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Magno F Formiga,1,2 Kathryn E Roach,1 Isabel Vital,3 Gisel Urdaneta,3 Kira Balestrini,3 Rafael A Calderon-Candelario,3,4 Michael A Campos,3,4,* Lawrence P Cahalin1,* 1Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA; 2CAPES Foundation, Ministry of Education of Brazil, Brasilia, Brazil; 3Pulmonary Section, Miami Veterans Administration Medical Center, Miami, FL, USA; 4Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA *These authors contributed equally to this work Purpose: The Test of Incremental Respiratory Endurance (TIRE) provides a comprehensive assessment of inspiratory muscle performance by measuring maximal inspiratory pressure (MIP) over time. The integration of MIP over inspiratory duration (ID) provides the sustained maximal inspiratory pressure (SMIP). Evidence on the reliability and validity of these measurements in COPD is not currently available. Therefore, we assessed the reliability, responsiveness and construct validity of the TIRE measures of inspiratory muscle performance in subjects with COPD. Patients and methods: Test–retest reliability, known-groups and convergent validity assessments were implemented simultaneously in 81 male subjects with mild to very severe COPD. TIRE measures were obtained using the portable PrO2 device, following standard guidelines. Results: All TIRE measures were found to be highly reliable, with SMIP demonstrating the strongest test–retest reliability with a nearly perfect intraclass correlation coefficient (ICC) of 0.99, while MIP and ID clustered closely together behind SMIP with ICC values of about 0.97. Our findings also demonstrated known-groups validity of all TIRE measures, with SMIP and ID yielding larger effect sizes when compared to MIP in distinguishing between subjects of different COPD status. Finally, our analyses confirmed convergent validity for both SMIP and ID, but not MIP. Conclusion: The TIRE measures of MIP, SMIP and ID have excellent test–retest reliability and demonstrated known-groups validity in subjects with COPD. SMIP and ID also demonstrated evidence of moderate convergent validity and appear to be more stable measures in this patient population than the traditional MIP. Keywords: psychometrics, respiratory muscles, chronic airflow obstruction

Introduction: Laryngeal cancer, especially in the advanced stages, is a highly devastating disease, characterized by increased invasiveness and high rates of metastasis. Gelatinases A and B (MMP-2 and -9 respectively) are of particular interest due to their contribution to various stages of carcinogenesis. There is a growing body of evidence with regard to the prognostic value of certain MMPs and their possible role as tumour markers. Aim: To identify the pattern of alteration of serum gelatinases A and B in patients with laryngeal cancer following treatment, and a possible correlation with various clinicopathological parameters. Materials and methods: Forty nine patients were included in this study. Pre-treatment and post-treatment serum samples were collected and processed by gelatin zymography and western blotting. Results: Only the latent forms of MMP-2 and -9 were identified. Both gelatinases were increased in the serum of laryngeal cancer patients compared to healthy individuals. Patients with supraglottic tumours and active smokers had significantly higher pre-treatment levels of proMMP-2 than patients with glottic tumours (p < 0.05) and ex-smokers (p < 0.05), respectively. Patients with primary disease and patients with lymph node involvement showed lower serum proMMP-9 pre-treatment levels than patients with recurrence (p < 0.05) and patients without neck disease (p < 0.1), respectively. During the follow-up period the proMMP-2 serum levels increased significantly in the first ten to fifteen days after treatment, gradually decreasing over the following months. The proMMP-9 serum levels showed a gradual decrease after treatment, which was statistically significant (p<0.05). Conclusions: The post-treatment alteration pattern of proMMP-9 serum levels shows a possible role of this molecule as a tumour marker in laryngeal cancer. Further research is necessary to clarify the contribution of both gelatinases to the disease progress and determine their role as prognostic factors and tumour markers. [ABSTRACT FROM AUTHOR]

Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory airway disease punctuated by exacerbations (AECOPD). Subjects with frequent AECOPD, defined by having at least two exacerbations per year, experience accelerated loss of lung function, deterioration in quality of life and increase in mortality. Fibroblast growth factor (FGF)23, a hormone associated with systemic inflammation and altered metabolism is elevated in COPD. However, associations between FGF23 and AECOPD are unknown. In this cross-sectional study, individuals with COPD were enrolled between June 2016 and December 2016. Plasma samples were analyzed for intact FGF23 levels. Logistic regression analyses were used to measure associations between clinical variables, FGF23, and the frequent exacerbator phenotype. Our results showed that FGF23 levels were higher in frequent exacerbators as compared to patients without frequent exacerbations. FGF23 was also independently associated with frequent exacerbations (OR 1.02; 95%CI 1.004-1.04; p = 0.017), after adjusting for age, lung function, smoking, and oxygen use. In summary, FGF23 was associated with the frequent exacerbator phenotype and correlated with number of exacerbations recorded retrospectively and prospectively. Further studies are needed to explore the role of FGF 23 as a possible biomarker for AECOPD to better understand the pathobiology of COPD and to help develop therapeutic targets.

