ᅟ

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The Basophil Activation Test reduces the need for a food challenge test in children suspected of IgE‐mediated cow's milk allergy

Abstract

Background

The gold standard for the diagnosis of cow's milk allergy is the Double‐Blind Placebo‐Controlled Food Challenge (DBPCFC) test. However, disadvantages of the DBPCFC are the potential risk of anaphylactic reactions, the time consuming procedure and high costs.

Objective

The aim of this study is to determine the reliability of the Basophil Activation Test (BAT) both for the initial diagnosis of cow's milk allergy in children and for determination of tolerance in children with cow's milk allergy.

Methods

97 BATs and cow's milk specific IgE (sIgE) tests were performed in 86 infants/young children, suspected of (persistent) cow's milk allergy, who were qualified for an in‐hospital DBPCFC. The BAT was performed with cow's milk extract and the purified major allergens casein, α‐lactalbumin, β‐lactoglubulin. Basophil activation was determined by CD63 up‐regulation measured by flow cytometry. The BAT results were compared to the DBPCFC outcomes.

Results

Based on unequivocal DBPCFC and BAT result combinations (80%), the BAT had a sensitivity and specificity of 100% (CI 86‐100% and 68‐100%, respectively) in IgE sensitized children (41% of the tested children). All non‐IgE sensitized children (59%) had a negative DBPCFC and BAT, except for five patients. These latter showed delayed and relatively mild symptoms in the DBPCFC with a negative BAT, supporting a non‐IgE mediated allergy in these children.

Conclusions and Clinical Relevance

The BAT seems reliable and cost‐effective to diagnose patients with an IgE‐mediated cow's milk allergy. In IgE sensitized patients a BAT might replace a DBPCFC. For non‐IgE sensitized patients presenting with mild symptoms we propose to consider a (double‐blind) extended (time) challenge test at home.

This article is protected by copyright. All rights reserved.

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Effect of Dual-Carrier Processing on the Intelligibility of Concurrent Vocoded Sentences

Purpose

The goal of this study was to examine the role of carrier cues in sound source segregation and the possibility to enhance the intelligibility of 2 sentences presented simultaneously. Dual-carrier (DC) processing (Apoux, Youngdahl, Yoho, & Healy, 2015) was used to introduce synthetic carrier cues in vocoded speech.

Method

Listeners with normal hearing heard sentences processed either with a DC or with a traditional single-carrier (SC) vocoder. One group was asked to repeat both sentences in a sentence pair (Experiment 1). The other group was asked to repeat only 1 sentence of the pair and was provided additional segregation cues involving onset asynchrony (Experiment 2).

Results

Both experiments showed that not only is the "target" sentence more intelligible in DC compared with SC, but the "background" sentence intelligibility is equally enhanced. The participants did not benefit from the additional segregation cues.

Conclusions

The data showed a clear benefit of using a distinct carrier to convey each sentence (i.e., DC processing). Accordingly, the poor speech intelligibility in noise typically observed with SC-vocoded speech may be partly attributed to the envelope of independent sound sources sharing the same carrier. Moreover, this work suggests that noise reduction may not be the only viable option to improve speech intelligibility in noise for users of cochlear implants. Alternative approaches aimed at enhancing sound source segregation such as DC processing may help to improve speech intelligibility while preserving and enhancing the background.

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Minimally Detectable Change and Minimal Clinically Important Difference of a Decline in Sentence Intelligibility and Speaking Rate for Individuals With Amyotrophic Lateral Sclerosis

Purpose

The purpose of this study was to determine the minimally detectable change (MDC) and minimal clinically important difference (MCID) of a decline in speech sentence intelligibility and speaking rate for individuals with amyotrophic lateral sclerosis (ALS). We also examined how the MDC and MCID vary across severities of dysarthria.

Method

One-hundred forty-seven patients with ALS and 49 healthy control subjects were selected from a larger, longitudinal study of bulbar decline in ALS, resulting in a total of 650 observations. Intelligibility and speaking rate in words per minute (WPM) were calculated using the Sentence Intelligibility Test (Yorkston, Beukelman, & Hakel, 2007), and the ALS Functional Rating Scale–Revised (Cedarbaum et al., 1999) was administered to capture patient perception of motor impairment. The MDC at the 95% confidence level was estimated using the following formula: MDC₉₅ = 1.96 × √2 × SEM. For estimation of the MCID, receiver operating characteristic curves were generated, and area under the curve and optimal thresholds to maximize sensitivity and specificity were calculated.

Results

The MDC for sentence intelligibility was 12.07%, and the MCID was 1.43%. The MDC for speaking rate was 36.57 WPM, and the MCID was 8.80 WPM. Both MDC and MCID estimates varied with severity of dysarthria.

Conclusions

The findings suggest that declines greater than 12% sentence intelligibility and 37 WPM are required to be outside measurement error and that these estimates vary widely across dysarthria severities. The MDC and MCID metrics used in this study to detect real and clinically relevant change should be estimated for other measures of speech outcomes in intervention research.

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Changing Developmental Trajectories of Toddlers With Autism Spectrum Disorder: Strategies for Bridging Research to Community Practice

Purpose

The need for community-viable, evidence-based intervention strategies for toddlers with autism spectrum disorder (ASD) is a national priority. The purpose of this research forum article is to identify gaps in intervention research and needs in community practice for toddlers with ASD, incorporate published findings from a randomized controlled trial (RCT) of the Early Social Interaction (ESI) model (Wetherby et al., 2014) to illustrate community-based intervention, report new findings on child active engagement from the ESI RCT, and offer solutions to bridge the research-to-community practice gap.

