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Mu L, Chen J, Li J, Nyirenda T, Hegland KW, Beach TG. Mechanisms of Swallowing, Speech and Voice Disorders in Parkinson's Disease: Literature Review with Our First Evidence for the Periperal Nervous System Involvement. Dysphagia 2024:10.1007/s00455-024-10693-3. [PMID: 38498201 DOI: 10.1007/s00455-024-10693-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024]
Abstract
The majority of patients with Parkinson's disease (PD) develop swallowing, speech, and voice (SSV) disorders. Importantly, swallowing difficulty or dysphagia and related aspiration are life-threatening conditions for PD patients. Although PD treatments have significant therapeutic effects on limb motor function, their effects on SSV disorders are less impressive. A large gap in our knowledge is that the mechanisms of SSV disorders in PD are poorly understood. PD was long considered to be a central nervous system disorder caused by the death of dopaminergic neurons in the basal ganglia. Aggregates of phosphorylated α-synuclein (PAS) underlie PD pathology. SSV disorders were thought to be caused by the same dopaminergic problem as those causing impaired limb movement; however, there is little evidence to support this. The pharynx, larynx, and tongue play a critical role in performing upper airway (UA) motor tasks and their dysfunction results in disordered SSV. This review aims to provide an overview on the neuromuscular organization patterns, functions of the UA structures, clinical features of SSV disorders, and gaps in knowledge regarding the pathophysiology underlying SSV disorders in PD, and evidence supporting the hypothesis that SSV disorders in PD could be associated, at least in part, with PAS damage to the peripheral nervous system controlling the UA structures. Determining the presence and distribution of PAS lesions in the pharynx, larynx, and tongue will facilitate the identification of peripheral therapeutic targets and set a foundation for the development of new therapies to treat SSV disorders in PD.
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Affiliation(s)
- Liancai Mu
- Upper Airway Reserch Laboratory, Center for Discovery and Innovation, Hackensack Meridian Health, 111 Ideation Way, Nutley, NJ, 07110, USA.
- Center for Discovery and Innovation, Hackensack Meridian Health, 111 Ideation Way, Nutley, NJ, 07110, USA.
| | - Jingming Chen
- Upper Airway Reserch Laboratory, Center for Discovery and Innovation, Hackensack Meridian Health, 111 Ideation Way, Nutley, NJ, 07110, USA
| | - Jing Li
- Upper Airway Reserch Laboratory, Center for Discovery and Innovation, Hackensack Meridian Health, 111 Ideation Way, Nutley, NJ, 07110, USA
| | - Themba Nyirenda
- Upper Airway Reserch Laboratory, Center for Discovery and Innovation, Hackensack Meridian Health, 111 Ideation Way, Nutley, NJ, 07110, USA
| | - Karen Wheeler Hegland
- Upper Airway Dysfunction Laboratory, M.A. Program in Communication Sciences & Disorders, Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, 1225 Center Dr., Gainesville, FL, 32611, USA
| | - Thomas G Beach
- Director of Neuroscience, Director of Brain and Body Donation Program, Banner Sun Health Research Institute, 10515 West Santa Fe Dr, Sun City, AZ, 85351, USA
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Li D, Zeng WT, Jiang JG, Chen JC. Translocation of a fish spike from the pharynx to the thyroid gland: A case report. World J Clin Cases 2024; 12:1365-1370. [PMID: 38524516 PMCID: PMC10955535 DOI: 10.12998/wjcc.v12.i7.1365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/17/2024] [Accepted: 02/03/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND A fish spike stuck in the throat is a common ear, nose, and throat (ENT) emergency. However, it is very rare for a fish spike to reach the thyroid tissue through the throat, which is very dangerous and can lead to pharyngeal fistula, cervical abscess, mediastinal abscess, and thyroid abscess. Proper and timely management can help reduce complications, especially in elderly patients. CASE SUMMARY In the case presented here, the causative factor was dentures, but improper management aggravated the condition. In the case presented here, an elderly woman with a history of accidentally swallowing fish bones for 20 d had a sensation of foreign bodies in her throat. Eventually, computed tomography (CT) of the neck showed that the left side of the thyroid gland had a dense shadow in the form of a stripe. CONCLUSION If a fishbone foreign body is not visible during endoscopic examination but the patient has significant symptoms, the surgeon should be aware that the fishbone may be lodged in the thyroid. To avoid a misdiagnosis, ultrasound, CT, and other tests can be used to clarify the diagnosis. T The first step in treating a fish bone in the thyroid gland is to determine the position of the foreign body and the extent of the infection, and to develop a personalized surgical plan for its removal. At the same time, scientific information should be made available to the general public so that people know that if a fish bone is accidentally lodged, they should not force it to be swallowed or be spit out by inducing vomiting, which are incorrect methods and may aggravate the condition or even cause it to migrate outside the cavity, leading to serious complications, as in this reported case.
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Affiliation(s)
- Deng Li
- Department of Otolaryngology Head and Neck Surgery, Army Medical Center of PLA, Chongqing 400042, China
| | - Wan-Ting Zeng
- Department of Otolaryngology Head and Neck Surgery, Army Medical Center of PLA, Chongqing 400042, China
| | - Jian-Guo Jiang
- Department of Otolaryngology Head and Neck Surgery, Army Medical Center of PLA, Chongqing 400042, China
| | - Ji-Chuan Chen
- Department of Otolaryngology Head and Neck Surgery, Army Medical Center of PLA, Chongqing 400042, China
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Bayona HHG, Inamoto Y, Saitoh E, Aihara K, Kobayashi M, Otaka Y. Prediction of Pharyngeal 3D Volume Using 2D Lateral Area Measurements During Swallowing. Dysphagia 2024:10.1007/s00455-023-10659-x. [PMID: 38245902 DOI: 10.1007/s00455-023-10659-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024]
Abstract
This study evaluated the validity of pharyngeal 2D area measurements acquired from the lateral view for predicting the actual 3D volume in healthy adults during swallowing. Seventy-five healthy adults (39 females, 36 males; mean age 51.3 years) were examined using 320-row area detector computed tomography (320-ADCT). All participants swallowed a 10 mL honey-thick barium bolus upon command while seated in a 45° semi-reclining position. Multi-planar reconstruction images and dynamic 3D-CT images were obtained using Aquilion ONE software. Pharyngeal 2D area and 3D volume measurements were taken before swallowing and at the frame depicting maximum pharyngeal constriction. Pharyngeal volume before swallowing (PVhold) was accurately predicted by 2D area (R2 = 0.816). Adding height and sex to the model increased R2 to 0.836. Regarding pharyngeal volume during maximum constriction (PVmax), 2D area also exhibited acceptable predictive power (R2 = 0.777). However, analysis of statistical residuals and outliers revealed a greater tendency for prediction errors when there is less complete constriction of the pharynx as well as asymmetry in bolus flow or movement. Findings highlight the importance of routinely incorporating anterior-posterior views during VFSS exams. Future work is needed to determine clinical utility of pharyngeal volume measurements derived from 320-ADCT.
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Affiliation(s)
- Howell Henrian G Bayona
- Graduate School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Yoko Inamoto
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Eichii Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Keiko Aihara
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Masanao Kobayashi
- Faculty of Radiology, School of Medical Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
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Ait Idir M, Trinh JM, Chanson A, Salleron J, Henrot P. Impact of systematic dynamic maneuvers during computed tomography scan on the T classification of head and neck cancers. Clin Imaging 2024; 105:110023. [PMID: 37992627 DOI: 10.1016/j.clinimag.2023.110023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/04/2023] [Accepted: 11/02/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES To evaluate the impact of systematic dynamic maneuvers during CT scan on the T-staging of head and neck cancer (HNC). MATERIALS AND METHODS CT scans from the initial workup of 443 consecutive patients treated for HNC in our institution were retrospectively analyzed. CT scans were performed in both expert centers (comprehensive cancer center and university hospital) and non-expert centers. We noted whether dynamic maneuvers (DM) were performed, in 3 categories, namely: DM not done (DMND), done and inadequate (DMDI), done and adequate (DMDA). In the group with DMDA, T-stage was evaluated without and with DM. Interobserver agreement for T staging was assessed after independent double reading of CT scans with and without DM by two radiologists in a random sample. RESULTS Among the 443 CT scans, DMND was observed in 36.3%, DMDI in 9.3% and DMDA in 54.4%. DMDA were significantly more frequent in expert than in non-expert centers (93.4 vs 6.6%, p < 0.001). In CT scans with DMDA, analysis of the 141 scans rated as T1, T2, T3, or T4 without DM showed agreement of 88.7% with scans with DM, corresponding to a reclassification rate of 11.3% (kappa = 0.85, 95%CI [0.78;0.92]). Among lesions initially classed as Tx without DM (N = 100), the reclassification rate was 76% including DM. CONCLUSION The performance of systematic DM integrated into CT protocols is useful to reclassify the T stage in HNC and is essential in case of lesions initially classified as Tx without DM. DM should be performed routinely in expert and nonexpert centers.
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Affiliation(s)
- M Ait Idir
- Department of Radiology, Institut de Cancerologie de Lorraine, 54519 Vandoeuvre-les-Nancy Cedex, France
| | - J M Trinh
- Department of Radiology, Institut de Cancerologie de Lorraine, 54519 Vandoeuvre-les-Nancy Cedex, France
| | - A Chanson
- Department of Radiology, Institut de Cancerologie de Lorraine, 54519 Vandoeuvre-les-Nancy Cedex, France
| | - J Salleron
- Department of Biostatistics, Institut de Cancerologie de Lorraine, 54519 Vandoeuvre-les-Nancy Cedex, France
| | - P Henrot
- Department of Radiology, Institut de Cancerologie de Lorraine, 54519 Vandoeuvre-les-Nancy Cedex, France.
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Heise KM, Miller S, Ptok M, Jungheim M. [Prevalence of mucosal injuries during flexible endoscopic evaluation of swallowing in the presence of a nasogastric tube]. HNO 2024; 72:25-31. [PMID: 37796338 PMCID: PMC10781840 DOI: 10.1007/s00106-023-01361-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND The flexible endoscopic evaluation of swallowing (FEES) is an established low-risk examination method to assess the risk of penetration or aspiration in patients with dysphagia. FEES might be more difficult or of higher-risk when a nasogastric tube is in place. OBJECTIVE This study aims to identify whether the prevalence of mucosal lesions is higher when the endoscopy is carried out with a nasogastric tube in place. Pre-existing mucosal lesions were also documented. METHODS In a retrospective, monocentric study, a total of 918 FEES procedures routinely performed in hospitalized patients of a university hospital from January 2014 to March 2019 were evaluated. Mucosal lesions were identified and characterized for descriptive statistics. RESULTS In the video material analysed here, no endoscopy-related injuries were identified. However, pre-existing mucosal lesions, which often occurred as multiple lesions, were detected in 48.6% of the endoscopies. Further analysis showed that these pre-existing lesions were not worsened by the endoscopy performed. CONCLUSION The results demonstrate that transnasal flexible endoscopy is a safe, low-risk examination method, even in patients with a nasogastric tube. A very high number of pre-existing mucosal lesions were found, which is probably related to the previous insertion of the nasogastric tube. Due to the high number of pre-existing lesions, strategies should be developed to minimize injuries when placing nasogastric tubes.
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Affiliation(s)
- Kira-Milena Heise
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Simone Miller
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Martin Ptok
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Michael Jungheim
- Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Dantas RO, Alves LMT, Silva ACV, Cassiani RA, Alves DC, Nascimento WV. Eating Assessment Tool (EAT-10) Scores to Detect Self-Reported Dysphagia in Brazilians. Dysphagia 2023; 38:1609-1614. [PMID: 37272949 DOI: 10.1007/s00455-023-10588-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/02/2023] [Indexed: 06/06/2023]
Abstract
The Eating Assessment Tool (EAT-10) detects swallowing impairments (dysphagia) self-reported by patients according to their perception. This noninvasive, inexpensive, self-administered instrument is quickly and easily filled out. The objective of this investigation was to evaluate the scores, sensitivity, and specificity of the method to define self-reported dysphagia in Brazilians. EAT-10 scores were evaluated in 443 healthy individuals (273 women and 170 men), aged 20 to 84 years, with no swallowing difficulties or diseases, and 72 patients with diseases that cause dysphagia (35 women and 37 men), aged 29 to 88 years. Each of the 10 instrument items has a 0-4 rating scale, in which 0 indicates no problem and 4, a severe problem; total results range from 0 to 40. The median EAT-10 score of healthy subjects was 0 (range: 0-20), and that of patients was 14.5 (range: 1-40). Considering a ≥ 3 cutoff score to define dysphagia risk, it was self-reported by 97.2% of patients with dysphagia and 9.5% of no-disease individuals (97.2% sensitivity and 90.7% specificity). The positive predictive value of the test was 63% and the negative predictive value was 99.5%. Healthy women had higher scores (median 0, range: 0-20) than healthy men (median 0, range: 0-8, p < 0.01) and more results indicative of self-reported dysphagia (11.7%) than healthy men (5.9%). The EAT-10 cutoff score to detect self-reported dysphagia in Brazilians should be 3, as previously considered. Healthy women complain more of self-reported dysphagia than healthy men. The test has high sensitivity and specificity.
