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1.
J Laryngol Otol ; 134(4): 354-361, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32284084

RESUMEN

OBJECTIVE: To evaluate the upper airway morphology changes associated with ageing in adult Chinese patients with obstructive sleep apnoea. METHODS: A total of 124 male patients diagnosed with obstructive sleep apnoea by overnight polysomnography, who underwent upper airway computed tomography, were enrolled. The linear dimensions, cross-sectional area and volume of the upper airway region and the surrounding bony frame were measured. The association between ageing and upper airway morphology was analysed. RESULTS: Soft palate length, minimum cross-sectional area of the retroglossal region, lateral dimensions at the minimum cross-sectional area of the retropalatal and retroglossal regions, nasopharyngeal volume, and average cross-sectional area of the nasopharyngeal region were found to significantly increase with ageing in all patients, while the upper airway shape flattened with ageing. The volume of the retropalatal region increased with ageing among the patients with a body mass index of less than 24 kg/m2. The volume of parapharyngeal fat pad increased with ageing among patients with a body mass index greater than 28 kg/m2. CONCLUSION: A number of dimensional, cross-sectional and volumetric parameters of the pharynx increased with age, indicating that non-anatomical factors may play a more important role in the pathogenesis of obstructive sleep apnoea in aged patients.


Asunto(s)
Remodelación de las Vías Aéreas (Respiratorias)/fisiología , Nasofaringe/patología , Paladar Blando/patología , Faringe/patología , Apnea Obstructiva del Sueño/fisiopatología , Adolescente , Adulto , Factores de Edad , Índice de Masa Corporal , China/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Nasofaringe/anatomía & histología , Nasofaringe/diagnóstico por imagen , Paladar Blando/anatomía & histología , Paladar Blando/diagnóstico por imagen , Faringe/anatomía & histología , Faringe/diagnóstico por imagen , Polisomnografía/métodos , Estudios Retrospectivos , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Adulto Joven
2.
Cancer Radiother ; 24(2): 93-98, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32057645

RESUMEN

OBJECTIVE: Postradiation nasopharyngeal necrosis (PRNN) is a notorious complication after radiotherapy that affects prognosis in patients with nasopharyngeal carcinoma (NPC). It is important for clinical doctors to realize this problem in order to cope with this severe clinical situation. The aim of our study was to assess the bacteriology of PRNN and to demonstrate the antimicrobial susceptibility pattern that should guide the clinicians towards more appropriate antibiotic use. METHODS: Sixty-nine NPC patients with PRNN in our department between March 2013 and December 2017 were retrospectively enrolled. Pathogenic culture and drug sensitivity test were performed in these 69 NPC patients with PRNN. The infection rate of Pathogens and the sensitivity of the drugs were analyzed based on these results. RESULTS: Sixty-nine NPC patients with PRNN were enrolled in our study. Pathogens were identified in 58 (84%) patients. Of the 58 patients, Staphylococcus aureus was isolated in 34 (58.6%) patients. And the second most common group of bacterial isolates was Pseudomonas aeruginosa. Antibiotic sensitivity showed that Levofloxacin was the highest (88.5%), followed by Ciprofloxacin (85.2%) and Gentamicin (80.3%). The only pathologic fungus was Candidaalbicans, about 6.8%. The positive rates of bacterial and fungal culture in PRNN patients were not significantly different from the patients' gender, age, stage, number of radiotherapy courses (P>0.05), but the cure rate was statistically higher in culture-negative patients in comparison with culture-positive patients (63.6% vs 20.7%, P=0.011). CONCLUSION: Our results provide an overall picture of the microbiology and drug susceptibility patterns for NPC patients with PRNN and could help implement guidelines for more rational treatment and improve therapeutic outcome.


Asunto(s)
Antibacterianos/uso terapéutico , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/radioterapia , Nasofaringe/efectos de la radiación , Traumatismos por Radiación/microbiología , Adulto , Anciano , Candida albicans/efectos de los fármacos , Ciprofloxacino/uso terapéutico , Femenino , Gentamicinas/uso terapéutico , Humanos , Levofloxacino/uso terapéutico , Masculino , Persona de Mediana Edad , Nasofaringe/diagnóstico por imagen , Nasofaringe/patología , Necrosis/diagnóstico por imagen , Necrosis/microbiología , Pseudomonas aeruginosa/efectos de los fármacos , Traumatismos por Radiación/diagnóstico por imagen , Traumatismos por Radiación/patología , Estudios Retrospectivos , Staphylococcus aureus/efectos de los fármacos , Resultado del Tratamiento
3.
Ann R Coll Surg Engl ; 102(2): e45-e47, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31538802

