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Αλέξανδρος Γ. Σφακιανάκης

Monday, March 29, 2021

Potential influence of prenatal 2.45 GHz radiofrequency electromagnetic field exposure on Wistar albino rat testis

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Histol Histopathol. 2021 Mar 25:18331. doi: 10.14670/HH-18-331. Online ahead of print.

ABSTRACT

An ever-increasing use of wireless devices over the last decades has forced scientists to clarify their impact on living systems. Since prenatal development is highly sensitive to numerous noxious agents, including radiation, we focused on the assessment of potential adverse effects of microwave radiation (MR) on testicular development. Pregnant Wistar albino rats (3 months old, weighing 282±8 g) were exposed to pulsed MR at a frequency of 2.45 GHz, mean power density of 2.8 mW/cm², and a specific absorption rate of 1.82 W/kg for 2 hours/day throughout pregnancy. Male offspring were no longer exposed to MR following birth. Samples of biological material were collected after reaching adulthood (75 days). In utero MR exposure caused degenerative changes in the testicular parenchyma of adult rats. The shape of the seminiferous tubules was irr egular, germ cells were degenerated and often desquamated. The diameters of the seminiferous tubules and the height of the germinal epithelium were significantly decreased (both at ∗∗p<0.01), while the interstitial space was significantly increased (∗∗p<0.01) when compared to the controls. In the group of rats prenatally exposed to MR, the somatic and germ cells were rich in vacuoles and their organelles were often altered. Necrotizing cells were more frequent and empty spaces between Sertoli cells and germ cells were observed. The Leydig cells contained more lipid droplets. An increased Fluoro Jade - C and superoxide dismutase 2 positivity was detected in the rats exposed to MR. Our results confirmed adverse effects of MR on testicular development.

PMID:33779980 | DOI:10.14670/HH-18-331

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Sequential osseointegration from osseohealing to osseoremodeling - Histomorphological comparison of novel 3D porous and solid Ti-6Al-4V titanium implants

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Histol Histopathol. 2021 Mar 29:18333. doi: 10.14670/HH-18-333. Online ahead of print.

ABSTRACT

In the present study, we analyzed the histological characteristics of osseointegration of an open-porous Ti-6Al-4V material that was produced in a space holder method creating a 3-D through-pores trabecular design that mimics the inhomogeneity and size relationships of trabecular bone in macro- as well as microstructure. Pairs of cylindrical implants with a porosity of 49 % and an average pore diameter of 400 µm or equal sized solid, corundum blasted devices as reference were bilaterally implanted press fit in the lateral condyles of 16 rabbits. Histological examination was performed after 4 weeks of short-term osseohealing and 12 weeks of mid-term osseoremodeling and we summarized the criteria for sequential osseointegration. After 4 weeks, osteoid had already been largely replaced by mineralized woven bone in both types of implants but wa s only represented to a greater extent in the deeper pores of PI. The cortical as well as trabecular region showed regular osseohealing with excessive and spatially undirected formation of immature woven bone. A dense bone mass was found in the cortical area, while in the trabecular region the bone mass was reduced distinctly, presenting large lacuna-like recesses and a demarcating trabecular structure. The pores near the implant surface contained more mineralized woven bone than the deeper pores. After 12 weeks, the osseoremodeling was largely completed with a physiological maturation to lamellar bone. The newly formed bone mass increased for PI and SI compared to the 4-week group and osteoid was only detectable in the deeper pores. The inhomogeneous trabecular design of the pores enables an excellent ingrowth of mineralized lamellar bones after remodeling to a pore depth of 1800 µm, which proves a functional load transfer from the surrounding bone into the implant. According to t he concept of osseointegration by Branemark and Albrektsson, the histological evaluation confirms a successful, superior osseointegration of the presented porous properties improving long-term implant stability. The presented study protocol allows an excellent evaluation and comparison of the sequential osseointegration from short-term osseohealing to mid-term osseoremodeling.

PMID:33779981 | DOI:10.14670/HH-18-333

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Patients' and clinicians' preferences for treatment for Graves' disease: A discrete choice experiment

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Eur J Endocrinol. 2021 Mar 1:EJE-20-1490.R1. doi: 10.1530/EJE-20-1490. Online ahead of print.

ABSTRACT

OBJECTIVE: Treatment options for Graves' disease (GD) consist of antithyroid drugs (ATD), radioactive iodine (RAI) and total thyroidectomy (TT). Guidelines recommend to discuss these options with patients, taking into account patients' preferences. This study aims to evaluate and compare patients' and clinicians' preferences and the trade-offs made in choosing treatment.

DES IGN AND METHODS: A discrete choice experiment (DCE) was performed with GD patients with a first diagnosis or recurrence in the previous year, and with clinicians. Participants were offered hypothetical treatment options which differed in type of treatment, rates of remission, severe side effects, permanent voice changes and hypocalcemia. Preference heterogeneity was assessed by latent-class analysis.

