Distribution Characteristics of Juvenile-Onset Recurrent Respiratory Papillomatosis at First-Time Surgery

xlomafota13 shared this article with you from Inoreader Distribution Characteristics of Juvenile-Onset Recurrent Respiratory Papillomatosis at First-Time Surgery Via ear nose throat Ear Nose Throat J. 2021 Oct 26:1455613211049845. doi: 10.1177/01455613211049845. Online ahead of print. ABSTRACT OBJECTIVES: The lesion distribution of juvenile-onset recurrent respiratory papillomatosis (JORRP) during first-time surgery has been rarely reported. The purpose of this study was to describe the anatomical distribution of papilloma across 25 Derkay sites during initial surgery and to assess the impact of the lesion distribution on disease severity. METHODS : Surgical videos and medical records of 106 patients with JORRP (27 aggressive and 79 nonaggressive cases) were retrospectively reviewed. Lesion locations were recorded using Derkay anatomical sites. Logistic regression was used to analyze the effect of the lesion distribution on disease severity. RESULTS: Among the 106 patients, the true vocal cords (90.6% left, 84.0% right) were the most frequently involved site, followed by the false vocal cords (39.6% left, 35.8% right) and the anterior commissure (26.4%). Two patients (1.9%) had tracheal involvement. Patients with false vocal cord involvement (odds ratio [OR] = 3.425, 95% confidence interval [CI] [1.285, 9.132], P = .014) and a younger age at diagnosis (OR = .698, 95% CI [.539, .905], P = .007) were more likely to require more than 4 procedures in the year following first-time surgery. CONCLUSIONS: Lesions were most common on the true vocal cords. False vocal cord involvement and a younger age at diag nosis were risk factors for disease severity. PMID:34702097 | DOI:10.1177/01455613211049845 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prospective Validation of the Use It or Lose It Paradigm: Secondary Analysis of Sub-Acute Dietary Outcomes by Eat and Exercise Status During Oropharyngeal Radiotherapy

xlomafota13 shared this article with you from Inoreader Prospective Validation of the Use It or Lose It Paradigm: Secondary Analysis of Sub-Acute Dietary Outcomes by Eat and Exercise Status During Oropharyngeal Radiotherapy Via swallowing exercises Int J Radiat Oncol Biol Phys. 2021 Nov 1;111(3S):e408-e409. doi: 10.1016/j.ijrobp.2021.07.1176. ABSTRACT PURPOSE/OBJECTIVE(S): The investigators' 2013 use it or lose it study suggested functional benefit of two pharyngeal activities during head and neck radiotherapy (RT) - maintenance of oral intake (EAT) and swallowing exercise. EAT and EXERCISE independently associated with better odds of resuming a regular diet in long term survivorship and shorter duration of gastrostomy (FT) d ependence. The prior work is limited by the retrospective nature of the dataset and historically far higher FT utilization. Our aim was to validate the previous work in a contemporary cohort of oropharyngeal cancer (OPC) survivors treated with RT using prospectively acquired validated outcome measures. MATERIALS/METHODS: Endpoints included subacute diet after RT per the performance status scale for head and neck cancer (PSS-HN; solid food diet coded as ≥60 and no FT) and length of FT-dependence in days. Primary independent variables included oral intake (PO) at the end of RT (nothing per oral/NPO; partial PO; full PO) and swallow exercise adherence. Multiple linear regression and logistic regression models were analyzed adjusting for tumor location, baseline diet, chemotherapy and N and T stage. RESULTS: Analysis included 595 patients treated with primary radiotherapy (RT; 19% 111) /chemoradiation (CRT; 73% 434) or primary TORS + CRT (8% 50) for OPC (base of tongue/glo ssopharyngeal sulcus [46% 276]; tonsil [44% 263]; other [9% 56]). At the end of RT 9% of patients were NPO (55), 19% partial PO (115), 71% full PO (425). Statistically significant (P < 0.05) covariates for EAT and/or EXERCISE included tumor location, chemotherapy, N and T stage. Fifty-seven percent of patients (340) reported adherence to swallow exercises. Overall, 66% (394) of patients returned to a solid diet by 3-6 months. In adjusted models, EAT and EXERCISE during RT were independently, significantly (P < 0.01) associated with sub-acute diet recovery and FT duration. Patients who maintained full PO during RT were 2.5 times more likely to eat a solid diet by 3-6 months (OR 2.5, 95% CI: 1.3, 5) when compared to those who were NPO during treatment. Patients who exercised were 2.9 times more likely to return to a solid diet (OR 2.9, 95% CI: 1.8, 4.4) relative to those who did not. Thirty-eight percent of patients received a FT (231) and the median duration of tube dependence was 89 days (IQR: 28-142). EAT was independently associated with FT duration (P < 0.001, Coefficient, -123.6, 95% CI: -148.7, -98.4), while EXERCISE was not (P = .73). CONCLUSION: These prospective registry data validate prior work that indicate independent benefit of EAT and swallowing EXERCISE adherence during RT on subacute functional outcomes. Patients who maintained full PO and/or exercise were more likely to eat solid foods by 3-6 months after treatment, while patients who EAT during treatment expectedly have the shortest feeding tube dependence. PMID:34701381 | DOI:10.1016/j.ijrobp.2021.07.1176 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evaluation of a Custom‐Designed Human‐Robot Collaboration Control System for Dental Implant Robot

