Photoangiolytische Laser in der Laryngologie

Sprache Stimme Gehör 2018; 42: 185-191
DOI: 10.1055/a-0682-2946

© Georg Thieme Verlag KG Stuttgart · New York

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Quantifizierung des Outcomes phonochirurgischer Interventionen bei benignen Stimmlippenläsionen

Sprache Stimme Gehör 2018; 42: 168-174
DOI: 10.1055/a-0682-1469

© Georg Thieme Verlag KG Stuttgart · New York

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Hörgeräte bei Erwachsenen mit leichtem bis mittelschwerem Hörverlust

Sprache Stimme Gehör 2018; 42: 164-165
DOI: 10.1055/a-0749-6493

© Georg Thieme Verlag KG Stuttgart · New York

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Phonochirurgie

Sprache Stimme Gehör 2018; 42: 166-167
DOI: 10.1055/a-0665-2987

© Georg Thieme Verlag KG Stuttgart · New York

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Stottern

Sprache Stimme Gehör 2018; 42: 208-208
DOI: 10.1055/a-0665-2962

© Georg Thieme Verlag KG Stuttgart · New York

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Injektionsglottoplastik

Sprache Stimme Gehör 2018; 42: 175-184
DOI: 10.1055/a-0682-3055

© Georg Thieme Verlag KG Stuttgart · New York

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Medienunterstütztes Narrationstraining mit kontextreichen Fotos: Erprobung eines innovativen Ansatzes in der Aphasietherapie

Sprache Stimme Gehör 2018; 42: 201-207
DOI: 10.1055/a-0659-6418

Hintergrund In der autobiografischen Narration, dem Erzählen über sich selbst, kann Identitätsarbeit gelingen. Personen mit Aphasie (PMA) benötigen aufgrund der hohen linguistischen Komplexität Unterstützungsmaßnahmen innerhalb von narrativen Texten, die Narration im sozialen Austausch erleichtern bzw. ermöglichen. Methode In einem ersten Pilotprojekt im Rahmen einer Masterarbeit wurde eine narrativ ausgerichtete Intervention konzipiert und erprobt, in der PMA in Erzählsituationen über persönlich relevante Themen sog. Visual-Scene-Displays (VSD) mit kontextreichen Fotos am Smartphone einsetzen. Die Machbarkeit der Intervention wurde mit 2 PMA erprobt und der Mehrwert des Medieneinsatzes u. a. für den kommunikativen Austausch zwischen PMA und Gesprächspartnern anhand einer qualitativen und quantitativen Gesprächsanalyse untersucht. Ergebnisse Zwischen den Bedingungen mit vs. ohne VSD-Dateien-Nutzung zeigten sich vielfältige Unterschiede im Gesprächsverhalten, sowohl bei den PMA als auch ihren KommunikationspartnerInnen (KP). Beide Patienten initiierten bis zu 18 % mehr Äußerungen und mussten bis zu 18 % weniger auf Fragen antworten. Sie erlebten die Kommunikation subjektiv als positiver. Die KP stellten bis zu 40 % weniger Verständnisfragen. Sie kommentierten dafür bis zu 19 % mehr und gaben bis zu 18 % mehr positive Bestätigung. Das Verständnis i. S.v. „content units" war erhöht. Auch die KP waren mit der Kommunikation subjektiv zufriedener. Diskussion Die Studie liefert damit einen neuen Ansatz zur logopädischen Versorgung bei Aphasie mit einer personenzentrierten und ressourcenorientierten Ausrichtung. Erste Ergebnisse bestätigen die Machbarkeit der Intervention sowie verschiedene positive Auswirkungen des hier beschriebenen Medieneinsatzes auf den kommunikativen Austausch über persönliche Themen. Eine Replikation mit größeren Stichproben ist notwendig.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Therapieintensität

Sprache Stimme Gehör 2018; 42: 155-155
DOI: 10.1055/a-0665-3020

© Georg Thieme Verlag KG Stuttgart · New York

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Rechtschreibung direkt entwickeln und schulen

Sprache Stimme Gehör 2018; 42: 156-157
DOI: 10.1055/a-0707-5851

© Georg Thieme Verlag KG Stuttgart · New York

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Laryngoplastik zur Medialisierung bei Lähmungen und Defekten der Glottis

Sprache Stimme Gehör 2018; 42: 192-198
DOI: 10.1055/a-0682-3030

© Georg Thieme Verlag KG Stuttgart · New York

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Menschliche Hörzellen aus dem Reagenzglas

Sprache Stimme Gehör 2018; 42: 157-158
DOI: 10.1055/a-0770-4099

© Georg Thieme Verlag KG Stuttgart · New York

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Glottisdefekt nach Chordektomie

Sprache Stimme Gehör 2018; 42: 162-163
DOI: 10.1055/a-0665-3056

© Georg Thieme Verlag KG Stuttgart · New York

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Bonobos: Menschenaffen mit „hohen Tönen“

Sprache Stimme Gehör 2018; 42: 158-158
DOI: 10.1055/a-0768-1156

© Georg Thieme Verlag KG Stuttgart · New York

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Bilingualität und Erwerbszeitpunkt

Sprache Stimme Gehör 2018; 42: 158-159
DOI: 10.1055/a-0794-9989

© Georg Thieme Verlag KG Stuttgart · New York

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Logopenische Variante der Primär Progredienten Aphasie

Sprache Stimme Gehör 2018; 42: 160-161
DOI: 10.1055/a-0665-2949

© Georg Thieme Verlag KG Stuttgart · New York

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Der Zusammenhang von pragmatisch-kommunikativen Fähigkeiten und Empathie bei Demenz vom Typ Alzheimer

Sprache Stimme Gehör 2018; 42: 199-200
DOI: 10.1055/a-0665-2848

© Georg Thieme Verlag KG Stuttgart · New York

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Liebe Leserinnen und Leser,

Sprache Stimme Gehör 2018; 42: 151-151
DOI: 10.1055/a-0665-2976

© Georg Thieme Verlag KG Stuttgart · New York

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Deep sequencing salivary proteins for periodontitis using proteomics

Abstract

Objectives

Saliva is a bodily fluid transuded from gingival crevice fluid and blood and contains many proteins. Proteins in saliva have been studied as markers for periodontal diseases. Mass spectrometric analysis is applied to investigate biomarker proteins that are related to periodontitis.

