Extralaryngeal Spread in Total Laryngectomy: Comparing the Need for Thyroidectomy.

Objective: At our institution, thyroid preservation during total laryngectomy (TL) varies by surgeon, offering a distinctive dataset to compare disease outcomes in TL patients with or without thyroidectomy. Methods: This retrospective chart review study, conducted at a tertiary referral medical center, comprises patients who underwent TL for laryngeal or hypopharyngeal squamous cell carcinoma from 2014 to 2022. The study includes data on patient demographics, surgeries, pathological staging, tumor subsites, thyroid involvement, and adjuvant therapy. Results: In this study, 147 patients, mostly male (83%) and white (82%), were included. Surgeries comprised 60 hemi thyroidectomies, 35 total or completion thyroidectomies, 48 without thyroid removal, and 4 isthmusectomies. Data analysis compared these 4 groups and the cohort of no thyroid removal (NT) versus any thyroidectomy (T = 99). Among the 99 patients, 27 showed positive gland involvement, primarily due to direct disease extension (26 cases). No significant difference was found in recurrence rates or recurrence-related mortality among the 4 groups or between NT and T (P = .156). However, there was a significant difference in T staging and prognostic staging among the groups and between NT versus T (P = .043). The NT cohort showed a higher likelihood of being T3, while T was more likely to be T4. Conclusion: We found no significant difference in recurrence rates or mortality between TL patients with or without thyroid removal. However, those without thyroid removal often had lower T stages. Notably, 27% of thyroidectomy patients had gland invasion, highlighting the importance of thyroid removal in TL.

Reirradiation in head and neck squamous cell carcinoma; prognostic indicators, oncologic and functional outcomes.

OBJECTIVES: Patients with recurrent squamous cell carcinoma of the head and neck (HNSCC) have a poor prognosis and limited therapeutic alternatives. While reirradiation is feasible, it is usually associated with high treatment toxicity and is not yet considered the standard of care. Based on current NCCN guidelines, in the context of very advanced head and neck cancer (recurrent and/or persistent disease), surgical intervention is explored initially with/without adjuvants while unresectable disease is approached with radiation and/or systemic therapies. Specific and reliable prognostic indicators for both -oncologic and functional outcomes- have yet to be defined for this population. METHODS: Retrospective chart review of 54 patients treated with reirradiation at a tertiary academic institution between January of 1998 and January of 2024. Only patients with non-metastatic recurrent, and second primary HNSCC were included in the series. Demographics, staging, radiation dose and technique, additional therapy, histopathologic variables, EORTC toxicity, pre- and post-treatment PEG/tracheotomy dependency and oncologic outcomes were retrieved. RESULTS: The study cohort consisted of 54 patients (37 males, 17 females) with HNSCC, averaging 62.7 years in age. Initial tumors were locally advanced in over 42 % of cases, with 58 % being node-negative. The head and cutaneous regions (24.5 %) and tongue (20.8 %) were the most common tumor sites. Primary surgical resection and adjuvant radiation were performed in 47.2 % of cases, and concurrent chemotherapy was used in 40.7 %. Reirradiation was mainly for local or regional recurrence (88.9 %), often following salvage surgery (68.5 %), with a mean dose of 5623 Gy over 52.5 fractions. Positive surgical margins were present in 29.4 % of cases, and extracapsular spread in 59.5 %. No significant differences were found between the salvage surgery and definitive reirradiation groups except for tumor site (P = 0.022). Median follow-up was 52.6 months, with 27 deaths reported. Lymphovascular invasion was significantly correlated with overall survival (P = 0.017), while initial tumor T-stage and neck disease involvement were linked to local-regional control (P = 0.030 and P = 0.033, respectively). Reirradiation increased tracheotomy and PEG-tube dependency by 20 % (P = 0.011) and 23 % (P = 0.003), respectively. CONCLUSIONS: Reirradiation is a feasible therapeutic alternative in recurrent head and neck SCC. Oncologic outcomes observed in this series compare favorably to most published reports. Complete response and perineural invasion were independent prognostic factors for survival and locoregional control. While no mortality directly associated with treatment was observed in this series, reirradiation had a significant impact in functional outcomes in terms of increased risk of tracheotomy and peg tube dependency. Further studies are required to define the role of this treatment in head and neck cancer.

The Microvascular Anastomotic Coupler for Venous Anastomosis in Head and Neck Reconstruction: An Institutional Experience.

