Rol de los cuidados perioperatorios guiados por protocolo para mejorar la recuperación tras la cirugía de cáncer de cabeza y cuello: experiencia institucional / Role of protocol-guided perioperative care to enhance recovery after head and neck neoplasm surgery: An institutional experience

Antecedentes: Enhanced recovery after surgery (ERAS) mejora la recuperación tras la cirugía. El objetivo de este estudio fue determinar si ERAS causa una reducción de la estancia hospitalaria y mejora la recuperación funcional global tras la cirugía de cáncer de cabeza y cuello. Métodos Realizamos un estudio prospectivo de control de casos histórico tras la aplicación de ERAS. La base de datos del hospital seleccionó 50 pacientes elegibles confirmados para el grupo control no ERAS, incluyéndose prospectivamente 54 pacientes en el grupo ERAS. El resultado primario fue el tiempo transcurrido hasta la disposición al alta (TRD), siendo los resultados secundarios la duración de la estancia hospitalaria (DEH), la tasa de reingreso de hasta 30 días y la puntuación QoR-15 (Quality of recovery). Los datos fueron comparados mediante pruebas paramétricas y no paramétricas adecuadas. Resultados Los datos demográficos basales de los pacientes fueron comparables entre ambos grupos. Los pacientes del grupo ERAS reflejaron un TRD significativamente más breve, en comparación con el grupo no ERAS: 8 (6-10) frente a 11 (8-16); p=0,002. La DEH fue también significativamente más corta en el grupo ERAS en comparación con el grupo no ERAS (8 [7-11] frente a 12 [9-17]; valor p=0,002). El reingreso en el plazo de 30 días no fue diferente, con una cifra de 6 pacientes en cada grupo. La puntuación QoR-15 fue estadísticamente mejor en el grupo ERAS (94,88±12,50) en comparación con el grupo no ERAS (85,44±12,68; p <0,001). Conclusión La implementación del programa ERAS redujo el TRD y la DEH, mejorando la puntuación QoR-15 sobre el resultado de la recuperación reportado por el paciente en las cirugías de cáncer de cabeza y cuello. (AU)

Background: Enhanced recovery after surgery (ERAS) improve recovery after surgery. This study aimed to determine whether ERAS leads to a decrease in stay in the hospital and improves global and functional recovery after head and neck neoplasms surgery. Methods We performed a prospective case and historical control study after the ERAS application. The hospital database selected 50 confirmed eligible patients in control non-ERAS group. Prospectively 54 patients were included in the ERAS group. The primary outcome was time to readiness for discharge (TRD); secondary outcomes were the length of stay (LOS), readmission rate of up to 30 days and Quality of recovery score QoR-15. Data were compared with appropriate parametric and nonparametric tests. Results Baseline demographic data of patients were comparable between the two groups. Patients in ERAS group had significantly shorter TRD compared to the non-ERAS group 8 (6-10) versus 11 (8-16); P=.002. LOS was also significantly shorter in the ERAS group compared to the non-ERAS group (8 [7-11] versus 12 [9-17]; P=.002). Readmission at 30-days was no different, with six patients in each group. QoR-15 score was statistically better in ERAS group (94.88±12.50) compared to non-ERAS group (85.44±12.68; P<.001). Conclusion Implementing the ERAS programme decreased TRD and LOS and improved patient-reported recovery outcome QoR-15 in head and neck neoplasms surgery. (AU)

Role of protocol-guided perioperative care to enhance recovery after head and neck neoplasm surgery: An institutional experience.

