Intensity‐modulated proton radiation therapy as a radical treatment modality for nasopharyngeal carcinoma in China: A cost‐effectiveness analysis

xlomafota13 shared this article with you from Inoreader Intensity‐modulated proton radiation therapy as a radical treatment modality for nasopharyngeal carcinoma in China: A cost‐effectiveness analysis Via Head & Neck Abstract Background Compared to conventional intensity-modulated photon radiation therapy (IMRT), intensity-modulated proton radiation therapy (IMPT) has potential to reduce irradiation-induced late toxicities while maintaining excellent tumor control in patients with nasopharyngeal carcinoma (NPC). However, the relevant cost-effectiveness remains controversial. Methods A Markov decision tree analysis was performed under the assumption that IMPT offered normal tissue complication probability reduction (NTCP reduction) in long-term dysphagia, xerostomia, and hearing loss, compared to IMRT. Base-case evaluation was performed on T2N2M0 NPC of median age (43 years old). A Chinese societal willingness-to-pay threshold (33558 US dollars [$])/quality-adjusted life-year [QALY]) was adopted. Results For patients at median age and having NTCP reduction of 10%, 20%, 30%, 40%, 50%, and 60%, their incremental cost-effectiveness ratios were $102684.0/QALY, $43161.2/QALY, $24134.7/QALY, $13991.6/QALY, $8259.8/QALY, and $4436.1/QALY, respectively; IMPT should provide an NTCP reduction of ≥24% to be considered cost-effective. Conclusions IMPT has potential to be cost-effective for average Chinese NPC patients and should be validated clinically. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Insula: A Stimulating Island of the Brain

xlomafota13 shared this article with you from Inoreader The Insula: A Stimulating Island of the Brain Via cortical auditory Brain Sci. 2021 Nov 19;11(11):1533. doi: 10.3390/brainsci11111533. ABSTRACT Direct cortical stimulation (DCS) in epilepsy surgery patients has a long history of functional brain mapping and seizure triggering. Here, we review its findings when applied to the insula in order to map the insular functions, evaluate its local and distant connections, and trigger seizures. Clinical responses to insular DCS are frequent and diverse, showing a partial segregation with spatial overlap, including a posterior somatosensory, auditory, and vestibular part, a central olfactory-gustatory region, and an anterior visceral and cognitive-emotional portion. The study of cortico-cortical evoked potentials (CCEPs) has shown that the anterior (resp. posterior) insula has a higher connectivity rate with itself than with the posterior (resp. anterior) insula, and that both the anterior and posterior insula are closely connected, notably between the homologous insula r subdivisions. All insular gyri show extensive and complex ipsilateral and contralateral extra-insular connections, more anteriorly for the anterior insula and more posteriorly for the posterior insula. As a rule, CCEPs propagate first and with a higher probability around the insular DCS site, then to the homologous region, and later to more distal regions with fast cortico-cortical axonal conduction delays. Seizures elicited by insular DCS have rarely been specifically studied, but their rate does not seem to differ from those of other DCS studies. They are mainly provoked from the insular seizure onset zone but can also be triggered by stimulating intra- and extra-insular early propagation zones. Overall, in line with the neuroimaging studies, insular DCS studies converge on the view that the insula is a multimodal functional hub with a fast propagation of information, whose organization helps understand where insular seizures start and how they propagate. PMID:34827532 | DOI:10.3390/brainsci11111533 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Kinase-Inhibitors in Iodine-Refractory Differentiated Thyroid Cancer-Focus on Occurrence, Mechanisms, and Management of Treatment-Related Hypertension

