36.
J Craniofac Surg. 2020 Mar 13. doi: 10.1097/SCS.0000000000006313. [Epub ahead of print]
Gelatin Sponge Induced Maxillary Sinusitis After Transsphenoidal Pituitary Surgery.
Abstract
Transsphenoidal pituitary surgery is a safe, well-established treatment method, but it is associated with several postoperative nasal complications. However, gelatin sponge induced maxillary sinusitis after transsphenoidal pituitary surgery has not been reported. In this study, we present an unusual case of gelatin sponge induced maxillary sinusitis after transsphenoidal pituitary surgery. Therefore, it should be recognized that gelatin sponge induced maxillary sinusitis may occur as a complication after transsphenoidal pituitary surgery.
37.
J Craniofac Surg. 2020 Mar 13. doi: 10.1097/SCS.0000000000006315. [Epub ahead of print]
Supraclavicular Flap Reconstruction in Head and Neck Oncologic Surgery.
Abstract
Free flaps have been considered as the gold standard for reconstruction of head and neck region after ablative oncologic surgery. However, the reconstructive surgeon's armamentarium should also involve pedicled flaps for certain situations such as patients having comorbid diseases necessiating shorter duration of surgical procedure. The supraclavicular flap is a pedicled thin fasciacutaneous flap used to reconstruct the defects in head and neck area. The flap has advantages of wide rotation of arc, easy matching with skin color of recipient area and relatively shorter flap harvesting time. Its bloods supply depends on supraclavicular artery which is a branch of transverse cervical artery. Between August 2016 and September 2019, the pedicled supraclavicular flap was used to reconstruct 17 head and neck cancers patients after ablative oncologic surgery. In 15 patients this flap was primary choice and in 2 patients it was used as a salvage reconstructive tool. Two of 17 flaps had very distal partial necrosis. There was no total loss of any flap. Flap harvesting time was always less than 1 hour. Mean duration for drainage tube removal at the donor side was 5 days. Functional outcomes were perfect. In our suggestion pedicled supraclavicular flap is a very good alternative option to free flap reconstruction especially for skin and oral cavity defects.
38.
J Craniofac Surg. 2020 Mar 13. doi: 10.1097/SCS.0000000000006292. [Epub ahead of print]
Evaluating the Effect of Infraorbital Region Taping Procedure on Patient Anxiety, Satisfaction, Edema, and Ecchymosis Level on Primary Septorhinoplasty.
Abstract
AIM:
This study aims to evaluate the effect of infraorbital region taping on patients' postoperative edema and ecchymosis, satisfaction levels, and anxiety during follow-up.
METHODS:
A total of 64 patients who underwent septorhinoplasty were included in this randomized controlled prospective study. According to the randomization list, the taping group's (TG) infraorbital region was taped with adhesive strips. Others were included in the control group and were classified as the nontaping group. Two blinded physicians evaluated the degree of edema and ecchymosis according to the photographs of patients taken on the first, second, fifth, and seventh postoperative days. Patient's appearance satisfaction was evaluated for ecchymosis levels. State anxiety inventory (STAI-S) and trait anxiety inventory (STAI-T) were used to measure preoperative and postoperative anxiety levels of patients.
RESULTS:
The degree of ecchymosis and edema were not significantly different except on the first day in the TG (P = 0.01, P = 0.01, respectively). Significant increment was found in the TG on first, second, and fifth days based on the satisfaction levels of patients for their appearance (P = 0.05, P = 0.03, P = 0.04, respectively). Preoperative STAI-S and STAI-T were similar for the groups (P = 0.78, P = 0.17, respectively). However, postoperative STAI-S of the TG were significantly lower compared with those of the nontaping group except seventh day (P < 0.05).
CONCLUSION:
Infraorbital taping did not decrease the edema and ecchymosis except on the first postoperative day. However, it had a significant ameliorating effect on patients' anxiety and satisfaction levels.
39.
Rhinology. 2020 Mar 16. doi: 10.4193/Rhin19.412. [Epub ahead of print]
Lack of impact of radiologic septal measurements upon patient symptoms and performance of septoplasty during endoscopic sinus surgery.
Abstract
BACKGROUND:
Recent literature suggests that concurrent septoplasty during endoscopic sinus surgery (ESS) improves patient outcomes, however, the underlying indications for performing concurrent septoplasty are unknown. The objective of this study was to investigate the relationship between objective radiologic measures of nasal septal deviation with preoperative patient symptomatology and measures of CRS disease severity. We also sought to understand the association of objective radiologic measurements with surgeon performance of concurrent septoplasty during ESS.
METHODOLOGY:
Seventy-four patients with CRS undergoing ESS were prospectively enrolled. Angles of septal deviation, intranasal areas and volumes were assessed on preoperative computed tomography (CT) scans and correlated with a robust battery of patient reported outcomes measures (PROMs), objective measures of CRS severity including olfaction scores, radiologic and endoscopic staging, and performance of septoplasty.
RESULTS:
Intranasal areas and volumes demonstrated only weak linear associations with patient-reported nasal congestion, however, angles of septal deviation alone did not correlate with congestion or any other PROM measure. Meanwhile, radiologic septal-related measurements did not correlate with objective measures of CRS disease severity or the performance of a concurrent septoplasty.
CONCLUSIONS:
Though prior studies demonstrate improved patient outcomes in the setting of concurrent septoplasty during ESS, this study failed to establish an association between preoperative radiologic septal-related measurements and patient symptomatology or surgeon decision to perform septoplasty. Although objective factors to identify patients most likely to benefit from concurrent septoplasty remain unidentified, the potential improvement of surgical recommendations and patient outcomes makes this an important area of continued investigation.
40.
Rhinology. 2020 Mar 16. doi: 10.4193/Rhin19.230. [Epub ahead of print]
Retronasal olfactory testing using candies sent by post and for screening purposes: a feasibility study.
Abstract
BACKGROUND:
The olfactory system is able to detect external odours through the orthonasal- and internal odours through the retronasal route. Flavour perception strongly relies on the sense of smell and this back route. In contrast to orthonasal, retronasal olfactory tests (ROT) are less frequently applied, although testing should be recommended for several reasons. The aim of the present investigation was to propose a suitable form of ROT for home-testing (and postal distribution) and evaluate a retronasal screening test.
METHODOLOGY:
Initially, 111 participants were tested using a 27-item version of the Candy Smell Test (CST). Fifty-four participants performed retesting, of which 25 subjects did so in a home-setting being supplied with professionally packed "candy-chains". Seven candies were chosen by means of hit rate differences in normosmics and severely hyposmics/anosmics. The 7-CST is designed in a non-forced-choice fashion with same seven flavours to choose from.
RESULTS:
For the 27-item CST both groups (subjects performing home-testing and those performing retesting at the clinic) showed highly significant test-rest-reliabilities. The 7-CST was capable of discriminating healthy from diseased subjects when being tested in 116 healthy subjects and 47 patients suffering from olfactory dysfunction.
CONCLUSION:
The CST is suitable for home-testing and postal distribution. The new 7-item CST can be valuable for rapidly revealing anosmics. These findings help in further standardizing ROT, may encourage rhinologists to more routinely evaluate retronasal olfactory abilities and pave the way for larger epidemiologic studies also in regard to food preferences and nutritional behaviour.
