Ultrasonography and Fine‐Needle Aspiration in Indeterminate Thyroid Nodules: A Systematic Review of Diagnostic Test Accuracy

xlomafota13 shared this article with you from Inoreader Ultrasonography and Fine‐Needle Aspiration in Indeterminate Thyroid Nodules: A Systematic Review of Diagnostic Test Accuracy Via The Laryngoscope Objectives/Hypothesis Sonographic risk criteria may assist in further prognostication of indeterminate thyroid nodules (ITNs). Our aim was to determine whether sonographic criteria could further delineate the post-test probability of malignancy in ITNs. Study Design Meta-analysis of diagnostic test accuracy. Methods A systematic review of Web of Science, MEDLINE, EMBASE, and CINAHL was performed from inception to April 15, 2021. Eligible studies included those which reported ultrasonographic evaluations with the American Thyroid Association (ATA) or the Thyroid Imaging Reporting and Data System (TIRADS) in adult patients with ITNs. ATA or TIRADS were scored as low (negative) or high (positive) malignancy risk using a previously validated binary classification. Primary outcomes included pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratio for all sonographic criteria. Studies were appraised using Quality Assessment of Diagnostic Accuracy Studies and the data were pooled using bivariate random-effects models. Results Seventeen studies were included in the analysis. For Bethesda III, ATA had a specificity (0.90, 95% confidence interval (CI): 0.74–0.94), but a sensitivity of 0.52 (95% CI: 0.25–0.77). Conversely, K-TIRADS had the highest sensitivity (0.78, 95% CI: 0.62–0.89) with a specificity of 0.53 (95% CI: 0.31–0.74). Furthermore, American College of Radiology and EU TIRADS had specificities of 0.60 (95% CI: 0.36–0.80) and 0.81 (95% CI: 0.73–0.87) with sensitivities of 0.70 (95% CI: 0.37–0.90) and 0.38 (95% CI: 0.20–0.60), respectively. There were few studies with Bethesda IV nodules. Conclusions Though dependent on malignancy rates, Bethesda III nodules with low-suspicion TIRADS features may benefit from clinical observation, whereas nodules with high-suspicion ATA features may require molecular testing and/or surgery. Level of Evidence NA Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Age and Comorbidities Impact Medical Complications and Mortality Following Free Flap Reconstruction

xlomafota13 shared this article with you from Inoreader Age and Comorbidities Impact Medical Complications and Mortality Following Free Flap Reconstruction Via The Laryngoscope Objective Determine if age correlated with surgical or medical complications following head and neck free flap reconstruction. Study Design Retrospective review of prospectively collected databases. Methods Patients undergoing head and neck free flap reconstruction at three tertiary care institutions were included (n = 1972). Cohorts were based on age (<65, 65–75, 75–85, and >85). Outcomes reviewed operative duration, length of stay, surgical complications (free flap failure, fistula, hematoma, dehiscence, and infection), and medical complications (thromboembolism, stroke, cardiac, and pulmonary). Results Anatomic site (P < .0001) and donor site varied by age (P < .0001). There was no difference in operative duration (P = .3) or length of hospitalization (P = .8) by age. The incidence of medical complications increased with increasing age. Pulmonary complication rates: <65 (3.9%), 65 to 75 (4.8%), 75 to 85 (7.1%), and >85 (11%) (P = .02). Cardiac complication rates: <65 (2.0%), 65 to 75 (7.3%), 75 to 85 (6.1%), and >85 (16.4%) (P < .0001). Mortality increased with age: <65 (0.4%), 65 to 75 (0.8%), 75 to 85 (1.1%), and >85 (4.1%) (P < .003). Medical complications correlated with mortality rates: pulmonary (3.5% vs. 0.6%; OR: 5.5; 95% CI: 1.5–20.0; P = .004); cardiac (3.3% vs. 0.6%; OR: 6.0; 95% CI: 1.6–21.8; P = .002); thromboembolism (4.6% vs. 0.7%; OR: 7.3; 95% CI: 1.6–33.6; P = .003); stroke (42% vs. 0.5%; OR: 149; 95% CI: 40–558; P < .0001); and sepsis (5% vs. 0.7%; OR 7.5; 95% CI: 1.0–60.5; P = .03). Age did not correlate with free flap success (P = .5), surgical complications (hematoma, P = .33; fistula, P = .23; infection, P = .07; and dehiscence, P = .37), or thirty-day readmission (P = .3). Conclusion Following free flap reconstruction, patient age did not correlate with development of a surgical complication. Patient age did correlate with development of a medical complication. Postoperative medical complications were found to correlate with perioperative mortality. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prognostic Value of Tumor‐Infiltrating Lymphocytes in Sinonasal Mucosal Melanoma

