RESUMEN
PURPOSE: Laryngopharyngeal reflux disease (LPRD) is mainly treated with proton pump inhibitors (PPI) such as esomeprazole, which have shortcomings like delayed absorption and increased osteoporosis. Fexuprazan is a novel potent potassium-competitive acid blocker that inhibits gastric acid secretion with rapid onset and long duration of action. To assess the efficacy and safety of fexuprazan compared to esomeprazole in patients with LPRD. METHODS: This prospective, randomized, double-blinded, multicenter, active-controlled trial was conducted in nine otolaryngologic clinics. Patients with reflux symptom index (RSI) ≥ 13 and reflux finding score (RFS) ≥ 7 were randomly assigned to the fexuprazan or esomeprazole groups, and received fexuprazan 40-mg or esomeprazole 40-mg once daily for 8 weeks. The outcomes were (1) mean change, change rate, and valid rate in RSI, RFS, and LPR-related questionnaires; and (2) adverse events. RESULTS: A total of 136 patients (fexuprazan n = 68, esomeprazole n = 68) were followed up for ≥ 1 month. Each parameter significantly improved after 4 and 8 weeks in each group, with no significant differences between the two groups. For those with severe symptoms (RSI ≥ 18), the fexuprazan group (n = 32) showed more improvement in the mean change and change rate in the RSI than esomeprazole group (n = 31) after 4 weeks (p = .036 and .045, respectively). This phenomenon was especially observed in hoarseness and troublesome cough. CONCLUSION: Fexuprazan improved symptoms and signs without no serious adverse events in patients with LPRD. In patients with severe symptoms, fexuprazan resulted in a faster symptom improvement than PPI. TRIAL REGISTRATION: KCT0007251, https://cris.nih.go.kr/cris/search/detailSearch.do?seq=22100 .
RESUMEN
BACKGROUND: Nutritional status and sarcopenia affects the prognosis of head and neck cancers including hypopharyngeal cancer. Hypopharyngeal cancer patients tend to exhibit sarcopenia, which is associated with poor treatment outcomes. This study aims to determine the correlation between nutritional status and sarcopenia, and their prognostic role in surgically treated hypopharyngeal cancer. MATERIALS AND METHODS: Patients who had been diagnosed with squamous cell carcinoma originating from the hypopharynx and underwent surgery between January 2009 and December 2019 were enrolled in this study. The median neutrophil-to-lymphocyte ratio and prognostic nutritional index (PNI) of the cohort were considered the cut-off values. Sarcopenia was evaluated by measuring skeletal muscle index (SMI) at the third lumbar vertebra. Clinical and serological factors predictive of survival outcomes were evaluated. RESULTS: Patients with high PNI showed better 5-year Overall survival (OS) (52.8% vs. 27.2%, p = 0.001) and disease-free survival (DFS) (59.6% vs. 44.6%, p = 0.033) than those with low PNI. Likewise, patients with low SMI showed worse 5-year OS (25.0% vs. 60.9%, p = 0.002) and DFS (42.4% vs. 68.7%, p = 0.034) than patients with high SMI. Among the patients with high PNI, those with sarcopenia displayed significantly worse OS than those with high SMI (78.0% vs. 34.4%, p = 0.049). High PNI with high SMI presented better overall (p = 0.010) and DFS (p = 0.055) than any other group. CONCLUSIONS: Both sarcopenia and PNI were associated with the prognosis of hypopharyngeal cancer. Considering that PNI and sarcopenia indicate the nutritional status, nutritional status may be a significant risk factor. Therefore, nutritional support that ameliorates sarcopenia may improve survival outcomes in surgically treated patients with hypopharyngeal cancer.
