Αρχειοθήκη ιστολογίου

Πέμπτη 6 Μαΐου 2021

Therapeutic effects of melatonin on an ovalbumin-induced allergic rhinitis

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Publication date: Available online 5 May 2021

Source: Auris Nasus Larynx

Author(s): Asli Cakir Cetin, Mustafa Cenk Ecevit, Mukaddes Gumustekin, Cetin Pekcetin, Seda Ozbal, Hande Efe, Pelin Koca, Ozge Akcay, Yesim Tuncok

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Laryngeal lichen planus mimicking vocal fold dysplasia

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Publication date: Available online 6 May 2021

Source: Auris Nasus Larynx

Author(s): Giuseppe Leoncini, Maria Grazia Marin, Carmine Squeglia, Silvia Elisabetta Aquilini, Livio Zanetti

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Integrating Robot‐Assisted Ultrasound Tracking and 3D Needle Shape Prediction for Real‐Time Tracking of the Needle Tip in Needle Steering Procedures

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Abstract

Background

Needle insertions have been used in several minimally invasive procedures for diagnostic and therapeutic purposes. Real‐time position of the needle tip is an important information in needle steering systems.

Methods

This work introduces a robot‐assisted ultrasound tracking (R‐AUST) system integrated with a needle shape prediction method to provide 3D position of the needle tip. The tracking system is evaluated in phantom and ex‐vivo beef liver tissues.

Results

An average error of 0.60 mm was found for needle insertion tests inside the phantom tissue. The R‐AUST integrated with shape prediction in the beef liver tissue was able to track the needle tip with an average and maximum error of 0.37 and 0.67mm, respectively. The average error reported in this work is within the mean allowable needle placement error (<2.7mm) in targeted procedures.

Conclusions

Integration of R‐AUST tracking method with needle shape prediction results in a reasonably accurate real‐time tracking suitable for ultrasound‐guided needle insertions.

This article is protected by copyright. All rights reserved.

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Assessment of eye closure and blink with facial palsy: A systematic literature review

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J Plast Reconstr Aesthet Surg. 2021 Mar 30:S1748-6815(21)00149-2. doi: 10.1016/j.bjps.2021.03.059. Online ahead of print.

ABSTRACT

Facial palsy can cause the impairment of eye closure and affect blink, ocular health, communication, and esthetics. Dynamic surgical procedures can restore eye closure in patients with decreased facial nerve function. There are no standardized measures of voluntary and spontaneous eye closure that are used to evaluate the outcomes of blink restoration procedures. The purpose of this systematic literature review was to identify the measures used to assess normal and abnormal eye closure and blinking in patients with facial palsy. A literature search of the PubMed database using the keyword "facial nerve/surgery" was conducted. Only English language articles that pertain to the use of facial paralysis assessment systems published in the past 20 years, which involve eyelid closure were included. There were 57 articles that used a facial paralysis classification system with an eyelid closure component: House-Brackmann Facial Nerve Grading Scale (n = 43, 67%); Sunnybrook Facial Grading Scale (n = 9); palpebral fissure heights (n = 4), and the electronic clinician-graded facial function tool (n = 3) and three additional measures were reported once. Although the Terzis and Bruno Scoring System, blink ratio, and electronic, clinician-graded facial function scale(eFACE) Clinician-Graded Scoring System were valid measures of eyelid closure, there was no one comprehensive eye assessment that demonstrated all aspects of eye closure in facial palsy, which include closure amplitude, spontaneity, and quality of life. For blink assessment, eFACE is the most comprehensive tool currently available and recommended to be used with a patient-reported quality of life supplement that captures the specific domains related to facial nerve dysfunction.

PMID:33952434 | DOI:10.1016/j.bjps.2021.03.059

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The combined use of pedicled profunda artery perforator and bilateral gracilis flaps for pelvic reconstruction: A cohort study

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J Plast Reconstr Aesthet Surg. 2021 Mar 30:S1748-6815(21)00128-5. doi: 10.1016/j.bjps.2021.03.038. Online ahead of print.

ABSTRACT

The result of an extra-levator abdominoperineal excision of the rectum (ELAPE) is a composite three-dimensional defect. This is performed for locally advanced anorectal cancer, and may involve partial excision of the vagina. The aim of reconstruction is to achieve wound healing, restore the pelvic floor and to allow micturition and sexual function. We aim to evaluate the concurrent use of profunda artery perforator (PAP) and bilateral gracilis flaps for vaginal and pelvic floor reconstruction. We performed a retrospective case note review of patients undergoing pelvo-perineal reconstruction with combined gracilis and PAP flaps between July 2018 and December 2019. Eighteen pedicled flaps were performed on six patients with anal or vulval malignancies. All underwent pre-operative radiotherapy. Four patients h ad extended abdominoperineal tumour resections, while two patients underwent total pelvic exenteration. The median age was 57 (range 47-74) years, inpatient stay was 22 (11-47) days and the follow-up was 10 (5-21) months. Four patients developed partial perineal wound dehiscence, of which one was re-sutured. One patient had a post-operative bleed requiring radiological embolisation of an internal iliac branch and had subsequent 1cm PAP flap loss. All other flaps survived completely. Median time to heal was 4 (1-6) months. This is the first series reporting combined bilateral gracilis and PAP flaps for pelvic reconstruction. The wound dehiscence rate and healing times were expected in the context of irradiation and radical pelvic tumour resection. This is a reliable technique for perineal and vaginal reconstruction with minimal donor site morbidity.

