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Αλέξανδρος Γ. Σφακιανάκης

Sunday, January 16, 2022

Profile of Injured Singers: Expectations and Insights

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Objectives

To discover patterns of phonotraumatic lesions in singers and investigate factors that differentiate those who underwent surgery from those who did not. We hypothesized that 1) lesion type distribution differs by age, sex, singer classification (professional/amateur), and history of formal voice training; 2) the likelihood of surgery is associated with singer classification and voice training.

Study Design

Retrospective.

Methods

Retrospective review of 438 singers with phonotraumatic lesions over a 9-year period. Lesion type distribution was analyzed with respect to sex, age, singer classification, and voice training. The association of eventual surgery with these factors was also analyzed.

Results

Nodules accounted for over half of the cohort (58%), followed by pseudocysts (20%), polyps (14%), and cysts (4%). Nearly two of every three injured female singers, but fewer than one out of every three injured male singers, had nodules. In contrast, over half of the injured males had polyps, whereas only 6% of injured females had polyps. In females, polyps occurred at a later age, and in males, nodules occurred at a younger age compared to other lesion types. Only 14% of the total cohort eventually underwent surgery. Professional singers without formal voice training were almost eight times more likely to have undergone surgery than amateur singers with voice training.

Conclusions

Professional singers were more likely to undergo surgery than amateurs, and formal voice training was associated with a lower likelihood of surgery. The observation that polyps tended to occur in older women may have implications for the pathogenesis of vocal fold polyps.

Level of Evidence

4 Laryngoscope, 2022

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FOCUS THEME ISSUE: CONCISE COMMUNICATION Dysbiosis of nail microbiome in patients with psoriasis

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ABSTRACT

Shifts in skin microbiome are considered to be involved in the pathogenesis of psoriasis. However, data on the microbial dysbiosis of nail psoriasis is scarce. In this study, we aim to investigate and characterize the nail bacterial and fungal microbiome in patients with psoriasis. Nail samples were collected prospectively from 36 subjects with nail psoriasis, 24 psoriatic subjects without nail involvement, and 32 healthy controls. Amplicon sequencing was performed to evaluate the bacterial and fungal community compositions. Significant alterations in the bacterial microbiome were found in the nail samples of psoriatic patients. The unaffected nails in psoriatic patients were associated with higher bacterial diversity, and a higher relative abundance of Enhydrobacter, whereas nail psoriasis was correlated with a decreased relative abundance of Anaerococcus. Shifts in fungal community composition was reflected by a higher proportion of Malassezia in the unaffec ted nails of psoriatic patients and an increased proportion of Candida in psoriatic nails. Shifts in the nail microbiome in psoriasis suggest a potential role of microbes in the development of nail psoriasis. Future researches focusing on these microorganisms may help to explain the pathogenesis of psoriasis.

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Development of a therapeutic education program for prostate cancer patients undergoing new generation hormone therapy

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Bull Cancer. 2022 Jan 10:S0007-4551(21)00681-0. doi: 10.1016/j.bulcan.2021.11.014. Online ahead of print.

ABSTRACT

New generation hormone therapies (NGHT) is the gold standard treatment for metastatic prostate cancers and/or castration-resistant tumors. Four molecules have been approved: enzalutamide, abiraterone acetate, apalutamide and darolutamide. These treatments are oral therapies taken on a daily basis, which raise issues of adherence to treatment, adverse effects and drug interactions. Therapeutic educational programs for patients represent an emerging care activity that allows patients to acquire skills to better live with their disease and treatment. As of today, no such specific program to new generation hormone therapy in prostate cancer has been developed in France, which was the goal of our current study. This was conducted in three steps: i) identification of patients' educational needs through an exchange with a focus g roup of patients, ii) gathering of expert opinions on useful information to be given to patients on NGHT via a questionnaire submitted to GETUG members and iii) implementation of the program per se. Qualitative analysis of exchanges with the focus group of patients led to the identification of 7 meaning categories. Expert opinions regarding useful information to deliver to patients identified 13 key items. Based on these preliminary data concerning patients' educational needs, we set up the first french program dedicated to metastatic prostate cancer patients undergoing NGHT that included three therapeutic education workshops: "Experience of the disease", "Management of the treatment" and "Physical activity and diet".

PMID:350271 62 | DOI:10.1016/j.bulcan.2021.11.014

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Specificities of supportive care in geriatric oncology

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Bull Cancer. 2022 Jan 10:S0007-4551(21)00679-2. doi: 10.1016/j.bulcan.2021.12.004. Online ahead of print.