Background This study aimed to identify outcome predictors with the GEM microvascular coupler system (GEM Coupler) in a series of patients undergoing free flap reconstruction for head and neck defects. Methodology In this retrospective chart review of 218 consecutive microvascular procedures performed on 204 patients at an academic tertiary care center, demographics, comorbidities, surgical data, and outcomes were retrieved. The endpoints for the analysis were microvascular revision surgery and flap survival. Results The study included 142 (70.2%) males and 62 (29.8%) females, with a mean age of 56 years, primarily treated for malignancy (76%). The anterolateral thigh and fibula were the most commonly used flaps (40.4% and 27.1%, respectively). In 21 (9.6%) cases, a double venous anastomosis was performed. There were nine flap failures requiring microvascular revision surgery; the flap was salvaged in four of these cases yielding an overall success rate of 97.7%. Factors associated with total flap loss included a history of a thrombotic or embolic event (p = 0.017), deep circumflex iliac artery flap (p < 0.001), and absence of monitoring skin paddle (p < 0.001). Conclusions Prothrombotic conditions, buried flaps, and flap type are outcome predictors in patients undergoing microvascular reconstruction with GEM Coupler.

Head and neck cancer surveillance: The value of computed tomography and clinical exam.

PURPOSE: The recurrence of head and neck cancer (HNC) is most prevalent during the initial two years following curative treatment, underscoring the criticality of regular surveillance for HNC survivors. This study aims to evaluate the effectiveness of computed tomography (CT) imaging and clinical physical examination (CE) in HNC surveillance, assessing whether these imaging protocols meet the current treatment limitations confronting HNC specialists. METHODS: Retrospective chart review of a 9-year experience with head and neck cancer patients at a single, academic tertiary care center. Demographic data was collected along with data regarding whether the recurrences were detected primarily through CE, flexible endoscopic exam (scope exam), or CT or CT/PET scan. Subsets of the data were analyzed and compared by sensitivity, specificity, and negative predictive values. RESULTS: 264 HNC patients were identified. 72 total recurrences (27 %) were noted. The method of initial detection spurring further investigation was imaging in 42 (58.3 %) patients, CE (33.3 %) in 24 patients, scope exam in 6 (8.4 %) patients. Overall, 65 (90.3 %) patients had imaging that showed recurrence regardless of method of initial detection. Sensitivity, (87.1 % vs 70.5 %), and specificity (93.95 % vs 96.9 %) were noted for CT and CE respectively. Combined sensitivity and specificity for CT and CE was 96.2 % and 91.05 % respectively. CONCLUSION: The data suggests that imaging could provide sufficient methods of HNC surveillance despite limitations the COVID-19 pandemic presents.

Oncological outcomes of partial thickness calvarial resection for locally advanced scalp malignancies.

OBJECTIVE: Traditionally, locally advanced scalp malignancies have been managed through composite, full-thickness calvarial resection. The aim of this study is to explore the oncologic outcomes of partial calvarial resection for locally invasive scalp malignancies without medullary space invasion, employing a burr-down approach. STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center. METHODS: This study analyzed records of 26 adult patients diagnosed with scalp cancer that spread to the calvarial region. Data collected included demographics, medical history, adjuvant therapy details, imaging, surgical outcomes, and postoperative oncological results. RESULTS: 26 patients with cancerous scalp lesions necessitating calvarial resection for deep margin control were identified in 22 men and 4 women. Mean age at diagnosis was 72.7 years. The most common histopathological diagnosis was Squamous cell carcinoma (n = 16). Partial removal of the calvarial lesions was achieved in all patients without any intraoperative complications. Twelve patients received adjuvant therapy consisting of the following modalities: radiation (6), chemotherapy (1), immunotherapy (1), a combination of immunotherapy and radiation (2), and a combination of chemotherapy and radiotherapy (2). There was a total of 7 recurrences: local (n = 3,11.5 %), regional (n = 3,11.5 %), distal (n = 1,3.8 %). Long term local control was achieved in (n = 23,88.4 %) of patients. The mean time of follow-up was 19.1 months, and the mean time to recurrence was 15.1 months. CONCLUSION: Partial calvarial resection represents a viable, safe, and effective surgical technique for cancerous tissue removal, reducing risks associated with full thickness calvarial resection, and enhancing soft tissue healing when compared to the established gold standard.

Coronary heart disease and tuberculosis: an unnoticed syndemia. Review of literature and management proposal.

