Differentiating stable buckle fractures from other distal radius fractures: the 1-cm rule

Abstract

Background

Treatment pathways for isolated distal radius fractures in children are becoming more tailored to specific fracture types and include different management plans for stable buckle fractures versus potentially unstable distal radius fractures.

Objective

To propose a measurement rule to aid in differentiating stable buckle fractures from other distal radius fractures in children.

Materials and methods

A medical record search identified 203 children with closed distal radius fractures during a 14-month period. A consensus of two senior readers served as a reference standard to distinguish buckle fractures from other distal radius fractures. We measured fracture-to-physis distance on posteroanterior (PA) and lateral radiographs for each of the isolated distal radius fractures. We analyzed diagnostic accuracy, using fracture-to-physis distance as a predictor for buckle fractures, in children ages 3–16 years. We used a receiver operating characteristic (ROC) curve to determine the cut-off values tested.

Results

There were 148 buckle fractures (73%) and 55 isolated potentially unstable distal radius fractures (27%). For children 7–16 years, buckle fracture-to-physis distance was <1 cm in only 1/106 (0.9%) on the PA projection and none on the lateral projection. Diagnostic accuracy for buckle fracture diagnosis was 82% using a cut-off of 14 mm (PA) and 13 mm (lateral). In children 3–6 years old, the buckle fracture-to-physis distance was <1 cm in 1/42 (2.4%) on the PA radiographs and another 1/42 (2.4%) on the lateral radiographs. Diagnostic accuracy was low for younger children for all tested distances.

Conclusion

We propose utilizing a measurement rule to increase diagnostic accuracy for buckle fractures in children ≥7 years old. An isolated distal radius fracture in a child 7 years or older is not likely to be a buckle fracture if the fracture-to-physis distance is <1 cm.

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Pediatric neuroimaging at a university hospital in Rwanda: a pictorial essay

Abstract

Rwanda is a country of 12 million people with 41% of its population under the age of 14 years. Despite major improvements in health care since the 1994 genocide, pediatric neuroimaging in Rwanda remains challenging. Prenatal and advanced imaging techniques, such as magnetic resonance imaging (MRI), are not widespread. As a result, many children with neurological diseases present unexpectedly as newborns or are in advanced stages of disease at diagnosis. The goal of this essay is to describe some unique features of the practice of pediatric neuroradiology in Rwanda in 2018.

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Relation among the knowledge of teachers about hearing loss degree, technological devices and communication strategies

RESUMO Objetivo Analisar a relação entre o conhecimento dos professores sobre grau de perda auditiva, dispositivos tecnológicos, aparelho de amplificação sonora individual (AASI), implante coclear (IC) e sistema de frequência modulada (Sistema FM) e estratégias de comunicação. Método Participaram deste estudo 42 professores que atuavam com alunos com deficiência auditiva (DA), os quais lecionaram no segundo semestre do ano letivo e no primeiro semestre do ano subsequente, correspondendo a 24 professores do Ensino Fundamental II, 11 do Ensino Fundamental I e sete da Educação Infantil. Os dados foram obtidos através do Questionário sobre Conhecimentos e Experiências, desenvolvido por Delgado-Pinheiro e Omote (2010). As respostas dos questionários foram categorizadas, e analisada a frequência de ocorrência. A análise estatística foi realizada, utilizando-se o Teste de Qui-quadrado. Resultados Houve diferença estatisticamente significante entre as respostas, as quais demonstraram que os professores não conhecem o grau da perda auditiva, mas modificam as estratégias de comunicação, para manter a atenção do aluno. Além disso, os resultados também revelaram que os professores não conhecem os dispositivos tecnológicos e estratégias de comunicação mais adequadas para o aluno com DA. Conclusão Os resultados indicaram que os professores não apresentam conhecimentos sobre deficiência auditiva, porém, modificam suas estratégias de comunicação diante do aluno, mesmo não tendo conhecimentos sobre quais são as estratégias de comunicação mais apropriadas.

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ABSTRACT Purpose To analyze the relations among the knowledge of teachers about hearing loss degree, technological devices, hearing aids (HA), cochlear implant (CI), frequency modulation system (FM), and communication strategies. Methods Forty-two (42) teachers that taught students with hearing impairment participated in this study. This sample included 24 middle school teachers, 11 elementary school teachers, and 7 preschool teachers, whose taught in the second semester of the school year and in the first semester of the following year. The data was obtained through the Knowledge and Experience Questionnaire developed by Delgado-Pinheiro & Omote (2010). The questionnaire answers were categorized, and the frequency of occurrence was analyzed. Statistical analysis was performed using the chi-square test. Results There was a statistically significant difference between the answers which showed that the teachers do not know about the degree of hearing loss, but they modify the communication strategies to keep the attention of the students. In addition, the results also showed that teachers do not know the technological devices and communication strategies most appropriate for the student with hearing impairment. Conclusion The results showed that teachers do not have sufficient knowledge about hearing impairment and as a result they modify their communication strategies for the student, even though they are unaware of the most appropriate communication strategies.

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A mapping of the Speech Language Pathology practice pathway in verbal expressivity in the work of communicative competence

RESUMO Objetivo Apresentar um mapeamento do eixo condutor da prática fonoaudiológica em expressividade verbal no trabalho de competência comunicativa. Método Participaram do estudo 40 fonoaudiólogos voluntários, com larga experiência de atuação na área de voz. Eles responderam perguntas sobre duração do trabalho, número de participantes, instrumentos de avaliação e formação do fonoaudiólogo que atua nessa área, além de discutir questões relacionadas às estratégias de expressividade, aos recursos vocais e aos exercícios utilizados, e à terminologia empregada. Resultados O grupo concordou que o trabalho de competência comunicativa é prático, realizado com grupos pequenos e conduzido, preferencialmente, por um fonoaudiólogo especialista em voz. Os exercícios de expressividade compõem grande parte do trabalho e têm como objetivo promover uma comunicação condizente com o conteúdo do discurso. Leitura de textos com diferentes emoções, simulações e exercícios com fala encadeada foram citados como estratégias frequentemente utilizadas. Pontos a serem aprofundados estão relacionados à duração do trabalho de competência comunicativa, às questões de ensino-aprendizagem e andragogia e, principalmente, à utilização de terminologia comum aos fonoaudiólogos dessa área. Conclusão A opinião dos fonoaudiólogos sobre expressividade em competência comunicativa revela pontos de concordância quanto aos objetivos, exercícios e estratégias utilizadas. Ainda há, contudo, imprecisão na terminologia empregada e falta detalhamento na descrição do trabalho realizado. Futuras discussões envolvendo tais aspectos parecem ser fundamentais para a organização sistemática das informações referentes ao tema.

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ABSTRACT Purpose Present a mapping of the Speech-language Pathology (SLP) practice pathway in verbal expressivity in the work of communicative competence. Methods Study participants were 40 volunteer speech-language pathologists with extensive experience in the area of voice. They responded to questions about duration of work, number of participants, evaluation instruments, and training of the speech language pathologists who work in this area. They discussed specific issues related to the strategies of expressivity proposed and the vocal resources, exercises and terminology used. Results The group agreed that communicative competence work is practical, conducted with small groups and preferably guided by a voice specialist. Expressivity exercises comprise a large part of the work and aim to promote communication consistent with the context and intention of discourse. Oral reading of texts with different emotions, simulations, and exercises of connected speech were mentioned as frequently-used strategies. Some points to be considered are associated with duration of communicative competence work, teaching-learning and andragogy issues involved in this process, and use of specific terminology in this area. Conclusion Further discussions involving such aspects seem to be fundamental for the systematic organization of information on the theme.

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Instrumentalized evaluation for diagnosis of developmental disorders in childhood: a new Brazilian reality

RESUMO Objetivo Apresentar a Escala de Desenvolvimento Mental de Griffiths (EDMG), bem como sua adaptação transcultural para o Brasil. Método EDMG é um instrumento diagnóstico de avaliação do desenvolvimento infantil. O resultado de sua aplicação permite verificar se o desenvolvimento é típico ou se há diagnóstico de alteração em determinada área específica (motora grossa, pessoal-social, linguagem, motora fina-adaptativa e execução) ou do desenvolvimento global. Após contato com autores, permissão de utilização da EDMG e cumprimento dos aspectos éticos, a versão do instrumento em português europeu foi adaptada para o português brasileiro, com manutenção de equivalências semântica, idiomática, experimental e conceitual. A adaptação foi realizada por duas fonoaudiólogas, experientes em avaliação de lactentes, que realizaram o curso de capacitação para aplicar o instrumento. A versão final adaptada foi aplicada em 21 lactentes com desenvolvimento típico. Resultados Foram adaptados 39 itens, sem exclusão alguma. Todos os itens foram possíveis de serem aplicados, adequados à faixa etária alvo, sem ausência de resposta em nenhum item. Conclusão A EDMG é adaptada transculturalmente em diversos países e amplamente utilizada por realizar diagnóstico em faixa etária essencial para estimulação com a plasticidade cerebral em pleno desenvolvimento. Foi realizada a adaptação transcultural da EDMG para o Brasil, transformando o cenário brasileiro em relação à atenção a lactentes. Após normatização e verificação das medidas psicométricas, será possível, além de diagnóstico precoce, melhorar a qualidade dos atendimentos a esta população; realizar estudos transculturais e publicar em revistas internacionais com a viabilidade de a EDMG ser aceita e utilizada internacionalmente.

