bluuebunny/crossref_metadata_2025 huggingface dataset:
Temporal Trends in Adverse Events After Everolimus-Eluting Bioresorbable Vascular Scaffold Versus Everolimus-Eluting Metallic Stent Implantation
Authors: Montone Rocco A. , Niccoli Giampaolo , De Marco Federico , Minelli Silvia , D’Ascenzo Fabrizio , Testa Luca , Bedogni Francesco , Crea Filippo
Published: May 2017

Background:

Bioresorbable coronary stents have been introduced into clinical practice to improve the outcomes of patients treated with percutaneous coronary intervention. The everolimus-eluting bioresorbable vascular scaffold (BVS) is the most studied of these stent platforms; however, recent trials comparing BVS with everolimus-eluting metallic stents (EES) raised concerns about BVS safety. We aimed to assess the efficacy and safety of BVS versus EES in patients undergoing percutaneous coronary intervention.

Methods:

We searched Medline, Embase, the Cochrane Central Register of Controlled Trials, scientific sessions abstracts, and relevant Web sites for randomized trials with a follow-up of ≥2 years investigating percutaneous coronary interventions with BVS versus EES. The primary outcomes of our analysis were definite/probable stent thrombosis (ST) and target lesion failure (TLF; device-oriented composite end point of cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization [TLR]). Secondary outcomes were target vessel myocardial infarction, TLR, and cardiac death. We calculated the risk estimates for main outcomes according to a fixed-effect model.

Results:

We included 7 trials comprising data for 5583 patients randomized to receive either a BVS (n=3261) or an EES (n=2322). Median follow-up was 24 months (range, 24–36 months). Patients treated with BVS had a higher risk of definite/probable ST compared with patients treated with EES (odds ratio, 3.33; 95% confidence interval, 1.97–5.62;
P
<0.00001). In particular, patients with BVS had a higher risk of subacute, late, and very late ST, whereas the risk of acute ST was similar. Patients treated with BVS compared with EES had a higher risk at 2 years of TLF (odds ratio, 1.47; 95% confidence interval, 1.14–1.90;
P
=0.003), driven mainly by an increased risk of target vessel myocardial infarction (odds ratio, 1.73; 95% confidence interval, 1.31–2.28;
P
=0.0001;
I
2
=0%) and of TLR (odds ratio, 1.27; 95% confidence interval, 1.00–1.62;
P
=0.05). Of importance, the risk of TLF and TLR for patients with BVS was higher between 1 and 2 years, whereas there was no difference in the first year. Risk of cardiac death was similar between the 2 groups.

Conclusions:

Our meta-analysis of randomized trials with a follow-up of ≥2 years demonstrated a higher risk of ST and of TLF in patients treated with BVS compared with EES. Of note, BVS had a higher risk of subacute, late, and very late ST, whereas the risk of TLF and TLR was higher between 1 and 2 years.
Role of B‐Type Natriuretic Peptide and N‐Terminal Prohormone BNP as Predictors of Cardiovascular Morbidity and Mortality in Patients With a Recent Coronary Event and Type 2 Diabetes Mellitus
Authors: Wolsk Emil , Claggett Brian , Pfeffer Marc A. , Diaz Rafael , Dickstein Kenneth , Gerstein Hertzel C. , Lawson Francesca C. , Lewis Eldrin F. , Maggioni Aldo P. , McMurray John J. V. , Probstfield Jeffrey L. , Riddle Matthew C. , Solomon Scott D. , Tardif Jean‐Claude , Køber Lars
Published: May 2017

Background

Natriuretic peptides are recognized as important predictors of cardiovascular events in patients with heart failure, but less is known about their prognostic importance in patients with acute coronary syndrome. We sought to determine whether B‐type natriuretic peptide (
BNP
) and N‐terminal prohormone B‐type natriuretic peptide (
NT
‐pro
BNP
) could enhance risk prediction of a broad range of cardiovascular outcomes in patients with acute coronary syndrome and type 2 diabetes mellitus.

Methods and Results

Patients with a recent acute coronary syndrome and type 2 diabetes mellitus were prospectively enrolled in the
ELIXA
trial (n=5525, follow‐up time 26 months). Best risk models were constructed from relevant baseline variables with and without
BNP
/
NT
‐pro
BNP
. C statistics, Net Reclassification Index, and Integrated Discrimination Index were analyzed to estimate the value of adding
BNP
or
NT
‐pro
BNP
to best risk models. Overall,
BNP
and
NT
‐pro
BNP
were the most important predictors of all outcomes examined, irrespective of history of heart failure or any prior cardiovascular disease.
BNP
significantly improved C statistics when added to risk models for each outcome examined, the strongest increments being in death (0.77–0.82,
P
<0.001), cardiovascular death (0.77–0.83,
P
<0.001), and heart failure (0.84–0.87,
P
<0.001).
BNP
or
NT
‐pro
BNP
alone predicted death as well as all other variables combined (0.77 versus 0.77).

Conclusions

In patients with a recent acute coronary syndrome and type 2 diabetes mellitus,
BNP
and
NT
‐pro
BNP
were powerful predictors of cardiovascular outcomes beyond heart failure and death, ie, were also predictive of
MI
and stroke. Natriuretic peptides added as much predictive information about death as all other conventional variables combined.

