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1.
Clin Epigenetics ; 13(1): 26, 2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33536049

RESUMO

BACKGROUND: Early detection of colorectal carcinoma (CRC) would help to identify tumors when curative treatments are available and beneficial. However, current screening methods for CRC, e.g., colonoscopy, may affect patients' compliance due to the uncomfortable, invasive and time-consuming process. In recent decades, methylation profiles of blood-based circulating tumor DNA (ctDNA) have shown promising results in the early detection of multiple tumors. Here we conducted a study to investigate the performance of ctDNA methylation markers in early detection of CRC. RESULTS: In total, 742 participants were enrolled in the study including CRC (n = 332), healthy control (n = 333), benign colorectal disease (n = 65) and advanced adenoma (n = 12). After age-matched and randomization, 298 participants (149 cancer and 149 healthy control) were included in training set and 141 (67 cancer and 74 healthy control) were in test set. In the training set, the specificity was 89.3% (83.2-93.7%) and the sensitivity was 88.6% (82.4-93.2%). In terms of different stages, the sensitivities were 79.4% (62.1-91.2%) in patients with stage I, 88.9% (77.3-95.8%) in patients with stage II, 91.4% (76.9-98.2%) in patients with stage III and 96.2% (80.3-99.9%) in patients with stage IV. Similar results were validated in the test set with the specificity of 91.9% (83.1-97.0%) and sensitivity of 83.6% (72.5-91.6%). Sensitivities for stage I-III were 87.0% (79.7-92.4%) in the training set and 82.5% (70.2-91.3%) in the test set, respectively. In the unmatched total population, the positive ratios were 7.8% (5.2-11.2%) in healthy control, 30.8% (19.9-43.5%) in benign colorectal disease and 58.3% (27.5-84.7%) in advanced adenoma, while the sensitivities of stage I-IV were similar with training and test sets. Compared with methylated SEPT9 model, the present model had higher sensitivity (87.0% [81.8-91.2%] versus 41.2% [34.6-48.1%], P < 0.001) under comparable specificity (90.1% [85.4-93.7%] versus 90.6% [86.0-94.1%]). CONCLUSIONS: Together our findings showed that ctDNA methylation markers were promising in the early detection of CRC. Further validation of this model is warranted in prospective studies.

2.
ANZ J Surg ; 91(4): E190-E195, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33559307

RESUMO

BACKGROUND: There are only a few studies on the prognosis of patients with complete response of the tumour (ypT0) after neoadjuvant chemoradiotherapy (NCRT) and radical resection of rectal cancer. The aim of the study was to identify prognostic factors with regard to oncological outcome in ypT0 patients after NCRT and radical resection. METHODS: All ypT0 patients with rectal cancer after NCRT and radical resection between January 2010 and June 2019 were included. Cox univariate and multivariate regression analyses were used to determine the prognostic factors of these patients. RESULTS: Seventy-six patients with ypT0 rectal cancer were included. In nine patients (11.8%), lymph node metastasis was identified. Age, gender, elevated carcinoembryonic antigen (CEA) and ypN+ were risk factors associated with a worse 5-year disease-free survival (DFS) rate in univariate analysis (P = 0.08, 0.14, 0.007 and 0.003, respectively). In multivariate analysis, ypN+ and elevated CEA before NCRT were independent risk factors for worse 5-year DFS (P = 0.005 and 0.021, respectively). Elevated CEA before NCRT, post-operative chemotherapy and ypN+ were risk factors associated with worse overall survival in univariate analysis (P = 0.14, 0.002 and 0.17, respectively). However, in multivariate analysis, none of these three factors were independent risk factors for worse overall survival (P = 0.20, 0.34 and 0.06, respectively). CONCLUSION: ypN+ and elevated CEA before NCRT were found to be independent risk factors for an unfavourable DFS in ypT0 patients with complete response of the tumour after neoadjuvant chemoradiotherapy for rectal cancer.