Material and methods

Saliva samples were collected from 207 participants including 36 pairs matched for age, sex, and smoking who joined Yangpyeong health cohort. Periodontitis was defined by 2005 5th European guideline. Shotgun proteomics was applied to detect proteins from saliva samples. Principal component analysis and Ingenuity Pathway Analysis for canonical pathway and protein pathway were applied. Protein-protein interaction was also applied. Enzyme-linked immunosorbent assay (ELISA) was used to verify the candidate protein markers among another matched participants (n = 80).

Results

Shotgun proteomics indicated that salivary S100A8 and S100A9 were candidate biomarkers for periodontitis. ELISA confirmed that both salivary S100A8 and S100A9 were higher in those with periodontitis compared to those without periodontitis (paired-t test, p < 0.05).

Conclusion

Our proteomics data showed that S100A8 and S100A9 in saliva could be candidate biomarkers for periodontitis. The rapid-test-kit using salivary S100A8 and S100A9 will be a practical tool for reducing the risk of periodontitis and promotion of periodontal health.

Clinical relevance

A rapid-test-kit using salivary biomarkers, S100A8 and S100A9, could be utilized by clinicians and individuals for screening periodontitis, which might reduce the morbidity of periodontitis and promote periodontal health.

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Vocal Tract Discomfort and Dysphonia in Patients Undergoing Empiric Therapeutic Trial with Proton Pump Inhibitor for Suspected Laryngopharyngeal Reflux

the aim of this study was to evaluate the correlation among dysphonic and vocal tract discomfort symptoms in patients who underwent empiric therapeutic trial with proton pump inhibitor (PPI) for a suspected laryngopharyngeal reflux (LPR).

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Pathogenic Role of Reinke's Edema in Snoring and Obstructive Sleep Apnea

To investigate the association between vocal fold Reinke's edema, snoring, and obstructive sleep apnea.

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Polymorphisms associated with oral clefts as potential susceptibility markers for oral and breast cancer

Publication date: Available online 14 December 2018

Source: Archives of Oral Biology

Author(s): Edimilson Martins de Freitas, Renato Assis Machado, Edilmar de Moura Santos, Felipe Rodrigues de Matos, Hébel Cavalcanti Galvão, Priscila Bernardina Miranda Soares, Roseana de Almeida Freitas, Hercílio Martelli

ABSTRACT

Objective

To evaluate the association of single nucleotide polymorphisms (SNPs) in genes/loci consistently altered in nonsyndromic oral clefts in patients with oral and breast cancer in a Brazilian population.

Design

This case-control study evaluated the association of SNPs in IRF6 (rs642961), WNT3A (rs708111), GSK3β (rs9879992), 8q24 (rs987525) and WNT11 (rs1533767), representing regions consistently identified as of susceptibility for oral clefts, with oral cancer (oral squamous cell carcinoma) and breast cancer. Logistic regression analyses were used for confounding adjustments, and p values ≤0.01 were considered statistically significant (Bonferroni correction = 0.05 / 5 polymorphic markers).

Results

The minor G allele of rs9879992 in GSK3β was associated with oral cancer risk (p = 0.02), whereas rs1533767 in WNT11 showed a protective effect against it (p = 0.04). Several SNP-SNP interactions containing GSK3β rs9879992 were significantly associated with oral cancer after 1,000 permutation test. To breast cancer, the A allele of rs987525 was associated with increase risk in early stage (p = 0.02) and SNP-SNP interactions involving the 5 SNPs were significantly observed, with the most significant interaction among rs708111, rs1533767, rs9879992 and rs642961 (p_{1000permutation}<0.001).

Conclusion

Our results reveal associations of SNPs consistently altered in oral cleft with oral and breast cancer risk, raising interesting possibilities to identify risk markers for those tumors.

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Automatic Evaluation of End-to-End Dialog Systems with Adequacy-Fluency Metrics

Publication date: Available online 15 December 2018

Source: Computer Speech & Language

Author(s): Luis Fernando D'Haro, Rafael E. Banchs, Chiori Hori, Haizhou Li

ABSTRACT

End-to-End dialog systems are gaining interest due to the recent advances of deep neural networks and the availability of large human-human dialog corpora. However, in spite of being of fundamental importance to systematically improve the performance of this kind of systems, automatic evaluation of the generated dialog utterances is still an unsolved problem. Indeed, most of the proposed objective metrics shown low correlation with human evaluations. In this paper, we evaluate a two-dimensional evaluation metric that is designed to operate at sentence level, which considers the syntactic and semantic information carried along the answers generated by an end-to-end dialog system with respect to a set of references. The proposed metric, when applied to outputs generated by the systems participating in track 2 of the DSTC-6 challenge, shows a higher correlation with human evaluations (up to 12.8% relative improvement at the system level) than the best of the alternative state-of-the-art automatic metrics currently available.

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System-Independent ASR error detection and classification using Recurrent Neural Network

Publication date: Available online 14 December 2018

Source: Computer Speech & Language

Author(s): Rahhal Errattahi, Asmaa El Hannani, Thomas Hain, Hassan Ouahmane

Abstract

This paper addresses errors in continuous Automatic Speech Recognition (ASR) in two stages: error detection and error type classification. Unlike the majority of research in this field, we propose to handle the recognition errors independently from the ASR decoder. We first establish an effective set of generic features derived exclusively from the recognizer output to compensate for the absence of ASR decoder information. Then, we apply a variant Recurrent Neural Network (V-RNN) based models for error detection and error type classification. Such model learn additional information to the recognized word classification using label dependency. As a result, experiments on Multi-Genre Broadcast Media corpus have shown that the proposed generic features setup leads to achieve competitive performances, compared to state of the art systems in both tasks. Furthermore, we have shown that V-RNN trained on the proposed feature set appear to be an effective classifier for the ASR error detection with an Accuracy of 85.43%.

