Low-Risk Papillary Thyroid Cancer: Treatment De-Escalation and Cost Implications

xlomafota13 shared this article with you from Inoreader Low-Risk Papillary Thyroid Cancer: Treatment De-Escalation and Cost Implications Via radioactive iodine J Surg Res. 2022 Mar 17;275:273-280. doi: 10.1016/j.jss.2022.01.019. Online ahead of print. ABSTRACT INTRODUCTION: The American Thyroid Association (ATA) updated consensus guidelines in 2015 for radioactive iodine (RAI) and resection for low-risk papillary thyroid cancer. The objective of this study was to describe the evolution of institutional practice patterns and estimate the cost implications of these trends. MATERIALS AND METHODS: Patients with cT1-T2N0 papillary thyroi d cancer were identified via an institutional tumor registry. Incidences of total thyroidectomy or RAI were tracked longitudinally using cumulative sum. Real-world costs for RAI and each surgical encounter were adjusted for inflation and standardized to national average costs from National Inpatient Sample cost data. RESULTS: Sixty-one patients met inclusion criteria between 2007 and 2018. Among these, 28 patients underwent total thyroidectomies and received RAI treatments based on criteria pre-dating the 2015 ATA guidelines. Cumulative sum revealed significant decreases in the rate of total thyroidectomy following May 2015 (15.8% versus 59.5%, P = 0.002) and RAI following March 2013 (3.0% versus 32.1%, P = 0.002). There were no locoregional recurrences in either period. The average cost savings attributable to these institutional practice changes was $1580 per patient. CONCLUSIONS: De-escalation in surgical and RAI utilization for low-risk papillary thyroid cancer accor ding to 2015 ATA guidelines is associated with a substantial decrease in real-world costs. PMID:35306263 | DOI:10.1016/j.jss.2022.01.019 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A simple, reliable and accurate approach for assessing [131I]-capsule activity leading to significant reduction of radiation exposure of medical staff during radioiodine therapy

xlomafota13 shared this article with you from Inoreader A simple, reliable and accurate approach for assessing [<sup>131</sup>I]-capsule activity leading to significant reduction of radiation exposure of medical staff during radioiodine therapy Via radioactive iodine Phys Med. 2022 Mar 17;96:157-165. doi: 10.1016/j.ejmp.2022.03.009. Online ahead of print. ABSTRACT PURPOSE: According to German law, the [131I]-capsule activity has to be checked in the context of radioiodine therapy (RIT) immediately before application. The measurement leads to significant radiation exposure of the medical personnel, especially of their hands. We aimed to establish a method for estimating [131I]-capsule activity by measuring the dose rate (DR ) at contact of the delivered lead closed container carrying the [131I]-capsules and to evaluate radiation exposure in comparison to conventional [131I]-capsule measurement using a dose calibrator. METHODS: DR on the surface of the closed lead container was measured at two locations and correlated linearly with the [131I]-capsule activity measured in a dose calibrator to create calibrating curves. The hand and whole body (effective) doses were determined with official dose meters during validation of our method in clinical practice. RESULTS: The determination coefficients (R2) of linear calibration curves were greater than 0.9974. The total relative uncertainty for estimating [131I]-capsule activity with our method was <±7.5% which is lower than the uncertainty of the nominal activity and quite close to the threshold limit for the maximum allowed uncertainty of ± 5% for measuring activity in radioactive drugs. T he reduction of the hand dose caused by our method was 97% compared with the conventional measurements of the [131I]-capsules in a dose calibrator. CONCLUSION: Measuring DR on the surface of the closed lead containers enables the [131I]-capsules activity to be estimated simply, reliably and with sufficient accuracy leading to significant reduction of the radiation exposure for the medical staff. PMID:35306454 | DOI:10.1016/j.ejmp.2022.03.009 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Ophthalmic features and management of 86 patients with cryptophthalmos-A refined classification to assist in surgical planning

