Manual Therapy for Patients With Radiation-Associated Trismus After Head and Neck Cancer

xlomafota13 shared this article with you from Inoreader Manual Therapy for Patients With Radiation-Associated Trismus After Head and Neck Cancer Via JAMA Otolaryngology–Head & Neck Surgery Online First This case series study examines the effect size and associations of response to manual therapy to increase oral opening in the setting of radiation-associated trismus. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinical Factors Predictive of Lymph Node Metastasis in Thyroid Cancer Patients: A Multivariate Analysis

xlomafota13 shared this article with you from Inoreader Clinical Factors Predictive of Lymph Node Metastasis in Thyroid Cancer Patients: A Multivariate Analysis Via radioactive iodine J Am Coll Surg. 2022 Apr 1;234(4):691-700. doi: 10.1097/XCS.0000000000000107. ABSTRACT BACKGROUND: Early-stage thyroid cancers have excellent survival. However, lymph node metastases (LNM) confer a worse prognosis and are not always known preoperatively. Therefore, investigation on the clinical and histological factors predictive of LNM in thyroid cancers was conducted to tailor the extent of surgery and radioactive iodine therapy. STUDY DESIGN: Multivariate logistic regressi ons were performed based on retrospective data from thyroid cancer patients seen between 2013 and 2020 at a single institution. RESULTS: Among 913 patients, mean age was 49.4 years, 76.5% were female, 58.3% were White, 21.2% were Black, and 27.9% had LNM. In the multivariate analyses in which the outcome was LNM, White (odds ratio [OR] 1.74, 95% CI 0.98 to 3.15, p = 0.064) and Hispanic patients (OR 2.36, 95% CI 0.97 to 5.77, p = 0.059) trended toward higher risk of LNM compared to Black patients, whereas age (OR 0.98, 95% CI 0.97 to 1.00, p = 0.008) showed protective effect. Tumor size (OR 1.04, 95% CI 1.01 to 1.07, p = 0.007), extrathyroidal extension (OR 2.46, 95% CI 1.53 to 3.97, p < 0.001), lymphovascular invasion (OR 6.30, 95% CI 3.68 to 11.14, p < 0.001), and multifocality (OR 1.47, 95% CI 1.01 to 2.12, p = 0.042) were associated with higher risk of LNM. In another model with outcome as >5 LNM, tumor size (OR 1.07, 95% CI 1.03 to 1.11, p = 0.001), age (OR 0.95, 95% CI 0.93 to 0.97, p < 0.001), extrathyroidal extension (OR 3.20, 95% CI 1.83 to 5.61, p < 0.001), and lymphovascular invasion (OR 6.82, 95% CI 3.87 to 12.17, p < 0.001) remained significant predictors. CONCLUSION: Our analyses demonstrated and confirmed that age, tumor size, extrathyroidal extension, and lymphovascular invasion are independent predictors of significant LNM, thereby conferring higher risk of recurrence. Risk of LNM based on these patient characteristics should be considered when planning an operative approach. PMID:35290290 | DOI:10.1097/XCS.0000000000000107 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pediatric morphometric study to guide the optimized implantation of the Osia® 2 implant system

