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Ranking methods based on the dominance degree. An investigation of rank reversal
No full textpeer reviewedMulti-criteria decision making methods have been used in many applications to derive a ranking of objects evaluated on several criteria. In case these evaluations are imprecise, integrating imprecision in the overall assessment is a further issue. In this paper, we deal with imprecise evaluations in the form of intervals. Therefore, the problem is to rank multi-dimensional interval data.
In recent years, a scoring method using the dominance degree has been proposed in order to rank interval data. This index is ordinal in the sense that it takes only into account the ordering of the endpoints of the evaluation intervals. It is computed by considering the evaluations of all the other objects to be ranked. This implies that the dominance degree, hence the ranking, may change when the set of objects to be ranked is altered. This phenomenon is known as rank reversal in the literature.
We analyze the occurrence of rank reversal when we remove an object from (or add one to) the set of objects to be ranked. We introduce variants of the dominance degree rule and analyze them similarly. This is done both analytically and by simulation. We then compare the dominance degree approach with an adaptation of the Borda rule. We also examine how the presence of a set of reference points can reduce the rank reversal phenomenon and enhance the discrimination power of the method
Validity and Reliability of the Singer Reflux Symptom Score (sRSS).
Get PDFpeer reviewedObjectives: To investigate the reliability and validity of the Singer Reflux Symptom Score (sRSS), a new patient-reported outcome questionnaire documenting the severity of reflux symptoms in singing voice is proposed. Methods: Amateur and professional singers consulting the European Reflux Clinic for laryngopharyngeal reflux disease (LPRD) symptoms and findings were prospectively recruited from January 2022 to February 2023. The diagnosis was based on a Reflux Symptom Score (RSS) > 13 and Reflux Sign Assessment (RSA) > 14. A control group of asymptomatic singer subjects was recruited from the University of Mons. The sRSS was rated within a 7-day period to assess test-retest reliability. Internal consistency was measured using Cronbach's α in patients and controls. A correlation analysis was performed between sRSS and Singing Voice Handicap Index (sVHI) to evaluate convergent validity. Responsiveness to change was evaluated through pre- to post-treatment sRSS changes. The sRSS threshold for suggesting a significant impact of LPRD on singing voice was determined by receiver operating characteristic (ROC) analysis. Results: Thirty-three singers with suspected LPRD (51.5% female; mean age: 51.8 ± 17.2 years) were consecutively recruited. Difficulty reaching high notes and vocal fatigue were the most prevalent LPRD-related singing complaints. The sRSS demonstrated high internal consistency (Cronbach-α = 0.832), test-retest reliability, and external validity (correlation with sVHI: r = 0.654; p = 0.015). Singers with suspected LPRD reported a significant higher sRSS compared to 68 controls. sRSS item and total scores significantly reduced from pre-treatment to 3 months post-treatment except for the abnormal voice breathiness item. ROC analysis revealed superior diagnostic accuracy for sRSS (AUC = 0.971) compared to sRSS-quality of life (AUC = 0.926), with an optimal cutoff at sRSS > 38.5 (sensitivity: 90.3%; specificity: 85.0%). Conclusions: The sRSS is a reliable and valid singer-reported outcome questionnaire for documenting singing symptoms associated with LPRD leading to personalized management of Singers. Future large-cohort studies are needed to evaluate its specificity for LPRD compared to other vocal fold disorders in singers
Diagnostic Performance of ChatGPT-4o in Analyzing Oral Mucosal Lesions: A Comparative Study with Experts.
