Αρχειοθήκη ιστολογίου

Πέμπτη 6 Ιανουαρίου 2022

Disulfiram Exerts Antiadipogenic, Anti-Inflammatory, and Antifibrotic Therapeutic Effects in an In Vitro Model of Graves' Orbitopathy

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Thyroid, Ahead of Print.
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Optimal Multiple-Layered Anterior Skull Base Reconstruction Using a 360° Suturing Technique

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Oper Neurosurg (Hagerstown). 2022 Jan 1;22(1):e1-e6. doi: 10.1227/ONS.0000000000000013.

ABSTRACT

BACKGROUND: Advances in technique and instrumentation have improved outcomes after resection of anterior skull base tumors. However, cerebrospinal fluid (CSF) leak occurs in 4%-20% of patients. To reduce the risk of CSF leak, we have developed a novel reconstruction technique that consists of a 4-layered graft with patchwork suturing and hard material.

OBJECTIVE: To evaluate the effectiveness of this reconstruction technique when used for resection of anterior skull base tumors.

METHODS: This case series included 59 patients with anterior skull base tumors in whom the 4-layered closure technique was used. The main outcome measures were complications, including CSF leak, meningitis, postoperative bleeding, and infection.

RESULTS: There were no CSF leak cases or serious complications after closure of the anterior skull base using t he 4-layered technique.

CONCLUSION: Closure of the anterior skull base in 4 layers prevented CSF leak and was not associated with any serious complications. However, further studies in larger numbers of patients are needed to confirm our outcomes using this closure method.

PMID:34982903 | DOI:10.1227/ONS.0000000000000013

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Clown Nose: A Rare Hypopharyngeal Cancer Metastasis

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Ear Nose Throat J. 2022 Jan 5:1455613211069349. doi: 10.1177/01455613211069349. Online ahead of print.

ABSTRACT

Cutaneous metastases from squamous cell carcinomas of the head and neck region are uncommon, and their location at the nasal tip is exceptionally rare. A patient, previously treated with surgery and chemoradiation for a hypopharyngeal squamous cell carcinoma, developed several red nodular skin lesions at the nasal tip. Biopsy revealed cutaneous metastasis from the primary tumor. This manifestation was previously described as a "clown nose," given their appearance and location. Skin lesions should raise suspicion of malignancy, despite their location at uncommon places, particularly in patients with previous diagnosed cancer. Clinicians must be aware that metastases from head and neck cancer can present as a "clown nose."

PMID:34983248 | DOI:10.1177/01455613211069349

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Eustachian Tube Functions in Concurrent Chemoradiotherapy for Head and Neck Cancer Patients

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Abstract

Ototoxicity is a dose-limiting adverse event for concurrent chemoradiotherapy (CCRT) with high-dose cisplatin for locally advanced head and neck squamous cell carcinoma (HNSCC). Both irradiation to the Eustachian tube (ET) and weight loss are risk factors for patulous ET. The aim of this prospective, observational study was to elucidate the incidences of patulous ET conditions before and after CCRT in HNSCC patients by means of ET function tests. This prospective, observational study was conducted in 27 HNSCC patients who received CCRT with high-dose cisplatin, and ET function tests (sonotubometry and tubo-tympano-aerodynamic graphy) were performed before and 3 months after CCRT. Factors potentially affecting the incidence of patulous ET conditions after CCRT were evaluated. Of the 54 ears from 27 patients investigated, patulous ET conditions were observed in 12 ears (22.2%) from 9 patients (33.3%) before CCRT and 15 ears (27.8%) from 11 patients (40.7%) at 3 months after CCRT. Only patulous ET conditions before CCRT in each ear were significantly associated with patulous ET conditions after CCRT (p = 0.010). This is the first report to describe the incidences of patulous ET conditions before and after CCRT in HNSCC patients. HNSCC patients are potentially at higher risk of patulous ET.

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Olfactory dysfunction is associated with cognitive impairment in patients with obstructive sleep apnea: a cross-sectional study

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Eur Arch Otorhinolaryngol. 2022 Jan 6. doi: 10.1007/s00405-021-07194-6. Online ahead of print.

ABSTRACT

PURPOSE: Obstructive sleep apnea (OSA) increases the risk for olfactory dysfunction. However, the relationship between olfactory function and cognition in OSA patients is unclear. The present study aimed to investigate the relationship between cognition and olfactory dysfunction (OD) in patients with OSA.

