Surgical and radiologic anatomy of a cochleostomy produced via posterior tympanotomy for cochlear implantation based on three-dimensional reconstructed temporal bone CT images

Purpose

In this study, we evaluated the surgical and radiologic anatomy of a cochleostomy produced via posterior tympanotomy for cochlear implantation (CI).

Materials and methods

Twenty computed tomography (CT) images of the temporal bone from patients aged between 20 and 60 years were selected. The inclusion criterion was a radiologically normal temporal bone CT scan. Three-dimensional (3D) reconstructed images were obtained using high-resolution axial temporal bone CT scans. Eight points were used to evaluate the surgical anatomy of the posterior tympanotomy and cochleostomy. The length of lines between the points and the angles between the lines were measured.

Results

The mean length of line AB (superior-inferior length of the posterior tympanotomy for CI) was 6.48 ± 0.26 mm, while line AC (width of the chorda tympani and facial nerves) was 3.60 ± 0.2 mm. The mean angle of ABC (angle at which the chorda tympani nerve branched from the facial nerve) was 18.40° ± 1.05°. The mean length of line AD (distance from the facial ridge to the point of cochleostomy) was 9.58 ± 0.47 mm.

Conclusions

3D imaging of the facial recess and round window can be used to identify the facial recess before surgery. This may help to avoid injury to the chorda tympani nerve during posterior tympanotomy, and make it easier to insert the electrode array during CI by creating a large enough posterior tympanotomy to avoid injury to the facial nerve, which can cause immediate or delayed facial palsy.     

Sodium caseinate induces mouse granulopoiesis

Objective and design

Sodium caseinate (CasNa) induces differentiation and M-CSF production in mouse band granulocytes in vitro; however, it is not yet known if this molecule can also induce the proliferation and activation of the granulocyte lineage in vivo. In this work we evaluated the induction in vivo of granulopoiesis and the activation of granulocytes in mice treated with CasNa.

Material or subjects

BALB/c male mice 8–12?weeks old were used.

Treatment

The animals were inoculated intraperitoneally with 1?ml of CasNa (10% in PBS p/v) four times (every 48?h).

Methods

Granulocyte proliferation was evaluated by flow cytometry; activation was evaluated by phagocytic indices. The cytokine was measured using an ELISA assay.

Results

We show that CasNa increased bone marrow granulopoiesis percentage (38.35?±?10.88 vs. 64.94?±?34.14 BrdU+/Gr-1+ cells) and the granulocytes generated presented increased phagocytic indices (0.3?±?0.1 vs. 0.6?±?0.11, p?p?Conclusions CasNa induces granulopoiesis with functional granulocytes, suggesting that this molecule could be an innate immune system activator.     

Wedging of vertebral bodies at the thoracolumbar junction in asymptomatic healthy subjects on magnetic resonance imaging

Purpose

Wedging of the vertebral body on radiological examination is a valuable indicator of a vertebral compression fracture, although it can also be observed in subjects with no history of trauma. The purpose of this study was to elucidate the normative value of vertebral wedging at the thoracolumbar junction in asymptomatic healthy subjects for differential diagnosis of vertebral compression fractures using MRI.

Methods

A total of 115 subjects without back pain at the time of the examination and without history of spinal trauma was included (68 males, 47 females, mean age 49.5?years). They underwent MRI of the thoracic and lumbar spine, and the ratio of anterior vertical height to posterior vertical height of the vertebral body (APR) was determined from T10 to L2 on T2 weighted sagittal images.

Results

APR was 0.92?±?0.08 at T10, 0.92?±?0.08 at T11, 0.90?±?0.06 at T12, 0.89?±?0.06 at L1, and 0.90?±?0.07 at L2, indicating that vertebral bodies at the thoracolumbar junction appear wedge-shaped rather than rectangular. Males, thinner subjects, smokers, and subjects with abnormalities of the endplates such as a Schmorl nodule had a significantly smaller APR than females, fatter subjects, non-smokers, and those without endplate abnormalities.

