Risk of operating on the wrong site: how to avoid a never event

Joy C Edlin<br />May 7, 2018; 2018:bcr-2017-223704-bcr-2017-223704<br />Images in...

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Maxillomandibular advancement is a successful treatment for obstructive sleep apnoea: a systematic review and meta-analysis

Publication date: Available online 2 June 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): C.R. John, S. Gandhi, A.R. Sakharia, T.T. James
The primary objective of this review was to establish the effectiveness of maxillomandibular advancement (MMA) as a successful treatment modality in improving airway patency in patients with obstructive sleep apnoea (OSA). A systematic and detailed search was performed using PubMed Central, covering the period January 2000 to December 2015, with well-defined selection criteria. The authors independently conducted the study selection, data extraction, and assessed the risk of bias of the included studies. Twenty studies met the inclusion criteria. The outcome measures studied were the apnoea–hypopnoea index (AHI), respiratory disturbance index (RDI), Epworth Sleepiness Scale (ESS), lowest oxygen saturation (LSAT), and body mass index (BMI). The random-effects model was adopted for meta-analysis as moderate heterogeneity was identified. The analysis revealed significant changes in the outcome measures after the intervention. The results showed that the preoperative severity of OSA based on AHI and RDI significantly influences the outcome of MMA intervention, with a strong positive correlation between the pre MMA AHI values and the percentage change post intervention. The surgical success of MMA in patients with OSA was found to be 100% with respect to AHI and RDI scores. It is concluded that MMA is a successful treatment for OSA.



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Tracheostomy: Experience at Tertiary Hospital

Abstract

An attempt was made to find indications of tracheostomy procedure and its complications in the modern era of medicine with refined surgical techniques at a tertiary hospital. A retrospective study of 240 patients, who had undergone tracheostomy, was done during the period from January 2013 to April 2017 at Govt. Medical College Hospital. Various details of all participants such as age and sex of patients, detailed history of the current disease, and detailed information about tracheostomy and complications were recorded. In the present study, the most common indication for tracheostomy was prolonged ventilation due to Organophosphorus poisoning and Snake bite. The complication rate for tracheostomy procedure was 11.5%. The most common complication was tubal occlusion (7.5%) followed by Granulations around stoma (2.5%), Tracheal stenosis (1.25%), tracheoesophageal fistula (0.4%). No death was occurred during the tracheostomy procedure. The morbidity and mortality due to tracheostomy are reduced definitely. Tracheostomy Complications can be prevented by refined surgical techniques, use of high volume low pressure cuffed tracheostomy tubes and attentive post-operative nursing care. Yet complications of tracheomalacia and tracheal stenosis call for further improvement.

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Evaluation of Role of Mitomycin C in the Cases of Nasolacrimal Duct Blockage Undergoing Endoscopic Dacryocystorhinostomy

Abstract

Dacryocystorhinostomy is a common surgical procedure done for the treatment of obstruction of the lacrimal sac or nasolacrimal duct. Adjunctive use of a wound healing inhibitor like Mitomycin C is considered to minimize the risk of complications and increase the success rate of endoscopic endonasal DCR. The current study is aimed to compare the results of endoscopic DCR without silicon stents with or without Mitomycin C and to see for any complications resulting from the surgery. This was a prospective study carried out in the department of Otorhinolaryngology at Safdarjung Hospital, New Delhi from February 2015 to September 2017. Out of the 30 patients who were included in the study, 15 underwent endoscopic DCR without the application of Mitomycin C (Group I) and the remaining 15 with application of Mitomycin C without using stents (Group II). The main criteria for success were the resolution of epiphora and patency on lacrimal irrigation. Success rate in Group I was 86.67% as compared to Group II where the success rate was 93.33%. There were two failures in Group I (13.33%) whereas one failure in Group II (6.66%). More complications were noted in Group I (granulations 13.33%, synechiae 13.33%, persistent epiphora 13.33%) than in Group II (granulations 13.33%, synechiae 6.67%, persistent epiphora 6.67%). To conclude, we have found topical Mitomycin C as a safe and effective means of preventing adhesions and ostium closures in patients undergoing endoscopic DCR.

