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Τετάρτη 9 Ιουνίου 2021

Assessment of Intelligibility in Children with Velopharyngeal Insufficiency: The Relationship between Intelligibility in Context Scale and Experimental Measures

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Purpose: The purpose of this study was to investigate the clinical application of the Intelligibility in Context Scale (ICS) instrument in children with velopharyngeal insufficiency (VPI). This study investigated the relationship between clinical speech outcomes and parental reports of speech intelligibility across various communicative partners. Methods: The ICS was completed by the parents of 20 English-speaking children aged 4–12 years diagnosed with VPI. The parents were asked to rate their children's speech intelligibility across communication partners using a 5-point scale. Clinical metrics obtained using standard clinical transcription on the Picture-Cued SNAP-R Test were: (1) percentage of consonants correct (PCC), (2) percentage of vowels correct (PVC), and (3) percentage of phonemes correct (PPC). Nasalance from nasometer data was included as an indirect measure of nasality. Intelligibility scores obtained from naive listener's transcriptions and speech-language pathologists' (SLP) ratings were compared with the ICS results. Result: Greater PCC, PPC, PVC, and transcription-based intelligibility values were significantly associated with higher ICS values, respectively (r[20] = 0.84, 0.82, 0.51, and 0.70, respectively; p #x3c; 0.05 in all cases). There was a negative and significant correlation between ICS mean scores and SLP ratings of intelligibility (r = –0.74; p #x3c; 0.001). The re was no significant correlation between ICS values and nasalance scores (r[20] = –0.28; p = 0.22). Conclusion: The high correlations obtained between the ICS with PCC and PPC measures indicate that articulation accuracy has had a great impact on parents' decision-making regarding intelligibility in this population. Significant agreement among ICS scores with naive listener transcriptions and clinical ratings supports use of the ICS in practice.
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Biologics in Otolaryngology

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Biologics have been widely adopted in multiple subspecialties of otolaryngology. This article provides an overview of past, present, and future uses of biologics in otolaryngology with emphasis on allergic rhinitis, chronic rhinosinusitis with polyposis, head and neck squamous cell carcinoma, salivary and skull base tumors, hearing loss, and other otologic disorders.
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Epidermal Growth Factor Receptor-Targeted Therapy for Head and Neck Cancer

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The epidermal growth factor receptor (EGFR) is an important therapeutic target in head and neck squamous cell carcinomas (HNSCCs). EGFR-targeted agents including monoclonal antibodies and tyrosine kinase inhibitors have shown mixed results in clinical trials. To date, only cetuximab, an anti-EGFR monoclonal antibody, is approved for use in local/regional advanced and recurrent or metastatic HNSCC. This article reviews the mechanism of action of cetuximab and its antitumor immune effects and the data to support its use in HNSCC. It additionally provides an overview of other EGFR monoclonal antibodies and small molecule tyrosine kinase inhibitors that have been studied.
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Mechanisms and Practical Use of Biologic Therapies for Allergy and Asthma Indications

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This article presents a concise overview of the important aspects of the immunologic mechanisms targeted by T-helper 2–directed monoclonal antibodies, as well as their practical applications in the treatment of allergic disorders (specifically allergic rhinitis) and asthma. Several of these novel agents treat multiple diseases, so understanding their targets and the underlying disease process can aid patient selection. In addition, the particular targets of the therapeutics seem to be shifting to include not only agents that intervene against inflammatory cytokines or their receptors but also specific molecular epitopes and cellular surface proteins.
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Anti-PD-1 Immune Checkpoint Blockade for Head and Neck Cancer

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Immunotherapy in recent years has solidified its position as the fourth pillar of cancer treatment alongside surgery, chemotherapy, and radiation. Although in its infancy, when compared with these other conventional therapeutic strategies, immunotherapy has provided a chance for prolonged survival, and in some cases even cure, for patients who previously would have been given a terminal diagnosis. In head and neck cancer in particular, the advent of antiprogrammed cell death protein 1 (anti-PD-1) immune checkpoint blockade has shown modest response rates in patients with recurrent or metastatic mucosal squamous cell carcinoma.
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Past and Future Biologics for Otologic Disorders

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Biologic therapies have the ability to fundamentally change the management of hearing loss; clinicians need to familiarize themselves with their prospective applications in practice. This article reviews the current application of 4 categories of biological therapeutics—growth factors, apoptosis inhibitors, monoclonal antibodies, and gene therapy—in otology and their potential future directions and applications.
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Choosing the Right Patient for Biologic Therapy in Chronic Rhinosinusitis with Nasal Polyposis

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There are many phenotypes of chronic sinusitis and clinical variables that differ between patients. The ability to accurately diagnose, predict prognosis, and select the appropriate treatment depends on the understanding of disease endotypes. Chronic sinusitis is in the early stages of disease endotyping. The ability to identify endotypes is at the forefront of clinical research. Endotyping of chronic sinusitis uses clinical information, radiographic studies, and pathophysiologic data. Understanding of the full spectrum of chronic sinusitis is in its infancy. A personalized approach to treatment will consider standard medical therapies, sinus surgeries, and targeted use of biologic agents.
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Immunotherapeutic Strategies for Head and Neck Cancer

