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Αλέξανδρος Γ. Σφακιανάκης

Monday, September 6, 2021

Possibilities of coblation in otorhinolaryngology: analytical review

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Eur Arch Otorhinolaryngol. 2021 Sep 5. doi: 10.1007/s00405-021-07055-2. Online ahead of print.

ABSTRACT

OBJECTIVE: Review literature data on the coblation method in otorhinolaryngology.

MATERIALS AND METHODS: All materials from our study are published in peer-reviewed journals. The review is PubMed generated. In our clinic, 20 patients with bilateral paralytic laryngeal stenosis underwent cold-plasma posterior arytenoidcordotomy with Coblator II.

RESULTS: The analysis of the high-energy techniques currently applied in otorhinolaryngology shows the benefits of coblation due to the effect of lower temperatures on tissues. Patients subjectively reported improved breathing on day 10 with a closed coblation tracheostoma; after 3-6 months everyone underwent successful decannulation with plastic surgery of the cutaneous-tracheal fistula. Lately, the operated vocal fold was in the abduction position and the lumen of the glottis in the posterior third was 7-8 mm. Compensation of vocal function in the long-term postoperative period was achieved by patients due to long-term orthophonic training and the development of a vestibuloscapular phonation mechanism.

CONCLUSION: The advantages of coblation are mainly minimal trauma to the surrounding tissues, convenient resection, the ability to perform complete hemostasis at one time, and easier postoperative period for the patient.

PMID:34482444 | DOI:10.1007/s00405-021-07055-2

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Therapeutic Potential of Human Nasal Inferior Turbinate-Derived Stem Cells: Microarray Analysis of Multilineage Differentiation

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Introduction: Human nasal inferior turbinate-derived stem cells (hNTSCs) are attractive sources of adult stem cells for medical application because they can be easily obtained and cultivated with a highly proliferative capacity. The ability of hNTSCs to differentiate into chondrocytes, osteocytes, and neural cells makes them potential replacement therapeutic candidates in intractable disease. Nevertheless, detailed expression pattern of genes associated with trilineage differentiation (osteogenesis, chondrogenesis, and neurogenesis) in hNTSCs has not been revealed yet. Methods: In this study, we aimed to evaluate gene expression patterns of various transcription factors and marker genes associated with a particular lineage (osteogenesis, chondrogenesis, and neurogenesis) of differentiation of hNTSCs by DNA microarrays. Results: In microarrays, 36 transcripts such as E2F transcription factor 1, activating transcription factor 5, and AKR1B10 were upregulated and 36 transcripts such as CA9, PPFIA4, HAS2, and COL4A4 were downregulated in osteogenically differentiated hNTSCs. In chondrogenically differentiated hNTSCs, 3 transcripts (NUDT14, CPA4, and heparin-binding epidermal growth factor-like growth factor) were upregulated and 82 transcripts such as PTGS1, CLEC2D, and TET1 were downregulated. In neurally differentiated hNTSCs, 61 transcripts such as insulin-like growth factor-binding protein-1, nerve growth factor receptor, FGF1, OLFML1, and EPGN were upregulated and 98 transcripts such as ACAN, RUN X2, and C21orf96 were downregulated. In gene ontology (GO) analysis, cell signal-related GO terms were highly expressed. By contrast, catalysis GO terms and GO terms related to oxidoreductase were overrepresented in chondrogenically differentiated hNTSCs and osteogenically differentiated hNTSCs, respectively. Conclusion: Considering overall results, hNTSCs-specific genetic information may promote further studies on intracellular mechanisms defining key features of these cells.
ORL
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The Use of Tele Practice in Assessment of Middle Ear Function in Adults Living with HIV During the COVID-19 Pandemic

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Abstract

Coronavirus disease (COVID-19) pandemic is the latest threat to global health that causes severe acute respiratory syndrome (SARS). Tele-practice has inadvertently sprung to the forefront to become a common practice amongst healthcare providers during COVID-19. Limited evidence exists on the use of tele-practice in assessing middle ear function in adults living with HIV during the COVID-19 pandemic. The aims of this study were to investigate the use of tele-practice for assessment of middle ear function in adults with HIV during the COVID-19 pandemic. A quantitative observational, cross-sectional design was adopted. A total of 134 adults diagnosed with HIV were purposively selected from the HIV clinic. An audiology researcher, in the role of site-facilitator, captured video otoscopic images of the tympanic membrane using a video otoscopy for all participants through asynchronous tele-practice. All captured images were sent to two independent otorhinolaryngologist s for diagnosis. Findings of this study indicated that tele-practice can be used to assess middle ear function in adults living with HIV during COVID-19 pandemic. When asynchronous tele-practice was used, there was a moderate diagnostic agreement (k = 0.58) between the two otorhinolaryngologists on abnormality versus normality, but poor agreement (k = 0.15) on the nature of abnormality (e.g. OME vs CSOM). Current findings highlight the urgent need for a widespread use of tele-practice during the continued clinical follow up and management of adults living with HIV, and the implementation of tele-practice, particularly in low- and middle-income countries (LMICs) where capacity versus demand challenges related to ear and hearing care continue to exists.

