Search

Margin assessment during transoral robotic surgical (TORS) resections of head and neck mucosal malignancies can be complex, originating in part from discrepancies in definitions of positive or close margins, and the technical difficulty of revising microscopic margins intraoperatively without incurring the functional consequences associated with soft tissue deficits in the oropharynx and larynx. Intraoperative optical imaging modalities, including confocal laser endomicroscopy (CLE), may represent an alternative or adjunctive option to delineate tumor footprint and assess for peripheral margin status. We present a case series describing our use of the Cellvizio® probe-based CLE platform as an intraoperative modality to assess for peripheral mucosal margins in the larynx, oropharynx, and hypopharynx during TORS resections using robotic instrumentation to establish basic feasibility and create the groundwork for future investigations of relative efficacy and impact on local recurrence rates.

Abstract Accurate determination of sexual dimorphism in skeletal structures is crucial in forensic anthropology and medical diagnostics. This study aimed to assess sexual dimorphism in various indices of the second cervical vertebra (axis) and other associated structures. A comprehensive analysis was conducted on axis dimensions, vertebral foraminal measurements, body diameters, odontoid process parameters, and auricular facet indices in male and female subjects. A total of 122 specimens were examined, comprising 62 male and 62 female specimens.The analysis revealed significant differences between male and female subjects in various morphological indices. In terms of axial dimensions, males exhibited larger average height, length, and width of the axis compared to females, indicating sexual dimorphism. Similarly, significant differences were observed in the maximum length and width of the vertebral foramen, with males demonstrating larger measurements. Additionally, males showed larger transverse and sagittal diameters of the body compared to females. Regarding the odontoid process, males displayed greater sagittal and transverse diameters, as well as maximum height, suggesting sexual dimorphism in this aspect. Furthermore, significant differences were noted in the mean sagittal angle of the dens axis between males and females. Analysis of the superior and inferior auricular facets also indicated notable morphological variations between the sexes.The findings highlight pronounced sexual dimorphism in the morphology of the second cervical vertebra and associated structures. These results underscore the importance of considering sex-related variations in skeletal assessments for forensic and diagnostic purposes. Further research in this area can enhance the accuracy of sex determination in skeletal remains and contribute to the development of new identification methodologies.

Complete subglottic stenosis is often managed with surgical resection. However, involvement of the high subglottis can limit candidacy for open resection, and there are few treatment options for these patients. We refined an endoscopic approach that evolved into a tracheal rendezvous technique with T-tube placement as an alternative to open surgical resection. Here, we present our series, technique, and outcomes. A retrospective review was performed to identify patients who underwent endoscopic management of complete high subglottic stenosis at the University of California San Diego. The surgical technique was initially a two-step staged procedure and was subsequently revised to a single-stage procedure with stenosis ablation, dilation, and insertion of a T-tube, which was completed in one day. Patients were seen at regular follow-up intervals for reassessment. Five patients were identified with complete stenosis not amenable to surgical resection. The average age of the cohort was 44.8 years. The etiology of stenosis in all patients was related to prolonged intubation and tracheostomy, and the average length of stenosis was 19.6 mm. Stenosis resection was accomplished via laser ablation and balloon dilation, and the average T-tube length was 50.3 mm. All patients were discharged on postoperative day one. Two patients developed airway crusting within the T-tube and required emergency department visits. Decannulation was attempted in three patients, although failed in two. Tracheal rendezvous is a safe and effective procedure for patients with grade IV subglottic stenosis. This provides a feasible endoscopic alternative to patients who are not candidates for open surgical resection, ye are motivated to have phonatory capacity.

With the recent rise in the development of deep learning techniques, image inpainting—the process of restoring missing or corrupted regions in images—has witnessed significant advancements. Although state-of-the-art models are effective, they often fail to inpaint complex missing areas, especially when handwritten occlusions are present in the image. To address this issue, an image inpainting model based on a residual CycleGAN is proposed. The generator takes as input the image occluded by handwritten missing patches and generates a restored image, which the discriminator then compares with the original ground truth image to determine whether it is real or fake. An adversarial trade-off between the generator and discriminator motivates the model to improve its training and produce a superior reconstructed image. Extensive experiments and analyses confirm that the proposed method generates inpainted images with superior visual quality and outperforms state-of-the-art deep learning approaches.

