Endoscopic Versus Microscopic Type‐1 Tympanoplasty: A Meta‐Analysis of Randomized Trials

alexandrossfakianakis shared this article with you from Inoreader Endoscopic Versus Microscopic Type‐1 Tympanoplasty: A Meta‐Analysis of Randomized Trials via The Laryngoscope Although microscope-assisted tympanoplasty remains the gold standard, the merits of endoscopic approaches have been well-documented. This meta-analysis compares the outcomes of endoscopic to microscopic tympanoplasty incorporating only randomized trials. The result from this meta-analysis provides level 1 evidence demonstrating that endoscopic and microscopic-assisted type-1 tympanoplasty have similar outcomes in both graft success and hearing improvement, with endoscopic approaches yielding a shorter operative time. Objectives Totally endoscopic ear surgery is becoming increasingly utilized in otologic practice. Although the well-established microscope-assisted tympanoplasty remains the most common technique to repair a tympanic membrane defect, the merits of endoscopic approaches have been well-documented. This systematic review and meta-analysis compares the outcomes of endoscopic to microscopic tympanoplasty incorporating only randomized trials. Study Design Systematic review and meta-analysis. Methods A comprehensive search of PubMed/MEDLINE, Scopus, Cochrane Library, and EMBASE was conducted. All randomized studies comparing endoscopic to microscopic tympanoplasty were collected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Quality assessment was carried out utilizing the Risk of Bias 2. Results The initial search identified 1711 studies, of which 9 met the inclusion criteria comprising of 540 patients (microscopic tympanoplasty 51.5%; endoscopic tympanoplasty 49.5%). The mean age was 32.5 years with a similar number of males (50.1%) and females (49.9%). Both endoscopic and microscopic groups had comparable outcomes with regards to graft success rate (RD 0.00; 95% confidence interval [CI], −0.04 to. 0.05; p = 0.87) and hearing improvement (MD 0.57 dB; 95% CI, −1.23 to 2.36; p = 0.54). A significantly shorter operative time was noted in the endoscopic group (MD, −24.73 min; 95% CI, −38.56 to −10.89; p = 0.0005). Conclusion Our results, assimilating level 1 evidence, demonstrates that endoscopic and microscopic-assisted type-1 tympanoplasty have similar outcomes in both graft success and hearing improvement, with endoscopic approaches yielding a shorter operative time. Level of Evidence 1 Laryngoscope, 2022 View on Web

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A GntR Family Transcription Factor in Porphyromonas gingivalis Regulates Bacterial Growth, Acylpeptidyl Oligopeptidase and Gingipains Activity

alexandrossfakianakis shared this article with you from Inoreader A GntR Family Transcription Factor in Porphyromonas gingivalis Regulates Bacterial Growth, Acylpeptidyl Oligopeptidase and Gingipains Activity via Molecular Oral Microbiology SUMMARY Porphyromonas gingivalis (P. gingivalis) is a keystone pathogen for periodontitis. The function of the GntR family transcription factor is poorly studied in P. gingivalis. Numerous processes govern bacterial growth. The survival and pathogenicity of P. gingivalis depend heavily on its capacity to acquire amino acids as nutritional sources. In this investigation, a GntR transcription factor, pg1007, was identified in P. gingivalis, the deletion of which significantly inhibited bacterial growth. The mutant strain also exhibited increased extracellular activity of gingipains and acylpeptidyl oligopeptidase (AOP). Global gene expression profiling revealed that the expression levels of 59 genes were significantly altered in the Δpg1007 mutant, with an up-regulation in gene expression for AOP, ABC transporters, and some membrane proteins. In addition, His-PG1007 protein was purified as a recombinant protein from Escherichia coli, and the conserved DNA sequence bound by it was determined using electrophoretic mobility shift assays (EMSA) and DNase I footprinting assays. Consequently, this study demonstrated that pg1007 is a crucial transcription factor in P. gingivalis and regulates the bacterial growth and activity of gingipains and AOP. These findings may enhance our understanding of the regulation of bacterial proliferation and protease activity in P. gingivalis. This article is protected by copyright. All rights reserved View on Web

