Blog Archive

Αλέξανδρος Γ. Σφακιανάκης

Friday, February 10, 2023

Office‐based Blue Laser Therapy of Vocal Fold Polyps: A Cohort of 18 Patients

alexandrossfakianakis shared this article with you from Inoreader

Objective

To investigate the effect of office-based blue laser therapy of vocal fold polyps on voice.

Methods

The medical records and video recordings of patients who underwent office-based laser therapy in a tertiary referral center between February 2020 and May 2020, and May 2021 and October 2022 was conducted. Only patients with vocal fold polyps who had undergone office-based blue laser therapy were included. The voice was evaluated before and after surgery using the Voice Handicap Index-10 (VHI-10), GRB perceptual evaluation, acoustic analysis, and maximum phonation time.

Results

A total of 18 patients were included. The mean age of the study group was 52.5 ± 11.94 years. The male-to-female ratio was 2:1. Ten patients of the total group (53.6%) had hemorrhagic polyps and the most common site was the mid-third of the vocal fold. All patients who presented for follow-up (n = 15) had partial or complete regression of the lesion (4 and 11, respectively). There was a significant decrease in the mean score of VHI-10 (17.6 ± 9.97 vs. 4.27 ± 5.76, p < 0.001) and in the means of grade of dysphonia (2.0 ± 0.73 to 0.5 ± 0.63, p < 0.001), roughness (1.88 ± 0.81 to 0.44 ± 0.51, p < 0.001) and breathiness (0.81 ± 0.75 to 0.13 ± 0.34 p < 0.001). There was also a marked decrease in the perturbation parameters (jitter and shimmer) and a significant increase in the MPT from 10.66 ± 4.22 s to 14.26 ± 6.26 s (p = 0.028).

Conclusion

Office-based blue laser therapy is an effective treatment modality in patients with vocal fold polyps.

Level of Evidence

4 Laryngoscope, 2023

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Endoscopic Multiport Approach for Exenteration of the Infratemporal Fossa

alexandrossfakianakis shared this article with you from Inoreader
Endoscopic Multiport Approach for Exenteration of the Infratemporal Fossa

New minimally endoscopic multiport approach to infratemporal fossa. Step-by-step cadaveric dissection.


Objective

To demonstrate anatomic relationships pertinent to the endoscopic multiport approach to the infratemporal fossa (ITF). Discuss advantages and limitations of each individual approach.

Study Design

Cadaveric study.

Methods

Endoscopic and endoscopic-assisted endonasal transpterygoid, sublabial transmaxillary, endoscopic transorbital, and endoscopic transoral approaches to accessing the ITF were completed in five silicone-injected fresh cadaveric specimens (10 sides) with the assistance of 0, 30, and 450 rods-lens endoscopes. Image guidance was used to confirm and document the anatomical relationships encountered in each approach.

Results

The endonasal endoscopic transpterygoid approach provides better visualization and more direct exposure to median structures. Endoscopic-assisted sublabial transmaxillary approach enhances the field of exposure, angle of attack, and ease of instrumentation to the lateral part of the ITF. Endoscopic-assisted transorbital approach via the inferior orbital fissure provided cephalic and anterior access. Endoscopic-assisted transoral approach complements the access to lesions extending inferior to the hard palate or far lateral to the mandibular condyle.

Conclusions

A combination of minimal access infratemporal approaches can provide adequate exposure of the entire ITF while avoiding some of the morbidity associated with open approaches.

Level of Evidence

NA Laryngoscope, 2023

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Dose‐Dependent Glucocorticoid Regulation of Transcription Factors in Vocal Fold Fibroblasts and Macrophages

alexandrossfakianakis shared this article with you from Inoreader
Dose-Dependent Glucocorticoid Regulation of Transcription Factors in Vocal Fold Fibroblasts and Macrophages

Steroid-based therapies are associated with variable outcomes for laryngeal disease. This study provides incremental data related to potential mechanisms of this variability including divergent effects on the glucocorticoid receptor phosphorylation.


Objective

Variable outcomes of glucocorticoid (GC) therapy for laryngeal disease are putatively due to diverse interactions of the GC receptor (GR) with cell signaling pathways, limited consideration regarding concentration-dependent effects, and inconsistent selection of GCs. In the current study, we evaluated the concentration-dependent effects of three frequently administered GCs on transcription factors with an emphasis on the phosphorylation of GR at Ser203 and Ser211 regulating the nuclear translocation of GR. This study provides foundational data regarding the diverse functions of GCs to optimize therapeutic approaches.

Study design

In vitro.