41.
Front Cell Dev Biol. 2020 Feb 27;8:93. doi: 10.3389/fcell.2020.00093. eCollection 2020.
Olfactory Sensitivity Is Related to Erectile Function in Adult Males.
Abstract
BACKGROUND:
The olfactory system influences human social behavior, in particular the selection of a spouse. However, there is currently a lack of clinical research on the relationship between the olfactory system and erectile dysfunction (ED) in adult males.
AIM:
We explored the association between olfactory sensitivity and erectile function and its possible mechanisms.
RESULTS:
A total of 574 patients, adult males aged between 19 and 42 years, diagnosed with ED in the Department of Infertility and Sexual Medicine of the Third Affiliated Hospital of Sun Yat-sen University from 2015 to 2018 were analyzed retrospectively. Among them, 115 patients (20.03%) had rhinologic diseases (RDs). In addition, in 201 adult male patients who underwent nasal surgery in the ENT department from 2012 to 2016, including 29 (14.43%) with ED, nasal congestion, nasal discharge, and hyposmia were the most common complaints based on the numerical rating scale (NRS). Furthermore, a prospective study was performed in a total of 102 sequential outpatients (male adults) with RD only (n = 46), ED only (n = 42) and both RD and ED (n = 14) in 2019, together with 40 healthy (male adults) volunteers as controls. The results showed that ED patients with RD had severe nasal discomfort and decreased erectile function (P < 0.0001). The olfactory sensitivity of patients with ED was lower than that of the controls, and patients with both ED and RD had the worst olfactory sensitivity (P < 0.0001). Spearman correlation analyses showed that sense of smell was positively correlated with the International Index of Erectile Function-5 score (R = 0.507, P ≤ 0.0001) and the Erection Hardness Scale score (R = 0.341, P < 0.0001). Logistic regression analyses showed that having an olfactory disorder (OD), RD, age, and visual analog scale (VAS, over 5) score were risk factors for ED outcome, indicating that OD patients had a 16.479-fold increased risk for an ED outcome (P < 0.05).
CONCLUSION:
A significant correlation was detected between olfactory sensitivity and erectile function in adult males. In particularly, impairment of olfactory sensitivity is more common in patients with both ED and RD than in patients suffering from a single disease.
Copyright © 2020 Deng, Feng, Zhou, Kong, Ma, Hu, Luo, Xi, Zhang and Yang.
KEYWORDS:
IIEF-5; Sniffin’ Sticks test; erectile dysfunction; olfactory sensitivity; rhinologic diseases; vomeronasal organ
42.
Gland Surg. 2020 Feb;9(Suppl 2):S105-S119. doi: 10.21037/gs.2019.12.16.
Modern surgery for advanced thyroid cancer: a tailored approach.
Abstract
Surgical treatment of advanced thyroid malignancy can be morbid, compromising normal functions of the upper aerodigestive tract. There is a paucity of guidelines dedicated to the management of advanced disease. In fact, there is not even a uniform definition for advanced thyroid cancer currently. The presence of local invasion, bulky cervical nodes, distant metastases or recurrent disease should prompt careful preoperative evaluation and planning. Surgical strategy should evolve from multidisciplinary discussion that integrates individual disease characteristics and patient preference. Intraoperative neuromonitoring has important applications in surgery for advanced disease and should be used to guide surgical strategy and intraoperative decision-making. Recent paradigm shifts, including staged surgery and use of neoadjuvant targeted therapy hold potential for decreasing surgical morbidity and improving clinical outcomes. Modern surgical planning provides optimal treatment for each patient through a tailored approach based on exact extent and type of disease as well as incorporating appreciation of surgical complications, patient preferences and intraoperative findings.
2020 Gland Surgery. All rights reserved.
KEYWORDS:
Advanced thyroid cancer; intraoperative neuromonitoring; neoadjuvant therapy; staged surgery; tailored approach
43.
Cureus. 2020 Feb 1;12(2):e6841. doi: 10.7759/cureus.6841.
Deep Neck Space Infections: A Retrospective Study of 183 Cases at a Tertiary Hospital.
Abstract
Objective Our study was performed to identify the clinical findings, risk factors, and complications of deep neck space infections (DNSI) at our center and compare our experience with the experiences of others. Methods Retrospectively, 183 cases of DNSI met our inclusion criteria from 2000 to 2018 at King Abdulaziz Medical City (KAMC) in Jeddah, Western Region, Saudi Arabia. Results In our study, analysis showed that males are more likely to have DNSI (88.7%). The most common site of infection is the peritonsillar abscess (30.6%). Dental infections were found to be the most common etiological factor for DNSI (42.6%). Streptococcus pyogenes was found to be the most common microorganism (39.3%) followed by Staphylococcus aureus (21.3%). Diabetes and hypertension (45.2% and 23.7%, respectively) are the most commonly associated disorders in patients with DNSI. Extension to another space was the most common complication of DNSI. Conclusion Despite the wide usage of antibiotics, DNSI still occur and are life-threatening conditions that need urgent management to avoid unpleasant complications.
Copyright © 2020, Almutairi et al.
KEYWORDS:
deep neck space abscess; dental infection; dnsi; infections; ludwig’s angina; neck
44.
Front Neurosci. 2020 Feb 26;14:114. doi: 10.3389/fnins.2020.00114. eCollection 2020.
Musical Emotion Perception in Bimodal Patients: Relative Weighting of Musical Mode and Tempo Cues.
Abstract
Several cues are used to convey musical emotion, the two primary being musical mode and musical tempo. Specifically, major and minor modes tend to be associated with positive and negative valence, respectively, and songs at fast tempi have been associated with more positive valence compared to songs at slow tempi (Balkwill and Thompson, 1999; Webster and Weir, 2005). In Experiment I, we examined the relative weighting of musical tempo and musical mode among adult cochlear implant (CI) users combining electric and contralateral acoustic stimulation, or "bimodal" hearing. Our primary hypothesis was that bimodal listeners would utilize both tempo and mode cues in their musical emotion judgments in a manner similar to normal-hearing listeners. Our secondary hypothesis was that low-frequency (LF) spectral resolution in the non-implanted ear, as quantified via psychophysical tuning curves (PTCs) at 262 and 440 Hz, would be significantly correlated with degree of bimodal benefit for musical emotion perception. In Experiment II, we investigated across-channel spectral resolution using a spectral modulation detection (SMD) task and neural representation of temporal fine structure via the frequency following response (FFR) for a 170-ms /da/ stimulus. Results indicate that CI-alone performance was driven almost exclusively by tempo cues, whereas bimodal listening demonstrated use of both tempo and mode. Additionally, bimodal benefit for musical emotion perception may be correlated with spectral resolution in the non-implanted ear via SMD, as well as neural representation of F0 amplitude via FFR - though further study with a larger sample size is warranted. Thus, contralateral acoustic hearing can offer significant benefit for musical emotion perception, and the degree of benefit may be dependent upon spectral resolution of the non-implanted ear.
Copyright © 2020 D’Onofrio, Caldwell, Limb, Smith, Kessler and Gifford.
KEYWORDS:
bimodal; cochlear implant; frequency following response; hearing loss; music perception; musical emotion; psychophysical tuning curve; spectral modulation detection
45.
