One of the uses of Helmholtz resonators is as sound absorbers for room acoustic applications, especially for the low frequency range. Their efficiency is centered around their resonance frequency which is mainly depended on elements of their geometry such as the resonator volume and neck dimensions. Incorporating additional necks on the body of a Helmholtz resonator (depending on whether they are open or closed) has been found to alter the resulted resonance frequency. For this study, tunable Helmholtz resonators to multiple resonance frequencies, are proposed and investigated utilizing additional necks. The resonance frequencies of various multi-neck Helmholtz resonators are first modeled with the use of finite element method (FEM), then calculated with the use of an analytical approach and the results of the two approaches are finally compared. Results of this study show that Helmholtz resonators with multiple resonances at desired frequencies are achievable with the use of additional necks, while FEM and analytical methods can be used for the estimation of the resonance frequencies. Analytical and FEM approach results show a good agreement in cases of small number of additional necks, while the increasing differences in cases of higher neck additions, were attributed to the change in effective length of the necks as demonstrated by FEM. The proposed approach can be useful for tunable sound absorbers for room acoustics applications according to the needs of a space. Also, this approach can be applied in cases of additional tunable air resonances of acoustic instruments (e.g. string instruments).

In this paper, a multi-mode waveguide-based optical resonator is proposed for an integrated optical refractive index sensor. Conventional optical resonators have been studied for single-mode waveguide-based resonators to enhance the performance, but mass production is limited owing to the high fabrication costs of nano-scale structures. To overcome this problem, we designed an S-bend resonator based on a micro-scale multi-mode waveguide. In general, multi-mode waveguides cannot be utilized as optical resonators, because of a performance degradation resulting from modal dispersion and an output transmission with multi-peaks. Therefore, we exploited the mode discrimination phenomenon using the bending loss, and the resulting S-bend resonator yielded an output transmission without multi-peaks. This phenomenon is utilized to remove higher-order modes efficiently using the difference in the effective refractive index between the higher-order and fundamental modes. As a result, the resonator achieved a Q-factor and sensitivity of 2.3x10³ and 52 nm/RIU, respectively, using the variational finite-difference time-domain method. These results show that the multi-mode waveguide-based S-bend resonator with a wide line width can be utilized as a refractive index sensor.

Fatal motorcycle accidents on- and off-road continue to be overlooked in the literature. Research is scant on morbidity and mortality due to neck injury, which leaves patients and their families debilitated chronically. Great Lakes EMS Inc. conducted a 10-year retrospective case study, which highlighted that motocross riders who do not wear a neck brace are at an 89% higher risk of a critical cervical spine injury; highly unstable cervical spinal fractures have a sustainably higher risk of morbidity and mortality. Proposed mechanisms of motocross neck braces displace the forces on the neck onto the helmet of the rider to provide a smooth distribution of forces, whereas lack of neck brace use places riders at risk for upper cervical spine fractures such as Jefferson fractures, Hangman's fractures, and Odontoid fractures. Further, evidence suggests the use of back protectors may increase the risk of thoracic and upper spine injuries during a motorcycle crash. The limited data on this topic continues to be a challenge, as there is a lack of understanding of the nature of these injuries, which are likely preventable with proper neck protection.

Objectives: Endovascular aneurysm repair (EVAR) in hostile neck has been associated with adverse outcomes. We aimed to determine the association of infrarenal aortic neck angle and length and establish an optimal cutoff value to predict intraoperative neck complications and post-operative outcomes. Methods: This was a retrospective review of intact infrarenal abdominal aortic aneurysm (AAA) with severe neck angulation (> 60 degrees) who underwent EVAR from October 2010 to October 2018. Demographic data, aneurysm morphology, and operative details were collected. The ratio of neck angle and length was calculated the optimal cutoff value of the aortic neck angle-length index. Patients were classified into two groups using latent profile analysis. Intraoperative neck complications, adjunct neck procedures, and early and late outcomes were compared. Results: 115 patients were included. Group 1(G1), aortic neck angle-length index ≤ 4.8, had 95 patients and Group 2 (G2), aortic neck angle-length index > 4.8, had 20 patients. Demographic data and aneurysm morphology were not significantly different between groups except for neck length (P < 0.001). G2 had more intra-operative neck complications than G1 (21.1% vs 55%, P = 0.005). Adjunctive neck procedures were more common in G2 (18.9% vs 60%, P < 0.001). Thirty-day mortality rate was not statistically different. G1 patients had a 5-year proximal neck re-intervention free rate comparable to G2 patients (93.7%G1 vs 87.5%G2, P = 0.785). The 5-year overall survival rate was not statistically different (59.9%G1 vs 69.2%G2, P = 0.891). Conclusions: Patients with aortic neck angle-length index > 4.8 are at greater risk of intraoperative neck complications and adjunctive neck procedures than patients with an aortic neck angle-length index ≤ 4.8. The 5-year proximal neck re-intervention free rate and the 5-year survival rate were not statistically different. The aortic neck angle-length index is a reliable predictor of intra-operative neck complications during EVAR in AAA with severe neck angulation.

Background and Objectives: The deltopectoral (DP) flap represents a reconstructive option for head and neck. It is a fasciocutaneous flap raised from the anterior chest wall below the clavicle. Its role partially declined with the arise of free flaps. However, it still remains a valid option in patients that could not undergo a reconstruction with free flaps. The aim of this retrospective study was to evaluate the role of the DP flap in head and neck reconstruction, with a focus on surgical outcomes and complications. Materials and Methods: Thirty-one patients who underwent head and neck reconstruction with DP flap were included in the study. The delayed technique was not used in any procedure to harvest the flap beyond the deltopectoral groove. The patients’ characteristics, the recipient site, the closure of the donor site and the flap-related complications were recorded. Results: The median time to autonomization of DP flap was 23 days. Post-operative complications were observed in 10 subjects (32.3%). A partial necrosis was seen in 5 patients (16.1%), while a complete necrosis developed only in one case (3.2%). The diabetes mellitus was the only parameter associated to post-operative complications. In particular, the percentage of necrosis in subjects with or without diabetes was 66.7% and 8.0%, respectively. Conclusions: The DP has a wide range of applications in head and neck reconstruction and a low complication rate can be observed. The delayed technique does not necessarily need to be applied, and the flap can be extended beyond the deltopectoral groove when necessary. However, patients with diabetes mellitus have a higher risk of postoperative necrosis of the distal portion of the flap.

