Development of machine learning models for the prediction of positive surgical margins in transoral robotic surgery (TORS)

alexandrossfakianakis shared this article with you from Inoreader Development of machine learning models for the prediction of positive surgical margins in transoral robotic surgery (TORS) via Head & Neck Abstract Purpose To develop machine learning (ML) models for predicting positive margins in patients undergoing transoral robotic surgery (TORS). Methods Data from 453 patients with laryngeal, hypopharyngeal, and oropharyngeal squamous cell carcinoma were retrospectively collected at a tertiary referral center to train (n = 316) and validate (n = 137) six two-class supervised ML models employing 14 variables available pre-operatively. Results The accuracy of the six ML models ranged between 0.67 and 0.75, while the measured AUC between 0.68 and 0.75. The ML algorithms showed high specificity (range: 0.75–0.89) and low sensitivity (range: 0.26–0.64) in detecting patients with positive margins after TORS. NPV was higher (range: 0.73–0.83) compared to PPV (range: 0.45–0.63). T classification and tumor site were the most important predictors of positive surgical margins. Conclusions ML algorithms can identify patients with low risk of positive margins and therefore amenable to TORS. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Speicheldrüsenkarzinome - Monozentrische Erfahrung zu Subtypen und deren Inzidenz über 42 Jahre

alexandrossfakianakis shared this article with you from Inoreader Speicheldrüsenkarzinome - Monozentrische Erfahrung zu Subtypen und deren Inzidenz über 42 Jahre via Laryngo-Rhino-Otologie Laryngorhinootologie DOI: 10.1055/a-1976-9694 Hintergrund Speicheldrüsenkarzinome sind selten und heterogen. Über 20 Subtypen sind anerkannt und Risikofaktoren sind vielfältig. Ziel dieser Arbeit war die Bewertung des Subtyps und weiterer Risikofaktoren bei einem monozentrischen Kollektiv aus über vier Jahrzehnten. Material und Methoden 205 Fälle (Diagnosezeitraum 1972–2014) wurden retrospektiv erhoben und hinsichtlich der Verteilung von Risikofaktoren und deren Einfluss auf die Gesamtüberlebenszeit (overall survival, OS) statistisch ausgewertet. Ergebnisse 19/24 (79,2%) der in der WHO-Klassifikation gelisteten Subtypen kamen in der Kohorte selten vor (< 5%). Davon wurden 10/24 (41,7%) Subtypen nie diagnostiziert. Das Plattenepithelkarzinom (PEC), Adenokarzinom (AdenoCa), Azinuszellkarzinom (AzinusCa), Mukoepidermoidkarzinom (MEC) und adenoidzystische Karzinom (ACC) sind mit zusammen 145/205 (70,7%) die mit Abstand häufigsten Subtypen. Risikofaktoren sind in diesen Gruppen signifikant unterschiedlich vertreten (z.B. lymphogene Metastasierung und Differenzierungsgrad beim AdenoCa und Alter, T- und UICC-Stadium beim PEC). Das 5-Jahres Gesamtüberleben aller Patienten war 66,9% und unterscheidet sich signifikant innerhalb der häufigsten Subtypen. Ein unabhängiger Einfluss auf das Gesamtüberleben war in der multivariaten Analyse feststellbar für das Alter der Patienten (p<0,001), sowie das T- (p=0,003) und N-Stadium (p=0,046). Schlussfolgerungen Die meisten Subtypen traten auch innerhalb von Jahrzehnten ausgesprochen selten oder gar nicht auf. Die häufigsten Diagnosen unterscheiden sich bezüglich der Risikofaktoren als auch hinsichtlich des OS, so dass 3 Risikogruppen gebildet werden können. Schlussfolgernd ist die Betrachtung von TNM alleine für die Prognoseabschätzung beim Speicheldrüsenkarzinom unzureichend. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Rehabilitation of long‐term mandibular defects by whole‐process digital fibula flap combining with implants: a case report

