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Κυριακή 18 Σεπτεμβρίου 2022

The T‐shaped FST pharyngoplasty step‐by‐step closure technique

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Abstract

Pharyngocutaneous fistula is one of the most common and serious complications associated with total laryngectomy. Numerous studies tried to evaluate causative and predisposing factors associated with this complication, but data are considerably variable and there is still no international consensus. Incidence rate varies considerably between studies, with reported rates from 3% to 65%. This 4K video presents our T-shaped four-step technique (FST) for closing the pharyngeal mucosa after total laryngectomy in a step-by-step manner. All sutures were performed by braided absorbable 3/0 26 mm 1/2c (Vicryl plus 3.0; Ethicon, Somerville, NJ, USA). Recordings were performed using a Karl Storz 4K 3D VITOM® exoscope (Karl Storz SE & Co. KG, Tuttlingen, Germany). We have been described this technique through a high-definition video, showing each step, and tips from the authors. Our T-shaped pharyngoplasty closure technique can be divided into four steps: 1. "Key Stitches"; 2. "A rea Refinement Stitches"; 3. "Modified Connell Suture"; 4. "Modified Purse String Suture." Our T-shaped FST closure technique proved to be an effective and reproducible method, which we feel could be the preferred choice for primary pharyngoplasty closure.
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Systemic conditions associated with increased risk to develop oral squamous cell carcinoma: Systematic review and meta‐analysis

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Abstract

This study aimed to map systemic alterations predisposing to oral squamous cell carcinoma (OSCC) onset. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Five databases were used to access (1) reports of OSCC co-occurring in patients with systemic conditions, (2) prevalence of OSCC among these patients, and (3) clinicopathological profiles. Data from more than 1 million patients worldwide showed that Fanconi's anemia, xeroderma pigmentosum, dyskeratosis congenital, chronic fatigue syndrome, and patients post bone marrow transplantation (BMT) present increased risk for OSCC development. The overall prevalence of OSCC in syndromic patients and post-BMT were 0.65% (95% CI = 0.13–3.11, p < 0.01) and 5.83% (95% CI = 0.00–30.90, p < 0.01), respectively. The certainty of the evidence was moderate. This study demonstrated that some systemic conditions predispose to OSCC. These results present an impact on the screening of OSCC in systemically compromised patients.
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Development of the remote 100 ml water swallow test versus clinical assessment in patients with head and neck cancer: Do they agree?

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Abstract

Background

The 100 ml water swallow test (WST) is a validated swallow assessment used in head and neck cancer (HNC). We aimed to determine the level of agreement when completing the 100 ml WST via clinician-graded video-testing or patient self-testing compared to standard face-to-face assessment (FTF).

Methods

Convenience sampling from four UK centers. Inclusion criteria: patients with HNC treated with any modality prior to, or within 5 years of treatment. Participants were recruited to complete the 100 ml WST by video-testing or self-testing and compared with FTF.

Results

Sixty-three patients were recruited; 1 was unable to perform the task; 30 in video-testing; and 32 in self-testing. There was no difference in swallow capacity (p = 0.424) and volume (p = 0.363) for the video-testing or the self-testing swallow capacity (p = 0.777) and volume (p = 0.445).

Conclusions

This study demonstrates that video-testing and self-testing are reliable methods of completing the 100 ml WST for this sample of patients with HNC.
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Response assessment in pediatric craniopharyngioma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group

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Abstract
Craniopharyngioma is a histologically benign tumor of the suprasellar region for which survival is excellent but quality of life often poor secondary to functional deficits from tumor and treatment. Standard therapy consists of maximal safe resection with or without radiation therapy. Few prospective trials have been performed, and response assessment has not been standardized. The Response Assessment in Pediatric Neuro-Oncology (RAPNO) committee devised consensus guidelines to assess craniopharyngioma response prospectively. Magnetic resonance imaging (MRI) is the recommended radiologic modality for baseline and follow-up assessments. Radiologic response is defined by two-dimensional measurements of both solid and cystic tumor components. In certain clinical contexts, response of solid and cystic disease may be differentially considered based on their unique natural histories and responses to treatment. Importantly, the committee incorporated fu nctional endpoints related to neuro-endocrine and visual assessments into craniopharyngioma response definitions. In most circumstances, cystic disease should be considered progressive only if growth is associated with acute, new-onset or progressive functional impairment. Craniopharyngioma is a common pediatric CNS tumor for which standardized response parameters have not been defined. A RAPNO committee devised guidelines for craniopharyngioma assessment to uniformly define response in future prospective trials.
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Hyperkalaemia and potassium binders: Retrospective observational analysis looking at the efficacy and cost effectiveness of calcium polystyrene sulfonate and sodium zirconium cyclosilicate

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Hyperkalaemia and potassium binders: Retrospective observational analysis looking at the efficacy and cost effectiveness of calcium polystyrene sulfonate and sodium zirconium cyclosilicate

Both CPS and SZC are equally effective at lowering acutely raised potassium concentrations with a cost analysis that favours CPS. Any claims of benefits of newer agents over established medications need to be explored in randomized trials.


