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Κυριακή 12 Φεβρουαρίου 2023

Roid Rage: Historical Perspective on the Emergence of Oral Steroids as a Treatment of Idiopathic Sudden Sensorineural Hearing Loss

AlexandrosSfakianakis shared this article with you from Inoreader
imageObjectives To review the historical circumstances that led to the emergence of corticosteroid therapy for idiopathic sudden sensorineural hearing loss (ISSNHL) and to discuss how this history has influenced current perspectives on the condition. Methods PubMed and Google scholar were used to identify articles of ISSNHL and oral corticoid steroid use. Historical articles accessed through our institutional medical library were also reviewed. Results The use oral corticosteroids as a treatment for ISSNHL was seemingly influenced by three key historical circumstances that, together, provided the substrate for the treatment's use in ISSNHL. First, ISSNHL was a frustrating condition with uncertainty regarding its etiology and few reliable treatment options. Second, the discovery of corticosteroids was awarded the Nobel Prize in 1950, which led to widespread application of this therapy. Third historical circumstance was the evolution and emergence of more rigorous methodological study designs in clinical research. In 1980, these events culminated in a double-blind study evaluating the effectiveness of oral steroids for treatment of ISSNHL. Interestingly, this study is often misrepresented as a randomized controlled trial, which ultimately contributed to adoption of a new standard for treatment in ISSNHL. Research subsequent to these historical events has challenged the notion of corticosteroids as a gold standard but has not altere d the historically established paradigm of corticosteroid treatment. Conclusions The use of steroids as a treatment for ISSNHL evolved from our specialty's need to address a complex condition, a novel therapeutic discovery, and a landmark study that met emerging methodological standards. Despite these strong historical foundations, ISSNHL remains a condition with an unknown etiology and the therapeutic value of corticosteroids remains unpredictable despite their gold standard label.
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Recurrent Benign Paroxysmal Positional Vertigo in DFNB16 Patients with Biallelic STRC Gene Deletions

AlexandrosSfakianakis shared this article with you from Inoreader
imageObjective Deletions of STRC gene (DFNB16) account for 12% of isolated congenital mild to moderate hearing loss (HL). In mice, the stereocilin protein, encoded by STRC, is present in the vestibular kinocilium embedded in the otoconial membrane of the utricular macula. Despite this, effects on vestibular function have not been widely investigated. The aim of this study was to investigate the prevalence of benign paroxysmal positional vertigo (BPPV) in a cohort of DFNB16 patients. Study Design Observational descriptive epidemiological study. Setting Single-center study, in a tertiary referral center. Patients Older than 5 years, with a genetic diagnosis of HL related to biallelic STRC gene deletions, diagnosed between 2015 and 2021 Intervention Patients or their parents were interviewed to determine whether they had experienced vertigo or episodes of BPPV. Main Outcome Measure Criteria were at least five acute episodes of rotatory vertigo, each lasting less than 1 minute, episodes triggered by changes in specific head position, and an absence of neurological symptoms. Results Sixty-four patients having mild (33%) to moderate (66%) HL were included. Median age was 15 years (range, 6–48 yr). Prevalence of BPPV was 39% (25 of 64). Median age of first onset was 13 years (range, 3–18 yr). Conclusions This study showed recurrent BPPV and early age of onset in patients with biallelic STRC gene deletions. BPPV may be associated with the HL phenotype in patients with STRC gene deletions. It is important to inform patients and families of this potential risk such that appropriate management can be proposed.
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Impedance Change as an Indicator of Cochlear Implant Failure

AlexandrosSfakianakis shared this article with you from Inoreader
imageObjective In February 2020, Advanced Bionics initiated a field action notice to remove the MS Ultra (V1) implant from circulation. In this study, we quantify a single site's incidence with device failure and examine the relationship between impedance change and declining speech perception. Study Design Retrospective/cohort study. Setting Tertiary healthcare center. Patients Forty-nine adult patients (52 devices) were implanted between October 2017 and December 2019, with the following exclusion criteria: 15%. Device failures were confirmed through analyses completed by the manufacturer. Results To date, 21% (11/52) of devices have met all three criteria for a confirmed failure with an average decline in speech perception of 27.7 ± 22%. The average length of time for detection of device failure was 21.9 ± 5 months postimplantation. An additional 7 devices (13%) are currently being monitored for failure but have not yet met full criteria. There was no predictive relationship between degree of impedance change and speech perception scores. Electrodes along the entire array (channels 1–16) can be affected. Conclusions Impedance values can be used as a reliable indicator of device malfunction, thus facilitating patient counseling and early intervention. No correlation was identified between impedance changes and speech perception scores.
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Growth Rates of Pulmonary Carcinoid Tumors and Hamartomas

