OtoRhinoLaryngology by Alexandros G.Sfakianakis

Τρίτη 31 Οκτωβρίου 2017

Effect of Modified Shaker Exercise on the Amplitude and Duration of Swallowing Sounds: Evidence from Cervical Auscultation.

Effect of Modified Shaker Exercise on the Amplitude and Duration of Swallowing Sounds: Evidence from Cervical Auscultation.

Rehabil Res Pract. 2017;2017:6526214

Authors: Babu S, Balasubramaniam RK, Varghese A

Abstract
OBJECTIVE: Anecdotal evidence shows that the Shaker exercise and its modifications improve pharyngeal muscle contraction. However, there is no experimental evidence for the same. Thus, the present study examined the effect of modified Shaker exercise on the amplitude and duration of pharyngeal muscle contraction using cervical auscultation.
DESIGN: The study follows a cross-sectional study design, where 50 healthy individuals (23 males and 27 females) performed modified Shaker exercise and noneffortful swallow during 10 ml water swallowing. Swallow sound characteristics were analyzed with and without modified Shaker exercise using cervical auscultation.
RESULTS: The results of mixed ANOVA revealed significant differences for the amplitude of swallow sound with modified Shaker exercise (mean = 47.24, SD = 20.64) when compared to noneffortful swallow (mean = 28.19, SD = 10.26) at p < 0.05. However, no significant difference was obtained for the swallow sound duration with (mean = 0.19, SD = 0.07) and without (mean = 0.18, SD = 0.07) modified Shaker exercise at p > 0.05. No significant difference across the genders was also noted at p > 0.05.
CONCLUSION: The outcomes of the study suggest that modified Shaker exercise improves the amplitude of pharyngeal muscle contraction. Further studies are needed to confirm this finding using gold standard tools like videofluoroscopy.

PMID: 29082044 [PubMed]

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Diagnostic significance of serum periostin in eosinophilic chronic sinusitis with nasal polyps.

Diagnostic significance of serum periostin in eosinophilic chronic sinusitis with nasal polyps.

Acta Otolaryngol. 2017 Oct 28;:1-5

Authors: Xu M, Zhang W, Chen D, Zhou H, Chen L

Abstract
OBJECTIVES: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous disease. Eosinophilic CRSwNP (ENP) exhibits a strong tendency for recurrence after surgery. Given that the treatment strategy of ENP differs from that of non-eosinophilic CRSwNP (nENP), clinical diagnostic criteria that distinguish ENP from nENP are needed.
METHODS: In total, 94 CRSwNP patients were enrolled in the cohort. Factors associated with ENP were determined with regression analysis, and optimal cutoff points of the predictors were determined by a receiver operating characteristic curve.
RESULTS: Serum periostin levels, blood eosinophils and basophils counts significantly differed between ENP and nENP. A combination of the cut-off values for the three predictors, including absolute blood eosinophil and basophil counts, yielded a sensitivity of 79.2% and 70.8%, and a specificity of 84.8% and 73.9%, respectively. Serum periostin levels yielded a sensitivity of 72.9% and a specificity of 60.9% for the diagnosis of ENP. The predicted probability of periostin in combination with blood eosinophils and basophils counts (AUC, 0.872) exhibited moderate accuracy. In addition, patients with ENP displayed an increased prevalence of smoking.
CONCLUSIONS: Periostin in combination with blood eosinophils and basophils counts has the potential to better refine current CRSwNP phenotypes.

PMID: 29081260 [PubMed - as supplied by publisher]

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Prenatal and/or postnatal high-fat diet alters testicular parameters in adult Wistar Albino rats.

Prenatal and/or postnatal high-fat diet alters testicular parameters in adult Wistar Albino rats.

