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Αλέξανδρος Γ. Σφακιανάκης

Tuesday, January 26, 2021

Complications following titanium cranioplasty compared with nontitanium implants cranioplasty: A systematic review and meta-analysis.

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Complications following titanium cranioplasty compared with nontitanium implants cranioplasty: A systematic review and meta-analysis.

J Clin Neurosci. 2021 Feb;84:66-74

Authors: Zhu S, Chen Y, Lin F, Chen Z, Jiang X, Zhang J, Wang J

Abstract
Decompressive craniectomy is widely used to treat medically refractory intracranial hypertension. There were still few studies focusing on the complications between titanium cranioplasty with non-titanium materials cranioplasty. Our systematic review and meta-analysis aimed to assess the complications following titanium cranioplasty and to make a comparison with nontitanium materials. A systematic review was used to review titanium cranioplasty characters in recent articles. A systematic literature review and meta-analysis were performed by using PubMed/MEDLINE, Scopus, the Cochrane databases and Embase for studies reporting on cranioplasty procedures that compared complication outcomes between titanium with non-titanium materials. The final 15 studies met inclusion criteria and represented 2258 cranioplasty procedures (896 titanium, 1362 nontitanium materials). Overall complications included surgical site infection, hematoma, implant exposure, seizure, cerebrospinal fluid le ak, imprecise fitting. Titanium cranioplasty was associated with a significant decrease in overall complications rate (OR, 0.72; P = 0.007), hematoma rate (OR, 0.31; P = 0.0003) and imprecise fitting rate (OR, 0.35; P = 0.04). However, it also suggested that titanium cranioplasty can be greatly increased implant exposure rate (OR, 4.11; P < 0.00001). Our results confirmed the advantages of titanium cranioplasty in reducing complications including hematoma, imprecise fitting, and also suggested that clinicians should pay more attention to postoperative implant exposure. With new synthetic materials emerging, it would also be interesting to study the cost-effect and functional outcomes associated with cranioplasty materials.

PMID: 33485602 [PubMed - in process]

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Downregulation of miR-146b-3p Inhibits Proliferation and Migration and Modulates the Expression and Location of Sodium/Iodide Symporter in Dedifferentiated Thyroid Cancer by Potentially Targeting MUC20.

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Downregulation of miR-146b-3p Inhibits Proliferation and Migration and Modulates the Expression and Location of Sodium/Iodide Symporter in Dedifferentiated Thyroid Cancer by Potentially Targeting MUC20.

Front Oncol. 2020;10:566365

Authors: Hou S, Xie X, Zhao J, Wu C, Li N, Meng Z, Cai C, Tan J

Abstract
The dedifferentiation of differentiated thyroid cancer (DTC) is a challenging problem for radioactive iodine (131I) treatment, also known as radioiodine refractory differentiated thyroid cancer (RAIR-DTC). The purpose of this study was to further explore the mechanism of the redifferentiation of dedifferentiated thyroid cancer. Ineffective and effective groups of 131I therapy were analyzed and compared in both our clinical and TCGA samples. Whole-exome sequencing, mutation analysis, transcriptome analysis, and in vitro functional experiments were conducted. FLG, FRG1, MUC6, MUC20, and PRUNE2 were overlapping mutation genes between our clinical cases, and the TCGA cases only appeared in the ineffective group. The expression of miR-146b-3p target MUC20 was explored. The expression levels of miR-146b-3p and MUC20 were significantly increased, and the inhibition of miR-146b-3p expression significantly inhibited proliferation and migration, promoted apoptosis, regulated the expres sion and location of thyroid differentiation-related genes, and sodium/iodide symporter (NIS) in dedifferentiated thyroid cancer cells (WRO). Thus, miR-146b-3p potentially targets MUC20 participation in the formation of DTC dedifferentiation, resulting in resistance to 131I and the loss of the iodine uptake ability of DTC cancer foci, promoting refractory differentiated thyroid cancer. miR-146b-3p may be a potentially therapeutic target for the reapplication of 131I therapy in dedifferentiated thyroid cancer patients.

