Tissues Of Neck Research Articles

Dickkopf-1 is a Prognostic Biomarker of Head and Neck Squamous Cell Carcinoma that Correlates with Immune Infiltrates

<h3>Purpose/Objective(s)</h3> Head and neck squamous cell carcinoma (HNSCC) is associated with high immune cell infiltration, and immunotherapy is currently one of the most promising treatments for HNSCC. Dickkopf-1 (DKK1), a Wnt-signaling inhibitor and mediator of immune activation, is highly associated with tumor progression and the tumor microenvironment and, thus, disease prognosis. However, the associations between DKK1 expression, HNSCC prognosis, and tumor-infiltrating lymphocytes remain unknown. <h3>Materials/Methods</h3> We investigated these relationships in this study by exploring DKK1-expression differences in multiple tumor tissues and normal tissues, using the TIMER, Oncomine, and UALCAN databases. We searched the Kaplan–Meier database to assess correlations between DKK1 mRNA-expression levels and clinical outcomes. Subsequently, we evaluate the correlation between DKK1 expression and tumor immune-cell infiltration using the TIMER platform and TISIDB website. In addition, we assessed DKK1, CD3, and CD4 expression in 27 head and neck tumor samples and DKK1 expression in 15 normal head and neck tissue samples by immunohistochemistry. Moreover, we used the cBioPortal and UCSC Xena databases to explore aberrant DKK1 expression during tumorigenesis. <h3>Results</h3> DKK1 significantly upregulated in HNSCC tissues versus normal tissues. DKK1 expression was related to the HNSCC tumor stage, tumor grade, histology, lymph node metastasis, and a poor clinical prognosis. DKK1 expression correlated negatively with CD3+ (P < 0.0001) and CD4+ (P < 0.0001) immune cell infiltration in HNSCC tumor tissues. Moreover, DKK1 closely correlated with genetic markers of various immune cells. The prognosis of HNSCC correlated negatively with DKK1 expression in immune cells. Copy-number variation and DNA methylation may promote abnormal DKK1 upregulation in HNSCC. These results help understand the role of DKK1 in HNSCC immunotherapy and provide a rationale for clinical research on treating HNSCC by targeting DKK1. <h3>Conclusion</h3> DKK1 may therefore serve as a prognostic indicator and a biomarker for immune infiltration in HNSCC, and potentially as a central target for improving the diagnosis and immunotherapy efficacy of HNSCC.

403 Feasibility of Training for Ultrasound-Guided Cricothyrotomy Using a Novel 3-D Printed Training Model Simulating a Difficult Cricothyrotomy With Thick Pre-Tracheal Neck Tissue

403 Feasibility of Training for Ultrasound-Guided Cricothyrotomy Using a Novel 3-D Printed Training Model Simulating a Difficult Cricothyrotomy With Thick Pre-Tracheal Neck Tissue

Large Vascular Bundle Phloem Area 4 enhances grain yield and quality in rice via source-sink-flow.

In rice (Oryza sativa L.), vascular bundle phloem tissue in the panicle neck is vital for the transport of photosynthetic products from leaf to panicle and is positively associated with grain yield. However, genetic regulation of the single large vascular bundle phloem area (LVPA) in rice panicle neck tissue remains poorly understood. In this study, we carried out genome-wide association analysis of LVPA in the panicle neck using 386 rice accessions and isolated and characterized the gene LVPA4, which is allelic to NARROW LEAF1 (NAL1). Phenotypic analyses were carried out on the near-isogenic line (NIL) NIL-LVPA4LT in the high-yielding indica (xian) cultivar Teqing and on overexpression lines transformed with a vector carrying the Lemont alleles of LVPA4. Both NIL-LVPA4LT and LVPA4 overexpression lines exhibited significantly increased LVPA, enlarged flag leaf size, and improved panicle type. NIL-LVPA4LT had a 7.6%-9.6% yield increase, mainly due to the significantly higher filled grain number per panicle, larger vascular system for transporting photoassimilates to spikelets, and more sufficient source supply that could service the increased sink capacity. Moreover, NIL-LVPA4LT had improved grain quality compared with Teqing, which was mainly attributed to substantial improvement in grain filling, especially for inferior spikelets in NIL-LVPA4LT. The single-nucleotide variation in the third exon of LVPA4 was associated with LVPA, spikelet number, and leaf size throughout sequencing analysis in 386 panels. The results demonstrate that LVPA4 has synergistic effects on source capacity, sink size, and flow transport and plays crucial roles in rice productivity and grain quality, thus revealing the value of LVPA4 in rice breeding programs for improved varieties.

