S-100 Immuno-Positive Low Grade Myofibroblastic Sarcoma of Nasal Cavity: A Rare Case Presentation and Review of Literature

xlomafota13 shared this article with you from Inoreader S-100 Immuno-Positive Low Grade Myofibroblastic Sarcoma of Nasal Cavity: A Rare Case Presentation and Review of Literature Via Otolaryngology Indian Abstract Introduction Myofibroblastic neoplasms comprise a spectrum of benign/malignant neoplasms. Only low-grade malignant forms have been reproducibly characterized as a diagnostic entity in the WHO classification. Low grade myofibroblastic sarcoma (LGMFS) confined to the nasal cavity is extremely rare. Objective To review previously reported cases of nasal cavity LGMFS and provide a better insight regarding its clinical and immunohistochemical features. Data synthesis A review was performed involving two databases (PubMed and Google Scholar). Four cases of nasal cavity LGMFS were included. The lesion showed no gender or nasal-side predilection. All cases underwent wide excision. None showed distant metastasis while half recurred locally. Histologically, mitotic rate ranged from 1 to 3/10 high-power-field (HPF) and none exhibited spontaneous necrosis. Immuno-expression of calponin, smooth muscle actin (SMA) and vimentin were seen in either all four or three-fourth of cases. Diffuse S-100 expression was a unique finding in present case and not reported previously, that caused a diagnostic dilemma with schwannomas. Conclusion LGMFS of nasal cavity is extremely rare. A wide resection is the primary treatment of choice. Adjuvant therapies (chemotherapy or radiotherapy) are of uncertain significance. Distant metastasis is rather unusual. Calponin, SMA and vimentin are highly sensitive immuno-markers. Diffuse S-100 expression is a possible finding. Mitotic rate < 6/10 HPF and absence of spontaneous necrosis are characteristic indolent features differentiating from high grade lesions. Trifecta of clinical and morphological features plus immunohistological phenotype, are sufficient for a definitive diagnosis. Electron microscopy is the most definitive confirmation test, however, should be reserved only for equivocal/atypical immunostaining pattern. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

An inhibitor of programmed death ligand 1 enhances natural killer cell-mediated immunity against malignant melanoma cells

xlomafota13 shared this article with you from Inoreader An inhibitor of programmed death ligand 1 enhances natural killer cell-mediated immunity against malignant melanoma cells Via Head and neck cancers by Young Shin Lee, Woong Heo, Ho-Jung Choi, Hae-Ryung Cho, Ji Ho Nam, Yong Gan Ki, Hong-Rae Lee, Woo-Chang Son, You-Soo Park, Chi-Dug Kang, Jaeho Bae Since ionizing radiation has showed the dramatic effect to kill the cancer cells through direct DNA damage as well as triggering anti-cancer immune responses including induction of NKG2D ligands, it has used for long time to treat many cancer patients. However, it has been known that radiotherapy might promote the remnant cancer cells to escape immune system and metastasis. One of the suggested ways of immune evasion is induction of a ligand for programmed death-1 (PD-L1) in head and neck cancer, bladder cancer and lung cancer cells which engages the receptor, programmed death-1 (PD-1) in immune cells. PD-1/PD-L1 axis transduces the inhibitory signal and suppresses the adaptive immunity. However, their role in innate immunity remains poorly understood. Therefore, we investigated whether ionizing radiation could change the expression of PD-L1 in malignant melanoma cells and the receptor, programmed death-1 (PD-1), in NK-92 cells. Surface PD-L1 levels on melanoma cells were increased b y ionizing radiation in a dose-independent manner but the level of PD-L1 was not changed significantly in NK-92 cells. Radiation-induced PD-L1 suppressed the activity of the NK-92 cells against melanoma cells despite of upregulation of NKG2D ligands. Furthermore, activated NK cells had high level of PD-1 and could not kill PD-L1+ melanoma cells effectively. When we used PD-L1 inhibitor or silenced PD-L1 gene, inhibited PD-1/PD-L1 axis reversed the activity of the suppressed NK cells. Through these results, we supposed that PD-1/PD-L1 blockade could enhance the immune responses of NK cells against melanoma cells after radiotherapy and might overcome the PD-L1 mediated radioresistance of cancer cells. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Efficacy Profile and Safety of Very Low-Dose Rituximab in Patients with Graves' Orbitopathy

xlomafota13 shared this article with you from Inoreader Efficacy Profile and Safety of Very Low-Dose Rituximab in Patients with Graves' Orbitopathy Via liebertpub1 Thyroid, Ahead of Print. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Diabetes and glycemic control in necrotizing otitis externa (NOE)

