[Exercise-induced laryngeal obstruction†: diagnosis and management]. / Obstruction laryngée induite à l'effort: méthodes diagnostiques et prise en charge.

Exercise-induced laryngeal obstruction (EILO) is a condition characterized by temporary narrowing or closure of the larynx during physical activity, in particular during intense physical exertion. It generally affects teenagers and young adults and is often misdiagnosed as exercise-induced asthma. Symptoms include dyspnea, wheezing and a feeling of throat tightness during exercise. The aim of this article is to review this often underrecognized condition, its diagnosis and its management.

L'obstruction laryngée induite à l'effort (EILO) est une affection caractérisée par le rétrécissement ou la fermeture temporaire du larynx au cours d'une activité physique, en particulier lors d'un effort physique intense. Elle touche généralement les adolescents et les jeunes adultes et est souvent diagnostiquée à tort comme de l'asthme d'effort. Les symptômes comprennent une dyspnée, une respiration sifflante et une sensation d'oppression au niveau de la gorge pendant l'exercice. Cet article passe en revue cette pathologie souvent méconnue, son diagnostic et sa prise en charge.

Correlation Theory of the Maxillary Central Incisor, Face and Dental Arch Shape in the Serbian Population.

Background and Objectives: According to the modified Williams theory, the shape of the maxillary central incisor corresponds to the shape of the maxillary alveolar ridge (dental arch) and the shape of the face. Moreover, the standards of beauty suggest that the center of the face of an individual with a full set of teeth should match the center of the maxillary and mandibular dental arches. The purpose of this study is to conduct a comparative cross-sectional study on the matching of the shape of the face, maxillary central incisor and maxillary dental arch as well as the matching of the midfacial line and dental arches in subjects with complete dentition. Materials and Methods: The study included 90 subjects of both sexes. The matching of the shape of the face and midfacial line, i.e., dental arches and maxillary incisors, was determined by analysing photographs, whereas the shape of the dental arch was determined by analysing plaster models. Results: No significant gender-related differences were found either in the shape of the maxillary central incisor that matched the shape of the maxillary dental arch (p = 0.349) or in the shape of the dental arch that matched the shape of the face (p = 0.697). However, a significant difference was noted in the shape of the teeth that matched the shape of the face (p = 0.043), which was more significantly impaired in men. In addition, the matching of the mid-face and the mid-dental arch was significantly greater in women (p = 0.016). Conclusions: The modified Williams theory was confirmed in most subjects, thus it can be considered a relevant guideline when determining the shape of teeth after their loss. The highest percentage of matching in both sexes was with the shape of the face and dental arch. There was no positive correlation between the middle of the maxillary and mandibular dental arch in most cases.

Opportunities for psychologists to advance health equity: Using liberation psychology to identify key lessons from 17 years of praxis.

Health and health care inequities persist because the efforts to eliminate them have ignored structural racism, typically using a power neutral approach to diagnose and solve the problem. Critical theory can address many of the conceptual weaknesses of current approaches, help identify how racism operates in health care, and open the door for more effective individual employee and organizational actions to advance health equity. We apply Martín-Baró's (1996) liberation psychology to lessons we learned through implementing a transdisciplinary national health and health care equity program. The program, which began in 2005, conducts equity-focused health services interventions and research, using the best available evidence to assist health and health care policymakers, payers, community-based organizations, care delivery organizations, and patients to transform and align their activities in order to advance health equity. It serves as a rare model to explore how misconceptions resulting from racist structures can hinder progress, even when everyone involved is highly motivated to address health and health care inequities. Liberation psychology guides our interpretation of the lessons learned and recommendations for the field of psychology. Psychologists advancing equity in health and health care should integrate liberation psychology and other critical theories into their own work. In addition, partnerships with other disciplines and communities outside of academia and professional health services are key to success. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Diagnostic value and prognostic significance of MRI findings in sudden sensorineural hearing loss.

