Obesity as a Risk Factor for Postoperative Adverse Events in Skull Base Surgery

xlomafota13 shared this article with you from Inoreader Obesity as a Risk Factor for Postoperative Adverse Events in Skull Base Surgery Via otol rhinol Ann Otol Rhinol Laryngol. 2022 Jan 26:34894221074745. doi: 10.1177/00034894221074745. Online ahead of print. ABSTRACT OBJECTIVE: To determine the implications of obesity on postoperative adverse events following skull base surgery. METHODS: The 2005-2017 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for adverse events in skull base surgery cases. Patients were stratified by body mass index (BMI) into normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30) cohorts. Logistic regression was used to assess the association of overweight or obese BMI with various 30-day postoperative adverse events. RESULTS: A total of 2305 patients were included for analysis, of which 732 (31.8%) and 935 (40.6%) were overweight or obese, respectively. The mean age was 53.8 ± 15.3 years and 1214 (52.7%) patients were female. Obese patients were younger (P = .033) and possessed higher frailty (P < .001) and ASA scores (P < .001). Operation times and lengths of hospitalization were not significantly different across patient cohorts (all P > .05). On propensity score-adjusted multivariable analysis, only bleeding (OR = 0.42, P < .001) and deep vein thrombosis (OR = 6.46, P = .015) were significantly associated with obesity. There were no significant differences in rates of readmission, reoperation, or mortality be tween normal weight and obese patients (all P > .05). CONCLUSIONS: Obesity was associated with decreased postoperative bleeding and increased deep vein thromboses. Obese patients were otherwise at no higher risk for medical or surgical complications. Elevated BMI did not confer an increased risk for readmission, reoperation, or death. Thus, patient obesity should not be a major determinant in offering skull base surgery in individuals who would otherwise benefit from treatment. PMID:35081772 | DOI:10.1177/00034894221074745 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Birth of the Beta-knife Thyroidectomy: The Radiance of Saul Hertz

xlomafota13 shared this article with you from Inoreader Birth of the Beta-knife Thyroidectomy: The Radiance of Saul Hertz Via radioactive iodine Am Surg. 2022 Jan 26:31348211060463. doi: 10.1177/00031348211060463. Online ahead of print. ABSTRACT This is the story of how one man's life's work allowed for Iodine-131 (I-131) to become a therapy for hyperthyroidism and thyroid cancer. What is now a standard in our times arose from Saul Hertz's rather challenging and humble beginnings. Thyroid lobectomy and total thyroidectomy were therapeutic mainstays for thyroid disease until Hertz treated his first patient with radioactive i odine (RAI) ablation therapy at Massachusetts General Hospital (MGH) on March 31, 1941. His concepts for using beta particle emission from RAI to ablate thyroid tissue were revolutionary. Hertz's RAI therapy translated to research with thyroid cancer by the mid-1940s. The high-energy beta particles produced cytolethal effects on remnant thyroid tissue left behind by total thyroidectomy, thereby accomplishing completion thyroidectomy in some patients. Progressive surgeons from the Hertz era incorporated RAI into their practice. MGH surgery resident Francis Moore took sabbatical from clinical training to do translational research with RAI and other radioisotopes. Irving Ariel of New York became known as a nuclear surgeon in the wake of Hertz's work. George Crile Jr of Cleveland became an RAI advocate for the surgical community, implementing several paradigm-changing concepts in thyroid disease along the way. Hertz was a visionary who sparked this movement, predicting many of the molec ular dilemmas with RAI-tumor avidity that clinical researchers continue to navigate today. This timely history for surgical oncologists and endocrine surgeons traces the development of RAI therapy through the life of Saul Hertz, a biographical window influenced by social stigma, political controversy, and mainstream media. PMID:35081787 | DOI:10.1177/00031348211060463 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The role of Glut-1 and H+/K+-ATPase expression in hyperplasia of mice laryngeal epithelium induced by pepsin

