Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Δευτέρα 25 Οκτωβρίου 2021

Association between Thyroid Function and Heart Rate Monitored by Wearable Devices in Patients with Hypothyroidism

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Endocrinol Metab (Seoul). 2021 Oct 21. doi: 10.3803/EnM.2021.1216. Online ahead of print.

ABSTRACT

BACKGROUND: Heart rate (HR) monitored by a wearable device (WD) has demonstrated its clinical feasibility for thyrotoxicosis subjects. However, the association of HR monitored by wearables with hypothyroidism has not been examined. We assessed the association between serum thyroid hormone concentration and three WD-HR parameters in hypothyroid subjects.

METHODS: Forty-four subje cts scheduled for radioactive iodine therapy (RAI Tx) after thyroid cancer surgery were included. Thirty subjects were prepared for RAI Tx by thyroid hormone withdrawal (hypothyroidism group) and 14 subjects by recombinant human thyrotropin (control group). Three WD-HR parameters were calculated from the HR data collected during rest, during sleep, and from 2:00 AM to 6:00 AM, respectively. We analyzed the changes in conventionally measured resting HR (On-site rHR) and WDHR parameters relative to thyroid hormone levels.

RESULTS: Serum free thyroxine (T4) levels, On-site rHR, and WD-HR parameters were lower in the hypothyroid group than in the control group at the time of RAI Tx. WD-HR parameters also reflected minute changes in free T4 levels. A decrease in On-site rHR and WD-HR parameters by one standard deviation (On-site rHR, approximately 12 bpm; WD-HR parameters, approximately 8 bpm) was associated with a 0.2 ng/dL decrease in free T4 levels (P<0.01) and a 2-fold incre ase of the odds ratio of hypothyroidism (P<0.01). WD-HR parameters displayed a better goodness-of-fit measure (lower quasi-information criterion value) than On-site rHR in predicting the hypothyroidism.

CONCLUSION: This study identified WD-HR parameters as informative and easy-to-measure biomarkers to predict hypothyroidism.

PMID:34674500 | DOI:10.3803/EnM.2021.1216

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Whole-Body Radioiodine Effective Half-Life in Patients with Differentiated Thyroid Cancer

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Diagnostics (Basel). 2021 Sep 22;11(10):1740. doi: 10.3390/diagnostics11101740.

ABSTRACT

Background: Radioactive 131I (RAI) therapy is used in patients with differentiated thyroid cancer (DTC) after total thyroidectomy for remnant ablation, adjuvant treatment or treatment of persistent disease. 131I retention data, which are used to indicate the time at which a 131I treated DTC patient can be released from the hospital, may bring some insight s regarding clinical factors that prolong the length of hospitalization. The aim of this study was to investigate the 131I whole-body retention in DTC patients during 131I therapy. Methods: We monitored 166 DTC patients to follow the 131I whole-body retention during 131I therapy with a radioactivity detector fixed on the ceiling of each protected room. A linear regression fit permitted us to estimate the whole-body 131I effective half-life in each patient, and a relationship was sought between patients' clinical characteristics and whole-body effective 131I half-life. Results: The effective 131I half-life ranged from 4.08 to 56.4 h. At multivariable analysis, longer effective 131I half-life was related to older age and extensive extra-thyroid disease. Conclusions: 131I effective half-life during 131I treatment in DTC patients is highly variable amon g patients and is significantly longer in older and in patients with RAI uptake in large thyroid remnants or in extrathyroidal disease that significantly prolongs the whole-body retention of 131I.

PMID:34679438 | PMC:PMC8535104 | DOI:10.3390/diagnostics11101740

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Chronic Lymphocytic Thyroiditis and Aggressiveness of Pediatric Differentiated Thyroid Cancer

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Laryngoscope. 2021 Oct 23. doi: 10.1002/lary.29908. Online ahead of print.

ABSTRACT

OBJECTIVES/HYPOTHESIS: Hashimoto's Thyroiditis (HT) is a common cause of hypothyroidism. Among adults with differentiated thyroid cancer (DTC), HT appears to be associated with less severe disease burden. In the absence of information regarding HT and disease burden among children with DTC, we assessed the relationship between pediatric DTC severity and HT.

