Does reproductive stage impact cardiovascular disease risk factors? Results from a population-based cohort in Lausanne (CoLaus study).

CONTEXT: Menopause has been associated with adverse cardiovascular disease (CVD) risk profile, yet it is unclear whether the changes in CVD risk factors differ by reproductive stage independently of underlying ageing trajectories. DESIGN: The CoLaus study is a prospective population-based cohort study in Lausanne, Switzerland. PATIENTS: We used data from women at baseline and follow-up (mean: 5.6 ± 0.5 years) from 2003 to 2012 who did not use hormone therapy. We classified women into (i) premenopausal, (ii) menopausal transition, (iii) early (≤5 years) and (iv) late (>5 years) postmenopausal by comparing their menstruation status at baseline and follow-up. MEASUREMENTS: We measured fasting lipids, glucose and cardiovascular inflammatory markers. We used repeated measures (linear mixed models) for longitudinal analysis, using premenopausal women as a reference category. We adjusted analyses for age, medications and lifestyle factors. RESULTS: We used the data from 1710 women aged 35-75 years. Longitudinal analysis showed that the changes in CVD risk factors were not different in the other three menopausal categories compared to premenopausal women. When age was used as a predictor variable and adjusted for menopause status, most CVD risk factors increased, while interleukin-6 and interleukin-1ß decreased with advancing age. CONCLUSION: The current study suggests that women have a worsening cardiovascular risk profile as they age, and although menopausal women may have higher levels of cardiovascular risk factors compared to premenopausal women at any given time, the 5-year changes in cardiovascular risk factors may not depend on the reproductive stage.

Therapeutic Vaccines for HPV-Associated Oropharyngeal and Cervical Cancer: The Next De-Intensification Strategy?

The rise in human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) has prompted a quest for further understanding of the role of high-risk HPV in tumor initiation and progression. Patients with HPV-positive OPSCC (HPV+ OPSCC) have better prognoses than their HPV-negative counterparts; however, current therapeutic strategies for HPV+ OPSCC are overly aggressive and leave patients with life-long sequalae and poor quality of life. This highlights a need for customized treatment. Several clinical trials of treatment de-intensification to reduce acute and late toxicity without compromising efficacy have been conducted. This article reviews the differences and similarities in the pathogenesis and progression of HPV-related OPSCC compared to cervical cancer, with emphasis on the role of prophylactic and therapeutic vaccines as a potential de-intensification treatment strategy. Overall, the future development of novel and effective therapeutic agents for HPV-associated head and neck tumors promises to meet the challenges posed by this growing epidemic.

Improved COD Measurements for Organic Content in Flowback Water with High Chloride Concentrations.

An improved method was used to determine chemical oxygen demand (COD) as a measure of organic content in water samples containing high chloride content. A contour plot of COD percent error in the Cl(-)-Cl(-):COD domain showed that COD errors increased with Cl(-):COD. Substantial errors (>10%) could occur in low Cl(-):COD regions (<300) for samples with low (<10 g/L) and high chloride concentrations (>25 g/L). Applying the method to flowback water samples resulted in COD concentrations ranging in 130 to 1060 mg/L, which were substantially lower than the previously reported values for flowback water samples from Marcellus Shale (228 to 21 900 mg/L). It is likely that overestimations of COD in the previous studies occurred as result of chloride interferences. Pretreatment with mercuric sulfate, and use of a low-strength digestion solution, and the contour plot to correct COD measurements are feasible steps to significantly improve the accuracy of COD measurements.

Communication, socialization, and ITC. The psychosocial construction of sustainability.

Over the past two decades, the facets related to environmental crises (in the plural) have grown increasingly intricate. What began as environmentalists' apprehension over nature degradation and the encouragement of citizen-driven initiatives has evolved. The current shift in emphasis and prevailing message strives to foster a culture where citizens refrain from independent initiatives. Instead, the directive is to heed the guidance of the knowledgeable (scientists, politicians, corporations, interest groups, etc.), as substantiated by our investigative findings, which align, in part, with existing literature. Conversely, our exploration into environmental communication, notably the insights gleaned from longitudinal research concerning pro-environmental knowledge, attitudes, and actions, reveals a decline in citizens' effective inclinations toward embracing pro-environmental behaviors. Meanwhile, the escalation of the climate crisis is fueling heightened levels of echo-anxiety and solastalgia. This trajectory is closely intertwined with a growing global disillusionment within society - not just regarding the future - instilling a sense of disillusionment concerning pro-environmental messages and slogans disseminated by governing bodies and corporations. This has led to a state resembling learned helplessness, as articulated by Seligman, or what we prefer to term "induced" helplessness, rather than fostering conditions conducive to empowerment. This article comprehensively examines various reports and our inquiries, revealing how communication management and its constituents lie at the heart of forging novel narratives, fresh cognitive dissonances, and emerging social representations. Notably emphasized is the pivotal role played by information and communication technologies (ICT), particularly through dissemination on widely-used social networks. Since the 2010s, these platforms have assumed a paramount role in shaping socialization processes, surpassing educational institutions and conventional mass media.

