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Τετάρτη 19 Ιανουαρίου 2022

Utility of Ultrasonography for Diagnosis of Salivary Gland Sialolithiasis: A Meta‐Analysis

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Objectives

We hypothesized that ultrasonography for salivary gland stone detection would have a diagnostic accuracy similar to that confirmed by sialendoscopy, sialography, or surgery. Therefore, we evaluated the diagnostic characteristics of ultrasonography in terms of submandibular and parotid stone detection compared to confirmatory methods.

Methods

We searched PubMed, Embase, the Web of Science, SCOPUS, and the Cochrane database to October 31, 2021. The risk of bias was evaluated using the QADAS-2 tool.

Results

Ten studies involving 1393 patients were included in the analysis. The diagnostic odds ratio of ultrasonography was 162.6013 (95% confidence interval [CI] [53.9883; 489.7208] and I 2 value 81.0%). The area under the summary receiver operating characteristic curve was 0.963. The sensitivity, specificity, negative predictive value, and positive predictive value were 0.8992 (95% CI [0.8534; 0.9318]; I 2 = 79.9%), 0.9664 (95% CI [0.9290; 0.9844], I 2 = 65.6%), 0.8076 (95% CI [0.7256; 0.8694]; I 2 = 80.4%), and 0.9853 (95% CI [0.9629; 0.9943]; I 2 = 77.4%), respectively. However, high-level among-study heterogeneity (I 2 ≥ 50%) was evident, attributable to the inclusion of different glands. On subgroup analysis, significant differences in the negative predictive values (parotid gland only [0.9392], submandibular gland only [0.6718], and parotid and submandibular glands [0.8105]) were apparent. We found no significant among-study difference in the sensitivity, specificity, positive predictive value, or diagnostic odds ratio (P > .05).

Conclusion

Ultrasonography usefully detects submandibular and parotid gland stones. Ultrasonography of the parotid gland was associated with the highest diagnostic accuracy, but further clinical studies are needed.

Level of Evidence

NA Laryngoscope, 2022

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Systemic Bevacizumab Treatment for Recurrent Respiratory Papillomatosis: Long‐Term Follow‐Up

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Objectives/Hypothesis

Systemic bevacizumab is a new adjuvant therapy for recurrent respiratory papillomatosis (RRP) that has shown promising preliminary results in children. The objective of this study was to report the largest series to date that includes long-term follow-up data on bevacizumab treatment.

Study Design

Retrospective chart review.

Methods

Retrospective review of seven pediatric patients treated within the past 6 years with systemic bevacizumab for RRP refractory to traditional debridement.

Results

All seven patients had a significant reduction in disease burden after initiation of systemic bevacizumab. There have been no major complications associated with systemic therapy so far. Median duration of bevacizumab treatment was 2.13 years. Three of the seven patients have been on treatment for over 3 years with the longest duration of treatment in our first patient now at 5.5 years. One patient experienced significant disease recurrence on two occasions when therapy was temporarily discontinued and was recently diagnosed with squamous cell carcinoma of the lung.

Conclusion

Systemic bevacizumab is an effective therapy for cases of severe RRP with promising results both in short-term and long-term follow-up. Side effects are minimal. Patients must be followed closely to determine appropriate dosing intervals to control disease and to screen for disease progression.

Level of Evidence

IV Laryngoscope, 2022

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Quality of life after tonsillectomy in adult patients with recurrent acute tonsillitis: a systematic review

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Eur Arch Otorhinolaryngol. 2022 Jan 19. doi: 10.1007/s00405-022-07260-7. Online ahead of print.

ABSTRACT

PURPOSE: The aims of this systematic review were to (1) explore the evidence for improved quality of life (QOL) in adult patients undergoing tonsillectomy because of recurrent acute tonsillitis (RT) and (2) evaluate which set of guidelines for tonsillectomy in adult RT patients is preferable, using QOL as outcome measure.

METHODS: A systematic search was conducted in the PubMed, Embase, and Scopus databases. RCT/cohort studies exploring the effect of elective tonsillectomy in adult RT patients using any QOL assessment tool no less than 6 months after surgery were included. Studies were divided into two guideline groups based on the number of tonsillitis episodes required for tonsillectomy (Group 1: ≥ 5; Group 2: ≤ 4).

