Κυριακή 9 Οκτωβρίου 2022

Fourteen years old as the best age cutoff to differentiate prepubertal from pubertal papillary thyroid carcinoma

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Abstract

Background

It is unclear whether differences in clinical presentation and/or prognosis exist between prepubertal papillary thyroid cancer (PTC) and pubertal PTC. At present, there is a lack of definition for the appropriate cutoff age to define prepubertal PTC.

Methods

This study retrospectively reviewed 227 pediatric PTC patients (aged ≤18 years) who underwent initial surgery from March 2000 to December 2018. The median duration of follow-up was 85 months (range, 8–258).

Results

The age range was basically linearly related to multiple risk factors, such as T3–T4 disease, distant metastasis. Age (p = 0.032) was an independent risk factor for recurrence and persistent disease. Patients aged <14 years had obviously higher rates of extensive disease. The 10-year disease-free survival (DFS) rate of patients aged <14 years was 59.5% and that of patients aged ≥14 years was 82.6% (p = 0.004).

Conclusions

Fourteen years of age may be an appropriate cutoff to differentiate prepubertal PTC from pubertal PTC.

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Association of Genre of Singing and Phonotraumatic Vocal Fold Lesions in Singers

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Association of Genre of Singing and Phonotraumatic Vocal Fold Lesions in Singers

This study revealed previously unrecognized associations between singing genre and specific types of vocal fold injury. These findings help to inform mechanistic inferences surrounding the pathophysiology of specific phonotrauma. A combination of factors most likely account for these findings, including vocal technique, acoustic environment and performance schedules.


Objectives/Hypothesis

To determine if (1) the likelihood of presenting with phonotraumatic lesions differs by singing genre in treatment-seeking singers and (2) if the distribution of phonotraumatic lesion types differs by singing genre.

Study Type

Retrospective.

Methods

Records of singers who presented with a voice complaint over the course of 2.5 years (June 2017–December 2019) were reviewed to determine the proportion of those with phonotraumatic lesions as a function of genre (Study 1). Separately, the lesion types and genres of singers diagnosed with phonotraumatic lesions over a 9-year period (July 2011–March 2020) were determined (Study 2).

Results

In Study 1, 191 of 712 (26.8%) dysphonic singers were diagnosed with phonotraumatic lesions. Country/folk, gospel/jazz, and musical theater singers were more likely to present with phonotraumatic lesions. In Study 2, in 443 singers with phonotraumatic lesions, polyps and pseudocysts, but not nodules, were found to be distributed unequally across genres (χ 2 p = 0.006, p < 0.0001, p = 0.064, respectively). Praise/worship singers had significantly higher proportions of polyps compared to choral singers (OR 4.8 [95% CI 1.9–12.5]) or compared to musical theater singers (OR 7.2 [95% CI 2.5–20.8]). Opera singers had significantly higher proportions of pseudocysts than choral singers (OR 3.1 [95% CI 1.5–6.1]) or musical theater singers (OR 3.7 [95% CI 1.8–7.6]).

Conclusions

The higher incidence of polyps in praise/worship singers likely reflects the more emphatic nature of singing and the tendency for acute injury. The higher incidence of pseudocysts in opera singers may reflect a more chronic nature of injury.

Level of Evidence

4 Laryngoscope, 2022

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Perioperative Hypercoagulability in Free Flap Reconstructions Performed for Intracranial Tumors

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Perioperative Hypercoagulability in Free Flap Reconstructions Performed for Intracranial Tumors

Patients with intracranial tumors have a higher risk of thromboembolic events. A multi-institutional retrospective chart review was performed of patients who underwent free tissue transfer for scalp/cranial reconstruction. There is an increase in perioperative flap thrombosis in patients with intracranial tumors undergoing free tissue scalp reconstruction, and anticoagulation appears to mitigate this risk.


Objective(s)

Patients with intracranial tumors have a higher risk of thromboembolic events. This risk increases at the time of surgical intervention. We have noted an anecdotal increase in perioperative flap thrombosis in patients undergoing free tissue transfer for intracranial tumor resection. This study aims to formally evaluate this risk.

Methods

A multi-institutional retrospective chart review was performed of patients who underwent free tissue transfer for scalp/cranial reconstruction. Perioperative thrombosis and free flap outcomes were evaluated.

