[Universal scoring system for assessing speech function in patients with cleft palate at the stages of surgical treatment]. / Universal'naya ball'naya sistema otsenki rechevoi funktsii u patsientov s rasshchelinoi neba na etapakh khirurgicheskogo lecheniya.

OBJECTIVE: To develop a universal system for assessing the speech function in patients with congenital palatal cleft in the postoperative period. MATERIALS AND METHODS: A universal system for assessing the speech function for patients with a palatal cleft can be applied both after the primary operation of uranoplasty and for patients diagnosed with velopharyngeal insufficiency (VPI). The patient's speech is assessed according to the following criteria: defects in the pronunciation of consonants by place of articulation: labial, labiodental, lingual-dental, lingual-palatal, lingual-alveolar; speech breathing; tongue position; directed air stream; voicing disorders; The patient's is also evaluated for the following findings: hypernasality (reflected speech); hypernasality (spontaneous speech); hyponasality; pharyngeal reflex; audible nasal emission/turbulence; facial grimaces; speech intelligibility. The speech therapy and dental assessments are added to obtain a value characterizing the patient's condition: from 0 to 10 scoring indicates than only speech therapy correction is needed; from 11 to 18 - the decision on the necessity of surgical treatment is made by the surgeon together with the speech therapist, from 18 to 25 - surgical treatment is necessary with subsequent sessions with a speech therapist. RESULTS: With the help of this questionnaire, the operating surgeon can more accurately and objectively assess in dynamics the result of the surgical treatment, regardless of the results of speech therapy treatment in the postoperative period. The creation of this scoring system for speech assessment is aimed at objectivizing the results of uranoplasty and speech-improving operations. It allows the surgeon to compare the effectiveness of different surgical methods. CONCLUSION: The universal scoring system for assessing the state of speech function can be applied in the diagnosis of a patient with a palatal cleft both after the primary operation on the palate and after corrective surgical interventions. It allows monitoring progress and identifying dynamics in surgical and speech therapy treatment.

Convergence in a multi-method study between Rorschach and self-report data of traumatized refugees assessed before and after psychotherapy.

Rorschach and self-report instruments represent methodologically different types of assessment, which together may yield incremental information about the test-taker. There is little evidence on whether and when results from these methods converge. OBJECTIVE: To examine possible convergences between Rorschach trauma-related personality variables and self-reported variables. METHOD: Before and after psychotherapy 22 traumatized adult refugee patients were assessed with the Rorschach Performance Assessment System (R-PAS), symptom checklists of posttraumatic stress, anxiety and depression, and a quality of life questionnaire. Correlational analyses between eight R-PAS variables and 10 self-reported variables were performed. RESULTS: The findings showed inconsistent and nonsignificant correlations pretherapy. Posttherapy, however, all R-PAS variables except Complexity correlated positively with symptoms of mental disorder, and negatively with the quality of life variables, as predicted. The R-PAS variables Mutuality of Autonomy-Pathology, Poor Human Representation, Critical Content, and Form Quality-minus%, converged significantly with most of the self-reported variables, with medium to large correlations. CONCLUSION: The finding of convergence only after psychotherapy, may tentatively suggest greater self-knowledge and internal consistency through the therapy experience, and increased trust and self-disclosure through the repeated meetings with the researchers. The findings represent a promising contribution to a cumulative validation process of convergence between Rorschach and self-report data.

Therapeutic efficacy of topically used luliconazole vs. terbinafine 1% creams.

OBJECTIVES: Dermatomycoses of zoophilic origin, especially those caused by Trichophyton mentagrophytes, often pose considerable therapeutic problems. This is reflected in the growing number of strains of this species with resistance to terbinafine caused by a mutation in the squalene epoxidase (SQLE) gene. Therefore, it is reasonable to look for alternative therapies to the commonly used terbinafine. The aim of the present study was to assess the in vivo effectiveness of topical therapy with luliconazole or terbinafine 1% cream. METHODS: Therapeutic efficacy was assessed using direct examination in KOH with DMSO, qPCR analysis with pan-dermatophyte primers and culturing. Moreover, in vitro susceptibility tests for luliconazole and terbinafine were performed. RESULTS: The results demonstrated significantly higher antifungal activity of luliconazole than terbinafine against dermatomycoses caused by T. mentagrophytes. The geometric mean of the MIC value for luliconazole against all T. mentagrophytes strains was 0.002 µg/ml, while this value for terbinafine was 0.004 µg/ml. In all studied cases, 28-day local therapy with luliconazole contributed to complete eradication of the aetiological agent of infection. CONCLUSIONS: Given the increasingly frequent reports of difficult-to-treat dermatophytoses caused by zoophilic terbinafine-resistant strains, the 1% luliconazole cream can be alternative solution in topical therapy.