RESULTS: 286 (82%) patients and 61 (18%) clinicians participated in the DCE. All treatment characteristics had a significant effect on treatment choice (p<0.05). Remission rate was the most important determinant and explained 37% and 35% of choices in patients and clinicians, respectively. Both patients and clinicians preferred ATD over surgery and RAI. A strong negative preference towards RAI treatment was observed in a subclass of patients, whereas clinicians preferred RAI over surgery.

CONCLUSION: In both patients and clinicians, remission rate was the most important d eterminant of treatment choice and ATD was the most preferred treatment option. Patients had a negative preference towards RAI compared to alternatives, whereas clinicians preferred RAI over surgery. Clinicians should be aware that their personal attitude towards RAI differs from their patients. This study on patients' and clinicians' preferences can support shared decision making and thereby improve clinical treatment.

PMID:33780350 | DOI:10.1530/EJE-20-1490

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Desensitization to Methimazole

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Endocr Pract. 2021 Mar;27(3):185-190. doi: 10.1016/j.eprac.2020.10.019. Epub 2020 Dec 15.

ABSTRACT

OBJECTIVE: Thionamides (methimazole and propylthiouracil) have been associated with common side effects, such as rash and pruritus, and rare but serious adverse effects, such as agranulocytosis and hepatotoxicity. Methimazole is usually the preferred thionamide for the treatment of hyperthyroidism if the patient is not planning to conceive or not in the first trimester of pregnancy, g iven the less frequent dosing and lower risk of hepatotoxicity. In patients who experience rash or itching when treated with methimazole, switching them to propylthiouracil is one treatment option. Here we report our experience regarding desensitization to methimazole to allow continued treatment with methimazole as an alternative management option.

METHODS: We conducted a retrospective chart review of patients at a single institution who had side effects to methimazole and who were desensitized to methimazole under the supervision of an allergist. A total of 7 patients were included who experienced side effects to methimazole that did not include agranulocytosis or hepatotoxicity.

RESULTS: All 7 patients were able to take methimazole for treatment of their hyperthyroidism, either for continued medical therapy or as a bridge to definitive therapy, with either surgery or radioactive iodine treatment.

CONCLUSION: Under the supervision of an allergist, desensitization to methimazole is an option for treating patients who experience side effects to methimazole (excluding agranulocytosis and hepatotoxicity).

PMID:33779553 | DOI:10.1016/j.eprac.2020.10.019

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Robotic transmaxillary approach to the lateral infratemporal fossa: A preclinical cadaveric study using a next‐generation single‐port robotic system

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Abstract

Robotic transmaxillary skull base surgery has been described using multiport systems. This cadaveric study investigates the feasibility of transmaxillary skull base surgery using a next‐generation robot. An extended Caldwell‐Luc antrostomy, measuring 3.3 cm by 4.0 cm, was performed in 15 min using a Kerrison rongeur and the robotic endoscope. A single‐port, robotic system (da Vinci Sp®, Intuitive Surgical, Inc, Sunnyvale, CA, USA) was then deployed throught the extended Caldwell‐Luc approach and provided sufficient reach, visualization, and maneuverability to work within the pterygopalatine fossa (PPF) and the infratemporal fossa (ITF) using three surgical instruments. The ITF dissection was easiest with two instruments using the third instrument to retract the muscles of mastication. This study demonstrates the feasibility of single‐port robotic transmaxillary approaches to the lateral ITF. Using a single‐port robotic system, the operating surgeon can for the fir st time work in the PPF and ITF using two functional arms for tumor dissection and a third to retract.

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Primary central nervous system angiosarcoma with recurrent acute subdural hematoma

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Neurocirugia (Astur). 2021 Mar 22:S1130-1473(21)00027-0. doi: 10.1016/j.neucir.2021.02.002. Online ahead of print.

ABSTRACT

Angiosarcoma is an infrequent tumor among sarcomas, especially presenting as a primary tumor within the central nervous system, which can lead to a rapid neurological deterioration and death in few months. We present a 41-year old man with a right frontal enhancing hemorrhagic lesion. Surgery was performed with histopathological findings suggesting a primary central nervous system angiosarcoma. He was discharged uneventfully and received adjuvant chemotherapy and radiotherapy. At 5 months, the follow-up MRI showed two lesions with an acute subdural hematoma, suggesting a relapse. Surgery was again conducted finding tumoral membranes attached to the internal layer of the duramater around the right hemisphere. The patient died a few days later due to the recurrence of the subdural hematoma. This case report illustrates a r are and lethal complication of an unusual tumor. The literature reviewed shows that gross-total resection with adjuvant radiotherapy seems to be the best treatment of choice.

PMID:33766476 | DOI:10.1016/j.neucir.2021.02.002

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Effective Nasal Disinfection as an Overlooked Strategy in Our Fight against COVID-19

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Ear Nose Throat J. 2021 Mar 26:1455613211002929. doi: 10.1177/01455613211002929. Online ahead of print.

