Bilateral upper extremity motor priming (BUMP) plus task-specific training for severe, chronic upper limb hemiparesis: study protocol for a randomized clinical trial

alexandrossfakianakis shared this article with you from Inoreader Bilateral upper extremity motor priming (BUMP) plus task-specific training for severe, chronic upper limb hemiparesis: study protocol for a randomized clinical trial via Trials - Latest Articles Various priming techniques to enhance neuroplasticity have been examined in stroke rehabilitation research. Most priming techniques are costly and approved only for research. Here, we describe a priming techni... View on Web

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Investigations Into Obesity and the Risk of Malignant Disease in Pediatric Thyroid Nodules—Reply

alexandrossfakianakis shared this article with you from Inoreader Investigations Into Obesity and the Risk of Malignant Disease in Pediatric Thyroid Nodules—Reply via JAMA Otolaryngology–Head & Neck Surgery Online First In Reply We thank Gallant et al for their interest in our recent publication regarding the association of body mass index (BMI) with thyroid cancer in children with thyroid nodules. We agree that differences in design may account for some discrepancies between our study and theirs. Different methods of calculating BMI z-scores might play a role, although our selection of the Centers for Disease Control and Prevention nomograms reflects their wide use in clinical practice. Similarly, our use of nodule diameter rather than nodule volume reflec ts current recommendations for thyroid nodule evaluation, and is unlikely to be relevant given the excellent correlation of these measures in our cohort (r = 0.97; 95% CI, 0.96-0.97). View on Web

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Investigations Into Obesity and the Risk of Malignant Disease in Pediatric Thyroid Nodules

alexandrossfakianakis shared this article with you from Inoreader Investigations Into Obesity and the Risk of Malignant Disease in Pediatric Thyroid Nodules via JAMA Otolaryngology–Head & Neck Surgery Online First To the Editor It is with great interest that we read the recent contribution from Ivanova et al, in which the authors found no association between body mass index z-score (BMIz) and the risk of malignant disease in pediatric thyroid nodules. The authors' findings contrast with our own study, in which we found BMIz to be a significant and independent predictor of pediatric thyroid cancer. We want to highlight a few differences between the studies, which may explain variance in the results. View on Web

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Risk of Stroke After Definitive Radiotherapy—Cause for Concern or Modest Risk?

alexandrossfakianakis shared this article with you from Inoreader Risk of Stroke After Definitive Radiotherapy—Cause for Concern or Modest Risk? via JAMA Otolaryngology–Head & Neck Surgery Online First With the rapidly increasing prevalence of oropharyngeal squamous cell carcinoma (OPSCC), largely driven by the human papillomavirus (HPV) epidemic, and with relative equipoise between radiation-based and surgery-based treatment protocols, there has been renewed interest in describing differences in functional outcomes between the 2 treatment modalities. Radiation is theoretically related to stroke risk due to carotid artery intimal injury, which could lead to the development of atherosclerosis. Both carotid artery stenosis and carotid intima -medial thickness have been shown to be associated with radiation therapy providing a biologic basis for the findings. A retrospective population-based cohort study of veterans with OPSCC authored by Sun et al reported a 12.5% imputed stroke risk within 10 years after treatment. The major finding of this study is that there was an observed 23% relative risk reduction of stroke in patients treated with definitive surgery as compared with those treated with definitive radiotherapy. Although there were notable differences between the groups at baseline, in particular higher T- and N-stage as well as worse ECOG performance status and Charlson Comorbidity Index in the nonsurgical group, the authors conducted propensity score–based analyses to account for these imbalances. Interestingly, there was no increase in stroke risk among surgical patients treated with adjuvant radiation as compared with those treated with surgery alone. (Other population-based studies have observed the same.) View on Web

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Cooled Radiofrequency Ablation of Genicular Nerves Provides 24‐Month Durability in the Management of Osteoarthritic Knee Pain: Outcomes from a Prospective, Multicenter, Randomized Trial

alexandrossfakianakis shared this article with you from Inoreader Cooled Radiofrequency Ablation of Genicular Nerves Provides 24‐Month Durability in the Management of Osteoarthritic Knee Pain: Outcomes from a Prospective, Multicenter, Randomized Trial via Pain Practice Abstract Objective To assess long-term outcomes of cooled radiofrequency ablation (CRFA) of genicular nerves for chronic knee pain due to osteoarthritis (OA). Methods A prospective, observational extension of a randomized, controlled trial was conducted on adults randomized to CRFA. Subjects were part of a 12-month clinical trial comparing CRFA of genicular nerves to a single hyaluronic injection for treatment of chronic OA knee pain, who then agreed to visits at 18- and 24-months post CRFA and had not undergone another knee procedure since. The subjects were evaluated for: pain using the Numeric Rating Scale (NRS), function using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), subjective benefit using the Global Perceived Effect (GPE) scale, quality of life using the EuroQol-5-Dimensions-5 Level (EQ-5D-5L) questionnaire, and safety. Results Of 57 subjects eligible, 36 enrolled; 32 completed the 18-month visit with a mean NRS score of 2.4 and 22 (69%) reporting ≥50% reduction in pain from baseline (primary endpoint); 27 completed the 24-month visit, with a mean NRS of 3.4 and 17 (63%) reporting ≥50% pain relief. Functional and quality of life improvements persisted similarly, with mean changes from baseline of 53.5% and 34.9% in WOMAC total scores, and 24.8% and 10.7% in EQ-5D-5L Index scores, at 18- and 24-months, respectively. There were no identified safety concerns in this patient cohort. Conclusion In this subset of subjects, CRFA of genicular nerves provided durable pain relief, improved function, and improved quality of life extending to 24 months post procedure, with no significant safety concerns. View on Web

