Long-Term Functional Outcomes in Pediatric Head and Neck Cancer Patients: A Systematic Review.

OBJECTIVE: The multimodal treatments for pediatric head and neck (H&N) malignancies can have significant long-term functional consequences for growing patients. This systematic review aims to analyze the current knowledge of functional outcomes for pediatric H&N cancer survivors. DATA SOURCES: PubMed, Embase, Web of Science. REVIEW METHODS: Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed, and 1356 papers were reviewed by 3 team members with conflict resolution by a senior member. RESULTS: Fourteen studies were included. Nine of 14 (64%) papers reported issues with swallowing, characterized as either dysphagia, odynophagia, oropharyngeal fibrosis, esophageal stenosis, xerostomia, trismus, or general issues with the throat and mouth. Six of 14 papers noted nutritional and feeding deficiencies, and 5 of 14 additionally noted issues with speech and voice changes. Four of 14 (29%) reported hearing impairments and/or loss. A majority of papers (9/14) reported long-term functional characteristics as a secondary outcome. Three of 14 (21%) reported a quality of life (QoL) measure. Heterogeneity in methodology and reporting precluded analysis of any relationship between treatment type and functional outcomes. Recommendations include integration of objective measures of feeding support and swallowing, as well as regular measurements of function and QoL parameters during treatment to better understand the evolution of QoL and function throughout care. CONCLUSION: Relatively few studies focus on functional outcomes following the treatment of pediatric H&N cancer. Swallowing difficulty is the most frequently reported deficit, but objective data is rarely reported. Standardization of functional outcome assessment could improve the quality of evidence for pediatric patients treated for H&N cancer.

Bidirectional needs assessment of otolaryngology-head and neck surgery short-term surgical trips in Zimbabwe.

Objectives: To describe findings from an otolaryngology-specific needs assessment tool in Zimbabwe. Methods: Surveys were developed and shared with Low-Middle Income Country (LMIC) hosting institutions in Zimbabwe and to High-Income Country surgical trip participants (HIC). Respondents were otolaryngologists identified online and through professional networks who had participated in a surgical trip. Results: The most common procedures Zimbabwe otolaryngologists reported treating were adenotonsillectomy (85.7%), chronic rhinosinusitis (71.4%), chronic otitis (57.1%), and head and neck tumor intervention (57.1%). The most common untreatable conditions that host physicians wanted to treat were skull base surgery (71.4%), flap reconstructions (57.1%), and laryngotracheal reconstruction (57.1%). The largest discrepancy between host desires and visiting team offerings were flap reconstruction (57.1%), nasal bone deformities (37.1%), and laryngotracheal reconstruction (17.1%). Perceptions of short-term surgical trips (STST) were recorded for host and visiting teams, and important differences between the public and private sectors of care in Zimbabwe were also identified. Conclusion: The surveys utilized in this study served as a bidirectional needs assessment of the requirements and care goals of host institutions and visiting teams in Zimbabwe. Differences between public and private sectors of care, particularly regarding infrastructure, resources, and surgical goals, were revealed, and the results can be utilized as part of efforts to maximize efforts within global surgical partnerships. Level of Evidence: VI.

Analysis of Temporal Artery Biopsy by Provider Across a Large Multi-State Health Care Network.

Temporal artery biopsy (TAB) is the standard test for diagnosing giant cell arteritis. Our objective was to determine which specialists perform TABs and if there is variation across the United States. We performed a cross-sectional analysis in a multi-state health care system, evaluating differences between observed counts of surgical specialty by region, positive diagnoses by region, and positive diagnoses by specialty. Temporal arterial biopsy was performed on 3825 patients with the proportion of specialties performing TAB differing between regions. Temporal artery biopsy was performed by a significantly higher percentage of general surgeons in the Midwest (53.6%) and less vascular surgeons in the West (30.4%). The percentage of positive diagnoses was higher for vascular surgeons (32.7%). We concluded that TAB is performed by physicians of many specialties with the specialty performing most of these procedures varying by region. There is also a difference in the rate of positive diagnoses that varies with surgical specialty.

Cochlear Implant Outcomes in the Chinese-Speaking Adult Population: A Systematic Review.

