Neurosurgical Performance between Experts and Trainees: Evidence from Drilling Task

xlomafota13 shared this article with you from Inoreader Neurosurgical Performance between Experts and Trainees: Evidence from Drilling Task Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Background Lumbar laminectomy is a common neurosurgery that requires precise manipulation of power drills. We examined the fine movement controls of novice neurosurgeons in drilling tasks and compared its accuracy to expert surgeons' performance. Methods Four expert and three novice neurosurgeons performed a lumbar laminectomy on a 3D printed spine model. Scene video and surgeons' eye movements were recorded. Independent sample T-Tests were conducted on the number of jump, total fixation durations, pre-jump fixation durations, post-jump fixation durations, and jump distances over novice and expert surgeons. Results No statistically significant differences were recorded in terms of total fixations and pre-jump fixation durations. However, novices had more jumping events, greater jump distances, and longer post-jump fixation durations when compared to expert neurosurgeons. Conclusion Differences in movement accuracy and eye measures were found between expert and novice neurosurgeons during a simulated microscopic lumbar laminectomy. A more comprehensive understanding of surgeon's fine movement control mechanism and eye-hand coordination in microsurgery is essential for us before building an enhanced training protocol for surgical residents in neurosurgery. 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.

Vestibular Migraine and Its Comorbidities

xlomafota13 shared this article with you from Inoreader Vestibular Migraine and Its Comorbidities Via Otolaryngologic Clinics of North America Vestibular migraine (VM) is one of the most common neurologic causes of vertigo. Symptoms and International Classification of Headache Disorders criteria are used to diagnose VM because no objective tests, imaging or audiologic, have been shown to reliably diagnose this condition. Central auditory, peripheral, and central vestibular pathway involvement has been associated with VM. Although the interaction between migraine and other vestibular disorders can be a challenging scenario for diagnosis and treatment, there are data to show that vestibular rehabilitation and a variety of pharmacologic agents improve reported symptoms and vertigo frequency. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Acute Vestibular Syndrome and ER Presentations of Dizziness

xlomafota13 shared this article with you from Inoreader Acute Vestibular Syndrome and ER Presentations of Dizziness Via Otolaryngologic Clinics of North America Acute vestibular syndrome (AVS) describes sudden onset, severe, continuous dizziness that persists for more than 24 hours. Its wide differential presents a diagnostic challenge. Vestibular neuritis is the most common cause, but stroke, trauma, medication effects, infectious, and inflammatory causes all present similarly. The TiTrATE model (Timing, Triggers, And Targeted Exam) is systematic way to evaluate these patients, and the HINTS Plus exam (Head Impulse, Nystagmus, Test of Skew, plus hearing loss) is critical in differentiating central and peripheral causes. The importance of recognizing risk factors for stroke and the role of imaging is also discussed. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Neuropsychology of Dizziness and Related Disorders

xlomafota13 shared this article with you from Inoreader The Neuropsychology of Dizziness and Related Disorders Via Otolaryngologic Clinics of North America There is a reciprocal relationship between vestibular and neuropsychological disorders. People with vertigo and dizziness are at higher risk of various psychiatric disorders, particularly anxiety, depression, and panic disorder. On the other hand, people with mood disorders are at higher risk of experiencing vertigo and dizziness. Vestibular information plays a crucial role in cognitive processes, especially visuo-spatial abilities. Consequently, vestibular disorders (both peripheral and central) often result in visuo-spatial deficits. In addition, lesions of the cortical and subcortical components of the vestibular system result in disorders of higher vestibular function, such as hemispatial neglect, pusher syndrome, and topographagnosia. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Progressive and Degenerative Peripheral Vestibular Disorders

xlomafota13 shared this article with you from Inoreader Progressive and Degenerative Peripheral Vestibular Disorders Via Otolaryngologic Clinics of North America Initial diagnosis of peripheral vestibulopathy requires a detailed history, physical examination, and, in some cases, audiovestibular testing, radiographic imaging, or serology. Differentiation of a peripheral vestibulopathy as progressive or degenerative is often nuanced and influenced by a characterization of a patient's symptoms or natural history over time. A diverse group of vestibular pathology may fit into this category, including Ménière's disease, autoimmune conditions, congenital pathologies, ototoxic medications, radiation therapy, and perilymphatic fistula. Differentiation among these entities may be guided by initial or subsequent symptomatology, with various combinations of audiovestibular testing, serology, and imaging. Treatment options are disparate and disease-specific, ranging from observation to medical management or surgical intervention, underscoring the need for astute investigation and diagnosis. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Allergy, Immunotherapy, and Alternative Treatments for Dizziness

