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Αλέξανδρος Γ. Σφακιανάκης

Thursday, May 5, 2022

Contribution and safety of the side‐to‐end hypoglossal‐to‐facial transfer in multidisciplinary facial reanimation

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Abstract

Background

This study evaluates facial and tongue function in patients undergoing side-to-end hypoglossal-to-facial transfer (HFT) with additional techniques.

Methods

Thirty-seven patients underwent a side-to-end HFT. Twelve had additional cross-face grafts, and 9 had an additional masseter-to-facial transfer. Facial was assessed with House–Brackmann (HB), Sunnybrook Facial Grading Scale (SFGS), and eFACE. Martins scale and the Oral-Pharyngeal Disability Index (OPDI) were used to assess tongue function.

Results

Ninety-four percent of cases reached HB grades III–IV. Mean total SFGS score improved from 16 ± 15 to 59 ± 11, while total eFACE score from 52 ± 13 to 80 ± 5. Dual nerve transfers were a predictor for a better eFACE total score p = 0.034, β = 2.350 [95% CI, 0.184–4.516]), as well as for a higher SFGS total score (p = 0.036, β = 5.412 [95% CI, 0.375–10.449]). All patients had Martin's grade I. Mean postoperative OPDI scores were 84 ± 17 (local physical), 69 ± 16 (simple and sensory motor components), 82 ± 14 (complex functions), and 73 ± 22 (psychosocial).

Conclusions

The side-to-end HFT offers predictable facial function outcome and preserves tongue function in nearly all cases. Dual nerve transfers appear to improve the final outcome.

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Assessing the risks associated with the emergence of Florona and possible preventive measures

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Κορωνοϊός: Τι είναι η Delmicron και η Florona

REUTERS / MAY JAMES
Το στέλεχος Όμικρον του SARS-CoV-2 κυριαρχεί πλέον στην Ευρώπη και οδηγεί σε κατακόρυφη αύξηση των νέων κρουσμάτων COVID-19. Πρόσφατα, δύο νέοι όροι έχουν έρθει στο προσκήνιο. Ο λόγος για τους όρους Delmicron και Florona.

Οι Ιατροί της Θεραπευτικής Κλινικής της Ιατρικής Σχολής του Εθνικού και Καποδιστριακού Πανεπιστημίου Αθηνών Θεοδώρα Ψαλτοπούλου, Γιάννης Ντάνασης, Πάνος Μαλανδράκης και Θάνος Δημόπουλος (Πρύτανης ΕΚΠΑ) συνοψίζουν τα νεότερα σχετικά με τα Delmicron και Florona.

Αρχικά πρέπει να σημειωθεί ότι και οι δύο όροι δεν αναφέρονται σε κάποιο νέο στέλεχος του SARS-CoV-2, αλλά σε συνύπαρξη του στελέχους Όμικρον είτε με το στέλεχος Δέλτα (Delmicron) είτε με την εποχική γρίπη (Florona).

Σύμφωνα με τον Παγκόσμιο Οργανισμό Υγείας (ΠΟΥ), η επικράτηση του στελέχους Όμικρον δεν θα πρέπει να μας κάνει να λησμονήσουμε άλλες πολύ συχνές ιογενείς λοιμώξεις που συνυπάρχουν στην κοινότητα και μπορεί να εμφανιστούν παράλληλα σε ευάλωτα άτομα. Γι' αυτό το λόγο, τονίζεται η ανάγκη πλήρους εμβολιασμού με όλες τις απαραίτητες αναμνηστικές δόσεις τόσο έναντι του SARS-CoV-2 όσο και έναντι της εποχικής γρίπης, παράλληλα με την τήρηση των κανόνων σωματικής απομάκρυνσης για την πρόληψη της μετάδοσης και των δύο λοιμώξεων.

Τι είναι η Delmicron: Ποια τα συμπτώματα
Τα άτομα με εξασθενημένο ανοσοποιητικό σύστημα, τα άτομα μεγαλύτερης ηλικίας και με συνυπάρχουσες παθήσεις παρουσιάζουν αυξημένο κίνδυνο COVID-19 και μάλιστα είναι πιθανό να νοσήσουν ταυτόχρονα και από δύο επικρατούντα στελέχη του SARS-CoV-2, δηλαδή το Όμικρον και το Δέλτα.

