"We want to really help our patients learn not to be concerned or stressed about the dentist, and to have a really good experience when they come in," Revell said. Revell said children love seeing their favorite Disney character in the office, and it makes them feel more comfortable when going to the dentist.
Publication date: Available online 31 October 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Isabela de Oliveira Amui, José Vicente Tagliarini, Emanuel C. Castilho, Mariângela de Alencar Marques, Yoshio Kiy, José Eduardo Corrente, Gláucia M.F.S. Mazeto
IntroductionEndogenous thyroid-stimulating hormone-stimulated thyroglobulin collected after total thyroidectomy is a useful predictor of better prognosis in patients with differentiated thyroid carcinomas in general, but studies with microcarcinomas are scarce.ObjectiveTo assess whether the first postoperative stimulated thyroglobulin measurement is a prognostic factor in patients with microcarcinoma.MethodsThe medical data of 150 differentiated thyroid carcinoma patients were studied retrospectively, and 54 (36%) cases with microcarcinoma were selected. The first postoperative stimulated thyroglobulin (1st stimulated thyroglobulin), measured after thyroidectomy, initial presentation data, and microcarcinomas treatment were assessed regarding outcome. Worse prognosis was defined as neoplasm persistence/recurrence.ResultsPersistence/recurrence occurred in 27.6% of the cases. These patients were identified according to the following parameters: receiving more than one 131iodine dose (100% vs. 0%; p<0.0001); accumulated 131iodine dose (232.14±99.09 vs. 144±33.61mCi; p<0.0001); presented active disease in the last assessment (53.3% vs. 0%; p<0.0001); follow-up time (103.07±61.27 vs. 66.85±70.14 months; p=0.019); and 1st stimulated thyroglobulin (19.01±44.18 vs. 2.19±2.54ng/dL; p<0.0001). After multivariate logistic regression, only the 1stSTg [odds ratio=1.242; 95% confidence interval: 1.022–1.509; p=0.029] and follow-up time (odds ratio=1.027; 95% confidence interval: 1.007–1.048; p=0.007) were independent predictors of risk of persistence/recurrence. The cutoff point of 1.6ng/dL for the 1st stimulated thyroglobulin was significantly associated with disease persistence/recurrence [area under the curve=0.713 (p=0.019)].ConclusionThe first stimulated thyroglobulin predicted disease persistence/recurrence in patients with microcarcinoma.
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Publication date: Available online 31 October 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): M.K. Harishankar, A. Mathan Mohan, A. Vinod Krishnan, Devi Arikketh
IntroductionOral verrucous carcinoma is a special form of well-differentiated squamous cell carcinoma which possesses specific clinical, morphologic and cytokinetic features that differ from other types of oral cancers and hence diagnosis requires immense experience in histopathology. Hence it is certainly important to distinguish such a lesion from other oral tumors as treatment strategies vary widely between them.ObjectiveIn search of a critical diagnostic marker in distinguishing oral verrucous carcinoma from oral squamous cell carcinoma, Notch4 receptor, one of the key regulatory molecules of the Notch signaling family has been aberrantly activated in the progression of several types of tumors. However its function in oral verrucous carcinoma remains unexplored. Thus the present study aims in determining the differential expression pattern of Notch4 in oral verrucous carcinoma and oral squamous cell carcinoma.MethodsTen patients reported positive for oral cancer (5 patients with oral verrucous carcinoma and 5 patients with oral squamous cell carcinoma). Five normal tissue samples were also obtained and evaluated for clinicopathological parameters and immunohistochemistry, western blotting and RT-PCR for Notch4 expression.ResultsOur results reveal that the expression of Notch4 was considerably high in oral squamous cell carcinoma lesions compared to normal tissue, whereas in oral verrucous carcinoma, irrespective of the clinicopathological features, complete regulação descendente of Notch4 was observed.ConclusionsThese preliminary findings strongly support the fact that Notch4 is downregulated in oral verrucous carcinoma and could be considered as a suitable prognostic marker in distinguishing oral verrucous carcinoma from oral squamous cell carcinoma. This distinguishing marker can help in improving therapeutic options in patients diagnosed with oral verrucous carcinoma.
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10 randomised trials were included in this review of he adjunctive use of statins with scaling and root planing for treatment of chronic periodontitis . The findings suggest additional benefits with their use regardless of health or smoking status.
The post Scaling and root planing: Do adjunctive statins improve effectiveness? appeared first on National Elf Service.
Otolaryngology-Head and Neck Surgery, Ahead of Print.
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To investigate the fracture behavior and marginal gap region of CAD/CAM fabricated lithium disilicate (L) and zirconium dioxide (Z) crowns using palatal venting (PV), pre-cementation with custom analogs (CA), or conventional cementation technique (SP) with adhesive cement (A) or resin-modified glass ionomer cement (B).
Twelve groups (n = 6) were set according to material (L, Z), cement (A, B), and technique (PV, CA, SP). Specimens were thermo-mechanical aged (TML), loaded until fracture (LF) and fracture patterns recorded. Marginal gap width and quality were assessed and compared to replicas obtained before and after TML.
Crown material significantly influenced LF with a mean of 1037.6 ± 282.4 N in L and 5356.3 ± 1207.0 N in Z groups (p < .001). Neither cement material nor cementation method affected the outcome. Fractures occurred along the mesial-distal central fissure in both materials. Gap width before TML was 22.04 ± 13.42 μm for L and 19.98 ± 12.72 μm for Z specimens, with overall no influence of crown material, cement type, or method. Marginal cleanliness just below the polished implant shoulder reached 66.7%–88.9% with A, and 91.7%–100% with B, and tended to increase in all groups during TML indicating a decrease in excess cement. Implant-crown junctions were cleaner with B compared to A (p ≤ .001) and along Z crown surfaces compared to L (p ≤ .007).
Crown venting of lithium disilicate and zirconium dioxide crowns did not affect the fracture load and patterns. Complete cement removal was rare, and the observed particle ablation requires further clinical attention, particularly with submucosal margins.
Lung adenocarcinomas with a micropapillary pattern (MPP) are characterized by more frequent and pronounced vascular invasion, higher incidence and more advanced lymph node involvement and poorer prognosis than papillary adenocarcinomas without an MPP. Here we established a new lung cancer cell line featuring micropapillary structure.
A 73-year-old never-smoker Japanese female, presenting with an abnormal chest shadow, was diagnosed with a clinical T2aN0M0 Stage IB lung adenocarcinoma and underwent left upper lobectomy with mediastinal lymph node dissection. Pathological study demonstrated a T2aN2M0 Stage IIIA micropapillary adenocarcinoma. Tumor cells were obtained from freshly resected lung material and used to establish the KU-Lu-MPPt3 cell line.
