Anterolateral Thigh Fascia Lata Rescue Flap: A New Weapon in the Battle Against Osteoradionecrosis

xlomafota13 shared this article with you from Inoreader Anterolateral Thigh Fascia Lata Rescue Flap: A New Weapon in the Battle Against Osteoradionecrosis Via The Laryngoscope Objectives To demonstrate that the anterolateral thigh fascia lata (ALTFL) rescue flap may be effectively used for management of osteoradionecrosis (ORN) in selected patients. Study Design Retrospective case review. Methods Retrospective chart review was performed on patients who underwent ALTFL free flap repair to various sites of ORN in the head and neck between 2011 and 2018. Inclusion criteria were patients with radiographic and clinical evidence of head and neck ORN who either failed previous hyperbaric oxygen (HBO) therapy or with extensive disease, which was unlikely to respond to conservative management. Results Twenty-three patients with average age of 63 years (40–78) who underwent 24 ALTFL free flap procedures were reviewed. ORN sites were the mandible (n = 16), palatomaxilla (n = 4), skull base and cervical spine (n = 3), and calvarium (n = 2). Recipient vessels used were superficial temporal (n = 11), common facial (n = 10), and angular (n = 3). Average hospital stay was 3.0 (1–10) days. Prior HBO therapy was performed in 13 (57%) patients. There were four major complications: flap failure, recurrent mandibular infection resolved with IV antibiotic course, mandibular fracture with malunion requiring occlusal adjustment, and unresolved sequelae of ORN requiring fibular free flap. There were four minor complications: thigh hematoma, thigh seroma, and intraoral scar formation causing trismus (n = 2). The procedure was successful in 22 of 23 (95.7%) patients with radiographic arrest of ORN, resolution o f symptoms, and elimination of antibiotic requirements. Conclusion The ALTFL rescue flap merits strong consideration in ORN management and appears to prevent progression to more extensive disease, which would require full segmental bone resection and reconstruction. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Perivascular clusters of Th2 cells and M2 macrophages in allergic contact dermatitis to methylchloroisothiazolinone and methylisothiazolinone

xlomafota13 shared this article with you from Inoreader Perivascular clusters of Th2 cells and M2 macrophages in allergic contact dermatitis to methylchloroisothiazolinone and methylisothiazolinone Via Experimental Dermatology Abstract Background Methylisothiazolinone (MI) and Methylchloroisothiazolinone (MCI) are among the most common skin sensitizers, yet the immunological events that occur during MCI/MI allergic contact dermatitis (ACD) are still poorly understood. Objectives: To analyze dendrocytes, macrophage subtypes and T cells in skin during the elicitation phase of MCI/MI ACD. Methods Thirteen patients with positive patch test reactions to MCI/MI (ACD group) and 11 individuals with negative patch test results were selected. Skin biopsies were only performed at 48 hours of patch testing. Immunohistochemistry was conducted to assess T cells, dendrocytes (Factor XIIIa), M1 (p-Stat1, CD68) and M2 (c-Maf, CD163) macrophages. Transcriptional analyses were performed for cytokines and related factors; and further compared to atopic dermatitis samples (n=4). Immunofluorescence assays addressed T cells location, along with IL-4 or IL-13, within the skin. Results MCI/MI elicited dermal dendrocytes and macrophages, pronouncedly the M2 subtype. T cells, majorly CD4+ T cells, accumulated in the perivascular areas. Similarly, abundant IL-4 protein was detected in these areas. There was an upregulation of IL-4 and IL-13 mRNA expression, a mild increase in IFNG mRNA levels and a down-regulation of RORC in the ACD group. Immunofluorescence revealed dermal clusters of T cells co-localized with IL-4. Conclusions M2 macrophages and Th2 cells participate in the immunopathogenesis of MCI/MI ACD. Dermal dendrocytes and M2 macrophages may assist the formation of CD4+ T cells perivascular clusters. These findings render a mechanistic insight into the MCI/MI reaction. Further analysis at different timepoints of patch testing are required to fully comprehend this ACD kinetics. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