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Intestinal absorption of the wheat allergen gliadin in rats

Publication date: Available online 15 December 2018

Source: Allergology International

Author(s): Tomoharu Yokooji, Takahiro Fukushima, Koh Hamura, Naoki Ninomiya, Ryo Ohashi, Takanori Taogoshi, Hiroaki Matsuo

Abstract

Background

Aspirin enhances food allergy symptoms by increasing absorption of ingested allergens. The objective of this study is to elucidate the role of aspirin in facilitating intestinal absorption of the wheat allergen, gliadin, in rats.

Methods

Plasma concentrations of gliadin were determined after oral administration by gavage or administration into a closed intestinal loop in rats. We used an in situ intestinal re-circulating perfusion experiment to examine the effect of pepsin on aspirin-facilitated gliadin absorption. Fluorescein isothiocyanate (FITC)-labeled dextran-40 (FD-40) was used as a marker of non-specific absorption. The molecular size of gliadin and its allergenicity in plasma were examined using immunoblot analysis and intradermal reaction tests with Evans blue dye (EBD) extravasation, respectively.

Results

Aspirin increased plasma concentrations of gliadin after oral administration but had no effect in the closed intestinal loop study. An in situ intestinal re-circulating perfusion study showed that FITC-labeled gliadin was absorbed similarly to FD-40. Aspirin increased absorption of both intact and pepsin-digested gliadin, with a more significant effect on absorption of pepsin-treated gliadin. Immunoblotting showed that most gliadin was absorbed in intact form. When the gliadin fraction was extracted from rat plasma after gavage and injected intradermally into gliadin-sensitized rats, EBD extravasation was observed at injection sites in a gliadin dose-dependent manner.

Conclusions

Aspirin increased the absorption of intact and pepsin-digested gliadin via the paracellular pathway, maintaining their allergenicity. Moreover, the effect of aspirin on gliadin absorption was enhanced by modification and digestion of gliadin in the stomach.

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Perceptual and Interpretive Error in Diagnostic Radiology—Causes and Potential Solutions

Publication date: Available online 14 December 2018

Source: Academic Radiology

Author(s): Andrew J. Degnan, Emily H. Ghobadi, Peter Hardy, Elizabeth Krupinski, Elena P. Scali, Lindsay Stratchko, Adam Ulano, Eric Walker, Ashish P. Wasnik, William F. Auffermann

Interpretation of increasingly complex imaging studies involves multiple intricate tasks requiring visual evaluation, cognitive processing, and decision-making. At each stage of this process, there are opportunities for error due to human factors including perceptual and ergonomic conditions. Investigation into the root causes of interpretive error in radiology first began over a century ago. In more recent work, there has been increasing recognition of the limits of human image perception and other human factors and greater acknowledgement of the role of the radiologist's environment in increasing the risk of error. This article reviews the state of research on perceptual and interpretive error in radiology. This article focuses on avenues for further error examination, and strategies for mitigating these errors are discussed. The relationship between artificial intelligence and interpretive error is also considered.

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Behavioral and neural evidence on the processing of ambiguous adjective-noun dependencies in Korean sentence comprehension

Publication date: January 2019

Source: Brain and Language, Volume 188

Author(s): Yunju Nam, Upyong Hong

Abstract

In Korean, it is allowed for an adjective to modify a distant noun that appears after an intervening relative clause instead of an adjacent noun. The current study investigated the time course of syntactic and semantic integration between an adjective (A) and an adjacent noun (N1) and/or a distant noun (N2) during on-line reading comprehension of Korean sentences. Semantic congruence between adjectives and nouns were manipulated, such that A was congruent with both N1 and N2, either with N1 or N2, or with none of N1/N2. The reading times and ERPs to critical words revealed that under A-N1 semantic incongruence, not the processing load of N1, but those of the relative clause verb and N2 which is semantically incongruent with A increased. These results imply that the semantic incongruence suppressed the A-N1 integration until the relative clause verb occurred, and the processor immediately attempted the A-N2 integration for a way out from the ultimate processing breakdown even before the occurrence of the main verb.

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Lung Cancer Screening with Low-Dose CT: Baseline Screening Results in Shanghai

Publication date: Available online 14 December 2018

Source: Academic Radiology

Author(s): Li Fan, Yun Wang, Ying Zhou, Qiong Li, Wenjie Yang, Shengping Wang, Fei Shan, Xingwei Zhang, Jingyun Shi, Wufei Chen, Shi-Yuan Liu

Objective

To report the initial baseline lung cancer screening results with low dose computed tomography (LDCT) in a multicenter study in Shanghai.

Methods

A total of 14,506 subjects underwent LDCT lung cancer screening and completed questionnaires consisting of 13 risk factors for lung cancer in the prospective study. The positive result was defined as any size and density nodule. The nodules were classified into calcified, solid, part-solid, and nonsolid nodules. The positive rate and incidental detection rate of lung cancer and stage I lung cancer were calculated. The proportion of lung nodule and lung cancer with different density and size was analyzed.

Results

The positive rate and incidental detection rate of lung cancer was 29.89% and 1.23%, respectively. The incidental detection rate of stage I lung cancer was 0.97%. The proportion of lung cancer in lung nodules and stage I in lung cancer was 3.48% and 81.09%, respectively. The ratio of nonsolid nodule, part-solid nodule, and solid nodule in lung cancer was 52.94%, 31.93%, and 15.13%, respectively. 74.88% lung nodules were less than 5 mm and 94.12% lung cancers were larger than 5mm in size.

Conclusion

The baseline LDCT lung cancer screening showed subsolid nodules accounted for the majority of lung cancer, and 5 mm in size would be recommended as the positive result threshold.

