Tuesday, February 8, 2022

Benign paroxysmal positional vertigo: is hypothyroidism a risk factor for recurrence?

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Acta Otorhinolaryngol Ital. 2022 Feb 7. doi: 10.14639/0392-100X-N1775. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the relationship between risk of Benign Paroxysmal Positional Vertigo (BPPV) recurrence and hypothyroidism treated with hormone replacement therapy (HRT).

METHODS: 797 patients with idiopathic BPPV were divided into two groups: 250 patients with recurrence of BPPV (R-BPPV) and 547 patients without recurrence (NR-BPPV). Regarding patients with thyroid disease on HRT, we collected serum test results of thyroidstimulating hormone (TSH), free triiodothyronine f-T3, free thyroxine f-T4, thyroglobulin antibodies (TG-Ab) and thyroid peroxidase antibodies (TPO-Ab).

RESULTS: Hypothyroidism in long-term HRT was found in 61/250 (24.4%) patients of the RBPPV group vs 79/547 (14.4%) of the NR-BPPV-group (p = 0.0006). Hashimoto thyroiditis (HT) was associated with recurrence (p < 0.0001). A significant correlation was found between recurrence and level of serum TPO-Ab (p = 0.0117) and TG-Ab (p = 0.0025), but not with mean serum TSH, f-T3 and f-T4.

CONCLUSIONS: We assume that patients with hypothyroidism in HRT have an increased risk of BPPV recurrence, which is particularly strong for patients with HT and positive thyroid antibodies, suggesting an association between autoimmunity and recurrent vertigo.

PMID:35129542 | DOI:10.14639/0392-100X-N1775

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Sphenoidotomy kinetics in patients with chronic rhinosinusitis without nasal polyps

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Acta Otorhinolaryngol Ital. 2022 Feb 7. doi: 10.14639/0392-100X-N1545. Online ahead of print.

ABSTRACT

OBJECTIVE: Stenosed sphenoid sinus ostia are among the most common findings in revision endoscopic sinus surgery. This study sought to identify the optimal intraoperative sphenoidotomy size for prevention of postoperative stenosis.

METHODS: 32 patients affected by chronic rhinosinusitis not associated with nasal polyps (CRSsNP) underwent 52 sphenoidotomies. Sphenoidot omy size was assessed using a ruler intraoperatively and at the first, third and sixth months postoperatively. Ostia sizes, SNOT-22 questionnaire findings, episodes of recurrent sinusitis and need for revision surgery were recorded.

RESULTS: All sphenoidotomies exhibited a significant size reduction (mean 43.4 ± 6.8%) at the first month postoperatively, with a tendency to enlarge at 3 months and stabilise at 6 months. Ostia larger than 61.3 mm2 did not exhibit stenoses postoperatively. Stenosis was observed in 11 sphenoidotomies (21.2%); however, only five presented with recurrent symptoms (9.6%), while three required revision sphenoid surgery (5.8%).

CONCLUSIONS: Sphenoidotomy size significantly reduced during the first postoperative month and then stabilised. A baseline sphenoidotomy size of 61.3 mm2 at the time of the operation seemed sufficient to prevent ostium stenosis. Half of stenosed ostia presented with recurrent symptoms.

PMID:35129538 | DOI:10.14639/0392-100X-N1545

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Machine‐learning‐based approach for predicting postoperative skeletal changes for orthognathic surgical planning

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Abstract

Background

Manually surgical planning becomes an increasing workload of surgeons because of the fast-growing patient population. This study introduced a machine-learning-based approach to assist surgical planning in orthognathic surgery.

Methods

Both preoperative and one-year-later postoperative CT images of 56 patients were collected. A 12-layers cascaded deep neural network structure with two successive models was proposed to yield an end-to-end solution, where the first model extracts landmarks from 2D patches of 3D volume and the second model predicts postoperative skeletal changes.

Results

The experimental results showed that the model obtained a prediction accuracy of 5.4 mm at the landmark level in 42.9 s. It also represented 74.4% of 3D regions at volume level when compared with the ground truth of human surgeons.

Conclusions

This study demonstrated the feasibility of predicting postoperative skeletal changes for orthognathic surgical planning by using machine learning, showing great potential for reducing the workload of surgeons.

This article is protected by copyright. All rights reserved.

