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Δευτέρα 4 Οκτωβρίου 2021

Days alive and out of hospital following transoral robotic surgery: Cohort study of 262 patients with head and neck cancer

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Abstract

Background

Days alive and out of hospital (DAOH) is a validated outcome in clinical trials, since it reflects procedure-associated morbidity and mortality. Transoral robotic surgery (TORS) has become a widely adopted procedure with increasing demand for knowledge and data on morbidity.

Methods

Retrospective single-center assessment of a prospective TORS database comprising patients treated for malignancy between 2013 and 2018 using DAOH to describe procedure- and disease-related morbidity the first 12-postoperative months.

Results

For 262 patients, median DAOH365 was 357 days (IQR 351–360). Indications for TORS were (i) primary curative resection (61%), (ii) salvage resection (15%), and (iii) diagnostic work-up of cancer of unknown primary in the head and neck (24%). Median DAOH365 was 359 days (IQR 351–361 days), 348 days (IQR 233–355), and 357 days (351–361), respectively. Pneumonia had the highest impact in DAOH365 reduction.

Conclusion

Total median DAOH365 after TORS was 357 days. The main cause leading to DAOH365 reduction was pneumonia.

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Solitary neurofibroma in the external auditory canal

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Ear Nose Throat J. 2021 Oct 2:1455613211048978. doi: 10.1177/01455613211048978. Online ahead of print.

ABSTRACT

Significance Statement: Neurofibromas, derived from perineural cells, are usually benign in the nervous system. Although neurofibromas are common in the head and neck, they rarely affect the external auditory canal (EAC), and few cases have been reported. We describe a case of a solitary EAC neurofibroma with otoscopy, radiological imaging, a surgical approa ch, and an uneventful outcome.

PMID:34601890 | DOI:10.1177/01455613211048978

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Resolvin D2 suppresses NLRP3 inflammasome by promoting autophagy in macrophages

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Exp Ther Med. 2021 Nov;22(5):1222. doi: 10.3892/etm.2021.10656. Epub 2021 Aug 26.

ABSTRACT

Inflammasome, a multiprotein complex that regulates interleukin (IL)-1β secretion and pyroptosis, participates in numerous inflammatory diseases, including sepsis, atherosclerosis and type-2 diabetes. Investigating the inflammasome regulation is therefore crucial to understand the inflammasome activation and develop treatment for the related diseases. In addition, it remains unknown how the inflammasome is naturally suppressed during the inflammatory process. The present study aimed to investigate the role of resolvin D2 (RvD2), an innate suppressor of inflammation produced from essential ω3-polyunsaturated fatty acids, in the activation of the inflammasome via in vitro and in vivo experiments. The effects of RvD2 on the cytokine production of inflammasome-related peritonitis were determined, and the NLRP3 inflammasome activation was investigated in the presence of RvD2. Moreover, the potential mechanisms underlying RvD2 in NLRP3 inflammasome regulation through autophagy and proteasome were investigated. The results of the present study demonstrated that RvD2 suppressed inflammasome-mediated peritonitis in vivo and regulated the NLR family pyrin domain containing 3 (NLRP3) inflammasome, but not in absent in melanoma 2 (AIM2), NLR family CARD domain containing 4 (NLRC4) inflammasomes. Mechanistically, RvD2 was found to promote the degradation of NLRP3 through autophagy, and the inhibition of autophagy could reverse the RvD2-mediated suppression of NLRP3 inflammasome in vitro and partially reverse the inflammasome-mediated peritonitis in vivo. In summary, the present study reported the negative regulation of NLRP3 inflammasome activation by RvD2. The findings from this study may extend the knowledge of the innate regulation of inflammasome and highlight a possible target for inflammasome-r elated diseases.

PMID:34603519 | PMC:PMC8453332 | DOI:10.3892/etm.2021.10656

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Antibodies against thyroid-stimulating hormone receptor cause maternal-neonatal transmission of Graves' Disease

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Exp Ther Med. 2021 Nov;22(5):1253. doi: 10.3892/etm.2021.10688. Epub 2021 Sep 3.