The KU-Lu-MPPt3 cells featured adherent monolayers, adherent tufts, and suspended tufts without adhesion under the same culture conditions. The cells were positive for cytokeratin, epithelial cell-adhesion molecules, E-cadherin, mucin-1, thyroid transcription factor-1, vimentin, and anti-programmed death ligand 1. Xenograft tumors clearly demonstrated micropapillary structures. Sequencing and fragment analysis of the epidermal growth factor receptor in the primary tumor tissue and KU-Lu-MPPt3 cells revealed an in-frame deletion E746-A750 in exon 19.
This cell line represents a new model system for molecular studies of lung adenocarcinoma which may be suitable for investigation of cancer spread and also for development of molecular-targeting and immunotherapies, both in vitro and in vivo.
Rucker's Makin' Batch Candies, Inc. of Bridgeport, IL is voluntarily recalling the specific code dates listed below of The Toothsome Chocolate Emporium Dark Chocolate Coffee Beans, due to an undeclared milk allergen. People who have an allergy or severe sensitivity to milk allergen run the risk of serious or life threatening allergic reaction if they consume this product. No illness has been reported to date.
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The number of children under the age of 10 needing hospital treatment because of tooth decay is twice as high as the number needing help for a broken arm, according to new analysis. While arm fractures are one of the more common ailments for youngsters, hospital medics are treating twice as many children with rotten teeth, according to data shared with the Press Association.
To present a Danish national series of oncocytic carcinoma (OC) patients, including data on treatment, recurrence and survival.
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To investigate factors affecting the effect of physical rehabilitation therapy for synkinesis as a sequela to facial nerve palsy.
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To integrate the available data published on central mucoepidermoid carcinoma (CMC) into a comprehensive analysis of its clinical aspects, histology, treatment, and prognostic factors.
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Head and neck cancer is the tenth leading cause of cancer mortality. Ninety percent of tumours in the oral cavity are squamous cell carcinomas. Information about the exact localisation of OSCC is missing in the literature. In the present study, we retrospectively analysed a total of 1501 OSCC patients, who were treated between 1975 and 2009. The purpose of this study was to examine the localisation of OSCC tumours and to analyse the influence of various parameters on tumour localisation. 71.5% of these patients were male and 28.5% were female.
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Surgery in endocrine orbitopathy should address exophthalmos and adjunct stigmata such as increased lid aperture and scleral show. Secondary to decompression, rehabilitative surgical treatment such as blepharoplasty is routinely used to achieve this goal. Until now, however, there has been no investigation to measure the effect of decompression surgery on scleral show and lid aperture 3-dimensionally.
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The aim of this study was to determine the effect of vascularized fibula free flap (VFFF) harvest on gait variables during the six-minute walk test (6MWT). Eleven patients who had undergone VFFF harvest and 11 healthy peers participated in this case–control study. The main evaluation consisted of the collection of gait variables using the GAITRite system during three periods of the 6MWT: beginning (0–1min), middle (2:30–3:30min), and end (5–6min). The 6MWT was significantly shorter in the VFFF group than in the reference group (−31%, P<0.001).
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This work was aimed at establishing the molecular etiology of hearing loss in a 9-year old girl with post-lingual non-syndromic mild sensorineural hearing loss with a complex family history of clinically heterogeneous deafness.
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An increasing number of end-stage heart failure patients are supported with left ventricular assist device (LVAD) implantation and must be maintained on a consistent anticoagulation regimen. Preemptive extraction of carious teeth in these patients is necessary to seeding of the implanted device and endocarditis. Thus, the objective of this study was to evaluate bleeding complications after minor oral surgery, specifically teeth extractions, in this unique patient population requiring chronic anticoagulation.
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Rucker's Wholesale and Service Co of Bridgeport, IL is voluntarily recalling all of Uncle Buck's and Family Choice Dark Chocolate Peanuts packaged in standup twist tie bag, due to the presence of an undeclared milk ingredient. People who have an allergy or sensitivity to milk run the risk of serious or life threatening allergic reaction if they consume this product. No illness associated with this recall has been reported.
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Liver transplant recipients have a higher prevalence of anal squamous intraepithelial lesions
British Journal of Cancer, Published online: 31 October 2017; doi:10.1038/bjc.2017.370
The last remaining charges against a local dentist who was accused of sexually assaulting female patients were dismissed in court Tuesday at the prosecution's request. Dr. Nikhilkumar M. Patel, 55, of 64 O'Donnell Ave., Shrewsbury was scheduled to go to trial Tuesday in Central District Court on three counts of indecent assault and battery stemming from allegations that he squeezed a woman's breast on three occasions during dental procedures in 2015 and 2016 in his office at 130 Lincoln St. The charges were dropped, however, after Assistant District Attorney Alyssa A. Kilmurray filed a motion to dismiss saying the complaining witness did not wish to go forward with the trial.
Five Whole Foods Market stores in Northern California are voluntarily recalling frosted Pumpkin Drop cookies because the products contained tree nut allergens (walnuts) that were not listed on the product label. People who have an allergy or severe sensitivity to walnuts run the risk of serious or life-threatening allergic reactions if they consume these products.
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21st Century Snack Foods, of Ronkonkoma NY 11779, is voluntarily issuing the following recall: Dark Chocolate Almonds packaged in a 6 oz peg / stand up bag. UPC# 030603 228549. Affected Lot #'s are 16100 thru 17300. The product brand is 21st Century Snack Foods.
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E. Ramírez de Arellano et al.
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J. Gomez-Torres et al.
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This retrospective follow-up study evaluates the efficacy and safety of bioactive glass (BAG) S53P4 when applied as filler material in mastoid obliteration surgery performed on non-cholesteatomatous chronic otitis media (NC-COM) patients with chronically discharging ears despite conservative therapy. 94 Patients (96 ears) were included. Patients underwent either intact canal wall (ICW) or canal wall down (CWD) mastoid surgery between 2005 and 2015. The intervention group comprised 23 patients (23 ears) who were treated with additional mastoid obliteration using BAG S53P4; the remaining 71 patients (73 ears) were considered controls. All patients underwent preoperative CT scanning of the mastoid. Primary functional outcome, as defined by control of suppuration, was assessed using Merchant's scale. Hearing results as measured by air–bone gap and the incidence of adverse events were assessed as secondary outcomes. Thirty-two ears (44%) in the control group (n = 73) achieved complete control of infection at the most recent postoperative clinic visit vs 17 (74%) in the S53P4 obliteration group (n = 23). Comparing these outcomes yielded an odds ratio (OR) of 3.6 (p = 0.012, 95% CI 1.3–10.3). Complete failure to manage infection significantly differed (p = 0.048) between the control group (11 ears; 15%) and the S53P4 obliteration group (0 ears). No adverse events were observed in either group. Pre- and postoperative ABG results did not differ significantly between groups. Obliteration of the mastoid cavity using BAG S53P4 along with mastoidectomy in patients with chronically discharging NC-COM significantly improves the achievement of a dry and safe ear as compared to mastoidectomy alone. Importantly, no adverse events were observed with S53P4 BAG obliteration.
