ACR Appropriateness Criteria® Head Trauma: 2021 Update

xlomafota13 shared this article with you from Inoreader ACR Appropriateness Criteria® Head Trauma: 2021 Update Via leak of cerebrospinal fluid J Am Coll Radiol. 2021 May;18(5S):S13-S36. doi: 10.1016/j.jacr.2021.01.006. ABSTRACT Head trauma (ie, head injury) is a significant public health concern and is a leading cause of morbidity and mortality in children and young adults. Neuroimaging plays an important role in the management of head and brain injury, which can be separated into acute (0-7 days), subacute (<3 months), then chronic (>3 months) phases. Over 75% of acute head trauma is classified as mild, of which over 75% have a normal Glasgow Coma Scale score of 15, therefore clinical practice guidelines universally recommend selective CT scanning in this patient population, which is often based on clinical decision rules. While CT is considered the first-line imaging modality for suspected intracranial injury, MRI is useful when there are persistent neurologic deficits that remain unexplained after CT, especially in the subacute or chronic phase. Regardless of time frame, he ad trauma with suspected vascular injury or suspected cerebrospinal fluid leak should also be evaluated with CT angiography or thin-section CT imaging of the skull base, respectively. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. PMID:33958108 | DOI:10.1016/j.jacr.2021.01.006 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Tension pneumoventricle: Reversible cause for aphasia

xlomafota13 shared this article with you from Inoreader Tension pneumoventricle: Reversible cause for aphasia Via leak of cerebrospinal fluid Qatar Med J. 2021 Apr 23;2021(1):15. doi: 10.5339/qmj.2021.15. eCollection 2021. ABSTRACT Pneumocephalus is air in the cranium commonly seen in postcraniotomy and in head injury patients. When this air causes an increase in intracranial pressure leading to neurological deterioration, it is called tension pneumocephalus. Similarly, intraventricular air causing compression on vital centers and increasing intracranial pressure is called tension pneumoventricle, and this causes expressive aphasia, which is rarely described in the literature. This study reported a case of a traumatic cerebrospinal fluid (CSF) leak leading to tension pneumoventricle and aphasia. Case: A young male patient sustained severe head injury and had extradural hematoma (EDH) and multiple skull and skull base fractures. EDH was drained, and he recovered and was discharged with a Glasgow coma scale score of 15. He presented to neurosurgical outpatient with CSF leak, aphasia, and loss of bowel and bladder control for a duration of three days. Computed tomography brain scan showed tension pneumoventricles, and he was started on conservative management. His general condition deteriorated, and the next day, his pupils became unequal, and Glasgow coma scale (GCS) dropped to 8/15. He was immediately taken to theater, and the air was aspirated from the ventricles, and an external ventricular drain was inserted. The patient woke up in the immediate postoperative period and started talking normally by day four. Conclusion: Tension pneumoventricles should be considered a cause of aphasia. Immediate intervention and reduction of intracranial pressure are crucial to reverse neurological abnormality and improve patient's outcome. PMID:33959489 | PMC:PMC8067619 | DOI:10.5339/qmj.2021.15 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Increased risk of secondary lung cancer in patients with tuberculosis: A nationwide, population-based cohort study

xlomafota13 shared this article with you from Inoreader Increased risk of secondary lung cancer in patients with tuberculosis: A nationwide, population-based cohort study Via Head and neck cancers by Li-Ju Ho, Hung-Yi Yang, Chi-Hsiang Chung, Wei-Chin Chang, Sung-Sen Yang, Chien-An Sun, Wu-Chien Chien, Ruei-Yu Su Background Tuberculosis (TB) presents a global threat in the world and the lung is the frequent site of metastatic focus. A previous study demonstrated that TB might increase primary lung cancer risk by two-fold for more than 20 years after the TB diagnosis. However, no large-scale study has evaluated the risk of TB and secondary lung cancer. Thus, we evaluated the risk of secondary lung cancer in patients with or without tuberculosis (TB) using a nationwide population-based dataset. Methods In a cohort study of 1,936,512 individuals, we selected 6934 patients among patients with primary cancer and TB infection, based on the International Classification of Disease (ICD-p-CM) codes 010–011 from 2000 to 2015. The control cohort comprised 13,868 randomly selected, propensity-matched patients (by age, gender, and index date) without TB exposure. Using this adjusted date, a possible association between TB and the risk of developing secondary lung cancer was estimated using a C ox proportional hazards regression model. Results During the follow-up period, secondary lung cancer was diagnosed in 761 (10.97%) patients with TB and 1263 (9.11%) patients without TB. After adjusting for covariates, the risk of secondary lung cancer was 1.67 times greater among primary cancer in the cohort with TB than in the cohort without TB. Stratification revealed that every comorbidity (including diabetes, hypertension, cirrhosis, congestive heart failure, cardiovascular accident, chronic kidney disease, chronic obstructive pulmonary disease) significantly increased the risk of secondary lung cancer when comparing the TB cohort with the non-TB cohort. Moreover, the primary cancer types (including head and neck, colorectal cancer, soft tissue sarcoma, breast, kidney, and thyroid cancer) had a more significant risk of becoming secondary lung cancer. Conclusion A significant association exists between TB and the subsequent risk for metastasis among primary cancers and comorbidities. Therefore, TB patients should be evaluated for the subsequent risk of secondary lung cancer. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