STUDY DESIGN: Retrospective cohort.< /p>

METHODS: Charts from 90 pediatric patients who underwent surgical removal of DTC from 2002 to 2017 at tertiary-care children's hospital were reviewed. Demographic, clinical, surgical, pathology, and outcome details were compared between patients with and without HT. Consistency among diagnostic modalities of HT was also evaluated.

RESULTS: Median age at presentation was 16.0 years (range 4.2-18.9 years). Twenty-two patients were male (24%). Forty-five patients (50%) had HT based on presence of thyroid autoantibodies and/or surgical pathology findings and 45 patients did not have HT. Patients with HT had increased odds of microcalcifications (odds ratio [OR]: 3.01, P = .031) and decreased odds of palpable nodules (OR: 0.212, P = .024) and T2 lesions (vs. T1) (OR: 0.261, P = .015) compared with non-HT. No significant differences in demographics and the incidence of multifocality, extrathyroidal extension, lymphovascular invasion, lymph node or pulmonary metastases, disease recurrence, or radioactive iodine treatment were found between the two groups. Thyroglobulin/thyroid peroxidase autoantibodies and surgical pathology indicative of HT were concordant in 82.4% (κ = 0.635, P < .001).

CONCLUSION: HT was present in 50% of children with DTC. Patients with DTC and HT presented with smaller tumors compared to non-HT patients. No significant differences in other markers of disease aggressiveness were found between the two groups.

LEVEL OF EVIDENCE: 3 Laryngoscope, 2021.

PMID:34687456 | DOI:10.1002/lary.29908

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Reusable surgical drapes in Plastic surgery: What is the sticking point?

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J Plast Reconstr Aesthet Surg. 2021 Oct 7:S1748-6815(21)00468-X. doi: 10.1016/j.bjps.2021.09.027. Online ahead of print.

NO ABSTRACT

PMID:34688592 | DOI:10.1016/j.bjps.2021.09.027

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A comparative study of porous polyethylene versus absorbable polydextro- and polylevolactic-lactide plate in reconstruction of isolated medial orbital wall fracture

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J Plast Reconstr Aesthet Surg. 2021 Sep 17:S1748-6815(21)00410-1. doi: 10.1016/j.bjps.2021.08.023. Online ahead of print.

ABSTRACT

BACKGROUND: Several materials for medial orbital wall reconstruction have been mentioned in the literature. Our main purpose was to investigate postoperative enophthalmos and diplopia after medial orbital wall reconstruction with polydextro- and polylevolactic (poly-L/DL) acid (P[L/DL]LA) mesh plates and porous polyethylene plates.

METHODS: Using a retrospective study design, we enrolled a cohort of isolated medial blowout fracture patients treated during a 58-month interval. The predictor variable was medial orbital wall reconstruction materials (P(L/DL)LA mesh plate and porous polyethylene plate. The main outcome variables included the occurrence of postoperative enophthalmos and diplopia at 1 week, 1, 3, 6, and 12 months post-surgery . Appropriate descriptive, uni- and bivariate statistics were computed, and P < 0.05 was considered significant.

RESULTS: Three hundred-two isolated medial blowout fracture patients were included (24.5% females, 67% treated with P(L/DL)LA mesh plate). Exophthalmos measured highest in both groups 1 week after surgery and decreased steadily for 6 months postoperatively. Statistically significant differences were observed between both groups at 1 week, 1 month, and 3 months after surgery, with a higher incidence of exophthalmos observed in the P(L/DL)LA mesh plate group (P < 0.001). No significant differences were observed at 6 and 12 months after surgery.

CONCLUSION: The occurrence of enophthalmos after medial blowout fracture reconstruction with P(L/DL)LA mesh plate is comparable with the use of porous polyethylene plate. Both P(L/DL)LA mesh and porous polyethylene plates are, th erefore, reliable implants for medial orbital wall reconstruction.

PMID:34690092 | DOI:10.1016/j.bjps.2021.08.023

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Treatment of cancer pain

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Bull Cancer. 2021 Oct 20:S0007-4551(21)00376-3. doi: 10.1016/j.bulcan.2021.08.007. Online ahead of print.

