Κυριακή 5 Φεβρουαρίου 2023

Differentiation of Bolus Texture During Deglutition via High‐Density Surface Electromyography: A Pilot Study

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Differentiation of Bolus Texture During Deglutition via High-Density Surface Electromyography: A Pilot Study

This pilot study evaluated high-density surface electromyography (HDsEMG) during pharyngeal swallows of five different bolus textures from eight healthy human subjects. Results indicate HDsEMG can differentiate swallows of varying consistencies through analysis of EMG signal features such as power and peak counts while maintaining a spatial orientation. This may prove useful in both future diagnostic and behavioral swallow applications.


Objective

Swallowing is a complex neuromuscular task. There is limited spatiotemporal data on normative surface electromyographic signal during swallow, particularly across standard textures. We hypothesize the pattern of electromyographic signal of the anterior neck varies cranio-caudally, that laterality can be evaluated, and categorization of bolus texture can be differentiated by high-density surface electromyography (HDsEMG) through signal analysis.

Methods

An HDsEMG grid of 20 electrodes captured electromyographic activity in eight healthy adult subjects across 240 total swallows. Participants swallowed five standard textures: saliva, thin liquid, puree, mixed consistency, and dry solid. Data were bandpass filtered, underwent functional alignment of signal, and then placed into binary classifier receiver operating characteristic (ROC) curves. Muscular activity was visualized by creating two-dimensional EMG heat maps.

Results

Signal analysis results demonstrated a positive correlation between signal amplitude and bolus texture. Greater differences of amplitude in the cranial most region of the array when compared to the caudal most region were noted in all subjects. Lateral comparison of the array revealed symmetric power levels across all subjects and textures. ROC curves demonstrated the ability to correctly classify textures within subjects in 6 of 10 texture comparisons.

Conclusion

This pilot study suggests that utilizing HDsEMG during deglutition can noninvasively differentiate swallows of varying texture noninvasively. This may prove useful in future diagnostic and behavioral swallow applications.

Level of Evidence

Level 4 Laryngoscope, 2023

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Differences in morphology of temporomandibular joint ankylosis of traumatic and infective origin

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The aim of this study was to determine whether there are any differences in morphology between temporomandibular joint ankylosis (TMJA) of traumatic and infective origin. Cone beam computed tomography (CBCT) scans of 25 patients (28 joints) with TMJA of traumatic origin (trauma group) and 15 patients (15 joints) with TMJA of infectious origin (infection group) were included. The following morphological parameters were evaluated on multiple sections of the CBCT scans: lateral juxta-articular bone growth, residual condyle, residual glenoid fossa, ramus thickening, ankylotic mass fusion line, sclerosis of the ankylosed condyle and spongiosa of the glenoid fossa, and mastoid and glenoid fossa air cell obliteration. (Source: International Journal of Oral and Maxillofacial Surgery)
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A new glutamine synthetase index to evaluate hepatic lobular restoration in advanced fibrosis during anti‐HBV therapy

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Abstract

Hepatic lobular architecture distortion is a deleterious turning point and a crucial histological feature of advanced liver fibrosis in chronic liver diseases. Regression of fibrosis has been documented in chronic hepatitis B (CHB) patients. However, whether lobular architecture could be restored following fibrosis regression after antiviral therapy is still unclear. Glutamine synthetase (GS) is generally expressed by perivenular hepatocytes around hepatic veins (HV). In this study, we defined abnormal lobular architecture (GSPT) as GS expressing in the vicinity of portal tracts (PT), which denotes parenchymal extinction and lobular collapse. We defined normal lobular architecture (GSHV) as GS positivity area not approximating PTs. Therefore, we propose a new GS-index, defined as the percentage of GSHV/(GSHV+GSPT), to evaluate the extent of architectural disruption and restoration. We evaluated 43 CHB patients with advanced fi brosis (Ishak stage ≥ 4). Post-treatment liver biopsy was performed after 78 weeks of anti-HBV therapy. The median GS-index improved from 7% (IQR: 0%-23%) at baseline to 36% (IQR: 20%-57%) at week 78 (P < 0.001). Totals of 22 patients (51%) had significant GS-index improvement from 0% (IQR: 0%-13%) to 55% (IQR: 44%-81%), while the other half had almost no change between 17% (IQR: 0%-33%) to 20% (IQR: 12%-31%). When GS-index78w ≥ 50% was used to define hepatic lobular restoration, 37% of patients (16/43) achieved lobular restoration, with much improvement in ALT and AST levels (median value of ∆/Baseline in ALT: restored vs. non-restored was 79.1% vs. 48.8%, P = 0.018; median value of ∆/Baseline in AST: restored vs. non-restored was 69.1% vs. 32.5%, P = 0.005). More importantly, lobular restoration correlated with fibrosis regression (median value of ∆/Baseline in Ishak stage: restored vs. non-restored was 25.0% vs. 0%, P = 0.008). Therefore, in the era of antiviral therapy for CHB, restoration of hepatic lobular architecture is achievable in patients with advanced fibrosis. GS-index provides additional insight into fibrosis regression that goes beyond collagen degradation.