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ABSTRACT Purpose To present the Griffiths Mental Development Scale (GMDS), as well as its cross-cultural adaptation to Brazil. Methods GMDS is a diagnostic tool for assessing child development. The result of its application allows verifying if development is typical or if there are alterations in a certain specific area (gross motor, personal-social, language, fine-adaptive motor and execution) or global development. After contact with the authors, permission to use GMDS was obtained and in compliance with ethical aspects, the Portuguese version of the instrument was adapted to Brazilian Portuguese with maintenance of semantic, idiomatic, experimental and conceptual equivalences. The adaptation was carried out by two speech therapists, experienced in evaluating infants, who were submitted to training course prior to the application of the instrument. The adapted final version was applied to 21 infants with typical development. Results Thirty-nine items were adapted without any exclusion. All items were possible to be applied, suitable for the target age group, with no response in any item. Conclusion GMDS has been trans-culturally adapted in several countries and widely used for performing diagnosis in the age group essential for stimulation with brain plasticity in full development. The cross-cultural adaptation of GMDS for Brazil was carried out, transforming the Brazilian scenario in relation to child care. After normalization and verification of psychometric measures, it was possible, in addition to early diagnosis, to improve the quality of care for this population; carry out cross-cultural studies and publish the results in international journals regarding the feasibility of GMDS being accepted and used worldwide.

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Musical and temporal auditory skills in cochlear implant users after music therapy

RESUMO Objetivo Verificar o desempenho das habilidades de percepção musical e das habilidades auditivas temporais de resolução e ordenação pré e pós-musicoterapia em pacientes pós-linguais usuários de implante coclear. Método Participaram do estudo 11 indivíduos (média de idade: 47,64 anos) pós-linguais implantados, que foram submetidos a 10 sessões de musicoterapia, sendo uma por semana. Para a avaliação auditiva, foram utilizados o teste Montreal Battery Evaluation of Amusia e o teste de padrão de frequência (TPF). Todos os participantes passaram por um momento placebo antes da musicoterapia e foram avaliados em três momentos distintos. Resultados Foi observada melhora significativa nos subtestes das habilidades musicais de contorno e melodia após musicoterapia. Não foi observado efeito placebo e nem diferença do TPF após a musicoterapia. Conclusão A musicoterapia foi uma ferramenta útil para melhorar as habilidades auditivas musicais em indivíduos adultos pós-linguais usuários de IC.

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ABSTRACT Purpose Verify the performance of musical perception and temporal auditory resolution and ordering skills in pre- and post-music therapy patients with cochlear implants (CI). Methods Study participants were 11 postlingual CI users with mean age of 47.64 years. All individuals underwent 10 weekly music therapy sessions. Auditory assessment was conducted using the Montreal Battery of Evaluation of Amusia (MBEA) and the Frequency Pattern Test (FPT). All participants were submitted to a placebo condition prior to music therapy and were evaluated at three different times. Results Significant improvement was observed in the subtests of contour and melody memory after music therapy. No placebo effect or difference in the FPT was observed after music therapy. Conclusion Music therapy is a useful tool to improve musical skills in adult postlingual users of CI.

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Identification of swallowing disorders: the perception of patients with neurodegenerative diseases

RESUMO Objetivo Verificar a percepção de indivíduos com doenças neurodegenerativas quanto às alterações de deglutição, e conhecer as sensações ao deglutir que podem favorecer a identificação precoce de disfagia. Método Trata-se de um estudo transversal com 44 sujeitos com doenças neurodegenerativas. Todos responderam a um questionário para investigação da sensação percebida ao deglutir e mensuração da intensidade da sensação. Foram questionados quanto à presença de fadiga por meio da Fatigue Severity Scale. Para detecção de queixas de deglutição, foi utilizada a versão traduzida e adaptada para o português brasileiro do Swallowing Disturbance Questionaire. A Funcional Oral Intake Scale foi utilizada para classificar o nível de ingestão oral. Realizou-se videofluoroscopia da deglutição para verificar a correspondência entre a percepção dos participantes e a fisiopatologia da deglutição. Foi realizada análise estatística descritiva e exploratória. Resultados Houve correspondência entre os achados da videofluoroscopia e a percepção dos sujeitos em 76,5% casos. Sensações como desconforto, cansaço e incômodo foram percebidas ao engolir, especialmente, na consistência sólida. Tais sensações foram referidas, predominantemente, na região da garganta, da metade para o final das refeições. Houve associação entre fadiga durante a alimentação e odinofagia. A fadiga durante a deglutição foi associada à pior funcionalidade oral. Conclusão A maioria dos participantes percebeu as alterações presentes em sua deglutição. Sensações como ardor, desconforto, incômodo, cansaço, dor, câimbra ou irritação foram referidas pelos participantes e se mostraram associadas com sinais e sintomas que sugerem risco de aspiração laringotraqueal, especialmente, devido à fadiga muscular decorrente de fraqueza, incoordenação e/ou rigidez da musculatura.

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ABSTRACT Purpose To verify the perception of patients with neurodegenerative diseases regarding swallowing changes and to know the perceptions of swallowing sensations that can promote the early identification of dysphagia. Methods It is a cross-sectional study with 44 patients with neurodegenerative diseases. All of them answered a questionnaire to know the sensation perceived during swallowing and its intensity. The Fatigue Severity Scale was applied to measure fatigue and the Swallowing Disturbance Questionnaire was applied to detect swallowing complaints. The Functional Oral Intake Scale was used to classify the swallowing functionality. Videofluoroscopic swallowing study (VFSS) was performed to verify the correspondence between the patient's perceptions and swallowing physiopathology. A descriptive and exploratory statistical analysis was performed. Results There was correspondence between VFSS findings and the patient's perception in 76.5% of the cases. Sensations such as discomfort and fatigue were perceived during swallowing, especially with solids. Such feelings have predominantly been reported in the throat, from the half to the end of the meal. There was association between fatigue and odynophagia. Fatigue during swallowing was associated with worse functionality of oral intake. Conclusion Most participants perceived the disorders in their swallowing. Sensations such as burning, discomfort, tiredness, pain, cramp, or irritation were perceived by participants and were associated with symptoms that may suggest risk of aspiration due to fatigue resulting from weakness, incoordination, and/or stiffness of muscles.

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Effects of cochlear implantation on adulthood

RESUMO Objetivo Compreender os benefícios da implantação coclear na idade adulta sob a perspectiva dos usuários. Método Pesquisa qualitativa, tendo o Interacionismo Simbólico e a Teoria Fundamentada nos Dados Straussiana como referencial teórico e metodológico, respectivamente. Projeto aprovado pelo Comitê de Ética em Pesquisa da instituição (Parecer n°482.019). Participaram do estudo 16 adultos usuários de implante coclear há pelo menos um ano, com idade entre 28 e 58 anos. O instrumento de coleta de dados foi a entrevista semiestruturada, que abrangeu questões inquirindo as mudanças causadas pelo implante coclear nas relações sociais, na comunicação, no sistema familiar e na vida pessoal, acadêmica e profissional do adulto. Resultados A categoria Repercussões do Implante Coclear na Vida Adulta faz parte de um estudo teórico fundamentado maior sobre o enfrentamento da surdez em adultos usuários de implante coclear. Junto às subcategorias que a compõem, ela evidencia que este dispositivo intervém de forma revolucionária na vida dos usuários, uma vez que ele aumenta a segurança, possibilita enxergar a vida sob uma nova perspectiva, resgata a autoconfiança e a autoestima, permite comunicar-se e interagir de modo mais eficaz, apreciar música e outros entretenimentos, retomar projetos e fazer planos para o futuro; ajudando, assim, no processo de resgate da independência da vida adulta. Conclusão As impressões subjetivas dos usuários mostraram que o uso do implante coclear não apenas melhora o aproveitamento auditivo, mas traz também inúmeras mudanças positivas para sua inserção social e sua qualidade de vida. Portanto, esta intervenção mostra-se altamente benéfica para adultos com surdez.

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ABSTRACT Purpose To understand the benefits of cochlear implantation in adulthood under the perspective of users. Methods Qualitative study using Symbolic Interactionism and Straussian Grounded Theory as theoretical and methodological frameworks, respectively. The project was approved by the Research Ethics Committee of the aforementioned Institution (Opinion no. 482,019). Sixteen adult cochlear implant (CI) users aged 28-58 years participated in the study. The data collection instrument was a semi-structured interview with questions about changes caused by CI in the social relations, communication, family system, and personal, academic and professional spheres of life of users. Results The category Cochlear Implant Effects on Adulthood is part of a more comprehensive theoretical study that addresses how adult CI users cope with deafness. Together with its subcategories, it shows that CI intervenes in a revolutionary way in the lives of its users, because it increases their sense of security, enables them to see life from a new perspective, rescues self-confidence and self-esteem, enables them to communicate and interact more effectively, enjoy music and other entertainment, rescue old projects, and make plans for the future; thus assisting with the process of recovering independence in adult life. Conclusion Subjective impressions of the users showed that cochlear implants not only improve their auditory performance, but also bring several positive changes to their social insertion and quality of life. Therefore, this intervention is highly beneficial to deaf adults.

