Semantic Versus Orthographic Preferences in Aphasia: Behavioral Evidence

In this study, we compared the orthographic and semantic preferences of healthy adults and age and gender matched adults with aphasia, an acquired language disorder. Previous research in word retrieval and word associations has addressed semantic and phonological connections, but it has not as often included analyses of orthographic skills. We matched (on age and gender) 10 neurotypical adults and 11 older adults with aphasia and administered to both groups a lexical discrimination task requiring them to select, from 18 choices, those words that were most different from three words (daughter, laughter, son). Among the choices were foil words (e.g., daughter), orthographic similarities (laughter) and semantic similarities (son). Results revealed that individuals with aphasia focused on orthographic differences, while healthy adults chose semantic differences. Further studies should further explore this orthographic focus to develop treatment strategies, using behavioral and objective measures, for word-finding deficits in aphasia.

Primary cryotherapy for localised or locally advanced prostate cancer

BACKGROUND

Traditionally, radical prostatectomy and radiotherapy with or without androgen deprivation therapy have been the main treatment options to attempt to cure men with localised or locally advanced prostate cancer. Cryotherapy is an alternative option for treatment of prostate cancer that involves freezing of the whole prostate (whole gland therapy) or only the cancer (focal therapy), but it is unclear how effective this is in comparison to other treatments.

OBJECTIVES

To assess the effects of cryotherapy (whole gland or focal) compared with other interventions for primary treatment of clinically localised (cT1-T2) or locally-advanced (cT3) non-metastatic prostate cancer.

SEARCH METHODS

We updated a previously published Cochrane Review by performing a comprehensive search of multiple databases (CENTRAL, MEDLINE, EMBASE), clinical trial registries (ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform) and a grey literature repository (Grey Literature Report) up to 6 March 2018. We also searched the reference lists of other relevant publications and conference proceedings. We applied no language restrictions.

SELECTION CRITERIA

We included randomised or quasi-randomised trials comparing cryotherapy to other interventions for the primary treatment of prostate cancer.

DATA COLLECTION AND ANALYSIS

Two independent reviewers screened the literature, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We rated the quality of evidence (QoE) according to the GRADE approach.

MAIN RESULTS

We included only one comparison of whole gland cryotherapy versus external beam radiotherapy, which was informed by two trials with a total of 307 randomised participants. The median age of the included studies was around 70 years. The median follow-up of included studies ranged from 100 to 105 months.Primary outcomes: we are uncertain about the effect of whole gland cryotherapy compared to radiation therapy on time to death from prostate cancer; hazard ratio (HR) of 1.00 (95% confidence interval (CI) 0.11 to 9.45; 2 trials, 293 participants; very low QoE); this would correspond to zero fewer death from prostate cancer per 1000 men (95% CI 85 fewer to 520 more). We are equally uncertain about the effect of quality of life-related urinary function and bowel function (QoL) at 36 months using the UCLA-Prostate Cancer Index score for which higher values (range: 0 to 100) reflect better quality of life using minimal clinically important differences (MCID) of 8 and 7 points, respectively; mean difference (MD) of 4.4 (95% CI -6.5 to 15.3) and 4.0 (95% CI -73.96 to 81.96), respectively (1 trial, 195 participants; very low QoE). We are also uncertain about sexual function-related QoL using a MCID of 8 points; MD of -20.7 (95% CI -36.29 to -5.11; 1 trial, 195 participants; very low QoE). Lastly, we are uncertain of the risk for major adverse events; risk ratio (RR): 0.91 (95% CI 0.47 to 1.78; 2 trials, 293 participants; very low QoE); this corresponds to 10 fewer major adverse events per 1000 men (95% CI 58 fewer to 86 more).

SECONDARY OUTCOMES

we are very uncertain about the effects of cryotherapy on time to death from any cause (HR 0.99, 95% CI 0.05 to 18.79; 2 trials, 293 participants; very low QoE), and time to biochemical failure (HR 2.15, 95% CI 0.07 to 62.12; 2 trials, 293 participants; very low QoE). Rates of secondary interventions for treatment failure and minor adverse events were either not reported in the trials, or the data could not be used for analyses.We found no trials that compared whole gland cryotherapy or focal cryotherapy to other treatment forms such as radical surgery, active surveillance, watchful waiting or other forms of radiotherapy.