Η συλλοίμωξη με τα δύο στελέχη (Delmicron) μπορεί επίσης να παρατηρηθεί σε περιοχές με χαμηλή εμβολιαστική κάλυψη του πληθυσμού. Και αυτό ισχύει γιατί μπορεί το στέλεχος Όμικρον να είναι το κυρίαρχο, ωστόσο το στέλεχος Δέλτα δεν έχει εκλείψει. Στο γενικό πληθυσμό η πιθανότητα της ταυτόχρονης λοίμωξης με δύο στελέχη SARS-CoV-2 είναι χαμηλή, ωστόσο σε περιπτώσεις συνωστισμού μπορεί να συνυπάρχουν κρούσματα τόσο Δέλτα όσο και Όμικρον.

Εάν τα άτομα που έχουν εξασθενημένο ανοσοποιητικό βρεθούν στο πλήθος, θα εκτεθούν πιθανότατα και στα δύο στελέχη και μπορεί να εμφανίσουν κλινική νόσο και από τα δύο στελέχη.

Τα συμπτώματα είναι ουσιαστικά ο συνδυασμός των συμπτωμάτων από τα δύο στελέχη και περιλαμβάνουν εμπύρετο, βήχα, ανοσμία, αγευσία, πονοκέφαλο, καταρροή και πονόλαιμο.

Τι είναι η Florona: Τα συμπτώματα και οι επιπλοκές
Πολύ πρόσφατα αναφέρθηκε στο Ισραήλ η περίπτωση μιας εγκύου που προσήλθε στο νοσοκομείο για τοκετό και διαγνώσθηκε με παράλληλη λοίμωξη COVID-19 και γρίπης (Florona). Η ασθενής δεν είχε εμβολιαστεί για κανέναν από τους δύο ιούς.

Παρόλο που ο όρος Florona μπορεί να προέκυψε πρόσφατα, η συλλοίμωξη δεν αποτελεί κάτι καινούργιο για την ιατρική κοινότητα. Ο ιός SARS-CoV-2 και ο ιός της γρίπης μεταδίδονται με παρόμοιο τρόπο, δηλαδή με την κοντινή επαφή σε απόσταση μικρότερη των 2 μέτρων μέσω αναπνευστικών σταγονιδίων ή/και αερολύματος κατά τη διάρκεια της ομιλίας, του βήχα και του πτερνίσματος.

Οι δύο λοιμώξεις έχουν κοινά συμπτώματα όπως βήχας, πυρετό και καταρροή.

Διαφορετικές δοκιμασίες PCR για τον ιό της γρίπης και για τον SARS-CoV-2 μπορεί να αποσαφηνίσουν σε κάθε περίπτωση την αιτιολογία των συμπτωμάτων. Και οι δύο λοιμώξεις μπορεί να έχουν σοβαρές επιπλοκές όπως πνευμονία, οξεία αναπνευστική ανεπάρκεια, πολυ-οργανική ανεπάρκεια, καρδιακά συμβάματα, εγκεφαλίτιδα, μυοκαρδίτιδα, ισχαιμικό εγκεφαλικό επεισόδιο και θάνατο.


Unlike some of the claims made by fake news posts of social media, Florona is not a new Covid-19 variant. The last Covid-19 variant that was detected was Omicron and no further variants have since been identified by the World Health Organisation.

The WHO does, however, confirm that co-infection with both Covid-19 (any variant) and the flu virus is indeed possible and added that the best way to avoid such a condition is to get vaccinated against both Covid-19 and Influenza.

What are the symptoms of Florona?

While both Covid-19 and influenza affect the respiratory system, there are some differences between the way flu and Covid-19 impacts health and manifests themselves.

Symptoms of "Florona" include high fever, consistent chest pain or constriction, shortness of breath and loss of appetite. It can also lead to states of confusion and anxiety.

According to the WHO, mild symptoms of a double Covid-19 and flu infection can be treated at home itself without requiring any hospitalisation.

In severe cases, symptoms of Florona may also include pneumonia, myocarditis and inflammation in heart muscles.

Is Florona a matter of concern?

Both Covid-19 and flu are viruses that affect the respiratory tract and can cause severe illness and even death. While the symptoms and means of transmission for both viruses are the same, both have different treatments and different vaccines. Double infection with both viruses can cause complications the body and stress out the immune system.

While "Florona" is not a new variant, the occurrence might be indicative of a weakened immune system under attack from two virus infections, Dr Nahla Abdel Wahab, Cairo University Hospital doctor, was quoted by Israeli media following the emergence of the disease.

Amid the ongoing winter months, otherwise known as "flu season", season influenza breakouts are not uncommon in several countries. With Covid-19 cases also peaking across the world following the emergence of Omicron, fear of "Florona" cases spiking may not be unfounded.

(Credit: Pixabay)

How to prevent Florona?