METHOD: This was a cross-sectional study in which 74 patients with OSA and 22 controls were recruited. All subjects completed polysomnography, Sniffin' Sticks, and -neurocognitive assessments. According to results of Sniffin' Sticks, OSA patients were divided into two groups: OSA with OD (53 cases) and OSA without OD (21 cases). Neurocognitive function was assessed by Montreal Cognitive Assessment (MoCA), Memory and Executive Screening (MES), and Shape Trail Test (STT). Cognition was compared between OSA with and without OD. C orrelation between olfactory parameters and respiratory sleep parameters and neurocognitive assessments was analyzed.

RESULTS: Compared with OSA without OD, OSA with OD showed significantly decreased neurocognitive scores of MoCA (29-27 vs 27-23, p < 0.01), MES-5R (45-40.1 vs 43-33.5, p < 0.01) and increased consuming time of STT-B (91.66 vs 121.63, p < 0.01). A positive correlation was found between the scores of MoCA and MES-5R and all olfactory parameters. In addition, a negative correlation was present between the time consumed for STT-B and odor thresholds (r = - 0.344, p < 0.01), odor identification (r = - 0.335, p < 0.01), and threshold-discrimination-identification scores (r = - 0.448, p < 0.01).

CONCLUSION: Olfactory function is associated cognitive function in patients with OSA and may provide a new direction for early treatment interventions in OSA patients at risk for cognitive impairment.

PMID:34988658 | DOI:10.1007/s00405-021-07194-6

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CPPS and Voice-Source Parameters: Objective Analysis of the Singing Voice

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In recent years cepstral analysis and specific cepstrum-based measures such as smoothed cepstral peak prominence (CPPS) has become increasingly researched and utilized in attempts to determine the extent of overall dysphonia in voice signals. Yet, few studies have extensively examined how specific voice-source parameters affect CPPS values.
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Postoperative Radiation Therapy in Oral Cavity Verrucous Carcinoma

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Objectives/Hypothesis

We investigate the clinicopathologic and treatment factors associated with the use of postoperative radiation therapy (PORT) and its effect on overall survival (OS) for patients with oral cavity verrucous carcinoma (VC).

Study Design

Retrospective cohort study.

Methods

A retrospective cohort study of the National Cancer Database (NCDB) from 2006 to 2015 was performed. Multivariable logistic regression was used to identify independent predictive factors associated with the use of PORT. Cox Regression survival and propensity score analyses were used to evaluate the effect of PORT on mortality.

Results

A total of 356 adult patients with primary oral cavity VC who underwent definitive surgical resection were identified. A total of 10.7% of patients underwent definitive surgical resection followed by PORT. Variables associated with PORT included distance to the hospital per 10 miles (adjusted odds ratio [aOR], 0.81 [95% confidence interval (CI), 0.70–0.95]) and stage III–IV disease (aOR, 12.13 and 23.92, respectively). Multivariable Cox regression survival analysis indicated no evidence of survival benefit in patients undergoing PORT compared to surgery alone (adjusted hazard ratio 1.50 [0.74–3.05], P = .23). Propensity score analysis also showed no OS benefit with the use of PORT (P = .41).

Conclusions

Variables associated with the use of PORT on multivariable analysis included closer distance to hospital and stage III–IV disease. No clear survival benefit with PORT was identified on either multivariable survival analysis or propensity score analysis. These results suggest that surgery alone with negative margins may be the optimal treatment for patients with oral cavity VC.

Level of Evidence

4 Laryngoscope, 2022

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Characterizing Polarity Sensitivity in Cochlear Implant Recipients: Demographic Effects and Potential Implications for Estimating Neural Health

