The Retornus-2 study: impact of respiratory muscle training in subacute stroke patients with dysphagia, study protocol of a double-blind randomized controlled trial

xlomafota13 shared this article with you from Inoreader The Retornus-2 study: impact of respiratory muscle training in subacute stroke patients with dysphagia, study protocol of a double-blind randomized controlled trial Via swallowing exercises Trials. 2021 Jun 25;22(1):416. doi: 10.1186/s13063-021-05353-y. ABSTRACT BACKGROUND: Stroke can lead to varying degrees of oropharyngeal dysphagia, respiratory muscle dysfunction and even increase medical complications such as aspiration, malnutrition and death. Recent studies suggest that inspiratory and expiratory respiratory muscle training (IEMT) can improve swallowing efficacy and may reduce aspiration events. The main purpose of this study is to examine whether an 8-week IEMT programme can improve respiratory muscle strength and swallow dysfunction severity in subacute stroke patients with dysphagia. METHODS: Retornus-2 is a two-arm, prospectively registered, randomized controlled study with blinded assessors and the participation of fifty individuals who have suffered a stroke. The intervention group undergoes IEMT training consisting of 5 sets of 10 repetitions, three times a day for 8 weeks. Training loads increase weekly. The control group undergoes a sham-IEMT protocol. The primary outcome examines the efficacy of the IEMT protocol to increase respiratory muscle strength and reduce dysphagia severity. The secondary outcome assesses the longitudinal impact of dysphagia on body composition and nutritional assessment over a 6-month follow-up. DISCUSSION: IEMT induces an improvement in respiratory muscle strength and might be associated with relevant benefits in dysphagia patterns, as well as a reduction in the number of aspiration events c onfirmed by videofluoroscopy or fiberoptic endoscopic evaluation of swallowing. The description of the impact of swallowing impairment on nutritional status will help develop new strategies to face this known side-effect. TRIAL REGISTRATION: Clinicaltrials.gov NCT03021252. Registered on 10 January 2017. https://clinicaltrials.gov/ct2/results?cond=retornus+2&term=&cntry=ES&state=&city=&dist= WHO trial Registration data set: Due to heavy traffic generated by the COVID-19 outbreak, the ICTRP Search Portal does not respond. The portal recommends other registries such as clinicaltrials.gov. Protocol version: RETORNUS 2_ PROTOCOL_2. PMID:34172071 | PMC:PMC8229262 | DOI:10.1186/s13063-021-05353-y View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Endoscopic Repair of Type 1 Laryngeal Clefts and Deep Interarytenoid Notches: Cold Steel Versus Laser

xlomafota13 shared this article with you from Inoreader Endoscopic Repair of Type 1 Laryngeal Clefts and Deep Interarytenoid Notches: Cold Steel Versus Laser Via The Laryngoscope Objectives/Hypothesis Endoscopic repair is the preferred surgical treatment for type 1 laryngeal clefts (T1LCs) and deep interarytenoid notches (DINs). No studies exist showing differences in repair rates using laser and cold steel. Our objective is to assess overall success and revision rate for endoscopic cleft repair and determine whether there is any difference in surgical outcomes between cold steel and laser techniques. Study Design Retrospective chart review, cohort study. Methods Retrospective review at a quaternary care pediatric hospital. Included all patients who underwent endoscopic repair for T1LCs and DINs between January 2010 and December 2019. Demographics, comorbidities, surgical data, outcomes, and revision status were collected and analyzed. We excluded patients who did not have a follow-up at our institution. Results A total of 194 patients were identified, 14 were excluded for lack of follow-up data so 180 were analyzed. Of these, 127 had cold steel repair and 53 had laser repair. There is no significant difference in demographics or comorbidities. In the cold steel group, 4 of 127 (3.1%) had breakdown and in the laser group, 10 of 53 (18.9%) had breakdown. Patients who failed after a cold steel repair tended to break down later (median 12.7 months) when compared to laser repairs (median 2.1 months). Nine of the 10 patients with breakdown after laser repair were noted on initial postoperative evaluation. Conclusions Endoscopic cleft repair is a well-described and effective method for repair of T1LCs and DINs. Both cold steel and laser have high success rates; however, higher failure rates were noted in the laser repair group. Failure after laser repair may occur earlier than failure after cold steel repair. But this did not reach significance. Level of Evidence III Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Second Sets of Tympanostomy Tubes Extrude Sooner

