Robot‐assisted beating‐heart surgery for atrial septal defect repair in a case of situs inversus totalis with dextrocardia

xlomafota13 shared this article with you from Inoreader Robot‐assisted beating‐heart surgery for atrial septal defect repair in a case of situs inversus totalis with dextrocardia Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Background This paper describes a case of a patient with situs inversus totalis (SIT) and dextrocardia in which robotic atrial septal defect (ASD) repair was successfully performed in a beating heart. Methods and Results A 45-year-old female patient who had SIT and dextrocardia was diagnosed with secundum ASD 5 years ago. Because of progressive dyspnoea, fatigue, and obvious cough, she came to our hospital for surgical treatment. Transthoracic echocardiography showed the defect located in the middle and lower segments of the atrial septum with a maximum diameter of 27 mm, with a left-to-right shunt. Transcatheter ASD closure could not be performed because there was not enough tissue surrounding the defect. After communicating with the patient, we performed robotic ASD repair in a beating heart using the da Vinci surgical system. The operation was successful, and the patient recovered quickly. Conclusion As a minimally invasive approach, robotic cardiac surgery has many advantages and is feasible and safe in suitable patients. This article is protected by copyright. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Assessment of the Validity of the Sinonasal Outcomes Test‐22 in Pituitary Surgery: A Multicenter Prospective Trial

xlomafota13 shared this article with you from Inoreader Assessment of the Validity of the Sinonasal Outcomes Test‐22 in Pituitary Surgery: A Multicenter Prospective Trial Via The Laryngoscope Objectives/Hypothesis Sinonasal Outcomes Test-22 (SNOT-22) is used widely as a patient-reported sinonasal quality-of-life (QOL) instrument for endoscopic endonasal pituitary surgery. However, it has never been validated in this population. This study explores the psychometric validity of SNOT-22 to determine if it is a valid scale in patients undergoing endoscopic pituitary surgery. Study Design Multicenter prospective trial. Methods Adult patients (n = 113) with pituitary tumors undergoing endoscopic surgery were enrolled in a multicenter study. Patient-reported QOL was assessed using SNOT-22 and the Anterior Skull Base Nasal Inventory-12. Face validity, internal consistency, responsiveness to clinical change, test–retest reliability, and concurrent validity were determined using standard statistical methods. Results Internal consistency using Cronbach's alpha at baseline and 2 weeks postoperatively were 0.911 and 0.922, indicating SNOT-22 performed well as a single construct. Mean QOL scores were significantly worse at 2 weeks than baseline (16.4 ± 15.1 vs. 23.1 ± 16.4, P < .001), indicating the scale is responsive to clinical change. However, only 11/22 items demonstrated significant changes in mean scores at 2 weeks. Correlation between scores at 2 and 3 weeks was high, suggesting good test–retest reliability, r(107) = 0.75, P < .001. Factor analysis suggests the five-factor solution proposed for the SNOT-22 in rhinosinusitis patients is not valid in pituitary surgery patients. Conclusions The SNOT-22 is a valid QOL instrument in patients undergoing endoscopic pituitary surgery. However, because it includes 22 items, can be applied only as a single construct, 50% of the items do not demonstrate changes after surgery, and is not as sensitive to change as other scales, shorter instruments developed specifically for this patient population may be preferable. Level of Evidence II Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Should Isotretinoin be Stopped Prior to Surgery?

xlomafota13 shared this article with you from Inoreader Should Isotretinoin be Stopped Prior to Surgery? Via The Laryngoscope View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Interferon‐γ downregulates tight junction function, which is rescued by interleukin‐17A

xlomafota13 shared this article with you from Inoreader Interferon‐γ downregulates tight junction function, which is rescued by interleukin‐17A Via Experimental Dermatology ABSTRACT Although atopic dermatitis (AD) has been reported to be a typical type 2 immune response disease, it is also an inflammatory skin disease that involves cytokines, such as Th1, Th17, and Th22. However, little is known about the mechanism by which the candidate cytokines, alone or in combination, are involved in AD pathology. Differences in cytokine balance, which contribute to the complexity of AD pathology, may influence the stratum corneum barrier function through tight junction (TJ) functional stability and contribute to disease severity. To confirm the regulatory mechanism of TJ protein expression in AD, we investigated the Th1 and Th17 pathways, which are the initiation factors of chronic AD pathology. We examined the effects of these cytokines on TJ protein expression in normal human epidermal keratinocytes in vitro. We also examined their function in a human skin-equivalent model. We observed a time- and dose-dependent inhibitory effect of claudin-1 on IFN-γ via the IFN-γ receptor/JAK/STAT signaling pathway. IFN-γ impaired TJ function in a human skin-equivalent model. Moreover, we investigated co-stimulation with IL-17A, which is highly expressed in AD skin lesions, and found that IL-17A restores IFN-γ-induced TJ dysfunction. This restoration of TJ function was mediated by atypical protein kinase C zeta activation without recovery of TJ protein expression. These results are informative for personalized AD treatment via systemic therapies using anti-cytokine antibodies and/or JAK inhibitors. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effect of Gender on Acoustic Voice Quality Index 02.03 and Dysphonia Severity Index in Indian Normophonic Adults

