bluuebunny/crossref_metadata_2025 huggingface dataset:
Nasal Polyposis: Role of Allergy on Therapeutic Response of Eosinophil- and Noneosinophil-Dominated Inflammation
Authors: Kirtsreesakul Virat , Atchariyasathian Viraporn
Published: August 2018

Background

It is considered that allergy, at least in some cases, is associated with nasal polyps and affects recurrence rate. Our purpose was to determine the effects of aeroallergen hypersensitization on therapeutic response of eosinophil- and noneosinophil-dominated inflammation.

Methods

Sixty-eight patients were enrolled. Histopathological investigation and a skin-prick test were done and categorized as eosinophil-dominated inflammation with positive (ESPT+) or negative skin test (ESPT-) and nonesoinophil-dominated inflammation with positive (NESPT+) or negative skin test (NESPT-). Patients were treated over 6 weeks with budesonide nasal spray, 400 μg/day. At 0, 3, and 6 weeks after treatment, nasal symptoms, polyp size, nasal and oral peak expiratory flow (PEF) index and overall assessment within and between groups were evaluated and compared.

Results

At 3 and 6 weeks after treatment, the ESPT- group showed the most, and the NESPT+ group showed the least therapeutic improvement. In comparing between the positive and negative skin tests in each histopathology, the positive skin tests tended to have less improvement than the negative skin tests in all variables. The differences increased over time and reached statistical significance at 6 weeks in the PEF index and overall assessment of eosinophil-dominated inflammation (p = 0.004 and 0.033, respectively) and in sneezing score, postnasal drip score, and overall assessment of noneosinophil-dominated inflammation (p = 0.019, 0.035, and 0.013, respectively).

Conclusion

Nonallergic eosinophilic polyps had the best and allergic noneosinophilic polyps had the worst therapeutic response. Within each histopathology, allergic nasal polyps had less therapeutic response than nonallergic nasal polyps. This augmented effect could be caused by concomitant allergic inflammation.
Computed Tomography Scans in the Evaluation of Patients with Olfactory Dysfunction
Authors: Mueller Christian , Temmel Andreas F.P. , Toth Josef , Quint Christian , Herneth Andreas , Hummel Thomas
Published: August 2018

Background

The necessity of computed tomography (CT) scans of the olfactory cleft and the sinuses in patients presenting with olfactory dysfunction is a matter of debate. This study aimed to investigate the significance of CT scans for the diagnosis of olfactory loss and for therapeutic decisions.

Methods

This retrospective study included 137 consecutive patients presenting with the main complaint of olfactory loss. Standardized history; ear, nose, and throat examination; and olfactory tests were administered. In addition, a CT scan of the nasal sinuses was obtained. The assumed diagnosis (sinonasal disease [SND] or non-SND) was compared with the diagnosis when additionally considering results from the CT scan.

Results

CT scans suggested SND in 7/101 patients without clinical evidence of its presence. In 12/36 patients with suspected SND-related olfactory loss, no signs of SND were detected in CT scans.

Conclusion

CT scans are useful to diagnose conductive/inflammatory olfactory loss in patients suspected of non-SND, which may then justify a course with systemic steroids. Alternatively, considering low costs and rare side effects of a short course with steroids in selected patients, CT scans appear to be of clinical significance only when surgical treatment is contemplated or where the use of systemic corticosteroids is not possible.
Expression and Distribution of Aquaporin-1 in Nasal Polyps: Does it have any Significance in Edema Formation?
Authors: Altuntaş Ali , Yılmaz Mustafa Deniz , Aktepe Fatma , Kahveci Orhan Kemal , Derekoy Sefa , Dilek Hüsniye , Serteser Mustafa
Published: August 2018

Background

The aim of this study was to investigate the expression of Aquaporin 1 (AQP1) and AQP4 in polyp tissue.

Methods

Nasal polyps were obtained from 34 patients with nasal polyposis during endoscopic sinus surgery. Bullous middle turbinates with normal-appearing mucosa of 10 patients were used as controls. Expression of AQP1 and AQP4 water channels were determined by immunohistochemical methods.

Results

AQP1 has been found to be expressed in fibroblasts located in polyp tissue, especially in the subepithelial area, periphery of seromucous glands, and endothelial cells of venules.

Conclusion

We have established a high expression of AQP1 water channels in nasal polyp tissue and have suggested two mechanisms to explain this finding. Increased AQP1 expression may be a cause or a consequence of edema formation. Thus, additional studies are needed to elucidate the true mechanism underlying this relationship.
Acoustic Rhinometry Predicts Tolerance of Nasal Continuous Positive Airway Pressure: A Pilot Study
Authors: Morris Luc G. , Setlur Jennifer , Burschtin Omar E. , Steward David L. , Jacobs Joseph B. , Lee Kelvin C.
Published: August 2018

Background

Nasal continuous positive airway pressure (nCPAP) is usually the first-line intervention for obstructive sleep apnea, but up to 50% of patients are unable to tolerate therapy because of discomfort–-usually nasal complaints. No factors have been definitively correlated with nCPAP tolerance, although nasal cross-sectional area has been correlated with the level of CPAP pressure, and nasal surgery improves nCPAP compliance. This study examined the relationship between nasal cross-sectional area and nCPAP tolerance.

