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Gilbert Gadegaard posted an update 6 months, 3 weeks ago
Purpose Patients receive multiple bolus trials during a videofluoroscopic swallowing study (VFSS) to assess swallow function, inclusive of narrowing within the pharyngoesophageal segment (PES). While differences in the narrowest and widest segments are visualized, the ratio of distention across boluses is not well understood. Method A retrospective review of 50 consecutive VFSSs with five boluses of varied viscosity and volume was performed. Still images at maximal PES distention were captured and scaled using a 19-mm disk. Measurements of the narrowest and widest segments were obtained, and a distention ratio was calculated. Studies were categorized by PES phenotype as normal, esophageal web, cricopharyngeal bar, or narrow PES. PES distention ratios were evaluated across bolus trials and within PES phenotypes using a mixed-methods repeated-measures analysis of variance. Results Of the 50 studies, there were 11 normal, 16 web, 10 bar, and 13 narrow PES. Quantitative differences were present for the narrowest (p = .01) and widest (p = .002) points across bolus volumes. No difference was present in distention ratio (p = .2) across volumes. Evaluating the PES phenotype, web, normal, bar, and narrow PES distention ratios differed (p = .03). Bar and PES narrow distention ratios were lower compared to that of the normal group (p = .01 for normal vs. DL-Thiorphan cell line bar and p = .02 for normal vs. PES narrow). Conclusions PES distention ratio stability across varying bolus volumes and phenotypes suggests that a reduction in trials during a VFSS may permit an equivalent PES evaluation to traditional exams. Ultimately, this could improve our understanding and accurate diagnosis of PES dysfunction.Vulvovaginitis is a frequent reason for women to see a health care provider and has been linked to adverse reproductive and psychosocial consequences. Accurate diagnosis is a cornerstone of effective treatment, yet misdiagnosis of this condition approaches 50%, raising the risk of recurrence. The past 3 decades have seen few improvements over the traditional means of diagnosing the 3 main causes of vaginitis bacterial vaginosis, Candida infections, and trichomoniasis. Newer molecular tests, which are both more sensitive and specific, have introduced the potential to transform the diagnosis of vaginitis-ensuring more accurate diagnoses and timely interventions, while reducing health care costs and enhancing patients’ quality of life. Clinical approaches and professional guidelines should be updated to reflect advances in molecular testing and improve the diagnosis and management of acute and recurrent vulvovaginitis.Purpose Sensitivity to sounds and atypical reactions to sensory input by individuals with autism spectrum disorder (ASD) have been reported in the literature. In response to this sensitivity, some individuals use ear protection devices (EPDs) such as noise-canceling headphones, earplugs, or earmuffs to attenuate the perceived unpleasant sounds. Given the communication deficits often noted in this population and the essential role of hearing in speech and language development, the impact of wearing EPDs to attenuate sound needs to be explored. The purpose of this study was to obtain information from various stakeholders regarding their opinions about use of EPDs in individuals with ASD and perceived benefits and possible concerns of EPD use. Method A survey was constructed to assess the opinions of speech-language pathologists, audiologists, teachers, and graduate students about EPDs among individuals with ASD. A total of 255 professionals and graduate students completed the survey. Results The vast majority of respondents indicated a level of awareness of EPDs within this population. Regarding observed use of such devices, the majority of participants (66%) reported observing individuals with ASD using EPDs. The most commonly used devices observed were headphones (91%), followed by earmuffs (44%) and earplugs (33%). Respondents who had experience recommending and/or using EPDs with individuals with ASD were asked to report on major reasons why the devices were used and the perceived benefits and possible negative effects. Conclusions There appears to be uncertainty among various stakeholders of the benefits and possible negative effects of EPD use by individuals with ASD. Additionally, there is a dearth of research in this area, and the necessity for specific guidelines for recommending and monitoring EPD use is indicated.We compared voluntary oscillatory sway for eight subjects tested in 1.8-g and 1-g gravito-inertial force (GIF) levels of parabolic flight. Subjects performed voluntary forward-backward (FB) and lateral left-right (LR) swaying as the forces and moments under the soles of each foot were measured. We calculated the experimental values of three parameters two ankle stiffness parameters KSAP and KSML acting in orthogonal FB and LR directions and one parameter KED related to leg pivot shifting. Simulations of the engaged leg model (Bakshi A, DiZio P, Lackner JR. J Neurophysiol 121 2042-2060, 2019; Bakshi A, DiZio P, Lackner JR. J Neurophysiol 121 2028-2041, 2019) correctly predicted the experimentally determined stability bounds of upright balance and also the scaling of the postural parameters as a function of GIF magnitude. The effective stiffness, KSAP, at the ankles played the primary role to prevent falling in FB swaying and both model predictions, and experimental data showed KSAP to scale up in proportion torgravity conditions. ELM can also be applied to terrestrial clinical situations for pathologies that generate postural asymmetries.
The CheckMate 066 trial investigated nivolumab monotherapy as first-line treatment for patients with previously untreated
wild-type advanced melanoma. Five-year results are presented herein.
In this multicenter, double-blind, phase III study, 418 patients with previously untreated, unresectable, stage III/IV, wild-type
melanoma were randomly assigned 11 to receive nivolumab 3 mg/kg every 2 weeks or dacarbazine 1,000 mg/m
every 3 weeks. The primary end point was overall survival (OS), and secondary end points included progression-free survival (PFS), objective response rate (ORR), and safety.
Patients were followed for a minimum of 60 months from the last patient randomly assigned (median follow-up, 32.0 months for nivolumab and 10.9 months for dacarbazine). Five-year OS rates were 39% with nivolumab and 17% with dacarbazine; PFS rates were 28% and 3%, respectively. Five-year OS was 38% in patients randomly assigned to dacarbazine who had subsequent therapy, including nivolumab (n = 37). ORR was 42% with nivolumab and 14% with dacarbazine; among patients alive at 5 years, ORR was 81% and 39%, respectively.
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