ABSTRACT

The present study aimed to investigate whether the thyroid-stimulating hormone receptor (TSHR) autoantibodies (Ab) from mothers with Graves' disease (GD) could cause neonatal thyroid disease and the underlying mechanisms of this. An adenovirus expressing the TSHR A-subunit and a control adenovirus expressing β-galactosidase was constructed by Beijing Sino Geno Max Co., Ltd. The sequences were subsequently verified and amplified via PCR. A GD model was established in female BALB/c mice (n=90) by three intramuscular injections of a TSHR-expressing adenovirus (Ad-TSHR). Mice injected with Ad-β-galactosidase served as a sham immunization group. The immunized females were paired with unimmunized males to generate offspring. The serum levels of TSHR-Ab and thyroxine (T4) of mothers and neonates were measured after delivery. Breast milk was collected f rom the stomachs of neonatal mice to determine the TSHR-Ab levels. The positive rate of serum TSHR-Ab (>0.3 IU/l) in the TSHR group was 99% (89/90) and 0% in the sham group. The mother mice in the TSHR group had elevated serum T4 levels and the thyroid pathological features of Graves' hyperthyroidism.GD mice gave birth to smaller newborns with thyroid pathological changes and higher serum levels of TSHR-Ab and T4, compared to the offspring in the sham group. The TSHR-Ab levels in breast milk from the GD mice declined with time. Mice immunized with Ad-TSHR exhibited the clinicopathological features of human GD and give birth to neonates with thyroid disease at birth.

PMID:34603521 | PMC:PMC8453324 | DOI:10.3892/etm.2021.10688

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MicroRNA-34a directly targets high-mobility group box 1 and inhibits the cancer cell proliferation, migration and invasion in cutaneous squamous cell carcinoma

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Exp Ther Med. 2021 Nov;22(5):1257. doi: 10.3892/etm.2021.10692. Epub 2021 Sep 3.

ABSTRACT

[This retracts the article DOI: 10.3892/etm.2017.5245.].

PMID:34603525 | PMC:PMC8453323 | DOI:10.3892/etm.2021.10692

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The added value of three-dimensional ultrasonography in uterine pathology

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Exp Ther Med. 2021 Nov;22(5):1261. doi: 10.3892/etm.2021.10696. Epub 2021 Sep 6.

ABSTRACT

The rapid development achieved over the last decades in volume rendering of ultrasound data, known as three-dimensional (3D) ultrasound technique, leads to new opportunities for refining the diagnosis in many gynaecologic conditions. The aim of the present study was to evaluate the advantages of 3D ultrasound over two-dimensional (2D) ultrasound in uterine pathology and to establish the optimal time point during the menstrual cycle to perform 3D ultrasound examination in order to achieve the maximum of useful information. A cross-sectional study on 200 patients who underwent gynaecologic 2D and 3D ultrasound examinations was performed. The addition of 3D examination to 2D ultrasound in uterine pathology provided the most useful information concerning: Congenital uterine anomalies, intrauterine devices (IUDs), adenomyosis, and submucous myomas. The findings showed that the 3D ultrasound scan is a useful tool in gynaecology, especially in cases with congenital uterine anomalies, myoma, and IUD. Although initially it was used for research purposes only, recent findings suggest its usefulness in routine ultrasound scan and the possibility of witnessing its introduction as a recommended examination procedure in the foreseeable future. Further research should be conducted in order to establish the sensitivity of 3D ultrasound in the detection of minor endometrial conditions, by correlating the imaging findings with the hysteroscopic results.

PMID:34603529 | PMC:PMC8453339 | DOI:10.3892/etm.2021.10696

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Biological therapies targeting the type 2 inflammatory pathway in severe asthma (Review)

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Exp Ther Med. 2021 Nov;22(5):1263. doi: 10.3892/etm.2021.10698. Epub 2021 Sep 6.

ABSTRACT

Asthma is a variable chronic respiratory disease characterized by airway inflammation and hyperresponsiveness, bronchoconstriction, and mucus hypersecretion. While most patients with asthma achieve good control of the disease, 5-10% experience severe symptoms and recurrent exacerbation despite the maximal offered therapy with inhaled corticosteroids and long acting bronchodilators. In previous years, novel biological therapies have become available, and various asthma phenotypes that are characterized by specific biomarkers have been identified. Currently approved biological agents target inflammatory molecules of the type 2 inflammatory pathway, and are effective at decreasing the frequency of asthma attacks, controlling symptoms and decreasing use of systemic steroids. The present study reviewed the effectiveness and safety profile of the curren tly approved biological drugs and provided an overview of the assessment of patients with severe asthma who are potentially suitable for biological therapy, in order to help clinicians to select the most appropriate biological agent.

