Thyroid, Ahead of Print.
https://ift.tt/2wB3tid
Παρασκευή 11 Μαΐου 2018
“White Thyroid” on Unenhanced Computed Tomography in Amiodarone-Induced Thyrotoxicosis Type 2
A comparative study of the effect of two dosages of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective randomized study
Abstract
Introduction
The aim of this clinical study was to evaluate and compare the relative efficacy of two different dosages of dexamethasone, i.e., 4 and 8 mg injected submucosally to reduce postoperative discomfort after mandibular third molar surgery.
Methodology
A prospective randomized study was conducted on 45 patients requiring surgical removal of an impacted third molar. Selected patients were divided randomly into three groups of 15 patients each: group I patients received one regimen single dose of 4 mg dexamethasone submucosally, group II received one regimen single dose of 8 mg dexamethasone submucosally, and group III (control group), no dexamethasone was given but only received injection of normal saline submucosally after establishing local anesthesia. The postoperative sequelae were assessed on the second and seventh postoperative day.
Result
As compared to group III, groups I and II showed statistically significant reduction in pain and swelling whereas no statistically significant difference was found between the test groups.
Conclusion
It can be concluded that corticosteroids are effective in curtailing the postoperative edema of lower third molar surgery but have negligible analgesic effect. As no statistically significant difference is found between both the regimes of dexamethasone, i.e., 4 and 8 mg so within the confines of our study, it may be concluded that 4 mg dexamethasone can be given safely to reduce the postoperative edema after the third molar surgery.
https://ift.tt/2rEGrB0
A comparative study of the effect of two dosages of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective randomized study
Abstract
Introduction
The aim of this clinical study was to evaluate and compare the relative efficacy of two different dosages of dexamethasone, i.e., 4 and 8 mg injected submucosally to reduce postoperative discomfort after mandibular third molar surgery.
Methodology
A prospective randomized study was conducted on 45 patients requiring surgical removal of an impacted third molar. Selected patients were divided randomly into three groups of 15 patients each: group I patients received one regimen single dose of 4 mg dexamethasone submucosally, group II received one regimen single dose of 8 mg dexamethasone submucosally, and group III (control group), no dexamethasone was given but only received injection of normal saline submucosally after establishing local anesthesia. The postoperative sequelae were assessed on the second and seventh postoperative day.
Result
As compared to group III, groups I and II showed statistically significant reduction in pain and swelling whereas no statistically significant difference was found between the test groups.
Conclusion
It can be concluded that corticosteroids are effective in curtailing the postoperative edema of lower third molar surgery but have negligible analgesic effect. As no statistically significant difference is found between both the regimes of dexamethasone, i.e., 4 and 8 mg so within the confines of our study, it may be concluded that 4 mg dexamethasone can be given safely to reduce the postoperative edema after the third molar surgery.
https://ift.tt/2rEGrB0
Zika virus vaccines: immune response, current status, and future challenges
Justin M Richner | Michael S Diamond
https://ift.tt/2I9ElEF
Immunological responses to influenza vaccination: lessons for improving vaccine efficacy
Taia T .Wang | Stylianos Bournazos | Jeffrey V Ravetch
https://ift.tt/2KR1Uj3
MR1 antigen presentation to MAIT cells: new ligands, diverse pathways?
Hamish EG McWilliam | Jose A Villadangos
https://ift.tt/2ICGHeI
Dr. elliot f. ellis: initiating personalized asthma management in children
Elliot F. Ellis is indeed a giant in the field of allergy and immunology. From his leadership role in developing a pediatric allergy and immunology fellowship at National Jewish Health and his seminal work in theophylline pharmacokinetics, he trained many excellent clinicians and researchers. He assumed the role of Chair of Pediatrics at the Children's Hospital of Buffalo in 1974 and transformed that training program in pediatrics to a top-rated program in the country along with his own training program in allergy and immunology.
https://ift.tt/2Ii0KM5
Impact Of Early Intravelar Veloplasty At Six Months On Mandibular Growth In Patients With Pierre Robin Sequence
Pierre Robin Sequence (PRS) combines mandible microretrognathia, asynchronism of the pharynx and tongue, glossoptosis and, in some cases, cleft palate. Its principal functional consequences are respiratory and feeding problems during the neonatal period.In this study, we focused on the impact of early closure of the cleft at six months on mandibular growth in patients with PRS.We performed a retrospective study of 15 patients followed for PRS and undergoing surgery performed by the same senior surgeon (HB) at our cleft center between 2005 and 2012.
https://ift.tt/2rDr7of
Complications associated with surgical treatment of sleep-disordered breathing among hospitalized U.S. adults
The purpose of this cross-sectional study is to examine the relationship between surgical treatments for sleep-disordered breathing (SDB) and composite measure of surgical complications in a nationally representative sample of hospital discharges among U.S. adults. We performed secondary analyses of 33,679 hospital discharges from the 2002-2012 Nationwide Inpatient Sample that corresponded to U.S. adults (≥18 years) who were free of head-and-neck neoplasms, were diagnosed with SDB and had undergone at least one of seven procedures.
https://ift.tt/2KS29dE
Histological Findings In Tmj Treated With Higt Condilectomy For Internal Derangement
Intra-Articular Temporo-Mandibular Disorders (TMD) are characterized by displacement of the disc that causes the condyles to slip back over the disc thus resulting in TMJ discal damage and erosion of the condyle's bone. The etiology of temporomandibular disorder (TMD) is multidimensional: biomechanical, neuromuscular, bio-psychosocial and biological factors may contribute to the disorder.The study involved 46 joints in 27 patients with a diagnosis of Intra-Articular Temporo-Mandibular Disorders (TMD) according to Axis I of Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications and underwent surgery between 2011 and 2014.
https://ift.tt/2rCJPwh
Survival of dental implants placed in vascularised fibula free flaps after jaw reconstruction
Ablative oncological surgery to treat head-and-neck cancer often triggers a requirement for jaw reconstruction. Modern surgical procedures using free microvascular flaps afford acceptable outcomes in terms of restoration of bony and soft tissue defects. A fibula free flap is often the preferred flap, as the bone length is considerable and a two-surgeon approach is possible. Dental implants play important roles in functional rehabilitation. Our aim was to evaluate the survival of dental implants placed in reconstructed areas after transfer of fibula tissue to the jaw.
https://ift.tt/2KXW27A
A novel microsurgical anastomosis training model using gradually thawed cryopreserved microvessels of rat cadavers
In consideration of the 3-R-rule (Refine-Replace-Reduce) as a guideline for promoting ethical use of animals for surgical training, we present a novel training model for microvessel anastomosis. In a rat cadaveric study, we evaluated the surgical anatomy of the common carotid artery (CCA), external jugular vein (EJV) and femoral vessels (FV) which were then used as templates for the present investigation. Anatomical dissection of 30 rat cadavers was performed. Two residents without prior microsurgical experience were included in the study and performed 5 CCA, 5 femoral artery, 5 EJV and 5 femoral vein anastomoses.
https://ift.tt/2rARGuz
Making a Difference in Low-Resource Settings
By Nathan Douthit
In February, 1999, the World Health Organization partnered with more than 20 non-governmental organizations involved in eye care to launch VISION2020: The Right to Sight. The goal of this initiative is to eliminate the main preventable and treatable causes of blindness by the year 2020. The threefold strategy involves disease control, human resource development, and infrastructure and appropriate technology development. Despite major improvements, there is still work to be done.[1]
In "Management of a rhegmatogenous retinal detachment in a low-resource setting: treatment options when there is no vitreoretinal surgeon," Emsley et all highlight the difficulty in management of opthalmological problems in low resource settings, where no subspecialists are present. The patient presented with a treatable retinal detachment and retinal tear, but, "Unfortunately, no access to any vitreoretinal trained personnel or vitrectomy equipment currently exists in Sierra Leone…. [T]he nearest facility in Ghana is 2018 km away and beyond the financial means of the patient." Despite presenting with vision acuity of 20/30 bilaterally, "At review 8 months later, the visual acuity had dropped to 6/36 and the retina had completely detached.
In the discussion, the authors present the incidence of rhegmatogenous retinal detachment in sub-Saharan Africa and Sierra Leone. Despite the growing prevalence of this disease and the "late presentation with advanced disease and secondary complications" in the developing world, only 15 subspecialty trained vitreoretinal surgeons practice in the region of Senegal to Kenya and Ethiopia to Tanzania. The lack of equipment and continued training for opthalmologic specialties is a well documented problem.[2] The need to develop a system for screening, referring and transporting patients to well-equipped tertiary care centers is also well-described.[3]
Despite steps in these directions, however, there are still countless patients suffering with no access to the necessary specialties—in this case, a vitreoretinal surgeon. Rather than forgoing any care, healthcare professionals with appropriate training can optimize the treatment with the resources they have available to them. Emsley et al excellently describe several interventions in there article that would have helped this patient without the need for a vitreoretinal surgeon. They focus on pneumatic retinopexy, "[T]he ideal treatment option for the case described above in this setting."
BMJ Case Reports invites authors to submit global health case reports that describe feasible interventions that could alleviate disease in low-resource settings. These cases could focus on:
- Interventions that have been successfully instituted in a low-resource area
- Potential interventions to help a vulnerable population
- Challenges to instituting an intervention in a low-resource setting
- Low-resource interventions that have aided individual patients
Manuscripts may be submitted by students, physicians, nurses and allied health professionals to BMJ Case Reports via the submission system. For more information, review our guidance on how to write a global health case report and look through our online collection.
To read more about interventions in low resource settings at BMJ Case Reports, please review:
- Treatment of complex infantile hemangioma a in a resource-poor setting
- Management of paediatric head injury in remote Nepal
- Penetrating cardiac injury: sustaining health by building team resilience in growing civilian violence
To read more about opthalmologic care in the developing world, please review:
[1] World Health Organization. What is VISION 2020? [internet] Prevention of Blindness and Visual Impairment. WHO 2018. Accessed from: http://www.who.int/blindness/partnerships/vision2020/en/ on 3 May 2018
[2] Courtright P, Ndegwa L, Msosa J, Banzi J. Use of our existing eye care human resources: assessment of the productivity of cataract surgeons trained in eastern Africa. Archives of ophthalmology. 2007 May 1;125(5):684-7.
[3] Sommer A, Taylor HR, Ravilla TD, West S, Lietman TM, Keenan JD, Chiang MF, Robin AL, Mills RP. Challenges of ophthalmic care in the developing world. JAMA ophthalmology. 2014 May 1;132(5):640-4.
Competing Interests
None Declared
https://ift.tt/2jHt7bE
Making a Difference with Individual Patients-Health Equity, Power, and Dignity
By Nathan Douthit
At another session of CUGH's Annual Meeting, Richard Horton, Editor in Chief of the Lancet, debated Cheryl Heaton, director of New York University's Global Institute of Public Health, on the subject: Equity is the defining objective of global health in the 21st century. Heaton argued in favour of the motion, saying that our past neglect has created high reservoirs of need around the world. She made the point that equity creates hope and optimism in vulnerable populations, which turn motivate their ability to bring about change.