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Influence of cross‐sectional area and fat infiltration of paraspinal muscles on analgesic efficacy of epidural steroid injection in elderly patients

alexandrossfakianakis shared this article with you from Inoreader Influence of cross‐sectional area and fat infiltration of paraspinal muscles on analgesic efficacy of epidural steroid injection in elderly patients via Pain Practice Abstract Background An assessment of paraspinal muscle degeneration based on magnetic resonance imaging has been used to investigate both sarcopenia and myosteatosis. The morphologic changes in cross-sectional area and fat infiltration of the paraspinal muscles can affect pain outcomes after epidural steroid injection. Methods Patients ≥ 65 years of age who underwent fluoroscopy-guided lumbar epidural steroid injections were enrolled. Good analgesia was defined as ≥ 50% reduction in pain score at 4 weeks after injection. Cross-sectional area and grade of fat infiltration of the paraspinal muscles on magnetic resonance images at the level of L3-L4 disc were measured. Patient demographics, pain-related factors, clinical factors, and paraspinal muscle measurements were compared between good and poor analgesia groups. The factors associated with pain outcome after injection were identified using multivariate analysis. Results A total of 245 patients consisting of 149 and 96 patients in the good and poor analgesia groups, respectively, fully satisfied the study criteria for analysis. Patients of older age, opioid use, and high-grade foraminal stenosis were frequently observed in the poor analgesia group. The grade of fat infiltration of the paraspinal muscles was significantly higher in the poor analgesia group (Grade 2, 20.8 vs. 42.7%, P < 0.001), and this result was predominantly observed in female patients. However, there was no difference in muscle cross-sectional area between the two groups (18.29 ± 3.16 vs. 18.59 ± 3.03 cm2/m2, P = 0.460). The percentage of patients with good analgesia decreased as the grade of fat infiltration increased (Grade 0 = 75.0%, Grade 1 = 65.8%, Grade 2 = 43.0%, P < 0.001). Multivariate logistic regression analysis revealed that pre-injection opioid use [adjusted odds ratio (aOR) = 1.926, 95% confidence interval (CI) = 1.084–3.422, P = 0.025], moderate to severe foraminal stenosis (aOR = 2.859, 95% CI = 1.371–5.965, P = 0.005), and high-grade fat infiltration of the paraspinal muscles (aOR = 4.258, 95% CI = 1.805–10.043, P = 0.001) were significantly associated with poor analgesia after injection. Conclusion High fat infiltration of the paraspinal muscles at the mid-lumbar region appeared to be an independent factor associated with poor analgesia after epidural steroid injection in elderly patients with symptomatic degenerative lumbar spinal disease receiving conservative care. However, cross-sectional area of the paraspinal muscles was not associated with pain relief after injection. View on Web

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Temporomandibular joint prosthesis as treatment option for mandibular condyle fractures: a systematic review and meta-analysis

alexandrossfakianakis shared this article with you from Inoreader Temporomandibular joint prosthesis as treatment option for mandibular condyle fractures: a systematic review and meta-analysis via International Journal of Oral and Maxillofacial Surgery via MedWorm.com The aim of this study was to perform a systematic review of the literature on the temporomandibular joint (TMJ) prosthesis as a treatment option after mandibular condyle fracture. Three databases were searched (PubMed, Embase, Cochrane Library) and 2670 unique papers were identified. A total of 337 studies were included (121 case reports, 89 case series, and 127 cohort/clinical studies). In total 14,396 patients and 21,560 prostheses were described. Of the 127 cohort or clinical studies, 100 (79%) reported inclusion criteria, 54 (43%) reported exclusion criteria, and 96 (76%) reported the inclusion period. (Source: International Journal of Oral and Maxillofacial Surgery) View on Web