Methods

We performed acoustic rhinometry on 34 obstructive sleep apnea patients at the time of the initial sleep study. Patients titrated to nCPAP were interviewed 18 months after starting therapy to determine CPAP tolerance. Demographic, polysomnographic, and nasal cross-sectional area data were compared between CPAP-tolerant and -intolerant patients.

Results

Between 13 tolerant and 12 intolerant patients, there were no significant differences in age, gender, body mass index, CPAP level, respiratory disturbance index, or subjective nasal obstruction. Cross-sectional area at the inferior turbinate differed significantly between the two groups (p = 0.03). This remained significant after multivariate analysis for possibly confounding variables. A cross-sectional area cutoff of 0.6 cm2 at the head of the inferior turbinate carried a sensitivity of 75% and specificity of 77% for CPAP intolerance in this patient group.

Conclusion

Nasal airway obstruction correlated with CPAP tolerance, supporting an important role for the nose in CPAP, and providing a physiological basis for improved CPAP compliance after nasal surgery. Objective nasal evaluation, but not the subjective report of nasal obstruction, may be helpful in the management of these patients.
Th2 Immunological Inflammation in Allergic Fungal Sinusitis, Nonallergic Eosinophilic Fungal Sinusitis, and Chronic Rhinosinusitis
Authors: Carney A. Simon , Tan Lor-Wai , Adams Damian , Varelias Antiopi , Ooi Eng Hooi , Wormald Peter-John
Published: August 2018

Background

Noninvasive fungal sinusitis is a heterogenous group of conditions including allergic fungal sinusitis (AFS) and nonallergic eosinophilic fungal sinusitis (NEFS). Th2-mediated cascades have been postulated to be the major inflammatory response in patients with AFS although other mechanisms also may be involved. The detailed mucosal Th2 cytological status of NEFS still has not been studied in great depth.

Methods

Using a meticulous patient selection algorithm over a 2-year period, infundibular mucosal tissue from patients with AFS, NEFS, chronic rhinosinusitis (CRS), and normal controls was studied (n = 59). Immunohistochemistry for mast cells, eosinophils, and immunoglobulin E (IgE) cells was performed and cell counts per unit area were measured.

Results

Mast cell, eosinophil, and IgE+ cell numbers were significantly raised in patients with AFS, NEFS, and CRS when compared with controls. There was no significant difference between cell numbers in patients with AFS and NEFS.

Conclusion

Patients with AFS exhibit a classic Th2 inflammatory response in nasal mucosal tissue with NEFS and CRS patients showing evidence of a similar Th2 cascade, including the presence of IgE+ cells.
In Vivo Optical Coherence Tomography of the Nasal Mucosa
Authors: Mahmood Usama , Ridgway James , Jackson Ryan , Guo Shuguang , Su Jianping , Armstrong William , Shibuya Terry , Crumley Roger , Chen Zhongping , Wong Brian
Published: August 2018

Background

Optical coherence tomography (OCT) is an emerging imaging modality that uses light to produce in vivo high-resolution cross-sectional images (7 μm) of tissues to depths of up to 3 mm. OCT is analogous to ultrasound, but relies on interferometry and low-coherence optical sources to produce images of tissue structure at the histological level.

Methods

In this study, OCT was used to image the mucosa overlying structures in the nasal cavity to obtain information regarding normative in vivo tissue microstructure. An OCT system using a Michaelson interferometer and a 1.3-μm broadband light source was incorporated into a fiber-optic imaging device that was inserted into the nasal cavity. Cross-sectional tomographic images of the anterior and posterior nasal septum, turbinates, and vestibule were acquired in 44 patients in either the office or the operating room during surgical endoscopy.

Results

OCT images of the nasal mucosa identified the distinct boundaries between the epithelium, lamina propria, and underlying bone/cartilaginous tissue. Within the lamina propria, features consistent with glands, ducts, and blood vessels were clearly identified. In patients who underwent decongestant therapy, before and after images showed distinct morphological changes in the mucosa. The thickness of the epithelium was tabulated, as well.

Conclusion

This study establishes the potential of using OCT to produce high-resolution images of the nasal mucosa. As an in vivo tissue microstructural imaging modality, OCT may be valuable in studying the impact of allergic and infectious disease on the nasal mucosa and monitoring its response to pharmacologic therapy.
Signals through CD40 Play a Critical Role in the Pathophysiology of Schistosoma Mansoni Egg Antigen–Induced Allergic Rhinitis in Mice
Authors: Hattori Hisashi , Okano Mitsuhiro , Kariya Shin , Nishizaki Kazunori , Satoskar Abhay R.
Published: August 2018

Background

Interaction between CD40 and CD40L is thought to regulate immune responses in several allergic diseases. However, little is known about its in vivo role in the pathophysiology of allergic rhinitis. We sought to determine whether the lack of signals through CD40 affects the pathophysiology of allergic rhinitis using a murine model.

Methods

Wild type (WT) and CD40-deficient BALB/c (CD40-/-) mice were sensitized intranasally to Schistosoma mansoni egg antigen (SEA). After repeated sensitization, histamine responsiveness, serum antibody titer including immunoglobulin E (IgE), nasal eosinophilia, and cytokine production by nasal mononuclear cells were determined in each group.

