Communication, socialization, and ITC. The psychosocial construction of sustainability.

Over the past two decades, the facets related to environmental crises (in the plural) have grown increasingly intricate. What began as environmentalists' apprehension over nature degradation and the encouragement of citizen-driven initiatives has evolved. The current shift in emphasis and prevailing message strives to foster a culture where citizens refrain from independent initiatives. Instead, the directive is to heed the guidance of the knowledgeable (scientists, politicians, corporations, interest groups, etc.), as substantiated by our investigative findings, which align, in part, with existing literature. Conversely, our exploration into environmental communication, notably the insights gleaned from longitudinal research concerning pro-environmental knowledge, attitudes, and actions, reveals a decline in citizens' effective inclinations toward embracing pro-environmental behaviors. Meanwhile, the escalation of the climate crisis is fueling heightened levels of echo-anxiety and solastalgia. This trajectory is closely intertwined with a growing global disillusionment within society - not just regarding the future - instilling a sense of disillusionment concerning pro-environmental messages and slogans disseminated by governing bodies and corporations. This has led to a state resembling learned helplessness, as articulated by Seligman, or what we prefer to term "induced" helplessness, rather than fostering conditions conducive to empowerment. This article comprehensively examines various reports and our inquiries, revealing how communication management and its constituents lie at the heart of forging novel narratives, fresh cognitive dissonances, and emerging social representations. Notably emphasized is the pivotal role played by information and communication technologies (ICT), particularly through dissemination on widely-used social networks. Since the 2010s, these platforms have assumed a paramount role in shaping socialization processes, surpassing educational institutions and conventional mass media.

Therapeutic Vaccines for HPV-Associated Oropharyngeal and Cervical Cancer: The Next De-Intensification Strategy?

The rise in human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) has prompted a quest for further understanding of the role of high-risk HPV in tumor initiation and progression. Patients with HPV-positive OPSCC (HPV+ OPSCC) have better prognoses than their HPV-negative counterparts; however, current therapeutic strategies for HPV+ OPSCC are overly aggressive and leave patients with life-long sequalae and poor quality of life. This highlights a need for customized treatment. Several clinical trials of treatment de-intensification to reduce acute and late toxicity without compromising efficacy have been conducted. This article reviews the differences and similarities in the pathogenesis and progression of HPV-related OPSCC compared to cervical cancer, with emphasis on the role of prophylactic and therapeutic vaccines as a potential de-intensification treatment strategy. Overall, the future development of novel and effective therapeutic agents for HPV-associated head and neck tumors promises to meet the challenges posed by this growing epidemic.

Risk Prediction Models of Natural Menopause Onset: A Systematic Review.

CONTEXT: Predicting the onset of menopause is important for family planning and to ensure prompt intervention in women at risk of developing menopause-related diseases. OBJECTIVE: We aimed to summarize risk prediction models of natural menopause onset and their performance. METHODS: Five bibliographic databases were searched up to March 2022. We included prospective studies on perimenopausal women or women in menopausal transition that reported either a univariable or multivariable model for risk prediction of natural menopause onset. Two authors independently extracted data according to the CHARMS (critical appraisal and data extraction for systematic reviews of prediction modelling studies) checklist. Risk of bias was assessed using a prediction model risk of bias assessment tool (PROBAST). RESULTS: Of 8132 references identified, we included 14 articles based on 8 unique studies comprising 9588 women (mainly Caucasian) and 3289 natural menopause events. All included studies used onset of natural menopause (ONM) as outcome, while 4 studies also predicted early ONM. Overall, there were 180 risk prediction models investigated, with age, anti-Müllerian hormone, and follicle-stimulating hormone being the most investigated predictors. Estimated C-statistic for the prediction models ranged from 0.62 to 0.95. Although all studies were rated at high risk of bias mainly due to the methodological concerns related to the statistical analysis, their applicability was satisfactory. CONCLUSION: Predictive performance and generalizability of current prediction models on ONM is limited given that these models were generated from studies at high risk of bias and from specific populations/ethnicities. Although in certain settings such models may be useful, efforts to improve their performance are needed as use becomes more widespread.

