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Πέμπτη 24 Φεβρουαρίου 2022

A comparative study of artificial intelligence nasal polyp classification based on whole-slide imaging and JESREC diagnostic criteria

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Feb 7;57(2):136-141. doi: 10.3760/cma.j.cn115330-20210730-00500.

ABSTRACT

Objective: To explore the types and clinical characteristics of chronic rhinosinusitis with nasal polyps (CRSwNP) based on artificial intelligence and whole-slide imaging (WSI), and to explore the consistency of the diagnostic criteria of the Japanese epidemiological survey of refractory eosinophilic chronic rhinosinusitis (JESREC) in Chinese CRSwNP patients. Methods: The data of 136 patients with CRSwNP (101 males and 35 females, aging 14 to 70 years) who underwent endoscopic sinus surgery from 2018 to 2019 in the Department of Otorhinolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University were analysed retrospectively. The preoperative clinical characteristics of patients were collected, such as visual analogue scale (VAS) of nasal symptoms, peripheral blood in flammatory cell count, total immunoglobulin E (IgE), Lund-Kennedy score and Lund-Mackay score. The proportion of inflammatory cells such as eosinophils, lymphocytes, plasma cells and neutrophils were calculated on the WSI of each patient through artificial intelligence chronic rhinosinusitis evaluation platform 2.0 (AICEP 2.0), and the specific type of nasal polyps was then obtained as eosinophilic CRSwNP (eCRSwNP) or non-eosinophilic CRSwNP (non-eCRSwNP). In addition, the JESREC diagnostic criteria was used to classify the nasal polyps, and the classification results were compared with the current gold standard for nasal polyps diagnosis (pathological diagnosis based on WSI). The accuracy, sensitivity and specificity of the diagnostic criteria of JESREC were evaluated. The data were expressed in M (Q1, Q3) and statistically analyzed by SPSS 17.0. Results: There was no significant difference between eCRSwNP and non-eCRSwNP in age dis tribution, gender, time of onset, total VAS score, Lund-Kennedy score or Lund-Mackay score. However, there was a significant difference in the ratio of nasal polyp inflammatory cells (eosinophils 40.5% (22.8%, 54.7%) vs 2.5% (1.0%, 5.3%), neutrophils 0.3% (0.1%, 0.7%) vs 1.3% (0.5%, 3.6%), lymphocytes 49.9% (39.3%, 65.9%) vs 82.0% (72.8%, 87.5%), plasma cells 5.1% (3.6%, 10.5%) vs 13.0% (7.4%, 16.3%), χ2 value was 9.91, 4.66, 8.28, 5.06, respectively, all P<0.05). In addition, eCRSwNP had a significantly higher level of proportion of allergic symptoms (nasal itching and sneezing), asthma, peripheral blood eosinophil and total IgE (all P<0.05). The overall accuracy, sensitivity and specificity of the JESREC diagnostic criteria was 74.3%, 81.3% and 64.3%, respectively. Conclusions: The eCRSwNP based on artificial intelligence and WSI has significant high level of allergic symptoms, asthma, peripheral blood eosinophils and total IgE, and the percentages of inflammatory cells in nasal polyps are different from that of non-eCRSwNP. The JESREC diagnostic criteria has good consistency in our research.

PMID:35196756 | DOI:10.3760/cma.j.cn115330-20210730-00500

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Cell heterogeneity of laryngeal carcinoma and evolution trajectory of epithelial cells

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Feb 7;57(2):168-177. doi: 10.3760/cma.j.cn115330-20211217-00805.

