Tuesday, June 22, 2021

Machine learning‐based model for prediction of outcomes in palatal surgery for obstructive sleep apnea

xlomafota13 shared this article with you from Inoreader

Abstract

● Our retrospective cohort study aimed to elucidate which factors (nasal surgery: septoplasty or functional endoscopic sinus surgery (FESS), palate surgery: uvulopalatal flap (UPF) or palatal muscle resection (PMR)), demography, polysomnography, Friedman stage, drug-induced sleep endoscopy (DISE) results) influence the success of surgery in patients who had been operated to treat obstructive sleep apnea (OSA).

● We used seven machine learning (ML) models (logistic regression-based models (lasso, elastic net (EN), ridge), tree-based models (bagging, random forest (RF), support vector machine (SVM), and neural networks (NN)).

● Among the seven models, their performances were first ranked by the area under the receiver operating characteristic curve (AUC): lasso (0.8317), EN (0.7500), SVM (0.7163), bagging (0.7115), random forest (0.7115), NN (0.6923) and ridge (0.6538), which shows that lasso had the best performance.

● Tonsil grade and Nasopharynx Oropharynx Hypopharynx and Larynx (NOHL) classification of the epiglottis in DISE were selected as the most important variables in all models including lasso.

● Through the novel ML technique, the surgical success rate of OSA is ultimately dependent on tonsil grade and NOHL classification of the epiglottis in DISE regardless of the type of nasal or palate surgery.

View on the web

HPV-related oropharyngeal squamous cell carcinoma-Incidence steadily rising

xlomafota13 shared this article with you from Inoreader
Via hno

pubmed-meta-image.png

HNO. 2021 Jun 18. doi: 10.1007/s00106-021-01087-0. Online ahead of print.

ABSTRACT

The incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is steadily increasing worldwide and has already exceeded cervical cancer rates in the USA. Due to their tumor biology, HPV-positive tumors of the oropharynx, which have been included in the eighth edition of the AJCC/UICC (American Joint Committee on Cancer/Union Internationale Contre le Cancer) Staging Manual since 2018, represent a separate entity. Following biopsy, diagnostic confirmation is performed by immunohistochemical detection of p16 expression, with p16 acting as a surrogate marker. Therapeutically, surgical and radiotherapeutic approaches are considered equivalent in terms of efficacy. With a 5-year overall survival of up to 80%, patients with HPV-positive OPSCC have a better prognosis compared to patients with HPV-negative OPSCC, where survival rates are between 40 and 50%.

PMID:34143237 | DOI:10.1007/s00106-021-01087-0

View on the web

Opioid use patterns in patients with head and neck cancer receiving radiation therapy: A single‐institution retrospective analysis characterizing patients who did not require opioid therapy

xlomafota13 shared this article with you from Inoreader

Abstract

Background

We had previously analyzed the variables that determine the rates of opioid use at 1-year postradiotherapy in patients with head and neck cancer. Here we analyze the variables associated with opioid abstinence during and in the 12 months after radiotherapy at our institution.

Methods

We identified a cohort of patients with head and neck cancer who received radiotherapy as part of curative treatment at our institution. Logistic regression analyses were performed to determine socioeconomic and clinical factors associated with opioid abstinence.

Results

The cohort included 376 patients. On multivariable analysis, patients from an upper-income class (p = 0.004), black race (p = 0.004), older (p = 0.008), with dependent children (p < 0.001) or receiving surgery (p = 0.002) were more likely to abstain from opioids, while patients using analgesic mouthwash (p = 0.009) or higher pain scale (p = 0.002) were less likely.

Conclusion

Socioeconomic and treatment characteristics are associated with opioid abstinence during and following radiation treatment in patients with head and neck cancer.

View on the web

Consensus of free flap complications: Using a nomenclature paradigm in microvascular head and neck reconstruction

xlomafota13 shared this article with you from Inoreader

Abstract

Background

We aim to define a set of terms for common free flap complications with evidence-based descriptions.

