Systematic Review of CT Angiography in Guiding Management in Pediatric Oropharyngeal Trauma

alexandrossfakianakis shared this article with you from Inoreader Systematic Review of CT Angiography in Guiding Management in Pediatric Oropharyngeal Trauma via The Laryngoscope The utility of CT angiography (CTA) in children with minor appearing oropharyngeal trauma is controversial. This article is a systematic review of the changes in diagnosis and treatment based on CTA results in pediatric patients with oropharyngeal trauma. Objectives Pediatric oropharyngeal trauma is common. Although most cases resolve uneventfully, there have been reports of internal carotid artery injury leading to devastating neurovascular sequelae. There is significant controversy regarding the utility of CT angiography (CTA) in children with seemingly minor oropharyngeal trauma. The goal of this study was to appraise changes in diagnosis and treatment based on CTA results. Methods A comprehensive search of PubMed, Embase, CINAHL, Scopus, the Cochrane Ear, Nose and Throat Disorders Group Trials Register, and the ClinicalTrials.gov database was performed following PRISMA guidelines. Results The search yielded 5,078 unique abstracts, of which 8 articles were included. A total of 662 patients were included, with 293 having any CT head/neck imaging, and 255 with CTA. Eleven injuries/abnormalities of the carotid were found on CTAs, comprising edema around the carotid (n = 8), potential intimal tear (n = 1), carotid spasm (n = 1), and carotid compression (n = 1). The pooled proportion of imaging findings on CTA that could lead to changes in clinical management was 0.00 (95% CI 0.00–0.43). Angiography was obtained in 10 patients, in 6 cases due to abnormal CTA. Angiography identified 1 patient with vessel spasm and two patients with carotid intima disruption without thrombus. No patient underwent vascular repair or suffered cerebrovascular injury. Conclusion Imaging with CTA yielded radiological abnormalities in a few instances. These results do not support the routine use of CTA in screening pediatric oropharyngeal trauma when balanced against the risk of radiation, as it rarely resulted in management changes and was not shown to improve outcomes. Level of Evidence N/A Laryngoscope, 2022 View on Web

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Mucosal Melanoma of the Oral Cavity: What is the Role of Elective Neck Dissection?

alexandrossfakianakis shared this article with you from Inoreader Mucosal Melanoma of the Oral Cavity: What is the Role of Elective Neck Dissection? via The Laryngoscope This study uses the National Cancer Database to analyze factors associated with survival in oral cavity mucosal melanoma, as well as the role of elective neck dissections. Lymph node involvement, distant metastasis, age, race, and male sex were associated with worse outcomes. While elective neck dissections did not improve overall survival, they may have a prognostic role and help select patients for treatment intensification. Objectives Mucosal melanoma (MM) is a rare malignancy that can present in the head and neck (H&N). The Oral cavity is the second most common primary site in the H&N after sinonasal mucosa. This study investigates the impact of demographic and clinical factors on survival in oral cavity MM. Further, it investigates the outcomes and utility of elective neck dissections (END) in the management of oral MM. Methods The National Cancer Database was used to evaluate 432 patients with oral cavity MM from 2004 to 2016. Kaplan-Meir and Cox regression analyses were used to determine variables associated with survival. Results The mean age was 64.0 ± 16.0 years. Most patients were white (85.1%) and male (60.0%). Gingiva (37.6%) and hard palate (36.1%) were the most common primary subsites in the oral cavity. Five-year overall survival was 31.0%. Age (Hazards Ratio [95% Confidence Interval], 1.03 [1.01–1.06]), N-stage (1.94 [1.10–3.42]), M-stage (10.13 [3.33–30.86]), male sex (1.79 [1.06–3.03]), and African-American race (2.63 [1.14–6.11]) were significantly associated with worse survival. 199 patients (46.9%) underwent neck dissection including 118 with lymph node yield (LNY) ≥ 18. The rate of occult nodal positivity was 45.4% for LNY ≥ 18 and 28.3% for LNY ≥ 1. ENDs were not associated with improved outcomes. However, occult lymph node involvement was associated with worse overall survival (p = 0.004). Conclusions Oral cavity MM has a poor prognosis. Lymph node involvement, distant metastasis, age, race, and male sex are associated with worse outcomes. Performing an END did not improve survival. However, END may have a prognostic role and help select patients for treatment intensification. Level of Evidence 4 Laryngoscope, 2022 View on Web

