CT-based diagnosis in patients presenting with throat pain: A single institutional review.

RATIONALE AND OBJECTIVE: To determine if patient demographic data, medical history, physical examination, and laboratory tests will help predict likelihood of imaging-based diagnosis using CT of the neck performed in the ED for a chief complaint of throat pain. MATERIAL AND METHODS: Single institutional, retrospective review of 367 CT scans of the neck performed for the evaluation of throat pain in the ED from August 2013 to September 2019. Patients' clinical history, physical exams, lab findings, and imaging results were recorded. RESULTS: A total of 367 CT scans of the neck performed for the evaluation of throat pain included a recorded exam and clinical history. Of these cases, we noted that the presence of cervical lymphadenopathy (OR = 2.69; 95% CI, 1.37-5.49), tonsillar findings (OR = 2.94; 95% CI, 1.4-6.57), increased white blood cell count (OR = 1.08; 95% CI, 1.02-1.15), and temperature (OR = 1.94; 95% CI, 1.1-3.6) were associated with increased likelihood of obtaining a diagnostic CT scan. CONCLUSION: Consideration of tonsillar abnormalities, lymphadenopathy, body temperature, and measured leukocyte count prior to ordering CT scans of the neck for throat pain may increase the diagnostic yield of such exams and decrease CT utilization in the ED.

Review on the Significant Interactions between Ultrafine Gas Bubbles and Biological Systems.

Having sizes comparable with living cells and high abundance, ultrafine bubbles (UBs) are prone to inevitable interactions with different types of cells and facilitate alterations in physiological properties. The interactions of four typical cell types (e.g., bacterial, fungal, plant, and mammalian cells) with UBs have been studied over recent years. For bacterial cells, UBs have been utilized in creating the capillary force to tear down biofilms. The release of high amounts of heat, pressure, and free radicals during bubble rupture is also found to affect bacterial cell growth. Similarly, the bubble gas core identity plays an important role in the development of fungal cells. By the proposed mechanism of attachment of UBs on hydrophobin proteins in the fungal cell wall, oxygen and ozone gas-filled ultrafine bubbles can either promote or hinder the cell growth rate. On the other hand, reactive oxygen species (ROS) formation and mass transfer facilitation are two means of indirect interactions between UBs and plant cells. Likewise, the use of different gas cores in generating bubbles can produce different physical effects on these cells, for example, hydrogen gas for antioxidation against infections and oxygen for oxidation of toxic metal ions. For mammalian cells, the importance of investigating their interactions with UBs lies in the bubbles' action on cell viability as membrane poration for drug delivery can greatly affect cells' survival. UBs have been utilized and tested in forming the pores by different methods, ranging from bubble oscillation and microstream generation through acoustic cavitation to bubble implosion.

Multitargeted Herbal Prescription So Shiho Tang: A Scoping Review on Biomarkers for the Evaluation of Therapeutic Effects.

Alternative medicines, especially herbal remedies, have been employed to treat infections and metabolism-related chronic inflammation because their safety and multidimensional therapeutic potential outweigh those of synthetic drugs. So Shiho Tang (SSHT), a well-known Oriental prescription (Xiao Chai Hu Tang in Chinese) composed of seven herbs, is traditionally prescribed to treat various viral infections and chronic metabolic disorders in Asia with or without the support of other natural medicines. To provide a general background on how SSHT is used as a medicinal alternative, we conducted a scoping review using the PubMed database system. Among the 453 articles, 76 studies used aqueous extracts of SSHT alone. This result included seven clinical studies and 69 basic studies: cell-based, animal-based, and ex vivo studies. The in vitro and clinical reports mainly focus on hepatic infection and hepatocarcinoma, and the documentation of in vivo tests of SSHT presents a wide range of effects on cancer, fibrosis, inflammation, and several metabolic disorder symptoms. Additionally, among the seven clinical records, two reverse-effect case studies were reported in middle-aged patients. In brief, this systematic review provides general knowledge on the natural remedy SSHT and its potential in phytotherapeutic primary health care.

A comprehensive review of micro- and nano-plastics in the atmosphere: Occurrence, fate, toxicity, and strategies for risk reduction.