3.
Gastroenterol Rep (Oxf) ; 8(5): 343-348, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33163188

RESUMO

The Denonvilliers' fascia (DVF) plays an important role in rectal surgery because of its anatomic position and its relationship to the surrounding organs. It affects the surgical plane anterior to the rectum in the procedure of total mesorectal excision (TME). Anatomical and embryological studies have helped us to understand this structure to some extent, but many controversies remain. In terms of its embryonical origin, there are three mainstream hypotheses: peritoneal fusion of the embryonic cul-de-sac, condensation of embryonic mesenchyme, and mechanical pressure. Regarding its architecture, the DVF may be a single, two, or multiple layers, or a composite single-layer structure. In women, most authors deem that this structure does exist but they are willing to call it the rectovaginal septum rather than the DVF. Operating behind the DVF is supported by most surgeons. This article will review those mainstream studies and opinions on the DVF and combine them with what we have observed during surgery to discuss those controversies and consensuses mentioned above. We hope this review may help young colorectal surgeons to have a better understanding of the DVF and provide a platform from which to guide future scientific research.

4.
Cancer Cell ; 38(5): 734-747.e9, 2020 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-32888432

RESUMO

We integrate the genomics, proteomics, and phosphoproteomics of 480 clinical tissues from 146 patients in a Chinese colorectal cancer (CRC) cohort, among which 70 had metastatic CRC (mCRC). Proteomic profiling differentiates three CRC subtypes characterized by distinct clinical prognosis and molecular signatures. Proteomic and phosphoproteomic profiling of primary tumors alone successfully distinguishes cases with metastasis. Metastatic tissues exhibit high similarities with primary tumors at the genetic but not the proteomic level, and kinase network analysis reveals significant heterogeneity between primary colorectal tumors and their liver metastases. In vivo xenograft-based drug tests using 31 primary and metastatic tumors show personalized responses, which could also be predicted by kinase-substrate network analysis no matter whether tumors carry mutations in the drug-targeted genes. Our study provides a valuable resource for better understanding of mCRC and has potential for clinical application.

5.
Ann Transl Med ; 8(12): 743, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32647668

RESUMO

Background: Whether adjuvant chemotherapy is beneficial for rectal cancer patients who respond well to neoadjuvant chemoradiotherapy (NCRT) and undergo radical resection is controversial. This study aimed to assess the effect of adjuvant chemotherapy on the oncological outcomes of ypT0-2N0 rectal cancer patients after NCRT and radical resection, and identify the prognostic factors. Methods: The clinical and pathological data of rectal cancer patients with ypT0-2N0 who underwent NCRT and radical resection between January, 2010 and June, 2018 were collected and retrospectively analyzed. The oncological outcomes of the chemotherapy (chemo) group and the non-chemotherapy (non-chemo) group were compared. Multivariate analysis, using a Cox proportional hazard model, was performed to identify independent predictors of oncological outcome. Results: Of the 121 rectal cancer patients enrolled, 90 patients received postoperative adjuvant chemotherapy with no fewer than 3 cycles (the chemo group), and the other 31 patients with fewer than 3 cycles (the non-chemo group). There was no significant difference in the 5-year disease-free survival (DFS) or overall survival (OS) rates between the two groups (DFS: 79.1% vs. 82.9%, P=0.442; OS: 87.5% vs. 78.2%, P=0.667). cT4 is an independent risk factor for OS (HR =4.227, 95% CI: 1.128-15.838, P=0.02) and DFS (HR =4.878, 95% CI: 1.752-13.578). Preoperative consolidation chemotherapy with Capeox or FOLFOX after NCRT significantly improved the DFS rate (HR =0.212, 95% CI: 0.058-0.776, P=0.019). Conclusions: Rectal cancer patients with ypT0-2N0 who underwent NCRT and radical resection did not benefit significantly from postoperative adjuvant chemotherapy. For these patients, cT4 was an independent risk factor for OS and DFS. Preoperative consolidation chemotherapy with Capeox or FOLFOX after NCRT can significantly improve DFS.

6.
J Otolaryngol Head Neck Surg ; 49(1): 40, 2020 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-32571414

RESUMO

OBJECTIVE: To compare surgical results of endoscopic myringoplasty using double layer cartilage-perichondrium grafts versus single fascia grafts. STUDY DESIGN: Prospective, randomized, controlled. SETTING: University-affiliated teaching hospital. SUBJECTS AND METHODS: In total,134 patients who underwent endoscopic myringoplasty were included in this study. Patients in group A received a double layer tragal cartilage-perichondrium graft and those in group B received a temporal muscle fascia graft. The groups were compared with respect to the pre- and postoperative air-bone gap (ABG) and the graft success rate. RESULTS: The graft success rate was 98.5% (66/67) in the Group A and 94.0% (63/67) in the Group B at 6 months, the difference wasn't statistically significant (p = 0.362). However, the graft success rate was 97.0% (65/67) in the Group A and 85.1% (57/67) in the Group B at 12 months, the difference was statistically significant (p = 0.034). In addition, only one patient (1.49%) had small keratin pearls in the Group A, no patients developed cholesteatoma of middle ear in either group. CONCLUSIONS: The endoscopic double layer perichondrium-cartilage graft technique is feasible for repairing medium or larger perforations, it has a better long-term graft success rate and less operative time compared with the single layer fascia graft technique. However, long-term hearing outcomes were the same for the single and double layer closure techniques.

