Addressing the Pandemic Training Deficiency: Filling the Void with Simulation in Facial Reconstruction

xlomafota13 shared this article with you from Inoreader Addressing the Pandemic Training Deficiency: Filling the Void with Simulation in Facial Reconstruction Via The Laryngoscope Objective/Hypothesis To assess the use of a three‐dimensional (3D) printed, multilayer facial flap model for use in trainee education as an alternative method of teaching surgical techniques of facial reconstruction. Study Design Cohort study. Methods A 3D printed facial flap simulator was designed from a computed tomography scan and manufactured out of silicone for low‐cost, high‐fidelity simulation. This simulator was tested by a group of Otolaryngology–Head and Neck Surgery trainees at a single institution. The simulator group was compared to a control group who completed an exercise on a traditional paper facial flap exercise. Both groups underwent didactic lectures prior to completing their respective exercises. Pre‐ and post‐exercise Likert scale surveys measuring experience, understanding, effectiveness, and realism were completed by both groups. Central tendency, variability, and confidence intervals were measured to evaluate the outcomes. Results Trainees completing the facial flap simulator reported a statistically significant (p < 0.05) improvement in overall expertise in facial flap procedures, design of facial flaps, and excision of standing cutaneous deformities. No statistically significant improvement was seen in the control group. Conclusions Trainees found the facial flap simulator to be an effective and useful training tool with a high level of realism in surgical education of facial reconstruction. Surgical simulators can serve as an adjunct to trainee education, especially during extraordinary times such as the novel coronavirus disease 2019 pandemic, which significantly impacted surgical training. Level of Evidence NA Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Subjective and Objective Measures in Assessing Neck Disability and Pain in Head and Neck Cancer

xlomafota13 shared this article with you from Inoreader Subjective and Objective Measures in Assessing Neck Disability and Pain in Head and Neck Cancer Via The Laryngoscope Objective/Hypothesis The intensification of treatment for head and neck cancers (HNCs) has created a cohort of patients living with short‐ and long‐term comorbidities and functional deficits. This study aimed to determine whether there is a relationship between patient‐reported outcomes (PROs) and objective measures of neck function in survivors of HNCs. Study Design Cross‐sectional study. Methods Thirty‐one subjects (aged 64 ± 8.7 years; 28 males and three females) were recruited and completed the Neck Disability Index (NDI) and a numeric pain scale. At the same visit, subjects were fitted with two portable motion sensors to collect range of motion (ROM) and velocity data. Differences between ROM, velocity, and PRO subgroups were assessed using a one‐tailed t test (*P < .05). The Pearson correlation coefficient (r) was calculated between the NDI values and the ROM and velocity values for each motion. Results A moderate correlation (r = 0.507) was observed between NDI and neck pain. Patients with no disability according to the NDI had significantly higher ROM and velocity than patients with mild to moderate disability. Velocity in all degrees of freedom (axial rotation, flexion and extension, and lateral bending) was significantly lower for patients who perceived higher levels of neck pain and neck disability. Conclusions This study notes that patients who report neck disability and pain have more limited ROM and velocity following HNC treatment. These data may improve treatment planning and care delivery by facilitating an understanding of the experiences of HNC survivors and the pathophysiology that must be targeted to address their psychosocial and functional deficits. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Importance of extracutaneous organ involvement in determining the clinical severity and prognosis of incontinentia pigmenti caused by mutations in the IKBKG gene

xlomafota13 shared this article with you from Inoreader Importance of extracutaneous organ involvement in determining the clinical severity and prognosis of incontinentia pigmenti caused by mutations in the IKBKG gene Via Experimental Dermatology Abstract Incontinentia pigmenti (IP) is a rare X‐linked skin disease caused by mutations in the IKBKG gene, which is required for activation of the nuclear factor‐kappa B signaling pathway. Multiple systems can be affected with highly variable phenotypic expressivity. We aimed to clarify the clinical characteristics observed in molecularly confirmed Korean IP patients. The medical records of 25 females confirmed as IP by molecular genetic analysis were retrospectively reviewed. The phenotypic score of extracutaneous manifestations was calculated to assess the disease severity. The IKBKG gene partial deletion or intragenic mutations were investigated using long‐range PCR, multiplex ligation‐dependent probe amplification, and direct sequencing methods. Among the 25 individuals, 18 (72%) were sporadic cases. All patients showed typical skin manifestations at birth or during the neonatal period. Extracutaneous findings were noted in 17 (68%) patients; ocular manifestation s (28%), neurological abnormalities (28%), hair abnormalities (20%), dental anomalies (12%), nail dystrophy (8%). The common exon 4–10 IKBKG deletion was observed in 20 (80%) patients. In addition, five intragenic sequence variants were identified, including three novel variants. The phenotype scores were highly variable, ranging from abnormal skin pigmentation only to one or more extracutaneous features, although no significant difference was observed for each clinical characteristic between the group with sequence variants and that with common large deletion. Our cohort with IP showed heterogeneity of extracutaneous manifestations and high incidence of sporadic cases. Long‐term monitoring with multidisciplinary management is essential for evaluating the clinical status, providing adequate genetic counseling, and understanding the genotype‐phenotype correlation in IP. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Whole‐slide margin control through deep learning in Mohs micrographic surgery for basal cell carcinoma

