Wednesday, May 19, 2021

Wound healing applications of creams and “smart” hydrogels

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Abstract

Although superficial wounds are often easy to treat for healthy individuals, there are some more severe types of wounds (burns, ulcers, diabetic wounds, etc.) that are a challenge for clinicians. A good therapeutic result is based on the delivery of a treatment at the right time, for the right patient. Our goal was to sum up useful knowledge regarding wound healing and wound treatments, based on creams and hydrogels with various active ingredients. We concluded that both preparations have application in preventing infections and promoting healing, but their efficacy is clearly conditioned by the type, depth, severity of the wound and patient profile. However, due to their superior versatility and capability of maintaining the integrity and functionality of the active ingredient, as well as it's controlled release at site, hydrogels are more suited for incorporating different active ingredients. New wound healing devices can combine smart hydrogel dressings with physical therapie s to deliver a more efficient treatment to patients if the indications are appropriate.

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Mitigating the Effects of Acute Vocal Exertion in Individuals With Vocal Fatigue

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Objectives/Hypothesis

To investigate the effects of acute vocal exertion on individuals with vocal fatigue and to determine whether semi-occluded vocal tract exercises (SOVTEs) are more effective than vocal rest in mitigating acute effects.

Study Design

Prospective, repeated-measures design.

Methods

On consecutive days, 10 individuals (6 males, 4 females) with scores indicating vocal fatigue on the Vocal Fatigue Index completed two 10-minute vocal exertion tasks. Vocal rest or SOVTEs were interspersed in counterbalanced order between exertion tasks. Respiratory kinematic, acoustic, aerodynamic, and self-perceptual measures were collected at baseline, following vocal exertion, following SOVTE/vocal rest, and following the second exertion task.

Results

Acute vocal exertion worsened phonation threshold pressure (P < .001) and vocal effort (P < .001) and reduced maximum fundamental frequency (P < .001). Speech was terminated at lower lung volumes following vocal exertion (decreased lung volume termination [LVT], P < .001). Exertion-induced changes in vocal effort and LVT were significantly reversed by both vocal rest and SOVTE. Detrimental changes in voice measures reoccurred following the second vocal exertion task. SOVTE and vocal rest protected against changes in respiratory kinematics when vocal exertion was resumed.

Conclusions

Vocal exertion impacted laryngeal, respiratory, and self-perceptual measures in individuals with vocal fatigue. Both SOVTE and vocal rest partially mitigated changes in voice measures and prompted more efficient respiratory strategies that were maintained when vocal exertion resumed. These data increase our understanding of how individuals with vocal fatigue respond to vocal exertion tasks and offer preliminary guidance for optimal clinical recommendations.

Level of Evidence

3 Laryngoscope, 2021

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Prevalence and Features of Laryngopharyngeal Reflux in Patients with Primary Burning Mouth Syndrome

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Objectives/Hypothesis

To investigate the prevalence and features of laryngopharyngeal reflux (LPR) in patients with primary burning mouth syndrome (BMS).

Study Design

Prospective uncontrolled study.

Methods

Patients who visited our Departments of Otolaryngology-Head and Neck and Maxillofacial surgery with BMS were prospectively recruited from September 2018 to September 2020. Patients benefited from dental, maxillofacial, otolaryngological examinations, and hypopharyngeal–esophageal impedance pH-monitoring (HEMII-pH). Oral, pharyngeal, and laryngeal findings and symptoms were rated with Reflux Sign Assessment (RSA) and Reflux Symptom Score-12 (RSS-12). Patients were treated with a combination of diet, pantoprazole, and alginate.

Results

From the 81 included patients, 76 reported >1 pharyngeal reflux events (93.8%), accounting for 35 (46.1%), 24 (31.6%), and 17 (22.3%) acid, mixed, and nonacid LPR, respectively. Thirty-two patients had both LPR and gastroesophageal reflux disease (GERD). Thirty-eight patients benefited from pepsin saliva measurement, which was positive in 86.8% of cases. The mean scores of mouth/tongue burning, RSS-12, and RSA significantly improved from pre- to post-treatment (P < .004). At 3-month post-treatment, 62.5% of patients reported an improvement of mouth/tongue burning score. Patients with both GERD and LPR reported higher baseline RSS-12 and RSA scores.

Conclusion

Acid, weakly acid, and nonacid LPR may be involved in the development of BMS. The use of an appropriate treatment considering the reflux features is associated with an improvement of symptoms and findings.

Level of Evidence

4 Laryngoscope, 2021

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Invasive fungal sinusitis in post COVID‐19 patients: a new clinical entity

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Abstract

Objectives

Occurrence of invasive fungal respiratory superinfections in patients with COVID-19 has gained increasing attention in the latest studies. Yet, description of acute invasive fungal sinusitis with its management in those patients is still scarce. This study aims to describe this recently increasing clinical entity in relation to COVID-19 patients.

Methods

Prospective longitudinal study included patients diagnosed with acute invasive fungal rhinosinusitis after a recent COVID-19 infection. Antifungal agents given included amphotericin B, voriconazole and/or posaconazole. Surgical treatment was restricted to patients with PCR negative results for COVID-19. Endoscopic, open and combined approaches were utilized to eradicate infection. Follow-up for survived patients was maintained regularly for the first postoperative month.