7.
ACS Appl Mater Interfaces ; 12(28): 32023-32030, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32564591

RESUMO

Flexible capacitance sensors play a key role in wearable devices, soft robots, and the Internet of things (IoT). To realize these feasible applications, subtle pressure detection under various conditions is required, and it is often limited by low sensitivity. Herein, we demonstrate a capacitive touch sensor with excellent sensing capabilities enabled by a three-dimensional (3D) network dielectric layer, combining a natural viscoelastic property material of thermoplastic polyurethane (TPU) nanofibers wrapped with electrically conductive materials of Ag nanowires (AgNWs). Taking advantage of the large deformation and the increase of effective permittivity under the action of compression force, the device has the characteristics of high sensitivity, fast response time, and low detection limit. The enhanced sensing mechanism of the 3D structures and the conductive filler have been discussed in detail. These superior functions enable us to monitor a variety of subtle pressure changes (pulse, airflow, and Morse code). By detecting the pressure of fingers, a smart piano glove integrated with 10 circuits of finger joints is made, which realizes the real-time performance of the piano and provides the possibility for the application of intelligent wearable electronic products such as virtual reality and human-machine interface in the future.

8.
Research (Wash D C) ; 2020: 8716847, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32529189

RESUMO

Using wearable devices to monitor respiration rate is essential for reducing the risk of death or permanent injury in patients. Improving the performance and safety of these devices and reducing their environmental footprint could advance the currently used health monitoring technologies. Here, we report high-performance, flexible bioprotonic devices made entirely of biodegradable biomaterials. This smart sensor satisfies all the requirements for monitoring human breathing states, including noncontact characteristic and the ability to discriminate humidity stimuli with ultrahigh sensitivity, rapid response time, and excellent cycling stability. In addition, the device can completely decompose after its service life, which reduces the risk to the human body. The cytotoxicity test demonstrates that the device shows good biocompatibility based on the viability of human skin fibroblast-HSAS1 cells and human umbilical vein endothelial (HUVECs), illustrating the safety of the sensor upon integration with the human skin.

9.
Appl Opt ; 59(11): 3353-3359, 2020 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-32400445

RESUMO

We present a practical wide-field optical design for a 60 m aperture submillimeter telescope, which is currently under conceptual design study in China. The telescope is specified to operate over a wavelength range of 0.65-3 mm and provide a wide field of view (FOV) of 1° in diameter. We designed an F/6 Ritchey Chrétien (RC) system with a quasi-planar tertiary corrector, which cancels all spherical, coma, and astigmatism aberrations. It also achieves a good balance among the mirror sizes, central obscuration, and focal-plane curvature. The problems of focal surface curvature and nontelecentricity are treated in the subfield instrumental design, which employs a simple silicon wedge prism to obtain flat and telecentric focal planes for each subfield instrument module. Our studies show that by such a design, more than ${{10}^5}$105 detector pixels can be efficiently and uniformly fed at the shortest wavelength band with Strehl ratios above 0.85 across the entire 1° FOV. Several practical issues related to the telescope optics are also discussed.

10.
ACS Appl Mater Interfaces ; 12(21): 24339-24347, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32369336

RESUMO

For the mimicry of human skin, one of the challenges is how to detect and recognize different stimulus by electronic device, while still has the ability of skin self-recovery at the same time. Because of the excellent elasticity and flexibility, strong self-healing ability, in this paper, we reported a bifunctional self-healing e-skin with polyurethane (PU) and polyurethane@multiwalled carbon nanotubes (PU@CNT) as the sensing materials by integrating a resistance temperature sensor on top of a capacitive pressure sensor on the same flexible cellulose nanocrystals@carboxylated nitrile rubber@polyethylenimine (CNC@XNBR) substrate. Studies found that each type of sensor exhibited fast and superior response to only the target stimuli. Meanwhile, due to the self-recovery properties of PU and CNC@XNBR, as-fabricated e-skin has the self-healing ability after damage and remains excellent sensitivity to temperature and pressure after healing. A 5 × 5 device array was also fabricated, which can simultaneously image the pressure and temperature distribution.