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Evaluation of the sensitivity of the Psychosocial Scale of Facial Appearance in peripheral facial paralysis

RESUMO Objetivo Investigar a sensibilidade e consistência interna do instrumento a partir da comparação com os resultados dos instrumentos de avaliação funcional facial, escala de House-Brackmann (HBS) e Sistema de Graduação Facial, e implicações psicossociais a partir da aplicação da Escala Hospitalar de Ansiedade e Depressão (HADS). Método Pesquisa aprovada pelo comitê de ética em pesquisa, sob o protocolo nº. 196.977 e 230.982. A avaliação da sensibilidade do questionário foi realizada por meio de entrevistas fechadas em sujeitos adultos com PFP, sendo 38 selecionados para essa etapa. A análise estatística foi realizada para cada uma das etapas deste estudo, os dados foram digitados em Excel®, analisados pelos programas SPSS versão 17.0 para Windows e AMOS versão 22.0 para Windows®. Resultados Participaram 38 sujeitos, entre 19 e 78 anos, com predominância de paralisia idiopática (44,7%). Os resultados do Alfa de Cronbach mostraram uma consistência interna forte entre os grupos temáticos e as questões, no entanto a análise fatorial confirmatória alerta para questões cuja relação de causa entre os grupos temáticos foi fraca, como nos casos das questões 5 e 6 do grupo temático Aspectos Funcionais da Face, questão 17 dos Aspectos Sociais e questão 23 dos Aspectos Emocionais. Conclusão Essa pesquisa constituiu os primeiros passos para o subsídio e respaldo de um instrumento que investiga os aspectos psicossociais associados à PFP, sendo possível a elaboração de questões e ordenação em grupos temáticos. Porém, faz-se necessária a continuidade de estudos para a efetivação dos processos de validação.

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ABSTRACT Purpose To investigate the sensitivity and internal consistency of the Psychosocial Scale of Facial Appearance (PSFA) based on the comparison between its results and those from other facial functional assessment instruments: House-Brackmann scale (HBS) and Facial Grading System - and the psychosocial implications measured by the Hospital Anxiety and Depression Scale (HADS). Methods The study was approved by the Research Ethics Committee of the aforementioned Institution under protocols no. 196.977 and 230.982. Thirty-eight adult individuals with Peripheral Facial Palsy (PFP) were submitted to closed interviews in order to evaluate the sensitivity of the questionnaire. Statistical analyses were conducted for each stage of this study. Data were entered in Excel® spreadsheet and analyzed using SPSS 17.0 and AMOS 22.0 for Windows®. Results Study participants were 38 individuals with PFP aged 19-78 years with predominance of idiopathic paralysis (44.7%). Results of the Cronbach's Alpha coefficient showed strong internal consistency between the thematic groups and the questions; however, Confirmatory Factor Analysis indicated some questions with week causal relationship between thematic groups, namely, questions 5 and 6 of the group Functional Aspects of Face, question 17 of the group Social Aspects, and question 23 of the group Emotional Aspects. Conclusion This study provided the first steps for the subsidy and support of an instrument designed to investigate the psychosocial aspects associated with PFP, enabling the preparation of questions and their organization into thematic groups. However, further studies are needed to conclude the validation processes.

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Voice therapy for the elderly with progression of intensity, frequency, and phonation time: case reports

RESUMO Este trabalho pretende verificar o efeito imediato e em médio prazo na voz e na laringe de dois idosos submetidos à terapia vocal intensiva com progressão de intensidade e frequência vocais e de duração do tempo de fonação. Dois idosos (um homem, 79 anos e uma mulher, 82 anos) com queixa vocal e características de presbilaringe, realizaram 12 sessões de terapia vocal intensiva com progressão de intensidade e frequência da voz e duração do tempo de fonação, durante três semanas. Para analisar o efeito terapêutico foram realizadas avaliações perceptivoauditivas e acústicas da voz, de tempo máximo de fonação (TMF), de autorreferência da qualidade de vida em voz e do comportamento laríngeo nos momentos pré, imediatamente após e um mês depois do processo de terapia vocal. Os valores da maioria das medidas resultantes dessas avaliações indicaram mudanças positivas imediatamente após a terapia vocal para os idosos. Observou-se redução das medidas perceptivoauditivas de desvio da qualidade vocal e diminuição das medidas de perturbação e ruído do sinal acústico, o que indica melhora na voz. Houve elevação da frequência fundamental e, aumento do TMF, além de autorreferência de melhor qualidade de vida em voz. A avaliação das imagens laríngeas não mostrou diferença consistente. Após um mês do término da terapia alguns parâmetros pioraram em relação ao momento pós-imediato, mesmo assim, permaneceram melhores em relação ao momento pré-terapia. Desta forma os resultados da proposta terapêutica são promissores e seus efeitos devem ser pesquisados em estudos clínicos controlados para verificar sua eficácia em idosos.

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ABSTRACT This study aims to verify the immediate and medium-term effects of an intensive voice therapy, with progression of vocal intensity and frequency and phonation time, on the voice and larynx of two elderly. A 79-year-old male and an 82-year-old female with vocal complaints and presbylarynx characteristics underwent 12 sessions of intensive voice therapy, with progression of voice intensity and frequency and phonation time, for three weeks. To analyze the therapeutic effects, the following assessments were performed pre-, post-immediately, and one month after voice therapy: auditory-perceptual analyses of the voice, acoustic analysis, and evaluation of maximum phonation time (MPT), self-reference voice-related quality of life, and laryngeal behavior. Most results of these measurements indicated positive changes immediately after voice therapy. There was reduction in the measures of vocal quality deviation, perturbation, and harmonics-to-noise pre-, post-immediately, and one month after voice therapy, which indicates vocal improvement. There was increase in fundamental frequency, maximum phonation time and self-reference voice-related quality of life. Assessment of the laryngeal images showed no consistent difference. One month after voice therapy, worsening of some results was observed compared with the post-immediate assessment, but improvements were maintained in relation to the initial evaluation. The results of this therapeutic proposal are promising, and their effects should be investigated in controlled clinical trials to verify their efficacy.

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Association of facial massage, dry needling, and laser therapy in Temporomandibular Disorder: case report

ABSTRACT This case report aims to evaluate the treatment of Temporomandibular Disorder (TMD) of muscular origin by associating facial massage (FM), dry needling (DN), and low-level laser therapy (LLLT). The pre- and post-treatment evaluations consisted of clinical examinations based on the Research Diagnostic Criteria (RDC) for TMD, pain intensity quantification by means of the Visual Analog Scale (VAS), mandibular movement measurement, and electromyographic (EMG) analysis of the masseter and temporal muscles. Post-therapy assessment indicated a decrease in pain sites of 58%, in pain intensity mean (1.3), and an increase in the maximum aperture of 10 mm, in addition to normalization of EMG signals. We conclude that, after application of the treatment protocol, there was a decrease in painful sites, gain in amplitude of mandibular movements, and normalization of EMG activity.

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RESUMO O objetivo do presente relato de caso é avaliar a associação entre a Massagem Facial (MF), Agulhamento a Seco (AS) e Terapia a Laser de Baixa Intensidade (TLBI) no tratamento da Disfunção Temporomandibular (DTM) de origem muscular. Paciente com DTM crônica foi submetida a 4 sessões de associação entre a MF, AS e TLBI. A avaliação inicial e final foi composta por exame clínico baseado nos Critérios diagnósticos de pesquisa para DTM (RDC - Research Diagnostic Criteria), quantificação da intensidade da dor por meio da Escala visual analógica de dor, mensuração dos movimentos mandibulares e análise eletromiográfica (EMG) dos músculos masseter e temporal. Na pós-terapia, foi observada a redução de 58% dos sítios dolorosos, da média (1,3) da intensidade de dor e aumento de 10 mm na abertura máxima, além da normalização dos sinais EMG. Conclui-se que, após a aplicação de protocolo de tratamento, houve a redução dos sítios dolorosos, ganho de amplitude dos movimentos mandibulares e normalização da atividade EMG.

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Pseudowords to the Phonological Therapy: a new therapeutic approach

RESUMO As pseudopalavras são um recurso pouco utilizado na prática clínica, mas podem representar uma excelente opção para a terapia fonológica. O objetivo deste estudo foi verificar o progresso terapêutico de crianças com desvio fonológico tratadas a partir de uma nova abordagem terapêutica, considerando o ambiente linguístico favorecedor em pseudopalavras e palavras com significado. A amostra foi composta por 3 crianças, com idades entre 4 e 8 anos, submetidas a uma nova abordagem terapêutica com base fonológica. As crianças foram tratadas com diferentes alvos envolvendo pseudopalavras e palavras reais, em ambiente linguístico favorecedor e neutro. Nos resultados, pode-se observar que a terapia envolvendo ambiente linguístico favorecedor apresentou melhores resultados quando comparada com a realizada em ambiente neutro. Em relação às palavras-alvo, os sujeitos tratados simultaneamente com pseudopalavras e palavras reais apresentaram resultados satisfatórios, indicando que os alvos foram adequados à terapia. A nova abordagem terapêutica envolvendo pseudopalavras e palavras reais em ambientes favorecedores mostrou-se eficaz para o tratamento dos desvios fonológicos.