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imageBackground Pulmonary nodule growth is often measured by volume doubling time (VDT), which may guide management. Most malignant nodules have a VDT of 20 to 400 days, with longer VDTs typically observed in indolent nodules. We assessed the utility of VDT in differentiating pulmonary carcinoids and hamartomas. Methods A review was performed from January 2012 to October 2021 to identify patients with pathologic diagnoses and at least 2 chest computed tomography scans obtained 6 or more months apart. Visualization software was used to segment nodules and calculate diameter and volume. Volume doubling time was calculated for scans with 1-mm slices. For the remainder, estimated nodule volume doubling time (eVDT) was calculated using nodule diameter. Volume doubling times/eVDTs were placed into growth categories: less than 400 days; 400–600 days; and more than 600 days. Results Sixty nodules were identified, 35 carcinoids and 25 hamartomas. Carcinoids were larger than hamartomas (median diameter, 13.5 vs 11.5 mm; P = 0.05). For carcinoid tumors, median VDT (n = 15) was 1485 days, and median eVDT (n = 32) was 1309 days; for hamartomas, median VDT (n = 8) was 2040 days and median eVDT (n = 25) was 2253 days. Carcinoid tumor eVDT was significantly shorter than hamartomas (P = 0.03). By growth category, 1 of 25 hamartomas and 5 of 35 carcinoids had eVDT less than 400 days and 24 of 25 hamartomas and 27 of 35 carcinoids had eVDT more than 600 days. Of 4 carcinoid tumors with metastases, 2 had eVDT less than 400 days and 2 had eVDT more than 600 days. Conclusions Growth rate was not a reliable differentiator of pulmonary hamartomas and carcinoids. Slow growing carcinoids can metastasize. Radiologists should be cautious when discontinuing computed tomography follow-up based on growth rates alone.
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Imaging Gallbladder Lesions: What Can Positron Emission Tomography/Computed Tomography Add to the Conventional Imaging Approach?

AlexandrosSfakianakis shared this article with you from Inoreader
imageObjective Incidental gallbladder lesions are common in imaging studies, although it is not always easy to discriminate benign lesions from gallbladder cancer with conventional imaging procedures. The present study aims to assess the capacity of positron emission tomography/computed tomography (PET/CT) with 2-[18F]FDG to distinguish between benign and malignant pathology of the gallbladder, compared with conventional imaging techniques (contrast-enhanced CT or magnetic resonance imaging). Methods Positron emission tomography/CT and conventional imaging studies of 53 patients with gallbladder lesions were evaluated and visually classified as benign, malignant, or inconclusive. Agreement between PET/CT and conventional imaging was determined, and imaging findings were correlated with histology or follow-up. Positron emission tomography/CT images were also analyzed semiquantitatively (SUVmax and maximum tumor-to-liver ratio [TLRmax]). The presence of adenopathies and distant metastases was assessed and compared between both imaging procedures. Results According to histology or follow-up, 33 patients (62%) had a malignant process and 20 (38%) had benign lesions. Positron emission tomography/CT and conventional imaging showed a moderate agreement (κ = 0.59). Conventional imaging classified more studies as inconclusive compared with PET/CT (17.0% and 7.5%, respectively), although both procedures showed a similar accuracy. Malignant lesions had significantly higher SUVmax and, especially, TLRmax (0.89 and 2.38 [P = 0.00028] for benign and malignant lesions, respectively). Positron emission tomography/CT identified more pathologic adenopathies and distant metastases, and patients with regional or distant spread had higher SUVmax and TLRmax in the gallbladder. Conclusions Positron emission tomography/CT is accurate to distinguish between benign and malignant pathology of the gallbladder, with a similar performance to conventional imaging procedures but with less inconclusive results. Malignant lesions present higher SUVmax and TLRmax values.
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Investigation of the Value of T2 Mapping in the Prediction of Eosinophilic Chronic Rhinosinusitis With Nasal Polyps

