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Κυριακή 5 Σεπτεμβρίου 2021

Speech pathology service enhancement for people with head and neck cancer living in rural areas: Using a concept mapping approach to inform service change

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Abstract

Background

Speech pathology (SP) services provide swallowing and communication intervention to people with head and neck cancer (HNC) across the continuum of care. However, difficulties exist with access and delivery of services in rural areas. The study aim was to identify actionable goals for SP change, utilizing a concept mapping approach.

Methods

Eleven SP staff from two regional/remote services completed the concept mapping process. Multivariate analysis and multidimensional scaling were used to develop a final set of prioritized goals for change.

Results

Between the two participating health services, 30 actionable goals were identified within the "green-zone" on the go-zone graph of importance and changeability. Among the most highly rated areas for change was the need to deliver and receive more support for training, mentoring, and supervision to consolidate skills.

Conclusions

This methodology enabled identification of prioritized, actionable changes to improve SP services for people with HNC living in regional/remote areas.

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Hyperspectral imaging and artificial intelligence to detect oral malignancy – part 1 - automated tissue classification of oral muscle, fat and mucosa using a light-weight 6-layer deep neural network

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Hyperspectral imaging (HSI) is a promising non-contact approach to tissue diagnostics, generating large amounts of raw data for whose processing computer vision (i.e. deep learning) is particularly suitable. A...
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A retrospective study of 44 patients with head and neck Castleman's disease

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Eur Arch Otorhinolaryngol. 2021 Sep 4. doi: 10.1007/s00405-021-07065-0. Online ahead of print.

ABSTRACT

PURPOSE: To explore the clinical and pathological features, therapy and prognosis of Castleman's disease (CD) in the head and neck.

METHODS: We retrospectively analyzed the clinical and pathological data of 44 patients with head and neck CD who were diagnosed in the Fujian Medical University Union hospital (Fujian, China) between May 2008 and June 2021. According to the clinical classification, they were divided into two groups, the unicentric CD (UCD, n = 20) and the multicentric CD (MCD, n = 24). Their clinical features, imaging findings, laboratory examination, and treatment results were, respectively, analyzed.

RESULTS: The age of UCD patients was younger than that of MCD patients. Most of the UCD patients (80%) were female, with asymptomatic single lymphadenectasis, and the prognosis was favorable; while 70.8% of the MCD patients were male, with multiple lymph nodes throughout the body, and more prone to hepatosplenomegaly, pneumonia, serous effusion, anemia, hypoalbuminemia, elevated globulin, coagulation disorders, etc., the prognosis was bleak. Two cases of MCD patients were with systemic lupus erythematosus (SLE).

CONCLUSIONS: UCD usually manifests as asymptomatic single lymph node enlargement, complete surgical resection was the mainstay of treatment modality. MCD has relatively complicated clinical symptoms and poor prognosis, and anti-IL-6 therapy may be effective.

PMID:34480599 | DOI:10.1007/s00405-021-07065-0< /p>

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Type 4 persistent primitive olfactory artery associated with contralateral accessory middle cerebral artery arising from the fenestrated segment of the distal anterior cerebral artery

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Surg Radiol Anat. 2021 Sep 4. doi: 10.1007/s00276-021-02831-5. Online ahead of print.

ABSTRACT

Persistent primitive olfactory artery (PPOA) is a rare variation of the proximal anterior cerebral artery (ACA) that generally follows an extreme anteroinferior course and takes a hairpin turn before continuing to the A2 segment of the ACA (type 1). There are four other types of extremely rare variations. The type 4 variation continues to the accessory middle cerebral artery (MCA) instead of the ACA. Only a few cases have been reported. We herein report a case of type 4 PPOA in which the contralateral side of the accessory MCA arose from the fenestrated segment of the distal ACA. No similar cases were found in the relevant English-language literature. For the identification of these variations on MR angiography, volume-rendering images were superior to maximum-intensity-projection images.

