Nutrition Education: Optimizing Preparation and Recovery for Benign Esophageal Surgery

alexandrossfakianakis shared this article with you from Inoreader Nutrition Education: Optimizing Preparation and Recovery for Benign Esophageal Surgery via Journal of Human Nutrition and Dietetics Abstract Background Patients requiring upper gastrointestinal surgery for benign esophageal conditions are at nutrition risk before and after surgery. There is a dearth of published evidence guiding clinicians on effective collaboration with patients to mitigate perioperative nutritional challenges. We conducted a qualitative study to explore patients' perioperative food, nutrition, and educational experiences to guide future care. Methods Adult patients who had undergone elective, benign esophageal surgery were invited to participate in semi-structured interviews within 3 weeks of hospital discharge. Interviews were transcribed and analyzed with a reflexive form of inductive thematic analysis in addition to synthesized member checking. Results Interviews with 12 patients identified three major themes. First, nutrition education fosters a better surgical recovery experience: patients expressed a desire to be prepared for their upcoming surgery a nd engage in the recovery process with informed food choices. Most patients preferred preoperative education given limited capacity for learning during hospital admission. Second, patients have priorities for nutrition information: patients expressed that educational material should be printed, comprehensive, practical, include familiar foods, and focus on managing postoperative physical symptoms. Third, food impacts social and emotional experiences of surgery: resumption of a normal diet was a sign of recovery that enabled social reintegration. Identified themes resonated with Knowles' six-core principles of andragogy. Conclusions Patients with benign esophageal conditions perceived nutrition education to be a vital aspect of surgical preparation and recovery. Re-designing perioperative education with patient input has the potential to improve outcomes and experiences. This article is protected by copyright. All rights reserved. View on Web

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Current trends in carotid body tumors: Comprehensive review

alexandrossfakianakis shared this article with you from Inoreader Current trends in carotid body tumors: Comprehensive review via Head & Neck Abstract Background Carotid body tumor (CBT) is a rare neoplasm that has been increasingly studied during the last decades; nevertheless, it continues to be a topic of controversy. This review aims to provide an update on the general features of CBT and particularly review different treatment strategies and primary outcomes. Methods Data for this literature review were identified by PubMed, Scopus, and Medline. 93 articles from the initial search were included, as well as 28 relevant studies utilizing the snowballing method; totaling 121 articles about CBT. Results Main features such as anatomy, embryology, genetics, clinical presentation, and diagnosis of CBT are presented, followed by evidence of different treatment strategies such as radiotherapy, preoperative embolization, vascular resection, and vascular reconstruction. Main complications are also discussed. Conclusion This review summarizes the most critical aspects regarding CBT. Future studies should compare different treatments to attain the best surgical results with lower morbidity rates. View on Web

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Autogenous Bone Block versus Collagenated Xenogeneic Bone Block in the reconstruction of the atrophic alveolar ridge: a non‐inferiority randomized clinical trial

alexandrossfakianakis shared this article with you from Inoreader Autogenous Bone Block versus Collagenated Xenogeneic Bone Block in the reconstruction of the atrophic alveolar ridge: a non‐inferiority randomized clinical trial via Journal of Clinical Periodontology Abstract Objective To compare the efficacy of equine derived collagenated bone blocks (CXBB) and autogenous bone block (ABB) for lateral alveolar ridge augmentation and two-stage implant placement. Materials and methods Sixty-four patients with tooth gaps up to 4 teeth and atrophic alveolar ridges with ≤ 4 mm were randomly assigned to lateral augmentation using CXBB or ABB. Lateral bone thickness was measured 2 mm below the alveolar crest at augmentation surgery and 30 weeks later at implant placement. Implant related outcomes, adverse events, surgery duration, pain sensation, analgesic consumption and oral health-related quality of life were also assessed. Data was analyzed using Fisher's exact, Mann–Whitney, and Wilcoxon signed-rank tests. Results At 30 weeks, the median change in lateral bone thickness amounted to 2.90 (CXBB) and 3.00 (ABB), respectively. Secondary endpoints demonstrated similar results for CXBB and ABB in terms of possibility to place an implant, need to perform a secondary bone augmentation at implant placement and rate of complications. Early implant failure was 20% for CXBB and 10% for ABB, with no difference between the groups. Pain scores and postoperative consumption of analgesics were significantly lower in the CXBB group than in the ABB group, especially during the first days post-surgery. Conclusion CXBB is non-inferior to ABB for horizontal alveolar ridge augmentation and two-stage implant placement. This article is protected by copyright. All rights reserved. View on Web

