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Neoadjuvant Capecitabine in Operable HPV-Negative Head and Neck Cancer: Fortuitous Findings in a Resource Constrained Setting. 新辅助卡培他滨治疗可手术的 HPV 阴性头颈癌:资源有限环境中的偶然发现
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-01 Epub Date: 2024-09-29 DOI: 10.1002/ohn.1003
Marco A Mascarella, Keith Richardson, Alex Mlynarek, Michael P Hier, Derin Caglar, Livia Florianova, Marc Philippe Pusztaszeri, Khalil Sultanem, Nader Sadeghi, Nathaniel Bouganim, Khashayar Esfahani

Objective: Limited progress has occurred in treating operable human papillomavirus (HPV)-negative head and neck squamous cell carcinoma (HNSCC). Accessing timely care remains challenging in public health care systems, potentially resulting in disease progression before treatment initiation.

Study design: A prospective cohort of patients receiving neoadjuvant capecitabine (NC) was compared to stage-matched patients undergoing standard of care (SC).

Setting: This study was performed at 2 academic centers in Montreal, Canada.

Methods: To ascertain the effect of 2 cycles of NC in operable HPV-negative HNSCC patients on clinical-to-pathologic stage migration. Comparison to an SC group was performed to site and TNM stage matched patients. Pathologic treatment response was measured using the modified Ryan score.

Results: We compared 16 NC patients (11 oral cavity, 3 skin, 2 larynx) with 32 SC patients. Ten NC patients exhibited a pathologic response (1 complete, 3 major, 6 minor). Clinical-to-pathologic stage migration differed significantly between NC and SC groups: downstage (6 vs 1), upstage (3 vs 14), no change (7 vs 17, P = .0047). There was no severe treatment toxicity related to capecitabine. All patients in the NC group underwent surgery.

Conclusion: NC followed by surgery demonstrates measurable pathologic response in HPV-negative HNSCC, suggesting potential utility in resource-limited health care settings.

目的:可手术的人乳头瘤病毒(HPV)阴性头颈部鳞状细胞癌(HNSCC)的治疗进展有限。在公共医疗系统中,及时获得治疗仍是一项挑战,这可能导致疾病在开始治疗前就已恶化:研究设计:将接受新辅助卡培他滨(NC)治疗的前瞻性队列患者与接受标准治疗(SC)的分期匹配患者进行比较:研究在加拿大蒙特利尔的两个学术中心进行:方法:确定可手术的HPV阴性HNSCC患者接受2个周期NC治疗对临床到病理分期迁移的影响。对部位和TNM分期相匹配的患者与SC组进行比较。病理治疗反应采用改良瑞安评分法进行测量:我们将 16 例 NC 患者(11 例口腔癌、3 例皮肤癌、2 例喉癌)与 32 例 SC 患者进行了比较。10例NC患者出现了病理反应(1例完全反应,3例大反应,6例小反应)。NC组和SC组的临床到病理分期迁移有显著差异:下期(6 vs 1)、上期(3 vs 14)、无变化(7 vs 17,P = .0047)。卡培他滨没有引起严重的治疗毒性。NC组所有患者均接受了手术治疗:结论:对HPV阴性的HNSCC患者进行NC治疗后再进行手术可获得可测量的病理反应,这表明该疗法在资源有限的医疗环境中具有潜在的实用性。
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引用次数: 0
Current Demography and Treatment Strategy of Vestibular Migraine in Neurotologic Perspective. 从神经听觉角度看前庭性偏头痛的人口统计和治疗策略现状。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-07 DOI: 10.1002/ohn.923
Kuei-You Lin, Steven D Rauch

Objective: This study aims to describe the demographic features of vestibular migraine (VM) compared to other common peripheral vestibulopathies, and to assess the efficacy of trigger management as primary VM treatment.

Study design: Retrospective study.

Setting: Tertiary referral medical center.

Methods: A retrospective chart review was performed of patients presenting with dizziness in a tertiary neurotology clinic. Among the newly diagnosed dizzy patients, those with a diagnosis of either VM, Ménière's disease, benign paroxysmal positional vertigo, or vestibular neuritis/labyrinthitis were selected for comparisons of the disease demographics. VM patients with multiple clinic visits in the study period were included for the treatment strategy analysis.

Results: A total of 1285 patients met the study inclusion criteria. In the newly diagnosed dizzy group comprising 814 patients, VM patients accounted for the largest (25%) and youngest (mean age 47 years) cohort, showing an obvious female preponderance of approximately 3.3:1. Furthermore, prevalence of VM declined significantly with advancing age, from 69%, to 34%, to 11%, in age groups of ≤30, 31 to 60, and >60 years, respectively. Trigger management, when employed as the primary VM first-year treatment, was effective for both sexes. Notably, it was more effective for women aged over than under 45 years.

Conclusion: In our tertiary referral neurotologic center, VM was the most common diagnosis in newly diagnosed dizzy patients aged under 60 years, especially in women. For primary VM treatment, trigger management is an effective option deserving consideration.

