Oral Incompetence: changes in speech intelligibility following facial nerve paralysis

BACKGROUND

Speech may be compromised following facial nerve paralysis (FNP), depending on the cause of the paralysis. This can result in lower quality of life and a reduced capacity to return to vocational roles. Despite its prevalence, it is incompletely understood and rarely described. This study prospectively evaluated the impact of FNP on speech intelligibility.

METHODS

This observational study recruited patients who were diagnosed with FNP and who reported oral incompetence from the Sydney Facial Nerve Service. Their speech was analysed using patient reported outcome measures (Speech Handicap Index) and perceived intelligibility (Speech Pathologist, community member control participants, participant self-rating, and dictation software).

RESULTS

Forty participants with FNP and 40 controls were recruited. Participants with FNP rated their intelligibility to be significantly worse than other raters (p <0.001). Consonant analysis demonstrated bilabial, fricatives and labiodental phonemes to be most commonly affected following FNP.

CONCLUSION

Oral competence is compromised after FNP which can lead to a poorer perception of their intelligibility and reduced speech related quality of life.

Efficacy of pelvic floor rehabilitation for bowel dysfunction after anterior resection for colorectal cancer: a systematic review

PURPOSE

Bowel dysfunction is common after anterior resection for colorectal cancer (CRC). Pelvic floor rehabilitation (PFR) may improve functional outcomes after surgery. This review aimed to evaluate the efficacy of PFR for patients with bowel symptoms after anterior resection.

METHODS

MEDLINE, CINHAL, PUBMED, EMBASE, Scopus, PsycINFO, Web of Science, PEDRO and Cochrane Library were searched from inception to June 2019. A final search was performed on 11 July 2020. Randomised controlled trials (RCTs), cohort studies, case-control studies and case series of bowel dysfunction after CRC surgery and PFR were eligible for review. Outcome measures were bowel function changes measured by patient-reported outcomes and manometric measurement. Risk of bias assessments using Methodological Index for Non-Randomized Studies (MINORS) tool and Newcastle Ottawa Scale (NOS) were conducted.

RESULTS

Eleven trials met eligibility criteria: four retrospective studies and seven prospective, non-randomised controlled studies. A total of 516 participants were included, of which 455 received PFR. Functional outcomes were measured by bowel functional outcome questionnaires, patient diary, anorectal manometry and three studies measured quality of life. Faecal incontinence was improved in seven studies, and bowel frequency also decreased in five studies. The mean MINORS score was 10 (8-13) out of 16 in non-comparative groups and 18 (16-22) out of 24 in comparative groups; the NOS was 4.2 (3-7) out of 9. The overall risk of bias was high in most studies.

CONCLUSIONS

PFR appears to be beneficial for improving bowel function after anterior resection for CRC. However, the studies included had methodological limitations, so further investigation on the effectiveness of PFR is warranted.

Abstract P6-03-02: Breast Reduction Mammoplasty and Incidence of Occult Carcinoma. A 10 Year Experience

Background: The aim of this study was to report the incidence of cancer in reduction mammoplasty specimens and suggest alternative pragmatic cost-effective way of identifying and treating patients with carcinoma. Methods: All patients who underwent breast reduction surgery at Northern General Hospital over a 10-year period were identified from a prospective database. The histopathology reports and case records of all patients with significant abnormalities were analysed. All breast reduction specimens were sliced at 1 cm intervals and examined macroscopically. At least 3 blocks per breast were examined microscopically in addition to sampling of any grossly abnormal tissue.

