Head and Neck Malignant Paragangliomas: Experience from a Single Institution

xlomafota13 shared this article with you from Inoreader Head and Neck Malignant Paragangliomas: Experience from a Single Institution Via ear nose throat Ear Nose Throat J. 2021 Oct 15:1455613211052338. doi: 10.1177/01455613211052338. Online ahead of print. ABSTRACT Objectives: To summarize the clinicopathological and genetic features of malignant paragangliomas in head and neck cancer and to explore the appropriate treatment options for this rare lesion. Methods: Six patients harboring head and neck malignant paraganglioma from Beijing Tongren Hospital were retrospectively reviewed. The clinicopathological char acteristics, gene mutations, and prognosis of these patients were analyzed. Results: Of these 6 patients, 3 were male and 3 were female; 4 patients harbored malignant carotid body tumors, and two had malignant vagal paragangliomas. Three patients had cervical lymph node metastasis, two presented with lung and bone metastasis, and 1 had lung and liver metastasis. Of the 6 patients, four underwent surgical resection, and the other two patients denied surgery and instead received chemotherapy with paclitaxel, ifosfamide, and dacarbazine. These 2 patients with vagal paraganglioma received postoperative radiotherapy. All 6 patients are still alive at the present time, with a median follow-up time of 66 months. Positive Ki-67 expression in tumor tissue ranged from 1% to 40%. Genetic mutations in SDHD, SDHB, ATR, and MAP3K13 were identified in 4 patients. Conclusions: After comprehensive treatment, head and neck malignant paraganglioma can attain a favorable prognosis. Geneti c mutations are commonly detected in patients with malignant paragangliomas. This study also identified mutations in ATR and MAP3K13 in these patients. PMID:34654328 | DOI:10.1177/01455613211052338 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Coblation supraglottoplasty: a ten-year experience in a tertiary referral hospital

xlomafota13 shared this article with you from Inoreader Coblation supraglottoplasty: a ten-year experience in a tertiary referral hospital 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 Oct 16. doi: 10.1007/s00405-021-07130-8. Online ahead of print. ABSTRACT PURPOSE: The present study aims to review the outcomes of coblation supraglottoplasty performed for children with different types of laryngomalacia, and we discuss the factors affecting these outcomes. METHODS: We retrospectively reviewed the medical records of laryngomalacia patients admitted to the Otorhinolaryngology Department, Mansoura University, from 2010 to 2020. We examined the patient's demography, symptoms, comorbidities, type of laryngomalacia, oxygen saturation, and final outcomes. RESULTS: Our study included 235 patients; 122 patients responded to medical therapy, while 113 underwent surgical management. There is a significant relation between the types and therapy they underwent (p ≤ 0.001). Larger percentage within type I underwent medical therapy. There is a statistically significant difference between the studied groups regarding age at surgery. On pairwise comparison, patients with type II had the lowest age significantly at the surgery when compared with each other individual group (p ≤ 0.001). On multivariate regression analysis, the presence of comorbid congenital heart disease, neurological comorbidities significantly increased the risk of failure of surgical intervention by 17.32 and 5.803 folds, respectively. CONCLUSIONS: Coblation supraglottoplasty is effective and safe to treat severe laryngomalacia. Different morphological types of laryngomalacia require slight surgical variations of coblation supraglottoplasty. The presence of comorbid congenital heart disease, neurological comorbidities significantly increased the risk of failure of surgical intervention. PMID:34654950 | DOI:10.1007/s00405-021-07130-8 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Preclinical Implementation of a Steerable, Da Vinci Xi ® Compatible CO2‐Laser Fiber Carrier for Transoral Robotic Surgery (TORS): a Cadaveric Feasibility Study

xlomafota13 shared this article with you from Inoreader Preclinical Implementation of a Steerable, Da Vinci Xi ® Compatible CO2‐Laser Fiber Carrier for Transoral Robotic Surgery (TORS): a Cadaveric Feasibility Study Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Introduction Monopolar electrocautery is the most common dissection and coagulation tool during transoral robotic surgery (TORS) but causes significant collateral tissue damage as opposed to CO2 laser. We aimed at combining both modalities in one robotic instrument arm. Methods We developed a steerable CO2-laser fiber carrier serving as an add-on to the existing Endowrist® monopolar spatula of the Da Vinci Xi. Feasibility and safety were assessed in a preclinical setting. Results One radical tonsillectomy with monopolar cautery and 3 with the instrument prototype were performed in 2 cadavers by 2 surgeons. No serious prototype-related intra-operative difficulties were observed. Safe and efficient switching between energy sources proved possible in all simulated intra-operative bleeding events. Prototype use allowed for the identification of the majority of key anatomical structures and was scored favorably on NASA-TLX ques tionnaires. Discussion The reported prototype successfully combines the advantages of CO2-laser with the advantages of TORS. This article is protected by copyright. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The clinical and financial impact of introducing robotic‐assisted hysterectomy in a tertiary referral center: a direct cost analysis of consecutive hysterectomies during a decade

