Run-time motion and first-order shim control by expanded servo navigation.

PURPOSE: To provide a navigator-based run-time motion and first-order field correction for three-dimensional human brain imaging with high precision, minimal calibration and acquisition, and fast processing. METHODS: A complex-valued linear perturbation model with feedback control is extended to estimate and correct for gradient shim fields using orbital navigators (2.3 ms). Two approaches for sensitizing the model to gradient fields are presented, one based on finite differences with three additional navigators, and another projection-based approximation requiring no additional navigators. A mechanism for noise decorrelation of the matrix and the data is proposed and evaluated to reduce unwanted parameter biases. RESULTS: The rigid motion and first-order field control achieves robust motion and gradient shim corrections improving image quality in a series of phantom and in vivo experiments with varying field conditions. In phantom scans, magnet drifts, forced gradient field perturbations and field distortions from shifts of a second bottle phantom are successfully corrected. Field estimates of the magnet drifts are in good agreement with concurrent field probe measurements. For in vivo scans, the proposed method mitigates field variations from torso motions while being robust to head motion. In vivo gradient field precisions were 30 nT / m $$ 30\;\mathrm{nT}/\mathrm{m} $$ along with single-digit micrometer and millidegree rigid precisions. CONCLUSION: The navigator-based method achieves accurate, high-precision run-time motion and field corrections with low sequence impact and calibration requirements.

tsRNA in head and neck tumors: Opportunities and challenges in the field.

Transfer RNA-derived small RNAs (tsRNAs) are a newly recognized class of small non-coding RNAs that are implicated in a variety of cancers, including head and neck tumors. Studies have identified tsRNAs with differential expression profiles in head and neck malignancies, highlighting their potential as biomarkers for diagnosis and prognosis. Functional analyses show that tsRNAs are involved in regulating critical cellular pathways, including those related to cell proliferation, migration, and metabolic processes. Despite these encouraging insights, there are myriad challenges that must be tackled. In summary, tsRNAs present considerable potential as therapeutic targets and biomarkers in the realm of head and neck tumors, meriting further investigation and clinical application to optimize outcomes in the management of these complex diseases. This literature review synthesizes current research on tsRNAs, tsRNAs hold significant promise as biomarkers and therapeutic targets, with the potential to transform diagnostic and treatment strategies for head and neck tumors, ultimately improving patient outcomes.

Comparative analyses of short- and long-term outcomes between endoscopic submucosal dissection and endoscopic laryngo-pharyngeal surgery for superficial pharyngeal carcinomas.

Objectives: Endoscopic treatment of superficial pharyngeal carcinomas includes endoscopic submucosal dissection (ESD; usually performed by endoscopists), and endoscopic laryngo-pharyngeal surgery (ELPS; primarily performed by otolaryngologists). Few studies have compared the efficacy of the two techniques in treating superficial pharyngeal carcinomas. In this study, we compared the outcomes of these two techniques to determine the advantages. Methods: We retrospectively examined the short- and long-term outcomes of 93 consecutive patients with superficial pharyngeal carcinoma who either underwent an ESD or ELPS between August 2008 and December 2021. Results: There were 35 lesions among 29 patients and 93 lesions among 71 patients in the ESD and ELPS groups, respectively. The ELPS group had a significantly shorter procedure time (121.2 ± 97.4 min vs. 54.7 ± 40.2 min, p<0.01), greater procedure speed (0.10 ± 0.06 min/min vs. 0.30 ± 0.23 min/min, p<0.01), and less laryngeal edema than that of the ESD group. There were no significant differences in the 3-year overall, relapse-free, or disease-specific survival rates between the two groups. Intervention with ESD during ELPS was most commonly required when it was difficult to secure the visual field. Conclusions: There were no differences in batch resection rates or long-term prognoses between the two groups; nevertheless, the ELPS group had a shorter treatment time and less laryngeal edema than the ESD group. However, the treatment of narrow areas, such as the esophageal inlet patch, is a technical limitation of ELPS; thus, ELPS should be combined with ESD techniques.

Short-term outcomes with routine use of size ≥40 femoral heads in THA: A retrospective cohort study.