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Prospective, Multi‐Center Study of the Anatomic Distribution of Recurrent Respiratory Papillomatosis

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Objectives/Hypothesis

To create a model of the anatomic distribution, recurrence, and growth patterns of recurrent respiratory papillomatosis (RRP).

Study Design

Prospective, multi-institutional cohort study.

Methods

Adult patients with a diagnosis of RRP evaluated between August 1, 2018 and February 1, 2021 at six participating centers were invited to enroll. At each office or operating room encounter, laryngologists recorded the location and size of RRP lesions using a 22-region schematic. A generalized linear mixed effects model was used to compare region variations in lesion prevalence and recurrence.

Results

The cohort comprised 121 patients: 74% were male, 81% had been diagnosed with adult-onset RRP, and a plurality (34%) had undergone 0 to 3 RRP interventions prior to enrollment. Across the study period, the odds of a lesion occurring in the glottis was significantly higher (odds ratio [OR]: 26.51; 95% confidence interval [CI]: 11.76–59.75, P < .001) compared with all other areas of the larynx and trachea. Within the true vocal folds, the membranous vocal folds had significantly higher odds (OR: 6.16; 95% CI: 2.66–14.30, P < .001) of lesion occurrence compared to the cartilaginous vocal folds. Despite these strong trends in lesion distribution, there were no differences in the odds of lesion recurrence, growth, or in the time to recurrence, between anatomic subsites.

Conclusions

RRP lesions are most likely to occur in the glottis, particularly the membranous vocal folds, compared with other regions of the larynx or trachea. However, all lesions demonstrate similar behavior with respect to recurrence, growth, and time to recurrence regardless of anatomic location.

Level of Evidence

3 Laryngoscope, 2022

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Functional imaging in thyroid cancer patients with metastases and therapeutic implications

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Presse Med. 2022 Feb 4:104113. doi: 10.1016/j.lpm.2022.104113. Online ahead of print.

ABSTRACT

Functional imaging plays a central role in the management of thyroid cancer patients. In patients with a differentiated thyroid cancer (DTC), radioactive iodine (RAI) is used mostly with a therapeutic intent, either post-operatively or as the first line systemic treatment in patients with known structural disease. A whole body scan is performed a few days after the RAI administration, and this procedure is very sensitive to detect all tumor foci with RAI uptake. PET/CT with 18F-FDG complements the use of RAI at the initial evaluation of patients with high-risk DTC, during follow-up in those with rising serum thyroglobulin levels over time, for the work-up of patients with documented structural disease and for assessing the efficacy of focal or systemic treatment modalities. 18F-FDG uptake is a prognostic indicator in all these clinical conditions. A dosimetric approach with 124I PET/CT showed encouraging results. Several functional imaging modalities are currently available for medullary thyroid carcinoma (MTC) patients. 18F-FDG-PET/CT may be sensitive in MTC patients with high FDG uptake that signals aggressive disease. 18F-DOPA is the most sensitive imaging technique to visualize small tumor foci, and is also highly specific in patients with a known MTC, but should be complemented by a CT scan of the chest and by a MRI of the liver to detect small metastases.

PMID:35131318 | DOI:10.1016/j.lpm.2022.104113

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Vitamin D status in Dupuytren's disease: Association with clinical status and vitamin D receptor expression

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J Plast Reconstr Aesthet Surg. 2022 Jan 20:S1748-6815(22)00024-9. doi: 10.1016/j.bjps.2022.01.012. Online ahead of print.

ABSTRACT

BACKGROUND: Dupuytren's disease (DD) is a progressive fibroproliferative condition involving contractures of the fascia of the palm. Up to now, there are no relevant investigations on patients with DD in case of serum vitamin D deficiency. We hypothesized that transforming growth factor-β1 (TGF-β1) is increased in patients with DD in consequence of vitamin D deficiency, thereby leading to myofibroblast differentiation and subsequent progression of contractures.

METHODS: The aim of this study was to analyze serum vitamin D levels and explore possible clinical and immunohistochemical correlates with vitamin D concentrations in a group of patients with DD. Vitamin D levels were measured in all patients with DD and healthy controls. In the patient group, clinical characteristics were compared between vi tamin D deficient and nondeficient subgroups. Diseased palmar fascia samples were obtained from 14 patients undergoing fasciectomy for DD. Correlations between vitamin D levels and vitamin D receptor(VDR), TGF-β1 expression levels in collected fascia samples were evaluated.