AUTHORS' CONCLUSIONS

Based on very low quality evidence, primary whole gland cryotherapy has uncertain effects on oncologic outcomes, QoL, and major adverse events compared to external beam radiotherapy. Reasons for downgrading the QoE included serious study limitations, indirectness due to the use of lower doses of radiation in the comparison group than currently recommended, and serious or very serious imprecision.

Penile Lengthening, Girth, and Size Preservation at the Time of Penile Prosthesis Insertion

INTRODUCTION

Penile prosthetic devices are the gold standard treatment of medication-refractory erectile dysfunction. Inflatable penile prosthetic (IPP) devices have been available and used for more than four decades. Oftentimes, medical conditions causing erectile dysfunction also cause penile shortening, causing decreased patient quality of life.

AIM

To identify and review all available penile lengthening procedures that can be performed at time of IPP insertion.

METHODS

An extensive, systematic literature review was performed using PubMed searching for key terms penile lengthening, inflatable penile prosthesis, penile girth, corporoplasty, glans augmentation, and penile enhancement; all articles with subjective and/or objective penile length outcomes were reviewed.

MAIN OUTCOME MEASURES

A review of various techniques for penile length and girth preservation and enhancement during penile prosthesis insertion.

RESULTS

Several advanced and novel techniques were found for penile length preservation and enhancement at time of IPP insertion, including the sub-coronal IPP insertion technique, and adjuvant maneuvers during insertion, such as the sliding technique, modified sliding technique, multiple slice technique, and circumferential incision and grafting. Other adjuvant techniques that can enhance perception of increased length include ventral phalloplasty, suprapubic lipectomy, and suspensory ligament release. Further enhancement can be obtained using augmentation corporoplasty and glans augmentation with hyaluronic acid and other fillers. The different techniques vary in complexity and could require specialized training and experience. Maximum length gain appears to be limited by the length of the neurovascular bundles.

CONCLUSION

Overall, surgical penile lengthening procedures at time of IPP insertion appear safe and effective for treatment of patients with penile shortening and severe erectile dysfunction. These therapies can significantly improve patient self-esteem and quality of life in properly selected patients. Tran H, Goldfarb R, Ackerman A, Valenxuela RJ. Penile Lengthening, Girth and Size Preservation at the Time of Penile Prosthesis Insertion. Sex Med Rev 2017;5:403-412.

Fibromuscular Dysplasia in a Normotensive Patient Presented With Renal Infarct: Case Report and Endovascular Technique

Fibromuscular dysplasia (FMD) is a well-known disease, but its diagnosis can be challenging. Typically, the symptomatic FMD are reported by young and middle aged people with high blood pressure refractory to medical treatment. We present a rare case of a young, healthy, and normotensive patient who presented with pain secondary to renal infarction, without any prior signs or symptoms or history of hypertension. This presentation of FMD has not been previously described. The typical but subtle angiographic findings of the macro-aneurysmal FMD as well as the successful endovascular treatment are discussed herein. The macro-aneurysmal form of FMD should be considered in the differential diagnosis of acute renal infarction in young and middle aged patients even if they do not have a history of hypertension.

Transcriptional repression of Caveolin-1 (CAV1) gene expression by GATA-6 in bladder smooth muscle hypertrophy in mice and human beings

