Development of the remote 100 ml water swallow test versus clinical assessment in patients with head and neck cancer: Do they agree?

alexandrossfakianakis shared this article with you from Inoreader Development of the remote 100 ml water swallow test versus clinical assessment in patients with head and neck cancer: Do they agree? via Head & Neck Abstract Background The 100 ml water swallow test (WST) is a validated swallow assessment used in head and neck cancer (HNC). We aimed to determine the level of agreement when completing the 100 ml WST via clinician-graded video-testing or patient self-testing compared to standard face-to-face assessment (FTF). Methods Convenience sampling from four UK centers. Inclusion criteria: patients with HNC treated with any modality prior to, or within 5 years of treatment. Participants were recruited to complete the 100 ml WST by video-testing or self-testing and compared with FTF. Results Sixty-three patients were recruited; 1 was unable to perform the task; 30 in video-testing; and 32 in self-testing. There was no difference in swallow capacity (p = 0.424) and volume (p = 0.363) for the video-testing or the self-testing swallow capacity (p = 0.777) and volume (p = 0.445). Conclusions This study demonstrates that video-testing and self-testing are reliable methods of completing the 100 ml WST for this sample of patients with HNC. View on Web

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Integrated longitudinal analysis of adult grade 4 diffuse gliomas with long-term relapse interval revealed upregulation of TGF-β signaling in recurrent tumors

alexandrossfakianakis shared this article with you from Inoreader Integrated longitudinal analysis of adult grade 4 diffuse gliomas with long-term relapse interval revealed upregulation of TGF-β signaling in recurrent tumors via Neuro-Oncology Advance Access Abstract Background Adult-type diffuse gliomas, CNS WHO grade 4 are the most aggressive primary brain tumors and represent a particular challenge of therapeutic intervention. Methods In a single-center retrospective study of matched pairs of initial and post-therapeutic glioma cases with a recurrence period greater than one year, we performed whole exome sequencing combined with mRNA and microRNA expression profiling to identify processes that are altered in recurrent gliomas. Results Mutational analysis of recurrent gliomas revealed early branching evolution in seventy-five percent of patients. High plasticity was confirmed at the mRNA and miRNA levels. SBS1 signature was reduced and SBS11 was elevated, demonstrating the effect of alkylating agent therapy on the mutational landscape. There was no evidence for secondary genomic alterations driving therapy resistance. ALK7/ACVR1C and LTBP1 were upregulated, whereas LEFTY2 was downregulated, pointing towards enhanced Tumor Growth Factor β (TGF-β) signaling in recurrent gliomas. Consistently, altered microRNA expression profiles pointed towards enhanced Nuclear Factor Kappa B and Wnt signaling that, cooperatively with TGF-β, induces epithelial to mesenchymal transition (EMT), migration and stemness. TGF-β-induced expression of pro-apoptotic proteins and repression of anti-apoptotic proteins were uncoupled in the recurrent tumor. Conclusions Our results suggest an important role of TGF-β signaling in recurrent gliomas. This may have clinical implication, since TGF-β inhibitors have entered clinical phase studies and may potentially be used in combination therapy to interfere with chemoradiation resistance. Recurrent gliomas show high incidence of early branching evolution. High tumor plasticity is confirmed at the level of mic roRNA and mRNA expression profiles. View on Web

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Response assessment in pediatric craniopharyngioma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group

alexandrossfakianakis shared this article with you from Inoreader Response assessment in pediatric craniopharyngioma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group via Neuro-Oncology Advance Access Abstract Craniopharyngioma is a histologically benign tumor of the suprasellar region for which survival is excellent but quality of life often poor secondary to functional deficits from tumor and treatment. Standard therapy consists of maximal safe resection with or without radiation therapy. Few prospective trials have been performed, and response assessment has not been standardized. The Response Assessment in Pediatric Neuro-Oncology (RAPNO) committee devised consensus guidelines to assess craniopharyngioma response prospectively. Magnetic resonance imaging (MRI) is the recommended radiologic modality for baseline and follow-up assessments. Radiologic response is defined by two-dimensional measurements of both solid and cystic tumor components. In certain clinical contexts, response of solid and cystic disease may be differentially considered based on their unique natural histories and responses to treatment. Importantly, the committee incorporated fu nctional endpoints related to neuro-endocrine and visual assessments into craniopharyngioma response definitions. In most circumstances, cystic disease should be considered progressive only if growth is associated with acute, new-onset or progressive functional impairment. Craniopharyngioma is a common pediatric CNS tumor for which standardized response parameters have not been defined. A RAPNO committee devised guidelines for craniopharyngioma assessment to uniformly define response in future prospective trials. View on Web

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Hyperkalaemia and potassium binders: Retrospective observational analysis looking at the efficacy and cost effectiveness of calcium polystyrene sulfonate and sodium zirconium cyclosilicate