alexandrossfakianakis shared this article with you from Inoreader Rehabilitation of long‐term mandibular defects by whole‐process digital fibula flap combining with implants: a case report via Journal of Prosthodontics Abstract Currently, the gold standard and workhorse in mandibular reconstruction is the free vascularized fibula flap. Particularly for patients who have had mandibulectomy for a long time, it is still difficult to precisely reconstruct the mandibular contour and successfully restore the patient's chewing function and aesthetics. For the restoration and rehabilitation of long-term mandibular abnormalities, 3D virtual surgical planning and 3D-printed surgical guides are essential. Digital design and manufacturing were used to improve the accuracy of prostheses, and facilitate occlusal reconstruction. Therefore, equipped with the methods of 3D virtual surgical planning, 3D printed surgical guides, free vascularized fibular flap, and immediate dental implants, this clinical report provides a feasible solution for mandibular reconstruction. This article is protected by copyright. All rights reserved View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Therapieadhärenz drei Monate nach Einleitung einer nichtinvasiven CPAP-Therapie bei 1078 Patienten mit obstruktiver Schlafapnoe (OSA)

alexandrossfakianakis shared this article with you from Inoreader Therapieadhärenz drei Monate nach Einleitung einer nichtinvasiven CPAP-Therapie bei 1078 Patienten mit obstruktiver Schlafapnoe (OSA) via Laryngo-Rhino-Otologie Laryngorhinootologie DOI: 10.1055/a-1949-3026 Einleitung Die nächtliche kontinuierliche positive Überdruckatmung (CPAP) gilt als therapeutischer Goldstandard einer obstruktiven Schlafapnoe (OSA). Die CPAP-Therapie stellt zumeist eine Dauertherapie mit geringen Nebenwirkungen dar. Trotzdem ist die Therapietreue unbefriedigend. In dieser Arbeit wurden die Therapietreue betrachtet und typische Probleme katalogisiert. Methode 1078 OSA-Patienten wurden nach diagnostischer Polygrafie (PG) oder Polysomnografie (PSG) auf eine CPAP-Therapie eingestellt. Die Therapietreue wurde nach 3 Monaten nachverfolgt. Folgende Therapieadhärenz-Gruppen wurden festgelegt: 1. gute CPAP-Einstellung und Nutzung, 2. CPAP-Abbruch nach anfänglicher Nutzung, 3. mangelnde CPAP-Nutzung wegen Nebenwirkungen, 4. Abbruch aufgrund fehlender Motivation/geringem Leidensdruck, 5. Masken-Unverträglichkeit, 6. CPAP-Versagen aufgrund fehlenden Therapieeffekts, 7. Umstellung auf anderes Beatmungsverfahren, 8. keine Kontrolle erfolgt. Ergebnisse Von 1078 CPAP-Patienten erschienen 830 Patienten (77 %) zur Therapiekontrolle. Hiervon waren 450 Patienten (54,2%) in Gruppe 1, 216 Patienten (26%) in Gruppe 2, 71 Patienten (8,5%) in Gruppe 3, 35 Patienten (4,2%) in Gruppe 4, 14 Patienten (1,7%) in Gruppe 5, 3 Patienten (0,4 %) in Gruppe 6 und 41 Patienten (4,9%) in Gruppe 7. Ein geringer obstruktiver Ereignisindex, niedriger CPAP-Druck und tendenziell auch ein geringer Epworth-Sleepiness-Score waren Prädiktoren für CPAP-Versagen. Für die Therapietreue konnten keine signifikanten Prädiktoren dargestellt werden. Diskussion Eine effektive Therapienutzung von 54% nach 3 Monaten ist ein suboptimales Ergebnis. Prädiktoren für CPAP-Versagen waren Parameter, die vor Therapie auf geringen Leidensdruck der Patienten deuteten. Trotz großer Patientenkohorte konnten keine signifikanten CPAP-Adhärenz-Prädiktoren durch anthropometrische oder PSG-Daten dargestellt werden. Vielmehr könnten Erfahrungen in den ersten Therapietagen ausschlaggebend sein. CPAP-Geräte bieten Komforteinstellungen, die kenntnisgerecht auf den Patienten individualisiert werden müssen. Eine große Auswahl an unterschiedlichen Maskenformen erfordert Erfahrung und Training bei der patientenorientierten Maskenanpassung. Eine 3-monatige Wiedervorstellung erscheint zu lang, um Therapieprobleme zeitnah mit dem Patienten zu besprechen. Telemedizinische Möglichkeiten oder kurzfristige telefonische Beratungsoptionen sollten in Betracht gezogen werden. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Akute Atemwegsinfekte und Antibiotikaverordnungen: Welche Erwartungen haben Patient*innen?

