Thursday, April 15, 2021

‘’Comparison of Two Surgical Techniques for the Treatment of Transverse Olecranon Fractures: A Finite Element Study’’

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ABSTRACT

Background

In this study, we aimed to compare the stability of traditional tension band wiring (TBW) and screw combined TBW (SC‐TBW) fixation methods performed for a transverse olecranon osteotomy‐fracture during different degrees of elbow movement by using finite element analysis (FEA).

Methods

Three‐dimensional solid modeling of the olecranon was obtained by computed tomography (CT) images. Transverse olecranon fracture was created and fixed by TBW and SC‐TBW with respect to triceps muscle force. Open‐angle, twisting angle and interplanar translation occurring on the fracture line were evaluated at 45° and 90° elbow flexion.

Results

Open‐Angle: 0.71°, 0.87° at 45° and 0.64°, 0.67° at 90° elbow flexion for TBW and SC‐TBW respectively. Twisting‐Angle: ‐0.01°, ‐0,19° at 45° flexion and 0.19°, 0.30° at 90° flexion for TBW and SC‐TBW respectively. Interplanar Translation: 1.93 mm, 4.65 mm at 45° flexion and 1,78 mm, 3,95 mm at 90° flexion for TBW and SC‐TBW respectively.

Conclusion

TBW fixation provides more stability than SC‐TBW fixation model.

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A new robotically assisted system for total knee arthroplasty: A sheep model study

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Abstract

Background

We investigated the accuracy and safety of a new HURWA robotic‐assisted total knee arthroplasty (TKA) system in a sheep model.

Methods

Ten male Small‐tailed Han sheep were used in this study. Sheep were imaged by computed tomography scan before and after bone resection and the cutting errors between actual bone preparation and preoperative planning of the femur and tibia in 3 dimensions were measured .

Results

The overall accuracies after surgery compared with that from preoperative surgical planning of the left and right femurs were 1.93±1.02° and 1.93±1.23°, respectively. Additionally, similarly high overall accuracies for the left and right tibia of 1.26±1.04 and 1.68±0.92°, respectively, were obtained. The gap distances of the distal cut, anterior chamfer, anterior cut, posterior chamfer, and posterior cut on the medial side were 0.47±0.35 mm, 0.41±0.37 mm, 0.12±0.26 mm, 0.41±0.44 mm, and 0.12±0.23 mm, respectively. No intraoperative complications, such as intraoperative fracture, massive bleeding or death, occurred

Conclusion

This new HURWA robotic‐assisted TKA system is an accurate and safe tool for TKA surgery based on the sheep model.

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Efficacy and Safety of Propranolol vs Atenolol in Infants With Problematic Infantile Hemangiomas

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This randomized clinical trial compares the efficacy and safety of propranolol vs atenolol in Chinese infants with problematic infantile hemangiomas.
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Rapid Sequence Induction and Intubation for Patients With Hereditary Hemorrhagic Telangiectasia

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This case report describes a middle-aged man with severe recurrent epistaxis refractory to medical therapy who underwent operative ablation of intranasal telangiectasias.
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Importance of Margins, Radiotherapy, and Systemic Therapy in Mucosal Melanoma of the Head and Neck

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Objectives/Hypothesis

The ideal strategy in the treatment of mucosal melanoma of the head and neck (MMHN) remains unclear. Our objective was to evaluate the importance of surgical margins, radiotherapy, and systemic therapy in MMHN.

Study Design

Retrospective Single Institutional Review.

Methods

Retrospective review of patients with MMHN treated at a tertiary care oncology center between 1999 and 2016.

Results

Seventy‐six patients were included, 60 of whom were treated with curative intent. Negative or close margins compared with positive margins were associated with higher 3‐year overall survival (OS) (62% vs. 29% vs. 13% P = .012), disease‐free survival (33% vs. 29% vs. 4% P = .003), and distant control (48% vs. 29% vs. 22% P = .039). Cases with pre‐/postoperative radiotherapy had a marginally higher locoregional control versus without (69% vs. 59%, P = .117). Immunotherapy for recurrent and/or metastatic disease was associated with an increase in 3‐year OS (15% vs. 3% P = .01).

Conclusion

Achieving negative surgical margins is relevant in disease control. Despite small sample size, our data suggest that radiotherapy may enhance surgical outcomes. Immunotherapy has therapeutic benefit.

Level of Evidence

3 Laryngoscope, 2021

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Long-term outcomes of dual innervation in functional muscle transfers for facial palsy

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J Plast Reconstr Aesthet Surg. 2021 Mar 22:S1748-6815(21)00096-6. doi: 10.1016/j.bjps.2021.03.007. Online ahead of print.

ABSTRACT

BACKGROUND: This study describes a different approach with a 2-stage facial reanimation in patients with long-standing unilateral facial paralysis using free gracilis muscle transfer, innervated by both cross-facial nerve graft and masseteric nerve. The authors present their rationale, surgical technique, and long-term outcomes.