In healthy subjects nasal nitric oxide does not correlate with olfactory sensitivity, trigeminal sensitivity, and nasal air flow

xlomafota13 shared this article with you from Inoreader In healthy subjects nasal nitric oxide does not correlate with olfactory sensitivity, trigeminal sensitivity, and nasal air flow Via Clinical Otolaryngology Abstract Objective To determine the relationship between nasal nitric oxide (nNO) and olfactory sensitivity, trigeminal sensitivity, and nasal airflow in healthy subjects. Study design Correlational study. Setting Tertiary referral centre. Participants Forty healthy participants were recruited. Main outcome measures nNO was measured using a chemiluminescence analyser (Niox Vero®, Circassia AB, Uppsala, Sweden), olfactory sensitivity was determined using phenyl ethyl alcohol odour thresholds using the "Sniffin' Sticks", trigeminal sensitivity was assessed with carbon dioxide delivered by an automated device, and nasal airflow was measured using the peak nasal inspiratory flow (PNIF). Results The median nNO was 518 ppb (IQR = 333) in the right nostril, and it was 567 ppb (IQR = 314) in the left nostril. The median odour threshold was 7.1 (IQR = 4.4), the median CO2 threshold was 919 ms (IQR = 1297), and the mean PNIF was 108 L/min (SEM = 4.9). nNO did not correlate significantly with odour threshold, CO2 threshold or PNIF (Spearman's |ρ| < 0.15, p > 0.18). Conclusion In healthy subjects nNO does not appear to be associated with olfactory sensitivity, trigeminal sensitivity, and PNIF. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Virus Load and Incidence of Olfactory, Gustatory, Respiratory, Gastrointestinal Disorders in COVID‐19 Patients: A Retrospective Cohort Study

xlomafota13 shared this article with you from Inoreader Virus Load and Incidence of Olfactory, Gustatory, Respiratory, Gastrointestinal Disorders in COVID‐19 Patients: A Retrospective Cohort Study Via Clinical Otolaryngology Abstract Objectives This study investigated the relationship between viral load and the incidence of olfactory and gustatory dysfunction (OD and GD), the incidence of respiratory and gastrointestinal symptoms, and the recovery of OD and GD in COVID-19 patients. Design A Retrospective Cohort Study. Setting and Participants this cohort, conducted on 599 outpatients' cases in Golestan province between February and Juan 2020. Main Outcome Measures The incidence, severity (complete or partial), and recovery time of OD and GD and their associations with cycle threshold (CT) values of SARS-CoV-2 polymerase chain reaction was assessed. Results The mean age of patients was 38.27±13.62 years. The incidence of general symptoms included myalgia 70.1%, headache 51.8%, fever 47.7%, and dyspnea 21.4%. 41.9% of patients had gastrointestinal symptoms, including abdominal pain 26.5%, diarrhea 25.2%, nausea 20.5%, and vomiting 12.9%. 12.2% of patients had comorbidity. The trimester recovery rates of OD and GD were 93.94% and 94.74%, respectively. The mean recovery time of OD and GD was 14.56±13.37 and 13.8±3.77 days, respectively. The mean CT value in all patients was 27.45±4.55. There were significant associations between the mean of CT value with headache (P=0.04), GD (P=0.002) and OD (P=0.001). Conclusions The finding of this study indicates a possible association between viral load with incidence of OD and GD in COVID-19 patient's cases and assures the recovery of OD/GD in these patients. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Development of a Decision Aid for Parents Who Elect Tonsillectomy for Obstructive Sleep Apnea

xlomafota13 shared this article with you from Inoreader Development of a Decision Aid for Parents Who Elect Tonsillectomy for Obstructive Sleep Apnea Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Aug 6:34894211037187. doi: 10.1177/00034894211037187. Online ahead of print. ABSTRACT OBJECTIVE: To develop a novel patient decision aid (PtDA) for parents considering tonsillectomy for their children diagnosed with obstructive sleep apnea (OSA) and compare it to validated scales related to decision making in this context. These included scales for decisional conflict (DC) and shared decision making (SDM). METHODS: A parental survey during 2017 to 2018 in a tertiary care pediatric otolaryngology clinic was conducted comparing a validated Decisional Conflict Scale (DCS) with a new PtDA that included an SDM scale, parental treatment goals, and knowledge about adenotonsillectomy and OSA. DCS scores range from 0 to 100 with values less than 25 considered to be low DC. The DQ was determined by a score on the PtDA. The PtDA was composed of a knowledge score, SDM score and 5 related values scored along a continuum (these were: resolution of symptoms, avoiding anesthesia, avoiding surgery, avoiding pain/bleeding, and resumption of normal behavior). A high score meant that all answers were consistent with choosing tonsillectomy and imply better DQ. RESULTS: A total of 89 parents or guardians participated in the study. The mean DC score was 4.32 (95% CI: 2.57-6.07). The mean DQ score was 22.69 (95% CI: 21.86-23.51). Mean values score was 5.35 (95% CI: 5.05-5.65). The mean knowledge score was 9.00 (95% CI: 8.60-9.40). SDM score mean was 8.38 (95% CI: 7.85-8.91). Using Spearman's rho, DC versus DQ inversely correlated with a coefficient -.209 via a 2-tailed test (P = .05). Cronbach's alpha for the DQ score was .78. CONCLUSION: DC scores overall were low for the group. DQ, as measured with the novel PtDA, had an inverse correlation with DC scores, suggesting validity of the proposed PtDA. Our instrument has potential use as a PtDA for parents who are offered tonsillectomy for their children. PMID:34362262 | DOI:10.1177/00034894211037187 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Complications after 1002 endoscopic endonasal approach procedures at a single center: lessons learned, 2010-2018

