The hemostatic effect of hot saline irrigation in endoscopic sinus surgery: a systematic review and meta-analysis.

BACKGROUND: A good control of intraoperative bleeding is key for adequate anatomical visualization during endoscopic sinus surgery (ESS). The objective of this review was to assess the practice of hot intranasal saline irrigation (HSI) in achieving intraoperative hemostasis and good surgical field quality during ESS. METHODS: An electronic search was performed via PubMed, SCOPUS, Google Scholar, and Cochrane from inception to June 2022. The included trials were evaluated according to the recommendations of the Cochrane Handbook for Systematic Reviews. The primary outcome assessed was the intraoperative bleeding score of the surgical field. The mean arterial pressure, duration of the surgery, amount of blood loss and surgeon's satisfaction score were assessed as the secondary outcomes. The risk of bias for each study was evaluated using the Cochrane risk of bias tool. RESULTS: A total of 254 records were identified after removal of duplicates. Based on the title and abstract 246 records were excluded, leaving seven full texts for further consideration. Five records were excluded following full text assessment. Three trials with a total of 212 patients were selected. Hot saline irrigation was superior to control in the intraoperative bleeding score (MD - 0.51, 95% CI - 0.84 to - 0.18; P < 0.001; I2 = 72%; very low quality of evidence) and surgeon's satisfaction score (RR 0.18, 95% CI 0.09 to 0.33; P < 0.001; I2 = 0%; low quality of evidence). The duration of surgery was lengthier in control when compared to HSI (MD - 9.02, 95% CI - 11.76 to - 6.28; P < 0.001; I2 = 0; very low quality of evidence). The volume of blood loss was greater in control than HSI (MD - 56.4, 95% CI - 57.30 to - 55.51; P < 0.001; I2 = 0%; low quality of evidence). No significant difference between the two groups for the mean arterial pressure was noted (MD - 0.60, 95% CI - 2.17 to 0.97; P = 0.45; I2 = 0%; low quality of evidence). CONCLUSIONS: The practice of intranasal HSI during ESS is favorable in controlling intraoperative bleeding and improving the surgical field quality. It increases the surgeon's satisfaction, reduces blood loss, shortens operative time and has no effect on intraoperative hemodynamic instability. TRIAL REGISTRATION: PROSPERO registration number: CRD42019117083.

The Effects of Tamoxifen on Tolerogenic Cells in Cancer.

Tamoxifen (TAM) is the most prescribed selective estrogen receptor modulator (SERM) to treat hormone-receptor-positive breast cancer patients and has been used for more than 20 years. Its role as a hormone therapy is well established; however, the potential role in modulating tolerogenic cells needs to be better clarified. Infiltrating tumor-microenvironment-regulatory T cells (TME-Tregs) are important as they serve a suppressive function through the transcription factor Forkhead box P3 (Foxp3). Abundant studies have suggested that Foxp3 regulates the expression of several genes (CTLA-4, PD-1, LAG-3, TIM-3, TIGIT, TNFR2) involved in carcinogenesis to utilize its tumor suppressor function through knockout models. TAM is indirectly concomitant via the Cre/loxP system by allowing nuclear translocation of the fusion protein, excision of the floxed STOP cassette and heritable expression of encoding fluorescent protein in a cohort of cells that express Foxp3. Moreover, TAM administration in breast cancer treatment has shown its effects directly through MDSCs by the enrichment of its leukocyte populations, such as NK and NKT cells, while it impairs the differentiation and activation of DCs. However, the fundamental mechanisms of the reduction of this pool by TAM are unknown. Here, we review the vital effects of TAM on Tregs for a precise mechanistic understanding of cancer immunotherapies.

Heterogeneity of Genetic Landscapes in Salivary Gland Tumors and Their Critical Roles in Current Management.

Salivary gland neoplasms (SGNs) are rare and heterogeneous tumors in the head and neck region. Although progress has been recently made in revealing the molecular landscape of salivary glands tumors, it is limited and appears to be the tip of the iceberg. Some genetic aberrations include chromosomal translocations, such as CRTC1/3-MAML2 in mucoepidermoid carcinoma, g MYB-NFIB gene fusions in adenoid cystic carcinoma, and PLAG1-HMGA2 gene changes in pleomorphic adenoma and carcinoma ex pleomorphic adenoma. These chromosomal translocations provide fresh insights into the molecular etiology of diverse SGNs and aid in their classification and in approaching treatment. In future, these genetic variations may serve as critical tools for diagnosing salivary gland tumors and optimizing the management as well as prognosis of patients. This review presents the most recent advances in the molecular pathology of salivary gland cancers, with an emphasis on distinguishing molecular features that can be used for optimizing current patient management.

The prevalence of frontal cell variants according to the International Frontal Sinus Anatomy Classification and their associations with frontal sinusitis.

