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Αλέξανδρος Γ. Σφακιανάκης

Sunday, June 13, 2021

Cell therapy and delivery strategies for spinal cord injury

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Histol Histopathol. 2021 Jun 10:18350. doi: 10.14670/HH-18-350. Online ahead of print.

ABSTRACT

Spinal cord injury (SCI) is a complex neuropathological condition that represents a major challenge for clinicians and scientists due to patient's functional dysfunction and paralysis. Several treatments have been proposed including biological factors, drugs and cells administered in various ways. Stem cells arise as good candidates to treat SCI since they are known to secrete neurotrophic factors, improving neuroregeneration, but also due to their role in modulating the inflammatory process, favoring a pro-regenerative status. There are several types of cells that have been tested to treat SCI in experimental and clinical studies, but we still face many unanswered questions; one of them is the type of cells that can offer the best benefits and, also the ideal dose and administration routes. This review aimed to summarize recent research on cell treatment, focusing on current delivery strategies for SCI therapy and their effects in tissue repair and regeneration.

PMID:34109994 | DOI:10.14670/HH-18-350

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A conservative treatment for chronic obstructive sialoadenitis by intraductal instillation of mucolytic, steroids and antibiotic solution

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Eur Arch Otorhinolaryngol. 2021 Jun 10. doi: 10.1007/s00405-021-06930-2. Online ahead of print.

ABSTRACT

PURPOSES: Reporting our experience in treating chronic obstructive sialadenitis with a protocol consisting of sialoendoscopy and intraductal instillation of antibiotics, steroids and n-acetyl-cysteine (NAC) solution.

METHODS: Prospective study of patients with chronic obstructive sialadenitis with no apparent lithiasic obstructions, with recurrent non-lithiasic sialoadenitis and patients with lithiasic sialoadenitis not solved with sialoendoscopy. In all cases, a sialoendoscopy was performed. All the patients affected by lithiasic sialoadenitis where the chronic inflammation was resolved with sialoendoscopy were excluded from the study. The mid-term follow-up was performed at 12 months via phone interview, to understand whether patients had developed any further symptoms after the treatment.

RESULTS: This study included 26 patients. All the patient without sialolithiasis have not reported any symptoms during the follow-up period. Two of those with sialolithiasis have not shown any signs of recurrence. The remaining three patients with non-resolved sialolithiasis had a recurrence of symptoms which were treated again with 1 intraductal administration of betamethasone, gentamicine and NAC, showing immediately a regression of the symptoms.

CONCLUSIONS: Intraductal administration of gentamicin + NAC + betamethasone seemed effective for the therapy of chronic obstructive sialoadenitis. Our protocol seemed effective also in that cases where it was not possible to remove or detect endoscopically an obstruction. In all these cases we have noticed an increase in the symptom-free time even in cases where it was not possible to remove the stones.

PMID:34110456 | DOI:10.1007/s00405-021-06930-2

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'Benefits of the pedicled osteoplastic flap as a surgical approach of mastoidectomy in cochlear implant surgery'

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Eur Arch Otorhinolaryngol. 2021 Jun 10. doi: 10.1007/s00405-021-06907-1. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the esthetic and functional results of an osteoplastic flap for mastoid cavity closure in cochlear implant surgery.

STUDY DESIGN: Double-blind, prospective, randomized clinical trial.

SETTING: tertiary referral center.

INTERVENTION(S): On hundred and twenty-six patients were randomized in 2 groups for cochlear implant surgery. Cases (n: 63) underwent simple mastoidectomy using an anteriorly pedicled osteoplastic flap for mastoid closure. In controls (n: 63), a traditional periosteal flap was used. Evaluation with the POSAS questionnaire was performed 1 year after surgery to assess surgical wound esthetics. Sixteen patients from each group had postoperative CT-scans and wideband tympanometry to assess mastoid aeration and middle ear absorbance. Gender and time after surgery were correlated.