Results

The 209 patients who underwent 246 free tissue transfers were included in the study. The 28 free flap scalp reconstructions were associated with intracranial tumors, 19 were performed following composite cranial resections with associated dural resection/reconstruction, and 199 were performed in the absence of intracranial tumors (control group). There was a significantly higher incidence of perioperative flap thrombosis in the intracranial tumor group (11/28, 39%) when compared to controls (38/199, 19%) (p = 0.0287). This was not seen when scalp tumors extended to the dura alone (4/19, 21%, p = 0.83). Therapeutic anticoagulation used for perioperative thrombosis (defined as intraoperative or in the immediate postoperative phase up to 5 days) was associated with a lower risk of flap failure, although this was not statistically significant (p = 0.148). Flap survival rates were equivalent between flaps performed for intracranial pathology (93.3%) and controls (95%).

Conclusion

There is an increase in perioperative flap thrombosis in patients with intracranial tumors undergoing free tissue scalp reconstruction. Anticoagulation appears to mitigate this risk.

Level of Evidence

This recommendation is based on level 3 evidence (retrospective case–control studies, systematic review of retrospective studies, and case reports) Laryngoscope, 2022

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Timing of Oral Feeding in Patients Who have Undergone Free Flap Reconstruction for Oral Cancer

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Timing of Oral Feeding in Patients Who have Undergone Free Flap Reconstruction for Oral Cancer


Objective

Determine the safety and effectiveness of a nasogastric tube removal plan designed to shorten nasogastric tube indwelling time after oral cancer surgery plus free flap reconstruction.

Materials and Methods

A parallel randomized clinical trial was conducted from May 2021 to December 2021 at Peking University School of Stomatology. Volunteers (n = 128) were separated into four groups: non-tracheostomy control and intervention groups and tracheostomy control and intervention groups. Control patients received the conventional nasogastric tube removal plan. Non-tracheotomy intervention patients were asked to swallow 5 ml of water on the first postoperative day. If there was no coughing, they were allowed progressively increasing amounts of water for the following 2 days. The nasogastric tube was removed only after ensuring level I/II performance on the Watian water swallowing test, no "wet voice" after drinking water, no marked decrease in blood oxygen saturation after drinking, and satisfactory daily oral nutritional intake. Tracheotomy intervention patients received the same protocol plus an additional Watian water swallowing test after tracheal tube removal.

Results

Nasogastric tube removal time was earlier in the intervention subgroups than in control subgroups: 5.0 ± 2.3 days versus 7.8 ± 3.9 days (p = 0.001) in non-tracheostomy patients and 9.8 ± 1.1 days versus 16.2 ± 13.0 days (p = 0.049) in tracheostomy patients. Incidence of wound complications and daily food intake were comparable between the groups. The incidence of pneumonia was lower in the tracheostomy intervention group than in the tracheostomy control group (12.5% vs. 3.1%, p = 0.162). Pharyngeal pain score was lower in tracheotomy intervention patients than in tracheotomy control patients (p = 0.029). Postoperative hospital stay was shorter in tracheotomy intervention patients than in tracheotomy control patients (p = 0.005).

Conclusions

On the basis of ensuring safety and effectiveness, patients undergone free flap reconstruction for oral cancer could be offered oral intake early after surgery, which will not increase the incidence of wound complications and pneumonia or adversely affecting the oral intake of the patients; it can also help minimize pharyngeal pain and shorten postoperative hospital stay of patients with a tracheotomy.

Level of Evidence

II Laryngoscope, 2022

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Effect of sacubitril/valsartan on cognitive impairment in colchicine‐induced Alzheimer’s model in rats

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Abstract

Background

Alzheimer's disease (AD) is a complex neurodegenerative disease. There is epidemiological evidence that heart failure (HF) patients are at higher risk of developing AD and the impact of sacubitril/valsartan, the first angiotensin receptor-neprilysin inhibitor (ARNI) approved for HF, on cognitive functions is still controversial.

Objective

To investigate the effect of sacubitril/valsartan on cognitive functions in colchicine-induced AD rat model.