xlomafota13 shared this article with you from Inoreader Whole‐slide margin control through deep learning in Mohs micrographic surgery for basal cell carcinoma Via Experimental Dermatology Abstract Background Basal cell carcinoma (BCC) is the most common type of skin cancer with incidence rates rising each year. Mohs micrographic surgery (MMS) is most often chosen as treatment for BCC on the face for which each frozen section has to be histologically analysed to ensure complete tumor removal. This causes a heavy burden on health economics. Objectives To develop and evaluate a deep learning model for the automated detection of BCC‐negative slides and classification of BCC in histopathology slides of MMS based on whole‐slide image (WSI). Methods Two deep learning models were developed on the basis of 171 digitized H&E frozen slides from 70 different patients. The first model had a U‐Net architecture and was used for the segmentation of BCC. A subsequent convolutional neural network used the segmentation to classify the whole slide as BCC or BCC‐negative. Results Quantitative evaluation over manually labelled ground truth data resulted in a Dice score of 0.66 for the segmentation of BCC and an area under the receiver operating characteristic curve (AUC) of 0.90 for the slide‐level classification. Conclusions This study demonstrates that through WSIs deep learning models may be a feasible option to improve the clinical workflow and reduce costs in histological analysis of BCC in MMS. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Coexistence of two accessory flexor pollicis longus heads or coexistence of two-headed flexor pollicis longus with an unrecognized anatomical structure?

xlomafota13 shared this article with you from Inoreader Coexistence of two accessory flexor pollicis longus heads or coexistence of two-headed flexor pollicis longus with an unrecognized anatomical structure? Via radiol anat Surg Radiol Anat. 2021 Mar 3. doi: 10.1007/s00276-021-02721-w. Online ahead of print. ABSTRACT The flexor pollicis longus (FPL) is located in the anterior compartment of the forearm. It is morphologically variable in both point of origin and insertion. An additional head of the FPL can lead to anterior interosseous syndrome. This report presents a morphological variation of the FPL (additional head in proximal attachment and bifurcated tendinous insertion in distal attachmen t) and an unrecognized structure that has not so far been described in the literature. This structure originates in six heads (attached to the FPL or interosseous membrane) that merge together, and inserts on to the FPL. All the variations noted have clinical significance, ranging from potential nerve compression to prevention of tendon rupture. PMID:33656594 | DOI:10.1007/s00276-021-02721-w View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Tracheostomy complications in otorhinolaryngology are rare despite the critical airway

xlomafota13 shared this article with you from Inoreader Tracheostomy complications in otorhinolaryngology are rare despite the critical airway Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Mar 3. doi: 10.1007/s00405-021-06707-7. Online ahead of print. ABSTRACT PURPOSE: To identify complications of surgical tracheostomies in otorhinolaryngologic patients and adjust our processes to be properly prepared in the future. METHODS: We reviewed retrospectively all surgical tracheostomies (n = 255) performed by otolaryngologist-head and neck surgeons at Helsinki University Hospital between Jan 2014 and Feb 2017. Patient demographics, surgical details, surgical and medical complications, and tracheostomy-related mortality were recorded from the hospital charts. Risk factors for complications were assessed. RESULTS: Altogether, 55 (22%) complications were identified in 39 (15%) patients, with pneumonia, accidental decannulation, and bleeding being the most common. No patient or surgery-related factor reached significance in overall complication risk factor analysis. Medical complications were more common after elective tracheostomies compared to emergency procedures (10.6% vs. 3.5%, p < 0.05). Majority of complications (78%) were classified as mild or moderate according to Clavien-Dindo. Only 2 (0.8%) tracheostomy-related deaths were recorded. CONCLUSION: In otorhinolaryngologists service, severe complications and tracheostomy-related deaths are very rare. Reducing their prevalence even further with careful planning is possible. PMID:33656585 | DOI:10.1007/s00405-021-06707-7 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Preoperative Radiological Findings Associated with Failure of Frontal Sinusotomy: A Prospective Study

