Management of cerebrospinal fluid leak in the lateral recess of the sphenoid sinus with transpterygoid approach: A case report

xlomafota13 shared this article with you from Inoreader Management of cerebrospinal fluid leak in the lateral recess of the sphenoid sinus with transpterygoid approach: A case report Via leak of cerebrospinal fluid Int J Surg Case Rep. 2021 Nov 12;89:106594. doi: 10.1016/j.ijscr.2021.106594. Online ahead of print. ABSTRACT BACKGROUND: Cerebrospinal fluid (CSF) leak that occurred in the lateral sphenoid sinus is a rare and difficult case. This paper aims to report a case of defect closure in the lateral recess of the sphenoid sinus endoscopically with a transpterygoid approach. CASE PRESENTATION: A 38-year-old Indonesian woman reported a CSF leak, and identified a defect in the lateral recess of the left sphenoid sinus. CSF leak was repaired with endoscopic transethmoid-pterygoid or transpterygoid endoscopic surgery and no CSF leak was found. The surgical procedure was successful even though it was only performed by an otorhinolaryngologist. DISCUSSION: Endoscopic transethmoid-pterygoid or transpterygoid endoscopic surgery is effective in repairing defects in the lateral recess of the sphenoid sinus in which surgical procedure is performed by a single otorhinolaryngologist. CONCLUSION: Endoscopic transpterygoid approach gained access to lateral site of sphenoid sinus was an effective approach in managing CSF leak of lateral sphenoid recess. Closure of the defect using a bone graft and mucosa of the middle turbinate was proven to be effective. It had been carried out successfully in Indonesia. PMID:34794074 | DOI:10.1016/j.ijscr.2021.106594 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Association of self‐reported financial burden with quality of life and oncologic outcomes in head and neck cancer

xlomafota13 shared this article with you from Inoreader Association of self‐reported financial burden with quality of life and oncologic outcomes in head and neck cancer Via Head & Neck Abstract Background There is a paucity of data on financial toxicity among patients with head and neck squamous cell carcinoma (HNSCC). Materials This was a retrospective, cross-sectional study of patients with HNSCC surveyed at an outpatient oncology clinic. Results The sample included 202 patients with HNSCC with a mean age of 59.6 years (SD 10.0). There were 53 patients (26%) with self-reported financial burden. Education of high school or less was a significant predictor of self-reported financial burden (OR 2.52, 95% CI 1.03–6.14, p = 0.042). Patients reporting financial burden had significantly worse physical (p = 0.003), mental (p = 0.003), and functional (p = 0.036) health-related quality of life (HRQOL). Patients reporting financial burden appeared to have lower 5-year overall survival (74.3% vs. 83.9%, p = 0.165), but this association did not reach statistical significance. Conclusion Financial burden or toxicity may affect approximately a quarter of patients with HNSCC and appears to be associated with worse HRQOL outcomes. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Predictive Modeling and Risk Stratification of Patients With Enlarged Vestibular Aqueduct

xlomafota13 shared this article with you from Inoreader Predictive Modeling and Risk Stratification of Patients With Enlarged Vestibular Aqueduct Via The Laryngoscope Objectives/Hypothesis To investigate patient-specific characteristics that independently predict for progressive hearing loss in patients with enlarged vestibular aqueduct (EVA). Utilize multivariable predictive models to identify subgroups of patients with significantly different progression risks. Study Design Retrospective analysis of patients evaluated at an academic tertiary care center. Cohort included 74 ears of patients with a diagnosis of EVA as defined by the Cincinnati criteria. Methods Hearing trajectories were characterized, and a Kaplan–Meier estimator was utilized to determine progressive phenotype probabilities across the first 10 years after diagnosis. Cox proportional hazard regression was used to identify patient characteristics that independently altered this probability. Stratified risk groups were delineated from generated nomogram scores. Results Male gender was associated with a 4.53 hazard ratio for progressive hearing loss (95% confidence interval [CI], 2.53 to 12.59). Each millimeter increase in operculum size was independently associated with an 80.40% increase in expected hazard (95% CI, 40.18 to 120.62). Each dB increase in air pure tone average at time of diagnosis decreased expected hazard by 1.59% (95% CI, −3.02 to −0.17). The presence of incomplete partition type II was associated with a 2.44 hazard ratio (95% CI, 1.04 to 5.72). Risk groups stratified by median nomogram score evidenced the discriminative ability of our model with the progression probability in the high-risk group being six times higher at 1 year, nearly five times greater at 3 years, and three times greater at 9 years. Conclusions EVA patient characteristics can be used to predict hearing loss probability with a high degree of accuracy (C-index of 0.79). This can help clinicians make more proactive management decisions by identifying patients at high risk for hearing loss. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Design of a Vibration Damping Robot and Force Evaluation In Intraoperative Robotic Assisted Femoral Shaft Repair Using a Modified Soft Damper