Does reproductive stage impact cardiovascular disease risk factors? Results from a population-based cohort in Lausanne (CoLaus study).

CONTEXT: Menopause has been associated with adverse cardiovascular disease (CVD) risk profile, yet it is unclear whether the changes in CVD risk factors differ by reproductive stage independently of underlying ageing trajectories. DESIGN: The CoLaus study is a prospective population-based cohort study in Lausanne, Switzerland. PATIENTS: We used data from women at baseline and follow-up (mean: 5.6 ± 0.5 years) from 2003 to 2012 who did not use hormone therapy. We classified women into (i) premenopausal, (ii) menopausal transition, (iii) early (≤5 years) and (iv) late (>5 years) postmenopausal by comparing their menstruation status at baseline and follow-up. MEASUREMENTS: We measured fasting lipids, glucose and cardiovascular inflammatory markers. We used repeated measures (linear mixed models) for longitudinal analysis, using premenopausal women as a reference category. We adjusted analyses for age, medications and lifestyle factors. RESULTS: We used the data from 1710 women aged 35-75 years. Longitudinal analysis showed that the changes in CVD risk factors were not different in the other three menopausal categories compared to premenopausal women. When age was used as a predictor variable and adjusted for menopause status, most CVD risk factors increased, while interleukin-6 and interleukin-1ß decreased with advancing age. CONCLUSION: The current study suggests that women have a worsening cardiovascular risk profile as they age, and although menopausal women may have higher levels of cardiovascular risk factors compared to premenopausal women at any given time, the 5-year changes in cardiovascular risk factors may not depend on the reproductive stage.

Evaluating the effect of a water exercise routine on the postural stability of the elderly / Evaluación del efecto de una rutina de ejercicios acuáticos sobre la estabilidad postural de adultos mayores

Abstract Background: Postural stability enables humans to maintain the center of mass of their body within their base of support. Nevertheless, over time, such stability is affected by different factors such as age, repetitive strain, and accidents. Although studies in this field have investigated the effectiveness of hydrotherapy, only a few of them have explored its influence on postural stability, which is reflected in a lack of research that estimates its impact on rehabilitation. Aim: To determine the immediate and final effects of an aquatic routine protocol on the postural stability of elderly subjects. Methods: The postural stability of 20 adults over 60 years of age was analyzed using electromyographic and baropodometric methods. Electromyographic signals were obtained from the tibialis anterior, soleus, both gastrocnemius, vastus medialis, and biceps femoris to calculate the coactivation percentage of the muscles in charge of postural stability. The baropodometric data were collected to analyze the area of the stabilometric ellipse, mean plantar pressure, and weight distribution percentage. Results: The outcome of both methods revealed improvements in the elderly patients after the aquatic routine protocol was applied, which indicates that the type of water exercises implemented in this study has positive effects on their postural stability. Conclusion: The postural stability of the elderly participants was improved after each session because their stability index decreased along with the electrical activity of some muscle pairs, their body weight was better distributed, and the area of body oscillation was reduced. However, this effect was immediate and not final.

Resumen Antecedentes: La estabilidad postural permite a los humanos mantener el centro de masa de su cuerpo dentro de su base de apoyo. Sin embargo, con el tiempo, dicha estabilidad se ve afectada por diferentes factores como la edad, el esfuerzo repetitivo y los accidentes. Si bien los estudios en este campo han investigado la efectividad de la hidroterapia, solo algunos de ellos han explorado su influencia en la estabilidad postural, lo que se refleja en la falta de investigaciones que estimen su impacto en la rehabilitación. Objetivo: Determinar los efectos inmediatos y finales de un protocolo de rutina acuática sobre la estabilidad postural de adultos mayores. Métodos: Se analizó la estabilidad postural de 20 adultos mayores de 60 años mediante métodos electromiográficos y baropodométricos. Se obtuvieron señales electromiográficas del tibial anterior, sóleo, gastrocnemio, vasto interno y bíceps femoral para calcular el porcentaje de coactivación de los músculos encargados de la estabilidad postural. Los datos baropodométricos se recolectaron para analizar el área de la elipse estabilométrica, la presión plantar media y el porcentaje de distribución del peso corporal. Resultados: Ambos métodos mostraron mejoras en los pacientes luego de la aplicación del protocolo de rutina acuática, lo que indica que el tipo de ejercicios acuáticos implementados en este estudio tiene efectos positivos en su estabilidad postural. Conclusión: La estabilidad postural de los participantes mejoró después de cada sesión porque su índice de estabilidad disminuyó junto con la actividad eléctrica de algunos pares de músculos, su peso corporal se distribuyó mejor y se redujo el área de oscilación corporal. Sin embargo, este efecto fue inmediato y no definitivo.

