bluuebunny/crossref_metadata_2025 huggingface dataset:
What Makes Tinnitus Loud?
Authors: Yakunina Natalia , Nam Eui-Cheol
Published: November 2020

Introduction:

Tinnitus loudness is a subjective measure, and it does not directly reflect either tinnitus severity or the impact on daily life. Nevertheless, loud tinnitus may be the most frequent clinical complaint of tinnitus patients. Factors contributing to the loudness of the phantom sound have rarely been studied. We evaluated both matched and self-rated loudness in a large sample of patients with tinnitus and analyzed the influencing factors among demographic, hearing, and tinnitus characteristics.

Methods:

Two hundred ninety-nine patients with chronic tinnitus were enrolled. We evaluated the matched loudness, minimal masking level (MML), and visual analog scale (VAS) loudness. Stepwise multiple regression analyses were performed for each loudness measure using independent variables of age, sex, time since tinnitus onset, tinnitus laterality, pure-tone average, tinnitus pitch, tinnitus handicap inventory (THI) score, VAS annoyance, disturbance and daily tinnitus duration, and depression score. We calculated bivariate correlations between each loudness measure and all independent variables.

Results:

The psychoacoustic loudness measures (matched loudness and MML) were highly correlated and were affected by the hearing deficit and tinnitus pitch (Pearson r > 0.5 for pure tone averages, and r > 0.3 for tinnitus pitch for both variables, p < 0.05), whereas the subjective measurement (VAS loudness) exhibited little to no correlation with the other two measures and was related to psycho-emotional factors such as the THI score, VAS variables, and depression (Pearson r > 0.6 for VAS annoyance, r > 0.4 for VAS daily duration and disturbance and THI score, r > 0.3 for the depression score, p < 0.05).

Conclusion:

The matched tinnitus loudness and MML values were influenced principally by the extent of hearing loss and related factors, suggesting that rehabilitation using hearing aids could help reduce perception of tinnitus loudness. A psycho-emotional approach might more effectively lessen self-perceived loudness.
Access to the Apical Cochlear Modiolus for Possible Stem Cell-based and Gene Therapy of the Auditory Nerve
Authors: Wrobel Christian , Bevis Nicholas F. , Meyer Alexander C. , Beutner Dirk
Published: November 2020

Objective:

Loss of spiral ganglion neurons (SGN) is permanent and responsible for a substantial number of patients suffering from hearing impairment. It can derive from the degeneration of SGNs due to the death of sensory hair cells as well as from auditory neuropathy. Utilizing stem cells to recover lost SGNs increasingly emerges as a possible therapeutic option, but access to human SGNs is difficult due to their protected location within the bony impacted cochlea. Aim of this study was to establish a reliable and practicable approach to access SGNs in the human temporal bone for possible stem cell and gene therapies.

Methods:

In seven human temporal bone specimen a transcanal approach was used to carefully drill a cochleostomy in the lateral second turn followed by insertion of a tungsten needle into the apical modiolus to indicate the spot for intramodiolar injections. Subsequent cone beam computed tomography (CBCT) served as evaluation for positioning of the marker and cochleostomy size.

Results:

The apical modiolus could be exposed in all cases by a cochleostomy (1.6 mm2, standard deviation ±0.23 mm2) in the lateral second turn. 3D reconstructions and analysis of CBCT revealed reliable positioning of the marker in the apical modiolus, deviating on average 0.9 mm (standard deviation ±0.49 mm) from the targeted center of the second cochlear turn.

Conclusion:

We established a reliable, minimally invasive, transcanal surgical approach to the apical cochlear modiolus in the human temporal bone in foresight to stem cell-based and gene therapy of the auditory nerve.
Effect of Repetitive Administration of a Next-generation Sensory Organization Test in Adults With and Without Vestibular Dysfunction
Authors: Grove Colin R. , Whitney Susan L. , Hetzel Scott J. , Heiderscheit Bryan C. , Pyle G. Mark
Published: November 2020

Hypothesis:

The overall aim was to assess the effects of repetitive testing on performance on a next-generation Sensory Organization Test (NG-SOT).

Background:

The psychometric properties of sensory organization assessment with a next-generation posturography device are not fully characterized. Thus, a better understanding of the reliability of the NG-SOT is required to support its use as an outcome measure.

Methods:

Forty adults (20 vestibular-impaired) participated. Test–retest reliability was determined using the interclass correlation coefficient [ICC (3,1)] for the composite, somatosensory, vision, vestibular, and visual preference scores. Learning effects were assessed by analyzing the change in the composite score over time.

Results:

Analyzing the NG-SOT scores across all participants produced the following interclass correlation coefficients [95% confidence interval (CI)]: composite = 0.95 (0.92, 0.97), somatosensory = 0.20 (−0.06, 0.44), vision = 0.93 (0.88, 0.96), vestibular = 0.91 (0.85, 0.94), and visual preference = 0.19 (−0.07, 0.43). The mean differences (95% CI; p value) for the composite score between administrations were: 2.7 (1.0, 4.4; 0.002) for visits 1 and 2; 1.4 (−0.3, 3.1; 0.099) for visits 2 and 3; 0.7 (−1.0, 2.4; 0.403) for visits 3 and 4; and 0.4 (−1.3, 2.1; 0.653) for visits 4 and 5.

Conclusions:

Test–retest reliability was excellent for the composite, vision, and vestibular scores, but it was poor for the somatosensory and visual preference scores. A learning effect for the composite score was identified, but performance was stable after two administrations. Changes in the composite score that are greater than 6.5 points exceed the measurement error for the test.
Prognostic Factors for the Outcome of Translabyrinthine Surgery for Vestibular Schwannomas
Authors: de Boer Nick P. , Koot Radboud W. , Jansen Jeroen C. , Böhringer Stefan , Crouzen Jeroen A. , van der Mey Andel G. L. , Malessy Martijn J. A. , Hensen Erik F.
Published: November 2020

Objective:

To identify predictors of tumor recurrence and postoperative facial nerve function after translabyrinthine surgery for unilateral vestibular schwannomas.

