International guidelines for intratumoral and intranodal injection of NBTXR3 nanoparticles in head and neck cancers.

BACKGROUND: An international multidisciplinary panel of experts aimed to provide consensus guidelines describing the optimal intratumoral and intranodal injection of NBTXR3 hafnium oxide nanoparticles in head and neck squamous cell carcinoma (HNSCC) of the oral cavity, oropharynx, and cervical lymph nodes and to review data concerning safety, feasibility, and procedural aspects of administration. METHODS: The Delphi method was used to determine consensus. A 4-member steering committee and a 10-member monitoring committee wrote and revised the guidelines, divided into eight sections. An independent 3-member reading committee reviewed the recommendations. RESULTS: After two rounds of voting, strong consensus was obtained on all recommendations. Intratumoral and intranodal injection was deemed feasible. NBTXR3 volume calculation, choice of patients, preparation and injection procedure, potential side effects, post injection, and post treatment follow-up were described in detail. CONCLUSIONS: Best practices for the injection of NBTXR3 were defined, thus enabling international standardization of intratumoral nanoparticle injection.

Safety Precautions for Self-Performed Severe Acute Respiratory Syndrome Coronavirus 2 Tests: A Case of a Swallowed Swab.

Oropharyngeal and nasopharyngeal specimens collected by swabbing are the pillars of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostics. Commercially available rapid antigen tests and self-sampling polymerase chain reaction services have made specimen collection available anytime and anywhere in nonmedical settings. In this study, we report the case of a 45-year-old man who accidentally ingested a swab during self-performed SARS-CoV-2 rapid antigen testing. Imaging studies revealed an elongated foreign body in the stomach. Urgent gastroscopy confirmed the presence of the swabbing applicator in the gastric lumen, which was retrieved using a loop without any complications. Millions of SARS-CoV-2 tests are performed daily, of which an increasing proportion are performed by laypeople. Foreign bodies account for a particular set of complications, which can be avoided by cautious sampling and using the correct technique. Radiopaque labeling of instruments would be useful. Otherwise, rare serious events can occur that may require immediate medical interventions.

Report of an Otic Capsule Disrupting Fracture of the Temporal Bone: Visualization of Pneumolabyrinth and Functional Assessment.

Blunt trauma of the head can result in temporal bone fracture. Different classifications exist, but from a functional perspective, to distinguish otic capsule sparing and otic capsule disrupting fractures is superior to the classic nomenclature. Disruption of the otic capsule is often associated with sensorineural hearing loss, vestibular dysfunction, cerebrospinal leakage, or even intracranial consequences. Pneumolabyrinth describes the condition when air is enclosed within the inner ear. It is a result of a pathological communication between the labyrinth and the middle ear spaces that often occurs due to trauma. It is not a ubiquitous but obvious radiographic hallmark of otic capsule violation. The present case is about a young woman who suffered a temporal bone fracture that involved the right lateral semicircular canal. Multiplanar and segmentation images were generated to depict the pneumolabyrinth developed in the lateral semicircular canal. Despite the preserved hearing, vestibular dysfunction was registered during the video head impulse test and videonystagmography. Treatment of pneumolabyrinth after temporal bone fracture can be a matter of surgery or conservative therapy. In the present case, we preferred conservative therapy because of the absence of serious consequences. Nevertheless, timing and the type of therapeutic modality must be personalized.

Elevated platelet count as a possible prognostic marker of survival in patients with head and neck tumours / A magasabb vérlemezkeszám mint a fej-nyak tumoros betegek túléléssel kapcsolatos esetleges prognosztikai faktora.