Int J Biol Sci. 2020 Feb 10;16(7):1264-1273. doi: 10.7150/ijbs.38415. eCollection 2020.
SASH1 promotes melanin synthesis and migration via suppression of TGF-β1 secretion in melanocytes resulting in pathologic hyperpigmentation.
Abstract
Dyschromatosis universalis hereditaria (DUH) is an autosomal dominant pigmentary genodermatosis characterized by the presence of patches of hyperpigmentation and hypopigmented macules distributed over the body, with most cases reported in Asia. DUH is a heterogeneous disease and a small portion of patients carry the ABCB6 variant. In the present study, exome sequencing of four generations of a Chinese family with DUH identified a c.1761C>G (p.Ser587Arg) mutation in exon 15 of SAM and SH3 domain containing 1 (SASH1) that was found to co-segregate in some family members. Immunohistological analysis of biopsy specimens showed that SASH1 was diffusely distributed in all layers of the epidermis, suggesting increased transepithelial migration of melanocytes (MCs). The point mutation c.1761C>G of SASH1 was successfully induced in immortalized human melanocyte (PIG1) cells, which resulted in the downregulation of SASH1 expression. Bioinformatics analysis showed that mutated SASH1 downregulated thrombospondin 1 (THBS1) expression and inactivated transforming growth factor beta 1 (TGF-β1) signaling. TGF-β1 expression by PIG1cells was found to negatively regulate SASH1 protein expression. Transwell migration and wound-healing assays showed an increase in the migration and invasion capabilities of the cells carrying the mutation. Further, SASH1 mutations induced downregulation of melanin content. The study results suggest cross-talking between SASH1-TGF-β1 signaling, demonstrating the proposed MC migration modulation models and affecting melanin trafficking in the epithelium.
© The author(s).
46.
J Anaesthesiol Clin Pharmacol. 2020 Jan-Mar;36(1):62-65. doi: 10.4103/joacp.JOACP_330_18. Epub 2020 Feb 18.
Assessment of head and neck position for optimal ultrasonographic visualisation of the internal jugular vein and its relation to the common carotid artery: A prospective observational study.
Abstract
BACKGROUND AND AIMS:
There is a wide variation in the anatomical relationship of the Internal Jugular Vein (IJV) to the Common Carotid Artery (CCA). This makes landmark based techniques of IJV cannulation and head rotation questionable and may lead to accidental arterial puncture. We conducted this study to determine the anatomical relation of the IJV to the CCA using (USG) in patients undergoing IJV cannulation for central venous access, and to analyse the effect of head rotation on this relationship.
MATERIAL AND METHODS:
A prospective observational study was conducted on 100 patients requiring central venous access, in the operation theatre or the intensive care unit. Anatomical relationship of the IJV to CCA at the level of the cricoid cartilage was analysed by noting the segment position (1-12) around the CCA using a high frequency linear USG probe on patients in neutral head position, on both sides and also with the head rotated to the contra lateral side by 15° and 45°.
RESULTS:
Antero-lateral segments 1 and 2 were the most common positions (50% on the right and 73% on the left side). Change in segment causing increase in overlap of IJV and CCA with 15° head rotation was seen in 44% subjects on the right and 39% on the left. Statistically, a higher number of subjects showed overlap with 45° rotation (99% on right and 97% on left, P < 0.05).
CONCLUSION:
There is a wide variation in anatomical location of the IJV in relation to the CCA as seen by USG. Excessive head rotation causes overlap of IJV over CCA which may cause inadvertent arterial puncture, even under USG guidance. Thus, it is preferable to cannulate the IJV in neutral or near neutral head and neck position.
Copyright: © 2020 Journal of Anaesthesiology Clinical Pharmacology.
KEYWORDS:
Common carotid artery; Trendelenburg; internal jugular vein; ultrasonography
47.
Noise Health. 2019 Mar-Apr;21(99):69-76. doi: 10.4103/nah.NAH_18_19.
Does noise exposure during pregnancy affect neonatal hearing screening results?
Abstract
OBJECTIVE:
The aim is to investigate whether noise is effective on hearing screening tests of neonates born to mothers exposed to noise during pregnancy.
MATERIAL AND METHOD:
Screening results of 2653 infants from the period of January 2013-May 2017 were evaluated. Transient Evoked Otoacoustic Emissions (TEOAE) and Auditory Brainstem Response (ABR) were used. Infants of 65 mothers exposed to noise (LAeq 80-85 dBA/8 hours/day) during pregnancy (Week ± SD; 32.58 ± 2.71) comprised the study group while the control group consisted of infants of 2588 mothers without noise exposure.
RESULTS:
Among the 65 infants, 23 (35.4%) passed screening at the first emission test (OAE1); 34 (52.3%) at the second emission test (OAE2); 7 (10.8%) at the ABR stage, 1 (1.5%) infant was referred to a tertiary center. In the control group, 458 (17.7%) infants passed at OAE1; 1822 (70.4%) at OAE2; 289 (11.2%) at ABR stages, 19 (0.7%) infants were referred to a tertiary center. The rate of infants that passed screening at OAE1 in the study group was high (P = 0.00001). Sixty-four (98.46%) infants in the study group and 2569 (99.26%) infants in the control group passed the tests. The difference between the two groups was not significant, indicating that exposure to noise during pregnancy had no unfavorable effects on auditory functions (P = 0.392).
CONCLUSION:
Unfavorable effect of noise exposure during pregnancy was not observed on auditory functions of the infants. The higher rate of infants that passed the screening test at OAE1 stage in the study group raised the question, "Does the exposure of the noise at exposure action levels (80-85 dB A) during pregnancy contribute to auditory maturation of fetus?"
KEYWORDS:
Hearing; neonatal screening; neonate; occupational noise; otoacoustic emissions; pregnancy
48.
Ear Nose Throat J. 2020 Mar 15:145561320911735. doi: 10.1177/0145561320911735. [Epub ahead of print]
Septal Nasal Extramedullary Plasmacytoma: A Rare Tumor in an Unusual Area.
Di Stadio A1, Ralli M2, Messineo D3, Ciancia G4, Cascone A4, Salzano G5, De Vincentiis M6, Salzano FA4.
Abstract
We present an extreme rare case of extramedullary nasal plasmacitoma that arise from nasal septum. The mass surgically removed was analyzed by a pathologist who diagnosed an extramedullary nasal plasmacytoma. The patient did not present systemic involvement. A short cycle of radiotherapy was performed after the surgery. At 9-month follow-up, the patient is recurrence free.
KEYWORDS:
epistaxis; extramedullary nasal plasmacitoma; nasal mass; septum; treatment
49.
Eur Radiol Exp. 2020 Mar 16;4(1):16. doi: 10.1186/s41747-020-0146-x.
Paediatric haemodynamic modelling: development and experimental validation using quantitative flow MRI.
Abstract
BACKGROUND:
Congenital vascular disease is one of the leading causes of death in paediatric age. Despite the importance of paediatric haemodynamics, large investigations have been devoted to the evaluation of circulation in adults. The novelty of this study consists in the development of a well calibrated mathematical model of cardiovascular circulation in paediatric subjects. To reach the purpose, a model for adult circulation was modified and recalibrated with experimental data and literature from children to be able to calculate the flow rates and pressures in the brain and neck.