研究目的本研究旨在描述前庭性偏头痛(VM)与其他常见外周性前庭疾病相比的人口统计学特征,并评估触发治疗作为VM主要治疗方法的疗效:研究设计:回顾性研究:研究设计:回顾性研究:方法:对在一家三级神经病学诊所就诊的头晕患者进行回顾性病历审查。在新确诊的眩晕患者中,选择诊断为VM、梅尼埃病、良性阵发性位置性眩晕或前庭神经炎/迷路炎的患者进行疾病人口统计学比较。研究期间多次就诊的眩晕症患者被纳入治疗策略分析:共有 1285 名患者符合研究纳入标准。在由 814 名患者组成的新诊断眩晕组中,VM 患者人数最多(25%),年龄最小(平均年龄 47 岁),女性患者明显占多数,比例约为 3.3:1。此外,随着年龄的增长,眩晕症的发病率明显下降,在≤30 岁、31 至 60 岁和大于 60 岁的年龄组中,眩晕症的发病率分别从 69% 降至 34% 和 11%。触发管理作为 VM 第一年的主要治疗方法,对男女患者均有效。值得注意的是,对45岁以上的女性比对45岁以下的女性更有效:结论:在我们的三级神经病学转诊中心,60 岁以下新诊断的头晕患者中,VM 是最常见的诊断,尤其是女性。对于原发性 VM 的治疗,触发治疗是一种值得考虑的有效方法。
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引用次数: 0
Postoperative Respiratory Complications After Adenotonsillectomy in Children With High-Risk Obstructive Sleep Apnea. 高危阻塞性睡眠呼吸暂停儿童腺样体切除术后的呼吸道并发症。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-28 DOI: 10.1002/ohn.961
Yann-Fuu Kou, Jonathan R Korpon, Helene Dabbous, Romaine F Johnson, Ron B Mitchell, Anna Wani, Stephen R Chorney

Objective: Identify patient characteristics and polysomnogram (PSG) parameters associated with postoperative respiratory complications after adenotonsillectomy (AT) among children with high-risk obstructive sleep apnea (OSA).

Study design: Case series with chart review.

Setting: Tertiary care children's hospital.

Methods: Pediatric patients (<18 years) with high-risk OSA (any 1 of: apnea-hypopnea index [AHI] >30, O2 nadir <80% and peak CO2 >60 mm Hg) on overnight PSG from 2019 to 2021 were included. Primary outcomes were major respiratory intervention during the postoperative admission, prolonged hospitalization, and intensive care unit (ICU) stay.

Results: A total of 307 patients met inclusion criteria. Median age was 6.5 years and 63% were male. Twenty-five (8.1%) required major respiratory intervention and 29 (9.7%) required ICU admission after AT. Major interventions and ICU admissions were significantly associated with neuromuscular disease (P < .01), higher obstructive apnea-hypopnea index (oAHI), higher CO2 peak, and lower O2 nadir. Prolonged admission had similar findings except oAHI was not significantly associated. Younger children were significant more likely to require ICU admission or prolonged admission.

Conclusion: Increased oAHI and worsening O2 and CO2 parameters on preoperative PSG were associated with postoperative respiratory complications in children with high-risk OSA. Children with neuromuscular disease and age 0 to 2 had higher risk of ICU stay and prolonged hospitalization. Clinicians should recognize the importance of parameters beyond oAHI when anticipating postoperative monitoring.

目的:确定与高危阻塞性睡眠呼吸暂停(OSA)儿童腺样体扁桃体切除术(AT)术后呼吸并发症相关的患者特征和多导睡眠图(PSG)参数:确定与高危阻塞性睡眠呼吸暂停(OSA)儿童腺样体切除术(AT)术后呼吸系统并发症相关的患者特征和多导睡眠图(PSG)参数:研究设计:病例系列,病历回顾:研究设计:病例系列与病历回顾:纳入2019年至2021年接受过夜PSG的儿科患者(30例,O2 nadir 2 >60 mm Hg)。主要结果为术后入院期间的主要呼吸干预、住院时间延长和重症监护室(ICU)住院时间:共有 307 名患者符合纳入标准。中位年龄为 6.5 岁,63% 为男性。25例(8.1%)患者需要进行重大呼吸系统干预,29例(9.7%)患者在AT术后需要入住重症监护室。主要干预措施和入住重症监护室与神经肌肉疾病(P 2 峰值)和较低的血氧饱和度(O2 nadir)显著相关。除oAHI无显著相关性外,入院时间过长也有类似的结果。年龄较小的儿童更有可能需要入住重症监护室或延长入院时间:结论:高危 OSA 患儿术前 PSG 的 oAHI 增加、O2 和 CO2 参数恶化与术后呼吸系统并发症有关。患有神经肌肉疾病和年龄在 0 至 2 岁之间的儿童入住重症监护室和延长住院时间的风险更高。临床医生在进行术后监测时应认识到除 oAHI 之外的其他参数的重要性。
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引用次数: 0
Risk Factors for Plate Infection, Exposure, and Removal in Mandibular Reconstruction. 下颌骨重建中钢板感染、暴露和移除的风险因素。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-05 DOI: 10.1002/ohn.928
Keshav V Shah, Saawan D Patel, Karthik Rajasekaran, Steven B Cannady, Ara A Chalian, Robert M Brody

Objective: Mandibular plate reconstruction (MPR) is often indicated after tumor ablation, osteoradionecrosis excision, and traumatic bone loss to restore oral functionality and facial cosmetics. There are limited analyses identifying risk factors that lead to plate infection (PIn), exposure, and removal ("plate complications").

