Sunday, October 3, 2021

Current therapeutic options for low‐risk papillary thyroid carcinoma: A scoping evidence review

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Abstract

Most cases of thyroid carcinoma are classified as low risk. These lesions have been treated with open surgery, remote access thyroidectomy, active surveillance, and percutaneous ablation. However, there is lack of consensus and clear indications for a specific treatment selection. The objective of this study is to review the literature regarding the indications for management selection for low-risk carcinomas. Systematic review exploring inclusion and exclusion criteria used to select patients with low-risk carcinomas for treatment approaches. The search found 69 studies. The inclusion criteria most reported were nodule diameter and histopathological confirmation of the tumor type. The most common exclusions were lymph node metastasis and extra-thyroidal extension. There was significant heterogeneity among inclusion and exclusion criteria according to the analyzed therapeutic approach. Alternative therapeutic approaches in low-risk carcinomas can be cautiously considered. Open thy roidectomy remains the standard treatment against which all other approaches must be compared.

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Human microRNA‐182‐5p and kinectin 1: Potential biomarkers for prognosis in oral squamous cell carcinoma

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Abstract

Background

The prognostic impact of hsa-miRNA-182-5p in oral cancer remains unexplored. Therefore, the aim of this study was to investigate the prognostic value of hsa-miRNA-182-5p and its predicted target kinectin 1 (KTN1) in oral squamous cell carcinoma (OSCC).

Method

Expression level of hsa-miRNA-182-5p was analyzed in tumor tissue (n = 36) and healthy oral mucosal tissue (n = 17) using quantitative real-time polymerase chain reaction. Protein level of the predicted target KTN1 was detected via immunohistochemistry. Results were validated in a cohort of The Cancer Genome Atlas (TCGA).

Results

After dividing the data into a subgroup with high and low hsa-miRNA-182-5p expression level, a significant better overall (p = 0.016), recurrence-free (p = 0.009), and progression-free survival (p = 0.004) was observed in an upregulation of hsa-miRNA-182-5p. Staining intensity of KTN1 showed a reciprocal impact on the prognosis. Validation in a TCGA cohort confirmed these results.

Conclusion

Our results indicate hsa-miRNA-182-5p and KTN1 as potential biomarkers for OSCC.

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Mini-Incision Parotidectomy-Our Technique

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Abstract

Traditional parotidectomy incision was devised by Blair (1912) which was modified by Bailey (1941). Over the years various approaches and techniques have evolved to improve the aesthetic outcome and at the same time for complete disease clearance with reduced complications. In this study, we evaluated the feasibility of our mini-incision parotidectomy technique along with the surgical and quality of life (QOL) outcomes. This prospective case series was conducted at Apollo Hospitals, Bangalore over a period of 2 years (June 2018-August 2020) and includes 20 patients. The surgical outcomes were assessed in terms of feasibility of mini-incision technique with respect to levels of parotid involved and functional outcomes in terms of presence or absence of complications like facial palsy (temporary or permanent), seroma and Frey's syndrome. Patient related quality of life (QOL) outcomes were assessed in terms of post-operative pain score, patient comfort score and cosmetic score by using numerical rating scale-11 (NRS-11). The mini-incision parotidectomy technique is feasible for lesions in all the parotid levels and conversion or lengthening of incision was not needed in any of the cases. 2(10%) patients had temporary facial palsy (House-Brackman grade III) which was recovered within 3 weeks after surgery. One patient (5%) with adenoid cystic carcinoma had permanent facial palsy. Out of 20 patients 2(10%) had seroma and 1(5%) patient presented with Frey's syndrome. Mean post-operative pain score at 0, 6 and 24 h were 4.8, 3.4 and 1.8 out of 10 respectively. Mean comfort score was 9 out of 10 and mean cosmetic score was 9.5 out of 10. Mini-incision parotidectomy technique can render improved functional as well as aesthetic outcomes after parotidectomy without compromising the surgical clearance of the disease process.

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Outcomes of Tympanoplasty Performed in Dry and Wet Ear Groups: A Comprehensive Comparative Study

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Abstract

There are various factors which affect the success rate of tympanic membrane (perforation) closure, including age of the patient, size of the perforation, duration of the ear discharge, the presence or absence of infective discharge at the time of surgery. Our aim was to observe the effect of presence of discharge from the ear on the success (outcome) of tympanoplasty. This is prospective study which was conducted on 300 cases with 150 patients each in dry and wet ear group. The study was conducted on patients of age 12–65 years and of either sex presenting with chronic otitis media. Ear discharge for less than 10 years, 78% in dry ear group and 81% in wet ear group. Around 64% had complaint of decreased hearing for < 5 years in dry ear group and 60% in wet ear group. The size of perforation in dry ear group, moderate size perforation was found being predominant 46%, large in 42% and small in 12% patients. In wet ear group 46% patients had moderate, 16% patients had small and 38% patients had large perforation. Improvement in hearing was seen in 105 (70%) cases and worsening in 9 (6%) cases in dry ear group and 114 (76%) hearing improvement, 9 (6%) worsening in wet eargroup. Graft failure was 12 (8%) in dry ear and 15(10%) in wet ear. Worsening in the hearing was seen in 6% cases in both dry and wet ear groups. No other complications were noted in patients during follow up period.

