Cervical Skin Research Articles

Hybrid surgical approach for a large schwannoma from the cervical esophagus to the upper thoracic esophagus: a case report

BackgroundEsophageal schwannoma is an extremely rare esophageal submucosal tumor. We report a case of a hybrid surgery for a large esophageal schwannoma that had extended from the cervical to the upper thoracic esophagus by using thoracoscopic and cervical approaches.Case presentationA 58-year-old male was referred to our hospital for further examination and treatment of dysphagia and weight loss over the past 6 months. Upper gastrointestinal endoscopy revealed a 5.7-cm submucosal tumor from the cervical esophagus to the upper thoracic esophagus. The submucosal tumor was diagnosed as esophageal schwannoma by endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA). Contrast-enhanced CT showed that the tumor had not invaded surrounding organs. Since the tumor extended from the cervical esophagus to the upper thoracic esophagus, we decided that it should be resected by not only the cervical but also the thoracoscopic approach. In operation, the patient was first placed in the prone position, and a thoracoscopic dissection of the upper thoracic esophagus containing the tumor was performed from the surrounding area. After changing the patient’s position from prone to supine, a cervical skin incision was performed, and we underwent the tumor enucleation. After enucleation, the esophageal wall was thinned, so the right sternocleidomastoid muscle was used to reinforce the esophageal wall. The tumor size of the specimen was 60 × 52 × 42 mm. The postoperative course was uneventful, and the patient was discharged on the 22nd day after surgery.ConclusionsEnucleation of a large esophageal schwannoma from the cervical to the upper thoracic esophagus could be safely performed using both thoracoscopic and cervical approaches. The sternocleidomastoid muscle flap is useful in the occasion considering stenosis by muscular layer suture.

Combined local flap placement and negative-pressure wound therapy for the management of critical peritracheostomal pharyngocutaneous fistula

ObjectivePeritracheostomal pharyngocutaneous fistula (PCF), a direct connection between the PCF and tracheal stoma due to a skin defect, is among the most problematic complications after total laryngectomy or pharyngolaryngectomy. Peritracheostomal PCFs can cause lethal complications, including severe pneumonia or carotid blowout, secondary to salivary leakage directly into the tracheal stoma, and their management is challenging without early invasive surgical closure. We aimed to evaluate the utility of our novel and minimally invasive combined local skin flap placement and negative-pressure wound therapy (NPWT) method for the management and conservative closure of peritracheostomal PCFs. MethodsWe retrospectively enrolled patients who developed a peritracheostomal PCF from July 2015 to September 2021 at our institution and affiliated hospitals. Postoperative PCFs were all initially managed with appropriate wound bed preparation. Subsequently, a small local flap of healthy, lower neck skin was elevated and transferred anterior to the PCF to replace the peritracheostomal skin defect. The flap served to provide a sufficient surface for film dressing attachment and facilitated airtight sealing during NPWT. We initiated NPWT after confirming the local skin flap was firmly sutured to the tracheal mucosa. A flexible hydrocolloid dressing was applied to the peritracheostomal skin flap, and a film dressing was placed on the flexible hydrocolloid dressing and surrounding cervical skin. We inserted the NPWT foam shallowly into the fistula tract and applied negative pressure (73.5–125 mmHg). NPWT was continued until the PCF was closed or became so small that salivary leakage was minimal and could be managed by conventional compression dressings. ResultsWe enrolled six patients [male, n = 6; mean age, 66.5 years (range, 57–80 years)]. NPWT was applied for an average of 18.2 days (range, 2–28 days). During NPWT, air leakage occurred once (2 cases), only a few times (2 cases), or not at all (2 cases). In all patients, complete fistula closure was achieved in an average of 28.2 days (range, 15–55 days) after the start of NPWT, and no patient required further surgical intervention. There were no lethal complications (e.g., severe pneumonia) during treatment. ConclusionOur method of combined local flap placement and NPWT enabled effective management of salivary aspiration and accelerated wound healing, which allowed conservative fistula closure in all patients. We believe combined local flap placement and NPWT should be considered a first-line treatment for intractable peritracheostomal PCF.