xlomafota13 shared this article with you from Inoreader Prognostic Value of Tumor‐Infiltrating Lymphocytes in Sinonasal Mucosal Melanoma Via The Laryngoscope Objectives/Hypothesis Tumor-infiltrating lymphocytes (TILs) predict better outcome in several types of cancers. However, the prognostic value of TILs in sinonasal mucosal melanoma (SNMM) is uncertain. Here, we investigated whether TILs can be used as a prognostic indicator for survival in SNMM. Study Design Retrospective cohort study. Methods Patient history and histologic specimens from 27 patients with primary SNMM were retrospectively analyzed. TIL grade was determined and associations between TILs and AJCC tumor stage, overall survival, and recurrence-free survival were analyzed. Results Patients with TILs in the primary tumor classified as brisk or non-brisk survived significantly longer than patients with SNMMs lacking lymphocyte infiltrates. Brisk TILs were associated with the lower T3 stage and increased recurrence-free and 5-year survival. Conclusion Our results indicate that TIL density is a strong prognostic factor for better survival in SNMM. Prospective studies with larger case numbers are warranted to determine whether TILs should be included in future AJCC staging guidelines. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Hearing Aid Use in Children With Unilateral Hearing Loss: A Randomized Crossover Clinical Trial

xlomafota13 shared this article with you from Inoreader Hearing Aid Use in Children With Unilateral Hearing Loss: A Randomized Crossover Clinical Trial Via The Laryngoscope Objectives/Hypothesis In children with mild to moderately severe unilateral hearing loss (UHL), assess whether subject-reported quality of life (QOL) and teacher- and parent-reported perception of listening difficulty are affected by use of a hearing aid (HA) with baseline accommodations, compared to children receiving only baseline accommodations. Study Design Randomized crossover clinical trial. Methods Thirty-seven children 6–12 years of age with mild to moderately severe UHL and ≥80% word recognition scores in the poorer hearing ear were randomized into arm 1, using baseline accommodations (frequency-modulated system and strategic seating) for 12 weeks, followed by addition of a HA for 12 weeks. The other participants were randomized into the reverse methodology: arm 2, using a HA in addition to baseline accommodations for 12 weeks, followed by baseline accommodations alone. Surveys of QOL (Hearing Environments and Reflection on Quality of Life) and listening difficulties or challenges with hearing amplification (CHILD and LIFE-R questionnaires) were administered at 6-week intervals. Differences in mean survey scores, percent change, and improvement over time were computed between the two arms and inter-arm intervals. Per-protocol analysis was used. Results Of the 37 children enrolled, 34 children underwent the study interventions and were included in the analysis, (arm 1 = 20, arm 2 = 14) (mean [standard deviation] age = 8 [1.5] years; 21 boys [61.8%]). Survey scores averaged across both arms during the HA interval (77.79 [15.13]) were significantly higher than during the baseline-only interval (69.67 [14.69], P = .036). There was no significant difference between trial arms in mean scores between the two HA intervals (P = .450) and two baseline-only intervals (P = .539). Conclusions Hearing-related QOL and listening ability improved in children who met eligibility criteria with mild to moderately severe UHL with HA use compared with baseline accommodations alone. Trial Registration: ClinicalTrials.gov identifier: NCT02269124. Level of Evidence 1 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparison of the Signal Intensity of Vestibular Schwannoma Between Growing and Nongrowing Tumors

