Oligometastatic adenoid cystic carcinoma: Correlating tumor burden and time to treatment with outcomes

xlomafota13 shared this article with you from Inoreader Oligometastatic adenoid cystic carcinoma: Correlating tumor burden and time to treatment with outcomes Via Head & Neck Abstract Background There is limited information on the management and outcomes of oligometastases (OM) in adenoid cystic carcinoma (ACC). Methods Retrospective study of 42 patients with metastatic ACC of the head and neck. Imaging studies were analyzed to identify patients with OM (1–5 lesions) at any point during follow-up. Results There was radiographic evidence of OM in 33/42 (79%) patients. Eighteen patients had OM when treated for metastases, with median overall survival (OS) of 36.0 versus 9.2 years for patients with polymetastases (6+ lesions, HR 0.38, 95%CI 0.14–0.89). Earlier locally ablative treatment, but not systemic treatment, of patients with OM predicted improved survival 3 years after metastasis (HR 0.15, 95%CI 0.02–0.63) and postponed systemic treatment by 80 more months (HR 0.22, 95%CI 0.07–0.71). Conclusions There is a considerable population of ACC patients with detectable oligometastases, and early locally ablative treatment of oligometastases may be associated with improved outcomes. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Assessment of deep inferior epigastric perforator flap perfusion with near-infrared fluorescence: A pilot study and description of a standardized working protocol

xlomafota13 shared this article with you from Inoreader Assessment of deep inferior epigastric perforator flap perfusion with near-infrared fluorescence: A pilot study and description of a standardized working protocol Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Nov 16:S1748-6815(21)00590-8. doi: 10.1016/j.bjps.2021.11.043. Online ahead of print. ABSTRACT Fat necrosis (FN) is a common complication after autologous breast reconstruction (ABR) using a free flap, which can influence reconstruction outcome and patient satisfaction. Intraoperative near-infrared fluorescence imaging using indocyanine green (ICG) permits the visualization of flap perfusion. The aim of this study was to assess the effect of near-infrared fluorescence on FN incidence in patients undergoing an ABR with a deep inferior epigastric perforator flap (DIEP) and to propose a standard working protocol for this technique. In this prospective study, patients undergoing one-sided ABR with a DIEP were included. The standard DIEP procedure was complemented with near-infrared fluorescence imaging using the fluorescent tracer ICG to evaluate flap perfusion. This cohort was compared to a retrospectiv e cohort of DIEP procedures without near-infrared fluorescence imaging. Patients and surgery characteristics, as well as postoperative complications, were registered and compared. In both cohorts, 24 patients were included. No significant differences were present between patients and surgery characteristics, including no difference in duration of surgery. In the prospective and retrospective group, the incidence of FN was 4.2% and 33%, respectively (p-value = 0.023). Moreover, microsurgeons were positive about using near-infrared fluorescence as it either provided additional information about perfusion or confirmed the clinical assessment. Our pilot study showed a significant decrease of FN in patients undergoing an ABR with a DIEP when near-infrared fluorescence imaging was used to assess flap perfusion. This study provides a standardized working protocol for near-infrared fluorescence imaging. In the future, large multicenter studies should focus on the quantification of near-infr ared fluorescence imaging. PMID:34924327 | DOI:10.1016/j.bjps.2021.11.043 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pharyngo‐Esophageal Modulatory Swallow Responses to Bolus Volume and Viscosity Across Time

xlomafota13 shared this article with you from Inoreader Pharyngo‐Esophageal Modulatory Swallow Responses to Bolus Volume and Viscosity Across Time Via The Laryngoscope Objectives/Hypothesis Modulation of the pharyngeal swallow to bolus volume and viscosity is important for safe swallowing and is commonly studied using high-resolution pharyngeal manometry (HRPM). Use of unidirectional pressure sensor technology may, however, introduce variability in swallow measures and a fixed bolus administration protocol may induce time and order effects. We aimed to overcome these limitations and to investigate the effect of time by repeating randomized measurements using circumferential pressure sensor technology. Study Design Sub-set analysis of data from the placebo arm of a randomized, repeated measures trial. Methods HRPM with impedance was recorded using a solid-state catheter with 36 circumferential pressure sensors and 18 impedance segments straddling from hypopharynx to stomach. Testing included triplicates of 5, 10, and 20 ml thin liquid and 10 ml thick liquid boluses, the order of the thin liquid boluses was randomized. The swallow challenges were repeated approximately 10 minutes after finishing the baseline measurement. Results We included 19 healthy adults (10/9 male/female; age 24.5 ± 4.1 year). Intrabolus pressure, all upper esophageal sphincter (UES) opening and relaxation metrics, and flow timing metrics increased with larger volumes. A thicker viscosity decreased UES relaxation time, UES basal pressure, and flow timing metrics, whereas UES opening extent increased. Pre-swallow UES basal pressure and post-swallow UES contractile integral decreased over time. Conclusion Using circumferential pressure sensor technology, the effects of volume and viscosity were largely consistent with previous reports. UES contractile pressures reduced over time. The growing body of literature offers a benchmark for recognizing aberrant pharyngo-esophageal motor responses. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evaluation of LMR, NLR and PLR as predictors of malignancy in indeterminate thyroid nodules

