Limited contribution of indocyanine green (ICG) angiography for the detection of parathyroid glands and their vascularization during total thyroidectomy: A STROBE observational study

xlomafota13 shared this article with you from Inoreader Limited contribution of indocyanine green (ICG) angiography for the detection of parathyroid glands and their vascularization during total thyroidectomy: A STROBE observational study Via oto-rhino-laryngologie Eur Ann Otorhinolaryngol Head Neck Dis. 2022 Mar 2:S1879-7296(22)00026-6. doi: 10.1016/j.anorl.2022.02.004. Online ahead of print. ABSTRACT INTRODUCTION: In total thyroidectomy, indocyanine green (ICG) angiography has mainly been evaluated at end of procedure to predict postoperative hypoparathyroidism. By using it during surgery, we sought to determine whether it could also be an aid to the surgeon. OBJECTIVE: To determine whether ICG used intraoperatively in total thyroidectomy modified the surgical procedure. MATERIAL AND METHOD: Thirty-two patients who underwent ICG angiography during total thyroidectomy were included in our single-center retrospective study. The number of parathyroid (PT) glands visualized in white light and on ICG angiography was collected, as well as PT vitality of at end of surgery according to these two modalities. Vitality scores were 0 (no vascularity), 1 (moderately vascularized) or 2 (well vascularize d). Postoperative calcemia at D1, D2 and D7 was analyzed. RESULTS: In the 32 operations, the surgical procedure was modified in 10 cases (31%). The average number of PTs detected was 2.4 (77 PT) on ICG angiography and 2 (65 PT) in white light. Eleven patients (37.5%) had postoperative hypocalcemia. Cumulative vitality scores at end of procedure were 3.75/8 and 3.37/8 in white light and on ICG angiography respectively (P=0.648). The use of the device did not predict the occurrence of postoperative hypocalcemia. CONCLUSION: Indocyanine green angiography used in thyroid surgery could assist the surgeon in the identification of PT glands, sparing them in one third of cases. PMID:35248501 | DOI:10.1016/j.anorl.2022.02.004 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cumulative Sum Analysis of the Learning Curve of Free Flap Reconstruction in Head and Neck Cancer Patients

xlomafota13 shared this article with you from Inoreader Cumulative Sum Analysis of the Learning Curve of Free Flap Reconstruction in Head and Neck Cancer Patients Via pubmed: "clin exp otorhinola... Clin Exp Otorhinolaryngol. 2022 Mar 4. doi: 10.21053/ceo.2021.01053. Online ahead of print. ABSTRACT OBJECTIVES: Owing to the functional and structural complexity of the head and neck area, the reconstruction of defects in these areas is challenging. Free flap surgery has become standard for the reconstruction of the head and neck with improvements in microvascular surgery. The aim of this study was to use the cumulative sum (CUSUM) method to evaluate the learning curve for free-flap head and neck reconstruction performed by a single surgeon. METHODS: We retrospectively reviewed the medical records of 47 patients who underwent free-flap reconstruction from 2017 to 2021. The clinical demographics and surgical outcomes were analyzed. The total operation time was analyzed using the CUSUM method, which is an analytical approach for visualizing patterns in data by converting raw data into an accumulation of deviations from the average value. RESULTS: CUSUM analysis showed two phases of the learning curve: phase 1 (cases 1-22) and phase 2 (cases 23-47). The operative time in phase 1 (579.9±128.2 minutes) was significantly longer than that in phase 2 (418.6±80.9 minutes) (P<0.001). The re-exploration rate was higher in phase 1 (31.8%) than in phase 1 (4%) (P=0.018). The flap failure rate was higher in phase 1 (9.1%) than in phase 1 (4%), but this difference was not statistically significant (P=0.593). CONCLUSION: The learning curve of free-flap head and neck reconstruction seems to stabilize after approximately 20 cases. PMID:35249319 | DOI:10.21053/ceo.2021.01053 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Current management and perspectives for locally advanced nasopharyngeal carcinoma

xlomafota13 shared this article with you from Inoreader Current management and perspectives for locally advanced nasopharyngeal carcinoma Via oto-rhino-laryngologie Cancer Radiother. 2022 Mar 3:S1278-3218(22)00030-0. doi: 10.1016/j.canrad.2021.11.026. Online ahead of print. ABSTRACT Nasopharyngeal carcinoma diagnosis is often made at a locally advanced stage (75 to 90% of cases) due to its deep localization. Concomitant radio-chemotherapy is the cornerstone of the treatment of locally advanced forms. The advent of intensity-modulated radiotherapy has improved oncological outcomes and reduced toxicity and is currently the gold standard for irradiation technique. For the locally advanced stage, the addition of induction chemotherapy has become the new standard care according to the latest international recommendations to reduce tumor volumes and act early on micro-metastases. Despite these therapeutic advances, the local and especially distant failure rate remains high. This article reviews current treatment strategies and discuss new approaches and perspectives of locoregional and systemic treatment to re duce treatment failures. PMID:35249815 | DOI:10.1016/j.canrad.2021.11.026 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Neural Contributions to the Cochlear Summating Potential: Spiking and Dendritic Components

