Stage N2 Research Articles

Risk factors of the low anterior resection syndrome (LARS) after ileostomy reversal in rectal cancer patient.

This study is aimed at identifying risk factors of Low Anterior Resection Syndrome following ileostomy reversal in rectal cancer patients who had undergone preventive ileostomy. This retrospective analysis was conducted on a cohort of 605 patients treated at the Fourth Hospital of Hebei Medical University between January 2018 and December 2021. These patients were grouped based on LARS score, and Clinical and follow-up data were collected to conduct univariate analyses of potential factors influencing LARS occurrence based on variable type. Variables with statistical significance were included in a logistic regression model to analyze potential influences on the occurrence of LARS. Univariate and Multivariate logistic regression analysis showed that N2 stage (OR = 2.290 95%CI: 1.076-4.873, P = 0.031), chemoradiotherapy (OR = 2.271, 95%CI: 1.246-4.138, P = 0.007), and anastomosis height (OR = 0.836, 95%CI: 0.717-0.975, P = 0.022) were independent influences on the occurrence of LARS. In model 3 (adjusting for all covariates), the relationship between anastomotic height and patient LARS status showed a negative correlation. In subgroup analyses, there were significant differences in the effect of anastomotic height on LARS in subgroups with different hemoglobin concentrations. A high occurrence rate of LARS is observed in rectal cancer patients with preventive ileostomy reversal. N2 stage, history of chemoradiotherapy, and anastomotic height are independent influence factors for the occurrence of major LARS after ileostomy reversal.

Influence of sleep on seizures and interictal epileptiform discharges in epilepsy.

Sleep significantly influences seizure occurrence and interictal epileptiform discharges (IEDs) in patients with epilepsy. Sleep-related epilepsy, where seizures occur exclusively or predominantly during sleep, has been observed in various epilepsy syndromes. Understanding the influence of sleep on seizures and IEDs is crucial in the diagnosis, classification, and management of epilepsy. Although there is a bidirectional relationship between sleep and epilepsy, this review focuses on the influence of sleep on seizures and IEDs in epilepsy. Seizures are more common during non-rapid eye movement (NREM) sleep, particularly during stage N2, and are suppressed during rapid eye movement (REM) sleep. Sleep also activates IEDs, increasing the diagnostic yield of EEG recordings. The rate of IEDs increases during NREM sleep, reaches its maximum during stage N3, and decreases during REM sleep. Sleep affects the electrical field of IEDs, with an increase of spiking fields during NREM sleep and a decrease during REM sleep. In the localization of epileptogenic foci, REM sleep is less sensitive but more specific than NREM sleep. Thalamocortical EEG synchronization during NREM sleep and desynchronization during REM sleep underlie their opposing effects on seizures and IEDs. Accumulating evidence has suggested an antiseizure effect of orexinergic antagonism in animal studies. Interventions that promote REM sleep, including orexinergic antagonists, should be studied in the future as novel treatment strategies for epilepsy.

Associations Among Sleep Apnea, Objective or Subjective Sleep Duration, and Recurrence of Atrial Fibrillation in Patients Who Undergo Radiofrequency Catheter Ablation for Persistent Atrial Fibrillation - A Prospective Observational Study.

Sleep apnea (SA), subjective sleep duration (SSD), and objective sleep duration (OSD) were reported as risk factors for atrial fibrillation (AF). However, the association between AF and the combination of SA and OSD has not been clarified. Nor has a mismatch between SSD and OSD been investigated. We assessed SA with polysomnography, OSD with actigraphy, and SSD in patients who underwent radiofrequency catheter ablation for persistent AF. We investigated associations among SA, OSD, OSD×3% oxygen desaturation index (3%ODI), and AF recurrence, considering SSD-OSD (i.e., the difference between SSD and OSD) and OSD. Seventy of 94 (74.4%) participants had moderate-to-severe SA (apnea-hypopnea index [AHI] ≥15). Participants were classified into OSD tertiles. Participants in Tertile 3 (mean OSD: 7.3 h) had decreased SSD-OSD (0.0 h) with increased Stage N1 sleep. Over 27.6 months, 10 AF recurrences occurred in 51 participants without treatment for SA. AHI ≥20 and OSD Tertile 3 were associated with AF recurrence (hazard ratios 5.7 [95% confidence interval 1.1-24.7] and 10.3 [95% confidence interval 1.2-88.4], respectively). Participants with AF recurrence had a higher OSD×3%ODI. SA and long OSD were predictors of recurrent AF through long exposure to intermittent hypoxia during sleep. SSD-OSD was low in patients with long OSD, possibly because of decreased sleep quality.

