A predictive survival model for patients with stage IV oropharyngeal squamous cell carcinoma treated with chemoradiation.

PURPOSE: To evaluate the pre-treatment and post-treatment clinical factors associated with rate of survival at 1, 3, and 5 years in stage IV oropharyngeal cancer patients treated with concurrent chemoradiation with/without neoadjuvant chemotherapy. METHODS: This retrospective cohort study involved 128 Stage IV oropharyngeal cancer patients that were treated at our tertiary referral center between 2008 and 2020. The pre-treatment and post-treatment clinical parameters including nutritional status and inflammatory markers were retrospectively reviewed. RESULTS: The 5-year overall survival rate for all patients was 36.72%. The disease-specific survival (DSS) at 1-year and 3-year were 80% and 63%, whereas the disease-free survival (DFS) at 1-year and 3-year were 49% and 40%, respectively. In multivariate analyses, pretreatment hemoglobin (Hb) < 12 g/dL (hazard ratio [HR] 2.551, 95% confidence interval [CI] 1.366-4.762, p = 0.003), pretreatment systemic immune inflammation (SII) ≥ 1751 (HR 2.173, 95% CI 1.015-4.652, p = 0.046), and posttreatment systemic inflammation response index (SIRI) ≥ 261 (HR 2.074, 95% CI 1.045-4.115, p = 0.037) were independent indicators for worsened DSS. Pretreatment Hb < 12 g/dl (HR 1.692, 95% CI 1.019-2.809, p = 0.032), pretreatment SII ≥ 1751 (HR 1.968, 95% CI 1.061-3.650, p = 0.032), and posttreatment SII ≥ 1690 (HR 1.922, 95% CI 1.105-3.345, p = 0.021) were independent indicators for worsened DFS. A nomogram was developed using pretreatment Hb, pretreatment SII, and posttreatment SIRI to forecast DSS. CONCLUSIONS: The pretreatment Hb, pretreatment SII, posttreatment SII, and posttreatment SIRI are associated with survival in patients with stage IV oropharyngeal cancers. The developed nomogram aids in survival prediction and treatment adjustment.

Predicting the Outcomes of Oropharyngeal Surgery in Patients With Obstructive Sleep Apnea Using Tongue-Retaining Devices.

OBJECTIVE: To determine the efficacy of a tongue-retaining device (TRD) in predicting the outcomes of oropharyngeal surgery in patients with obstructive sleep apnea (OSA) before surgery. STUDY DESIGN: A prospective case-control study. SETTING: A single tertiary medical center. METHODS: Patients with moderate-severe OSA who underwent both uvulopalatopharyngoplasty and tongue base suspension between January 2022 and July 2022 were included. Each patient underwent a series of 3 overnight polysomnography. Objective outcomes include apnea-hypopnea index (AHI), minimal oxygen saturation, and reduction rate of AHI. The correlation between the reduction rate of AHI with TRD and surgery was analyzed with linear regression. RESULTS: The reduction rates of AHI were significantly different between the group using TRD (44 ± 24%) and the postoperative group (55 ± 21%). The cross-tabulation revealed a strong association between a positive response to TRD treatment and a positive response to surgery. The use of TRD to evaluate surgical response demonstrated a positive predictive value of 90% and a negative predictive value of 70%. A strong correlation between the decrease in AHI was observed in both TRD and surgery groups, which was demonstrated by a steep slope in the scatter plot and a significant simple linear regression line. CONCLUSION: Preoperative TRD response is an accurate tool for predicting the success of oropharyngeal surgery in managing OSA patients before surgical treatment. Furthermore, a quantifiable positive linear correlation exists between the efficacy of preoperative TRD treatment and surgery.

Quantifying the impact of green infrastructure change on landscape patterns using intensity analysis and landscape metrics in the Taipei metropolitan area.

