Complications of facial cosmetic botulinum toxin A injection: analysis of the UK Medicines & Healthcare Products Regulatory Agency registry and literature review

xlomafota13 shared this article with you from Inoreader Complications of facial cosmetic botulinum toxin A injection: analysis of the UK Medicines & Healthcare Products Regulatory Agency registry and literature review Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 17:S1748-6815(21)00332-6. doi: 10.1016/j.bjps.2021.05.074. Online ahead of print. ABSTRACT BACKGROUND: Botulinum toxin A (BoNT-A) injection is one of the most frequently undertaken procedures in aesthetic medicine. The Medicines & Healthcare products Regulatory Agency (MHRA) is the government body in the United Kingdom (UK) mandated to ensure that the provision and administration of medicines is safe. We analyzed adverse events of facial cosmetic BoNT-A injections reported to the MHRA and assessed whether the incidence of reported adverse events in this government registry is comparable to published retrospective and prospective studies. METHODS: A freedom of information (FOI) request was submitted to the MHRA to obtain recorded complications of BoNT- A. Complications reported to the MHRA between 1991 and 2020 were analyzed. Only cases with BoNT-A where the indication was specified as f or facial cosmetics were included in the analysis. Additionally, the literature was reviewed on adverse events of facial cosmetic BoNT- A injections, and a statistical meta-analysis of complication rates was carried out. RESULTS: A total of 188 adverse events of aesthetic BoNT-A injections were reported to the MHRA. The literature search resulted in 30 studies and a total of 17,352 injection sessions, where the complication rate was 16% (95% CI = 8% to 25%). Frequent adverse events included localized skin reactions such as bruising with an incidence of 5% (95% CI = 3% to 7%), headache in 3% (95% CI = from 1% to 5% ), and facial paresis in 2% (95% CI = 1% to 3%) of injection sessions. CONCLUSIONS: This is the first paper to obtain and evaluate data on adverse events of BoNT-A from the MHRA. An estimate of the likely complication rate of aesthetic BoNT-A in the UK, according to the MHRA database, is significantly lower than the rate recorded from our meta-analysis of the i nternational literature. This suggests that the MHRA may be underestimating the adverse events of aesthetic BoNT-A treatment, which would have implications for patient safety and informed consent. Therefore, legislative changes may be required to ensure more robust reporting of aesthetic BoNT-A in the UK. PMID:34456155 | DOI:10.1016/j.bjps.2021.05.074 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Burnout in microvascular reconstructive otolaryngology – head and neck surgeons: Potential modifiable workplace factors

xlomafota13 shared this article with you from Inoreader Burnout in microvascular reconstructive otolaryngology – head and neck surgeons: Potential modifiable workplace factors Via Head & Neck Abstract Background Burnout has been previously assessed in head and neck microvascular reconstructive surgeons (HNMVS), but not in the context of modifiable workplace factors. Methods Anonymous, cross-sectional survey. The Abbreviated Maslach Burnout Inventory – Human Services Survey for Medical Personnel (aMBI-HSS) was utilized to assess emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). Modifiable risk factors were also evaluated. Results High risk of burnout by EE, DP, and PA was demonstrated in 24%, 9%, and 27% of respondents, respectively. EE was associated with <10% dedicated research time, lack of autonomy over clinic schedule, inadequate inpatient support, and lack of supportive clinical partner. DP was associated with >3 operative days, difficulty balancing academic commitments, and lack of supportive clinical partner. Dedicated research time and two or fewer days of block time were protective. Conclusions Burnout was associated with several modifiable workplace factors. Addressing these may prevent moderate to severe burnout in HNMVS. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Microwave ablation of benign thyroid nodules: 3‐year follow‐up outcomes

