Intratumoral therapies in head and neck squamous cell carcinoma: A systematic review and future perspectives.

BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) presents an ideal scenario for intratumoral therapies (IT), due to its local recurrence pattern and frequent superficial extension. IT therapies aim to effect tumor regression by directly injecting antineoplastic agents into lesions. However, there is a lack of updated evidence regarding IT therapies in HNSCC. PATIENTS AND METHODS: A systematic literature search (CRD42023462291) was conducted using WebOfScience, ClinicalTrials.gov, and conference abstracts from ESMO and ASCO, identifying for IT clinical trials in patients with HNSCC, from database creation to September 12th, 2023. Efficacy as well as safety (grade ≥ 3 treatment-related adverse events[trAEs]) were reported. RESULTS: After evaluation of 1180 articles identified by the systematic search, 31 studies treating 948 patients were included. IT injectables were categorized as chemotherapies with or without electroporation (k = 4, N = 268), oncolytic viruses, plasmids, and bacteria-based (k = 16, N = 446), immunotherapies and EGFR-based therapies (k = 5, N = 160), radioenhancer particles (k = 2, N = 68), and calcium electroporation (k = 1, n = 6). EGFR-antisense plasmids, NBTXR3 radioenhancer and immune innate agonists show best overall response rates, at 83 %, 81 % and 44 % respectively. Eleven (35 %) studies added systemic therapy or radiotherapy to the IT injections. No study used predictive biomarkers to guide patient selection. 97 % studies were phase I-II. Safety-wise, electroporation and epinephrine-based injectable trials had significant local symptoms such as necrosis, fistula formation and post-injection dysphagia. Treatment-related tumor haemorrhages of various grades were described in several trials. Grade ≥ 3 trAEs attributable to the other therapies mainly comprised general symptoms such as fatigue. There were 3 injectable-related deaths across the systematic review. CONCLUSION: This is the first review to summarize all available evidence of IT in HNSCC. As of today, IT therapies lack sufficient evidence to recommend their use in clinical practice. Continuing research on potential molecules, patient selection, safe administration of injections and controlled randomized trials are needed to assess their added benefit.

Validated machine learning tools to distinguish immune checkpoint inhibitor, radiotherapy, COVID-19 and other infective pneumonitis.

BACKGROUND: Pneumonitis is a well-described, potentially disabling, or fatal adverse effect associated with both immune checkpoint inhibitors (ICI) and thoracic radiotherapy. Accurate differentiation between checkpoint inhibitor pneumonitis (CIP) radiation pneumonitis (RP), and infective pneumonitis (IP) is crucial for swift, appropriate, and tailored management to achieve optimal patient outcomes. However, correct diagnosis is often challenging, owing to overlapping clinical presentations and radiological patterns. METHODS: In this multi-centre study of 455 patients, we used machine learning with radiomic features extracted from chest CT imaging to develop and validate five models to distinguish CIP and RP from COVID-19, non-COVID-19 infective pneumonitis, and each other. Model performance was compared to that of two radiologists. RESULTS: Models to distinguish RP from COVID-19, CIP from COVID-19 and CIP from non-COVID-19 IP out-performed radiologists (test set AUCs of 0.92 vs 0.8 and 0.8; 0.68 vs 0.43 and 0.4; 0.71 vs 0.55 and 0.63 respectively). Models to distinguish RP from non-COVID-19 IP and CIP from RP were not superior to radiologists but demonstrated modest performance, with test set AUCs of 0.81 and 0.8 respectively. The CIP vs RP model performed less well on patients with prior exposure to both ICI and radiotherapy (AUC 0.54), though the radiologists also had difficulty distinguishing this test cohort (AUC values 0.6 and 0.6). CONCLUSION: Our results demonstrate the potential utility of such tools as a second or concurrent reader to support oncologists, radiologists, and chest physicians in cases of diagnostic uncertainty. Further research is required for patients with exposure to both ICI and thoracic radiotherapy.

Imaging in trauma of the facial skeleton and soft tissues of the neck.