OBJECTIVE: The purpose of this study is to perform a systematic review of speech perception outcomes in the Chinese-speaking adult cochlear implant (CI) population. DATABASES REVIEWED: PubMed, EMbase, and Scopus. METHODS: A comprehensive English literature search was performed with MeSH search terms, keywords, and phrases. Literature written in a language other than English was not included. Full-text articles were screened by two blinded reviewers and adjudicated by a third. Relevant outcomes and demographic data were extracted. Qualitative summaries were performed of the demographics and assessment tools. Speech perception outcomes were assessed with quantitative measures. RESULTS: Forty-four studies (n = 467) notable for marked heterogeneity in speech perception assessment utilized and reporting of relevant patient demographics were included. Mean duration of deafness among studies reporting this metric was 10.27 years (range, 0.08-49; SD, 7.70; n = 250), with 80% of subjects reporting >5 years' duration of deafness and only 19 subjects (7.6%) with <1 year of deafness preimplantation. A summary of the most commonly used assessments is provided. CONCLUSION: Within the English-language literature, there is marked heterogeneity and lack of standardization regarding speech perception outcomes, tests utilized, and reported patient demographics in the Chinese-speaking adult CI population. Most Chinese-speaking CI users for whom data were available had prolonged duration of deafness before implantation. This study may serve as an initial reference for providers counseling Chinese-language CI candidates and who may be interested in adopting these tests, while highlighting the need for continued efforts to measure speech perception outcomes after CI for tonal language speakers.

Augmented Reality in Minimally Invasive Spinal Surgery: A Narrative Review of Available Technology.

INTRODUCTION: Spine surgery has undergone significant changes in approach and technique. With the adoption of intraoperative navigation, minimally invasive spinal surgery (MISS) has arguably become the gold standard. Augmented reality (AR) has now emerged as a front-runner in anatomical visualization and narrower operative corridors. In effect, AR is poised to revolutionize surgical training and operative outcomes. Our study examines the current literature on AR-assisted MISS, synthesizes findings, and creates a narrative highlighting the history and future of AR in spine surgery. MATERIAL AND METHODS: Relevant literature was gathered using the PubMed (Medline) database from 1975 to 2023. Pedicle screw placement models were the primary intervention in AR. These were compared to the outcomes of traditional MISS RESULTS: We found that AR devices on the market show promising clinical outcomes in preoperative training and intraoperative use. Three prominent systems were as follows: XVision, HoloLens, and ImmersiveTouch. In the studies, surgeons, residents, and medical students had opportunities to operate AR systems, showcasing their educational potential across each phase of learning. Specifically, one facet described training with cadaver models to gauge accuracy in pedicle screw placement. AR-MISS exceeded free-hand methods without unique complications or contraindications. CONCLUSIONS: While still in its infancy, AR has already proven beneficial for educational training and intraoperative MISS applications. We believe that with continued research and advancement of this technology, AR is poised to become a dominant player within the fundamentals of surgical education and MISS operative technique.

Sirolimus-induced pulmonary hemorrhage of an infant with massive cervicofacial lymphatic malformation: A case report.

Lymphatic malformations (LMs) are uncommon congenital abnormalities of the lymphatic system. As more than half of these lesions develop in the head and neck, LMs can be life-threatening if associated with airway involvement. LMs necessitate a multidisciplinary treatment approach, frequently including surgery and sclerotherapy. We present a case report of a 32-week pre-term male infant with a massive cervicofacial LM necessitating delivery via ex-utero intrapartum treatment (EXIT). The patient was treated with numerous rounds of sclerotherapy, systemic sirolimus, and surgical debulking, but ultimately died at 4 months of age due to acute pulmonary hemorrhage, which may have been related to sirolimus due to the absence of any other associable organ involvement or derangement. We document the patient's clinical course and treatment regimen, highlighting the myriad modalities employed to treat these challenging lesions, and describe a potentially lethal complication of sirolimus therapy not previously described in the treatment of pediatric LM.

Functional dynamics observations of haptoral armature in Mizelleus indicus (Jain 1957) Pandey et al. 2003.