A combined treatment for self-traumatic chronic skin lesions associated with post-surgical neuropathic pain in a domestic cat: a pharmacological and cold atmospheric plasma approach.

Cold atmospheric plasma (CAP) has been employed as a therapy against both acute and chronic skin lesions, contaminated or not, and has effects on angiogenesis and reepithelialization promoting healing. In this context, the present study aimed to evaluate the effects of a CAP jet associated with pharmacological treatment described by the 2015 AAHA/AAFP pain management guidelines and the 2022 WSAVA guidelines for the recognition, assessment, and treatment of pain, on the healing of chronic skin lesions caused by a pruritic reaction resulting from post-surgical neuropathic pain. To this end, a single CAP application was performed on a feline patient with a 6months old recurrent contaminated cervical skin lesions along with administration of ketamine (10µg/kg/min) following the prescription of prednisone (1mg/kg, SID, 6days), gabapentin (8mg/kg, BID, 60days) and amitriptyline (0.5mg /kg, SID, 60days). A single application of plasma associated with an NMDA antagonist, anti-inflammatory steroid, tricyclic antidepressant and gabapentinoid thus provided a significant improvement in the macroscopic appearance of the lesion within 10days, and the owner reported the cessation of intense itching within the first four hours after treatment and a consequent improvement in the animal's quality of life. The medical treatment was finished almost a year since the writing of this paper, without clinical or reported recurrent signs of the condition. Therefore, we observed that single dose CAP application associated with ketamine, gabapentin, amitriptyline and prednisone leads to significant healing of chronically infected skin lesions resulting from post-surgical neuropathic pain.

Versatility of the supraclavicular artery island flap for head and neck reconstruction.

To present our experience using the supraclavicular artery island flap (SCAIF) for head and neck reconstruction. We performed a retrospective chart review to identify patients who underwent head and neck reconstruction with SCAIF at our institution. The following data were collected: age, sex, surgical indications, flap harvest time, flap dimensions, length of hospital stay, complications, and clinical outcomes. Thirty-three patients underwent SCAIF reconstruction, of whom four underwent pectoralis major myocutaneous flap reconstruction simultaneously. Twenty flaps were used to repair pharyngeal or esophageal defects following resection for tonsillar, hypopharyngeal, laryngeal, and cervical esophageal cancers. Five flaps were used for tracheal reconstruction following resection for tracheal or thyroid gland cancer. Seven flaps were used for reconstruction of cervical skin defects or fistulas related to a previous treatment. One flap for tracheal stenosis following tracheotomy. The mean age of the patients was 60.69 ± 11.47 years. The mean flap harvest time was 32.00 ± 4.44 min. The mean flap size was 10.16 ± 3.91 × 5.78 ± 0.68 cm. The mean length of hospital stay is 24.84 ± 13.78 days. Three patients had partial necrosis of the distal portion of the flap, which resolved with anti-infection therapy and local wound care. One patient developed a fistula that was resolved with wound care and further surgical intervention. Complete flap loss or major complications were not observed. No donor site complication or compromised shoulder function was observed. The SCAIF can be successfully used to reconstruct head and neck defects with good outcomes and limited morbidity. 4.

Safe and reliable use of supraclavicular flaps for head and neck reconstruction.

The supraclavicular flap is a regional flap in the supraclavicular area nourished by the transverse cervical or supraclavicular arteries. This flap gained popularity in the 2000s as it requires less surgical time than free flap reconstruction and has minimal donor-site morbidity. However, a high rate of postoperative complications has been reported. Moreover, there is ongoing debate regarding the indications and limitations of this flap. In this study, we confined the flap design to the supraclavicular fossa, considering flap vascularity and in an effort to minimize donor site morbidity. Between 2014 and 2023, we performed supraclavicular flap reconstruction in 3 cases of cervical skin defects and 1 case of a pharyngeal mucosal defect. The average defect and flap sizes were 7×3.9cm and 11.5×4.4cm, respectively. The lower border of the flap remained above the clavicle, and the lateral border did not exceed the acromioclavicular joint. When the flaps were transferred using the transposition method, the angle of transposition was limited to <90 degrees. When the VY advancement or turnover method was selected, we paid attention to the tension-free flap inset. We successfully reconstructed the defects without flap-related complications, and donor site scars were inconspicuous in all patients. In conclusion, we believe that confining the flap design to the supraclavicular fossa, limiting the indications of this flap to the reconstruction of medium-sized defects, and using tension-free flap insets are important for the successful application of this flap.