Asunto(s)
Neoplasias Hipofaríngeas , Estado Nutricional , Sarcopenia , Humanos , Sarcopenia/complicaciones , Neoplasias Hipofaríngeas/cirugía , Neoplasias Hipofaríngeas/mortalidad , Neoplasias Hipofaríngeas/complicaciones , Neoplasias Hipofaríngeas/patología , Masculino , Femenino , Pronóstico , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Evaluación Nutricional , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/patología , Tasa de Supervivencia , AdultoRESUMEN
Importance: Ethanol ablation (EA) was shown to be safe and effective for treating ranula, but few studies have assessed long-term outcomes and recurrence of ranula after EA. Objective: To evaluate the long-term outcomes and the risk factors for recurrence and receipt of subsequent surgery in patients who underwent treatment with EA for ranula. Design, Setting, and Participants: This case-series study was conducted at a single tertiary hospital and assessed patients who were treated with EA between July 2009 and March 2021. Among 70 consecutive patients, those with follow-up loss or who were followed up for less than 24 months were excluded. Exposures: EA for ranula. Main Outcomes and Measures: The primary outcome was recurrence at last follow-up after single or multiple EA sessions. Secondary outcomes included receipt of subsequent surgery and the recurrence-free survival (RFS) rate after initial EA. Factors possibly associated with outcomes included patient age and sex; ranula site, type, diameter, volume, and echogenicity; the presentation-to-EA interval; parapharyngeal space extension; and sublingual gland herniation. Risk factors were identified on logistic regression analyses. Two-year RFS rates were analyzed for the initial cohort using the Kaplan-Meier method and compared by log-rank tests. Results: A total of 57 patients (mean [SD] age, 26.4 [12.1] years; 24 female individuals [42%]) who were followed up for a median of 57 months (range, 24-167 months) were included. The recurrence rate was 33% (n = 19), and 11 (19%) underwent subsequent surgery. Among patients with recurrence, 86% (31 of 36) experienced first recurrence within 12 months after initial EA. A presentation-to-EA interval of 12 months or longer was associated with an increased risk of recurrence (adjusted odds ratio [OR], 3.74; 95% CI, 1.01-13.82). No risk factors were significantly associated with subsequent surgery (highest OR in parapharyngeal space extension: adjusted OR, 4.96; 95% CI, 0.94-26.35). Among the initial cohort of 70 patients, 2-year RFS was lower in a maximum diameter of ranula of 5 cm or greater than less than 5 cm (24% [95% CI, 7%-41%] vs 50% [95% CI, 34%-66%]; difference, 26% [95% CI, -4% to 56%]; log-rank test, P = .02). Conclusions and Relevance: This case-series study found that the recurrence rate of ranula after EA was 33%. A presentation-to-EA interval of 12 months or longer may be a risk factor for recurrence, suggesting that early intervention with EA might minimize recurrence. Most first recurrences occurred within 12 months after EA, with a maximum diameter of ranula of 5 cm or greater being a possible risk factor.
Asunto(s)
Etanol , Ránula , Recurrencia , Humanos , Femenino , Masculino , Factores de Riesgo , Ránula/cirugía , Etanol/uso terapéutico , Técnicas de Ablación/métodos , Adolescente , Adulto , Niño , Estudios Retrospectivos , Resultado del Tratamiento , Persona de Mediana Edad , Adulto JovenRESUMEN
In this study, Barium Titanate (BT)/Lead Zirconate Titanate (PZT) multilayer thin films were fabricated by the spin-coating method on Pt (200 nm)/Ti (10 nm) SiO2 (100 nm)/P-Si (100) substrates using BaTiO3 and Pb(Zr0.90Ti0.10)O3 metal alkoxide solutions. The coating and heating procedure was repeated several times to form the multilayer thin films. All of BT/PZT multilayer thin films show X-ray diffraction patterns typical to a polycrystalline perovskite structure and a uniform and void free grain microstructure. The thickness of the BT and PZT film by one-cycle of drying/sintering was approximately 50 nm and all of the films consisted of fine grains with a flat surface morphology. The electrocaloric properties of BT/PZT thin films were investigated by indirect estimation. The results showed that the temperature change ΔT can be calculated as a function of temperature using Maxwell's relation; the temperature change reaches a maximum value of ~1.85 °C at 135 °C under an applied electric field of 260 kV/cm.
RESUMEN
The purpose of this study was to analyze the prevalence of vocal nodules and to identify factors related with an increased risk for vocal nodules.This study was conducted using data from the Korean National Health and Nutrition Examination Survey 2008 to 2011. The subjects consisted of 19,636 men and women aged ≥19 years. Related factors such as age, marital status, incomes, and education level were assessed in individual interviews, and health-related behaviors including smoking, alcohol, and activity were assessed with self-administered questionnaires. Also, examination survey such as laryngoscopy examination, basic physical examination, and blood sampling was conducted.The prevalence of vocal nodules was 1.31% (n = 258). Among variable factors, age, education level, and voice disorder were related with the presence of vocal nodules (Pâ<â0.05). Other factors including sex, alcohol, smoking, physical activities, hypertension, obesity, waist circumference and metabolic syndrome, hypercholesterolemia, serum calcium, and vitamin D did not show any meaningful relationship with the presence of vocal nodules.This result may help reduce the incidence of vocal nodules and offer proper management for patients with vocal nodules, and may also facilitate efficient allocation of public health resources.
