bluuebunny/crossref_metadata_2025 huggingface dataset:
Muscle Atrophy and Hypertrophy
Authors: Shaibani Aziz
Published: March 2018

Muscle atrophy is usually caused by interruption of axonal flow [axonal neuropathies, motor neuron diseases (MNDs), etc.]. If weakness is out of proportion to atrophy, demyelinating neuropathy should be suspected. Chronic myopathies and immobility also may cause atrophy, but no electromyography (EMG) evidence of denervation or myopathy is found. The pattern of atrophy is often helpful to localize the lesions. Atrophy of the interossi and preservation of the bulk of the thenar muscles suggest ulnar neuropathy, but atrophy of both would suggest a C8 or plexus pathology. Muscle enlargement may be due to fatty replacement, which can be confirmed by EMG and magnetic resonance imaging (MRI), or due to real muscle hypertrophy from excessive discharges (neuromyotonia).
Clinical Signs
Authors: Shaibani Aziz
Published: March 2018

In clinical neuromuscular medicine, clinical signs are very important and can lead to accurate diagnosis. There is nothing better than videos to demonstrate these signs and their elicitation and significance. We selected several clinical signs from our video archives for this purpose. A good clinician should use ancillary testing as an extension of the clinical examination rather than blindly. There is alternative to good observation and methodological elicitation of the physical findings. The art of the clinical examination starts by watching the patient walking to the examination room and stepping up to the examination table. It is curtail to unrobe and examine the back and front of the patient.
Skin Signs
Authors: Shaibani Aziz
Published: March 2018

Many neuromuscular diseases are expressed by skin manifestations such as dermatomyositis. Skin changes of dermatomyositis can be of many types and be subtle in dark skin. They include heliotropes, periungual telangiectasia, and thickening and fissuring of the skin. Unlike SLE rash, dermatomyositis rash affects the knuckles. Many systemic inflammatory diseases are associated with neuromuscular disease, such as vasculitis, systemic lupus erythematosus (SLE), and scleroderma. Steroids may lead to acne like skin lesions that should be differentiated from the rash of the underlying disease. This chapter provides examples of skin signs that are associated with neuromuscular diseases.
Diet, Gut, and Brain: A New Horizon
Authors: Bazzan Anthony J. , Monti Daniel A.
Published: March 2018

There is growing data that dietary factors have profound effects on inflammation, the gut microbiome, intestinal permeability, and the blood–brain barrier; all of which impact brain health and psychological well-being. The Western diet in particular is deleterious for both physical and cognitive/emotional health. This occurs primarily by causing inflammation in the gut and an activation of the immune system along with causing impairment in the integrity of the gut lining. This allows many reactive molecules to enter the general circulation and even cross the blood–brain barrier. Recent research advances elucidate that understanding the harmful physiological effects of certain dietary behaviors is as important as knowing the role of critical nutrients for optimal brain health. This chapter reviews current knowledge regarding diet and nutrition in the context of psychiatric disorders and brain health. Information is reviewed regarding the most appropriate dietary and nutrition approaches to support optimum brain health.
Behavioral Strategies for Happiness and Satisfaction
Authors: Greenberg Cathy , Nadler Relly
Published: March 2018

The neural circuitry associated with experiencing emotional pleasure such as derived from spiritual fulfillment, happiness, or love is likely the same or closely replicative of the neural circuitry associated with experiencing physical pleasure such as from sex, music, or warmth. The neural circuitry associated with experiencing physical pain such as from a headache, injury, or disease is likely the same or closely related to that associated with experiencing emotional pain such as social rejection, depression, or self-criticism. Attention management is essential for developing happiness and satisfaction, while the opposite, attention mismanagement, is a catalyst for unhappiness and dissatisfaction. Happiness is believed to have a set point in each person, and by all indications this set point can be enhanced through deliberate and supportive constructs. This chapter reviews the differences between positive and negative psychological components and how people can optimize them to support brain health and psychological well-being.
Mindfulness-Based Interventions for Psychiatric Disorders
Authors: Moss Aleeze , Reibel Diane
Published: March 2018

Mindfulness-Based Interventions (MBIs) are nonpharmacological interventions that show promise for the treatment of a number of mental health conditions. This chapter describes several MBIs, specifically Mindfulness-Based Stress Reduction (MBSR), Mindfulness-Based Cognitive Therapy (MBCT), Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT) and the research that supports the efficacy of these interventions in the treatment of psychiatric disorders. MBSR and MBCT have been shown to be effective in the treatment of anxiety and depression. DBT has been shown to be effective in the treatment of borderline personality disorder and ACT effective in the treatment of obsessive-compulsive disorder. New MBIs are being developed to work specifically with populations suffering with posttraumatic stress disorder, eating disorders, addictions, and attention deficit hyperactivity disorder. Current research on neural mechanisms associated with mindfulness training and its benefits are demonstrating structural and functional changes in the brain.
Integrative Approaches to Cognitive Decline
Authors: Kelly Thomas J. , Serruya Mijail
Published: March 2018

