Κυριακή 8 Αυγούστου 2021

Vestibular paroxysmia (VP) is a condition with recurrent short bouts of vertigo and is thought to be part of a neurovascular compression syndrome caused by the vascular loop

Vascular Loops: The Innocent Bystander for Vestibular Paroxysmia
2dby Carren Sui-Lin Teh via otol rhinol

Ann Otol Rhinol Laryngol. 2021 Aug 5:34894211037211. doi: 10.1177/00034894211037211. Online ahead of print.

ABSTRACT

INTRODUCTION: Vestibular paroxysmia (VP) is a condition with recurrent short bouts of vertigo and is thought to be part of a neurovascular compression syndrome caused by the vascular loop. However, this is still being debated as vascular loops are considered as normal variants with limited studies involving vertiginous patients.

OBJECTIVES: The aim of this paper is to study the association between audiovestibular symptoms and the presence of vascular loops and to study the association between vestibular paroxysmia and vascular loops.

DESIGN: This is a retrospective analysis of clinical, audiological and MRI findings of patients with and without vascular loops and vestibular paroxysmia from 2000 to 2020.

RESULTS: A total of 470 MRI Internal Auditory Meatus scans were performed during the study period of which, 71 (15.1%) had vascular loops and 162 (34.5%) had normal MRI which were used as controls. From the 233 subjects recruited, there were 37 subjects with VP and 196 non VP subjects were used as controls. There was no association between the vascular loop and control groups in terms of co-morbidity and audiovestibular symptoms. The VP group had a significantly older mean age of 51.8 (SD ± 10.3) as compared to the non VP group with the mean age of 45.6 (SD ± 15.5). The VP group had higher number of patients presenting with hearing loss at 97.3% when compared with those without VP (80.1%) (P = .01). The odds of having a vascular loop giving rise to VP was not statistically significant at 0.82 (95% CI 0.3735-1.7989) P = .62.

CONCLUSION: The vascular loop is a normal variant which may or may not give rise to audiovestibular symptoms or vestibular paroxysmia. Clinical assessment is still most important tool in deriving a diagnosis of VP and MRI may be useful to rule out other central causes.

PMID:34353133 | DOI:10.1177/00034894211037211

#
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
Telephone consultation 11855 int 1193,

Efficacy of a Graphene Oxide/Chitosan Sponge for Removal of Radioactive Iodine-131 from Aqueous Solutions

xlomafota13 shared this article with you from Inoreader

pubmed-meta-image.png

Life (Basel). 2021 Jul 20;11(7):721. doi: 10.3390/life11070721.

ABSTRACT

Iodine-131 is increasingly used for diagnostic and therapeutic applications. The excretion of radioactive iodine is primarily through the urine. The safe disposal of radioactive waste is an important component of overall hospital waste management. This study investigated the feasibility of using graphene oxide/chitosan (GO/CS) sponges as an adsorbent for the removal of iodine-131 from aqueous solutions. The ad sorption efficiency was investigated using iodine-131 radioisotopes to confirm the results in conjunction with stable isotopes. The results revealed that the synthetic structure consists of randomly connected GO sheets without overlapping layers. The equilibrium adsorption data fitted well with the Langmuir model. The separation factor (RL) value was in the range of 0-1, confirming the favorable uptake of the iodide on the GO/CS sponge. The maximum adsorption capacity of iodine-131 by GO/CS sponges was 0.263 MBq/mg. The highest removal efficiency was 92.6% at pH 7.2 ± 0.2. Due to its attractive characteristics, including its low cost, the ease of obtaining it, and its eco-friendly properties, the developed GO/CS sponge could be used as an alternative adsorbent for removing radioiodine from wastewater.

PMID:34357093 | DOI:10.3390/life11070721

View on the web

Treatment outcomes of neoadjuvant chemotherapy and transoral robotic surgery in locoregionally advanced laryngopharyngeal carcinoma

xlomafota13 shared this article with you from Inoreader

Abstract

Background

We aimed to identify the optimal indications of neoadjuvant chemotherapy (NACT) and transoral robotic surgery (TORS) in patients with locoregionally advanced (T3-4 or N2-3) head and neck cancer (HNC).

Methods

A total of 50 patients were included in the study.

Results

T1 was identified in seven cases, T2 in 19, T3 in 22, and T4 in 2. N0 was identified in nine cases, N1 in 18, N2 in 22, and N3 in 1. There were 25 patients (50%) with complete remission of the primary lesion and 25 patients (50%) with partial remission. On pathologic examination of surgical specimens after neoadjuvant chemotherapy and TORS, 2 patients (4%) had a positive surgical margin, and 48 patients (96%) had a negative margin. Pathologic metastatic lymph nodes (LNs) were not observed in 39 cases (78%), and one metastatic LN was observed in 11 cases (22%). The 3-year recurrence-free survival (RFS) of all patients was 85.4%. On multivariate analysis, lymphovascular invasion showed a significant correlation with RFS.

