Modified Killian Method for Flexible Nasopharyngoscopic Observation of the Hypopharynx: A Systematic Review and Meta-Analysis.

OBJECTIVE: Flexible nasopharyngoscopy is a common procedure for evaluating the hypopharynx. The modified Killian method has been reported to enhance visualization during this examination. The aim of this study was to compare the visibility of the hypopharynx using conventional and modified Killian methods. METHODS: A systematic literature search was conducted in PubMed, EMBASE, and the Cochrane Library to identify studies that compared the visibility of the hypopharynx using the 2 methods. Comprehensive meta-analysis software was used to analyze the data. Studies that evaluated the overall hypopharyngeal visibility score and the visibility of the pyriform sinus, postcricoid region, and upper esophageal sphincter were included. RESULTS: Five studies were included in the analysis. The pooled results showed that the modified Killian method significantly improved overall visibility score (SMD=1.09; 95% CI, 0.39-1.80) and complete visibility of the pyriform sinus, postcricoid region, and upper esophageal sphincter (log OR=3.83; 95% CI, 2.30-5.35; log OR=4.20; 95% CI, 3.21-5.19; log OR=3.38; 95% CI, 1.68-5.08). CONCLUSION: The modified Killian method is a valuable technique for improving hypopharyngeal visibility during flexible nasopharyngoscopy. This technique can enhance the detection of potential abnormalities or lesions, leading to better diagnostic accuracy and improved patient outcomes.

Sublabial excision versus transnasal endoscopic marsupialization for nasolabial cysts: A systematic review and meta-analysis.

OBJECTIVES: To compare the intraoperative and postoperative outcomes of sublabial excision and transnasal endoscopic marsupialization, the two primary surgical approaches for nasolabial cysts. DESIGN AND SETTING: A comprehensive meta-analysis of studies identified from PubMed, Embase, and the Cochrane Library. PARTICIPANTS: Patients diagnosed with nasolabial cysts who underwent surgical treatment. MAIN OUTCOME MEASURES: Operative time, postoperative pain, overall postoperative complications, admission rate, length of hospital stay, use of general anaesthesia, medical costs, and recurrence rate. RESULTS: The pooled analysis revealed that the transnasal endoscopic marsupialization group had shorter operative time (mean differences [MD], -32.51; 95% confidence interval [CI], -38.52 to -26.51), reduced postoperative pain (MD, -4.25; 95% CI, -7.62 to -0.89), fewer overall postoperative complications (risk difference [RD], -0.68; 95% CI, -0.90 to -0.46), lower admission rates (RD, -0.86; 95% CI, -1.11 to -0.61), shorter hospital stays (MD, -1.74; 95% CI, -2.58 to -0.89), decreased use of general anaesthesia (RD, -0.40; 95% CI, -0.76 to -0.03), and reduced medical costs (MD, -229.69; 95% CI, -338.64 to -120.75). The recurrence rate between the two groups showed no significant difference (RD, -0.01; 95% CI, -0.05 to 0.04). CONCLUSION: Transnasal endoscopic marsupialization presents as a promising alternative to sublabial excision in the treatment of nasolabial cysts. It offers advantages like reduced operative time, decreased postoperative pain, fewer complications, lower admission rates, shorter hospital stays, diminished need for general anaesthesia, and cost savings. Clinicians can leverage these findings to select the most suitable surgical approach for their patients.

Metabolic Changes Associated With Cardiomyocyte Dedifferentiation Enable Adult Mammalian Cardiac Regeneration.

BACKGROUND: Cardiac regeneration after injury is limited by the low proliferative capacity of adult mammalian cardiomyocytes (CMs). However, certain animals readily regenerate lost myocardium through a process involving dedifferentiation, which unlocks their proliferative capacities. METHODS: We bred mice with inducible, CM-specific expression of the Yamanaka factors, enabling adult CM reprogramming and dedifferentiation in vivo. RESULTS: Two days after induction, adult CMs presented a dedifferentiated phenotype and increased proliferation in vivo. Microarray analysis revealed that upregulation of ketogenesis was central to this process. Adeno-associated virus-driven HMGCS2 overexpression induced ketogenesis in adult CMs and recapitulated CM dedifferentiation and proliferation observed during partial reprogramming. This same phenomenon was found to occur after myocardial infarction, specifically in the border zone tissue, and HMGCS2 knockout mice showed impaired cardiac function and response to injury. Finally, we showed that exogenous HMGCS2 rescues cardiac function after ischemic injury. CONCLUSIONS: Our data demonstrate the importance of HMGCS2-induced ketogenesis as a means to regulate metabolic response to CM injury, thus allowing cell dedifferentiation and proliferation as a regenerative response.