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Outcomes of Tympanoplasty Performed in Dry and Wet Ear Groups: A Comprehensive Comparative Study

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Abstract

There are various factors which affect the success rate of tympanic membrane (perforation) closure, including age of the patient, size of the perforation, duration of the ear discharge, the presence or absence of infective discharge at the time of surgery. Our aim was to observe the effect of presence of discharge from the ear on the success (outcome) of tympanoplasty. This is prospective study which was conducted on 300 cases with 150 patients each in dry and wet ear group. The study was conducted on patients of age 12–65 years and of either sex presenting with chronic otitis media. Ear discharge for less than 10 years, 78% in dry ear group and 81% in wet ear group. Around 64% had complaint of decreased hearing for < 5 years in dry ear group and 60% in wet ear group. The size of perforation in dry ear group, moderate size perforation was found being predominant 46%, large in 42% and small in 12% patients. In wet ear group 46% patients had moderate, 16% patients had small and 38% patients had large perforation. Improvement in hearing was seen in 105 (70%) cases and worsening in 9 (6%) cases in dry ear group and 114 (76%) hearing improvement, 9 (6%) worsening in wet eargroup. Graft failure was 12 (8%) in dry ear and 15(10%) in wet ear. Worsening in the hearing was seen in 6% cases in both dry and wet ear groups. No other complications were noted in patients during follow up period.

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A New Biomarker in Differentiation of Mucosal Chronic Otitis Media from Squamous Chronic Otitis Media: The Systemic Immune-Inflammation Index (SII)

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Abstract

The Systemic Immune-inflammation Index (SII) is a new biomarker based on the number of neutrophils, platelets, and lymphocytes in the Complete blood count, and is shown as diagnostic and prognostic in many diseases. Mucosal or Squamous COM differentiation is necessary preoperatively in chronic otitis media patients. The purpose of this study was to test the predictive value of inflammation markers to predict the differentiation of Mucosal COM and Squamous COM. Our aim is; using "SII" as a powerful test to differentiate cholesteatoma and active mucosal middle ear disease. In the present study, 300 patients who underwent mastoidectomy ± tympanoplasty between 2010 and 2020 were retrospectively evaluated. The patients were divided into two equal groups as clinical, microscopically, and pathologically Squamosal COM (Cholesteatoma) and Mucosal COM (Suppurative) (n = 150). Routine hemogram tests were performed for both groups. White blood cell, red blood cell, neutrophil, lymphocyte, and platelet numbers were calculated. The SII value was calculated manually according to the formula of "neutrophil × platelet/lymphocyte. There were a total of 300 patients who were aged 20–63 in both groups. A total of 130 of these patients were male (43%), and 170 (57%) were female. In terms of NLR and PLR, Group 2 (Mucosal COM) had higher values at statistically significant levels (p < 0.001, p < 0.001, respectively). In terms of SII, Group 2 (Mucosal COM) had higher values at statistically significant levels (p < 0.001). According to the results of the ROC Analysis in our series, it was found that NLR, PLR, and SII values were above the acceptable level, and were statistically significant (p < 0.001, p < 0.001, p < 0.001, respectively). The cut-off value of SII was 470.29, sensitivity was 65.8, and specificity was 34. According to our study, hig h SII values in COM differentiation are very important in diagnosing Mucosal COM. SII values can help to the diagnosis in Squamous COM/Mucosal COM differentiation. There is no current practical, inexpensive, and widespread laboratory test used in the Mucosal/Squamous COM differentiation. SII can be diagnostic, and determine the treatment in this differentiation. A great number of studies are needed for SII values to become standard in COM.

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Congenital Malleus Bar Fixing to External Auditory Canal Causing Conductive Hearing Loss

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Ear Nose Throat J. 2021 Sep 30:1455613211049659. doi: 10.1177/01455613211049659. Online ahead of print.

NO ABSTRACT

PMID:34592848 | DOI:10.1177/01455613211049659

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Three‐dimensional (3D) reconstruction and navigation in robotic‐assisted partial nephrectomy (RAPN) for renal masses in the solitary kidney: a comparative study

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Abstract

Background

Numerous efforts were made to improve renal function and oncologic outcomes in surgery for patients with kidney cancer. We explored new robotic methods in solitary kidneys.

Materials and Methods

We prospectively registered and included 16 patients in the 3D-RAPN group with a solitary kidney (anatomic or functional), and retrospectively identified 25 patients with a solitary kidney who received RAPN also operated by us for comparison.

