Expanding the indications for the bone anchored hearing system (BAHS) in patients with single sided deafness

PurposeProvide data to support expansion of FDA indications for the Bone anchored hearing system (BAHS).Materials and methodsThis retrospective study in a tertiary otologic referral center included106 consecutive subjects who were implanted with a Bone Anchored Hearing System (BAHS) between January 2009 and January 2015 for single sided deafness. Subjects were divided into three groups by bone conduction pure tone average (PTA) of the better hearing ear: 0–20 dB (group 1), 21–40 dB (group 2) and 41–55 dB (group 3). All patients underwent BAHS implantation. Speech perception data (Hearing In Noise Test and Consonant-Nucleus-Consonant testing) was collected before and after surgical intervention. Patient-reported quality of life measures were obtained at least 6 months after activation. These included the Abbreviated Profile of Hearing Aid Benefit and Glasgow Benefit Inventory.ResultsAll three groups of subjects demonstrated statistically significant improvement in outcome measures following BAHS. Subject reported quality of life outcome measures demonstrated significant improvement in disability from hearing loss and in quality of life.ConclusionsPatients with single sided deafness who have bone conduction thresholds worse than 20 dB in their contralateral ear are still able to benefit significantly from BAHS.     

Clinical characteristics and risk factors for low dose methotrexate toxicity: A cohort of 28 patients

Objective

Low dose (10–25 mg/week) methotrexate is widely used for the management of systemic inflammatory diseases, and is considered to be relatively safe. Toxicity due to low dose MTX has been reported but is poorly characterized. We describe the clinical features, risk factors, and outcomes of low dose MTX toxicity in a large case series at our center.

Patients and methods

We conducted a retrospective case series of all adult (> 18 years) patients hospitalized at Sheba Medical Center, between 2005 and 2012 for low dose MTX toxicity.

Results

We identified 28 patients (age: 70.4 ± 13.7 years, range: 33–88; 20 (71%) females) hospitalized for low dose MTX toxicity. Indications for MTX therapy included: rheumatoid arthritis (39.2%), psoriasis ± arthritis (21.5%), polymyalgia rheumatica (10.8%) and other inflammatory conditions (28.5%). Pancytopenia was the most common manifestation of low dose MTX toxicity detected in 78.5% of the patients. Potential risk factors included acute renal failure, hypoalbuminemia, concurrent use of drugs known to interact with MTX, and dose errors. Serum MTX concentrations (n = 20, mean 0.04 ± 0.07 μg/mL range: 0–0.3) did not correlate with the degree of either neutropenia (r = − 0.36; p = 0.18) or thrombocytopenia (r = 0.44; p = 0.10). Seven (25%) patients died, all from pancytopenia followed by sepsis. Serum MTX concentrations did not differ between the patients who died from MTX toxicity (n = 6; mean: 0.05 ± 0.04 μg/mL) and those who survived the toxicity (n = 14 mean 0.04 ± 0.08; p = 0.45).

Conclusions

Low-dose MTX toxicity can be life threatening, mainly due to myelosuppression. There is no rationale for MTX therapeutic drug monitoring in the setting of low-dose toxicity.     

Balloon‐occluded retrograde transvenous obliteration for recurrent fundal gastric variceal bleeding in an adolescent

Gastric variceal bleeding is associated with high morbidity and mortality. Balloon‐occluded retrograde transvenous obliteration is a relatively new treatment used to control bleeding gastric varices that involves transvenous sclerosis of gastric varices through a spontaneous gastrorenal shunt. Here, we report on a 14‐yr‐old patient that underwent balloon‐occluded retrograde transvenous obliteration for refractory bleeding fundal varices in the setting of esophageal varices and cirrhosis, which did not respond to medical management or endoscopic injection. This case report serves as a reminder that balloon‐occluded retrograde transvenous obliteration can successfully control fundal variceal bleeding in pediatric patients and may serve as a bridge to liver transplantation.     

Accuracy and Reliability of Working Length Determination by Gold Reciproc Motor in Reciprocating Movement

Introduction

The purpose of this study was to assess the accuracy and reliability of the apex locator function of the Gold Reciproc Motor (VDW GmbH, Munich, Germany) during reciprocating movement.

Methods

Forty extracted incisors with mature apices were included in the study. The canal length was determined by introducing #10 file into the canal until it emerged at the apical foramen. The incisal edge of each tooth was adjusted to obtain 18 mm standard length and to produce a flat reference point. The teeth were embedded in Plexiglas tubes filled with alginate and measured by Root ZX (J. Morita Corp, Tokyo, Japan) and Bingo 1020 (Forum Engineering Technologies, Rishon Lezion, Israel) apex locators. The root canals were instrumented in a reciprocating mode using an R25 Reciproc file in the Gold Reciproc Motor until the green LEDs and orange LED were reached. According to the manufacturer, these LEDs represent the zone between the apical constriction and the apical foramen.

Results

No statistically significant differences were found between the length measurements of the 2 electronic apex locators and the third green LED, which is suggested by the manufacturers as the recommended working length.

Conclusions

With the limitation of this ex vivo study, the Gold Reciproc Motor's integrated electronic apex locator was found to be as reliable and accurate as the Root ZX and Bingo 1020 apex locators in terms of length control during root canal preparation in the reciprocation mode.     

Healing Kinetics of Periapical Lesions Enhanced by the Apexum Procedure: A Clinical Trial

The new Apexum procedure (Apexum Ltd, Or-Yehuda, Israel) is based on a minimally invasive removal of periapical chronically inflamed tissues through a root canal access. Its goal is to enhance healing kinetics of periapical lesions. This clinical study was conducted to explore the safety and efficacy of this procedure. The Apexum procedure was applied, as a supplementary step, during conventional root canal treatment in 48 teeth with periapical lesions. Safety and efficacy were clinically and radiographically assessed and teeth of the Apexum-treated group were compared with 39 similar teeth treated by the same endodontic procedure with no additional intervention. No adverse events occurred in either the Apexum-treated or conventional treatment groups. Furthermore, healing kinetics was significantly enhanced in the Apexum-treated group (p < 0.005). At 3 and 6 months, 87% and 95% of the lesions in the Apexum-treated group, respectively, presented advanced or complete healing, whereas only 22% and 39% of the lesions in the conventional treatment group presented this degree of healing at 3 and 6 months, respectively.     

Vascular endothelial growth factor increases neurogenesis after traumatic brain injury

Activation of endogenous stem cells has been proposed as a novel form of therapy in a variety of neurologic disorders including traumatic brain injury (TBI). Vascular endothelial growth factor (VEGF) is expressed in the brain after TBI and serves as a potent activator of angiogenesis and neurogenesis. In this study, we infused exogenous VEGF into the lateral ventricles of mice for 7 days after TBI using mini-osmotic pumps to evaluate the effects on recovery and functional outcome. The results of our study show that VEGF significantly increases the number of proliferating cells in the subventricular zone and in the perilesion cortex. Fate analysis showed that most newborn cells differentiated into astrocytes and oligodendroglia and only a few cells differentiated into neurons. Functional outcome was significantly better in mice treated with VEGF compared with vehicle-treated animals after TBI. Injury size was significantly smaller at 90 days after TBI in VEGF-treated animals, suggesting additional neuroprotective effects of VEGF. In conclusion, VEGF significantly augments neurogenesis and angiogenesis and reduces lesion volumes after TBI. These changes are associated with significant improvement in recovery rates and functional outcome.