xlomafota13 shared this article with you from Inoreader Microwave ablation of benign thyroid nodules: 3‐year follow‐up outcomes Via Head & Neck Abstract Purpose To evaluate the effectiveness of microwave ablation (MWA) for the treatment of thyroid nodules according to nodule composition. Materials and methods This study evaluated 171 patients with 180 benign thyroid nodules (BTNs) that had been treated with ultrasound-guided MWA. The volume reduction rate (VRR) of thyroid nodules and factors, which had an influence on the VRR, were assessed. Therapeutic success was defined as a >50% volume reduction at the 12-month follow-up. Multivariate regression analysis was used to identify independent predictors of VRR for BTNs after MWA treatment. Results The mean diameter and volume of the nodules were 4.3 ± 1.3 cm and 18.9 ± 2.1 ml, respectively. The VRRs at the 1-, 3-, 6-, 12-, 24-, and 36-month follow-ups were 47.1%, 68.2%, 79.7%, 87.4%, 90.1%, and 93.2%, respectively. Of the 180 BTNs, there were 87 solid, 74 predominantly solid, and 19 predominantly cystic nodules. Solid nodules showed significantly lower VRRs compared with the predominantly solid and predominantly cystic nodules at the 1-, 3-, and 6-month follow-ups. For the multivariate regression analysis, the cyst component was an active prognostic factor for the VRR at the 1-, 3-, and 6-month follow-ups; the cyst component was not significantly associated with the VRR at the 12-, 24-, and 36-month follow-ups. Conclusion Our study suggested that ultrasound-guided MWA is an effective and safe procedure for the treatment of BTNs. Solid nodules indicate a lower VRR and less efficient than predominant solid nodules and predominant cystic nodules after MWA. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Acute appendicitis secondary to desmoplastic melanoma metastasis in immune-checkpoint inhibitors era

xlomafota13 shared this article with you from Inoreader Acute appendicitis secondary to desmoplastic melanoma metastasis in immune-checkpoint inhibitors era Via Melanoma Research - Published Ahead-of-Print No abstract available View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

CircAGFG1 acts as a sponge of miR-4306 to stimulate esophageal cancer progression by modulating MAPRE2 expression

xlomafota13 shared this article with you from Inoreader CircAGFG1 acts as a sponge of miR-4306 to stimulate esophageal cancer progression by modulating MAPRE2 expression Via histochem Acta Histochem. 2021 Aug 27;123(7):151776. doi: 10.1016/j.acthis.2021.151776. Online ahead of print. ABSTRACT OBJECTIVE: This work aims to determine the role of circular RNA (circRNA) AGFG1 and related molecular mechanism in esophageal squamous cell carcinoma (ESCC) cells. METHODS: CircAGFG1 expression in ESCC cell lines was probed with qRT-PCR. ESCC cells were transfected/cotransfected with si-circAGFG1, pcDNA3.1-circAGFG1, si-Microtubule Associated Protein RP/EB Fami ly Member 2 (MAPRE2), pcDNA3.1-circAGFG1 + miR-4306 mimic or pcDNA3.1-circAGFG1 + si-MAPRE2. The interactions between circAGFG1 and miR-4306 as well as miR-4306 and MAPRE2 were confirmed by dual-luciferase reporter assay. Cell proliferation, migration and invasion were detected by CCK-8, cell scratch and Transwell assays, respectively. Relative RNA expression levels of circAGFG1, miR-4306 and MAPRE2 in ESCC cells were measured by qRT-PCR. The protein level of MAPRE2 in ESCC cells was monitored by Western blot. RESULTS: CircAGFG1 was observably upregulated in ESCC cell lines. Besides, circAGFG1 silencing hindered ESCC cell development in vitro, and these effects were enhanced by miR-4306 overexpression or MAPRE2 silencing. Mechanistic analysis evidenced that circAGFG1 might act as a competitive endogenous RNA of miR-4306 to relieve the repressive effect of miR-4306 on its target MAPRE2. CONCLUSION: CircAGFG1 facilitates ESCC progression via the miR-4306/MAPRE2 axis, and i t may act as a possible biomarker for therapy and diagnosis in ESCC treatment. PMID:34461454 | DOI:10.1016/j.acthis.2021.151776 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Can intensity modulation of the auditory response explain intensity-decrement mismatch negativity?

xlomafota13 shared this article with you from Inoreader Can intensity modulation of the auditory response explain intensity-decrement mismatch negativity? Via cortical auditory Neurosci Lett. 2021 Aug 27:136199. doi: 10.1016/j.neulet.2021.136199. Online ahead of print. ABSTRACT Mismatch negativity (MMN) elicited by decrements in sound pressure level has been asserted as evidence for its dependence upon general deviance detection, while refuting the proposition that it is simply caused by modulating the intrinsic sensory response with different physical properties of sound. However, reports of intensity-decrement MMN are sparse compared with MMN to stimulus frequency or duration changes, and verifying the mechanisms that shape difference waveform morphology is essential for their responsible use as clinical biomarkers. In the present study, open-access EEG data from 40 healthy young adults recorded during an intensity-decrement oddball paradigm was analyzed to establish the effects of transitions between different level stimuli on the auditory evoked response. Standard stimuli were 80 dB and deviant stimuli were 70 d B. Event-related potentials were extracted from standards after standards (sS), deviants after standards (sD), and standards after deviants (dS). Mean amplitude across a recommended measurement window for MMN (125 to 225 ms) was calculated for each ERP waveform. This revealed statistically significant negative amplitude shift elicited by lower-intensity deviant stimuli, as expected, and an opposite direction, positive amplitude shift elicited by higher-intensity standard stimuli that followed lower-intensity deviants, relative to standard stimuli presented consecutively. These findings indicate that intensity-modulation of the auditory response influences cortical activity measured during the latency range of MMN. To what extent the hypothesized deviance detection mechanisms may also contribute is uncertain and remains to be elucidated. PMID:34461160 | DOI:10.1016/j.neulet.2021.136199 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Robotic rectal resection preserves anorectal function: systematic review and meta‐analysis