Get PDFpeer reviewedBackground and Objectives: this pilot study aimed to evaluate the diagnostic accuracy of ChatGPT-4o in analyzing oral mucosal lesions from clinical images. Materials and Methods: a total of 110 clinical images, including 100 pathological lesions and 10 healthy mucosal images, were retrieved from Google Images and analyzed by ChatGPT-4o using a standardized prompt. An expert panel of five clinicians established a reference diagnosis, categorizing lesions as benign or malignant. The AI-generated diagnoses were classified as correct or incorrect and further categorized as plausible or not plausible. The accuracy, sensitivity, specificity, and agreement with the expert panel were analyzed. The Artificial Intelligence Performance Instrument (AIPI) was used to assess the quality of AI-generated recommendations. Results: ChatGPT-4o correctly diagnosed 85% of cases. Among the 15 incorrect diagnoses, 10 were deemed plausible by the expert panel. The AI misclassified three malignant lesions as benign but did not categorize any benign lesions as malignant. Sensitivity and specificity were 91.7% and 100%, respectively. The AIPI score averaged 17.6 ± 1.73, indicating strong diagnostic reasoning. The McNemar test showed no significant differences between AI and expert diagnoses (p = 0.084). Conclusions: In this proof-of-concept pilot study, ChatGPT-4o demonstrated high diagnostic accuracy and strong descriptive capabilities in oral mucosal lesion analysis. A residual 8.3% false-negative rate for malignant lesions underscores the need for specialist oversight; however, the model shows promise as an AI-powered triage aid in settings with limited access to specialized care
Neurological and Olfactory Disturbances After General Anesthesia.
Get PDFpeer reviewedNeurological and olfactory disturbances are increasingly recognized as potential complications of general anesthesia, particularly in vulnerable populations, such as the elderly, children, and individuals with comorbidities. Recent studies have highlighted the need for tailored anesthetic approaches in these high-risk groups to mitigate potential long-term effects. These disturbances, including postoperative cognitive dysfunction, delirium, and olfactory deficits, often arise from shared pathophysiological mechanisms, such as neuroinflammation, oxidative stress, and disruptions in cerebral perfusion. The olfactory system is particularly susceptible to anesthesia-induced neurotoxicity given its proximity to central nervous system structures and its role in sensory and cognitive processing. Furthermore, the unique regenerative capacity of olfactory neurons may be compromised by prolonged or repeated exposure to anesthetic agents, potentially leading to long-term olfactory dysfunction. Risk factors, such as advanced age, neurodegenerative diseases, diabetes, cardiovascular conditions, genetic predispositions, and the type and duration of anesthesia exposure, further exacerbate these complications. Preventive strategies, including comprehensive preoperative risk assessment, personalized anesthetic protocols based on genetic and physiological profiles, and proactive postoperative care with early intervention programs, are critical for reducing impairments and improving long-term patient outcomes. Emerging evidence highlights the potential role of neuroprotective agents, such as antioxidants and anti-inflammatory therapies, in mitigating the effects of anesthesia-induced neurotoxicity. Longitudinal studies are needed to evaluate the long-term effects of anesthesia on cognitive and sensory health, particularly in high-risk populations. These studies should incorporate advanced neuroimaging techniques and biomarker analysis to elucidate the underlying mechanisms of anesthesia-induced neurological and olfactory disturbances. This narrative review provides a comprehensive overview of the mechanisms, risk factors, and preventive strategies for neurological and olfactory disturbances after general anesthesia and highlights future directions for research to improve patient outcomes. We conducted a comprehensive literature search using databases, such as PubMed and Scopus, to identify relevant studies
Parotid gland sialolithiasis: a comprehensive systematic review and meta-analysis : Title page.
Get PDFpeer reviewed[en] PURPOSE: Parotid sialolithiasis represents unique diagnostic and therapeutic challenges due to the anatomy of the gland and the proximity of the facial nerve. The aim of this systematic review and meta-analysis was to evaluate the efficacy and safety of various treatment modalities for parotid gland stones.
METHODS: A systematic review was conducted in accordance with the PRISMA guidelines. Eligible studies were identified by searching PubMed/MEDLINE, the Cochrane Library, Scopus and Google Scholar. Eligible observational studies and clinical trials reporting on patients with parotid stones were included. The outcomes assessed included stone-free rate, symptom improvement and the presence of any complications. A single-arm random-effects meta-analysis was performed, focusing on endoscopy-only, endoscopy-assisted and extracorporeal shock wave lithotripsy (ESWL). Bias risk was assessed using the Newcastle-Ottawa Scale.
RESULTS: A total of 42 studies involving 1,559 patients were analyzed. Endoscopy-assisted removal showed the highest stone-free rate (93%, 95%CI: 90-96) and symptom improvement (91%, 95%CI: 92-99) (p < 0.05). Combined endoscopic-external approaches were effective for complex stones but had higher complication rates (24%, 95% CI: 14-37). ESWL had a lower stone-free rate (58%) but aided long-term symptom control (p < 0.05). CT-navigation did not significantly enhance clearance (80%). Most complications were minor; no permanent facial nerve injuries were reported. The quality of the evidence was limited by heterogeneity and the lack of any randomized trials.