Currently, data regarding optimal treatment modality, response, and outcome specifically for N3 head and neck cancer are lacking. This study aimed to compare the treatment outcomes between definitive concurrent chemoradiotherapy (CCRT) to the neck and upfront neck dissection followed by adjuvant CCRT. 93 N3 squamous cell carcinoma head and neck cancer patients were included. Primary tumor treatment was divided to definitive CCRT (CCRT group) or curative surgery followed by adjuvant CCRT (surgery group). Neck treatment was also classified into two treatment modalities: definitive CCRT to the neck (CCRT group) or curative neck dissection followed by adjuvant CCRT (neck dissection group). Overall, the 2-year overall survival (OS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), and distant metastasis-free survival (DMFS) were 51.8%, 47.3%, 45.6%, and 43.6%, respectively. In both oropharyngeal cancer and nonoropharyngeal cancer patients, in terms of OS, LRFS, RRFS or DMFS no difference was noted regarding primary tumor treatment (CCRT vs. surgery) or neck treatment (CCRT vs. neck dissection). In summary, N3 neck patients treated with definitive CCRT can achieve similar outcomes to those treated with upfront neck dissection followed by adjuvant CCRT. Cautions should be made to avoid overtreatment for this group of patients.

Opium smoking for long hours and over many years is common in Iran, and the Covid-19 pan-demic and false beliefs about the protective effects of that opium against COVID-19 infection has caused the increasing of opium smoking during the pandemic. The aim of this study was to in-vestigate the relationship between non-ergonomic positions of traditional opium smoking in Iran with the occurrence of neck pain and disability, forward head posture and hyperkyphosis. In this cross-sectional and correlation study 120 people who smoke opium were selected based on the inclusion criteria and were interviewed about their addiction profile and evaluated for the pres-ence of pain and disability in the neck by Maudsley Addiction Profile, Leeds Dependence Ques-tionnaire, the Visual Analog Scale and Neck Disability Index. Also, they were evaluated about forward head posture (FHP) through side view photography and hyperkyphosis (HK) through flexible ruler. Data were analyzed by correlation coefficient tests and stepwise linear regression. There was a significant relation between homelessness, the duration of lifetime opium smoking (months), the duration of daily opium smoking (minutes) and drug dependence severity with the severity of neck pain, neck disability, forward head posture and hyperkyphosis. Homelessness is the strongest predictive variable of the possibility of neck pain and disability, FHP and HK, fol-lowed by ‘‘the number of months of opium smoking’’ and ‘‘the number of minutes of opium smoking in one day’’ respectively. Increasing the duration of sitting in non-ergonomic positions can lead to neck pain and disability, FHP and HK due to their non-neutral posture in opium smokers.

The kipping handstand push-up (kHSPU) is an exercise performed by many thousands of CrossFit participants. The safety of kHSPUs has been questioned because of vertical impacts upon the head. Here, we measured the axial loads placed upon the head during kHSPUs and sought to identify other factors that may place participants at risk of injury. 16 volunteers from a single gym performed 3 sets of up to 7 kHSPUs with their head and one hand contacting force platforms. Forces were recorded continuously and video recording were made while performing the exercises. The force profiles showed distinct landing and kipping peaks. Participants landed with more force than during their normal headstand, but less than their body weight. The force on the head was greatest during the "kip," and was usually more than body weight. Participants who reported pain following kHSPUs moved their head into extension during the exercises. Forces to the head during kHSPUs were below forces proposed for damage to the young male cervical spine, but overlapped those proposed for female cervical spines. While kipping handstand push-ups may be safe for young and previously uninjured male athletes, they may be unsafe for females and for those with previous injury or other compromising factors.

Stereotactic body radiation therapy (SBRT) is a precise and conformal radiation therapy (RT) that aims to deliver a high dose of radiation to the tumor with sparing surrounding normal tissue, making it an attractive option for head and neck cancer (HNC) patients who are not suitable for traditional long course of RT with comprehensive RT target volume. Definitive SBRT for HNC has been investigated in different settings, including early stage glottis cancer, and as alternative to brachytherapy boost after external beam RT. It also used as a primary treatment option for elderly or medically unfit patients. More recently, SBRT combination with immunotherapy in the neoadjuvant setting for HNC showed promising results. Salvage or adjuvant SBRT for HNC can be used in appropriately selected cases. Future studies are warranted to determine the optimum dose and fractionation schedules in any of these indications.

Manifestation of cystic hygroma in adulthood is very rare. In this study, we reported a rare case of Cervical Cystic Hygroma in Adults. We report 20 years old male with a diagnosis of left-side neck cystic Hygroma and discuss the presentation, diagnosis, and clinical, radiological, and operative aspects of it.

Upper limb control depends on accurate internal models of limb position relative to the head and neck, accurate sensory inputs, and accurate cortical processing. Transient alterations in neck afferent feedback induced by muscle vibration may impact upper limb proprioception. This research aimed to determine the effects of neck muscle vibration on upper limb proprioception using a novel elbow repositioning task (ERT). 26 right-handed participants aged 22.21 2.64 performed the ERT consisting of three target angles between 80-90 (T1), 90-100 (T2) and 100-110 (T3). Controls (CONT) (n=13, 6F) received 10 minutes of rest and the vibration group (VIB) (n=13, 6F) received 10 minutes of 60Hz vibration over the right sternocleidomastoid and left cervical extensor muscles. Task performance was reassessed following experimental manipulation. Significant time by group interactions occurred for T1: (F1,24 = 25.330, p &lt; 0.001, p2 = 0.513) where CONT improved by 26.08% and VIB worsened by 134.27%, T2: (F1,24 = 16.157, p &lt; 0.001, p2 = 0.402) where CONT improved by 20.39% and VIB worsened by 109.54%, and T3: (F1,24 = 21.923, p &lt; 0.001, p2 = 0.447) where CONT improved by 37.11% and VIB worsened by 54.39%. Improvements in repositioning accuracy indicates improved proprioceptive ability with practice in controls. Decreased accuracy following vibration suggests that vibration altered proprioceptive inputs used to construct body schema, leading to inaccurate joint position sense and the observed changes in elbow repositioning accuracy.