Tuberculosis is an increasing disease that affects about one-third of the global population. In line with the rise of tuberculosis, cardiovascular disease has shown a similar trend, with ischemic coronary heart disease becoming the leading cause of death worldwide. Based on the literature, a relationship can be drawn between tuberculosis and ischemic coronary heart disease through their shared multiple risk factors and a possible pathophysiological substrate linking them. The presentation of these two conditions reported so far is varied: it has been found as the onset of acute coronary syndrome in patients with active tuberculosis, the progressive development of coronary atherosclerosis in patients with latent tuberculosis, among others. Given this possible link and the progressive increase in their incidence rates, we can assert that we are facing an unnoticed syndemic, with their concurrent management posing a challenge due to significant pharmacological interactions. The purpose of this review is to clarify this possible link, propose an approach for diagnosis, and provide a treatment algorithm for the entire spectrum of coronary disease coexisting with tuberculosis according to the current available literature.

La tuberculosis es una enfermedad que viene en aumento y que afecta cerca de un tercio de la población mundial. En consonancia con el aumento de la tuberculosis, la enfermedad cardiovascular ha tenido un comportamiento similar, de este grupo, la cardiopatía coronaria isquémica se ha convertido en la principal causa de muerte en todo el mundo. Se podría extraer, en base a la literatura, una relación entre la tuberculosis y la cardiopatía coronaria isquémica a través de que comparten múltiples factores de riesgo en común y desde un posible sustrato fisiopatológico que las vincula. La forma conjunta de presentación de estas dos entidades reportada hasta el momento es variada: se ha encontrado como debut de un síndrome coronario agudo en pacientes con tuberculosis activa, el desarrollo progresivo de aterosclerosis coronaria en pacientes con tuberculosis latente, entre otras. Dado este posible vínculo y el aumento progresivo de sus tasas de incidencia podemos afirmar que estamos ante una sindemia inadvertida, siendo su manejo conjunto un desafío por las grandes interacciones farmacológicas. El propósito de esta revisión es esclarecer este posible vínculo, plantear un enfoque para el diagnóstico, así como suministrar un algoritmo de tratamiento de todo el espectro de la enfermedad coronaria que coexiste con la tuberculosis de acuerdo con la literatura actual disponible.

Functional Status Predicts Delay to Radiation in Free Tissue Transfer for Head and Neck Cancer.

OBJECTIVE: Evaluate the effect of functional status and patient factors on delays in treatment with adjuvant therapy. METHODS: Retrospective chart review (2020-2022) was conducted at a single tertiary referral center. Data were collected between January 2020 and October 2022, and 63 patients underwent free flap reconstructive surgery of the head and neck due to the presence of cancer and received adjuvant radiation therapy (RT). The main outcomes measured were Area Deprivation Index (ADI), Beale scores, distance to radiation center, functional status, patient demographics, gender, and length from surgery to initiation of RT. RESULTS: Of the 63 patients who were reviewed, the average age was 65.5 years old and 63.8% were male. The average ADI state score was 5.6 and the national percentile of 77.1. The average Beale score was 3.7. The average distance traveled was 101.1 miles. Thirty-five patients were living independently, 16 were living in assisted living or received home care, and 15 were dependent or lived in a nursing home. Mann-Whitney U analysis revealed a significant association of increasing levels of dependence to delays in treatment compared to on-time treatment (p = 0.002). The odds of treatment delay were increased almost 10-fold for every additional increase in dependency level (OR = 9.87, 95% CI = 1.42-68.83). CONCLUSIONS AND RELEVANCE: Degree of dependent functional status correlates with delays in postoperative adjuvant RT in patients undergoing free tissue transfer for head and neck cancer. Preoperative risk stratification allows for physicians to address barriers to adjuvant therapy prior to delay. LEVEL OF EVIDENCE: Level 3 Laryngoscope, 2024.

Functional Outcomes After the Sacrifice of Mandibular Condyle Using Fibula Free Flap for Immediate Surgical Reconstruction.

Introduction Head and neck cancer with mandibular invasion often necessitates composite resection, leading to defects requiring reconstruction. Microvascular fibula free flap (FFF) surgery is a common approach for this purpose. In this study, we focus on our experience with condyle sacrifice, emphasizing treatment outcomes and functional results. Additionally, we highlight a contemporary perspective by discussing surgical techniques and radiographic outcomes based on a 3D analysis of neo-condyle placement on CT imaging. Methods We studied 23 patients who had undergone segmental mandibulectomy requiring FFF reconstruction between 2009 and 2020. These were all performed by the same surgeon (M.M.) at an academic tertiary care center. Twenty-three reconstructions included condyle sacrifice. Retrospective chart review was performed with a focus on treatment, functional outcomes, and surgical technique. Results A total of 23 patients were included in the study group (13 females and 10 males) with a mean age of 58.1 years. The most common surgical indication was for oncologic purposes (n=9; 39.1%). Twenty (87%) patients required tracheostomy, and all were decannulated. In terms of surgical complications, two (8.7%) patients had a degree of arterial insufficiency and two (8.7%) developed delayed infections. The average inpatient stay was 5.61 days, with a subsequent average clinic follow-up after 16.9 days. CT or MRI imaging was available for 21 (91.3%) patients, showing 14 (66.7%) neo-condyles within the glenoid fossa. Fifteen (71.4%) patients had some element of anterior displacement (average=6.27 mm), and seven (33.3%) patients had a component of lateral displacement (average=2.23 mm). Three (13%) patients died during the follow-up period. Eighteen (90%) of the surviving patients returned to an oral diet within an average of 24.9 days. All patients returned to normal interincisal distance by 12 months. All FFFs, with and without complications, remained viable. Conclusion We achieved favorable oral function outcomes in the majority of our patients. Intriguingly, although radiographic evidence revealed anterior and/or lateral displacement of the neo-condyle, there was no observed correlation with the resumption of oral diet, trismus, or crossbite among these patients.

