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Asian Pacific Journal of Cancer... Jan 2024Squamous Cell Carcinoma (SCC) of the buccal mucosa and gingiva accounts for approximately 10% of oral and pharyngeal cancers diagnosed in the United States each year,...
BACKGROUND
Squamous Cell Carcinoma (SCC) of the buccal mucosa and gingiva accounts for approximately 10% of oral and pharyngeal cancers diagnosed in the United States each year, with a disproportionally higher incidence in individuals of South Asian descent. However, little has been documented regarding trends pertaining to overall survival. Thus, this research serves to identify predictors of survival and determine if overall survival (OS) differs for South Asians compared to other races once they develop non-metastatic buccal mucosa or gingiva squamous cell carcinoma.
METHODS
A population-based, cohort study of patients registered in the National Cancer Database® (NCDB) between the years 2004-2016 was performed. Kaplan-Meyer Survival Curves were executed to examine overall survival, while univariable (UVA) and multivariable analysis (MVA) was performed to determine the effect of multiple variables on OS.
RESULTS
South Asians had longer median OS at 88.7 months, compared to 58.6 months and 38.3 months for Caucasians and African Americans respectively (p<0.001). In UVA, race was highly significant, but when the cohort was selected to include only those who had undergone surgical resection, no statistically significant difference remained. On MVA, lack of surgery, older age, higher grade, higher T and N stage, use of chemotherapy, higher comorbidity scores were associated with worse OS, but race was not significant.
CONCLUSION
South Asians in the US with non-metastatic buccal mucosa or gingiva SCC have better OS compared to Caucasians or African Americans, likely due to younger age at diagnosis (median 59 vs. 71 and 62 years old) and more frequent surgical resection (75% vs. 72% and 64%). In MVA, South Asians have similar OS as Caucasians.
Topics: Humans; United States; Mouth Mucosa; Cohort Studies; Prognosis; Carcinoma, Squamous Cell; Mouth Neoplasms; Squamous Cell Carcinoma of Head and Neck; Head and Neck Neoplasms; Retrospective Studies
PubMed: 38285790
DOI: 10.31557/APJCP.2024.25.1.241 -
Anaesthesia, Critical Care & Pain... Apr 2024Transesophageal echocardiogram probe insertion in intubated critically ill patients can be difficult, leading to complications, such as gastric bleeding or lesions in... (Randomized Controlled Trial)
Randomized Controlled Trial
Videolaryngoscope versus conventional technique for insertion of a transesophageal echocardiography probe in intubated ICU patients (VIDLARECO trial): A randomized clinical trial.
BACKGROUND
Transesophageal echocardiogram probe insertion in intubated critically ill patients can be difficult, leading to complications, such as gastric bleeding or lesions in the oropharyngeal mucosa. We hypothesised that the use of a videolaryngoscope would facilitate the first attempt at insertion of the transesophageal echocardiogram probe and would decrease the incidence of complications compared to the conventional insertion technique.
METHODS
In this clinical trial, patients were randomly assigned the insertion of a transesophageal echocardiogram probe using a videolaryngoscope or conventional technique. The primary outcome was the successful transesophageal echocardiogram probe insertion on the first attempt. The secondary outcomes included total success rate, number of insertion attempts, and incidence of pharyngeal complications.
RESULTS
A total of 100 intubated critically ill patients were enrolled. The success rate of transesophageal echocardiogram probe insertion on the first attempt was higher in the videolaryngoscope group than in the conventional group (90% vs. 58%; absolute difference, 32%; 95% CI 16%-48%; p < 0.001). The overall success rate was higher in the videolaryngoscope group than in the conventional group (100% vs. 72%; absolute difference, 28%; 95% CI 16%-40%; p < 0.001). The incidence of pharyngeal mucosal injury was smaller in the videolaryngoscope group than in the conventional group (14% vs. 52%; absolute difference, 38%; 95% CI 21%-55%; p < 0.001).
CONCLUSIONS
Our study showed that in intubated critically ill patients required transesophageal echocardiogram, the use of videolaryngoscope resulted in higher successful insertion on the first attempt with lower rate of complications when compared with the conventional insertion technique.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT04980976.