Clinical Trial Registration

URL
:
http://www.clinicaltrials.gov
. Unique identifier:
NCT
01147250.
Tangible Distributed Computer Music for Youth
Authors: Shapiro R. Benjamin , Kelly Annie , Ahrens Matthew , Johnson Ben , Politi Heather , Fiebrink Rebecca
Published: May 2017

Computer music research realizes a vision of performance by means of computational expression, linking body and space to sound and imagery through eclectic forms of sensing and interaction. This vision could dramatically influence computer science education, simultaneously modernizing the field and drawing in diverse new participants. In this article, we describe our work creating an interactive computer music toolkit for youth called BlockyTalky. This toolkit enables users to create networks of sensing devices and synthesizers, and to program the musical and interactive behaviors of these devices. We also describe our work with two middle-school teachers to codesign and deploy a curriculum for 11- to 13-year-old students. We draw on work with these students to evidence how computer music can support learning about computer science concepts and change students' perceptions of computing. We conclude by outlining some remaining questions around how computer music and computer science may best be linked to provide transformative educational experiences.
Different Electrophysiological Correlates of Visual Awareness for Detection and Identification
Authors: Koivisto Mika , Grassini Simone , Salminen-Vaparanta Niina , Revonsuo Antti
Published: May 2017

Detecting the presence of an object is a different process than identifying the object as a particular object. This difference has not been taken into account in designing experiments on the neural correlates of consciousness. We compared the electrophysiological correlates of conscious detection and identification directly by measuring ERPs while participants performed either a task only requiring the conscious detection of the stimulus or a higher-level task requiring its conscious identification. Behavioral results showed that, even if the stimulus was consciously detected, it was not necessarily identified. A posterior electrophysiological signature 200–300 msec after stimulus onset was sensitive for conscious detection but not for conscious identification, which correlated with a later widespread activity. Thus, we found behavioral and neural evidence for elementary visual experiences, which are not yet enriched with higher-level knowledge. The search for the mechanisms of consciousness should focus on the early elementary phenomenal experiences to avoid the confounding effects of higher-level processes.
Martin Buber’s Socialism
Authors: Löwy Michael
Published: May 2017

Martin Buber was a creative and heterodox socialist thinker. His socialist utopia was based on the idea of a new community that does not hark back to ancient forms, but wants to overcome modern society while incorporating its achievements, such as the principle of individual freedom. It is not bound, like the old Gemeinschaft—the tribe, the clan, the religious sect—by one single word or opinion that soon freezes into dogma and rigid law, but by a common life characterized by freedom and creativity, which require a diversity of opinions.
Interiority, Exteriority and the Realm of Intentionality
Authors: Ashworth Peter D.
Published: May 2017

The realm of intentionality is definitive of phenomenology as a reflective methodology. Yet it is precisely the focus on the intentionalgiventhat has been condemned recently.Speculative realism(e.g. Meillassoux, 2008/2006) argues that phenomenology is unsatisfactory since the reduction to the intentional realm excludes the ‘external’, i.e. reality independent of consciousness. This criticism allows me to clarify the nature of intentionality.Material phenomenologyfinds, in contrast, that the intentional realm excludes the ‘inner’ (‘auto-affective life’—Henry, 1973/1963). This criticism allows me to discuss the way in whichipseityenters as an element of experience. Intentionality, viewed psychologically, is rightly the distinct arena of phenomenological psychology. However, there is no doubting the difficulty of maintaining a research focus precisely on the realm of intentionality; there areaporiasof the reduction. I discuss some of the difficulties.
Five new species and one new combination in Brazilian Myrtaceae
Authors: SOBRAL MARCOS , COSTA IDIMÁ G. , SOUZA MARCELO C. , ZORZANELLI JOÃO PAULO F.
Published: May 2017

Eugenia asema, E. trichogyna, Myrcia altomontana, M. fria and M. macucana are described and illustrated, and the new combination Eugenia subglomerata, based on Myrtus subglomerata, is proposed. Eugenia asema, from the state of Rio de Janeiro, seems related to E. subavenia, but has glabrous shining blades and smaller flowers; E. trichogyna, also from Rio de Janeiro, is apparently close to E. pluriflora, but has wider blades and pilose flowers with unequal pairs of calyx lobes; Myrcia altomontana, from Espírito Santo, is related to M. neocambessedeana, but differs by its denser indumentum and shorter inflorescences; M. fria, also from Espírito Santo, is apparently related to Calyptranthes pauciflora but has glabrous flowers and larger inflorescences, and M. macucana, from the state of Minas Gerais, is apparently close to Calyptranthes anceps, from which it is distinguished by its markedly shorter inflorescences. Additionally, conservation status is assessed for the species described here.
Calliandra mayana (Leguminosae, Mimosoideae), a new narrowly endemic species from Campeche, Mexico
Authors: HERNÁNDEZ HÉCTOR M. M. , GÓMEZ-HINOSTROSA CARLOS
Published: May 2017

A new species of Calliandra (Leguminosae, Mimosoideae, tribe Ingeae) from a restricted locality of Campeche, Mexico is herein described and illustrated. The species appears to be closely related to C. molinae, a species from Honduras, El Salvador and Nicaragua, from which it may be distinguished by being allopatric, and by a more limited development of suberose bark in stems and branches, comparatively smaller leaflets, consistently glabrous leaflets and corollas, and by the scarcely villous pods. Calliandra mayana appears to be restricted to an extremely small seasonally flooded savannah surrounded by tropical deciduous forest and, based on IUCN criteria, it is provisionally considered Critically endangered.
Oreocharis zhenpingensis (Gesneriaceae), a new species from Shaanxi, China
Authors: LI JIA-MEI , WANG TING , ZHANG YAO-GUANG
Published: May 2017

