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

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Τρίτη 12 Ιανουαρίου 2021

Early Physiological and Cellular Indicators of Cisplatin-Induced Ototoxicity

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Abstract

Cisplatin chemotherapy often causes permanent hearing loss, which leads to a multifaceted decrease in quality of life. Identification of early cisplatin-induced cochlear damage would greatly improve clinical diagnosis and provide potential drug targets to prevent cisplatin's ototoxicity. With improved functional and immunocytochemical assays, a recent seminal discovery revealed that synaptic loss between inner hair cells and spiral ganglion neurons is a major form of early cochlear damage induced by noise exposure or aging. This breakthrough discovery prompted the current study to determine early functional, cellular, and molecular changes for cisplatin-induced hearing loss, in part to determine if synapse injury is caused by cisplatin exposure. Cisplatin was delivered in one to three treatment cycles to both male and female mice. After the cisplatin treatment of three cycles, threshold shift was observed across frequencies tested like previous studies. After t he treatment of two cycles, beside loss of outer hair cells and an increase in high-frequency hearing thresholds, a significant latency delay of auditory brainstem response wave 1 was observed, including at a frequency region where there were no changes in hearing thresholds. The wave 1 latency delay was detected as early cisplatin-induced ototoxicity after only one cycle of treatment, in which no significant threshold shift was found. In the same mice, mitochondrial loss in the base of the cochlea and declining mitochondrial morphometric health were observed. Thus, we have identified early spiral ganglion-associated functional and cellular changes after cisplatin treatment that precede significant threshold shift.

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Clinical and survival analysis of nasopharyngeal carcinoma with consistently negative Epstein–Barr virus DNA

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Abstract

Background

To assess the clinical and survival features of nasopharyngeal carcinoma (NPC) with consistently negative Epstein–Barr virus (EBV) DNA level.

Methods

Propensity score matching (PSM) method was used to create well‐balanced cohorts. Kaplan–Meier method and Cox proportional hazards models were performed to conduct survival analysis.

Results

Four hundred and eighty patients were enrolled. Patients with consistently negative plasma EBV DNA level had a greater chance to present a relatively earlier T and N classification compared with those with positive EBV DNA level (p < .001; p = .015). And patients with consistently negative EBV level were significantly associated with preferable 3‐year DFS (95.0% vs. 84.4%, p = .004), DMFS (98.3% vs. 89.4%, p = .009), and OS (100% vs. 97.6%, p = .004).

Conclusions

NPC patients with consistently negative EBV DNA level performed an earlier clinical stage and negative EBV DNA level was related to preferable survival outcomes.

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Odontogenic infection and antiresorptive agent-related osteonecrosis of the jaw with facial subcutaneous abscess formation: A retrospective clinical study of difficult-to-diagnose cases

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Publication date: Available online 9 January 2021

Source: Auris Nasus Larynx

Author(s): Yuma Matsumoto, Hidenori Yokoi, Tetsuya Ikeda, Michitsugu Kawada, Masataka Ogawa, Koichiro Saito

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Management of tracheostomy in COVID-19 patients: The Japanese experience

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Publication date: Available online 9 January 2021

Source: Auris Nasus Larynx

Author(s): Taizo Yokokawa, Yosuke Ariizumi, Mariko Hiramatsu, Yujin Kato, Kazuhira Endo, Kazufumi Obata, Kayoko Kawashima, Toshifumi Sakata, Shigeru Hirano, Torahiko Nakashima, Tatsurou Sekine, Asanori Kiyuna, Saeko Uemura, Keisuke Okubo, Taro Sugimoto, Ichiro Tateya, Yasushi Fujimoto, Arata Horii, Yurika Kimura, Masamitsu Hyodo

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A Novel Visualization System of Using Augmented Reality in Knee Replacement Surgery: Enhanced Bidirectional Maximum CorrentropyAlgorithm

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Abstract

Background and aim

Image registration and alignment are the main limitations of augmented reality‐based knee replacement surgery. This research aims to decrease the registration error, eliminate outcomes that are trapped in local minima to improve the alignment problems, handle the occlusion and maximize the overlapping parts.