Thick Skin on the Dorsal Spine in Osteoproliferative Disease: Ossification of the Posterior Longitudinal Ligament and Diffuse Idiopathic Skeletal Hyperostosis.

Background Although the correlation between reduced skin thickness and reduced bone density has been investigated, no study has evaluated skin thickness and osteoproliferative diseases, including ossification of the posterior longitudinal ligament (OPLL) and diffuse idiopathic skeletal hyperostosis (DISH). Methodology This retrospective cohort study consisted of 99 consecutive patients aged ≥60 years treated for spinal surgery at our hospital between January 2022 and March 2023. Skin thickness was measured at the dorsal side of the cervical, thoracic, and lumbar vertebrae on the sagittal cross-section image of whole-spine CT. Based on the median value, skin thickness was categorized into two groups based on a median thickness of 4 mm. Bone mineral density (BMD) was assessed. The sum of the vertebral body and intervertebral bridging osteophytes of the anterior longitudinal and posterior longitudinal ligament were defined as the OALL index and OPLL index. Serum levels of bone metabolism-related markers, such as tartrate-resistant acid phosphatase type 5b, procollagen I N-propeptide, 25-hydroxyvitamin D, and periostin, were measured. To assess the association between skin thickness and imaging findings, we calculated the adjusted odds ratios, adjusting for age, sex, and body mass index (BMI) and using univariate and multivariate logistic regression analyses. Results No significant differences were found in skin thickness in the three dorsal regions of the cervical, thoracic, and lumbar spine (median = 3.3 mm versus 3.5 mm versus 3.4 mm, p = 0.357) and bone metabolism-related markers. Adjusting for age, sex, and BMI, cervical, thoracic, and lumbar skin thicknesses were related to DISH, the OPLL index, and the OPLL and OPLL index, respectively. Conclusions Skin thickness did not correlate with BMD but with the amount of spinal ossification. A correlation was found between skin thickness and vertebral and intervertebral ossification; vertebral osteophytes, OPLL, and DISH may be more common in thicker skin.

Value of high‐definition laryngoscopy in the diagnosis of pyriform sinus fistula

AbstractObjectiveEfficient methods are available to diagnose pyriform sinus fistula (PSF). This study aimed to assess the value of high‐definition laryngoscopy (HDL) in the diagnosis of PSF.MethodsFrom January 2017 to December 2019, patients with PSF were enrolled into this study. HDL was performed without general anesthesia. Laryngoscopy characteristics were analyzed. An inner orifice in the pyriform fossa indicated the presence of PSF. The diagnostic accuracy of HDL was compared to that of barium swallow.ResultsA total of 56 patients (33 males and 23 females, ages 2–57 years) were included. The positive predictive value of HDL was 96.4%, and that of barium swallow was 89.2%. Compared to pronouncing the English letter “e,” anterior cervical skin traction plus Valsalva maneuver could offer a clearer view of the inner orifice in the pyriform fossa (χ2 = 11.187, p &lt; 0.05). Nevertheless, compared to barium swallow, HDL showed no statistically significant difference in diagnosing PSF (χ2 = 2.598, p &gt; 0.05).ConclusionsBoth HDL and barium swallow have their advantages and are complementary in diagnosing PSF. Their combination may achieve a higher diagnostic accuracy for PFS.

The gold protocol: A combined treatment approach for neck rejuvenation with calcium hydroxyapatite, botulinum toxin, and hyaluronic acid in the same session.