xlomafota13 shared this article with you from Inoreader The role of Glut-1 and H<sup>+</sup>/K<sup>+</sup>-ATPase expression in hyperplasia of mice laryngeal epithelium induced by pepsin Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2022 Jan 27. doi: 10.1007/s00405-021-07221-6. Online ahead of print. ABSTRACT PURPOSE: To explore the role played by Glut-1 and H+/K+-ATPase in pepsin-induced, mouse laryngeal epithelial proliferation, growth, and development. METHODS: We established a mouse model of laryngopharyngeal reflux and measured Glut-1 and H+/K+-ATPase expression levels in mouse laryngeal epithelium treated with artificial gastric juice containing pepsin. RESULTS: Artificial pepsin-containing gastric juice induced significant hyperplastic changes in mouse laryngeal epithelium compared to control mice at 15, 30, and 45 days. Inhibition of Glut-1 expression by 2-DG significantly suppressed such hyperplasia compared to mice exposed to artificial gastric juice containing pepsin at 15, 30, and 45 days. After treatment with pepsin-containing artificial gastric juice, RT-PCR and Wester n blotting showed that the levels of Glut-1 and H+/K+-ATPase α, β increased significantly. CONCLUSIONS: Pepsin-containing artificial gastric juice promoted mouse laryngeal epithelial hyperplasia associated with abnormal expression of Glut-1 and H+/K+-ATPase α, β. PMID:35083516 | DOI:10.1007/s00405-021-07221-6 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Recurrent Pleomorphic Adenoma of the Parotid Gland

xlomafota13 shared this article with you from Inoreader An Institutional Review of Recurrent Pleomorphic Adenoma of the Parotid Gland Via ear nose throat Ear Nose Throat J. 2022 Jan 27:1455613211068574. doi: 10.1177/01455613211068574. Online ahead of print. ABSTRACT OBJECTIVE: Surgical resection is standard treatment for pleomorphic adenoma (PA) of the parotid gland. A small number (2-5%) of these tumors recur. Recurrence usually necessitates re-operation, which is technically challenging and puts the facial nerve (FN) at risk. The aim of this study is to characterize the recurrent parotid PA population and compare outcomes af ter surgery for singly recurrent and multiply recurrent tumors. METHODS: This study was a retrospective chart review of patients at a single tertiary care academic medical center who underwent operations for recurrent PA of the parotid gland between 2007 and 2020. Demographic data, details of surgical interventions, pre-and post-operative FN function, and recurrence rates were studied. These factors were compared between patients with singly and multiply recurrent tumors. RESULTS: Thirty-eight patients met criteria: 4 patients presented for primary PA and subsequently recurred, 26 with a first recurrence, 7 with a second recurrence, and 1 with a fourth recurrence. Multiply recurrent PAs were more likely to require at least partial nerve sacrifice at the time of reoperation (p=0.0092). Significantly worse long-term FN outcomes were seen following surgery for multiply recurrent PA (p=0.008). There was no significant difference between the rate of re-recurrence following fi rst revision surgery versus 2nd-4th revision surgery. Time to re-operation was significantly shorter between the first and second revision surgery than between the primary surgery and first revision (p=0.0017). CONCLUSION: Surgery for recurrent PA incurs high risk to the FN, and this risk appears to increase in the setting of multiple recurrences. PMID:35081805 | DOI:10.1177/01455613211068574 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A structured ICA-based process for removing auditory evoked potentials

