Reducing Opioid Prescribing and Consumption After Surgery

xlomafota13 shared this article with you from Inoreader Reducing Opioid Prescribing and Consumption After Surgery Via JAMA Otolaryngology–Head & Neck Surgery Online First Many patients receive their first opioid prescription from a surgeon. While surgery is a large concern for most patients, receiving an opioid prescription may seem more incidental. Yet 1 of every 17 patients who uses an opioid after otolaryngologic surgery continues to require opioids long after postoperative care has been completed. Overall, 1 of every 25 adults in the US regularly uses prescription opioid medications. For years, opioids have been assumed to be the de facto choice for pain management after surgery, but evidence is accumulati ng that nonopioid medications are highly effective for postoperative pain and may offer substantial advantages compared with opioids in improved safety. Despite this growing awareness, in a 2018 survey of American Rhinological Society members, 94% of respondents reported prescribing opioids after endoscopic sinus surgery, with an average of 27 opioid tablets prescribed. If prescribing opioids means opening a Pandora's box without additional efficacy, then what should be their legitimate role after surgery? View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Association of Laryngeal Botulinum Neurotoxin Injection With Work Productivity for Patients With Spasmodic Dysphonia

xlomafota13 shared this article with you from Inoreader Association of Laryngeal Botulinum Neurotoxin Injection With Work Productivity for Patients With Spasmodic Dysphonia Via JAMA Otolaryngology–Head & Neck Surgery Online First This case series examines whether employed patients with spasm odic dysphonia experience voice-related work productivity impairment before with treatment botulinum neurotoxin injection. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A dosing algorithm for individualized radioiodine treatment of cats with hyperthyroidism

xlomafota13 shared this article with you from Inoreader A dosing algorithm for individualized radioiodine treatment of cats with hyperthyroidism Via radioactive iodine J Vet Intern Med. 2021 Aug 5. doi: 10.1111/jvim.16228. Online ahead of print. ABSTRACT BACKGROUND: Radioiodine (131 I) is the treatment of choice for hyperthyroidism in cats, but current 131 I-dosing protocols can induce iatrogenic hypothyroidism and expose azotemia. OBJECTIVES: To develop a cat-specific algorithm to calculate the lowest 131 I dose to resolve hyperthyroidism, while minimizing risk of iatrogenic hypothyroidism and subsequent az otemia. ANIMALS: One thousand and four hundred hyperthyroid cats treated with 131 I. METHODS: Prospective case series (before-and-after study). All cats had serum concentrations of thyroxine (T4 ), triiodothyronine (T3 ), and thyroid-stimulating hormone (TSH) measured (off methimazole ≥1 week). Using thyroid scintigraphy, each cat's thyroid volume and percent uptake of 99m Tc-pertechnatate (TcTU) were determined. An initial 131 I dose was calculated by averaging dose scores for T4 /T3 concentrations, thyroid volume, and TcTU; 80% of that composite dose was administered. Twenty-four hours later, percent 131 I uptake was measured, and additional 131 I administered, as needed, to deliver an adequate radiation dose to the thyroid tumor(s). Serum concentrations of T4 , TSH, and creatinine were determined 6 to 12 months later. RESULTS: The median calculated 131 I dose was 1.9 mCi (range, 1.0-10.6 mCi); 1380 cats required additional 131 I administration on day 2. Of the cats, 1047 (74.8%) became euthyroid, 57 (4.1%) became overtly hypothyroid, 240 (17.1%) became subclinically hypothyroid, and 56 (4%) remained hyperthyroid. More overtly (71.9%) and subclinically (39.6%) hypothyroid cats developed azotemia than euthyroid cats (14.2%; P < .0001). CONCLUSIONS AND CLINICAL IMPORTANCE: Our algorithm for calculating individual 131 I doses resulted in cure rates similar to historical treatment rates, despite much lower 131 I doses. This algorithm appears to lower prevalence of both 131 I-induced overt hypothyroidism and azotemia. PMID:34351027 | DOI:10.1111/jvim.16228 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Outcomes of endoscopic and open resection of sinonasal malignancies: a systematic review and meta-analysis