RESULTS: Vitamin D concentrations were significantly lower in patients than in healthy controls. In addition, total extension deficit of involved fingers was higher in vitamin D deficient patients. Moreover, a positive correlation was found between vitamin D levels and expression of VDR in pathologic fascia in patients undergoing fasciectomy for contracture. Serum vitamin D levels were found to be low in patients with DD. Expression of VDR was lower in the vitamin D deficient group.

CONCLUSIONS: The results suggest a potential link between vitamin D status and DD but causation is not yet established. The potential role of vitamin D and its interaction with VDR and the TGF-β1 signaling pathway in the pathogenesis of DD needs to be explored further.

PMID:35131190 | DOI:10.1016/j.bjps.2022.01.012

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Usage trends, perceptions and ethical views regarding social media: A survey of Canadian plastic surgeons

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J Plast Reconstr Aesthet Surg. 2022 Jan 31:S1748-6815(22)00052-3. doi: 10.1016/j.bjps.2022.01.039. Online ahead of print.

ABSTRACT

Parallel to the rise in usage of Social Media (SoMe) worldwide, plastic surgeons are becoming increasingly present online. Although more are being published, there is a paucity of studies regarding academic and international plastic surgeons. The authors sought to determine current usage trends among Canadian plastic surgeons. A 16-item survey concerning usage, post content, perceptions and ethics towards SoMe was sent to academic and esthetic plastic surgeons across Canada. The survey yielded a 14.2% response rate, from which 37% had a single SoMe account for both personal and professional use, with Instagram (36%) being the most preferred platform and only 10% of post content being academically inclined. Surgeons without a professional account seemed to be more likely to believe it is unethical to discuss procedures with patients over SoMe (75% vs. 29%) and were more likely to believe it is unethical to post procedural/intra-operative videos on SoMe (75% vs. 21%). This survey highlights the diverging views regarding the ethics surrounding SoMe usage, which can be influenced by the type of accounts managed by surgeons. The authors hope this can help elucidate more ethical, safe and effective practices of SoMe.

PMID:35131195 | DOI:10.1016/j.bjps.2022.01.039

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Quantification of near-infrared fluorescence imaging with indocyanine green in free flap breast reconstruction

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J Plast Reconstr Aesthet Surg. 2022 Jan 14:S1748-6815(22)00003-1. doi: 10.1016/j.bjps.2021.12.004. Online ahead of print.

ABSTRACT

BACKGROUND: One of the complications of free flap breast reconstruction is the occurrence of skin and fat necrosis. Intra-operative use of near-infrared (NIR) fluorescence imaging with Indocyanine Green (ICG) has the potential to predict these complications. In this study, the quantification of the fluorescence intensity measured in free flap breast reconstruction was performed to gain insight into the perfusion patterns observed with ICG NIR fluorescence imaging.

METHODS: ICG NIR fluorescence imaging was performed in patients undergoing free flap breast reconstruction following mastectomy. After completion of the arterial and venous anastomosis, 7.5 mg ICG was administered intravenously. The fluorescence intensity over time was recorded using the Quest Spectrum Platform®. Four regions of interest (R OI) were selected based on location and interpretation of the NIR fluorescence signal: (1) The perforator, (2) normal perfusion, (3) questionable perfusion, and (4) low perfusion. Time-intensity curves were analyzed, and two parameters were extracted: Tmax and Tmax slopes.

RESULTS: Successful ICG NIR fluorescence imaging was performed in 13 patients undergoing 17 free flap procedures. Region selection included 16 perforators, 17 normal perfusions, 8 questionable perfusions, and 5 low perfusion ROIs. Time-intensity curves of the perforator ROIs were comparable to the ROIs of normal perfusion and demonstrated a fast inflow. No outflow was observed for the ROIs with questionable and low perfusion.

CONCLUSION: This study provides insight into the perfusion patterns observed with ICG NIR fluorescence imaging in free flap breast reconstruction. Future studies should correlate quantitative parameters with clinical perfusion assessment and outcome.

PMID:35131194 | DOI:10.1016/j.bjps.2021.12.004

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Predicting outcomes from sentinel node biopsy for melanoma in the UK: Is the MIA nomogram the answer?