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Affiliation(s)
- Roberto Oliveira Dantas
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil.
- , Ribeirão Preto, Brazil.
| | | | | | | | | | - Weslania Viviane Nascimento
- Laboratory of Gastrointestinal Physiology, Department of Surgery, Hospital of Mataró, Universitat Autonoma de Barcelona, Mataró, Spain
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Lee E, Kim GJ, Ryu H, Jung KI, Yoo WK, Ohn SH. Pharyngeal Structure and Dysphagia in Patients with Parkinson's Disease and Related Disorders. Dysphagia 2023:10.1007/s00455-023-10631-9. [PMID: 37902836 DOI: 10.1007/s00455-023-10631-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/15/2023] [Indexed: 11/01/2023]
Abstract
Pharyngeal muscle changes occur in patients with Parkinson's disease and related disorders (PRD); however, the association between the structural alterations in the pharynx and the symptoms of dysphagia remains unclear. We assessed structural changes and contractile forces by measuring pharyngeal wall thickness and width. We aimed to define the pharyngeal measurements and determine their value as diagnostic tools for dysphagia. The pharyngeal wall thickness (PWT), pharyngeal width at rest (PWR), and shortest pharyngeal width at swallowing (PWS) were measured using lateral neck roentgenograms and videofluoroscopic swallowing study. We compared the PWR and PWT between the PRD and control groups using an independent t-test. The Kendall correlation test was performed on the radiological data of the pharynx (PWT, PWR and PWS), dysphagia scales (Penetration-Aspiration scale [PAS] and Dysphagia Outcome and Severity Scale [DOSS]), and Hoehn and Yahr scale (HY scale). The PWT was smaller and the PWR greater in the PRD than in the control group (p < 0.05). The dysphagia scales (PAS and DOSS) were correlated with the radiological data (PWT and PWS) and the HY scale (p < 0.05). The HY scale score also correlated with the PWT (p < 0.05). The optimal cutoff points of the PWT and PWR for predicting aspiration were 4.05 and 16.05 mm in the PRD group, respectively. Using the PWT, PWR and PWS, muscle atrophy and contractile strength of the pharynx can be estimated. The combination of the PWT and PWR can be a simple indicator for predicting swallowing disorders at the bedside.
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Affiliation(s)
- Eunjee Lee
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 Beon-gil Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea
| | - Gyu Jin Kim
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 Beon-gil Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea
| | - Hyewon Ryu
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 Beon-gil Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea
| | - Kwang-Ik Jung
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 Beon-gil Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 Beon-gil Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea
| | - Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 Beon-gil Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea.
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Abdali SS, Yokoyama T, Nakamuta N, Saino T, Yamamoto Y. Immunohistochemical analysis of glutamatergic and serotonergic signaling pathways in chemosensory cell clusters in the pharynx and larynx of rats. Tissue Cell 2023; 82:102122. [PMID: 37262979 DOI: 10.1016/j.tice.2023.102122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/03/2023]
Abstract
The present study examined cellular components and the localization of vesicular glutamate transporter (VGLUT) 1 and 2 and serotonin (5-HT) in chemosensory cell clusters in the rat pharynx and larynx. Triple immunolabeling for guanine nucleotide-binding protein G (t), subunit ⍺3 (GNAT3) and nucleoside triphosphate diphosphohydrolase 2 (NTPDase2) with synaptotagmin-1 (Syt1) revealed NTPDase2-immunoreactive type I-like cells in addition to GNAT3-immunoreactive type II-like and Syt1-immunoreactive type III-like cells in pharyngolaryngeal chemosensory cell clusters. Therefore, these clusters appear to comprise similar cell types to those in the lingual taste buds with slight morphological modifications. An immunofluorescence analysis of VGLUT1 or VGLUT2 and GNAT3 with P2X3 purinoceptors revealed that VGLUTs co-localized to P2X3-immunoreactive spherical nerve terminals closely associated with GNAT3-immunoreactive type II-like cells. Moreover, triple immunolabeling for Syt1/synaptosomal-associated protein, 25 kDa (SNAP25) and P2X3 with VGLUT1 or VGLUT2 revealed punctate immunoreactive products for VGLUT1 and VGLUT2 within P2X3-immunoreactive flat axon terminals wrapped around Syt1/SNAP25-immunoreactive type III-like cells. The afferent nerve fibers innervating cell clusters may contain glutamate and release it by exocytosis. On the other hand, immunoreactive products for 5-HT and dopa decarboxylase were detected in Syt1-immunoreactive cells, indicating the release of 5-HT by these cells. The present results suggest that chemosensory cell clusters in the pharynx and larynx may be modulated by intrinsic glutamate and 5-HT.
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Affiliation(s)
- Sayed Sharif Abdali
- Department of Anatomy (Cell Biology), Iwate Medical University, Yahaba, Japan.
| | - Takuya Yokoyama
- Department of Anatomy (Cell Biology), Iwate Medical University, Yahaba, Japan
| | - Nobuaki Nakamuta
- Laboratory of Veterinary Anatomy and Cell Biology, Faculty of Agriculture, Iwate University, Morioka, Japan
| | - Tomoyuki Saino
- Department of Anatomy (Cell Biology), Iwate Medical University, Yahaba, Japan
| | - Yoshio Yamamoto
- Laboratory of Veterinary Anatomy and Cell Biology, Faculty of Agriculture, Iwate University, Morioka, Japan
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Byard RW, Heath KJ. Infection and sudden lethal upper airway occlusion - An overview. J Forensic Leg Med 2023; 97:102541. [PMID: 37207530 DOI: 10.1016/j.jflm.2023.102541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/29/2023] [Accepted: 05/14/2023] [Indexed: 05/21/2023]
Abstract
A multitude of conditions may cause acute and unexpected upper airway compromise in both children and adults. These include mechanical blockage of the airways either from internal obstructions due to inhaled food or foreign objects, or from external compression. In addition, kinking of the airway in cases of positional asphyxia may compromise aeration. Infections represent another cause of airway narrowing with the potential for occlusion. The case of a 64-year-old man with acute laryngo-epiglottitis is used to demonstrate that death may occur from infections in previously structurally-normal airways. Infections may compromise respiration due to acute airway occlusion from intraluminal material/mucus, mural abscesses or from acutely inflamed and oedematous mucosa with adherent tenacious mucopurulent secretions. External compression from nearby abscesses may also critically narrow air passages.
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Affiliation(s)
- Roger W Byard
- Forensic Science SA, School of Biomedicine, Australia; The University of Adelaide, Adelaide, South Australia, Australia.
| | - Karen J Heath
- Forensic Science SA, School of Biomedicine, Australia
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Zhou Y, Rothe M, Schunck WH, Ruess L, Menzel R. Serotonin-induced stereospecific formation and bioactivity of the eicosanoid 17,18-epoxyeicosatetraenoic acid in the regulation of pharyngeal pumping of C. elegans. Biochim Biophys Acta Mol Cell Biol Lipids 2023; 1868:159304. [PMID: 36914111 DOI: 10.1016/j.bbalip.2023.159304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/15/2023]
Abstract
17,18-Epoxyeicosatetraenoic acid (17,18-EEQ), the most abundant eicosanoid generated by cytochrome P450 (CYP) enzymes in C. elegans, is a potential signaling molecule in the regulation of pharyngeal pumping activity of this nematode. As a chiral molecule, 17,18-EEQ can exist in two stereoisomers, the 17(R),18(S)- and 17(S),18(R)-EEQ enantiomers. Here we tested the hypothesis that 17,18-EEQ may function as a second messenger of the feeding-promoting neurotransmitter serotonin and stimulates pharyngeal pumping and food uptake in a stereospecific manner. Serotonin treatment of wildtype worms induced a more than twofold increase of free 17,18-EEQ levels. As revealed by chiral lipidomics analysis, this increase was almost exclusively due to an enhanced release of the (R,S)-enantiomer of 17,18-EEQ. In contrast to the wildtype strain, serotonin failed to induce 17,18-EEQ formation as well as to accelerate pharyngeal pumping in mutant strains defective in the serotonin SER-7 receptor. However, the pharyngeal activity of the ser-7 mutant remained fully responsive to exogenous 17,18-EEQ administration. Short term incubations of well-fed and starved wildtype nematodes showed that both racemic 17,18-EEQ and 17(R),18(S)-EEQ were able to increase pharyngeal pumping frequency and the uptake of fluorescence-labeled microspheres, while 17(S),18(R)-EEQ and also 17,18-dihydroxyeicosatetraenoic acid (17,18-DHEQ, the hydrolysis product of 17,18-EEQ) were ineffective. Taken together, these results show that serotonin induces 17,18-EEQ formation in C. elegans via the SER-7 receptor and that both the formation of this epoxyeicosanoid and its subsequent stimulatory effect on pharyngeal activity proceed with high stereospecificity confined to the (R,S)-enantiomer.
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Affiliation(s)
- Yiwen Zhou
- Humboldt-Universität zu Berlin, Institue of Biology, Ecology, Philippstr. 13, 10115 Berlin, Germany
| | - Michael Rothe
- Lipidomix GmbH, Robert-Rössle-Str. 10, 13125 Berlin, Germany
| | - Wolf-Hagen Schunck
- Max Delbrück Center for Molecular Medicine, Robert-Rössle-Str. 10, 13125 Berlin, Germany
| | - Liliane Ruess
- Humboldt-Universität zu Berlin, Institue of Biology, Ecology, Philippstr. 13, 10115 Berlin, Germany
| | - Ralph Menzel
- Humboldt-Universität zu Berlin, Institue of Biology, Ecology, Philippstr. 13, 10115 Berlin, Germany.
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Pan Z, Breininger K, Aubreville M, Stelzle F, Oetter N, Maier A, Mantsopoulos K, Iro H, Goncalves M, Sievert M. Defining a baseline identification of artifacts in confocal laser endomicroscopy in head and neck cancer imaging. Am J Otolaryngol 2023; 44:103779. [PMID: 36587604 DOI: 10.1016/j.amjoto.2022.103779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Zhaoya Pan
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Katharina Breininger
- Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Florian Stelzle
- Department of Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Nicolai Oetter
- Department of Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Andreas Maier
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-, Nürnberg, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-, Nürnberg, Germany
| | - Miguel Goncalves
- Department of Otorhinolaryngology, Plastic Head and Neck Surgery, Rheinische Westfälische Technische Hochschule Aachen, University Hospital, Aachen, Germany
| | - Matti Sievert
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-, Nürnberg, Germany.
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Al-Somairi MAA, Liu Y, Almashraq AA, Almaqrami BS, Alshoaibi LH, Alyafrusee ES, Al-Tayar B, An X, Alhammadi MS. Correlation between the three-dimensional maxillomandibular complex parameters and pharyngeal airway dimensions in different sagittal and vertical malocclusions. Dentomaxillofac Radiol 2023; 52:20220346. [PMID: 36695712 PMCID: PMC9944012 DOI: 10.1259/dmfr.20220346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES This study aimed to determine the three-dimensional (3D) correlation between maxillomandibular complex parameters and pharyngeal airway dimensions in different sagittal and vertical malocclusions. METHODS This retrospective cross-sectional study included the CBCT scans of 368 patients with a mean age of 23.81 ± 3.01 years. The patients were classified into three groups (skeletal Class I, II, and III). Each class group was divided into three subgroups based on vertical growth patterns (hypo-, normo-, and hyperdivergent). The maxillomandibular complex was evaluated in the three planes using 16 skeletal measurements. Naso-, oro-, hypo-, and total pharyngeal airway spaces were assessed in terms of width, volume, surface area, and minimum constricted area (MCA). Two-way ANOVA followed by the Bonferroni post-hoc test were used. RESULTS The nasopharyngeal airway space was significantly lowest regarding sagittal and lateral widths in the skeletal Class III patients, the lowest volume and surface area were in hyperdivergent patients, and MCA was the highest in Class II and hypodivergent patients. The oro- and hypopharyngeal sagittal width, volume, surface area, and MCA were the lowest in the hyperdivergent patients, and oropharyngeal lateral width and hypopharyngeal sagittal width were the highest in skeletal Class III. The total pharyngeal volume, surface area, and MCA were the lowest in the hyperdivergent patients, and skeletal Class II patients had the lowest MCA. CONCLUSIONS The pharyngeal airway dimensions differ with various sagittal and vertical malocclusions. These differences could apply to diagnosis, treatment planning, and possible changes following orthodontic/orthopedic or surgical treatment.