Histol Histopathol. 2017 Oct 30;:11941

Authors: Campos-Silva P, Costa WS, Sampaio FJB, Gregorio BM

Abstract
Here, we evaluated the effects of a high-fat diet during the prenatal and/or postnatal period on the metabolic parameters and testes of 4-month-old Wistar rats. The experimental groups, composed of male Wistar rats, were: C/C (n=8), HF/HF (n=8) (pups with the same diet as their dams, after weaning), C/HF (n=8), and HF/C (n=9) (pups with a different diet after weaning, from that of their dams). The biometric parameters, blood glucose levels, serum levels, the gonadosomatic index, sperm parameters, testes, and genital fat deposits were evaluated. The HDL-c serum levels were significantly lower in the C/HF group (P=0.0100), whereas animals in the HF/C group presented hypertriglyceridemia (P=0.0005). The sperm concentration was lower in the HF/HF group than in the HF/C group (P=0.0072), and sperm viability was lower in all groups receiving a high-fat diet (P<0.0001). The tubular compartment was the smallest in the HF/HF group (P<0.0001). The diameter of the seminiferous tubule was the widest in the HF/C group (P<0.0001). The height of the seminiferous epithelium in all groups was lower than that in the C/C group (PP<0.0001). Testosterone and steroidogenic acute regulatory protein (STAR) expression levels were lower in the C/HF group (P=0.0218 and P=0.0215, respectively). The HF diet, regardless of the administration period, induced a limited number of metabolic changes, and modifications in the histoarchitecture of the testes and sperm parameters. These data suggest that a HF diet may cause disturbances in spermatogenesis and fertility impairment in adulthood.

PMID: 29083015 [PubMed - as supplied by publisher]

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Prenatal and/or postnatal high-fat diet alters testicular parameters in adult Wistar Albino rats.

Prenatal and/or postnatal high-fat diet alters testicular parameters in adult Wistar Albino rats.

Histol Histopathol. 2017 Oct 30;:11941

Authors: Campos-Silva P, Costa WS, Sampaio FJB, Gregorio BM

PMID: 29083015 [PubMed - as supplied by publisher]

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Maturation of auditory neural processes in autism spectrum disorder - A longitudinal MEG study.

http:--linkinghub.elsevier.com-ihub-imag

Maturation of auditory neural processes in autism spectrum disorder - A longitudinal MEG study.

Neuroimage Clin. 2016;11:566-77

Authors: Port RG, Edgar JC, Ku M, Bloy L, Murray R, Blaskey L, Levy SE, Roberts TP

Abstract
BACKGROUND: Individuals with autism spectrum disorder (ASD) show atypical brain activity, perhaps due to delayed maturation. Previous studies examining the maturation of auditory electrophysiological activity have been limited due to their use of cross-sectional designs. The present study took a first step in examining magnetoencephalography (MEG) evidence of abnormal auditory response maturation in ASD via the use of a longitudinal design.
METHODS: Initially recruited for a previous study, 27 children with ASD and nine typically developing (TD) children, aged 6- to 11-years-old, were re-recruited two to five years later. At both timepoints, MEG data were obtained while participants passively listened to sinusoidal pure-tones. Bilateral primary/secondary auditory cortex time domain (100 ms evoked response latency (M100)) and spectrotemporal measures (gamma-band power and inter-trial coherence (ITC)) were examined. MEG measures were also qualitatively examined for five children who exhibited "optimal outcome", participants who were initially on spectrum, but no longer met diagnostic criteria at follow-up.
RESULTS: M100 latencies were delayed in ASD versus TD at the initial exam (~ 19 ms) and at follow-up (~ 18 ms). At both exams, M100 latencies were associated with clinical ASD severity. In addition, gamma-band evoked power and ITC were reduced in ASD versus TD. M100 latency and gamma-band maturation rates did not differ between ASD and TD. Of note, the cohort of five children that demonstrated "optimal outcome" additionally exhibited M100 latency and gamma-band activity mean values in-between TD and ASD at both timepoints. Though justifying only qualitative interpretation, these "optimal outcome" related data are presented here to motivate future studies.
CONCLUSIONS: Children with ASD showed perturbed auditory cortex neural activity, as evidenced by M100 latency delays as well as reduced transient gamma-band activity. Despite evidence for maturation of these responses in ASD, the neural abnormalities in ASD persisted across time. Of note, data from the five children whom demonstrated "optimal outcome" qualitatively suggest that such clinical improvements may be associated with auditory brain responses intermediate between TD and ASD. These "optimal outcome" related results are not statistically significant though, likely due to the low sample size of this cohort, and to be expected as a result of the relatively low proportion of "optimal outcome" in the ASD population. Thus, further investigations with larger cohorts are needed to determine if the above auditory response phenotypes have prognostic utility, predictive of clinical outcome.

PMID: 27158589 [PubMed - indexed for MEDLINE]

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Effects of light wavelength on MEG ERD/ERS during a working memory task.

Effects of light wavelength on MEG ERD/ERS during a working memory task.