The ability to remember, plan, communicate, and multitask changes with normal, healthy aging. These cognitive abilities decline more rapidly and with greater severity in the setting of neurodegenerative disease. The most common etiology of neurodegenerative cognitive decline is Alzheimer’s disease, and other processes, such as those triggered by stroke, dementia with Lewy bodies, and traumatic brain injury, also cause significant debility. The purpose of this chapter is to review evidence-based integrative medical interventions that may slow both normal and disease-related cognitive decline in order to improve day-to-day function. Aerobic exercise, healthy nutrition, daily social and cognitive engagement, good sleep hygiene, and neuromodulatory approaches including mindfulness meditation and yoga, when all followed together in a consistent manner, interact synergistically to become more than the sum of their parts as a potent, integrative intervention that can sustain healthy, thriving cognitive function.
Somatic treatments
Authors: Lam Raymond W.
Published: March 2018

Somatic treatments for depression include non-invasive modalities such as wake therapy (sleep deprivation), exercise, and light therapy. The modern techniques now used for electroconvulsive therapy make it an effective, safe, and well-tolerated (but still underutilized) treatment for patients with severe, psychotic, or medication-resistant depression. Repetitive transcranial magnetic stimulation now has good evidence for acute efficacy, but its use is still limited by lack of data on maintenance and long-term management. Surgical and neuromodulation treatments, such as vagus nerve stimulation, deep brain stimulation, and limbic neurosurgery, may be clinically useful for some patients with difficult-to-treat and refractory depression.
Elements of Medical Cytogenetics
Authors: McKinlay Gardner R. J , Amor David J
Published: March 2018

Chromosome is a combination of Greek words meaning colored (chrom) body (soma). Albeit that molecular methodologies have substantially taken over from classical cytogenetics, and providing a different view of the genetic material, the word chromosome will surely last forever. This chapter provides a very brief historical introduction, and a basic introduction to what chromosomes are, and the ways in which they can be abnormal. The distinction is made between disorders in which there is an excess (trisomy, duplication) of chromosome material, and those in which there is a deficiency (monosomy, deletion). Ethical questions are rehearsed that may arise in the context of the clinical management of chromosome abnormalities.
The Origins and Consequences of Chromosome Pathology
Authors: McKinlay Gardner R. J , Amor David J
Published: March 2018

To deal intelligently with common questions from “chromosomal families,” counselors need a broad knowledge of how gametes form, how chromosomes behave, and how the early conceptus grows. This chapter describes the ways in which chromosomes are transmitted, and the ways in which these processes can go wrong and lead to clinical abnormality. The distinction is made between “pure” aneuploidies, and abnormalities due to structural rearrangement. In particular, meiotic nondisjunction, with respect to the generation of pure aneuploidy, is discussed in considerable detail. The origins of chromosome mosaicism are reviewed. Mention is made of abnormalities due to epigenetic mechanisms.
Sex Chromosome Translocations
Authors: McKinlay Gardner R. J , Amor David J
Published: March 2018

The sex chromosomes (gonosomes) are different, and sex chromosome translocations need to be considered separately from translocations between autosomes. A sex chromosome can engage in translocation with an autosome, with the other sex chromosome, or even with its homolog. The qualities of the sex chromosomes have unique implications in terms of the genetic functioning of gonosome-autosome translocations. This chapter acknowledges the specific peculiarities that the sex chromosomes imply: the X being subject to transcriptional silencing; and the very small Y gene complement being confined largely to sex-determining loci. It reviews translocations between sex chromosomes and autosomes; between X and Y chromosomes; and even the very rare circumstance of between X chromosomes and between Y chromosomes. The differences in assessing risk, according to chromosome form, in comparison with the autosomal translocation, are reviewed, and the biology behind these differences is discussed.
Robertsonian Translocations
Authors: McKinlay Gardner R. J , Amor David J
Published: March 2018

Robertsonian translocations are among the most common balanced structural rearrangements seen in the general population, with a frequency in newborn surveys of about 1 in 1,000. Robertsonian translocations have their own peculiar characteristics and need to be considered separately. These translocations arise from fusions between different acrocentric chromosomes (heterologous Robertsonian translocation) or, rather rarely, between the same chromosome (homologous Robertsonian translocation). The imbalances which may be seen in gametes/offspring of carriers are either pure aneuploidies, or full uniparental disomies. There is also an association with male infertility. This chapter considers the case of the phenotypically normal person who carries, in balanced form, a Robertsonian translocation.
Chromosome Instability Syndromes
Authors: McKinlay Gardner R. J , Amor David J
Published: March 2018

A defect of DNA repair is the factor underlying the chromosome instability syndromes, also known as chromosome breakage syndromes. The “instability” refers to the predisposition of the chromosomes to undergo rearrangement or to display other abnormal cytogenetic behavior. The classic chromosome instability syndromes are individually rare: Fanconi syndrome, ataxia-telangiectasia, and Bloom syndrome. Smaller-print conditions are yet more rare, including Roberts syndrome; the immunodeficiency, centromeric instability, facial anomalies (ICF) syndrome; and Nijmegen breakage syndrome. The role of cytogenetics in diagnosis is less central than formerly, but the interest in these conditions remains, and this chapter provides a full listing. Autosomal recessive inheritance is typical, albeit not universal.
Normal Chromosomal Variation
Authors: McKinlay Gardner R. J , Amor David J
Published: March 2018

