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Κυριακή 31 Οκτωβρίου 2021

The added value of non-contrast 3-Tesla MRI for the pre-operative localization of hyperparathyroidism

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Braz J Otorhinolaryngol. 2021 Oct 17:S1808-8694(21)00160-9. doi: 10.1016/j.bjorl.2021.07.010. Online ahead of print.

ABSTRACT

OBJECTIVE: We investigated the efficacy of non-contrast 3-Tesla MR imaging added to the combination of sestamibi with99mTc (MIBI) scintigraphy and Ultrasonography (US) for the pre-operative localization of Primary Hyperparathyroidism (PHPT) lesions.

METHODS: A total of 34 parathyroid glands, including nine normal glands, were examined with MIBI, US, and non-contrast 3-Tesla MRI. MRI was performed with the acquisition of T1- and T2-weighted images and fat-suppressed T2-weighted images. We calculated the sensitivities of MIBI, US, and the 'additional' MRI, with knowledge of the former two modalities' results.

RESULTS: For the diagnosis of PHPT lesions, the sensitivity values of MIBI, US, and additional MRI were 88.0% (22/25), 84.0% (21/25), and 92.0% (23/25), respectively. Normal glands were not visualized with any modality (0/9). One lesion was detected neither with US nor MRI, but only with MIBI, with the limitation that MIBI represented no more than laterality. The two glands not identified in MRI were 4 mm and 6 mm in their size, which are within the range of normal gland's size. Two lesions were not detected with US or MIBI but were visualized with the additional MRI, which indicated that the MRI contributed an 8.0% (2/25) improvement of sensitivity, compared from that of US. Fat-suppressed T2-weighted images were useful in the identification of parathyroid lesions, as these images helped to differentiate between the lesion and the adjacent tissue.

CONCLUSION: Additional non-contrast 3-Tesla MRI was a useful adjunctive tool for localization of PHPT, which improved the sensitivity of the pre-operative localization of PHPT lesions. Fat-suppressed T2-weighted images contributed to their identification.

LEVEL VI: Evidence from a single descriptive or quali tative study.

PMID:34716111 | DOI:10.1016/j.bjorl.2021.07.010

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Evaluation of nasal mucociliary clearance by saccharine test in rheumatoid arthritis

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Braz J Otorhinolaryngol. 2021 Oct 17:S1808-8694(21)00157-9. doi: 10.1016/j.bjorl.2021.08.005. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to reveal whether there is nasal involvement by examining the Nasal Mucociliary Clearance (NMC) and the relationship between this activity and disease severity in Rheumatoid Arthritis (RA) patients.

METHODS: In this prospective study, NMC time, disease activity (Disease Activity Score 28) and blood parameters of RA patients (n = 87) were investigated and compared with the healthy control group (n = 50). In addition, the relationship between DAS 28 and NMC was investigated.

RESULTS: The mean NMC of the RA group was 9.51 ± 3.54 min, the mean NMC of the control group was 8.69 ± 2.85 min, and there was no significant difference between the two groups. There was no correlation between NMC and disease duration, and DAS 28. The mean NMC of the RA patients with Anti Cyclic Citrulled Pep tide (Anti-CCP) positive was significantly higher than the negative ones.

CONCLUSION: Although there was no significant difference in NMC values between the RA and control group, the NMC of the Anti-CCP positive patients was higher.

LEVEL OF EVIDENCE: Level 2.

PMID:34716105 | DOI:10.1016/j.bjorl.2021.08.005

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Can Red Blood Cell Distribution Width Predict Laryngectomy Complications or Survival Outcomes?

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Ann Otol Rhinol Laryngol. 2021 Oct 29:34894211056117. doi: 10.1177/00034894211056117. Online ahead of print.

ABSTRACT

OBJECTIVE: Red blood cell distribution width (RDW), a reported biomarker for morbidity and mortality in chronic disease and following certain surgeries, has not been well-studied in head and neck cancer patients. The aim of the study was to examine the association of RDW with postoperative complications and survival among patients who underwent primary or sal vage laryngectomy.

METHODS: We analyzed a retrospective case series study of patients diagnosed with squamous cell carcinoma of the larynx treated with total laryngectomy. Survival outcomes were examined using Kaplan-Meier analysis.