Int J Psychophysiol. 2016 Jun;104:10-6

Authors: Okamoto Y, Nakagawa S

Abstract
We investigated the effects of light wavelengths on cortical oscillatory activity associated with working memory processes. Cortical activity responses were measured using magnetoencephalography (MEG) while participants performed an auditory Sternberg memory task during exposure to light of different wavelength. Each trial of the memory task consisted of four words presented as a memory set and one word presented as a probe. All words were presented audibly. Participants were instructed to indicate whether the probe word was or was not presented within the memory set. A total of 90 trials were conducted under the light exposure. Event-related synchronization (ERS) and event-related desynchronization responses in the alpha frequency range during the task were analyzed. Results showed that, during memory encoding, ERS responses were significantly greater in the short-wavelength (blue) light condition than in the middle-wavelength (green) light condition, approximately 20-30min after the onset of light exposure. Behavioral performance was very high throughout the experiment and there was no difference between the light conditions. Although the light effects were not observed in behavior, the result of ERS suggests that 20-30min of exposure to blue light enhances cortical activity related to active memory maintenance and/or attention to auditory stimuli.

PMID: 27040560 [PubMed - indexed for MEDLINE]

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Event-related oscillations (ERO) during an active discrimination task: Effects of lesions of the nucleus basalis magnocellularis.

Event-related oscillations (ERO) during an active discrimination task: Effects of lesions of the nucleus basalis magnocellularis.

Int J Psychophysiol. 2016 May;103:53-61

Authors: Sanchez-Alavez M, Ehlers CL

Abstract
The cholinergic system in the brain is involved in attentional processes that are engaged for the identification and selection of relevant information in the environment and the formation of new stimulus associations. In the present study we determined the effects of cholinergic lesions of nucleus basalis magnocellularis (NBM) on amplitude and phase characteristics of event related oscillations (EROs) generated in an auditory active discrimination task in rats. Rats were trained to press a lever to begin a series of 1kHz tones and to release the lever upon hearing a 2kHz tone. A time-frequency based representation was used to determine ERO energy and phase synchronization (phase lock index, PLI) across trials, recorded within frontal cortical structures. Lesions in NBM produced by an infusion of a-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) resulted in (1) a reduction of the number of correct behavioral responses in the active discrimination task, (2) an increase in ERO energy in the delta frequency bands, (3) an increase in theta, alpha and beta ERO energy in the N1, P3a and P3b regions of interest (ROI), and (4) an increase in PLI in the theta frequency band in the N1 ROIs. These studies suggest that the NBM cholinergic system is involved in maintaining the synchronization/phase resetting of oscillations in different frequencies in response to the presentation of the target stimuli in an active discrimination task.

PMID: 25660307 [PubMed - indexed for MEDLINE]

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Deep Vein Thrombosis Complicated by Spontaneous Iliopsoas Hematoma in Patient with Septic Shock.

Deep Vein Thrombosis Complicated by Spontaneous Iliopsoas Hematoma in Patient with Septic Shock.

Am J Case Rep. 2017 Oct 30;18:1148-1152

Authors: Butt MU, Buzsaki LA, Smyth SS, Elayi SC

Abstract
BACKGROUND Spontaneous retroperitoneal hemorrhage (SRH) is a rare and difficult-to-diagnose entity. It is not associated with trauma, pathology, or iatrogenic manipulations. Few cases have been reported, with the only precipitating factor recognized being bleeding diatheses such as anticoagulation states, inherited coagulopathies, and hemodialysis. However, none of these have been described in combination with septic shock, which itself is associated with platelet dysfunction, coagulation dysfunction, and vasculopathy. CASE REPORT Our case involves an elderly man presenting with altered mental status of unknown etiology, in addition to hemodynamic instability, presumably due to septic shock, without any overt signs of bleeding. After his initial exam revealed lower-extremity edema and decubitus ulcers, a venous Doppler was performed, which revealed extensive deep vein thrombosis. It was unknown whether the sepsis or DVT occurred first. Therapeutic anticoagulation with heparin was subsequently started. On hospital day 4, a CT abdomen with contrast identified retroperitoneal hematoma after the patient's hemoglobin lowered without any overt signs of bleeding. The diagnosis of spontaneous retroperitoneal hematoma was one of exclusion and posed a therapeutic dilemma (conservative versus invasive management). CONCLUSIONS Sepsis-related coagulopathy and heparin use in an elderly patient predisposed him to an iliopsoas hematoma. In this case, conservative management with reversal of anticoagulation and blood transfusion was sufficient to stabilize the patient.

PMID: 29081491 [PubMed - in process]

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Assessing hearing loss self-management in older adults.

Assessing hearing loss self-management in older adults.