CONCLUSIONS: Endoscopy-assisted and combined approaches offer effective, gland-preserving options for parotid sialolithiasis. ESWL and laser techniques remain adjunctive but warrant further research. Prospective, standardized trials are needed to define any optimal management strategies
Clinical Relevance and Therapeutic Findings of Chronic Cough Related to Laryngopharyngeal Reflux Disease.
Get PDFpeer reviewed[en] OBJECTIVE: To investigate clinical significance of chronic cough in patients with laryngopharyngeal reflux disease (LPRD) and evaluate the potential of cough as a predictor for clinical findings and treatment outcomes.
METHODS: Data of patients with a positive diagnosis of LPRD at the 24-hour hypopharyngeal-esophageal multi-channel intraluminal impedance-pH monitoring (HEMII-pH) prospectively followed at the European Reflux Clinic and Elsan Hospital from January 2017 to August 2024 were retrieved. Four study groups were established based on chronic cough severity. Between-group analysis included HEMII-pH parameters (number and pH of pharyngeal reflux events), pretreatment and post treatment reflux symptom scores (RSS), reflux sign assessment (RSA), and gastrointestinal endoscopy findings.
RESULTS: The study included 523 patients [303 females (57.9%) and 220 males (42.1%)]. Of the 523 patients with LPRD, 326 (62.3%) had mild-to-severe chronic cough. The mean ages of patients ranged from 50.3 to 52.7 years. The cough severity score was associated with the severity of otolaryngological, digestive, and non-cough respiratory symptoms, with the mildest presentations in patients without chronic cough. The magnitude of pretreatment to post treatment changes in RSS and RSA decreased as cough severity increased. Patients with chronic cough demonstrated higher post therapeutic otolaryngological and non-cough respiratory symptom scores, while there were no significant differences across groups for digestive symptoms. The therapeutic response rate was 75.1%, without demonstrating significant differences between patients with chronic cough (75.9%) and those without (73.8%). The cough severity score was a predictor of the post treatment RSS (rs = 0.222; P = 0.001).
CONCLUSION: Chronic cough is a predominant symptom in LPRD with a prevalence of 62.3%. At baseline presentation, chronic cough severity is suggestive of a significant prognostic indicator of LPRD RSS severity
Pleomorphic Adenoma: Extracapsular Dissection vs. Superficial Parotidectomy-An Updated Systematic Review and Meta-Analysis.
Get PDFpeer reviewedBackground/Objectives: The aim of our study was to evaluate clinical outcomes in patients with small pleomorphic adenoma (PA) after extracapsular dissection (ED) versus superficial parotidectomy (SP). Methods: Following the PRISMA guidelines, a systematic review covering the years from 1950 to 2025 was conducted using the Pubmed/MEDLINE, Cochrane Library, Scopus, Ovid MEDLINE and Embase databases. A single-arm meta-analysis was performed to evaluate intraoperative capsular rupture, recurrence, transient and permanent facial nerve palsy, Frey's syndrome, salivary fistula, seroma and hematoma of patients who underwent ED vs. those who underwent SP, and funnel plots were constructed to evaluate the robustness of the findings. Results: Of the 1793 identified papers, 21 articles met the inclusion criteria. The meta-analysis (2507 patients) reported the following: (1) the risk of recurrence is similar in patients treated with ED and SP; (2) the transient facial nerve palsy rate is lower after ED (p < 0.05), while the permanent facial nerve palsy rate is similar with ED and SP; (3) post-operative complications, especially Frey's syndrome (p < 0.05), are more common after SP. Conclusions: Given the similar recurrence rate and the lower morbidity compared to SP, ED could be considered the treatment of choice for pleomorphic adenomas of the parotid gland that are up to 3 cm in size, mobile and located in the superficial lobe of the parotid gland
The Role of the Microbiome in Oropharyngeal Squamous Cell Carcinoma: A Systematic Review.
