Κυριακή 18 Ιουλίου 2021

Novel DIO1 Gene Mutation Acting as Phenotype Modifier for Novel Compound Heterozygous TPO Gene Mutations Causing Congenital Hypothyroidism

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Thyroid, Ahead of Print.
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Improvement of image quality of laryngeal squamous cell carcinoma using noise‐optimized virtual monoenergetic image and nonlinear blending image algorithms in dual‐energy computed tomography

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Abstract

Background

Dual-energy computed tomography (DECT) has been used to improve image quality of head and neck squamous cell carcinoma (SCC). This study aimed to assess image quality of laryngeal SCC using linear blending image (LBI), nonlinear blending image (NBI), and noise-optimized virtual monoenergetic image (VMI+) algorithms.

Methods

Thirty-four patients with laryngeal SCC were retrospectively enrolled between June 2019 and December 2020. DECT images were reconstructed using LBI (80 kV and M_0.6), NBI, and VMI+ (40 and 55 keV) algorithms. Contrast-to-noise ratio (CNR), tumor delineation, and overall image quality were assessed and compared.

Results

VMI+ (40 keV) had the highest CNR and provided better tumor delineation than VMI+ (55 keV), LBI, and NBI, while NBI provided better overall image quality than VMI+ and LBI (all corrected p < 0.05).

Conclusions

VMI+ (40 keV) and NBI improve image quality of laryngeal SCC and may be preferable in DECT examination.

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Stereotactic body ablative radiotherapy for reirradiation of small volume head and neck cancers is associated with prolonged survival: A large, single‐institution, modern cohort study

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Abstract

Background

Recurrent head and neck cancer has poor prognosis. Stereotactic body radiotherapy (SBRT) may improve outcomes by delivering ablative radiation doses.

Methods

We reviewed patients who received definitive-intent SBRT reirradiation at our institution from 2013 to 2020. Patterns of failure, overall survival (OS), and toxicities were analyzed.

Results

One hundred and thirty-seven patients were evaluated. The median OS was 44.3 months. The median SBRT dose was 45 Gy and median target volume 16.9 cc. The 1-year local, regional, and distant control was 78%, 66%, and 83%, respectively. Systemic therapy improved regional (p = 0.004) and distant control (p = 0.04) in nonmetastatic patients. Grade 3+ toxicities were more common at mucosal sites (p = 0.001) and with concurrent systemic therapy (p = 0.02).

Conclusions

In a large cohort of SBRT reirradiation for recurrent, small volume head and neck cancers, a median OS of 44.3 months was observed. Systemic therapy improved regional and distant control. Toxicities were modulated by anatomic site and systemic therapy.

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Simultaneous SPECT imaging with 123I and 125I - a practical approach to assessing a drug and its carrier at the same time with dual imaging

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Int J Pharm. 2021 Jul 13:120884. doi: 10.1016/j.ijpharm.2021.120884. Online ahead of print.

ABSTRACT

Radiolabeling of a drug with radioactive iodine is a good method to determine its pharmacokinetics and biodistribution in vivo that only minimally alters its physicochemical properties. With dual labeling, using the two radioactive iodine isotopes 123I and 125I, two different drugs can be evaluated at the same time, or one can follow both a drug and its drug de livery system using a single photon emission computed tomography (SPECT) imager. One difficulty is that the two radioisotopes have overlapping gamma spectra. Our aim was therefore to develop a technique that overcomes this problem and allows for quantitative analysis of the two radioisotopes present at varied isotope ratios. For this purpose, we developed a simple method that included scatter and attenuation corrections and fully compensated for 123I/125I crosstalk, and then tested it in phantom measurements. The method was applied to the study of an orally administered lipid formulation for the delivery of fenofibrate in rats. To directly compare a traditional study, where fenofibrate was determined in plasma samples to SPECT imaging with 123I-labeled fenofibrate and 125I-labeled triolein over 24 hours, the drug concentrations were converted to standardized uptake values (SUVs), an unusual unit for pharmaceutical scientists, but the stand ard unit for radiologists. A generally good agreement between the traditional and the radioactive imaging method was found in the pharmacokinetics and biodistribution results. Small differences are discussed in detail. Overall, SPECT imaging is an excellent method to pilot a new formulation with just a few animals, replaces blood sampling, and can very quickly highlight potential administration problems, the excretion pathways and the kinetics. Furthermore, dual labeling with the two radioisotopes 123I and 125I clearly shows if a drug and its drug delivery system stay together when traveling through the body, if slow drug release takes place, and where degradation/excretion of the components occurs.

