Periprocedural imaging compared to endometrial biopsy: is biopsy required prior to uterine artery embolisation?

AIM: To compare the detection rate of magnetic resonance imaging (MRI) and ultrasound relative to endometrial biopsy for endometrial abnormalities in both pre- and post-menopausal women. MATERIALS AND METHODS: The present study was an institutional review board-approved, single-institution retrospective analysis of patients who underwent pelvic MRI within 1 year of diagnostic-quality biopsies from 2008-2018 (n=668). There were 303 patients who received uterine artery embolisation (UAE) and 478 patients who received pelvic ultrasound within the study period. Medical records were evaluated for radiological-histopathological correlation, demographics, laboratory studies, and clinical follow-up. RESULTS: In this cohort of 668 patients, there were 37 biopsies positive for malignancy; women with malignancy were older (58 versus 47 years, p<0.0001) and more likely to be post-menopausal (66% versus 12%, p<0.0001). There were 303 patients who underwent UAE and underwent a diagnostic-quality endometrial biopsy during the pre-procedural evaluation, none of whom were post-menopausal and had a mean age of 45 years. In women with abnormal uterine bleeding (AUB) or post-menopausal bleeding (PMB), the sensitivity of MRI for detecting endometrial cancer was 96.2%, with a negative predictive value (NPV) of 99.8%, compared to 68% and 97% for ultrasound, respectively. The receiver operating characteristic (ROC) curve of pre-biopsy MRI in identifying pre-malignant and malignant endometrial pathology demonstrated an AUC of 0.8920 (p<0.0001). CONCLUSION: In women with AUB or PMB, MRI has a 99.8% NPV in ruling out endometrial cancer. Further consideration should be made towards optimising pre-procedural evaluation for UAE.

[Neurofeedback for the treatment of chronic tinnitus : Review and future perspectives]. / Neurofeedback in der Behandlung des chronischen Tinnitus : Überblick und Ausblick.

Neurofeedback is a noninvasive neuromodulation technique employing real-time display of brain activity in terms of electroencephalography (EEG) signals to teach self-regulation of distinct patterns of brain activity or influence brain activity in a targeted manner. The benefit of this approach for control of symptoms in attention deficit disorders, hyperactivity, depression, and migraine has been proven. Studies in recent years have also repeatedly shown this treatment to improve tinnitus symptoms, although it has not become established as routine therapy. The primary focus of this review is the rational of EEG neurofeedback for tinnitus treatment and the currently available data from published studies. Furthermore, alternative neurofeedback protocols using real-time functional magnetic resonance imaging (fMRI) measurements for tinnitus control are considered. Finally, this article highlights how modern EEG analysis (source localization, connectivity) and the improving understanding of tinnitus pathology can contribute to development of more focused neurofeedback protocols for more sustainable control of tinnitus.

Lower glutamate and GABA levels in auditory cortex of tinnitus patients: a 2D-JPRESS MR spectroscopy study.

We performed magnetic resonance spectroscopy (MRS) on healthy individuals with tinnitus and no hearing loss (n = 16) vs. a matched control group (n = 17) to further elucidate the role of excitatory and inhibitory neurotransmitters in tinnitus. Two-dimensional J-resolved spectroscopy (2D-JPRESS) was applied to disentangle Glutamate (Glu) from Glutamine and to estimate GABA levels in two bilateral voxels in the primary auditory cortex. Results indicated a lower Glu concentration (large effect) in right auditory cortex and lower GABA concentration (medium effect) in the left auditory cortex of the tinnitus group. Within the tinnitus group, Glu levels positively correlated with tinnitus loudness measures. While the GABA difference between groups is in line with former findings and theories about a dysfunctional auditory inhibition system in tinnitus, the novel finding of reduced Glu levels came as a surprise and is discussed in the context of a putative framework of inhibitory mechanisms related to Glu throughout the auditory pathway. Longitudinal or interventional studies could shed more light on interactions and causality of Glu and GABA in tinnitus neurochemistry.

Neurophysiological correlates of residual inhibition in tinnitus: Hints for trait-like EEG power spectra.

OBJECTIVE: To investigate oscillatory brain activity changes following acoustic stimulation in tinnitus and whether these changes are associated with behavioral measures of tinnitus loudness. Moreover, differences in ongoing brain activity between individuals with and without residual inhibition (RI) are examined (responders vs. non-responders). METHODS: Three different types of noise stimuli were administered for acoustic stimulation in 45 tinnitus patients. Subjects resting state brain activity was recorded before and after stimulation via EEG alongside with subjective measurements of tinnitus loudness. RESULTS: Delta, theta and gamma band power increased, whereas alpha and beta power decreased from pre to post stimulation. Acoustic stimulation responders exhibited reduced gamma and a trend for enhanced alpha activity with the latter localized in the right inferior temporal gyrus. Post stimulation, individuals experiencing RI showed higher theta, alpha and beta power with a peak power difference in the alpha band localized in the right superior temporal gyrus. Neither correlations with behavioral tinnitus measures nor stimulus-specific changes in EEG activity were present. CONCLUSIONS: Our observations might be indicative of trait-specific forms of oscillatory signatures in different subsets of the tinnitus population related to acoustic tinnitus suppression. SIGNIFICANCE: Results and insights are not only useful to understand basic neural mechanisms behind RI but are also valuable for general neural models of tinnitus.

