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Τετάρτη 3 Φεβρουαρίου 2021

Are water precautions necessary after tympanostomy tube placement? A cadaver study.

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Are water precautions necessary after tympanostomy tube placement? A cadaver study.

Int J Pediatr Otorhinolaryngol. 2021 Jan 23;143:110632

Authors: Sanchez A, Arom G, Perez HA, Royal L, O-Lee TJ

Abstract
OBJECTIVES: To determine whether Armstrong pressure equalization tubes allow passage of water into the middle ear with complete submersion in water up to 76 cm for 2 min.
METHODS: 10 adult cadaver heads were first assessed for the presence of fluid in both middle ears with zero-degree rigid endoscopes, after being submerged for 2 min in a plastic receptacle filled with 76 cm of water. A 25% perforation was then made in the tympanic membrane of one ear. A myringotomy was then made in the tympanic membrane of the contralateral ear, with the placement of a beveled Armstrong pressure equalization tube. The head was then submerged again for 2 min. Both ears were then examined for the presence of fluid in the middle ear using a rigid endoscope and with suction.
RESULTS: Eight out of ten (80%) of the heads showed the presence of fluid in the middle ear on the perforation side after submersion, whereas none of the heads showed fluid in the middle ear on the side with the pressure equalization tube.
CONCLUSIONS: At depths of 76 cm, total submersion in water for 2 min does not facilitate the passage of water into the middle ear via an Armstrong pressure equalization tube.

PMID: 33517069 [PubMed - as supplied by publisher]

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Breast cancer with neuroendocrine differentiation: an update based on the latest WHO classification

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Modern Pathology, Published online: 02 February 2021; doi:10.1038/s41379-021-00736-7

Breast cancer with neuroendocrine differentiation: an update based on the latest WHO classification
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Fentanyl or fentanyl for sedation in mechanically ventilated adults with sepsis

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The MENDS2 trial was intended as a study comparing dexmedetomidine to propofol. However, the doses of these medications used in the study weren't high enough to be impactful. In retrospect, the study may actually be an investigation of how clinicians approach the agitated intubated patient – potentially revealing an over-reliance on opioid infusions.

EMCrit Project by Josh Farkas.

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Highly multiplexed oligonucleotide probe-ligation testing enables efficient extraction-free SARS-CoV-2 detection and viral genotyping

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Modern Pathology, Published online: 03 February 2021; doi:10.1038/s41379-020-00730-5

Highly multiplexed oligonucleotide probe-ligation testing enables efficient extraction-free SARS-CoV-2 detection and viral genotyping
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Reproducibility of scoring criteria for HER2 immunohistochemistry in endometrial serous carcinoma: a multi-institutional interobserver agreement study

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Modern Pathology, Published online: 03 February 2021; doi:10.1038/s41379-021-00746-5

Reproducibility of scoring criteria for HER2 immunohistochemistry in endometrial serous carcinoma: a multi-institutional interobserver agreement study
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A new tool for technical standardization of the Ki67 immunohistochemical assay

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Modern Pathology, Published online: 03 February 2021; doi:10.1038/s41379-021-00745-6

A new tool for technical standardization of the Ki67 immunohistochemical assay
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Tumor spread through air spaces (STAS): prognostic significance of grading in non-small cell lung cancer

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Modern Pathology, Published online: 03 February 2021; doi:10.1038/s41379-021-00748-3

Correction: Tumor spread through air spaces (STAS): prognostic significance of grading in non-small cell lung cancer
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Factors associated with under-reporting of head and neck squamous cell carcinoma in cause-of-death records: A comparative study of two national databases in France from 2008 to 2012

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by Caroline Even, Luis Sagaon Teyssier, Yoann Pointreau, Stéphane Temam, Florence Huguet, Lionnel Geoffrois, Michaël Schwarzinger, on behalf of the EPICORL Study Group

Objective

To date, no study has evaluated the detection rate of head and neck squamous cell carcinoma (HNSCC) in cause-of-death records in Europe. Our objectives were to compare the number of deaths attributable to HNSCC from two national databases in France and to identify factors associated with under-reporting of HNSCC in cause-of-death records.

