A novel scoring system based on small vestibular schwannomas to determine consideration for cochlear implantation

xlomafota13 shared this article with you from Inoreader A novel scoring system based on small vestibular schwannomas to determine consideration for cochlear implantation Via Clinical Otolaryngology Abstract Simultaneous translabyrinthine tumor resection and cochlear implantation is a promising treatment method with hearing rehabilitation for sporadic vestibular schwannomas. Size of vestibular schwanomma, distance to modiolus, residual hearing and promontory stimulation electrical brainstem response audiometry are important preoperative predictive factors for determining a positive post tumour resection electrically evoked auditory brain stem response. The presence of an electrically evoked auditory brain stem response with an intracochlear test electrode after tumour resection was used to determine whether a patient received a cochlear implant Positive electrically evoked auditory brain stem responses measured with an intracochlear test electrode after tumour resection seem to correlate well with auditory perception with a cochlear implant. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Locoregional Recurrence in p16‐Positive Oropharyngeal Squamous Cell Carcinoma After TORS

xlomafota13 shared this article with you from Inoreader Locoregional Recurrence in p16‐Positive Oropharyngeal Squamous Cell Carcinoma After TORS Via The Laryngoscope Objective To analyze the patterns, risk factors, and salvage outcomes for locoregional recurrences (LRR) after treatment with transoral robotic surgery (TORS) for HPV-associated oropharyngeal squamous cell carcinoma (HPV+ OPSCC). Study Design Retrospective analysis of HPV+ OPSCC patients completing primary TORS, neck dissection, and NCCN-guideline-compliant adjuvant therapy at a single institution from 2007 to 2017. Methods Features associated with LRR, detailed patterns of LRR, and outcomes of salvage therapy were analyzed. Disease-free survival (DFS) and overall survival (OS) were calculated for subgroups of patients receiving distinct adjuvant treatments. Results Of 541 patients who completed guideline-indicated therapy, the estimated 5-year LRR rate was 4.5%. There were no identifiable clinical or pathologic features associated with LRR. Compared to patients not receiving adjuvant therapy, those who received indicated adjuvant radiation alone had a lower risk of LRR (HR 0.28, 95% CI [0.09–0.83], P = .023), but there was no difference in DFS (P = .21) and OS (P = .86) between adjuvant therapy groups. The 5-year OS for patients who developed LRR was 67.1% vs. 93.9% for those without LRR (P < .001). Patients who initially received adjuvant chemoradiation and those suffering local, in-field, and/or retropharyngeal node recurrences had decreased disease control after salvage therapy. Conclusion LRR rates are low for HPV+ OPSCCs completing TORS and guideline-compliant adjuvant therapy. Patients without indication for adjuvant therapy more often suffer LRR, but these recurrences are generally controllable by salvage therapy. Improved understanding of the patterns of recurrence most amenable to salvage therapy may guide treatment decisions, counseling, and adjuvant therapy de-escalation trials. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

ANLN promotes carcinogenesis in oral cancer by regulating the PI3K/mTOR signaling pathway

xlomafota13 shared this article with you from Inoreader ANLN promotes carcinogenesis in oral cancer by regulating the PI3K/mTOR signaling pathway Via Head & Face Medicine Oral cancer is a malignant disease that threatenshuman life and greatly reducespatientquality of life. ANLN was reported to promote the progression of cancer. This study aims to investigate the role of ANLNin ... View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Ototoxicity of Artemisinin-Based Combination Therapy: A Case Presentation

xlomafota13 shared this article with you from Inoreader Ototoxicity of Artemisinin-Based Combination Therapy: A Case Presentation Via Otolaryngology Indian Abstract Neuroauditory-toxicity should always be borne in mind prior to treatment of severe conditions like cerebral-malaria and due attention should be paid to auditory monitoring. Artemisinin-based combination therapy is the best available treatment for cerebral malaria however its attribution to hearing loss remains undetermined. This report manifests ototoxic effect of artemisinin. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Patient-reported opioid use for tissue expander-based breast reconstruction

xlomafota13 shared this article with you from Inoreader Patient-reported opioid use for tissue expander-based breast reconstruction Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Apr 18:S1748-6815(21)00218-7. doi: 10.1016/j.bjps.2021.03.114. Online ahead of print. ABSTRACT INTRODUCTION: There is limited evidence for appropriate post-operative opioid prescribing in breast reconstruction patients. We sought to describe postoperative outpatient prescription opioid use patterns (quantity and duration) following discharge after immediate breast reconstruction with tissue expanders (TE) and to identify demographic and/or clinical risk factors associated with postoperative outpatient opioid use. METHODS: Patients 18 years and older undergoing immediate TE-based breast reconstruction were given a 28-day postoperative pain medication log book. Descriptive statistics were performed to describe the quantity and duration of opioid use. Preoperative, intraoperative, and postoperative characteristics were examined and tested for their associations with postoperative opioid use. RESULTS: A total of 45 logbooks were completed. On average, patients used opioids for 7.42 days (SD = 6.45) after discharge home and used 15.9 (SD = 18.71) oxycodone 5 mg tablet equivalents (119.3 morphine milligram equivalents, SD = 140.31). The total number of oxycodone 5 mg equivalents consumed prior to discharge was associated with the amount of post-discharge opioid consumption (IRR=1.08, p<0.01). Each additional year of age was associated with a reduction in the days-to-opioid cessation by a factor of 0.97 (p=0.01). Each additional oxycodone 5mg equivalent consumed prior to hospital discharge was associated with an increase in the days-to-cessation after discharge by a factor of 1.04 (p=0.026). CONCLUSIONS: These patient-reported data will provide a benchmark which plastic surgeons can use to minimize narcotic use in patients and will help prevent issues of dependence, misuse, and diversion, while being mindful of adequate pain control. For patients discharging home after a one-night stay for immediate TE breast reconstruction, we recommend a prescription for 10 oxycodone 5 mg tablets, or 15 tablets if they are less than age 49 or have had high inpatient opioid use. Patients should also be counseled that the expected duration of outpatient opioid use is 7-11 days, and that 20 % of patients did not use any opioids following hospital discharge, making nonnarcotic pain regimens a real possibility. PMID:34078588 | DOI:10.1016/j.bjps.2021.03.114 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Combined Transcranial-endonasal Reconstructive Surgery for Cerebrospinal Fluid Leakage Resulting from Traumatic Anterior Skull Base Fractures Involving the Parasellar Region

