Sunday, September 19, 2021

Robotic‐Arm Assisted versus Manual Total Hip Arthroplasty: Systematic Review and Meta‐analysis of Radiographic Accuracy

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Abstract

Background

We systematically reviewed the radiological outcomes of studies comparing robotic-assisted (RA-THA) and manual total hip arthroplasty (mTHA) .

Methods

The PubMed, Embase, and Cochrane databases were queried from 1994-2021 for articles comparing radiographic outcomes between RA-THA and mTHA cohorts. A meta-analysis was conducted whenever sufficient data was present for common outcomes.

Results

Our analysis included 20 articles reporting on 4,140 patients (RA-THA: n=1,228; mTHA: n= 2,912). No differences were demonstrated for acetabular inclination or anteversion. However, RA-THA demonstrated higher rates of cup orientation within the Lewinnek and Callanan safe zones, improved femoral stem alignment, and lower global offset difference (GOD) and limb length discrepancy (all p-values <0.05). Superior femoral canal fill and combined offset were seen among RA-THA patients.

Conclusion

Our review found that the use of RA-THA yields superior radiographic outcomes compared to mTHA counterparts. This information can inform healthcare systems considering investing in and implementing these technologies.

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Complications of Robot‐assisted Thymectomy: A Single‐arm Meta‐analysis and Systematic Review

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Abstract

Background

Recently, thymectomy using minimally invasive approaches has been increasing with the development of robotic video-assisted thoracoscopic surgery (R-VATS). Although multimodal approach is effective for robot assisted thymectomy, it is necessary to determine the approach (left, right or sub xiphoid) associated with the least complications.

Methods

An electronic retrieval from PubMed, Embase, Web of Science, GreyNet International, and The Cochrane Library. The single-arm meta-analysis was performed to compare the rate of complications of right and left-side approaches by R-VATS.

Results

A total of 21 studies including 930 patients were identified. The pooled incidence of total complications was 12.2% (CI: 10.0%−14.8%) for all studies. The overall complication rate was 17.3% for the right side compared with 7.4% for the left side (P<0.001, OR=2.484, 1.601−3.852). The pooled incidence of air leak was significantly higher for the right vs. left side (5.1% vs. 1.2%, respectively; P=0.004). The incidence of atrial fibrillation was higher for the right- compared with the left-side approach (4% vs. 1.2%, respectively; P=0.004). The open conversion rate was significantly higher for the right vs. the left side (6.5% vs. 2.9%, respectively; P=0.004). However, there was no significant difference in the pooled incidence of pleural effusion and thoracic duct fistula when comparing the right- and left-side approaches. In subgroup analysis, In the left approach, The incidence of overall complications (28.6% vs 5.5%, respectively;p=0.002) and pleural effusion(14.3% vs 1%, respectively;p=0.002) was higher for the "Old Age" group compared with the "Youth" group; there was no significant difference in the incidence of complications after thymectomy.

Conclusion

R-VATS can be performed on the left- and right-sides; However, complications are minimal with the left-side approach. These data demonstrate that the incidence of overall complications, atrial fibrillation, open conversion ratios, and air leak rate of left-side R-VATS thymectomy are lower than those of right-side. Further subgroup analysis showed that the incidence of postoperative complications was higher in the older group.

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5-aza-2’-deoxycytidine induces apoptosis and inhibits tumour growth in vivo of FaDu cells, a specific HPVnegative HNSCC cell line

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journal.pone.0253756.g007&size=inline

by Reem Miari, Naiel Azzam, Rinat Bar-Shalom, Fuad Fares

Head and neck cancer squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide, resulting in over 600,000 new diagnoses annually. Traditionally, HNCC has been related to tobacco and alcohol exposure; however, over the past decade, a growing number of head and neck cancers are attributed to human papillomavirus (HPV) infection. 5-Aza-2'-deoxycytidine (5-AzaD) was demonstrated as an effective chemotherapeutic agent for acute myelogenous leukaemia. Preclinical data revealed that 5-aza inhibits growth and increases cell death of HPV(+) cancer cells. These effects are associated with reduced expression of HPV genes, stabilization of TP53, and activation of TP53-dependent apoptosis. The aim of the present study is to test the effect of 5-AzaD on growth of human squamous cell carcinoma (FaDu), a HPV(-) and p53 mutated cells, in vitro and in vivo. The effect of 5-AzaD on cell viability, cell cycle progression and induction of apoptosis was tested in vitro. The effect of 5-AzaD on tumour growth in vivo was tested using xenograft mice inoculated with FaDu cells. The results indicated that 5-AzaD reduced cell viability and induced apoptosis in FaDu cells in vitro. In vivo studies revealed that 5-AzaD suppresses the growth of tumours in xenograft mice inoculated with FaDu cells through inhibition of proliferation and induction of apoptosis. These findings may emphasis that 5-AzaD is effective in treatment of HPV(-) HNSCC tumours through TP53 independent pathway. Future studies are needed in order to clarify the molecular mechanism of action of 5-AzaD in HPV(-) cancer cells.
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A Comparative Study of Interventions of Middle Turbinate Medialization in Endoscopic Sinus Surgery