Utilization of learned skills in cognitive behavioural therapy for panic disorder.

BACKGROUND: Research has long investigated the cognitive processes in the treatment of depression, and more recently in panic disorder (PD). Meanwhile, other studies have examined patients' cognitive therapy skills in depression to gain insight into the link between acquiring such skills and treatment outcome. AIMS: Given that no scale exists to examine in-session patient use of panic-related cognitive behavioural therapy (CBT) skills, the aim of this study was to develop a new measure for assessing patients' cognitive and behavioural skills in CBT for PD. METHOD: This study included 20 PD patients who received 12 weekly individual therapy sessions. The Cognitive Behavioral Therapy Panic Skills (CBTPS) rating system was developed. Three independent raters coded tapes of therapy sessions at the beginning and end of treatment. RESULTS: The coefficient alphas and inter-rater reliability were high for the cognitive and behavioural subscales. Improvement in the patients' CBTPS scores on both subscales indicated overall symptom improvement, above improvement in anxiety sensitivity. CONCLUSION: To our knowledge, this is the first study examining the impact of patient acquisition of CBT PD skills on treatment outcome. A new measure was developed based on the observations and was deemed reliable and valid. The measure facilitates the examination of the mechanisms of change in treatment for PD. An in-depth examination of the CBTPS may refine our understanding of the impact of each skill on PD treatment outcome. Further research relating to acquiring CBT skills could shed light on the mechanisms of change in treatment.

Conceptualisation and use of executive functions in paediatrics: A scoping review of occupational therapy literature.

BACKGROUND/AIM: Knowledge and understanding of deficits in executive functions has expanded in recent years and its relevance to occupational therapy has been established. The purpose of this review was to identify, analyse, synthesise and describe the updated occupational therapy scientific literature that addresses the subject of executive functions, specifically focusing on children and adolescents. METHOD: Scoping review methodology was implemented to map the occupational therapy literature on executive functions in children and adolescents over the past decade. Articles were retrieved from five electronic databases. RESULTS: Fifty publications met the inclusion criteria. The research included a wide age range, different diagnoses, use of diverse executive functions definitions and assortment of assessments and interventions. CONCLUSION: A unique definition of executive functions among children and adolescents was proposed. This definition can assist both clinicians and researchers in the field. Continued research to establish the profession in a key position is recommended to understand the underlying mechanisms of daily performance.

Impact of shared decision making on asthma quality of life and asthma control among children.

OBJECTIVE: Few studies have examined the effectiveness of shared decision making (SDM) in clinical practice. This study evaluated the impact of SDM on quality of life and symptom control in children with asthma. METHODS: We conducted a prospective 3-year study in six community-based practices serving a low-income patient population. Practices received training on SDM using an evidence-based toolkit. Patients aged 2-17 with a diagnosis of asthma were identified from scheduling and billing data. At approximate 6-month intervals, patients completed a survey consisting of the Mini Pediatric Asthma Quality of Life Questionnaire (range 1-7) and the control domain of the Pediatric Asthma Therapy Assessment Questionnaire (range 0-7). We used propensity scores to match 46 children receiving SDM to 46 children receiving usual care with decision support. Included children had completed a baseline survey and at least one follow-up survey. Random coefficient models incorporated repeated measures to assess the effect of SDM on asthma quality of life and asthma control. RESULTS: The sample was primarily of non-White patients (94.6%) with Medicaid insurance (92.4%). Receipt of SDM using an evidence-based toolkit was associated with higher asthma quality of life [mean difference 0.9; 95% confidence interval (CI) 0.4-1.4] and fewer asthma control problems (mean difference -0.9; 95% CI -1.6--0.2) compared to usual care with decision support. CONCLUSIONS: Implementation of SDM within clinical practices using a standardized toolkit is associated with improved asthma quality of life and asthma control for low-income children with asthma when compared to usual care with decision support.