Oreocharis zhenpingensis is described and illustrated as a new species from Shaanxi province, China. The new species is easily distinguished from O. giraldii by crenate leaf blade margin, unbranched cymes, 1–4-flowered inflorescence, 1–2-dentate calyx lobes margin, yellowish corolla with a shallowly notched upper lip, slightly curved tube to 1.5 cm long, and pistil and capsule pubescent. Comments on the affinities, geographical distribution, ecology, phenology and conservation status of the new species are also provided.
Redescription of Cletocamptus albuquerquensis and C. dominicanus (Harpacticoida: Canthocamptidae incertae sedis), and description of two new species from the US Virgin Islands and Bonaire
Authors: GÓMEZ SAMUEL , GERBER RAY , FUENTES-REINÉS JUAN MANUEL
Published: May 2017

The history surrounding the identity of Cletocamptus albuquerquensis (Herrick, 1894) and C. dominicanus Kiefer, 1934 is very complex. This complexity has been exacerbated by incomplete, and in some cases erroneous, original descriptions of these two species. Also, new records from other locations did not describe the significant characters needed to clearly delineate them. This led several authors to consider C. dominicanus as a synonym of C. albuquerquensis, among other taxonomical considerations regarding, for example, the status of Marshia brevicaudata Herrick, 1894. Inspection of biological material from Saskatchewan (southern Canada), Wyoming (central US), Trinidad and Tobago, and the British Virgin Islands, identified by other researchers as C. albuquerquensis, as well as of newly collected material from Great Salt Lake (Utah, central US), Puerto Rico, Culebra Island, Vieques Island, St. John Island (US Virgin Islands), San Salvador (Bahamas), and Santa Marta (Colombia), revealed that C. albuquerquensis and C. dominicanus are distinct and identifiable species, distributed in a more restricted area than previously thought. Additionally, we describe a new species, C. tainoi sp. nov., from St. John Island (US Virgin Islands), and we propose another new species, C. chappuisi sp. nov., for two males from Bonaire previously identified as C. albuquerquensis. Finally, we give some observations on tube-pore-like structures, previously overlooked, on the endopod of the male leg three.
An Improved QPE over Complex Terrain Employing Cloud-to-Ground Lightning Occurrences
Authors: Minjarez-Sosa Carlos Manuel , Castro Christopher L. , Cummins Kenneth L. , Waissmann Julio , Adams David K.
Published: May 2017

A lightning–precipitation relationship (LPR) is studied at high temporal and spatial resolution (5 min and 5 km). As a proof of concept of these methods, precipitation data are retrieved from the National Severe Storms Laboratory (NSSL) NMQ product for southern Arizona and western Texas while lightning data are provided by the National Lightning Detection Network (NLDN). A spatial- and time-invariant (STI) linear model that considers spatial neighbors and time lags is proposed. A data denial analysis is performed over Midland, Texas (a region with good sensor coverage), with this STI model. The LPR is unchanged and essentially equal, regardless of the domain (denial or complete) used to obtain the STI model coefficients. It is argued that precipitation can be estimated over regions with poor sensor coverage (i.e., southern Arizona) by calibrating the LPR over well-covered domains that are experiencing similar storm conditions. To obtain a lightning-estimated precipitation that dynamically updates the model coefficients in time, a Kalman filter is applied to the STI model. The correlation between the observed and estimated precipitation is statistically significant for both models, but the Kalman filter provides a better precipitation estimation. The best demonstration of this application is a heavy-precipitation, high-frequency lightning event in southern Arizona over a region with poor radar and rain gauge coverage. By calibrating the Kalman filter over a data-covered domain, the lightning-estimated precipitation is considerably greater than that estimated by radar alone. Therefore, for regions where both rain gauge and radar data are compromised, lightning provides a viable alternative for improving QPE.
BME Spatiotemporal Estimation of Annual Precipitation and Detection of Drought Hazard Clusters Using Space–Time Scan Statistics in the Yun-Gui-Guang Region, Mainland China
Authors: Wang Chao-Lin , Zhong Shao-Bo , Yao Guan-Nan , Huang Quan-Yi
Published: May 2017

Drought disasters cause great economic losses in China every year, especially in its southwest, and they have had a major influence on economic development, lives, and property. In this study, precipitation and drought hazards were examined for a region covering Yunnan, Guizhou, and Guangxi Provinces to assess the spatial and temporal distribution of different drought hazard grades in this region. Annual precipitation data from 90 meteorological stations in or around the study area were collected and organized for the period of 1964–2013. A spatiotemporal covariance model was calculated and fitted. The Bayesian maximum entropy (BME) method, which considers physical knowledge bases to reduce errors, was used to provide an optimal estimation of annual precipitation. Regional annual precipitation distributions were determined. To analyze the spatiotemporal patterns of the drought hazard, the annual standardized precipitation index was used to measure drought severity. A method that involves space–time scan statistics was used to detect the most likely spatiotemporal clusters of the drought hazards. Test-significance p values for all of the calculated clusters were less than 0.001, indicating a high significance level. The results showed that Yunnan Province was a drought-prone area, especially in its northwest and center, followed by Guizhou Province. In addition, Yunnan and Guizhou Provinces were cluster areas of severe and extreme drought. The most likely cluster year was 1966; it was clustered five times during the study period. In this study, the evolutionary process of drought hazards, including spatiotemporal distribution and spatiotemporal clustering characteristics, was considered. The results may be used to provide support for prevention and mitigation of drought in the study area such as optimizing the distribution of drought-resisting resources, drought monitoring, and evaluating potential drought impacts.
Understanding Bias in the Evaporative Damping of El Niño–Southern Oscillation Events in CMIP5 Models
Authors: Ferrett Samantha , Collins Matthew , Ren Hong-Li
Published: May 2017