Results

The rates of global clamping reduced in the 3D-RAPN group (37.5% VS 76%)while selective rates were higher (56.2% VS 20%) (p=0.028). The mean percentages of Scr increase (+20.2% VS +30.2%, p=0.045) and eGFR reduction ( -16.8% VS -27.1%) as well as rate of opening collecting systems (31.3% VS 72%, p=0.010) were lower in 3D-RAPN group.

Conclusions

3D-RAPN less impaired the renal function of patients with a solitary kidney and showed superiority or non-inferiority in other evaluation indexes compared to conventional RAPN.

This article is protected by copyright. All rights reserved.

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Molecular genotyping in refractory thyroid cancers in 2021: When, how and why? A review from the TUTHYREF network

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Bull Cancer. 2021 Sep 27:S0007-4551(21)00303-9. doi: 10.1016/j.bulcan.2021.06.009. Online ahead of print.

ABSTRACT

Refractory thyroid cancers include radio-iodine-refractory cancers, metastatic or locally advanced unresectable medullary and anaplastic thyroid cancers. Their management has been based for several years on the use of multi-target kinase inhibitors, with anti-angiogenic action, with the exception of anaplastic cancers usually treated with chemo- and radiotherapy. The situation has recently evolved due to the availability of molecular genotyping techniques allowing the discovery of rare but targetable molecular abnormalities. New treatment options have become available, more effective and less toxic than the previously available multi-target kinase inhibitors. The management of refractory thyroid cancers is therefore becoming more complex both at a diagnosis level with the need to know when, how and why to look for these mo lecular abnormalities but also at a therapeutic level, innovative treatments being hardly accessible. The cost of molecular analyzes and the access to treatments need also to be homogenized because disparities could lead to inequality of care at a national or international level. Finally, the strategy of identifying molecular alterations and treating these rare tumors reinforces the importance of a discussion in a multidisciplinary consultation meeting.

PMID:34593218 | DOI:10.1016/j.bulcan.2021.06.009

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Erythropoietin levels in children with obstructive sleep apnea

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Publication date: Available online 1 October 2021

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Nick D. Kalogritsas, Vasileios A. Lachanas, Panagiotis Liakos, Emmanuel I. Alexopoulos, Despoina Beka, Efthymia Petinaki, Jiannis Hajiioannou, George Simos, Charalampos E. Skoulakis

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Treatment of burn contractures with allogeneic human dermal fibroblasts improves Vancouver scar scale: A phase I/II trial

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J Plast Reconstr Aesthet Surg. 2021 Sep 17:S1748-6815(21)00405-8. doi: 10.1016/j.bjps.2021.08.018. Online ahead of print.

NO ABSTRACT

PMID:34593339 | DOI:10.1016/j.bjps.2021.08.018

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Does Frailty or Age Increase the Risk of Postoperative Complications Following Cochlear Implantation?

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OTO Open. 2021 Sep 24;5(3):2473974X211044084. doi: 10.1177/2473974X211044084. eCollection 2021 Jul-Sep.

ABSTRACT

OBJECTIVE: To evaluate whether frailty or age increases the risk of postoperative complications following cochlear implant (CI) surgery.

STUDY DESIGN: Retrospective cohort study.

SETTING: Tertiary academic center.

METHODS: An evaluation of all adult patients undergoing cochlear implantation between 2006 and 2020 was performed. The 5-item Modified Frailty Index (mFI-5, comprising preoperative history of pulmonary disease, heart failure, hypertension, diabetes, and partially/totally dependent functional status) was calculated for all patients included in analysis in addition to demographic characteristics. The primary outcome was postoperative complications following CI within a 3-month period. Major complications included myocardial infarction, bleeding, and cerebrospinal fluid leak, among others. Predictors of pos toperative complications were examined using multivariable logistic regression reporting odds ratios (ORs) and 95% CIs.

RESULTS: There were 520 patients included for review with a median age of 68 (range, 18-94) years and a slight male predominance (n = 283, 54.4%). There were 340 patients (65.4%) who were robust (nonfrail) with an mFI of 0, while 180 (34.6%) had an mFI of ≥1. There were 20 patients who experienced a postoperative complication (3.85%). There was no statistically significant association between postoperative complications as a result of preoperative frailty (OR, 1.56; 95% CI, 0.98-2.48, P = .06) or age as a continuous variable (OR, 0.99; 95% CI, 0.97-1.02, P = .51).

CONCLUSIONS: CI is safe for elderly and frail patients and carries no additional risk of complications when compared to younger, healthier patients. While medical comorbidities should always be considered perioperatively, this study supports the notion that implantation is low risk in older, frail patients.

PMID:34595366 | PMC:PMC8477701 | DOI:10.1177/2473974X211044084

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