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Garcinia section Garcinia (Clusiaceae) is revised for Thailand with three species and one variety, i.e., two native species: G. celebica and G. exigua, and one cultivated species: G. mangostana var. mangostana. Detailed morphological descriptions, illustrations, and an identification key to the species are presented, along with notes on distributions, habitats and ecology, phenology, conservation assessments, etymology, vernacular names, uses, and specimens examined. The section is recognized by its terminal inflorescences of simple cymes, or sometimes a solitary flower; flowers with 4 sepals and 4 petals; male flowers often with a pistillode, and stamens united into a single 4-lobed or 4-angled bundle, and with 2-thecous anthers; usually multilocular ovaries and stigmas with distinct or weak lobes and smooth or rough; and fruits with a smooth surface. Three associated synonyms of G. celebica: G. ferrea, G. basacensis, and G. hombroniana, are lectotypified here in a second-step. In Thailand, Garcinia celebica is found in a very wide variety of habitats, at elevations of 0–1,500 m amsl., and is known to be naturally distributed in all floristic regions. G. exigua is found in dry evergreen forest on limestone hills and in littoral dry evergreen forest on limestone hills, at elevations of 50–100 m amsl. in Krabi Province, the peninsular region. G. mangostana var. mangostana is found only in cultivation. Garcinia exigua has a conservation status of Vulnerable [VU B2ab(iii)] and the other two species have a conservation status of Least Concern [LC]. The fleshy pulp surrounding the seeds of two species, G. celebica and G. mangostana var. mangostana is edible and has a sweet-sour taste.

Watermelon rind extract is rich in protein, citrulline, and lycopene, whereas orange peel essential oil contains vitamins A, C, and E. Both ingredients have demonstrated potential in preventing hair loss. This study aimed to develop an oleogel that combines these two components to address hair loss. The efficacy of the oleogel for promoting hair growth was evaluated in male DDY (Deutchland Denken Yonken) mice. The oleogel characteristics, including pH, viscosity, color, homogeneity, oil binding capacity, spreadability, and organoleptic evaluations, were assessed through physical quality tests. Organoleptic analysis was conducted with 30 respondents from IPB University to identify the most preferred oleogel formulation. The yield of watermelon rind extract was 28.88%, while the orange peel essential oil constituted 2% (v/w) of the formulation. The optimal oleogel contained 3% watermelon rind extract and 1% orange peel essential oil, resulting in 100% hair growth in the mice. All the formulations met the standard requirements for oleogels, with the most favored being Formula F3, which includes 1% watermelon rind extract and 3% orange peel essential oil. This research highlights the potential of watermelon rind extract and orange peel essential oils as effective nutrients for hair loss treatment.

A taxonomic revision of Rhizophora L. (Rhizophoraceae) in Thailand is presented. Two species, R. apiculata Blume and R. mucronata Poir., are enumerated with updated morphological descriptions, illustrations and a taxonomic identification key, together with notes on distributions, habitats and ecology, phenology, conservation assessments, etymology, vernacular names, uses, and specimens examined. Three names in Rhizophora, are lectotypified: R. apiculata and two associated synonyms of R. mucronata (i.e., R. latifolia Miq. and R. macrorrhiza Griff.). R. longissima Blanco, a synonym of R. mucronata, is neotypified. All two Rhizophora species have a conservation assessment of Least Concern (LC). Based on the morphological identification, these two species can be distinguished from one another by the shape and width of the leaf laminae and the length of a terminal stiff point of the leaf laminae; the type and position of the inflorescences and the number of flowers per inflorescence; the character and color of the bracteoles; the presence or absence of the flower pedicels; the shape of the mature flower buds; the shape, color, and texture of the sepals; the shape, character, and the presence or absence of hairs of the petals; the number of stamens per flower; the size of the fruits; the color and size of the hypocotyls; the color and diameter of the cotyledonous cylindrical tubes; and the color of the colleters and exudate. The thick cuticles, sunken stomata, large hypodermal cells, and cork warts are adaptive anatomical features of leaves in Rhizophora that live in the mangrove environments. The pollen grains of Thai Rhizophora species are tricolporate, prolate spheroidal or oblate spheroidal shapes, small-sized, and reticulate exine sculpturing.