Method

Research findings were reviewed to identify gaps in the evidence base for toddlers with ASD. Published and new findings from the multisite ESI RCT compared the effects of two different ESI conditions for 82 toddlers with ASD to teach parents how to support active engagement in natural environments.

Results

The RCT of the ESI model was the only parent-implemented intervention that reported differential treatment effects on standardized measures of child outcomes, including social communication, developmental level, and adaptive behavior. A new measure of active engagement in the natural environment was found to be sensitive to change in 3 months for young toddlers with ASD and to predict outcomes on the standardized measures of child outcomes. Strategies for utilizing the Autism Navigator collection of web-based courses and tools using extensive video footage for families and professional development are offered for scaling up in community settings to change developmental trajectories of toddlers with ASD.

Conclusions

Current health care and education systems are challenged to provide intervention of adequate intensity for toddlers with ASD. The use of innovative technology can increase acceleration of access to evidence-based early intervention for toddlers with ASD that addresses health disparities, enables immediate response as soon as ASD is suspected, and rapidly bridges the research-to-practice gap.

Presentation Video

https://doi.org/10.23641/asha.7297817

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Introduction to the Research Symposium Forum

Purpose

The purpose of this introduction is to provide an overview of the articles contained within this research forum of JSLHR. Each of these articles is based upon presentations from the 2017 ASHA Research Symposium.

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SMARTer Approach to Personalizing Intervention for Children With Autism Spectrum Disorder

Purpose

This review article introduces research methods for personalization of intervention. Our goals are to review evidence-based practices for improving social communication impairment in children with autism spectrum disorder generally and then how these practices can be systematized in ways that personalize intervention, especially for children who respond slowly to an initial evidence-based practice.

Method

The narrative reflects on the current status of modular and targeted interventions on social communication outcomes in the field of autism research. Questions are introduced regarding personalization of interventions that can be addressed through research methods. These research methods include adaptive treatment designs and the Sequential Multiple Assignment Randomized Trial. Examples of empirical studies using research designs are presented to answer questions of personalization.

Conclusion

Bridging the gap between research studies and clinical practice can be advanced by research that attempts to answer questions pertinent to the broad heterogeneity in children with autism spectrum disorder, their response to interventions, and the fact that a single intervention is not effective for all children.

Presentation Video

https://doi.org/10.23641/asha.7298021

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The Dimensionality of Oral Language in Kindergarten Spanish–English Dual Language Learners

Purpose

The purpose of this study was to examine the latent dimensionality of language in dual language learners (DLLs) who spoke Spanish as their native language and were learning English as their second language.

Method

Participants included 259 Spanish–English DLLs attending kindergarten. In the spring of their kindergarten year, children completed vocabulary, grammar, listening comprehension, and higher level language measures (comprehension monitoring and inferencing) in Spanish and English.

Results

Two models with similar fits best describe the data. The first was a bifactor model with a single general language factor "l," plus 2 additional language factors, 1 for Spanish and 1 for English. The second model was a 4-factor model, 1 for English that included all English language measures and 3 additional factors that included Spanish vocabulary, Spanish grammar, and Spanish higher level language.

Conclusions

These results indicate that a general language ability may underlie development in both Spanish and English. In contrast to a unidimensional structure found for monolingual English-speaking kindergarteners, oral language appears to be multidimensional in Spanish–English DLL kindergarteners, but multidimensionality is reflected in Spanish, not English.

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Executive Function Skills in School-Age Children With Autism Spectrum Disorder: Association With Language Abilities

Purpose

This article reviews research on executive function (EF) skills in children with autism spectrum disorder (ASD) and the relation between EF and language abilities. The current study assessed EF using nonverbal tasks of inhibition, shifting, and updating of working memory (WM) in school-age children with ASD. It also evaluated the association between children's receptive and expressive language abilities and EF performance.

Method

In this study, we sought to address variables that have contributed to inconsistencies in this area of research—including task issues, group comparisons, and participant heterogeneity. EF abilities in children with ASD (n = 48) were compared to typically developing controls (n = 71) matched on age, as well as when statistically controlling for group differences in nonverbal cognition, socioeconomic status, and social communication abilities. Six nonverbal EF tasks were administered—2 each to evaluate inhibition, shifting, and WM. Language abilities were assessed via a standardized language measure. Language–EF associations were examined for the ASD group as a whole and subdivided by language status.

Results

Children with ASD exhibited significant deficits in all components of EF compared to age-mates and showed particular difficulty with shifting after accounting for group differences in nonverbal cognition. Controlling for social communication—a core deficit in ASD—eliminated group differences in EF performance. A modest association was observed between language (especially comprehension) and EF skills, with some evidence of different patterns between children on the autism spectrum with and without language impairment.

Conclusions

There is a need for future research to examine the direction of influence between EF and language. It would be beneficial for EF interventions with children with ASD to consider language outcomes and, conversely, to examine whether specific language training facilitates aspects of executive control in children on the autism spectrum.

Presentation Video

https://doi.org/10.23641/asha.7298144

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Spontaneous Otoacoustic Emissions Reveal an Efficient Auditory Efferent Network

Purpose

Understanding speech often involves processing input from multiple modalities. The availability of visual information may make auditory input less critical for comprehension. This study examines whether the auditory system is sensitive to the presence of complementary sources of input when exerting top-down control over the amplification of speech stimuli.

Method

Auditory gain in the cochlea was assessed by monitoring spontaneous otoacoustic emissions (SOAEs), which are by-products of the amplification process. SOAEs were recorded while 32 participants (23 women, nine men; M _age = 21.13) identified speech sounds such as "ba" and "ga." The speech sounds were presented either alone or with complementary visual input, as well as in quiet or with 6-talker babble.