One-Year Adherence to Continuous Positive Airway Pressure With Telemonitoring in Sleep Apnea Hypopnea Syndrome: A Randomized Controlled Trial

xlomafota13 shared this article with you from Inoreader One-Year Adherence to Continuous Positive Airway Pressure With Telemonitoring in Sleep Apnea Hypopnea Syndrome: A Randomized Controlled Trial Via Laryngologie Front Med (Lausanne). 2021 Apr 20;8:626361. doi: 10.3389/fmed.2021.626361. eCollection 2021. ABSTRACT Study Objective: Telemedicine (TM) for continuous positive airway pressure (CPAP) treated patients may save health-care resources without compromising treatment effectiveness. We assessed the effect of TM (AirView Online System, ResMed) during the CPAP habituation phase on 3-month and 1-year treatment adherence and efficacy in patients with moderate-to-severe obstructive sleep apnea (OSA). Methods: At CPAP initiation, 120 patients diagnosed with OSA were randomized to either usual care (UC) or TM during the habituation phase (clinical registration: ISRCTN12865936). Both groups received a first face-to-face appointment with a sleep care giver at CPAP initiation. Within the following month, 2 other physical visits were scheduled in the UC group whereas two phone consultations were planned in the TM group, in which CPAP parameters were remotely adapted. Additional physical visits were programmed at the patient's request. Face-to-face consultations were scheduled at 3 and 12 months after CPAP initiation. The primary outcome was the mean CPAP daily use over the course of 12 months. Results: Twenty of 60 patients stopped CPAP therapy in the UC group vs. 14 of 60 in the TM group (p = 0.24). In per protocol analysis, mean [95% CI] daily CPAP use among 86 patients still using CPAP at 12 months was 279 [237; 321] min in the 38 patients on UC and 279 [247; 311] min in the 43 patients on TM, mean difference [95% CI]: 0 [-52; 52] min, P = 0.99. Total consultation time per patient was not different between groups, TM: 163 [147; 178] min, UC: 178 [159; 197] min, difference: -15 [-39; 9] min, p = 0.22. Conclusions: Telemedicine during the CPAP habituation phase did not alter daily CPAP use or treatment adherence and did not require more healthcare time. Telemedicine may support clinic at tendance for CPAP titration. Clinical Trial Registration: [ISRCTN], identifier [ISRCTN12865936]. PMID:33959620 | PMC:PMC8093813 | DOI:10.3389/fmed.2021.626361 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intra-dural intercommunications between dorsal roots of adjacent spinal nerves and their clinical significance

xlomafota13 shared this article with you from Inoreader Intra-dural intercommunications between dorsal roots of adjacent spinal nerves and their clinical significance Via radiol anat Surg Radiol Anat. 2021 May 7. doi: 10.1007/s00276-021-02761-2. Online ahead of print. ABSTRACT PURPOSE: The dorsal roots of adjacent spinal nerves are known to communicate with each other through rami communicantes. These intercommunications can cause deviations in the normal dermatomal organization which leads to errors during clinical decision-making. The objective of the study was to augment the existing knowledge of these communications which shall help minimize the diagn ostic and therapeutic errors. METHODS: The present study examined thirty cadaveric spinal cord specimens to document the data of intra-dural, intercommunications between dorsal roots of adjacent spinal nerves. RESULTS: All the regions of the spinal cord exhibited the presence of intercommunications with variable frequency. The intercommunications were categorized into a total of nine groups based on their patterns. The levels of spinal cord exhibiting higher and lower frequencies of intercommunications were identified. CONCLUSION: This information will be useful during the clinical evaluation of patients with spinal cord pathologies or radiculopathies. The outcomes of rhizotomy can also be improved with knowledge of intercommunications. PMID:33961081 | DOI:10.1007/s00276-021-02761-2 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