Trauma to the face and neck is a frequent reason for emergency department attendance. Imaging is invaluable in the characterisation of such injuries, enabling delineation of fracture patterns as well as identification of vascular and other soft tissue injuries. It may also be used to prevent long-term mortality and morbidity and provide a roadmap for surgical intervention so that form and function may be restored. This article gives a pictorial review of the imaging of craniofacial trauma, stratified according to the thirds of the face, followed by a review of blunt and penetrating trauma of the neck. It discusses appropriate imaging modalities for each trauma category, describes major patterns of craniofacial trauma on cross-sectional imaging and identifies clinically relevant imaging features that should trigger subspecialist review or be of relevance to pre-surgical planning. It starts with the upper third comprising frontal sinus fractures before describing the component fractures of the middle third (including nasal, zygomaticomaxillary and orbital fractures) and then focusing on the lower third (specifically mandibular and dentoalveolar fractures). The article concludes with a review of soft tissue injuries of the neck, particularly penetrating, blunt and laryngeal trauma.

A purveyor team's experience: lessons learned from implementing a behavioral health care program in primary care settings.

A growing body of literature indicates that evidence-based behavioral health practices and programs are not being implemented into clinical settings effectively. As a result, many adolescents living with a behavioral health problem are not receiving the quality of services they need. This feasibility study addressed this science-to-service gap through the implementation of an evidence-based adolescent behavioral health screening, assessment, and brief intervention protocol in five distinct primary care settings. This case study documents the authors' experiences in utilizing Fixsen, Naoom, Blase, Friedman, and Wallace's (2005) implementation framework to guide their purveyor efforts, and outlines solutions to overcoming the challenges purveyors may face when implementing evidence-based programs into primary care.

Barriers and facilitators of adolescent behavioral health in primary care: Perceptions of primary care providers.

Several major policy reports describe the central role of primary care in improving the delivery of behavioral health care services to children and adolescents. Although primary care providers are uniquely positioned to provide these services, numerous obstacles hinder the integration of these services, including time, clinic management and organization issues, training, and resources. Although many of these obstacles have been described in the literature, few studies have investigated these issues from the first-person perspective of front-line providers. The purpose of this study, therefore, is to provide an in-depth description of primary care providers' attitudes and perceptions of adolescent behavioral health care across a diversity of primary care settings (i.e., Federally Qualified Health Center [FQHC], FQHC-Look Alike, school-based, military). Sixteen focus groups were conducted at 5 primary care clinics. Thematic analysis was used to analyze the focus group data. Obstacles to integration are presented as well as strategies to overcome these challenges, using training and education, working groups, and community collaboratives.

O uso do aspirado de medula óssea de ilíaco em falhas ósseas de fêmures de camundongos: estudo experimental / The use of inhaled bone marrow of ileum in bone failures of femurs of rats: experimental study

Os autores estudam a utilizacão de medula óssea em camundongos como estimulacão da formacão de calo ósseo. Foram utilizados dez camundongos adultos machos de linhagem isogênica gioto com peso de aproximadamente 250 gramas, e realizadas falhas ósseas na região distal do fêmur com alternância do lado direito e esquerdo, divididos em grupos A e B, sendo como controle camundongos com falha óssea isolado e com falhas ósseas com medula óssea colhida previamente de cada camundongo. Após análise qualitativa e quantitativa foi observado que o uso do aspirado de medula óssea não leva à estimulacão da formacão do calo ósseo e não há o aumento de processo inflamatório local.

Efeito do concentrado de plasma em falhas ósseas provocadas em fêmures de camundongos como estimulação de formação óssea. Estudo experimental / Effect of plasma concentrate on bone defects induced in mice fêmurs via stimulation of bone formation: an experimental study

Os autores estudam experimentalmente o efeito do concentrado de plasma na estimulação óssea em camundongos. Foram utilizados dez camundongos isogênicos de linhagem gioto, onde após a coleta do sangue periférico de um camundongo, foi centrifugado este sangue e obtido um concentrado de plasma; foi utilizado o concentrado de plasma em falhas ósseas na região distal do fêmur, alternando-se os lados direito e esquerdo, sendo um lado com falha óssea isolada e o outro com falha óssea mais o concentrado de plasma e analisados quantitativamente e qualitativamente. Observou-se que o plasma não leva à estimulação da formação do calo ósseo, não ocorrendo aumento do processo inflamatório, e havendo apenas uma tendência a formar mais matriz óssea com o seu uso.

