Classifying and Predicting Surgical Complications After Laryngectomy: A Novel Approach to Diagnosing and Treating Patients

xlomafota13 shared this article with you from Inoreader Classifying and Predicting Surgical Complications After Laryngectomy: A Novel Approach to Diagnosing and Treating Patients Via ear nose throat Ear Nose Throat J. 2021 Jul 30:1455613211029749. doi: 10.1177/01455613211029749. Online ahead of print. ABSTRACT OBJECTIVES: The total laryngectomy is one of the most standardized major surgical procedures in otolaryngology. Several studies have proposed the Clavien-Dindo classification (CDC) as a solution to classifying postoperative complications into 5 grades from less severe to severe. Yet more data on classifying larger patient populations undergoing major otolaryngolog ic surgery according to the CDC are needed. Predicting postoperative complications in clinical practice is often subject to generalized clinical scoring systems with uncertain predictive abilities for otolaryngologic surgery. Machine learning offers methods to predict postoperative complications based on data obtained prior to surgery. METHODS: We included all patients (N = 148) who underwent a total laryngectomy after diagnosis of squamous cell carcinoma at our institution. A univariate and multivariate logistic regression analysis of multiple complex risk factors was performed, and patients were grouped into severe postoperative complications (CDC ≥ 4) and less severe complications. Four different commonly used machine learning algorithms were trained on the dataset. The best model was selected to predict postoperative complications on the complete dataset. RESULTS: Univariate analysis showed that the most significant predictors for postoperative complications were t he Charlson Comorbidity Index (CCI) and whether reconstruction was performed intraoperatively. A multivariate analysis showed that the CCI and reconstruction remained significant. The commonly used AdaBoost algorithm achieved the highest area under the curve with 0.77 with high positive and negative predictive values in subsequent analysis. CONCLUSIONS: This study shows that postoperative complications can be classified according to the CDC with the CCI being a useful screening tool to predict patients at risk for postoperative complications. We provide evidence that could help identify single patients at risk for complications and customize treatment accordingly which could finally lead to a custom approach for every patient. We also suggest that there is no increase in complications with patients of higher age. PMID:34328819 | DOI:10.1177/01455613211029749 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Epiglottitis in Patients With Preexisting Autoimmune Diseases: A Nationwide Case-Control Study in Taiwan

xlomafota13 shared this article with you from Inoreader Epiglottitis in Patients With Preexisting Autoimmune Diseases: A Nationwide Case-Control Study in Taiwan Via ear nose throat Ear Nose Throat J. 2021 Jul 30:1455613211033689. doi: 10.1177/01455613211033689. Online ahead of print. ABSTRACT OBJECTIVES: The role of autoimmune diseases on the risk for acute epiglottitis remains uncertain. This study aimed to delineate the association between epiglottitis and autoimmune diseases using population database. METHODS: A population-based retrospective study was conducted to analyze claims data from Taiwan National Health Insurance Research Database col lected over January, 2000, to December, 2013. RESULTS: In total, 2339 patients with epiglottitis were matched with 9356 controls without epiglottitis by sex, age, socioeconomic status, and urbanization level. The correlation between autoimmune diseases and epiglottitis was analyzed by multivariate logistic regression. Compared with controls, patients with epiglottitis were much more likely to have preexisting Sjögren syndrome (adjusted odds ratio [aOR]: 2.37; 95% CI: 1.14-4.91; P = .021). In addition, polyautoimmunity was associated with increased risk of epiglottitis (aOR: 2.08; 95% CI: 1.14-3.80; P = .018), particularly in those aged >50 years (aOR: 2.61; 95% CI: 1.21-5.66; P = .015). CONCLUSIONS: Among autoimmune diseases, we verify the association between epiglottitis and Sjögren syndrome in Taiwan. Furthermore, we present the novel discovery that patients with epiglottitis have an increased risk of polyautoimmunity, particularly those aged >50 years. PMID:34328820 | DOI:10.1177/01455613211033689 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Adolescent Tracheostomy for COVID-19 Respiratory Failure

