Analysis of cost and outcomes in bony versus soft tissue midface free flap reconstruction

alexandrossfakianakis shared this article with you from Inoreader Analysis of cost and outcomes in bony versus soft tissue midface free flap reconstruction via Head & Neck Abstract Background Outcomes and cost of soft tissue versus bony midface free flap reconstruction (MR) with and without virtual surgical planning (VSP) were evaluated. Methods Retrospective review of MR including ischemic time (IT), operative duration (OD), length of stay (LOS), and total cost (TC). Eighty-one soft tissue and 76 bony MR (VSP = 23) were reviewed. Results Bony MR was used for higher complexity defects (p = 0.003) and was associated with higher IT (p < 0.001), OD (p < 0.001), LOS (p = 0.032), and TC (p < 0.001). VSP was associated with a mean 111.2 ± 37.9 minute reduction in OD (p = 0.004) compared to non-VSP bony flaps. VSP was associated with higher itemized cost, but no increase in TC (p = 0.327). Conclusions Bony MR was used for higher complexity MR and was associated with increased TC, LOS, OD, and IT. VSP shortened OD with no significant increase in TC. View on Web

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Role of podoplanin, E-cadherin, Ki-67 in the dissemination of tumor cells in ovarian surface epithelial carcinoma-An immunohistochemical study

alexandrossfakianakis shared this article with you from Inoreader Role of podoplanin, E-cadherin, Ki-67 in the dissemination of tumor cells in ovarian surface epithelial carcinoma-An immunohistochemical study via Annals of Diagnostic Pathology Publication date: Available online 7 June 2022 Source: Annals of Diagnostic Pathology Author(s): Jonathan Roy Varghese, Dharma Saranya, Swaminathan Kalyanasundaram, Shantaraman Kalyanaraman View on Web

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Efficacy and safety of piezocision in accelerating maxillary anterior teeth en-masse retraction: study protocol for a randomized controlled trial

alexandrossfakianakis shared this article with you from Inoreader Efficacy and safety of piezocision in accelerating maxillary anterior teeth en-masse retraction: study protocol for a randomized controlled trial via Trials - Latest Articles Orthodontic treatment is commonly more time-consuming in adults than in teenagers, especially when it comes to the maxillary en-masse retraction, which may take 9 months or even longer. As to solve this concer... View on Web

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Keeping up with the guidelines: design changes to the STREAM stage 2 randomised controlled non-inferiority trial for rifampicin-resistant tuberculosis

alexandrossfakianakis shared this article with you from Inoreader Keeping up with the guidelines: design changes to the STREAM stage 2 randomised controlled non-inferiority trial for rifampicin-resistant tuberculosis via Trials - Latest Articles Results from the STREAM stage 1 trial showed that a 9-month regimen for patients with rifampicin-resistant tuberculosis was non-inferior to the 20-month regimen recommended by the 2011 WHO treatment guidelines... View on Web

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Amylase as a Diagnostic Tool for Plunging Ranula: Clinical Series and Description of the Technique

alexandrossfakianakis shared this article with you from Inoreader Amylase as a Diagnostic Tool for Plunging Ranula: Clinical Series and Description of the Technique via The Laryngoscope Objectives This study describes a technique of measurement for neck cyst amylase content and reviews the experience of a tertiary referral center for cases of suspected plunging ranula. Methods A retrospective study was performed at the Manukau Surgical Center in Auckland, New Zealand. Patients with a possible diagnosis of plunging ranula based on clinical presentation and diagnostic aspiration of the cyst contents were included. Demographic data, imaging and laboratory findings were collected, along with findings from surgery and histology. The technique for measuring the amylase of the aspirated cyst contents was also carefully recorded. Results The 37 cases of confirmed plunging ranula included in this study had a submandibular cystic swelling that was aspirated. Imaging features consistent with a plunging ranula were seen in 89% of the study group. All cases had detectable levels of amylase of ≥3 U/L in the ranula contents. There was large variability (range: 5–560 U/L) in the concentration of amylase, with 70% of the cases demonstrating an amylase concentration below 200 U/L. Aspirates were typically described as viscous (87.5%) and yellow or straw-colored. Conclusion The combination of clinical presentation, imaging and the presence of amylase in the cyst contents is diagnostic for plunging ranula. Level of Evidence IV Laryngoscope, 2022 View on Web

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Long-term outcomes and late toxicity of adult medulloblastoma treated with combined modality therapy: a contemporary single-institution experience

alexandrossfakianakis shared this article with you from Inoreader Long-term outcomes and late toxicity of adult medulloblastoma treated with combined modality therapy: a contemporary single-institution experience via Neuro-Oncology Advance Access Abstract Background Medulloblastoma (MB) is a rare central nervous system malignancy of adults, with limited contemporary studies to define treatment guidelines and expected late toxicity. Methods A single-center, retrospective study was conducted of patients age ≥18-years from 1997-2019 with MB and who were treated with postoperative radiotherapy. Late toxicity was defined as a minimum of 18-months from diagnosis. Overall survival (OS) and progression-free survival (PFS) were characterized using Kaplan-Meier and Cox regression analyses. Results Fifty-nine patients met criteria, with median age of 25-years (range 18-62y) and median follow-up of 6.5-years (range 0.7-23.1y). At diagnosis, 68% were standard-risk, 88% Chang M0, and 22% with anaplastic histology. Gross total resection was achieved in 75%; median craniospinal irradiation dose was 30.6Gy(relative biological effectiveness [RBE]), median total dose was 54.0Gy(RBE), 80 % received proton radiotherapy; 81% received chemotherapy. 5-year PFS and OS were 86.5% and 95.8%, respectively; 10-year PFS and OS were 83.9% and 90.7%, respectively. Anaplastic histology was associated with worse PFS (p=0.04). Among eight recurrences, 25% presented after 5-years. Most common grade ≥2 late toxicities were anxiety/depressive symptoms (30%), motor dysfunction (25%), and ototoxicity (22%). Higher posterior fossa radiation dose was associated with increased risk of late toxicity, including worse cognitive dysfunction (p = 0.05). Conclusions Adults with MB have favorable survival outcomes, but late failures and toxicity are not uncommon. Better understanding of prognostic factors, possibly from molecular subtyping, may help to define more personalized treatments for patients with high risk of recurrence and long-term treatment sequelae. View on Web