Postauricular Incision Versus Modified Blair Incision in Parotidectomy: A Systematic Review and Meta-Analysis.

OBJECTIVE: The mainstay of first-line treatment of parotid tumors is adequate surgical removal. The present study was conducted to compare the differences between parotidectomy with postauricular incision (PI) and modified Blair incision (MBI). DATA SOURCES: A systematic search of PubMed, Embase and the Cochrane Library was performed. METHODS: The data of interest and study characteristics were extracted from the included studies. Statistical analysis was performed with Comprehensive Meta-Analysis software (version 3; BioStat, Englewood, NJ). Dichotomous data and continuous data were analyzed by calculating the risk difference and the mean difference with the 95% confidence interval respectively. RESULTS: Four retrospective studies were included in the present meta-analysis. The pooled results revealed that the cosmetic satisfaction score was higher in the PI group (MD = 2.67; 95% CI, 2.12 to 3.23) and that intraoperative blood loss was lower in the PI group (MD = -55.35; 95% CI, -100.33 to -10.36). The operative duration (MD = -5.15; 95% CI, -24.06 to 13.75), tumor size (MD = -.07; 95% CI, -.27 to .13) and incidences of common postoperative complications were comparable between the two groups. CONCLUSIONS: According to these findings, the use of PI in parotidectomies may be one of the options for improving cosmetic outcomes. This technique may be considered if oncological safety can be secured.

Preoperative prognostic nutritional index predicts prognosis of patients with oral cavity cancer.

OBJECTIVE: To investigate whether prognostic nutritional index (PNI) predicts patient survival outcomes in oral cavity squamous cell carcinoma (OSCC). MATERIALS AND METHODS: The data of a total of 360 patients subjected to primary surgery for OSCC were retrospectively analysed. Patients were categorised into high-PNI (≥51.75) and low-PNI (<51.75) groups based on the PNI cut-off value attained from receiver operating characteristic analyses (p < .001), and the intergroup differences in clinicopathological features were determined. The Kaplan-Meier method and Cox proportional hazard model were employed to determine the survival prediction ability of the PNI, and a nomogram based on the PNI was established for individualised survival prediction. RESULTS: A low PNI was noted to exhibit a significant association with shorter overall survival (OS) and disease-free survival (DFS) (both p < .001). Multivariate Cox analyses showed that a lower PNI independently indicated shorter OS and DFS (hazard ratio [HR] = 2.187; p = .001 and HR = 1.459; p = .023, respectively). The concordance index and calibration plots of the PNI-based nomogram revealed the high discriminative ability for OS. CONCLUSIONS: Preoperative PNI is a valuable biomarker for predicting OSCC prognosis, and the proposed PNI-based nomogram can provide individualised prognostic prediction.

Intratympanic steroid injection versus hyperbaric oxygen therapy in refractory sudden sensorineural hearing loss: a meta-analysis.

OBJECTIVE: The present meta-analysis aims to compare the efficacy of intratympanic steroid (ITS) injection and hyperbaric oxygen (HBO) therapy as salvage treatments for refractory sudden sensorineural hearing loss (SSNHL). DATA SOURCES: Comprehensive searches were performed in PubMed, EMBASE and the Cochrane Library from the date of the database inception to June 2020. All studies reporting the use of salvage ITS and HBO treatments in refractory SSNHL patients were included. Subsequently, the full texts of the eligible studies were evaluated. METHODS: The quality and bias of the studies were assessed using the Newcastle-Ottawa Scale and Cochrane's risk of bias tools for nonrandomized and randomized studies, respectively. The data were analyzed using Comprehensive Meta-Analysis software (Version 3; Biostat, Englewood, NJ). RESULTS: Three hundred and fourteen subjects in 3 observational studies and 1 randomized controlled trial met our inclusion criteria. The pooled results demonstrated that there were no significant differences in the mean posttreatment hearing gain between the ITS and HBO groups. The changes in word discrimination and hearing gain at 250, 500, 1000, 2000, 4000 and 8000 Hz were also comparable between the two salvage treatment groups. CONCLUSIONS: The pooled results demonstrated that there were no significant differences in hearing improvements between salvage ITS injection and salvage HBO therapy after failed primary systemic steroid treatment in patients with SSNHL. However, spontaneous recovery could bias the treatment outcomes, and these results should be interpreted with caution. Clinicians may choose these salvage treatments according to personal experience and treatment availability. In cases in which specialized HBO facilities are difficult to access, salvage ITS injection can be provided with comparable responses.

