Head and neck free-flap salvage

xlomafota13 shared this article with you from Inoreader Head and neck free-flap salvage Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review To highlight three clinical arenas in which head and neck free-flap compromise is encountered and acted upon: nonoperative, operative and postoperative realms. Recent findings Time to identification and intervention is paramount to successful free-flap salvage. Surgical microvascular revision remains chief amongst strategies to revert vascular compromise of a free-flap. Adjuncts, such as thrombolytics and systemic anticoagulation have an important role in the complex work of microvascular free tissue care. Venous congestion of free flaps holds favorable for salvage when compared with arterial insufficiency. Summary Vascular compromise of head and neck free flaps is a rare and feared event for microvascular surgeons, with successful transfers rates approaching above 95%. Success in salvage is dependent on prompt identification of tissue compromise and timely, directed interventions to re-establish tissue perfusion. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Emerging artificial intelligence applications in otological imaging

xlomafota13 shared this article with you from Inoreader Emerging artificial intelligence applications in otological imaging Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review To highlight the recent literature on artificial intelligence (AI) pertaining to otological imaging and to discuss future directions, obstacles and opportunities. Recent findings The main themes in the recent literature centre around automated otoscopic image diagnosis and automated image segmentation for application in virtual reality surgical simulation and planning. Other applications that have been studied include identification of tinnitus MRI biomarkers, facial palsy analysis, intraoperative augmented reality systems, vertigo diagnosis and endolymphatic hydrops ratio calculation in Meniere's disease. Studies are presently at a preclinical, proof-of-concept stage. Summary The recent literature on AI in otological imaging is promising and demonstrates the future potential of this technology in automating certain imaging tasks in a healthcare environment of ever-increasing demand and workload. Some studies have shown equivalence or superiority of the algorithm over physicians, albeit in narrowly defined realms. Future challenges in developing this technology include the compilation of large high quality annotated datasets, fostering strong collaborations between the health and technology sectors, testing the technology within real-world clinical pathways and bolstering trust among patients and physicians in this new method of delivering healthcare. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Current management of skull base osteomyelitis

xlomafota13 shared this article with you from Inoreader Current management of skull base osteomyelitis Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Skull base osteomyelitis (SBO) is a life-threatening condition. Due to an aging and increasingly multimorbid population, clinicians are more often challenged with this disease. Yet, there is no consensus on the optimal diagnostic and follow-up management. This review should aid clinicians in decision-making for their patients. Recent findings Treatment-resistant otalgia or headache is suspicious of SBO. Pseudomonas aeruginosa remains the most common pathogen but clinicians are challenged with increasing rates of sterile or fungal cultures due to previously applied antibiotics/steroids. No single imaging modality is able to detect the full extent of the disease. Whereas functional nuclear imaging with gallium-67 or methylene diphosphonate-technetium-99m was once advocated, its actual benefit is questionable. Newer modalities such as fluoro-D-glucose-positron emission tomography (PET)/computed tomography, PET/magnetic resonance imaging (MRI), or diffusion-weighted MRI seem to be promising in diagnosis and follow-up. Finding the causative pathogen is of utmost importance followed by long-term intravenous antibiotics until the disease has completely resolved. Surgery plays a minor role in treatment but can be helpful in selected cases. Summary The numerous challenges in SBO render management difficult, but with a clear work-up including regular clinical, laboratory and imaging examinations, outcome can be improved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Segmental mandibular reconstruction in patients with poor lower extremity perfusion, vessel-depleted necks and/or profound medical frailty