PMID:342 71154 | DOI:10.1016/j.ijpharm.2021.120884

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Protein 4.1 family and ion channel proteins interact to regulate the process of heart failure in rats

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Acta Histochem. 2021 Jul 13;123(6):151748. doi: 10.1016/j.acthis.2021.151748. Online ahead of print.

ABSTRACT

Heart failure (HF) is a major cause of death in cardiovascular diseases worldwide, and its molecular mechanisms and effective prevention strategies remain to be further studied. The myocardial cytoskeleton plays a pivotal role in many heart diseases. However, little is known about the function of the membrane cytoskeleton 4.1 protein family and related regulatory mec hanisms in the pathogenesis of HF. In this study, we detected the localization and expression of the protein 4.1 family and ion channel proteins in a rat HF model induced by doxorubicin (DOX), and studied the interactions between them. Our results showed that compared with the control group, the HF group displayed an increased expression level of protein 4.1R and decreased levels of protein 4.1 G and 4.1 N. The Nav1.5 protein levels were significantly increased, while the SERCA2a and Cav1.2 protein levels were significantly decreased in the HF group. Furthermore, there is co-localization and interaction between protein 4.1R and Nav1.5, protein 4.1 G and SERCA2a, protein 4.1 N and Cav1.2, respectively. Taken together, the results indicated that the protein 4.1 family might be involved in the occurrence and development of HF through its interaction with ion channel proteins, suggesting that 4.1 proteins may serve as a novel therapeutic target for HF.

PMID:34271280 | DOI:10.1016/j.acthis.2021.151748

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Thecal sac ligation for the treatment of post-infectious intrathecal-prevertebral CSF fistula in a paraplegic patient

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Clin Neurol Neurosurg. 2021 Jul 9;207:106803. doi: 10.1016/j.clineuro.2021.106803. Online ahead of print.

ABSTRACT

The occurrence of a symptomatic post-infectious intrathecal to prevertebral fistula is rare. We report the presentation and management of a 38-year-old chronically paraplegic male with longstanding thoracic osteomyelitis and epidural infection who developed a cerebrospinal fluid (CSF) fistula causing symptomatic intracranial hypotension (IH). During an interventional radiology (IR)-guided aspiration of what was thought to be residual abscess, pulsatile, clear fluid was observed. A subsequent CT myelogram showed air in the spinal canal and a CSF fistula between the thecal sac and the pre-vertebral space. Upon intraoperative exploration, a large ventral dural defect was identified with insufficient native dura for primary closure and the thecal sac was tied off cranial to the level of the fistula. Given the large ventral dural defe ct, the fistula was likely the result of longstanding infection in the epidural space rather than the IR guided aspiration. The aspiration likely transgressed an existing fistula and may have exacerbated the symptoms of IH by providing another route for CSF egress. The patient's postural headaches completely resolved post-operatively. Thecal sac ligation is a viable treatment option in select circumstances with symptomatic CSF fistula.

