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Τρίτη 17 Νοεμβρίου 2020

Clinical Swallowing Profile Change in HNC Patients Treated with C/RT

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Objectives/Hypothesis

To demonstrate utility of the Mann Assessment of Swallowing Ability‐Cancer (MASA‐C) to describe change in swallowing ability in a cohort of HNC patients from pre‐C/RT to post‐C/RT to follow up at 3 months post‐C/RT. An exploratory analysis compared patients treated with radiotherapy (RT) only to patients treated with chemoradiation (CRT).

Study Design

Prospective Cohort.

Methods

The MASA‐C and Functional Oral Intake Scale (FOIS) were completed on 85 HNC patients within the first 5 days of CRT initiation, at the completion of C/RT (6 weeks), and 3 months after completion of C/RT. MASA‐C total scores and clinical profiles were used to describe change in swallowing performance at each time point.

Results

MASA‐C and FOIS scores were significantly lower at 6 weeks and 3 months compared to baseline. Patients treated with CRT demonstrated more frequent and more severe dysphagia. Post C/RT items demonstrating the most deterioration included taste, diet level, oral mucosa, saliva, weight loss, and pharyngeal functions. Significant recovery was observed between 6 weeks and 3 months on both the MASA‐C and FOIS. MASA‐C items revealing the greatest recovery included taste, diet level, oral mucosa, tongue movement, weight loss, oral transit, voice, and pharyngeal phase. Few significant differences were noted between RT and CRT cases at 3 months.

Conclusions

Swallowing functions deteriorate significantly following C/RT with incomplete recovery at 3 months. Few differences were noted between RT and CRT treated patients at 3 months. Clinical profiling with the MASA‐C provides a standard, simple method to document swallow function change over time in these patients.

Level of Evidence

2 Laryngoscope, 2020

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Malnutrition as a Risk Factor in Cleft Lip and Palate Surgery

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Objectives/Hypothesis

To assess the prevalence of acute and chronic malnutrition at the time of surgery in patients with cleft lip and/or palate (CLP) at our institution, and to quantify nutrition as a risk factor for postsurgical complications following CLP surgery.

Study Design

Retrospective cohort study.

Methods

Retrospective review of 855 children undergoing initial cleft lip or palate surgery, or revision surgery after fistula/dehiscence of initial cleft repair. We measured acute and chronic malnutrition using World Health Organization Z‐scores of weight‐for‐age and height‐for‐age, respectively, and noted any postsurgical fistula or dehiscence.

Results

Among patients with cleft lip, 22.3% were at least moderately chronically malnourished at the time of initial repair, and 17.5% were at least moderately acutely malnourished. Among patients undergoing initial repair of cleft palate, 20.9% were at least moderately chronically malnourished, and 8.1% were at least moderately acutely malnourished. Increasing nutritional status, as measured by height‐for‐age, predicts decreased odds of fistula (OR 0.78, P = .01) after cleft palate surgery.

Conclusions

Chronic malnutrition significantly increases the risk of fistula formation in patient with cleft palate. Preoperative strategies to manage this risk and influence surgical timing can avoid morbid and costly postoperative complications.

Level of Evidence

4 Laryngoscope, 2020

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Pediatric unilateral isolated choanal atresia is not associated with mandibular condyle hypoplasia

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Publication date: Available online 12 November 2020

Source: American Journal of Otolaryngology

Author(s): Melissa S. Oh, Nadja Kadom, Shelly Abramowicz, Norman Wendell Todd

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Functional outcomes after extracapsular dissection with partial facial nerve dissection for small and large parotid neoplasms

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Publication date: January–February 2021

Source: American Journal of Otolaryngology, Volume 42, Issue 1

Author(s): Samuel R. Auger, Dallas E. Kramer, Brendan Hardy, Danny Jandali, Kerstin Stenson, Mehmet Kocak, Samer Al-Khudari

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Efficacy of inhaled budesonide on serum inflammatory factors and quality of life among children with acute infectious laryngitis

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Publication date: January–February 2021

Source: American Journal of Otolaryngology, Volume 42, Issue 1

Author(s): Tao Huang, Zhong-Fang Xia, Wen-Qing Li

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Apolipoprotein M inhibits proliferation and migration of larynx carcinoma cells.

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Via Polyps
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Apolipoprotein M inhibits proliferation and migration of larynx carcinoma cells.

Sci Rep. 2020 Nov 10;10(1):19424

Authors: Xue H, Yu M, Zhou Y, Zhang J, Mu Q, Chen T, Luo G, Liu J

Abstract
Prior studies have shown that apolipoprotein M (APOM) is involved in the development of some cancers. Here we investigated the effects of APOM on larynx cancer (LC). 20 patients with vocal cord polyps and 18 patients with LC were included in this study. The protein and mRNA levels of the samples were analysed using the Wes-ProteinSimple system (or traditional Western blot) and PCR technology, respectively. APOM protein level in cancer tissues was lower than that in paracarcinomatous (P = 0.0003) and polyp tissues (P < 0.0001). APOM overexpression significantly inhibited TU686 cell proliferation (P < 0.0001) and migration (P < 0.01), and increased expression of vitamin D receptor (VDR, P < 0.0001) as well as nuclear factor erythroid 2-like 3 (NFE2L3, P = 0.0215). In addition, matrix metalloproteinase-10 (MMP-10) mRNA level was significantly reduced in the APOM overexpression group (P = 0.0077). However, Western blot analysis showed that APOM overexpression did not change VDR, NFE2L3 and MMP-10 protein levels (P > 0.05). In summary, APOM inhibits the proliferation and migration of LC cells, but may not be related to VDR, NFE2L3 and MMP-10, which needs further study.