Therapy assessment in multiple myeloma with PET.

Multiple myeloma is a plasma cell dyscrasia producing bone lytic lesions. In recent years, a wide spectrum of therapeutic approaches are available to treat the disease: an accurate therapy assessment has, therefore, become of utmost importance. In this field, imaging is becoming a cornerstone, especially in association with clinical parameters. Among imaging procedures, FDG PET/CT is recognized to provide reliable information, achieved in a very safe and fast procedure.  The literature has produced very concordant results from different groups assessing the value of FDG PET/CT as a prognostic factor in general and in therapy assessment, but some issues remain regarding a standardization of image interpretation especially in borderline cases. So far, no data regarding nor other imaging compounds and the use of hybrid tomographs PET/MR are available to define therapy assessment in PET.

Therapy assessment in prostate cancer using choline and PSMA PET/CT.

While PET with non-FDG tracers (mainly choline and Ga-PSMA) has commonly been used for restaging in men with biochemically recurrent prostate cancer, as well as for primary staging, it is only recently that a few preliminary studies have addressed the possible use of PET for monitoring the response to systemic therapy of metastatic disease, especially innovative treatments such as abiraterone and enzalutamide. This article aims to evaluate the role of PET imaging with different non-FDG radiotracers for assessment of therapy in advanced prostate cancer patients.

Efficacy of qualitative response assessment interpretation criteria at 18F-FDG PET-CT for predicting outcome in locally advanced cervical carcinoma treated with chemoradiotherapy.

OBJECTIVES: To evaluate the utility of a standardized qualitative scoring system for treatment response assessment at 18F-FDG PET-CT in patients undergoing chemoradiotherapy for locally advanced cervical carcinoma and correlate this with subsequent patient outcome. METHODS: Ninety-six consecutive patients with locally advanced cervical carcinoma treated with radical chemoradiotherapy (CRT) in a single centre between 2011 and 2014 underwent 18F-FDG PET-CT approximately 3 months post-treatment. Tumour metabolic response was assessed qualitatively using a 5-point scale ranging from background level activity only through to progressive metabolic disease. Clinical and radiological (MRI pelvis) follow-up was performed in all patients. Progression-free (PFS) and overall survival (OS) was calculated using the Kaplan-Meier method (Mantel-Cox log-rank) and correlated with qualitative score using Chi-squared test. RESULTS: Forty patients (41.7 %) demonstrated complete metabolic response (CMR) on post-treatment PET-CT (Score 1/2) with 38 patients (95.0 %) remaining disease free after a minimum follow-up period of 18 months. Twenty-four patients (25.0 %) had indeterminate residual uptake (ID, Score 3) at primary or nodal sites after treatment, of these eight patients (33.3 %) relapsed on follow-up, including all patients with residual nodal uptake (n = 4Eleven11 of 17 patients (64.7 %) with significant residual uptake (partial metabolic response, PMR, Score 4) subsequently relapsed. In 15 patients (15.6 %) PET-CT demonstrated progressive disease (PD, Score 5) following treatment. Kaplan-Meier analysis showed a highly statistically significant difference in PFS and OS between patients with CMR, indeterminate uptake, PMR and PD (Log-rank, P < 0.0001). Chi-squared test demonstrated a highly statistically significant association between increasing qualitative score and risk of recurrence or death (P < 0.001). CONCLUSION: Use of a 5-point qualitative scoring system to assess metabolic response to CRT in locally advanced cervical carcinoma predicts survival outcome and this prognostic information may help guide further patient management.

The Value of FDG PET/CT in Treatment Response Assessment, Follow-Up, and Surveillance of Lung Cancer.

OBJECTIVE: The purpose of this article is to summarize the evidence regarding the role of FDG PET/CT in treatment response assessment and surveillance of lung cancer and to provide suggested best practices. CONCLUSION: FDG PET/CT is a valuable imaging tool for assessing treatment response for patients with lung cancer, though evidence for its comparative effectiveness with chest CT is still evolving. FDG PET/CT is most useful when there is clinical suspicion or other evidence for disease recurrence or metastases. The sequencing, cost analysis, and comparative effectiveness of FDG PET/CT and conventional imaging modalities in the follow-up setting need to be investigated.