Комбинированное использование трансуретральной резекции и буккального графта в лечении рецидивного стеноза шейки мочевого пузыря

Bladder neck contracture after prostate surgery is a rare but feared complication. The treatment of choice is endoscopic incision or resection of fibrotic tissue. In case of ineffective transurethral correction, bladder neck reconstruction has to be done. In this report, we present a complicated case treated with combined transurethral and laparoscopic bladder neck reconstruction with buccal mucosal graft inlay. Using retrograde endoscopy fibrotic tissue in the bladder neck was resected to achieve a smooth and wide prostate cavity. After that the laparoscopy performed. The retropubic space is created and prostatic urethra opened via longitudinal prostatic-vesical incision. Buccal mucosal graft was fixed in place. Bladder and prostatic urethra were closed with resorbable suture. Two weeks after surgery the urethral catheter was removed and adequate voiding reestablished. After eleven months patient had no urination complaints and any sings of recurrence. Thus, the combined surgical approach for bladder neck reconstruction using buccal mucosa inlay may be a durable option for treatment of recalcitrant bladder neck contracture.

Assessment of Thyroid Nodules using TIRADS Classification: Interobserver Agreement and Correlation with Histopathology

Classification of thyroid nodules (TNs) based on TIRADS category is important for predicting malignancy, avoiding unnecessary biopsy and aiding in the management of patients. A prospective nonintervention study was carried out in the period from February 2020 to February 2021 in King Fahad Specialist Hospital in Dammam (Saudi Arabia). The study included 222 patients with suspected TNs (TIRADS 3-5). The thyroid ultrasound scanning was performed with a high frequency linear array probe (9 MHz and 15 MHz). The thyroid gland and adjacent neck tissues were scanned. The diagnostic performance of the TIRADS classifications was evaluated against final histology. Three highly experienced sonographers independently rated the US features of each nodule. Each sonographer assigned points to each TN for the five separate categories (composition, echogenicity, shape, margin, and echogenic foci), according to the TIRADS protocols produced by ACR. Cohen’s kappa scale was used to measure the interobserver agreement in categorizing TNs, and then the performance of ACR TIRADS categories for predicting malignancy was assessed using fine needle aspiration (FNA) as reference standard. For estimation of the diagnostic performance of ACR TIRADS to predict malignancy, the category for each TN was assigned by the principal investigator (Observer 1). This study included only TIRADS 3-5 (mildly to highly suspicious nodules: TR3-TR5), according to ACR TIRADS classification. The agreement for all sonographic features of TN among three observers (principal Observer 1 and two sub-investigators [Observer 2 and Observer 3]) was perfect, being 0.91-1.00 (Cohen’s kappa). Out of 222 patients with TNs, the percentage of malignancy in 68 TIRADS-5 nodules was 91.2%, while in 154 TIRADS 3-4 nodules the percentage of malignancy was 29.9%. The study concluded that interobserver agreement in TIRADS classification and characterization of suspicious thyroid nodule was perfect.

A Novel Deep Learning Framework for Automatic Recognition of Thyroid Gland and Tissues of Neck in Ultrasound Image

Recognition of thyroid glands and tissues of the neck is vital for screening related diseases in ultrasound videos. This task is subjective, challenging, and dependent on the experience of sonographer in current clinical practice. The purpose is to develop a fully automated thyroid gland and tissues of neck recognition framework to assist doctors in distinguishing the boundaries of different tissues. In this paper, we propose a novel deep learning framework that consists of a feature extraction network, region proposal network, object detection head, and spatial pyramid RoIAlign-based segmentation head. Designed spatial pyramid RoIAlign can efficiently capture local and global context features, and aggregates the multiple context information that makes the result much more reliable. A large dataset is constructed to train the proposed method. The performance is evaluated using the COCO metrics. The experimental results demonstrate that the proposed deep learning method can effectively realize the automatic recognition of the thyroid gland and tissues of neck in ultrasound videos. Considering the clinical practical application scenarios, we developed an automatic recognition system of thyroid and neck tissue based on edge computing, which can expediently assist doctors in distinguishing the boundaries between different tissues.