Safety and efficacy of office-based surgery with monitored anesthesia care/sedation in 4778 consecutive plastic surgery procedures.

Office-based surgery has several potential benefits over hospital-based surgery, including cost containment, ease of scheduling, and convenience to both patients and surgeons. Scrutiny of office-based surgery by regulators and state-licensing agencies has increased and must be addressed by improved documentation of safety and efficacy. To evaluate the safety and efficacy of the authors' office-based plastic surgery, a review was undertaken of 3615 consecutive patients undergoing 4778 outpatient plastic surgery procedures under monitored anesthesia care/sedation in a single office. The charts of 3615 consecutive patients who had undergone office-based surgery with monitored anesthesia care/sedation between May of 1995 and May of 2000 were reviewed. In all cases, the anesthesia protocol used included sedation with midazolam, propofol, and a narcotic administered by a board-certified registered nurse anesthetist with local anesthesia provided by the surgeon. Charts were reviewed for patient profile, types of procedures, multiple procedures, duration of anesthesia, American Society of Anesthesiologists class, and complications related to anesthesia. Outcomes measured included death, airway compromise, dyspnea, hypotension, venous thrombosis, pulmonary emboli, protracted nausea and vomiting lasting more than 24 hours, and unplanned hospital admissions. Statistical analyses were performed using the Microsoft Excel program and the SAS package. Results were as follows: 92.3 percent of the patients were female and 7.7 percent were male, with a mean age of 42.7 years (range, 3 to 83 years). Patients underwent aesthetic (95.6 percent) and reconstructive (4.4 percent) plastic surgery procedures. Same-session multiple procedures occurred in 24.8 percent of patients. The vast majority of patients were healthy: 84.3 percent of patients were American Society of Anesthesiologists class I, 15.6 percent were class II, and 0.1 percent were class III. The operations required a mean of 111 minutes. There were no deaths, ventilator requirements, deep venous thromboses, or pulmonary emboli. Complications were as follows: 0.05 percent (n = 2) of patients had dyspnea that resolved, 0.2 percent (n = 6) of patients had protracted nausea and vomiting, and 0.05 percent (n = 2) of patients had unplanned hospital admissions (<24 hours). One patient had an emergent intubation. No prolonged adverse effects were noted. There was a 30-day follow-up minimum. Outpatient surgery is an important aspect of plastic surgery. It was shown that office-based surgery with intravenous sedation, performed by board-certified plastic surgeons and nurse anesthetists, is safe. Appropriate accreditation, safe anesthesia protocols, and proper patient selection constitute the basis for safe and efficacious office-based outpatient plastic surgery.

Basal cell nevus syndrome: guidelines for early detection.

Basal cell nevus syndrome is an autosomal dominant condition with complete penetrance and variable expressivity. It is characterized by five major components, including multiple nevoid basal cell carcinomas, jaw cysts, congenital skeletal abnormalities, ectopic calcifications, and plantar or palmar pits. Other features include a host of benign tumors, ocular defects, and cleft lip and palate. Guidelines for diagnosis include a family history, careful oral and skin examinations, chest and skull radiographs, panoramic radiographs of the jaw, magnetic resonance imaging of the brain, and pelvic ultrasonography in women.

Modified Z-plasty repair of webbed neck deformity seen in Turner and Klippel-Feil syndrome.

