Τρίτη 19 Ιουλίου 2022

Documentation in Pediatric Microlaryngoscopy/Bronchoscopy: International Modified Delphi Consensus

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Documentation in Pediatric Microlaryngoscopy/Bronchoscopy: International Modified Delphi Consensus

Pediatric microlaryngoscopy and bronchoscopy is a common procedure where adequate documentation is crucial for patient care and medicolegal purposes. There is significant variability in operative reports. We sought to develop an expert consensus of the key components for operative documentation, to improve patient care, communication and research.


Background

Complete and accurate documentation of surgical procedures is essential for optimizing patient care, yet significant variation in operative notes persists within and across institutions. We sought to reach consensus on the most important components of an operative note for pediatric microlaryngoscopy and bronchoscopy.

Methods

A modified Delphi consensus process was used. A checklist for operative documentation, created by fellowship-trained pediatric otolaryngologists-head and neck surgeons, was sent to surgeons identified as experts in pediatric laryngoscopy and bronchoscopy. In the first round, items were rated as "keep" or "remove". In the second round, each item was rated on a 7-point Likert scale for importance. The mean score of each item was calculated to determine if consensus was reached.

Results

Overall, 43/74 (58.1%) surgeons responded to our survey. After two rounds of editing, 28 components reached consensus, 24 were near consensus, and 26 did not reach consensus. Items that reached final consensus had mean (SD) ratings of 6.12 (0.94) (range, 5.31–6.72).

Conclusion

Pediatric otolaryngologists identified as bronchoscopy experts were able to create a checklist of essential components of an operative note for pediatric laryngoscopy and bronchoscopy using a Delphi method. Items reaching consensus included procedure name, description of breathing, grade of airway view, description of normal anatomic structures, grade of subglottic stenosis if present, presence and description of tracheobronchomalacia, presence of fistulae, cleft and rings, and several special cases including foreign body and tracheostomy management, as well as end of procedure disposition and complications.

Level of Evidence

5 Laryngoscope, 2022
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Proximal Scar Progression in Idiopathic Subglottic Stenosis After Wedge Excision: Does it Happen?

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Proximal Scar Progression in Idiopathic Subglottic Stenosis After Wedge Excision: Does it Happen?

The first study to evaluate proximal scar progression in idiopathic subglottic stenosis (iSGS) patients who have undergone CO2 laser wedge excision demonstrates a baseline glottic involvement rate of 4.5% in iSGS and low risk of glottic involvement resulting from the procedure.


Objective

To compare the incidence of glottic stenosis in idiopathic subglottic stenosis (iSGS) patients with no prior surgical intervention to those with a history of endoscopic dilation and characterize the incidence of glottic involvement, changes in scar length, and progression of scar toward glottis following laser wedge excision (LWE).

Methods

A retrospective review of iSGS patients who underwent LWE between 2002 and 2021 was performed. Patients without prior airway surgery were labeled LWE primary (LWEP) and operative findings for LWEP patients were reviewed for glottic involvement, scar length (DL), and distance from the glottis to superior-most aspect of scar (DGS). Rates (in mm/procedure) of DΔL, reflecting an increase in length, and D−ΔGS, reflecting proximal migration, were calculated by dividing DΔL and D−ΔGS by the number of LWE procedures.

Results

213 iSGS patients underwent LWE, with 132 being LWEP patients. LWEP had a lower incidence of baseline glottic involvement (n = 6, 4.5%) than LWE secondary (LWES; n = 6, 7.5%). Four new cases of glottic involvement were noted in LWEP patients following LWE, with only one being clinically significant resulting in permanently decreased vocal fold mobility. With each procedure, scar length increased by 1.0 mm and DGS decreased by 0.7 mm, reflecting a migration or decrease in DGS of 9.5% with each procedure with respect to initial DGS. Overall rates of glottic stenosis following operations were similar between LWEP and LWES cohorts, 7.6% and 7.5% respectively.

Conclusion

There appears to be a low risk of glottic involvement resulting from the LWE procedure in iSGS patients.

Level of Evidence

4 Laryngoscope, 2022
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Comparative Evaluation of the Antibacterial Effect of Allium Sativum, Calcium hydroxide and Their Combination as Intracanal Medicaments in Infected Mature Anterior Teeth A Randomized Clinical Trial

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Abstract

Aim

The purpose of this study was to compare the antibacterial effects of Allium Sativum (garlic extract), calcium hydroxide (Ca (OH)2), and their combination as intracanal medicaments in infected mature anterior teeth using real-time PCR.

Material& Methods

This prospective double-blind, controlled, parallel, superiority, randomized clinical trial was carried out on sixty-six permanent, necrotic incisors associated with asymptomatic apical periodontitis in sixty-six male patients. Patients were randomly divided into three groups (n =22) according to the intra -canal medications used. After access preparation, four microbiological samples (S) were taken using sterile absorbent paper points as follows: S1: before canal instrumentation. S2: after cleaning and shaping. The third samples (S3) and fourth samples (S4) were taken after the placement of the tested intracanal medications into their corresponding canals for 7 and 14 days, respectively. Total DNA was extracted from microbiological samples and relative quantitative real time PCR reactions were done to quantify the relative gene expression fold change (FC) for Enterococcus faecalis and Streptococcus species. At significance level p ≤ 0.05, the data were statist ically analyzed in SPSS software using Kruskal-Wallis and Freidman's tests, followed by Dunn-Bonferroni post-hoc test for pairwise comparisons.

