Effectiveness of the Chiari Health Index for Pediatrics instrument in measuring postoperative health-related quality of life in pediatric patients with Chiari malformation type I.

p.aythelady61 shared this article with you from Inoreader Effectiveness of the Chiari Health Index for Pediatrics instrument in measuring postoperative health-related quality of life in pediatric patients with Chiari malformation type I. Via Pediatric Neurosurgeons Related Articles Effectiveness of the Chiari Health Index for Pediatrics instrument in measuring postoperative health-related quality of life in pediatric patients with Chiari malformation type I. J Neurosurg Pediatr. 2020 Dec 04;:1-6 Authors: Sellyn GE, Tang AR, Zhao S, Sherburn M, Pellegrino R, Gannon SR, Guidry BS, Ladner TR, Wellons JC, Shannon CN Abstract OBJECTIVE: The authors' previously published work validated the Chiari Health Index for Pediatrics (CHIP), a new instrument for measuring health-related quality of life (HRQOL) for pediatric Chiari malformation type I (CM-I) patients. In this study, the authors further evaluated the CHIP to assess HRQOL changes over time and correlate changes in HRQOL to changes in symptomatology and radiological factors in CM-I patients who undergo surgical intervention. Strong HRQOL evaluation instruments are currently lacking for pediatric CM-I patients, creating the need for a standardized HRQOL instrument for this patient population. This study serves as the first analysis of the CHIP instrument's effectiveness in measuring short-term HRQOL changes in pediatric CM-I patients and can be a useful tool in future CM-I HRQOL studies. METHODS: The authors evaluated prospectively collected CHIP scores and clinical factors of surgical intervention in patients younger than 18 years. To be included, patients completed a baseline CHIP captured during the preoperative visit, and at least 1 follow-up CHIP administered postoperatively. CHIP has 2 domains (physical and psychosocial) comprising 4 components, the 3 physical components of pain frequency, pain severity, and nonpain symptoms, and a single psychosocial component. Each CHIP category is scored on a scale, with 0 indicating absent and 1 indicating present, with higher scores indicating better HRQOL. Wilcoxon paired tests, Spearman correlations, and linear regression models were used to evaluate and correlate HRQOL, symptomatology, and radiographic factors. RESULTS: Sixty-three patients made up the analysis cohort (92% Caucasian, 52% female, mean age 11.8 years, average follow-up time 15.4 months). Dural augmentation was performed in 92% of patients. Of the 63 patients, 48 reported preoperative symptoms and 42 had a preoperative syrinx. From baseline, overall CHIP scores significantly improved over time (from 0.71 to 0.78, p < 0.001). Significant improvement in CHIP scores was seen in patients presenting at baseline with neck/back pain (p = 0.015) and headaches (p < 0.001) and in patients with extremity numbness trending at p = 0.064. Patients with syringomyelia were found to have improvement in CHIP scores over time (0.75 to 0.82, p < 0.001), as well as significant improvement in all 4 components. Additionally, improved CHIP scores were found to be significantly associated with age in patients with cervical (p = 0.009) or thoracic (p = 0.011) syrinxes. CONCLUSIONS: The study data show that the CHIP is an effective instrument for measuring HRQOL over time. Additionally, the CHIP was found to be significantly correlated to changes in symptomatology, a finding indicating that this instrument is a clinically valuable tool for the management of CM-I. PMID: 33276337 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Long-term stability of fusiform dilatation of the internal carotid artery following surgery adjacent to the circle of Willis: report of 2 cases.

p.aythelady61 shared this article with you from Inoreader Long-term stability of fusiform dilatation of the internal carotid artery following surgery adjacent to the circle of Willis: report of 2 cases. Via Pediatric Neurosurgeons Related Articles Long-term stability of fusiform dilatation of the internal carotid artery following surgery adjacent to the circle of Willis: report of 2 cases. J Neurosurg Pediatr. 2020 Dec 04;:1-4 Authors: Karsten MB, Scott RM Abstract Fusiform dilatation of the internal carotid artery (FDCA) is a known postoperative imaging finding after craniopharyngioma resection. FDCA has also been reported following surgery for other lesions in the suprasellar region in pediatric patients and is thought to be due to trauma to the internal carotid artery (ICA) wall during tumor dissection. Here, the authors report 2 cases of pediatric patients with FDCA. Case 1 is a patient in whom FDCA was visualized on follow-up scans after total resection of a craniopharyngioma; this patient's subsequent scans and neurological status remained stable throughout a 20-year follow-up period. In case 2, FDCA appeared after resection and fenestration of a giant arachnoid cyst in a 3-year-old child, with 6 years of stable subsequent follow-up, an imaging finding that to the authors' knowledge has not previously been reported following surgery for arachnoid cyst fenestration. These cases demonstrate that surgery involving dissection adjacent to the carotid artery wall in pediatric patients may lead to the development of FDCA. On very long-term follow-up, this imaging finding rarely changes and virtually all patients remain asymptomatic. Neurointerventional treatment of FDCA in the absence of symptoms or significant late enlargement of the arterial ectasia does not appear to be indicated. PMID: 33276338 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Development and Considerations for Virtual Reality Simulations for Resuscitation Training and Stress Inoculation.

