Upper Aerodigestive Endoscopy Contamination: Is Flexible Laryngoscopy Different?

xlomafota13 shared this article with you from Inoreader A Manufacturer and User Facility Device Experience Analysis of Upper Aerodigestive Endoscopy Contamination: Is Flexible Laryngoscopy Different? Via The Laryngoscope Objectives/Hypothesis Several recent studies have observed a high incidence of duodenoscope microbial contamination and an association of contamination with healthcare‐acquired infections. This study sought to quantify nasopharyngoscope microbial contamination relative to that of other endoscope categories and characterize the manufacturers, outcomes, and microbial profiles associated with these cases. Study Design Retrospective, cross‐sectional study. Methods A total of 3,865 adverse events were collected from 2013 to 2019 using the US Food and Drug Administration Manufacturer and User Facility Device Experience database. The fraction of total device failures associated with contamination was quantified for nasopharyngoscopes, bronchoscopes, duodenoscopes, and gastroscopes. Odds ratios of nasopharyngoscope contamination compared to that of bronchoscopes, duodenoscopes, or gastroscopes were calculated, and significance was assessed by χ2 analysis. The Kruskal‐Wallis test was used for nonparametric testing of significance. Results Nasopharyngoscope device failures were reported at an incidence of 0.646 per month; 34.1% involved contamination, comparable to the frequency observed for bronchoscopes (23.4%, P = .118), duodenoscopes (29.2%, P = .493), and gastroscopes (45.3%, P = .178). The frequency of device contamination was observed to be significantly higher for a particular endoscope manufacturer regardless of endoscope category (Kruskal‐Wallis P = .021). In instances of contamination, nasopharyngoscopes were significantly less associated with patient harm or death than bronchoscope (odds ratio [OR] = 10.2) and duodenoscope (OR = 4.81) cases. Conclusions Although the rates of contamination were comparable across all endoscope categories, nasopharyngoscope contamination was less commonly associated with patient harm or death. In an era of rising healthcare costs, determining adequate disinfection standards for nasopharyngoscopes and their impact on patient safety is crucial. Level of Evidence NA Laryngoscope, 131:598–605, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

ERAS for Head and Neck Tissue Transfer Reduces Opioid Usage, Peak Pain Scores, and Blood Utilization

xlomafota13 shared this article with you from Inoreader ERAS for Head and Neck Tissue Transfer Reduces Opioid Usage, Peak Pain Scores, and Blood Utilization Via The Laryngoscope Objectives We implement a novel enhanced recovery after surgery (ERAS) protocol with pre‐operative non‐opioid loading, total intravenous anesthesia, multimodal peri‐operative analgesia, and restricted red blood cell (pRBC) transfusions. 1) Compare differences in mean postoperative peak pain scores, opioid usage, and pRBC transfusions. 2) Examine changes in overall length of stay (LOS), intensive care unit LOS, complications, and 30‐day readmissions. Methods Retrospective cohort study comparing 132 ERAS vs. 66 non‐ERAS patients after HNC tissue transfer reconstruction. Data was collected in a double‐blind fashion by two teams. Results Mean postoperative peak pain scores were lower in the ERAS group up to postoperative day (POD) 2. POD0: 4.6 ± 3.6 vs. 6.5 ± 3.5; P = .004) (POD1: 5.2 ± 3.5 vs. 7.3 ± 2.3; P = .002) (POD2: 4.1 ± 3.5 vs. 6.6 ± 2.8; P = .000). Opioid utilization, converted into morphine milligram equivalents, was decreased in the ERAS group (POD0: 6.0 ± 9.8 vs. 10.3 ± 10.8; P = .010) (POD1: 14.1 ± 22.1 vs. 34.2 ± 23.2; P = .000) (POD2: 11.4 ± 19.7 vs. 37.6 ± 31.7; P = .000) (POD3: 13.7 ± 20.5 vs. 37.9 ± 42.3; P = .000) (POD4: 11.7 ± 17.9 vs. 36.2 ± 39.2; P = .000) (POD5: 10.3 ± 17.9 vs. 35.4 ± 45.6; P = .000). Mean pRBC transfusion rate was lower in ERAS patients (2.1 vs. 3.1 units, P = .017). There were no differences between ERAS and non‐ERAS patients in hospital LOS, ICU LOS, complication rates, and 30‐day readmissio ns. Conclusion Our ERAS pathway reduced postoperative pain, opioid usage, and pRBC transfusions after HNC reconstruction. These benefits were obtained without an increase in hospital or ICU LOS, complications, or readmission rates. Level of Evidence 3 Laryngoscope, 131:E792–E799, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Lateral Chest Placement of IPG for Hypoglossal Nerve Stimulator Implantation