Abstract

What is Known and Objective

Hyperkalaemia is a common medical emergency in patients admitted to hospital. There is a limited evidence base supporting some of the commonly applied treatment strategies. Although, NICE has recommended the use of sodium zirconium cyclosilicate (SZC) (TA599) and patiromer (TA623) in both acute and chronic hyperkalaemia, there is a limited evidence base for their use in acute hyperkalaemia in the hospital setting, particularly when compared to the present standard of care calcium polystyrene sulfonate (CPS).

Methods

A retrospective review of the electronic patient record system across our hospital over a 6-month period identified 138 patients who received either SZC (65 patients) or CPS (73 patients) to manage hyperkalaemia, investigating their efficacy and cost effectiveness. Results were analysed using simple descriptive statistics. Based on the results a naïve cost comparison between the two drugs was made.

Results and Discussion

CPS and SZC both effectively reduced plasm potassium concentrations in patients with hyperkalaemia (6.07 and 6.03 mmol/L respectively) by 1.17 mmol/L and 1.24 mmol/L taking a similar amount of time to work (2.97 days vs. 3 days). The principle causes of hyperkalaemia identified were acute kidney injury, medication, and chronic kidney disease. Cost comparison analysis which took into account raw product price and time needed to dispense medications revealed that CPS has slightly better cost effectiveness compared to SZC albeit at a cost of increased staff input.

What is New and Conclusion

Both CPS and SZC were equally effective at lowering acutely raised potassium concentrations. The cost difference between the two products appears to be small. Claims regarding the benefits of newer agents over older established medications need to be properly explored in randomized trials rather than being based on small scale non-comparative studies.
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Risk Characteristics of Hydrogen Sulphide Exposure in Wastewater Collection and Treatment Related Occupations

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Abstract
Objectives
Water and wastewater workers can be exposed to hydrogen sulphide (H2S), with an unpredictable exposure pattern, dominated by sharp peaks. These peaks can often be high above the ceiling value (CV) at 10 ppm.
Methods
We have analyzed self-administrated H2S exposure data among 60 wastewater workers in the Municipality of Trondheim, Norway, from 2015 till 2021. The detection range of the personal alarm equipment used was 1.6 to 100 ppm H2S. The workers were divided in four similar exposed groups (SEGs): wastewater collection net, wastewater treatment plants, wastewater pumping stations and water distribution net.
Results
We identified measurements from 7083 different workdays, approximately 10% of the workdays between 2015 and 2021. Within these, 1295 days had readings above 1.6 ppm H2S, and 424 (33%) of these days had readings that exceeded the CV of 10 ppm H2S. This percentage was similar across the SEGs. Only one workday had a time weighted average (TWA) exceeding the occupational exposure limit (OEL) of 5 ppm H2S, and only 14 days exceeded 0.5 ppm H2S, 1/10th of the OEL.
Conclusions
Wastewater workers in this study are regularly exposed to short peaks of H2S, but even high peaks do not influence the 8-h TWA values significantly. A preliminary measurement program over 3 days according to EN 689 to evaluate the need for further measurements would probably not find TWA values greater than 1/10 of OEL; the EN 689 standard is not made for evaluation to peak exposures. Exceedances of CV at 10 ppm H2S occur in 6% of workdays, and in 33% of days with exposure above 1.6 ppm. The toxicity and exposure profile of H2S makes continuous exposure monitoring necessary for alarm purposes. Reliance on the 8-h occupational exposure limit as has been the normal in Norway, will not be ade quately protective for wastewater workers. H2S alarm equipment should continue to be used.
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Extracapsular dissection with a transparotid facial nerve dissection approach versus partial superficial parotidectomy for benign tumours in the tail of the parotid gland: a single-centre retrospective study of 89 patients