xlomafota13 shared this article with you from Inoreader Allergy, Immunotherapy, and Alternative Treatments for Dizziness Via Otolaryngologic Clinics of North America Allergic reactions may result in central symptoms of dizziness, including nonspecific chronic imbalance, Meniere's disease, and autoimmune inner ear disease. Excepting first-generation antihistamines, and short-term use of steroids, most pharmacotherapies used to treat allergic rhinitis have limited benefit in treating allergically induced or related dizziness. Allergy immunotherapy and/or an elimination diet for diagnosed food allergies have been found to be effective treatments. Individuals diagnosed with autoimmune inner ear disease remain challenging to treat and may require high-dose, long-term steroid treatment, biologics, or immunomodulators for symptom control. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Efficient Use of Vestibular Testing

xlomafota13 shared this article with you from Inoreader Efficient Use of Vestibular Testing Via Otolaryngologic Clinics of North America While the majority of vestibular disorders may be diagnosed solely on clinical grounds, a variety of clinical scenarios exist in which objective functional assessment of the vestibular system provides data that facilitate diagnosis and treatment decisions. There exists a veritable armamentarium of sophisticated vestibular test modalities, including videonystagmography, rotary chair testing, video head impulse testing, and vestibular-evoked myogenic potentials. This article aims to help clinicians apply an accessible decision-making rubric to identify the clinical scenarios that may and may not benefit from data derived from specific vestibular function tests. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Positional Vertigo

xlomafota13 shared this article with you from Inoreader Positional Vertigo Via Otolaryngologic Clinics of North America Positional vertigo is a complex symptom that may arise from several disorders. In this chapter, we define positional vertigo and provide a comprehensive review of the disorders in the differential diagnosis, including benign paroxysmal positional vertigo, central paroxysmal positional vertigo, cervical vertigo and vertebrobasilar insufficiency, and persistent postural perceptual dizziness. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Primary undifferentiated pleomorphic sarcoma in oral-maxillary area: retrospective study and molecular analysis

xlomafota13 shared this article with you from Inoreader Primary undifferentiated pleomorphic sarcoma in oral-maxillary area: retrospective study and molecular analysis Via Cellular and Molecular Biology Histol Histopathol. 2021 Jul 20:18359. doi: 10.14670/HH-18-359. Online ahead of print. ABSTRACT Undifferentiated pleomorphic sarcoma (UPS) in oral-maxillary area is rarely reported. Herein, we aimed to investigate the clinical characteristics, treatment strategies, prognosis, and molecular features of the oral-maxillary UPS. In total, 10 cases with primary oral-maxillary UPS were included. The rapidly progressive UPS can easily develop to an advanced and life-threatening stage, especially concerning the complex anatomical structures and spaces in the oral-maxillary area. The final diagnosis for UPS greatly depended on histological findings and immunohistochemistry staining after the exclusion of all possible differential diagnoses. Retrospectively, the treatment strategies for the included cases still referred to those of oral squamous cell carcinoma (OSCC). Statistically, the median overall survival (OS) for all the included cases was 7.75 months (range: 5-17 months). Comparatively, 3 cases had improved OS (median survival: 17 months, range: 17-18 months) and experienced PR/SD with neoadjuvant chemotherapy (anlotinib). The molecular features were demonstrated by using whole exonic sequencing for 1 included case. Cancer driver gene detection revealed GBP4 as a candidate driver gene for the primary oral-maxillary UPS. Additionally, a missense mutation in gene PIK3CA (p.E545K) was also identified. Our findings could greatly expand the knowledge about primary oral-maxillary UPS, and provide molecular evidences to improve the therapeutic options for primary oral-maxillary UPS. PMID:34282850 | DOI:10.14670/HH-18-359 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sklerotherapie eines Zystadenolymphoms – eine alternative Therapieoption