Knowing what is normal and what is not is becoming a particular challenge in this era of molecular karyotyping. This chapter reviews the normal chromosome variation from classical times, now very well understood. This is followed by a discussion of the complexity and uncertainty that the molecular approach has, in this century, challenged researchers with. In particular, the chapter discusses the concept of the copy number variant (CNV) and how the harmlessness, or not, of a CNV may be assessed. Mention is made of CNVs potentially acting as “second hits,” such that, while nonpathogenic in one setting, they may contribute to an abnormal phenotype in the context of another, independent chromosome abnormality or CNV. The “sliding scale” of interpretation from “known pathogenic” through “known benign” Is noted. The chapter refers to useful databases to which the counselor may have access.
The “Drugs-Crime Nexus”
Authors: de Andrade Dominique
Published: March 2018

The prioritization of imprisonment as a response to drug use in many countries has led to growing prison populations, with little impact on drug use, drug-related harm, or drug-related crime. There is increased international debate around how to best manage and respond to at-risk populations, with good evidence to suggest that embracing harm reduction strategies in the community and in prison can lead to reduced rates of imprisonment, infectious disease, and other preventable harms. Despite this, evidence-based treatment and harm reduction programs have largely failed to penetrate the walls of correctional institutions in most countries. This chapter provides an overview of major drug groups and explores the impact of drug policy on international imprisonment rates, and the diversity of responses to people who use drugs in the community and prison. The potential for corrections to play a significant therapeutic role in addressing the urgent treatment and harm reduction needs of at-risk, drug-using populations in prison and during their transition back to the community is highlighted.
Substance Use and Consequences Among People Who Have Been Incarcerated
Authors: Binswanger Ingrid A. , Finlay Andrea K.
Published: March 2018

This chapter explores how the transition from prison to the community can lead to poor health outcomes, especially substance-related health complications. These adverse health effects may occur via one or more of the following mechanisms: (1) the toxic effects of tobacco, alcohol, and other drugs; (2) health behaviors associated with using or acquiring substances or under the influence of substances, as well as poor chronic disease self-management; (3) conditions that are acquired, exacerbated, or progress as a result of the “downstream” social, behavioral, occupational, and economic consequences of addiction; and (4) institutional, policy, environmental, and social contexts that do not support maximum well-being and health. These conceptual categorizations, while not exhaustive, may help practitioners, policymakers, and public health officials design appropriately targeted preventive and intervention strategies. People released from prisons should also be included in broader public health efforts to reduce the risk of overdose and address substance-related harms.
Cranial nerves
Authors: Anbarasu Arangasamy , Lane Jack I.
Published: March 2018

This section discusses the cranial nerve. Cranial nerves are important structures involved with special functions of smell, sight, lacrimation, hearing, balance, taste, facial movement, mastication and swallowing. There are twelve pairs of cranial nerves which are named anatomically by the level at which they exit the brain and brainstem, with lower numbered cranial nerves exiting superior and anterior to higher numbered ones.
Livedoid Vasculopathy Presenting in a Patient With Sickle Cell Disease
Authors: Reagin Heather , Marks Etan , Weis Stephen , Susa Joseph
Published: March 2018

We report a case in which a 43-year-old African American male with medical history of sickle cell disease (SCD) presented with a nonhealing ulcer. Biopsy revealed features of livedoid vasculopathy. Previously, livedoid vasculopathy had only been described in a patient with sickle cell trait, but never in a patient with SCD. Livedoid vasculopathy most commonly affects the distal lower extremities and is characterized by irregular, punched-out, painful ulcers that heal with stellate white scars of atrophie blanche. Histologically, it reveals segmental hyalinizing vessels, focal thrombosis, and endothelial proliferation. The etiology is currently unclear, but it has been shown to be related to procoagulant states and a diagnosis of livedoid vasculopathy should prompt a thorough hypercoagulable workup, including testing for SCD in high-risk patients.
Giant Pilomatricoma Arising as a Rapidly Growing Vascularized Tumor in a Child
Authors: Yannoutsos Alexandra , Malloizel-Delaunay Julie , Tournier Emilie , Abid Abdelaziz , Bura-Rivière Alessandra
Published: March 2018

In this observation, we report an unusual presentation of a pilomatricoma in an 8-year-old girl who was initially referred to the department of vascular medicine for diagnosis and care of a suspected mixed lymphatic venous malformation. The lesion on her left shoulder presented as a giant bluish-purple red solitary mass, painful and rapidly growing, measuring 7 cm in anteroposterior diameter. This mass did not present the typical characteristics of a lymphatic venous malformation but exhibited warning signs of malignancy on clinical examination and imaging. The diagnosis of pilomatricoma was reached by fine-needle aspiration biopsy of the mass, showing mummified “ghost” squamous cells and a granulomatous inflammatory reaction stroma with scattered multinucleated giant cells and no sign of malignancy. Complete surgical excision associated with plastic surgery was curative. Diagnostic and management approach to skin lesion in childhood is subject of great concern for health care professionals, including dermatologists and vascular medicine specialists who may be confronted with this atypical presentation of one of the most common causes of superficial neck masses in children.
Human Papillomavirus–Driven Squamous Lesions: High-Risk Genotype Found in Conjunctival Papillomas, Dysplasia, and Carcinoma
Authors: Moyer Amanda B. , Roberts Jordan , Olsen Randall J. , Chévez-Barrios Patricia
Published: March 2018

Background:

Human papillomavirus (HPV) is a causative agent for intraepithelial squamous neoplasms, particularly on mucosal surfaces. HPV has a well-established association with squamous cell carcinoma (SCC) of the oropharynx and genital tract, and recent studies suggest a potential role in ocular and periocular squamous neoplasms. Multiple high-risk HPV genotypes are associated with histologically similar squamous neoplasms, and some HPV genotypes have been differentially associated with high- or low-grade lesions.