Study design: Retrospective cohort study.

Setting: Academic tertiary medical center.

Methods: Patients who underwent MPR from 2013 to 2022 were identified. Risk factors for plate complications were analyzed based on demographic, clinical, intraoperative, and postoperative factors. Multivariable analysis was conducted with logistic regression. Survival analysis was conducted with a Cox model.

Results: Of the 188 patients analyzed, 48 (25.5%) had a plate complication [infection: 22 (11.7%); exposure: 23 (12.2%); removal: 35 (18.6%)]. Multivariate analysis revealed predictive associations between at least 1 plate complication and the following variables: smoking status, soft tissue defect size, number of plates, average screw length, and various postoperative complications. Other associations approached the threshold for significance. Prior and adjuvant radiation therapy, type of free flap, stock versus custom plates, and perioperative antibiotic prophylaxis regimens were not associated with plate complications. No plate complication was independently associated with lower overall survival. PIn (hazard ratio, HR: 7.99, confidence interval, CI [4.11, 15.54]) and exposure (HR: 3.56, CI [1.79, 7.08]) were independently associated with higher rates of plate removal.

Conclusion: Plate complications are relatively common after MPR. Smoking history, specific disease characteristics, hardware used during surgery, and postoperative complications may help identify higher-risk patients, but additional larger-scale studies are needed to validate our findings and resolve discrepancies in the current literature.

目的:下颌骨骨板重建(MPR)通常适用于肿瘤消融、骨坏死切除和创伤性骨缺失后,以恢复口腔功能和面部美观。研究设计:回顾性队列研究:研究设计:回顾性队列研究:研究设计:回顾性队列研究:方法:对 2013 年至 2022 年期间接受 MPR 的患者进行识别。根据人口统计学、临床、术中和术后因素分析钢板并发症的风险因素。采用逻辑回归法进行多变量分析。采用 Cox 模型进行生存分析:在分析的 188 名患者中,48 人(25.5%)出现了钢板并发症[感染:22 人(11.7%);暴露:23 人(12.2%);移除:35 人(18.6%)]。多变量分析显示,至少一种钢板并发症与以下变量之间存在预测关联:吸烟状况、软组织缺损大小、钢板数量、平均螺钉长度和各种术后并发症。其他关联接近显著性阈值。之前和辅助放疗、游离皮瓣类型、库存钢板与定制钢板以及围手术期抗生素预防方案与钢板并发症无关。没有任何钢板并发症与较低的总生存率相关。PIn(危险比,HR:7.99,置信区间,CI [4.11,15.54])和暴露(HR:3.56,CI [1.79,7.08])与较高的钢板移除率独立相关:结论:MPR术后钢板并发症相对常见。吸烟史、特定疾病特征、手术中使用的硬件以及术后并发症可能有助于识别高风险患者,但还需要更多更大规模的研究来验证我们的发现并解决当前文献中存在的差异。
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引用次数: 0
Pathologic Characteristics and Surgical Outcomes of Pediatric Versus Adult Well-Differentiated Thyroid Cancer. 小儿与成人甲状腺分化良好癌的病理特征和手术效果。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-01 Epub Date: 2024-10-17 DOI: 10.1002/ohn.916
Shivee Gilja, Arvind Kumar, Aldo V Londino, Diana N Kirke, Scott A Roof, Maaike van Gerwen

Objective: Despite the rising incidence of pediatric differentiated thyroid cancer (DTC), postoperative outcomes for such tumors have not been well-characterized. The objective of this study was to compare pathologic tumor characteristics and treatment outcomes for pediatric and adult patients with DTC.

Study design: Retrospective case-control study.

Setting: National database.

Methods: Pediatric (<18 years old) and adult (≥18 years old) patients who underwent surgery for DTC in the National Cancer Database (2004-2020) were included. Multivariable logistic, negative binomial, and linear regressions were used to compare pathologic tumor characteristics, treatment characteristics, and short-term surgical outcomes.

Results: 337,864 patients with DTC met the study eligibility criteria; 3584 (1.1%) were pediatric patients and 334,280 (98.9%) were adults. After adjustment, pediatric patients were found to have higher rates of pathologic T upstaging (adjusted odds ratio [ORadj]: 1.40, 95% confidence interval [CI]: 1.23-1.59), N upstaging (ORadj: 2.53, 95% CI: 2.23-2.88), and extrathyroidal extension (ORadj: 1.58, 95% CI: 1.29-1.94), compared to adult patients. Pediatric patients were also more likely to receive neck dissection (ORadj: 2.80, 95% CI: 2.55-3.07) and radioactive iodine (ORadj: 1.42, 95% CI: 1.30-1.55). Pediatric patients had higher rates of positive surgical margins (ORadj: 1.25, 95% CI: 1.11-1.41) and 30-day readmissions (ORadj: 1.26, 95% CI: 1.00-1.58) than adult patients.

Conclusion: These findings demonstrate that pediatric DTC is associated with more aggressive disease presentations, more radical treatment, and worse short-term surgical outcomes compared to DTC in adults. Pediatric DTC should be considered a unique clinical entity that requires personalized evaluation and multidisciplinary treatment by specialized providers.