Study Design:

Retrospective study.

Setting:

Tertiary referral center.

Patients:

Between 1996 and 2017 a total of 596 patients with unilateral vestibular schwannoma underwent translabyrinthine surgery. Pre- and postoperative clinical status, radiological, and surgical findings were evaluated.

Intervention(s):

Translabyrinthine surgery.

Main Outcome Measure(s):

Potential predictors for tumor recurrence and facial nerve outcome were analyzed using Cox regression and ordinal logistic regression, respectively.

Results:

The extent of tumor removal was total in 32%, near-total in 58%, and subtotal in 10%. In 5.5% (33/596) of patients the tumor recurred. Subtotal tumor resection (p = 0.004, hazard ratios [HR] = 10.66), a young age (p = 0.008, HR = 0.96), and tumor progression preoperatively (p = 0.042, HR = 2.32) significantly increased the risk of recurrence, whereas tumor size or histologic composition did not. A good postoperative facial nerve function (House–Brackmann grade 1–2) was achieved in 85%. The risk of postoperative facial nerve paresis or paralysis increased with tumor size (p < 0.001, OR = 1.52), but was not associated with the extent of tumor removal, histologic composition, or patient demographics.

Conclusions:

Translabyrinthine surgery is an effective treatment for vestibular schwannoma, with a good local control rate and facial nerve outcome. The extent of tumor removal is a clinically relevant predictor for tumor recurrence, as are young patient age and preoperative tumor progression. A large preoperative tumor size is associated with a higher risk of postoperative facial nerve paresis or paralysis.
Sémont Maneuver for Benign Paroxysmal Positional Vertigo Treatment: Moving in the Correct Plane Matters
Authors: Gebhart Isabel , Götting Carina , Hool Sara-Lynn , Morrison Miranda , Korda Athanasia , Caversaccio Marco , Obrist Dominik , Mantokoudis Georgios
Published: November 2020

Hypothesis:

We aimed to investigate the effect of the head excursion angle on the success of the Sémont Maneuver (SM).

Background:

SM is performed with the head turned by 45 degrees toward the unaffected ear. In clinical routine, it is unlikely that physicians can turn the head to a position of exactly 45 degrees. Moreover, it is unclear how possible deviations from 45 degrees would affect the outcome with SM.

Methods:

We used an in vitro model (upscaled by ×5) of a posterior semicircular canal with canalithiasis to study head excursion angles (0–75 degrees) and minimum waiting times in SM. Additionally, we measured actual head excursion angles performed by trained physicians during SM on a healthy subject.

Results:

Successful canalith repositioning to the utricle was possible at head excursion angles between 21 and 67 degrees. Waiting time increased from 16 to 30 seconds with increasing deviation from 45 degrees. Angles larger than 67 degrees or smaller than 21 degrees did not lead to successful repositioning even after a waiting period of 5 minutes. Physicians set head excursion angles of 50 degrees ±SD 4.8 degrees while performing the SM.

Conclusion:

Angular deviations up to ±20 degrees from the ideal SCC plane (45 degrees) still allows for successful SM. Although the tested physicians tended to underestimate the actual head excursion angle by 5 degrees (and more), the success of SM will not be affected provided that the waiting time is sufficiently long. Further, the results suggest that the Brandt-Daroff maneuver is a form of habituation training rather than a liberatory maneuver.
Dynamics of Blood Flows in Aortic Stenosis: Mild, Moderate, and Severe
Authors: Jhun Choon-Sik , Newswanger Raymond , Cysyk Joshua P. , Ponnaluri Sailahari , Good Bryan , Manning Keefe B. , Rosenberg Gerson
Published: November 2020

Supraphysiologic high shear stresses created in calcific aortic stenosis (AS) are known to cause hemostatic abnormalities, however, the relationship between the complex blood flows over the severity of AS and hemostatic abnormalities still remains unclear. This study systematically characterized the blood flow in mild, moderate, and severe AS. A series of large eddy simulations (LES) validated by particle image velocimetry were performed on physiologically representative AS models with a peak physiologic flow condition of 18 liter per minute. Time-accurate velocity fields, transvalvular pressure gradient, and laminar viscous—and turbulent (or Reynolds) shear stresses (RSSmax) were evaluated for each degree of severity. The peak velocities of mild, moderate, and severe AS were on the order of 2.0, 4.0, and 8.0 m/s, respectively. Jet velocity in severe AS was highly skewed with extremely high velocity (as high as 8 m/s) and mainly traveled through the posterior aortic wall up to the aortic arch while still carrying a relatively high velocity, that is, >4 m/s. The mean laminar viscous wall shear stresses (WSS) for mild, moderate, and severe AS were on the order of 40, 100, and 180 Pa, respectively. The RSSmax were on the order of 260, 490, and 2,500 Pa for mild, moderate, and severe AS, respectively. This study may provide a link between altered flows in AS and hemostatic abnormalities such as acquired von Willebrand syndrome and hemolysis, thus, help diagnosing and timing of the treatment.
Orthotopic Heart Transplantation in a Child with Single Ventricle after Pneumonectomy
Authors: Marey Gamal M. , Said Sameh M. , Sakhitab-Kerestes Alyssa , Mchugh Kristy , Jang Subin , Steiner Marie E. , Griselli Massimo , Ameduri Rebecca
Published: November 2020

We report a 6-year-old with single ventricle physiology secondary to tricuspid atresia who had cardiorespiratory failure who was not a candidate for further single ventricle palliation. The patient underwent planned staged left pneumonectomy for recurrent pneumonias secondary to bronchomalacia followed by orthotopic heart transplantation. This aggressive approach improved the patient candidacy for heart transplantation by removing the source of recurrent infection and respiratory failure (left lung).
High blood pressure in Chinese youth across categories of BMI and waist circumference
Authors: Zhang Ying-Xiu , Wang Shu-Rong
Published: November 2020

Background

BMI and waist circumference (WC) have commonly been used to identify obesity in practice. The aim of the present study was to assess the blood pressure (BP) status among Chinese college students categorized by BMI and WC.

