Quality of life after extended versus transsellar endoscopic skull base surgery from 767 patients

Objectives/Hypothesis

The aim of this study was to compare sinonasal‐related quality of life (QOL) in patients treated by extended or transsellar endoscopic skull base surgery.

Study Design

Prospective data analysis.

Methods

Prospectively collected data from patients who underwent endoscopic skull base surgery between 2012 and 2017 were analyzed. Primary outcomes were preoperative Sino‐Nasal Outcome Test‐20 (SNOT‐20) scores and then 1‐month, 3‐month, and 6‐month follow‐up. Comparative analysis was performed between the endoscopic transsellar approach (ETA) group (n = 647) and an extended endoscopic endonasal approach (EEEA) group (n = 120). In ETA group, the SNOT‐20 score was compared between patients with a nasoseptal flap (NSF) (ETA‐NSF) and without an NSF (ETA‐no NSF).

Results

The mean total SNOT‐20 score was significantly worse in the EEEA than ETA group at 1, 3, and 6 months postoperatively (P < .05). Although there was no significant difference in total SNOT‐20 score between the ETA‐NSF and ETA‐no NSF group at 3 and 6 months after surgery, the percentage of patients with significant change (≥0.8) in the SNOT‐20 score was higher in the NSF used group at 1, 3, and 6 months postoperatively (22.92% vs. 13.51%, P = .029; 20.59% vs. 5.59%, P = .039; and 24.00% vs. 4.03%, P = .003, respectively). According to multivariate analysis conducted regarding factors that deteriorate sinonasal QOL at 6 months following surgery, only NSF usage is significantly associated with poor outcome (odds ratio: 4.371, P = .011)

Conclusions

Sinonasal‐related QOL was significantly worse in patients treated by the EEEA versus ETA. Use of an NSF is the only poor prognostic factor in sinonasal QOL after endoscopic skull base surgery.

Level of Evidence

2b Laryngoscope, 2018

https://ift.tt/2UYp8sM

Dental Lasers

Editor's message Naresh Thukral Journal of Dental Lasers 2018 12(2):45-45

An update on the effect of low-level laser therapy on growth factors involved in oral healing Ashwini Savia Colaco Journal of Dental Lasers 2018 12(2):46-49 Low-level laser therapy (LLLT) refers to irradiation with red-beam or near-infrared lasers that are typically of narrow spectral width to pathology to reduce inflammation, pain, and promote tissue regeneration. Lasers have varied and growing applications in the field of medicine. This technology has attracted major interest in the field of tissue engineering and healing. The goal of this review is to present the biological action of LLLT on various growth factors involved in oral healing. This article highlights the series of photochemical reactions, mechanism of action, and synthesis of several cytokines. Furthermore, it elucidates the cellular responses to LLLT providing insight into the current strategies that promote healing. This review was based on electronic search of scientific papers from 2000 to 2017 which was accomplished using PubMed and MEDLINE search engines to include relevant scientific citations from the peer-reviewed journals published in English. A total of 68 articles were included, of which 23 were excluded based on the exclusion criteria. The remaining 45 articles were evaluated, and specific information was retrieved from relevant 22 articles. The 22 articles included review articles and in vivo and in vitro studies that discussed in detail the effect of lasers on various growth factors. LLLT has a biomodulating effect on oral healing. LLLT influences the release of chemical mediators, reduces the duration of inflammation, and consequently promotes tissue repair. LLLT has therapeutic actions on the growth factors involved in oral healing and hence accelerates healing.

Knowledge and practices of dental lasers among dental professionals in India: A survey-based study Sudha Yadav, Sarika Chaudhry, Sangeeta Talwar, Mahesh Verma Journal of Dental Lasers 2018 12(2):50-55 Aim: This study aims to assess the attitude, awareness, and knowledge of the dental professionals regarding dental lasers in India. Materials and Methods: This survey was conducted at the 69th Indian Dental Conference, 2016, after approval from the organizing committee. Three-hundred copies of the questionnaire were distributed among the practitioners attending the conference. The questionnaire consisted of 23 questions. The first part of the questionnaire was about dental laser education and the second part was about the knowledge of dental laser applications. The second part was divided into six subsections. Each section consisted of several items related to the uses of laser in five different dental specialties in addition to a section on laser protection. Results: Only 21% of the respondents had received any formal training before the use of lasers. Most of the participants had insufficient knowledge regarding the applications of laser in dentistry. Students' knowledge of the uses of dental laser in periodontics, oral surgery, and operative dentistry was better than their knowledge in pediatric dentistry, orthodontic, and endodontics. Conclusion: The results of this survey suggest that there is a need to educate and train dental professionals regarding dental lasers to utilize this new technology to its full potential in future.