Background: Using larger femoral heads during total hip arthroplasty (THA) may result in a more stable hip. Greater volumetric wear and frictional torque, however, may result in increased postoperative complications. The purpose of this study was to compare outcomes of patients with femoral head size ≥40 mm compared to those with femoral head size <40 mm. Materials and methods: A retrospective chart review of 504 THAs performed by a single surgeon at a single institution from 2009 to 2016 was conducted. Following exclusions, 131 THAs were identified with femoral heads ≥40 mm and 348 THAs were identified with femoral heads <40 mm. In addition to demographic data, all postoperative complications were recorded. Plain radiographs were used to rule out/in periprosthetic osteolysis and/or acetabular loosening. Chi-square tests and Student's t-tests were used to compare categorical and continuous variables, respectively. Results: Mean follow-up period for the entire cohort was 5.5 years. Complications with ≥40 mm femoral heads included 1 superficial infection and 1 deep periprosthetic joint infection (PJI). There were no cases of dislocation, osteolysis, acetabular loosening, or trunnionosis. In contrast, complications with <40 mm femoral heads included 9 dislocations and 7 PJIs. Conclusion: The routine use of large femoral heads (≥40-mm) during THA appears to be a safe option for patients at short-term clinical follow-up. Notably, 0 patients had a clinical course complicated by dislocation, osteolysis, acetabular loosening, or trunnionosis. Level of evidence: Level III Retrospective Cohort Study.

On the Cranial Nerves.

The twelve cranial nerves play a crucial role in the nervous system, orchestrating a myriad of functions vital for our everyday life. These nerves are each specialized for particular tasks. Cranial nerve I, known as the olfactory nerve, is responsible for our sense of smell, allowing us to perceive and distinguish various scents. Cranial nerve II, or the optic nerve, is dedicated to vision, transmitting visual information from the eyes to the brain. Eye movements are governed by cranial nerves III, IV, and VI, ensuring our ability to track objects and focus. Cranial nerve V controls facial sensations and jaw movements, while cranial nerve VII, the facial nerve, facilitates facial expressions and taste perception. Cranial nerve VIII, or the vestibulocochlear nerve, plays a critical role in hearing and balance. Cranial nerve IX, the glossopharyngeal nerve, affects throat sensations and taste perception. Cranial nerve X, the vagus nerve, is a far-reaching nerve, influencing numerous internal organs, such as the heart, lungs, and digestive system. Cranial nerve XI, the accessory nerve, is responsible for neck muscle control, contributing to head movements. Finally, cranial nerve XII, the hypoglossal nerve, manages tongue movements, essential for speaking, swallowing, and breathing. Understanding these cranial nerves is fundamental in comprehending the intricate workings of our nervous system and the functions that sustain our daily lives.

Impact of physical exercise (strength and stretching) on repairing craniovertebral and reducing neck pain: A systematic review and meta-analysis.

Background: The craniovertebral (CV) junction is crucial for head support, mobility, and protecting the upper spinal cord and vital nerve structures. Disorders in this area can cause severe symptoms such as neck pain, restricted movement, and neurological issues such as headaches and balance problems. Exercise and physical activity improves muscle strength, flexibility, joint stability, reducing pain, and enhancing joint function, while specifically for the CV junction, exercise can relieve muscle tension, boost blood flow, and improve posture, although the specific impact on CV junction health remains underexplored. Methods: A comprehensive literature search was conducted using databases MEDLINE, Cochrane, Lilacs, and ScienceDirect, alongside manual searches through reference lists. The review focuses on exercise and CV junction issues and includes randomized controlled trials, cohort or case-control studies, and systematic reviews. Primary outcomes include pain levels, joint mobility, function, and quality of life. Results: Results yield four meta-analyses with corrective exercise and conventional exercise in improving forward head posture risk difference 0.00 (-0.09, 0.09) 95% confidence interval (CI), between cervical and thoracic exercises odds ratio 1.04 (0.59, 1.84) 95% CI. Comparing exercise treatment and physiotherapy showed risk difference 0.11 (-0.10, 0.32) 95% CI and the comparative analysis between training and no treatment showed risk difference 0.09 (-0.01, 0.20) 95% CI. Conclusion: Exercise-based rehabilitation programs tailored to patients with CV junction problems offer robust evidence, benefiting clinical management, and prevention efforts.

Knowledge, attitude, and practice toward advanced precision radiotherapy among patients with head and neck cancer.