Mouth Leak is Associated with Sleep Fragmentation During Nasal CPAP Treatment of OSA and May Be Detected by Leak Waveform Analysis.

Mouth air leak is a major cause of low adherence to nasal CPAP in patients with obstructive sleep apnea (OSA). However, CPAP reports do not distinguish mouth from mask leak. We hypothesized that mouth air leak is terminated abruptly by an arousal from sleep and mouth closing that can be detected by CPAP leak waveform analysis. Describe patterns of mouth air leak waveform during polysomnography (PSG) in patients with OSA treated with well-fitted nasal CPAP. PSG recordings with a jaw motion sensor to detect mouth opening were performed in OSA patients treated with nasal CPAP with suspected mouth air leak. Careful mask fitting and visual inspection excluded mask leak. Mouth leak episodes were characterized by an increase (≥ 20%) above the intentional leak. Leak episodes were classified as intermittent (< 5 minutes) or continuous (≥ 5 minutes). Twenty patients (80% men; age: 63±11 years; body mass index: 29.9±6 kg/m2; baseline apnea hypopnea index: 46.9±19 events/h) treated with nasal CPAP and documented mouth leak completed the study. All but one patient experienced an overlap of intermittent and continuous mouth leak. Most mouth leak episodes ended with mouth closure (97.7%) and an arousal (52.7%) or awakening (38.6%). Only 34.9% of the leak episodes were associated with respiratory events. Intermittent mouth air leak was more common in sleep stages N1+ N2 (P<0.01), while continuous leak was more common in sleep stage N3 (P<0.01). Continuous episodes of air leak were associated with a higher amplitude of mouth opening. CPAP report waveform was able to detect only 29.6% of the leak episodes detected by PSG. Only 10 patients (50%) had a high unintentional leak according to the criterion adopted by ResMed and only 2 patients (10%) presented large leak according to the Philips criterion. Intermittent and continuous mouth leak during nasal CPAP frequently co-exist and contribute to sleep fragmentation. Identification of leak waveform patterns may help detect mouth air leak which in turn is an important cause of poor CPAP adherence.

Interhemispheric asynchrony of NREM EEG at the beginning and end of sleep describes evening vigilance performance in patients undergoing diagnostic polysomnography

Objective.Obstructive sleep apnea (OSA) is associated with deficits in vigilance. This work explored the temporal patterns of OSA-related events during sleep and vigilance levels measured by the psychomotor vigilance test (PVT) in patients undergoing polysomnography (PSG) for suspected OSA.Approach.The PVT was conducted prior to in-laboratory PSG for 80 patients suspected of having OSA. Three groups were formed based on PVT-RT-outcomes and participants were randomly allocated into Training (n= 55) and Test (n= 25) samples. Sleep epochs of non-rapid-eye movement (NREM) electroencephalographic (EEG) asynchrony data, and REM and NREM data for respiratory, arousal, limb movement and desaturation events were analysed. The data were segmented by sleep stage, by sleep blocks (SB) of stable Stage N2, Stage N3, mixed-stage NREM sleep (NXL), and, by Time of Night (TN) across sleep. Models associating this data with PVT groups were developed and tested.Main Results.Amodel using NREM EEG asynchrony data segmented by SB and TN achieved 81.9% accuracy in the Test Cohort. Models based on interhemispheric asynchrony SB data and OSA data segmented by TN achieved 80.6% and 79.5% respectively.Significance.Novel data segmentation methods via blocks of NXL and TN have improved our understanding of the relationship between sleep, OSA and vigilance.

Impact of surgical intervention on overall survival in malignant pleural mesothelioma: A population-based cohort study with propensity score matching