Methods:

Squamous lesions were screened with immunohistochemical markers p16 and Ki-67 to compare expression in conjunctival papillomas (n = 21) to papillomas with high-grade dysplasia, SCC in situ, and invasive SCC (n = 40). Polymerase chain reaction was performed using the Roche COBAS HPV assay to identify the 14 most common high-risk HPV genotypes.

Results:

Compared with squamous papillomas, the lesions showing high-grade dysplasia or worse expressed p16 with greater intensity and in a greater percentage of the lesion. A trend toward mild Ki-67 expression in papillomas versus marked Ki-67 expression in high-grade squamous lesions was also observed. HPV-16 was present in 7 of the SCC in situ and invasive SCC lesions but none of the papillomas.

Conclusions:

HPV may have an important role in squamous lesions of the conjunctiva. In addition to positive polymerase chain reaction results, strong and diffuse p16 expression with marked Ki-67 is strongly suggestive of an HPV-driven lesion.
Vaginal estrogen and mammogram results: case series and review of literature on treatment of genitourinary syndrome of menopause (GSM) in breast cancer survivors
Authors: Zuo Stephanie Wang , Wu Harold , Shen Wen
Published: March 2018

Objective:

To examine mammographic density before and after at least 1 year of vaginal estrogen use in a small cohort of healthy postmenopausal women and women with a personal history of breast cancer.

Methods:

We extracted data via chart review of patients from a single practitioner's menopause specialty clinic in Baltimore, MD. Mammographic change was primarily determined via the Bi-RADS scoring system, including the Bi-RADS density score. In addition, we conduct a narrative review of the current literature on the usage of local estrogen therapy, and systemic and local alternatives in the treatment of genitourinary syndrome of menopause (GSM) in breast cancer survivors.

Results:

Twenty healthy postmenopausal women and three breast cancer survivors fit our inclusion criteria. Amongst these two groups, we did not find an increase in mammographic density after at least 1 year and up to 18 years of local vaginal estrogen. Ospemifene use in one patient did not appear to be associated with any change in Bi-RADS score. Our narrative review found little data on the effects of vaginal estrogen therapy or newer alternative systemic therapies such as ospemifene on mammographic density.

Conclusions:

Low-dose vaginal estrogen use for 1 or more years in a small cohort of women with GSM did not appear to be associated with any changes in breast density or Bi-RADS breast cancer risk scores in the majority of study participants, including three breast cancer survivors. Larger long-term controlled clinical trials should be conducted to examine the effects of low-dose vaginal estrogen on mammographic density in women with and without a personal history of breast cancer. Furthermore, relative efficacy and risk of vaginal estrogen compared with other forms of treatment for GSM should also be studied in long-term trials.
Contextual factors that influence quality improvement implementation in primary care: The role of organizations, teams, and individuals
Authors: Shea Christopher M. , Turner Kea , Albritton Jordan , Reiter Kristin L.
Published: March 2018

Background:

Recent emphasis on value-based health care has highlighted the importance of quality improvement (QI) in primary care settings. QI efforts, which require providers and staff to work in cross-functional teams, may be implemented with varying levels of success, with implementation being affected by factors at the organizational, teamwork, and individual levels.

Purpose:

The purpose of our study was to (a) identify contextual factors (organizational, teamwork, and individual) that affect implementation effectiveness of QI interventions in primary care settings and (b) compare perspectives about these factors across roles (health care administrators, physician and nonphysician clinicians, and administrative staff).

Methods/Approach:

We conducted semistructured interviews with 24 health care administrators, physician and nonphysician primary care providers, and administrative staff representing 10 primary care practices affiliated with one integrated delivery system.

Results:

Participants across all roles identified similar organizational- and team-level factors that influence QI implementation including organizational capacity to take on new initiatives (e.g., time availability of physicians), technical capability for QI (e.g., data analysis skills), and team climate (e.g., how well staff work together). There was greater variation in terms of individual-level factors, particularly perceived meaning and purpose of QI. Perceptions about value of QI ranged from positive impacts on patient care and practice competitiveness to decreased efficiency and distractions from patient care, but differences did not appear attributable to role.

Conclusions:

Successful QI implementation requires effective collaboration within cross-functional teams. Additional research is needed to assess how best to employ implementation strategies that promote cross-understanding of QI among team members and, ultimately, effective implementation of QI programs.