xlomafota13 shared this article with you from Inoreader Second Sets of Tympanostomy Tubes Extrude Sooner Via The Laryngoscope Introduction Some clinicians believe second sets of tympanostomy tubes extrude more quickly than first sets. Study Design Retrospective case-control series. Methods We identified children who were examined 12 months after placement of their second set of tympanostomy tubes and compared them to a similar number of children who were examined 12 months after their first set of tympanostomy tubes. Extrusion was determined by otoscopy, otomicroscopy, and/or tympanometry. Results One hundred eighteen children had 12-month follow-up data available after their first set of tubes, 54 had 12-month follow-up data available for their second set, and 56 had 12-month follow-up data after their first and second sets. A total of 568 tubes were observed. Looking at each tube, second set tubes were significantly more likely to be extruded at 12 months (48%) compared to first set (28%) (P < .001). Patient age was not associated with extrusion rate. For patients who had 12-month follow-up for both their first and second set of tubes, there was no correlation between extrusion of first and second set tubes. Conclusion Second set tympanostomy tubes are significantly less likely to remain functional 12 months after placement than first sets, independent of patient age at placement and independent of whether the child's first tubes extruded by 12 months. Given the short duration of second tube function, delaying second set placement until the fall might be a better choice for some children. Level of Evidence 3—Case–control studies Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Benign Intratracheal Thyroid: A Systematic Review of 43 Cases With Five New Case Reports

xlomafota13 shared this article with you from Inoreader Benign Intratracheal Thyroid: A Systematic Review of 43 Cases With Five New Case Reports Via The Laryngoscope Objective/Hypothesis To examine the clinical features of benign intratracheal thyroid (ITT) and their management strategies and outcomes. Study Design Case series study. Methods This systemic review was conducted in two international academic centers. This review includes 43 patients: one new case from the Massachusetts Eye and Ear Infirmary, four new cases from Beijing Tongren Hospital, and 38 previously published cases. We analyzed these 43 cases and summarized the patients' epidemiological data, clinical features, and treatment regimens. Results ITTs were less common in men than in women (male:female ratio of 3:10). ITT was observed in patients as young as neonates and as old as 85 years. Orthotopic thyroid nodules were present in 55.8% of the patients with ITT. Malignancy was incidentally found in 4.6% of all ITTs. Imaging examinations showed that the ITTs were typically attached to the posterolateral/lateral tracheal wall of the first, second, or third tracheal rings. Tissue attachment between the ITT and normal thyroid lobes was seen in 59.5% of the patients. Thirty-seven patients underwent surgery: 30 underwent open surgery, and seven underwent endoscopic debulking resections. One neonate received thyroid suppression therapy. One patient with ITT and papillary thyroid cancer was treated with radiotherapy and ultimately died after recurrence. Conclusions Surgical resection is an effective treatment for benign ITT. We hypothesized that abnormalities during the embryonic development of Berry's ligament might play a role in ITT pathogenesis. Level of Evidence NA Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Location, location, location: Melanoma cells “living at the edge”

xlomafota13 shared this article with you from Inoreader Location, location, location: Melanoma cells "living at the edge" Via Experimental Dermatology Abstract Abnormal cell migration and invasion underlie metastatic dissemination, one of the major challenges for cancer treatment. Melanoma is one the deadliest and most aggressive forms of skin cancer due in part to its migratory and metastatic potential. Cancer cells use a variety of migratory strategies regulated by cytoskeletal remodelling. In particular, we discuss the importance of amoeboid invasive melanoma strategies, since they have been identified at the edge of human melanomas. We hypothesize that the presence of amoeboid melanoma cells will favour tumour progression since they are invasive and metastatic; they support immunosuppression; they harbour cancer stem cell properties and they are involved in therapy resistance. The Rho-ROCK-Myosin II pathway is key to maintain amoeboid melanoma invasion but this pathway is further regulated by pro-tumorigenic/pro-metastatic/pro-survival signalling pathways such as JAK-STAT3, TGFβ-SMAD, NF-κB, Wnt11/5-FDZ7 and BRAFV600E-ME K-ERK. These pathways support amoeboid behaviour and are actionable in the clinic. After melanoma wide surgical margin removal, we propose that possible remaining melanoma cells should be eradicated using anti-amoeboid therapies. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Screening for Olfactory Dysfunction in COVID-19 Patients Using Quick Smell Identification Test

