Preamble and Transition to ACC/AHA Guidelines to Reduce Cardiovascular Risk S50

The goals of the American College of Cardiology (ACC) and the American Heart Association (AHA) are to prevent cardiovascular diseases (CVD); improve the management of people who have these diseases through professional education and research; and develop guidelines, standards, and policies that promote optimal patient care and cardiovascular health. Toward these objectives, the ACC and AHA have collaborated with the National Heart, Lung, and Blood Institute (NHLBI) and stakeholder and professional organizations to develop …

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2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk

Jeffrey L. Anderson, MD, FACC, FAHA, Chair 

Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect 

Nancy M. Albert, PhD, RN, FAHA

Biykem Bozkurt, MD, PhD, FACC, FAHA

Ralph G. Brindis, MD, MPH, MACC

Lesley H. Curtis, PhD, FAHA

David DeMets, PhD[¶¶][1]

Lee A. Fleisher, MD, FACC, FAHA

Samuel

/pdf/2014-acc-aha-guideline-on-perioperative-cardiovascular-3firuin78y.pdf

2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: A report of the American college of cardiology/American heart association task force on practice guidelines

Signalling through the ERBB/HER receptors is intricately involved in human cancer and already serves as a target for several cancer drugs. Because of its inherent complexity, it is useful to envision ERBB signalling as a bow-tie-configured, evolvable network, which shares modularity, redundancy and control circuits with robust biological and engineered systems. Because network fragility is an inevitable trade-off of robustness, systems-level understanding is expected to generate therapeutic opportunities to intercept aberrant network activation.

EGF–ERBB signalling: towards the systems level

The text consists of two sections, one for those studying or practicing diagnostic radiology, nuclear medicine and radiation oncology; the other for those engaged in the study or clinical practice of radiation oncology--a new chapter, on radiologic terrorism, is specifically for those in the radiation sciences who would manage exposed individuals in the event of a terrorist event. The 17 chapters in Section I represent a general introduction to radiation biology and a complete, self-contained course especially for residents in diagnostic radiology and nuclear medicine that follows the Syllabus in Radiation Biology of the RSNA. The 11 chapters in Section II address more in-depth topics in radiation oncology, such as cancer biology, retreatment after radiotherapy, chemotherapeutic agents and hyperthermia.

Radiobiology for the Radiologist

von Hippel-Lindau disease

Differences in neural encoding of speech in noise between cochlear implant users with and without preserved acoustic hearing

BACKGROUND Cochlear implants (CI) restore hearing by stimulating spiral ganglion neurons via multichannel electrodes inserted into the cochlea. Many types of electrode arrays have been developed and fall into three categories based on intracochlear position: perimodiolar (PM), lateral wall (LW), and midscala (MS) electrodes. PM electrodes are designed to hug the medial wall to reduce the distance between the electrodes and the spiral ganglion neurons and typically do not coil around the apex. LW electrodes are designed to remain laterally in the scala tympani, with longer array options capable of reaching the apex. MS electrodes are a new type of electrode designed to remain in the middle of the scala tympani, thereby avoiding contact with either the medial or lateral walls to decrease trauma and fibrosis. It has been hypothesized that PM electrodes may have improved hearing performance and longer battery life given their closer proximity to the spiral ganglion. With less electrical current needed to stimulate the spiral ganglion neurons at each electrode position, PM electrodes theoretically should offer improved speech discrimination. When considering electrode type, however, the surgeon must also consider other factors that vary based on electrode type, such as insertional trauma, development of intracochlear fibrosis, transcalar positioning, battery life, and extrusion rates. This article summarizes the major advantages and disadvantages of these electrodes to help guide this decision. LITERATURE REVIEW Since the development of PM electrodes, many studies have compared their design and performance with LW electrodes. A recent study by O’Connell et al. retrospectively looked at 184 patients (220 implants; mean age at time of CI 60.2 years) and showed that electrode type was predictive of scalar position, with LW electrodes successfully placed in the scala tympani in 95.6% of patients compared to significantly lower rates for PM (48.7%) and MS electrodes (42.9%). Electrode placement completely within the scala tympani minimizes trauma to the surrounding structures because accidental translocation into the scala vestibuli damages the basilar and, potentially, Reissner’s membranes and the organ of Corti. Given the intracochlear trauma caused by interscalar translocation of the electrode arrays, the authors concluded that LW electrodes are likely the superior choice to PM. Their MS group was too small to draw conclusions. Other studies have specifically compared which electrode type is better at preserving low-frequency hearing. Wanna et al. performed a retrospective study of 196 patients (225 implants, mean age at time of CI 63.7 years) looking at hearing preservation, which they defined as a postoperative air-conduction threshold <= 80 dB hearing loss (HL) at 250 Hz. They found that LW electrodes were more likely to preserve functional hearing when compared to PM electrodes at both short-term (2–3 weeks postoperative) and long-term (>1 year postoperative) follow-up. Although MS electrodes had 3.4 times higher odds of hearing preservation when compared to PM arrays in the short term, there was no significant difference between these two in the long term. The authors suggested that at least part of the reason for improved hearing preservation was that LW electrodes are more likely to remain within the scala tympani, causing less trauma. Studies have also looked at outcomes in pediatric populations. Gordin et al. performed a prospective nonrandomized control trial involving 115 children to look for differences in performance between the Nucleus 24M straight array (LW), the PM Nucleus 24RC Contour, and the PM Nucleus 24RE with stylet insertion (Cochlear Ltd., Sydney, Australia). Children implanted with the 24RE PM From the Department of Otolaryngology–Head and Neck Surgery (R.K.T., M.R.H.); the Department of Neurosurgery (M.R.H.); and the Institute of Clinical and Translational Sciences (M.R.H.), the University of Iowa, Iowa City, Iowa, U.S.A. Editor’s Note: This Manuscript was accepted for publication on March 1, 2019. Marlan Hansen is a cofounder of IotaMotion, Inc., and holds stock in the company. This article does not discuss any of the technologies under development at IotaMotion. The authors have no other funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Marlan R. Hansen, MD, Department of Otolaryngology–Head and Neck Surgery, The University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242. E-mail: marlan-hansen@uiowa.edu