Evaluating the effect of a water exercise routine on the postural stability of the elderly.

Background: Postural stability enables humans to maintain the center of mass of their body within their base of support. Nevertheless, over time, such stability is affected by different factors such as age, repetitive strain, and accidents. Although studies in this field have investigated the effectiveness of hydrotherapy, only a few of them have explored its influence on postural stability, which is reflected in a lack of research that estimates its impact on rehabilitation. Aim: To determine the immediate and final effects of an aquatic routine protocol on the postural stability of elderly subjects. Methods: The postural stability of 20 adults over 60 years of age was analyzed using electromyographic and baropodometric methods. Electromyographic signals were obtained from the tibialis anterior, soleus, both gastrocnemius, vastus medialis, and biceps femoris to calculate the coactivation percentage of the muscles in charge of postural stability. The baropodometric data were collected to analyze the area of the stabilometric ellipse, mean plantar pressure, and weight distribution percentage. Results: The outcome of both methods revealed improvements in the elderly patients after the aquatic routine protocol was applied, which indicates that the type of water exercises implemented in this study has positive effects on their postural stability. Conclusion: The postural stability of the elderly participants was improved after each session because their stability index decreased along with the electrical activity of some muscle pairs, their body weight was better distributed, and the area of body oscillation was reduced. However, this effect was immediate and not final.

Antecedentes: La estabilidad postural permite a los humanos mantener el centro de masa de su cuerpo dentro de su base de apoyo. Sin embargo, con el tiempo, dicha estabilidad se ve afectada por diferentes factores como la edad, el esfuerzo repetitivo y los accidentes. Si bien los estudios en este campo han investigado la efectividad de la hidroterapia, solo algunos de ellos han explorado su influencia en la estabilidad postural, lo que se refleja en la falta de investigaciones que estimen su impacto en la rehabilitación. Objetivo: Determinar los efectos inmediatos y finales de un protocolo de rutina acuática sobre la estabilidad postural de adultos mayores. Métodos: Se analizó la estabilidad postural de 20 adultos mayores de 60 años mediante métodos electromiográficos y baropodométricos. Se obtuvieron señales electromiográficas del tibial anterior, sóleo, gastrocnemio, vasto interno y bíceps femoral para calcular el porcentaje de coactivación de los músculos encargados de la estabilidad postural. Los datos baropodométricos se recolectaron para analizar el área de la elipse estabilométrica, la presión plantar media y el porcentaje de distribución del peso corporal. Resultados: Ambos métodos mostraron mejoras en los pacientes luego de la aplicación del protocolo de rutina acuática, lo que indica que el tipo de ejercicios acuáticos implementados en este estudio tiene efectos positivos en su estabilidad postural. Conclusión: La estabilidad postural de los participantes mejoró después de cada sesión porque su índice de estabilidad disminuyó junto con la actividad eléctrica de algunos pares de músculos, su peso corporal se distribuyó mejor y se redujo el área de oscilación corporal. Sin embargo, este efecto fue inmediato y no definitivo.

Preoperative assessment of CD44-mediated depth of invasion as predictor of occult metastases in early oral squamous cell carcinoma.