The delineation of the clinical target volumes (CTVs) for radiation therapy is time-consuming, requires intensive training and shows high inter-observer variability. Supervised deep learning methods depend heavily on consistent training data, thus state-of-the-art research focuses on making CTV labels more homogeneous and strictly bounding them to current standards. International consensus expert guidelines standardize CTV delineation by conditioning the extension of the clinical target volume on surrounding anatomical structures. Training strategies that directly following the construction rules given in the expert guidelines or the possibility to quantify the conformance of manually drawn contours with the guidelines are still missing. 71 anatomical structures that are relevant for CTV delineation in head and neck cancer patients according to the expert guidelines were segmented on 104 CT scans to assess the possibility to automate their segmentation by state-of-the-art deep learning methods. nnU-Net models were trained to automatically segment those 71 structures on planning CT scans. We report the DICE, HD and sDICE for 71 + 5 anatomical structures for most of which no previous segmentation accuracies have been reported. For those structures, for that prediction values have been reported, our segmentation accuracy matched or exceeded the reported values. The predictions from our models were always better than those predicted by the TotalSegmentator. The sDICE with 2mm margin was larger than 80% for almost all structures. Individual structures with decreased segmentation accuracy are analyzed and discussed with respect to their impact on the CTV delineation following the expert guidelines. No deviation is expected to affect the rule-based automation of the CTV delineation.

Patients with locally advanced head and neck squamous cell carcinoma (HNSCC) frequently require primary radiochemotherapy (RCT). Despite intensity-modulation, desired radiation-induced effects observed in HNSCC, may also be observed as side-effects in healthy tissue e.g. the sternocleidomastoideus muscle (SCM). These side-effects (e.g. tissue fibrosis) depend on the interval between completion of RCT and restaging-CT. For salvage surgery, the optimal time window for surgery is currently postulated between 6 and 12 weeks after completion of RCT. Thus, no extensive tissue fibrosis is to be expected. This interval is based on studies exploring surgical complications. Studies directly exploring radiation-induced changes of the SCM in HNSCC-patients are sparse. The present study quantifies tissue alterations in SCM and paravertebral musculature (PVM) after RCT applying radiomics to determine the optimal time window for salvage surgery. Three radiomic key parameters 1) volume, 2) mean positivity of pixels (MPP) and 3) uniformity were extracted with mint lesionTM in the staging-CTs and restaging-CTs of 98 HNSCC-patients. Of these, 25 were female, the mean age was 62 (±9.6) years and 80.9% were UICC Stage IV. The mean restaging-interval was 55 (±28; range29-229) days. Only the mean volume significantly decreased after RCT from 9.0 to 8.4 and 96.5 to 91.9 ml for SCM and PVM, respectively (both p=0.007, both Cohen’s d=0.28). In addition, the mean body mass index (BMI) decreases from 23.9 (±4.2) to 21.0 (±3.6) kg/m² (p<0.001); Cohen's d = 0.9). The mean BMI-decrease significantly correlated with the volume decrease for SCM (r=0.27; p=0.007) and PVM (r=0.41; p<0.001). If t-test p-values were adjusted for the BMI-decrease, no significant change in volumes for SCM and PVM was observed (both p>0.05). The present data supports the postulated optimal interval for salvage surgery of 6 to 12 weeks. Irrespective of the remaining risk-benefit ratio of salvage surgery, the risk of additional surgical complications due to fibrosis is not supported by the present observations.

Single Nucleotide Polymorphisms (SNPs) are the most common type of genetic variation found in individual’s DNA sequences. SNPs can occur in both coding and non-coding regions of the genome and can affect gene expression, protein function, and disease susceptibility. In this systematic review we evaluate the influence of SNPs as a biomarker in the assessment of oral mucositis (OM) in head and neck cancer (HNC) patients. The study selection process involved screening 66 articles from different platforms, and after removing duplicates and excluding irrelevant articles, 23 articles were included for full-text evaluation. The main characteristics and findings of the selected articles are presented and discussed. We conclude that SNPs can be used as a reliable biomarker for the assessment of OM in HNC patients, and further research is needed to explore the potential of SNPs in personalized medicine for HNC treatment.

Passive dynamics is an aspect of locomotion which is entirely dependent on the mechanical configuration and linkages of adjacent body segments. Tension distribution along mechanical linkages enables execution of movement patterns with reduced need for complex neurological pathways and may play a role in reestablishing postural stability following external disturbances. Here we demonstrate a uni-directional mechanical relationship between the equine forelimb, head and neck, which may have implications for balance and forelimb loading in the horse. These observations suggest that forelimb, head and neck movement coordination (observed in the horse during unrestrained locomotion) is largely controlled by the mechanical linkages between body segments, rather than being entirely dependent on neurological input as previously thought. This highlights the potential significance of research directed at investigating passively induced movements in understanding common locomotory patterns. Additionally, it suggests a mode of postural control which may provide instantaneous adjustments to postural disturbances, thus promoting rapid and efficient locomotion.

Importance: The rapidly expanding 2019 novel coronavirus pandemic (COVID-19, caused by the SARS-CoV-2 virus) has challenged the medical community to an unprecedented degree. Physicians and healthcare workers are at added risk of exposure and infection during the course of the patient care. Due to the rapid spread of this disease through respiratory droplets, healthcare providers such as otolaryngologists-head & neck surgeons who come in close contact with the upper aerodigestive tract during diagnostic and therapeutic procedures are particularly at risk. Here we present a set of safety recommendations based on our review of literature and communications with physicians with first-hand knowledge of safety procedures during the 2019 COVID-19 pandemic.Observations: A high number of healthcare providers were infected during the first phase of the pandemic in Wuhan province. Subsequently, by adopting strict safety precautions, other regions were able to achieve high levels of safety for healthcare providers without jeopardizing the care of patients. We reviewed the most common procedures related to the examination and treatment of upper aerodigestive tract diseases. Each category was reviewed based on the potential risk imposed to healthcare workers. Specific recommendations were made, based on the literature, when available, or consensus best practices. Specific safety recommendations were made for performing tracheostomy in COVID-19 patients. Conclusions and Relevance: Preserving highly skilled healthcare work force is a top priority for any community and healthcare system. Based on the experience of healthcare systems in Asia and Europe, by following strict safety guidelines, the risk of exposure and infection of healthcare providers could be significantly reduced, while providing high levels of care. The provided recommendations could be used as broad guidance for all healthcare workers who are involved with the care of COVID-19 patients.