Methodology

markerless image registration method was used for Augmented reality‐based knee replacement surgery to guide and visualize the surgical operation. While weight least square algorithm was used to enhance stereo camera‐based tracking by filling border occlusion in right to left direction and non‐border occlusion from left to right direction.

Results

This study has improved video precision to 0.57 mm ∼ 0.61 mm alignment error. Furthermore, with the use of bidirectional points, i.e. Forwards and backwards directional cloud point, the iteration on image registration was decreased. This has led to improved t he processing time as well. The processing time of video frames was improved to 7.4 ∼11.74 fps.

Conclusions

It seems clear that this proposed system has focused on overcoming the misalignment difficulty caused by movement of patient and enhancing the AR visualization during knee replacement surgery. The proposed system was reliable and favourable which helps in eliminating alignment error by ascertaining the optimal rigid transformation between two cloud points and removing the outliers and non‐Gaussian noise. The proposed augmented reality system helps in accurate visualization and navigation of anatomy of knee such as femur, tibia, cartilage, blood vessels, etc.

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Evaluation and comparison of tympanoplasty efficacy with tympanic membrane perforation after chronic suppurative otitis media in dry ear with different microorganisms

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Publication date: Available online 9 January 2021

Source: American Journal of Otolaryngology

Author(s): Bingbing Yang, Linghao Zhang, Xiaoyun Chen

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Predominant Vertical Location of Benign Vocal Fold Lesions by Sex and Music Genre: Implication for Pathogenesis

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Objectives/Hypothesis

Vertical locations of vocal fold mucosal lesions (VFMLs) vary along the free edge. As the vertical contact area of vocal folds (VFs) depends on the vocal register, lesions may occur in the contact area of more frequently used vocal registers. This study investigated the cause of location variations by comparing the vertical sites of VFMLs in singers of both sexes with different music genres.

Study Design

Retrospective review.

Methods

Sixty professional classical and rock singers (11 male classical [M‐classical], 22 male rock [M‐rock], 13 female classical [F‐classical], and 14 female rock [F‐rock] singers) who underwent microlaryngeal surgery for VF polyps and nodules and their 108 lesions were enrolled. The VF free edge was vertically divided into three equal parts and classified into the following four lesion sites: upper, middle, lower, and multiple sites.

Results

Upper lesions were most common among F‐classical singers (73.9%), whereas lower lesions were most common among M‐classical (90.0%) and M‐rock (60.6%) singers. Among lesions localized to a single site, lower lesions were most common among F‐rock singers (37.0%). F‐classical singers had significantly more upper lesions than the other groups (P < .001). M‐classical singers had significantly more lower lesions than female singers of any genre (P < .001).

Conclusion

Upper lesions were most common among F‐classical singers who mostly used the head voice. Lower lesions were most common among singers who mainly used the modal voice. This study suggests that sex, the dominant vocal register used for singing, and mechanical stress on VFs influence the vertical site of VFMLs.

Level of Evidence

4 Laryngoscope, 2021

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Surgical Management of Cervical Non‐seminomatous Germ Cell Tumor Metastases

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Objective/Hypothesis

Testicular cancer is the most common malignancy of young males. Limited reports describe perioperative and long‐term outcomes after surgical resection of metastatic, cervical, non‐seminomatous germ cell tumors (NSGCT). The objective of this study was to investigate the effectiveness and safety of cervical lymphadenectomy in the management of metastatic NSGCT.

Study Design

Retrospective case series.

Methods

A single institution, retrospective review from 1998 to 2020 of patients with metastatic NSGCT who underwent cervical lymphadenectomy was conducted. Clinicopathological, surgical, and postoperative data were collected and analyzed.