Elective Neck Dissection in Patients Undergoing Salvage Laryngectomy: Outcomes, Complications, and Considerations.

Objective In this study, we sought to identify the predictors for occult nodal disease (OND) and compare oncologic outcomes in patients undergoing elective neck dissection (END) at the time of salvage laryngectomy (SLE) versus the observation group. Methods A retrospective chart review was conducted involving all patients with clinically node-negative (cN0) necks who underwent SLE at a tertiary academic center over 12 years. A total of 58 patients met the inclusion criteria and were divided into two groups: END (n=39) and observation (n=19). Primary endpoints were OND, regional recurrence-free survival (RRFS), and disease-specific survival (DSS). Univariate analysis was performed to establish the association between variables with Fisher's exact test and Mann-Whitney U test. Survival analysis was performed with the log-rank test. Results The cohort comprised 46 (79.3%) males and 12 (20.7%) females, with a mean age of 60 years. Pathological nodal disease was identified in five of 71 (7%) examined neck dissection specimens, with positive nodes found in levels II through IV. The only statistically significant predictor of OND was the rT3/rT4 stage (p=0.017). There were no differences in perioperative complications, RRFS (p=0.216), or DSS (p=0.298) between the END and observation groups. Conclusions In cN0 necks, the advanced recurrent T-stage (rT3-rT4) is a predictor for OND. As OND was found involving levels II, III, and IV in this study's specimens, formal lateral neck dissection should be the procedure of choice if END is to be performed alongside SLE. While END did not show a significantly higher morbidity profile versus conservative management in this cohort, the procedure did not improve loco-regional control or survival, even when stratifying by tumor stage.

Resistencia a la Fractura de Premolares Según el Diseño de Cavidad de Acceso Endodóntico. Estudio in vitro

La preparación de la cavidad de acceso es el primer paso y un requisito esencial, para la instrumentación y obturación de los conductos radiculares durante el tratamiento endodóntico. El objetivo del presente estudio fue comparar la resistencia a la fractura in vitro de premolares con cavidad de acceso tradicional (CAT), cavidad de acceso conservador (CAC) y cavidad de acceso ultraconservador (CAU). Esta fue una investigación transversal, prospectiva y experimental pura. Se realizó con 40 segundos premolares superiores, divididos en 4 grupos. Todas las muestras fueron desinfectadas y almacenadas en recipientes con suero fisiológico al 0,9 %. Al primer grupo se designó como el control, al segundo grupo CAT, al tercer grupo CAC y al cuarto grupo CAU. Se realizaron todos los accesos endodónticos con una pieza de mano de alta velocidad con refrigeración respetando el protocolo de cada uno de los diseños, posterior a ello se realizó el tratamiento endodóntico y restauración de los especímenes. Una vez preparadas todas las muestras, estas fueron sometidas a una prueba de fatiga en una máquina de ensayo universal y los resultados se registraron en Newtons. La prueba estadística usada fue ANOVA con un nivel de significancia de 5 %. Las CAT obtuvieron el menor valor de resistencia a la fractura en comparación con el grupo control. Sin embargo, no se observaron diferencias estadísticamente significativas entre los grupos CAT, CAC Y CAU. Entre los grupos CAC y CAU, no se encontraron diferencias estadísticamente significativas en comparación con el grupo control.