Conclusion

The normative values of APR obtained in the present study can represent a valuable reference in the diagnosis of vertebral compression fracture to help prevent confusion with physiological vertebral wedging.     

Usefulness of C-reactive protein as a marker of early post-infarct left ventricular systolic dysfunction

Objective

To assess the usefulness of in-hospital measurement of C-reactive protein (CRP) concentration in comparison to well-established risk factors as a marker of post-infarct left ventricular systolic dysfunction (LVSD) at discharge.

Materials and methods

Two hundred and four consecutive patients with ST-segment-elevation myocardial infarction (STEMI) were prospectively enrolled into the study. CRP plasma concentrations were measured before reperfusion, 24?h after admission and at discharge with an ultra-sensitive latex immunoassay.

Results

CRP concentration increased significantly during the first 24?h of hospitalization (2.4?±?1.9 vs. 15.7?±?17.0?mg/L; p?p?p?p?p?Conclusion Measurement of CRP plasma concentration at discharge may be useful as a marker of early LVSD in patients after a first STEMI.     

Long-term treatment with methanandamide attenuates LPS-induced periodontitis in rats

Objective

Evidence exists of the anti-inflammatory and immunological properties of endocannabinoids in various tissues; the aim of the present study was therefore to assess the effect of long-term treatment with the synthetic cannabinoid methanandamide (Meth-AEA) on the progression of periodontitis in rats.

Materials and methods

Periodontitis was induced by injecting LPS (1?mg/ml) into the gingiva around the neck of the first upper and lower molars, and into the inter-dental space between the first and second molars. This protocol was repeated for 6?weeks on days 1, 3, and 5 of each week.

Results

Long-term treatment with topical Meth-AEA (500?ng/ml), applied daily to gingival tissue of rats induced with periodontitis, significantly diminished the alveolar bone loss, measured as the distance between the cemento-enamel junction and the alveolar crest, in both maxillary and mandibular first molars, compared to rats without treatment (P?P?P?Conclusion These results demonstrate the beneficial effects of treatment with Meth-AEA on gingival tissue of rats with periodontitis.     

Posterior tympanotomy is a riskier procedure in chronic otitis media than in a normal mastoid: a high-resolution computed tomography study

Purpose

The aim of our study was to compare the difficulty in performing a posterior tympanotomy in chronic otitis media (COM) versus the same procedure in a normal mastoid.

Materials and methods

The study included 122 patients who underwent tympanomastoidectomy for unilateral chronic otitis media with contralateral normal mastoid pneumatization. We evaluated the anatomical relationships between the mastoid segment and neighboring structures by analyzing axial temporal bone computed tomography scans. A vertical line (line A) was drawn tangential to the most lateral end of the posterior semicircular canal (point A). Three distances were measured: the distance (D1) between the point A and the most lateral end of the mastoid segment of the facial nerve (point B), the distance (D2) between the line A and the point B, and the distance (D3) between the point B and the posterior end of the bony annulus of the external auditory canal.

Results

The average measurements of D1 and D3 were 3.79 ± 0.55 and 2.63 ± 0.51 mm, respectively, in the normal mastoid ears and 3.47 ± 0.59 and 2.35 ± 0.44 mm, respectively, in the COM ears. The measurements of D1 and D3 were statistically shorter in the COM ears than in the normal ears.

Conclusions

These findings suggest that the facial recess in COM may be narrower than in a normal mastoid and that performing a posterior tympanotomy may be riskier in COM than in a normal mastoid due to the potential for injury to the neighboring structures and the facial nerve.

     

Exhaled breath condensate pH in patients with cystic fibrosis

Objective and design

Exhaled breath condensate (EBC) pH has been proposed as a useful, non-invasive marker of airway inflammation in pulmonary diseases. In this study we tested whether cystic fibrosis (CF) is associated with acidification of EBC, when pH is assessed by the CO₂ gas standardization method.

Methods

EBC was collected using two different devices (EcoScreen and R-Tube) in 46 stable CF patients during routine clinical visits and in 28 healthy controls.