Garcinia section Xanthochymus (Clusiaceae) is revised for Thailand with four native species, i.e., G. dulcis, G. nervosa, G. prainiana, and G. xanthochymus. All species are described with updated morphological descriptions, illustrations, and an identification key, together with notes on distributions, distribution maps, habitats and ecology, phenology, conservation assessments, etymology, vernacular names, uses, and specimens examined. Four taxa, G. andamanica, G. andamanica var. pubescens, G. cambodgiensis and G. vilersiana, are synonymized under G. dulcis, and two taxa, G. nervosa var. pubescens and G. spectabilis, are newly synonymized under G. nervosa. Nine names are lectotypified: G. dulcis and its associated synonyms (G. cambodgiensis and G. vilersiana), G. nervosa and its associated synonyms (G. andersonii, G. nervosa var. pubescens, and G. spectabilis), G. prainiana, and G. xanthochymus. All species have a conservation assessment of Least Concern (LC). The fruits of all species are edible and have a sour or sweet-sour taste.

Abstract The interplay between long‐term environmental variability and litterfall is complex and through this study, we quantified the response of peak leaf, flower, and fruit litterfall production to such variability in a lower montane evergreen forest located in Doi Suthep‐Pui National Park, Thailand. We observed seasonality in litterfall accumulation with peak leaf and flower litterfalls occurring mostly during the cool and hot dry seasons, while fruit litterfall occurs mostly during the wet season. Probable associations with environmental drivers (barometric pressure, temperature, relative humidity, number of sunlight hours, evaporation, wind speed, and vapor pressure deficit) were tested on a 5‐year litter trap dataset using superposed epoch analysis and Granger causality tests. The tests indicated that significant deviations in barometric pressure, maximum temperature, maximum relative humidity, and wind speed were the most plausible precursors to peak litter production of all components. Additionally, we observed a lag in peak litterfall production relative to climate variability by up to 4 months for most of the climate variables. Changing environmental conditions can affect both the timing and amount of litterfall production, which in turn can alter the nutrient recycling rate and other essential ecosystem services of such forests.

Roof gardening is popular for increasing green space in cities due to the restricted urban areas. However, when watering plants on a roof garden, one should consider loading capacity of the roof, which may limit water supply to the plants therein. To improve the efficiency in irrigating trees in a roof garden, we evaluated plant water status, represented by midday leaf water potential (ΨL), and leaf gas exchange parameters including stomatal conductance (gs) and net photosynthesis (An) of a tree (Tabebuia argentea, Ta) and a palm (Ptychosperma macarthurii, Pm) species, which dominate the garden. The ΨL mediated responses of gs and An, regulating plant water use and growth, to soil moisture. Results showed that ΨL of Ta significantly varied with changes in soil moisture, being low at low and high soil moisture. Nevertheless, gs of Ta linearly decreased when ΨL increased, suggesting a stronger response of gs to atmospheric demand. In contrast, no significant responses among the study variables were observed in Pm. For both species, An initially increased with gs and saturated after gs reached 200 mmol m-2 s-1, indicating similar stomatal regulation on atmospheric carbon dioxide absorption. The limited space for root growth and the location with surrounded building walls contributed to unconventional response patterns observed in Ta. Nonetheless, our results suggested that Ta was more sensitive to changing environments, especially the atmospheric demand, than Pm. Additionally, Ta should be irrigated during daytime and when atmospheric vapor pressure deficit is less than 2.6 kPa to allow high photosynthesis and evaporative cooling while Pm may be watered less frequently to reduce the roof’s loading and save water. This initial investigation implied that maintaining urban trees using appropriate irrigation that is specific to tree species is the key to maximize benefits from urban trees and optimize urban water use.

We analyzed the content of mitragynine (MG) found in kratom leaves (Mitragyna speciosa) and the influence of different environmental conditions (air and soil variables) on the yield in various regions of Thailand. The content of MG in kratom leaves ranged from 7.5 – 26.6 mg g-1 of dry leaf weight. Canonical correspondence analysis showed that the most significant environmental variables affecting the MG content among the various regions were light intensity, relative humidity, soil volumetric water content (VW), soil pH, and calcium. This study is a first step towards providing information about environmental conditions suitable to maximize the quality and quantity of bioactive alkaloids in kratom. Future studies should focus on leaf collection and the post-harvest processes in order to assure the desired alkaloidal content in finished products, when produced under suitable environmental conditions identified in this study.

Rosewood and Teak are valuable timber species, which have been heavily logged from both natural forests and plantations. Climate change has also contributed to a reduction in their numbers. We studied their light adaptability at the seedling stage to quantify the growth and physiological characteristics under 10% and 100% of full sunlight. Rosewood performed better, as indicated by the relative growth rate, chlorophyll content, and chlorophyll efficiency, under both shade and sunlight. We also simulated a sudden change in light intensity (gap opening up in the canopy) by exposing seedlings, previously under shade, to full sunlight. Rosewood seedlings responded faster (higher relative growth rate) to changing light conditions relative to Teak. We conclude that Rosewood seedlings can be planted either under shade, or in full sunlight, or in a location experiencing sudden change from shade to sunlight, while Teak seedlings should be planted under at least 10% sunlight, but not in full sunlight, as it can lead to chlorophyll and tissue damage.

