Πέμπτη 24 Ιουνίου 2021

A review of the research progress of interventional medical equipment and methods for prostate cancer

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Abstract

Background

Prostate cancer is a common disease in men and has a relatively high mortality rate. However, the interventional medical equipment used for prostate biopsy and brachytherapy has always been a social concern.

Methods

To understand interventional medical equipment for prostate cancer, the structure of manual, semi-automatic, and automatic medical equipment were considered as the mainline, while the corresponding research on these structures were the auxiliary lines. The characteristics and corresponding research status have been discussed.

Results

Interventional medical equipment for prostate cancer with different degrees of automation and its characteristics were determined, and the imaging principles and characteristics of computed tomography, transrectal ultrasound, and magnetic resonance imaging have been briefly described.

Conclusion

Certain feasible research suggestions have been proposed for future development from the perspective of structure, accuracy, and safety. These include flexible and compact robot structures, high-precision image recognition and guidance, accurate dose planning and monitoring, real-time imaging monitoring without delay, high-precision needle insertion strategy, master-slave control, virtual reality, and remote control.

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A case report of concurrence of aberrant extracranial internal carotid artery and nonrecurrent laryngeal nerve in a patient of advanced thyroid carcinoma invading hypopharynx

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Gland Surg. 2021 May;10(5):1786-1791. doi: 10.21037/gs-20-663.

ABSTRACT

Aberrant extracranial internal carotid artery and nonrecurrent laryngeal nerve (NRLN) are neurovascular anomalies, which clinicians should be aware of to prevent severe complications while performing transoral or open surgery in the head and neck area. These two variants can occur simultaneously because of similar etiology of embryological maldevelopment of arch arteries. In this study, a 64-year-old woman comp laining of hoarseness presented a bulge in the left hypopharynx. A contrasted computed tomography scan indicated left thyroid mass with hypopharynx invasion, accompanied by right aberrant extracranial internal carotid artery and subclavian artery. Fine needle aspiration biopsy of the mass revealed papillary thyroid carcinoma (PTC). She underwent total thyroidectomy, partial hypopharyngectomy, neck dissection, and tracheotomy. Intraoperatively, a right NRLN was found above the level of the cricothyroid junction that entered the larynx. The patient did not present severe complications postoperatively. Radioactive iodine therapy was applied after the surgery. At the 3-year follow-up, she remained cancer-free, and the hoarseness has improved. This is the first report of concurrent aberrant extracranial internal carotid artery and NRLN. NRLN of right side can be predicted in the computed tomography scan by the sign of the right subclavian artery origining from the left side of the aortic arch and running an abnormal course between the esophagus and the vertebra. Meanwhile, aberrant extracranial internal carotid artery may occur simultaneously. Recognition of aberrant neurovascular structures enables clinicians to prevent severe surgical complications.

PMID:34164322 | PMC:PMC8184399 | DOI:10.21037/gs-20-663

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Clinical Analysis of the Short-Term Outcome of Papillary Thyroid Micro Carcinoma After 131I Treatment

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Cancer Manag Res. 2021 Jun 14;13:4691-4698. doi: 10.2147/CMAR.S308012. eCollection 2021.

ABSTRACT

PURPOSE: To explore the factors that influence the short-term clinical outcome after the first 131I treatment of papillary thyroid micro carcinoma (PTMC).

PATIENTS AND METHODS: From October 2015 to June 2018, patients who were diagnosed with PTMC with lymph node metastasis were analyzed retrospectively, excluding patients with incomplete clinical data, distant metastas is, positive TGAb, TSH<30 mIU/L. The baseline data of sex, age, time from last surgery to first 131I treatment, tumor pathology information, and biochemical information were collected before admission. All patients included had radioactive iodine (RAI) with 3.70 GBq. The treatment response of patients was evaluated 6-8 months after discharge. By means of univariate and multivariate analysis, including excellent response (ER) and non-excellent response (NER) groups of clinical data, we assessed the impact of 131I on patients' outcome. A nomogram model was established based on the above independent risk factors.