Classification of voice quality using neck-surface acceleration: Comparison with glottal flow and radiated sound

The aim of the present study is to investigate the usefulness of features extracted from miniature accelerometers attached to speaker's tracheal wall below the glottis for classification of phonation type. The performance of the accelerometer features is evaluated relative to features obtained from inverse filtered and radiated sound. While the former is a good proxy for the voice source, obtaining robust voice source features from the latter is considered difficult since it also contains information about the vocal tract filter. By contrast, the accelerometer signal is largely unaffected by the vocal tract and although it is shaped by subglottal resonances and the transfer properties of the neck tissue, these properties remain constant within a speaker. For this reason, we expect it to provide a better approximation of the voice source than the raw audio. We also investigate which aspects of the voice source are derivable from the accelerometer and microphone signals. Five trained singers (two females and three males) were recorded producing the syllable [pæ:] in three voice qualities (neutral, breathy and pressed) and at three pitch levels as determined by the participants' personal preference. Features extracted from the three signals were used for classification of phonation type using a random forest classifier. In addition, accelerometer and microphone features with highest correlation with the voice source features were identified. The three signals showed comparable classification error rates, with considerable differences across speakers both with respect to the overall performance and the importance of individual features. The speaker-specific differences notwithstanding, variation of phonation type had consistent effects on the voice source, accelerometer and audio signals. With regard to the voice source, AQ, NAQ, L1L2 and CQ all showed a monotonic variation along the breathy - neutral - pressed continuum. Several features were also found to vary systematically in the accelerometer and audio signals: HRF, L1L2 and CPPS (both the accelerometer and the audio), as well as the sound level (for the audio). The random forest analysis revealed that all of these features were also among the most important for the classification of voice quality. Both the accelerometer and the audio signals were found to discriminate between phonation types with an accuracy approaching that of the voice source. Thus, the accelerometer signal, which is largely uncontaminated by vocal tract resonances, offered no advantage over the signal collected with a normal microphone.

Improving Patient-Centered Communication in Aesthetic Surgery: A Patient Survey.

Professional communication is fundamental to the practice of medicine. In 1999, the Accreditation Council for Graduate Medical Education identified professionalism and interpersonal and communication skills as two of the six core competencies that all physicians must demonstrate.1,2 Unlike in other fields, the language used in aesthetic surgery is largely influenced by marketing and culture rather than scientific terminology.3 Professional communication requires sensitivity to a diverse patient population and attention to each patient’s language preferences, yet little is known about how patients perceive informal aesthetic terminology. After institutional review board approval, a survey instrument was revised iteratively through prepilot and pilot testing. (See Document, Supplemental Digital Content 1, which shows the 15-item electronic survey instrument, https://links.lww.com/PRS/F325.) Between July and August of 2020, we invited 898 aesthetic surgery patients to participate in the anonymous online survey. All adult patients who were scheduled to undergo aesthetic surgery between January and December of 2019 at our academic medical center were invited by email. (See Document, Supplemental Digital Content 2, which shows procedures that met criteria for inclusion in the aesthetic surgery patient sample, https://links.lww.com/PRS/F326.) Two subsequent email requests were sent to nonrespondents. A total of 347 patients completed the survey (38.6 percent). The median age was 51 years, most were female (95.7 percent), and the majority were White (85.6 percent). The demographic characteristics of respondents and nonrespondents were comparable (nonrespondent median age, 50 years; 92.8 percent female; 76.6 percent White). More than one-third of respondents (37.3 percent) perceived the phrase “mommy makeover” as inappropriate when discussing aesthetic surgery after pregnancy (Table 1). More than one-quarter (25.9 percent) disapproved of the term “nose job.” Nearly half (44.7 percent) perceived the term “turkey neck” as inappropriate when describing neck tissue laxity. Nearly one-third (29.2 percent) disapproved of the phrase “love handles.” A majority (66.0 percent) believed the phrase “boob job” to be inappropriate. Nearly three-quarters (70.9 percent) preferred, or were neutral about, the exclusive use of medical terminology when discussing aesthetic surgery. Table 1. - Patient Perceptions of Informal Aesthetic Surgery Terms Term Which Would Best Describe This Term if Used by My Surgeon when Talking to Me?* Inappropriate Neutral Appropriate Mommy makeover (n = 322) 120 (37.3) 95 (29.5) 107 (33.2) Tummy tuck (n = 331) 22 (6.6) 67 (20.2) 242 (73.1) Boob job (n = 338) 223 (66.0) 59 (17.5) 56 (16.6) Nose job (n = 328) 85 (25.9) 102 (31.1) 141 (43.0) Crow’s feet (n = 334) 45 (13.5) 86 (25.7) 203 (60.8) Turkey neck (n = 331) 148 (44.7) 81 (24.5) 102 (30.8) Bunny lines (n = 327) 78 (23.9) 126 (38.5) 123 (37.6) Love handles (n = 332) 97 (29.2) 87 (26.2) 148 (44.6) *The number of respondents does not total 347 because not all respondents answered all questions. Values are expressed as n (%). As shown, a considerable proportion of patients found informal aesthetic surgery phrases to be inappropriate. In open response comments, patients characterized colloquial phrases as “degrading,” “patronizing,” and “a barrier to clear communication.” Implicit in many informal terms is a message that the patient’s body is socially unacceptable. A patient-centered approach to communication is one that favors uncontroversial language that is suitable for the widest array of patients. A majority of respondents preferred or were neutral about the exclusive use of medical terminology, which represents the most professional approach to communication. By extension, informal phrases should also be avoided in marketing and education. It is true that some patients prefer informal terminology. Medical terms may be inaccessible to those with low health literacy, presenting a barrier to communication. Furthermore, not all informal terms are viewed negatively (Fig. 1). The use of colloquial or informal language should reflect an understanding of a patient’s language preferences. Whereas using informal terms should not be the default communication practice, they may be appropriate to adopt when a patient brings them into the conversation. When informal terms are used, body-positive language is preferable. For example, “extra neck skin” or “neck laxity” are more appropriate descriptions than “turkey neck.” “Mommy makeover” is better described by its component procedures, or by a different phrase, such as “body makeover.”Fig. 1.: Relative perceptions of informal aesthetic surgery terms. “Appropriate,” “neutral,” and “inappropriate” responses were assigned values of +1, 0, and –1, respectively. Values were summed and the net score was divided by the number of respondents.Professional communication is foundational to the provision of high-quality aesthetic care. Additional research is needed to identify language that is patient-centered and promotes professional communication. Moreover, linguistic preferences are constantly evolving4,5 and vary by region, representing an opportunity for continual growth in the delivery of quality aesthetic care. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. No direct funding was provided for this study.

