Transoral laser exoscopic surgery of the larynx: state of the art and comparison with traditional transoral laser microsurgery.

Objective: To evaluate the efficacy of transoral laser exoscopic surgery (TOLES) in a unicentric series of patients affected by benign and malignant glottic and supraglottic lesions, and compare outcomes with those of transoral laser microsurgery (TOLMS). Methods: To demonstrate the non-inferiority of TOLES in terms of operative time, margin status and complication rates, we compared outcomes of 93 patients treated by TOLES between July 2021 and July 2023 with those of a match-paired group of 107 historical patients treated by TOLMS. To perform a multiparametric ergonomic evaluation of TOLES vs TOLMS, we used observational methods for biomechanical overload risk assessment and wearable technologies comparing 15 procedures with TOLES vs a paired match of 13 surgeries performed with TOLMS by the same surgeon. Results: No significant differences were found in terms of surgical duration, positive margins, or complications between TOLES and TOLMS. Ergonomics assessment by inertial measurement units and electromyographic surface electrodes demonstrated a reduced biomechanical overload with TOLES compared to TOLMS. Conclusions: The many advantages of TOLES, such as its superior didactic value, better digital control of light even through small-bored laryngoscopes, improved binocular vision, and increase in surgical performance by 3 or 4-hand techniques, are difficult to be quantified. In contrast, its non-inferiority in terms of oncological results and better ergonomics compared to TOLMS are demonstrated herein.

Determinants of SARS-CoV-2 infection in Italian healthcare workers: a multicenter study.

Healthcare workers (HCWs) are at increased risk of being infected with SARS-CoV-2, yet limited information is available on risk factors of infection. We pooled data on occupational surveillance of 10,654 HCW who were tested for SARS-CoV-2 infection in six Italian centers. Information was available on demographics, job title, department of employment, source of exposure, use of personal protective equipment (PPEs), and COVID-19-related symptoms. We fitted multivariable logistic regression models to calculate odds ratios and 95% confidence intervals of infection. The prevalence of infection ranged from 3.0 to 22.0%, and was correlated with that of the respective areas. Women were at lower risk of infection compared to men. Fever, cough, dyspnea and malaise were the symptoms most strongly associated with infection, together with anosmia and ageusia. No differences in the risk of infection were detected according to job title, or working in a COVID-19 designated department. Reported contact with a patient inside or outside the workplace was a risk factor. Use of a mask was strongly protective against risk of infection as was use of gloves. The use of a mask by the source of exposure (patient or colleague) had an independent effect in reducing infection risk.

Systematic review and meta-analysis of epidemiological studies on the association of occupational exposure to free crystalline silica and systemic lupus erythematosus.

OBJECTIVES: Some evidence suggests that exposure to free crystalline silica may contribute to the risk of developing SLE. A systematic search was carried out for all published epidemiological studies concerning this association. A meta-analysis was conducted on relevant studies. METHODS: We searched PubMed and EMBASE databases for original articles published from 1960 to November 2019 in any language. In addition, we also searched the reference lists of included studies manually for additional relevant articles. Finally, seven studies were included in the systematic review and six studies in the meta-analysis (four case-control and two cohort studies). The odds ratio and 95% CI were calculated using a random effect meta-analysis. RESULTS: The meta-analysis of the studies, applying a random effect model, yielded an overall odds ratio of 3.49 (95% CI, 1.24, 9.83), with I2 = 92.36% (pronounced heterogeneity). We also stratified the meta-analysis by study design; case-control studies: odds ratio 1.85 (95% CI, 0.96, 3.59) with I2 = 75.92%; and cohort studies (cases with silicosis): odds ratio 9.71 (95% CI, 1.13, 83.58) with I2 = 72.65%. CONCLUSIONS: The obtained results support the hypothesis of a possible association between occupational exposure to free crystalline silica and SLE, in particular at higher exposure levels, known to induce silicosis. The studies that have investigated this association are still scarce and the heterogeneity between the studies remains high. New studies are deemed necessary to confirm the association.