This study examines the extent of the Pacific double–intertropical convergence zone (ITCZ) bias in an ensemble of CMIP5 coupled general circulation models and the relationship between this common bias and equatorial Pacific evaporative heat flux feedbacks involved in El Niño–Southern Oscillation (ENSO). A feedback decomposition method, based on the latent heat flux bulk formula, is implemented to enable identification of underlying causes of feedback bias and diversity from dynamical and thermodynamical processes. The magnitude of mean precipitation south of the equator in the east Pacific (an indicator of the extent of the double-ITCZ bias in a model) is linked to the mean meridional surface wind speed and direction in the region and is consequently linked to diversity in the strength of the wind speed response during the ENSO cycle. The ENSO latent heat flux damping is weak in almost all models and shows a relatively large range in strength in the CMIP5 ensemble. While both humidity gradient and wind speed feedbacks are important drivers of the damping, the wind speed feedback is an underlying cause of the overall damping bias for many models and is ultimately more dominant in driving interensemble variation. Feedback biases can also persist in atmosphere-only (AMIP) runs, suggesting that the atmosphere model plays an important role in latent heat flux damping and double-ITCZ bias and variation. Improvements to coupled model simulation of both mean precipitation and ENSO may be accelerated by focusing on the atmosphere component.
Recent Trends in Extreme Precipitation and Temperature over Southeastern South America: The Dominant Role of Stratospheric Ozone Depletion in the CESM Large Ensemble
Authors: Wu Yutian , Polvani Lorenzo M.
Published: May 2017

Observations show an increase in maximum precipitation extremes and a decrease in maximum temperature extremes over southeastern South America (SESA) in the second half of the twentieth century. The Community Earth System Model (CESM) Large Ensemble (LE) experiments are able to successfully reproduce the observed trends of extreme precipitation and temperature over SESA. Careful analysis of a smaller ensemble of CESM-LE single forcing experiments reveals that the trends of extreme precipitation and temperature over SESA are mostly caused by stratospheric ozone depletion. The underlying dynamical mechanism is investigated and it is found that, as a consequence of stratospheric ozone depletion and the resulting southward shift of tropospheric jet streams, anomalous easterly flow and more intense cyclones have occurred over SESA, which are favorable for heavier rainfall extremes and milder heat extremes.
Implantable Cardioverter Defibrillator for the Primary Prevention of Sudden Cardiac Death in Patients With Nonischemic Cardiomyopathy
Authors: Cavalcanti Rafael , Aboul-Hosn Nael , Morales Gustavo , Abdel-Latif Ahmed
Published: May 2017

Objectives:

The benefit of implanting patients with nonischemic cardiomyopathy (NICMP) with an implantable cardioverter defibrillator (ICD) for primary prevention has not been demonstrated in any randomized controlled trial. This also holds true for the most recent study on the subject. This systematic review and meta-analysis aims to examine the effectiveness of primary prevention using an ICD in the NICMP population.

Methods:

We searched the literature for randomized controlled trials examining the effectiveness of ICD in reducing all-cause mortality in patients with NICMP. The primary outcome of our analysis was all-cause mortality. A fixed-effects model was used for the primary analysis.

Results:

A total of 5 randomized controlled trials focused on primary prevention of sudden cardiac death for patients with NICMP that met our inclusion and exclusion criteria. They have individually failed to consistently show a benefit for the use of an ICD in this population. However, the cumulative effect of ICD implantation in patients with NICMP demonstrated a 21% relative risk reduction in mortality (Relative risk [RR]: 0.79; confidence interval: 0.66-0.95).

Conclusion:

There is a decrease in mortality with the use of ICD for primary prevention in patients with NICMP having left ventricular ejection fraction <35%.
Reliability of the Perceptual Evaluation of Adductor Spasmodic Dysphonia
Authors: Chhetri Dinesh K. , Merati Albert L. , Blumin Joel H. , Sulica Lucian , Damrose Edward J. , Tsai Veling W.
Published: May 2017

Objectives: Although perceptual assessment by experienced voice clinicians remains the gold standard for the diagnosis and assessment of severity of adductor spasmodic dysphonia (ADSD), the interrater reliability of voice experts for this task has not been assessed. In addition, it is unknown whether telephone-recorded or -transmitted voice samples could be used for this task. The aims of this study were 1) to assess the reliability of perceptual analysis of ADSD severity by voice experts and 2) to compare the results between digitally recorded voice samples and those recorded over the telephone.

Methods: Five laryngologists randomly selected voice samples from 46 ADSD patients and rated the severity of ADSD on a 5-point rating scale. A set of digital voice recordings and a set of telephone voice recordings made from filtering the digital set via the telephone were rated, and each voice set was rated twice. Measures of intrarater and interrater reliability, as well as a measure of the probability of agreement among the raters, were calculated.