Topics: Humans; Laryngoscopy; Echocardiography, Transesophageal; Critical Illness; Laryngoscopes; Intubation, Intratracheal; Intensive Care Units
PubMed: 38278357
DOI: 10.1016/j.accpm.2024.101346 -
Endoscopy Dec 2024
Topics: Humans; Endoscopic Mucosal Resection; Hypopharynx; Carcinoma
PubMed: 38262458
DOI: 10.1055/a-2233-3082 -
BMC Anesthesiology Jan 2024Dyclonine hydrochloride mucilage is a topical anaesthetic formulated for mucosal surfaces. It is employed frequently for topical anaesthesia of the pharynx prior to...
BACKGROUND
Dyclonine hydrochloride mucilage is a topical anaesthetic formulated for mucosal surfaces. It is employed frequently for topical anaesthesia of the pharynx prior to endoscopic examinations such as electronic gastroscopy, and few adverse reactions have been reported. This article describes a patient who experienced a transient but severe disturbance of consciousness following oral dyclonine hydrochloride mucilage administration.
CASE PRESENTATION
A 75-year-old female presenting with gastrointestinal bleeding was examined by electronic gastroscopy. Six minutes after oral dyclonine hydrochloride mucilage administration, the patient entered a comatose-like state accompanied by loss of limb muscle tone and profuse perspiration. This response was not accompanied by changes in cardiac rhythm, blood pressure, or respiration rate, suggesting an effect on higher brain centres. After ten minutes, the patient's symptoms were alleviated.
CONCLUSION
We suggest that sites of dyclonine hydrochloride mucilage use be equipped with appropriate rescue devices for these rare events.
Topics: Female; Humans; Aged; Consciousness; Brain; Administration, Oral; Anesthesia, Local; Propiophenones
PubMed: 38254013
DOI: 10.1186/s12871-024-02407-x -
Clinical Laboratory Jan 2024HPVs are considered to have high-oncogenic risk. These genotypes have been proven to have a causal link to cancers, in pediatric and youth patients, with high rates of...
BACKGROUND
HPVs are considered to have high-oncogenic risk. These genotypes have been proven to have a causal link to cancers, in pediatric and youth patients, with high rates of HPV presence in the tonsillar tissues.
OBJECTIVE
A prospective case-control research for determining HPV 6/11 genotypes in tonsillar specimens of children who underwent operations in the otolaryngology departments of the Medical City Complex, Baghdad, Iraq, for their non-oncologic palatine and pharyngeal tonsillar hypertrophies.
METHODS
This study enrolled 102 tonsillar tissues, 82 from pediatric patients aged from 4 to 12 years and who underwent tonsillectomies for non-oncologic palatine and pharyngeal tonsillar hypertrophies; 38 specimens were from single operations while 22 were multiple specimens from the same pediatric patients, represented as a total of 44 tissues). In addition, trimmed nasal tissues from 20 patients, with unremarkable pathological changes, were included as the control group. For HPV 6/11 DNA detection, specific DNA probes were used for the chromogenic in situ hybridization (CISH) technique.
RESULTS
In the palatine tonsillar hypertrophied tissue group, 26.2% of the tissues revealed positive CISH signals for HPV 6/11 DNA. Regarding the pharyngeal tonsillar hypertrophied tissues, 22.5% of the specimens expressed positive CISH reactions. Among the 22 pediatric patients who had combined pharyngeal and palatine tonsillectomies, in 22.7% both sites expressed positive signals. No positive-CISH reactions were documented in the control nasal tissues. Statistically a significant difference was seen when compared to the control group.
CONCLUSIONS
Significant rates of HPV were observed which pointed to the spread of HPV, among other STIs, and in mothers of at least this studied pediatric group. Also, this represented a critical mark as reservoir tissue sites, allowing transmission to other mucosal tissue localizations, playing part in their pathogenesis.
Topics: Adolescent; Humans; Child; Human papillomavirus 6; Papillomavirus Infections; Tonsillitis; DNA, Viral; Genotype; Hypertrophy
PubMed: 38213222
DOI: 10.7754/Clin.Lab.2023.230615 -
Journal of Dentistry Feb 2024To assess the performance, time-efficiency, and consistency of a convolutional neural network (CNN) based automated approach for integrated segmentation of...
OBJECTIVES
To assess the performance, time-efficiency, and consistency of a convolutional neural network (CNN) based automated approach for integrated segmentation of craniomaxillofacial structures compared with semi-automated method for creating a virtual patient using cone beam computed tomography (CBCT) scans.