Methods

The national hospital discharge database and the national underlying cause-of-death records were compared for all HNSCC-attributable deaths in adult patients from 2008 to 2012 in France. Factors associated with under-reporting of HNSCC in cause-of-death records were assessed using multivariate Poisson regression.

Results

A total of 41,503 in-hospital deaths were attributable to HNSCC as compared to 25,647 deaths reported in national UCoD records (a detection rate of 62%). Demographics at death were similar in both databases with respect to gender (83% men), age (54% premature deaths at 25–64 years), and geographi c distribution. In multivariate Poisson regression, under-reporting of HNSCC in cause-of-death records significantly increased in 2012 compared to 2010 (+7%) and was independently associated with a primary HNSCC site other than the larynx, a former primary or second synchronous cancer other than HNSCC, distant metastasis, palliative care, and death in hospitals other than comprehensive cancer care centers. The main study results were robust in a sensitivity analysis which also took into account deaths outside hospital (overall, 51,129 HNSCC-attributable deaths; a detection rate of 50%). For the year 2012, the age-standardized mortality rate for HNSCC derived from underlying cause-of-death records was less than half that derived from hospital discharge summaries (14.7 compared to 34.1 per 100,000 for men and 2.7 compared to 6.2 per 100,000 for women).

Conclusion

HNSCC is largely under-reported in cause-of-death records. This study documents the value of national hospital disch arge databases as a complement to death certificates for ascertaining cancer deaths.

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Prediction of aortic valve regurgitation after continuous-flow left ventricular assist device implantation using artificial intelligence trained on acoustic spectra

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Abstract

Significant aortic regurgitation (AR) is a common complication after continuous-flow left ventricular assist device (LVAD) implantation. Using machine-learning algorithms, this study was designed to examine valuable predictors obtained from LVAD sound and to provide models for identifying AR. During a 2-year follow-up period of 13 patients with Jarvik2000 LVAD, sound signals were serially obtained from the chest wall above the LVAD using an electronic stethoscope for 1 min at 40,000 Hz, and echocardiography was simultaneously performed to confirm the presence of AR. Among the 245 echocardiographic and acoustic data collected, we found 26 episodes of significant AR, which we categorized as "present"; the other 219 episodes were characterized as "none". Wavelet (time–frequency) analysis was applied to the LVAD sound and 19 feature vectors of instantaneous spectral components were extracted. Important variables for predicting AR were searched usi ng an iterative forward selection method. Seventy-five percent of 245 episodes were randomly assigned as training data and the remaining as test data. Supervised machine learning for predicting concomitant AR involved an ensemble classifier and tenfold stratified cross-validation. Of the 19 features, the most useful variables for predicting concomitant AR were the amplitude of the first harmonic, LVAD rotational speed during intermittent low speed (ILS), and the variation in the amplitude during normal rotation and ILS. The predictive accuracy and area under the curve were 91% and 0.73, respectively. Machine learning, trained on the time–frequency acoustic spectra, provides a novel modality for detecting concomitant AR during follow-up after LVAD.

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Efficacy of Agomelatine 25–50 mg for the Treatment of Anxious Symptoms and Functional Impairment in Generalized Anxiety Disorder: A Meta-Analysis of Three Placebo-Controlled Studies

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Abstract

Introduction

The purpose of this study is to investigate the effects of agomelatine on anxious symptoms and functional impairment in a pooled dataset from randomized placebo-controlled trials for generalized anxiety disorder (GAD).