RESUMEN

Parapharyngeal infections carry a significant risk of extensive suppuration and airway compromise. We report the case of a patient presenting with a right paranasopharyngeal abscess, featuring atypical symptoms that made diagnosis particularly challenging. Complications included evidence of right vocal cord paralysis, likely secondary to involvement of the vagus nerve. Notably, this paralysis occurred in isolation, without involvement of cranial nerves IX or XI, which would be expected from jugular foramen encroachment. Imaging demonstrated the presence of a collection extending towards the skull base, which was drained using a transnasal endoscopic approach, avoiding the use of external incisions. Tissue biopsies from the abscess wall suggest that the underlying aetiology was minor salivary gland sialadenitis, which has not been previously reported in the literature.


Asunto(s)
Absceso/etiología , Enfermedades Faríngeas/etiología , Sialadenitis/complicaciones , Parálisis de los Pliegues Vocales/etiología , Absceso/diagnóstico , Absceso/cirugía , Adolescente , Biopsia , Drenaje , Endoscopía , Femenino , Humanos , Imagen por Resonancia Magnética , Cavidad Nasal/diagnóstico por imagen , Cavidad Nasal/patología , Nasofaringe/diagnóstico por imagen , Nasofaringe/patología , Enfermedades Faríngeas/diagnóstico , Enfermedades Faríngeas/cirugía , Nervio Laríngeo Recurrente/diagnóstico por imagen , Glándulas Salivales Menores/patología , Sialadenitis/diagnóstico , Sialadenitis/patología , Base del Cráneo/diagnóstico por imagen , Base del Cráneo/patología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Parálisis de los Pliegues Vocales/diagnóstico
4.
Anesth Analg ; 130(4): 1018-1025, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31162158

RESUMEN

BACKGROUND: Preformed nasal endotracheal tubes (NETs) come with a predefined insertion depth due to their curved design. While size indication refers to internal diameter, there is a considerable variability in the corresponding lengths and proportions of same-sized tubes of different manufacturers which is probably based on the lack of data of nasolaryngeal distances (NLDs) in the adult population. Choosing the best-fitting NET is therefore difficult and carries the risk of endobronchial intubation or, on the contrary, cuff inflation at the vocal cord level. The aim of this study was to develop a prediction model for NLD and a selection guide to choose the appropriate NET based on a radiographic description of NLD in comparison to the measurements of available NETs of several manufacturers. METHODS: After institutional ethics board review, 388 computed tomography (CT) scan images of head, neck, and upper thorax in a heterogeneous adult cohort were included. Mean distances from the nares to the lower border of the thyroid cartilage were measured. NETs from different manufacturers were measured and compared to the NLD derived from the radiographic analysis. The patients' sex, body height, and weight were considered as possible covariates in quantile regression models for predicting the NLD. RESULTS: Data from 200 patients were analyzed. NLD was associated with sex, body height, and weight. A simple quantile regression model using the body height as the only covariate sufficed to achieve accurate predictions of NLD. Validation on independent test data showed that 92.8% of the NLD predictions were closer than ±20 mm to the observed NLD values. Measurements of equal-sized NETs varied considerably in outer diameter, proportion, the nasopharyngeal part, and guide marks. Length differences of the bend-to-cuff distance, containing the anatomically NLD, ranged between 218 and 270 mm at same sizes. CONCLUSIONS: A reliable prediction of NLD can be obtained simply by body height, using the formula (Equation is included in full-text article.). As manufacturers' tube lengths vary substantially, additional information about the bend-to-cuff distance as corresponding tube section would allow for more accurate tube selection.


Asunto(s)
Intubación Intratraqueal/instrumentación , Laringe/anatomía & histología , Nariz/anatomía & histología , Adulto , Anciano , Anciano de 80 o más Años , Estatura , Peso Corporal , Estudios de Cohortes , Diseño de Equipo , Femenino , Humanos , Laringe/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Nasofaringe/anatomía & histología , Nasofaringe/diagnóstico por imagen , Nariz/diagnóstico por imagen , Valores de Referencia , Reproducibilidad de los Resultados , Caracteres Sexuales , Cartílago Tiroides/anatomía & histología , Cartílago Tiroides/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto Joven
6.
J Craniofac Surg ; 30(8): 2451-2455, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31689729

