Σφακιανάκης Αλέξανδρος
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5 Άγιος Νικόλαος
Κρήτη 72100
00302841026182
00306932607174
alsfakia@gmail.com

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Τετάρτη 17 Νοεμβρίου 2021

Effect of swallowing rehabilitation using traditional therapy, kinesiology taping and neuromuscular electrical stimulation on dysphagia in post-stroke patients: A randomized clinical trial

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Clin Neurol Neurosurg. 2021 Nov 6;211:107020. doi: 10.1016/j.clineuro.2021.107020. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to evaluate the functional recovery of stroke patients with orophyaryngeal dysphagia after treatment with traditional swallowing therapy (TST), neuromuscular electrical stimulation (NMES), and kinesiology taping (KT), by using clinical swallowing assessments and objective fiberoptic endoscopic evaluation of swallowing (FEES).

METHODS: A total of 37 patients were randomized in three groups: those who received TST and NMES as Group 1 (n:12), those who received both TST and KT as Group 2 (n:13), and those who received TST, NMES, and KT together as Group 3 (n:12). Patients were evaluated before treatment, after treatment, and three months after treatment onset with bedside water-swallow test, Eating Assessment Tool (EAT-10), Functional Oral Intake Scale (FOIS), penetration-aspiration scale (PAS), and Nationa l Institute of Health-Swallow Safety Scale (NIH-SSS). FOIS, PAS, and NIS-SSS were completed according to results of fiberoptic endoscopic evaluation of swallowing (FEES).

RESULTS: A statistically significant decrease was observed in bedside water-swallow test, EAT-10, PAS, and NIH-SSS scores in all treatment groups 5 weeks and 3 months after treatment onset compared to pre-treatment scores (p < 0.05). There was a statistically significant increase in FOIS scores 5 weeks and 3 months after treatment compared to pretreatment scores in all treatment groups (p < 0.05). When the pre-treatment, 3-week, and 5-month swallow scale scores of all groups were compared, there was no significant different difference in terms of bedside water-swallow test, EAT-10, FOIS, PAS, or NIH-SSS scores (p > 0.05).

CONCLUSION: According to the results of our study, KT is a new option in the treatment of stroke-related dysphagia, is an effective treatment approach and its efficacy is main tained throughout long-term follow-up.

PMID:34781221 | DOI:10.1016/j.clineuro.2021.107020

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MGMT and temozolomide sensibility

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Bull Cancer. 2021 Nov 12:S0007-4551(21)00393-3. doi: 10.1016/j.bulcan.2021.08.011. Online ahead of print.

NO ABSTRACT

PMID:34782119 | DOI:10.1016/j.bulcan.2021.08.011

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Epigenetic therapy to enhance therapeutic effects of PD-1 inhibition in therapy-resistant melanoma

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Targeted therapy and immunotherapy have revolutionized the treatment of metastatic skin melanoma but around half of all patients develop resistance early or late during treatment. The situation is even worse for patients with metastatic uveal melanoma (UM). Here we hypothesized that the immunotherapy of therapy-resi stant skin melanoma or UM can be enhanced by epigenetic inhibitors. Cultured B16F10 cells and human UM cells were treated with the histone deacetylase inhibitor (HDACi) entinostat or BETi JQ1. Entinostat-induced HLA expression and PD-L1, but JQ1 did not. A syngeneic mouse model carrying B16-F10 melanoma cells was treated with PD-1 and CTLA4 inhibitors, which was curative. Co-treatment with the bioavailable BETi iBET726 impaired the immunotherapy effect. Monotherapy of a B16-F10 mouse model with anti-PD-1 resulted in a moderate therapeutic effect that could be enhanced by entinostat. Mice carrying PD-L1 knockout B16-F10 cells were also sensitive to entinostat. This suggests HDAC inhibition and immunotherapy could work in concert. Indeed, co-cultures of UM with HLA-matched melanoma-specific tumor-infiltrating lymphocytes (TILs) resulted in higher TIL-mediated melanoma killing when entinostat was added. Further exploration of combined immunotherapy and epigenetic therapy in metastatic melanoma resistant to PD-1 inhibition is warranted. * Present address: Harry Perkins Institute of Medical Research, 6 Verdun St, WA 6009, Nedlands, Perth, Australia. Received 21 July 2021 Accepted 23 September 2021 Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.melanomaresearch.com. Correspondence to Jonas A. Nilsson, PhD, Sahlgrenska Center for Cancer Research, Box 425, University of Gothenburg, 40530 Gothenburg, Sweden, Tel: +46 730 273039; e-mail: jonas.nilsson@perkins.org.au This is an open access article distributed under the Creative Commons Attribution License 4.0(CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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Phonation Threshold Pressure Revisited: Effects of Intrinsic Laryngeal Muscle Activation

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Objectives/Hypothesis

Phonation threshold pressure (P th) is the minimum subglottic pressure required to reach phonation onset and is considered a marker for vocal efficiency and health. We investigated the effects of intrinsic laryngeal muscle (ILM) activation on P th.