Diode laser in the treatment of dentinal hypersensitivity: A reliable approach Rekha Bilichodmath, R Vinaya Kumar, Shivaprasad Bilichodmath, Ume Sameera Journal of Dental Lasers 2018 12(2):56-62 Aim: The purpose of this prospective clinical study was to compare the clinical efficacy of diode laser and topical 0.4% stannous fluoride (SnF2) gel in the management of dentinal hypersensitivity (DH). Materials and Methods: A total of 8 patients contributing 200 teeth with DH were enrolled in the study. The sensitive teeth were randomly allocated into 4 groups of 50 each: Group I teeth were treated with 0.4% SnF2 only; Group II with 0.4% SnF2 and diode laser irradiation in continuous, noncontact mode; Group III with diode laser only in continuous, noncontact mode; and Group IV with SnF2 and diode laser in continuous, contact mode. Pain/sensitivity was recorded using the visual analog scale before treatment, 10 min after treatment and 7, 15, and 30 days posttherapy.Results: All the groups showed significant reduction in DH. However, the use of both 0.4% SnF2 and diode laser in contact and noncontact mode showed statistically significant reduction in sensitivity (P < 0.001) when compared to SnF2 gel and diode laser alone. Conclusion: The adjunctive use of diode laser with SnF2 appears to be a promising treatment alternative in alleviating sensitivity.

Release of ankyloglossia using diode laser Akanksha Samvedi, MM Dayakar, Prakash Pai, George Philip, H Shivanand Journal of Dental Lasers 2018 12(2):63-66 Ankyloglossia is defined as a condition in which the tip of the tongue cannot be protruded beyond the lower incisor teeth because of a short lingual frenulum. The prevalence of ankyloglossia is 4.8%. An unusually short lingual frenum results in complications in speech, oral hygiene, lingual recession, etc. To have a healthy lifestyle, treatment becomes necessary. Lingual frenectomy is the treatment of choice. With the advent of lasers, the treatment has become simple, precise, and less discomfort compared to the conventional. The present case report deals with the treatment of ankyloglossia using 980 nm diode laser.

Excision of traumatic fibroma by diode laser Praveen Raj Jain, Shefali Jain, Shilpi Awadhiya, Priyank Sethi Journal of Dental Lasers 2018 12(2):67-69 Irritation fibroma is the most common tumor-like and submucosal reactive lesion in the oral cavity that composed of fibrous or connective tissue causing by traumatic irritants such as calculi, foreign bodies, chronic biting, overhanging margin restoration, sharp spicules of bones, and overextended borders of appliances. It is a well-defined lesion, slow in growth, and can occur in any age group but is more prevalent in the third, fourth, and fifth decades with a female predilection. The tumor may be small or may increase to several centimeters in diameter. The tumor may become irritated and inflamed and sometimes may even show ulcers, which is superficial in nature. The lesions are nonsymptomatic, and the patient usually reports for treatment due to the problem and discomfort during mastication. The fibroma appears as a nodular growth mainly on the buccal mucosa along the occlusal plane. Other common sites are the gingiva, palate, lips, and the tongue. The management of this reactive lesion can be done through conservative surgical approach.

Teeth bleaching using diode laser as an adjunct to a bleaching agent Shivaprasad Bilichodmath, Veenadharini Gundapaneni, Anju Cecil, Rekha Bilichodmath Journal of Dental Lasers 2018 12(2):70-73 The use of hydrogen peroxide (H2O2) for conventional bleaching was introduced way back in 1884. Today bleaching products are often found in the form of gels containing various concentrations of carbamide peroxide and H2O2depending on the application and methods. Laser-assisted tooth bleaching has proven faster and efficient results. This case report emphasizes on the efficacy of diode laser for tooth bleaching. Opalescent® (Potassium nitrate and fluoride) was used as a bleaching gel. Diode laser (810 nm) was used to irradiate the tooth surfaces and microabrasion was carried out. Visible reduction in tooth discoloration was seen after a period of 3 weeks. On the basis of the results obtained, diode laser can be considered as an efficient and reliable treatment modality compared to conventional bleaching.

Diode laser for lingual frenectomy Soni Bista, Khushbu Adhikari, Charanjeet Singh Saimbi, Bikash Agrahari Journal of Dental Lasers 2018 12(2):74-76 Ankyloglossia or tongue tie is characterized by short lingual frenum restricting tongue movement which causes feeding difficulties and speech problems. Such condition can be treated by frenectomy using scalpel, laser, and electrocautery. The present case reports ankyloglossia in an 11-year-old female patient treated with diode laser and followed up without any complications.