Conclusions

In patients with locoregionally advanced HNC, NACT and TORS achieved favorable oncologic and functional outcomes.

View on the web

Vascularized Prelaminated Thermoplastic Bioabsorbable Scaffold in Tracheal Reconstruction

xlomafota13 shared this article with you from Inoreader

Abstract

Successful tracheal reconstruction remains a challenging task for the reconstructive surgeon. A variety of techniques have been previously employed, using both autografts and allografts. The authors present a novel method for tracheal reconstruction utilizing a prelaminated fascial flap in conjunction with a bioabsorbable scaffold. Laryngoscope, 2021

View on the web

Ergonomic Analysis of Functional Endoscopic Sinus Surgery Using Novel Inertial Sensors

xlomafota13 shared this article with you from Inoreader

Objectives/Hypothesis

Suboptimal ergonomics during endoscopic sinus surgery can lead to considerable physical discomfort and fatigue for the surgeon. The purpose of this pilot study is to objectively evaluate the ergonomic positions of trainee and attending surgeons while performing functional endoscopic sinus surgery (FESS).

Study Design

Pilot prospective trial.

Methods

Six surgeons (two attendings and four trainees) performed FESS while wearing 11 inertial measurement units (IMUs) affixed to either side of each major joint. Screen placement was standardized to be 1 m directly in front of the surgeon and on the patient's left, 0–15° declined from the surgeons' eyes. Bed height was standardized such that the workspace was 0 to 10 cm below the elbows. IMU data were analyzed to calculate joint angles. Ideal joint angles (i.e., <10° for neck and trunk) were determined by the validated Rapid Entire Body Assessment tool. Subjects subsequently completed a modified National Aeronautics and Space Administration Task Load Index to assess cognitive and physical burden and pain. Student's t-test was employed to detect differences between groups.

Results

Trainees adopted positions involving significantly greater neck flexion (9.90° vs. −6.48°, P = .03) and reported significantly higher frustration levels (3.04 vs. 1.33, P = .02) while operating than attendings. For both cohorts, increased operative time was significantly correlated with greater back flexion (r = 0.90, P = .02; r = 0.55, P = .04, respectively).

Conclusions

Our data suggest that trainees operate with higher risk neck postures than do attendings. These data indicate high-risk operative postures may be borne of inexperience and present an opportunity for postural interventions at an early stage of training.

Level of Evidence

N/A Laryngoscope, 2021

View on the web

Adjuvant Therapy and Prognosticators of Survival in Head and Neck Mucosal Melanoma

xlomafota13 shared this article with you from Inoreader

Objectives/Hypothesis

To identify prognosticators and determine the efficacies of surgery with adjuvant radiotherapy (SR) and surgery with immunotherapy (SI) of head and neck mucosal melanoma (HNMM).

Study Design

Retrospective database study.

Methods

The 2004 to 2017 National Cancer Database was queried for HNMM patients. Cox proportional hazards and Kaplan-Meier analyses evaluated prognosticators of mortality and survival benefits conferred by SR, SI, or surgery with adjuvant radiotherapy and immunotherapy (SRI). Logistic regression identified predictors of adjuvant radiotherapy or immunotherapy use.

Results

Overall, 1,910 cases (845 surgery, 802 SR, 51 SI, 101 SRI) were analyzed, with 50.3% females and an average age of 68.6 ± 13.8 years. SI was associated with greater overall survival (OS) than surgery (hazard ratio [HR] 0.672; P = .036). SI (HR 0.425; P = .024) and SRI (HR 0.594; P = .045) were associated with superior OS than SR. Older age (HR 1.607; P < .001), female sex (HR 0.757; P = .006), paranasal sinus localization (HR 1.648; P < .001), T4 classification (HR 1.443; P < .001), N1 classification (HR 2.310; P < .001), M1 classification (HR 3.357; P < .001), and positive surgical margins (HR 1.454; P < .001) were survival prognosticators. Adjuvant radiotherapy use was negatively correlated with older age, oral cavity localization, and M0 or T3 tumors (all P < .05). Adjuvant immunotherapy use was pos itively correlated with younger age and M1 tumors (all P < .05).

Conclusions

Although SR did not confer survival benefits in HNMM patients, SI and SRI yielded greater OS than surgery alone. SRI was associated with superior survival outcomes than SR. Certain demographic and clinical factors were associated with increased mortality risk. Patient age and certain tumor characteristics were predictors of adjuvant radiotherapy or immunotherapy use.