xlomafota13 shared this article with you from Inoreader The clinical and financial impact of introducing robotic‐assisted hysterectomy in a tertiary referral center: a direct cost analysis of consecutive hysterectomies during a decade Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Background Economic data and the clinical impact of introducing robotic-assisted hysterectomy in a European setting are scarce with conflicting findings. Methods In this retrospective cohort study, the cost and complication rate of the different approaches of hysterectomy are investigated, both benign and (pre)malignant indications were included. Results 844 patients were included: 323 (38.3%) patients underwent robotic-assisted hysterectomy (RAH), 317 (37.5%) total abdominal hysterectomy (TAH), and 204 (24.2%) total laparoscopic hysterectomy (TLH). TAH dropped from 67.2% to 25.5% of procedures, whilst RAH rose to 41.8% of cases. The total hospitalization cost was for RAH €5208.39 (± €916.91), for TAH €5846.61 (± €4464.37) and for TLH €3790.06 (± €1267.05). The postoperative complication rate of TAH (9.1%) was significantly higher in comparison with TLH and RAH (5.4% and 3.1% respectively, p=0.005). Conclusions RAH h as replaced TAH in most cases, especially for large uteri, early-stage endometrial cancer and in selected endometriosis cases, resulting in reduced morbidity with lower hospitalization costs. The indications for TLH remained, including menorrhagia, adenomyosis and persistent cervical dysplasia. This article is protected by copyright. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Long-term swallowing-related outcomes in oral cancer patients receiving proactive swallowing therapy

xlomafota13 shared this article with you from Inoreader Long-term swallowing-related outcomes in oral cancer patients receiving proactive swallowing therapy Via swallowing exercises Oral Oncol. 2021 Oct 13;122:105569. doi: 10.1016/j.oraloncology.2021.105569. Online ahead of print. ABSTRACT OBJECTIVES: The present study aimed to evaluate the impact of proactive swallowing rehabilitation on swallowing function and quality of life (QoL) in oral cancer patients in the first two years after definitive treatment. MATERIALS AND METHODS: Consecutive adult patients with locally advanced oral cancer who received radical surgery, free flap reconstruction, and adjuv ant radiotherapy were recruited prospectively, to whom proactive swallowing rehabilitation was provided. Body weight (BW); fiberoptic endoscopic evaluation of swallowing (FEES), functional oral intake scale (FOIS), and diet level; 10-item eating assessment tool (EAT-10), and MD Anderson Dysphagia Inventory (MDADI); and adherence at baseline, 1, 3, 6, 12, and 24 months were evaluated. RESULTS: A total of 104 patients were included during May 2018 to July 2020. Compared to the baseline, significant deterioration in BW, FOIS, and MDADI was noted at one month. However, a trend of recovery was observed in FOIS from one month, and in BW and MDADI from three months. A total of 94% patients were free of tube feeding at 12 months but with a diet requiring special preparations or compensation. Safe swallowing could be achieved in approximately 90% of the participants after six months with diet modification or compensatory maneuvers. BW at 18 and 24 months did not differ significantly fr om baseline. CONCLUSION: Proactive swallowing therapy is feasible for patients with locally advanced oral cancer receiving definitive treatments. It facilitates safe oral intake and adequate nutrition. Patients who performed swallowing exercises had a faster and better recovery in swallowing function and swallowing-related QoL. PMID:34656054 | DOI:10.1016/j.oraloncology.2021.105569 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

GLI-1 polymorphisms of Hedgehog pathway as novel risk and prognostic biomarkers in melanoma patients

xlomafota13 shared this article with you from Inoreader GLI-1 polymorphisms of Hedgehog pathway as novel risk and prognostic biomarkers in melanoma patients Via Melanoma Research - Published Ahead-of-Print Objective In adult organisms, deregulation of the sonic hedgehog (SHH) signaling pathway is significantly correlated with different malignancies. Currently, data associating genetic polymorphisms in the SHH pathway with melanoma are scarce and largely unknown. The objective of our study was to elucidate an association between gene polymorphisms in the SHH pathway and prognosis of melanoma skin cancer patients. Methods The current study investigated the association of PTCH1 (rs357564), SMO (rs2228617) and GLI1 (rs2228224, rs2228226), polymorphisms with melanoma predisposition and prognosis. Single-nucleotide polymorphisms were assessed by TaqMan SNP Genotyping Assays. The study involved 93 melanoma patients and 97 individuals in the control group. Results Melanoma patients with the variant mutant genotype GG of GLI1 rs2228226 polymorphism had poorer overall survival and recurrence-free survival (P = 0.0001 and P = 0.037, respectively). The multivariate analysis revealed that disease progression [hazard ratio (HR) = 14.434, P = 0.0001] and the GLI1 rs2228226 polymorphism (HR = 4.161, P = 0.006) persisted as independent prognostic factors. Mutated allele carriers (combined heterozygous and mutated genotypes) for GLI1 rs2228224 G and GLI1 rs2228226 G allele significantly increased melanoma risk [odds ratio (OR) = 2.261, P = 0.007; OR = 2.176, P = 0.010]. Conclusion Our study demonstrated that genetic variants in GLI1, downstream member of the HH signaling pathway, are the risk factors for melanoma susceptibility and it can be a novel marker for melanoma prognosis. As a crucial SHH signaling member, GLI1 can also be regarded as a novel drug target for anti-cancer treatment in melanoma. * Marija Dunjic and Nikola Lukic contributed equally to the writing of this article. Received 13 August 2021 Accepted 16 September 2021 Correspondence to Gordana Supic, PhD, Associate Professor, Medical Faculty of Military Medical Academy, University of Defence, Crnotravska 17, 11000 Belgrade, Serbia, Tel: +381113608381; e-mail: gogasupic@gmail.com Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evaluation of the Neuroanatomical Basis of Olfactory Dysfunction