BackgroundMalignant pleural mesothelioma (MPM) is a rare and aggressive cancer with limited treatment options. This study aims to assess the impact of surgical intervention on overall survival (OS) in patients with MPM and to identify prognostic factors influencing survival outcomes. MethodsData from the SEER-17 Database between 2000 and 2019 were analyzed. Patients were categorized into surgery and no-surgery groups. Survival analyses were conducted using Kaplan-Meier curves and Cox proportional hazards models. Propensity score matching (PSM) was applied to reduce biases. ResultsThe study included a total of 3901 MPM patients, with 1190 in the surgery group and 2711 in the no-surgery group. The median OS for the entire cohort was 10 months. The surgery group had a median OS of 15 months compared to 8 months in the no-surgery group (p < 0.001). The 1-year and 5-year OS rates for surgery patients were 56.9% and 11.2%, respectively, while for no-surgery patients, they were 34.9% and 3.7% (p < 0.001). Multivariate analysis indicated that no-surgery was an independent risk factor for worse OS (HR 1.38, 95% CI 1.21-1.39, p < 0.001). After PSM, no-surgery remained an independent risk factor influencing OS. Subgroup analysis indicated that surgery benefited most groups except those aged ≥80 years, bilateral disease, N3 stage, and certain histological grades. ConclusionSurgical intervention significantly improves survival in patients with MPM. However, benefits vary across subgroups, and careful consideration of patient-specific factors is essential.

Postoperative Outcome And Complications Among Peritoneal Carcinomatosis Patients

Introduction: Peritoneal carcinomatosis is a recurrence pattern in gastric cancer, commonly complicating the postoperative course, especially in high-risk individuals. These complications adversely affect quality of life, increase mortality, and have immediate postoperative clinical implications. Surgery is the best treatment for early-stage tumors, despite its associated risks, including mortality. Aim: To evaluate the impact of postoperative complications on the clinical outcomes of patients undergoing peritoneal cancer surgery. Methods: This cross-sectional observational study was conducted at the National Institute of Cancer Research and Hospital, Dhaka, Bangladesh, over twenty-one months from July 2017 to March 2019. Forty-two patients were selected based on inclusion and exclusion criteria and diagnosed clinically, radiologically, and histopathologically. Data were collected using a structured case record form and analyzed using SPSS-22. Results: The mean age of participants was 66.19 ± 10.38 years, with 33.3% aged 56-65 years. The cohort included 64.3% males and 35.7% females, with 52.4%, 40.5%, and 7.1% having a BMI of 18.5-24.9 kg/m², 25- 30 kg/m², and &gt;30 kg/m², respectively. Smoking and betel leaf use were common (61.9% and 83.3%, respectively), with 69% from the middle class. Tumors primarily involved the proximal and distal stomach, with a mean size of 6.20 ± 1.86 cm, predominantly Type 3 and Type 4, and stages T4a and N2. No metastasis was observed. Total and lower radical gastrectomies were performed, with complications occurring in 9.5% (chest infection) and 14.3% (wound infection), while 76.2% had no complications. Conclusion: Complications can serve as indicators of postoperative clinical outcomes. The findings highlight the need for systemic changes in healthcare to reduce postoperative morbidity and mortality, thereby decreasing hospital stays.

Construction and Validation of a Prognostic Prediction Model for Gastric Mucinous Adenocarcinoma Based on the SEER Database

This study focused on the development and validation of a prognostic model to predict overall survival (OS) in patients with gastric mucinous adenocarcinoma (GMA), utilizing data from the SEER database. A cohort of 537 GMA patients was analyzed to identify factors affecting survival, using both univariate and multivariate Cox regression analyses on demographic and clinicopathological variables. The analysis led to the creation of a nomogram model. Findings revealed that TNM staging and the administration of radiotherapy or chemotherapy were significant factors impacting survival outcomes. Specifically, patients at stages T4, N3, and M1 faced a notably higher mortality risk, while those who received radiotherapy and chemotherapy experienced a significant reduction in mortality risk. The model's performance, as indicated by C-indices of 0.73 in the training set and 0.66 in the validation set, suggests robust predictive capability. The area under the curve (AUC) analysis confirmed high accuracy in predicting 1-year, 3-year, and 5-year survival rates, and calibration curves displayed strong agreement between predicted and actual outcomes. Decision curve analysis (DCA) demonstrated that the model exhibited significant clinical utility across various thresholds. Overall, this study presents a reliable prognostic tool for individualized risk stratification and clinical treatment in GMA patients. Future work should focus on enhancing the model by incorporating molecular biological data to increase its predictive accuracy and applicability.

Polysomnographic Findings into Sleep Disorders in Essential Tremor and Essential Tremor Plus: A Comparison with Healthy Controls.