RESULTS: A total of 364 unique records were identified. Seven studies (n = 409 patients) were includ ed in a qualitative analysis and four studies were included in a meta-analysis. Patients' QOL rose significantly, primarily because of improvements in the general and physical domains. In the meta-analysis, 96% (293/304) of patients benefitted from tonsillectomy. Patients included in guideline Group 1 studies had significantly higher QOL scores (Glasgow Benefit Inventory (GBI) 39.6) compared to patients in Group 2 studies (GBI 24.9) (p < 0.001).

CONCLUSION: Adult patients undergoing tonsillectomy because of RT reported improved QOL 6-84 months after surgery. The benefit of tonsillectomy was higher among patients in studies with a higher minimum number of tonsillitis episodes compared to those included in studies with less strict criteria. Whether the improved QOL outweigh the morbidity associated with surgery in both guideline groups remains unclear.

PMID:35044507 | DOI:10.1007/s00405-022-07260-7

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Τρίτη 18 Ιανουαρίου 2022

Transient Receptor Potential Vanilloid 3 Expression Is Increased In Non‐Lesional Skin Of Atopic Dermatitis Patients

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Abstract

TRPV3 (transient receptor potential vanilloid 3) is a pro-inflammatory ion channel mostly expressed by keratinocytes of the human skin. Previous studies have shown that the expression of TRPV3 is markedly upregulated in the lesional epidermis of atopic dermatitis (AD) patients suggesting a potential pathogenetic role of the ion channel in the disease. In the current study, we aimed at defining the molecular and functional expression of TRPV3 in non-lesional skin of AD patients as previous studies implicated that healthy-appearing skin in AD are markedly distinct from normal skin with respect to terminal differentiation and certain immune function abnormalities. By using multiple, complementary immunolabeling and RT-qPCR technologies on full-thickness and epidermal shave biopsy samples from AD patients (lesional, non-lesional) and healthy volunteers, we provide the first evidence that the expression of TRPV3 is markedly upregulated in non-lesional human AD epidermis, similar to les ional AD samples. Of further importance, by using the patch-clamp method on cultured healthy and non-lesional AD keratinocytes, we also show that this upregulation is functional as determined by the significantly augmented TRPV3-specific ion current (induced by agonists) on cultured non-lesional AD keratinocytes when compared to healthy ones.

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AT-rich interactive domain 1A (ARID1A) cannot be considered a morphological marker for prostate cancer progression: A pilot study

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Via histochem

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Acta Histochem. 2022 Jan 14;124(2):151847. doi: 10.1016/j.acthis.2022.151847. Online ahead of print.

ABSTRACT

Prostate cancer (PCa) is one of the most common cancers worldwide but it presents many subtypes and patient heterogeneity. It is necessary to discriminate localised not aggressive PCa and metastatic cancer in order to better define the personalised treatment. The identification of an appropriate biomarker to combine with Gleason grading system, that is one of the mos t important prognostic factors in prostate cancer outcome, remains a major clinical issue. We have tested AT-rich interactive domain 1A (ARID1A) in prostate tissue is order to verify its possible role as morphological marker for prostate cancer progression. ARID1A is a tumour suppressor protein playing a pivotal role in chromatin remodelling during transcriptional regulation. It was decreased in many cancers correlating with tumour aggressiveness. Our data shown that ARID1A had a nuclear staining and that it is significantly decreased in prostate cancers suggesting that it can be involved in this neoplasm but it is not able to discriminate prostate cancer progression.

PMID:35038591 | DOI:10.1016/j.acthis.2022.151847

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Effects of Carbonation on Swallowing: Systematic Review and Meta‐Analysis

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Objectives

The effectiveness of the use of carbonation in preventing penetration/aspiration or enhancing swallowing function in adults remains unclear. This systematic review aimed to evaluate the effectiveness of carbonation on improving swallowing function in adult subjects.

Methods

Literature published before March 2021 was inspected using MEDLINE, CINAHL, Web of Science Core Collection, The Cochrane Library, Cochrane Central Register of Controlled Trials, and Ichushi-web databases. We searched for intervention studies or randomized control trials considering the effects of carbonated liquids on swallowing function. The risk of bias was assessed using the Cochrane tool for assessing the risk of bias for randomized controlled trials and the Risk of Bias Assessment Tool for Nonrandomized Studies.