xlomafota13 shared this article with you from Inoreader Robotic rectal resection preserves anorectal function: systematic review and meta‐analysis Via The International Journal of Medical Robotics and Computer Assisted Surgery ABSTRACT Background Improving survival rates in rectal cancer patients has generated a growing interest in functional outcomes after total mesorectal excision (TME). The well-established low anterior resection syndrome (LARS) score assesses postoperative anorectal impairment after TME. Our meta-analysis is the first to compare bowel function after open, laparoscopic, transanal, and robotic TME. Methods All studies reporting functional outcomes after rectal cancer surgery (LARS score) were included, and results were compared with a consecutive series of robotic TME (n=48). Results Thirty-two publications were identified, including 5 565 patients. Anorectal function recovered significantly better within one year after robotic TME (3.8 [95%CI -9.709–17.309]) versus laparoscopic TME (26.4 [95%CI 19.524–33.286]), p=0.006), open TME (26.0 [95%CI 24.338–29.702], p=0.002), and transanal TME (27.9 [95%CI 22.127–33.669], p=0.003). Conclusions Robotic TME enables better recovery of anorectal function compared to other techniques. Further prospective, high-quality studies are needed to confirm the benefits of robotic surgery. This article is protected by copyright. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Reading and comprehension: phoniatric assessment in students with reading difficulties

xlomafota13 shared this article with you from Inoreader Reading and comprehension: phoniatric assessment in students with reading difficulties Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Jul 21:S1808-8694(21)00125-7. doi: 10.1016/j.bjorl.2021.05.014. Online ahead of print. ABSTRACT INTRODUCTION: Reading is a highly refined skill that encompasses two main components: decoding graphic symbols and understanding the written message. These aspects generally develop together, but reading comprehension is a much more complex process, sustained not only by the identification of written words and vocabulary but also by language systems, such as syntax and general knowledge. Although there is a well-established technique for performing the phoniatric assessment, there is no common use of tests that assess reading comprehension or the association of this information with other assessment data. OBJECTIVE: The objective of this study is, in the context of the phoniatric consultation, to evaluate the reading and retelling in children with relevant reading difficulties and to correlate the decoding and comprehension problems with the alterations observed in auditory and visual perceptual tests, pointing out the evidence that best contributed to the differential diagnosis of these subjects. METHODS: Starting from a population of 301 children enrolled in the 4th and 5th grades of elementary school, 13 children with evident reading and writing difficulties were evaluated regarding the reading and retelling tasks and separated into groups according to the problem of decoding, fluency, and comprehension. Reading performance was correlated with the performance in visual and auditory perceptual tests and based on the similarity analysis, the tests considered to be the most relevant in the diagnosis process of these children were identified. RESULT: The results suggest that the tasks: naming of figures, repetition of numbers in reverse order, figure copying, syllabic synthesis, phonemic synthesis, rhyme, and phonemic manipulation altogether contribute to diagnosis and mul tidisciplinary intervention aspects. CONCLUSION: Some tasks are more relevant to the diagnostic process of children with complaints of learning difficulties in reading. PMID:34462203 | DOI:10.1016/j.bjorl.2021.05.014 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Transmastoid exposure of the labyrinthine segment of the facial nerve: an anatomical study

