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Αλέξανδρος Γ. Σφακιανάκης

Monday, July 19, 2021

The role of thymic stromal lymphopoietin in the development of chronic otitis media with effusion

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Eur Arch Otorhinolaryngol. 2021 Jul 19. doi: 10.1007/s00405-021-06995-z. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the effect of thymic stromal lymphopoietin on the development of chronic otitis media with effusion MATERIALS AND METHODS: This study was conducted on 40 patients who had adenoidectomy operation. The objects were divided into two groups. Group 1; adenoidectomy with chronic serous otitis media, group 2; adenoidectomy without chronic serous otitis media. Serum and tissue thymic stromal lymphopoietin levels were measured by ELISA. Serum and tissue TLSP levels, mast cell count, adenoid size were compared between the groups.

RESULTS: Twenty-four (60%) of patients were female and 16 (40%) were male. Twenty patients (55%) had adenoid hypertrophy with chronic serous otitis media, and 18 (45%) had adenoid hypertrophy without chronic serous otitis media. The mean age of the patients was 6.21 ± 2.31 years. The me an mast cell count was significantly higher in group 1 compared with group 2 (p = 0.017). The mean tissue thymic stromal lymphopoietin measurement was also significantly higher in group 1 than group 2 (p = 0.023). However, there was no significant difference in regards to serum levels between the groups (p = 0.480).

CONCLUSION: The number of mast cells as well as thymic stromal lymphopoietin levels in the adenoids of children was significantly high in the chronic serous otitis media patients. The release of thymic stromal lymphopoietin from the adenoid tissue plays a role in initiating and maintaining a local inflammatory reaction in the eustachian tube that may lead eventually to middle ear effusion in non-atopic patients.

PMID:34279733 | DOI:10.1007/s00405-021-06995-z

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Intraoral and extraoral approach for surgical treatment of Eagle's syndrome: a retrospective study

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Eur Arch Otorhinolaryngol. 2021 Jul 19. doi: 10.1007/s00405-021-06914-2. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Eagle's syndrome is not uncommon in clinical work. Because of its atypical symptoms, it is easy to be misdiagnosed as other diseases, further leading to misdiagnosis and mistreatment. At present, there is no expert consensus or treatment guidelines for the disease. We evaluated the clinical characteristics and postoperative efficacy of 103 patients with Eagle's syndrome based on their clinical symptoms, radiological studies, and physical examination. Through the multicenter clinical study of Tongji Medical College and Dalian Medical University, we found some characteristics of Eagle's syndrome in operation and imaging.

METHODS: In total, 103 patients with Eagle's syndrome (treated from January 2010 to January 2020) were retrospectively enrolled. The postoperative curative effect was analyzed by three su rgical methods: styloid process resection through the external cervical approach (styloid process could not be touched through the mouth or could be touched under the jaw or when the CT scan showed that the inclination angle was not large), tonsillectomy + styloidectomy, and preservation of the tonsil for styloidectomy (the styloid process bone could be touched directly during intraoral palpation or in whom the distal part of the styloid process could not be directly touched, but the CT scan showed that the bone inclined toward the oropharynx and its distal part was relatively close to the oropharynx cavity; whether tonsillectomy was performed depended on whether the patient's tonsil was too large to affect the surgical incision). According to the Quality of Well-Being Scale (QWB), we calculated the W value of the scale before operation and 30 days, 3 months, 6 months and 12 months after operation, and compared the W value of each group.

RESULTS: The average length of the styl oid process was 33 mm (range 25-61 mm). The patients were followed up for 12-36 months (average 15 months). Of the 103 patients, 21 underwent styloid process resection through the external cervical approach, 49 underwent tonsillectomy and styloidectomy, and 33 underwent styloidectomy with preservation of the tonsil. The treatment cured 48 (46%) cases, was effective in 35 (34%) and was ineffective in 20 (20%). The R language 3.6.3 software was used to perform the nonparametric rank sum test, differences in characteristics between groups were analyzed using the Kruskal-Wallis test with Dunn post hoc tests ( R package FSA) for categorical variables, and there was no significant difference between the three types of operations (H = 0.491, P = 0.782). QWB showed that the quality of life after operation was improved compared with that before operation.