ABSTRACT

Although the recent advent of a vaccine and other therapeutic aids in our fight against COVID-19 has brought us a step closer to controlling the pandemic, our fight is far from over. Handwashing, masks, and social distancing practices are considered reasonable measures to control the spread of the disease have been well accepted by government officials and public health officials despite scarce and conflicting scientific evidence. Taking into consideration the aforementioned measures, there is an additional perhaps overlooked practice that warrants our attention-nasal disinfection and hygiene.

PMID:33765853 | DOI:10.1177/01455613211002929

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Cost-Effective Microscopic Draping: COVID-19 Umbrella

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Ear Nose Throat J. 2021 Mar 26:1455613211005113. doi: 10.1177/01455613211005113. Online ahead of print.

ABSTRACT

We describe a cost-effective solution to limit aerosol transmission to the surgeon and other personnel in the operating room during otologic surgery.

PMID:33765854 | DOI:10.1177/01455613211005113

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The Utility of Glasgow Prognostic Score and Palliative Prognostic Index in Patients With Head and Neck Squamous Cell Carcinoma Under Palliative Care

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Ear Nose Throat J. 2021 Mar 26:1455613211005114. doi: 10.1177/01455613211005114. Online ahead of print.

ABSTRACT

OBJECTIVES: Palliative care patients with head and neck squamous cell carcinoma (HNSCC) often experience dysphagia and airway trouble; thus, each patient requires a specific palliative care plan based on their prognostication. However, no established specific prognostic tool performed on the day of starting end-of-life care is available for such patients. We asses sed the accuracy of Glasgow prognostic score (GPS) and palliative prognostic index (PPI) and their combination to establish a specified prognostic tool for patients with HNSCC in end-of-life setting.

METHODS: A retrospective clinical chart review was undertaken on patients with HNSCC in end-of life setting who were decided in Kagawa University Hospital and National Hospital Organization Shikoku Cancer Center between April 2011 and March 2019. The patients were divided into 2 categories according to GPS (0-1 and 2) and PPI (groups A-B and C). These were combined into 4 categories (PPI group A-B and GPS score 0-1: good; PPI group A-B and GPS score 2: intermediate; PPI group C and GPS score 2: poor; and PPI group C and GPS score 0-1: others). The survival curves were compared for the former 3 categories.

RESULTS: The median survival of the scores 0-1 and 2 on GPS were 114 (72-148) and 39 (25-52) days, respectively (P < .01). These of groups A-B and C on PPI were 7 9 (64-99) and 16 (9-29) days, respectively (P < .01). The median survival of the good, intermediate, and poor categories was 127 (73-149), 64 (44-80), and 15 (9-27) days, respectively (P < .01 among all categories).

CONCLUSIONS: In this study, the survival of terminally ill patients with HNSCC can be predicted by the GPS, PPI, and their combination with sufficient probability.

PMID:33765857 | DOI:10.1177/01455613211005114

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Efficacy of Office-Based Intralesional Steroid Injections in the Management of Subglottic Stenosis: A Systematic Review

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Ear Nose Throat J. 2021 Mar 26:1455613211005119. doi: 10.1177/01455613211005119. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the efficacy of office-based intralesional steroid injections (ILSI) as a management therapy for adult subglottic stenosis (SGS).

DATA SOURCES: A systematic review was completed using PubMed and Science Direct for office-based management of SGS due to various etiologies.

REVIEW METHODS: The primary end point measured was a chang e in surgery free interval (SFI) between endoscopic procedures due to office-based serial ILSI. The secondary end point was to determine what percentage of patients did not require further operative intervention for SGS maintenance therapy after changing management to office-based serial ILSI.

RESULTS: We identified 187 abstracts, 4 of which were included in the analysis. The total number of participants was 55. The mean age was 50.4, and 78.1% were women. The etiologies were as follows: idiopathic (58.2%), postintubation/tracheotomy (29.1%), and autoimmune (12.7%). The SFI was reported in 3 of the 4 studies. The reported mean pre-ILSI SFI was 362.9 days and the post-ILSI SFI was 582.2 days. The secondary outcome was reported in 3 of the 4 studies. Forty-one of the 55 patients (74.5%) did not require further operative intervention during the duration of the study.

CONCLUSION: This review explored office-based ILSI as a potential treatment option for patients with SGS. Th e limited data presented found ILSI significantly lengthened SFI, potentially reducing surgical burden. In addition, ILSI was found to be safe with few reported side effects.

PMID:33765859 | DOI:10.1177/01455613211005119

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A Rare Case of Hemoptysis Caused by a Laryngeal Leech

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Ear Nose Throat J. 2021 Mar 26:1455613211000804. doi: 10.1177/01455613211000804. Online ahead of print.

ABSTRACT

The larynx is an uncommon location for live foreign bodies. The leech can reach the glottis during consumption of contaminated water but is usually expelled by an effective cough reflex. Patients present with hoarseness and dysphagia and occasionally with dyspnea or hemoptysis. Endoscopically, a mobile mass is usually noted in the supraglottic area. We present a r are case of a laryngeal leech in a 62-year-old-male farmer who lives in a rural area. The leech was removed successfully with direct laryngoscopy under general anesthesia.

PMID:33765858 | DOI:10.1177/01455613211000804

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