Nasal Skin Research Articles

The effect of nasal skin thickness on the outcome of rhinoplasty

The effect of nasal skin thickness on the outcome of rhinoplasty

Topical Tretinoin in the Management of Thick-skinned Rhinoplasty Patients.

Despite the increasing popularity of cosmetic surgeries, some patients still experience skin problems, particularly those with thick nasal skin. Isotretinoin is a commonly used drug for severe acne, and its effects on rhinoplasty aesthetic results have recently been studied. This placebo-controlled clinical trial aimed to investigate the effects of topical tretinoin gel on the cosmetic outcomes of rhinoplasty in patients with thick nasal skin. Forty-nine individuals were randomly allocated to either the treatment group or the control group in Mashhad, Iran from 2019 to 2021. The treatment group received topical tretinoin gel (0.05%) beginning on the 31st postoperative day and continued for six months, while the control group received a usual dermatological recommendation as a placebo. Patients were assessed during the first, third, and sixth months after the intervention, and their cosmetic results were evaluated by an expert surgeon and dermatologist. There were no significant differences in baseline features between the two groups. The median score given by the surgeon was not significantly different between the groups. However, the median score given by the dermatologist was significantly higher in the treatment group during the first, third, and sixth months (P<0.001). Patient satisfaction scores were also significantly higher in the treatment group during the third and sixth months compared to the control group. (P=0.02 and 0.01, respectively). Topical tretinoin gel could effectively reduce acne in patients with thick nasal skin after rhinoplasty and increase patient satisfaction in the early months following surgery. However, it did not significantly affect final cosmetic outcomes.

Child With Profound Brain and Respiratory Disabilities: Evaluation of Unpleasant States by Nasal Skin Temperature

Child With Profound Brain and Respiratory Disabilities: Evaluation of Unpleasant States by Nasal Skin Temperature

Management of Nodular Nasal Basal Cell Carcinoma with Wide Excision, Transpositional Median Forehead Flap, Forehead Split Thickness Skin Graft: Case Report

Introduction: Basal cell carcinoma (BCC) is the most common skin type cancer with an incidence rate of around 75-80%. The most common location is in the head and neck area around 70-80% and followed by other body parts around 25% consist of the penis, vulva or perianal area and 5% on the skin. BCC occurs more frequently in light-skinned individuals compared to dark-skinned individuals. The incidence rate is relatively lower in Asians, blacks ethnic, and Hispanics.&#x0D; Case Presentation: A 66 years-old woman complained of scabs on the right side of her nose which had become increasingly widespread for the past 2 years. The wound was initially the size of a mole and was scratched until it spread until the patient was hospitalized. Physical examination showed a wound in the nasal area measuring 4 x 5 x 1 cm, irregular wound edges, cartilaginous wound base with necrotic tissue and pus. The first biopsy examination showed poorly differentiated basal cell carcinoma. The patient was treated with Nasal Reconstruction surgery consisting of wide excision was performed by surgical oncologist, transpositional median forehead Flap and forehead Split Thickness Skin Graft were performed by reconstructive plastic surgeon.&#x0D; Discussion: The diagnosis of BCC in this patient was based on regarding history taking, physical examination and histopathological examination. However, for defects with a diameter of more than 1.5 to 2 cm, generally recommended using axial pattern flaps such as forehead flaps, nasolabial flaps and dorsal nose flaps. In this case, the patient was treated with wide excision followed by nasal reconstruction with a transpositional forehead flap and forehead split thickness skin graft.&#x0D; Conclusion: Nevertheless, regional flaps remain the recommended procedure for nasal reconstruction after wide excision of the tumor. Accurate analysis of the damage combined with evaluation of the patient's clinical condition is necessary to select the best surgical technique. Thorough knowledge of regional vascular anatomy and a comprehensive multidisciplinary approach are important first steps for proper treatment of nasal skin cancer, so that the procedure for wide excision of nasal basal cell carcinoma followed by nasal reconstruction with transpositional forehead flap and split thickness skin graft, can provide satisfactory result.

A-T Flap for Reconstruction of Nasal Dorsum Skin Defects.