Methods

A total of 4226 college students (2107 males and 2119 females) aged 19–22 years included in the study. The WHO BMI cutoffs were used to define underweight, normal weight and overweight. The WC cutoffs (90 cm for man and 80 cm for woman) were used to define central obesity. High BP was defined as SBP/DBP ≥140/90 mmHg. The BP status of subjects within each category across BMI and WC were assessed.

Results

When subjects were categorized by BMI, overweight males and females had a higher prevalence of high BP than their nonoverweight counterparts. When WC was used to diagnose central obesity, subjects with central obesity had a higher prevalence of high BP than those with normal WC. A positive association between BMI, WC and BP was also observed even in normal-weight subjects, with ‘high normal BMI’ subgroup (BMI = 23.7–24.9) had a higher BP level and prevalence of high BP than ‘low normal BMI’ subgroups (BMI = 18.5–19.7 and BMI = 19.8–21.0, P < 0.05).

Conclusion

Prevention of overweight/obesity in youth may be an effective approach for preventing the development of hypertension in the future; for normal-weight youth, it is essential to keep their BMI at a lower level within normal range.
Growth, body composition, and endocrine issues in Williams syndrome
Authors: Stanley Takara L. , Leong Aaron , Pober Barbara R.
Published: November 2020

Purpose of review

Williams syndrome is a multisystem disorder caused by a microdeletion on chromosome 7q. Throughout infancy, childhood, and adulthood, abnormalities in body composition and in multiple endocrine axes may arise for individuals with Williams syndrome. This review describes the current literature regarding growth, body composition, and endocrine issues in Williams syndrome with recommendations for surveillance and management by the endocrinologist, geneticist, or primary care physician.

Recent findings

In addition to known abnormalities in stature, calcium metabolism, and thyroid function, individuals with Williams syndrome are increasingly recognized to have low bone mineral density, increased body fat, and decreased muscle mass. Furthermore, recent literature identifies a high prevalence of diabetes and obesity starting in adolescence, and, less commonly, a lipedema phenotype in both male and female individuals. Understanding of the mechanisms by which haploinsufficiency of genes in the Williams syndrome-deleted region contributes to the multisystem phenotype of Williams syndrome continues to evolve.

Multiple abnormalities in growth, body composition, and endocrine axes may manifest in individuals with Williams syndrome. Individuals with Williams syndrome should have routine surveillance for these issues in either the primary care setting or by an endocrinologist or geneticist.
Correction of slope-intercept glomerular filtration rate measurement without scaling for body size
Authors: McMeekin Helena , Burniston Maria T. , Barnfield Mark , Peters A. Michael
Published: November 2020

Aim

The aim of this study was to evaluate a slope-intercept glomerular filtration rate (GFR) one-compartment correction method based exclusively on the rate constant (
α

2) of the exponential between 2 and 4 h post-injection that requires no scaling for BSA.

Methods

The correction factor is 1/([C.
α

2]+1). C depends on the difference between one-compartment-corrected and uncorrected GFR, so varies with different correction procedures. Patients were in four groups: group 1 (51Cr-EDTA; n = 141) and group 2 (99mTc-DTPA; n = 47) had sampling at 2, 3 and 4 h. Groups 3A (99mTc-DTPA; n = 168) and 3B (99mTc-DTPA; n = 361) gave nine samples up to 480 min. C was calculated from GFR corrected using Brochner-Mortensen (BM) without prior BSA-scaling (C
BM; GFRBM), after BSA-scaling then reverse-scaling as per British Nuclear Medicine Society (BNMS) guidelines (C
BNMS; GFRBNMS), and after correction using the equations containing ‘f’ described by Fleming (C
Flem; GFRFlem) and Jodal and Brochner-Mortensen (C
JBM; GFRJBM). In group 3A, C (C
9) was determined from GFR measured from all nine samples (GFR9) and from seven samples (C
7) up to 240 min. In 3B, GFRC, corrected using 1/([C
9.α
2]+1), was compared with GFRBM, GFRBNMS, GFRFlem and GFRJBM against GFR9 (gold-standard).

Results

C derived from these one-compartment correction formulae ranged from 25 to 32 min. In group 3, C
7 and C
9 were 28 ± 11 and 38 ± 14 min (P < 0.0001). Biases of GFRBM, GFRBNMS, GFRJBM, GFRFlem and GFRC against GFR9 were 2.7, 1.5, 4.2, 3.4 and 0.4 ml/min. Corresponding precisions were 9.3, 7.3, 7.0, 6.7 and 7.6 ml/min.

Conclusion

Correction using
α

2 avoids BSA scaling, has a low bias against gold-standard GFR and does not over-correct at high GFR.
Direct correlation between ischemic burden induced by dipyridamole and stress peak filling rate: a gated perfusion single-photon emission computed tomography study
Authors: Bestetti Alberto , Cuko Besart , Gasparini Massimo , De Servi Stefano
Published: November 2020

Aim and patients

The aim of the present study was to assess the effects of dipyridamole on stress and rest peak filling rate in consecutive patients who showed perfusion and, or function abnormalities at Gated-SPECT. Were enrolled 96 patients (73 males (76%); mean age 71.7 ± 9.57). Forty patients (41.7%) had an history of myocardial infarction and fifty-seven (59.4%) of previous cardiac revascularization. All patients underwent a 2-day 99mTc-SestaMIBI gated perfusion SPECT protocol.