xlomafota13 shared this article with you from Inoreader Transmastoid exposure of the labyrinthine segment of the facial nerve: an anatomical study Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Aug 11:S1808-8694(21)00136-1. doi: 10.1016/j.bjorl.2021.07.002. Online ahead of print. ABSTRACT INTRODUCTION: Compression of the labyrinthine segment of the facial nerve by edema has been considered as an important pathology in the majority of the cases of idiopathic facial nerve paralysis. Hence, it is suggested that total decompression of the facial nerve should also include the labyrinthine segment by a middle fossa approach. However, the middle fossa approach requires craniotomy and temporal lobe retraction, which increases the morbidity. The labyrinthine segment of the facial nerve can also be reached through mastoidectomy. However, many ear surgeons are not familiar with this approach due to the lack of anatomical data on this surgical area. OBJECTIVE: To study the anatomical limitations of decompression of the labyrinthine segment via transmastoid approach. METHODS: Complete mastoidectom y was performed in six adult cadavers heads. Dissection was extended in the zygomatic root and posterior bony wall of the external auditory canal to visualize the incudomallear joint completely. The bone between tympanic segment, lateral and superior semicircular canal's ampullas and middle fossa dural plate was removed. Fine dissection was carried out over tympanic segment of the facial nerve in an anterosuperomedial direction the labyrinthine segment was reached. RESULTS: All the mastoids were well pneumatized. Distances between the labyrinthine segment and middle fossa dura, and between the labyrinthine segment and superior semicircular canal, were 2.5 and 4.5 mm on average, respectively. In addition, distances between the middle fossa dura and dome of the lateral semicircular canal, and between the middle fossa dura and tympanic segment were 4.6 mm and 4.3 mm on average, respectively. CONCLUSION: It is possible to expose the labyrinthine segment of the facial nerve t hrough mastoidectomy by dissecting the bone in the area between the tympanic segment of the facial nerve, middle fossa dural plate and ampullary ends of the lateral and superior semicircular canals. PMID:34462204 | DOI:10.1016/j.bjorl.2021.07.002 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A challenging TSH/GH co-secreting pituitary adenoma with concomitant thyroid cancer; a case report and literature review

xlomafota13 shared this article with you from Inoreader A challenging TSH/GH co-secreting pituitary adenoma with concomitant thyroid cancer; a case report and literature review Via radioactive iodine BMC Endocr Disord. 2021 Aug 30;21(1):177. doi: 10.1186/s12902-021-00839-x. ABSTRACT BACKGROUND: Thyroid stimulating hormone (TSH) secreting pituitary adenoma (TSHoma) with coexisting thyroid cancer is extremely rare, and proper treatment of both diseases may pose a unique clinical challenge. When TSHoma has plurihormonality, particularly involving the co-secretion of growth hormone (GH), management can be more complicated. Herein, we present a difficult-to-manage case of papillary thyroid cancer with an incurable TSH/GH-secreting pituitary adenoma. CASE PRESENTATION: A 59-year-old man was referred to our hospital due to memory impairment and inappropriate TSH level. Sella magnetic resonance imaging revealed a huge pituitary mass extending to the suprasellar area. Clinical diagnosis of TSH/GH co-secreting pituitary adenoma was made based on elevated free T4, total T3, serum α-subunit, insulin-like growth factor-1 levels and non-suppressible GH levels after oral glucose loading. Rectal cancer and multifocal papillary thyroid microcarcinoma (PTMC) were diagnosed during initial screening for internal malignancy; lower anterior resection was performed and close observation was planned for PTMC. Long-acting octreotide therapy was commenced, which resulted in a dramatic reduction in TSHoma size and facilitated control of hormonal excess. Total thyroidectomy and radioactive iodine (RAI) therapy were needed during follow up due to the growth of PTMC. After the surgery, the pituitary adenoma represented resistance to somatostatin analogue therapy and the tumor size gradually increased despite the addition of dopamine agonist therapy. Furthermore, TSH suppressive therapy with levothyroxine was impossible and an adequate TSH level for RAI therapy was unmountable. Late debulking pituitary surgery was ineffective, and the patient gradually deteriorated and lost to follow up. CONCLUSION: We report the first aggravated case of TSH/GH co-secreting pituitary tumor after total thyroidectomy for concomitant multifocal PTMC. Deferring of thyroid surgery until the TSHoma is well controlled may be the optimal therapeutic strategy in patients with TSHoma and coexistent thyroid cancer; ablative thyroid surgery may result in catastrophic pituitary tumor growth. PMID:34461869 | DOI:10.1186/s12902-021-00839-x View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Identification of Two Different Phenotypes of Patients with Amiodarone-Induced Thyrotoxicosis and Positive Thyrotropin Receptor Antibody Tests

xlomafota13 shared this article with you from Inoreader Identification of Two Different Phenotypes of Patients with Amiodarone-Induced Thyrotoxicosis and Positive Thyrotropin Receptor Antibody Tests Via liebertpub1 Thyroid, Ahead of Print. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.