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Πέμπτη 2 Φεβρουαρίου 2023

Equivocal end‐of‐therapy imaging findings do not predict a higher risk of local relapse after definitive radiotherapy in pediatric Ewing sarcoma and rhabdomyosarcoma

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Abstract

Background

Posttherapy imaging studies can provide reassurance or induce anxiety regarding risk of recurrence for patients and their families. In some cases, it is difficult to determine if imaging findings represent posttreatment changes or residual disease. Equivocal radiographic findings can occur due to therapy-related inflammation or residual, inactive soft tissue masses, but it is unknown if such findings indicate an increased likelihood of local recurrence. The aim of this study was to assess the value of initial posttherapy scans for predicting local relapse in patients with Ewing sarcoma (EWS) or rhabdomyosarcoma (RMS) who received radiotherapy (RT) for local control. These findings are critical to inform clinicians' surveillance recommendations and ability to accurately counsel patients and their families.

Procedure

The primary endpoint was time to local progression (LP). Patients were classified as having posttherapy scans that were "positive" (residual disease within the RT field), "negative" (no evidence of residual disease within the RT field), or "equivocal" (no determination could be made). The value of initial posttreatment scans for predicting LP was assessed using positive predictive value (PPV) and negative predictive value (NPV).

Results

Negative imaging findings (n = 51) had an NPV of 88%, and positive imaging findings (n = 1) had a PPV of 100%. When equivocal findings (n = 16) were categorized with negative results (i.e., positive vs. equivocal/negative), the NPV was 90%. When equivocal findings were categorized with positive results (equivocal/positive vs. negative), the PPV was 12%.

Conclusion

Equivocal findings within the RT field on end-of-therapy imaging studies indicate no higher risk of local recurrence than negative findings. These results may contribute to appropriate surveillance schedules and accurate counseling of patients with RMS and EWS who have received RT for local control.

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Limited enhancement of antibody and B‐cell responses to prototype booster vaccination following SARS‐CoV‐2 Delta breakthrough infection

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Abstract

COVID-19 vaccines are effective at preventing the ancestral severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) symptomatic infection and severe disease. However, many new SARS-CoV-2 variants of concern (VOCs), including Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), Delta (B.1.617.2) and the most recent Omicron (B.1.1.529) variants, continue to evolve with enhanced immune escape capabilities, posing serious challenges to the efficacy of current vaccines. Recent studies showed booster doses can remarkably reduce VOCs escape from neutralizing antibody response and can induce strong T-cell and memory B-cell responses[1-4](#ref-0001). Hybrid immunity resulting from the combinations of SARS-CoV-2 infection and vaccination has also been proved to produce antibodies with increased potency and breadth and elicit robust CD4+ T-cell populations with enhanced antiviral properties[5,6](#ref-0005). But is unclear that how infection and vaccination history affect immune imprinting and whether it's necessary to have a booster vaccination for people who had a breakthrough infection post-vaccination

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Masseter muscle cross‐sectional area and late implant failure: A case–control study

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Abstract

Introduction

Occlusal overload is considered to be one of the causes of late implant failure. However, it is unclear whether the magnitude of the patient's occlusal force is a risk factor for late implant failure.

Purpose

This case–control study aimed to clarify the association between the cross-sectional area (CSA) of the masseter muscle and late implant failure.

Methods

This case–control study was limited to implant-supported fixed prostheses. We compared cases with at least one late implant failure (n = 25 patients) to controls (n = 82 patients) without implant failure. Patients were matched by age, sex, year of surgery, jaw and tooth type, and bone graft. Log-rank and Cox proportional hazard regression analyses were used to identify possible risk factors for late implant failure.

Results

The incidence of late implant failure was significantly associated with masseter muscle CSA ≥504.5 mm2 (hazard ratio: 4.43; 95% CI: 1.82–10.79; p < 0.01).

Conclusion

Higher masseter muscle CSA increases the risk of late implant failure.

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Lip Squamous Cell Carcinoma With Spontaneous Eruption and Drainage

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A 69-year-old woman with a newly diagnosed squamous cell carci noma of the lower lip mucosa presented 3 days after initiating neoadjuvant immune checkpoint blockade immunotherapy with redness and swelling of the tumor site. What is your diagnosis?
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