Fwd: Ultrasound grayscale ratio in differentiating markedly hypoechoic and anechoic minimal thyroid nodules

Ultrasound grayscale ratio in differentiating markedly hypoechoic and anechoic minimal thyroid nodules
To:

 p. 1567
Zhi-Kai Lei, Ming-Kui Li, Ding-Cun Luo, Zhi-Jiang Han
DOI:10.4103/jcrt.JCRT_1031_17  
Purpose: This study explored ultrasound grayscale ratios (USGRs) for differentiating markedly hypoechoic and anechoic minimal thyroid nodules. Materials and Methods: Longitudinal scan images of 193 markedly hypoechoic papillary thyroid microcarcinoma (PTMC) lesions from 184 patients were retrospectively reviewed using RADinfo and compared with 123 anechoic micronodular goiters (MNGs) from 110 patients. Final diagnosis was validated by pathological examination; MNGs predominantly manifested with cyst formation. Grayscale values of PTMC, MNG, and normal surrounding tissues were obtained from grayscale histograms; USGRs (grayscale ratios of pathologic tissue to surrounding normal tissue) of PTMC and MNG were calculated. Optimal USGRs for differentiating PTMC and MNG were determined with receiver operating characteristic (ROC) curves. Results: Among 193 PTMC and 123 MNG lesions, USGRs were 0.24–0.51 (mean ± standard deviation [SD]: 0.41 ± 0.07) and 0.01–0.38 (mean ± SD: 0.12 ± 0.08), respectively. The area under the ROC curve for distinguishing markedly hypoechoic PTMC and anechoic MNG was 0.992. As USGRs decreased, sensitivity decreased and specificity increased for MNG diagnosis. At a USGR of 0.26, the Youden index was high (0.933), corresponding to 94.3% sensitivity and 99% specificity for predicting anechoic MNG. At a USGR of 0.23, sensitivity and specificity for diagnosing anechoic MNG were 92.7% and 100%, respectively. In contrast, as USGR increased, sensitivity decreased and specificity increased for predicting PTMC. At a USGR of 0.38, sensitivity and specificity for diagnosing markedly hypoechoic PTMC were 68.4% and 100%, respectively. Conclusions: USGRs could objectively quantize grayscale values of markedly hypoechoic and anechoic lesions, enabling accurate and quantitative determination of nodular properties.
http://www.cancerjournal.net/currentissue.asp?sabs=y

Fwd: Serum miR-20a and miR-486 are potential biomarkers for discriminating colorectal neoplasia

Serum miR-20a and miR-486 are potential biomarkers for discriminating colorectal neoplasia
To:

: A pilot study p. 1572
Qinglan Yang, Shuiming Wang, Jianfeng Huang, Chengwan Xia, Heiying Jin, Yimei Fan
DOI:10.4103/jcrt.JCRT_1198_16  
Aim: Recent advances in circulating microRNAs (miRNAs) as noninvasive biomarkers have provided promising prospect in detecting colorectal cancer (CRC). However, the capability of miRNAs for detecting colorectal neoplasia (CRN, including precancerous lesions and curable stage CRCs) remains unclear. This study aimed to identify the potential of serum miRNAs (miR-20a, miR-486, miR-92a, and miR-135b) selected from the literature for discriminating CRN patients. Materials and Methods: The serum samples from 46 CRN patients and 33 healthy controls were analyzed with quantitative reverse transcription-polymerase chain reaction. Results: Serum miR-20a and miR-486 were significantly downregulated in CRN patients compared to that of in healthy controls (fold change = 0.697 and 0.696, P = 0.01 and 0.05, respectively). The serum level of miR-92a was not significantly different between two groups, while miR-135b level in serum was too low to be accurately quantified. In addition, serum miR-486 level was much more downregulated in tubulovillous adenoma and high-grade intraepithelial neoplasia patients than that of in healthy controls. For miR-20a and miR-486, the area under the receiver operating characteristic curve for discriminating CRN patients were 0.676 and 0.629, respectively, while their combined value was 0.698. No significant correlation was observed between miR-20a and miR-486 serum levels with age, gender, location, or lesion size. Conclusion: The results suggested that serum miR-20a and miR-486 could be potential noninvasive biomarkers for identifying CRN patients.
http://www.cancerjournal.net/currentissue.asp?sabs=y