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Affiliation(s)
| | - Yi Liu
- Department of Orthodontics, School of Stomatology, China Medical University, Shenyang, China
| | - Abeer A. Almashraq
- Department of Pre-Clinical Oral Health Sciences, College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Lina H. Alshoaibi
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, China
| | | | - Barakat Al-Tayar
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, China
| | - Xiaoli An
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, China
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Poddubnaya LG, Warren MB, Bullard SA. FOREGUT ULTRASTRUCTURE OF ADULT SANGUINICOLA VOLGENSIS (RAŠÍN, 1929) MCINTOSH, 1934 (DIGENEA: APOROCOTYLIDAE). J Parasitol 2023; 109:27-34. [PMID: 36826441 DOI: 10.1645/22-79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Herein, we use scanning and transmission electron microscopy to describe the foregut (mouth, pharyngeal canal, and associated epithelia and musculature) of an adult freshwater fish blood fluke, Sanguinicola volgensis (Rašín, 1929) McIntosh, 1934, infecting the blood of sabre, Pelecus cultratus Linnaeus, 1758 (Cypriniformes: Leuciscidae) from the Volga River, Russia. Our results indicate that S. volgensis has a pharynx and lacks an oral sucker and that its pharyngeal canal acts as a peristaltic pump that sucks blood into the esophagus, whereupon digestion commences with granules secreted from the esophageal epithelium. We saw no evidence of longitudinal muscle fibers beneath the pharyngeal canal epithelium, pharyngeal glands, or pharyngeal epithelial cells or muscle cells within the pharyngeal muscular complex; collectively indicating the presence of a pharynx rather than an oral sucker. The specialized epithelial lining associated with the mouth and pharyngeal canal evidently is unique among neodermatans; it is smooth, ∼40 nm thick anteriorly, and thickens (∼250-700 nm) posteriorly as the mouth cavity transitions into the pharyngeal canal. The pharyngeal canal epithelium has lumps of dense material resembling those of the basal lamina and fibrous coat of the tegument. The actin-like material within the pharyngeal cavity epithelium could provide structural support to the pharynx.
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Affiliation(s)
- Larisa G Poddubnaya
- Papanin Institute for Biology of Inland Waters, Russian Academy of Sciences, Borok, Yaroslavl Province 152742, Russia
| | - Micah B Warren
- Aquatic Parasitology Laboratory and Southeastern Cooperative Fish Parasite and Disease Laboratory, Auburn University, 559 Devall Drive, Auburn, Alabama, 36832
| | - Stephen A Bullard
- Aquatic Parasitology Laboratory and Southeastern Cooperative Fish Parasite and Disease Laboratory, Auburn University, 559 Devall Drive, Auburn, Alabama, 36832.,Department of Zoology, School for Environmental Sciences and Development, North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
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Slater A, del Solar R, Raj J. Nasopharyngeal abscess causing inspiratory dyspnoea in a domestic cat. JFMS Open Rep 2023; 9:20551169231178448. [PMID: 37441537 PMCID: PMC10333994 DOI: 10.1177/20551169231178448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 07/15/2023] Open
Abstract
Case summary An 11-month-old female domestic shorthair cat presented with a 24 h history of inspiratory dyspnoea, abnormal upper respiratory tract sounds, gagging, retching and making exaggerated swallowing motions. Retroflexed nasopharyngoscopy revealed a large, right-sided nasopharyngeal mass that was seen to exude purulent material and a possible small foreign body when pressure was applied with forceps. Thorough expression of the mass alleviated clinical signs. Cytology revealed septic neutrophilic inflammation, and a Pasteurella species with no noted antimicrobial resistance was cultured. The cat was discharged with oral antibiotics and analgesia and made a full recovery, with no recurrence of clinical signs at the 6-month follow-up. Relevance and novel information Abscess formation in the nasopharyngeal region has not been previously reported in cats, to the authors' knowledge. The cause of the abscess was suspected to be a foreign body, but other aetiologies could not be fully excluded. This case demonstrates that nasopharyngeal abscesses are a rare but potentially significant differential diagnosis for upper respiratory tract obstruction in cats.
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Affiliation(s)
- Annie Slater
- Annie Slater MA, VetMB, MRCVS, Southfields
Veterinary Specialists (part of Linnaeus Veterinary), Cranes Point, Gardiners Ln S,
Basildon SS14 3AP, UK
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15
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Hassan EA, Mohamed SN, Hamouda EH, Ahmed NT. Clinical evaluation for the pharyngeal oxygen saturation measurements in shocked patients. BMC Nurs 2022; 21:290. [PMID: 36316710 PMCID: PMC9624017 DOI: 10.1186/s12912-022-01073-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Background Monitoring oxygen saturation in shocked patients is a challenging nursing procedure. Shock syndrome alters peripheral tissue perfusion and hinders peripheral capillary oxygen saturation (SpO2) measurements. Our study aimed to find a solution to this problem. The pharynx is expected to be an accurate SpO2 measurement site in shocked patients. We clinically evaluated the pharyngeal SpO2 measurements against the arterial oxygen saturation (SaO2) measurements. Methods A prospective cohort research design was used. This study included 168 adult shocked patients. They were admitted to five intensive care units from March to December 2020 in an Egyptian hospital. A wrap oximeter sensor was attached to the posterior surface of an oropharyngeal airway (OPA) by adhesive tape. The optical component of the sensor adhered to the pharyngeal surface after the OPA insertion. Simultaneous pharyngeal peripheral capillary oxygen saturation (SpO2) and arterial oxygen saturation (SaO2) measurements were recorded. The pharyngeal SpO2 was clinically evaluated. Also, variables associated with the SpO2 bias were evaluated for their association with the pharyngeal SpO2 bias. Results The pharyngeal SpO2 bias was − 0.44% with − 1.65 to 0.78% limits of agreement. The precision was 0.62, and the accuracy was 0.05. The sensitivity to detect mild and severe hypoxemia was 100%, while specificity to minimize false alarm of hypoxemia was 100% for mild hypoxemia and 99.4% for severe hypoxemia. None of the studied variables were significantly associated with the pharyngeal SpO2 bias. Conclusion The pharyngeal SpO2 has a clinically acceptable bias, which is less than 0.5% with high precision, which is less than 2%.
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Affiliation(s)
- Eman Arafa Hassan
- grid.7155.60000 0001 2260 6941Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Sherouk Nasser Mohamed
- grid.7155.60000 0001 2260 6941Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Emad Hamdy Hamouda
- grid.7155.60000 0001 2260 6941Critical Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Nadia Taha Ahmed
- grid.7155.60000 0001 2260 6941Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
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Madhan S, Holte MB, Diaconu A, Thorn JJ, Ingerslev J, Nascimento GG, Cornelis M, Pinholt EM, Cattaneo PM. Pharyngeal airway changes five years after bimaxillary surgery - A retrospective study. J Craniomaxillofac Surg 2022; 50:848-857. [PMID: 36473761 DOI: 10.1016/j.jcms.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/31/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to retrospectively evaluate pharyngeal airway (PA) changes after bimaxillary surgery (BMS). Preoperative, immediate- and 5-year postoperative cone-beam computed tomography images of subjects who underwent BMS were assessed. The primary outcome variable was the PA volume. The secondary outcome variables were the retropalatal and oropharyngeal volumes, cross-sectional area, minimal hydraulic diameter, soft tissue, skeletal movements and sleep-disordered breathing (SDB). A total of 50 patients were included, 33 female and 17 male, with a mean age of 26.5 years. A significant increase in the PA volume was seen immediately after surgery (40%), and this increase was still present at 5-year follow-up (34%) (P < 0.001). A linear mixed model regression analysis revealed that a mandibular advancement of ≥5 mm (P = 0.025) and every 1-mm upward movement of epiglottis (P = 0.016) was associated with a volume increase of the oropharyngeal compartment. Moreover, ≥5-mm upward movement of hyoid bone (P = 0.034) and every 1-mm increase in minimal hydraulic diameter (P < 0.001) correlated with an increase of the PA volume. A total of 30 subjects reported improvement in the SDB at 5-year follow-up. This study demonstrated that BMS led to an increase in PA dimensions in non-OSA patients, and these changes were still present at 5-year follow-up. BMS seemed to induce clinical improvement in SDB.
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Affiliation(s)
- Sivaranjani Madhan
- Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark; Section of Orthodontics, Section of Orofacial Pain and Joint Function, Department of Dentistry and Oral Health, Faculty of Health, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus, Denmark.
| | - Michael Boelstoft Holte
- Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark.
| | - Alexandru Diaconu
- Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark.
| | - Jens Jørgen Thorn
- Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark.
| | - Janne Ingerslev
- Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark.
| | - Gustavo G Nascimento
- Section for Periodontology, Department of Dentistry and Oral Health, Faculty of Health, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus, Denmark.
| | - Marie Cornelis
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 720 Swanston St, Carlton, 3053, Victoria, Australia.
| | - Else Marie Pinholt
- Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark.
| | - Paolo M Cattaneo
- Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Finsensgade 35, 6700, Esbjerg, Denmark; Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 720 Swanston St, Carlton, 3053, Victoria, Australia.
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Wright O, Zhang TT, Gyimah DA, Davies-Husband C. MRI has a limited role in investigating odynophagia if examination is normal: a binary logistic regression analysis of 484 patients presenting to a tertiary head and neck clinic. Clin Otolaryngol 2022; 47:650-655. [PMID: 35899971 DOI: 10.1111/coa.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 04/06/2022] [Accepted: 05/14/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Investigation of head and neck cancers places a significant burden on the National Health Service and effective resource allocation is of perpetual importance. Existing risk calculators are designed to stratify the likelihood of underlying malignancy according to symptoms, but are less relevant in secondary care as they do not integrate clinical examination findings (e.g. naso-endoscopy). We looked to evaluate the utility of magnetic resonance imaging (MRI) in investigating patients with unilateral odynophagia and a normal clinical examination. METHODS A retrospective analysis was conducted over a 54-month period; 484 consecutively-recruited adult patients who underwent MRI of the neck for suspected malignancy were included. Imaging reports, case notes, and histopathology results were reviewed. Patients with previously diagnosed/treated malignancy, undergoing surveillance, or those with pathology of the salivary glands, oral cavity or thyroid gland, were excluded. A multivariate binary logistical regression model was performed to calculate the odds ratios and probabilities of malignancy for each presenting symptom, with and without negative nasoendoscopy findings. RESULTS The overall incidence of malignancy within the cohort was 173/484 patients (35.7%; 95% CI 31.5 - 40.2%) with no cases of malignancy in patients presenting with odynophagia and a normal nasoendoscopy (0/39). The presence of a neck lump was significantly associated with malignancy, (OR 2.03 p = 0.001; 95% CI 1.59 - 2.58), as was dysphagia (OR 1.52 p = 0.009; 95%CI 1.11 - 2.11). Conversely, globus was found to have an inverse association (OR 0.41 p < 0.001; 95% CI 0.24 - 0.70). SUMMARY New patients presenting with odynophagia alone and normal endoscopy or globus have a low likelihood of underlying malignancy, justifying reassurance and follow-up in the event of persistent symptoms. Contrariwise, patients with a neck lump, dysphagia, odynophagia and multiple concurrent aerodigestive tract symptoms, or an abnormal endoscopy have a high likelihood of underlying malignancy and should be investigated accordingly.