Following social distancing protocols, wearing masks and getting vaccinated against both Covid-19 and influenza is the only way to prevent Florona. Flu vaccines have been used since 1949, especially among vulnerable groups such as senior citizens. Meanwhile, a majority of countries have rolled out vaccination plans for their adult populations.

Abstract

The emergence of novel variants of SARS-CoV-2, especially the VOCs (variants of concern), has been considered a severe threat amid the mighty efforts of various nations to contain the negative repercussions of the COVID-19 pandemic caused by SARS-CoV-2.

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Longer length of stay, days between discharge/first readmission, and pulmonary involvement ≥50% increase prevalence of admissions in ICU in unplanned readmissions after COVID‐19 hospitalizations

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Abstract

Hospital readmissions due to COVID-19 are one of the main concerns for the health system due to risks to the patient's life and increased use of health resources. Studies focusing on this issue are important to understand the risk factors and create strategies to avoid readmissions. We evaluated the readmission of patients with confirmed COVID-19 in a private hospital in southern Brazil, between March 2020 and 2021. Also, the characteristics and clinical outcomes of patients admitted to the intensive care unit (ICU) and nonadmitted were compared. Poisson regression models with prevalence ratio (PR) with 95% confidence intervals (95% CIs) were applied to confirm the association between variables and ICU admission. Of the 2084 hospitalized patients with COVID-19, 1806 were discharged alive. Among them, 106 were readmitted for unplanned reasons during one year. Early hospital readmission (≤30 days) occurred in 52.8% of the cases. The main reasons were respiratory, gastroe nterological, kidney, and cardiac disease. The median age was 73.0 years old and women correspond to 52.8%. The presence of at least one comorbidity was detected in 87.7% of patients. Hypertension, diabetes, cardiac, and lung disease were more frequent. The ICU admitted patients (n = 43; 40.5%) mostly had 4–5 comorbidities, pulmonary involvement ≥50%, length of stay (LOS), and days between discharge and first readmission. Longer LOS (PR: 3.46; 95% CI: 1.24–5.67), days between discharge/first readmission (PR: 2.21; 95% CI: 1.15–5.88), and pulmonary involvement (≥50%; PR: 1.59; 95% CI: 1.11–3.54) were independently associated with ICU admission. Longer LOS, longer days between discharge/first readmission, and pulmonary involvement (≥50%) were associated with ICU admission in readmitted patients. Readmissions evaluation is pivotal and may help in ensuring safe care transition and postdischarge follow-up.

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Two conserved amino acids differentiate the biology of high‐risk and low‐risk HPV E5 proteins.

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Abstract

The high-risk alpha human papillomaviruses (HPVs) are responsible for 99% of cervical cancers. While the biological functions of the HPV E6 and E7 oncoproteins are well-characterized, the function of E5 has remained elusive. Here, we examined gene expression changes induced by E5 proteins from high-risk HPV-16 and low-risk HPV-6b in multiple pools of primary human keratinocytes. Surprisingly, microarray analysis revealed that over 700 genes were significantly regulated by HPV-6b E5, while only 25 genes were consistently and significantly regulated by HPV-16 E5 in three biological replicates. However, we observed that more than thousand genes were altered in individual sample compared to vector. The gene expression profile induced by 16E5 in primary genital keratinocytes was very different from what has been previously published using immortalized HaCaT cells. Genes altered by HPV-16 E5 were unaffected by HPV-6b E5. Our data demonstrate that E5 proteins from the high- and low-risk HPVs have different functions in the HPV-host cell. Interestingly, conversion of two amino acids in HPV-16 E5 to the low-risk HPV-6b sequence eliminated the induction of high-risk related cellular genes.

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The moderating role of sexual minority status in the associations of the experience and tolerance of shame‐related emotions to suicide risk

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Abstract

Objective

This study examined the associations of the experience and tolerance of shame-related emotions to suicide risk, as well as the moderating role of sexual minority status.

Methods

Community adults (N = 360) were recruited via MTurk and completed self-report questionnaires. Hierarchical regression analyses examined the main and interactive associations of sexual minority status and shame-related variables to suicide risk.

Results

Results revealed significant positive associations between self-disgust and suicide risk for sexual minority and heterosexual participants, although the magnitude was greater for sexual minority participants. Additionally, tolerance of shame was significantly negatively related to suicide risk only among sexual minority participants. Finally, exploratory analyses examining the three-way interaction of self-disgust, shame tolerance, and sexual minority status revealed a significant negative association between shame tolerance and suicide risk only among sexual minority participants with high levels of self-disgust.

Conclusion

Results highlight the relevance of shame-related experiences to suicide risk among sexual minorities.