xlomafota13 shared this article with you from Inoreader A structured ICA-based process for removing auditory evoked potentials Via cortical auditory Sci Rep. 2022 Jan 26;12(1):1391. doi: 10.1038/s41598-022-05397-3. ABSTRACT Transcranial magnetic stimulation (TMS)-evoked potentials (TEPs), recorded using electroencephalography (EEG), reflect a combination of TMS-induced cortical activity and multi-sensory responses to TMS. The auditory evoked potential (AEP) is a high-amplitude sensory potential-evoked by the "click" sound produced by every TMS pulse-that can dominate the TEP and obscure observation of other neural components. The AEP is peripherally evoked and therefore should not be stimulation site specific. We address the problem of disentangling the peripherally evoked AEP of the TEP from components evoked by cortical stimulation and ask whether removal of AEP enables more accurate isolation of TEP. We hypothesized that isolation of the AEP using Independent Components Analysis (ICA) would reveal features that are stimulation site specific and unique individual features. In order to i mprove the effectiveness of ICA for removal of AEP from the TEP, and thus more clearly separate the transcranial-evoked and non-specific TMS-modulated potentials, we merged sham and active TMS datasets representing multiple stimulation conditions, removed the resulting AEP component, and evaluated performance across different sham protocols and clinical populations using reduction in Global and Local Mean Field Power (GMFP/LMFP) and cosine similarity analysis. We show that removing AEPs significantly reduced GMFP and LMFP in the post-stimulation TEP (14 to 400 ms), driven by time windows consistent with the N100 and P200 temporal characteristics of AEPs. Cosine similarity analysis supports that removing AEPs reduces TEP similarity between subjects and reduces TEP similarity between stimulation conditions. Similarity is reduced most in a mid-latency window consistent with the N100 time-course, but nevertheless remains high in this time window. Residual TEP in this window has a time-c ourse and topography unique from AEPs, which follow-up exploratory analyses suggest could be a modulation in the alpha band that is not stimulation site specific but is unique to individual subject. We show, using two datasets and two implementations of sham, evidence in cortical topography, TEP time-course, GMFP/LMFP and cosine similarity analyses that this procedure is effective and conservative in removing the AEP from TEP, and may thus better isolate TMS-evoked activity. We show TEP remaining in early, mid and late latencies. The early response is site and subject specific. Later response may be consistent with TMS-modulated alpha activity that is not site specific but is unique to the individual. TEP remaining after removal of AEP is unique and can provide insight into TMS-evoked potentials and other modulated oscillatory dynamics. PMID:35082350 | DOI:10.1038/s41598-022-05397-3 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Modulation Depth Discrimination by Cochlear Implant Users

xlomafota13 shared this article with you from Inoreader Modulation Depth Discrimination by Cochlear Implant Users Via Journal of the Association for Research in Otolaryngology Abstract Cochlear implants (CIs) convey the amplitude envelope of speech by modulating high-rate pulse trains. However, not all of the envelope may be necessary to perceive amplitude modulations (AMs); the effective envelope depth may be limited by forward and backward masking from the envelope peaks. Three experiments used modulated pulse trains to measure which portions of the envelope can be effectively processed by CI users as a function of AM frequency. Experiment 1 used a three-interval forced-choice task to test the ability of CI users to discriminate less-modulated pulse trains from a fully modulated standard, without controlling for loudness. The stimuli in experiment 2 were identical, but a two-interval task was used in which participants were required to choose the less-modulated interval, ignoring loudness. Catch trials, in which judgements based on level or modulation depth would give opposing answers, were included. Experiment 3 employed novel stimuli whose modulation envelope could be modified below a variable point in the dynamic range, without changing the loudness of the stimulus. Overall, results showed that substantial portions of the envelope are not accurately encoded by CI users. In experiment 1, where loudness cues were available, participants on average were insensitive to changes in the bottom 30% of their dynamic range. In experiment 2, where loudness was controlled, participants appeared insensitive to changes in the bottom 50% of the dynamic range. In experiment 3, participants were insensitive to changes in the bottom 80% of the dynamic range. We discuss potential reasons for this insensitivity and implications for CI speech-processing strategies. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A dose-neutral image quality comparison of different CBCT and CT systems using paranasal sinus imaging protocols and phantoms