A Multilayer Monte Carlo Analysis of Optical Interactions in Reflectance Neck Photoplethysmography.

This paper presents a multilayer Monte Carlo model of a healthy human neck to investigate the light-tissue interaction during different perfusion states within its dermal layer. Whilst there is great interest in advancing wearable technologies for medical applications, and non-invasive techniques like photoplethysmography (PPG) have been studied in detail, research has focused on more conventional body regions like the finger, wrist, and ear. Alternatively, the neck could offer access to additional physiological parameters which other body regions are unsuitable for. The aim of this work was to investigate the effects of several factors that would influence the optimum design of a reflectance PPG sensor for the neck. These included the source-detector separation on the optical path, penetration depth, and light detection efficiency. The results were generated from a static multilayer model in a reflectance mode geometry at two wavelengths, 660 nm and 880 nm, containing different blood volume fractions with a fixed oxygen saturation. Simulations indicated that both wavelengths penetrated similar depths, where optimal source-detector separation should not exceed 3 mm or 2.4 mm, for red and infrared respectively. Within this range, light interrogates the dermal-fat boundary corresponding to the last neck tissue layer positively contributing to a neck PPG acquisition.

Management of deep neck infections in adults and importance of clinical and laboratory findings

This study aimed to analyze laboratory and radiological imaging results in the prediction of treatment strategy in patients with deep neck infections. Eighty-three patients (55 (66.3%) men, mean age: 38.2±14.5...

Abstract 753: Comprehensive genomic profiling (CGP) reveals site-specific enrichment of immunotherapy biomarkers and targetable alterations in non-small cell lung cancer (NSCLC) metastasis

