Πέμπτη 28 Ιανουαρίου 2021

Transoral robotic submandibular gland transposition to reconstruct radical tonsillar resection defects

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Abstract

Significant dysphagia, pain, and risk of bleeding occur after transoral robotic surgery (TORS) radical tonsillectomy. We present a novel surgical technique utilizing robotically assisted submandibular gland transposition (SMGT) to reconstruct the radical tonsillar defect. A 48‐year‐old male with p16+ tonsillar squamous cell carcinoma underwent deep TORS radical tonsillectomy, contralateral tonsillectomy, ipsilateral neck dissection, and TORS‐assisted reconstruction of the radical defect with ipsilateral SMGT. Postoperatively, the patient experienced minimal pain and was discharged on postoperative day (POD) 3 tolerating a soft diet. There were no episodes of postoperative bleeding. This procedure was performed in five other cases as well. Transoral robotic SMGT can be used successfully to repair deep TORS radical tonsillectomy defects and may theoretically reduce dysphagia, pain, and the risk of hemorrhage.

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Dynamic facial reanimation using active implantable prosthesis: restoring blink

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Publication date: Available online 27 January 2021

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Shaheen Hasmat, Jacinta Cleary, Gregg J. Suaning, Nigel H. Lovell, Tsu-Hui (Hubert) Low, Jonathan R. Clark

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A novel approach to the Basophil Activation Test for characterizing peanut allergic patients in the clinical setting

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Via Allergy
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Annular Flow in the Upper Esophageal Sphincter Demonstrated with Dynamic 320-row Area Detector Computed Tomography

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Via Dysphagia

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Abstract

Understanding bolus flow patterns in swallowing (rheology, the study of flow) is fundamental to assessment and treatment of dysphagia. These patterns are complex and poorly understood. A liquid swallow is typically biphasic, including air, so the actual bolus has both liquid and gas phases. We report a novel observation of annular two-phase flow (a ring of liquid around a core of air) as thin liquids passed through the upper esophageal sphincter (UES). Dynamic CT was performed on 27 healthy asymptomatic volunteers swallowing liquid barium in a semi-reclining position. Each subject swallowed 3, 10, and 20 ml of either thin (14 subjects) or thick liquid (13 subjects). Sagittal and axial images were analyzed. Flow patterns in the UES were assessed on cross-sectional images. Annular flow was seen in the majority of subjects with thin liquid but few with thick liquid swallows. The percentage of Annular flow during UES opening was 3 ml 58%, 10 ml 58%, 20  ml 56% in thin and 3 ml 0%, 10 ml 4%, 20 ml 1% in thick. Annular flow was usually observed from the second or third frames after onset of UES opening. The other pattern, Plug flow was seldom seen with thin but was typical with thick liquid swallows. Annular flow was the most common pattern for thin liquids (but not thick liquids) passing through the UES. Annular flow has been defined as a liquid continuum adjacent to the channel wall with a gas continuum (core) in the center of the channel. The two regions are demarcated by a gas–liquid interface. Annular flow is typical for two-phase gas–liquid flow in a vertical or inclined channel. It results from the interaction of viscosity with cohesive and adhesive forces in the two phases. We infer that the difference in flow pattern between thin liquid–air and thick liquid–air boluses resulted from the differing magnitudes of viscous forces.

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Primary diffuse large B-cell lymphoma of the major salivary glands: Increasing incidence and survival

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Publication date: Available online 28 January 2021

Source: American Journal of Otolaryngology

Author(s): Avigeet Gupta, Joshua A. Lee, Shaun A. Nguyen, Eric J. Lentsch

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Why Clinicians Choose Their Language Intervention Approach: An International Perspective on Intervention for Children with Developmental Language Disorder