Results

The systematic review identified 19 studies with a total of 586 participants. The effects of carbonation on swallowing function are diverse. Overall, most studies showed that carbonation promotes swallowing function compared to other liquids. Five studies were included in the quantitative synthesis. Meta-analysis showed that carbonated liquids prevent aspiration (risk difference [RD] −0.27%, 95% confidence interval [CI] −0.44 to −0.10; I 2 = 0%; number needed to treat 3.8, 95% CI 2.2 to 15.0; moderate quality of evidence) when compared to noncarbonated thin liquids. Carbonated liquids also increased the duration of swallowing apnea than did noncarbonated liquids (standardized mean difference 0.25 (mean difference 0.36 seconds), 95% CI 0.03 to 0.47; I 2 = 0%; low quality of evidence).

Conclusions

Carbonation had favorable effects on swallowing function. Further in-depth studies are needed to clarify the benefits of carbonation.

Level of Evidence

NA Laryngoscope, 2022

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Laryngectomy-free survival after salvage partial laryngectomy: a systematic review and meta-analysis

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Eur Arch Otorhinolaryngol. 2022 Jan 17. doi: 10.1007/s00405-022-07257-2. Online ahead of print.

ABSTRACT

PURPOSE: Radiotherapy (RT) is widely used for early glottic cancer. Patients failing this treatment are referred to surgical management of their disease. Salvage partial laryngectomy (SPL) has the advantage of preserving laryngeal function with total laryngectomy (TL) remaining as a last resort. The purpose of this study was to determine the efficacy of SPL in preventing total laryngectomy, following failed RT, for early glottic cancer.

METHODS: A meta-analysis of all published English literature was performed. All publications that included patients undergoing SPL were reviewed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) reporting guidelines. The search strategy identified 154 relevant articles. A total of 15 retrospective studies that included 323 suitable patients were subseq uently analyzed in this meta-analysis. The main outcome measure was the rate of laryngectomy-free survival (LFS) following SPL. The indications for salvage TL (i.e., disease recurrence and poorly functional larynxes) as well as subgroup analyses for open and trans-oral SPLs were also calculated.

RESULTS: The overall rate of LFS following SPL was 81.2% (fixed effects model range: 75.7-86.8%). Salvage TL following SPL were performed in 96.8% due to disease recurrence and in 3.2% to poorly functional larynxes. A subgroup analysis showed a 90.4% LFS after open SPL and 78.6% following trans-oral SPL.

CONCLUSION: A high rate of successful salvage partial laryngectomies, regardless of surgical technique, is to be anticipated in well-selected patients after RT failure.

PMID:35039895 | DOI:10.1007/s00405-022-07257-2

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How Often Does Retrieval of a Clipped Lymph Node Change Adjuvant Therapy Recommendations? A Prospective, Consecutive, Patient Cohort Study

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Ann Surg Oncol. 2022 Jan 18. doi: 10.1245/s10434-022-11324-7. Online ahead of print.

ABSTRACT

BACKGROUND: Prior studies examining sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) for cN1 patients have demonstrated that 20% of biopsied, clipped lymph nodes (cLNs) are nonsentinel lymph nodes (non-SLNs). Our goal was to determine how often the cLN was a non-SLN among both cN0 and cN1 patients and how often cLN pathology impacted management.

METHODS: Overall , 238 patients treated with NAC and surgery January 2019 to June 2020 were prospectively examined. Patients underwent routine axillary ultrasound, biopsy of suspicious nodes, and clip placement. Radioactive iodine-125 seed localization of the cLN was performed in cN1 patients only. Isolated tumor cells (ITCs) were considered node positive (ypN+) for both cN0 and cN1 cohorts. Chart review was performed to determine if cLNs were non-SLN and their ypN status.

RESULTS: Of 118 cN0 patients, 115 of 118 (97%) underwent successful SLNB, 33 of whom had a cLN present; 21 of 33 (64%) cLNs were non-SLNs. Overall, 9 of 118 (8%) were ypN+; no cLN was ypN+ without additional +SLNs. Of 120 cN1 patients, 104 of 120 (87%) converted to cN0, 98 of 104 (94%) of which had attempted SLNB, and 95 of 98 (97%) successfully mapped. The cLN was a non-SLN in 18 of 95 (19%). Overall, 58 of 104 (56%) cN1 patients were ypN+. One patient had a positive cLN in the absence of +SLNs. This patient underwent axill ary lymph node dissection (ALND); adjuvant treatment recommendations were unchanged.

CONCLUSIONS: The cLN was a non-SLN in 19% of cN1 patients. cLN pathology did not impact adjuvant therapy recommendations, calling into question the utility of routinely clipping biopsied lymph nodes.

