Comparative analyses of short- and long-term outcomes between endoscopic submucosal dissection and endoscopic laryngo-pharyngeal surgery for superficial pharyngeal carcinomas.

Objectives: Endoscopic treatment of superficial pharyngeal carcinomas includes endoscopic submucosal dissection (ESD; usually performed by endoscopists), and endoscopic laryngo-pharyngeal surgery (ELPS; primarily performed by otolaryngologists). Few studies have compared the efficacy of the two techniques in treating superficial pharyngeal carcinomas. In this study, we compared the outcomes of these two techniques to determine the advantages. Methods: We retrospectively examined the short- and long-term outcomes of 93 consecutive patients with superficial pharyngeal carcinoma who either underwent an ESD or ELPS between August 2008 and December 2021. Results: There were 35 lesions among 29 patients and 93 lesions among 71 patients in the ESD and ELPS groups, respectively. The ELPS group had a significantly shorter procedure time (121.2 ± 97.4 min vs. 54.7 ± 40.2 min, p<0.01), greater procedure speed (0.10 ± 0.06 min/min vs. 0.30 ± 0.23 min/min, p<0.01), and less laryngeal edema than that of the ESD group. There were no significant differences in the 3-year overall, relapse-free, or disease-specific survival rates between the two groups. Intervention with ESD during ELPS was most commonly required when it was difficult to secure the visual field. Conclusions: There were no differences in batch resection rates or long-term prognoses between the two groups; nevertheless, the ELPS group had a shorter treatment time and less laryngeal edema than the ESD group. However, the treatment of narrow areas, such as the esophageal inlet patch, is a technical limitation of ELPS; thus, ELPS should be combined with ESD techniques.

Cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS): a family with five affected sibs from Turkey.

BACKGROUND: Cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS), a relatively common cause of late-onset progressive ataxia, is a genetic disease characterised by biallelic pentanucleotide AAGGG repeat expansion in intron 2 of the replication factor complex subunit 1 gene. Herein, we describe the first molecularly confirmed CANVAS family with five affected siblings from Turkey. CASE PRESENTATION: The family comprised seven siblings born from healthy non-consanguineous parents. CANVAS phenotype was present in five of them; two were healthy and asymptomatic. Chronic cough was the first symptom reported in all five siblings, followed by the development of sensory symptoms, oscillopsia and imbalance. Clinical head impulse test (HIT) was positive in all cases and video HIT performed on three patients revealed very low vestibulo-ocular reflex gains bilaterally. Magnetic resonance imaging and nerve conduction studies revealed cerebellar atrophy and sensory neuronopathy, respectively. RP-PCR confirmed the homozygous presence of the AAGGG repeat expansion in all five cases. CONCLUSION: Genetic screening for CANVAS should be considered in all patients with late-onset ataxia, sensory disturbances and vestibular involvement, especially in the presence of chronic cough.

FNA diagnosis of secondary malignancies in the parotid gland: over 20 years of experience from a single institute.

INTRODUCTION: Metastatic solid tumors account for a significant portion of malignancies in the parotid gland. Fine-needle aspiration (FNA) is a primary tool to diagnose these tumors. MATERIALS AND METHODS: We retrospectively reviewed 134 FNA cases of metastatic solid tumors affecting the parotid gland, spanning from 2000 to 2023 at our institute. We summarized the medical histories, cytology diagnoses, correlations with surgical resections, clinical treatments, and follow-up outcomes. RESULTS: The patient cohort included 107 male and 27 female patients, with a median age of 71 years (range: 4-96 years). Eighty-five percent of metastases (113 of 134) originated from head and neck (H&N) malignancies, comprising 66% from cutaneous source and 19% from mucosal sites. The most frequent primary sites outside the H&N were lung (4%), kidney (2%), and non-H&N skin (2%). Sixty-eight percent of metastases (92 of 134) were squamous cell carcinoma (SqCC) including 61% conventional type and 7% human papillomavirus-related SqCC. Melanoma is the second most common metastatic malignancy (28 of 134, 21%). The median time from primary diagnosis to metastasis was 10 months (range: 0 to 132 months). During clinical follow-up, 59 (44%) patients died from the disease in a median follow-up of 10 months (range: 2 to 56 months). CONCLUSIONS: This study represents one of the largest series of secondary malignancies in the parotid gland collected from a single institution. Most of these tumors are metastases from H&N malignancies, with cutaneous SqCC being the most prevalent primary site and histology. Accurate diagnosis relies heavily on clinical history, morphologic evaluation, and ancillary studies.