Abstract Introduction NSCLCs are frequently identified at a later stage, with 30-40% of cases presenting with metastasis at the time of diagnosis. Metastatic progression is a major cause of cancer death, thereby making it critical to understand the genomic differences across metastatic sites and their associated treatment implications. Methods CGP was performed on 64,062 NSCLCs for all classes of alterations in at least 324 genes (Foundation Medicine, Inc.). The cohort comprised 59% lung (LB), 25% metastatic site (MB) and 17% regional/distant lymph node (LN) biopsies. A subset of 386 patients with matched LB/MB samples were examined. Tumor mutational burden (TMB) was determined on 0.8-1.1 Mb and PD-L1 IHC (DAKO 22C3) was evaluated in a subset of cases. Results MB NSCLCs comprised liver (23%), brain (23%), bone (15%), soft tissue (14%), adrenal gland (8%) and other rare sites (e.g., spine, head&amp;neck, kidney). MB NSCLCs had elevated TMB compared to LB NSCLCs (median 7.8 v 6.3 mut/Mb; P &amp;lt; 10-4), most notably in brain (11.3 mut/Mb), adrenal gland (10.4 mut/Mb) and kidney (9.2 mut/Mb) MB, whereas TMB in liver MB was similar to LB (6.3 mut/Mb). Heterogeneity in PD-L1 expression (≥50%) was also observed, with higher rates in head&amp;neck (42%), adrenal gland (40%), LN (39%), and soft tissue (35%) compared to LB (30%; all P &amp;lt; 0.05). Clinically informative alterations and known NSCLC drivers exhibited site-specific patterns. EGFR alterations differed by sites with the highest rates in omentum (40% v 15% LB), bone (20%) and liver (18%). Fusions in ALK, RET and ROS1 were more common in MB NSCLCs relative to LB, while MET exon 14 skipping alterations were rarer in MB NSCLCs. Liver MB had fewer KRAS alterations (21% v 31% LB, P&amp;lt;10-4), while brain MB had elevated rates of KRAS, KEAP and STK11 alterations (37% v 31%, 16% v 9%, 23% v 15%, respectively, P&amp;lt;10-4). A repertoire of genes with potential role in metastatic spread (e.g., SMARCA4, RICTOR, PIK3CG), were identified to be enriched in specific MB NSCLCs. Of note, MB NSCLCs also presented with significantly higher rates of aneuploidy across the genome. 386 patients with longitudinal LB/MB samples were available (median collection time difference = 474 days). Concordance, defined by percent positive agreement (PPA) of alterations with LB, varied by site and was highest in bone and brain MB. While truncal, driver events were often shared, short variants in PIK3CA, ARID1A and copy number alterations in MYC, RICTOR, MET and CDKN2A/2B were frequently acquired in MB. TMB was elevated in MB compared to LB in 204 cases, though only 39 patients transitioned from TMB &amp;lt;10 to TMB ≥10 mut/Mb status. Conclusions NSCLC metastases exhibit heterogeneity in clinically actionable alterations and immunotherapy biomarkers (PD-L1, TMB). Site-specific alterations may have clinical implications and inform the biology of metastatic progression. Citation Format: Benjamin G. Kaplan, Richard S. Huang, Lucas Dennis, Lee A. Albacker, Garrett M. Frampton, Ethan S. Sokol, Smruthy Sivakumar. Comprehensive genomic profiling (CGP) reveals site-specific enrichment of immunotherapy biomarkers and targetable alterations in non-small cell lung cancer (NSCLC) metastasis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 753.

Abstract 3844: COL11A1: A driver of tumor progression and immune evasion in head and neck squamous cell carcinoma (HNSCC)

Abstract We previously reported that collagen type XI alpha 1 (COL11A1) is upregulated in head and neck squamous cell carcinoma (HNSCC) and contributes to tumor progression. Here we tested the hypothesis that COL11A1 regulates the expression of immune regulatory markers in HNSCC. Xena Browser was used to analyze 520 and 42 cancer free normal head and neck tissue samples for COL11A1 expression. The Cancer Genome Atlas (TCGA) RNASeq data from 522 HNSCC samples was downloaded and sorted by clinical parameters and RNA expression for 20,000 genes. COL11A1 expression was correlated with tumor stage (T) and clinical stage (I-IV). Data was sorted by COL11A1 high and low based on the mean COL11A1 expression level and run through the CIBERSORT analysis tool for prediction of immune cell proportions in the tumor. HNSCC lines with COL11A1 knockdown were assessed for immune regulatory markers at the RNA and protein level. COL11A1 was found to be increased in HNSCC relative to normal tissue (tumor vs. normal p&amp;lt;0.0001). COL11A1 expression is highest in HPV negative HNSCC. Its expression correlates with increased tumor (T1 vs T4 p=0.033) and clinical stage (stage III vs. stage IV p=0.023). CIBERSORT analysis demonstrates COL11A1hi patients have significantly decreased active natural killer (NK) cells (active vs. inactive p=0.0166), CD8+ T cells (CD8 low vs. high p&amp;lt;0.0001) and active dendritic cells (active vs. inactive p=0.0035) suggesting immune modulation. COL11A1 targeted lines in vitro show decreased expression of hla-a, -c and cd274 (PD-L1), suggesting COL11A1 expression modulates immune activation by regulating immune suppressive ligands on the tumor cell. COL11A1 is overexpressed in HNSCC and drives tumor proliferation, migration and invasion. Expression levels correlate with tumor and clinical stage. Bioinformatics tool CIBERSORT, predicts decreased immune cell activity in patients with high COL11A1. Targeting COL11A1 in vitro decreased expression of immune suppressive ligands. These preliminary results indicate COL11A1 may drive immune evasion in HPV negative HNSCC. Targeting COL11A1 may improve patient response to immunotherapeutic targets in HNSCC. Citation Format: Harmony Ivanna Saunders, Levi Arnold, Mary Markiewicz, Sufi M. Thomas. COL11A1: A driver of tumor progression and immune evasion in head and neck squamous cell carcinoma (HNSCC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3844.