Results

Sixty‐eight predominantly white (91.0%) male patients with mean age 33.0 ± 11.3 years were included. Most (82.2%) presented with stage III disease at initial diagnosis. All patients had undergone primary platinum‐based chemotherapy 1.0 to 22.7 months prior to selective ND. Surgery mainly involved nodal levels III (67.6%), IV (92.6%) and/or Vb (77.9%) and was frequently performed with concomitant thoracoabdominal NSGCT resections (63.2%). Cervical specimens predominantly revealed mature teratoma (83.8%) as solitary (69.1%) or component of mixed (14.7%) NSGCT. Ten (14.7%) perioperative complications occurred as vocal cord paresis (n = 6) from thoracic surgery and chyle leakage (n = 4). All resolved conservatively except two vocal cord paralyzes that required surgical repair due to tumor involvement of vagus nerve. Six instances of cervical recurrence occurred at median 12.5 (range, 5.8–38.6) months from ND, all re‐demonstrating purely mature teratoma. The two‐year cervical, non‐cervical, and overall recurrence‐free survivals were 83%, 55%, and 55%, respectively. Two‐year disease‐free and overall survivals were both 93%.

Conclusions

Selective neck dissection is a safe, effective method for managing cervical NSGCT metastases.

Level of Evidence

IV Laryngoscope, 2021

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A Novel Solution of Using Mixed Reality in Bowel and Oral and Maxillofacial Surgical Telepresence: 3D Mean Value Cloning algorithm

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Abstract

Background and aim

Most of the Mixed Reality models used in the surgical telepresence are suffering from the discrepancies in the boundary area and spatial‐temporal inconsistency due to the illumination variation in the video frames. The aim behind this work is to propose a new solution that helps produce the composite video by merging the augmented video of the surgery site and virtual hand of the remote expertise surgeon. The purpose of the proposed solution is to decrease the processing time and enhance the accuracy of merged video by decreasing the overlay and visualization error and removing occlusion and artefacts.

Methodology

The proposed system enhanced mean value cloning algorithm that helps to maintain the spatial‐temporal consistency of the final composite video. The enhanced algorithm includes the 3D mean value coordinates and improvised mean value interpolant in the image cloning process, which helps to reduce the sawtooth, smudging and discoloration artefacts around the blending region.

Results

The accuracy in terms of overlay error of the proposed solution is improved from 1.01mm to 0.80mm whereas the accuracy in terms of visualization error is improved from 98.8% to 99.4%. The processing time is reduced to 0.173 seconds from 0.211 seconds. The processing time and the accuracy of the proposed solution are enhanced as compared to the state of art solution.

Conclusion

Our solution helps make the object of interest consistent with the light intensity of the target image by adding the space distance that helps maintain the spatial consistency in the final merged video.

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Neuroprotectin D1 Attenuates Blast Overpressure Induced Reactive Microglial Cells in the Cochlea

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Objective/Hypothesis

We examined a neuroinflammatory response associated with glial activation in the cochlea exposed to blast overpressure and evaluated the potential therapeutic efficacy of specialized pro‐resolving mediators such as neuroprotectin D1, NPD1; (10R, 17S‐dihydroxy‐4Z, 7Z, 11E, 13E, 15Z, 19Z‐docosahexaenoic acid) in a rodent blast‐induced auditory injury model.

Study Design

Animal Research.

Methods

A compressed‐air driven shock tube was used to expose anesthetized adult male Long‐Evan rats to shock waves simulating an open‐field blast exposure. Approximately 30 minutes after blast exposure, rats were treated with NPD1 (100 ng/kg body wt.) or vehicle delivered intravenously via tail vein injection. Rats were then euthanized 48 hours after blast exposure. Unexposed rats were included as controls. Tissue sections containing both middle and inner ear were prepared with hematoxylin–eosin staining to elucidate histopathological changes associated with blast exposure. Cochlear tissues were evaluated for relative expression of ionized calcium‐binding adaptor 1 (Iba1), as an indicator of microglial activation by immunohistochemistry and western blot analyses.