The signs of aging seem to be more visible on the neck compared to other locations, especially if a patient has already gone through facial rejuvenation procedures. Treatment of the aging neck imposes a challenge to the clinician, since one single approach is usually not enough to achieve the desired result, requiring multiple injections and sessions, which apart from being painful for the patients, is time-consuming for the clinician. To describe the use of calcium hydroxyapatite, incobotulinum toxin type A and Cohesive poly-densified matrix hyaluronic acid diluted in the same syringe and injected in the same session for neck rejuvenation. Fifteen women, older than 18 years, with cervical skin flaccidity grade 1-4 in a previously validated 5-point rating scale (Dermatologic Surg, 2016; 42, S94), who sought neck rejuvenation were injected in this pilot study with a single session with a combined hybrid mixture of calcium hydroxyapatite, incobotulinum toxin type A, and Cohesive poly-densified matrix hyaluronic acid and followed up for 90-180 days. At the 4-month post injection evaluation, 93.3% of the patients presented at least 1-grade improvement in the 5-point scale as evaluated by the investigator. No serious adverse events were reported, being most mild and transient in nature. CaHA, incoBonTA, and CPM-HA have complementary mechanisms of action and may be injected from the same syringe in the same session, boosting the final outcome, with high patient satisfaction, and ease of process for both patients and clinicians.

Analysis of Family Support in Enhancing Life Quality among Breast Cancer Patients at Haji Adam Malik Central General Hospital Medan

&lt;div&gt;&lt;table cellspacing="0" cellpadding="0" align="left"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" valign="top"&gt;&lt;p&gt;&lt;em&gt;Cancer is the most common chronic disease worldwide, with cervical cancer, breast cancer, ovarian cancer, and skin cancer being the most prevalent. Breast cancer ranks second globally after lung cancer. Patients diagnosed with breast cancer undergo changes in their physical, sexual, social, and daily life activities, affecting their overall life quality. One crucial factor that can enhance the life quality for patients is the support from their families, which is a pivotal determinant for individual well-being. To determine the differences in the life quality among breast cancer patients with high and low family support and to analyze the correlation between family support and the breast cancer patients life quality. This study employed a quantitative analytic survey with a cross-sectional design. The research was conducted at Haji Adam Malik Central General Hospital from August to October 2023. The study population included all stage I and II breast cancer patients, totaling 205 outpatient individuals from March to April 2022, with a sample size of 66. Simple random sampling was utilized for participant selection. Data collection involved questionnaire interviews. Data analysis comprised two steps: first, univariate analysis using descriptive and frequency statistics, and second, bivariate analysis using Pearson's test and independent t-test with a significance level of 95% (p-value ≤ 0.05). Statistical results indicated a significant difference in the life quality between breast cancer patients with high and low family support (p=0.037). It was concluded that there is a significantive correlation between family support and the breast cancer patients life quality (p=0.001; r=-0.644). Family support is crucial for patients facing chronic diseases such as breast cancer. It is recommended that families strive to enhance their support to ensure patients' comfort during treatment and therapy programs, ultimately improving the breast cancer patients life quality.&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/div&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Keyword: Breast Cancer, Family, Life Quality&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;

Cytotoxic Dammarane-Type Triterpenoids from &lt;i&gt;Aglaia cucullata&lt;/i&gt; Peel Fruit

Four triterpenoids, known as dammarane-type, dammaradienone (1), 20(S),25-epoxy-5α-dammar-20-en-3-one (2), 20(S)-5α-dammar-24-en-3α,20-diol-3-acetate (3) and 3α-acetyl-20S,24S-epoxy-25-hydroxydammarane (4), were isolated from Aglaia cucullata peel fruit. The structures of isolated compounds were identified based on their HR-TOFMS data and extensive NMR spectroscopic analysis, as well as compared with literature data. Compounds 1-4 were assessed for cytotoxic effects against HeLa cervical and B16-F10 melanoma skin cancer cells. All compounds showed moderate to weak activity against B16-F10 cancer cells, while compound 2 exhibited the strongest activity against HeLa cancer cells with IC50 of 7.10 µg/mL indicating that the existence of an epoxy moiety at the side chain increases the cytotoxicity to HeLa cells.