Pigmented basal cell carcinoma mimicking nodular melanoma.

The most common form of primary skin cancer is basal cell carcinoma (BCC). Pigmented BCC is a less common clinical presentation in BCC spectrum, where the tumour contains pigment. Some cases can exhibit morphological features that mimic those of nodular melanoma (NM). We present a woman in her late 40's who had an asymptomatic firm, hyperpigmented nodule on the right cheek resembling pigmented NM. Dermoscopy showed diffuse hyperpigmentation with irregular shiny surface and a solitary haemorrhagic crust. Melanoacanthoma and irritated seborrheic keratosis were the other differentials considered. Punch biopsy showed features of trichoepithelioma initially, subsequent complete excision was suggestive of pigmented BCC.Mortality related to BCC is rare, whereas NM is aggressive. Hence, clinicians need to be aware of this rare presentation of BCC as a hyperpigmented nodule, particularly in dark-skinned individuals. Timely differentiation between melanoma and BCC is crucial given their differing prognosis.

Prevention of radiation induced dermatitis in head and neck cancer patients using cryptomphalus aspersa secretion.

INTRODUCTION: Radiotherapy (RT) is a technique widely used in oncology, acquiring special prominence in head and neck cancer (HNC). RT of HNC may be associated with secondary effects including skin reaction, being dermatitis the most common radio-induced side effect during treatment. PURPOSE: The use of a wide variety of agents is reported to handle skin toxicity. The aim of the present work is to evaluate the different level-concentration of Snail Cryptomphalus Aspersa (SCA) that best protect from radiation-induced radiodermatitis in HNC. MATERIAL AND METHOD: We performed a single institutional pilot study to assess the skin toxicity with 0%, 5%, 10% and 15% SCA concentration during RT treatment and 1 and 3 months after the treatment finished according to the Radiation Therapy Oncology Group (RTOG) scoring. A total of 72 patients with HNC diagnosis who received RT with/without Chemotherapy (Ch) between January of 2018 and June of 2020 were assessed. Radiodermatitis grade was stastistically correlated with the SCA level-concentration and with the influence of extranodal extension status (ENE). RESULTS: A reduction in the rate of grade ≥ II patients' dermatitis was dependent on SCA level-concentration. We found that with higher SCA level-concentration (10 and 15%, patients had 34 and 38% grade ≥ II respectively), this was less than with 0 and 5% SCA level-concentration where a 58% radiodermatitis grade ≥ II was found by Cox regression analysis; p = 0.017 and p = 0.045 respectively. CONCLUSION: We could conclude that the application of a 10-15% SCA level-concentration after adjusting by ENE, was the best concentration to reduce the rate of grade ≥ II radiodermatitis.

Computed Tomographic Scan for Head Injury Patients: Any Justification for Adapting Routine Cranio-Cervical Examination Irrespective of Clinical Severity?

Background and Objective: This study aimed to assess the prevalence of concomitant cervical spine and head injury at our University Teaching Hospital in Nigeria and attempted to justify examining patients' head and cervical spine using computed tomography (CT) scan at presentation irrespective of the head injury severity by clinical assessment using Glasgow Coma Scale (GCS). Patients and Methods: All eligible patients, 1-80 years of age who presented with head injuries in the accident and emergency (A&E) unit during the study period, were included if they satisfied the inclusion criteria. Post-resuscitation GCS was assessed clinically, and head and cervical spine injury (CSI) were observed radiologically on cranio-cervical CT scan for all patients. The presence of cervical spine fractures, subluxation or dislocation was considered a confirmation of CSI. Results: There were 143 patients with head injuries studied; 90.2% of them were males. The mean age of the patients was 28.87 ± 15.93 years. The most common cause of injury was road traffic accidents in 110 (76.90%). The prevalence of CSI was 11.2%. Majority of the patients with CSI in this study (56.25%) had a mild head injury, 25% had a moderate head injury, and 18.75% had a severe head injury. The lower cervical spine was the most frequently injured segment in this study, involving 10 patients. Multi-level cervical vertebral body fractures of C3 to C6 were the most common form of CSI in this segment. Conclusion: The prevalence of concomitant cervical spine and head injury was significant in this study. This was confirmed among study subjects with a clinical diagnosis of mild-to-moderate head injury as compared with moderate-to-severe head injury. Therefore, all patients who sustained a head injury irrespective of severity are required to have a complete and rapid evaluation of the cervical spine.