Anaplastic carcinoma of the thyroid gland (ATC) is one of the most aggressive cancers in humans. With insufficient treatment, the disease most often leads to death in suffocation. From 2002, our treatment strategy has been hyperfractionated accelerated radiotherapy (HART) with high doses (64 Gy) to the neck, followed by surgery 4–8 weeks later if feasible, with the aim to gain control in the neck. After a pathology review, 51 patients were diagnosed with ATC in the period 2002–2014 in the south-east of Norway. Thirty-one received HART, and we present a study of these patients, with death in suffocation as the primary endpoint and survival as the second. No patients treated with HART died in suffocation. Six had a tracheostomy during their course of disease, of whom four were dependent on a tracheal cannula when they died. The best median survival, 19 months, was obtained in the 13 patients where both radiotherapy and surgery were possible as primary treatments. Only surgery came out as a prognostic factor for survival in multivariate analysis. Patients surviving more than 2 years were characterised by having surgery with R0 resection and no or small residual foci of ATC in the specimens. Stage 4C patients survived 3 months only.
We describe a technique for approaching petrous apex cholesteatoma using combined lateral microscopic/endoscopic approaches, and discuss the utility of endoscopy in managing matrix inside the petrous apex. In our two cases, total view inside the petrous apex was achieved under endoscopy without mobilizing the internal carotid artery, and the matrix was successfully removed. Neither patient has presented with postoperative recurrence thanks to the wide-angle endoscopic view inside the petrous apex. Since the number of patients was small, comparisons with microscopic treatments are not yet valid, but endoscopes could offer a helpful tool for operating inside the petrous apex.
Posterior pharyngeal wall squamous cell carcinomas (SCCs) are rare and have an associated poor prognosis. Progress in transoral resection techniques, in particular, transoral robotic surgery (TORS), have renewed the role of surgery in their treatment. This article presents the oncological and functional results obtained by the French Group of Head and Neck Robotic Surgery for TORS for posterior pharyngeal wall SCC-curative surgery. This retrospective, multicentre study presents data collected between September 2009 and November 2013 for patients treated with TORS for posterior pharyngeal wall SCCs. Analysis of patient characteristics, tumour and treatment details were completed. Kaplan–Meier analysis was used to calculate overall survival rates and recurrence-free survival rates. Student's t test and Chi2 test were also calculated. 23 patients were included (mean age of 62 years). 12 patients had a prior HNSCC. Ten patients had pT1 cancers. The overall two-year survival rate was 59%, but 89% for pT1 compared to 28% for pT2-T3 (p = 0.01). It was noted that TORS was simple to perform, but generated significant post-operative dysphagia. Two cases of spondylodiscitis were reported as specific post-operative complications of TORS. In conclusion, TORS is a treatment solution for selected posterior pharyngeal wall SCCs. It provides a possible alternative to medical treatment for early pT1 lesions and is often the only remaining curative solution in patients previously treated with radiotherapy. In cases of bulky resection, or when there is a past medical history of radiotherapy, a tissue reconstruction by forearm free-flap may be indicated.
Describe the indications and outcome of subtotal petrosectomy for cochlear implant recipients. Tertiary care referral center. This is a retrospective study of all subtotal petrosectomies and cochlear implants performed between January 2012 and December 2014. We review the charts of these patients collecting the following data: age, gender, otologic history, audiologic tests, indication of subtotal petrosectomy, data of surgery, surgical and immediate complications, late complications and follow-up of for at least 2.5 years. 12 cases of subtotal petrosectomies with cochlear implantation in 11 patients were performed during this period; 2 children and 10 adults. The indication for a cochlear implant was in 10 cases bilateral severe to profound sensorineural hearing loss and in the remaining 2 cases was asymmetric hearing loss or unilateral hearing loss. The reason for performing a subtotal petrosectomy was chronic otitis media with or without cholesteatoma, radical cavities from previous surgeries or electrode extrusion of previously implanted devices. All cases were performed in one stage. One patient had an infectious complication that required revision surgery and finally an explantation. No other complications are described. Subtotal petrosectomy combined with cochlear implantation is a procedure required in certain situations. It is an effective and safe procedure for managing middle ear problems and creating a safe cavity to receive a cochlear implant either in adults and children.
We reviewed the surgical management of primary hyperparathyroidism through a retrospective chart review of 200 parathyroidectomy procedures performed over a 12 year period. Epidemiological data and accuracy of radiological investigations used in identifying pathological parathyroid tissue location were assessed. We determined how often simultaneous removal of thyroid tissue was required during parathyroidectomy and the associated pathology. Radiology reports were screened to determine if confirmed thyroid pathology from histological specimens were referenced pre-operatively. Open parathyroid surgery was performed in 71%, the remainder endoscopically. 95% of parathyroid specimens were confirmed as benign adenomas, with eight cases of hyperplasia and two parathyroid carcinomas. Pre-operative ultrasound and SPECT-CT imaging demonstrated sensitivity of 55% and 73% respectively with regards correct adenoma localisation. Forty-nine patients (25%) underwent simultaneous partial thyroidectomy, 45 (92%) with dual pathology confirmed. Malignant thyroid lesions were identified in 18% (n = 8), Graves' disease 2% (n = 1), thyroiditis 9% (n = 4), multinodular goitre 56% (n = 25), unilateral nodule 4% (n = 2), hyperplasia 7% (n = 3) and intra-thyroid adenoma 4% (n = 2). Reference to these thyroid lesions was made in only 36% of preoperative imaging reports. In conclusion, synchronous thyroid surgery was carried out in a quarter of all parathyroidectomy procedures performed for treatment of primary hyperparathyroidism. Coincidental thyroid pathology was common. The limitations of pre-operative imaging in reliably locating involved parathyroid tissue are demonstrated and the importance of considering the potential need to perform thyroid surgery during parathyroidectomy and obtaining appropriate informed consent.