xlomafota13 shared this article with you from Inoreader Kinase-Inhibitors in Iodine-Refractory Differentiated Thyroid Cancer-Focus on Occurrence, Mechanisms, and Management of Treatment-Related Hypertension Via radioactive iodine Int J Mol Sci. 2021 Nov 12;22(22):12217. doi: 10.3390/ijms222212217. ABSTRACT Differentiated thyroid cancer (DTC) usually has a good prognosis when treated conventionally with thyroidectomy, radioactive iodine (RAI) and thyroid-stimulating hormone suppression, but some tumors develop a resistance to RAI therapy, requiring alternative treatments. Sorafenib, lenvatinib and cabozantinib are multikinase inhibitors (MKIs) approved for the treatment of RAI-refractory DTC. The drugs have been shown to improve progression-free survival (PFS) and overall survival (OS) via the inhibition of different receptor tyrosine kinases (RTKs) that are involved in tumorigenesis and angiogenesis. Both sorafenib and lenvatinib have been approved irrespective of the line of therapy for the treatment of RAI-refractory DTC, whereas cabozantinib has only been approved as a second-line treatment. Adverse effects (AEs) such as hypertension are often seen with MKI treatment, but are generally well manageable. In this review, current clinical studies will be discussed, and the toxicity and safety of sorafenib, lenvatinib and cabozantinib treatment will be evaluated, with a focus on AE hypertension and its treatment options. In short, treatment-emergent hypertension (TE-HTN) occurs with all three drugs, but is usually well manageable and leads only to a few dose modifications or even discontinuations. This is emphasized by the fact that lenvatinib is widely considered the first-line drug of choice, despite its higher rate of TE-HTN. PMID:34830100 | DOI:10.3390/ijms222212217 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Audiovestibular Symptoms in Patients With Idiopathic Hypertrophic Pachymeningitis: Systematic Literature Review

xlomafota13 shared this article with you from Inoreader Audiovestibular Symptoms in Patients With Idiopathic Hypertrophic Pachymeningitis: Systematic Literature Review Via Acta Otorrinolaringologica English Publication date: November–December 2021 Source: Acta Otorrinolaringologica (English Edition), Volume 72, Issue 6 Author(s): Eugenia López-Simón, Patricia Corriols-Noval, Nathalia Castillo-Ledesma, Minerva Rodríguez-Martín, Carmelo Morales-Angulo View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Paraneoplastic acute vestibular syndrome: What, when and how

xlomafota13 shared this article with you from Inoreader Paraneoplastic acute vestibular syndrome: What, when and how Via Acta Otorrinolaringologica English Publication date: November–December 2021 Source: Acta Otorrinolaringologica (English Edition), Volume 72, Issue 6 Author(s): Carolina Moreno-de-Jesús, Lucía Prieto-Sánchez-de-Puerta, Irene Mármol-Szombathy, Emilio Domínguez-Durán View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Fabrication of Skin-Mountable Flexible Sensor Patch for Monitoring of Swallowing Function

xlomafota13 shared this article with you from Inoreader Fabrication of Skin-Mountable Flexible Sensor Patch for Monitoring of Swallowing Function Via swallowing exercises Methods Mol Biol. 2022;2393:863-876. doi: 10.1007/978-1-0716-1803-5_46. ABSTRACT Swallowing is a critical function that enables humans to sustain life. When swallowing is compromised, the consequences can be devastating and include malnutrition, dehydration, respiratory compromise, and even death. Swallowing disorders (i.e., dysphagia) are very common in many disorders and diseases, such as stroke, ALS, Parkinson disease, and more, and in fact millions of people across the world ar e diagnosed with oropharyngeal swallowing disorders every year. Current rehabilitative interventions for dysphagia can be effective, but require daily performance of swallowing exercises that primarily rely on expensive biofeedback devices (e.g., oral manometers, electromyographic (EMG) devices, and endoscopic devices). These types of devices are often only available in medical facilities. However, it is not feasible or economically viable for patients to make multiple visits per day or week to a clinic to receive intensive treatment, especially given mobility limitations that many affected patients often experience. This can reduce treatment adherence and result in decreased rehabilitation potential, re-hospitalizations, and increased healthcare costs. To address this gap, we designed a novel specialized portable skin-mounted flexible sensor system that allows remote signal acquisition of swallowing-related signals. Herein, we report technical details for the fabrication of the ski n-mounted flexible sensor patch that is tailored for the human submental (under the chin) area, enabling the continuous, reliable monitoring of both muscles' activity (i.e., EMG signals) and laryngeal movements during swallowing events. The sensor patch is wired to a portable reusable wireless (Bluetooth) unit compatible with smart watches, phones, and tablets for post-data analysis and reporting through a cloud server, which would potentially enable telemonitoring of patients with dysphagia. PMID:34837216 | DOI:10.1007/978-1-0716-1803-5_46 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Rare anastomosis between a replaced right hepatic artery and left branch of the proper hepatic artery