Micro- and nano-plastics (MNPs) have received considerable attention over the past 10 years due to their environmental prevalence and potential toxic effects. With the increase in global plastic production and disposal, MNP pollution has become a topic of emerging concern. In this review, we describe MNPs in the atmospheric environment, and potential toxicological effects of exposure to MNPs. Studies have reported the occurrence of MNPs in outdoor and indoor air at concentrations ranging from 0.0065 items m-3 to 1583 items m-3. Findings have identified plastic fragments, fibers, and films in sizes predominantly <1000 µm with polyamide (PA), polyester (PES), polyethylene terephthalate (PET), polypropylene (PP), rayon, polyethylene (PE), polystyrene (PS), polyvinyl chloride (PVC), polyacrylonitrile (PAN), and ethyl vinyl acetate (EVA) as the major compounds. Exposure through indoor air and dust is an important pathway for humans. Airborne MNPs pose health risks to plants, animals, and humans. Atmospheric MNPs can enter organism bodies via inhalation and subsequent deposition in the lungs, which triggers inflammation and other adverse health effects. MNPs could be eliminated through source reduction, policy/regulation, environmental awareness and education, biodegradable materials, bioremediation, and efficient air-filtration systems. To achieve a sustainable society, it is crucial to implement effective strategies for reducing the usage of single-use plastics (SUPs). Further, governments play a pivotal role in addressing the pressing issue of MNPs pollution and must establish viable solutions to tackle this significant challenge.

Double free flaps for complex oromandibular defects with two teams of head and neck reconstructive surgical oncologists.

From December 2019 to July 2021, double free flaps were used by two teams of head-and-neck reconstructive surgical oncologists in 10 patients with large composite mandibulofacial defects following malignant tumor (n = 8) and osteoradionecrosis (n = 2) ablation. Our report included 10 patients. All of our patients were reconstructed by two free flaps, a combination of an anterolateral thigh flap (n = 8) or a radial forearm flap (n = 2) with an osteocutaneous fibula flap. The survival rate of these flaps was 100%. The mean operative time was 597 ± 41.7 min (range 545-660 min). There were no patients with major complications. Most of our patients had accepted functional and cosmetic results of both recipient site and donor site after a median follow-up of 22.5 months. Two teams of reconstructive surgical oncologists may shorten the operative time and reduce the rate of major complications. Main Points: Huge complex oromandibular defects may require the use of double free flap reconstruction.Double free flaps were used by two teams of head-and-neck reconstructive surgical oncologists.This approach may shorten the operative time and reduce the rate of major complications.

Association between early blood urea nitrogen-to-albumin ratio and one-year post-hospital mortality in critically ill surgical patients: a propensity score-matched study.

BACKGROUND: Blood urea nitrogen to albumin ratio (BAR) is increasingly recognized as an early predictor for short-term outcomes in critically ill patients, but the association of BAR with long-term outcomes in critically ill surgical patients remains underexplored. METHODS: We enrolled consecutive patients who were admitted to surgical intensive care units (ICUs) at Taichung Veterans General Hospital between 2015 and 2020, and the dates of death were retrieved from Taiwan's National Health Insurance Research Database. In addition to Cox regression, we also used propensity score matching to determine the hazard ratios (HRs) and 95% confidence intervals (CIs) for one-year post-hospital mortality of the variables. RESULTS: A total of 8,073 eligible subjects were included for analyses. We found that age, male gender, high Charlson Comorbidity Index, high Acute Physiology and Chronic Health Evaluation II score, positive microbial culture, and leukocytosis were predictors for mortality, whereas high body mass index, scheduled surgery, and high platelet counts were protective factors against long-term mortality. The high BAR was independently associated with increased post-hospital mortality after adjustment for the aforementioned covariates (adjHR 1.258, 95% CI, 1.127-1.405). Notably, the association tended to be stronger in females and patients with fewer comorbidities and lower disease severity of critical illness. The propensity score matching, dividing subjects by BAR higher or lower than 6, showed a consistent association between week-one BAR and post-hospital mortality (adjHR 1.503, 95% CI 1.247-1.811). CONCLUSIONS: BAR is a newly identified predictor of short-term outcome, and we identified long-term outcome-relevant factors, including BAR, and the identified factors may be useful for risk stratification of long-term outcomes in patients discharged from surgical ICUs.