Methods

Human vocal fold fibroblasts and THP1-derived macrophages were treated with different concentrations of dexamethasone, methylprednisolone, and triamcinolone in combination with IFN-γ, TNF-α, or IL4. Phosphorylated STAT1, NF-κB family molecules, and phosphorylated STAT6 were analyzed by Western blotting. Ser211-phosphorylated GR (S211-pGR) levels relative to GAPDH and Ser203-phosphorylated GR (S203-pGR) were also analyzed.

Results

GCs differentially altered phosphorylated STAT1 and NF-κB family molecules in different cell types under IFN-γ and TNF-α stimuli. GCs did not alter phosphorylated STAT6 in IL4-treated macrophages. The three GCs were nearly equivalent. A lower concentration of dexamethasone increased S211-pGR/GAPDH ratios relative to increased S211-pGR/S203-pGR ratios regardless of cell type and treatment.

Conclusion

The three GCs employed in two cell lines had nearly equivalent effects on transcription factor regulation. Relatively high levels of Ser203-phosphorylation at low GC concentrations may be related to concentration-dependent differential effects of GCs in the two cell lines.

Level of Evidence

NA Laryngoscope, 2023

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Evaluation of the quality of life and the satisfaction level after reconstruction with anterior iliac crest graft and implant supported fixed prosthesis treatment

alexandrossfakianakis shared this article with you from Inoreader

Abstract

Purpose

To evaluate oral health-related quality of life (OHRQoL) and satisfaction levels related to treatment in patients who have complete implant treatment and prosthetic rehabilitation after anterior iliac crest grafting.

Materials and Methods

Fifty-four patients (37 F, 17 M) with a total of 487 implants placed and implant-supported fixed prosthesis treatment completed were included in the study. OHIP-14 scale and satisfaction Likert scale questions were used to evaluate the oral health-related quality of life and the satisfaction levels related to the treatment applied, respectively. To compare the outcomes, the significance test and the Mann-Whitney U-test were used. One-way analysis of variance (ANOVA) and Kruskal-Wallis were used to assess the significance of differences among or between the groups.

Results

The quality of life was higher and the mean OHIP-14 scores were lower in women, older patients, and longer follow-up period, recorded as 13.6 ± 10.3 (p:0.263), 12.9 ± 11.3 (p: 0.079), and 11.8 ± 9.6 (p: 0.015*), respectively. Also, satisfaction levels of the patients related to the treatment were 83.3%.

Conclusions

The treatment of severely atrophic jaws with anterior iliac crest for the implant and prosthetic rehabilitation has a positive effect on the quality of life, this effect has increased with time, and the satisfaction levels of the patients related to this procedure were high and their expectations regarding this treatment were met at a high level.

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Cross reactivity of SARS‐CoV‐2 with other pathogens, especially dengue virus: A historical perspective

alexandrossfakianakis shared this article with you from Inoreader

Abstract

Dengue is a vector borne viral disease caused by a Flavivirus whereas the COVID-19 pandemic was caused by a highly contagious virus, SARS-CoV-2 belonging to family Coronaviridae. However, COVID-19 severity was observably less in dengue endemic countries and vice versa especially during the active years of the pandemic (2019-2021). We observed that dengue virus (DENV) antibodies (Abs) could cross-react with SARS-CoV-2 spike antigen. This resulted in SARS-CoV-2 false positivity by rapid Ab test kits. DENV Abs binding to SARS-CoV-2 receptor binding domain (and the reverse scenario), as revealed by docking studies further validated DENV and SARS-CoV-2 cross-reactivity. Finally, SARS-CoV-2 Abs were found to cross-neutralize DENV1 and DENV2 in virus neutralization test (VNT). Abs to other pathogens like Plasmodium, were also cross-reactive but non-neutralizing for SARS-CoV-2. Here, we analyse the existing data on SARS-CoV-2 cross-reactivity with other pathoge ns, especially dengue to assess its impact on health (cross-protection?) and differential sero-diagnosis/surveillance.

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Immunogenicity of novel DNA vaccines encoding receptor‐binding domain (RBD) dimer‐Fc fusing antigens derived from different SARS‐CoV‐2 variants of concern