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ABSTRACT The pseudowords are a resource rarely used in clinical practice, but may be an excellent option for phonological therapy. This study aimed to verify the therapeutic progress of children with phonological disorder, treated from a new therapeutic approach, considering the favorable linguistic environment in pseudowords and words. The sample consisted of three children, aged between 4 and 8 years old, who submitted to a new therapeutic approach to phonological basis. The children were treated with different targets involving pseudowords and real words in favorable and neutral linguistic environments. In the results, it can be observed that the therapy involving favorable linguistic environment the best results when compared to realize in neutral environment. Regarding the target words, subject treated simultaneously with pseudowords and real words presented satisfactory results, indicating that the targets were appropriate to therapy. The new therapeutic approach involving pseudowords and real words in favorable environments proved to be effective for the treatment of phonological disorders.

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Clinical protocol for Hearing Health Services for the care of adults and elderly

RESUMO Objetivo Desenvolver um protocolo clínico para o atendimento ao paciente no processo de seleção, verificação e validação das próteses auditivas e estabelecer a representação gráfica do protocolo por meio de um fluxograma com algoritmos. Método Foi realizado um estudo bibliográfico para levantamento dos procedimentos necessários na elaboração de protocolos clínicos em saúde e quanto aos principais procedimentos em cada etapa do processo de seleção e adaptação de próteses auditivas. Posteriormente, foi realizada a elaboração por extenso do protocolo, que passou pela avaliação de oito fonoaudiólogos quanto ao conteúdo e aplicabilidade. Houve a adequação dos fatores levantados pelos profissionais e elaboração do documento final, além da constituição de um fluxograma com algoritmos do processo. Resultados: O protocolo foi desenvolvido após extenso levantamento de literatura; todos os fonoaudiólogos participantes referiram ser de grande valia a utilização do instrumento em sua prática clínica; e, ao final, houve a constituição do fluxograma com algoritmos, realizada após a elaboração do protocolo por extenso, originando o Procedimento Operacional Padrão no processo de seleção e adaptação de próteses auditivas. Conclusão O protocolo clínico para o atendimento ao paciente no processo de seleção, verificação e validação do uso das próteses auditivas foi desenvolvido e validado por meio de sua aplicação por profissionais, o que gerou, posteriormente, a representação gráfica do protocolo e suas etapas por meio de um fluxograma com algoritmos.

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ABSTRACT Purpose To develop a clinical protocol for patient care in the selection, verification, and validation process of hearing aids; to verify the viability of the protocol during its use by specialists in the field; to establish the graphical representation of the protocol by means of a flowchart with algorithms. Methods We conducted a literature review to collect the procedures required for developing clinical protocols in healthcare services and the main procedures at each step along the process of fitting hearing aids. Subsequently, we developed the protocol, which was evaluated by eight audiologists in terms of its content and ease of use. We considered the issues raised by the professionals and then drew up a final document, as well as a flowchart with process algorithms. Results A protocol after having conducted an extensive survey of the literature was developed; all audiologists reported that the use of the instrument was of great value in their clinical practice; finally, we created the flowchart with algorithms after having developed the protocol and, by extension, we also created the Standard Operational Procedure for the selection, verification and validation process of hearing aids. Conclusion The clinical protocol for the care of patients in the selection, verification and validation process of hearing aids was developed and validated by means of its use by professionals. The information and data we collected allowed a graphical representation of the protocol and its steps as a flowchart with algorithms.

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Surface electromyographic biofeedback for behavioral dysphonia in adult people: a systematic review

ABSTRACT Purpose To review systematically the literature and to analyze the effectiveness of surface electromyographic biofeedback in the rehabilitation of adults with behavioral dysphonia. Research strategies Two authors performed an independent search in the following databases: Clinical Trials, Cochrane Library, Embase, LILACS, PubMed, and Web of Science. A specific search strategy was developed for each database. Selection criteria The review included studies that examined the effectiveness of surface electromyographic biofeedback compared to other direct vocal therapy intervention in adults with behavioral dysphonia. There were no restrictions in regard to language or date of publication. Data analysis Analysis of the risk of bias, heterogeneity, quantitative and qualitative data, sensitivity, subgroups, and publication bias. Results 51 studies were identified, but only two cohort studies remained as prospects for analysis. The studies showed 100% uncertain risk of selection, performance, and detection bias. There was a high degree of clinical heterogeneity. The descriptive analysis showed a reduction in muscle electrical activity and improvement in vocal self-assessment using electromyographic biofeedback; however, it was not possible to calculate the effect size of the interventions. The present study was limited by the fact that it was unable to show a consensus for the majority of data analyzed. Conclusion The available literature does not support a conclusive finding about the effectiveness of surface electromyographic biofeedback compared to other direct interventions used in the rehabilitation of adults with behavioral dysphonia. The studies analyzed vary widely in their clinical procedures and methodology, making it impossible to determine the procedure's effectiveness.

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RESUMO Objetivo Revisar sistematicamente a literatura e analisar a efetividade do biofeedback eletromiográfico de superfície na reabilitação de adultos com disfonia comportamental. Estratégia de pesquisa Dois autores realizaram uma busca independente nas bases de dados: Clinical Trials , Cochrane Library, Embase, LILACS, PUBMED e Web of Science. Elaborou-se uma estratégia de busca específica para cada base. Critérios de seleção Foram incluídos estudos que analisaram a efetividade do biofeedback eletromiográfico de superfície comparado com outras intervenções de terapia vocal direta em adultos com disfonia comportamental. Não houve restrição de idioma e data de publicação. Análise de dados Análise do risco de viés, heterogeneidade, dados quantitativos e qualitativos, sensibilidade, subgrupos e viés de publicação. Resultados foram identificados 51 estudos, sendo que apenas dois estudos coorte prospectivos foram analisados. Os estudos apresentaram 100% de risco incerto de viés de seleção, performance e detecção. Houve alta heterogeneidade clínica. A análise descritiva mostrou redução da atividade elétrica muscular e melhora da autoavaliação vocal com o uso do biofeedback eletromiográfico, porém, não foi possível calcular o tamanho do efeito das intervenções. O presente estudo apresentou limitações por não conseguir apresentar um consenso para a maioria dos dados analisados. Conclusão A literatura disponível não permite gerar uma evidência conclusiva acerca da efetividade do biofeedback eletromiográfico comparado a outras intervenções diretas na reabilitação de sujeitos adultos com disfonia comportamental.

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Socioeconomic factors impact quality of life outcomes and olfactory measures in chronic rhinosinusitis

Background

Healthcare disparities related to socioeconomic factors may adversely impact disease states and treatment outcomes. Among patients with chronic rhinosinusitis (CRS), the impact of socioeconomic factors on outcomes following endoscopic sinus surgery (ESS) remains uncertain.

Methods

Adult patients with refractory CRS were prospectively enrolled into an observational, multi‐institutional cohort study between March 2011 and June 2015. Socioeconomic factors analyzed included household income, insurance status, years of education completed, race, age, and ethnicity. Income was stratified according to the Thompson and Hickey model. The 22‐item Sino‐Nasal Outcome Test (SNOT‐22) and Brief Smell Identification Test (BSIT) were completed preoperatively and postoperatively.

Results

A total of 392 patients met inclusion criteria. Higher age and male gender were associated with better mean preoperative SNOT‐22 scores (both p < 0.02), whereas Medicare insurance status and male gender were associated with worse preoperative mean BSIT scores (both p < 0.02). Postoperatively, higher household income ($100,001+/year) and lower age were associated with a greater likelihood of improving at least 1 minimal clinically important difference (MCID) on SNOT‐22 scores (OR = 2.40 and 1.03, respectively, both p < 0.05), while no factors were associated with increased odds of achieving a MCID on BSIT scores.

Conclusions

Preoperative olfactory function and postoperative quality of life (QOL) improvement were associated with metrics of socioeconomic status in patients with CRS electing ESS. The odds of experiencing a clinically meaningful QOL improvement were more than twice as likely for patients with the highest household income level compared to other income tiers. Further investigation is warranted to identify barriers to postoperative improvement.

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Draf IIB with superior septectomy: finding the “middle ground”

Background

Previous studies have demonstrated a high failure rate of endoscopic sinus surgery (ESS) with Draf IIa in patients with diffuse polyposis, asthma, and aspirin‐exacerbated respiratory disease. A high percentage of these patients progress to endoscopic modified Lothrop procedure (EMLP). We describe a modification of the Draf IIb with a superior septectomy (IIb+SS), which may provide similar therapeutic benefit as demonstrated by the distribution of sinus irrigations in the sinus cavity with ESS with IIb+SS vs ESS with EMLP IIb+SS vs ESS with EMLP.

Methods

ESS with IIb+SS was performed on 6 cadaver heads. Fluorescein‐dyed irrigations were performed on each head and penetration was recorded using video endoscopy. EMLP was subsequently performed on each head with repeat dye‐irrigation and video endoscopy. The videos were reviewed by 4 blinded fellowship‐trained rhinologists, and irrigant penetration of the maxillary, ethmoid, frontal, sphenoid sinuses, and olfactory cleft was graded 0 to 3 (3 implying complete staining).