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Abstract

The shape and position of middle turbinate play an important role in ventilation and drainage of the osteomeatal complex. The preservation of middle turbinate is one of the major goals of functional endoscopic sinus surgery (FESS). Middle turbinate intervention is essential to prevent obliteration of osteomeatal complex. The aim of this prospective study is to postulate which middle turbinate intervention is most effective and compare the results with conventional technique. In this randomized controlled study, 60 patients were included of the age group of 15–60 years who presented to the Otorhinolaryngology OPD of our institute between November 2017 to June 2019 with symptoms of chronic sinusitis with clinical and radiological evidence and who underwent FESS. The patients were divided into three group, Group A—Bolgerization (n = 20), Group B—Vicryl—conchopexy (n = 20) and Group C—No intervention, Control group (n = 20). The patency of middle meatus and the status of middle turbinate (medialized or lateralized or neither of the two) was ascertained postoperatively. Improvement in symptoms was also evaluated. The middle turbinate was medialized in 90% of Group A and 95% of Group B cases. The middle turbinate was neither medialized nor lateralized in 70% of patients in Group C. 70% of the patients in Group A and 80% of patients in Group B had complete improvement in symptoms with no recurrence of sinusitis compared to Group C in which only 50% of the patients had improvement in symptoms due to development of synechiae. Medialization of the middle turbinate should be considered as one of the essential steps of FESS as it helps in improving the surgical outcome.

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External Auditory Canal Pleomorphic Adenoma: A Rare Case Presentation

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Abstract

Pleomorphic adenoma originating from the external auditory canal is extremely rare, benign tumor. Ceruminal glands are modified sweat glands of the skin, present in the external auditory canal that may give rise to (a) benign tumors such as ceruminous adenoma, pleomorphic adenoma, and syringocystadenoma papilliferum, or (b) malignant tumors such as ceruminous adenocarcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma. We report a case where a 25-year-old woman presented with right aural swelling and otalgia since 1 year. A canal-filling aural mass was noted on clinical examination. Computed tomography imaging showed no intracranial extension or any association with the adjacent parotid gland. Subsequent excision biopsy and histologic examination revealed features suggestive of pleomorphic adenoma. Similar to the pleomorphic adenoma of salivary glands, recurrence or malignant degeneration with cellular atypia and metastasis can occur on rare occasions. Care must be taken to distinguish this from adenoid cystic carcinomas, ceruminous adenocarcinomas, and mucoepidermoid carcinomas.

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Surgical Treatment of Type III Laryngotracheoesophageal Clefts: Techniques and Outcomes

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Objectives/Hypothesis

Determine surgical and swallowing outcomes after surgery for type III laryngotracheoesophageal cleft (LTEC).

Study Design

Case series with chart review.

Methods

Chart review was performed on patients with type III LTEC between 2000 and 2019. Demographics, surgical outcomes, and swallowing outcomes were collected and analyzed.

Results

Thirty-three patients met inclusion criteria (28 open and 5 endoscopic repairs). Mean age was 3.4 years for the open group and 0.9 years for the endoscopic group. Seventeen (51.5%) patients had a syndromic diagnosis, most commonly Opitz syndrome and Trisomy 21. Mean follow-up was 33.6 months. Thirteen (39.4%) patients had a previous repair attempt prior to repair at our institution. Twenty-four (70.6%) patients had a tracheostomy prior to or at the time of surgical repair and 13 (38.2%) remain tracheostomy-dependent. Nine patients (27.3%) required a revision cleft repair and four (12.1%) required two revisions. Thirty-one patients had an intact repair at last follow-up (93.9). Two patients died outside the hospital over a year after surgery. Preoperatively 13 of 17 patients with swallowing evaluations aspirated. After repair, 11 of 20 patients were deemed safe for all consistencies and seven were safe for thickened. Endoscopic approaches were performed during the last 2 ye ars of the study and had significantly lower operative time (354.4 minutes vs. 171.5 minutes).