PMID:33952435 | DOI:10.1016/j.bjps.2021.03.038

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Computer-assisted mandibular curved osteotomy: An automatic method to design the new aesthetic gonion and osteotomy line

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J Plast Reconstr Aesthet Surg. 2021 Apr 6:S1748-6815(21)00157-1. doi: 10.1016/j.bjps.2021.03.067. Online ahead of print.

ABSTRACT

BACKGROUND: Digital technology has been widely used in mandibular curved osteotomy to improve accuracy. However, the planning process still highly dependent on the experience and judgement of the surgeon. This study describes an automatic method to design the new gonion and osteotomy line based on the aesthetic standards in attractive women, and assesses its clinical outcomes.

METHODS: An automatic surgical planning method for mandibular curved osteotomy was developed based on our previous research of mandibular angle aesthetics. A prospective clinical study was conducted from April 2016 to April 2018. Twenty-five female patients with prominent mandibular angle were enrolled. Pre- and postoperative skull computed tomography (CT) was performed. Three-dimensional (3D) CT data were obtained and processed by Mimics 18.0. Surgical templates were designed according to the automatic surgical planning method and 3D printed for the surgery. Preoperative measurements, surgical simulation and postoperative measurements were taken to evaluate the surgical outcomes.

RESULTS: There were significant differences between the preoperative and the postoperative groups' results (p < 0.01). There was no difference between the surgical simulation and the postoperative results. All postoperative measurements were consistent with aesthetic features of mandibles. Patients were satisfied with their outcomes in terms of outline, symmetry and lower facial width.

CONCLUSIONS: Our study developed an automatic method to position the new aesthetic gonion and osteotomy line for prominent mandibular angle patients. We proved that this method is safe, effective and reliable.

PMID:33952433 | DOI:10.1016/j.bjps.2021.03.067

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Neurilemmoma of the Nasal Cavity and Paranasal Sinuses

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Ear Nose Throat J. 2021 May 5:1455613211007947. doi: 10.1177/01455613211007947. Online ahead of print.

ABSTRACT

OBJECTIVES: Neurilemmoma in the nasal cavity and paranasal sinuses is very rare. The study aimed to improve the understanding of neurilemmoma in the nasal cavity and paranasal sinuses.

MATERIALS AND METHODS: The clinical data of 10 patients with neurilemmoma in the nasal cavity and paranasal sinuses treated from January 2014 to June 2019 in our hospital were retrospectively studied.

RESULTS: There were 6 females and 4 males patients in our study. The mean age was 49.5 years (range 37-77 years), and the most common clinical symptom was unilateral nasal obstruction. The site of tumor included the nasal cavity, maxillary sinus, ethmoid sinus, and sphenoid sinus. There were 2 cases with malignant neurilemmoma. Nine patients underwent functional endoscopic sinus surgery (FESS); however, 1 patient underwent FESS combined with the lateral rhinotomy for complete resection of the tumor. Two patients with malignant neurilemmoma received postoperative radiotherapy. The mean follow-up was 3.82 years (range 2-7 years). There were no incidences of tumor recurrence during the study period.

CONCLUSIONS: Neurilemmoma in the nasal cavity and paranasal sinuses is a mainly benign tumor. Complete surgical excision by FESS is the only treatment option for neurilemmoma in the nasal cavity and paranasal sinuses; while malignant neurilemmoma needs p ostoperative radiotherapy.

PMID:33951978 | DOI:10.1177/01455613211007947

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Fluorescence Imaging to Identify Occult and Ectopic Parathyroid Glands—Revealing the Unseen

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In this issue of JAMA Otolaryngology—Head & Neck Surgery, Kennedy and colleagues describe intraoperative molecular imaging (IMI) using the near-infrared (NIR) agent indocyanine green (ICG) to identify parathyroid glands. One of the most important contributions of this study is that it directly compares 2 methods of fluorescent imaging—use of autofluorescence ("label-free") vs use of ICG as a contrast agent. The use of IMI demonstrated superior signal-to-background ratios (SBRs) compared with autofluorescence. Excitingly, in the 2 patients who underwent reexploration parathyroidectomy, IMI successfully localized the ectopic parathyroid gland, which could not be identified by conventional methods. These results suggest that IMI is an accurate and reproducible method for localizing parathyroid glands and that ICG imaging is supe rior to autofluorescence for parathyroid gland identification.
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Use of Near-Infrared Molecular Imaging For Localizing Visually Occult Parathyroid Glands in Ectopic Locations