Risk Prediction Models of Natural Menopause Onset: A Systematic Review.

CONTEXT: Predicting the onset of menopause is important for family planning and to ensure prompt intervention in women at risk of developing menopause-related diseases. OBJECTIVE: We aimed to summarize risk prediction models of natural menopause onset and their performance. METHODS: Five bibliographic databases were searched up to March 2022. We included prospective studies on perimenopausal women or women in menopausal transition that reported either a univariable or multivariable model for risk prediction of natural menopause onset. Two authors independently extracted data according to the CHARMS (critical appraisal and data extraction for systematic reviews of prediction modelling studies) checklist. Risk of bias was assessed using a prediction model risk of bias assessment tool (PROBAST). RESULTS: Of 8132 references identified, we included 14 articles based on 8 unique studies comprising 9588 women (mainly Caucasian) and 3289 natural menopause events. All included studies used onset of natural menopause (ONM) as outcome, while 4 studies also predicted early ONM. Overall, there were 180 risk prediction models investigated, with age, anti-Müllerian hormone, and follicle-stimulating hormone being the most investigated predictors. Estimated C-statistic for the prediction models ranged from 0.62 to 0.95. Although all studies were rated at high risk of bias mainly due to the methodological concerns related to the statistical analysis, their applicability was satisfactory. CONCLUSION: Predictive performance and generalizability of current prediction models on ONM is limited given that these models were generated from studies at high risk of bias and from specific populations/ethnicities. Although in certain settings such models may be useful, efforts to improve their performance are needed as use becomes more widespread.

Iodine intakes of 100-300 µg/d do not modify thyroid function and have modest anti-inflammatory effects.

Little information is available as to whether doses of iodide similar to those recommended in clinical practice for the prevention of iodine deficiency in pregnant women affect thyroid function. The aim of the present study was to analyse whether doses of iodide can affect thyroid function in adults, and evaluate its effect on plasma markers of oxidative stress, inflammation and acute-phase proteins. A total of thirty healthy volunteers (ten men and twenty women) with normal thyroid function were randomly assigned to three groups (n 10). Each group received a daily dose of 100, 200 or 300 µg of iodide in the form of KI for 6 months. Free tetraiodothyronine (FT4) levels at day 60 of the study were higher in the groups treated with 200 and 300 µg (P = 0·01), and correlated with the increase in urinary iodine (r 0·50, P = 0·007). This correlation lost its significance after adjustment for the baseline FT4. The baseline urinary iodine and FT4 correlated positively with the baseline glutathione peroxidase. On day 60, urinary iodine correlated with C-reactive protein (r 0·461, P = 0·018), and free triiodothyronine correlated with IL-6 (r - 0·429, P = 0·025). On day 60, the changes produced in urinary iodine correlated significantly with the changes produced in α1-antitrypsin (r 0·475, P = 0·014) and ceruloplasmin (r 0·599, P = 0·001). The changes in thyroid-stimulating hormone correlated significantly with the changes in α1-antitrypsin (r - 0·521, P = 0·005) and ceruloplasmin (r - 0·459, P = 0·016). In conclusion, the administration of an iodide supplement between 100 and 300 µg/d did not modify thyroid function in a population with adequate iodine intake. The results also showed a slight anti-inflammatory and antioxidative action of iodide.

Evaluating the effect of a water exercise routine on the postural stability of the elderly.