To explore sleep patterns in individuals with Essential Tremor (ET) and Essential Tremor Plus (ET-Plus), compared to healthy controls, and assess differences between ET and ET-Plus, given the lack of established polysomnography (PSG) data on these groups and the potential for sleep disturbances to serve as clinical markers. We conducted a prospective cross-sectional study at NIMHANS, Bengaluru, from November 2021 to August 2023 on 45 patients (26 ET, 19 ET-Plus) and 45 controls. Tremor severity was assessed using TETRAS and FTMTRS, and sleep symptoms with ESS, PSQI, Mayo Sleep Questionnaire, RLS-Q, BQ, GAD-7 and PHQ-9. All cases and controls underwent overnight video PSG. Sleep scoring was manually done by a technically adequate sleep researcher and the first author following AASM (2022) guidelines with data analysed using R studio. ET patients exhibited younger onset age (30.8 ± 16.7 years) compared to ET-Plus patients (46.8 ± 11.1 years). ET-Plus had higher TETRAS and FTMRS scores (P < 0.001) than ET. Both ET and ET-Plus patients exhibited poorer sleep quality, excessive daytime sleepiness, REM sleep behavior disorder (RBD), and Restless Legs Syndrome (RLS) symptoms compared to controls. PSG findings supported these clinical observations, showing elevated Apnea-Hypopnea Index (AHI), reduced Total Sleep Time (TST), prolonged REM latency, decreased sleep efficiency, increased N1 stage duration, and reduced N2/N3 durations and percentages in patients versus controls. The study highlights significant sleep architecture abnormalities in both ET and ET-Plus patients as compared to healthy controls, with no differences between the ET groups.

Characteristics of clinical descriptive variables and polysomnographic findings of catathrenia.

Catathrenia has been classified as a sleep-related breathing disorder variant in the third edition of the International Classification of Sleep Disorders, but its validity remains unverified. We analyzed the clinical descriptive variables and polysomnographic findings of catathrenia and discussed the similarities and differences to those of obstructive sleep apnea (OSA), non-REM parasomnias, and sleep bruxism (SB). A retrospective analysis was conducted on 47 patients diagnosed with nocturnal groaning through polysomnography. We examined sex, body mass index, age at symptom onset, weekly symptom frequency, and presence/absence of comorbidities, including OSA, periodic limb movement disorder, non-REM parasomnia, and SB. The groaning event (GE) index was calculated according to sleep position and sleep stage. The distribution of patients with catathrenia did not show sex difference (male/female = 20:27), body mass index was 20.6 ± 3.0 kg/m2, and age of onset was 18.2 ± 7.4 years. The GE index was higher in stages N1 and R than in stage N3 and in the supine position than in the lateral position. There were no cases complicated with non-REM parasomnia, but the complication of SB was observed in 30% of the participants, and SB events appeared immediately before or during the interictal period of the GE episodes in these cases. Given the clinical background, posture- and sleep stage-dependent appearance of GEs, and the relatively high complication rate of SB, catathrenia pathogenesis may be heterogeneous or comprise elements of different sleep disorders.

Impaired Sleep-Dependent Memory Consolidation in Pediatric Narcolepsy Type 1.

Disrupted nighttime sleep (DNS) is common in pediatric Narcolepsy type 1, yet its cognitive impact is unknown. As N2 sleep spindles are necessary for sleep-dependent memory consolidation, we hypothesized that Narcolepsy Type 1 impairs memory consolidation via N2 sleep fragmentation and N2 sleep spindle alterations. We trained 28 pediatric Narcolepsy Type 1 participants and 27 healthy controls (HC) on a spatial declarative memory task before a nocturnal in-lab polysomnogram and then gave them a cued recall test upon awakening in the morning. We extracted wake and sleep stage bout numbers and N2 spindle characteristics from the polysomnogram and conducted mixed model analysis of sleep-dependent memory consolidation to identify group differences. Narcolepsy Type 1 participants had shorter N2 bout durations and associated shorter N2 spindles vs. HC, but other N2 spindle features were similar. Narcolepsy Type 1 participants had worse memory performance post-sleep than HCs after adjusting for age and gender (mean memory consolidation HC: -3.1% ± 18.7, NT1: -15.6 ± 24.8, main effect group x time of testing F=5.3, p=0.03). We did not find significant relationships between sleep-dependent memory consolidation and N2 spindle characteristics. Notably, increased N1% was associated with worse sleep-dependent memory consolidation with results driven by the Narcolepsy Type 1 group. Sleep-dependent memory consolidation is mildly impaired in youth with Narcolepsy Type 1 and findings may be attributed to increases in N1 sleep. Further studies are needed to determine if these findings are generalizable and reversible with sleep-based therapies.

Selection of induction chemotherapy cycles for stage N3 nasopharyngeal carcinoma based on pre-treatment plasma EBV DNA.

