PR >0%, HER2-negative, PR >10% and Ki67 < 14%; Luminal B, ER or PR >0%, (PR ≤10% or HER2-positive or Ki67 ≥ 14%); HER2E, ER 0%, PR 0%, HER2 positive; Core basal, ER 0%, PR 0%, HER2 negative and EGFR positive. Multivariate categorical and fractional polynomials (MFP) models were used to construct prognostic subsets by clinicopathologic characteristics.
RESULTS: In a multivariate model, mortality rate was significantly associated with age, tumor size, nodal status, invasion, histological type and grade, as well as subtype classification.
CONCLUSIONS: With 35 years of follow-up, in this population of high-risk patients with no systemic therapy, no subgroup based on a composite prognostic score and/or molecular subtypes could be identified without excess mortality as compared to the background population.

PMID: 29168407 [PubMed - as supplied by publisher]

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Me too-drugs with limited benefits - the tale of regorafenib for HCC.

Me too-drugs with limited benefits - the tale of regorafenib for HCC.

Nat Rev Clin Oncol. 2017 Nov 28;:

Authors: Gyawali B, Prasad V

Abstract
This corrects the article DOI: 10.1038/nrclinonc.2017.100.

PMID: 29182165 [PubMed - as supplied by publisher]

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Targeting RET-driven cancers: lessons from evolving preclinical and clinical landscapes.

Targeting RET-driven cancers: lessons from evolving preclinical and clinical landscapes.

Nat Rev Clin Oncol. 2017 Nov 28;:

Authors: Drilon A, Hu ZI, Lai GGY, Tan DSW

Abstract
This corrects the article DOI: 10.1038/nrclinonc.2017.175.

PMID: 29182164 [PubMed - as supplied by publisher]

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Association between slow-wave activity, cognition and behaviour in children with sleep-disordered breathing.

Association between slow-wave activity, cognition and behaviour in children with sleep-disordered breathing.

Sleep Med. 2016 Sep;25:49-55

Authors: Weichard AJ, Walter LM, Hollis SL, Nixon GM, Davey MJ, Horne RSC, Biggs SN

Abstract
BACKGROUND: It has been suggested that impaired dissipation of slow-wave activity (SWA) in children with sleep-disordered breathing (SDB) may be a potential mechanism for daytime dysfunction. We aimed to examine whether resolution of SDB resulted in normalisation of SWA dissipation and whether this was associated with improved cognition and behaviour.
METHODS: Children (aged 3-6 y) diagnosed with SDB and age-matched non-snoring control children were followed up for 3 y after a baseline study. At the follow-up, children were categorised into control (N = 13), resolved SDB (N = 15) and unresolved SDB (N = 14). Delta activity on the electroencephalogram over the sleep period was used to calculate SWA and a battery of cognitive assessments and behaviour questionnaires were conducted at both time points.
RESULTS: There was no change in the average SWA between the baseline and follow-up and no differences between the groups. Cognitive and behavioural performance in the resolved group did not improve to control levels. However, decreased SWA at the beginning of the sleep period (β = -0.04, p = 0.002) and a decrease in obstructive apnoea-hypopnoea index (β = -2.2, p = 0.022) between the baseline and follow-up predicted improvements in measures of sustained attention. Increased SWA at the beginning of the sleep period between the baseline and follow-up predicted worsening of externalising behaviour (β = 0.02, p = 0.039).
CONCLUSIONS: This study suggests that resolution of SDB is not associated with changes in the dissipation of SWA. However, the association between decreases in SWA and improvements in cognitive and behavioural outcomes suggest that irrespective of disease, children whose quantitative sleepiness improves have improved attention and reduced externalising behaviours.

PMID: 27823716 [PubMed - indexed for MEDLINE]

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Long-term outcome after laparoscopic sleeve gastrectomy in patients over 65 years old: a retrospective analysis.

Long-term outcome after laparoscopic sleeve gastrectomy in patients over 65 years old: a retrospective analysis.