xlomafota13 shared this article with you from Inoreader Effect of Gender on Acoustic Voice Quality Index 02.03 and Dysphonia Severity Index in Indian Normophonic Adults Via Otolaryngology Indian Abstract Acoustic Voice Quality Index and Dysphonia Severity Index are the two most widely used multiparametric objective measures that can successfully quantify voice quality. Latoszek et al. (2019) reported that gender had no influence on both AVQI and DSI in Dutch population. However, there is a lack of research focussed on investigating the gender effect on both DSI and AVQI and on investigating the relationship between DSI and AVQI in the Indian adult population. The present study is aimed to investigate the effect of gender on DSI and AVQI and to explore the relation between the two in the Indian adult population. 138 normophonic individuals (74 females and 64 males) were considered as participants. The phonation of /a/ and reading samples were considered as stimuli for extracting AVQI analysed using AVQI script version 02.03. The raw values of MPT, highest frequency, lowest intensity, and Jitter% were obtained from VRP module and MDVP module of Computerized Speech Lab to calculate the DSI. The results revealed that gender has significant effect on CPPs, HNR and TiltLTAS, ShimLocal, ShimdB, MPT, F0-High and Jitter%. While the overall AVQI, DSI, SlopeLTAS and I-Low were independent of gender effect. To conclude, the present study provides the reference data for AVQI v.2.03 and DSI for healthy Indian adults and discusses the influence of gender on AVQI, DSI and their constituent parameters. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Tumor-Related and Patient-Related Variables Affecting Length of Hospital Stay Following Vestibular Schwannoma Microsurgery

xlomafota13 shared this article with you from Inoreader Tumor-Related and Patient-Related Variables Affecting Length of Hospital Stay Following Vestibular Schwannoma Microsurgery Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Jul 1:34894211029103. doi: 10.1177/00034894211029103. Online ahead of print. ABSTRACT OBJECTIVE: Review a single institution's vestibular schwannoma (VS) microsurgery experience to determine (1) correlations between demographics, comorbidities, and/or surgical approach on hospital length of stay (LOS) and discharge disposition and (2) trends in surgical approach over time. METHODS: Retrospective case series from a multidisciplinary skull base program at a tertiary care, academic hospital. All adult (>18 years) patients undergoing primary microsurgery for VS between 2008 and 2018 were included. RESULTS: A total of 147 subjects were identified. Surgical approach was split between middle fossa (MF) (16%), retrosigmoid (RS) (35%), and translabyrinthine (TL) (49%) craniotomies. For the 8% of patients had other than routine (OTR) discharge. Mean LOS was significantly longer for patients undergoing RS than either MF or TL. Brainstem compression by the tumor was associated with longer LOS as were diagnoses of chronic obstructive pulmonary disease (COPD) and peripheral vascular disease (PVD). For all discharges, the 40 to 50- and 50 to 60-year-old subgroups had significantly shorter LOS than the 70-years-and-older patients. For the 92% of patients routinely discharged, there was a significantly shorter LOS in the 40 to 50-year-olds compared to the 70-years-and-older patients. There was a significant shift in surgica l approach from RS to TL over the study period. CONCLUSION: Over 90% of VS microsurgery patients were routinely discharged with a median hospital LOS of 3.2 days, both of which are consistent with published data. There is an inverse relationship between age and LOS with patients older than 70 years having significantly longer LOS. Brainstem compression, COPD, PVD, and the RS approach negatively affect LOS. LEVEL OF EVIDENCE: 4. PMID:34210194 | DOI:10.1177/00034894211029103 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Skull Vibration-Induced Nystagmus Test in a Human Model of Horizontal Canal Plugging

