Τρίτη 12 Ιανουαρίου 2021

Bypass grafting in recurrent nasopharyngeal carcinoma patients with internal carotid artery invasion

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Publication date: Available online 12 January 2021

Source: American Journal of Otolaryngology

Author(s): Zhouyang Zhao, Lijin Huang, Jinhua Chen, Weijia Huang, Xiaobin Zhang, Yue Ma, Hongshen Zhu, Zhang Liu

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Intra-operative parathyroid hormone evaluation is superior to frozen section analysis in parathyroid surgery

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Publication date: Available online 12 January 2021

Source: American Journal of Otolaryngology

Author(s): Süleyman Özkan Aksoy, Süleyman Cem Adiyaman, Ali Durubey Çevlik, Merih Güray Durak, Mustafa Seçil, Ali İbrahim Sevinç

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Edoscopic posterior nasal neurectomy with submucosal turbinectomy for the treatment of intractable severe chronic rhinitis

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Publication date: Available online 11 January 2021

Source: Auris Nasus Larynx

Author(s): Serika Sonoda, Daisuke Murakami, Yuichi Saito, Yusuke Miyamoto, Ryota Higuchi, Yoshikazu Kikuchi, Motohiro Sawatsubashi, Takashi Nakagawa

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Oscillatory biomarkers of early auditory information processing predict cognitive gains following targeted cognitive training in schizophrenia patients.

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Oscillatory biomarkers of early auditory information processing predict cognitive gains following targeted cognitive training in schizophrenia patients.

Schizophr Res. 2020 01;215:97-104

Authors: Hochberger WC, Thomas ML, Joshi YB, Molina J, Treichler EBH, Nungaray J, Cardoso L, Sprock J, Swerdlow N, Light GA

Abstract
Auditory-based targeted cognitive training (TCT) is an effective and well-validated intervention for the treatment of cognitive impairment in schizophrenia patients. Improvements in higher-order cognition, reductions in symptom severity, and increases in psychosocial functioning secondary to TCT are thought to be driven by "bottom-up" enhancement of early auditory information processing (EAIP). Despite strong evidence of efficacy at the group level, there is significant variability in response to TCT, with few well-delineated biomarkers for predicting individual benefit. EEG biomarkers of EAIP are indicators of early-treatment sensitivity that predict full-course TCT outcome; however, further characterization is necessary for biomarker-guided clinical trials. The current study examined baseline and early-treatment sensitivity (i.e., change from baseline after 1 h) in theta band oscillatory activity to deviant stimuli as moderators of full course (30 h) TCT response in tre atment-refractory schizophrenia patients randomly assigned to receive either treatment-as-usual (TAU; n = 22) or TAU augmented with TCT (n = 30). Theta evoked power and phase locking at baseline predicted patient improvements in global cognitive function after 30 h of TCT. Decrease in theta activity to deviant stimuli after 1 h of TCT predicted improvements in verbal learning after 30 h. Exploratory analyses using EEG composite scores had high levels of sensitivity and specificity for identifying patients most likely to benefit from TCT. The integrity of baseline neurophysiologic activity associated with EAIP, as well as the sensitivity of the underlying circuity to change, likely reflects an intermediate therapeutic process underlying the effectiveness of TCT that can be used to predict patient response to treatment.

PMID: 31759809 [PubMed - indexed for MEDLINE]

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Role of the temporoparietal fascia free flap in salvage total laryngectomy

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Abstract

The procedure for salvage total laryngectomy (STL) is burdened by a high rate of postoperative complications as a result of delayed wound healing in previously irradiated tissue. Several observational studies have investigated the role of prophylactic vascularized flaps to aid pharyngeal closure after STL and prevent the development of PCF. The use of a temporoparietal fascia free flap (TFFF) as an overlay flap for STL has been described previously in two published studies and both sets of authors agreed that the most obvious benefit of the TFFF in STL is a reduced PCF rate with low site morbidity and good functional outcomes. The aim of this video is to illustrate the use of the temporoparietal fascia flap to provide an adjunctive reinforcement layer in the reconstruction of the pharynx.