xlomafota13 shared this article with you from Inoreader Rare anastomosis between a replaced right hepatic artery and left branch of the proper hepatic artery Via radiol anat Surg Radiol Anat. 2021 Nov 27. doi: 10.1007/s00276-021-02863-x. Online ahead of print. ABSTRACT Appreciation of the potential anatomical variation of the hepatic arterial supply and branches of the abdominal aorta is of paramount importance in pancreatic and hepatobiliary surgery. Here we describe a hitherto un-reported coelio-mesenteric anastomotic connection between a replaced right hepatic artery, originating from the superior mesenteric artery, and the left hepatic branc h of the proper hepatic artery. The embryological origins of the variant anatomy as well as its potential surgical implications are discussed with a view to encourage thorough pre-operative interrogation of available imaging by radiologists and surgeons to successfully identify such variants and take advantage of their potentially useful functionality. PMID:34837499 | DOI:10.1007/s00276-021-02863-x View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Possible pathomechanism behind the transient hypofunction of the affected canal in BPPV. Letter to the editor regarding 'Clinical significance of video head impulse test in benign paroxysmal positional vertigo: a meta-analysis' by Elsherif M et al. European Archives of Oto-Rhino-Laryngology (2021);278(12):4645-4651

xlomafota13 shared this article with you from Inoreader Possible pathomechanism behind the transient hypofunction of the affected canal in BPPV. Letter to the editor regarding "Clinical significance of video head impulse test in benign paroxysmal positional vertigo: a meta-analysis" by Elsherif M et al. European Archives of Oto-Rhino-Laryngology (2021);278(12):4645-4651 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. 2021 Nov 27. doi: 10.1007/s00405-021-07202-9. Online ahead of print. NO ABSTRACT PMID:34837518 | DOI:10.1007/s00405-021-07202-9 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Topical κ‐Opioid Receptor Agonist Asimadoline Improves Dermatitis in a Canine Model of Atopic Dermatitis

xlomafota13 shared this article with you from Inoreader Topical κ‐Opioid Receptor Agonist Asimadoline Improves Dermatitis in a Canine Model of Atopic Dermatitis Via Experimental Dermatology Abstract This prospective, 4-week, placebo-controlled, cross-over study aimed to investigate the efficacy of 1% topical κ-opioid agonist, asimadoline, in a model of canine atopic dermatitis (AD). Fourteen beagles were challenged with house dust mites every 3-4 days for a total of 9 challenges. Severity of dermatitis was assessed and pruritus was monitored using GoPro HERO cameras. Pruritus scoring was evaluated at 10 time periods; baseline, 4 hours post allergen challenge and the last day of the study on Day 28. Scoring was done blindly by personnel using BORIS software. A global subjective score was also given using a visual analogue scale (VAS). A 4-week washout period occurred and dogs were crossed-over, the study was repeated and the results were analyzed using combined data. Gel was applied once daily on inguinal area (0.6 ml/dog). ANOVA showed significant effect of time (p<0.0001) and group (p=0.0001) on dermatitis scores. Overall, no statistically significant effect on pruritus was found due to a crossing of scores on day 17. Overtime the placebo scores increased while the active ingredient showed decrease after first 3 weeks. It is concluded that this approach is promising in dogs with AD and longer studies with more frequent application may be beneficial. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Double‐Barrel Versus Single‐Barrel Fibula Flaps for Mandibular Reconstruction: Safety and Outcomes