RESUMEN

OBJECTIVE: To evaluate the morphological changes of the upper airway of patients with skeletal Class III malocclusion after undergoing bilateral mandibular ramus dislocated mandibular retrogression (SSRO) or SSRO combined with Le Fort I maxillary osteotomy and 3-dimensional imaging. METHODS: All previous studies related to the upper airway in patients with skeletal class III malocclusion and orthognathic surgery were collected from the PubMed, EMB, Cochrane Library, Web of science, ClinicalKey, EBSCO, Weipu, Wanfang, China National Knowledge Infrastructure, and Chinese BioMedical Literature databases. The search date ends in August 2017. RevMan5.3 software was used to perform a meta-analysis related to upper airway morphology. Ten studies were included. RESULTS: The meta-analysis showed that 6 months after SSRO, CV1, and CV2 did not change significantly (P >0.05), whereas CV3 and CV4 narrowed (P <0.05) and remained narrow after 1 year (P <0.05). (CV1,CV2,CV3,CV4: Plans parallel to the FH plane passing through the most anterior inferior point of the anterior arch of the atlas, the 2nd cervical vertebra, the 3rd cervical vertebra, the 4th cervical vertebra.) There was no significant change in nasopharyngeal volume or laryngeal pharyngeal volume (P >0.05), but oropharyngeal volume and total volume decreased (P ≤0.01). Six months after SSRO combined with Le Fort I maxillary osteotomy, the minimum cross-sectional area of the upper airway was smaller (P <0.05), there was no significant change in nasopharyngeal volume or oropharyngeal volume (P >0.05), and oropharynx volume and total volume decreased (P <0.05). CONCLUSIONS: Single and double jaw surgery has no significant effect on nasopharynx and oropharynx, but reduces laryngopharynx and total volume; however, whether this will result in postoperative obstructive sleep apnea-hypopnea syndrome or become ameliorated over time requires more in-depth study and a longer period of clinical observation.


Asunto(s)
Maloclusión de Angle Clase III/cirugía , Cirugía Ortognática , Humanos , Hipofaringe/diagnóstico por imagen , Imagenología Tridimensional/métodos , Nasofaringe/diagnóstico por imagen
7.
Am J Orthod Dentofacial Orthop ; 156(2): 257-265, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31375236

RESUMEN

INTRODUCTION: Children with unilateral cleft lip and palate (UCLP) exhibit snoring and mouth breathing. They are also reported to show obstructive sleep apnea syndrome. However, their upper airway ventilation condition is not clearly understood. Therefore, this study was performed to evaluate upper airway ventilation condition in children with UCLP with the use of computational fluid dynamics. METHODS: Twenty-one children (12 boys, 9 girls; mean age 9.1 years) with UCLP and 25 children (13 boys, 12 girls; mean age 9.2 years) without UCLP who required orthodontic treatment underwent cone-beam computed tomography (CBCT). Nasal resistance and upper airway ventilation condition were evaluated with the use of computational fluid dynamics from CBCT data. The groups were compared with the use of Mann-Whitney U tests and Student t tests. RESULTS: Nasal resistance of the UCLP group (0.97 Pa/cm3/s) was significantly higher than that of the control group (0.26 Pa/cm3/s; P < 0.001). Maximal pressure of the upper airway (335.02 Pa) was significantly higher in the UCLP group than in the control group (67.57 Pa; P < 0.001). Pharyngeal airway (from choanae to base of epiglottis) pressure in the UCLP group (140.46 Pa) was significantly higher than in the control group (15.92 Pa; P < 0.02). CONCLUSIONS: Upper airway obstruction in children with UCLP resulted from both nasal and pharyngeal airway effects.


Asunto(s)
Labio Leporino/patología , Fisura del Paladar/patología , Tomografía Computarizada de Haz Cónico/métodos , Hidrodinámica , Laringe/anatomía & histología , Nariz/anatomía & histología , Tonsila Faríngea/anatomía & histología , Puntos Anatómicos de Referencia , Niño , Labio Leporino/diagnóstico por imagen , Fisura del Paladar/diagnóstico por imagen , Epiglotis/anatomía & histología , Epiglotis/diagnóstico por imagen , Femenino , Humanos , Hueso Hioides/anatomía & histología , Imagenología Tridimensional/métodos , Laringe/diagnóstico por imagen , Maloclusión de Angle Clase I , Nasofaringe/anatomía & histología , Nasofaringe/diagnóstico por imagen , Nariz/diagnóstico por imagen , Respiración , Apnea Obstructiva del Sueño
8.
Am J Orthod Dentofacial Orthop ; 156(1): 53-60, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31256838