xlomafota13 shared this article with you from Inoreader Sklerotherapie eines Zystadenolymphoms – eine alternative Therapieoption Via Laryngo-Rhino-Otologie Laryngorhinootologie DOI: 10.1055/a-1543-6655 Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Impact of Body Mass Index and Discomfort on Upper Airway Stimulation: ADHERE Registry 2020 Update

xlomafota13 shared this article with you from Inoreader Impact of Body Mass Index and Discomfort on Upper Airway Stimulation: ADHERE Registry 2020 Update Via The Laryngoscope Objectives/Hypothesis To provide the ADHERE registry Upper Airway Stimulation (UAS) outcomes update, including analyses grouped by body mass index (BMI) and therapy discomfort. Study Design Prospective observational study. Methods ADHERE captures UAS outcomes including apnea-hypopnea index (AHI), Epworth sleepiness scale (ESS), therapy usage, patient satisfaction, clinician assessment, and safety over a 1-year period. BMI ≤32 kg/m2 (BMI32) and 32 < BMI ≤35 kg/m2 (BMI35) group outcomes were examined. Results One thousand eight hundred forty-nine patients enrolled in ADHERE, 1,019 reached final visit, 843 completed the visit. Significant changes in AHI (−20.9, P < .0001) and ESS (− 4.4, P < .0001) were demonstrated. Mean therapy usage was 5.6 ± 2.2 hr/day. Significant therapy use difference was present in patients with reported discomfort versus no discomfort (4.9 ± 2.5 vs. 5.7 ± 2.1 hr/day, P = .01). Patients with discomfort had higher final visit mean AHI versus without discomfort (18.9 ± 18.5 vs. 13.5 ± 13.7 events/hr, P = .01). Changes in AHI and ESS were not significantly different. Serious adverse events reported in 2.3% of patients. Device revision rate was 1.9%. Surgical success was less likely in BMI35 versus BMI32 patients (59.8% vs. 72.2%, P = .02). There was a significant therapy use difference: 5.8 ± 2.0 hr/day in BMI32 v ersus 5.2 ± 2.2 hr/day in BMI35 (P = .028). Conclusions Data from ADHERE demonstrate high efficacy rates for UAS. Although surgical response rate differs between BMI32 and BMI35 patient groups, the AHI and ESS reduction is similar. Discomfort affects therapy adherence and efficacy. Thus, proper therapy settings adjustment to ensure comfort is imperative to improve outcomes. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Correlations between olfactory psychophysical scores and SARS‐CoV‐2 viral load in COVID‐19 patients.

xlomafota13 shared this article with you from Inoreader Correlations between olfactory psychophysical scores and SARS‐CoV‐2 viral load in COVID‐19 patients. Via The Laryngoscope Abstract Objective The aim of this study was to evaluate the correlations between the severity and duration of olfactory dysfunctions (OD), assessed with psychophysical tests, and the viral load on the rhino-pharyngeal swab determined with a direct method, in patients affected by coronavirus disease 2019 (COVID-19). Methods Patients underwent psychophysical olfactory assessment with Connecticut Chemosensory Clinical Research Center test and determination of the normalized viral load on nasopharyngeal swab within 10 days of the clinical onset of COVID-19. Results Sixty COVID-19 patients were included in this study. On psychophysical testing 12 patients (20% of the cohort) presented with anosmia, 11 (18.3%) severe hyposmia, 13 (18.3%) moderate hyposmia and 10 (16.7%) mild hyposmia with an overall prevalence of OD of 76.7%. The overall median olfactory score was 50 (IQR 30–72.5) with no significant differences between clinical severity subgroups. The median normalized viral load detected in the series was 2.56E+06 viral copies/106 copies of human beta-2microglobulin mRNA present in the sample (IQR 3.17E+04–1.58E+07) without any significant correlations with COVID-19 severity. The correlation between viral load and olfactory scores at baseline (R2 = 0.0007; p = 0.844) and 60-day follow-up (R2 = 0.0077; p = 0.519) was weak and not significant. Conclusions the presence of OD does not seem to be useful in identifying subjects at risk for being super-spreaders nor who is at risk of developing long-term OD. Similarly, the pathogenesis of OD is probably related to individual factors rather than to viral load and activity. 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.