Head and neck cancers arise from mucosa lining the oral cavity, oropharynx, hypopharynx, larynx, sinonasal tract, and nasopharynx and the etiology of head and neck cancers is complex and involves many factors, among which oncogenic viruses are also enumerated. Nevertheless, this type of cancers are among the most common cancers around the world. The thorough knowledge of the pathogenesis of viral infection is needed to fully understand its impact on cancer development.

The cyclooxygenase-2 (COX-2) is a potent enzyme that converts arachidonic acid to prostaglandins (PG), including PGE2, a key mediator of inflammation and angiogenesis. Importantly, COX-2 is activated in response to inflammatory stimuli, where it is also believed to promote the development and progression of head and neck cancers (HNC). COX-2 can mediate its protumorigenic effect through various mechanisms such as inducing cell proliferation, inhibition of apoptosis, and suppressing the host’s immune response. Furthermore, COX-2 can induce the production of vascular endothelial growth factors, hence promoting angiogenesis. Indeed, the ability of COX-2 inhibitors to selectively restrict the proliferation of tumor cells and mediating apoptosis provides promising therapeutic targets for cancer patients. Thus, in this comprehensive review, we summarized the reported differential expression patterns of COX-2 in different stages of head and neck carcinogenesis—from potentially premalignant lesions to invasive carcinomas. Furthermore, we examined the available meta-analysis evidence for COX-2 role in the carcinogenesis of HNC. Finally, further understanding of the biological processes of COX-2 and its role in orchestrating cell proliferation, apoptosis and angiogenesis may give therapeutically beneficial insight to develop the management plan of HNC patients and improve their clinical outcomes.

Background: Infantile hemangiomas (IHs) are the most common benign vascular tumors of infancy. Methods: We report our experience of 248 patients with head and neck IHs. Results: The median age on admission was 4 months, and female/male ratio was 2.17. Among the cases, 45% were followed without treatment. No local complications were observed in any of these patients. Propranolol was given to all patients who received medical treatment. The median duration of treatment was 12 months (1-30 months), and the median follow-up period of all patients was 14 months (0-118 months). The treatment response was 98%. Complication rate was 17% and children aged between 3 and 9 months accounted for 60% of patients who developed complications. Most of the complications were local complications such as bleeding, ulcer, and infection. Conclusion: Although most of them regress spontaneously, complications may occur. Propranolol alone is an effective treatment option, and early treatment initiation increases success rates.

Cardiovascular diseases (CVDs) are the leading cause of death in the globally. Morbidity and disability related to non-fatal events are increasing exponentially. There are several symptoms that may arise after invasive therapeutic approaches such as coronary artery bypass graft (CABG), including chronic pain in anatomical areas connected to the mediastinum; these pains can be found not only initially after surgery, but also years later. We present a case where non-specific neck pain (NNP), in a patient undergoing CABG five years earlier, was approached with an osteopathic technique, working the pericardial area. To the knowledge of the Authors, it is the first case report where osteopathy is associated with a gentle treatment on the pericardial area to resolve a NNP.

There is great interest in thoracic kyphosis as it is thought to be a contributor to neck pain, neck disability, and sensorimotor control measures; though this has not been completely inves-tigated in treatment or case control studies. This case control design investigated participants with non-specific chronic neck pain. Eighty participants with a defined hyper-kyphosis (> 55°) were compared to 80 matched participants with normal thoracic kyphosis (< 55°). Participants were matched for age and neck pain duration. Hyper-kyphosis was further categorized into two distinct types: postural kyphosis (PK) and Scheuermann’s kyphosis (SK). Posture measures included formetric thoracic kyphosis and the craniovertebral angle (CVA) to assess forward head posture. Sensorimotor control was assessed by the following measures: smooth pursuit neck torsion test (SPNT), overall stability index (OSI) and left and right rotation repositioning accuracy. A measure of autonomic nervous system function included the amplitude and latency of skin sympathetic response (SSR). Differences in variable measures were examined using the Student’s t-test to compare the means of continuous variables between the two groups. Pearson correlation was used to evaluate the relationship between participant’s thoracic kyphosis magnitude (in each group separately and as an entire population) and their CVA, SPNT, OSI, head repositioning ac-curacy, and SSR latency and amplitude. Hyper-kyphosis participants had a significantly greater neck disability index compared to the normal kyphosis group (p < 0.001) with the SK group having greatest disability (p < 0.001). Statistically significant differences between the two kyphosis groups and the normal kyphosis group for all the sensorimotor measured variables were identified with the SK group having the most decreased efficiency of the measures in the hyper-kyphosis group, including: SPNT, OSI and left and right rotation repositioning accuracy. Also, there was a signif-icant difference in neurophysiological findings for SSR amplitude (entire sample of kyphosis vs. normal kyphosis, p < 0.001), but there was no significant difference for SSR latency (p = .07). The CVA was significantly greater in the hyper-kyphosis group (p < 0.001). The magnitude of the thoracic kyphosis correlated with worsening CVA (with the SK group having the smallest CVA; p < 0.001) and the magnitude of the decreased efficiency of the sensorimotor control measures and the amplitude and latency of the SSR. The PK group, overall, showed the greatest correlations between thoracic kyphosis and measured variables. Participants with hyper-thoracic kyphosis exhibited abnormal sensorimotor control and autonomic nervous system dysfunction compared to those with normal thoracic kyphosis.