Összefoglaló. Bevezetés: Régóta ismert, hogy a daganatokhoz társuló emelkedett vérlemezkeszám rosszabb túléléssel társul. Fej-nyak tumoros betegek esetében kevés információ áll rendelkezésünkre ezzel az összefüggéssel kapcsolatban. Célkituzés: Vizsgálatunk célja a fej-nyak daganatos betegek prognózisa és a thrombocytosis közötti összefüggés tanulmányozása volt. Módszer: Különféle stádiumú és lokalizációjú, 312, fej-nyak tumoros beteg retrospektív adatait elemeztük. A mutét elotti vérlemezkeszámokat vizsgáltuk, a 300 G/l feletti értéket tekintettük emelkedett thrombocytaszámnak. A vérlemezkeszám és a túlélés közötti kapcsolatot Kaplan-Meier-módszerrel és multivariáns Cox-regresszióval elemeztük. Eredmények: Emelkedett thrombocytaszám mellett szignifikánsan rosszabb túlélést észleltünk (5 éves túlélés: p = 0,007, betegségmentes túlélés: p = 0,192). Ez az összefüggés még akkor is fennállt, amikor multivariáns analízissel nemre, korra, stádiumra, differenciáltsági fokra, lokalizációra, valamint fehér- és vörösvérsejtszámra korrigáltuk az elemzést (5 éves túlélés: p = 0,027). A különféle anatómiai lokalizációkban eltéro mértékben észleltünk 300 G/l feletti vérlemezkeszámot (algarat: 43,6%, sub- és supraglottis: 35,8%, szájüreg: 35,7%, hangszalag: 22,5%, szájgarat: 19%, multiplex: 50%), ez azonban nem befolyásolta szignifikánsan a túlélést (p = 0,603). Következtetés: A daganathoz társuló thrombocytosis összefüggésbe hozható a fej-nyak tumoros betegek rosszabb túlélésével. Az egyes lokalizációkban talált különbözo vérlemezkeszámok nem befolyásolják eltéro mértékben a túlélést. Orv Hetil. 2021; 162(17): 676-682. INTRODUCTION: The association between cancer-related thrombocytosis and worse survival has been described with a variety of solid neoplasms. However, only limited data are available on the prognostic significance of elevated platelet count in head and neck tumours. OBJECTIVE: We aimed to investigate the correlation between the survival of patients with head and neck cancer and thrombocytosis. METHOD: We conducted an analysis of the data from 312 patients with head and neck squamous cell carcinoma of various stages and locations. Preoperative platelet counts were analysed; elevated platelet count was defined as 300 G/l or higher. The influence of platelet count on survival was calculated with the Kaplan-Meier method as well as with multivariate Cox regression. RESULTS: In patients with excessive thrombocytosis, survival was significantly worse (overall survival: p = 0.007, disease-free survival: p = 0.192). This association remained significant even after adjusting the multivariate analysis for age, gender as well as tumour stage, grade, location, red and white blood cell count (overall survival: p = 0.027). The magnitude of thrombocytosis differed among tumours of different anatomical locations (hypopharynx: 43.6%, sub- and supraglottis: 35.8%, oral cavity: 35.7%, vocal cord: 22.5%, oropharynx: 19%, multiple: 50%), but this did not affect survival significantly (p = 0.603). CONCLUSION: Elevated platelet count may be related to a worse prognosis in head and neck squamous cell carcinoma patients. The impact of thrombocytosis does not vary with the anatomical location of the tumour. Orv Hetil. 2021; 162(17): 676-682.

Neutrophil-To-Lymphocyte and Platelet-To-Lymphocyte Ratios as Prognostic Markers of Survival in Patients with Head and Neck Tumours-Results of a Retrospective Multicentric Study.

BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) may be useful for drawing conclusions about the survival of head and neck squamous cell carcinoma (HNSCC) patients. METHODS: Clinical data of 156 patients managed for HNSCC at two head and neck surgery centres were analyzed retrospectively. We studied the relationships between survival and PLR as well as NLR. RESULTS: With regards to 5-year survival, the difference between the two groups with PLR values lower or higher than the threshold was statistically significant (p = 0.004), and we found the same for disease-free survival (p = 0.05), and tumour-specific mortality (p = 0.009). Concerning NLR, the difference in tumour-specific survival was statistically significant (p = 0.006). According to the multivariate analysis, NLR values higher than the threshold indicated an enhanced risk for overall as well as for tumour-specific mortality. CONCLUSION: In HNSCC patients, a high NLR may be considered as an independent risk factor for 5-year overall survival.

Comparative study of the effect of bilastine and cetirizine on cognitive functions at ground level and at an altitude of 4,000 m simulated in hypobaric chamber: a randomized, double-blind, placebo-controlled, cross-over study.

INTRODUCTION: Antihistamines are easily accessible and cover the vast majority of the medical therapy of allergic rhinitis. However, their systemic administration may more frequently associate with their well-known side-effect, sedation, which is a serious problem in persons in safety-critical jobs such as aviation. We have a poor understanding whether a non-sedative antihistamine has an impact on vigilance when hypobaric hypoxia occurs during flight. METHODS: In this randomized, placebo-controlled, double-blind, cross-over study the effect of 20 mg bilastine was compared to 10 mg cetirizine and to placebo (20 mg pyridoxine) in 33 individuals at ground level and at 4,000 m altitude simulated in hypobaric chamber. Levels of vigilance, ultrashort memory, combined distributive attention, monotony tolerance and peripheral blood oxygen saturation (SpO2) were assessed. RESULTS: Bilastine did not impair the tested abilities in comparison with the control groups either at ground level or hypobaric hypoxia. Administration of cetirizine increased the number of errors at ground level. At the simulated altitude, already impaired results were additionally demonstrated with regards to the distributive attention test. CONCLUSIONS: From the two examined antihistamines, bilastine should be the preferred medication for by individuals who require constant attention and are exposed to hypobaric hypoxia.