Hypertrophy occurs in urinary bladder wall smooth muscle (BSM) in men with partial bladder outlet obstruction (PBOO) caused by benign prostatic hyperplasia (BPH) and in animal models of PBOO. Hypertrophied BSM from the rabbit model exhibits down-regulation of caveolin-1, a structural and functional protein of caveolae that function as signaling platforms to mediate interaction between receptor proteins and adaptor and effector molecules to regulate signal generation, amplification, and diversification. Caveolin-1 expression is diminished in PBOO-induced BSM hypertrophy in mice and in men with BPH. The proximal promoter of the human and mouse caveolin-1 (CAV1) gene was characterized, and it was observed that the transcription factor GATA-6 binds this promoter, causing reduced expression of caveolin-1. Furthermore, caveolin-1 expression levels inversely correlate with the abundance of GATA-6 in BSM hypertrophy in mice and human beings. Silencing of GATA6 gene expression up-regulates caveolin-1 expression, whereas overexpression of GATA-6 protein sustains the transcriptional repression of caveolin-1 in bladder smooth muscle cells. Together, these data suggest that GATA-6 acts as a transcriptional repressor of CAV1 gene expression in PBOO-induced BSM hypertrophy in men and mice. GATA-6-induced transcriptional repression represents a new regulatory mechanism of CAV1 gene expression in pathologic BSM, and may serve as a target for new therapy for BPH-induced bladder dysfunction in aging men.

Accuracy of clinical judgment of the chin-down posture for dysphagia during the clinical/bedside assessment as corroborated by videofluoroscopy in adults with acute stroke

Speech-language pathologists tend to rely on the noninstrumental swallowing evaluation in making recommendations about a patient's diet and management plan. The present study was designed to examine the sensitivity and specificity of the accuracy of using the chin-down posture during the clinical/bedside swallowing assessment. In 15 patients with acute stroke and clinically suspected oropharyngeal dysphagia, the correlation between clinical and videofluoroscopic findings was examined. Results identified that there is a difference in outcome prediction using the chin-down posture during the clinical/bedside assessment of swallowing compared to assessment by videofluoroscopy. Results are discussed relative to statistical and clinical perspectives, including site of lesion and factors to be considered in the design of an overall treatment plan for a patient with disordered swallowing.

Noun-verb ambiguity in chronic undifferentiated schizophrenia

This study investigated noun-verb retrieval patterns of 30 adults with chronic undifferentiated schizophrenia and 67 typical adults, to determine if schizophrenia affected nouns (associated with temporal lobe function) differently from verbs (associated with frontal lobe function). Stimuli were homophonic homographic homonyms, balanced according to frequency of occurrence, where N>V, N<V, or N approximately V. Systematicity effects, in which systematic noun and verb meanings are transparently related (e.g., "drain"), and unsystematic noun and verb meanings appear to be unrelated (e.g., "seal"), were also examined. Adults with schizophrenia overselected nouns, in both phrase and sentence tasks. Typical participants strongly preferred verbs in the phrase task, but nouns in the sentence task. Frequency of occurrence yielded statistically significant effects in control, but not in experimental groups. Effects of systematicity were statistically significant in some, but not all tasks and conditions. Age of typical participants was not significant.

LEARNING OUTCOMES

Readers will be introduced to (a) evidence of noun-verb organization in the brain; (b) evidence of ambiguous noun-verb preference to differentiate the language of schizophrenia from the language of typical adults; and (c) evidence of ambiguous noun-verb preference to differentiate the language of schizophrenia from fluent aphasia.

Grammatical category ambiguity in aphasia

This study asked whether aphasic adults show different noun/verb retrieval patterns based upon their clinical categorization as fluent or nonfluent. Participants selected either the noun or the verb meaning of target words, as presented in three contexts. The framework was that nouns (associated with temporal lobe function) are processed, stored, and retrieved separately from verbs (associated with frontal lobe function), implying separate status in the mental lexicon. Stimuli were homophonic homographs, words that are spelled and pronounced the same but which have different meanings (in this case, noun and verb meanings). Another contrast was the putative difference between systematic pairs (e.g., "kiss" and "farm"), in which noun and verb meanings are transparently related, and may be stored as a unit, and unsystematic pairs (e.g., "squash" and "sink"), in which noun and verb meanings are apparently unrelated, implying discrete storage. Results demonstrated significant interactions between fluent and nonfluent participants, suggesting that, as expected, fluent aphasic adults have more difficulty with nouns, nonfluent aphasic adults have more difficulty with verbs. There was no effect of systematicity. Contrary to expectations, verbs proved less vulnerable, rather than more vulnerable, to aphasic impairment.