Cytoglobin has been implicated in a range of pathological conditions including fibrosis and cancer, where cytoglobin expression is linked to hypoxia- and drug-resistance. One disease where there is evidence of a role for cytoglobin is head and neck squamous cell carcinoma, a disease with a poor prognosis and where clinical resistance to platinum-based drugs is common. In the current study, we demonstrate that 3D-culture of head and neck cancer cells (PE/CA-PJ41, Liv-22K) and normal oral keratinocyte cells (NOK-hTERT) results in changes in sensitivity to cisplatin cytotoxicity compared to 2D-cultures. Relative to 2D-cultures, 3D-cultures of PE/CA-PJ41 and NOK-hTERT cells demonstrated increased cisplatin resistance. In contrast, 3D-cultures of Liv-22K cells were more sensitive to cisplatin. Evidence for cisplatin genotoxicity was observed in the form of GADD45A activation in PE/CA-PJ41 cells but not the other two cell types investigated. Furthermore, DNA-strand breaks were also detected by the alkaline comet assay in PE/CA-PJ41 cells although levels were not significantly affected by 3D-culture. Cytoglobin expression levels were elevated by 3D-culture in all three cell lines investigated and there were also changes in expression of genes related to cell division (MKI57, GJB6), cell adhesion (CDH1), stress response (NFkB, NQO1) and apoptosis (Casp3) but these changes were cell line specific. We also observed consistent transcriptional activation of HIF1a in 3D-cultures of all three cell lines, suggestive of hypoxic conditions in spheroids. In support of a direct role of hypoxia in cytoglobin induction, the HIF1a stabiliser cobalt chloride also induced cytoglobin expression in spheroids. Transcriptomic profiling of PE/CA-PJ41 cells over-expressing cytoglobin identified 121 differentially regulated genes, when cells were cultured under hypoxic conditions. Major changes identified included, upregulation of G1/S cell cycle regulation as well as wnt- and RhoGTPase-signalling pathways. In conclusion, 3D-cultures are a useful model to further study the biological function of cytoglobin in head and neck cancer and we provide evidence that further supports a role for cytoglobin in hypoxia-dependent cellular proliferation and phenotypic changes that could contribute to cisplatin resistance in vivo.

In the past decade, it has been discovered that intestinal flora can influence various organ-specific cancers by altering the body's energy balance, increasing obesity, synthesizing genetic toxins and small signaling molecules, initiating and modulating immune responses, and metabolizing indigestible dietary components, exogenous substances, and drugs. In this review, we will focus on elucidating the role of gut flora based on its molecular mechanisms and its potential therapeutic implications in head and neck tumors in the near future.

Abstract: The pursuit of youth and attractiveness is a fundamental desire in contemporary society. For many individuals, the appearance of visible signs of aging, such as skin laxity, gravitational changes in facial and neck soft tissues, and loss of harmonious proportions, can be psychologically distressing. The choice of effective methods for addressing these changes depends on their specific characteristics, the patient's anatomical features, and the type of facial aging. The introduction of 3D imaging to determine the hyoid bone level, the volume of soft tissue structures in the cervico-mental area, ptosis of subplatysmal structures, and the volume of submandibular glands, in addition to ultrasound study of the submental projection at the preoperative stage, are key for taking the best decision regarding preoperative planning. This case report aims to illustrate how modern imaging techniques are a fundamental part of the preoperative assessment of the mid and lower third of the face to ensure the most favorable aesthetic outcomes for each patient. Key message: To attain harmonious results in surgical correction of age-related facial and neck changes, it is crucial to consider the patient's anatomical features and the extent of age-related alterations. A comprehensive facial analysis, taking into account the type of facial aging and employing a CT scan and ultrasound examination of the soft tissues in the chin region, facilitates the development of an individualized plan tailored to achieve the patient's desired outcome.

(1) Background: Globally, neck pain is prevalent, affecting around thirty percent of the population annually. To better understand the influence of pain on the myofascial layers, the present study investigated these on the upper trapezius muscle in unilateral, more severe neck pain. (2) Methods: This study was a cross-sectional study. Forty patients (42.2 ± 14.7) with a confirmed diagnosis of unilateral neck pain were examined using durometry and indentometry. The study evaluated stiffness, elasticity, and pressure pain threshold of both sides of the neck (symptomatic side: SS; healthy side: HS). Furthermore, the range of motion of the cervical spine (lateral flexion, rotation) was quantified using a digital goniometer. (3) Results: A significant lateral discrepancy was observed in stiffness between groups (durometry: SS – 33.76 ± 7.78, HS – 29.75 ± 7.45, p&lt;0.001; indentometry: SS – 59.73 ± 33.93, HS – 4.18 ± 12.69, p=0.024). In contrast, no differences were found between the comparison sides of the upper trapezius for the parameter’s elasticity (SS – 0.101 ± 1.09, HS – -0.006 ± 0.29, p=0.416), cervical spine mobility (lateral flexion: SS – 37.08 ± 8.15, HS – 37.73 ± 7.61, p=0.559; rotation: SS – 73.55 ± 12.37, HS – 72.85 ± 11.10, p=0.660) and algometry (SS – 36.41 ± 17.53, HS – 37.22 ± 17.00, p=0.657). (4) Conclusion: Overall, it can be concluded that more severe neck pain unilaterally shows differences in stiffness on the same side. Future research is needed to investigate the links.

Background: Spinal pain is highly prevalent and in Spain it produces a very high economic cost and the scientific evidence supporting treatments shows low to moderate evidence for exercise. Therefore, the aim of this study was to assess the effectiveness of a therapeutic group exercise protocol in reducing pain intensity and disability in patients with spinal pain in primary health care setting. Methods: A total sample of 149 patients who suffered from chronic non-specific spinal pain. Patients received a therapeutic exercise protocol, including exercises of auto-mobilization of the neck and lumbar regions, as well as core stabilization exercises. Pain intensity and disability were evaluated before and after the therapeutic exercise protocol. Results: Statistically significant differences (P&lt;0.05) were shown for pain intensity and disability of patients with neck and low back pain with an effect size from moderate to large. Conclusions: A therapeutic exercise protocol may provide beneficial effects on disability and pain intensity in patients with chronic non-specific spinal pain, including neck and low back pain conditions. Clinicians should consider the use of self-administered exercise protocols, demonstrate great effectiveness, and be less costly.