xlomafota13 shared this article with you from Inoreader A dose-neutral image quality comparison of different CBCT and CT systems using paranasal sinus imaging protocols and phantoms Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2022 Jan 27. doi: 10.1007/s00405-022-07271-4. Online ahead of print. ABSTRACT PURPOSE: To compare the image quality produced by equivalent low-dose and default sinus imaging protocols of a conventional dental cone-beam computed tomography (CBCT) scanner, an extremity CBCT scanner and a clinical multidetector computed tomography (MDCT) scanner. METHODS: Three different phantoms were scanned using dose-neutral ultra-low-dose and low-dose sinus imaging protocols, as well as default sinus protocols of each device. Quantified parameters of image quality included modulation transfer function (MTF) to characterize the spatial response of the imaging system, contrast-to-noise ratio, low contrast visibility, image uniformity and Hounsfield unit accuracy. MTF was calculated using the line spread and edge spread functions (LSF and ESF). RESULTS: The dental CBCT had superior performance over the extremity CBC T in each studied parameter at similar dose levels. The MDCT had better contrast-to-noise ratio, low contrast visibility and image uniformity than the CBCT scanners. However, the CBCT scanners had better resolution compared to the MDCT. Accuracy of HU values for different materials was on the same level between the dental CBCT and MDCT, but substantially poorer performance was observed with the extremity CBCT. CONCLUSIONS: The studied dental CBCT scanner showed superior performance over the studied extremity CBCT scanner when using dose-neutral imaging protocols. In case a dental CBCT is not available, the given extremity CBCT is still a viable option as it provides the benefit of high resolution over a conventional MDCT. PMID:35084532 | DOI:10.1007/s00405-022-07271-4 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparison of Outcomes of Surgical Repair of Spontaneous Temporal Bone CSF Leaks and Encephaloceles Using Bone Cement and Autologous Material

xlomafota13 shared this article with you from Inoreader Comparison of Outcomes of Surgical Repair of Spontaneous Temporal Bone CSF Leaks and Encephaloceles Using Bone Cement and Autologous Material Via leak of cerebrospinal fluid Otol Neurotol. 2022 Jan 27. doi: 10.1097/MAO.0000000000003467. Online ahead of print. ABSTRACT OBJECTIVE: To compare outcomes transmastoid repair of spontaneous middle fossa cerebrospinal fluid (CSF) leak using only bone cement (BC) versus only autologous material (AM) or combined materials (CM) with both bone cement and autologous material. STUDY DESIGN: Retrospective Chart Review. SETTING: Tertiary Care Hospital. PATIENTS: Forty-three adult patients undergoing transmastoid repair of spontaneous middle fossa CSF leak between 2014 and 2020 (BC:12, AM:15, CR:16). INTERVENTIONS: Cortical mastoidectomy, identification of defect, and repair with BC (Cranios® hydroxyapatite), AM (local bone, fascia, fat, and/or cartilage), or CM (Cranios® combined with autologous materials). MAIN OUTCOME MEASURES: Successful repair without recurrent CSF leak or encephalocele throughout follow up. RESULTS: Fifty-one percent of subjects were female. Mean age at repair was 58.6 years (SD 10.9). Mean BMI was 35.4 (SD 7.6; BC:36.3, AM:36.5, CM:33.6). Forty (93%) patients had successful repair without known recurrent CSF leak or encephalocele since surgery (BC:11, 91.6%; AM:14, 93.3%; CM:15, 93.8%; p = 0.49) over a mean length of follow up of 49.6 months (BC: 37.9, AM: 59.2, CR: 49.5). The difference in mean operative time amongst the groups was faster for patients using bone cement (BC: 100.2 min, AM: 182.8, CM: 133.2; p < 0.00001). CONCLUSIONS: BC, AM, and CM techniques each demonstrate effective and sustained means of repair for middle fossa CSF leak and encephalocele, even in the presence of multiple defects. Use of isolated BC offers a significant decrease in operative time with a noninferior outcome. Active CSF leak at the time of surgery is associated with increased risk of recurrence. PMID:35085113 | DOI:10.1097/MAO.0000000000003467 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.