https://onlinelibrary.wiley.com/doi/pdf/10.1002/lary.27944

Does the intracochlear position of an electrode array impact performance

Interaction of micropatterned topographical and biochemical cues to direct neurite growth from spiral ganglion neurons.

Minimally traumatic surgical techniques and advances in cochlear implant (CI) electrode array designs have allowed acoustic hearing present in a CI candidate prior to surgery to be preserved post-operatively. As a result, these patients benefit from combined electric-acoustic stimulation (EAS) post-operatively. However, 30-40% of EAS CI users experience a partial loss of hearing up to 30 dB after surgery. In the present study, electrocochleography (ECoG) was used to study cochlear microphonic (hair cell response) and auditory nerve neurophonic (neural response) in patients with preserved hearing and patients with loss of hearing. These measures were obtained longitudinally over the course of CI use. At each test session, ECoG amplitude growth functions for several low-frequency stimuli were obtained. The threshold, slope, and suprathreshold amplitude at a fixed stimulation level was obtained from each growth function at each time point. Subjects were categorized as having stable hearing or loss of hearing. Longitudinal linear mixed effects models were used study trends in ECoG thresholds, slopes, and amplitudes for these two categories of subjects. Results showed that CM and ANN thresholds and amplitudes were stable in CI users with preserved residual hearing. CM and ANN thresholds increased (worsened) while CM and ANN amplitudes decreased (worsened) for those with delayed hearing loss. The slope did not distinguish between subjects with stable hearing and subjects with delayed loss of hearing. These results provide a new application of post-operative ECoG as an objective tool to monitor residual hearing and understand the pathophysiology of delayed hearing loss.

Longitudinal Electrocochleography as an Objective Measure of Serial Behavioral Audiometry in Electro-Acoustic Stimulation Patients

Functional outcomes with neural prosthetic devices, such as cochlear implants, are limited in part due to physical separation between the stimulating elements and the neurons they stimulate. One strategy to close this gap aims to precisely guide neurite regeneration to position the neurites in closer proximity to electrode arrays. Here, we explore the ability of micropatterned biochemical and topographic guidance cues, singly and in combination, to direct the growth of spiral ganglion neuron (SGN) neurites, the neurons targeted by cochlear implants. Photopolymerization of methacrylate monomers was used to form unidirectional topographical features of ridges and grooves in addition to multidirectional patterns with 90° angle turns. Microcontact printing was also used to create similar uni- and multi-directional patterns of peptides on polymer surfaces. Biochemical cues included peptides that facilitate (laminin, LN) or repel (EphA4-Fc) neurite growth. On flat surfaces, SGN neurites preferentially grew on LN-coated stripes and avoided EphA4-Fc-coated stripes. LN or EphA4-Fc was selectively adsorbed onto the ridges or grooves to test the neurite response to a combination of topographical and biochemical cues. Coating the ridges with EphA4-Fc and grooves with LN lead to enhanced SGN alignment to topographical patterns. Conversely, EphA4-Fc coating on the grooves or LN coating on the ridges tended to disrupt alignment to topographical patterns. SGN neurites respond to combinations of topographical and biochemical cues and surface patterning that leverages both cues enhance guided neurite growth.

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Marlan R. Hansen

Papers

Differences in neural encoding of speech in noise between cochlear implant users with and without preserved acoustic hearing

Does the intracochlear position of an electrode array impact performance

Interaction of micropatterned topographical and biochemical cues to direct neurite growth from spiral ganglion neurons.

Longitudinal Electrocochleography as an Objective Measure of Serial Behavioral Audiometry in Electro-Acoustic Stimulation Patients

Interaction of micropatterned topographical and biochemical cues to direct neurite growth from spiral ganglion neurons