The effects of background noise on dichotic listening to consonant-vowel syllables: An fMRI study

The present fMRI study attempts to identify brain areas that may underlie the effect of different background noises on functional brain asymmetry in a dichotic listening task. Previous studies have shown that the prominent right ear advantage in dichotic listening to consonant-vowel syllables is affected by background noise. To explore the underlying neuronal processes, haemodynamic brain responses using fMRI were recorded while participants performed the dichotic listening task in two different noisy backgrounds (conversational “babble” and traffic noise). The behavioural results showed a reduction of the right ear advantage in the background noise conditions, especially in the traffic noise condition. The behavioural results are discussed in terms of alertness-attentional mechanisms. The effects of background noise on brain activation involved significant activations in a speech-processing network. Specifically the changes in activations in the peri-Sylvian region of the superior temporal gyrus and in the temporo-parietal junction part in the left hemisphere, as well as in the superior temporal gyrus/sulcus area in the right hemisphere may mirror the effects of noise on behavioural performance. The effects of noise on brain activation are discussed with regard to pre-activation mechanisms.     

Microsurgical reconstruction of maxillectomy defects: experience of 24 cases

Introduction

The defect complexity and reconstructive options make the maxillary reconstruction a controversial theme and in a constant debate. The maxilla is a fundamental aesthetic and functional structure of the face. Microsurgical vascularized flaps replaced the usage of prosthetic material and pedicled flaps as a “gold standard” for the reconstruction of complex defects following maxillectomy.

Methods

The authors report their experience of 24 maxillectomies with immediate microsurgical reconstruction, performed by the senior author (H.C.) between 1998 and 2011. They evaluate and classify the defects and the reconstructive options according to the classification system as proposed by Cordeiro and Santamaria in 2000, by a patient questionnaire and post-operative surgeon follow-up for the functional (diet, speech, and vision) and aesthetic end results.

Results

There were no flap failures. The main etiology was squamous cell carcinoma and the most used flap was rectus abdominis free flap. Classes I and II were responsible for the cases in which the reconstructive algorithm was not followed. Most patients responded as having a normal diet, a nearly normal speech and unaffected vision. In a score of 1 to 5, the mean score in esthetic given by the patient was 3.62, while the mean score given by the surgeons was 4.13.

Conclusions

Microsurgical reconstruction of maxillectomy defects with free flaps is the best reconstructive option, being the osteomyocutaneous flaps as the gold standard. Although with limited rehabilitation, good functional and aesthetic results are to be expected with myocutaneous flaps. The existence of an algorithm facilitates the classification and systematization of maxillary reconstruction. However, due to defect complexity and large number of reconstructive options, a perfect solution does not exist. The individual assessment of the patient and the defect always provides the best method for the reconstructive planning, mainly when choosing free flaps. Level of Evidence: Level IV, therapeutic study.     

Concomitant dysregulation of androgen secretion and dysfunction of adipose tissue induced insulin resistance

Hyperandrogenism and hyperinsulinemia have resulted from dysfunction of the theca cell of the ovary and adipose tissue and each one potentiates the other in patients with androgen excess disorders e.g., polycystic ovary disease and idiopathic hirsutism. Possible external and/or internal triggers can produce such cellular dysfunction. There is evidence that sodium valproate acts as a trigger of cellular dysfunction and produces both hyperinsulinemia and hyperandrogenism. Therefore, the elimination of these triggers can help the patients to recover from hyperinsulinemia, insulin resistance and hyperandrogenism.     

Successful renal transplantation in a family with a novel mutation in COL4A3 gene and autosomal recessive Alport syndrome

Alport syndrome (AS) is an inherited disorder of basement membranes caused by mutations affecting specific proteins of the type IV collagen family, presenting with nephropathy and extrarenal manifestations such as sensorineural deafness and ocular anomalies. Ten percentage to 15% of the patients with AS have autosomal recessive (ARAS) due to mutation in either COL4A3 or COL4A4 gene. We report a novel mutation in the COL4A3 gene in an Indian family with ARAS. The above‐mentioned genetic anomaly was a missense variation in exon 26 of the COL4A3 gene (chr2:228137797G>A; c.1891G>A) that resulted in the amino acid substitution of Arginine for Glycine at codon 631 (p.Gly631Arg) that was present in the heterozygous state in the asymptomatic parents and homozygous state in the male offspring who presented with early‐onset end‐stage renal disease, lenticonus and hearing loss. The patient (male offspring) underwent successful renal transplantation with his mother as a donor.     

Teaching cardiac examination skills

OBJECTIVE: To determine if structured teaching of bedside cardiac examination skills improves medical residents’ examination technique and their identification of key clinical findings. DESIGN: Firm-based single-blinded controlled trial. SETTING: Inpatient service at a university-affiliated public teaching hospital. PARTICIPANTS: Eighty Internal Medicine residents. METHODS: The study assessed 2 intervention groups that received 3-hour bedside teaching sessions during their 4-week rotation using either: (1) a traditional teaching method, “demonstration and practice” (DP) (n=26) or (2) an innovative method, “collaborative discovery” (CD) (n=24). The control group received their usual ward teaching sessions (n=25). The main outcome measures were scores on examination technique and correct identification of key clinical findings on an objective structured clinical examination (OSCE). RESULTS: All 3 groups had similar scores for both their examination technique and identification of key findings in the preintervention OSCE. After teaching, both intervention groups significantly improved their technical examination skills compared with the control group. The increase was 10% (95% confidence interval [CI] 4% to 17%) for CD versus control and 12% (95% CI 6% to 19%) for DP versus control (both P<.005) equivalent to an additional 3 to 4 examination skills being correctly performed. Improvement in key findings was limited to a 5% (95% CI 2% to 9%) increase for the CD teaching method, CD versus control P=.046, equivalent to the identification of an additional 2 key clinical findings. CONCLUSIONS: Both programs of bedside teaching increase the technical examination skills of residents but improvements in the identification of key clinical findings were modest and only demonstrated with a new method of teaching. The authors have no conflicts of interest to declare for this article. Financial support: This study was performed as part of a Faculty Development Program in Clinical Epidemiology and Research sponsored by the Collaborative Research Unit of John H. Stroger Jr. Hospital of Cook County i Rush Medical College.