CONCLUSIONS: Operation is an effective method for treating Eagle's syndrome. There were no significant differences between the effec ts of the intraoral and external cervical approaches. Imaging examination-especially CT scanning and 3D reconstruction of the styloid process-is very helpful for diagnosis, but not an absolute criterion for the selection of surgery protocol.

PMID:34279732 | DOI:10.1007/s00405-021-06914-2

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Paroxysmal Atrial Fibrillation Induced by Ice-Cold Water Ingestion in a Triathlete: A Case Report

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Am J Case Rep. 2021 Jul 19;22:e931460. doi: 10.12659/AJCR.931460.

ABSTRACT

BACKGROUND Swallowing-induced tachyarrhythmias are rare, and their possible mechanisms are still not completely elucidated. Even though a mechanical stimulation has been suggested, involvement of the autonomic nervous system has not been completely excluded. Moreover, tachyarrhythmias are not so frequent in athletes. CASE REPORT We present a case of a 35-year-old male triathlete who reported palpitations aft er swallowing ice-cold water following physical activity. His physical examination and basal electrocardiogram were essentially normal. The 24-h Holter monitoring showed a sinus rhythm with sporadic isolated supraventricular ectopic beat and a 2-h run of atrial fibrillation (160-200 beats/min). This episode of paroxysmal atrial fibrillation was related to and occurred after the ingestion of ice-cold water following physical exercise. We were able to reproduce this event. Notably, the tachyarrhythmia was only triggered by swallowing ice-cold water; nothing happened with room-temperature water. No therapy was given to the triathlete to avoid influencing his physical performance in any way. CONCLUSIONS This case suggests that both an esophageal mechanical stimulation and autonomic nervous system involvement were at the base of this tachyarrhythmia. The influence of water temperature on the esophageal thermoceptors has to be considered.

PMID:34280178 | DOI:10.12659/AJCR.931460

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Functionalized Ionic Porous Organic Polymers Exhibiting High Iodine Uptake from Both the Vapor and Aqueous Medium

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ACS Appl Mater Interfaces. 2021 Jul 19. doi: 10.1021/acsami.1c07178. Online ahead of print.

ABSTRACT

Large-scale generation of radioactive iodine (129I, 131I) in nuclear power plants pose a critical threat in the event of fallout, thus rendering the development of iodine sequestering materials (from both the vapor and aqueous medium) highly pivotal. Herein, we report two chemically stable ionic polymers containing multiple binding sites, including phenyl rings , imidazolium cations, and bromide anions, which in synergy promote adsorption of iodine/triiodide anions. In brief, exceptional iodine uptake (from the vapor phase) was observed at nuclear fuel reprocessing conditions. Furthermore, the ionic nature propelled removal of >99% of I3- from water within 30 min. Additionally, benchmark uptake capacities, as well as unprecedented selectivity, were observed for I3-anions. The excellent affinity (distribution coefficient, ∼105 mL/g) enabled iodine capture from seawater-spiked samples. Moreover, iodine-loaded compounds showed conductivity (10-4 S/cm, 10-6 S/cm), placing them among the best known conducting porous organic polymers. Lastly, DFT studies unveiled key insights in coherence with the experimental findings.

PMID:34279084 | DOI:10.1021/acsami.1c07178

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Epley Maneuver Versus Gans Repositioning Maneuver in Treating Posterior Canal BPPV and Familial Incidence of BPPV: Protocol for A Randomized Controlled Trial

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Abstract

Benign paroxysmal positional vertigo (BPPV) is a widely recognized vestibular disorder which occurs with short periods of paroxysmal vertigo produced in specific positions. This investigation targets contrasting the adequacy of two unique moves utilized in the management of posterior canal BPPV (PC-BPPV). One is traditional procedure, Epley repositioning maneuver (ERM) and another is Gans Repositioning maneuver (GRM). To compare the efficacy of maneuvers on vertigo and dizziness for people with posterior canal BPPV using Dix hallpike test, Vertigo Analogue Scale (VAS) and Dizziness Handicap Inventory (DHI), 100 people will be recruited confirming to eligibility criteria for this two group (ERM group and GRM group) participant and assessor blinded randomized control study. After Participants will be randomly assigned to either group, the respective maneuver will be performed one or two times until the symptoms resolve. Post maneuver instructions will be demon strated to each subject nicely. Then, family history will be taken using a questionnaire. Outcomes will be taken once after giving maneuver and then, once after 1 month of treatment. Main outcome variables include VAS, DHI, and Dix hallpike test negativity. If the results indicate that Gans Manoeuvre is equivalent to Epley manoeuvre, then in older and postural compromised BPPV patients who has cervical related neck stiffness and pain or any other disorder, where Epley manoeuvre can not be given as it involves neck extension and rotation, Gans manoeuvre can be given. Trial registration: Clinical Trials Registry (CTRI/2019/10/021681). October 16, 2019.