xlomafota13 shared this article with you from Inoreader Diabetes and glycemic control in necrotizing otitis externa (NOE) 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 Apr 1. doi: 10.1007/s00405-021-06772-y. Online ahead of print. ABSTRACT PURPOSE: Although the association between necrotizing otitis externa (NOE) and diabetes mellitus (DM) is well known, there is little knowledge in regards to the effects of DM and glycemic control on the outcome of NOE. The aim of the study was to determine the effects of DM duration and glycemic control, and in-hospital glycemic control on NOE severity. METHODS: A retrospective case series analysis, including all patients hospitalized between 1990 and 2018 due to NOE were included. Data collected included NOE disease characteristics, duration of DM, DM-associated comorbidities, glycated hemoglobin (HbA1c), urine microalbumin and in-hospital blood glucose measurements. Disease severity was defined based on duration of hospitalization (above or below 20 days) and need for surgery. RESULTS: Eighty-nine patients were included in the study. Eighty-three patients (94.3%) had DM. Preadmission HbA1c was 8.13% (5.8-12.6%). Forty-nine patients (65.5%) had mean blood glucose of ≥ 140 mg/dL and 26 (34.5%) had ≤ 140 mg/dL. DM duration was 157.88 months among NOE patients who required surgery, and 127.6 months among patients who were treated conservatively (p value 0.25). HbA1c in patients hospitalized < 20 days was 7.6%, and 8.7% among NOE hospitalized ≥ 20 days (p value 0.027). Seven patients with mean blood glucose of ≤ 140 mg/dL had Pseudomonas Aeruginosa (PA-NOE) (26.7%), in comparison to 25 (51.0%) with mean blood glucose measurement of ≥ 140 mg/dL (p = 0.045). CONCLUSIONS: HbA1c at admission is associated with longer hospitalization duration among NOE patients. Mean blood glucose during hospitalization was associated with a higher likelihood of PA infection, however, it had no effect on disease outcome. PMID:33792784 | DOI:10.1007/s00405-021-06772-y View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Reducing unnecessary antibiotic prescription through implementation of a clinical guideline on self-limiting respiratory tract infections

xlomafota13 shared this article with you from Inoreader Reducing unnecessary antibiotic prescription through implementation of a clinical guideline on self-limiting respiratory tract infections Via Otitis media by Xavier Sánchez, María Orrico, Toa Morillo, Andrea Manzano, Ruth Jimbo, Luciana Armijos Background Clinical guidelines (CG) are used to reduce variability in practice when the scientific evidence is sparse or when multiple therapies are available. The development and implementation of evidence-based CG is intended to organize and provide the best available evidence to support clinical decision making in order to improve quality of care. Upper respiratory tract infections (URTI) are the leading cause of misuse of antibiotics and a CG may reduce the unnecessary antibiotic prescription. Methods The aim of this quasi-experimental, before-after study was to analyze the short- and long-term effects of the implementation of a CG to decrease the rate of antibiotic prescription in URTI cases in the emergency department of a third level private hospital in Quito, Ecuador. The study included 444 patients with a main diagnosis of URTI. They were distributed in three groups: a baseline cohort 2011 (n = 114), a first post-implementation cohort 2011 (n = 114), and a later po st-implementation cohort 2018 (n = 216). The implementation strategy consisted of five key steps: acceptance of the need for implementation of the CG, dissemination of the CG, an educational campaign, constant feedback, and sustainability of the strategy through continuous training. Results The results of this study show a 42.90% of antibiotic prescription rate before the CG implementation. After the implementation of the CG, the prescription rate of antibiotics was significantly reduced by 24.5% (42.9% vs 18.4%, p Conclusions The implementation of CGs decreases the rate of antibiotic prescription in URTI cases. The results are remarkable after early implementation, but the effect persists over time. The emphasis must shift from guideline development to strategy implementation. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Radioiodine Remnant Ablation for Differentiated Thyroid Cancer: A Systematic Review and Meta-analysis