Results

Analyses revealed that there was a greater reduction in the amplification of noisy auditory stimuli compared with quiet. This reduced amplification may aid in the perception of speech by improving the signal-to-noise ratio. Critically, there was a greater reduction in amplification when speech sounds were presented bimodally with visual information relative to when they were presented unimodally. This effect was evidenced by greater changes in SOAE levels from baseline to stimuli presentation in audiovisual trials relative to audio-only trials.

Conclusions

The results suggest that even the earliest stages of speech comprehension are modulated by top-down influences, resulting in changes to SOAEs depending on the presence of bimodal or unimodal input. Neural processes responsible for changes in cochlear function are sensitive to redundancy across auditory and visual input channels and coordinate activity to maximize efficiency in the auditory periphery.

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Lexical Development in Young Children With Autism Spectrum Disorder (ASD): How ASD May Affect Intake From the Input

Purpose

Most children with autism spectrum disorder (ASD) have below-age lexical knowledge and lexical representation. Our goal is to examine ways in which difficulties with social communication and language processing that are often associated with ASD may constrain these children's abilities to learn new words and to explore whether minimizing the social communication and processing demands of the learning situation can lead to successful learning.

Method

In this narrative review of recent work on lexical development in ASD, we describe key findings on children's acquisition of nouns, pronouns, and verbs and outline our research program currently in progress aimed at further elucidating these issues.

Conclusion

Our review of studies that examine lexical development in children with ASD suggests that innovative intervention approaches that take into account both the social communication and processing demands of the learning situation may be particularly beneficial.

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A Survey of Clinician Decision Making When Identifying Swallowing Impairments and Determining Treatment

Purpose

Speech-language pathologists (SLPs) are the primary providers of dysphagia management; however, this role has been criticized with assertions that SLPs are inadequately trained in swallowing physiology (Campbell-Taylor, 2008). To date, diagnostic acuity and treatment planning for swallowing impairments by practicing SLPs have not been examined. We conducted a survey to examine how clinician demographics and swallowing complexity influence decision making for swallowing impairments in videofluoroscopic images. Our goal was to determine whether SLPs' judgments of swallowing timing impairments align with impairment thresholds available in the research literature and whether or not there is agreement among SLPs regarding therapeutic recommendations.

Method

The survey included 3 videofluoroscopic swallows ranging in complexity (easy, moderate, and complex). Three hundred three practicing SLPs in dysphagia management participated in the survey in a web-based format (Qualtrics, 2005) with frame-by-frame viewing capabilities. SLPs' judgments of impairment were compared against impairment thresholds for swallowing timing measures based on 95% confidence intervals from healthy swallows reported in the literature.

Results

The primary impairment in swallowing physiology was identified 67% of the time for the easy swallow, 6% for the moderate swallow, and 6% for the complex swallow. On average, practicing clinicians mislabeled 8 or more swallowing events as impaired that were within the normal physiologic range compared with healthy normative data available in the literature. Agreement was higher among clinicians who report using frame-by-frame analysis 80% of the time. A range of 19–21 different treatments was recommended for each video, regardless of complexity.

Conclusions

Poor to modest agreement in swallowing impairment identification, frequent false positives, and wide variability in treatment planning recommendations suggest that additional research and training in healthy and disordered swallowing are needed to increase accurate dysphagia diagnosis and treatment among clinicians.

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Early Motor and Communicative Development in Infants With an Older Sibling With Autism Spectrum Disorder

Purpose

A recent approach to identifying early markers of risk for autism spectrum disorder (ASD) has been to study infants who have an older sibling with ASD. These infants are at heightened risk (HR) for ASD and for other developmental difficulties, and even those who do not receive an eventual ASD diagnosis manifest a high degree of variability in trajectories of development. The primary goal of this review is to summarize findings from research on early motor and communicative development in these HR infants.

Method

This review focuses on 2 lines of inquiry. The first assesses whether delays and atypicalities in early motor abilities and in the development of early communication provide an index of eventual ASD diagnosis. The second asks whether such delays also influence infants' interactions with objects and people in ways that exert far-reaching, cascading effects on development.

Results

HR infants who do and who do not receive a diagnosis of ASD vary widely in motor and communicative development. In addition, variation in infant motor and communicative development appears to have cascading effects on development, both on the emergence of behavior in other domains and on the broader learning environment.

Conclusions

Advances in communicative and language development are supported by advances in motor skill. When these advances are slowed and/or when new skills are not consolidated and remain challenging for the infant, the enhanced potential for exploration afforded by new abilities and the concomitant increase in opportunities for learning are reduced. Improving our understanding of communicative delays of the sort observed in ASD and developing effective intervention methods requires going beyond the individual to consider the constant, complex interplay between developing communicators and their environments.

Presentation Video

https://doi.org/10.23641/asha.7299308

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Measuring Articulation Rate: A Comparison of Two Methods

Purpose

Mean articulatory rate (MAR) is an alternative approach to measure articulation rate and is defined as the mean of 5 rate measures in minimally 10 to maximally 20 consecutive syllables in perceptually fluent speech without pauses. This study examined the validity of this approach.

Method

Reading and spontaneous speech samples were collected from 80 typically fluent adults ranging in age between 20 and 59 years. After orthographic transcription, all samples were subjected to an articulation rate analysis first using the prevailing "global" method, which takes into account the entire speech sample and involves manipulation of the speech sample, and then again applying the MAR method. Paired-samples t tests were conducted to compare global measurements to MAR measurements.

Results

For both spontaneous speech and reading, a strong correlation was found between the 2 methods. However, for both speech tasks, the paired-samples t tests revealed a significant difference with MAR values being higher than the global method values.

