Prevalence of Forward head posture among car and bike drivers and its relation with neck and cardiopulmonary health parameters- a cross-sectional study.

OBJECTIVES: This study aimed to evaluate and compare the prevalence of Forward Head Posture (FHP) in car and bike drivers, and its potential correlation with neck and cardiopulmonary parameters. METHODS: This cross-sectional study involved 400 participants from urban and suburban areas around Lucknow, Uttar Pradesh, India, including 200 car drivers and 200 bike drivers aged 18-65 years with a minimum five-year driving history. Neck health was assessed using measurements such as cervical range of motion and Neck Disability Index (NDI), cardiopulmonary parameters were evaluated through resting heart rate, blood pressure, and pulmonary function tests using the spirometry test, and FHP was assessed using Surgimap application. Statistical analysis was performed using IBM SPSS Statistics software (version 26.0) and included descriptive statistics, hypothesis testing, Chi-square or Fisher's exact test for binary data, and correlation analyses. RESULTS: The result show that difference in the mean FHP between car and bike drivers was statistically significant (p = 0.0001), indicating a higher prevalence of FHP among car drivers than among bike drivers. Correlation analyses revealed significant associations between FHP and neck health metrics, especially cervical flexion (r = 0.71, p<0.05), (r = 0.78, p<0.05) and left-side rotation (r = 0.56, p<0.05), (r = 0.61, p<0.05) in car and bike drivers. Among the cardiopulmonary parameters, significant correlations with FHP were observed in resting heart rate (r = 0.33, p<0.05), (r = 0.42, p<0.05), spirometry results FVC (r = 0.29, p<0.05), FEV1 (r = 0.22, p<0.05), and FVC (r = 0.31, p<0.05) for car and bike drivers. CONCLUSION: We observed a higher incidence of FHP in car drivers, indicating that a prolonged static posture may lead to greater postural deviation than dynamic movement during biking. This association suggests that FHP could have wide-reaching implications for systemic health, beyond musculoskeletal issues. These findings have the potential to influence preventative strategies and interventions aimed at improving the overall health outcomes for drivers.

Feasibility of a Novel Surface-Guided Setup Technique to Reproduce Neck Curvature Using two Regions of Interest.

PURPOSE: To improve the setup reproducibility of neck curvature using real-time optical surface imaging (OSI) guidance on 2 regions of interest (ROIs) to infer cervical spine (c-spine) curvature for surface-guided radiotherapy (SGRT) of head-and-neck (HN) and c-spine cancer. METHODS: A novel SGRT setup approach was designed to reproduce neck curvature with 2 ROIs: upper-chest ROI and open-face ROI. It was hypothesized that the neck curvature could be reproduced if both ROIs were aligned within ±3 mm/2˚ tolerance. This was tested prospectively in 7 volunteers using real-time 3D-OSI guidance and lateral 2D-photography verification after the 3D and 2D references were captured from the initial conventional setup. Real-time SGRT was performed to align chest-ROI and face-ROI, and the longitudinal distance between them was adjustable using a head-support slider. Verification of neck curvature anteriorly and posteriorly was achieved by overlaying edge-extracted lateral pictures. Retrospectively, the relationship between anterior surface and spinal canal alignment was checked in 11 patients using their simulation CT (simCT) and setup cone-beam CT (CBCT). After the anterior surface was rigidly aligned, the spinal canal alignment was checked and quantified using the mean-distance-to-agreement (MDA) and DICE similarity index, and surface-to-spine correlation was calculated. RESULTS: The reproducibility of neck curvatures using the 2xROI SGRT setup is verified and the mean neck-outline-matching difference is within ±2 mm in lateral photographic overlays. The chest-ROI alignment takes 110 ± 58 s and the face-ROI takes 60 ± 35 s. When the anterior body surface is aligned (MDA = 1.1 ± 0.6 mm, DICE = 0.96 ± 0.02,) the internal spinal canal is also aligned (MDA = 1.0 ± 0.3 mm, DICE = 0.84 ± 0.04) in 11 patients. The surface-to-spine correlation is c = 0.90 (MDA) and c = 0.85 (DICE). CONCLUSION: This study demonstrates the feasibility of the novel 2-ROI SGRT setup technique to achieve reproducible neck and c-spine curvature regardless of neck visibility and availability as ROI. Staff training is needed to adopt this unconventional SGRT technique to improve patient setup.