PMID:34271423 | DOI:10.1016/j.clineuro.2021.106803

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Research progress and development trend of surgical robot and surgical instrument arm

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Abstract

Background

In recent years, surgical robots have become an indispensable part of the medical field. Surgical robots are increasingly being used in the areas of gynecological surgery, urological surgery, orthopedic surgery, general surgery, etc. In this paper, the development of surgical robots in different operations is reviewed and analyzed. In the type of master-slave surgical robotic system, the robotic surgical instrument arms were located in the execution terminal of a surgical robot system, as one of the core components, and directly contact with the patient during the operation, which plays an important role in the efficiency and safety of the operation. In clinical, the arm function and design in different systems varies. Furtherly, the current research progress of robotic surgical instrument arms used in different operations is analyzed and summarized. Finally, the challenge and trend are concluded.

Methods

According to the classification of surgical types, the development of surgical robots for laparoscopic surgery, neurosurgery, orthopedics and microsurgery are analyzed and summarized. Then, focusing on the research of robotic surgical instrument arms, according to structure type, the research and application of straight-rod surgical instrument arm, joint surgical instrument arm and continuous surgical instrument arm are analyzed respectively.

Results

According to the discussion and summary of the characteristics of the existing surgical robots and instrument arms, it is concluded that they still have a lot of room for development in the future. Therefore, the development trends of the surgical robot and instrument arm are discussed and analyzed in the five aspects of structural materials, modularization, telemedicine, intelligence and human-machine collaboration.

Conclusion

Surgical robots have shown the development trend of miniaturization, intelligence, autonomy and dexterity. Thereby, in the field of science and technology, the research on the next generation of minimally invasive surgical robots will usher in a peak period of development.

This article is protected by copyright. All rights reserved.

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Efficacy of da Vinci robot‐assisted lymph node surgery than conventional axillary lymph node dissection in breast cancer – A comparative study

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Abstract

Background

da Vinci robot-assisted axillary lymph node dissection (dVALND) can be a minimally invasive technique to minimize post-operative complications.

Objective

To explore the clinical efficacy of dVALND in breast cancer (BC) patients for mitigating the postoperative complications than conventional ALND.

Methods

Total 60 female patients with BC were admitted to our hospital since September 2018 and these patients segregated into two groups of 30 patients each. Modified radical mastectomy for BC was performed to the patients in both groups. In Group 1 (control group), ALND was performed using conventional mode of axillary lymph node surgery. In Group 2 (Test group), the dVALND was performed using da Vinci robot-assisted surgery. Wound healing, aesthetic effect, and patient's satisfaction were evaluated after conventional method and dVALND.

Results

Postoperative complications viz., wound infection (1/30 (3.33%), p < 0.05), fat necrosis (3/30 (10%), p < 0.05), and lymphedema of upper limbs (2/30 (6.67%), p < 0.05) were observed in dVALND than conventional surgery. Local recurrence or metastasis was minimized and overall aesthetic effect not observed during follow-up.

Conclusion

dVALND improved the overall patient's quality of life by mitigating postoperative complications than ALND.

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Initial Referring Physician and Radiologist Experience with Neck Imaging Reporting and Data System

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Objectives/Hypothesis

Neck Imaging Reporting and Data System (NI-RADS) is a radiology reporting system developed for head and neck cancer surveillance imaging, using standardized terminology, numeric levels of suspicion, and linked management recommendations. Through a multidisciplinary, interdepartmental quality improvement initiative, we implemented NI-RADS for the reporting of head and neck cancer surveillance CT. Our objective is to summarize our initial experience from the standpoints of head and neck cancer providers and radiologists.

Study Design

Quality improvement study.

Methods

Before and 3 months post-implementation, surveys were offered to referring physicians (n = 21 pre-adoption; 22 post-adoption) and radiologists (n = 17 pre- and post-adoption). NI-RADS utilization was assessed over time.