Results

Mean EBC pH in CF patients and in healthy controls was similar (EcoScreen: CF patients: 6.38?±?0.03 versus controls: 6.39?±?0.03, p?=?0.699; R-tube: CF patients: 5.94?±?0.04 versus controls: 6.02?±?0.03, p?=?0.159). Inflammatory cell counts in spontaneously expectorated sputum obtained in a subset of patients (n?=?20) showed no correlation with pH values. EBC samples collected with the R-tube were more acidic than those collected with the EcoScreen device (p?Conclusions Our data suggest that EBC pH does not discriminate between healthy controls and those with CF disease indicating that the clinical applicability of EBC pH measurements for assessing airway inflammation in CF is limited.     

Effects of Preoperative Short Term Use of Atorvastatin on Endothelial Progenitor Cells after Coronary Surgery: A Randomized, Controlled Trial

Objectives

We investigated the effects of short-term use of atorvastatin on CD34+/VEGF-R2+/CD133+/CD45- endothelial progenitor cell (EPC) count after on-pump coronary artery bypass surgery (CABG).

Methods

Between Feb-2010 and May-2010, we randomly assigned, in a placebo-controlled, double-blind study, 60 consecutive patients who underwent isolated, first-time CABG to receive either 14-day atorvastatin (40 mg/day) or placebo preoperatively. Urgent CABG and recent myocardial infarction were excluded. EPCs were quantified (cells/μl) by flow cytometric phenotyping obtained from venous blood samples collected preoperatively (T₁), 6-hours (T₂), and on the 5th day postoperatively (T₃). Levels of markers of inflammation and serum cardiac troponin I were also measured preoperatively and daily until day-5 after surgery.

Results

There were no differences in baseline risk factors including cholesterol profiles, and EuroSCORES between the groups. The composite primary end-point, favored statin group with higher amount of circulating, early EPC count (cells/μl) at all time points compared with placebo (T₁, 2.30?±?0.02 versus 1.58?±?0.03, p?2, 5.00?±?0.06 versus 2.19?±?0.06, p?3, 3.03?±?0.08 versus 1.78?±?0.02, p?1, 0.8?±?0.1 versus 2.2?±?1.5, p?2, 72.9?±?3.2 versus 96.0?±?3.6, p?3, 4.3?±?1.2 versus 11.4?±?4.1, p?p?=?0.02).

Conclusions

Short-term atorvastatin use increases circulating early EPCs both pre- and post-operatively and is associated with better preservation of sinus rhythm and reduced hsCRP levels. (ClinicalTrials.gov number, NCT01096875)     

Posterior condylar cartilage may distort rotational alignment of the femoral component based on posterior condylar axis in total knee arthroplasty

Purpose

Among several anatomical references, the posterior condylar axis is the most apparent landmark to decide the femoral rotation for total knee arthroplasty. External rotation based on the posterior condylar axis requires condylar twist angle in order to set the femoral component parallel to trans-epicondylar axis although the angle is not constant. The angle during surgery differs from the pre-operative measurement on epicondylar view, because X-rays do not show the posterior condylar residual cartilage thickness. The thickness should be measured for the accurate femoral rotation.

Methods

We investigated the two twist angles on preoperative X-ray and during surgery, and the impact of residual cartilage on the setting of rotational angle of the femoral component in 184 knees in 112 patients with varus osteoarthritis (mean femorotibial angle: 185?±?6.9 from 169 to 205°).

Results

The twist angle during surgery was 5.2?±?1.3° (1.5–8.5°) and the angle on X-ray was 6.5?±?2.3° (0.6–13.5°). The rotational angle influenced by the residual cartilage was calculated to be 1.7?±?1.3° (0.0–4.6°). The discrepancy in the two twist angles was close to the rotational angle. There were, however, wide variations in all angles.

Conclusion

The results suggested the importance of considering the influence of the residual cartilage and the individual variation in determining the femoral component setting. Multiple reference frames for femoral component rotation or combination with gap technique may help to minimize malalignment which may lead to poor clinical outcome.     

