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Τετάρτη 17 Νοεμβρίου 2021

Effect of swallowing rehabilitation using traditional therapy, kinesiology taping and neuromuscular electrical stimulation on dysphagia in post-stroke patients: A randomized clinical trial

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Clin Neurol Neurosurg. 2021 Nov 6;211:107020. doi: 10.1016/j.clineuro.2021.107020. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to evaluate the functional recovery of stroke patients with orophyaryngeal dysphagia after treatment with traditional swallowing therapy (TST), neuromuscular electrical stimulation (NMES), and kinesiology taping (KT), by using clinical swallowing assessments and objective fiberoptic endoscopic evaluation of swallowing (FEES).

METHODS: A total of 37 patients were randomized in three groups: those who received TST and NMES as Group 1 (n:12), those who received both TST and KT as Group 2 (n:13), and those who received TST, NMES, and KT together as Group 3 (n:12). Patients were evaluated before treatment, after treatment, and three months after treatment onset with bedside water-swallow test, Eating Assessment Tool (EAT-10), Functional Oral Intake Scale (FOIS), penetration-aspiration scale (PAS), and Nationa l Institute of Health-Swallow Safety Scale (NIH-SSS). FOIS, PAS, and NIS-SSS were completed according to results of fiberoptic endoscopic evaluation of swallowing (FEES).

RESULTS: A statistically significant decrease was observed in bedside water-swallow test, EAT-10, PAS, and NIH-SSS scores in all treatment groups 5 weeks and 3 months after treatment onset compared to pre-treatment scores (p < 0.05). There was a statistically significant increase in FOIS scores 5 weeks and 3 months after treatment compared to pretreatment scores in all treatment groups (p < 0.05). When the pre-treatment, 3-week, and 5-month swallow scale scores of all groups were compared, there was no significant different difference in terms of bedside water-swallow test, EAT-10, FOIS, PAS, or NIH-SSS scores (p > 0.05).

CONCLUSION: According to the results of our study, KT is a new option in the treatment of stroke-related dysphagia, is an effective treatment approach and its efficacy is main tained throughout long-term follow-up.

PMID:34781221 | DOI:10.1016/j.clineuro.2021.107020

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Epigenetic therapy to enhance therapeutic effects of PD-1 inhibition in therapy-resistant melanoma

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Targeted therapy and immunotherapy have revolutionized the treatment of metastatic skin melanoma but around half of all patients develop resistance early or late during treatment. The situation is even worse for patients with metastatic uveal melanoma (UM). Here we hypothesized that the immunotherapy of therapy-resi stant skin melanoma or UM can be enhanced by epigenetic inhibitors. Cultured B16F10 cells and human UM cells were treated with the histone deacetylase inhibitor (HDACi) entinostat or BETi JQ1. Entinostat-induced HLA expression and PD-L1, but JQ1 did not. A syngeneic mouse model carrying B16-F10 melanoma cells was treated with PD-1 and CTLA4 inhibitors, which was curative. Co-treatment with the bioavailable BETi iBET726 impaired the immunotherapy effect. Monotherapy of a B16-F10 mouse model with anti-PD-1 resulted in a moderate therapeutic effect that could be enhanced by entinostat. Mice carrying PD-L1 knockout B16-F10 cells were also sensitive to entinostat. This suggests HDAC inhibition and immunotherapy could work in concert. Indeed, co-cultures of UM with HLA-matched melanoma-specific tumor-infiltrating lymphocytes (TILs) resulted in higher TIL-mediated melanoma killing when entinostat was added. Further exploration of combined immunotherapy and epigenetic therapy in metastatic melanoma resistant to PD-1 inhibition is warranted. * Present address: Harry Perkins Institute of Medical Research, 6 Verdun St, WA 6009, Nedlands, Perth, Australia. Received 21 July 2021 Accepted 23 September 2021 Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.melanomaresearch.com. Correspondence to Jonas A. Nilsson, PhD, Sahlgrenska Center for Cancer Research, Box 425, University of Gothenburg, 40530 Gothenburg, Sweden, Tel: +46 730 273039; e-mail: jonas.nilsson@perkins.org.au This is an open access article distributed under the Creative Commons Attribution License 4.0(CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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Applied anatomy of the medial orbital wall

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Vestn Otorinolaringol. 2021;86(5):119-123. doi: 10.17116/otorino202186051119.

ABSTRACT

The article provides an overview of foreign and domestic studies on the anatomy of the medial wall of the orbit. Possible structural variants of the osseus structures of the medial wall and their applied clinical significance are indicated, including those having individual occurrence: additional lacrimal bone, morphological features of the structure of the fossa of the lacrimal sac, location, shape and size of the cells of the ethmoid bone, Onody cells, Haller infraorbital cell, the relative position of the anterior and posterior ethmoid foramina, the presence of additional ethmoid foramina, dysgenesis of the lacrimal bone and the orbital plate of the ethmoid bone. The anatomical prerequisites for the occurrence of intraoperative complications with surgical access to the medial wall of the orbit are described.

PMID:34783485 | DOI:10.17116/otorino202186051119

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The significance of microanatomy of the round window in terms of cochlear implantation

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Vestn Otorinolaringol. 2021;86(5):42-47. doi: 10.17116/otorino20218605142.

ABSTRACT

Sensoneural hearing loss is a polyetiological disease, which is often a secondary reflection of systemic pathology and is associated with damage of the cochlea and auditory nerve receptors. An important point in the surgical stage of cochlear implantation is the introduction of an implant active electrode into the cochleostomy spiral channel through the cochleostoma or round window. However, the issue of intra-cochlear structures surgical trauma in such surgical intervention seems to be very important, as it may reduce the success of subsequent rehabilitation. Therefore, the study of the anatomy of the round window and adjuscent areas was the objective of this work.

