Postoperative analysis of osseous midface reconstructions: The value of imaging and a novel scoring system for complexity and operative success

alexandrossfakianakis shared this article with you from Inoreader Postoperative analysis of osseous midface reconstructions: The value of imaging and a novel scoring system for complexity and operative success via Head & Neck Abstract Background Few standardized methods exist for evaluating the postoperative outcomes of osteocutaneous free flaps. We propose an anatomic-based scoring system for midface free flap reconstruction. Methods One hundred and twelve patients across four institutions underwent osteocutaneous reconstruction of the midface. Postoperative scans were scored based on the number of independent osseous subunits reconstructed (Subunit Score), the number of different bony appositions with bony contact (Contact Score), and the number of osseous segments in anatomic position (Position Score). These were added together to create a Total Score. Results Osteocutaneous radial forearm flaps had the lowest Subunit Score (p = 0.001). Fibula flaps had the highest Contact Score (p = 0.0008) and Position Score (p = 0.001). Virtual surgical planning was associated with an increased Subunit Score (p = 0.02) and Total Score (p = 0.04). Conclusions We propose a novel scoring system for osseous midface reconstruction based on postoperative imaging scans. This can help guide management decisions and create a common language to compare outcomes. View on Web

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Diagnostic efficacy of positron emission computerized tomography scans in suspicious laryngeal findings postorgan preservation treatment

alexandrossfakianakis shared this article with you from Inoreader Diagnostic efficacy of positron emission computerized tomography scans in suspicious laryngeal findings postorgan preservation treatment via Head & Neck Abstract Background Larynx preservation protocols (LPP) for glottic primary squamous cell carcinoma has gained popularity worldwide. Direct laryngoscopy (DL) with biopsy is mandated when recurrence is suspected. The efficacy of 18Fluoro-deoxy-glucose positron emission computerized tomography (PET-CT) as alternative first-line diagnostic investigation in suspected recurrence was evaluated. Methods A retrospective study of patients with suspicious fiber-optic findings at more than 12 weeks after LPP. Sensitivity, specificity, and the negative predictive value (NPV) of DL and PET-CT were compared. Results Seventy-two patients presenting 105 cases of suspicious events were included in this study. Fifty-two events were initially investigated by DL and 53 events by PET-CT. The sensitivity of DL and PET-CT was 56.25% and 100%, respectively. The NPV was 84% for DL and 100% for PET-CT (p = 0.015). Conclusion Negative PET scans after LPP are highly accurate in ruling out recurrent/persistent disease and may spare the patient from negative biopsies. View on Web

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Effect of a high‐fat meal on the relative bioavailability of HMPL‐689

alexandrossfakianakis shared this article with you from Inoreader Effect of a high‐fat meal on the relative bioavailability of HMPL‐689 in Chinese Healthy Volunteers via Fundamental & Clinical Pharmacology Abstract Purpose The aim of this study was to investigate the effect of a high-fat meal on the single-dose pharmacokinetics (PK) and tolerability of HMPL-689 in Chinese healthy volunteers. Methods In this study, 34 eligible male volunteers received a single 30 mg dose of HMPL-689 capsules following an overnight fast or a high-fat breakfast prior to dosing. Blood samples were collected at the designated time points for pharmacokinetic analysis. Safety and tolerability were assessed throughout the study. Results Total 32 healthy male volunteers were completed in the study. The GMRs of AUC0-t, AUC0-∞, Cmax and their 90% CIs were 1.12 (1.09, 1.15), 1.12 (1.09, 1.15), and 0.64 (0.58, 0.70), respectively, in healthy male subjects after oral administration of HMPL-689 following intake of a high-fat diet versus under fasting state. The 90% CI of Cmax GMR fell outside the acceptable equivalent range (0.8-1.25). In addition, the median Tmax of HMPL-689 was 1.0 hours and 4.0 hours under the fasting and the fed conditions. Conclusions The study indicated that intake of a high-fat diet had an impact on the in vivo PK profile of HMPL-689 in healthy Chinese male subjects, which could obviously reduce the oral absorption rate of HMPL-689 and had little effect on the extent of oral absorption (AUC). View on Web

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Comparative analysis and trends in liver transplant hospitalizations with clostridium difficile infections: A 10‐year national cross‐sectional study