Agriculture crop residue burning has become a major environmental problem facing the Indo-Gangetic plain, as well as contributing to global warming. This paper reports the results of a comprehensive study, examining the variations in aerosol optical, microphysical, and radiative properties that occur during biomass-burning events at Amity University Haryana (AUH), at a rural station in Gurugram (Latitude: 28.31° N, Longitude: 76.90° E, 285 m AMSL), employing ground-based observations of AERONET and Aethalometer, as well as satellite and model simulations during 7–16 November 2021. The smoke emissions during the burning events enhanced the aerosol optical depth (AOD) and increased the Angstrom exponent (AE), suggesting the dominance of fine-mode aerosols. A smoke event that affected the study region on 11 November 2021 is simulated using the regional NAAPS model to assess the role of smoke in regional aerosol loading that caused an atmospheric forcing of 230.4 W/m2. The higher values of BC (black carbon) and BB (biomass burning), and lower values of AAE (absorption Angstrom exponent) are also observed during the peak intensity of the smoke-event period. A notable layer of smoke has been observed, extending from the surface up to an altitude of approximately 3 km. In addition, the observations gathered from CALIPSO regarding the vertical profiles of aerosols show a qualitative agreement with the values obtained from AERONET observations. Further, the smoke plumes that arose due to transport of a wide-spread agricultural crop residue burning are observed nationwide, as shown by MODIS imagery, and HYSPLIT back trajectories. Thus, the present study highlights that the smoke aerosol emissions during crop residue burning occasions play a critical role in the local/regional aerosol microphysical and radiation properties, and hence in the climate variability.

PurposeHuman papillomavirus (HPV) plays a major role in oncogenesis and circular extrachromosomal DNA (ecDNA) is found in many cancers. However, the relationship between HPV and circular ecDNA in human cancer is not understood.Experimental designForty-four primary tumor tissue samples were obtained from a cohort of patients with HPV-positive oropharynx squamous cell carcinoma (OPSCC). Twenty-eight additional HPV oropharyngeal cancer (HPVOPC) tumors from The Cancer Genome Atlas (TCGA) project were analyzed as a separate validation cohort. Genomic, transcriptomic, proteomic, computational, and functional analyses of HPVOPC were applied to these datasets.ResultsOur analysis revealed circular, oncogenic DNA in nearly all HPVOPC, with circular human and human-viral hybrid ecDNA present in over a third of HPVOPC and viral circular DNA in remaining tumors. Hybrid ecDNA highly express fusion transcripts from HPV promoters and HPV oncogenes linked to downstream human transcripts that drive oncogenic transformation and immune evasion, and splice multiple, diverse human acceptors to a canonical SA880 viral donor site. HPVOPC have high E6*I expression with specific viral oncogene expression pattern related to viral or hybrid ecDNA composition.ConclusionsNonchromosomal circular oncogenic DNA is a dominant feature of HPVOPC, revealing an unanticipated link between HPV and ecDNA that leverages the power of extrachromosomal inheritance to drive HPV and somatic oncogene expression.