PMID: 33489878 [PubMed]

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Exposure to antithyroid drugs and ethylenethiourea and risk of thyroid cancer: a systematic review of the epidemiologic evidence.

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Exposure to antithyroid drugs and ethylenethiourea and risk of thyroid cancer: a systematic review of the epidemiologic evidence.

Eur J Cancer Prev. 2021 Jan 22;:

Authors: La Vecchia C, Turati F, Negri E

Abstract
INTRODUCTION: The thyroid peroxidase inhibiting compounds methimazole, methylthiouracil, propylthiouracil, thiouracil (i.e. 'antithyroid' drugs) and ethylenethiourea have been associated to thyroid tumours in rodents. According to a systematic review by the International Agency for Research on Cancer (IARC) published in 2000, evidence for the human carcinogenicity was inadequate.
METHODS: We performed an up-to-date systematic review of human epidemiological studies on the association between such compounds and thyroid cancer incidence or mortality.
RESULTS: The literature research (1999-March 2020) identified four relevant articles. Considering also reports from the previous IARC review, this systematic review considered seven reports (five distinct studies) on antithyroid drugs and two on ethylenethiourea. As for antithyroid drugs, three reports based on different follow-ups gave results from a cohort of patients treated for hyperthyroidism in 1946-1964. In the earlier report, thyroid cancer incidence was higher in patients primarily treated with antithyroid drugs (3.2/1000) than in those originally treated with thyroidectomy (0.34/1000) or radioactive iodine (0.88/1000), which can be explained by the higher frequency of subsequent thyroidectomy, and hence the higher chance of cancer detection, in that group (30 vs. 0.5 and 1.2%). The two subsequent reports found no deaths from thyroid cancer among patients treated exclusively with antithyroid drugs through 1990 and 2014. A nested case-control study found an odds ratio (OR) of thyroid cancer of 2.79 [95% confidence interval (CI), 0.78-10.02, from a 2-year lag analysis] for ≥3 vs. no propylthiouracil prescriptions. The increased risk can be attributed to advanced diagnosis of an underlying cancer, as suggested by the stronger association observed in a no-lag analysis (OR, 8.03). In a historical cohort of newly diagnosed hyperthyroid patients, the hazard ratio for treatment with radioactive iodine vs. thionamides only was 0.45 (95% CI, 0.21-0.99), possibly due to the closer surveillance of patients receiving thionamides only. Two case-control studies did not find any association with the use of antithyroid drugs. As for ethylenethiourea, no thyroid cancer cases were found in a historical cohort of 1929 workers occupationally exposed in a 15-year period and no association with proxies of mancozeb exposure (a fungicide whose main metabolite is ethylenethiourea) was detected in a cohort of >236 000 farmers.
CONCLUSION: There is no evidence for a relevant role of either antithyroid drugs or ethylenethiourea on thyroid cancer.

PMID: 33492873 [PubMed - as supplied by publisher]

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Telocytes in the atherosclerotic carotid artery: Immunofluorescence and TEM evidence.

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Telocytes in the atherosclerotic carotid artery: Immunofluorescence and TEM evidence.

Acta Histochem. 2021 Jan 22;123(2):151681

Authors: Xu Y, Tian H, Qiao G, Zheng W

Abstract
Telocytes, which possess distinct body shapes and long telopodes, are allocated in the vascular wall. As a fundamental cell type, telocytes construct a three-dimensional network to form a support structure for the artery. This study aims to characterize the morphology and ultrastructure of telocytes in atherosclerotic arteries. ApoE gene-deficient mice were selected as the atherosclerosis animal model and fed a high-fat diet for at least 12 weeks, and immunofluorescence assays and transmission electron microscopy techniques were used to observe changes in telocytes in atherosclerotic arteries. By immunofluorescence staining, CD34, CD117 and PDGFR-α were positive compared with negative CD28/vimentin in telocytes in the atherosclerotic carotid artery, and they were distributed in the tunica intima and tunica adventitia. Under transmission electron microscopy, the bodies of telocytes became larger, while telopodes became shorter compared with their normal condition, and a mass of lipidosomes was present during the progression of atherosclerosis. These results demonstrate that immunofluorescence with TEM is the critical method for identifying TCs and that steatosis of TCs is a reason for atherosclerotic artery dysfunction.