Asunto(s)
Granuloma Laríngeo/epidemiología , Granuloma Laríngeo/etiología , Pliegues Vocales/patología , Trastornos de la Voz/epidemiología , Trastornos de la Voz/etiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios Transversales , Escolaridad , Femenino , Granuloma Laríngeo/patología , Encuestas Epidemiológicas , Humanos , Incidencia , Masculino , Estado Civil , Persona de Mediana Edad , Encuestas Nutricionales , Prevalencia , República de Corea/epidemiología , Factores de Riesgo , Factores Socioeconómicos , Trastornos de la Voz/patología , Adulto JovenRESUMEN
Transoral removal of a distal salivary stone is common. We have used postoperative sialography to evaluate the results and changes in the salivary ducts after removal of a salivary distal stone without sialodochoplasty. Of 20 patients who had had transoral operations for submandibular stones, 19 recovered normally with no recurrence. One developed partial stenosis and one a spontaneous neo-opening as a result of severe adhesions and inflammation between the salivary stone and the duct. None of the patients had any symptoms of recurrence during the 12-month follow-up. Sialodochoplasty may not be necessary in patients who have had a distal salivary stone removed. Removal without sialodochoplasty resulted in full anatomical recovery of the salivary ducts.
Asunto(s)
Conductos Salivales/cirugía , Cálculos de las Glándulas Salivales/cirugía , Sialografía , Enfermedades de la Glándula Submandibular/cirugía , Estudios de Seguimiento , Humanos , Conductos Salivales/patología , Glándula SubmandibularRESUMEN
BACKGROUND: Adenoid cystic cancer arising in the salivary glands has distinctive features such as perineural invasion, distant metastasis, and a variable prognosis. In salivary gland cancer, c-kit, EGFR, and VEGF are representative molecular markers that may predict remnant and recurrent tumors. In this study, the expression of c-kit, EGFR, and VEGF in adenoid cystic cancer was evaluated, and the relationships between the expression of these markers and the clinical findings were investigated. METHODS: The medical records of 48 patients who were treated for parotid adenoid cystic cancer from January 1990 to January 2006 were reviewed. The tumor location, size, histological subtypes, perineural invasion, the resected margin status, and lymph node metastasis were assessed. Immunohistochemical staining and semiquantitative analysis of c-kit, EGFR and VEGF were performed. The relationship between the expression of each marker and the clinicopathological factors were analyzed. RESULTS: Positive c-kit immunostaining was present in 45 patients (94%), with weak positivity (+1) in 23, moderate positivity (+2) in 19 and strong positivity (+3) in three. Positive EGFR immunostaining was observed in 27 (56%), with weak positivity (+1) in 19 and moderate positivity (+2) in eight with no strong positive staining. Positive VEGF immunostaining was present in 42 patients (88%) with weak positivity (+1) in 12, moderate positivity (+2) in 17, and strong positivity (+3) in 13. Only the expression of VEGF was significantly higher in parotid gland tumors than in any other gland (P = 0.032). Marginal involvement was associated with strong VEGF expression (P = 0.02). No marker was significantly correlated with recurrence or the survival rate. Lymph node status was related to the survival rate. CONCLUSIONS: The expression of c-kit, EGRF, and VEGF had no predictive value for recurrence or the prognosis of adenoid cystic cancer. Only the lymph node status was related to the prognosis.
Asunto(s)
Biomarcadores de Tumor/metabolismo , Carcinoma Adenoide Quístico/diagnóstico , Recurrencia Local de Neoplasia/diagnóstico , Neoplasias de las Glándulas Salivales/diagnóstico , Carcinoma Adenoide Quístico/metabolismo , Carcinoma Adenoide Quístico/mortalidad , Receptores ErbB/metabolismo , Femenino , Estudios de Seguimiento , Humanos , Técnicas para Inmunoenzimas , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Proteínas Proto-Oncogénicas c-kit/metabolismo , Estudios Retrospectivos , Neoplasias de las Glándulas Salivales/metabolismo , Neoplasias de las Glándulas Salivales/mortalidad , Tasa de Supervivencia , Análisis de Matrices Tisulares , Factor A de Crecimiento Endotelial Vascular/metabolismoRESUMEN
Many kinds of broken instruments, such as needles, probes, scalpels and catheters, are reported to be left in patients after surgery. These parts should be removed as soon as possible to prevent further complications. However, it is not easy to identify the exact location of the instrument intraoperatively, and a risk of damage exists for neighbouring nerves or vessels during the removal. The C-arm used in orthopaedic surgery, is seen as a useful and safe way to detect metal materials intraoperatively. However, its application for removal of broken instruments in the oral and maxillofacial area is not practical because of its large size. In our experiences with the removal of eight broken instruments in the oral and maxillofacial area, the newly developed dental mini C-arm was useful in finding broken instruments in soft tissue (five cases) and in paranasal sinus (one case), because it gives real time in situ information. This is important, because the position of the broken instrument can be changed due to traction of the soft tissue or swelling. The dental mini C-arm was less helpful in finding broken instruments in soft tissues compared to hard tissues (two cases) as the position of instruments did not change.