p.aythelady61 shared this article with you from Inoreader Development and Considerations for Virtual Reality Simulations for Resuscitation Training and Stress Inoculation. Via Cricothyrotomy Related Articles Development and Considerations for Virtual Reality Simulations for Resuscitation Training and Stress Inoculation. Simul Healthc. 2020 Dec 02;: Authors: Chang TP, Hollinger T, Dolby T, Sherman JM Abstract INTRODUCTION: Resuscitation simulations immerse learners into the complexity of emergency patient management. Head-Mounted Display Virtual Reality (VR) has been used for stress inoculation therapy for phobias and posttraumatic stress disorder. However, VR for stress inoculation in resuscitation leadership training has not been studied. We sought to develop VR simulation for stress inoculation, as exposure therapy training, for resuscitations. METHODS: We explain the conceptual design, development, production, and initial evaluation process for 2 VR simulations in infant status epilepticus and pediatric anaphylactic shock. We further describe deliberate game mechanic choices to maximize psychological fidelity. In-virtual reality performance data for time-to-critical actions and stress physiology markers (heart rate, salivary cortisol) were collected from expert pediatric emergency physicians and novice pediatric residents. Data were analyzed to examine differences between the 2 groups for both outcome types to determine the extent of stress response or performance deficit the VR induced. RESULTS: Multiple difficulties and distractions were designed for the 2 scenarios; we evaluated the highest difficulty and environmental distraction versions. Between 19 expert physicians and 15 novice physicians, no performance differences were found in typical airway, breathing, and circulation actions. Residents preferred more lorazepam first-line antiepileptics than attendings (P = 0.003) and performed a cricothyrotomy later than attendings (P = 0.02). Residents, however, manifested higher salivary cortisol levels than attendings (+0.07 μg/dL, 95% confidence interval = 0.03-0.12, P = 0.001). CONCLUSIONS: A VR resuscitation simulation manifested expected stress physiology changes in physicians. Further evaluation is needed to determine the effect of VR simulation as longitudinal stress inoculation for healthcare providers. PMID: 33273419 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Decoding infraorbital dark circles with lasers and fillers.

p.aythelady61 shared this article with you from Inoreader Message: Patients who had tear troughs and/or hollow eyes responded well to fillers, patients with loose and wrinkled skin to CO2 laser, patients with tear troughs and hyperpigmentation to fillers, Q switched Nd:YAG and topical agents and patients with tear troughs and veins to fillers and long pulsed Nd:YAG lasers. Decoding infraorbital dark circles with lasers and fillers. Via Journal of Dermatological Treatment Related Articles Decoding infraorbital dark circles with lasers and fillers. J Dermatolog Treat. 2020 Dec 03;:1-8 Authors: Kounidas G, Kastora S, Rajpara S Abstract BACKGROUND: The degree and severity of dark circles varies according to the skin type, age, and lifestyle. OBJECTIVES: To evaluate different non-surgical treatment options for dark circles. METHODS: In a private practice setting in the UK and India, 34 patients with dark circles with different Fitzpatrick skin types were treated with fillers (Group 1), lasers (Group 2), and fillers and lasers combined (Group 3). Pre and post treatment photos were taken and subjective and objective outcomes in appearance were reported. RESULTS: All treatment options were effective in all three groups with minimal side effects reported. No statistically significant difference was found between the three treatment groups. Patients who had tear troughs and/or hollow eyes responded well to fillers, patients with loose and wrinkled skin to CO2 laser, patients with tear troughs and hyperpigmentation to fillers, Q switched Nd:YAG and topical agents and patients with tear troughs and veins to fillers and long pulsed Nd:YAG lasers. Most patients (82%) rated the improvement in their appearance as excellent. CONCLUSIONS: All 3 treatment modalities were effective in the reduction of periorbital dark circles depending on underlying cause. Non-surgical treatments are capable of correcting and improving dark circles with minimum complications and downtime. PMID: 33272039 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Simultaneous bilateral cochlear implantation under local anaesthesia in a visually impaired adult with profound sensorineural deafness: A case report.