xlomafota13 shared this article with you from Inoreader Ophthalmic features and management of 86 patients with cryptophthalmos-A refined classification to assist in surgical planning Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2022 Feb 26:S1748-6815(22)00078-X. doi: 10.1016/j.bjps.2022.02.007. Online ahead of print. ABSTRACT BACKGROUND/AIMS: This study aimed to describe a cohort of patients with cryptophthalmos (CO), characterize associated oculofacial abnormalities, and expand the classification to summarize surgical strategies for managing CO. METHODS: A retrospective, interventional case series was conducted on 86 patients (124 eyes) with CO. The study proposed further classifying complete and incomplete CO into cyst, microphthalmia, anophthalmia, and normal eyeball based on globe structures and then modifying surgery accordingly. The demography, ophthalmic features, systemic anomalies, operation methods, and treatment outcomes were reviewed. RESULTS: CO was complete in seven eyes (5.6%) and incomplete in eight eyes (6.5%). A total of 109 eyes (87.9%) of abortive CO were encountered. Among 15 eyes (13 patients) o f complete and incomplete types, 9 (60.0%) eyeballs were identified as cysts, 3 (20.0%) as microphthalmia, 1 (6.7%) as anophthalmia, and 2 (13.3%) as normal eyeballs. Cyst reduction was performed in eight eyes and one patient underwent enucleation with hydroxyapatite implantation. The socket was fit with an ocular prosthesis or a conformer after fornix and eyelid reconstruction. Microphthalmia was enucleated, and hydroxyapatites were implanted; patients were fit with ocular prosthesis or conformer after fornix and eyelid reconstruction. A complete CO with normal eyeball was reported with the eyesight of hand movement after ocular surface reconstruction. The upper eyelid contour and adequate fornix were maintained after coloboma repair and fornix reconstruction in all patients with abortive CO. CONCLUSION: This study demonstrates the clinical manifestations of different types of CO and expands the manifestation spectrum, proposing a refined classification of CO and modifying su rgical strategies accordingly. PMID:35305918 | DOI:10.1016/j.bjps.2022.02.007 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The effects of Cricothyroid Visor Maneuver (CVM) therapy on the voice characteristics of patients with muscular tension dysphonia: A Case Series Study

xlomafota13 shared this article with you from Inoreader The effects of Cricothyroid Visor Maneuver (CVM) therapy on the voice characteristics of patients with muscular tension dysphonia: A Case Series Study Via Voice Publication date: Available online 20 March 2022 Source: Journal of Voice Author(s): Shahouzaie Nasrin, Dehqan Ali, Jamali Jamshid, Ghaemi Hamed, Rasoulian Bashir, Ghaemi Hamide View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Feasibility of Mobile and Sensor Technology for Remote Monitoring in Cancer Care and Prevention

xlomafota13 shared this article with you from Inoreader Feasibility of Mobile and Sensor Technology for Remote Monitoring in Cancer Care and Prevention Via swallowing exercises AMIA Annu Symp Proc. 2022 Feb 21;2021:979-988. eCollection 2021. ABSTRACT Objectives. Remote monitoring (RM) of health-related outcomes may optimize cancer care and prevention outside of clinic settings. CYCORE is a software-based system for collection and analyses of sensor and mobile data. We evaluated CYCORE's feasibility in studies assessing: (1) physical functioning in colorectal cancer (CRC) patients; (2) swallowing exercise adherence in head and neck cancer (HNC) pati ents during radiation therapy; and (3) tobacco use in cancer survivors post-tobacco treatment (TTP). Methods. Participants completed RM: for CRC, blood pressure, activity, GPS; for HNC, video of swallowing exercises; for TTP, expired carbon monoxide. Patient-reported outcomes were assessed daily. Results. For CRC, HNC and TTP, respectively, 50, 37, and 50 participants achieved 96%, 84%, 96% completion rates. Also, 91-100% rated ease and self-efficacy as highly favorable, 72-100% gave equivalent ratings for overall satisfaction, 72-93% had low/no data privacy concerns. Conclusion. RM was highly feasible and acceptable for patients across diverse use cases. PMID:35308916 | PMC:PMC8861680 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Common exacerbation-prone phenotypes across asthma and chronic obstructive pulmonary disease (COPD)