Surg Obes Relat Dis. 2017 Jan;13(1):1-6

Authors: Garofalo F, Denis R, Pescarus R, Atlas H, Bacon SL, Garneau P

Abstract
BACKGROUND: Bariatric surgery has been proven to be a safe and effective treatment for obesity with BMI (body mass index) reduction, and resolution or lowering of obesity-related co-morbidities. The relative age limit for bariatric surgery has gradually been increased to 60 years of age and above.
OBJECTIVES: The aim of this study was to assess the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) performed in older patients (≥65 years old).
SETTING: University hospital.
METHODS: Between May 1, 2007 and November 30, 2013, 30 consecutive patients≥65 years old were included in this retrospective study of our prospectively collected bariatric database.
RESULTS: A total of 27 (90%) primary LSG and 3 revisional LSG (10%) were performed. Mean patient age was 67.2 (range: 65-74) years, and mean preoperative BMI (±standard deviation [SD]) was 44.1±5.6 kg/m2. Thirty-day morbidity included 3 cases of self-limiting nausea and vomiting and 1 case of gastric sleeve stenosis necessitating conversion to gastric bypass. No mortality reported. The overall mean percentage of excess weight loss (±SD) and percentage of total weight loss (±SD) at 12 months were 53.8±19.8 and 23.9±8.4; 52.9±21.8 and 24±9.9 at 36 months, respectively. No patients were lost to follow-up but 5 were excluded because they underwent revisions. Age-adjusted mixed model analyses revealed that baseline BMI (P = .018), BMI>45 kg/m2 (P = .001), and having diabetes (P = .030) were associated with excess weight loss<50% across follow-up.
CONCLUSION: LSG seems to be effective and safe for patients≥65 years old. Obesity related co-morbidities have improved across follow-up. BMI>45 kg/m2 and diabetes is associated with insufficient weight loss or weight regain.

PMID: 27516222 [PubMed - indexed for MEDLINE]

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Real-Life Clinical Use of Symbicort® Maintenance and Reliever Therapy for Asthmatic Patients in Korea.

https:--e-aair.org-src-LinkOut-aair_link

Real-Life Clinical Use of Symbicort® Maintenance and Reliever Therapy for Asthmatic Patients in Korea.

Allergy Asthma Immunol Res. 2018 Jan;10(1):88-94

Authors: Kim SH, Kim TB, Kim SH, Park HW, Song SH, Jeong JW, Jee YK, Park SW, Kim MS, Yoon HJ

Abstract
The aim of this study was to examine the daily practice patterns of Symbicort® Maintenance and Reliever Therapy (SMART) in Korean asthmatic patients and to analyze clinical signs related to overuse. This study used an observational, multicenter, noninterventional, prospective, uncontrolled design for examining asthmatic patients prescribed SMART to assess the frequency and pattern of Symbicort® usage as a maintenance and reliever medication. The characteristics of patients showing signs of overuse (frequency of inhalation: 8 or more times per day) were also analyzed. Among the 1,518 patients analyzed, 1,292 (85.1%) completed the trial. The number of mean inhalations per day was 2.14±1.15; the number of patients who had at least 1 as needed usage (PRN) inhalation per day was 843 (55.5%); the mean frequency of PRN use was 0.25±0.67 inhalations per day. The number of patients who overused for at least 1 day was 260 (17.1%). In particular, young patients, patients with limited physical activity, and patients with nocturnal symptoms demonstrated high frequency of overuse. The frequency of overuse during SMART was not high in Korean asthmatic patients and the asthma status of follow-up outpatients improved overall. However, there is a need for careful education targeted toward younger patients, patients with limited physical activity, and patients with nocturnal symptoms owing to their tendency to frequently overuse.

PMID: 29178682 [PubMed]

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Clinical Course of Chronic Spontaneous Urticaria in the Korean Adult Population.

Clinical Course of Chronic Spontaneous Urticaria in the Korean Adult Population.

Allergy Asthma Immunol Res. 2018 Jan;10(1):83-87

Authors: Kim YS, Park SH, Han K, Lee JH, Kim NI, Roh JY, Seo SJ, Song HJ, Lee MG, Choi JH, Park YM

Abstract
Knowledge of the clinical course of chronic spontaneous urticaria (CSU) remains unclear. The purpose of our study was to investigate the clinical course of CSU in the Korean adult population. Each patient in the CSU group who was defined by disease codes between 2003 and 2007 was tracked whether he or she went into remission or not until 2013. Kaplan-Meier survival analysis was carried out to analyze remission, and log-rank tests were performed for between-group comparisons. Demographic differences between subjects who went into remission 1 year after the initial diagnosis and those who did not were analyzed using χ² tests. A total of 13,969 subjects were included in the CSU group. The 1-, 2-, 3-, 4-, and 5-year remission rates of CSU were 21.5%, 33.0%, 38.9%, 42.6%, and 44.6%, respectively. The proportion of subjects in the 65+ age group (P=0.050) and with male gender (P=0.002) was significantly higher among subjects who did not go into remission 1 year after the initial diagnosis. Our study indicates that CSU could have a more persistent course than previously reported.