Practice Implications:

Health care managers in primary care settings should strive to create a strong teamwork climate, reinforced by opportunities for staff in various roles to discuss QI as a collective.
Application of Regenerative Treatment for Tympanic Membrane Perforation With Cholesteatoma, Tumor, or Severe Calcification
Authors: Kanemaru Shin-ichi , Kanai Rie , Yoshida Misaki , Kitada Yuji , Omae Kaoru , Hirano Shigeru
Published: March 2018

Objective:

To apply regenerative treatment for tympanic membrane (TM) perforation to patients with severe calcification of the TM, cholesteatomas, or tumors localized to the tympanic cavity.

Study Design:

Controlled clinical pilot study.

Setting:

General hospitals.

Patients:

Forty-five patients (age: 8–85; M = 19, F = 26) were selected from patients with or without TM perforation for the regenerative treatment. Twenty-five patients had cholesteatomas, 3 had tumors, and 17 had severe TM calcification. Patients were classified into three groups based on TM perforation size: less than 1/3 of the TM as Grade I (n = 5), 1/3 to 2/3 as Grade II (n = 19), and over 2/3 as Grade III (n = 21). Twenty patients who underwent standard tympanoplasty type I were selected as historical controls.

Materials and Methods:

Materials for the TM repair included gelatin sponge with basic fibroblast growth factor and fibrin glue. After lesions were removed through the TM perforation, gelatin sponge immersed in basic fibroblast growth factor was placed over the perforation. Fibrin glue was then dripped onto the sponge. Treatment efficacy was evaluated 6 months posttreatment.

Results:

Complete closure of the TM perforation was achieved in 91% (n = 41/45) of the patients in this regenerative treatment. Improvement in average hearing levels and air-bone gap were much better with this treatment than in the historical control group.

Conclusion:

This new regenerative therapy is useful not only for patients with simple TM perforations but also for those with cholesteatomas, tumors, or severe calcification without requiring conventional surgical procedures. This regenerative therapy is an easy, safe, cost-effective, and minimally-invasive treatment.
History of Publications from the American Otological Society: A Celebration of the 150-Year History of the American Otological Society
Authors: Lustig Lawrence R.
Published: March 2018

The American Otological Society (AOS) has been on the forefront of advancing the science of auditory and vestibular physiology, and art of ear medicine since its founding in 1868. For 150 years, through its publications, the AOS has provided a critical forum to debate these advances, highlighting treatment successes and failures, and served a place to celebrate its history. This historical review provides an overview of the publications of the AOS since its founding: the Transactions of the annual meeting from 1868 through 2006, Treatises on Otosclerosis (1928–1935), the History of the Society from the 100 and 125th anniversary, and the sponsored Society journals—American Journal of Otology (1879–1883, 1979–2000) and Otology & Neurotology (2001–present).
Practice of Otology During the First Quarter Century of the American Otological Society (1868–1893)
Authors: Sioshansi Pedrom C. , Jackler Robert K. , Alyono Jennifer C.
Published: March 2018

Objective:

To describe the practice of otology in America during the first quarter century of the American Otological Society (AOS).

Methods:

Two sources were used to determine the most prevalent disease conditions cared for and surgical procedures undertaken during this era. All articles published in the AOS transactions between 1868 and 1893 were studied as were the otology textbooks published by 6 of the first 10 Presidents of the Society.

Results:

The primary emphasis of late 19th century American otological scholarship was on chronic ear infection with numerous articles focusing on complications of otitis including frequent descriptions of fatalities. Much emphasis was placed upon the Eustachian tube with catheterization and insufflation a major part of otological practice. Due to limitations in technology, the overwhelming focus was on diseases of the ear canal and middle ear. Understanding of temporal bone anatomy was much superior to that of physiology. Erroneous speculations on the function of the middle and inner ear were common. Surgical interventions were largely limited to myringotomy and mastoidectomy, the latter of which was sometimes life saving during the preantibiotic era.

Conclusion:

The latter half of the 19th century saw the emergence of otology as a specialty in America and many emerging diagnostic and therapeutic advances were adopted. While capabilities were notably limited during this era, the efforts of a small band of pioneer otologists in the founder generation of the AOS contributed greatly to the progress of the emerging specialty.
Women of the American Otological Society
Authors: Alyono Jennifer C. , Jackler Robert K. , Chandrasekhar Sujana S.
Published: March 2018

Objective:

To describe the history of women in the American Otological Society (AOS).

Methods:

Biographies of the early women of the AOS were compiled through review of the AOS transactions, their published scholarship, newspaper articles, and memorials. Interviews were conducted with the only two women to have led the society and also with former colleagues and family members of pioneering AOS women members who are no longer with us. The evolving gender composition of the society over time was researched from AOS membership lists and compared with data on surgical workforce composition from multiple sources such as the Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, American Medical Association, and the American Academy of Otolaryngology—Head and Neck Surgery.

Results:

Although American women specialized in otology as far back as 1895, the first woman to be invited to join the AOS as Associate member in 1961 was Dorothy Wolff, PhD. The first female full member was otologic surgeon LaVonne Bergstrom, M.D., who was elected in 1977, 109 years after the foundation of the Society. As of 2017, only two women have served as AOS President. The first was Aina Julianna Gulya, M.D., who took office during the 133rd year in 2001. At the time of the sesquicentennial (2017), 7.5% of AOS members are women including three of eight who serve on the AOS Council. This compares with 15.8% of women among the otolaryngology workforce and a growing 10.9% representation among those who have earned subcertification in neurotology.