METHODS:
The haemodynamic model simulates the 76 main arteries, together with the main veins in brain and neck. A proper magnetic resonance imaging (MRI) dataset of 29 volunteers aged 12 ± 5 years (mean ± standard deviation) was used to extract age-dependent physiological and clinical parameters such as heart rate, flow rate, vessel cross section area, and blood pressure. The computational model was calibrated using such experimental data. The paediatric and adult model results were compared.
RESULTS:
Increase of the vessels stiffness due to aging contributes to a flow rate decrease while blood pressure increases. In accordance, our simulation results show about 16% decrease in mean pressure of internal jugular vein in paediatric rather than adult subjects. The model outcomes indicated about 88% correlation with MRI data.
CONCLUSIONS:
The mathematical model simulates the paediatric head and neck blood circulation. The model provides detailed information of human haemodynamics including arterial and venous network to study both paediatric and adult blood circulation.
KEYWORDS:
Blood pressure; Cardiovascular system; Computer simulation; Hemodynamics; Pediatrics
50.
Int J Surg. 2020 Mar 12. pii: S1743-9191(20)30222-3. doi: 10.1016/j.ijsu.2020.03.010. [Epub ahead of print]
Development and validation of nomograms to accurately predict risk of recurrence for patients with laryngeal squamous cell carcinoma: Cohort Study.
Abstract
BACKGROUND:
Recurrence is still major obstacle to long-term survival in laryngeal squamous cell carcinoma (LSCC). We aimed to establish and validate a nomogram to precisely predict recurrence probability in patients with LSCC.
METHODS:
A total of 283 consecutive patients with LSCC received curative-intend surgery between 2011 and 2014 at were enrolled in this study. Subsequently, 283 LSCC patients were randomly assigned to a training cohort (N=171) and a validation cohort (N=112) in a 3:2 ratio. According to the results of multivariable Cox regression analysis in the training cohort, we developed a nomogram. The predictive accuracy and discriminative ability of the nomogram were evaluated by calibration curve and concordance index (C-index), and compared with TNM stage system by C-index, receiver operating characteristic (ROC) analysis. Decision curve analysis (DCA) was performed to estimate clinical value of our nomogram.
RESULTS:
Six independent factors rooted in multivariable analysis of the training cohort to predict recurrence were age, tumor site, smoking, alcohol, N stage and hemoglobin, which were all integrated into the nomogram. The calibration curve for the probability of recurrence presented that the nomogram-based predictions were in good correspondence with actual observations. The C-index of the nomogram was 0.81 (0.75-0.88), and the area under curve (AUC) of nomogram in predicting recurrence free survival (RFS) was 0.894, which were significantly better than traditional TNM stage. Decision curve analysis further affirmed that our nomogram had a larger net benefit than TNM stage. The results were confirmed in the validation cohort.
CONCLUSION:
A risk prediction nomogram for patients with LSCC, incorporating readily assessable clinicopathologic variables, generates more accurate estimations of the recurrence probability when compared TNM stage alone, but still needs additional data before being used in clinical implications.
Copyright © 2020. Published by Elsevier Ltd.
KEYWORDS:
laryngeal squamous cell carcinoma; nomogram; overall survival; prediction; surgical treatment
51.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2020 Mar 12. pii: S2212-4403(20)30018-3. doi: 10.1016/j.oooo.2020.01.004. [Epub ahead of print]
Epithelioid rhabdomyosarcoma: report of the first case in the jaw.
Abstract
OBJECTIVES:
Epithelioid rhabdomyosarcoma (EpiRMS) is a novel morphologically distinct variant of rhabdomyosarcoma, with an unusually challenging microscopic diagnosis. The occurrence of rhabdomyosarcomas in the jaws is extremely rare. This study presents the first case of EpiRMS in the jaw (mandible) and a literature review of the previous 35 cases of EpiRMS.
STUDY DESIGN:
Here, we report a case of EpiRMS affecting an 18-year-old male patient. Clinical, imaging, microscopic, and immunohistochemical features are discussed and previously reported cases of EpiRMS are reviewed.
RESULTS:
An 18-year-old male patient presented with an exophytic sessile growth on the buccal gingiva, and orthopantomography revealed irregular bone loss. Microscopic analysis showed a large number of cells with epithelioid appearance. Immunohistochemistry staining was positive for desmin, myogenin, MyoD1, smooth muscle actin, h-caldesmon, INI-1, and AE1-AE3. The patient's disease was staged as T4aN1M0 and was treated with surgical excision combined with chemotherapy.
CONCLUSIONS:
The occurrence of RMS in the mandible is rare, and this is the first case of EpiRMS in the jaw. EpiRMS is an unusual histologic subtype that mimics other sarcomas and epithelial malignancies, making diagnosis a challenge. A specific immunohistochemistry panel aids in the diagnosis. EpiRMS has an aggressive course and an unfavorable prognosis.
Copyright © 2020 Elsevier Inc. All rights reserved.
52.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2019 Mar 1. pii: S2212-4403(19)30152-X. doi: 10.1016/j.oooo.2019.02.019. [Epub ahead of print]
Widely distributed purple-colored bullae and nodules in the oral cavity.
53.
J Allergy Clin Immunol Pract. 2020 Mar 12. pii: S2213-2198(20)30229-4. doi: 10.1016/j.jaip.2020.03.001. [Epub ahead of print]
The Rationale for Multidisciplinary Management of Chronic Rhinosinusitis with Nasal Polyposis.
54.
Auris Nasus Larynx. 2020 Mar 12. pii: S0385-8146(20)30067-5. doi: 10.1016/j.anl.2020.02.017. [Epub ahead of print]
Tympanic membrane findings of otitis media with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV).
Morita Y1, Kitazawa M2, Yagi C2, Nonomura Y2, Takahashi K2, Yamagishi T2, Ohshima S2, Izumi S2, Horii A2.
Abstract
OBJECTIVE:
Otitis media with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV) is characterized by adult otitis media refractory to conventional treatments. OMAAV is either an aural manifestation of existing ANCA-associated vasculitis (AAV) or an initial aural manifestation of AAV. OMAAV occasionally causes an irreversible profound sensorineural hearing loss that may require a cochlear implant even in the latter case. In such a case, prompt diagnosis of OMAAV is important but sometimes difficult. When diagnosing OMAAV, repetitive otitis media with effusion (OME) in adults is the most difficult differential diagnosis. Precise evaluation of tympanic membrane (TM) findings would help to achieve a prompt diagnosis. The objective of this study was to discriminate OMAAV from adult OME based on tympanic TM findings.
METHODS:
10 with OMAAV and 10 with adult OME were included. We established a scoring system of OMAAV tympanic membrane (SCOT) to evaluate TM findings of OMAAV consisted of following three characteristic findings: thickening of pars tensa, vasodilation of pars tensa, and posterior wall swelling. Each TM finding in OMAAV and OME was scored from 0 to 3 by 20 otolaryngologists who never knew the diagnosis. Reliability of the scoring system in terms of consistency between examiners was evaluated by intraclass correlation coefficients (ICC). Validity was tested by comparing the TM scores between OMAAV and OME and by the area under the curve (AUC) of receiver operating characteristic (ROC) curve to discriminate OMAAV from OME. Correlations between the TM scores and various systemic markers of OMAAV including white blood cell count, C-reactive protein, myeloperoxidase-anti-neutrophil cytoplasmic antibody, and Birmingham Vasculitis Activity Score were examined.