Background: Postural stability enables humans to maintain the center of mass of their body within their base of support. Nevertheless, over time, such stability is affected by different factors such as age, repetitive strain, and accidents. Although studies in this field have investigated the effectiveness of hydrotherapy, only a few of them have explored its influence on postural stability, which is reflected in a lack of research that estimates its impact on rehabilitation. Aim: To determine the immediate and final effects of an aquatic routine protocol on the postural stability of elderly subjects. Methods: The postural stability of 20 adults over 60 years of age was analyzed using electromyographic and baropodometric methods. Electromyographic signals were obtained from the tibialis anterior, soleus, both gastrocnemius, vastus medialis, and biceps femoris to calculate the coactivation percentage of the muscles in charge of postural stability. The baropodometric data were collected to analyze the area of the stabilometric ellipse, mean plantar pressure, and weight distribution percentage. Results: The outcome of both methods revealed improvements in the elderly patients after the aquatic routine protocol was applied, which indicates that the type of water exercises implemented in this study has positive effects on their postural stability. Conclusion: The postural stability of the elderly participants was improved after each session because their stability index decreased along with the electrical activity of some muscle pairs, their body weight was better distributed, and the area of body oscillation was reduced. However, this effect was immediate and not final.

Antecedentes: La estabilidad postural permite a los humanos mantener el centro de masa de su cuerpo dentro de su base de apoyo. Sin embargo, con el tiempo, dicha estabilidad se ve afectada por diferentes factores como la edad, el esfuerzo repetitivo y los accidentes. Si bien los estudios en este campo han investigado la efectividad de la hidroterapia, solo algunos de ellos han explorado su influencia en la estabilidad postural, lo que se refleja en la falta de investigaciones que estimen su impacto en la rehabilitación. Objetivo: Determinar los efectos inmediatos y finales de un protocolo de rutina acuática sobre la estabilidad postural de adultos mayores. Métodos: Se analizó la estabilidad postural de 20 adultos mayores de 60 años mediante métodos electromiográficos y baropodométricos. Se obtuvieron señales electromiográficas del tibial anterior, sóleo, gastrocnemio, vasto interno y bíceps femoral para calcular el porcentaje de coactivación de los músculos encargados de la estabilidad postural. Los datos baropodométricos se recolectaron para analizar el área de la elipse estabilométrica, la presión plantar media y el porcentaje de distribución del peso corporal. Resultados: Ambos métodos mostraron mejoras en los pacientes luego de la aplicación del protocolo de rutina acuática, lo que indica que el tipo de ejercicios acuáticos implementados en este estudio tiene efectos positivos en su estabilidad postural. Conclusión: La estabilidad postural de los participantes mejoró después de cada sesión porque su índice de estabilidad disminuyó junto con la actividad eléctrica de algunos pares de músculos, su peso corporal se distribuyó mejor y se redujo el área de oscilación corporal. Sin embargo, este efecto fue inmediato y no definitivo.

Intake and home use of olive oil or mixed oils in relation to healthy lifestyles in a Mediterranean population. Findings from the prospective Pizarra study.

Discordances exist in epidemiological studies regarding the association between the intake of nutrients and death and disease. We evaluated the social and health profile of persons who consumed olive oil in a prospective population cohort investigation (Pizarra study) with a 6-year follow-up. A food frequency questionnaire and a 7 d quantitative questionnaire were administered to 538 persons. The type of oil used in food preparation was determined by direct measurement of the fatty acids in samples obtained from the kitchens of the participants at baseline and after follow-up for 6 years. The fatty acid composition of the serum phospholipids was used as an endogenous marker of the type of oil consumed. Total fat intake accounted for a mean 40 % of the energy (at baseline and after follow-up). The concordance in intake of MUFA over the study period was high. The fatty acid composition of the serum phospholipids was significantly associated with the type of oil consumed and with fish intake. The concentration of polar compounds and polymers, indicative of degradation, was greater in oils from the kitchens where sunflower oil or refined olive oil was used, in oils used for deep frying and in oils that had been reused for frying five times or more. Consumption of olive oil was directly associated with educational level. Part of the discordance found in epidemiological studies between diet and health may be due to the handling of oils during food preparation. The intake of olive oil is associated with other healthy habits.

Preoperative assessment of CD44-mediated depth of invasion as predictor of occult metastases in early oral squamous cell carcinoma.