BACKGROUND: Enhanced recovery after surgery (ERAS) improve recovery after surgery. This study aimed to determine whether ERAS leads to a decrease in stay in the hospital and improves global and functional recovery after head and neck neoplasms surgery. METHODS: We performed a prospective case and historical control study after the ERAS application. The hospital database selected 50 confirmed eligible patients in control non-ERAS group. Prospectively 54 patients were included in the ERAS group. The primary outcome was time to readiness for discharge (TRD); secondary outcomes were the length of stay (LOS), readmission rate of up to 30 days and Quality of recovery score QoR-15. Data were compared with appropriate parametric and nonparametric tests. RESULTS: Baseline demographic data of patients were comparable between the two groups. Patients in ERAS group had significantly shorter TRD compared to the non-ERAS group 8 (6-10) vs 11 (8-16); p-value = 0.002. LOS was also significantly shorter in the ERAS group compared to the non-ERAS group [8 (7-11) vs 12 (9-17); p-value = 0.002]. Readmission at 30-days was no different, with six patients in each group. QoR-15 score was statistically better in ERAS group (94.88 ±â€¯12.50) compared to non-ERAS group (85.44 ±â€¯12.68) [p value < 0.001]. CONCLUSION: Implementing the ERAS programme decreased TRD and LOS and improved patient-reported recovery outcome QoR-15 in head and neck neoplasms surgery.

Synthesis, biological evaluation, and molecular docking study of some new rohitukine analogs as protein tyrosine phosphatase 1B inhibitors.

Rohitukine (RH) was extracted from the stem bark of Dysoxylum binectariferum Hook. It was derivatized to different arylsulphanmides by treating with the corresponding aryl sulphonyl chlorides. These derivatives were tested in-vitro on protein tyrosine phosphatase 1B (PTP1B) inhibition. Among these the active compounds K2, K3, K5, and K8 significantly inhibited the PTP1B by 51.3%, 65.6%, 71.9%, and 55.9% respectively at 10 µg/ml, the results were also supported by in-silico docking experiments. The most potent compound K5 was analyzed for antidiabetic and antidyslipidemic activity in vivo. It showed a marked reduction in blood glucose level (random and fasting) and serum insulin level in db/db mice. It improved glucose intolerance as ascertained by the oral glucose tolerance test (OGTT). These NCEs (New Chemical Entities) also lowered cholesterol and triglyceride profiles while improved high-density lipoprotein cholesterol in db/db mice. The K5 was further evaluated for antiadipogenic activity on MDI (Methylisobutylxanthine, dexamethasone, and insulin)-induced adipogenesis. where it significantly inhibited MDI-induced adipogenesis in 3 T3-L1 preadipocytes, at 10 µM and 20 µM concentration. These results were compared with the parent compound RH which inhibited 35% and 45% lipid accumulation while the RH analog K5 inhibited the lipid accumulation by 41% and 51% at 10 and 20 µM concentration, respectively. These results well corroborated with in-silico studies.

Numerical analysis of lasing characteristics in highly bend-compensated large-mode-area ytterbium-doped double-clad leakage channel fibers.

The bend-induced mode-area reduction and thermal effects are vital factors that affect the power scaling of fiber lasers. Recently, bend-compensated large-mode-area double-clad modified hybrid leakage channel fiber (M-HLCF) has been reported with a mode area greater than 1000 µm, while sustaining the single-mode behavior at 1064 nm for high-temperature environments. In this work, the lasing characteristics of a newly designed ytterbium-doped double-clad M-HLCF (YDMHLCF) have been numerically investigated for strongly pumped conditions. The doped region size is optimally found through simulations, equivalent to the size of core diameter ∼38 µm in order to achieve maximum conversion efficiency for the bent and straight cases. Numerical simulations further confirm that a 2 m long YDMHLCF exhibits slope efficiency of 78% and conversion efficiency of 79% for the straight case and also almost the same for the practical bending radius of 7.5 cm when pumped with a 975 nm laser source.

Autologous total ossicular replacement prosthesis.

OBJECTIVE: To develop an autologous total ossicular replacement prosthesis with sustainable hearing results. METHODS: The ears of 40 patients, who had chronic otitis media with absent suprastructure of the stapes and long process of the incus, were repaired using the autologous total ossicular replacement technique. Post-operative results were evaluated after 6 and 12 months on the basis of average pure tone air conduction and average air-bone gap measured at 0.5, 1, 2 and 3 kHz. RESULTS: Successful rehabilitation of pure tone average to 30 dB or less was achieved in 75 per cent of patients, and air-bone gap to 20 dB or less was attained in 82.5 per cent of patients. Overall mean improvement in air-bone gap was 23.9 ± 8.5 dB (p < 0.001). Mean improvements in air-bone gap were significantly greater (p < 0.05) in the tympanoplasty only group (27.3 ± 6.6 dB) and the intact canal wall tympanoplasty group (25.9 ± 6.3 dB) than in the canal wall down tympanoplasty group (16.3 ± 8.9 dB). CONCLUSION: This paper describes an autologous total ossicular replacement prosthesis that is biocompatible, stable, magnetic resonance imaging compatible and, above all, results in sustainable hearing improvement.