Abstrak Perencanaan struktur beton biasanya dilakukan dengan berdasarkan asumsi dari Bernoulli dan Navier untuk menganalisis penampang akibat momen lentur. Distribusi regangan dianggap linier dan ini dianggap masih berlaku meskipun penampang telah retak. Balok tinggi merupakan salah satu contoh kasus pada suatu elemen struktur yang dapat mengakibatkan terjadinya distribusi tegangan non linier, sehingga asumsi diatas tidak berlaku. Balok dikatakan balok tinggi apabila rasio bentang terhadap tingginya lebih kecil dari lima. Salah satu alternatif pendekatan untuk mengatasi elemen struktur seperti balok tinggi adalah menggunakan pendekatan Strut and Tie Model, yaitu dengan membagi struktur dalam daerah B (Bernoulli) dan D (Disturb) dan menggambarkan alur gaya (load path) sebagai transfer gaya yang terjadi pada struktur beton bertulang pada kondisi retak akibat pembebanannya. Parameter–parameter dari Strut and Tie Model yaitu batang tekan (strut), batang tarik (tie) dan titik nodal (nodal zone) sebagai daerah pertemuan. Tujuan dari tulisan ini adalah untuk menganalisis alternatif perencanaan/desain tulangan struktur balok tinggi beton bertulang diatas dua tumpuan sederhana akibat beban merata yang dikonversi menggunakan beban terpusat 2 titik pembebanan.Metode yang digunakan adalah Strut and Tie Model yang akan menghasilkan luas tulangan longitudinal yang lebih kecil dengan selisih 25%, di mana dengan luas tulangan yang lebih kecil dari segi kekuatan masih memenuhi syarat. Hal ini menunjukkan bahwa perhitungan perencanaan balok tinggi tanpa bearing plate dengan menggunakan metode Strut and Tie Model pun dapat lebih optimum/efisien. Kata kunci: Prinsip Bernoulli, Strut and Tie Model, D – Region, B – Region Abstract Concrete structure planning is usually carried out based on the assumptions of Bernoulli and Navier to analyze the section due to bending moments. The strain distribution is considered linear and it is considered still valid even after the section has cracked. The deep beam is one example of a structural element that can result in a non–linear stress distribution, so the above assumption does not apply. A beam is said to be a deep beam if the span to height ratio is less than five. One alternative approach to dealing with structural elements such as deep beams is to use the Strut and Tie Model approach, namely by dividing the structure into areas B (Bernoulli) and D (Disturb) and describing the load path as a force transfer that occurs in the concrete structure. Reinforced in cracked conditions due to loading. The parameters of the Strut and Tie Model are the strut, tie, and nodal zone as the meeting area. The purpose of this paper is to analyze the alternative planning/design of reinforced concrete beams structure on two simple supports due to evenlydistributed loads that are converted using the two-point load centered load. The method used is the Strut and Tie Model which will produce a smaller area of longitudinal reinforcement with a difference of 25%, where the area of reinforcement is smaller in terms of strength still meets the requirements. This shows that the calculation of deep beam planning without bearing plate using the strut and tie model method can be more optimal/efficient. Keywords: Bernoulli’s Principle, Strut and Tie Model, D - Region, B - Region

In this paper, we present the morphology, taxonomy, anatomy, and palynology of Papaver somniferum. A detailed morphological description and illustrations of the species are provided, along with information about the identification, distribution, cultivation areas, habitats, pollinators, specimens examined, growing periods, phenology, etymology, vernacular name, and uses. The species can be characterized as a glabrous and glaucous herb with unlobed or pinnately lobed leaves, and an amplexicaul base; variations in color and morphological characteristics of petals; and white filaments, occasionally purple with a white basal part, broadened at the apical part. Two rings of discontinuous and widely spaced collateral vascular bundles are recognized in the transverse section of the stems. The shape of epidermal cells on the adaxial surface is polygonal, while that on the abaxial surface is polygonal or irregular. The anticlinal cell walls of the epidermal cells on the adaxial surface are straight or slightly curved, while those on the abaxial surface are straight, slightly curved, sinuate, or strongly sinuate. The stomata are anomocytic and are confined to the lower epidermis. The stomatal density is 54–199/mm2 (with a mean of 89.29 ± 24.97). The mesophyll is not distinctly differentiated into palisade and spongy regions. Laticifers are found in the phloem areas of the stems and leaves. The pollen grains can be spheroidal or prolate spheroidal in shape, sometimes oblate spheroidal [polar axis (P) diameter/equatorial axis (E) diameter ratio = 0.99–1.12 (with a mean of 1.03 ± 0.03)]. The pollen aperture is tricolpate and the exine sculpturing is microechinate.

