Endoscopic‐assisted total maxillectomy with precise surgical margins

alexandrossfakianakis shared this article with you from Inoreader Endoscopic‐assisted total maxillectomy with precise surgical margins via Head & Neck Abstract In traditional open maxillectomy, identifying the posterior margin is difficult because of its deep location and bleeding from the pterygoid venous plexus. Here, we present our endoscope-assisted total en bloc maxillectomy technique and discuss its merits and demerits compared to previously reported methods. We developed an endoscope-assisted total en bloc maxillectomy procedure. We reviewed a series of total maxillectomies performed with and without endoscopic assistance to verify the advantages of endoscopic assistance over conventional total maxillectomy. We analyzed (1) the precision using the distance of the remaining pterygoid process, (2) the operation time, and (3) blood loss. The length of the remnant pterygoid process was significantly shorter in the endoscopic assistance group. The operation time and blood loss were not significantly different between the two groups. Endoscopic assistance makes total maxillectomy more precise without requiring additional time and is a r easonable option for total maxillectomies. View on Web

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Medical body modification in youth with gender dysphoria or body dysmorphic disorder – is current practice coherent and evidence‐based?

alexandrossfakianakis shared this article with you from Inoreader Editorial Perspective: Medical body modification in youth with gender dysphoria or body dysmorphic disorder – is current practice coherent and evidence‐based? via Journal of Child Psychology and Psychiatry In recent decades, there has been a steady increase in the number of people, including adolescents, undergoing medical body modification (MBM) to alter their physically healthy bodies in invasive and nearly irreversible ways through medical treatment (e.g. surgery). While MBM is often recommended for youth with persisting gender dysphoria (GD), in body dysmorphic disorder (BDD) it has been considered contraindicated. Here, we outline the current controversies surrounding MBM practice and recommendations in adolescents with GD versus those with BDD in order to better understand under what circumstances we may or may not support adolescents who want to change their bodies medically and often irreversibly. We compare the two disorders in terms of the overlap and uniqueness of their behavioural and psychological features. In doing so, we discuss limitations of the existing (often low-quality) evidence for and against MBM in young patients. We conclude that the c urrently available evidence is too preliminary and far from conclusive to make any robust recommendations in terms of benefits and harms of MBM in youth with persisting GD or BDD. However, we strongly recommend further urgent scientific discussions and systematic research efforts into more robust evaluations and the identification of more precise psychological characteristics that may serve as decision criteria for or against MBM – particularly in those adolescents who did not respond to non-MBM, that is, psychiatric/psychological treatment and psychosocial support, if available at all. This will greatly benefit youth healthcare professionals in their challenging clinical practice of making decisions regarding MBM today and in the future. View on Web

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Corticosteroid Nasal Irrigation as Early Treatment of Olfactory Dysfunction in COVID‐19: A prospective randomized controlled trial

alexandrossfakianakis shared this article with you from Inoreader Corticosteroid Nasal Irrigation as Early Treatment of Olfactory Dysfunction in COVID‐19: A prospective randomized controlled trial via Clinical Otolaryngology Abstract Objective This study aimed to evaluate the efficacy of corticosteroid irrigation compared to saline to no nasal irrigation in COVID-19 patients with olfactory loss. Design and Setting A randomized controlled study was conducted at the Otolaryngology-Head & Neck Surgery Department, Ramathibodi Hospital, Faculty of Medicine, Mahidol University. Participants Two hundred thirty-seven COVID-19 participants with a new-onset smell loss were recruited into the study. Two hundred twenty-two participants met the inclusion criteria and were randomized into three groups; corticosteroid irrigation, saline irrigation, and no treatment. Main outcome measures The primary outcome was the mean difference in the smell sensation score among the groups after treatment at 1, 2, and 6 weeks. The secondary outcomes measurements included 1)a self-rating quality of life(QOL)-related smell dysfunction score, 2)the change over time in smell sensation score and self-rating QOL-related smell dysfunction score, and 3)the median time to complete recovery of smell loss. Results The mean differences in smell sensation scores among the three groups were not statistically significant at any follow-up period. The mean score of self-rating QOL-related smell dysfunction in the corticosteroid group was significantly better than the other groups at one week. The change of outcome scores showed significant improvement over time, regardless of the treatments. The median time to complete smell recovery was similar: three weeks. Conclusion This study emphasized that corticosteroid nasal irrigation is not superior to saline or no nasal irrigation in restoring the sense of smell in COVID-19-associated olfactory loss. This article is protected by copyright. All rights reserved. View on Web