While Horton agreed that equity is a valuable and admirable goal, he argued that global health, as it is currently framed, makes this impossible to achieve. He argued that global health "is not about equity; it is about power", with power held by the privileged. He continued "before there can be equity, individuals must have liberty and power over their lives." Further, liberty requires that all humans be recognized for their dignity. Dignity affirms that every individual is an end unto themselves; not a means to our ends. "Without dignity, there can be no equity." Horton concluded that our obligation is to challenge authorities that deny liberty. We must discharge this obligation if we are to see the dignity of individual patients recognized.
BMJ Case Reports is committed to recognizing the dignity and worth of individual patients. Our case reports focus on patients at the center of clinical medicine and global health. While our clinical case reports highlight the challenges of dealing with disease, our global health case reports shed light on the determinants of health and disease: the environments in which patients live and work; education and financial well-being; access to healthcare; local and national politics; instability and conflict; the practice of corporations and industry; and, ethnic and cultural histories. Our authors argue for better living conditions and improvements in health at the level of the individual – working towards global health one patient at a time. Each patient is an end unto themselves. We encourage our authors to work with their patients in writing each global health case report and want to be not merely a repository of global health problems and solutions but a repository of patient voices from across the world.
BMJ Case Reports invites authors to submit global health case reports that give voice to individual patients and uphold their dignity. These reports should examine the determinants of health:
- The effects of culture and environment
- Education and literacy
- How occupation may exacerbate or cause disease
- The effects of conflict, disaster, migration and poverty
- Access to healthcare
- The interventions and innovations put into place in global health to treat individual patients.
- The disproportional effect of social determinants of health on vulnerable communities
Manuscripts may be submitted by students, physicians, nurses and allied health professionals to BMJ Case Reports via the submission system. For more information, review our guidance on how to write a global health case report and look through our online collection.
Competing Interests
None Declared
https://ift.tt/2JFhNZg
What causes a piercing rejection to occur?
Sometimes, the body will reject a piercing. Piercing rejection happens when the immune system sees the jewelry as a foreign object and tries to push it back out. This can cause discomfort and scarring. In this article, we look at how to spot a piercing rejection, prevention tips, and stopping the process of rejection.
https://ift.tt/2KU5VTS
Both High and Low Maternal Thyroid Function Are Associated with Child Autistic Spectrum Disorders, While Only Hypothyroxinemia Is Associated with Child ADHD
Clinical Thyroidology, Volume 30, Issue 5, Page 220-222, May 2018.
https://ift.tt/2IdzT3v
More Dynamic Diagnostic Criteria Are Needed to Define Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP)
Clinical Thyroidology, Volume 30, Issue 5, Page 200-202, May 2018.
https://ift.tt/2I6pPxc
Noninvasive Follicular Thyroid Neoplasms With Papillary-like Nuclear Features (NIFTP) Show Molecular and Clinical Similarity to Follicular Adenomas
Clinical Thyroidology, Volume 30, Issue 5, Page 203-205, May 2018.
https://ift.tt/2Ibv2ju
TSH Stimulation Increases DOTATATE Scanning Sensitivity but Decreases Its Sensitivity for Follicular-Cell–Derived Thyroid Cancer Metastases
Clinical Thyroidology, Volume 30, Issue 5, Page 226-229, May 2018.
https://ift.tt/2jRipze
Using the American College of Radiology Thyroid Imaging Reporting and Data System Will Decrease the Number of Thyroid Nodule Biopsies While Improving Diagnostic Accuracy
Clinical Thyroidology, Volume 30, Issue 5, Page 206-209, May 2018.
https://ift.tt/2Ibv0YU
Neonatal TSH <0.90 mIU/L Increases the Risk for Hyperthyroidism in Infants of Mothers with Graves’ Disease
Clinical Thyroidology, Volume 30, Issue 5, Page 217-219, May 2018.
https://ift.tt/2IaB5sD
Minimal Extrathyroidal Extension Carries a Modest Increase for Recurrence but Not Mortality in Differentiated Thyroid Cancer
Clinical Thyroidology, Volume 30, Issue 5, Page 210-212, May 2018.
https://ift.tt/2IcHqzv
Radioactive Iodine Ablation Decreases Serum Anti-Müllerian Hormone Concentrations (as a Marker of Ovarian Reserve) in Women with Thyroid Cancer
Clinical Thyroidology, Volume 30, Issue 5, Page 223-225, May 2018.
https://ift.tt/2jRi4ws
Management of Thyroid Nodules in Post-Septuagenarians Needs to Consider Coexistent Serious Diseases
Clinical Thyroidology, Volume 30, Issue 5, Page 213-216, May 2018.
https://ift.tt/2IdzSfX
Does the Level of Certain Thyroidal mRNAs Change with Age?
Clinical Thyroidology, Volume 30, Issue 5, Page 230-233, May 2018.
https://ift.tt/2jRRCTN
Human papillomavirus detection in gargles, tonsil brushings, and frozen tissues in cancer-free patients
Source:Oral Oncology, Volume 82
Author(s): J.D. Combes, C. Clavel, V. Dalstein, T. Gheit, G.M. Clifford, M. Tommasino, S. Franceschi, J. Lacau St Guily
https://ift.tt/2G8x8ia
Maté consumption association with upper aerodigestive tract cancers: A systematic review and meta-analysis
Source:Oral Oncology, Volume 82
Author(s): Fernanda Weber Mello, Fernanda Marcello Scotti, Gilberto Melo, Saman Warnakulasuriya, Eliete Neves Silva Guerra, Elena Riet Correa Rivero
Maté is a beverage regularly consumed by Latin American populations. Upper aerodigestive tract (UADT) cancers are frequent in this region and are suspected to be associated with maté consumption. The aim of this systematic review and meta-analysis was to answer a focused question: "Is there an association between maté consumption and occurrence of the UADT cancer?". Studies investigating any association between maté consumption and occurrence of UADT cancer were included. Out of the 569 studies, 18 met the inclusion criteria for qualitative and 15 for quantitative analysis. An increased odds was observed regarding maté consumption and overall occurrence of UADT cancer (OR = 2.24; 95%CI = 1.74–2.87). Consistent evidence of a positive association was found for all UADT subsites, oral, pharynx, esophagus and larynx. No differences in effect were found between consumption of cold/warm and hot/very hot mate (OR = 1.08; 95%CI = 0.83–1.41). Consumption of more than one liter of maté per day was associated with increased odds of having UADT cancer compared to an intake of less than one liter per day (OR = 1.72; 95%CI = 1.47–2.01). According to published data, regardless of the temperature, maté consumption significantly increased the odds of occurrence of UADT cancer.
https://ift.tt/2jRpTCA
Impact of radical treatments on survival in locally advanced T4a and T4b buccal mucosa cancers: Selected surgically treated T4b cancers have similar control rates as T4a
Source:Oral Oncology, Volume 82
Author(s): Manish D. Mair, Noopur Sawarkar, Santosh Nikam, Rajiv Sarin, Deepa Nair, Tejpal Gupta, Pankaj Chaturvedi, Anil D'cruz, Sudhir Nair
IntroductionIn the absence of any robust data supporting the TNM classification of T4 buccal mucosa cancers, we did this prospective study to compare the oncologic outcomes of T4a and T4b buccal mucosa cancer patients.Patients and methodsThis is a prospective study of 210 treatment naïve T4 buccal mucosa cancer patients. All patients underwent upfront radical surgery followed by adjuvant radiotherapy (RT)/chemoradiotherapy (CCRT). This is the largest prospective series in the literature on T4 buccal cancers.ResultsT4a disease was seen in 135(64.3%) patients and T4b in 75(35.7%) patients. On comparison between all T4a and T4b cases, a significant difference was observed with regard to 3-year local control (49.6% vs. 41.1%: p-0.025) and disease-free survival (DFS) (65.3% vs. 42%: p-0.035) with a slightly higher incidence of distant metastasis in T4b patients (17.3% vs. 9.6%). Inadequate cut margin (<5 mm) was seen only in 7.4% patients with T4a disease and 12% patients with T4b disease. When patients with adequate cut margins were considered for analysis, local recurrence rate was similar for T4a (26/135; 19.3%) and T4b (15/66; 22.7%) disease suggesting the importance of radical surgery in infra-notch T4b buccal cancers. While the 3-year survival for T4a patients who received adjuvant RT alone was 72.2%, it was only 42.1% for similar T4b patients suggesting a need to intensify adjuvant treatment for these patients.ConclusionSurgery should be considered as the primary modality of treatment for T4b patients, where clear margins are achievable. The benefit of treatment intensification with adjuvant CCRT should be explored in T4b buccal cancers.
https://ift.tt/2G6dqnl
MicroRNA-155, -185 and -193b as biomarkers in human papillomavirus positive and negative tonsillar and base of tongue squamous cell carcinoma
Source:Oral Oncology, Volume 82
Author(s): Cinzia Bersani, Michael Mints, Nikolaos Tertipis, Linnea Haeggblom, Anders Näsman, Mircea Romanitan, Tina Dalianis, Torbjörn Ramqvist
ObjectiveThree-year disease-free survival (DFS) is 80% for human papillomavirus (HPV) positive tonsillar and base of tongue cancer (TSCC/BOTSCC) treated with radiotherapy alone, and today's intensified therapy does not improve prognosis. More markers are therefore needed to more accurately identify patients with good prognosis or in need of alternative therapy. Here, microRNAs (miRs) 155, 185 and 193b were examined as potential prognostic markers in TSCC/BOTSCC.Material and methods168 TSCC/BOTSCC patients diagnosed 2000–2013, with known data on HPV-status, CD8+ tumour infiltrating lymphocytes, tumour staging and survival were examined for expression of miR-155, -185 and -193b using Real-Time PCR. Associations between miR expression and patient and tumour characteristics were analysed using univariate testing and multivariate regression.ResultsTumours compared to normal tonsils showed decreased miR-155 and increased miR-193b expression. miR-155 expression was associated with HPV-positivity, low T-stage, high CD8+ TIL counts and improved survival. miR-185 expression was associated with HPV-negativity and a tendency towards decreased survival, while miR-193b expression was associated with higher T-stage, male gender and lower CD8+ TIL counts, but not with outcome. Upon Cox regression, miR-185 was the only miR significantly associated with survival. Combining miR-155 and miR-185 to predict outcome in HPV+ patients yielded an area under curve (AUC) of 71%.ConclusionIncreased miR-155 expression was found as a positive predictor of survival, with the effect mainly due to its association with high CD8+ TIL numbers, while miR-185 independently associated with decreased survival. Addition of these miRs to previously validated prognostic biomarkers could improve patient stratification accuracy.