The impact of tinnitus distress on cognition.

Tinnitus is the chronic perception of a phantom sound with different levels of related distress. Past research has elucidated interactions of tinnitus distress with audiological, affective and further clinical variables. The influence of tinnitus distress on cognition is underinvestigated. Our study aims at investigating specific influences of tinnitus distress and further associated predictors on cognition in a cohort of n = 146 out-ward clinical tinnitus patients. Age, educational level, hearing loss, Tinnitus Questionnaire (TQ) score, tinnitus duration, speech in noise (SIN), stress, anxiety and depression, and psychological well-being were included as predictors of a machine learning regression approach (elastic net) in three models with scores of a multiple choice vocabulary test (MWT-B), or two trail-making tests (TMT-A and TMT-B), as dependent variables. TQ scores predicted lower MWT-B scores and higher TMT-B test completion time. Stress, emotional, and psychological variables were not found to be relevant predictors in all models with the exception of small positive influences of SIN and depression on TMT-B. Effect sizes were small to medium for all models and predictors. Results are indicative of specific influence of tinnitus distress on cognitive performance, especially on general or crystallized intelligence and executive functions. More research is needed at the delicate intersection of tinnitus distress and cognitive skills needed in daily functioning.

[Long-term follow-up after surgery for thoracic outlet syndrome (TOS)]. / Langzeitresultate nach operativer Therapie bei Thoracic-outlet-Syndrom (TOS).

This is a long-term follow-up analysis of patients who have been operated on for Thoracic Outlet Syndrome (TOS) at our clinic in order to evaluate the quality of therapy and the criteria of indications for surgery. 39 patients with a total of 45 surgical procedures were examined after a median follow-up of 8.8 years. The results in this study are based exclusively on the subjective outcome assessment by the patients themselves. Assessment of the long-term result in the "vascular TOS" group (13 cases = 29 %) was good in ten cases (77 %), fair in two cases (15 %) and poor in one case (8 %). In agreement with the literature, we were able to achieve the best results in this group. In the "true neurological TOS" group (28 cases = 62 %), assessment of the long-term result was good in 19 cases (68 %), fair in six cases (21 %) and poor in three cases (11 %). A clear tendency to a poor prognosis could be seen in women with a combination of cervical rib and fibrous band and a long delay between onset of symptoms and surgery. Assessment of long-term result in the "disputed TOS" group (four cases = 9 %) showed good results in three cases and a fair result in one case. In the absence of objective pathologies, only few and carefully selected patients were operated upon. The presented long-term results confirm the use of individual therapeutic concepts with special consideration of anatomy and clinical picture.

Mitochondrial impact on nerve growth factor production in vascular smooth muscle-derived cells.

Ht30/=Ht5). Cells with reduced mitochondrial activity also showed abnormal responses to the stimulation of NGF output. Thrombin and phorbol ester elevated NGF production from Ht100, Ht30 and Ht10 cells, but not from Ht5 cells. Ht30 cells, despite secreting less NGF basally than Ht100 cells, reached a similar or greater NGF output upon stimulation. Mitogens increased NGF output and NGF mRNA levels with the largest effect on NGF protein in Ht30 cells. Free radical production and the ability of cells to respond to NGF-inducing agents were related. These data suggest that chronic impairment of mitochondrial function associates with disturbances in cellular production of a signaling protein.

Increased nerve growth factor mRNA stability may underlie elevated nerve growth factor secretion from hypertensive vascular smooth muscle cells.