Research of Building 3D Model in External Fixator for Proximal Femoral Fracture Based on Locking Plate Shape

The software of 3D-Modeling(UG NX 10.0) was used to design a new external fixator model for proximal femoral fracture, and fresh femoral cadaver specimens were used to simulate experimental operation. The results showed that the external fixator designed with the proximal femoral locking plate shape can improve the accuracy of Kirschner wire penetration into the femoral neck, reduce fluoroscopic and soft tissue incision injuries, and make a good stability and is easy to operate, which has a certain value for patients with proximal femoral fracture, such as intolerant surgery and poor physical condition.

Estimation of Carcass Tissue Composition from the Neck and Shoulder Composition in Growing Blackbelly Male Lambs.

This study was designed to develop predictive equations estimating carcass tissue composition in growing Blackbelly male lambs using as predictor variables for tissue composition of wholesale cuts of low economic value (i.e., neck and shoulder). For that, 40 lambs with 29.9 ± 3.18 kg of body weight were slaughtered and then the left half carcasses were weighed and divided in wholesale cuts, which were dissected to record weights of fat, muscle, and bone from leg, loin, neck, rib, and shoulder. Total weights of muscle (CM), bone (CB) and fat (CF) in carcass were recorded by adding the weights of each tissue from cuts. The CM, CF and CB positively correlated (p < 0.05; 0.36 ≤ r ≤ 0.86), from moderate to high, with most of the shoulder tissue components, but it was less evident (p ≤ 0.05; 0.32≤ r ≤0.63) with the neck tissue composition. In fact, CM did not correlate with neck fat and bone weights. Final models explained (p < 0.01) 94, 92 and 88% of the variation observed for CM, CF and CB, respectively. Overall, results showed that prediction of carcass composition from shoulder (shoulder) tissue composition is a viable option over the more accurate method of analyzing the whole carcass.

Feasibility of machine-delivered sequential massage for the management of lymphedema in the head and neck cancer survivor.

BackgroundLymphedema after treatment for head and neck cancer negatively impacts the quality of life and can produce neck tissue stiffness, dysphagia, pain, and swelling. One form of treatment for lymphedema is machine‐delivered sequential lymphedema massage, which is home based and self administered. This study was undertaken to determine economic and system access to home‐based lymphedema therapy and to measure patient‐reported outcomes among those able to access therapy.MethodsThis study is a retrospective cohort study of 84 head and neck cancer patients who met the criteria for referral for home‐based lymphedema treatment. Patients who were able to access lymphedema therapy were surveyed prior to initiation of therapy and again after therapy.ResultsThirty‐five out of 84 patients were approved for home‐based therapy and received the equipment. Medicare denial of coverage (21/84) was the most common cause of the inability to access therapy. Of the 35 patients who accessed therapy, presenting complaints included: stiffness (31), pain (29), dysphagia (20), and swelling (19). The average time from completion of cancer treatment to initiation of lymphedema therapy was 9 months. Thirty‐four (97%) reported compliance with prescribed therapy, 33 (94%) reported reduced fibrosis, and 30 (89%) reported improvement in activities of daily living. All reported symptoms improved with therapy in 30 (86%) patients. Thirty‐two (91%) reported overall satisfaction with home‐based lymphedema treatment.ConclusionsStiffness and pain were the most common complaints of our patients with head and neck lymphedema. Forty‐two percent of patients who were recommended home lymphedema machine use were able to obtain this with cost coverage by their insurance company or by donation from the company. We found a high compliance rate and a highly reported improvement in symptoms with the machine. The only identifiable factor for the patients with less improvement in symptoms was a greater time gap between treatment and initiation of use of home lymphedema machine.Level of evidence2 Retrospective cohort analysis.