Study Design

In vivo animal study.

Methods

In an in vivo canine phonation model, laryngeal adductor muscles were activated together by stimulation of the recurrent laryngeal nerves (RLNs) and individually via stimulation of respective terminal nerve branches. Cricothyroid (CT) muscles were activated via stimulation of the superior laryngeal nerves. ILMs were activated in a graded manner at various combinations as transglottal airflow was gradually increased. Aerodynamic and glottal posture parameters were measured at phonation onset.

Results

Graded RLN stimulation decreased glottal distance and increased P th. Thyroarytenoid (TA) muscle activation alone increased P th. Lateral cricoarytenoid (LCA) muscle activation alone had minimal effects. However, graded TA activation as a function of LCA activation level revealed a synergistic relationship between the two muscles in increasing P th. Effects of CT activation were dependent on adductor stimulation level: CT activation increased P th at low RLN stimulation levels and decreased P th at high RLN levels.

Conclusions

The effects of ILM activation on P th were consistent with their expected effects on vocal fold stiffness and tension. TA was the primary adductor controlling P th. While LCA alone had minimal effects on P th, it enhanced the role of TA in controlling P th. TA and CT have antagonistic roles in controlling P th. These relationships should be considered in clinical efforts to improve ease of phonation and vocal efficiency.

Level of Evidence

N/A, basic science Laryngoscope, 2021

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Applied anatomy of the medial orbital wall

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Vestn Otorinolaringol. 2021;86(5):119-123. doi: 10.17116/otorino202186051119.

ABSTRACT

The article provides an overview of foreign and domestic studies on the anatomy of the medial wall of the orbit. Possible structural variants of the osseus structures of the medial wall and their applied clinical significance are indicated, including those having individual occurrence: additional lacrimal bone, morphological features of the structure of the fossa of the lacrimal sac, location, shape and size of the cells of the ethmoid bone, Onody cells, Haller infraorbital cell, the relative position of the anterior and posterior ethmoid foramina, the presence of additional ethmoid foramina, dysgenesis of the lacrimal bone and the orbital plate of the ethmoid bone. The anatomical prerequisites for the occurrence of intraoperative complications with surgical access to the medial wall of the orbit are described.

PMID:34783485 | DOI:10.17116/otorino202186051119

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A case of obliteration of a round window in otosclerosis

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Vestn Otorinolaringol. 2021;86(5):75-81. doi: 10.17116/otorino20218605175.

ABSTRACT

The article presents a brief review of the literature on the anatomy and physiology of the round window (RW) niche, the causes of occlusion, the diagnosis of this pathology, the features of auditory disorders and tactics when it is detected in patients with otosclerosis (OS). A clinical case of diagnosis and effective surgical treatment for obliteration of RW in a patient with advanced OS, which occurred in 2019 in 0.7% of cases, is described. Removal of RW niche obliteration was carried out with a curette and microcresis by smoothing the canopy over RW until partial visualization of the secondary membrane. It was this stage of the operation that made it possible to restore the normal hydrodynamics of the inner ear fluids and contributed to a functional result. Thus, the diagnosis of RW obliteration in patients with OS is difficult, but possible when us ing computed tomography of the temporal bones and assessing the mobility of the RW membrane or analyzing changes in hearing at the end of the operation, if it is performed under local anesthesia. The simultaneous performance of stapedoplasty and the removal of bone obliteration of RW makes it possible to safely achieve functional rehabilitation in patients with OS.

PMID:34783478 | DOI:10.17116/otorino20218605175

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The significance of microanatomy of the round window in terms of cochlear implantation

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Vestn Otorinolaringol. 2021;86(5):42-47. doi: 10.17116/otorino20218605142.

ABSTRACT

Sensoneural hearing loss is a polyetiological disease, which is often a secondary reflection of systemic pathology and is associated with damage of the cochlea and auditory nerve receptors. An important point in the surgical stage of cochlear implantation is the introduction of an implant active electrode into the cochleostomy spiral channel through the cochleostoma or round window. However, the issue of intra-cochlear structures surgical trauma in such surgical intervention seems to be very important, as it may reduce the success of subsequent rehabilitation. Therefore, the study of the anatomy of the round window and adjuscent areas was the objective of this work.

PMID:34783472 | DOI:10.17116/otorino20218605142

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Improving of the nasal cavity mucous membrane restoration efficiency of the after rhinosurgical interventions

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Vestn Otorinolaringol. 2021;86(5):63-69. doi: 10.17116/otorino20218605163.