Altered nerve growth factor (NGF) regulation has been linked to the pathophysiology of hypertension. Vascular smooth muscle cells from an inbred hypertensive, but normoactive rat strain (WKHT) secreted NGF at a greater rate than from a hyperactive, normotensive strain (WKHA). Exposure to phorbol ester increased NGF secretion rates from WKHT by 400-800% but not from WKHA vascular muscle. NGF secretion rates from both WKHT and WKHA vascular cells were elevated by co-application of platelet-derived growth factor (PDGF) and transforming growth factor-beta1 (TGF-beta1) by 300-1000%. This response was partially attenuated by actinomycin D, an inhibitor of RNA transcription. These results suggest that regulation of NGF production does not occur solely at the level of transcription and post-transcriptional mechanisms operate. Analysis of NGF mRNA stability in the two strains following PDGF and TGF-beta1 treatment showed that NGF mRNA in WKHT had a half-life of 126.2+/-11.68 min while in WKHA vascular smooth muscle cells, the half-life was 47. 33+/-11.98 min. In addition to increased NGF mRNA stability in WKHT vascular muscle, these cells have an increased translational efficiency of NGF protein; elevated synthesis of NGF protein per unit NGF mRNA. Differences in signaling pathways may result in increased NGF mRNA stability and translational efficiency that may account for the elevated NGF protein in WKHT vascular smooth muscle cells.

Assessment by audiotympanometric testing: three case reports.

Tympanometric measurements are versatile and accurate when more than one type of ear disease is present. Three cases are presented where information from tympanometry beyond that derived from otological and routine audiological testing yielded accurate diagnoses. A patient with a history of middle-ear disease presented with a sensori-neural loss. Measures of static conductance correctly identified the problem as stiffness of the ossicular chain. An infant with unilateral congenital atresia and questionable hearing in her normal-appearing ear was determined to have serous otitis media by tympanometry and reflex testing. The course of the disease was monitored and reversed. A 17-year-old female suffered a basal skull fracture with a sudden conductive hearing loss. Low conductance and high impedance correctly identified loss of mobility of the ossicular chain which was confirmed surgically. These three cases illustrate the advantages of tympanometry in making rapid, accurate, objective measurements involving complex diagnoses of middle-ear function.

Characterization of 86 bruxing patients with long-term study of their management with occlusal devices and other forms of therapy.

Of 353 patients screened, 86 answered positively to questions designed to identify bruxers. The bruxing patient profile revealed that 100% had working excursive interferences, 78% had balancing excursive interferences, and 95.4% had a premature contact into maximum intercuspation. Most of the bruxing patients had a chief complaint that related to pain, and 89.6% of the patients had a craniomandibular disorder. The patients were initially managed with an anterior deprogrammer and were later managed with other occlusal devices as signs and symptoms dictated. Definitive treatment was determined by the patient's maxillomandibular relationship.

Productivity of respiratory therapy personnel.

An analysis was conducted of 630 periodic observations of work activities of 10 respiratory therapy personnel of a department during 14 consecutive days. It was found that the staff were spending about one-third of their working hours non-productively. The natures of the productive activities related to patient care were identified and each activity was categorized according to the level of difficulty and the skill required for performing it. The peak loads of the department were found to occur immediately before and after patients' meal hours and visiting hours. Nearly one-third of all the staff's productive time was spent administering IPPB. The personnel of various skill levels appeared to be performing different tasks regardless of their levels of difficulty.

An FDA phase I clinical trial of quinacrine sterilization (QS).

OBJECTIVE: To review the significance of a United States Food and Drug Administration (FDA) approved Phase I clinical trial of a new use for an old drug, quinacrine. To discover whether ultrasound may have utility in quinacrine sterilization (QS). METHOD: This clinical trial began on 16 September 2000 at the Women's and Children's Hospital of Buffalo (WCHOB) in Buffalo, New York. Ten patients volunteered to have QS. These subjects were carefully followed with regularly scheduled examinations, including extensive laboratory blood tests. In addition, each patient had a trans-abdominal ultrasound examination six weeks or later past the date of the second insertion of quinacrine. The trial was completed on 30 April 2003. RESULTS: Laboratory results fell within normal limits, thus providing additional evidence to affirm the lack of toxic effects of QS. With ultrasound, we were able to see scars in both oviducts on all of our patients. One patient with a small scar as seen on ultrasound became pregnant. CONCLUSION: QS was found to be safe and effective. Ultrasound holds the promise of reducing the failure rate.

Trauma from occlusion. Restorative concerns.

Trauma from occlusion and restorative concerns may affect the tooth itself, the supporting structures inside and around the tooth's immediate structures, and the total articulating system, which includes the neuromuscular system, the temporomandibular joints, and other systems such as the impairment of hearing or vision and many other peripheral conditions. A thorough examination and a differential diagnosis procedure is essential to restore the health of the articulating system and reverse peripheral condition. This includes the ability to restore the individual tooth in its best anatomic position as a complement to the articulating system using all individual disciplines of dentistry in the finest abilities of treatment and the ability to share and distinguish the possible parafunctional habits and the need for behavioral understanding, support, and management to limit or lessen the wear and destruction of the individual tissues and to restore a healthier physical support.

Reproducibility of occlusal contacts utilizing a computerized instrument.