[Clinical anatomy of the free latissimus dorsi myocutaneous flap and its application in the restoration of giant defects of the head and neck].

PURPOSE: To investigate the feasibility and effect of free latissimus dorsi myocutaneous flap in the reconstruction of giant head and neck defects. METHODS: Free latissimus dorsi myocutaneous flap on the cadaver was simulated dissected, and measured by Image-Pro Plus 6.0 to assess the feasibility of repairing giant head and neck defects. Between May 2011 and September 2022, seven patients with giant head and neck defects of different causes repaired with the latissimus dorsi myocutaneous flap were retrospectively analyzed. RESULTS: The diameter of the initiating thoracodorsal artery was (4.03±0.56) mm, and the mean lengths of the arteriolar and venous pedicles of the latissimus dorsi myocutaneous flaps obtained from human specimens were (85.5±10.5) mm and (104±4.2) mm, respectively. Among 7 patients, 5 cases had scalp defects, the remaining 2 cases had neck defects. There were no substantial postoperative problems in the donor site, and all seven latissimus dorsi myocutaneous flaps were successfully transplanted. CONCLUSIONS: For the treatment of considerable head and neck deformities, the latissimus dorsi myocutaneous flap is an optimal muscle flap due to its abundance of tissue, enough length of vascular pedicles, and sufficient venous drainage.

[Ultrasonographic features of Castleman disease in the head and neck: a report of 7 cases].

PURPOSE: To summarize the ultrasonographic features of head and neck Castleman disease (CD), and to clarify its diagnostic key points. METHODS: Seven patients with head and neck CD confirmed by histopathology were collected from Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. The clinical features and ultrasound findings of the patients were evaluated. RESULTS: Of the 7 patients (1 male and 6 females), the mean age at diagnosis was 31.4 years (7-60 years). All the cases were hyaline vascular type. On ultrasound, 3 lesions (42.9%) were located in the parotid gland, 4 lesions(57.1%) in the neck. All the lesions presented as a solitary, well-defined and solid mass without calcification. The echogenicity was markedly hypoechoic in 1 case(14.3%) and hypoechoic in 6 cases (85.7%). Of the 7 CD cases, 4 cases (57.1%) were heterogeneous masses with linear echogenic septa. All lesions had mixed pattern in vascularity on color Doppler sonography. CONCLUSIONS: Most CDs in the head and neck represent as a markedly hypoechoic or hypoechoic lesion with mixed pattern in vascularity. The neoplasm may be characterized by the presence of linear echogenic septa within the mass.

Between-Session Reliability of Field-Based Assessments of Isometric Neck Strength.

The reliability of the fixed-frame dynamometer for measuring isometric neck strength is established, but with limited field-based applications. This study aimed to establish the inter- and intra-session reliability of the peak force for neck flexors, extensors, and side flexors using the VALD ForceFrame and DynaMo and the force-time characteristics in the quadruped position (ForceFrame). Twenty-seven recreationally active males performed three repetitions of isometric neck flexion, extension, and side flexion over two sessions in random order using the VALD ForceFrame and DynaMo. Both devices demonstrated acceptable reliability, with the Forceframe ICC > 0.8 and CV% < 13.8% and the DynaMo ICC > 0.76 and CV% < 13.8%. No systematic or proportional differences were found using the Passing-Bablock procedure, and Bland-Altman analysis confirmed agreement across measures. Reliability was shown for right-side (ICC > 0.76) and left-side (ICC > 0.79) flexion and flexion (ICC > 0.75) across 50, 100, 150, and 200 ms. Statistical parametric mapping indicated no differences in ForceFrame-generated isometric force-time curves between sessions, though the CV was highest in the force development phase. The findings suggest that both tools can reliably assess neck strength, supporting their use in sports and clinical settings. However, assessment methods are not interchangeable, emphasising the need for standardised neck strength assessment approaches.