Support Systems

As the population of older adults increases, there is a corresponding increase in the number of individuals with communication disorders resulting from brain damage. The purpose of this article was to describe the effects of aphasia and dementia on language and communication, and to suggest support systems for improving communication and maximizing residual language abilities. For both these disorders, we address the psychosocial environment, the roles of professionals and caregivers, individual versus group therapy, and support groups. Finally, we report on 2 specific support groups, one for aphasia and one for Alzheimer's dementia, with which the authors have been involved for many years.

Prognostic value of immunohistochemical expression of p53, bax, Bcl-2 and Bcl-xL in resected non-small-cell lung cancers

AIMS

Some experimental evidence suggests that in lung cancer, development, progression and an increased proliferation rate can be linked to apoptosis-related factors. In this study we evaluated the possible role of p53 and Bcl-2 gene family members as prognostic factors for non-small-cell lung cancer.

METHODS AND RESULTS

We investigated the immunohistochemical expression of p53 and Bcl-2 gene family members (bax, Bcl-2 and Bcl-xL) in 94 non-small-cell lung cancer specimens to establish the role of these genes in lung cancer pathogenesis, and to evaluate their prognostic importance. The expression of Bcl-2 was correlated with a shorter patient survival time and with the nodal status of the neoplasm. We also found frequent over-expression of bax and Bcl-xL to be of no prognostic significance. Finally, we found no correlation between frequent detection of aberrant p53 protein and expression of either Bcl-2, bax or Bcl-xL or with patient survival time.

CONCLUSIONS

This study confirms a relevant role for apoptosis-regulatory proteins in the pathogenesis of lung cancer, and highlights the possible role of Bcl-2 as a prognostic factor for this tumour.

Communicative Responsibility and Semantic Task in the Language of Adults with Dementia

A probe technique requiring convergent and divergent semantic behavior and representing five levels of communicative responsibility served as the research tool. Stimuli were presented to adults identified as having Alzheimer disease or multi-infarct dementia. Within each group differences were observed on the semantic task (convergent and divergent) and on communicative responsibility. Group characteristics are compared with data previously published in 1994 on aphasic and schizophrenic adults responding to the same stimuli.

Comprehension of indirect requests by persons with fluent aphasia

This study examined the judgments and response latencies of 10 participants with aphasia and 10 participants without aphasia for responses to indirect requests. Modals such as can and should were drawn from 5 indirect request categories. There was a significant difference in judgment errors and response latency between participants with and without aphasia. There were no significant differences between aphasic participants' judgments for literal versus nonliteral contrasts. There was a significant effect among the modals and among the categories of indirect requests. Response latency reflected aphasic participants' understanding of these indirect requests.

Transposition of words as indicators of semantic state in aphasia

Semantic judgment tasks, based on antecedent pronouns and on word order, were presented to 16 aphasic adult subjects. Responses on the elicited imitation task were better than on comprehension tasks, a finding which parallels the language-acquisition behavior of children. Addition of features to a basic judgment of animate vs inanimate did not affect subjects' performance.

Communicative responsibility and semantic task in aphasia and "schizophasia"

A probe technique requiring convergent and divergent semantic behavior and representing five levels of communicative responsibility served as the research tool. Stimuli were presented to 29 asphasic adults (13 Broca's, 7 Wernicke's, and 9 anomic), 26 adults with chronic undifferentiated schizophrenia, and 32 normal elderly control subjects. Within each group significant differences were observed on the semantic task (convergent and divergent) and on level of communicative responsibility. Among subjects with aphasia, differences appeared to relate more to severity than type. Differences between unclassified aphasic and "schizophasic" groups occurred only when multiword responses were required. We conclude that continued use of the term "schizophasia" may be unwarranted and that the linguistic behaviors we observed in aphasia and the language of schizophrenia may contribute to differential diagnosis.