ABSTRACT

Objective: To analyze the classification and functions of cell subsets in laryngeal carcinoma and metastatic lymph nodes, and to explore the evolution trajectory of epithelial cells to tumor cells. Methods: Single-cell RNA sequencing was performed on 5 cases of laryngeal cancer, matched metastatic lymph nodes and 3 normal tissues. Patients were admitted to Ningbo Medical Center Lihuili Hospital from October 22, 2019 to December 16, all patients were male, aged 53-70 years old. Cell subsets of the above-mentioned tissues were analyzed by the Seurat, and the biological functions of cell subpopulation were investigated by functional enrichment analysis. Malignant epithelial cells were identified using copy number variation (CNV). The evolutionary trajectory of epithelial cells to cancer cells was anal yzed by cell trajectory analysis, and cancerous transitional cells were identified. The highly expressed genes in transitional cells were analyzed by the FindAllMarker of the Seurat and verified by immunohistochemistry. Results: A total of 66 969 high-quality cells were obtained in 9 major clusters: epithelial cells, T cells, B cells, fibroblasts, endothelial cells, myeloid cells, mast cells, plasmacytoid dendritic cells and nerve cells. The first 5 cell clusters were divided into 8, 6, 4, 3 and 2 subgroups, respectively. Four epithelial cell subsets (C0, C1, C2 and C5) were derived from tumor tissues and metastatic lymph nodes, and had high levels of CNV and tumor cell content. Cell trajectory analysis showed that the evolution trajectory of epithelial cells was from normal epithelial subpopulation C4 to early cancerous cell population C0, which differentiated into three major malignant cell subsets C1, C3, and C5. Epithelial cell C0 may represent the transitional cell popul ation of carcinogenesis, and were enriched in biological processes such as epithelial-mesenchymal transformation and angiogenesis. C0 highly expressed sulforaphane (SFN) which may be related to the occurrence and development of cancer. Immunohistochemistry confirmed that SFN was highly expressed in tumor tissues and metastatic lymph nodes compared with paracancerous tissues. Conclusion: Single-cell sequencing may be used to elucidate the diversity of cells and functions in laryngeal carcinoma tissues and metastatic lymph nodes, and cell population C0 plays a key role in the evolution of cells.

PMID:35196760 | DOI:10.3760/cma.j.cn115330-20211217-00805

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extramedullary plasmacytoma of the head and neck

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Feb 7;57(2):197-200. doi: 10.3760/cma.j.cn115330-20210424-00222.

ABSTRACT

Objective: To explore the clinical characteristics, treatment methods and outcomes of extramedullary plasmacytoma of the head and neck. Methods: A retrospective analysis was conducted on 10 cases with extramedullary plasmacytoma of the head and neck who were admitted to Henan Tumor Hospital from January 2005 to January 2020. Among the 10 patients, 6 were male and 4 were female. The average age at diagnosis was 56.3 years old (34-74 years old). Among them, 3 cases were located in the nasal cavity, 2 cases in the nasopharynx, 1 case in the sinuses, 2 cases in the larynx, 1 case in the oropharynx, and 1 case in the cervical lymph nodes. Treatments were administered according to tumor size and resection extent. Complete surgical excision (negative margins) was preferred, followed by adjuvant radiothera py or radiotherapy alone. The clinical characteristics, diagnosis, treatment and prognosis of EMP were analyzed. Results: The patients' symptoms were not specific, frequently with local obstruction symptom and localized masses. All patients were confirmed pathologically as suffering from monoclonal plasmacytoma, with negative bone marrow biopsy and negative skeletal survey. Five patients received surgery, 3 received radiotherapy, and 2 received surgery with additional radiation. The follow-up time was 16-125 months, with a median of 92 months. Two patients developed into multiple myeloma. One patient who received radiotherapy after surgery relapsed after 7 years of follow-up and again received surgical treatment, with no evidence of second recurrence. The remaining patients had no recurrence or progression. Conclusion: Extramedullary plasmacytoma of the head and neck has a good prognosis. Surgical treatment can be considered for completely resectable lesions.

PMI D:35196764 | DOI:10.3760/cma.j.cn115330-20210424-00222

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Visual Servoing of Continuum Robots: Methods, Challenges, and Prospects

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Abstract

Recent advancements in continuum robotics have accentuated developing efficient and stable controllers to handle shape deformation and compliance. The control of continuum robots using physical sensors attached to the robot, particularly in confined spaces, is difficult due to their limited accuracy in three-dimensional deflections and challenging localization. Therefore, using non-contact imaging sensors finds noticeable importance, particularly in medical scenarios. Accordingly, given the need for direct control of the robot tip and notable uncertainties in kinematics and dynamics of continuum robots, many papers have focused on the visual servoing of continuum robots in recent years. The significance of this research toward safe human-robot interaction has fueled our survey on the previous methods, current challenges, and future opportunities. Beginning with actuation modalities and modeling approaches, the paper investigates visual servoing methods in medical and non-medical s cenarios. Finally, challenges and prospects of visual servoing for continuum robots are discussed, followed by concluding remarks.

This article is protected by copyright. All rights reserved.