Reconstruction of nasal defects can be challenging, especially when encountering larger defects. We describe the use of a single-stage conversion of an 'A' shaped defect to a 'T' shaped scar of large nasal skin defects in the cosmetically sensitive supra-tip and supra-alar regions. This study aimed to determine whether an A-T flap is a suitable option for nasal reconstruction and if so where and what size defects it can be used for. Retrospective case series review over an 8-year period (2011-2019) in a tertiary referral center in the United Kingdom. Case analysis was undertaken in 2020 including all patients who underwent A-T reconstruction of nasal defects. A review of histology, case notes, and clinical photography was undertaken. A total of 27 patients were identified-13 (48%) female and 14 (52%) male. The median age was 73 years (range 31-90 years). Defect locations were supra-tip (48%) and supra-alar (52%). The largest defect closed was 895 mm2 (30 × 38 mm). Range 35 to 895 mm2 (median 264 mm2). No patient required revision or corrective procedures. No functional impairment was identified. Patient and clinician reported aesthetic outcomes as good in all cases. No reports of this technique could be identified in the literature. The A-T flap is a viable option for supra-tip and supra-alar skin defects (up to 895 mm2 in our series). It aligns well with the basic principles of nasal reconstruction. The flap can be performed under local anesthesia in one stage, resulting in good functional and aesthetic outcomes and so can be considered a valuable tool for the nasal reconstructive surgeon.

Patient Satisfaction Following Primary Closure or Second Intention Healing After Conventional Nasal Skin Cancer Excision: A Cross-sectional Cohort Study.

Nasal reconstruction after conventional surgical excision (CSE) of nonmelanoma skin cancer (NMSC) can be challenging. After excision and before the pathologic report, a simple reconstruction is favored. Yet, little is known about patient satisfaction after primary closure and second intention healing. Patient satisfaction after nasal defect reconstruction with primary closure or second intention healing, using the FACE-Q Skin Cancer. All patients who underwent CSE of nasal NMSC with immediate primary closure or second intention healing between March 2018 and March 2020 at Máxima Medisch Centrum Veldhoven were identified and asked to complete the FACE-Q Skin Cancer. Of 183 patients, 140 patients completed the questionnaire. Fifty-five defects were closed by primary closure (38.5%) and 88 by second intention healing (61.5%). Thirty-one complications were reported (16.7%), of which 87.1% ( n = 27) after second intention healing ( p = .004). Both groups experienced high facial and scar satisfaction, low appearance-related distress, and no to minimal adverse effects. Second intention healing had 2.7 higher odds of achieving the maximum scar satisfaction score ( p = .02). This study shows high satisfaction on facial and scar appraisal, low appearance-related distress, and no to minimal adverse effects for second intention healing and primary closure after CSE of nasal NMSC.

Frontal Flaps for Reconstruction of Nasal Defects

Nasal reconstruction is no longer just about filling in a nasal defect, it aims for an aesthetic and functional results. It is a three-dimensional reconstruction, restoring the mucosal plane, the osteo-cartilaginous architecture and the skin coverage to which Burget added a fourth dimension, the aesthetic result. Frontal flaps have been used for a very long time to repair nasal defects. Their popularity is mainly linked to their proximity to the recipient site, their good vascularization and especially the color and texture of the frontal skin which are significantly similar to those of the nasal skin. The frontal flap is the technique of choice in the reconstruction of full-thickness nasal tissue defects. We adopted the reconstruction by frontal flaps for the repair of multiple nasal defects, concerning multiple patients all treated at the plastic and aesthetic surgery department of the Mohammed VI University Hospital of Tangier over a period of 2 years going from March 2021 to March 2023. The goal of this study is to evaluate its contribution and answer the following question; What are the indications of using frontal flaps, its advantages and limitations in rhinopoiesis? and to draw practical recommendations regarding its use.

