A retrospective study on the outcomes of stapedotomy with vein graft interposition and vein graft surround techniques

OBJECTIVE

This study evaluated audiological outcomes of stapedotomy using two different techniques, vein graft interposition and vein graft surround, for sealing the stapes fenestra.

METHOD

A retrospective study of 130 patients who underwent stapedotomy for otosclerosis was performed. A total of 84 patients underwent the vein graft surround procedure and 46 underwent the vein graft interposition procedure. Post-operative hearing outcome was compared between them.

RESULTS

A total of 55 of 130 patients had a post-operative air-bone gap of less than 10 dB. A total of 57 patients had an air-bone gap within 20 dB. The average air-bone gap was 13.16 dB at 3 months with a mean improvement of 22.06 dB (11.98 dB for vein graft interposition and 13.80 dB for vein graft surround; p = 0.79).

CONCLUSION

There was no significant difference in hearing outcome between the two techniques. The vein graft interposition technique is preferred for large fenestra or stapedectomy cases and in cerebrospinal fluid gusher cases. The vein graft surround technique is easier to perform and preferred in small fenestra stapedotomy.

Sustained benefit of cognitive behaviour therapy for health anxiety in medical patients (CHAMP) over 8 years: a randomised-controlled trial

BACKGROUND

Health anxiety is an under-recognised but a frequent cause of distress. It is particularly common in general hospitals.

METHODS

We carried out an 8-year follow-up of medical out-patients with health anxiety (hypochondriasis) enrolled in a randomised-controlled trial in five general hospitals in London, Middlesex and Nottinghamshire. Randomisation was to a mean of six sessions of cognitive behaviour therapy adapted for health anxiety (CBT-HA) or to standard care in the clinics. The primary outcome was a change in score on the Short Health Anxiety Inventory, with generalised anxiety and depression as secondary outcomes. Of 444 patients aged 16-75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics, 306 (68.9%) were followed-up 8 years after randomisation, including 36 who had died. The study is registered with controlled-trials.com, ISRCTN14565822.

RESULTS

There was a significant difference in the HAI score in favour of CBT-HA over standard care after 8 years [1.83, 95% confidence interval (CI) 0.25-3.40, p = 0.023], between group differences in generalised anxiety were less (0.54, 95% CI -0.29 to 1.36), p = 0.20, ns), but those for depression were greater at 8 years (1.22, 95% CI 0.42-2.01, p < 0.003) in CBT-HA than in standard care, most in standard care satisfying the criteria for clinical depression. Those seen by nurse therapists and in cardiology and gastrointestinal clinics achieved the greatest gains with CBT-HA, with greater improvement in both symptoms and social function.

CONCLUSIONS

CBT-HA is a highly long-term effective treatment for pathological health anxiety with long-term benefits. Standard care for health anxiety in medical clinics promotes depression. Nurse therapists are effective practitioners.

The effects of N95 mask and face shield on speech perception among healthcare workers in the coronavirus disease 2019 pandemic scenario

OBJECTIVE

The current circumstances of the coronavirus disease 2019 pandemic necessitate the use of personal protective equipment in hospitals. N95 masks and face shields are being used as personal protective equipment to protect from aerosol-related spread of infection. Personal protective equipment, however, hampers communication. This study aimed to assess the effect of using an N95 mask and face shield on speech perception among healthcare workers with normal hearing.

METHODS

Twenty healthcare workers were recruited for the study. Pure tone audiometry was conducted to ensure normal hearing. Speech reception threshold and speech discrimination score were obtained, first without using personal protective equipment and then repeated with the audiologist wearing an N95 mask and face shield.

RESULTS

A statistically significant increase in speech reception threshold (mean of 12.4 dB) and decrease in speech discrimination score (mean of 7 per cent) was found while using the personal protective equipment.

CONCLUSION

Use of personal protective equipment significantly impairs speech perception. Alternate communication strategies should be developed for effective communication.

Adenomyosis:A Clinico-pathological Study

BACKGROUND

Adenomyosis is defined by the presence within the myometrium of benign endometrial glands and stroma. Several theories have evolved to explain the pathogenesis of adenomyosis. A third of adenomyosis cases are asymptomatic. Symptoms are however non-specific and are generally related to abnormal vaginal bleeding, pain, infertility, and feeling of pelvic mass. Adenomyosis do coexist with other pathological entities. Diagnosis is achieved through imaging and histology. Treatment could be medical, surgical or a combination of both. The objective of this study was to analyze diagnosed st stcases of adenomyosis, between 1 January 2007, and 31 December 2013 at the Jos University Teaching Hospital in relation to patient's age, common symptoms, and coexisting utero-cervical pathologies.

METHODOLOGY

The data from the Medical Records department, Radiology department, and Histopathology department at the Jos University Teaching Hospital, Jos, were mobilized. The information retrieved for each case included: age, symptoms, and coexisting utero-cervical lesions. Archival slides were reviewed to histologically confirm the diagnosis of adenomyosis. In cases with missing slides, archival tissue blocks were retrieved, sectioned into 5µm slides, stained with haematoxylin and eosin, and reviewed microscopically to confirm the diagnosis of adenomyosis.