Results

Intranasal sensitization with SEA in WT mice elicited a strong Th2 response including SEA-specific IgE production, nasal eosinophilia, and interleukin (IL)-4, and IL-5 production by nasal mononuclear cells after antigen challenge. Production of SEA-specific IgE and IgG1 was abolished in SEA-sensitized CD40-/- mice. These mice showed impaired nasal eosinophilia and displayed markedly reduced histamine-induced nasal hyperresponsiveness as compared with WT mice. Furthermore, reduced production of IL-4 and IL-5 by nasal mononuclear cells was seen in CD40-/- mice.

Conclusion

These results show that signals through CD40 play a critical role in not only IgE production but also pathophysiology of allergic rhinitis such as nasal hyperresponsiveness and nasal eosinophilia.
Bacteriology of Chronic Sinusitis in Relation to Middle Meatal Secretion
Authors: Jiang Rong-San , Su Mao-Chang , Liao Chung-Yu , Lin Jen-Fu
Published: August 2018

Background

The bacteriology of chronic sinusitis has been studied widely, but some factors may affect the results, such as sample sources and sampling techniques. However, whether the presence of secretion in the middle meatus affects the culture result has been studied rarely.

Methods

When patients with chronic sinusitis underwent functional endoscopic sinus surgery, swab specimens were taken from the ipsilateral middle meatuses and ethmoid sinuses under endoscopic guidance. While taking specimens from the middle meatuses, we observed the presence of secretions in the middle meatuses. The severity of chronic sinusitis was evaluated by preoperative computed tomography, which was scored by the Lund–Mackay system. The scores of the frontal, anterior ethmoid, maxillary sinus, and ostiomeatal complex were cumulated.

Results

Between March 2001 and February 2004, 210 pairs of specimens were collected. The secretion was present in 82 middle meatuses and was absent in the other 128 middle meatuses. The culture rates of middle meatus and ethmoid sinus specimens were 70.7 and 51.2%, respectively, for patients with secretions in the middle meatuses and 53.1 and 44.5%, respectively, for patients without secretions in the middle meatuses. The culture rate was significantly different for middle meatus specimens (p = 0.011) and the mean cumulated computed tomography score also was significantly higher in patients with secretions in the middle meatuses than in patients without secretions in the middle meatuses (p < 0.001).

Conclusion

The results of this study suggest that the presence of secretion in the middle meatus indicates more severe disease in the anterior group of paranasal sinuses.
Medical Students’ Attitudes toward the use of an Endoscopic Sinus Surgery Simulator as a Training Tool
Authors: Glaser Aylon Y. , Hall Charles B. , Uribe S. Jose I. , Fried Marvin P.
Published: August 2018

Background

Modern adult learning theory characterizes self-directed learning as most effective. While studying the effectiveness of an endoscopic sinus surgery simulator (ES3) as a training tool and acknowledging that its successful integration into a training program is dependent on its acceptance and self-driven use by trainees, we sought to determine our study subjects’ attitudes toward the simulator.

Methods

Twenty-six medical students were enrolled and trained in our ES3 study. Each student was asked to complete a 28-item questionnaire on completion of training. This questionnaire contained 10-point Likert scale instruments, yes/no questions, and one open-ended question.

Results

All but four subjects responded to the questionnaire; 90.9% of the respondents rated the training benefit derived from the simulator's novice mode as 6 or greater on a 10-point scale; the mean was 7.82 (±2.22). The training benefit of the intermediate mode also was scored highly, with a mean score in the 7–9 range for all but one component–-heart rate response to actions performed. Trainees appreciated the simulator's ability to help them adapt to a three-dimensional space on a two-dimensional display. They also noted its strengths in elucidating intranasal anatomy.

Conclusion

Medical students who enrolled in our study, as a group, felt that the ES3 provided them with significant training benefits. Although subjective, these attitudes, coupled with objective data indicating that there is a measurable benefit from use of the ES3, will ensure its full acceptance and use in otolaryngology training programs.
Low-Dosage Adrenaline Induces Transient Marked Decrease of Blood Pressure during Functional Endoscopic Sinus Surgery
Authors: Zhao Feng , Wang Zhongyun , Yang Jianjun , Sun Jie , Wang Qiuping , Xu Jianguo
Published: August 2018

Background

Low-dosage adrenaline contained in local anesthetics is commonly used for hemostasis during functional endoscopic sinus surgery (FESS), but often causes significant hemodynamic side effects that might be neglected. A randomized, controlled, prospective clinical trial was designed to find out these effects after local infiltration of different concentrations and/or different dosages of adrenaline during FESS under general anesthesia.

Methods

One hundred eight adult patients were randomized into one of four groups to receive 2 mL of 2% lidocaine and adrenaline 1:200,000 (group I), 4 mL of 1% lidocaine and adrenaline 1:400,000 (group II), 4 mL of 1% lidocaine and adrenaline 1:200,000 (group III), or 4 mL of 1% lidocaine (group IV) for local infiltration, respectively. Heart rate, systolic blood pressure (BP), diastolic BP, and mean arterial pressure were monitored continuously in radial artery.

Results

Significant hemodynamic changes, particularly decrease of BP (p < 0.001) with slightly increased heart rate (p < 0.001) ∼1.5 minutes after local infiltration, were observed in group I, group II, and group III compared with the baseline, but not in group IV. However, no significant hemodynamic changes were observed between group I, group II, and group III at the same time points (p > 0.05).