This study aimed to explore the selection of induction chemotherapy (IC) cycles for stage N3 nasopharyngeal carcinoma (NPC). We employed propensity score matching (PSM) to categorize patients into 3-cycle and 4-cycle IC groups (IC = 3 and IC = 4). The log-rank and chi-squared tests were used respectively to evaluate the differences in survival and acute toxicities. Survival outcomes including overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRRFS) were evaluated among the two groups. After PSM, each group comprised 99 patients. The IC = 4 group exhibited markedly improved survival outcomes compared with the IC = 3 group. Multivariate analysis revealed that pre-EBV DNA was an independent risk factor affecting PFS and DMFS. For high-risk patients with pre-EBV DNA ≥ 7800 copies/ml, the IC = 4 group demonstrated greater survival compared to the IC = 3 group. Among low-risk patients with pre-EBV DNA < 7800 copies/ml, both groups showed comparable survival outcomes. In terms of acute adverse reactions, the IC = 4 group experienced higher incidences, particularly with grade 2-4 alanine transaminase elevation and thrombocytopenia. For stage N3 NPC, pre-EBV DNA could be a powerful predictor for guiding the selection of IC cycles. The IC = 4 regimen is probably more beneficial to high-risk patients due to superior survival, while for low-risk patients, the IC = 3 regimen may be sufficient.

Survival Outcomes of Neoadjuvant Therapy Followed by Sleeve Lobectomy in Non-Small Cell Lung Cancer

This study was carried out to evaluate the impact of neoadjuvant therapy on long-term survival in non-small cell lung cancer (NSCLC) patients undergoing sleeve lobectomy. A total of 613 patients were retrospectively analyzed, including 124 who received neoadjuvant therapy. A 1:2 Propensity score matching (PSM) method was adopted to create a balanced cohort including 110 with neoadjuvant therapy and 169 without neoadjuvant therapy. Survival was estimated using the Kaplan-Meier method and compared using the Log-rank test and Cox proportional hazards models. Neoadjuvant therapy was associated with improved 3-year DFS (73.6% vs. 54.4%, P<0.001) and OS (80.9% vs. 63.9%, P=0.002) compared to patients without neoadjuvant therapy. Moreover, neoadjuvant chemoimmunotherapy significantly improved 3-year DFS (85.3% vs. 54.4%, P=0.001) and OS (88.2% vs. 63.9%, P=0.006), whereas chemotherapy alone did not show a significant effect. Multivariable Cox regression analysis revealed that neoadjuvant therapy was an independent predictor of improved DFS and OS while pathological N2 stage was independently associated with poorer DFS and OS. Furthermore, subgroup analysis in the neoadjuvant arm revealed that pathological N2 stage was an independent risk factor for DFS (HR, 3.830; 95% CI, 1.687-8.694; P=0.001), and achieving major pathologic response (MPR) was an independent predictor for better OS (HR, 0.120; 95% CI, 0.015-0.933; P=0.043). Neoadjuvant therapy prior to sleeve lobectomy significantly increased DFS and OS in locally advanced NSCLC. Sleeve lobectomy is advisable followed by neoadjuvant therapy, especially with chemoimmunotherapy.

Exploring Molecular Signatures in Early-Stage Pancreatic Ductal Adenocarcinoma: Implications for Patient Management and Therapeutic Strategies