Tunable optical parametric amplification characteristics of liquid-filled chalcogenide photonic crystal fibers.

A new technique to attain tunable parametric amplification in photonic crystal fibers (PCFs) through control of chromatic dispersion is proposed and empirically investigated. By infiltrating the air channels of the PCFs with suitable thermo-optic liquids, the zero-dispersion wavelength (ZDW) can be tailored to provide a wider gain spectrum in the mid-IR range and generate blueshifted frequency components. It is deduced that a change of 10-20 nm in the ZDW around the pump creates a gain region several hundred nanometers from the pump wavelength by only varying the temperature of the liquid externally.

Bragg x-ray survey spectrometer for ITER.

Several potential impurity ions in the ITER plasmas will lead to loss of confined energy through line and continuum emission. For real time monitoring of impurities, a seven channel Bragg x-ray spectrometer (XRCS survey) is considered. This paper presents design and analysis of the spectrometer, including x-ray tracing by the Shadow-XOP code, sensitivity calculations for reference H-mode plasma and neutronics assessment. The XRCS survey performance analysis shows that the ITER measurement requirements of impurity monitoring in 10 ms integration time at the minimum levels for low-Z to high-Z impurity ions can largely be met.

Smart nanocarriers for pH-triggered targeting and release of hydrophobic drugs.

The use of hybrid pH-sensitive micelles based mainly on the (PEO)(129)(P2VP)(43)(PCL)(17) ABC miktoarm star copolymer as potential triggered drug delivery systems was investigated. Co-micellization of this star copolymer with a second copolymer labeled by a targeting ligand, i.e. biotin, on the pH sensitive block (poly-2-vinylpyridine) is considered here in order to impart possible active targeting of the tumor cells. Two architectures were studied for these labeled copolymers, i.e. a miktoarm star or a linear ABC terpolymer, and the respective hybrid micelles are compared in terms of cytotoxicity (cells viability) and cellular uptake (using fluorescent dye loaded micelles). Finally, the triggered drug release in the cytosol of tumor cells was investigated by studying, on the one hand, the lysosomal integrity after internalization and, on the other hand, the release profile in function of the pH.

Stealth properties of poly(ethylene oxide)-based triblock copolymer micelles: a prerequisite for a pH-triggered targeting system.

Evaluation of the biocompatibility of pH-triggered targeting micelles was performed with the goal of studying the effect of a poly(ethylene oxide) (PEO) coating on micelle stealth properties. Upon protonation under acidic conditions, pH-sensitive poly(2-vinylpyridine) (P2VP) blocks were stretched, exhibiting positive charges at the periphery of the micelles as well as being a model targeting unit. The polymer micelles were based on two different macromolecular architectures, an ABC miktoarm star terpolymer and an ABC linear triblock copolymer, which combined three different polymer blocks, i.e. hydrophobic poly(ε-caprolactone), PEO and P2VP. Neutral polymer micelles were formed at physiological pH. These systems were tested for their ability to avoid macrophage uptake, their complement activation and their pharmacological behavior after systemic injection in mice, as a function of their conformation (neutral or protonated). After protonation, complement activation and macrophage uptake were up to twofold higher than for neutral systems. By contrast, when P2VP blocks and the targeting unit were buried by the PEO shell at physiological pH, micelle stealth properties were improved, allowing their future systemic injection with an expected long circulation in blood. Smart systems responsive to pH were thus developed which therefore hold great promise for targeted drug delivery to an acidic tumoral environment.

Prevalence of hepatitis C virus genotypes and impact of T helper cytokines in achieving sustained virological response during combination therapy: a study from Central India.

