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Αλέξανδρος Γ. Σφακιανάκης

Tuesday, October 12, 2021

Radioiodine

Comparison of Pericranial Autograft and AlloDerm for Duraplasty in Patients With Type I Chiari Malformation: Retrospective Cohort Analysis

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Oper Neurosurg (Hagerstown). 2021 Oct 11:opab343. doi: 10.1093/ons/opab343. Online ahead of print.

ABSTRACT

BACKGROUND: Pericranial autograft is a popular option for duraplasty during Chiari decompression with several theoretical advantages, but comparisons to other materials have yielded mixed results.

OBJECTIVE: To compare outcomes between pericranial autograft and AlloDerm (BioHorizons).

METHODS: Consecutive suboccipital craniectomies for patients with type I Chiari malformation (CM-I) over an 8-yr period at a single institution were identified. Exclusion criteria included revision surgeries and suboccipital decompressions without duraplasty. Outcomes included incisional cerebrospinal fluid (CSF) leakage, length of stay (LOS), wound complication, aseptic meningitis, syrinx improvement, and symptomatic improvement.

RESULTS: A total of 101 patients (70 females and 31 males) with a median (interquartile range) age of 17 yr ( 11-32) met the inclusion criteria. There were 51 (50%) patients who underwent duraplasty with pericranial autograft, and the remainder underwent duraplasty with AlloDerm. There were 9 (9%) patients who experienced a postoperative CSF leak. After adjusting for confounding factors, obesity (odds ratio [OR]: 4.69, 95% CI: 1.03-25.6) and use of AlloDerm (OR: 10.54, 95% CI: 1.7-206.12) were associated with CSF leak. Wound complication occurred in 8 (8%) patients but was not associated with graft type (P = .8). Graft type was not associated with LOS, syrinx improvement, or symptom improvement. Reoperations occurred in 10 patients with 4 in the autograft group and 6 in the AlloDerm group (P = .71).

CONCLUSION: In patients with CM-I, expansile duraplasty with AlloDerm was associated with greater odds of CSF leakage than pericranial autograft. Obesity was also associated with increased odds of CSF leakage.

PMID:34634804 | DOI:10.1093/ons/opab343

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Resveratrol protects against inorganic arsenic-induced oxidative damage and cytoarchitectural alterations in female mouse hippocampus

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Via histochem

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Acta Histochem. 2021 Oct 8;123(7):151792. doi: 10.1016/j.acthis.2021.151792. Online ahead of print.

ABSTRACT

Prolonged inorganic arsenic (iAs) exposure is widely associated with brain damage particularly in the hippocampus via oxidative and apoptotic pathways. Resveratrol (RES) has gained considerable attention because of its benefits to human health. However, its neuroprotective potential against iAs-induced toxicity in CA1 region of hippocampus remains unexplored. Therefor e, we investigated the neuroprotective efficacy of RES against arsenic trioxide (As2O3)-induced adverse effects on neuronal morphology, apoptotic markers and oxidative stress parameters in mouse CA1 region (hippocampus). Adult female Swiss albino mice of reproductive maturity were orally exposed to either As2O3 (2 and 4 mg/kg bw) alone or in combination with RES (40 mg/kg bw) for a period of 45 days. After animal sacrifice on day 46, the perfusion fixed brain samples were used for the observation of neuronal morphology and studying the morphometric features. While the freshly dissected hippocampi were processed for biochemical estimation of oxidative stress markers and western blotting of apoptosis-associated proteins. Chronic iAs exposure led to significant decrease in Stratum Pyramidale layer thickness along with reduction in cell density and area of Pyramidal neurons in contrast to the controls. Biochemical analysis showed reduced hippo campal GSH content but no change in total nitrite (NO) levels following iAs exposure. Western blotting showed apparent changes in the expression levels of Bax and Bcl-2 proteins following iAs exposure, however the change was statistically insignificant. Contrastingly, iAs +RES co-treatment exhibited substantial reversal in morphological and biochemical observations. Together, these findings provide preliminary evidence of neuroprotective role of RES on structural and biochemical alterations pertaining to mouse hippocampus following chronic iAs exposure.

PMID:34634674 | DOI:10.1016/j.acthis.2021.151792

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Predicting cancer‐specific mortality in patients with parotid gland carcinoma by competing risk nomogram

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Abstract

Background

The aim of the present study was to establish a competing risk nomogram to predict parotid gland cancer-specific mortality (PGC-SM).

Methods

Seven thousand nine hundred and sixty-two patients extracted from SEER database were randomly categorized into training and validation sets. The competing risk model was used to identify factors associated with PGC-SM. The nomogram was evaluated via concordance indexes (C-indexes), calibration plots, and decision curve analysis (DCA).

Results

Male, elderly, white, widowed, larger tumor, no surgery, advanced tumor grade, lymph node (LN) metastasis, adenocarcinoma (ADC), and higher TNM stage were associated with higher incidence of PGC-SM. Calibration plots showed that the nomogram was well calibrated. C-indexes for nomogram were 0.84 (95% CI: 0.81–0.86) and 0.84 (95% CI: 0.82–0.86) in training and validation sets, respectively. DCA demonstrated the clinical usefulness of nomogram.

Conclusions

The competing risk nomogram shows high performance in predicting PGC-SM, which might enable clinicians formulate suitable treatment protocols for patients with parotid gland carcinoma (PGC).

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Success rate and learning curve of intraoperative neural monitoring of the external branch of the superior laryngeal nerve in thyroidectomy

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Abstract

Background

This study aimed to evaluate the success rate and learning curve of intraoperative neural monitoring (IONM) of the external branch of the superior laryngeal nerve (EBSLN) in thyroidectomy.