p.aythelady61 shared this article with you from Inoreader Simultaneous bilateral cochlear implantation under local anaesthesia in a visually impaired adult with profound sensorineural deafness: A case report. Via British Cochlear Implant Group Related Articles Simultaneous bilateral cochlear implantation under local anaesthesia in a visually impaired adult with profound sensorineural deafness: A case report. Cochlear Implants Int. 2020 Dec 03;:1-6 Authors: Abrar R, Mawman D, Martinez de Estibariz U, Datta D, Stapleton E Abstract Objective: The National Institute of Clinical Excellence recommends that adult patients with severe to profound deafness are eligible for simultaneous bilateral cochlear implantation if they are blind or have other disabilities increasing their reliance on auditory stimuli. Cochlear implant (CI) surgery is routinely performed under general anaesthesia (GA), precluding patients who have higher risk associated with GA. Recent literature describes the safety and efficacy of performing unilateral CI surgery under local anaesthesia (LA). We report the first simultaneous bilateral CI under LA in the UK in an adult patient with profound sensorineural deafness and visual impairment. Case study: A 46-year-old gentleman, registered blind, presented with a 20-year history of bilateral progressive hearing loss. He was assessed as unfit for surgery under GA due to significant cardiac comorbidities. We performed simultaneous bilateral CI surgery under LA on the patient; he was discharged h ome the following day. Postoperative free field audiometry showed a significant improvement; speech discrimination using Bamford, Kowal and Bench sentences presented in quiet, increased from 0% pre-operatively to 100% four months post-operatively. Conclusion: Simultaneous bilateral CI surgery under LA is a safe and feasible procedure for eligible patients who may otherwise have been denied surgery due to their GA risk. PMID: 33272141 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A novel treatment for CI extrusion with vacuum-assisted closure device.

p.aythelady61 shared this article with you from Inoreader A novel treatment for CI extrusion with vacuum-assisted closure device. Via British Cochlear Implant Group Related Articles A novel treatment for CI extrusion with vacuum-assisted closure device. Cochlear Implants Int. 2020 Dec 03;:1-6 Authors: Chua CA, Thong JF, Binte Sudirman SR Abstract OBJECTIVE: To assess if a vacuum-assisted closure device initially utilised as a temporising measure to dress a wound defect over a cochlear implant prior to definitive surgical intervention could instead be used to close the soft tissue and avoid surgery. METHOD: This is a case report describing the novel use of VAC (Vacuum-Assisted Closure Device) in the successful closure of a wound defect with cochlear implant hardware exposure post soft tissue infection during the Covid-19 pandemic. RESULTS: While the VAC system was initiated for temporary wound coverage, it was observed at each dressing change to be successfully decreasing the soft tissue defect for our patient. This resulted in complete epithelisation of the soft tissue defect at Day 35 and avoidance of a surgical procedure. The patient was able to restart wearing her device on Day 50 and Cochlear MAPping performed on Day 58 showed minimal changes in patient's current requirements compared to her settings pre-infection. CONCLUSION: The use of V.A.C dressing for a small soft tissue defect over an extruded cochlear implant seems promising as exemplified by our case study. However, due to the lack of literature, more studies should be done to prove its usefulness in such an application. PMID: 33272148 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Elevated circulating Glutamate associates with subclinical Atherosclerosis independently of established Risk Markers: a cross-sectional study.