Conclusion:

Gender disparities remain in the AOS, but both participation and scholarly contributions by women in otology have grown substantially since the society's inception 150 years ago, and particularly in the 21st century. Increasing the presence of women in leadership provides role models and mentorship for the future.
Diagnoses of Dizziness- and Vertigo-related Disorders in ENT Practices in Germany
Authors: Seidel David Ulrich , Park Jonas Jae-Hyun , Sesterhenn Andreas M. , Kostev Karel
Published: March 2018

Aim:

The aim of this study was to analyze the prevalence of dizziness- and vertigo-related diagnoses in ear, nose, and throat (ENT) practices in Germany and the associated demographic characteristics based on data from a representative nationwide practice database.

Method:

The study sample included patients from 138 ENT practices in Germany who received dizziness- and vertigorelated diagnoses (ICD-10 code) between January 2012 and December 2015. Collected parameters included age, sex, insurance status, prescribed medication (anatomical therapeutic chemical [ATC] class), and referrals to other specialists and hospitals.

Results:

A total of 107,458 patients were available for analysis. Most common diagnoses were “dizziness and giddiness” (67.7%), “benign paroxysmal vertigo” (10.2%) and “disorder of vestibular function, unspecified” (7.2%). Referrals and admissions were made in 12.8%, mostly to radiologists (7.7%), followed by neurologists (3.7%), and hospitals (1.4%). Most referrals were made for unspecific diagnoses and for “vestibular neuronitis.” The rate of medical prescriptions was 37.3%, with the most common prescription being for antivertigo preparations.

Conclusions:

Dizziness- and vertigo-related disorders are frequently diagnosed in ENT practices in Germany. The majority of these diagnoses are unspecific and lead to an increased rate of referrals and hospital admissions. The medical prescription rate, especially of antivertigo preparations, was high, even among patients with benign paroxysmal positioning vertigo. This study reflects a mostly pragmatic approach to a complex diagnostic and therapeutic challenge in daily ENT practice as well as the limited ability of the ICD-10 system to classify the underlying etiology.
Prevalence of Myocardial Fibrosis by Left Ventricular Assist Device Apical Core Biopsy and Correlation with Other Markers of Myocardial Recovery
Authors: Schultz Jessica , John Ranjit , Martin Cindy , Kamdar Forum , Thenappan Thenappan , Cogswell Rebecca
Published: March 2018

Myocardial fibrosis identified by apical core pathology at the time of left ventricular assist device (LVAD) implantation may add information regarding myocardial recovery potential. In this analysis, we report the prevalence of myocardial fibrosis by cardiomyopathy type and its association with other known markers of left ventricular recovery. Left ventricular assist device core pathology was reviewed on 332 patients who underwent LVAD implantation at a single institution between 2005 and 2016. Baseline clinical and echocardiographic characteristics were compared among patients with and without myocardial fibrosis by cardiomyopathy type. Among the 332 LVAD core specimens, myocardial fibrosis was present in 79%. Myocardial fibrosis was more common in ischemic than in nonischemic patients (90% vs. 66%; p < 0.001). Patients with fibrosis were older than those without (58 ± 12 vs. 55 ± 19; p < 0.05). Among the nonischemic cardiomyopathy cases, those with fibrosis were more likely to have an implantable cardioverter defibrillator (ICD) 81% and to be diabetic 81%. Fibrosis was not associated with left ventricular end-diastolic diameter (LVEDD), creatinine, or N-terminal prohormone of brain natriuretic peptide (NT-pro BNP). Myocardial fibrosis by apical core biopsy correlated with several known markers of left ventricular recovery including cardiomyopathy type, age, and presence of an ICD. In nonischemic cardiomyopathy patients, the degree of myocardial fibrosis may add information regarding recovery potential.
Biologics in pediatric lung disease
Authors: McGhee Sean A.
Published: March 2018

Purpose of review

Although biologic therapies can provide outstanding efficacy in the management of lung disease, especially asthma, most of these agents have been approved only for adults. Recent findings provide new strategies for using these agents in children.

Recent findings

Extensive evidence has consistently demonstrated the efficacy and safety of biologic therapy for asthma. In addition, some studies have documented potentially important secondary effects, such as improving response to respiratory virus infection in asthmatic patients. Additional strategies for improving asthma control using biologic therapy, such as seasonal administration, have been suggested, and may limit cost while still providing a high degree of efficacy.