Results: There was a high level of agreement on ADSD severity, with excellent interrater and intrarater reliability (Cronbach's alpha, .93 to .96). The probabilities of rater agreement on the digitally recorded and telephone-filtered voice samples were similar (χ2, p = .07). The ratings of digital versus telephone voice samples were highly correlated (Pearson r, 0.99; p<.001).

Conclusions: These results demonstrate that voice experts are reliably able to judge and agree on the severity of ADSD. Telephone-filtered voices appear to convey adequate ADSD perceptual cues for expert listeners to judge the severity of spasmodic dysphonia.
Sequential Bilateral Hearing Loss in Multiple Sclerosis
Authors: Oh Young-Mi , Oh Dong-Hoon , Jeong Seong-Hae , Koo Ja-Won , Kim Ji Soo
Published: May 2017

Objectives: We describe a case of multiple sclerosis presenting with sequential bilateral hearing loss.

Methods: A 46-year-old woman underwent a series of audiological and neurologic evaluations for sequential bilateral hearing losses that occurred 6 months apart.

Results: Initially, the patient suffered from sudden left hearing loss, and magnetic resonance imaging documented an enhancing lesion in the left middle cerebellar peduncle. Six months later, another episode of sudden vertigo, right hearing loss, and right facial palsy developed. Magnetic resonance imaging disclosed a new lesion in the right middle cerebellar peduncle.

Conclusions: Sequential bilateral hearing loss may be a manifestation of multiple sclerosis. In younger patients with sudden hearing loss, multiple sclerosis should be included in the differential diagnosis.
Bilateral Stapedectomy: Association between First- and Second-Ear Surgical Findings and Their Effects on the Second-Ear Outcome
Authors: Shine Neville P. , Rodrigues Stephen , Miller Stuart , Packer Peter
Published: May 2017

Objectives: We assessed the association between first-ear and second-ear surgical findings in patients undergoing second-ear stapedectomy for bilateral otosclerosis and the impact of such findings on the audiometric outcome of the second ear.

Methods: A retrospective chart review of all stapedectomy patients who underwent stapes surgery by one of two surgeons in a single tertiary referral institution from 1962 to 2001 was performed, and those patients who underwent bilateral stapedectomy were identified. Patient demographic data, surgical findings, procedure performed, and preoperative and postoperative audiometric data were recorded.

Results: A total of 459 patients (918 ears) underwent bilateral stapedectomy for bilateral otosclerosis during the study period, of whom 426 had complete data for analysis. The finding of a white or obliterated footplate in the second ear was significantly higher if the first ear had this disease manifestation (p < .001, χ2 test). The association between a second drill-out's being performed and a drill-out in the first operation was significant (p < .001, χ2 test). Statistical analysis identified that those who underwent a drill-out procedure had a 2.9-fold increase in unsuccessful outcome in comparison to those who did not have a drill-out (odds ratio, 2.89; 95% confidence interval, 1.41 to 5.89). Facial nerve anomalies were infrequently encountered, affecting only 23 patients, of whom 3 had bilateral abnormalities. The finding of an overhanging or dehiscent facial nerve in the second ear was significantly more likely if such an abnormality was identified during the first procedure (23% versus 2.5%; p = .005, Fisher's exact test).

Conclusions: Second-ear hearing results are poorer in those who require a drill-out of this ear, and this is more likely to be required if a drill-out was required in the first ear, regardless of a successful outcome of the first procedure. Patients should be aware of the reduced likelihood of success in these cases and be counseled regarding risks and benefits of second-ear surgery based, in part, on the findings from the first ear. This study confirms that bilateral advanced footplate obliteration and overhanging or dehiscent facial nerves may be anticipated in patients found to have these abnormalities during first-ear stapedectomy.
Effects of Cochlear Nuclei Electrical Stimulation with Surface Brain Stem Implants in Nonhuman Primates
Authors: Manrique Manuel , Cervera-Paz Francisco Javier , Insausti Ana M. , Nevison Barry
Published: May 2017

Objectives: We undertook morphological evaluation of the cochlear nucleus complex (CNC) after implantation of a surface auditory brain stem implant (ABI).

Methods: We used 14 nonhuman primates (Macaca fascicularis). They underwent translabyrinthine bilateral auditory deafferentation and simultaneous unilateral implantation of an ABI. In 6 cases the ABI was not activated, whereas it was activated in 8 cases. The ABI array consisted of 3 platinum disc electrodes mounted on a silicone pad with the back side covered with polyethylene terephthalate mesh, connected via a cable to an external stimulator in animals undergoing electrical stimulations.

Results: All animals tolerated the procedures well. In both groups of animals, neuropathologic lesions or changes attributed to surgical trauma were found. The biotolerance of neural tissue to the materials used was adequate. The stimulation times ranged from 0 to 732 hours. Neuropathologic examination and stereological assessment revealed that the animals showed no signs of significant neural damage after CNC chronic stimulation if this took place within the safety limits. Time of stimulation did not seem to play a significant role in changes.

Conclusions: Besides surgical trauma, the most important factors responsible for CNC changes are the electrical stimulation parameters.
Inflammatory Cytokine Responses to Synthetic Extracellular Matrix Injection to the Vocal Fold Lamina Propria
Authors: Thibeault Susan L. , Duflo Suzy
Published: May 2017

Objectives: We determined cytokine profiles for tumor necrosis factor alpha (TNF-α), interleukin (IL)-6, IL-la, and IL-Iβ after injection of a synthetic extracellular matrix into the vocal fold lamina propria.