PMID: 33493960 [PubMed - as supplied by publisher]

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Resection of Carotid Body Tumors in Patients of Advanced Age: Experience From a Single Center.

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Resection of Carotid Body Tumors in Patients of Advanced Age: Experience From a Single Center.

Ear Nose Throat J. 2021 Jan 25;:145561320981442

Authors: Li L, Xu H, Zhou J, Mydlarz WK, Yu Z, Chen X, London NR

Abstract
INTRODUCTION: Resection of carotid body tumor (CBT) in patients of advanced ages has not been appreciated.
OBJECTIVES: This study aims to assess the clinical characteristics and perioperative comorbidities for CBT resection in patients of advanced age and to validate the application of an "isolated island" technique for extirpation of CBT.
METHODS: Eight patients of advanced age (≥60 years) who underwent CBT resection were enrolled as the study group (SG). Another 29 patients of younger age (<45 years old) underwent CBT extirpation were assigned as the control group (CG). The perioperative issues were compared between these 2 groups.
RESULTS: The "isolated island" technique was successfully applied for resection of CBT in all 37 patients. The prevalence of Shamblin classification I, II, and III tumors in the SG was 12.5%, 62.5%, and 25%; whereas in the CG was 10.3%, 55.2%, and 34.5%, respectively. Bilateral CBT was observed in 7 patients of the CG and none in the SG. Vascular reconstruction was required for 1 (12.5%) patient in the SG, while it was required for 8 (27.6%) patients in the CG. Postoperative vocal cord palsy occurred in 37.5% of patients in SG, whereas the vocal cord palsy (34.5%) and dysphagia (6.9%) were commonly encountered in CG. In addition to postoperative length of stay (P = .004), no significant difference for operative time, intraoperative blood loss, or mortality were observed between these 2 groups (P > .05).
CONCLUSION: Extirpation of CBT in patients of advanced age is rationale in appropriately selected patients. The "isolated island" technique is safe for CBT resection with seemingly low complication rates.

PMID: 33491478 [PubMed - as supplied by publisher]

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Oral Losartan After Limited Mandibulectomy for Treatment of Desmoid-Type Fibromatosis.

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Oral Losartan After Limited Mandibulectomy for Treatment of Desmoid-Type Fibromatosis.

Ear Nose Throat J. 2021 Jan 25;:145561320987641

Authors: Curry DE, Al-Sayed AA, Trites J, Wheelock M, Acott PD, Midgen C, Johnson LB, Bezuhly M

Abstract
Desmoid-type fibromatosis (DF) is a rare soft tissue lesion with an annual incidence of 2 to 4 per million population and peak incidence occurring at approximately 4.5 years of age. While benign, the tumor has a locally aggressive infiltrative growth pattern and a high rate of recurrence. Given the functional and aesthetic implications of excision and reconstruction in the facial skeleton, novel medical treatment options are highly desirable. We describe the case of a 3-year-old boy who presented with an enlarging, asymptomatic mass involving the left mandible. Biopsy revealed an immunohistochemical profile consistent with DF. Despite the high likelihood of recurrence, conservative, mandible-sparing en bloc resection and limited mandibulectomy were performed. Pathological and immunohistochemical analysis of the resection specimen revealed DF with grossly positive margins and elevated expression of angiotensin II type 1 receptor. Postoperative medical treatment with the angiot ensin receptor blocker losartan was initiated. The patient remains medically stable and disease progression-free on repeat imaging at 20 months post-resection. We describe for the first time the successful use of the angiotensin blocker losartan following conservative surgery for management of DF.