Conclusions

Endoscopic and open approaches are effective for treatment of type III LTEC with 27.3% requiring revision and 93.9% of repairs intact at last follow-up. Overall swallowing outcomes were good in patients who underwent postoperative instrumental swallow evaluation.

Level of Evidence

IV Laryngoscope, 2021

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Safety of surgical tracheostomy under continued antithrombotic therapy: a retrospective cohort study

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Abstract

Objective

Although various guidelines have been established for the management of antithrombotic therapy during surgical treatments, surgical tracheostomy (ST) under continued antithrombotic therapy (CAT) remains a challenge. We investigated the risk factors for complications after ST by focusing on CAT use during ST.

Method

Patients' medical records from 2009 to 2020 were reviewed in this retrospective study. We selected patients who underwent ST at the Department of Otolaryngology of our hospital. Patient demographics, complications, and blood test values were recorded and statistically analyzed to identify the risk factors for postoperative complications.

Results

We identified 288 patients (median age: 64 years; 184 men [64%]), among whom 40 (median age: 67 years; 29 men [73%]) underwent CAT. Although the patients undergoing CAT had significantly higher values of activated partial thromboplastin time (p = 0.002) and prothrombin time-international normalized ratio (p = 0.006) than those of antithrombotic naïve patients, no statistically significant intergroup differences were observed in the risks of bleeding, infection, or subcutaneous emphysema. Instead, ST under local anesthesia (p = 0.01) and ST for airway emergency (p = 0.02) significantly increased the risk of early postoperative complications.

Conclusion

The results of the present study suggest that ST under CAT can be safely performed without any increased risk of postoperative complications. Nevertheless, surgeons should be extra cautious about early complications after ST under local anesthesia without intubation or ST for airway emergency.

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Stratum corneum lipidomics analysis reveals altered ceramide profile in atopic dermatitis patients across body sites with correlated changes in skin microbiome

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Abstract

Background

Atopic dermatitis (AD) is driven by the interplay between a dysfunctional epidermal barrier and a skewed cutaneous immune dysregulation. As part of the complex skin barrier dysfunction, abnormalities in lipid organization and microbiome composition have been described. We set out to systematically investigate the composition of the stratum corneum lipidome, skin microbiome and skin physiology parameters at three different body sites in patients with AD and healthy volunteers.

Methods

We analysed tape strips from different body areas obtained from 10 adults with AD and 10 healthy volunteers matched for FLG mutation status for 361 skin lipid species using the Metabolon mass spectrometry platform. 16S rRNA data were available from all probands.

Results

Our study showed that the lipid composition differs significantly between body sites and between AD patients and healthy individuals. Ceramide species NS was significantly higher in AD patients compared to healthy volunteers and was also higher in AD patients with a FLG mutation compared to AD patients without a FLG mutation. The correlation analysis of skin lipid alterations with the microbiome showed that Staphylococcus colonization in AD is positively correlated with ceramide subspecies AS, ADS, NS and NDS.

Conclusion

This is the first study to reveal site-specific lipid alterations and correlations with the skin microbiome in AD.

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Characterization of the microbiome in the infant diapered area: Insights from healthy and damaged skin

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Abstract

It has been recognized for nearly a century that human beings are inhabited by a remarkably dense and diverse microbial ecosystem, yet we are only just beginning to understand and appreciate the many roles that these microbes play in human health and development. Establishment of the microbiome begins at birth, but many previous studies on infant skin health have focused on Candida species. Little is known on the full microbial composition across different areas and even less is known on how these communities change during disease/inflammatory states. In this clinical study, infants were recruited during periods of diaper dermatitis (DD) and health to characterize the skin microbiome in these two states. Substantial shifts in the skin microbiome were observed across four sites in the diapered area (genitals, intertriginous, buttocks and perianal), as well as during periods of DD. As DD scores increased, there was a shift in relative abundance that demonstrated higher community per centages of faecal coliforms, such as Enterococcus, and lower percentages of Staphylococcus strains. In high-rash samples, the predominant Staphylococcus species is S aureus, potentially implicating S aureus as a DD aetiological agent. This study provides new information related to the microbiome on infant skin in the diapered area and provides insights into the role of the microbiome in the development of DD.