Results

Twenty-nine (30.2%) patients showed fixed perfusion defects, 54 (56.2%) showed partially or completely reversible ones, while 13 (13.5%) showed normal perfusion but reduced LVEF. SSS was significantly higher than SRS (9.55 ± 9.29 vs. 7.10 ± 8.48; P = 0.0001). Stress peak filling rate was not significantly higher than rest peak filling rate (1.73 EDV/s ± 0.69 EDV/s vs. 1.67 EDV/s ± 0.56 EDV/s; P = 0.62). At a multivariate regression analysis, only stress peak filling rate, as independent variable, was directly correlated with myocardial ischemia (SDS) (P = 0.018). We divided patients according to SDS in those with mild (SDS < 5) and severe (SDS ≥ 5) ischemia. Stress peak filling rate was the only parameter significantly different between groups.

Conclusion

Stress PFR showed a better correlation with the degree of ischemia compared to the remaining perfusion and functional parameters. The direct correlation between SDS and stress PFR leads us to speculate that dipyridamole could improve diastolic function in ischemic patients.
Bone single-photon emission computed tomography/computed tomography in cancer care in the past decade: a systematic review and meta-analysis as well as recommendations for further work
Authors: Mohd Rohani Mohd Fazrin , Zanial Ahmad Zaid , Suppiah Subapriya , Phay Phay Khor , Mohamed Aslum Khan Farahnaz , Mohamad Najib Fatin Hayyani , Mohd Noor Noramaliza , Arumugam Manohar , Amir Hassan Siti Zarina , Vinjamuri Sobhan
Published: November 2020

Skeletal whole-body scintigraphy (WBS), although widely used as a sensitive tool for detecting metastatic bone disease in oncology cases, has relatively low specificity. Indeterminate bone lesions (IBLs) detected by WBS cause a diagnostic dilemma, which hampers further management plans. In the advent of hybrid imaging, single-photon emission computed tomography/computed tomography (SPECT/CT) has been gaining popularity as a tool to improve the characterisation of IBLs detected by WBS. As yet, there has not been a systematic review to objectively evaluate the diagnostic capabilities of SPECT/CT in this area. We conducted a systematic review of relevant electronic databases up to 30 August 2020. The outcomes of interest were the reporting of SPECT/CT to identify benign and malignant IBLs and the calculation of the sensitivity and specificity of the index test, based on histopathological examination or clinical and imaging follow-up as the reference standard. After the risk of bias and eligibility assessment, 12 articles were identified and synthesised in the meta-analysis. The pooled sensitivity and specificity of SPECT/CT for diagnosing IBLs are 93.0% [95% confidence interval (CI) 0.91–0.95] and 96.0% (95% CI 0.94–0.97), respectively. There was heterogeneity of the articles due to variable imaging protocols, duration of follow-up and scoring methods for interpreting the SPECT/CT results. The heterogeneity poses a challenge for accurate interpretation of the true diagnostic capability of SPECT/CT. In conclusion, targeted SPECT/CT improves the specificity of diagnosing bone metastases, but efforts need to be made to standardise the thresholds for SPECT/CT, methodology, as well as harmonising the reporting and interpretation criteria. We also make some recommendations for future works.
Accuracy of next-day single-sample measurement for low glomerular filtration rate and comparison with same-day slope-intercept glomerular filtration rate
Authors: McMeekin Helena , Wickham Fred , Fongenie Ben , Burniston Maria
Published: November 2020

Aim

We aimed to investigate the accuracy of a single-sample glomerular filtration rate (SS-GFR) technique with a sample taken at 24 h post-injection for patients with GFR lower than 25 mL/min/1.73 m2. A comparison with the results from same-day slope-intercept GFR (SI-GFR) was also performed.

Methods

Data from patients referred for GFR assessment to inform the management of chronic kidney disease at the Royal Free Hospital were reviewed. Four-sample SI-GFR calculation with samples at 2-, 4-, 6-, and 24-h post-injection was taken as the reference measurement to which the Gref and Karp SS-GFR (24-h sample) and same-day SI-GFR (2- and 4-h samples) were compared. The effect of protein binding on GFR accuracy was modelled.

Results

A total of 43 GFR examinations with reference GFR less than 25 mL/min/1.73 m2 were included in the analysis. Bland–Altman analysis gave mean differences of 0.4 mL/min/1.73 m2 (95% confidence interval: 0–0.7) for SS-GFR (24 h) and 3.0 mL/min/1.73 m2 (95% confidence interval: 1.9–4.2) for same-day SI-GFR. 95% limits of agreement were –2.0 to 2.8 mL/min/1.73 m2 for SS-GFR (24 h) and –4.0 to 10.1 mL/min/1.73 m2 for same-day SI-GFR.

Conclusions

SS-GFR with a 24-h sample is more accurate than same-day SI-GFR in patients with GFR less than 25 mL/min/1.73 m2. Using SS-GFR with a 24-h sample in routine clinical practice will result in clinically insignificant differences in GFR result compared with the reference technique, whereas a same-day SI-GFR measurement could cause large inaccuracies.
Dosimetry-guided radioiodine therapy of hyperthyroidism: long-term experience and implications for guidelines
Authors: Leitha Thomas , Schartel Manuela , Hurtl Ingrid , Bednar Rudolf , König Franz , Mayrhofer Karl , Pietschmann Flavia
Published: November 2020

Background

Long-term follow-up after radioactive iodine therapy (RIT) for Graves’ disease and toxic thyroid autonomy is incompletely addressed by current guidelines. We retrospectively analyzed the clinical course of 1233 out of 1728 consecutive Graves’ disease (n = 536) and thyroid autonomy (n = 1192) patients after dosimetry-guided RIT to optimize follow-up.