Results

A total of 36 patients with a mean age of 52.92 ± 11.30 years old were included. Most common associated disease was diabetes mellitus (27.8%). Mycological analysis revealed infection with Mucor and Aspergillus species in 77.8% and 30.6% of patients, respectively. Sino-nasal, orbital, cerebral and palatine involvement was found in 100%, 80.6%, 27.8% and 33.3% of patients, respectively. The most common reported symptoms and signs are facial pain (75%), facial numbness (66.7%), ophthalmoplegia and visual loss (63.9%). All patients were treated simultaneously by surgical debridement with antifungal medications except for two patients with PCR positive swab for COVID-19. These two patients received antifungal therapy alone. Overall survival rate was 63.89% (23/36).

Conclusion

Clinical suspicion of acute invasive fungal sinusitis among COVID-19 patients and early management with antifungal therapy and surgical debridement is essential for better outcomes and higher survival.

Level of evidence

IV.

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Pseudocyst in Neck: A Case Report on Rare Complication of Ventriculoperitoneal Shunt

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Case Rep Otolaryngol. 2021 Apr 30;2021:6656506. doi: 10.1155/2021/6656506. eCollection 2021.

ABSTRACT

INTRODUCTION: Ventriculoperitoneal shunt is a common neurosurgical procedure, for the definitive management of hydrocephalus. Shunt failures may occur due to various causes but are usually due to infections in adults and catheter occlusion in the paediatric population. Case Report. The 13-year-old girl presented with a right lateral neck swelling. In detailed history, she was found to be an old case of ventriculoperitoneal shunt. The clinical examination and radiological investigation revealed proximal dislodgment of the stent from the cranium, causing persistent cerebrospinal fluid (CSF) leak and pseudocyst formation in the neck.

CONCLUSION: The case highlights CSF pseudocyst formation as a rare differential for lateral neck swellings.

PMID:34007501 | PMC:PMC8110417 | DOI:10.1155/2021/6656506

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Inflammatory Myofibroblastic Tumor (IMT) of the Trachea Excised by Transtracheal Surgery: Case Report

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Ear Nose Throat J. 2021 May 19:1455613211014076. doi: 10.1177/01455613211014076. Online ahead of print.

ABSTRACT

This report describes an extremely rare case of a primary inflammatory myofibroblastic tumor of the trachea. The patient underwent surgical resection by a transtracheal approach and reconstruction with esophageal tracheoplasty. This case report highlights the rarity of such tumors and a minimally invasive and safe surgical technique for tumors around the central ne ck structures.

PMID:34006125 | DOI:10.1177/01455613211014076

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Effects of Age on Recovery of Olfactory Function After Endoscopic Sinus Surgery and Related Risk Factors

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Ear Nose Throat J. 2021 May 18:1455613211012927. doi: 10.1177/01455613211012927. Online ahead of print.

ABSTRACT

OBJECTIVES: To study the effects of age on the olfactory function recovery of chronic rhinosinusitis patients after endoscopic sinus surgery and related risk factors.

METHODS: A total of 176 chronic rhinosinusitis (CRS) patients enrolled from February 2017 to October 2019 were divided into child, youth, middle-aged, and elderly groups. Their baseline data, T &T olfactory test score, visual analogue scale (VAS) olfactory score, sinus computed tomography (CT) Lund-Mackay score, and Lund-Kennedy score were compared. Based on postoperative olfactory function, they were divided into good and poor improvement groups.

RESULTS: Complication with nasal polyps, allergic rhinitis history, and sinus surgery history had significant differences among patients of different ages (P < .05). Three months after surgery, T&T olfactory, VAS olfactory, Lund-Mackay, and Lund-Kennedy scores all rose with increasing age, with significant differences between any 2 groups (P < .05). The improvement of postoperative olfactory function became poorer with aging (P < .05). T&T and VAS olfactory scores had significant positive correlations with Lund-Mackay and Lund-Kennedy scores (P < .001). Age, preoperative Lund-Mackay and Lund-Kennedy scores, complication with nasal polyps, allergic rhinitis history, sinus s urgery history, and postoperative complications were risk factors for the poor improvement of postoperative olfactory function. Doctor-directed treatment was a protective factor for good improvement.

CONCLUSIONS: The improvement of olfactory function of CRS patients after endoscopic sinus surgery declines with aging. Age, preoperative Lund-Mackay and Lund-Kennedy scores, complication with nasal polyps, allergic rhinitis history, sinus surgery history, and postoperative complications are risk factors for the poor improvement of postoperative olfactory function. Doctor-directed treatment is a protective factor for good improvement.

PMID:34006133 | DOI:10.1177/01455613211012927

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Bilateral Vocal Fold Granuloma and Anterior Glottic Web After Papilloma Excision

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Ear Nose Throat J. 2021 May 18:1455613211012112. doi: 10.1177/01455613211012112. Online ahead of print.