Methods: Transcript expression of inflammatory cytokines was measured with real-time polymerase chain reaction on postoperative days 1,3,5,10, and 21 in 25 rabbits that underwent bilateral vocal fold biopsy with Extracel-LG (Carbylan-GSX 5%) immediately injected into the wound in the left vocal fold and saline solution injected into the wound in the right vocal fold. Two unwounded normal rabbit larynges were also harvested for controls.

Results: Significantly elevated levels of TNF-α, IL-Iβ, and IL-6 were measured on day 3 in a comparison between Extracel-LG-injected vocal folds and saline solution-injected control vocal folds and between Extracel-LG-injected vocal folds and normal vocal folds. All cytokine levels returned to baseline by day 21.

Conclusions: A mild short-term inflammatory response was measured early after injection of a synthetic extracellular matrix into the vocal fold lamina propria.
Impact of Bilaterality and Headache on Health-Related Quality of Life in Meniere's Disease
Authors: Lopez-Escamez Jose A. , Viciana David , Garrido-Fernandez Pablo
Published: May 2017

Objectives

We analyzed the impact of bilaterality and headache on the health-related quality of life (HRQL) of patients with Meniere's disease (MD).

Methods

A case series including 86 patients with a diagnosis of definite MD according to the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) diagnostic criteria was evaluated by the Short Form 36 (SF-36) Health Instrument and the Dizziness Handicap Inventory Short Form (DHI-S).

Results

The scores on all scales of the SF-36 were significantly lower for bilateral MD than for unilateral cases, except for body pain. Both groups had scores worse than those of their sex- and age-matched normative population on all SF-36 scales (p = 0.017 to p = 0.0001), except for body pain in men. The DHI-S scores were also better for unilateral than for bilateral cases (p = 0.04), suggesting that the dizziness is perceived to be more disabling in bilateral MD. Migraine was significantly associated with bilateral MD (odds ratio, 3.58 [95% confidence interval, 1.25 to 10.31]; p = 0.021). Headache and score on the AAO-HNS functional scale, which evaluates the effect of vertigo attacks on daily activities, were two independent factors that explained a great part of the variability on all SF-36 scales, except for “role emotional” in bilateral MD.

Conclusions

Patients with bilateral MD perceived their dizziness to be more disabling and had a worse HRQL than did patients with unilateral MD. Migraine was more frequently found in patients with bilateral involvement. Headache and score on the AAO-HNS functional scale were factors associated with the HRQL in bilateral MD.
Impulse Noise: Theoretical Solutions to the Quandary of Cochlear Protection
Authors: Clifford Royce E. , Rogers Rick A.
Published: May 2017

Workers in industries with impact noise, as well as soldiers exposed to supersonic blasts from armament and explosive devices, appear to be more at risk for hearing loss than are their counterparts exposed to continuous noise. Alternative considerations for hearing protection are dictated because of a disproportionately increased biophysical response in comparison to continuous noise. Impulse noise is a significant and distinct problem that requires a new strategy for hearing protection. A review of current clinical and occupational literature suggests that impulse noise may be more damaging than continuous sound. Statistical measurements such as kurtosis hold promise for the quantitative prediction of hearing loss. As sound energy to the cell increases, the mechanism of cochlear damage shifts from biochemical injury to mechanical injury. Outer hair cells appear to be more sensitive than inner hair cells to impulse noise because of their energy requirements, which lead to increased production of reactive oxygen and nitrogen species and self-destruction by apoptosis. Hearing protective devices currently in use for impulse noise include hunters' hearing devices, active noise-reduction headsets, and various in-ear plugs, including nonlinear reacting inserts. Existing equipment is hampered by the materials used and by present-day electronic technology. Antioxidants administered before sound exposure show promise in mitigating hearing loss in industrial and combat situations. New materials with improved damping, reflective, and absorption characteristics are required. Hearing protective devices that allow passage of ambient sound while blocking harmful noise might improve the compliance and safety of those exposed. Sensing devices that instantaneously and selectively hyperpolarize outer hair cells are discussed as alternate protection.
Hyperfractionated Radiotherapy: Improvement of Survival in Locally Advanced Nasopharyngeal Carcinoma
Authors: Mesia Ricard , Maños Manel , Nogués Julio , Galiana Ramón , Martínez García María , Lozano Alicia , Tornero Jordi , Germa José Ramón
Published: May 2017

Objectives

Standard treatment with concomitant chemotherapy (CT) and radiotherapy (RT) for nasopharyngeal cancer has shown rates of locoregional control of 80% and has improved the rate of 5-year survival to 67% to 84%. Hyperfractionated radiotherapy (HFRT) may increase locoregional control of tumors of the head and neck, but the addition of concomitant CT involves an unacceptable level of toxicity. Adding induction CT may control distant metastasis. Here we compare the results of our protocol with induction CT followed by HFRT alone with the results obtained with concomitant treatments.

Methods

Between October 1994 and May 2002, 46 patients with nasopharyngeal carcinoma were treated with HFRT. The patients with N+ or T4 lesions also received cisplatin-based induction CT (55%).