The effects of adjunctive interventions on cervical skin health post-chemotherapy: a systematic review and meta-analysis

The effects of adjunctive interventions on cervical skin health post-chemotherapy: a systematic review and meta-analysis

The Sesquiterpenoids from Aglaia cucullata Peel Fruit and Their Cytotoxic Activities Against B16-F10 and HeLa Cancer Cell Lines

Sesquiterpenoids are terpenoid derivative compounds that have a diverse chemical structure and pharmacological effects. Sesquiterpenoids can be found in many plants of Aglaia which is the large source of natural compounds in the Meliaceae family. This research was aimed to elucidate the structure of sesquiterpenoids from the peel fruit of Aglaia cucullata and their cytotoxic activities against two human cancer cell lines. The n-hexane extract was separated and further purified by various chromatographic methods to yiled three sesquiterpenoids. The structure of these sesquiterpenoids were identified by spectroscopy analysis including MS, IR, 1H-NMR, 13C-NMR and DEPT as well as compared with spectral data which reported previously. The sesquiterpenoid compounds 1-3 were identified as spathulenol (1), alismol (2), and 10-oxo-isodauc-3-en-15-al (3). The cytotoxic activity of three sesquiterpenoid compounds were tested against HeLa cervical cancer cell and B16-F10 skin cancer cell using the PrestoBlue method. Compound 2 exhibited the highest activity against both HeLa and B16-F10 cancer cell lines with IC50 48.11 μg/mL and 57.05 μg/mL, respectively.

The Efficacy of Carbon Dioxide Paste in Alleviating Pain in Patients After Neck Dissection: Protocol for a Double-Blinded, Randomized Controlled Trial.

Head and neck cancers that cause severe aesthetic and functional disorders normally metastasize to the cervical lymph nodes. Patients with cervical lymph node metastasis are undergoing neck dissection. Shoulder complaints are common after neck dissection, with patients reporting symptoms such as pain, weakness, shoulder droop, and disability. However, no safe and effective treatment is available for this condition at present. We will conduct a double-blinded, randomized controlled trial to evaluate the efficacy of carbon dioxide (CO2) paste in relieving pain in patients after neck dissection. This will be the first clinical study to compare the efficacy of CO2 paste with placebo in relieving postoperative pain in patients who underwent neck dissection. We will perform this trial at the Kobe University Hospital in Japan. Patients will be randomized 1:1 into the CO2 paste and control groups. Patients in the CO2 paste group will have the CO2 paste applied to the cervical surface skin for 10 minutes once per day for 14 consecutive days. The primary end point of the study is a change in the visual analog scale (VAS) scores of neck pain from baseline on day 1 (preapplication) to the end of drug application (day 15). Secondary end points include changes in the following parameters from baseline on day 1 to the end of drug application (day 15) or the study (day 29): neck pain VAS score (days 1-29), grip strength (days 1-15 and 1-29), VAS scores for subjective symptoms (the feeling of strangulation, numbness, swelling, and warmth in the neck and shoulder region) for days 1-15 and 1-29, whether the VAS score improved more than 30% (days 1-15), the arm abduction test (days 1-15 and 1-29), shoulder range of motion (abduction and flexion) for days 1-15 and 1-29, occurrence of skin disorders, and occurrence of serious side effects. Periodic monitoring will be conducted for participants during the trial. This study was approved by the certified review board of Kobe University. The intervention commenced in May 2021 and will continue until March 2024. The collected data will provide information on the efficacy of the CO2 paste treatment. The primary end point will be compared using the Wilcoxon test, with the 1-sided significance level set at 5%. Each evaluation item will be summarized. Secondary efficacy end points will be analyzed to provide additional insights into the primary analysis. Findings based on the treatment effects are expected to be submitted for publication in 2025. This trial will provide exploratory evidence of the efficacy and safety of CO2 paste in relieving pain in patients after neck dissection. Japan Registry of Clinical Trials (jRCT) identifier: jRCTs051210028; https://jrct.niph.go.jp/en-latest-detail/jRCTs051210028. DERR1-10.2196/50500.