Radiomics-based model for prediction of TGF-ß1 expression in head and neck squamous cell carcinoma.

OBJECTIVE: To explore the connection between TGF-ß1 expression and the survival of patients with head and neck squamous cell carcinoma (HNSCC), as well as whether non-invasive CT-based Radiomics can predict TGF-ß1 expression in HNSCC patients. METHODS: Data on transcriptional profiling and clinical information were acquired from the TCGA database and subsequently categorized based on the TGF-ß1 expression cutoff value. Based on the completeness of enhanced arterial phase CT scans, 139 HNSCC patients were selected. The PyRadiomics package was used to extract radiomic features, and the 3D Slicer software was used for image segmentation. Using the mRMR_RFE and Repeat LASSO algorithms, the optimal features for establishing the corresponding gradient enhancement prediction models were identified. RESULTS: A survival analysis was performed on 483 patients, who were divided into two groups based on the TGF-ß1 expression cut-off. The Kaplan-Meier curve indicated that TGF-ß1 was a significant independent risk factor that reduced patient survival. To construct gradient enhancement prediction models, we used the mRMR_RFE algorithm and the Repeat_LASSO algorithm to obtain two features (glrlm and ngtdm) and three radiation features (glrlm, first order_10percentile, and gldm). In both the training and validation cohorts, the two established models demonstrated strong predictive potential. Furthermore, there was no statistically significant difference in the calibration curve, DCA diagram, or AUC values between the mRMR_RFE_GBM model and the LASSO_GBM model, suggesting that both models fit well. CONCLUSION: Based on these findings, TGF-ß1 was shown to be significantly associated with a poor prognosis and to be a potential risk factor for HNSCC. Furthermore, by employing the mRMR_RFE_GBM and Repeat_LASSO_GBM models, we were able to effectively predict TGF-ß1 expression levels in HNSCC through non-invasive CT-based Radiomics.

Differences and Similarities Between Primary Open Angle Glaucoma and Primary Angle-Closure Glaucoma.

Glaucoma is the leading cause of irreversible blindness worldwide. It is an ocular disease characterized by an increase in intraocular pressure or, in some cases, normal intraocular pressure, which leads to optic nerve damage and progressive constriction of the visual field (VF). Primary Open-Angle Glaucoma (POAG) and Primary Angle-Closure Glaucoma (PACG) represent the predominant forms of glaucoma. Numerous hypotheses have been posited to elucidate the pathogenic mechanisms underlying these conditions. There is an emerging understanding of the distinct pathological processes that differentiate the various types of glaucoma. While some similarities in the mechanisms between PACG and POAG have been suggested, evidence indicates that there are also significant differences between the two. This review synthesizes the similarities and differences in the etiology of optic neuropathy caused by POAG and PACG, considering their respective pathophysiological mechanisms, the morphology of the optic disc and surrounding tissues, genetic characteristics, optical coherence tomography angiography, optical coherence tomography, and structural and functional features from VF examinations. These characteristics may contribute to a deeper comprehension of the underlying pathogenesis of glaucoma and enhance the management of different types of this ocular condition.

Effectiveness of combinations of active compression-decompression cardiopulmonary resuscitation, impedance threshold devices and head-up cardiopulmonary resuscitation in adult out-of-hospital cardiac arrest: A systematic review.