Results

The patients received a mean of 3 CT cycles (range, 2 to 5). At 5 years, the rate of progression-free survival was 66% (range, 51.3% to 82.1%), and the global survival rate was 75.7% (range, 61.9% to 89.5%).

Conclusions

The use of HFRT in association with induction CT in patients with the greatest risk of metastasis may be as effective as concomitant CT-RT for treatment of nasopharyngeal cancer. Efforts should now concentrate on minimizing the acute and chronic toxicities.
Quantifying Vocal Fatigue Recovery: Dynamic Vocal Recovery Trajectories after a Vocal Loading Exercise
Authors: Hunter Eric J. , Titze Ingo R.
Published: May 2017

Objectives

We quantified the recovery of voice following a 2-hour vocal loading exercise (oral reading).

Methods

Eighty-six adult participants tracked their voice recovery using short vocal tasks and perceptual ratings after an initial vocal loading exercise and for the following 2 days.

Results

Short-term recovery was apparent, with 90% recovery within 4 to 6 hours and full recovery at 12 to 18 hours. Recovery was shown to be similar to a dermal wound healing trajectory.

Conclusions

The new recovery trajectory highlighted by the vocal loading exercise in the current study is called a vocal recovery trajectory. By comparing vocal fatigue to dermal wound healing, this trajectory is parallel to a chronic wound healing trajectory (as opposed to an acute wound healing trajectory). This parallel suggests that vocal fatigue from the daily use of the voice could be treated as a chronic wound, with the healing and repair mechanisms in a state of constant repair. In addition, there is likely a vocal fatigue threshold at which point the level of tissue damage would shift the chronic healing trajectory to an acute healing trajectory.
Measurement of the Viscoelastic Properties of the Vocal Folds
Authors: Wiikmann Christian , da Silva Marcelo Alves , Arêas Elizabeth Pinheiro Gomes , Tsuji Domingos Hiroshi , Sennes Luiz Ubirajara
Published: May 2017

Objectives

Studies of the viscoelastic properties of the vocal folds are normally performed with rheometers that use parallel plates whose interplate space is usually arbitrarily assigned a fixed value. In tissues subject to variation of thickness between samples, fixed gaps could result in different compressions, compromising the comparison among them. We performed an experimental study to determine whether different compressions can lead to different results in measurements of dynamic viscosity (DV) of vocal fold samples.

Methods

We measured the DV of vocal fold samples of 10 larynges of cadavers under 3 different compression levels, corresponding to 0.2, 0.5, and 10 N on an 8-mm-diameter parallel-plate rheometer.

Results

The DV directly varied with compression. We observed statistically significant differences between the results of 0.2 and 10 N (p = 0.0396) and 0.5 and 10 N (p = 0.0442).

Conclusions

The study demonstrated that the level of compression influences the DV measure and suggests that a defined compression level should be used in rheometric studies of biological tissues.
Acute Myopericarditis Complicating Acute Tonsillitis: A Prospective Study
Authors: Talmon Yoav , Ishai Reuven , Samet Alvin , Sturman Alexander , Roguin Nathan
Published: May 2017

Objectives

We describe a prospective study of 100 consecutive cases of acute tonsillitis tested for cardiac involvement. There was 1 clear-cut case of acute myopericarditis and 5 more patients with pathological findings suggesting cardiac complication.

Methods

During a 6-month period (November 2006 to April 2007), we prospectively studied 100 consecutive patients admitted to our department with acute tonsillitis for the purpose of detecting acute myopericarditis. We obtained for each patient a serial electrocardiogram and echocardiogram, and took blood samples. All blood samples were analyzed for the presence of the marker troponin 1 and for cardiac enzymes.

Results

One patient (male) had a definitive diagnosis of myopericarditis, and another 5 patients (3 of whom were female) had abnormal cardiac findings suggestive of myopericarditis.

Conclusions

Otolaryngologists should be aware of the possibility of cardiac involvement in acute tonsillitis and perform an adequate workup whenever such a possibility is suspected.
Regenerative Effects of Basic Fibroblast Growth Factor on Extracellular Matrix Production in Aged Rat Vocal Folds
Authors: Ohno Tsunehisa , Yoo Mi Jin , Swanson Erik R. , Hirano Shigeru , Ossoff Robert H. , Rousseau Bernard
Published: May 2017

Objectives

We investigated acute changes in extracellular matrix (ECM) gene expression and histologic changes in the deposition of collagen and hyaluronan (hyaluronic acid; HA) after basic fibroblast growth factor (bFGF) treatment of the aged rat vocal fold.

Methods

For the polymerase chain reaction (PCR) experiments, we divided ten 18-month-old Sprague-Dawley rats into two groups that received serial injections of sham (saline solution) or bFGF (2 ng/uL) and euthanized them 2 weeks after the initial injection to investigate acute changes in ECM gene expression. We treated a separate group of 5 animals unilaterally and sacrificed them 4 weeks after the initial injection to investigate histologic changes in the deposition of collagen and HA.

Results

Real-time PCR revealed significantly up-regulated HA synthase (HAS)-2, HAS-3, matrix metalloproteinase (MMP)-2, and procollagen type I gene expression in the bFGF treatment group as compared to the sham treatment group. Histologic staining revealed significantly increased deposition of HA in the bFGF-treated vocal fold as compared to the sham-treated vocal fold. No differences in ECM collagen levels were observed between treatment sides.