Obstructive sleep apnoea (OSA) is a condition characterised by repetitive upper airway collapse during sleep. The condition carries a range of health sequelae that can prove fatal in cases with co-existing risk factors for the condition, such as obesity and hypertension. Utilisation of a high-performance screening tool for OSA is thus important. A retrospective audit using the ESS and Stop-Bang scores, alongside Apnoea–Hypopnea Index values, for patients who underwent polysomnography over 1 year. Multinomial logistic regression was used to compare the predictive abilities of ESS, SBM, and body mass index (BMI) for the patient outcome groups, "None" (No OSA), "Notreat" (OSA not requiring treatment) and "treat" (OSA requiring treatment). The influences of age, gender and BMI on outcome group were also assessed. 126 bariatric and 66 non-bariatric patients were included. Multinomial logistic regression failed to demonstrate predictive ability of ESS. A higher Stop-Bang score significantly increases the risk being in the "treat" group. In addition, male gender, greater age and a higher BMI each individually increase the risk of OSA requiring treatment. Stop-Bang failed to demonstrate predictive significance when age and gender were controlled for. ESS is not an appropriate screening tool for OSA. Stop-Bang, however, remains a useful screening tool, with the ability to detect patient with OSA in need of treatment. Further study may benefit the development and implementation of a concise and more specific screening tool that considers high evidence-based risk factors for OSA, including male gender, greater age and raised BMI.
Total laser energy in CO2 stapedotomy depends on the laser settings and the amount of applications. It is unclear if the amount of total laser energy affects bone-conduction hearing thresholds and if possible effects are temporary or permanent. Alterations of bone-conduction hearing thresholds after single or multiple-shot CO2 laser stapedotomy were analyzed between 1 and 3 weeks and 1.5–6 months after primary (n = 501) or revision surgeries (n = 153) and correlated to time, laser energy, frequency, surgical technique, and pathology encountered in revision stapedotomy. In both time periods, most patients showed a lower bone-conduction threshold in the four-tone puretone average (PTA) at frequencies of 0.5, 1, 2, and 3 kHz that further improved over time. Between 1 and 3 weeks, the improvement was significant in subgroups with cumulative energies lower 1 J and successful one-shot technique or in revisions without laser application. The remaining subgroups with higher total energies showed significant improvements between 1.5 and 6 months. At 4 and 8 kHz, significant improvements were found during 1.5–6 months after primary and revision surgery independent of the used energy. Repeated CO2 laser applications showed no impairment in bone-conduction thresholds and can thus be considered as safe. In most patients, significant, yet unexplained, improvements in bone-conduction hearing thresholds were noticed in a time- and energy-related pattern.
The objective of this paper is to assess synkinesis associated with post paretic voluntary facial movements using the objective OSCAR method and to investigate the correlation between synkinesis and paresis to compare the objective results with the subjective scaling systems of Fisch and House–Brackmann. The development of an objective assessment of synkinesis with the OSCAR method is focused on the clinically most relevant eye-mouth and forehead-mouth synkinetic movements. Thirteen patients with unilateral facial paralysis and synkinesis of the University Hospital Zurich were examined. Two types of clinically relevant facial synkinesis were found: a maximal synkinesis and a relative synkinesis. Neither Synkinesis-Index correlates well with the underlying degree of global facial palsy. The relative Synkinesis-Index (rSI) correlates well with the subjective evaluation of synkinesis according to the Fisch Grading, but shows a poor correlation with the traditional House–Brackmann grading. Therefore a single scaling index combining the degree of facial nerve palsy and synkinesis is inappropriate and we propose the use of two independent scaling systems for the evaluation of facial palsy: one for the voluntary facial movements, the other for the involuntary synkinetic movements. The adequate evaluation of the post paretic face should include the results of both scaling systems.
This communication is the response to letter to the editor in reference to "The transotic approach for vestibular schwannoma: indications and results".
K. Klitgaard et al.
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J. Marino et al.
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In Nelson, dentist Karen Doouss might extract three teeth a week, but on a recent volunteer trip to Vanuatu, she pulled out hundreds in the same time frame. She was part of a 54-strong team that included doctors, nurses, occupational therapists, physiotherapists and optometrists from a number of different countries.
A series of new sulfonamides have been synthesized from Ampyrone with different benzene sulfonyl chlorides to yield the N-1,5-dimethyl-3-oxo-2-phenyl-2,3-dihydro-1H-pyrazol-4-yl) benzenesulfonamides (4a–e). All synthesized compounds were characterized on the basis of FTIR, 1H NMR, and 13C NMR, and also by the aid of mass spectral data. Further, all synthesized compounds have studied for their in vitro antimicrobial activities against selected bacterial as well as fungal strains by the agar well diffusion method. Free radical scavenging activity has been investigated by using DPPH method. Among all the synthesized compounds, 4b, 4d, and 4e exhibited significant antimicrobial and antioxidant activities.
A. Balajee et al.
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J. A. Walldorf et al.
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To evaluate the non-inferiority of the adjunct of a xenogeneic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions and compare superiority in patient reported outcomes (PROM).
187 subjects (92 CMX) with 485 recessions in 14 centres were randomized and followed-up for 6-months. Patients filled daily diaries for 15 days to monitor patient reported experience. Primary outcome was change in position of the gingival margin. Multilevel analysis used centre, subject, and tooth as levels and baseline parameters as covariates.
Average baseline recession was 2.5 ± 1.0 mm. The surgery was 15.7 minutes shorter (95%CI from 11.9 to 19.6, P<0.0001) and perceived lighter (11.9 VAS units, 95%CI from 4.6 to 19.1, P=0.0014) in CMX subjects. Time to recovery was 1.8 days shorter in CMX. Six-month root coverage was 1.7 ± 1.1 mm for CMX and 2.1 ± 1.0 mm for CTG (difference of 0.44 mm, 95%CI from 0.25 to 0.63 mm). The upper limit of the confidence interval was over the non-inferiority margin of 0.25 mm. Odds of complete root coverage were significantly higher for CTG (OR = 4.0, 95% CI 1.8–8.8).
Replacing CTG with CMX shortens time to recovery and decreases morbidity but the tested generation of devices is probably inferior to autologous CTG in terms of root coverage. Significant variability in PROMs was observed among centres.
This article is protected by copyright. All rights reserved.
Otolaryngology-Head and Neck Surgery, Ahead of Print.
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Otolaryngology-Head and Neck Surgery, Ahead of Print.