THIRVE in Foreign Body Bronchus Removal–A Novel Approach

xlomafota13 shared this article with you from Inoreader THIRVE in Foreign Body Bronchus Removal–A Novel Approach Via Otolaryngology Indian Abstract We prospectively studied novel anesthetic and surgical approach to foreign body bronchus removal using HHFNC (heated humidified high flow nasal cannula)/THRIVE technique(Transnasal Humidified Rapid-Insufflation ventilatory Exchange) in eleven cases. MacIntosh Laryngoscope was used to expose laryngeal inlet and FB was removed with an optical forcep (mounted over 2.7 mm rigid bronchoscope) without using ventilating bronchosocope. Total intravenous anaesthesia (TIVA) was given in all cases. FB was removed completely in all eleven cases. The average duration of procedure was 4.5 min. HHFNC improved the apnoea time with 6 min as maximum procedure time. Induction with Fentanyl, Intermittent Propofol injection and succinylcholine prevented excessive coughing, irritation, movement of the patient, vocal cords and posterior tracheal wall. Time management during this novel approach is crucial starting from removal of FB and check bronchoscopy. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Quality of Life and Morbidity after Endoscopic Endonasal Skull Base Surgeries Using the Sinonasal Outcomes Test (SNOT): A Tertiary Hospital Experience

xlomafota13 shared this article with you from Inoreader Quality of Life and Morbidity after Endoscopic Endonasal Skull Base Surgeries Using the Sinonasal Outcomes Test (SNOT): A Tertiary Hospital Experience Via International Journal of Otolaryngology Introduction. Endoscopic endonasal skull base surgery (EESBS) has been associated with a minimally invasive and effective approach for pathology of the anterior skull base and associated with less overall morbidity compared with open approaches. However, it is associated with its own potential morbidity related to surgical manipulation or resection of normal and noninflamed intranasal structures to gain adequate access. The assessment of sinonasal QOL (quality of life) postsurgery is therefore a vital aspect in follow-up of these patients. Objectives. To assess quality of life and morbidity after endoscopic endonasal skull base surgery using the Sinonasal Outcomes Test (SNOT-22). Methodology. A single-center retrospective cross-sectional review with a sample of 80–100 patients undergoing endoscopic endonasal transsphenoidal surgery was conducted at the ENT and Neurosurgery departments of King Fahad Specialist Hospital-Dammam (KFSH-D) for a period of 10 years from March 2010 to March 2020. Data were collected through hospital records and database, as well as from patients through phone call interviews. Records were reviewed for diagnosis, demographic features, and 22-item Sinonasal Outcomes Test (SNOT-22) scores noted at three points in time: prior to procedure and after, at 3 months and 6 months. Results. Within the study cohort comprising 96 patients, the mean age of the participants was 39.5 ± 12.1 years, and diagnostic typing before and after histopathological investigations revealed maximum pituitary adenomas (46.9%) closely followed by CSF-related ailments (41.7%). The changes in the mean and standard deviation of the total SNOT-22 scores postoperatively at the 3rd month (9.5 ± 5.4) and the 6th month (8.8 ± 5.2) were statistically significant () when compared to the preoperative score (10.8 ± 5.1). Conclusion. Although there was a predicted passivity of symptoms in the post-EESBS period, several significant positive outcomes were seen. The increase in discomfort in the sleep domains postsurgery is an issue to pursue and reason out. The overall SNOT-22 scores noted preoperatively and 3 and 6 months postoperatively showed statistically significant improvements in QOL with no long-term effects. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

IL-6 regulates the bone metabolism and inflammatory microenvironment in aging mice by inhibiting Setd7

xlomafota13 shared this article with you from Inoreader IL-6 regulates the bone metabolism and inflammatory microenvironment in aging mice by inhibiting Setd7 Via histochem Acta Histochem. 2021 May 4;123(5):151718. doi: 10.1016/j.acthis.2021.151718. Online ahead of print. ABSTRACT Aging, which has become a worldwide problem, leads to the degeneration of multiple organs and tissues. Two of the main changes in aging are dysregulation of the tissue microenvironment and abnormal functioning of specific stem cells. Bone marrow stem cells (BMSCs) in the aging microenvironment are not only effector cells but also immunomodulatory cells that change the microenvironment. IL-6 is a primary inflammatory response factor associated with bone diseases. In this study, we stimulated BMSCs with IL-6 to investigate a novel mechanism of age-related osteoporosis. IL-6 activated the TLR2, TLR4 and AKT pathway as well as inhibited the expression of β-catenin and Setd7. In addition, Setd7 expression in the bone tissues of aged mice was suppressed. Setd7 not only promoted BMSC osteogenic differentiation but also mediated proinflammatory gene expression in BMSCs under IL-6 stimulation. Due to its dual functions in BMSCs, Setd7 may be a novel molecular target for age-related osteoporosis prevention and treatment. PMID:33962150 | DOI:10.1016/j.acthis.2021.151718 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Expression and localization of FGFR1, FGFR2 and CTGF during normal human lung development