Results

The mean scores when comparing IIb+SS to EMLP were as follows: overall 1.99 vs 1.97 (p = 0.816), maxillary sinus 2.67 vs 2.38 (p = 0.128), ethmoid sinus 1.88 vs 1.98 (p = 0.536), sphenoid sinus 2.58 vs 2.50 (p = 0.467), frontal sinus 1.13 vs 1.38 (p = 0.073), and olfactory cleft 1.71 vs 1.63 (p = 0.529). There was no significant difference between subsites. Interrater reliability was good (Cronbach's alpha = 0.781).

Conclusion

Performing ESS with IIb+SS provides similar irrigation delivery benefits to ESS with EMLP, without the need for altering natural sinus outflow and creating circumferential scarring. Further studies evaluating its use in patients that are high risk for revision surgery are needed.

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Alternaria‐induced barrier dysfunction of nasal epithelial cells: role of serine protease and reactive oxygen species

Background

Upper airway barrier dysfunction has been associated with chronic rhinosinusitis and allergic rhinitis. Alternaria is commonly found in nasal secretion and plays a role in the pathogenesis of airway diseases. The aim of this study was to investigate the effects of Alternaria on the junctional complex of nasal epithelial cells.

Methods

Air‐liquid interface nasal epithelial cultures from the inferior turbinate of septal surgery patients were stimulated with Alternaria alternate. Production of intracellular reactive oxygen species (ROS) and transepithelial resistance (TER) was measured. The expression of tight junction (TJ) and adherens junction (AJ) molecules was determined using real‐time reverse transcriptase‐polymerase chain reaction, Western blot analysis, and confocal microscopy. Protease activity in Alternaria was determined using protease inhibitors and heat inactivation.

Results

Alternaria enhanced the production of ROS and reduced the TER. Alternaria decreased the messenger RNA and protein expression of TJs (zonula occludens‐1, occludin, and claudin‐1), but did not influence the AJ molecule. When Alternaria was pretreated with serine protease inhibitor and heat inactivation, ROS, TER, and TJ molecule expression returned to their nonstimulated levels.

Conclusion

Serine protease in Alternaria altered nasal epithelial barrier function. Intracellular ROS induced by Alternaria may influence the barrier function of nasal epithelial cells and enhance the inflammatory process of nasal mucosa.

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Gastroesophageal reflux disease increases the risk of chronic rhinosinusitis: a nested case‐control study using a national sample cohort

Background

The purpose of this study was to evaluate the relations between gastroesophageal reflux disease (GERD) and chronic rhinosinusitus (CRS) in a Korean population.

Methods

Subjects from the Korean National Health Insurance Service‒National Sample Cohort, all ≥20 years old, were assessed from 2002 to 2013. In total, 23,489 CRS participants were matched with 93,956 controls at a ratio of 1:4 with respect to age, group, sex, income group, region of residence, hypertension, diabetes, and dyslipidemia. We analyzed previous history of GERD in the CRS and control groups. The CRS group included patients identified using International Classification of Diseases 10th edition (ICD‐10) codes (J32) who had treated their CRS ≥2 times and had undergone head and neck computed tomography (CT). The GERD group included patients identified using the ICD‐10 (K21) code who had treated their GERD ≥2 times and had taken a proton pump inhibitor (PPI) for ≥2 weeks. Crude and adjusted odds ratios (ORs) were analyzed using unconditional logistic regression analyses. The 95% confidence intervals (CIs) were calculated. Subgroup analyses were performed according to age and sex.

Results

The rate of GERD was higher in the CRS group (17.1% [4020 of 23,489]) than in the control group (9.1% [8522 of 93,956]; p < 0.001). The adjusted OR of GERD was 2.04 (95% CI, 1.96‐2.13; p < 0.001) in the CRS group. The results of the subgroup analyses were consistent.

Conclusion

The ORs of GERD were increased in CRS participants. This relationship was consistent in all age and sex groups.

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Wait times for endoscopic sinus surgery influence patient‐reported outcome measures in patients with chronic rhinosinusitis who fulfill appropriateness criteria

Background

Previous studies on the impact of wait times for endoscopic sinus surgery (ESS) in medically recalcitrant chronic rhinosinusitis (rCRS) have not examined its influence on the 5 distinct symptoms domains of the 22‐item Sino‐Nasal Outcome Test (SNOT‐22), and have not applied evidence‐based surgical indications. Our primary study objective was to investigate the impact of ESS wait times on postoperative SNOT‐22 global and symptom domain scores in patients with rCRS deemed "appropriate" surgical candidates.

Methods

This was a retrospective analysis of adult patients with rCRS undergoing ESS, categorized as "appropriate" surgical candidates. Primary outcome measure was change in SNOT‐22 global/symptom domain score (preoperative – 6‐month postoperative). Correlational analyses were performed between wait time and change in SNOT‐22 global and symptom domain scores. For significant negative correlations, the threshold wait time to generate a worsening in health‐related quality‐of‐life (HRQoL) equivalent to the mean clinically important difference (MCID) was calculated.

Results

A total of 104 patients with a mean ± standard deviation (SD) wait time of 310.8 ± 155.9 days were analyzed. Postoperative SNOT‐22 global and symptom domain scores significantly improved postoperatively. Wait time for ESS was negatively correlated with change in SNOT‐22 global, rhinologic, extranasal rhinologic, and ear/facial domain scores (p < 0.05), and a wait time threshold of 287, 452, 421, and 381 days corresponded to a decrease equivalent to the MCID, respectively.

Conclusion

We identified less improvement in HRQoL after ESS with increasing surgical wait time. Moreover, prolonged wait times may result in less improvement in disease‐specific symptoms, but do not appear to worsen psychological or sleep dysfunction.

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Cervical Spine Disability in Correlation with Subjective Voice Handicap in Patients With Voice Disorders: A Retrospective Analysis

Neck muscle dysfunction has been considered as risk factor or consequence of voice disorders. This study investigates the correlation between neck and voice-related subjective symptoms in patients with voice disorders.

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Modulating the Microbiome: The Future of Allergy Therapeutics?

The incidence of IgE sensitization and associated diseases has been on the rise since the late 19th century reaching epidemic proportions in the current era.1 This increase has occurred over just four generations, a rate that far exceeds the rate at which genetics alone could account for the change. Explaining the cause for this epidemic has proven to be a challenge for epidemiologists, scientists and clinical researchers alike. In 1980, David Strachan proposed the well-known "hygiene hypothesis" which proposed that the increase in hay fever and eczema was a result of the decrease in "opportunity for cross infection in young families" at least partially caused by higher standards of personal cleanliness.

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ω-3 LCPUFA supplementation during pregnancy and risk of allergic outcomes or sensitisation in offspring: a systematic review and meta-analysis

In the last two decades allergic diseases have seen a rise worldwide with children suffering the highest burden of the condition(1). Food allergies, eczema and asthma are the most common allergic disorders in children(1-2). The increasing burden of allergic conditions is an important public health concern and understanding how to prevent the development of allergic diseases is a vital area of research.

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Acute Eosinophilic Pneumonia due to Piperacillin/Tazobactam

Eosinophilic pneumonia (EP) is a rare and severe disease that belongs to the group of pulmonary eosinophilias (PE). There are two clinical presentations: chronic eosinophilic pneumonia (CEP) and acute eosinophilic pneumonia (AEP). In 1989, Allen et al. described the first case of AEP. 1 Many causes of AEP have been described, although the idiopathic form is the most common.3 We herein present a case of AEP probably due to piperacillin/tazobactam (P/T).

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The Microbiome in Asthma: Role in pathogenesis, phenotype, and response to treatment

Asthma was first described by Hippocrates as a disease of breathlessness, potentially caused by emotional distress1. The 17th century writings of Sir John Floyer describe bronchial constriction and the concepts of attacks and triggers2. In the 20th century, mounting evidence led to the characterization of asthma as an inflammatory condition2. Asthma symptoms were recognized as narrowing of the airways with distinctive sputum and swelling of the bronchial mucous membranes, triggered by a variety of circumstances or exposures that stimulate immune cells2.

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The impact of age on oral squamous cell carcinoma: a longitudinal cohort study of 2782 patients

Abstract

Background

The purposes of this study were to assess the influence of age on oral squamous cell carcinoma patients and sought to analyze the reasons that may contribute to this difference.

Methods

This study enrolled 2782 patients included 2443 patients in a retrospective cohort to find the influence of age and 339 patients in a prospective cohort to testify these findings. The patients were divided into young age group (≤40 years old), moderate age group (41–75 years old) and advanced age group (>75 years old). All patients were diagnosed as oral squamous cell carcinoma and were surgically treated in our hospital. Chi square test, Kaplan‐Meier analysis and Cox proportional‐hazards regression model were performed for statistical analysis.

Results

Younger patients started smoking (p<0.001) and drinking (p<0.001) earlier than the older patients and consumed more tobacco (p=0.005) and alcohol (p=0.156). Patients with advanced age had worse outcomes in both recurrence (p=0.002) and survival (p<0.001). They also had more severe comorbidity (p<0.001) and were more likely to receive conservative treatment (p=0.011).