12.
J Otolaryngol Head Neck Surg ; 49(1): 13, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32143701

RESUMO

OBJECTIVE: To evaluate the graft success rate and postoperative hearing gain for marginal perforations using endoscopic cartilage myringoplasty with the removal of a small rim of the external auditory canal (EAC). STUDY DESIGN: Prospective case series. MATERIALS AND METHODS: We performed a prospective study in 41 patients with marginal perforations who underwent endoscopic cartilage myringoplasty with the removal of a small rim of EAC. Patients were followed up for 6 months. RESULTS: Of the 41 patients with unilateral marginal perforation included in this study, the graft success rate was 100% (41/41). The mean ABG improved from 11.31 ± 9.71 dB preoperatively to 7.31 ± 2.32 dB postoperatively for small-and medium-sized perforations (P = 0.13); the mean ABG improved from 21.46 ± 8.39 dB preoperatively to 9.84 ± 2.41 dB postoperatively for large perforations (P < 0.05); the mean ABG improved from 28.79 ± 6.74 dB preoperatively to 10.13 ± 3.56 dB postoperatively for subtotal and total perforations (P < 0.05). There were no cases of graft lateralization or significant blunting or atelectasis or graft adhesions. Three patients developed postoperative otorrhoea and five patients had mild myringitis. CONCLUSIONS: Endoscopic cartilage myringoplasty with the removal of a small rim of the EAC is simple and feasible, showing a high graft success rate and minimal complications for repairing marginal perforations.

13.
Artigo em Inglês | MEDLINE | ID: mdl-32044273

RESUMO

INTRODUCTION: Sigmoid sinus diverticulum has been considered the most common cause of pulsatile tinnitus; the mechanism underlying sigmoid sinus diverticulum formation is unclear. To the best of our knowledge, no previous studies have assessed whether the formation of sigmoid sinus diverticulum is related to compression of the internal jugular vein by the styloid process. OBJECTIVE: To discuss the relationship between the styloid process and the formation of sigmoid sinus diverticulum. METHODS: The medical records of nine patients diagnosed with venous pulsatile tinnitus caused by sigmoid sinus diverticulum were reviewed between April 2009 and May 2019. All patients underwent high-resolution computed tomography of the temporal bones, computed tomography venogram of the head and neck, magnetic resonance venography, and brain magnetic resonance imaging. The length and medial angulation of the styloid process were measured, and compression of the internal jugular vein was recorded. RESULTS: The study population consisted of nine female right-sided pulsatile tinnitus patients with a mean age of 53.8±4.6 years. The mean lengths of the styloid process were 3.9±0.6cm on the right side and 4.1±0.7cm on the left side. The mean medial angulation of the styloid process was significantly smaller on the right side than the left side (65.3°±1.2° vs. 67.8°±1.7°, p<0.05). In addition, computed tomography venogram of the head and neck demonstrated the left internal jugular vein was compressed by the styloid process in eight of the nine patients. CONCLUSION: The formation of sigmoid sinus diverticulum with venous pulsatile tinnitus may be related to compression of the contralateral internal jugular vein by the styloid process. However, accumulation of data in additional cases is required to verify this suggestion.

14.
Adv Mater ; 32(16): e1908419, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32104957

RESUMO

Infrared (IR) photodetectors are a key optoelectronic device and have thus attracted considerable research attention in recent years. Photosensitivity is an increasingly important device performance parameter for nanoscale photodetectors and image sensors, as it determines the ultimate imaging quality and contrast. However, photosensitivities of state-of-the-art low-dimensional nanostructure-based IR detectors are considerably low, limiting their practical applications. Herein, a biomimetic IR detection amplification (IRDA) system that boosts photosensitivity by several orders of magnitude by introducting nanowire field effect transistors (FETs), resulting in a peak photosensitivity of 7.6 × 104 under an illumination of 1342 nm, is presented. Consequently, high-contrast imaging of IR light is obtained on the flexible IRDA arrays. The image information can be then trained and recognized by an artificial neural network for higher image-recognition efficiency. This work provides a new perspective for developing high-performance IR imaging systems, and is expected to undoubtedly enlighten future work on artificial intelligence and biorobotic systems.