METHODS: Between August 2012 and March 2016, 11 patients (6 female and 5 male patients) underwent a 2-staged dually innervated gracilis muscle transfer. Patients were evaluated with physical examination and needle electromyography. A standardized assessment of preoperative and postoperative photographs and videos was performed using Terzis' smile functional grading system at 48 months following surgery and the Emotrics software to assess improvement in symmetry over a 36-month postoperative period.

RESULTS: Voluntary contraction of the gracilis muscle was observed in all patients at a mean of 4 months and 4 days following muscle transfer. A spontaneous smile produced without teeth clenching was developed in all patients by 18 months postoperatively. Six patients achieved excellent and 5 good results. The difference between the averaged pre- and postoperative scores was statistically significant. With Emotrics, there were significant improvements in the smile angle, upper lip elevation, commissural excursion, and commissural height, with continuous improvement over 36 months. The postoperative electromyography (EMG) confirmed dual innervation of the gracilis muscle by the facial and masseteric donor motor neural sources. We present our results at minimum 48 months postoperatively.

CONCLUSIONS: Dual innervated two-stage gracilis transfer is an effective method for reanimation in long-standing unilateral facial paralysis, providing both rapid re innervation of the transferred muscle, together with a powerful, synchronous smile.

PMID:33853750 | DOI:10.1016/j.bjps.2021.03.007

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Evaluation of Metastatic Lymph Nodes in Oral Squamous Cell Carcinoma: A Comparative Study of Clinical, FNAC, Ultra Sonography and Computed Tomography with Post Operative Histopathology

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Abstract

All the head and neck tumours, more than 90% are squamous cell carcinomas (SCC). The presence of metastatic cervical lymph nodes histologically positive for SCC provides one of the simplest and most important prognostic factor in patients with head and neck cancer. In this study, all patients were examined clinically for, location, number, size, shape, consistency and fixation of cervical neck nodes to the underlying structure, and the same was carried out by FNAC, USG and CT. Findings of these modalities and histopathological results were compared for the overall metastases of lymph nodes in the neck. The accuracy of clinical examination was 87.77% and sensitivity only 41.66%. FNAC has the greatest specificity, 98.71% and least sensitivity, 33.33%. The accuracy of FNAC was 90%. The positive predictive value and negative predictive value of FNAC were 80.0% and 90.58% respectively. USG revealed 50% of sensitivity. Specificity of USG was 93.58% and accuracy 87.77%. CT scan have the highest sensitivity among all other tests, 66.66%.The negative predictive value for CT scan was also the highest, 94.59%. Specificity and accuracy of CT scan was 89.74% and 86.66% respectively. This study concludes that USG with FNAC is the most accurate in evaluating metastatic lymph nodes in oral squamous cell carcinoma patients along with other investigations like CT scan for staging of the oral squamous cell carcinoma.

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A cartilage conserving concept of a surgical tracheostomy-introduction and analysis of safety and complications of the Visor-tracheostomy-a retrospective monocentric comparative study over 8 years

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Eur Arch Otorhinolaryngol. 2021 Apr 14. doi: 10.1007/s00405-021-06802-9. Online ahead of print.

ABSTRACT

INTRODUCTION: For decades, surgical tracheostomy using a Bjoerk-flap has been the standard procedure to create a reliable epithelialized tracheostomy in head and neck tumour surgery. This technique is being used as the gold standard approach in every surgical subspecialty. Preparation of the Bjoerk-flap requires splitting one or two tracheal rings, causing potential tracheal instability and tissue trauma. As a surgical alternative, the Visor-tracheostomy allows creating an epithelialized tracheostomy without splitting tracheal rings. This work aimed to prove the safety of the Visor-tracheostomy method, due to peri- and early postoperative complications.

METHODS: We present a step-by-step approach of this "new tracheostomy method". Monocentric, retrospective data within 8 years were evaluated. Complications such as wound infect ion, tracheostoma bleeding, tracheostoma dehiscence, and via falsa in a total of 453 tracheostomies (161 Bjoerk-flap and 292 Visor-tracheostomies) were compared and the results were analysed descriptively.

RESULTS: Our data did not reveal a statistically significant difference in risk for a complication between the two methods (Visor-tracheostomy vs. Bjoerk-flap; p = 0.60; OR = 1.26, 95%-CI 0.60-2.82). This supports the hypothesis that applying the new cartilage conserving Visor-tracheostomy does not result in a reduction of safety for the patient.

CONCLUSION: We contend, that the Visor-tracheostomy has the potential to supersede other surgical tracheostomy techniques in some indications.

LEVEL OF EVIDENCE: III (Comparative retrospective monocentric study).