Magnitude and distribution of cancer in a private teaching hospital, Bahir Dar, Ethiopia

Background Cancer affects every country in the world irrespective of their developmental status. Since most studies have been performed primarily in public referral hospitals, this study aimed to describe the prevalence and histopathological patterns of cancer in a private setting. Cancer is one of the most common noncommunicable diseases, and regional variations in cancer incidence are responsible for the majority of deaths. The main objective of this study was to determine the magnitude and distribution of cancer among patients at GAMBY Teaching General Hospital. Methods This retrospective study included a total of 4320 histopathological examination results recorded from January 1, 2016, to December 30, 2020. Descriptive statistics were used to present the results. The SPSS version 26 computer software package was used for data analysis. Results A total of 4320 examinations revealed that 895 (20.7%) patients had confirmed malignancies. A total of 655 (73.2%) of the cases were females, with a male-to-female ratio of 1:2.73. The mean age of all the confirmed cases was 49.3±14.9 years. The age range was between 2 and 85 years. The mean ages of the females and males were 47.67±13.36 and 53.19±17.93 years, respectively. The most common cancers were cervical cancer (31.9%), breast cancer (12.7%), and skin cancer (11.6%). The top five cancers in the female patients were cervical, breast, nonmelanomatous skin, thyroid, and lymph node malignancies. Among male patients’ nonmelanomatous skin cancer, lymph node malignancies, colorectal cancer, bone and soft tissue cancer, and breast cancer constituted the top five cancers. Cancer involving the lung, eye and pancreas is the least common cancer. Conclusions The results indicate that the pattern of cancer varies significantly from the global pattern of cancer distribution, as do studies in Africa and other regions of the country. The expansion of oncologic services, health education, screening and vaccination services, advancements in diagnostic modalities, and the involvement of the private sector in the management and care of cancer patients are very important health system focuses and forces policy makers to allocate resources accordingly. This study provided good insight into this pattern, but a wider multicenter survey and evaluation of sociodemographic and environmental factors are needed to assess the reasons for the variations.

Factors Associated with Complications after Total Pharyngo-Laryngo-Esophagectomy and Free Jejunal Flap Reconstruction

Introduction: Free jejunal flap (FJF) reconstruction is a standard procedure for pharyngeal and cervical esophageal defects resulting from head and neck cancer resection. However, improvements in patients’ quality of life after surgery require a further statistical approach. Methods: An observational, retrospective, multivariate analysis was designed to report the incidence of postoperative complications and their association with clinical factors in 101 patients who underwent total pharyngo-laryngo-esophagectomy and FJF reconstruction for head and neck cancer at a university hospital between January 2007 and December 2020. Results: Postoperative complications were observed in 69% of patients. In the reconstructive site, anastomotic leak, observed in 8% of patients was associated with vascular anastomosis in the external jugular vein system (age-adjusted odds ratio [OR]: 9.05, p = 0.044) and anastomotic stricture, observed in 11% of patients was associated with postoperative radiotherapy (age-adjusted OR: 12.60, p = 0.02). Cervical skin flap necrosis was the most common complication (34%) and was associated with vascular anastomosis on the right cervical side (age- and sex-adjusted OR: 4.00, p = 0.005). Conclusion: Although FJF reconstruction is a useful procedure, 69% of patients suffer a postoperative complication. We suppose that anastomotic leak is related to the low blood flow resistance of the FJF and inadequate drainage of the external jugular venous system, and anastomotic stricture is related to the vulnerability of the intestinal tissue to radiation. Furthermore, we hypothesized that the location of the vascular anastomosis may affect the mesenteric location of the FJF and the dead space in the neck, leading to the development of cervical skin flap necrosis. These data contribute to increasing our knowledge about postoperative complications related to FJF reconstruction.

The impact of music therapy on opioid use in cancer survivors with chronic pain.