xlomafota13 shared this article with you from Inoreader Outcomes of endoscopic and open resection of sinonasal malignancies: a systematic review and meta-analysis Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Jul 20:S1808-8694(21)00127-0. doi: 10.1016/j.bjorl.2021.06.004. Online ahead of print. ABSTRACT OBJECTIVE: To compare the efficacy of endoscopic and open resection of sinonasal malignancies. METHODS: The search was performed using PubMed (1950-2020), Embase (1974-2020), the Cochrane library, and the website clinicaltrials.gov. The hazard ratio, HR, 95% confidence interval, CI, of the rates of overall survival and disease-free survival and the demographic characteristics of the included studies were extracted and analyzed. Pooled analysis was conducted with the studies' individual patient data, using log-rank test, Kaplan-Meier survival, and Cox regression analysis. RESULTS: Of 1939 articles retrieved, 23 articles were included. Overall, 1373 cases were incorporated into the final analysis, 653 (47.56%) of which underwent the surgery through an endoscopic approach, whereas 720 (52.44%) cases uti lized the open approach. The overall survival was comparable between endoscopic and open resection (HR = 0.84 [95% CI: 0.65-1.07], p = 0.16; random effects analysis). Pooled analysis with Cox regression revealed signifcant differences in overall survival (HR = 0.568 [95%CI:0.380-0.849], p = 0.006) and disease-free survival (HR = 0.628 [95%CI:0.424-0.929], p = 0.02) between endoscopic and open approaches. CONCLUSION: The aggregated evidence suggests the survival outcome of endoscopic resection is comparable or greater than that of open resection of sinonasal malignancies. PMID:34348855 | DOI:10.1016/j.bjorl.202 1.06.004 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Determining attributed factors of hearing handicap in individuals with auditory sensory and neural pathology

xlomafota13 shared this article with you from Inoreader Determining attributed factors of hearing handicap in individuals with auditory sensory and neural pathology Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Jul 21:S1808-8694(21)00126-9. doi: 10.1016/j.bjorl.2021.06.003. Online ahead of print. ABSTRACT INTRODUCTION: There is a modest relationship between speech perception skills and perceived hearing handicap in individuals with hearing loss. In this study, an attempt is made at linking psychoacoustic results and speech perception skills to understand the subjective handicap and quality of life. OBJECTIVE: To investigate how speech perception in noise (signal to noise ratio-50), difference limen frequency, temporal modulation transfer function, hearing handicap inventory for adults, and quality of life in auditory neuropathy spectrum disorder differs from sensorineural hearing loss. Further we attempt to discern attributed factors of hearing handicap in auditory neuropathy spectrum disorder and sensorineural hearing loss. METHODS: A cross-sectional study with comparative and correlational research designs were utilized. Eighty-four participants were grouped into sensorineural hearing loss (n = 49), and auditory neuropathy spectrum disorder (n = 35) was sub-grouped into mild, moderately severe, and severe. We evaluated signal to noise ratio-50, difference limen frequency, and temporal modulation transfer function. In addition, hearing handicap inventory for adults, and quality of life questionnaires were administered. RESULTS: Mild auditory neuropathy spectrum disorder showed impairment in speech perception and discriminating frequency, which were similar to the severe sensory neural hearing loss. Temporal resolution impairment in auditory neuropathy spectrum disorder mild was significantly higher than in each sub-groups of sensorineural hearing loss. The severity of the hearing handicap in was similar to severe sensorineural hearing loss, quality of life was equally affected in sensorineural hearing loss and auditory neuropathy spectrum disorder. In sensorineural hearin g loss, signal to noise ratio-50 was positively related, and quality of life was negatively related to hearing handicap. In auditory neuropathy spectrum disorder, no contributory factors were related to hearing handicap. CONCLUSION: Mild auditory neural pathology demonstrates impairment in speech recognition and psychoacoustic skills similar to severe cochlear pathology. In sensorineural hearing loss, hearing handicap is predicted from quality of life and speech perception, but none of the contributory factors predicted hearing handicap in auditory neuropathy spectrum disorder. PMID:34348857 | DOI:10.1016/j.bj orl.2021.06.003 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Microanatomic analyses of extratemporal facial nerve and its branches, hypoglossal nerve, sural nerve, and great auricular nerve

