The two‐handed template for planning fibular free flap reconstruction of the head and neck

xlomafota13 shared this article with you from Inoreader The two‐handed template for planning fibular free flap reconstruction of the head and neck Via Head & Neck Abstract Fibular free flap reconstruction of head and neck defects is complex, and the anatomic relationships among components of the fibular flap pose challenges to reconstructive surgeons. Various techniques have been employed in planning for fibular free flap procedures, but these are often cumbersome and difficult to implement in clinically. We devised a simplistic tool for pre-operative leg selection, wherein the surgeon uses two hands to represent the various components of the fibular flap. The senior author has used this method to aid in leg selection for fibular free flaps. In all cases, utilization of this technique allowed for appropriate leg selection relative to the location of the vascular pedicle and posterior crural septum. The two-handed template for fibular free flap reconstruction is a simple, reproducible, and affordable tool that can aid reconstructive surgeons when they are planning to use a fibular flap. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Construction of an automatic score for the evaluation of speech disorders among patients treated for a cancer of the oral cavity or the oropharynx: The Carcinologic Speech Severity Index

xlomafota13 shared this article with you from Inoreader Construction of an automatic score for the evaluation of speech disorders among patients treated for a cancer of the oral cavity or the oropharynx: The Carcinologic Speech Severity Index Via Head & Neck Abstract Background Speech disorders impact quality of life for patients treated with oral cavity and oropharynx cancers. However, there is a lack of uniform and applicable methods for measuring the impact on speech production after treatment in this tumor location. Objective The objective of this work is to (1) model an automatic severity index of speech applicable in clinical practice, that is equivalent or superior to a severity score obtained by human listeners, via several acoustics parameters extracted (a) directly from speech signal and (b) resulting from speech processing and (2) derive an automatic speech intelligibility classification (i.e., mild, moderate, severe) to predict speech disability and handicap by combining the listener comprehension score with self-reported quality of life related to speech. Methods Eighty-seven patients treated for cancer of the oral cavity or the oropharynx and 35 controls performed different tasks of speech production and completed questionnaires on speech-related quality of life. The audio recordings were then evaluated by human perception and automatic speech processing. Then, a score was developed through a classic logistic regression model allowing description of the severity of patients' speech disorders. Results Among the group of parameters subject to extraction from automatic processing of the speech signal, six were retained, producing a correlation at 0.87 with the perceptual reference score, 0.77 with the comprehension score, and 0.5 with speech-related quality of life. The parameters that contributed the most are based on automatic speech recognition systems. These are mainly the automatic average normalized likelihood score on a text reading task and the score of cumulative rankings on pseudowords. The reduced automatic YC2SI is modeled in this way: Y C2SIp = 11.48726 + (1.52926 × Xaveraged normalized likelihood reading) + (−1.94e-06 × Xscore of cumulative ranks pseudowords). Conclusion Automatic processing of speech makes it possible to arrive at valid, reliable, and reproducible parameters able to serve as references in the framework of follow-up of patients treated for cancer of the oral cavity or the oropharynx. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Distal Brachial Artery Perforator flap: a new chimeric option for complex hand and digits defects

xlomafota13 shared this article with you from Inoreader Distal Brachial Artery Perforator flap: a new chimeric option for complex hand and digits defects Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Sep 17:S1748-6815(21)00406-X. doi: 10.1016/j.bjps.2021.08.019. Online ahead of print. ABSTRACT INTRODUCTION: Reconstruction of fingers pose unique challenges, as a thin and flexible flap is needed in order to guarantee a good functional outcome. For the first time, in this report, we present the DBAp (distal brachial artery perforator) flap, based on the distal perforator closer to the medial epicondyle. The DBAp flap was used to reconstruct complex digit defects as free flap, and to cover an elbow defect while raised as a propeller. METHODS: Four patients underwent finger reconstruction (free flaps): two patients presented an unstable finger scar following previous surgery, whereas the other two patients presented a terminalized finger at the level of the middle phalanx. A further patient presented a post-traumatic loss of substance at the elbow and was reconstructed using a perforator propell er DBAP flap. RESULTS: Loss of tissues included skin and subcutaneous tissue in all patients and in one patient it included a bone component. Flap dimensions ranged from 48 to 18 cm2 (average: 32 cm2). Among complications, patient n.2 flap presented a marginal flap necrosis requiring a small skin graft after necrosis debridement. CONCLUSION: The DBAp flap provides a slim, glabrous and pliable skin tissue with a well-hidden donor site scar and thanks to the anatomic location of the distal perforator can be designed to include a vascularized bone graft from the medial epicondyle. Despite the low number of cases, we believe that this flap should be considered as a dependable and effective source for complex reconstructions of both soft tissue and bone in fingers. PMID:34728156 | DOI:10.1016/j.bjps.2021.08.019 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Nipple-areolar tattoo: Comprehensive review of history, theory, technique, and outcomes