PMID: 29178681 [PubMed]

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T-Helper Type 2 Cells Direct Antigen-Induced Eosinophilic Skin Inflammation in Mice.

T-Helper Type 2 Cells Direct Antigen-Induced Eosinophilic Skin Inflammation in Mice.

Allergy Asthma Immunol Res. 2018 Jan;10(1):77-82

Authors: Kaminuma O, Nishimura T, Kitamura N, Saeki M, Hiroi T, Mori A

Abstract
Eosinophilic inflammation in combination with immunoglobulin E (IgE) production is a characteristic feature of atopic dermatitis. Although activated T-helper type (Th) 2 cells play critical roles in the local accumulation and activation of eosinophils, whether they induce eosinophilic skin inflammation, independent of the IgE-mediated pathway has been unclear. To address the functional role of T cells in allergic skin diseases, we herein transferred Th1/Th2-differentiated or naive DO11.10 T cells into unprimed BALB/c mice. Ovalbumin-specific Th2 cells, as well as eosinophils, accumulated in the skin upon antigen challenge, despite the absence of antigen-specific IgE. Neither antigen-specific Th1 nor naive T cells induced eosinophil accumulation, although Th1 cells by themselves migrated into the skin. Interleukin (IL)-4, IL-5, and eotaxin were specifically produced in the skin of antigen-challenged, Th2 cell-transferred mice, whereas interferon (IFN)-γ and regulated on activation, normal T cell expressed and secreted (RANTES) were preferentially produced in Th1 cells-transferred mice. Production of monocyte chemoattractant protein (MCP)-1 and MCP-3 was enhanced by both Th1 and Th2 cells. The accumulation of eosinophils and Th2 cells in the skin was suppressed by both dexamethasone and FK506, indicating an essential role of Th2 cells in eosinophil recruitment. We conclude that Th2 cells can induce eosinophilic infiltration into the skin in the absence of antigen-specific IgE.

PMID: 29178680 [PubMed]

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Heterozygous SSBP1 start loss mutation co-segregates with hearing loss and the m.1555A>G mtDNA variant in a large multigenerational family.

Heterozygous SSBP1 start loss mutation co-segregates with hearing loss and the m.1555A>G mtDNA variant in a large multigenerational family.

Brain. 2017 Nov 22;:

Authors: Kullar PJ, Gomez-Duran A, Gammage PA, Garone C, Minczuk M, Golder Z, Wilson J, Montoya J, Häkli S, Kärppä M, Horvath R, Majamaa K, Chinnery PF

Abstract
The m.1555A>G mtDNA variant causes maternally inherited deafness, but the reasons for the highly variable clinical penetrance are not known. Exome sequencing identified a heterozygous start loss mutation in SSBP1, encoding the single stranded binding protein 1 (SSBP1), segregating with hearing loss in a multi-generational family transmitting m.1555A>G, associated with mtDNA depletion and multiple deletions in skeletal muscle. The SSBP1 mutation reduced steady state SSBP1 levels leading to a perturbation of mtDNA metabolism, likely compounding the intra-mitochondrial translation defect due to m.1555A>G in a tissue-specific manner. This family demonstrates the importance of rare trans-acting genetic nuclear modifiers in the clinical expression of mtDNA disease.

PMID: 29182774 [PubMed - as supplied by publisher]

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Genetic analysis of a Chinese family with members affected with Usher syndrome type II and Waardenburg syndrome type IV.

Genetic analysis of a Chinese family with members affected with Usher syndrome type II and Waardenburg syndrome type IV.