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American Board of Prosthodontics Annual Report

Publication date: December 2018

Source: The Journal of Prosthetic Dentistry, Volume 120, Issue 6

Author(s):

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Non-invasive MRI of brain clearance pathways using multiple echo time arterial spin labelling: An Aquaporin-4 study

Publication date: Available online 15 December 2018

Source: NeuroImage

Author(s): Yolanda Ohene, Ian F. Harrison, Payam Nahavandi, Ozama Ismail, Eleanor V. Bird, Ole P. Ottersen, Erlend A. Nagelhus, David L. Thomas, Mark F. Lythgoe, Jack A. Wells

Abstract

There is currently a lack of non-invasive tools to assess water transport in healthy and pathological brain tissue. Aquaporin-4 (AQP4) water channels are central to many water transport mechanisms, and emerging evidence also suggests that AQP4 plays a key role in amyloid-β (Aβ) clearance, possibly via the glymphatic system. Here, we present the first non-invasive technique sensitive to AQP4 channels polarised at the blood-brain interface (BBI). We apply a multiple echo time (multi-TE) arterial spin labelling (ASL) MRI technique to the mouse brain to assess BBI water permeability via calculation of the exchange time (Texw), the time for magnetically labelled intravascular water to exchange across the BBI. We observed a 31% increase in exchange time in AQP4-deficient (Aqp4^−/−) mice (452 ± 90 ms) compared to their wild-type counterparts (343 ± 91 ms) (p = 0.01), demonstrating the sensitivity of the technique to the lack of AQP4 water channels. More established, quantitative MRI parameters: arterial transit time (δ_a), cerebral blood flow (CBF) and apparent diffusion coefficient (ADC) detected no significant changes with the removal of AQP4. This clinically relevant tool may be crucial to better understand the role of AQP4 in water transport across the BBI, as well as clearance of proteins in neurodegenerative conditions such as Alzheimer's disease.

Graphical abstract

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Vascular burden and APOE ε4 are associated with white matter microstructural decline in cognitively normal older adults

Publication date: Available online 15 December 2018

Source: NeuroImage

Author(s): Owen A. Williams, Yang An, Lori Beason-Held, Yuankai Huo, Luigi Ferrucci, Bennett A. Landman, Susan M. Resnick

Abstract

White matter microstructure can be measured with diffusion tensor imaging (DTI). While increasing age is a predictor of white matter (WM) microstructure changes, roles of other possible modifiers, such as cardiovascular risk factors, APOE ε4 allele status and biological sex have not been clarified.

We investigated 665 cognitively normal participants from the Baltimore Longitudinal Study of Aging (age 50–95, 56.7% female) with a total of 1384 DTI scans. WM microstructure was assessed by fractional anisotropy (FA) and mean diffusivity (MD). A vascular burden score was defined as the sum of five risk factors (hypertension, obesity, elevated cholesterol, diabetes and smoking status). Linear mixed effects models assessed the association of baseline vascular burden on baseline and on rates of change of FA and MD over a mean follow-up of 3.6 years, while controlling for age, race, and scanner type. We also compared DTI trajectories in APOE ε4 carriers vs. non-carriers and men vs. women.

At baseline, higher vascular burden was associated with lower FA and higher MD in many WM structures including association, commissural, and projection fibers. Higher baseline vascular burden was also associated with greater longitudinal decline in FA in the hippocampal part of the cingulum and the fornix (crus)/stria terminalis and splenium of the corpus callosum, and with greater increases in MD in the splenium of the corpus callosum. APOE ε4 carriers did not differ from non-carriers in baseline DTI metrics but had greater decline in FA in the genu and splenium of the corpus callosum. Men had higher FA and lower MD in multiple WM regions at baseline but showed greater decreases than women in FA in the hippocampal part of the cingulum and greater increase in MD in the genu of the corpus callosum. Women showed greater decreases over time in FA in the gyrus part of the cingulum, compared to men.

Our findings show that modifiable vascular risk factors (1) have a negative impact on white matter microstructure and (2) are associated with faster microstructural deterioration of temporal WM regions and the splenium of the corpus callosum in cognitively normal adults. Reducing vascular burden in aging could modify the rate of WM deterioration and could decrease age-related cognitive decline and impairment.

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Single-trial EEG dissociates motivation and conflict processes during decision-making under risk

Publication date: Available online 14 December 2018

Source: NeuroImage

Author(s): Narun Pornpattananangkul, Shannon Grogans, Rongjun Yu, Robin Nusslock

Abstract

In making decisions under risk (i.e., choosing whether to gamble when the outcome probabilities are known), two aspects of decision are of particular concern. The first, if gambling, is how large are potential gains compared to losses? The subjectively larger, the more rewarding to gamble. Thus, this aspect of decision-making, quantified through expected utility (EU), is motivation-related. The second concern is how easy is it to reach the decision? When subjective desirability between gambling and not-gambling is clearly different from each other (regardless of the direction), it is easier to decide. This aspect, quantified through utility distance (UD), is conflict-related. It is unclear how the brain simultaneously processes these two aspects of decision-making. Forty-five participants decided whether to gamble during electroencephalogram (EEG) recording. To compute trial-by-trial variability in EU and UD, we fit participants' choices to models inspired by Expected-Utility and Prospect theories using hierarchical-Bayesian modeling. To examine unique influences of EU and UD, we conducted model-based single-trial EEG analyses with EU and UD as simultaneous regressors. While both EU and UD were positively associated with P3-like activity and delta-band power, the contribution of EU was around 200 ms earlier. Thus, during decision-making under risk, people may allocate their attention to motivation-related aspects before conflict-related aspects. Next, following learning the options and before reporting their decision, higher EU was associated with stronger alpha and beta suppression, while higher UD was associated with a stronger contingent-negativity-variation-like activity. This suggests distinct roles of EU and UD on anticipation-related processes. Overall, we identified time and frequency characteristics of EEG signals that differentially traced motivation-related and conflict-related information during decision-making under risk.

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Survey on practice patterns in imaging utilization in patients with Crohn's disease

Publication date: Available online 14 December 2018

Source: Clinical Imaging

Author(s): Vinit Baliyan, Hamed Kordbacheh, Jessica Serrao, Michael S. Gee, Vijay Yajnik, Dushyant V. Sahani, Avinash Kambadakone Ramesh

Abstract

Purpose

To perform a survey-based assessment of imaging practice preferences in Crohn's disease (CD).

Methods

An internet-based questionnaire was sent to physicians involved in CD care. The questionnaire addressed the experience, practice patterns, choice of modality, and recent trends in imaging utilization.