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Polygenic risk scores for prediction of breast cancer

alexandrossfakianakis shared this article with you from Inoreader Polygenic risk scores for prediction of breast cancer in Korean women via International Journal of Epidemiology - Advance Access Abstract Background Polygenic risk scores (PRSs) for breast cancer, developed using European and Asian genome-wide association studies (GWAS), have been shown to have good discrimination in Asian women. However, prospective calibration of absolute risk prediction models, based on a PRS or PRS combined with lifestyle, clinical and environmental factors, in Asian women is limited. Methods We consider several PRSs trained using European and/or Asian GWAS. For each PRS, we evaluate the discrimination and calibration of three absolute risk models among 41 031 women from the Korean Cancer Prevention Study (KCPS)-II Biobank: (i) a model using incidence, mortality and risk factor distributions (reference inputs) among US women and European relative risks; (ii) a recalibrated model, using Korean reference but European relative risks; and (iii) a fully Korean-based model using Korean reference and relative risk estimates from KCPS. Results< /div>All Asian and European PRS improved discrimination over lifestyle, clinical and environmental (Qx) factors in Korean women. US-based absolute risk models overestimated the risks for women aged ≥50 years, and this overestimation was larger for models that only included PRS (expected-to-observed ratio E/O = 1.2 for women <50, E/O = 2.7 for women ≥50). Recalibrated and Korean-based risk models had better calibration in the large, although the risk in the highest decile was consistently overestimated. Absolute risk projections suggest that risk-reducing lifestyle changes would lead to larger absolute risk reductions among women at higher PRS. Conclusions Absolute risk models incorporating PRS trained in European and Asian GWAS and population-appropriate average age-specific incidences may be useful for risk-stratified interventions in Korean women. View on Web

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Pediatric renal tumor epidemiology: Global perspectives, progress, and challenges

alexandrossfakianakis shared this article with you from Inoreader Pediatric renal tumor epidemiology: Global perspectives, progress, and challenges via Pediatric Blood & Cancer Abstract Pediatric renal tumors account for 3%–11% of childhood cancers, the most common of which is Wilms tumor or nephroblastoma. Epidemiology plays a key role in cancer prevention and control by describing the distribution of cancer and discovering risk factors for cancer. Large pediatric research consortium trials have led to a clearer understanding of pediatric renal tumors, identification of risk factors, and development of more risk-adapted therapies. These therapies have improved event-free and overall survival for children. However, several challenges remain and not all children have benefited from the improved outcomes. In this article, we review the global epidemiology of pediatric renal tumors, including key consortium and global studies. We identify current knowledge gaps and challenges facing both high and low middle-incomes countries. View on Web

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Metformin use and the risks of herpes zoster and postherpetic neuralgia in patients with type 2 diabetes

alexandrossfakianakis shared this article with you from Inoreader Metformin use and the risks of herpes zoster and postherpetic neuralgia in patients with type 2 diabetes via Journal of Medical Virology Abstract Herpes zoster and postherpetic neuralgia cause substantial pain in patients. Persons with type 2 diabetes (T2D) are prone to zoster infection and postherpetic neuralgia due to compromised immunity. We conducted this study to evaluate the risks of herpes zoster and postherpetic neuralgia between metformin users and nonusers. Propensity score matching was utilized to select 47472 pairs of metformin users and nonusers from Taiwan's National Health Insurance Research Database between January 1, 2000, and December 31, 2017. The Cox proportional hazards models were used for comparing the risks of herpes zoster and postherpetic neuralgia between metformin users and nonusers in patients with T2D. Compared with no-use of metformin, the aHRs (95% CI) for metformin use in herpes zoster and postherpetic neuralgia were 0.70 (0.66, 0.75) and 0.510 (0.39, 0.68), respectively. A higher cumulative dose of metformin had further lower risks of herpes zoster and postherpetic ne uralgia than metformin no-use. This nationwide cohort study demonstrated that metformin use was associated with a significantly lower risk of herpes zoster and postherpetic neuralgia than metformin no-use. Moreover, a higher cumulative dose of metformin was associated with further lower risks of these outcomes. This article is protected by copyright. All rights reserved. View on Web

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Platelet‐rich fibrin combined with a particulate bone substitute versus guided bone regeneration in the damaged extraction socket: an in vivo study

alexandrossfakianakis shared this article with you from Inoreader Platelet‐rich fibrin combined with a particulate bone substitute versus guided bone regeneration in the damaged extraction socket: an in vivo study via Journal of Clinical Periodontology Abstract Aim It has been proposed that platelet-rich fibrin (PRF) can be used to support bone regeneration during alveolar ridge augmentation. The aim of this study was to determine if an approach utilizing PRF provides similar performance to the established guided bone regeneration (GBR) procedure. Materials and Methods Two-wall defects were surgically created in beagle dogs and treated in three experimental groups: (i) sticky bone (SB) substitute prepared using liquid PRF and deproteinized porcine bone mineral (DPBM), (ii) SB covered with solid PRF compressed into a membrane, and (iii) GBR performed using DPBM covered by a collagen membrane. The quantitative reverse-transcription polymerase chain reaction was applied to specimen after 1 week of healing, and microcomputed tomography (micro-CT) and histological outcomes were analyzed after 8 weeks of healing. Results Compared with GBR, PRF resulted in a moderate increase in the expression levels of osteoblast and osteoclast markers, osteocalcin, and calcitonin receptor. Moreover, PRF modestly increased angiogenesis and the inflammation markers VEGF and IL-6. Micro-CT and histological analyses confirmed the expected increased alveolar ridge area, with no significant differences between the three groups. Consistently, graft consolidation as indicated by new bone formation at the defect site did not differ significantly between groups. Conclusion The present results demonstrate that PRF-based approaches performed comparably to the established GBR procedure in terms of the consolidation of DPBM in two-wall alveolar defects. This article is protected by copyright. All rights reserved. View on Web