RESULTS: A total of 206 patients (59 males and 147 females, mean age 43.4 ± 10.6 years) were included in the study. The median follow-up time was 169.4 ± 10.5 days, including 139 patients in ER group (67.4%) and 67 patients in NER group (32.5%). Four factors including combining Hashimoto's thyroiditis, pre-ablative Tg levels, UIE levels, and la teral lymph node numbers were statistically different between ER group and NER group with significance at P < 0.05. Further multivariate analysis showed that Hashimoto's thyroiditis and Ps-Tg levels could be used as independent factors. The model verification showed that the C-index of the modeling set was 0.822, indicating that the nomogram model had a good predicted accuracy.

CONCLUSION: Our data suggest that coexisting Hashimoto's thyroiditis and elevated Ps-Tg levels are predictive factors for short-term outcome of thyroid micro papillary carcinoma after 131I treatment. Also, the nomogram model had a good predicted accuracy.

PMID:34163244 | PMC:PMC8214364 | DOI:10.2147/CMAR.S308012

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Asthma increased in young adults from 2008–2016 despite stable allergic rhinitis and reduced smoking

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Via Rhinitis

journal.pone.0253322.g003&size=inline

by Styliana Vasileiadou, Linda Ekerljung, Anders Bjerg, Emma Goksör

Background

Studies have produced inconsistent results on prevalence trends in asthma and allergic rhinitis (AR). We surveyed young adults about asthma in 2008 and 2016 and examined the impact of gender, AR and smoking.

Methods

Thirty-thousand randomly selected subjects aged 16–75 years in Western Sweden received postal questionnaires in 2008 and 50,000 in 2016. This study is based on responders aged 16–25 years, 2,143 in 2008 and 2,484 in 2016.

Results

From 2008–2016 current asthma increased from 9.3% to 11.5% (p = 0.014) and was significant in males without AR (aOR 1.83, 95% CI 1.09–3.07) and male smokers (aOR 3.02, 95% CI 1.12–8.13). In both years the risk of current asthma was reduced by growing up on a farm (aOR 0.26, 95% CI 0.81–0.84 and aOR 0.47, 95% CI 0.23–0.996), independent of a family history of asthma or allergy. AR did not differ significantly from 2008–2016 (22.5% vs 24.4%, p = 0.144). Current smoking decreased from 20.3% to 15.2% (p Con clusion

Current asthma increased in respondents aged 16–25 from 2008–2016, mainly among males without AR and male smokers. Current AR levelled off in this young population, while current smoking decreased among females.

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Mandibular advancement device use in obstructive sleep apnea: ORCADES study 5-year follow-up data

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J Clin Sleep Med. 2021 May 3. doi: 10.5664/jcsm.9308. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: Mandibular advancement devices (MADs) are an alternative to continuous positive airway pressure (CPAP) for the management of obstructive sleep apnea (OSA). The ORCADES study is investigating the long-term effectiveness of MAD therapy in OSA patients who refused or were intolerant with CPAP. Five-year follow-up data are presented.

METHODS: Data were available in 172/331 patients treated with a custom-made computer-aided design/computer-aided manufacturing bi-block MAD (Narval CCTM; ResMed). The primary endpoint was treatment success (≥50% decrease in apnea-hypopnea index from baseline).

RESULTS: Five-year treatment success rates were 52% overall, and 25%, 52% and 63%, respectively, in patients with mild, moderate or severe OSA. This reflects a decline over time versus 3-6 months (79% overall) and 2 years (68%). Rates declined in all patient subgroups, but to the greatest extent in mild OSA patients. The slight worsening of respiratory parameters over time was not associated with any relevant changes in sleepiness and symptoms. Moderate or severe OSA at baseline, treatment success at 3-6 months, and no previous CPAP use were significant independent predictors of 5-year treatment success on multivariate analysis. No new safety signals emerged during long-term follow-up. The proportion of patients using their MAD for ≥4 h/night on ≥4 days/week was 93.3%; 91.3% of patients reported device usage of ≥6 h/night at 5 years. At 5-year follow-up, 96.5% of patients reported that they wanted to continue MAD therapy.