Methods

Patients were referred between 1990 and 2018; follow-up was monitored according to available electronic registers with medical reports, including autopsies from 9 hospitals and 10 residential care homes.

Results

In total, 495/1728 cases were censored because of incomplete 6-month follow-up data. The conversion rates to hypothyroidism in Graves’ disease and different forms of thyroid autonomy can be deconvoluted into two follow-up periods: first year after RIT and afterward. The conversion rate in Graves’ disease was significantly higher than that in all thyroid autonomy subgroups during the first year but almost identical afterwards. Thyroxine substitution started between 10 and 7900 days after RIT at thyroid stimulating hormone between 0.11 and 177 µU/ml.

Conclusions

We advise earlier (2–3 weeks) first follow-up checks after RIT in all Graves’ disease patients and thyroid autonomy under antithyroid drugs (ATD) and re-checks every 2–4 weeks until conversion to hypothyroidism during the first year. The first check in thyroid autonomy without ATD should be after 3–4 weeks with re-checks every 4–6 weeks. After 1 year, both groups can be re-checked every 4–6 months over the next 5 years. The success rate of RIT in thyroid autonomyincreases with age but the history of RIT is rapidly lost during follow-up.
Impact of 18F-2-fluoro-2-deoxy-D-glucose PET/computerized tomography on the initial staging and changing the management intent in head and neck squamous cell carcinoma
Authors: Kandeel Ahmed , Saied Mona , Aldaly Moustafa , Darwish Hanan , Alsayed Yasser
Published: November 2020

Objective

To assess the role of 18F-FDG PET/CT in initial staging of head and neck squamous cell carcinoma and its impact on changing the management compared to other conventional methods.

Patients and methods

A prospective study of 31 patients (21 male and 10 female), mean age 49.3 ± 12.1 years with histologically confirmed squamous cell carcinoma of the head and neck (nasopharynx was the commonest cancer in 15 patients (48.4%), poorly differentiated grade represented 64.5% of all tumors. Initial staging was achieved according to routine physical examination, endoscopy, CT, U/S, MRI.

Results

The overall change in TNM staging by 18F-FDG PET/CT in relation to conventional methods was encountered in 15/31 patients (48.4%). PET/CT changed; T staging in three patients (9.6%), upstaging in two patients and downstaging in one patient. PET/CT upstaged all 13/31 patients in N staging (41.9%). 18F-FDG PET/CT changed; M staging in 3/31 (9.6%) patients, upstaging in two and downstaging in one patient. PET/CT results caused radiotherapy modification in 21/31 patients (67.7%). PET/CT detected intra-parotid nodule in four patients, so additional radiation was added to the parotid in the treatment field. Retropharyngeal nodes were detected by PET/CT in three patients that were missed by conventional imaging. 18F-FDG PET/CT detected two patients of thyroid papillary carcinoma and one case of sigmoid neoplasm confirmed by histopathology.

Conclusion

18F-FDG-PET/CT is considered a valuable diagnostic test in head and neck squamous cell carcinoma at initial assessment which would change staging and radiotherapy planning and hence proper management.
Whole-body 18-F-FDG-PET in patients with leptomeningeal disease and correlation with MRI
Authors: Panda Ananya , Hintermeister Holly A. , Hunt Christopher H. , Kendi Ayse Tuba
Published: November 2020

Objective

Studies evaluating leptomeningeal disease on whole-body 18F-FDG PET are lacking. The purpose was to evaluate PET imaging of leptomeningeal disease and investigate the incremental utility of newer PET reconstructions in leptomeningeal disease.

Methods

PET imaging of 56 patients with leptomeningeal disease detected initially on MRI (n = 53) or cytopathology (n = 35) were retrospectively reviewed. Regular 3-dimensional iterative reconstruction (3D IR, n = 56) and advanced reconstruction (AdvRecon, n = 41) PET images were evaluated by readers blinded to clinical and MRI findings for uptake involving cauda equina, posterior fossa and spinal cord. Spinal cord uptake pattern was classified as normal (uptake < liver), uptake = liver, conus uptake > liver, conus and cervical cord uptake > liver and multifocal/diffuse uptake > liver. SUVmax ratios of conus/liver, conus/left atrium and conus/cervical cord were compared between 3D IR and AdvRecon datasets.

Results

Cauda equina uptake was seen in 64% and 78% on 3D IR and AdvRecon; posterior fossa uptake was seen in 52% and 54% on 3D IR and AdvRecon, respectively. Twelve percent had cauda equina or posterior fossa uptake visible only on AdvRecon. On 3D IR, normal spinal cord uptake was most common (27%); on AdvRecon, conus and cervical cord uptake > liver was most common (32%). Seven of 11 patients with normal spinal cord uptake on 3D IR were upgraded to increased uptake on AdvRecon. AdvRecon showed significantly higher conus/liver, conus/blood pool and conus/cervical cord SUVmax ratios (P < 0.0001).

Conclusion

Abnormal uptake in cauda equina, posterior fossa and spinal cord uptake are visible on FDG PET in leptomeningeal disease with increased conspicuity advanced PET reconstructions.
Osteoblastic and hyperostotic craniofacial lesion detected by 99mTc-labeled methylene diphosphonate bone scintigraphy and single-photon emission computed tomography/computed tomography: a pictorial essay
Authors: Ju Huijun , Paycha Frédéric
Published: November 2020

99mTc-bisphophonates bone scan, planar and single-photon emission computed tomography/computed tomography (SPECT/CT) modalities, is a commonly used technique that provides high sensitivity and specificity for detection of osseous metastases. However, besides bone metastases, SPECT/CT provides an accurate evaluation of the localization of the lesions and supplies anatomic information that can be valuable for diagnosis of nonmalignant bone diseases, occasionally disclosed in the skull. Reporting of craniofacial lesions detected by 99mTc-MDP (99mTc-labeled methylene diphosphonate) bone scintigraphy and SPECT/CT in the literature is limited. The aim of this pictorial review is to present the findings detected by 99mTc-MDP bone scintigraphy and SPECT/CT including cases under two broad categories: osteoblastic and hyperostosis craniofacial lesions.
The impact of permanent pacemaker implantation on thallium myocardial perfusion examination detecting ischemic heart disease
Authors: Huang Mu-Shiang , Chen Tse-Wei , Liu Yi-Sheng , Wang Yi-Shen , Lee Cheng-Han , Chen Ju-Yi
Published: November 2020

Objectives

Patients with permanent pacemaker (PPM) implantation may have altered coronary perfusion patterns that may influence the accuracy of myocardial perfusion examination modalities, which was observed in previous studies but with limited statistic power. Our aim was to examine the performance of thallium-201 (TL-201) myocardial perfusion examination in patients with implanted PPM.