Serum Levels of Calreticulin in Correlation with Disease Activity in Patients with Rheumatoid Arthritis

Objective

The aim of our study was to investigate the contribution of serum calreticulin (CRT) in the assessment of disease activity in rheumatoid arthritis (RA).

Methods

Serum CRT levels were measured by ELISA in 70 patients with established RA, 30 systemic lupus erythematosus (SLE), 25 other autoimmune diseases, 20 osteoarthritis (OA), and 35 of healthy controls (HC). Correlations of CRT serum levels with disease activity [Disease Activity Score for 28 joints (DAS28)], erythrocyte sedimentation rate(ESR) and C-reactive protein (CRP) were assessed. Serum CRT levels were also detected in RA patients whose RF, anti-CCP and anti- MCV antibodies were positive and negative.

Results

Serum CRT levels in RA patients (4.817?±?2.425 ng/ml) was significantly higher (P <0.05) compared with those in the serum of OA (3.574?±?0.942 ng/ml), SLE (4.013?±?1.536 ng/ml), other autoimmune diseases (3.882?±?0.837 ng/ml) and HC (3.726?±?0.627 ng/ml). Significant positive correlation of CRT with DAS28, ESR and CRP was found in RA patients. Furthermore, RA patients whose anti-CCP and anti-MCV antibodies were positive had higher levels of CRT (P?<?0.01).

Conclusion

Serum CRT levels were increased in patients with RA compared with those controls. Moreover, a significant correlation was observed between serum CRT levels and disease activity in RA. It might be used as a potential biomarker for clinical diagnosis and provide additional information regarding disease activity along with the traditional indices such as ESR and CRP.     

Histamine and calcium secretion in the submandibular gland of the cat evoked by two types of stimulation

The aim of this work was to compare the pools of histamine and calcium in the submandibular gland of the cat during two kinds of stimulation of the gland. Submandibular glands of the cat were stimulated electrically (chorda tympani nerve) and by close arterial infusion of pilocarpine. Each stimulation was adjusted in such a way as to obtain a near maximal secretory response. Concentrations of histamine and calcium were measured in nonstimulated and stimulated glands, in saliva, secreted during stimulation and in the venous outflow from the gland before and during the stimulation. The experiments showed that:

1. pilocarpine stimulation lowered the histamine concentration in the gland more than electrical stimulation of the chorda tympani nerve. Calcium stores in the gland were depleted to the same extent by each type of stimulation,
2. the concentration of histamine and calcium in the saliva produced by close arterial pilocarpine infusion was significantly higher than in the saliva secreted during nerve stimulation,
3. histamine and calcium concentrations were higher in the venous outflow from stimulated glands than before stimulation.

The results indicate a close relationship between histamine and calcium in salivary secretion, although the origins of the two substances are different.     

Reduced Bone Density in Patients with Autosomal Dominant Hyper-IgE Syndrome

Background and Purpose

Autosomal dominant hyper-IgE syndrome (AD-HIES) is a rare primary immunodeficiency disorder . It has been recognized as a multisystem disorder and is characterized by both immunologic and non-immunologic manifestations. Possible bone involvement in autosomal dominant HIES include fractures, scoliosis, cystic bone changes, and osteopenia. We sought to evaluate the changes in bone density in adolescents and young adults with AD-HIES, mostly with proven STAT3 mutation, followed in our institute.

Methods

We studied eight patients with AD-HIES who attended our immunology clinic. All patients underwent at least one bone mass dual-energy x-ray absorptiometry assessment (dual-energy x-ray absorptiometry scan).These findings were evaluated.

Results

The age of the patients at the time of their first bone density scan ranged between 10 and 24 years (mean 16.1?±?4.0 years); the duration of follow-up was 4–11 years (mean 5.8?±?3.5 years). Four patients had a history of fractures. Mean Z score in these patients was ?1.8?±?0.7. For three patients, Z score was below ?1. The other four patients had no history of fractures. Mean Z score in these patients was ?0.9?±?0.5. Only one patient in this group had a Z score below ?1. Bone density was below average in all patients; mean spinal Z score was ?1.6?±?0.4. Four patients were followed through the second decade, and all showed progressive deterioration in bone density. Three were treated with alendronate sodium, with improvement in the bone scan results.