METHODS
Thirty CBCT scans were selected. Six craniomaxillofacial structures, encompassing the maxillofacial complex bones, maxillary sinus, dentition, mandible, mandibular canal, and pharyngeal airway space, were segmented on these scans using semi-automated and composite of previously validated CNN-based automated segmentation techniques for individual structures. A qualitative assessment of the automated segmentation revealed the need for minor refinements, which were manually corrected. These refined segmentations served as a reference for comparing semi-automated and automated integrated segmentations.
RESULTS
The majority of minor adjustments with the automated approach involved under-segmentation of sinus mucosal thickening and regions with reduced bone thickness within the maxillofacial complex. The automated and the semi-automated approaches required an average time of 1.1 min and 48.4 min, respectively. The automated method demonstrated a greater degree of similarity (99.6 %) to the reference than the semi-automated approach (88.3 %). The standard deviation values for all metrics with the automated approach were low, indicating a high consistency.
CONCLUSIONS
The CNN-driven integrated segmentation approach proved to be accurate, time-efficient, and consistent for creating a CBCT-derived virtual patient through simultaneous segmentation of craniomaxillofacial structures.
CLINICAL RELEVANCE
The creation of a virtual orofacial patient using an automated approach could potentially transform personalized digital workflows. This advancement could be particularly beneficial for treatment planning in a variety of dental and maxillofacial specialties.
Topics: Humans; Artificial Intelligence; Spiral Cone-Beam Computed Tomography; Image Processing, Computer-Assisted; Neural Networks, Computer; Cone-Beam Computed Tomography
PubMed: 38163456
DOI: 10.1016/j.jdent.2023.104829 -
Cureus Nov 2023Background Oral submucous fibrosis (OSMF) is a chronic, progressive, and potentially malignant oral disorder that causes scarring of the oral cavity, pharynx, and...
Background Oral submucous fibrosis (OSMF) is a chronic, progressive, and potentially malignant oral disorder that causes scarring of the oral cavity, pharynx, and upper oesophagus. It is most common in Southeast Asia, but it is also found in other parts of the world. Oral potentially malignant disorders (OPMDs) are a group of oral lesions that have an increased risk of developing into oral cancer. The study aimed to evaluate the prevalence of OSMF associated with other OPMDs. The presence of multiple OPMDs existing in one patient is a significant finding, as it is associated with an elevated risk of developing malignancy. The risk of malignant transformation increases with the number of OPMDs present in a patient; patients with two OPMDs have a three to four times higher risk of developing malignancy than those with a single OPMD. Patients with three or more OPMDs have a 7-10 times higher risk and the risk of malignant transformation depends on the type of OPMD. Materials and methods The study was conducted in the Department of Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Chennai, India, to investigate the prevalence of OSMF with other OPMDs. The study team retrieved 630 case records of patients with OSMF from the electronic database between January 2018 and March 2023. All of the patients in the study had OSMF, as well as other OPMDs such as leukoplakia, candidiasis, actinic cheilitis, dyskeratosis congenita, erythroplakia, lichen planus, sideropenic dysphagia (Plummer-Vinson syndrome), and discoid lupus erythematosus. Both clinical and histopathological examinations confirmed these diagnoses. Oral mucosal lesions without coexisting OSMF were excluded. The study was done on the basis of age group, habits, type of habits, associated coexisting lesions, and systemic condition. Results The patients were clinically examined and diagnosed. Of the 630 cases, 10% had OSMF with OPMDs. The most common OPMDs associated with OSMF were leukoplakia (86%), followed by candidiasis (12%) and both leukoplakia and candidiasis (2%). Based on gender, the incidence of OSMF was higher in males compared to females with 67% and 33%, respectively. Conclusion OSMF is more likely to develop into malignancy; the widespread use of areca nut products in India has contributed to the rising incidence of OSMF. Accumulating epidemiological data can help to identify high-risk populations for prevention and control measures. Earlier oral cancer diagnosis and treatment can increase the likelihood of a favourable outcome.
PubMed: 38161840
DOI: 10.7759/cureus.49642 -
Asian Pacific Journal of Cancer... Dec 2023Chemoradiotherapy is the standard treatment for advanced Oropharyngeal squamous cell carcinoma (OPSCC). Upcoming hypofractionation has led to better compliance and...
AIMS
Chemoradiotherapy is the standard treatment for advanced Oropharyngeal squamous cell carcinoma (OPSCC). Upcoming hypofractionation has led to better compliance and non-inferior results in various sites such as breast and prostate cancer etc. This study prospectively compared a dose-intensified schedule in advanced OPSCC with standard hypofractionation.
