Predicting value for incomplete recovery in Bell's palsy of facial nerve ultrasound versus nerve conduction study.

OBJECTIVE: This longitudinal study aims at assessing the predictive value of facial nerve high-resolution ultrasound (HRUS) for incomplete clinical recovery in patients with Bell's palsy, the most common facial nerve disease. METHODS: We prospectively enrolled 34 consecutive patients with Bell's palsy. All patients underwent neurophysiological testing (including facial nerve conduction study) and HRUS evaluations 10-15 days (T1), one month (T2), and three months (T3) after the onset of Bell's palsy. Patients who did not experience complete recovery within three months were also evaluated after six months (T4). We have then compared the accuracy of HRUS with that of the facial nerve conduction study in predicting incomplete clinical recovery at three and six months. RESULTS: At T1, the facial nerve diameter, as assessed with HRUS, was larger on the affected side than on the normal side, particularly in patients with incomplete recovery at T2, T3 and T4. ROC curve analysis, however, showed that the facial nerve diameter at T1 had a lower predictive value than the facial nerve conduction study for an incomplete clinical recovery at three (T3) and six (T4) months. Still, the facial nerve diameter asymmetry, as assessed with HRUS, had a relatively high negative predictive value (thus indicating a strong association between normal HRUS examination and a good prognosis). CONCLUSIONS: Although HRUS shows abnormally increased facial nerve diameter in patients in the acute phase of Bell's palsy, the predictive value of this technique for incomplete clinical recovery at three and six months is lower than that of the nerve conduction study. SIGNIFICANCE: Nerve ultrasound has a low predictive value for incomplete clinical recovery in patients with Bell's Palsy.

Systematic review and meta-analysis of non RCT's on health related quality of life after radical cystectomy using validated questionnaires: Better results with orthotopic neobladder versus ileal conduit.

PURPOSE: The current literature on the impact of different urinary diversions on patients' health related quality of life (HR-QoL) showed a marginally better quality of life scores of orthotopic neobladder (ONB) compared to ileal conduit (IC). The aim of this study was to update the review of all relevant published studies on the comparison between ONB and IC. MATERIALS AND METHODS: Studies were identified by searching multiple literature databases, including MEDLINE, CINAHL, the Cochrane Library, PubMed Data were synthesized using meta-analytic methods conformed to the PRISMA statement. RESULTS: The current meta-analysis was based on 18 papers that reported a HR-QoL comparison between IC and ONB using at least a validate questionnaire. Pooled effect sizes of combined QoL outcomes for IC versus ONB showed a slight, but not significant, better QoL in patients with ONB (Hedges' g = 0.150; p = 0.066). Patients with ileal ONB showed a significant better QoL than those with IC (Hedges' g = 0.278; p = 0.000); in case series with more than 65% males, ONB group showed a slight significant better QoL than IC (Hedges' g = 0.190; p = 0.024). Pooled effects sizes of all EORTC-QLQ-C30 aspects showed a significant better QoL in patients with ONB (Hedges' g = 0.400; p = 0.0000). CONCLUSIONS: This meta-analysis of not-randomized comparative studies on the impact of different types of urinary diversions on HR-QoL showed demonstrated a significant advantage of ileal ONB compared to IC in terms of HR-QoL.

Low vitamin D intake is associated with increase in cardiovascular risk factors in obese adolescents.

OBJECTIVES: This study aimed to investigate the effect of vitamin D on cardiovascular risk in obese adolescents. METHODS: Thirty (16 females/14 males) post-puberty obese adolescents (15-19 years) were involved and measurements of inflammatory biomarkers, body composition, visceral fat, and vitamin D (serum and intake) were performed. The adolescents were submitted to a long-term interdisciplinary therapy with physical exercise, nutritional, psychological, and clinical interventions. RESULTS: Negative correlations between vitamin D intake with plasminogen activator inhibitor-1 (PAI-1) (r=-0.69; p=0.01) and vascular cell adhesion molecule (VCAM-1) (r=-0.82; p=0.001) were found in the population analyzed. Improvement in PAI-1, VCAM-1, body composition, and visceral fat, were observed. CONCLUSIONS: We showed that low vitamin D intake is associated with an increase in the cardiovascular risk factors in obese adolescents.

Sleep patterns and acute physical exercise: the effects of gender, sleep disturbances, type and time of physical exercise.

AIM: Aim of the study was to determine which factors influence sleep patterns after a single session of physical exercise. METHODS: Adult sedentary volunteers (N.=221; 104 men and 117 women) aged 31.40±9.40 were randomised into groups with three different types of physical exercise (resistance, aerobic and interval). After the exercise protocol was explained, each volunteer was given the first polysomnographic (PSG) and performed the acute session of physical exercise (resistance: based on a 1RM test; aerobic: based on a maximum effort test (MET) and interval: 10 series with 4-minute intervals between series). The second PSG was performed the day after the acute session of physical exercise. RESULTS: A negative correlation was found between sleep latency and the acute physical exercise session practiced in the evening, and a positive correlation was found between the total sleep time and female gender. The REM sleep stage (%) was positively correlated with the control, obstructive sleep apnea (OSA) and periodic leg movement (PLM) groups and the acute physical exercise session practiced in the morning. Positive correlations were observed in the arousal index and the PLM group and female gender; the PLM index and the control and OSA groups; minimum oxygen saturation and the OSA and PLM groups. CONCLUSION: Therefore, these results suggested that such factors as gender, the presence of sleep disturbance (PLM and/or OSA), type of physical exercise (aerobic, resistance or interval) and the time that it was practiced (morning, afternoon or evening) can influence sleep patterns after a single session of physical exercise. However, the gender seems to be the most important factor to influence sleep pattern in the situation studied.