BACKGROUND: Epithelial-mesenchymal transition and cancer stem-like cells (CSC) have been linked to increased metastatic potential. We evaluated the prognostic impact of CD44, a CSC biomarker, on depth of invasion (DOI) and outcome in oral squamous cell carcinoma (OSCC). METHODS: Using a multivariable logistic regression model, we evaluated in early OSCCs the relationship between CD44 expression at the invasive tumor front, DOI, sentinel lymph node biopsy, extension of nodal involvement, and survival. We also assessed whether CT and/or MRI could predict DOI preoperatively. RESULTS: CD44 expression was associated with increased DOI (P = .018), worse disease-specific survival (P = .041) but not with positive sentinel lymph node biopsy (P > .05). Each millimeter increase in DOI was associated with a 31.1% higher risk for positive sentinel lymph node biopsy (95% CI: 5.8%-62.4%, P = .013) and with higher metastatic ratio (P = .015). Preoperative estimation of DOI by CT and/or MRI and histopathological DOI showed a strong correlation (P < .0001). CONCLUSIONS: CD44 expression correlates with DOI, which predicts occult lymph node metastasis. Preoperative CT and/or MRI provides an accurate estimation of histopathological DOI. Both pieces of information gained preoperatively can help surgeons tailor their operation in regard to the surgical management of the neck.

Effect of the interaction between the fatty acid binding protein 2 gene Ala54Thr polymorphism and dietary fatty acids on peripheral insulin sensitivity: a cross-sectional study.

BACKGROUND: The intestinal fatty acid-binding protein (FABP2) is involved in the intracellular transport and metabolism of fatty acids and may affect insulin sensitivity and glucose metabolism. OBJECTIVE: The objective was to study the effect of interaction between the Ala54Thr polymorphism of the FABP2 gene (FABP2) and the type of dietary cooking oil used on peripheral insulin sensitivity in a population from southern Spain. DESIGN: The study was cross-sectional. Anthropometric measurements were obtained for 1226 persons aged 18-65 y selected randomly from the municipal census of Pizarra, Spain. An oral-glucose-tolerance test was given to 1020 of these persons. Insulin resistance was measured by homeostasis model assessment. Samples of the cooking oil being used were taken from the kitchens of a random subset of 538 persons. RESULTS: Persons who consumed sunflower oil and who also had the Thr54 variant had higher insulin resistance than did those who consumed olive oil (P = 0.01). We detected an interaction between the Ala54Thr polymorphism and the type of oil consumed that accounted for the variance in insulin resistance (P = 0.02). CONCLUSIONS: The effect of dietary fatty acids on the populational pattern of insulin resistance is not independent of the Ala54Thr polymorphism of FABP2. An interaction existed between this polymorphism and the intake of dietary fats in a population with a high intake of monounsaturated fatty acids.

Histopathologic Effects of Onabotulinum Toxin A Treatment in Pediatric Submandibular Glands.

Onabotulinum toxin A (OBTXA) is an effective treatment for drooling. Our objective was to determine if there are histologic changes in the submandibular glands (SMGs) after repetitive OBTXA injections. The study included blinded histologic analysis and comparison of SMGs with ≥4 OBTXA injections versus controls who never received OBTXA. The number of acinar cells were counted, and the morphology of the cells was evaluated within each histologic sample of the SMGs. Thirty-one glands were analyzed (14 control, 17 cases). No physical differences were observed between the 2 acinar cell groups. There was no significant difference in the number acinar cells per surface area in the control group as compared with the OBTXA group (1.29 ± 0.13 vs 1.17 ± 0.11 cells/µm2, respectively). To conclude, no significant histologic findings were established in this first human study on SMGs post-OBTXA treatment.

Morbidly obese individuals with impaired fasting glucose have a specific pattern of insulin secretion and sensitivity: effect of weight loss after bariatric surgery.

