Impact of the Integrated Activation System on Door-to-Balloon Times and Clinical Outcomes in STEMI Patients Receiving Primary PCI.

Background: The door-to-balloon (D2B) time is a critical quality measure in managing ST-segment elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (PCI). We developed an integrated STEMI activation system, named Acute Myocardial Infarction Software Aids (AMISTAD), to optimize care for STEMI patients. This study aimed to evaluate the impact of the AMISTAD system on D2B times and clinical outcomes. Methods: We retrospectively collected data of consecutive STEMI patients receiving primary PCI between July 2017 and December 2018 at a single center. The patients were categorized into AMISTAD and non-AMISTAD groups. Outcomes included D2B time, length of hospital stay, and 12-month cardiovascular outcomes. Data were analyzed using multiple regression models; subgroup and sensitivity analyses were applied to examine the robustness of the results. Results: A total of 114 STEMI patients were enrolled (38 AMISTAD, 76 non-AMISTAD). The AMISTAD group had a significantly shorter mean D2B time (66.7 ± 13.2 vs. 76.6 ± 24.9 minutes, p = 0.02) and non-significantly shorter length of hospital stay (4.7 vs. 7.2 days, p = 0.09). The 12-month cardiovascular outcomes between the two groups were not significantly different (adjusted hazard ratio 0.79, 95% confidence interval 0.30-2.09, p = 0.64). Subgroup and sensitivity analyses had consistent outcomes. Conclusions: Integrating the AMISTAD system into the STEMI workflow was associated with a reduced D2B time and shorter hospital stay. Further research involving larger cohorts and extended follow-up periods is needed to assess the generalizability and impact on cardiovascular outcomes. The AMISTAD system has the potential to improve the quality of care for STEMI patients.

WISP-1 promotes VEGF-C-dependent lymphangiogenesis by inhibiting miR-300 in human oral squamous cell carcinoma cells.

Oral squamous cell carcinoma (OSCC), which accounts for nearly 90% of head and neck cancers, is characterized by a poor prognosis and a low survival rate. Vascular endothelial growth factor-C (VEGF-C) has been implicated in lymphangiogenesis and is correlated with cancer metastasis. WNT1-inducible signaling pathway protein-1 (WISP)-1/CCN4 is an extracellular matrix-related protein that belongs to the CCN family and stimulates many biological functions. Our previous studies showed that WISP-1 plays an important role in OSCC migration and angiogenesis. However, the effect of WISP-1 on VEGF-C regulation and lymphangiogenesis in OSCC is poorly understood. Here, we showed a correlation between WISP-1 and VEGF-C in tissue specimens from patients with OSCC. To examine the lymphangiogenic effect of WISP-1, we used human lymphatic endothelial cells (LECs) to mimic lymphatic vessel formation. The results showed that conditioned media from WISP-1-treated OSCC cells promoted tube formation and cell migration in LECs. We also found that WISP-1-induced VEGF-C is mediated via the integrin αvß3/integrin-linked kinase (ILK)/Akt signaling pathway. In addition, the expression of microRNA-300 (miR-300) was inhibited by WISP-1 via the integrin αvß3/ILK/Akt cascade. Collectively, these results reveal the detailed mechanism by which WISP-1 promotes lymphangiogenesis via upregulation of VEGF-C expression in OSCC. Therefore, WISP-1 could serve as therapeutic target to prevent metastasis and lymphangiogenesis in OSCC.

WISP-1 a novel angiogenic regulator of the CCN family promotes oral squamous cell carcinoma angiogenesis through VEGF-A expression.

Oral squamous cell carcinoma (OSCC), which accounts for nearly 90% of head and neck cancers, is characterized by poor prognosis and a low survival rate. VEGF-A is the most established angiogenic factor involved in the angiogenic-regulated tumor progression. WISP-1/CCN4 is an extracellular matrix-related protein that belongs to the Cyr61, CTGF, Nov (CCN) family and regulates many biological functions, such as angiogenesis. Previous studies indicated the role of WISP-1 in tumor progression. However, the angiogenic property of WISP-1 in the cancer microenvironment has never been discussed. Here, we provide novel insights regarding the role of WISP-1 in the angiogenesis through promoting VEGF-A expression. In this study, the correlation of WISP-1 and VEGF-A was confirmed by IHC staining of specimens from patients with OSCC. In vitro results indicated that WISP-1 induced VEGF-A expression via the integrin αvß3/FAK/c-Src pathway, which transactivates the EGFR/ERK/HIF1-α signaling pathway in OSCC. This pathway in turn induces the recruitment of endothelial progenitor cells and triggers the neovascularization in the tumor microenvironment. Our in vivo data revealed that tumor-secreted WISP-1 promoted the angiogenesis through VRGF expression and increased angiogenesis-related tumor growth. Our study offers new information that highlights WISP-1 as a potential novel therapeutic target for OSCC.