xlomafota13 shared this article with you from Inoreader Design of a Vibration Damping Robot and Force Evaluation In Intraoperative Robotic Assisted Femoral Shaft Repair Using a Modified Soft Damper Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Closed intramedullary nailing fixation is a method for treating fractured femurs with minimal invasiveness. However, this method lacks safety and precision. To avert prevailing problems such as extended cracks in the already broken bone, the design of a vibration damping robot and force evaluation system is essential. This paper present a sensor-based clamping robot system embedded with a regulated pressurized air balloon. Drilling forces were monitored by a force sensor attached to the end robot effector, while the reduced vibration result was measured by a non-contact laser displacement sensor. A two degree of freedom (2DOF) model was developed. Force and vibration data were obtained using a data acquisition module (EMS 309) and analyzed using MATLAB software (Version R2015b). Results obtained shows that both the frequencies and amplitudes of the vibration is reduced at 6 bar with effector's spindle speed of 1500rpm. This proposed concept shows that dril ling force and vibration can be reduced simultaneously using a robot effector coupled with a damper. 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.

An integrative multi‐omic analysis reveals a major metabolic rewiring between baby foreskin keratinocytes and adult female abdominal keratinocytes.

xlomafota13 shared this article with you from Inoreader An integrative multi‐omic analysis reveals a major metabolic rewiring between baby foreskin keratinocytes and adult female abdominal keratinocytes. Via Experimental Dermatology Abstract Even though its development starts early in utero, neonatal skin is still immature at birth relative to adult and undergoes a maturation process extending to the first years of life. It is now established that the stratum corneum is thinner and dryer, and that skin contains less natural moisturizing factors and lipids in newborns compared to children and adults. Moreover, it has been shown that skin surface area expansion is not linear throughout life and is peaking perinatally, suggesting that baby skin has a higher epidermal cellular turnover. Despite growing resources showing differences between adult and infant skin physiology, molecular and metabolic specificities of baby skin are still poorly understood. To address this critical knowledge gap, we performed an integrative transcriptomic and metabolomic study comparing human primary foreskin and abdominal keratinocytes from male babies and female adults, respectively. Based on state-of-the-art integrative frameworks, our analyses revealed a major shift in the global energetic metabolism in baby foreskin keratinocytes compared to adult abdominal keratinocytes, highlighting increased amino acid metabolism and mitochondrial oxidative phosphorylation in baby cells to fuel the citric acid cycle, while showing glycolysis as the major cell energy source in adult cells. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Gene expression profiling of laminin α3 blocked keratinocytes reveals an immune‐independent mechanism of blistering

xlomafota13 shared this article with you from Inoreader Gene expression profiling of laminin α3 blocked keratinocytes reveals an immune‐independent mechanism of blistering Via Experimental Dermatology Abstract Laminin-332 pemphigoid is a rare and chronic autoimmune blistering disease which results in subepidermal blisters and erosive lesions predominantly localized to mucous membranes. As histologic inflammation is variable, and non-complement fixing IgG antibodies against laminin-332 are the predominant class of autoantibodies deposited at the epidermal basement membrane zone, we hypothesized that complement-independent pro-inflammatory and blistering pathways existed similarly to that previously shown in BP. As autoantibodies to laminin α3 are most prevalent, we studied the major cellular response to blockade of laminin α3 using a well characterized monoclonal antibody (P3H9-2). RNA-seq revealed upregulation of numerous desmosomal genes (DSG1, DSG3, DSC1, DSC3, DSP) as well as KRT1 and KRT10. Additionally, P3H9-2 treated cells demonstrated downregulation of most hemidesmosomal genes. A pro-inflammatory response was not appreciated. Using pharmacological inhibito rs, we identified both protein kinase C and NOTCH as key regulators of P3H9-2 induced differentiation. We lastly utilized 3D human skin equivalents to determine whether blockade of laminin α3 would lead to delayed blistering, consistent with keratinocyte differentiation. Significant blistering was noted after 72 hours of treatment, with only minimal separation at 24 hours. In summary, blockade of laminin α3 alters keratinocyte differentiation, representing a potential complement-independent mechanism of blistering. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Gene expression profiling of laminin α3 blocked keratinocytes reveals an immune‐independent mechanism of blistering