RESULTS:
The ICC of each score was over 0.95. Each of and the total TM scores were significantly higher in OMAAV than in OME. AUC of ROC curve was 0.9134. The cut-off value set at 2 points had the best combination of sensitivity (93.0%) and specificity (74.0%) to distinguish OMAAV from OME. No significant correlations were found between the total score of SCOT and systemic markers. However, the total score of SCOT significantly correlated with the average hearing level of both air (p = 0.021) and bone conductions (p = 0.032).
CONCLUSION:
Reliability and validity of SCOT in discriminating OMAAV from adult OME, the most difficult differential diagnosis, were demonstrated, suggesting that SCOT would be useful to make an early diagnosis of OMAAV. Correlation of SCOT with hearing level suggests that SCOT is also useful to evaluate disease status of OMAAV.
Copyright © 2020. Published by Elsevier B.V.
KEYWORDS:
Anti-neutrophil cytoplasmatic antigen; Otitis media; Tympanic membrane; Vasculitis
55.
Auris Nasus Larynx. 2020 Mar 13. pii: S0385-8146(20)30063-8. doi: 10.1016/j.anl.2020.02.013. [Epub ahead of print]
Evaluation of the structure of the otoconial layer using micro-computed tomography.
Abstract
OBJECTIVE:
Estrogen deficiency caused by bilateral ovariectomy (OVX) has been reported to lead to morphological changes in otoconia. Thus, we examined the morphological changes in the otoconial layer after OVX. We also investigated whether micro-computed tomography (µCT) is useful for the detection of morphological changes in the otoconial layer.
METHODS:
The otic capsules of C57BL/6 J mice were removed and evaluated using histological techniques and µCT at 2, 4, and 8 weeks after OVX or sham surgery. The volume of the utricle otoconial layer was measured and compared between the OVX and sham groups. The µCT scan and histological study results were also compared.
RESULTS:
The volume of the utricle otoconial layer was significantly increased 4 weeks after OVX compared to the sham group in both histological and µCT studies (p < 0.05). The volume of the otoconial layer measured using µCT was significantly correlated with the histological study results (p < 0.05).
CONCLUSION:
The volume of the utricle otoconial layer increased after OVX. These morphological changes could be detected by µCT.
Copyright © 2020. Published by Elsevier B.V.
KEYWORDS:
Benign paroxysmal positional vertigo; Estrogen; Micro-computed tomography; Otoconia, utricle
56.
Auris Nasus Larynx. 2020 Mar 12. pii: S0385-8146(20)30064-X. doi: 10.1016/j.anl.2020.02.014. [Epub ahead of print]
Neck dissection prolongs survival in patient with stage IVC hypopharyngeal carcinoma with mixed responses to nivolumab.
Abstract
Surgical intervention aids in maintaining quality of life in patients with recurrent metastatic head and neck carcinoma with mixed responses to nivolumab treatment. However, the mechanisms involved in these mixed responses remain unclear. Systemic chemotherapy using the EXTREME regimen was administered to the patient with hypopharyngeal carcinoma and liver metastases as well as cervical lymph node metastases. The patient was subsequently treated with nivolumab after developing signs of progressive disease. Although the hypopharyngeal tumors and liver metastases were well-controlled, cervical lymph node dissection was performed because of the enlargement of some of the lymph node metastases. Postoperative nivolumab administration was resumed, and this patient is presently alive and disease-free. Immediately after neck dissection, the LNs that responded and those that did not respond to nivolumab were separated and evaluated. The LNs that responded well to nivolumab presented with prominent interstitial fibrosis. Conversely, in LNs that enlarged after nivolumab, significant proliferation of the viable tumor cells and almost no degeneration or necrosis was observed. Additionally, we performed immunohistological assessments on pathologic samples of multiple lesions with differing responses to treatment. Targeted surgical intervention appears to be a valuable adjunct to treatment with nivolumab.
Copyright © 2020. Published by Elsevier B.V.
KEYWORDS:
CD8 + T cell; Hypopharyngeal carcinoma; Mixed responses; Nivolumab; Regulatory T cell (Treg); Surgery
57.
J Voice. 2020 Mar 13. pii: S0892-1997(20)30061-8. doi: 10.1016/j.jvoice.2020.02.009. [Epub ahead of print]
Classification of Voice Disorders Using a One-Dimensional Convolutional Neural Network.
Abstract
OBJECTIVES:
Auditory-perceptual voice analysis is a standard method for quantifying pathological voice quality, but perceptual ratings are based on subjective evaluations and therefore may vary among examiners. Although many acoustic metrics have been studied for potential use in the objective evaluation of pathological voices, the interpretation of acoustic metrics in individual cases is difficult and the technique is not widely used by clinicians. The aim of this study was to establish standardized methods to discriminate grade, roughness, breathiness, asthenia, strain (GRBAS) scale scores of pathological voices directly using one-dimensional convolutional neural network (1D-CNN) models.
METHODS:
We constructed an original dataset utilizing 1,377 voice samples of sustained phonation of the vowel /a/. Each voice sample was rated by three experts according to the GRBAS scale and the median values were used as the correct answer label. We designed an end-to-end 1D-CNN model with a raw voice waveform input having a frame width of 9,600 samples. The models were trained with our original dataset for each GRBAS category individually and the model performance was tested by the five-fold cross validation method.
RESULTS:
The accuracy, F1 score, and quadratic weighted Cohen's kappa for the testing dataset were determined. The metrics for the G scale showed the most balanced model performance, with high accuracy (0.771) and substantial agreement (kappa = 0.710). The model for the R scale had relatively high accuracy (0.765) and F1 score (0.743) with moderate agreement (kappa = 0.536). The accuracy (0.883) and the F1 score (0.865) for the S scale were the highest among the five categories, whereas the Cohen's kappa was the lowest (0.190).
CONCLUSIONS:
The end-to-end 1D-CNN models can evaluate overall pathological voice quality with a reliability comparable to human evaluations. The efficiency with which the machine learning models can be trained and evaluated is closely related to the dataset quality.
Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
KEYWORDS:
Auditory perceptual voice analysis; Deep learning; GRBAS scale; One-dimensional convolutional neural network; Voice disorder
58.
J Voice. 2020 Mar 12. pii: S0892-1997(19)30461-8. doi: 10.1016/j.jvoice.2020.01.026. [Epub ahead of print]
Relating Cepstral Peak Prominence to Cyclical Parameters of Vocal Fold Vibration from High-Speed Videoendoscopy Using Machine Learning: A Pilot Study.
Abstract
OBJECTIVE:
Smoothed cepstral peak prominence (CPPs) has been shown to be an effective indicator of breathiness (Hillenbrand and Houde, 1996). High-speed videoendoscopy (HSV) is frequently being used as a complement to stroboscopy especially when asymmetric or aperiodic vocal fold vibration is present in dysphonic voices. In an HSV image data set obtained with normal (nondisordered) voice subjects, we have observed that some degree of asymmetry is present in many of the vocal fold displacement curves extracted from the HSV exam videos; therefore, we have used this data set for a pilot study to investigate the relationship of CPPs to cyclical vocal fold vibration parameters, including left-right vocal fold (LVRF) phase asymmetry, in subjects with normal (nondisordered) voices.