This study was designed to examine clinically the accuracy and reproducibility of occlusal contacts made by a computerized device (the T-scan) in ten asymptomatic subjects. The results showed 100% accuracy and reproducibility for all contacts in all subjects. A great advantage of this instrument over silk marking ribbon is that it not only records contacts but can also analyze the timing and force of each contact.

The effect of implant diameter, restoration design, and occlusal table variations on screw loosening of posterior single-tooth implant restorations.

The purpose of this study was to (1) determine in vitro the effect of narrowing the buccolingual width of the occlusal table on the untightening torque required to loosen gold prosthetic screws after subjecting implants and implant-supported restorations to occlusal loads, and (2) to compare the incidence of screw loosening and values of untightening torque of the screws among crowns supported by 1 wide-diameter as opposed to 2 standard implants after loading in vitro. The restorations were divided into 4 groups (group 1, a narrow crown supported by one 5-mm wide-diameter implant; group 2, a narrow crown supported by 2 standard 3.75-mm-diameter implants; group 3, a wide crown supported by one 5-mm wide-diameter implant; and group 4, a wide crown supported by 2 standard 3.75-mm-diameter implants). A custom-designed chewing machine was used to simulate the grinding phase of the masticatory cycle and lateral excursions. The crowns were subjected to a 6-kg load for 16660 cycles over 5.5 hours and were loaded at the outer and inner inclines and cusp tips with an untightening loading pattern. The untightening torque was measured for the gold screws in the different groups before and after loading at 4 different locations for 8 cycles on the simulated chewing machine. A 1-way analysis of variance indicated a significant difference (P < .001) among the test groups. Pairwise multiple comparison tests (Scheffe) were carried out on mean "change scores." Group 3 was significantly different from the other groups, which were not significantly different from each other. Restoring missing molars with 1 wide-diameter implant had a greater incidence of screw loosening as compared with 2 implants. Narrowing the occlusal table of the restoration is critical when using 1 implant to support a missing molar. The untightening torque of gold screws was not affected by changing the width of the occlusal table of crowns supported by 2 implants.

Treatment of idiopathic headshaking in horses with pulsed high-dose dexamethasone.

BACKGROUND: Treatment of idiopathic headshaking in horses is complicated by an incomplete understanding of underlying pathophysiology and partially effective treatments. If an inflammatory etiology exists, corticosteroids could be beneficial. HYPOTHESIS: An anti-inflammatory dose of dexamethasone reduces the signs of idiopathic headshaking in a field setting. ANIMALS: Convenience sample of 20 adult horses with idiopathic headshaking syndrome. Cases were recruited from the general population and diagnosed by attending veterinarians. METHODS: Prospective, blinded clinical trial. Pulsed dosing was with oral dexamethasone (60 mg PO Q24h × 4 days, q3 weeks for 4 months) or placebo (inert paste). Owners were blinded and asked to score the headshaking from 0 to 4 (4 = most severe) 3 days per week. The change in headshaking scores (HS) over each treatment pulse was compared between groups by ordinal logistic regression. RESULTS: Twelve horses completed the trial. There was no significant difference between treated or placebo horses (P = .987). Sun (P ≤ .001), wind (P = .028), and exercise (P ≤ .045) significantly increased HS. CONCLUSIONS AND CLINICAL IMPORTANCE: No benefit of dexamethasone treatment was detected for idiopathic headshaking. The results confirmed previous reports of common triggers for headshaking behavior

South African child deaths 1990-2011: have HIV services reversed the trend enough to meet Millennium Development Goal 4?

OBJECTIVE: To analyse trends in under-five mortality rate in South Africa (1990-2011), particularly the contribution of AIDS deaths. METHODS: Three nationally used models for estimating AIDS deaths in children were systematically reviewed. The model outputs were compared with under-five mortality rate estimates for South Africa from two global estimation models. All estimates were compared with available empirical data. RESULTS: Differences between the models resulted in varying point estimates for under-five mortality but the trends were similar, with mortality increasing to a peak around 2005. The three models showing the contribution of AIDS suggest a maximum of 37-39% of child deaths were due to AIDS in 2004-2005 which has since declined. Although the rate of progress from 1990 is not the 4.4% needed to meet Millennium Development Goal 4 for child survival, South Africa's average annual rate of under-five mortality decline between 2006 and 2011 was between 6.3 and 10.2%. CONCLUSION: In 2005, South Africa was one of only four countries globally with an under-five mortality rate higher than the 1990 Millennium Development Goal baseline. Over the past 5 years, the country has achieved a rate of child mortality reduction exceeded by only three other countries. This rapid turnaround is likely due to scale-up of prevention of mother-to-child transmission of HIV, and to a lesser degree, the expanded roll-out of antiretroviral therapy. Emphasis on these programmes must continue, but failure to address other aspects of care including integrated high-quality maternal and neonatal care means that the decline in child mortality could stall.