alexandrossfakianakis shared this article with you from Inoreader Akute Atemwegsinfekte und Antibiotikaverordnungen: Welche Erwartungen haben Patient*innen? via Laryngo-Rhino-Otologie Laryngorhinootologie DOI: 10.1055/a-1949-3397 Einleitung Der Einsatz von Antibiotika in der Humanmedizin ist für den globalen Anstieg der Antibiotika-Resistenzen mitverantwortlich. Aufklärungskampagnen, Kommunikationstrainings und Verordnungsfeedback führten zu einer deutlichen Reduktion der Antibiotika-Verordnungen. Basierend auf Daten der Cluster-randomisierten Studie CHANGE-3 steht in der vorliegenden Analyse die Frage nach der patientenseitigen Erwartungshaltung für ein Antibiotikum bei akuten Atemwegsinfektionen im Mittelpunkt. Methoden An der Untersuchung beteiligten sich 106 von 114 Hausarztpraxen in Baden-Württemberg und Mecklenburg-Vorpommern. 4736 Patient*innen, die von Oktober 2018 bis Mai 2019 mit akuten Atemwegsinfekten in die Praxen kamen, füllten nach der Arztkonsultation einen Fragebogen aus. Die Analyse erfolgte deskriptiv. Ergebnisse 16,7 % der Patient*innen mit akuten Atemwegsinfekten gaben an, Antibiotika von ihren Hausärzt*innen erhalten zu haben. 13,3 % der Patient*innen hatten ein Antibiotikum erhofft und 5,5 % gaben an, die/den Hausärzt*in darum gebeten zu haben. Der geringste Anteil an Antibiotika-Verordnungen entfiel auf Patient*innen, die die Diagnose eines grippalen Infekts vom/von der Ärzt*in kommuniziert bekamen. Mit spezifischen Diagnosen in Abgrenzung zum unkomplizierten Atemwegsinfekt wurde ein Anstieg sowohl der Anzahl der erhofften als auch der verordneten Antibiotika beobachtet. Diskussion Patient*innen erhalten nach wie vor häufiger Antibiotika, als es von ihnen erhofft wird. Auf Seiten der Hausärzt* innen könnten die Verordnungen nach wie vor aufgrund eines gefühlten Drucks durch die Patient*innen stattfinden, die sich jedoch so nicht in der Erwartungshaltung der Patient*innen widerspiegelt. Neben einer offenen Exploration der Erwartungshaltung der Patient*innen könnten die Stärkung ihrer Gesundheitskompetenz, eine achtsame Arzt-Patienten-Kommunikation und angebotene Wiedervorstellungsmöglichkeiten bei spezifischen Diagnosen den gefühlten Druck auf Seiten der Ärzt*innen weiter reduzieren. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Ghost Cell Odontogenic Carcinoma: A Case Report and Literature Review

alexandrossfakianakis shared this article with you from Inoreader Ghost Cell Odontogenic Carcinoma: A Case Report and Literature Review via The Laryngoscope Ghost cell odontogenic carcinoma (GCOC) is an exceptionally rare malignant odontogenic neoplasm with a significant potential for aggressive growth. Although the literature on this tumor is limited, its high recurrence rates suggest that early and multimodal intervention may be beneficial. This study reports a case of GCOC of the mandible that was successfully treated with surgical resection, reconstruction, and radiation. A comprehensive literature review was performed, and the relevant genomic and histopathological characteristics of this malignancy were determined. Laryngoscope, 2022 View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The maximum phonation time as marker for voice treatment efficacy: a network meta‐analysis