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Comparison of the skin microbiota in acne and rosacea

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Abstract

Acne and rosacea, despite their similar clinical presentations, follow distinct clinical courses, suggesting that fundamental differences exist in their pathophysiology. We performed a case-control study profiling the skin microbiota in rosacea and acne patients compared to matched controls. Nineteen rosacea and eight acne patients were matched to controls by age ± 5 years, sex and race. DNA was extracted from facial skin swabs. The V3V4 region of the bacterial 16S rRNA gene was sequenced using Illumina MiSeq and analysed using QIIME/Metastats 2.0 software. The mean relative abundance of Cutibacterium acnes in rosacea with inflammatory papules and pustules (20.454% ±16.943%) was more similar to that of acne (19.055% ±15.469%) than that of rosacea without inflammatory papules and pustules (30.419% ±21.862%). C acnes (P = .048) and Serratia marcescens (P = .038) were significantly enriched in individuals with rosacea compared to acne. Investigating the differences between the skin microbiota in acne and rosacea can provide important clues towards understanding the disease progression in each condition.

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A systematic review and critical appraisal of metagenomic and culture studies in hidradenitis suppurativa

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Abstract

Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic inflammatory skin disease with still largely unknown pathogenesis. While infectious organisms have been identified in lesions of the disease since the 1980s, questions remain over the role that bacteria and microbiome play. Recent studies using 16S ribosomal RNA gene sequencing and larger culture-based studies have begun to paint a clearer picture of the microbial world of HS. With this systematic review, we summarize all the work that has been done to date in HS bacteriology, analyse potential pitfalls and limitations of the current studies, and address future directions of investigation. This systematic review attempted to collate and analyse all bacteriology studies done to date. This review was prospectively registered with PROSPERO (1670769) performed in line with the PRISMA checklist. Twenty two studies were identified comprising 862 individual HS patients for culture studies and 206 HS patients for 16S rRNA gene sequencing studies. Methodology tended to be varied, with different sampling, culturing and sequencing methods as well as amount of analysis and stratification of patients. Bacteria identified as elevated in HS lesions in sequencing studies as well as grown from HS lesions in culture studies are identified and discussed. These primarily included the anerobic Gram-negative bacilli Prevotella, Porphyromonas and Fusibacterium, the Gram-positive bacilli Corynebacterium, and the Gram-positive cocci Staphylococcus, Streptococcus and Parvimonas. Potential interactions, as well as work in other disease models with related bacteria are also discussed. Areas of further investigation include in vitro studies of interactions between bacteria and keratinocytes, gut and oral microbiome studies and deep sequencing studies for virulence and phage factors.

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Risk Factors for Procurence of Mucormycosis and its Manifestations Post Covid-19: a Single Arm Retrospective Unicentric Clinical Study

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Abstract

To assess the risk factors causative of ROCM post COVID-19. To determine the clinical manifestations, causative factors leading to surge in ROCM & factors contributing to poor prognosis in ROCM cases occurring in Western Rajasthan post COVID-19. In a Retrospective observational study, 56 post COVID-19 ROCM patients were analyzed from 'May–June 2021' at M.D.M. Hospital, Jodhpur. All patients after onset of disease were assessed as per selection criteria, included patients were examined for risk factors and clinical manifestations & then were statistically evaluated. Median age was 53 years with male to female ratio 2.7:1. Uncontrolled diabetes was noted in at least 85% patients. Steroid use was seen in 66%. Other major contributing factor to ROCM was the occupation; Out of 56 patients 69% were FARMERS.72% had no history of COVID-19 vaccination. Only 3% had no underlying disease. Overall mortality rate was 16% .2 determinants were associated with poor prognosis: higher HbA1c-Out of 7 cases of orbital exenteration, 6 (85%) had HbA1c > 12. 36% took immoderate amounts of Steam inhalation. Maxillary sinuses were the most involved sites (94%). Orbital involvement was seen in 33 and 12% were PL negative. Palatal involvement & intracranial involvement were seen in 14% and 7% respectively. Bilateral disease was seen in 28%. Uncontrolled DM & Humid working conditions came out to be the main predisposing factors for ROCM. Facial pain is considered to be the most common presenting complain. Maxillary sinus is the most involved site.

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