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Macroscopic Extranodal Extension In Oral Squamous Cell Carcinoma‐A Subgroup With Poor Survival

alexandrossfakianakis shared this article with you from Inoreader Macroscopic Extranodal Extension In Oral Squamous Cell Carcinoma‐A Subgroup With Poor Survival via The Laryngoscope Background Oral cancer portends a significant cause of morbidity and mortality worldwide. Cervical lymph node metastasis with extranodal extension (ENE) is associated with a poor prognosis. There has been accumulating evidence regarding the extent of ENE to be associated with prognosis and survival. Aim This observational study was performed to analyze the prognostic implication of macroscopic and microscopic ENE in metastatic cervical lymph nodes of oral cavity cancer patients. Methods A total of 92 oral cavity cancer patients with pathologically detected ENE were included in this study. Both the groups (macroscopic and microscopic ENE) were compared in terms of overall survival and disease-free survival by using Kaplan –Meier. The pattern of failure was determined by Fischer's exact test. Univariate and multivariate analyses were calculated to determine the significant risk factors of death. Results The 2 years of disease-free survival and overall survival rates for the whole cohort were 51.2% and 53.9% respectively. The 2-year survival rate for the microscopic group (≤2 mm) and macroscopic (>2 mm) was 72.6% and 0% respectively, while the distant failure rate in the microscopic ENE group and macroscopic ENE group was 44.83% and 22.22% respectively (p-value = 0.026). Conclusions Macroscopic ENE (>2 mm) in oral cavity squamous cell cancer represents an aggressive entity with early regional and distant failure as compared to microscopic ENE (≤2 mm). Thus, macroscopic ENE (>2 mm) warrants a distinct subgroup with special consideration for intensification of treatment. Level of Evidence 3 Laryngoscope, 2022 View on Web

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Pharmacological and clinical monitoring in children with acute lymphoblastic leukemia treated with a biogeneric PEG‐l‐asparaginase product

alexandrossfakianakis shared this article with you from Inoreader Pharmacological and clinical monitoring in children with acute lymphoblastic leukemia treated with a biogeneric PEG‐l‐asparaginase product via Pediatric Blood & Cancer Abstract Background l-Asparaginase (ASP) plays a crucial role in the treatment of childhood acute lymphoblastic leukemia (ALL). Currently, different ASP products are available in the market, including both native and pegylated drugs. Several biogeneric Escherichia coli ASP (GEN-ASP) products have been developed in response to shortages and expensiveness of the native E. coli ASP innovator compounds, but some concerns have been raised about their quality. Recently, a number of generic pegylated ASP products (GEN-PEG-ASP) have been marketed to substitute for the innovator product (PEG-ASP). Methods Clinical courses and serum asparaginase activity (SAA) levels were monitored in 12 children with ALL, who were treated in our institution with two doses of a GEN-PEG-ASP product, given IV at 2500 IU/m2 during the remission induction phase. Results were compared with those obtained in a reference cohort of 35 patients treated in our institution, who received the innovator PEG-ASP product at same dosage and within the same chemotherapy background. Results Compared to the reference cohort treated with PEG-ASP, SAA levels were significantly lower in the 12 patients receiving GEN-PEG-ASP (p < .0001); a higher proportion of ASP-associated hypersensitivity reactions (2/12 vs. 0/35; p = .061) and silent inactivation (3/12 vs. 0/35; p = .014) were observed in comparison with the reference cohort. Conclusions Our results highlighted different pharmacological profiles and different rates of hypersensitivity reactions and silent inactivation in the GEN-PEG-ASP cohort compared to those treated with the innovator product. Our findings suggest that a rigorous clinical attention and a thorough pharmacological monitoring are advisable in patients treated with GEN-PEG-ASP products. View on Web

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FDA approval summary: Crizotinib for pediatric and young adult patients with relapsed or refractory systemic anaplastic large cell lymphoma

alexandrossfakianakis shared this article with you from Inoreader FDA approval summary: Crizotinib for pediatric and young adult patients with relapsed or refractory systemic anaplastic large cell lymphoma via Pediatric Blood & Cancer Abstract In January 2021, the U.S. Food and Drug Administration (FDA) approved crizotinib for pediatric patients 1 year and older and young adults with relapsed or refractory systemic anaplastic large cell lymphoma (sALCL). This is the first approval for pediatric sALCL. Approval was based on a single-arm trial of crizotinib monotherapy that included 26 patients, aged 1–20 years, with previously treated sALCL. Efficacy was based on centrally assessed objective response rate (88%) and duration of response. Herein, we highlight unique aspects of the regulatory review, including extension of the indication to young adults, postmarketing safety, and dose optimization strategies. View on Web