BACKGROUND: Obesity is often associated with hyper-secrection of insulin. Impaired fasting glucose (IFG) has recently been redefined as a fasting plasma glucose of 5.6-6.9 mmol/L. The aim of this study was to determine whether changes in insulin secretion in morbidly obese persons also commence with normal serum glucose levels. METHODS: 32 morbidly obese subjects were studied before and after bariatric surgery. Measurements were made of glucose tolerance (K(G)), insulin sensitivity (SI), first-phase insulin release and the disposition index (DI) from a frequently sampled intravenous glucose tolerance test. RESULT: In morbidly obese subjects, the SI (P<0.01), DI (P<0.01) and first-phase insulin release (P<0.02) started changing with serum glucose levels considered to be normal (5.00-5.28 mmol/L). K(G) showed a clear slope according to the baseline glycemia status (P<0.05), and it was significantly related with the DI, both before (r=0.76, P<0.001) and after (r=0.57, P=0.002) surgery. Following surgery, all the variables significantly associated with insulin secretion and insulin sensitivity recovered significantly. The most significant changes occurred in morbidly obese individuals with IFG. CONCLUSIONS: Morbidly obese subjects show slopes of insulin sensitivity and insulin secretion in accordance with their baseline serum glucose levels. The fall in first-phase insulin release begins when serum glucose values are considered normal. Morbidly obese persons with the IFG phenotype have a specific pattern of insulin sensitivity and insulin secretion. K(G) clearly discriminates the clinical phenotypes, depending on baseline serum glucose levels.

Evaluating the effect of a water exercise routine on the postural stability of the elderly / Evaluación del efecto de una rutina de ejercicios acuáticos sobre la estabilidad postural de adultos mayores

Abstract Background: Postural stability enables humans to maintain the center of mass of their body within their base of support. Nevertheless, over time, such stability is affected by different factors such as age, repetitive strain, and accidents. Although studies in this field have investigated the effectiveness of hydrotherapy, only a few of them have explored its influence on postural stability, which is reflected in a lack of research that estimates its impact on rehabilitation. Aim: To determine the immediate and final effects of an aquatic routine protocol on the postural stability of elderly subjects. Methods: The postural stability of 20 adults over 60 years of age was analyzed using electromyographic and baropodometric methods. Electromyographic signals were obtained from the tibialis anterior, soleus, both gastrocnemius, vastus medialis, and biceps femoris to calculate the coactivation percentage of the muscles in charge of postural stability. The baropodometric data were collected to analyze the area of the stabilometric ellipse, mean plantar pressure, and weight distribution percentage. Results: The outcome of both methods revealed improvements in the elderly patients after the aquatic routine protocol was applied, which indicates that the type of water exercises implemented in this study has positive effects on their postural stability. Conclusion: The postural stability of the elderly participants was improved after each session because their stability index decreased along with the electrical activity of some muscle pairs, their body weight was better distributed, and the area of body oscillation was reduced. However, this effect was immediate and not final.

Resumen Antecedentes: La estabilidad postural permite a los humanos mantener el centro de masa de su cuerpo dentro de su base de apoyo. Sin embargo, con el tiempo, dicha estabilidad se ve afectada por diferentes factores como la edad, el esfuerzo repetitivo y los accidentes. Si bien los estudios en este campo han investigado la efectividad de la hidroterapia, solo algunos de ellos han explorado su influencia en la estabilidad postural, lo que se refleja en la falta de investigaciones que estimen su impacto en la rehabilitación. Objetivo: Determinar los efectos inmediatos y finales de un protocolo de rutina acuática sobre la estabilidad postural de adultos mayores. Métodos: Se analizó la estabilidad postural de 20 adultos mayores de 60 años mediante métodos electromiográficos y baropodométricos. Se obtuvieron señales electromiográficas del tibial anterior, sóleo, gastrocnemio, vasto interno y bíceps femoral para calcular el porcentaje de coactivación de los músculos encargados de la estabilidad postural. Los datos baropodométricos se recolectaron para analizar el área de la elipse estabilométrica, la presión plantar media y el porcentaje de distribución del peso corporal. Resultados: Ambos métodos mostraron mejoras en los pacientes luego de la aplicación del protocolo de rutina acuática, lo que indica que el tipo de ejercicios acuáticos implementados en este estudio tiene efectos positivos en su estabilidad postural. Conclusión: La estabilidad postural de los participantes mejoró después de cada sesión porque su índice de estabilidad disminuyó junto con la actividad eléctrica de algunos pares de músculos, su peso corporal se distribuyó mejor y se redujo el área de oscilación corporal. Sin embargo, este efecto fue inmediato y no definitivo.

Comparison between a multiple daily insulin injection regimen (basal once-daily glargine plus mealtime lispro) and continuous subcutaneous insulin infusion (lispro) using continuous glucose monitoring in metabolically optimized type 1 diabetes patients: A randomized open-labelled parallel study.