PMID: 33491484 [PubMed - as supplied by publisher]

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Spontaneous Bilateral Facial Paralysis Secondary to Metastatic Breast Cancer.

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Spontaneous Bilateral Facial Paralysis Secondary to Metastatic Breast Cancer.

Ear Nose Throat J. 2021 Jan 25;:145561320982693

Authors: King J, Virani FR, Thomas R, Squires L

Abstract
Sudden onset, bilateral facial paralysis is a rare clinical entity, representing less than 2% of all diagnoses of facial nerve paralysis. The differential for these patients is necessarily broad and includes numerous etiologies. Metastatic breast carcinoma to the bilateral parotid glands is also exceedingly rare with only 2 reported case reports noted in the literature, neither of which demonstrated facial nerve paralysis. Here, we report the only known occurrence of a patient presenting with synchronous bilateral facial nerve paralysis secondary to metastatic breast carcinoma to the bilateral parotid glands. This exceedingly rare clinical presentation was further confounded by the presence of autoimmune antibodies, highlighting the importance of the diagnostic process and maintaining broad clinical suspicion.

PMID: 33491485 [PubMed - as supplied by publisher]

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Surgical Experiences of Pediatric Cervical Bronchogenic Cysts: A Case Series of 6 Patients.

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Surgical Experiences of Pediatric Cervical Bronchogenic Cysts: A Case Series of 6 Patients.

Ear Nose Throat J. 2021 Jan 25;:145561320982194

Authors: Li Y, Wang S, Tai J, Zhang J, He L, Zhang N, Zhang X, Liu Q, Sun N, Ni X

Abstract
OBJECTIVES: Bronchogenic cyst is a rare congenital disease which occurs especially in the neck region. This report presents 6 cases of bronchogenic cysts and discusses the diagnosis and surgical experience of this anomaly.
METHODS: A retrospective study of 6 pediatric patients with cervical bronchogenic cysts treated in our hospital during 2016 to 2019 was performed. We recorded and analyzed the clinical data of the patients, including age, symptoms, imaging findings, surgical procedure, and complications.
RESULTS: All patients underwent surgical excision. The chondroid tissues were found at the base of cysts which clung to the trachea in 5 patients and completely removed by surgery without recurrence. One patient showed recurrence due to residual cartilage after the first surgery, and the second surgery was required to resect the remaining cartilage. During the surgery, the recurrent laryngeal nerve (RLN) detector was used, which confirmed that all the RLNs clung to the side wall of cysts. All cases were cured without complications.
CONCLUSIONS: Although rare, bronchogenic cysts should be considered in the differential diagnosis of peritracheal masses in children. Complete resection of the bronchogenic cysts, including the cartilages at the base, is vital in preventing recurrence. The RLN must be protected during the surgery.

PMID: 33491486 [PubMed - as supplied by publisher]

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Investigation of Serum Calcium and 25-Hydroxy Vitamin D Levels in Benign Paroxysmal Positional Vertigo Patients.

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Investigation of Serum Calcium and 25-Hydroxy Vitamin D Levels in Benign Paroxysmal Positional Vertigo Patients.