PMID:34480592 | DOI:10.1007/s00276-021-02831-5

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(−)-Epigallocatechin-3-gallate (EGCG) prevents aminoglycosides-induced ototoxicity via anti-oxidative and anti-apoptotic pathways

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Publication date: Available online 4 September 2021

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Yulong Zong, Fang Chen, Shanshan Li, Hui Zhang

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Πέμπτη 2 Σεπτεμβρίου 2021

Identification of specific clinical risk factors associated with the malignant transformation of oral epithelial dysplasia

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Abstract

Background

Factors that increase the risk of malignant transformation of oral epithelial dysplasia (OED) are not completely elucidated.

Methods

A retrospective chart review was performed assessing risk factors for transformation of OED, and cancer staging for transformed cases at Sunnybrook Health Sciences Centre.

Results

Two-hundred four patients were diagnosed with OED, and 16.7% (34) underwent malignant transformation. Risk factors associated with transformation included: heavy tobacco smoking, excessive EtOH consumption, non-homogenous leukoplakia, size >200 mm2, moderate dysplasia or greater than moderate, progression of dysplasia grades, and immunosuppression. Transformed cases followed for a dysplastic lesion were associated with a stage-I cancer diagnosis, and cancer cases with no prior biopsy were associated with a stage-IV diagnosis.

Conclusions

In addition to commonly cited risk factors, immunosuppression was associated with malignant transformation, including the use of topical steroids. Analyzing risk factors can help clinicians define risk of progression in patients with OED.

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Dysphagia in non-intubated patients affected by COVID-19 infection

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Eur Arch Otorhinolaryngol. 2021 Sep 1:1-7. doi: 10.1007/s00405-021-07062-3. Online ahead of print.

ABSTRACT

PURPOSE: Patients affected by COVID-19 are assumed to be at high risk of developing swallowing disorders. However, to our best knowledge, data on the characteristics and incidence of dysphagia associated with COVID-19 are lacking, especially in non-intubated patients. Therefore, we investigated the onset of swallowing disorders in patients with laboratory-confirmed COVID-19 infection who have not been treated with invasive ventilation, in order to evaluate how the virus affected swallowing function regardless of orotracheal intubation.

METHODS: We evaluated 41 patients admitted to the COVID department of our Hospital when they had already passed the acute phase of the disease and were therefore asymptomatic but still positive for SARS-CoV-2 RNA by RT-PCR. We examined patients' clinical history and performed the Volume-Visco sity Swallow Test (VVST). Each patient also answered the Swallowing Disturbance Questionnaire (SDQ). After 6 months, we performed a follow-up in patients with swallowing disorders.

RESULTS: Eight of 41 patients (20%) presented with dysphagia symptoms during hospitalization and 2 of them (25%) still presented a SDQ high score and swallowing disorders with liquid consistency after 6 months.

CONCLUSION: Non-intubated patients can experience various grades of swallowing impairment that probably directly related to pulmonary respiratory function alterations and viral direct neuronal lesive activity. Although these symptoms show natural tendency to spontaneous resolution, their impact on a general physical impaired situation should not be underestimated, since it can adversely affect patients' recovery from COVID-19 worsening health outcomes.

PMID:34468824 | PMC:PMC8408570 | DOI:10.1007/s00405-021-07062-3

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Iatrogenic Vocal Fold Paralysis: A Population-Based Cohort Study in Taiwan

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Ann Otol Rhinol Laryngol. 2021 Sep 1:34894211041226. doi: 10.1177/00034894211041226. Online ahead of print.

ABSTRACT

OBJECTIVE: Iatrogenic vocal fold paralysis is an important issue in laryngology, yet there are few population-based studies regarding the epidemiology. This study used a nationwide population-based claims database (the National Health Insurance Research Database) to investigate the epidemiology of iatrogenic unilateral and bilateral vocal fold paralysis (UVFP/ BVFP) among the general adult population in Taiwan.

METHOD: This study analyzed patients (20-90 years old) who underwent thyroid, parathyroid, thoracic, cardiac, or anterior cervical spine operations with vocal fold paralysis among adults in Taiwan from January 1, 2007 to December 31, 2013. The codes for vocal fold paralysis were defined by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Claims data in the Taiwan National Health Insurance Research Database were used.