Purpose: We evaluated the clinical significance of magnetic resonance imaging (MRI) findings and their prognostic value for initial hearing loss and recovery in patients with sudden sensorineural hearing loss (SSNHL). Materials and Methods: This retrospective study included consecutive adult patients with unilateral SSNHL, contrast-enhanced MRI and audiometric testing evaluated in our institution between 2005 and 2017. MRI reports, patient data, treatment, and audiometric tests were reviewed, with the relationship between MRI findings and hearing loss/recovery analyzed. Results: Overall, 266 patients were included. Additional symptoms comprised tinnitus (114/266; 43%), vertigo (45/266; 17%), ear pain (26/266; 10%), and ear pressure (6/266; 2%). At least one cardiovascular risk factor (hypertension, diabetes, hypercholesterolemia, cardiopathy, and active smoking) existed in 167/266 (63%) patients. Corticosteroid treatment was followed by 198/266 (74%) patients while contraindications/refusal/compliance precluded treatment in 68/266(26%). Complete, partial or slight hearing recovery occurred in 167/266 (63%) patients. Three MRI patient groups were identified: a group with normal MRI examinations or incidentalomas (128/266; 48%), a group with peripheral auditory system (PAS) lesions (95/266; 36%), and a group with central nervous system (CNS) lesions (43/266; 16%). PAS lesions included lesions from the cochlea to the brain stem (e.g., schwannoma, meningioma, labyrinthitis, intracochlear hemorrhage, vestibulocochlear neuritis), whereas CNS lesions corresponded in 42/43(98%) of cases to leukoaraiosis and other vascular lesions (e.g., stroke, hemorrhage, aneurysm, venous sinus thrombosis, and cavernoma). Belonging to one of the three MRI groups did not influence the degree of initial hearing loss, affected frequencies or treatment, p > .05. Gender and cardiovascular risk factors did neither affect initial hearing loss nor recovery. However, age > 70 years negatively affected initial hearing loss in all frequencies, as well as recovery in all frequencies except 1000 Hz. Also, poor recovery of initial high-frequency hearing loss (>1000 Hz) was significantly associated with CNS lesions. Conclusion: Age > 70 years and CNS lesions depicted by MRI independently predicted poor auditory recovery, albeit in different frequencies. Lay Summary: In patients with sudden hearing loss, older age (above 70 years) predicts poorer hearing recovery than in younger patients in most hearing frequencies. In addition, abnormalities of brain tissue revealed by MRI predict poorer hearing recovery at high frequencies. Level of Evidence: Level III.

The robotic-assisted extended "Sistrunk" approach for tumors of the upper aerodigestive tract with limited transoral access: First description of oncological and functional outcomes.

We report on the first clinical experience with the robotic-assisted extended "Sistrunk" approach (RESA) for access to constrained spaces of the upper aerodigestive tract. This prospective case cohort study include six patients that underwent RESA if transoral exposure could not be achieved. Three patients received previous radiation. Patients were postoperatively followed until week 16 for perioperative complications, surgical margins, and functional outcomes. In all patients RESA allowed adequate exposure and resection with negative margins. Three patients who underwent salvage surgery experienced a minor or intermediate grade postoperative bleeding. No patient developed a pharyngocutaneous fistula. Three patients recovered their swallowing to their preoperative status and the remaining three experienced an improvement. All patients experienced complete recovery of their voice. RESA has the potential to provide a new organ preservation approach for head and neck cancer (HNC) not amenable to transoral exposure and thus warrants further prospective clinical studies.

Polymethyl methacrylate resin for provisional restoration affects rat macrophage function in in vitro conditions.