Developing a sound urban green infrastructure system is critical for addressing climate change. Green infrastructure (GI) also plays an essential role in the urban system by providing ecosystem services for urban residents. Although some research on GI has been published in Taiwan, there is a lack of understanding of how changes in land use and GI affect the landscape patterns in urban fringe areas. This study explores the impact of changes in GI on the landscape pattern of the urban fringe and urban core areas in the Taipei metropolitan area (TMA). We used intensity analysis to investigate changes in land area and land use intensity between 1981 and 2015 at three levels: interval, category, and transition. Landscape metrics were employed to analyze changes in GI patterns. We found, firstly, that although the rate of change in the urban core area of the TMA was faster than the rate of change in the urban fringe area during 1981-1995 and 1995-2006, changes in the urban fringe area nevertheless maintained a state of rapid change in 1995-2006 and 2006-2015. Secondly, forest and agricultural lands in urban fringe areas were the GI categories with the greatest changes in area from 1981 to 2015. Thirdly, transition areas among forest, agricultural, and built-up areas in urban fringe areas were larger during 1995-2015 than 1981-1995. Finally, the results of landscape pattern analysis indicate that the urban fringe area of the TMA is experiencing landscape fragmentation. Although forest land remained the main category in the urban fringe from 1981 to 2015, the integrity of its patch area decreased over time, and the prevalence of small and complex patches of built-up and agricultural land increased. Spatial planning should therefore consider how to build a GI system to promote ecosystem services in urban fringe areas so as to enhance the ability to respond to climate change.

Bruns Nystagmus in Cerebellopontine Angle Hemangioblastoma.

Bruns nystagmus is a form of jerk nystagmus that has a localizing value in cerebellopontine angle (CPA) tumors. Hemangioblastomas involving the CPA is rare. A case of a 57-year-old male presented with Bruns nystagmus which led to the discovery of a large CPA hemangioblastoma is described. The nystagmus was compatible with the laterality of the tumor. High quality video of Bruns nystagmus was recorded.

Narrow-band imaging for detecting nasal lymphoma.

INTRODUCTION: Narrow-band imaging (NBI) is an advanced endoscopic technique that enhances the mucosal neovascularization. The utilization of narrow-band imaging on the detection of nasal lymphomas is not well-established. AIM: To present a clinical case whose nasal lymphoma was detected with the aid of NBI. CASE REPORT: A 91-year-old male presented to the ear, nose, and throat clinic with right persisting nasal obstruction for 4 months. NBI revealed a well demarcated lesion with an elongated vessel on the surface of the right inferior nasal turbinate. Histopathologic analysis of tissue specimen proved to be extranodal NK/T-cell lymphoma, nasal type. CONCLUSIONS: NBI is useful for the detection of nasal lymphomas. NBI may be a valuable screening tool for nasal lymphomas as it is non-invasive and affordable.

PAI-1 as a critical factor in the resolution of sepsis and acute kidney injury in old age.

Elevated plasma levels of plasminogen activator inhibitor type 1 (PAI-1) are documented in patients with sepsis and levels positively correlate with disease severity and mortality. Our prior work demonstrated that PAI-1 in plasma is positively associated with acute kidney injury (AKI) in septic patients and mice. The objective of this study was to determine if PAI-1 is causally related to AKI and worse sepsis outcomes using a clinically-relevant and age-appropriate murine model of sepsis. Sepsis was induced by cecal slurry (CS)-injection to wild-type (WT, C57BL/6) and PAI-1 knockout (KO) mice at young (5-9 months) and old (18-22 months) age. Survival was monitored for at least 10 days or mice were euthanized for tissue collection at 24 or 48 h post-insult. Contrary to our expectation, PAI-1 KO mice at old age were significantly more sensitive to CS-induced sepsis compared to WT mice (24% vs. 65% survival, p = 0.0037). In comparison, loss of PAI-1 at young age had negligible effects on sepsis survival (86% vs. 88% survival, p = 0.8106) highlighting the importance of age as a biological variable. Injury to the kidney was the most apparent pathological consequence and occurred earlier in aged PAI-1 KO mice. Coagulation markers were unaffected by loss of PAI-1, suggesting thrombosis-independent mechanisms for PAI-1-mediated protection. In summary, although high PAI-1 levels are clinically associated with worse sepsis outcomes, loss of PAI-1 rendered mice more susceptible to kidney injury and death in a CS-induced model of sepsis using aged mice. These results implicate PAI-1 as a critical factor in the resolution of sepsis in old age.