The preparation of the access cavity is the first step and an essential requirement for the instrumentation and obturation of the root canals during endodontic treatment. The objective of the present study was to compare the in vitro fracture resistance of premolars with traditional access cavity (CAT), conservative access cavity (CAC) and ultraconservative access cavity (CAU). This was a cross-sectional, prospective and pure experimental research. It was carried out with 40 upper second premolars, divided into 4 groups. All samples were disinfected and stored in containers with 0.9 % physiological saline. The first group was designated as the control, the second group CAT, the third group CAC and the fourth group CAU. All endodontic accesses were carried out with a high-speed handpiece with refrigeration, respecting the protocol of each of the designs, after which the endodontic treatment and restoration of the specimens was carried out. Once all the samples were prepared, they were subjected to a fatigue test in a universal testing machine and the results were recorded in Newtons. The statistical test used was ANOVA with a significance level of 5 %. The CAT obtained the lowest fracture resistance value, presenting statistically significant differences with the control group. However, no statistically significant differences were observed between the CAT, CAC, and CAU groups. Furthermore, between the CAC and CAU groups, no statistically significant differences were found compared to the control group.

Utility of video fluoroscopic swallow study in advancing oral diet post TORS for oropharyngeal malignancies.

OBJECTIVE: TORS is a minimally invasive surgical alternative to chemoradiotherapy for oropharyngeal malignancies. While early postoperative oropharyngeal dysphagia is linked to TORS, this study explores both subjective and objective swallowing outcomes. STUDY DESIGN: Retrospective and prospective review of the patients who underwent TORS for oropharyngeal malignancy from 2018 to 2023. SETTING: Single tertiary referral center. METHODS: Postoperative transnasal feeding tubes were administered to 142 patients undergoing TORS. Data on oncological, clinical, surgical, and pathological parameters, including VFSS records, pain with swallow, and feeding tube removal timing, were collected. Clinical swallow exam (CSE) was conducted on POD-1, with a formal swallow study pursued if inconclusive. Once a safe swallow was confirmed, oral diets were initiated, and the feeding tube removed, with most patients discharged on POD-2. RESULTS: At an average age of 59.3 years on the day of operation, the palatine tonsil (N = 101) was the predominant subsite. A dobhoff feeding tube was intraoperatively placed in 98 % of patients (N = 139). On POD-1, CSE was conducted in 119 patients, with 26 % (37/119) cleared for total oral diet (NOMS ≥ 4). Additionally, 30 out of 73 VFSS patients were cleared for total oral diet. A total of 54.9 % (78/142) had the feeding tube removed before discharge on POD-2, with a mean time of 6.5 ± 6.6 days. Overall, 71.1 % (101/142) achieved a total oral diet within one week after TORS. CONCLUSION: Early post-TORS swallowing is vital for oropharyngeal malignancies. VFSS assesses post-operative swallowing safety, allowing most patients to resume total oral nutrition shortly after TORS.

Oncologic Outcomes of Salvage Surgery in Recurrent Oral Tongue Squamous Cell Carcinoma.

OBJECTIVE: This study aimed to determine the oncologic outcomes and identify prognostic factors in patients undergoing salvage glossectomy for recurrent oral tongue squamous cell carcinoma (OTSCC). METHODS: A retrospective chart review was conducted encompassing all patients who underwent salvage oral glossectomy out of 259 individuals undergoing oral glossectomy at a tertiary academic center. Inclusion criteria comprised patients who met the following conditions: 1) biopsy-proven oral tongue recurrence, 2) salvage glossectomy performed with curative intent, 3) availability of imaging records, and 4) comprehensive documentation. Cases involving base of tongue tumors and second primaries were excluded from the analysis. Categorical data were expressed as proportions, and continuous data as medians/quartiles. Univariate analysis used Fisher's exact test for categorical variables and Student's t-test for continuous ones. Survival analysis employed Kaplan-Meier estimates and the log-rank test. RESULTS: High-risk histopathological risk factors were significantly more common with recurrence compared to initial presentation. The mean locoregional disease-free interval was 35 months. Kaplan-Meier estimates for one- and three-year disease-free survival (DFS) were 62.7% and 33.4%, while disease-specific survival (DSS) rates were 73% and 38.9%, respectively. Recurrent T-stage was a predictor for DFS, while margin status was a strong predictor for both LR control (p = 0.024) and DSS (p = 0.030), as was perineural invasion (p = 0.001 and p = 0.030). Alcohol use was associated with worse overall survival (p = 0.024). In contrast to other reports, nodal status was not a predictor in this series. CONCLUSIONS: Upon recurrence, histopathological analysis unveils detrimental changes in tumor biology, which significantly influence disease control. Notably, consistent with findings from other studies, factors, such as recurrent T-stage, presence of perineural invasion, and, most importantly, margin status, play pivotal roles in determining oncologic outcomes. Consequently, the imperative for aggressive salvage surgery becomes evident in achieving sufficient disease control. This underscores the necessity for proactive management strategies aimed at addressing these factors to enhance patient outcomes.

Reconstruction for Salvage Laryngectomy With Limited Pharyngectomy.