Effects of different physical exercises on leptin concentration in obese adolescents.

In order to compare the effects of leisure physical activity (LPA), aerobic training (AT) and aerobic plus resistance training (AT + RT) as part of a 6-month interdisciplinary therapy in body composition, insulin resistance and leptin concentrations in obese adolescents, 72 volunteers (n = 24 in each group) ages 15-19 years were evaluated. Delta (Δ) body mass (kg) and Δ BMI (kg/m(2)) was different between AT and LPA groups and in AT + RT group compared to both LPA and AT groups; Δ body fat mass (kg and %) was different only in AT + RT group compared to both LPA and AT; Δ body lean mass (%) was different only in AT + RT group; Δ body lean mass (kg) was negative only in AT and positive and different from AT in AT + RT group; ΔHOMA-IR did not differ among groups; Δ leptin (ng/ml) was negative and different from LPA for both AT and AT + RT groups. In conclusion, both AT and AT + RT promoted a reduction on leptin levels, however, the adolescents subjected to AT + RT presented better results in body composition than the AT group. These results highlight the importance of associating aerobic and resistance training with nutritional and psychological approaches in the treatment of obese adolescents.

Evaluating urinary continence and preoperative predictors of urinary continence after robot assisted laparoscopic radical prostatectomy.

PURPOSE: We evaluated urinary continence using a validated questionnaire in a series of consecutive patients who underwent robot assisted laparoscopic radical prostatectomy, and identified the preoperative predictors of the return to urinary continence. MATERIALS AND METHODS: The clinical records of 308 consecutive patients who underwent robot assisted laparoscopic radical prostatectomy for clinically localized prostate cancer at a tertiary academic center were prospectively collected. All patients were continent before surgery. Urinary continence was evaluated using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form instrument. All of the patients reporting no leak in response to the question, "How often do you leak urine?" were defined as continent. RESULTS: A total of 273 patients (90%) were continent 12 months after robot assisted laparoscopic radical prostatectomy. Continent patients were significantly younger (61.4 +/- 6.4 vs 64.1 +/- 6.1 years, p = 0.02) than those who were incontinent. On univariable regression analysis patient age at surgery (OR 1.075, p = 0.024) and Charlson comorbidity index (OR 1.671, p = 0.007) were significantly associated with 12-month continence status. On multivariable analysis age (OR 1.076, p = 0.027) and Charlson comorbidity index (OR 1.635, p = 0.009) were independent predictors of continence rates. CONCLUSIONS: Using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form 90% of patients undergoing robot assisted laparoscopic radical prostatectomy reported no urine leak 12 months after surgery. Patient age at surgery and Charlson comorbidity index were independent predictors of the return to urinary continence, whereas notably no variable related to prostate cancer was significantly correlated with urinary continence.

Speech perception results in children implanted with Clarion devices: Hi-Resolution and Standard Resolution modes.

CONCLUSIONS: Formal testing showed that HiRes users seem to make significant use of acoustic information. Furthermore, from observations reported by experienced care-givers, for example, family, teachers and speech therapists, these children learn a lot from their surrounding environment. Incidental learning, which takes place when acquiring skills or knowledge through naturally occurring events, is a key become available to these deaf paediatric cochlear implant recipients. OBJECTIVE: To compare speech perception skills in children with a Clarion cochlear implant using different speech coding strategies, such as continuous interleaved sampling (CIS), simultaneous analogue stimulation (SAS) and Hi-Resolution (HiRes). MATERIAL AND METHODS: The study population comprised 40 children, 17 implanted with a Clarion Hi-Focus 1.2 and 23 with a Clarion CII. All children were pre-lingually deaf and differed in terms of age and cause of deafness. All children had undergone a trial (minimum 6 months) with hearing aids before implantation. Children implanted with a Clarion 1.2 were either CIS or SAS users [Standard Resolution mode (SRM) group]; children implanted with a Clarion CII were Hi-Resolution users [Hi-Resolution mode (HRM) group]. Findings were assessed according to-Erber's hierarchical model (detection, discrimination, identification, recognition and comprehension), making use of a battery of speech perception tests calibrated to the age of the child. Further information concerning use of the implant in everyday situations was obtained by means of the Meaningful Auditory Integration Scale (MAIS) questionnaire, which was administered to the parents. Tests were carried out prior to each fitting session, at switch-on and then at 3, 6, 9 and 12 months. Findings at pre-implantation and at 12 months follow-up were collected for both the SRM and HRM groups. Speech perception results were analysed for the SRM and HRM groups, independent of age at implantation, for five subgroups of children according to the paediatric test battery in use and for two subgroups of children, one < and one > 5 years of age. RESULTS: Clarion-implanted children using the Hi-Resolution strategy can develop better speech perception skills at 12 months post-implantation compared to children fitted with the SAS or CIS strategy. SAS or CIS users implanted before the age of 5 years tend to achieve better results at 1 year follow-up than children implanted later. In contrast, in Hi-Resolution users, a trend towards better results for recognition and comprehension tasks was observed in children implanted after 5 years of age.