xlomafota13 shared this article with you from Inoreader Complications after 1002 endoscopic endonasal approach procedures at a single center: lessons learned, 2010-2018 Via leak of cerebrospinal fluid J Neurosurg. 2021 Aug 6:1-12. doi: 10.3171/2020.11.JNS202494. Online ahead of print. ABSTRACT OBJECTIVE: The endoscopic endonasal approach (EEA) has evolved into a mainstay of skull base surgery over the last two decades, but publications examining the intraoperative and perioperative complications of this technique remain scarce. A prior landmark series of 800 patients reported complications during the first era of EEA (1998-2007), parallel to the development of many now-routine techniques and technologies. The authors examined a single-institution series of more than 1000 consecutive EEA neurosurgical procedures performed since 2010, to elucidate the safety and risk factors associated with surgical and postoperative complications in this modern era. METHODS: After obtaining institutional review board approval, the authors retrospectively reviewed intraoperative and postoperative complications and their outcomes in patients who underwe nt EEA between July 2010 and June 2018 at a single institution. RESULTS: The authors identified 1002 EEA operations that met the inclusion criteria. Pituitary adenoma was the most common pathology (n = 392 [39%]), followed by meningioma (n = 109 [11%]). No patients died intraoperatively. Two (0.2%) patients had an intraoperative carotid artery injury: 1 had no neurological sequelae, and 1 had permanent hemiplegia. Sixty-one (6.1%) cases of postoperative cerebrospinal fluid leak occurred, of which 45 occurred during the original surgical hospitalization. Transient postoperative sodium dysregulation was noted after 87 (8.7%) operations. Six (0.6%) patients were treated for meningitis, and 1 (0.1%) patient died of a fungal skull base infection. Three (0.3%) patients died of medical complications, thereby yielding a perioperative 90-day mortality rate of 0.4% (4 deaths). High-grade (Clavien-Dindo grade III-V) complications were identified after 103 (10%) EEA procedures, and multiv ariate analysis was performed to determine the associations between factors and these more serious complications. Extradural EEA was significantly associated with decreased rates of these high-grade complications (OR [95% CI] 0.323 [0.153-0.698], p = 0.0039), whereas meningioma pathology (OR [95% CI] 2.39 [1.30-4.40], p = 0.0053), expanded-approach intradural surgery (OR [95% CI] 2.54 [1.46-4.42], p = 0.0009), and chordoma pathology (OR [95% CI] 9.31 [3.87-22.4], p < 0.0001) were independently associated with significantly increased rates of high-grade complications. CONCLUSIONS: The authors have reported a large 1002-operation cohort of EEA procedures and associated complications. Modern EEA surgery for skull base pathologies has an acceptable safety profile with low morbidity and mortality rates. Nevertheless, significant intraoperative and postoperative complications were correlated with complex intradural procedures and meningioma and chordoma pathologies. PMID:34359021 | DOI:10.3171/2020.11.JNS202494 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effect of Progressive Head Extension Swallowing Exercise on Lingual Strength in the Elderly: A Randomized Controlled Trial