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Predictors of posttraumatic stress symptom severity and meaning made in treatment‐seeking veterans

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Abstract

Objective

Combat-exposed veterans risk encountering events that disrupt beliefs. To facilitate reduced discrepancy between prior beliefs and current trauma appraisals, veterans may engage in a process of meaning-making. Meaning-making can lead to positive outcomes, such as integrating the traumatic event into one's life narrative or adapting global meaning (meaning made) or elicit distress. Given these potentially different outcomes, this study examined potential correlates of posttraumatic stress symptom (PTSS) severity and meaning made, including relationship attachment dimensions of anxiety and avoidance, and difficulties with emotion regulation, while controlling for combat exposure.

Method

Veterans receiving mental health services at a Veterans Affairs (VA) Medical Center and a VA community-based outpatient clinic (N = 130) completed measures through a paper-and-pencil survey. Almost all participants (92%) were male, with a mean age of 55.92 years.

Results

In terms of meaning made, lower levels of attachment anxiety and emotional clarity (an aspect of emotion regulation) predicted higher meaning made. In terms of PTSS severity, higher attachment avoidance, attachment anxiety, and difficulties engaging in goal-directed behavior (an aspect of emotion regulation) significantly predicted higher PTSS severity.

Conclusion

Aspects of both attachment style and emotion regulation difficulties affect meaning made and PTSS severity. These constructs may be especially relevant for clinicians working with veterans to help PTSS and support meaning made postcombat.

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A Novel Spinal Cord Stimulation System with a Battery‐Free Micro Implantable Pulse Generator

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Abstract

Spinal cord stimulation (SCS) is effective for the treatment of chronic intractable pain of the trunk and limbs. The mechanism of action may be based, at least in part, upon the gate control theory; however, new waveforms may suggest other mechanisms. Although benefits of the SCS technology generally outweigh the complications associated with SCS, some complications such as infection and skin erosion over the implant can result in device removal. Additional reasons for device removal, such as pocket pain and battery depletion, have driven technological innovations including battery-free implants and device miniaturization. The neurostimulation system described here was specifically designed to address complications commonly associated with implantable batteries and/or larger implantable devices. The benefits of the small size are further augmented by a minimally invasive implant procedure. Usability data show that patients found this novel neurostimulation system to be easy to use and comfortable to wear. What is more, clinical data demonstrate that the use of this system provides statistically significant reduction in pain scores with responder rates (defined as ≥ 50% reduction in pain) of 78% in the low back and 83% in the leg(s). Advances in miniaturization technology arose from the considerable shrinkage of the integrated circuit, with an increase in performance, according to Moore's law (1965). However, commensurate improvements in battery technology have not maintained a similar pace. This has prompted some manufacturers to place the battery outside, against the skin, thereby allowing a massive reduction in the implant volume, with the hopes of fewer device-related complications.

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In Silico Finite Element Analysis of Implant‐Supported CAD‐CAM Resin Composite Crowns

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Abstract

Purpose

The aim of this study was to evaluate the mechanical behavior of an implant-supported crown made using computer-aided design and computer aided manufacturing (CAD-CAM) resin composite (RC) blocks in the posterior region.

Material and methods

Four commercially available CAD-CAM RC blocks were used in this study: Cerasmart 300 (CS300; GC, Tokyo, Japan), Katana Avencia P Block (KAP; Kuraray Noritake Dental, Niigata, Japan); KZR HR3 Gamma Theta (HR3; Yamakin, Osaka, Japan), and Estelite P block (ESP; Tokuyama Dental, Tokyo, Japan). Katana Zirconia STML (ST; Kuraray Noritake Dental) was used as the control group. The elastic moduli of each material were determined by a three-point bending test. After the CAD models were designed, two different loading scenarios (oblique, vertical) were created. 3D finite element analysis was conducted with the prepared models.

Results

The elastic modulus of the material utilized for the implant restorations did not cause any change in the stresses transmitted to the implant or peripheral bone. An important difference was detected in the abutment–crown junction area. The minimum von Mises value at the abutment-crown interface was obtained in ST, which has the closest elastic modulus to the titanium abutment.

Conclusions

The 3D finite element model designed in this study was used to demonstrate that implant-supported crowns fabricated with four different CAD-CAM RCs showed no critical stress concentrations in the bone or implant under all loading conditions. These results suggest that CAD-CAM RC blocks could be used as an alternative material for implant-supported restorations in the posterior region in terms of stress distribution.

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Digital Determination and Recording of Edentulous Maxillomandibular Relationship Using A Jaw Movement Tracking System

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Abstract

Purpose

To establish a direct digital method for determining and recording edentulous maxillomandibular relationship using a custom-made jaw movement tracking system and evaluate its accuracy.