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In an earlier study from this laboratory, Vibrio fluvialis BD146, a clinical isolate from Kolkata, India, 2002, was found to be resistant to all the fourteen antibiotics tested. It harboured a high copy number plasmid pBD146 and a low copy number plasmid. In the present study, a more detailed analysis was carried out to unravel different resistance mechanisms in this isolate. Sequencing showed that variable region of class 1 integron located on low copy number plasmid harbored arr3-cmlA-bla OXA10-aadA1 gene cassettes. Analysis for extended spectrum beta lactamases (ESBLs) revealed that BD146 was ESBL positive. Efflux pumps were involved in the drug resistance phenotype for chloramphenicol, kanamycin, streptomycin and tetracycline. Sequence analysis of pBD146 revealed the presence of genes encoding BDint an integrase with a unique sequence having little similarity to other known integrases, toxin–antitoxin (parE/parD), a replicase, trimethoprim resistance (dfrVI) and quinolone resistance (qnrVC5). Presence of cmlA, putative novel integrase and toxin–antitoxin system in V. fluvialis has been documented for the first time in this report. pBD146 showed 99% sequence similarity with pVN84 from V. cholerae O1 of Vietnam, 2004 and a plasmid from V. parahaemolyticus v110 of Hong Kong, 2010. Conjugation experiments proved the ability of pBD146 and the low copy number plasmid, to get transferred to another host imparting their antibiotic resistance traits to the transconjugants. Therefore, present study has indicated that plasmids played an important role for dissemination of drug resistance.
Otolaryngology-Head and Neck Surgery, Ahead of Print.
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Otolaryngology-Head and Neck Surgery, Ahead of Print.
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Alveolar bone response to light-force tipping and bodily movement in maxillary incisor advancement:A prospective randomized clinical trial.
Angle Orthod. 2017 Oct 30;:
Authors: Chaimongkol P, Thongudomporn U, Lindauer SJ
Abstract
OBJECTIVE: To compare alveolar bone thickness and height changes between untreated incisors (control), incisors advanced with light-force tipping, and incisors advanced with bodily movement mechanics.
MATERIALS AND METHODS: Forty-three subjects (aged 9.49 ± 1.56 years) with anterior crossbite were allocated into an untreated group (control), tipping group, or bodily movement group. Lateral cephalograms were taken before advancement (T0) and after obtaining normal overjet (T1). Changes in labial and palatal alveolar bone thickness and height surrounding maxillary incisors were evaluated with limited field-of-view cone-beam computed tomography before advancement (CT0) and 4 months after normal overjet was obtained (CT1). Wilcoxon matched-pairs signed-rank and Kruskal-Wallis one-way ANOVA tests were used to compare changes within and between groups, as appropriate. The significance level was set at .05.
RESULTS: Labial alveolar bone thickness at the midroot and apical levels were significantly decreased in the bodily movement group (P < .05). However, between groups, there was no statistically significant difference in labial bone thickness changes at any level. Palatal and total alveolar bone thickness at the midroot and apical levels were significantly decreased in the tipping group compared with the control and bodily movement groups (P < .05). Neither labial nor palatal bone height changes were significantly different among groups.
CONCLUSIONS: Maxillary incisor advancement with light-force tipping and bodily movement in growing patients resulted in labial alveolar bone thickness and labial and palatal alveolar bone height changes that were similar to the untreated group.
PMID: 29083225 [PubMed - as supplied by publisher]
A free, three-day clinic will be held at the new mosquito control facility at 10550 Veterans Blvd. between 8 a.m. and 6 p.m. on Jan. 19 and 20 and between 8 a.m. and 3 p.m. on Jan. 21, the city-parish announced in a Monday news release. "Professionals will be available to help with dental, vision and medical needs.
Several data indicate that migraine, especially migraine with aura, is associated with an increased risk of ischemic stroke and other vascular events. Of concern is whether the risk of ischemic stroke in migra...
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Safety evaluation of HOWARU(®) Restore (Lactobacillus acidophilus NCFM, Lactobacillus paracasei Lpc-37, Bifidobacterium animalis subsp. lactis Bl-04 and B. lactis Bi-07) for antibiotic resistance, genomic risk factors, and acute toxicity.
Food Chem Toxicol. 2017 Oct 25;:
Authors: Morovic W, Roper JM, Smith AB, Mukerji P, Stahl B, Rae JC, Ouwehand AC
Abstract
Although probiotic lactobacilli and bifidobacteria are generally considered safe by various regulatory agencies, safety properties, such as absence of transferable antibiotic resistance, must still be determined for each strain prior to market introduction as a probiotic. Safety requirements for probiotics vary regionally and evaluation methods are not standardized, therefore methodologies are often adopted from food ingredients or chemicals to assess microbial safety. Four individual probiotic strains, Lactobacillus acidophilus NCFM(®), Lactobacillus paracasei Lpc-37(®), Bifidobacterium animalis subsp. lactis strains Bl-04(®), and Bi-07(®), and their combination (HOWARU(®) Restore) were examined for antibiotic resistance by broth microdilution culture, toxin genes by PCR and genome mining, and acute oral toxicity in rats. Only B. lactis Bl-04 exhibited antibiotic resistance above a regulated threshold due to a tetW gene previously demonstrated to be non-transferable. Genomic mining did not reveal any bacterial toxin genes known to harm mammalian hosts in any of the strains. The rodent studies did not indicate any evidence of acute toxicity following a dose of 1.7-4.1 × 10(12) CFU/kg body weight. Considering a 100-fold safety margin, this corresponds to 1.2-2.8 × 10(12) CFU for a 70 kg human. Our findings demonstrate a comprehensive approach of in vitro, in silico, and in vivo safety testing for probiotics.
PMID: 29080807 [PubMed - as supplied by publisher]
Surface Roughness Changes in Denture Liners in Denture Stomatitis Patients.
Int J Prosthodont. 2017 Oct 30;:
Authors: Valentini F, Luz MS, Boscato N, Pereira-Cenci T
Abstract
PURPOSE: This randomized clinical trial assessed how surface roughness (Ra) in resilient liners was affected by soft tissue health conditions and time-related aspects in patients with complete dentures.
METHODS: Specimens of acrylic resin (control) and denture liners (silicone-based or acrylic resin-based) were inserted into the dentures of patients with and without denture stomatitis (n = 30). Ra was evaluated before denture insertion and after 7, 14, and 21 days of prosthesis wearing. Data were analyzed using three-way analysis of variance and Student-Newman-Keuls test.
RESULTS: Patients with stomatitis showed a higher Ra (P < .001), while all liners presented rougher surfaces after 14 days of clinical service, irrespective of the soft tissue health condition.