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Patterns of Facial Fractures

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Objective/Hypothesis

To report characteristics and management of facial fractures in a major metropolitan center within the United States.

Study Design

Retrospective chart review.

Methods

Retrospective review at a level 1 trauma academic medical center of 3,946 facial fractures in 1,914 patients who presented from 2008 to 2017. Demographics, injury mechanism, associated injuries, and treatment information were collected. Logistic regression analyses were performed to determine factors associated with management.

Results

There were 1,280 males and 630 females with a median age of 42 years. Orbital fractures were the most common (41.4%) followed by maxilla fractures (21.9%). The most common mechanism was fall (43.6%). Surgical management was recommended for 38% of patients. The odds of surgical management were less for females (OR 0.59, 95% CI 0.48–0.73). Patients over 70 years were significantly less likely to undergo surgery compared to other age groups (OR 0.15–0.36, P < .001). The odds of surgical management were 1.69 times greater for patients with more than three fractures than for a single fracture (95% CI 1.18–2.42) and 2.23 times greater for traffic injuries compared to injuries from activities of daily living (95% CI 1.42–3.5).

Conclusions

This represents one of the largest comprehensive databases of facial fractures. Our patients were most frequently injured during activities of daily living, most commonly from falls. The majority of patients were managed conservatively. Gender, age, fracture number, and mechanism of injury were independently associated with the decision to treat surgically. Our data are in stark contrast to that from other populations in which assault or motor vehicle accidents predominate.

Level of Evidence

4 Laryngoscope, 2021

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Glutamine Inhibition Reduces Iatrogenic Laryngotracheal Stenosis

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Objective/Hypothesis

Glutamine inhibition has been demonstrated an antifibrotic effect in iatrogenic laryngotracheal stenosis (iLTS) scar fibroblasts in vitro. We hypothesize that broadly active glutamine antagonist, DON will reduce collagen formation and fibrosis‐associated gene expression in iLTS mice.

Study Design

Prospective controlled animal study.

Methods

iLTS in mice were induced by chemomechanical injury of the trachea using a bleomycin‐coated wire brush. PBS or DON (1.3 mg/kg) were administered by intraperitoneal injection (i.p.) every other day. Laryngotracheal complexes were harvested at days 7 and 14 after the initiation of DON treatment for the measurement of lamina propria thickness, trichrome stain, immunofluorescence staining of collagen 1, and fibrosis‐associated gene expression.

Results

The study demonstrated that DON treatment reduced lamina propria thickness (P = .025) and collagen formation in trichrome stain and immunofluorescence staining of collagen 1. In addition, DON decreased fibrosis‐associated gene expression in iLTS mice. At day 7, DON inhibited Col1a1 (P < .0001), Col3a1 (P = .0046), Col5a1 (P < .0001), and Tgfβ (P = .023) expression. At day 14, DON reduced Co1a1 (P = .0076) and Tgfβ (P = .023) expression.

Conclusions

Broadly active glutamine antagonist, DON, significantly reduces fibrosis in iLTS mice. These results suggest that the concept of glutamine inhibition may be a therapeutic option to reduce fibrosis in the laryngotracheal stenosis.

Level of Evidence

N/A Laryngoscope, 2021

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Middle turbinate mucosal flap: A low‐morbidity option in the management of skull base defects

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Abstract

Background

To describe the low morbidity of middle turbinate mucosal flap (MTMF) to repair anterior skull base defects.

Methods

Skull base endonasal endoscopic surgeries performed at a tertiary hospital between 2015 and 2018 were analyzed. Patients were divided into two groups according the existence or not of a significant intraoperative cerebrospinal fluid (CSF) leak. In Group 1 (n = 28), gasket seal and a pedicled endonasal flap were used to repair the defect: 13 nasoseptal flaps (NSF), 8 inferolateral wall flaps (ILF), and 7 MTMF. In Group 2 only an endonasal flap was used: 9 NSF, 4 ILF, and 18 MTMF. Surgical and recovery time were analyzed (Student's t test). Our favorite surgical technique is described.

Results

Fifty‐nine patients were included. Average surgical time was 27.7, 41.6, and 11.3 min for NSF, ILF, and MTMF, respectively. MTMF showed a faster recovery.