RESUMEN

INTRODUCTION: Pharyngeal airway space (PAS) assessment has been used in the past for a better understanding of orthodontic and surgical outcomes; however, this analysis could be unreliable. Our objective was to evaluate possible changes in the PAS reading in the same patient from their consecutive cone-beam computed tomography (CBCT) scans. METHODS: We evaluated a total of 27 patients' CBCT scans obtained at 2 time points with the use of a standardized acquisition protocol. The mean age at T0 was 31 years (range 17-62 years) and the follow-up records (T1) were taken after 4-6 months. Dolphin Imaging software was used to measure the volumes of the nasopharynx, oropharynx, and hypopharynx. We also evaluated the craniocervical position with the use of a lateral cephalogram. RESULTS: The variables exhibited high intraclass correlation coefficients (ICCs) when measuring the same CBCT scan twice (T0 and T0). However, The ICC between the measurements performed on the first and second CBCT scans (T0 and T1) showed that the only variable with high reproducibility between the 2 scans was cranial base, with an ICC >0.97. Average differences of 682.1 mm3, 2255.3 mm3, and 517.4 mm3 were found for the nasopharynx, oropharynx, and hypopharynx, respectively. Regarding the cephalometric angles, average differences between T0 and T1 scans were 0.6°, 2.7°, and 0.4° for OPT.CVT, OPT.SN, and cranial base, respectively. CONCLUSIONS: Different CBCT exams with equal scanning and patient positioning protocols can result in different 3D PAS readings. A more careful interpretation of CBCT volumetric data to achieve adequate conclusions of the clinical outcomes is necessary.


Asunto(s)
Tomografía Computarizada de Haz Cónico/métodos , Tomografía Computarizada de Haz Cónico/normas , Posicionamiento del Paciente/métodos , Posicionamiento del Paciente/normas , Faringe/anatomía & histología , Faringe/diagnóstico por imagen , Adolescente , Adulto , Cefalometría/métodos , Femenino , Estudios de Seguimiento , Humanos , Hipofaringe/anatomía & histología , Hipofaringe/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodos , Imagenología Tridimensional/métodos , Masculino , Persona de Mediana Edad , Nasofaringe/anatomía & histología , Nasofaringe/diagnóstico por imagen , Variaciones Dependientes del Observador , Orofaringe/anatomía & histología , Orofaringe/diagnóstico por imagen , Procedimientos Quirúrgicos Ortognáticos , Valores de Referencia , Reproducibilidad de los Resultados , Programas Informáticos , Adulto Joven
9.
Comput Methods Programs Biomed ; 177: 203-209, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31319949

RESUMEN

BACKGROUND AND OBJECTIVE: Sneezing is one of the most critical conditions that can occur in the human upper airway. As some reports confirm the injury to the human upper respiratory airway while sneezing. Therefore, the accurate study of the distribution of pressure and velocity in this case is of great importance. METHODS: In the present study, using a real human upper airway model, the pressure and velocity of the airflow generated in the tract during the sneezing have been investigated. Also, considering the results from a spirometer device as a boundary condition in the simulation process, the calculations have become reliable. RESULTS: According to the results, during sneezing, taking into account that the average outlet flow rate from the mouth is 4.79 L/s, the velocity of outlet airflow from the mouth and nose reaches 5.3 and 8.4 m/s, respectively. These values were 11.5 and 19, respectively, when the desired maximum flow rate was 10.58 L/s. It can be concluded that the increasing of trachea flow rate, leads to higher percentage of the outlet flow rate from the nose . The highest average pressure and velocity have been occurred in the trachea. Among other salient results of this report, increased average static pressure of larynx to approximately 10 kPa can be pointed which indicates that this area is critical so that the thyroid cartilage defect is likely to occur. It is also noteworthy that the increase of speed at nasopharynx is up to 125 m/s so that the cross-section changing in this area leads the fluid acts as a jet flow. Due to the specific geometry of the nasal cavity, some streams similar to poor shocks are formed, these shocks get stronger by increasing of the flow rate. The thyroid cartilage and nasal cavity are exposed to maximum static pressure extremums, respectively. CONCLUSIONS: We introduced a model simulating a normal sneezing for two cases using a healthy 30-year-old male person. We believe that the model should be applied for different persons and an atlas of data could be obtained from different cases. This may help the medical system to have more data about the sneezing process.