xlomafota13 shared this article with you from Inoreader Adolescent Tracheostomy for COVID-19 Respiratory Failure Via ear nose throat Ear Nose Throat J. 2021 Jul 30:1455613211034594. doi: 10.1177/01455613211034594. Online ahead of print. ABSTRACT Pediatric tracheostomy for COVID-19 infections is uncommon and requires age-appropriate adaptations. This case adds to a limited body of literature related to tracheostomy placement and management in an adolescent. Thoughtful planning and communication by a dedicated tracheostomy team was crucial in obtaining a successful outcome. PMID:34328811 | DOI:10.1177/01455613211034594 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Immune reconstitution inflammatory syndrome-associated Graves disease in HIV-infected patients: clinical characteristics and response to radioactive iodine therapy

xlomafota13 shared this article with you from Inoreader Immune reconstitution inflammatory syndrome-associated Graves disease in HIV-infected patients: clinical characteristics and response to radioactive iodine therapy Via radioactive iodine HIV Med. 2021 Jul 30. doi: 10.1111/hiv.13148. Online ahead of print. ABSTRACT OBJECTIVES: We aimed to describe the clinical characteristics and the response to radioactive iodine (RAI) treatment of immune reconstitution inflammatory syndrome-associated Graves disease (IRIS-GD) in comparison to Graves disease (GD) seen in HIV-uninfected patients. METHODS: We retrospectively reviewed the medical records of patients treated with RAI for GD. We obtained clinical, biochemical and HIV-related information of patients from their medical records. We compared patient characteristics and response to RAI treatment between patients with IRIS-GD and GD seen in HIV-uninfected patients. RESULTS: A total of 253 GD patients, including 51 patients with IRIS-GD, were included. Among IRIS-GD patients, CD4 cell nadir was 66 cells/µL (range: 37-103) with a peak HIV viral load of 60 900 copies/mL (range: 36 542-64 500). At the time of diagnosis of IRIS-GD, all patients had a completely suppressed HIV viraemia with a CD4 cell count of 729 cells/µL (range: 350-1279). The median interval between the commencement of HIV treatment and the onset of GD was 63 months. At 3 months follow-up, the proportion of patients with IRIS-GD achieving a successful RAI treatment outcome (euthyroid/hypothyroid state) was lower than that of HIV-uninfected patients (35.3% vs. 63.4%, respectively; p < 0.001). The response rate remained lower (60.8%) among patients with IRIS GD than among HI V-uninfected GD patients (80.2%, p = 0.004) at 6 months follow-up. After correcting for differences in age, gender and pre-treatment thyroid-stimulating hormone level, there was no significant difference in RAI treatment response between the two groups. CONCLUSIONS: After correcting for possible confounders, the response to RAI treatment was not different between patients with IRIS-GD and GD in HIV-uninfected patients. PMID:34328251 | DOI:10.1111/hiv.13148 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Measuring auditory cortical responses in Tursiops truncatus

xlomafota13 shared this article with you from Inoreader Measuring auditory cortical responses in Tursiops truncatus Via cortical auditory J Comp Physiol A Neuroethol Sens Neural Behav Physiol. 2021 Jul 30. doi: 10.1007/s00359-021-01502-5. Online ahead of print. ABSTRACT Auditory neuroscience in dolphins has largely focused on auditory brainstem responses; however, such measures reveal little about the cognitive processes dolphins employ during echolocation and acoustic communication. The few previous studies of mid- and long-latency auditory-evoked potentials (AEPs) in dolphins report different latencies, polarities, and magnitudes. These inconsistencies may be due to any number of differences in methodology, but these studies do not make it clear which methodological differences may account for the disparities. The present study evaluates how electrode placement and pre-processing methods affect mid- and long-latency AEPs in (Tursiops truncatus). AEPs were measured when reference electrodes were placed on the skin surface over the forehead, the external auditory meatus, or the dorsal surface anterior to the dorsal fin. Data were pre-processed with or without a digital 50-Hz low-pass filter, and the use of independent component analysis to isolate signal components related to neural processes from other signals. Results suggest that a meatus reference electrode provides the highest quality AEP signals for analyses in sensor space, whereas a dorsal reference yielded nominal improvements in component space. These results provide guidance for measuring cortical AEPs in dolphins, supporting future studies of their cognitive auditory processing. PMID:34327551 | DOI:10.1007/s00359-021-01502-5 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Characteristics of aspiration pneumonia patients in acute care hospitals: A multicenter, retrospective survey in Northern Japan