Conclusion

MTMF is a safe reconstructive option for anterior skull base defects.

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VHI-10 Scores in a Treatment-Seeking Population With Dysphonia

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The VHI-10 is a patient-reported outcome measure used to record the patient's perception of impairment or handicap due to a voice problem. Scores above 11 are abnormal and indicate voice handicap. Amongst a treatment-seeking population in a large tertiary voice center, scores below the VHI-10 cutoff score of 11 were frequently noted. The aim of this study was to examine the number of people seeking voice therapy for dysphonia who scored below the established VHI-10 cutoff score.
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Expression and Role of Thyrotropin Receptors in Proopiomelanocortin-Producing Pituitary Cells

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Thyroid, Ahead of Print.
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Use of a modular ontology and a semantic annotation tool to describe the care pathway of patients with amyotrophic lateral sclerosis in a coordination network

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journal.pone.0244604.g004&size=inline

by Sonia Cardoso, Pierre Meneton, Xavier Aimé, Vincent Meininger, David Grabli, Gilles Guezennec, Jean Charlet

The objective of this study was to describe the care pathway of patients with amyotrophic lateral sclerosis (ALS) based on real-life textual data from a regional coordination network, the Ile-de-France ALS network. This coordination network provides care for 92% of patients diagnosed with ALS living in Ile-de-France. We developed a modular ontology (OntoPaRON) for the automatic processing of these unstructured textual data. OntoPaRON has different modules: the core, medical, socio-environmental, coordination, and consolidation modules. Our approach was unique in its creation of fully defined concepts at different levels of the modular ontology to address specific topics relating to healthcare trajectories. We also created a semantic annotation tool specific to the French language and the specificities of our corpus, the Ontology-Based Semantic Annotation Module (OnBaSAM), using the OntoPaRON ontology as a reference. We used these tools to annotate the records of 928 patients automati cally. The semantic (qualitative) annotations of the concepts were transformed into quantitative data. By using these pipelines we were able to transform unstructured textual data into structured quantitative data. Based on data processing, semantic annotations, sociodemographic data for the patient and clinical variables, we found that the need and demand for human and technical assistance depend on the initial form of the disease, the motor state, and the patient age. The presence of exhaustion in care management, is related to the patient's motor and cognitive state.
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Associated factors, health-related quality of life, and reported costs of chronic otitis media in adults at two otologic referral centers in a middle-income country

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journal.pone.0244797.g002&size=inline

by Lucia C. Pérez-Herrera, Daniel Peñaranda, Sergio Moreno-López, Ana M. Otoya-Tono, Lorena Gutiérrez- Velasco, Juan Manuel García, Augusto Peñaranda

Background

Despite the high prevalence of chronic otitis media (COM) in low to middle-income countries, there are few studies regarding its associated factors, health-related quality of life, and treatment costs. This study aimed to identify associated factors of COM, assess its impact on the quality of life as well as estimate the patients' reported costs of COM treatment in Colombia.

Methods

Cross-sectional study. Two otology-referral centers in Bogotá (Colombia) were included. Questionnaires focusing on sociodemographic and clinical associated factors, quality of life, and patients' reported costs were administered to 200 adults with COM diagnosis and 144 control adults. Otoscopic evaluation and audiometric data were collected.

Results

The mean age was 42.2 years (SD: 14.44). The median length of COM was 26.13 years (SD: 17.06), and 79.5% of the COM patients reported otorrhea during childhood (P-value: 0.01). The most frequently reported allergic disease amon g our study population was allergic rhinitis (26.5%). COM was less frequent in patients with a medium-high socioeconomic status (PR: 0.54; 95% CI: 0.39–0.72), and more frequent in patients who reported increased ear discharge due to upper respiratory tract infections (PR: 1.69; 95% CI: 1.68–1.70). The global score of the "Chronic Suppurative Otitis Media Questionnaire-12" showed a difference of 9 points between patients with active and inactive COM (P Conclusions

Associated factors found in this study are consistent with previous reports. COM has a significant financial impact and affects patients' quality of life. Worldwide research addressing these issues in poor-resource countries is scarce, further studies are needed.

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