Short-term study of the effect of speech coding strategy on the auditory performance of pre- and post-lingually deafened adults implanted with the Clarion CII.

OBJECTIVE: The auditory performance of cochlear implantees is linked to numerous variables, such as audiological characteristics, age and type of speech coding strategy. In recent years, many different ways of processing sounds have been developed, with possible implications for auditory performance. The purpose of this study was to evaluate the intra-individual differences of patients for speech perception tasks in quiet and in noise as a result of switching from a standard strategy [Continuous Interleaved Sampling (CIS)/Simultaneous Analog Strategy (SAS)] to Hi-Resolution (HiRes). MATERIAL AND METHODS: A total of 14 post-lingual adults implanted with the Clarion CII were selected for trials. At switch-on, six patients chose a CIS strategy and eight an SAS strategy. After an average period of 9.3 months, all patients were switched over to HiRes. All patients were tested (open-set mode) with bisyllabic words and sentences, in both quiet and noise [speech/noise ratio (SNR) = +10]. Testing was carried out after an initial period with the CIS/SAS strategy and 3 months after switching over to HiRes. RESULTS: After switch-over a significant improvement was seen for both speech in quiet (words +25.2%, sentences +10.8%) and speech in noise (words 44.8%, sentences 45.4%). CONCLUSION: Despite individual differences, all patients improved their performance with HiRes use, the greatest improvements being seen under unfavourable listening conditions (SNR = +10). Subjective improvements in speech discrimination and overall sound quality perception were reported even after the first week of HiRes use.

Compression of SAR raw data through range focusing and variable-rate trellis-coded quantization.

There is an ever-growing interest in the compression of SAR data because of the huge resources required for storage and transmission. This is especially true for spaceborne sensors, given the limited capacity of the downlink channel. Unfortunately, SAR data lack the useful properties on which compression algorithms rely; indeed, these are present in the focused images, but focusing is too complex for on-board implementation at this time. Poggi et al. (2000) proposed to perform on the satellite only the low-complexity range focusing, which increases the data correlation and better concentrates their energy. These properties were then exploited by adopting a variable-rate vector quantizer, with a clear performance improvement with respect to reference techniques. However, vector quantization (VQ) is too complex for actual on-board implementation, and therefore, here we replace VQ with trellis-coded VQ. To limit complexity, only small vectors are used, which reduces VQ's ability to exploit data dependencies; on the other hand, trellis coding allows one to encode large blocks of data at once, and to obtain a better partition of the input space. Experiments on real SAR data show that the overall performance is comparable to that of Poggi et al., but the complexity is much lower, making on-board implementation possible.

[Approach in acute respiratory tract disfunction] / Abordagem na disfunção respiratória aguda.

OBJECTIVE: To present a review of the current diagnostic and therapeutic approach to the major conditions found in pediatric emergency department, which course with acute respiratory tract disfunction, stressing some clinical and epidemiological characteristics that are useful to the pediatrician in the differential diagnosis.METHODS: Outstanding articles related to the subject were selected after literature review of the last 20 years, using Md Consult, Medline and Lilacs databases.RESULTS: Many diseases can produce respiratory disfunction. Taking into account only those with acute symptoms, infectious and/or inflammatory causes predominate. History, examination findings and at least a chest X-ray are almost always sufficient for the diagnosis, but, sometimes other complimentary tests are necessary.CONCLUSIONS: If not properly treated, acute respiratory emergencies can result in significant morbidity and mortality. Any pediatrician taking part in an emergency team has to obtain respiratory management skills and knowledge concerning distinctive aspects and severity estimation of the several respiratory diseases.

Nutrient and oxygen redistribution during a spring neap tidal cycle in a temperature estuary.

Spring tidal currents produce homogeneous water columns in a number of estuaries that are moderately stratified during neap tides. In the York River estuary, this destratification redistributes ammonium and phosphate regenerated by the benthos as well as oxygen from the surface. This redistribution has significant implications for nutrient cycles, organism distributions, and the management of estuaries.

Endocytic mechanisms of the digestive cells of Hydra viridis. 1. Morphological aspects.

The endocytic mechanisms of the digestive cells of Hydra viridis were examined by transmission electron microscopy. Algae which form a stable intracellular symbiosis are phagocytosed by uncoated plasmalemma, as are large (greater than 0.5 micron) food particles. Discoidal coated vesicles apparently effect the endocytosis of smaller particles, including macromolecules. Competition experiments indicate that the uptake of algae and larger food particles utilize similar endocytic membrane.