xlomafota13 shared this article with you from Inoreader Gene expression profiling of laminin α3 blocked keratinocytes reveals an immune‐independent mechanism of blistering Via Experimental Dermatology Abstract Laminin-332 pemphigoid is a rare and chronic autoimmune blistering disease which results in subepidermal blisters and erosive lesions predominantly localized to mucous membranes. As histologic inflammation is variable, and non-complement fixing IgG antibodies against laminin-332 are the predominant class of autoantibodies deposited at the epidermal basement membrane zone, we hypothesized that complement-independent pro-inflammatory and blistering pathways existed similarly to that previously shown in BP. As autoantibodies to laminin α3 are most prevalent, we studied the major cellular response to blockade of laminin α3 using a well characterized monoclonal antibody (P3H9-2). RNA-seq revealed upregulation of numerous desmosomal genes (DSG1, DSG3, DSC1, DSC3, DSP) as well as KRT1 and KRT10. Additionally, P3H9-2 treated cells demonstrated downregulation of most hemidesmosomal genes. A pro-inflammatory response was not appreciated. Using pharmacological inhibito rs, we identified both protein kinase C and NOTCH as key regulators of P3H9-2 induced differentiation. We lastly utilized 3D human skin equivalents to determine whether blockade of laminin α3 would lead to delayed blistering, consistent with keratinocyte differentiation. Significant blistering was noted after 72 hours of treatment, with only minimal separation at 24 hours. In summary, blockade of laminin α3 alters keratinocyte differentiation, representing a potential complement-independent mechanism of blistering. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Misconceptions about paraoxonase-1

xlomafota13 shared this article with you from Inoreader Misconceptions about paraoxonase-1 Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Oct 26:S1808-8694(21)00171-3. doi: 10.1016/j.bjorl.2021.08.009. Online ahead of print. NO ABSTRACT PMID:34794918 | DOI:10.1016/j.bjorl.2021.08.009 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

'Just Pulse it!' Introduction of a conservative implant salvage protocol to manage infection in pre-pectoral breast reconstruction: Case series and literature review

xlomafota13 shared this article with you from Inoreader "Just Pulse it!" Introduction of a conservative implant salvage protocol to manage infection in pre-pectoral breast reconstruction: Case series and literature review Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Oct 22:S1748-6815(21)00502-7. doi: 10.1016/j.bjps.2021.09.060. Online ahead of print. ABSTRACT Post-operative implant infection is generally rare after breast augmentation, but it can occur in up to 35% of cases in post-mastectomy breast reconstruction. Standard treatment consists in the administration of antibiotics, implant removal, and delayed prosthesis replacement leading to multiple operations, with a negative impact on patient's clinical, economical, and psychological outcomes. There is little information published in the literature on the management of periprosthetic infection following pre-pectoral reconstructions. Capsule's removal from a pre-pectoral plane brings the risk of excessive tissue thinning and the compromise of skin flaps viability. In this preliminary multi-center case series, eight patients diagnosed with implant infection following oncological mastectomy and two-stage heterol ogous pre-pectoral breast reconstruction underwent the same protocol, consisting in tissue expander removal and conservative surgical revision supplemented by an antibiotate pulse lavage of the pocket surface. All patients achieved a successful infection resolution with immediate prosthesis replacement switching the temporary expander to definitive implant. No additional surgical revision was registered during follow-up. The intermittent irrigation is meant to disrupt the biofilm structure and restore antibiotic susceptibility. Moreover, pulse lavage allows the cleansing of the prosthetic capsule, thus avoiding the vascular stress associated with subcutaneous capsulectomy. To the best of our knowledge, this is the first series reporting on the use of Pulsavac in periprosthetic infection following pre-pectoral breast reconstruction, in an attempt to set the basis for an alternative conservative protocol to manage breast implant infection. A thorough literature review on pulse lavage in breast surgery was carried out. PMID:34794920 | DOI:10.1016/j.bjps.2021.09.060 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Virtual 3D planning and prediction accuracy in two bimaxillary face transplantations in Helsinki