Value of gallium imaging in the evaluation of tattoo granulomas due to sarcoidosis

We report the case of a patient who developed granulomas in a ten-year-old tattoo. Total body gallium scanning detected the presence of bilateral hilar adenopathy not apparent on routine chest roentgenograms and thus established a diagnosis of systemic sarcoidosis.

Detection of gastroesophageal reflux in the head and neck: the role of scintigraphy

Patients with gastroesophageal reflux (GER) present to the head and neck specialist with a myriad of nonspecific complaints that may be manifestations of pharyngoesophageal or upper airway involvement. Numerous diagnostic tests for GER have been used in the past with varying success. In the present study, gastroesophageal scintigraphy using 99mtechnetium-sulfur colloid was used to evaluate 28 patients with head and neck manifestations of GER. The role of gastroesophageal scintigraphy as an accurate and noninvasive method of detecting GER is discussed in the context of other current diagnostic modalities.

Isolated renal artery dissection secondary to medial degeneration

Renal artery aneurysms can have variable presentations, often resulting in a therapeutic dilemma to the clinician. We review the causes, clinical features, pathological conditions and treatment options for this problem. We report a case of a thrombus in 1 of 2 left renal arteries, which resulted in uncontrollable hypertension. At nephrectomy the angiographically normal vessel had medial degeneration, demonstrating the diffuse nature of this disease. Conservative renal-sparing management should be considered whenever possible.

Regional myocardial blood flow and function in experimental myocardial ischemia

Experiments are reviewed in conscious dogs instrumented with ultrasonic crystals for measuring systolic wall thickening and myocardial blood flow (microsphere technique), and studied under a variety of conditions during acute or chronic circumflex coronary stenosis. With acute progressive stenosis, a nearly linear relation was found between normalized subendocardial flow and function. There were no consistent ST segment changes in the body surface electrocardiogram if wall thickening was less than 25%, although changes occurred in the subendocardial electrogram. The regional flow-function relation was then examined during exercise with various degrees of coronary stenosis; the mean flow-function relation was shifted to the right of the resting relation, but when subendocardial flow was expressed per beat and function normalized as a fraction of that in normal wall the relationship was superimposable upon the resting relation, suggesting that ischemia is absolute (not relative) in the subendocardium during steady state conditions. When the normal increase of wall thickening during exercise was prevented by mild coronary stenosis ischemia could not be clearly detected, but when function during exercise averaged 20% below the resting value, subendocardial blood flow changes and other evidence of ischemia were readily apparent, indicating the sensitivity of wall motion for detecting subcritical coronary stenosis. The regional flow-function relation was also studied in chronic single vessel coronary artery stenosis (ameroid constrictor), in which function was normal at rest (collateral development) but exercise produced large decreases in both regional flow and function. At matched levels of treadmill exercise, a calcium channel blocker (diltiazem) together with beta blockade (atenolol) produced an additive effect that was greater than with either drug alone, with substantial increases in both subendocardial flow and regional function. Finally, studies showing reversible post-reperfusion dysfunction after 15 minutes or two hours of coronary occlusion are reviewed. Partial ischemia for 5-hours, followed by reperfusion also produced regional dysfunction which persisted for at least 3 days but reverted to normal by one week, with little or no histologic damage of the free wall. These studies on regional flow and function during ischemia may carry implications for a number of important clinical phenomena.

Word-association responses to time-altered stimuli by schizophrenic adults

This research addressed the relationship between the speed of presentation of stimuli through the auditory and visual modalities and the number of syntagmatic and paradigmatic word-association responses of 49 chronic undifferentiated schizophrenic adults. In word-association tests administered to subjects stimuli were balanced for frequency of occurrence in written English language (frequent, infrequent), word length (long, short), abstraction level (low, medium, high), and part of speech (noun, verb, adjective). The words were presented auditorily at normal speed (equivalent to 10 phonemes per second) and at half speed (equivalent to 5 phonemes per second) speech. Words were also presented visually, using a tachistoscope, at extended fixation speed (equivalent to 1,000 msec.) and at sweep speed (equivalent to 10 msec.). More paradigmatic responses occurred on word stimuli if nouns, long, and frequently occurring presented auditorily; and if concrete, nouns, and presented slowly and visually. Results were compared to previously reported data for aphasic and normal adults, and differentiating features and clinical implications were discussed.