PMID:34603531 | PMC:PMC8453334 | DOI:10.3892/etm.2021.10698

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Falx Cerebelli Meningioma: Case Report of a Rarely Occurring Tumor, Management Nuances, and Literature Review

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J Neurol Surg Rep. 2021 Sep 29;82(3):e32-e35. doi: 10.1055/s-0041-1735905. eCollection 2021 Jul.

ABSTRACT

The falx cerebelli is a small crescent fold of dura mater that is attached to the internal occipital crest and projects forward into the posterior cerebellar notch between the cerebellar hemispheres. We report a rare case of a 61-year-old female who presented with a 1-month history of headache and gait instability. Imaging findings were suggestive of a meningioma arising from the falx cerebelli. Complete surgical resection was achieved with a standard posterior fossa midline approach. Duraplasty was performed using animal allograft dura (Duraguard) and additional layers of oxidized cellulose preparation (Surgicel), fibrin sealant, and nonsuturable collagen matrix (Duragen) were utilized to reduce the risk of a cerebrospinal fluid leak. Pathology confirmed a World Health Organization (WHO) grade-I meningioma. Postoperatively, patient with asymptomatic thrombosis of the left transverse/sigmoid sinuses and later with a pseudomeningocele managed with a lumbar drain. To our knowledge, this is the second documented case in the literature. We discuss intraoperative nuances and unique aspects in the postoperative care and management of these patients.

PMID:34603931 | PMC:PMC8481004 | DOI:10.1055/s-0041-17359 05

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Vocal Cord Hemangioma: A Common Tumor in an Unusual Localization. A Case Report with Short Review of Literature

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Abstract

Laryngeal adult-type hemangiomas are very rare lesions, more frequent in men, whose optimal treatment consists of microlaryngoscopical excision. We herein report a case of larynx cavernous hemangioma in a 64-year-old woman with hoarseness for about six months. Histologically, the tumor was composed of multiple vessels embedded in an edematous stroma.

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Needle Fracture During Injection Medialization Laryngoplasty

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Awake injection medialization laryngoplasty is one of the most common therapeutic procedures done by laryngologists in the office or at the bedside. Complications of injection needle fracture are rarely reported.
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Nusinersen by subcutaneous intrathecal catheter for symptomatic spinal muscular atrophy patients with complex spine anatomy

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Muscle Nerve. 2021 Oct 4. doi: 10.1002/mus.27425. Online ahead of print.

ABSTRACT

INTRODUCTION/AIMS: Intrathecal administration of nusinersen is challenging in patients with spinal muscular atrophy (SMA) who have spine deformities or fusions. We prospectively studied the safety and efficacy of nusinersen administration via an indwelling subcutaneous intrathecal catheter (SIC) for SMA patients with advanced disease.

METHODS: Seventeen participants commenced nusinersen therapy between 2.7 and 31.5 years of age and received 9-12 doses via SIC. Safety was assessed in all participants. A separate efficacy analysis comprised 11 non-ambulatory, treatment-naïve SMA patients (18.1 ± 6.8 years) with three SMN2 copies and complex spine anatomy.

RESULTS: In the safety analysis, 14 treatment-related adverse events (AEs) occurred among 12 (71%) participants; all were related to the SIC and not nusinersen. Device-related AEs interfered with 2. 5% of nusinersen doses. Four SICs (24%) required surgical revision due to mechanical malfunction with or without cerebrospinal fluid leak (n = 2), and one (6%) was removed due to Staphylococcus epidermidis meningitis. In the efficacy analysis, mean performance on the Nine Hole Peg Test improved in dominant (15.9%, p = 0.0.012) and non-dominant (19.0%, p = 0.008) hands and grip strength increased 44.9% (p = 0.0.031). We observed no significant changes in motor scales, muscle force, pulmonary function, or SMA biomarkers. All participants in the efficacy cohort reported one or more subjective improvements of endurance, purposeful hand use, arm strength, head control, and/or speech.

DISCUSSION: For SMA patients with complex spine anatomy, the SIC allows for reliable outpatient administration of nusinersen that results in meaningful improvements of upper limb function, but introduces risks of technical malfunction and iatrogenic infection. This article is protected by copyright. Al l rights reserved.

PMID:34606118 | DOI:10.1002/mus.27425

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