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Purpose: Considerable progress has been made in recent years in generating external evidence underpinning interventions for children with developmental language disorder (DLD), but less is known about the practitioner decision-making process underpinning such interventions and whether such decisions are context specific or are internationally generalizable. Methods: An online survey about clinical practice was developed by members of COST Action IS1406, an EU-funde d research network, which included representation from 39 countries. The participants were 2,408 practitioners who answered questions in relation to their decision making for a specific child of their choosing with DLD. Analysis of open-ended questions was undertaken, and data were converted into codes for the purpose of quantitative analysis. Results: Although a wide range of intervention approaches and rationales were reported, the majority of responses referenced a client-centred approach. Level of functioning was used as a rationale only if a child had severe DLD. Practitioners with university level education or above were less likely to report basing intervention on client-centred factors. A number of differently named interventions with variable theoretical and empirical underpinnings were used in different countries. Conclusions: Specific client and practitioner characteristics have an impact on the intervention approaches and rationales adopted ac ross countries. A limited number of practitioners reported use of external scientific evidence, which suggests that there should be more initiatives in basic training of practitioners and continuing professional development to encourage the uptake of scientific evidence-based practice.
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Biomarkers in atopic dermatitis - a review on behalf of the international eczema council

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Atopic dermatitis (AD) is a common yet complex skin disease, posing a therapeutic challenge with increasingly recognized different phenotypes among variable patient populations. As therapeutic response may vary based on the heterogenous clinical and molecular phenotypes, a shift towards precision medicine approaches may improve AD management. Herein we will consider biomarkers as potential instruments in the toolbox of precision medicine in AD and will review the process of biomarker development and validation, the opinion of AD experts on the use of biomarkers, types of biomarkers, encompassing biomarkers that may improve AD diagnosis, biomarkers reflecting disease severity, and those potentially predicting AD development, concomitant atopic diseases or therapeutic response, and current practice of biomarkers in AD.
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Skin-resident natural killer T cells participate to cutaneous allergic inflammation in atopic dermatitis

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Skin-resident CXCR4+ NKT cells have a role in atopic dermatitis.
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Acute Laryngeal Injury After Intubation

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Although intubation is often necessary and lifesaving, there are known laryngotracheal consequences. Otolaryngologists are all too familiar with the vocal-fold damage and inflammatory conditions that are associated with prolonged intubation because patients often present in the hospital or clinic with dysphonia or dyspnea. The size of the endotracheal tube and the duration of intubation are known to be risk factors for postintubation damage. The pathophysiology is well understood to be caused by pressure-induced damage to the mucosal and car tilaginous structures of the larynx. However, despite this knowledge, laryngeal damage is often considered unavoidable, accrued as a result of a lifesaving stay in an intensive care unit. The resulting disease state can be so functionally devastating and difficult to treat that many otolaryngologists are left wondering: is there something we can do to prevent this from happening?
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Early Intervention for the Treatment of Acute Laryngeal Injury After Intubation

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This cohort study compares functional outcomes between early and late inter vention for patients with intubation-related laryngeal injury.
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De Novo vs Inverted Papilloma–Associated Sinonasal Squamous Cell Carcinoma Survival Outcomes

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This systematic review and meta-analysis uses data from studies retrieved f rom an Ovid Medline, Embase, Scopus, and Cochrane Library database search to investigate survival differences between de novo and inverted papilloma–associated sinonasal squamous cell carcinoma pathogenesis.
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Prevalence of anemia among patients with solid cancers at diagnosis

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by Mazen Almehmadi, Magdi Salih, Tariq E. Elmissbah, Abdulaziz Alsharif, Naif Alsiwiehri, Khalid Alzahrani, Alaa Shafie, Haytham Dahlawi

Objectives

The aim of this study was to estimate the prevalence of anemia among patients newly diagnosed with solid malignancies at King Faisal Hospital in Taif Province, Kingdom of Saudi Arabia.

Methods

A descriptive, cross-sectional, hospital-based study was conducted from December 2017 to March 2020. A total of 320 patients newly diagnosed with solid malignancy were examined to assess anemia prevalence.

Results

Of 320 patients with solid cancers, 245 (76.6%) were female and 75 (23.4%) were male. The median (interquartile range) age of 57 (45 ─ 66) years, range between 16 and 108 years. The types of cancer included were breast (29.1%), female genital tract (20.0%), colorectal (25.3%), head and neck (10.3%), urinary bladder (4.7%), prostate (5.0%), lung (2.5%), liver (2.2%) and lymphoma (0.9%). The prevalence of anemia at diagnosis of cancer was 44.1% across all cancer types. A higher anemia prevalence was noted in colorectal (n = 46/81, 56.8%) (p = 0.047).

Conclusion

Patients with colorectal or female genital tract cancers had a higher anemia prevalence (56.8% and 43.8%, respectively) than did patients with other cancers.

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