目的:尽管小儿分化型甲状腺癌(DTC)的发病率不断上升,但此类肿瘤的术后疗效尚未得到很好的描述。本研究旨在比较儿童和成人分化型甲状腺癌患者的病理肿瘤特征和治疗效果:研究设计:回顾性病例对照研究:环境:国家数据库:方法:儿科(结果:337 864 名 DTC 患者337,864例DTC患者符合研究资格标准,其中3584例(1.1%)为儿科患者,334,280例(98.9%)为成人患者。经调整后发现,与成人患者相比,儿科患者的病理T向上分期率(调整后的几率比[ORadj]:1.40,95%置信区间[CI]:1.23-1.59)、N向上分期率(ORadj:2.53,95%置信区间[CI]:2.23-2.88)和甲状腺外扩展率(ORadj:1.58,95%置信区间[CI]:1.29-1.94)更高。儿童患者也更有可能接受颈部切除术(ORadj:2.80,95% CI:2.55-3.07)和放射性碘治疗(ORadj:1.42,95% CI:1.30-1.55)。小儿患者的手术边缘阳性率(ORadj:1.25,95% CI:1.11-1.41)和30天再入院率(ORadj:1.26,95% CI:1.00-1.58)高于成人患者:这些研究结果表明,与成人 DTC 相比,小儿 DTC 的疾病表现更具侵袭性,治疗更彻底,短期手术效果更差。小儿 DTC 应被视为一种独特的临床实体,需要由专业医疗人员进行个性化评估和多学科治疗。
{"title":"Pathologic Characteristics and Surgical Outcomes of Pediatric Versus Adult Well-Differentiated Thyroid Cancer.","authors":"Shivee Gilja, Arvind Kumar, Aldo V Londino, Diana N Kirke, Scott A Roof, Maaike van Gerwen","doi":"10.1002/ohn.916","DOIUrl":"10.1002/ohn.916","url":null,"abstract":"<p><strong>Objective: </strong>Despite the rising incidence of pediatric differentiated thyroid cancer (DTC), postoperative outcomes for such tumors have not been well-characterized. The objective of this study was to compare pathologic tumor characteristics and treatment outcomes for pediatric and adult patients with DTC.</p><p><strong>Study design: </strong>Retrospective case-control study.</p><p><strong>Setting: </strong>National database.</p><p><strong>Methods: </strong>Pediatric (<18 years old) and adult (≥18 years old) patients who underwent surgery for DTC in the National Cancer Database (2004-2020) were included. Multivariable logistic, negative binomial, and linear regressions were used to compare pathologic tumor characteristics, treatment characteristics, and short-term surgical outcomes.</p><p><strong>Results: </strong>337,864 patients with DTC met the study eligibility criteria; 3584 (1.1%) were pediatric patients and 334,280 (98.9%) were adults. After adjustment, pediatric patients were found to have higher rates of pathologic T upstaging (adjusted odds ratio [OR<sub>adj</sub>]: 1.40, 95% confidence interval [CI]: 1.23-1.59), N upstaging (OR<sub>adj</sub>: 2.53, 95% CI: 2.23-2.88), and extrathyroidal extension (OR<sub>adj</sub>: 1.58, 95% CI: 1.29-1.94), compared to adult patients. Pediatric patients were also more likely to receive neck dissection (OR<sub>adj</sub>: 2.80, 95% CI: 2.55-3.07) and radioactive iodine (OR<sub>adj</sub>: 1.42, 95% CI: 1.30-1.55). Pediatric patients had higher rates of positive surgical margins (OR<sub>adj</sub>: 1.25, 95% CI: 1.11-1.41) and 30-day readmissions (OR<sub>adj</sub>: 1.26, 95% CI: 1.00-1.58) than adult patients.</p><p><strong>Conclusion: </strong>These findings demonstrate that pediatric DTC is associated with more aggressive disease presentations, more radical treatment, and worse short-term surgical outcomes compared to DTC in adults. Pediatric DTC should be considered a unique clinical entity that requires personalized evaluation and multidisciplinary treatment by specialized providers.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1682-1689"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Serum Levels of Stereocilin as a Hearing Biomarker. 作为听力生物标志物的血清立体异构体蛋白水平
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-01 Epub Date: 2024-07-21 DOI: 10.1002/ohn.915
Carly Malesky, Diana Daniel, Erika Skoe, Kourosh Parham

Noise-induced hearing loss (NIHL) often presents with an insidious onset, resulting from the cumulative effect of chronic, high-level noise exposure regardless of etiology. Stereocilin (STRC) is a protein that supports stereocilia attachment and cochlear hair cell function, 2 common targets of noise trauma. In this study, we explored the relationship between STRC and daily noise exposure in young, healthy adults. We found that higher noise exposure levels were associated with lower serum levels of STRC, as was the case for another inner-ear protein, prestin. There was a statistically significant positive correlation between serum STRC and prestin levels. These results support a biomarker approach for the diagnosis and monitoring of NIHL. The ability to detect and measure STRC in the blood also has implications for targeted gene therapy. STRC mutations are known to be associated with autosomal recessive deafness, a condition that is now amenable to targeted gene therapy.