Asunto(s)
Nasofaringe/fisiología , Respiración , Mecánica Respiratoria , Estornudo , Tráquea/fisiología , Adulto , Algoritmos , Simulación por Computador , Humanos , Hidrodinámica , Imagenología Tridimensional , Masculino , Modelos Anatómicos , Cavidad Nasal/diagnóstico por imagen , Cavidad Nasal/fisiología , Nasofaringe/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Tráquea/diagnóstico por imagen
10.
BMJ Case Rep ; 12(6)2019 Jun 08.
Artículo en Inglés | MEDLINE | ID: mdl-31177192

RESUMEN

We report a 35-year-old woman with complaints of nasal obstruction and mild post-nasal drip for 6 months. She did not improve with medical treatment. Clinical examination had no positive finding. She was evaluated with a CT scan and MRI that revealed a polypoid mass lesion in nasopharynx without any adhesion to adjacent tissue. Endoscopic examination of nasopharynx revealed an exophytic nasopharyngeal mass in anterior wall of nasopharynx that complete macroscopic transnasal endoscopic resection was performed. The histopathological examination reported thyroid-like low-grade nasopharyngeal papillary adenocarcinoma that was confirmed on immunohistochemical staining. After complete macroscopic resection of the mass, patient was regularly followed-up for 6 years and there was no evidence of recurrence. This example has the educational tips of the optimal therapeutic strategies for primary nasopharyngeal adenocarcinomas with long follow-up.


Asunto(s)
Adenocarcinoma Papilar/patología , Neoplasias Nasofaríngeas/patología , Nasofaringe/patología , Adenocarcinoma Papilar/metabolismo , Adenocarcinoma Papilar/cirugía , Adulto , Cuidados Posteriores , Endoscopía/métodos , Femenino , Humanos , Imagen por Resonancia Magnética , Neoplasias Nasofaríngeas/cirugía , Nasofaringe/diagnóstico por imagen , Glándula Tiroides/patología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
11.
Biomed Res Int ; 2019: 5012037, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31008106

RESUMEN

Purpose: We investigated the pharyngeal airway dimensions and their correlations in patients who underwent mandibular setback surgery versus those who did not. Materials and Methods: One hundred and sixty cephalometric radiographs (120 patients) were obtained from patients with three skeletal malocclusion classifications: Class I and Class II in the nonsurgery group and Class III in the surgery group (preoperative and postoperative cephalograms). The following dimensions were measured: nasopharyngeal airway (NOP), uvulopharyngeal airway (UOP), shortest distance from the posterior tongue to the pharyngeal wall (TOP), and distance from the epiglottis to the pharyngeal wall (EOP). Paired t test, one-way analysis of variance, and Pearson correlation coefficients were used for statistical analysis. Results: Preoperatively, UOP and TOP of skeletal Class III patients (15.2 mm and 16.6 mm) were significantly larger than those of skeletal Class II (11.5 mm and 12 mm) and Class II (12.3 mm and 12.9 mm) patients, respectively. No differences were observed in EOP between the three skeletal patterns. The hyoid bone of Class III patients was significantly anterior to that of Class I/II patients. Furthermore, UOP had a moderate negative correlation with soft palate length. Postoperatively, no significant difference (UOP, TOP, EOP, soft palate width, and hyoid bone) was found between the skeletal classes. Conclusion: Preoperatively, UOP and TOP of skeletal Class III patients were significantly wider than those of skeletal Class I/II patients. Pre- and postoperatively, EOP did not exhibit significant differences among the three skeletal classifications. No differences were found in all postoperative pharyngeal airway dimensions between Class III patients and nonsurgery patients (Class I and Class II).


Asunto(s)
Cefalometría , Epiglotis/diagnóstico por imagen , Nasofaringe/diagnóstico por imagen , Faringe/diagnóstico por imagen , Adolescente , Adulto , Epiglotis/fisiopatología , Epiglotis/cirugía , Femenino , Humanos , Hueso Hioides/diagnóstico por imagen , Hueso Hioides/fisiopatología , Masculino , Maloclusión de Angle Clase III/diagnóstico por imagen , Maloclusión de Angle Clase III/fisiopatología , Maloclusión de Angle Clase III/cirugía , Mandíbula/diagnóstico por imagen , Mandíbula/fisiopatología , Mandíbula/cirugía , Nasofaringe/fisiopatología , Nasofaringe/cirugía , Procedimientos Quirúrgicos Ortognáticos , Paladar Blando/diagnóstico por imagen , Paladar Blando/fisiopatología , Paladar Blando/cirugía , Faringe/fisiopatología , Faringe/cirugía , Radiografía , Lengua/diagnóstico por imagen , Lengua/fisiopatología
12.
Radiology ; 291(3): 677-686, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30912722