xlomafota13 shared this article with you from Inoreader Expression and localization of FGFR1, FGFR2 and CTGF during normal human lung development Via histochem Acta Histochem. 2021 May 4;123(5):151719. doi: 10.1016/j.acthis.2021.151719. Online ahead of print. ABSTRACT Aim of our study was to provide insight into the temporal and spatial expression of FGFR1, FGFR2 and CTGF during normal human lung development which may have an important impact on understanding occurrence of developmental lung anomalies. Morphological parameters were analysed using double immunofluorescence on human embryonal (6th and 7th developmental week-dw) and f oetal (8th, 9th and 16th developmental week) human lung samples. FGFR1 and FGFR2 was positive during all the dw in both the epithelium and mesenchyme. The highest number of FGFR1 positive cells was observed during the 6th dw (112/mm2) and 9th dw (87/mm2) in the epithelium compared to the 7th, 8th and 16th dw (Kruskal-Wallis test, p < 0.001, p < 0.0001). The highest number of FGFR1 positive cells in the mesenchyme was observed during the 8th dw (19/mm2) and 16th dw (13/mm2) compared to the 6th, 7th, and 9th dw (Kruskal-Wallis test, p < 0.001, p < 0.0001). The number of FGFR1 positive cells in the epithelium was higher for FGFR2 compared to number of positive cells (Mann-Whitney test, p < 0.0001). FGFR2 showed the highest number in the epithelium during the 7th dw (111/mm2) and 9th dw (87/mm2) compared to 6th, 8th and 16th dw (Kruskal-Wallis test, p < 0.001, p < 0.0001, p < 0.01 respectively). Th e highest number of FGFR2 positive cells in the mesenchyme was observed during the 9th dw (26/mm2), compared to the 6th, 7th,8th and 16th dw (Kruskal-Wallis test, p < 0.0001), while the number of FGFR2 positive cells in the epithelium was significantly higher than in the mesenchyme (Mann-Whitney test, p < 0.0001). CTGF was negative in both epithelium and mesenchyme during all except the 16th dw in the mesenchyme where it co-localized with FGFR2. FGFR1 and FGFR2 might be essential for epithelial-mesenchymal interactions that determine epithelial branching and mesenchymal growth during early lung development. Sudden increase in FGF1 in the epithelium and FGF2 in the mesenchyme in the foetus at 9th dw could be associated with the onset of foetal breathing movements. CTGF first appear during the foetal lung development. PMID:33962151 | DOI:10.1016/j.acthis.2021.151719 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Predicting survival in head and neck cancer: External validation and update of the prognostic model OncologIQ in 2189 patients

xlomafota13 shared this article with you from Inoreader Predicting survival in head and neck cancer: External validation and update of the prognostic model OncologIQ in 2189 patients Via Head & Neck Abstract Background Disclosing prognostic information is necessary to enable patients to make well‐informed treatment decisions. OncologIQ is a prognostic model that predicts the overall survival (OS) probability in patients with head and neck squamous cell carcinoma (HNSCC). We aimed to externally validate and update the model with new prognostic factors and translate it to a clinically useful tool. Methods A consecutive retrospective sample of 2189 patients eligible for curative treatment of a primary HNSCC were selected. Discriminative performance was determined using the C‐statistic. Results External validation showed systematic underestimation of OS in the new population, and reasonable discrimination (C‐statistic 0.67). Adding smoking, pack years, BMI, weight loss, WHO performance, socioeconomic status, and p16 positivity to the recalibrated multivariable model, improved the internally validated C‐statistic to 0.71. The model showed minor optimism and was translated in an online tool (www.oncologiq.nl). Conclusions The updated model enables personalized patient counseling during treatment decision consultations. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Maxillectomy defects: Virtually comparing fibular and scapular free flap reconstructions

xlomafota13 shared this article with you from Inoreader Maxillectomy defects: Virtually comparing fibular and scapular free flap reconstructions Via Head & Neck Abstract Background This study virtually compares patient‐specific fibular and scapular reconstructions for maxillectomies. Methods Nine maxillectomy defects were created on 10 maxillas and virtually reconstructed with patient‐specific fibulas and scapulas. Reconstructions were compared for restoring midface cephalometrics, dental implantability, and pedicle length. Results Of 90 maxillectomy defects, the vertically oriented scapula provided improved orbital floor and maxillary height reconstructions (p < 0.001), albeit at the cost of dental implantability compared to the fibula (p < 0.001). In two defects crossing the midline, the fibula, allowing for more osteotomies, provided improved maxillary projection. In the remaining three defects crossing the midline, the horizontally oriented scapula was comparable to the fibula. Fibular and scapular reconstructions were amenable for dental implantation and had similar pedicle lengths, although favoring scapula in extensive defects. Conclusion Fibular and scapular reconstructions of maxillectomy defects provide unique strengths. This virtual analysis can guide a goal‐oriented reconstruction based on defect type and patient‐specific goals. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.