Background: Advancements in radiotherapy (RT) technology have led to the prominence of precision RT in head and neck cancer (HNC) treatment. The new progress in precision RT offers more efficient therapy, potentially improving outcomes for HNC patients. Objective: The present cross-sectional study aimed to assess the knowledge, attitude, and practice (KAP) of patients in advanced precision RT for HNC treatment. Methods: This study enrolled HNC patients at the Affiliated Hospital of Hebei University of Engineering between October 2023 and May 2024. Then, the demographic data and KAP scores were collected using an investigator-designed questionnaire. Afterwards, descriptive statistics were provided for all study variables, and the relationship among KAP was analyzed using appropriate statistical tests, including Spearman correlation, logistic regression, and path analysis. Results: A total of 436 participants with a mean age of 52.03 ± 12.19 years old were included. The mean knowledge score, attitude score, and practice score were 18.33 ± 4.21, 36.14 ± 1.71, and 26.26 ± 1.83, respectively. Although most of the participants were unfamiliar with advanced precision RT, they expressed a high willingness to follow their doctor's recommendation for this treatment. The multivariable analysis revealed a positive association between attitude score and proactive practice. The path analysis revealed that knowledge directly influenced attitude and practice, while attitude directly impacted practice. Conclusion: HNC participants had poor knowledge of advanced precision RT techniques, but had a positive attitude and the willingness to undergo treatment when recommended by their physicians. These results suggest that improving patients' awareness for advanced precision RT can help to promote better attitude and advanced precision RT practice.

Psychological and physiological health outcomes of virtual reality-based mindfulness interventions: A systematic review and evidence mapping of empirical studies.

Objective: In the past two decades, mindfulness, rooted in Buddhist traditions, has gained considerable scientific interest. Virtual reality (VR) technology, in particular head-mounted displays, offers immersive experiences and is examined in this systematic review in terms of VR-based mindfulness interventions and their effects on psychological and physiological health outcomes. Methods: Using the Preferred Reporting Items for Systematic Review and Meta Analyses guidelines, a systematic search was conducted with the following search terms: [(mindful* OR "meditat*") AND ("virtual reality" OR "VR") AND (health OR physio* OR psycho* OR mental OR physical)]. Considering critiques of methodological quality in existing systematic reviews, this study adopts Boell and Cecez-Kecmanovic's hermeneutic approach, critically evaluating research outcomes. Results: Psychological benefits include improved anxiety, mindfulness, emotions, disease patterns, affect, stress, (presleep) arousal, meditation and others. Physiological effects focus on neurobiological markers, heart rate/heart rate variability, pain, blood pressure, cortisol and galvanic skin resistance. Evidence mapping shows that more research has been conducted in the last 6 years, particularly by North American and South Korean authors, and points to gaps in study methodology. In addition, attention regulation is identified as a primary mindfulness mechanism in VR scenarios, often in nature-based virtual environments, with mainly single-session studies lasting 5 or 10 minutes. Discussion: Critical mapping reveals the need for additional studies to support and extend initial findings in this emerging research field. Methodologically, there is a call for more true-experimental studies to enhance rigor. From a content perspective, VR protocols are currently still strongly characterized by single-session interventions, which makes it especially difficult to make a dose-response statement regarding long-term effects. Conclusion: In summary, the studies provide important initial findings on psychological and physiological effects of VR-based mindfulness interventions on health. In addition, the need for more methodologically rigorous studies was emphasized, along with other methodological adjustments that must be carefully considered in the planning of future studies.

Convergence insufficiency as a predictor of poor prognosis after acute mild traumatic brain injury.