Methods

Clinical consensus surveys were conducted among a panel of head and neck/reconstructive surgeons (N = 11). A content validity index for relevancy and clarity for each item was computed and adjusted for chance agreement (modified kappa, K). Items with K < 0.74 for relevancy (i.e., ratings of "good" or "fair") were eliminated.

Results

Five out of nineteen terms scored K < 0.74. Eliminated terms included "vascular compromise"; "cellulitis"; "surgical site abscess"; "malocclusion"; and "non- or mal-union." Terms that achieved consensus were "total/partial free flap failure"; "free flap takeback"; "arterial thrombosis"; "venous thrombosis"; "revision of microvascular anastomosis"; "fistula"; "wound dehiscence"; "hematoma"; "seroma"; "partial skin graft failure"; "total skin graft failure"; "exposed hardware or bone"; and "hardware failure."

Conclusion

Standardized reporting would encourage multi-institutional research collaboration, larger scale quality improvement initiatives, the ability to set risk-adjusted benchmarks, and enhance education and communication.

View on the web

Efficacy of cidofovir versus bevacizumab in recurrent respiratory papillomatosis: A randomized, double-blind, placebo-controlled pilot study

xlomafota13 shared this article with you from Inoreader

1-s2.0-S0001651921X00039-cov150h.gif

Publication date: Available online 18 June 2021

Source: Acta Otorrinolaringológica Española

Author(s): Yuria Ablanedo-Terrazas, Oscar Estrada-Camacho, Claudia Alvarado-de la Barrera, Arturo Ramírez-García, Gabriel Tona-Acedo, Daniel Bross-Soriano, José Schimelmitz-Idi

View on the web

The promising role of Gelsolin expression to predict survival in patients with squamous cell carcinoma of the larynx

xlomafota13 shared this article with you from Inoreader

Braz J Otorhinolaryngol. 2021 Jun 3:S1808-8694(21)00094-X. doi: 10.1016/j.bjorl.2021.05.009. Online ahead of print.

ABSTRACT

INTRODUCTION: Gelsolin protein has important cellular functions, including cell motility and apoptosis. Altered gelsolin expression has been reported in several types of neoplasms, but clinicopathological features of gelsolin are currently unclear in patients with laryngeal squamous cell carcinoma.

OBJECTIVES: Our aim is to investigate the clinicopathological significance of gelsolin as a prognostic biomarker for laryngeal squamous cell carcinoma.

METHODS: Tissue specimens from 168 patients with laryngeal squamous cell carcinoma were immunohistochemically assessed for the Gelsolin expression. Prognostic significance of Gelsolin and its interaction with clinical parameters was analysed.

RESULTS: Gelsolin expression was confirmed in 70.2% of cases. Gelsolin expression is significantly associated w ith tumor stage, tumor grade, and locoregional recurrence. Kaplan-Meier survival curves revealed that Gelsolin expression inversely correlated with both disease-specific and overall survival.

CONCLUSION: This research is the first to demonstrate that Gelsolin expression is associated with a poor prognosis in laryngeal squamous cell carcinoma. Gelsolin is a novel promising biomarker and attractive target for the treatment of laryngeal squamous cell carcinoma.

PMID:34144901 | DOI:10.1016/j.bjorl.2021.05.009

View on the web

Biopsy of the olfactory epithelium from the superior nasal septum: is it possible to obtain neurons without damaging olfaction?

xlomafota13 shared this article with you from Inoreader

Braz J Otorhinolaryngol. 2021 Jun 5:S1808-8694(21)00093-8. doi: 10.1016/j.bjorl.2021.05.008. Online ahead of print.

ABSTRACT

INTRODUCTION: Olfactory epithelium biopsy has been useful for studying diverse otorhinolaryngological and neurological diseases, including the potential to better understand the pathophysiology behind COVID-19 olfactory manifestations. However, the safety and efficacy of the technique for obtaining human olfactory epithelium are still not fully established.

OBJECTIVE: This study aimed to determine the safety and efficacy of harvesting olfactory epithelium cells, nerve bundles, and olfactory epithelium proper for morphological analysis from the superior nasal septum.