Materials and methods

A novel jaw tracking system was used to record the trajectory of habitual opening-closing jaw movement, and mandibular rest position (MRP) in 10 edentulous patients. 3D surface scanning was performed on the conventional maxillomandibular impressions and facial structures of patients in MRP. The multi-source data were registered using a custom-made recording tool. A plane parallel to the ala-tragus and horizontal lines was constructed 2 mm above the MRP, and its vertical position was used to determine the vertical relationship. The intersections of the trajectory passing through the plane were located, and their density distributions were analyzed. The coordinates of highest density, which presented the highest repeatability of jaw movement, were used to construct the digital maxillomandibular relationship (test group). The maxillomandibular relationship of the new complete dentures with artificial teeth in the intercuspal position was defined as the control group. The displacement s of the anterior reference point and 3D deviations of the entire mandibular arch were measured and compared between the test and control groups using a Wilcoxon signed-ranks test and a one-sample t-test, respectively.

Results

With reference to the centric relationship position, the maximum displacements of the anterior reference points were in the horizontal anteroposterior direction for both groups, and there were no significant differences. Compared to the control group, the 3D deviations of the entire mandibular arch in the test group were significant (95% confidence interval: 0.76 mm to 1.35 mm, P < 0.001).

Conclusions

By analyzing the individual trajectory features obtained by the in-house developed jaw tracking system, a digital method for determining and recording edentulous maxillomandibular relationships was established; however, the accuracy needs to be further improved.

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Feasibility of face mask spirometry during decannulation in head and neck surgery: prospective cohort study

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Abstract

Objectives

To analyze the relationship between spirometric parameters measured with a face mask versus a mouthpiece, as well as the feasibility of face mask spirometric evaluation in a head and neck surgery (HNS) decannulation context. Furthermore, we examine peak inspiratory flow (PIF) cut-off values before and after decannulation.

Design

Prospective cohort study.

Setting

Otolaryngology HNS Department of a University teaching hospital.

Participants

Twenty-four patients were selected. A maximal flow-volume loop was conducted before (with mouthpiece) and after (with mouthpiece and face mask) decannulation.

Main outcome measures

Recorded outcomes were forced vital capacity (FVC), forced expiratory volume in the first second, peak expiratory flow, PIF, forced expiratory flow at 50% of FVC and forced inspiratory flow at 50% of FVC. Spearman correlation coefficients between spirometric parameters measured with a face mask versus a mouthpiece were calculated. Wilcoxon test was used to check differences between mouthpiece and face mask values.

Results

Correlation between mouthpiece and face mask spirometric values was moderate to high (r = 0.46 to 0.95). All parameters measured by spirometry were significantly lower with a face mask than those obtained with a mouthpiece (p < 0.05). Before decannulation, the lowest PIF value (tested with mouthpiece) that allowed successful decannulation was 1 L/s. After decannulation, the lowest PIF value tested with mouthpiece and face mask for successful completion of the decannulation process were 0.77 and 0.56 L/s, respectively.

Conclusion

Face mask is a feasible option to perform a spirometry when face diseases hinder spirometric evaluation through a mouthpiece in an HNC surgery context.

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Tooth as graft material: Histologic study

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Abstract

Background

An effective regenerative protocol is key to reestablish and maintain the hard and soft tissue dimensions over time. The choice of the graft material and its properties also could have an impact on the results. To prevent alveolar ridge dimensional changes, since numerous graft materials have been suggested and in the past years, a growing interest in teeth material has been observed as a valuable alternative to synthetic biomaterials.

Aim

The aim of the study was to explore the histomorphometric outcomes of tooth derivative materials as used as bone substitute material in socket preservation procedure.

Methods

After alveolar socket preservation (ASP) procedures using autologous demineralized tooth as graft material prepared by means of an innovative device, was evaluated. A total of 101 histological samples, from 96 subjects, were analyzed by evaluating the total amount of bone (BV), residual tooth material (residual graft, TT), and vital bone (VB). The section from each sample was then split in nine subsections, resulting in 909 subsections, to allow statistical comparison between the different areas.

Results

It was not noticed a statistically significant difference between maxillary and mandibular sites, being the amount of VB in upper jaw sites 37.9 ± 21.9% and 38.0 ± 22.0% in lower jaw sites and the amount of TT was 7.7 ± 12.2% in maxilla and 7.0 ± 11.1% in mandibles. None of the other considered parameters, including defect type and section position, were statistically correlated to the results of the histomorphometric analysis.

Conclusions

ASP procedure using demineralized autologous tooth-derived biomaterial may be a predictable procedure to produce new vital bone potentially capable to support dental implant rehabilitation.

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