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Characteristics of Orbital Injuries Associated with Maxillofacial Trauma

alexandrossfakianakis shared this article with you from Inoreader Characteristics of Orbital Injuries Associated with Maxillofacial Trauma via The Laryngoscope Introduction The incidence of ocular injury associated with maxillofacial trauma remains poorly defined, with reported rates ranging from 0.8% to 92%. Our study aims to more accurately characterize ocular injuries associated with midface fractures. Methods We performed a retrospective review of 1677 patients from 2015 to 2020 with midface fractures at a Level I trauma center. Isolated nasal bone and frontal process of the maxilla fractures were excluded. Demographic information, mechanism of injury, need for surgery, and ophthalmologic findings were documented. Statistical analysis was conducted using SPSS. Results 773 patients between the ages of 15 and 92 were identified. Trauma most commonly resulted from assault (63.8%). The association between the mechanism of injury and ocular injury was statistically significant (p = 0.003), with 78.6% of gunshot wounds and 44.3% of assault patients having an ocular injury. The Ophthalmology service evaluated 62.6% of cases preoperatively. Minor ocular injury occurred in 36% of patients, including 46.1% of isolated orbital floor, and 28.2% of zygomaticomaxillary complex fractures. Major ocular injury occurred in 10.5% of patients. Conclusions Over 10% of patients with midface fractures were found to have major ocular injuries. Ophthalmologic exams should be performed for all patients with midface fractures to guide clinical decision making and prevent further intraoperative ocular insults. Level of Evidence Level 4. This study represents a retrospective cohort study analyzing ocular injuries detected in patients presenting to a Level I trauma center with maxillofacial fractures between 2015 and 2020 Laryngoscope, 2022 View on Web

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Improving Methods of Identifying Anaphylaxis for Medical Product Safety Surveillance Using Natural Language Processing and Machine Learning

alexandrossfakianakis shared this article with you from Inoreader Improving Methods of Identifying Anaphylaxis for Medical Product Safety Surveillance Using Natural Language Processing and Machine Learning via American Journal of Epidemiology - Advance Access Abstract We sought to determine whether machine learning and natural language processing (NLP) applied to electronic medical records could improve performance of automated healthcare claims-based algorithms to identify anaphylaxis events using data on 516 patients with outpatient, emergency department, or inpatient anaphylaxis diagnosis codes during 2015-2019 in two integrated healthcare institutions in the Northwest United States. We used one site's manually reviewed gold standard outcomes data for model development and the other's for external validation based on cross-validated (cv) area under the receiver operating characteristic curve (cv AUC), positive predictive value (PPV), and sensitivity. In the development site 154 (64%) of 239 potential events met adjudication criteria for anaphylaxis compared to 180 (65%) of 277 in the validation site. Logistic regression models using only structured claims data achieved a cv-AUC of 0.58 (95% CI: 0.54, 0. 63). Machine learning improved cv-AUC to 0.62 (0.58, 0.66); incorporating NLP-derived covariates further increased cv AUCs to 0.70 (0.66, 0.75) in development and 0.67 (0.63, 0.71) in external validation data. A classification threshold with cv-PPV of 79% and cv-sensitivity of 66% in development data had cv-PPV of 78% and cv-sensitivity of 56% in external data. Machine learning and NLP-derived data improved identification of validated anaphylaxis events. View on Web

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Update of the classification of midpalatal suture behaviour after surgically assisted rapid maxillary expansion using computed tomography

alexandrossfakianakis shared this article with you from Inoreader Update of the classification of midpalatal suture behaviour after surgically assisted rapid maxillary expansion using computed tomography via International Journal of Oral and Maxillofacial Surgery via MedWorm.com The aim of this study was to update the midpalatal suture classification after surgically assisted rapid maxillary expansion (SARME) using computed tomography (CT). Thirty-five patients with a transverse maxillary deficiency and unilateral or bilateral posterior crossbite underwent SARME with osteotomy of the pterygoid apophysis of the sphenoid. CT was performed before installation of the Hyrax expander appliance and after the final activation. Opening of the midpalatal suture was classified into three types: type I, total midpalatal suture opening from anterior nasal spine (ANS) to posterior nasal spine (PNS); type II, partial midpalatal suture opening from ANS to the transverse palatine suture, with partial or non-existent opening of the midpalatal suture posterior to the transverse pala... View on Web

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