alexandrossfakianakis shared this article with you from Inoreader Comparative analysis and trends in liver transplant hospitalizations with clostridium difficile infections: A 10‐year national cross‐sectional study via Transplant Infectious Disease ABSTRACT Goals and Background Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated diarrhea in the United States. We aimed to determine comparative trends in inpatient outcomes of liver transplant (LT) patients based on CDI during hospitalizations. Methods The national inpatient sample (NIS) database was used to conduct the present retrospective study regarding CDI among the LT hospitalizations from 2009, to 2019. Primary outcomes included ten-year comparative trends of the length of stay (LOS) and mean inpatient charges (MIC). Secondary outcomes included comparative mortality and LT rejection trends. Results There was a 14.05% decrease in CDI in LT hospitalizations over the study period (P = 0.05). The trend in LOS did not significantly vary (P = 0.9). MIC increased significantly over last decade in LT hospitalizations with CDI (P < 0.001). LT hospitalizations of autoimmune etiology compared against non-autoimmune did not increase association with CDI, adjusted odds ratio (aOR) 0.97 [95% confidence interval (CI) 0.75-1.26, P = 0.87]. CDI was associated with increased mortality in LT hospitalizations, aOR 1.84 [95% confidence interval (CI) 1.52-2.24, P < 0.001].  In-hospital mortality for LT hospitalizations with CDI decreased by 7.75% over the study period (P = 0.3). CDI increased transplant rejections, aOR 1.3 [95% CI 1.08-1.65, P < 0.001]. There was a declining trend in transplant rejection for LT hospitalization with CDI from 5% to 3% over the study period (P = 0.0048). Conclusion CDI prevalence doesnot increase based on autoimmune LT etiology. It increases mortality in LT hospitalizations; however, trend for mortality and transplant rejections has been declining over the last decade. This article is protected by copyright. All rights reserved View on Web

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The Use of Dissemination and Implementation to Improve Multimodal Analgesia in Head and Neck Surgery

alexandrossfakianakis shared this article with you from Inoreader The Use of Dissemination and Implementation to Improve Multimodal Analgesia in Head and Neck Surgery via The Laryngoscope The use of a multimodal analgesia approach in a Randomized Clinical Trial including acetaminophen, ketorolac, gabapentin, and a neurogenic extremity block in patients undergoing major head and neck ablative and reconstructive surgery significantly reduced the need for opioids in the immediate postoperative period of a seven-day hospital stay. Coordination of care and reducing variability in pain medication administration were highly dependent on dissemination and implementation processes put in place for perioperative phases of care. Objectives To optimize the delivery of multimodal analgesia to patients undergoing major head and neck oncologic surgeries. Methods Pilot study included patients enrolled to receive either scheduled acetaminophen and as-needed opioids (control group) or scheduled acetaminophen, gabapentin, ketorolac, and as-needed opioids (experimental group). RCT, a hybrid type 1 effectiveness-implementation pragmatic trial, was designed to test the effectiveness of the intervention. Arm A received scheduled acetaminophen and as-needed opioids. Arm B received scheduled gabapentin, ketorolac, a regional nerve block at the free tissue donor site, scheduled acetaminophen and as-needed opioids. Results Pilot: Thirty-one patients undergoing major head and neck surgery were enrolled. Mean MMEs administered in control group (n = 15) was 251.60 mg (SD = 224.57 mg); mean MMEs in Experimental group (n = 16) was 195.78 mg (SD = 131.08 mg), p = 0.401. LOS was 8.0 days in control versus 7.0 days in experimental group (p = 0.054). RCT: Interim analysis for safety and futility was planned during trial's design after 30 patients (n = 14 Arm A, and n = 16 Arm B). Mean MMEs administered were 135.1 mg in Arm A, (SD = 86.0 mg) versus mean MME of 51.3 mg in Arm B (SD = 43.3 mg, (p < 0.05)). Given clear superiority results, the trial was prematurely terminated. Functional pain scores, LOS, and complications were similar between the arms (p > 0.05). Variability of mean MME was compared before and after implementation of the management protocols: SD in RCT#1 was 181.46 mg versus 124.6 mg in RCT#2. Conclusion Multimodal analgesia significantly reduced the need for opioids in patients undergoing major head and neck surgery. Level of Evidence 1, Randomized Clinical Trial Laryngoscope, 2022 View on Web

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The Influence of Age on the Frequency of Rhythmic Masticatory Muscle Activity During Sleep in General Population differs from that in Clinical Research Samples

alexandrossfakianakis shared this article with you from Inoreader The Influence of Age on the Frequency of Rhythmic Masticatory Muscle Activity During Sleep in General Population differs from that in Clinical Research Samples via Journal of Oral Rehabilitation Abstract Introduction During sleep, limb and jaw muscle motor activity can be quantified by electromyography (EMG). The frequency of periodic limb activity during sleep increases with age in both the general and clinical research populations. The literature is controversial regarding stability, over age, of the frequency of rhythmic masticatory muscle activity (RMMA), which is one biomarker of sleep bruxism (SB). The purpose of this retrospective sleep laboratory study was to assess if any change in RMMA frequency occurs over age in the general population (GP) and two clinical research (CR) samples. Method RMMA signals from polysomnography (PSG) recordings of 465 individuals, irrespective of SB awareness, were analysed. The sample comprised 164 individuals from the GP of Sao Paulo, and 301 individuals from Montreal and Osaka CR samples. Data were divided into two subgroups, younger (15–39) and older (40–80) participants. RMMA was classified as low frequency (<2 events/hr) or high (>2 events/hr). Pearson correlation (R) and B (slope) analyses were performed with power estimations. Results In the GP sample, no significant change over age was noted in the RMMA index/year. In the CR samples, a significant reduction was observed in the RMMA index/year (-0.05) with age (R2=0.042; p<0.001; 3.5 to 1.5 RMMA/hr from 20 to 60 years old). Conclusions In the GP, the RMMA index remained stable over age. In the CR samples, a significant, reduction was observed. Prospective studies with multiple home sleep recordings, in both general and clinical research populations, are needed before extrapolating from the present findings. View on Web