Milan system for reporting salivary gland cytology in diagnosis and surgery of parotid gland lesions.

INTRODUCTION: A cytology report is always a challenge for both head and neck surgeons and cytopathologists to diagnose and manage parotid gland (PG) diseases, because of the various similar features between the lesions. OBJECTIVES: The present study was conducted to assess our practice using the Milan System for Reporting Salivary Cytopathology (MSRSGC) and to evaluate the risk of malignancy (ROM) in different categories. PATIENTS AND METHODS: The patients with parotid gland lesions were diagnosed by clinical examination, ultrasound, and FNAC under ultrasound guidance at our hospital from 1 May 2019 to 30 April 2021. The FNAC results were divided into six categories according to the Milan system. We calculated the ROM for each category of the Milan system based on histopathological follow-up. RESULTS: This study included 204 patients. There were 115 men (56 %) aged 46-60 years. Pathology results were 33 cases for malignant and 182 cases for benign. The rate of malignancy for each category according to the MSRSGC were 23.1 % (non-neoplastic), 20 % (atypical), 50 % (neoplastic), 1 % (benign), 10.3 % (salivary neoplasm of uncertain neoplastic potential), 84.6 % (suspicious for malignancy), and 100 % (malignant) categories. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNAC with application of Milan system were respectively 90.9 %, 98.2 %, 90.9 %, 98.9 % and 97 %. CONCLUSION: When the Milan system was applied, FNAC had a high efficacy, suggesting that MSRSGC can improve the communication between the cytopathologist and the surgeon. This system can allow the surgeon to decide the extent of the surgery.

Nucleobase and Linker Modification for Triple-Helical Recognition of Pyrimidines in RNA Using Peptide Nucleic Acids.

Triple-helical recognition of any sequence of double-stranded RNA requires high affinity Hoogsteen hydrogen binding to pyrimidine interruptions of polypurine tracts. Because pyrimidines have only one hydrogen bond donor/acceptor on Hoogsteen face, their triple-helical recognition is a formidable problem. The present study explored various five-membered heterocycles and linkers that connect nucleobases to backbone of peptide nucleic acid (PNA) to optimize formation of X•C-G and Y•U-A triplets. Molecular modeling and biophysical (UV melting and isothermal titration calorimetry) results revealed a complex interplay between the heterocyclic nucleobase and linker to PNA backbone. While the five-membered heterocycles did not improve pyrimidine recognition, increasing the linker length by four atoms provided promising gains in binding affinity and selectivity. The results suggest that further optimization of heterocyclic bases with extended linkers to PNA backbone may be a promising approach to triple-helical recognition of RNA.

Real-world evidence in lung and hematologic oncology health technology appraisals: a review of six assessment agencies.

Aim: To assess the use and acceptability of real-world evidence (RWE) in lung and hematologic cancer appraisals. Materials & methods: A review of appraisals published by National Institute for Health and Care Excellence (NICE) in the UK was conducted. A total of 20 case studies employing RWE were identified and compared across five additional health technology assessment agencies: Scottish Medicines Consortium (SMC) (Scotland), CADTH (Canada), INESSS (Quebec), HAS (France) and IQWiG (Germany). Results: Of 80 RWE references from 20 case studies from NICE, 67 were identified in the respective CADTH submissions, 46 in IQWiG, 37 in INESSS, 37 in HAS, and 33 in SMC. NICE had the highest RWE acceptance rate (90%), followed by HAS (88%), SMC (82%), INESSS (73%), IQWiG (68%) and CADTH (67%). Conclusion: RWE was generally accepted by respective committees, allowing improved access to innovative treatments.

Use of real-world evidence for assessing the value of cancer treatments Health technology assessment (HTA) is a process used to decide whether a drug works well enough to be worth paying for. Most drugs have data showing how well they work from special studies called clinical trials. Sometimes a manufacturer also has evidence of a drug or disease that is not from a clinical trial but from the real world. This review discusses how real-world evidence (RWE) is being used for HTAs of new lung and blood cancer therapies. We reviewed twenty HTA submissions for new therapies. All twenty were submitted to these agencies: National Institute for HealthCare and Excellence (NICE; UK), Scottish Medicines Consortium (SMC; Scotland), Canadian Agency for Drugs and Technologies in Health (CADTH; Canada), National Institute of Excellence in Health and Social Services (INESSS; Quebec), French National Authority for Health (HAS; France) and Institute for Quality and Efficiency in HealthCare (IQWiG; Germany). RWE was often used to describe the type of patient that needs the new therapy. RWE was also used to show the cost of the treatment and how well the treatment worked in relation to its cost. It was also used to show how well the new therapy works compared with other treatments. Most of the RWE was accepted by the agencies. High-quality RWE in relevant patients helped support access to new treatments.