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This proof-of-principle clinical trial examines use of intraoperative molecular imaging for localizing visually occult parathyroid glands in both anatomic and ectopic locations.
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Prognostic Role of Tumor‐Infiltrating Lymphocytes and Tumor Budding in Early Oral Tongue Carcinoma

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Objectives/Hypothesis

Occult lymph metastasis is an important prognosticator for the treatment of early oral tongue squamous cell carcinoma (SCC). The objective of this study was to evaluate the prognostic significance of tumor‐infiltrating lymphocytes (TILs) in early oral tongue SCC. The combination of the TIL subtype and intermediate‐ or high‐grade budding scores was investigated as a prognostic marker for occult neck metastases.

Study Design

Retrospective study.

Methods

Specimens from 62 patients with early oral tongue SCC treated with only primary surgery were analyzed by immunohistochemistry for CD4+, CD8+, FoxP3+, and CD45RO+ T cells and CD163+ macrophages. The highest number of each TIL subtype was counted in two areas of parenchyma and stroma in the tumor (Tumor) and peripheral stroma of the invasion margin.

Results

Based on multivariate analysis, a high density of Tumor CD163+ macrophages served as the poorest prognostic factor for regional control (RC) and disease‐free survival (DFS). Patients with both a high density of Tumor CD163+ macrophages and an intermediate‐ or a high‐grade budding score had a poor prognosis for RC according to the log‐rank test.

Conclusions

In summary, each TIL subtype may use different mechanisms during early and advanced stages of oral tongue SCC. A high density of Tumor CD163+ macrophages was determined to be a risk factor for RC and DFS as well as an additional stratification factor for RC in patients with intermediate‐ or high‐grade budding scores. Therefore, identifying TIL subtypes in daily clinical practice can help determine a more successful and individualized therapeutic approach for early oral tongue SCC.

Level of Evidence

Step 4 (Level 4) Laryngoscope, 2021

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Intratympanic Lipopolysaccharide Elevates Systemic Fluorescent Gentamicin Uptake in the Cochlea

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Objectives/Hypothesis

Lipopolysaccharide (LPS), a key component of bacterial endotoxins, activates macrophages and triggers the release of inflammatory cytokines in mammalian tissues. Recent studies have shown that intratympanic injection of LPS simulates acute otitis media (AOM) and results in morphological and functional changes in the inner ear. Here we established an AOM mouse model with LPS to investigate the uptake of ototoxic gentamicin in the inner ear, and elucidated the underlying mechanism by focusing on cochlear inflammation as a result of AOM.

Study Design

Preclinical rodent animal model.

Methods

Fluorescently tagged gentamicin (GTTR) was systemically administered to mice with AOM. Iba1‐positive macrophage morphology and inner ear cytokine profile were evaluated by immunofluorescence technique and a mouse cytokine array kit, respectively.

Results

We observed characteristic symptoms of AOM in the LPS‐treated ears with elevated hearing thresholds indicating a conductive hearing loss. More importantly, the LPS‐induced AOM activated cochlear inflammatory responses, manifested by macrophage infiltration, particularly in the organ of Corti and the spiral ligament, in addition to the up‐regulation of proinflammatory cytokines. Meanwhile, GTTR uptake in the stria vascularis and sensory hair cells from all the LPS‐treated ears was significantly enhanced at 24, 48, and 72‐hour post‐treatment, as the most prominent enhancement was observed in the 48‐hour group.

Conclusion

In summary, this study suggests that the pathological cochlea is more susceptible to ototoxic drugs, including aminoglycosides, and justified the clinical concern of aminoglycoside ototoxicity in the AOM treatment. Laryngoscope, 2021

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Τετάρτη 5 Μαΐου 2021

q-Powders: a quick test for screening retronasal olfactory disorders with tasteless powders

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Eur Arch Otorhinolaryngol. 2021 May 4. doi: 10.1007/s00405-021-06849-8. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the clinical utility of q-Powders-a retronasal identification screening test.

METHODS: A total of 156 subjects (92 females, mean age: 54.5 years ± 17.3 years) completed a 3-item q-Powders retronasal identification test and a 16-items Sniffin' Sticks orthonasal identification test. We analyzed whether the q-Powders test could differentiate between subjects with normosmia and subjects with an olfactory disorder.

RESULTS: Our data indicated that subjects with an olfactory disorder scored lower in the q-Powders test than subjects with normosmia. The analyses revealed q-Powders test sensitivity of 84% and a test specificity of 64.9% with a score of 2 points taken as a cutoff for olfactory disorders.

CONCLUSION: The 3-item q-Powders retronasal test may be used for screening purposes in clinical re search.

LEVEL OF EVIDENCE: 4.

PMID:33948681 | DOI:10.1007/s00405-021-06849-8

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