BACKGROUND AND OBJECTIVE: Advantages of continuous subcutaneous insulin infusion (CSII) over multiple daily injections with glargine (MDI/G) are still uncertain. We compared CSII vs. MDI/G therapy in unselected patients with type 1 diabetes using continuous glucose monitoring (CGSM). The primary end-points were glycaemic control and quality of life (QOL). METHODS: A total of 45 patients with long-term diabetes and mean HbA1c values of 8.6±1.8% (70.5±15.4mmol/mol), previously treated with MDI/NPH, were switched to MDI/G for 6 months and then, unfulfilling therapy CSII indication, were randomly assigned to CSII or MDI/G for another six months. We evaluated QOL (EsDqol) and glycaemic control by measuring HbA1c levels, rate of hypoglycaemia, ketoacidosis and CGSM data. RESULTS: After the first phase (MDI/NPH to MDI/G) there was a significant improvement in total EsDQOL (99.72±18.38 vs. 92.07±17.65; p<0.028), a 0.5% decrease in HbA1c values (8.4±1.2 vs. 7.9±0.7% [68±9.7 vs. 63±5.5mmol/mol]; p<0.032), an improvement in glycaemic variability (standard deviation 66.9±14 vs. 59.4±16mg/dl; p<0.05), a decrease in insulin requirements (0.87±0.29 vs. 0.80±0.25U/kg; p<0.049), a decrease in number of severe hypoglycaemia episodes (0.44±0.9 vs. 0.05±0.2; p<0.014), and an increase in periods of normoglycaemia measured with CGSM (15.8±10.9% vs. 23±18.4%; p<0.003). Six months after randomization, significant improvements were seen in the HbA1c (7.9±0.7 vs. 7±0.6% [63±5.5 vs. 53±4.5mmol/mol]; p<0.001) and EsQOL (91.66±22 vs. 84.53±1.63; p<0.045) only in the CSII group. The HbA1c value was significantly lower when compared with the MDI/G group (CSII 7±0.6% [53±4.5mmol/mol] vs. MDI/G 7.6±0.9% [59.6±7.7mmol/mol]; p<0.03). CONCLUSIONS: Intensive insulin therapy with CSII vs. MDI/G was associated with better levels of HbA1c in patients with long-term type 1 diabetes.

Effect of recurrent onabotulinum toxin A injection into the salivary glands: An ultrasound measurement.

OBJECTIVES/HYPOTHESIS: Onabotulinum toxin A (OBTXA) injection is a well-established therapeutic option for the management of drooling. Many of the children treated undertake repeated injections every 3 to 6 months. We aimed to assess quantitative salivary gland changes via ultrasound imaging after intraglandular injection of OBTXA for sialorrhea treatment in children, as a method that suggests permanent changes in glandular size can cause a decrease in functionality or atrophy. STUDY DESIGN: Case-control study. METHODS: The parotid and submandibular glands of 22 patients with sialorrhea with previous repetitive OBTXA treatments were measured via ultrasound. These were compared with a control group of 38 healthy children. RESULTS: A total of 60 patients were included in the study (38 boys, 22 females). Body mass index, sex, and age were defined as confounders. The mean age was 7 years (standard deviation [SD] ±2.3 years) and 9 years (SD ±3.8 years) for treatment and control groups, respectively. There were no postinjection complications. We found significant decrease in the size dimensions (surface area and depth) of both submandibular glands and one parotid gland in the treatment group (P < .05). Significant smaller anterior-posterior dimension of the submandibular glands (P < .01) was also found. CONCLUSIONS: The chronic use of intraglandular OBTXA reduced the size of the salivary glands measured ultrasonographically. Results were correlated with clinical outcomes. Pathological studies should be done to correlate whether ultrasound changes result in atrophy or apoptosis of the glands. LEVEL OF EVIDENCE: 3b

Salivary glands of healthy children versus sialorrhea children, is there an anatomical difference? An ultrasonographic biometry.