MAIN OUTCOME MEASURE(S): Evaluation of the quality of the surgical wound with the application of a questionnaire validated in the medical literature and translated into Portuguese language called POSAS, considering the perception of the blinded patient and doctor regarding the surgical technique proceeded. A lower POSAS score suggests better esthetics of the surgical wound. Secondary outcomes are volumetric measurement of aeration inside mastoid cavity using 3D computer tomography exam, which aims to analyze the influence of fibrocicatricial retraction in the surgical wound into the mastoid and the interference of its aeration volume in the absorption of sound in the middle ear, using the wideband tympanometry exam.

RESULTS: The POSAS questionnaire in the Case group showed a lower level of local pain and itchiness, a skin color and thickness more similar to the surrounding skin and less irregularity and stiffness, with no influence from time after surgery and gender compar ed to the Control group. The median tomographic volume was 6.37 cc in the cases and 4.60 cc in controls. Wideband tympanometry showed general smaller sound absorbance in the Case group results, specially, at 1000 Hz frequency. No intraoperative or postoperative complications were observed with the osteoplastic flap.

CONCLUSIONS: This technique is an effective and safe alternative to alleviate common problems of mastoid surgery for cochlear implantation. In addition to esthetic benefits, it has less interference in middle ear physiology of sound absorbance and less fibrous tissue into the mastoid cavity during the follow-up of more than 1 year.

PMID:34110455 | DOI:10.1007/s00405-021-06907-1

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The psychological status in patients with nasopharyngeal carcinoma during radiotherapy

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Eur Arch Otorhinolaryngol. 2021 Jun 10. doi: 10.1007/s00405-021-06892-5. Online ahead of print.

ABSTRACT

PURPOSE: The psychological status of nasopharyngeal carcinoma (NPC) patients cannot be ignored. Few studies have studied the dynamic changes and influencing factors of psychological status in NPC patients during radiotherapy. The purpose of this study was to investigate the changing trends and risk factors of anxiety and depression in NPC patients during radiotherapy.

METHODS: Demographic and clinical data of 232 newly treated NPC patients were collected. Before radiotherapy, the fourth week, and the end of radiotherapy were observational timepoints. Anxiety and depression states were evaluated by the hospital anxiety and depression scale.

RESULTS: Scores of anxiety before radiotherapy, in the fourth week and at the end of radiotherapy were 6.32 ± 3.19, 7.87 ± 3.49, and 9.08 ± 3.69, respectively (P < 0.001). Incide nce rates of anxiety were 34.0%, 55.1%, and 64.0% (P < 0.001). Depression scores were 5.31 ± 3.19, 7.07 ± 3.63, and 8.32 ± 3.89 (P < 0.001). Incidence rates of depression were 25.0%, 43.9%, and 56.0% (P < 0.001). Gender, age, education level, smoking, and treatment-related toxicity scores (P < 0.05) were independent risk factors for anxiety in patients with NPC during radiotherapy, while age, education level, and treatment-related toxicity scores (P < 0.05) were independent risk factors for depression in these patients.

CONCLUSION: The incidence and degree of anxiety and depression in NPC patients increased during radiotherapy. Age, education level, and treatment-related side effects influenced anxiety and depression. More psychological nursing should be given to the NPC patients who are more likely to suffer from psychological distress.

PMID:34110454 | DOI:10.1007/s00405-021-06892-5

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Expression of renal vitamin D receptors and metabolizing enzymes in IgA nephropathy

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Acta Histochem. 2021 Jun 7;123(5):151740. doi: 10.1016/j.acthis.2021.151740. Online ahead of print.

ABSTRACT

AIM: One of the main causes of end-stage renal disease (ESRD) in the world is IgA nephropathy (IgAN). Since kidney is a key player in vitamin D metabolism, we investigated the expression of renal vitamin D receptors (VDR) and metabolizing enzymes in IgA nephropathy patients (IgAN-P).