Use of Sail Excision in Alar Morphology Modification of Asian Noses

Globular hanging nasal alae, described as convex round shaped alar lobule which may be an aesthetic nuisance in the final result of rhinoplasty, are commonly seen among Southeast Asian noses. Such alar lobule morphology is an important part of nasal aesthetics and should not be disregarded. Surgical techniques used to address a hanging ala include direct external approaches. External rim excision was proposed to address hidden columella, sigmoid alae, small nostrils, dropped rim and foreshortened nose.1,2 Rim tissue was excised in full thickness fashion and sutured in one layer. Others proposed alar groove excision followed by alar repositioning and full-thickness skin grafting to reposition the alar base and correct hanging alae.3 Although these approaches have been proven to correct hanging alae, they leave a visible scar and/or permanent alar rim deformity if not done cautiously, especially on thick skinned patients.1-3 The alar rim may not be natural looking since it is lined by a scar, thus losing the lobular texture of the rim. A vestibular incision has been proposed to correct a hanging ala with unsightly scar.4 A maximum of 3mm elliptical vestibular skin was recommended to be removed to lift the alar rim with significant results. However, this recommendation was based on estimates and surgeon’s experience in western noses and may be insufficient for Asian noses. In addition, performing this technique without specific landmarks is difficult in achieving accurate results, especially when performed by a novice surgeon. Hence, further modification is important to address these concerns. Attempting to address the hanging alae in Asian noses, the senior author (ECY) modified the vestibular incision and came up with the sail excision technique based on the patient’s nasal anatomy.5 By presenting definite landmarks, the technique resulted in an alar lift procedure with reproducible outcomes. Furthermore, after performing sail excision in several patients, the authors noted the effect of this technique on alar morphology. This procedure is done by excising a precisely marked piece of inner nasal vestibular skin that is shaped like the sail of a boat to achieve a symmetrical and redictable result. This creates a lifting effect and improves the alar columellar disproportion specially when combined with septal advancement techniques.6,7 Furthermore, limiting the excision along the inner vestibular area and rolling the alar rim skin inwards results in correction of hanging ala (with a hidden scar) without an obvious, external scar. After performing the technique on several patients, we observed that in addition to its effect on lifting a hanging ala, the sail excision technique also changes the alar morphology from a globular-shaped lobule to a more aesthetically pleasing ridge-shaped lobule. To the best of our knowledge, such an effect of sail excision on alar morphology has not been described in the literature. This article aims to demonstrate the effect of the sail excision technique on alar rim morphology of Asian noses by describing the step-by-step procedure, surgical landmarks, and pearls in performing this technique.

Antibiotic Prophylaxis for Nasal Skin Flaps in Mohs Micrographic Surgery: A Retrospective Case Series.

Antibiotic Prophylaxis for Nasal Skin Flaps in Mohs Micrographic Surgery: A Retrospective Case Series.

The Human Microbiome and Its Role in Musculoskeletal Disorders.

Musculoskeletal diseases (MSDs) are characterized as injuries and illnesses that affect the musculoskeletal system. MSDs affect every population worldwide and are associated with substantial global burden. Variations in the makeup of the gut microbiota may be related to chronic MSDs. There is growing interest in exploring potential connections between chronic MSDs and variations in the composition of gut microbiota. The human microbiota is a complex community consisting of viruses, archaea, bacteria, and eukaryotes, both inside and outside of the human body. These microorganisms play crucial roles in influencing human physiology, impacting metabolic and immunological systems in health and disease. Different body areas host specific types of microorganisms, with facultative anaerobes dominating the gastrointestinal tract (able to thrive with or without oxygen), while strict aerobes prevail in the nasal cavity, respiratory tract, and skin surfaces (requiring oxygen for development). Together with the immune system, these bacteria have coevolved throughout time, forming complex biological relationships. Changes in the microbial ecology of the gut may have a big impact on health and can help illnesses develop. These changes are frequently impacted by lifestyle choices and underlying medical disorders. The potential for safety, expenses, and efficacy of microbiota-based medicines, even with occasional delivery, has attracted interest. They are, therefore, a desirable candidate for treating MSDs that are chronic and that may have variable progression patterns. As such, the following is a narrative review to address the role of the human microbiome as it relates to MSDs.