Conclusions

Local infiltration of low-dosage adrenaline causes temporary significant hemodynamic changes, particularly marked decrease of BP during FESS, and there were no significant hemodynamic changes between adrenaline 1:200,000 and 1:400,000.
Endoscopic Vidian Neurectomy
Authors: Robinson Simon R. , Wormald Peter John
Published: August 2018

Background

Vidian neurectomy has in the past been advocated for the treatment of vasomotor rhinitis. With the recent better understanding of nasal and sinus anatomy, the surgical technique and outcomes of this procedure have been reassessed in this preliminary report.

Methods

A total of nine patients with symptoms of vasomotor rhinitis underwent 14 endoscopic vidian neurectomies between 1998 and 2001. All patients had negative screening for allergies on their serum or on skin-prick tests. The surgical technique for endoscopic vidian neurectomy is presented. The outcomes for the patients were retrospectively assessed with patients asked to score their pre- and postoperative symptoms rating these symptoms on a scale of 1–10 after a mean follow-up of 25 months (range, 21–36 months).

Results

On this retrospective analysis there was a significant improvement in the symptoms of rhinorrhea (p = 0.018) and nasal obstruction (p = 0.011). There was no significant difference between the pre- to postoperative symptoms for postnasal drip or sneezing. The most common minor adverse effect was dry eyes (35.7%) and nasal crusting (28.6%).

Conclusion

Endoscopic vidian neurectomy improves the symptoms of nasal obstruction and rhinorrhea in patients with vasomotor rhinitis.
Decongestion Test in Patients with Allergic Rhinitis: Functional Evaluation of Nasal Airflow
Authors: Ciprandi Giorgio , Cirillo Ignazio , Vizzaccaro Andrea , Pallestrini Eugenio , Tosca Maria Angela
Published: August 2018

Background

Rhinomanometry measures nasal airflow that is frequently impaired in allergic rhinitis. Decongestion tests consist of spraying an intranasal vasoconstrictor drug to evaluate the reversibility of nasal airflow limitation. The aim of this study was to evaluate the decongestion test in patients with seasonal allergic rhinitis (SAR) caused by pollen sensitization, perennial allergic rhinitis (PAR) caused by sensitization to perennial allergens only, or mixed allergic rhinitis (MAR) caused by sensitization to both allergens.

Methods

One hundred twenty-three subjects (112 men and 11 women, mean age, 22.9 ± 5.7 years) were studied; 40 subjects had PAR, 43 subjects had MAR, and 40 subjects had SAR. Total symptom score (including: nasal itching, sneezing, rhinorrhea, and nasal obstruction) was assessed. Rhinomanometry and decongestion tests were performed in all subjects.

Results

Nasal symptom severity was superimposable in the three groups (p was not significant). After decongestion tests, an increase of nasal airflow and a decrease of nasal resistance was shown in PAR (p < 0.01), MAR (p < 0.001), and SAR subjects (p < 0.001). The intergroup analysis showed that SAR patients had less reversibility than PAR (p < 0.01).

Conclusion

This study provides the first evidence of the different response to decongestion tests, taking into consideration the causal allergens.
Progression of Sinus Disease in the Intubated Patient
Authors: Payne Spencer C. , Benninger Michael S.
Published: August 2018

Background

Sinus disease in the intubated patient remains a frequent reason behind otolaryngological consultation to the Intensive Care Unit. Previous prospective studies often have been limited to only one computed tomography (CT) scan of the sinuses. The purpose of this study was to verify the development of sinus disease in the orotracheally intubated patient and determine a radiographic pattern of its progression if present.

Methods

The charts of all patients admitted to the hospital with a diagnosis of aneurysm or subarachnoid hemorrhage over a 2-year period were evaluated. Patients who were orotracheally intubated with at least one postintubation CT scan of the head were included. CT scans obtained after the initiation of antibiotics or tracheostomy were excluded. The Lund–Mackay staging system was used to evaluate the scans.

Results

A total of 50 patients with 172 scans were evaluated. Analysis revealed a significant trend toward increasing severity of radiological sinus disease over the first 7 days of intubation (p < 0.001). The presence of a nasogastric tube (NGT) resulted in an increased Lund–Mackay score, but the trend remained significant for patients without an NGT as well.

Conclusion

This study shows that the presence and progression of sinus findings is fairly common in the intubated patient and that although the placement of an NGT increased the rate of development of sinus findings, the lack of one did not preclude sinus disease. Clinical exam remains a more important indicator of disease when evaluating the Intensive Care Unit patient for rhinosinusitis.
Validation of the Oswestry Risk of Knee Arthroplasty Index (ORKA-1) for Patients Undergoing Autologous Chondrocyte Implantation
Authors: Ackermann Jakob , Barbieri Mestriner Alexandre , Arango Dillon , Ogura Takahiro , Gomoll Andreas H.
Published: August 2018

Objective

The purpose of this study was first to externally validate the Oswestry Risk of Knee Arthroplasty index (ORKA-1) by applying it to an autologous chondrocyte implantation (ACI) patient cohort in the United States with a broader definition of failure than only arthroplasty, and second, to determine predictive factors for the risk of ACI failure as defined by the senior author.

Design

A total of 171 patients that underwent ACI were included to validate the ORKA-1 as all factors needed for calculation and outcomes were recorded. For Cox regression analysis, 154 patients were included as they completed preoperative Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner, Lysholm, International Knee Documentation Committee (IKDC), and 12-item Shor Form (SF-12) scores. Patient- and lesion-associated parameters were recorded for each patient.