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J Plast Reconstr Aesthet Surg. 2022 Jan 21:S1748-6815(22)00031-6. doi: 10.1016/j.bjps.2022.01.017. Online ahead of print.

NO ABSTRACT

PMID:35131192 | DOI:10.1016/j.bjps.2022.01.017

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Preliminary study of virtual touch tissue imaging quantification in diffuse testicular diseases of male infertility

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Acta Histochem. 2022 Feb 4;124(2):151860. doi: 10.1016/j.acthis.2022.151860. Online ahead of print.

ABSTRACT

Objective To explore the preliminary application method and diagnostic value of virtual touch tissue imaging quantification (VTIQ) in diffuse testicular diseases of male infertility. A total of 70 male examiners in our hospital from June 2019 to March 2020 were selected as the research objects. According to whether the subjects are sick (testicular microlithiasis, vari cocele), all subjects are divided into three groups: normal group, testicular microlithiasis group, and varicocele group. Whether there is a difference between the groups, and analyze whether there is a correlation between the index reflecting the quality of the semen and the testicular shear wave velocity. The measurement of different positions in the testis will affect the magnitude of the shear wave velocity (P < 0.05). The shear wave velocities of the testes of different diseases are obviously different from the normal side. At the same time, postural changes will have a certain impact on the shear wave velocities of both testes (all P < 0.05). There is a certain correlation between the testicular shear wave velocity and the conventional semen quality index (total sperm motility (P < 0.05)) of the subjects. Acoustic palpation tissue imaging quantitative technology can be applied to the diagnosis of male testes and testicular-related diseases (especially diffuse testicul ar diseases), and is more suitable for male infertility, which can provide clinical diagnosis and treatment options certain imaging basis.

PMID:35131591 | DOI:10.1016/j.acthis.2022.151860

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Depleting hsa_circ_0000567 suppresses acquired gefitinib resistance and proliferation of lung adenocarcinoma cells through regulating the miR-377-3p / ZFX axis: an in vitro and in vivo study

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Histol Histopathol. 2022 Feb 8:18431. doi: 10.14670/HH-18-431. Online ahead of print.

ABSTRACT

BACKGROUND: Circular RNAs (circRNAs) expression profile has been reported in lung adenocarcinoma (LUAD) cells resistant to gefitinib, and hsa_circ_0000567 was abnormally upregulated. However, its precise role in gefitinib resistance remains unclarified.

METHODS: Levels of hsa_circ_0000567, microRNA (miR)-377-3p and zinc finger protein X-linked (ZFX) were detected by real-time quantitative PCR. Direct attachment was confirmed by dual-luciferase reporter assay and RNA immunoprecipitation assay. Gefitinib resistance was measured by MTT assay, colony formation assay, flow cytometry, western blotting, and xenograft in mice.

RESULTS: Expression of hsa_circ_0000567 was upreguated in human gefitinib-resistant human LUAD tissues and cells (HCC827/GR and PC9/GR). Clinically, higher hsa_circ_0000567 correlated with advanced tumor burden. Blo ckage of hsa_circ_0000567 suppressed cell viability, half maximal inhibitory concentration (IC₅₀) value, colony formation ability, and expression of Bcl-2 and proliferating cell nuclear antigen (PCNA) in HCC827/GR and PC9/GR cells under gefitinib treatment or not, accompanied with enhanced apoptosis rate and Bax expression. In vivo, tumor growth of PC9/GR cells untreated and treated with gefitinib was restrained by silencing hsa_circ_0000567. miR-377-3p was directly regulated by hsa_circ_0000567, and then targeted ZFX. Similar to hsa_circ_0000567 knockdown, overexpressing miR-377-3p inhibited chemoresistance in genitinib-resistant LUAD cells in vitro, whereas, depleting miR-377-3p was able to promote gefitinib resistance in spite of hsa_circ_0000567 knockdown. Moreover, restoring ZFX abrogated miR-377-3p-mediated chemosensitivity in genitinib-resistant LUAD cells in vitro.

CONCLUSION: The hsa_circ_0000567/miR-377-3p/ZFX axis might contribute to acquired gefitinib resistanc e in LUAD cells both in vitro and in vivo, suggesting hsa_circ_0000567 as a novel therapeutic target in treatment of gefitinib-resistant LUAD.

PMID:35133000 | DOI:10.14670/HH-18-431

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