Ethnic rhinoplasty: Preliminary results of our technique in the pursuit of the harmonious nose

According to the American Society of Plastic Surgery, cosmetic surgery procedures for "ethnic patients" are annually increasing. Ethnic rhinoplasty traditionally represents a difficult challenge for plastic surgeons. Herein, we describe our personal technique to ethnic rhinoplasty to achieve a harmonious nose maintaining the characteristics of individual ethnicity and identity. In this study, we retrospectively reviewed ethnic patients treated with rhinoplasty at our institution between January 2019 and October 2022. We described our personal rhinoplasty technique step by step. At a minimum follow-up time of six months, postoperative pictures were taken, and patients were reassessed, evaluating aspects such as global symmetry and shape and contour of the nose. Finally, patient satisfaction was investigated according to rhinoplasty outcomes evaluation (ROE) questionnaire. A total of 1321 patients were included in the study. They reported a significant satisfactory aesthetic result in nasal image, as indicated by the mean postoperative ROE score (92.12). No cases of nasal contracture were recorded. None of the grafts was extruded or collapsed. Wounds healed without reported major infection. This study demonstrated that our approach is a safe procedure that contributes to improved functional outcomes with a high patient satisfaction rate and a low rate of postoperative complication. The creation of a solid base structure, nasal skin preparation, and an integrated patient approach are key elements of this surgery.

Study on the influence of buried thread nasal augmentation on dorsal soft tissue of nose and revision rhinoplasty

To investigate the influence of buried thread nasal augmentation on dorsal soft tissue of nose and revision rhinoplasty. A clinical data of 29 patients requesting revision rhinoplasty after buried thread nasal augmentation, who were admitted between July 2017 and July 2019 and met the selection criteria, was retrospectively analyzed. All patients were female with an average age of 26.8 years (range, 18-43 years). The patiens were admitted to the hospital at 3-48 months after buried thread nasal augmentation (median, 15 months). Among them, there were 18 cases of insufficient nasal tip projection, 22 cases of insufficient nasal root projection, 7 cases of threads ectasia, 5 cases of threads exposure, 3 cases of infection, and 10 cases with two or more conditions. There were 9 cases of combined short nose deformity, 1 case of spherical hypertrophy of the nasal tip, 3 cases of deviation of the nasal columella, 3 cases of excessive width of the nasal base, and 1 case of nasal hump. Three infected patients only underwent threads removal and debridement. The rest patients underwent revision rhinoplasty, and the dorsum of the nose was made with polytetrafluoroethylene expansion; the tip of the nose was reshaped by taking autologous rib cartilage and alar cartilage in 16 cases, and by taking autologous septal cartilage and alar cartilage in another 10 cases. The threads and surrounding tissue specimens removed during operation were subjected to histologic observation. Nasal length and nasal tip projection were measured after revision rhinoplasty and the ratio was calculated to evaluate the nasal morphology; patient satisfaction was evaluated using the Likert 5-grade scale. Patients were followed up 12-48 months (mean, 18 months). Inflammation was controlled in 3 patients with infections caused by buried thread nasal augmentation. The remaining 26 patients had satisfactory results immediately after revision rhinoplasty. Before revision rhinoplasty and at 7 days and 6 months after revision rhinoplasty, the nasal length was (4.11±0.34), (4.36±0.25), and (4.33±0.22) cm, respectively; the nasal tip projection was (2.34±0.25), (2.81±0.18), and (2.76±0.15) cm, respectively; and the nasal tip projection/nasal length ratio was 0.57±0.08, 0.65±0.05, and 0.64±0.04, respectively. There were significant differences in the nasal length and the nasal tip projection between time points ( P<0.05). There was a significant difference in the nasal tip projection/nasal length ratio between pre- and post-operation ( P<0.05), but there was no significant difference between 7 days and 6 months after operation ( P>0.05). The Likert score for satisfaction ranged from 1.5 to 5.0 (mean, 4.05). During follow-up period of 26 patients, no nasal prosthesis was exposed, and the shape of the nose was stable, and the nasal skin of 5 patients with exposed threads could be seen with different degrees of scarring; there was no infection, cartilage resorption, and no cartilage deformation, displacement, or exposure. Histological observation showed that absorbable threads were not only absorbed after implantation, but also with the prolongation of time, the inflammatory changes in the surrounding tissues caused by decomposition and absorption of the threads showed a gradual aggravation of the first, the heaviest inflammatory reaction in 6 to 12 months, and then gradually reduce the trend. After implantation of the absorbable thread into the subcutaneous tissue of the nasal dorsum, the nature of the thread is different from the body's own tissue, which will affect the soft tissue compliance of the nasal dorsum. The degradation and absorption of the thread will stimulate the infiltration of inflammatory cells and the proliferation of fibroblasts in the surrounding tissue and then form scar tissue, which will affect the design and effect of revision rhinoplasty.