e24124 Background: Chronic pain and persistent opioid use are significant problems for many cancer survivors. Opioid tapering comes with major challenges. It is therefore recommended that cancer survivors learn non-pharmacological techniques to support opioid tapering. Methods: The purpose of this pilot study ( N = 26) was to examine the benefits of interactive music therapy (IMT) for opioid tapering in cancer survivors with chronic pain who are persistent opioid users. Those with a history of polysubstance abuse/substance use disorder or who were receiving maintenance methadone or suboxone were excluded. Participants were randomized to 10 weekly, individual IMT ( n = 14) or social attention control ( n = 12) sessions. We measured daily opioid use and chronic pain outcomes (pain interference, pain-related self-efficacy, and pain intensity) at baseline, post-intervention (week 10) and 3-month follow-up (FU). We also conducted semi-structured interviews to gain understanding of participants’ perspectives on the usefulness of IMT for opioid tapering. We modeled the pattern of mean daily opioid dose change over time using multilevel models. The cross-level interaction between time and treatment was used to determine the effect of treatment condition on the pattern of change in the target outcomes. We used restricted maximum likelihood to estimate model parameters and to test the significance of random effects. Given the small sample size, we relied on effect sizes for interpretation. Interview transcripts were analyzed using thematic analysis. Results: Participants were 58±13 years old. Most participants identified as female (58%), not Hispanic or Latino (92%), and white (58%) or Black (38%), and reported to have had breast (23%), cervical (8%), lung (8%), or melanoma skin cancer (8%). A total of 85% of participants said that they were quite to very motivated to taper their opioid use. About one third had had prior opioid tapering attempts and 31% stated that they had concerns related to opioid tapering. We found a large effect of IMT on mean daily opioid use at week 10 ( η2p = 0.36) and at 3-month FU ( η2p = 0.27). There was a medium effect of IMT on pain interference at week 10 ( η2p = 0.18) and a large effect at 3-month FU ( η2p = 0.30). For pain-related self-efficacy, we found a medium effect at week 10 ( η2p = 0.21) and small effect at 3-month FU ( η2p = 0.09). IMT resulted in a small treatment effect for pain intensity at week 10 and at 3-month FU (week 10: η2p = 0.05; 3 month: η2p = 0.09). The quantitative results were congruent with the qualitative findings as many IMT participants reported feeling more “in control” of their pain and being able to apply the music-based self-management strategies outside of the sessions to help with pain management and improve their functioning. Conclusions: These promising findings warrant further research on the effects of IMT on opioid tapering and chronic pain management in cancer survivors. Clinical trial information: NCT03782506 .

Challenges in the Sustainability of Brachytherapy Service in Contemporary Radiotherapy

Brachytherapy has a long history of delivering a highly conformal radiation dose to the target volume with sparing of adjacent normal tissue and has an irreplaceable role in certain cancers, such as cervical and prostate cancers. There have been futile attempts to replace brachytherapy with other radiation techniques. Despite that there are multifaceted challenges in preserving this dying art, from establishment, to a trained workforce, to maintenance of the equipment and source replacement costs. Here we focus on the challenges to access brachytherapy, the availability and distribution of care across the globe and appropriate training leading to proper implementation of the procedure. Brachytherapy holds a significant place in the treatment armamentarium of most common cancers, such as cervical, prostate, head and neck and skin cancers. However, there is an uneven distribution of brachytherapy facilities, not only across the globe, but also at a national level, with a larger proportion of facilities concentrated in certain regions, more so in low and low-middle income countries. The regions with the highest incidence of cervical cancer have the least access to brachytherapy facilities. Attempts to bridge the gap are essential and should be focused on uniform distribution and access to care, improving training of the workforce through specialised training programmes, reducing the cost of care, planning to reduce the recurring cost, generating evidence and research guidelines, renewing interest in brachytherapy through rebranding, use of social media and building an attainable long-term roadmap.

Event of Nasopharyngeal Carcinoma in Coastal Areas: Review Article

Background: Indonesia is a country consisting of islands and oceans that are rich in potential natural resources. Abundant marine products make the Indonesian people empower fish catches into long-lasting salted fish processed foods. People living in coastal areas have a high level of consumption of salted seafood products, such as salted fish. Consuming salted fish is one of the factors causing the incidence of nasopharyngeal carcinoma.&#x0D; Contents: Nasopharyngeal carcinoma (NPC) is a type of cancer found in the head and neck. NPC cases can be caused by various factors, one of which is caused by environmental factors. Environmental factors that can cause the incidence of NPC are environments that have a population of both passive and active smokers, formaldehyde exposure, and consumption of salted fish. Clinical manifestations that can arise in patients with NPC, such as epistaxis, nasal congestion, ringing in the ears, headaches, facial pain, and lumps can be seen on the top of the neck of the patient.&#x0D; Conclusion: NPC is the fourth most common malignant tumor in Indonesia after cervical cancer, breast cancer, and skin cancer. NPC cases are most commonly found in men compared to women in the elderly age group, in the range of 45-55 years. Several treatments such as radiotherapy, chemotherapy, and surgical intervention can be done to treat NPC cases.&#x0D;