xlomafota13 shared this article with you from Inoreader Segmental mandibular reconstruction in patients with poor lower extremity perfusion, vessel-depleted necks and/or profound medical frailty Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Options for segmental mandibular reconstruction in patients poorly suited to undergo fibula free flap (FFF). Recent findings Although FFF is the current 'gold standard' for segmental mandibular reconstruction, other reconstructive options must be considered when FFF is contraindicated or disfavoured and/or patient frailty precludes a lengthy anaesthetic. In addition to various nonvascularized and soft tissue only reconstructions, excellent osseous free flap alternatives for functional segmental mandibular reconstruction may be employed. The subscapular system free flaps (SSSFF) may be ideal in frail and/or elderly patients, as SSSFF allows for early mobility and does not alter gait. In extensive and/or symphyseal defects, functional mandibular reconstruction in lieu of a free flap is extremely limited. Pedicled segmental mandibular reconstructions remain reasonable options, but limited contemporary literature highlights unpredictable bone graft perfusion and poor long-term functional outcomes. Summary There are several excellent free flap alternatives to FFF in segmental mandibular reconstruction, assuming adequate cervical recipient vessels are present. On the basis of the current literature, the optimal mandibular reconstruction for the medically frail, elderly and/or patients with extreme vessel-depleted necks is limited and debatable. In qualifying (i.e. limited, lateral) defects, soft tissue only reconstructions should be strongly considered when osseous free flaps are unavailable. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Assessment of peak inspiratory flow in the management of acute inspiratory dyspnoea

xlomafota13 shared this article with you from Inoreader Assessment of peak inspiratory flow in the management of acute inspiratory dyspnoea 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. 2021 Sep 2. doi: 10.1007/s00405-021-07066-z. Online ahead of print. ABSTRACT PURPOSE: Assessment of inspiratory dyspnoea associated with upper airway obstruction is based on subjective clinical and nasal fibreoptic laryngoscopy (NFL) signs. The aim of this study was to determine whether peak inspiratory flow (PIF) measurement could indicate the need for upper airway release surgery in patients with acute inspiratory dyspnoea during emergency. METHODS: A retrospective single-institution study (February 2018-March 2020) of 48 patients with acute inspiratory dyspnoea and PIF measurement (Peak Flow In-Check Dial G16®-Harlow-England) was conducted. The surgical decision was based on the clinical evaluation of the patient's respiratory tolerance and NFL. RESULTS: Forty-eight patients were included in this study. Thirty-five patients underwent surgery (PIF: 36 L/min), and 13 patients did not (PIF: 58 L/min) (p = 0.0009). Three of these 13 patients underwent an operation later (PIF value: 42 L/min versus 63 L/min for the 10 others [p = 0.25]). CONCLUSION: PIF measurement is a quantitative, objective, inexpensive, non-invasive, and quick test that is potentially useful for general practitioners, mobile medical teams, or for ear-nose-and-throat specialists. A threshold of 42 L/min can help doctors in emergency decision making to refer patients to an ear-nose-and-throat specialist to release the upper airway and perform surgery or to choose medical monitoring for patients with emergency inspiratory dyspnoea. PMID:34476594 | DOI:10.1007/s00405-021-07066-z View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The use of polypropylene mesh in inguinal hernia surgery: A retrospective study

xlomafota13 shared this article with you from Inoreader The use of polypropylene mesh in inguinal hernia surgery: A retrospective study Via Experimental and therapeutic medicine Exp Ther Med. 2021 Oct;22(4):1193. doi: 10.3892/etm.2021.10627. Epub 2021 Aug 17. ABSTRACT Previously, inguinal hernia surgery was based exclusively on repairing the abdominal wall defects using the patient's own tissues, which were put in contact with and tensioned to recalibrate the natural orifices. At present, inguinal hernia surgery is based almost solely on mounting an allograft, which has the role of strengthening the weakened groin region that allowed the herniation. This modern method of operation on inguinal hernia can be performed in a classic or laparoscopic manner. The mesh is made of polypropylene, which is a polymer of cyclic hydrocarbons. The aim of the present study was to evaluate the effectiveness, biocompatibility, as well as the immediate and long-term complications in textile allografts used in open surgery of inguinal hernia repair. Another aim was to demonstrate once again the superiority of low-weight meshes wi th large pores by decreasing the number of complications caused by the synthetic material used, but also by a decrease in the tension on the tissues to which it was fixed. The present study included 255 cases submitted to inguinal hernia surgery. Only 1.5% required immediate reintervention before discharge to evacuate hematoma. The short duration of hospitalization, the quality-price ratio, the good postoperative results, as well as the rapid socio-professional reintegration, render the use of polypropylene mesh in inguinal hernia surgery very attractive for patients. PMID:34475983 | PMC:PMC8406872 | DOI:10.3892/etm.2021.10627 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Detection of mitochondrial coupling factor 6 in placental tissues from preeclamptic pregnancies and its influence on biological behavior of trophoblast cells