xlomafota13 shared this article with you from Inoreader Evaluation of a Custom‐Designed Human‐Robot Collaboration Control System for Dental Implant Robot Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Background The purpose of this study is to develop a methodology to better control a human-robot collaboration for robotic dental implant placement. We have designed a human-robotic collaborative implant system (HRCDIS) which is based on a zero-force hand-guiding concept and a operational task management workflow that can achieve highly accurate and stable osteotomy drilling based on a surgeon's decision and robotic arm movements during implant surgery. Method The HRCDIS brings forth the robot arm positions, exact drilling location, direction and performs automatic drilling. The HRCDIS can also avoid complex programing in the robot. The purpose of the study is to evaluate the accuracy of drilling resulting from our developed operational task management method (OTMM). The OTMM can enable the robot to switch, pause, and resume drilling tasks. The force required for hand-guiding in a zero-force control mode of the robot was detected by a 6D force sensor. We co mpared our force data to those provided by the manufacturer's manual. The study was conducted on a phantom head with a 3D-printed jaw bone to verify the validity of our HRCDIS. We appraised the discrepancies between free-hand drillings and the HRCDIS controlled drillings at apical center and head center of the implant and implant angulation to the baseline data from a virtual surgical planning model.. Results The average required force used by hand-guiding to operate the robot with HRCDIS was near 7 Newton which is much less than the manufacturer's specification (30 Newton). The results from our study showed that the average error at implant head was 1.04±0.37 mm, 1.56±0.52 mm at the implant apex, and deviation of implant angle was 3.74±0.67°. Conclusions The results from this study validate the merit of the human-robot collaboration control by the HRCDIS. Based on the improved navigation system using HRCDIS, a robotic implant placement can provid e seamless drilling with ease, efficiency and accuracy. This article is protected by copyright. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Diagnosing complications following cochlear implantation using transcutaneous ultrasound

xlomafota13 shared this article with you from Inoreader Diagnosing complications following cochlear implantation using transcutaneous ultrasound Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Oct 26. doi: 10.1007/s00405-021-07128-2. Online ahead of print. ABSTRACT PURPOSE: The aim of this study was to investigate the feasibility and reliability of transcutaneous ultrasound for the detection of complications after cochlear implantation. METHODS: In a single center retrospective cohort study, 115 consecutive cases of suspected complications after cochlear implantation (intervention group) were examined. The rate of pathologic ultrasound findings for specific leading symptoms and diagnoses was compared to a control group comprising twenty consecutive cochlear implants in symptom-free patients. RESULTS: Diagnostic ultrasound showed distinctly more pathologic findings in the intervention group (n = 67; 58.3%; p < 0.001) compared to the control group (n = 1; 5%). Ultrasound revealed significantly more pathologic findings in haematoma or seroma around the implant (n = 17; 100%; p < 0.001; ϕ = 0.94) and magnet dislocation (n = 44; 97.7%; p < 0.001; ϕ = 0.92) confirmed by a strong effect. Ultrasound examination showed a medium to high effect size in patients presenting with local infections (n = 3; 21.4%; p = 0.283; ϕ = 0.25) and skin flap oedema (n = 2; 50%; p = 0.061; ϕ = 0.51). In contrast, ultrasound examinations displayed a low effect size in undefined cephalgia (0%; p = 0.444; ϕ = 0.17) and device malfunction or failure (0%; p > 0.999; ϕ = 0.13). CONCLUSION: Transcutaneous ultrasound can be advocated as a feasible and effective method in the diagnostic work-up of magnet dislocation and haematoma or seroma around the implant following cochlear implantation. Contrary, ultrasound findings can be expected to be inconspicuous in patients presenting with undefined cephalgia and device malfunction or failure. PMID:34704135 | DOI:10.1007/s00405-021-07128-2 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Merocel compression dressing: a novel modified surgical technique for treating auricular pseudocyst