METHODS: The sample included twelve IgAN-P who underwent ultrasound-guided rena l biopsies and five controls who underwent nephrectomy due to clear renal carcinoma. Immunofluorescent staining was used to determine the expression of VDR, 25-hydroxyvitamin D3 -alpha-hydroxylase (1alpha-OHase) and vitamin D3 24-hydroxylase (CYP24A1).

RESULTS: Significant increase in expression of VDR, which was prominent in distal tubular cells (DTCs) in tissues from IgAN-P, was found in comparison to the controls (p = 0.0368). The expression of 1alpha-OHase, calcitriol synthesizing enzyme, was significantly lower in IgAN-P, in comparison with controls (p < 0.0001). The opposite, expression of CYP24A1 (vitamin D degrading enzyme), was significantly higher in IgAN-P in comparison with controls (p = 0.0003). Additionally, we found significant negative correlation between percentage of CYP24A1 immunoreactive nuclei in proximal tubular cells (PTCs) and estimated glomerular filtration rate (eGFR) in IgAN-P (r = -0.6139; p = 0.0337).

CONCLUSIONS: Our research indicates su bstantially decreased renal calcitriol production and increased vitamin D degradation in kidneys of IgAN-P, but larger studies are needed to confirm our results.

PMID:34111685 | DOI:10.1016/j.acthis.2021.151740

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Evaluation of the OSA treatment protocol in syndromic craniosynostosis during the first 6 years of life

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J Plast Reconstr Aesthet Surg. 2021 Mar 28:S1748-6815(21)00123-6. doi: 10.1016/j.bjps.2021.03.033. Online ahead of print.

ABSTRACT

INTRODUCTION: Obstructive sleep apnea (OSA) is frequently present in patients with syndromic craniosynostosis. The aim of this study is to determine the long-term effectiveness of our OSA treatment protocol in our tertiary center in a cohort of children with syndromic craniosynostosis.

METHODS: Children with syndromic craniosynostosis born between January 2005 and December 2013 were eligible for inclusion (n = 114). Data from ambulatory and inhospital polysomnographies were used. The obstructive-apnea/hypopnea index was used for OSA classification.

RESULTS: Polysomnographies were performed in 83 patients. Mild OSA was diagnosed in 19, moderate in six, and severe in seven children. Of the 32 patients with OSA, 12 patients (37.5%) initially received expectant care of which OSA resolved spontaneous ly in nine without recurrence. Twenty patients were surgically treated. Adenotonsillectomy (ATE) had a 90% success rate with no OSA recurrence. Monobloc surgery was performed in four patients with mild OSA, although not OSA-indicated. Monobloc was performed for moderate or severe OSA in six patients, in four patients in combination with ATE and with mandibular distraction in one. Monobloc surgery for moderate or severe OSA had a 100% success rate in treating OSA and decannulation.

CONCLUSION: Expectant care is often sufficient to resolve mild OSA in patients with syndromic craniosynostosis, and should also be considered in patients with moderate OSA with close follow-up. ATE has an important role in the OSA treatment protocol. Monobloc surgery, combined with mandibular distraction on indication, is effective in resolving moderate to severe OSA with a stable long-term result.

PMID:34112566 | DOI:10.1016/j.bjps.2021.03.033

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Schwannoma of the Supraglottis

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Ear Nose Throat J. 2021 Jun 10:1455613211018586. doi: 10.1177/01455613211018586. Online ahead of print.

ABSTRACT

Hoarseness lasting greater than 2 weeks should be thoroughly evaluated. Here, a case is presented of a 38-year-old female with a 10-year history of dysphonia. Endoscopic examination confirmed the presence of a supraglottic mass, for which operative biopsy and imaging were performed. Pathology confirmed the diagnosis of supraglottic schwannoma. This was excised end oscopically with close management postoperatively to monitor for rapid recurrence and airway compromise. At one month postoperatively, the patient is still mildly dysphonic but vocally improved and the operative site continues to heal well.