RESUMEN

Background Nasopharyngeal carcinoma (NPC) may be cured with radiation therapy. Tumor proximity to critical structures demands accuracy in tumor delineation to avoid toxicities from radiation therapy; however, tumor target contouring for head and neck radiation therapy is labor intensive and highly variable among radiation oncologists. Purpose To construct and validate an artificial intelligence (AI) contouring tool to automate primary gross tumor volume (GTV) contouring in patients with NPC. Materials and Methods In this retrospective study, MRI data sets covering the nasopharynx from 1021 patients (median age, 47 years; 751 male, 270 female) with NPC between September 2016 and September 2017 were collected and divided into training, validation, and testing cohorts of 715, 103, and 203 patients, respectively. GTV contours were delineated for 1021 patients and were defined by consensus of two experts. A three-dimensional convolutional neural network was applied to 818 training and validation MRI data sets to construct the AI tool, which was tested in 203 independent MRI data sets. Next, the AI tool was compared against eight qualified radiation oncologists in a multicenter evaluation by using a random sample of 20 test MRI examinations. The Wilcoxon matched-pairs signed rank test was used to compare the difference of Dice similarity coefficient (DSC) of pre- versus post-AI assistance. Results The AI-generated contours demonstrated a high level of accuracy when compared with ground truth contours at testing in 203 patients (DSC, 0.79; 2.0-mm difference in average surface distance). In multicenter evaluation, AI assistance improved contouring accuracy (five of eight oncologists had a higher median DSC after AI assistance; average median DSC, 0.74 vs 0.78; P < .001), reduced intra- and interobserver variation (by 36.4% and 54.5%, respectively), and reduced contouring time (by 39.4%). Conclusion The AI contouring tool improved primary gross tumor contouring accuracy of nasopharyngeal carcinoma, which could have a positive impact on tumor control and patient survival. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Chang in this issue.


Asunto(s)
Aprendizaje Profundo , Interpretación de Imagen Asistida por Computador/métodos , Imagen por Resonancia Magnética/métodos , Carcinoma Nasofaríngeo/diagnóstico por imagen , Neoplasias Nasofaríngeas/diagnóstico por imagen , Adolescente , Adulto , Algoritmos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nasofaringe/diagnóstico por imagen , Estudios Retrospectivos , Adulto Joven
13.
Ann Diagn Pathol ; 40: 1-6, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30822626

RESUMEN

We characterize the clinicopathological features of two patients (one 38 year old woman and one 42 year old man, both of Chinese ethnicity) with Epstein Barr Virus positive non-keratinizing nasopharyngeal carcinoma from an endemic region with prominent presence of amyloid and one case with both amyloid and abundant intracytoplasmic hyaline globules. The amyloid material was positive for Congo red and showed apple green birefringence when examined under polarized light. The amyloid was immunoreactive for cytokeratins and was located both intra- and extracellularly. Frequently the amyloid had a light microscopical spherical appearance and displayed peripheral radiating fibrils from a central homogenous core. One of the patients had a unique presentation of nasopharyngeal carcinoma with perceived hemoptysis and coughing up two pieces of tumor tissue. In reality, the nasopharyngeal tumor was polypoid and the two fragments were pinched of from the main tumor mass.


Asunto(s)
Amiloide/metabolismo , Infecciones por Virus de Epstein-Barr/diagnóstico por imagen , Herpesvirus Humano 4/aislamiento & purificación , Hialina/metabolismo , Carcinoma Nasofaríngeo/diagnóstico por imagen , Neoplasias Nasofaríngeas/diagnóstico por imagen , Adulto , Infecciones por Virus de Epstein-Barr/patología , Femenino , Humanos , Masculino , Carcinoma Nasofaríngeo/patología , Neoplasias Nasofaríngeas/patología , Nasofaringe/diagnóstico por imagen , Nasofaringe/patología
16.
Med Biol Eng Comput ; 57(5): 1145-1150, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30673976

RESUMEN

The possible negative outcomes of mandibular setback surgery (MSS) on the upper airway (UA) have become an important issue in recent years. The purpose of the present study was to compare the different amounts of MSS and to confirm the accepted maximum amount of mandibular setback by using Computational Fluid Dynamics (CFD) method. An anatomically similar UA model was constructed from magnetic resonance images of a systemically healthy individual. Two out of six models were kept as control models and the remaining four models were created to represent MSS scenarios with different amounts to correct Class III skeletal abnormality. The airflow was assumed laminar, incompressible, and the surrounding soft tissue was assumed to be linear elastic. The sixth model that was representative of 15 mm of MSS showed statistically significant differences from the other models (p < 0.05). No significant differences were observed among other models in terms of all the parameters (p > 0.05). CFD has been recently used in researches by modeling the UA flow; however, to the best of our knowledge, none of the studies have proved the maximum limits of MSS amounts with this technique. Graphical abstract ᅟ.