xlomafota13 shared this article with you from Inoreader Skull Vibration-Induced Nystagmus Test in a Human Model of Horizontal Canal Plugging Via Laryngologie Audiol Res. 2021 Jun 24;11(3):301-312. doi: 10.3390/audiolres11030028. ABSTRACT BACKGROUND/AIM: the aim of this study was to assess the skull vibration-induced nystagmus test (SVINT) results and vestibular residual function after horizontal semicircular canal (HSCC) plugging. METHODS: In this retrospective chart review performed in a tertiary referral center, 11 patients who underwent unilateral horizontal semicircular canal plugging (uHSCCP) for disabling Menière's disease (MD) were included. The skull vibration-induced nystagmus (SVIN) slow-phase velocity (SPV) was compared with the results of the caloric test (CaT), video head impulse test (VHIT), and cervical vestibular-evoked myogenic potentials (cVEMP) performed on the same day. RESULTS: Overall, 10 patients had a strong SVIN beating toward the intact side (Horizontal SVIN-SPV: 8.8°/s ± 5.6°/s), 10 had a significant or severe ipsilateral CaT hypofunction, 10 had an ipsil ateral horizontal VHIT gain impairment, and 3 had altered cVEMP on the operated side. Five had sensorineural hearing worsening. SVIN-positive results were correlated with CaT and horizontal VHIT (HVHIT) results (p < 0.05) but not with cVEMP. SVIN-SPV was correlated with CaT hypofunction in % (p < 0.05). Comparison of pre- and postoperative CaT % hypofunction showed a significant worsening (p = 0.028). CONCLUSION: SVINT results in a human model of horizontal canal plugging are well correlated with vestibular tests exploring horizontal canal function, but not with cVEMP. SVINT always showed a strong lesional nystagmus beating away from the lesion side. SVIN acts as a good marker of HSCC function. This surgical technique showed invasiveness regarding horizontal canal vestibular function. PMID:34202582 | DOI:10.3390/audiolres11030028 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Post‐Extubation Dysphagia and Dysphonia amongst Adults with COVID‐19 in the Republic of Ireland: a Prospective Multi‐Site Observational Cohort Study

xlomafota13 shared this article with you from Inoreader Post‐Extubation Dysphagia and Dysphonia amongst Adults with COVID‐19 in the Republic of Ireland: a Prospective Multi‐Site Observational Cohort Study Via Clinical Otolaryngology Abstract Objectives This study aims to (i) investigate post-extubation dysphagia and dysphonia amongst adults intubated with SARS-COV-2 (COVID-19) and referred to speech and language therapy (SLT) in acute hospitals across the Republic of Ireland (ROI) between March and June 2020; (ii) identify variables predictive of post-extubation oral intake status and dysphonia and (iii) establish SLT rehabilitation needs and services provided to this cohort. Design A multi-site prospective observational cohort study Participants 100 adults with confirmed COVID-19 who were intubated across eleven acute hospital sites in ROI and who were referred to SLT services between March and June 2020 inclusive. Main Outcome Measures Oral intake status, level of diet modification and perceptual voice quality. Results Based on initial SLT assessment, 90% required altered oral intake and 59% required tube feeding with 36% not allowed oral intake. Age (OR 1.064; 95% CI 1.018-1.112), proning (OR 3.671; 95% CI 1.128-11.943), and pre-existing respiratory disease (OR 5.863; 95% CI 1.521-11.599) were predictors of oral intake status post-extubation. Two-thirds (66%) presented with dysphonia post-extubation. Intubation injury (OR 10.471; 95% CI 1.060-103.466) and pre-existing respiratory disease (OR 24.196; 95% CI 1.609-363.78) were predictors of post-extubation voice quality. Thirty-seven percent required dysphagia intervention post-extubation whereas 20% needed intervention for voice. Dysphagia and dysphonia persisted in 27% and 37% cases respectively at hospital discharge. Discussion Post-extubation dysphagia and dysphonia were prevalent amongst adults with COVID-19 across the ROI. Predictors included iatrogenic factors and underlying respiratory disease. Prompt evaluation and intervention is needed to minimise complications and inform rehabilitation planning. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Immunohistochemical Analysis of Toll-Like Receptors, MyD88, and TRIF in Human Papillary Thyroid Carcinoma and Anaplastic Thyroid Carcinoma

xlomafota13 shared this article with you from Inoreader Immunohistochemical Analysis of Toll-Like Receptors, MyD88, and TRIF in Human Papillary Thyroid Carcinoma and Anaplastic Thyroid Carcinoma Via Journal of Thyroid Research Purpose. We hypothesized that innate immune response pathways might be involved in thyroid carcinogenesis. To investigate this hypothesis, we aimed at analyzing the expression of several receptors and molecules in the innate immune system in papillary thyroid carcinoma (PTC) and anaplastic thyroid carcinoma (ATC) tissues. Methods. Of the surgically resected specimens, 11 ATC tissues, 25 PTC tissues, and 8 nodular hyperplasia (NH) tissues were selected and examined for the expression of toll-like receptor (TLR) 2, TLR3, TLR4, TLR5, TLR7, TLR9, the myeloid differentiation primary response gene 88 (MyD88), and toll-interleukin-1 receptor domain-containing adaptor inducing INF-β (TRIF) by immunohistochemistry (IHC). Results. Several TLRs were expressed in each tissue. TLR3 was strongly expressed in all tissues. In contrast, TLR4 was not detected in any tissues. While TLR5 was moderately expressed in NH but significantly reduced in PTC and ATC, TLR9 was absent in NH tissue but moderately expressed in both PTC and ATC. On MyD88 expression, no significant difference was found between PTC and ATC. TRIF was significantly upregulated in PTC and ATC compared to NH. Surprisingly, PTC and ATC tissues exhibited similar expression patterns of TLRs, MyD88, and TRIF. Conclusion. These data suggest the involvement of the innate immune system in both PTC and ATC. Specifically, TLR3-mediated TRIF activation was confirmed in PTC and ATC. This provides new insight into thyroid carcinogenesis. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The effect of implant surface on the recurrence rates of capsular contracture following revision breast surgery: Early results from a single surgeon retrospective comparative study