Cognitive discrimination in brain-damaged adults: color vs form preference

The relative preference of color, form, and other dimensions as the basis for discrimination between stimuli has been investigated in a variety of normal and language-impaired populations. In aphasic adults, previous studies have been contradictory, and no studies of non-aphasic, brain-damaged adults have been reported. In this study color vs form preference was examined in 20 left brain-damaged, aphasic adults, 20 right brain-damaged non-aphasic adults, and 20 control subjects. Significant differences were found among all groups, with preference of color over form greatest for left brain-damaged subjects, followed by right-damaged and control subjects.

Work association of time-altered auditory and visual stimuli in aphasia

A word association test was administered to a group of 32 aphasic adults and to a control group of 32 normal adults similar in age, sex, and education. Word stimuli were balanced according to frequency of occurrence in written English language usage (frequent, infrequent), word length (short, long), abstraction level (low, medium, high), and grammatical class (noun, verb, adjective). Stimuli were presented auditorily at normal speed (equivalent to 10 phonemes per sec) and at half speed (equivalent to 5 phonemes per sec) speech. When word stimuli were presented at half speed (slower), the aphasic adults but not the controls produced significantly more paradigmatic (same grammatical class) responses. Twenty aphasic subjects and twenty controls supplied association responses to words presented tachistoscopically at fixation speed (equivalent to 250 msec) and at sweep speed (equivalent to 10 msec). When word stimuli were shown for a longer time, the aphasic adults but not the controls produced significantly more paradigmatic responses. Also analyzed were paradigmatic responses to the word association test produced in relation to frequency of occurrence, word length, levels of word abstraction, and grammatical class.

Espousing melodic intonation therapy in aphasia rehabilitation: a case study

A program of Melodic Intonation Therapy (MIT) was adapted as a home training procedure to enable a severely affected aphasic adult to respond to 52 simple questions bearing relevance to his daily life. MIT involves embedding short phrases or sentences in a simple, non-distinct melody pattern. As the patient progresses through the program, the melodic aspect is faded and the program eventually leads to production of the target phrase or sentence in normal speech prosody. The present procedure consisted of three levels of training designed to advance the subject from an initial level of intoning responses in a simple melody to producing the responses in normal speech prosody. The subject's wife was trained to administer MIT both in the clinical and home settings. Considerable improvement was obtained in imitation and in context related responses to questions. These findings lend support to the proposal that the music dominance to the right hemisphere assists, and perhaps diminishes the language dominance of, the damaged left hemisphere. The limitations of use of Melodic Intonation Therapy were discussed.

Direct fluorescent assay of urokinase and plasminogen activators of normal and malignant cells: kinetics and inhibitor profiles

A direct rate assay for plasminogen activator has been developed using a synthetic fluorogenic peptide substrate, 7-(N-Cbz-glycylglycylargininamido)-4-methylcoumarin trifluoroacetate. The assay correlates well with the standard 125I-labeled fibrin plate assay using highly purified urokinase, culture fluids from WI-38, Chinese hamster vary or HeLa cells, or Rous sarcoma virus-transformed chick fibroblasts as the source of plasminogen activator. The assay is sensitive, rapid, and linear throughout a wide range of enzyme concentrations. With this substrate it is possible to determine inhibitor profiles for the various plasminogen activators, independently of the interfering potential of plasmin. All of the enzymes tested are inhibited by leupeptin and antipain but not by the related aldehydes, elastatinal and chymostatin. The macromolecular inhibitors soybean trypsin inhibitor and trasylol have little or no effect on the plasminogen activators tested. This substrate should be useful for the study of the effect of various agents on functional changes in cells secreting this enzyme and also should allow kinetic measurements of potential inhibitors.