Conclusions

Basic fibroblast growth factor induced the up-regulation of HAS-2, HAS-3, MMP-2, and procollagen type I. Histologically, aged vocal folds treated with bFGF revealed increased deposition of HA as compared to sham-treated vocal folds.
Temporalis Fascia and Cartilage-Perichondrium Composite Shield Grafts for Reconstruction of the Tympanic Membrane
Authors: Yetiser Sertac , Hidir Yusuf
Published: May 2017

Objectives

We sought to compare the long-term functional results of tympanic membrane reconstruction with temporalis fascia and cartilage shield grafting.

Methods

This study includes 113 patients who had tympanoplasty type I tympanic membrane reconstruction between 1997 and 2007, 47 with tragal cartilage and 66 with temporalis fascia. Fourteen patients in the cartilage group and 9 patients in the temporalis fascia group also had mastoidectomy. The average follow-up was 3.2 years. The hearing threshold was calculated as the mean value of the thresholds for 500, 1,000, 2,000, and 3,000 Hz. A paired-samples t-est was used for comparison of the preoperative and postoperative air and bone conduction hearing thresholds and air-bone gaps.

Results

Significant recovery was found in the postoperative air conduction threshold and air-bone gap in both the temporalis fascia and cartilage groups as compared to those before surgery (p < 0.001). However, the average air and bone conduction thresholds and air-bone gap were found to be statistically different after surgery in the cartilage group as compared to those in the temporalis fascia group. There was no significant difference in hearing parameters before and after surgery in patients with or without mastoidectomy in either the cartilage group or the temporalis fascia group.

Conclusions

The hearing gain in patients with cartilage shield grafting was better than that in those who had temporalis fascia tympanoplasty, although experimental analysis shows loss of acoustic energy for thick and large shield cartilage grafts.
Comparison of Pediatric Voice Handicap Index Scores with Perceptual Voice Analysis in Patients following Airway Reconstruction
Authors: de Alarcon Alessandro , Brehm Susan Baker , Kelchner Lisa N. , Meinzen-Derr Jareen , Middendorf Janet , Weinrich Barbara
Published: May 2017

Objectives

We performed a retrospective review to compare a subjective parental proxy-derived voice handicap survey to an observer-derived method of measuring voice perturbation in children who have undergone airway reconstruction. The main outcome measures were the Pediatric Voice Handicap Index (pVHI) total score and the Overall Severity score on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V).

Methods

The percent Overall Severity CAPE-V score (score divided by 100) and the percent pVHI score (score divided by 92) were calculated. A Wilcoxon signed rank test was used to compare CAPE-V scores with the pVHI total scores. The relationship between the pVHI scores and the CAPE-V scores was investigated with a Spearman correlation. Subgroup analysis was performed to determine the relationship of surgery type to CAPE-V and pVHI scores.

Results

Fifty subjects with a history of airway surgery who were evaluated between 2005 and 2008 were identified. Forty-two of the 50 subjects had complete data for review. Their median age was 7.1 years (range, 3.3 to 17.9 years). Their pVHI total scores had a median of 30 (range, 1 to 80). Their Overall Severity CAPE-V scores had a median of 50.5 (range, 0 to 98). Their median CAPE-V percent was higher than their median pVHI percent (50.5% versus 32.6%; p = 0.0003). A weak correlation was found between the Overall Severity CAPE-V score and the pVHI total score (rho = 0.41; p = 0.0003). There was a trend toward higher Overall Severity CAPE-V scores in patients who underwent cricotracheal resection. The total number of airway surgeries was significantly correlated with the Overall Severity CAPE-V score (rho = 0.6; p < 0.0001) but not with the pVHI score.

Conclusions

Children who undergo airway reconstruction often have a resulting voice disturbance that can affect their lives in multiple dimensions. The results of this study revealed a weak-to-fair correlation between the parent-reported pVHI total score and expert ratings of voice quality using the CAPE-V. In this patient population, both of these tools provided important information regarding the relationship of the severity of voice disturbance to its handicapping effects.
Microdebrider-Assisted Supraglottoplasty for Laryngomalacia
Authors: Groblewski Jan C. , Shah Rahul K. , Zalzal George H.
Published: May 2017

Objectives

We describe our series in the surgical treatment of laryngomalacia using a microdebrider.

Methods

We performed a retrospective review of patients who underwent microdebrider-assisted supraglottoplasty for laryngomalacia between October 2004 and February 2008. Patients with neurologic conditions and secondary airway lesions were excluded. The main outcome measures included complications, pain, resolution of stridor, presence of aspiration, and need for revision surgery.

Results

Twenty-eight patients underwent microdebrider-assisted supraglottoplasty. The mean age at diagnosis was 109 days, and the mean age at the time of the procedure was 182 days. Nineteen patients (68%) had gastroesophageal reflux at diagnosis. The average operative time was 35.7 minutes (range, 11 to 65 minutes). No intraoperative complications or device problems occurred. Two patients remained intubated after the procedure. One patient required a tracheotomy, and 1 patient underwent revision supraglottoplasty. Three patients had aspiration that resolved. There was negligible pain from the procedure, as all patients immediately resumed a diet. All patients had immediate or eventual resolution of stridor.

Conclusions

This is the largest series of patients who underwent microdebrider-assisted supraglottoplasty for laryngomalacia. This procedure is relatively safe, with minimal pain, and effective in patients with laryngomalacia. Microdebrider-assisted supraglottoplasty is the method of choice for supraglottoplasty in our institution.