Conclusions

Bone density decreases considerably over time in adolescents and young adults suffering from AD- HIES. Treatment with alendronate sodium may be effective in alleviating osteopenia.     

Self-Weighing Frequency Is Associated with Weight Gain Prevention over 2 Years Among Working Adults

Background

Little is known about the association between self-weighing frequency and weight gain prevention, particularly in worksite populations.

Purpose

The degree to which self-weighing frequency predicted 2-year body weight change in working adults was examined.

Method

The association between self-weighing frequency (monthly or less, weekly, daily, or more) and 24-month weight change was analyzed in a prospective cohort analysis (n?=?1,222) as part of the larger HealthWorks trial.

Results

There was a significant interaction between follow-up self-weighing frequency and baseline body mass index. The difference in weight change ranged from ?4.4?±?0.8?kg weight loss among obese daily self-weighers to 2.1?±?0.4?kg weight gain for participants at a healthy weight who reported monthly self-weighing.

Conclusion

More frequent self-weighing seemed to be most beneficial for obese individuals. These findings may aid in the refinement of self-weighing frequency recommendations used in the context of weight management interventions.     

The medial head of the triceps brachii. Anatomy and blood supply of a new muscular free flap: the medial triceps free flap

Purpose

The anatomical features of the posterior compartment of the arm seem to provide the basis to raise one of the smallest free muscular flaps, with minimal donor site morbidity: the medial triceps free flap.

Methods

The anatomic study was carried out on 27 fresh cadaver arms: 7 prepared for corrosion cast, 15 for simple dissection and 5 for dissection after latex injection. Morphological data of the muscle, as well as pedicle constancy and size, were recorded.

Results

The mean size of the medial head was 10.7?×?2.5?×?3.3?cm; the mean weight was 30.1?g. We found a constant and unique pedicle supplying the whole medial head of triceps muscle, composed by the middle collateral artery (MCA), two veins and a nerve. The mean length of MCA was 2.9?cm and the ??extended?? pedicle, including the deep brachial artery (DBA), was 8?C12?cm long. At their origin, the mean caliber of MCA was 1.5?mm and the mean caliber of DBA 2.4?mm.

Conclusions

Our findings confirmed the reliability of the MC vessels and their anatomical relationships with the medial head of triceps brachii muscle, which could be harvested as a free flap or as a pedicled flap based on anterograde or retrograde flow. This technique should be safe, yielding mild donor site morbidity, and suitable in regional reconstruction or distant reanimations.     

Body Image in Patients with Systemic Lupus Erythematosus

Background

Systemic lupus erythematosus (SLE), a multisystemic disease of young women may be disfiguring and affect physical and emotional health. Body image literature in SLE is scant and controversial.

Purpose

We compared body image-related quality of life in subjects with (n?=?87) and without (n?=?78) SLE and determined its correlates using the body image quality of life inventory (BIQLI).

Method

The tool was self-administered to consenting individuals. Demographic information along with disease activity and damage assessments for SLE patients were obtained. T test, chi square test, correlational, and regression analyses were used to make comparisons.

Results

Mean age (±SD) were 42.4?±?13.1 and 38.7?±?13.2?years for SLE and non-SLE subjects, respectively. Mean (±SD) BIQLI scores were significantly worse in SLE than non-SLE subjects: 19.9?±?33.2 and 41.6?±?24.8 (p?=?0.001). In SLE, BIQLI scores correlated inversely with overall damage, irreversible cutaneous damage, alopecia, and self-reported depression, and directly with age and health status.

Conclusion

Body image in SLE is poor, and effective interventions may be directed at cutaneous disease activity, damage, and depression.     