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Abstract

Stimulus polarity can affect both physiological and perceptual measures in cochlear-implant recipients. Large differences between polarities for various outcome measures (e.g., eCAP threshold, amplitude, or slope) theoretically reflect poorer neural health, whereas smaller differences reflect better neural health. Therefore, we expect large polarity effects to be correlated with other measures shown to contribute to poor neural health, such as advanced age or prolonged deafness. Our earlier studies using the electrically evoked compound action potential (eCAP) demonstrated differences in polarity effects between users of Cochlear and Advanced Bionics devices when device-specific clinical pulse designs were used. Since the stimuli differed slightly between devices, the first goal of this study was to determine whether small, clinically relevant differences in pulse phase duration (PD) have a significant impact on eCAP polarity effects to potentially explain the de vice differences observed previously. Polarity effects were quantified as the difference in eCAP thresholds, mean normalized amplitudes, and slope of the amplitude growth function obtained for anodic-first versus cathodic-first biphasic pulses. The results showed that small variations in PD did not explain the observed differences in eCAP polarity effects between devices. Therefore, eCAP polarity sensitivity measures are relatively robust to small differences in pulse parameters. However, it remains unclear what underlies the observed manufacturer differences, which may limit the utility of eCAP polarity sensitivity measures. The second goal was to characterize polarity sensitivity in a large group of CI recipients (65 ears) to relate polarity sensitivity to age and duration of deafness as a proxy for neural health. The same pulse parameters were used for both device groups. The only significant predictors of eCAP polarity effects were age for threshold and amplitude polarity effect s for Cochlear recipients and age and duration of deafness for slope for AB recipients. However, three of these four correlations were in the opposite direction of what was expected. These results suggest that eCAP polarity sensitivity measures likely reflect different mechanisms than the effects that age and duration of deafness induce on the peripheral auditory system.

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Importance of the Graded Chronic Pain Scale as a Biopsychosocial Screening Instrument in TMD Pain Patient Subtyping

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J Oral Facial Pain Headache. 2021 Fall;35(4):303-316. doi: 10.11607/ofph.2983.

ABSTRACT

AIMS: To compare the suitability of Graded Chronic Pain Scale (GCPS) pain intensity and interference assessments (GCPS version 1.0 vs 2.0) for the biopsychosocial screening and subtyping of Finnish tertiary care referral patients with TMD pain.

METHODS: Altogether, 197 TMD pain patients participated in this study. All patients received Axis II specialist-level psychosocial questionn aires from the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD-FIN) and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD-FIN), as well as questionnaires for the assessment of additional pain-related, biopsychosocial, and treatment-related variables. Clinical examinations were performed according to the DC/TMD Axis I protocol. The patients were categorized into TMD subtypes 1, 2, and 3 (GCPS I and II-low; II-high; and III and IV, respectively) based on their biopsychosocial profiles according to GCPS versions 1.0 and 2.0.

RESULTS: The distribution of TMD pain patients into TMD subtypes was similar according to the GCPS 1.0 compared to the GCPS 2.0. Over 50% of the patients were moderately (TMD subtype 2) or severely (TMD subtype 3) compromised. Patients in subtype 3 experienced biopsychosocial symptoms and reported previous health care visits significantly more often than patients in subtypes 1 and 2. Patients in subtype 2 reported intermediate biopsychosocial burden compared to subtypes 1 and 3.

CONCLUSION: TMD pain patients differ in their biopsychosocial profiles, and, similarly to the GCPS 1.0, the GCPS 2.0 is a suitable instrument for categorizing TMD tertiary care pain patients into three biopsychosocially relevant TMD subtypes. The GCPS 2.0 can be regarded as a suitable initial screening tool for adjunct personalized or comprehensive multidisciplinary assessment.

PMID:34990499 | DOI:10.11607/ofph.2983

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Refractory Orofacial Pain: Is It the Patient or the Pain?

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J Oral Facial Pain Headache. 2021 Nov-Dec;35(4):317-325. doi: 10.11607/ofph.3009.

ABSTRACT

AIMS: To highlight and discuss the term "refractory" when used to describe pain conditions and its application to orofacial pain, as well as to highlight the factors that must be considered in a refractory patient.

METHODS: A scoping review of recent publications (2010 to 2021) applying the term "refractory" to orofacial pain was conducted, and this paper presents their limitatio ns and definitions.

RESULTS: The term "refractory" is often used to describe pain instead of "persistent" or "nonresponsive." There are clear definitions in the use of refractory for migraine, cluster headaches, and other nonheadache disorders. Currently, the term is applied to pain conditions in order to alter the patient pathway of treatment, sometimes to escalate a patient from one care sector to another and sometimes to escalate treatment to more costly surgical interventional techniques.

CONCLUSION: There is a need for a clear definition for use of the term "refractory" in orofacial pain conditions, excluding migraine and cluster headaches. In addition, there is a requirement for a consensus on the implications of the use of refractory when assessing and managing patients.

PMID:34990500 | DOI:10.11607/ofph.3009

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Temporomandibular Disorders Core Curriculum for Predoctoral Dental Education: Recommendations from the American Academy of Orofacial Pain

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J Oral Facial Pain Headache. 2021 Fall;35(4):271-277. doi: 10.11607/ofph.3073.

NO ABSTRACT

PMID:34990495 | DOI:10.11607/ ofph.3073

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