Background: Inspiratory muscle function in COPD has been traditionally described in terms of maximal inspiratory pressure (MIP). Arguably, however, is the day-to-day relevance of MIP, given that individuals rarely need maximal inspiratory forces to perform general tasks, but rather repeated breathing muscle contractions which demand endurance. The sustained maximal inspiratory pressure (SMIP) reflects the ability of the respiratory muscles to maintain force over time (i.e. single-breath work capacity). We investigated the relationships between SMIP and COPD-related clinical outcomes, hypothesizing that SMIP would have superior correlational and discriminatory value when compared to MIP., Methods: 61 males with mild-to-very severe airflow obstruction underwent measures of spirometry, whole-body plethysmography, symptomatology, comorbidity, quality of life, exacerbations and mental health. MIP and SMIP were obtained via the Test of Incremental Respiratory Endurance., Results: The mean ± SD MIP and SMIP were 77.2 ± 22.9 cmH 2 O and 407.9 ± 122.8 PTU. Both MIP and SMIP positively correlated with pulmonary function, with SMIP displaying the highest correlations. We found significant differences in spirometry, hyperinflation, symptomatology, exacerbation frequency, comorbidity, quality of life and anxiety in subjects grouped as having reduced or normal single-breath work capacity. Finally, significantly lower SMIP values were found in individuals with an IC/TLC ratio ≤25%., Conclusions: The assessment of SMIP appears to have superior clinical value than MIP in COPD. Our analyses revealed that subjects whose SMIP was reduced experienced more severe airflow obstruction, greater hyperinflation, as well as worse health and mental status with increased symptomatology and impaired quality of life., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: The Test of Incremental Respiratory Endurance is a novel testing method that provides a unique examination of one's inspiratory muscle strength, work and endurance. Little is known about the relationship between inspiratory muscle performance and mortality risk in obstructive lung disease. We examined the relationship between the Test of Incremental Respiratory Endurance measures and the Body-mass index, airflow Obstruction, Dyspnea and Exercise index in chronic obstructive pulmonary disease., Methods: In all, 70 males with mild-to-very severe chronic obstructive pulmonary disease (mean ± standard deviation of 70.2 ± 5.9 years) underwent measurements of body-mass index, spirometry, dyspnea and a 6-min walk test from which the Body-mass index, airflow Obstruction, Dyspnea and Exercise score was calculated. The Test of Incremental Respiratory Endurance provided measures of maximal inspiratory pressure, sustained maximal inspiratory pressure and inspiratory duration., Results: All Test of Incremental Respiratory Endurance parameters inversely correlated with the Body-mass index, airflow Obstruction, Dyspnea and Exercise score: maximal inspiratory pressure (r = -0.355, p = 0.00), sustained maximal inspiratory pressure (r = -0.426, p = 0.00) and ID (r = -0.278, p = 0.02), with sustained maximal inspiratory pressure displaying the highest correlation. Independent significant correlations were also observed between the sustained maximal inspiratory pressure and all Body-mass index, airflow Obstruction, Dyspnea and Exercise score components, except for body-mass index. Finally, sustained maximal inspiratory pressure was significantly different among the Body-mass index, airflow Obstruction, Dyspnea and Exercise index quartiles., Discussion: The significant association between the Body-mass index, airflow Obstruction, Dyspnea and Exercise score and inspiratory muscle performance, in particular sustained maximal inspiratory pressure, suggests that these measures may have a potential prognostic value in the evaluation of chronic obstructive pulmonary disease., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Plain English Summary: The impacts of involvement in research are often described in terms of the difference made to the research, the people involved and less frequently the researchers. This paper focuses on the researchers' experiences of involvement, based on an evaluation of a pilot project supporting patient/carer involvement in research at Parkinson's UK. Telephone interviews were conducted with researchers from eight different research projects with involvement. The researchers reported gaining new knowledge from patients and carers. They used this knowledge to change their project designs, interventions and new devices. They also gained new skills in communicating with the public. Meeting patients for the first time had a profound impact on some researchers, causing a change in their professional values. Face-to-face contact seemed particularly important to gain a sense of the 'people behind the data', which suggests such meetings may result in impacts beyond those typically achieved through an exchange of documents. Involvement also influenced one researcher's choices and preferences, in terms of who to ask to take part in their study In summary, researchers often learn something new from talking to patients and carers. Facilitating this conversation seems important to maximise the impact of this learning. In future, it might be helpful for evaluations of involvement to ask researchers in more detail about what they learnt from patients/carers and how they applied their new skills and knowledge. This may help to understand how involvement can influence researchers' thinking to have an impact on research., Abstract: Background The impacts of patient/public involvement are often described in terms of the difference made to the research, the researchers and the people involved. Involvement often impacts on research by influencing the design, delivery and dissemination. Patients/the public report gaining new skills and knowledge, increased self-confidence, and satisfaction from making a difference. There are fewer reports of the impacts on researchers . This paper discusses the findings from an evaluation of a pilot project supporting patient/carer involvement in research at Parkinson's UK, focusing on the researchers' experiences. Methods Semi-structured telephone interviews were conducted with one researcher from each of the eight research projects which involved patients/carers in the pilot. The findings were analysed using theoretical thematic analysis. Results and discussion Learning can be described as acquiring new knowledge, behaviours, skills, values, or preferences. The researchers' reports reflected these different types of learning. They reported gaining new knowledge from patients and carers, which they recognised as distinct from their textbook knowledge of the condition. They used this learning to change their project designs and their new interventions and devices. They also gained new skills in communicating with patients and carers about the aims and significance of their research. Meeting patients for the first time had a profound impact on some researchers causing them to change their professional values. Face-to-face contact seemed particularly important to gain a sense of the 'people behind the data', which suggests such meetings may result in impacts beyond those typically achieved through an exchange of documents. The involvement also influenced one researchers' priorities and preferences, in terms of what questions to ask and of whom, in their project. Conclusions Researchers learn from an exchange of knowledge with patients/ carers, which influences their plans and actions. This seems to be one way that involvement subsequently has an impact on research. Facilitating this exchange seems important to support mutual learning and to enhance the impact on researchers. Future evaluations of involvement might benefit from exploring what researchers learnt from patients/carers and how they applied their new skills and knowledge.

