Risk Stratification of Acute Invasive Fungal Rhinosinusitis in Patients With Hematologic Pathology

alexandrossfakianakis shared this article with you from Inoreader Risk Stratification of Acute Invasive Fungal Rhinosinusitis in Patients With Hematologic Pathology via The Laryngoscope This study sought to identify objective perioperative diagnostic factors for acute invasive fungal rhinosinusitis (AIFS) to develop a diagnostic scoring system. A retrospective case-control study was developed identifying patients with underlying hematologic malignancy with concerns for AIFS. Patients with hematologic malignancy-related AIFS have measurable differences in lab values and standard imaging, which were utilized to develop a novel scoring system. Objective The purpose of this study is to identify objective perioperative diagnostic factors for acute invasive fungal rhinosinusitis (AIFS) to create a diagnostic scoring system using objective criteria. Methods Retrospective case–control study performed at an academic, tertiary care center. Biopsy-proven cases of AIFS identified from pathology records (2015–2019) were compared to patients the otolaryngology service was consulted to "Rule out AIFS" in the year 2019, only including those with underlying hematologic malignancy. Eighteen patients with AIFS and 20 patients without were included. One and two tailed T-tests were used for p-values. Receiver operating characteristic curves were generated for the significant data, and Youden's J-statistic was used to create the ideal cutoff values for each. Likelihood ratios were used to give a power for the scoring system. Results Compared to patients with non-hematologic malignancy-related AIFS, patients with hematologic malignancy-related AIFS have significantly elevated C-reactive protein (CRP) and blood glucose; while albumin, hematocrit, platelet count, and absolute neutrophil count (ANC) were found to be significantly lower. In addition, Lund-Mackay score asymmetry, extra-sinus spread, aspergillus antigen, and pre-existing diabetes mellitus correlated with disease. A scoring system with three categories: AIFS Unlikely, Indeterminate/AIFS Suspicious, and AIFS Highly Likely was developed. Conclusion Patients with hematologic malignancy-related AIFS have measurable differences in lab values and standard imaging that could be used in determining the diagnostic probability of AIFS including: CRP, albumin, hematocrit, platelets, ANC, blood glucose, aspergillus antigen, Lund-Mackay score asymmetry, extra-sinus spread, and pre-existing diabetes mellitus. A novel scoring system was proposed that will require prospective validation. Level of Evidence 3 Laryngoscope, 2022 View on Web

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De‐Novo Depression, Prophylactic Antidepressant, and Survival in Patients With Head and Neck Cancer

alexandrossfakianakis shared this article with you from Inoreader De‐Novo Depression, Prophylactic Antidepressant, and Survival in Patients With Head and Neck Cancer via The Laryngoscope Kaplan-Meier Survival Curve Modeled for Time to Death from Enrollment stratified by Primary Outcome of Moderate or Greater Depression. Objective To study the association between the development of moderate or greater depression during curative-intent therapy and overall survival (OS) in patients with stages II-IV head and neck cancer (HNC). Methods In this secondary analysis of a randomized double-blind placebo-controlled trial, of 148 eligible participants diagnosed with stages II-IV HNC but without baseline depression, 125 were evaluable and were randomly allocated to prophylactic escitalopram oxalate (n = 60) or placebo (n = 65). Participants were followed for development of moderate or greater depression, using Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR, range 0–27, score ≥11 indicated moderate or greater depression), and were stratified by demographics; cancer site and stage; and primary treatment modality (surgery with or without radiotherapy vs. radiotherapy with or without chemotherapy). Single variable and multivariable Cox proportional-hazard models were used to evaluate differences in OS. Results Clinically significant depression developed in 22 of 125 patients (17.6%) during HNC treatment. The mean follow-up was 5.0 years (SD 2.4). OS was similar for patient groups, when stratified by development of moderate or greater depression (HR 0.54 [CI, 0.21–1.43]) or use of prophylactic antidepressant (HR 0.64 [CI, 0.34–1.21]). Conclusion There was no significant association between OS and development of moderate or greater depression in patients being treated for stages II-IV HNC, or between OS and use of prophylactic antidepressant escitalopram. Prophylactic antidepressant may be considered in patients with HNC for prevention of clinically significant depression and may offer improved quality of life outcomes. Level of Evidence II Laryngoscope, 2022 View on Web

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VEGF and VEGFR family members are expressed by neoplastic cells of NF1-associated tumors and may play an oncogenic role in malignant peripheral nerve sheath tumor growth through an autocrine loop

alexandrossfakianakis shared this article with you from Inoreader VEGF and VEGFR family members are expressed by neoplastic cells of NF1-associated tumors and may play an oncogenic role in malignant peripheral nerve sheath tumor growth through an autocrine loop via Annals of Diagnostic Pathology Publication date: Available online 23 June 2022 Source: Annals of Diagnostic Pathology Author(s): Benjamin Bonsang, Laurent Maksimovic, Pascale Maille, Nadine Martin, Ingrid Laurendeau, Eric Pasmant, Ivan Bièche, Justin Deschamps, Pierre Wolkenstein, Nicolas Ortonne View on Web