Results

The response rate was 7.57% (122/1598) with 43.8% of respondents involved in care of CD for ≥10 years. CT was mostly preferred by ED physicians, internists and primary care physicians, while MRI by gastroenterologists and pediatricians. Practitioners from non-teaching facilities had higher preference for CT (CT:42% andMR:27%), compared to teaching/academic hospitals (MR:45% and CT: 40%) (p = 0.06). MR was preferred by pediatric practitioners compared to physicians serving older age group of patients (>16 yrs) (p = 0.01). CT was preferred by physicians taking care of <50 patients/year (CT:37, MR:27, No preference = 19) and MR preferred by physicians serving ≥50 patients/year (CT:12, MR:21, No preference:3)(p = 0.02). CT/CT enterography was the most widely used exam (93.3%) and preferred modality for evaluation of acute CD exacerbation (87.7%), followed by assessment for new symptoms (73.7%) and extra-intestinal manifestations (61.3%). MR/MR enterography (58%) was more preferred for asymptomatic CD patients for disease surveillance.

Nearly 80% of respondents reported a change in imaging preferences, 46.5% respondents indicating growing preference for MRI while 33.3% reported increasing preference for CT. 29.6% physicians reported a patient preference for MRI over CT (13%) with the most common factor for choice of MRI being fear of harmful effects of radiation (60.2%).

Conclusion

Physician practices reported continued preference for CT in evaluation of patients with CD, particularly for evaluation of acute exacerbation, new symptoms or extra-intestinal manifestations. Physician providers with large practice volume, younger patient population and GI sub-specialty expertise report growing MRI utilization.

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Mast Cell Granules: Modulating adaptive immune response remotely

Publication date: Available online 14 December 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Rohit Jain, Shweta Tikoo, Wolfgang Weninger

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Vitamin D Supplements Don’t Reduce Cancer Incidence

Vitamin D Supplements Don't Reduce Cancer Incidence, Trial Shows
12/13/2018
	In the largest-ever randomized trial testing vitamin D for cancer prevention, the supplement did not lower the risk of developing cancer. The Vitamin D and Omega-3 Trial (VITAL) includes a nationally representative sample of nearly 26,000 participants.

Indian Journal of Nephrology (Indian J Nephrol)