Int J Pediatr Otorhinolaryngol. 2017 Nov;102:114-118

Authors: Wang X, Lin XJ, Tang X, Chai YC, Yu DH, Chen DY, Wu H

Abstract
AIMS: The purpose of this study was to identify the genetic causes of a family presenting with multiple symptoms overlapping Usher syndrome type II (USH2) and Waardenburg syndrome type IV (WS4).
METHODS: Targeted next-generation sequencing including the exon and flanking intron sequences of 79 deafness genes was performed on the proband. Co-segregation of the disease phenotype and the detected variants were confirmed in all family members by PCR amplification and Sanger sequencing.
RESULTS: The affected members of this family had two different recessive disorders, USH2 and WS4. By targeted next-generation sequencing, we identified that USH2 was caused by a novel missense mutation, p.V4907D in GPR98; whereas WS4 due to p.V185M in EDNRB. This is the first report of homozygous p.V185M mutation in EDNRB in patient with WS4.
CONCLUSION: This study reported a Chinese family with multiple independent and overlapping phenotypes. In condition, molecular level analysis was efficient to identify the causative variant p.V4907D in GPR98 and p.V185M in EDNRB, also was helpful to confirm the clinical diagnosis of USH2 and WS4.

PMID: 29106856 [PubMed - indexed for MEDLINE]

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Primary Ewing Sarcoma of the Thyroid-Eight Cases in a Decade: A Case Report and Literature Review.

Primary Ewing Sarcoma of the Thyroid-Eight Cases in a Decade: A Case Report and Literature Review.

Front Endocrinol (Lausanne). 2017;8:257

Authors: Kabata P, Kaniuka-Jakubowska S, Kabata W, Lakomy J, Biernat W, Sworczak K, Jaśkiewicz J, Świerblewski M

Abstract
Sarcomas represent less than 1% of all malignant tumors found in the thyroid. Of these, primary extraosseoussarcoma has been reported only a few times in the past decade. We present the case of a 34-year-old male who had a fast-growing hard mass in the lower left neck. FNA was inconclusive. Core needle biopsy revealed the diagnosis of an Ewing sarcoma/primitive neuroectodermal tumor. Mutation of EWSR1 was confirmed using the FISH method. Following treatment by neoadjuvant chemotherapy, we observed clinical, radiological, and finally histopathological remission. This was followed by a left-sided isthmolobectomy with unilateral cervical lymph node dissection by lateral lymphadenectomy, which revealed no residual disease. Posttreatment radiotherapy was administered but discontinued upon the patient's request. After 18 months of observation, the patient had no recurrence or metastasis and required l-thyroxine supplementation. We discuss our case using a comparative literature review to the few other known case reports.

PMID: 29163353 [PubMed]

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Peroral endoscopic myotomy in treatment-naïve achalasia patients versus prior treatment failure cases.

Peroral endoscopic myotomy in treatment-naïve achalasia patients versus prior treatment failure cases.

Endoscopy. 2017 Nov 23;:

Authors: Nabi Z, Ramchandani M, Chavan R, Tandan M, Kalapala R, Darisetty S, Lakhtakia S, Rao GV, Reddy DN

Abstract
Background and study aim Peroral endoscopic myotomy (POEM) has emerged as an effective treatment modality for achalasia. Prior treatment may affect the outcomes of subsequent management. In this study, we aimed to compare the safety and efficacy of POEM in treatment-naïve patients vs. those with prior treatment failure (PTF). Patients and methods The data of consecutive patients with achalasia who underwent POEM at a single tertiary care center from January 2013 to November 2016 were analyzed retrospectively. A comparative analysis was performed between treatment-naïve and PTF cases. Technical and clinical success, adverse events, and operative time for POEM were compared between the two groups. Results Overall, 502 patients with achalasia underwent POEM during the study period: 260 patients (51.8 %) in the treatment-naïve group and 242 patients (48.2 %) in the PTF group. The mean operative time was significantly longer in the PTF group compared with the treatment-naïve group (74.9 ± 30.6 vs. 67.0 ± 27.1 minutes; P = 0.002). On multivariate analysis, type of achalasia, dilated esophagus ( > 6 cm), disease duration, prior treatment, occurrence of adverse events, and type of knife used were significant predictors of operative time. Technical success (98.1 % vs. 97.1 %; P = 0.56) and clinical success (92.4 % vs. 92.5 %; P = 0.95) were comparable in the treatment-naïve and PTF cases, respectively. Occurrence of gas-related events and mucosotomy were similar in both groups. Elevated DeMeester score was found in 17 /53 patients (32.1 %) in the PTF group and in 11 /44 patients (25.0 %) in the treatment-naïve group (P = 0.50). Conclusion POEM is safe and equally effective for treatment-naïve patients and for those in whom prior treatment has failed. POEM should be considered the treatment of choice in patients in whom prior treatment has failed.