https://ift.tt/2jRpS1y
Clinicopathological characteristics and outcome of 31 patients with ETV6-NTRK3 fusion gene confirmed (mammary analogue) secretory carcinoma of salivary glands
Publication date: July 2018
Source:Oral Oncology, Volume 82
Author(s): E. Boon, M.H. Valstar, W.T.A. van der Graaf, E. Bloemena, S.M. Willems, C.A. Meeuwis, P.J. Slootweg, L.A. Smit, M.A.W. Merkx, R.P. Takes, J.H.A.M. Kaanders, P.J.T.A. Groenen, U.E. Flucke, C.M.L. van Herpen
ObjectivesIn 2010, a new subtype of salivary gland cancer (SGC), (mammary analogue) secretory carcinoma (SC), was defined, characterized by the ETV6-NTRK3 fusion gene. As clinical behavior and outcome data of this histological subtype tumor are still sparse, we aimed to describe the clinicopathological course and outcome of a series of translocation positive SC patients.Patient and methodsWe re-evaluated the pathological diagnosis of a subset of SGCs, diagnosed in 4 of 8 Dutch head and neck centers. Subsequently, tumors with a morphological resemblance to SC were tested for the ETV6-NTRK3 fusion gene using RT-PCR. Furthermore, patients prospectively diagnosed with SC were included. The clinical characteristics and outcomes were retrieved from the patient files.ResultsThirty-one patients with ETV6-NTRK3 fusion gene positive SC were included. The median age was 49 years, 17 patients (55%) were male. Eighteen tumors (58%) arose in the parotid gland. One patient presented with lymph node metastasis. All patients underwent tumor resection and 4 patients had a neck dissection. Four patients had re-resection and 15 patients (48%) received postoperative radiotherapy. One patient developed a local recurrence, no regional recurrences or distant metastases were observed. After a median follow-up of 49 months the 5- and 10-year overall survival were 95%, the 5- and 10-year disease free survival were 89%.ConclusionThe clinical course of SC is favorable with a low rate of locoregional recurrence and excellent survival. Given the low incidence of nodal metastases, elective neck treatment, i.e. surgery and/or radiotherapy, does not seem to be indicated.
https://ift.tt/2G8itDJ
Interobserver variations in the delineation of target volumes and organs at risk and their impact on dose distribution in intensity-modulated radiation therapy for nasopharyngeal carcinoma
Source:Oral Oncology, Volume 82
Author(s): Ying-lin Peng, Li Chen, Guan-zhu Shen, Ya-ning Li, Ji-jin Yao, Wei-wei Xiao, Lin Yang, Shu Zhou, Jia-xin Li, Wan-qin Cheng, Ying Guan, Hai-qun Xia, Shuai Liu, Chong Zhao, Xiao-wu Deng
ObjectiveThis study aimed to (a) assess the differences in the delineation of target volumes and organs-at-risk (OARs) by different physicians designing an intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) and (b) analyze the impact of these differences on the treatment plan optimization.Materials and methodsThe planning target volumes (PTVs) and OARs for radiotherapy were manually delineated from computed tomography images of a patient with NPC, and a standard delineation was determined using the STAPLE algorithm of ABAS software. IMRT was designed using one standard plan and 10 individual plans based on the same constraints and field conditions. The maximum/minimum ratio (MMR) of the PTV and OAR volumes and the coefficient of variation (CV) for the different groups were evaluated and compared to the volume of the standard contour.ResultsSignificant differences were seen in the PTVs of the nasopharynx (PTVnx), neck lymph node (PTVnd) and the OARs manually delineated by different physicians. Compared to the standard plan, the mean dose-related parameters of various OARs in different individual plans were not significantly different, while that of most organs in different individual plans were reduced. However, a significant difference in the dose at each organ was noted in different individual plans.ConclusionSignificant differences were noted in the PTV and OAR delineations by different physicians in radiotherapy of NPC, and their dosimetric parameters were significantly different from the standard planned parameters. Therefore, multicenter trials should pay attention to the impact of these differences on the clinical evaluation.
https://ift.tt/2HPcuFf
AJCC 8th Edition oral cavity squamous cell carcinoma staging – Is it an improvement on the AJCC 7th Edition?
Source:Oral Oncology, Volume 82
Author(s): Katherine Pollaers, Anton Hinton-Bayre, Peter L. Friedland, Camile S. Farah
ObjectivesTo explore the prognostic and discriminatory ability of the AJCC 8th Edition Oral Cavity cancer staging in a non-North American population, and compare it to the previously used AJCC 7th Edition.Materials and methodsRetrospective chart review was performed at a tertiary referral Otolaryngology, Head Neck and Skull Base Department in Australia, from June 2002 to June 2017. Oral cavity squamous cell carcinoma cases were staged according to AJCC 8th Edition, which was compared to AJCC 7th Edition staging, for disease-free survival (DFS) and overall survival (OS). DFS and OS were analysed using Kaplan-Meier curves.ResultsThere were 118 patients treated for OSCC, with an average age of 61 years, 63% were male. Overall survival grouped by stage demonstrated statistically significant discrimination between cancer stages using both the AJCC 7th and AJCC 8th Editions. AJCC 7th Edition did not discriminate between stages for DFS. Conversely, AJCC 8th Edition did statistically significantly discriminate for DFS (p = 0.0002). The DFS for both Stage 4a and 4b was significantly worse than cases in Stage 1. AJCC 8th Edition T stage was statistically significantly related to DFS (p = 0.0199), while the AJCC 7th Edition T stage was not.ConclusionThe AJCC Cancer Staging Manual 8th Edition includes both the depth of primary tumour invasion and extracapsular extension of lymph node metastases. The AJCC 8th Edition OSCC staging system showed improved disease-free survival discrimination between overall stages and between T categories, while AJCC 7th Edition did not.
https://ift.tt/2G760Ah
Establishment of prognostic factors in recurrent nasopharyngeal carcinoma patients who received salvage intensity-modulated radiotherapy: A meta-analysis
Source:Oral Oncology, Volume 81
Author(s): Qiuyuan Yue, Mingwei Zhang, Yunbin Chen, Dechun Zheng, Ying Chen, Meimei Feng
Local recurrence remains a major cause of therapeutic failure in patients with nasopharyngeal carcinoma (NPC) and the effective treatment of recurrent NPC (r-NPC) is still a challenge. Intensity-modulated radiotherapy (IMRT) is considered as a favorable technique in the management of r-NPC, especially for extensive lesions. However, local r-NPC is a highly heterogeneous disease and the survival outcome following salvage IMRT varies. Furthermore, due to varied samples and therapeutic protocols, no consensus has been reached in the establishment of prognostic values. Hence, we used Medline and Embase electronic databases to conducted a meta-analysis to generate the best estimation of the prognostic factors in local r-NPC following salvage IMRT. Finally, a total of 783 patients in seven studies were enrolled. Overall, the pooled HR for OS of recurrent T stage and recurrent tumor volume was 1.77 (95% CI = 1.15–2.39) and 2.12 (95% CI = 1.42–2.82), without any heterogeneity. In addition, despite a significant association was observed in the pooled HR of significant compliance for OS, however, significant heterogeneity was also observed (I2 = 76.6%, p = 0.039). Furthermore, no significant association was observed among the pooled HRs for OS in terms of age, gender, recurrent time interval, synchronous nodal recurrence, chemotherapy and total re-irradiation dose. Therefore, the present meta-analysis demonstrated that recurrent T stage and tumor volume may serve as the prognostic factors for OS in patients with r-NPC who received salvage IMRT. The other factors such as age, gender, and optimal re-irradiation dose warranted further investigation.
https://ift.tt/2G8LiQg
The role of protein methyltransferases as potential novel therapeutic targets in squamous cell carcinoma of the head and neck
Publication date: June 2018
Source:Oral Oncology, Volume 81
Author(s): Vassiliki Saloura, Theodore Vougiouklakis, Cem Sievers, Kyunghee Burkitt, Yusuke Nakamura, Gordon Hager, Carter van Waes
Squamous cell carcinoma of the head and neck is a lethal disease with suboptimal survival outcomes and standard therapies with significant comorbidities. Whole exome sequencing data recently revealed an abundance of genetic and expression alterations in a family of enzymes known as protein methyltransferases in a variety of cancer types, including squamous cell carcinoma of the head and neck. These enzymes are mostly known for their chromatin-modifying functions through methylation of various histone substrates, though evidence supports their function also through methylation of non-histone substrates. This review summarizes the current knowledge on the function of protein methyltransferases in squamous cell carcinoma of the head and neck and highlights their promising potential as the next generation of therapeutic targets in this disease.
https://ift.tt/2KTf7Id
Assessing the carcinogenic potential of E-cigarette
Source:Oral Oncology
Author(s): A. Thirumal Raj, Shankargouda Patil, Kamran Habib Awan, Shivaranjhany Sivakumar
https://ift.tt/2G9dWRh
Nivolumab vs investigator’s choice in recurrent or metastatic squamous cell carcinoma of the head and neck: 2-year long-term survival update of CheckMate 141 with analyses by tumor PD-L1 expression
Source:Oral Oncology, Volume 81
Author(s): Robert L. Ferris, George Blumenschein, Jerome Fayette, Joel Guigay, A. Dimitrios Colevas, Lisa Licitra, Kevin J. Harrington, Stefan Kasper, Everett E. Vokes, Caroline Even, Francis Worden, Nabil F. Saba, Lara Carmen Iglesias Docampo, Robert Haddad, Tamara Rordorf, Naomi Kiyota, Makoto Tahara, Mark Lynch, Vijayvel Jayaprakash, Li Li, Maura L. Gillison
ObjectivesWe report 2-year results from CheckMate 141 to establish the long-term efficacy and safety profile of nivolumab and outcomes by tumor PD-L1 expression in patients with recurrent or metastatic (R/M),platinum-refractory squamous cell carcinoma of the head and neck (SCCHN).MethodsPatients with R/M SCCHN with tumor progression/recurrence within 6 months of platinum therapy were randomized 2:1 to nivolumab 3 mg/kg every 2 weeks or investigator's choice (IC). Primary endpoint: overall survival (OS). Data cutoff: September 2017.ResultsWith 24.2 months' minimum follow-up, nivolumab (n = 240) continued to improve OS vs IC (n = 121), hazard ratio (HR) = 0.68 (95% CI 0.54–0.86). Nivolumab nearly tripled the estimated 24-month OS rate (16.9%) vs IC (6.0%), and demonstrated OS benefit across patients with tumor PD-L1 expression ≥1% (HR [95% CI] = 0.55 [0.39–0.78]) and < 1% (HR [95% CI] = 0.73 [0.49–1.09]), and regardless of tumor HPV status. Estimated OS rates at 18, 24, and 30 months with nivolumab were consistent irrespective of PD-L1 expression (<1%/≥1%). In the nivolumab arm, there were no observed differences in baseline characteristics or safety profile between long-term survivors and the overall population. Grade 3–4 treatment-related adverse event rates were 15.3% and 36.9% for nivolumab and IC, respectively.ConclusionNivolumab significantly improved OS at the primary analysis and demonstrated prolonged OS benefit vs IC and maintenance of a manageable and consistent safety profile with 2-year follow-up. OS benefit was observed with nivolumab irrespective of PD-L1 expression and HPV status. (Clinicaltrials.gov: NCT02105636)
https://ift.tt/2jOvgSQ
Depth of invasion, size and number of metastatic nodes predicts extracapsular spread in early oral cancers with occult metastases
Source:Oral Oncology, Volume 81
Author(s): Manish D. Mair, Rathan Shetty, Deepa Nair, Yash Mathur, Sudhir Nair, Anuja Deshmukh, Shiva Thiagarajan, Gouri Pantvaidya, Sarbani Lashkar, Kumar Prabhash, Devendra Chaukar, Prathmesh Pai, Anil D. Cruz, Pankaj Chaturvedi
ObjectivePresence of extracapsular spread (ECS) significantly decreases survival in oral cancer patients. Considering its prognostic impact, we have studied the incidence and factors predicting ECS in clinically node negative early oral cancers.Materials and MethodsWe performed a retrospective chart review of 354 treatment naïve clinically node negative early oral cancer patients operated between 2012 and 2014. Chi-square test and logistic regression were used for identifying predictors of ECS, while cox-regression test was used for survival analysis.ResultsThe incidence of occult nodal metastasis was 28.5% (101/354). Among them, ECS was seen in 15.3%(54/354) patients. The incidence of ECS in T1 and T2 lesion was 13.4% (21/157) and 16.8% (33/197), respectively. The overall incidence of ECS was 48% and 29% in lymph nodes smaller than 10 mm and 5 mm respectively. We found that tumor depth of invasion (>5 mm; p-0.027) and node (metastatic) size >15 mm (p-0.018) were significant predictors of ECS. p N2b disease was seen in 41/354 (11.6%) of which 31/354 (8.7%) had ECS, i.e. 75.6% of pN2b patients been ECS positive (p-0.000). The 3-year OS of patients without nodal metastasis, nodal metastasis without ECS and nodal metastasis with ECS was 88.4%, 66.9% and 59.2% (p-0.000) respectively.ConclusionA significant number of patients with metastatic nodal size less than 1 cm have ECS which suggests aggressive behavior of the primary tumor. Thus, elective neck dissection is the only way of detecting ECS in these patients which may warrant treatment intensification.