Clinical Practice in PET/CT for the Management of Head and Neck Squamous Cell Cancer.

OBJECTIVE: The purpose of this article is to summarize the evidence for the value of PET/CT for the management of patients with head and neck squamous cell cancer and suggest best clinical practices. CONCLUSION: FDG PET/CT is a valuable imaging tool for identifying unknown primary tumors in patients with known cervical node metastases leading to management change and is the standard of care for the initial staging of stage III and IV head and neck squamous cell carcinomas (HNSCCs), for assessing therapy response when performed at least 12 weeks after chemoradiation therapy, and for avoiding unnecessary planned neck dissection. Neck dissection is avoided if PET/CT findings are negative-regardless of the size of the residual neck nodes-because survival outcomes are not compromised. FDG PET/CT is valuable in detecting recurrences and metastases during follow-up when suspected because of clinical symptoms and serves as a prognostic marker for patient survival outcomes, for 5 years. Using FDG PET/CT for routine surveillance of HNSCC after 6 months of treatment without any clinical suspicion should be discouraged.

Qualitative interpretation of PET scans using a Likert scale to assess neck node response to radiotherapy in head and neck cancer.

PURPOSE: The aim of this study was to determine whether PET scans after radiotherapy (RT), visually interpreted as equivocal regarding metabolic neck node response can be used to accurately categorize patients as responders or nonresponders using a Likert scale and/or maximum standardized uptake value (SUVmax). Other aims were to determine the performance of different methods for assessing post-RT PET scans (visual inspection, a Likert scale and SUVmax) and to establish whether any method is superior in predicting regional control (RC) and overall survival (OS). METHODS: In 105 patients with neck node-positive head and neck cancer, the neck node response was evaluated by FDG PET/CT 6 weeks after RT. The scans were clinically assessed by visual inspection and, for the purposes of this analysis, re-evaluated using the Deauville criteria, a five-point Likert scale previously used in lymphoma studies. In addition, SUVmax was determined. RESULTS: All assessment methods were able to significantly predict RC but not OS. The methods were also able to significantly predict remission of tumour after completion of RT. Of the 105 PET scans, 19 were judged as equivocal on visual inspection. The Likert scale was preferable to SUVmax for grouping patients as responders or nonresponders. CONCLUSION: All methods (visual inspection, SUVmax and the Likert scale) identified responders and nonresponders and predicted RC. A Likert scale is a promising tool to reduce to a minimum the problem of PET scans judged as equivocal. Consensus regarding qualitative assessment would facilitate PET reporting in clinical practice.

Therapy Response Assessment and Patient Outcomes in Head and Neck Squamous Cell Carcinoma: FDG PET Hopkins Criteria Versus Residual Neck Node Size and Morphologic Features.

OBJECTIVE: This study investigates the prognostic value of (18)F-FDG PET/CT qualitative therapy assessment (Hopkins criteria) in patients with head and neck squamous cell carcinomas (HNSCCs) with residual neck nodes after definitive chemoradiation therapy and compares the Hopkins criteria with anatomic nodal size and morphologic features for prediction of survival outcomes. MATERIALS AND METHODS: A total of 72 patients with HNSCC, with negative primary tumor and positive residual neck nodes (CT criteria > 1 cm short-axis diameter) after the completion of definitive chemoradiation therapy, were included. PET/CT was performed 6-24 weeks after completion of treatment. FDG uptake in residual nodes on PET/CT was interpreted using a structured qualitative 5-point scale (Hopkins criteria). The 5-point scale was dichotomized to negative (scores 1, 2, and 3) or positive (scores 4 and 5) results. Cystic or necrotic nodes were defined as those with central low attenuation with a relatively hyperdense capsule. Kaplan-Meier curve and Cox regression analysis were performed. RESULTS: On the basis of the Hopkins criteria, 10 (13.9%) patients had positive findings and 62 (86.1%) had negative findings for residual nodal disease. According to CT interpretation, 25 patients (34.7%) had residual cervical lymph nodes greater than or equal to 1.5 cm in diameter, and 41 (56.9%) patients had cystic or necrotic nodes. Patients were followed for a median of 27 months after posttherapy PET/CT. There was a statistically significant difference in overall survival (OS) (hazard ratio, 7.06; p < 0.001) and progression-free survival (PFS) (hazard ratio, 6.18; p < 0.001) between patients with negative versus positive residual FDG nodal uptake. There was no statistically significant difference in OS and PFS in patients categorized on the basis of nodal size or morphologic features. CONCLUSION: PET-based structured qualitative therapy assessment (Hopkins criteria) can predict survival outcomes of patients with HNSCC with residual neck nodes after definitive chemoradiotherapy.

