Microelectrodes and radiofrequency for transoral horizontal supraglottic laryngectomy in T3 tumors

alexandrossfakianakis shared this article with you from Inoreader Microelectrodes and radiofrequency for transoral horizontal supraglottic laryngectomy in T3 tumors via Head & Neck Abstract The aim of this manuscript is to show the surgical technique for horizontal supraglottic laryngectomy in T3 carcinomas by a transoral approach using microelectrodes and radiofrequency. From 2009 to 2020, 11 selected cases of T3 laryngeal supraglottic carcinomas invading the pre-epiglottic space, with preserved vocal cords mobility underwent surgery. The technique is described step by step. Average time duration of the larynx surgery was 95 min. Nine percent of the patients presented a profuse hemorrhage 7 days postoperative; in 73% of patients the nasogastric feeding tube was withdrew 10 days after surgery. We emphasize a remarkable short surgical time and high hemostatic effectiveness. The ME tips allow to perform cuts at angles and contribute with a sense of touch. The low cost of the equipment and its easy handling and maintenance is a remarkable advantage over other technologies for transoral surgery. View on Web

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Monkeypox treatment: current evidence and future perspectives

alexandrossfakianakis shared this article with you from Inoreader Monkeypox treatment: current evidence and future perspectives via Journal of Medical Virology Abstract As of 11 September 2022, 57,669 reports of monkeypox infection raised global concern. Previous vaccinia virus vaccination can protect from monkeypox. However, after smallpox eradication, immunization against that was stopped. Indeed, therapeutic options following the disease onset are of great value. This study aimed to review the available evidence on virology and treatment approaches for monkeypox and provide guidance for patient care and future studies. Since no randomized clinical trials were ever performed, we reviewed monkeypox animal model studies and clinical trials on the safety and pharmacokinetics of available medications. Brincidofovir and tecovirimat were the most studied medications that got approval for smallpox treatment according to the Animal Rule. Due to the conserved virology among orthopoxviruses, available medications might also be effective against monkeypox. However, tecovirimat has the strongest evidence to be effective and saf e for monkeypox treatment, and if there is a choice between the two drugs, tecovirimat has shown more promise so far. The risk of resistance should be considered in patients who failed to respond to tecovirimat. Hence, the target-based design of novel antivirals will enhance the availability and spectrum of effective anti-orthopoxvirus agents. This article is protected by copyright. All rights reserved. View on Web

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Adequacy of protein and calorie delivery according to the expected calculated targets. A day‐by‐day assessment in critically ill patients undergoing enteral feeding

alexandrossfakianakis shared this article with you from Inoreader Adequacy of protein and calorie delivery according to the expected calculated targets. A day‐by‐day assessment in critically ill patients undergoing enteral feeding via Journal of Human Nutrition and Dietetics Abstract Background In critically-ill patients requiring mechanical ventilation for longer than 48-72 hours enteral nutrition (EN) should be started early. Since EN alone may be unable to reach the target nutritional requirement, supplemental parenteral nutrition should be administered. This study aimed at describing the daily rate of administered calories and proteins according to the expected calculated targets. The impact of calorie adequacy, deficit or excess on relevant clinical outcomes was explored. Methods Retrospective cohort study in 217 cardiac-surgery patients admitted postoperatively in intensive care unit (ICU) and undergoing EN. The effective intake provided via EN, parenteral nutrition (PN), oral nutritional supplements (ONS) and non-nutritional calories (NNC) was documented for a maximum of 20 days. The administered/required calories and proteins ratios (KcalA/R, ProtA/R) were calculated daily. Patients receiving 80-100%, < 80 % or > 100% of KcalA/R and ProtA/R were identified. The association between mean KcalA/R between day 4-7 and 30-days mortality was explored. Results A mean KcalA/R ratio of 92.0±40.6% was ensured between days 4-20. During days 4-7 the 80-100% calorie target was achieved in 26.9% of patients, while 44.9% were below and 28.2% over this range. EN contributed for 47.1% and PN for 41.2% to the total energy intake. An increase in 30-days mortality risk was documented for patients exceeding 100% of KcalA/R ratio (adjusted-HR 5.2; 95% CI 1.1-23.9; p=0.035). Conclusions Despite a preliminary estimate of nutritional requirement, a steady daily optimal 80-100% KcalA/R was not ensured to all patients. EN contributed only partially to both energy and protein intakes so that PN was largely used to achieve the desired nutritional targets. This a rticle is protected by copyright. All rights reserved. View on Web