Many of the current biologics are able to readily establish control even in asthmatic patients for whom inhaled steroid and long-acting β agonist have failed. However, biologics currently have limited regulatory approval and availability in the pediatric age range, despite this age being disproportionately affected by asthma. In addition, successful biologics for asthma to date have largely been limited to the Th2-high endotype of asthma, and there is great need for similar medications to target the Th2-low endotype. Other pediatric lung disease might well benefit from the specificity allowed by biologic therapy.
A novel antibiotic-like substance isolation from a dermatophyte, Trichophyton rubrum
Authors: Aubaid Adnan H. , Al-Shawi Haider A. , Al-Dujaili Nawfal H.
Published: March 2018

Secondary metabolites (SM) products permanently played an important role in medicine; fungi metabolites have increasingly become major players in recent pharmaceutical discovery in particular antimicrobial agents. The aim of study was to prepare and characterize of potential biological extract of culture filtrate ofTrichophyton rubrumand tested as antibacterial, antioxidant agents. Local isolates of a dermatophyteT. rubrumwere used and examined for production of SM. Extracts were checked for physical and chemical characterization using Fourier transform infrared spectrophotomete and HPLC and their cytotoxicity using a sensitive in-vitro brine shrimp lethality bioassay. The results revealed the isolation, preparation and characterization of different components of SM, included especially kojic acid, fusidic acid, amides and sulfones which gave antibacterial and antioxidant properties. In conclusion, the current study established the ability of a dermatophyte,T. rubrumto produce antibiotic-like substances, especially the sulfones which not isolated and recorded previously fromT. rubrum.
Mediastinal Synovial Sarcoma
Authors: Terra Simone B.S.P. , Aesif Scott W. , Maleszewski Joseph J. , Folpe Andrew L. , Boland Jennifer M.
Published: March 2018

Synovial sarcoma (SS), a translocation-associated sarcoma characterized by SS18-SSX1/2 fusion, presents most often in the extremities of young adults. While SS regularly occurs in the pleuropulmonary parenchyma, the mediastinum is an exceedingly rare primary site; the literature on this subject is predominantly composed of case reports and small series, mostly without molecular confirmation. Cases of mediastinal SS were selected from our institutional and consultation archives. Diagnoses were confirmed by either SS18 fluorescence in situ hybridization (n=6) or reverse transcription polymerase chain reaction for SS18-SSX1/2 (n=15). Mediastinal SSs occurred in 21 patients (15 men; mean age, 38 y; range, 21 to 75). Only 1 patient was older than 50 years. Average tumor size was 13.5 cm (range: 6.4 to 23 cm). One tumor was biphasic and the rest were monophasic, 11 of which were poorly differentiated (52%). Of 10 cases with known fusion transcripts, 6 had SS18-SSX2 and 4 had SS18-SSX1. Follow-up was known for 16 patients (mean: 18.9 mo; range: 5 to 45): 14 had local disease progression or recurrence, and 6 had metastasis. Death from disease occurred in 11 of 16 patients (69%) at 5 to 32 months, and 5 (36%) were alive with disease at last follow-up (6 to 45 mo). Mediastinal SS is a rare and aggressive malignancy most common in patients younger than 50 years. Most are monophasic and reach large size before detection. Poorly differentiated morphology is common. SS should be included in the differential diagnosis of spindle cell, biphasic and poorly differentiated mediastinal tumors. Because of the rarity of SS at this site, molecular testing is recommended to confirm the diagnosis.
Characterization of Pediatric In-Hospital Cardiopulmonary Resuscitation Quality Metrics Across an International Resuscitation Collaborative*
Authors: Niles Dana E. , Duval-Arnould Jordan , Skellett Sophie , Knight Lynda , Su Felice , Raymond Tia T. , Sweberg Todd , Sen Anita I. , Atkins Dianne L. , Friess Stuart H. , de Caen Allan R. , Kurosawa Hiroshi , Sutton Robert M. , Wolfe Heather , Berg Robert A. , Silver Annemarie , Hunt Elizabeth A. , Nadkarni Vinay M.
Published: March 2018

Objectives:

Pediatric in-hospital cardiac arrest cardiopulmonary resuscitation quality metrics have been reported in few children less than 8 years. Our objective was to characterize chest compression fraction, rate, depth, and compliance with 2015 American Heart Association guidelines across multiple pediatric hospitals.

Design:

Retrospective observational study of data from a multicenter resuscitation quality collaborative from October 2015 to April 2017.

Setting:

Twelve pediatric hospitals across United States, Canada, and Europe.

Patients:

In-hospital cardiac arrest patients (age < 18 yr) with quantitative cardiopulmonary resuscitation data recordings.

Interventions:

None.

Measurements and Main Results:

There were 112 events yielding 2,046 evaluable 60-second epochs of cardiopulmonary resuscitation (196,669 chest compression). Event cardiopulmonary resuscitation metric summaries (median [interquartile range]) by age: less than 1 year (38/112): chest compression fraction 0.88 (0.61–0.98), chest compression rate 119/min (110–129), and chest compression depth 2.3 cm (1.9–3.0 cm); for 1 to less than 8 years (42/112): chest compression fraction 0.94 (0.79–1.00), chest compression rate 117/min (110–124), and chest compression depth 3.8 cm (2.9–4.6 cm); for 8 to less than 18 years (32/112): chest compression fraction 0.94 (0.85–1.00), chest compression rate 117/min (110–123), chest compression depth 5.5 cm (4.0–6.5 cm). “Compliance” with guideline targets for 60-second chest compression “epochs” was predefined: chest compression fraction greater than 0.80, chest compression rate 100–120/min, and chest compression depth: greater than or equal to 3.4 cm in less than 1 year, greater than or equal to 4.4 cm in 1 to less than 8 years, and 4.5 to less than 6.6 cm in 8 to less than 18 years. Proportion of less than 1 year, 1 to less than 8 years, and 8 to less than 18 years events with greater than or equal to 60% of 60-second epochs meeting compliance (respectively): chest compression fraction was 53%, 81%, and 78%; chest compression rate was 32%, 50%, and 63%; chest compression depth was 13%, 19%, and 44%. For all events combined, total compliance (meeting all three guideline targets) was 10% (11/112).