BACKGROUND: Mild traumatic brain injury (mTBI) is becoming a more common emergency department (ED) presentation. Towards this end, many types of testing in the acute setting are being investigated. One of these is screening for convergence insufficiency (CI) symptoms. These are common problems reported by patients with mTBI, but such oculomotor testing is rarely performed in the ED. OBJECTIVE: To assess the feasibility of convergence insufficiency screening in the ED and investigate whether CI is associated with adverse events such as post-concussive symptoms or hospital admission. METHODS: Written informed consent was obtained from patients age 18 years or older who experienced a mild head injury from any mechanism resulting in an mTBI. Patients underwent screening for CI symptoms using a standardized instrument of 15 questions, known as the convergence insufficiency symptom survey (CISS), with responses based on the Likert scale. These data were correlated to outcomes of hospital admission, occurrence of post-concussive symptoms, and 30-day hospital re-admission. RESULTS: A total of 116 patients were prospectively enrolled, of which 58 were male. The median age was 31 years, with a range of 18 to 95 years of age. The median CISS score was 13, with an interquartile range (IQR) of 6 to 21 and an overall range of 0 to 53. Females presented with a median CISS score of 14, which was higher compared to the male median score of 10. The higher the CISS score, the more likely the patient was to be admitted to the hospital (p = 0.0378), develop symptoms of post-concussive syndrome at 30-day follow up (p = 0.0322), and be readmitted within 30 days (p = 0.0098). CONCLUSIONS: Screening for CI symptoms using the CISS can be a solid adjunct in the evaluation of mTBI in the ED. The CISS is easy and fast to administer, and it is a useful tool to stratify patients in terms of who is at the highest risk of developing complications related to the mTBI.

Abusive head trauma: Annual medical costs for inpatient care of children managed at a single tertiary care centre in Malaysia.

BACKGROUND: Abusive head trauma (AHT) is a leading cause of traumatic head injury in young children. This study estimated the annual direct medical cost of managing AHT at a single tertiary care centre in Malaysia. METHODS: Criteria were set for categorisation of patients as moderate or severe based on resource utilisation. The two methods used for cost computation were (1) cost estimation based on predefined clinical pathways for case management (2) computation of actual costs using patient-level data from retrospective review of all AHT admissions in 2021. Both methods utilised a combination of activity-based and top-down costing according to availability of reference data. Costs are presented in USD. RESULTS: Costs for 9 severe and 3 moderate cases in 2021 amounted to $70,532.16, of which 93 % was for severe cases. Cost estimate for moderate cases was $2009.88 while actual costs ranged between $749.37-3115.47 (median $1422.76). Cost estimates of $15,125.76-$17,958.18 for severe cases exceeded actual costs of $2195.57-$13,186.03 (median $7379.40) for severe cases due to shorter-than-expected duration of stay, with only 2 who underwent neurosurgical procedures. Major cost contributors were duration of stay, intensive care, ventilation and neurosurgical procedures. CONCLUSION: Cost comparison utilising predefined treatment standards versus actual patient data which reveals major cost determinants enables refinement of budget allocation. Median medical costs for severe cases which exceeded the monthly income ceilings of low- and middle-income households in Malaysia demonstrate the economic burden of AHT, reinforcing the need to invest in prevention.

Exploring patient stratification in head and neck squamous cell carcinoma using machine learning techniques: Preliminary results.

BACKGROUND: Head and Neck Squamous Cell Carcinoma (HNSCC) presents a significant challenge in oncology due to its inherent heterogeneity. Traditional staging systems, such as TNM (Tumor, Node, Metastasis), provide limited information regarding patient outcomes and treatment responses. There is a need for a more robust system to improve patient stratification. METHOD: In this study, we utilized advanced statistical techniques to explore patient stratification beyond the limitations of TNM staging. A comprehensive dataset, including clinical, radiomic, genomic, and pathological data, was analyzed. The methodology involved correlation analysis of variable pairs and triples, followed by clustering techniques. RESULTS: The analysis revealed that HNSCC subpopulations exhibit distinct characteristics, which challenge the conventional one-size-fits-all approach. CONCLUSION: This study underscores the potential for personalized treatment strategies based on comprehensive patient profiling, offering a pathway towards more individualized therapeutic interventions.

Telaglenastat as an alternative to cisplatin as a radiosensitizer in the treatment of head and neck squamous cell carcinoma.

The efficacy of radiation treatment (RT) of head and neck squamous cell carcinoma (HNSCC) is limited by radioresistance and the toxicity of FDA approved radiosensitizers. In extension to our previous research where we demonstrated that telaglenastat (CB839) increased efficacy of RT in in vitro and in vivo HNSCC models, here, we examine the radiosensitizing effects of telaglenastat in comparison to cisplatin's, as cisplatin is currently the standard of care for concurrent therapy. Combination of telaglenastat with RT reduced tumor volume in a HNSCC patient derived xenograft mouse model. The efficacy of telaglenastat with RT in reducing cell survival and increasing apoptosis was similar if not greater than that of cisplatin with RT in Cal27 and HN5 HNSCC cells. The addition of telaglenastat increased reactive oxygen species and reduced the antioxidant glutathione in both Cal27 and HN5 cells. Reverse Phase Protein Array analyses revealed alterations in cell death and DNA damage response proteins. This study provides the scientific underpinnings for the use of telaglenastat as a radiosensitizer in the treatment of HNSCC either as an alternative to cisplatin or in cisplatin-ineligible patients.