Conclusions

The MAR method is a valid method to measure articulation rate. However, it cannot be used interchangeably with the prevailing global method. Further standardization of the MAR method is needed before general clinical use can be suggested.

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The Shape Bias in Children With Autism Spectrum Disorder: Potential Sources of Individual Differences

Purpose

Children with autism spectrum disorder (ASD) demonstrate many mechanisms of lexical acquisition that support language in typical development; however, 1 notable exception is the shape bias. The bases of these children's difficulties with the shape bias are not well understood, and the current study explored potential sources of individual differences from the perspectives of both attentional and conceptual accounts of the shape bias.

Method

Shape bias performance from the dataset of Potrzeba, Fein, and Naigles (2015) was analyzed, including 33 children with typical development (M = 20 months; SD = 1.6), 15 children with ASD with high verbal abilities (M = 33 months; SD = 4.6), and 14 children with ASD with low verbal abilities (M = 33 months; SD = 6.6). Lexical predictors (shape-side noun percentage from the MacArthur–Bates Communicative Development Inventory; Fenson et al., 2007) and social-pragmatic predictors (joint attention duration during play sessions) were considered as predictors of subsequent shape bias performance.

Results

For children in the low verbal ASD group, initiation of joint attention (positively) and passive attention (negatively) predicted subsequent shape bias performance, controlling for initial language and developmental level. Proportion of child's known nouns with shape-defined properties correlated negatively with shape bias performance in the high verbal ASD group but did not reach significance in regression models.

Conclusions

These findings suggest that no single account sufficiently explains the observed individual differences in shape bias performance in children with ASD. Nonetheless, these findings break new ground in highlighting the role of social communicative interactions as integral to understanding specific language outcomes (i.e., the shape bias) in children with ASD, especially those with low verbal abilities, and point to new hypotheses concerning the linguistic content of these interactions.

Presentation Video

https://doi.org/10.23641/asha.7299581

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Time Course of the Second Morpheme Processing During Spoken Disyllabic Compound Word Recognition in Chinese

Purpose

This study aimed to investigate the time course of meaning activation of the 2nd morpheme processing of compound words during Chinese spoken word recognition using eye tracking technique with the printed-word paradigm.

Method

In the printed-word paradigm, participants were instructed to listen to a spoken target word (e.g., "大方", /da4fang1/, generous) while presented with a visual display composed of 3 words: a morphemic competitor (e.g., "圆形", /yuan2xing2/, circle), which was semantically related to the 2nd morpheme (e.g., "方", /fang1/, square) of the spoken target word; a whole-word competitor (e.g., "吝啬", /lin4se4/, stingy), which was semantically related to the spoken target word at the whole-word level; and a distractor, which was semantically related to neither the morpheme or the whole target word. Participants were asked to respond whether the spoken target word was on the visual display or not, and their eye movements were recorded.

Results

The logit mixed-model analysis showed both the morphemic competitor and the whole-word competitor effects. Both the morphemic and whole-word competitors attracted more fixations than the distractor. More importantly, the 2nd-morphemic competitor effect occurred at a relatively later time window (i.e., 1000–1500 ms) compared with the whole-word competitor effect (i.e., 200–1000 ms).

Conclusion

Findings in this study suggest that semantic information of both the 2nd morpheme and the whole word of a compound was activated in spoken word recognition and that the meaning activation of the 2nd morpheme followed the activation of the whole word.

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Treating Speech Movement Hypokinesia in Parkinson's Disease: Does Movement Size Matter?

Purpose

This study evaluates the effects of a novel speech therapy program that uses a verbal cue and gamified augmented visual feedback regarding tongue movements to address articulatory hypokinesia during speech in individuals with Parkinson's disease (PD).

Method

Five participants with PD participated in an ABA single-subject design study. The treatment aimed to increase tongue movement size using a combination of a verbal cue and augmented visual feedback and was conducted in 10 45-min sessions over 5 weeks. The presence of visual feedback was manipulated during treatment. Articulatory working space of the tongue was the primary outcome measure and was examined during treatment and in cued and uncued sentences pre- and posttreatment. Changes in speech intelligibility in response to a verbal cue pre- and posttreatment were also examined.

Results

During treatment, 4/5 participants showed a beneficial effect of visual feedback on tongue articulatory working space. At the end of the treatment, they used larger tongue movements when cued, relative to their pretreatment performance. None of the participants, however, generalized the effect to the uncued sentences. Speech intelligibility of cued sentences was judged as superior posttreatment only in a single participant.

Conclusions

This study demonstrated that using an augmented visual feedback approach is beneficial, beyond a verbal cue alone, in addressing articulatory hypokinesia in individuals with PD. An optimal degree of articulatory expansion might, however, be required to elicit a speech intelligibility benefit.

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Vocal Biomarkers of Mild-to-Moderate Hearing Loss in Children and Adults: Voiceless Sibilants

Purpose

The purpose of this study was to determine if an objective measure of speech production could serve as a vocal biomarker for the effects of high-frequency hearing loss on speech perception. It was hypothesized that production of voiceless sibilants is governed sufficiently by auditory feedback that high-frequency hearing loss results in subtle but significant shifts in the spectral characteristics of these sibilants.

Method

Sibilant production was examined in individuals with mild to moderately severe congenital (22 children; 8–17 years old) and acquired (23 adults; 55–80 years old) hearing losses. Measures of hearing level (pure-tone average thresholds at 4 and 8 kHz), speech perception (detection of nonsense words within sentences), and speech production (spectral center of gravity [COG] for /s/ and /ʃ/) were obtained in unaided and aided conditions.