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Ataxia‐telangiectasia after hepatoblastoma: The reverse chronology

alexandrossfakianakis shared this article with you from Inoreader Ataxia‐telangiectasia after hepatoblastoma: The reverse chronology via Pediatric Blood & Cancer View on Web

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Soft tissue phenotype modification predicts gingival margin long‐term (10‐year) stability: Longitudinal analysis of six randomized clinical trials

alexandrossfakianakis shared this article with you from Inoreader Soft tissue phenotype modification predicts gingival margin long‐term (10‐year) stability: Longitudinal analysis of six randomized clinical trials via Journal of Clinical Periodontology Abstract Aim To assess the prognostic value of soft tissue phenotype modification following root coverage procedures for predicting the long-term (10-year) behaviour of the gingival margin. Materials and Methods Participants from six randomized clinical trials on root coverage procedures at the University of Michigan were re-invited for a longitudinal evaluation. Clinical measurements were obtained by two calibrated examiners. A data-driven approach to model selection with Akaike information criterion (AIC) was carried out via multilevel regression analyses and partial regression plotting for changes in the level of the gingival margin over time and interactions with the early (6-month) results of soft tissue phenotypic modification. Results One-hundred and fifty-seven treated sites in 83 patients were re-assessed at the long-term recall. AIC-driven model selection and regression analyses demonstrated that 6-month keratinized tissue width (KTW) and gingival thickness (GT) influenced the trajectory of the gingival margin similarly in a concave manner; however, GT was the driving determinant that predicted significantly less relapse in the treatments, with stability of the treated gingival margin obtained beyond values of 1.46 mm. Conclusions Among a compliant patient cohort, irrespective of the rendered therapy, the presence of at least 1.5 mm KTW and 1.46 mm GT was correlated with the long-term stability of the gingival margin. View on Web

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Temporal lobe myxoid glioneuronal tumor, PDGFRA p.K385L‐mutant with DNA methylation confirmation

alexandrossfakianakis shared this article with you from Inoreader Temporal lobe myxoid glioneuronal tumor, PDGFRA p.K385L‐mutant with DNA methylation confirmation via Brain Pathology View on Web

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Analgesic effect of auricular point acupressure for acute pain in patients with dementia: study protocol for a randomized controlled trial

alexandrossfakianakis shared this article with you from Inoreader Analgesic effect of auricular point acupressure for acute pain in patients with dementia: study protocol for a randomized controlled trial via Trials - Latest Articles Common and frequent as acute pain is, it is often underestimated and undertreated in older people with dementia in nursing homes and inadequate pain management remains an issue. View on Web

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Psychological risk indicators for peri‐implantitis: a cross‐sectional study

alexandrossfakianakis shared this article with you from Inoreader Psychological risk indicators for peri‐implantitis: a cross‐sectional study via Journal of Clinical Periodontology Abstract Aim The aim of this analytical cross-sectional study was to evaluate the association between peri-implantitis and psychological distress, and potentially related/mediating factors such as general health, bruxism and lifestyle factors. Material and methods Patients having received dental implants at a private practice in the Netherlands between January 2011 and January 2014 were recalled on a 5-year clinical and radiographic follow-up examination. Presence of peri-implantitis was examined and patients completed questionnaires measuring psychological distress (Symptom Checklist-90), bruxism, general health and lifestyle factors. Associations between the self-reported factors and peri-implantitis were analyzed with univariable and multivariable logistic regression models. Results A total of 230 patients (with 347 implants) were included in the analysis. Prevalence of (mild to severe) peri-implantitis was 30% (69 patients). Variables that showed a significant univariable association with peri-implantitis (p<0.10) were: SCL-90 subdomain depression, smoking, current medical treatment and lung problems. In the multivariable regression analysis, only the variable depression was significantly associated with peri-implantitis (p<0.05). Conclusions The presence of depressive symptoms is a risk indicator for peri-implantitis. Recognizing the potential negative impact of depressive symptoms may allow for better identification of high risk patients. View on Web

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