Iatrogenic facial artery pseudoaneurysm.

Tonsillectomy is one of the most common procedures performed by Otolaryngologists. Hemorrhage is the most common complication. Iatrogenic hemorrhage resulting from pseudoaneurysm of the facial artery is rare. In this video, a case of a 30-year-old male who presented with recurrent hemorrhage from an iatrogenic pseudoaneurysm arising from the left facial artery 22 days after undergoing tonsillectomy is described. Treatment options and warning sign of iatrogenic pseudoaneurysms are discussed.

Assessing the Readability of App Descriptions and Investigating its Role in the Choice of mHealth Apps: Retrospective and Prospective Analyses.

People with low health literacy are more likely to use mobile apps for health information. The choice of mHealth apps can affect health behaviors and outcomes. However, app descriptions may not be very readable to the target users, which can negatively impact app adoption and utilization. In this study, we assessed the readability of mHealth app descriptions and explored the relationship between description readability and other app metadata, as well as description writing styles. The results showed that app descriptions were at eleventh- to fifteenth-grade level, with only 6% of them meeting the readability recommendation (third- to seventh-grade level). The description readability played a vital role in predicting app installs when an app had no reviews. The content analysis showed copy-paste behaviors and identified two potential causes for low readability. More work is needed to improve the readability of app descriptions and optimize mHealth app adoption and utilization.

Protective effect of Fisetin against angiotensin II-induced apoptosis by activation of IGF-IR-PI3K-Akt signaling in H9c2 cells and spontaneous hypertension rats.

BACKGROUND: Fisetin, a polyphenolic compound, has drawn notable attention owing to its antioxidant, anti-inflammatory, anti-cancer and neuroprotective effects. However, the cardiac effects of fisetin are not clear yet. HYPOTHESIS: The aim of the present study is to examine the cardioprotective effect of fisetin against Ang-II induced apoptosis in H9c2 cells and in spontaneous hypertensive rats (SHR). METHODS/STUDY DESIGN: The in vitro protective effect of fisetin was evaluated after the cells were treated with fisetin (50 µM/ml/ 24  h) for 2  h prior or after Ang-II administration to induce apoptosis. For in vivo experiments, SHRs were orally administered with fisetin (10  mg/kg) twice a week for 6 weeks. Cellular apoptosis was analyzed by TUNEL staining assay and the modulation in the expression levels of proteins involved in apoptosis and cell survival were determined by western blotting. RESULTS: Our results demonstrate the potent cardioprotective efficacy of fisetin against Ang-II induced apoptosis in H9c2 cells and in SHR models. Fisetin administration reduced the apoptotic nuclei considerably And reduced the expression of apoptotic proteins such as TNF- α, Fas L, FADD, Cleaved caspase-3 and Cleaved PARP and increased the cell survival and anti-apoptotic proteins like Bcl-2, Bcl-xL, p-IGF1R, p-PI3K and p-AKT in both in vitro and in vivo models. CONCLUSION: In conclusion, the results of the present study reveal that fisetin activates the IGF-IR-dependent p-PI3K/p-Akt survival signaling pathway and suppresses the caspase dependent apoptosis.

Acute hypoxic preconditioning prevents palmitic acid-induced cardiomyocyte apoptosis via switching metabolic GLUT4-glucose pathway back to CD36-fatty acid dependent.

Metabolic syndrome is a risk factor for the development of cardiovascular diseases. Myocardial cell damage leads to an imbalance of energy metabolism, and many studies have indicated that short-term hypoxia during myocardial cell injury has a protective effect. In our previous animal studies, we found that short-term hypoxia in the heart has a protective effect, but long-term hypoxia increases myocardial cell injury. Palmitic acid (PA)-treated H9c2 cardiomyoblasts and neonatal rat ventricle cardiomyocytes were used to simulate hyperlipidemia model, which suppress cluster of differentiation 36 (CD36) and activate glucose transporter type 4 (GLUT4). We exposed the cells to short- and long-term hypoxia and investigated the protective effects of hypoxic preconditioning on PA-induced lipotoxicity in H9c2 cardiomyoblasts and neonatal rat cardiomyocytes. Preconditioning with short-term hypoxia enhanced both CD36 and GLUT4 metabolism pathway protein levels. Expression levels of phospho-PI3K, phospho-Akt, phospho-AMPK, SIRT1, PGC1α, PPARα, CD36, and CPT1ß induced by PA was reversed by short-term hypoxia in a time-dependent manner. PA-induced increased GLUT4 membrane protein level was reduced in the cells exposed to short-term hypoxia and si-PKCζ. Short-term hypoxia, resveratrol and si-PKCζ rescue H9c2 cells from apoptosis induced by PA and switch the metabolic pathway from GLUT4 dependent to CD36 dependent. We demonstrate short-term hypoxic preconditioning as a more efficient way as resveratrol in maintaining the energy metabolism of hearts during hyperlipidemia and can be used as a therapeutic strategy.