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Optimal Diagnostic Criteria and a Staging System for Otogenic Skull Base Osteomyelitis

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J Neurol Surg B Skull Base
DOI: 10.1055/s-0041-1732308

Objective Diagnostic criteria for otogenic skull base osteomyelitis (SBO) have been conflicting among researchers. We aimed to propose clinically useful diagnostic criteria and a staging system for otogenic SBO that is associated with infection control and mortality. Design The present study is designed as a retrospective one. Setting This study was conducted at the University Hospital. Participants Thirteen patients with otogenic SBO who met the novel rigorous diagnostic criteria consisted of symptomatic and radiological signs on high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI). Simple refractory external otitis was not included. A staging system according to disease extent revealed by HRCT and MRI is proposed: lesions limited to the temporal bone (stage 1), extending to less than half (stage 2), exceeding the midline (stage 3), and extending to the whole of the clivus (stage 4). All patients received long-term antibiotic therapy. Patients were divided into infection-uncontrolled or -controlled groups based on symptoms, otoscopic findings, and C-reactive protein level at the last follow-up. The mean follow-up period was 27.7 months. Main Outcome Measures Possible prognostic factors, such as immunocompromised status and symptoms, including cranial nerve palsy, pretreatment laboratory data, and treatments, were compared between the infection-uncontrolled and -controlled groups. Disease stages were correlated with infection control and mortality. Results The infection-uncontrolled rate and mortality rate were 38.5 and 23.1%, respectively. There were no significant differences in possible prognostic factors between the infection-uncontrolled and -controlled groups. HRCT-based stages significantly correlated with infection control and mortality. Conclusion We proposed here the clinically useful diagnostic criteria and staging systems that can predict infection control and prognosis of otogenic SBO.
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Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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Intraoperative Indocyanine Green Angiography for Assessing Flap Perfusion in Skull Base Reconstruction: A Systematic Review

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J Neurol Surg B Skull Base
DOI: 10.1055/s-0041-1732309

Objective This study was aimed to study the current use of intraoperative indocyanine green (ICG) angiography during skull base reconstruction and understand its efficacy in predicting postoperative magnetic resonance imaging (MRI) enhancement and flap. Study Design The Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Google Scholar databases were searched from the date of inception until August 2020 for studies of ICG flap perfusion assessment during skull base reconstruction. The primary outcome of interest was the development of cerebrospinal fluid (CSF) leak after skull base reconstruction. Secondary outcomes of interest included postoperative meningitis, flap MRI enhancement, flap necrosis, flap perfusion measurements, and total complications. Results Search results yielded 189 studies, from which seven studies with a total of 104 patients were included in the final analysis. There were 44 nasoseptal flaps (NSF), two lateral nasal wall flaps (LNWF), 14 pericranial flaps (PCF), and 44 microvascular free flaps. The rates of CSF leak and postoperative MRI enhancement were 11 and 94%, respectively. There was one case of postoperative meningitis. Pooled analysis of the available data showed that intraoperative ICG flap perfusion was associated with flap enhancement on postoperative MRI (p = 0.008) and CSF leak (p = 0.315) by Fisher's exact test. Conclusion The available literature suggests intraoperative ICG enhancement is associated with postoperative MRI enhancement. Given the small sample sizes in the literature and the rarity of complications associated with skull base reconstruction, intraoperative ICG enhancement has not been predictive of flap necrosis or postoperative complications such as CSF leak or meningitis. Level of Evidence This study presents level 3 evidence as a systematic review of case studies, case reports, and retrospective and prospective trials with no blinding, controls, and inconsistently applied reference standards.
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Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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