Αρχειοθήκη ιστολογίου

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

Κυριακή 26 Δεκεμβρίου 2021

Gustatory Function and Salivary Flow Rate in Healthy Adults

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Objectives/Hypothesis

In this study, we assessed gustatory function and whole-mouth saliva in healthy adults and investigated the association between gustatory function, salivary flow rate (SFR), and dry mouth.

Study Design

Descriptive clinical study.

Methods

We recruited 413 participants who reported a normal sense of smell–taste, comprising 206 females and 207 males with an age range of 19 to 80 years. Taste scores were obtained using whole-mouth tests to evaluate the gustatory function, SFR was assessed using the spitting method, and dry mouth was measured with the visual analog scale.

Results

The total taste score (TTS) and SFR were significantly negatively correlated with age (r taste = −0.522, P < .001; r SFR = −0.200, P < .001): TTS was significantly lower after the age of 50 and SFR decreased significantly after age 65. Women exhibited a significantly higher TTS than men (P < .001). However, there was no effect of sex on SFR. Dry mouth was negatively correlated with TTS (r = −0.223, P < .01) and SFR (r = −0.218, P < .01). Multiple regression analysis showed the independent variables of age, sex, and dry mouth predicted 34% of the variation in taste, while the independent variables of age and dry mouth predicted 6.1% of the variation in whole-mouth saliva. TTS was not significantly correlated with the SFR in healthy adults (r = 0.094, P = .056).

Conclusions

Age and dry mouth are important factors affecting gustatory function and whole-mouth saliva, with women exhibiting better taste sensitivity than men. Furthermore, there is no direct correlation between SFR and gustatory function in healthy adults.

Level of Evidence

3 Laryngoscope, 2021

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Anterior Palatoplasty With Expansion Sphincter Pharyngoplasty for All Type of Pharyngeal Collapse

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Objectives/Hypothesis

This study was aimed to compare the efficiency of the anterior palatoplasty and expansion sphincter pharyngoplasty (APwESP) technique for all patterns of velopharyngeal obstruction (anterior–posterior [APPC], lateral [LPC], or combined circular pharyngeal collapse [CPC]).

Study Design

The study was designed as a randomized prospective trial at Kâtip Çelebi University, Atatürk Training, and Research Hospital.

Methods

Patients only with velopharyngeal obstruction were included. Three groups were created according to the obstruction pattern (APPC, LPC, and CPC) for the study. Outcome parameters included patient's demographics, apnea-hypopnea index (AHI), lowest oxygen saturation (LOS), Stanford subjective scale of snoring (SSSS), and Epworth sleepiness scale (ESS).

Results

Thirty-one (34.1%) patients were in APPC group, while 30 (33.0%) patients were in LPC, and 30 (33.0%) were in CPC group. Preoperatively for all patients, on average, AHI was 33.4 ± 13.6, SSSS was 8.3 ± 1.0, ESS was 16.5 ± 2.6, and LOS was determined as 85.5 ± 3.6. There was a significant postoperative improvement in all parameters for all patients. There was no significant difference in outcome parameters between the groups according to obstruction pattern postoperatively. After APwESP surgery, obstruction pattern was not a significant factor for AHI (P = .234), SSSS (P = .180), and LOS (P = .280) (repeated measure analysis of variance test). The rate of surgical success was detected similarly for both of the study groups (P = .435). The rate of successful surgery for severe obstructive sleep apnea in the APPC group was 72.2%, 88.2% in the LPC group, and 75.0% in the CPC group (P =& nbsp;.472).

Conclusion

A combination of APwESP surgery can manage all types of pharyngeal obstruction confidently.

Level of Evidence

3 Laryngoscope, 2021

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Role and mechanism of the Dectin-1-mediated Syk/NF-κB signaling pathway in Talaromyces marneffei infection

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Exp Ther Med. 2022 Jan;23(1):84. doi: 10.3892/etm.2021.11007. Epub 2021 Nov 25.