xlomafota13 shared this article with you from Inoreader Common exacerbation-prone phenotypes across asthma and chronic obstructive pulmonary disease (COPD) Via Rhinitis by Kentaro Hyodo, Hironori Masuko, Hisayuki Oshima, Rie Shigemasa, Haruna Kitazawa, Jun Kanazawa, Hiroaki Iijima, Hiroichi Ishikawa, Takahide Kodama, Akihiro Nomura, Katsunori Kagohashi, Hiroaki Satoh, Takefumi Saito, Tohru Sakamoto, Nobuyuki Hizawa Background and objectives Chronic inflammatory airway diseases, including asthma and chronic obstructive pulmonary disease (COPD), are complex syndromes with diverse clinical symptoms due to multiple pathophysiological conditions. In this study, using common and shared risk factors for the exacerbation of asthma and COPD, we sought to clarify the exacerbation-prone phenotypes beyond disease labels, and to specifically investigate the role of the IL4RA gene polymorphism, which is related to type 2 inflammation, in these exacerbation-prone phenotypes. Methods The study population comprised patients with asthma (n = 117), asthma-COPD overlap (ACO; n = 37) or COPD (n = 48) and a history of exacerbation within the previous year. Cluster analyses were performed using factors associated with both asthma and COPD exacerbation. The association of the IL4RA gene polymorphism rs8832 with each exacerbation-prone phenotype was evaluated by multinomial logistic analyses usi ng non-asthma non-COPD healthy adults as controls (n = 1,529). In addition, the genetic influence of rs8832 was also examined in asthma patients with allergic rhinitis and no history of exacerbation (n = 130). Results Two-step cluster analyses identified five clusters that did not necessarily correspond to the diagnostic disease labels. Cluster 1 was characterized by high eosinophil counts, cluster 2 was characterized by smokers with impaired lung function, cluster 3 was characterized by the presence of gastroesophageal reflux, cluster 4 was characterized by non-allergic females, and cluster 5 was characterized by allergic rhinitis and elevated total immunoglobulin E levels. A significant association with rs8832 was observed for cluster 5 (odds ratio, 3.88 (1.34–11.26), p = 0.013) and also for the type 2 exacerbation-prone phenotypes (clusters 1 and 5: odds ratio, 2.73 (1.45–5.15), p = 1.9 × 10−3). Discussion Our results indicated that t he clinical heterogeneity of disease exacerbation may reflect the presence of common exacerbation-prone endotypes across asthma and COPD, and may support the use of the treatable traits approach for the prevention of exacerbations in patients with chronic inflammatory airway diseases. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Immune system response to isometric handgrip exercise and effects of duration and intensity of the exercise protocol on selected immune system parameters in prehypertensives

xlomafota13 shared this article with you from Inoreader Immune system response to isometric handgrip exercise and effects of duration and intensity of the exercise protocol on selected immune system parameters in prehypertensives Via International Journal of Physiology, Pathophysiology and Pharmacology Int J Physiol Pathophysiol Pharmacol. 2022 Feb 15;14(1):24-32. eCollection 2022. ABSTRACT BACKGROUND: Recent studies have shown that physical exercise significantly modulates immunocyte dynamics and possibly plays a significant role on immune function. This study examined the responses of some selected immune system parameters to isometric handgrip exercise and identified possible effects of intensity and duration of the exercise protocols. METHODS: One hundred and ninety-two (N=192) sedentary pre-hypertensive subjects, aged between 30-50 years were recruited into the study. They were randomly distributed into three groups of 64 subjects each. A detailed explanation and a demonstration of the exercise protocol were given to the subjects and they were asked to report at the Exercise Physiology unit of the Physiotherapy department, Federal Medical Centre, Asaba, Delta State at 4.00 pm daily for the exercise practice. The training s ession for each day took place between the hours of 4.00 pm and 8.00 pm daily (FMC/ASB/A81.VOL.XII/101). The subjects performed a 24 consecutive day's isometric handgrip exercise at 30% Maximum Voluntary Contraction (MVC). At the end of the 24 days, group one (GP1) discontinued with the exercise protocol, while group two (GP2) and group three (GP3) continued with the exercise protocol for another 24 consecutive days nevertheless GP3 performed at an increased intensity of 50% MVC. The clinical trial was registered with Nigeria Clinical Trial Registry, Federal Ministry of Health, Abuja Nigeriawith Trial No: 1216582 (https://www.nctr.nhrec.net/viewTrials.php?TID=1216582). RESULTS: At the end of the study, the result shows thatthe number of CD4 cells and CD4/CD8 ratio significantly (P<0.05) increased while the CD8 cell decreased in GP2 and GP3. It was further shown that increase in duration produced a more significant change compared to an increase in intensity of the isometric effort. CONCLUSION: The study established that isometric handgrip exercise alters the circulating levels of the immune system parameters which could have positive beneficial effects on the prehypertensive individuals as the number of CD4 cells and CD4/CD8 ratio increased especially when practiced over a longer duration. PMID:35310864 | PMC:PMC8918609 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Laboratory and imaging findings of necrotizing otitis externa are associated with pathogen type and disease outcome: A retrospective analysis