xlomafota13 shared this article with you from Inoreader Merocel compression dressing: a novel modified surgical technique for treating auricular pseudocyst Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Oct 26. doi: 10.1007/s00405-021-07152-2. Online ahead of print. ABSTRACT PURPOSE: Auricular pseudocyst (AP) is a benign, noninflammatory swelling to the ear, located on either the front or side surface. Deroofing surgery with variable compression methods is considered the most effective method. However, post-operative wound pain is the main drawback following compression. We are introducing a novel painless surgical procedure which involves deroofing technique followed by Merocel® compression dressing. METHODS: From 2015 to 2020, thirty-one patients with AP received this new surgical compression method in our university-affiliated tertiary hospital. Retrospective chart review and the analysis of the results were conducted. RESULTS: All patients had unilateral lesions, with left side lesions (58.1%) predominant. The concha cymba (38.7%) and concha cavum (35.8%) were the most common sites. Pre vious aspiration or drainage had been performed for the cysts in eight patients (25.8%). Only one patient had the recurrence after post-operative 3 months and received the revised surgery without following recurrence and discomfort. Among all patients, 29 (93.5%) patients claimed minimal pain around 0 or 1 in numeric rating scale of pain score. Three patients had mild ecchymosis but recovered after conservative treatment. One patient had mild auricular deformity after surgery due to pre-treatment partial cartilage necrosis. All patients had follow-up for at least 6 months. CONCLUSION: This novel Merocel® compression dressing technique to treat AP after deroofing is an effective procedure. Minimal pain, simple to do and easily acquired materials were the advantages of this novel procedure. PMID:34704136 | DOI:10.1007/s00405-021-07152-2 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Opioids for the Prevention of Post-dural Puncture Headache in Obstetrics: A Systematic Review and Meta-analysis of Efficacy and Safety

xlomafota13 shared this article with you from Inoreader Opioids for the Prevention of Post-dural Puncture Headache in Obstetrics: A Systematic Review and Meta-analysis of Efficacy and Safety Via leak of cerebrospinal fluid Pain Physician. 2021 Nov;24(7):E1155-E1162. ABSTRACT BACKGROUND: Post-dural puncture headache (PDPH), or spinal headache, is the most common serious complication resulting from iatrogenic puncture of the dura during epidural or spinal anesthesia and cerebrospinal fluid (CSF) leak in pregnant women. OBJECTIVE: To analyze the effectiveness and safety of opioids as a prophylaxis approach in treating obstetric patients who underwent unintentional dural puncture during the initiation of neuraxial anesthesia. STUDY DESIGN: A systematice review and meta-analysis. SETTING: No restriction regarding study type. METHODS: PubMed, Embase, and the Cochrane library were searched for available papers published up to September 2020. RESULTS: According to the eligibility criteria, 10 studies were included with post-dural puncture headache (PDPH) incidence as the primary outcome and the number of epidural blood patch (EBP) required as the second outcome. The risk estimates of each study were reported as odds ratios (ORs). The results showed morphine does not decrease the incidence of PDPH (OR = 0.45, 95% CI: 0.15 - 1.34, P = 0.153, I2 = 74.4%, Pheterogeneity = 0.004) and the use of EBP (OR = 0.40, 95% CI: 0.08 - 1.95, P = 0.259, I2=73.7%, Pheterogeneity = 0.004). Fentanyl does not decrease the incidence of PDPH (OR = 0.35, 95% CI: 0.01-13.77, P = 0.576, I2 = 81.0%, Pheterogeneity = 0.022). LIMITATIONS: The small number of included studies, high heterogeneity, and variety in study designs. CONCLUSIONS: Exposure to opioids for any reason after the diagnosis of unintentional dural puncture is not associated with a reduced risk of PDPH and does not decrease the need for therapeutic EBP. PMID:34704725 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Long non-coding RNA-KCNQ1OT1 mediates miR-423-5p/microfibril-associated protein 2 axis in colon adenocarcinoma