Results

At final follow-up (maximum of 10 years post-ACI), a total of 27 patients (15.8%) were considered a failure by senior author’s definition. With ACI failure as endpoint, the mean survival was 7.96 years in risk group 1 and 5.4 years in risk group 5. Cox regression analysis identified preoperative KOOS Sport/Recreation as the only significant predictive factor for ACI failure ( P = 0.007).

Conclusion

The ORKA-1 is a helpful tool for surgeons to estimate an individual patient’s likelihood of ACI survival. Further studies with larger patient cohorts as well as a consensus definition of failure are needed to further refine predictors of ACI failure.
Osteoarthritic Synovial Fluid and TGF-β1 Induce Interleukin-18 in Articular Chondrocytes
Authors: Carballo Camila B. , Coelho Thiago R. P. , de Holanda Afonso Rosenilde C. , Faria Jane Cristina de Oliveira , Alves Tercia , Monte Samylla M. , Ventura Matioszek Grasiella M. , Moura-Neto Vivaldo , Brito José M. de
Published: August 2018

Objective

Synovial fluid (SF) plays an important role in the maintenance of articular cartilage. SF is a dynamic reservoir of proteins derived from cartilage and synovial tissue; thus, its composition may serve as a biomarker that reflects the health and pathophysiological condition of the joint. The purpose of the current study was to evaluate the osteoarthritic synovial fluid (OASF) and transforming growth factor-β1 (TGF-β1) activity in articular chondrocytes catabolic and inflammatory responses.

Design

Chondrocytes were seeded at passage 2 and cultured for 72 hours under different conditions. Human chondrocytes were subjected to OASF while rat chondrocytes were subjected to either healthy synovial fluid (rSF) or TGF-β1 and then assigned for cell viability analysis. In addition, the effects of OASF and TGF-β1 on chondrocytes metalloprotease (MMP)-3 and MMP-13 and interleukin-18 (IL-18) expression were evaluated by immunocytochemistry, ELISA, and reverse transcriptase-polymerase chain reaction.

Results

SF from osteoarthritic patients significantly induced MMP-3, MMP-13, and IL-18 receptor expression in chondrocytes. To put in evidence the inflammatory activity of OASF, healthy chondrocytes from rat were cultured with TGF-β1. In the presence of TGF-β1 these cells started to express MMP-3, MMP-13, and IL-18 genes and attached to each other forming a chondrocyte aggregated structure. Healthy SF was able to maintain a typical monolayer of rounded chondrocytes with no inflammatory response.

Conclusion

In summary, these observations demonstrated that TGF-β1, one of the components of OASF, has a dual effect, acting in chondrocyte maintenance and also inducing inflammatory and catabolic properties of these cells.
Gene therapy for hemophilia: what does the future hold?
Authors: Doshi Bhavya S. , Arruda Valder R.
Published: August 2018

Recent phase I/II adeno-associated viral vector-mediated gene therapy clinical trials have reported remarkable success in ameliorating disease phenotype in hemophilia A and B. These trials, which highlight the challenges overcome through decades of preclinical and first in human clinical studies, have generated considerable excitement for patients and caregivers alike. Optimization of vector and transgene expression has significantly improved the ability to achieve therapeutic factor levels in these subjects. Long-term follow-up studies will guide standardization of the approach with respect to the combination of serotype, promoter, dose, and manufacturing processes and inform safety for inclusion of young patients. Certain limitations preclude universal applicability of gene therapy, including transient liver transaminase elevations due to the immune responses to vector capsids or as yet undefined mechanisms, underlying liver disease from iatrogenic viral hepatitis, and neutralizing antibodies to clotting factors. Integrating vectors show promising preclinical results, but manufacturing and safety concerns still remain. The prospect of gene editing for correction of the underlying mutation is on the horizon with considerable potential. Herein, we review the advances and limitations that have resulted in these recent successful clinical trials and outline avenues that will allow for broader applicability of gene therapy.
Post marketing study of hemodynamic and hematological noninvasive readings in a blood bank
Authors: Segman Yosef (Joseph) , Sheiman Ella
Published: August 2018

Objectives:

This validation test was conducted in the Fujisan Blood Bank, Fortaleza, Brazil and evaluated the noninvasive TensorTip MTX (MTX, Cnoga Medical Ltd.) readings of hemoglobin, hematocrit, red blood cells, blood pressure, and heart rate compared to reference lab device readings. Generally, these parameters are measured from venous or capillary blood samples run on a laboratory analyzer or handheld invasive testing devices. Needle sticks are inconvenient to blood donors with relatively high exposure risks. To our vision, noninvasive determination would be of benefit to blood contributors and medical professional teams; it would be fast and painless.

Methods:

A total of 334 subjects were included in the Fujisan blood bank validation (65% male, 35% female). Hemoglobin, hematocrit, and red blood cells, as well as blood pressure and heart rate, were measured noninvasively using the MTX device and were compared to venous blood samples run on two laboratory hematology analyzers (Horiba ABX Micros60 and Siemens blood count analyzer), to digital sphygmomanometer (OMRON BP786) and to manual auscultation. The noninvasive measurement with the appropriate virtual arm cuff setting was performed simultaneously with the blood sample extraction of the reference devices measurement.