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A novel diindolylmethane analog, 1,1-bis(3’-indolyl)-1-(p-chlorophenyl) methane, inhibits the tumor necrosis factor-induced inflammatory response in primary murine synovial fibroblasts through a Nurr1-dependent mechanism

Publication date: September 2018
Source:Molecular Immunology, Volume 101
Author(s): Maryam F. Afzali, Katriana A. Popichak, Lindsey H. Burton, Anna L. Klochak, William J. Wilson, Stephen Safe, Ronald B. Tjalkens, Marie E. Legare
The progression of rheumatoid arthritis involves the thickening of the synovial lining due to the proliferation of fibroblast-like synoviocytes (FLS) and infiltration by inflammatory cells. Tumor necrosis factor alpha (TNFα) is a pro-inflammatory cytokine involved in progression of the disease. Under rheumatoid conditions, FLS express the tumor necrosis factor (TNF)-recognition complex (TNFR1, TNFR2, VCAM-1 and ICAM-1), which induces local macrophage activation and leads to downstream nuclear factor κB (NF-κB) signaling. The NF-κB-regulated inflammatory gene, cyclooxygenase (COX), increases synthesis of prostaglandins that contribute to the propagation of inflammatory damage within the joint. Because the nuclear orphan receptor, NR4A2 (Nurr1), can negatively regulate NF-κB-dependent inflammatory gene expression in macrophages, we postulated that activation of this receptor by the Nurr1 ligand 1,1-bis(3'-indolyl)-1-(p-chlorophenyl) methane (C-DIM12) would modulate inflammatory gene expression in synovial fibroblasts by inhibiting NF-κB. Treatment with C-DIM12 suppressed TNFα-induced expression of adhesion molecules and NF-κB regulated genes in primary synovial fibroblasts including vascular adhesion molecule 1 (VCAM-1), PGE2 and COX-2. Immunofluorescence studies indicated that C-DIM12 did not prevent translocation of p65 and stabilized nuclear localization of Nurr1 in synovial fibroblasts. Knockdown of Nurr1 expression by RNA interference prevented the inhibitory effects of C-DIM12 on inflammatory gene expression, indicating that the anti-inflammatory effects of this compound are Nurr1-dependent. Collectively, these data suggest that this receptor may be a viable therapeutic target in RA.



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Preparation and Application of a Monoclonal Antibody Against Chicken TRIM62

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.


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Generation of Rat Monoclonal Antibodies Specific for DZIP3

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.


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The Common Clinical Presentation of Patients Selected for Septoplasty in Northern Saudi Arabia

Background. Nasal septal deviation (NSD) plays a critical role in nasal obstruction symptoms, aesthetic look of the nose, increased nasal resistance, and occasionally snoring. Septoplasty is the most common method for correction of deviated nasal septum (DNS). Therefore, the aim of the present study was to assess the association between initial clinical presentations of patients selected for septoplasty and demographical characteristics in Northern Saudi Arabia. Methodology. Archives related to all patients selected for septoplasty between 2012 and 2017 were retrieved from ENT Department at King Khalid Hospital in Hail, Northern Saudi Arabia. Only adults over 18 years of age were included in this study. Results. With regard to the clinical presentations, almost all patients presented with variable degrees of nasal congestions, nasal blockages, breathing troubles, sleeping troubles, and exercise problems. Conclusion. Nasal obstruction is prevalent in Northern Saudi Arabia with peaks being in the years 2016 and 2014 with the most etiological factor being DNS.

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Combining Autologous Bone Marrow Mononuclear Cells seeded on Collagen sponge with Nano Hydroxyapatite, and Platelet-rich Fibrin: Reporting a Novel Strategy for Alveolar Cleft Bone Regeneration

The aim of this study was to examine and assess the use of autologous bone marrow mononuclear cells (BMMNCs) combined with platelet-rich fibrin (PRF) and nanohydroxyapatite for bone regeneration as an effective technique for alveolar cleft repair.

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Thromboelastometry-guided hemostatic therapy for hemorrhagic shock in the postoperative period of vascular surgery: a case report

Hemorrhagic shock is a medical emergency that often complicates vascular surgery and can lead to death. Hemorrhagic shock is characterized by hypoperfusion and hemodynamic abnormalities leading to the collapse...

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Japanese translation, cross-cultural adaption and multicentre validation of the Zurich chronic middle ear inventory (ZCMEI-21-Jap)

In the assessment of chronic otitis media (COM) and its treatment, patient-reported outcomes are becoming increasingly important. The aim of the present study was to translate and validate the Zurich chronic middle ear inventory (ZCMEI-21) in Japanese in order to provide the first Japanese-language instrument for measuring health-related quality of life (HRQoL) in COM.

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Maxillomandibular advancement is a successful treatment for obstructive sleep apnoea: a systematic review and meta-analysis

The primary objective of this review was to establish the effectiveness of maxillomandibular advancement (MMA) as a successful treatment modality in improving airway patency in patients with obstructive sleep apnoea (OSA). A systematic and detailed search was performed using PubMed Central, covering the period January 2000 to December 2015, with well-defined selection criteria. The authors independently conducted the study selection, data extraction, and assessed the risk of bias of the included studies.