xlomafota13 shared this article with you from Inoreader Combined Transcranial-endonasal Reconstructive Surgery for Cerebrospinal Fluid Leakage Resulting from Traumatic Anterior Skull Base Fractures Involving the Parasellar Region Via leak of cerebrospinal fluid Neurol Med Chir (Tokyo). 2021 Jun 1. doi: 10.2176/nmc.tn.2021-0085. Online ahead of print. ABSTRACT Extensive traumatic anterior skull base fractures from the frontal sinus to the parasellar region are frequently accompanied by multiple dural defects that cause persistent cerebrospinal fluid (CSF) leakage. Conventional transcranial reconstruction using a frontal periosteal flap is frequently insufficient, and parasellar dural defects are often deep, complex, and difficult to identify. In this report, we describe a combined transcranial-endonasal reconstructive technique and report our experience. Simultaneous combined transcranial and endoscopic surgery was performed in three patients with CSF leakage resulting from traumatic anterior skull base fractures. Dural defects were thoroughly identified from the transcranial and endonasal surgical fields, and covered using a multilayer sealing technique. The anterior regions of the anterior skull ba se were reconstructed using a free fascial flap and frontal periosteal flap; posterior and parasellar regions were reconstructed using a fat graft, vascularized nasoseptal flap, and endonasal balloon. Suturing the transcranial grafts to the parasellar dura mater was performed collaboratively by the transcranial and endonasal surgeons. In our cases, complete cessation of CSF leakage was achieved without perioperative lumbar drainage in all patients. Mean time to postoperative ambulation was 7 days (range, 3-11). No surgical complications occurred. Simultaneous transcranial and endonasal procedures were helpful to detect all sites of CSF leakage and secure reconstructive grafts. The combined transcranial and endonasal reconstructive technique achieved secure skull base reconstruction without recurrence of CSF leakage, and allowed early postoperative ambulation. This technique can be a reliable surgical option to repair CSF leakage resulting from extensive anterior skull base fractures . PMID:34078831 | DOI:10.2176/nmc.tn.2021-0085 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Brain pharmacokinetics of two BBB penetrating bispecific antibodies of different size

xlomafota13 shared this article with you from Inoreader Brain pharmacokinetics of two BBB penetrating bispecific antibodies of different size Via radioactive iodine Fluids Barriers CNS. 2021 Jun 2;18(1):26. doi: 10.1186/s12987-021-00257-0. ABSTRACT BACKGROUND: Transferrin receptor (TfR1) mediated enhanced brain delivery of antibodies have been studied extensively in preclinical settings. However, the brain pharmacokinetics, i.e. brain entry, distribution and elimination are still not fully understood for this class of antibodies. The overall aim of the study was to compare the brain pharmacokinetics of two BBB-penetrating bispecific antibodies of different size (210 vs 58 kDa). Specifically, we wanted to investigate if the faster systemic clearance of the smaller non-IgG antibody di-scFv3D6-8D3, in comparison with the IgG-based bispecific antibody mAb3D6-scFv8D3, was also reflected in the brain. METHODS: Wild-type (C57/Bl6) mice were injected with 125I-iodinated ([125I]) mAb3D6-scFv8D3 (n = 46) or [125I]di-scFv3D6-8D3 (n = 32) and euthanized 2, 4, 6, 8, 10, 12, 16, or 24 h post injection. Ex vivo radioactivity in whole blood, peripheral organs and brain was measured by γ-counting. Ex vivo autoradiography and nuclear track emulsion were performed on brain sections to investigate brain and parenchymal distribution. Capillary depletion was carried out at 2, 6, and 24 h after injection of [125I]mAb3D6-scFv8D3 (n = 12) or [125I]di-scFv3D6-8D3 (n = 12), to estimate the relative levels of radiolabelled antibody in brain capillaries versus brain parenchyma. In vitro b inding kinetics for [125I]mAb3D6-scFv8D3 or [125I]di-scFv3D6-8D3 to murine TfR were determined by LigandTracer. RESULTS: [125I]di-scFv3D6-8D3 showed faster elimination from blood, lower brain Cmax, and Tmax, a larger parenchymal-to-capillary concentration ratio, and a net elimination from brain at an earlier time point after injection compared with the larger [125I]mAb3D6-scFv8D3. However, the elimination rate from brain did not differ between the antibodies. The study also indicated that [125I]di-scFv3D6-8D3 displayed lower avidity than [125I]mAb3D6-scFv8D3 towards TfR1 in vitro and potentially in vivo, at least at the BBB. CONCLUSION: A smaller size and lower TfR1 avidity are likely important for fast parenchymal delivery, while elimination of brain-associated bispecific antibodies may not be dependent on these characteristics. PMID:34078410 | DOI:10.1186/s12987-021-00257-0 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.