Results:

There was no statistically significant difference ( p > 0.05, paired, two-tailed t-test) between the average daily hemoglobin, hematocrit, and red blood cells measurements provided by the MTX device and the laboratory hematology analyzer. In addition, there was no significant difference between the daily blood pressure and heart rate results provided by the MTX device and the digital and manual sphygmomanometers. The error calculated between the MTX and the reference device was found to be sufficiently accurate according to the relevant standards.

Conclusion:

The MTX accuracy of noninvasive hemoglobin, hematocrit, red blood cells, blood pressure, and heart rate measurements satisfies the industrial standards; therefore, the device enables more accurate, efficient, and effective patient care.
Impact of symptom bilaterality and hand dominance on patient-reported disability outcomes
Authors: Razmjou Helen , Dwyer Tim , Holtby Richard
Published: August 2018

Objectives:

It is not clear if using patients with bilateral symptoms would impact the level of disability reported in orthopaedic research. The purposes of this study were to (1) examine the prevalence of bilateral shoulder symptoms (significant pain, stiffness or weakness affecting function) in patients with rotator cuff impingement syndrome, rotator cuff tear and osteoarthritis of the glenohumeral joint, (2) explore risk factors associated with bilateral shoulder symptoms, and (3) examine the impact of symptom bilaterality and hand dominance on pre- and post-operative patient-oriented disability outcomes.

Methods:

This study involved secondary analysis of prospectively collected data of patients who had undergone shoulder surgery and had returned for their 1-year follow-up. Two outcome measures were collected prior to surgery and at 1-year following surgery: the American Shoulder and Elbow Surgeons and the Constant–Murley Score.

Results:

Data of 772 patients, 376 (49%) females, 396 males (51%); 288 (impingement syndrome), 332 (rotator cuff tear), and 152 (osteoarthritis) were included in the analysis. There was a statistically significant difference in the prevalence of bilateral symptoms being 44%, 28%, and 22% in the osteoarthritis, impingement syndrome, and rotator cuff tear groups, respectively (p < 0.0001). The prevalence of dominant side involvement was 71%, 67%, and 53% in the rotator cuff tear, impingement syndrome, and osteoarthritis groups (p < 0.0001). Older age and female sex were risk factors for development of bilateral symptoms only in patients with rotator cuff tear. Neither symptom bilaterality nor dominant arm involvement had a negative impact on patient-oriented disability outcome measures prior to or after surgery (p > 0.05).

Conclusion:

This study shows that patients with osteoarthritis of the glenohumeral joint have the highest prevalence of bilateral shoulder complaints. The older age and the female sex increased the risk of having bilateral symptoms in patients with rotator cuff tear. Having bilateral shoulder symptoms or dominant side involvement was not associated with higher level of disability prior or after surgery.
Tetralogy of Fallot With Absent Pulmonary Valve and Nonconfluent Pulmonary Arteries: A Management Conundrum
Authors: Swaminathan Sethuraman , Agarwal Arpit , Infante Juan C. , Rosenkranz Eliot
Published: August 2018

Tetralogy of Fallot with absent pulmonary valve syndrome is a rare form of congenital heart disease. Among the different variations with this rare anomaly is nonconfluent pulmonary artery branches with anomalous origin of the left pulmonary artery from the ductus arteriosus. The authors present one such case which was diagnosed prenatally to have tetralogy of Fallot with absent pulmonary valve and identified postnatally to have nonconfluent pulmonary artery branches in addition. We discuss the conundrum of respiratory management in this patient pre- and postoperatively due to a unique ventilation perfusion mismatch problem, which varies between the two lungs.
Hypoalbuminemia as an Independent Risk Factor for Perioperative Complications Following Surgical Decompression of Spinal Metastases
Authors: Hussain Awais K. , Cheung Zoe B. , Vig Khushdeep S. , Phan Kevin , Lima Mauricio C. , Kim Jun S. , Di Capua John , Kaji Deepak A. , Arvind Varun , Cho Samuel K.
Published: August 2018

Study Design:

Retrospective cohort study.

Objective:

Malnutrition has been shown to be a risk factor for poor perioperative outcomes in multiple surgical subspecialties, but few studies have specifically investigated the effect of hypoalbuminemia in patients undergoing operative treatment of metastatic spinal tumors. The aim of this study was to assess the role of hypoalbuminemia as an independent risk factor for 30-day perioperative mortality and morbidity after surgical decompression of metastatic spinal tumors using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2011 to 2014.

Methods:

We identified 1498 adult patients in the ACS-NSQIP database who underwent laminectomy and excision of metastatic extradural spinal tumors. Patients were categorized into normoalbuminemic and hypoalbuminemic (ie, albumin level <3.5 g/dL) groups. Univariate and multivariate regression analyses were performed to examine the association between preoperative hypoalbuminemia and 30-day perioperative mortality and morbidity. Subgroup analysis was performed in the hypoalbuminemic group to assess the dose-dependent effect of albumin depletion.

Results:

Hypoalbuminemia was associated with increased risk of perioperative mortality, any complication, sepsis, intra- or postoperative transfusion, prolonged hospitalization, and non-home discharge. However, albumin depletion was also associated with decreased risk of readmission. There was an albumin level–dependent effect of increasing mortality and complication rates with worsening albumin depletion.