15.
J Immunol ; 204(5): 1146-1157, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31932498

RESUMO

Upon activation by CD40 or TLR signaling, B lymphocytes activate NF-κB to induce activation-induced cytidine deaminase and, therefore, Ig class switch DNA recombination, as central to the maturation of the Ab and autoantibody responses. In this study, we show that NF-κB activation is boosted by colocalization of engaged immune receptors, such as CD40, with RAB7 small GTPase on mature endosomes, in addition to signals emanating from the receptors localized on the plasma membrane, in mouse B cells. In mature endosomes, RAB7 directly interacts with TRAF6 E3 ubiquitin ligase, which catalyzes K63 polyubiquitination for NF-κB activation. RAB7 overexpression in Cd19+/creRosa26fl-STOP-fl-Rab7 mouse B cells upregulates K63 polyubiquitination activity of TRAF6, enhances NF-κB activation and activation-induced cytidine deaminase induction, and boosts IgG Ab and autoantibody levels. This, together with the extensive intracellular localization of CD40 and the strong correlation of RAB7 expression with NF-κB activation in mouse lupus B cells, shows that RAB7 is an integral component of the B cell NF-κB activation machinery, likely through interaction with TRAF6 for the assembly of "intracellular membrane signalosomes."


Assuntos
Linfócitos B/imunologia , Endossomos/imunologia , Switching de Imunoglobulina , NF-kappa B/imunologia , Fator 6 Associado a Receptor de TNF/imunologia , Ubiquitinação/imunologia , Proteínas rab de Ligação ao GTP/imunologia , Animais , Antígenos CD19/genética , Antígenos CD19/imunologia , Linfócitos B/citologia , Endossomos/genética , Camundongos , Camundongos Transgênicos , NF-kappa B/genética , Fator 6 Associado a Receptor de TNF/genética , Ubiquitinação/genética , Proteínas rab de Ligação ao GTP/genética
17.
J Otolaryngol Head Neck Surg ; 48(1): 72, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852515

RESUMO

OBJECTIVE: We evaluated microwave ablation (MWA) for treatment of idiopathic recurrent anterior epistaxis (RAE) in children, in terms of technical feasibility, efficacy, and safety. STUDY DESIGN: A prospective pilot case series. SETTING: Tertiary university hospital. METHODS: Children with idiopathic RAE were treated with endoscopic MWA and reevaluated at 1 and 4 weeks and at 6 months thereafter. The primary outcome was successful hemostasis on the day of the procedure. Secondary outcomes were the rebleeding rates after 1 and 4 weeks, and 6 months, and any complications. RESULTS: Of the 92 children with idiopathic RAE who met the inclusion criteria, the operation was interrupted in 7 children due to intraoperative noncooperation, and silver nitrate cautery was performed instead. All procedures were completed, and hemostasis was achieved within 10-20 s by MWA in 85 children. Two to four ablations were conducted. No recurrent epistaxis occurred and no severe MWA -related complications, such as septal perforation or synechiae formation, were observed at the 6-month follow-up. CONCLUSIONS: Endoscopic MWA is a feasible and safe technique for the treatment of idiopathic pediatric RAE in the clinical setting, especially those cases that do not respond to in-office chemical cautery.


Assuntos
Epistaxe/terapia , Técnicas Hemostáticas , Micro-Ondas/uso terapêutico , Terapia por Radiofrequência/métodos , Adolescente , Criança , Endoscopia , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Projetos Piloto , Estudos Prospectivos , Recidiva , Resultado do Tratamento
18.
Ear Nose Throat J ; : 145561319891264, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31779475