xlomafota13 shared this article with you from Inoreader Laboratory and imaging findings of necrotizing otitis externa are associated with pathogen type and disease outcome: A retrospective analysis Via ear nose throat Ear Nose Throat J. 2022 Mar 19:1455613221080973. doi: 10.1177/01455613221080973. Online ahead of print. ABSTRACT OBJECTIVE: To examine associations of laboratory and imaging data with diagnostic parameters of necrotizing otitis externa (NOE) and its severity, and to compare between bacterial and fungal infections. METHODS: Records of patients diagnosed with NOE during 2010-2018 at the Department of Otolaryngology, Head and Neck Surgery were reviewed retrospectively for demographics; disease characteristics; and laboratory, scintigraphy, and imaging results. RESULTS: Of 48 patients with NOE, the mean age is 73±11.6 years; 32 (67%) were males; 83% had diabetes mellitus. Common pathogens were pseudomonas (49%) and fungi (33%). Sensitivities of the technetium-scan (SPECT ratio ≥1.5), temporal bone computed tomography (CT), and gallium-scan (SPECT ratio ≥1.3) were: 78.7%, 48.8%, and 31.4%, respectively. Gallium-scan results correlated positively with CT bone involvement (p=0.002) and hospital length of stay (p=0.0014). C-reactive protein (CRP) level correlated with hospital length of stay (p=0.028) and positive technetium-scan results (p=0.012). Fungal infection had a higher technetium SPECT ratio (2.16 vs. 1.77, p=0.04), gallium SPECT ratio (1.4 vs. 1.2, p=0.02), longer duration of systemic treatment (87.4 vs. 37.9 days, p=0.014), and longer hospital length of stay (31.6 vs. 15.2 days, p=0.004) compared to non-fungal infection. Eight (17%) patients had responded poorly to treatment. Fungal pathogens, facial nerve paresis, extra-auricular, and bilateral disease were more prevalent among the non-responders. CONCLUSION: The technetium scan has higher sensitivity than temporal bone CT for diagnosing NOE. The gallium scan and CRP correlated well with hospital length of stay. A high rate of fungal infection was found, with significantly higher technetium and gallium SPECT ratios and worse outcome compared to bacterial infection. Fungal NOE remains therapeutically challenging. PMID:35311376 | DOI:10.1177/01455613221080973 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Endoscopic surgery for intraconal orbital tumors