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The evolution of fertility preservation care models in a large pediatric cancer and blood disorders center

alexandrossfakianakis shared this article with you from Inoreader The evolution of fertility preservation care models in a large pediatric cancer and blood disorders center via Pediatric Blood & Cancer Abstract Background Children and adolescents who receive gonadotoxic treatments are at risk for future infertility. While there is a growing focus on integrating fertility preservation (FP) within pediatric cancer and blood disorder centers, wide variations in care models and methods exist across institutions. The purpose of this work is to describe the evolution of FP care models within a large pediatric hematology/oncology center. Methods Models of care and associated timeframes are described, including a pre-FP program model, establishment of a formal FP program, integration of nurse navigators, and the addition of FP consult stratification based on urgency (urgent/nonurgent). The number of patient consults within each model, patient sex, diagnosis (oncologic/hematologic), and consult timing (pre-gonadotoxic treatment/posttreatment completion) were abstracted from the clinical database. Results The number of annual consults increased from 24 during the pre-FP program model (2015) to 181 during the current care model (2020). Over time, the proportion of consults for females and patients with nonmalignant hematologic disorders increased. Patient stratification reduced the proportion of consults needing to be completed urgently from 75% at the advent of the FP program to 49% in the current model. Conclusions The evolution of care models within our FP program allowed for growth in the number of consults completed, expansion of services to more patients with nonmalignant hematologic disorders, and more consults for female patients. Nurse navigators play a critical role in care facilitating referrals, coordination, and patient education. Urgency stratification has allowed FP team members to manage increasing FP-related encounters. View on Web

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Off‐label pharmacological treatment for neuropathic pain: A Delphi study by the Spanish Pain Society Neuropathic Pain Task Force

alexandrossfakianakis shared this article with you from Inoreader Off‐label pharmacological treatment for neuropathic pain: A Delphi study by the Spanish Pain Society Neuropathic Pain Task Force via Pain Practice Abstract Objectives The use of off-label pharmacotherapies for neuropathic pain (NP) is growing relating to the many unmet needs of patients. However, clinical guidelines fail to address it, and the available evidence is sparse and fragmented. We arranged a formal expert consensus to address this controversial issue and provide some guidance on judicious use. Methods A two-round standard Delphi survey that involved pain clinic specialists with experience in the research and management of NP was done over an ad hoc 40-item questionnaire prepared by the authors. Consensus on each statement was defined as at least either 80% endorsement or rejection after the second round. Results Forty-three and thirty-seven panelists participated in the first and second round, respectively. Consensus was reached in 34 out of 40 statements. Endorsed alternatives for unresponsive patients include non-gabapentinoid antiepileptics (oxcarbazepine and eslicarbazepine), venlafaxine, intravenous lidocaine (when doses can be optimized), and some vaporized cannabinoids (under appropriate surveillance). In addition, lacosamide, low-dose naltrexone, propofol or ketamine could prove beneficial if subjected to more research. Other options were rejected, and there was controversy about the usefulness of topical preparations. Discussion For patients who do not respond to standard NP treatments, some other viable pharmacological options can be attempted before advancing to other therapeutic stages. This may help patients who are reluctant to or have some contraindication for interventional therapies. View on Web

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Computational fluid dynamics and NOSE scale to assess nasal respiratory function, and correlation with linear maxillary measurements after surgically assisted rapid maxillary expansion

alexandrossfakianakis shared this article with you from Inoreader Computational fluid dynamics and NOSE scale to assess nasal respiratory function, and correlation with linear maxillary measurements after surgically assisted rapid maxillary expansion via International Journal of Oral and Maxillofacial Surgery via MedWorm.com Nasal obstruction is common in patients with a transverse maxillary deficiency. The aim of this study was to determine the variation in nasal airway resistance in adult patients with a transverse maxillary deficiency before and after surgically assisted rapid maxillary expansion (SARME) by computational fluid dynamics (CFD) using computed tomography scans, and to correlate this variation with maxillary linear measurements obtained by means of plaster models. The subjective symptoms of nasal obstruction were also analysed using a visual analogue scale (VAS) for nasal breathing and the Nasal Obstruction Symptom Evaluation (NOSE) scale. (Source: International Journal of Oral and Maxillofacial Surgery) View on Web

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