ABSTRACT

We present a case of delayed vocal process granulomas and anterior glottic web after treatment of vocal fold papillomas with a laryngeal microdebrider and CO2 laser ablation. This case highlights a risk of vocal fold granuloma in the setting of recurrent respiratory papillomatosis and microdebrider use, warranting close follow-up and consideration of prophylactic voice therapy, anti-reflux medications, and steroid injection in cases of violation of vocal cord epithelium.

PMID:34006147 | DOI:10.1177/01455613211012112

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Precisely Closed Reduction of Nasal Bone Fracture Assisted With Plain Film Measurements Under the Picture Archiving and Communication System

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Ear Nose Throat J. 2021 May 18:1455613211012111. doi: 10.1177/01455613211012111. Online ahead of print.

ABSTRACT

OBJECTIVES: To prevent aesthetic and functional deformities, precisely closed reduction is crucial in the management of nasal fractures. Plain film radiography (PF), ultrasonography (USG), and computed tomography can help confirm the diagnosis and classification of fractures and assist in performing closed reduction. However, no study in the literature reports on precisely closed reduction assisted with PF measurements under the picture archiving and communication system (PACS).

METHODS: We retrospectively evaluated 153 patients with nasal bone fracture between January 2013 and December 2017. Surgeons conducted precisely closed reduction assisted with PF measurement of the distance between the fracture site and nasal tip under PACS on 34 patients (group A). Another group on 119 patients were reduced under surgeon's experience (group B).

RESULTS: No significant differences in age, gender, Arbeitsgemeinschaft fur Osteosynthesefragen (AO) classification, and reduction outcome were observed between group A and group B (P > .05). The operative time of the group A was significantly lower (12.50 ± 4.64 minutes) compared to group B (23.78 ± 11.20 minutes; P < .001). After adjusted age, gender, and AO classification, patients in group A scored 10.46 minutes less on the operative time than those in group B (P & lt; .001). In addition, the severity of nasal bone fracture (AO classification, β = 3.37, P = .002) was positive associated with the operative time.

CONCLUSIONS: In this study, closed reduction in nasal bone fracture assisted with PF measurements under PACS was performed precisely, thereby effectively decreasing operative time and the occurrence of complications. This procedure requires neither the use of new instruments or C-arm nor USG or navigation experience. Moreover, reduction can be easily performed using this method, and it requires short operative time, helps achieve great reduction, less radiation exposures, and is cost-effective.

PMID:34006146 | DOI:10.1177/01455613211012111

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A Hybrid Learning‐based Hysteresis Compensation Strategy for Surgical Robots

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Abstract

Background

The hysteretic forces arising from the electric cables that externally run along the robotic joints are the main disturbance to the precise parameter estimation of gravity compensation model, for the Master Tool Manipulator (MTM) of the da Vinci Research Kit (dVRK). Because such nonlinear disturbance forces and the gravitational forces are often hybrid and in the same magnitude.

Methods

A strategy is proposed to separate these two hybrid forces, and model them by individual learning-based. A specially designed Elastic Hysteresis Neural Network (EHNN) model, is employed to capture the hysteresis nature of disturbance forces.

Results

The experimental results show that our proposed strategy has higher compensation accuracy (78.64% - 93.32%), and fewer real samples are required for model estimation (100 samples for each joint).

Conclusions

Our proposed gravity compensation strategy for the MTM of the dVRK shows great improvement over existing state-of-the-arts methods through conducted comparative experiments.

This article is protected by copyright. All rights reserved.

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Effect of application of fibrin glue on vocal fold healing after surgical manipulation in rabbits

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Braz J Otorhinolaryngol. 2021 May 6:S1808-8694(21)00077-X. doi: 10.1016/j.bjorl.2021.04.005. Online ahead of print.

ABSTRACT

INTRODUCTION: A challenge in phonosurgery is achieving good vocal quality with minimal vocal fold fibrosis. Fibrin glue can be applied to minimize fibrosis; however, its use in the larynx is based primarily on clinical experience, particularly in extensive lesions.

OBJECTIVE: The objective of this study was to evaluate the effect of application of fibrin glue on collagen concentration at the late phase of the healing process after detaching a pedicled flap of the vocal fold cover in rabbits.

METHODS: In this prospective animal study, twelve adult male rabbits underwent laryngeal microsurgery, in which an incision was made along the entire length of both vocal folds, followed by extensive mucosal detachment and section of the incision ends. Fibrin glue was applied in the left vocal fold, and the mucosa was repositioned. In the right vocal fold, the mucosa was repositioned without treatment with fibrin glue. After 3-months, the rabbits were euthanized. Histological analyses were performed, and the data collected were subjected to statistical analysis.

RESULTS: Vocal folds treated with fibrin glue presented higher collagen concentration in Masson trichrome staining and significantly higher (p < 0.05) collagen concentration in picrosirius red staining compared to control vocal folds.

CONCLUSION: Treatment with fibrin glue led to greater vocal fold fibrogenesis in the present study. Nonetheless, further studies are necessary to determine the prophylactic effect of sealants in laryngeal surgeries that require extensive detachment of the vocal fold cover.

PMID:34006476 | DOI:10.1016/j.bjorl.2021.04.005

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