p.aythelady61 shared this article with you from Inoreader Elevated circulating Glutamate associates with subclinical Atherosclerosis independently of established Risk Markers: a cross-sectional study. Via American Goiter Association Related Articles Elevated circulating Glutamate associates with subclinical Atherosclerosis independently of established Risk Markers: a cross-sectional study. J Clin Endocrinol Metab. 2020 Dec 05;: Authors: Lehn-Stefan A, Peter A, Machann J, Schick F, Randrianarisoa E, Heni M, Wagner R, Birkenfeld AL, Fritsche A, Häring HU, Staiger H, Stefan N Abstract OBJECTIVE: Elevated plasma glutamate levels associate with an increased risk of cardiovascular disease (CVD). Because plasma glutamate levels also strongly associate with visceral adiposity, NAFLD, insulin resistance and high circulating levels of branched-chain amino acids (BCAA), it is unknown to what extent elevated circulating glutamate is an independent marker of an increased risk of atherosclerosis. METHODS: Plasma levels of glutamate and BCAA were measured in 102 subjects who were precisely phenotyped for body fat mass and distribution (MR tomography), liver fat content ( 1H-MR spectroscopy), insulin sensitivity [oral glucose tolerance test and hyperinsulinemic, euglycemic clamp (N=57)] and carotid intima-media thickness (cIMT). RESULTS: Plasma glutamate levels, adjusted for age, sex, body fat mass and visceral fat mass, correlated positively with liver fat content and cIMT (all std.-ß≥0.22, all p≤0.023) and negatively with insulin sensitivity (std.-ß≤-0.31, p≤0.0019). Glutamate levels also associated with cIMT, independently of additional adjustment for liver fat content, insulin sensitivity and BCAA levels (std.-ß≥0.24, p≤0.021). Furthermore, an independent positive association of glutamate and IL-6 levels was observed (N=50; std. ß=0.39, p=0.028). While glutamate, adjusted for age, sex, body fat mass and visceral fat mass, also correlated positively with cIMT in this subgroup (std. ß=0.31, p=0.019), after additional adjustment for the parameters liver fat content, insulin sensitivity, BCAA or IL-6 levels, adjustment for IL-6 most strongly attenuated this relationship (std. ß=0.28, p=0.05). CONCLUSIONS: Elevated plasma glutamate levels are associated with increased cIMT, independently of established CVD risk factors and this relationship may in part be explained by IL-6-associated subclinical inflammation. PMID: 33277657 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

TNF-α Priming Elicits Robust Immunomodulatory Potential of Human Tonsil-Derived Mesenchymal Stem Cells to Alleviate Murine Colitis.

p.aythelady61 shared this article with you from Inoreader TNF-α Priming Elicits Robust Immunomodulatory Potential of Human Tonsil-Derived Mesenchymal Stem Cells to Alleviate Murine Colitis. Via Head and Neck Related Articles TNF-α Priming Elicits Robust Immunomodulatory Potential of Human Tonsil-Derived Mesenchymal Stem Cells to Alleviate Murine Colitis. Biomedicines. 2020 Dec 02;8(12): Authors: Shin TH, Ahn JS, Oh SJ, Shin YY, Yang JW, Kang MJ, Kim JM, Lee BJ, Seo Y, Kim HS Abstract Mesenchymal stem cells (MSCs) have been spotlighted in the field of cell therapies as a promising tool for the treatment of intractable inflammatory diseases. However, their therapeutic potency still shows a gap between preclinical and clinical settings, and distinctive characteristics of specific tissue-derived MSCs and definitive ways to maximize their beneficial functions have not been fully elucidated yet. We previously identified the unique MSCs population from human palatine tonsil (TMSCs) and revealed their superior properties in proliferation and ROS regulation. Based on these findings, we explored further characteristics of TMSCs particularly focused on immunomodulatory function. We found the merit of TMSCs as a therapeutic agent that retains favorable MSCs properties until relatively late passages and revealed that pre-treatment of TNF-α can enhance the immunomodulatory abilities of TMSCs through the upregulation of the PTGS2/PGE2 axis. TMSCs primed with TNF-α eff ectively restrained the proliferation and differentiation of T lymphocytes and macrophages in vitro, and more interestingly, these TNF-α-licensed TMSCs exhibited significant prophylactic and therapeutic efficacy in a murine model of autoimmune-mediated acute colitis via clinical and histopathological assessment compared to unprimed naïve TMSCs. These findings provide novel insight into the optimization and standardization of MSCs-based anti-inflammatory therapies, especially targeting inflammatory bowel disease (IBD). PMID: 33276479 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

NRF2 and the Ambiguous Consequences of Its Activation during Initiation and the Subsequent Stages of Tumourigenesis.