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Bilateral upper extremity motor priming (BUMP) plus task-specific training for severe, chronic upper limb hemiparesis: study protocol for a randomized clinical trial

alexandrossfakianakis shared this article with you from Inoreader Bilateral upper extremity motor priming (BUMP) plus task-specific training for severe, chronic upper limb hemiparesis: study protocol for a randomized clinical trial via Trials - Latest Articles Various priming techniques to enhance neuroplasticity have been examined in stroke rehabilitation research. Most priming techniques are costly and approved only for research. Here, we describe a priming techni... View on Web

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Investigations Into Obesity and the Risk of Malignant Disease in Pediatric Thyroid Nodules—Reply

alexandrossfakianakis shared this article with you from Inoreader Investigations Into Obesity and the Risk of Malignant Disease in Pediatric Thyroid Nodules—Reply via JAMA Otolaryngology–Head & Neck Surgery Online First In Reply We thank Gallant et al for their interest in our recent publication regarding the association of body mass index (BMI) with thyroid cancer in children with thyroid nodules. We agree that differences in design may account for some discrepancies between our study and theirs. Different methods of calculating BMI z-scores might play a role, although our selection of the Centers for Disease Control and Prevention nomograms reflects their wide use in clinical practice. Similarly, our use of nodule diameter rather than nodule volume reflec ts current recommendations for thyroid nodule evaluation, and is unlikely to be relevant given the excellent correlation of these measures in our cohort (r = 0.97; 95% CI, 0.96-0.97). View on Web

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Investigations Into Obesity and the Risk of Malignant Disease in Pediatric Thyroid Nodules

alexandrossfakianakis shared this article with you from Inoreader Investigations Into Obesity and the Risk of Malignant Disease in Pediatric Thyroid Nodules via JAMA Otolaryngology–Head & Neck Surgery Online First To the Editor It is with great interest that we read the recent contribution from Ivanova et al, in which the authors found no association between body mass index z-score (BMIz) and the risk of malignant disease in pediatric thyroid nodules. The authors' findings contrast with our own study, in which we found BMIz to be a significant and independent predictor of pediatric thyroid cancer. We want to highlight a few differences between the studies, which may explain variance in the results. View on Web

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Risk of Stroke After Definitive Radiotherapy—Cause for Concern or Modest Risk?

alexandrossfakianakis shared this article with you from Inoreader Risk of Stroke After Definitive Radiotherapy—Cause for Concern or Modest Risk? via JAMA Otolaryngology–Head & Neck Surgery Online First With the rapidly increasing prevalence of oropharyngeal squamous cell carcinoma (OPSCC), largely driven by the human papillomavirus (HPV) epidemic, and with relative equipoise between radiation-based and surgery-based treatment protocols, there has been renewed interest in describing differences in functional outcomes between the 2 treatment modalities. Radiation is theoretically related to stroke risk due to carotid artery intimal injury, which could lead to the development of atherosclerosis. Both carotid artery stenosis and carotid intima -medial thickness have been shown to be associated with radiation therapy providing a biologic basis for the findings. A retrospective population-based cohort study of veterans with OPSCC authored by Sun et al reported a 12.5% imputed stroke risk within 10 years after treatment. The major finding of this study is that there was an observed 23% relative risk reduction of stroke in patients treated with definitive surgery as compared with those treated with definitive radiotherapy. Although there were notable differences between the groups at baseline, in particular higher T- and N-stage as well as worse ECOG performance status and Charlson Comorbidity Index in the nonsurgical group, the authors conducted propensity score–based analyses to account for these imbalances. Interestingly, there was no increase in stroke risk among surgical patients treated with adjuvant radiation as compared with those treated with surgery alone. (Other population-based studies have observed the same.) View on Web

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Cooled Radiofrequency Ablation of Genicular Nerves Provides 24‐Month Durability in the Management of Osteoarthritic Knee Pain: Outcomes from a Prospective, Multicenter, Randomized Trial