噪声性听力损失(NIHL)通常起病隐匿,由长期暴露于高强度噪声环境的累积效应引起,与病因无关。立体定向蛋白(STRC)是一种支持立体定向纤毛附着和耳蜗毛细胞功能的蛋白质,是噪声创伤的两个常见目标。在这项研究中,我们以年轻、健康的成年人为研究对象,探讨了 STRC 与日常噪音暴露之间的关系。我们发现,噪声暴露水平越高,血清中的 STRC 水平越低,而另一种耳内蛋白--prestin 的情况也是如此。在统计学上,血清 STRC 与预蛋白水平呈显著正相关。这些结果为诊断和监测 NIHL 的生物标志物方法提供了支持。在血液中检测和测量 STRC 的能力也对靶向基因治疗有影响。众所周知,STRC 突变与常染色体隐性耳聋有关,这种情况现在可以进行基因靶向治疗。
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引用次数: 0
Vestibular Rehabilitation Using Dynamic Posturography: Objective and Patient-Reported Outcomes from a Randomized Trial. 使用动态后凸图进行前庭康复:一项随机试验的客观结果和患者报告。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-01 Epub Date: 2024-07-06 DOI: 10.1002/ohn.893
Eytan A David, Navid Shahnaz

Objective: Balance deficits are common and debilitating. Standard treatments have limitations in addressing symptoms and restoring dynamic balance function. This study compares a rehabilitative computerized dynamic posturography (CDP) protocol, computerized vestibular retraining therapy (CVRT), with a home exercise program (HEP) for patients with objectively confirmed unilateral vestibular deficits (UVDs).

Study design: Single-center, randomized, interventional trial, with 1-sided crossover.

Setting: A tertiary neurotology clinic.

Methods: Patients with UVDs and Dizziness Handicap Inventory (DHI) score >30 were randomized to receive either CVRT or HEP. After completion of treatment, the HEP group was crossed over to CVRT. Outcome measures were the sensory organization test (SOT) and 3 participants reported dizziness disability measures: the DHI, Activity-Specific Balance Confidence Scale (ABC) scale, and Falls Efficacy Score-International (FES-I).

Results: We enrolled 37 patients: 18 participants completed CVRT and 12 completed HEP, 11 of whom completed the crossover. Seven participants withdrew. The CVRT group demonstrated a greater improvement in SOT composite score than the HEP group (P = .04). Both groups demonstrated improvement in participant-reported measures but there were no differences between groups (DHI: P = .2604; ABC: P = .3627; FES-I: P = .96). Following crossover to CVRT after HEP, SOT composite (P = .002), DHI (P = .03), and ABC (P = .006) improved compared to HEP alone.

Conclusion: CVRT and HEP were both associated with improved participant-reported disability outcomes. CVRT was associated with greater improvement in objective balance than HEP. Adding CVRT after HEP was superior to HEP alone. Multimodal CDP-based interventions, such as CVRT, should be considered as an adjunct to vestibular physiotherapy for patients with UVD.

目的:平衡障碍是一种常见的衰弱性疾病。标准疗法在解决症状和恢复动态平衡功能方面存在局限性。本研究比较了一种康复性计算机动态后坐力测定(CDP)方案、计算机前庭再训练疗法(CVRT)和一种家庭锻炼计划(HEP),用于治疗经客观证实的单侧前庭功能障碍(UVDs)患者:单中心、随机、介入性试验,单侧交叉:研究设计:单中心随机干预试验,单侧交叉:方法:患有 UVDs 且头晕障碍量表(DHI)评分大于 30 分的患者随机接受 CVRT 或 HEP 治疗。治疗结束后,HEP 组交叉接受 CVRT 治疗。结果测量包括感觉组织测试(SOT)和 3 项参与者报告的头晕残疾测量:DHI、特定活动平衡信心量表(ABC)和国际跌倒效能评分(FES-I):我们共招募了 37 名患者:结果:我们招募了 37 名患者:18 人完成了 CVRT,12 人完成了 HEP,其中 11 人完成了交叉治疗。7 名患者退出。与 HEP 组相比,CVRT 组的 SOT 综合评分改善幅度更大(P = .04)。两组的参与者报告指标均有所改善,但组间无差异(DHI:P = .2604;ABC:P = .3627;FES-I:P = .96)。在 HEP 后交叉使用 CVRT 后,SOT 综合指标(P = .002)、DHI(P = .03)和 ABC(P = .006)与单独使用 HEP 相比均有所改善:结论:CVRT 和 HEP 均可改善参与者报告的残疾结果。与 HEP 相比,CVRT 对客观平衡的改善更大。在 HEP 后添加 CVRT 比单独使用 HEP 效果更好。应考虑将 CVRT 等基于 CDP 的多模式干预作为 UVD 患者前庭物理治疗的辅助疗法。
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引用次数: 0
Longitudinal Success of Tonsillectomy for Obstructive Sleep Apnea in Children with Down Syndrome. 唐氏综合征儿童扁桃体切除术治疗阻塞性睡眠呼吸暂停的纵向成功案例。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-01 Epub Date: 2024-07-21 DOI: 10.1002/ohn.908
Obinna R Diala, Pinar Polat, Kaci Pickett-Nairne, Norman R Friedman

Objective: Obstructive sleep apnea is common in children with Down syndrome (DS). Tonsillectomy is recommended as the first-line approach in treating children with obstructive sleep apnea (OSA), however, there is limited data on the long-term outcomes in children with DS who undergo tonsillectomy. In this retrospective study, we examined the long-term polysomnographic and symptomatic outcomes in children with DS who underwent tonsillectomy with or without an adenoidectomy (T&A). We hypothesize that the success of T&A to treat OSA in children with DS will diminish with time.