xlomafota13 shared this article with you from Inoreader Screening for Olfactory Dysfunction in COVID-19 Patients Using Quick Smell Identification Test Via Otolaryngology Indian Abstract Objective: To determine the prevalence of OD in the confirmed case with COVID-19 among our population using quick smell identification test (Q-SIT) as screening tool. Methods: Cross- sectional study carried out in Qatif area—Saudi Arabia among adult hospitalized patient with confirm COVID-19 during the period between May and July, 2020. All adults confirmed COVID-19 patients were interviewed for history of current disease and associated symptoms as well as performing Q-SIT. Participants who had history of olfactory dysfunction, and critical cases required ICU admission were excluded. Results: The prevalence of OD among COVID-19 cases was (16.3%) in our population using Q-SIT compared to (27.4%) for self-reported symptom. Females were having higher prevalence in compare to males (30.5% and 11.1%) respectively; which was statistically significant (P < 0.001). The patients reported higher prevalence of ageusia (31.9%) with significant association w ith OD (P < 0.001). Q-SIT showed high positive and negative predictive value in detecting OD among patients with COVID-19 (84% and 93% respectively). Conclusion: Q-SIT is a useful, validated and easy to apply tool for screening OD among patients with COVID-19. Some patients presented solely with this symptom which can occurs unnoticed in COVID-19 patients, and there for required objective test for detection. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Correlation Between Video-Otoendoscopy and Tympanograms of Patients with Acute Middle Ear Infections

xlomafota13 shared this article with you from Inoreader Correlation Between Video-Otoendoscopy and Tympanograms of Patients with Acute Middle Ear Infections Via Otolaryngology Indian Abstract The tympanic membrane (TM) undergoes a number of pathological changes in middle ear disease which can be detected by a video-otoendoscope. Middle ear disease is also accompanied by changes in middle ear pressure which can be assessed by tympanometry. The objectives of this study were to find the correlation between video-otoendoscopy and tympanometry in acute middle ear infections and to deduce which of the two is more efficient and reliable for early diagnosis. 75 patients with AOM or OME were included over 1 year where each patient was followed for 21 days. Detailed history and clinical examination with videootoendoscope and tympanometry was done on each visit. Each TM was graded using OMGRADE scale. Symptoms and clinical findings consistent with acute otitis media were given a clinical score (CO Score). The results were collected and correlation between video-otoendoscopy and tympanometry was determined and their individual sensitivity, specificity a nd diagnostic accuracy was calculated. The sensitivity, specificity and diagnostic accuracy for tympanometry and video-otoendoscopy was calculated individually for each of the 4 visits and positive correlation between the 2 was found. Our study showed that tympanometry had a higher overall sensitivity than video-otoendoscopy. While, video-otoendoscopy showed a higher specificity than Tympanometry. Otoendoscopy is good for ruling out AOM/OME but cannot rule out persisting Middle Ear Effusion and Tympanometry is a better tool for detecting MEE but cannot differentiate well between AOM and OME. We found that tympanometry plus otoendoscopy together greatly increase the chances of detecting AOM and OME thus improving diagnostic accuracy, reducing financial costs associated with over or mis-diagnosis. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Objectifying growth of vascularized bone transfers after mandibular reconstruction in the pediatric population

xlomafota13 shared this article with you from Inoreader Objectifying growth of vascularized bone transfers after mandibular reconstruction in the pediatric population Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 11:S1748-6815(21)00262-X. doi: 10.1016/j.bjps.2021.05.010. Online ahead of print. ABSTRACT BACKGROUND: Autologous vascularized bone transfer is the preferred strategy for the reconstruction of mandibular defects in a pediatric population. The principal argument is the theoretical postoperative growth potential of the neomandible, which uses vascularized donor tissues. OBJECTIVES: The purpose of this study was to objectify the veritable growth potential of vascularized bone transfers in children. METHODS: A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, revealing 57 patients younger than or equal to 18 years who had undergone a mandibular reconstruction with a vascularized free flap. Only studies using postoperative imaging were included. Outcomes regarding growth and postoperative corrections and complica tions were analyzed. RESULTS: Neomandibular growth was observed in 63.2% of all included patients. The proportion of growth was higher in patients with condylar preservation (95.7%) than that of patients with condylar involvement (41.2%). Reconstruction of the condyle by a free flap, which includes an epiphyseal growth plate or cartilage increased postoperative growth potential (77.8%) but did not reduce the need for later orthognathic surgery. CONCLUSION: After mandibular reconstruction with a vascularized bone transfer, the majority of pediatric patients shows neomandibular growth. Condylar preservation, the inclusion of epiphyseal growth plates or cartilage, and the patients age at the time of reconstruction are essential defining parameters. PMID:34187765 | DOI:10.1016/j.bjps.2021.05.010 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Composition, Quoracy and Cost of Specialist Skin Cancer Multidisciplinary Team Meetings in the United Kingdom