Importance: Closure technique for optimization of postoperative and functional outcomes following salvage laryngectomy remains an area of debate among head and neck surgeons. Objective: To investigate the association of salvage laryngectomy closure technique with early postoperative and functional outcomes. Design, Setting, and Participants: This retrospective cohort study included patients from 17 academic, tertiary care centers who underwent total laryngectomy with no or limited pharyngectomy after completing a course of definitive radiotherapy or chemoradiotherapy with curative intent between January 2011 and December 2016. Patients with defects not amenable to primary closure were excluded. Data were analyzed from February 14, 2021, to January 29, 2024. Exposures: Total laryngectomy with and without limited pharyngectomy, reconstructed by primary mucosal closure (PC), regional closure (RC), or free tissue transfer (FTT). Main Outcomes and Measures: Patients were stratified on the basis of the pharyngeal closure technique. Perioperative and long-term functional outcomes were evaluated with bivariate analyses. A multivariable regression model adjusted for historical risk factors for pharyngocutaneous fistula (PCF) was used to assess risk associated with closure technique. Relative risks (RRs) with 95% CIs were determined. Results: The study included 309 patients (256 [82.8%] male; mean age, 64.7 [range, 58.0-72.0] years). Defects were reconstructed as follows: FTT (161 patients [52.1%]), RC (64 [20.7%]), and PC (84 [27.2%]). A PCF was noted in 36 of 161 patients in the FTT group (22.4%), 25 of 64 in the RC group (39.1%), and 29 of 84 in the PC group (34.5%). On multivariable analysis, patients undergoing PC or RC had a higher risk of PCF compared with those undergoing FTT (PC: RR, 2.2 [95% CI, 1.1-4.4]; RC: RR, 2.5 [95% CI, 1.3-4.8]). Undergoing FTT was associated with a clinically meaningful reduction in risk of PCF (RR, 0.6; 95% CI, 0.4-0.9; number needed to treat, 7). Subgroup analysis comparing inset techniques for the RC group showed a higher risk of PCF associated with PC (RR, 1.8; 95% CI, 1.1-3.0) and predominately pectoralis myofascial flap with onlay technique (RR, 1.9; 95% CI, 1.2-3.2), but there was no association of pectoralis myocutaneous flap with cutaneous paddle interposition with PCF (RR, 1.2; 95% CI, 0.5-2.8) compared with FTT with cutaneous inset. There were no clinically significant differences in functional outcomes between the groups. Conclusion and Relevance: In this study of patients with limited pharyngeal defects, interpositional fasciocutaneous closure technique was associated with reduced risk of PCF in the salvage setting, which is most commonly achieved by FTT in academic practices. Closure technique was not associated with functional outcomes at 1 and 2 years postoperatively.

Wearable Biosensor Technology in Education: A Systematic Review.

Wearable Biosensor Technology (WBT) has emerged as a transformative tool in the educational system over the past decade. This systematic review encompasses a comprehensive analysis of WBT utilization in educational settings over a 10-year span (2012-2022), highlighting the evolution of this field to address challenges in education by integrating technology to solve specific educational challenges, such as enhancing student engagement, monitoring stress and cognitive load, improving learning experiences, and providing real-time feedback for both students and educators. By exploring these aspects, this review sheds light on the potential implications of WBT on the future of learning. A rigorous and systematic search of major academic databases, including Google Scholar and Scopus, was conducted in accordance with the PRISMA guidelines. Relevant studies were selected based on predefined inclusion and exclusion criteria. The articles selected were assessed for methodological quality and bias using established tools. The process of data extraction and synthesis followed a structured framework. Key findings include the shift from theoretical exploration to practical implementation, with EEG being the predominant measurement, aiming to explore mental states, physiological constructs, and teaching effectiveness. Wearable biosensors are significantly impacting the educational field, serving as an important resource for educators and a tool for students. Their application has the potential to transform and optimize academic practices through sensors that capture biometric data, enabling the implementation of metrics and models to understand the development and performance of students and professors in an academic environment, as well as to gain insights into the learning process.