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Early maladaptive schemas and ICD‐11 CPTSD symptoms: Treatment considerations

alexandrossfakianakis shared this article with you from Inoreader Early maladaptive schemas and ICD‐11 CPTSD symptoms: Treatment considerations via Psychology and Psychotherapy: Theory, Research and Practice Abstract Objectives Early maladaptive schemas (EMS) can result from adverse interpersonal traumatic experiences. The ICD-11 updated the concept of disorders following traumatic experiences with the new disorder of complex post-traumatic stress disorder (CPTSD). There is now a need to develop and test interventions for CPTSD. An essential step in identifying interventions that are particularly relevant to the treatment of CPTSD is to explore psychological constructs associated more closely with CPTSD compared to PTSD. The current study explored the associations of EMS with PTSD and CPTSD. Design The sample consisted of 603 adults (mean age = 41.65, SD = 13.8), recruited through social media and e-mails, and who responded to an online questionnaire. Methods Participants completed measures of demographic, traumatic life events, EMS, PTSD and CPTSD symptoms. Results Overall, results suggest that participants with CPTSD present with higher schema elevations across all schemas compared to those with PTSD or no diagnosis. Secondly, the schemas of emotional deprivation, abandonment/instability, social isolation/alienation, defectiveness/shame, enmeshment/undeveloped self, subjugation, emotional inhibition and insufficient self-control/self-discipline were significantly associated with the symptom clusters of CPTSD. Finally, results indicate that different schemas form significant associations with the individual symptom clusters of CPTSD. Conclusions Although results require replication in clinical samples, initial findings suggest that specific EMS may be important psychological correlates of CPTSD symptoms. Wider treatment considerations of these findings are discussed. View on Web

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Hypermethylation of RASSF1A gene in pediatric rhabdoid tumor of the kidney and clear cell sarcoma of the kidney

alexandrossfakianakis shared this article with you from Inoreader Hypermethylation of RASSF1A gene in pediatric rhabdoid tumor of the kidney and clear cell sarcoma of the kidney via Pediatric Blood & Cancer Abstract Background Among pediatric renal tumors, rhabdoid tumor of the kidney (RTK) and clear cell sarcoma of the kidney (CCSK) are rare and associated with an unfavorable prognosis, while congenital mesoblastic nephroma (CMN) is associated with a good prognosis. Methylation of the Ras association domain-containing protein 1 isoform A (RASSF1A) promoter has been reported to correlate with a poor prognosis in patients with Wilms tumors, while its methylation status is unclear in other types of pediatric renal tumors. Method DNA methylation of the RASSF1A promoter in several pediatric renal tumors was analyzed with pyrosequencing. In order to clarify the correlation between expression of RASSF1A and DNA methylation of its promoter, the RTK cell line was treated with 5-Aza-2′-deoxycytidine (5-Aza-dC). RASSF1A was overexpressed in the RTK cell line to evaluate its functional effects. Results Quantitative methylation analysis demonstrated hypermethylation in the RASSF1A promoter region in RTK and CCSK, but not CMN. The 5-Aza-dC treatment induced demethylation of the RASSF1A promoter as well as increased RASSF1A mRNA expression. The transduction of RASSF1A has an effect on the suppression of viability and proliferation of RTK cells. Conclusion DNA methylation-mediated deficiency of RASSF1A might be involved in the development and aggressiveness of some pediatric renal tumors and correlated with a poor prognosis. View on Web

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Transient neonatal hemolytic anemia due to the novel gamma globin gene mutation HBG2:C.290T>C, p.Leu97Pro (hemoglobin Wareham)

alexandrossfakianakis shared this article with you from Inoreader Transient neonatal hemolytic anemia due to the novel gamma globin gene mutation HBG2:C.290T>C, p.Leu97Pro (hemoglobin Wareham) via Pediatric Blood & Cancer Abstract Unstable gamma globin variants can cause transient neonatal hemolytic anemia. We have identified a novel variant in a newborn who presented with jaundice and anemia requiring phototherapy and red blood cell transfusion. The patient was found to be heterozygous for the mutation HGB2:c.290T>C, p.Leu97Pro, which we have termed hemoglobin (Hb) Wareham. This substitution is expected to generate an unstable hemoglobin with increased oxygen affinity based on the homologous mutation previously described in the beta globin gene, which is termed as Hb Debrousse. The patient fully recovered by 9 months of age as expected with the transition from fetal to adult hemoglobin. View on Web

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Shared understanding and social connection: Integrating approaches from social psychology, social network analysis, and neuroscience

alexandrossfakianakis shared this article with you from Inoreader Shared understanding and social connection: Integrating approaches from social psychology, social network analysis, and neuroscience via Social and Personality Psychology Compass Abstract Meaningfully connecting with others is critical to the well-being of individuals. What phenomena contribute to and stem from social connection? In this paper, we integrate emerging work that uses neuroimaging and social network analysis with theories that explore the links between shared reality and social connection. We highlight recent work suggesting that the extent to which people have aligned mental processing and shared subjective construals to those around them—as shown by neural similarity—is associated with both objective and subjective social connection. On the other hand, idiosyncrasies are linked to difficulties with social connection. We conclude by suggesting how the links between shared understanding and social connection can be productively used as a framework to study psychosocial phenomena of interest. View on Web