https://ift.tt/2G9dQsT
A clinical prognostic model compared to the newly adopted UICC staging in an independent validation cohort of P16 negative/positive head and neck cancer patients
Source:Oral Oncology, Volume 81
Author(s): Jacob H. Rasmussen, Katrin Håkansson, Gregers B. Rasmussen, Ivan R. Vogelius, Jeppe Friborg, Barbara M. Fischer, Søren M. Bentzen, Lena Specht
ObjectivesA previously published prognostic model in patients with head and neck squamous cell carcinoma (HNSCC) was validated in both a p16-negative and a p16-positive independent patient cohort and the performance was compared with the newly adopted 8th edition of the UICC staging system.Materials and methodsConsecutive patients with HNSCC treated at a single institution from 2005 to 2012 were included. The cohort was divided in three. 1.) Training cohort, patients treated from 2005 to 2009 excluding patients with p16-positive oropharyngeal squamous cell carcinomas (OPSCC); 2.) A p16-negative validation cohort and 3.) A p16-positive validation cohort. A previously published prognostic model (clinical model) with the significant covariates (smoking status, FDG uptake, and tumor volume) was refitted in the training cohort and validated in the two validation cohorts. The clinical model was used to generate four risk groups based on the predicted risk of disease recurrence after 2 years and the performance was compared with UICC staging 8th edition using concordance index.ResultsOverall 568 patients were included. Compared to UICC the clinical model had a significantly better concordance index in the p16-negative validation cohort (AUC = 0.63 for UICC and AUC = 0.73 for the clinical model; p = 0.003) and a borderline significantly better concordance index in the p16-positive cohort (AUC = 0.63 for UICC and 0.72 for the clinical model; p = 0.088).ConclusionThe validated clinical model provided a better prognostication of risk of disease recurrence than UICC stage in the p16-negative validation cohort, and similar prognostication as the newly adopted 8th edition of the UICC staging in the p16-positive patient cohort.
https://ift.tt/2KTeWN3
Predictors of oropharyngeal cancer survival in Europe
Source:Oral Oncology, Volume 81
Author(s): D. Anantharaman, A. Billot, T. Waterboer, T. Gheit, B. Abedi-Ardekani, P. Lagiou, A. Lagiou, W. Ahrens, I. Holcátová, F. Merletti, K. Kjaerheim, J. Polesel, L. Simonato, L. Alemany, M. Mena Cervigon, T.V. Macfarlane, A. Znaor, P.J. Thomson, M. Robinson, C. Canova, D.I. Conway, S. Wright, C.M. Healy, M.E. Toner, M. Pawlita, M. Tommasino, P. Brennan
ObjectivesHPV16-positive oropharyngeal cancer (OPC) patients experience better outcomes compared to HPV16-negative patients. Currently, strategies for treatment de-escalation are based on HPV status, smoking history and disease stage. However, the appropriate cut-point for smoking and the role of other non-clinical factors in OPC survival remains uncertain.Materials and MethodsWe examined factors associated with OPC outcome in 321 patients recruited in a large European multi-center study. Seropositivity for HPV16 E6 was used as a marker of HPV16 positive cancer. Hazard ratios (HR) and confidence intervals (CI) were estimated using Cox proportional models adjusted for potential confounders.ResultsOverall 5-year survival following OPC diagnosis was 50%. HPV16-positive OPC cases were at significantly lower risk of death (aHR = 0.51, 95% CI: 0.32–0.80). A significant effect on OPC survival was apparent for female sex (aHR 0.50: 95% CI: 0.29–0.85) and being underweight at diagnosis (aHR: 2.41, 95% CI: 1.38–4.21). A 10 pack year smoking history was not associated with overall survival. Higher stage at diagnosis appeared as the only factor significantly associated with OPC recurrence (aHR: 4.88, 95% CI: 2.12–11.21).ConclusionThis study confirms that HPV16 status is an independent prognostic factor for OPC survival while female sex lowers risk of death and being underweight at diagnosis increases the risk of death. Smoking was not an independent predictor of OPC survival.
https://ift.tt/2G7HS04
Age- and localization-dependent functional and psychosocial impairments and health related quality of life six months after OSCC therapy
Source:Oral Oncology, Volume 81
Author(s): Sabine S. Linsen, Nils-Claudius Gellrich, Gertrud Krüskemper
ObjectivesThe aim of the current study was to evaluate the functional and psychosocial impacts and changes in overall quality of life (QoL) following oral squamous cell carcinoma (OSCC) therapy in different age groups and in different oral locations.Materials and MethodsThe study assessed questionnaire responses from patients with OSCC (n = 1319) after 6 months of oncologic therapy, as collected in the DÖSAK Rehab Study. Oncological variables, dental status, sensory, QoL, psychosocial outcomes and coping strategies in younger (45–60 years) and older (61–100 years) patients were assessed for different OSCC locations including the entire oral cavity, maxilla, mandible and others besides the maxilla and mandible.ResultsYounger patients were generally less satisfied with their dental status and experienced more sensory and QoL impairments, as well as more psychological burden, compared to the older patients. Depending on the age group, different coping strategies were used. Oncologic therapy targeted to the mandible and other locations besides the maxilla and mandible led to the strongest sensory and QoL limitations.ConclusionsRegardless of age, oncologic OSCC therapy leads to profound sensory and psychosocial restrictions and to limitations in QoL. Reasons for the poorer functional and QoL outcomes in younger patients include a more invasive treatment and a lower psychosocial resilience. The identification of patients with depressive and dysfunctional coping strategies should be carried out for all ages, but especially in younger patients, in order to develop functional coping strategies through individualized counseling, treatment and rehabilitation.Registration of clinical trialsObservational study, therefore not required.
https://ift.tt/2jPK4AF
Surgical outreach and microvascular surgery in developing countries
Source:Oral Oncology, Volume 81
Author(s): Chad A. Zender, Kate Clancy, Jason E. Thuener, Kyle Mannion
Due to the discrepancy between surgical demand and resources in Low-Middle Income Countries (LMIC), surgical outreach programs (SOP) have increased in popularity. In these resource-constrained healthcare environments, the resources necessary to perform basic head and neck procedures are often lacking, and offering microvascular reconstruction adds yet another level of complexity. Here we discuss the difficulties and challenges in establishing a SOP abroad and more specifically some of the challenges specific to microvascular reconstruction – including patient selection, burden of cost, lack of infrastructure and equipment, and patient follow up and outcomes. Although challenges certainly exist, we present the feasibility and the benefit for patient care as well as the role it can play in the foundation development of a low-resource region. The goals of the SOP must be well-defined, and incorporating microvascular surgery can be used as an adjunct to enhance the development of many aspects of the LMIC healthcare system. We present a model of care in which the initial focus is centered on providing safe care to these patients undergoing complex procedures, but after the development of a strong foundation, the focus can begin to include program sustainability and education.
https://ift.tt/2G4MrZf
Bisphosphonate-related osteonecrosis of the human jaw: A combined 3D assessment of bone descriptors by histology and synchrotron radiation-based microtomography
Source:Oral Oncology
Author(s): Alessandra Giuliani, Giovanna Iezzi, Marco Mozzati, Giorgia Gallesio, Serena Mazzoni, Giuliana Tromba, Franco Zanini, Adriano Piattelli, Carmen Mortellaro
https://ift.tt/2KWobfp
Progression beyond nivolumab: Stop or repeat? Dramatic responses with salvage chemotherapy
Source:Oral Oncology
Author(s): Amaury Daste, Erwan De-Mones, Valérie Cochin, Charles Dupin, Laurence Digue, Alain Ravaud, Charlotte Domblides
https://ift.tt/2G7HRcw
Editorial Board/Aims & Scope
Source:Oral Oncology, Volume 80
https://ift.tt/2KWo4R1
Chronic Obesity and Incident Hypertension in Latina Women Are Associated with Accelerated Telomere Length Loss over a 1-Year Period
Metabolic Syndrome and Related Disorders, Ahead of Print.
https://ift.tt/2IeraOD
Can Posting Be a Catalyst for Dating Violence? Social Media Behaviors and Physical Interactions
Violence and Gender, Ahead of Print.