In this paper, we present the morphology, taxonomy, anatomy, and palynology of Arundo donax. A detailed morphological description and illustrations of the species are provided, along with information about the identification, distribution, the specimens examined, habitat and ecology, the International Union for Conservation of Nature (IUCN) conservation assessment, phenology, etymology, vernacular name, and uses. The species can be distinguished by its large, tall rhizomatous perennial reed; cauline leaves; an open, large, plumose panicle inflorescence; subequal glumes as long as the spikelets; glabrous rachilla; all bisexual florets; and a lemma with a straight awn and with long white hairs outside below the middle part. In this study, two names were lectotypified: Arundo bifaria and A. bengalensis, which are synonyms of A. donax. The culm internodes in the transverse section have numerous vascular bundles scattered in the ground tissue, and the parenchyma cells have significantly lignified cell walls. Vascular bundles are composed of phloem and xylem and are enclosed in a continuous sclerenchymatous bundle sheath. The chloroplasts in the transverse section of the leaf blades are found only in the mesophyll cells but are absent in the bundle sheath cells, which indicates that it is a C3 grass. The leaves have stomata on both surfaces and are confined to the intercostal zones. The stomata are typically paracytic, with two lateral subsidiary cells placed parallel to the guard cells. The stomatal density is higher on the abaxial surface [450–839/mm2 (606.83 ± 72.71)] relative to the adaxial surface [286–587/mm2 (441.27 ± 50.72)]. The pollen grains are spheroidal or subspheroidal [polar axis length/equatorial axis length ratio (P/E ratio) = 0.89–1.16 (1.02 ± 0.07)] with a single pore surrounded by a faint annulus, and the exine sculpturing is granular.

Abstract Tropical forests are experiencing reduced productivity and will need restoration with suitable species. Knowledge of species-specific responses to changing environments during early stage can help identify the appropriate species for sustainable planting. Hence, we investigated the variability in whole-tree canopy conductance and transpiration (G t and E L ) in potted saplings of common urban species in Thailand, viz., Pterocarpus indicus, Lagerstroemia speciosa, and Swietenia macrophylla, across wet and dry seasons in 2017–2018. Using a Bayesian modeling framework, G t and E L were estimated from sap flux density, informed by the soil, atmospheric and tree measurements. Subsequently, we evaluated their variations with changing vapor pressure deficit (VPD) and soil moisture across timescales and season. We found that G t and E L were higher and highly variable in L. speciosa across seasons than S. macrophylla and P. indicus. Our results implied that water-use in these species was sensitive to seasonal VPD. L. speciosa may be suitable under future climate variability, given its higher G t and E L across atmospheric and soil moisture conditions. With their lower G t and E L , P. indicus and S. macrophylla may photosynthesize throughout the year, maintaining their stomatal opening even under high VPD. These findings benefit reforestation and reclamation programs of degraded lands.

Abstract Background Trees remove atmospheric carbon dioxide through photosynthesis, hereafter CO2 absorption (A). Despite growing urban green areas, only a few studies have quantified A of urban trees and assessed their dynamical changes with varying atmospheric conditions. Hence, we investigated A in nine dominant tree species in a new park of Bangkok. Results Results revealed that A of two tree species (Millingtonia hortensis and Afzelia xylocarpa) significantly increased with vapor pressure deficit (VPD) until it reached a maximum and declined when VPD decreased, with no seasonal difference. Five of them (Dalbergia cochinchinensis, Tabebuia rosea, Lagerstroemia floribunda, Dipterocarpus alatus and Bauhinia purpurea) exhibited different response patterns of A to VPD between wet and dry seasons. In contrast, the A of two tree species (Samanea saman and Homalium tomentosum) did not respond to changing VPD in either season. Conclusions Comparing planting scenarios of insensitive (i.e. no response to VPD) versus sensitive (i.e. significant response to VPD) species, we found that planting a mixture of sensitive and insensitive tree species would improve the park’s capacity of A across seasons, allowing climate change adaptation to adverse environmental impacts such as droughts and the urban heat island effects, and would increase biodiversity. Additionally, planting insensitive tree species would significantly increase the capacity of the park for CO2 mitigation. These findings are useful for those who design parks and expand urban green areas to fully benefit ecosystem services from trees.