Immediate reconstruction of nasal alar defects after malignant skin tumor excision without mohs surgery

Objectives: The National Comprehensive Cancer Network guidelines state that any nasal region with squamous or basal cell skin cancer is at high risk. Although Mohs surgery is the gold-standard procedure for many types of skin cancer, it is not applicable worldwide. A mean of 1.7 Mohs surgery stage is performed in cases of tumors. Nasal obstruction is a problem with Mohs surgery. In this study, we aimed to investigate nasal alar region nonmelanoma malignant skin tumor excision using immediate reconstruction without Mohs surgery. Methods: Ten patients underwent reconstruction surgery between 2018 and 2022. The inclusion criterion were ulcerated lesions in the nasal alar region measuring less than 1 cm in diameter, the lesions which were suspected either as basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) on dermatoscopic examination, the patients who had intact nasal mucosa during anterior rhinoscopy. Results: The mean follow-up duration was 26 months. No patient required re-operation because of an excisional biopsy result that involved border proximity. We observed no serious complications or long-term recurrences. Conclusion: We recommend our algorithm for patients for whom Mohs surgery is not applicable.

Comparative pharmacodynamic study delineating the efficacy of amantadine loaded nano-emulsified organogel via intranasal versus transdermal route in rotenone-induced Parkinson's disease rat model

Owing to the dysphagia and gastroparesis in patients concomitant with Parkinson's disease (PD), oral amantadine (AMT) medications are susceptible to poor bioavailability and clinical outcomes. A self-given delivery system controlling the release of AMT is sought to attain high patient compliance and enhanced therapeutic effect. This work focuses on the synthesis of a new potent low-molecular weight organogelator for the formulation of AMT nano-emulsified organogel (AMT-NEO). Among the gelators, the N-palmitoyl l-serine methyl ester (PSM) was selected for its highest gelation power and lowest critical gelation concentration. The D-optimal design was adopted for optimization of formulation variables; A: PSM amount, B: oil amount, and C: oil type. Evaluation of the particle size, zeta potential, polydispersity index, and AMT release was performed for all the formulations. The desirability function of the optimized formula was 0.949. The optimized formula possessed small particle size (162.58 nm), low polydispersity index (0.373), high zeta potential (−22.24 mV) and controlled the AMT release over 12h. A comparative pharmacodynamic study of the intranasal versus the transdermal administration of the optimized AMT-NEO to rats with rotenone-induced PD was performed. The results demonstrated the superiority of the nasal route to neutralize the deleterious effect of rotenone on motor behaviour and the measured biochemical parameters without affecting the histopathological morphology of nasal vestibules or skin layers. Therefore, the intranasal AMT-NEO might offer a shifted paradigm for the controlled release of such polar drug for the management of PD. This will be highly important especially for PD patients suffering from dysphagia.

A Prospective Clinical Trial Evaluating the Efficacy and Safety of Non-Animal Stabilized Hyaluronic Acid Injections for Non-Surgical Rhinoplasty