xlomafota13 shared this article with you from Inoreader The Preoperative Radiological Findings Associated with Failure of Frontal Sinusotomy: A Prospective Study Via Clinical Otolaryngology Abstract Objectives The study aimed to assess the association between the preoperative CT findings and the patency outcome of the frontal sinus after endoscopic frontal sinusotomy in the early follow‐up period. Design A prospective cohort study Setting Tertiary hospital centre Main outcome measures The study measures the association between the frontal sinusotomy outcome and the standard preoperative radiological scores, including Harvard, Kennedy, and Lund Mackay. It also measures the impact of the degree of sinus mucosal thickness on the outcome. Furthermore, it measures the effect of the anteroposterior lengths of both the frontal sinus ostium and the frontal recess on postoperative frontal sinus patency. Results Harvard, Kennedy, and Modified Lund Mackay scores showed no evidence of association with the frontal sinusotomy patency outcome (p values 0.397, 0.487, and 0.501), respectively. Still, the Lund Mackay score showed a negative correlation with symptom improvement. Sinuses with a high‐grade mucosal thickness on CT scan were associated with high failure rates (p‐value: 0.009*). The anteroposterior length of the frontal sinus ostium significantly affects the outcome (p‐value: 0.001*). In contrast, there was no association between the anteroposterior length of the frontal recess and the outcome (p‐value: 0.965). Conclusion The Harvard, Kennedy, and Lund Mackay scores could not predict the frontal sinusotomy patency outcome. Failed cases were associated with advanced degrees of mucosal pathology in the preoperative CT scan. Sinuses ostia with anteroposterior diameters less than 5.36 mm showed more susceptibility for sinus restenosis postoperatively. The variability of the anteroposterior length of the frontal recess did not affect the surgical outcome. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The transcriptome characteritics of vestibular organs from delayed endolymphatic hydrops patients(Menieres disease)

xlomafota13 shared this article with you from Inoreader The transcriptome characteritics of vestibular organs from delayed endolymphatic hydrops patients(Menieres disease) Via Clinical Otolaryngology Abstract Objectives To identify genes that are related to delayed endolymphatic hydrops (DEH) in patients by RNA‐Seq analysis. Design Observational study. Setting Eye & ENT Hospital, Fudan University (Shanghai, China). Participants We collected the entire vestibular system from four patients with DEH who underwent labyrinthectomy. Three control samples were collected from patients with acoustic neuroma or facial neuroma treated via the translabyrinthine approach. High‐throughput RNA‐Seq analysis was performed to investigate gene expression in the pathological vestibular system. Main outcome measures Our bioinformatics analysis identified 17 genes that were upregulated and eight genes that were downregulated in patients with DEH compared to the controls. Results The altered gene expression profile suggested that DEH is closely related to neuropathy and autoimmune disease. In addition, many of the differentially regulated genes were involved in cell adhesion, suggesting a role of cell adhesion in DEH. Immunofluorescence analysis confirmed the expression of PMP2 and CLDN19 in the cytoplasm of hair cells and scattered expression of MPZ at cell junctions. The protein expression levels were higher in specimens from patients with Ménière's disease and DEH compared to controls. Conclusions The protein expression profile of vestibular organs in patients with endolymphatic hydrops exhibited a degree of similarity to that of Ménière's disease. Endolymphatic hydrops is characterized by autoimmune abnormalities. DEH and Ménière's disease are likely to be different manifestations of the same disease, with disparate clinical symptoms. RNA‐Seq is a useful analytical tool to characterise the vestibular pathology based on its transcriptome. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Fine-Tuning Lipid Metabolism by Targeting Mitochondria-Associated Acetyl-CoA-Carboxylase 2 in BRAFV600E Papillary Thyroid Carcinoma