Characterisation of host immune response to hepatitis C virus (HCV) genotypes may have an important prognostic and therapeutic implication. Genotype-3 was more prevalent in the examined cohort and demonstrated a significantly higher response to combination therapy than genotype-1. Sustained virological response (SVR) was 94.74% in genotype-3 and 45.45% in genotype-1. The patients who achieved SVR reported higher levels of circulating T helper 1 cytokines in comparison to subjects with no SVR in both the studied groups. Besides providing local prevalence, our study might also assist in understanding the host immune mechanisms involved to achieve SVR during combination therapy in chronic HCV patients.

Diagnosis of gastrointestinal tuberculosis: Using cytomorphological, microbiological, immunological and molecular techniques - A study from Central India.

The present study included three groups: (A) age and gender matched control (n=24) with no previous signs of M. tuberculosis complex (MTBC) infection, (B) patients (n=28) diagnosed with gastro-intestinal TB (GITB), (C) patients (n=50) with clinical and histo-pathological signs of GITB, but were culture and AFB negative. Real time assay performed using fluorescence resonance energy transfer hybridization probes showed a positivity index of 36 % in group C, i.e. 18 were found reactive from the total 50 cases studied. In addition, immune characterization of these 18 cases showed depleted CD(4) (+) count and increased levels of IFN-γ and TNF-α cytokines. No positive case was found in group A, while in group B, out of total 28 cases studied 27 were found positive. A combinatorial diagnostic approach for rapid detection and characterization of GITB might provide specific therapeutic strategies for prevention and treatment of the infection in future.

Correlation of aberrant expression of p53, Rad50, and cyclin-E proteins with microsatellite instability in gallbladder adenocarcinomas.

Gallbladder carcinoma is an uncommon, but highly malignant tumor, with poor prognostic, and diagnostic manifestations in early stages. The Indian Council of Medical Research reported increased incidence of gallbladder carcinoma in the surviving population of the Bhopal gas tragedy that involved exposure of more than 500,000 people to methyl isocyanate gas. The severity of exposure, and increased multi-systemic morbidity in the survivors stimulated us to examine the molecular changes leading to gallbladder carcinoma. Surgically resected samples (N = 40) of gallbladder carcinoma were studied for the p53, Rad50, and cyclin-E expression by immunohistofluorescence bioimaging. Among the 40 samples, 23, 11, and 10 showed p53, Rad50, and cyclin-E expression, respectively, in moderately differentiated adenocarcinomas, demonstrating the prevalence and invasiveness of this disease in the methyl isocyanate-exposed population (P = 0.0009). Nevertheless, co-expression of Rad50, and cyclin-E with p53 was absent in adenomas with dysplasia, demonstrating their independent roles. We conclude that there was altered expression of p53, Rad50, and cyclin-E in the malignant transformation of gallbladder carcinoma in this methyl isocyanate gas-exposed cohort. Hence, these proteins may be useful as markers to identify premalignant lesions that are likely to progress into malignant adenocarcinoma.

Design and simulation of 1310 nm and 1480 nm single-mode photonic crystal fiber Raman lasers.

We have numerically investigated the Raman lasing characteristics of a highly nonlinear photonic crystal fiber (HNPCF). HNPCF Raman lasers are designed to deliver outputs at 1.3 microm and 1.48 microm wavelengths through three and six cascades of Raman Stokes cavities when the pumps of 1117 nm and 1064 nm are injected into HNPCF module, respectively. A quantum efficiency of approximately 47% was achieved in a short length of HNPCF for 1.3 microm lasing wavelength. The HNPCF design is modified further to operate in single-mode fashion keeping intact its Raman lasing characteristics. The modified HNPCF design consists of two air-hole rings where the higher-order modes in the central core are suppressed by enhancing their leakage losses drastically, thus ceasing their propagation in the short length of HNPCF. On the other hand, the fundamental mode is well confined to the central core region, unaffecting its lasing performances. Further, the lasing characteristics of HNPCF at 1480 nm are compared with conventional highly nonlinear fiber Raman laser operating at 1480 nm. It is found that one can reduce the fiber length by five times in case of HNPCF with nearly similar conversion efficiency.