The imprint of viral oncoproteins on the variable clinical behavior among human papilloma virus-related oropharyngeal squamous cell carcinomas.

Human papilloma virus-related (HPV+) oropharyngeal squamous cell carcinomas (OPSCCs) are variable in their progression, immune landscape, treatment responses, and clinical outcomes. Their behavior is impacted not only by differences in host genomic alterations but also by diversity in levels and activity of HPV-encoded oncoproteins. Striking differences in HPV mRNA levels are found among HPV+ OPSCCs and likely derive in part from variations in the structurally diverse mix of integrated and episomal HPV genomes they often contain. Viral oncoprotein levels and function are also impacted by differential splicing of the two long polycistronic transcripts of HPV16, the HPV type within most HPV+ OPSCCs. Further variation in viral oncoprotein function arises from the distinct lineages and sub-lineages of HPV16, which encode polymorphisms in functionally important portions of oncogenes. Here we review the limited current knowledge linking HPV mRNA expression and splicing to differences in oncoprotein function that likely influence OPSCC behavior. We also summarize the evolving understanding of HPV16 physical genome state and genetic variants and their potential contributions to HPV oncoprotein levels and function. Addressing considerable remaining challenges in defining the quantitative and qualitative imprint of HPV oncoproteins on each OPSCC holds promise to guide personalization of therapy for this disease.

Immersive virtual reality for learning exoskeleton-like virtual walking: a feasibility study.

PURPOSE: Virtual Reality (VR) has proven to be an effective tool for motor (re)learning. Furthermore, with the current commercialization of low-cost head-mounted displays (HMDs), immersive virtual reality (IVR) has become a viable rehabilitation tool. Nonetheless, it is still an open question how immersive virtual environments should be designed to enhance motor learning, especially to support the learning of complex motor tasks. An example of such a complex task is triggering steps while wearing lower-limb exoskeletons as it requires the learning of several sub-tasks, e.g., shifting the weight from one leg to the other, keeping the trunk upright, and initiating steps. This study aims to find the necessary elements in VR to promote motor learning of complex virtual gait tasks. METHODS: In this study, we developed an HMD-IVR-based system for training to control wearable lower-limb exoskeletons for people with sensorimotor disorders. The system simulates a virtual walking task of an avatar resembling the sub-tasks needed to trigger steps with an exoskeleton. We ran an experiment with forty healthy participants to investigate the effects of first- (1PP) vs. third-person perspective (3PP) and the provision (or not) of concurrent visual feedback of participants' movements on the walking performance - namely number of steps, trunk inclination, and stride length -, as well as the effects on embodiment, usability, cybersickness, and perceived workload. RESULTS: We found that all participants learned to execute the virtual walking task. However, no clear interaction of perspective and visual feedback improved the learning of all sub-tasks concurrently. Instead, the key seems to lie in selecting the appropriate perspective and visual feedback for each sub-task. Notably, participants embodied the avatar across all training modalities with low cybersickness levels. Still, participants' cognitive load remained high, leading to marginally acceptable usability scores. CONCLUSIONS: Our findings suggest that to maximize learning, users should train sub-tasks sequentially using the most suitable combination of person's perspective and visual feedback for each sub-task. This research offers valuable insights for future developments in IVR to support individuals with sensorimotor disorders in improving the learning of walking with wearable exoskeletons.

Development and validation of a nomogram for predicting overall survival of head and neck adenoid cystic carcinoma.

This study aimed to develop and validate a nomogram using clinical variables to guide personalized treatment strategies for adenoid cystic carcinoma of the head and neck (ACCHN). Data from 1069 patients with ACCHN diagnosed between 2004 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were used to construct the nomogram. External validation was performed using an independent cohort of 70 patients from Fujian Cancer Hospital. Multivariate Cox regression analysis was conducted using IBM SPSS version 26.0 and R Software version 4.2.3. The concordance index (C-index) and receiver operating characteristic (ROC) curves were used to assess the predictive accuracy of the nomogram. Age, tumor site, surgery, N stage, M stage, and TNM stage were identified as independent prognostic factors through univariate and multivariate Cox analyses. The nomogram demonstrated superior predictive performance compared to the TNM staging system, effectively stratifying patients into high-risk and low-risk groups. This nomogram offers a valuable tool for predicting overall survival in patients with ACCHN and tailoring individualized treatment approaches.