Level of Evidence

4 Laryngoscope, 2021

View on the web

Cancer‐Related Activity Limitations Among Head and Neck Cancer Survivors

xlomafota13 shared this article with you from Inoreader

Objectives/Hypothesis

To characterize self-reported cancer-related activity limitations among a broad population of head and neck (HNC) survivors and identify sociodemographic factors associated with these limitations.

Study Design

Cross-sectional analysis of data from the National Health Interview Survey.

Methods

The study population included individuals who completed the National Health Interview Survey (NHIS) from 1997 to 2018 and self-reported a cancer diagnosis. Data regarding activity limitations, cancer history, mental health, and demographics were extracted from the NHIS. Poisson regression was used to evaluate associations between demographics and cancer-related limitations, and a descriptive analysis was performed to identify the most common types of cancer-related limitations experienced by HNC survivors.

Results

Individuals with HNC were more than twice as likely to report having a disability caused by cancer when compared to individuals with other cancers (24% vs. 11%, P < .001). Cancer-related disability was highest among HNC survivors who were Black (adjusted prevalence ratio (aPR) = 1.57, 95% CI = 1.13–2.18), were aged 50 to 64 (aPR = 1.74, 95% CI = 1.1–2.74), had high school or lower education (aPR = 2.40, 95% CI = 1.07–5.37), and had Medicaid insurance (aPR = 2.58, 95% CI = 1.62–4.10). Among HNC patients who reported a cancer-related limitation, the most common limitations included difficulty working (78%), going out (51%), and socializing (42%).

Conclusions

Cancer-related activity limitations are more common among HNC survivors compared to survivors of other cancers, and disproportionately affect socioeconomically disadvantaged HNC survivors. Clinicians should be aware of the limitations experienced by HNC survivors to provide counseling and resources to help patients cope with these limitations.

Level of Evidence

3 Laryngoscope, 2021

View on the web

Balloon‐Assisted Rib Graft Placement in Endoscopic Posterior Cricoid Split Procedure

xlomafota13 shared this article with you from Inoreader
View on the web

Extended Anterior Ethmoidal Artery Flap: Novel Endoscopic Technique for Large Septal Perforation

xlomafota13 shared this article with you from Inoreader
View on the web

Anterolateral Thigh Fascia Lata Rescue Flap: A New Weapon in the Battle Against Osteoradionecrosis

xlomafota13 shared this article with you from Inoreader

Objectives

To demonstrate that the anterolateral thigh fascia lata (ALTFL) rescue flap may be effectively used for management of osteoradionecrosis (ORN) in selected patients.

Study Design

Retrospective case review.

Methods

Retrospective chart review was performed on patients who underwent ALTFL free flap repair to various sites of ORN in the head and neck between 2011 and 2018. Inclusion criteria were patients with radiographic and clinical evidence of head and neck ORN who either failed previous hyperbaric oxygen (HBO) therapy or with extensive disease, which was unlikely to respond to conservative management.

Results

Twenty-three patients with average age of 63 years (40–78) who underwent 24 ALTFL free flap procedures were reviewed. ORN sites were the mandible (n = 16), palatomaxilla (n = 4), skull base and cervical spine (n = 3), and calvarium (n = 2). Recipient vessels used were superficial temporal (n = 11), common facial (n = 10), and angular (n = 3). Average hospital stay was 3.0 (1–10) days. Prior HBO therapy was performed in 13 (57%) patients. There were four major complications: flap failure, recurrent mandibular infection resolved with IV antibiotic course, mandibular fracture with malunion requiring occlusal adjustment, and unresolved sequelae of ORN requiring fibular free flap. There were four minor complications: thigh hematoma, thigh seroma, and intraoral scar formation causing trismus (n = 2). The procedure was successful in 22 of 23 (95.7%) patients with radiographic arrest of ORN, resolution o f symptoms, and elimination of antibiotic requirements.

Conclusion

The ALTFL rescue flap merits strong consideration in ORN management and appears to prevent progression to more extensive disease, which would require full segmental bone resection and reconstruction.

Level of Evidence

4 Laryngoscope, 2021

View on the web

Perivascular clusters of Th2 cells and M2 macrophages in allergic contact dermatitis to methylchloroisothiazolinone and methylisothiazolinone

xlomafota13 shared this article with you from Inoreader

Abstract

Background

Methylisothiazolinone (MI) and Methylchloroisothiazolinone (MCI) are among the most common skin sensitizers, yet the immunological events that occur during MCI/MI allergic contact dermatitis (ACD) are still poorly understood. Objectives: To analyze dendrocytes, macrophage subtypes and T cells in skin during the elicitation phase of MCI/MI ACD.