Conclusions:

Hypoalbuminemia is an independent risk factor for perioperative mortality and morbidity following surgical decompression of metastatic spinal tumors with a dose-dependent effect on mortality and complication rates. Therefore, it is important to address malnutrition and optimize nutritional status prior to surgery.
Short-term Outcomes of Arthroscopic Debridement and Selected Acromioplasty of Bursal- vs Articular-Sided Partial-Thickness Rotator Cuff Tears of Less Than 50%
Authors: Dwyer Tim , Razmjou Helen , Henry Patrick , Misra Shashank , Maman Eran , Holtby Richard
Published: August 2018

Background:

While it is believed that good results can be achieved by arthroscopic debridement of partial-thickness tears (PTTs) of <50% tendon thickness, few studies have directly compared the treatment of articular- versus bursal-sided PTTs of <50%.

Purpose:

To compare the postoperative outcomes of patients with articular- versus bursal-sided PTTs of <50% tendon thickness that were treated with arthroscopic debridement and selective acromioplasty (for type II or III acromions).

Study Design:

Cohort study; Level of evidence, 3.

Methods:

An analysis was performed with data from 76 consecutive patients diagnosed with a PTT <50% tendon width (Ellman grade II) who had undergone arthroscopic debridement and selective acromioplasty (for type II or III acromions). Outcome measures included the short version of the Western Ontario Rotator Cuff index, the American Shoulder and Elbow Surgeons score, and the relative Constant-Murley score, as well as strength of the affected shoulder. A statistical paired t test (preoperative vs 2 years postoperative) and an independent t test were utilized to compare outcomes between patients with bursal- and articular-sided tears.

Results:

Between 2001 and 2010, there were 40 (53%) articular- and 36 (47%) bursal-sided tears treated with debridement and selective acromioplasty. The mean patient age was 55 years (range, 36-77 years) for the bursal group and 56 years (range, 33-81 years) for the articular group. The mean follow-up was 24 months (range, 22-26 months). Both groups showed significant improvement in the short version of the Western Ontario Rotator Cuff index, American Shoulder and Elbow Surgeons score, and relative Constant-Murley score 2 years after surgery ( P < .0001) as well as in strength ( P < .0001 for bursal tears, P = .006 for articular tears). There was no statistically significant difference between groups in any of the postoperative outcome measures at 2 years.

Conclusion:

The results of this study demonstrate that good outcomes can be achieved with arthroscopic debridement and selective acromioplasty among patients with articular- or bursal-sided PTT of <50% tendon thickness. No difference was observed between groups at 2-year follow-up.
Coloring Weight Stigma: On Race, Colorism, Weight Stigma, and the Failure of Additive Intersectionality
Authors: Reece Robert L.
Published: August 2018

America’s obsession with obesity has spawned increasing amounts of research examining how body size shapes social outcomes. Generally, body size negatively correlates with these outcomes, with larger people suffering lower self-esteem, marriage rates, and wages. However, these outcomes are unevenly distributed among racial groups, as black people counterintuitively seem robust to many of the ravages of weight discrimination. Understanding why black people do not suffer a “double burden” where weight is concerned has baffled social scientists using basic models of intersectionality to explain outcomes. The author attempts to deepen understanding of intersectionality and the structure of race in the United States by examining the combined effect of body size and skin tone or color on individual income for black Americans. The author finds that light-skinned black Americans suffer an obesity income penalty similar to white Americans, whereas medium- and dark-skinned black Americans seem to suffer no obesity income penalty.
Repositioning Individualized Homeopathy as a Psychotherapeutic Technique With Resolvable Ethical Dilemmas
Authors: Prousky Jonathan E.
Published: August 2018

The author puts forth the argument that the complementary and alternative medicine community should endorse specific aspects of the entire individualized homeopathic process, including its unique holistic consultation process, having dedicated lengths of time to enumerate the complete illness context, and the prescribing of homeopathic remedies, to reposition this modality as a psychotherapeutic technique. Moreover, placebo effects derived from homeopathic remedies could be used to further exploit favorable therapeutic effects that have accrued from the entirety of the homeopathic consultation process. The overall aim of this bold shift is to sustain the clinical practice of homeopathy from an ethical and clinically responsible (and plausible) framework that is properly evidence-informed.
A cloning and expression system to probe T-cell receptor specificity and assess functional avidity to neoantigens
Authors: Hu Zhuting , Anandappa Annabelle J. , Sun Jing , Kim Jintaek , Leet Donna E. , Bozym David J. , Chen Christina , Williams Louise , Shukla Sachet A. , Zhang Wandi , Tabbaa Diana , Steelman Scott , Olive Oriol , Livak Kenneth J. , Kishi Hiroyuki , Muraguchi Atsushi , Guleria Indira , Stevens Jonathan , Lane William J. , Burkhardt Ute E. , Fritsch Edward F. , Neuberg Donna , Ott Patrick A. , Keskin Derin B. , Hacohen Nir , Wu Catherine J.
Published: August 2018

There is a Blood Commentary on this article in this issue.
Fetal γ-globin genes are regulated by the BGLT3 long noncoding RNA locus
Authors: Ivaldi Maria Soledad , Diaz Luis Francisco , Chakalova Lyubomira , Lee Jongjoo , Krivega Ivan , Dean Ann
Published: August 2018

Key Points

BGLT3 is a developmental stage-specific lncRNA encoded downstream of HBG1 that positively regulates γ-globin genes. BGLT3 locus and transcript have distinct functions in looping and mediator interaction to increase γ-globin transcription.
Enteral nutritional therapy of inpatients: clinical and nutritional outcomes
Authors: Homelis Fernanda Gonçalves Guidetti , Nakayama Daniely , Perpétuo Kárin Rios , dos Santos Fulop Karina Vasconcelos , Froio Marcela Domingues , Marins Tânia Reinaldo , de Barros Thaís Batistone Tentor , de Miranda Vânia Bentes , Papini Silvia Justina , Cunha Natália Baraldi
Published: August 2018

Background

Enteral nutritional therapy (ENT) has the principle of maintaining or recovering the nutritional status of individuals who cannot or unable to feed them the oral diet. The aim of this study was to verify the clinical and nutritional outcome of patients on ENT during the period of 1 year.