Study design: A retrospective chart review of children with DS who underwent T&A between 2009 and 2015 was conducted. Inclusion criteria were children with at least 1 postoperative polysomnogram (PSG) within 6 months of T&A with an obstructive apnea/hypopnea index (OAHI) < 5. Outcomes were determined by subsequent clinic visits and postoperative polysomnograms: OAHI ≥ 5, snoring reported during clinic visit and time to reoccurrence.

Setting: Childrens Hospital Colorado.

Results: Of the 57 children with mild OSA at 1st (initial) PSG, 13/40 (33%) children had OAHI ≥ 5 at the 2nd postoperative PSG. Of the 18 patients who underwent a 3rd PSG, 4 (22%) progressed to moderate/severe OSA. A total of 17 patients out of the original 57 (30%) progressed to moderate/severe OSA with the median time for the additional post-op PSG's being 2.3 years.

Conclusion: Children with DS who have at most mild OSA (OAHI < 5) following a T&A are at risk for progressing to at least moderate OSA within 2 years after their T&A. A surveillance PSG 2 years following surgery will identify these children.

目的:阻塞性睡眠呼吸暂停在唐氏综合征(DS)儿童中很常见。扁桃体切除术被推荐为治疗阻塞性睡眠呼吸暂停(OSA)患儿的一线方法,然而,有关接受扁桃体切除术的唐氏综合征患儿长期疗效的数据却很有限。在这项回顾性研究中,我们研究了接受扁桃体切除术并同时接受或不接受腺样体切除术(T&A)的 DS 儿童的长期多导睡眠图和症状治疗效果。我们假设,T&A治疗DS患儿OSA的成功率会随着时间的推移而降低:研究设计:我们对2009年至2015年间接受T&A治疗的DS患儿进行了回顾性病历审查。纳入标准:在 T&A 术后 6 个月内至少进行过一次术后多导睡眠图(PSG)检查,且呼吸暂停/低通气指数(OAHI)为阻塞性:科罗拉多儿童医院:在 57 名第一次 PSG 时患有轻度 OSA 的儿童中,13/40(33%)名儿童在术后第二次 PSG 时 OAHI ≥ 5。在接受第 3 次 PSG 的 18 名患者中,有 4 名(22%)发展为中度/重度 OSA。在最初的 57 名患者中,共有 17 名患者(30%)发展为中度/重度 OSA,术后 PSG 检查的中位时间为 2.3 年:结论:患有轻度 OSA 的 DS 儿童(OAHI
{"title":"Longitudinal Success of Tonsillectomy for Obstructive Sleep Apnea in Children with Down Syndrome.","authors":"Obinna R Diala, Pinar Polat, Kaci Pickett-Nairne, Norman R Friedman","doi":"10.1002/ohn.908","DOIUrl":"10.1002/ohn.908","url":null,"abstract":"<p><strong>Objective: </strong>Obstructive sleep apnea is common in children with Down syndrome (DS). Tonsillectomy is recommended as the first-line approach in treating children with obstructive sleep apnea (OSA), however, there is limited data on the long-term outcomes in children with DS who undergo tonsillectomy. In this retrospective study, we examined the long-term polysomnographic and symptomatic outcomes in children with DS who underwent tonsillectomy with or without an adenoidectomy (T&A). We hypothesize that the success of T&A to treat OSA in children with DS will diminish with time.</p><p><strong>Study design: </strong>A retrospective chart review of children with DS who underwent T&A between 2009 and 2015 was conducted. Inclusion criteria were children with at least 1 postoperative polysomnogram (PSG) within 6 months of T&A with an obstructive apnea/hypopnea index (OAHI) < 5. Outcomes were determined by subsequent clinic visits and postoperative polysomnograms: OAHI ≥ 5, snoring reported during clinic visit and time to reoccurrence.</p><p><strong>Setting: </strong>Childrens Hospital Colorado.</p><p><strong>Results: </strong>Of the 57 children with mild OSA at 1st (initial) PSG, 13/40 (33%) children had OAHI ≥ 5 at the 2nd postoperative PSG. Of the 18 patients who underwent a 3rd PSG, 4 (22%) progressed to moderate/severe OSA. A total of 17 patients out of the original 57 (30%) progressed to moderate/severe OSA with the median time for the additional post-op PSG's being 2.3 years.</p><p><strong>Conclusion: </strong>Children with DS who have at most mild OSA (OAHI < 5) following a T&A are at risk for progressing to at least moderate OSA within 2 years after their T&A. A surveillance PSG 2 years following surgery will identify these children.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1918-1924"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Enhancing Health Literacy: Evaluating the Readability of Patient Handouts Revised by ChatGPT's Large Language Model. 提高健康素养:评估经 ChatGPT 大语言模型修订的患者手册的可读性。
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-06 DOI: 10.1002/ohn.927
Austin R Swisher, Arthur W Wu, Gene C Liu, Matthew K Lee, Taylor R Carle, Dennis M Tang

Objective: To use an artificial intelligence (AI)-powered large language model (LLM) to improve readability of patient handouts.

Study design: Review of online material modified by AI.

Setting: Academic center.