CONCLUSIONS: Long-term MAD therapy remained effective after 5 years in >50% of patients, with good levels of patient satisfaction and adherence.

PMID:34165074 | DOI:10.5664/jcsm.9308

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Surgical Outcome of Potassium-Titanyl-Phosphate (KTP) Laser Photocoagulation for Vocal Fold Vascular Lesions

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Laser technology is used in microscopic direct laryngeal surgery for a variety of indications. Lasers are categorized broadly as photoangiolytic or cutting/ablating lasers, based on the chromophores that absorb their energy. Photoangiolytic lasers such as the 532 nm Potassium-Titanyl-Phosphate (KTP) laser are absorbed selectively by the chromophore hemoglobin, facilitating controlled intravascular coagulation, with preservation of the overlying epithelium and adjacent tissue. Efficacy of the KTP laser has been demonstrated for incision, coagulation, and ablation in vocal fold (VF) surgery.
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Endoscopic and Computed Tomography Evaluation of Posterior Glottic Closure During Phonation

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Objectives/Hypothesis

The anatomy of the posterior glottis, specifically the states of the posterior glottis during phonation, has not been thoroughly explored in laryngology. Conventional wisdom about the posterior glottis indicates that it tends to be completely closed in men but may be open in women. Furthermore, professional singers are expected to have a completely closed posterior glottis. The aim of this study was to investigate whether these generalizations are true by comparing rigid videolaryngostroboscopy results with high-resolution computed tomography (HRCT) and three-dimensional (3D) reconstruction findings.

Study Design

Prospective study.

Methods

Of the 90 volunteers (58 women, 32 men) examined, 48 were female professional singers, 10 were female nonsingers, 22 were male professional singers, and 10 were male nonsingers. Rigid videolaryngostroboscopy as well as HRCT scans were performed during singing at the average singing fundamental frequency. HRCT images of the larynx and air-column were 3D visualized using the software MIMICS®. The states of the posterior glottis were assessed in both examinations and compared among participants.

Results

The sensitivity of endoscopy was 67.5%. Complete closure of the posterior glottis was observed in 62.5% men and 52% women (P = .33). Complete closure of the posterior glottis was observed in 35% nonsingers and 61% professional singers (P = .036).

Conclusions

The closure of the posterior glottis seen on videolaryngostroboscopy does not always correlate with actual closure. There seems to be no link between sex and complete closure of the glottis. However, there is strong evidence that posterior glottis closure can be influenced, to some degree, by vocal training.

Level of Evidence

4 Laryngoscope, 2021

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Association of Plate Contouring With Hardware Complications Following Mandibular Reconstruction

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Objectives/Hypothesis

Despite considerable effort being dedicated to contouring reconstruction plates, there remains limited evidence demonstrating an association between contour and reconstructive outcomes. We sought to evaluate whether optimizing mandibular reconstruction plate contouring is associated with reduced postoperative hardware complications.

Study Design

Retrospective cohort study.

Methods

A cohort study was performed with adult patients (age ≥18 years) who underwent mandibulectomy and osseous free flap reconstruction following oncologic ablation at the University Health Network in Toronto, Canada, between January 1, 2003 and December 31, 2014. Patients with computed tomography scans performed within 1 year of reconstruction were included. Computer-based three-dimensional models were generated and used to calculate the mean plate-to-bone gap (mm). The primary outcome was plate exposure. Secondary outcome included a composite of plate exposure or intraoral dehiscence. Logistic regression models were fitted for each outcome accounting for other patient and surgical characteristics associated with the primary outcome.