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Japanese translation, cross-cultural adaption and multicentre validation of the Zurich chronic middle ear inventory (ZCMEI-21-Jap)

Publication date: Available online 2 June 2018
Source:Auris Nasus Larynx
Author(s): David Bächinger, Daiki Takagi, Hiroyuki Yamada, Masato Teraoka, Masahiro Okada, Jun Hyodo, Christof Röösli, Alexander M. Huber, Naohito Hato
ObjectiveIn the assessment of chronic otitis media (COM) and its treatment, patient-reported outcomes are becoming increasingly important. The aim of the present study was to translate and validate the Zurich chronic middle ear inventory (ZCMEI-21) in Japanese in order to provide the first Japanese-language instrument for measuring health-related quality of life (HRQoL) in COM.MethodsThe ZCMEI-21 was translated into Japanese according to published guidelines. In order to assess validity, the ZCMEI-21-Jap total score was compared to a question directly addressing HRQoL as well as the five-level version of the EQ-5D questionnaire, a generic measure of HRQoL.ResultsDemographic data and validity were assessed in a total of 91 COM patients. The ZCMEI-21-Jap total and subscale scores were well comparable to those of the original validation study. Cronbach's α of the ZCMEI-21-Jap was 0.85, indicating an excellent internal consistency. The ZCMEI-21-Jap total score showed a strong correlation (r=0.68, p<0.0001) to the question directly addressing HRQoL and, as expected, only a moderate correlation to the EQ-5D scores (r=0.49, p<0.0001 for descriptive system score and r=0.44, p<0.0001 for VAS score).ConclusionWe successfully translated the ZCMEI-21 into Japanese and were able to obtain sufficient information during the validation process for the use of the ZCMEI-21-Jap to quantify HRQoL in patients with COM. With the current study, we aim to take a step forward towards an international standardization of reporting HRQoL in COM.



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In vitro comparison of an Er:YAG laser-activated bleaching system with different light-activated bleaching systems for color change, surface roughness, and enamel bond strength

Abstract

To compare an Er:YAG laser-activated bleaching system with different light-activated in-office bleaching systems for color change, surface roughness, and post-bleaching enamel bond strength. 51 enamel slabs were prepared from the sound buccal enamel of extracted bovine teeth. The teeth were randomly divided into three groups according to different light-activated office bleaching systems (n = 17): diode laser (Epic, Biolase) (940 nm, 7 W, continuous mode), Er:YAG laser (LightWalker, Fotona) (2940 nm, 50 mJ, 10 Hz, 1000 μs), and LED (Radii Plus) (440–480 nm, 1500 mW/cm²). All systems were used with their compatible bleaching agents according to manufacturers' recommendations. The tooth color and surface roughness (Ra) were assessed at baseline and after bleaching using a spectrophotometer and a surface profilometer, respectively. The color change was determined by the CIE L*a*b* system (ΔE, ΔL*, Δa*, Δb*). Kruskal-Wallis test was used for color change whereas Kruskal-Wallis and Wilcoxon tests were used to analyze the roughness data. For shear bond strength test (SBS), composite cylinders were bonded on bleached enamel samples 14 days after bleaching procedures and stored in water (37 °C). Specimens were then debonded with a universal testing machine at 1 mm/min and data were analyzed by using Kruskal-Wallis test. All the tested bleaching systems were effective on color change (ΔE > 3.3) and produced similar color change (p > 0.05). There were no significant differences among the Ra values of the groups neither at baseline nor after bleaching (p > 0.05). However, comparing the baseline and after bleaching Ra values, a significant increase was observed for all tested groups (p < 0.05). Significant differences were also found among all systems for SBS (p < 0.05). The highest values were obtained in Er:YAG group, whereas the LED group revealed the lowest values (p < 0.05). All tested bleaching systems were effective on tooth whitening, whereas they all led to an increase on surface roughness. Although the current Er:YAG laser-activated bleaching system did not differ from other tested bleaching systems according to color change and surface roughness, it appears to provide better results in terms of SBS.