ABSTRACT

Supportive care in geriatric oncology is crucial care that should be proposed from the beginning of cancer treatment. More than the quantity of life, the quality of life is a primary goal when treating cancer in the older patients. An initial assessment of the frailty of the older patients should be carried out. The eight domains requiring in-depth assessment are social environment, functional status, walking and balance, cognition, psychological status, co-morbidity and polypharmacy, nutrition and sensory deficiencies. The alteration of these domains has an impact on the patient's outcome, his quality of life and the tolerance of the treatment. One of the major challenges is to maintain the autonomy of the older patient, which involves preserving his functional status, his neuropsychological state and his nutritional stat e. Corrective actions for each of the domains must be implemented and must be adjusted throughout the course. It is also important to anticipate risks that may compromise or delay the continuation of anti-tumor treatment such as falls, delirium, organ decompensation, iatrogenic risk and social isolation.

PMID:35027163 | DOI:10.1016/j.bulcan.2021.12.004

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Update on recurrent mutations in angioimmunoblastic T-cell lymphoma

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Int J Clin Exp Pathol. 2021 Dec 15;14(12):1108-1118. eCollection 2021.

ABSTRACT

Angioimmunoblastic T-cell lymphoma (AITL) is a subtype of peripheral T cell lymphoma (PTCL), defined by genetic alterations that induce abnormal immune activity and inflammatory disorders. Through recent discoveries using genomic studies, the identification of various recurrent mutations has provided greater insight and changed our understanding of the molecular genetics of the disease. By acknowledging these recurrent mutations and their affected pathways, the diagnosis, prognosis, treatment, and survival of AITL can be improved. In this review, we summarize the known recurrent mutations present in the molecular pathogenesis of AITL by emphasizing the effects of mutations on signaling pathways and genes, as well as the multistep process of AITL development.

PMID:35027991 | PMC:PMC8748014

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Analysis of clinicopathologic features and gene mutations in gastrointestinal stromal tumor: a series of 58 patients

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Int J Clin Exp Pathol. 2021 Dec 15;14(12):1128-1137. eCollection 2021.

ABSTRACT

BACKGROUND: In gastrointestinal stromal tumor (GIST), mutually exclusive gain-of-function mutations of c-kit and PDGFRα are associated with different mutation-dependent clinical features. We analyzed clinico-pathologic features and genotypes of GIST among patients in China.

METHODS: Adult patients with GIST in the stomach, small intestine, colorectum, or extra-gastrointestinal areas were enrolled in this study. These patients had been subjected to surgical resection without imatinib (Gleevec) treatment at the Cancer Hospital, Chinese Academy of Medical Sciences from January 2009 to January 2019. Samples were obtained for histopathologic examination. Mutations in c-kit and PDGFRα genes were analyzed by PCR and next generation sequencing (NGS). Clinico-pathologic characteristics of each gene were also analyzed.

RESULTS: A total of 58 GIST patien ts was enrolled in this study. In terms of genotypes, there were 51 (87.9%) c-kit mutations, 5 (8.6%) PDGFRα mutations, and 2 (3.4%) wild-type mutations. In terms of cell types, there were 40 cases (69.0%) with spindle cell type, 3 cases (5.2%) with epithelioid cell type and 3 cases (5.2%) with mixed spindle-epithelioid cell type. Among the 4 mutant forms of c-kit exon-11, the most common were point mutations in 16 cases (38.1%), deletion mutations in 13 cases (31.0%), insertion mutations in 4 cases (9.5%), and mixed mutations in 9 cases (21.4%). Based on risk grade classification of the National Institutes of Health (NIH), 3 cases (5.2%) were very-low risk, 9 cases (15.5%) were low risk, 19 cases (32.8%) were medium risk, and 23 cases (39.7%) were high risk. Significant differences in cell type were identified across different gene types (P = 0.022). Similarly, differences in tumor risk were found among different mutant forms of c-kit gene exon-11 (P = 0.039).

CONCLUSION: With c-kit mutations, spindle cell type prevalence exceeded that of the epithelioid cell type and mixed spindle-epithelioid cell type. Spindle and mixed spindle-epithelioid cell types were the most prevalent in the category of PDGFRα mutations. In wild type cases, spindle and epithelioid cell types were the most common. A high risk of deletion and mixed mutations, and intermediate risk of point and insertion mutations were observed in c-kit exon-11 mutation type.

PMID:35027993 | PMC:PMC8748011

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Clinicopathologic analysis of malignant or premalignant cutaneous neoplasms in Japanese kidney transplant recipients

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Int J Clin Exp Pathol. 2021 Dec 15;14(12):1138-1147. eCollection 2021.