Results

For both children and adults, detection of nonsense words increased significantly as hearing thresholds improved. Spectral COG for /ʃ/ was unaffected by hearing loss in both listening conditions, whereas the spectral COG for /s/ significantly decreased as high-frequency hearing loss increased. The distance in spectral COG between /s/ and /ʃ/ decreased significantly with increasing hearing level. COG distance significantly predicted nonsense-word detection in children but not in adults.

Conclusions

At least one aspect of speech production (voiceless sibilants) is measurably affected by high-frequency hearing loss and is related to speech perception in children. Speech production did not predict speech perception in adults, suggesting a more complex relationship between auditory feedback and feedforward mechanisms with age. Even so, these results suggest that this vocal biomarker may be useful for identifying the presence of high-frequency hearing loss in adults and children and for predicting the impact of hearing loss in children.

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Human Voice as a Measure of Mental Load Level

Purpose

The aim of this study was to determine a reliable and efficient set of acoustic parameters of the human voice able to estimate individuals' mental load level. Implementing detection methods and real-time analysis of mental load is a major challenge for monitoring and enhancing human task performance, especially during high-risk activities (e.g., flying aircraft).

Method

The voices of 32 participants were recorded during a cognitive task featuring word list recall. The difficulty of the task was manipulated by varying the number of words in each list (i.e., between 1 and 7, corresponding to 7 mental load conditions). Evoked pupillary response, known to be a useful proxy of mental load, was recorded simultaneously with speech to attest variations in mental load level during the experimental task.

Results

Classic features (fundamental frequency, its standard deviation, number of periods) and original features (frequency modulation and short-term variation in digital amplitude length) of the acoustic signals were predictive of memory load condition. They varied significantly according to the number of words to recall, specifically beyond a threshold of 3–5 words to recall, that is, when memory performance started to decline.

Conclusions

Some acoustic parameters of the human voice could be an appropriate and efficient means for detecting mental load levels.

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Masthead

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Star flap: new reconstructive technique for defects of the scalp

The scalp has unique challenges for surgeons, because the tissue is inelastic and thick, it is often hair bearing, and small defects can be hard to cover. We have developed a technique using four flaps for reconstruction after the excision of skin cancer, which to our knowledge has never been described before.

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Retrospective comparison of the number of screws used for fixation of skeletal anchorage plates in orthodontics, and their failure rates

The aim of this study was to compare the failure rate of fixation of skeletal orthodontic anchorage plates (SAP) with two screws with that of three screws, and to find out if there is a relation between the number of screws used to fix the plates and the failure rate. We reviewed clinical records of 65 patients from five hospitals with 176 SAP, and took into account other factors that may have affected the failure. The overall failure rate was 15/176 (8.5%), and for with two-screw fixation it was 9/86 compared with 6/90 for those with three-screw fixation.

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Cone-beam computed tomography guidance with navigational overlay for percutaneous lung nodule biopsy

Abstract

Background

Cone-beam CT is increasingly used in pediatric interventional radiology procedures. However, the feasibility or safety of using this mode of imaging guidance for percutaneous lung nodule biopsy in children has not been assessed.

Objective

To retrospectively evaluate safety and diagnostic accuracy of percutaneous lung nodule biopsy in people treated at a pediatric hospital using cone-beam CT with navigational overlay.

Materials and methods

Thirty-six consecutive patients from two large tertiary-care children's hospitals with lung nodules of 48 mm or smaller underwent percutaneous lung nodule biopsy using cone-beam CT with navigational overlay. We evaluated patient demographics, pre- and post-biopsy diagnoses, number of biopsy passes, complications, radiation exposure and technical success.

Results

Percutaneous lung nodule biopsy was performed for 37 nodules in 36 patients (23 males, 13 females, median age 15.5 years, range 8 months to 23 years). One patient underwent biopsy of two nodules at a single procedure. Median patient weight was 55 kg (range 8–97 kg). Pre-biopsy diagnoses included metastatic sarcoma or other solid tumor (n=11), leukemia/lymphoma (n=13), infection (n=10), chronic granulomatous disease (n=2) and post-transplant lymphoproliferative disorder (PTLD; n=1). Mean number of passes was 5 (range 2–15). Mean pre-procedure international normalized ratio (INR) was 1.1 and platelet count 193 × 10⁹/L. Diagnostic specimens were obtained in 32 of 36 patients (89%). Thirteen complications were encountered in 12 patients (33% of cohort), including 9 pneumothoraces (4 requiring chest tubes); 1 hemothorax, which required a chest tube; and 3 self-limited pulmonary hemorrhages. Mean and median radiation doses were as follows: fluoroscopy time 3 min and 2.4 min, dose-area product (DAP) (recorded in 31 patients) 23,402 Gy·cm² and 12,453 Gy·cm², and air kerma 88 mGy and 58 mGy.

Conclusion

Percutaneous lung nodule needle biopsy can be performed accurately using cone-beam CT with navigational overlay.

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RIG-I Signaling via MAVS Is Dispensable for Survival in Lethal Influenza Infection In Vivo

Retinoic acid-inducible gene I (RIG-I) is an important regulator of virus-induced antiviral interferons (IFNs) and proinflammatory cytokines. It requires interaction with an adaptor molecule, mitochondrial antiviral-signaling protein (MAVS), to activate downstream signaling pathways. To elucidate the mechanism(s) by which RIG-I-dependent recognition of IAV infection in vivo triggers innate immune responses, we infected mutant mice lacking RIG-I or MAVS with influenza A virus (IAV) and measured their innate immune responses. As has previously been demonstrated with isolated deletion of the virus recognition receptors TLR3, TLR7, and NOD2, RIG-I or MAVS knockout (KO) did not result in higher mortality and did not reduce IAV-induced cytokine responses in mice. Infected RIG-I KO animals displayed similar lung inflammation profiles as did WT mice, in terms of the protein concentration, total cell count, and inflammatory cell composition in the bronchoalveolar lavage fluid. RNA-Seq results demonstrated that all types of mice exhibited equivalent antiviral and inflammatory gene responses following IAV infection. Together, the results indicated that although RIG-I is important in innate cytokine responses in vitro, individual deletion of the genes encoding RIG-I or MAVS did not change survival or innate responses in vivo after IAV infection in mice.