p.aythelady61 shared this article with you from Inoreader NRF2 and the Ambiguous Consequences of Its Activation during Initiation and the Subsequent Stages of Tumourigenesis. Via Head and Neck Related Articles NRF2 and the Ambiguous Consequences of Its Activation during Initiation and the Subsequent Stages of Tumourigenesis. Cancers (Basel). 2020 Dec 02;12(12): Authors: Robertson H, Dinkova-Kostova AT, Hayes JD Abstract NF-E2 p45-related factor 2 (NRF2, encoded in the human by NFE2L2) mediates short-term adaptation to thiol-reactive stressors. In normal cells, activation of NRF2 by a thiol-reactive stressor helps prevent, for a limited period of time, the initiation of cancer by chemical carcinogens through induction of genes encoding drug-metabolising enzymes. However, in many tumour types, NRF2 is permanently upregulated. In such cases, its overexpressed target genes support the promotion and progression of cancer by suppressing oxidative stress, because they constitutively increase the capacity to scavenge reactive oxygen species (ROS), and they support cell proliferation by increasing ribonucleotide synthesis, serine biosynthesis and autophagy. Herein, we describe cancer chemoprevention and the discovery of the essential role played by NRF2 in orchestrating protection against chemical carcinogenesis. We similarly describe the discoveries of somatic mutations in NFE2L2 and the gene encodi ng the principal NRF2 repressor, Kelch-like ECH-associated protein 1 (KEAP1) along with that encoding a component of the E3 ubiquitin-ligase complex Cullin 3 (CUL3), which result in permanent activation of NRF2, and the recognition that such mutations occur frequently in many types of cancer. Notably, mutations in NFE2L2, KEAP1 and CUL3 that cause persistent upregulation of NRF2 often co-exist with mutations that activate KRAS and the PI3K-PKB/Akt pathway, suggesting NRF2 supports growth of tumours in which KRAS or PKB/Akt are hyperactive. Besides somatic mutations, NRF2 activation in human tumours can occur by other means, such as alternative splicing that results in a NRF2 protein which lacks the KEAP1-binding domain or overexpression of other KEAP1-binding partners that compete with NRF2. Lastly, as NRF2 upregulation is associated with resistance to cancer chemotherapy and radiotherapy, we describe strategies that might be employed to suppress growth and overcome drug resistance in tumours with overactive NRF2. PMID: 33276631 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effect of Endoscopic Glottoplasty on Acoustic Measures and Quality of Voice: A Systematic Review and Meta-Analysis.

p.aythelady61 shared this article with you from Inoreader Effect of Endoscopic Glottoplasty on Acoustic Measures and Quality of Voice: A Systematic Review and Meta-Analysis. Via Head and Neck Related Articles Effect of Endoscopic Glottoplasty on Acoustic Measures and Quality of Voice: A Systematic Review and Meta-Analysis. J Voice. 2020 Dec 01;: Authors: Aires MM, Marinho CB, Souza CSC Abstract INTRODUCTION: The voice is an important marker of the transition process to the new gender identity of the transgender person. For 20% of patients seeking voice feminization, voice therapy is not completely satisfactory, and surgery should be considered, with endoscopic glottoplasty being the current practice. While the increase in fundamental frequency (F0) after glottoplasty has been well described, no systematic review of the literature or meta-analysis regarding other acoustic parameters and quality of voice has been performed yet. OBJECTIVE: To define the effect of endoscopic glottoplasty on acoustic measures and quality of voice by assessing F0, maximum phonation time (MPT), frequency range, and grade of dysphonia. METHODS: A literature review was performed in Medline/PubMed, Cochrane, Science Direct, LILACS, and Google Scholar, following PRISMA guidelines, with no constraints on publication date. We included studies in English, Portuguese or Spanish that assessed transgender women who underwent endoscopic glottoplasty. All the included articles were measured in terms of their methodological quality. RESULTS: The PRISMA approach yielded 14 studies, totaling 566 patients. There was significant heterogeneity between studies regarding follow-up time, surgical technique and perioperative care. Thirteen studies were submitted to meta-analysis. The results showed significant changes in pre- to postglottoplasty mean differences of F0 = 78.49 Hz (95%CI: 75.69-81.30), MPT = -1.11 seconds (95%CI -1.67 to -0.54), frequency range = -3.55 semitones (95%CI -5.74 to -1.36) and grade of dysphonia on the GRBAS scale = 0.44 (95%CI 0.27-0.61). CONCLUSION: Glottoplasty is effective in significantly increasing fundamental frequency, but slightly decreases MPT, frequency range and vocal quality measured by the grade of dysphonia on the GRBAS scale. PMID: 33277130 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.