Risk factors affect the survival outcome of hard palatal and maxillary alveolus squamous cell carcinoma: 10-year review in a tertiary referral center.

OBJECTIVE: Hard palatal cancer is relatively rare in the head and neck region. Treatment outcome, risk factors that lead to poor survival outcome, and treatment strategy are still controversial. STUDY DESIGN: Retrospective study in a tertiary medical center. RESULTS: Surgery is a better treatment strategy than concurrent chemoradiation therapy (CCRT) for achieving positive survival outcomes. We also found a higher surgical salvage rate in patients with hard palatal cancer who had local recurrence or neck relapse. Soft palate or infratemporal fossa involvement had poor outcomes. Ulcerative tumor features, tumor volumes larger than 10 mL, and local recurrent tumors that could not undergo salvage surgery also had poorer survival outcomes in our study. CONCLUSION: Surgical management is still the first choice for patients with hard palate or alveolus squamous cell carcinomas even when patients had local or neck regional recurrence.

Improvement in otitis media with effusion in patients undergoing tracheostomy after prolonged endotracheal intubation.

OBJECTIVES: Otitis media with effusion (OME) has a higher incidence in adult intensive care unit (ICU) patients. This observational study sought to examine the effect of tracheostomy on OME in critically ill patients and explore the predisposing factors. MATERIALS AND METHODS: Twenty-seven ICU patients who had undergone prolonged intubation (more than 14 days) received traditional tracheostomies. Otoscopic examination, tympanometry, and spectral gradient acoustic reflectometry were performed both at the time of the tracheostomy and 7 days later. We collected data on the patients' demographics (age and gender), underlying diseases, duration of intubation prior to the tracheostomy, history of gastroesophageal reflux disease, length of antibiotic use, level of consciousness, and presence of nasogastric tubes. RESULTS: At the time of the tracheostomy, 25 (46%) ears from 14 (52%) patients were classified as cases of OME, 17 (31%) ears and 7 (26%) patients as normal cases, and 12 (11%) ears from 6 (11%) patients as cases of negative pressure in the tympanic cavity. Seven days after the tracheostomy, OME was resolved in 17 (68%) ears and persisted in 6 (24%) ears, whereas negative pressure developed in 2 (8%) ears. Our data showed that the incidence of OME reduced from 46% to 22% after tracheostomy was performed on the patients. CONCLUSION: The incidence of OME in adult ICU patients who were intubated for more than 14 days was found to reduce after tracheostomy. Notably, the rate of improvement in the conscious patients was significantly higher than that in the unconscious patients.

Parotid tumors: a 10-year experience.

PURPOSE: The aim of the present study was to analyze the clinical presentation, histopathology, and complications of parotid tumors, as well as the management of malignant parotid tumors. METHODS: We retrospectively reviewed the medical records of 271 patients who underwent parotidectomy from August 1996 to July 2006. Data including age, sex, clinical signs and symptoms, histologic findings, complications, malignant tumor stage, and prognosis were collected from medical charts. RESULTS: Of the 271 patients who underwent parotidectomy, 229 (85%) had benign tumors, 33 (12%) had malignant tumors, and 9 had chronic inflammatory disease (3%). The most common benign tumor was pleomorphic adenoma (51%), and the most common malignant tumor was mucoepidermoid carcinoma (3%). The 5-year overall survival rate was 42%, and the disease-specific survival rate for malignant tumor was 72%. Only disease stage was the statistically significant prognostic factor of malignancy. The most common complication of parotidectomy was transient facial palsy (18%). CONCLUSIONS: Standardized superficial and total parotidectomy are safe procedures for treating parotid tumors. Management of malignant tumors depends on tumor stage and histologic grade. Advanced tumor stage is a predictor of poor outcome.

Middle ear effusion in intensive care unit patients with prolonged endotracheal intubation.

OBJECTIVES: The purpose of this study is to explore the factors related to the occurrence of middle ear effusion (MEE) in prolonged endotracheal intubation patients in the intensive care unit (ICU). METHODS: Information about the age, sex, duration of endotracheal intubation, level of consciousness, and placement of nasogastric tube was retrospectively collected from medical charts of 20 prolonged endotracheal intubation (>7 days) patients in the ICU. All patients received otoscopic examination, tympanometry studies, and spectral gradient acoustic reflectometry for evidence of MEE. RESULTS: Among the 40 ears examined in this study, 20 ears had MEE (50%), 14 ears were normal (35%), and 6 ears had negative pressure in the middle ear (15%). In addition, patients with conscious disturbance and those who had been intubated for 14 days had a significantly higher incidence of MEE. Nasogastric tube was not implicated in MEE in this study. No episodes of acute otitis media or systemic infection were encountered in this study. CONCLUSIONS: Prolonged endotracheal intubation (>7 days) in adult ICU patients contributed to the high incidence of MEE (50%). Moreover, conscious disturbance and endotracheal intubation for 14 days were also significant contributing factors of MEE.