PURPOSE: This study evaluated the cytotoxic effects of polymethyl methacrylate resin extracts on rat macrophage viability in in vitro conditions. METHODS: Prepared test specimens were immersed in 5 mL of artificial saliva and incubated for 24, 48, and 72 h at 37°C. The cytotoxicity of the obtained solutions of extracted resins, used as a stock solution (100%) and diluted with Roswell Park Memorial Institute (RPMI) medium to obtain the working solutions (50, 40, 30, 20, 10, and 5%), was evaluated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. RESULTS: No dose-dependent toxic activity in macrophage culture was detected for the three types of extracts obtained after 24, 48, and 72 h of material extraction. The shortest extraction of material was found to be completely non-toxic, and the 20% concentration of this extract obtained caused a significant increase in cell ability to metabolize MTT. Extracts obtained after 72 h of extraction showed the highest cytotoxic potential of 50%, 40% and 30%, and extracts obtained after 48 and 72 h of extraction at concentrations of 5% and 10% had a proliferative effect on the macrophage cell line. CONCLUSION: This study demonstrated that the highest cytotoxic effect was observed in cells exposed to the highest concentrations (50, 40, and 30%) of the extracts that were extracted for 72 h.

Application of the Kvaal Method in Age Estimation of the Serbian Population Based on Dental Radiographs.

This study aimed to evaluate the applicability of the Kvaal method in determining the age of a Serbian population. In this retrospective descriptive study, 170 dental patients (age range 16-77 years) were included. The measurements of six types of teeth were performed on digital orthopantomography radiographs according to the Kvaal method. Statistical inter-observer and intra-observer reliabilities were calculated to evaluate the reproducibility of the measurements, as well as to examine the correlation between chronological age and measured values. The evaluation revealed a substantial difference (over 12 years) between chronological and estimated age. The P ratio had the strongest correlation with chronological age for the maxillary central (r = ±0.293) and lateral incisors (r = ±0.240), whereas the pulp/root width ratio at level A had the strongest correlation for the mandibular first premolars (r = ±0.270). The lowest SD values, for measurements on teeth 15/25 (SD = 125,787), had the most accurate correlation with age. Thus, we can conclude that the original Kvaal method is not applicable in the age estimation of the Serbian population. For future research, we suggest using cone beam computer tomography as a precise technology to evaluate the applicability of Kvaal and other methods for age estimation.

Critical Theory, Culture Change, and Achieving Health Equity in Health Care Settings.

Achieving optimal health for all requires confronting the complex legacies of colonialism and white supremacy embedded in all institutions, including health care institutions. As a result, health care organizations committed to health equity must build the capacity of their staff to recognize the contemporary manifestations of these legacies within the organization and to act to eliminate them. In a culture of equity, all employees-individually and collectively-identify and reflect on the organizational dynamics that reproduce health inequities and engage in activities to transform them. The authors describe 5 interconnected change strategies that their medical center uses to build a culture of equity. First, the medical center deliberately grounds diversity, equity, and inclusion efforts (DEI) in critical theory, aiming to illuminate social structures through critical analysis of power relations. Second, its training goes beyond cultural competency and humility to include critical consciousness, which includes the ability to critically analyze conditions in the organizational and broader societal contexts that produce health inequities and act to transform them. Third, it works to strengthen relationships so they can be change vehicles. Fourth, it empowers an implementation team that models a culture of equity. Finally, it aligns equity-focused culture transformation with equity-focused operations transformation to support transformative praxis. These 5 strategies are not a panacea. However, emerging processes and outcomes at the medical center indicate that they may reduce the likelihood of ahistorical and power-blind approaches to equity initiatives and provide employees with some of the critical missing knowledge and skills they need to address the root causes of health inequity.

[COVID-related ENT affections: acute management and issues of rehabilitation strategy]. / Atteintes ORL liées au Covid : prise en charge aiguë et enjeux de la stratégie rééducative.

The ENT specialist manages patients with SARS-CoV-2 infection in the acute phase as well as in the long-term sequelae. Acute management includes evaluation of patients with prolonged orotracheal intubation, surgical tracheostomies and monitoring of their weaning as well as airway assessment. Long-term sequelae include olfactory disorders, upper airway damage, laryngeal damage and their functional consequences : dyspnea, dysphonia and dysphagia. ENT symptoms after SARS-CoV-2 infection have an impact on patients' morbidity and quality of life. We created an ENT Task Force at the CHUV to better organize medical management. This article summarizes the main points.