BACKGROUND: Epithelial-mesenchymal transition and cancer stem-like cells (CSC) have been linked to increased metastatic potential. We evaluated the prognostic impact of CD44, a CSC biomarker, on depth of invasion (DOI) and outcome in oral squamous cell carcinoma (OSCC). METHODS: Using a multivariable logistic regression model, we evaluated in early OSCCs the relationship between CD44 expression at the invasive tumor front, DOI, sentinel lymph node biopsy, extension of nodal involvement, and survival. We also assessed whether CT and/or MRI could predict DOI preoperatively. RESULTS: CD44 expression was associated with increased DOI (P = .018), worse disease-specific survival (P = .041) but not with positive sentinel lymph node biopsy (P > .05). Each millimeter increase in DOI was associated with a 31.1% higher risk for positive sentinel lymph node biopsy (95% CI: 5.8%-62.4%, P = .013) and with higher metastatic ratio (P = .015). Preoperative estimation of DOI by CT and/or MRI and histopathological DOI showed a strong correlation (P < .0001). CONCLUSIONS: CD44 expression correlates with DOI, which predicts occult lymph node metastasis. Preoperative CT and/or MRI provides an accurate estimation of histopathological DOI. Both pieces of information gained preoperatively can help surgeons tailor their operation in regard to the surgical management of the neck.

Histopathologic Effects of Onabotulinum Toxin A Treatment in Pediatric Submandibular Glands.

Onabotulinum toxin A (OBTXA) is an effective treatment for drooling. Our objective was to determine if there are histologic changes in the submandibular glands (SMGs) after repetitive OBTXA injections. The study included blinded histologic analysis and comparison of SMGs with ≥4 OBTXA injections versus controls who never received OBTXA. The number of acinar cells were counted, and the morphology of the cells was evaluated within each histologic sample of the SMGs. Thirty-one glands were analyzed (14 control, 17 cases). No physical differences were observed between the 2 acinar cell groups. There was no significant difference in the number acinar cells per surface area in the control group as compared with the OBTXA group (1.29 ± 0.13 vs 1.17 ± 0.11 cells/µm2, respectively). To conclude, no significant histologic findings were established in this first human study on SMGs post-OBTXA treatment.

Dehiscencia uterina diagnosticada un mes postparto: presentación de un caso y revisión bibliográfica / Uterine dehiscence discovered one month after delivery: case report and literature review

La rotura uterina es una complicación obstétrica cuyas consecuencias pueden ser graves. Se diagnostica principalmente antes o durante el trabajo de parto en mujeres con antecedente de cesárea y una extracción rápida del feto es necesaria. Sin embargo, pocos casos de dehiscencia uterina son diagnosticados a distancia del parto. Presentamos el caso de una paciente con útero cicatrizado, que consulta por metrorragia 27 días después de parto por vía vaginal, en la que se diagnosticó una dehiscencia uterina con consecuente histerectomía abdominal a través de una incisión de Pfannenstiel. Por medio de este caso se evaluarán los signos y síntomas para el diagnóstico temprano de una dehiscencia, permitiendo así proporcionar el tratamiento más conservador posible (AU)

Uterine rupture is an uncommon but potentially devastating maternal and obstetric complication that is usually diagnosed in women with a prior caesarean delivery before or during labour, leading to an emergency foetal extraction. However, there are very few reports of uterine rupture diagnosed in the postpartum period. We report the case of a patient with a scarred uterus who presenting with metrorrhagia 27 days after a vaginal delivery. A diagnosis of uterine dehiscence was made, requiring an abdominal hysterectomy through Pfannenstiel incision. Through this case we highlight the symptoms and signs to establish an early diagnosis, which allow provision of the most conservative treatment possible (AU)

Improved COD Measurements for Organic Content in Flowback Water with High Chloride Concentrations.

An improved method was used to determine chemical oxygen demand (COD) as a measure of organic content in water samples containing high chloride content. A contour plot of COD percent error in the Cl(-)-Cl(-):COD domain showed that COD errors increased with Cl(-):COD. Substantial errors (>10%) could occur in low Cl(-):COD regions (<300) for samples with low (<10 g/L) and high chloride concentrations (>25 g/L). Applying the method to flowback water samples resulted in COD concentrations ranging in 130 to 1060 mg/L, which were substantially lower than the previously reported values for flowback water samples from Marcellus Shale (228 to 21 900 mg/L). It is likely that overestimations of COD in the previous studies occurred as result of chloride interferences. Pretreatment with mercuric sulfate, and use of a low-strength digestion solution, and the contour plot to correct COD measurements are feasible steps to significantly improve the accuracy of COD measurements.