Abstract Introduction/Objective Pancreatic ductal adenocarcinoma (PDAC) poses significant challenges to patient survival, predominantly due to its tendency for late-stage diagnosis and high rates of post-surgical cancer recurrence. Therefore, a comprehensive understanding of the molecular characteristics associated with the early stages of PDAC is imperative. This understanding holds the potential to improve patient treatment strategies by enabling targeted interventions and personalized therapies. Methods/Case Report Initially, RNA-seq datasets of early-stage PDAC cases (stages IA, IB, IIA, and IIB, all without distant metastasis; M0) were extracted from the GEO database. Subsequently, the datasets were analyzed in four distinct groups, and differentially expressed genes were identified within each group. Group 1 compared T1T2 cases with T3 cases (T: primary tumor), irrespective of N status (N: regional lymph nodes), while group 2 compared N0 cases with N1 cases, regardless of T status. Group 3 included comparisons between T1T2N0 cases and T3N0 cases, and group 4 compared T1T2N1 cases with T3N1 cases. Utilizing a Venn diagram, commonalities between gene expression profiles were isolated. Afterward, gene ontology and signaling pathways were determined using KEGG and Enrichr. Finally, a protein network was constructed, and the proteins were evaluated using the GEPIA and TCGA clinical databases. Results (if a Case Study enter NA) The study encompassed a total of 43 cases, with 25 (58.1%) being male and 18 (41.9%) female. The mean age of the participants was 64.4 years. In group 1, the expression levels of MUC5AC, AKAP13, and SPG7 were significantly upregulated in T3 cases. In group 2, STAB1, PDLIM1, and MTUS1 emerged as the top upregulated genes in N1 cases. Group 3 exhibited notable upregulation of CCNL2, CEACAM6, and TSPAN3 in T3N0 cases, while group 4 demonstrated marked upregulation of LTBR, AKAP12, and BOP1 in T3N1 cases. These genes exhibited diverse functions in PDAC progression. They contributed to the regulation of gene expression and cell cycle progression, modulating cell proliferation, inhibiting tumor growth, regulating cell signaling, and were involved in cytoskeletal organization. Conclusion The upregulated genes in cases with the T3 and/or N1 staging components may shed light on the potential mechanisms of progression from stage IA/B to stage IIA/B in PDAC cases. Furthermore, the identified genetic alterations may hold potential therapeutic and prognostic applications for future use in the early stages of PDAC.

Trypanosoma cruzi infection enhances olfactory response in Triatoma pallidipennis Stål (Hemiptera: Triatominae) to compounds potentially useful for insect control.

In Mexico, Triatoma pallidipennis is a major vector of Trypanosoma cruzi, the causative agent of Chagas disease. Current efforts are focused on developing attractants to control these vectors, using volatile substances derived from vertebrate hosts or compounds known to attract hematophagous insects. However, the efficacy of these compounds in attracting parasite-infected triatomines remains to be evaluated. In this study, we assessed the attractant activity of octenol (1-octen-3-ol), nonanal and a mixture of odorants consisting of ammonium hydroxide, lactic acid and hexanoic acid (in a ratio of 1:0.2:0.4 respectively), at concentrations of 1, 10 and 100 ng on the N3, N4 and N5 nymphal stages of T. pallidipennis, both infected and non-infected with T. cruzi. We also evaluated the synergistic effect of the most effective compounds and doses. All experiments were performed in a laboratory using a Y-type glass olfactometer. We found that both infected and non-infected N3 and N4 nymphs were attracted to low doses of octenol, nonanal and the odorant mixture. Particularly noteworthy was the synergistic effect observed between the odorant mixture and nonanal, which significantly increased attraction of T. cruzi-infected individuals. These findings contribute to the development of baited traps utilising these compounds for monitoring triatomines in epidemiological studies or for mass trapping to control these vectors.

Therapeutic and Diagnostic Tactics for Metastases to the Lymph Nodes of the Neck without an Identified Primary Focus

Introduction. Metastatic squamous cell carcinoma from an unknown primary focus accounts for less than 5 % of malignant tumors in the head and neck. Improving the methods of diagnosis can reduce the incidence of this pathology. Materials and methods. A retrospective analysis of the results of diagnosis and treatment of 59 patients with metastasis to the lymph nodes of the neck without an identified primary focus was performed. The proportion of male patients was 86 % (51/59), female — 14 % (8/59). The average age of patients is 61 years. Squamous cell carcinoma prevailed — 79 % (47/59). Results. Metastatically affected lymph nodes were localized in 92 % of cases at levels II and III. The proportion of patients with stages N2, N3 prevailed — 55 % (abs. 26), 32 % (abs. 15), respectively. Overexpression of the P­16 protein in metastatically affected lymph nodes was detected in 70 %, PD­L1 in 48 %, and Epstein­Barr virus (EBV) in 6 %. Ipsilateral diagnostic palatine tonsillectomy of an apparently unchanged tonsil was performed in 15 % (9/59) of cases, revealing the primary site in one instance. Of the special treatment methods, complex and combined treatment prevailed — 55 % (abs. 26). Radiation therapy in an independent version was performed by 48 % of patients, while 76 % received the full course (abs. 16). Combined treatment (a course of Radiation therapy followed by chemotherapy) — in 7 % (abs. 3) 20 % of patients received polychemotherapy. Palliative immunotherapy (pembrolizumab 200 mg IV — 5 courses) was given to 1 patient. The average life expectancy was higher with complex treatment — it was 60 months (95 % CI 43.5–76.4), the median survival is 60 months. Discussion. The main methods of treatment of patients with metastases of squamous cell carcinoma without were radiation therapy in an independent version, as well as complex treatment. Ipsilateral diagnostic palatine tonsillectomy of an apparently unchanged tonsil was performed in 15 % (abs. 9), and allowed to identify the primary focus in 1 case.Conclusion. Metastasis to the lymph nodes of the neck without remains an urgent interdisciplinary problem. Prospective multicenter studies are required to improve and optimize the algorithms for diagnosis and treatment of these patients.