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Low dose provocation and skin tests in patients with hypersensitivity to Gadolinium‐based contrast agents

Abstract

Reported reactions rates with gadolinium‐based contrast agents (GBCA) ranged from 0.07 to 2.4%, the rate of hypersensitivity reaction (HS) is around 0.1% (1) and immediate and delayed HS have been reported (1–4). The diagnosis of HS to GBCA is challenging, based on clinical history and skin tests. Although little data is available on the performances of the GBCA skin tests, its negative predictive value appears to be of interest (5).

This article is protected by copyright. All rights reserved.

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Plosive voicing acoustics and voice quality in Yerevan Armenian

Publication date: November 2018

Source: Journal of Phonetics, Volume 71

Author(s): Scott Seyfarth, Marc Garellek

Abstract

Yerevan Armenian is a variety of Eastern Armenian with a three-way voicing contrast that includes voiced, voiceless unaspirated, and voiceless aspirated stops, but previous work has not converged on a description of how voice quality is involved in the contrast. We demonstrate how voice quality can be assessed in a two-dimensional acoustic space using a spectral tilt measure in conjunction with a measure of spectral noise. Eight speakers produced a list of words with prevocalic word-initial and postvocalic word-final plosives. The results suggest that Yerevan Armenian has breathy-voiced plosives which are produced with closure voicing and a relatively spread glottis that is maintained into a following vowel. These qualitatively differ from some Indic ones in that they do not have an extended interval of voiced aspiration after the closure. For the voiceless unaspirated plosives, most speakers produced acoustically modal voiceless plosives, although two showed evidence for some glottal constriction and tensing. Many acoustic cues contribute to overall reliable discriminability of the three-way contrast in both initial and final position. Nevertheless, closure voicing intensity and aspiration duration together provide a robust separation of the three categories in both positions. We also find that back vowels are fronted after the breathy-voiced plosives, which supports a historical analysis in which early Armenian voiced stops were also breathy, rather than plain voiced.

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The insertion torque-depth curve integral as a measure of implant primary stability: An in vitro study on polyurethane foam blocks

Publication date: November 2018

Source: The Journal of Prosthetic Dentistry, Volume 120, Issue 5

Author(s): Danilo Alessio Di Stefano, Paolo Arosio, Giorgio Gastaldi, Enrico Gherlone

Abstract

Statement of problem

Recent research has shown that dynamic parameters correlate with insertion energy—that is, the total work needed to place an implant into its site—might convey more reliable information concerning immediate implant primary stability at insertion than the commonly used insertion torque (IT), the reverse torque (RT), or the implant stability quotient (ISQ). Yet knowledge on these dynamic parameters is still limited.

Purpose

The purpose of this in vitro study was to evaluate whether an energy-related parameter, the torque-depth curve integral (I), could be a reliable measure of primary stability. This was done by assessing if (I) measurement was operator-independent, by investigating its correlation with other known primary stability parameters (IT, RT, or ISQ) by quantifying the (I) average error and correlating (I), IT, RT, and ISQ variations with bone density.

Material and methods

Five operators placed 200 implants in polyurethane foam blocks of different densities using a micromotor that calculated the (I) during implant placement. Primary implant stability was assessed by measuring the ISQ, IT, and RT. ANOVA tests were used to evaluate whether measurements were operator independent (P>.05 in all cases). A correlation analysis was performed between (I) and IT, ISQ, and RT. The (I) average error was calculated and compared with that of the other parameters by ANOVA. (I)-density, IT-density, ISQ-density, and RT-density plots were drawn, and their slopes were compared by ANCOVA.

Results

The (I) measurements were operator independent and correlated with IT, ISQ, and RT. The average error of these parameters was not significantly different (P>.05 in all cases). The (I)-density, IT-density, ISQ-density, and RT-density curves were linear in the 0.16 to 0.49 g/cm³ range, with the (I)-density curves having a significantly greater slope than those regarding the other parameters (P≤.001 in all cases).

Conclusions

The torque-depth curve integral (I) provides a reliable assessment of primary stability and shows a greater sensitivity to density variations than other known primary stability parameters.

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The Essentials

Publication date: November 2018

Source: The Journal of Prosthetic Dentistry, Volume 120, Issue 5

Author(s):

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Table of Contents

Publication date: November 2018

Source: The Journal of Prosthetic Dentistry, Volume 120, Issue 5

Author(s):

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Sponsoring Organizations and Liaisons

Publication date: November 2018

Source: The Journal of Prosthetic Dentistry, Volume 120, Issue 5

Author(s):

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Editorial Board

Publication date: November 2018

Source: The Journal of Prosthetic Dentistry, Volume 120, Issue 5

Author(s):

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Effect of the number of splinted abutments on the accuracy of zirconia copings

Publication date: November 2018

Source: The Journal of Prosthetic Dentistry, Volume 120, Issue 5

Author(s): Min-Wuk Kim, Jong-Yub Kim, June-Sung Shim, Sunjai Kim

Abstract

Statement of problem

Splinting periodontally or structurally compromised abutments is a common procedure. However, studies that investigated the effect of splinting on the accuracy of zirconia copings are lacking.