Le spécialiste ORL prend en charge les patients avec infection due au SARS-CoV-2, en aigu mais aussi dans le cadre des séquelles à long terme. La prise en charge aiguë comprend l'évaluation des patients avec intubation orotrachéale prolongée, la réalisation de trachéotomies et le suivi de leur sevrage ainsi qu'un bilan des voies aériennes. Les séquelles à long terme comprennent les troubles olfactifs et du goût, les lésions des voies aériennes supérieures, les atteintes laryngées et leurs conséquences fonctionnelles : dyspnée, dysphonie et dysphagie. Les symptômes ORL liés au SARS-CoV-2 ont un impact sur la morbidité et la qualité de vie des patients. Une Task Force ORL a été créée au sein du CHUV pour mieux coordonner la prise en charge. Cet article en résume les principaux axes.

Unincorporated Health: Understanding Residents' Perspectives on Factors Impacting Their Health and Emergent Place-Based Solutions.

Increased mortality rates and decreased life expectancy in the United States are associated with rurality, even after adjusting for poverty. In unincorporated rural communities, high population density may compound the negative health impact of the upstream factors associated with rurality, yet little is known about how this context contributes to residents' health. We conducted nine focus groups with youth and adults from March-July 2017 in two Texas unincorporated rural communities. Using ecosocial theory and applied thematic analysis for focus groups, we investigated social, political, and historical factors that affect health. We identified two primary themes: upstream barriers to community health and K-12 schools as facilitators of community health. K-12 schools, and full-service community schools, in particular, may have an important role in closing the rural-urban health gap, even in the context of structural constraints associated with unincorporated rural status.

Reframing school-based restorative justice as a structural population health intervention.

School-based restorative justice has gained national prominence as an effective approach to interrupting the school-to-prison pipeline. Remarkably, despite its simultaneous positive association with academic success, school safety, and school connectedness, most scholars and practitioners do not associate restorative justice with health. Using ecosocial theory, we conceptualize school-based restorative justice as a structural population health intervention. Our findings indicate that students attending schools using restorative justice have lower odds of missing school due to adverse health and better academic outcomes compared to students who do not. Restorative justice shows promise as a structural intervention that can contribute to improving population health.

Assessment of the impact of temporomandibular disorders on maximum bite force.

AIM: Temporomandibular disorders (TMD) refer to functional disorders of the masticatory system, temporomandibular joint (TMJ) and masticatory muscles. The main objective of this study was to determine whether and to what extent temporomandibular disorders (TMD) affect the maximum bite force (MBF). METHODS: The present study included subjects with and without temporomandibular disorder. The presence of TMD was assessed by means of the Helkimo clinical dysfunction index analysis. We measured the maximum bite pressure (MBP) and occlusal contact area (OCA) by means of a Fuji Prescale Pressure measurement film. Based on the MBP and OCA values obtained, MBF values were determined. RESULTS: The MBF values were significantly lower in patients with TMD compared to subjects without TMD (P Conclusion: TMDs have a significant impact on MBF and masticatory muscle action potential. More research is needed to determine the impact of reduced maximum bite force on the functional efficiency of the masticatory system.

Bamboo Nodes of Vocal Folds: A Description of 10 Cases and Review of the Literature.

OBJECTIVE: Bamboo nodes are vocal fold lesions, mostly associated with autoimmune diseases. PATIENTS AND METHODS: This is a retrospective clinical study including 10 patients with bamboo nodes. Data were collected regarding associated autoimmune disorder and type of treatment. A systematic review of the literature was conducted. RESULTS: All patients were women, with hoarseness as the most frequent symptom. There was in most cases an associated autoimmune disease: 3 patients with systemic lupus erythematosus; 3 with rheumatoid arthritis; 1 with Sjögren syndrome; 1 with Hashimoto disease; and 1 with mixed connective tissue disease. Four patients were treated with speech therapy, 3 with oral steroids, 1 with speech therapy and oral steroids combined, 1 with oral steroids and laryngeal steroid injections, and 1 had oral steroids, surgery, and speech therapy. Speech therapy was the first-line treatment. CONCLUSION: Bamboo nodes should be looked for in every patient with a diagnosis of autoimmune disease complaining of dysphonia.