Int J Audiol. 2017 Oct 28;:1-8

Authors: Convery E, Meyer C, Keidser G, Hickson L

Abstract
OBJECTIVE: To evaluate the capacity of a self-management assessment tool to identify unmet hearing health care (HHC) needs; to determine whether such an assessment yields novel and clinically useful information.
DESIGN: Hearing loss self-management (HLSM) was assessed with the Partners in Health scale and the Cue and Response interview from the Flinders Chronic Condition Management Program™. The results of the scale and the interview were compared to determine the extent to which they each contributed to the assessment of HLSM.
STUDY SAMPLE: Thirty older adults who currently receive HHC.
RESULTS: The two assessment tools were useful in identifying the specific domains in which participants lacked good HLSM skills. While participants tended to have a high level of knowledge about hearing loss and technology-based interventions, many reported the presence of unmet psychosocial needs with no clear plan for addressing them. There was considerable variation in terms of the extent to which their audiologists facilitated shared decision-making.
CONCLUSIONS: The results suggest that HLSM has the potential to play an important role in audiological rehabilitation. A HLSM assessment tool that more precisely matches the unique needs of people with hearing loss should be developed, along with interventions to meet those needs.

PMID: 29081257 [PubMed - as supplied by publisher]

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Long non-coding RNA MALAT-1 modulates metastatic potential of tongue squamous cell carcinomas partially through the regulation of small proline rich proteins.

Long non-coding RNA MALAT-1 modulates metastatic potential of tongue squamous cell carcinomas partially through the regulation of small proline rich proteins.

BMC Cancer. 2016 Sep 01;16:706

Authors: Fang Z, Zhang S, Wang Y, Shen S, Wang F, Hao Y, Li Y, Zhang B, Zhou Y, Yang H

Abstract
BACKGROUND: We previously described several abnormally expressed long non-coding RNA (lncRNA) in tong squamous cell carcinomas (TSCCs) that might be associated with tumor progression. In the present study, we aimed to investigate the role of abnormally expressed metastasis-associated lung adenocarcinoma transcript 1 (MALAT-1) lncRNA in the metastatic potential of TSCC cells and its molecular mechanisms.
METHODS: Expression levels of MALAT-1 lncRNA were examined via quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) in 127 TSCC samples as well as paired adjacent normal tissues and lymph node metastases (if exist). Lentiviral vectors expressing short hairpin RNA (shRNA) were used to knock down the expression of MALAT1 gene in two TSCC cell lines (CAL27 and SCC-25) with relatively higher MALAT-1 expression. Proliferational ability of the TSCC cells was analyzed using water soluble tetrazolium-1 (WST-1) assay. Metastatic abilities of TSCC cells were estimated in-vitro and in-vivo. We also performed a microarray-based screen to identify the genes influenced by MALAT-1 alteration, which were validated by real-time PCR analysis.
RESULTS: Expression of MALAT-1 lncRNA was enhanced in TSCCs, especially in those with lymph node metastasis (LNM). Knockdown (KD) of MALAT-1 lncRNA in TSCC cells led to impaired migration and proliferation ability in-vitro and fewer metastases in-vivo. DNA microarray analysis showed that several members of small proline rich proteins (SPRR) were up-regulated by KD of MALAT-1 lncRNA in TSCC cells. SPRR2A over-expression could impair distant metastasis of TSCC cells in-vivo.
CONCLUSION: Enhanced expression of MALAT-1 is associated with the growth and metastatic potential of TSCCs. Knock down of MALAT-1 in TSCCs leads to the up-regulation of certain SPRR proteins, which influenced the distant metastasis of TSCC cells.

PMID: 27586393 [PubMed - indexed for MEDLINE]

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StatPearls

StatPearls

Book. 2017 06

Authors:

Abstract
The nasopharynx is a small, tubular structure above the soft palate that connects the nose to the oropharynx. Cancers that arise from this area are usually squamous cell carcinomas that behave differently than the other head and neck cancers. Most common place of origin is the fossa of Rosenmuller, which is the pharyngeal recess. Virus-related oncogenesis is a common theme in head/neck cancers. Oropharyngeal cancers are associated with human papillomavirus (HPV) infection, and nasopharyngeal cancers (NPC) are associated with Ebstein-Barr virus (EBV). The exact pathogenesis is still unknown. However viral oncogenes LMP-1, LMP-2, and EBNA1 have been known to play an important role. In areas with high incidence of disease, most cases are related to EBV infection. Although HPV related nasopharyngeal cancers have also been reported, no clear association has been established. The clinical behavior of nasopharyngeal cancers varies depending on its histological subtype. The World Health Organization (WHO) has classified nasopharyngeal carcinoma into the three subtypes based on histology. Type 1 is keratinizing squamous cell carcinoma which is associated with EBV infection in around 70% to 80% of the cases. Type 2 is differentiated non-keratinizing carcinoma, and type 3 is undifferentiated nonkeratinizing carcinoma and is the most common form of nasopharyngeal cancer. The latter two types are also most responsive to treatment. Almost all cases of type 2 and type 3 are related to EBV and occur in the area where EBV is endemic. Nasopharyngeal cancer with basaloid features is a newer, rarer histologic category, known to behave aggressively. Treatment does not vary based on histologic subtypes. In general, mortality related to nasopharyngeal cancers has improved in the last decade owing to early detection and advances in treatment.

PMID: 29083686

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Laryngeal surgical treatment in transgender women: A systematic review and meta-analysis.

http:--media.wiley.com-assets-7315-19-Wi

Laryngeal surgical treatment in transgender women: A systematic review and meta-analysis.

Laryngoscope. 2017 Nov;127(11):2596-2603

Authors: Schwarz K, Fontanari AMV, Schneider MA, Borba Soll BM, da Silva DC, Spritzer PM, Kazumi Yamaguti Dorfman ME, Kuhl G, Costa AB, Cielo CA, Villas Bôas AP, Lobato MIR

Abstract
OBJECTIVE: To identify the effects of laryngeal surgical treatment in the voice of transgender women, especially on the fundamental frequency (f0).
STUDY DESIGN: We performed a systematic review in PubMed and Scopus in July 2016, covering the period between 2005 and 2016.
METHODS: Inclusion criteria were studies in English or Portuguese about the laryngeal surgical treatment in transgender women, featuring experimental design, title, year of publication, country of origin, journal of publication, participants, intervention, results. For the meta-analysis, only studies that had control group were selected. Exclusion criteria were articles that mentioned the use of surgical techniques but did not use the procedure in research, animal studies, studies of revision, and postmortem studies.
RESULTS: Four hundred and twenty-three articles were identified in the initial search; 94 were selected for analysis by two referees, independently. After applying all the selection criteria, five studies remained in the meta-analysis. The surgical procedures that were identified included laryngoplasty with or without thyrohyoid approximation, Wendler glottoplasty, cricothyroid approximation, laser glottoplasty reduction and the vocal fold shortening and retrodisplacement of anterior commissure. There was no significant difference between the experimental group and the control group in relation to f0.
CONCLUSION: No randomized clinical trials and prospective cohort studies are available, and a small number of retrospective cohort and case-control studies of surgical techniques reveal an increase in the f0. The evidence produced is not conclusive regarding which surgical technique would be better for vocal treatment of transgender women.
LEVEL OF EVIDENCE: NA Laryngoscope, 127:2596-2603, 2017.

PMID: 28671273 [PubMed - indexed for MEDLINE]

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Home-based telehealth service for swallowing and nutrition management following head and neck cancer treatment.

Home-based telehealth service for swallowing and nutrition management following head and neck cancer treatment.

J Telemed Telecare. 2017 Dec;23(10):866-872

Authors: Collins A, Burns CL, Ward EC, Comans T, Blake C, Kenny L, Greenup P, Best D

Abstract
Introduction Following (chemo)radiotherapy (C/RT) for head and neck cancer (HNC), patients return to hospital for regular outpatient reviews with speech pathology (SP) and nutrition and dietetics (ND) for acute symptom monitoring, nutritional management, and swallowing and communication rehabilitation. The aim of the current study was to determine the feasibility of a home-based telehealth model for delivering SP and ND reviews, to provide patients with more convenient access to these appointments. Methods Service outcomes, costs, and consumer satisfaction were examined across 30 matched participants: 15 supported via the standard model of care (SMOC), and 15 via the home-based telehealth model of care (TMOC). Results All patients were successfully managed via telehealth. The TMOC was more efficient, with a reduced number ( p < 0.003) and duration ( p < 0.01) of appointments required until discharge. Significant patient cost savings ( p = 0.002) were reported for the TMOC due to decreased travel requirements. While staff costs were reduced, additional telehealth equipment levies resulted in a lower but non-significant overall cost difference to the health service when using the TMOC. High satisfaction was reported by all participants attending the TMOC. Discussion The findings support the feasibility of a home-based telehealth model for conducting SP and ND reviews post C/RT for HNC.