Foliar Diseases and the Associated Fungi in Rice Cultivated in Kenya

We conducted a survey to assess the occurrence and severity of rice blast and brown spot diseases on popular cultivars grown in the Busia, Kirinyaga, and Kisumu counties of Kenya in 2019. Working with agricultural extension workers within rice production areas, we interviewed farmers (n = 89) regarding their preferred cultivars and their awareness of blast disease, as this was the major focus of our research. We scored the symptoms of blast and brown spot and assessed the lodging, plant height, and maturity of the crops (days after planting). Furthermore, we collected leaf and neck tissues for the assessment of the prevailing fungal populations. We used specific DNA primers to screen for the prevalence of the causal pathogens of blast, Magnaporthe oryzae, and brown spot, Cochliobolus miyabeanus, on asymptomatic and symptomatic leaf samples. We also conducted fungal isolations and PCR-sequencing to identify the fungal species in these tissues. Busia and Kisumu had a higher diversity of cultivars compared to Kirinyaga. The aromatic Pishori (NIBAM 11) was preferred and widely grown for commercial purposes in Kirinyaga, where 86% of Kenyan rice is produced. NIBAM108 (IR2793-80-1) and BW196 (NIBAM 109) were moderately resistant to blast, while NIBAM110 (ITA310) and Vietnam were susceptible. All the cultivars were susceptible to brown spot except for KEH10005 (Arize Tej Gold), a commercial hybrid cultivar. We also identified diverse pathogenic and non-pathogenic fungi, with a high incidence of Nigrospora oryzae, in the rice fields of Kirinyaga. There was a marginal correlation between disease severity/incidence and the occurrence of causal pathogens. This study provides evidence of the need to strengthen pathogen surveillance through retraining agricultural extension agents and to breed for blast and brown spot resistance in popular rice cultivars in Kenya.

180-W GreenLight laser photoselective vaporization with multiple triamcinolone acetonide injections for the treatment of bladder neck contractures.

Bladder neck contracture (BNC), one of the most challenging complications after transurethral resection of the prostate (TURP) and photoselective vaporization of the prostate (PVP), lacks effective treatment. In the present study, our experience in treating BNC using GreenLight laser vaporization with triamcinolone acetonide (TA) injections was shared. This is a retrospective cohort study that included 46 patients with BNC after TURP and PVP in our center. GreenLight laser surgeries (180W) were carried out and TA was administrated simultaneously. TA injections were repeated every week for three times after surgeries. The perioperative and postoperative parameters were reviewed and compared. Bladder neck tissues were examined by immunohistochemical staining to explore the expressions of collagen I, matrix metalloproteinase-3 (MMP-3), and transforming growth factor-β (TGF-β) after treatments. The chief complaint symptoms of all patients were significantly relieved after our treatments. None of them showed BNC recurrence during the follow-up. Complications were rare and mild. Postoperative assessments including maximal urinary flow rate (P < 0.01), International Prostate Symptom Score (P < 0.01), quality of life index (P < 0.01), and post-void residual volume (P < 0.001) were significantly better than baseline values, respectively. Immunohistochemical staining showed significantly lower expressions of collagen I (P < 0.001), MMP-3 (P < 0.001), and TGF-β (P < 0.001) after treatments. In conclusion, 180-W GreenLight laser with repeated TA injections demonstrated the safety and long-term efficacy in treating BNC, by inhibiting the expressions of fibrotic factors. Our procedure was a promising treatment for BNC after PVP and TURP.

Morphometric and ultrasonographic determinants of difficult laryngoscopy in obese patients: A prospective observational study.

Obese people have a higher risk of difficult laryngoscopy due to their thick neck, large tongue, and redundant pharyngeal soft tissue. However, there is still no established predictive factor for difficult laryngoscopy in obese population. We conducted a prospective assessor-blind observational study to enroll adult patients with a body mass index of 30 kg·m-2 or higher undergoing laparoscopic sleeve gastrectomy at a medical center between May 2020 and August 2021. Conventional morphometric characteristics along with ultrasonographic airway parameters were evaluated before surgery. The primary outcome was difficult laryngoscopy, defined as a Cormack and Lehane's grade III or IV during direct laryngoscopy. Logistic regression analyses were performed to evaluate the association between included factors and difficult laryngoscopy. Discrimination performance of predictive factors was assessed using area under the receiver operating characteristic curve (AUC). A total of 80 patients were evaluated, and 17 (21.3%) developed an event of difficult laryngoscopy. Univariate analyses identified five factors associated with difficult laryngoscopy, including age, sex, hypertension, neck circumference, and cross-sectional area of tongue base. After adjusting for these variables, neck circumference was the only independent influential factor, adjusted odds ratio: 1.227 (95% confidence interval, 1.009-1.491). Based on Youden's index, the optimal cutoff of neck circumference was 49.1 cm with AUC: 0.739 (sensitivity: 0.588, specificity: 0.889; absolute risk difference: 0.477, and number needed to treat: 3). Greater neck circumference was an independent risk factor for difficult laryngoscopy in obese patients. This finding provides a way of reducing unanticipated difficult airway in this high-risk population.