xlomafota13 shared this article with you from Inoreader Nipple-areolar tattoo: Comprehensive review of history, theory, technique, and outcomes Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Oct 7:S1748-6815(21)00462-9. doi: 10.1016/j.bjps.2021.09.024. Online ahead of print. ABSTRACT Breast reconstruction aims to achieve a natural look and can involve manipulation or removal of the nipple-areola complex (NAC) as well. One of the final steps of the breast reconstruction process involves creation of the appearance of a new NAC, either via surgical intervention or medical tattooing. Medical tattooing involves little to no surgical intervention while still resulting in aesthetically pleasing results. This specific type of tattooing can be performed by a member of the plastic surgeon team, or a medical tattoo specialist. Integration of this method into plastic surgery practice can prove beneficial to the patient as a viable solution for aesthetically pleasing NAC recreation. PMID:34728157 | DOI:10.1016/j.bjps.2021.09.024 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

RET Proto-Oncogene Mutational Analysis in 45 Iranian Patients Affected with Medullary Thyroid Carcinoma: Report of a New Variant

xlomafota13 shared this article with you from Inoreader RET Proto-Oncogene Mutational Analysis in 45 Iranian Patients Affected with Medullary Thyroid Carcinoma: Report of a New Variant Via Journal of Thyroid Research Background. The aim of this study was to identify germline mutation of the RET (rearranged during transfection) gene in patients with medullary thyroid carcinoma (MTC) and their first-degree relatives to find presymptomatic carriers for possible prophylactic thyroidectomy. Methods/Patients. We examined all six hot spot exons (exons 10, 11, 13, and 14–16) of the RET gene by PCR and bidirectional Sanger sequencing in 45 Iranian patients with MTC (either sporadic or familial form) from 7 unrelated kindred and 38 apparently sporadic cases. First-degree relatives of RET positive cases were also genotyped for index mutation. Moreover, presymptomatic carriers were referred to the endocrinologist for further clinical management and prophylactic thyroidectomy if needed. Results. Overall, the genetic sta tus of all of the participants was determined by RET mutation screening, including 61 affected individuals, 22 presymptomatic carriers, and 29 genetically healthy subjects. In 37.5% (17 of 45) of the MTC referral index patients, 8 distinct RET germline mutations were found, including p.C634R (35.3%), p.M918T (17.6%), p.C634Y (11.8%), p.C634F (5.9%), p.C611Y (5.9%), p.C618R (5.9%), p.C630R (5.9%), p.L790F (5.9%), and one uncertain variant p.V648I (5.9%). Also, we found a novel variant p.H648R in one of our apparently sporadic patients. Conclusion. RET mutation detection is a promising/golden screening test and provides an accurate presymptomatic diagnostic test for at-risk carriers (the siblings and offspring of the patients) to consider prophylactic thyroidectomy. Thus, according to the ATA recommendations, the screening of the RET proto-oncogene is indicated for patients with MTC. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cerebrospinal fluid leak post COVID-19 nasopharyngeal swab for a patient with idiopathic intracranial hypertension: a case report

xlomafota13 shared this article with you from Inoreader Cerebrospinal fluid leak post COVID-19 nasopharyngeal swab for a patient with idiopathic intracranial hypertension: a case report Via leak of cerebrospinal fluid J Surg Case Rep. 2021 Oct 28;2021(10):rjab456. doi: 10.1093/jscr/rjab456. eCollection 2021 Oct. ABSTRACT Coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 is an infectious disease that led to a global pandemic. In this article, we reported a case of a young women who is known to have idiopathic intracranial hypertension, with iatrogenic skull base injury from a nasopharyngeal swab. Her case was complicated by meningitis. PMID:34729169 | PMC:PMC8557649 | DOI:10.1093/jscr/rjab456 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Readability Analysis of Spanish Language Patient-Reported Outcome Measures in Laryngology

xlomafota13 shared this article with you from Inoreader Readability Analysis of Spanish Language Patient-Reported Outcome Measures in Laryngology Via Journal of Voice Laryngologists use patient-reported outcome measures (PROM) to determine the efficacy of an intervention or to evaluate a patient's symptomatology. PROMs should be developed for a diverse target audience, including patients of all literacy levels. The American Medical Association (AMA) recommends that PROMs are written at or below the sixth- grade level. In recent studies, readability scores for otolaryngology PROMs in English were above the recommended reading level. To date, there is limited data regarding the readability of Spanish PROMs. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Decreased CFTR/PPARgamma and increased transglutaminase 2 in nasal polyps