PMID: 29081270 [PubMed - in process]

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Swallowing interventions for the treatment of dysphagia after head and neck cancer: a systematic review of behavioural strategies used to promote patient adherence to swallowing exercises.

Swallowing interventions for the treatment of dysphagia after head and neck cancer: a systematic review of behavioural strategies used to promote patient adherence to swallowing exercises.

BMC Cancer. 2017 Jan 10;17(1):43

Authors: Govender R, Smith CH, Taylor SA, Barratt H, Gardner B

Abstract
BACKGROUND: Dysphagia is a significant side-effect following treatment for head and neck cancers, yet poor adherence to swallowing exercises is frequently reported in intervention studies. Behaviour change techniques (BCTs) can be used to improve adherence, but no review to date has described the techniques or indicated which may be more associated with improved swallowing outcomes.
METHODS: A systematic review was conducted to identify behavioural strategies in swallowing interventions, and to explore any relationships between these strategies and intervention effects. Randomised and quasi-randomised studies of head and neck cancer patients were included. Behavioural interventions to improve swallowing were eligible provided a valid measure of swallowing function was reported. A validated and comprehensive list of 93 discrete BCTs was used to code interventions. Analysis was conducted via a structured synthesis approach.
RESULTS: Fifteen studies (8 randomised) were included, and 20 different BCTs were each identified in at least one intervention. The BCTs identified in almost all interventions were: instruction on how to perform the behavior, setting behavioural goals and action planning. The BCTs that occurred more frequently in effective interventions, were: practical social support, behavioural practice, self-monitoring of behaviour and credible source for example a skilled clinician delivering the intervention. The presence of identical BCTs in comparator groups may diminish effects.
CONCLUSIONS: Swallowing interventions feature multiple components that may potentially impact outcomes. This review maps the behavioural components of reported interventions and provides a method to consistently describe these components going forward. Future work may seek to test the most effective BCTs, to inform optimisation of swallowing interventions.

PMID: 28068939 [PubMed - indexed for MEDLINE]

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Coordination between respiration and swallowing during non-invasive positive pressure ventilation.

Coordination between respiration and swallowing during non-invasive positive pressure ventilation.

Respirology. 2016 Aug;21(6):1062-7

Authors: Hori R, Isaka M, Oonishi K, Yabe T, Oku Y

Abstract
BACKGROUND AND OBJECTIVE: The purpose of this study was to test the hypothesis that the risk of silent aspiration is increased in non-invasive positive pressure ventilation.
METHODS: We analysed the coordination between respiration and swallowing, in 12 young volunteers and 10 elder volunteers, by simultaneously monitoring respiratory flow, laryngeal movement and swallowing sound in three different conditions: control, continuous positive airway pressure (CPAP), and bi-level positive airway pressure (BiPAP). A step-wise multiple regression analysis was performed with the occurrence rate of inspiration after swallows as the dependent variable and various correlated variables as the independent variables.
RESULTS: In both subject groups, the occurrence rate of inspiration after swallow was greater with BiPAP compared with control and CPAP conditions. Repetitive saliva swallowing test count and swallow non-inspiratory flow occurrence rate were extracted as predictor variables for risk of inspiration after swallows during BiPAP treatment.
CONCLUSION: We found that the occurrence rate of inspiration after swallow is increased with BiPAP use irrespective of age. The results suggest that swallow non-inspiratory flow may trigger inspiratory support in the BiPAP mode, resulting in a risk of aspiration.

PMID: 27027264 [PubMed - indexed for MEDLINE]

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Human Fetal Brain Connectome: Structural Network Development from Middle Fetal Stage to Birth.

Human Fetal Brain Connectome: Structural Network Development from Middle Fetal Stage to Birth.