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Effectiveness of root canal instrumentation for the treatment of apical periodontitis: A systematic review and meta‐analysis

alexandrossfakianakis shared this article with you from Inoreader Effectiveness of root canal instrumentation for the treatment of apical periodontitis: A systematic review and meta‐analysis via International Endodontic Journal Abstract Background The development of endodontic instruments has rapidly advanced but their impact on endodontic outcome parameters remain unclear. Objectives This systematic review aimed to answer the following PICOT questions: In patients with apical periodontitis (P) what is the effectiveness of root canal instrumentation [(Q1) performed with contemporary techniques (I) in comparison with "traditional" techniques (C)] and [(Q2) performed with contemporary engine-driven NiTi instruments (I) compared with other types of contemporary engine-driven NiTi instruments (with different design and/or technology) (C)] in terms of clinical and patient-related outcomes (O)? Methods After PROSPERO protocol registration, a literature search was conducted using Clarivate Analytics' Web of Science, Scopus, PubMed, and Cochrane Central Register of Controlled Trials. Grey literature and major journal contents were examined. Two independent reviewers performed the study selection, data extraction, and appraisal of included studies. A quantitative meta-analysis was considered and statistical heterogeneity and overall quality of evidence were assessed. Results Nine studies were identified showing substantial methodological differences. Five studies addressed PICOT 1 and three PICOT 2, whereas one study aimed both. A random-effects meta-analysis model was considered for the outcome "radiographic evidence of normal periodontal ligament space or reduction of apical lesion size" (PICOT 1) based in three studies with 332 evaluable participants and showed that contemporary instrumentation was associated with a more favourable outcome (p= .005) compared to root canal preparation with stainless steel instruments (odds ratio=2.07 [95%-confidence interval=1.25-3.44]) with no evidence of statistical heterogeneity (I2=0%) but low quality of evidence. Discussion Albeit a few studies fulfilled eligible criteria, no study had a low risk of bias. Compelling evidence indicating significantly different outcome rates using different endodontic instruments when treating teeth with apical periodontitis is lacking. Conclusions In terms of healing, the results of the meta-analysis determined the higher effectiveness of root canal instrumentation performed with contemporary techniques in comparison with conventional stainless steel instruments in patients with apical periodontitis followed for a minimum of 1 year with low quality of evidence. No differences could be demonstrated between preparations with traditional stainless steel and contemporary NiTi instruments for other clinical and patient-related outcomes. View on Web

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Polygenic early‐onset colorectal cancer in pediatric patients

alexandrossfakianakis shared this article with you from Inoreader Polygenic early‐onset colorectal cancer in pediatric patients via Pediatric Blood & Cancer Abstract Colorectal cancer in the pediatric population is a rare but transpirable phenomenon. The occurrence should prompt suspicion for underlying genetic mutations in the setting of a hereditary cancer predisposition syndrome. In this series, we outline three pediatric patients with colonic adenocarcinoma who were found to have one or more germline mutations. The presence of compound mutations may lead to a hypermutator phenotype resulting in earlier presentation of colorectal cancer in childhood and adolescence. The diagnosis of colorectal cancer in pediatric patients warrants timely recognition, multigene panel testing, genetic counseling for the patient and family, and increased surveillance for intestinal and extra-intestinal tumors. View on Web

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Cumulative erythemal ultraviolet radiation and risk of cancer in three large US prospective cohorts

alexandrossfakianakis shared this article with you from Inoreader Cumulative erythemal ultraviolet radiation and risk of cancer in three large US prospective cohorts via American Journal of Epidemiology - Advance Access Abstract Ultraviolet radiation (UVR) exposure is the major risk factor for melanoma. However, epidemiologic studies on UVR and non-cutaneous cancers have reported inconsistent results, with some suggesting an inverse relationship potentially mediated by vitamin D. To address this, we examined three U.S. prospective cohorts, the Health Professionals Follow-Up Study (HPFS) (1986) and Nurses' Health Study (NHS) I and II (1976 and 1989), for associations between cumulative erythemal UVR and incident cancer risk, excluding non-melanoma skin cancer. We used a validated spatiotemporal model to calculate erythemal UVR. Participants (47,714 males; 212,449 females) were stratified into quintiles by cumulative average erythemal UVR, using the first quintile as reference for Cox proportional hazards regression analysis. In the multivariable-adjusted meta-analysis of all cohorts, compared to the lowest quintile, risk of any cancer was slightly increased across all o ther quintiles [highest quintile Hazard Ratio (HR),1.04; 95% Confidence Interval (CI),1.01,1.07; P-heterogeneity (P-het)=0.41]. All UVR quintiles were associated with similarly increased risk of any cancer excluding melanoma. As expected, erythemal UVR was positively associated with risk of melanoma (highest quintile HR,1.17; 95% CI,1.04,1.31; P-het=0.83). These findings suggest that elevated UVR is associated with increased risk of both melanoma and non-cutaneous cancers. View on Web

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