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Immunotherapy has revolutionized the treatment of cancer, including head and neck squamous cell carcinoma (HNSCC). Most immune therapies consist of biologics, including monoclonal antibodies, vaccines, and cell therapy. This article reviews basic tumor immunology and provides an overview of immunotherapeutic strategies used for HNSCC. The current indications for use of programmed cell death protein 1 immune checkpoint inhibitors in recurrent/metastatic HNSCC are summarized. In addition, new immunotherapeutic biologics and combinations under investigation in early-phase clinical trials are highlighted.
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Advances in Adoptive Cell Therapy for Head and Neck Cancer

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This article reviews the most recent literature describing clinical advances in adoptive cell therapy for patients with head and neck cancer. Clinical trials with tumor-infiltrating lymphocyte and gene-engineered T-cell receptor T-cell therapy are highlighted.
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Knowledge Gaps and Research Needs for Biologic Therapy in Rhinology Practice

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Biologic agents are emerging for chronic rhinosinusitis with nasal polyposis (CRSwNP) patients with recalcitrant disease. Although early work has shown promise, and several trials are ongoing, there is significant work to be done in this field. CRS patients form a heterogeneous group, and identification of appropriate patients for the use of biologic agents is critical. The determination of endotype-specific biomarkers will help define patient selection and predict treatment response. As more biologic agents become approved, head-to-head trials will be needed to compare them with similar products. Ultimately, cost-effectiveness analyses and further quality of life studies will guide treatment recommendations.
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Differences and Reliability of Linear and Nonlinear Acoustic Measures as a Function of Vocal Intensity in Individuals With Voice Disorders

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Linear acoustic indices are significantly influenced by speaking voice intensity. The main aim of this work was to compare acoustic measures based on linear and nonlinear models in different speaking voice intensity levels and to analyze the reliability of those measures in different intensity levels in subjects with voice disorders.
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Detecting epidemiological relevance of adenoid hypertrophy, rhinosinusitis, and allergic rhinitis through an Internet search

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Eur Arch Otorhinolaryngol. 2021 Jun 9. doi: 10.1007/s00405-021-06885-4. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to detect the epidemiological relevance between adenoid hypertrophy (AH) and rhinosinusitis, and AH and allergic rhinitis (AR) through an Internet search.

METHODS: Internet search query data from January 2011 to December 2019 in China were retrieved from the Baidu Index (BI). Spearman's correlation coefficients were used to detect the correlation among the search volumes of AH, rhinosinusitis, and AR. We also collected search data from the first 5 months of 2020, when quarantine was implemented in China due to the coronavirus disease 2019 epidemic. Then, we compared the search data to those obtained during the same period in 2019 to assess the effects of isolation on AH and AR.

RESULTS: Statistically significant relevance was found between the search variations of AH and rhinosinusitis during 201 1-2019 (R = 0.643, P < 0.05). However, the relationship between AH and AR was weak (R = - 0.239, P < 0.05) and that between rhinosinusitis and AR (R = - 0.022, P > 0.05) was not relevant. The average monthly search volume of AH and rhinosinusitis had a strong correlation (R = 0.846, P < 0.01), but AH and AR and rhinosinusitis and AR were not correlated (R = - 0.350, P > 0.05; R = - 0.042, P > 0.05, respectively). AH and rhinosinusitis search volumes decreased consistently during the first 5 months of 2020 (isolation), whereas that for AR increased during January-February.

CONCLUSION: AH had an epidemiological relationship with rhinosinusitis, which was not consistent with AR. The decrease in public gathering effectively reduced the morbidities of AH and rhinosinusitis but not those of AR.

PMID:34104981 | DOI:10.1007/s00405-021-06885-4

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Therapeutic applications of radioactive sources: from image-guided brachytherapy to radio-guided surgical resection

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Q J Nucl Med Mol Imaging. 2021 Jun 9. doi: 10.23736/S1824-4785.21.03370-7. Online ahead of print.

ABSTRACT

It is well known nowadays that radioactivity can destroy the living cells it interacts with. It is therefore unsurprising that radioactive sources, such as iodine-125, were historically developed for treatment purposes within radiation oncology with the goal of damaging malignant cells. However, since then, new techniques have been invented that make creative use of the same r adioactivity properties of these sources for medical applications. Here, we review two distinct kinds of therapeutic uses of radioactive sources with applications to prostate, cervical, and breast cancer: brachytherapy and radioactive seed localization. In brachytherapy (BT), the radioactive sources are used for internal radiation treatment. Current approaches make use of real-time image guidance, for instance by means of magnetic resonance imaging, ultrasound, computed tomography, and sometimes positron emission tomography, depending on clinical availability and cancer type. Such image-guided BT for prostate and cervical cancer presents a promising alternative and/or addition to external beam radiation treatments or surgical resections. Radioactive sources can also be used for radio-guided tumor localization during surgery, for which the example of iodine-125 seed use in breast cancer is given. Radioactive seed localization (RSL) is increasingly popular as an alternative tumor loca lization technique during breast cancer surgery. Advantages of applying RSL include added flexibility in the clinical scheduling logistics, an increase in tumor localization accuracy, and higher patient satisfaction; safety measures do however have to be employed. We exemplify the implementation of RSL in a clinic through experiences at the Netherlands Cancer Institute.

PMID:34105339 | DOI:10.23736/S1824-4785.21.03370-7

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