Results

Survey response rates were 62% (13/21) and 73% (16/22) for referring physicians pre- and post-adoption, respectively, and 94% (16/17) for radiologists pre- and post-adoption. Among post-adoption provider respondents, 100% (16/16) strongly agreed or agreed with "I want our radiologists to continue using NI-RADS," "The NI-RADS numerical rating of radiologic suspicion is helpful," and "The language and style of NI-RADS neck CT reports are clear and understandable." Among radiologist respondents, 88% (14/16) strongly agreed or agreed with "NI-RADS improves consistency among our radiologists in the reporting of surveillance neck CTs." Radiologist NI-RADS utilization increased over time (46% month 1; 72% month 3).

Conclusions

Most referring physicians and radiologists preferred NI-RADS. Head and neck cancer providers indicated that NI-RADS reports are clear, understandable, direct, and helpful in guiding clinical management. Radiologists indicated that NI-RADS improves radiologist consistency in the reporting of surveillance neck CT, and radiologists increasingly used NI-RADS over time.

Level of Evidence

Level 4 Laryngoscope, 2021

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Normative Value for the Laryngopharyngeal Measure of Perceived Sensation

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Objectives/Hypothesis

The Laryngopharyngeal Measure of Perceived Sensation (LUMP) is a recently validated patient-reported outcome measure (PROM) aimed at evaluating the symptom severity of patients with globus pharyngeus (GP). The objective of this study was to define the normative values for the LUMP questionnaire.

Study Design

Prospectively collected, descriptive research/scale development.

Methods

The LUMP questionnaire was completed by 88 subjects. Individuals without throat-related symptoms such as dysphagia, dysphonia, or cough were provided LUMP. The results of the eight-item questionnaire were analyzed for standard error of the mean (SEM), mean, and standard deviation (SD).

Results

Review of the 88 LUMP questionnaires elucidated a mean of 0.42 (SEM = 0.10, SD = 0.96) in the normative population. By gender, the female (n = 50) mean was 0.24, SD = 0.66, SEM = 0.09; for males (n = 38), the mean was 0.66, SD = 1.21, SEM = 0.20.

Conclusions

This study provides normative data for the LUMP, a recently established PROM useful in patients with GP. A LUMP score greater than or equal to 3 should be considered abnormal and warrants additional attention.

Level of Evidence

3 Laryngoscope, 2021

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Long‐Term Outcomes of Olfactory Neuroblastoma: MD Anderson Cancer Center Experience and Review of the Literature

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Objectives/Hypothesis

Olfactory neuroblastoma (ONB) is a rare sinonasal malignant neoplasm that is known to develop late recurrence. The aim of this study is to evaluate the long-term outcomes of patients with ONB and to determine the factors associated with prognosis.

Study Design

Retrospective study.

Methods

A retrospective review of the medical records of 139 patients diagnosed with ONB at MD Anderson Cancer Center was performed between 1991 and 2016. Descriptive statistics were calculated, and Kaplan–Meier curves were utilized to assess survival.

Results

Median follow-up time was 75 months. Overall, 129 patients (92.8%) had surgery as part of their treatment and 82 (58.9%) patients received postoperative radiation therapy (PORT) or concurrent chemoradiotherapy. Endoscopic approaches were utilized for 72 patients, 69.4% of whom had pure endoscopic endonasal approaches. Five-year overall survival and disease-specific survival were 85.6% and 93.4%, respectively. Recurrence rate was 39.6% with a median time to recurrence of 42 months. Among the 31 patients who received elective nodal irradiation (ENI), two patients developed neck recurrence (6.4%) compared with 20 who developed neck recurrence when ENI was omitted (34.4%) (P = .003). Advanced Kadish stage, orbital invasion, intracranial invasion, and presence of cervical lymphadenopathy at the time of presentation were significantly associated with poor survival.

Conclusion

ONB has an excellent survival. Surgical resection with PORT when indicated is the mainstay of treatment. Endoscopic approaches can be used as a good tool. Elective neck irradiation reduces the risk of nodal recurrence among patients with clinically N0 neck. Despite the excellent survival, recurrence rate remains high and delayed, highlighting the need for long-term surveillance.

Level of Evidence

Level 4 Laryngoscope, 2021

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