xlomafota13 shared this article with you from Inoreader Comparison of the Signal Intensity of Vestibular Schwannoma Between Growing and Nongrowing Tumors Via The Laryngoscope Objectives/Hypothesis To determine the relationship between signal intensity on gadolinium (Gd)-enhanced magnetic resonance images and growth of vestibular schwannomas (VSs). Study Design Cross-sectional study. Methods In this cross-sectional study, we retrospectively reviewed the data of 31 patients with VSs who underwent magnetic resonance imaging (MRI). The mean signal intensities within the regions of interest in the tumor, pons, and temporal muscles were measured on Gd-enhanced T1-weighted MRI. Relative intensity ratios were calculated as follows: T/N pons ratio (T/Np) is the tumor signal intensity/pons signal intensity and T/N muscle ratio (T/Nm) is the tumor signal intensity/temporal muscle signal intensity. Volume measurements were used to assess the tumor size. Growth rate was determined by assessing previous imaging studies. Growing VS was defined as a tumor with a growth rate >100 mm3/year. Results The mean (standard deviation) T/Np and T/Nm were 1.47 (0.27) and 1.50 (0.24), respectively, in nongrowing tumors and 1.78 (0.17) and 1.90 (0.12), respectively, in growing tumors. The T/Np and T/Nm differed significantly between the two groups (T/Np, P < .001; T/Nm, P < .001). Receiver operating characteristic curve analysis showed that cutoffs of 1.56 and 1.76 for T/Np (93.33% sensitivity, 75.00% specificity) and T/Nm (100.00% sensitivity, 93.75% specificity), respectively, could be used to diagnose a growth rate of >100 mm3/year. The area under the curve was 0.85 (95% confidence interval, 0.70–1.00) for T/Np and 0.94 (0.82–1.00) for T/Nm. Conclusion Growing VSs show higher signal intensities on Gd-enhanced MRI. Thus, measuring the signal intensity of VS on Gd-enhanced MRI may aid in predicting VS growth. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cricothyroid Muscle Dysfunction Affects Aerodynamic Performance in Patients with Unilateral Vocal Fold Paralysis

xlomafota13 shared this article with you from Inoreader Cricothyroid Muscle Dysfunction Affects Aerodynamic Performance in Patients with Unilateral Vocal Fold Paralysis Via Journal of Voice Emerging evidence has revealed that cricothyroid (CT) muscle dysfunction in unilateral vocal fold paralysis (UVFP) further impairs patients' voices. Given that CT muscle dysfunction does not influence vocal fold position, the mechanism of voice dysfunction induced by dysfunction of CT muscle in UVFP patients remains controversial. This study compares aerodynamics between UVFP patients with and without CT muscle involvement. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Skin Microbiome Alterations in Seborrheic Dermatitis and Dandruff: A Systematic Review

xlomafota13 shared this article with you from Inoreader Skin Microbiome Alterations in Seborrheic Dermatitis and Dandruff: A Systematic Review Via Experimental Dermatology Abstract Seborrheic dermatitis (SD) and dandruff (DF) are common chronic inflammatory skin diseases characterized by recurrent greasy scales, sometimes with erythema and itchiness. Although the exact pathophysiology of the disease is still unclear, current theories highlight the role of microbes on the skin surface in the pathogenesis of SD. Here, we conducted a systematic review to investigate the skin microbiome alterations in patients with SD/DF. We searched Medline/PubMed, Embase and Web of Science for research studies published in English between January 1st, 2000 and December 31st, 2020. A total of 12 studies with 706 SD/DF samples and 379 healthy samples were included in this study. The scalp and face were predominated by the fungi of Ascomycota and Basidiomycota and the bacteria of Actinobacteria and Firmicutes. In general, the included studies demonstrated an increased M. restricta/M. globosa ratio and a reduction in the Cutibaterium/S taphylococcus ratio in the setting of SD/DF. Staphylococcus was associated with epidermal barrier damage, including elevated levels of trans-epidermal water loss and pH, while Cutibacterium had a positive correlation with water content. Malassezia was also found to be related to an increased itching score and disease severity. Further studies focusing on the interactions between various microbes and the host and microbes can help us to better understand the pathogenesis of SD/DF. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.