Intratherapy or Posttherapy FDG PET or FDG PET/CT for Patients With Head and Neck Cancer: A Systematic Review and Meta-analysis of Prognostic Studies.

OBJECTIVE: The objective of this study was to determine the predictive value of intra-therapy or posttherapy FDG PET or FDG PET/CT with regard to overall survival (OS) and event-free survival (EFS) outcomes for patients with head and neck cancer (HNC). MATERIALS AND METHODS: A systematic search of the MEDLINE and EMBASE databases was performed. Studies in which PET/CT was performed during or after completion of primary therapy and for which survival outcomes were reported were included. OS and EFS were considered as outcomes. The pooled estimates of hazard ratios (HRs) and Mantel-Haenszel risk ratios (RRs) were generated for summary effects. RESULTS: Twenty-six studies were eligible for inclusion. The pooled HRs for OS (nine studies, 600 patients) and EFS (eight studies, 479 patients) were 3.55 (95% CI, 2.35-5.37) and 4.73 (95% CI, 2.61-8.56), respectively. Results from the RR analyses, including all 26 studies, showed that intratherapy or posttherapy PET/CT could significantly predict the 2-year and 3- to 5-year risk of death or disease progression. A positive PET result was associated with a more-than-sixfold increase in the risk of death within 2 years (2-year RR, 6.19 [95% CI, 3.04- 12.62]), which is attenuated--but remains significant--with longer follow-up (3- to 5-year RR, 2.42 [95% CI, 1.76-3.32]). The estimated pooled RRs for 2-year mortality were 8.31 (95% CI, 3.83-18.01) for posttherapy PET/CT versus 3.99 (95% CI, 1.43-11.10) for intratherapy PET/CT. CONCLUSION: Positive results of intratherapy or posttherapy PET/CT examinations strongly predict the risk of adverse events and death, particularly within 2 years but also up to 5 years, for patients with HNC.

Two-time-point FDG PET/CT: liver SULmean repeatability.

OBJECTIVE. The purpose of this study was to evaluate the repeatability of liver mean standardized uptake value normalized to lean body mass (SULmean) in the same patients at different time points within the right lobe of the liver at (18)F-FDG PET/CT, in a clinical setting. MATERIALS AND METHODS. Two PET/CT studies performed on two different dates from each of 130 patients who had normal livers according to structural imaging were included in this reader study. The mean (± SD) length of time between the studies was 235 ± 192 days. SULmean was measured with a 30-mm diameter spherical volume of interest (VOI) placed within the right lobe of the liver (above, below, and at the level of the main portal vein) by two expert readers. ANOVA, intraclass correlation coefficient (ICC), and Bland-Altman analysis were performed. RESULTS. The ICC for the first and second set of studies varied between 0.487 and 0.535 for reader 1 and between 0.472 and 0.545 for reader 2. The mean percentage variation for SULmean between the two time scans for the VOIs placed above, below, and at the level of the main portal vein were 3.55% ± 23.19%, 4.65% ± 23.87%, and 4.30% ± 23.03%, respectively, for reader 1 and 4.49% ± 23.23%, 4.33% ± 23.74%, and 4.48% ± 23.01%, respectively, for reader 2. Using 95% CI, the reference range for intrapatient variations between the studies in liver SULmean was -0.5 to 0.60. CONCLUSION. There is only fair repeatability of liver SULmean measured between two time points in the same patient in a clinical setting. Scan-to-scan intrapatient variation in absolute liver SULmean was -0.5 to 0.60.

FDG PET/CT in the management of colorectal and anal cancers.