RESULTS: The most commonly performed operations which were related to vocal fold paralysis in Taiwan were, in descending order of frequency, thyroid, cervical spine, cardiac, thoracic (esophagectomy), and parathyroid operations. The operations that put laryngeal nerves at risk (ONRs) most commonly associated with a diagnosis of UVFP were, in descending order of frequency, thoracic, thyroid, parathyroid, cardiac, and cervical spine. For both UVFP and BVFP, the most commonly associated age group was 51 to 60. For both UVFP and BVFP, the more commonly associated sex was women. Increased length of stay was associated with a higher incidence of UVFP and BVFP. Charlson medical co-morbidity index (CCI) was not associated with UVFP but BVFP was associated with higher Charlson medical co-morbidity scores.

CONCLUSIONS: Thyroid operations, age 51 to 60, longer hospital stays are associated with vocal fold paralysis. Overall women are more surgically affected than men. This is the first population-based study of iatrogenic vocal fold paralysis.

PMID:34470521 | DOI:10.1177/00034894211 041226

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Intraoperative Parathyroid Hormone in Minimally Invasive Parathyroidectomy

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To the Editor My attention was arrested by the article by Quinn et al on the use of intraoperative parathyroid hormone (ioPTH) in minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism (PHP). To our knowledge, it is the first meta-analysis on this topic showing a beneficial association of ioPTH with cure rates—98% vs 94.8% without ioPTH. It will have a considerable effect on surgical treatment for PHP. Nonetheless, I have some comments on the methodology, results, and conclusion of the trial.
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Neoadjuvant PD-1/PD-L1 Inhibitors for Resectable Head and Neck Cancer

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This systematic review and meta-analysis assesses the efficacy and safety of neoadjuvant immunotherapy for resectable head and neck squamous cell carcinoma.
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Is extracellular matrix (ECM) a promising scaffold biomaterial for bone repair?

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Histol Histopathol. 2021 Sep 2:18370. doi: 10.14670/HH-18-370. Online ahead of print.

ABSTRACT

The increasing demand for bone grafts and the scarcity of donors worldwide are promoting researchers to seek alternatives. The extracellular matrix (ECM) has been reported to enhance properties of osteoconduction and osteoinduction by simulating the molecular structure of bone and facilitating cell infiltration for bone repair. As one of several novel biomaterials, ECM has many desirable properties, including biocompatibility, bioactivity, and biosafety. Thus, we evaluated whether ECM is a promising scaffold biomaterial for bone repair. In this review, we explore ECM composition, the sources and fabrication methods, especially the decellularization technique, of ECM scaffolds. Furthermore, we highlight recent progress in the use of ECM as a scaffold biomaterial for bone repair. Generally, ECM is used in 1) three-dimensional (3D) cell cultures to promote osteogenic differentiation, 2) combinations with other biomaterials to increase their osteogenic effects, 3) 3D printing to produce customized or patient-tailored scaffolds for bone repair, and 4) hydrogels derived from ECM used for bone repair. In addition, we focus on future prospects for application of ECM as a scaffold material used for bone repair. From this review, we expect to have a perfect understanding of ECM-based scaffold materials in the hope that this leads to further research of the production of ECM biomaterials to meet the clinical needs for bone repair.

PMID:34472621 | DOI:10.14670/HH-18-370

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Schwannoma of the Zygomatic Branch of the Facial Nerve

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Ear Nose Throat J. 2021 Sep 2:1455613211041235. doi: 10.1177/01455613211041235. Online ahead of print.

ABSTRACT

SIGNIFICANCE STATEMENT: Facial nerve schwannoma is extremely uncommon. Despite its rarity, it is considered the most common facial nerve tumor and potentially affects any segment of the nerve. Presenting symptoms vary depending on the location of the neoplasm. Tumors pertaining to the extratemporal course of the nerve mainly appear as an asymptomatic parotid mass. We present a rare case of schwannoma of the zygomatic branch of the right facial nerve that was surgically resected, without facial nerve injury.

PMID:34472361 | DOI:10.1177/01455613211041235

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