Purpose

The purpose of this in vitro study was to evaluate the magnitude of marginal and internal gaps of zirconia copings based on the number of splinted abutments and digital scan technique.

Material and methods

Four maxillary acrylic resin incisors were prepared for ceramic restorations. Epoxy resin master models were fabricated by duplicating the acrylic resin model. An intraoral scanner was used to build 40 digital models (direct digital scan group [DD]); an additional 40 digital models were constructed by scanning 40 maxillary definitive casts using a laboratory scanner (indirect digital scan group [ID]). During computer-aided design, the DD and ID groups were subdivided into 4 groups; single unit (group SU); 2-unit splinted (group 2S); 3-unit splinted (group 3S), and 4-unit splinted (group 4S). Zirconia copings were then fabricated. Using the replica technique, marginal, axial, and occlusal gaps were measured and statistically evaluated (α=.05).

Results

In DD, group 4S exhibited larger marginal gaps than groups SU, 2S, and 3S (P<.001). In ID, group SU exhibited smaller marginal and occlusal gaps than group 4S (P<.001). Group 4S exhibited significantly greater axial gaps than groups SU, 2S, and 3S (P<.001).

Conclusions

As the number of splinting units increased, the magnitude of the marginal gap tended to increase; however, the differences were less than 5 μm, which is clinically insignificant. Axial gaps in the ID group demonstrated a significant difference (>35 μm) among the groups.

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News and Notes

Publication date: November 2018

Source: The Journal of Prosthetic Dentistry, Volume 120, Issue 5

Author(s):

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Maxillofacial prosthetic rehabilitation: A survey on the quality of life

Publication date: November 2018

Source: The Journal of Prosthetic Dentistry, Volume 120, Issue 5

Author(s): Jeroen P.J. Dings, Matthias A.W. Merkx, Manon T.P. de Clonie Maclennan-Naphausen, Pascal van de Pol, Thomas J.J. Maal, Gert J. Meijer

Abstract

Statement of problem

Maxillofacial prostheses, especially those supported by endosseous implants, are regarded as a viable, secure treatment for the reconstruction of facial defects to restore quality of life. The long-term quality of life of patients treated with facial prostheses with different retentive systems is unclear.

Purpose

The purpose of this clinical study was to assess the long-term quality of life of patients treated with facial prostheses with different retentive systems over a 14-year period at a Dutch oral and maxillofacial surgery unit.

Material and methods

A total of 66 patients with facial prostheses were inventoried and categorized based on anatomic location and type of retention. A 62-item questionnaire was designed to survey the daily prosthetic use, care, quality, durability, longevity, and reliability of retention. Furthermore, issues relating to general satisfaction, self-image, and socialization frequency were addressed.

Results

Completed validated questionnaires were returned by 52 patients. Of the prosthetic replacements, 23% (n=12) were orbital, 33% (n=17) nasal, and 44% (n=23) auricular prostheses. The survey showed that a prosthetic reconstruction led to high satisfaction scores with regard to wearing comfort, anatomic fit, color, and anatomic form. A significant difference was shown for implant-retained facial prostheses, which provided enhanced retention and increased ease of placement and removal (Fisher exact test P=.01 and P=.04). Patients with nasal prostheses were less satisfied with the junction of their prostheses to the surrounding soft tissue and more aware of others noticing their prosthetic rehabilitation. Patients with auricular defects were less embarrassed (P=.01) by their prostheses. Although auricular prostheses were less frequently cleaned (P=.01), no significant difference was found in minor soft tissue complications between different anatomic locations and the various retentive systems.

Conclusions

Implant-retained prostheses have advantages over adhesive-retained prostheses in terms of ease of handling. However, improvements in prosthetic material properties, including color stability and durability, are needed to increase the longevity of facial prostheses.

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Infantile myofibromatosis: review of imaging findings and emphasis on correlation between MRI and histopathological findings

Publication date: Available online 8 November 2018

Source: Clinical Imaging

Author(s): Lena Naffaa, Ibrahim Khalifeh, Rida Salman, Malak Itani, Raya Saab, Aghiad Al-kutoubi

Abstract

Background

Infantile myofibromatosis (IM) is the most common fibrous tumor of infancy. MRI is considered the gold standard in IM evaluation. Very little has been published about IM with histopathology correlation in the pediatric age.

Purpose

Describe imaging findings in IM and correlate MRI findings with histopathology.

Material and methods

Imaging findings of 17 patients with IM were retrospectively analyzed including CT, US and MRI. Signal characteristics on T1-, T2-weighted and STIR imaging, extent of T2-hyperintensity, degree & pattern of enhancement, diffusion restriction, location & margins, & involvement of adjacent structures were tabulated. Histopathology findings included cellularity, collagenization, myxoid changes, atypia, mitosis & microscopic invasion. Established grading scores were utilized.

Results

Relative to normal skeletal muscle, on T1-weighted imaging, 9 lesions had similar signal while the remaining had a mixture of iso & hypo intensity; whereas on T2-weighted and STIR imaging, all 12 lesions demonstrated a mixture of iso, hypo & hyperintensity. T2-hyperintensity was grade 2 in one, grade 3 in 8 & grade 4 in 3 lesions. Intensity of enhancement was grade 2 in one, grade 3 in 8 & grade 4 in 3 lesions. Enhancement was predominantly peripheral in all 12 lesions.

Extent of T2-hyperintensity & degree of enhancement corresponded to variable grades on histopathology.

CT and US showed nonspecific findings.

Conclusion

On MRI, IM has a mixture of signal intensity with predominant hyperintense signal on T2W images. However various signal & enhancement features correlated poorly with specific histopathologic grades.