Methods: Five handout materials obtained from the American Rhinologic Society (ARS) and the American Academy of Facial Plastic and Reconstructive Surgery websites were assessed using validated readability metrics. The handouts were inputted into OpenAI's ChatGPT-4 after prompting: "Rewrite the following at a 6th-grade reading level." The understandability and actionability of both native and LLM-revised versions were evaluated using the Patient Education Materials Assessment Tool (PEMAT). Results were compared using Wilcoxon rank-sum tests.

Results: The mean readability scores of the standard (ARS, American Academy of Facial Plastic and Reconstructive Surgery) materials corresponded to "difficult," with reading categories ranging between high school and university grade levels. Conversely, the LLM-revised handouts had an average seventh-grade reading level. LLM-revised handouts had better readability in nearly all metrics tested: Flesch-Kincaid Reading Ease (70.8 vs 43.9; P < .05), Gunning Fog Score (10.2 vs 14.42; P < .05), Simple Measure of Gobbledygook (9.9 vs 13.1; P < .05), Coleman-Liau (8.8 vs 12.6; P < .05), and Automated Readability Index (8.2 vs 10.7; P = .06). PEMAT scores were significantly higher in the LLM-revised handouts for understandability (91 vs 74%; P < .05) with similar actionability (42 vs 34%; P = .15) when compared to the standard materials.

Conclusion: Patient-facing handouts can be augmented by ChatGPT with simple prompting to tailor information with improved readability. This study demonstrates the utility of LLMs to aid in rewriting patient handouts and may serve as a tool to help optimize education materials.

Level of evidence: Level VI.

目的:使用人工智能(AI)驱动的大型语言模型(LLM)提高患者手册的可读性:使用人工智能(AI)驱动的大型语言模型(LLM)提高患者手册的可读性:研究设计:审查经人工智能修改的在线资料:学术中心:使用经过验证的可读性指标对从美国鼻科学会(ARS)和美国面部整形外科学会网站上获取的五份讲义进行评估。根据提示将讲义输入到 OpenAI 的 ChatGPT-4 中:"以六年级的阅读水平重写以下内容"。使用患者教育材料评估工具(PEMAT)对原生版本和 LLM 修订版本的可理解性和可操作性进行了评估。结果采用 Wilcoxon 秩和检验进行比较:结果:标准版(ARS,美国面部整形与重建外科学会)材料的平均可读性评分为 "困难",阅读类别介于高中和大学年级之间。相反,LLM 修订版讲义的平均阅读水平为七年级水平。在几乎所有测试指标中,LLM 修订版讲义的可读性都更好:Flesch-Kincaid 阅读轻松度(70.8 vs 43.9;P 结论:LLM 修订版讲义的可读性更好:面向患者的讲义可以通过 ChatGPT 进行扩充,并通过简单的提示来定制信息,从而提高可读性。这项研究证明了 LLMs 在帮助改写患者手册方面的实用性,可作为帮助优化教育材料的工具:证据等级:VI 级。
{"title":"Enhancing Health Literacy: Evaluating the Readability of Patient Handouts Revised by ChatGPT's Large Language Model.","authors":"Austin R Swisher, Arthur W Wu, Gene C Liu, Matthew K Lee, Taylor R Carle, Dennis M Tang","doi":"10.1002/ohn.927","DOIUrl":"10.1002/ohn.927","url":null,"abstract":"<p><strong>Objective: </strong>To use an artificial intelligence (AI)-powered large language model (LLM) to improve readability of patient handouts.</p><p><strong>Study design: </strong>Review of online material modified by AI.</p><p><strong>Setting: </strong>Academic center.</p><p><strong>Methods: </strong>Five handout materials obtained from the American Rhinologic Society (ARS) and the American Academy of Facial Plastic and Reconstructive Surgery websites were assessed using validated readability metrics. The handouts were inputted into OpenAI's ChatGPT-4 after prompting: \"Rewrite the following at a 6th-grade reading level.\" The understandability and actionability of both native and LLM-revised versions were evaluated using the Patient Education Materials Assessment Tool (PEMAT). Results were compared using Wilcoxon rank-sum tests.</p><p><strong>Results: </strong>The mean readability scores of the standard (ARS, American Academy of Facial Plastic and Reconstructive Surgery) materials corresponded to \"difficult,\" with reading categories ranging between high school and university grade levels. Conversely, the LLM-revised handouts had an average seventh-grade reading level. LLM-revised handouts had better readability in nearly all metrics tested: Flesch-Kincaid Reading Ease (70.8 vs 43.9; P < .05), Gunning Fog Score (10.2 vs 14.42; P < .05), Simple Measure of Gobbledygook (9.9 vs 13.1; P < .05), Coleman-Liau (8.8 vs 12.6; P < .05), and Automated Readability Index (8.2 vs 10.7; P = .06). PEMAT scores were significantly higher in the LLM-revised handouts for understandability (91 vs 74%; P < .05) with similar actionability (42 vs 34%; P = .15) when compared to the standard materials.</p><p><strong>Conclusion: </strong>Patient-facing handouts can be augmented by ChatGPT with simple prompting to tailor information with improved readability. This study demonstrates the utility of LLMs to aid in rewriting patient handouts and may serve as a tool to help optimize education materials.</p><p><strong>Level of evidence: </strong>Level VI.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1751-1757"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of Tracheostomy Status on Sternal Wound Infections in Children Following Median Sternotomy. 气管造口状态对中线缝合术后儿童胸骨伤口感染的影响
IF 2.6 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-12-01 Epub Date: 2024-08-10 DOI: 10.1002/ohn.939
Rohit Nallani, Brevin J Miller, Janelle R Noel-MacDonnell, Meghan Tracy, Jason R Brown, James E O'Brien, Daniel R Jensen