Methods

Data of consecutive patients from our institution who had coronary angiography examination followed by TL-201 myocardial perfusion examination in pairs within 1 year were collected between January 2010 and December 2016 and were divided into PPM and control groups. Propensity score matching (PSM) was performed to compare the positive predictive value (PPV) of perfusion examinations.

Results

A total of 934 pairs of studies were evaluated, with 81 in the PPM group and 853 controls. The PPV decreased significantly in the PPM group (28.2 vs. 62.9%, P < 0.001). The finding of large (>20%) ischemic areas correlated significantly with all-cause mortality in the control group (OR, 2.34; P = 0.001), but not in the PPM group (OR,1.05; P = 0.943). After PSM, the PPV was still significantly lower in the PPM group than in the non-PPM group (28.6 vs. 66.2%, P < 0.001).

Conclusion

Study results do not support the appropriateness of using TL-201 perfusion examinations for risk stratification in patients with implanted PPM.

Video Abstract: http://links.lww.com/NMC/A181.
Rasch analysis to evaluate the motor function measure for patients with facioscapulohumeral muscular dystrophy
Authors: Mul Karlien , Horlings Corinne G.C. , Faber Catharina G. , van Engelen Baziel G.M. , Merkies Ingemar S.J.
Published: November 2020

Patient-relevant outcome measures for facioscapulohumeral muscular dystrophy (FSHD) are needed. The motor function measure (MFM) is an ordinal-based outcome measure for neuromuscular disorders, but its suitability to measure FSHD patients is questionable. Here, we performed Rasch analyses on MFM data from 194 FSHD patients to assess clinimetric properties in this patient group. Both the total scale and its three domains were analyzed (D1: standing position and transfers; D2: axial and proximal motor function; D3: distal motor function). Fit to the Rasch model, sample-item targeting, individual item fit, threshold ordering, sex- and age-based differential item functioning, response dependency and unidimensionality were assessed. Rasch analysis revealed multiple limitations of the MFM for FSHD, the most important being a large ceiling effect and suboptimal sample-item targeting, which were most pronounced for domains D2 and D3. There were disordered thresholds for most items, often resulting in items functioning in a dichotomous fashion. It was not possible to remodel the MFM into a Rasch-built interval scale. Remodeling of domain D1 into an interval scale with adequate fit statistics was achieved, but sample-item targeting remained suboptimal. Therefore, the MFM should be used with caution in FSHD patients, as it is not optimally suited to measure functional abilities in this patient group.
Clinicopathologic Characteristics of Mesonephric Adenocarcinomas and Mesonephric-like Adenocarcinomas in the Gynecologic Tract
Authors: Pors Jennifer , Segura Sheila , Chiu Derek S. , Almadani Noorah , Ren Hezhen , Fix Daniel J. , Howitt Brooke E. , Kolin David , McCluggage W. Glenn , Mirkovic Jelena , Gilks Blake , Park Kay J. , Hoang Lynn
Published: November 2020

Mesonephric adenocarcinoma (MA) and mesonephric-like adenocarcinoma (MLA) are uncommon neoplasms of the gynecologic tract that have until recently been poorly understood. Although their morphologic, immunohistochemical, and molecular profiles have been recently defined, little is known about their clinical behavior. Small studies have demonstrated inconsistent findings and no large studies have examined the clinical behavior of these adenocarcinomas. In this multi-institutional study, representing the largest and most stringently defined cohort of cases to date, we examined the clinicopathologic features of 99 MAs and MLAs (30 MAs of the uterine cervix, 44 MLAs of the endometrium, and 25 MLAs of the ovary). Only tumors with characteristic mesonephric morphology and either immunohistochemical or molecular support were included. Our results demonstrate that the majority of mesonephric neoplasms presented at an advanced stage (II to IV) (15/25 [60%] MA of the cervix, 25/43 [58%] MLA of the endometrium, and 7/18 [39%] MLA of the ovary). The majority (46/89 [52%] overall, 12/24 [50%] MA of the cervix, 24/41 [59%] MLA of the endometrium, and 10/24 [42%] MLA of the ovary) developed recurrences, most commonly distant (9/12 [75%] MA of the cervix, 22/24 [92%] MLA of the endometrium, and 5/9 [56%] MLA of the ovary). The 5-year disease-specific survival was 74% (n=26) for MA of cervix, 72% (n=43) for MLA of endometrium, and 71% (n=23) for MLA of ovary. Our results confirm that mesonephric neoplasms are a clinically aggressive group of gynecologic carcinomas that typically present at an advanced stage, with a predilection for pulmonary recurrence.
Striking Association of Lymphoid Enhancing Factor (LEF1) Overexpression and DUSP22 Rearrangements in Anaplastic Large Cell Lymphoma
Authors: Ravindran Aishwarya , Feldman Andrew L. , Ketterling Rhett P. , Dasari Surendra , Rech Karen L. , McPhail Ellen D. , Kurtin Paul J. , Shi Min
Published: November 2020