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Offset analgesia is increased intra‐orally

alexandrossfakianakis shared this article with you from Inoreader Offset analgesia is increased intra‐orally via Journal of Oral Rehabilitation Abstract Background Offset analgesia (OA) is commonly used to quantify endogenous pain inhibition. However, the potential role of afferent inputs and the subsequent peripheral factors from different body areas on the underlying mechanisms are still unclear. Objectives The aim of this cross-sectional study was to compare the magnitude of OA in four different body areas representing a) glabrous and non-glabrous skin, b) trigeminal and extra-trigeminal areas, and c) intra- and extra-oral tissue. Methods OA was assessed at the oral mucosa of the lower lip, at the skin of the cheek, the forearm and the palm of the hand in 32 healthy and pain-free participants. OA testing included two trials: (1) a constant trial (30 seconds of constant heat stimulation at an individualized temperature of Pain50 (pain intensity of 50 out of 100)), and (2) an offset trial (10 seconds of individualized Pain50, followed by 5 seconds at Pain50+1°C and 15 seconds at Pain50). Participants continuously rated their pain during each trial with a computerized visual analog scale. Results A significant OA response was recorded at the oral mucosa (p<0.001, d=1.24), the cheek (p<0.001, d=0.84) and the forearm (p<0.001, d=1.04), but not at the palm (p=0.19, d=0.24). Significant differences were shown for OA recorded at the cheek versus the mucosa (p=0.02), and between palm and mucosa (p=0.007), but not between the remaining areas (p>0.05). Conclusion This study suggests that intra-oral endogenous pain inhibition assessed with OA is enhanced and supports the role of peripheral mechanisms contributing to the OA response. View on Web

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‘Reduced Cell Surface Levels of C-C Chemokine Receptor 5 and Immunosuppression in Long Coronavirus Disease 2019 Syndrome’

alexandrossfakianakis shared this article with you from Inoreader Response to 'Reduced Cell Surface Levels of C-C Chemokine Receptor 5 and Immunosuppression in Long Coronavirus Disease 2019 Syndrome' via Clinical Infectious Diseases Advance Access to the editor—Gaylis et al offer "an unexpected mechanism of abnormal immune downmodulation in some persons that is normalized by leronlimab" [1]. The disclosure of a public statement [2] and a Warning Letter [3] on leronlimab (PubChem SID 384585377) by the Food and Drug Administration (FDA) is appropriate. Gaylis et al offer no biostatistical methods but cite the clinical trial record. Using the Supplementary Data provided by Gaylis et al [1] with nonparametric Wilcoxon signed ranked test for change (Weeks 8–0), the 2-sided P-values for Figure 1A are .003 (leronlimab) and .0139 (placebo) and for Figure 1B are .0002 (leronlimab, Improving), .7344 (leronlimab, not improving), .0640 (placebo, not improving), and .1272 (placebo, not improving). Paired t-test results were not meaningfully different. Reporting nonsignificance (NS) for the latter 2 P-values with the given sample sizes is not advised, but the NS for placebo (Figure 1A) is significant and affects the conclusion. They do not define "responder" or state if the definition was made a priori. Some of the symptoms may not be independent (eg, cough/sore throat, headache/sleep disturbance) so using them all to generate a "responder" score should be explained. They fail to provide a mechanism of action or gene expression results to explain how a monoclonal antibody to CCR5, a G-protein-coupled receptor (GPCR), might increase the proportion of CD45+/CCR5+ T cells relative to total cell counts or increase expression of CCR5 in T cells. The authors should report the time between positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test and enrollment, duration of COVID-19 infection, re-exposure to SARS-CoV-2, especially to variants different from the original infecting viruses, other factors that affect immune responses, distribution of severity of COVID-19 among the treatment groups, the results by age and sex, the receptor occupancy, and the potential effects of the half-life of leronlimab. Galanti and Shaman [4] report multiple (re-)infections per year in the same subjects with other coronaviruses. Lee et al [5] reported that "granulocyte macrophage colony-stimulating factor caused a marked decrease of CXCR4 (from ∼5000 ABS to <500) while up-regulating CCR5 expression (from ∼5000 to ∼20 000 ABS)." Jacobson et al [6] reported 'mean terminal half-lives (PRO 140 Serum Concentration) were 3.4 and 3.7 days, but Yang et al [7] suggested an "estimated half-life of about 10 days." With T-cell proliferation and the potential increase in CCR5 expression, the half-life and receptor occupancy need to be appropri ately addressed in different patient populations. Roche and Futura state that "plasma membrane of eukaryotic cells is constantly being internalized" [8]; how long a 146.7 kDa [9] antibody bound to the 62 kDa [10] transmembrane CCR5 (NP_001381712.1) remains at the surface or, when it is internalized, whether it is trafficked back to surface or to the lysosomes is of interest. T-cell exhaustion [11] could help explain the results; with small sample sizes, imbalances can occur so duration, sev erity, and time from PCR test for each patient is important. Finally, genotypes of CCR5, which may affect binding of leronlimab, and of the ligands of CCR5, such as CCL3L1 with copy number variants [12], and any antidrug antibodies (ADA) against leronlimab would help elucidate this finding. View on Web