xlomafota13 shared this article with you from Inoreader Long non-coding RNA-KCNQ1OT1 mediates miR-423-5p/microfibril-associated protein 2 axis in colon adenocarcinoma Via Cellular and Molecular Biology Histol Histopathol. 2021 Oct 27:18386. doi: 10.14670/HH-18-386. Online ahead of print. ABSTRACT BACKGROUNDS: Long non-coding RNAs (lncRNAs) function as competing endogenous RNAs (ceRNAs) that contribute to carcinogenesis. Herein, we plan to explore whether lncRNA KCNQ1OT1 modulated miR-423-5p/microfibril-associated protein 2 (MFAP2) signaling axis is implicated in the progression of human colon adenocarcinoma. MATERIAL AND METHODS: Clinical specimens were collected for histologic examination and gene expression analysis. In vitro experimental measurements, including CCK8, transwell and TUNEL staining, were performed to evaluate cell proliferation, migration and apoptosis. RESULTS: up-regulation of KCNQ1OT1 and MFAP2 and down-regulation of miR-423-5p in COAD tissues were substantiated by The Cancer Genome Atlas (TCGA) database and our clinical specimens. In vitro experimental measurements exhibited that knockdown of KCNQ1OT1 facilitated miR-423-5p expression and inhibited MFAP2 expression, simultaneously. Transfection of si-KCNQ1OT1, miR-423-5p mimics or si-MFAP2 had the ability to repress malignant phenotypes of COAD cells. Intriguingly, overexpression of MFAP2 restrained si-KCNQ1OT1- or miR-423-5p mimics-induced the inhibition of cell proliferation and migration and elevation of the apoptotic proportion of COAD cells. CONCLUSIONS: KCNQ1OT1 serves as a molecular sponge of miR-423-5p to accelerate the expression of MFAP2 that may be involved in the development of COAD. Our findings present a novel signaling axis KCNQ1OT1/miR-423-5p/MFAP2, which provides a theoretical basis and therapeutic target for the treatment of COAD. PMID:34704601 | D OI:10.14670/HH-18-386 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

HPV‐Positive Status Is an Independent Factor Associated With Sinonasal Inverted Papilloma Recurrence

xlomafota13 shared this article with you from Inoreader HPV‐Positive Status Is an Independent Factor Associated With Sinonasal Inverted Papilloma Recurrence Via The Laryngoscope Abstract Objectives The present study aimed to evaluate human papillomavirus (HPV) occurrence in sinonasal inverted papilloma (SNIP), and to assess factors associated with HPV positivity and SNIP recurrence. Study Design Prospective study. Methods We prospectively collected clinical data and fresh tissue specimens from 90 consecutive patients treated for SNIP at Helsinki University Hospital, between 2015 and 2019. Fourteen patients with recurrent SNIP underwent repeated tumor sampling. All tissue specimens were analyzed for the presence of HPV. Factors associated with SNIP recurrence and HPV positivity were assessed. Results Among 107 SNIP specimens, 14 (13.1%) were positive for low-risk HPV and 6 (5.6%) were positive for high-risk HPV. HPV positivity was associated with an increased risk of recurrence (P = .004). Smoking was significantly associated with HPV positivity in SNIP (P = .01), but a history of HPV-related diseases or patient sexual habits did not correlate with HPV positivity. The recurrence rate was lower among patients with SNIP that underwent an attachment-oriented resection, compared to patients treated without attachment-oriented resections (78.6% vs 25.8%, P < .001). Conclusions The risk of SNIP recurrence was highly associated with 1) HPV positivity and 2) surgery without an attachment-oriented resection. Oncogenic HPV was rare in SNIP. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Predictors of Postoperative Nausea and Vomiting After Endoscopic Skull Base Surgery