Resección laparoscópica de quiste de duplicación gástrica asistida por endoscopia / Laparoscopic resection of gastric duplication cyst assisted by endoscopy

Introducción. Las duplicaciones gástricas son entidades congénitas poco frecuentes que se diagnostican principalmente en las etapas tempranas de la vida, y rara vez en pacientes adultos. El objetivo de este artículo fue presentar el caso de un adulto con esta patología, tratado exitosamente mediante cirugía. Caso clínico. Mujer de 26 años de edad con epigastralgia crónica refractaria a manejo médico, a quien durante endoscopia digestiva superior se le identificó una lesión quística sugestiva de tumor estromal gastrointestinal, confirmada por ultrasonido endoscópico. Resultados. Se realizó una resección quirúrgica laparoscópica asistida por endoscopia, con buena evolución postoperatoria. El estudio anatomo-patológico informó la presencia de un quiste de duplicación gástrica. Conclusiones. A pesar de las ayudas diagnósticas disponibles en la actualidad, esta patología representa un reto diagnóstico importante que, en muchas ocasiones solo puede ser confirmado mediante el estudio anatomo-patológico. En paciente asintomático, continúa la controversia entre observarlo o llevarlo a cirugía, por el riesgo de malignidad. Actualmente, el manejo de las duplicaciones gástricas en adultos se considera eminentemente quirúrgico. Las resecciones laparoscópicas y el uso de endoscopia intraoperatoria permiten garantizar la resección completa de la lesión, preservando la mayor cantidad de tejido sano adyacente y previniendo estenosis o deformidades gástricas que afecten su adecuado funcionamiento.

Introduction. Gastric duplications are rare congenital entities that are diagnosed primarily in early life, and rarely in adult patients. The objective of this article was to present the case of an adult with this pathology, successfully treated by surgery. Clinical case. A 26-year-old woman with chronic epigastralgia refractory to medical management, who during upper digestive endoscopy was identified with a cystic lesion suggestive of gastro-intestinal stromal tumor, confirmed by endoscopic ultrasound. Results. A laparoscopic surgical resection assisted by endoscopy was performed, with good postoperative evolution. The anatomopathological study reported the presence of a gastric duplication cyst. Conclusions. Despite the diagnostic adjuncts currently available, this pathology represents an important diagnostic challenge that, in many cases, can only be confirmed through pathology. In asymptomatic patients, the controversy continues between observing them or taking them to surgery due to the risk of malignancy. Currently, the management of gastric duplications in adults is considered eminently surgical. Laparoscopic resections and the use of intraoperative endoscopy ensure complete resection of the lesion, preserving the greatest amount of adjacent healthy tissue and preventing gastric stenosis or deformities that affect its proper functioning.

Implementation of a Real-Time Brain-to-Brain Synchrony Estimation Algorithm for Neuroeducation Applications.

This study centers on creating a real-time algorithm to estimate brain-to-brain synchronization during social interactions, specifically in collaborative and competitive scenarios. This type of algorithm can provide useful information in the educational context, for instance, during teacher-student or student-student interactions. Positioned within the context of neuroeducation and hyperscanning, this research addresses the need for biomarkers as metrics for feedback, a missing element in current teaching methods. Implementing the bispectrum technique with multiprocessing functions in Python, the algorithm effectively processes electroencephalography signals and estimates brain-to-brain synchronization between pairs of subjects during (competitive and collaborative) activities that imply specific cognitive processes. Noteworthy differences, such as higher bispectrum values in collaborative tasks compared to competitive ones, emerge with reliability, showing a total of 33.75% of significant results validated through a statistical test. While acknowledging progress, this study identifies areas of opportunity, including embedded operations, wider testing, and improved result visualization. Beyond academia, the algorithm's utility extends to classrooms, industries, and any setting involving human interactions. Moreover, the presented algorithm is shared openly, to facilitate implementations by other researchers, and is easily adjustable to other electroencephalography devices. This research not only bridges a technological gap but also contributes insights into the importance of interactions in educational contexts.

Real-time EEG-based emotion recognition for neurohumanities: perspectives from principal component analysis and tree-based algorithms.

Within the field of Humanities, there is a recognized need for educational innovation, as there are currently no reported tools available that enable individuals to interact with their environment to create an enhanced learning experience in the humanities (e.g., immersive spaces). This project proposes a solution to address this gap by integrating technology and promoting the development of teaching methodologies in the humanities, specifically by incorporating emotional monitoring during the learning process of humanistic context inside an immersive space. In order to achieve this goal, a real-time emotion recognition EEG-based system was developed to interpret and classify specific emotions. These emotions aligned with the early proposal by Descartes (Passions), including admiration, love, hate, desire, joy, and sadness. This system aims to integrate emotional data into the Neurohumanities Lab interactive platform, creating a comprehensive and immersive learning environment. This work developed a ML, real-time emotion recognition model that provided Valence, Arousal, and Dominance (VAD) estimations every 5 seconds. Using PCA, PSD, RF, and Extra-Trees, the best 8 channels and their respective best band powers were extracted; furthermore, multiple models were evaluated using shift-based data division and cross-validations. After assessing their performance, Extra-Trees achieved a general accuracy of 94%, higher than the reported in the literature (88% accuracy). The proposed model provided real-time predictions of VAD variables and was adapted to classify Descartes' six main passions. However, with the VAD values obtained, more than 15 emotions can be classified (reported in the VAD emotion mapping) and extend the range of this application.