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Long-term complications of microtia reconstruction: A systematic review

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J Plast Reconstr Aesthet Surg. 2021 Aug 17:S1748-6815(21)00376-4. doi: 10.1016/j.bjps.2021.08.001. Online ahead of print.

ABSTRACT

BACKGROUND: Microtia is a rare disorder characterized by malformation or even complete absence of the auricle. Reconstruction is often performed using autologous costal cartilage (ACC) or porous polyethylene implants (PPE). However, the long-term outcomes of both methods are unclear.

OBJECTIVE: This systematic review aimed to analyze long-term complications and suggest minimal reporting criteria for future original data studies.

METHODS: A systematic literature search was conducted in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials from inception through October 14, 2020. Articles on auricular reconstruction in patients with microtia using ACC or PPE were included provided that the follow-up period was at least one year. This publication focused on long-term complications reported in patients with a postoperative follow-up period of at least one year.

RESULTS: Twenty-nine publications reported on complications during long-term follow-up. Overall long-term complication rates were not reported. The incidence of individual complications during long-term follow-up was less than 10% after ACC reconstruction and less than 15% in PPE reconstruction. Framework resorption and wire exposure were reported even after an extended follow-up of more than five years after ACC reconstruction, while reports on the extended long-term results of PPE reconstruction are limited. Data synthesis was limited due to heterogeneity and poor study quality.

CONCLUSIONS: Future studies should report on long-term complications including framework exposure or extrusion, graft loss, framework resorption, wire exposure and scalp and auricular scar complications. We recommend a surgical follow-up of at least five years.

PMID:34481742 | DOI:10.1016/j.bjps.2021.08.001

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3D-printed template and optical needle navigation in CT-guided iodine-125 permanent seed implantation

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J Contemp Brachytherapy. 2021 Aug;13(4):410-418. doi: 10.5114/jcb.2021.108595. Epub 2021 Aug 24.

ABSTRACT

PURPOSE: To preliminarily verify the accuracy of navigation-assisted seed implantation by comparing pre-operative and actual differences in puncture characteristics and dosimetry in computed tomography (CT)-guided, navigation-assisted radioactive iodine-125 seed implantation, using 3D-printed templates for malignant tumors' treatment.

MATERIAL AND METHODS: A total of 27 t umor patients, who were treated with seed implantation under combination guidance in our hospital between December 2019 and December 2020 were enrolled in this study. Navigation needles (n = 1-3) were placed in each patient to obtain pre-operative and intra-operative puncture information, such as angle, depth, insertion point, and tip position. Moreover, dosimetry parameters in pre-operative and post-operative plans, including D90, V100, V150, V200, minimum peripheral dose (MPD), conformal index, external index, and homogeneity index of target area were investigated.

RESULTS: Mean errors of the angle, depth, insertion point, and tip position were 0.5 ±0.5°, 4.0 ±2.0 mm, 1.7 ±1 mm, and 3.1 ±1.8 mm, respectively. There were no significant differences between intra-operative and pre-operative angles (p = 0.271), but there was a significant difference in the depth (p = 0.002). Errors of the angle, depth, and ins ertion point were larger for the pelvic/retroperitoneal area than for the head and neck/chest wall (p < 0.05). With the exception of MPD, there was no significant difference in dosimetry indices between post-operative and preoperative plans (p > 0.05).

CONCLUSIONS: Seed implantation under combination guidance showed good accuracy, and the actual intra-operative puncture information and post-operative doses were in agreement with those in the pre-operative plan, thereby demonstrating promising prospects for further development.

PMID:34484355 | PMC:PMC8407253 | DOI:10.5114/jcb.2021.108595

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Combined skin-sparing mastectomy and immediate implant-based breast reconstruction: Outcome following mantle field irradiation versus outcome following whole-breast irradiation

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J Plast Reconstr Aesthet Surg. 2021 Aug 18:S1748-6815(21)00378-8. doi: 10.1016/j.bjps.2021.08.003. Online ahead of print.