Conclusions

Compared with young patients, older patients had worse prognosis, and it was related with their more severe comorbidity and received more conservative treatment. Young adults smoking and drinking earlier and heavier than old patients, it may relate with their occurrence of oral squamous cell carcinoma.

This article is protected by copyright. All rights reserved.

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Radical vs conservative treatment of intraosseous ameloblastoma: systematic review and meta‐analysis

Abstract

Objectives

The aim of the present study was to assess the outcomes of radical and conservative treatment approaches of solid/multicystic and unicystic ameloblastoma in terms of recurrence rates.

Material and methods

A systematic review and meta‐analysis was conducted based on the PRISMA statement. Search was performed using PubMed, Embase, SCOPUS, and Web of Science for articles published from January 1969 until March 2018. Quality assessment of the selected articles was conducted using the Quality Appraisal of Case Series Studies Checklist. The meta‐analysis was performed using the MedCalc program.

Results

The search strategy yielded 6984 articles; 20 studies met the eligibility criteria and were included in the meta‐analysis. The pooled recurrence rate of solid/multicystic ameloblastomas following radical treatment was 8%, while conservative treatment caused recurrences in 41%. For unicystic ameloblastomas, these values were 3% and 21%, respectively. The risk of recurrences in both types of ameloblastomas following radical treatment was lower than following conservative treatment.

Conclusions

The present study showed statistically significant differences in recurrence favoring radical treatment for both unicystic and solid/multicystic ameloblastoma. The solid/multicystic type showed more recurrences than the unicystic type. Unfortunately, since only retrospective studies were available, the evidence is less strong as wished for.

This article is protected by copyright. All rights reserved.

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Issue Information

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Common Terminology and Acoustic Measures for Human Voice and Birdsong

Purpose

The zebra finch is used as a model to study the neural circuitry of auditory-guided human vocal production. The terminology of birdsong production and acoustic analysis, however, differs from human voice production, making it difficult for voice researchers of either species to navigate the literature from the other. The purpose of this research note is to identify common terminology and measures to better compare information across species.

Method

Terminology used in the birdsong literature will be mapped onto terminology used in the human voice production literature. Measures typically used to quantify the percepts of pitch, loudness, and quality will be described. Measures common to the literature in both species will be made from the songs of 3 middle-age birds using Praat and Song Analysis Pro. Two measures, cepstral peak prominence (CPP) and Wiener entropy (WE), will be compared to determine if they provide similar information.

Results

Similarities and differences in terminology and acoustic analyses are presented. A core set of measures including frequency, frequency variability within a syllable, intensity, CPP, and WE are proposed for future studies. CPP and WE are related yet provide unique information about the syllable structure.

Conclusions

Using a core set of measures familiar to both human voice and birdsong researchers, along with both CPP and WE, will allow characterization of similarities and differences among birds. Standard terminology and measures will improve accessibility of the birdsong literature to human voice researchers and vice versa.

Supplemental Material

https://doi.org/10.23641/asha.7438964

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Influence of surface wetness on bonding effectiveness of universal adhesives in etch‐and‐rinse mode

The purpose of this study was to evaluate whether surface wetness would influence the bonding effectiveness of universal adhesives in etch‐and‐rinse mode. All‐Bond Universal (AB), G‐Premio Bond (GP), Prime & Bond Active (PB), and Scotchbond Universal Adhesive (SU) were evaluated. Initial bond strengths and bond‐fatigue strengths of universal adhesives to both wet and dry enamel and dentin in etch‐and‐rinse mode were determined. Scanning electron microscopy observations of the adhesive interfaces were also conducted. The bond‐fatigue durability of universal adhesive to enamel in etch‐and‐rinse mode was influenced by the surface wetness, unlike that to dentin. The bond fatigue durability of AB and GP to dentin in etch‐and‐rinse mode was different depending on the surface wetness, unlike that of PB and SU. The thicknesses of the adhesive or hybrid layer of resin–dentin interfaces were not influenced by the surface wetness, but the length of resin tags in the wet group was longer than in the dry group. Some universal adhesives with the addition of specific components and optimization of water content can achieve stable bonds regardless of surface wetness, but the surface wetness of dentin is still a significant factor for universal adhesive bonding in etch‐and rinse mode, unlike that of enamel.

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Anticaries activity of egg ovalbumin in an experimental caries biofilm model on enamel and dentin

Abstract

Objectives

Limited evidence suggests a putative inhibitory effect of dietary proteins on demineralization during the carious process. The aim was to explore a potential anticaries activity of the egg protein ovalbumin on a relevant in vitro approach.

Materials and methods

Biofilms of Streptococcus mutans UA159 were formed on saliva-coated enamel and dentin bovine slabs. Biofilms were challenged with 10% sucrose followed by either a 200 μg/mL solution of ovalbumin or 1:10, 1:100, and 1:1000 (v/v) serial dilutions of that ovalbumin solution, for the entire length of the experiment. Biofilms exposed to 10% sucrose followed only by 0.9% NaCl served as caries-positive control. Once completed the experimental phase, biofilms were analyzed for biomass, viable bacteria, and polysaccharide formation. Final surface hardness (SH) was obtained to calculate %SH loss (demineralization). Two independent experiments were conducted, in triplicate. Data were analyzed by ANOVA and a post hoc test at the 95% confidence level.

Results

A reduction (p < 0.05) in biomass and extracellular polysaccharide formation, but not in the number of viable cells, was observed for both dental substrates. All ovalbumin concentrations tested showed lower demineralization than the positive control (p < 0.05), in a dose-dependent manner. The highest concentration showed a reduction in the %SH loss of about 30% for both enamel and dentin.

Conclusion

Egg ovalbumin presented to sucrose-challenged biofilms of Streptococcus mutans seems to reduce cariogenicity of a biofilm-caries model.

Clinical relevance

Ovalbumin may counteract the cariogenic effect of sugars. If these findings are clinically confirmed, novel preventive approaches for caries are warranted.

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Subgingival lipid A profile and endotoxin activity in periodontal health and disease

Abstract

Objectives

Regulation of lipopolysaccharide (LPS) chemical composition, particularly its lipid A domain, is an important, naturally occurring mechanism that drives bacteria-host immune system interactions into either a symbiotic or pathogenic relationship. Members of the subgingival oral microbiota can critically modulate host immuno-inflammatory responses by synthesizing different LPS isoforms. The objectives of this study were to analyze subgingival lipid A profiles and endotoxin activities in periodontal health and disease and to evaluate the use of the recombinant factor C assay as a new, lipid A-based biosensor for personalized, point-of-care periodontal therapy.

Materials and methods

Subgingival plaque samples were collected from healthy individuals and chronic periodontitis patients before and after periodontal therapy. Chemical composition of subgingival lipid A moieties was determined by ESI-Mass Spectrometry. Endotoxin activity of subgingival LPS extracts was assessed using the recombinant factor C assay, and their inflammatory potential was examined in THP-1-derived macrophages by measuring TNF-α and IL-8 production.

Results

Characteristic lipid A molecular signatures, corresponding to over-acylated, bi-phosphorylated lipid A isoforms, were observed in diseased samples. Healthy and post-treatment samples were characterized by lower m/z peaks, related to under-acylated, hypo-phosphorylated lipid A structures. Endotoxin activity levels and inflammatory potentials of subgingival LPS extracts from periodontitis patients were significantly higher compared to healthy and post-treatment samples.

Conclusions

This is the first study to consider structure-function-clinical implications of different lipid A isoforms present in the subgingival niche and sheds new light on molecular pathogenic mechanisms of subgingival biofilm communities.

Clinical relevance

Subgingival endotoxin activity (determined by lipid A chemical composition) could be a reliable, bacterially derived biomarker and a risk assessment tool for personalized periodontal care.

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Contents: Volume 46

Publication date: December 2018

Source: Journal of Cranio-Maxillofacial Surgery, Volume 46, Issue 12

Author(s):

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Quantitative assessment of symmetry recovery in navigation-assisted surgical reduction of zygomaticomaxillary complex fractures

Publication date: Available online 12 December 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Tingwei Bao, Di Yu, Qifeng Luo, Huiming Wang, Jianhua Liu, Huiyong Zhu

Summary

Purpose

To evaluate the effects of surgical navigation in zygomaticomaxillary complex (ZMC) fracture reduction. ZMC symmetry was assessed quantitatively.

Materials and Methods

The sample comprised 25 patients who underwent surgical reduction of comminuted ZMC fractures. They were divided into two groups according to the use of surgical navigation. Reduction outcomes were evaluated using three-dimensional computed tomography models. Five pairs of landmarks were identified on all craniofacial models, and asymmetry scores were calculated based on their coordinates. In quantitative analyses, symmetry and orbital volume were compared between groups.

Results

All patients recovered uneventfully. Greater symmetry was observed in the navigation group than in the control group for three of the five pairs of landmarks (p < 0.05). Although postoperative volumes of the injured orbits were similar between the two groups (p > 0.05), reduced orbital volumes were larger in the navigation group, indicating better restoration of the fractured orbits (p < 0.05).