xlomafota13 shared this article with you from Inoreader Effect of Progressive Head Extension Swallowing Exercise on Lingual Strength in the Elderly: A Randomized Controlled Trial Via swallowing exercises J Clin Med. 2021 Jul 31;10(15):3419. doi: 10.3390/jcm10153419. ABSTRACT Lingual strengthening training can improve the swallowing function in older adults, but the optimal method is unclear. We investigated the effects of a new progressive resistance exercise in the elderly by comparing with a conventional isometric tongue strengthening exercise. Twenty-nine participants were divided into two groups randomly. One group performed forceful swallow of 2 mL of water every 10 s for 20 m in, and a total of 120 swallowing tasks per session at 80% angle of maximum head extension. The other group performed five repetitions in 24 sets with a 30 s rest, and the target level was settled at 80% of one repetition maximum using the Iowa Oral Performance Instrument (IOPI). A total of 12 sessions were carried out by both groups over a 4-week period. Blinded measurements (for maximum lingual isometric pressure and peak pressure during swallowing) were obtained using IOPI before exercise and at four weeks in both groups. After four weeks, both groups showed a significant improvement in lingual strength involving both isometric and swallowing tasks. However, there was no significant difference between the groups in strength increase involving both tasks. Regardless of the manner, tongue-strengthening exercises substantially improved lingual pressure in the elderly with equal effect. PMID:34362202 | DOI:10.3390/jcm10153419 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The real-world efficacy and safety of anlotinib in advanced non-small cell lung cancer

xlomafota13 shared this article with you from Inoreader The real-world efficacy and safety of anlotinib in advanced non-small cell lung cancer Via oral multi-targeted angiogenesis inhibitor J Cancer Res Clin Oncol. 2021 Aug 6:1-15. doi: 10.1007/s00432-021-03752-x. Online ahead of print. ABSTRACT PURPOSE: Anlotinib is an anti-angiogenetic multi-targeted tyrosine kinase inhibitor. This study aimed to evaluate the efficacy and safety of anlotinib in advanced non-small cell lung cancer (aNSCLC) in the real world. METHODS: Patients with aNSCLC receiving anlotinib were enrolled in two cohorts (treatment naive and previously treated). The endpoints included progression-free survival (PFS), overall survival (OS) and anlotinib-related adverse events (ar-AEs). RESULTS: 203 patients accrued in the study. In the treatment-naïve cohort (n = 80), the PFS was 7.4 (95% confidence interval [CI] 4.1-10.7) and OS was 10.8 (95% CI 5.8-15.8) months of monotherapy group (immature survival for combination group). In previously treated cohort (n = 123), the PFS was 8.0 months (95% CI 6.1-9.9) in the combination group and 4.3 months (95% CI 2.1-6.6) in the monotherapy group (hazard ratio [HR] 0.49; 95% CI 0.29-0.83; p = 0.007), respectively. The OS was 18.5 months (95% CI 10.5-26.6) in the combination group and 7.8 months (95% CI 7.1-8.4) in the monotherapy group (HR 0.38; 95% CI 0.22-0.66; p = 0.001), respectively. The ar-AEs of grade ≥ 3 in the monotherapy and the combination groups were hypertension (9.0 and 8.7%), fatigue (8.1 and 7.6%), hand-foot syndrome (8.1 and 6.5%), diarrhea (5.4 and 8.7%), proteinuria (5.4 and 5.4%), and mucositis oral (6.3 and 8.7%). CONCLUSION: In aNSCLC, anlotinib monotherapy has a promising efficacy in the first-line setting. It may be an option for those who are ineligible for chemotherapy; anlotinib combination therapy in a ≥ second-line setting showed manageable toxicities and encouraging efficacy, indicating a good application prospect. TRIAL REGISTRATION: This study was retrospectively registered with ISRCTN Registry (ID ISRCTN35543977) on January 26th, 2021 and Chi nese Clinical Trial Register (ChiCTR2000032265) on April 4th, 2020. PMID:34357411 | PMC:PMC8343360 | DOI:10.1007/s00432-021-03752-x View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Remote assessments for bone conduction hearing devices during the COVID-19 pandemic