xlomafota13 shared this article with you from Inoreader Case Report: Lateral Chest Placement of IPG for Hypoglossal Nerve Stimulator Implantation Via The Laryngoscope Hypoglossal nerve stimulation for the treatment of obstructive sleep apnea is an increasingly common procedure. The hypoglossal nerve is stimulated by an implanted pulse generator that is placed in a subcutaneous pocket in the upper chest over the pectoralis muscle. A pressure sensor is placed through a separate incision between two ribs to detect respiratory effort. This case reports an alternative implantation of the device and pressure sensor through a single shared incision lateral to the breast in a thin patient with a previous history of breast cancer, mastectomy, and subpectoral breast implant reconstruction. Laryngoscope, 131:E1010–E1012, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The HSP90 inhibitor RGRN‐305 exhibits strong immunomodulatory effects in human keratinocytes

xlomafota13 shared this article with you from Inoreader The HSP90 inhibitor RGRN‐305 exhibits strong immunomodulatory effects in human keratinocytes Via Experimental Dermatology Abstract Keratinocytes are the key cellular target for IL‐17A‐mediated effects in psoriasis and HSP90 is important for IL‐17A‐mediated signalling. RGRN‐305 is a novel HSP90 inhibitor reported to reduce psoriatic phenotypes in preclinical animal models. The aim of this study was to investigate the effect of RGRN‐305 on a psoriasis‐like inflammatory response in human keratinocytes in vitro. Using RT‐qPCR we demonstrated a significantly increased expression of the HSP90 isoforms HSP90AB1, HSP90B1 and TRAP1 in lesional compared with nonlesional psoriatic skin. In a psoriasis‐like setting where keratinocytes were stimulated with TNFα and/or IL‐17A, we analysed the mRNA expression using the NanoString nCounter technology and demonstrated that the HSP90 inhibitor RGRN‐305 significantly reduced the IL‐17A‐ and TNFα‐induced gene expression of a number of proinflammatory genes, including the psoriasis‐associated genes CCL20, NFKBIZ, IL36G, and IL23A. In agreement with the mRNA data, the protein level of CCL20, IκBζ and IL‐36γ were inhibited by RGRN‐305 as demonstrated by western blotting and ELISA. Interestingly, when keratinocytes were stimulated with a TLR3 agonist, RGRN‐305 also demonstrated potent immunomodulatory effects, significantly inhibiting poly(I:C)‐induced expression of the proinflamma tory genes TNFα, IL1B, IL6, and IL23A. Taken together, our data support a role for HSP90 not only in the pathogenesis of psoriasis, but also in broader immune responses. Therefore, HSP90 provides an attractive target for the treatment of psoriasis and other diseases where the innate immune system plays an important role. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Key regulatory genes and signaling pathways involved in islet culture: a bioinformatic analysis.

xlomafota13 shared this article with you from Inoreader Key regulatory genes and signaling pathways involved in islet culture: a bioinformatic analysis. Via International Journal of Clinical and Experimental Pathology Related Articles Key regulatory genes and signaling pathways involved in islet culture: a bioinformatic analysis. Int J Clin Exp Pathol. 2021;14(2):292-303 Authors: Shi J, Zhang YQ, Hao DD, Fu SH, Meng JL Abstract Type 1 diabetes (T1D) is characterized by non-ideal mass and low survival rate of islets. Therefore, it is necessary to find intrinsic factors that prolong the survival of islets. This study aimed to track out hub genes and pathways in the process of islet culture by bioinformatic analysis. We downloaded the gene expression microarray of GSE42591 from the Gene Expression Omnibus (GEO). Aberrant Differentially methylated genes (DMGs) were obtained using the GEO2R tool. Gene ontology (GO) analysis and Kyoto Encyclopedia of Gene and Genome (KEGG) pathway enrichment analyses were performed on selected genes by using the Database for Annotation Visualization and Integrated Discovery (DAVID). A protein-protein interaction (PPI) network was constructed with the Retrieval of Interacting Genes (STRING) and visualized in Cytoscape 3.7.2. A total of 434 genes were overexpressed and 114 genes underexpressed in fresh to cultured 4 h tissue. KEGG pathway enrichment analyses revealed the TG F-beta signaling pathway, MAPK signaling pathway, or VEGF signaling pathway. The genes FN1, MKI67, IGF1, MAPK14, COL1A1 might be involved in islet culture. In general, this work scrutinized islet culture-relevant knowledge and provided insight into the regulation and mediation of islet survival. PMID: 33564361 [PubMed] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Use of Vascular Clues to Locate Ectopic Parathyroid Glands and Predict Anatomic Abnormalities