Brian effects of electroacupuncture on sleep quality and cognitive function in patients with insomnia related to cerebral infarction

To observe the effects of electroacupuncture (EA) on sleep quality, sleep structure, and cognitive function in patients with insomnia related to cerebral infarction, and to explore the brain effect mechanism of EA on insomnia related to cerebral infarction. Thirty-six patients with insomnia related to cerebral infarction were randomly divided into an EA group (18 cases, 1 case was eliminated and 1 case dropped out) and a sham acupuncture group (18 cases, 1 case was eliminated and 2 cases dropped out). Both groups received conventional treatment for cerebral infarction. The EA group received EA at Sishencong (EX-HN 1) with continuous waves at a frequency of 2 Hz, at an intensity tolerable to the patient. The sham acupuncture group received sham acupuncture at non-acupoints with the same EA parameters but electrical stimulation was interrupted after 30 s. Both groups were treated for 20 min each session, once daily, 5 days per week, for a total of 4 weeks. Pittsburgh sleep quality index (PSQI), Montreal cognitive assessment-basic (MoCA-B) scores, and short-term memory (STM) encoding test accuracy and average reaction time were observed before and after treatment in the two groups. Polysomnography (PSG) was used to evaluate sleep structure, and electroencephalogram (EEG) data were collected to observe the standardized power value of the Theta frequency band before and after treatment. Compared with before treatment, PSQI score was decreased and MoCA-B score was increased in the EA group after treatment (P<0.001); the EA group had lower PSQI score and higher MoCA-B score than those in the sham acupuncture group (P<0.001, P<0.01). Compared with before treatment, STM encoding test accuracy was increased and average reaction time was shortened in the EA group after treatment (P<0.01, P<0.001); sleep efficiency (SE) was increased (P<0.01), total sleep time (TST), REM, and N3 stages were prolonged (P<0.01, P<0.05), and sleep latency (SL) was shortened (P<0.01). The standardized power value of the Theta frequency band in EEG channels F3, C3, C4, O1 and O2 was decreased (P<0.05). After treatment, the EA group had higher STM encoding test accuracy, shorter average reaction time (P<0.05), higher SE (P<0.01), longer TST, REM and N3 stages (P<0.01), and shorter SL (P<0.01) than those in the sham acupuncture group. There was no statistically significant difference in the standardized power value of the Theta frequency band between the two groups (P>0.05). EA could regulate sleep quality and structure in patients with insomnia related to cerebral infarction, and improve cognitive function, possibly related to the reduction of slow-wave activity in EEG.

Polysomnographic and clinical characteristics of sleep apnea headache patients.

Sleep apnea headache can be defined as a persistent, widespread, throbbing headache that occurs recurrently, is not accompanied by any additional symptoms after waking up, and usually resolves within four hours. Diagnosis of the condition requires confirmation through polysomnography with an apnea-hypopnea index of at least 5, indicating the presence of obstructive sleep apnea syndrome (OSAS). While sleep apnea headaches are common in 10-15% of individuals with OSAS, morning headaches are experienced by 5% of this population. The aim of this study is to examine both polysomnographic and clinical features associated with sleep apnea headache in individuals confirmed to have OSAS by polysomnography. The study was conducted in the sleep center of University of Health Science, Erenköy Mental and Nervous Disease Training and Research Hospital. We have examined the clinical and polysomnographic data of the patients with sleep apnea headache (SAH) diagnosed according to IHS-3 criteria retrospectively and grouped the patients as mild, moderate and severe OSAS. Patients with morning headache except sleep apnea headache and under PAP titration treatment were excluded. The differences between the sleep macro structures of patients with (WSAH) and without sleep apnea headache (WOSAH) were examined. The WSAH group consisted of 384 participants and the control group (WOSAH) consisted of 294 participants The mean age was 46.29 ± 12.18 and 45.08 ± 12.62 years, respectively. Patients in the WSAH group had significantly higher scores on the Epworth Sleepiness Scale (ESS) (p = 0.004) and higher periodic limb movement index (PLMI) (p = 0.014) compared to the WOSAH group. WSAH patients exhibited shorter wake times after sleep onset (WASO) and lower scores on the sleep quality index, in contrast to WOSAH patients. Additionally, within the WSAH group, there was a negative correlation between age and several sleep parameters, including total sleep parameters. A positive correlation was observed between sleep duration (p = 0.009), waking up after sleep (p = 0.043), sleep efficiency (p = 0.001) and apnea-hypopnea index (AHI) (p = 0.018). Additionally, ESS scores were positively correlated with AHI and total awake time (p = 0.000 and p = 0.008, respectively), while negatively correlated with stage N3 sleep percentage and mean minimum oxygen level (p = 0.001 and p = 0.020, respectively) in the WSAH group. The causes and possible mechanisms of sleep apnea headache are not fully clarified and the underlying processes are not fully understood. Sleep apnea headaches appear to be related to disturbances in nocturnal sleep. Dysregulation in regions that modulate sleep and nociception may be one possible mechanism.