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Affiliation(s)
- Oliver Wright
- 1 Brick kiln court, St Gabriel's Road, Easton.,ENT Registrar, Musgrove Park Hospital, Taunton
| | - Ting Ting Zhang
- Consultant Radiologist, University Hospitals Sussex NHS Trust
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Ogasawara N, Kikuchi D, Tanaka M, Ochiai Y, Okamura T, Hayasaka J, Suzuki Y, Mitsunaga Y, Nomura K, Odagiri H, Yamashita S, Matsui A, Hoteya S. Comprehensive risk evaluation for metachronous carcinogenesis after endoscopic submucosal dissection of superficial pharyngeal squamous cell carcinoma. Esophagus 2022; 19:460-468. [PMID: 35099639 DOI: 10.1007/s10388-022-00907-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/23/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pharyngeal squamous cell carcinoma (PSCC) is associated with a high likelihood of metachronous carcinogenesis, which is known to have a poor prognosis. This study aimed to identify comprehensive risk evaluation indicators for metachronous carcinogenesis after endoscopic submucosal dissection (ESD) of superficial PSCC. METHODS The risk of metachronous carcinogenesis was evaluated in 144 patients with superficial PSCC (with no history of PSCC or esophageal squamous cell carcinoma) who underwent initial ESD from 2008 to 2020. Multiple lugol-voiding lesions (LVLs) in the background pharyngeal and esophageal epithelium were evaluated as endoscopic indicators. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score was analyzed as a serum marker. RESULTS The median follow-up period was 4.3 years. The coincidence rate for pharyngeal and esophageal LVL grade was 55%. The cumulative 3-year metachronous PSCC rate was 18.9%. The cumulative 3-year second metachronous PSCC rate was 43.9%. Forward stepwise multivariate Cox proportional hazards regression analysis identified pharyngeal LVL grade and a lower HALP score as significant independent predictors. Pharyngeal LVL grade was superior to esophageal LVL grade as a predictor of metachronous PSCC. A lower HALP score was significantly associated with younger age in forward stepwise multivariate logistic regression analysis. CONCLUSIONS Patients with a history of superficial PSCC remain at risk for metachronous carcinogenesis over time, and long-term follow-up is imperative. Comprehensive evaluation of endoscopic features with a novel serum marker, namely, the HALP score, can help predict metachronous carcinogenesis.
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Affiliation(s)
- Nobuhiko Ogasawara
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Daisuke Kikuchi
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan.
| | - Masami Tanaka
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Yorinari Ochiai
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Takayuki Okamura
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Junnosuke Hayasaka
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Yugo Suzuki
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Yutaka Mitsunaga
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Kosuke Nomura
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Hiroyuki Odagiri
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Satoshi Yamashita
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Akira Matsui
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
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Ahn D, Kwak JH, Lee GJ, Sohn JH. Ultrasonography for masses of the pharynx and larynx and assessment of laryngeal squamous cell carcinoma. Auris Nasus Larynx 2022; 49:868-874. [PMID: 35354545 DOI: 10.1016/j.anl.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/01/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the ultrasonography (US) characteristics of pharyngeal/laryngeal masses and the role of US in the assessment of laryngeal squamous cell carcinoma (LSCC). METHODS This study enrolled patients who underwent US for evaluation of pharyngeal/laryngeal masses between 2018 and 2021. Characteristics of pharyngeal/laryngeal masses and subsite invasion in cases of LSCC were evaluated using US. RESULTS Forty-six patients with pharyngeal (n = 22) /laryngeal (n = 24) masses were enrolled. The pathological results were benign and malignant in 7 (15.2%) and 39 (84.8%) patients, respectively. Malignant masses were significantly associated with US characteristics of heterogeneity (P = 0.002), irregular/speculated margin (P < 0.001), and increased internal vascularity (P = 0.014) compared with benign masses. In patients with LSCC, the detection rate of US for subsites invasion, including that of the anterior commissure, paraglottic space, outer cortex of the thyroid cartilage, cricoid cartilage, and extralaryngeal soft tissue, was similar to that of computed tomography (CT). Although the difference was not statistically significant, US more frequently demonstrated invasion of the inner cortex of the thyroid cartilage than CT (40.9% vs. 22.7%; P = 0.195). US and CT had a concordance rate of 81% (18 of 22 patients) in determining the tumour stage of the lesions. CONCLUSION US could facilitate differentiation between benign and malignant masses of the pharynx and larynx in selective patients and has a possible role in the assessment of LSCC.
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Affiliation(s)
- Dongbin Ahn
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Ji Hye Kwak
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Gil Joon Lee
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Ho Sohn
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Diaconu A, Holte MB, Cattaneo PM, Pinholt EM. A semi-automatic approach for longitudinal 3D upper airway analysis using voxel-based registration. Dentomaxillofac Radiol 2022; 51:20210253. [PMID: 34644181 PMCID: PMC8925868 DOI: 10.1259/dmfr.20210253] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To propose and validate a reliable semi-automatic approach for three-dimensional (3D) analysis of the upper airway (UA) based on voxel-based registration (VBR). METHODS Post-operative cone beam computed tomography (CBCT) scans of 10 orthognathic surgery patients were superimposed to the pre-operative CBCT scans by VBR using the anterior cranial base as reference. Anatomic landmarks were used to automatically cut the UA and calculate volumes and cross-sectional areas (CSA). The 3D analysis was performed by two observers twice, at an interval of two weeks. Intraclass correlations and Bland-Altman plots were used to quantify the measurement error and reliability of the method. The relative Dahlberg error was calculated and compared with a similar method based on landmark re-identification and manual measurements. RESULTS Intraclass correlation coefficient (ICC) showed excellent intra- and inter-observer reliability (ICC ≥ 0.995). Bland-Altman plots showed good observer agreement, low bias and no systematic errors. The relative Dahlberg error ranged between 0.51 and 4.30% for volume and 0.24 and 2.90% for CSA. This was lower when compared with a similar, manual method. Voxel-based registration introduced 0.05-1.44% method error. CONCLUSIONS The proposed method was shown to have excellent reliability and high observer agreement. The method is feasible for longitudinal clinical trials on large cohorts due to being semi-automatic.
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Affiliation(s)
- Alexandru Diaconu
- 3D Lab Denmark, Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Esbjerg, Denmark
| | | | - Paolo Maria Cattaneo
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
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Sievert M, Aubreville M, Gostian AO, Mantsopoulos K, Koch M, Mueller SK, Eckstein M, Rupp R, Stelzle F, Oetter N, Maier A, Iro H, Goncalves M. Validity of tissue homogeneity in confocal laser endomicroscopy on the diagnosis of laryngeal and hypopharyngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 2022; 279:4147-4156. [PMID: 35226181 PMCID: PMC9249707 DOI: 10.1007/s00405-022-07304-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/07/2022] [Indexed: 12/29/2022]
Abstract
Purpose Confocal laser endomicroscopy (CLE) allows imaging of the laryngeal mucosa in a thousand-fold magnification. This study analyzes differences in tissue homogeneity between healthy mucosa and squamous cell carcinoma (SCC) via CLE. Materials and methods We included five SCC patients with planned total laryngectomy in this study between October 2020 and February 2021. We captured CLE scans of the tumor and healthy mucosa. Analysis of image homogeneity to diagnose SCC was performed by measuring the signal intensity in four regions of interest (ROI) in each frame in a total of 60 sequences. Each sequence was assigned to the corresponding histological pattern, derived from hematoxylin and eosin staining. In addition, we recorded the subjective evaluation of seven investigators regarding tissue homogeneity. Results Out of 3600 images, 1620 (45%) correlated with benign mucosa and 1980 (55%) with SCC. ROIs of benign mucosa and SCC had a mean and standard deviation (SD) of signal intensity of, respectively, 232.1 ± 3.34 and 467.3 ± 9.72 (P < 0.001). The mean SD between the four different ROIs was 39.1 ± 1.03 for benign and 101.5 ± 2.6 for SCC frames (P < 0.001). In addition, homogeneity yielded a sensitivity and specificity of 81.8% and 86.2%, respectively, regarding the investigator-dependent analysis. Conclusions SCC shows a significant tissue inhomogeneity in comparison to the healthy epithelium. The results support this feature’s importance in identifying malignant mucosa areas during CLE examination. However, the examiner-dependent evaluation emphasizes that homogeneity is a sub-criterion that must be considered in a broad context.
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Affiliation(s)
- Matti Sievert
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Waldstrasse 1, 91054, Erlangen, Germany.
| | | | - Antoniu-Oreste Gostian
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Waldstrasse 1, 91054, Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Waldstrasse 1, 91054, Erlangen, Germany
| | - Michael Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Waldstrasse 1, 91054, Erlangen, Germany
| | - Sarina Katrin Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Waldstrasse 1, 91054, Erlangen, Germany
| | - Markus Eckstein
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Robin Rupp
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Waldstrasse 1, 91054, Erlangen, Germany
| | - Florian Stelzle
- Department of Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Nicolai Oetter
- Department of Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Andreas Maier
- Pattern Recognition Laboratory, Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital, Waldstrasse 1, 91054, Erlangen, Germany
| | - Miguel Goncalves
- Department of Otorhinolaryngology, Plastic Head and Neck Surgery, Rheinische Westfälische Technische Hochschule Aachen, University Hospital, Aachen, Germany
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Trojanowski NF, Fang-Yen C. Optogenetic Perturbation of Individual C. elegans Pharyngeal Neurons While Monitoring Feeding Behavior. Methods Mol Biol 2022; 2468:117-131. [PMID: 35320563 DOI: 10.1007/978-1-0716-2181-3_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Optogenetic approaches have proven to be powerful for examining the roles of specific neurons in generating behaviors, especially in systems where electrophysiological manipulation is not possible. Here we describe a method for optogenetically manipulating single pharyngeal neurons in intact C. elegans while monitoring pharyngeal behavior. This approach provides bidirectional and dynamic control of pharyngeal neural activity while quantitatively assessing behavior and has allowed us to test hypotheses about the roles of individual pharyngeal neurons in feeding behavior.
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Affiliation(s)
- Nicholas F Trojanowski
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biology, Brandeis University, Waltham, MA, USA
| | - Christopher Fang-Yen
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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23
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Png LH, Toh ST, Teo NWY. Transoral endoscopic approach to upper cervical spine migrated foreign bodies. J Laryngol Otol 2021;:1-3. [PMID: 34823613 DOI: 10.1017/S0022215121003765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Migrated ingested foreign bodies in the aerodigestive tract can lodge within vital organs and vessels, causing potentially devastating complications. It is often difficult to localise these foreign bodies, with extrication resulting in the requirement for open approaches which may cause significant morbidity. CASE REPORT This paper presents the case of an ingested migrated stingray bone lodged adjacent to the vertebral artery in the upper cervical spine. This was managed via an endoscopic transoral approach, with the assistance of an image-guidance system. RESULTS Successful extraction of the foreign body was achieved, with minimal residual morbidity. CONCLUSION Our study showed that image-guided endoscopic surgery is a safe, precise and feasible option for the localisation and removal of migrated foreign bodies in the aerodigestive tract involving critical neurovascular structures.
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Kiaee B, Nucci L, Sarkarat F, Talaeipour AR, Eslami S, Amiri F, Jamilian A. Three-dimensional assessment of airway volumes in patients with unilateral cleft lip and palate. Prog Orthod 2021; 22:35. [PMID: 34746995 PMCID: PMC8572890 DOI: 10.1186/s40510-021-00382-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022] Open
Abstract
Background Considering the adverse consequences of respiratory insufficiency in cleft lip and palate (CLP) patients, this study aimed to assess the pharyngeal airway dimensions in 9–12-year-old patients with unilateral CLP. This historical cohort evaluated the cone-beam computed tomography (CBCT) scans of 30 patients with non-syndromic unilateral CLP between 9 and 12 years and 30 age- and sex-matched non-cleft controls. Three-dimensional (3D) images were reconstructed by the Mimics software, and the nasopharyngeal, oropharyngeal, and total airway volumes, as well as the minimal cross-sectional area of the airway (minAx), and posterior airway length (PAL) were all measured in the sagittal plane. Data were analyzed by the Student’s t test. Results The oropharyngeal and the total airway volumes, as well as the minAx and PAL in CLP patients, were significantly smaller than the corresponding values in the control group (P < 0.05). Despite smaller nasopharyngeal airway volume in CLP patients than controls, this difference was not statistically significant (P > 0.05). Conclusions Nine- to twelve-year-old non-syndromic unilateral CLP patients have smaller pharyngeal airway dimensions than non-cleft controls, and are therefore at higher risk of respiratory insufficiency.