Objective: To investigate the efficacy of hyperbaric oxygen therapy as a salvage treatment for patients with sudden sensorineural hearing loss (SSHL)., Materials and Methods: Fifteen patients affected by sudden hearing loss and treated with hyperbaric oxygen after steroid and vasodilator therapy failed constituted the study group. A control group of 30 patients who were treated with steroids and vasodilator alone was also included. Hyperbaric oxygen was administered once daily for 15 sessions at a constant pressure of 2.2 atmospheres. Pure-tone hearing thresholds were obtained for both groups before and after each treatment and frequency-specific thresholds 3 months after the end of hyperbaric oxygen therapy., Results: Salvage hyperbaric oxygen therapy was performed with a mean delay of 24 days from the onset of SSHL. The overall rate of hearing improvement was higher in the study group (7/15 cases, 46.6%) compared with the control group (4/30 cases, 13.3%). The mean pure-tone hearing average thresholds after salvage treatment in the study group was 53.4 dB HL (mean gain, 12.1 dB HL), which was significantly lower than that in the control group of 67.9 dB HL (mean gain, 2.7 dB HL). Hearing recovery was found to be better at low frequencies (250-500 Hz)., Conclusion: Hyperbaric oxygen therapy should be suggested to all patients for whom initial conventional medical treatment for SSHL has failed.

Introduction. The nonsquamous carcinomas of the larynx are considered rare with the majority of malignant tumors in this area, reaching the rate of 95%, to be squamous cell neoplasms. Case Report. The case refers to a 53-year-old man that presented with symptomatology of motor nerve disease. During the evaluation of the neurologic disease, a subglottic mass of the larynx was revealed accidentally in the imaging examination. Under general anesthesia, we performed direct laryngoscopy and biopsy of the mass. The histopathologic examination revealed a hybrid carcinoma coexistence of two different carcinomas, an adenoid cystic carcinoma and an adenocarcinoma, not otherwise specified with poor differentiation. Regarding the therapeutic plan, the mass was considered inoperable due to its expansion to trachea and the patient received radiotherapy. Conclusions. Both the adenocarcinoma and adenoid cystic carcinoma are extremely rare types of malignant tumors in the larynx. The special interest of the present case is the coexistence of these two rare tumors in the same region of the larynx, being a hybrid tumor of the salivary glands in the larynx, which is the second reported case, based on our systematic literature review.