METHODS:
Twenty subjects with normal (nondisordered) voices produced sustained vowel phonations while undergoing a transoral HSV examination of the vocal folds with synchronized recording of the voice signal. Glottal area waveform (GAW) and cyclical parameters open quotient (OQ), closed quotient (CQ), speed quotient (SQ), and LVRF skew were extracted from the HSV exam videos, and CPPs measures were obtained from acoustic analysis of the audio recordings. Correlations among the cyclical parameters and CPPs values were investigated using machine learning with the Regression Learner application in the MATLAB© Statistics and Machine Learning Toolbox (version 9.5.0.944444, R2018b, August 28, 2018, (c) 1984-2018, The MathWorks, Inc., Natick, MA).
RESULTS:
Because the sample size of the data set used for this study was small, and because there possibly was multicollinearity among the predictor variables used, the only meaningful result that was obtained with the data set of 20 normal subjects in the four predictor variables was the constant model (ie, the best prediction of CPPs was just the average value of the 20 observations), when the model validation feature of the app was turned on to protect against overfitting. In order to fully investigate the usefulness of the Regression Learner App, however, the validation feature was turned off and 48 more model types were investigated. While these were not necessarily indicative of the best regression model for the current data set, the results obtained in this manner nevertheless demonstrated the utility of the automated approach for finding a regression model for a larger data set to be collected in the future.
CONCLUSION:
Further work is warranted to collect a data set from a larger sample size of disordered voice patients with breathy and/or rough voice. It is speculated that a correlation between CPPs and cyclical parameters of vocal fold vibration may be more evident with disordered voices, because there will be more asymmetry in LRVF displacement with an effect on the acoustic voice signal.
Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
KEYWORDS:
High-speed videoendoscopy—Cepstral peak prominence—Glottal area waveform—Vocal fold displacement—Machine learning
59.
Br J Oral Maxillofac Surg. 2020 Mar 12. pii: S0266-4356(20)30084-X. doi: 10.1016/j.bjoms.2020.02.025. [Epub ahead of print]
Head and neck ablative and microvascular reconstructive surgery in the UK: current operating team composition.
Abstract
We sought to explore the current landscape of team composition in the provision of major head and neck ablative and reconstructive surgery in the UK. We conducted a survey of maxillofacial surgery units and compiled data on the operating model adopted at each institution. Our survey confirmed 54 active maxillofacial units undertaking microvascular free flap reconstructive surgery, with 44 (82%) hospitals adopting a two-team operative approach. We found no significant association between hospital type and volume of free flaps undertaken and prevailing operating team model. Our study provides an interesting snapshot of the current head and neck microvascular reconstructive practice in the UK.
Copyright © 2020 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
KEYWORDS:
Two team operating; UK; free tissue transfer; head and neck surgery; operating model; reconstructive practice
60.
Burns. 2020 Mar 12. pii: S0305-4179(20)30058-9. doi: 10.1016/j.burns.2020.03.001. [Epub ahead of print]
Craniofacial and neck burns in the pediatric population.
Abstract
INTRODUCTION:
Burn injuries can present with catastrophic physical and psychiatric harm with extensive, long-term sequelae. The pediatric population may especially be at-risk given this population's early neurocognitive and behavioral state of development. Innovations in treatment modalities and the development of evidence-based guidelines have helped mitigate burn morbidity and mortality in the pediatric population. Unfortunately, a surprising dearth of literature identifies risk-factors, epidemiological data, injury mechanisms, and prognostic factors within the pediatric population in the setting of craniofacial burns.
METHODS:
An analysis of emergency department visits under the National Electronic Injury Surveillance System was conducted for the most recent 5-year period available (2014-2018). Available information includes demographical data, such as age and sex, mechanism of injury, visit circumstances, as well as visit disposition. Additionally, details surrounding the injury, including type of burn and anatomical location of injury, were compared.
RESULTS:
After a review of results, a total of 2599 patients were included for analysis. Our study shows that infants and young children are at increased risk for grave injury 27.3% and 13% of infants and toddlers transferred or admitted, respectively, p < 0.05). 59.8% of infant burns in particular were caused by liquid or kitchen products, while 44.5% of burns in toddlers were caused by chemical products (p < 0.05 for both). Conversely, adolescents are at greater risk of burns in the setting of occupational and hobby-based activities (20.4% of adolescent burns).
CONCLUSIONS:
Craniofacial burns in the pediatric population may present with complex pathology and sometimes necessitate advanced care. Presentations and prognoses are different dependent upon age and injury mechanism. These findings may serve as important framework in the establishment of guidelines for medical and legislative reform.
Copyright © 2020 Elsevier Ltd and ISBI. All rights reserved.
KEYWORDS:
Burns; Craniofacial; Pediatric; Plastic surgery; Reconstructive surgery
61.
Rev Bras Anestesiol. 2020 Feb 19. pii: S0034-7094(19)30170-9. doi: 10.1016/j.bjan.2019.12.005. [Epub ahead of print]
[Short term olfactory memory and olfactory function after inhalation anesthetic agents: a randomized clinical trial].
[Article in Portuguese]
Sari H1, Atar Y2, Mingir T3, Kumral TL2, Akgun MF2, Ahmed EA2, Aydogdu I2, Salturk Z2, Berkiten G2, Uyar Y2.
Abstract
BACKGROUND AND OBJECTIVES:
This clinical trial aimed to evaluate the effects of two different inhalation anesthetic agents on postoperative olfactory memory and olfactory function in patients who underwent micro laryngeal surgery.
METHODS:
This randomized prospective controlled study consisted of 102 consecutive patients with a voice disorder. The patients underwent micro laryngeal surgery for voice disorders under general anesthesia. Patients who did not meet inclusion criteria and/or declined to participate (n=34) were excluded from the study. Patients were divided into two groups. Four patients from Group 1 and four patients from Group 2 were lost to follow-up. Group 1 (n=30) received sevoflurane, and Group 2 (n=30) received desflurane during anesthesia. We compared the results by performing the pre-op and post-op Connecticut Chemosensory Clinical Research Center Olfactory test.
RESULTS:
Thirty-three patients (55%) were male and 27 (45%) were female. The mean age was 48.18±13.88 years (range: 19-70 years). Preoperative and postoperative olfactory functions did not show a significant difference within the groups postoperatively (p> 0.05). Preoperative and postoperative olfactory memory showed a significant decrease 3hours after the surgery (p <0.05).
CONCLUSIONS:
Olfactory functions and memory were not affected by desflurane in the early postoperative period. Although sevoflurane did not affect olfactory functions, it had a temporary negative effect on olfactory memory in the early postoperative period.
Copyright © 2020 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.
KEYWORDS:
Anestesia inalatória; Desflurane; Desflurano; Inhalation anesthesia; Memória olfativa; Olfactory memory; Sevoflurane; Sevoflurano
62.