RESULTS

One hundred and fifty seven (157) cases of adenomyosis were diagnosed at the Jos University Teaching Hospital. All cases were histologically diagnosed retrospectively after hysterectomy. The cases were divided into two broad groups: 107(68.2%) cases with adenomyosis only (A), and 50(31.8%) with coexistence of adenomyosis and leiomyoma (AL). The mean age for the general study population was 43.57+8.56, while those for A and AL groups were 44.37+9.12, and 41.86+6.99 respectively. The age group 41-50 years had the highest number of cases in both the A and AL groups: 53(49.5%) and 21(42.0%) cases respectively. The most frequent symptom was menorrhagia, occurring in 87(81.3%), 43(86.0%), and 130(82.8%) cases in the A, AL, and general population respectively.

CONCLUSION

Adenomyosis is commoner in the fourth decade of life. It commonly coexists with leiomyoma with menorrhagia being the most frequent symptom. Retrospective histology after a hysterectomy is the diagnostic tool for the disease in our center.

Microdamage induced by in vivo Reference Point Indentation in mice is repaired by osteocyte-apoptosis mediated remodeling

Reference Point Indentation (RPI) is a technology that is designed to measure mechanical properties that relate to bone toughness, or its ability to resist crack growth, in vivo. Independent of the mechanical parameters generated by RPI, its ability to initiate and propagate microcracks in bone is itself an interesting issue. Microcracks have a crucial biological relevance in bone, are central to its ability to maintain homeostasis. In healthy tissues, a process of targeted remodeling routinely repairs microcracks in a process mediated by osteocyte apoptosis. However, in diseases such as osteoporosis this process becomes deficient and microcracks can accumulate. Small animal models such are crucial for the study of such diseases, but it is technically challenging to create microcracks in these animals without causing outright failure. Therefore we sought to use RPI as a focal microdamage placement tool, to introduce microcracks to mouse long bones and investigate whether the same pathway mediates their repair as that described in other microdamage systems. We first used SEM to confirm that microdamage is formed RPI in mouse bone. Then, since RPI is carried out transdermally, we sought to confirm that no periosteal response occurred at the indented region. We then used a pan-caspase inhibitor (QVD) to determine whether osteocyte apoptosis plays the same pivotal role in microdamage repair in this model, as has been demonstrated in others. In conclusion, we validated that the microdamage-apoptosis-remodeling pathway is maintained with this method of microdamage induction in mice. We show that RPI can be used as a reliable and reproducible microdamage placement tool in living mouse long bones without inducing a periosteal response. We also used a caspase inhibitor, to block osteocyte apoptosis and thus abrogate the remodeling response to microdamage. This demonstrates that the well described microdamage repair system, involving targeted remodeling mediated by osteocyte apoptosis, is conserved in this novel mouse model using an in vivo RPI loading system.

Sunbed use and campaign initiatives in the Danish population, 2007-2009: a cross-sectional study

BACKGROUND

Denmark has experienced an increase in melanoma incidence since the 1960s. In 2007, a skin cancer prevention campaign was launched, one of the targets being the widespread use of sunbeds in Denmark. The antisunbed campaign comprised public affairs initiatives and campaign activities, which included the social media, with young people as the main target.

OBJECTIVE

The aim of this study was to describe the development in sunbed use after the start of the campaign in the period 2007-2009.

METHODS

A population-based sample of 14,514 respondents aged 15-59 years completed four questionnaires in 2007-2009 on artificial exposure to ultraviolet radiation. We examined the relations between sunbed use, time and demographic factors using logistic regression analysis.

RESULTS

The odds ratio (OR) for being a sunbed user in 2009 when compared with 2007 was 0.61 (0.54-0.69); in the age group of 15-19 years, the OR was 0.42 (0.30-0.69). In 2009, however, 23% of Danes (33% of 15-19-year-olds) still reported sunbed use within the past 12 months, and more than 50% had experienced sunburn caused by a sunbed. In 2009, the majority of the population, including the age group of 15-19 years, was in favour of restricting admission to sunbed parlours for children under 18 years.

CONCLUSIONS

Sunbed use in Denmark decreased concurrently with the campaign activities, with the largest change in the youngest age group, which was a prioritized target of the campaign. Results suggest that a legislative solution should be found to avoid exposure of a large proportion of children to ultraviolet radiation and to reduce future melanoma incidence.

Inception and movement of a 'subgrain boundary precursor' in ice under an applied stress, observed by X-ray synchrotron radiation Bragg imaging

Basal slip of dislocations, the easiest deformation mechanism of ice crystals, does not allow a response to any strain state. The first steps of another mechanism, with a moving subgrain boundary precursor region, which permits accommodating the effect of an applied load, is investigated on an ice single crystal, mainly using synchrotron radiation Bragg diffraction imaging. During this process, the evolution of the local integrated intensity shows that there is both a general multiplication of dislocations within the crystal and a movement of basal dislocations towards the surface. The 'subgrain boundary precursor' region evolves towards a classical grain boundary when further deformed.

