Lamb larynx model for training in endoscopic and CO 2 laser-assisted surgeries for benign laryngotracheal obstructions

Abstract

Purpose

With adequate indication and meticulous execution, endoscopic procedures can efficiently treat a subset of adult and pediatric benign laryngotracheal stenosis and obstructions, but these procedures are precise and very demanding. The difference between a successful and a failed surgery, with potentially debilitating side effects, resides in small details. The learning curve is long and very few centers worldwide have a sufficient case load making adequate training difficult. While indications and concepts of endoscopic procedures can be learned in books and by observing trained colleagues, the dexterity and the precise realization need to be practiced, ideally not initially on patients.

Methods

We describe here the lamb model system for the initial training in such procedures. We provide a step-by-step guide for endoscopic approaches intended to treat pathologies such as laryngomalacia, bilateral vocal fold paralysis, posterior glottic stenosis, and laryngotracheal clefts.

Conclusions

The lamb model system does not pose ethical issues, and it is easy to obtain and to handle. It was used during an international training course for laryngotracheal stenosis by novice and advanced airway surgeons. It was unanimously judged as relevant and useful by the participants.

https://ift.tt/2xGkFn0

Orbital infections: a complete cycle 7-year audit and a management guideline

Abstract

Objectives

Orbital infections are regularly encountered and are managed by various healthcare disciplines. Sepsis of the orbit and adjacent tissues can be associated with considerable acute complication and long-term sequelae. Therefore, prompt recognition and management of this condition are crucial. This article presents the outcomes of a 7-year complete cycle audit project and describes the development of the new local guideline on the management of orbital infections in our tertiary centre.

Methods

(1) A retrospective 5-year audit cycle on patients with orbital infections. (2) A review of available evidence on the management of orbital infections. (3) A new local multidisciplinary guideline on the management of orbital infections. (4) A retrospective 2-year second audit cycle to assess the clinical outcomes.

Results

Various disciplines intersect in the management of orbital infections. Standardising the management of this condition proved to be achievable through the developed guideline. However, room for improvement in practice exists in areas such as the promptness in referring patients to specialist care, the multidisciplinary assessment of patients on admission, and the improvement of scanning requests of patients.

https://ift.tt/2LYE59B

Gold nanorod-assisted near-infrared stimulation of bullfrog sciatic nerve

Abstract

Infrared neural stimulation (INS) is a new and developing approach for neural repair, with the advantages of being non-contact, spatially precise, and artifact-free. However, the disadvantage of infrared light is that it is difficult to stimulate deep tissue because of its weak penetrating power. Therefore, this paper introduces an improved method using near-infrared laser to stimulate bullfrog sciatic nerves because of its strong penetrating power. Meanwhile, gold nanorods (Au NRs) are injected into the nerve to increase the absorption of light. The mechanism is the instantaneous temperature rise caused by the absorption of infrared light by Au NRs. The compound muscle action potential (CMAP) associated with the irradiated sciatic nerve is recorded by a multi-channel physiological signal instrument. The peak to peak amplitude (V_pp) of CMAP for sciatic nerves injected with Au NRs increases significantly compared to the CMAP for control nerves without Au NRs. These results demonstrate INS by labeling nerves with nanoparticle exhibiting latent capacity to increase the efficiency, spatial resolution, and the neural responsivity, and especially, can increase the penetration depth and reduce the requisite radiant exposure level.

https://ift.tt/2JcYtly

Raman spectral feature selection using ant colony optimization for breast cancer diagnosis

Abstract

Pathology as a common diagnostic test of cancer is an invasive, time-consuming, and partially subjective method. Therefore, optical techniques, especially Raman spectroscopy, have attracted the attention of cancer diagnosis researchers. However, as Raman spectra contain numerous peaks involved in molecular bounds of the sample, finding the best features related to cancerous changes can improve the accuracy of diagnosis in this method. The present research attempted to improve the power of Raman-based cancer diagnosis by finding the best Raman features using the ACO algorithm. In the present research, 49 spectra were measured from normal, benign, and cancerous breast tissue samples using a 785-nm micro-Raman system. After preprocessing for removal of noise and background fluorescence, the intensity of 12 important Raman bands of the biological samples was extracted as features of each spectrum. Then, the ACO algorithm was applied to find the optimum features for diagnosis. As the results demonstrated, by selecting five features, the classification accuracy of the normal, benign, and cancerous groups increased by 14% and reached 87.7%. ACO feature selection can improve the diagnostic accuracy of Raman-based diagnostic models. In the present study, features corresponding to ν(C–C) αhelix proline, valine (910–940), νs(C–C) skeletal lipids (1110–1130), and δ(CH2)/δ(CH3) proteins (1445–1460) were selected as the best features in cancer diagnosis.

https://ift.tt/2LXqPSv

Marginal quality of ceramic inlays after three different instrumental cavity preparation methods of the proximal boxes

Abstract

Objectives

The marginal quality of ceramic inlays was evaluated after the use of three different instrumental finishing methods in mesio-occluso-distal (mod) cavity boxes in vitro after hydrothermal loading (HTL).