xlomafota13 shared this article with you from Inoreader Neural Contributions to the Cochlear Summating Potential: Spiking and Dendritic Components Via Journal of the Association for Research in Otolaryngology Abstract Using electrocochleography, the summating potential (SP) is a deflection from baseline to tones and an early rise in the response to clicks. Here, we use normal hearing gerbils and gerbils with outer hair cells removed with a combination of furosemide and kanamycin to investigate cellular origins of the SP. Round window electrocochleography to tones and clicks was performed before and after application of tetrodotoxin to prevent action potentials, and then again after kainic acid to prevent generation of an EPSP. With appropriate subtractions of the response curves from the different conditions, the contributions to the SP from outer hair cells, inner hair cell, and neural "spiking" and "dendritic" responses were isolated. Like hair cells, the spiking and dendritic components had opposite polarities to tones — the dendritic component had negative polarity and the spiking component had positive polarity. The magnitude of the spiking component was larger than the dendritic across frequencies and intensities. The onset to tones and to clicks followed a similar sequence; the outer hair cells responded first, then inner hair cells, then the dendritic component, and then the compound action potential of the spiking response. These results show the sources of the SP include at least the four components studied, and that these have a mixture of polarities and magnitudes that vary across frequency and intensity. Thus, multiple possible interactions must be considered when interpreting the SP for clinical uses. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Firing Rate Adaptation of the Human Auditory Nerve Optimizes Neural Signal-to-Noise Ratios

xlomafota13 shared this article with you from Inoreader Firing Rate Adaptation of the Human Auditory Nerve Optimizes Neural Signal-to-Noise Ratios Via Journal of the Association for Research in Otolaryngology Abstract Several physiological mechanisms act on the response of the auditory nerve (AN) during acoustic stimulation, resulting in an adjustment in auditory gain. These mechanisms include—but are not limited to—firing rate adaptation, dynamic range adaptation, the middle ear muscle reflex, and the medial olivocochlear reflex. A potential role of these mechanisms is to improve the neural signal-to-noise ratio (SNR) at the output of the AN in real time. This study tested the hypothesis that neural SNRs, inferred from non-invasive assessment of the human AN, improve over the duration of acoustic stimulation. Cochlear potentials were measured in response to a series of six high-level clicks embedded in a series of six lower-level broadband noise bursts. This paradigm elicited a compound action potential (CAP) in response to each click and to the onset of each noise burst. The ratio of CAP amplitudes elicited by each click and noise burst pair (i.e., neural SNR) was tracke d over the six click/noise bursts. The main finding was a rapid (< 24 ms) increase in neural SNR from the first to the second click/noise burst, consistent with a real-time adjustment in the response of the auditory periphery toward improving the SNR of the signal transmitted to the brainstem. Analysis of cochlear microphonic and ear canal sound pressure recordings, as well as the time course for this improvement in neural SNR, supports the conclusion that firing rate adaptation is likely the primary mechanism responsible for improving neural SNR, while dynamic range adaptation, the middle ear muscle reflex, and the medial olivocochlear reflex played a secondary role on the effects observed in this study. Real-time improvements in neural SNR are significant because they may be essential for robust encoding of speech and other relevant stimuli in the presence of background noise. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Bioinspired Super-Strong Aqueous Synthetic Tissue Adhesives

xlomafota13 shared this article with you from Inoreader Bioinspired Super-Strong Aqueous Synthetic Tissue Adhesives Via leak of cerebrospinal fluid Matter. 2022 Mar 2;5(3):933-956. doi: 10.1016/j.matt.2021.12.018. Epub 2022 Jan 25. ABSTRACT Existing tissue adhesives and sealants are far from satisfactory when applied on wet and dynamic tissues. Herein, we report a strategy for designing biodegradable super-strong aqueous glue (B-Seal) for surgical uses inspired by an English ivy adhesion strategy and a cement particle packing theory. B-Seal is a fast-gelling, super-strong, and elastic adhesive sealant composed of injectable water-borne biodegradable polyurethane (WPU) nanodispersions with mismatched particle sizes and counterions in its A-B formulation. B-Seal showed 24-fold greater burst pressure than DuraSeal®, 138-fold greater T-pull adhesive strength than fibrin glue, and 16-fold greater lap shear strength than fibrin glue. In vivo evaluation on a rat cerebrospinal fluid (CSF) rhinorrhea model and a porcine craniotomy model validated the safety and efficacy of B-Seal for effective C SF leak prevention and dura repair. The plant-inspired adhesion strategy combined with particle packing theory represents a new direction of designing the next-generation wet tissue adhesives for surgeries. PMID:35252844 | PMC:PMC8896806 | DOI:10.1016/j.matt.2021.12.018 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Kidney and lung injury in rats following acute diquat exposure