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Functional and biomechanical assessment of the hand following ulnar forearm free flap transfer: Prospective self‐controlled study

alexandrossfakianakis shared this article with you from Inoreader Functional and biomechanical assessment of the hand following ulnar forearm free flap transfer: Prospective self‐controlled study via Head & Neck Abstract Background There is a shortage of well-designed self-controlled studies evaluating hand biomechanics following ulnar forearm flap (UFF) harvest. This study was conducted to evaluate objective and subjective functional outcomes of the donor's hand following UFF harvest. Methods All patients undergoing UFF were included for analysis. Grip strength, wrist movement, forearm supination and pronation, pinch strengths, sensation to light touch and temperature, and hand dexterity were assessed preoperatively and at 1, 3, and 6 months postoperatively. In addition, DASH score (disabilities of the arm, shoulder, and hand score) and Patient and Observer Scar Assessment Scale (POSAS) were analyzed. Results A total of 18 patients were enrolled. A significant reduction in grip strength for donor's hand was observed between preoperative and postoperative 1 and 3 months (mean difference = 14 kg, 7.38 kg, respectively, p = 0.000 for all). A similar trend was observed for pinch strength and range of motion (p < 0.05). Three months after surgery, there is still a significant reduction in tip pinch, tripod pinch, wrist extension, and supination. All biomechanics outcomes returned to preoperative baseline at 6 months after surgery. No patients suffered significant changes in sensation to light touch, temperature, and numbness by 6 months. There was a significant increase in DASH score by 3.37 points 6 months after operation (p = 0.000). The POSAS score indicates satisfaction with the appearance of the donor site. Conclusions UFF is a safe and reliable option for oral cavity reconstruction with minimum donor site morbidities, mainly when cosmesis is paramount. Furthermore, objective hand biomechanics ultimately returns to its preoperative state within 6 months after surgery. View on Web

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Assessing masticatory performance with a color mixing‐ability test using smartphone camera images

alexandrossfakianakis shared this article with you from Inoreader Assessing masticatory performance with a color mixing‐ability test using smartphone camera images via Journal of Oral Rehabilitation Abstract Background Color-mixing ability tests are frequently used to assess masticatory performance but the image acquisition process may be cumbersome and technique sensitive. Objectives To evaluate the reliability of smartphone camera images in assessing masticatory performance using a color-mixing ability test. Methods Participants were recruited into three groups of dental state (n=20 each): fully dentate, removable partial denture wearers and complete denture wearers. After performing a color-mixing ability test, images of the gum specimens (Hue-Check Gum©) were captured with two smartphones and compared with the images obtained from a flat-bed scanner by two examiners. The images were analyzed with a subjective- (SA) and an opto-electronical assessment (VoH). Inter- and intra-rater reliability were tested. ANOVA models with repeated measures were used for statistical analysis (⍺=0.05). Results All three image acquisition techniques were able to distinguish masticatory performance between different dental states. For SA, intra-rater reliability was slight to moderate and inter-rater reliability was substantial to almost perfect. For VoH, intra-rater reliability with the smartphones were significantly different between two examiners, but the inter-rater assessment was reliable. The opto-electronic analysis with smartphone images underestimated the masticatory performance significantly when compared to the flat-bed scanner analysis. Seven-day ageing of the specimens did not significantly affect the results. Conclusions The assessment of masticatory performance with the Hue-Check Gum© is a reliable method. The use of smartphones may occasionally underestimate masticatory performance; image acquisition with a flatbed scanner remains the gold standard. A centralized analysis of the photographed wafer may foster the reliability of the diagnosis. View on Web

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Effects of anterior bite planes fabricated from acrylic resin and thermoplastic material on masticatory muscle responses and maximum bite force in children with a deep bite: a 6‐month randomized controlled trial

alexandrossfakianakis shared this article with you from Inoreader Effects of anterior bite planes fabricated from acrylic resin and thermoplastic material on masticatory muscle responses and maximum bite force in children with a deep bite: a 6‐month randomized controlled trial via Journal of Oral Rehabilitation Abstract Background Anterior bite planes are bite-raising appliances used for deep bite correction. However, muscle responses to anterior bite planes of different hardnesses may vary. Objectives To prospectively evaluate masticatory muscle activity, muscle balance, and maximum bite force (MBF) responses to anterior bite planes fabricated from acrylic resin (ABP) or bi-laminate thermoplastic (TBP) over 6 months in children with a deep bite. Methods Sixty-six children were randomly assigned to the ABP, TBP, or untreated control groups. Masticatory muscle activity, activity index (AC), and percentage overlapping coefficient (POC) were assessed by surface electromyography; MBF, using a custom-made bite force sensor. Data were collected before, immediately after appliance insertion, and after 2 weeks and 1, 3, and 6 months of treatment. Within- and between-group differences were analyzed using one-way ANOVA/Kruskal-Wallis and Mann Whitney U-tests (α=0.05); Friedman's tests were used to assess within-group differences over time (α=0.08). Results At rest, no dependent variables changed throughout the study. At maximum clenching, masticatory muscle activity immediately dropped significantly but returned to baseline values and was equal to the control group at 1-3 months. The ABP group had significantly lower masseter activity and AC than the TBP group after insertion. Neither POC nor MBF were significantly different within or between groups. Conclusion Masticatory muscle activity reduced after anterior bite plane insertion but returned to baseline after 1-3 months. Masseter activity decreased significantly more in the ABP group than TBP group. Neither appliance significantly affected POC or MBF. View on Web

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