xlomafota13 shared this article with you from Inoreader Endoscopic surgery for intraconal orbital tumors Via hno HNO. 2022 Mar 17. doi: 10.1007/s00106-022-01156-y. Online ahead of print. ABSTRACT Traditionally, external craniofacial approaches have been used for orbital tumor resection. Over the last 30 years, endoscopic sinonasal and skull base techniques have become widely used throughout the world. These experiences paved the way for the extension of transnasal endoscopic techniques to the intraconal orbit. Transnasal endoscopic intraconal surgery has several advantages regarding mo rbidity and outcome as compared with purely external approaches. However, the anatomical knowledge and experience of the surgeon is crucial for the success of the surgery. Endoscopic approaches for intraconal tumor removal are feasible for medial and inferior lesions as well as for lesions lateral to the optic nerve provided they remain inferior to the "plane of resectability" and no optic nerve retraction is required. As intraorbital tumors are rare, new international staging systems including CHEER (Cavernous Hemangioma Exclusively Endonasal Resection) and ORBIT (Orbital Resection by Intranasal Technique) help to standardize safety, efficacy, and outcome. PMID:35298667 | DOI:10.1007/s00106-022-01156-y View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evaluation of thermal plasma process for treatment disposal of solid radioactive waste

xlomafota13 shared this article with you from Inoreader Evaluation of thermal plasma process for treatment disposal of solid radioactive waste Via radioactive iodine J Environ Manage. 2022 Mar 14;311:114895. doi: 10.1016/j.jenvman.2022.114895. Online ahead of print. ABSTRACT The management of radioactive waste is a worldwide activity based on the guidelines of the International Atomic Energy Agency (IAEA), and all stages of management require scientifically proven methods for possible deployment. The management of radioactive waste is a huge challenge due to the high risk in the collection, gathering, transport, handling, and storage. In this s tudy, a thermal plasma treatment process was evaluated for its efficiency to process solid radioactive waste. Experiments were carried out with the application of stable isotopes of Lead, Iodine, Cobalt, and Cesium. After the thermal plasma treatments, the slag and the residual gas were analyzed to verify the influence of process time and discharge power on the efficiency of the process. The treatment for 25 min and 10 kW was sufficient to reduce the mass by 50% of the slag. When the applied power was increased to 15 kW, an expressive reduction in the treatment time (10 min) was able to promote the same mass reduction. The results indicated that the treatment of radioactive waste by thermal plasma is a promising method to manage and reduce the mass and volume for the final disposal. PMID:35299134 | DOI:10.1016/j.jenvman.2022.114895 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Readmission Rates Following Major Head and Neck Surgery With Concurrent Tracheostomy

xlomafota13 shared this article with you from Inoreader Readmission Rates Following Major Head and Neck Surgery With Concurrent Tracheostomy Via otol rhinol Ann Otol Rhinol Laryngol. 2022 Mar 18:34894221083778. doi: 10.1177/00034894221083778. Online ahead of print. ABSTRACT OBJECTIVES: To determine the influence of major head and neck procedures on readmission and complication rates following tracheostomy. METHODS: A retrospective cohort study using the 2005 to 2017 National Surgical Quality Improvement Program (NSQIP) database. Current Procedural Terminology codes were used to identify tracheostomy patients and to define the underlying head and neck procedure. Patients under the age of 18 and with unknown pre-operative variables were excluded. Univariate and multivariable analyses were performed. RESULTS: A total of 3240 tracheostomy patients undergoing major head and neck surgery were identified in NSQIP. The 30-day mortality rate was 104 (3.2%) and 258 (9.0%) patients were readmitted. 637 (19.7%) patients had an unplanned return to the operating room. There were 1606 (49.6%) non-tracheostomy specific complications, which included 850 (26.2%) medical and 1142 (35.2%) surgical complications. On multivariable analysis, we found that the underlying procedures did not impact the risk of readmission (P > .05 for all). The underlying procedure was also not associated with unplanned return to the operating room except for thyroidectomies, which had a lower risk than free tissue graft reconstruction (OR = 0.53 (95%CI 0.31, 0.88), P = .018). CONCLUSION: While almost 1 in every 2 patients had a complication following major head and neck surgery that included creation of a tracheostomy, the rate of readmission is comparatively low and is not associated with the underlying procedure. These findings should reassure head and neck surgeons that properly managed tracheostomies do not constitute a disproportionate risk of readmission. PMID:35301871 | DOI:10.1177/00034894221083778 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.