Diarrheagenic Escherichia coli with Multidrug Resistance in Cattle from Mexico.

Mexico is an important producer/exporter of cattle and cattle products. In the last decade, an increase in antibiotic resistance in E. coli pathotype strains from livestock environments has been reported. This study aimed to determine the prevalence and antibiotic resistance profiles of E. coli pathotype strains from the feces of beef or dairy cattle reared in the states of Aguascalientes (AG, central) and Nuevo Leon (NL, northeastern) in Mexico. One hundred and ten fecal samples were collected (beef cattle-AG = 30; dairy cattle-AG = 20; beef cattle-NL = 30; dairy cattle-NL = 30). From these, E. coli was isolated using selective/differential media and confirmed on chromogenic media. Multiplex PCR was used to identify diarrheagenic E. coli, and the Kirby-Bauer technique was used to determine the antimicrobial susceptibilities. All the animals harbored E. coli, and pathotypes were found in 34 animals from both, beef and dairy cattle, mainly from Aguascalientes. Of the positive samples, 31 harbored a single E. coli pathotype, whereas three samples harbored two different pathotypes; EHEC was the most prevalent, followed by EPEC, ETEC, and EIEC or the combination of two of them in some samples. Most pathotype strains (19/37) were isolated from beef cattle. Neither the animals' productive purpose (beef or dairy cattle) (r = 0.155) nor the geographic regions (Aguascalientes or Nuevo Leon) (r = -0.066) had a strong positive correlation with the number of E. coli pathotype strains. However, animals reared in Aguascalientes had up to 8.5-fold higher risk of harboring E. coli pathotype strains than those reared in Nuevo Leon. All pathotype strains were resistant to erythromycin, tetracycline, and trimethoprim/sulfamethoxazole, and all dairy cattle pathotype strains were further resistant to five ß-lactams (χ2, P = 0.017). The existence of these pathotypes and multidrug-resistant pathogens in the food chain is a risk to public health.

Chromosome-level assembly of the gray fox (Urocyon cinereoargenteus) confirms the basal loss of PRDM9 in Canidae.

Reference genome assemblies have been created from multiple lineages within the Canidae family; however, despite its phylogenetic relevance as a basal genus within the clade, there is currently no reference genome for the gray fox (Urocyon cinereoargenteus). Here, we present a chromosome-level assembly for the gray fox (U. cinereoargenteus), which represents the most contiguous, non-domestic canid reference genome available to date, with 90% of the genome contained in just 34 scaffolds and a contig N50 and scaffold N50 of 59.4 and 72.9 Megabases, respectively. Repeat analyses identified an increased number of simple repeats relative to other canids. Based on mitochondrial DNA, our Vermont sample clusters with other gray fox samples from the northeastern United States and contains slightly lower levels of heterozygosity than gray foxes on the west coast of California. This new assembly lays the groundwork for future studies to describe past and present population dynamics, including the delineation of evolutionarily significant units of management relevance. Importantly, the phylogenetic position of Urocyon allows us to verify the loss of PRDM9 functionality in the basal canid lineage, confirming that pseudogenization occurred at least 10 million years ago.

Virtual surgical planning for mandibular reconstruction in an abbreviated admission pathway.

OBJECTIVES: Virtual Surgical Planning (VSP) creates individualized surgical plans for free flap reconstruction of mandibular defects. Prior studies indicate that VSP can offer cost benefits due to reduced operative time and length of stay (LOS). We assessed the impact of VSP in the context of a validated postoperative abbreviated LOS clinical pathway. METHODS: This study assessed patients undergoing VSP vs conventional fibular free flap reconstruction for mandibular defects (12/2015-10/2020) and their operative time, ischemia time, and LOS were evaluated. RESULTS: Forty-four patients underwent VSP reconstruction, while 52 patients underwent conventional reconstruction for mandibular defects. VSP was associated with significantly lower total operative time (6 h and 57 mins vs 7 h and 54 mins, p = 0.011), but not length of stay or ischemia time. Total OR time was significantly increased with increasing number of segments needed in both the VSP group (p = 0.002) and the conventional group (p = 0.015). CONCLUSION: Shorter operative times and LOS have been attributed to the use of VSP in free tissue transfers. It is argued that these reductions offset the added cost of VSP. Our study indicates that there is no cost benefit for VSP utilization due to a significantly reduced operative time with no impact on length of admission in an abbreviated admission clinical pathway following free tissue transfer.