Asunto(s)
Obstrucción de las Vías Aéreas/diagnóstico por imagen , Mandíbula/cirugía , Simulación por Computador , Análisis de Elementos Finitos , Humanos , Imagen por Resonancia Magnética , Mandíbula/diagnóstico por imagen , Nasofaringe/diagnóstico por imagen , Apnea Obstructiva del Sueño/diagnóstico por imagen , Apnea Obstructiva del Sueño/etiología
17.
Eur Radiol ; 29(8): 4105-4113, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30617473

RESUMEN

OBJECTIVES: To determine the predictive value of pretreatment MRI texture analysis for progression-free survival (PFS) in patients with primary nasopharyngeal carcinoma (NPC). METHODS: Ethical approval by the institutional review board was obtained for this retrospective analysis. In 79 patients with primary NPC, texture analysis of the primary tumour was performed on pretreatment T2 and contrast-enhanced T1-weighted images (T2WIs and CE-T1WIs). The Cox proportional hazards model was used to determine the association of texture features, tumour volume and the tumour-node-metastasis (TNM) stage with PFS. Survival curves were plotted using the Kaplan-Meier method. The prognostic performance was evaluated with the receiver operating characteristic (ROC) analyses and C-index. RESULTS: Tumour volume (hazard ratio, 1.054; 95% confidence interval [CI], 1.016-1.093) and CE-T1WI-based uniformity (hazard ratio, 0; 95% CI, 0-0.001) were identified as independent predictors for PFS (p < 0.05). Kaplan-Meier analysis showed that smaller tumour volume (less than the cut-off value, 11.699 cm3) and higher CE-T1WI-based uniformity (greater than the cut-off value, 0.856) were associated with improved PFS (p < 0.05). The combination of CE-T1WI-based uniformity with tumour volume and the overall stage predicted PFS better (area under the curve [AUC], 0.825; Cindex, 0.794) than the tumour volume (AUC, 0.659; C-index, 0.616) or the overall stage (AUC, 0.636; C-index, 0.627) did (p < 0.05). CONCLUSIONS: A texture parameter of pretreatment CE-T1WI-based uniformity improves the prediction of PFS in NPC patients. KEY POINTS: • Higher CE-T1WI-based uniformity and smaller tumour volume are predictive of improved PFS in NPC patients. • The combination of CE-T1WI-based uniformity with tumour volume and the overall stage has a better predictive ability for PFS than the tumour volume or the overall stage alone. • Pretreatment MRI texture analysis has a prognostic value for NPC patients.


Asunto(s)
Imagen por Resonancia Magnética/métodos , Carcinoma Nasofaríngeo/diagnóstico por imagen , Carcinoma Nasofaríngeo/patología , Neoplasias Nasofaríngeas/diagnóstico por imagen , Neoplasias Nasofaríngeas/patología , Adolescente , Adulto , Anciano , Medios de Contraste , Femenino , Humanos , Aumento de la Imagen/métodos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Nasofaringe/diagnóstico por imagen , Nasofaringe/patología , Pronóstico , Modelos de Riesgos Proporcionales , Curva ROC , Estudios Retrospectivos , Carga Tumoral , Adulto Joven
18.
Int Forum Allergy Rhinol ; 9(3): 305-310, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30485734

RESUMEN

BACKGROUND: Signs of inflammation are commonly encountered during endoscopic examination of the Eustachian tube (ET) region. The clinical applicability of these findings may be enhanced by use of a standardized assessment score. METHODS: Digital video recordings were obtained of 50 nasal endoscopy examinations of the nasopharyngeal portion of the ET. Four fellowship-trained rhinologists independently reviewed the videos with regard to specific physical findings: edema of the ET torus, erythema of the ET torus, exudate at the ET orifice, and presence of tubal tonsil. Scoring of this Endoscopic Evaluation of the Eustachian Tube (3ET) was reported using both 2-point and 3-point scales. Each reviewer repeated the scoring at a 10-day interval. Interrater and intrarater agreement were calculated for each item and the total scores. RESULTS: Interrater and intrarater agreement were greater for the 3-point scale than the 2-point scale. Interrater agreement for overall instrument using the 3-point scale was in the "acceptable" range for Krippendorff's alpha on both the first trial (0.6922) and second trial (0.7238). Intrarater agreement was generally "excellent" for individual items as well as the overall instrument. CONCLUSION: The 3ET comprising these 4 physical findings has acceptable interrater and intrarater reliability, and may be applied to future clinical studies of ET function and disease.