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Hearing Loss After COVID-19 Vaccination Does Not Outweigh Vaccine Benefit

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Sudden sensorineural hearing loss is an acute onset impairment of hearing that may lead to permanent hearing loss and tinnitus. The exact pathophysiological mechanisms are unknown, and many cases are idiopathic, although viral infection is 1 possible causative factor. As a result, vaccination against viral infections may play a role in reducing the occurrence of sudden sensorineural hearing loss. However, little is known about sudden sensorineural hearing loss as a potential adverse event after immunization; existing reports of sudden sensorineural hearing loss occurring after vaccination are rare, and an association has not been established. In this issue of JAMA Otolaryngology–Head & Neck Surgery, 2 articles investigate occurrences of sudden sensorineural hearing loss after COVID-19 vaccination.
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Changing Trends in the Clinical Characteristics and Treatment Strategies for Odontogenic Sinusitis Over the Past 10 Years

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Ear Nose Throat J. 2022 Feb 24:1455613221080918. doi: 10.1177/01455613221080918. Online ahead of print.

ABSTRACT

OBJECTIVES: The incidence of odontogenic sinusitis has been gradually increasing due to the recent increases in invasive dental procedures. This study aimed to describe the clinical features of present patients with odontogenic sinusitis compared to the past, confirm the importance of endoscopic sinus surgery (ESS), and analyze the predictive factors for ESS.

< p>METHODS: This retrospective review included all patients diagnosed with odontogenic sinusitis between January 2010 and December 2011 and between January 2019 and December 2020. The patients were classified into 2 groups (past and present) depending on the time of the first visit. The clinical characteristics and treatment modalities were compared between the two groups. In addition, among patients in the present group, we analyzed variables to identify factors contributing to the risk of undergoing ESS.

RESULTS: This study included 56 patients (23 in the past group and 33 in the present group). Compared to the past group, the present group had an older mean age (P = .001) and significantly increased iatrogenic etiologies (52.1% vs 90.9%; P = .002). The proportion of patients treated with ESS also increased in the present group compared to that in the past group (39.1% vs 66.7%; P = .041). In the present group, 11 patients (33.3%) were cured with conserva tive treatment, while 22 patients (66.7%) underwent additional ESS. Multivariate analysis revealed that the Lund-Mackay score was the only significant predictor of ESS (odds ratio [OR]: 14.901, P = .035).

CONCLUSION: The incidence of odontogenic sinusitis with iatrogenic etiologies has increased compared to the past. In addition, two-thirds of the patients in the present study underwent ESS, a significantly higher proportion than in the past. Therefore, ESS is one of the most important treatment modalities for odontogenic sinusitis, especially iatrogenic, in recent years. A severe Lund-Mackay score was associated with a significantly increased risk of ESS.

PMID:35199606 | DOI:10.1177/01455613221080918

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Single‐cell transcriptomics in human skin research: available technologies, technical considerations, and disease applications

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Abstract

Single-cell technologies have revolutionized research in the last decade, including for skin biology. Single-cell RNA sequencing has emerged as a powerful tool allowing the dissection of human disease pathophysiology at unprecedented resolution by assessing cell-to-cell variation, facilitating identification of rare cell populations and elucidating cellular heterogeneity. In dermatology, this technology has been widely applied to inflammatory skin disorders, fibrotic skin diseases, wound healing complications and cutaneous neoplasms. Here, we discuss the available technologies and technical considerations of single-cell RNA sequencing and describe its applications to a broad spectrum of dermatological diseases.

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Phase II study of apatinib combined with temozolomide in patients with advanced melanoma after failure of immunotherapy

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Objective Treatment for advanced melanoma after progression on immunotherapy is limited. This phase II trial (NCT03422445) was conducted to evaluate the efficacy and safety of apatinib plus temozolomide in patients with advanced melanoma after failure of immunotherapy. Methods Patients with unresectable stage III or stage IV melanoma after progression on immunotherapy were treated with temozolomide 300 mg on days 1–5 and apatinib 500 mg daily every 28-day cycle until disease progression or intolerable toxicities. Besides immunotherapy, prior chemotherapy, targeted therapy, and clinical trials were allowed. The primary endpoint was progression-free survival. Secondary endpoints were objective response rate, disease control rate, overall survival, and safety. Results Of 29 patients, 28 (96.6%) had metastatic diseases, and the predominant subtypes were mucosal [12 (41.4%)] and acral melanoma [eight (27.6%)]. Five (17.2%) patients showed BRAF, CKIT, or NRAS mutation. Five achieved confirmed partial response, with an objective response rate of 17.2%. The disease control rate was 82.8%. The median progression-free survival was 5.0 months [95% confidence interval (CI): 4.7–5.3], and the median overall survival was 10.1 months (95% CI: 5.1–15.0). Grade 3–4 treatment-related adverse events included proteinuria [four (13.8%)], thrombocytopenia [two (6.9%)], hypertension [one (3.4%)], and hyperbilirubinemia [one (3.4%)]. No treatment-related death occurred. Conclusion Apatinib plus temozolomide demonstrated promising efficacy and manageable safety profile in patients with advanced melanoma after progression on immunotherapy. * Li Zhou and Yue Yang contributed equally to the writing of this article and are the co-first authors. Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.melanomaresearch.com. Received 11 November 2021 Accepted 25 January 2022 Correspondence to Chuanliang Cui, Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China, Tel: +8610 88196317 -mail: 1008ccl@163.com Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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Τετάρτη 23 Φεβρουαρίου 2022