BACKGROUND: The International Frontal Sinus Anatomy Classification (IFAC) is introduced to simplify the classification of different frontal cell variants based on their topographical structures. The objectives of our study were to determine the prevalence of the frontal cell variants according to IFAC and their association with the development of frontal sinusitis. METHODOLOGY: A retrospective chart review on computed tomography paranasal sinus (CTPNS) was conducted. A total of 200 patients who had clinical and endoscopic findings of chronic rhinosinusitis (CRS) and undergone CTPNS were reviewed. The CTPNS was evaluated for the presence of frontal cell variants according to IFAC and mucosal changes consistent with frontal sinus involvement. RESULT: A total of 400 sides of the CTPNS were analyzed. The agger nasi cells (ANCs) were the most common (95.5%) followed by supra bulla cells (SBCs) (60.8%), supra bulla frontal cells (SBFCs) (53.0%), supra agger cells (SACs) (50.0%), supra agger frontal cells (SAFCs) (36.0%), frontal septal cells (FSCs) (8.3%), and supraorbital ethmoidal cells SOECs (5.5%). There was significant association between SOEC (p = 0.001) and FSC (p = 0.044) with the development of frontal sinusitis. CONCLUSIONS: Apart from ANCs, the posterior-based cells (SBCs and SBFCs) have higher prevalence than the anterior-based cells (SACs and SAFCs). Despite being the least, both SOECs and FSCs are significantly associated with frontal sinusitis.

Impact of Narrow Band Imaging in Pre-Operative Assessment of Suspicious Oral Cavity Lesions: A Systematic Review.

INTRODUCTION: Narrow band imaging (NBI) is a powerful tool that allows visualizing the mucosal and submucosal vasculature. Among the available diagnostic techniques, NBI is one of the most valid for early detection of oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: We carried out a bibliographic search in PubMed, Scopus and Web of Science databases using relevant keywords. Articles selected were screened by two independent authors based on inclusion and exclusion criteria. Nine papers were singled out according to the eligibility criteria and included in this review. We investigated the articles for pooled sensitivity, specificity, accuracy, positive predictive value and negative predictive value of pre-operative NBI. RESULTS: The use of NBI examination in the oral cavity revealed higher specificity, sensitivity, positive and negative predictive values and accuracy compared to white light examination for the diagnosis of oral squamous cell cancer (OSCC). In addition, NBI has proved great utility in detecting malignancy features in oral pre-malignant lesions. CONCLUSIONS: This review shows that NBI is a powerful tool for examining oral suspicious lesions. Most of the articles examined revealed high values of sensitivity, specificity, positive predictive value, negative predictive value and accuracy in detection of oral malignant and pre-malignant lesions. Therefore, the use of NBI is highly recommended for the early detection of oral cancer and potentially malignant disorders. Future studies should seek to affirm the validity of NBI and in particular to standardize NBI classification.

Ni endoscopic classification for Storz Professional Image Enhancement System (SPIES) endoscopy in the detection of upper aerodigestive tract (UADT) tumours.

The diagnostic procedure for upper aerodigestive tract (UADT) tumours is by white light endoscopy (WLE) combined with biopsy. However, WLE has difficulty identifying minute epithelial changes which hinders early diagnosis. Storz Professional Image Enhancement System (SPIES) is designed to enhance the visualization of microvasculature on the mucosal surface and detect any epithelial changes. In this study, we aimed to evaluate the use of Ni endoscopic classification with SPIES endoscopy in the detection of UADT tumours. Fifty-nine patients with suspected UADT tumours underwent WLE followed by SPIES endoscopy. All the tumours were biopsied and sent for histopathological examination (HPE). The kappa index (κ) was used to evaluate the agreement between the methods. The level of agreement between SPIES using Ni classification and HPE showed almost perfect agreement as compared to moderate agreement between WLE and HPE. The sensitivity and specificity for WLE and HPE were 77.5% and 84.2% respectively with positive predictive value (PPV) of 91.2% and negative predictive value (NPV) of 64%. The sensitivity and specificity for SPIES endoscopy using Ni classification and HPE were 97.5% and 94.7% respectively with PPV of 97.5% and NPV of 94.7%. SPIES endoscopy using Ni classification is a valid tool for earlier tumour detection.

Technical Considerations in Ex Vivo Human Regulatory T Cell Migration and Suppression Assays.