Bend-insensitive lasing characteristics of single-mode, large-mode-area ytterbium-doped photonic crystal fiber.

The bend-insensitive lasing characteristics of a newly designed ytterbium-doped photonic crystal fiber (YPCF) are evaluated numerically. The designed YPCF remains single-mode and possesses large-mode-area of 1400 microm(2) at 1064 nm wavelength with the beam quality factor (M(2)) of 1.15, suggesting a diffraction-limited and continuous-wave lasing operation. The doped-region size is optimized for maximum conversion efficiency and it is found through numerical simulations that the doped radius should be more than 21 microm. The "mode expansion", which is the self-expansion of the fundamental mode within the doped region with wavelength increments on bending the fiber, is the basic physical mechanism to give the bend-insensitive lasing performances of YPCF. It leads to an unusual variation of overlap factor when the wavelength is increased. A 41 cm long piece of YPCF demonstrates more than 83% of slope efficiency with 75% of conversion efficiency when pumped with a 975 nm laser source delivering an input power of 1 W.

Strategies for realizing photonic crystal fiber bandpass filters.

Numerical design strategies are presented to achieve efficient broad or narrow band-pass filters based on index-guiding, solid-core, and single-mode photonic crystal fibers (PCFs). The filtering characteristics have been verified through BPM solver. By scaling the pitch constant, the bandpass window can be shifted accordingly. The fiber design constitutes a fluorine-doped central core, enlarged air-holes surrounding the down-doped core, and small air-holes in the cladding. The proposed bandpass filter is based on controlling the leakage losses, so one can tune filter characteristics simply by changing its length. From numerical simulations we show that for large values of air-hole diameter in the first ring, the bandpass window is narrow, while for low doping concentration and small sized air-holes in the first ring, bandpass window is very broad. We also simulate how the hole-size and number of rings in the PCF cladding affects the device characteristics. We find that a 5-cm long PCF with down-doped core and eleven rings of air-holes can result in approximately 440 nm 3-dB bandwidth with more than 90% of transmission. The longer device has reduced transmission and smaller 3-dB bandwidth. Tolerance analysis has also been performed to check the impact of fiber tolerances on the performance of the PCF bandpass filter. It has been observed that the decrement in cladding hole-diameter by 1% reduces the transmission to 21% from its peak value of 93%, however +/-1% tolerance in the inner hole-diameter degrades the transmission to 75% from its peak.

Leiomyoma of the nose.

Leiomyomas are benign neoplasms that are thought to originate from the vascular smooth muscle. They have a propensity to arise from the gastrointestinal tract, female genital tract (uterus) and subcutaneous tissue. The nasal cavity is an uncommon site for a leiomyoma. We report a 24-year-old woman with a rare nasal leiomyoma. A brief review of the literature and histological variations are described.

Rosai Dorfman syndrome with extranodal manifestation.

Rosai Dorfman Syndrome (RDS) is a benign condition and a rare cause of cervical lymphadenopathy. It usually occurs in the first decade of life and manifest as massive enlargement of cervical lymph nodes. The disease has a benign course and involvement of the nasal cavity as an extranodal site is exceptional. A 22-year-old male presented as progressive massive bilateral cervical lymphadenopathy accompanied with nasal obstruction and occasional episodes of epistaxis. A FNAC from cervical lymph node and biopsy from nasal mass was compatible with RDS.

Measurement of chromatic dispersion and Raman gain efficiency of a hole-assisted fiber: Influence of bend.

We have experimentally measured the Raman gain efficiency (RGE) and chromatic dispersion (CD) of a hole-assisted fiber (HAF). The RGE of a HAF was characterized using standard pump on/off technique while the CD of the fiber was measured using optical network analyzer. Theoretical simulations of the modal characteristics and the RGE of HAF were carried out using an accurate full-vectorial finite element method. Further, the bending effects on the CD and the RGE of a HAF with a smallest feasible bending radius are demonstrated. It was found that the CD increases while the RGE is decreased by bending HAF in a smallest bending radius of 5 mm. Numerical predictions from the theory are shown to be in good agreement with the experimental results.