xlomafota13 shared this article with you from Inoreader Use of Vascular Clues to Locate Ectopic Parathyroid Glands and Predict Anatomic Abnormalities Via JAMA Otolaryngology–Head & Neck Surgery Current Issue This case report describes a woman in her 60s who was referred for primary hyperparathyroidism and was subsequently diagnosed with an aberrant right subclavian artery. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Nasal Saline Irrigations in the COVID-19 Pandemic—Reply

xlomafota13 shared this article with you from Inoreader Nasal Saline Irrigations in the COVID-19 Pandemic—Reply Via JAMA Otolaryngology–Head & Neck Surgery Current Issue In Reply We thank Radulesco et al for their interest in our article and their letter in response. We agree that it would be beneficial to explore the utility of other topical additives in prevention and treatment of respiratory viruses, such as severe acute respiratory syndrome coronavirus 2. Regarding the potential use of copper, it is certainly encouraging to note its antiviral efficacy. The literature is particularly supportive of its use as an antimicrobial coating for surfaces. However, there is not yet strong evidence regarding the safety of copper as an additive for nasal saline irrigations. As the authors address, 1 preliminary study performed by Huang et al does note the safety of a nasal solution enriched with copper, among other additives. However, the product evaluated in that study reports only that it is enriched with coppe r and does not further specify the concentration or form of copper used. Though the aforementioned study notes safety of a nasal solution enriched with copper, animal studies of nasally applied copper salts and nanoparticles have demonstrated the potential toxic effects of copper, resulting in direct olfactory neuron damage or intracranial translocation, resulting in neurologic damage. These concerns were further described in a recent review of copper toxicology, which notes concern for copper-induced cell damage through the release of reactive oxygen species. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Increasing Confidence in Detecting Metastatic Thyroid Cancer With Neck Ultrasonography

xlomafota13 shared this article with you from Inoreader Increasing Confidence in Detecting Metastatic Thyroid Cancer With Neck Ultrasonography Via JAMA Otolaryngology–Head & Neck Surgery Current Issue Ultrasonography is the modality of choice for neck nodal surveillance after thyroidectomy for patients with differentiated thyroid cancer (DTC), according to the American Thyroid Association and the European Thyroid Association. In a cross-sectional survey study published in this issue of JAMA Otolaryngology–Head & Neck Surgery, Kovatch and colleagues draw attention to low confidence in ultrasonography among a cohort of 320 endocrinologists, general surgeons, and otolaryngologists. The authors found that only 1 in 5 physicians reported having high confidence in their own ability to use ultrasonography to detect lymph nodes suggestive of recurrence; 3 in 5 reported having high confidence in a radiologist's ability to detect recurrence; and 1 in 3 did not have high confidence in either their own or a radiologist's ability to detect recurrence. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Transient Delivery of a KCNQ2/3-Specific Channel Activator 1 Week After Noise Trauma Mitigates Noise-Induced Tinnitus

xlomafota13 shared this article with you from Inoreader Transient Delivery of a KCNQ2/3-Specific Channel Activator 1 Week After Noise Trauma Mitigates Noise-Induced Tinnitus Via Journal of the Association for Research in Otolaryngology Abstract Exposure to loud noise can cause hearing loss and tinnitus in mice and humans. In mice, one major underlying mechanism of noise-induced tinnitus is hyperactivity of auditory brainstem neurons, due at least in part, to decreased Kv7.2/3 (KCNQ2/3) potassium channel activity. In our previous studies, we used a reflex-based mouse model of tinnitus and showed that administration of a non-specific KCNQ channel activator, immediately after noise trauma, prevented the development of noise-induced tinnitus, assessed 1 week after trauma. Subsequently, we developed RL-81, a very potent and highly specific activator of KCNQ2/3 channels. Here, to test the timing window within which RL-81 prevents tinnitus in mice, we modified and employed an operant animal model of tinnitus, where mice are trained to move in response to sound but not move in silence. Mice with behavioral evidence of tinnitus are expected to move in silence. We validated this mouse model by testing the ef fect of salicylate, which is known to induce tinnitus. We found that transient administration of RL-81 1 week after noise exposure did not affect hearing loss but reduced significantly the percentage of mice with behavioral evidence of tinnitus, assessed 2 weeks after noise exposure. Our results indicate that RL-81 is a promising drug candidate for further development for the treatment of noise-induced tinnitus. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Test of Masticating and Swallowing Solids (TOMASS): Reliability, Validity and Normative Data for the Adult Indian Population