xlomafota13 shared this article with you from Inoreader Composition, Quoracy and Cost of Specialist Skin Cancer Multidisciplinary Team Meetings in the United Kingdom Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 6:S1748-6815(21)00271-0. doi: 10.1016/j.bjps.2021.05.019. Online ahead of print. ABSTRACT BACKGROUND: Multidisciplinary team (MDT) meetings are an integral component of skin cancer service provision, enabling the implementation of evidence-based decisions and standardised patient outcomes. OBJECTIVES: We sought to evaluate the composition, quoracy and cost of Specialist Skin Cancer Multidisciplinary Teams (SSMDTs) in the United Kingdom (UK) to establish the functionality and financial impact of these meetings. METHODS: Cross-sectional design with a national freedom of information request made to 65 NHS trusts in the UK hosting an SSMDT. Detailed information with regard to attendance frequency and core membership from attendance registers was requested. Quoracy was measured against the 2006 National Institute for Health and Care Excellence Cancer Services standard 'Improving outcomes f or people with skin tumours including melanoma'. We costed the SSMDT utilising the running time, core membership salaries derived from national pay scales and overhead values provided by trusts. RESULTS: Out of 58 respondents (89% response rate), only 15 SSMDTs (26%) were quorate by membership. Forty SSMDTs (69%) were quorate by meeting frequency. The main reasons for membership noncompliance was lack of clinical oncology presence. There was a large variation in the cost per patient (µ = £132.68, range: £31.67-£313.10). There was no geographical variation in quoracy or cost between England, Wales, Scotland and Northern Ireland. PMID:34187763 | DOI:10.1016/j.bjps.2021.05.019 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Bracketing with Multiple Radioactive Seeds to Achieve Negative Margins in Breast Conservation Surgery: Multiple Seeds in Breast Surgery

xlomafota13 shared this article with you from Inoreader Bracketing with Multiple Radioactive Seeds to Achieve Negative Margins in Breast Conservation Surgery: Multiple Seeds in Breast Surgery Via radioactive iodine Clin Breast Cancer. 2021 Jun 3:S1526-8209(21)00141-5. doi: 10.1016/j.clbc.2021.05.013. Online ahead of print. ABSTRACT INTRODUCTION: Breast conservation surgery (BCS) is the treatment of choice for unifocal, early-stage breast cancer. The ability to offer BCS to a wider subset of patients, including those with multifocal/multicentric cancer as well as extensive ductal carcinoma in situ, has emerged over time, especially in those undergoing joint oncoplastic reconstruction and those treated with neoadjuvant therapy. However, localization techniques using multiple radioactive seeds for bracketing in this patient subset have not been validated. MATERIALS AND METHODS: A single-institution retrospective review was conducted of all patients with breast cancer who underwent BCS, guided by multiple bracketed iodine I 125 radioactive seeds between January 2014 and April 2017. RESULTS: Bracketing of breast cancer using 2 or more radioactive seeds was performed in 157 breasts in 156 patients. Negative margins were achieved in 124 of 157 (79%) breasts, including 33 cases (21%) that underwent targeted margin reexcision at the time of surgery after intraoperative, multidisciplinary margin assessment. Thirty-three cases (21%) resulted in close or positive margins, of which 11 (7%) and 10 (6.4%) underwent completion mastectomy or repeat lumpectomy, respectively. Twelve patients (7.6%) did not undergo reexcision. En bloc resection was successful in 134 of 157 (85. 4%) lumpectomies. Eighty-nine percent of the procedures were coupled with oncoplastic reconstruction. CONCLUSION: Bracketing techniques using multiple radioactive seeds expands the indications for breast conservation therapy in patients who would have traditionally required mastectomy. Intraoperative margin assessment improves surgical and pathologic success. Larger defects created by multifocal resection are optimally managed in concert with oncoplastic reconstruction to minimize asymmetries and aesthetic defects. PMID:34187752 | DOI:10.1016/j.clbc.2021.05.013 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Reliability and toxicity of bevacizumab for neurofibromatosis type 2-related vestibular schwannomas: A systematic review and meta-analysis

xlomafota13 shared this article with you from Inoreader Reliability and toxicity of bevacizumab for neurofibromatosis type 2-related vestibular schwannomas: A systematic review and meta-analysis Via American Journal of Otolaryngology Publication date: November–December 2021 Source: American Journal of Otolaryngology, Volume 42, Issue 6 Author(s): Jianwei Shi, Dafeng Lu, Ruxin Gu, Huaping Sun, Li Yu, Ruihan Pan, Yansong Zhang View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.