xlomafota13 shared this article with you from Inoreader Pediatric morphometric study to guide the optimized implantation of the Osia<sup>®</sup> 2 implant system Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2022 Mar 16. doi: 10.1007/s00405-022-07338-2. Online ahead of print. ABSTRACT PURPOSE: Continuous technological advances result in the availability of new bone conduction hearing implants, of which their suitability for pediatric patients is of major concern. The CochlearTMOsia® 2 is a new active osseointegrated steady-state implant system that uses digital piezoelectric stimulation to treat hearing loss. The implant in the United States was approved for patients aged 12 years and above, whereas the CE mark is independent of age, the only requirement is body weight of at least 7 kg. Therefore, further clinical studies are required to assess device characteristics in younger patients. The aim of our study was to perform a morphometric study among 5-12-year-old children, and to develop a surgical protocol for Osia 2 system implantation based on these findings. METHODS: We examined r etrospectively cranial CT scans of 5-12-year-old patients from our clinical database. We measured the bone and soft-tissue thickness in the region of interest, and the position of the sigmoid sinus. 3D printed temporal bones were also used for planning. RESULTS: Soft-tissue thickness varied between 3.2 ± 0.5 mm and 3.6 ± 0.6 mm and bone thickness varied between 3.5 ± 1.1 mm and 4.7 ± 0.3 mm. The sigmoid sinus was located 1.3 ± 0.2 cm posterior to the ear canal, and the anterior distance was 4.8 ± 0.9 to 7.1 ± 1.1 mm. CONCLUSIONS: Our morphometric studies showed that patients aged 5-12 have different anatomical dimensions compared to adults, but that implantation of the Osia 2 system is feasible in these patients using an altered implant positioning recommended by our data. The Cochlear™ Osia® 2 is, therefore, an option for hearing rehabilitation in younger pediatrics. PMID:35292851 | DOI:10.1007/s00405-022-07338-2 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Nipple delay prior to nipple-sparing mastectomy: the protective effect on nipple-areola complex ischaemia

xlomafota13 shared this article with you from Inoreader Nipple delay prior to nipple-sparing mastectomy: the protective effect on nipple-areola complex ischaemia Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2022 Feb 19:S1748-6815(22)00074-2. doi: 10.1016/j.bjps.2022.02.005. Online ahead of print. ABSTRACT BACKGROUND: Nipple-sparing mastectomy (NSM) has become increasingly popular over the past decade, offering perceived superior cosmetic outcomes and psychological benefits. The main concern in NSM is that of nipple-areola complex (NAC) ischaemia, occurring in up to 15% of cases. We investigate the utility of nipple delay (ND) in protecting the NAC from ischaemic complications. METHODS: A retrospective study of all NSM for a single surgeon from 2010 to 2020 was performed, with those not receiving a prior ND procedure included as a control arm. Variables were recorded, including time to mastectomy from delay, degree of breast ptosis, cup size, mastectomy weight, previous radiotherapy, and presence of ischaemic risk factors. Outcomes recorded were the development of NAC ischaemia, graded from epidermolysi s to partial or full-thickness necrosis (FTN). RESULTS: A total of 62 women for a total of 84 breasts were part of the delay cohort. Ten (12%) breasts in the delay group developed ischaemic complications, with only five breasts developing FTN requiring debridement. Moreover, 33 women for a total of 43 breasts were part of the non-delay cohort. A total of 14 (33%) breasts in the non-delay cohort developed ischaemic complications, with six breasts developing FTN requiring debridement. Delay was protective against ischaemic complications with an OR 0.28 (p=0.007). Mastectomy weight of >600 g and >400 g predicted the development of ischaemic complications in the delay and non-delay cohorts, respectively. CONCLUSION: ND was shown to protect against the development of ischaemic complications prior to NSM, with the greatest protective effects shown in those with morphologically large breasts. PMID:35296381 | DOI:10.1016/j.bjps.2022.02.005 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Mycobacterium avium and Mycobacterium intracellulare in potable water in the USA