Methods

It is a quantitative, descriptive, retrospective, and documentary research, through the analysis of medical records of all individuals who used ENT for 1 year in a public hospital of Bauru, SP, with evaluation of weight loss, time of ENT’s use, and outcomes such as death and weaning. The collection took place in the adult hospital unit containing 165 hospital beds, including 33 beds of the intensive care unit (ICU), and 132 beds divided into nine clinics (surgical and medical), with reference mainly to trauma, neurosurgery, and neurology. All patients admitted to these wards using ENT were collected.

Results

A total of 527 patients were included, and it was observed that the majority of ENT’s indications came from neurological diseases (42.2%), with the onset of the ENT in the intensive care unit with 69.0% due to needs for mechanical ventilation. The mean number of ENT days was 20.4 days. There was a positive correlation between the percentage of weight loss and time of ENT’s use (p < .0001). There was worst outcome and lower weaning rate in the elderly.

Conclusions

It has been shown that the longer the time of ENT’s use, the greater the percentage of weight loss of these individuals; malnourished patients present longer time using the therapy, and the elderly presented higher mortality rate.
Identifying the language skill of consecutive interpreters. Towards the development of recommendations on language choices in interpreters’ notes
Authors: SASAKI ANNA
Published: August 2018

This article reports on a small-scale empirical study on note-taking in consecutive interpretation. Present-day interpretation labor market has faced a number of changes, as nowadays interpreters challenge themselves to work with different language combinations. A sufficient level of an in-demand language skill is now critical for employability of young trainees in the labor market. The present research illustrates the way interpreter trainees with different language skill sets carry out similar tasks in different interpretation settings.For primary research data, the study uses results of a background survey, complete with audio recordings of the performance and the notes produced by eight subjects while interpreting an English source text consecutively into Japanese. The aim of the study is to explore the differences in consecutive interpretation of interpreters in classical settings (L2 to L1) and in emerging new trends in the labor market (L2 to L3). The article argues that the language skill required for each trend in the interpretation labor market is defined by the specific interpretation settings.
Protection of Spermatogenesis with β-Carotene in Radiation Exposure. Message 1: Single Acute External γ-Irradiation. Short-Term Application of Carothynoid
Authors: Беляев И. , Belyaev I. , Самойлов А. , Samoylov A.
Published: August 2018

Purpose: Experimental evaluation of β-carotene correction of radiation induced by single acute γ-irradiation of spermatogenesis disorders in male (♂) F1 CBAxC97Bl mice and non-linear rats with short-term carotenoid prescription. Material and methods: Single external gamma irradiation ♂ was performed at the IGUR facility (137Cs, dose rate 0.029 Gy/s). The β-carotene suspension was administered ♂ orally 19 and 4 hours before, 4 and 24 hours after irradiation. The damage and effectiveness of protection of spermatogenesis of irradiated ♂ were judged by the state of their reproductive function. Results: The effects of correction of the short-term prescription of β-carotene radiation-induced by a single acute external gamma irradiation at doses of 3 and 5 Gy of spermatogenesis disorders in mice and rats at stages of mature spermatozoa, spermatids and spermatogonium have been established. β-carotene in ♂ mice reduced total embryonic mortality in 8–14 and 77–84 days after irradiation at a dose of 3 Gy from 46 to 36 and from 41 to 28 %, preimplantation – after 8–14 and 15–21 days – from 24 up to 13 and from 31 to 22 %, postimplantation – after 0–7 and 77–84 days – from 24 to 15 and from 25 to 7 %. In ♂ rats 0–7 days after irradiation at a dose of 5 Gy β-carotene reduced total, pre-, post- and induced postimplantation embryonic mortality from 62 to 41, from 34 to 17, from 41 to 30 and from 38 to 26 %, respectively. After 13–20 days – preimplantation mortality from 27 to 11 %. At the stage of spermatozoa after irradiation at a dose of 3 Gy increased the breeding efficiency from 70 to 100 %, fecundity – by 23–31 %; reduced total and preimplantation mortality from 49 to 39 % and from 41 to 27 %, respectively. At the stage of spermatids –sterilization was prevented and the efficiency of breeding was normalized, reduced post- and induced postimplantation mortality from 25 to 20 and from 17 to 12 %, respectively. The therapeutic and prophylactic effects of β-carotene at the spermatocyte stage are not revealed. In the spermatogonium stage, the carotenoid increased the total number and number of live embryos in pregnant female (♀) from 36 to 55 and from 20 to 50 %, reduced total and pre-implantation mortality from 81 to 56 and from 69 to 42 %, respectively. Conclusions: The prospects of β-carotene use for correction of gonadal radiation injuries in the risk groups of exposure to ionizing radiation and the inclusion of β-carotene in the scheme of drug prevention of acute radiation injuries of spermatogenesis are shown.