xlomafota13 shared this article with you from Inoreader Detection of mitochondrial coupling factor 6 in placental tissues from preeclamptic pregnancies and its influence on biological behavior of trophoblast cells Via Experimental and therapeutic medicine Exp Ther Med. 2021 Oct;22(4):1185. doi: 10.3892/etm.2021.10619. Epub 2021 Aug 16. ABSTRACT Increased levels of mitochondrial coupling factor 6 (CF6) are present in the peripheral blood of patients with preeclamptic pregnancies, and are particularly evident in cases of early-onset or severe preeclampsia. The present study examined the location and expression levels of CF6 in the placental tissue and its effect on the biological behavior of trophoblast cells. Placental tissue microarrays, including placental villous cytotrophoblast and extravillous cytotrophoblast microarrays, were used to detect the location and relative expression levels of CF6 in the placenta using immunohistochemistry. It was found that CF6 was expressed in both the normal and preeclamptic placenta, but its levels were higher in the preeclamptic tissues. In addition, the effects of the hypoxic environment on the biological behaviors of trophoblast cells were investig ated in the JAR and JEG-3 cell lines. Following induction of hypoxia, the expression levels of CF6 were increased. Moreover, exogenous addition of human recombinant CF6 attenuated cell invasion, but exerted no effect on cell proliferation. At the molecular level, the expression levels of MMP-2 were decreased and were accompanied with a reduction in cell invasion following addition of exogenous CF6. In conclusion, the increased expression levels of CF6 and its effects in reducing the invasive abilities of trophoblast cells may be involved in the pathogenesis of severe preeclampsia. PMID:34475975 | PMC:PMC8406808 | DOI:10.3892/etm.2021.10619 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Rosuvastatin protects PC12 cells from hypoxia/reoxygenation-induced injury by inhibiting endoplasmic reticulum stress-induced apoptosis

xlomafota13 shared this article with you from Inoreader Rosuvastatin protects PC12 cells from hypoxia/reoxygenation-induced injury by inhibiting endoplasmic reticulum stress-induced apoptosis Via Experimental and therapeutic medicine Exp Ther Med. 2021 Oct;22(4):1189. doi: 10.3892/etm.2021.10623. Epub 2021 Aug 17. ABSTRACT The endoplasmic reticulum stress (ERS) response serves an important role in cerebral ischemia-reperfusion injury (CIRI). However, to the best of the our knowledge, the effect of rosuvastatin on the ERS response in CIRI has not yet been studied. In the present study, the effect of rosuvastatin on cell damage in CIRI was investigated; furthermore, the effect of rosuvastatin on the ERS response was explored. Firstly, a hypoxia/reoxygenation (H/R)-induced cell damage model was established in PC12 cells. Cell viability was subsequently detected by a Cell Counting Kit-8 assay. A lactate dehydrogenase kit was used to detect cytotoxicity. TUNEL assay was then used to measure the extent of cell apoptosis, and western blotting was used to analyze the expression levels of the apoptosis-associated proteins Bax, Bcl-2, cleaved caspase-3 and cleaved caspase-9. In addition, western blotting was used to detect the expression levels of ERS-associated proteins, including phosphorylated (p)-protein kinase R-like endoplasmic reticulum kinase (PERK), p-eukaryotic initiation factor 2α and other proteins. Treatment with rosuvastatin led to an increased activity of H/R-induced PC12 cells and a decrease in their cytotoxicity. Rosuvastatin also led to an inhibition in apoptosis and ERS in H/R-induced PC12 cells. After administration of the ERS response activator thapsigargin (TG), TG was found to reverse the protective effect of rosuvastatin on injury of H/R-induced PC12 cells. Taken together, these findings have shown that rosuvastatin is able to protect PC12 cells from H/R-induced injury via inhibiting ERS-induced apoptosis, providing a strong theoretical basis for the use of rosuvastatin in the clinical treatment of CIRI. PMID:34475979 | PMC:PMC8406900 | DOI:10.3892/etm.2021.10623 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Rapamycin suppresses the PI3K/AKT/mTOR signaling pathway by targeting SIRT1 in esophageal cancer