Acute audiogenic stress-induced activation of CRH neurons in the hypothalamic paraventricular nucleus and catecholaminergic neurons in the medulla oblongata.

Strong c-fos expression was induced in neuronal cells of several brain nuclei and the auditory cortex by a short duration auditory stimulation (white noise) in rats. By double immunostaining, Fos-immunoreactive cell nuclei appeared in corticotropin-releasing hormone (CRH)-containing neurons in the hypothalamic paraventricular nucleus, but not in CRH neurons elsewhere in the brain including the central nucleus of the amygdala. Among brain catecholaminergic neurons, only cells in the medulla oblongata (in the A1/C1and A2/C2 cell groups) established double immunostaining for Fos and tyrosine hydroxylase. Sound stimulus in rats with unilateral tympanotomy and plugging the airways resulted in side differences of Fos immunoreactivity in neurons of the auditory pathways and the auditory cortex, but the effect was bilateral in hypothalamic and amygdaloid nuclei. The present data provide evidence for the participation of CRH-synthesizing neurons in hypothalamus and medullary catecholaminergic neurons in the central organization of responses to audiogenic stress stimuli.

Investigation of the complex descending innervation of the dorsal cochlear nucleus in the rat: a transneuronal tract-tracing study using pseudorabies virus.

The afferent neuronal connections of the dorsal cochlear nucleus were investigated in rats by using a trans-synaptic retrograde tract-tracing method. The neurotropic viral tracer, the Bartha strain of the pseudorabies virus was stereotaxically injected into the dorsal cochlear nucleus, ipsilaterally. Neurons, which project directly or indirectly (one or multiple relays by other neurons) to the dorsal cochlear nucleus were infected and visualized by immunohistochemistry. Labeled neurons were found in each components of the auditory pathway, some of the monoaminergic cell groups in the lower brainstem, the hypothalamus and in some limbic areas.

The c-MYC protooncogene expression in cholesteatoma.

Cholesteatoma is an epidermoid cyst, which is most frequently found in the middle ear. The matrix of cholesteatoma is histologically similar to the matrix of the epidermoid cyst of the skin (atheroma); their epithelium is characterized by hyperproliferation. The c-MYC protooncogene located on chromosome 8q24 encodes a transcription factor involved in the regulation of cell proliferation and differentiation. Previous studies have found aneuploidy of chromosome 8, copy number variation of c-MYC gene, and the presence of elevated level c-MYC protein in cholesteatoma. In this study we have compared the expression of c-MYC gene in samples taken from the matrix of 26 acquired cholesteatomas (15 children and 11 adults), 15 epidermoid cysts of the skin (atheromas; head and neck region) and 5 normal skin samples (retroauricular region) using RT-qPCR, providing the first precise measurement of the expression of c-MYC gene in cholesteatoma. We have found significantly elevated c-MYC gene expression in cholesteatoma compared to atheroma and to normal skin samples. There was no significant difference, however, in c-MYC gene expression between cholesteatoma samples of children and adults. The significant difference in c-MYC gene expression level in cholesteatoma compared to that of atheroma implies a more prominent hyperproliferative phenotype which may explain the clinical behavior typical of cholesteatoma.

Acoustic stress activates tuberoinfundibular peptide of 39 residues neurons in the rat brain.

Strong acoustic stimulation (105 dB SPL white noise) elicited c-fos expression in neurons in several acoustic system nuclei and in stress-sensitive hypothalamic nuclei and limbic areas in rats. In the present study, using this type of loud noise for 30 min, Fos-like immunoreactivity (Fos-ir) was investigated in neurons that synthesize tuberoinfundibular peptide of 39 residues (TIP39) in the rat brain: in the subparafascicular area of the thalamus, the posterior intralaminar complex of the thalamus and the medial paralemniscal nucleus in the lateral part of the pons. By double labeling, Fos-ir was shown in nearly 80% of TIP39-positive cells in the medial paralemniscal nucleus, 43% in the posterior intralaminar complex and 18.5% in the subparafascicular area 30 min after the end of a 30-min loud noise period. In control rats, only few neurons, including 0-4% of TIP39-positive neurons showed Fos-ir. While the majority of the Fos-ir neurons were TIP39-positive in the subparafascicular area and medial paralemniscal nucleus, a fairly high number of TIP39-immunonegative, chemically uncharacterized neurons expressed c-fos in the subparafascicular area and the posterior intralaminar complex of the thalamus. These observations clearly show that some TIP39 neurons in the so-called "acoustic thalamus" and the majority of TIP39 neurons in the medial paralemniscal nucleus are sensitive to loud noise and they may participate in the central organization of responses to acoustic stress. Furthermore, the present data suggest that non-TIP39-expressing neurons may play a prevalent role in the activity of the "acoustic thalamus".