xlomafota13 shared this article with you from Inoreader Virtual 3D planning and prediction accuracy in two bimaxillary face transplantations in Helsinki Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Oct 22:S1748-6815(21)00501-5. doi: 10.1016/j.bjps.2021.09.061. Online ahead of print. ABSTRACT BACKGROUND: The aim of this study was to describe the 3D planning process used in our two composite face transplantations and to analyze the accuracy of a virtual transplantation in predicting the end-result of face transplantation. METHODS: The study material consists of two bimaxillary composite face transplantations performed in the Helsinki University Hospital in 2016 and 2018. Computed tomography (CT) scans of the recipient and donor were used to define the osteotomy lines and perform the virtual face transplantation and to 3D print customized osteotomy guides for recipient and donor. Differences between cephalometric linear and angular measurements of the virtually simulated and the actual postoperative face transplantation were calculated. RESULTS: No changes to the planned osteotomy line s were needed during surgery. The differences in skeletal linear and angular measurements of the virtually simulated predictions and the actual postoperative face transplantations of the two patients varied between 0.1-5.6 mm and 0.7°-4°. The postoperative skeletal relationship between maxilla and mandible in both patients were almost identical in comparison to the predictions. CONCLUSIONS: 3D planning is feasible and provides close to accurate bone reconstruction in face transplantation. Preoperative virtual transplantation assists planning and improves the outcome in bimaxillary face transplantation. PMID:34794919 | DOI:10.1016/j.bjps.2021.09.061 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Early outcomes of endoscopic endonasal approach pituitary adenomas resection with minimal nasal injury

xlomafota13 shared this article with you from Inoreader Early outcomes of endoscopic endonasal approach pituitary adenomas resection with minimal nasal injury Via leak of cerebrospinal fluid Medicine (Baltimore). 2021 Nov 19;100(46):e27843. doi: 10.1097/MD.0000000000027843. ABSTRACT To report the results of a consecutive series of pituitary adenomas resected through endoscopic endonasal approach (EEA) with minimal nasal injury.Retrospectively review tumor characteristics and surgical outcomes of a consecutive series of EEA pituitary adenomas resection performed mainly by a single author between March 2018 and June 2019.A total of 75 endoscopic endonasal approach pituitary adenoma resections were performed by the authors' team. Of the 75 patients, 28 through mononostril EEA, 47 through Binonostril EEA. Hadad-Bassagasteguy vascularized nasoseptal flap was harvested in only 4 (5.3%) patients with a high risk of postoperative cerebrospinal fluid leak, and one side middle turbinate only been resected in 2 (2.7%) patients, other patients preserved bilateral middle turbinate. Of the 75 patients, gross total resection is 74.7%, near-tota l resection is 16.0%. Endocrinological remission was achieved in 76.9% of GH-secreting adenomas, 61.5% of prolactin-secreting adenomas. The postoperative cerebrospinal fluid leak rate was 2.7%. Two patients had suprasellar hemorrhage, 1 patient had perioperative stroke, 2 patients had permanent diabetes insipidus, no cranial nerve deficits, internal carotid artery injury, anosmia, and death. The sino-nasal function was measured with the Sino-Nasal Outcome Test-22 and visual analog scale for olfaction preoperatively and postoperatively, and there was no statistically significant difference.The EEA is an effective approach to resect pituitary adenomas, the gross total resection and near-total resection rate and endocrinological remission rate are satisfactory. The EEA is a safe approach, as the complication rate is acceptable compared with those reported in the previous series of microscopic and endoscopic approaches. These results can be achieved with minimal nasal injury. PMID :34797319 | DOI:10.1097/MD.0000000000027843 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.