alexandrossfakianakis shared this article with you from Inoreader

Abstract

The continuously emerging of SARS-CoV-2 variants of concern (VOCs) led to a decline in effectiveness of the first-generation vaccines. Therefore, optimized vaccines and vaccination strategies, which show advantages in protecting against VOCs, are urgently needed. Here we constructed an optimized DNA vaccine plasmid containing built-in CpG adjuvant, and designed vaccine candidates encoding five forms of antigens derived from Wuhan-Hu-1. The results showed that plasmid with RBD dimer-Fc fusing antigen (2RBD-Fc) induced the highest level of RBD-specific IgG and neutralizing antibodies in mice. Then 2dRBD-Fc and 2omRBD-Fc vaccines, respectively derived from delta and omicron VOCs, were constructed. The 2dRBD-Fc induced potent humoral and cellular immune responses, while the immunogenicity of 2omRBD-Fc was low. We also observed that sequential immunization with 2RBD-Fc, 2dRBD-Fc and 2omRBD-Fc effectively elicited neutralizing antibodies against each immunized strain, and RBD-specific T cell responses. To be noted, the Wuhan-Hu-1, delta and omicron neutralizing antibody titers induced by sequential immunization were comparable to that induced by repetitive immunization with 2RBD-Fc, 2dRBD-Fc or 2omRBD-Fc respectively. The results suggest that sequential immunization with DNA vaccines encoding potent antigens derived from different VOCs, may be a promising strategy to elicit immune responses against multiple variants.

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Comparable humoral and cellular immunity against Omicron variant BA.4/5 of once‐boosted BA.1/2 convalescents and twice‐boosted COVID‐19‐naïve individuals

alexandrossfakianakis shared this article with you from Inoreader

Abstract

The fourth vaccination dose confers additional protective immunity against SARS-CoV-2 infection in individuals with no prior coronavirus disease-19 (COVID-19). However, its immunological benefit against currently circulating BA.4/5 is unclear in individuals who have received a booster shot and been infected with Omicron variant BA.1/2. We analyzed immune responses in whom had been boosted once and did not have COVID-19 (n = 16), boosted once and had COVID-19 when BA.1/2 was dominant in the Korea (Hybrid-6M group, n = 27), and boosted twice and did not have COVID-19 (Vx4 group, n = 15). Antibody binding activities against RBDo BA.1 and RBDo.BA.4/5, antigen-specific memory CD4+ and CD8+ T-cell responses against BA.4/5, and B-cell responses against SARS-CoV-2 wild-type did not differ statistically between the Hybrid-6M and Vx4 groups. The humoral and cellular immune responses of the Hybrid-6M group against BA.4/5 were c omparable to those of the Vx4 group. Individuals who had been boosted and had an Omicron infection in early 2022 may not have high priority for an additional vaccination.

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The assessment of the long-term prognosis of burning mouth syndrome following treatment necessitates a reappraisal

alexandrossfakianakis shared this article with you from Inoreader
Despite the importance of studies evaluating the long-term prognosis of burning mouth syndrome (BMS), there is a paucity of reliable literature available on this subject. We read with interest a recently published article by Kim et al.,1 titled "Long-term prognosis of burning mouth syndrome following treatment", which concluded that the long-term prognosis of BMS was good in patients who responded well to treatment, and that xerostomia and taste disturbance were associated with a relapse of oral discomfort in some of the responders. (Source: International Journal of Oral and Maxillofacial Surgery)
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Two-centre experience in the treatment of thyroglossal duct remnants using the modified muscle-sparing Sistrunk technique

alexandrossfakianakis shared this article with you from Inoreader
The Sistrunk procedure has long been the method of choice for treating patients with thyroglossal duct remnants (TDRs). However, the extent of the surgical resection in the suprahyoid segment of the TDR remains controversial, as this anatomical site is the origin of both disease recurrence and surgical morbidity. The aim of this two-centre retrospective cohort study was to investigate the outcomes of a modified muscle-sparing Sistrunk procedure in primary TDRs. The primary predictor was the surgical approach, and the outcome variable was the recurrence rate. (Source: International Journal of Oral and Maxillofacial Surgery)
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Friends or foes: The mononuclear phagocyte system in ischemic stroke

alexandrossfakianakis shared this article with you from Inoreader
Friends or foes: The mononuclear phagocyte system in ischemic stroke

Pathophysiological effects of mononuclear phagocyte system MPS in ischemic stroke.


Abstract

Ischemic stroke (IS) is a major cause of disability and death in adults, and the immune response plays an indispensable role in its pathological process. After the onset of IS, an inflammatory storm, with the infiltration and mobilization of the mononuclear phagocyte system (MPS), is triggered in the brain. Microglia are rapidly activated in situ, followed by waves of circulating monocytes into the ischemic area. Activated microglia and monocytes/macrophages are mainly distributed in the peri-infarct area. These cells have similar morphology and functions, such as secreting cytokines and phagocytosis. Previously, the presence of the MPS was considered a marker of an exacerbated inflammatory response that contributes to brain damage. However, recent studies have suggested a rather complicated role of the MPS in IS. Here, we reviewed articles focusing on various functions of the MPS among different phases of IS, including recruitment, polarization, phagocytosis, angiogenesis, and in teraction with other types of cells. Moreover, due to the characteristics of the MPS, we also noted clinical research addressing alterations in the MPS as potential biomarkers for IS patients for the purposes of predicting prognosis and developing novel therapeutic strategies.

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