We present the results of classifying plants at species level that can tolerate air pollution, provide cooling, and simultaneously survive and thrive in urban environments. For this purpose, we estimated the air pollution tolerance index (APTI) and anticipated performance index (API) of several species growing in a park located in central Bangkok, Thailand. The cooling effect was quantified by calculating the reduction in soil and air temperatures. Melaleuca quinquenervia (Cav.) S.T. Blake, Albizia saman (Jacq.) Merr., Chukrasia tabularis A. Juss. had the highest API score and were able to substantially reduce the temperature and were in a group of highly recommended species which also included other species like A. saman, C. tabularis, Tabebuia rosea (Bertol.) Bertero ex A. DC., Dalbergia cochinchinensis Pierre etc. Species from both evergreen and deciduous habitat were able to provide ambient cooling but were vulnerable to air pollution and included Elaeocarpus grandifloras Sm. and Bauhinia purpurea L. However, there were other species which had a high air pollution tolerance but failed to provide adequate cooling, such as Hopea odorata Roxb. and Millingtonia hortensis L.f. The results would be of interest to urban greenspace landscapers in such climates while selecting suitable species that can provide multiple ecosystem services ranging from air pollution tolerance to temperature reduction without reducing plant vitality.

This study aims at comparing the carbon storage ability of Monastery bamboo (Thyrsostachys siamensis Gamble) and Pai Liang (Dendrocalamus membranaceus × Thyrsostachys siamensis) in terms of the different physiological responses to the microclimate. The stomatal conductance, leaf-to-air vapor pressure deficit (LAVPD), chlorophyll content, and water use efficiency (WUE) were measured. Pai Liang had a greater dry biomass per culm than Monastery bamboo, resulting in more carbon storage. Monastery bamboo kept opening its stomata even when LAVPD increased, resulting in the loss of more water and a lower WUE leading to a lower rate of growth and carbon storage. Pai Liang contained higher amount of carbon and nitrogen in the leaf tissue, indicating a better WUE. With regards to the climate change, Pai Liang is recommended owing to a greater carbon fixation and more rapid growth rate compared to the Monastery bamboo.

Introduction: This study reports our experience with open reconstructive surgery in patients with laryngotracheal stenosis (LTS) following prolonged intubation and/or tracheostomy in the context of COVID-19., Methods: All patients underwent a preoperative endoscopic airway assessment. Posterior glottic lesions were graded according to the Bogdasarian classification, subglottic-tracheal lesions according to the Cotton-Myers classification and postoperative complications reported by the Clavien-Dindo classification. We report postoperative outcomes and functional results in this patient subset., Results: We include 14 patients diagnosed to have post COVID LTS, one female and 13 males. This group was compared with a control group, diagnosed with LTS following prolonged intubation. In the COVID group, mean age of patients at the time of the airway surgery was 52.1 ± 16.8 years (range: 13.7-76.3). More than half the patients were multi-morbid with hypertension and obesity being the most common conditions. Eleven patients had multi-site stenoses. Open surgical interventions performed were tracheal resection and anastomosis, laryngotracheal reconstruction and extended cricotracheal resection, and postoperative complications were seen in 12 (85.6%) patients. 70% patients with pre-existing tracheostomy were decannulated. Oral swallowing was not tolerated in one-fifth of the patients and a significant number of them have poor voice quality., Conclusion: Post-COVID pandemic, airway surgeons are seeing an increased number of patients with complex LTS, and we report significant postoperative complications in this patient subset. Decannulation rates, voice and swallowing results are poor in patients with glottic involvement as compared to isolated tracheal stenosis., (© 2024. The Author(s).)