PMID: 33173129 [PubMed - in process]

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The Role of Parvalbumin-positive Interneurons in Auditory Steady-State Response Deficits in Schizophrenia.

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The Role of Parvalbumin-positive Interneurons in Auditory Steady-State Response Deficits in Schizophrenia.

Sci Rep. 2019 12 06;9(1):18525

Authors: Metzner C, Zurowski B, Steuber V

Abstract
Despite an increasing body of evidence demonstrating subcellular alterations in parvalbumin-positive (PV+) interneurons in schizophrenia, their functional consequences remain elusive. Since PV+ interneurons are involved in the generation of fast cortical rhythms, these changes have been hypothesized to contribute to well-established alterations of beta and gamma range oscillations in patients suffering from schizophrenia. However, the precise role of these alterations and the role of different subtypes of PV+ interneurons is still unclear. Here we used a computational model of auditory steady-state response (ASSR) deficits in schizophrenia. We investigated the differential effects of decelerated synaptic dynamics, caused by subcellular alterations at two subtypes of PV+ interneurons: basket cells and chandelier cells. Our simulations suggest that subcellular alterations at basket cell synapses rather than chandelier cell synapses are the main contributor to these deficits. Pa rticularly, basket cells might serve as target for innovative therapeutic interventions aiming at reversing the oscillatory deficits.

PMID: 31811155 [PubMed - indexed for MEDLINE]

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Microtubule-associated proteins (MAPs) in microtubule cytoskeletal dynamics and spermatogenesis.

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Microtubule-associated proteins (MAPs) in microtubule cytoskeletal dynamics and spermatogenesis.

Histol Histopathol. 2020 Nov 11;:18279

Authors: Wang L, Yan M, Wong CKC, Ge R, Wu X, Sun F, Cheng CY

Abstract
The microtubule (MT) cytoskeleton in Sertoli cells, a crucial cellular structure in the seminiferous epithelium of adult mammalian testes that supports spermatogenesis, was studied morphologically decades ago. However, its biology, in particular the involving regulatory biomolecules and the underlying mechanism(s) in modulating MT dynamics, are only beginning to be revealed in recent years. This lack of studies in delineating the biology of MT cytoskeletal dynamics undermines other studies in the field, in particular the plausible therapeutic treatment and management of male infertility and fertility since studies have shown that the MT cytoskeleton is one of the prime targets of toxicants. Interestingly, much of the information regarding the function of actin-, MT- and intermediate filament-based cytoskeletons come from studies using toxicant models including some genetic models. During the past several years, there have been some advances in studying the biology of MT cytos keleton in the testis, and many of these studies were based on the use of pharmaceutical/toxicant models. In this review, we summarize the results of these findings, illustrating the importance of toxicant/pharmaceutical models in unravelling the biology of MT dynamics, in particular the role of microtubule-associated proteins (MAPs), a family of regulatory proteins that modulate MT dynamics but also actin- and intermediate filament-based cytoskeletons. We also provide a timely hypothetical model which can serve as a guide to design functional experiments to study how the MT cytoskeleton is regulated during spermatogenesis through the use of toxicants and/or pharmaceutical agents.

PMID: 33174615 [PubMed - as supplied by publisher]

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Optimizing remote ischemic conditioning (RIC) of cutaneous microcirculation in humans: Number of cycles and duration of acute effects.

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Optimizing remote ischemic conditioning (RIC) of cutaneous microcirculation in humans: Number of cycles and duration of acute effects.

J Plast Reconstr Aesthet Surg. 2020 Oct 21;:

Authors: Sogorski A, Spindler S, Wallner C, Dadras M, Wagner JM, Behr B, Lehnhardt M, Kolbenschlag J

Abstract
OBJECTIVE: Non-invasive Remote Ischemic Conditioning (RIC) offers an approach to reduce tissue damage in various organs/tissues. Besides attenuation of Ischemia-Reperfusion injury (I/R), beneficial effects on cutaneous microcirculation of free microsurgical flaps have been reported. Given the recency of this technique, there are considerable gaps in the current understanding of its mechanism of action. As a result, clinical transfer of RIC is prolongated in several fields. We aimed to optimize the RIC protocol by examination of different RIC-cycle numbers and its effect on changes of cutaneous microcirculation and duration.
METHODS: 80 subjects were divided into groups (1, 3, 5, 7 RIC cycles). RIC was applied via an inflatable tourniquet. Cutaneous microcirculation was continuously assessed at the contralateral anterior lateral thigh utilizing a ©O2C-device continuously.
RESULTS: RIC caused significant and sustained changes in microcirculation. Four hours after completion of RIC, a maximum increase of +80.8% (CI 1.395-2.221) in blood flow and +23.5% (CI 1.098-1.372) in tissue oxygen saturation was measured (three-cycle group). A higher number of applied cycles was accompanied with significant higher mean pain.
CONCLUSION: Acute improvement of cutaneous microcirculation due to RIC lasted for at least 4 h after completion of the RIC-protocol. Dose-dependent effects of RIC are likely. With regard to the increase in pain, we recommend a RIC protocol of 3 cycles for future clinical application.