xlomafota13 shared this article with you from Inoreader Message: Key Points Question What are the neuroanatomical correlates of olfactory function in the general population? Findings In this cross-sectional study of 541 participants who underwent brain imaging and olfactory assessment, olfactory bulb volume was independently associated with olfactory function and a robust mediator of the association between volumes of central olfactory structures (amygdala, hippocampus, insular cortex, and medial orbitofrontal cortex) and olfactory function. Meaning Olfactory dysfunction may primarily originate from the pathology of the olfactory bulb or more distal structures, whereas olfactory bulb volume may serve as a preclinical marker for the identification of individuals who are at an increased risk for developing neurodegenerative diseases later in life. Abstract Importance Olfactory dysfunction is a prodromal manifestation of many neurodegenerative disorders, including Alzheimer and Parkinson disease. However, its neuroanatomical basis is largely unknown. Objective To assess the association between olfactory brain structures and olfactory function in adults 30 years or older and to examine the extent to which olfactory bulb volume (OBV) mediates the association between central olfactory structures and olfactory function. Design, Setting, and Participants This cross-sectional study analyzed baseline data from the first 639 participants with brain magnetic resonance imaging (MRI) in the Rhineland Study, an ongoing population-based cohort study in Bonn, Germany. Participants were enrolled between March 7, 2016, and October 31, 2017, and underwent brain MRI and olfactory assessment. Data were analyzed from March 1, 2018, to June 30, 2021. Exposure Volumetric measures were derived from 3-T MRI T1-weighted brain scans, and OBV was manually segmented on T2-weighted images. The mean volumetric brain measures from the right and left sides were calculated, adjusted by head size, and normalized to all participants. Main Outcomes and Measures Performance on the 12-item smell identification test (SIT-12) was used as a proxy for olfactory function. Results A total of 541 participants with complete data on MRI-derived measures and SIT-12 scores were included. This population had a mean (SD) age of 53.6 (13.1) years and comprised 306 women (56.6%). Increasing age (difference in SIT-12 score, –0.04; 95% CI, –0.05 to –0.03), male sex (–0.26; 95% CI, –0.54 to 0.02), and nasal congestion (–0.28; 95% CI, –0.66 to 0.09) were associated with worse olfactory function (SIT-12 scores). Conversely, larger OBV was associated with better olfactory function (difference in SIT-12 score, 0.46; 95% CI, 0.29-0.64). Larger volumes of amygdala (difference in OBV, 0.12; 95% CI, 0.01-0.24), hippocampus (0.16; 95% CI, 0.04-0.28), insular cortex (0.12; 95% CI, 0.01-0.24), and medial orbitofrontal cortex (0.10; 95% CI, 0.00-0.20) were associated with larger OBV. Larger volumes of amygdala (volume × age interaction effect, 0.17; 95% CI, 0.03-0.30), parahippocampal cortex (0.17; 95% CI, 0.03-0.31), and hippocampus (0.21; 95% CI, 0.08-0. 35) were associated with better olfactory function only in older age groups. The age-modified association between volumes of central olfactory structures and olfactory function was largely mediated through OBV. Conclusions and Relevance This cross-sectional study found that olfactory bulb volume was independently associated with odor identification function and was a robust mediator of the age-dependent association between volumes of central olfactory structures and olfactory function. Thus, neurodegeneration-associated olfactory dysfunction may primarily originate from the pathology of peripheral olfactory structures, suggesting that OBV may serve as a preclinical marker for the identification of individuals who are at an increased risk of neurodegenerative diseases. Evaluation of the Neuroanatomical Basis of Olfactory Dysfunction Via JAMA Otolaryngology–Head & Neck Surgery Current Issue This cross-sectional study evaluates the role of the components of the olfactory pathway structures in impaired olfactory function. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.