Giant Cerebriform Nevus Lipomatosus Cutaneous- Superficialis with Diffuse Lipomatosis: An Unusual Presentation on the Neck.

A 25-year-old man presented with gradually increasing swelling of 15 years' duration on the left side of his neck. There had been occasional foul-smelling discharge from the swelling. Local examination revealed an 8 cm × 5 cm oblong-shaped, yellowish to skin-colored, soft, -cerebriform swelling. There were multiple open comedones (Figure 1a). The surrounding skin had small and soft skin-colored papules. On palpation, there was no ulceration, tenderness, induration, or bag of worms. A scar from the past surgery was visible. Systemic examina- tion was unremarkable. The differential diagnosis demonstrated plexiform neurofibroma and nevus lipomatosus cutaneous superficialis (NLCS; Figure 2).

Cervicofacial Actinomycetoma Presenting with Black Grain: A Rare Clinical Scenario.

Mycetoma is a chronic skin and subcutaneous tissue infection characterized by a triad of localized swelling, draining sinuses, and grains or granules (composed of aggregations of the causative organism) within the sinus tracts. It is caused by filamentous higher bacteria (known as actinomycetoma) or fungus (known as eumycetoma). Usually actinomycetoma presents with white-yellow grains and majority of eumycetoma causes black grains. However, actinomycetoma caused by Streptomyces sp. produces large brown-black grain, which is often misdiagnosed as eumycetoma, therefore confirmation by culture is necessary. Here, we present a case of 28-year-old female presenting with typical features of mycetoma at cervicofacial region. On direct microscopy (40×) with potassium hydroxide (KOH) mount of discharge released from sinuses showed large and black grains, initially raising a suspicion of eumycetoma, but later, it was confirmed by culture as actinomycetoma caused by Streptomyces sp. Patient is now symptomatically better on treatment. Production of black grain by actinomycetoma is a rare clinical scenario.

The deflection of fatigued neck.

The human neck is a unique mechanical structure, highly flexible but fatigue prone. The rising prevalence of neck pain and chronic injuries has been attributed to increasing exposure to fatigue loading in activities such as prolonged sedentary work and overuse of electronic devices. However, a causal relationship between fatigue and musculoskeletal mechanical changes remains elusive. This work aimed to establish this relationship through a unique experiment design, inspired by a cantilever beam mechanical model of the neck, and an orchestrated deployment of advanced motion-force measurement technologies including dynamic stereo-radiographic imaging. As a group of 24 subjects performed sustained-till-exhaustion neck exertions in varied positions-neutral, extended, and flexed, their cervical spine musculoskeletal responses were measured. Data verified the occurrence of fatigue and revealed fatigue-induced neck deflection which increased cervical lordosis or kyphosis by 4-5° to 11°, depending on the neck position. This finding and its interpretations render a renewed understanding of muscle fatigue from a more unified motor control perspective as well as profound implications on neck pain and injury prevention.

A practical nomogram for preoperatively predicting lateral cervical lymph node metastasis in medullary thyroid carcinoma: a dual-center retrospective study.

