The effect of asymmetric pharyngoesophageal pressures on manofluorographic measurements

The fact that pressures in the pharynx are asymmetric has raised questions about the validity of measurements made using manofluorography. Using a special manometric catheter that measures the pressures in four different directions, manofluorography was performed on seven normal volunteers and the measurements in the four directions were compared. When the bolus was not present the measurements were found to be asymmetrical. When the bolus filled the cavity, the measurements were symmetrical. Therefore, manometric measurements made in the pharynx during bolus flow are not invalidated by variations in the orientation of the catheter.     

Surgical Variables Affecting Speech in Treated Patients With Oral and Oropharyngeal Cancer

Postoperative speech function may be influenced by a number of treatment variables. The objective of this study was to examine the relationships among various treatment factors to determine the impact of these measures on speech function. Speech function was tested prospectively in 142 patients with surgically treated oral and oropharyngeal cancer 3 months after treatment. Each patient's speech was recorded during a 6- to 7-minute conversation and while performing a standard articulation test, producing speech outcome measures of percent correct consonant phonemes and percent conversational understandability. Correlational analyses were used to determine the relationships among the speech outcome measures and 14 treatment parameters. Speech function was mildly to moderately negatively correlated with most surgical resection variables, indicating that larger amounts of tissue resected were associated with worse speech function. Overall measures of conversational understandability and percent correct consonant phonemes were related to extent of oral tongue resection, floor of mouth resection, soft palate resection, and total volume of tissue resected. These relationships varied depending on the method of surgical closure. Method of surgical reconstruction had a profound impact on postoperative speech function 3 months after treatment and was an important factor in determining how oral tongue resection influenced articulation and intelligibility. The combination of closure type, percent oral tongue resected, and percent soft palate resected had the strongest relationship with overall speech function for patients with surgically treated oral and oropharyngeal cancer 3 months after treatment.     

Assessing the Efficiency of HIV Prevention around the World: Methods of the PANCEA Project

Objective. To develop data collection methods suitable to obtain data to assess the costs, cost-efficiency, and cost-effectiveness of eight types of HIV prevention programs in five countries.
Data Sources/Study Setting. Primary data collection from prevention programs for 2002–2003 and prior years, in Uganda, South Africa, India, Mexico, and Russia.
Study Design. This study consisted of a retrospective review of HIV prevention programs covering one to several years of data. Key variables include services delivered (outputs), quality indicators, and costs.
Data Collection/Extraction Methods. Data were collected by trained in-country teams during week-long site visits, by reviewing service and financial records and interviewing program managers and clients.
Principal Findings. Preliminary data suggest that the unit cost of HIV prevention programs may be both higher and more variable than previous studies suggest.
Conclusions. A mix of standard data collection methods can be successfully implemented across different HIV prevention program types and countries. These methods can provide comprehensive services and cost data, which may carry valuable information for the allocation of HIV prevention resources.     

Scaffold-Mediated Sustained,Non-viral Delivery of miR-219/miR-338 Promotes CNS Remyelination

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CD10 expression by melanoma cells is associated with aggressive behavior in vitro and predicts rapid metastatic progression in humans

BackgroundNo biological or molecular marker of primary melanoma tumor cells has been shown to predict clinical outcome in melanoma.ObjectiveTo determine whether CD10, CD133, nestin and CD20 may evaluate the prognosis of melanoma.MethodsThe differential expression of these molecules was assessed in pairs of cell lines. We evaluated, by both immunohistochemical staining and RT-qPCR, their expression in a cohort of 32 patients (68 samples) with a history of metastatic melanoma, divided into two groups according to their clinical outcome profile.ResultsCD10 over expression in cancer cell lines was associated with more aggressive behavior in vitro. A CD10-positive staining was more frequent in patients in the “rapidly progressive” group than those in the “long survivor” group (23/35 versus 2/18, p < 10^?4). CD10 expression was associated with a lower median overall survival (1.15 year – IQR: [0.50–2.58] versus 4.27 – IQR: [1.66–6.33]; p = 10^?4). The Odds Ratio of displaying a “rapidly progressive” melanoma when tumor cells expressed CD10 was 15 (95% confidence interval: [3–78]). After adjusting for confounding factors, CD10 expression in melanoma tumor cells remained associated with an increased risk of death and more rapid disease progression (p = 6 × 10^?4; HR = 3.71).ConclusionCD10 may predict clinical outcome in melanoma patients.     

Clinical application of the manofluorogram

The purpose of this paper is to illustrate the clinical usefulness of simultaneous fluoroscopy and manometry, as analyzed by the manofluorogram, in the evaluation of dysphagia. Four quantitative parameters calculated from the manofluorogram are analyzed and compared in six representative cases of dysphagia. The manofluorogram adds diagnostic information which cannot be obtained by barium swallow or standard manometry.     

Manofluorographic analysis of swallowing

A quantitative evaluation of the pharyngeal swallow is described using a new method--manofluorography. Eleven parameters have been established, and the clinical significance of the most important ones has been highlighted. The propulsive tongue action and hypopharyngeal suction pump have been designated as the major bolus driving forces.     

Indications for tracheoesophageal puncture speech rehabilitation

Many methods of speech rehabilitation after total laryngectomy have been attempted and abandoned. As experience increased with the tracheoesophageal puncture technique, we found it to be a reliable and reproducible form of speech rehabilitation when certain criteria are met. This study reviews our experience and analyzes the reasons for failure in those populations. Factors analyzed include the evidence of hypopharyngeal stenosis, patient education, XRF, and the flanged prosthesis versus the nonflanged prosthesis. The indications for this type of speech rehabilitation procedure are presented based on our findings.