AlexandrosSfakianakis shared this article with you from Inoreader
imageObjectives Patients with eosinophilic chronic rhinosinusitis with nasal polyps (eosCRSwNP) usually have more extensive sinus disease, severe symptoms, and poorer disease control compared with patients with non-eosCRSwNP. Separating these entities will be crucial for patient management. The purpose of this study is to investigate T1, T2, and apparent diffusion coefficient (ADC) values of the nasal polyps in patients with CRSwNP and evaluate the usefulness of these parameters for differentiating these diseases. Methods Sinonasal magnetic resonance imaging was performed in 36 patients with eosCRSwNP and 20 patients with non-eosCRSwNP (including T1 mapping, T2 mapping, and diffusion-weighted imaging) before surgery. The T1, T2, and ADC values were calculated and correlated with pathologically assessed inflammatory cells of nasal polyps. Results Significant higher T2 value, higher eosinophil count, and lower lymphocyte count of the nasal polyps were observed in eosCRSwNP than those in non-eosCRSwNP. There was no significant difference in T1 or ADC values between the 2 groups. T2 value was correlated with eosinophil count and lymphocyte count in CRSwNP. The area under the curve of T2 value for predicting eosCRSwNP was 0.78 with 89.9% sensitivity and 60.0% specificity. Conclusion T2 value is a promising imaging biomarker for predicting eosCRSwNP. It can help to distinguish eosCRSwNP from non-eosCRSwNP.
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Automated detection of glottic laryngeal carcinoma in laryngoscopic images from a multicentre database using a convolutional neural network

AlexandrosSfakianakis shared this article with you from Inoreader

Abstract

Objective

Little is known about the efficacy of using artificial intelligence (AI) to identify laryngeal carcinoma from images of vocal lesions taken in different hospitals with multiple laryngoscope systems. This multicentre study aimed to establish an AI system and provide a reliable auxiliary tool to screen for laryngeal carcinoma.

Study design

Multicentre case–control study.

Setting

Six tertiary care centres.

Participants

Laryngoscopy images were collected from 2179 patients with vocal fold lesions.

Outcome measures

An automatic detection system of laryngeal carcinoma was established and used to distinguish malignant and benign vocal lesions in 2179 laryngoscopy images acquired from 6 hospitals with 5 types of laryngoscopy systems. Pathological examination was the gold standard for identifying malignant and benign vocal lesions.

Results

Out of 89 cases in the malignant group, the classifier was able to correctly identify laryngeal carcinoma in 66 patients (74.16%, sensitivity). Out of 640 cases in the benign group, the classifier was able to accurately assess the laryngeal lesion in 503 cases (78.59%, specificity). Furthermore, the region-based convolutional neural network (R-CNN) classifier achieved an overall accuracy of 78.05%, with a 95.63% negative predictive value and a 32.51% positive predictive value for the testing data set.

Conclusion

This automatic diagnostic system has the potential to assist clinical laryngeal carcinoma diagnosis which may improve and standardise the diagnostic capacity of laryngologists using different laryngoscopes.
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The role of interleukin 36γ in the epithelial–mesenchymal transition process of chronic rhinosinusitis: A pilot study

AlexandrosSfakianakis shared this article with you from Inoreader

Abstract

Purpose

Epithelial–mesenchymal transition (EMT) is an important characteristic in the remodelling of chronic rhinosinusitis with nasal polyps (CRSwNP). IL-36γ and fibroblast activation protein (FAP) may exacerbate remodelling in CRS. Here, we aimed to determine whether IL-36γ and FAP expression are associated with EMT and may be a predictor for CRSwNP prognosis.

Methods

Fifty-two non-Eos CRSwNP patients and 12 control patients were obtained and were followed up for more than 1 year after surgery. IL-36γ, FAP and EMT markers expression were evaluated by real-time polymerase chain reaction and western blot. Masson trichrome staining was adopted to assess tissue fibrotic changes. Furthermore, the soluble form of IL-36γ and FAP in nasal secretions was detected by ELISA.