PMID: 29169196 [PubMed - as supplied by publisher]

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Skull Base; +19 new citations

19 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

Skull Base

These pubmed results were generated on 2017/11/29

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A new approach for the determination of ECAP thresholds.

A new approach for the determination of ECAP thresholds.

Cochlear Implants Int. 2017 Nov 22;:1-11

Authors: Hoth S, Spitzer P, Praetorius M

Abstract
BACKGROUND: Electrically evoked compound action potentials (ECAPs) of the auditory nerve are routinely recorded for testing the cochlear implant integrity and its functional connection to the auditory system. The response thresholds derived from ECAP recordings are widely used as a helpful guide in the fitting of the dynamic range of electric stimulation, although they may not always predict the behavioral thresholds of individuals well. Conventionally, this threshold is based on the identification of a minimum N peak and maximum P peak and linear extrapolation of the resulting amplitude growth function (AGF). As an alternative, a new procedure involving numeric signal processing and requiring less user intervention is presented here. Data acquisition: In 12 adults implanted with MED-EL FLEX28 electrodes, two series of ECAPs were recorded immediately after implantation: (i) a full profile involving all 12 channels across the whole stimulus range in steps of 200 current units and (ii) a high resolution section (20 records in the immediate neighborhood of the threshold) of the AGF in one selected channel. Data treatment: It was observed that N and P wave latencies do not depend on stimulus intensity. Fixed time windows were hence defined for stimulus plus noise and noise alone regions. In these windows, the variance of the compound signal representing response and noise is extracted, whereas the noise variance is extracted from the tail of the curve following this time window. The base line is corrected by fitting an exponential function to reduce stimulus or amplifier artifacts. The response threshold is then derived from the response to noise ratio which should exceed the limit of 6 dB.
RESULTS: The ECAP thresholds obtained from the new procedure coincide well with those determined by the conventional linear extrapolation of the AGF and they correlate to a greater degree with psychometric thresholds than the existing approach.
CONCLUSIONS: The new ECAP algorithm looks promising and may reduce the need for user intervention in determining thresholds.

PMID: 29161976 [PubMed - as supplied by publisher]

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The influence of occlusal stabilization appliances on cervical dystonia symptoms.

The influence of occlusal stabilization appliances on cervical dystonia symptoms.

Clujul Med. 2017;90(4):438-444

Authors: Navrotchi C, Badea ME

Abstract
Objectives: The aim of this study was to assess the therapeutic efficiency of the occlusal stabilization appliance (OSA) in patients with cervical dystonia (CD).
Methods: The study included 11 patients aged between 29 and 80 years, 7 women and 4 men, diagnosed with primary CD. The patients underwent an extra- and intra-oral clinical examination, followed by para-clinical examinations, necessary for the specifications of the OSA. The following data were recorded: demographic parameters, CD duration, management of the disease, dental impression, recording of the centric relationship, recording of the position of the upper jaw with the facial bow. A standardized OSA was manufactured in a private dental laboratory. Patients received instructions for wearing the OSA for 24 hours. Patients filled a questionnaire designed by us, which evaluated the effects of wearing the OSA over a 24-hours period on the symptoms of CD: muscles contraction, pain, discomfort while walking, sleep quality, tremor. The patients kept the dental appliances, and after three months they completed the questionnaire one more time.
Results: The OSA was applied on the lower arch in 3 (27.3%) patients and on the upper arch in 8 (72.7%) patients. The OSA wearing time for the first 24 h was on average 19.2±6 hours. Total relaxation of dystonic muscles was reported by 9 (81.8%) patients, while 2 (18.2%) patients related partial muscle relaxation. Seven (63.6%) patients reported a pain decrease. Increased comfort while walking was observed by 8 (72.7%) patients. Two (18.2%) patients described an increase of sleep quality. In two (18.2%) patients the tremor disappeared. All patients reported difficulties while eating and removed the OSA during meals. Patients who wore the OSA for more hours, experienced a pain decrease (p=0.08), an increase in sleep quality (p=0.1), the disappearance of the tremor (p=0.1). After three months, only seven patients continued to use the OSA. More patients described a pain decrease after three months (5 (71.4%) vs. 4 (57.1%); p=0.5), relaxation of dystonic muscles (7 (100%) vs. 6 (85.7%); p=0.3).
Conclusions: The use of OSA might be beneficial in CD patients, as it reduced the dystonic symptoms, pain severity and improved the quality of sleep.

PMID: 29151795 [PubMed]

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