OBJECTIVES: There is no literature about the average size of the salivary glands in the pediatric population with drooling (sialorrhea). Studies have shown that some pathologies affect the functionality of the salivary glands. We assessed via ultrasonography the sizes of the submandibular and parotid glands in 9 healthy children who were not suffering from local or systemic diseases that could affect the salivary glands. We also compared this group with a group of 9 patients with sialorrhea. METHODS: Volunteers were matched based on age, gender, and BMI. Body weight did not differ more than 20% from ideal weight. The parotid and submandibular glands of 9 patients with sialorrhea without any previous treatment were measured via ultrasound and matched to a healthy control. Children with various causes for drooling were included (neurological disorders, neuromuscular disorders, lack of oral motor control). RESULTS: Dimensions of the parotid glands in drooling and healthy patients were: surface area 2.96 cm(2) (SD ±0.90) and 2.81 cm(2) (SD ±0.54); in depth 1.68 cm (SD ±0.24) and 1.61 cm (SD ±0.27); in the axis longitudinal to the horizontal mandibular ramus 3.18 cm (±0.46) and 3.15 cm (SD ±0.45) in drooling and healthy groups respectively. The means of submandibular glands of drooling and healthy patients measured in surface area: 3.20 cm(2) (SD ±0.66) and 3.08 cm(2) (SD ±0.65); anterior-posterior length 1.55 cm (SD ±0.23) and 1.46 cm (SD ±0.23), medio-lateral length 3.07 cm (SD ±0.39) and 3.07 cm (SD ±0.32). There was no statistical significance in comparison with the healthy group control. CONCLUSION: The parotid and submandibular salivary glands in the pediatric population do not differ in size in children with or without drooling. Measuring the glands at baseline and post treatment with botulinum toxin injections allows one to evaluate if there are changes in the gland related to the treatment.

Cricothyroid onabotulinum toxin A injection to avert tracheostomy in bilateral vocal fold paralysis.

IMPORTANCE: More than half of children with bilateral vocal fold paralysis require a tracheostomy for airway management. We report an innovative, minimally invasive approach consisting of onabotulinum toxin A injection into the cricothyroid muscles. OBSERVATIONS: Onabotulinum toxin A was injected under direct vision into the cricothyroid muscles of 6 pediatric patients with bilateral abductor vocal fold paralysis. None of the patients had fold fixation on laryngoscopy performed at the time of the injection. All patients had a documented increase in airway patency as visualized on flexible laryngoscopy within days after injection. This procedure successfully averted a tracheostomy in 5 patients and permitted decannulation of the sixth patient. CONCLUSIONS AND RELEVANCE: Onabotulinum toxin A injection into the cricothyroid muscles leads to an increase in the glottic space, providing an adequate airway. Onabotulinum toxin A injection in the cricothyroid muscles could be offered as a safe, effective, noninvasive first-line option for patients with bilateral vocal fold paralysis.

Onabotulinum toxin A for the treatment of sialorrhea in familial dysautonomia.

Familial dysautonomia is a rare disease affecting the nervous system. Symptoms include speech and movement problems, anterior sialorrhea (drooling) due to hypersalivation as a consequence of poor oropharyngeal coordination; dysphagia and aspiration pneumonia secondary to recurrent posterior sialorrhea. The treatment for sialorrhea in this population is very challenging. Traditional drugs carry a number of side-effects that are difficult to control in this disease. We report the first documented case series of 3 patients with this condition that successfully responded to Onabotulinum toxin A injection into their salivary glands. This is an innovative, safe method for drooling control in this population.

Acute mastoiditis in children with cochlear implants: is explantation required?

OBJECTIVE: Acute mastoiditis is an uncommon but challenging condition when it occurs in children with cochlear implant. The literature is scarce as to the management of this condition with regards to explantation. The objective of the study is to determine the need for explantation in patients with cochlear implants who suffer from acute mastoiditis. DATA SOURCES: Online medical databases-PubMed, Ovid Medline, Ovid Medline in process, Embase, Cochrane Library, CINAHL, Biosis, Google Scholar, and Scopus. REVIEW METHODS: A systematic review of all publications addressing the treatment of mastoiditis in cochlear implant children prior to November 2013 was conducted. Data were collected from online medical databases-PubMed, Ovid Medline, Ovid Medline in process, Embase, Cochrane Library, CINAHL, Biosis, Google Scholar, and Scopus. The review was performed in 3 phases; an initial screening review of abstracts was performed, followed by a detailed review of full articles based on inclusion and exclusion criteria, and lastly a final review to extract data from selected articles. RESULTS: Twelve articles were found eligible for this systematic review including a total of 43 patients. Subperiosteal abscess was present in 14.3%. All patients received intravenous antibiotics as an initial treatment, and if needed, surgical intervention was performed. Only 1 patient required explantation (2.3%). CONCLUSION: Prompt, aggressive medical and if needed surgical therapy can help in saving the implant and result in a favorable outcome.