ABSTRACT

It is well known that recipients of kidney transplants are at an increased risk of developing malignant or premalignant cutaneous neoplasms (MPCNs) after transplantation. However, the pathogenesis of MPCNs after kidney transplant has not been well-studied in Asian populations. This study aimed to describe the clinicopathologiccharacteristics of MPCNs in an Asian population. We retrospectively reviewed the medical records of 1956 patients who received kidney transplants at two hospitals in Japan, between 2003 and 2019. Among these patients, 24 developed 50 MPCN lesions, including 14 squamous cell carcinoma (SCC, 28%), 23 Bowen's disease (BD, 46%), 11 actinic keratosis (AK, 22%), and two basal cell carcinoma (BCC, 4%). No patient had malignant melanoma. The duration from transplantation to the diagnosis was significantly longer for SCC than for BD or AK (P=0. 021, 0.036, respectively). Seven patients had multiple MPCNs in sun-exposed areas of skin. Among the 50 MPCNs, 40 (80%) were located in sun-exposed areas, and 10 (20%) were located in sun-protected areas. MPCNs in sun-exposed skin were frequently accompanied by dermal solar elastosis (90%, 36/40). We found high-risk human papillomavirus (HR-HPV) infections in two anogenital lesions (100%, 2/2). In contrast, HR-HPV infections were not detected in any extragenital lesions (0%, 0/30). Our results suggested that, among Japanese recipients of kidney transplant, MPCNs in sun-exposed skin areas may be associated with immunosuppression and ultraviolet exposure.

PMID:35027994 | PMC:PMC8748015

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Negative loop electrosurgical excision procedure (LEEP) following cervical biopsy diagnosis of high grade squamous intraepithelial lesion

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Int J Clin Exp Pathol. 2021 Dec 15;14(12):1148-1154. eCollection 2021.

ABSTRACT

CONTEXT: Loop Electrosurgical Excision Procedure (LEEP) is commonly performed after cervical biopsy diagnosis of high grade squamous intraepithelial lesion (HSIL/CIN2 or CIN 3). Histological and immunohistochemical assessments are made to differentiate reactive and metaplastic changes from dysplastic changes. A Human Papillomavirus (HPV) test is used for prognostic assessment after conization.

OBJECTIVE: We retrospectively reviewed cases where the cervical biopsy showed HSIL but the LEEP specimen was negative for high grade dysplasia. Our aim was to determine the cause of miscorrelation.

DATA: IRB approval was obtained and a search was made of all LEEP specimens received during 2018. We reviewed 25 of 137 LEEP specimens that did not correlate with the diagnosis of HSIL rendered on the cervical biopsy. These were from women between 25 to 54 years . All cases had positive high-risk HPV with 80% being non16/18 subtype. On review, 8/25 had HSIL with the remainder of cases falling short of HSIL diagnosis. Follow up cytology with HPV test after the LEEP procedure was negative in all but one case of LSIL with persistent non-16/18 HPV.

CONCLUSION: The study highlights the diagnostic difficulties of distinguishing HSIL from immature squamous metaplasia. The practical implication is that in cases with non-16/18 high risk HPV which have thin epithelium and fall short of definite morphologic criteria of HSIL, presence of immature squamous metaplasia should be carefully evaluated. The specific role of CK7 and CK17 which highlight squamocolumnar junctional cells and metaplastic cells, respectively, needs to be explored in these cases.

PMID:35027995 | PMC:PMC8748010

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Monitoring Spinal Cord Tissue Oxygen in Patients With Acute, Severe Traumatic Spinal Cord Injuries

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Crit Care Med. 2022 Jan 6. doi: 10.1097/CCM.0000000000005433. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine the feasibility of monitoring tissue oxygen tension from the injury site (psctO2) in patients with acute, severe traumatic spinal cord injuries.

DESIGN: We inserted at the injury site a pressure probe, a microdialysis catheter, and an oxygen electrode to monitor for up to a week intraspinal pressure (ISP), spinal cord perfusion pressure (SCPP), tissue glucose, lactate/pyruvate ratio (LPR), and psctO2. We analyzed 2,213 hours of such data. Follow-up was 6-28 months postinjury.

SETTING: Single-center neurosurgical and neurocritical care units.

SUBJECTS: Twenty-six patients with traumatic spinal cord injuries, American spinal injury association Impairment Scale A-C. Probes were inserted within 72 hours of injury.

INTERVENTIONS: Insertion of subarachnoid oxygen electrode (Licox; Integra LifeSciences, Sophi a-Antipolis, France), pressure probe, and microdialysis catheter.