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Thyroid Surgeries in Asymptomatic Patients

alexandrossfakianakis shared this article with you from Inoreader Thyroid Surgeries in Asymptomatic Patients via JAMA Otolaryngology–Head & Neck Surgery Online First In this issue of JAMA Otolaryngology−Head & Neck Surgery, Dr Sajisevi and colleagues report the findings of a retrospective analysis of 1328 patients in 16 centers in 4 countries who underwent thyroid surgery for thyroid pathology in 2019. Patients were classified by the mode of detection of the thyroid findings that led to surgery: endocrinopathic condition, patient-requested screening, clinician-screening physical examination, radiologic serendipity, diagnostic cascade, symptomatic thyroid disease, and under surveillance. The primary outcomes were the mode of detection and the proportion and size of thyroid cancers discovered in patients who were asymptomatic. The authors found that 41% of patients were asymptomatic at the time of the detection of the thyroid condition, while 34% of patients had structural thyroid symptoms at the time of detection. The remaining 25% of patients were either under surveillance for known thyroid pathology, such as thyroid nodules, or had an endocrinopathic condition, such as hyperthyroidism, hyperparathyroidism, or multiple endocrine neoplasia syndrome. Of the 1328 cases, 613 (46%) revealed thyroid cancer. The authors also found that 51% of these cancers were in asymptomatic patients, while only 30% were in symptomatic patients. Finally, the mean tumor size was significantly larger in symptomatic compared with asymptomatic patients (3.2 cm vs 2.1 cm). View on Web

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Postoperative Gabapentin's Effect on Opioid Consumption and Pain Control Following Sinonasal Surgery

alexandrossfakianakis shared this article with you from Inoreader Postoperative Gabapentin's Effect on Opioid Consumption and Pain Control Following Sinonasal Surgery via The Laryngoscope Objective This study investigates the impact of postoperative gabapentin on opioid consumption and pain control following endoscopic sinus surgery (ESS) and/or septoplasty. Methods Patients who underwent ESS and/or septoplasty at a single institution from 2021 to 2022 were enrolled. All patients received postoperative hydrocodone-acetaminophen for pain control. Half of the patients were also prescribed gabapentin for the first postoperative day in addition to hydrocodone-acetaminophen. Subjects completed the Revised American Pain Society Patient Outcome Questionnaire 24 h and 7 days after surgery. We conducted a multivariable regression analysis to assess opioid consumption and improvement in pain scores in the first week between gabapentin and non-gabapentin groups. Results A total of 102 subjects, 51 in each arm, were enrolled. The mean age was 52 years and 53% of participants were female. Controlling for important baseline demographic, clinical, and surgically related variables, the addition of postoperative gabapentin was associated with a 44% (9.5 mg from 21.6 mg) reduction in opioids consumed in the first postoperative week (B = −9.54, 95% C.I. = [−17.84, −1.24], p = 0.025). In addition, patients in both arms exhibited similar improvement in pain severity and sleep interference in the first 7 days (B = −1.59, 95% C.I. = [−5.03, 1.84], p = 0.36). Conclusion To the best of our knowledge, this is the first study to investigate the impact of postoperative gabapentin on opioid consumption and pain control following ESS and/or septoplasty. Our analysis demonstrated that postoperative gabapentin effectively reduced opioid use during the first postoperative week without compromising pain control. Level of Evidence 3 Laryngoscope, 2022 View on Web

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