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Near infrared laser irradiation induces NETosis via oxidative stress and autophagy

Abstract

NETosis is a novel immune defense strategy in which neutrophil activation results in the formation of extracellular DNA/protein network which is able to kill microbial populations. NETosis can be induced in vitro by lipopolysaccharide (LPS) or phorbol myristate acetate (PMA). Due to the importance of NETosis in different physiological and pathological processes, photobiostimulation effect on this neutrophil activation mechanism has been investigated. Human granulocytes, isolated from venous blood of healthy donors, were stimulated with a diode laser emitting at 980 nm with an energy intensity ranging from 0 to 75 joules. After 3 h of laser stimulation, granulocytes were fixed and colored with crystal violet in order to assess the NETosis morphology while extracellular DNA produced has been quantified using Sytox Green fluorescent dye. To evaluate ROS production and autophagy role in photobiostimulation-induced NETosis, granulocytes were pre-treated with ROS scavengers (vitamin C, sodium pyruvate, l-NAME, sodium azide), and an autophagy inhibitor (wortmannin). Laser stimulation induced an energy-dependent neutrophil extracellular trap (NET) production in human granulocytes starting from 50-J laser intensity. ROS scavengers and the autophagy inhibitor were able to abrogate both morphological features of NETosis and extracellular DNA production without modifying the basal level of NETosis. Photobiostimulation induced an increase in NET production due to an increase in ROS levels and autophagy activation.

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Prognostic role of resection margin in open oncologic laryngeal surgery: survival analysis of a cohort of 139 patients affected by squamous cell carcinoma

Publication date: Available online 2 June 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Carmelo Saraniti, Riccardo Speciale, Salvatore Gallina, Pietro Salvago
IntroductionThe treatment of laryngeal squamous cell carcinoma needs accurate risk stratification, in order to choose the most suitable therapy. The prognostic significance of resection margin is still highly debated, considering the contradictory results obtained in several studies regarding the survival rate of patients with a positive resection margin.ObjectiveTo evaluate the prognostic role of resection margin in terms of survival and risk of recurrence of primary tumour through survival analysis.MethodsBetween 2007 and 2014, 139 patients affected by laryngeal squamous cell carcinoma underwent partial or total laryngectomy and were followed for mean of 59.44±28.65 months. Resection margin status and other variables such as sex, age, tumour grading, pT, pN, surgical technique adopted, and post-operative radio- and/or chemotherapy were investigated as prognostic factors.Results45.32% of patients underwent total laryngectomy, while the remaining subjects in the cohort underwent partial laryngectomy. Resection margins in 73.39% of samples were free of disease, while in 21 patients (15.1%) anatomo-pathological evaluation found one of the margins to be close; in 16 subjects (11.51%) an involved resection margin was found. Only 6 patients (4.31%) had a recurrence, which occurred in 83.33% of these patients within the first year of follow-up. Disease specific survival was 99.24% after 1 year, 92.4% after 3 years, and 85.91% at 5 years. The multivariate analysis of all covariates showed an increased mortality rate only with regard to Pn (HR=5.043; p=0.015) and recurrence (HR=11.586; p=0.012). Resection margin did not result an independent predictor (HR=0.757; p=0.653).ConclusionsOur study did not recognize resection margin as an independent prognostic factor; most previously published papers lack unanimous, methodological choices, and the cohorts of patients analyzed are not easy to compare. To reach a unanimous agreement regarding the prognostic value of resection margins, it would be necessary to carry out meta-analyses on studies sharing definition of resection margin, methodology and post-operative therapeutic choices.



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Prevalence, prognosis, and treatment implications of retropharyngeal nodes in unknown primary head and neck carcinoma

Publication date: July 2018
Source:Oral Oncology, Volume 82
Author(s): Gilad Horowitz, Ali Hosni, Eugene Yu, Wei Xu, Lin Lu, Michael Au, Peter R. Dixon, Dale Brown, Douglas B. Chepeha, Ralph W. Gilbert, David P. Goldstein, Patrick J. Gullane, Jonathan C. Irish, Andrew Bayley, John Cho, Meredith Giuliani, Shao Hui Huang, Andrew Hope, John Kim, Brian O'Sullivan, Jolie Ringash, John Waldron, Ilan Weinreb, Bayardo Perez-Ordonez, Scott V. Bratman, John R. de Almeida
Objective(1) To estimate the prevalence of radiographically positive Retro-Pharyngeal Lymph Nodes (RPLN) in unknown primary carcinoma of the head and neck and (2) to determine the prognostic implications of radiographically positive RPLN and other radiographic features (3) to identify patients at low risk for retropharyngeal metastasis.Materials and methodsThe medical records of all 68 eligible patients treated at the Princess Margaret Cancer Centre between 2000 and 2014 were retrospectively reviewed for demographic, clinical, pathologic, and radiologic data. Radiologic data included: RPLN, extra capsular spread (ECS), neck staging and cystic/necrotic or matted neck nodes. LRR, DR, DFS and OS were estimated using the competing risk methods and the Kaplan-Meier method.ResultsSeven patients had concerning RPLN (10.3%). Forty-four patients were p16 positive (65%). RPLN status did not have any effect on LRR, DFS, DR and OS. Radiological ECS and p16 (neg.) status were found to be significant predictors of LRR (p = 0.023; p = 0.014). Matted nodes, radiological ECS and p16 (neg.) status were found to be significant predictors of DFS (p = 0.012; p < 0.001; p = 0.014). Matted nodes and radiological ECS were found to be significant predictors of OS (p = 0.017; p = 0.0036). Only radiological ECS was found to be a significant predictor of distant recurrence (p = 0.0066).Conclusions10% of CUP patients will harbor radiological positive RPLN. A large proportion of CUP patients are positive for p16. Radiologic features such as ECS and matted nodes can predict worse outcomes.