Fwd: Diagnosis and treatment of hemangiopericytoma in the central nervous system

Diagnosis and treatment of hemangiopericytoma in the central nervous system

 p. 1578
Fang Liu, Boning Cai, Yu Du, Yurong Huang
DOI:10.4103/jcrt.JCRT_210_18  
Objective: This study aimed to explore the clinical characteristics and treatment of the hemangiopericytoma (HPC) in the central nervous system. Materials and Methods: Clinical data from 14 patients with HPC in the central nervous system who were followed up for 12–107 months were retrospectively analyzed, and relevant literature was reviewed. Results: All 14 patients underwent surgery and postoperative pathologic diagnosis, including 8 cases of total excision, 3 cases of subtotal excision, and 3 cases of partial excision. There were 7 recurrent cases (50%, 4 cases of total excision, 1 case of subtotal excision, and 2 cases of partial excision, none of them received postoperative radiotherapy) with a median relapse time of 39 months, where the median relapse time after total excision was 41.5 months, and after nontotal excision was 17 months. In addition, patients could survive for a long time after reoperation following relapse and after receiving postoperative radiotherapy. Conclusion: The diagnosis of HPC depends on the pathology. Currently, the surgery and postoperative radiotherapy provide a good treatment results, while the wholeness of surgical resection is of particular importance.
http://www.cancerjournal.net/currentissue.asp?sabs=y

Fwd: Preintravenous injection of parecoxib, combined with transversus abdominis plane block in strategy of enhanced recovery after radical resection of colorectal cancer

Preintravenous injection of parecoxib, combined with transversus abdominis plane block in strategy of enhanced recovery after radical resection of colorectal cancer
To: <alsfakia@gmail.com>

 p. 1583
Jiangbo Zheng, Zhaoming Feng, Junfeng Zhu
DOI:10.4103/jcrt.JCRT_215_18  
Objective: The objective of this study was to investigate the effect of preintravenous injection of parecoxib, combined with transversus abdominis plane (TAP) block and postoperative patient-controlled intravenous analgesia (PCIA) pump, in strategy of enhanced recovery after surgery for patients with radical resection of colorectal cancer. Materials and Methods: In this prospective study, 80 patients that underwent radical resection for colorectal cancer were randomly divided into four groups: (1) the parecoxib group, with preintravenous injection of parecoxib and postoperative PCIA after surgery; (2) the TAP group, with TAP block and postoperative PCIA; (3) the parecoxib + TAP group, with parecoxib combined with TAP block and postoperative PCIA; and (4) the control group, with only postoperative PCIA and preinjection of normal saline. The visual analog score was used to measure the pain. The mean operative time, PCIA pressing time, time for first out-of-bed activity, first anus exhaust time, hospital stay duration, and complications were recorded. Results: Operative time of the TAP group and parecoxib + TAP group was significantly longer than that of the parecoxib group and control group. The first out-of-bed activity time, first anus exhaust time, and hospital stay time of the parecoxib + TAP group were significantly shorter than those of the other groups, while the control group was all significantly higher than the other groups. Complication rates in all strategy groups were significantly lower than in the control group; however, no significant difference was found among the strategy groups. Conclusion: The combination of parecoxib, TAP, and PCIA pump could significantly reduce patient postoperative pain and enhance recovery.
http://www.cancerjournal.net/currentissue.asp?sabs=y

Fwd: Gujarati hypertensives

Gujarati hypertensives
To:

: A cross-sectional study p. 153
Jayesh Dalpatbhai Solanki, Hemant B Mehta, Sunil J Panjwani, Hirava B Munshi, Chinmay J Shah
DOI:10.4103/jpp.JPP_59_18  
Objective: To study the effect of different classes and combinations of antihypertensive agents on arterial stiffness and central hemodynamic parameters. Materials and Methods: A cross-sectional study was conducted in 446 treated apparently healthy hypertensives. Oscillometric PWA was performed by Mobil-o-Graph (IEM, Germany) to derive cardiovascular parameters that were further analyzed in groups stratified by antihypertensive used. Study parameters were brachial hemodynamics (blood pressure (BP), heart rate, and rate pressure product); arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, and pulse pressure amplification); and central hemodynamics (central BP, cardiac output, and stroke work). Statistical significance was kept at P < 0.05. Results: All groups were selected by matching of age, gender, and body mass index. They were comparable with major confounding factors. There was no difference between study parameters in hypertensives taking exclusive angiotensin-converting enzyme inhibitor (ACEI), calcium channel blocker (CCB), or angiotensin II receptor blocker. Multitherapy showed better hemodynamics and monotherapy showed better stiffness parameters. Addition of CCB to ACEI did not make a difference except with diastolic BP. For most comparisons, most of the results lacked statistical significance. Conclusion: Discrete PWA parameters showed no class difference in hypertensives, treated by conventional monotherapy or combination, ACEI appears to be the best drug. This also indicates that early diagnosis and blood pressure control are more important than antihypertensive used.
http://www.jpharmacol.com/currentissue.asp?sabs=y