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Chitinase 3‐like 1 protein plays a critical role in RSV‐induced airway inflammation

Abstract

Background

Chitinase 3‐like 1 protein (CHI3L1) (YKL‐40 in humans and breast regression protein [BRP]‐39 in mice) is required for optimal allergen sensitization and Th2 inflammation in various chronic inflammatory diseases including asthma. However, the role of CHI3L1 in airway inflammation induced by respiratory viruses has not been investigated. The aim of this study is to investigate the relationship between CHI3L1 and airway inflammation caused by respiratory syncytial virus (RSV) infection.

Methods

We measured YKL‐40 levels in human nasopharyngeal aspirate (NPA) from hospitalized children presenting with acute respiratory symptoms. Wild‐type (WT) and BRP‐39 knockout (KO) C57BL/6 mice were inoculated with live RSV (A2 strain). Bronchoalveolar lavage fluid and lung tissue samples were obtained on day 7 after inoculation to assess lung inflammation, airway reactivity, and expression of cytokines and BRP‐39.

Results

In human subjects, YKL‐40 and IL‐13 levels in NPA were higher in children with RSV infection than in control subjects. Expression of BRP‐39 and Th2 cytokines, IL‐13 in particular, were increased following RSV infection in mice. Airway inflammation caused by RSV infection was reduced in BRP‐39 KO mice as compared to WT mice. Th2 cytokine levels were not increased in the lungs of RSV‐infected BRP‐39 KO mice. BRP‐39 regulated M2 macrophage activation in RSV‐infected mice. Additionally, treatment with anti‐CHI3L1 antibody attenuated airway inflammation and Th2 cytokine production in RSV‐infected WT mice.

Conclusions

These findings suggest that CHI3L1 could contribute to airway inflammation induced by RSV infection. CHI3L1 could be a potential therapeutic candidate for attenuating Th2‐associated immunopathology during RSV infection.

This article is protected by copyright. All rights reserved.

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Mechanical impairment on alveolar bone graft: a literature review

Publication date: Available online 7 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Caroline Dissaux, Delphine Wagner, Daniel George, Camille Spingarn, Yves Rémond

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Human and computational models of atopic dermatitis: a review and perspectives by an expert panel of the International Eczema Council

Publication date: Available online 7 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Kilian Eyerich, Sara J. Brown, Bethany E. Perez White, Reiko J. Tanaka, Robert Bissonette, Sandipan Dhar, Thomas Bieber, Dirk J. Hijnen, Emma Guttman-Yassky, Alan Irvine, Jacob P. Thyssen, Christian Vestergaard, Thomas Werfel, Andreas Wollenberg, Amy S. Paller, Nick J. Reynolds

Abstract

Atopic dermatitis (AD) is a prevalent disease worldwide associated with systemic co-morbidities, representing a significant burden on individuals, their families and society. Therapeutic options for AD remain limited, in part due to lack of well-characterised animal models. To better define pathophysiological mechanisms and to identify novel therapeutic targets and biomarkers that predict therapeutic response, there has been increasing interest in developing experimental approaches to study the pathogenesis of human AD in vivo, in vitro, and in silico. This review critically appraises a range of models including: genetic mutations relevant to AD; experimental challenge of human skin in vivo; tissue culture models; integration of "omic" datasets; and the development of predictive computational models. Whilst no one individual model recapitulates the complex AD pathophysiology, our review highlights insights gained into key elements of cutaneous biology, molecular pathways and therapeutic target identification through each approach. Recent developments in computational analysis, including the application of machine learning and a systems approach to data integration and predictive modelling, highlight the applicability of these methods to AD subclassification (endotyping), therapy development and precision medicine. Such predictive modelling will highlight knowledge gaps, further inform refinement of biological models, and support new experimental and systems approaches to AD.

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Immunology of the Ancestral Differences in Eosinophilic Esophagitis

Publication date: Available online 7 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Leah Kottyan, Jonathan M. Spergel, Antonella Cianferoni

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Review of 400 Consecutive Oral Food Challenges to Almond

Publication date: Available online 7 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Mary Grace Baker, Jacob Kattan

Abstract

Background

Diagnosis of almond allergy is complicated by a high rate of false positive test results. Accurate diagnosis of almond allergy is critical as almond is a source of nutrition and milk products for children with other food allergies.

Objectives

We reviewed the outpatient almond oral food challenges (OFCs) performed at our institution to analyze the pass rate and identify variables that predict OFC outcome.

Methods

We reviewed all almond OFCs performed at our pediatric, university-based outpatient practice between October 2015 and July 2017. OFC details, including dosing, reactions, and treatments, as well as demographic, clinical, and laboratory data were compiled. Statistical analysis was performed using the Fisher's exact and student t-tests.

Results

We identified 400 patients who underwent consecutive almond OFCs. Of these, 375 passed (93.8%, median sIgE 1.41 kU_A/L, mean SPT wheal 3.23 mm), 16 failed (4.0%, sIgE 2.54 kU_A/L, SPT 5.0 mm), and 9 were indeterminate (2.3%, sIgE 3.33 kU_A/L, SPT 5.0 mm). Among children who reacted, pruritus was the most common symptom. Only two children had reactions that required epinephrine. There was no difference in demographics or allergic comorbidities between those who passed and failed.

Conclusions

Among patients in our cohort, the probability of passing an almond OFC was 94%. Although higher almond sIgE level and SPT wheal size correlated with OFC failure, the pass rate remained >95% for patients with sIgE up to 10 kU_A/L and SPT wheal size up to 5 mm. Among the patients who had a reaction to almond, anaphylaxis was uncommon. Our data support that performing outpatient OFCs to almond is safe for select patients.

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