Transoral Vestibular Robotic Surgery for Anterior Central Neck Mass.

ABSTRACT: A 44-year-old female without any systemic diseases had a slowly enlarging anterior neck mass for 1 year. She had received transcervical surgery for a left thyroid cyst 3 years ago. An enhanced computed tomography scan showed a hyper-dense, markedly enhancing, and homogenous mass at the level of the thyrohyoid membrane. under the impression of an ectopic thyroid gland, operation was scheduled. However, she worried about cosmesis pitfalls besides the existing scar from her previous thyroid surgery. Transoral vestibular robotic surgery was arranged to prevent an additional neck incision wound. The mass was removed and confirmed as an ectopic thyroid nodule by pathological examination. No recurrence was found at the 1-year follow-up, and the surgical and aesthetic outcomes were satisfied. The surgery can provide adequate surgical exploration with excellent cosmesis, whereas managing cervical masses. For the cosmetic concerns, this procedure is the potential alternative in other neck surgeries.

Postauricular Incision Versus Conventional Transcervical Incision in Second Branchial Cleft Cyst Excision: A Systematic Review and Meta-Analysis.

Surgical removal is the treatment of choice for second branchial cleft cysts (SBCCs), which are congenital anomalies. The conventional procedure is performed through a transcervical approach, which would lead to a visible scar in the anterior neck. Conversely, the postauricular approach could keep the scar in the hairline or retroauricular sulcus, rendering it almost invisible after the surgery. The purpose of this meta-analysis was to evaluate the differences between the postauricular and conventional transcervical approaches to SBCC excision. A systematic review was performed using PubMed, Embase, and the Cochrane Library to identify studies comparing outcomes of SBCC surgery via postauricular and conventional transcervical approaches. The data of interest were analyzed with Comprehensive Meta-Analysis software (version 3). The data of interest were analyzed by calculating the risk difference (RD), the standardized mean difference, and the mean difference (MD) with the 95% confidence interval (CI). Three studies were eligible for the final analysis. The pooled analysis demonstrated that the cosmetic satisfaction score was significantly higher with the postauricular approach (standardized mean difference, 2.12; 95% CI, 0.68-3.56). The operative duration was significantly longer with the postauricular approach than with the conventional transcervical approach (MD, 12.81; 95% CI, 2.39-23.23). The incidences of postoperative marginal mandibular nerve palsy (RD, 0.00; 95% CI, -0.09 to 0.09), bleeding complications (RD, -0.02; 95% CI, -0.09 to 0.05), salivary complications (RD, -0.00; 95% CI, -0.07 to 0.06), cyst size (MD, 0.02; 95% CI, -0.96-0.99), and length of hospital stay (MD, -2.50; CI, -7.30 to 2.30) were comparable between the 2 groups. The postauricular approach is feasible for use in SBCC excision and yields better cosmetic outcomes, a longer operative duration, and a similar rate of complications.

A novel melatonin-regulated lncRNA suppresses TPA-induced oral cancer cell motility through replenishing PRUNE2 expression.

The inhibitory effect of melatonin on cancer cell dissemination is well established, yet the functional involvement of lncRNAs in melatonin signaling remains poorly understood. In this study, we identified a melatonin-attenuated lncRNA acting as a potential melatonin-regulated oral cancer stimulator (MROS-1). Downregulation of MROS-1 by melatonin suppressed TPA-induced oral cancer migration through replenishing the protein expression of prune homolog 2 (PRUNE2), which functioned as a tumor suppressor in oral cancer. Melatonin-mediated MROS-1/PRUNE2 expression and cell motility in oral cancer were regulated largely through the activation of JAK-STAT pathway. In addition, MROS-1, preferentially localized in the nuclei, promoted oral cancer migration in an epigenetic mechanism in which it modulates PRUNE2 expression by interacting with a member of the DNA methylation machinery, DNA methyltransferase 3A (DNMT3A). Higher methylation levels of PRUNE2 promoter were associated with nodal metastases and inversely correlated with PRUNE2 expression in head and neck cancer. Collectively, these findings suggest that MROS-1, serving as a functional mediator of melatonin signaling, could predispose patients with oral cancer to metastasize and may be implicated as a potential target for antimetastatic therapies.