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Affiliation(s)
- Bita Kiaee
- Department of Orthodontic, Tehran University of Medical Sciences, Tehran, Iran
| | - Ludovica Nucci
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Farzin Sarkarat
- Department of Oral and Maxillofacial Surgery, Dental School, Cranio Maxillofacial Research Center, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Ahmad Reza Talaeipour
- Department of Oral and Maxillofacial Radiology, Dental School, Cranio Maxillofacial Research Center, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Sara Eslami
- Orthodontist at Private Orthodontic Office, Tiergartenstraße 130, Hannover, Germany
| | - Faezeh Amiri
- DDS, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Jamilian
- Department of Orthodontics, Dental School, Cranio Maxillofacial Research Center, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
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Süslü AE, Katar O, Külekçi Ç. Supine or non-supine apnea; which can be treated better with expansion sphincter pharyngoplasty? Auris Nasus Larynx 2021; 49:431-436. [PMID: 34753636 DOI: 10.1016/j.anl.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/26/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Expansion sphincter pharyngoplasty is a well-known palatal correction surgery applied for obstructive sleep apnea patients. Even though high success rates are reported, in some patients, the desired outcome cannot be achieved. Therefore, patient selection is crucial to avoid undesirable outcomes. In this study we present our results with expansion sphincter pharyngoplasty, and we aim to show the difference between supine and non-supine apnea in terms of their response to the surgery, in order to utilize position dependency for selection of surgical candidates. METHODS Pre- and post-operative polysomnography results of patients who underwent expansion sphincter pharyngoplasty were analyzed retrospectively. Total AHI, supine AHI, non-supine AHI, supine/non-supine AHI ratio and surgical success values are compared. RESULTS 85 patients were included to the study. Mean AHI significantly decreased from 48.7 ± 27.99 to 26.37 ± 21.16 with the surgery. Surgical success rate was found to be 51.8%. Both supine and non-supine apnea decreased significantly with the surgery, but the decrease was significantly higher in non-supine apnea (20.6% to 39.1% respectively, p = 0.016). There was significant negative correlation between pre-operative supine to non-supine AHI ratio and the change in AHI, showing that supine dominant patients had less improvement with the surgery (r = 0.274, p = 0.01). CONCLUSION Expansion sphincter pharyngoplasty is an effective surgery which achieves significant improvement in AHI. Non-supine respiratory events respond better to the surgery than supine events.
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Affiliation(s)
- Ahmet Emre Süslü
- Hacettepe University Faculty of Medicine, Department of Otolaryngology, Turkey.
| | - Oğuzhan Katar
- Hacettepe University Faculty of Medicine, Department of Otolaryngology, Turkey.
| | - Çağrı Külekçi
- Hacettepe University Faculty of Medicine, Department of Otolaryngology, Turkey.
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Agarwal P, Dhiman A, Rashid N, Kataria R. Head and neck injuries after leopard attack: Presentation and management. Chin J Traumatol 2021; 24:389-393. [PMID: 33678537 PMCID: PMC8606610 DOI: 10.1016/j.cjtee.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/10/2020] [Accepted: 11/11/2020] [Indexed: 02/04/2023] Open
Abstract
Leopard attacks on humans are reported most often from the Indian subcontinent. The bite wounds are complex injuries infected with polymicrobial inoculum and may present as punctures, abrasions, lacerations or avulsions. The presentation and acceptable treatment of these injuries vary according to the wound. We hereby describe the clinical presentation and treatment of a male victim with leopard bite injuries on the head and neck region. As bite injuries are commonly found on and around the face, maxillofacial surgeons should be familiar with the therapy. Through thorough clinical and radiological examination, it is essential to prevent missing any hidden injuries, which can easily turn lethal. To benefit the rural population, more health facilities need to be established in remote areas.
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Affiliation(s)
- Padmanidhi Agarwal
- Department of Dentistry and Craniomaxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, India,Corresponding author.
| | - Ajay Dhiman
- Department of Trauma Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Nouman Rashid
- Department of Dentistry and Craniomaxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Ruby Kataria
- Department of Trauma Surgery, All India Institute of Medical Sciences, Rishikesh, India
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Ababneh EI, Shah AA. Oro- and Nasopharyngeal Papillomas with Squamous and Respiratory Features: A Case Series of Schneiderian-Like Papillomas of the Pharynx. Head Neck Pathol 2022; 16:486-93. [PMID: 34694538 DOI: 10.1007/s12105-021-01389-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022]
Abstract
There is limited literature detailing the histology of pharyngeal papillomas. Herein, we report our experience with papillomas occurring in the oro-and nasopharynx that have both squamous and respiratory features akin to the sinonasal Schneiderian papilloma. We retrospectively reviewed pharyngeal papillomas that were composed of both squamous and respiratory epithelium received at our institution between 2010 and 2020. Cases of sinonasal papillomas directly extending into the pharynx were excluded. Immunohistochemistry for p16 as well as RNA in situ hybridization to evaluate for 6 low-risk and 18 high-risk HPV genotypes were performed on all cases. Thirteen cases were included. Mean age was 61 with 12 males and 1 female. While often incidentally found, presenting symptoms included globus sensation, hemoptysis, and hoarseness of voice. Histologically, all tumors consisted of squamous and respiratory epithelium with neutrophilic infiltrates arranged in an exophytic/papillary architecture that was reminiscent of the exophytic type of Schneiderian papilloma. Immunohistochemistry for p16 was negative in all papillomas. 85% were positive for low-risk human papillomavirus (HPV) subtypes and all were negative for high-risk HPV subtypes. A well-differentiated, invasive squamous cell carcinoma was associated with two of the cases. Papillomas with squamous and respiratory features similar to the sinonasal exophytic Schneiderian papilloma can arise in the oro- and nasopharynx and like their sinonasal counterparts show an association with HPV. While many in this series were benign, they can be harbingers for invasive squamous cell carcinoma.
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Verdonck J, Van de Perck E, Claes J, Vanderveken OM. Uvulopalatopharyngoplasty for nasal blockage 21 years after total rhinectomy. J Laryngol Otol 2021; 135:937-9. [PMID: 34446116 DOI: 10.1017/S0022215121001948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Total rhinectomy is an invasive procedure that significantly impairs the intranasal turbulence, humidification and heating of inspired air. The use of uvulopalatopharyngoplasty for the treatment of sleep-disordered breathing disorders such as primary snoring and obstructive sleep apnoea has diminished over the past years because of the emergence of less invasive procedures and alternative therapeutic options. This clinical record presents the treatment of a long-term side effect of total rhinectomy using uvulopalatopharyngoplasty. CASE REPORT In 1997, a 62-year-old male underwent total rhinectomy for a nasal schwannoma, followed by rehabilitation with a nasal prosthesis. Twenty-one years later, he presented with severe complaints of nasal blockage and breathing difficulties during both daytime and night-time. Clinical examination revealed no major anomalies besides significant velopharyngeal narrowing. Thus, in 2019, uvulopalatopharyngoplasty was performed to re-establish velopharyngeal patency. Hereafter, the symptoms of nasal blockage disappeared, resulting in an improved quality of life. CONCLUSION Uvulopalatopharyngoplasty may prove useful to treat selected patients with daytime breathing difficulties due to velopharyngeal narrowing.
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Cohen O, John MM, Kaufman AE, Kundel V, Burschtin O, Khan S, Fayad Z, Mani V, Shah NA. Novel non-invasive assessment of upper airway inflammation in obstructive sleep apnea using positron emission tomography/magnetic resonance imaging. Sleep Breath 2021; 26:1087-1096. [PMID: 34448065 DOI: 10.1007/s11325-021-02480-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/10/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To develop a novel non-invasive technique to quantify upper airway inflammation using positron emission tomography/magnetic resonance imaging (PET/MRI) in patients with obstructive sleep apnea (OSA). METHODS Patients with treatment naïve moderate-to-severe OSA underwent [18F]-fluoro-2-deoxy-D-glucose (FDG) PET/MRI. Three readers independently performed tracings of the pharyngeal soft tissue on MRI. Standardized uptake values (SUV) were generated from region of interest (ROI) tracings on corresponding PET images. Background SUV was measured from the sternocleidomastoid muscle. SUV and target-to-background (TBR) were compared across readers using intraclass correlation coefficient (ICC) analyses. SUV from individual image slices were compared between each reader using Bland-Altman plots and Pearson correlation coefficients. All tracings were repeated by one reader for assessment of intra-reader reliability. RESULTS Five participants completed our imaging protocol and analysis. Median age, body mass index, and apnea-hypopnea index were 41 years (IQR 40.5-68.5), 32.7 kg/m2 (IQR 28.1-38.1), and 30.7 event per hour (IQR 19.5-48.1), respectively. The highest metabolic activity regions were consistently localized to palatine or lingual tonsil adjacent mucosa. Twenty-five ICC met criteria for excellent agreement. The remaining three were TBR measurements which met criteria for good agreement. Head-to-head comparisons revealed strong correlation between each reader. CONCLUSIONS Our novel imaging technique demonstrated reliable quantification of upper airway FDG avidity. This technology has implications for future work exploring local airway inflammation in individuals with OSA and exposure to pollutants. It may also serve as an assessment tool for response to OSA therapies.
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Affiliation(s)
- Oren Cohen
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Mira M John
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Audrey E Kaufman
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vaishnavi Kundel
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Omar Burschtin
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samira Khan
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zahi Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Venkatesh Mani
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Neomi A Shah
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Miranda-Viana M, Freitas DQ, Machado AH, Gomes AF, Nejaim Y. Do the dimensions of the hard palate have a relationship with the volumes of the upper airways and maxillary sinuses? A CBCT study. BMC Oral Health 2021; 21:356. [PMID: 34284755 PMCID: PMC8290584 DOI: 10.1186/s12903-021-01724-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022] Open
Abstract
Background As the hard palate is a central structure of the skull, and its close relationship with the nasal cavity, oral cavity, and maxillary sinuses, it would be of interest to study if there is a relationship between this bone and other structures of the stomatognathic system. Thus, this study aimed to assess the dimensions of the hard palate and associate them with sex, and skeletal and breathing patterns. Also, to investigate if there is a relationship between these dimensions and the volumes of the upper airways and maxillary sinuses.
Methods Two hundred and ninety-eight CBCT scans of patients were classified according to sex, and skeletal and breathing patterns. Then, the linear dimensions of width and height of the hard palate at the regions of the first premolars and first molars, and the volumes of the upper airways and maxillary sinuses were measured using the CS 3D Imaging and ITK-SNAP software, respectively. Data were submitted to multi-way analysis of variance and linear regression, with a significance level of 5% (α = 0.05). Results Sex and facial type influenced the hard palate dimensions (p < 0.05). Males had greater width and height of the hard palate than females (p < 0.0001). It was observed greater width for brachycephalics at the first premolars region (p = 0.0032), and greater height for dolichocephalics at the first premolars (p = 0.0154) and first molars (p = 0.0038) regions. Skeletal malocclusion and breathing pattern did not influence the measurements of the hard palate (p > 0.05). There was a significant relationship between the width and height of the hard palate at the premolar’s region and the total volume of the upper airways (p = 0.018, and p = 0.038), and between both dimensions of the hard palate at the molar’s region and the total volume of the maxillary sinuses (p < 0.0001). Conclusions The hard palate dimensions are influenced by sex and facial type, but not by skeletal malocclusion or breathing pattern. Also, there is an association between these dimensions and the volumes of the upper airways and maxillary sinuses.
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Affiliation(s)
- Murilo Miranda-Viana
- Department of Oral Diagnosis - Oral Radiology Area, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil.