J Equine Vet Sci. 2020 Apr;87:102934. doi: 10.1016/j.jevs.2020.102934. Epub 2020 Jan 23.
Evaluation of Dynamic Structural Disorders in the Upper Airways and Applied Rein Tension in Healthy Dressage Horses During Riding in Different Gaits and Head-Neck Positions.
Abstract
Flexion of the horse's head and neck during dressage riding reduces the pharyngeal lumen with the risk of increased upper airway resistance and upper airway obstructions. According to the Fédération Equestre Internationale, hyperflexion is achieved through force, whereas the position low-deep-round is nonforced. The objectives of this study were to evaluate (1) applied rein tension and (2) dynamic structural disorders in the upper airways in dressage horses in different gaits and different head-neck positions (HNPs). Overground endoscopy (OGE) and rein tension were evaluated in 13 clinically healthy and high-performance Warmblood dressage horses while being ridden in a standardized program comprised of four different gaits (halt, walk, trot, and canter) and in four HNPs (unrestrained, competition frame, hyperflexion, and low-deep-round). All included horses were able to achieve the desired HNPs. The HNP low-deep-round showed significantly lower rein tension than competition frame (P < .001) and hyperflexion (P < .001). An association was found between dynamic structural disorders in the upper airway tract evaluated by OGE and head-neck flexion, but this association was not linked to the degree of flexion. The HNP hyperflexion was neither associated with greater rein tension nor severe dynamic structural disorders than the HNP competition frame. This study confirms that low-deep-round is a nonforced position, in contrast to hyperflexion. Further studies are needed to evaluate whether dynamic structural disorders are a result of flexion or if the degree of flexion has an impact.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
Competition frame; Head–neck angle; Hyperflexion; Low–deep–round; Overground endoscopy
63.
J Laryngol Otol. 2020 Mar 16:1-4. doi: 10.1017/S0022215120000596. [Epub ahead of print]
Efficacy of small-volume gastrografin videofluoroscopic screening for detecting pharyngeal leaks following total laryngectomy.
Abstract
OBJECTIVES:
Pharyngocutaneous fistulae are dreaded complications following total laryngectomy. This paper presents our experience using 3-5 ml gastrografin to detect pharyngeal leaks following total laryngectomy, and compares post-operative videofluoroscopy with clinical follow-up findings in the detection of pharyngocutaneous fistulae.
METHODS:
A retrospective case-control study was conducted of total laryngectomy patients. The control group (n = 85) was assessed clinically for development of pharyngocutaneous fistulae, while the study group (n = 52) underwent small-volume (3-5 ml) post-operative gastrografin videofluoroscopy.
RESULTS:
In the control group, 24 of 85 patients (28 per cent) developed pharyngocutaneous fistulae, with 6 requiring surgical correction. In the study group, 24 of 52 patients (46 per cent) had videofluoroscopy-detected pharyngeal leaks; 4 patients (8 per cent) developed pharyngocutaneous fistulae, but all cases resolved following non-surgical management. Patients who underwent videofluoroscopy had a significantly lower risk of developing pharyngocutaneous fistulae; sensitivity and specificity in the detection of pharyngocutaneous fistulae were 58 per cent and 100 per cent respectively.
CONCLUSION:
Small-volume gastrografin videofluoroscopy reliably identified small pharyngeal leaks. Routine use in total laryngectomy combined with withholding feeds in cases of early leaks may prevent the development of pharyngocutaneous fistulae.
KEYWORDS:
Deglutition; Deglutition Disorders; Diatrizoate Meglumine; Fistula; Laryngectomy
64.
J Laryngol Otol. 2020 Mar 16:1-5. doi: 10.1017/S0022215120000638. [Epub ahead of print]
Post-rhinoplasty outcomes in an Indian population assessed using the FACE-Q appraisal scales: a prospective observational study.
Abstract
OBJECTIVES:
The primary goal of rhinoplasty is patient satisfaction and improved quality of life. The present study was conducted to assess patient satisfaction with face and nose appearance, and quality of life after rhinoplasty.
METHODS:
Patients presenting for rhinoplasty completed the FACE-Q survey. This is a new instrument that measures patient-reported outcomes in those undergoing aesthetic procedures. The FACE-Q scales include satisfaction with facial appearance overall, satisfaction with the nose, psychological well-being, psychosocial distress and social function.
RESULTS:
Sixty-five patients completed the FACE-Q at pre-operative and at post-operative follow-up visits. Post-operative scores increased significantly in terms of: satisfaction with facial appearance (p < 0.0001, t = 15.639, degrees of freedom = 64); social function (p < 0.0001, t = 12.208, degrees of freedom = 64); psychosocial distress (p < 0.0001, t = 13.864, degrees of freedom = 64); psychological function (p < 0.0001, t = 12.681, degrees of freedom = 64); and satisfaction with nose (p < 0.0001, t = 16.421, degrees of freedom = 64). Most patients reported more than 79 per cent satisfaction with the post-operative outcome.
CONCLUSION:
The FACE-Q is an adequate instrument for determining successful aesthetic surgery based on patient satisfaction.
KEYWORDS:
FACE-Q; Quality Of Life; Rhinoplasty
65.
Ann Otol Rhinol Laryngol. 2020 Mar 16:3489420911656. doi: 10.1177/0003489420911656. [Epub ahead of print]
Effect of Gender, Age, and Profound Disease on Upper Airway Stimulation Outcomes.
Abstract
OBJECTIVE:
To evaluate treatment outcomes of upper airway stimulation (UAS) in obstructive sleep apnea (OSA) patients based on patient age, gender, and preoperative disease severity.
METHODS:
Retrospective chart review of patients undergoing UAS from 2014 to 2018 at a tertiary care center. Data collected included demographic information, implantation records, and pre- and postoperative polysomnography (PSG) results. Profound OSA was defined as AHI >65 and age ≥65 was considered advanced age. The primary outcome measured was initial treatment response, defined as a post-operative AHI <20 with a >50% reduction from baseline.
RESULTS:
145 patients underwent UAS at our institution including 98 males and 47 females with a mean age of 61.7 ± 11.5 years, mean BMI of 29.1 ± 3.9 kg/m2, and mean preoperative AHI of 34.1 ± 18.2 events/hour. After surgery, patients had a significantly lower mean AHI of 8.6 ± 15.0 events/hour (<0.001). Older patients had a lower initial treatment response rate (78%) when compared to their younger counterparts (94%) (P = 0.005). Male gender and profound disease status did not significantly impact treatment response rates; young age was the only variable found to predict early treatment response on multivariate analysis (P = 0.003).
CONCLUSION:
Although the overall OSA population showed significant postoperative AHI reduction with UAS, patients age ≥65 years were less likely to have an initial response to treatment, when compared to their younger counterparts. A larger proportion of elderly patients and patients with profound OSA had residual moderate disease (AHI > 15) after UAS.
LEVEL OF EVIDENCE:
4.
KEYWORDS:
obstructive sleep apnea; treatment response; upper airway stimulation
66.
Acta Neurochir (Wien). 2020 Mar 15. doi: 10.1007/s00701-020-04277-x. [Epub ahead of print]
Surgical nuances of the expanded endoscopic anterior skull base craniectomy for hyperostotic meningioma resection.