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The aims of this study were (1) to evaluate the transparotid facial nerve dissection approach (TFND), in which the intraparotid cervicofacial or temporofacial division is identified first through a superficial lobe incision; and (2) to compare extracapsular dissection with a TFND (ECD-TFND) with partial superficial parotidectomy with a retrograde approach (PSP) for benign tumours in the tail of the parotid gland with respect to surgical outcomes. Eighty-nine patients underwent PSP or ECD-TFND for benign tumours in the tail of the parotid gland: 49 were treated surgically with PSP and 40 with ECD-TFND. (Source: International Journal of Oral and Maxillofacial Surgery)
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Analysis of the accuracy of computer‐assisted DCIA flap mandibular reconstruction applying a novel approach based on geometric morphometrics

alexandrossfakianakis shared this article with you from Inoreader

Abstract

Background

This study evaluated the accuracy of computer-assisted surgery (CAS)–driven DCIA (deep circumflex iliac artery) flap mandibular reconstruction by traditional morphometric methods and geometric morphometric methods (GMM).

Methods

Reconstruction accuracy was evaluated by measuring distances and angles between bilateral anatomical landmarks. Additionally, the average length of displacements vectors between landmarks was computed to evaluate factors assumed to influence reconstruction accuracy. Principal component analysis (PCA) was applied to unveil main modes of dislocation.

Results

High reconstruction accuracy could be demonstrated for a sample consisting of 26 patients. The effect of the number of segments and length of defect on reconstruction accuracy were close to the commonly used significance threshold (p = 0.062/0.060). PCA demonstrated displacement to result mainly from sagittal and transversal shifts.

Conclusions

CAS is a viable approach to achieve high accuracy in mandibular reconstruction and GMM can facilitate the evaluation of factors influencing reconstruction accuracy and unveil main modes of dislocation in this context.
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Radiomics based on magnetic resonance imaging for preoperative prediction of lymph node metastasis in head and neck cancer: Machine learning study

alexandrossfakianakis shared this article with you from Inoreader

Abstract

Background

In this study, we use machine learning techniques to develop an efficient preoperative magnetic resonance imaging (MRI) radiomics approach for evaluation of cervical lymph node (CLN) status.

Methods

After collecting all patients' MRI images, we used CLN radiomic features, the apparent diffusion coefficients (ADC) from diffusion-weighted imaging (DWI), and lymph node short diameter of the CLN to build MRI model to predict the status of the CLN.

Results

One hundred and twenty cases met inclusion criteria. The MRI model including the radiomic features, ADC, and lymph node size of the CLN achieved better performance for CLN status prediction with the area under the receiver operating characteristic (ROC) curve (AUC) of 0.83.

Conclusions

The multiomic signature of MRI radiomics, ADC, and lymph node size of CLNs has high predictive value for the status of CLNs. This model has provided scientific value to the surgeon regarding cervical lymph nodes before surgery.
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Comparative effectiveness of BNT162b2 and mRNA-1273 booster dose after BNT162b2 primary vaccination against the Omicron variants: A retrospective cohort study using large-scale population-based registries in Japan

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Abstract
Background
Direct comparative effectiveness of booster doses of BNT162b2 and mRNA-1273 after BNT162b2 primary vaccination is unknown.
Methods
We investigated comparative effectiveness of BNT162b2 and mRNA-1273 booster dose using data from registry systems for vaccination and COVID-19 infection in a local city in Japan. We followed participants aged ≥16 years who completed the BNT162b2 primary vaccination between November 22, 2021, and April 15, 2022. We collected information on age, sex, vaccination status, vaccine type, and infection status. Age was categorized as 16–44, 45–64, 65–84, and ≥85 years. Vaccine effectiveness for mRNA-1273 and no booster vaccination against BNT162b2 was estimated using age-stratified Cox regression adjusted for age, sex, and days since the second vaccination. The estimated hazard ratios for mRNA-1273 and no booster vaccinations were integrated separately using random effects meta-analyses .
Results
During the study period, we identified 62,586 (40.4%), 51,490 (33.2%), and 40,849 (26.4%) participants who received BNT162b2, mRNA-1273, and no booster dose, respectively. The median age was 69, 71, and 47 years for BNT162b2, mRNA-1273, and no booster dose, respectively. The integrated hazard ratio with reference to BNT162b2 was 1.72 for no booster vaccination and 0.62 for mRNA-1273. The comparative effectiveness of mRNA-1273 was similar across age categories.
Conclusions
Both homologous and heterologous vaccinations are effective against Omicron variants. In the head-to-head comparison, the effect was stronger in people who received heterologous vaccination than in those who received homologous vaccination. These findings may help improve logistics and decision making in future vaccination programs.
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