https://ift.tt/2KWV23U
Durvalumab, Tremelimumab and Stereotactic Body Radiation Therapy in Treating Participants With Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma
Conditions: Metastatic Head and Neck Squamous Cell Carcinoma; Recurrent Head and Neck Squamous Cell Carcinoma
Interventions: Biological: Durvalumab; Other: Laboratory Biomarker Analysis; Radiation: Stereotactic Body Radiation Therapy; Biological: Tremelimumab
Sponsors: University of Washington; National Cancer Institute (NCI)
Not yet recruiting
https://ift.tt/2I8tj2k
Interventions: Biological: Durvalumab; Other: Laboratory Biomarker Analysis; Radiation: Stereotactic Body Radiation Therapy; Biological: Tremelimumab
Sponsors: University of Washington; National Cancer Institute (NCI)
Not yet recruiting
https://ift.tt/2I8tj2k
Intensity-Modulated Radiation Therapy & Nivolumab for Recurrent or Second Primary Head & Neck Squamous Cell Cancer
Condition: Recurrent Head and Neck Squamous Cell Carcinoma
Interventions: Radiation: IMRT; Biological: Nivolumab
Sponsors: Emory University; Bristol-Myers Squibb; The Cleveland Clinic; Medical College of Wisconsin
Not yet recruiting
https://ift.tt/2IgguPz
Interventions: Radiation: IMRT; Biological: Nivolumab
Sponsors: Emory University; Bristol-Myers Squibb; The Cleveland Clinic; Medical College of Wisconsin
Not yet recruiting
https://ift.tt/2IgguPz
Efficacy of stem cells in maxillary sinus floor augmentation: systematic review and meta-analysis
The aim of this review was to test the hypothesis of no difference in the efficacy of bone regeneration when using stem cells in maxillary sinus floor augmentation surgery in comparison to other grafts. Nine randomized clinical trials and one follow-up study involving human subjects were identified through a search of the PubMed/MEDLINE, Scopus, Cochrane, and Web of Science databases, supplemented by a hand search. No significant difference between groups was found for the implant survival rate, increase in bone height, marginal bone loss following implant placement, or new bone formation.
https://ift.tt/2IATDlc
Benign thyroid nodule unresponsive to radiofrequency ablation treated with laser ablation: a case report
Radiofrequency ablation and laser ablation are safe and effective techniques for reducing thyroid nodule volume, neck symptoms, and cosmetic complaints. Therapeutic success is defined as a nodule reduction > 5...
https://ift.tt/2rAilaM
Antibiotic use in facial plastic surgery
Purpose of review The aim of this study was to review and discuss recent literature regarding perioperative use of antibiotics in the context of facial plastic surgery. Recent findings Despite research efforts, there continues to be insufficient evidence in support of, or against, the use of antimicrobial prophylaxis. Summary Current available evidence regarding antibiotic use in facial plastic surgery procedures fails to demonstrate routine benefit. Therefore, the advantages accompanying administration of preoperative antibiotics should be weighed against any potential complications on a case-by-case basis. Future large-scale prospective studies will be beneficial in developing standardized criteria directing appropriate antibiotic use. Correspondence to Jessyka G. Lighthall, MD, Penn State College of Medicine, The Milton S. Hershey Medical Center, Division of Otolaryngology-Head and Neck Surgery, 500 University Drive, MC H091, Hershey, PA 17033, USA. E-mail: jlighthall@pennstatehealth.psu.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2rCHoKp
https://ift.tt/2rCHoKp
Modern postoperative monitoring of free flaps
Purpose of review Flap failure in microvascular reconstruction is a costly complication with total flap loss being the worst-case scenario. With the aim to rapidly identify a postoperative circulatory problem, some susceptible flaps can be saved by careful clinical monitoring or by various technical monitoring methods. In head and neck surgery, where the flaps are often buried and difficult to monitor clinically, a reliable technical monitoring method would be useful. A broad range of different techniques are in use varying according to practical and personal preferences among clinics and surgeons. However, no evidence for any particular technique being superb has emerged. We review reports of some frequently used and modern free flap monitoring techniques. Recent findings Clinical monitoring is still the gold standard to which other techniques are compared to. Laser Doppler flowmetry and near-infrared spectroscopy have been reported to identify early circulatory problems, but both techniques are not well suited for buried flaps. Implantable Doppler, flow coupler, partial tissue oxygen pressure and microdialysis are invasive monitoring methods suitable for buried flaps. Summary More research with practical and clinically relevant parameters, that is flap salvage rate, false positive rate and cost-efficiency are needed before objective comparisons between different monitoring techniques can be made. Correspondence to Jussi Laranne, Department of Otorhinolaryngology - Head and Neck Surgery, Kokkola Central Hospital, Mariankatu 16, 67200 Kokkola, Finland. Tel: +358 50 5271727; e-mail: jussilaranne@me.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2KW855A
https://ift.tt/2KW855A
Management of obstructive sleep apnoea: an update on the role of distraction osteogenesis
Purpose of review This article reviews the current literature on the use of distraction osteogenesis as a treatment for patients with obstructive sleep apnoea (OSA). We reviewed the indications, surgical protocols and outcomes for distraction osteogenesis in paediatric and adult OSA cases described in the literature. Recent findings There is evidence that distraction osteogenesis is effective in treating children with OSA as a result of underdevelopment of jaws such as those with craniofacial syndromes. Distraction osteogenesis appears to be the only available treatment that prevents tracheostomy in some of these cases, or allows decannulation after distraction. For adult OSA patients, distraction osteogenesis is reported to be reserved for challenging cases such as OSA as a consequence of temporomandibular joint ankylosis. It is used where conventional orthognathic surgery is not feasible. The studies reported high success rate/cure rate of OSA after distraction osteogenesis. Technological advances such as three-dimensional printing assist the execution of an accurate distraction process. Summary Distraction osteogenesis appears to be an effective treatment for paediatric OSA patients with craniofacial anomalies, and is used in selected cases of adult with severe OSA. With the improvement in distraction device designs and computer technology, distraction osteogenesis may play a bigger role in the treatment of OSA. Correspondence to Yiu Yan Leung, Oral and Maxillofacial Surgery, Prince Philip Dental Hospital, 34 Hospital Road, Pokfulam, Hong Kong. Tel: +852 28590511; fax: +852 2857 5570; e-mail: mikeyyleung@hku.hk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2rBdPsC
https://ift.tt/2rBdPsC
A Comparative Study of Type-I Underlay Tympanoplasty with Temporalis Fascia Graft Alone and with Conchal Cartilage
Abstract
Tympanoplasty which is the repair of the tympanic membrane using temporalis fascia, has been done worldwide and has stood the test of time. However in cases of reperforation or large/subtotal perforations, we are often left in need of some sturdy material for grafting. To compare the graft uptake and hearing improvement in patients undergoing type I tympanoplasty using temporalis fascia alone and temporalis fascia along with conchal cartilage. The current research is a prospective study of 60 patients with chronic suppurative otitis media (Tubo tympanic type), undergoing type I tympanoplasty, using temporalis fascia alone and temporalis fascia along with conchal cartilage. The graft uptake and hearing improvement was much better using temporalis fascia along with conchal cartilage graft as compared to cartilage alone. The use of temporalis fascia along with conchal cartilage graft is beneficial for patients with chronic suppurative otitis media (tubotympanic type) undergoing type I tympanoplasty than using temporalis fascia alone.
https://ift.tt/2KUjR0n
Implementation of closed-loop-assisted intra-operative goal-directed fluid therapy during major abdominal surgery: A case–control study with propensity matching
BACKGROUND Goal-directed fluid therapy (GDFT) has been associated with improved patient outcomes. However, implementation of GDFT protocols remains low despite growing published evidence and the recommendations of multiple regulatory bodies in Europe. We developed a closed-loop-assisted GDFT management system linked to a pulse contour monitor to assist anaesthesiologists in applying GDFT. OBJECTIVE To assess the impact of our closed-loop system in patients undergoing major abdominal surgery in an academic hospital without a GDFT programme. DESIGN A case–control study with propensity matching. SETTING Operating rooms, Erasme Hospital, Brussels. PATIENTS All patients who underwent elective open major abdominal surgery between January 2013 and December 2016. INTERVENTION Implementation of our closed-loop-assisted GDFT in April 2015. METHODS A total of 104 patients managed with closed-loop-assisted GDFT were paired with a historical cohort of 104 consecutive non-GDFT patients. The historical control group consisted of patients treated before the implementation of the closed-loop-system, and who did not receive GDFT. In the closed-loop group, the system delivered a baseline crystalloid infusion of 3 ml kg−1 h−1 and additional 100 ml fluid boluses of either a crystalloid or colloid for haemodynamic optimisation. MAIN OUTCOME MEASURES The primary outcome was intra-operative net fluid balance. Secondary outcomes were composite major postoperative complications, composite minor postoperative complications and hospital length of stay (LOS). RESULTS Baseline characteristics were similar in both groups. Patients in the closed-loop group had a lower net intra-operative fluid balance compared with the historical group (median interquartile range [IQR] 2.9 [1.6 to 4.4] vs. 6.2 [4.0 to 8.3] ml kg−1 h−1; P
https://ift.tt/2Kb8Mqv
https://ift.tt/2Kb8Mqv
Peri-operative copeptin concentrations and their association with myocardial injury after vascular surgery: A prospective observational cohort study
BACKGROUND Copeptin levels in conjunction with cardiac troponin may be used to rule out early myocardial infarction in patients presenting with chest pain. Raised pre-operative copeptin has been shown to be associated with postoperative cardiac events. However, very little is known about the peri-operative time course of copeptin or the feasibility of very early postoperative copeptin measurement to diagnose or rule-out myocardial injury. OBJECTIVES In this preparatory analysis for a larger trial, we sought to examine the time course of peri-operative copeptin and identify the time at which concentrations returned to pre-operative levels. Second, in an explorative analysis, we sought to examine the association of copeptin in general and at various time points with myocardial injury occurring within the first 48 h. DESIGN Preparatory analysis of a prospective, observational cohort study. SETTING Single university centre from February to July 2016. PATIENTS A total of 30 consecutive adults undergoing vascular surgery. INTERVENTION Serial peri-operative copeptin measurements. MAIN OUTCOME MEASURE We measured copeptin concentrations before and immediately after surgery (0 h), then at 2, 4, 6 and 8 h after surgery and on the first and second postoperative day. Postoperative concentrations were compared with pre-operative levels with a Wilcoxon signed-rank test. Second, we explored an association between postoperative copeptin concentrations and myocardial injury by the second postoperative day. Myocardial injury was defined as a 5 ng l−1 increase between pre-operative and postoperative high-sensitivity cardiac troponin T with an absolute peak of at least 20 ng l−1. RESULTS Immediate postoperative copeptin concentrations (median [interquartile range]) increased nearly eight-fold from pre-operative values (8.5 [3.6 to 13.8] to 64.75 pmol l−1 [29.6 to 258.7]; P
https://ift.tt/2Iw0bkR
https://ift.tt/2Iw0bkR
A Comparative Study of Type-I Underlay Tympanoplasty with Temporalis Fascia Graft Alone and with Conchal Cartilage
Abstract
Tympanoplasty which is the repair of the tympanic membrane using temporalis fascia, has been done worldwide and has stood the test of time. However in cases of reperforation or large/subtotal perforations, we are often left in need of some sturdy material for grafting. To compare the graft uptake and hearing improvement in patients undergoing type I tympanoplasty using temporalis fascia alone and temporalis fascia along with conchal cartilage. The current research is a prospective study of 60 patients with chronic suppurative otitis media (Tubo tympanic type), undergoing type I tympanoplasty, using temporalis fascia alone and temporalis fascia along with conchal cartilage. The graft uptake and hearing improvement was much better using temporalis fascia along with conchal cartilage graft as compared to cartilage alone. The use of temporalis fascia along with conchal cartilage graft is beneficial for patients with chronic suppurative otitis media (tubotympanic type) undergoing type I tympanoplasty than using temporalis fascia alone.
https://ift.tt/2KUjR0n
Correlations of SOX9 expression with serum IGF1 and inflammatory cytokines IL-1α and IL-6 in skin lesions of patients with acne
OBJECTIVE: To study the correlations of sex determining region Y-box 9 (SOX9) expression with serum type-1 insulin-like growth factor (IGF-1), interleukin-1α (IL-1α), and interleukin-6 (IL-6) in skin lesion tissues of patients with acne.