ABSTRACT

BACKGROUND: Mastectomy may be needed in the context of previous radiotherapy in cases of breast carcinoma following mantle field radiotherapy for Hodgkin lymphoma or in cases of local relapse or second primary tumours after breast conserving therapy including whole-breast irradiation (BCT). The outcome of combined skin-sparing mastectomy and immediate implant-based breast reconstruction (SSM-IIBR) has been reported to be unfavourable in these cases.

PURPOSE: To compare the outcome of SSM-IIBR after mantle field radiotherapy to that after BCT and to compare both to the outcome observed in non-irradiated breasts.

METHODOLOGY: The prevalences of short-term events, device loss, long-term corrections and secondary reconstructions, and reversion to autologous tissue techniques of 42 SSM-IIBRs performe d after mantle field irradiation were compared to those of 47 salvage SSM-IIBRs following BCT. Both outcomes were compared to the outcome in the contralateral, non-irradiated breast of the subgroup of 23 women in the BCT group.

RESULTS: The groups were comparable in terms of patient- and procedure-related risk factors, except for time lapse after previous therapy, intraoperative device weight, and the fraction of immediate use of a definitive implant. The outcome of SSM-IIBR after mantle field irradiation significantly differs favourably from that after BCT. It matches the outcome observed in non-irradiated breasts.

CONCLUSION: Skin-sparing mastectomy combined with immediate implant-based breast reconstruction is a fully justifiable option for women who previously underwent mantle field irradiation for Hodgkin lymphoma. We feel that the unfavourable outcome observed in women who previously underwent BCT necessitates an alternative reconstructive modality.

PMID:34483080 | DOI:10.1016/j.bjps.2021.08.003

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LINC00937 suppresses keloid fibroblast proliferation and extracellular matrix deposition by targeting the miR-28-5p/MC1R axis

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Histol Histopathol. 2021 Aug 23:11372. doi: 10.14670/HH-18-372. Online ahead of print.

ABSTRACT

Long noncoding RNAs (lncRNAs) are the most recently discovered class of noncoding RNAs. LncRNAs play a crucial role in multiple disorders. However, the role and mechanism of action of lncRNAs in keloids remain unclear. Here, qRT-PCR and western blotting assays were performed to determine the expression of genes and proteins, respectively. MTT assays were carried out to measure the proliferation of keloid fibroblasts. In addition, a luciferase activity assay was conducted to investigate the relationships between LINC00937 and miR-28-5p and between miR-28-5p and MC1R. The results showed that LINC00937 and MC1R were decreased, whereas miR-28-5p was increased in keloid tissues. LINC00937 overexpression in keloid fibroblasts could repress the extracellular matrix (ECM) deposition and cell proliferation and promote MC1R expression. Moreover, high expression of miR-28-5p and low expression of LINC00937 were detected in keloid fibroblasts. We further showed that LINC00937 promoted MC1R expression by sponging miR-28-5p. Finally, our data indicated that LINC00937 inhibited the ECM deposition and proliferation of keloid fibroblasts by inhibiting miR-28-5p and facilitating MC1R expression. Overall, LINC00937 suppressed the ECM deposition and proliferation of keloid fibroblasts by acting as an miR-28-5p sponge and promoting MC1R expression. Our data suggested that LINC00937 is a potential target for keloid treatment.

PMID:34486677 | DOI:10.14670/HH-18-372

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Insurance Status Effect on Laryngeal Cancer Survival: A Population Based Study

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Ann Otol Rhinol Laryngol. 2021 Sep 4:34894211044231. doi: 10.1177/00034894211044231. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze insurance status effect on overall survival (OS) and disease-specific survival (DSS) in laryngeal cancer.

STUDY DESIGN: Cross-sectional population analysis.

SETTING: Surveillance, Epidemiology, and End Results (SEER) database.

PARTICIPANTS: Laryngeal cancer patients from 2007 to 2016.

MAIN OUTCOME MEASURES: Kaplan- Meier method with log-rank statistic analyzed OS and DSS by insurance status. Multivariable cox proportional hazard modeling generated survival prognostic factors.