Methods

Data from three randomized, placebo-controlled trials that evaluated the efficacy of agomelatine 25–50 mg were pooled. The short-term (12 weeks) efficacy of agomelatine was assessed in regards to (1) anxious symptoms using the Hamilton Anxiety Scale (HAM-A), and (2) functional impairment using the Sheehan Disability Scale (SDS). Meta-analysis using a random effect model was used to assess differences between groups. Remission and response rates for the HAM-A and SDS were calculated, and analyses were repeated in participants with more severe anxiety symptoms.

Results

In total, 669 patients (340 on agomelatine; 329 on placebo) were included in the analyses. Compared to placebo, the agomelatine group had a significant reduction in HAM-A total score at week 12 (between group difference: 6.30 ± 2.51, p = 0.012). Significant effects were also found for symptom response on the HAM-A (67.1% of patients on agomelatine vs. 32.5% on placebo) and symptom remission (38.8% of patients on agomelatine vs. 17.3% on placebo). Compared to placebo, there was a significant difference in favour of the agomelatine group at week 12 on the SDS total score (5.11 ± 1.81, p = 0.005). Significant effects were also found for functional response on the SDS (79.1% of patients on agomelatine vs. 43.2% of placebo) and functional remission (55.2% of patients on agomelatine vs. 25.4% on placebo). All findings for anxious symptoms and functional impairment were confirmed in the subset of more severely anxious patients. Agom elatine was well tolerated by patients.

Conclusion

This meta-analysis confirms that agomelatine reduces anxiety symptoms and improves the global functioning of GAD patients.

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The effect on subsequent fracture risk of age, sex, and prior fracture site by recency of prior fracture

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Abstract

Summary

The risk of a recurrent fragility fracture varies by age and sex, as by site and recency of sentinel fracture.

Introduction

The recency of prior fractures affects subsequent fracture risk. Variable recency may obscure other factors that affect subsequent fracture risk. The aim of this study was to quantify the effect of a sentinel fracture by site, age, and sex where the recency was held constant.

Methods

The study used data from the Reykjavik Study fracture register that documented prospectively all fractures at all skeletal sites in a large sample of the population of Iceland. Fracture incidence was compared to that of the general population determined at fixed times after a sentinel fracture (humeral, clinical vertebral, forearm, hip, and minor fractures). Outcome fractures comprised a major osteoporotic fracture and hip fracture.

Results

Sentinel osteoporotic fractures were identified in 9504 men and women. Of these, 3616 individuals sustained a major osteoporotic fracture as the first subsequent fracture, of whom 1799 sustained a hip fracture. Hazard ratios for prior fracture were consistently higher in men than in women and decreased progressively with age. Hazard ratios varied according to the site of sentinel fracture with higher ratios for hip and vertebral fracture than for humerus, forearm, or minor osteoporotic fracture.

Conclusion

The risk of a recurrent fragility fracture varies by age, sex, and site of sentinel fracture when recency is held constant.

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Efficacy of platelet-rich plasma injection in comparison to physical therapy for treatment of chronic partial supraspinatus tear

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Abstract

Background

Supraspinatus tendon is a part of the rotator cuff of the shoulder, partial or full-thickness tear can affect the tendon secondary to trauma or repeated microtrauma. The aim of the present study is to evaluate the efficacy of platelet-rich plasma (PRP) injection in comparison to physical therapy for treatment of chronic partial supraspinatus tears.

Results

At the beginning of the study, there were no significant differences between both groups in all parameters: (a) PRP injection had significantly improved the visual analog scale (VAS), disabilities of arm, shoulder and hand scale (DASH) and shoulder range of motion (ROM) but not size of tear at 6 and 12 weeks post-injection in comparison to baseline recordings; (b) physical therapy had significantly improved VAS, DASH but not shoulder ROM nor size of tear at 6 and 12 weeks post-injection in comparison to baseline recordings; and (c) PRP injection was superior to physical therapy in the improvement of VAS, shoulder ROM, and DASH score.

Conclusion

The US-guided PRP injection is superior to physical therapy in improving pain, ROM, and function in treatment of partial thickness tear of supraspinatus tendon.

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