ABSTRACT

Two hundred patients were refereed for advanced cancer to the oncology department of Luxembourg Hospital in Bamako. All these patients reported intense pain (88 %) which was only treated before admission by OMS level 1 analgesics. It clearly shows that cancer pain is undertreated in Malian peripheral sanitary structures. After evaluation of the pain by analog visual and verbal scales patients, the appropriate analgesic drugs such as morphine (OMS level 3) were given. A control of the pain was obtained in all the patients (100 %) with a dramatic improvement in quality of life. This study emphasizes the need for a pain control program at the Malian state level with a basic education of care givers, hospital-centric networks and access to morphine and opioids at the different levels involved in cancer management.

PMID:< a href="https://pubmed.ncbi.nlm.nih.gov/34688484/?utm_source=Inoreader&utm_medium=rss&utm_content=1pWbXSyt-bgOwyfswAxLlZpSXeeWbmCyNlsY-SXJggVtkrlgb7&ff=20211026004807&v=2.15.0" target="_blank" rel="noopener" class="underlink bluelink">34688484 | DOI:10.1016/j.bulcan.2021.08.007

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Computational Modeling of Information Propagation during the Sleep-Waking Cycle

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Biology (Basel). 2021 Sep 22;10(10):945. doi: 10.3390/biology10100945.

ABSTRACT

Non-threatening familiar sounds can go unnoticed during sleep despite the fact that they enter our brain by exciting the auditory nerves. Extracellular cortical recordings in the primary auditory cortex of rodents show that an increase in firing rate in response to pure tones during deep phases of sleep is comparable to those evoked during wakefulness. This result challenges the hypothesis that during sleep cortical responses are weakened through thalamic gating. An alternative explanation comes from the observation that the spatiotemporal spread of the evoked activity by transcranial magnetic stimulation in humans is reduced during non-rapid eye movement (NREM) sleep as compared to the wider propagation to other cortical regions during wakefulness. Thus, cortical responses during NREM sleep remain local and the stimulus only reaches nearby neuronal populations. W e aim at understanding how this behavior emerges in the brain as it spontaneously shifts between NREM sleep and wakefulness. To do so, we have used a computational neural-mass model to reproduce the dynamics of the sensory auditory cortex and corresponding local field potentials in these two brain states. Following the synaptic homeostasis hypothesis, an increase in a single parameter, namely the excitatory conductance g¯AMPA, allows us to place the model from NREM sleep into wakefulness. In agreement with the experimental results, the endogenous dynamics during NREM sleep produces a comparable, even higher, response to excitatory inputs to the ones during wakefulness. We have extended the model to two bidirectionally connected cortical columns and have quantified the propagation of an excitatory input as a function of their coupling. We have found that the general increase in all conductances of the cortical excitatory synapses that drive the system from NREM sleep to wakefulness does not boost the effective connectivity between cortical columns. Instead, it is the inter-/intra-conductance ratio of cortical excitatory synapses that should raise to facilitate information propagation across the brain.

PMID:34681044 | PMC:PMC8533346 | DOI:10.3390/biology10100945

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Development and assessment of a MOOC about delirium in geriatric oncology

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Bull Cancer. 2021 Oct 21:S0007-4551(21)00383-0. doi: 10.1016/j.bulcan.2021.05.014. Online ahead of print.

ABSTRACT

INTRODUCTION: Among the themes to be addressed by a Massive Open Online Course (MOOC) on geriatric oncology, one of the priorities was delirium, due to its frequency, complications and difficulties encountered by healthcare professionals in diagnosing and managing delirium. Our study aims to evaluate professional practices in the area of education, regarding the evaluation of the content of a MOOC module about delirium syndrome in geriatric oncology.

METHODS: We created a multidisciplinary group to define the scientific content, the pedagogical objectives, the scriptwriting and the development of a training module. The quality of instructional design was then evaluated according to eleven MOOC design principles to promote learning. Participants were studied.

RESULTS: Seven of the eleven criteria for evaluating pedagogical quality were documented. Among the 1020 participants, 455 (44.6%) completed the final test concerning delirium: 417 (40.8%) passed the final test; 406 documented their profession and the region of France where they worked: 146 (32%) nurses (confirming the participation of the targeted audience), 103 (22.6%) doctors/pharmacists (illustrating the multi-professional interest of the thematic), with a wide distribution of the participants over the national territory.