xlomafota13 shared this article with you from Inoreader Double‐Barrel Versus Single‐Barrel Fibula Flaps for Mandibular Reconstruction: Safety and Outcomes Via The Laryngoscope Objectives/Hypothesis Fibula flaps are routinely used for osseous reconstruction of head and neck defects. However, single-barrel fibula flaps may result in a height discrepancy between native mandible and grafted bone, limiting outcomes from both an aesthetic and dental standpoint. The double-barrel fibula flap aims to resolve this. We present our institution's outcomes comparing both flap designs. Study Design Retrospective cohort study. Methods We conducted a retrospective review of all patients undergoing free fibula flap mandibular reconstruction at our institution between October 2008 and October 2020. Patients were grouped based on whether they underwent single-barrel or double-barrel reconstruction. Postoperative outcomes data were collected and compared between groups. Differences in categorical and continuous variables were assessed using a Chi-square test or Student's t-test, respectively. Results Out of 168 patients, 126 underwent single-barrel and 42 underwent double-barrel reconstruction. There was no significant difference in postoperative morbidity between approaches, including total complications (P = .37), flap-related complications (P = .62), takeback to the operating room (P = .75), flap salvage (P = .66), flap failure (P = .45), and mortality (P = .19). In addition, there was no significant difference in operative time (P = .86) or duration of hospital stay (P = .17). After adjusting for confounders, primary dental implantation was significantly higher in the double-barrel group (odds ratio, 3.02; 95% confidence interval, 1.2–7.6; P = .019). Conclusion Double-barrel fibula flap mandibular reconstruction can be performed safely without increased postoperative morbidity or duration of hospital stay relative to single-barrel reconstruction. Moreover, the double-barrel approach is associated with higher odds of primary dental implantation and may warrant further consideration as part of an expanded toolkit for achieving early dental rehabilitation. Level of Evidence III Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evaluation of Recurrence Risk in Patients with Papillary Thyroid Cancer through Tumor-Node-Metastasis Staging: A Single-Center Observational Study in Taiwan

xlomafota13 shared this article with you from Inoreader Evaluation of Recurrence Risk in Patients with Papillary Thyroid Cancer through Tumor-Node-Metastasis Staging: A Single-Center Observational Study in Taiwan Via radioactive iodine Biomed J. 2021 Nov 19:S2319-4170(21)00169-4. doi: 10.1016/j.bj.2021.11.009. Online ahead of print. ABSTRACT BACKGROUND: Many patients with papillary thyroid cancer (PTC) demonstrate satisfactory outcomes. However, 8%-28% of patients with PTC show tumor recurrence, which may affect prognosis. Therefore, identifying factors associated with tumor recurrence in patients with PTC may be helpful to refine therapeutic strategies. PATIENTS AND METHODS: To identify factors associated with PTC recurrence, we retrospectively reviewed demographic features (sex and age), operation method, image character, serum thyroglobulin (Tg), accumulated radioactive iodine (I-131) therapeutic dose, I-131 uptake, and metastases at diagnosis in 829 patients with PTC. Patients were grouped into early (stage I and II; n = 698) and advanced (stage III and IV; n = 131) tumor-node-metastasis (TNM) stages. Recurrence rate, mortality rate, risk factors of recurrence, recurrent free survival and overall survival curve were compared between two groups. RESULTS: Patients in the early stage demonstrated a lower recurrence rate (7.2%) than did those in the advanced stage (28.2%, p < 0.05). The mortality rate of patients with recurrence in the advanced stage was higher than that of those in the early stage (51.4% vs. 12.0%). The major impact factors on tumor recurrence in early TNM stage were distant metastasis and lymph node metastasis, while in advanced TNM stage were distant metas tasis, male gender, total thyroidectomy with limited lymph node dissection, and a high serum Tg level. CONCLUSIONS: Strategies to monitor tumor recurrence might be refined according to the TNM stages of PTC patients. PMID:34808423 | DOI:10.1016/j.bj.2021.11.009 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.