OBJECTIVE: Webbed neck deformity exists in many syndromes including Turner's or Klippel-Feil syndrome. Multiple problems are encountered with existing techniques to correct a webbed neck deformity. In Turner's syndrome, a subcutaneous band of thickened fascia and a low neck hairline present a challenge to the surgeon when designing a repair. The authors propose the following new technique that addresses both issues. MATERIAL AND METHODS: Five patients with webbed neck underwent this new procedure. A Z-plasty is performed with the midline arm down the length of the web. The subcutaneous fibrous band is excised, the shortened trapezius is released, and the hair-bearing flap is excised. The anterior flap is rotated and advanced to join its mate flap from the contralateral neck at the posterior midline. A resultant dog-ear near the acromion is corrected with an additional Z-plasty. RESULTS: In all five patients, the functional and aesthetic results were very satisfactory to both patient and surgeon. An 11-year follow-up is presented with excellent correction of the webbing. Both limited range of motion and the cosmetic deformity are addressed by this technique. CONCLUSION: The results obtained by using the simplified modified Z-plasty technique for repair of webbed neck deformity are very satisfactory. We propose the use of this technique for correction of webbed neck deformities whenever the posterior surface of the neck web contains a significant amount of hair.

Carpal tunnel release in the United States and Sweden: reimbursement patterns, cost for treatment, and return to work.

Cost containment plays an increasingly important role in health care, affecting providers and recipients. The present investigation addressed a limited number of factors that relate to the total cost for surgical treatment of carpal tunnel syndrome. The purpose of this study was to compare socioeconomic factors in two different societies and how worker's compensation plays a role in the cost, rehabilitation, and operative practices. To that purpose, the authors studied hospital and insurance records from a total of 123 female patients treated in two tertiary referral centers (University of Pittsburgh, Pa., and University of Umea, Sweden). The 123 patients were referred to three subgroups. Group A comprised patients from the University of Pittsburgh with worker's compensation (n = 34), group B comprised patients from the University of Pittsburgh without worker's compensation (n = 47), and group C comprised patients from the University of Umea (n = 42). The analyzed data showed a tendency toward longer duration of postoperative sick leave for those with worker's compensation than those without worker's compensation for patients from the University of Pittsburgh. However, operating room times and operating times, operative cost, use of postoperative therapy, and duration for sick leave were substantially less for patients treated at the University of Umea. There was no statistically significant difference in time off work between group A and group B. The results may indicate that the effect of compensation on a patient's ability or willingness to recover after treatment for carpal tunnel syndrome may be less important than factors that do not primarily relate to the patient or the surgical procedure.

Shur-clens: an agent to remove silicone gel after breast implant rupture.

Removal of silicone gel from surrounding tissues after implant rupture is difficult. Local inflammation, infection, and silicone granulomas warrant thorough removal of the silicone gel. Shur-Clens (20% solution of the surfactant poloxamer 188), povidone-iodine, and saline are agents that are used to aid in the removal of silicone gel from tissue. The purpose of this study was to compare the efficacy of silicone gel removal by these three agents in vitro. Shur-Clens, povidone-iodine, and saline were compared as solvents for silicone gel. Four weight increments of silicone gel (0.02 g, 0.04 g, 0.06 g, and 0.08 g) were placed on glass slides. These slides were placed in separate beakers containing 40 ml test solution. The slides were soaked for 1 minute with gentle agitation. The slides were removed, rinsed gently with de-ionized water, and placed in a vacuum desiccator to dry. The slides were weighed to determine the amount of silicone removed after soaking in the solution. Analysis of variance was used to determine the significance between the three solvents. The percentages of silicone gel removed for the four weight increments (0.02 g, 0.04 g, 0.06 g, and 0.08 g) in saline were 5.6%, 2.9%, 2.1%, and 5.8%, respectively. In povidone-iodine solution, the percentages were 18.9%, 25.4%, 28.8%, and 51.9%. In Shur-Clens, the percentages were 31.3%, 43.0%, 63.5%, and 79.9%. The greater percentage of silicone gel removed by Shur-Clens was significant compared with the other solutions (p < or = 0.05). Shur-Clens was shown to be a more effective solvent for removal of silicone gel in vitro. This enhanced efficacy is a result of the fact that Shur-Clens contains 20% of the surfactant poloxamer 188. The authors' clinical experience with 7 patients who underwent ruptured silicone breast implant removal demonstrated the superiority of Shur-Clens. Shur-Clens is a surfactant cleanser that is widely available, is inexpensive, and has a good safety profile. They propose the use of Shur-Clens to clean silicone gel spillage to decrease local complications resulting from residual silicone gel.