METHODS: During nasal surgery, 22 individuals without olfactory complaints underwent olfactory epithelium biopsies from the superior nasal septum. The efficacy of obtaining olfactory epithelium, verification of intact olfactory epithelium and the presence of nerve bundles in biopsies were assessed using immunofluorescence. Safety for the olfactory function was tested psychophysically using both unilateral and bilateral tests before and 1 month after the operative procedure.

RESULTS: Olfactory epithelium was found in 59.1% of the subjects. Of the samples, 50% were of the quality necessary for morphological characterization and 90.9% had nerve bundles. There was no difference in the psychophysical scores obtained in the bilateral olfactory test (University of Pennsylvania Smell Identification Test [UPSIT®]) between means before biopsy: 32.3 vs. postoperative: 32.5, p = 0.81. Also, no significant decrease occurred in unilateral testing (mean unilateral test scores 6 vs. 6.2, p = 0.46). None out of the 56 different odorant identification significantly diminished (p > 0.05).

CONCLUSION: The technique depicted for olfactory epithelium biopsy is highly effective in obtaining neuronal olfactory tissue, but it has moderate efficacy in achieving samples useful for morphological analysis. Olfactory sensitivity remained intact.

PMID:34144902 | DOI:10.1016/j.bjorl.2021.05.008

View on the web

Prognostic importance of expression of mini-chromosome maintenance proteins (MCMs) in patients with nasopharyngeal cancer treated with curative radiotherapy

xlomafota13 shared this article with you from Inoreader

Braz J Otorhinolaryngol. 2021 Jun 8:S1808-8694(21)00108-7. doi: 10.1016/j.bjorl.2021.05.012. Online ahead of print.

ABSTRACT

OBJECTIVE: The prognostic importance of minichromosome maintenance complex expression in nasopharyngeal cancer is still unknown. We aimed to find whether minichromosome maintenance complex 2-7 expression may potentially be used to predict the prognosis of nasopharyngeal cancer patients treated with definitive radiotherapy.

METHODS: Between April 2007 and July 2020, patients with nasopharyngeal cancer treated with radiotherapy were identified. Immunohistochemical analysis was performed on formalin-fixed paraffin-embedded tissues of cases. A single pathologist analyzed the histologic specimens of all patients.

RESULTS: Totally, 67 patients were included. The median followup was 75.3 months. Higher tumor (T) stage was correlated with minichromosome maintenance complex 2 overexpression. Minichromosome mai ntenance complex s expression was also associated with histopathologic subgroups. According to univariate analysis, AJCC stage, histopathological subgroups, tumor response after treatment, minichromosome maintenance complex 2, 3, 5, 6 and 7 expression were the prognostic factors that predict overall survival. According to multivariate analysis minichromosome maintenance complex 7 expression was the only prognostic marker for both PFS and OS.

CONCLUSION: The overexpression of minichromosome maintenance complex 2, 3, 5, 6 and 7 indicated bad prognosis. Minichromosome maintenance complex 7 was an independent prognostic factor for survival outcomes in nasopharyngeal cancer and may be a potential therapeutic target for treatment.

PMID:34144903 | DOI:10.1016/j.bjorl.2021.05.012

View on the web

Absent pyramidal eminence and stapedial tendon associated with congenital stapes footplate fixation: Intraoperative and radiographic findings

xlomafota13 shared this article with you from Inoreader

1-s2.0-S0196070921X00038-cov150h.gif

Publication date: November–December 2021

Source: American Journal of Otolaryngology, Volume 42, Issue 6

Author(s): Ashley M. Nassiri, John C. Benson, Karl W. Doerfer, Elizabeth L. Perkins, Alex D. Sweeney, Neil S. Patel, Seilesh C. Babu, Alejandro Rivas, John I. Lane, Matthew L. Carlson