Get PDFpeer reviewedObjective: This systematic review aimed to investigate existing evidence regarding the implications of the microbiome in the initiation and progression of oropharyngeal squamous cell carcinoma (OPSCC). Methods: PubMed, Scopus, and Cochrane Library systematic searches were conducted according to the PRISMA statements to identify the relevant studies examining microbiome signatures, underlying molecular mechanisms, and their associations with clinical and oncological outcomes in OPSCC. The bias analysis was conducted with the MINORS. Results: Of the 83 identified papers, 12 met the inclusion criteria (298 OPSCC patients). Spirochaetes and most Bacteroidetes may be predominant in OPSCC versus control specimens, while Proteobacteria may be predominant in control tissues compared to tumor. Leptotrichia, Selenomonas, and Treponema trended to be overrepresented in OPSCC compared to control specimens. Neisseria, Porphyromonas, Rothia, Streptococcus, and Veillonela were predominantly reported in normal compared to OPSCC patient specimens. Microbiome compositional shifts were associated with chemoradiation response, HPV status, and addictions. Methodological heterogeneity was noted in sampling protocols, control selection, and analytical approaches, with limited statistical power due to small cohort sizes. Conclusions: OPSCC demonstrates different microbiome signatures from healthy tissues, influenced by HPV status and addictions. A microbiome shift is plausible from pre- to post-chemoradiotherapy, with the baseline microbiome acting as a predictive response factor; however, the low number of studies and substantial methodological heterogeneity across investigations limit the drawing of valid conclusions. The identification of key species is important in the development of OPSCC for developing personalized medicine considering bacterial mediators in terms of prevention, and targeted therapy using the microbiome-tumor-host interaction pathways
Laryngeal Reinnervation Techniques for Unilateral Vocal Fold Paralysis-Clinical Outcomes and Surgical Approaches: A Systematic Review and Meta-Analysis.
Get PDFpeer reviewed[en] BACKGROUND: Laryngeal reinnervation is a promising therapeutic option for unilateral vocal fold paralysis (UVFP). However, the efficacy of the different techniques remains controversial.
OBJECTIVES: To systematically evaluate clinical outcomes and surgical approaches employed for laryngeal reinnervation in UVFP, using both objective and subjective parameters.
METHODS: A systematic review was conducted in accordance with PRISMA guidelines. PubMed/MEDLINE, Embase, the Cochrane Library, and Web of Science were searched for studies published between 2011 and 2024. Study quality was assessed using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. A meta-analysis was performed for maximum phonation time (MPT) and the Voice Handicap Index (VHI).
RESULTS: Twenty-six studies comprising 956 patients were included: 23 observational studies, two clinical trials, and one randomized controlled trial. The most frequently reported technique was the ansa cervicalis-to-recurrent laryngeal nerve anastomosis, as reported in 17 studies. MPT significantly improved from a baseline of 7.36 to 12.8 seconds at 6 months and remained stable at 11.7 seconds at 12 months, with moderate heterogeneity (I² = 65.6%-76.7%). VHI scores decreased significantly from a baseline of 47.0 to 16.6 at 6 months and 19.4 at 12 months, despite high heterogeneity (I² > 90%). Follow-up durations ranged from 3 months to 12 years, with minimal complications reported.
CONCLUSIONS: Laryngeal reinnervation demonstrates effectiveness in improving both objective and subjective outcomes in UVFP. Our updated literature synthesis underscored the value of reinnervation in UVFP and how an urgent need for standardized outcome measures and multicenter randomized trials is required to define its optimal role among emerging surgical alternatives
Artificial Intelligence-Assisted Diagnosis of an Unusual Cause of Periodic Epistaxis: A Case Report.
Get PDFpeer reviewedEpistaxis is a common cause of consultation in otolaryngology, manifesting either as isolated episodes or recurrent events. In this paper, we report the history of an 8-year-old African male who presented with periodic epistaxis temporally associated with joint inflammation. The diagnostic work-up, supported by artificial intelligence-based clinical decision support, led to the diagnosis of rheumatic fever. This case describes a very rare etiology of periodic epistaxis and demonstrates the potential usefulness of artificial intelligence as an adjunctive clinical tool. To our knowledge, this is the first reported case of rheumatic fever presenting with periodic epistaxis in the pediatric population