xlomafota13 shared this article with you from Inoreader Rapamycin suppresses the PI3K/AKT/mTOR signaling pathway by targeting <em>SIRT1</em> in esophageal cancer Via Experimental and therapeutic medicine Exp Ther Med. 2021 Oct;22(4):1190. doi: 10.3892/etm.2021.10624. Epub 2021 Aug 17. ABSTRACT Rapamycin, a secondary metabolite produced by Streptomyces hygroscopicus, is known for its pharmacological effects, especially antitumor and immunosuppressive activities. However, the antitumoral effects of rapamycin in human esophageal cancer (EC) are still poorly understood. To investigate the potential of rapamycin in EC treatment, sirtuin 1 (SIRT1) mRNA expression was quantified in the tissue of patients with EC or in EC cell lines using reverse transcription-quantitative PCR. The protein levels of SIRT1 and PI3K/AKT/mTOR were measured via western blotting. Furthermore, cell viability, migration and invasion were investigated by Cell Counting Kit-8, wound healing and Transwell assays, respectively. The present results suggested that SIRT1 expression was upregulated in EC. In vitro, the inhibitory effect of r apamycin on cell viability in EC was strengthened or weakened after small interfering (si)-SIRT1 or pcDNA3.1/SIRT1 transfection. Furthermore, SIRT1 rescued the inhibitory effect of rapamycin on the migration and invasion of EC cells. In vivo, si-SIRT1 or SIRT1 overexpression in mice could enhance or rescue the inhibitory effects of rapamycin on tumor growth. In addition, SIRT1 transfection rescued the decreased level of phosphorylated (p)-PI3K, p-AKT and p-mTOR induced by rapamycin treatment. Taken together, the present results suggested that rapamycin suppressed the cell viability, migration, invasion and PI3K/AKT/mTOR signaling pathway in EC by negatively regulating SIRT1. PMID:34475980 | PMC:PMC8406672 | DOI:10.3892/etm.2021.10624 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The differential expression of perilipin-2 in hepatoblastoma and its association with prognosis

xlomafota13 shared this article with you from Inoreader The differential expression of perilipin-2 in hepatoblastoma and its association with prognosis Via Cellular and Molecular Biology Histol Histopathol. 2021 Sep 3:18371. doi: 10.14670/HH-18-371. Online ahead of print. ABSTRACT Perilipin-2, a lipid droplet (LD) coating protein, has been found to be involved in cancer progression. However, its role in hepatoblastoma (HB) is undefined. We collected 87 HB samples and the corresponding clinical data. Immunohistochemistry (IHC) staining was performed to detect perilipin-2 and the association of the perilipin-2 expression with clinical characteristics and prognosis was analyzed. The expression of perilipin-2 was increased in fetal HB components in comparison to embryonal HB components. The predominant staining pattern was vesicular in fetal HB cells, while it was granular in embryonal HB cells. Furthermore, strong expression of perilipin-2 was associated with the histopathological type of fetal predominant HB. Although event-free survival (EFS) did not differ to a statistically significant extent between the strong and we ak expression groups in a univariate survival analysis, a multivariate survival analysis revealed that EFS was significantly improved in the strong perilipin-2 expression group. In conclusion, perilipin-2 is differentially expressed in HB and the strong expression of perilipin-2 predicts a better prognosis. PMID:34477212 | DOI:10.14670/HH-18-371 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Speech pathology service enhancement for people with head and neck cancer living in rural areas: Using a concept mapping approach to inform service change

xlomafota13 shared this article with you from Inoreader Speech pathology service enhancement for people with head and neck cancer living in rural areas: Using a concept mapping approach to inform service change Via Head & Neck Abstract Background Speech pathology (SP) services provide swallowing and communication intervention to people with head and neck cancer (HNC) across the continuum of care. However, difficulties exist with access and delivery of services in rural areas. The study aim was to identify actionable goals for SP change, utilizing a concept mapping approach. Methods Eleven SP staff from two regional/remote services completed the concept mapping process. Multivariate analysis and multidimensional scaling were used to develop a final set of prioritized goals for change. Results Between the two participating health services, 30 actionable goals were identified within the "green-zone" on the go-zone graph of importance and changeability. Among the most highly rated areas for change was the need to deliver and receive more support for training, mentoring, and supervision to consolidate skills. Conclusions This methodology enabled identification of prioritized, actionable changes to improve SP services for people with HNC living in regional/remote areas. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.