Twelve Years of Establishing the Strategies for Tongue Reconstruction.

BACKGROUND: Reconstruction after resection of malignant tongue tumors remains one of the most difficult problems in head and neck oncology. Recent trends in tongue reconstruction have focused on optimizing speech and swallowing functions and maximizing quality of life. In the recent literature, several reconstructive strategies including regional flaps and free flaps have been described. PATIENTS AND METHODS: A case series of 328 patients underwent oral tongue reconstruction between March 2011 and March 2022. Functional evaluation was performed in all patients 3 months after reconstruction (where the patients required no adjuvant radiotherapy) or after radiotherapy. RESULTS: Total flap necrosis was seen in 5 patients with free flap reconstruction (2 radial forearm flaps, 1 lateral arm flap, and 2 anterolateral thigh flaps), 5 patients with infrahyoid myocutaneous flap, and 1 patient reconstructed with a supraclavicular flap. Our success rate is 96.6%; partial flap necrosis was observed in 11 patients with infrahyoid myocutaneous flap and 2 patients with a supraclavicular flap. Most patients with subtotal glossectomy or smaller defects (type II-IVA defects) could communicate on the phone and had the near-normal capacity for an oral diet. The remaining patients (type IVB-V defects) had significantly lower speech scores. The majority of patients could eat liquid and semiliquid foods. CONCLUSION: Tongue cancer surgery and subsequent reconstruction posed exciting challenges for the surgeon to optimize tongue function and quality of life for patients. Attention to the principles of tongue reconstruction and choosing appropriate flap for each defect achieve better functional results.

Transoral endoscopic thyroidectomy with or without central neck dissection.

PURPOSES: Minimally invasive thyroid surgeries are universally accepted. We report on one, transoral endoscopic thyroidectomy with or without central neck dissection. METHODS: A case series of 103 patients were operated on between December 2018 and December 2021. We performed transoral endoscopic thyroidectomy vestibular approach (TOETVA) for 76 patients with a benign nodule, and 27 with papillary thyroid carcinoma (PTC). The patients with malignant nodules also underwent ipsilateral central neck dissection. The extent of surgery, operative time and operative complications were analyzed. RESULT: No cases were converted to open surgery. Average tumor size was 3.8 ± 1.62 cm, mean operative time was 116.5 ± 41.7 min, median blood loss 40.1 ± 49 mL. There were 95 patients with lobectomy and 8 patients with total thyroidectomy. Temporary hoarseness occurred in 9 patients (8.7 %). No patients developed permanent hoarseness. Twelve patients had middle chin numbness. CONCLUSION: The transoral endoscopic thyroidectomy vestibular approach, with or without central neck dissection, is a safe, effective and highly aesthetic treatment.

Use of the double-paddle anterolateral thigh flap for locally advanced tongue carcinoma requiring second site reconstruction.