Results

Ninety-four patients met inclusion criteria, with a mean age of 60.4 (standard deviation [SD] 14.9). The mean follow-up time was 31.4 months (range 3–94). Reconstruction was performed with fibular (57%) and scapular free flaps (43%). In the multivariable model, small mean plate-to-bone gap (<1 mm) was independently associated with 86% reduced odds of plate exposure (odds ratio [OR] 0.12; 95% confidence interval [CI] 0.02–0.55). Mean plate-to-bone gap less than 1 mm was also independently associated with reduced odds of developing a composite of plate exposure or intraoral dehiscence (OR, 0.29; 95%CI, 0.11–0.75).

Conclusion

Optimizing plate contouring during mandibular reconstruction may decrease the development of postoperative hardware complications.

Level of Evidence

IV Laryngoscope, 2021

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Effects of Cough Suppression Therapy on Voice Disorder Severity

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Objectives//Hypothesis

To determine changes in voice severity when treating chronic cough refractory to medical treatment with cough suppression therapy (CST) in patients with chronic cough and voice complaints. Chronic cough has been reported to be refractory to medical treatment and frequently co-occurs with voice disorders. The possible effects of CST on self-assessed changes in chronic cough and voice disorders have not been demonstrated.

Study Design

Retrospective analysis of the effects of cough suppression therapy (CST) on self-assessed changes in chronic cough and voice disorder severity in patients with both chronic cough and voice disorders.

Methods

Forty-three adult patients with the primary complaint of chronic refractory cough underwent pre- and post-treatment diagnostic examinations, completed pre- and post-treatment Voice Handicap Index-10 (VHI-10) and Cough Severity Index assessments, and were treated by a licensed speech-language pathologist using CST. Twenty-seven subjects were assigned to the cough (C) group and 16 to the cough-voice (CV) group based on the severity of their VHI-10 scores.

Results

Post-test analysis showed significant improvement in cough severity for both groups and significant improvement in voice severity for the CV group. The VHI-10 scores for the C group did not change significantly. The median number of treatment sessions was 3, with a range of 1–13 sessions. Correlation between changes in severity and number of treatment sessions was not found to be significant at the tested level.

Conclusions

CST represents a unifying approach for treatment of patients with CRC and comorbid voice disorders. CST offered cross-over effects to the voice when subjects were treated for their primary complaint of chronic cough. This treatment of the primary complaint improves function in systems that share a common pathway.

Level of Evidence

IV Laryngoscope, 2021

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Quality of life comparison in thyroxine hormone withdrawal versus triiodothyronine supplementation prior to radioiodine ablation in differentiated thyroid carcinoma: a prospective cohort study in the Indian population

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Eur Arch Otorhinolaryngol. 2021 Jun 24. doi: 10.1007/s00405-021-06948-6. Online ahead of print.

ABSTRACT

BACKGROUND: Thyroid withdrawal in preparation for radioiodine ablation (RIA) may have a profound impact on health-related quality of life (HRQL). Cost implications and scheduling limit the use of recombinant TSH and triiodothyronine (T3) with its shorter half-life is a conceptually attractive alternative.

METHODS: Prospective cohort study design with patients having withdrawal of thyroxine (n = 37) or T3 supplementation (n = 33). HRQL was assessed using EORTC QLQ-C30, QLQ-H&N35 and modified Billewicz questionnaires. Time interval to achieve optimal TSH levels (at least 30 mIU/ml) prior to RIA was determined.

RESULTS: With the exception of emotional domain (QLQ-C30 p = 0.045), LT3 supplementation did not confer significant benefit when compared to LT4 withdrawal. Target serum TSH levels was achieved in 95% of patients by week 4 post thyroidectomy.

CONCLUSIONS: LT3 supplementation delivered equivocal benefit and therefore the alternate strategies to minimize the impact on HRQL of reduction in the duration of hypothyroidism in T4 withdrawal are suggested.

PMID:34165625 | DOI:10.1007/s00405-021-06948-6

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Evolution of Topic Corticosteroid Therapy for the Management of Sinonasal Inflammatory Disease

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Ear Nose Throat J. 2021 Jun;100(5):293-294. doi: 10.1177/01455613211015746.

NO ABSTRACT

PMID:34166128 | DOI:10.1177/01455613211015746

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