RESULTS: One hundred seventy-seven patients were included in the final analysis. The most common tumor subsite was the supraglottis (60%). On bivariate analysis, patients with RDW ≥14.5 had higher prevalence of non-surgical, systemic complications, including deep venous thrombosis, pneumonia, cardiovascular events, and difficulty weaning from mechanical ventilation. However, there was no significant difference in laryngectomy-specific post-operative complications, including pharyngocutaneous fistula, wound infection, stoma complications, and chyle leak. RDW was not found to be associated with survival outcomes following laryngectomy.

CONCLUSIONS: Among laryngectomy patients, RDW ≥14.5 is associated with higher prevalence of systemic morbidity, but not with specific local surgical complications or decreased survival.

PMID:34715735 | DOI:10.1177/00034894211056117

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Noninvasive Respiratory Support as an Alternative to Tracheostomy in Severe Laryngomalacia

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Objectives/Hypothesis

To analyze the role of noninvasive respiratory support (NRS) as an alternative to tracheostomy in the management of severe laryngomalacia.

Study Design

We conducted a monocentric retrospective study in a tertiary pediatric care center.

Methods

All children under the age of 3 years with severe laryngomalacia, treated between January 2014 and December 2019, were included. Patient demographics, medical history, nutrition, surgery, NRS, and outcome were reviewed. Predictors for NRS were analyzed.

Results

One hundred and eighty-eight patients were included. Mean age was 4 ± 5 months and mean weight was 4,925 ± 1,933 g. An endoscopic bilateral supraglottoplasty was performed in 183 (97%) patients and successful in 159 (87%). NRS was initiated in 29 (15%) patients at a mean age of 3 ± 2 months (1–11 months): 15 (52%) patients were treated with NRS after surgical failure, 9 (31%) were treated with NRS initiated prior to surgery because of abnormal overnight gas exchange, and 5 (17%) were treated exclusively with NRS due to comorbidities contraindicating an endoscopic procedure. NRS was successfully performed in all patients with a mean duration of 6 ± 11 months. No patient required a tracheostomy. Univariate analysis identified the following predictors of NRS: neonatal respiratory distress (P = .003), neurological comorbidity (P < .001), associated laryngeal abnormality (P < .001), cardiac surgery (P&n bsp;= .039), surgical endoscopic revision (P = .007), and nutritional support (P < .001).

Conclusion

NRS is a safe procedure, which may avoid a tracheostomy in severe laryngomalacia, in particular, in case of endoscopic surgery failure, respiratory failure before surgery, and/or severe co-morbidity.

Level of Evidence

3 Laryngoscope, 2021

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Analysis of Determinants of Postoperative Satisfaction After Rhinoplasty

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Objectives/Hypothesis

To analyze different variables that influence postrhinoplasty quality of life outcomes to ascertain the determinants of postoperative satisfaction.

Study Design

Prospective, observational study.

Methods

This was a prospective, observational study where patients were divided into two groups based on the postoperative Rhinoplasty Outcome Evaluation (ROE) score: high satisfaction group, when postoperative ROE scores were >50, and low satisfaction group, when postoperative ROE scores were ≤50. Patients' general characteristics, Portuguese version of the Nasal Obstruction Symptom Evaluation (NOSE-p) score, the Body Dysmorphic Disorder Examination, nasal angles, and measures from the esthetic facial analysis of postoperative photographs were compared between the groups.

Results

Seventy-eight patients were included: 19 in the low satisfaction group and 58 in the high satisfaction group. The median reduction in the NOSE-p score was −45 (interquartile range [IIQ] −20 to −60) (P < .001) in the high satisfaction group and −10 (IIQ −10 to −30) in the low satisfaction group (P = .053). The high satisfaction group had a significantly higher reduction in NOSE-p scores. There was no significant difference between the groups in terms of the analyzed facial parameters, although a significant difference was found when comparing them with the ones established in the literature as a pattern. Previous rhinoplasty, preoperative crooked nose, and higher NOSE-p scores were significantly associated with lower ROE scores (P < .05) in the robust Poisson regression model.

Conclusion

Functional results play an important role in satisfaction after rhinoplasty. Neoclassical canons were not fulfilled even in a group of patients with a high postoperative satisfaction evaluation.