xlomafota13 shared this article with you from Inoreader Predictors of Postoperative Nausea and Vomiting After Endoscopic Skull Base Surgery Via The Laryngoscope Objectives/Hypothesis The objective of this study is to evaluate the impact of patient and surgical factors, including approach and reconstruction type, on postoperative nausea and vomiting episodes following endoscopic skull base surgery. Study Design Retrospective review. Methods We performed a retrospective chart review from July 2018 to August 2020 of 99 consecutive patients undergoing endoscopic skull base surgery at a tertiary academic skull base surgery program. All patients were treated with a standardized postoperative protocol consisting of scheduled ondansetron, along with promethazine and scopolamine for breakthrough nausea and vomiting episodes. Cumulative nausea and vomiting episodes throughout hospital stay were recorded for each patient. Results Of the 99 patients identified, the mean number of nausea and vomiting episodes per patient were 0.4 ± 1.2 and 0.3 ± 0.7, respectively. Female sex (β = .65, P = .034) and extended surgical approach (β = .90, P = .027) were associated with increased risk for postoperative nausea. Furthermore, female sex (β = .44, P = .018), cavernous sinus dissection (β = .52, P = .002), and extended approach (β = .79, P = .025) significantly increased odds of postoperative vomiting episodes. There was no association between total operative time or total postoperative opioid dose and nausea and vomiting episodes (all Ps > .05). Neither increased nausea nor vomiting episodes significantly increased odds of prolonged hospitalization (P = .105 and .164, respectively). Conclusion This report highlights novel risk factors for patients undergoing endoscopic skull base surgery. Upfront standing antiemetic therapy may be considered when treating patients with independent predictors of postoperative nausea and vomiting, including female sex, cavernous sinus dissection, and extended surgical approach. Level of Evidence IV Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evolution of Voice Quality in Type 1–2 Transoral CO2 Laser Cordectomy: A Prospective Comparative Study

xlomafota13 shared this article with you from Inoreader Evolution of Voice Quality in Type 1–2 Transoral CO2 Laser Cordectomy: A Prospective Comparative Study Via The Laryngoscope Abstract Objectives/Hypothesis To compare the 12-month evolution of voice quality outcomes in patients who benefited from types 1–2 transoral CO2 laser cordectomy (TLC) for an early-stage vocal fold squamous cell carcinoma (VFSCC). Study Design Prospective uncontrolled study. Methods Sixty patients with cT1 VFSCC were consecutively recruited from a single medical center. Thirty patients benefited from type 1 TLC, while type 2 TCL was performed in 30 patients. The following voice quality outcomes were evaluated at baseline, 3-, 6-, and 12-month post-TLC: voice handicap index (VHI), GRBAS, speech rate, maximum phonation time (MPT), and acoustic parameters. Voice quality evolution was compared between type 1 and type 2 TLC. Results Fifty-seven patients completed the evaluations. Type 1 TLC patients reported significant improvements of VHI, grade of dysphonia, and breathiness at 3-, 6-, and 12-month post-TLC. Speech rate and jitter values improved 6- and 12-month post-TLC. A few voice quality outcomes reported 3- or 6-month post-TLC improvements in type 2 TLC group, while VHI, grade of dysphonia improved at 6- and 12-month post-TLC. MPT significantly decreased at 6- and 12-month post-TLC, while there were no acoustic measurement changes in type 2 TLC. Conclusions The effect of TLC on voice quality may depend on the type of TLC. Type 1 TLC was associated with faster voice quality improvements compared with type 2 TLC. VHI and dysphonia grade were identified as the most relevant tool of voice changes irrespective to the TLC type. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Severe Versus Very Severe Pediatric Obstructive Sleep Apnea Outcomes After Adenotonsillectomy

xlomafota13 shared this article with you from Inoreader Severe Versus Very Severe Pediatric Obstructive Sleep Apnea Outcomes After Adenotonsillectomy Via The Laryngoscope Objectives/Hypothesis Adenotonsillectomy (AT) is generally considered the first line treatment for pediatric patients with obstructive sleep apnea (OSA). Pediatric patients with severe OSA have worse outcomes after AT than patients with milder OSA. It is currently unclear if this group of higher morbidity patients should be subdivided further. This study investigates patients with severe pediatric OSA to determine if there are differences in postsurgical outcomes based on initial severity of sleep disordered breathing, medical comorbidities, or demographic factors. Study Design Retrospective cohort study at a single tertiary referral center. Methods Patients aged 2–18 who underwent polysomnogram (PSG) from October 2012 to January 2019, had an apnea-hypopnea index (AHI) >10, and subsequently underwent AT were identified using a filter through electronic medical record. A total of 112 patients underwent both pre- and postoperative PSG. Bivariate analysis was conducted via Pearson chi-square test. Univariate and multivariate analyses via binary logistic and multinomial linear regressions were performed using SPSS. Results Of the 112 patients included in this study, 68 patients were identified as having severe OSA (AHI = 10–20) and 44 as having very severe OSA (AHI > 20). Very severe OSA patients were significantly less likely to be cured of sleep disordered breathing or have their OSA reduced to mild OSA. Obese patients were found to have less reduction in AHI after AT. Conclusions The postsurgical outcomes of patients with severe and very severe OSA are significantly different indicating that patients traditionally categorized as having severe OSA may need to be further subcategorized. Level of Evidence IV Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.