alexandrossfakianakis shared this article with you from Inoreader Cooled Radiofrequency Ablation of Genicular Nerves Provides 24‐Month Durability in the Management of Osteoarthritic Knee Pain: Outcomes from a Prospective, Multicenter, Randomized Trial via Pain Practice Abstract Objective To assess long-term outcomes of cooled radiofrequency ablation (CRFA) of genicular nerves for chronic knee pain due to osteoarthritis (OA). Methods A prospective, observational extension of a randomized, controlled trial was conducted on adults randomized to CRFA. Subjects were part of a 12-month clinical trial comparing CRFA of genicular nerves to a single hyaluronic injection for treatment of chronic OA knee pain, who then agreed to visits at 18- and 24-months post CRFA and had not undergone another knee procedure since. The subjects were evaluated for: pain using the Numeric Rating Scale (NRS), function using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), subjective benefit using the Global Perceived Effect (GPE) scale, quality of life using the EuroQol-5-Dimensions-5 Level (EQ-5D-5L) questionnaire, and safety. Results Of 57 subjects eligible, 36 enrolled; 32 completed the 18-month visit with a mean NRS score of 2.4 and 22 (69%) reporting ≥50% reduction in pain from baseline (primary endpoint); 27 completed the 24-month visit, with a mean NRS of 3.4 and 17 (63%) reporting ≥50% pain relief. Functional and quality of life improvements persisted similarly, with mean changes from baseline of 53.5% and 34.9% in WOMAC total scores, and 24.8% and 10.7% in EQ-5D-5L Index scores, at 18- and 24-months, respectively. There were no identified safety concerns in this patient cohort. Conclusion In this subset of subjects, CRFA of genicular nerves provided durable pain relief, improved function, and improved quality of life extending to 24 months post procedure, with no significant safety concerns. View on Web

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Influence of cross‐sectional area and fat infiltration of paraspinal muscles on analgesic efficacy of epidural steroid injection in elderly patients

alexandrossfakianakis shared this article with you from Inoreader Influence of cross‐sectional area and fat infiltration of paraspinal muscles on analgesic efficacy of epidural steroid injection in elderly patients via Pain Practice Abstract Background An assessment of paraspinal muscle degeneration based on magnetic resonance imaging has been used to investigate both sarcopenia and myosteatosis. The morphologic changes in cross-sectional area and fat infiltration of the paraspinal muscles can affect pain outcomes after epidural steroid injection. Methods Patients ≥ 65 years of age who underwent fluoroscopy-guided lumbar epidural steroid injections were enrolled. Good analgesia was defined as ≥ 50% reduction in pain score at 4 weeks after injection. Cross-sectional area and grade of fat infiltration of the paraspinal muscles on magnetic resonance images at the level of L3-L4 disc were measured. Patient demographics, pain-related factors, clinical factors, and paraspinal muscle measurements were compared between good and poor analgesia groups. The factors associated with pain outcome after injection were identified using multivariate analysis. Results A total of 245 patients consisting of 149 and 96 patients in the good and poor analgesia groups, respectively, fully satisfied the study criteria for analysis. Patients of older age, opioid use, and high-grade foraminal stenosis were frequently observed in the poor analgesia group. The grade of fat infiltration of the paraspinal muscles was significantly higher in the poor analgesia group (Grade 2, 20.8 vs. 42.7%, P < 0.001), and this result was predominantly observed in female patients. However, there was no difference in muscle cross-sectional area between the two groups (18.29 ± 3.16 vs. 18.59 ± 3.03 cm2/m2, P = 0.460). The percentage of patients with good analgesia decreased as the grade of fat infiltration increased (Grade 0 = 75.0%, Grade 1 = 65.8%, Grade 2 = 43.0%, P < 0.001). Multivariate logistic regression analysis revealed that pre-injection opioid use [adjusted odds ratio (aOR) = 1.926, 95% confidence interval (CI) = 1.084–3.422, P = 0.025], moderate to severe foraminal stenosis (aOR = 2.859, 95% CI = 1.371–5.965, P = 0.005), and high-grade fat infiltration of the paraspinal muscles (aOR = 4.258, 95% CI = 1.805–10.043, P = 0.001) were significantly associated with poor analgesia after injection. Conclusion High fat infiltration of the paraspinal muscles at the mid-lumbar region appeared to be an independent factor associated with poor analgesia after epidural steroid injection in elderly patients with symptomatic degenerative lumbar spinal disease receiving conservative care. However, cross-sectional area of the paraspinal muscles was not associated with pain relief after injection. View on Web

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Temporomandibular joint prosthesis as treatment option for mandibular condyle fractures: a systematic review and meta-analysis

alexandrossfakianakis shared this article with you from Inoreader Temporomandibular joint prosthesis as treatment option for mandibular condyle fractures: a systematic review and meta-analysis via International Journal of Oral and Maxillofacial Surgery via MedWorm.com The aim of this study was to perform a systematic review of the literature on the temporomandibular joint (TMJ) prosthesis as a treatment option after mandibular condyle fracture. Three databases were searched (PubMed, Embase, Cochrane Library) and 2670 unique papers were identified. A total of 337 studies were included (121 case reports, 89 case series, and 127 cohort/clinical studies). In total 14,396 patients and 21,560 prostheses were described. Of the 127 cohort or clinical studies, 100 (79%) reported inclusion criteria, 54 (43%) reported exclusion criteria, and 96 (76%) reported the inclusion period. (Source: International Journal of Oral and Maxillofacial Surgery) View on Web

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