Methods

Forty adult male Wistar rats were equally allocated into four groups (each of 10 rats). Group I: normal control, Group II: intracerebroventricular injection of colchicine (15μg/5μl/bilaterally), Group III: colchicine (15μg/5μl/bilaterally, icv) + oral sacubitril/valsartan (100 mg/kg/day) for 25 days and Group IV: colchicine (15μg/5μl/bilaterally, icv) + oral valsartan (50 mg/kg/day) for 25 days. Behavioral assessment was done using Morris water maze and passive avoidance tasks. Biochemically, β-amyloid (1-40 and 1-42) peptides, oxidative stress (malondialdehyde and superoxide dismutase) and inflammatory (tumor necrosis factor-alpha) parameters were measured in hippocampus and prefrontal cortex.

Results

Sacubitril/valsartan exaggerated colchicine-induced cognitive impairment in both Morris water maze and passive avoidance tasks, and was associated with significant increase in β-amyloid accumulation, oxidative stress and inflammation versus valsartan.

Conclusion

Sacubitril/valsartan caused deleterious effect on cognitive impairment and biochemical alterations in colchicine-induced AD rat model. Hence, special caution should be taken following long-term intake of ARNI on cognitive functions.

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Protective assessment of progesterone and its receptor on experimental diabetic neuropathy: Anti‐oxidant and anti‐inflammatory effects

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Abstract

Introduction

Diabetes induces a disorder in mitochondrial activity, which causes damage to the nuclear and mitochondrial DNA, and ultimately increases the release of inflammatory cytokines and damages the sciatic nerve and dorsal root ganglion and induces neuropathy. It has been shown that progesterone has anti-inflammatory and anti-oxidative effects and prevents nerve cell damage. Therefore, the aim of this experiment was to investigate the effect of progesterone receptor neuroprotection on diabetic neuropathy.

Methods

Forty male Sprague-Dawley rats were divided into 4 groups, including control group, diabetic control group, diabetic control group+Progesterone(30mg/kg), diabetic control group+combination of Progesterone(30mg/kg) and RU486(10mg/kg). After the induction of diabetes, blood glucose level, body weight, behavioral tests, electrophysiological tests, oxidative and inflammatory factors, and histological parameters were measured.

Results

Progesterone treatment significantly reduced the level of sensitivity to hot plate without significant effect on glucose level, and significant changes were also observed in the results of tail flake test. In addition, the results showed that the administration of progesterone can improve MNCV and significantly reduce the serum levels of oxidative stress and inflammatory factors, as well as inflammation and edema around the sciatic nerve. However, RU486 inverted the beneficial effects of progesterone.

Conclusion

Progesterone can be considered as a protective agent in reducing DN because of its ability to reduce inflammation and nerve damage. In addition, RU486, a progesterone receptor blocker, inhibits the beneficial effects of progesterone on the DN, thus progesterone receptors play an important role in the neuroprotective effect of progesterone.

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LEUKOTRIENE METABOLISM AND PROIFLAMMATORY CYTOKINES IN CRIMEAN CONGO HEMORRHAGIC FEVER

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Abstract

Crimean-Congo hemorrhagic fever (CCHF) is an emerging acute viral infection disease, yet its pathophysiology remains largely uncharacterized. Lipid mediators are molecules that play numerous roles in the physiologic and pathophysiologic conditions in certain viral diseases. No previous study evaluated the status of cysteinyl leukotrienes (CYSLT) and 5-lipoxygenase (5-LO) and their relationship with proinflammatory cytokines in CCHF. A total of 90 subjects including 60 CCHF patients and 30 healthy controls were enrolled the study. Serum CYSLT, 5-LO, interleukin-6 (IL-6) and ferritin levels were determined in the study population. Lower median 5-LO level was determined in patients compared to healthy controls (p = 0.0004). Higher ferritin (p < 0.001) and IL-6 (p < 0.001) levels in patients than healthy controls. No statistically significant difference was observed between patients and controls in terms of CYSLT levels. No statistically significant differ ences were observed between mild, moderate, and severe groups in terms of both 5-LO and CYSLT levels. IL-6 and ferritin levels were higher in severe group compared mild and moderate groups. In conclusion, changes in 5-LO enzyme and increased inflammation are related with the disease molecular mechanism. Higher inflammatory status contributes to the impaired hemostatic balance in CCHF. Thus, treatment strategies to reduce inflammation may help to prevent bleeding and DIC in patients. IL-6 and ferritin can be used to as an additional biomarker in the estmation of the prognosis and diagnosis of the patients.

