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Τρίτη 12 Ιανουαρίου 2021

Transnasal endoscopic skull base and brain surgery: Surgical anatomy and its applications. Aldo C. Stamm Joao Mangussi‐Gomes New York, NY: Thieme, 2019, 690 pp., $229.99.

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The importance of smoking status at diagnosis in human papillomavirus‐associated oropharyngeal cancer

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Abstract

Background

Smoking status at point of diagnosis is not used in defining risk groups for human papillomavirus (HPV)‐associated oropharyngeal cancer (OPC) despite its prognostic value in head and neck cancer.

Methods

Retrospective analysis of consecutive patients treated with chemoradiotherapy between January 2005 and July 2017 was performed with multivariable analysis to explore the impact of smoking status at diagnosis (current/former/never) on overall survival (OS), cancer‐specific survival (CSS) and progression‐free survival (PFS).

Results

Median follow‐up was 61 months. Four hundred and four patients were included. Current smokers had inferior OS versus never and former smokers [adjusted HR 2.37 (95% CI 1.26–4.45, p < 0.01) and 2.58 (95% CI 1.40–4.73, p < 0.01), respectively] and inferior PFS versus never smokers [adjusted HR 1.83 (95% CI 1.00–3.35, p = 0.04)]. Smoking status did not predict for CSS.

Conclusion

Detailed smoking behavior should be considered in refining risk groups in HPV‐associated OPC treated with radiotherapy and in future trial design eligibility and stratification.

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Association of early‐life gut microbiome and lifestyle factors in the development of eczema in Hong Kong infants

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Abstract

Childhood eczema is common but its prevalence is variable in different regions of the world. In this study, we explore the associations of various risk factors such as the microbiome, environment, lifestyle, diet and maternal stress with the development of eczema among infants in Hong Kong. Upon enrolment in the study, the infants' parents provided demographic data by self‐reporting. At enrolment and 1 year after birth, the infants' allergic conditions, lifestyles and dietary factors and the degree of maternal stress were assessed using various questionnaires. The infants' gut microbiomes were analysed by 16S RNA sequencing, and the longitudinal changes in various bacterial strains were compared between control and eczema‐affected groups. Multivariate analyses (after adjustment for other significant factors) revealed that the changes in the abundance of Hungatella hathewayi in the gut were significantly associated with the development of eczema (p = 0.005). In conclusion, the increased abundance of Hungatella hathewayi was associated with an increased risk of developing eczema by 1 year of age. This study thus explored the potential risk factors for the development of eczema in Hong Kong infants, and sheds light on the possible association between early‐life gut microbiome and other environmental factors.

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Prognostic Value of Third Cervical Vertebra Skeletal Muscle Index in Oral Cavity Cancer: A Retrospective Study

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Objectives/Hypothesis

To assess the prognostic utility of third cervical vertebra skeletal muscle index (C3 SMI) measured from preoperative head and neck computed tomography (CT) in patients with oral cavity squamous cell carcinoma (OSCC).

Study Design

Retrospective study.

Methods

We retrospectively reviewed the medical records of 125 patients who underwent primary curative surgery for OSCC between 2009 and 2017. Their preoperative C3 SMI was calculated by adjusting the C3 cross‐sectional area delineated on head and neck CT by body height squared. A Cox proportional hazard model was employed to identify prognostic factors, and a novel nomogram based on C3 SMI was built for individualized survival prediction.

Results

In Kaplan–Meier analysis, high C3 SMI was significantly associated with higher 5‐year disease‐free survival (DFS) and overall survival (OS) than low C3 SMI. In multivariate analysis, low C3 SMI was an independent risk factor for poor DFS and OS (hazard ratio [HR]: 2.197; 95% confidence interval [CI], 1.170–4.512, P = .032 and HR: 2.143; 95% CI, 1.232–3.728, P = .007, respectively). The concordance‐index (C‐index) of the nomogram based on C3 SMI was 0.814 for OS, higher than that of the nomogram based on tumor–node–metastasis staging alone (C‐index = 0.731).

Conclusions

C3 SMI might serve as a novel prognosticator in OSCC patients undergoing curative surgery, and the nomogram based on C3 SMI might provide good prognostic discrimination ability for individualized survival prediction.