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis - Oral Radiology Area, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | - Alessiana Helena Machado
- Department of Oral Diagnosis - Oral Radiology Area, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | - Amanda Farias Gomes
- Department of Oral Diagnosis - Oral Radiology Area, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | - Yuri Nejaim
- Oral Radiology Area, Dental School, Federal University of Mato Grosso Do Sul, Campo Grande, MS, Brazil
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Satheeshkumar PS, El-Dallal M, Raita Y, Mohan MP, Boakye EA. Association between palliative care referral and burden of illness among cancers of the lip, oral cavity and pharynx. Support Care Cancer 2021; 29:7737-7745. [PMID: 34159429 DOI: 10.1007/s00520-021-06370-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the burden of illness--length of stay (LOS), total charges, and discharge disposition--among cancers of the lip, oral cavity and pharynx (CLOP) patients with and without palliative care (PC) referral. METHODS This cross-sectional study utilized the 2017 National inpatient sample database to identify hospitalizations with a primary diagnosis of CLOP. Generalized linear models were used to assess the association between PC referral status and the outcomes-LOS, total charges, and discharge disposition while controlling for patients' characteristics. RESULTS There were 4165 PC referral among 52, 524 CLOP patients. The geometric mean of LOS for non-PC referral patients was 3.7 days, and for PC referral was 5.02 days, P < 0.001. In the adjusted analysis, CLOP patients with PC referral were more likely to have a higher LOS (Coefficient: 1.16; 95% CI, 1.01-1.25) compared to those without PC referral. The geometric mean of total charge among non-PC referral group was 48,308 USD, and CLOP-PC referral was 48,983 USD, P = 0.72. After adjusting for covariates, there was still no significant difference between the PC and non-PC referral groups. Discharge disposition were considerably different across the non-PC vs. PC referral groups. Compared to non-PC referral patients, PC referral patients were more likely to be discharge to skilled nursing facility, intermediate care, and another type of facility (aOR = 7.10; CIs, 5.51-9.12), or home health care (aOR = 4.13; CIs, 3.31-5.15). CONCLUSION During primary hospitalization, total charges was not different between patient non-PC and PC referral groups; however, the LOS and discharge dispositions were significantly different.
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Affiliation(s)
- Poolakkad S Satheeshkumar
- Harvard Medical School, Boston, MA, USA. .,Now with the Department of Oral Oncology, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, USA.
| | - Mohammed El-Dallal
- Division of Hospital Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA.,Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Y Raita
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Minu P Mohan
- Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - E Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA
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Kudva A, Dhara V, Patil BR, Sankaran M. Caution with carotids: A necessary cognizance. Oral Oncol 2021;:105392. [PMID: 34167899 DOI: 10.1016/j.oraloncology.2021.105392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/09/2021] [Indexed: 11/21/2022]
Abstract
Most aberrations in the cervical course of the internal carotid artery are generally encountered as incidental findings due to their asymptomatic nature. However these morphological variations if not identified intra operatively or pre operatively may lead to vascular accidents. It is essential to be aware of the existence of tortuosity, kinking, and coiling of these great vessels while considering patients for surgeries of head and neck cancer, pharyngeal resections, traumatic injury repair, etc. Our paper presents a case series of four patients in whom carotid dolichoarteriopathies were observed during the course of neck dissection. It aims to highlight the precautions required to avoid morbidity in such patients.
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Haywood M, Lovell L, Roe J, Clunie G, Sandhu G, Al Yaghchi C. Perioperative instrumental swallowing evaluation in adult airway reconstruction: A retrospective observational cohort study. Clin Otolaryngol 2021; 46:1229-1236. [PMID: 34087029 DOI: 10.1111/coa.13820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/13/2021] [Accepted: 05/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Airway reconstruction for laryngotracheal stenosis (LTS) encompasses several procedures. Dysphagia is a well-recognised sequela of LTS and airway surgery, however studies have employed mostly non-validated assessments post-operatively in small, heterogenous samples, perpetuating uncertainty around the contributions of LTS and its management to impaired deglutition. Consequently, considerable variation in LTS perioperative nutritional management exists. Our objective was to characterise baseline and post-operative dysphagia with instrumental assessment in an LTS cohort undergoing airway reconstruction and provide a gold-standard management framework for its management. DESIGN, SETTING, PARTICIPANTS AND MAIN OUTCOME MEASURES We performed a retrospective cohort study of adult airway reconstruction procedures from 2016-2020 at our quaternary centre. Patient background, LTS aetiology, procedure type, tube feeding duration, length of stay and serial Functional Oral Intake Scale (FOIS) and International Dysphagia Diet Standardisation Initiative (IDDSI) scores were noted. Baseline, post-operative day one and post-stent removal Fibreoptic Endoscopic Evaluation of Swallow (FEES) generated Penetration Aspiration Scale (PAS) scores. RESULTS Forty-four patients underwent forty-six reconstructions. Baseline incidence of penetration-aspiration was considerably higher than the general population and worsened in the immediate post-operative period, however FOIS and PAS scores generally returned to baseline by discharge. Post-operative FOIS correlated negatively with tracheostomy or airway stent placement. At discharge, 80% tolerated soft or normal diet and 93% were feeding tube independent. CONCLUSIONS We present the largest adult airway reconstruction cohort with instrumental swallow assessment perioperatively. LTS patients have a higher incidence of underlying dysphagia but swallowing tends to return to baseline with appropriate postoperative rehabilitation. Such practice may avoid the complications, costs and morbidity of prolonged nutritional support.
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Affiliation(s)
- Matthew Haywood
- National Centre for Airway Reconstruction, Charing Cross Hospital, London, UK
| | - Lindsay Lovell
- National Centre for Airway Reconstruction, Charing Cross Hospital, London, UK
| | - Justin Roe
- National Centre for Airway Reconstruction, Charing Cross Hospital, London, UK
| | - Gemma Clunie
- National Centre for Airway Reconstruction, Charing Cross Hospital, London, UK
| | - Guri Sandhu
- National Centre for Airway Reconstruction, Charing Cross Hospital, London, UK
| | - Chadwan Al Yaghchi
- National Centre for Airway Reconstruction, Charing Cross Hospital, London, UK
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Shujaat S, Jazil O, Willems H, Van Gerven A, Shaheen E, Politis C, Jacobs R. Automatic segmentation of the pharyngeal airway space with convolutional neural network. J Dent 2021; 111:103705. [PMID: 34077802 DOI: 10.1016/j.jdent.2021.103705] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/30/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study proposed and investigated the performance of a deep learning based three-dimensional (3D) convolutional neural network (CNN) model for automatic segmentation of the pharyngeal airway space (PAS). METHODS A dataset of 103 computed tomography (CT) and cone-beam CT (CBCT) scans was acquired from an orthognathic surgery patients database. The acquisition devices consisted of 1 CT (128-slice multi-slice spiral CT, Siemens Somatom Definition Flash, Siemens AG, Erlangen, Germany) and 2 CBCT devices (Promax 3D Max, Planmeca, Helsinki, Finland and Newtom VGi evo, Cefla, Imola, Italy) with different scanning parameters. A 3D CNN-based model (3D U-Net) was built for automatic segmentation of the PAS. The complete CT/CBCT dataset was split into three sets, training set (n = 48) for training the model based on the ground-truth observer-based manual segmentation, test set (n = 25) for getting the final performance of the model and validation set (n = 30) for evaluating the model's performance versus observer-based segmentation. RESULTS The CNN model was able to identify the segmented region with optimal precision (0.97±0.01) and recall (0.96±0.03). The maximal difference between the automatic segmentation and ground truth based on 95% hausdorff distance score was 0.98±0.74mm. The dice score of 0.97±0.02 confirmed the high similarity of the segmented region to the ground truth. The Intersection over union (IoU) metric was also found to be high (0.93±0.03). Based on the acquisition devices, Newtom VGi evo CBCT showed improved performance compared to the Promax 3D Max and CT device. CONCLUSION The proposed 3D U-Net model offered an accurate and time-efficient method for the segmentation of PAS from CT/CBCT images. CLINICAL SIGNIFICANCE The proposed method can allow clinicians to accurately and efficiently diagnose, plan treatment and follow-up patients with dento-skeletal deformities and obstructive sleep apnea which might influence the upper airway space, thereby further improving patient care.
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Affiliation(s)
- Sohaib Shujaat
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven, Belgium.
| | - Omid Jazil
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven, Belgium
| | | | | | - Eman Shaheen
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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OuYang Z, Lou Z, Lou Z, Jin K, Sun J, Chen Z. Microwave ablation for the removal of pharyngeal benign lesions: A prospective pilot case series. Am J Otolaryngol 2021; 42:102916. [PMID: 33485048 DOI: 10.1016/j.amjoto.2021.102916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We evaluated microwave ablation (MWA) for treatment of isolated pharyngeal benign lesions, in terms of technical feasibility, efficacy, and safety. METHODS The patients with pharyngeal benign lesions were treated with endoscopic MWA with a 2450-MHz single cooled-shaft microwave antenna and sent for histological examination. Postoperative pain intensity was measured via visual analogue scale (VAS) on the 12th hour and the third postoperative days. RESULTS Of the 137 patients with pharyngeal benign lesions who met the inclusion criteria. The most commonly involved site was the uvula (n = 66, 48.2%), followed by the lateral pharyngeal wall (n = 37, 27.0%), the nasopharyngeal posterior wall (n = 23, 16.8%) and the soft palate (n = 11, 8.0%). All of the procedures were completed using local anesthesia and were well-tolerated by the patients. The ablation time was 5-10 min, with an average duration of 6.3 ± 1.8 min. The most common pathology was papilloma (n = 96, 70.1%), followed by nasopharyngeal cysts (n = 21, 15.3%), polyp (n = 10, 7.3%), epidermoid cysts (n = 8, 5.8%) and Thornwaldt cysts (n = 2, 1.5%). The mean VAS pain score was 2.36 ± 1.08 on postoperative 12th hour and 1.21 ± 0.54 on postoperative third day. At the 6-month follow-up examination, there were no severe complications, such as recurrence, bleeding, or synechiae of the nasal cavity, eustachian tube injury, in any of the patients. CONCLUSIONS The MWA for the treatment of isolated pharyngeal benign lesion is feasible and alternative to conventional surgical methods, it allows excision of the lesion while providing hemostasis, involves only a short ablation time and has a very low risk of complications. Most of our patients well-tolerate the procedure, which may be performed under local anesthesia in the outpatient setting.
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Affiliation(s)
- ZhiGuo OuYang
- Department of Otorhinolaryngology, Yiwu Hospital of Wenzhou Medical University (Yiwu Central Hospital), Yiwu City 322000, Zhejiang Province, China
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai 200233, China
| | - Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Hospital of Wenzhou Medical University (Yiwu Central Hospital), Yiwu City 322000, Zhejiang Province, China.
| | - Kangfen Jin
- Department of Otorhinolaryngology, Yiwu Hospital of Wenzhou Medical University (Yiwu Central Hospital), Yiwu City 322000, Zhejiang Province, China
| | - Junzhi Sun
- Department of Otorhinolaryngology, Yiwu Hospital of Wenzhou Medical University (Yiwu Central Hospital), Yiwu City 322000, Zhejiang Province, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai 200233, China.
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Inamoto Y, González-Fernández M, Saitoh E. 3D-CT Evaluation of Swallowing: Metrics of the Swallowing Response Using Swallowing CT. Dysphagia 2021. [PMID: 33818630 DOI: 10.1007/s00455-021-10288-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/16/2021] [Indexed: 10/28/2022]
Abstract
Videofluoroscopy and videoendoscopy dramatically changed the evaluation and management of swallowing disorders. Later advancements in techniques for the instrumental evaluation of swallowing were limited by technique and positioning. The advent of 320-row area detector CT solved previous challenges and allowed for the study of swallowing physiology and dysphagia in greater detail. In this summary, we describe the history and evolution of CT technology and describe research and clinical applications for the evaluation of swallowing physiology and pathophysiology.
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Kaoutar C, Ahmedou AB, Oukessou Y, Abada R, Mohamed R, Mohamed M. Synovialosarcoma of the pharynx: A case report and literatture review. Int J Surg Case Rep 2021; 80:105639. [PMID: 33621727 DOI: 10.1016/j.ijscr.2021.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/07/2021] [Accepted: 02/07/2021] [Indexed: 11/16/2022] Open
Abstract
Synovial sarcoma is a rare malignant neoplasm. The location in pharynx is extremely rare. The diagnosis of synovial sarcoma is confirmed by surgical biopsy. The objective of this study is to describe the clinical, radiological and histological features of pharyngeal synovial sarcoma and to discuss its therapeutic management.
Introduction Synovial sarcoma is a rare tumor to be encountered in the head and neck region and is always a challenge in terms of diagnosis, treatment, as our case. Presentation of case We present a 23-year old female patient with synovial sarcoma of posterolateral pharyngeal wall. The radiological and clinicopathological features along with various diagnostic tests and treatment options are discussed. Discussion The objective of this study is to describe - from a clinical case reported from our institution, and from literature review- the clinical, radiological and histological features of pharyngeal synovial sarcoma and to discuss its therapeutic management. Conclusion Synovial sarcoma of pharynx is extremely a rare tumor in current practice.