Acquisition repeatability of MRI radiomics features in the head and neck: a dual-3D-sequence multi-scan study

Radiomics has increasingly been investigated as a potential biomarker in quantitative imaging to facilitate personalized diagnosis and treatment of head and neck cancer (HNC), a group of malignancies associated with high heterogeneity. However, the feature reliability of radiomics is a major obstacle to its broad validity and generality in application to the highly heterogeneous head and neck (HN) tissues. In particular, feature repeatability of radiomics in magnetic resonance imaging (MRI) acquisition, which is considered a crucial confounding factor of radiomics feature reliability, is still sparsely investigated. This study prospectively investigated the acquisition repeatability of 93 MRI radiomics features in ten HN tissues of 15 healthy volunteers, aiming for potential magnetic resonance-guided radiotherapy (MRgRT) treatment of HNC. Each subject underwent four MRI acquisitions with MRgRT treatment position and immobilization using two pulse sequences of 3D T1-weighed turbo spin-echo and 3D T2-weighed turbo spin-echo on a 1.5 T MRI simulator. The repeatability of radiomics feature acquisition was evaluated in terms of the intraclass correlation coefficient (ICC), whereas within-subject acquisition variability was evaluated in terms of the coefficient of variation (CV). The results showed that MRI radiomics features exhibited heterogeneous acquisition variability and uncertainty dependent on feature types, tissues, and pulse sequences. Only a small fraction of features showed excellent acquisition repeatability (ICC > 0.9) and low within-subject variability. Multiple MRI scans improved the accuracy and confidence of the identification of reliable features concerning MRI acquisition compared to simple test-retest repeated scans. This study contributes to the literature on the reliability of radiomics features with respect to MRI acquisition and the selection of reliable radiomics features for use in modeling in future HNC MRgRT applications.

Stricter Postoperative Oropharyngeal Cancer Radiation Therapy Normal Tissue Dose Constraints Are Feasible

PurposeAlthough dose de-escalation is one proposed strategy to mitigate long-term toxicity in human papillomavirus associated oropharyngeal cancer, applying more stringent normal tissue constraints may be a complementary approach to further reduce toxicity. Our study demonstrates that in a postoperative setting, improving upon nationally accepted constraints is achievable and leads to reductions in normal tissue complication probabilities (NTCP) without compromising disease control. Methods and MaterialsWe identified 92 patients at our institution between 2015 and 2019 with p16+ oropharyngeal cancer who were treated with adjuvant volumetric modulated arc therapy. We included patients treated to postoperative doses and standard volumes (including bilateral neck). Doses delivered to organs at risk were compared with recommended dose constraints from a recent cooperative group head and neck cancer trial of radiation therapy to 60 Gy. We applied validated and published NTCP models for dysphagia, dysgeusia, esophagitis, oral mucositis, and xerostomia relevant to oropharyngeal cancer. ResultsAchievable and delivered mean doses to most normal head and neck tissues were well below national recommended constraints. This translates to notable absolute NTCP reductions for salivary flow (10% improvement in contralateral parotid, 35% improvement in submandibular gland), grade ≥ 2 esophagitis (23% improvement), grade ≥ 3 mucositis (17% improvement), dysgeusia (10% improvement), and dysphagia (8% improvement). Locoregional control at a median follow-up of 26.3 months was 96.7%, with only 3 patients experiencing locoregional recurrence (1 local, 2 regional). ConclusionsModern radiation therapy planning techniques allow for improved normal tissue sparing compared with currently established dose constraints without compromising disease control. These improvements may lead to reduced toxicity in a patient population expected to have favorable long-term outcomes. Stricter constraints can be easily achieved and should be used in conjunction with other evolving efforts to mitigate toxicity.