Background: Non-surgical rhinoplasty with hyaluronic acid (HA) filler is a three-dimensional reshaping technique that achieves tissue enhancement by placing HA deep to nasal skin. Due to its unique rheology, Restylane® Lyft (HA-L, Galderma, Uppsala, Sweden) may be particularly well-suited for injection rhinoplasty, as it has high gel firmness (G’) for strong structural support with minimal integration propensity. Methods: A prospective clinical trial was conducted to evaluate HA-L use for non-surgical rhinoplasty. Thirty-three females were observed over eight months, using the following schedule: Visit 1 = Baseline/Treatment 1; Visit 2 = Optional touch up (Week 2); Visits 3–6 = Follow-ups (Months 1,3,6,8). The primary endpoint was subject improvement at Month 1 assessed by a blinded evaluator using the Global Aesthetic Improvement Scale (GAIS). Subject satisfaction and adverse events (AEs) were also evaluated. Results: A deep, periosteal injection using a bolus technique and 0.34 cc of HA-L was most often used. Seven cases of positive aspiration occurred in 167 injection points (4.19%), among 6/33 (18.18%) subjects. Based on the GAIS, 100% of subjects met the primary endpoint. Subject satisfaction was maximal at Month 1 (100%) and largely maintained at Month 8 (78.57%). Besides expected injection-related AEs (eg, ecchymosis, erythema), immediate AEs during/following treatment were limited to presyncopal symptoms [5/33 subjects (15.15%)]. Importantly, no cases of ischemia were observed. Subject-reported AEs (eg, swelling, erythema, pain) dissipated within 2 to 7 days. Conclusion: Given the technical nature of this technique, HA-L may be well-suited for injection rhinoplasty, due to its strong safety and efficacy profile. Level of Evidence: Level III: Evidence obtained from well-designed cohort study.

Cutaneous Porphyrin Exhibits Anti-Stokes Fluorescence Emission Under Continuous Wave Laser Excitation

We report the discovery that anti-Stokes fluorescence emission can be induced from porphyrins by continuous wave (cw) laser excitation. An anti-Stokes spectroscopy and imaging technique with an integrated multimodal imaging system was developed to study cutaneous porphyrin in psoriasis, acne, and nasal skin. We experimentally demonstrated that under 785 nm cw laser excitation, photoporphyrin IX (PpIX) powder exhibited anti-Stokes fluorescence with its intensity linearly depending on the excitation power, confirmed that it is a single-photon process. Anti-Stokes fluorescence imaging of psoriasis scale, acne sebum smear, and nasal skin was performed. The results showed that Anti-Stokes fluorescence is sensitive and also specific for porphyrin detection without interference from other skin fluorophores.

French Neonatal Society issues recommendations on preventing nasal injuries in preterm newborn infants during non-invasive respiratory support.

To issue practical recommendations regarding the optimal care of nasal skin when non-invasive ventilation support is used. We performed a systematic search of PubMed to identify relevant papers published in English or French through December 2019. Different grades of evidence were evaluated. Forty-eight eligible studies. The incidence in preterm infants was high. The lesions were more frequent for preterm infants born under 30 weeks of gestational age and/or below 1500 g. The lesion was most often located on the skin of the nose but could also be found on the intranasal mucous membranes or elsewhere on the face. Nasal injuries appear early after the beginning of non-invasive ventilation at a mean of 2-3 days for cutaneous lesions and eight or nine for intranasal lesions. The most effective strategies to prevent trauma are the use of a hydrocolloid at the beginning of the support ventilation, the preferential use of a mask and the rotation of ventilation interfaces. Nasal injuries with continuous positive airway pressure treatment in preterm newborn infants were frequent and can induce pain, discomfort and sequelae. The immature skin of preterm newborn infants needs specific attention from trained caregivers and awareness by parents.

THE OUTCOME OF MODIFIED‐SMILE REGIMEN AS THE FIRST‐LINE TREATMENT FOR NEWLY DIAGNOSED FRAIL ADVANCED HIGH‐RISK NK/T CELL LYMPHOMA: A RETROSPECTIVE OBSERVATION STUDY