Retrospective study on the potential of albumin/globulin ratio as a prognostic biomarker for oral cavity cancer patients.

PURPOSE: Although the serum albumin/globulin ratio (AGR) is recognized as a valuable prognostic biomarker in various cancers, its clinical value in oral cavity squamous cell carcinoma (OSCC) is still unclear. We aimed to probe the prognostic value of AGR in patients with OSCC undergoing curative surgery. METHODS: This retrospective study analyzed 306 patients who were newly diagnosed as having OSCC and receiving curative surgery between 2008 and 2017. The correlation of AGR with survival outcomes was estimated using Cox proportional hazards models and Kaplan-Meier analysis. A nomogram based on AGR was established, and its accuracy was assessed according to the concordance index. RESULTS: The log rank test and Kaplan-Meier analysis indicated that patients who had low AGR had significantly shorter disease-free survival (DFS) as well as 5-year overall survival (OS) than those with high AGR. The multivariate Cox analysis revealed that low AGR was an independent predictor of poor OS and DFS (adjusted hazard ratio [aHR] = 2.812; 95% CI 1.729-4.573; p < 0.001, and aHR = 1.743; 95% CI 1.201-2.530; p = 0.003, respectively). The concordance index of the nomogram model based on TNM staging alone was 0.656 and could increase to 0.783 with the inclusion of AGR and other prognostic variables in the calculation. CONCLUSION: Preoperative AGR may represent an accessible, valuable prognostic biomarker in patients with OSCC. The nomogram model incorporating AGR and clinicopathological prognostic variables may improve the accuracy of prognostic predictions in these patients.

Transseptal Suturing With Turbinate Coblation in Nasal Septoturbinoplasty.

OBJECTIVE: Transseptal suture-assisted septoplasty and coblation are two techniques that can effectively treat septal deviation and inferior turbinate hypertrophy without the need for post-operative packing. In the existing literature, however, the early post-operative symptoms and surgical outcomes of the combination of these 2 procedures have not been addressed. METHOD: This retrospective study included 65 patients who underwent concomitant nasal septoturbinoplasty. The patients were divided into two groups: the transseptal suture-assisted septoplasty and inferior turbinate coblation group (no-packing group: 33 patients) and the conventional septoturbinoplasty group with merocel packing (packing group: 32 patients). The post-operative symptoms within 14 days, complications and surgical outcomes at 3 months after surgery were recorded and analyzed. RESULTS: The patients in the no-packing group experienced less nasal obstruction on the first, second and third days post-operatively than those in the packing group (P < 0.000, P < 0.000, and P = 0.043, respectively). The patients in the no-packing group also had less nasal bleeding (P = 0.000 and P = 0.001), dry mouth sensation (P = 0.016 and P = 0.034) and swallowing disturbance (P = 0.013 and P = 0.012) on the first and second days post-operatively, respectively. In terms of orbital symptoms, the patients in the packing group had more severe epiphora (P = 0.031) and swelling sensations (P = 0.040) on the first day post-operatively. CONCLUSIONS: Transseptal suturing and coblation-assisted septoturbinoplasty can be considered to prevent packing-related comorbidities and reduce post-operative discomfort.

Stapler closure versus manual closure in total laryngectomy for laryngeal cancer: A systematic review and meta-analysis.