ABSTRACT

The article discusses aspects of the use of irrigation therapy after surgical interventions on intranasal structures, in particular, the features of using the Aqua Maris Leyka device in comparison with traditional methods of nasal cavity care in this group of patients. The use of the Adriatic Sea salt solution for nasal lavage Aqua Maris using a special device in the postoperative period leads to an earlier subsidence of reactive postoperative changes in the nasal cavity, a decrease in edema, an increase of reparative processes. This is evidenced by the dynamics of clinical signs and the results of cytological examination of smears-prints from the nasal cavity. During the irrigation of the nasal cavity using the Aqua Maris Leyka device, the liquid is supplied by gravity, without additional pressure, ensuring safety and uniform irrigation of all parts of the nasal cavity with saline solution, which is especially important in the presence of reactive changes in the postoperative period.

PMID:34783476 | DOI:10.17116/otorino20218605163

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Herpangina. Clinical case

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Vestn Otorinolaringol. 2021;86(5):97-102. doi: 10.17116/otorino20218605197.

ABSTRACT

Enterovirus infections are a group of acute infectious diseases caused by enteroviruses (including Coxsackie A and B viruses, ECHO viruses), which clinically present symptoms of damage to the central nervous system, cardiovascular system, gastrointestinal tract, muscular system, mucous membranes and skin, fever. This article presents a clinical case of patient L., 12 years old, who admitted to an otorhinolaryngologist with clinical manifestations of herpangina. The diagnosis was confirmed by PCR. The patient was prescribed, adequate rehydration, diet with the exclusion of salty, spicy and fried foods, restriction of physical activity, exclusion of thermal procedures, Benzydamine Spray (Oralsept) 0.255 mg/dose, 6 doses 3 times/day, topically, on demand and inosine pranobex (Groprinosin) in a daily dose of 50 mg/kg of body weight: 1 tablet 500 mg 4 times a day for 7 days (at the rate of 1 tablet of 500 mg per 10 kg of body weight; for a patient weighing 41 kg - 4 tablets per day). On the 10th day from the onset of the disease, the docter noted a complete regression of clinical symptoms and the patient was discharged with recovery.

PMID:34783481 | DOI:10.17116/otorino20218605197

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Medicinal products in the treatment and prevention of occupational diseases of the upper respiratory tract

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Vestn Otorinolaringol. 2021;86(5):109-113. doi: 10.17116/otorino202186051109.

ABSTRACT

Occupational diseases of the upper respiratory tract (URT) represent a significant section of occupational pathology of the respiratory system, since the mucous membrane of the nasal cavity and paranasal sinuses is the outpost that first comes into contact with inhaled agents (pollutants), including professional aerosols. The pathogenesis of occupational diseases of URT is based on long-term contact of pollutants with cells of the scintillating epithelium and violation of the function of the mucociliary system of URT. Occupational diseases of URT include: chronic catarrhal, subatrophic, atrophic, hypertrophic rhinitis, rhinopharyngolaryngitis; all forms of laryngitis, laryngotracheobronchitis, allergic diseases. Treatment and prevention of these diseases should be comprehensive with the use of personal respiratory protection equipment, mandatory prev entive examinations and various local effects (inhalation, instillation, lavage, herbal medicine, etc.).

PMID:34783483 | DOI:10.17116/otorino202186051109

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Objective parameters of auditory function in premature infants in the first year of life after taking ototoxic antibiotics

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Vestn Otorinolaringol. 2021;86(5):12-16. doi: 10.17116/otorino20218605112.

ABSTRACT

OBJECTIVE: To compare the condition of auditory function during the first year of life according to the registration of distortion product otoacoustic emission (DPOAE) and short-latency evoked potentials (SLEP) in premature infants who received ototoxic antibiotics to those ones, who did not.

MATERIAL AND METHODS: Auditory function was examined in 145 premature infants. Auditory assessment was carried out by registration of DPOAEs, SLEPs and tympanometry. Statistical processing was performed using the program Statgraphics Centurion XV.

RESULTS: In this study, according to DPOAE, the average response values of the cochlea in premature infants who had a history of ototoxic therapy, undergo final changes after children reach the age of 6 months. The study of latent periods and threshold values of the V peak of SLEP showed a delay in the maturat ion process of the perceiving and conducting auditory structures during the first year of life in children who received ototoxic antibiotics in the first month of life.

CONCLUSION: We evaluated the timing of the completion of response changes in children of the control group using the DPOAE and SLEP registration data. In children of the study group, we evaluated the effect of the administered ototoxic antibiotics. Timing of audiological control of the hearing organ condition are demonstrated for premature children after ototoxicosis, required methods of its examination are established.

PMID:34783467 | DOI:10.17 116/otorino20218605112

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