Conclusions

The use of surgical navigation can increase postoperative symmetry of the bilateral ZMC. The quantitative evaluation of clinical outcomes is precise and highly reliable.

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A mathematical approach improves the predictability of length of hospitalization due to acute odontogenic infection: A retrospective investigation of 303 patients

Publication date: Available online 11 December 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Nils Heim, Moritz Berger, Wiedemeyer Valentin, Rudolf Reich, Markus Martini

Summary

Purpose

Increasing rates of hospitalization of patients diagnosed with acute odontogenic infection have become a burden for public health care, with significant economic concerns. The aim of this study was to investigate factors that tend to prolong hospital length of stay (LOS) in the treatment of severe infections. We present a statistical model that enables the prediction of LOS by exposing the feasibility of the essential statistical determinants.

Materials and Methods

A 5-year retrospective study investigated records of 303 in-hospital patients with abscess of odontogenic origin. Time-to-event models were used to analyse data where the outcome variable is the time to the occurrence of a specific event. Here, the focus is on a statistical model for the prediction of LOS of patients.

Results

The group of all patients (n=303) was analysed by considering seven characteristics of the patients (age, gender, spreading of infection, localization of infection focus, type of administered antibiotics, diagnosed diabetes mellitus, and existence of a remaining infection focus). Age (p=0.049; rc=−0.007) and spreading of infection (p<0.001; rc=−0.965) showed a significant impact on the LOS. Subjects were divided into two groups. Group A (n=185) consisted of patients who presented with a severe odontogenic infection and not yet removed infection focus; group B were patients having undergone outpatient operative tooth removal (n=118). To group A patients' data, two new risk factors ("days between abscess incision and removal of infection focus" = dbir and "removal of infection focus during the same stay as abscess incision" = riss) replaced the risk factors "remaining infection focus." A significant impact on the LOS was detected for dbir (p<0.001;rc=−0.15) and riss (p<0.001; rc=−1.76). Our statistical model explicitly describes how the probability for discharge depends on the time and how specific characteristics affect the LOS. We observed a significantly higher LOS in older patients and subjects with infection spreading. In group A patients, dbir and riss had a highly significant impact on the LOS.

Conclusion

Predicting the LOS may promote transparency to costs and management of patients under inpatient treatment. Our statistical model describes the probability of a discharge at time t compared to a discharge later than t (a LOS longer than t). Furthermore, the model enables a prediction of the LOS of each patient for practitioners in an easy way.

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EACMFS Prizes & Awards

Publication date: December 2018

Source: Journal of Cranio-Maxillofacial Surgery, Volume 46, Issue 12

Author(s):

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Announcements

Publication date: December 2018

Source: Journal of Cranio-Maxillofacial Surgery, Volume 46, Issue 12

Author(s):

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Author Index: Volume 46

Publication date: December 2018

Source: Journal of Cranio-Maxillofacial Surgery, Volume 46, Issue 12

Author(s):

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Keyword index: Volume 46

Publication date: December 2018

Source: Journal of Cranio-Maxillofacial Surgery, Volume 46, Issue 12

Author(s):

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Reduction of cerebral blood flow in community-based adults with subclinical cerebrovascular atherosclerosis: A 3.0T magnetic resonance imaging study

Publication date: Available online 12 December 2018

Source: NeuroImage

Author(s): Hualu Han, Runhua Zhang, Gaifen Liu, Huiyu Qiao, Zhensen Chen, Yang Liu, Xiaoyi Chen, Dongye Li, Yongjun Wang, Xihai Zhao

Abstract

Reduction in cerebral blood flow (CBF), one of the major metrics for cerebral perfusion, is associated with many brain disorders. Therefore, early characterization of CBF prior to occurrence of symptoms is essential for prevention of cerebral ischemic disorders. We hypothesized that large artery atherosclerosis might be a potential indicator for decline in cerebral perfusion. The aim of this study was to investigate the relationship between large artery atherosclerosis and CBF in asymptomatic adults. A total of 134 asymptomatic subjects (mean age, 56.2 ± 12.8 years; 54 males) were recruited and underwent magnetic resonance (MR) imaging for brain and intracranial and extracranial carotid arteries. Presence or absence of cerebrovascular atherosclerosis was determined on MR vessel wall images. The CBF was measured with pseudo-continuous arterial spin labeling (pCASL) imaging. The CBF values in internal carotid artery (ICA) (37.2 ± 5.8 vs. 39.0 ± 4.9 ml/100 g/min, P = 0.049) and vertebrobasilar (VA-BA) artery territories (42.0 ± 6.8 vs. 44.8 ± 7.0 ml/100 g/min, P = 0.023) were significantly reduced in subjects with cerebrovascular plaque compared to those without. Presence of cerebrovascular plaque was significantly associated with CBF of VA-BA territory before (odds ratio, 2.89; 95% confidence interval, 1.37–6.08; P = 0.005) and after adjusted for confounding factors including age, gender, BMI, diabetes, systolic blood pressure, hyperlipidemia and history of cardiovascular disease (odds ratio, 2.76; 95% confidence interval, 1.18–6.46; P = 0.019). In conclusion, presence of cerebrovascular atherosclerosis is independently associated with reduction in CBF measured by pCASL in asymptomatic adults, suggesting that cerebrovascular large artery atherosclerosis might be an effective indicator for impairment of cerebral microcirculation hemodynamics.

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A generative model of realistic brain cells with application to numerical simulation of the diffusion-weighted MR signal

Publication date: Available online 12 December 2018

Source: NeuroImage

Author(s): Marco Palombo, Daniel C. Alexander, Hui Zhang

Abstract

To date, numerical simulations of the brain tissue have been limited by their lack of realism and flexibility. The purpose of this work is to propose a controlled and flexible generative model for brain cell morphology and an efficient computational pipeline for the reliable and robust simulation of realistic cellular structures with application to numerical simulation of intra-cellular diffusion-weighted MR (DW-MR) signal features. Inspired by the advances in computational neuroscience for modelling brain cells, we propose a generative model that enables users to simulate molecular diffusion within realistic digital brain cells, such as neurons, in a completely controlled and flexible fashion. We validate our new approach by showing an excellent match between the morphology (no statistically different 3D Sholl metrics, P > 0.05) and simulated intra-cellular DW-MR signal (mean relative difference < 2%) of the generated digital model of brain cells and those of digital reconstruction of real brain cells from available open-access databases. We demonstrate the versatility and potential of the framework by showing a select set of examples of relevance for the DW-MR community. The computational models introduced here are useful for synthesizing intra-cellular DW-MR signals, similar to those one might measure from brain metabolites DW-MRS experiments. They also provide the foundation for a more complete simulation system that will potentially include signals from extra-cellular compartments and exchange processes, necessary for synthesizing DW-MR signals of relevance for DW-MRI experiments.

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Metástasis cutánea de carcinoma tiroideo folicular de células de Hürthle

Publication date: Available online 11 December 2018

Source: Revista Española de Medicina Nuclear e Imagen Molecular

Author(s): F.J. García-Gómez, T. Cambil-Molina, T. Martín-Hernández, G. Sabatel-Hernández, M.C. Calvo-Morón, J. Castro-Montaño

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PET/TC en tumores uterinos. Avanzando por buen camino

Publication date: Available online 11 December 2018

Source: Revista Española de Medicina Nuclear e Imagen Molecular

Author(s): A.P. Caresia Aróztegui, L. Ribot Luna

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Translational research on clinically failed zirconia implants

Publication date: Available online 12 December 2018

Source: Dental Materials

Author(s): Susanne S. Scherrer, Mustapha Mekki, Claude Crottaz, Michael Gahlert, Eric Romelli, Laurine Marger, Stéphane Durual, Eric Vittecoq

Abstract

Objectives

To provide fractographic analysis of clinically fractured zirconia implants recovered with their cemented crown. To calculate bending moments, corresponding stress and crack onset location on the implant's fracture surface using a mathematical model integrating spatial coordinates of the crown-implant part and occlusal loading obtained from 2D and 3D images.

Methods

15 fractured zirconia implants parts (11 posterior and 4 anterior) with their all- ceramic crowns still cemented on it were recovered. The implants were first generations from four manufacturers (AXIS Biodental, Z-Systems, Straumann, Swiss Dental Solutions). The time-to-failure varied between 2 weeks and 9 years. Fractography was performed identifying the failure origin and characteristic surface crack features. From 2D and 3D digital images of the crown-implant part, spatial coordinates anchoring the crown's occlusal contacts with the implant's central axis and reference plane were integrated in a mathematical model spreadsheet. Loads of 500 N in total were selectively distributed over identified occlusal contacts from wear patterns. The resultant bending and torsion moments, corresponding shear, tensile, maximum principal stress and von Mises stress were calculated. The fracture crack onset location on the implant's fracture surface was given by an angular position with respect to an occlusal reference and compared with the location of the fracture origin identified from fractographic analysis.

Results

Implants fractured from the periphery of the smaller inner diameter between two threads at the bone-entrance level except for one implant which failed half-way within the bone. The porous coating (AXIS Biodental) and the large grit alumina sandblasting (Z-System) created surface defects directly related to the fracture origin. The model spreadsheet showed how occlusal loading with respect to the implant's central axis affects bending moments and crack onset. Dominant loads distributed on contacts with important wear pattern provided a calculated crack onset location in good agreement with the fractographic findings of the fracture origin.