MATERIALS AND METHODS
Patients with advanced stage III and IV OPSCC suitable for radical chemoradiotherapy were eligible. Patients were alternatively allocated to both the treatment arms. Arm A planned to receive 64 Gy in 25 fractions (#) with concurrent cisplatin and Arm B received standard fractionation 70 Gy in 35 # with concurrent cisplatin. All patients completed a median follow up of 6 to 18 months. The primary end point was acute toxicity (less than 3 months) and late toxicity at 1 year. Secondary end point was disease free survival and overall survival at 1 year.
RESULTS
44 patients in arm A and 49 patients in arm B were recruited over 18 months. 34 patients completed full-dose radiotherapy in both arms. Maximum acute toxicity in arm A in terms of skin reaction was Grade II in 47.05% cases and mucositis grade II in 67.6% cases. In arm B grade II skin toxicity was seen in 47.1% and mucositis grade II was seen in 79.4 % cases. Ryle's tube dependency was seen in 38.2 % cases in arm A and 50% in arm B. Complete response rate at 3 months was equivalent in both arms in Arm A (100%), and in Arm B (96.7%). Disease free survival (DFS), Overall survival (OS) at 3 month, 6 months, and 12 months was comparable.
CONCLUSIONS
64 Gy in 25 fractions with concomitant chemotherapy is tolerable in patients with equivalent results and better compliance. Shorter fractionation schedule is more acceptable and we look forward for more randomized control trials.
Topics: Humans; Male; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Squamous Cell; Chemoradiotherapy; Cisplatin; Head and Neck Neoplasms; Mucositis; Oropharynx; Prospective Studies; Squamous Cell Carcinoma of Head and Neck; Female
PubMed: 38156840
DOI: 10.31557/APJCP.2023.24.12.4077 -
Frontiers in Immunology 2023Adaptive humoral immunity against SARS-CoV-2 has mainly been evaluated in peripheral blood. Human secondary lymphoid tissues (such as tonsils) contain large numbers of...
BACKGROUND
Adaptive humoral immunity against SARS-CoV-2 has mainly been evaluated in peripheral blood. Human secondary lymphoid tissues (such as tonsils) contain large numbers of plasma cells that secrete immunoglobulins at mucosal sites. Yet, the role of mucosal memory immunity induced by vaccines or natural infection against SARS-CoV-2 and its variants is not fully understood.
METHODS
Tonsillar mononuclear cells (TMNCs) from adults (n=10) and children (n=11) were isolated and stimulated using positive SARS-CoV-2 nasal swabs. We used endpoint enzyme-linked immunosorbent assays (ELISAs) for the measurement of anti-S1, -RBD, and -N IgG antibody levels and a pseudovirus microneutralization assay to assess neutralizing antibodies (nAbs) in paired serum and supernatants from stimulated TMNCs.
RESULTS
Strong systemic humoral response in previously SARS-CoV-2 infected and vaccinated adults and children was observed in accordance with the reported history of the participants. Interestingly, we found a significant increase in anti-RBD IgG (305 and 834 folds) and anti-S1 IgG (475 and 443 folds) in the stimulated TMNCs from adults and children, respectively, compared to unstimulated cells. Consistently, the stimulated TMNCs secreted higher levels of nAbs against the ancestral Wuhan strain and the Omicron BA.1 variant compared to unstimulated cells by several folds. This increase was seen in all participants including children with no known history of infection, suggesting that these participants might have been previously exposed to SARS-CoV-2 and that not all asymptomatic cases necessarily could be detected by serum antibodies. Furthermore, nAb levels against both strains were significantly correlated in adults (r=0.8788; = 0.0008) and children (r = 0.7521; = 0.0076), and they strongly correlated with S1 and RBD-specific IgG antibodies.
CONCLUSION
Our results provide evidence for persistent mucosal humoral memory in tonsils from previously infected and/or vaccinated adults and children against recent and old variants upon re-exposure. They also highlight the importance of targeting mucosal sites with vaccines to help control infection at the primary sites and prevent potential breakthrough infections.
Topics: Adult; Child; Humans; Immunity, Humoral; Palatine Tonsil; SARS-CoV-2; COVID-19; Immunoglobulin G; Antibodies, Neutralizing; Vaccines
PubMed: 38149243
DOI: 10.3389/fimmu.2023.1291534