Clinical Outcomes of Polytetrafluoroethylene-Covered Stents for Coronary Artery Perforation in Elderly Patients Undergoing Percutaneous Coronary Interventions.

BACKGROUND: Coronary artery perforation (CAP) during percutaneous coronary intervention (PCI) is associated with increased mortality. Polytetrafluoroethylene covered stents (CS) are an effective approach to treat CAP, but data regarding elderly patients requiring CS implantation for CAP are limited. The aim of this study is to report clinical data for elderly CAP patients undergoing CS implantation during PCI. METHODS: Nineteen consecutive elderly patients (≥ 65 years) undergoing CS implantation due to PCI-induced CAP in a tertiary referral center from July 2003 to April 2016 were retrospectively examined. RESULTS: There were 13 men and six women, with a mean age of 75.3 ± 5.6 years (range: 65-86 years). Perforation grade was Ellis type II in five patients (26.3%), and Ellis type III in 14 patients (73.7%). Cardiac tamponade developed in six patients (31.6%), and intra-aortic balloon pumping was needed in four patients (21.1%). The overall success rate for CS implantation rate was 94.7%. The overall in-hospital mortality rate was 15.8%; the in-hospital myocardial infarction rate was 63.2%. Among 16 survival-to-discharge cases, dual antiplatelet therapy (DAPT) was prescribed in 14 cases (87.5%) for a mean duration of 14 months. Overall, there were five angiogram- proven CS failures among 18 patients receiving successful CS implantation. The 1, 2 and 4 years of actuarial freedom from the CS failure were 78%, 65%, and 43% in the angiogram follow-up patients. CONCLUSIONS: CS implantation for CAP is feasible and effective in elderly patients, while CS failure remains a major concern that encourages regular angiographic follow-up in these case.

Short-Term Hypoxia Reverses Ox-LDL-Induced CD36 and GLUT4 Switching Metabolic Pathways in H9c2 Cardiomyoblast Cells.

High levels of circulating low-density lipoproteins (LDL, plasma proteins that carry cholesterol and triglycerides) are associated with type 2 diabetes, arteriosclerosis, obesity, and hyperlipidemia. In the heart, the accumulation of oxidized low-density lipoprotein (Ox-LDL) has been proposed to play a role in the development of cardiovascular disease. We obtain cholesterol from animals and animal-derived foods such as milk, eggs, and cheese. In previous studies, the ratio of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) was shown to be important for our health. High levels of LDL cholesterol lead to atherosclerosis, increasing the risk of heart attack and ischemic stroke. In this study, we utilized Ox-LDL-treated H9c2 cardiomyoblast cells as a simulated hyperlipidemia model. CD36 metabolism pathway proteins (phospho-Akt, SIRT1, PGC1α, PPARα, CPT1ß, and CD36) increased at low doses of Ox-LDL. However, high doses (150 and 200 mg/dL) of Ox-LDL reduced the levels of these proteins. Interestingly, expression of GLUT4 metabolism pathway proteins (phospho-PKCζ) were reduced at low doses, while the expression of phospho-AMPK, phospho-PI3K, phospho-PKCζ, GLUT4, and PDH proteins increased at high doses. Ox-LDL acute treatment induces apoptosis in cardiomyocytes as evidenced by apoptotic nuclei apparition, caspase-3 activation, and cytochrome c release from mitochondria. In our results, Ox-LDL induced lipotoxicity in cardiomyocytes, and subsequent exposure to short-term hypoxia or reversed the Ox-LDL-induced metabolic imbalance. The same result was obtained with the pharmacological activation of SIRT1 by resveratrol and si-PKCζ. The mechanism of metabolic switching during Ox-LDL lipotoxicity seems to be mediated by SIRT1 and PKC ζ. J. Cell. Biochem. 118: 3785-3795, 2017. © 2017 Wiley Periodicals, Inc.