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HEY1 is expressed independent of NOTCH1 and is associated with poor prognosis in head and neck squamous cell carcinoma

Publication date: July 2018
Source:Oral Oncology, Volume 82
Author(s): Eleni M. Rettig, Justin A. Bishop, Nishant Agrawal, Christine H. Chung, Rajni Sharma, Fernando Zamuner, Ryan J. Li, Wayne M. Koch, Joseph A. Califano, Theresa Guo, Daria A. Gaykalova, Carole Fakhry
ObjectivesNotch signaling is frequently altered in head and neck squamous cell carcinoma (HNSCC). However, the nature and clinical implications of this dysregulation are not well understood. We previously described an association of transcriptionally active NOTCH1 Intracellular Domain (NICD1) immunohistochemical (IHC) expression pattern with high-risk pathologic characteristics. Here we further characterize Notch signaling in HNSCC.Materials and methodsIHC expression patterns and clinicopathologic associations of Notch pathway molecules were evaluated among 78 tumors with known NOTCH1 mutation status. IHC was performed for JAG1, a NOTCH1 activating ligand, and HEY1, an NICD1 transcriptional target and Notch pathway activation marker. IHC pattern and H-score (% staining × intensity) were recorded and compared to clinicopathologic characteristics and survival. Survival was analyzed using Kaplan Meier method and Cox proportional hazards models (HR).ResultsJAG1 and NICD1 expression patterns were highly concordant among tumors without truncating NOTCH1 mutations (p < 0.001), but were dissimilar among tumors with truncating NOTCH1 mutations (p = 0.24). There was evidence for JAG1-independent NOTCH1 activation among seven tumors, all with wild-type NOTCH1. HEY1 expression was associated with neither JAG1 nor NICD1 expression, but was associated with NOTCH1 mutation status (p = 0.03). Twelve (16%) tumors expressed HEY1 but not NICD1. Higher HEY1 H-score was significantly associated with worse overall (adjusted hazard ratio [aHR] 2.0, 95% CI = 1.0–4.2) and disease-specific (aHR = 3.3, 95% CI = 1.4–7.9) survival, whereas JAG1 and NICD1 expression were not associated with survival.ConclusionsThese findings suggest both NOTCH1-dependent and -independent HEY1 regulation, and imply a previously unrecognized prognostic role for HEY1 in HNSCC.



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Investigation of the surgical strategies for unilateral multifocal cystadenolymphomas of the parotid gland

Publication date: July 2018
Source:Oral Oncology, Volume 82
Author(s): Konstantinos Mantsopoulos, Michael Koch, Miguel Goncalves, Heinrich Iro
ObjectivesThe aim of the study was to compare multifocal extracapsular dissection with complete parotidectomy in the treatment of unilateral multifocal cystadenolymphomas of the parotid gland.Materials and methodsThe records from all patients treated for unilateral multifocal cystadenolymphomas of the parotid gland at a tertiary referral center between 2000 and 2016 were retrospectively analyzed.Results203 patients were included in the study. 96 patients were managed by multifocal extracapsular dissection, 107 patients underwent complete parotidectomy. Metachronous tumors were detected in 7 cases (3.4%) with a significant difference in the occurrence rate between multifocal extracapsular dissection (7/96, 7.3%) and complete parotidectomy (0/107, 0%) (p = 0.004). Permanent facial palsy was significantly more common after complete parotidectomy (21/107, 19.6%) than multifocal extracapsular dissection (2/96, 2.1%) (p = 0.000).ConclusionsThe functional benefit of multifocal extracapsular dissection was counterbalanced by the advantage of complete parotidectomy, in terms of recurrences. Extracapsular dissection is at its limit in cases of multifocal cystadenolymphomas and the indication for it should be thoroughly verified in each and every case.



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