Objective: This review summarises the current evidence base for combinations of neuroprotective CPR adjuncts (active compression-decompression chest compressions, impedance threshold devices, and head-up positioning) during out-of-hospital cardiac arrest. Methods: A systematic search (PROSPERO registration CRD42023432302) was performed in English on MEDLINE, EMBASE, and the Cochrane Library in August 2023, and repeated in February 2024. All randomised and observational studies (not abstracts) reporting on any combination of the aforementioned CPR adjuncts were included. Papers were screened independently by two researchers, with a third reviewer acting as tiebreaker. Out-of-hospital, non-traumatic, cardiac arrests in patients >18 years were eligible for inclusion. Risk of bias was assessed using the Risk of Bias 2 tool and the Newcastle-Ottawa scale. Results: Eight of 1172 unique articles identified in the initial searches were included, with five randomised controlled trials and three observational studies. No randomised trial investigated a bundle of all three interventions. All randomised controlled trials were at intermediate or high risk of bias. Neurologically favourable survival was greater in patients treated with an impedance threshold device and active compression-decompression CPR when compared to standard CPR (8.9% vs 5.8%, p = 0.019) in the largest existing randomised trial. Conflicting results were found in observational studies comparing the complete neuroprotective bundle to standard CPR. Conclusions: This review was limited by small study numbers and overlapping samples, which precluded a meta-analysis. Limited data suggests that combinations of adjuncts to improve cerebral perfusion during CPR may improve survival with favourable neurological outcome. A randomised controlled trial is required to establish whether combining all three together results in improved outcomes.

Differentiating Myelography Contrast from Intraventricular and Subarachnoid Hemorrhage Using Dual-Energy CT of the Head: A Case Report and a Review of Literature.

Single-energy computed tomography (SECT) head is a common diagnostic tool to evaluate for intracranial hemorrhage in emergency settings due to its widespread accessibility and non-invasive nature. However, SECT has densitometric evaluation limitations. For example, hyperdensities on SECT such as blood product and iodine contrast appear similarly. Dual-energy CT (DECT) is a relatively under-utilized imaging modality that has the capability to differentiate between multiple materials. This imaging technique can be extremely useful in identifying materials that are otherwise indistinguishable from standard SECT. The authors present a case of a patient with findings suspicious of intraventricular and subarachnoid hemorrhage on conventional SECT. The suspected hemorrhage was subsequently ruled out utilizing DECT, as iodinated contrast can be subtracted out, yielding an image that can differentiate iodine contrast from blood or other hyperdense material. The authors discuss the underlying physics, potential advantages, and limitations of the DECT.

A Veiled Lymphatic Malformation: Stridor in a Child.

Lymphatic malformation (LM) is a congenital lymphatic dysplasia associated with the p110α subunit of PI3K (PIK3CA) mutation. A two-year-old boy presented with a history of noisy breathing from the age of two months, which was progressively worsening. Inspiratory stridor was audible with subcostal recession. Flexible nasopharyngolaryngoscopy (FNPLS) revealed an enlarged right arytenoid. Other supraglottic structures were normal, and bilateral vocal cords were mobile. Direct laryngoscopy showed that the right arytenoid was enlarged with a smooth surface. On the subsequent visit, there was a painless soft lateral neck swelling, 4 cm x 4 cm in size, with normal skin. MRI confirmed LM with the predominantly macro-cystic component, involving primarily the right neck and upper mediastinum, causing airway compression. Sirolimus therapy was initiated, and at one month of follow-up after the treatment, his stridor had improved. The incidence of stridor secondary to head and neck tumors such as teratomas, hemangiomas, and LM accounts for less than 3%. The typical manifestation of LM often involves a painless, soft, and compressible mass that progressively increases in size. Features of macrocystic LM on MRI are multilocular and hyperintense cystic mass on T2-weighted imaging. The treatment methods for LM include surgical and non-surgical options. Despite being an off-label application, the response rate of sirolimus therapy in children with LM is reported to be 91%, and the first clinical response was observed in less than three weeks. Stridor is frequently encountered in children but rarely due to head and neck tumors. However, as in our case, a large LM may cause recurrent airway obstruction, and the neck swelling may appear later. Atypical airway findings, especially endoscopic examination, in a child with stridor should be complemented with imaging to examine the possibility of extra-laryngeal mass or external compression.