xlomafota13 shared this article with you from Inoreader The Test of Masticating and Swallowing Solids (TOMASS): Reliability, Validity and Normative Data for the Adult Indian Population Via Otolaryngology Indian Abstract The Test of Masticating and Swallowing Solids (TOMASS) is a reliable and well-validated tool to assess the effectiveness of solid bolus ingestion. Previous studies have established normative values for 4 to 80+ years across a range of commercially available crackers and countries. The current study aimed to establish normative data for the TOMASS across age and gender groups for a commercially available biscuit (cracker) for the adult Indian population. A total of 300 typical individuals in the age range of 21 to 80 years grouped by age and sex participated in the study. Participants were instructed to eat a commercially (locally) available biscuit 'as quickly and comfortably as possible,' and the task was video recorded. The recorded video samples were analyzed to obtain measures of the number of bites, number of masticatory cycles, number of swallows, and total time taken to complete the ingestion of biscuit. Cronbach's α values revealed a moderat e to good (0.71 to 0.82) test–retest reliability; ICC values were suggestive of a high level (> 0.76) of interrater reliability for all the measures of TOMASS. The results of the one-way ANOVA revealed a significant main effect of age (F = 3.12, p < 0.01) and gender (F = 4.37, p < 0.01), but not an interaction between the two. Normative data stratified by age and gender were also generated. The TOMASS assessment procedure was feasible, reliable, and valid. In the current study, we observed that males took fewer bites, took less time, chewed less, and swallowed fewer times than females. A definitive age effect was observed for the number of bites, masticatory cycles, and total time. The normative data generated by the current study can serve as clinical benchmarks to assess the ingestion of solid bouls in the adult Indian population. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Concept and Prelimnary Design of an Economical Bag Valve Mask Compressor as a Prototype for Simple Ventilator During COVID-19

xlomafota13 shared this article with you from Inoreader Concept and Prelimnary Design of an Economical Bag Valve Mask Compressor as a Prototype for Simple Ventilator During COVID-19 Via Otolaryngology Indian Abstract The pandemic of COVID 19 has taken a massive toll of lives since its outbreak. Throughout the world with a large number of people being affected by covid 19, the need for the ventilators has risen. However, there is disproportionate ratio of demand versus supply of ventilators due to the menace caused by Covid 19 which has become unmanageable. This paper describes the design of the low cost portable mechanical bag valve mask compressor which could serve as a preliminary ventilator for the patients needing ventilator support in COVID 19. This prototype ventilator delivers breaths by compressing a conventional bag-valve mask (BVM) with a motor, eliminating the need for a human operator for the BVM. It is driven by a wind shield wiper electric motor powered by a 12 V battery. Additionally it can be used to deliver oxygen through either Laryngeal mask or compact face masks or nasopharyngeal airways where intubation is awaited in early breathlessness. Future additions for our prototype ventilator will include a controllable inspiration to expiration time ratio, a pressure relief valve, PEEP capabilities and an LCD screen. With a prototyping cost of only $150, the concept of BVM compressor is a low-cost, low-power portable ventilator technology that will provide essential ventilator features at a fraction of the cost of existing technology. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Role of Systemic Therapy in Advanced Cutaneous Squamous Cell Carcinoma

xlomafota13 shared this article with you from Inoreader The Role of Systemic Therapy in Advanced Cutaneous Squamous Cell Carcinoma Via Otolaryngologic Clinics of North America Systemic therapy for patients with head and neck cutaneous squamous cell carcinoma (HNCSCC) generally is used for patients with advanced disease and most often employed for patients in the palliative setting when disease is unresectable and/or widely metastatic. Cytotoxic agents and epidermal growth factor receptor pathway targeted therapy have been utilized most commonly, with few clinical data to support their efficacy. Adjuvant postoperative chemoradiation with platinum has been called into question based on recent data. Programmed cell death protein 1 receptor immune checkpoint inhibitors have demonstrated profound activity in HNCSCC, and cemiplimab and pembrolizumab now are approved for use for unresectable/metastatic disease. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.