xlomafota13 shared this article with you from Inoreader The effect of implant surface on the recurrence rates of capsular contracture following revision breast surgery: Early results from a single surgeon retrospective comparative study Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 6:S1748-6815(21)00269-2. doi: 10.1016/j.bjps.2021.05.016. Online ahead of print. ABSTRACT INTRODUCTION: This retrospective comparative study aimed to evaluate the effect of implant surface in two cohorts of consecutive patients who underwent revision surgery following capsular contracture (Baker III-IV) after primary breast augmentation with textured implants. METHODS: All patients underwent the same surgical procedure (capsulectomy - pocket plane change - implant exchange) and the only difference was that two different types of implants were used during the implant exchange: textured(Group A - biocell) or nanotextured(Group B - silksurface). A comparative analysis was performed using the following parameters: patients' demographics, age, the time between the primary breast augmentation and the revision surgery, the surgical and follow-up outcomes; and the incidence, timing, and capsular co ntracture recurrence. RESULTS: Eighty consecutive females were included, Group A(textured): age of 35(19-65) years and time between primary and secondary surgery of 59(6-209) months; and Group B(nanotextured): age of 39(26-58) years and time between primary and secondary surgery of 65(7-218) months. For both groups, at a mean follow-up of 25(21-36) months for Group A(textured), and at a mean follow-up of 24(21-34) months for Group B(nanotextured); capsular contracture reoccurred in 3 cases (7.5%), at 7, 10, and 14 months in Group A and in 3 cases (7,5%), at 9, 10, and 16 months in Group B, post revision surgery. Students' t-test demonstrated no statistically significant differences between the recurrences of the two implant surfaces (p-value>0.05). CONCLUSION: In capsular contracture revision surgery, the type of implant surface (textured or nanotextured) does not appear to influence recurrence rates. Further studies are required to identify the clinical impact on the implant surface in long-term outcomes of capsular contracture breast surgery. PMID:34210625 | DOI:10.1016/j.bjps.2021.05.016 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Staging computerized tomography before delayed breast reconstruction could alter the management plan

xlomafota13 shared this article with you from Inoreader Staging computerized tomography before delayed breast reconstruction could alter the management plan Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 6:S1748-6815(21)00256-4. doi: 10.1016/j.bjps.2021.05.004. Online ahead of print. ABSTRACT BACKGROUND: Delayed breast reconstruction (DBR) comprises a significant proportion of breast reconstruction practice post completion of breast cancer treatment. The tumour's biology, staging, time constraints, ongoing treatment, and patient and surgeon's preference influence the decision to pursue DBR. There are no guidelines for assessing the oncological status before DBR in otherwise asymptomatic patients, particularly in those with a higher risk of recurrence. The purpose of this study was to identify the cohort of patients who could potentially benefit from staging CT scan before DBR regardless of the reconstructive modality and its impact on the overall management. MATERIAL AND METHODS: A retrospective review on 207 consecutive patients, who underwent staging CT scan before DBR in the period betwe en 2009 and 2019 was performed. The CT scan findings were correlated with the breast prognostication scoring model (Nottingham Prognostic Index [NPI]) as an indicator factor for staging reasons. RESULTS: Incidental findings were reported in 34% (71/207) of the reviewed CT scans (incidentaloma group). There was no statistical significance in the NPI scores between non incidentaloma and incidentaloma groups. However, 5.7% (12/207) had their DBR procedure cancelled or the surgical plan altered. CONCLUSION: The patients with moderate to poor prognosis (NPI score 3.4 and above) could benefit from CT staging scan before DBR. This scan could detect adverse prognostic features precluding major surgery, which saves patients from unnecessary surgical risks and discomfort, and direct them towards the relevant management pathway. PMID:34210626 | DOI:10.1016/j.bjps.2021.05.004 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.