PurposeStandard cytotoxic induction chemotherapy for acute myeloid leukemia (AML) results in prolonged neutropenia and risk of infection. Romyelocel-L is a universal, allogeneic myeloid progenitor cell product being studied to reduce infection during induction chemotherapy.Patients and methodsOne hundred sixty-three patients with de novo AML (age ≥ 55 years) receiving induction chemotherapy were randomly assigned on day 0 (d0), of whom 120 were evaluable. Subjects received either romyelocel-L infusion on d9 with granulocyte colony-stimulating factor (G-CSF) starting daily d14 (treatment group) or G-CSF daily alone on d14 (control) until absolute neutrophil count recovery to 500/µL. End points included days in febrile episode, microbiologically defined infections, clinically diagnosed infection, and days in hospital.ResultsMean days in febrile episode was shorter in the treatment arm from d15 through d28 (2.36 v 3.90; P = .02). Similarly, a trend toward decreased microbiologically defined infections and clinically diagnosed infection in the treatment arm was observed from d9 to d28 (35.6% v 47.5%; P = .09), reaching a statistically significant difference from d15 to d28 (6.8% v 27.9%; P = .002). Because of this, antibacterial or antifungal use for treatment of an infection was significantly less in the treatment group (d9-d28: 44.1% v 63.9%; P = .01). Significantly fewer patients in the treatment arm received empiric antifungals from d9 tod28 (42.4% v 63.9%; P = .02) and d15-d28 (42.4% v 62.3%; P = .02). Patients in the treatment arm also had 3.2 fewer hospital days compared with control (25.5 v 28.7; P = .001). Remission rates and days to absolute neutrophil count recovery were similar in the two groups. No patients in the romyelocel-L plus G-CSF group died because of infection compared with two patients in the control arm. No graft-versus-host disease was observed.ConclusionSubjects receiving romyelocel-L showed a decreased incidence of infections, antimicrobial use, and hospitalization, suggesting that romyelocel-L may provide a new option to reduce infections in patients with AML undergoing induction therapy.

ObjectivesA subset of patients who require revision rhinoplasty will change surgeons for their second procedure. We sought to investigate the rate of surgeon change and identify associated predictors using a population-based, ambulatory surgery database.Methods/study designIn this retrospective review, 9172 rhinoplasty procedures over a 5-year period were analyzed using the Healthcare Cost and Utilization Project (HCUP) Florida State Ambulatory Surgery and Services Database (SASD). We identified 380 patients who had at least two rhinoplasty procedures between 2009 and 2014. Logistic regression analysis was used to identify predictors of patients changing surgeons for their second documented rhinoplasty.ResultsAmong the 380/8531 (4.4%) patients who underwent a revision rhinoplasty, 117/380 (30.8%) patients changed surgeons for their subsequent procedure within a 5-year period. Multivariable logistic regression identified a lower likelihood of surgeon change in patients undergoing functional or cosmetic cartilage grafting procedures (OR 0.342, 95%CI 0.155-0.714, P = .006) and in patients who self-paid for their procedure (OR 0.476, 95%CI 0.225-0.984, P = .048). One hundred twenty-four patients underwent a cosmetic revision rhinoplasty and were twice as likely to change surgeons as those who underwent functional revision rhinoplasty (OR 2.042 95%CI 1.046-4.050, P = .038). Time elapsed (>2 years) was positively correlated with likelihood of surgeon change (OR 1.236, 95%CI 1.153-1.333, P

BackgroundOtolaryngologists represent a subset of health care workers uniquely vulnerable to COVID-19 transmission. Given the segmentation of extant guidelines concerning precautions and protective equipment for SARS-CoV2, we aimed to provide consolidated recommendations regarding appropriate personal protective equipment (PPE) in head neck surgery during the COVID-19 era.MethodsGuidelines published by international and US governing bodies were reviewed in conjunction with published literature concerning COVID-19 transmission risk, testing, and PPE, to compile situation-specific recommendations for head and neck providers managing COVID-19 patients.ResultsHigh-quality data regarding the aerosolization potential of head and neck instrumentation and appropriate PPE during head and neck surgeries are lacking. However, extrapolation of recommendations by governing bodies suggests strongly that head and neck mucosal instrumentation warrants strict adherence to airborne-level precautions.ConclusionWe present a series of situation-specific recommendations for PPE use and other procedural precautions for otolaryngology providers to consider in the COVID-19 era.