Purpose: To review the management of patients with lingual thyroid (LT) causing upper airway obstruction and to suggest a diagnostic and therapeutic workflow., Methods: A PubMed review of published cases from January 1980 up to December 2020 of LT causing upper airway obstruction. We selected cases of confirmed LTs that presented with non-state-dependent airway obstruction. An illustrative case report is presented., Results: Twenty-one articles fulfilling the inclusion criteria were found, reporting 24 cases (7 neonatal, 2 pediatric and 15 adults). The main presenting symptoms was dyspnea with increased work of breathing, followed by dysphagia and stridor most commonly in neonates. At least one imaging modality was performed in all patients. Thyroid function was altered in half the patients and normal in the other half. The LT was the only thyroid tissue in all cases except 2. Altogether, 5/24 patients required tracheostomies and two-thirds of the patients underwent surgical resection of the LT (mostly transoral). Also 2/3 of the patients received thyroid replacement therapy. After a median follow-up of 17 months, airway symptoms had fully resolved for all patients but one., Conclusion: While rare, ectopic LTs should be considered in the differential diagnosis of stridor, dyspnea and airway obstruction. In neonates, concomitant presence of hypothyroidism on neonatal screening and airway obstruction should prompt the search for a LT. Early identification and thyroid replacement therapy seem to significantly relieve symptoms of upper airway obstruction, but severe obstruction and concomitant airway lesions may require more definitive management approaches., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Importance: Multidisciplinary perioperative assessment for patients undergoing complex oncologic head and neck cancer (HNC) surgery is widely implemented. However, to our knowledge, the association of multiprofessional preoperative assessment, information, and briefing with postoperative outcomes has not been evaluated., Objective: To compare postoperative complications, length of hospital stay (LOS), readmissions, mortality, and costs per case among patients undergoing complex oncologic HNC surgery before and after the implementation of a comprehensive preoperative multiprofessional assessment and information day (MUPAID)., Design, Setting, and Participants: This retrospective, single-center case-control study was conducted at a tertiary referral head and neck anticancer center/university cancer institute and compared patients with HNC who were undergoing complex oncological surgeries between January 2012 and July 2018 before (control group) and after (intervention group) implementation of the institutional MUPAID. Data analysis was conducted between 2019 and 2020. The intervention group comprised patients who participated in the MUPAID beginning in February 2015. These patients were assessed by a multiprofessional team and provided with structured and comprehensive information on the surgical procedure and its functional, social, financial, and psychological effects, as well as the postoperative care, rehabilitation, and follow-up period. Patients in the control group had also undergone complex oncologic HNC surgery and were selected through surgical procedure codes., Main Outcomes and Measures: The end points were postoperative rate and severity of complications, LOS, readmissions, mortality, and costs per case., Results: The study included 161 patients, 81 in the intervention (25 women [30.9%]) and 80 in the control group (18 women [22.5%]). The groups showed no relevant differences in sociodemographic, disease, and procedural characteristics. The intervention cohort presented with fewer major local and systemic complications (Clavien-Dindo score, III-V: 34.6% vs 52.5%; difference proportion, -0.179; 95% CI, -0.33 to -0.03), shorter median LOS (12 days [IQR, 10-16 days] vs 16 days [IQR, 11-20] days; effect size, 0.482; 95% CI Cohen d, 0.152-0.812) and decreased median charge per case ($50 848 [IQR, $42 510-$63 479] vs $69 602 [IQR, $45 631-$96 280]; effect size, 0.534; 95% CI Cohen d, 0.22-0.85)., Conclusions and Relevance: The results of this case-control study suggest that MUPAID for patients who are undergoing complex oncologic HNC surgery is associated with shortened LOS and costs per case as well as decreased complications severity. These results are promising on a patient level in the potential to minimize individual treatment burden, as well as on an institutional and health care system level in the potential significant optimization of surgical outcomes and financial aspects.

Major congenital anomalies are known to play a role in the management and prognosis of airway obstruction. Most studies assess acquired forms of airway obstruction. Data on congenital or otherwise non-acquired forms of airway obstruction is sparse. In this retrospective, single-institution cohort study, we sought to evaluate and compare the patterns of airway obstruction in children with and without major congenital anomalies, and to assess the impact of management and outcome, irrespective of aetiology. Fifty-five patients were included, 23 with and 32 without underlying major congenital anomalies. Multilevel airway obstruction (usually affecting the nasopharynx, oropharynx, and the trachea) was more common in children with congenital anomalies (91% vs. 41%, p < .001). Consequently, these children required more frequent and earlier surgical management, especially tracheostomy and adenotonsillar surgery.Conclusions: Major congenital anomalies are associated with multilevel airway obstruction and poor functional prognosis. A simple clinical definition considering impact of major congenital anomalies on development and growth may help guide management plans following endoscopic evaluation of the entire airway and flanked by multidisciplinary discussions. What is Known: • Children with major comorbidities display increased disease severity and more prevalent multilevel airway obstruction • Previous studies include both children with acquired and non-acquired forms of airway obstruction; therefore, the actual impact major comorbidities in children with non-acquired causes of airway obstruction remain unclear. What is New: • A total of 42% children in this study population had major comorbidities with and impact on growth and/or psychomotor development, with a higher prevalence of multilevel airway obstruction and worse rates of functional improvement/recovery. • Children with major comorbidities require tracheostomy more often and earlier than those without major comorbidities, and remain tracheostomy-dependent for a longer time., (© 2021. The Author(s).)