ORIGINAL ARTICLES
	Epidemiology and outcomes of acute kidney injury in critically ill: Experience from a tertiary care center	p. 413
	PS Priyamvada, R Jayasurya, Vijay Shankar, S Parameswaran DOI:10.4103/ijn.IJN_191_17   There is only limited information on the epidemiology and outcomes of acute kidney injury (AKI) in critically ill patients from low- and middle-income countries. This study aims to identify the etiology, short-term outcomes, and determinants of mortality in patients with AKI admitted to multiple medical and surgical Intensive Care Units (ICU's) in a tertiary care center. The study also aims to compare the clinical characteristics and outcomes of community-acquired AKI (CAAKI) and hospital-acquired AKI (HAAKI). A prospective, observational study was done from June 2013 to October 2015. All patients over 18 years with AKI admitted in various medical and surgical ICU's seeking nephrology referral were included. AKI was defined according to KDIGO criteria. The follow-up period was 30 days. A total of 236 patients were recruited from five medical and nine surgical ICU's. Majority (73.3%) were males. About 53.38% patients had CAAKI, whereas 46.61% had HAAKI. The predominant etiologies for AKI were sepsis (22.4%), trauma due to road traffic accidents (21.18%), acute abdomen (perforation, acute pancreatitis, bowel gangrene, intestinal obstruction and cholangitis) (18.64%), and cardiac diseases (10.59%). Sepsis and acute abdomen were the most common causes of CAAKI, whereas trauma and cardiac causes were the predominant causes of HAAKI (P < 0.05). Patients with HAAKI were younger, admitted in surgical units, had lower SOFA scores, lower serum creatinine, lesser need for dialysis, longer hospital stay, and earlier stages of AKI compared to patients with CAAKI (P < 0.05). The 30-day mortality was 52.54%. The mortality was not different between CAAKI and HAAKI (56.3% vs. 48.18%; relative risk = 0.86: 95% confidence interval 0.67–1.1). The mortality was similar across different stages of AKI.
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	Skin microcirculatory changes in relation to arteriovenous fistula maturation	p. 421
	Siew Cheng Chai, Wan Azman Wan Sulaiman, Arman Zaharil Mat Saad, Aida Hanum Rasool, Amran Ahmed Shokri DOI:10.4103/ijn.IJN_402_17   Maturation of arteriovenous fistula (AVF) involves complex vascular remodeling. In this study, we evaluated the changes of skin microvascular perfusion over the extremity with AVF maturation using the laser Doppler fluximetry (LDF). A total of 45 patients with chronic kidney disease, Stages IV–V, were included; they had undergone AVF creation from July 2014 to June 2016 at our institute. The measurement of skin microvascular perfusion was accomplished proximal and distal to the fistula anastomosis site: pre- and post-operative day 1, week 2, week 6, and week 12. Thirty-two patients with mean age of 55.6 had achieved AVF maturation. There were 40.6% radial-based and 59.4% brachial-based AVF. There was a 32.8% reduction of mean skin perfusion distal to the fistula by day 1 compared to the baseline perfusion; however, perfusion increased 47% by week 2 compared to day 1 and no dramatic change was subsequently noted. There was an increase of mean skin perfusion, proximal to fistula anastomosis, over 12 weeks with 35.8% at day 1 from the baseline. However, the changes of the mean skin perfusion were not statistically significant. There was no significant relation of skin perfusion changes with the type of fistula, diabetes mellitus, hypertension, and hyperlipidemia. LDF successfully detected the subclinical change of skin microvascular perfusion in relation to AVF creation. Reduction of skin perfusion distal to the fistula suggests that in patients with existing perfusion inadequacy of extremities, they may experience ischemic symptoms as early as day 1 postoperation, and require close monitoring for distal limb ischemic-related complications.
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	Urinary neutrophil gelatinase-associated lipocalin and urinary soluble CXCL16 as biomarkers of activity in pediatric lupus nephritis	p. 427
	MA El-Gamasy, W El-Naghy DOI:10.4103/ijn.IJN_265_17   One of the challenges of treating patients with lupus nephritis (LN) is to assess disease activity. The aim of this study was to measure the urinary neutrophil gelatinase-associated lipocalin (uNGAL) and urinary soluble chemokine (C-X-C motif) ligand 16 (CXCL16) levels in children and adolescents with systemic lupus erythematosus (SLE) and investigate whether they are elevated in active LN. This study was conducted on 80 patients diagnosed as SLE by the Systemic Lupus International Collaborating Clinics criteria and 60 apparently healthy individuals as controls. Global and renal disease activities were evaluated by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and renal SLEDAI, respectively. uNGAL and urinary CXCL16 were measured for all participants by ELISA. Renal biopsy was done for all cases at initial diagnosis and was graded using ISN/RPS classification. uNGAL and CXCL16 were higher in patients than in the controls (8.9 ± 3.56 ng/dl and 1067 ± 367 ug/L vs. 2.26 ± 1.95 ng/dl and 471 ± 106 ug/L, respectively). uNGAL had higher sensitivity and specificity than urinary CXCL16 as predictor of LN (95% and 90% vs. 85% and 80%, respectively). There was significant positive correlations between uNGAL levels, 24-h urinary proteins (r = 0.732, P = 0.001), and SLEDAI (r = 0.359, P = 0.001). There was also significant positive correlations between urinary CXCL16 levels, 24-h urinary proteins (r = 0.47, P = 0.001), and SLEDAI (r = 0.17, P = 0.001). uNGAL and CXCL16 were reliable indicators of the activity of LN.
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	Optimization of treatment modality in elderly end-stage renal disease population: Peritoneal dialysis versus transplant	p. 433
	A Kaul, MR Behera, R Kishore, B Karthikeyan, DS Bhadauria, P Mishra, N Prasad, A Gupta, RK Sharma DOI:10.4103/ijn.IJN_305_17   Despite kidney transplantation (KT) being considered as the best treatment modality for end-stage renal disease (ESRD), patient and graft survival in the elderly population is poorer than younger individuals. Many authors argue that prolonged life expectancy outweighs the risk of remaining on dialysis, but few studies had compared the treatment modalities, especially with peritoneal dialysis (PD). A retrospective study was conducted at a tertiary care institute to compare outcome of elderly ESRD patients, who received KT with those continued on PD; and to evaluate the predictors of patient survival. Patient survival at 1 year was (76.2% vs. 91.1%); 5 years (53.7% vs. 21.8%); and 10 years (35.6% vs. 0.00%) among KT and PD population, respectively. Infection was the most common cause of death among KT group (35 [41.2%] vs. 34 [28.2%]) while cardiovascular mortality in PD group (55 [46.2%] vs. 7 [8.2%]). Technique survival at 1, 5, and 10 years in PD group was 92.8%, 58.5%, and 0%, respectively. Similarly, graft survival at 1, 5, and 10 years in KT group was 98.7%, 90.2%, and 90.2%, respectively. Multivariate analysis showed body mass index (BMI) (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.82–0.93, p < 0.001), and albumin (HR 0.55, 95% CI 0.37–0.80, p = 0.002) were significant predictors of survival. In the 1st year, patient survival was better in PD than KT, but after adjustment for BMI and albumin, both short-term and long-term survival in elderly KT group was better than that of PD. Hence, elderly ESRD patients should not be barred from KT just because of age.
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	Role of blood oxygen level-dependent MRI in differentiation of acute renal allograft dysfunction	p. 441