Why Do Parotid Pleomorphic Adenomas Recur? A Systematic Review of Pathological and Surgical Variables.

BACKGROUND: The recurrence of pleomorphic adenoma (PA) has been extensively debated, mostly in relation to the extent of parotidectomy. METHODS: A systematic review was undertaken to clarify the surgical and pathological variables related to PA recurrence. Inclusion criteria were as follows: English literature, and prospective or retrospective studies. Exclusion criteria were as follows: single case reports, reviews, and lack of PA recurrence data. RESULTS: Pathology-related variables associated with recurrence include the histological subtype, the thickness and incompleteness of the tumor capsule, pseudopodia, and satellite nodules. Surgery-related variables associated with recurrence are the presence of intact margins and tumor puncture or spillage. Other factors are the size of the tumor and the age of patient. Myxoid subtypes of PA tend to have incomplete and thinner capsules and to recur more frequently. Surgical variables related to recurrence include positive margins and tumor spillage. CONCLUSION: Myxoid and/or large PA, especially in young patients, should be approached more cautiously to avoid recurrences.

[Vestibular and visual stimulation : simultaneous perception or not ?] / Stimulation vestibulaire et visuelle : perception simultanée ou pas ?

The human brain is able to consider that two sensory stimuli are synchronous while they activate the cortex with some delay because they follow different neurological pathways. This process is only possible if the time interval between the two stimuli does not exceed a certain limit, called "Temporal Binding Window" (TBW). Studies of this parameter, involving the vestibular perception, are difficult because subjects must be moved, which generates parasitic proprioceptive information. By cons, in patients equipped with a vestibular implant, it is possible to generate a vestibular perception selectively by electrical stimulation of the vestibular nerve. These patients are therefore an unique model to study the TBW between visual and vestibular perception.

Le cerveau humain est capable de considérer que deux stimuli sensoriels sont synchrones alors qu'ils activent le cortex avec un décalage temporel dû au fait qu'ils suivent des voies neurologiques différentes. Ce processus n'est possible que si l'intervalle de temps entre les deux stimuli ne dépasse pas un certain délai, qu'on appelle « Temporal Binding Window ¼ (TBW). Etudier ce paramètre en mettant en jeu la perception vestibulaire est difficile puisqu'il faut bouger le sujet et donc générer aussi des informations proprioceptives. Par contre, chez les patients porteurs d'un implant vestibulaire, il est possible de délivrer une perception vestibulaire de façon sélective par stimulation électrique du nerf vestibulaire. Ces patients représentent donc un modèle unique pour étudier le TBW entre les perceptions visuelle et vestibulaire.

Trends in the disapproval and use of marijuana among adolescents and young adults in the United States: 2002-2013.

BACKGROUND: Despite policy changes related to the use and distribution of marijuana in cities and states across the country, few studies have examined changes in disapproval and use of marijuana among American youth. OBJECTIVES: To examine trends in disapproval and use of marijuana among adolescents and young adults in the United States. METHOD: We employed nationally representative data spanning the period of 2002-2013. Analyses were based on self-reported measurements from 105,903 younger adolescents (aged 12-14); 110,949 older adolescents (aged 15-17); and 221,976 young adults (aged 18-25). RESULTS: Between 2002 and 2013 the proportion of adolescents aged 12-14 reporting "strong disapproval" of marijuana use initiation increased significantly from 74.4-78.9%. Concurrently, a significant decrease in past 12-month marijuana use (OR = 0.98, 95% CI = 0.97-0.99) was observed among younger adolescents. No significant trend was observed for marijuana use disapproval among adolescents aged 15-17 between 2002 and 2013. Yet a significant (OR = 0.99, 95% CI = 0.98-0.99) decrease in the past 12-month marijuana use was observed (2002 = 26.2%, 2013 = 21.9%) among this group. Among young adults (aged 18-25), a substantial decrease - from 40.5% in 2002 to 22.6% in 2013 - was observed in the proportion reporting "strong disapproval" of marijuana use initiation; however, increases in the past 12-month use were relatively small among young adults (Δ = 2.21) but statistically significant (OR = 1.02, 95% = 1.01-1.02). CONCLUSIONS: Changes are underway in the perception and use of marijuana among American youth. However, changes differ in important ways among youth from distinct developmental subgroups.