View on the web

Li Maneuver for geotropic horizontal canal benign paroxysmal positional vertigo (HC-BPPV) -A better choice

xlomafota13 shared this article with you from Inoreader

1-s2.0-S0196070921X00038-cov150h.gif

Publication date: Available online 19 June 2021

Source: American Journal of Otolaryngology

Author(s): Pengju Zhao, Jinrang Li, Yili Ding, Yuqing Wang, Shizhen Zou

View on the web

Cellular blue nevus tumor presenting as a submandibular lymph node in a 16-year-old

xlomafota13 shared this article with you from Inoreader

1-s2.0-S0196070921X00038-cov150h.gif

Publication date: Available online 19 June 2021

Source: American Journal of Otolaryngology

Author(s): L. Boven, M. Noonan, H. Sans-Cuellar, N. Dela-Cruz, C. Nathan, A. Gungor

View on the web

Open epidural blood patch to augment durotomy repair in lumbar spine surgery: Surgical technique and cohort study

xlomafota13 shared this article with you from Inoreader

Spine J. 2021 Jun 15:S1529-9430(21)00732-4. doi: 10.1016/j.spinee.2021.06.011. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Incidental durotomy during elective spine surgery is relatively common. While usually benign and self-limited, it can be associated with morbidity, increased cost, and medicolegal ramifications. Dural repair typically involves performing a primary closure using a suture or dural staple; repairs are then frequently augmented with a sealant, patch, or fat/fascial graft. Although primary repair of an incidental durotomy is standard practice, the ideal secondary sealant or augment choice remains unclear. A wide variety of commercially available dural sealant options exist, and while none have demonstrated consistent superiority, all are associated with single-use costs in the hundreds to thousands of dollars and have concerns regarding swelling, local inflammation, or short-lived dural adherence.

PURPOSE: The go al of this study is to compare the results of dural repair augmentation using an open intraoperative epidural blood patch to a hydrogel technique.

STUDY DESIGN/SETTING: Retrospective comparative cohort study at an academic referral center PATIENT SAMPLE: Adult patients undergoing lumbar spine surgery from March 2017 to January 2021 who sustained an incidental durotomy. Patients undergoing surgery for infection were excluded.

OUTCOME MEASURES: The primary outcome was failure of the repair as determined by a return to the operating room for re-exploration of a persistent cerebrospinal fluid (CSF) leak within 30 days of the index procedure. A secondary outcome was the incidence of a postoperative positional headache, and if present, the method used to obtain resolution. The primary predictor was use of a suture and hydrogel technique ("hydrogel" group), or the use of an epidural blood patch ("EBP" group).

METHODS: The method for applying an open epidural blood patch i s presented in detail and involves primarily repairing the durotomy followed by allowing whole blood to pool and clot in the operative field until the durotomy is completely covered. This was compared with a group of patients undergoing secondary augmentation with commercially available hydrogel. In both groups, mechanical resistance to CSF leakage was confirmed with direct visualization and a Valsalva maneuver, respectively. Patients were instructed to remain flat until the morning after surgery. Chart review was used for data abstraction on preoperative, demographic, perioperative, and postoperative clinical factors. To compare between the hydrogel and EBP group, Wilcoxon rank-sum testing was used to test for non-parametric comparisons of means, and chi-square testing between binomial data.

RESULTS: Of 732 patients during the study period, forty-eight patients met study criteria. Twenty-five patients were in the hydrogel group and 23 in the EBP group. Mean age was 69.3 years (standard error 1.3 years). Patients were predominantly female (n = 31, 64.6%) with a mean BMI of 29.5 (SE 0.8), with no significant baseline differences between the hydrogel and EBP groups. Two patients in the hydrogel group (8.0%) and two in the EBP group (8.7%) had mild positional headaches postoperatively that resolved without intervention within 24 hours. One (4.3%) patient in the EBP group had positional headaches following an initial headache-free period; this patient was returned to the operating room and no evidence of a persistent CSF leak was found despite meticulous exploration.

CONCLUSIONS: An open, intraoperatively placed epidural blood patch may be an efficacious and cost-effective way to manage an incidental durotomy. This method merits further study as an allergy-free, no swell, cost-neutral method of dural repair augmentation.

PMID:34144204 | DOI:10.1016/j.spinee.2021.06.011

View on the web

Collaboration request

Hi there How would you like to earn a 35% commission for each sale for life by selling SEO services Every website owner requires the ...