xlomafota13 shared this article with you from Inoreader Microanatomic analyses of extratemporal facial nerve and its branches, hypoglossal nerve, sural nerve, and great auricular nerve Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Jul 20:S1808-8694(21)00129-4. doi: 10.1016/j.bjorl.2021.06.006. Online ahead of print. ABSTRACT OBJECTIVE: To investigate microanatomic organizations of the extratemporal facial nerve and its branches, hypoglossal nerve, sural nerve, and great auricular nerve. METHODS: Nerve samples were dissected in 12 postmortem autopsies, and histomorphometric analyses were conducted. RESULTS: There was no significant difference between the right and left sides of the nerve samples for the nerve area, fascicle area, number of fascicles and average number of axons. The lowest mean fascicle number was found in the hypoglossal nerve (4.9 ± 1.4) while the highest was in great auricular nerve (11.4 ± 6.8). The highest nerve area (3,182,788 ± 838,430 μm2), fascicle area (1,573,181 ± 457,331 μm2) and axon number (14,772 ± 4402) were in hypoglossal nerve (p < 0.05). The number of axon s per unit nerve area was higher in the facial nerve, truncus temporofacialis, truncus cervicofacialis and hypoglossal nerve, which are motor nerves, compared to the sural nerve and great auricular nerve, which are sensory nerves (p < 0.05). The number of axons per unit fascicle area was also higher in motor nerves than in sensory nerves (p < 0.05). CONCLUSION: In the present study, it was observed that each nerve contained a different number of fascicles and these fascicles were different both in size and in the number of axons they contained. All these variables could be the reason why the desired outcomes cannot always be achieved in nerve reconstruction. PMID:34348859 | DOI:10.1016/j.bjorl.2021.06.006 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Validation of a classification and scoring system for the diagnosis of laryngeal and pharyngeal squamous cell carcinomas by confocal laser endomicroscopy

xlomafota13 shared this article with you from Inoreader Validation of a classification and scoring system for the diagnosis of laryngeal and pharyngeal squamous cell carcinomas by confocal laser endomicroscopy Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Jul 20:S1808-8694(21)00124-5. doi: 10.1016/j.bjorl.2021.06.002. Online ahead of print. ABSTRACT INTRODUCTION: Confocal laser endomicroscopy is an optical imaging technique that allows in vivo, real-time, microscope-like images of the upper aerodigestive tract's mucosa. The assessment of morphological tissue characteristics for the correct differentiation between healthy and malignant suspected mucosa requires strict evaluation criteria. OBJECTIVE: This study aims to validate an eight-point score for the correct assessment of malignancy. METHODS: We performed confocal laser endomicroscopy between March and October 2020 in 13 patients. 197 sequences (11.820 images) originated from the marginal area of pharyngeal and laryngeal carcinomas. Specimens were taken at corresponding locations and analyzed in H&E staining as a standard of reference. A total of six examiners evaluated the sequences bas ed on a scoring system; they were blinded to the histopathological examination. The primary endpoints are sensitivity, specificity, and accuracy. Secondary endpoints are interrater reliability and receiver operator characteristics. RESULTS: Healthy mucosa showed epithelium with uniform size and shape with distinct cytoplasmic membranes and regular vessel architecture. Confocal laser endomicroscopy of malignant cells demonstrated a disorganized arrangement of variable cellular morphology. We calculated an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 83.2%, 81.3%, 85.5%, 86.7%, and 79.7%, respectively, with a κ-value of 0.64, and an area under the curve of 0.86. CONCLUSION: The results confirm that this scoring system is applicable in the laryngeal and pharyngeal mucosa to classify benign and malignant tissue. A scoring system based on defined and reproducible characteristics can help translate this experimental method to broad clinical practice in head and neck diagnosis. PMID:34348858 | DOI:10.1016/j.bjorl.2021.06.002 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Olfactory neuroepithelium in the middle turbinate: is there any impact on olfaction function after lateral marsupialization for concha bullosa surgery?