RESUMO

OBJECTIVE: The objective is to reduce the rates of misdiagnosis and inappropriate treatment of laryngeal tuberculosis (LTB). STUDY DESIGN: Retrospective case series. MATERIALS AND METHODS: Medical records of 3 histopathology-confirmed cases at a tertiary medical center from 2000 to 2018. RESULTS: Seventeen patients with LTB included in this study. Of the 17 patients, 16 patients were male and 1 was female; 11 patients had a history of smoking. Odynophagia was the chief complaint in 6 cases, and 11 patients complained of hoarseness. The appearance of the affected larynx was ranged from diffuse swelling (n = 7, 41.2%), mucosa white lesion (n = 5,29.4%), and granulomatous tumors (n = 2, 11.76%), and these features presented together (n = 2, 11.76%). Seventeen patients with LTB were misdiagnosed as acute epiglottitis in 4 (23.5%) patients, acute laryngitis in 1 (5.9%) patient, leukoplakia in 5 (29.4%) patients, laryngopharyngeal reflux (LPR) in 6 (35.3%) patients, and laryngocarcinoma in 1 (5.9%) patient. Chest computed tomography reported old pulmonary tuberculosis in 2 (11.7%) patients, active pulmonary tuberculosis in 7 (41.2%) patients, and normal lung status in 8 (47.1%) patients. Histopathological examination reported Mycobacterium tuberculosis infection by revealing epithelioid cell granulomas with Langhans-type giant cells in 14 (82.4%) patients and epithelioid cell granulomas with caseous necrosis and Langhans-type giant cells in 3 (17.6%) patients. CONCLUSIONS: Laryngeal tuberculosis was easily misdiagnosed as acute epiglottitis or leukoplakia because of diffuse swelling of the epiglottis or white lesions over the true vocal cord, especially patients with increasing LTB were misdiagnosed as LPR with the enhancement of LPR awareness among otolaryngologist. Clinicians should be aware of the possibility of LTB for chronic intractable laryngitis with failure treatment of proton pump inhibitor and recurrent acute epiglottitis with foreign body injury.

19.
Artigo em Inglês | MEDLINE | ID: mdl-31722853

RESUMO

INTRODUCTION: Recurrent epistaxis is commonly encountered in the rhinology outpatient clinic. Under endoscopic guidance, both bipolar cautery and monopolar forceps (combined with suction) have been employed to control the bleeding. However, the use of monopolar forceps requires the placement of grounding pads. Most procedures are currently performed in operating rooms. OBJECTIVE: We investigated outcomes after the use of Microwave Ablation (MWA) to control epistaxis in adults with isolated mucosal bulge lesions. All procedures were performed with patients under local anesthesia in our outpatient clinic. METHODS: This is a retrospective cohort study. We included 83 adults with epistaxis of isolated mucosal bulge lesions. Microwave ablation was performed in the outpatient clinic to control bleeding, after induction of local anesthesia. The primary outcome was successful hemostasis. The secondary outcomes were the rebleeding rates at weeks 1 and 4 and month 6, and complications (crust or synechiae formation, septal perforation, and/or orbit or brain complications). RESULTS: All bleeding points were successfully ablated; hemostasis was achieved within 1-2min. The mean pain score was 1.83 intra-operatively and 0.95 1h postoperatively. No patient re-bled, and no severe MWA-related complication (septal perforation, synechiae formation, or orbit or brain complication) was recorded to 6 months of follow-up. CONCLUSIONS: Endoscopic microwave ablation with patients under local anesthesia is a novel, safe, effective, rapid, well-tolerated, outpatient treatment for adults with epistaxis of isolated mucosal bulge lesions, especially those for whom general anesthesia might be risky, those with electrical implants, and those exhibiting contraindications for arterial embolization.

20.
Ear Nose Throat J ; : 145561319879238, 2019 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-31597530

RESUMO

OBJECTIVE: To compare the outcomes of adult patients with recurrent epistaxis treated intraoperatively with either bipolar electrocautery or microwave ablation (MWA). STUDY DESIGN: Prospective randomized control study. MATERIALS AND METHODS: One hundred ten patients with idiopathic recurrent epistaxis who met the inclusion criteria were randomly assigned into MWA group and bipolar electrocautery group. Primary outcomes were the proportion of patients in each group whose bleeding had stopped within 24 hours after treatment and time to achieve successful hemostasis. Secondary outcomes were the rebleeding rate after 3 days, 1 and 12 weeks, and 6 months and complications. RESULTS: Successful immediate arrest of epistaxis was achieved in all patients. The times to achieve successful hemostasis were 2.13 ± 1.04 minutes in the MWA group and 6.60 ± 2.68 minutes in the bipolar electrocautery group (P = .000). The rates of recurrent bleeding were similar in patients treated with the different approaches (P = .231). However, secondary crusting was observed endoscopically in 59 patients in the bipolar electrocautery group, while pseudomembrane of the ablation zone was seen in 19 (36.5%) patients in the MWA group. Nevertheless, there were no severe postoperative complications, including septal perforation and orbit and brain complications, in either group at the 6-month follow-up. CONCLUSION: Bipolar electrocautery and MWA had similar outcomes for the treatment of adult patients with recurrent epistaxis. However, MWA resulted in rapid hemostasis with less local nasal pain and less crust. Thus, MWA could be a favorable treatment option for patients with idiopathic recurrent epistaxis.

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