Introduction: To explore an effective and well-tolerant treatment for newly diagnosed advanced high-risk extranodal natural killer/T cell lymphoma (NKTCL) patients with poor performance status. We analyzed the efficacy and toxicity of modified-SMILE (dexamethasone, methotrexate, ifosfamide, L-asparaginase, etoposide) regimen in untreated advanced high-risk NKTCL patients retrospectively. Methods: Ten newly diagnosed advanced high-risk extranodal natural killer/T cell lymphoma (NKTCL) patients with a performance status of 2 were included in Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from May 2017 to May 2019. At least two cycles of modified-SMILE chemotherapy were administered as the first-line treatment. The primary endpoint was overall survival (OS) and progression-free survival (PFS). The secondary endpoint was the adverse effects of the treatment. Results: A total of 10 patients with newly diagnosed advanced high-risk NKTCL were enrolled, with a median age of 31.5 years (18-57 years). The male: female ratio was 7:3. The performance status of all patients was 2. Seven patients had B symptoms at the initial diagnosis, all presenting as hyperpyrexia. Extranodal organs involvement at the initial diagnosis included nasal cavity (8/10), skin (5/10), bone (4/10), lung (3/10), breast (2/10), pancreas (2/10), liver (1/10), stomach (1/10), intestine (2/10), adrenal glands (1/10) and uterine adnexa (1/10). Bone marrow involvement was present in 3 patients, and the spleen was involved in 2 patients. The prognostic index of NKTCL with Epstein-Barr virus DNA (PINK-E) of all patients was higher than 3. The median OS and PFS were 9 months (2-53 months) and 3 months (1-53 months), respectively. The main adverse effects were hematological toxicities including neutropenia, thrombocytopenia, and decreased fibrinogen. The grade 3/4 neutropenia happened in 2 patients, and the grade 4 thrombocytopenia happened in 1 patient. All toxicities were tolerable. To Mar 2023, the median follow-up period was 9 months (2-53 months), and the median OS was 9 months (2-53 months). Nine patients died and 1 patient survived. Of the 9 patients who died, all patients were diagnosed with Lymphoma-associated haemophilic syndrome (LAHS). Conclusions: The prognosis of advanced high risk NKTCL is very poor because of the poor tolerance to the intensive chemotherapy and the high incidence of LAHS. The modified-SMILE regimen might be an effective and well-tolerance chemotherapy to this intractable condition. Keywords: Chemotherapy, Combination Therapies No conflicts of interests pertinent to the abstract.

A Case of Granulomatosis with Polyangiitis with Submandibular Abscess as Primary Manifestation

Granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis, is a rare immunological small vessel disease which usually affects respiratory tract and kidneys. However, salivary gland involvement in GPA is rare as a primary manifestation. We report a case of GPA with the primary presentation of submandibular gland involvement. A 48-year-old female patient presented submandibular swelling with a skin defect that lasted for 1 month. Although the biopsy result was chronic inflammation, the skin defect did not heal for a month. Further imaging study revealed multiple lung and renal masses. More clinical manifestations such as gingivitis, ischemic change of finger joint and nasal tip skin, and positive c-ANCA test was presented. Additional biopsy was made at the submandibular gland, lung, and finger skin. The patient was finally diagnosed with GPA and treated with steroid pulse therapy and cyclophosphamide. The patient showed improvement of prior clinical symptoms.

Combining skin and olfactory α-synuclein seed amplification assays (SAA)—towards biomarker-driven phenotyping in synucleinopathies

Seed amplification assays (SAA) are becoming commonly used in synucleinopathies to detect α-synuclein aggregates. Studies in Parkinson’s disease (PD) and isolated REM-sleep behavior disorder (iRBD) have shown a considerably lower sensitivity in the olfactory epithelium than in CSF or skin. To get an insight into α-synuclein (α-syn) distribution within the nervous system and reasons for low sensitivity, we compared SAA assessment of nasal brushings and skin biopsies in PD (n = 27) and iRBD patients (n = 18) and unaffected controls (n = 30). α-syn misfolding was overall found less commonly in the olfactory epithelium than in the skin, which could be partially explained by the nasal brushing matrix exerting an inhibitory effect on aggregation. Importantly, the α-syn distribution was not uniform: there was a higher deposition of misfolded α-syn across all sampled tissues in the iRBD cohort compared to PD (supporting the notion of RBD as a marker of a more malignant subtype of synucleinopathy) and in a subgroup of PD patients, misfolded α-syn was detectable only in the olfactory epithelium, suggestive of the recently proposed brain-first PD subtype. Assaying α-syn of diverse origins, such as olfactory (part of the central nervous system) and skin (peripheral nervous system), could increase diagnostic accuracy and allow better stratification of patients.