Poorly Differentiated Squamous Cell Carcinoma With Jaw Bone Osteomyelitis and Skin Perforation: A Report of a Rare Clinical Case.

Oral squamous cell carcinoma is a perpetual challenge for current clinicians and oral pathologists. In this case report, we present an unusual case of oral squamous cell carcinoma involving the left buccal mucosa with extensive bone exposure and skin perforation. It showed features of ulceration, necrosis, and maggot infestation. On histological examination, the malignant epithelial cells in the dense fibrous connective tissue stroma were keratinized, highly pleomorphic, had a high nucleo-cytoplasmic ratio, and were organized in sheets, cords, and nests. Decalcified tissue sections revealed the presence of necrotic bone. Immunohistochemistry indicated diffuse PanCK (cytokeratin) positivity confirming the epithelial origin of the malignant tumor cells. A final diagnosis of poorly differentiated squamous cell carcinoma (Bryne score 13/16) with chronic osteomyelitis and skin involvement was confirmed. Palliative care with supportive therapy was recommended. Hence, this case report emphasizes how critical it is to receive an early diagnosis and treatment to stop the disease progression, prevent the host's immune suppression, and improve the overall quality of life of the patient.

Neoadjuvant Chemotherapy for Borderline Resectable Head and Neck Cancers: A Comparative Study of Three-Drug and Two-Drug Regimens in a Low- and Middle-Income Country (LMIC) Context.

Background Borderline resectable head and neck squamous cell carcinoma (HNSCC) presents a significant therapeutic challenge, particularly in low- and middle-income countries (LMICs) like India. Neoadjuvant chemotherapy (NACT) aims to downstage tumors to achieve operability, but the optimal regimen remains controversial due to varying efficacy and toxicity profiles. This study compares the efficacy and toxicity of a three-drug regimen (TPF: docetaxel, cisplatin, and 5-fluorouracil) with a two-drug regimen (taxane and platinum) in patients with borderline resectable HNSCC in an LMIC setting. Methods In this retrospective cohort study, a total of 90 patients with borderline resectable HNSCC were included. Forty-three patients received the TPF regimen (Arm A), while 47 received the taxane + platinum regimen (Arm B). The outcomes measured included conversion to operability, stage-specific outcomes, overall survival (OS), progression-free survival (PFS), and treatment-related toxicity. Statistical analyses included chi-square tests for categorical variables, Kaplan-Meier survival analysis, and Cox proportional hazards modeling for multivariate analysis. Results The conversion to operability was significantly higher in the TPF group (72% vs. 51%, p=0.03). Patients in Arm A also exhibited a trend toward higher pathological complete response (pCR) rates compared to Arm B (60% vs. 43%, p=0.08). The overall survival and progression-free survival were improved in the TPF group, although the study did not reach statistical significance in these endpoints due to the limited sample size. However, the TPF regimen was associated with significantly higher toxicity. Grade 3-4 neutropenia occurred in 55% of the patients in Arm A compared to 32% in Arm B (p=0.01), and mucositis was observed in 47% of Arm A patients compared to 19% in Arm B (p=0.002). Febrile neutropenia was also more frequent in the TPF group (28% vs. 13%, p=0.04). Multivariate analysis identified the chemotherapy regimen (HR=1.45, 95% CI 1.05-2.01, p=0.02) and baseline nutritional status (HR=1.78, 95% CI 1.12-2.82, p=0.01) as independent predictors of overall survival. Conclusion While the TPF regimen offers superior efficacy in terms of tumor downstaging and conversion to operability, its higher toxicity profile limits its applicability in resource-constrained settings, such as LMICs. The taxane + platinum regimen, although less effective in downstaging, presents a more favorable toxicity profile, making it a viable alternative for patients with comorbidities or poor performance status. The choice between these regimens should be individualized, considering the patient's overall health, nutritional status, and the availability of supportive care. Further research is warranted to optimize NACT strategies for patients in LMICs.