DISCUSSION: The multidisciplinary team's investment in developing these teaching materials strengthened the group's cohesion and valuated its professional skills. All teaching resources developed for access via the internet must be accompanied by an evaluation of the quality of the scientific content, objectives and teaching methods, before being able to appreciate its use in the field and assess its real impact on the participants' learning and practice.

PMID:34689979 | DOI:10.1016/j.bulcan.2021.05.014

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The roles of microglia in neural remodeling during retinal degeneration

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Histol Histopathol. 2021 Oct 25:18384. doi: 10.14670/HH-18-384. Online ahead of print.

ABSTRACT

Retina remodeling is a consequence of many retinal degenerative diseases that are characterized by progressive photoreceptor death. Retina remodeling involves a series of complex pathological processes, consisting of photoreceptor degeneration and death, as well as retinal cell reprogramming and "rewiring". This rewiring alters retinal neural circuits that are centered on synaptic connections and lead to widespread death of retinal cells. Retinal remodeling, especially inner retinal remodeling, is the major factor that limits the effectiveness of various treatment strategies, including cell therapy; thus, it is important to elucidate the mechanisms involved in retinal remodeling during retinal degeneration. Microglia are the dominant immune cells in the retina. Microglia monitor the retinal microenvironment, are activated following retinal i njury or degeneration, have powerful phagocytosis capabilities, and play a critical role in synaptic pruning during central neural system development. Analogously, microglia have been found to participate in the clearance of synaptic elements in a complement-dependent manner in the classic retinitis pigmentosa (RP) model, Royal College of Surgeons (RCS) rats, and retard the formation of ectopic neuritogenesis and the deterioration of visual function during retinal degeneration. Since previous research on microglia has rarely concentrated on synaptic remodeling during retinal degeneration, summarizing the microglial mechanisms involved in retinal remodeling is necessary in order to design compounds targeting microglia and retinal remodeling that might be promising therapeutic strategies for treating retinal degeneration.

PMID:34693982 | DOI:10.14670/HH-18-384

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Intermediate Invasive Fungal Sinusitis, a Distinct Entity From Acute Fulminant and Chronic Invasive Fungal Sinusitis

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Ann Otol Rhinol Laryngol. 2021 Oct 25:34894211052854. doi: 10.1177/00034894211052854. Online ahead of print.

ABSTRACT

BACKGROUND: The current classification system of invasive fungal sinusitis (IFS) includes acute (aIFS) and chronic (cIFS) phenotypes. Both phenotypes display histopathologic evidence of tissue necrosis, but differ by presence of angioinvasion, extent of necrosis, and disease progression. aIFS is defined by a rapid onset of symptoms, while cIFS slowly progresse s over ≥12 weeks. However, a subset of IFS patients do not fit into the clinical presentation and histopathologic characteristics of either aIFS or cIFS.

OBJECTIVES: To investigate the demographic, clinical, and histopathologic characteristics of a distinct subset of IFS.

METHODS: Retrospective review of patients with IFS from a single tertiary-care institution (2010-2020). Patients with symptoms for ≤4 weeks were classified as aIFS if they displayed endoscopic evidence of mucosal necrosis or fungal angioinvasion on pathology. Patients with slowly progressive IFS for ≥12 weeks were classified as cIFS. Patients with symptom duration between 4 and 12 weeks with evidence of invasive fungal disease were classified as a new entity and were further investigated.

RESULTS: Of the 8 patients identified, 50% were immunosuppressed at presentation. The mean symptom duration prior to presentation was 50.5 days (SD 16.8), and common symptoms included facial pain (100%), vi sion change (87.5%), and blindness (37.5%). Two patients (25%) died of their disease. Sites of fungal involvement confirmed by histopathology included sphenoid (62.5%) and ethmoid sinuses (12.5%), orbital apex (25%), optic nerve (12.5%), pterygopalatine fossa (12.5%), and clivus (12.5%). Fungal elements but without obvious angioinvasion, were identified in all specimens, and fungus balls (50%), granulomas (37.5%), and giant cells (25%) were also observed on histopathology. CT and MRI radiographic imaging showed findings consistent with orbital, intracranial, or skull base involvement in all patients.

CONCLUSION: We propose intermediate IFS as a new subgroup of patients with IFS who do not fit into the standard classification of aIFS or cIFS.

PMID:34694144 | DOI:10.1177/00034894211052854

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