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CytoSorb haemoadsorption for removal of apixaban—A proof‐of‐concept pilot case for a randomized controlled trial

alexandrossfakianakis shared this article with you from Inoreader CytoSorb haemoadsorption for removal of apixaban—A proof‐of‐concept pilot case for a randomized controlled trial via Journal of Clinical Pharmacy and Therapeutics Timely discontinuation of NOAC's therapy before surgery is not always achievable, especially in an emergency setting. This case report proves, with direct blood concentration measurements, the efficacy of CytoSorb hemofilter in apixaban removal during cardiopulmonary bypass for emergency aortic valve replacement. Abstract What is known and objective Emergent cardiac surgery in patients under anticoagulant therapy is still a major point of concern. Recently approved reversal agents are often not available or not suitable in the cardiac surgery setting, and timely discontinuation of the drug is not always feasible. CytoSorb® haemoadsorption therapy has been approved in Europe for intraoperative ticagrelor and rivaroxaban removal during cardiopulmonary bypass (CPB), but thus far the efficacy of CytoSorb® haemoadsorber on other anticoagulants (apixaban, dabigatran, edoxaban) has only been tested in vitro, and some signals of clinical benefits have reported in a few case reports. Case summary We describe a case of CPB implementation with CytoSorb® in a haemodynamic unstable patient with prosthetic aortic valve endocarditis on apixaban therapy. What is new and conclusion CytoSorb® proved to be effective for removal of apixaban in emergency surgery setting by direct measurements of drug levels before and during CPB circulation. View on Web

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Clinical outcomes of pediatric patients receiving multimodality treatment of second central nervous system relapse of neuroblastoma

alexandrossfakianakis shared this article with you from Inoreader Clinical outcomes of pediatric patients receiving multimodality treatment of second central nervous system relapse of neuroblastoma via Pediatric Blood & Cancer Abstract Background In high-risk neuroblastoma, multimodality therapy including craniospinal irradiation (CSI) is effective for central nervous system (CNS) relapse. Management of post-CSI CNS relapse is not clearly defined. Procedure Pediatric patients with neuroblastoma treated with CSI between 2000 and 2019 were identified. Treatment of initial CNS disease (e.g., CSI, intraventricular compartmental radioimmunotherapy [cRIT] with 131I-monoclonal antibodies targeting GD2 or B7H3) and management of post-CSI CNS relapse ("second CNS relapse") were characterized. Cox proportional hazards models to evaluate factors associated with third CNS relapse and overall survival (OS) were used. Results Of 128 patients (65% male, median age 4 years), 19 (15%) received CSI with protons and 115 (90%) had a boost. Most (103, 81%) received cRIT, associated with improved OS (hazard ratio [HR] 0.3, 95% confidence interval [CI]: 0.1–0.5, p < .001). Forty (31%) developed a second CNS relapse, associated with worse OS (1-year OS 32.5%, 95% CI: 19-47; HR 3.8; 95% CI: 2.4–6.0, p < .001), and more likely if the leptomeninges were initially involved (HR 2.5, 95% CI: 1.3–4.9, p = .006). Median time to second CNS relapse was 6.8 months and 51% occurred outside the CSI boost field. Twenty-five (63%) patients underwent reirradiation, most peri-operatively (18, 45%) with focal hypofractionation. Eight (20%) patients with second CNS relapse received cRIT, associated with improved OS (HR 0.1; 95% CI: 0.1–0.4, p < .001). Conclusions CNS relapse after CSI for neuroblastoma portends a poor prognosis. Surgery with hypofractionated radiotherapy was the most common treatment. Acknowledging the potential for selection bias, receipt of cRIT both at first and second CNS relapse was associated with improved survival. This finding necessitates further investigation. View on Web

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Tracheal stent aspergillosis occurring after aortic allograft of the trachea

alexandrossfakianakis shared this article with you from Inoreader Tracheal stent aspergillosis occurring after aortic allograft of the trachea via Transplant Infectious Disease Abstract Background Aspergillosis is a fungal infection with many clinical forms. Invasive aspergillosis is the most widely known severe manifestation but other forms can need intensive care. Aim Our purpose is to report a case of tracheal aspergilloma and provide a review of the literature concerning endobronchial aspergillus. Method We report a case of tracheal aspergilloma causing tracheal obstruction in a patient admitted in the ICU for respiratory distress. The aspergilloma occurred in a tracheal stent implanted during tracheal allograft for tracheal cancer. A combination of local and systemic antifungal was used with successful result. This article is protected by copyright. All rights reserved View on Web

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Global survival trends for brain tumors, by histology: analysis

alexandrossfakianakis shared this article with you from Inoreader Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000–2014 (CONCORD-3) via Neuro-Oncology Advance Access Abstract Background Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology. Methods We analyzed individual data for adults (15–99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000–2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator. Results The study included 556,237 adults. In 2010–2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%–38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in s urvival occurred between 2000–2004 and 2005–2009. These improvements were more noticeable among adults diagnosed aged 40–70 years than among younger adults. Conclusions To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines. View on Web