xlomafota13 shared this article with you from Inoreader Radioiodine Remnant Ablation for Differentiated Thyroid Cancer: A Systematic Review and Meta-analysis Via radioactive iodine JAMA Otolaryngol Head Neck Surg. 2021 Apr 1. doi: 10.1001/jamaoto.2021.0288. Online ahead of print. ABSTRACT IMPORTANCE: Postoperative radioactive iodine (RAI) remnant ablation for differentiated thyroid cancer (DTC) facilitates the early detection of recurrence and represents an adjuvant therapy that targets persistent microscopic disease. The optimal activity of RAI in low- and intermediate-risk DTC remains controversial. OBJECTIVE: To evaluate the long-term cure rate of dif ferent RAI activities in low- and intermediate-risk DTC. Secondary outcomes included successful remnant ablation, adverse effects, and hospital length of stay. DATA SOURCE: A systematic search of the databases PubMed, Cochrane Collaboration, Embase, Scopus, and Web of Science was performed to identify randomized clinical trials (RCTs) and observational studies that compared long-term outcomes (>12 months) for American Thyroid Association-classified low- and intermediate-risk DTC based on receipt of either low-activity or high-activity RAI postoperatively. STUDY SELECTION: All RCTs or observational studies evaluating patients with low- and intermediate-risk DTC who were treated initially with total/near-total thyroidectomy, followed by remnant RAI ablation with either low or high activities. Eligible studies had to present odds ratio, relative risk (RR), or hazard ratio estimates (with 95% CIs), standard errors, or the number of events necessary to calculate these for the outcome of interest rate. DATA EXTRACTION: Two investigators reviewed the literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Dichotomous variables were pooled as risk ratios and continuous data as weighted-mean differences. Quality assessment of the included studies was performed using the Newcastle-Ottawa and Jadad scales. MAIN OUTCOMES AND MEASURES: Disease recurrence was the primary outcome. Secondary outcomes included successful ablation, adverse effects, and length of stay. RESULTS: Ten studies that included 3821 patients met inclusion criteria, including 6 RCTs and 4 observational studies. There was no difference in long-term cure recurrence rates (RR, 0.88; 95% CI, 0.62-1.27, P = .50) or successful remnant ablation (RR, 0.95; 95% CI, 0.87-1.03; P = .20) between low-activity and high-activity RAI. CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, low-activity RAI was com parable with high-activity RAI regarding successful ablation and recurrence rates. This suggests that low-activity RAI is preferable to high-activity in low- and intermediate-risk DTC because of its similar efficacy but reduced morbidity. TRIAL REGISTRATION: PROSPERO Identifier: CRD42020166780. PMID:33792650 | DOI:10.1001/jamaoto.2021.0288 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Management of Meningitis Due to Cystic Cochleovestibular Malformation: a Stitch in Time

xlomafota13 shared this article with you from Inoreader Management of Meningitis Due to Cystic Cochleovestibular Malformation: a Stitch in Time Via Otolaryngology Indian Abstract Spontaneous CSF otorrhea alludes to those cases which have no known etiology like traumatic, iatrogenic, neoplastic or infectious. The presentation of the patient depends on the anatomical integrity of the eustachian tube as well as the tympanic membrane. Children with certain congenital inner ear malformations, including incomplete partition deformity, show a higher incidence of spontaneous CSF leaks and the resultant meningitis. Cystic vestibulocochlear deformity accounts for approximately 20% of inner ear malformations. In this case report, we discuss a child who presented with first episode of meningitis and with the help of thorough clinical otorhinolaryngological examination and radiology, was diagnosed with a congenital ear anomaly. With this paper, we stress upon the importance of keeping an open mind regarding the differential diagnosis of any condition, and the value of timely intervention. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sustained Chemosensory Dysfunction during the COVID-19 Pandemic

xlomafota13 shared this article with you from Inoreader Sustained Chemosensory Dysfunction during the COVID-19 Pandemic Via O.R.L. Journal for oto-rhino-laryngology and its borderlands Introduction: Chemosensory dysfunction (CD) has proven valuable in prediction of COVID-19, as it is a frequent and specific symptom of the disease. The aim of this study was to investigate the duration of CD in patients with sudden subjective olfactory and/or gustatory loss during the SARS-CoV-2 pandemic. The secondary aim was to identify possible prognostic factors for the duration of CD. Methods: An online baseline questionnaire was designed to assess subjective CD. Three rounds of follow-up questionnaires were sent out to any part icipants with persistent CD in 6-week intervals, prospectively assessing subjective chemosensory function and extending the follow-up time of this cohort significantly. Results: In total, 467 participants completed the baseline questionnaire. The most significant improvement and recovery of chemosensory function was observed within the first month after the initial loss. Rates became stagnant after about 2 months, and only little improvement and recovery was seen after 2–4 months. After a mean follow-up of 95.9 days (olfactory dysfunction) and 94.0 days (gustatory dysfunction), 86.7% of participants reported gustatory improvement and 82.6% reported olfactory improvement, while 55.0% reported full gustatory recovery and 43.8% reported full olfactory recovery. Female gender was associated with better improvement of gustatory function. High subjective severity of chemosensory loss was associated with lower rates of olfactory and gustatory recovery as well as improvement of olfactory function. Young age was not associated with a better prognosis. Discussion/Conclusion: Rates of improvement and recovery of chemosensory function decreased after 2–4 months after initial chemosensory loss, possibly indicating that prolonged and perhaps permanent chemosensory loss may be a complication of SARS-CoV-2 infections. High subjective severity of CD may worsen the prognosis for improvement and recovery of chemosensory function. ORL View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pediatric Malignant Mandibular Tumors: Personal Experience and Literature Options Discussion