Asunto(s)
Endoscopía Capsular/métodos , Edema/patología , Trompa Auditiva/inmunología , Inflamación/diagnóstico , Nasofaringe/patología , Adulto , Anciano , Trompa Auditiva/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nasofaringe/diagnóstico por imagen , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Evaluación de la Tecnología Biomédica , Grabación en Video
19.
Arch Dis Child Fetal Neonatal Ed ; 104(3): F321-F323, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30232093

RESUMEN

High flow therapy works partly by washout of airway dead space, the volume of which has not been quantified in newborns. This observational study aimed to quantify airway dead space in infants and to compare efficacy of washout between high flow devices in three-dimensional (3D) printed airway models of infants weighing 2.5-3.8 kg. Nasopharyngeal airway dead space volume was 1.5-2.0 mL/kg in newborns. A single cannula device produced lower carbon dioxide (CO2) levels than a dual cannula device (33.7, 31.2, 23.1, 15.9, 10.9 and 6.3 mm Hg vs 36.8, 35.5, 32.1, 26.8, 23.1 and 18.8 mm Hg at flow rates of 1, 2, 3, 4, 6 and 8 L/min, respectively; p<0.0001 at all flow rates). Airway pressure was 1 mm Hg at all flow rates with the single cannula but increased at higher flow rates with the dual cannula.Relative nasopharyngeal airway dead space volume is increased in newborns. In 3D-printed airway models, a single cannula high flow device produces improved CO2 washout with lower airway pressure.


Asunto(s)
Modelos Anatómicos , Terapia por Inhalación de Oxígeno/instrumentación , Impresión Tridimensional , Espacio Muerto Respiratorio/fisiología , Dióxido de Carbono/análisis , Presión de las Vías Aéreas Positiva Contínua/efectos adversos , Presión de las Vías Aéreas Positiva Contínua/instrumentación , Presión de las Vías Aéreas Positiva Contínua/métodos , Humanos , Recién Nacido , Cavidad Nasal , Nasofaringe/diagnóstico por imagen , Nasofaringe/fisiología , Terapia por Inhalación de Oxígeno/efectos adversos , Terapia por Inhalación de Oxígeno/métodos , Respiración de Presión Positiva Intrínseca/etiología , Volumen de Ventilación Pulmonar/fisiología , Tomografía Computarizada por Rayos X
20.
Orthod Craniofac Res ; 22(1): 9-15, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30421852

RESUMEN

OBJECTIVES: To clarify the associations among tongue volume, hyoid position, airway volume and maxillofacial form using cone beam computed tomography (CBCT) data for children with Class-I, Class-II and Class-III malocclusion. SETTING AND SAMPLE POPULATION: Sixty children (mean age, 9.2 years) divided into Class-I, Class-II and Class-III malocclusion groups according to the A-nasion-B angle. MATERIAL AND METHODS: Cone beam computed tomography was used for three-dimensional reconstruction of the maxillofacial region and airway. The hyoid position and the tongue, airway and oral cavity volumes were evaluated. Upper airway ventilation status was calculated using computational fluid dynamics. The groups were compared using analysis of variance and Kruskal-Wallis tests; relationships among the parameters were assessed using Pearson's and Spearman's rank correlation tests. RESULTS: The tongue volume was larger in Class-III patients (50.63 cm3 ) than in Class-I patients (44.24 cm3 ; P < 0.05). The hyoid position was lower (49.44 cm), and anatomical balance (AB; tongue volume/oral cavity volume; 85.06%) was greater in Class-II patients than in Class-I patients (46.06 cm, 80.57%, respectively; P < 0.05 for both). The hyoid height showed a positive correlation with AB (r = 0.614; P < 0.001). CONCLUSIONS: Children with Class-III malocclusion have large tongue volumes and small AB; the reverse is true for children with Class-II malocclusion. The hyoid position is closely associated with AB in children with malocclusion.


Asunto(s)
Hueso Hioides/patología , Maloclusión de Angle Clase III/patología , Maloclusión de Angle Clase II/patología , Maloclusión de Angle Clase I/patología , Nasofaringe/patología , Lengua/patología , Niño , Tomografía Computarizada de Haz Cónico , Cara/diagnóstico por imagen , Cara/patología , Femenino , Humanos , Hueso Hioides/diagnóstico por imagen , Imagenología Tridimensional , Masculino , Maloclusión de Angle Clase I/diagnóstico por imagen , Maloclusión de Angle Clase II/diagnóstico por imagen , Maloclusión de Angle Clase III/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Maxilar/patología , Nasofaringe/diagnóstico por imagen , Estudios Retrospectivos , Lengua/diagnóstico por imagen
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