xlomafota13 shared this article with you from Inoreader Characteristics of aspiration pneumonia patients in acute care hospitals: A multicenter, retrospective survey in Northern Japan Via Speech therapy by Jun Suzuki, Ryoukichi Ikeda, Kengo Kato, Risako Kakuta, Yuta Kobayashi, Akira Ohkoshi, Ryo Ishii, Ai Hirano-Kawamoto, Jun Ohta, Rei Kawata, Tomonori Kanbayashi, Masaki Hatano, Tadahisa Shishido, Yuya Miyakura, Kento Ishigaki, Yasunari Yamauchi, Miho Nakazumi, Takuya Endo, Hiroki Tozuka, Shiori Kitaya, Yuki Numano, Shotaro Koizumi, Yutaro Saito, Mutsuki Unuma, Ken Hashimoto, Eiichi Ishida, Toshiaki Kikuchi, Takayuki Kudo, Kenichi Watanabe, Masaki Ogura, Masaru Tateda, Takatsuna Sasaki, Nobuo Ohta, Tatsuma Okazaki, Yukio Katori Background Pneumonia is a common cause of illness and death of the elderly in Japan. Its prevalence is escalating globally with the aging of population. To describe the latest trends in pneumonia hospitalizations, especially aspiration pneumonia (AP) cases, we assessed the clinical records of pneumonia patients admitted to core acute care hospitals in Miyagi prefecture, Japan. Methods A retrospective multi-institutional joint research was conducted for hospitalized pneumonia patients aged ≥20 years from January 2019 to December 2019. Clinical data of patients were collected from the medical records of eight acute care hospitals. Results Out of the 1,800 patients included in this study, 79% of the hospitalized pneumonia patients were aged above 70 years. The most common age group was in the 80s. The ratio of AP to total pneumonia cases increased with age, and 692 out of 1,800 patients had AP. In univariate analysis, these patients had significantly older ages, lower body mass index (BMI), a lower ratio of normal diet intake and homestay before hospitalization, along with more AP recurrences and comorbidities. During hospitalization, AP patients had extended fasting periods, more swallowing assessments and interventions, longer hospitalization, and higher in-hospital mortality rate than non-AP patients. A total of 7% and 2% AP patients underwent video endoscopy and video fluorography respectively. In multivariate analysis, lower BMI, lower C-reactive protein, a lower ratio of homestay before hospitalization, a higher complication rate of cerebrovascular disease, dementia, and neuromuscular disease were noted as a characteristic of AP patients. Swallowing interventions were performed for 51% of the AP patients who had been hospitalized for more than two weeks. In univariate analysis, swallowing intervention improved in-hospital mortality. Lower AP recurrence before hospitalization and a lower ratio of homestay before hospitalization were indicat ed as characteristics of AP patients of the swallowing intervention group from multivariate analysis. Change in dietary pattern from normal to modified diet was observed more frequently in the swallowing intervention group. Conclusion AP accounts for 38.4% of all pneumonia cases in acute care hospitals in Northern Japan. The use of swallowing evaluations and interventions, which may reduce the risk of dysphagia and may associate with lowering mortality in AP patients, is still not widespread. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Surgical management of MILD hyperparathyroidism