The role of serotonin and serotonergic-related metabolites in pathogenesis of vasovagal syncope.

BACKGROUND: Serotonin is an important neurohormone that regulates vascular tone and autonomic reflexes, though its pathophysiological role in vasovagal syncope (VVS) remains uncertain. OBJECTIVE: This study sought to explore the involvement of serotonin and serotonergic-related metabolites in the pathogenesis of VVS. METHODS: Sixty-six patients (age 45.6±17.0 years; 33 females) with recurrent VVS underwent a head-up tilt test (HUTT). Blood samples were collected from all patients in a resting supine position, with an additional sample obtained from HUTT-positive patients during syncope. Plasma and platelet serotonin levels, and plasma concentrations of serotonergic-related metabolites-including serotonin's precursor 5-hydroxytryptophan (5-HTP), major metabolite 5-hydroxyindoleacetic acid (5-HIAA), and synthesis source tryptophan-were measured using the liquid chromatography tandem mass spectrometry (LC-MS/MS) method. RESULTS: HUTT was positive in 45 patients and negative in 21 patients. Significant differences were observed in plasma 5-HTP and 5-HIAA levels between HUTT+ and HUTT- patients (P<0.001 and P=0.040, respectively), as well as before and after syncope (all P<0.001), whereas no significant changes were found in serotonin and tryptophan levels. Notably, plasma serotonin levels significantly increased during syncope in patients with drug-free VVS (P=0.037), and a greater change in serotonin correlated with a shorter time to syncope (R2=0.38, P=0.015). Furthermore, certain serotonergic-related metabolites exhibited significant correlations with hemodynamic changes during VVS episodes, with 5-HTP demonstrating the highest sensitivity. CONCLUSIONS: Despite the unchanged plasma and platelet serotonin levels, certain serotonergic-related metabolites significantly changed and correlated with hemodynamic parameters during VVS episodes, suggesting the potential involvement of an altered serotonergic metabolic pathway in VVS.

Targeting superficial cancers with gold nanoparticles: a review of current research.

Superficial cancers typically refer to cancers confined to the surface layers of tissue. Low-targeting therapies or side effects prompt exploration of novel therapeutic approaches. Gold nanoparticles (AuNPs), due to their unique optical properties, serve as effective photosensitizers, enabling tumor ablation through photothermal therapy (PTT). PTT induced by AuNPs can be achieved through light sources externally applied to the skin. Near-infrared radiation is the main light candidate due to its deep tissue penetration capability. This review explores recent advancements in AuNP-based PTT for superficial cancers, specifically breast, head and neck, thyroid, bladder and prostate cancers. Additionally, challenges and future directions in utilizing AuNPs for cancer treatment are discussed, emphasizing the importance of balancing efficacy with safety in clinical applications.

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Cold atmospheric plasma activated media selectively affects human head and neck cancer cell lines.

OBJECTIVE: Cold atmospheric plasma (CAP) is a novel approach for cancer treatment. It can be used to treat liquids-plasma-activated media (PAM)-which are then transferred to the target as an exogenous source of reactive oxygen and nitrogen species (RONS). The present study aimed at chemically characterizing different PAM and assessing their in vitro selectivity against head and neck cancer cells (HNC). METHODS: PAM were obtained by exposing 2 and 5 mL of cell culture medium to CAP for 5, 10 and 20 min at a 6 mm working distance. Anions kinetics was evaluated by ion chromatography. Cell proliferation inhibition, apoptosis occurrence, and cell cycle modifications were assessed by MTS and flow cytometry, on human epidermal keratinocyte (HaCaT) and HNC cell lines HSC3, HSC4 and A253. RESULTS: The 2 mL conditions showed a significant reduction in cell proliferation whereas for the 5 mL the effect was milder, but the time-dependence was more evident. HaCaT were unaffected by the 5 mL PAM, indicating a selectivity for cancer cells. CONCLUSIONS: The media chemical composition modified by CAP exposure influenced cell proliferation by modulating cell cycle and inducing apoptosis in cancer cells, without affecting normal cells.