Purpose: Lateral lymph node metastasis (LLNM) is very common in medullary thyroid carcinoma (MTC), but there is still controversy about how to manage cervical lateral lymph nodes, especially for clinically negative MTC. The aim of this study is to develop and validate a nomogram for predicting LLNM risk in MTC. Materials and methods: A total of 234 patients from two hospitals were retrospectively enrolled in this study and divided into LLNM positive group and LLNM negative group based on the pathology. The correlation between LLNM and preoperative clinical and ultrasound variables were evaluated by univariable and multivariable logistic regression analysis. A nomogram was generated to predict the risk of the LLNM of MTC patients, validated by external dataset, and evaluated in terms of discrimination, calibration, and clinical usefulness. Results: The training, internal, and external validation datasets included 152, 51, and 31 MTC patients, respectively. According to the multivariable logistic regression analysis, gender (male), relationship to thyroid capsule and serum calcitonin were independently associated with LLNM in the training dataset. The predictive nomogram model developed with the aforementioned variables showed favorable performance in estimating risk of LLNM, with the area under the ROC curve (AUC) of 0.826 in the training dataset, 0.816 in the internal validation dataset, and 0.846 in the external validation dataset. Conclusion: We developed and validated a model named MTC nomogram, utilizing available preoperative variables to predict the probability of LLNM in patients with MTC. This nomogram will be of great value for guiding the clinical diagnosis and treatment process of MTC patients.

Reliability of cervicocephalic sense of force.

Cervicocephalic proprioception (CCP) is an important assessment item for people with a range of clinical conditions, where reduced CCP is associated with neck pain and imbalance. Reliability has been established for a range of positional and movements tests, but there is limited data regarding sense of force, particularly across three planes of movement. The current test-retest study assessed reliability when evaluating sense of force in healthy adults (8 males, 6 females, mean age 31.50 years [SD 10.14]) over two sessions, 4-7 days apart. A force matching protocol was used to evaluate reliability of absolute error (AE), constant error (CE), and variable error (VE) for 10 % and 25 % maximal voluntary contraction (MVC) target forces for flexion, extension, lateral flexion, and rotation. Participants were strapped to a chair to limit trunk movement and data was captured using a compressive force transducer fixed to an adjustable wall mount. Six trials were performed for each contraction-type, totaling 72 submaximal MVCs per session. ICC estimates for AE (0.15-0.77), CE (0.01-0.85), and VE (0.00-0.83) were varied and confidence intervals were mostly wide. Considering lower limits of confidence intervals, CE had best reliability values generally, but more specifically the most reliable contraction type and movement was 25 % MVC flexion (ICC 0.85, confidence interval 0.54-0.95). This study found that reliability for sense of force testing was dependent upon contraction, type of error, and target force utilized. Further reliability analysis should be performed when applying this test to measure validity outcomes in clinical populations.

[Preoperative Evaluation of Cervical Lymph Node Metastasis in Patients With Hashimoto's Thyroiditis Combined With Thyroid Papillary Carcinoma Using Machine Learning and Radiomics-Based Features: A Preliminary Study]. / åŸºäºŽå½±åƒç»„å­¦å’Œä¸´åºŠç‰¹å¾çš„æœºå™¨å­¦ä¹ æœ¯å‰è¯„ä¼°æ¡¥æœ¬ç”²çŠ¶è ºç‚Žåˆå¹¶ç”²çŠ¶è ºä¹³å¤´çŠ¶ç™Œé¢ˆéƒ¨æ·‹å·´ç»“è½¬ç§»çš„åˆæ­¥ç ”ç©¶.