OBJECTIVE: Total laryngectomy (TL) is a life-saving procedure for individuals with advanced laryngeal cancer and those suffering from recurrence after initial treatment. The present study aimed to evaluate the differences between stapler closure (SC) and manual closure (MC) of the pharynx during TL for patients with laryngeal cancer. DESIGN/SETTING: A systematic literature search was performed using the PubMed, EMBASE and Cochrane Library databases. The data were analysed using Comprehensive Meta-Analysis software (Version 3; Biostat). Dichotomous data were calculated as odds ratios (ORs), and continuous data were calculated as mean differences (MD) with 95% confidence intervals (CI). MAIN OUTCOME/RESULTS: A total of seven studies (535 patients) were included in this meta-analysis. Pooled analysis showed that the operative time of TL was significantly reduced in the SC group (MD, -63.2; 95% CI, -106.0 to -20.4). Moreover, the SC group had a lower incidence of pharyngocutaneous fistula (OR = 0.38; 95% CI, 0.18 to 0.83; P = .016) and hospital stay (MD, -2.9; 95% CI, -5.6 to -0.1). The incidence of postoperative surgical site infection (OR = 0.41; 95% CI, 0.02 to 8.73; P = .565) was comparable between the two groups. CONCLUSION: Based on these results, SC may be a useful option for patients who need TL.

Diagnostic Accuracy of Lateral Neck Radiography for Esophageal Foreign Bodies in Adults.

OBJECTIVE. The objective of our study was to evaluate the accuracy of signs on lateral neck radiography for the assessment of patients with suspected esophageal foreign bodies (FBs). MATERIALS AND METHODS. This retrospective study was conducted of 235 adult patients between January 2012 and December 2017. Group 1 was composed of 95 patients with esophageal FBs, and group 2 was composed of 140 patients without esophageal FBs. Four signs on lateral neck radiography were recorded in both groups: presence of abnormal radiopaque density, presence of abnormal air column lucency, loss of cervical lordosis, and increased prevertebral soft-tissue thickness. The prevertebral thickness was also evaluated in three groups of patients categorized by patient age: 19-29 years old, 30-59 years old, and 60 years old or older. RESULTS. The accuracy of the presence of abnormal radiopaque density, presence of abnormal air column lucency, loss of cervical lordosis, and increased prevertebral soft-tissue thickness was 84.3%, 66.8%, 54.0%, and 60.9%, respectively. Combined two signs of presence of radiopaque density with air column lucency provided the highest accuracy, 90.6%. The prevertebral thickness at C6 of group 1 was 14.28 ± 3.19 mm (mean ± SD), and the prevertebral thickness at C6 of group 2 was 13.34 ± 2.54 mm (p = 0.018). CONCLUSION. Lateral neck radiography is helpful for the initial evaluation of patients with suspected esophageal FBs. The presence of radiopaque density or air column lucency provided the highest practical diagnostic value. Loss of cervical lordosis, as a single diagnostic sign, did not seem to provide a diagnostic advantage. Despite the variations in values for the three age groups, clinicians should be alert regarding increased prevertebral thickness at C6 especially when it is more than 20 mm.

Treatment patterns and survival outcomes of advanced hypopharyngeal squamous cell carcinoma.

BACKGROUND: This study evaluated the treatment outcomes of the primary surgery (PS) or concurrent chemoradiotherapy (CCRT) as the initial treatment for hypopharyngeal squamous cell carcinoma (HPSCC). METHODS: This retrospective cohort study included patients with stages III-IV HPSCC from four tertiary referral centers consecutively enrolled from 2003 to 2012; of them, 213 (32.6%) and 439 (67.4%) had received PS and CCRT as their primary treatments, respectively. The 5-year overall survival (OS) and disease-free survival (DFS) rates were analyzed using the Kaplan-Meier method and Cox regression models. RESULTS: In patients undergoing PS and CCRT, OS rates were 45.0% and 33.1% (p < 0.001), respectively, and DFS rates were 36.2% and 28.9% (p = 0.003), respectively. In subgroup analysis, in patients with stage IVA HPSCC, PS was associated with higher OS rate (p = 0.002), particularly in those with T4 or N2 classification (p = 0.021 and 0.002, respectively). Multivariate analysis indicated that stage IVA HPSCC, stage IVB HPSCC, and CCRT were independent adverse prognostic factors for OS rate (p = 0.004, < 0.001, and 0.014, respectively). Furthermore, in patients with stage IVA HPSCC aged ≥ 65 years and with N2 classification, CCRT was significantly associated with lower OS rates than was PS (p = 0.027 and 0.010, respectively). CONCLUSIONS: In patients with advanced HPSCC, PS was significantly associated with better prognosis than CCRT. PS could be a favorable primary treatment modality for the management of patients with stage IVA HPSCC, particularly those aged ≥ 65 years and with T4 and N2 classification.