PMID:33855627 | DOI:10.1007/s00405-021-06802-9

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Appropriateness for SARS-CoV-2 vaccination for otolaryngologist and head and neck surgeons in case of pregnancy, breastfeeding, or childbearing potential: Yo-IFOS and CEORL-HNS joint clinical consensus statement

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Eur Arch Otorhinolaryngol. 2021 Apr 15. doi: 10.1007/s00405-021-06794-6. Online ahead of print.

ABSTRACT

PURPOSE: SARS-CoV-2 vaccines are a key step in fighting the pandemic. Nevertheless, their rapid development did not allow for testing among specific population subgroups such as pregnant and breastfeeding women, or elaborating specific guidelines for healthcare personnel working in high infection risk specialties, such as otolaryngology (ORL). This clinical consensus statement (CCS) aims to offer guidance for SARS-CoV-2 vaccination to this high-risk population based on the best evidence available.

METHODS: A multidisciplinary international panel of 33 specialists judged statements through a two-round modified Delphi method survey. Statements were designed to encompass the following topics: risk of SARS-Cov-2 infection and use of protective equipment in ORL; SARS-Cov-2 infection and vaccines and respective risks for the mother/ child dyad; and counseling for SARS-CoV-2 vaccination in pregnant, breastfeeding, or fertile healthcare workers (PBFHW). All ORL PBFHW were considered as the target audience.

RESULTS: Of the 13 statements, 7 reached consensus or strong consensus, 2 reached no consensus, and 2 reached near-consensus. According to the statements with strong consensus otorhinolaryngologists-head and neck surgeons who are pregnant, breastfeeding, or with childbearing potential should have the opportunity to receive SARS-Cov-2 vaccination. Moreover, personal protective equipment (PPE) should still be used even after the vaccination.

CONCLUSION: Until prospective evaluations on these topics are available, ORL-HNS must be considered a high infection risk specialty. While the use of PPE remains pivotal, ORL PBFHW should be allowed access to SARS-CoV-2 vaccination provided they receive up-to-date information.

PMID:33855628 | DOI:10.1007/s00405-021-06794-6

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Update and review of the gerodontology prospective for 2020's: Linking the interactions of oral (hypo)-functions to health vs. systemic diseases

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J Dent Sci. 2021 Mar;16(2):757-773. doi: 10.1016/j.jds.2020.09.007. Epub 2020 Oct 17.

ABSTRACT

New lines of evidence suggest that the oral-systemic medical links and oral hypo-function are progressively transcending beyond the traditional clinical signs and symptoms of oral diseases. Research into the dysbiotic microbiome, host immune/inflammatory regulations and patho-physiologic changes and subsequent adaptations through the oral-systemic measures under ageism points to pathways leading to mastication deficiency, dysphagia, signature brain activities for (neuro)-cognition circuitries, dementia and certain cancers of the digestive system as well. Therefore, the coming era of oral health-linked systemic disorders will likely reshape the future of diagnostics in oral geriatrics, treatment modalities and professional therapies in clinical disciplines. In parallel to these highlights, a recent international symposium was jointly held by the Inte rnational Association of Gerontology and Geriatrics (IAGG), Japanese Society of Gerodontology (JSG), the representative of USA and Taiwan Academy of Geriatric Dentistry (TAGD) on Oct 25th, 2019. Herein, specific notes are briefly addressed and updated for a summative prospective from this symposium and the recent literature.

PMID:33854730 | PMC:PMC8025188 | DOI:10.1016/j.jds.2020.09.007

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Immunotherapy-induced antibodies to endogenous retroviral envelope glycoprotein confer tumor protection in mice

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by Byong H. Kang, Noor Momin, Kelly D. Moynihan, Murillo Silva, Yingzhong Li, Darrell J. Irvine, K. Dane Wittrup

Following curative immunotherapy of B16F10 tumors, ~60% of mice develop a strong antibody response against cell-surface tumor antigens. Their antisera confer prophylactic protection against intravenous challenge with B16F10 cells, and also cross-react with syngeneic and allogeneic tumor cell lines MC38, EL.4, 4T1, and CT26. We identified the envelope glycoprotein (env) of a murine endogenous retrovirus (ERV) as the antigen accounting for the majority of this humoral response. A systemically administered anti-env monoclonal antibody cloned from such a response protects against tumor challenge, and prophylactic vaccination against the env protein protects a majority of naive mice from tumor establishment following subcutaneous inoculation with B16F10 cells. These results suggest the potential for effective prophylactic vaccination against analogous HERV-K env expressed in numerous human cancers.
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Sucralfate as an Adjunct to Analgesia to Improve Oral Intake in Children With Infectious Oral Ulcers: A Randomized, Double-Blind, Placebo-Controlled Trial

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We hypothesized that sucralfate along with oral analgesics (acetaminophen or ibuprofen) administered in the emergency department leads to a clinically significant improvement in oral intake in children with acute infectious oral ulcers.
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