xlomafota13 shared this article with you from Inoreader Decreased CFTR/PPARgamma and increased transglutaminase 2 in nasal polyps Via Polyps Auris Nasus Larynx. 2021 Oct 30:S0385-8146(21)00249-2. doi: 10.1016/j.anl.2021.10.006. Online ahead of print. ABSTRACT OBJECTIVE: Transglutaminase (TGM)2 and peroxisome proliferator-activated receptor (PPAR)γ are thought to participate in the pathogenesis of nasal polyp formation in cystic fibrosis (CF). We herein investigated expressions of cystic fibrosis transmembrane conductance regulator (CFTR), TGM2, PPARγ and isopeptide bonds, a reaction product of TGM, in non-CF nasal polyps. METHODS: Nasal polyps and inferior turbinates were collected from chronic rhinosinusitis patients without CF during transnasal endoscopic sinonasal surgery. Expressions of CFTR, TGM2, isopeptide bonds and PPARγ were examined by fluorescence immunohistochemistry and quantitative RT-PCR. Expression of CFTR was also analyzed by Western blot. RESULTS: Immunohistochemical fluorescence of the nasal polyp was significantly lower for CFTR and PPARγ, and s ignificantly higher for TGM2 and isopeptide bonds than that of the turbinate mucosa. Lower expression of CFTR in the nasal polyp than in the turbinate mucosa was also observed in Western blot. Expression of PPARG mRNA was significantly lower in the nasal polyp than in the turbinate mucosa, whereas expressions of CFTR mRNA or TGM2 mRNA did not differ between the two tissues. Immunohistochemical fluorescence for CFTR showed significant negative correlation with that for TGM2 and isopeptide bonds, and significant positive correlation with that for PPARγ. The fluorescence for TGM2 was positively correlated with that for isopeptide bonds and negatively correlated with that for PPARγ. The fluorescence for isopeptide bonds tended to be negatively correlated with that for PPARγ. CONCLUSIONS: These results suggest a possible role of the CFTR-TGM2-PPARγ cascade in the pathogenesis of nasal polyp formation in non-CF patients as in CF patients. PMID:34728118 | DOI:10.1016/j.anl.2021.10.006 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Describing the spine surgery learning curve during the first two years of independent practice

xlomafota13 shared this article with you from Inoreader Describing the spine surgery learning curve during the first two years of independent practice Via leak of cerebrospinal fluid Medicine (Baltimore). 2021 Oct 15;100(41):e27515. doi: 10.1097/MD.0000000000027515. ABSTRACT Retrospective cohort studyTo characterize the learning curve of a spine surgeon during the first 2 years of independent practice by comparing to an experienced colleague. To stratify learning curves based on procedure to evaluate the effect of experience on surgical complexity.The learning curve for spine surgery is difficult to quantify, but is useful information for hospital administrators/surgical programs/new graduates, so appropriate expectations and accommodations are considered.Data from a retrospective cohort (2014-2016) were analyzed at a quaternary academic institution servicing a geographically-isolated, mostly rural area. Procedures included anterior cervical discectomy and fusion, posterior cervical decompression and stabilization, single and 2-level posterior lumbar interbody fusion, lumbar discectomy, and laminectomy. Data related to pa tient demographics, after-hours surgery, and revision surgery were collected. Operative time was the primary outcome measure, with secondary measures including cerebrospinal fluid leak and early re-operation. Time periods were stratified into 6 month quarters (quarter [Q] 1-Q4), with STATA software used for statistical analysis.There were 626 patients meeting inclusion criteria. The senior surgeon had similar operative times throughout the study. The new surgeon demonstrated a decrease in operative time from Q1 to Q4 (158 minutes-119 minutes, P < .05); however, the mean operative time was shorter for the senior surgeon at 2 years (91 minutes, P < .05). The senior surgeon performed more revision surgeries (odds ratio [OR] 2.5 [95% confidence interval [CI] 1.7-3.6]; P < .001). Posterior interbody fusion times remained longer for the new surgeon, while laminectomy surgery was similar to the senior surgeon by 2 years. There were no differences in rates of cerebrospinal fluid le ak (OR 1.2 [95% CI 0.6-2.5]; P > .05), nor reoperation (OR 1.16 [95% CI 0.7-1.9]; P > .05) between surgeons.A significant learning curve exists starting spine practice and likely extends beyond the first 2 years for elective operations. PMID:34731139 | DOI:10.1097/MD.0000000000027515 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Circ_0000376 downregulation inhibits the progression of non-small cell lung cancer by mediating the miR-488-3p/BRD4 axis and the PI3K/PKB signaling pathway