Level of Evidence

3 Laryngoscope, 2021

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Decreased CFTR/PPARγ and increased transglutaminase 2 in nasal polyps

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Publication date: Available online 30 October 2021

Source: Auris Nasus Larynx

Author(s): Thi Nga Nguyen, Hideaki Suzuki, Yasuhiro Yoshida, Jun-ichi Ohkubo, Tetsuro Wakasugi, Takuro Kitamura

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Πέμπτη 28 Οκτωβρίου 2021

Transcriptomic profiling of recessive dystrophic epidermolysis bullosa wounded skin highlights drug repurposing opportunities to improve wound healing

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Abstract

Chronic wounds present a major disease burden in people with recessive dystrophic epidermolysis bullosa (RDEB), an inherited blistering skin disorder caused by mutations in COL7A1 encoding type VII collagen, the major component of anchoring fibrils at the dermal-epidermal junction. Treatment of RDEB wounds is mostly symptomatic and there is considerable unmet need in trying to improve and accelerate wound healing. In this study, we defined transcriptomic profiles and gene pathways in RDEB wounds and compared these to intact skin in RDEB and healthy control subjects. We then used a reverse transcriptomics approach to discover drugs or compounds which might restore RDEB wound profiles towards intact skin. Differential expression analysis identified >2000 differences between RDEB wounds and intact skin, with RDEB wounds displaying aberrant cytokine-cytokine interactions, Toll-like receptor signalling, and JAK-STAT signalling pathways. In silico prediction for compoun ds that reverse gene expression signatures highlighted methotrexate as a leading candidate. Overall, this study provides insight into the molecular profiles of RDEB wounds and underscores the possible clinical value of reverse transcriptomics data analysis in RDEB, and the potential of this approach in discovering or repurposing drugs for other diseases.

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Investigation of miR‐126‐3p loaded on adipose stem cell‐derived exosomes for wound healing of full‐thickness skin defects

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Abstract

Objective

To investigate the function of miR-126-3p loaded on adipose stem cell (ADSC)-derived exosomes (ADSC-Exos) in wound healing of full-thickness skin defects.

Methods

ADSCs transfected with miR-126-3p mimic, miR-126-3p inhibitor or pcDNA3.1-PIK3R2, or PKH26-marked ADSC-Exos were cultured with fibroblasts or human umbilical vein endothelial cells (HUVECs). The proliferation and migration rates of fibroblasts and angiogenesis of HUVECs were measured. Rats with full-thickness skin defects were injected with ADSC-Exos or exosomes extracted from ADSCs transfected with miR-126-3p inhibitor and the wound healing rates were measured. The wound bed, collagen deposition and angiogenesis in injured rats were assessed.

Results

ADSC-Exos could be ingested by fibroblasts and HUVECs. Co-incubation with ADSCs or ADSC-Exos promoted the proliferation and migration of fibroblasts and angiogenesis of HUVECs, which was further enhanced by miR-126-3p overexpression. Inhibition of ADSC-Exos or miR-126-3p or PIK3R2 overexpression suppressed the proliferation and migration of fibroblasts and angiogenesis of HUVECs. ADSC-derived exosomal miR-126-3p increased wound healing rate, collagen deposition and newly formed vessels in injured rats.

Conclusion

ADSC-derived exosomal miR-126-3p promotes wound healing of full-thickness skin defects by targeting PIK3R2.

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Revision surgery for chronically discharging mastoid cavities: mastoid obliteration with canal wall reconstruction versus non-obliteration surgery

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Eur Arch Otorhinolaryngol. 2021 Oct 27. doi: 10.1007/s00405-021-07138-0. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the surgical results of revision canal wall down (CWD) surgery for chronically discharging mastoid cavities and to compare the non-obliteration approach to mastoid obliteration with canal wall reconstruction.

METHODS: This is a retrospective cohort study. All adult patients (≥ 18 years) who underwent revision surgery for chronically draining mastoid cavities between January 2013 and January 2020 were included. Primary outcome measures included the dry ear rate, complications and postoperative hearing.

RESULTS: 79 ears were included; 56 ears received revision CWD with mastoid obliteration and posterior canal wall reconstruction and 23 ears received CWD without mastoid obliteration. The dry ear rate at the most recent outpatient clinic visit (median 28.0 months postoperative) was significantly higher in the obliteration group with 96.4% compared to 73.9% for the non-obliteration group (p = .002). There were no differences in audiological outcome and incidence of complications between the two techniques.