xlomafota.13 shared this article with you from Inoreader Occurrence revisited: Mycobacterium avium and Mycobacterium intracellulare in potable water in the USA Via Latest Results for Applied Microbiology and Biotechnology Abstract Nontuberculous mycobacterium (NTM) infections are increasing in the USA and have a high cost burden associated with treatment. Thus, it is necessary to understand what changes could be contributing to this increase in NTM disease rate. Water samples from 40 sites were collected from around the USA. They represented three water types: groundwater disinfected with chlorine and surface water disinfected with chlorine or monochloramine. Two methods, culture and qPCR, were used to measure M. avium and M. intracellulare. Heterotrophic bacteria and NTM counts were also measured. M. avium and M. intracellulare were molecularly detected in 25% (73/292) and 35% (102/292) of samples. The mean concentrations of M. avium and M. intracellulare were 2.8 × 103 and 4.0 × 103 genomic units (GU) L−1. The Northeast sites had the highest sample positively rate for both M. avium and M. intracellulare. The highest NTM counts and M. avium concentrations were observed in the surface water treated with chloramine. Geographic location and source water/disinfectant type were observed to significantly influence M. avium and M. intracellulare occurrence rates. These studies can help improve public health risk management by balancing disinfectant treatments and diverse microbial loads in drinking water. Key points • M. avium (MA) culture rate increased significantly: 1% (1999) to 13%. • Culture versus qPCR method: 13% vs 31% for MA and 6% vs 35% for MI. • The results of each method type tell two different stories of MA and MI occurrence. Graphical abstract View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Propensity Score Analysis of Outcomes Following Laparoscopic or Open Radical Resection for Gallbladder Cancer in T2 and T3 Stages

xlomafota.13 shared this article with you from Inoreader Propensity Score Analysis of Outcomes Following Laparoscopic or Open Radical Resection for Gallbladder Cancer in T2 and T3 Stages Via Latest Results for Journal of Gastrointestinal Surgery Abstract Background Although laparoscopic radical resection (LRR) has long been contraindicated in gallbladder cancer (GBC), recent studies have demonstrated laparoscopic surgery did not adversely affect the perioperative and survival outcomes of GBC patients. However, these literatures are mainly focused on GBC of relatively early stages or incidental GBC. This study aimed to investigate the perioperative and long-term outcomes of LRR versus open radical resection (ORR) for GBCs in T2 and T3 stages. Methods A retrospective study was conducted on 99 patients with GBC of T2 and T3 stages who underwent radical resection at Zhejiang Provincial People's Hospital from January 2010 to December 2020. A 1:1 propensity score matching (PSM), which is widely used to reduce selection bias, was performed to compare the surgical outcomes and long-term prognosis between LRR and ORR. A logistic regression analysis was implemented to identify the predictive risk factors of postoperative overall survival. Results By using PSM, the baseline characteristics of two groups (with 30 patients in each group) were generally well balanced. In the LRR group, the length of operation was significantly longer than the ORR group, but the intraoperative bleeding and postoperative days of hospital stay were significantly decreased compared to the ORR group. The two groups showed comparable outcomes regarding the incidence of biliary reconstruction, lymph node yield, the incidence of postoperative morbidities, the incidence of Clavien–Dindo (C–D) grades III–IV, the days of drainage tubes indwelling, mortality at 30 postoperative days and 90 postoperative days, and the incidence of port-site metastasis. The 1-, 2-, and 3-year overall survival rates were 61.2, 40.1, and 30.1%, respectively, in the LRR group, and 53.3, 40.1, and 40.1%, respectively, in the OLR group (P = 0.644). On multivariate analysis, T stage, vascular invasion, and tumor differentiation were found to be the independent risk factors for overall survival of GBC in T2 and T3 stages. Conclusions For GBC in T2 and T3 stages, LRR can achieve comparable perioperative outcomes and similar long-term survival benefit compared to ORR. LRR tends to show advantages over ORR regarding intraoperative bleeding and postoperative days of hospital stay. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pancreatico-Jejunostomy On Isolated Loop After Pancreatico-Duodenectomy: Is It Worthwhile?