Anaplastic large cell lymphomas (ALCLs) are broadly classified into ALK-positive and ALK-negative. ALK-negative ALCL is composed of DUSP22-rearranged, TP63-rearranged, and triple-negative cases. While lymphoid enhancer–binding factor (LEF1) plays a crucial role in T-cell maturation, limited data exist on its expression in T-cell lymphomas, including ALCL. We characterized the expression of LEF1 in ALCL by immunohistochemistry. LEF1 nuclear expression in the neoplastic cells was graded as negative (0), weak (1+), intermediate (2+), or strong (3+), with the percentage of LEF1-positive neoplastic cells recorded. A total of 45 ALCL cases were evaluated, of which 16 were DUSP22-rearranged. About 93.8% (15/16) DUSP22-rearranged cases showed strong expression of LEF1 in >75% tumor cells, compared with 3.4% (1/29) non–DUSP22-rearranged ALCL (P<0.0001). The striking association of LEF1 protein overexpression with DUPS22 rearrangement in ALCL was further confirmed by a gene expression profiling study which revealed significantly higher LEF1 expression in DUSP22-rearranged ALCL compared with other ALCL subtypes (P=0.0001). Although LEF1 is a nuclear mediator of the Wnt/β-catenin pathway, CTNNB1 RNA and protein levels were not overexpressed in LEF1-positive cases, suggesting the LEF1 overexpression in ALCL may not be involved in the Wnt/β-catenin pathway. The strong and uniform LEF1 expression pattern has a high positive predictive value (93.8%) and high negative predictive value (96%) for DUSP22 rearrangement in ALK-negative ALCL. The combination of characteristic morphologic and molecular features of DUSP22-rearranged cases with the high LEF1 expression further emphasizes that DUSP22-rearranged ALCL represents a distinct clinicopathologic subset of ALCL.
MYB RNA In Situ Hybridization Facilitates Sensitive and Specific Diagnosis of Adenoid Cystic Carcinoma Regardless of Translocation Status
Authors: Rooper Lisa M. , Lombardo Kara A. , Oliai Bahram R. , Ha Patrick K. , Bishop Justin A.
Published: November 2020

Adenoid cystic carcinoma (AdCC) can demonstrate histologic and immunohistochemical (IHC) overlap with a wide range of salivary and nonsalivary tumors, especially in small biopsy specimens. While MYB fluorescence in situ hybridization (FISH) frequently is used to confirm the diagnosis of AdCC, the pathognomonic MYB-NFIB fusion is only present in 40% to 70% of cases. Likewise, although MYB RNA overexpression is seen in the vast majority of AdCC regardless of translocation status, MYB IHC has shown suboptimal specificity for this diagnosis. In this study, we sought to determine whether a novel chromogenic RNA in situ hybridization (ISH) platform could directly detect MYB RNA overexpression and offer a rapid diagnostic adjunct for AdCC. We performed MYB RNA ISH on 84 cases of AdCC as well as 128 other salivary tumors and 108 basaloid and sinonasal carcinomas that mimic AdCC. MYB RNA ISH was 92% sensitive for AdCC, including 97% of cases with MYB rearrangement and 83% without MYB rearrangement by FISH. It was also 89% specific for AdCC overall, with 95% specificity among other salivary tumors and 81% specificity in basaloid and sinonasal carcinomas. In contrast, MYB IHC was 94% sensitive but just 54% specific for AdCC. Overall, MYB RNA ISH provides superior sensitivity for the diagnosis of AdCC compared with MYB FISH and superior specificity compared with MYB IHC. This assay could provide a useful tool for rapidly confirming the diagnosis of AdCC in formalin-fixed, paraffin-embedded specimens.
Stack-Up Technique to Create a Three-Dimensional Costal Cartilage Framework in Ear Reconstruction
Authors: Dong Liwei , Hao Dongyue , Liu Hengxin , Cui Jiangbo , Yao Wende , Wei Siming , Xia Wensen , Ma Xianjie
Published: November 2020

Background:

Ear reconstruction is one of the most challenging procedures for plastic surgeons. The costal cartilage is the most accepted material, and the framework fabrication methods also vary with the different ear reconstruction methods. This study aimed to present our clinical experience using a novel method for costal cartilage framework fabrication with the “fully expansion technique” ear reconstruction without a skin graft. From January 2017 to June 2018, 107 patients with unilateral microtia underwent ear reconstruction with the fully expansion technique. Costal cartilage was designed into different components and stacked up to form the multilayer structure and adequate projection. Preexpansion provided larger skin flap for fully cover the anterior and posterior parts of the framework. Then the anterior ear structures and the posterior sulcus, as well as the ideal bilateral symmetry, were established simultaneously without a skin graft. A total of 107 patients in this group were followed up for 8 to 24 month, and altogether 98 patients (91.6%) were satisfied with the reconstruction. The cartilage “stack-up” framework fabrication and fully expansion technique provided a well-defined, well-projected, and bilateral symmetrical reconstructed ear.
Secondary Treatment of Cleft Lip Correction Sequelae With Percutaneous Needleotomy, Autologous Fat Grafting, and Local Flaps: An Integrated Approach
Authors: Klinger Marco , Klinger Francesco , Battistini Andrea , Lisa Andrea , Maione Luca , Caviggioli Fabio , Vinci Valeriano
Published: November 2020

Introduction:

Cleft lip and/or palate (CL/P) is the most common congenital craniofacial malformation. The severity of the anatomic deformity is highly variable and different techniques can be employed depending on whether the defect is unilateral or bilateral, complete or incomplete. Patients usually undergo multiple steps of reconstruction throughout childhood and adolescence and, for this reason, secondary deformities of the nasolabial region of the midface may ensue. Considering our experience in the treatment of scars, we opted to correct the cleft lip surgery sequelae not only with local flaps/scar revisions, but we decided to add the use of the autologous fat grafting (AFG) to induce a regenerative effect in these young patients.