The Impact of Preoperative Flexible Fiberoptic Laryngoscopy on Anesthesia's Intubation Plans.

Purpose: To assess the value of conducting a preairway management review of flexible fiberoptic laryngoscopy examinations (FFL) by the anesthesia team for patients with head and neck cancer and to examine its impact on intubation strategies and overall patient safety. Methods: Prospective study at a single tertiary referral center including patients with stage T2 and greater cancers of the oropharynx, hypopharynx, or larynx who underwent intubation by the anesthesia team between May 2022 and April 2023. Pre- and postoperative surveys gathered data on the intubation plan, including details such as method, sedation, patient respiration, laryngoscope, tube size, and use of paralysis. Postoperative surveys gauged the FFL's subjective utility and documented intubation details and complications. Results: Thirty-four patients (49-87 years of age) were included in the study. Eleven intubation plans were changed after reviewing the FFL, while 23 were not. Although this was a pilot study, there was no significant correlation between location of the tumor and change in intubation plan. Of the 34 intubations, 9 were executed based on the plan after reviewing FFL. The majority of the attending anesthesiologists agreed or strongly agreed that seeing the FFL was more helpful than reading the findings in clinic notes and that reviewing the FFL was helpful in creating the intubation plan, 77% and 88%, respectively. Conclusion: Reviewing the FFL led to changes in the anesthesia team's intubation plan in 32% of the cases in our pilot study. While these findings are promising, they highlight the need for further research with larger sample sizes and across multiple centers to validate the impact of FFL on intubation strategies for patients with stage T2 and greater cancers of the oropharynx, hypopharynx, or larynx.

Awake Tracheostomy in a Pediatric Patient.

Awake tracheostomy is rare in the pediatric population. We describe the case of a 10-year-old male who underwent awake tracheostomy due to airway obstruction from an oropharyngeal rhabdomyosarcoma. Given the varying medical understanding and communication skills in children, advanced planning and interdisciplinary collaboration are essential to keep the patient calm and safe during awake tracheostomy.

Clinical Audit in the Elderly by Assessing Hydration and Renal Functions Before and After Contrast CT Scans at District Headquarters Hospital, Dera Ismail Khan, Pakistan.

Introduction Contrast-induced nephropathy (CIN) is a serious risk involved in computed tomography (CT) scans, particularly for older people. The main idea of this clinical audit was to assess current practices regarding renal function tests (RFTs) and hydration status before and after contrast CT scans in older patients at District Headquarters Hospital (DHQ), Dera Ismail Khan, Pakistan, and to implement recommendations for improvement. CIN is a form of acute kidney injury that occurs after the administration of contrast dye used in imaging procedures and is characterized by a sudden deterioration in renal functions. Methods This clinical audit checked adherence to renal protection protocols in elderly patients undergoing contrast CT scans. Conducted over three cycles from July 5 to August 15, 2022, this clinical audit included 30 patients aged 75 and above. Each cycle had 10 patients, divided equally between males and females, and further categorized into age groups of 75-85 years and 86-95 years. Data collection involved reviewing patient files, medication charts, and CT scan reports. Compliance with RFT documentation and hydration before and after the CT scan was assessed against the standards set by Basildon and Thurrock University Hospitals NHS Foundation Trust. Data were analyzed using Microsoft Excel 2023 (Microsoft® Corp., Redmond, WA), and graphs were created using Microsoft Word 2023 (Microsoft® Corp., Redmond, WA). Results The mean age ± standard deviation (SD) for males was 81.8 ± 5.01 in the first cycle, 83.4 ± 6.46 in the second cycle, and 82.4 ± 4.72 in the third cycle. For females, the mean age ± SD was 83.2 ± 5.80 in the first cycle, 85.2 ± 6.41 in the second cycle, and 83.0 ± 6.12 in the third cycle. The first audit cycle revealed that, while all patients (100%) had their RFTs documented before the CT scan, only 20% were adequately hydrated pre-scan, and none (0%) had RFTs performed post scan. Post-scan hydration was also low at 20%. These findings highlighted gaps in adherence to renal protection protocols. The second cycle showed improvements, with pre-scan hydration adherence increasing to 80%, post-scan RFTs to 60%, and post-scan hydration to 70%. By the third cycle, full compliance (100%) was achieved across all standards, including pre- and post-scan renal functions test and hydration. Conclusion The clinical audit at District Headquarters Hospital, Dera Ismail Khan, addressed gaps in renal protection protocols for elderly patients undergoing contrast CT scans. The audit improved adherence over three cycles through targeted interventions, including staff training, implementation of checklists, patient education, modifying the reporting format, and providing instructions in the local language. It also highlighted the importance of continuous education and regular monitoring. The clinical audit would be expanded to another hospital within the medical teaching institute, Dera Ismail Khan. This measure will maintain and enhance patient care, prevent CIN, and improve the renal health of elderly patients.