A Rare Case of Bilateral Cubital Valgus Secondary to Congenital Anterior Radial Head Dislocation.

Congenital radial head dislocation (CRHD) is a rare orthopedic condition that frequently goes undiagnosed due to its asymptomatic presentation in early life. It is often identified incidentally during imaging studies for unrelated complaints or trauma. CRHD is often associated with inherited syndromes, emphasizing the genetic predisposition in this condition. While the majority of individuals remain asymptomatic in childhood, many may develop symptoms later in life, including joint stiffness, restricted range of motion, locking of the elbow joint, and aesthetic concerns related to elbow deformity. These delayed presentations can pose diagnostic challenges and contribute to a late diagnosis. We report the case of a previously asymptomatic patient who presented after a fall with pain in the right elbow. Radiographic imaging revealed radial head dislocation, with characteristic findings including a dysplastic joint, hypoplastic capitulum, convex radial head, and pseudoarthrosis. Further evaluation with X-rays of the contralateral elbow showed similar abnormalities, leading to a diagnosis of bilateral congenital radial head dislocation. Despite the structural abnormalities observed, the patient was managed conservatively without surgical intervention. Follow-up over a five-year period demonstrated satisfactory functional outcomes, with no significant worsening of symptoms or range of motion. This case highlights the importance of recognizing CRHD, particularly in patients who remain asymptomatic until adulthood or present following trauma. Conservative management can be an effective treatment approach in cases without severe functional impairment or pain, reinforcing the need for individualized treatment plans based on the patient's clinical presentation and functional demands.

Proton Radiation Therapy for Head and Neck Cancers.

Head and neck (HnN) cancers are among the most common cancers in the world. Proton therapy (PT) is one of the latest advancements in the treatment modalities of cancers. Proton therapy is specifically used to treat HnN cancer patients due to its less toxic effects on the surrounding critical structures. Keeping in view the opportunities for further advancements, there is a lot of literature covering PT in HnN cancer patients. However, few compiled studies are not enough to compare the toxicities, overall survival (OS), local control (LC), and quality of life (QoL) of PT with that of intensity-modulated radiation therapy (IMRT). The objective of this review is to compile and summarize the literature available on the toxicities, OS, LC, and QoL in HnN cancer patients post PT. We have gathered and summarized the literature found under the keyword "proton therapy for head and neck cancers". Proton therapy is a preferable option over IMRT because it isolates tumors of the HnN, reduces exposure of healthy cells to radiation, and allows accurate tumor scanning using the pencil beam technique. In view of this article, we can say that PT is a preferable mode of radiotherapy for HnN cancer patients in view of its accuracy and lower incidents of acute and late toxicities.

Presence of the knockdown resistance (kdr) mutations in the head lice (Pediculus humanus capitis) population in the North of Iran.

Head lice infestation continues to be a major health problem worldwide. In order to solve this problem, frequent use of pediculocides has caused growing resistance among head lice population. This study aims to investigate the presence of the knockdown resistance (kdr) mutation in the head lice population in northern Iran. Adult head lice were collected from 115 infested individuals referring to the health centers in different parts of Mazandaran province, northern Iran. 38 samples were randomly selected, and Polymerase chain reaction (PCR) was used to amplify a 332-bp and ⁓ 900-bp fragment of the α-subunit of the voltage-sensitive sodium channel (VSSC) gene. According to the analysis of a 332-bp fragment of the VSSC gene, the frequency of kdr T917I mutation including homozygous susceptible (SS), heterozygous resistant (RS), and homozygous resistant (RR) were 45.83%, 12.5%, and 41.66%, respectively. The total frequency of the resistance allele was 54.16%. The results of the 900-bp fragment of the VSSC gene showed two new mutations in the IIS1-2 extracellular loop (H813P) and IIS2 (S825R) and old well-known kdr mutations (M815I-T917I-L920F). The results of Hardy-Weinberg's exact equilibrium test showed that the frequency of genotypes in the studied areas is different from expectations. Moreover, a positive inbreeding coefficient value (F is >0) was found in studied areas which indicated an excess of homozygotes. Overall, the results showed a high frequency of resistant alleles in the northern region of the country. Therefore, it is necessary to develop appropriate control programs for the treatment of pediculosis.