	Hira Lal, Ezaz Mohamed, Neelam Soni, Priyank Yadav, Manoj Jain, Dharmendra Bhadauria, Anupma Kaul, Narayan Prasad, Amit Gupta, RK Sharma DOI:10.4103/ijn.IJN_43_18   Early graft dysfunction after renal transplantation manifests as acute rejection (AR) or acute tubular necrosis (ATN). Blood oxygen level-dependent (BOLD) magnetic resonance (MR) imaging is a noninvasive method of assessing tissue oxygenation, which may be useful for predicting acute allograft dysfunction. This was a prospective study involving 40 patients scheduled for renal transplantation from August 2012 to August 2014. In addition, 15 healthy donors were also enrolled in this study. All recipients underwent BOLD MR imaging (MRI) and R2* mapping 10–20 days after transplant, and additionally within 48 h of biopsy if there was any evidence of graft dysfunction. The healthy donors underwent BOLD MRI 1–2 days before surgery. The biopsies were grouped into AR, ATN, and no evidence of AR or ATN. The mean medullary R2*, cortical R2*, corticomedullary gradient, and medullary: cortical R2* ratio were compared between groups using one-way analysis of variance. Spearman's correlation and multinomial linear regression were applied to determine the influence factors of R2* value. Overall, nine patients had graft dysfunction. Six were reported as AR, two as ATN, and one as no evidence of ATN or rejection. The mean medullary and cortical R2* were significantly higher in ATN group compared with AR and normal group, whereas the mean medullary and cortical R2* of AR group were significantly lower than normal group. The corticomedullary gradient of AR group was significantly lower compared with ATN and normal group. Medullary R2*:cortical R2* ratio was significantly lower in AR group compared with normal group. No significant difference was noted between the 15 donors and patients with normal graft function. R2* values on BOLD MRI are significantly decreased in AR allografts and increased in an early stage of ATN allografts, suggesting that BOLD MRI can become a valuable tool for discriminating between AR and ATN.
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	Prevalence and clinical correlates of white coat effect in patients with chronic kidney disease and the role of automated blood pressure device in its assessment	p. 448
	Srinivas Shenoy, Shankar Prasad Nagaraju, Nileshwar R Rau, Ravindra A Prabhu, Uday Venkat Mateti, Dharshan Rangaswamy, Indu R Rao, Karan Saraf DOI:10.4103/ijn.IJN_418_17   Context: Hypertension in chronic kidney disease (CKD) is an important modifiable cardiovascular risk factor. Patients with CKD can have clinically significant white coat effect (WCE), making routine clinic blood pressure (BP) measurements an unreliable indicator of actual BP control. Automated BP monitoring is useful in identifying WCE. The utility of automated BP monitoring has seldom been part of clinical practice in developing countries. Aim: The goal of this study was to estimate the prevalence and determinants of WCE in adult patients with CKD in an outpatient setting using an automated BP device. Materials and Method: In this prospective observational study, patients with CKD attending the nephrology clinic over a period of 6 months (January 2016 to July 2016), who were suspected to have WCE by the treating physician, were assigned to measurement of BP by both the standardized manual BP recording by a single nephrologist and with automated machine as per a defined protocol. Clinical, demographic characters that would influence outcomes were also studied. Results: Among 118 patients with CKD with suspected WCE, 57.6% showed WCE. The mean systolic and diastolic BPs were significantly lower with automated machine when compared with manual BP recordings in patients with WCE (p = 0.04). WCE was seen in all stages of CKD. Occurrence of WCE in CKD was not dependent on factors such as old age, sex, diabetes mellitus, or smoking status in our study. Conclusion:WCE is a highly prevalent and underdiagnosed entity in patients with CKD. Automated machine is a useful and time-saving tool in detection of WCE in patients with CKD attending the outpatient clinic and guide management.
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	Acute pyelonephritis: A single-center experience	p. 454
	L Umesha, SM Shivaprasad, EN Rajiv, MM Satish Kumar, V Leelavathy, CG Sreedhara, MR Niranjan DOI:10.4103/ijn.IJN_219_16   Acute pyelonephritis (APN), although a common clinical entity, still not much is known about the clinical profile in the Indian scenario. We prospectively collected clinical, biochemical, and radiological data of patients hospitalized with a diagnosis of APN from March 2014 to June 2016. A total of 296 cases were included in the study. Mean age was 53.85 ± 9.78 years. Male to females ratio was 1.93:1. Among the risk factors recognized for complicated pyelonephritis (PN), diabetes mellitus (DM) (54.4%) was the most common factor followed by renal calculi (14.4%), benign prostatic hyperplasia (6.7%), immunocompromised state (3.3%), stricture urethra and meatal stenosis (3.3%), and neurogenic bladder (2%). Urinary culture was negative in 153 (51.7%) and positive in 143 patient (48.3%). Most common organism isolated was Escherichia coli (29.7%), followed by Klebsiella pneumoniae (5.4%), pseudomonas (5.4%), Enterococcus (4.4%), and Proteus in 10 (3.4%). Serum creatinine of more than 1.5 mg/dl at admission was seen in 96.3% patients; 40% of them had underlying chronic kidney disease with DM being the most common. Multiorgan dysfunction either at admission or during the course in hospital stay was seen in 31.8% patients. Twelve (2%) had emphysematous PN. Six patients had Class II, 4 had Class III, 1 with Class I, and another with Class IV. A total of 18 deaths were noted (6.1%). Hemoglobin <10 g/dl, serum creatinine at admission >1.5 mg/dl, HbA1c% >10%, and immunosuppression had statistically significant association with the development of multiorgan dysfunction on univariate analysis, but on multivariate analysis, only hemoglobin, HbA1c%, and immunosuppression reached statistical significance. Even with attributable risk of mortality, only hemoglobin, HbA1c%, and immunosuppression reached statistical significance on multivariate analysis. HbA1c% adds to the predictive parameters to recognize at-risk patients to intensify the treatment and avoid complications.
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CASE REPORTS
	Hepatitis C virus-associated membranoproliferative glomerulonephritis treated with directly acting antiviral therapy	p. 462
	S Nayak, A Kataria, MK Sharma, A Rastogi, E Gupta, A Singh, SC Tiwari DOI:10.4103/ijn.IJN_235_17   Hepatitis C virus (HCV) infection has been shown to affect kidneys with various histopathological pattern on the kidney biopsy. These commonly include a membranoproliferative glomerulonephritis (MPGN) pattern with mixed cryoglobulinemia (CG), thrombotic microangiopathy, membranous nephropathy, and vasculitis affecting medium and small vessels of the kidneys causing polyarteritis nodosa. It has been rarely associated with MPGN without detectable CG. We present one such patient who presented to us with HCV-associated MPGN without detectable CG, who recovered completely with directly acting antiviral therapy without any immunosuppression.
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	Systemic lupus erythematosus with linear IgA bullous dermatosis and renal vascular lesions: An extremely rare association	p. 465
	R Malipatel, V Gnanapriya, A Manocha, YK Inchara DOI:10.4103/ijn.IJN_200_17   We report a rare case of systemic lupus erythematosus presenting initially with cutaneous manifestations of linear IgA bullous dermatosis. Later the patient developed renal abnormalities due to thrombotic microangiopathy and lupus nephritis with inflammatory necrotizing vasculitis. Paucity of immune deposits was observed on Immunofluorescence. This association of SLE with these cutaneous and renal lesions is rarely reported in the literature.
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	Xanthogranulomatous pyelonephritis: Intrahepatic and intrathoracic extension	p. 468