Results

Our animal model resulted in an acute injury mechanism manifested by damage to the tympanic membrane, hemorrhage, infiltration of inflammatory cells, and increased expression of Iba1 protein. Moreover, therapeutic intervention with NPD1 significantly reduced Iba1 expression in the cochlea, suggesting a reduction of a neuroinflammatory response caused by blast overpressure.

Conclusions

Blast overpressure resulted in an increased expression of proteins involved in gliosis within the auditory system, which were reduced by NPD1. Treatment of NPD1 suggests an effective strategy to reduce or halt auditory microglial cell activation due to primary blast exposure.

Level of Evidence

N/A Laryngoscope, 2021

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Longitudinal Assessment of Frailty and Quality of Life in Patients Undergoing Head and Neck Surgery

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Objective

To understand changes in frailty and quality of life (QOL) in frail versus non‐frail patients undergoing surgery for head and neck cancer (HNC).

Methods

Prospective cohort study of patients (median age 67 (50, 88)) with HNC undergoing surgery from December 2011 to April 2014. Fried's Frailty Index, Vulnerable Elders Survey (VES‐13), and comprehensive QOL assessments (EORTC QLQ‐C30 and HN35) were completed at baseline and 3, 6, and 12‐month post‐operative visits. Change in frailty and QOL over time was compared between frailty groups (non‐frail (score 0), pre‐frail (score 1–2), and frail (score 3–5)) using a mixed effects model. Predictors of long‐term elevated frailty (12 months > baseline) were analyzed using logistic regression.

Results

The study had 108 patients classified as non‐frail (47%), 104 pre‐frail (mean (SD) 1.3 (0.4), 45%), and 17 frail (3.4 (0.6); 7%). Frailty score decreased significantly for frail patients 3 months post‐operatively (2.1 (1.0); P = .002) and remained significantly lower than baseline at 6 and 12 months (2.1 (1.4); P = .0008 and 2.2 (1.5); P = .005, respectively) while frailty score increased for non‐frail patients at 3 months (1.1 (1.0); P < .001) and then decreased. Forty‐eight patients (21%) had long‐term elevated frailty, with baseline frailty and marital status identified as predictors on univariate analysis. The frail population had significantly worse QOL scores at baseline, which persisted 12 months post‐operatively.

Conclusions

Frail patients demonstrate a decrease in frailty score following surgical treatment of HNC. Frail patients have significantly worse QOL scores on longitudinal assessment and would benefit from supportive services throughout their care.

Level of Evidence

3 Laryngoscope, 2021

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Postoperative Disposition Following Pediatric Sistrunk Procedures: A National Database Query

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Objective/Hypothesis

Variability exists in the postoperative disposition of children following Sistrunk procedures. Management options include discharge home versus overnight observation, with the latter allowing monitoring for immediate postoperative complications, presumably reducing the need for subsequent readmission. This study investigates the association between overnight observation and ambulatory management of children undergoing Sistrunk procedures and relevant postoperative complication and revisit rates to clarify best practice for these patients.

Methods

This was a retrospective database review using the Pediatric Health Information System database from 2007 to 2016.

Results

The cited dataset identified 6,434 qualifying patients, categorized into ambulatory versus overnight observation cohorts. The overall 30‐day revisit rate was 4.9%; the revisit rate with overnight observation (6.1%) was higher than for ambulatory patients (3.8%, adjusted odds ratio (OR) 1.60; 95% confidence interval (CI): 1.21, 2.12). Revisit rates were significantly higher in patients 2 years of age or younger compared to older patients (6.7% vs. 4.3%). The rates of return to the operating room for the observation versus ambulatory groups were 1.8% and 0.5%, respectively. Cervical fluid collection and neck swelling were among the most common revisit indications in both groups, with a mean time to presentation of 9 days.

Conclusions

This study demonstrates that ambulatory management following a Sistrunk procedure is not associated with increased rates of common postoperative complications, readmission, or need for secondary surgical intervention. A Sistrunk procedure may be safely performed on an ambulatory basis in select cases.

Level of Evidence

IV Laryngoscope, 2021

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