xlomafota13 shared this article with you from Inoreader Pediatric Malignant Mandibular Tumors: Personal Experience and Literature Options Discussion Via O.R.L. Journal for oto-rhino-laryngology and its borderlands Introduction: Mandibular defects reconstruction could result challenging in childhood, due to facial and mandibular growth patterns. For these reasons, the choice of the most suitable reconstructive option in pediatric patients, affected by mandibular malignancies, still objects of debate. Objective: The aim of our study was to compare our reconstructive schedules to the existing literature in order to give a personal contribute to the present panorama. Method s: We performed, in October 2019, a retrospective evaluation of pediatric patients treated for biopsy-proven mandibular malignancies at our Institute between January 2013 and December 2016. All of them received multimodal therapy in accordance with standard guidelines and their demographic, clinical, treatment, and outcome parameters were collected and analyzed. Results: We observed a shorter duration of surgery, a faster tracheostomy tube and feeding-tube removal, and a minor hospitalization in patients who received grafts transfer compared to those who underwent microsurgical mandibular reconstruction. After a 36-month period of follow-up, osteochondral grafts showed a pattern of growth similar to the mandibular epiphysis (condilylion-gonion linear and vertical ratio ranging to 0.96–1.03 and 1–1.02 at orthopantomogram, respectively). No bone consolidation delays and functional impairment were recorded. Conclusions: Free flaps mandibular reco nstruction in children needs to be better assessed and proximal fibular epiphyseal free flap indication might deserve further studies. Osteochondral grafts find indication for lateral defects, 50–55 mm in maximum length and located in the mandibular ramus, without massive teeth or soft tissue defect. Condyle involvement does not represent an absolute contraindication to rib graft use. ORL View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prognostic value and therapeutic implications of nodal involvement in head and neck mucosal melanoma

xlomafota13 shared this article with you from Inoreader Prognostic value and therapeutic implications of nodal involvement in head and neck mucosal melanoma Via Head & Neck Abstract Background The prognostic significance of nodal involvement is not well established in head and neck mucosal melanoma (HNMM). Methods A retrospective, monocentric study was performed on 96 patients with HNMM treated between 2000 and 2017. Results At diagnosis, seventeen patients (17.8%) were cN1, with a higher risk for HNMM arising from the oral cavity (p = 0.01). cN status had no prognostic value in patients with nonmetastatic resectable HNMM. No occult nodal metastasis was observed in the cN0 patients after a nodal dissection (ND). The nodal recurrence rate was similar in the cN1 and the cN0 patients. No isolated nodal recurrences were noted. Among the patients who underwent a ND, no benefit of this procedure was noted. Conclusions cN1 status is not a prognostic factor in patients with resectable HNMM. Elective ND should not be systematically performed in cN0 HNMM. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A novel application of superior thyroid artery perforator flaps for medium‐sized intraoral reconstructions: A retrospective analysis of 12 cases

xlomafota13 shared this article with you from Inoreader A novel application of superior thyroid artery perforator flaps for medium‐sized intraoral reconstructions: A retrospective analysis of 12 cases Via Head & Neck Abstract Background To describe the indications, technique, and preliminary experience in the application of the superior thyroid artery perforator flap (STAPF) for the reconstruction of various medium‐sized intraoral defects. Methods From September 2018 to September 2019, 12 consecutive cases of oral squamous cell carcinoma underwent reconstruction with a STAPF. Clinical details were collected, and postoperative function was analyzed. Results The venous drainage of the STAPF is variable with drainage into the internal jugular vein in six cases, into both the internal and external jugular veins in four cases, and into the external jugular vein in two cases. Ten cases were harvested as pedicled flaps, while two cases required a venous anastomosis due to inadequate length of the venous pedicle. Ten flaps survived completely, whereas two flaps had partial necrosis that ultimately resolved with secondary healing. Conclusions STAPF is a reliable method for the reconstruction of medium‐sized intraoral defects. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.