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Posttraumatic Lingual Artery Pseudoaneurysm and Synchronous Multiple Pneumatosis in a Child

alexandrossfakianakis shared this article with you from Inoreader Posttraumatic Lingual Artery Pseudoaneurysm and Synchronous Multiple Pneumatosis in a Child via JAMA Otolaryngology–Head & Neck Surgery Current Issue This case report describes a lingual artery pseudoaneurysm in a child after a low-energy, blunt, neck trauma accompanied by subcutaneous emphysema, pneumothorax, pneumomediastinum, pneumopericardium, pneumoperitoneum, and pneumorrhachis. View on Web

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Surveillance for Survivors of Locoregionally Advanced Head and Neck Cancer

alexandrossfakianakis shared this article with you from Inoreader Surveillance for Survivors of Locoregionally Advanced Head and Neck Cancer via JAMA Otolaryngology–Head & Neck Surgery Current Issue The evaluation and management of head and neck cancers is an area of intense research and data-driven recommendations. However, once a patient completes definitive treatment for a head and neck cancer, there is surprisingly little evidence to guide the surveillance and long-term management of these patients. Most guidelines, such as those of the National Comprehensive Cancer Network, are based primarily on expert opinion and take a one-size-fits-all approach to head and neck cancers. However, the long-term prognoses of head and neck cancers vary widely, depending on numerous factors, such as subsite, staging, human papillomavirus (HPV) status for oropharyngeal cancers, and other tumor and patient characteristics. Furthermore, surveillance visits represent a substantial use of clinical resources, time, and patient expense for many years after cancer treatment. Clearly, this is an area in need of evidence-based approaches to ensure optimal patient care. View on Web

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BMI and Venous VTE Rates in Patients on Standard Chemoprophylaxis Regimens After H&N Surgery

alexandrossfakianakis shared this article with you from Inoreader BMI and Venous VTE Rates in Patients on Standard Chemoprophylaxis Regimens After H&N Surgery via JAMA Otolaryngology–Head & Neck Surgery Current Issue This cohort study assesses whether there is an association between body mass index and postoperative venous thromboembolism and hematoma rates in patients treated with prophylactic enoxaparin 30 mg twice daily. View on Web

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Cetuximab-Based vs Carboplatin-Based Chemoradiotherapy for Patients With Head and Neck Cancer

alexandrossfakianakis shared this article with you from Inoreader Cetuximab-Based vs Carboplatin-Based Chemoradiotherapy for Patients With Head and Neck Cancer via JAMA Otolaryngology–Head & Neck Surgery Current Issue This cohort study compares survival with cetuximab-based and carboplatin-based chemoradiotherapy in locally advanced head and neck squamous cell carcinoma. View on Web

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Assessment of Fat Fractions in the Tongue, Soft Palate, Pharyngeal Wall, and Parapharyngeal Fat Pad by the GOOSE and DIXON Methods

alexandrossfakianakis shared this article with you from Inoreader Assessment of Fat Fractions in the Tongue, Soft Palate, Pharyngeal Wall, and Parapharyngeal Fat Pad by the GOOSE and DIXON Methods via Investigative Radiology - Current Issue Objective The 2-point DIXON method is widely used to assess fat fractions (FFs) in magnetic resonance images (MRIs) of the tongue, pharyngeal wall, and surrounding tissues in patients with obstructive sleep apnea (OSA). However, the method is semiquantitative and is susceptible to B0 field inhomogeneities and R2* confounding factors. Using the method, although several studies have shown that patients with OSA have increased fat deposition around the pharyngeal cavity, conflicting findings was also reported in 1 study. This discrepancy necessitates that we examine the FF estimation method used in the earlier studies and seek a more accurate method to measure FFs. Materials and Methods We examined the advantages of using the GOOSE (globally optimal surface estimation) method to replace the 2-point DIXON method for quantifying fat in the tongue and surrounding tissues on MRIs. We first used phantoms with known FFs (true FFs) to validate the GOOSE method and examine the errors in the DIXON method. Then, we compared the 2 methods in the tongue, soft palate, pharyngeal wall, and parapharyngeal fat pad of 63 healthy participants to further assess the errors caused by the DIXON method. Six participants were excluded from the comparison of the tongue FFs because of technical failures. Paired Student t tests were performed on FFs to detect significant differences between the 2 methods. All measures were obtained using 3 T Siemens MRI scanners. Results In the phantoms, the FFs measured by GOOSE agreed with the true FF, with only a 1.2% mean absolute error. However, the same measure by DIXON had a 10.5% mean absolute error. The FFs obtained by DIXON were significantly lower than those obtained by GOOSE (P View on Web

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