Results: Between October 1999 and April 2010, 1,588 patients underwent reduction mammoplasty. The median age of patients was 38 years (range 16-75 years). Indications for surgery were macromastia in 1,194 (75.2%), congenital asymmetry in 182 (11.5%) and contralateral symmetry procedure post breast cancer surgery in 178 (11.2%). 9 specimens showed atypical hyperplasia (0.57%). 5 cancers were detected (0.31%). 4 of the 5 patients had normal mammograms 1-3 years before the reduction operation (not done in 1). Of these cancers, 4 were invasive (3 invasive lobular, 1 invasive ductal) (0.25%) (mean invasive tumour size 9 mm (SD 7.4)) and 1 was DCIS (4mm) (0.06%). A lump was felt macroscopically by the pathologist in 2 of the 4 patients with invasive cancer. The median age of patients with invasive cancer was 56 years (range 47-68 years). Patient found to have DCIS did not undergo further surgery while those with invasive disease underwent mastectomy (3) and axillary nodal staging (4). None of the patients with benign/normal post-reduction breast imaging had residual breast cancer on histology.

Conclusion: The incidence of occult carcinoma in reduction mammoplasty specimens is less than 0.5%. Pre-operative mammogram is not useful as 4 of the 5 patients with cancer had a normal mammogram 1-3 years before surgery and invasive lobular cancers are often not detected on mammogram. Mastectomy may be avoided in patients with no residual breast disease on post-reduction imaging.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-03-02.

Activation and clinical significance of the unfolded protein response in breast cancer

INTRODUCTION

The tumour microenvironment is hypoglycaemic, hypoxic and acidotic. This activates a stress signalling pathway: the unfolded protein response (UPR). The UPR is cytoprotective if the stressor is mild, but may initiate apoptosis if severe.Activation of the UPR in breast carcinoma is induced by microenvironmental stress such as glucose and oxygen deprivation, but may also be linked to oestrogen stimulation. It may be clinically significant as it may alter chemosensitivity to doxorubicin.

METHODS

395 human breast adenocarcinomas were immunohistochemically stained for UPR activation markers (glucose-regulated protein (GRP-78 and XBP-1). A model of UPR activation in vitro by glucose deprivation of T47D breast cancer cells was developed to determine how the UPR affects cellular sensitivity to doxorubicin and 5-fluorouracil. Cytotoxicity was assessed using a colorimetric cytotoxicity assay (MTT). The effect of oestrogen stimulation and tamoxifen exposure on UPR activation by T47D cells was determined by western blotting measurement of the key UPR protein, GRP-78.

RESULTS

Expression of GRP78 and XBP-1 was demonstrated in 76% and 90% of the breast cancers, respectively, and correlated with oestrogen receptor positivity (P=0.045 and 0.017, respectively). In vitro UPR activation induced resistance to both doxorubicin and 5-flurouracil, (P<0.05). Oestrogen stimulation induced GRP78 and XBP1 over-expression on western blotting. Tamoxifen did not block this response and may induce UPR activation in its own right.

CONCLUSIONS

The UPR is activated in the majority of breast cancers and confers resistance to chemotherapy. In vitro oestrogen stimulates UPR induction. UPR activation may contribute to breast cancer chemoresistance and interact with oestrogen response elements.

Is the Sky 2? Contextual Priming in Grapheme-Color Synaesthesia

Grapheme-color synaesthesia is a neurological phenomenon in which particular graphemes, such as the numeral 9, automatically induce the simultaneous perception of a particular color, such as the color red. To test whether the concurrent color sensations in grapheme-color synaesthesia are treated as meaningful stimuli, we recorded event-related brain potentials as 8 synaesthetes and 8 matched control subjects read sentences such as “Looking very clear, the lake was the most beautiful hue of 7.” In synaesthetes, but not control subjects, congruous graphemes, compared with incongruous graphemes, elicited a more negative N1 component, a less positive P2 component, and a less negative N400 component. Thus, contextual congruity of synaesthetically induced colors altered the brain response to achromatic graphemes beginning 100 ms postonset, affecting pattern-recognition, perceptual, and meaning-integration processes. The results suggest that grapheme-color synaesthesia is automatic and perceptual in nature and also suggest that the connections between colors and numbers are bidirectional.