CONCLUSION: Ra of the tested denture liners was increased in patients with denture stomatitis. It is presumed that a longer wearing period will result in rougher surfaces.
PMID: 29084304 [PubMed - as supplied by publisher]
Pivotal role for the ESCRT-II complex subunit EAP30/SNF8 in IRF3-dependent innate antiviral defense.
PLoS Pathog. 2017 Oct 30;13(10):e1006713
Authors: Kumthip K, Yang D, Li NL, Zhang Y, Fan M, Sethuraman A, Li K
Abstract
The activation of interferon (IFN)-regulatory factor-3 (IRF3), characterized by phosphorylation and nuclear translocation of the latent transcription factor, is central to initiating innate antiviral responses. Whereas much has been learned about the upstream pathways and signaling mechanisms leading to IRF3 activation, how activated IRF3 operates in the nucleus to control transcription of IFNs remains obscure. Here we identify EAP30 (a.k.a, SNF8/VPS22), an endosomal sorting complex required for transport (ESCRT)-II subunit, as an essential factor controlling IRF3-dependent antiviral defense. Depletion of EAP30, but not other ESCRT-II subunits, compromised IRF3-dependent induction of type I and III IFNs, IFN-stimulated genes (ISGs) and chemokines by double-stranded RNA or viruses. EAP30, however, was dispensable for the induction of inflammatory mediators of strict NF-κB target. Significantly, knockdown of EAP30 also impaired the establishment of an antiviral state against vesicular stomatitis virus and hepatitis C virus, which are of distinct viral families. Mechanistically, EAP30 was not required for IRF3 activation but rather acted at a downstream step. Specifically, a fraction of EAP30 localized within the nucleus, where it formed a complex with IRF3 and its transcriptional co-activator, CREB-binding protein (CBP), in a virus-inducible manner. These interactions promoted IRF3 binding to target gene promoters such as IFN-β, IFN-λ1 and ISG56. Together, our data describe an unappreciated role for EAP30 in IRF3-dependent innate antiviral response in the nucleus.
PMID: 29084253 [PubMed - as supplied by publisher]
Leptotrichia species in human infections II.
J Oral Microbiol. 2017;9(1):1368848
Authors: Eribe ERK, Olsen I
Abstract
Leptotrichia species are non-motile facultative anaerobic/anaerobic bacteria that are found mostly in the oral cavity and some other parts of the human body, in animals, and even in ocean sediments. Valid species include L. buccalis, L. goodfellowii, L. hofstadii, L. honkongensis, L. shahii, L. trevisanii, and L. wadei. Some species require serum or blood for growth. All species ferment carbohydrates and produce lactic acid that may be involved with tooth decay. Acting as opportunistic pathogens, they are involved in a variety of diseases, and have been isolated from immunocompromised but also immunocompetent individuals. Mucositis, oral lesions, wounds, and abscesses may predispose to Leptotrichia septicemia. Because identification of Leptotrichia species by phenotypic features occasionally lead to misidentification, genetic techniques such as 16S rRNA gene sequencing is recommended. Early diagnosis and treatment of leptotrichia infections is important for positive outcomes. Over the last years, Leptotrichia species have been associated with several changes in taxonomy and new associations with clinical diseases. Such changes are reported in this updated review.
PMID: 29081911 [PubMed]
Impact of prior therapies on everolimus activity: an exploratory analysis of RADIANT-4.
Onco Targets Ther. 2017;10:5013-5030
Authors: Buzzoni R, Carnaghi C, Strosberg J, Fazio N, Singh S, Herbst F, Ridolfi A, Pavel ME, Wolin EM, Valle JW, Oh DY, Yao JC, Pommier R
Abstract
BACKGROUND: Recently, everolimus was shown to improve median progression-free survival (PFS) by 7.1 months in patients with advanced, progressive, well-differentiated, nonfunctional neuroendocrine tumors (NET) of lung or gastrointestinal (GI) tract compared with placebo (HR, 0.48; 95% CI, 0.35-0.67; P<0.00001) in the Phase III, RADIANT-4 study. This post hoc analysis evaluates the impact of prior therapies (somatostatin analogs [SSA], chemotherapy, and radiotherapy) on everolimus activity.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01524783.
PATIENTS AND METHODS: Patients were randomized (2:1) to everolimus 10 mg/day or placebo, both with best supportive care. Subgroups of patients who received prior SSA, chemotherapy, or radiotherapy (including peptide receptor radionuclide therapy) were analyzed and reported.
RESULTS: A total of 302 patients were enrolled, of whom, 163 (54%) had any prior SSA use (mostly for tumor control), 77 (25%) received chemotherapy, and 63 (21%) were previously exposed to radiotherapy. Patients who received everolimus had longer median PFS compared with placebo, regardless of previous SSA (with SSA: 11.1 vs 4.5 months [HR, 0.56 {95% CI, 0.37-0.85}]; without SSA: 9.5 vs 3.7 months [0.57 {0.36-0.89}]), chemotherapy (with chemotherapy: 9.2 vs 2.1 months [0.35 {0.19-0.64}]; without chemotherapy: 11.2 vs 5.4 months [0.60 {0.42-0.86}]), or radiotherapy (with radiotherapy: 9.2 vs 3.0 months [0.47 {0.24-0.94}]; without radiotherapy: 11 vs 5.1 months [0.59 {0.42-0.83}]) exposure. The most frequent drug-related adverse events included stomatitis (59%-65%), fatigue (27%-35%), and diarrhea (24%-34%) among the subgroups.
CONCLUSION: These results suggest that everolimus improves PFS in patients with advanced, progressive lung or GI NET, regardless of prior therapies. Safety findings were consistent with the known safety profile of everolimus in NET.
PMID: 29081664 [PubMed]
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Apoptosis as a Mechanism for Keratinocyte Death in Canine Toxic Epidermal Necrolysis.
Vet Pathol. 2017 Mar;54(2):249-253
Authors: Banovic F, Dunston S, Linder KE, Rakich P, Olivry T
Abstract
In humans and dogs, toxic epidermal necrolysis (TEN) is a life-threatening dermatosis characterized by sudden epidermal death resulting in extensive skin detachment. There is little information on the pathogenesis of keratinocyte cell death in canine TEN. We studied the occurrence of apoptosis in skin lesions of dogs with TEN to determine if apoptosis contributes to the pathogenesis of this disease. Immunostaining with antibodies to activated caspase-3 and the terminal deoxynucleotidyl-transferase (TdT)-mediated deoxyuridine triphosphate (dUTP) nick-end labeling technique revealed positive apoptotic keratinocytes in basal and suprabasal epidermal compartments in 17 biopsy specimens collected from 3 dogs with TEN and 16 from 3 dogs with erythema multiforme (EM). There was no significant difference in the number of positively stained epidermal cells between TEN and EM. These results suggest that apoptosis of epidermal keratinocytes and lymphocytic satellitosis represent one of the early steps in the pathogenesis of canine TEN, as in the human disease counterpart.