xlomafota13 shared this article with you from Inoreader Kidney and lung injury in rats following acute diquat exposure Via Experimental and therapeutic medicine Exp Ther Med. 2022 Apr;23(4):275. doi: 10.3892/etm.2022.11201. Epub 2022 Feb 11. ABSTRACT Diquat (1,1'-ethylene-2,2'-bipyridylium) is a type of widely used agricultural chemical, whose toxicity results in damage to numerous tissues, including the lung, liver, kidney and brain. The aim of the present study was to establish a rat model of acute diquat exposure and explore the relationship between diquat concentration, and kidney and lung injury, in order to provide an experimental basis for clinical treatment. A total of 140 healthy adult male Wistar rats were randomly divided into control and exposure groups. The diquat solution was administered intragastrically to the exposure group at 1/2 of the lethal dose (140 mg/kg). An equal volume of water was administered to the control group. The dynamic changes in the plasma and tissue diquat levels were quantitatively determined at 0.5, 1, 2, 4, 8, 16 and 24 h following exposure using liquid chromatography mass spectrometry. The content of hydroxyproline (HYP) in the lung tissues, as well as the levels of blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA), kidney injury molecule-1 (KIM-1) and tumor growth factor (TGF)-β1, were detected using western blot analysis at every time point. Lung and kidney morphology were also assessed. Electron microscopy showed that the degree of renal damage gradually increased with time. Vacuolation gradually increased, some mitochondrial bilayer membrane structures disappeared and lysosomes increased. The lung tissue damage was mild, and the cell membrane integrity and organelles were damaged to varying degrees. The plasma and organ levels of diquat peaked at ~2 h, followed by a steady decrease, depending on the excretion rate. Over time, the serum concentrations of UA, BUN, Cr and KIM-1 were all significantly increased (P<0.05). Serum KIM-1 in rats was increased after 0.5 h, and was significantly increased after 4 h, suggesti ng that KIM-1 is an effective predictor of early renal injury. Early TGF-β1 expression was clearly observed in renal tissue, while no clear TGF-β1 expression was observed in the lung tissue. In conclusion, the concentration of diquat in the serum and tissue of rats with acute diquat poisoning peaked at an early stage and then rapidly decreased. The renal function damage and pathological changes persisted, the lung tissue was slightly damaged with inflammatory cell infiltration, and early pulmonary fibrosis injury was not obvious. PMID:35251341 | PMC:PMC8892614 | DOI:10.3892/etm.2022.11201 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinical impact of wireless capsule endoscopy for small bowel investigation (Review)

xlomafota13 shared this article with you from Inoreader Clinical impact of wireless capsule endoscopy for small bowel investigation (Review) Via Experimental and therapeutic medicine Exp Ther Med. 2022 Apr;23(4):262. doi: 10.3892/etm.2022.11188. Epub 2022 Feb 4. ABSTRACT Wireless capsule endoscopy is currently considered the gold standard in the investigation of the small bowel. It is both practical for physicians and easily accepted by patients. Prior to its development, two types of imaging investigations of the small bowel were available: radiologic and endoscopic. The first category is less invasive and comfortable for patients; it presents the ensemble of the small bowel, but it may imply radiation exposure. Images are constructed based on signals emitted by various equipment and require special interpretation. Endoscopic techniques provide real-time colored images acquired by miniature cameras from inside the small bowel, require interpretation only from a medical point of view, may allow the possibility to perform biopsies, but the investigation only covers a part of the small bowel and are more difficult to accept by patients. Wireless capsule endoscopy is the current solution that overcomes a part of the previous drawbacks: it covers the entire small bowel, it provides real-time images acquired by cameras, it is painless for patients, and it represents an abundant source of information for physicians. Yet, it lacks motion control and the possibility to perform biopsies or administer drugs. However, significant effort has been oriented in these directions by technical and medical teams, and more advanced capsules will surely be available in the following years. PMID:35251328 | PMC:PMC8892621 | DOI:10.3892/etm.2022.11188 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Paget's disease of bone and megaloblastic anemia in a 72-year-old patient: A case report and systematic literature review