BACKGROUND: Advanced oral tongue carcinoma can present with extension beyond the oral cavity. Operative defects after resection may involve multiple anatomical sites and significantly impact speech and swallowing. Dependence on long-term enteral feeding is not uncommon for these patients. The anterolateral thigh (ALT) flap is one of the most reliable and flexible flaps used in the reconstruction of total and subtotal tongue defects. The double-paddle flap modification may be a more suitable option for complex oral tongue defects after advanced tumor ablation. METHODS: Case series of 31 patients with oral tongue squamous cell carcinoma that were classified as stage IV. The age of patients ranged from 32 to 63 years. We designed the double-paddle ALT flaps to reconstruct the two-site surgical defects (tongue defect and pharynx or neck skin defect). Postoperative viability of the flap was checked by clinical observation. The last examination was performed at 3-months after the completion of adjuvant chemoradiotherapy. The functional capacity of our patients was evaluated by three physicians (Head and Neck Surgeon, Radiation Oncologist, and Physiatrist) using a Speech Intelligibility Score and the Functional Oral Intake Scale. RESULTS: A total of 31 patients with surgical defects after total or subtotal tongue resection for cancer underwent double-paddle ALT flaps for reconstruction from March 2018 to December 2019. The dimension of flaps from 8 × 12 cm to 10 × 18 cm were divided into double-paddle from 8 × 5 cm to 10 × 10 cm. There was one case of pedicle thrombosis, one case of postoperative bleeding, three cases of neck infection, and six cases of salivary fistula. Our patients were seen in follow up from 6 to 36 months, with median follow-up of 23.5 months. The survival rate of ALT flap was 100%. All of our patients achieved an oral diet by 9 months after surgery. The mean score speech intelligibility was 2.74 ± 0.68 (4-point ordinal scale). The 2-year disease-free survival rate was 61.3%. CONCLUSIONS: The double-paddle ALT flap is a reliable flap suitable for oral defects involving multiple subsites after ablative procedures. The majority of patients demonstrated acceptable functional rehabilitation. CLINICAL QUESTION/ LEVEL OF EVIDENCE: Therapeutic, IV.

Occurrence and distribution of microplastics in peatland areas: A case study in Long An province of the Mekong Delta, Vietnam.

Vietnam is known as one of the high plastic consumption countries in Southeast Asia. This study initially determined characteristics of microplastics (MPs) including morphology, polymer type, and abundance at peatland areas in Mekong Delta in Vietnam. The MPs level was found with an average abundance of 192.3 ± 261.3 items kg-1. In details, those values at Thanh Hoa, Duc Hue, and Tan Thanh were observed at 57.0 ± 110.4 items kg-1, 7.0 ± 10.6 items kg-1, and 513.0 ± 186.9 items kg-1, respectively. The results indicated that MP particle contaminations in peatland sediments are significant among sampling sites (p < 0.001). Also, FT-IR analysis indicated that polyvinyl chloride is the primary polymer (46.2 %), followed by polyethylene (20.9 %), and polypropylene (9.2 %) in peatland samples and their composition varies in different regions significantly. The fragments (67.0 %) and films (24.6 %) were the most common shapes, followed by fibers (7.6 %) and foams (0.9 %). Small MPs with particle size (300-1000 µm) was the most abundant in sediment samples. Moreover, the most popular colors observed in peatland sediments were aqua (26.6 %), white (25.6 %), blue (25.4 %), and green (12.7 %). Our findings indicated that anthropogenic factors and environmental processes that caused the transformation/transportation and accumulation, leading to rising MP contaminant concerns in peatland areas in Mekong Delta in Vietnam, mainly in terms of the spatial distribution of MPs. In summary, this study provided an in-depth knowledge of microplastic pollution in peatland areas, which is crucial for the building sustainable development strategies in these areas.

Crucial Role of Surfactants in Improving the Extraction Efficiency of ß-Amyrin from Dischidia major Using Ultrasound-Assisted Extraction Coupled with Gas Bubble Flotation.

Ultrasound-assisted extraction coupled with gas bubble flotation was developed as a green method for extracting ß-amyrin fromDischidia major. The solvent system was water:ethanol (9:1). To improve the adsorption of ß-amyrin onto the air/liquid interface during flotation, surfactants were employed; however, the positive effect was only observed with cationic surfactants. High-performance liquid chromatography with spectrophotometric detection (HPLC-PDA) was, for the first time, applied to quantify the ß-amyrin content in D. major and its extracts. With the assistance of surfactants, the foam layer collected from flotation showed high selectivity toward ß-amyrin. The product content was notably increased after surfactants had been removed from the solution.

Ursolic acid and its isomer oleanolic acid are responsible for the anti-dementia effects of Ocimum sanctum in olfactory bulbectomized mice.