	U Anandh, N Birajdar, R Kumar, S Babu DOI:10.4103/ijn.IJN_213_17   A 32-year-old female presented to us with worsening cough and expectoration, low-grade fever, and malaise for 3 months. She gave a history of pregnancy loss secondary to urinary tract infection (UTI) a year back. At that time, she was told to have an obstructive right renal calculus. She also had a history of recurrent UTI in the past 1 year. She had no other comorbidities. Her clinical evaluation revealed an enlarged right kidney and reduced air entry in the right hemithorax. Radiological investigations revealed a large right kidney invading into the inferior surface of the right lobe of the liver and the right pleural space. A clinical diagnosis of xanthogranulomatous pyelonephritis was made, and she was advised nephrectomy. Intraoperatively, the right kidney was found to invade both the right lobe of the liver and the right pleural cavity through a right diaphragmatic defect. Histopathology of the kidney revealed the presence of foamy histiocytes suggestive of xanthogranulomatous pyelonephritis. Invasive xanthogranulomatous pyelonephritis is known, however, invasion into the extra-abdominal structures has not been reported in the literature. Our case is a rare manifestation of a rare clinical entity – xanthogranulomatous pyelonephritis.
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	Crystalline nephropathy in renal transplant: A series of 4 cases	p. 472
	K Mnif, S Yaich, M Mars, K Kammoun, F Fendri, K Charfeddine, F Jarraya, T Boudawara, J Hachicha DOI:10.4103/ijn.IJN_76_17   Crystals are particles of endogenous inorganic or organic composition that can trigger kidney injury when deposited or formed inside the kidney. The most common forms of crystalline nephropathies (CNs) are nephrocalcinosis and oxalate nephropathy. The causes of early allograft dysfunction are changing constantly, and recently calcium oxalate (CaOx) crystal deposition has been added to this list. CaOx deposition in renal allograft is important and probably under-recognized cause of delayed graft function that requires adequate awareness with early intervention to improve the allograft outcome. Here, we describe four cases of irreversible renal graft injury due to CNs.
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	Allopurinol-induced drug reactions with eosinophilia and systemic symptoms syndrome with interstitial nephritis	p. 477
	T Aatif, J Fatihi, H El Annaz, O Qamouss DOI:10.4103/ijn.IJN_166_17   Allopurinol-induced drug reactions with eosinophilia and systemic symptoms (DRESS) is a severe illness related to hypersensitivity syndrome characterized by fever, skin rash, lymph node enlargement, hematological abnormalities, especially eosinophilia and atypical lymphocytosis, and single or multiple organ involvement. The syndrome is difficult to diagnose in view of its clinical heterogeneity and long latency period within 8 weeks after start treatment. We report a case of DRESS syndrome in a 64-year-old man, induced by allopurinol treatment for asymptomatic hyperuricemia, started 8 weeks earlier but stopped only 3 days after because of the onset of rash. The diagnosis was retained due to combining of interstitial nephritis with the clinical findings of fever, skin rash, cervical lymphadenopathy, eosinophilia, and reactivation of human herpesviruses specifically HHV-6. The glucocorticoids were started to relieve hypersensitivity. Five days later, the patient became afebrile, and the rash improved significantly. However, interstitial nephritis with renal function impairment progressed to severe azotemia, and even anuria requiring hemodialysis. Allopurinol-induced DRESS syndrome is associated with significant mortality, and care must, therefore, be exercised when given this drug.
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	Autosomal dominant polycystic kidney disease: Presence of hypomorphic alleles in PKD1 Gene	p. 482
	S Pandita, D Khullar, R Saxena, IC Verma DOI:10.4103/ijn.IJN_236_17   Autosomal dominant polycystic kidney disease is characterized by multiple cysts in both kidneys manifesting in adult life. In general, the disorder is caused by a pathogenic variant in one allele of PKD1 or PKD2 genes, while the other allele is normal. Pathogenic variants in both the alleles are rare and have variable phenotypes, from lethal or perinatal presentation to a mild form in later adulthood, depending on the type of variant. Here, we describe a proband with two variants (p.Thr1773Ile and p.Ala1871Thr in trans) in PKD1 gene, who presented with disease at age 24 years. Both the parents and one brother had a variant in one allele, the other being wild type only and had normal ultrasound findings. Segregation studies suggest that both the variants may act as "hypomorphic" or "incompletely penetrant" alleles and acting together resulted in haploinsufficiency of protein PC1 in renal cells, leading to cystogenesis in the proband. The consequences of the presence of two hypomorphic variants have been poorly documented in literature. We reviewed the few published cases having two hypomorphic variants and the data conform to the conclusions that we reached by study of the family described. It is emphasized that to resolve the significance of suspected hypomorphic variants, segregation studies in the parents and siblings are essential.
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	An unusual association of renal cell carcinoma and renal malakoplakia with focal segmental glomerulosclerosis in an elderly patient	p. 485
	M Vijayan, P Koshy, R Parthasarathy, M Mathew, G Abraham DOI:10.4103/ijn.IJN_289_17   The association of malignancy and glomerulonephritis may be missed, especially in elderly patients. Here, we report a case of eosinophilic variant of renal cell carcinoma and renal parenchymal malakoplakia discovered on renal biopsy in a patient with steroid-dependent nephrotic syndrome. The presence of malakoplakia in our biopsy was probably due to systemic steroid therapy for glomerulonephritis, presence of concomitant asymptomatic urinary tract infection, and/or history of diabetes mellitus. The patient had remission of proteinuria following laparoscopic removal of the tumor, indicating probable remission of glomerulonephritis.
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	Kidney transplantation from a hepatitis C virus-positive donor to a hepatitis C virus-negative recipient	p. 488
	M Kamalkiran, V Ravikiran, C Shashidhar, K. V. R Prasad, V Yeldandi DOI:10.4103/ijn.IJN_267_17   Kidney transplantation from a hepatitis C virus (HCV)-positive donor to an HCV-negative recipient till recently has been a contraindication. In view of the excellent sustained virological response (SVR) rates with directly acting antiviral agents, HCV-positive donors are being considered for the HCV-negative recipients in a few centers. We report the successful transplantation of an HCV-negative recipient transplanted with an HCV-positive donor kidney. Donor was treated with sofosbuvir and ribavirin for 12 weeks. At 10th and 16th weeks of starting treatment, her HCV-RNA PCR was negative. Three weeks later, transplantation was performed with basiliximab induction and triple immunosuppression with tacrolimus, mycophenolate, and prednisolone. The recipient was administered sofosbuvir and ribavirin for 12 weeks. He attained good graft function with a stable creatinine. His serial alanine transaminases were normal on 3rd, 6th, and 12th months, respectively. Six months posttransplant his anti-HCV antibody, and HCV-RNA PCR were negative.
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LETTERS TO EDITOR
	Cystinuria in a 13-Month-Old girl with absence of mutations in the SLC3A1 and SLC7A9 genes	p. 490
	MD Al-Mendalawi DOI:10.4103/ijn.IJN_46_18
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	Improving crossmatch techniques and graft outcomes	p. 491
	L Vincent DOI:10.4103/ijn.IJN_362_17
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	Estimated glomerular filtration rate using creatinine-based chronic kidney disease epidemiology collaboration equation	p. 492
	AA Rani, V Viswanathan DOI:10.4103/ijn.IJN_439_17
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