Infected Lingual Thyroglossal Duct Cyst Mimicking Supraglottitis.

A thyroglossal duct cyst (TGDC) is a common embryological remnant that typically presents as an anterior neck mass; however, this malformation can occur in any adjacent area, including the tongue base (lingual type), along the migration path of the thyroid during embryonic development. Lingual TGDC is often quiescent until infection occurs. Supraglottitis or inflammation of the supraglottis, is a potentially life-threatening disease. Because of the anatomical proximity of lingual TGDC to the supraglottis, lingual TGDC infection might be related to a presentation of supraglottitis. A 49-year-old male initially presented with clinical symptoms of acute supraglottitis. After intensive medical treatment resulting in no improvement, a computed tomography scan was performed. The result raised the suspicion of an infected lingual TGDC. Transoral marsupialization using a rigid laryngoscope was performed to drain the abscess inside the cyst. A diagnosis of lingual TGDC was made based on the characteristic histological pattern of the lesion. After treatment, a follow-up computed tomography scan showed no evidence of recurrence. To the authors' knowledge, only a few reports have pointed out similarities in the clinical and radiological findings between acute supraglottitis and an infected lingual TGDC. Clinicians should consider lingual TGDC during the differential diagnosis of supraglottitis, especially in patients with poor response to medical treatment.

Bidirectional Management of a Transnasal Intracranial Chopstick Transecting Optic Nerve.

Herein, the authors report a rare patient with a transnasal intracranial penetration injury caused by a chopstick that resulted in optic nerve transection as well as the removal of the chopstick using a bidirectional approach. A 25-year-old male presented to our emergency department with right blindness and bilateral epistaxis. Preoperative computed tomographic angiography demonstrated a transnasal stick-like foreign body causing a skull base fracture and suspected vascular injury. Due to the shape of the chopstick and the high risk of massive bleeding, an exclusively endoscopic or open craniotomy approach is not suitable for removal. A bidirectional method, including both an open craniotomy and transnasal endoscopy, was used to remove the chopstick. After the operation, there were no further neurologic deficits or complications during the treatment course and follow-up. The bidirectional approach may provide an alternative method to address a foreign body when the patient is not a candidate for an exclusively endoscopic or open craniotomy approach management.

Local PT symmetry violates the no-signaling principle.

Bender et al. [Phys. Rev. Lett. 80, 5243 (1998)] have developed PT-symmetric quantum theory as an extension of quantum theory to non-Hermitian Hamiltonians. We show that when this model has a local PT symmetry acting on composite systems, it violates the nonsignaling principle of relativity. Since the case of global PT symmetry is known to reduce to standard quantum mechanics A. Mostafazadeh [J. Math. Phys. 43, 205 (2001)], this shows that the PT-symmetric theory is either a trivial extension or likely false as a fundamental theory.

Prognostic importance of modified geriatric nutritional risk index in oral cavity squamous cell carcinoma.

We probed the associations of preoperative modified geriatric nutritional risk index (mGNRI) values with prognosis in patients receiving surgery for oral cavity squamous cell carcinoma (OCSCC). This retrospective study analyzed the clinical data of 333 patients with OCSCC and undergoing surgery between 2008 and 2017. The preoperative mGNRI was calculated using the following formula: (14.89/C-reactive protein level) + 41.7 × (actual body weight/ideal body weight). We executed receiver operating characteristic curve analyses to derive the optimal mGNRI cutoff and employed Kaplan-Meier survival curves and Cox proportional hazard model to probe the associations of the mGNRI with overall survival (OS) and disease-free survival (DFS). The optimal mGNRI cutoff was derived to be 73.3. We noted the 5-year OS and DFS rates to be significantly higher in the high-mGNRI group than in the low-mGNRI group (both p < 0.001). A preoperative mGNRI below 73.3 was independently associated with unfavorable DFS and OS. A mGNRI-based nomogram was constructed to provide accurate OS predictions (concordance index, 0.781). Hence, preoperative mGNRI is a valuable and cost-effective prognostic biomarker in patients with OCSCC. Our nomogram facilitates the practical use of mGNRI and offers individualized predictions of OS.