xlomafota13 shared this article with you from Inoreader Remote assessments for bone conduction hearing devices during the COVID-19 pandemic Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Aug 7. doi: 10.1007/s00405-021-07025-8. Online ahead of print. ABSTRACT PURPOSE: The COVID-19 pandemic had resulted in the suspension of many routine audiology services due to the risk of cross-infections in closed spaces. This has driven the need for exploring alternatives to conventional face-to-face consultations in the hospital outpatient setting. The aim of this study was to determine the efficacy of remote consultations and assessments for patients on the waiting list for consideration of bone conduction hearing devices (BCHDs), and whether this type of consultation could continue beyond the COVID-19 era. METHODS: This was a prospective cross-sectional study in a tertiary Neuro-otology Department. All new patients on the waiting list for assessment for BCHD as of 1 March 2020 were included. Patients' case notes were reviewed. All underwent a telephone consultation with an implant audiologist. If the patient wanted to go ahead with the remote trial, a BCHD sound processor on a headband would be mailed out and the patient would then have to use the device for two weeks and return the device after with their diary. RESULTS: There were 49 patients. The mean age was 55 (range 27-88, SD 16.3). Four did not proceed with the trial. All patients returned their devices to the department. Majority of patients (95.6%, n = 43), completed their diary. 75.6% wanted to proceed with surgery. All patients proceeding with surgery were happy with the remote assessment and would recommend this for the future. CONCLUSION: It is possible to satisfactorily assess appropriately screened patients for BCHDs remotely with a structured approach and explanation of process and expectations. It might be possible to consider this type of consultation as an option for assessing potential candidates for BCHDs beyond the COVID-19 era to reduce the number of hospital visits for patients. PMID:34363503 | DOI:10.1007/s00405-021-07025-8 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Auditory processing in normally hearing individuals with and without tinnitus: assessment with four psychoacoustic tests

xlomafota13 shared this article with you from Inoreader Auditory processing in normally hearing individuals with and without tinnitus: assessment with four psychoacoustic tests Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Aug 7. doi: 10.1007/s00405-021-07023-w. Online ahead of print. ABSTRACT PURPOSE: In most cases, tinnitus co-exists with hearing loss, suggesting that poorer speech understanding is simply due to a lack of acoustic information reaching the central nervous system (CNS). However, it also happens that patients with tinnitus who have normal hearing also report problems with speech understanding, and it is possible to suppose that tinnitus is to blame for difficulties in perceptual processing of auditory information. The purpose of the study was to evaluate the auditory processing abilities of normally hearing subjects with and without tinnitus. METHODS: The study group comprised 97 adults, 54 of whom had normal hearing and chronic tinnitus (the study group) and 43 who had normal hearing and no tinnitus (the control group). The audiological assessment comprised pure-tone audiometry and high-frequency pur e-tone audiometry, impedance audiometry, and distortion product oto-acoustic emission assessment. To evaluate possible auditory processing deficits, the Frequency Pattern Test (FPT), Duration Pattern Test (DPT), Dichotic Listening Test (DLT), and Gap Detection Threshold (GDT) tests were performed. RESULTS: The tinnitus subjects had significantly lower scores than the controls in the gap detection test (p < 0.01) and in the dichotic listening test (p < 0.001), but only for the right ear. The results for both groups were similar in the temporal ordering tests (FPT and DPT). Right-ear advantage (REA) was found for the controls, but not for the tinnitus subjects. CONCLUSION: In normally hearing patients, the presence of tinnitus may be accompanied with auditory processing difficulties. PMID:34363504 | DOI:10.1007/s00405-021-07023-w View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Tongue stretching: technique and clinical proposal

xlomafota13 shared this article with you from Inoreader Tongue stretching: technique and clinical proposal Via swallowing exercises J Complement Integr Med. 2021 Aug 9. doi: 10.1515/jcim-2020-0101. Online ahead of print. ABSTRACT OBJECTIVES: The tongue is an organ with multiple functions, from sucking to phonation, from swallowing to postural control and equilibrium. An incorrect position or mechanics of the tongue can causes sucking problems in the newborn or atypical swallowing in the adult, with repercussions on the position of the head and neck, up to influencing upright posture and other problems. Tongue d ysfunctions are quite frequent (10-15%) in the population. For the manual therapist, this frequency indicates one to two subjects every 30 patients. Exercises have been proposed to improve the tone and strength of the swallowing muscles but the results are not so clear in the literature. The aim of this study is to describe and provide a tongue muscle normalization technique that helps the manual therapist in the treatment of problems related to it. METHODS: The literature has been investigated through pubmed, Google scholar of the last 10 years, the keywords used and combined with the Boolean operators AND and OR, are: "tongue, tongue habits, tongue diseases, taste disorder, neck pain, posture, postural balance, atypical swallowing, muscle stretching exercise, tissue expansion, soft tissue therapy, osteopathic manipulative treatment". RESULTS AND CONCLUSIONS: The technique is possible to be executed even in a sitting position, in the case the patient is unable to assume a supine position, the subject should provides immediate feedback that allows the therapist to understand if the technique has been correctly executed. The simplicity of execution and application of the technique makes it a possible and immediate therapeutic tool in the clinical setting. PMID:34364317 | DOI:10.1515/jcim-2020-0101 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.