Objective: To analyze the radiomic and clinical features extracted from 2D ultrasound images of thyroid tumors in patients with Hashimoto's thyroiditis (HT) combined with papillary thyroid carcinoma (PTC) using machine learning (ML) models, and to explore the diagnostic performance of the method in making preoperative noninvasive identification of cervical lymph node metastasis (LNM). Methods: A total of 528 patients with HT combined with PTC were enrolled and divided into two groups based on their pathological results of the presence or absence of LNM. The groups were subsequently designated the With LNM Group and the Without LNM Group. Three ultrasound doctors independently delineated the regions of interest and extracted radiomic features. Two modes, radiomic features and radiomics-clinical features, were used to construct random forest (RF), support vector machine (SVM), LightGBM, K-nearest neighbor (KNN), and XGBoost models. The performance of these five ML models in the two modes was evaluated by the receiver operating characteristic (ROC) curves on the test dataset, and SHapley Additive exPlanations (SHAP) was used for model visualization. Results: All five ML models showed good performance, with area under the ROC curve (AUC) ranging from 0.798 to 0.921. LightGBM and XGBoost demonstrated the best performance, outperforming the other models (P<0.05). The ML models constructed with radiomics-clinical features performed better than those constructed using only radiomic features (P<0.05). The SHAP visualization of the best-performing models indicated that the anteroposterior diameter, superoinferior diameter, original_shape_VoxelVolume, age, wavelet-LHL_firstorder_10Percentile, and left-to-right diameter had the most significant effect on the LightGBM model. On the other hand, the superoinferior diameter, anteroposterior diameter, left-to-right diameter, original_shape_VoxelVolume, original_firstorder_InterquartileRange, and age had the most significant effect on the XGBoost model. Conclusion: ML models based on radiomics and clinical features can accurately evaluate the cervical lymph node status in patients with HT combined with PTC. Among the 5 ML models, LightGBM and XGBoost demonstrate the best evaluation performance.

[The clinicopathologic features of unicentric Castleman disease in the children's neck].

Objective:To investigate the clinical features, imaging findings, pathological phenotype, treatment and prognosis of unicentric Castleman disease in the children's neck, in order to improve the understanding of CD among Otolaryngology Head and Neck Surgery. Methods:Retrospective cross-sectional, observational study was undertaken in Kunming Children's Hospital, from the archival data between January July 2015 and June 2020. Only 6 cases of CD were identified after studying the histomorphological characteristics and neck mass diagnosed. The imaging and pathological features were summarized and the pathogenesis was discussed. Results:Among the 6 cases of Castleman disease, five were male and one was female. Histopathology: Five cases were hyaline vascular subtype, one was mixed type. The uniform clinicopathologic features seen in all hyaline vascular subtype of CD included atrophic germinal centre with lymphocyte depletion, concentric rings of small lymphocytes, increased vascularity and predominance of high endothelial vessels in interfollicular region. Twinning, in which two or more germinal centers are combined and surrounded by lymphocytes in the mantle zone was observed in two cases with lollipop pattern at the same time. All the cases underwent complete surgical resection, the median follow-up time was 48 months（26, 84）, both of them had good prognosis. Conclusion:Most cases of unicentric type CD in children are diagnosed late, which is clinical showed by painless lymphadenopathy. The most common pathological type is hyaline vascular. The overall prognosis of surgical treatment was good.

[Analysis of 14 cases of sarcoidosis of head and neck].

Objective:To explore the clinical characteristics of sarcoidosis of head and neck symptoms, and to summarize the diagnosis and treatment experience. Methods:A retrospective study was conducted on patients with nodular disease with main symptoms in the head and neck who visited Henan Provincial People's Hospital from January 2020 to August 2023. The clinical data including symptom characteristics, pathological characteristics, treatment methods, and prognosis were analyzed. Results:A total of 14 patients were included, with 4 males（28.6%） and 10 females（71.4%）, age ranged from 11 to 71 years, with an average age of（52.0±15.8） years. The lesions were located in the parotid gland in 2 cases and the neck in 12 cases. Twelve cases underwent neck mass resection surgery, and 2 cases underwent ultrasound-guided core biopsy of parotid gland tumor and postoperative pathological diagnosis was confirmed in all cases. Four cases received steroid treatment postoperatively, and showed good prognosis with reduced lesion size after 3 months. Three cases did not take medication and the lesions continued to persist, causing discomfort. Seven cases did not take medication postoperatively, and the lesions expanded with multi-organ progression. Conclusion:Patients with head and neck sarcoidosis are rare in clinical practice, and it is prone to misdiagnosis and missed diagnosis. Steroid therapy can achieve good therapeutic effects.