PMID:34112006 | DOI:10.1177/01455613211018586

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Intravascular Papillary Endothelial Hyperplasia (Masson's Tumor) of the Submandibular Gland: A Case Report

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Ear Nose Throat J. 2021 Jun 10:1455613211016707. doi: 10.1177/01455613211016707. Online ahead of print.

ABSTRACT

Intravascular papillary endothelial hyperplasia (IPEH), a rare benign endothelial vascular lesion related to thrombosis, generally develops in fingers, trunk, head, and neck. Nevertheless, it has been rarely reported in the salivary gland. In this article, we report a case of IPEH of the right submandibular gland in a 37-year-old female whose initial impression wa s sialadenitis secondary to sialolithiasis. To date, our case may be the first well-documented report of IPEH in the submandibular gland. The patient underwent ablation of the submandibular gland, and no evidence of recurrence was found during follow-up.

PMID:34112010 | DOI:10.1177/01455613211016707

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Comprehensive Analysis of the Diagnosis and Treatment of Tracheobronchial Foreign Bodies in Children

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Ear Nose Throat J. 2021 Jun 10:1455613211023019. doi: 10.1177/01455613211023019. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the factors influencing the diagnosis and treatment of tracheobronchial foreign bodies (TFBs) in children.

METHODS: The clinical data of 300 consecutive children with suspected TFBs who were admitted to our department between January 2016 and December 2019 were retrospectively collected, including demographics, diagnosis, history of for eign body inhalation, preoperative chest computed tomography (CT) findings, duration of foreign body retention, time from admission to operation, operation duration, duration of hospitalization, and complications.

RESULTS: Among the 300 cases, the male:female ratio was 193:107, and the age range was 6 months to 12 years (median age: 19 months). A total of 291 cases (97.0%) involved TFBs confirmed by rigid bronchoscopy, while the other 9 cases (3.0%) involved bronchopneumonia. The diagnostic accuracy, sensitivity, and specificity of a history of foreign body inhalation and chest CT were 96.0%, 98.6%, and 11.1% and 97.7%, 97.6%, and 100%, respectively. The duration of hospitalization, time from admission to operation, and operation duration were all related to bronchopneumonia (P < .05).

CONCLUSIONS: A detailed history, adequate physical examination, and preoperative imaging examination help improve the diagnostic accuracy. Preoperative bronchopneumonia in childr en with TFBs will increase the surgical risks and treatment costs, prolonging the duration of hospitalization.

PMID:34112007 | DOI:10.1177/01455613211023019

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Angiomatous Polyp Originating From the Inferior Turbinate: A Variant of the Sinonasal Polyp

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Ear Nose Throat J. 2021 Jun 10:1455613211019709. doi: 10.1177/01455613211019709. Online ahead of print.

ABSTRACT

Angiomatous polyps are an uncommon subtype of sinonasal polyps, characterized by extensive vascular proliferation and ectasia. The authors report the first case of angiomatous polyp originating from the inferior turbinate, which is a variant of the sinonasal polyp.

PMID:34112009 | DOI:10.1177/01455613211019709

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Clival Mucocele: A Rare Yet not Forgotten Pathology

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Ear Nose Throat J. 2021 Jun 10:1455613211021176. doi: 10.1177/01455613211021176. Online ahead of print.

ABSTRACT

Primary clival mucoceles are a rare clinical entity that usually represents an incidental finding on computed tomography or magnetic resonance imaging scanning. There are only a few reports in the literature of patients who presented with vague symptoms such as headaches, facial paresthesia, and numbness. Clival mucoceles can also be secondary, by extension of a s phenoid mucocele to the clivus. We present a case of primary clival mucocele, aiming to highlight the importance of a multidisciplinary approach.

PMID:34112008 | DOI:10.1177/01455613211021176

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