Asunto(s)
Falla de Equipo , Cara , Fluoroscopía/instrumentación , Cuerpos Extraños/cirugía , Boca , Radiografía Dental/instrumentación , Adolescente , Adulto , Implantes Dentales/efectos adversos , Operatoria Dental/instrumentación , Disección/métodos , Cara/diagnóstico por imagen , Cara/cirugía , Músculos Faciales/diagnóstico por imagen , Músculos Faciales/cirugía , Femenino , Cuerpos Extraños/diagnóstico por imagen , Humanos , Complicaciones Intraoperatorias , Masculino , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Persona de Mediana Edad , Boca/diagnóstico por imagen , Boca/cirugía , Mucosa Bucal/diagnóstico por imagen , Mucosa Bucal/cirugía , Agujas/efectos adversos , Preparación del Conducto Radicular/instrumentaciónRESUMEN
OBJECTIVE: To evaluate the effect of a porous geometry in particulate bone on new bone formation by comparison of anorganic bovine carbonate apatite (ABCA) with synthetic carbonated apatite (SCA), which have similar properties but different micro-structures. MATERIAL AND METHODS: Porous structures and anorganic components of ABCA and SCA were evaluated using scanning electron microscope and Fourier transform infrared. They were implanted in maxillary augmentation models with the mouth split design in a total of 15 Beagle dogs. The animals were sacrificed 4, 8 and 16 weeks after surgery, and the histomorphometrical results were statistically analyzed for the material's geometrical relationship and new bone formation in relation to the available space and contact surface for osteoconduction. RESULTS: Both materials showed a typical infrared pattern of CO(3)(2-) -substituted hydroxyapatite (HA). Porous structures and a bridging effect of osteoconductive bone material were relatively better observed in SCA. The ratio of the material area to the total area was higher (P<0.01) for ABCA (28.03±6.09) than for SCA (20.26±4.23). The ratio of the number of particles possessing a pore structure to the total number and the interparticular space was greater (P<0.001 and 0.01) for SCA (18.12±9.44 and 79.74±4.23) compared with ABCA (1.45±1.74 and 71.63±5.85). The new bone areas and the bone-material contact lengths were greater in SCA than in ABCA (P<0.05). CONCLUSIONS: The present study showed that porous structures may have an influence on new bone formation in osteoconductive bone substitutes.
Asunto(s)
Apatitas/farmacología , Sustitutos de Huesos/farmacología , Maxilar/cirugía , Osteogénesis , Animales , Apatitas/química , Sustitutos de Huesos/química , Bovinos , Perros , Ensayo de Materiales , Microscopía Electrónica de Rastreo , Porosidad , Espectroscopía Infrarroja por Transformada de Fourier , Estadísticas no Paramétricas , Propiedades de Superficie , Trasplante HeterólogoRESUMEN
OBJECTIVES: Positive airway pressure (PAP) is considered a standard treatment for moderate-to-severe obstructive sleep apnea (OSA) patients. However, compliance with PAP treatment is suboptimal because of several types of discomfort experienced by patients. This study investigated compliance with PAP therapy, and affecting factors for such compliance, in OSA patients. METHODS: We performed a survey on 69 patients who engaged in PAP therapy between December 2006 and November 2007. After diagnostic polysomnography and manual titration, patients trialed PAP using the ResMed instrument and explored autoadjusting PAP (APAP), continuous PAP (CPAP), and flexible PAP (using expiratory pressure relief [EPR]) at least once every week for 1 month. Compliance measures were mean daily use (hr), percentage of days on which PAP was used, and percentage of days on which PAP was used for >4 hr. Data were obtained at night using the software Autoscan version 5.7(R) of the ResMed Inc. We obtained data on anthropometric (age, BMI, neck circumflex, Epworth sleepiness scale, Pittsburgh Sleep Quality Index, hypertension, alcohol intake), polysomnographic data (severity of apnea-hypopnea index [AHI], proportion of nonsupine sleep time, position dependence of sleep), PAP mode and AHI during PAP use for affecting factors. RESULTS: After 1 month, 41 of the 69 patients (59.4%) were pleased with PAP therapy and purchased instruments. Twenty-four patients (34.7%) used PAP for more than 3 months. The percentage of days on which PAP was used was statistically higher in patients with hypertension than in normotensive patients (P=0.003). There were negative correlations 1) between nonsupine position sleep time and percentage of days on which PAP was used (r=-0.424, P=0.039), and 2) between the AHI during PAP use and the percentage of days on which PAP was used for >4 hr (r=-0.443, P=0.030). There were no statistical differences between AHI, BMI, PAP pressure, or other measured parameters, on the one hand, and compliance, on the other. CONCLUSION: The affecting factors for PAP use were hypertension history, sleep posture (shorter nonsupine sleep time), and lower AHI during PAP use.