PATIENTS AND METHODS: Six patients with acne who were treated for the first time in our outpatient clinic from June 2017 to July 2017 were selected as observation group, and 6 normal subjects were selected as control group. The expression of SOX9 was detected by immunohistochemistry. The protein expressions of IGF-1, IL-1α, and IL-6 were detected by enzyme-linked immunosorbent assay (ELISA). SOX9 was detected by quantitative polymerase chain reaction (qPCR).
RESULTS: Compared with that in control group, the expression of SOX9 in observation group was significantly increased (p < 0.05). Compared with those in control group, the expressions of IGF-1, IL-1α and IL-6 in observation group were significantly increased (p < 0.05). Compared with that in control group, the mRNA expression of SOX9 in observation group was significantly increased (p < 0.05). SOX9 was positively correlated with IGF-1, IL-1α and IL-6.
CONCLUSIONS: The expressions of SOX9, IGF-1, IL-1α, and IL-6 in skin lesion tissues of patients with acne are increased, and SOX9 is positively correlated with IGF-1, IL-1α, and IL-6 and can be used as a target for the treatment of acne inflammation.
L'articolo Correlations of SOX9 expression with serum IGF1 and inflammatory cytokines IL-1α and IL-6 in skin lesions of patients with acne sembra essere il primo su European Review.
https://ift.tt/2I84GTp
A Prospective Observational Study of Technical Difficulty With GlideScope-Guided Tracheal Intubation in Children
BACKGROUND: The GlideScope Cobalt is one of the most commonly used videolaryngoscopes in pediatric anesthesia. Although visualization of the airway may be superior to direct laryngoscopy, users need to learn a new indirect way to insert the tracheal tube. Learning this indirect approach requires focused practice and instruction. Identifying the specific points during tube placement, during which clinicians struggle, would help with targeted education. We conducted this prospective observational study to determine the incidence and location of technical difficulties using the GlideScope, the success rates of various corrective maneuvers used, and the impact of technical difficulty on success rate. METHODS: We conducted this observational study at our quaternary pediatric hospital between February 2014 and August 2014. We observed 200 GlideScope-guided intubations and documented key intubation–related outcomes. Inclusion criteria for patients were
https://ift.tt/2I7EoRf
https://ift.tt/2I7EoRf
Rates of Perioperative Respiratory Adverse Events Among Caucasian and African American Children Undergoing General Anesthesia
BACKGROUND: Perioperative respiratory adverse events (PRAEs) account for the major cause of morbidity and mortality in children undergoing general anesthesia. In our institutional clinical practice, we suspected that African American children experienced untoward respiratory events more frequently than other racial groups. Identification of high-risk groups can guide decision making in the perioperative period, and aggressive optimization of specific care can enhance safety and improve outcomes. METHODS: Data came from a retrospective chart review for records from August 2013 to December 2013. The primary aim was to compare the incidence of PRAEs among racial groups of young children at a single institution. We also analyzed factors that are potentially associated with a higher risk of PRAEs. There were 1148 records that met the inclusion criteria. Racial identities, PRAEs, and risk factors were identified. Logistic regression analysis was performed to evaluate differences in PRAEs among racial groups controlling for confounding variables. RESULTS: Of all 1148 patients, 62 (5.4%) had a PRAE. African American children had significantly higher incidences of PRAE (26/231, 11.4%) compared to Caucasian (27/777, 3.5%; P
https://ift.tt/2Ih2tRP
https://ift.tt/2Ih2tRP
Feasibility of Fully Automated Hypnosis, Analgesia, and Fluid Management Using 2 Independent Closed-Loop Systems During Major Vascular Surgery: A Pilot Study
Automated titration of intravenous anesthesia and analgesia using processed electroencephalography monitoring is no longer a novel concept. Closed-loop control of fluid administration to provide goal-directed fluid therapy has also been increasingly described. However, simultaneously combining 2 independent closed-loop systems together in patients undergoing major vascular surgery has not been previously detailed. The aim of this pilot study was to evaluate the clinical performance of fully automated hypnosis, analgesia, and fluid management using 2 independent closed-loop controllers in patients undergoing major vascular surgery before implementation within a larger study evaluating true patient outcomes. Accepted for publication March 30, 2018. Funding: Departmental. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). A. Joosten and V. Jame contributed equally and share first authorship. Institutional review board: This study was approved by our Institutional Review Board (IRB) of Erasme Hospital (808 Route de Lennik, 1070 Bruxelles, Belgium). E-mail: helene.francois@erasme.ulb.ac.be. Reprints will not be available from the authors. Address correspondence to Alexandre Joosten, MD, Hopital ERASME, 808, Rt de Lennik, 1070 Brussels, Belgium. Address e-mail to Alexandre.Joosten@erasme.ulb.ac.be; joosten-alexandre@hotmail.com. © 2018 International Anesthesia Research Society
https://ift.tt/2IgEG47
https://ift.tt/2IgEG47
Propensity Score Methods: Theory and Practice for Anesthesia Research
Observational data are often readily available or less costly to obtain than conducting a randomized controlled trial. With observational data, investigators may statistically evaluate the relationship between a treatment or therapy and outcomes. However, inherent in observational data is the potential for confounding arising from the nonrandom assignment of treatment. In this statistical grand rounds, we describe the use of propensity score methods (ie, using the probability of receiving treatment given covariates) to reduce bias due to measured confounders in anesthesia and perioperative medicine research. We provide a description of the theory and background appropriate for the anesthesia researcher and describe statistical assumptions that should be assessed in the course of a research study using the propensity score. We further describe 2 propensity score methods for evaluating the association of treatment or therapy with outcomes, propensity score matching and inverse probability of treatment weighting, and compare to covariate-adjusted regression analysis. We distinguish several estimators of treatment effect available with propensity score methods, including the average treatment effect, the average treatment effect for the treated, and average treatment effect for the controls or untreated, and compare to the conditional treatment effect in covariate-adjusted regression. We highlight the relative advantages of the various methods and estimators, describe analysis assumptions and how to critically evaluate them, and demonstrate methods in an analysis of thoracic epidural analgesia and new-onset atrial arrhythmias after pulmonary resection. Accepted for publication February 16, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Edward J. Mascha, PhD, Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, 9500 Euclid Ave, P77-007, Cleveland, OH 44195. Address e-mail to maschae@ccf.org. © 2018 International Anesthesia Research Society
https://ift.tt/2IgF1np
https://ift.tt/2IgF1np
Trainability of Cricoid Pressure Force Application: A Simulation-Based Study
BACKGROUND: Aspiration of gastric contents is a leading cause of airway management–related mortality during anesthesia practice. Cricoid pressure (CP) is widely used during rapid sequence induction to prevent aspiration. National guidelines for CP suggest a target force of 10 N before and 30 N after loss of consciousness. However, few studies have rigorously assessed whether clinicians can be trained to consistently achieve these levels of force. We hypothesized that clinicians can be trained effectively to deliver 10–30 N during application of CP. METHODS: Clinicians (attending anesthesiologist, anesthesiology residents, certified registered nurse anesthetists, or operating room nurses) applied CP on a Vernier force plate simulator with measurements taken at 4 time points over 60 seconds, 2 measurements before and 2 measurements after loss of consciousness. A successful cycle required all 4 time points to be within the target range (10 ± 5 and 30 ± 5 N, respectively). After baseline assessment (n = 100 clinicians), a subset of 40 participants volunteered for education on recommended force targets, underwent self-regulated practice, and then performed 30 1-minute cycles of high-frequency simulation analyzed by cumulative sum analysis to assess their change in performance. RESULTS: At baseline, 5 cycles (1.3% [confidence interval {CI}, 0.3%–2.50%]) out of 400 were successful. Performance improved after education and self-regulated practice (16% successful cycles [CI, 7.8%–25%]), and performance during the last 4 of 30 cycles was 45% (CI, 33%–58%). The odds of success increased over time (odds ratio, 1.1; P
https://ift.tt/2jOVODF
https://ift.tt/2jOVODF
Impact of 2 Distinct Levels of Mean Arterial Pressure on Near-Infrared Spectroscopy During Cardiac Surgery: Secondary Outcome From a Randomized Clinical Trial