Patterns of failure with 18F-DCFPyL PSMA-PET/CT in the post-prostatectomy setting: A regional cohort analysis.

This study aimed to assess the detection rate of prostate cancer recurrence by prostate-specific member antigen positron emission tomography/computed tomography (PSMA PET/CT) with 18F-DCFPyL in patients with residual disease or biochemical recurrence (BCR), and its association with surgical pathology and prostate-specific antigen (PSA) kinetics. Men from South Central Ontario enrolled in the PSMA Registry for Recurrent Prostate cancer (PREP) between April 2019 and December 2021 after radical prostatectomy (RP) and who had 1) pathologic stage N1 or persistent elevated PSA; or 2) BCR (PSA >0.10 ng/mL) where initial postoperative PSA was undetectable were included. A total of 169 men (median age 68 years; interquartile range [IQR] 62-71) with complete data met the above criteria. The median PSA was 0.27 ng/mL (IQR 0.16-0.85) prior to PSMA-PET. Overall positivity rate 59%; when PSA was <0.40 ng/mL, overall positivity rate 42% vs. 85% with PSA ≥0.40 ng/mL (p<0.001). Higher pathologic tumor stage increased detection of regional lymph nodes (LN) (pT2-3a: 32% vs. pT3b: 69%, p<0.001) but not distant metastases (pT2-3a: 12% vs. pT3b: 24%, p=0.15). PSMA-PET detected 18% with prostate bed, 42% with regional LN disease, and 44% with pelvic-only disease. The three most involved LN chains were the internal (21%) and external (20%) iliac, and obturator chains (16%). This prospective study of patients with residual disease or BCR after RP illustrates patterns of failure that could impact diagnosis and postoperative management. Such patients have significant risk of regional LN positivity on PSMA-PET highlighting a need to include pelvic LN within salvage radiotherapy volumes.

Structure of Spectral Composition and Synchronization in Human Sleep on the Whole Scalp: A Pilot Study.

We used numerical methods to define the normative structure of the different stages of sleep and wake (W) in a pilot study of 19 participants without pathology (18-64 years old) using a double-banana bipolar montage. Artefact-free 120-240 s epoch lengths were visually identified and divided into 1 s windows with a 10% overlap. Differential channels were grouped into frontal, parieto-occipital, and temporal lobes. For every channel, the power spectrum (PS) was calculated via fast Fourier transform and used to compute the areas for the delta (0-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), and beta (13-30 Hz) bands, which were log-transformed. Furthermore, Pearson's correlation coefficient and coherence by bands were computed. Differences in logPS and synchronization from the whole scalp were observed between the sexes for specific stages. However, these differences vanished when specific lobes were considered. Considering the location and stages, the logPS and synchronization vary highly and specifically in a complex manner. Furthermore, the average spectra for every channel and stage were very well defined, with phase-specific features (e.g., the sigma band during N2 and N3, or the occipital alpha component during wakefulness), although the slow alpha component (8.0-8.5 Hz) persisted during NREM and REM sleep. The average spectra were symmetric between hemispheres. The properties of K-complexes and the sigma band (mainly due to sleep spindles-SSs) were deeply analyzed during the NREM N2 stage. The properties of the sigma band are directly related to the density of SSs. The average frequency of SSs in the frontal lobe was lower than that in the occipital lobe. In approximately 30% of the participants, SSs showed bimodal components in the anterior regions. qEEG can be easily and reliably used to study sleep in healthy participants and patients.