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Abdel-Halim CN, Rosenberg T, Dyrvig AK, Høilund-Carlsen PF, Sørensen JA, Rohde M, Godballe C. Diagnostic accuracy of imaging modalities in detection of histopathological extranodal extension: A systematic review and meta-analysis. Oral Oncol 2021; 114:105169. [PMID: 33493691 DOI: 10.1016/j.oraloncology.2020.105169] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/30/2020] [Accepted: 12/24/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To present an up to date systematic review and meta-analysis evaluating the diagnostic accuracy of the most used imaging modalities in detection of histopathological extra nodal extension (ENE) in head and neck squamous cell carcinoma. MATERIALS AND METHODS Medline, Embase, and Cochrane databases were systematically searched on March 27th 2020. Screening, inclusion, quality assessment, and data extraction were done by two reviewers. Meta-analysis was conducted using the bivariate model approach after pooling the studies according to imaging modality. Heterogeneity was explored by meta-regression. Comparison was done by meta-regression and sub-group analyses. RESULTS Out of 476 initial hits, 25 studies were included for analysis. Of these, 14 dealt with CT, nine with PET/CT, four with MRI, two with ultrasound, and none with PET/MRI. Meta-analysis based on a total sample size of 3391 showed that CT had a sensitivity of 76% [67-82%] and specificity of 77% [69-83%], MRI a sensitivity of 72% [64-79%] and specificity of 78% [57-90%], and PET/CT a sensitivity of 80% [76-84%] and specificity of 83% [74-90%] in the ability to predict ENE. No meta-analysis could be done on ultrasound. There were no significant differences between modalities in overall accuracy; however, PET/CT had significantly higher sensitivity than CT and MRI. CONCLUSION There was no significant difference in the ability of CT, MRI, and PET/CT to diagnose histopathological ENE, except that PET/CT had a significantly higher sensitivity than CT and MRI.
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Affiliation(s)
- Chadi Nimeh Abdel-Halim
- Department of ORL - Head and Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark.
| | - Tine Rosenberg
- Department of ORL - Head and Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | | | | | - Jens Ahm Sørensen
- Department of Plastic Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Max Rohde
- Department of ORL - Head and Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Christian Godballe
- Department of ORL - Head and Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
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Takahashi N, Ikeda K, Iwai G, Shinbori K, Baba H, Sasaki T, Takahashi K, Morita Y, Horii A. Prediction of effectiveness of potassium-competitive acid blocker and serotonin noradrenaline reuptake inhibitor on abnormal sensation in the throat: use of patient-reported outcome measures (PROMs). Eur Arch Otorhinolaryngol 2021; 278:1483-1489. [PMID: 33388987 PMCID: PMC8057989 DOI: 10.1007/s00405-020-06544-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/01/2020] [Indexed: 11/22/2022]
Abstract
Purpose To determine patients with abnormal sensation in the throat (AST) who would respond to potassium-competitive acid blocker (P-CAB) or serotonin noradrenaline reuptake inhibitor (SNRI) treatment. Methods AST patients were randomly divided into two groups. Thirty-one and 21 patients received P-CAB and SNRI treatment, respectively. GETS-J, the Japanese version of Glasgow Edinburgh Throat Scales (GETS), consisted of three subscales of throat symptoms (globus sensation, pain/swelling of the throat, and dysphagia) and somatic distress due to the disease, Frequency Scale for the Symptoms of Gastro-esophageal reflux disease (FSSG), and Hospital Anxiety and Depression Scale (HADS) were used before and after treatments. Responders to treatments were defined as those who showed 50% or more decrease in symptom scores or somatic distress. Results Pre-treatment GETS-J pain/swelling scores and FSSG acid reflux scores were higher in P-CAB responders and decreased after treatment. Receiver operating characteristic curve for pain/swelling subscale had an area under the curve (AUC) of 0.792 to predict P-CAB responders and a score of 11 provided the best combination of sensitivity (62.5%) and specificity (80%). Somatic distress and HADS anxiety scores, but no other GETS-J symptom scores, decreased after SNRI treatment. Pre-treatment globus scores were lower in SNRI responders. AUC value for globus subscale to predict SNRI responders was 0.741 and a score of 6.5 provided the best combination of sensitivity (70%) and specificity (73%). Conclusions Pain/swelling is a characteristic symptom in AST patients who respond to P-CAB treatment. SNRI treatment would be effective for somatic distress in cases with mild symptoms.
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Affiliation(s)
- Nao Takahashi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan.
| | - Kaori Ikeda
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan
| | - Genki Iwai
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan
| | - Kaori Shinbori
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan
| | - Hironori Baba
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan
| | - Takanobu Sasaki
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan
| | - Kuniyuki Takahashi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan
| | - Yuka Morita
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan
| | - Arata Horii
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Japan
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Tretiakow D, Mollin E, Skorek A. Palatine tonsil adenoid cystic carcinoma. Oral Oncol 2020; 115:105135. [PMID: 33376056 DOI: 10.1016/j.oraloncology.2020.105135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Dmitry Tretiakow
- Department of Otolaryngology, Medical University of Gdansk, Gdansk, Poland.
| | - Edward Mollin
- Department of Otolaryngology, Medical University of Gdansk, Gdansk, Poland
| | - Andrzej Skorek
- Department of Otolaryngology, Medical University of Gdansk, Gdansk, Poland
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Lu X, Forte AJ, Allam O, Park KE, Junn A, Alperovich M, Steinbacher DM, Tonello C, Alonso N, Persing JA. Nasopharyngeal airway and subcranial space analysis in Pfeiffer syndrome. Br J Oral Maxillofac Surg 2020; 59:592-598. [PMID: 33863588 DOI: 10.1016/j.bjoms.2020.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/15/2020] [Indexed: 12/16/2022]
Abstract
Tracheotomy in infancy helps patients with Pfeiffer syndrome to survive by preventing respiratory crisis, but difficulty in decannulation may consequently be a challenge. This study has investigated the regional abnormalities of the nasopharyngeal airway in children with Pfeiffer syndrome to provide an anatomical basis for the surgical treatment and decannulation of the upper airway. Seventy-two preoperative computed tomograms (CT) (Pfeiffer syndrome n=30; control n=42) were included. The airway volume, cross-sectional area, and cephalometrics were measured using Materialise software. Patients with Pfeiffer syndrome developed a 50% (p<0.001) reduction of nasal airway volume, and a 44% (p=0.003) restriction in pharyngeal airway volume. In patients with Pfeiffer syndrome the cross-sectional area at the choana was only half that of the controls (p<0.001). The posterior width of the nasal airway in patients with Pfeiffer syndrome was shortened by 13% (p=0.003), and the height reduced by 21% (p<0.001). The cross-sectional areas at the condylion and gonion levels, which indicate the calibre of the pharyngeal airway at the entrance and midsection, were reduced by 67% (p<0.001) and 47% (p<0.001), respectively, when compared with the controls. The volume of the nasal airway in patients with Pfeiffer syndrome was significantly restricted in length, height, and width, and by choanal stenosis in all cases in this cohort. The reduced anteroposterior length of the nasal airway contributed to the shortened maxilla more than the anteroposterior position. The limited height and width of the nasal pathway was the result of a hypoplastic sphenoid. Restricted mediolateral and anteroposterior dimensions were evident across the entire course of the pharyngeal airway. Mediolateral maxillary expansion in addition to maxillomandibular advancement is therefore likely to benefit these patients.
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Affiliation(s)
- X Lu
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - A J Forte
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.
| | - O Allam
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - K E Park
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - A Junn
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - M Alperovich
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - D M Steinbacher
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - C Tonello
- Department of Craniofacial Surgery, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Bauru, São Paulo, Brazil.
| | - N Alonso
- Department of Plastic Surgery, University of São Paulo, São Paulo, Brazil.
| | - J A Persing
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA.
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Verma S, Kulke D, McCall JW, Martin RJ, Robertson AP. Recording drug responses from adult Dirofilaria immitis pharyngeal and somatic muscle cells. Int J Parasitol Drugs Drug Resist 2020; 15:1-8. [PMID: 33348209 PMCID: PMC7753077 DOI: 10.1016/j.ijpddr.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022]
Abstract
Despite being considered one of the most pathogenic helminth infections of companion animals, members of macrocyclic lactone class are the only drugs available for the prevention of heartworm disease caused by Dirofilaria immitis. Alarmingly, heartworm prevention is at risk; several studies confirm the existence of macrocyclic lactone resistance in D. immitis populations across the United States. To safeguard the long term prevention and control of this disease, the identification and development of novel anthelmintics is urgently needed. To identify novel, resistance-breaking drugs, it is highly desirable to: Unfortunately, none of the three above statements can be answered sufficiently for D. immitis and most of our hypotheses derive from surrogate species and/or in vitro studies. Therefore, the present study aims to improve our fundamental understanding of the neuromuscular system of the canine heartworm by establishing new methods allowing the investigation of body wall and pharyngeal muscle responses and their modulation by anthelmintics. We found that the pharynx of adult D. immitis responds to both ivermectin and moxidectin with EC50s in the low micromolar range. We also demonstrate that the somatic muscle cells have robust responses to 30 μM acetylcholine, levamisole, pyrantel and nicotine. This is important preliminary data, demonstrating the feasibility of electrophysiological studies in this important parasite.
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Affiliation(s)
- S Verma
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, 50011, USA
| | - D Kulke
- Drug Discovery and External Innovation, Bayer Animal Health GmbH, 51373, Leverkusen, Germany.
| | | | - R J Martin
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, 50011, USA
| | - A P Robertson
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, 50011, USA
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Hampton T, Allan J, Pearson D, Emerson H, Jones GH, Junaid M, Kanzara T, Lau AS, Siau R, Williams SP, Wilkie MD. A multi-centre analysis of a decade of endoscopic pharyngeal pouch surgery in Cheshire and Merseyside. J Laryngol Otol 2020; 134:1-6. [PMID: 33138870 DOI: 10.1017/s0022215120002224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There are sparse data on the outcomes of endoscopic stapling of pharyngeal pouches. The Mersey ENT Trainee Collaborative compared regional practice against published benchmarks. METHODS A 10-year retrospective analysis of endoscopic pharyngeal pouch surgery was conducted and practice was assessed against eight standards. Comparisons were made between results from the tertiary centre and other sites. RESULTS A total of 225 procedures were performed (range of 1.2-9.2 cases per centre per year). All centres achieved 90 per cent resumption of oral intake within 2 days. All centres achieved less than 2-day hospital stays. Primary success (84 per cent (i.e. abandonment of endoscopic stapling in 16 per cent)), symptom resolution (83 per cent) and recurrence rates (13 per cent) failed to meet the standard across the non-tertiary centres. CONCLUSION Endoscopic pharyngeal pouch stapling is a procedure with a low mortality and brief in-patient stay. There was significant variance in outcomes across the region. This raises the question of whether this service should become centralised and the preserve of either tertiary centres or sub-specialist practitioners.
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Affiliation(s)
- T Hampton
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Liverpool University Hospitals NHS Foundation Trust, UK
| | - J Allan
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - D Pearson
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - H Emerson
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
| | - G H Jones
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Liverpool University Hospitals NHS Foundation Trust, UK
| | - M Junaid
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
| | - T Kanzara
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Mid Cheshire Hospitals NHS Trust, Crewe, UK
| | - A S Lau
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - R Siau
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Liverpool University Hospitals NHS Foundation Trust, UK
| | - S P Williams
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - M D Wilkie
- Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK
- Department of ENT Surgery, Liverpool University Hospitals NHS Foundation Trust, UK
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von Arx T, Lozanoff S, Bornstein MM. Extraoral anatomy in CBCT – a literature review. Part 4: Pharyngocervical region. Swiss Dent J 2020; 130:768-784. [PMID: 33021766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This review about extraoral anatomy depicted in cone beam computed tomography describes the pharyngocervical region. Large (≥ 8 × 8 cm) field of views of the maxilla and/or mandible will inevita-bly depict the pharyngocervical region that com-prises the posterior upper airway, the pharyngeal part of the digestive tract, as well as the cervical segment of the spine. The latter consists of seven cervical vertebrae (C1-C7) with corresponding distinctive features, i.e., the atlas (C1) and the axis (C2). In addition, cervical vertebrae serve as ref-erences for the vertical position of anatomical structures. For instance, C4 is a typical landmark since it generally denotes the level of the chin, of the body of the hyoid bone, of the base of the epiglottis, and of the bifurcation of the common carotid artery, respectively. The pharynx, which is functionally involved in respiration, deglutition, and vocalization, extends from the lower aspect of the skull base to the esophagus. Anatomically, the pharynx is divided into three segments, i.e. the nasopharynx, the oropharynx, and the laryn-gopharynx. All communicate anteriorly with cor-responding cavities, i.e. the nasal cavities, the oral cavity, and the larynx. Although not directly located within the pharyngocervical region, the hyoid bone and the styloid process are also dis-cussed in this review, since both structures are commonly visible on CBCT images of this region.