CONCLUSION: We show that in our study population revision CWD surgery with mastoid obliteration and posterior canal wall reconstruction is superior to revision CWD surgery without mastoid obliteration in the management of chronically discharging mastoid cavities. In the obliteration group, a dry ear was achieved in 96.4% as this was 73.9% in the non-obliteration group. We found no differences in audiological outcome and in incidence of complications between the two techniques.

PMID:34705081 | DOI:10.1007/s00405-021-07138-0

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Oral Kaposi sarcoma development is associated with HIV viral load, CD4+ count and CD4+/CD8+ ratio

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Med Oral Patol Oral Cir Bucal. 2021 Oct 27:24708. doi: 10.4317/medoral.24708. Online ahead of print.

ABSTRACT

BACKGROUND: Kaposi's sarcoma (KS) is an uncommon, multifocal and angioproliferative lesion, which demonstrates a poor prognosis. The aim of the present research was to explore the association of HIV viral load, CD4+ and CD8+ counts and the CD4+/CD8+ ratio on the risk of oral Kaposi's sarcoma (KS) development.

MATERIAL AND METHODS: A total of 62 patients were retrieved from March 2008 to October 2020 from the files of two oral pathology centres. Clinical, laboratory and follow-up data were retrieved from their medical files. Poisson regression was used to explore the role of history of immunosuppression and its association with oral KS development. A P-value <0.05 was considered significant.

RESULTS: Sixty-two patients were included in the present study (32 with oral KS and 30 with no presentation of lesions anywh ere on the body). Patients with oral KS presented a mean age of 32.6 years, and male patients were more affected. The hard palate (15 cases; 46.8%) was the main anatomical site affected. The lesions were mostly presented as swellings (13 cases; 40.6%) and nodules (12 cases; 37.5%). Systemic manifestations were also observed, including candidiasis (4 cases; 12.5%), bacterial infection (3 cases; 9.3%), tuberculosis (3 cases; 9.3%), herpes simplex (3 cases; 9.3%) and pneumonia (3 cases; 9.3%). A significant correlation was observed between HIV viral load, CD4+ count and the CD4+/CD8+ ratio with oral KS development.

CONCLUSIONS: HIV viral load, CD4+ count and the CD4+/CD8+ ratio are associated with oral KS development.

PMID:347 04977 | DOI:10.4317/medoral.24708

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Is periapical surgery follow-up with only two-dimensional radiographs reliable? A retrospective cohort type sensitivity study

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Med Oral Patol Oral Cir Bucal. 2021 Oct 27:24447. doi: 10.4317/medoral.24447. Online ahead of print.

ABSTRACT

BACKGROUND: Two-dimensional (2D) radiographic techniques are commonly used for assessing lesion prognosis after endodontic surgery. The present retrospective cohort study analyzes the sensitivity and ability of different radiographic techniques in obtaining area and volume measurements of periapical lesions.

MATERIAL AND METHODS: Preoperative and follow-up (6-48 months) periapical and panoramic radiographs (index test) and cone-beam computed tomography (CBCT) images (reference standard) were selected from an endodontic microsurgery database. Sensitivity was analyzed independently by two examiners. The areas of the 2D radiographic images and CBCT volumes were studied using Itk-Snap software and Romexis viewer.

RESULTS: The sample comprised 105 patients and 105 teeth, with a mean follow-up of 21 months (range 6-48). P reoperatively, CBCT detected all the periapical areas, periapical radiography detected 67, and panoramic radiography detected 60. Postoperatively, of the 52 cases in which CBCT detected remains of the periapical area, periapical radiography detected 22, and panoramic radiography detected 17. The measurements of the areas obtained by the 2D methods, and the volumes obtained by CBCT, had to be transformed into linear measures for comparison purposes. The measurements were found to be significantly different in both the preoperative and the follow-up images.

CONCLUSIONS: Periapical radiography showed greater sensitivity than panoramic radiography, both preoperatively and at follow-up. The lesions measured with CBCT were larger, with significant differences than as evidenced by the periapical and panoramic radiographs.

PMID:34704982 | DOI:10.4317/medoral.24447

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