Materials and methods

Caries-free human molars were divided into three groups. Mod-cavities were conventionally prepared. Box finishing was performed in every group with rotating (RI), sonic (SI), or ultrasonic (USI) instruments. Surface roughness was examined. Twelve mod-cavities remained untreated. Continuous margin quality was evaluated with scanning electron microscopy (SEM). Ceramic inlays were cemented into cavities. After HTL microleakage, marginal and absolute marginal gaps were examined. All data were analyzed statistically.

Results

Significant differences were found, between cavity surface roughness of RI and SI groups, the RI and USI groups, but not between microleakage, marginal, absolute marginal gaps after HTL and in proximal marginal quality. No correlations between microleakage and marginal gaps nor between microleakage and surface roughness were found.

Conclusion

Mod-cavity proximal box finishing with SI or USI resulted in a higher surface roughness than the use of RI. The type of the finishing method did not influence the marginal quality of ceramic inlays. For the mod-cavity finishing, the use of SI and USI could be an alternative instrumental method to conventional RI methods with a lower risk of iatrogenic damage of the adjacent teeth.

Clinical relevance

This study allows the practitioner to better determine the proper indications and limitations of the sonic and ultrasonic instruments for mod-cavity proximal box finishing.

https://ift.tt/2xI8VQU

Accelerated subcutaneous nodulosis in patients with rheumatoid arthritis treated with tocilizumab: a case series

Tocilizumab is a monoclonal antibody directed against the interleukin-6 receptor, which is approved for the treatment of moderate-to-severe rheumatoid arthritis. Authors have found that it prevents lung and su...

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Complexity, Variation, and the Ever-moving Cheese

No abstract available

https://ift.tt/2xBk6uo

The 2018 AAAAI Foundation Faculty Development Awardees

Publication date: Available online 2 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Zuhair K. Ballas




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The use of honey in cochlear implant associated wounds in pediatric patients

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Anya Costeloe, Nathan Douglas Vandjelovic, Michel Anthony Evans, Sonal S. Saraiya
IntroductionThe use of honey in wound care is becoming more common due to the proven benefit in all three phases of wound healing, as well as the antibacterial and antibiofilm properties. We present our experience using TheraHoney gel, a medical grade honey, for the successful treatment of cochlear implant associated skin breakdown.ObjectiveTo describe the role of TheraHoney gel in the management of cutaneous infection and ulceration associated with cochlear implants.MethodsThree cases of wounds treated traditionally with antibiotics, plus the addition of TheraHoney, were retrospectively reviewed. The first patient had a superficial 1 × 1 cm ulcer, the second patient had bilateral ulcers: one superficial 1.5 × 1.5 cm ulcer and the other a 1.5 × 2 cm stage III pressure ulcer with an exposed receiver stimulator, and the third patient with a 3 × 3.5 cm stage III ulcer with an exposed receiver stimulator.ResultsWith the addition of TheraHoney gel, complete wound closure was achieved at all three patients without the need for surgical reconstruction.ConclusionCutaneous infection with or without skin breakdown is a common delayed complication after cochlear implantation. We demonstrate the efficacy of adding medical grade honey in promoting healing in infected scalp pressure ulcers overlying the cochlear implant site.



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Metabolic signature of squamous cell carcinoma of the head and neck: Consequences of TP53 mutation and therapeutic perspectives

Publication date: August 2018
Source:Oral Oncology, Volume 83
Author(s): Mark D. Wilkie, Andrew S. Lau, Nikolina Vlatkovic, Terence M. Jones, Mark T. Boyd
There is a pressing need to identify ways of sensitising squamous cell carcinomas of the head and neck (SCCHN) to the effects of current treatments, both from oncological and functional perspectives. Alteration to cellular metabolism is now widely considered a hallmark of the cancer phenotype; presents a potentially attractive therapeutic target in this regard; and as such has received renewed research interest in recent years. However, whilst metabolic disruption may occur to some degree in all tumours, there is undoubtedly heterogeneity and detailed study of individual tumour types is paramount if effective therapeutic strategies targeting metabolism are to be developed and effectively deployed. In this review we outline current understanding of altered tumour metabolism and how these adaptations promote tumorigenesis generally. We relate this specifically to SCCHN by focusing on several recent key studies specific to SCCHN, and by discussing the role TP53 mutation may play in this metabolic switch, given the fundamental role of this oncogenic event in SCCHN tumorigenesis. Finally, we also offer insight into the potential therapeutic implications this may have in the clinical setting and make recommendations for future study.



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