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Affiliation(s)
- Thomas von Arx
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Switzerland
| | - Scott Lozanoff
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medi-cine, University of Hawaii, Honolulu, USA
| | - Michael M. Bornstein
- Oral and Maxillofacial Radiol-ogy, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The Uni-versity of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR, China
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
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Barnes KM, Fan L, Moyle MW, Brittin CA, Xu Y, Colón-Ramos DA, Santella A, Bao Z. Cadherin preserves cohesion across involuting tissues during C. elegans neurulation. eLife 2020; 9:e58626. [PMID: 33030428 PMCID: PMC7544503 DOI: 10.7554/elife.58626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/25/2020] [Indexed: 12/17/2022] Open
Abstract
The internalization of the central nervous system, termed neurulation in vertebrates, is a critical step in embryogenesis. Open questions remain regarding how force propels coordinated tissue movement during the process, and little is known as to how internalization happens in invertebrates. We show that in C. elegans morphogenesis, apical constriction in the retracting pharynx drives involution of the adjacent neuroectoderm. HMR-1/cadherin mediates this process via inter-tissue attachment, as well as cohesion within the neuroectoderm. Our results demonstrate that HMR-1 is capable of mediating embryo-wide reorganization driven by a centrally located force generator, and indicate a non-canonical use of cadherin on the basal side of an epithelium that may apply to vertebrate neurulation. Additionally, we highlight shared morphology and gene expression in tissues driving involution, which suggests that neuroectoderm involution in C. elegans is potentially homologous with vertebrate neurulation and thus may help elucidate the evolutionary origin of the brain.
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Affiliation(s)
- Kristopher M Barnes
- Developmental Biology Program, Memorial Sloan Kettering Cancer CenterNew YorkUnited States
- Graduate Program in Neuroscience, Weill Cornell MedicineNew YorkUnited States
| | - Li Fan
- Developmental Biology Program, Memorial Sloan Kettering Cancer CenterNew YorkUnited States
| | - Mark W Moyle
- Department of Neuroscience and Department of Cell Biology, Yale University School of MedicineNew HavenUnited States
| | - Christopher A Brittin
- Developmental Biology Program, Memorial Sloan Kettering Cancer CenterNew YorkUnited States
| | - Yichi Xu
- Developmental Biology Program, Memorial Sloan Kettering Cancer CenterNew YorkUnited States
| | - Daniel A Colón-Ramos
- Department of Neuroscience and Department of Cell Biology, Yale University School of MedicineNew HavenUnited States
- Instituto de Neurobiología, Recinto de Ciencias Médicas, Universidad de Puerto RicoSan JuanUnited States
| | - Anthony Santella
- Developmental Biology Program, Memorial Sloan Kettering Cancer CenterNew YorkUnited States
- Molecular Cytology Core, Memorial Sloan Kettering Cancer CenterNew YorkUnited States
| | - Zhirong Bao
- Developmental Biology Program, Memorial Sloan Kettering Cancer CenterNew YorkUnited States
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Ethiraj D, Kumar SD, Indiran V, Maduraimuthu P. Imaging of Pharyngocele: An Occupational Overuse Syndrome. Oman Med J 2020; 35:e181. [PMID: 33083039 PMCID: PMC7568824 DOI: 10.5001/omj.2020.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 08/19/2019] [Indexed: 11/05/2022] Open
Abstract
Pharyngocele is a rare pathology of the pharynx caused by the laxity of the thyrohyoid membrane. Only about 60 true lateral pharyngocele cases have been reported in the literature over the last 133 years. Laryngocele is a close differential, and the two are difficult to tell apart. Though they have been described well in the literature, they are often misdiagnosed or interchangeably diagnosed. The acquired type of pharyngocele is due to prolonged increased intrapharyngeal pressure and pharyngeal wall weakness, and it is more common than congenital pharyngoceles. Close differential diagnoses include Zenker’s diverticulum, laryngocele, and jugular venous phlebectasia. Acquired lateral pharyngoceles are seen in wind instrument musicians and glassblowers. Hence, these diverticula are described as ‘overuse syndrome’. We present a case of bilateral neck swelling, which occurred doing the Valsalva maneuver with imaging studies.
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Affiliation(s)
- Dillibabu Ethiraj
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, India
| | - Suresh D Kumar
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, India
| | - Venkatraman Indiran
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, India
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Siddiqi K, Husain S, Vidyasagaran A, Readshaw A, Mishu MP, Sheikh A. Global burden of disease due to smokeless tobacco consumption in adults: an updated analysis of data from 127 countries. BMC Med 2020; 18:222. [PMID: 32782007 PMCID: PMC7422596 DOI: 10.1186/s12916-020-01677-9] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Smokeless tobacco (ST) is consumed by more than 300 million people worldwide. The distribution, determinants and health risks of ST differ from that of smoking; hence, there is a need to highlight its distinct health impact. We present the latest estimates of the global burden of disease due to ST use. METHODS The ST-related disease burden was estimated for all countries reporting its use among adults. Using systematic searches, we first identified country-specific prevalence of ST use in men and women. We then revised our previously published disease risk estimates for oral, pharyngeal and oesophageal cancers and cardiovascular diseases by updating our systematic reviews and meta-analyses of observational studies. The updated country-specific prevalence of ST and disease risk estimates, including data up to 2019, allowed us to revise the population attributable fraction (PAF) for ST for each country. Finally, we estimated the disease burden attributable to ST for each country as a proportion of the DALYs lost and deaths reported in the 2017 Global Burden of Disease study. RESULTS ST use in adults was reported in 127 countries; the highest rates of consumption were in South and Southeast Asia. The risk estimates for cancers were also highest in this region. In 2017, at least 2.5 million DALYs and 90,791 lives were lost across the globe due to oral, pharyngeal and oesophageal cancers that can be attributed to ST. Based on risk estimates obtained from the INTERHEART study, over 6 million DALYs and 258,006 lives were lost from ischaemic heart disease that can be attributed to ST. Three-quarters of the ST-related disease burden was among men. Geographically, > 85% of the ST-related burden was in South and Southeast Asia, India accounting for 70%, Pakistan for 7% and Bangladesh for 5% DALYs lost. CONCLUSIONS ST is used across the globe and poses a major public health threat predominantly in South and Southeast Asia. While our disease risk estimates are based on a limited evidence of modest quality, the likely ST-related disease burden is substantial. In high-burden countries, ST use needs to be regulated through comprehensive implementation of the World Health Organization Framework Convention for Tobacco Control.
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Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK. .,Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Scheherazade Husain
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - Aishwarya Vidyasagaran
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - Anne Readshaw
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - Masuma Pervin Mishu
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Medical School Doorway 3, Teviot Place, Edinburgh, EH8 9AG, UK
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Mattheis S, Lang S, Holtmann L, Haßkamp P, Hussain T. [Transoral resection of supraglottic laryngeal tumors with the Flex Robotic System]. HNO 2020; 68:662-5. [PMID: 32767027 DOI: 10.1007/s00106-020-00909-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The Flex Robotic System (Medrobotics, Raynham, MA, USA) allows flexible transoral endoscopic resection of head and neck tumors. The current article presents functional and first oncologic experiences with flexible transoral robot-assisted surgery for resection of supraglottic laryngeal tumors. From July 2014 to February 2020, supraglottic cancers in 32 patients (T1 = 11, T2 = 20, T3 = 1) were resected using the Flex Robotic System in the authors' clinic. Within a prospective clinical study, the feasibility, complications, and oncologic results were assessed. Tumors could be exposed, visualized, and successfully resected in all patients. In difficult-to-reach anatomic regions such as the aryepiglottic fold or petiole, the system provided a very good surgical overview. No serious adverse events occurred. Overall survival and local tumor control after 2 years were 88 and 94%, respectively. In conclusion, supraglottic tumors in difficult-to-reach areas have been successfully resected using the Flex Robotic System, with excellent local tumor control.
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Suzuki Y, Kikuchi K, Numayama-Tsuruta K, Ishikawa T. How do Caenorhabditis elegans worms survive in highly viscous habitats? J Exp Biol 2020; 223:jeb224691. [PMID: 32587072 DOI: 10.1242/jeb.224691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/21/2020] [Indexed: 11/20/2022]
Abstract
The nematode Caenorhabditis elegans is a filter feeder that lives in various viscous habitats such as soil, the intestines of slugs, and rotting materials such as fruits and stems. Caenorhabditis elegans draws in suspensions of bacteria and separates bacteria from water using the pharyngeal pump. Although these worms often live in highly viscous habitats, it is still unclear how they survive in these environments by eating bacteria. In this study, we investigated the effects of suspension viscosity on the survival rate of malnourished worms by combining live imaging and scaling analyses. We found that survival rate decreased with increases in viscosity because the high viscosity suppressed the amount of food ingested. The same tendency was found in two feeding-defective mutants, eat-6(ad467) and eat-6(ad997). We also found that the high viscosity weakened pump function, but the velocities in the pharynx were not zero, even in the most viscous suspensions. Finally, we estimated the amount of ingested food using scaling analyses, which provided a master curve of the experimental survival rates. These results illustrate that the survival rate of C. elegans worms is strongly dependent on the ingested bacteria per unit time associated with physical environments, such as the viscosity of food suspensions and the cell density of bacteria. The pump function of the C. elegans pharynx is not completely lost even in fluids that have 105 times higher viscosity than water, which may contribute to their ability to survive around the world in highly viscous environments.
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Affiliation(s)
- Yuki Suzuki
- Department of Finemechanics, Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki Aza Aoba, Sendai, Miyagi 980-8579, Japan
| | - Kenji Kikuchi
- Department of Finemechanics, Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki Aza Aoba, Sendai, Miyagi 980-8579, Japan
- Graduate School of Biomedical Engineering, Tohoku University, 6-6-01 Aramaki Aza Aoba, Sendai, Miyagi 980-8579, Japan
| | - Keiko Numayama-Tsuruta
- Graduate School of Biomedical Engineering, Tohoku University, 6-6-01 Aramaki Aza Aoba, Sendai, Miyagi 980-8579, Japan
| | - Takuji Ishikawa
- Department of Finemechanics, Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki Aza Aoba, Sendai, Miyagi 980-8579, Japan
- Graduate School of Biomedical Engineering, Tohoku University, 6-6-01 Aramaki Aza Aoba, Sendai, Miyagi 980-8579, Japan
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Baek S, Jung IH, Lee HY, Song J, Cha E, Jung KI, Yoo WK, Ohn SH. Changes in Pharyngeal Width Over Time as an Indicator of Dysphagia in Stroke Patients. Ann Rehabil Med 2020; 44:203-209. [PMID: 32475096 PMCID: PMC7349039 DOI: 10.5535/arm.19140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/17/2019] [Indexed: 12/11/2022] Open
Abstract
Objective To verify the pharyngeal width at rest as a measurement that could be used to assess changes in the degree of dysphagia over time in stroke patients. Methods In a cohort of stroke patients, we performed serial measurements of the pharyngeal width at the midpoints of the second (C2) and third (C3) cervical vertebral bodies using lateral neck X-rays while the patients were at rest. The JOSCYL width, a parameter named after the first initial of each developers’ surname and defined as the average value of the upper and lower pharyngeal widths, was used to formulate the JOSCYL scale, which was calculated as the JOSCYL width × 100/neck circumference. All patients also underwent serial videofluoroscopic swallowing studies (VFSSs). The Spearman correlation analysis was used to detect correlations between the serial VFSS results, JOSCYL widths, and JOSCYL scale values. Results Over time, we observed significant positive and negative correlations of change in the JOSCYL width and scale with changes in the Penetration-Aspiration Scale and the Dysphagia Outcome and Severity Scale scores, respectively. Conclusion The JOSCYL width and JOSCYL scale clearly reflected changes in dysphagia in stroke patients over time. These parameters may provide an easier method for evaluating whether post-stroke dysphagia has been alleviated.
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Affiliation(s)
- Seungki Baek
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Il Hwan Jung
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Ho Young Lee
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jimin Song
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Eunsil Cha
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kwang-Ik Jung
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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