Value of six comorbidity scales for predicting survival of patients with primary surgery for oral squamous cell carcinoma

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Abstract

Background

Comorbidities influence treatment outcome of oral squamous cell carcinoma (OSCC). This study compared the predictive performance of six comorbidity scales for overall survival after surgery for OSCC.

Methods

We retrospectively analyzed OSCC patients, surgically treated at an academic center in Belgium between January 01, 2000 and January 01, 2020. Validity of the scales was evaluated using the area under the curve (AUC) of receiver operating characteristic curves.

Results

Three hundred and twenty three patients were included. Elixhauser Comorbidity Index (AUC = 0.74, 95% CI: 0.55–0.92; AUC = 0.73, 95% CI: 0.55–0.80), modified Elixhauser Comorbidity Index (AUC = 0.72, 95% CI: 0.54–0.91; AUC = 0.69, 95% CI: 0.51–0.77), and Combined Comorbidity Index (AUC = 0.76, 95% CI: 0.58–0.84; AUC = 0.76, 95% CI: 0.59–0.84) were meaningful predictors for 2 and 5-year survival, respectively.

Conclusion

Selected comorbidity scales were capable of predicting overall survival for OSCC patients 2 and 5 years after primary surgery.

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Long-term follow-up of patients managed conservatively for acute traumatic CSF rhinorrhoea

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World Neurosurg. 2022 Feb 19:S1878-8750(22)00211-X. doi: 10.1016/j.wneu.2022.02.065. Online ahead of print.

ABSTRACT

OBJECTIVE: Conservative management of acute traumatic cerebrospinal fluid rhinorrhoea (TCR) results in cessation of the leak in most patients. The objective of this study was to estimate the incidence of recurrent cerebrospinal fluid (CSF) rhinorrhoea and meningitis in these patients on long-term follow-up and to determine the risk factors associated with them.

METHODS: Data on 50 patients with acute TCR who were successfully treated with conservative management between 2013 and 2015 and had long term follow-up was retrieved from our head injury database. Patient variables were analysed to determine the risk factors associated with recurrence of CSF rhinorrhoea and meningitis.

RESULTS: All patients in our series developed CSF rhinorrhoea within 48 hours of trauma. The mean duration of follow-up was 6.3 ± 1.3 years. CSF rhinorrhoea recurred in 16 (32%) patients, 15 (93.8%) of whom developed it within 3 years of trauma. Meningitis occurred in 5 (10%) patients and one of them died. Sphenoid sinus fractures and features of raised intracranial pressure on computerised tomography (CT) of the brain at admission were significantly associated with the development of meningitis. There were no risk factors identified for the recurrence of CSF rhinorrhoea.

CONCLUSIONS: Patients with acute TCR in whom rhinorrhoea subsides with conservative therapy, have the highest risk for recurrence of leak or meningitis within three years of the trauma. Therefore, we recommend that these patients be counselled about the need for periodic follow up for several years.

PMID:35192972 | DOI:10.1016/j.wneu.2022.02.065

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Necrotising Otitis Externa Antibiotic therapy complications: A retrospective cohort analysis

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Abstract

NOE is a rare but life-threatening condition. Treatment is long-term intravenous antibiotics. However, there is no evidence on the complications of antibiotic treatment in this complex cohort of patients In our study, patients on average are treated with two different antibiotic regimes 63% of these changes in regimen are due to direct adverse effects from treatment including drug intolerance and lack of significant clinical response leading to deterioration and morbid complications Patients requiring multiple antibiotic regimes have a statistically longer duration of treatment. These adverse effects appear to occur more frequently in patients with additional comorbidities. This novel data provides information clinicians can use when initiating treatment for NOE and counsel patients appropriately

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