xlomafota.13 shared this article with you from Inoreader Pancreatico-Jejunostomy On Isolated Loop After Pancreatico-Duodenectomy: Is It Worthwhile? Via Latest Results for Journal of Gastrointestinal Surgery Abstract Background Postoperative morbidity remains a significant problem after pancreatico-duodenectomy. The management of pancreatic stump continues to be a challenge, and many technical solutions have been developed over the years. In this study, we report the results obtained with the use of an isolated loop for pancreatico-jejunostomy in patients with soft pancreas and small pancreatic duct diameter. Methods Clinical data of patients submitted to pancreatico-duodenectomy in a period of sixteen years (2005–2020) were extracted from a prospective database. Patients with soft pancreas, main duct diameter < 2 mm and reconstruction by pancreatico-jejunostomy on single loop or isolated loop were selected. Primary end-point was the incidence of clinically relevant fistulas in the two groups of patients. Secondary endpoint was the length of postoperative hospital stay. A propensity score matching analysis was used for the statistics. Results Two hundred and twenty-one patients with the above characteristics were found in the database. One hundred and twelve of these received a single-loop reconstruction and 109 an isolated loop reconstruction. Incidence of clinically relevant fistulas was higher in the first group (41% vs 27%; p = 0.023). Postoperative hospital stay was significantly shorter in the second group (21 days vs 15; p < 0.001). These results were confirmed at the propensity score matching. Conclusion In patients with soft pancreatic texture and small main duct diameter, pancreatico-jejunostomy on isolated loop is associated with a lower incidence of clinically relevant fistulas than after classic reconstruction. The duration of postoperative hospital stay was significantly reduced, with consequent reduction of cost. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pregnancy, Fetal, and Infant Outcomes Following Maternal Exposure to Glatiramer Acetate During Pregnancy and Breastfeeding

xlomafota.13 shared this article with you from Inoreader Pregnancy, Fetal, and Infant Outcomes Following Maternal Exposure to Glatiramer Acetate During Pregnancy and Breastfeeding Via Latest Results for Drug Safety Abstract Introduction Published data support the safety of glatiramer acetate in patients with multiple sclerosis who are pregnant or breastfeeding, but long-term data are limited. Objective We aimed to assess pregnancy, fetal, and infant outcomes following maternal exposure to glatiramer acetate. Methods In-utero glatiramer acetate-exposed postmarketing pregnancy reports from 2019 to 2021 were extracted from Teva's pharmacovigilance database. Pregnancy data acquired prior to knowledge of pregnancy outcome or detection of congenital malformation (prospective reports) were used to estimate pregnancy and infant outcome rates for glatiramer acetate 20- and 40-mg/mL exposure. A subgroup of cases completed follow-up questionnaires and were analyzed separately. Results Prospective cases with 702 fetuses had known outcomes with 647 (92.2%) live births, 47 (6.7%) spontaneous abortions, 4 (0.6%) induced abortions, 2 (0.3%) ectopic pregnancies, and 2 (0.3%) fetal deaths. Rates of major congenital malformation (1.1%), preterm births (7.2%), and low/very low birth weight (4.8%), and parameters of growth were within background rates. No infant developmental delay was reported. Overall, pregnancy and infant outcomes were similar across glatiramer acetate doses. Conclusions Maternal exposure to glatiramer acetate does not appear to be related to adverse pregnancy, fetal, or infant outcomes. These data further support the safety of both glatiramer acetate 20-mg/mL and 40-mg/mL treatments during pregnancy and breastfeeding. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Characteristics and outcomes of carbapenemase harbouring carbapenem-resistant Klebsiella spp. bloodstream infections: a multicentre prospective cohort study in an OXA-48 endemic setting

xlomafota.13 shared this article with you from Inoreader Characteristics and outcomes of carbapenemase harbouring carbapenem-resistant Klebsiella spp. bloodstream infections: a multicentre prospective cohort study in an OXA-48 endemic setting Via Latest Results for European Journal of Clinical Microbiology & Infectious Diseases Abstract A prospective, multicentre observational cohort study of carbapenem-resistant Klebsiella spp. (CRK) bloodstream infections was conducted in Turkey from June 2018 to June 2019. One hundred eighty-seven patients were recruited. Single OXA-48-like carbapenemases predominated (75%), followed by OXA-48-like/NDM coproducers (16%). OXA-232 constituted 31% of all OXA-48-like carbapenemases and was mainly carried on ST2096. Thirty-day mortality was 44% overall and 51% for ST2096. In the multivariate cox regression analysis, SOFA score and immunosuppression were significant predictors of 30-day mortality and ST2096 had a non-significant effect. All OXA-48-like producers remained susceptible to ceftazidime-avibactam. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