MiR-133a-3p regulates the growth of hair follicle stem cells in white goats from the Yangtze River Delta

The Yangtze River Delta white goats are the sole goat breed producing brush hair of high quality. Owing to the particularities of its wool production, a higher demand is placed on breeding efforts for this animal. Studies on the developmental mechanisms of the aligned hair follicle stem cells (HFSCs) provide a theoretical basis for molecular breeding. In the present study, HFSCs were isolated using the technique of immunohistochemistry from the cervical spinal skin tissue samples from the fetal sheep, and the miR-133a-3p expression was confirmed using quantitative reverse-transcription PCR (RT-qPCR) and western blotting experiments from the isolated HFSCs. Additionally, the effects on the proliferation and apoptosis of HFSCs were detected using flow cytometry and 5-ethynyl-2'-deoxyuridine assays, along with other methods, following the overexpression of miR-133a-3p or its inhibition. The experimental results revealed that miR-133a-3p overexpressed could inhibit the proliferation of HFSCs and promote apoptosis by specifically targeting DUSP6. While the miR-133a-3p knockdown could promote the proliferation but inhibit the apoptosis of the HFSCs. Meanwhile, the miR-133a-3p knockdown experiments showed opposite outcomes. These results illustrate the presence of a relevant network between DUSP6 and miR-133a-3p, which regulates the production of superior-quality brush hair.

Mycobacterium avium subsp. paratuberculosis antigens induce cellular immune responses in cattle without causing reactivity to tuberculin in the tuberculosis skin test.

Mycobacterium avium subspecies paratuberculosis (MAP) causes chronic progressive granulomatous enteritis leading to diarrhea, weight-loss, and eventual death in ruminants. Commercially available vaccine provides only partial protection against MAP infection and can interfere with the use of current diagnostic tests for bovine tuberculosis in cattle. Here, we characterized immune responses in calves to vaccines containing four truncated MAP antigens as a fusion (Ag85A202-347-SOD1-72-Ag85B173-330-74F1-148+669-786), either displayed on protein particles, or expressed as a soluble recombinant MAP (rMAP) fusion protein as well as to commercially available Silirum® vaccine. The rMAP fusion protein elicited the strongest antigen-specific antibody responses to both PPDA and recombinant antigen and strong and long-lasting T-cell immune responses to these antigens, as indicated by increased production of IFN-γ and IL-17A in antigen-stimulated whole blood cultures. The MAP fusion protein particle vaccine induced minimal antibody responses and weak IFN-γ responses but stimulated IL-17A responses to recombinant antigen. The immune response profile of Silirum® vaccine was characterized by weak antibodies and strong IFN-γ and IL-17A responses to PPDA. Transcription analysis on antigen-stimulated leukocytes from cattle vaccinated with rMAP fusion protein showed differential expression of several immune response genes and genes involved in costimulatory signaling, TLR4, TLR2, PTX3, PTGS2, PD-L1, IL1B, IL2, IL6, IL12B, IL17A, IL22, IFNG, CD40, and CD86. Moreover, the expression of several genes of immune pathways correlated with cellular immune responses in the rMAP fusion protein vaccinated group. These genes have key roles in pathways of mycobacterial immunity, including autophagy, manipulation of macrophage-mediated killing, Th17- and regulatory T cells- (Treg) mediated responses. Calves vaccinated with either the rMAP fusion protein or MAP fusion protein particle vaccine did not induce reactivity to PPDA and PPDB in a comparative cervical skin test, whereas Silirum® induced reactivity to these tuberculins in most of the vaccinated animals. Overall, our results suggest that a combination of recombinant MAP antigens in the form of a soluble fusion protein vaccine are capable of inducing strong antigen-specific humoral and a balanced Th1/Th17-cell immune response. These findings, together with the absence of reactivity to tuberculin, suggest this subunit vaccine could provide protective immunity against intracellular MAP infection in cattle without compromising the use of current bovine tuberculosis surveillance test.