xlomafota13 shared this article with you from Inoreader Olfactory neuroepithelium in the middle turbinate: is there any impact on olfaction function after lateral marsupialization for concha bullosa surgery? Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Jul 20:S1808-8694(21)00128-2. doi: 10.1016/j.bjorl.2021.06.005. Online ahead of print. ABSTRACT INTRODUCTION: The effect of the quantity of olfactory neuroepithelium in the middle turbinate on the postoperative olfactory function for middle turbinate concha bullosa patients has not yet been evaluated. OBJECTIVE: The primary aim of this study was to investigate the olfactory structures in the middle turbinate by immunohistochemical analysis of the olfactory marker protein and to correlate the immunostaining results with the olfaction test results for patients with middle turbinate concha bullosa. METHODS: Surgical materials of 18 middle turbinate concha bullosa patients who had undergone lateral marsupialization surgery were immunostained with olfactory marker protein antibodies. Smell diskettes olfaction test was applied to all of the study group patients both preoperatively and three months po stoperatively. A visual analog scale was used to quantify the sense of nasal obstruction. RESULTS: It was observed that the postoperative smell scores and the nasal obstruction visual analog scale values were significantly improved as compared to the preoperative values (p < 0.05). In addition, there was a significant correlation between the smell score gain and the visual analog scale gain values (r = 0.682). Results also indicated no significant correlation between the olfactory marker protein staining scores and the smell scores (p > 0.05). CONCLUSION: This first paper demonstrated that the quantity of the olfactory mucosa in the middle turbinate was not a determining factor for the postoperative smell function degree for middle turbinate concha bullosa patients. The underlying cause of the olfactory deficit for middle turbinate concha bullosa patients seems to be obstruction related rather than the middle turbinate's olfactory mucosa containing status. PM ID:34348856 | DOI:10.1016/j.bjorl.2021.06.005 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Small interfering RNA-induced inhibition of epithelial Cell transforming sequence 2 suppresses the proliferation, migration and invasion of osteosarcoma cells

xlomafota13 shared this article with you from Inoreader Small interfering RNA-induced inhibition of epithelial Cell transforming sequence 2 suppresses the proliferation, migration and invasion of osteosarcoma cells Via Experimental and therapeutic medicine Exp Ther Med. 2021 Sep;22(3):976. doi: 10.3892/etm.2021.10408. Epub 2021 Jul 9. ABSTRACT [This retracts the article DOI: 10.3892/etm.2015.2306.]. PMID:34349847 | PMC:PMC8290433 | DOI:10.3892/etm.2021.10408 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

MicroRNA-212 suppresses the proliferation and migration of osteosarcoma cells by targeting forkhead box protein A1

xlomafota13 shared this article with you from Inoreader MicroRNA-212 suppresses the proliferation and migration of osteosarcoma cells by targeting forkhead box protein A1 Via Experimental and therapeutic medicine Exp Ther Med. 2021 Sep;22(3):977. doi: 10.3892/etm.2021.10409. Epub 2021 Jul 9. ABSTRACT [This retracts the article DOI: 10.3892/etm.2016.3880.]. PMID:34349848 | PMC:PMC8290419 | DOI:10.3892/etm.2021.10409 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

MicroRNA-101 has a suppressive role in osteosarcoma cells through the targeting of c-FOS

xlomafota13 shared this article with you from Inoreader MicroRNA-101 has a suppressive role in osteosarcoma cells through the targeting of c-FOS Via Experimental and therapeutic medicine Exp Ther Med. 2021 Sep;22(3):978. doi: 10.3892/etm.2021.10410. Epub 2021 Jul 9. ABSTRACT [This retracts the article DOI: 10.3892/etm.2016.3085.]. PMID:34349849 | PMC:PMC8290395 | DOI:10.3892/etm.2021.10410 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.