Results

Both bacterial mean FC decreased significantly after mechanical instrumentation (S1 to S2) in all groups. However, no statistically significant differences were found after intra-canal medicament placement (from S2 to S3 and from S3 to S4) except in the garlic group. Garlic significantly reduced Enterococcus faecalis FC in S3 and S4 when compared to Ca (OH) 2 and Ca (OH) 2+ garlic combination. However, garlic and Ca (OH)2 reduced Streptococcus bacteria in S3 similarly. While in S4, garlic showed significantly more reduction than Ca (OH) 2. The combination of Ca (OH) 2 with garlic extract showed the least significant bacterial reduction.

Conclusion

within the study limitations, garlic intra-canal medicament has a comparable anti-Streptococcus efficiency to Ca (OH) 2, while it is more effective against Enterococcus faecalis species. When Ca (OH)2 and garlic are combined, their antibacterial effectiveness is reduced. Increasing the time of application for tested intracanal medicaments by more than one week has no additional antibacterial effectiveness.
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Increased sensitivity of Aggregatibacter actinomycetemcomitans to human serum is mediated by induction of a bacteriophage

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Summary

Aggregatibacter actinomycetemcomitans, a Gram-negative oral pathobiont causing aggressive periodontitis and systemic infections demonstrates serum resistance. We have identified a dsDNA tailed bacteriophage S1249, which was found from this microorganism inducible by human serum to convert into lytic state to kill the bacterium. This phage demonstrated active transcripts when exposed to human serum: 20% of genes were up regulated greater than 10 folds and 45% of them were up regulated 5–10 folds, when the bacterium was grown in the presence of human serum compared to without. Transcriptional activation when grown in equine serum was less pronounced. This phage demonstrated a tail with the inner rigid tubes and outer contractile sheath, features of Myoviridae spp. Further characterization revealed that the lysogenized integration of the phage in the chromosome of A. actinomycetemcomitans occurred between the genes encoding for cold-shock DNA-binding domain-con taining protein (csp) and glutamyl-tRNA synthetase (gltX). Both phage DNA integrated lysogeny and non-integrated pseudolysogeny were identified in the infected bacterium. A newly generated, lysogenized strain using this phage displayed similar attributes, including 63% growth inhibition compared to its isogenic phage-free strain when in the presence of human serum. Our data suggest that bacteriophage S1249 can be induced in the presence of human serum and enters the lytic cycle, which reduces the viability of infected bacteria in vivo.

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The malignant property of circHIPK2 for angiogenesis and chemoresistance in non-small cell lung cancer

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Publication date: Available online 19 July 2022

Source: Experimental Cell Research

Author(s): Mingming Ren, Xiang Song, Jieting Niu, Guojie Tang, Zhen Sun, Yanguang Li, Fanyi Kong
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Orthopedic Surgery Causes Gut Microbiome Dysbiosis and Intestinal Barrier Dysfunction in Prodromal Alzheimer Disease Patients: A Prospective Observational Cohort Study

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imageObjective: To investigate gut microbiota and intestinal barrier function changes after orthopedic surgery in elderly patients with either normal cognition (NC) or a prodromal Alzheimer disease phenotype (pAD) comprising either subjective cognitive decline (SCD) or amnestic mild cognitive impairment (aMCI). Background: Homeostatic disturbances induced by surgical trauma and/or stress can potentially alter the gut microbiota and intestinal barrier function in elderly patients before and after orthopedic surgery. Methods: In this prospective cohort study, 135 patients were subject to preoperative neuropsychological assessment and then classified into: NC (n=40), SCD (n=58), or aMCI (n=37). Their gut microbiota, bacterial endotoxin (lipopolysaccharide), tight junction (TJ) protein, and inflammatory cytokines in blood were measured before surgery and on postsurgical day 1, 3, and 7 (or before discharge). Results: The short-chain fatty acid (SCFA)-producing bacteria were lower while the gram-negative bacteria, lipopolysaccharide and TJ were higher preoperatively in both the SCD and aMCI (pAD) groups compared with the NC group. After surgery, a decrease in SCFA-producing bacteria, and an increase in both gram-negative bacteria and plasma claudin were significant in the pAD groups relative to the NC group. SCFA-producing bacteria were negatively correlated with TJ and cytokines in pAD patients on postsurgical day 7. Furthermore, surgery-induced perioperative metabolic stress and inflammatory responses were associated with gut microbiota alterations. Conclusions: Surgery exacerbates both preexisting microbiota dysbiosis and intestinal barrier dysfunction in pAD patients, all of which may be associated with systemic inflammation and, in turn, may lead to further cognitive deterioration.
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NUT carcinoma of the mandible in a child: case report and systematic review

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This report illustrates the management of mandibular NUT carcinoma in a pediatric patient, complemented by a systematic review of head and neck NUT carcinoma. A 5-year-old female presented with an enlarging jaw mass that was diagnosed as BRD4-NUTM1 carcinoma and was treated with hemimandibulectomy and chemoradiation. (Source: International Journal of Oral and Maxillofacial Surgery)
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