RESULTS: Of 19 667 laryngeal cancer cases, initial disease presentation was stage I: 7770 patients (39.5%), stage II: 3337 patients (17.0%), stage III: 3289 patients (16.7%), and stage IV: 5226 patients (26.6%). Patients had non-Medicaid insurance (15 523, 78.9%), had Medicaid (3306, 16.8%), or were uninsured (891, 4.5%). Mean and median OS for insured, Medicaid, and uninsured patients were 60.5, 49.6, and 56.6 and 74.0, 40.0, and 65.0 months, respectively. Following multivariable analysis, OS for insured, Medicaid, and uninsured patients was stage I: 87.9, 82.8, and 88.4 (P < .001), stage II: 79.1, 75.1, and 78.3 (P = .12), stage III: 68.7, 66.1, and 72.1 (P = .11), and stage IV: 57.1, 51.7, and 50.3 (P < .001) months. DSS mean survival times were 77.0, 65.8, and 67.7 months (P< /i> < .001) for insured, Medicaid, and uninsured patients. Age (HR: 1.02/year, P < .001) and black (HR: 1.15, P = .001) compared to white race predicted worse survival. Compared to insured status, Medicaid insurance carried a death hazard ratio of 1.40 (P < .001) and uninsured status had a death hazard ratio of 1.40 (P < .001).

CONCLUSION: Insured laryngeal cancer patients had prolonged OS and DSS compared to Medicaid and uninsured patients. Medicaid patients had equivalent survival outcomes to uninsured patients.

LEVEL OF EVIDENCE: 2c.

PMID:34486418 | DOI:10.1177/000 34894211044231

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High-sensitivity FEES® with the professional image enhancement technology 'PIET'

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Eur Arch Otorhinolaryngol. 2021 Sep 6. doi: 10.1007/s00405-021-07067-y. Online ahead of print.

ABSTRACT

PURPOSE: Flexible endoscopic evaluation of swallowing (FEES®) is a standard diagnostic tool in dysphagia. The combination of FEES® and narrow band light (narrow band imaging; NBI) provides a more precise and detailed investigation method. So far, this technique could only be performed with the NBI illumination. The new version of the "professional image enhancement technique" (PIET) provides another image enhancing system. This study investigates the eligibility of PIET in the FEES® procedure.

METHODS: Both techniques, NBI and PIET, were compared using a target system. Furthermore, the image enhancement during FEES® was performed and recorded with the two systems during daily routine.

RESULTS: Performing an image enhancement during FEES® is possible with both sys tems PIET and NBI. On the target system, the contrast of the PIET showed a brighter and a more detailed picture. In dysphagia patients, no difference between PIET and NBI was detected.

CONCLUSIONS: PIET proved to be non-inferior to NBI during image enhancement FEES®. So far, image enhancement FEES® was exclusively connected to NBI. With the PIET system, an alternative endoscopy technology is available for certain indications.

PMID:34487219 | DOI:10.1007/s00405-021-07067-y

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Cochlear implantation under local anesthesia in 117 cases: patients' subjective experience and outcomes

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Eur Arch Otorhinolaryngol. 2021 Sep 6. doi: 10.1007/s00405-021-07061-4. Online ahead of print.

ABSTRACT

PURPOSE: To report the outcomes and the patients' subjective experience of cochlear implantation (CI) performed under local anesthesia (LA). To describe a new form of intraoperative cochlear monitoring based on the patients subjective sound perception during CI.

METHODS: In this retrospective case-cohort study, 117 patients underwent CI under LA with (n = 58) or without conscious sedation (n = 59). Included were primarily elderly patients with elevated risks for general anesthesia and recently patients with residual hearing eligible for electro-acoustic stimulation (EAS) (n = 27), in whom hearing could be monitored during the electrode insertion. A 500 Hz test tone was presented and the patient reported of subjective changes in loudness, leading to a modification of the insertion. A questionnaire was sent to all patients in whi ch they assessed their subjective experience.

RESULTS: All patients were successfully operated under LA without the need to intraoperatively convert to general anesthesia. 90% of the patients reported that the surgery was a positive experience. The vast majority, 90% of patients were satisfied with the overall treatment and with intraoperative pain management and 84% of the patients would opt for local anesthesia again. Cochlear monitoring by the patients' subjective sound perception enabled for atraumatic insertions as all EAS patients could hear the test tone up to the end of the surgery.

CONCLUSIONS: CI under LA was well tolerated and recommended by the vast majority of patients. In addition, it offers the possibility to monitor the patients' hearing during the electrode insertion, which may help to prevent insertion trauma.

PMID:34487218 | DOI:10.1007/s00405-021-07061-4

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