BACKGROUND: Near-infrared spectroscopy (NIRS) is used worldwide to monitor regional cerebral oxygenation (rScO2) during cardiopulmonary bypass (CPB). Intervention protocols meant to mitigate cerebral desaturation advocate to increase mean arterial pressure (MAP) when cerebral desaturation occurs. However, the isolated effect of MAP on rScO2 is uncertain. The aim of the present study was in a randomized, blinded design to elucidate the effect of 2 distinct levels of MAP on rScO2 values during CPB. We hypothesized that a higher MAP would be reflected in higher rScO2 values, lower frequency of patients with desaturation, and a less pronounced cerebral desaturation load. METHODS: This is a substudy of the Perfusion Pressure Cerebral Infarct trial, in which we investigated the impact of MAP levels during CPB on ischemic brain injury after cardiac surgery. Deviation in rScO2 was a predefined outcome in the Perfusion Pressure Cerebral Infarct trial. Patients were randomized to low MAP (LMAP; 40–50 mm Hg) or high MAP (HMAP; 70–80 mm Hg) during CPB. CPB pump flow was fixed at 2.4 L/min/m2, and MAP levels were targeted using norepinephrine. Intraoperatively, NIRS monitoring was performed in a blinded fashion, with sensors placed on the left and right side of the patient's forehead. NIRS recordings were extracted for offline analysis as the mean value of left and right signal during prespecified periods. Mean rScO2 during CPB was defined as the primary outcome in the present study. RESULTS: The average MAP level during CPB was 67 mm Hg ± SD 5.0 in the HMAP group (n = 88) and 45 mm Hg ± SD 4.4 in the LMAP group (n = 88). Mean rScO2 was significantly lower in the HMAP group during CPB (mean difference, 3.5; 95% confidence interval, 0.9–6.1; P = .010). There was no difference in rScO2 values at specified time points during the intraoperative period between the 2 groups. Significantly more patients experienced desaturation below 10% and 20% relative to rScO2 baseline in the HMAP group (P = .013 and P = .009, respectively), and the cerebral desaturation load below 10% relative to rScO2 baseline was more pronounced in the HMAP group (P = .042). CONCLUSIONS: In a randomized blinded study, we observed that a higher MAP induced by vasopressors, with a fixed CPB pump flow, leads to lower mean rScO2 and more frequent and pronounced cerebral desaturation during CPB. The mechanism behind these observations is not clear. We cannot exclude extracranial contamination of the NIRS signal as a possible explanation. However, we cannot recommend increasing MAP by vasoconstrictors during cerebral desaturation because this is not supported by the findings of the present study. Accepted for publication March 27, 2018. Funding: None. The authors declare no conflicts of interest. Clinicaltrial.gov identifier for main study (Perfusion Pressure Cerebral Infarct trial): NCT02185885. Reprints will not be available from the authors. Address correspondence to Frederik Holmgaard, BMSc, Department of Cardiothoracic Anesthesiology, Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9 – DK-2100, Copenhagen, Denmark. Address e-mail to frederik.holmgaard@regionh.dk. © 2018 International Anesthesia Research Society
https://ift.tt/2I7Elox
https://ift.tt/2I7Elox
Proximal Versus Distal Continuous Adductor Canal Blocks: Does Varying Perineural Catheter Location Influence Analgesia? A Randomized, Subject-Masked, Controlled Clinical Trial
BACKGROUND: A continuous adductor canal block provides analgesia after surgical procedures of the knee. Recent neuroanatomic descriptions of the thigh and knee led us to speculate that local anesthetic deposited in the distal thigh close to the adductor hiatus would provide superior analgesia compared to a more proximal catheter location. We therefore tested the hypothesis that during a continuous adductor canal nerve block, postoperative analgesia would be improved by placing the perineural catheter tip 2–3 cm cephalad to where the femoral artery descends posteriorly to the adductor hiatus (distal location) compared to a more proximal location at the midpoint between the anterior superior iliac spine and the superior border of the patella (proximal location). METHODS: Preoperatively, subjects undergoing total knee arthroplasty received an ultrasound-guided perineural catheter inserted either in the proximal or distal location within the adductor canal in a randomized, subject-masked fashion. Subjects received a single injection of lidocaine 2% via the catheter preoperatively, followed by an infusion of ropivacaine 0.2% (8 mL/h basal, 4 mL bolus, 30 minutes lockout) for the study duration. After joint closure, the surgeon infiltrated the entire joint using 30 mL of ropivacaine (0.5%), ketorolac (30 mg), epinephrine (5 μg/mL), and tranexamic acid (2 g). The primary end point was the median level of pain as measured on a numeric rating scale (NRS) during the time period of 8:00 AM to 12:00 PM the day after surgery. RESULTS: For the primary end point, the NRS of subjects with a catheter inserted at the proximal location (n = 24) was a median (10th, 25th–75th, 90th quartiles) of 0.5 (0.0, 0.0–3.2, 5.0) vs 3.0 (0.0, 2.0–5.4, 7.8) for subjects with a catheter inserted in the distal location (n = 26; P = .011). Median and maximum NRSs were lower in the proximal group at all other time points, but these differences did not reach statistical significance. There were no clinically relevant or statistically significant differences between the treatment groups for any other secondary end point, including opioid consumption and ambulation distance. CONCLUSIONS: For continuous adductor canal blocks accompanied by intraoperative periarticular local anesthetic infiltration, analgesia the day after knee arthroplasty is improved with a catheter inserted at the level of the midpoint between the anterior superior iliac spine and the superior border of the patella compared with a more distal insertion closer to the adductor hiatus. Accepted for publication March 27, 2018. Funding: This work was supported by the Department of Anesthesiology, University of California San Diego (San Diego, CA). The authors declare no conflicts of interest. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the funding entity. Institutional review board: University California San Diego Human Research Protections Program at (858) 657–5100, 9500 Gilman Dr, La Jolla, CA 92093-0052. E-mail: tnelson@ucsd.edu. This report describes human research and a prospective randomized clinical trial. The authors state that the report includes every item in the Consolidated Standards of Reporting Trials (CONSORT) checklist for a prospective randomized clinical trial. This study was conducted with written informed consent from the study subjects. The study was registered before patient enrollment. This was not an observational clinical study. Registry URL: clinicaltrials.gov NCT02523235. Reprints will not be available from the authors. Address correspondence to Brian M. Ilfeld, MD, MS , Department of Anesthesiology, University California San Diego, 9500 Gilman Dr, La Jolla, CA 92093-0898. Address e-mail to bilfeld@ucsd.edu. © 2018 International Anesthesia Research Society
https://ift.tt/2Ib2Ixt
https://ift.tt/2Ib2Ixt
Patient-Controlled Versus Clinician-Controlled Sedation With Propofol: Systematic Review and Meta-analysis With Trial Sequential Analyses
BACKGROUND: Sedation with propofol is frequently used to facilitate diagnostic and therapeutic procedures. Propofol can be administrated by the patient (patient-controlled sedation [PCS]) or by a clinician (clinician-controlled sedation [CCS]). We aimed to compare these 2 techniques. METHODS: PubMed, Embase, CENTRAL, and trial registries were searched up to October 2017 for randomized controlled trials comparing PCS with CCS with propofol. The primary end points were the risks of presenting at least 1 episode of oxygen desaturation, arterial hypotension, and bradycardia, and the risk of requiring a rescue intervention (pharmacologic therapies or physical maneuvers) for sedation-related adverse events. Secondary end points were the dose of propofol administrated, operator and patient satisfaction, and the risk of oversedation. A random-effects model and an α level of .02 to adjust for multiple analyses were used throughout. Trial sequential analyses were performed for primary outcomes. Quality of evidence was assessed according to the Grades of Recommendation, Assessment, Development, and Evaluation system. RESULTS: Thirteen trials (1103 patients; median age, 47 years; American Society of Anesthesiologists physical status I–III) describing various diagnostic and therapeutic procedures with propofol sedation were included. PCS had no impact on the risk of oxygen desaturation (11 trials, 31/448 patients [6.9%] with PCS versus 46/481 [9.6%] with CCS; risk ratio, 0.74 [98% confidence interval, 0.35–1.56]) but decreased the risk of requiring a rescue intervention for adverse events (11 trials, 29/449 patients [6.5%] with PCS versus 74/482 [15.4%] with CCS; risk ratio, 0.45 [98% confidence interval, 0.25–0.81]). For both outcomes, Trial sequential analyses suggested that further trials were unlikely to change the results, although the quality of evidence was graded very low for all primary outcomes. For the risk of arterial hypotension and bradycardia, the required sample size for a definitive conclusion had not been reached. Analysis of secondary outcomes suggested that PCS decreased the risk of oversedation and had no impact on propofol dose administrated, or on operator or patient satisfaction. CONCLUSIONS: PCS with propofol, compared with CCS with propofol, had no impact on the risk of oxygen desaturation, but significantly decreased the risk of rescue interventions for sedation-related adverse events. Further high-quality trials are required to assess the risks and benefits of PCS. Accepted for publication February 16, 2018. Funding: Departmental. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Lukas Kreienbühl, MD, Department of Anesthesiology, Intensive Care and Pain Medicine, Helios Klinikum Bad Saarow, Pieskower Straße 33, 15526 Bad Saarow, Germany. Address e-mail to lukas.kreienbuehl@helios-gesundheit.de. © 2018 International Anesthesia Research Society
https://ift.tt/2Ia8nrA
https://ift.tt/2Ia8nrA
The Bethesda System for Reporting Thyroid Cytopathology Explained for Practitioners: Frequently Asked Questions
Thyroid, Volume 28, Issue 5, Page 556-565, May 2018.
https://ift.tt/2G6kDDX
Associations of Urinary Cotinine-Verified Active and Passive Smoking with Thyroid Function: Analysis of Population-Based Nationally Representative Data
Thyroid, Volume 28, Issue 5, Page 583-592, May 2018.
https://ift.tt/2GajR8Y
Management of Subclinical Hypothyroidism in Pregnancy: A Comment from the Italian Society of Endocrinology and the Italian Thyroid Association to the 2017 American Thyroid Association Guidelines—“The Italian Way”
Thyroid, Volume 28, Issue 5, Page 551-555, May 2018.
https://ift.tt/2KSLjvi
Kallikreins Stepwise Scoring Reveals Three Subtypes of Papillary Thyroid Cancer with Prognostic Implications
Thyroid, Volume 28, Issue 5, Page 601-612, May 2018.
https://ift.tt/2G9gjDA
Systematic Review and Meta-Analysis of Unplanned Reoperations, Emergency Department Visits and Hospital Readmission After Thyroidectomy
Thyroid, Volume 28, Issue 5, Page 624-638, May 2018.
https://ift.tt/2KSLdnq
Correction to: Tertiary Care Experience of Sorafenib in the Treatment of Progressive Radioiodine-Refractory Differentiated Thyroid Carcinoma: A Korean Multicenter Study, by Kim M, Kim TH, Shin DY, Lim DJ, Kim EY, Kim WB, Chung JH, Shong YK, Kim BH, and Kim WG on behalf of Korean Thyroid Cancer Study Group (KTCSG).; Thyroid 2018;28(3)340–348. DOI: 10.1089/thy.2017.0356
Thyroid, Volume 28, Issue 5, Page 686-686, May 2018.
https://ift.tt/2G62q9p
Weight Changes After Thyroid Surgery for Patients with Benign Thyroid Nodules and Thyroid Cancer: Population-Based Study and Systematic Review and Meta-Analysis
Thyroid, Volume 28, Issue 5, Page 639-649, May 2018.