PMID:35041097 | DOI:10.1245/s10434-022-11324-7

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Occult lymph node metastasis in the contralateral neck of oropharyngeal squamous cell carcinoma: a meta-analysis and literature review

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Eur Arch Otorhinolaryngol. 2022 Jan 18. doi: 10.1007/s00405-021-07230-5. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to determine whether contralateral cervical lymph node dissection is needed in patients with oropharyngeal squamous cell carcinoma (OPSCC) with contralateral cervical cN0.

METHODS: We searched the PubMed, Web of Science, Embase, Chinese Biomedical Literature Database (CBM) and Cochrane Library databases up to August 14, 2021 for studies examining the contralateral neck occult metastasis rate of patients with ipsilateral clinical neck-negative (cN0) OPSCC and the contralateral neck occult metastasis rate of patients with ipsilateral clinical neck-positive (cN1, cN2a, cN2b) OPSCC. This rate is used to determine whether patients with contralateral cN0 OPSCC need contralateral cervical lymph node dissection.

RESULTS: A total of 14 articles, including 532 cases, were included in the anal ysis. When studying the rate of ipsilateral cervical occult metastasis in patients with ipsilateral cN0, 163 cases were included in 11 studies. The results showed that the rate of contralateral cervical occult lymph node metastasis in patients with ipsilateral cN0 was 0.6816% (95% CI 0.0000-4.4880 (P = 0.3005)). In the study of ipsilateral cN+ (cN1, cN2a, cN2b), a total of 369 cases of 10 articles were included in the analysis. The results showed that the rate of contralateral cervical occult lymph node metastasis in patients with ipsilateral cN+ was 11.4920% [95% CI 7.8944-15.5223 (P = 0.0000)].

CONCLUSION: For cancer treatment, the ultimate goal is to achieve the best control of cancer and the lowest complications. It seems unnecessary to intervene in the contralateral neck of patients with OPSCC with ipsilateral cN0. For OPSCC with ipsilateral cN+ , this index is a factor that cannot be ignored when making clinical decisions.

PMID:35041065 | DOI:10.1007/s00405-021-07230-5

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Surgical Management of Low-/Intermediate-Risk Node Negative Thyroid Cancer: A Single-Institution Study Using Propensity Matching Analysis to Compare Thyroid Lobectomy and Total Thyroidectomy

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Thyroid, Volume 32, Issue 1, Page 28-36, January 2022.
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Δευτέρα 17 Ιανουαρίου 2022

Prosthetic voice rehabilitation after laryngoesophagectomy: surgical and functional outcomes

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Eur Arch Otorhinolaryngol. 2022 Jan 16. doi: 10.1007/s00405-022-07251-8. Online ahead of print.

ABSTRACT

PURPOSE: Quality of Life (QoL) after extensive head and neck resections is of paramount importance, especially after pharyngolaryngectomy or pharyngolaryngoesophagectomy where complex digestive tract reconstruction is required (with gastric pull-up or colon transposition). Tracheodigestive puncture (TDP) is the only vocal restoration option in this group of patients. The aim of this study is to evaluate postoperative complications, vocal outcomes, voice-related and swallowing-related QoL after secondary TDP in this cohort of patients.

METHODS: A retrospective study was conducted in the tertiary referral center of Verona Hospital between June 2014 and June 2020. Patient demographics, clinical and surgical data were assessed. Speech objective and subjective evaluation was performed. QoL was assessed with Voice Handicap Index-10 (VHI-10) and M.D. Anderson Dysphagia Inventory (MDADI) questionnaires.

RESULTS: Seven patients met the inclusion criteria, but two had died before questionnaires were administered. No intraoperative complications were noted after TDP surgery. There were delayed complications in four cases (57.1%) and all were treated with restoration. Intelligible voice was restored in all patients. Maximum phonation time and maximal voice intensity recorded were 5.42 ± 3.27 s and 65.20 ± 5.45 dB, respectively. Acceptable average VHI-10 and MDADI scores were obtained in all patients.

CONCLUSIONS: Secondary TDP performed after gastric pull-up or colon transposition reconstructions are feasible and effective procedures. An intelligible voice was restored in all patients, with satisfactory patient-perceived voice-related and dysphagia-related quality-of-life outcomes.

PMID:35034188 | DOI:10.1007/s00405-022-07251-8

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