Comparison between a multiple daily insulin injection regimen (basal once-daily glargine plus mealtime lispro) and continuous subcutaneous insulin infusion (lispro) using continuous glucose monitoring in metabolically optimized type 1 diabetes patients: A randomized open-labelled parallel study / Comparación entre múltiples dosis de insulina (insulina glargina una vez al día y lispro en las comidas) e infusión subcutánea continua de insulina con monitorización continua de glucosa en pacientes con diabetes tipo 1 metabólicamente optimizados. Estudio randomizado

Background and objective: Advantages of continuous subcutaneous insulin infusion (CSII) over multiple daily injections with glargine (MDI/G) are still uncertain. We compared CSII vs. MDI/G therapy in unselected patients with type 1 diabetes using continuous glucose monitoring (CGSM). The primary end-points were glycaemic control and quality of life (QOL). Methods: A total of 45 patients with long-term diabetes and mean HbA1c values of 8.6 ± 1.8% (70.5 ± 15.4 mmol/mol), previously treated with MDI/NPH, were switched to MDI/G for 6 months and then, unfulfilling therapy CSII indication, were randomly assigned to CSII or MDI/G for another six months. We evaluated QOL (EsDqol) and glycaemic control by measuring HbA1c levels, rate of hypoglycaemia, ketoacidosis and CGSM data. Results: After the first phase (MDI/NPH to MDI/G) there was a significant improvement in total EsDQOL (99.72 ± 18.38 vs. 92.07 ± 17.65; p < 0.028), a 0.5% decrease in HbA1c values (8.4 ± 1.2 vs. 7.9 ± 0.7% [68 ± 9.7 vs. 63 ± 5.5 mmol/mol]; p < 0.032), an improvement in glycaemic variability (standard deviation 66.9 ± 14 vs. 59.4 ± 16 mg/dl; p < 0.05), a decrease in insulin requirements (0.87 ± 0.29 vs. 0.80 ± 0.25 U/kg; p < 0.049), a decrease in number of severe hypoglycaemia episodes (0.44 ± 0.9 vs. 0.05 ± 0.2; p < 0.014), and an increase in periods of normoglycaemia measured with CGSM (15.8 ± 10.9% vs. 23 ± 18.4%; p < 0.003). Six months after randomization, significant improvements were seen in the HbA1c (7.9 ± 0.7 vs. 7 ± 0.6% [63 ± 5.5 vs. 53 ± 4.5 mmol/mol]; p < 0.001) and EsQOL (91.66 ± 22 vs. 84.53 ± 1.63; p < 0.045) only in the CSII group. The HbA1c value was significantly lower when compared with the MDI/G group (CSII 7 ± 0.6% [53 ± 4.5 mmol/mol] vs. MDI/G 7.6 ± 0.9% 59.6 ± 7.7 mmol/mol];p < 0.03). Conclusions: Intensive insulin therapy with CSII vs. MDI/G was associated with better levels of HbA1c in patients with long-term type 1 diabetes (AU)