xlomafota13 shared this article with you from Inoreader Circ_0000376 downregulation inhibits the progression of non-small cell lung cancer by mediating the miR-488-3p/BRD4 axis and the PI3K/PKB signaling pathway Via Cellular and Molecular Biology Histol Histopathol. 2021 Nov 3:18390. doi: 10.14670/HH-18-390. Online ahead of print. ABSTRACT BACKGROUND: The involvement of circular RNAs (circRNAs) in the development of cancers has attracted much interest. This study aimed to determine the role of circ_0000376 in non-small cell lung cancer (NSCLC) and provide a new mechanism. METHODS: The expression of circ_0000376, miR-488-3p and bromodomain containing 4 (BRD4) mRNA was measured by quantitative real-time PCR (qPCR). Cell behaviors, including cell proliferation, invasion, migration, apoptosis and cell cycle progression were investigated using cell counting kit-8 (CCK-8) assay and colony formation assay, transwell assay, wound healing assay and flow cytometry assay, respectively. The putative relationship between miR-488-3p and circ_0000376 or BRD4 was verified by dual-luciferase reporter assay. The protein levels of BRD4 and phosphorylated PI3K/PKB were detected by western bl ot. Xenograft model was constructed to determine the role of circ_0000376 in vivo. RESULTS: Circ_0000376 was highly expressed in NSCLC tissues and cells. Circ_0000376 downregulation inhibited NSCLC cell proliferation, invasion and migration, promoted cell apoptosis and cell cycle arrest and slowed tumor growth in vivo. Circ_0000376 competitively bound to miR-488-3p to regulate the expression of BRD4. Rescue experiments showed that miR-488-3p deficiency reversed the effects of circ_0000376 downregulation, and miR-488-3p restoration-suppressed cell proliferation, migration and invasion were recovered by BRD4 overexpression. Moreover, circ_0000376 downregulation weakened the levels of phosphorylated PI3K and PKB, thus reducing the activity of the PI3K/PKB pathway. CONCLUSION: Circ_0000376 downregulation blocked the development of NSCLC by targeting the miR-488-3p/BRD4 network and suppressing the PI3K/PKB pathway, which broadens knowledge into the understanding of the role o f circ_0000376 in NSCLC. PMID:34730838 | DOI:10.14670/HH-18-390 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Radioactive iodine dose and survival in cats with hyperthyroidism (2015-2020)

xlomafota13 shared this article with you from Inoreader Radioactive iodine dose and survival in cats with hyperthyroidism (2015-2020) Via radioactive iodine J Feline Med Surg. 2021 Nov 3:1098612X211056837. doi: 10.1177/1098612X211056837. Online ahead of print. ABSTRACT OBJECTIVES: Radioactive iodine (131I) is the preferred treatment for feline hyperthyroidism but neither the optimal 131I dose nor consistent predictors of post-treatment azotaemia have been determined. The aims of the study were to evaluate the relationships between: (1) 131I dose and survival; and (2) pretreatment and post-treatment seru m creatinine concentration. METHODS: Medical records of hyperthyroid cats treated with 131I at a single referral hospital were reviewed. Information regarding signalment, body weight, pretreatment and post-treatment serum total thyroxine concentration (TT4), serum creatinine concentration, 131I dose and survival were determined. Multivariable Cox proportional hazards analysis was used to identify variables associated with survival. Multivariable linear regression analysis was used to identify variables associated with post-treatment serum creatinine concentration. RESULTS: One hundred and ninety-eight (79 male, 119 female) cats were treated for hyperthyroidism with 131I (median dose 138 MBq; interquartile range 92-168). Median survival time was 1153 days (range 16-1871). Post-treatment serum creatinine (P <0.001) and age (P = 0.049) were significantly associated with survival. Every 10 µmol/l increase in post-treatment s erum creatinine concentration and every year increase in age was associated with a 1.07 fold (confidence interval [CI] 1.04-1.11) and 1.17-fold (CI 1.00-1.37) increase in the daily hazard of death, respectively. Pretreatment serum creatinine concentration was directly, and post-treatment serum TT4 concentration was inversely, associated with post-treatment serum creatinine concentration. Every 1 μmol/l increase in pretreatment serum creatinine concentration was associated with an increase in post-treatment serum creatinine concentration of 0.7 μmol/l (SE 0.17; P <0.001). Conversely, every 1 nmol/l decrease in post-treatment serum TT4 concentration was associated with a 1.2 μmol/l (SE 0.61; P <0.001) increase in post-treatment serum creatinine concentration. CONCLUSIONS AND RELEVANCE: Post-treatment serum TT4 concentration was associated with post-treatment azotaemia, which was associated with survival. Although 131I dose was not directly assoc iated with survival, dosing strategies that minimise post-treatment hypothyroidism and azotaemia could improve patient survival. PMID:34730466 | DOI:10.1177/1098612X211056837 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.