Front Neurosci. 2017;11:561

Authors: Song L, Mishra V, Ouyang M, Peng Q, Slinger M, Liu S, Huang H

Abstract
Complicated molecular and cellular processes take place in a spatiotemporally heterogeneous and precisely regulated pattern in the human fetal brain, yielding not only dramatic morphological and microstructural changes, but also macroscale connectomic transitions. As the underlying substrate of the fetal brain structural network, both dynamic neuronal migration pathways and rapid developing fetal white matter (WM) fibers could fundamentally reshape early fetal brain connectome. Quantifying structural connectome development can not only shed light on the brain reconfiguration in this critical yet rarely studied developmental period, but also reveal alterations of the connectome under neuropathological conditions. However, transition of the structural connectome from the mid-fetal stage to birth is not yet known. The contribution of different types of neural fibers to the structural network in the mid-fetal brain is not known, either. In this study, diffusion tensor magnetic resonance imaging (DT-MRI or DTI) of 10 fetal brain specimens at the age of 20 postmenstrual weeks (PMW), 12 in vivo brains at 35 PMW, and 12 in vivo brains at term (40 PMW) were acquired. The structural connectome of each brain was established with evenly parcellated cortical regions as network nodes and traced fiber pathways based on DTI tractography as network edges. Two groups of fibers were categorized based on the fiber terminal locations in the cerebral wall in the 20 PMW fetal brains. We found that fetal brain networks become stronger and more efficient during 20-40 PMW. Furthermore, network strength and global efficiency increase more rapidly during 20-35 PMW than during 35-40 PMW. Visualization of the whole brain fiber distribution by the lengths suggested that the network reconfiguration in this developmental period could be associated with a significant increase of major long association WM fibers. In addition, non-WM neural fibers could be a major contributor to the structural network configuration at 20 PMW and small-world network organization could exist as early as 20 PMW. These findings offer a preliminary record of the fetal brain structural connectome maturation from the middle fetal stage to birth and reveal the critical role of non-WM neural fibers in structural network configuration in the middle fetal stage.

PMID: 29081731 [PubMed]

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Supplemental Screening Breast US in Women with Negative Mammographic Findings: Effect of Routine Axillary Scanning.

Supplemental Screening Breast US in Women with Negative Mammographic Findings: Effect of Routine Axillary Scanning.

Radiology. 2017 Oct 30;:171218

Authors: Lee SH, Yi A, Jang MJ, Chang JM, Cho N, Moon WK

Abstract
Purpose To evaluate the effect of routine axillary scanning when supplemental screening breast ultrasonography (US) is performed in women with negative mammographic findings. Materials and Methods This retrospective review included 12 844 screening breast US examinations performed in 8664 asymptomatic women aged 40 years or older with dense breasts and negative results for cancer at mammography performed between January 2012 and December 2014. Bilateral whole-breast US was performed with a handheld device by one of 10 experienced radiologists. The bilateral axillae were routinely scanned, and representative images were documented in all examinations. The abnormal interpretation rate (AIR), cancer detection rate (CDR), and positive predictive value (PPV) of screening breast US with and without axillary scanning were calculated. The 95% confidence intervals (CIs) were calculated for cancer detection after an abnormal finding at screening US. Results The frequency of positive axillary findings was 3.5 per 1000 (14 of 4009) baseline screening US examinations and 2.2 per 1000 (19 of 8835) subsequent screening US examinations. Of the 33 women with 33 positive axillary findings, 11 had positive breast findings; none were diagnosed with breast cancer. The remaining 22 women showed positive findings only in the axilla. The axillary findings revealed no malignancy at biopsy (n = 12) or during 22-54-month follow-up (n = 21) (95% CI: 0%, 10.6%). Without routine axillary scanning, the AIR of screening US decreased from 15.2% (610 of 4009 examinations) to 15.0% (602 of 4009 examinations) at baseline US and from 8.1% (714 of 8835 examinations) to 7.9% (700 of 8835 examinations) at subsequent US examinations, and the PPV for biopsy performed increased from 6.0% (five of 83 examinations) to 6.4% (five of 78 examinations) at baseline US and from 7.6% (13 of 170 examinations) to 7.9% (13 of 164 examinations) at subsequent US examinations, without a change in the CDR. Conclusion Routine axillary scanning during screening breast US had no effect on additional cancer detection, but rather increased the number of false-positive results. However, the conclusions based on these findings must be tempered by the low rate of positive findings. (©) RSNA, 2017.

PMID: 29083988 [PubMed - as supplied by publisher]

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Amide Proton Transfer MR Imaging of Endometrioid Endometrial Adenocarcinoma: Association with Histologic Grade.

Amide Proton Transfer MR Imaging of Endometrioid Endometrial Adenocarcinoma: Association with Histologic Grade.