Introducción y objetivo: Las ventajas de la infusión subcutánea continua de insulina (ISCI) sobre múltiples inyecciones diarias de insulina con glargina (MDI/G) son todavía inciertas. Comparamos ISCI frente a MDI/G en pacientes con diabetes tipo 1 sin indicación de terapia ISCI utilizando la monitorización continua de glucosa (CGSM). Los objetivos primarios fueron el control glucémico y la calidad de vida (QOL). Métodos: Un total de 45 pacientes con diabetes 1 de largo tiempo de evolución y valores medios de HbA1c de 8,6 ± 1,8% (70,5 ± 15,4 mmol/mol), previamente tratados con MDI/NPH, fueron cambiados a MDI/G durante 6 meses y luego sin cumplir criterios clínicos para terapia ISCI asignados aleatoriamente a ISCI o MDI/G durante seis meses. Se evaluó la calidad de vida (EsDqol) y el control de la glucemia mediante la medición de los niveles de HbA1c, la tasa de hipoglucemias, cetoacidosis y datos de CGSM. Resultados: Después de la primera fase (MDI/NPH a MDI/G) hubo una mejora significativa en EsDQOL total (99,72 ± 18,38 vs. 92,07 ± 17,65; p < 0.028), una disminución de 0,5% en los valores de HbA1c (8,4 ± 1,2 vs. 7,9 ± 0,7% [68 ± 9,7 vs. 63 ± 5,5 mmol/mol]; p < 0,032), una mejora en la variabilidad de la glucemia (desviación estándar 66,9 ± 14 vs. 59,4 ± 16 mg/dl; p <0,05), una disminución en las necesidades de insulina (0,87 ± 0,29 vs. 0,80 ± 0,25 U/kg; p <0,049), una disminución en el número de episodios de hipoglucemia grave (0,44 ± 0,9 vs. 0,05 ± 0,2; p <0,014), y un aumento en los periodos de normoglucemia medidos con CGSM (15,8 ± 10,9% vs. 23 ± 18,4%; p <0,003). Seis meses después de la aleatorización, se observaron mejoras significativas en la HbA1c (7,9 ± 0,7 vs. 7 ± 0,6%; [63 ± 5,5 vs. 53 ± 4.5 mmol/mol]; p <0,001) y la calidad de vida (91,66 ± 22 vs. 84,53 ± 1,63; p <0,045) sólo en el grupo ISCI. El valour de HbA1c fue significativamente menor en ISCI en comparación con el grupo MDI/G (CSII 7 ± 0,6% [53 ± 4,5 mmol/mol] vs. MDI/G 7,6 ± 0,9% [59,6 ± 7,7 mmol/mol]; p < 0,03). Conclusiones: La terapia insulínica intensiva con ISCI vs. MDI/G se asoció con mejores niveles de HbA1c en pacientes con diabetes tipo 1 de larga evolución (AU)

Comparison between a multiple daily insulin injection regimen (basal once-daily glargine plus mealtime lispro) and continuous subcutaneous insulin infusion (lispro) using continuous glucose monitoring in metabolically optimized type 1 diabetes patients: A randomized open-labelled parallel study.

BACKGROUND AND OBJECTIVE: Advantages of continuous subcutaneous insulin infusion (CSII) over multiple daily injections with glargine (MDI/G) are still uncertain. We compared CSII vs. MDI/G therapy in unselected patients with type 1 diabetes using continuous glucose monitoring (CGSM). The primary end-points were glycaemic control and quality of life (QOL). METHODS: A total of 45 patients with long-term diabetes and mean HbA1c values of 8.6±1.8% (70.5±15.4mmol/mol), previously treated with MDI/NPH, were switched to MDI/G for 6 months and then, unfulfilling therapy CSII indication, were randomly assigned to CSII or MDI/G for another six months. We evaluated QOL (EsDqol) and glycaemic control by measuring HbA1c levels, rate of hypoglycaemia, ketoacidosis and CGSM data. RESULTS: After the first phase (MDI/NPH to MDI/G) there was a significant improvement in total EsDQOL (99.72±18.38 vs. 92.07±17.65; p<0.028), a 0.5% decrease in HbA1c values (8.4±1.2 vs. 7.9±0.7% [68±9.7 vs. 63±5.5mmol/mol]; p<0.032), an improvement in glycaemic variability (standard deviation 66.9±14 vs. 59.4±16mg/dl; p<0.05), a decrease in insulin requirements (0.87±0.29 vs. 0.80±0.25U/kg; p<0.049), a decrease in number of severe hypoglycaemia episodes (0.44±0.9 vs. 0.05±0.2; p<0.014), and an increase in periods of normoglycaemia measured with CGSM (15.8±10.9% vs. 23±18.4%; p<0.003). Six months after randomization, significant improvements were seen in the HbA1c (7.9±0.7 vs. 7±0.6% [63±5.5 vs. 53±4.5mmol/mol]; p<0.001) and EsQOL (91.66±22 vs. 84.53±1.63; p<0.045) only in the CSII group. The HbA1c value was significantly lower when compared with the MDI/G group (CSII 7±0.6% [53±4.5mmol/mol] vs. MDI/G 7.6±0.9% [59.6±7.7mmol/mol]; p<0.03). CONCLUSIONS: Intensive insulin therapy with CSII vs. MDI/G was associated with better levels of HbA1c in patients with long-term type 1 diabetes.