xlomafota13 shared this article with you from Inoreader Surgical management of MILD hyperparathyroidism Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Jul 30. doi: 10.1007/s00405-021-06953-9. Online ahead of print. ABSTRACT INTRODUCTION: There is no consensus for management of Mild primary hyperparathyroidism (MILD-pHP). Specific management has been suggested by some authors. We have compared the surgical management of the patients with MILD-pHP to those with Classic primary hyperparathyroidism (C-pHP) treated by surgery according to The Fourth International Workshop on pHP. MATERIALS AND METHODS: Data of 173 patients who underwent a parathyroidectomy were reviewed and retrospectively analysed. Management of 32 patients with MILD-pHPT (18.5%) patients were compared to that of 141 (81.5%) patients with C-pHPT. RESULTS: MILD-pHP group was more often discovered after non-fractured osteoporosis (21.9% vs 7.1%, p = 0.02) and surgery for chondrocalcinosis was more often carried out (6.3% vs 0%, p = 0.03) in the MILD-pHP group. A Mini-Invasive Par athyroidectomy (MIP) was carried out in 81.3% of cases, and 87.5% of patients had a single adenoma. The rate of multiglandular pathology was not different. Same day discharge was significantly higher in MILD-pHP group (37.5% vs 17.7%, p = 0.01). Success was obtained in 87.5% in the MILD-pHP group, there was no significant difference with the C-pHP group (92.9%, p = 0.48). There was no significant difference in the imaging performances. Imaging discordance was observed in 18.8% of cases in MILD-pHP and 33.6% in C-pHP (p = 0.38) without correlation with surgical failure. CONCLUSION: This study suggests that, by selecting patients on the basis of concordant imaging and international recommendations, there is no difference in outcome between MILD-pHP and C-pHP treated surgically. PMID:34328555 | DOI:10.1007/s00405-021-06953-9 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Meta‐analysis of time to extrusion of tympanostomy tubes by tympanic membrane quadrant

xlomafota13 shared this article with you from Inoreader Meta‐analysis of time to extrusion of tympanostomy tubes by tympanic membrane quadrant Via Clinical Otolaryngology Abstract Objectives To investigate the published time to extrusion of tympanostomy tubes inserted in the various quadrants of the tympanic membrane. Methods Publications were selected by a search with "PubMed", "Embase", and "Web of Science". A meta-analysis of time to extrusion as a function of tympanic membrane quadrant intubation was carried out. Results Eleven studies describing 2232 tympanostomy tubes were enrolled into the quantitative meta-analysis. The extrusion rate was evaluated at 3-month intervals up to 24 months post-intubation and it did not differ significantly at any of the time points tested for the superior and inferior anterior quadrants. The cumulative extrusion rates were: 11 and 9%, 32 and 23%, 59 and 36%, 80 and 67%, 87 and 70%, 88 and 82%, and 96 and 89% in the superior and anterior quadrants, respectively, at 3, 6, 9, 15, 18, 21 and 24 months post-intubation, respectively. Conclusion Time to extrusion of tympanostomy tubes are similar for all 3 tympanic membrane quadrants. The anterior superior quadrant intubation has no superiority in terms of intubation time. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Improving Safety for Day Case Adenotonsillectomy in Paediatric Obstructive Sleep Apnoea

xlomafota13 shared this article with you from Inoreader Improving Safety for Day Case Adenotonsillectomy in Paediatric Obstructive Sleep Apnoea Via Clinical Otolaryngology Abstract Outcomes following adenotonsillectomy for paediatric obstructive sleep apnoea from our centre support the paediatric national safety strategy recommendations published in 2019 Age and significant comorbidities are key factors in determining post-operative complication risk following adenotonsillectomy in paediatric patients with obstructive sleep apnoea Day case surgery is safe for children aged 2 and over who do not have comorbidities There is no significant difference in post-operative bleeding rates for intracapsular coblation verses extracapsular dissection tonsillectomy techniques in our study View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effects of Knockdown of XPO5 by siRNA on the Biological Behavior of Head and Neck Cancer Cells