Conclusions:

Across an international pediatric resuscitation collaborative, we characterized the landscape of pediatric in-hospital cardiac arrest chest compression quality metrics and found that they often do not meet 2015 American Heart Association guidelines. Guideline compliance for rate and depth in children less than 18 years is poor, with the greatest difficulty in achieving chest compression depth targets in younger children.
Cardiac Index Changes With Fluid Bolus Therapy in Children With Sepsis—An Observational Study*
Authors: Long Elliot , Babl Franz E. , Oakley Ed , Sheridan Bennett , Duke Trevor
Published: March 2018

Objectives:

Fluid bolus therapy is the initial recommended treatment for acute circulatory failure in sepsis, yet it is unknown whether this has the intended effect of increasing cardiac index. We aimed to describe the effect of fluid bolus therapy on cardiac index in children with sepsis.

Design:

A prospective observational cohort study.

Setting:

The Emergency Department of The Royal Children’s Hospital, Melbourne, VIC, Australia.

Patients:

A convenience sample of children meeting international consensus criteria for sepsis with acute circulatory failure.

Intervention:

Treating clinician decision to administer fluid bolus therapy.

Measurements and Main Results:

Transthoracic echocardiography was recorded immediately before, 5 minutes after, and 60 minutes after fluid bolus therapy. Cardiac index was calculated by a pediatric cardiologist blinded to the timing of the echocardiogram. Cardiac index was calculated for 49 fluid boluses in 41 children. The median change in cardiac index 5 minutes after a fluid bolus therapy was +18.0% (interquartile range, 8.6–28.1%) and after 60 minutes was –6.0% (interquartile range, –15.2% to 3.0%) relative to baseline. Thirty-one of 49 fluid boluses (63%) resulted in an increase in cardiac index of greater than 10% at 5 minutes, and these participants were considered fluid responsive. This was sustained in four of 31 (14%) at 60 minutes. No association between change in cardiac index at 5 or 60 minutes and age, baseline mean arterial blood pressure, fluid bolus volume, and prior volume of fluid bolus therapy was found on linear regression.

Conclusions:

Fluid bolus therapy for pediatric sepsis is associated with a transient increase in cardiac index. Fluid responsiveness is variable and, when present, not sustained. The efficacy of fluid bolus therapy for achieving a sustained increase in cardiac index in children with sepsis is limited.
Anatomical Examination of Mandibular Condyle Protrusion Into the Middle Cranial Fossa
Authors: Wilson Charlotte , Iwanaga Joe , Oskouian Rod J. , Tubbs R. Shane
Published: March 2018

Trauma to the mandible can occasionally be a life-threatening event. Although extremely rare with only 56 reported patients in the English language, fracture of the floor of the middle cranial fossa with protrusion of the mandibular condyle into the middle cranial fossa was first reported in 1963 by Dingman. The authors review the anatomy of the temporomandibular joint in relation to the middle cranial fossa and demonstrate the possible complications due to condylar intrusion with anatomical dissection.
Complications of Cranioplasty
Authors: Sahoo Nanda Kishore , Tomar Kapil , Thakral Ankur , Rangan N. Mohan
Published: March 2018

Cranioplasty is a time-honoured surgical procedure to restore the calvarial form and function that is associated with a relatively high complication rate. The present article analyzed various complications and reviewed the complications based on study of the relevant research in the craniofacial literature. Complications were broadly divided into 2 groups, intraoperative and postoperative, for ease of understanding. The etiological factors, local and systemic condition of the patient, prevention, and management of various complications were widely discussed. The article also highlighted problems and complications associated with various reconstructive materials. Insights into various complications of cranioplasty enable surgeon to understand them better, minimize the chances of occurrence, and improve surgical outcome. In spite of reported high rate of complications, serious complications like meningitis, air embolism, and death are rare.
Predicting mucositis risk associated with cytotoxic cancer treatment regimens: rationale, complexity, and challenges
Authors: Bachour Petra C. , Sonis Stephen T.
Published: March 2018

Purpose of review

The goals of this review are to describe the complexity of factors influencing the risk of cancer regimen-related mucosal injury (CRRMI), to evaluate the contribution of the innate immune response to CRRMI risk, to compare the concordance of genome analytics in describing mechanism and risk, and to determine if common biological pathways are noted when CRRMI is compared to a disease with a similar phenotype.

Recent findings

The pathogenesis of and risk for CRRMI are complex and influenced by multiple intrinsic and extrinsic factors. It is incumbent on analyses to recognize the likelihood that the interplay and cross-talk of synergistically expressed factors is critical and that the contributing weights of these factors is not uniform from patient to patient. Genomically derived analyses imply final common pathways are implicit in phenotype expression.

The identification of specific factors (both genomic and otherwise) which contribute to CRRMI risk represents an important opportunity to apply principles of precision medicine to the management of regimen-related toxicities.