Effect of recurrent onabotulinum toxin A injection into the salivary glands: An ultrasound measurement.

OBJECTIVES/HYPOTHESIS: Onabotulinum toxin A (OBTXA) injection is a well-established therapeutic option for the management of drooling. Many of the children treated undertake repeated injections every 3 to 6 months. We aimed to assess quantitative salivary gland changes via ultrasound imaging after intraglandular injection of OBTXA for sialorrhea treatment in children, as a method that suggests permanent changes in glandular size can cause a decrease in functionality or atrophy. STUDY DESIGN: Case-control study. METHODS: The parotid and submandibular glands of 22 patients with sialorrhea with previous repetitive OBTXA treatments were measured via ultrasound. These were compared with a control group of 38 healthy children. RESULTS: A total of 60 patients were included in the study (38 boys, 22 females). Body mass index, sex, and age were defined as confounders. The mean age was 7 years (standard deviation [SD] ±2.3 years) and 9 years (SD ±3.8 years) for treatment and control groups, respectively. There were no postinjection complications. We found significant decrease in the size dimensions (surface area and depth) of both submandibular glands and one parotid gland in the treatment group (P < .05). Significant smaller anterior-posterior dimension of the submandibular glands (P < .01) was also found. CONCLUSIONS: The chronic use of intraglandular OBTXA reduced the size of the salivary glands measured ultrasonographically. Results were correlated with clinical outcomes. Pathological studies should be done to correlate whether ultrasound changes result in atrophy or apoptosis of the glands. LEVEL OF EVIDENCE: 3b

Salivary glands of healthy children versus sialorrhea children, is there an anatomical difference? An ultrasonographic biometry.

OBJECTIVES: There is no literature about the average size of the salivary glands in the pediatric population with drooling (sialorrhea). Studies have shown that some pathologies affect the functionality of the salivary glands. We assessed via ultrasonography the sizes of the submandibular and parotid glands in 9 healthy children who were not suffering from local or systemic diseases that could affect the salivary glands. We also compared this group with a group of 9 patients with sialorrhea. METHODS: Volunteers were matched based on age, gender, and BMI. Body weight did not differ more than 20% from ideal weight. The parotid and submandibular glands of 9 patients with sialorrhea without any previous treatment were measured via ultrasound and matched to a healthy control. Children with various causes for drooling were included (neurological disorders, neuromuscular disorders, lack of oral motor control). RESULTS: Dimensions of the parotid glands in drooling and healthy patients were: surface area 2.96 cm(2) (SD ±0.90) and 2.81 cm(2) (SD ±0.54); in depth 1.68 cm (SD ±0.24) and 1.61 cm (SD ±0.27); in the axis longitudinal to the horizontal mandibular ramus 3.18 cm (±0.46) and 3.15 cm (SD ±0.45) in drooling and healthy groups respectively. The means of submandibular glands of drooling and healthy patients measured in surface area: 3.20 cm(2) (SD ±0.66) and 3.08 cm(2) (SD ±0.65); anterior-posterior length 1.55 cm (SD ±0.23) and 1.46 cm (SD ±0.23), medio-lateral length 3.07 cm (SD ±0.39) and 3.07 cm (SD ±0.32). There was no statistical significance in comparison with the healthy group control. CONCLUSION: The parotid and submandibular salivary glands in the pediatric population do not differ in size in children with or without drooling. Measuring the glands at baseline and post treatment with botulinum toxin injections allows one to evaluate if there are changes in the gland related to the treatment.

Cricothyroid onabotulinum toxin A injection to avert tracheostomy in bilateral vocal fold paralysis.