xlomafota13 shared this article with you from Inoreader Fine-Tuning Lipid Metabolism by Targeting Mitochondria-Associated Acetyl-CoA-Carboxylase 2 in BRAFV600E Papillary Thyroid Carcinoma Via liebertpub1 Thyroid, Ahead of Print. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effect of rifampicin on anticoagulation of warfarin: A case report

paythelady.612 shared this article with you from Inoreader Effect of rifampicin on anticoagulation of warfarin: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Feb 16;9(5):1087-1095. doi: 10.12998/wjcc.v9.i5.1087. ABSTRACT BACKGROUND: The drug interaction between warfarin and rifampicin is widely known, but there are still some difficulties in managing the combination of the two drugs. CASE SUMMARY: A patient with brucellosis received strict monitoring from a Chinese pharmacist team during combination of warfarin and rifampicin. The dose of warfarin was increased to 350% in 3 mo before reaching the lower international normalized ratio treatment window. No obvious adverse reaction occurred during the drug-adjustment period. This is the first case report of long-term combined use of rifampicin and warfarin in patients with brucellosis and valve replacement in China based on the Chinese lower warfarin dose and international normalized ratio range. CONCLUSION: Anticoagulation for valve replacement in Chinese patients differs from that in other races. Establish ment of a pharmacist clinic provides vital assistance in warfarin dose adjustment. PMID:33644171 | PMC:PMC7896655 | DOI:10.12998/wjcc.v9.i5.1087 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Etomidate vs propofol in coronary heart disease patients undergoing major noncardiac surgery: A randomized clinical trial

paythelady.612 shared this article with you from Inoreader Etomidate <em>vs</em> propofol in coronary heart disease patients undergoing major noncardiac surgery: A randomized clinical trial Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Feb 26;9(6):1293-1303. doi: 10.12998/wjcc.v9.i6.1293. ABSTRACT BACKGROUND: The ideal depth of general anesthesia should achieve the required levels of hypnosis, analgesia, and muscle relaxation while minimizing physiologic responses to awareness. The choice of anesthetic strategy in patients with coronary heart disease (CHD) undergoing major noncardiac surgery is becoming an increasingly important issue as the population ages. This is because general anesthesia is associated with a risk of perioperative cardiac complications and death, and this risk is much higher in people with CHD. AIM: To compare hemodynamic function and cardiovascular event rate between etomidate- and propofol-based anesthesia in patients with CHD. METHODS: This prospective study enrolled consecutive patients (American Society of Anesthesiologists grade II/III) with stable CHD (New York Heart Association class I/II) undergoing m ajor noncardiac surgery. The patients were randomly allocated to receive either etomidate/remifentanil-based or propofol/remifentanil-based general anesthesia. Randomization was performed using a computer-generated random number table and sequentially numbered, opaque, sealed envelopes. Concealment was maintained until the patient had arrived in the operating theater, at which point the consulting anesthetist opened the envelope. All patients, data collectors, and data analyzers were blinded to the type of anesthesia used. The primary endpoints were the occurrence of cardiovascular events (bradycardia, tachycardia, hypotension, ST-T segment changes, and ventricular premature beats) during anesthesia and cardiac troponin I level at 24 h. The secondary endpoints were hemodynamic parameters, bispectral index, and use of vasopressors during anesthesia. RESULTS: The final analysis included 40 patients in each of the propofol and etomidate groups. The incidences of bradycardia, hypo tension, ST-T segment changes, and ventricular premature beats during anesthesia were significantly higher in the propofol group than in the etomidate group (P < 0.05 for all). The incidence of tachycardia was similar between the two groups. Cardiac troponin I levels were comparable between the two groups both before the induction of anesthesia and at 24 h after surgery. When compared with the etomidate group, the propofol group had significantly lower heart rates at 3 min after the anesthetic was injected (T1) and immediately after tracheal intubation (T2), lower systolic blood pressure at T1, and lower diastolic blood pressure and mean arterial pressure at T1, T2, 3 min after tracheal intubation, and 5 min after tracheal intubation (P < 0.05 for all). Vasopressor use was significantly more in the propofol group than in the etomidate group during the induction and maintenance periods (P < 0.001). CONCLUSION: In patients with CHD undergoing noncardiac major surgery, etomidate-based anesthesia is associated with fewer cardiovascular events and smaller hemodynamic changes than propofol-based anesthesia. PMID:33644196 | PMC:PMC7896684 | DOI:10.12998/wjcc.v9.i6.1293 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.