PMID: 33172821 [PubMed - as supplied by publisher]

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Development of an evidence-based approach to the use of acellular dermal matrix in immediate expander-implant-based breast reconstruction.

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Development of an evidence-based approach to the use of acellular dermal matrix in immediate expander-implant-based breast reconstruction.

J Plast Reconstr Aesthet Surg. 2020 Oct 21;:

Authors: Ganesh Kumar N, Berlin NL, Kim HM, Hamill JB, Kozlow JH, Wilkins EG

Abstract
BACKGROUND: Although acellular dermal matrix (ADM) is widely used in expander-implant-based breast reconstructions, previous analyses have been unable to demonstrate improvements in patient-reported outcomes (PROs) with this approach over non-ADM procedures. This study aims to develop a more selective, evidence-based approach to the use of ADM in expander-implant-based breast reconstruction by identifying patient subgroups in which ADM improved clinical outcomes and PROs.
STUDY DESIGN: The Mastectomy Reconstruction Outcomes Consortium Study prospectively evaluated immediate expander-implant reconstructions at 11 centers from 2012 to 2015. Complications (any/overall and major), and PROs (satisfaction, physical, psychosocial, and sexual well-being) were assessed two years postoperatively using medical records and the BREAST-Q, respectively. Using mixed-models accounting for centers and with interaction terms, we analyzed for differential ADM effects across various clinical subgroups, including age, body mass index, radiation timing, and chemotherapy.
RESULTS: Expander-implant-based breast reconstruction was performed in 1451 patients, 738 with and 713 without ADM. Major complication risk was higher in ADM users vs. nonusers (22.9% vs. 16.4% and p = 0.04). Major complication risk with ADM increased with higher BMI (BMI=30, OR=1.70; BMI=35, OR=2.29, interaction p = 0.02). No significant ADM effects were observed for breast satisfaction, psychosocial, sexual, and physical well-being within any subgroups.
CONCLUSION: In immediate expander-implant-based breast reconstruction, ADM was associated with a greater risk of major complications, particularly in high-BMI patients. We were unable to identify patient subgroups where ADM was associated with significant improvements in PROs. Given these findings and the financial costs of ADM, a more critical approach to the use of ADM in expander-implant reconstruction may be warranted.

PMID: 33172826 [PubMed - as supplied by publisher]

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Is Timing of Tracheotomy a Factor Influencing the Clinical Course in COVID-19 Patients?

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Is Timing of Tracheotomy a Factor Influencing the Clinical Course in COVID-19 Patients?

Ear Nose Throat J. 2020 Nov 10;:145561320974140

Authors: Mesolella M

Abstract
The timing of tracheotomy is a complex decision that requires understanding of the relative risks and benefits as compared with prolonging intubation. The role of tracheotomy during the COVID-19 pandemic remains to be determined. There is no evidence that early tracheostomy improves patient's clinical course and it is not impact on the natural history of these patients. In our opinion, the tracheotomy should be proposed in stable COVID-19 patients after 18th days after orotracheal intubation when the viral load is finished. Only in the case of patients with difficult of intubation do we perform earlier tracheotomies.

PMID: 33172287 [PubMed - as supplied by publisher]

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Pintail Comb Injury as a Rare Cause of Penetrating Temporal Bone Trauma With Facial Paralysis.

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Pintail Comb Injury as a Rare Cause of Penetrating Temporal Bone Trauma With Facial Paralysis.

Ear Nose Throat J. 2020 Nov 10;:145561320968933

Authors: Cooper DJ, Pelosi S

Abstract
We present a case of novel penetrating temporal bone trauma with a pintail comb causing facial paralysis. We describe a 42-year-old woman with acute facial paralysis, hearing loss, and dizziness following accidental tympanic membrane puncture. The patient underwent middle ear exploration with tympanoplasty and was found to have an intact but severely edematous facial nerve. The patient demonstrated less than 90% degeneration under electroneuronography and was treated medically without decompression, and by 6 months had exhibited complete resolution of facial nerve dysfunction with normal hearing. This case report highlights a unique cause of penetrating temporal bone trauma and supports the utility of electroneuronography in predicting the likelihood of recovery and need for decompression in patients where the facial nerve has obvious signs of trauma but remains grossly intact.

PMID: 33172309 [PubMed - as supplied by publisher]

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