Cancers of the head and ne¬ck and their treatment can cause disfigurement and loss of functioning, with a profound negative impact on the person’s self-image and psychosocial wellbeing. This can lead to experiences of shame and stigma, which are important targets for psychosocial interventions. Accurate measurement and identification of these problems enables clinicians to offer appropriate interventions and monitor patients’ progress. This study aimed to validate the Canadian version of the Shame and Stigma Scale (SSS) among French and English speaking head and neck cancer patients. Data from 258 patients from two major Canadian hospitals was analysed. The existing 4-factor structure of the SSS was supported, with the following subscales: Shame with Appearance, Sense of Stigma, Regret, and Social/Speech Concerns. The Canadian SSS showed adequate convergent and divergent validity and test-retest reliability. Rasch analysis suggested scale improvement by removing two misfitting item and two items with differential functioning between French and English speaking patients. The final 16-item scale version had adequate fit to the Rasch model. The SSS provides more accurate measures for people with high levels of shame and stigma, and thus has utility in identifying patients with more severe symptoms who may be in need of psychosocial interventions.

Chemoradiotherapy (CRT) is the standard treatment for locally advanced head and neck cancer; however, CRT may cause post-treatment dysphagia. Transcutaneous electrical sensory stimulation (TESS), developed in recent years for swallowing rehabilitation, has been used at many medical facilities. Although TESS has been used for dysphagia in several fields, its safety and efficacy in patients with head and neck cancer remain to be clarified. Therefore, this study evaluated the safety of TESS in ten patients with head and neck cancers undergoing CRT. Swallowing rehabilitation intervention and TESS implementation were performed for all patients during CRT. Non-blood toxicity adverse events (AEs), such as dermatitis and mucositis, occurred during CRT; however, the severity was less than Grade 3. No patient experienced pain due to TESS. As survival time analysis using the Kaplan–Meier method for interferential current device implementation rates revealed a feasibility of 100% for up to 60 Gy and a feasibility of 78% for up to 70 Gy, it concludes that TESS was feasible until 70 Gy. This study confirmed the feasibility and safety of TESS in the head and neck region, even during CRT. Although the precise mechanism of TESS on dysphagia is not yet clear, its continued use has great potential for improving sensory disturbance.

Chondrosarcoma, represents approximately 0.1% of all neoplasms of the head and neck, being considered a rare disease, but with a relatively good prognosis. The 5-year overall survival (OS) rate is estimated at 70-80%, being considered a disease with a low growth rate. About 13% of all cases of chondrosarcoma, are located in the region of the head and neck. We present the case of a young patient treated multimodally, lost from the oncological records less than two years after the diagnosis, without evidence of disease progression. The early loss from the oncological follow-up programs of patients with a lower risk of early repalpse, without evidence of a recurrence or metastasis could be the consequence of a major complication among which we could assume an aspiration pneumonia secondary to a dysphagia, associated with an aggressive multidisciplinary treatment. Large tumor size and positive resection margins (R1 resection) are risk factors that support an intensive adjuvant approach in order to reduce the risk of recurrence, but the low grade of tumor, associating a lower risk of recurrence as well as the adverse events (AE) of adjuvant radiotherapy and chemotherapy justifies a more reserved therapeutic approach. Taking into account the longer life expectancy of these patients, it is recommended to use a more conformal irradiation technique in order to reduce doses to radiosensitive structures as well as to omit elective neck irradiation, taking into account the lower risk of lymph node involvement. The lack of guidelines that include very rare tumors including low grade chondrosarcoma of head and neck make a unified approach difficult, but the data presented even in case reports could contribute to choosing the regimen that offers the best therapeutic ratio.

Most head and neck cancers are diagnosed in advanced stages, when the curative interventions are no longer possible. The assessment and the multidisciplinary therapeutic approach of the locally advanced cases are difficult since the onset of the disease becomes a significant challenge for the whole attending team (including both the patient and his family) because they have to deal with to an extensive symptomatology (abundant secretions, refractory pain, mutilations predominantly in the cephalic area), with the cure of stomas (tracheostomy, gastrostomy) and with various post-therapeutic sequelae. The present paper reflects the impact of late diagnosis, the complexity of the multimodal specific oncological treatment (chemotherapy, radiotherapy, immunotherapy, pal-liative and terminal treatment), the adaptation of medical care to the psycho-emotional structure, having as an example the case of 54-year old patient (with his consent) diagnosed with pharyn-golaryngeal neoplasm who presented himself to “St. Luca” Chronic Disease Hospital, the Oncol-ogy-Palliative Care Department, in September 2021. In patients with locally advanced head and neck cancers, besides the specifically oncological therapeutic decisions, the empathic-emotional connection between the medical team with the patient and his family plays a key role in the ther-apeutic conduct.

Abstract: Background: Intensity modulated radiotherapy (IMRT) is still a standard of care for radiotherapy in locally advanced head and neck cancer (LA-HNSCC). Simultaneous integrated boost (SIB) and moderate hypofractionation offer an opportunity for individual dose painting and a reduction in overall treatment time. We present retrospective data on toxicity and locore-gional control of a patient cohort with LA-HNSCC treated with an IMRT-SIB concept in compar-ison to normofractionated 3D-conformal radiotherapy (3D-RT) after a long-term follow-up. Methods: Between 2012 and 2014, n=67 patients with HNSCC (stages III/IV without distant me-tastases) were treated with IMRT-SIB either definitively (single/total doses: 2.2/66 Gy, 2.08/62.4 Gy, 1.8/54 Gy in 30 fractions) or in the postoperative setting (2.08/62.4 Gy, 1.92/57.6 Gy, 1.8/54 Gy). These patients' clinical courses were matched (for sex, primary, and treatment concept) as part of a matched-pair analysis with patients treated before mid-2012 with normofractionated 3D-CRT (definitive: 2/50 Gy followed by a sequential boost up to 70 Gy; postoperative: 2/60-64 Gy). Chemotherapy/ immunotherapy was given concomitantly in both groups in the definitive situation (postoperative dependent on risk factors). The primary endpoints were acute and late toxicity; the secondary endpoint was locoregional control (LRC). Results: Sixty-seven patients treated with IMRT-SIB (n = 20 definitive, n = 47 adjuvant) were matched with 67 patients treated with 3D-RT. There were minor imbalances between the groups concerning nonmatching variables such as extracapsular extension (ECE) and chemotherapy in IMRT-SIB. Significantly less toxicity was found in favor of IMRT-SIB concerning dysphagia, ra-diation dermatitis, xerostomia, fibrosis, and lymphedema. After a median follow-up of 63 months, the median LRC was not reached (IMRT-SIB) vs. 69.5 months (3D-RT) (p=0.63). Conclusions: This moderately hypofractionated IMRT-SIB concept was shown to be feasible with less toxicity than conventional 3D-RT in this long-term follow-up observation.