Abstract
BACKGROUND:
The rostral expanded endoscopic approach (EEA) to anterior cranial fossa (ACF) has several advantages over transcranial/craniofacial surgery, providing early access to the vascular supply of tumors and reducing morbidities of craniotomy especially that of brain retraction. This article presents endoscopic landmarks and nuances for a wide ACF corridor, with stepwise image-guided dissections highlighting surgical tricks and techniques to enhance surgical safety.
METHODS:
We describe an expanded endoscopic endonasal anterior skull base craniectomy for a recurrent large olfactory groove hyperostotic meningioma, with correlated cadaveric dissections.
CONCLUSION:
The widening of rostral EEA can provide a safe and feasible route to access ACF. This article highlights the specific landmarks in endoscopic anatomy with reference to the angle of visualization and bayonetted instruments.
KEYWORDS:
Anterior cranial fossa surgery; Craniectomy; Endonasal; Endoscopic; Hyperostosis; Olfactory groove meningioma; Suprasellar; Transcribriform; Transnasal
67.
Eur Arch Otorhinolaryngol. 2020 Mar 14. doi: 10.1007/s00405-020-05909-9. [Epub ahead of print]
Study on wideband tympanometry and absorbance within a Danish cohort of normal hearing adults.
Abstract
PURPOSE:
The objectives of this study was to present wideband tympanometry (WBT) data and absorbance with normal hearing and normal middle ear status.
METHODS:
Data were collected in 99 adult Caucasians with normal hearing and middle ear status. Energy absorbance was measured with an Interacoustics© Titan® using clicks for 1/24-octave frequency-intervals (0.226-8 kHz) with the ear canal air pressure alternated using a descending pressure sweep from + 250 to - 350 daPa.
RESULTS:
From the wideband energy absorbance tympanograms, the mean energy absorbance tympanogram, wideband averaged tympanogram and parameters such as ear canal volume, middle ear pressure and resonance frequency were determined.
CONCLUSIONS:
This study established a dataset containing descriptive analysis of wideband tympanograms and its derived parameters in Caucasian adults with normal hearing and normal middle ear conditions. The data presented in this study may serve as a future reference for WBT studies with Caucasian adults.
KEYWORDS:
Absorbance; Middle ear; Tympanometric peak pressure; Wideband tympanometry
68.
Eur Arch Otorhinolaryngol. 2020 Mar 14. doi: 10.1007/s00405-020-05887-y. [Epub ahead of print]
Immediate effects of water resistance therapy on patients with vocal fold mass lesions.
Abstract
INTRODUCTION:
Semi-occluded vocal tract exercises, such as water resistance therapy (WRT), are widely used in voice therapy. However, the potential positive effects of such a therapy on vocal fold oscillation patterns in patients indicating a need for phonomicrosurgery have not yet been explored. The presented study aims to analyze the effect of WRT in patients suffering from vocal fold mass lesions.
MATERIALS AND METHODS:
Eight participants with vocal fold mass lesions were asked to sustain a phonation on the vowel /i/ at a comfortable loudness and a fundamental frequency of 250 Hz (females) or 125 Hz (males). During phonation the subjects were simultaneously recorded with transnasal high-speed videoendoscopy (HSV, 20.000 fps), electroglottography, and audio signals. These subjects then performed a WRT (phonation in a silicone tube of 30 cm length, 5 cm below the water surface) for 10 min. Repeated measurements of sustained phonation were performed 0, 10, and 30 min after exercising. From the HSV data the glottal area waveform (GAW) was segmented and GAW parameters were computed.
RESULTS:
During WRT there was an increase of the GAW related open quotient and closing quotient. Immediately after WRT, there was a drop of both values followed by a rise of these parameters up to 30 min after the intervention. Furthermore, there was no correlation between GAW and electroglottographical open quotients.
CONCLUSIONS:
The effects observed after a single session of WRT on participants with vocal fold mass lesions showed a similar pattern to vocal fatigue.
KEYWORDS:
EGG; High-speed imaging; Vocal fold mass lesion; Water resistance therapy
69.
Curr Allergy Asthma Rep. 2020 Mar 14;20(4):10. doi: 10.1007/s11882-020-00905-9.
NSAID-ERD Syndrome: the New Hope from Prevention, Early Diagnosis, and New Therapeutic Targets.
Abstract
PURPOSE OF REVIEW:
This review summarizes the latest information on the appropriate identification, evaluation, and treatment of patients with nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NSAID-ERD), also known as aspirin-exacerbated respiratory disease (AERD). Within the framework of our understanding of the underlying pathophysiology of NSAID-ERD, we also provide an update regarding new surgical techniques and newly available or upcoming medical therapies that may benefit these patients.
RECENT FINDINGS:
There have been considerable developments regarding recommendations for both the extent and timing of sinus surgery for NSAID-ERD. The last few years have also given us several new biologic medications that warrant consideration in the treatment of patients with recalcitrant NSAID-ERD. Further clinical trials are underway to investigate additional medications that may decrease the type 2 inflammation that dominates this disease. Despite the severe lower respiratory inflammation and recurrent nature of the nasal polyps in patients with NSAID-ERD, significant recent advances now afford much-improved quality of life for these patients. Careful collaboration between Allergy/Immunology and Rhinology specialists is imperative to ensure proper treatment of patients with NSAID-ERD.
KEYWORDS:
AERD; Aspirin; Asthma; NSAID-ERD; NSAIDs; Nasal polyps
70.
Cell Mol Life Sci. 2020 Mar 14. doi: 10.1007/s00018-020-03494-y. [Epub ahead of print]
Bitter taste receptors stimulate phagocytosis in human macrophages through calcium, nitric oxide, and cyclic-GMP signaling.
Abstract
Bitter taste receptors (T2Rs) are GPCRs involved in detection of bitter compounds by type 2 taste cells of the tongue, but are also expressed in other tissues throughout the body, including the airways, gastrointestinal tract, and brain. These T2Rs can be activated by several bacterial products and regulate innate immune responses in several cell types. Expression of T2Rs has been demonstrated in immune cells like neutrophils; however, the molecular details of their signaling are unknown. We examined mechanisms of T2R signaling in primary human monocyte-derived unprimed (M0) macrophages (M[Formula: see text]s) using live cell imaging techniques. Known bitter compounds and bacterial T2R agonists activated low-level calcium signals through a pertussis toxin (PTX)-sensitive, phospholipase C-dependent, and inositol trisphosphate receptor-dependent calcium release pathway. These calcium signals activated low-level nitric oxide (NO) production via endothelial and neuronal NO synthase (NOS) isoforms. NO production increased cellular cGMP and enhanced acute phagocytosis ~ threefold over 30-60 min via protein kinase G. In parallel with calcium elevation, T2R activation lowered cAMP, also through a PTX-sensitive pathway. The cAMP decrease also contributed to enhanced phagocytosis. Moreover, a co-culture model with airway epithelial cells demonstrated that NO produced by epithelial cells can also acutely enhance M[Formula: see text] phagocytosis. Together, these data define M[Formula: see text] T2R signal transduction and support an immune recognition role for T2Rs in M[Formula: see text] cell physiology.
KEYWORDS:
Airway epithelium; G-protein-coupled receptors; Innate immunity; Live cell imaging; Quorum sensing
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