Level of Evidence

IV Laryngoscope, 2021

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Bypass grafting in recurrent nasopharyngeal carcinoma patients with internal carotid artery invasion

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Publication date: Available online 12 January 2021

Source: American Journal of Otolaryngology

Author(s): Zhouyang Zhao, Lijin Huang, Jinhua Chen, Weijia Huang, Xiaobin Zhang, Yue Ma, Hongshen Zhu, Zhang Liu

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Intra-operative parathyroid hormone evaluation is superior to frozen section analysis in parathyroid surgery

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Publication date: Available online 12 January 2021

Source: American Journal of Otolaryngology

Author(s): Süleyman Özkan Aksoy, Süleyman Cem Adiyaman, Ali Durubey Çevlik, Merih Güray Durak, Mustafa Seçil, Ali İbrahim Sevinç

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Edoscopic posterior nasal neurectomy with submucosal turbinectomy for the treatment of intractable severe chronic rhinitis

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Publication date: Available online 11 January 2021

Source: Auris Nasus Larynx

Author(s): Serika Sonoda, Daisuke Murakami, Yuichi Saito, Yusuke Miyamoto, Ryota Higuchi, Yoshikazu Kikuchi, Motohiro Sawatsubashi, Takashi Nakagawa

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Oscillatory biomarkers of early auditory information processing predict cognitive gains following targeted cognitive training in schizophrenia patients.

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Oscillatory biomarkers of early auditory information processing predict cognitive gains following targeted cognitive training in schizophrenia patients.

Schizophr Res. 2020 01;215:97-104

Authors: Hochberger WC, Thomas ML, Joshi YB, Molina J, Treichler EBH, Nungaray J, Cardoso L, Sprock J, Swerdlow N, Light GA

Abstract
Auditory-based targeted cognitive training (TCT) is an effective and well-validated intervention for the treatment of cognitive impairment in schizophrenia patients. Improvements in higher-order cognition, reductions in symptom severity, and increases in psychosocial functioning secondary to TCT are thought to be driven by "bottom-up" enhancement of early auditory information processing (EAIP). Despite strong evidence of efficacy at the group level, there is significant variability in response to TCT, with few well-delineated biomarkers for predicting individual benefit. EEG biomarkers of EAIP are indicators of early-treatment sensitivity that predict full-course TCT outcome; however, further characterization is necessary for biomarker-guided clinical trials. The current study examined baseline and early-treatment sensitivity (i.e., change from baseline after 1 h) in theta band oscillatory activity to deviant stimuli as moderators of full course (30 h) TCT response in tre atment-refractory schizophrenia patients randomly assigned to receive either treatment-as-usual (TAU; n = 22) or TAU augmented with TCT (n = 30). Theta evoked power and phase locking at baseline predicted patient improvements in global cognitive function after 30 h of TCT. Decrease in theta activity to deviant stimuli after 1 h of TCT predicted improvements in verbal learning after 30 h. Exploratory analyses using EEG composite scores had high levels of sensitivity and specificity for identifying patients most likely to benefit from TCT. The integrity of baseline neurophysiologic activity associated with EAIP, as well as the sensitivity of the underlying circuity to change, likely reflects an intermediate therapeutic process underlying the effectiveness of TCT that can be used to predict patient response to treatment.

PMID: 31759809 [PubMed - indexed for MEDLINE]

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Role of the temporoparietal fascia free flap in salvage total laryngectomy

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Abstract

The procedure for salvage total laryngectomy (STL) is burdened by a high rate of postoperative complications as a result of delayed wound healing in previously irradiated tissue. Several observational studies have investigated the role of prophylactic vascularized flaps to aid pharyngeal closure after STL and prevent the development of PCF. The use of a temporoparietal fascia free flap (TFFF) as an overlay flap for STL has been described previously in two published studies and both sets of authors agreed that the most obvious benefit of the TFFF in STL is a reduced PCF rate with low site morbidity and good functional outcomes. The aim of this video is to illustrate the use of the temporoparietal fascia flap to provide an adjunctive reinforcement layer in the reconstruction of the pharynx.

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Patterns of Facial Fractures

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Objective/Hypothesis

To report characteristics and management of facial fractures in a major metropolitan center within the United States.