PMID:34783472 | DOI:10.17116/otorino20218605142

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Objective parameters of auditory function in premature infants in the first year of life after taking ototoxic antibiotics

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Vestn Otorinolaringol. 2021;86(5):12-16. doi: 10.17116/otorino20218605112.

ABSTRACT

OBJECTIVE: To compare the condition of auditory function during the first year of life according to the registration of distortion product otoacoustic emission (DPOAE) and short-latency evoked potentials (SLEP) in premature infants who received ototoxic antibiotics to those ones, who did not.

MATERIAL AND METHODS: Auditory function was examined in 145 premature infants. Auditory assessment was carried out by registration of DPOAEs, SLEPs and tympanometry. Statistical processing was performed using the program Statgraphics Centurion XV.

RESULTS: In this study, according to DPOAE, the average response values of the cochlea in premature infants who had a history of ototoxic therapy, undergo final changes after children reach the age of 6 months. The study of latent periods and threshold values of the V peak of SLEP showed a delay in the maturat ion process of the perceiving and conducting auditory structures during the first year of life in children who received ototoxic antibiotics in the first month of life.

CONCLUSION: We evaluated the timing of the completion of response changes in children of the control group using the DPOAE and SLEP registration data. In children of the study group, we evaluated the effect of the administered ototoxic antibiotics. Timing of audiological control of the hearing organ condition are demonstrated for premature children after ototoxicosis, required methods of its examination are established.

PMID:34783467 | DOI:10.17 116/otorino20218605112

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Auditory brainstem response prior to MRI compared to standalone MRI in the detection of vestibular schwannoma: a modelling study

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Abstract

Objectives

To determine the cost-effectiveness of auditory brainstem response prior to MRI (ABR-MRI) compared to standalone MRI to diagnose vestibular schwannoma.

Design

A state transition model was developed to simulate costs and effects (quality-adjusted life years (QALY)) for both diagnostic strategies for patients suspected of a vestibular schwannoma. Model input was derived from literature, hospital databases, and expert opinions. Scenario and sensitivity analyses addressed model uncertainty.

Results

Over a lifetime horizon, ABR-MRI resulted in a limited cost-saving of €68 or €98 per patient (dependent on MRI sequence) and a health loss of 0.005 QALYs over standalone MRI. ABR-MRI, however, did miss patients with other important pathology (2% of the population) that would have been detected when using standalone MRI. In total, €14,203 or €19,550 could be saved per lost QALY if ABR-MRI was used instead of standalone MRI. The results were sensitive to the detection rate of vestibular schwannoma and health-related quality of life of missed patients.

Conclusion

The cost-saving with ABR-MRI does not seem to outweigh the number of missed patients with VS and other important pathologies that would have been detected when using standalone MRI.

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Primary Middle Ear Meningioma with Intact Tympanic Membrane: A Case Report and Literature Review

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Ear Nose Throat J. 2021 Nov 17:1455613211058100. doi: 10.1177/01455613211058100. Online ahead of print.

ABSTRACT

Primary ectopic meningioma of the middle ear is relatively rare in clinical practice. It is often difficult to distinguish it from chronic otitis media or otitis media with effusion due to its similar and atypical clinical symptoms. We report a case of epithelial tympanic ectopic meningioma with the main complaints of otalgia, aural fullness, and hearing loss. It was accidentally discovered during tympanotomy due to the symptoms of recurring refractory secretory otitis media. This article briefly reviews the relevant literature in recent years, summarizes the characteristics of primary ectopic tympanic meningioma with intact tympanic membrane, and emphasizes the diagnosis and treatment strategy of the middle ear mass.

PMID:34784773 | DOI:10.1177/01455613211058100

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The risk factors for Graves' ophthalmopathy

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Graefes Arch Clin Exp Ophthalmol. 2021 Nov 17. doi: 10.1007/s00417-021-05456-x. Online ahead of print.

ABSTRACT

PURPOSE: This review aimed to provide an overview of current research into the risk factors for Graves' ophthalmopathy (GO).

METHODS: To find information about the risk factors for GO, the research database PubMed was searched and relevant articles were obtained to extract information about risk factors.

RESULTS: Smoking has been widely accepted as an importan t risk factor and cigarette smoking cessation has been shown to improve the outcome and decrease the onset of GO. Radioactive iodine on the thyroid may induce hyperthyroidism and increase the occurrence of GO. Selenium deficiency is a risk factor for GO and the supplementation of selenium has been an adjuvant therapy. Decreasing stressful life events (SLE) may help improve GO. Imbalance in intestinal flora is essential to GO, with Yersinia enterocolitica and Escherichia coli both increased in the digestive tract of the individual with GO. In addition, controlling serum cholesterol may help improve GO since adipogenesis is an important pathological change in its pathogenesis. Considering the correlation between Graves' disease and GO, maintaining normal thyroid function hormone level is the first-line therapeutic strategy to prevent progression of GO. An increase in antibodies such as TSHR and IGF-1R is the main predictor of GO. Besides, gender and gene polymorphism are also risk fac tors towards GO.

CONCLUSIONS: Risk factors for GO arise from five sources: physical and chemical environment, social-psychological environment, biological environment, the human organism, and genetic codes. Risk factors within these categories may interact with each other and their mechanisms in promoting the development of GO are complex. Research into risk factors for GO may promote emerging fields related to GO such as control of autoantibodies and intestinal microbiota.

PMID:34787691 | DOI:10.1007/s00417-021-05456-x

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