xlomafota13 shared this article with you from Inoreader Evaluation of LMR, NLR and PLR as predictors of malignancy in indeterminate thyroid nodules Via Acta Otorhinolaryngol Ital Acta Otorhinolaryngol Ital. 2021 Dec;41(6):530-536. doi: 10.14639/0392-100X-N1515. ABSTRACT OBJECTIVE: Thyroid nodules with indeterminate cytology represent 20% of all thyroid nodules. Inflammation plays an important role in cancer. Lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are independent prognostic scores in numerous cancers, although no study has documented their role in cytology indeterminate nodules. The aim of this study is to evaluate the role of LMR, NLR and PLR values as predictors of malignancy in patients with cytology indeterminate nodules. METHODS: This retrospective study analysed data from 298 patients with indeterminate thyroid nodule. Anatomopathological and haematological data were analysed, dividing the population into two groups. LMR, NLR and PLR values were determined using ROC curve and data were analysed using independent samples t-test, test of proportions, Fisher's exact test and univariate and multivariate logistic regression. RESULTS: We found that a baseline LMR value ≥ 4.09 was indicative of benignity of indeterminate nodule. The probability of malignancy in patients with LMR < 4.09 was 26 times higher than patients with a LMR value ≥ 4.09. CONCLUSIONS: This study showed that only LMR has shown a concrete probability to find a thyroid cancer in patients with indeterminate nodules. Further studies are necessary to implement tailore d treatment. PMID:34928264 | DOI:10.14639/0392-100X-N1515 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effects of background noise on auditory response characteristics of primary auditory cortex neurons in awake mice

xlomafota13 shared this article with you from Inoreader Effects of background noise on auditory response characteristics of primary auditory cortex neurons in awake mice Via cortical auditory Nan Fang Yi Ke Da Xue Xue Bao. 2021 Nov 20;41(11):1672-1679. doi: 10.12122/j.issn.1673-4254.2021.11.11. ABSTRACT OBJECTIVE: To study the effects of different continuous background noises on auditory response characteristics of primary auditory cortex (A1) neurons in awake mice. METHODS: We performed in vivo cell-attached recordings in layer 4 neurons of the A1 of awake mice to investigate how continuous background noises of different levels affected the intensity tuning, frequency tuning and time characteristics of individual A1 neurons. According to the intensity tuning characteristics and types of stimulation, 44 neurons were devided into 4 groups: monotonic-intensity group (20 monotonic neurons), nonmonotonic-intensity group (6 nonmonotonic neurons), monotonic-frequency group (25 monotonic neurons) and monotonic-latency group (15 monotonic neurons). RESULTS: The A1 neurons only had transient spike response within 10 to 40 ms af ter the onset of continuous wild-band noise stimulation. The noise intensity had no significant effects on the background firing rates of the A1 neurons (P>0.05). The increase of background noise resulted in a significant linear elevation of the intensity threshold of monotonic and nonmonotonic neurons for tone-evoked response (R2>0.90, P < 0.05). No significant difference was observed in the slopes of threshold changes between monotonic and nonmonotonic neurons (P>0.05). The best intensity of nonmonotonic neurons increased along with the intensity of the background noise, and the variation of the best intensity was positively correlated with the change of the threshold of the same neuron (r=0.944, P < 0.001). The frequency response bandwidth and the firing rate of the A1 neurons decreased as the noise intensity increased (P < 0.001), but the best frequency almost remained unchanged (P < 0.001). The increase of background noise intensity resulted in an increased first spike latency of the neurons to the same tone stimulus (P < 0.05) without affecting the time accuracy of the first action potential (P>0.05). CONCLUSION: The acoustic response threshold of the A1 neurons increases linearly with the increase of background noise intensity. An increased background noise leads to compressed frequency band-width, a decreased firing rate and a prolonged spike latency, but the frequency selectivity and the time accuracy of auditory response to the same noise remain stable. PMID:34916193 | DOI:10.12122/j.issn.1673-4254.2021.11.11 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.