Surgical treatment of severe acne keloidalis nuchae.

Acne keloidalis nuchae (AKN) is a rare chronic inflammatory condition most commonly treated medically but in severe, treatment-refractory cases, surgery can be a better solution. In this case report, we present a patient with severe refractory AKN, treated with excision and direct split-thickness skin grafting in combination with negative pressure wound therapy. The patient achieved a satisfactory cosmetic and functional result within a relatively short healing period of six weeks.

Do Posterior Neck Lumps Need Ultrasound Evaluation: A Case Series of 623 Neck Ultrasound Studies at a Single Institution.

INTRODUCTION/OBJECTIVES: Neck lumps are a common presentation to primary care services. The aetiology of posterior neck lumps is poorly explored in the literature, and therefore remain a concern to patients and clinicians. This often results in an urgent referral for ultrasound assessment. The authors of this study sought to evaluate the aetiology of posterior neck lumps from a radiological perspective, to assess whether ultrasound can be used as a useful adjunct, rather than a first-line urgent investigation. METHODS: A retrospective case series was carried out, examining all primary care referred ultrasound studies for assessment of posterior neck lumps, performed at a single institution in Essex, United Kingdom, over a period of over 10 years dating between 2nd February 2012 to 8th November 2022. Data was collected on: patient age at the time of study, patient sex, whether the lump was single or multiple as palpated and documented by the primary care physician, size of the lump to the nearest 0.5 cm as documented on ultrasound using the longest dimension, sonographic diagnosis and any follow up imaging (not limited to ultrasound). RESULTS: A total of 623 neck ultrasounds were performed on 615 adults. Of the overall radiological diagnoses made from the 623 scans, 555 (89.09%) scans were benign, 63 (10.11%) scans had no lump found on sonography, and 3 (0.48%) scans showed malignancy. In the remaining 2 (0.32%) scans, the lump was deemed indeterminate. The most common aetiologies for benign lumps were due to: normal lymph nodes (n = 263; 42.21%), lipomas (n = 152; 24.39%), and benign dermal cysts (n = 105; 16.85%). All 3 malignant cases had co-existing anterior and posterior neck lumps. CONCLUSIONS: Given that the overwhelming majority of posterior neck lumps in our study had benign findings, we propose that patients with solitary or even multiple posterior neck lumps alone, regardless of size can either be investigated routinely or can be reassured depending on other clinical examination characteristics. Patients who have the presence of co-existing anterior and posterior neck palpable neck lumps justifies urgent or 2-week wait radiological investigation.

PHF6 cooperates with SWI/SNF complexes to facilitate transcriptional progression.

Genes encoding subunits of SWI/SNF (BAF) chromatin remodeling complexes are mutated in nearly 25% of cancers. To gain insight into the mechanisms by which SWI/SNF mutations drive cancer, we contributed ten rhabdoid tumor (RT) cell lines mutant for SWI/SNF subunit SMARCB1 to a genome-scale CRISPR-Cas9 depletion screen performed across 896 cell lines. We identify PHF6 as specifically essential for RT cell survival and demonstrate that dependency on Phf6 extends to Smarcb1-deficient cancers in vivo. As mutations in either SWI/SNF or PHF6 can cause the neurodevelopmental disorder Coffin-Siris syndrome, our findings of a dependency suggest a previously unrecognized functional link. We demonstrate that PHF6 co-localizes with SWI/SNF complexes at promoters, where it is essential for maintenance of an active chromatin state. We show that in the absence of SMARCB1, PHF6 loss disrupts the recruitment and stability of residual SWI/SNF complex members, collectively resulting in the loss of active chromatin at promoters and stalling of RNA Polymerase II progression. Our work establishes a mechanistic basis for the shared syndromic features of SWI/SNF and PHF6 mutations in CSS and the basis for selective dependency on PHF6 in SMARCB1-mutant cancers.