PMID: 27581387 [PubMed - indexed for MEDLINE]
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Extreme Esophageal Hyperkeratosis Presenting as an Arachnoid Mass.
Am J Gastroenterol. 2016 05;111(5):599
Authors: Abdelqader A, Goud A, Fleisher AS
PMID: 27151114 [PubMed - indexed for MEDLINE]
The main aim of this study was to investigate whether Hounsfield unit derived from computed tomography (HU/CT) and gray value derived from cone beam computed tomography (GV/CBCT) can predict the amount of new bone formation (NBF) in the defects after bone reconstruction surgeries.
Thirty calvaria defects created in 5 rabbits and grafted with both radiolucent (RL, n = 15) and radiopaque (RO, n = 15) bone substitute materials were evaluated, 8 weeks postoperatively. The defects were scanned by multislice computed tomography (Somatom®, Siemens Healthineers, Erlangen, Germany) and CBCT (NewTom VG®, Qualitative Radiology, Verona, Italy). MSCT and CBCT scans were matched to select the exact region of interest (ROI, diameter = 5 mm and height = 1 mm). HU/CT and GV/CBCT of each ROI were obtained. Mean amount of NBF in whole of the defects was measured using serial histomorphometric assessment. We investigated the correlation between HU/CT and GV/CBCT, HU/CT and NBF, and GV/CBCT and NBF generally, and separately among the RL or RO grafted defects, by linear generalized estimating equation modeling. Receiver operation characteristic analysis was performed to check the accuracy of HU/CT and GV/CBCT in diagnosing more than 10% NBF in the samples.
There were linear correlations between HU/CT and GV/CBCT, HU/CT and NBF, and GV/CBCT and NBF.
According to the results, both HU/CT and GV/CBCT can be considered as fairly good predictors for assessment of the amount of NBF following bone reconstruction surgeries.
May Hendry was the Dental Practice Adviser to the health board but left as she feared patient safety was being put at risk. A dentist who quit her senior role with the health board amidst a false allegation scandal has spoken of her relief at finally being vindicated.
The vocal fold epithelium that includes tight junction (TJ)-based barrier function protects underlying connective tissues from external insults. TJs play an important role to control paracellular permeability of not only solutes but also ions, and preserve the vocal fold homeostasis. However, the distribution of TJs and paracellular diffusion barrier across the entire vocal fold epithelium are still unknown. The aim of this study was to identify the distribution of TJs in the vocal fold epithelium and to characterize the recovery process of TJ-based paracellular diffusion barrier in a rat model of vocal fold injury.
Animal experiments with controls.
Normal and vocal fold–injured rats were used. Larynges were harvested for immunohistochemical examination of TJ proteins. For functional analysis, a tracer permeability assay was performed using EZ-Link Sulfo-NHS-LC-Biotin.
TJ proteins occludin and zonula occludens 1 signals were localized to the junctional regions of the most luminal cell layers of the vocal fold epithelium. The injured region had been recovered with epithelium at 5 days postinjury, but the paracellular diffusion barrier assays revealed that biotinylation reagents diffused into the lamina propria at 5 days postinjury, and were blocked at the epithelium at 14 and 28 days postinjury.
It was strongly suggested that TJs in the vocal fold epithelium exist at the junctional regions of the first layer of stratified squamous epithelium. TJ-based paracellular diffusion barrier following vocal fold injury is recovered by 14 days postinjury, and this period corresponds with the time course of structural changes in the regenerating epithelium layer.
NA Laryngoscope, 2017
Chronic bacterial infection of the larynx is characterized by long-standing hoarseness and exudative laryngitis. Prolonged antibiotic therapy is required to clear the infection, and methicillin-resistant staphylococcus aureus (MRSA) may be the responsible pathogen. The objective of this study was to describe the presentation, comorbidities, treatment response, and underlying etiology— including the incidence of MRSA—in our patient population with chronic bacterial laryngitis.
A review of patients with a diagnosis of chronic bacterial laryngitis from 2012 to 2016 was performed. Diagnosis of chronic bacterial laryngitis was based on clinical history and findings on flexible laryngoscopy. In selected cases, the diagnosis of bacterial laryngitis was confirmed by operative biopsy. Information regarding clinical presentation and course was collected.
Twenty-eight patients were included in the study. Twenty-three were treated empirically with Amoxicillin-clavulonic acid for a minimum of 21 days. Twelve of the 23 (52%) had recurrence or nonresolution of infection. Seven of the 12 nonresponders (58%) were found to have MRSA by laryngeal tissue culture. Five patients were treated initially with Sulfamethoxazole and trimethoprim, and all resolved the infection without the need for further treatment. There was a nonstatistically significant increase in smoking and reflux in the MRSA population compared to the non-MRSA group.
MRSA infection was documented in 30% of patients overall with chronic bacterial laryngitis. Based on the results of the study, a treatment algorithm for management of this unusual patient population is suggested.
4. Laryngoscope, 2017
Laryngeal muscles (LMs) are controlled by the recurrent laryngeal nerve (RLN), injury of which can result in vocal fold (VF) paralysis (VFP). We aimed to introduce a bioelectric approach to selective stimulation of LMs and graded muscle contraction responses.
Acute experiments in cats.
The study included six anesthetized cats. In four cats, a multichannel penetrating microelectrode array (MEA) was placed into an uninjured RLN. For RLN injury experiments, one cat received a standardized hemostat-crush injury, and one cat received a transection-reapproximation injury 4 months prior to testing. In each experiment, three LMs (thyroarytenoid, posterior cricoarytenoid, and cricothyroid muscles) were monitored with an electromyographic (EMG) nerve integrity monitoring system. Electrical current pulses were delivered to each stimulating channel individually. Elicited EMG voltage outputs were recorded for each muscle. Direct videolaryngoscopy was performed for visualization of VF movement.
Stimulation through individual channels led to selective activation of restricted nerve populations, resulting in selective contraction of individual LMs. Increasing current levels resulted in rising EMG voltage responses. Typically, activation of individual muscles was successfully achieved via single placement of the MEA by selection of appropriate stimulation channels. VF abduction was predominantly observed on videolaryngoscopy. Nerve histology confirmed injury in cases of RLN crush and transection experiments.