Altersgebrechlichkeit und Schlafapnoe

Background

Frailty and sleep apnea are common entities in the elderly. Frailty causes dependency and need of care. The prevention of frailty is a major topic in geriatrics. However, the relationship between sleep apnea and frailty has hardly been studied.

Methods

In a prospective pilot study, the relationship between the presence of at least one of the five frailty criteria proposed by Fried and sleep apnea were examined. Patients were eligible, if they able to communicate and had no dementia. Sleep apnea was diagnosed by overnight pulse oximetry. Tiredness was obtained using the questionnaire by Siegrist.

Results

A total of 42 patients with a mean age of 82?±?7 years were enrolled. There were 15 (36%) male and and 27 (64%) female patients, of which 28 (67%) patients met at least one frailty criterion. Patients with frailty criteria experienced significantly more often daytime sleepiness (1/14 vs. 17/28, p?<0.001), had a significantly higher incidence of severe sleep apnea with an oxygen desaturation index >?30/h (p?<0.04) and had a lower mean nocturnal oxygen saturation (95?±?2% vs. 91?±?4%, p?<0.02).

Conclusion

Our small pilot study showed an association between the presence of at least one frailty criterion, daytime sleepiness, and severe sleep apnea. Given the high frequency of both phenomena and regarding the clinical relevance of frailty, prospective studies are warranted to prove a causal relationship between sleep apnea and frailty.     

Surgical anatomy of the preauricular anteroparotid approach for mandibular condyle surgery

Purpose

The different surgical approaches used to treat mandibular condyle fractures are carried out in the periparotid skin area and can lead to facial nerve injury. We conducted a preauricular and anteroparotid surgical approach. Our main aim was to show the anatomical relationship between this approach site and the facial nerve branches, and to define cutaneous landmarks to locate the extraparotid facial nerve branches.

Method

A 2-step dissection of 13 fresh human cadaver semi-heads was performed: a preauricular approach followed by a superficial parotidectomy to visualize the facial nerve. Its course and ramifications were studied and compared to cutaneous landmarks. The proximity of the facial nerve branches with the surgical approach site was observed.

Results

The approach allowed systematically visualising the zygomatic and/or buccal branches. No facial nerve branches were sectioned. In three cases (23 %), a nerve branch was visualized during the approach. The buccal and zygomatic branches were ramified in 77 % of cases.

Conclusions

During our preauricular anteroparotid approach, the buccal and zygomatic branches were visualized but none was sectioned. Most often the approach was carried out between these two branches (46 % of cases). Cutaneous landmarks used were reliable to define a safe and nerve-free area for dissection. The buccal and zygomatic branches are very interesting because their high number of ramifications and anastomoses could serve as nerve relays in case of surgical lesion.     

The Contralateral Extremity has Also Benefit from the Locally Administered Bone Marrow-Derived Mononuclear Cells and Cord Blood Serum in Diabetic Ischemic Wound Healing

Objective

Impaired wound healing could be a disaster especially in diabetes and amputation is the major risk. The aim of this study was to evaluate the benefit of BMMCs and CBS on wound healing.

Methods

Diabetic rats were underwent bilateral limb ischemia and wounding of skin defects on both extremities. The groups were formed as BMMCs (group A), BMMCs and CBS (group B), only CBS (group C), and phosphate buffer solution (group D) that were injected into wounds on right legs.

Results

The complete recovery of right legs was established as a mean of 21.4?±?1.1 days, 12.9?±?1.5 days, 30.0?±?0.0 days and 38.1?±?1.5 days according to Groups A, B, C, and D (p?<?0.05). The recovery of left legs were calculated as a mean of 27.0?±?0.0 days, 24.0?±?0.0 days, 35.6?±?1.1 days and 37.3?±?1.6 days according to Groups A, B, C and D (p?<?0.05). At the end of the recovery, the HE staining showed that vascularity was increased in groups A and B.

Conclusion

Transplantation of BMMCs and CBS to the ischemic wounds of the diabetic rats accelerate the repair. The recovery was also superior in the same group although the treatment was not applied to the left extremity directly.