https://ift.tt/2jSg2fM
Antibiotic use in facial plastic surgery
Purpose of review The aim of this study was to review and discuss recent literature regarding perioperative use of antibiotics in the context of facial plastic surgery. Recent findings Despite research efforts, there continues to be insufficient evidence in support of, or against, the use of antimicrobial prophylaxis. Summary Current available evidence regarding antibiotic use in facial plastic surgery procedures fails to demonstrate routine benefit. Therefore, the advantages accompanying administration of preoperative antibiotics should be weighed against any potential complications on a case-by-case basis. Future large-scale prospective studies will be beneficial in developing standardized criteria directing appropriate antibiotic use. Correspondence to Jessyka G. Lighthall, MD, Penn State College of Medicine, The Milton S. Hershey Medical Center, Division of Otolaryngology-Head and Neck Surgery, 500 University Drive, MC H091, Hershey, PA 17033, USA. E-mail: jlighthall@pennstatehealth.psu.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2rCHoKp
https://ift.tt/2rCHoKp
Modern postoperative monitoring of free flaps
Purpose of review Flap failure in microvascular reconstruction is a costly complication with total flap loss being the worst-case scenario. With the aim to rapidly identify a postoperative circulatory problem, some susceptible flaps can be saved by careful clinical monitoring or by various technical monitoring methods. In head and neck surgery, where the flaps are often buried and difficult to monitor clinically, a reliable technical monitoring method would be useful. A broad range of different techniques are in use varying according to practical and personal preferences among clinics and surgeons. However, no evidence for any particular technique being superb has emerged. We review reports of some frequently used and modern free flap monitoring techniques. Recent findings Clinical monitoring is still the gold standard to which other techniques are compared to. Laser Doppler flowmetry and near-infrared spectroscopy have been reported to identify early circulatory problems, but both techniques are not well suited for buried flaps. Implantable Doppler, flow coupler, partial tissue oxygen pressure and microdialysis are invasive monitoring methods suitable for buried flaps. Summary More research with practical and clinically relevant parameters, that is flap salvage rate, false positive rate and cost-efficiency are needed before objective comparisons between different monitoring techniques can be made. Correspondence to Jussi Laranne, Department of Otorhinolaryngology - Head and Neck Surgery, Kokkola Central Hospital, Mariankatu 16, 67200 Kokkola, Finland. Tel: +358 50 5271727; e-mail: jussilaranne@me.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2KW855A
https://ift.tt/2KW855A
Management of obstructive sleep apnoea: an update on the role of distraction osteogenesis
Purpose of review This article reviews the current literature on the use of distraction osteogenesis as a treatment for patients with obstructive sleep apnoea (OSA). We reviewed the indications, surgical protocols and outcomes for distraction osteogenesis in paediatric and adult OSA cases described in the literature. Recent findings There is evidence that distraction osteogenesis is effective in treating children with OSA as a result of underdevelopment of jaws such as those with craniofacial syndromes. Distraction osteogenesis appears to be the only available treatment that prevents tracheostomy in some of these cases, or allows decannulation after distraction. For adult OSA patients, distraction osteogenesis is reported to be reserved for challenging cases such as OSA as a consequence of temporomandibular joint ankylosis. It is used where conventional orthognathic surgery is not feasible. The studies reported high success rate/cure rate of OSA after distraction osteogenesis. Technological advances such as three-dimensional printing assist the execution of an accurate distraction process. Summary Distraction osteogenesis appears to be an effective treatment for paediatric OSA patients with craniofacial anomalies, and is used in selected cases of adult with severe OSA. With the improvement in distraction device designs and computer technology, distraction osteogenesis may play a bigger role in the treatment of OSA. Correspondence to Yiu Yan Leung, Oral and Maxillofacial Surgery, Prince Philip Dental Hospital, 34 Hospital Road, Pokfulam, Hong Kong. Tel: +852 28590511; fax: +852 2857 5570; e-mail: mikeyyleung@hku.hk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2rBdPsC
https://ift.tt/2rBdPsC
Normative and validation data of an articulation test for Italian-speaking children
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Martina Tresoldi, Maria Rosaria Barillari, Federico Ambrogi, Elena Sai, Umberto Barillari, Elvira Tozzi, Letizia Scarponi, Antonio Schindler
ObjectivesAs a standardized instrument to assess speech sound development in Italian-speaking children is currently lacking, norms used to diagnose speech sound disorders (SSD) are mainly based on studies including English-speaking participants. This application may result in misidentification of SSD due to linguistic differences. The aims of the study were to establish normative data on speech sound development of Italian-speaking children and to evaluate psychometric properties of Rossi's articulation test, the picture-naming test selected to assess speech sound development.MethodsA cross-sectional study including 694 normally-developing Italian-speaking children aged from 3 to 7 years was conducted. Children were administered Rossi's articulation test, and percentages of speech sound correct production were calculated. To evaluate inter-rater reliability of the test, audio-recordings of 50 children were scored by an additional examiner. The same rater scored the audio-recordings of 50 children twice with an interval of at least 1 week. To evaluate test-retest reliability, 144 participants were re-tested after 1-3 weeks by the same assessor. Scores were compared through Intraclass Correlation Coefficient (ICC). To assess construct validity, the developmental progression of total scores across age groups was verified by the estimation of the reference range for the test, using a regression procedure.ResultsAlmost all Italian children in the sample produced vowels and approximants correctly. Singleton consonants were acquired before consonant clusters. Ages of acquisition of each consonant were presented: plosives and nasals were early mastered by Italian children, while dental affricates, alveolar fricatives and the palatal lateral were the latest acquired segments. All ICCs were superior to 0.9 (reliability). A statistically significant improvement in test score with age was found (construct validity).ConclusionsThe paper provides normative data for speech sound development of Italian-speaking children; preliminary psychometric analysis of Rossi's articulation test revealed satisfactory reliability and construct validity. Clinicians are recommended to use Rossi's articulation test to assess speech sound development in Italian children.
https://ift.tt/2rzAyVW
Is there a clinical application for tablet-based automated audiometry in children?
Publication date: July 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Olivia Pereira, Lauren E. Pasko, Jenna Supinski, Mackenzie Hammond, Thierry Morlet, Kyoko Nagao
IntroductionRecent research supports the clinical use of automated audiometry for pediatric hearing screenings. However, very few studies have tested whether tablet-based automated audiometry can offer a valid alternative to traditional manual audiometry for estimation of hearing thresholds in children. This study examined the validity and efficiency of automated audiometry in school-aged children.MethodsHearing thresholds for 0.5, 1, 2, 4, 6, and 8 kHz were collected in 32 children ages 6–12 years using standard audiometry and tablet-based automated audiometry in a soundproof booth. Test administration time, test preference, and medical history were also collected.ResultsResults exhibited that the majority (67%) of threshold differences between automated and standard were within the clinically acceptable range (10 dB). The threshold difference between the two tests showed that automated audiometry thresholds were higher by 12 dB in 6-year-olds, 7 dB in 7- to 9-year-olds, and 3 dB in 10- to 12-year-olds. In addition, test administration times were similar, such that standard audiometry took an average of 12.3 min and automated audiometry took 11.9 min.ConclusionsThese results support the use of tablet-based automated audiometry in children from ages 7–12 years. However, the results suggest that the clinical use of at least some types of tablet-based automated audiometry may not be feasible in children 6 years of age.
https://ift.tt/2I7Hd4O
Inhibiting EZH2 rescued bupivacaine-induced neuronal apoptosis in spinal cord dorsal root ganglia in mice
Abstract
Purpose
In the present work, we intended to explore the function of enhancer of zeste homolog 2 (EZH2) in modulated anesthetic reagent bupivacaine-induced neuronal apoptosis in spinal cord dorsal root ganglia (DRG).
Methods
Murine DRG explant was treated with 5 mM bupivacaine in vitro to induce neuronal apoptosis, which was examined by a TUNEL assay. Protein and mRNA expressions of EZH2 in bupivacaine-treated DRG were examined by western blot and qRT-PCR assays. EZH2 was downregulated by siRNA in bupivacaine-treated DRG. Its functional role in protecting bupivacaine-induced neuronal apoptosis was examined. In addition, apoptotic protein caspase-9 and EZH2-associated signaling pathway, and tropomyosin receptor kinase C (TrkC) were further investigated, by western blot assay, in EZH2-downregulated and bupivacaine-injured DRG.
Results
In vitro treatment of bupivacaine-induced DRG neuronal apoptosis, and upregulated EZH2 at both protein and mRNA levels. SiRNA transfection successfully downregulated EZH2, as confirmed by western blot and qRT-PCR assays. Examination of TUNEL assay showed that EZH2 downregulation rescued bupivacaine-induced DRG neuronal apoptosis. Moreover, in bupivacaine-injured DRG, EZH2 downregulation reduced caspase-9, whereas upregulated TrkC and phosphorylated-TrkC (p-TrkC).
Conclusion
EZH2 is upregulated, whereas inhibiting EZH2 exerted rescuing effect in anesthetics (bupivacaine)-induced spinal cord DRG. The possible downstream target of EZH2 inhibition may interact with caspase and TrkC signaling pathways.
https://ift.tt/2jNRDrC
Face Transplant: Status of Current Supporting Technology to Plan and Perform the Operation and Monitor the Graft in the Postoperative Period
Face transplant has rapidly advanced since the first operation in 2005, and to date, 40 partial or full-face transplants have been performed. The safety and efficacy of this operation are aided at all phases by supporting technologies. These include advanced imaging techniques to plan the operation, devices to monitor the flap in the immediate perioperative period, and noninvasive imaging and serum markers to monitor for acute and chronic rejection. Some of the technologies, such as those used in the immediate perioperative period, have extensive evidence supporting their use, whereas those to detect acute or chronic rejection remain investigational. The technologies of today will continue to evolve and make the operation safer with improved outcomes; however, the most significant barrier for face transplant continues to be immunologic rejection. Address correspondence and reprint requests to Edward J. Caterson, MD, PhD, Brigham and Women's Hospital, 75 Francis Street, Boston, MA; E-mail: ecaterson@bwh.harvard.edu Received 16 March, 2018 Accepted 17 March, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2I7OCkJ
https://ift.tt/2I7OCkJ
SLC22A5 Mutations in a Patient With Systemic Primary Carnitine Deficiency and Cleft Palate-Successful Perioperative Management
Background: Primary systemic carnitine deficiency (SCD) is an autosomal-recessive disorder caused by SLC22A5 gene mutation resulting in defective cellular carnitine transporter organic cation transporter 2. Defective carnitine transporter causes renal carnitine wasting and low serum carnitine. Carnitine is an essential cofactor for the transportation of long-chain fatty acids into the mitochondria. Lacking of carnitine may cause metabolic decompensation and sudden death when the patient is exposed to prolonged fasting before an operation. Methods: An asymptomatic 9-month-old boy with SCD diagnosed by local hospital was referred to the authors' hospital for incomplete cleft palate plastic surgery. Due to potential metabolic decompensation from prolonged fasting before the surgery, the patient underwent proper perioperative management. Results: The operation was successful and subsequent clinical course was fine. The patient was discharged on postoperative day 3. Conclusion: With proper perioperative management, patients with SCD and cleft palate can survive from prolonged fasting time before and during operation without metabolic decompensation manifestations. Early recognition of SCD and perioperative management can be lifesaving in preoperative infants with SCD. Address correspondence and reprint requests to Lun-Jou Lo, MD, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital 5, Fu-Shin Street, Kweishan, Taoyuan, Taiwan 333; E-mail: lunjoulo@cgmh.com.tw Received 5 November, 2017 Accepted 11 March, 2018 Presentation at professional meeting: 17th International Society of Craniofacial Surgery Biennal Meeting from October 24 to 28, 2017. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2rF4j7Y
https://ift.tt/2rF4j7Y
Εγγραφή σε:
Αναρτήσεις (Atom)