A survey of current practice with regard to oral care for children being treated for cancer

The aim of the study was to establish current UK oral care practice for children with cancer. A telephone survey of all 22 United Kingdom Children's Cancer Study Group (UKCCSG) centres was undertaken. Nineteen (86%) of the centres reported using guidelines/protocols for mouth care. The use of routine preventive oral care therapies showed the greatest variation between centres. Four centres (18%) did not use any prophylactic oral care therapy other than basic oral hygiene, whereas seven (32%) routinely used a combination of three or more agents. Chlorhexidine was the most frequently administered prophylactic therapy (17/22 centres, 77%), followed by nystatin (11/22 centres, 50%). There was little variation in advice given to parents/patients on basic oral hygiene. Regarding dental check-ups, 9/22 centres (41%) recommended children to attend a hospital-linked dental clinic. Only at 8/22 centres (36%) did children undergo a dental check-up before commencing cancer treatment. The survey identified significant variation in preventive oral care therapies and dental check-ups at the UKCCSG centres. Attention needs to be given to establishing evidence based, effective strategies.

Getting it: human event-related brain response to jokes in good and poor comprehenders

Joke comprehension has been decomposed into surprise registration followed by a coherence stage, involving frame-shifting (retrieving a new frame from long-term memory to reinterpret information in working memory). We examined this view by recording event-related brain potentials (ERPs) from adults reading one-line jokes or non-joke controls with equally unexpected endings. Joke and non-joke ERPs differed in several respects depending on participants' ability to get the joke and contextual constraint. In good joke comprehenders, all jokes elicited a left-lateralized sustained negativity (500-900 ms), indexing frame-shifting, low constraint jokes elicited a frontal positivity (500-900 ms), and high constraint jokes elicited an N400 and later posterior positivity. By contrast, poor joke comprehenders showed only a right frontal negativity (300-700 ms) to jokes. This pattern of effects does not map readily onto a two-stage model of joke comprehension.

Clinical research in paediatric oncology and the role of the research nurse in the UK

Survival rates for childhood cancer have improved considerably as new drugs, treatment protocols and supportive therapies have developed through clinical trials. Such studies take a considerable amount of time and organization and alongside scientific and medical staff the research nurse plays a vital role. The facets of this role will be outlined in this paper. Involvement begins at an early stage of study development and includes applying for Research Ethics Committee approval of the project. Once the study has opened the research nurse is then responsible for patient recruitment, monitoring and follow-up. The research nurse works within a team but also with a degree of autonomy ensuring that standards of patient care are maintained by adhering to guidelines for clinical research in general and those aimed at children specifically. Providing detailed information and support to the child and family, staff and outside agencies are other notable aspects of the post. The role of the research nurse continues to develop, as clinical trials maintain a significant role in improving the treatment for childhood cancer.

Time course of word identification and semantic integration in spoken language

The minimum duration signal necessary to identify a set of spoken words was established by the gating technique; most words could be identified before their acoustic offset. Gated words were used as congruous and incongruous sentence completions, and isolation points established in the gating experiment were compared with the time course of semantic integration evident in event-related brain potentials. Differential N400 responses to contextually appropriate and inappropriate words were observed about 200 ms before the isolation point. Semantic processing was evident before the acoustic signal was sufficient to identify the words uniquely. Results indicate that semantic integration can begin to operate with only partial, incomplete information about word identity. Influences of semantic constraint, word frequency, and rate of presentation are described.

Combining a continuous Bayesian approach with grouping information

When someone breaks glass a number of tiny fragments may be transferred to that person. If the glass is broken in the commission of a crime then these fragments may be used as evidence. A Bayesian interpretation of this evidence relies on, among other things, the forensic scientist's ability to assess the likelihood that the glass recovered from the suspect may have come from more than one source. This paper will examine the effect of including this information in the interpretation. We envisage working towards a system whereby the information loss that occurs during the normal casework activities of sample selection and glass fragment grouping is quantified.