Radiology. 2017 Oct 30;:170349

Authors: Takayama Y, Nishie A, Togao O, Asayama Y, Ishigami K, Ushijima Y, Okamoto D, Fujita N, Sonoda K, Hida T, Ohishi Y, Keupp J, Honda H

Abstract
Purpose To evaluate the utility of amide proton transfer (APT) imaging in estimating histologic grades of endometrioid endometrial adenocarcinoma (EEA). Materials and Methods The institutional review board approved this prospective study. Between June 2012 and March 2016, 32 patients with EEA underwent magnetic resonance (MR) imaging. After their surgical procedures, their EEAs were confirmed pathologically and classified into histologic grades: grade 1 (n = 11), grade 2 (n = 11), and grade 3 (n = 10). The APT signal intensities (SIs) and the mean and minimum apparent diffusion coefficients (ADCs) of the three grades were calculated and compared. Spearman rank correlation coefficient was also calculated between the APT SIs and histologic grades, and between the ADCs and histologic grades. Results The Spearman correlation coefficient with histologic grade of the APT SIs, the mean ADC, and the minimum ADC were 0.55 (P = .001), 0.03 (P = .84), and -0.30 (P = .09), respectively. The average APT SIs and the mean and minimum ADCs were 2.2% ± 0.2 (standard deviation), 0.9 × 10(-3) mm(2)/sec ± 0.2, and 0.6 × 10(-3) mm(2)/sec ± 0.1 for grade 1; 3.2% ± 0.3, 0.8 × 10(-3) mm(2)/sec ± 0.1, and 0.5 × 10(-3) mm(2)/sec ± 0.1 for grade 2; and 3.7% ± 0.3, 0.9 × 10(-3) mm(2)/sec ± 0.1, and 0.5 × 10(-3) mm(2)/sec ± 0.1 for grade 3, respectively. The APT SIs of grade 3 EEA were significantly higher than those of grade 1 EEA (P = .01), but other pairwise comparisons did not reveal any significant differences (P = .06-.51). The mean and minimum ADCs showed no significant differences among the three histologic grades (P =.13-.51). Conclusion The APT SI was positively correlated with the histologic grades of EEA. (©) RSNA, 2017 Online supplemental material is available for this article.

PMID: 29083987 [PubMed - as supplied by publisher]

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Effect of General Anesthesia versus Conscious Sedation for Stroke Thrombectomy on Angiographic Workflow in a Randomized Trial: A Post Hoc Analysis of the SIESTA Trial.

Effect of General Anesthesia versus Conscious Sedation for Stroke Thrombectomy on Angiographic Workflow in a Randomized Trial: A Post Hoc Analysis of the SIESTA Trial.

Radiology. 2017 Oct 30;:171002

Authors: Pfaff JAR, Schönenberger S, Nagel S, Ringleb PA, Hacke W, Bendszus M, Bösel J, Möhlenbruch MA

Abstract
Purpose To investigate whether the sedation mode (ie, conscious sedation [CS] vs general anesthesia [GA]) affects the angiographic workflow applied for treatment of endovascular stroke in a post hoc analysis of a recent randomized controlled trial, Sedation versus Intubation for Endovascular Stroke Treatment (SIESTA). Materials and Methods SIESTA was an institutional review board-approved, single-center, prospective, randomized, parallel-group, open-label treatment trial with a blinded end-point evaluation to compare GA with CS for treatment of endovascular stroke in 73 and 77 patients, respectively. By using descriptive data from SIESTA, the influence of the mode of sedation on angiographic workflow during treatment for endovascular stroke (eg, procedure times) and other radiologic outcome parameters (eg, radiation exposure) were analyzed. The time between angiographic key steps for patients who underwent GA and CS was evaluated with t tests. P values were corrected for false discovery rate. Results The median time from groin puncture to first intracranial flow restoration with CS was 47 minutes (interquartile range [IQR], 29-70 minutes), and for GA, it was 41 minutes (IQR, 28-60 minutes) (P = .546). The median time to the end of angiography with CS was 104 minutes (IQR, 75-150 minutes), and with GA, it was 73 minutes (IQR, 53-125 minutes) (P = .052). Fluoroscopy time with CS was 49 minutes (IQR, 25-85 minutes), and with GA, it was 35 minutes (IQR, 20-74 minutes) (P = .098). The times were comparable in both groups for these measures. The time from groin puncture to the final angiographic result with GA, at 72 minutes (IQR, 45-109 minutes) was shorter than that with CS, at 98 minutes (IQR, 64-135 minutes) (P = .048). Conclusion This post hoc analysis of the single-center SIESTA trial revealed that time from groin puncture to final angiographic result was shorter with patients under GA than that with patients under CS. (©) RSNA, 2017 Online supplemental material is available for this article.

PMID: 29083986 [PubMed - as supplied by publisher]

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