Use of fibrin sealant in neck contouring.

BACKGROUND: The "suture suspension" platysmaplasty technique has been shown to be an effective and reliable procedure over the last decade. OBJECTIVE: We investigated the effectiveness of fibrin sealant in reducing the recovery time after suture suspension platysmaplasty. METHODS: After contouring the neck with our standard suture sling, hemostasis was assured. The instruments and gloves were wet with saline to prevent adherence to the sealant once it was applied. The 2 syringes were mounted on a Duploject applicator. The fibrin sealant was then sprayed simultaneously into the pockets in thin layers for 60 seconds, the time required for the liquid sealant to activate. Gentle manual pressure was applied over the neck skin, with the surgeon's fingers spread evenly over the whole neck, to prevent pooling of the fibrin sealant in any given area. This pressure was applied for 3 minutes, the time required for the tissue fibrin sealant to solidify. The incisions were closed in a standard fashion. Paper tape was used to cover the neck, and dressings were placed. RESULTS: In 60 patients who underwent neck contouring with lipoplasty and suture suspension and lipoplasty with fibrin sealant between January and July 2001, the time necessary to return to activities of daily living was reduced from 7 to 10 days to 2 to 3 days by the use of fibrin sealant. No complications were reported. CONCLUSIONS: The use of fibrin tissue sealant has markedly improved the postoperative course of patients who underwent the neck suture suspension procedure by both eliminating most potential complications and decreasing recovery time. (Aesthetic Surg J 2002;22:519-525.).

Funçäo dos ligamentos alares e transverso na estabilidade entre o atlas e o áxis: estudo experimental / Function of alar and transverse ligaments in the stability between the atlas and the axis: experimental study

Os autores estudaram em modelo experimental, em vertebras de cäes, a funçäo dos ligamentos alares e transverso na estabilidade entre o atlas e o áxis. Com base nos testes biomecânicos realizados, concluem que a resistência dos ligamentos alares e transverso säo equivalentes e proporcionais e que a ruptura do ligamento transverso só foi obtida nos ensaios em flexocompressäo, enquanto que a ruptura dos alares foi obtida em todos os mecanismos simulados

Resistência dos complexos ligamentares da coluna vertebral à traçäo: estudo experimental em vértebras caninas / Resistance of spine ligamental complexes to traction: experimental study in vertebrae of dogs

Os autores estudaram experimentalmente, em vértebras de cäes, a resistência dos complexos anterior, médio e posterior do segmento toracolombar da coluna à traçäo. Concluem que o complexo ligamentar anterior foi o mais resistente, vindo a seguir o complexo ligamentar médio

Cirurgia profilática de luxaçäo do quadril em crianças com paralisia cerebral / Surgical prophylaxis of hip dislocation in children with cerebral palsy

A luxaçäo do quadril é, sem duvida, a deformidade mais grave nos pacientes com paralisia cerebral. Sabendo-se da complexidade do tratamento de quadris luxados e dos pobres resultados obtidos, é de grande importância reconhecer os quadris em risco e evitar que a luxaçäo ocorra. Os autores avaliaram os resultados do tratamento cirúrgico na profilaxia da luxaçäo do quadril, nas crianças com paralisia cerebral em tratamento na Casa da Esperança de Santos, bem como compararam os resultados com outro grupo submetido a tratamento conservador. Consideram os autores que a prevençäo da luxaçäo se faz imperativa através de correta avaliaçäo propedêutica, visando evitar a progressäo do quadro, no decorrer do desenvolvimento da criança, e seu conseqüente agravamento. Concluem que, uma vez identificado o quadril suspeito, faz-se necessário um acompanhamento e, se houver piora, instituir o tratamento cirúrgico