Results

While basal expression of E-cadherin decreased, the expression of IL-36γ, vimentin and FAP increased in nasal polyps. In well-prognosis patients, the expression of IL-36γ, vimentin and FAP were significantly decreased than in poor-prognosis patients, while the protein expression of E-cadherin was increased. The protein expression of IL-36γ was notably increased in recurrent nasal polyps than in preoperation specimens. A positive relationship between IL-36γ and FAP expression, a negative relationship between IL-36γ and E-cad expression was noted. The soluble form of IL-36γ and FAP increased during the development of non-Eos CRSwNP, with the highest level in poor-prognosis patients after surgery.

Conclusion

Non-Eos CRSwNP have partially undergone EMT under baseline conditions. IL-36γ and FAP expression were related with EMT, the soluble form of IL-36γ and FAP in nasal secretions may predict the prognosis of patients.
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Efficacy of carbon dioxide laser and caustic agent cauterisation for the focal granular myringitis: A randomised trial

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Abstract

Objectives

Granular myringitis (GM) is a troublesome disease with a high incidence of recurrence and relapse. CO2 laser vaporisation and trichloroacetic acid (TAA) have been applied in treating several otological diseases, both with favourable therapeutic efficacy. However, long-term therapeutic efficacy of both CO2 laser vaporisation and TAA cauterisation against GM has not yet been evaluated. We aimed to investigate the therapeutic potential of CO2 laser vaporisation and TAA cauterisation in GM management.

Study Design

Prospective and randomised study.

Participants

A total of 88 GM patients who failed therapy with boric acid, alcohol and glycerin ear drop otic solution between July 2009 and January 2018 were included. Participants were randomly assigned to receive CO2 laser vaporisation (n = 39) or TAA cauterisation (n = 49).

Main Outcome Measures

Main outcomes were treatment success, complications after 4 months of treatment, and recurrence within 4–12 months after treatment.

Results

The success rate was significantly higher in the CO2 group than in the TAA group (94.9% vs. 77.6%, p = .023). After 4 months of treatment, the GM recurrence rate was comparable between the two groups (13.5% vs. 18.4%, p = .562). The CO2 laser group had one case of perforation and one case of severe vertigo, whereas one participant in the TAA cauterisation group experienced hearing loss.

Conclusion

Both TAA cauterisation and CO2 laser vaporisation are safe and effective treatments for GM. The success rate of CO2 laser vaporisation for treating GM is higher than that of TAA cauterisation. Recurrence rates are comparable within 1 year.
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The use of epidural spinal cord stimulation in patients with chronic disorders of consciousness – neuroimaging and clinical results

AlexandrosSfakianakis shared this article with you from Inoreader

OBJECTIVE: Chronic disorders of consciousness are considered as a serious unresolved problem complicated by significant medical, social, and economic burden. Therefore, improving the conditions and facilitating the rehabilitation management of these patients is of particular interest. In recent years, interesting results of the use of spinal cord stimulation in patients with chronic disorders of consciousness appeared in the world literature, which makes the use of this technique promising in this category of patients.

PATIENTS AND METHODS: We analyzed the results of high cervical spinal cord stimulation, both, in tonic and "Burst" modes, in 21 patients with chronic disorders of consciousness and severe spasticity managed in the last two years in FRCC ICMR. In 9 of them pre- and post-stimulation fMRI before and right after the stimulation was also performed for brain functional connectivity assessment.

RESULTS: Improvement of the consciousness level was observed in 38.1% (n = 8) and a decrease in spasticity was obtained in 52.4% (n=11) of the patients. The difference in CRS-R score before and after spinal cord stimulation was statistically significant (p=0.028). The fMRI results revealed an increase in functional connectivity of the right anterior insula with several areas that are part of the Dorsal Attention, Visual and Default Mode networks after spinal cord stimulation.

CONCLUSIONS: Epidural spinal stimulation at the upper cervical spine level demonstrated its effectiveness in patients with chronic diseases of consciousness of various etiology. Evaluation of the effect of specific stimulation modes requires further controlled study in larger group of patients.

L'articolo The use of epidural spinal cord stimulation in patients with chronic disorders of consciousness – neuroimaging and clinical results sembra essere il primo su European Review.
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