The present study investigated the association of accelerometer-determined moderate-to-vigorous physical activity (MVPA) with neck circumference (NC) in adolescents and adults from eight Latin American countries. The sample consisted of 2370 participants from the Latin American Study of Nutrition and Health, a multicenter cross-sectional nutrition and health surveillance study of a nationally representative sample from eight Latin American countries. An Actigraph GT3X+ accelerometer was used to monitor MVPA. Adolescents were categorized as NC > 34.25 cm in boys and NC > 31.25 cm in girls, and adults were categorized as NC > 39 cm in men and NC > 35 cm in women. The average time of MVPA was 34.88 min/day, ranging from 31.16 in Venezuela to 40.27 in Chile. Concerning NC, 37.0% of the sample was classified as having elevated NC. Chile was the country with the highest percentage of people with elevated NC (56.9%), and Colombia had the lowest percentage (24.8%). Overall, the MVPA (min/day) was associated with elevated NC (OR = 0.994, CI95% = 0.990–0.998). In Costa Rica and Peru, there were significant associations between MVPA and NC when analyzed by country. Further research is required to understand the differences between countries in the observed associations.

The quest for surgical advancements regarding the enhancement of the submental and cervicofacial regions has witnessed a remarkable upsurge in recent years. Informed patients are actively seeking sophisticated plastic surgery techniques to achieve comprehensive rejuvenation in these specific areas. Common complaints expressed by these patients include sagging of the jawline, the emergence of deep perioral wrinkles, and the formation of "marionette lines" within the lower third of the face. Furthermore, the manifestation of age-related signs, including neck laxity, submental adipose accumulation, "witch's chin" deformity, and weakened platysma musculature, are common within this anatomical region. This literature review aims to summarize the recent technical improvements, historical evolution, indications, postoperative care, and challenges for facial rejuvenation of the lower third of the face and neck. Lastly, the application of minimally invasive procedures as part of a comprehensive approach to an aging face will also be discussed.

The quest for surgical advancements regarding the enhancement of the submental and cervicofacial regions has witnessed a remarkable upsurge in recent years. Informed patients are actively seeking sophisticated plastic surgery techniques to achieve comprehensive rejuvenation in these specific areas. Our clinical practice encounters an annual influx of approximately 400 patients, with 20% of them aged over 60, seeking facial rejuvenation encompassing the details of lower third of the face and neck. Common concerns expressed by these patients include sagging of the jawline, the emergence of deep perioral wrinkles, and the formation of "marionette lines" within the lower third of the face. Furthermore, the manifestation of age-related signs, including neck laxity, submental adipose accumulation, "witch's chin" deformity, and weakened platysma musculature, is frequently encountered within this intricate anatomical domain. This review aims to summarize the recent technical improvements, historical evolution, indications, postoperative care and challenges for facial rejuvenation of the lower third of the face and neck. Lastly, the application of minimally invasive procedures as part of a comprehensive approach to an aging face will also be discussed.

In daily travel and activities, pathfinding is a significant process. They are often used in transportation routes calculation. They have now evolved to be able to solve most situations of the pathfinding and its related problems. This review describes previous and recent studies on the pathfinding algorithms. It reviews the development of pathfinding algorithms in a classification base on their usage. The aim is to summarize the application of the pathfinding algorithms for the readers interested in the subject that can be used as a supplement.

Multi-Faith Spaces (MFS) are a relatively recent invention that quickly gained in significance. On the one hand, they offer a convenient solution for satisfying needs of people with diverse beliefs in the institutional context of hospitals, schools, airports, etc. On the other hand, as Andrew Crompton pointed out, they are politically significant because the multi-faith paradigm “is replacing Christianity as the face of public religion in Europe” (2012, p. 493). Due to their ideological entanglement, MFS are often used as the means to promote either a more privatised version of religion, or a certain denominational preference. Two distinct designs are used to achieve these means: negative in the case of the former, and positive in the latter. Neither is without problems, and neither adequately fulfils its primary purpose of serving diverse groups of believers. Both, however, seem to follow the biases and main problems of secularism. In this paper, I analyse recent developments of MFS to detail their main problems and answer the question, whether the MFS, and the underlying Multi-Faith Paradigm, can be classified as a continuation of secularism.

Abstract. Leiomyoma is a benign tumour of smooth muscle cells classified into three groups: solid leiomyoma, angioleiomyoma and leiomyoblastoma. Angioleiomyoma arises from the tunica media of veins and arteries of vascular smooth muscle.Nasal cavity, paranasal sinus and oral cavity are the most frequent locations in Head and Neck region. Here we present the case of a tongue base angioleiomyoma with an emphasis on clinical data, pathologic findings and surgical approach. The patient complained about a one-month of globus sensation, dysphagia and hemoptysis without other systemic symptoms. Laryngoscopy revealed the presence of a 2 cm solitary submucosal mass located on the left tongue base covered with normal mucosa. The patient underwent direct laryngoscopy to perform a biopsy for the purpose of achieving the conclusive diagnosis. Treatment options were discussed, included surgical resection. Transoral robot-assisted resection was performed without complications. Clearly the description of our case does not want to have a purpose in terms of indications but wants to describe the possibility of considering TORS in the case of benign tumours of the tongue base, especially in cases like this where a standard technique can difficulty be achieved. Current literature review was provided and discussed.