ABSTRACT

Dendritic cell-associated C-type lectin-1 (Dectin-1), a C-type lectin receptor, serves a critical role in host antifungal immunity. However, the molecular mechanism and function of Dectin-1-mediated signaling in response to infection by the pathogenic fungus Talaromyces marneffei remains unclear. To understand the role of Dectin-1 signaling against T. marneffei infection, the phosphorylation of spleen tyrosine kinase (Syk), nuclear factor of κ light polypeptide gene enhancer in B-cells inhibitor, α (IκBα) and NF-κB were analyzed using western blotting, and the secretion of cytokines was detected using ELISA. Upon sporular or hyphal heat-killed T. marneffei stimulation, Dectin-1 in THP-1 macrophages recognized and induced the activation of Syk, and in turn triggered phosphorylation of downstream molecules IκBα and NF-κB, thus increasing the secretion of TNF-α and IL-8. Conversely, knockdown of Dectin-1 in THP-1 macrophages downregulated the phosphorylation of Syk, IκBα and NF-κB molecules, and significantly decreased the production of TNF-α and IL-8. These results indicated that Dectin-1 may have a crucial role in inducing the inflammatory response via increasing levels of TNF-α and IL-8 induced by T. marneffei, whereas NF-κB may be the key downstream molecule involved in the response to T. marneffei infection. Subsequently, THP-1 macrophages could orchestrate the innate immune system by releasing the cytokines TNF-α and IL-8. Therefore, it was hypothesized that regulation of the Dectin-1 signaling pathway may effectively interfere with the defense ability of the host against T. marneffei infection.

PMID:34938366 | PMC:PMC8688926 | DOI:10.3892/etm.2021.11007

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Primary Diffuse Large B-Cell Lymphoma of the Tongue Base With Acute Airway Obstruction

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Ear Nose Throat J. 2021 Dec 23:1455613211066664. doi: 10.1177/01455613211066664. Online ahead of print.

NO ABSTRACT

PMID:34939459 | DOI:10.1177/01455613211066664

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Outcomes of Endolymphatic Sac Surgery for Meniere’s Disease with and without Comorbid Migraine

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Purpose. To explore outcomes of endolymphatic sac surgery for patients with Meniere's disease with and without the comorbid condition of migraine. Materials and Methods. A retrospective chart review of adult patients undergoing endolymphatic sac surgery at a single tertiary care center from 1987 to 2019 was performed. All adult patients who failed medical therapy and underwent primary endolymphatic sac surgery were included. The main outcome measures were vertigo control and functional level scale (FLS) score. Patient characteristics, comorbidities, and audiometric outcomes were tracked as well. Results. Patients with Meniere's disease and migraine had a stronger association with psychiatric comorbidities (64.29% vs. 25.80%, ), shorter duration of vertigo episodes (143 vs. 393 min, ), and younger age (36.6 vs. 50.8 yr, ) at the time of endolymphatic sac surgery. Postoperative pure tone averages and word recognition scores were nearly identical to preoperative baselines. Class A vertigo control (47.92%) was most common, followed by class B vertigo control (31.25%). The FLS score improved from 4.2 to 2.8 (). Both patients with and without migraine had classes A-B vertigo control (66.67% vs. 80.95%) without any statistically significant difference (). Of the patients who required secondary treatment (10.42%), none had migraine. Conclusions. Endolymphatic sac surgery is an effective surgical intervention for Meniere's disease with and without migraine. Patients with comorbid migraine tend to be younger and present with psychiatric comorbidities.
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Regulation of nuclear medicine services: Perception of the problems and challenges in Colombia for the approach to cancer

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Biomedica. 2021 Dec 15;41(4):692-705. doi: 10.7705/biomedica.6123.

ABSTRACT

Introduction: Colombia has modified the nuclear medicine norms that impact the administration of radioactive iodine therapy in the treatment of thyroid cancer. Objective: To identify the areas of agreement regarding the issue, as well as the current and emergent requirements associated with the normative for the operation of nuclear medicine services that have an impact on the care of patients with thyroid cancer in Colombia. Materials and methods: We conducted a two-round Delphi study for each expert, clinical, and regulatory group. The first round explored views on the implications of the regulations that apply to nuclear medicine. The second round rated the statements from the first round by their relevance. Results: The issues regarding nuclear medicine services were related to the normative clarity and the lack of synergy and coherence among inspection, surveillance, and control bodies. The demands on the waste management system require a high economic investment that can influence the service offer and have an impact on the integral control of thyroid cancer. Unification of the auditors' criteria, delimitation of the acting agent functions, technical assistance to the services to comply with the normative, and the oversight of the inspection, surveillance, and control bodies by the regulatory entities are among the current and future needs. Conclusions: Our findings suggest th at nuclear medicine services are going through a time of multiple institutional, regulatory, and economic challenges that put at risk the development and maintenance of nuclear medicine in cancer care.

PMID:34936254 | DOI:10.7705/biomedica.6123

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Machine learning can identify patients at risk of hyperparathyroidism without known calcium and intact parathyroid hormone

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Abstract

Background

To prove the concept of diagnosing primary hyperparathyroidism (pHPT) without calcium and parathyroid hormone (PTH) values and identifying potential risk factors for pHPT.