Purpose: Parapharyngeal space neoplasms (PSNs) are rare tumors of the head and neck region. In this study, we report our institutional experience with PSNs over a 27-years period., Methods: Patients treated between 1992 and 2018 were identified through our tumor board database. Data concerning demographics, clinical presentation, disease features, treatment, complications and follow-up were obtained retrospectively., Results: In total, 48 patients were identified. Most patients had benign tumors (67.5%), with pleomorphic adenoma and schwannoma being the most frequent entities. Malignant tumors represented the remaining 32.5% of neoplasms. Concerning tissue of origin, 67.5% of neoplasms originated from salivary glands and 17.5% were neurogenic. The vast majority of PSNs required open surgical approaches (77%). The most frequent reversible and irreversible complications included paralysis of facial, vagal, and hypoglossal nerves (transient 62.5%, permanent 31.3%). Tumor recurrences occurred in 16.7% of our patients., Conclusion: Neoplasms of the parapharyngeal space (PPS) are rare. In our series, consistent with the literature, most patients had benign tumors. Fine-needle aspiration cytology (FNAC) and/or transoral biopsy in selected cases combined with radiographic imaging are helpful to plan the optimal approach (open/transoral) and extent of primary surgery. Close follow-up in malignant neoplasms is crucial to assess recurrence early. We present one of the largest recent studies on PPS tumors treated in a center. Given the low incidence of these tumors, our results contribute to the existing sparse evidence regarding the management and outcome of such tumors., (© 2021. The Author(s).)

The diagnostic role of fine-needle aspiration cytology (FNAC) and core-needle biopsy (CNB) has not been comprehensively assessed in head and neck sarcomas. A systematic review of published cases (1990-2020) was conducted. Diagnostic performance of both FNAC/CNB to determine tumor dignity and histopathological diagnosis was calculated. One hundred and sixty-eight cases were included for which FNAC (n = 156), CNB (n = 8), or both (n = 4) were used. Predominant histologies were skeletal muscle, chondrogenic and vascular sarcomas. FNAC correctly assessed dignity in 76.3% and histology in 45% of cases. Dignity was significantly better for vascular tumors, metastatic and recurrent specimens, and worse for chondrogenic sarcomas. CNB showed a 92% accuracy to identify dignity and 83% for histopathology. FNAC and CNB are useful methods for the diagnosis of head and neck sarcomas, particularly well-suited in the context of recurrent or metastatic disease. The role of CNB remains largely unexplored for this indication., (© 2021 Wiley Periodicals LLC.)

Background : Lymph node metastases are associated with poor prognosis in head and neck squamous cell carcinoma (HNSCC). Neck dissection (ND) is often performed prior to or after (chemo)radiation (CRT) and is an integral part of HNSCC treatment strategies. The impact of CRT delivered prior to ND on lymph node yield (LNY) and lymph node ratio (LNR) has not been comprehensively investigated. Material and methods: A retrospective cohort study was conducted from January 2014 to 30 June 2019 at the University Hospital of Bern, Switzerland. We included 252 patients with primary HNSCC who underwent NDs either before or after CRT. LNY and LNR were compared in patients undergoing ND prior to or after CRT. A total of 137 and 115 patients underwent modified radical ND (levels I to V) and selective ND, respectively. The impact of several features on survival and disease control was assessed. Results: Of the included patients, 170 were male and 82 were females. There were 141 primaries from the oral cavity, 55 from the oropharynx, and 28 from the larynx. ND specimens showed a pN0 stage in 105 patients and pN+ in 147. LNY, but LNR was not significantly higher in patients undergoing upfront ND than in those after CRT (median: 38 vs. 22, p < 0.0001). Cox hazard ratio regression showed that an LNR ≥ 6.5% correlated with poor overall (HR 2.42, CI 1.12-4.89, p = 0.014) and disease-free survival (HR 3.416, CI 1.54-754, p = 0.003) in MRND. Conclusion: ND after CRT leads to significantly reduced LNY. An LNR ≥6.5% is an independent risk factor for decreased overall, disease-free, and distant metastasis-free survival for MRND.