This article is protected by copyright. All rights reserved.

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‘Like ships in the night’: A qualitative investigation of the impact of childhood cancer on parents’ emotional and sexual intimacy

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Abstract

Background

Childhood cancer is highly distressing for families and can place strain on parents' relationships. Parental functioning and cohesiveness are important predictors of family functioning and adaptation to stress. This qualitative study investigated the perceived impact of childhood cancer on parents' relationship with their partner, with a focus on emotional and sexual intimacy.

Methods

We conducted semi-structured interviews with 48 parents (42 mothers, six fathers) of children under the age of 18 who had completed curative cancer treatment. We analysed the interviews using thematic analysis.

Results

At interview, parents were on average 40.7 years old (SD = 5.5, range: 29–55 years), and had a child who had completed cancer treatment between 3 months and 10.8 years previously (M = 22.1 months). All participants were living with their partner in a married/de facto relationship. Most parents reported that their child's cancer treatment had a negative impact on emotional and sexual intimacy with their partner, with some impacts extending to the post-treatment period. Reasons for compromised intimacy included exhaustion and physical constraints, having a shifted focus, and discord arising from different coping styles. Some parents reported that their relationship strengthened. Parents also discussed the impact of additional stressors unrelated to the child's cancer experience.

Conclusions

Parents reported that childhood cancer had a negative impact on aspects of emotional and sexual intimacy, although relationship strengthening was also evident. It is important to identify and offer support to couples who experience ongoing relationship stress, which may have adverse effects on family functioning and psychological wellbeing into survivorship.

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Recovery of gland function after endoscopy-assisted removal of impacted hilo-parenchymal stones in the Wharton ’s duct

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The aim of this study was to evaluate the gland function of patients following endoscopy-assisted removal of impacted hilo-parenchymal stones in the Wharton 's duct. The study cohort comprised 115 patients who had undergone successful endoscopy-assisted lithotomy for hilo-parenchymal stones (mean diameter 7.7 mm). Gland function was evaluated at a mean 12 months after surgery using ultrasonography, sialography, and/or sialometry. Postoperative ultras onography of 51 affected glands revealed a regular gland size in 58.8%, normal parenchyma density in 51.0%, and ductal ectasia in 80.4%. (Source: International Journal of Oral and Maxillofacial Surgery)
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Nosocomial malaria transmissions resolved by genomic analyses – a retrospective case report study in France (2007-2021)

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Abstract
Background
Exposure of blood to malaria parasites can lead to infection even in the absence of the anopheles mosquito vector. During a stay in a healthcare facility, accidental inoculation of the skin with blood from a malaria patient might occur, referred to as nosocomial malaria transmission.
Methods
Between 2007 and 2021, we identified six autochthonous malaria cases that occurred in six different French hospitals, originating from nosocomial transmi ssion and imported malaria patients being the infection source. Four cases were observed during the COVID-19 pandemic. The genetic relatedness between source and nosocomial infections was evaluated by genome-wide short tandem repeats (STRs) and single-nucleotide polymorphisms (SNPs).
Results
None of the patients with autochthonous malaria had travel history to an endemic area nor had been transfused. For each case, both the source and recipient patients stayed a few hours in the same ward. After diagnosis, autochthonous cases were treated with antimalarials and all recovered except one. Genetically, each pair of matched source/nosocomial parasite infections showed less than 1% of different genome-wide STRs, and less than 6.9% (<1.5% for monoclonal infections) of different SNPs. Similar levels of genetic differences were obtained for parasite DNA samples that were independently sequenced twice as references of identical infections. Parasite phylogenomic results were consi stent with travel information reported by the source patients.
Conclusions
Our study demonstrates that genomics analyses may resolve nosocomial malaria transmissions, despite the uncertainty regarding the modes of contamination. Nosocomial transmission of potentially life-threatening parasites should be taken into consideration in settings or occasions where compliance with universal precautions is not rigorous.
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