Methods

Data were extracted from the clinical data warehouse (CDW) at the University of Arkansas for Medical Sciences (UAMS) Epic EHR (2014–2019).

Results

1737 patients with over 185 000 rows of clinical data were provided in a relational structure and processed/flattened to facilitate modeling. Phenotype elements were identified for pHPT without advance knowledge of calcium and PTH levels. The area under the curve (AUC) for the prediction of pHPT using our model was 0.86 with sensitivity and specificity of 0.8953 and 0.6686, respectively, using a 0.45 probability threshold.

Conclusion

Primary hyperparathyroidism was predicted from a dataset excluding calcium and PTH data with 86% accuracy. This approach needs to be validated/refined on larger samples of data and plans are in place to do this with other regional/national datasets.

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Proof of Concept Study For Using UR10 Robot To Help Total Hip Replacement

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Abstract

Background

The demand for total hip replacement (THR) for treating osteoarthritis has grown substantially worldwide. The existing robotic systems used in THR are invasive and costly. This study aims to develop a less-invasive and low-cost robotic system to assist THR surgery.

Methods

A preliminary robotic reaming system was developed based on a UR10 robot equipped with a reamer to cut acetabulum. A novel approach was proposed to cut through a 5mm hole in femur such that the operation is less invasive to the patients.

Results

The average error of the cutting hemisphere by the robotic reaming system is 0.118 2 mm which is smaller than the average result reaming by hand (0.130 1 mm)

Conclusion

The robotic reaming can help make THR procedures less invasive and more accurate. Moreover, the system is expected to be significantly less expensive than the robotic systems available in the market at present.

This article is protecte d by copyright. All rights reserved.

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A Systematic Review of Robotic Surgery: From Supervised Paradigms To Fully Autonomous Robotic Approaches

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Abstract

Background

From traditional open surgery to laparoscopic surgery and robot-assisted surgery (RAS), advances in robotics, machine learning, and imaging are pushing the surgical approach to-wards better clinical outcomes. Pre-clinical and clinical evidence suggests that automation may standardise techniques, increase efficiency, and reduce clinical complications.

Methods

A PRISMA-guided search was conducted across PubMed and OVID.

Results

Of the 89 screened articles, 51 met the inclusion criteria, with 10 included in the final review. Automatic data segmentation, trajectory planning, intra-operative registration, trajectory drilling, and soft tissue robotic surgery were discussed.

Conclusion

Although automated surgical systems remain conceptual, several research groups have developed supervised autonomous robotic surgical systems with increasing consideration for ethico-legal issues for automation. Automation paves the way for precision surgery and improved safety and opens new possibilities for deploying more robust artificial intelligence models, better imaging modalities and robotics to improve clinical outcomes.

This article is protected by copyright. All rights reserved.

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Implementing a Tailored Psychosocial Distress Screening Protocol in a Head and Neck Cancer Program

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Objectives/Hypothesis

Psychosocial distress is common among patients with head and neck cancer (HNC) and is associated with poorer quality of life and clinical outcomes. Despite these risks, distress screening is not widely implemented in HNC care. In this study, we investigated the prevalence of psychosocial distress and its related factors in routine care of patients with HNC.

Methods

Data from medical records between September 2017 and March 2020 were analyzed. Psychosocial distress was measured by the National Comprehensive Cancer Network's Distress Thermometer (DT), and a modified HNC-specific problem list; depression and anxiety were assessed using the Patient Health Questionnaire-4. Descriptive statistics and logistic regression were conducted to report prevalence of distress, depression and anxiety, and factors associated with clinical distress. Implementation outcomes, including rates of referrals and follow-up for distressed patients, are also reported.

Results

Two hundred and eighty seven HNC patients completed the questionnaire (age 64.3 ± 14.9 years), with a mean distress score of 4.51 ± 3.35. Of those, 57% (n = 163) reported clinical distress (DT ≥ 4). Pain (odds ratio [OR] = 3.31, 95% CI = 1.75–6.26), fatigue (OR = 2.43, 95% CI = 1.1.7–5.05), anxiety (OR = 1.63, 95% CI = 1.30–2.05), and depression (OR = 1.51, 95% CI = 1.04–2.18) were significantly associated with clinical distress (P < .05). Of patients identified as distressed, 79% received same-day psychosocial evaluation.

Conclusions

Clinical distress was identified in 57% of patients who completed the questionnaire, suggesting that an ultra-brief psychosocial screening protocol can be implemented in routine ambulatory oncology care, and identifies patients whose distress might otherwise go unrecognized.

Level of Evidence

4 Laryngoscope, 2021

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