Temporal effect of in vivo tendon fatigue loading on the apoptotic response explained in the context of number of fatigue loading cycles and initial damage parameters

Accumulation of damage is a leading factor in the development of tendinopathy. Apoptosis has been implicated in tendinopathy, but the biological mechanisms responsible for initiation and progression of these injuries are poorly understood. We assessed the relationship between initial induced damage and apoptotic activity 3 and 7 days after fatigue loading. We hypothesized that greater apoptotic activity (i) will be associated with greater induced damage and higher number of fatigue loading cycles, and (ii) will be higher at 7 than at 3 days after loading. Left patellar tendons were fatigue loaded for either 100 or 7,200 cycles. Diagnostic tests were applied before and after fatigue loading to determine the effect of fatigue loading on hysteresis, elongation, and loading and unloading stiffness (damage parameters). Cleaved Caspase-3 staining was used to identify and calculate the percent apoptosis in the patellar tendon. While no difference in apoptotic activity occurred between the 100 and 7,200 cycle groups, greater apoptotic activity was associated with greater induced damage. Apoptotic activity was higher at 7 than 3 days after loading. We expect that the decreasing number of healthy cells that can repair the induced damage in the tendon predispose it to further injury.

Endoglin differentially regulates TGF-β-induced Smad2/3 and Smad1/5 signalling and its expression correlates with extracellular matrix production and cellular differentiation state in human chondrocytes

OBJECTIVE

Transforming growth factor-β (TGF-β) plays a critical role in cartilage homeostasis and deregulation of its signalling is implicated in osteoarthritis (OA). TGF-β isoforms signal through a pair of transmembrane serine/threonine kinases known as the type I and type II TGF-β receptors. Endoglin is a TGF-β co-receptor that binds TGF-β with high affinity in the presence of the type II TGF-β receptor. We have previously shown that endoglin is expressed in human chondrocytes and that it forms a complex with the TGF-β signalling receptors. However, the functional significance of endoglin expression in chondrocytes is unknown. Our objective was to determine whether endoglin regulates TGF-β/Smad signalling and extracellular matrix (ECM) production in human chondrocytes and whether its expression varies with chondrocyte differentiation state.

METHOD

Endoglin function was determined by overexpression or antisense morpholino/siRNA knockdown of endoglin in human chondrocytes and measuring TGF-β-induced Smad phosphorylation, transcriptional activity and ECM production. Alterations in endoglin expression levels were determined during subculture-induced dedifferentiation of human chondrocytes and in normal vs OA cartilage samples.

RESULTS

Endoglin enhances TGF-β1-induced Smad1/5 phosphorylation and inhibits TGF-β1-induced Smad2 phosphorylation, Smad3-driven transcriptional activity and ECM production in human chondrocytes. In addition, the enhancing effect of endoglin siRNA knockdown on TGF-β1-induced Smad3-driven transcription is reversed by ALK1 overexpression. Furthermore, endoglin levels are increased in chondrocytes following subculture-induced dedifferentiation and in OA cartilage as compared to normal cartilage.

CONCLUSION

Together, our results suggest that endoglin regulates the balance between TGF-β/ALK1/Smad1/5 and ALK5/Smad2/3 signalling and ECM production in human chondrocytes and that endoglin may represent a marker for chondrocyte phenotype.

An interesting case of adenoviral hepatitis in a cardiac transplant recipient

Adenoviral infections are commonly described in pediatric transplant populations. However, much less information is available regarding the incidence of infection and clinical spectrum of disease in adult transplant recipients. Moreover, this infection usually manifests as involvement of the transplanted organ in one pathologic form or the other, in addition to other systemic manifestations. We present a case of adenoviral infection of a nontransplanted organ in a solid organ transplant recipient.

Absence of association of asporin polymorphisms and osteoarthritis susceptibility in US Caucasians

OBJECTIVE

An association between osteoarthritis (OA) and functional polymorphisms in the aspartic acid (d) repeat of the asporin (ASPN) gene was reported in Japanese and Han Chinese populations. The aim of this study was to assess the association of variants in the ASPN gene with the presence of radiographic hand and/or knee OA in a US Caucasian population.

METHODS

Ten single nucleotide polymorphisms (SNPs) within the ASPN gene were genotyped in 775 affected siblings with radiographically confirmed hand and/or knee OA, and the allelic, genotypic and haplotypic association results were examined.

RESULTS

One variant (SNP RS7033979) showed nominal evidence of association with both hand OA (P=0.042) and knee OA (P=0.032). Four additional SNPs showed nominal evidence of association with knee OA only. These associations were only observed with genotypic tests; the corresponding allelic and haplotype tests did not corroborate the single-point association results.

CONCLUSION

These data suggest that polymorphisms within ASPN are not a major influence in susceptibility to hand or knee OA in US Caucasians.