We demonstrated the ability of a penetrating MEA to selectively stimulate restricted fiber populations within the feline RLN and selectively elicit contractions of discrete LMs in both acute and injury-model experiments, suggesting a potential role for intraneural MEA implantation in VFP management.
NA Laryngoscope, 2017
To determine if patients with prior airway surgery for obstructive sleep apnea (OSA) had increased benefit following implantation with hypoglossal nerve stimulator.
Retrospective chart review at a single institution tertiary academic care center.
Following implantation with hypoglossal nerve stimulator device, the outcomes of patients who underwent prior airway surgery for OSA were compared with those who did not. Primary outcome measures included apnea-hypopnea index (AHI) and nadir oxyhemoglobin saturation (NOS) as measured by polysomnography. Secondary outcome measures included Epworth Sleepiness Scale.
Forty-seven patients underwent implantation with hypoglossal nerve stimulator. Of these, 30 patients had undergone prior airway surgery for OSA, whereas 16 did not. Mean preoperative AHI and NOS were 39.3 ± 2.8 and 78% ± 1.8% for all patients, 39.4 ± 3.7 and 79% ± 14% for patients with prior airway surgery, and 39.1 ± 4.0 and 77% ± 2.6% for patients without prior surgery. Mean postoperative AHI and NOS were 3.9 ± 1.2 and 91% ± 0.4% for all patients, 4.2 ± 1.7 and 91% ± 0.5% for patients with prior surgery, and 3.4 ± 1.5 and 93% ± 0.6% for patients without prior surgery (P = 0.756 and 0.053, respectively).
Overall, patients had significant improvement following implantation with hypoglossal nerve stimulator. Prior airway surgery had no statistically significant effect on postoperative AHI or NOS.
4. Laryngoscope, 2017
To analyze oropharyngeal squamous cell carcinoma incidence and mortality trends in the United States for the years 1973 through 2013.
Cross-sectional study using a large population-based cancer database.
Data on incidence and mortality rates were extracted from the Surveillance, Epidemiology, and End Results (SEER) 9 Database. Annual percentage change in rates was calculated using Joinpoint regression analysis (National Cancer Institute, Bethesda, MD).
Incidence rates increased (annual percent change [APC]; 1.52, 95% confidence interval [CI] 0.17 to 2.88) from 1973 to 1983, remained stable (APC −0.52, 95% CI −1.30 to 0.26) from 1983 to 1997, and increased (APC 1.32, 95% CI 0.83 to 1.81) from 1997 to 2013. Overall, incidence rates increased for males (APC 0.73, 95% CI 0.22 to 1.25) but not females (APC −0.77, 95% CI −0.68 to 0.82). Incidence rates increased in the white population (APC 0.79, 95% CI 0.33 to 1.25) but decreased in the black population (APC −0.72, 95% CI −1.41 to −0.02). The incidence rates increased for tongue-base tumors (APC 1.17, 95% CI 0.42 to 1.92) and tonsil tumors (APC 0.47, 95% CI 1.10 to 4.96) but decreased for other sites. Incidence-based mortality decreased (APC −0.78, 95% CI −1.13 to −0.42) from 1993 to 2013.
Oropharyngeal squamous cell carcinoma incidence rates increased in a nonlinear fashion from 1973 to 2013, whereas mortality rates declined. This, along with variation in trends by demographic and tumor factors, suggest that human papilloma virus is the main driver of the recent rise in incidence.
2b. Laryngoscope, 2017
Patients with human papillomavirus (HPV)–induced cancer of unknown primary (CUP) are generally excluded from clinical trials, despite surgical series reporting detection rates of occult oropharynx primaries of >80%. We performed a matched-pair analysis to compare outcomes between T0N1-3M0 HPV+ CUP and T1-2N1-3M0 HPV+ oropharynx known primary (OPX).
Retrospective cohort study at a single institution.
Patients with early T stage, node positive HPV+ OPX or CUP treated with curative intent between 1998 and 2016 were identified. For a subgroup of CUP patients with an unknown HPV status, we imputed HPV status and included patients with a >80% probability of being HPV+. Cohorts were matched based on patient demographics using a nearest neighbor propensity technique. After matching, patients were grouped according to either a favorable or unfavorable risk stratification designations per current NRG Oncology clinical trial enrollment criteria. Disease-free survival (DFS) and overall survival (OS) were calculated using Kaplan-Meier analysis.
Of 298 patients with T1-2N1-3 OPX, 48 were matched to 48 HPV+ CUP patients (32 with confirmed and 16 imputed HPV status). Median follow-up for CUP (34.1 months) and OPX (27.8 months) patients were similar (P = .23).There were no significant differences between the CUP and OPX groups for 3-year DFS (89% vs. 85%, P = .44), and 3-year OS (91% vs. 91%, P = .11), respectively.
Patients with T0N+M0 HPV-induced CUP have similar survival outcomes to matched patients with T1-2N+M0 HPV+ OPX. These patients can reasonably be included in clinical trials investigating the role of treatment deintensification and risk stratified similar to patients with early-stage known primary OPX cancer.
4. Laryngoscope, 2017
The objective of our systematic review is to investigate the postoperative gustatory function of the chorda tympani nerve following noninflammatory ear surgery for which the chorda tympani is at risk for iatrogenic injury (stretching, handling, or sacrificing).
PubMed and EMBASE.
A PubMed and EMBASE databases search was conducted on November 15, 2016. Study inclusion criteria included: 1) ear surgery performed for noninflammatory ear diseases, and 2) gustatory function of the chorda tympani reported as an outcome. The quality of eligible studies was assessed using the risk of bias assessment tool for nonrandomized studies. Study characteristics and outcome data of the included studies were extracted.
In total 1,094 articles were retrieved. Fourteen studies encompassing 1,062 operated ears were included after quality assessment. Stapedectomy was the most frequent surgical procedure performed in 398 ears. The follow-up time varied between 6 weeks and 99 months. Patients with a preserved chorda tympani were less symptomatic (24% was symptomatic) compared to patients with a stretched (53% was symptomatic) or sacrificed chorda tympani (47% was symptomatic). The recovery rate varied from 61% to 79%. The results of the electrogustometry and strip test showed a discrepancy with the subjective complaints of the patients.
Patients with a stretched chorda tympani were slightly more symptomatic compared to patients with a sacrificed chorda tympani. Therefore, in cases for which the chorda tympani greatly hinders a proper view of the surgical field, sacrificing the nerve could be considered to maximize surgical performance and have a satisfactory postoperative result. Laryngoscope, 2017