alexandrossfakianakis shared this article with you from Inoreader The maximum phonation time as marker for voice treatment efficacy: a network meta‐analysis via Clinical Otolaryngology ABSTRACT Purpose There is a diversity in treatment approaches for voice therapy in which aerodynamic treatment effects between the approaches are lacking. The evidence of voice treatments on the maximum phonation time (MPT) was quantified using the statistical approach of a network meta-analysis (NMA). Data sources Three databases and manual search from inception to November 2021 were evaluated. Study selection Studies were considered which were reports of randomized controlled/clinical trials (RCT) evaluating the efficacy of a specific voice therapy treatment using MPT as an outcome measure in adult participants with voice disorders. Studies were excluded if participants had been diagnosed with neurological-motor-speech disorders or who were vocally healthy. Furthermore, no medical, pharmacological, or technical instrumental treatments were used. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension Statement guidelines were followed. Two reviewers independently screened citations, extracted data and assessed risk of bias using PEDro scale. Random effects model was used for meta-analysis. Results We identified finally 12 RCT studies (treatment groups n=285, and control group without an intervention n=62). Eight interventions were evaluated. The only effective intervention with a significant effect was Vocal Function Exercises (VFE) (mean pre-post difference 6.16 sec, 95% confidence interval, 1.18 sec to 11.13 sec). Conclusions and Relevance VFE effectively improved MPT from pre- to post-treatment in comparison with other voice interventions which were identified in the present NMA. Further high-quality intervention studies with large samples sizes, multidimensional measures, and homogeneous groups of dysphonia are needed to support evidence-based practice in laryngology. This article is protected by copyright. All rights reserved. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Efficacy of prophylactic preoperative desmopressin administration during functional endoscopic sinus surgery for chronic rhinosinusitis: a systematic review and meta‐analysis of randomized placebo‐controlled trials

alexandrossfakianakis shared this article with you from Inoreader Efficacy of prophylactic preoperative desmopressin administration during functional endoscopic sinus surgery for chronic rhinosinusitis: a systematic review and meta‐analysis of randomized placebo‐controlled trials via Clinical Otolaryngology Abstract Aim To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) that examined the efficacy of prophylactic desmopressin versus placebo among patients undergoing functional endoscopic sinus surgery (FESS). Methods The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Scopus, and Web of Science databases were screened from inception until 18-March-2022. The included studies were evaluated for risk of bias. The efficacy endpoints were summarized as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). Results Five RCTs comprising 380 patients (desmopressin=191 patients and placebo=189 patients) were included. Collectively, the included RCTs had an overall low risk of bias. The pooled results showed that the mean intraoperative blood loss (n=5 RCTs, MD=–37.97 ml, 95% CI [–56.97, –18.96], p<0.001), 5-point Boezaart scores (n=2 RCTs, MD=–0.97, 95 CI [–1.21, –0.74], p<0.001), and 10-point Boezaart scores (n=2 RCTs, MD= –3.00, 95% CI [-3.61, -2.40], p<0.001) were significantly reduced in favor of the desmopressin group compared with the placebo group. Operation time did not significantly differ between both groups (n=5 RCTs, MD=–3.73 min, 95% CI [–14.65, 7.18], p=0.50). No patient in both groups developed symptomatic hyponatremia (n=3 RCTs, 194 patients) or thromboembolic events (n=2 RCTs, 150 patients) Conclusion Among patients undergoing FESS, prophylactic administration of desmopressin does not correlate with significant clinical benefits. Data on safety is limited. Future research may explore the synergistic antihemorrhagic efficacy and safety of tranexamic acid (TXA) plus desmopressin versus TXA alone among patients undergoing FESS. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Molecular heterogeneity of pediatric choroid plexus carcinomas determines the distinctions in clinical course and prognosis