Materials and Methods:

In this study we present the results obtained from a series of 12 consecutive Caucasian patients aged from 23 to 44 years with widened paramedian lip scars secondary to cleft lip reconstruction surgery, treated with a combination of needle-induced lysis of the scar tissue and AFG from January 2013 to December 2018.

Results:

After the procedure we observed an overall improvement in the quality of the scar tissue, in the function of mimic features, in the symmetry and cosmetics of the lower third of the nose. Patients’ satisfaction was excellent. Results were long lasting and remained virtually unchanged after 1 year of follow-up.

Conclusions:

Scar release by needle, AFG and local flaps are excellent tools for the treatment of cleft lip correction sequelae, but the combination of these surgical techniques can lead to even better results.

Level of Evidence: Level V
The Nasolabial Area Shown on Histology and P45 Sheet Plastination
Authors: Hwang Kun , Sui Hong-Jin , Han Seung Ho , Kim Hun
Published: November 2020

The aim of this study was to elucidate the relationships between the nasolabial fold and superficial fascia on histology and P45 sheet plastination.

Two centimeter width specimen of the nasolabial area were harvested from the skin to periosteum. Then, 10-μm sections were made, stained with Masson trichrome, and observed under a light microscope. Three head and neck specimens were sliced in horizontal sections (46 slices) using P45 sheet plastination (polyester resin corrosion-resistant method designed to preserve biological sectional specimens in situ). Through slicing, bleaching, dehydration, casting, forced impregnation, curing, cutting, and sanding the molds, P45 plastination provided good light transmission, allowing the internal structures within the sheet to be revealed clearly in their intact form.

The observations on histology and P45 sheet plastination correlated well. The nasolabial fold consisted of the superficial fatty layer of superficial fascia (SFS). At the beginning of the alar groove level, the nasolabial groove was located on the point where the medial limit of SFS met the levator labii superioris. At the alar base level, the nasolabial groove was located where the medial limit of the SFS met levator labii superioris. At the mouth corner level, the nasolabial groove was located where the medial limit of the SFS met the modiolus, including the orbicularis oris. The superficial fascia became scanty near the nasolabial groove, and the SFS comprised the nasolabial fold.

The results of the present study may be helpful for applying subcutaneous dissection or sub-superficial muscular aponeurotic system dissection in rejuvenation of the nasolabial area.
Does the Lockdown Influence the Oral and Maxillofacial Surgery Service in a Level 1 Trauma Hospital During the COVID-19 Pandemic?
Authors: Figueiredo Laura Braga , Araújo Stella Cristina Soares , Martins Gustavo Henrique , Costa Samuel Macedo , Amaral Marcio Bruno Figueiredo , Silveira Roger Lanes
Published: November 2020

The pandemic status of the Novel Coronavirus 2019 has affected many countries around the world, due to the high virulence of the SARS-CoV-2, the recommended protocol to prevent infection is social isolation. The purpose of this study was to compare the number of patients admitted and their epidemiological data on a Level 1 Trauma Hospital after the declaration of the pandemic status and the first week of mandatory lockdown, with the same period of time in the last year. This was a retrospective study of medical records from the patients admitted in the Oral and Maxillofacial Surgery of the João XXIII Hospital, between the March 24 and March 31 of 2020 and the same period of the last year. There was a 52.27% decrease in the total number of patients and 76.34% decrease in the total consultations of the service of oral and maxillofacial surgery during the lockdown. All the groups presented a decrease in significance with motor vehicle accidents events, the group 11 to 20 years old presented an increase on the correlation with violence (P = 0.019) and falls (P = 0.002). When comparing both sex with the etiologies, the male one presented an increase in the correlation with violence and falls. The female sex presented correlations only with the minor causes. No valid significance was observed when comparing females with violence events. The lockdown is an effective way to reduce the transmission of the COVID-19, the hospital usage and occupation.
Application of Medical Adhesive in Emergency Treatment of Head and Face Injury
Authors: Wang Chaochao , Zhang Li , Chen Muhu , Zhong Wu
Published: November 2020

Purpose:

The aim of this study was to analyze the application effect of medical adhesive in emergency surgical scalp and facial skin treatment. To explore the better application of medical adhesive in emergency work

Methods:

A total of 180 patients with scalp and facial skin laceration admitted to the emergency department of the Affiliated Hospital of Southwest Medical University from August 2018 to August 2019 were selected. The patients were divided into the control group (n = 70) and the treatment group (n = 110) using the random number table method. The control group was treated with debridement, local anesthesia, and suture technique without medical adhesive, whereas the treatment group was treated with medical adhesive after debridement without local anesthesia. The operation time, pain degree, total cost, and satisfaction of the 2 groups were compared.

Results:

The operation time in treatment group was shorter than that in control group (12.0 ± 2.6 minutes versus 17.7 ± 2.5 minutes, P < 0. 05), and the visual simulation score (VAS) of treatment group were lower than that in control group (2.45 ± 1.63 versus 5.66 ± 1.65, P < 0. 05), and the total cost in treatment group was higher than that in control group (¥906.6 ± 69.0 versus ¥329.8 ± 76.4, P < 0. 05). In control group 17 not satisfiedpatients, satisfied 37 patients, and 16 patients felt excellent; in treatment group, there are 7 not satisfiedpatients, 21 satisfied patients, and 82 felt excellent. Patients’ satisfaction was compared between the 2 groups, the difference was statistically significant (P < 0.05).

Conclusions:

The results suggest that Medical adhesive used in scalp skin trauma and facial wounds had the advantages of shorter operation time, less pain, and higher postoperative satisfaction of patients, but higher cost than conventional suture. Medical adhesive has obvious advantages and high feasibility in the treatment of scalp and facial skin wounds.