Objectives: The aim of this study is to evaluate the effectiveness of a new manoeuvre in the treatment of posterior canal benign paroxysmal positional vertigo (p-BPPV) based on the idea that highly accelerated endolymphatic flow may lead a mass of otoconia to collide with the walls of the posterior semicircular canal, resulting in its disintegration and/or in the expulsion of the free particles from the posterior semicircular canal., Material-Methods: Our study group included 146 patients with a diagnosis of p-BPPV. All patients underwent the new manoeuvre, which consisted of several high-acceleration successive head movements in the horizontal plane performed by the same physician. The results of the study group were compared with those of a sham control group of 30 patients with p-BPPV undergoing placebo treatment. The patients of both groups were reviewed in a follow-up appointment 1 month and 1 year after the initial treatment., Results: Complete resolution of symptoms immediately after the manoeuvre was observed in 92% of patients. At 1-month and 1-year follow-up assessment, all the patients in the study group reported complete relief from their symptoms compared with only 13% and 43% of control patients respectively. Recurrence of symptoms was reported in 12 patients (8%) from the study group, who responded successfully to one additional session., Conclusions: This study establishes the efficacy of the new manoeuvre in the short- and long-term management of p-BPPV. It is a quick office procedure, usually resolving this disorder with a single session, although there some limitations in patients with underlying cervical spine pathology.

Introduction: Warthin's tumour usually involves the parotid gland. However, it can also arise from ectopic salivary tissue in the para-parotid and latero-cervical lymph nodes., Case Report: We present the case of a 60-year-old man with a 3-month history of a smooth, mobile mass on the right side of the neck. Computed tomography (CT) scanning (coronal, axial and sagittal sections) showed a cystic lesion in the right upper neck without connection to the major salivary glands (8 x 4 x 3 cm). Complete surgical excision with a transverse neck incision was performed. Histological findings of the specimen revealed Warthin's tumour., Conclusion: This neoplasm should be included in the differential diagnosis of cystic lesions of the neck. Although rare, it has potential for malignant transformation. Coronal and sagittal CT scans are necessary to accurately localize the tumour and to differentiate the diagnosis from earring lesions of the parotid tail.

Objective: Hearing loss can significantly impair patient's quality of life, affecting communicative behavior, emotional and social function. This study assesses the impact of hearing aids on the quality of life of patients in a rural area and its correlation with socio-economic factors., Materials-Methods: Thirty patients (18 male, 12 female), with bilateral sensorineural hearing loss of variable etiology, using hearing aid for at least five years, were enrolled in this study. Mean age of subjects was 74 years. This study used the Glasgow Benefit Inventory (GBI) to quantify the changes in quality of life. Patients were divided in above and below criterion group. The criterion used was the median of the air contraction threshold improvement. The binaural use and the type of hearing aids were recorded and correlated with the type of social security service of patients., Results: Eighty per cent of patients reported significant benefit from the hearing aid use. The majority of patients (90%) used one hearing aid (mean GBI total score 35) and only 10% had binaural hearing aid (mean GBI total score 45). The majority of patients used analog hearing aid (56.5%) while 43.5% used digital hearing aid. Interestingly, it was found that patients did not attend appointments for hearing aids maintenance with a mean follow up of 2.5 years., Conclusion: This study demonstrates a trend of better quality of life for patients with bilateral hearing loss and binaural hearing aid use. The type of hearing aid is related to the funding from their social security service. Therefore more patients are using analog hearing aids, as they are less expensive than the digital hearing aids.

Problems/objectives: The aim of this study is to report on ossicular necrosis in the middle ear occurring shortly after head injury., Methodology: Our sample included 3 males and 2 females aged 9 to 37 years who complained of unilateral hearing loss after a head trauma that had occurred 3 to 6 months previously. The tympanic membranes were intact, and a CT-scan did not show fracture of the temporal bone. Audiometry showed a unilateral conductive hearing loss in all cases., Results: On tympanotomy exploration, 4 of the 5 patients had a necrosis of the lenticular process of the incus and one patient had a necrosis of the posterior and anterior crura of the stapes. Additionally, the incus was displaced at the incudomalleolar joint towards the promontory in two patients. The long process of the incus was surgically aligned and adjusted to the head of the stapes through interposition of either temporal fascia or a bone chip. At the 2-year-postoperative follow-up, the pure tone audiometry showed that the preoperative air-bone gap was almost closed with a mean of 11.8 dB., Conclusions: It is possible that the head injury resulted in ossicular displacement in the middle ear with disturbance of the local vascular supply. Due to the tenuous blood supply to the lenticular and long processes of the incus, this portion of the ossicular chain, including the stapes suprastructure, may become more vulnerable to an ischemic process and subsequent necrosis shortly after the head trauma.

The chondrosarcoma of the larynx is an exceptionally rare tumour. It appears mainly in white men in their 7th decade. The most significant clinical manifestation is hoarseness accompanied at times by stridor. It involves mainly the cricoid cartilage and the treatment of choice is surgical excision. A case of a large tumour of the cricoid cartilage is described. The diagnostic work-up consisted of two minor operations for biopsies and an MRI scan prior to the patient being treated with total laryngectomy.