IMPORTANCE: More than half of children with bilateral vocal fold paralysis require a tracheostomy for airway management. We report an innovative, minimally invasive approach consisting of onabotulinum toxin A injection into the cricothyroid muscles. OBSERVATIONS: Onabotulinum toxin A was injected under direct vision into the cricothyroid muscles of 6 pediatric patients with bilateral abductor vocal fold paralysis. None of the patients had fold fixation on laryngoscopy performed at the time of the injection. All patients had a documented increase in airway patency as visualized on flexible laryngoscopy within days after injection. This procedure successfully averted a tracheostomy in 5 patients and permitted decannulation of the sixth patient. CONCLUSIONS AND RELEVANCE: Onabotulinum toxin A injection into the cricothyroid muscles leads to an increase in the glottic space, providing an adequate airway. Onabotulinum toxin A injection in the cricothyroid muscles could be offered as a safe, effective, noninvasive first-line option for patients with bilateral vocal fold paralysis.

Acute mastoiditis in children with cochlear implants: is explantation required?

OBJECTIVE: Acute mastoiditis is an uncommon but challenging condition when it occurs in children with cochlear implant. The literature is scarce as to the management of this condition with regards to explantation. The objective of the study is to determine the need for explantation in patients with cochlear implants who suffer from acute mastoiditis. DATA SOURCES: Online medical databases-PubMed, Ovid Medline, Ovid Medline in process, Embase, Cochrane Library, CINAHL, Biosis, Google Scholar, and Scopus. REVIEW METHODS: A systematic review of all publications addressing the treatment of mastoiditis in cochlear implant children prior to November 2013 was conducted. Data were collected from online medical databases-PubMed, Ovid Medline, Ovid Medline in process, Embase, Cochrane Library, CINAHL, Biosis, Google Scholar, and Scopus. The review was performed in 3 phases; an initial screening review of abstracts was performed, followed by a detailed review of full articles based on inclusion and exclusion criteria, and lastly a final review to extract data from selected articles. RESULTS: Twelve articles were found eligible for this systematic review including a total of 43 patients. Subperiosteal abscess was present in 14.3%. All patients received intravenous antibiotics as an initial treatment, and if needed, surgical intervention was performed. Only 1 patient required explantation (2.3%). CONCLUSION: Prompt, aggressive medical and if needed surgical therapy can help in saving the implant and result in a favorable outcome.

Onabotulinum toxin A for the treatment of sialorrhea in familial dysautonomia.

Familial dysautonomia is a rare disease affecting the nervous system. Symptoms include speech and movement problems, anterior sialorrhea (drooling) due to hypersalivation as a consequence of poor oropharyngeal coordination; dysphagia and aspiration pneumonia secondary to recurrent posterior sialorrhea. The treatment for sialorrhea in this population is very challenging. Traditional drugs carry a number of side-effects that are difficult to control in this disease. We report the first documented case series of 3 patients with this condition that successfully responded to Onabotulinum toxin A injection into their salivary glands. This is an innovative, safe method for drooling control in this population.

Use of telemedicine in subjects with type 1 diabetes equipped with an insulin pump and real-time continuous glucose monitoring.

We evaluated a telemedicine system in patients with type 1 diabetes who had optimized treatment with an insulin pump and a real-time continuous glucose monitoring system. We conducted a prospective, one-year study of 15 subjects. Three medical visits took place: pre-baseline, baseline and at 6 months. Each month the subjects transmitted information from the glucose meter, glucose sensor and insulin pump. We adjusted the treatment and returned the information by email. We evaluated psychological and metabolic variables, including HbA(1c), hypoglycaemia, hyperglycaemia and glucose variability. At baseline the mean age of the subjects was 40 years and the mean duration of diabetes was 22 years. There was a significant reduction in HbA(1c) (7.50 to 6.97%) at 6 months, a significant increase in the number of self-monitoring blood glucose checks per day (5.2 to 6.2), and significant improvements in variability: MODD, mean of daily difference (67 to 53) and MAGE, mean amplitude of glycaemic excursions (136 to 102). There were significant improvements in quality of life (92 to 87), satisfaction with the treatment (34 to 32) and less fear of hypoglycaemia (36 to 32). Adult subjects with type 1 diabetes on treatment with a continuous insulin infusion system and a real time glucose sensor and who have acceptable metabolic control and optimized treatment can benefit from the addition of a telemetry system to their usual outpatient follow-up.