Substance use and teen pregnancy in the United States: evidence from the NSDUH 2002-2012.

INTRODUCTION: Few, if any, studies have systematically examined the relationship between substance use and teen pregnancy using population-based samples. We aim to provide a comprehensive examination of substance use among pregnant adolescents in the United States. METHOD: Employing data from the National Survey on Drug Use and Health between 2002 and 2012 (n=97,850), we examine the prevalence of the past 12-month and the past 30-day substance use and substance use disorders among pregnant and non-pregnant adolescents (ages 12-17). We also examine psychosocial and pregnancy-related correlates of current substance use among the subsample of pregnant adolescents (n=810). RESULTS: Pregnant teens were significantly more likely to have experimented with a variety of substances and meet criteria for alcohol (AOR=1.65, 95% CI=1.26-2.17), cannabis (AOR=2.29, 95% CI=1.72-3.04), and other illicit drug use disorders (AOR=2.84, 95% CI=1.92-4.19). Pregnant early adolescents (ages 12-14; AOR=4.34, 95% CI=2.28-8.26) were significantly more likely and pregnant late adolescents (ages 15-17; AOR=0.71, 95% CI=0.56-0.90) significantly less likely than their non-pregnant counterparts to be current substance users. CONCLUSIONS: Study findings point not only to a relationship between pregnancy and prior substance use, but also suggest that substance use continues for many teens during pregnancy. We found that substance use is particularly problematic among early adolescents and that the prevalence of substance use attenuates dramatically as youth progress from the first to the second and third trimesters of pregnancy.

Correlation analysis of craniomandibular index and gothic arch tracing in patients with craniomandibular disorders.

BACKGROUND/AIM: Complex etiology and symptomatology of craniomandibular dysfunction make the diagnosing and therapy of this disorder more difficult. The aim of this work was to assess the value of clinical and instrumental functional analyses in diagnosing of this type of disorders. METHODS: In this study 200 subjects were examined, 15 with temporomandibular joint disorder. They were subjected to clinical functional analysis (Fricton-Shiffman) and instrumental functional analysis by using the method of gothic arch. The parameters of the gothic arch records were analyzed and subsequently compared among the subjects of the observed groups. RESULTS: In the examined group of the population 7.5% of them were with craniomandibular dysfunction. The most frequent symptoms were sound in temporomandibular joint, painful sensitivity of the muscles on palpation and lateral turning of the lower jaw while opening the mouth. By analyzing the gothic arch records and comparing the obtained values between the observed groups it was assessed that: lateral and protrusion movements, lateral amplitude and the size of gothic arch were much bigger in the healthy subjects, and latero-lateral asymmetry was larger in the sick subjects. Latero-lateral dislocation of apex was recorded only in the sick subjects with average values of 0.22 +/- 0.130 mm. The correlation between the values of Fricton-Shiffman craniomandibular index and the parameters of the gothic arch records and latero-lateral amplitude and dislocation of apex records were established by correlative statistical analysis. CONCLUSION: Functional analysis of orofacial system and instrumental analysis of lower jaw movements (gothic arch method) can be recommended as precise and simple methods in diagnosing craniomandibular dysfunctions.