Palmitic acid interferes with energy metabolism balance by adversely switching the SIRT1-CD36-fatty acid pathway to the PKC zeta-GLUT4-glucose pathway in cardiomyoblasts.

Metabolic regulation is inextricably linked with cardiac function. Fatty acid metabolism is a significant mechanism for creating energy for the heart. However, cardiomyocytes are able to switch the fatty acids or glucose, depending on different situations, such as ischemia or anoxia. Lipotoxicity in obesity causes impairments in energy metabolism and apoptosis in cardiomyocytes. We utilized the treatment of H9c2 cardiomyoblast cells palmitic acid (PA) as a model for hyperlipidemia to investigate the signaling mechanisms involved in these processes. Our results show PA induces time- and dose-dependent lipotoxicity in H9c2 cells. Moreover, PA enhances cluster of differentiation 36 (CD36) and reduces glucose transporter type 4 (GLUT4) pathway protein levels following a short period of treatment, but cells switch from CD36 back to the GLUT4 pathway after during long-term exposure to PA. As sirtuin 1 (SIRT1) and protein kinase Cζ (PKCζ) play important roles in CD36 and GLUT4 translocation, we used the SIRT1 activator resveratrol and si-PKCζ to identify the switches in metabolism. Although PA reduced CD36 and increased GLUT4 metabolic pathway proteins, when we pretreated cells with resveratrol to activate SIRT1 or transfected si-PKCζ, both were able to significantly increase CD36 metabolic pathway proteins and reduce GLUT4 pathway proteins. High-fat diets affect energy metabolism pathways in both normal and aging rats and involve switching the energy source from the CD36 pathway to GLUT4. In conclusion, PA and high-fat diets cause lipotoxicity in vivo and in vitro and adversely switch the energy source from the CD36 pathway to the GLUT4 pathway.

Noninvasive evaluation of mental stress using by a refined rough set technique based on biomedical signals.

OBJECTIVE: Evaluating and treating of stress can substantially benefits to people with health problems. Currently, mental stress evaluated using medical questionnaires. However, the accuracy of this evaluation method is questionable because of variations caused by factors such as cultural differences and individual subjectivity. Measuring of biomedical signals is an effective method for estimating mental stress that enables this problem to be overcome. However, the relationship between the levels of mental stress and biomedical signals remain poorly understood. METHODS AND MATERIALS: A refined rough set algorithm is proposed to determine the relationship between mental stress and biomedical signals, this algorithm combines rough set theory with a hybrid Taguchi-genetic algorithm, called RS-HTGA. Two parameters were used for evaluating the performance of the proposed RS-HTGA method. A dataset obtained from a practice clinic comprising 362 cases (196 male, 166 female) was adopted to evaluate the performance of the proposed approach. RESULTS: The empirical results indicate that the proposed method can achieve acceptable accuracy in medical practice. Furthermore, the proposed method was successfully used to identify the relationship between mental stress levels and bio-medical signals. In addition, the comparison between the RS-HTGA and a support vector machine (SVM) method indicated that both methods yield good results. The total averages for sensitivity, specificity, and precision were greater than 96%, the results indicated that both algorithms produced highly accurate results, but a substantial difference in discrimination existed among people with Phase 0 stress. The SVM algorithm shows 89% and the RS-HTGA shows 96%. Therefore, the RS-HTGA is superior to the SVM algorithm. The kappa test results for both algorithms were greater than 0.936, indicating high accuracy and consistency. The area under receiver operating characteristic curve for both the RS-HTGA and a SVM method were greater than 0.77, indicating a good discrimination capability. CONCLUSIONS: In this study, crucial attributes in stress evaluation were successfully recognized using biomedical signals, thereby enabling the conservation of medical resources and elucidating the mapping relationship between levels of mental stress and candidate attributes. In addition, we developed a prototype system for mental stress evaluation that can be used to provide benefits in medical practice.