Methods

We studied 130 consecutive patients (200 nerves at risk [NARs]) who had undergone conventional thyroidectomy with IONM of the recurrent laryngeal nerve (RLN) and EBSLN from January 2017 to March 2020. The learning curve was defined as the number of NARs required to achieve an effective and reliable neuromonitoring rate.

Results

IONM of the EBSLN was successful in 136/200 (68%) NARs. The cutoff point of the learning curve was 45 NARs (28 patients). The neural identification rate of EBSLN was significantly higher in the post-learning 155 NARs group than the pre-learning group (82.6% vs. 17.8%, p < 0.001).

Conclusions

Approximately 45 NAR neuromonitoring attempts were required to reach a significant increase in the EBSLN identification rate and overcome the learning curve.

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Mechanisms and thermodynamic modelling of iodide sorption on AFm phases

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J Colloid Interface Sci. 2021 Sep 22;608(Pt 1):683-691. doi: 10.1016/j.jcis.2021.09.104. Online ahead of print.

ABSTRACT

Both, experimental and modelling evidence is presented in this study showing that interlayer anion exchange is the dominant sorption mechanism for iodide (I-) on AFm phases. AFm phases are Ca-Al(Fe) based layered double hydroxides (LDH) known for their large potential for the immobilization of anionic radionuclides, such as dose-relevant iodine-129, em anating from low- and intermediate-level radioactive waste (L/ILW) repositories. Monosulfate, sulfide-AFm, hemicarbonate and monocarbonate are safety-relevant AFm phases, expected to be present in the cementitious near-field of such repositories. Their ability to bind I- was investigated in a series of sorption and co-precipitation experiments. The sorption of I- on different AFm phases was found to depend on the type of the interlayer anion. Sorption Rd values are very similar for monosulfate, sulfide-AFm and hemicarbonate. A slightly higher uptake occurs by AFm phases with a singly charged anion in the interlayer (HS-AFm) as compared to AFm with divalent ions (monosulfate), whereas uptake by hemicarbonate is intermediate. No significant sorption occurs onto monocarbonate. Our derived thermodynamic solid solution models reproduce the experimentally obtained sorption isotherms on HS-AFm, hemicarbonate and monosulfate, indicating that anion exchange i n the interlayer is the dominant mechanism and that the contribution of I- electrostatic surface sorption to the overall uptake is negligible.

PMID:34634544 | DOI:10.1016/j.jcis.2021.09.104

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Necrotising Myositis - Learnings for a Plastic Surgeon

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J Plast Reconstr Aesthet Surg. 2021 Sep 20:S1748-6815(21)00434-4. doi: 10.1016/j.bjps.2021.08.046. Online ahead of print.

ABSTRACT

BACKGROUND: Necrotising myositis (NM) is a life-threatening emergency. Prompt treatment is associated with more favourable outcomes, but early diagnosis is challenging. The initial absence of cutaneous signs and symptoms coupled with delayed recognition commonly result in higher rates of morbidity and mortality.

OBJECTIVES: Analyse data regarding demographics, epidemiology, aetiology, clinical manifestations, diagnosis and treatment of previously reported cases. This publication is intended for plastic surgeons in training to help them look out for this disease.

SEARCH METHODS/CRITERIA: Publications reporting necrotising myositis between 1974 to January 2020 were identified from Embase, Medline All, Web of Science Core Collection, Google Scholar and Cochrane Central Register of Controlled Trial.

DATA COLLECTION AND ANALYSIS: Identified studies were exported to an end note library. In animal studies, studies relating to statin-induced myotoxicity and auto-immune myositis were excluded. The quality of included case reports was assessed using JBI Critical Appraisal Checklist for Case Reports.

MAIN RESULTS: The most common initial presentation was a few days of antecedent prodromal flu-like symptoms associated with muscle pain. The mean age was 43.3 years and 82% had no significant medical history. The most frequent misdiagnoses were muscle strain (11%), deep vein thrombosis (10%) and viral illness (9%). Seventy-four per cent of presentations were due to Group A Streptococcus infections and only 3.5% of cases were polymicrobial. The most common clinical course following the initial presentation was rapid deterioration into profound sepsis and progression into multi-organ failure. The overall mortality rate was 36.5%.

CONCLUSIONS: NM is a life-threatening musc le infection. It is a diagnostic conundrum as initial presentation is often only myalgia without features of preceding trauma. We propose that a high index of suspicion and increased awareness will reduce morbidity.

OTHER: PROSPERO (registration number CRD42018087060). Nil funding/conflict of interest.

PMID:34635455 | DOI:10.1016/j.bjps.2021.08.046

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Facial nerve paralysis: A review on the evolution of implantable prosthesis in restoring dynamic eye closure

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J Plast Reconstr Aesthet Surg. 2021 Sep 20:S1748-6815(21)00426-5. doi: 10.1016/j.bjps.2021.08.039. Online ahead of print.

ABSTRACT

Facial nerve paralysis (FNP) is a debilitating condition that leaves those affected with disfigurement and loss of function. The most important function of the facial nerve is protecting the eye through eye closure and blinking. A series of reanimation techniques have been reported to restore dynamic function in FNP, but the lack of a universally accepted method that is reliable and reproducible with immediate effect has led to the introduction of several implantable devices. Most of these devices have been applied to assist blinking; however, the delicate anatomy and unique mechanics of eye closure are difficult to replicate. Lid loading is the most frequently used implant today, which is a passive device that can aid in volitional eye closure but has a limited effect on blinking. Dynamic action can be ach ieved with active prostheses but achieving successful long-term function remains elusive. Device action must also be coupled with a real-time feedback mechanism in order to capture the natural variation in facial muscle movements. This review discusses all prostheses used for restoring eye closure and blinking to date and explores their relative merits.

PMID:34635457 | DOI:10.1016/j.bjps.2021.08.039

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