Objectives: Parotid lymph node metastases are common in head and neck cutaneous squamous cell carcinoma (cSCCHN). Here we evaluate the diagnostic, prognostic, and therapeutic implications of intraglandular lymph node (IGLN) metastases in cSCCHN., Study Design: Retrospective study in a tertiary referral university cancer institute., Methods: We included patients with cSCCHN who underwent parotidectomy and neck dissection (ND), with or without synchronous resection of the skin primary, between January 1999 and January 2018. The characteristics of cSCCHN with or without IGLN involvement were compared., Results: Altogether, 68 patients were included. Of the 29 (42.6%) patients classified as cN0, eight were upstaged pN+ and had concomitant IGLN involvement. Of 21 patients with pN0 disease, IGLN metastases were absent in only three cases, resulting in a specificity and sensitivity of parotid metastases to diagnose occult nodal neck metastases of 14.29% and 100%, respectively. The positive and negative predictive values were 14.29% and 100%, respectively. Univariate analyses only displayed a significantly higher rate of moderately and poorly differentiated primaries in patients with IGLN metastases (P = .015). Only advanced T-stages were significantly associated with neck recurrences., Conclusion: IGLN status in advanced cSCCHN is potentially predictive for occul nodal neck metastases. Our results suggest that ND in patients with histopathologically negative IGLNs and clinically negative neck lymph nodes may not be necessary given the high negative predictive value of IGLN status in this group of patients. Therefore, accurate diagnostic evaluation of IGLN involvement is mandatory., Level of Evidence: 4 Laryngoscope, 131:788-793, 2021., (© 2020 American Laryngological, Rhinological and Otological Society Inc, "The Triological Society" and American Laryngological Association (ALA).)

Objectives/hypothesis: To assess the ability of specific positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) features to detect extracapsular extension (ECE) in head and neck squamous cell carcinoma (HNSCC) patients., Study Design: Retrospective study in a tertiary certified university cancer institute., Methods: We performed a review of patients with advanced HNSCC at Bern University Hospital between 2014 and 2018. Patients with pretherapeutic PET/CT and/or MRI who underwent neck dissection were included, with 212 patients fulfilling inclusion criteria. Blinded evaluation of specific PET/CT and MRI features with respect to presence of ECE was performed. Histopathological examination of neck dissection specimens was used as the gold standard to determine ECE status., Results: Out of the 212 included patients, 184 had PET/CT, 186 MRI, and 158 both modalities. Overall clinical stage IV (odds ratio [OR]: 2.26, 95% confidence interval [CI]: 2.25-11.74), ill-defined margins in both PET/CT and MRI (OR: 3.48, 95% CI: 1.21-9.98 and OR: 2.14, 95% CI: 0.94-4.89, respectively), and a maximum standardized uptake value ≥ 10 (OR: 5.44, 95% CI: 1.21-9.98) were all significant independent predictors of ECE. When combined, these four features led to a cumulative score able to predict ECE status with an accuracy of 91.43%., Conclusions: The current findings indicate specific features in PET/CT and MRI are potential predictors of ECE status and may help in pretherapeutic stratification in HNSCC., Level of Evidence: 4 Laryngoscope, 131:E163-E169, 2021., (© 2020 The American Laryngological, Rhinological and Otological Society, Inc.)

Radiotherapy (RT) along with surgery is the mainstay of treatment in head and neck squamous cell carcinoma (HNSCC). Radioresistance represents a major source of treatment failure, underlining the urgent necessity to explore and implement effective radiosensitization strategies. The MET receptor widely participates in the acquisition and maintenance of an aggressive phenotype in HNSCC and modulates the DNA damage response following ionizing radiation (IR). Here, we assessed MET expression and mutation status in primary and metastatic lesions within a cohort of patients with advanced HNSCC. Moreover, we investigated the radiosensitization potential of the MET inhibitor tepotinib in a panel of cell lines, in vitro and in vivo , as well as in ex vivo patient-derived organotypic tissue cultures (OTC). MET was highly expressed in 62.4% of primary tumors and in 53.6% of lymph node metastases (LNM), and in 6 of 9 evaluated cell lines. MET expression in primaries and LNMs was significantly associated with decreased disease control in univariate survival analyses. Tepotinib abrogated MET phosphorylation and to distinct extent MET downstream signaling. Pretreatment with tepotinib resulted in variable radiosensitization, enhanced DNA damage, cell death, and G 2 -M-phase arrest. Combination of tepotinib with IR led to significant radiosensitization in one of two tested in vivo models. OTCs revealed differential patterns of response toward tepotinib, irradiation, and combination of both modalities. The molecular basis of tepotinib-mediated radiosensitization was studied by a CyTOF-based single-cell mass cytometry approach, which uncovered that MET inhibition modulated PI3K activity in cells radiosensitized by tepotinib but not in the resistant ones., (©2019 American Association for Cancer Research.)