Objective: Sternal wound infection (SWI) is a rare but potentially life-threatening complication in children following sternotomy. Risk factors include young age, extended preoperative hospitalization, and prolonged ventilatory support. Few studies have explored the impact of pre-existing tracheostomy on SWI in pediatric patients. The purpose of this study is to measure the effect of tracheostomy and other factors on SWI in children undergoing sternotomy.

Study design: Retrospective cohort study of a 12 year period.

Setting: Tertiary children's hospital.

Methods: Children with a tracheostomy prior to sternotomy (TPS) were identified and matched by age, height, and weight to children who underwent sternotomy alone. Demographics, medical comorbidities, surgical details, SWI diagnosis and management information, and surgical outcomes were collected.

Results: We identified 60 unique individuals representing 80 sternotomies. The incidence of SWI was 22.5% (n = 9) in children with a tracheostomy and 2.5% (n = 1) in those without. The incidence of SWI was greater in children with a tracheostomy (90% vs 10% in those without, P = .007) and underlying pulmonary disease (90% vs 10% in those without, P = .020). Infections in the TPS group also demonstrated greater frequency of Pseudomonas aeruginosa (n = 3) and polymicrobial growth (n = 2).

Conclusion: The risk of developing a SWI in children undergoing sternotomy is significantly greater in those with a tracheostomy and underlying pulmonary disease. Further study is needed to understand other contributing factors and ways to mitigate this risk.

目的:胸骨伤口感染(SWI)是儿童胸骨切开术后一种罕见但可能危及生命的并发症。风险因素包括年龄小、术前住院时间长以及长时间的通气支持。很少有研究探讨了儿童患者术前气管切开对 SWI 的影响。本研究的目的是测量气管切开术和其他因素对接受胸骨切开术的儿童 SWI 的影响:背景:三级儿童医院:地点:三级儿童医院:方法:确定胸骨切开术(TPS)前进行了气管切开术的儿童,并根据年龄、身高和体重将其与单独进行胸骨切开术的儿童进行配对。我们收集了人口统计学、合并症、手术细节、SWI 诊断和管理信息以及手术结果:结果:我们确定了 60 个独特的个体,代表了 80 例胸骨切开术。有气管造口术的患儿SWI发生率为22.5%(9例),无气管造口术的患儿SWI发生率为2.5%(1例)。有气管造口术的患儿(90%对10%,P = 0.007)和有潜在肺部疾病的患儿(90%对10%,P = 0.020)的SWI发生率更高。TPS组感染中铜绿假单胞菌(3例)和多微生物生长(2例)的频率也更高:结论:在接受胸骨切开术的儿童中,气管造口术和潜在肺部疾病患者发生SWI的风险明显更高。需要进一步研究以了解其他诱发因素和降低这一风险的方法。
{"title":"Impact of Tracheostomy Status on Sternal Wound Infections in Children Following Median Sternotomy.","authors":"Rohit Nallani, Brevin J Miller, Janelle R Noel-MacDonnell, Meghan Tracy, Jason R Brown, James E O'Brien, Daniel R Jensen","doi":"10.1002/ohn.939","DOIUrl":"10.1002/ohn.939","url":null,"abstract":"<p><strong>Objective: </strong>Sternal wound infection (SWI) is a rare but potentially life-threatening complication in children following sternotomy. Risk factors include young age, extended preoperative hospitalization, and prolonged ventilatory support. Few studies have explored the impact of pre-existing tracheostomy on SWI in pediatric patients. The purpose of this study is to measure the effect of tracheostomy and other factors on SWI in children undergoing sternotomy.</p><p><strong>Study design: </strong>Retrospective cohort study of a 12 year period.</p><p><strong>Setting: </strong>Tertiary children's hospital.</p><p><strong>Methods: </strong>Children with a tracheostomy prior to sternotomy (TPS) were identified and matched by age, height, and weight to children who underwent sternotomy alone. Demographics, medical comorbidities, surgical details, SWI diagnosis and management information, and surgical outcomes were collected.</p><p><strong>Results: </strong>We identified 60 unique individuals representing 80 sternotomies. The incidence of SWI was 22.5% (n = 9) in children with a tracheostomy and 2.5% (n = 1) in those without. The incidence of SWI was greater in children with a tracheostomy (90% vs 10% in those without, P = .007) and underlying pulmonary disease (90% vs 10% in those without, P = .020). Infections in the TPS group also demonstrated greater frequency of Pseudomonas aeruginosa (n = 3) and polymicrobial growth (n = 2).</p><p><strong>Conclusion: </strong>The risk of developing a SWI in children undergoing sternotomy is significantly greater in those with a tracheostomy and underlying pulmonary disease. Further study is needed to understand other contributing factors and ways to mitigate this risk.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1872-1878"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141913638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Otolaryngology- Head and Neck Surgery
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