MEASUREMENTS AND MAIN RESULTS: psctO2 was significantly influenced by ISP (psctO2 26.7 +/- 0.3 mm Hg at ISP > 10 mmHg vs psctO2 22.7 +/- 0.8 mm Hg at ISP <= 10 mm Hg), SCPP (psctO2 26.8 +/- 0.3 mm Hg at SCPP < 90 mm Hg vs psctO2 32.1 +/- 0.7 mm Hg at SCPP >= 90 mm Hg), tissue glucose (psctO2 26.8 +/- 0.4 mm Hg at glucose < 6 mM vs 32.9 +/- 0.5 mm Hg at glucose >= 6 mM), tissue LPR (psctO2 25.3 +/- 0.4 mm Hg at LPR > 30 vs psctO2 31.3 +/- 0.3 mm Hg at LPR <= 30), and fever (psctO2 28.8 +/- 0.5 mm Hg at cord temperature 37-38[degrees]C vs psctO2 28.7 +/- 0.8 mm Hg at cord temperature >= 39[degrees]C). Tissue hypoxia also occurred independent of these factors. Increasing the FIO2 by 0.48 increases psctO2 by 71.8% above baseline within 8.4 minutes. In patients with motor-incomplete injuries, fluctuations in psctO2 correlated with fluctuations in limb motor score. The injured cord spent 11% (39%) hours at psctO2 less than 5 mm Hg (< 20 mm Hg) in patients with motor-complete outcomes, compared with 1% (30%) hours at psctO2 less than 5 mm Hg (< 20 mm Hg) in patients with motor-incomplete outcomes. Complications were cerebrospinal fluid leak (5/26) and wound infection (1/26).

CONCLUSIONS: This study lays the foundation for measuring and altering spinal cord oxygen at the injury site. Future studies are required to investigate whether this is an effective new therapy.

PMID:35029868 | DOI:10.1097/CCM.0000000000005433

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A systematic review: metabolomics‐based identification of altered metabolites and pathways in the skin caused by internal and external factors

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Abstract

The skin's ability to function optimally is affected by many diverse factors. Metabolomics has a great potential to improve our understanding of the underlying metabolic changes and the affected pathways. Therefore, the objective of this study was to review the current state of the literature and to perform further metabolic pathway analysis on the obtained data. The aim was to gain an overview of the metabolic changes under altered conditions and to identify common and different patterns as a function of the investigated factors.

A cross-study comparison of the extracted studies from different databases identified 364 metabolites, whose concentrations were considerably altered by the following factor groups: irradiation, xenobiotics, aging, and skin diseases (mainly psoriasis). Using metabolic databases and pathway analysis tools the individual metabolites were assigned to the corresponding metabolic pathways and the most strongly affected signaling pathways were identified.

All factors induced oxidative stress. Thus, antioxidant defense systems, especially coenzyme Q10 (aging) and the glutathione system (irradiation, aging, xenobiotics) were impacted. Lipid metabolism was also impacted by all factors studied. The carnitine shuttle as part of β-oxidation was activated by all factor groups except aging. Glycolysis, Krebs (TCA) cycle and purine metabolism were mainly affected by irradiation and xenobiotics. The pentose phosphate pathway was activated and Krebs cycle was downregulated in response to oxidative stress. In summary, it can be ascertained that mainly energy metabolism, lipid metabolism, antioxidative defense and DNA repair systems were impacted by the factors studied.

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The effect of COVID-19 pandemic on laryngeal cancer in a tertiary referral center

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Eur Arch Otorhinolaryngol. 2022 Jan 15. doi: 10.1007/s00405-022-07268-z. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate whether there was a significant change in the laryngeal cancer stage before and after the COVID-19 pandemic.

METHODS: This retrospective cohort study was conducted to evaluate the data of patients who operated due to laryngeal cancer in a tertiary referral hospital's ear, nose, and throat (ENT) department between June 2018 and 2021. The patients were included at the same period of the years to rule out any seasonal changes. The basic characteristic, tumor localization, and TNM stage of the patients were compared.

RESULTS: 97 patients were operated due to laryngeal cancer during the time period reviewed. 57 (58.8%) patients were operated before and 40 (41.2%) after the COVID-19 pandemic. When comparing the patients before and after the COVID-19 pandemic period, the mean age significan tly differed between the study groups that older age was observed in patients who admitted before the COVID-19 pandemic (62.8 ± 6.5 vs. 57.3 ± 6.8, p < 0.001). Regarding the TNM classification, the patients in the after COVID-19 pandemic group had higher rates of T4 stage laryngeal cancer compared to before COVID-19 pandemic group (12 (30%) vs. 4 (7%), p: 0.003).

CONCLUSION: Younger patients have operated after the COVID-19 pandemic, and the patients were presented with larger tumor sizes. The pandemic may increase the time between diagnosis and surgery in laryngeal cancer patients.

PMID:35031859 | DOI:10. 1007/s00405-022-07268-z

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