The negative effect of monogenea on piscine host may vary in the host species. Genus Mizelleus (Monogenea: Ancyrocephalidae) was reported for the first time from the freshwater shark, Wallago attu (Bl. and Schn.) at Lucknow by Jain (1957). Haptor or opisthohaptor of monogenea which is more or less discoid muscular structure situated posteriorly, is the chief adhesive organ. It is usually provided with anchors and marginal hooklets. Anchors, ventral transverse bar, together with the additional supporting dorsal bars (patches) are active elements of haptor while, marginal hooklets serve as secondary supportive participants, whereas, the dorsal transverse bar can be treated as an inactive element in the whole organ of attachment. Functional dynamics detail of haptoral armature is almost unattended. The anchors in case of M. indicus (Jain 1957) Pandey et al. (2003) are disposed one against the other and used to act like four lobed grapnel like a spreader. All components of haptoral armature contribute in one way or another in the process of functional process. Interestingly the worms do not follow the same pattern of sequences during their movements. Various elements and factors are involved in the process. The authors tried to pinpoint the changes in the activity of one major element i.e., dorsal anchor. The movement and change in position/orientation of various elements with reference to dorsal anchors were observed and summarized. Present paper is rare effort in unexplored aspect in monogenea biology.

Evaluation of Antioxidant and Hepatoprotective Activities of Moringa oleifera Lam. Leaves in Carbon Tetrachloride-Intoxicated Rats.

The antioxidant and hepatoprotective activities of the extract of Moringa oleifera leaves were investigated against CCl4-induced hepatotoxicity in rats. Hepatotoxic rats were treated with ethanol extract of Moringa oleifera for a period of 60 days at the following three dose levels; 100, 200 and 400 mg/kg body weight/day, orally. The activities were studied by assaying the serum marker enzymes like SGOT, SGPT, GGT, LDH, ALP, ACP, as well as total bilirubin, total protein and albumin in serum concomitantly with the activities of LPO, SOD, CAT, GSH, GR and GPx in liver. The activities of all parameters registered a significant (p ≤ 0.001) alteration in CCl4 treated rats, which were significantly recovered towards an almost normal level in rats co-administered with M. oleifera extract in a dose-dependent manner. All the biochemical investigations were confirmed by the histopathological observations and compared with the standard drug. silymarin. Results suggest that the antioxidant and hepatoprotective activities of M. oleifera leaves are possibly related to the free radical scavenging activity which might be due to the presence of total phenolics and flavonoids in the extract and/or the purified compounds ß-sitosterol, quercetin and kaempferol, which were isolated from the ethanol extract of M. oleifera leaves.

Antioxidant Potential of Plumieride against CCl4-Induced Peroxidative Damage in Rats.

In search of a new potent as an antioxidant from natural sources, plumieride-an iridoid isolated from the methanol extract of the bark of Plumeria bicolor (family Apocynaceae) was evaluated for its antioxidant potential against CCl4-induced peroxidative damage in liver of rats. The antioxidant potential was evaluated by using hepatic tissue for SOD (superoxide dismutase), CAT (catalase), GSH (reduced glutathione), GPx (glutathione peroxidase), GR (glutathione reductase) and LPO (lipid peroxidation) alongwith the concomitant blood serum for AST & ALT (aspartate and alanine transaminases), GGT (gamma glutamyl transpeptidase), ALP (alkaline phosphatase), total bilirubin and total protein contents. All the biochemical parameters were significantly (p ≤ 0.001) altered by CCl4 (0.3 mL/kg body weight/twice a week, intra-peritoneally for 30 days). Simultaneously, oral treatment with plumieride (5, 10 and 20 mg/kg body weight/day for 30 days), restored all the parameters towards a normal level, remarkably. The histological findings of liver sections further corroborated the antioxidant potential of plumieride compared with standard drug-silymarin. In conclusion, plumieride consists of sugar molecules, which have alcoholic groups. Therefore, the alcoholic groups of sugar increase its antioxidant potential through intermolecular hydrogen bonding along with the thiol(SH) group of non-protein thiols and enzymes resulting in the restoration of the antioxidant system. Therefore, it might be considered a natural antioxidant against peroxidative damage in rats.