alexandrossfakianakis shared this article with you from Inoreader Molecular heterogeneity of pediatric choroid plexus carcinomas determines the distinctions in clinical course and prognosis via Neuro-Oncology Advance Access Abstract Background Choroid plexus carcinomas (CPCs) are rare aggressive pediatric tumors of the brain with no treatment standards. Genetic profiling of CPCs is often confined to possible association with Li–Fraumeni syndrome, though only about a half of CPCs develop from syndromic predispositions. Whole-chromosome gains and losses typical of CPCs reflect genomic instability of these tumors, but only partially explain the aggressive clinical course. Methods This retrospective study enrolled 25 pediatric patients with CPC, receiving treatment between January 2009 and June 2022. Molecular genetic testing was performed for 20 cases with available tumor tissue and encompassed mutational status, chromosomal aberrations and gene expression profiles. We analyzed several factors presumably influencing the outcomes, including molecular profiles and clinical parameters. The median follow-up constituted 5.2 years (absolute range 2.8–12.6 years ). Results All studied CPCs had smooth mutational profiles with the only recurrent event being TP53 variants, either germline or somatic, encountered in 13 cases. Unbalanced whole-chromosome aberrations, notably multiple monosomies, were highly typical. In seven tumors, chromosome losses were combined with complex genomic rearrangements: segmental gains and losses or signs of chromothripsis. This phenomenon was associated with extremely low 5-year survival: 20.0±17.9% vs. 85.7±13.2%; p=0.009. Transcriptomically, the cohort split into two polar clusters Ped_CPC1 and Ped_CPC2 differing by survival: 31.3±17.8% vs. 100%; p=0.012. Conclusion CPCs split into at least two molecular subtypes distinguished both genomically and transcriptomically. Clusterization of the tumors into Ped_CPC1 and Ped_CPC2 significantly correlates with survival. The distinct ion may prove relevant in clinical trials for dedicated and patient-oriented optimization of clinical protocols for these rare tumors. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Impact of SARS-CoV-2 variants on inpatient clinical outcome

alexandrossfakianakis shared this article with you from Inoreader Impact of SARS-CoV-2 variants on inpatient clinical outcome via Clinical Infectious Diseases Advance Access Abstract Background Prior observation has shown differences in COVID-19 hospitalization risk between SARS-CoV-2 variants, but limited information describes hospitalization outcomes. Methods Inpatients with COVID-19 at five hospitals in the eastern United States were included if they had hypoxia, tachypnea, tachycardia, or fever, and SARS-CoV-2 variant data, determined from whole genome sequencing or local surveillance inference. Analyses were stratified by history of SARS-CoV-2 vaccination or infection. The average effect of SARS-CoV-2 variant on 28-day risk of severe disease, defined by advanced respiratory support needs, or death was evaluated using models weighted on propensity scores derived from baseline clinical features. Results Severe disease or death within 28 days occurred for 977 (29%) of 3,369 unvaccinated patients and 269 (22%) of 1,230 patients with history of vaccination or prior SARS-CoV-2 infection. Among unvac cinated patients, the relative risk of severe disease or death for Delta variant compared to ancestral lineages was 1.30 (95% confidence interval [CI] 1.11-1.49). Compared to Delta, this risk for Omicron patients was 0.72 (95% CI 0.59-0.88) and compared to ancestral lineages was 0.94 (95% CI 0.78-1.1). Among Omicron and Delta infections, patients with history of vaccination or prior SARS-CoV-2 infection had half the risk of severe disease or death (adjusted hazard ratio 0.40, 95% CI 0.30-0.54), but no significant outcome difference by variant. Conclusions Although risk of severe disease or death for unvaccinated inpatients with Omicron was lower than Delta, it was similar to ancestral lineages. Severe outcomes were less common in vaccinated inpatients, with no difference between Delta and Omicron infections. View on Web

Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.