Study Design

Retrospective chart review.

Methods

Retrospective review at a level 1 trauma academic medical center of 3,946 facial fractures in 1,914 patients who presented from 2008 to 2017. Demographics, injury mechanism, associated injuries, and treatment information were collected. Logistic regression analyses were performed to determine factors associated with management.

Results

There were 1,280 males and 630 females with a median age of 42 years. Orbital fractures were the most common (41.4%) followed by maxilla fractures (21.9%). The most common mechanism was fall (43.6%). Surgical management was recommended for 38% of patients. The odds of surgical management were less for females (OR 0.59, 95% CI 0.48–0.73). Patients over 70 years were significantly less likely to undergo surgery compared to other age groups (OR 0.15–0.36, P < .001). The odds of surgical management were 1.69 times greater for patients with more than three fractures than for a single fracture (95% CI 1.18–2.42) and 2.23 times greater for traffic injuries compared to injuries from activities of daily living (95% CI 1.42–3.5).

Conclusions

This represents one of the largest comprehensive databases of facial fractures. Our patients were most frequently injured during activities of daily living, most commonly from falls. The majority of patients were managed conservatively. Gender, age, fracture number, and mechanism of injury were independently associated with the decision to treat surgically. Our data are in stark contrast to that from other populations in which assault or motor vehicle accidents predominate.

Level of Evidence

4 Laryngoscope, 2021

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Glutamine Inhibition Reduces Iatrogenic Laryngotracheal Stenosis

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Objective/Hypothesis

Glutamine inhibition has been demonstrated an antifibrotic effect in iatrogenic laryngotracheal stenosis (iLTS) scar fibroblasts in vitro. We hypothesize that broadly active glutamine antagonist, DON will reduce collagen formation and fibrosis‐associated gene expression in iLTS mice.

Study Design

Prospective controlled animal study.

Methods

iLTS in mice were induced by chemomechanical injury of the trachea using a bleomycin‐coated wire brush. PBS or DON (1.3 mg/kg) were administered by intraperitoneal injection (i.p.) every other day. Laryngotracheal complexes were harvested at days 7 and 14 after the initiation of DON treatment for the measurement of lamina propria thickness, trichrome stain, immunofluorescence staining of collagen 1, and fibrosis‐associated gene expression.

Results

The study demonstrated that DON treatment reduced lamina propria thickness (P = .025) and collagen formation in trichrome stain and immunofluorescence staining of collagen 1. In addition, DON decreased fibrosis‐associated gene expression in iLTS mice. At day 7, DON inhibited Col1a1 (P < .0001), Col3a1 (P = .0046), Col5a1 (P < .0001), and Tgfβ (P = .023) expression. At day 14, DON reduced Co1a1 (P = .0076) and Tgfβ (P = .023) expression.

Conclusions

Broadly active glutamine antagonist, DON, significantly reduces fibrosis in iLTS mice. These results suggest that the concept of glutamine inhibition may be a therapeutic option to reduce fibrosis in the laryngotracheal stenosis.

Level of Evidence

N/A Laryngoscope, 2021

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Middle turbinate mucosal flap: A low‐morbidity option in the management of skull base defects

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Abstract

Background

To describe the low morbidity of middle turbinate mucosal flap (MTMF) to repair anterior skull base defects.

Methods

Skull base endonasal endoscopic surgeries performed at a tertiary hospital between 2015 and 2018 were analyzed. Patients were divided into two groups according the existence or not of a significant intraoperative cerebrospinal fluid (CSF) leak. In Group 1 (n = 28), gasket seal and a pedicled endonasal flap were used to repair the defect: 13 nasoseptal flaps (NSF), 8 inferolateral wall flaps (ILF), and 7 MTMF. In Group 2 only an endonasal flap was used: 9 NSF, 4 ILF, and 18 MTMF. Surgical and recovery time were analyzed (Student's t test). Our favorite surgical technique is described.

Results

Fifty‐nine patients were included. Average surgical time was 27.7, 41.6, and 11.3 min for NSF, ILF, and MTMF, respectively. MTMF showed a faster recovery.

Conclusion

MTMF is a safe reconstructive option for anterior skull base defects.

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