Ear Nose Throat J. 2021 Jan 25;:145561321989451

Authors: Inan HC, Mertoğlu C, Erdur ZB

Abstract
OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) is characterized by recurrent attacks of vertigo caused by head movements. It occurs as a result of otoconia falling into the semicircular canal. Calcium and 25 hydroxyvitamin D [25(OH)D] metabolism in the inner ear play an important role in otoconia formation and degeneration. Our aim in this study was to investigate the relationship between 25(OH)D levels and BPPV.
METHODS: This retrospective, case-controlled study included 52 patients with posterior canal BPPV and 52 controls aged 18 to 80 years. Age, sex, serum calcium, corrected calcium, and 25(OH)D levels of the BPPV and control group were compared.
RESULTS: Twenty-three of the patients were male (44.2%) and 29 were female (55.8%). The average age was 55.6 years. The 25(OH)D level was 15.3 ng/mL in the BPPV group and 20.2 ng/mL in controls. There was no significant difference in 25(OH)D and albumin-corrected calcium values (P = .394; P = .084, respectively). In 80.7% of the BPPV group and 61.5% of the controls, 25(OH)D levels were 20 ng/mL and below. 25 hydroxyvitamin D deficiency was found statistically significantly more frequently in patients with BPPV (P = .030).
CONCLUSION: In our study, serum 25(OH)D levels were found to be lower in patients with BPPV, and the rate of vitamin D deficiency was higher in these patients. Based on these results, it is recommended to examine the 25(OH)D levels of patients with BPPV at the time of diagnosis.

PMID: 33491490 [PubMed - as supplied by publisher]

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Photoangiolytic Lasers in Laryngology

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[Photoangiolytic Lasers in Laryngology].

Laryngorhinootologie. 2020 09;99(9):607-612

Authors: Hess M, Fleischer S

Abstract
With photoangiolytic lasers like KTP (Potassium-Titanyl-Phosphate, 532 nm) lasers or the new "blue" laser (445 nm), even the smallest vessels and capillaries within the vocal fold can be treated without destroying the covering epithelium. This enables effective treatment of benign and malignant sub- and intraepithelial lesions of the vocal folds such as papilloma, edema, polyps, leukoplakia, dysplasia and capillary vessels while preserving the vibratory properties of the different layers of the lamina propria. Because photoangiolytic laser light can be routed through tiny glass fibers, office-based surgery with channelled flexible endoscopes are feasible as well as phonomicrosurgical operations under general anesthesia. Furthermore, the so called "blue" laser can cut tissues and thus broadens the technical armamentarium of the phonosurgeon.

PMID: 32851626 [PubMed - indexed for MEDLINE]

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Morphological consistency of bilateral hip joints in adults based on the X-ray and CT data.

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Morphological consistency of bilateral hip joints in adults based on the X-ray and CT data.

Surg Radiol Anat. 2021 Jan 23;:

Authors: Zhao R, Cai H, Tian H, Zhang K

Abstract
PURPOSE: The application of the anatomical parameters of the contralateral hip joint to guide the preoperative template of the affected side relies on the bilateral hip symmetry. We investigated the bilateral hip symmetry and range of anatomical variations by measurement and comparison of bilateral hip anatomical parameters.
METHODS: This study included 224 patients (448 hips) who were diagnosed with osteoarthritis (OA) and avascular necrosis (AVN) of the femur head, and underwent bilateral primary total hip arthroplasty (THA) in our hospital from January 2012 to August 2020. Imaging data included 224 patients X-ray and 30 CT data at the end of the cohort. Anatomical parameters, including the acetabular abduction angle and trochanteric height, were measured using the Noble method. Postoperative measurements included stem size, difference of leg length and offset.
RESULTS: Except for the isthmus width, there were no significant differences in the anatomical morphology of the hip joint. Among the demographic factors, there was a correlation between body weight and NSA. Among various anatomical parameters, a correlation was present between medullary cavity widths of T + 20, T, and T - 20. The difference in the use of stem size is not due to the morphological difference of bilateral medullary cavity, but due to the different of 1- or 2-stage surgery.
CONCLUSION: Bilateral symmetry was present among the patients with normal morphology of the hip medullary cavity, theoretically confirming the feasibility of structural reconstruction of the hip joint using the hip joint on the uninjured side. Additionally, the difference in the morphology of the hip medullary cavity is not present in a single plane but is synergistically affected by multiple adjacent planes.

PMID: 33486573 [PubMed - as supplied by publisher]

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