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Exposure, Susceptibility, and Recovery: A Framework for Examining the Intersection of the Social and Physical Environment and Infectious Disease Risk

alexandrossfakianakis shared this article with you from Inoreader Exposure, Susceptibility, and Recovery: A Framework for Examining the Intersection of the Social and Physical Environment and Infectious Disease Risk via American Journal of Epidemiology - Advance Access Abstract Despite well-documented evidence that structurally disadvantaged populations are disproportionately affected by infectious diseases, our understanding of the pathways that connect structural disadvantage to the burden of infectious diseases is limited. We propose a conceptual framework to facilitate more rigorous examination and testing of hypothesized mechanisms through which social and environmental factors shape the burden of infectious diseases and lead to persistent inequities. Drawing upon the principles laid out by Link and Phelan in their landmark paper on social conditions, we offer an explication of potential pathways through which structural disadvantage (e.g., racism, sexism, and economic deprivation) operates to produce infectious disease inequities. Specifically, we describe how the social environment impacts an individual's risk of infectious disease through 1) increasing exposure to infectious pathogens; and 2) increasing suscep tibility to infection. This framework will facilitate both the systematic examination of the ways in which structural disadvantage shapes the burden of infectious disease and the design of interventions that can disrupt these pathways. View on Web

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The Role of Pelvic Floor Muscle Training on Low Anterior Resection Syndrome: A Multicenter Randomized Controlled Trial

alexandrossfakianakis shared this article with you from Inoreader The Role of Pelvic Floor Muscle Training on Low Anterior Resection Syndrome: A Multicenter Randomized Controlled Trial via Annals of Surgery - Most Popular Articles Background and Objective: Total mesorectal excision (TME) for rectal cancer (RC) often results in significant bowel symptoms, commonly known as low anterior resection syndrome (LARS). Although pelvic floor muscle training (PFMT) is recommended in noncancer populations for treating bowel symptoms, this has been scarcely investigated in RC patients. The objective was to investigate PFMT effectiveness on LARS in patients after TME for RC. Methods: A multicenter, single-blind prospective randomized controlled trial comparing PFMT (intervention; n=50) versus no PFMT (control; n=54) 1 month following TME/stoma closure was performed. The primary endpoint was the proportion of participants with an improvement in the LARS category at 4 months. Secondary outcomes were: continuous LARS scores, ColoRectal Functioning Outcome scores, Numeric Rating Scale scores, stool diary items, and Short Form 12 scores; all assessed at 1, 4, 6, and 12 months. Results: The proportion of participants with an improvement in LARS category was statistically higher after PFMT compared with controls at 4 months (38.3% vs 19.6%; P=0.0415) and 6 months (47.8% vs 21.3%; P=0.0091), but no longer at 12 months (40.0% vs 34.9%; P=0.3897). Following secondary outcomes were significantly lower at 4 months: LARS scores (continuous, P=0.0496), ColoRectal Functioning Outcome scores (P=0.0369) and frequency of bowel movements (P=0.0277), solid stool leakage (day, P=0.0241; night, P=0.0496) and the number of clusters (P=0.0369), derived from the stool diary. No significant differences were found for the Numeric Rating Scale/quality of life scores. Conclusions: PFMT for bowel symptoms after TME resulted in lower proportions and faster recovery of bowel symptoms up to 6 months after surgery/stoma closure, justifying PFMT as an early, first-line treatment option for bowel symptoms after RC. View on Web

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Effect of the Use of Reinforced Stapling on the Occurrence of Pancreatic Fistula After Distal Pancreatectomy: Results of the REPLAY (REinforcement of the Pancreas in distaL pAncreatectomY) Multicenter Randomized Clinical Trial

alexandrossfakianakis shared this article with you from Inoreader Effect of the Use of Reinforced Stapling on the Occurrence of Pancreatic Fistula After Distal Pancreatectomy: Results of the REPLAY (REinforcement of the Pancreas in distaL pAncreatectomY) Multicenter Randomized Clinical Trial via Annals of Surgery - Most Popular Articles Objective: The aim of the study was to evaluate the impact of the use of a reinforced stapler (RS) during distal pancreatectomy (DP) on postoperative outcomes. Background: DP remains associated with significant postoperative morbidity owing to pancreatic fistula (PF). To date, there is no consensus on the management of the pancreatic stump. The use of an RS potentially represents a simple way to decrease the rate of PF. Methods: The REPLAY study (NCT03030170) is a prospective, multicenter, randomized study. Patients who underwent DP were randomized (1:1 ratio) in 2 groups for the use of a standard stapler (SS) or an RS to close remnant pancreatic parenchyma. The primary endpoint was the rate of overall PF. Secondary endpoints included severity of PF, length of hospital stay, overall morbidity, and rate of readmission for a PF within 90 days. Participants were blinded to the procedure actually carried out. Results: A total of 199 were analyzed (SS, n=99; RS, n=100). One patient who did not undergo surgery was excluded. Baseline characteristics were comparable in both groups. The rate of overall PF was higher in RS group (SS: 67.7%, RS: 83%, P=0.0121), but the rate of clinically relevant PF was similar (SS: 11.1%, RS: 14%, P=0.5387). Mean length of total hospital stay, readmission for PF, postoperative morbidity, and mortality at 90 days were similar. Conclusion: The results of this randomized clinical trial did not favor the use of RS during DP to reduce the rate of PF. View on Web

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