alexandrossfakianakis shared this article with you from Inoreader Hyperkalaemia and potassium binders: Retrospective observational analysis looking at the efficacy and cost effectiveness of calcium polystyrene sulfonate and sodium zirconium cyclosilicate via Journal of Clinical Pharmacy and Therapeutics Both CPS and SZC are equally effective at lowering acutely raised potassium concentrations with a cost analysis that favours CPS. Any claims of benefits of newer agents over established medications need to be explored in randomized trials. Abstract What is Known and Objective Hyperkalaemia is a common medical emergency in patients admitted to hospital. There is a limited evidence base supporting some of the commonly applied treatment strategies. Although, NICE has recommended the use of sodium zirconium cyclosilicate (SZC) (TA599) and patiromer (TA623) in both acute and chronic hyperkalaemia, there is a limited evidence base for their use in acute hyperkalaemia in the hospital setting, particularly when compared to the present standard of care calcium polystyrene sulfonate (CPS). Methods A retrospective review of the electronic patient record system across our hospital over a 6-month period identified 138 patients who received either SZC (65 patients) or CPS (73 patients) to manage hyperkalaemia, investigating their efficacy and cost effectiveness. Results were analysed using simple descriptive statistics. Based on the results a naïve cost comparison between the two drugs was made. Results and Discussion CPS and SZC both effectively reduced plasm potassium concentrations in patients with hyperkalaemia (6.07 and 6.03 mmol/L respectively) by 1.17 mmol/L and 1.24 mmol/L taking a similar amount of time to work (2.97 days vs. 3 days). The principle causes of hyperkalaemia identified were acute kidney injury, medication, and chronic kidney disease. Cost comparison analysis which took into account raw product price and time needed to dispense medications revealed that CPS has slightly better cost effectiveness compared to SZC albeit at a cost of increased staff input. What is New and Conclusion Both CPS and SZC were equally effective at lowering acutely raised potassium concentrations. The cost difference between the two products appears to be small. Claims regarding the benefits of newer agents over older established medications need to be properly explored in randomized trials rather than being based on small scale non-comparative studies. View on Web

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Risk Characteristics of Hydrogen Sulphide Exposure in Wastewater Collection and Treatment Related Occupations

alexandrossfakianakis shared this article with you from Inoreader Risk Characteristics of Hydrogen Sulphide Exposure in Wastewater Collection and Treatment Related Occupations via Annals of Work Exposures and Health Advance Access Abstract Objectives Water and wastewater workers can be exposed to hydrogen sulphide (H2S), with an unpredictable exposure pattern, dominated by sharp peaks. These peaks can often be high above the ceiling value (CV) at 10 ppm. Methods We have analyzed self-administrated H2S exposure data among 60 wastewater workers in the Municipality of Trondheim, Norway, from 2015 till 2021. The detection range of the personal alarm equipment used was 1.6 to 100 ppm H2S. The workers were divided in four similar exposed groups (SEGs): wastewater collection net, wastewater treatment plants, wastewater pumping stations and water distribution net. Results We identified measurements from 7083 different workdays, approximately 10% of the workdays between 2015 and 2021. Within these, 1295 days had readings above 1.6 ppm H2S, and 424 (33%) of these days had readings that exceeded the CV of 10 ppm H2S. This percentage was similar across the SEGs. Only one workday had a time weighted average (TWA) exceeding the occupational exposure limit (OEL) of 5 ppm H2S, and only 14 days exceeded 0.5 ppm H2S, 1/10th of the OEL. Conclusions Wastewater workers in this study are regularly exposed to short peaks of H2S, but even high peaks do not influence the 8-h TWA values significantly. A preliminary measurement program over 3 days according to EN 689 to evaluate the need for further measurements would probably not find TWA values greater than 1/10 of OEL; the EN 689 standard is not made for evaluation to peak exposures. Exceedances of CV at 10 ppm H2S occur in 6% of workdays, and in 33% of days with exposure above 1.6 ppm. The toxicity and exposure profile of H2S makes continuous exposure monitoring necessary for alarm purposes. Reliance on the 8-h occupational exposure limit as has been the normal in Norway, will not be ade quately protective for wastewater workers. H2S alarm equipment should continue to be used. View on Web

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Extracapsular dissection with a transparotid facial nerve dissection approach versus partial superficial parotidectomy for benign tumours in the tail of the parotid gland: a single-centre retrospective study of 89 patients

alexandrossfakianakis shared this article with you from Inoreader Extracapsular dissection with a transparotid facial nerve dissection approach versus partial superficial parotidectomy for benign tumours in the tail of the parotid gland: a single-centre retrospective study of 89 patients via International Journal of Oral and Maxillofacial Surgery via MedWorm.com The aims of this study were (1) to evaluate the transparotid facial nerve dissection approach (TFND), in which the intraparotid cervicofacial or temporofacial division is identified first through a superficial lobe incision; and (2) to compare extracapsular dissection with a TFND (ECD-TFND) with partial superficial parotidectomy with a retrograde approach (PSP) for benign tumours in the tail of the parotid gland with respect to surgical outcomes. Eighty-nine patients underwent PSP or ECD-TFND for benign tumours in the tail of the parotid gland: 49 were treated surgically with PSP and 40 with ECD-TFND. (Source: International Journal of Oral and Maxillofacial Surgery) View on Web

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Analysis of the accuracy of computer‐assisted DCIA flap mandibular reconstruction applying a novel approach based on geometric morphometrics

alexandrossfakianakis shared this article with you from Inoreader Analysis of the accuracy of computer‐assisted DCIA flap mandibular reconstruction applying a novel approach based on geometric morphometrics via Head & Neck Abstract Background This study evaluated the accuracy of computer-assisted surgery (CAS)–driven DCIA (deep circumflex iliac artery) flap mandibular reconstruction by traditional morphometric methods and geometric morphometric methods (GMM). Methods Reconstruction accuracy was evaluated by measuring distances and angles between bilateral anatomical landmarks. Additionally, the average length of displacements vectors between landmarks was computed to evaluate factors assumed to influence reconstruction accuracy. Principal component analysis (PCA) was applied to unveil main modes of dislocation. Results High reconstruction accuracy could be demonstrated for a sample consisting of 26 patients. The effect of the number of segments and length of defect on reconstruction accuracy were close to the commonly used significance threshold (p = 0.062/0.060). PCA demonstrated displacement to result mainly from sagittal and transversal shifts. Conclusions CAS is a viable approach to achieve high accuracy in mandibular reconstruction and GMM can facilitate the evaluation of factors influencing reconstruction accuracy and unveil main modes of dislocation in this context. View on Web

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