PurposeHuman papillomavirus (HPV)-related head and neck squamous cell carcinoma (HNSCC) is associated with daily marijuana use and is also increasing in parallel with increased marijuana use in the United States. Our study is designed to define the interaction between cannabinoids and HPV-positive HNSCC.Experimental designThe expression of cannabinoid receptors CNR1 and CNR2 was analyzed using The Cancer Genome Atlas (TCGA) HNSCC data. We used agonists, antagonists, siRNAs, or shRNA-based models to explore the roles of CNR1 and CNR2 in HPV-positive HNSCC cell lines and animal models. Cannabinoid downstream pathways involved were determined by Western blotting and analyzed in a primary HPV HNSCC cohort with single-sample gene set enrichment analysis (ssGSEA) and the OncoGenome Positioning System (Onco-GPS).ResultsIn TCGA cohort, the expression of CNR1 and CNR2 was elevated in HPV-positive HNSCC compared with HPV-negative HNSCC, and knockdown of CNR1/CNR2 expression inhibited proliferation in HPV-positive HNSCC cell lines. Specific CNR1 and CNR2 activation as well as nonselective cannabinoid receptor activation in cell lines and animal models promoted cell growth, migration, and inhibited apoptosis through p38 MAPK pathway activation. CNR1/CNR2 antagonists suppressed cell proliferation and migration and induced apoptosis. Using whole-genome expression analysis in a primary HPV HNSCC cohort, we identified specific p38 MAPK pathway activation signature in tumors from HPV HNSCC patients with objective measurement of concurrent cannabinoid exposure.ConclusionsCannabinoids can promote progression of HPV-positive HNSCC through p38 MAPK pathway activation.

Abstract Bioaerosols (or biological aerosols) consist of aerosol particles that originate biologically either as fully active component or as whole or part of inactive fragments. They are ubiquitously present in the atmospheric environment. They are the least investigated pollutants due to their complex structure and composition. The effects of bioaerosols, originating due to the processes, such as wastewater management, handling of sludge, composting, municipal solid waste, and animal facilities, on human health are well recognized. Proper identification, quantification, impacts and exposure threshold levels are essential to understand the nature and impact of bioaerosols on human health and climate. In this communication, we determine the inhalable (PM2.5) particulate matter concentration and embedded bioaerosol (bacteria and fungi) levels over a Municipal Solid Waste (MSW) landfill site in relation to surrounding upwind and downwind locations in Nagpur, India. Measurements were made using an Airmetrics MiniVol air sampler and bioaerosols were analyzed by adopting the culture-based method. A total of 23 fungal and 17 bacterial morphotypes were found in this study. The results showed dominance of bacterial bioaerosol over fungal bioaerosol at the landfill site. The bioaerosol levels were higher at the landfill than the upwind and downwind sites. The bioaerosols did not show any correlation to the PM2.5. In summary, the results indicate abundance of PM2.5, containing both bacterial and fungal bioaerosols, which can pose human health hazards over the study region. In our knowledge, it is the first study of bioaerosols at the landfill site in Nagpur, India.

Abstract Black Carbon (BC) aerosols are not only substantial climate-forcing drivers but also impact human health. The spatial distribution of BC aerosols depends on the combination of anthropogenic activities and meteorological conditions. In this study, we used the India Meteorological Department (IMD) Black Carbon Observational Network datasets to assess the diurnal, seasonal, and long-term BC trends for the period, 2016–2021. The majority of the IMD’s BC monitoring stations show an overall declining trend in the BC mass concentration during the study period in India. Maximum BC concentrations are observed in the post-monsoon and winter seasons due to the stubble-burning activity and lower values of Atmospheric Boundary Layer Height (ABLH). Minimum concentrations are observed at all stations in the monsoon season due to the wet scavenging of aerosols by rain. There is a clear decrease in the BC mass concentration from winter to monsoon months and an increase in the post-monsoon months. Regional emissions from crop residue burning in the post-harvesting seasons are the main contributing factor for extremely high levels of BC mass concentration. Low wind speed and shallow mixed layer were found to be the main reasons for high levels of aerosol concentration during the winter season. There is an increasing trend in Biomass Burning (BB) at most of the stations except for Thiruvananthapuram, where a prominent decreasing trend in BC concentration is also noticed. In the present study, the impact of local meteorological parameters such as wind, temperature, rainfall and Atmospheric Boundary Layer Height on BC mass concentration is investigated. The results show a negative correlation with rainfall, relative humidity, wind speed, temperature and ABL height. Both local activity and long-range transport at each study site are also found to be responsible for the significant changes in BC mass concentration.