Regulatory T cells (Tregs) are renowned for maintaining homeostasis and self-tolerance through their ability to suppress immune responses. For over two decades, Tregs have been the subject of intensive research. The immunosuppressive and migratory potentials of Tregs have been exploited, especially in the areas of cancer, autoimmunity and vaccine development, and many assay protocols have since been developed. However, variations in assay conditions in different studies, as well as covert experimental factors, pose a great challenge to the reproducibility of results. Here, we focus on human Tregs derived from clinical samples and highlighted caveats that should be heeded when conducting Tregs suppression and migration assays. We particularly delineated how factors such as sample processing, choice of reagents and equipment, optimization and other experimental conditions could introduce bias into the assay, and we subsequently proffer recommendations to enhance reliability and reproducibility of results. It is hoped that prioritizing these factors will reduce the tendencies of generating false and misleading results, and thus, help improve our understanding and interpretation of Tregs functional studies.

Significance of Nasal Septum Angulation and Its Association with Rhinosinusitis Symptom Scores.

OBJECTIVE: The aim of the study was to determine the association of angulation of nasal septum with the severity of rhinosinusitis as measured by symptom score and Visual Analog Score (VAS). METHOD: The study was performed as a cross sectional study conducted at two different centres in Malaysia. Ninety-eight patients who were diagnosed with rhinosinusitis and fulfilled the selection criteria were assessed as for the symptom score and VAS and the measurement of angulation of nasal septum was performed through a coronal view of CT paranasal sinuses in bone window setting at osteomeatal complex level. RESULTS: The result obtained from one-way ANOVA test revealed a significant association between category of severity of septal angulation and the symptom score of rhinosinusitis (p=0.025). In addition, the result obtained from one-way ANOVA test also revealed a significant association between category of severity of septal angulation and the VAS of rhinosinusitis (p<0.05). CONCLUSION: Severity of nasal septum angulation may be significantly associated with severity of rhinosinusitis based on symptom score and VAS. These findings could be used in tailored management of patient with rhinosinusitis especially during functional endoscopic sinus surgery.

Multidisciplinary approach to children with sinonasal tumors: A review.

Sinonasal tumors in children are rare and difficult to manage. These tumors can be broadly categorized into congenital or acquired and benign or malignant. The tumors mainly arise from the mucosa, cartilage, or bone of the nasal cavity and may occupy areas of the nasal septum, turbinates, osteomeatal complex, sinuses, and nasopharynx. The management of pediatric sinonasal tumors is challenging, especially in cases of malignancy. Malignant tumors pose a treatment dilemma because most such tumors tend to be aggressive and carry a poor prognosis. Multiple complications associated with the primary disease or treatment may occur, and such complications need to be fully addressed to provide optimal care. In most cases, a multidisciplinary team approach will offer the best possible outcome for children with sinonasal tumors.

Carcinoma Ex Pleomorphic Adenoma Presented as a Gigantic Tumor: Treatment and Diagnostic Challenges.

Parotid gland surgery can be challenging due to intricate relationship between the gland and facial nerve. Besides complete removal of the lesion, the main focus of surgery is centered on the facial nerve. Surgery can be technically demanding especially when the tumor is large or involves the deep lobe. We report a patient with a 30-year history of gigantic parotid mass, which initial fine-needle aspiration cytology reported as pleomorphic adenoma. The tumor, weighing 1.3 kg, was successfully resected with facial nerve preservation. Histopathological examination of the excised mass confirmed as carcinoma ex pleomorphic adenoma (CaExPA) of adenocarcinoma, not otherwise specified type. We describe the specific surgical and reconstruction techniques for successful removal of large parotid tumors with facial nerve preservation. To our knowledge, this is the heaviest CaExPA of the parotid gland in South-East Asian region.

The effectiveness of Tualang honey in reducing post-tonsillectomy pain.

OBJECTIVES: This study aims to evaluate the effectiveness of Tualang honey in reducing post-tonsillectomy pain. PATIENTS AND METHODS: The study included 63 patients (31 males, 32 females; mean age 10±4.16 years; range 3 to 18 years) who were planned to undergo tonsillectomy. Patients were randomized into two groups. Treatment group received topical Tualang honey intraoperatively followed by oral consumption of Tualang honey three times daily for seven days with intravenous sultamicillin three times daily for first and second day followed by oral sultamicillin twice daily for five days. Control group received intravenous sultamicillin for two days followed by oral sultamicillin twice daily for five days. Patients' pain was assessed according to visual analog scale, frequency of waking up at night due to pain, and additional use of analgesic from postoperative first to seventh day. Results from each group were statistically compared. RESULTS: Early postoperative pain was relieved slightly faster in Tualang honey + antibiotic group; however, the difference between groups was not statistically significant. On postoperative seventh day, all of patients (100%) in Tualang honey + antibiotic group experienced no pain compared to the antibiotic only group. Frequencies of waking up at night and use of analgesic were lower in the Tualang honey + antibiotic group compared to antibiotic only group. CONCLUSION: Early postoperative pain was relieved slightly faster in Tualang honey + antibiotic group, which may be attributed to the soothing effect of honey.