Radial Head Fracture (Mason Type 4) Fixation With Headless Compression Screws: The "Tripod Technique".

Radial head fractures are fairly common fractures in the general population accounting for up to 30% of elbow fractures. The management of these fractures is controversial, specially in the higher grade of fractures. The current case report presents a middle-aged male patient with a fracture dislocation of the radial head in the dominant hand. After undergoing adequate investigations, the fracture was classified and managed with headless compression screws using the tripod technique. The management of the patient, preoperative planning, and the complications faced are mentioned in the current report. The patient on follow-up shows a good range of motion and an improved Mayo elbow score. Thus, stating good results can be obtained in Mason type 4 fractures using osteosynthesis with headless compression screws.

Evidence summary on the rehabilitative management of dysphagia during radiotherapy for head and neck cancer patients.

Objective: To retrieve, extract, integrate and evaluate evidence on the rehabilitation of dysphagia in patients undergoing radiotherapy for head and neck cancer (HNC), and to provide a basis for the development of a rehabilitation management protocol for dysphagia in patients undergoing radiotherapy for HNC. Methods: An evidence-based systematic search of the literature related to the rehabilitation of dysphagia in patients with HNC during radiotherapy was conducted from January 2013 to March 2023, and the corresponding evaluation tools were selected according to the different types of literature for quality evaluation. "The Joanna Briggs Institute (JBI) evidence pre-grading system was used to evaluate the quality of the evidence. Results: A total of 17 articles were included, including 3 guidelines, 5 expert articles, 1 clinical decision, 1 practice recommendation, 2 evidence summaries and 5 systematic evaluations. A final total of 28 pieces of evidence were summarised, including 6 areas of swallowing disorder screening and assessment, physiotherapy, preventive swallowing function training, feeding management, pain control, and oral care. Conclusion: This study forms a multidisciplinary collaborative evidence summary for the rehabilitation management of dysphagia in patients undergoing radiotherapy for HNC, but the application of some of the evidence needs to be carried out in the context of the clinical setting and patient-specific circumstances for the rehabilitation evidence selected for patients' dysphagia to improve their swallowing function and their swallowing-related quality of life and reduce the occurrence of related complications.

How attentive is a student in class? A concentration evaluation method based on head Euler angle.

How attentive is a student in class? It is an interesting and challenging question in the field of education research. In this paper, a concentration evaluation method based on head Euler angle is proposed. First, a fine large-small-interval video sampling strategy is advocated and concepts of dynamic threshold and action amplitude coefficient are defined, which are fused together to get the head up rate. Second, head front-facing rate is computed through analyzing the yaw angle, which is obtained from a proposed spatial physical model of camera and student seat position. Third, for any given time period, class concentration of a student is derived by fusing and normalizing the head up rate and head front-facing rate based on Euclidean-distance. Finally, accuracy experiments are conducted, where the proposed method achieves an average accuracy of 89.8% compared with the average score from the questionnaire given by 22 reviewers. Also, robust experiments on several head pose estimation models are facilitated, which achieves an average accuracy of 98.43% on recorded video dataset, indicates insensitivity to the head pose estimation model used for data collection and verifies that the proposed method is independent on any specific head pose estimation model. The experimental results show that the proposed method is accurate, effective and robust for the concentration evaluation in class.