Methods

Thirteen patients with positive patch test reactions to MCI/MI (ACD group) and 11 individuals with negative patch test results were selected. Skin biopsies were only performed at 48 hours of patch testing. Immunohistochemistry was conducted to assess T cells, dendrocytes (Factor XIIIa), M1 (p-Stat1, CD68) and M2 (c-Maf, CD163) macrophages. Transcriptional analyses were performed for cytokines and related factors; and further compared to atopic dermatitis samples (n=4). Immunofluorescence assays addressed T cells location, along with IL-4 or IL-13, within the skin.

Results

MCI/MI elicited dermal dendrocytes and macrophages, pronouncedly the M2 subtype. T cells, majorly CD4+ T cells, accumulated in the perivascular areas. Similarly, abundant IL-4 protein was detected in these areas. There was an upregulation of IL-4 and IL-13 mRNA expression, a mild increase in IFNG mRNA levels and a down-regulation of RORC in the ACD group. Immunofluorescence revealed dermal clusters of T cells co-localized with IL-4.

Conclusions

M2 macrophages and Th2 cells participate in the immunopathogenesis of MCI/MI ACD. Dermal dendrocytes and M2 macrophages may assist the formation of CD4+ T cells perivascular clusters. These findings render a mechanistic insight into the MCI/MI reaction. Further analysis at different timepoints of patch testing are required to fully comprehend this ACD kinetics.

View on the web

In healthy subjects nasal nitric oxide does not correlate with olfactory sensitivity, trigeminal sensitivity, and nasal air flow

xlomafota13 shared this article with you from Inoreader

Abstract

Objective

To determine the relationship between nasal nitric oxide (nNO) and olfactory sensitivity, trigeminal sensitivity, and nasal airflow in healthy subjects.

Study design

Correlational study.

Setting

Tertiary referral centre.

Participants

Forty healthy participants were recruited.

Main outcome measures

nNO was measured using a chemiluminescence analyser (Niox Vero®, Circassia AB, Uppsala, Sweden), olfactory sensitivity was determined using phenyl ethyl alcohol odour thresholds using the "Sniffin' Sticks", trigeminal sensitivity was assessed with carbon dioxide delivered by an automated device, and nasal airflow was measured using the peak nasal inspiratory flow (PNIF).

Results

The median nNO was 518 ppb (IQR = 333) in the right nostril, and it was 567 ppb (IQR = 314) in the left nostril. The median odour threshold was 7.1 (IQR = 4.4), the median CO2 threshold was 919 ms (IQR = 1297), and the mean PNIF was 108 L/min (SEM = 4.9). nNO did not correlate significantly with odour threshold, CO2 threshold or PNIF (Spearman's |ρ| < 0.15, p > 0.18).

Conclusion

In healthy subjects nNO does not appear to be associated with olfactory sensitivity, trigeminal sensitivity, and PNIF.

View on the web

Virus Load and Incidence of Olfactory, Gustatory, Respiratory, Gastrointestinal Disorders in COVID‐19 Patients: A Retrospective Cohort Study

xlomafota13 shared this article with you from Inoreader

Abstract

Objectives

This study investigated the relationship between viral load and the incidence of olfactory and gustatory dysfunction (OD and GD), the incidence of respiratory and gastrointestinal symptoms, and the recovery of OD and GD in COVID-19 patients.

Design

A Retrospective Cohort Study.

Setting and Participants

this cohort, conducted on 599 outpatients' cases in Golestan province between February and Juan 2020.

Main Outcome Measures

The incidence, severity (complete or partial), and recovery time of OD and GD and their associations with cycle threshold (CT) values of SARS-CoV-2 polymerase chain reaction was assessed.

Results

The mean age of patients was 38.27±13.62 years. The incidence of general symptoms included myalgia 70.1%, headache 51.8%, fever 47.7%, and dyspnea 21.4%. 41.9% of patients had gastrointestinal symptoms, including abdominal pain 26.5%, diarrhea 25.2%, nausea 20.5%, and vomiting 12.9%. 12.2% of patients had comorbidity. The trimester recovery rates of OD and GD were 93.94% and 94.74%, respectively. The mean recovery time of OD and GD was 14.56±13.37 and 13.8±3.77 days, respectively. The mean CT value in all patients was 27.45±4.55. There were significant associations between the mean of CT value with headache (P=0.04), GD (P=0.002) and OD (P=0.001).

Conclusions

The finding of this study indicates a possible association between viral load with incidence of OD and GD in COVID-19 patient's cases and assures the recovery of OD/GD in these patients.

View on the web

Αρχειοθήκη ιστολογίου