This study aims to clarify the bioactive constituents responsible for the anti-dementia effects of Ocimum sanctum Linn. ethanolic extract (OS) using olfactory bulbectomized (OBX) mice, an animal model of dementia. The effects of OS or its extract further fractionated with n-hexane (OS-H), ethyl acetate (OS-E), and n-butanol (OS-B) on the spatial cognitive deficits of OBX mice were elucidated by the modified Y-maze tests. The effects of the major constituents of the most active OS fraction were also elucidated using the reference drug donepezil. The administration of OS and OS-E ameliorated the spatial cognitive deficits caused by OBX, whereas OS-H or OS-B had no effect. Two major constituents, ursolic acid (URO) and oleanolic acid (OLE), and three minor constituents were isolated from OS-E. URO (6 and 12 mg/kg) and OLE (24 mg/kg) attenuated the OBX-induced cognitive deficits. URO (6 mg/kg) and donepezil reversed the OBX-induced down-regulation of vascular endothelial growth factor (VEGF) and choline acetyltransferase expression levels in the hippocampus. URO inhibited the ex vivo activity of acetylcholinesterase with similar efficacy to donepezil. URO inhibited the in vitro activity of acetylcholinesterase (IC50 = 106.5 µM), while the effects of OS, OS-E, and other isolated compounds were negligible. These findings suggest that URO and OLE are responsible for the anti-dementia action of OS extract, whereas URO possesses a more potent anti-dementia effect than its isomer OLE. The effects of URO are, at least in part, mediated by normalizing the function of central cholinergic systems and VEGF protein expression.

Utilization of Ultrafine Gas Bubbles to Investigate the Jones-Ray Effect of Diluted Salt Solutions.

The cause of the Jones-Ray effect has been controversially debated for years. Ultrafine gas bubbles were employed to lessen the surface excess of the surface-active impurities adsorbing to the air/water interface of the salt solutions, which would lead to a direct shift in surface tension observable by the Wilhelmy plate method. It was concluded in this study that once the surface excess of the inevitable impurities in the salts is lessened by the introduction of ultrafine gas bubbles, which possess great air/water interfacial area, the Jones-Ray effect becomes nonobservable. Therefore, our finding hypothesized that the Jones-Ray effect might not originate from salts.

Vein preservation strategies to improve the survival rate of the infrahyoid musculocutaneous flap.

The infrahyoid musculocutaneous flap (IHMCF) is a good alternative in the reconstruction of moderate-sized oral cavity surgical defects. Insufficient venous drainage can significantly affect the survival rate of this flap. OBJECTIVES: Identify the survival rates of the IHMCF and evaluate the functional capacity of reconstructed patients. DESIGN: We report a case series. SETTING: This study took place at the Department of Head and Neck Surgery of Oncology Hospital Ho Chi Minh City, the largest oncology center in South Vietnam. PARTICIPANTS: One hundred and twelve patients with surgical defects after oral cavity resection for cancer underwent IHMCF reconstruction from November 2013 to November 2018. During the harvest of the flap, our modification of the surgical technique specifically attempted to preserve more secondary veins for IHMCF. MAIN OUTCOME MEASURES: Postoperative viability of the flap was checked by clinical observation. The last examination was performed at 3-months after reconstructive operation or after the completion of adjuvant radiotherapy. The functional capacity of our patients was evaluated by three physicians (Head and Neck Surgeon, Radiation Oncologist, and Physiatrist) with understandability of speech scale and the functional oral intake score items assessed. RESULTS: Two cases of partial skin necrosis (1.8%) were experienced. The majority of patients demonstrated favorable functional rehabilitation at long-term follow up. CONCLUSIONS: The IHMCF is a reliable flap suitable for moderate-sized defects of the oral cavity. Altering the surgical approach to specifically preserve more venous outflow can improve the survival rate of the flap. LEVEL OF EVIDENCE: 4.

A rare case of lipomatous pseudohypertrophy of the pancreas.

Lipomatous pseudohypertrophy of the pancreas is a rare disease with unknown etiology, and the pancreas parenchyma is replaced by pancreatic parenchyma by fat tissue. In this article, we aimed to report the case of a 26-year-old male patient admitted to hospital with loss of appetite for 6 months. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) scans showed diffuse enlargement and fatty replacement over the whole pancreas, with scattered remnants of pancreatic parenchyma. Histologic results defined lipomatous pseudohypertrophy of the pancreas. To summarize, this case report is to put forward this extremely rare presentation and to sensitize clinicians that this entity can be a cause of exocrine pancreatic insufficiency, which requires patient follow-up for the appropriate treatment.