xlomafota13 shared this article with you from Inoreader Effects of Knockdown of XPO5 by siRNA on the Biological Behavior of Head and Neck Cancer Cells Via The Laryngoscope Objectives/Hypothesis Dysregulated expression of microRNAs (miRNAs) and dysregulation of the mechanisms that regulate them are associated with carcinogenesis. Exportin-5 (XPO5), a member of the Karyopherin family, is responsible for the transfer of pre-miRNAs from the nucleus to the cytoplasm. Despite the high oncogenic potential of XPO5 as a critical regulator of the biogenesis of miRNAs, its role in head and neck squamous cell carcinoma (HNSCC) biology has not been explained yet. Study Design In-vitro translational. Methods The expression of XPO5 at the mRNA, protein, and intracellular level in SCC-9, FaDu SCC-90, and Detroit-562 cell lines were evaluated with quantitative reverse transcription polymerase chain reaction, Western-blot analysis, and immunofluorescence staining, respectively. The functional role of XPO5 in HNSCC was analyzed by silencing the gene expression with XPO5-small interfering RNA (siRNA) in the in vitro model. Cell proliferation, migration capacity, and apoptosis in XPO5 knockdown HNSCC cell lines were evaluated by MTT, wound-healing, and caspase-3 assay, respectively. Results Expression of XPO5 was determined to be upregulated at mRNA, protein, and intracellular level in metastatic cells compared to primary cells in HNSCC. XPO5 gene expression was knockdown by XPO5-siRNA transfection, verifying that it was suppressed at the mRNA, protein, and intracellular level. Silencing XPO5 caused a decrease in cell proliferation, delay in wound healing, and increase in Caspase-3 enzyme activity in HNSCC cell lines compared to control. Conclusions This report is the first to describe the oncogenic role of XPO5 in HNSCC biology by in vitro experiments. Consequently, XPO5 can be used as a potential biomarker and therapeutic target molecule against the disease in the diagnosis-treatment-follow-up of HNSCC. Level of Evidence N/A Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Speech ABR Findings in Auto Rickshaw Drivers Exposed to Occupational Noise

xlomafota13 shared this article with you from Inoreader Speech ABR Findings in Auto Rickshaw Drivers Exposed to Occupational Noise Via Otolaryngology Indian Abstract Most of the persons with noise exposure will have clinically normal hearing threshold while experiencing reduced speech comprehension. The motive of this study is to assess the impact of occupational noise on the encoding of speech stimuli in the auditory system in the auto-rickshaw drivers and compare the auditory brainstem responses (ABR) using speech stimuli with that of controls. The study was done in experimental design, where speech evoked ABR was measured in 21 auto-drivers who were continuously exposed to higher levels of occupational noise, and they were compared to the results of 37 individuals who were not exposed to noise. Speech ABR was administered in both the groups and the absolute latencies and amplitudes of the peaks V, A, C, D, E, F and O were compared. The results revealed that there is a statistically significant difference (p < 0.05) in the latency of peak V (F(1,32) = 6.13, p < 0.05, \(\eta_{p}^{2}\)  = 0.12) and peak A (F(1,32) = 4.03, p < 0.05, \(\eta_{p}^{2}\)  = 0.08) between the control and experimental group. Similarly, there was a statistically significant difference seen in the amplitude of peak D (F(1,32) = 6.38, p < 0.05, \(\eta_{p}^{2}\)  = 0.12) and peak F (F(1,32) = 7.97, p < 0.05, \(\eta_{p}^{2}\)  = 0.15). Acknowledging how the speech signals are coded in the brainstem may aid in the timely detection and intervention of hearing-related issues, even in individuals having normal hearing acuity. The results indicate that there is damage at the level of the brainstem which will lead to poor speech understanding in those who are exposed to occupational noise. These indicators are present even before routine audiometry indicates a hearing loss. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.