Precordial ST-Segment Elevation Caused by Proximal Occlusion of a Non-Dominant Right Coronary Artery.

UNLABELLED: For patients with ST-segment elevation myocardial infarction, primary percutaneous coronary intervention to the culprit lesion via electrocardiographic guidance is essential. We herein report the rare case of a 49-year-old man who presented with ST-segment elevation in the precordial leads, while coronary angiography results indicated total occlusion of the proximal non-dominant right coronary artery. We evaluated its possible pathophysiologic mechanisms and thoroughly discussed isolated right ventricular infarction and its electrocardiography findings. KEY WORDS: Coronary angiography; Myocardial infarction; Total occlusions.

Application of open porous poly(D,L-lactide-co-glycolide) microspheres and the strategy of hydrophobic seeding in hepatic tissue cultivation.

In this article, porous poly(D,L-lactide-co-glycolide) (PLGA) microsphere scaffolds with a size of ∼ 400 µm and pores of ∼ 20 µm were prepared for constructing injectable three-dimensional hepatocyte spheroids. The porous sites of PLGA microspheres provided a spatial space for hepatocyte distribution. Hepatocytes spheroids were cocultured with human umbilical vein endothelial cell, bone marrow mesenchymal stem cell, or NIH/3T3 cells by combining the porous PLGA microspheres with the relatively hydrophobic culture strategy. The combination of open porous microspheres, hepatocytes, and nonparenchymal cells was demonstrated for application in functional hepatic tissue reconstruction. Hepatocellular-specific functions can sustained up to 2 weeks in the support of coculturing with nonparenchymal cells. The spheroidal hepatocyte coculture system had the advantages of an injectable delivery, higher cell seeding density, protection from exerted shear stress, better exchange of nutrients, oxygen and metabolites, and heterotypic cell-cell contact within and between microspheres.

Increased Rosuvastatin Dose versus Concomitant Fenofibrate and Rosuvastatin Therapy to Achieve Lipid Goal in Patients with Diabetes or Atherosclerosis with Metabolic Syndrome.

PUPOSE: We aimed to ascertain whether increased rosuvastatin dose is non-inferior to concomitant fenofibrate and rosuvastatin therapy in patients with diabetes or atherosclerosis with metabolic syndrome. METHODS: After treatment with rosuvastatin 5 mg/day for 12 weeks, 112 patients were randomly assigned to receive either 10 mg/day rosuvastatin (group A) or 80 mg/day supra-film coated fenofibrate plus 5 mg/day rosuvastatin (group B). The therapy effects were evaluated by measuring the serum lipid profile, liver and muscle enzymes, and renal function after the treatment period. RESULTS: After the treatment, the total cholesterol, high-density-lipoprotein cholesterol (HDL-C), non HDL-C, low-density-lipoprotein cholesterol (LDL-C), and triglyceride were comparable between the 2 groups. The change in the non-HDL-C were -7.39 ± 26.58 (-6.62%) and -0.68 ± 24.49 (-1.19%) mg/dl (p = 0.28); and the change in the triglyceride were -36.61 ± 62.51 (-14.00%) and -44.77 ± 77.35 (-23.17%) mg/dl (p = 0.64), respectively. While 41.37% of group A and 38.69% of group B achieved their LDL-C goal (< 100 mg/dl) (p = 0.79), 37.26% of group A and 42.31% of group B achieved their triglyceride goal (< 150 mg/dl) (p = 0.53), respectively. The changes in the serum transaminase and creatinine phosphokinase were similar between the 2 groups. CONCLUSIONS: After 5 mg/day of rosuvastatin, the lipid profile in patients with diabetes or atherosclerotic vascular diseases with metabolic syndrome could be improved by increasing rosuvastatin dose, and the resultant decrease of non-HDL and triglyceride were similar to those obtained with combination therapy. Both therapies were safe and feasible. KEY WORDS: Combination therapy; Diabetes; Fenofibrate; Metabolic syndrome; Monotherapy; Statin.