xlomafota13 shared this article with you from Inoreader Paget's disease of bone and megaloblastic anemia in a 72-year-old patient: A case report and systematic literature review Via Experimental and therapeutic medicine Exp Ther Med. 2022 Apr;23(4):269. doi: 10.3892/etm.2022.11195. Epub 2022 Feb 8. ABSTRACT Paget's disease of bone (PDB) is characterized by abnormal osteoclastic bone resorption with disorganized bone neo-formation, primarily affecting elderly (>55 years) patients. Although the majority of patients are asymptomatic, some patients may experience bone pain due to local periosteal involvement or osteoarthritic lesions in the spine; in addition, limb deformities may lead to secondary gait problems or degenerative joint changes. Anemia has an overall prevalence of 12-17% in elderly adults (>65 years old), with macrocytic anemia being the less common type. Megaloblastic anemia is a macrocytic anemia characterized by the presence of large, immature, nucleated cells (megaloblasts) in the blood, with the most common cause being a deficiency of folate and/or vitamin B12. We herein report the rare case of a 72-year-old male patient exhibitin g both these conditions, with the aim of discussing the possible association between the two and, most importantly, the clinical management of the patient in a real-life setting over a period of 10 years. The patient was diagnosed based on clinical symptoms (bone pain), radiological imaging and specific laboratory tests, and received discontinuous courses of bisphosphonates and cyanocobalamin supplementation therapy, based mainly on aggravated symptomatology. A systematic literature review was also performed and revealed not only the scarcity of reports on similar cases, but also the mechanisms that may underlie the possible association of PDB with macrocytic anemia due to vitamin B12 deficiency in elderly patients. PMID:35251335 | PMC:PMC8892619 | DOI:10.3892/etm.2022.11195 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Neurological manifestations found in children with multisystem inflammatory syndrome

xlomafota13 shared this article with you from Inoreader Neurological manifestations found in children with multisystem inflammatory syndrome Via Experimental and therapeutic medicine Exp Ther Med. 2022 Apr;23(4):261. doi: 10.3892/etm.2022.11187. Epub 2022 Feb 4. ABSTRACT The pandemic that resulted from the spread of SARS-CoV-2 viral infections has affected the population worldwide but has characteristically shown a preponderance for affecting adults. However, cases of SARS-CoV-2 infection have been reported in children, showing a systemic echo and severe damage. Multisystem inflammatory syndrome in children (MIS-C) can occur, on average, 4 weeks after the infection of a child with SARS-CoV-2. The aim of the present study was to examine 30 cases of children affected by MIS-C in terms of symptoms, laboratory tests, and evolution. Patients included in the study presented with neurological symptomatology including headache, meningism, and drowsiness. Treatment was administered in concordance with the protocol for MIS-C. The evolution of the patients in the present study was favorable and the symptomatology remitted in days to weeks. The importance of identifying the features of this disease, its treatment, and that the most probable evolution is favorable is significant in the medical world, especially as the pandemic is ongoing. PMID:35251327 | PMC:PMC8892624 | DOI:10.3892/etm.2022.11187 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Delayed pathologic tibial fracture with chronic osteomyelitis after fibula free flap

xlomafota13 shared this article with you from Inoreader Delayed pathologic tibial fracture with chronic osteomyelitis after fibula free flap Via ear nose throat Ear Nose Throat J. 2022 Mar 7:1455613221075775. doi: 10.1177/01455613221075775. Online ahead of print. ABSTRACT The reported donor site morbidity of the fibula free flap (FFF) is low; however, several uncommon complications have been reported with tibia fracture rarely being reported. We present a case of a pathological tibial fracture in the setting of chronic osteomyelitis after FFF. A 54-year-old female presented with a benign fibro-osseous lesion of the right mandible an d was treated with mandibulectomy and reconstructed with a left FFF. Approximately 1 year following surgery, the patient presented to the emergency department. Imaging showed a pathological fracture of the distal third of the tibial shaft with persistent erythema and cellulitis of the lateral prior graft harvest site without signs of systemic infection. She was taken to the operating room for irrigation and debridement with culture and biopsy as well as external fixation of the tibial fracture. Intraoperative biopsy and culture demonstrated fracture site change with callus formation and negative culture. The patient was discharged on 6 weeks of IV vancomycin and ceftriaxone. In conclusion, tibial fracture following FFF is an uncommon complication, yet it can be exacerbated by chronic osteomyelitis. This report highlights the importance of close observation and comprehensive wound care of donor sites after free flap harvest for head and neck reconstruction. PMID:35254923 | DOI:10.1177/01455613221075775 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.