Significance

Recovered broken zirconia implant parts with their restorative crowns can provide not only information regarding the failure origin using fractography but also knowledge regarding occlusal crown loading with respect to the implant's axis. The mathematical model was helpful in showing how occlusal loading affects the location of the fracture initiation site on clinical zirconia implant fracture cases.

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The Asthma Controller Step-down Yardstick

Publication date: Available online 12 December 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Bradley E. Chipps, Leonard B. Bacharier, Kevin R. Murphy, David Lang, Judith R. Farrar, Matthew Rank, John Oppenheimer, Robert S. Zeiger

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The role of the skin microbiome in atopic dermatitis

Publication date: Available online 11 December 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Teruaki Nakatsuji, Richard L. Gallo

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Predicting the appropriate size of the uncuffed nasotracheal tube for pediatric patients: a retrospective study

Abstract

Objectives

The selection of an appropriate size of tracheal tube is important for airway management. For nasotracheal intubation, passing the nasal cavity should be taken into account for the selection of tube size. The aim of this study was to investigate the selection of appropriate size of nasotracheal tube in pediatric patients retrospectively.

Materials and methods

The 1–12-year patients underwent dental procedures under general anesthesia intubated nasotracheally. The correlation between height, age, weight, the tracheal diameters at C6, C7, Th2 on the chest X-ray, and actually performed tube sizes were calculated. In addition, we compared the relationships between the predicted tube size and actually the intubated tube size.

Results

The tube sizes intubated actually were between 4.0 and 6.0-mm ID. The formula by height could be most suitable for tube size. The correspondence rates for the tube with 4.5- and 5.0-mm ID were 78% and 53%. When they were predicted as 5.5- or 6.0-mm ID, 0.5 mm smaller size tube were intubated actually; 56% and 70%. When the predicted tube size was 4.0-mm ID, 0.5 mm larger size tube was intubated actually; 66%.

Conclusions

The formula by height could be most suitable for the selection of size for pediatric nasotracheal intubation. When the predicted tube size was 5.5 or 6.0-mm ID, 0.5 mm smaller size should be chosen at first. In the case of 4.0-mm ID, 0.5 mm larger size should be chosen for first trial.

Clinical relevance

The present data indicate that the selection of nasotracheal tube using the formula by height might be useful.

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Polymorphism of reduced folate carrier 1 (A80G) and non-syndromic cleft lip/palate: A systematic review and meta-analysis

Publication date: Available online 11 December 2018

Source: Archives of Oral Biology

Author(s): Mohammad Moslem Imani, Hamid Reza Mozaffari, Roohollah Sharifi, Masoud Sadeghi

Abstract

Objective

To evaluate the association between polymorphism of reduced folate carrier 1 (RFC1) A80 G in infants and the risk of non-syndromic cleft lip/palate (NSCL/P), in a meta-analysis of case-control studies.

Design

We searched databases of PubMed, Scopus, Web of Science, and Cochrane Library for studies on the association of mentioned polymorphism and NSCL/P risk published until August 2018.

Results

Seven articles were selected based on the criteria and were analyzed in this meta-analysis (1486 NSCL/P patients and 1596 controls). Overall, it was not obtained a significant association between the polymorphism and NSCL/P risk, with the exception of the recessive model (odds ratio = 1.45; 95% confidence interval = 1.03, 2.05; P = 0.03). A subgroup analysis showed that the frequency of GG genotype in the homozygote and recessive models in the Caucasian ethnicity was significantly higher in NSCL/P patients than in controls. Sensitivity analysis showed that the frequency of G allele and GG genotype in NSCL/P cases was significantly higher than that in controls.

Conclusions

The results identified an association between the GG genotype and NSCL/P risk and just confirmed this association in the Caucasian ethnicity. Therefore, the GG genotype of RFC1 (A80 G) polymorphism can be related to NSCL/P risk in some ethnicities more than others.

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Voice onset time and beyond: Exploring laryngeal contrast in 19 languages

Publication date: January 2019

Source: Journal of Phonetics, Volume 72

Author(s): Taehong Cho, D.H. Whalen, Gerard Docherty

Abstract

In this special collection entitled Marking 50 Years of Research on Voice Onset Time and the Voicing Contrast in the World's Languages, we have compiled eleven studies investigating the voicing contrast in 19 languages. The collection provides extensive data obtained from 270 speakers across those languages, examining VOT and other acoustic, aerodynamic and articulatory measures. The languages studied may be divided into four groups: 'aspirating' languages with a two-way contrast (English, three varieties of German); 'true voicing' languages with a two-way contrast (Russian, Turkish, Brazilian Portuguese, two Iranian languages Pashto and Wakhi); languages with a three-way contrast (Thai, Vietnamese, Khmer, Yerevan Armenia, three Indo-Aryan languages, Dawoodi, Punjabi and Shina, and Burushaki spoken in India); and Indo-Aryan languages with a more than three-way contrast (Jangli and Urdu with a four-way contrast, and Sindhi and Siraiki with a five-way contrast). We discuss the cross-linguistic data, focusing on how much VOT alone tells us about the voicing contrast in these languages, and what other phonetic dimensions (such as consonant-induced F0 and voice quality) are needed for a complete understanding of laryngeal contrast in these languages. Implications for various issues emerge: universal phonetic feature systems, effects of language contact on linguistic levelling, and the relation between laryngeal contrast and supralaryngeal articulation. The cross-linguistic VOT data also lead us to discuss how the distribution of VOT as measured acoustically may allow us to infer the underlying articulation and how it might be approached in gestural phonologies. The discussion on these multiple issues sparks new questions to be resolved, and provide indications of where the field may be best directed in exploring laryngeal contrast in voicing in the world's languages.

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Characterizing the Motor Skills in Children with Specific Language Impairment

Background/Aims: Specific language impairment (SLI) is characterized by deficits in language ability. However, studies have also reported motor impairments in SLI. It has been proposed that the language and motor impairments in SLI share common origins. This exploratory study compared the gross, fine, oral, and speech motor skills of children with SLI and children with typical development (TD) to determine whether children with SLI would exhibit difficulties on particular motor tasks and to inform us about the underlying cognitive deficits in SLI. Methods: A total of 13 children with SLI (aged 8–12 years) and 14 age-matched children with TD were administered the Movement Assessment Battery for Children – Second Edition and the Verbal Motor Production Assessment for Children to examine gross and fine motor skills and oral and speech motor skills, respectively. Results: Children with SLI scored significantly lower on gross, fine, and speech motor tasks relative to children with TD. In particular, children with SLI found movements organized into sequences and movement modifications challenging. On oral motor tasks, however, children with SLI were comparable to children with TD. Conclusion: Impairment of the motor sequencing and adaptation processes may explain the performance of children with SLI on these tasks, which may be suggestive of a procedural memory deficit in SLI.
Folia Phoniatr Logop 2019;71:42–55

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Effects of the Lidcombe Program and Parent-Child Interaction Therapy on Stuttering Reduction in Preschool Children

Purpose: The present study explored the effectiveness of the Lidcombe Program, the parent-child interaction therapy (PCIT) approach, and an integrated (Lid-PCIT) program on the treatment of children who stutter. Methods: The present research was a single-subject study with an alternative treatment design. Participants were 6 preschool children who were randomly assigned into three groups. Each group received the entire indirect (PCIT), direct (Lidcombe), or integrated (Lid-PCIT) program and were assessed through severity rating (SR), and percent stuttered syllables (%SS), and video analysis. Results: For all children the SR and the %SS were reduced but the percentage of non-overlapping data of the three interventions showed that it was reduced more in the Lidcombe and in the Lid-PCIT programs. Conclusions: This study provided preliminary evidence that Lidcombe, PCIT, and integrated programs were effective in reducing the SR and the %SS in preschool children who stutter. These results are potentially important as both indirect and direct interventions in the primary years can help children who stutter to overcome their disorder.
Folia Phoniatr Logop 2019;71:29–41

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An Examination of Vocal Tract Acoustics following Wendler’s Glottoplasty

Purpose: To investigate the formant frequency (FF) features of transgender females' (TFs) voice after Wendler's glottoplasty surgery and compare these levels with age-matched healthy males and females. Study Design: Controlled prospective. Methods: 20 TFs and 20 genetically male and female age-matched healthy controls were enrolled in the study. The fundamental frequency (F0) and FFs F1–F4 were obtained from TF speakers 6 months after surgery. These levels were compared with those of healthy controls. Results: Statistical analysis showed that the median F0 values were similar between TFs and females. The median F1 levels of TFs were different from females but similar to males. The F2 levels of TFs were similar to females but different from males. The F3 and F4 levels were significantly different from both male and female controls. Conclusion: Wendler's glottoplasty technique is an effective method to increase F0 levels among TF patients; however, these individuals report their voice does not sufficiently project femininity. The results obtained with regard to FF levels may be the reason for this problem. Voice therapy is recommended as a possible approach to assist TF patients achieve a satisfactory feminine voice.
Folia Phoniatr Logop 2019;71:24–28

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