MCM-41-supported double metal cyanide nanocomposite catalyst for ring-opening polymerisation of propylene oxide

xlomafota.13 shared this article with you from Inoreader MCM-41-supported double metal cyanide nanocomposite catalyst for ring-opening polymerisation of propylene oxide Via Latest Results for Journal of Nanoparticle Research Abstract The fabrication of low-cost, recyclable, reusable, and heterogeneous catalysts is of considerable significance for green chemistry. In this study, a nanocomposite catalyst, MCM-41-supported Zn–Co double metal cyanide (MCM-41@DMC), was prepared using the synchronous dropping method. Thereafter, the composition, crystal structure, complexing state, morphology, and thermal stability of the catalyst were characterised using scanning electron microscopy, X-ray diffraction, Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, Brunauer–Emmett–Teller analysis, and thermogravimetry. The effects of different organic ligands on the catalytic activity of samples were evaluated, and the results showed that ethyl acetoacetate exhibited the best catalytic activity owing to its ketone coordination. The use of the MCM-41 support was beneficial for improving the catalytic activity because it reduced the crystallinity and substantially increased the ex ternal specific surface area of the catalyst. The experimental results pertaining to the use of the MCM-41@DMC catalyst in the fabrication of polypropylene glycol showed that the conversion of propylene oxide and molecular weight reached 90.6% and 2900, respectively. This study provides a new strategy for the green synthesis of poly(propylene glycol) products. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Covered Transjugular Intrahepatic Portosystemic Shunt Improves Hypersplenism-Associated Cytopenia in Cirrhosis

xlomafota.13 shared this article with you from Inoreader Covered Transjugular Intrahepatic Portosystemic Shunt Improves Hypersplenism-Associated Cytopenia in Cirrhosis Via Latest Results for Digestive Diseases and Sciences Abstract Background Patients with cirrhosis often develop portal hypertension-associated splenomegaly and hypersplenism, potentially causing severe cytopenia. AIMS Systematic assessment on the impact of transjugular intrahepatic portosystemic shunt (TIPS) implantation on platelet count (PLT), hemoglobin (Hb), and white blood cell count (WBC). Methods Patients with cirrhosis undergoing covered TIPS implantation were retrospectively included. Patients with malignancies or hematologic disorders were excluded. Hematology lab work was recorded at baseline (pre-TIPS) and at regular intervals after TIPS. Results One hundred ninety-two patients (male: 72.4%, age: 56 ± 10 years; MELD: 12.1 ± 3.6) underwent TIPS implantation. Higher-grade (≥ G2) thrombocytopenia (PLT < 100 G/L) was present in 54 (28.7%),  ≥ G2 anemia (Hb < 10 g/dL) in 57 (29.7%), and  ≥ G2 leukopenia (WBC < 2 G/L) in 3 (1.6%) patients pre-TIPS, respectively. Resolution of ≥ G2 thrombocytopenia, anemia, and leukopenia occurred in 24/55 (43.6%), 23/57 (40.4%), and 2/3 (66.7%), respectively. Similar results were also observed in the subgroup of patients without 'bleeding' TIPS-indication, with improvements of G ≥ 2 thrombocytopenia and of G ≥ 2 anemia in 19.8% and 10.2% of patients after TIPS, respectively. Conclusions Thrombocytopenia, anemia, and leukopenia frequently improved after TIPS. Therefore, moderate- to higher-grade thrombocytopenia should not be regarded as a contraindication against TIPS, but rather be considered in case of severe thrombocytopenia—particularly prior to surgery or interventions. Graphical Abstract View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.