OBJECTIVE: CT remains the imaging modality of choice in the diagnosis of colorectal cancer (CRC) and anal cancer. However, advances in imaging have expanded the role of MRI and PET/CT. This article focuses on the evolving role of FDG PET/CT in the diagnosis, radiation therapy planning, therapy assessment, and posttherapy monitoring of CRC and anal cancer. CONCLUSION: FDG PET/CT is a valuable imaging modality that impacts the clinical management of patients with CRC and those with anal cancer.

A Rasch analysis of the Danish version of the occupational balance questionnaire (OBQ11).

BACKGROUND: OBQ11 was developed in a Swedish context. To evaluate occupational balance, accurate self-rating instruments in the native language are needed. AIM: The aim was to investigate the measurement properties of the Danish version of OBQ11, using the Rasch analysis. METHOD: Data for the analysis of the Danish version of OBQ11 (OBQ11-DK) was gathered online, and all full data records (n 366) were included in the analysis. RESULTS: Three items showed non-significant marginal under- or overfit, suggesting a degree of misfit between the data and the Rasch model. Unidimensionality was not reached, though, since the proportion of persons with different estimates were more than 5% and thus the OBQ11-DK cannot be said to assess a person's perception of occupational balance. CONCLUSION: The present version of the OBQ11-DK shows the need for further development and testing and is not tested for test/retest or in clinical samples. The results and small number of items may after modifications and further studies make it feasible to implement OBQ11-DK into settings where the measuring of occupational balance is needed.

In Vivo Tracking and 3D Mapping of Cell Death in Regeneration and Cancer Using Trypan Blue.

Tracking cell death in vivo can enable a better understanding of the biological mechanisms underlying tissue homeostasis and disease. Unfortunately, existing cell death labeling methods lack compatibility with in vivo applications or suffer from low sensitivity, poor tissue penetration, and limited temporal resolution. Here, we fluorescently labeled dead cells in vivo with Trypan Blue (TBlue) to detect single scattered dead cells or to generate whole-mount three-dimensional maps of large areas of necrotic tissue during organ regeneration. TBlue effectively marked different types of cell death, including necrosis induced by CCl4 intoxication in the liver, necrosis caused by ischemia-reperfusion in the skin, and apoptosis triggered by BAX overexpression in hepatocytes. Moreover, due to its short circulating lifespan in blood, TBlue labeling allowed in vivo "pulse and chase" tracking of two temporally spaced populations of dying hepatocytes in regenerating mouse livers. Additionally, upon treatment with cisplatin, TBlue labeled dead cancer cells in livers with cholangiocarcinoma and dead thymocytes due to chemotherapy-induced toxicity, showcasing its utility in assessing anticancer therapies in preclinical models. Thus, TBlue is a sensitive and selective cell death marker for in vivo applications, facilitating the understanding of the fundamental role of cell death in normal biological processes and its implications in disease.

Functional tests in women with patellofemoral pain: Which tests make a difference in physical therapy evaluation.

BACKGROUND: Patellofemoral pain (PFP) is characterized by anterior knee, which intensifies during functional activities that require the eccentric action of the quadriceps muscle, specially. In ths way, quantitatively measurable functional tests that simulate these activities should be included in the physical therapy evaluation. OBJECTIVE: To identify which functional tests are most indicated for the evaluation of women with PFD. METHOD: This study evaluated 100 young women (50 with PFP), during the execution of the following functional performance tests: Triple hop, Vertical Jump, Single leg squat, Step Down, YBalance tests, Lunge test and running. Dynamic valgus was also assessed in the tests. The isometric muscle strength of the following muscle groups: hip abductors, extensors and lateral rotators, knee extensors, evertors, and plantar flexors were evaluated. Functional Perception were evaluated by Anterior Knee Pain Scale and Activities of Daily Living Scale. RESULTS: PFP group showed lower performance during the Y-Balance, triple hop, vertical jump tests and running. Was observed an increase in dynamic valgus during Triple Hop, Vertical Jump tests and running in PFP group, besides a poorer perception of function. For all lower limb muscle groups, the PFP group showed a reduction in peak isometric force. CONCLUSION: The YBalance, triple hop, vertical jump tests, and running should be included in the physical therapy evaluation, in addition to aspects of lower limb muscle strength.