BACKGROUND: Head and Neck Sarcomas (HNSs) are rare malignant tumors derived from mesenchymal cells characterized by rapid growth, local aggressive behavior, and multiple re-lapses. The Rhabdomyosarcoma (RMS) and the Osteosarcoma (OS) are the more frequent HNS. The present study aims to evaluate the clinical impact of multimodal treatment in patients diagnosed with HNS. METHODS: A retrospective analysis of medical records from patients diagnosed with HNS multimodal treated, four groups were formed: a) surgery and chemotherapy (CTX); b) surgery, CTX, and RT; c) surgery and RT; d) CTX and RT exclusively. The overall survival (OSS), disease-free survival (DFS) and progression-free survival (PFS) rates were calculated using the Kaplan-Meier test. RESULTS: Among 39 patients, 23.1% were diagnosed with RMS , 66.7% with OS and 10.3% with other subtypes of HNS. Moreover, 59% showed initial clinical staging (T1/T2) and of those 35.9% were T1. Surgery was performed in 87.2% patients, RT in 35.9% and CTX in 84.7%. RT performed showed not statistically significant clinical role regarding OSS (p=0.74), DFS (p=0.09) and PFS (p=0.90) rates independent of histological subtype. Finally, OSS (p=0.89), DFS (p=0.13) and PFS (p=0.50) rates were not statistically different for patients treated with monotherapy or multimodal therapy. CONCLUSION: RT has not showed a clinically important role referred to improve OSS, DFS and PFS rates in patients with HNS, regardless of the histological subtype of the primary tumor. Multimodal treatment could influence in survival rates and locoregional control of the disease; however, longitudinal studies such as randomized clinical trials must be conducted.

The aim of this study was to measure the effects on 3D active cervical Range of Motion (ACROM) and perceived pain of a n elastic taping (ET) application in the cervical area. Thirty participants (n: 22M and 8F, age 35.4±4.4 years; body height 173.1±8.4 cm; body mass 73.5±12.8 kg) for the study group (SG) and twenty subjects (n: 11M and 9F, age 32.6±3.9 years; body height 174.9±10.9 cm; body mass 71.2±12.9 kg) for the control group (CG) were recruited. All subjects were symptomatic for neck and cervical pain in baseline condition. Each group performed on ACROM test and the perceived pain on neck basing as Numerical Rating Scale (NRS 0-10, a.u.): at the baseline (T0); after 20' from ET application (T1); after three days of wearing the ET application (T2). Between T0 and T1 an ET was applied on the cervical area of the SG participants. Statistical analysis did not show any significant change in CG in any measurement session for ACROM and neck pain parameters. Conversely, the SG showed significant improvements for ACROM rotation left (T0 64.8 ± 7.7° - T2 76.0 ± 11.1° p &lt; 0.000) and right (T0 66.0 ± 11.9° - T2 74.2 ± 9.6° p &lt; 0.000); lateral inclination left (T0 37.5 ± 6.9° - T2 40.6 ± 10.8° p &lt; 0.000) and right (T0 36.5 ± 7.9° - T2 40.9 ± 5.2° p &lt; 0.000); flexion posterior (T0 47.0 ± 12.9° - T2 55.1 ± 12.3° p &lt; 0.001) and anterior (T0 55.0 ± 3.6° - T2 62.9 ± 12.0° p &lt; 0.006). A significant decrease was measure also in SG for pain NRS between T0 and T2 (T0 7.5 ± 1.0° - T1 5.5 ± 1.4 - T2 1.4 ± 1.5° p &lt; 0.000). In conclusion, the results of this study underline the usefulness of a bilateral and symmetrical ET cervical application in terms to enhance multiplanar ACROM and to reduce subjective self-perceived cervical pain when it is needed. These findings can be applied for managing musculoskeletal health of different kind of individuals.

Oral mucositis (OM) is inflammation of the mouth caused by damage to the mucous membranes that line the mouth and throat. It is a side effect of cancer treatment, particularly in patients with head and neck squamous cell carcinoma (HNSCC) who undergo radiotherapy, chemotherapy, and/or immunotherapy with immune checkpoint inhibitors. The etiology and pathogenic mechanisms of OM is complex and multifaceted, involving cytotoxicity (cell death), inflammation, infection, change in microbiome, and immune-mediated cytotoxicity. We summarize the literature about attempts to use various omics methodologies (genomics, transcriptomics, microbiomics and metabolomics) to elucidate the biological pathways associated with the development or the severity of OM. Integrating different omics into multi-omics approaches carries the potential to discover links among host factors (genomics), host responses (transcriptomics, metabolomics), and local environment (microbiomics).

Background: Sinonasal squamous cell carcinoma (SNSCC) is rare in the general population. No clear and consistent etiologic correlation between human papillomavirus and SNSCC has yet been delineated in literature. p16 is a tumour suppressor protein used as a surrogate marker for HPV. This study aims to evaluate the relationship between p16 overexpression in SNSCC and its role in prognosis and survival. Methods: A population-based retrospective analysis was performed using prospectively collected data from the Northern Alberta Head and Neck Tumour Board, Alberta Cancer Registry, and Alberta Cancer Research Biobank. p16 overexpression was analyzed from pathologic sample of patients meeting study criteria, and participants were dichotomized by status. Subsequently, nonparametric analysis of demographics, initial staging, and initial treatment were performed, and a Kapan-Meier curve was developed to assess differences in survival. Results: 16 patients were included in analysis. p16 overexpression was seen in 68.8% of patients. p16 positive and negative groups were comparable for age, gender, smoking status, stage, and treatment. A statistically significant five-year survival advantage was observed in patients with p16 positive SNSCC (p = 0.013). Conclusions: This is the first Canadian study to demonstrate a high prevalence of p16 positivity in SNSCC and its presence denoting a statistically significant survival advantage. Results demonstrate a previously unconfirmed role of oncogenic HPV in SNSCC.

As neck and/or shoulder pain (NSP) frequently occur together with tension-type headache (TTH) and migraine, we explored how concomitant NSP affects perceived treatment responses to an analgesic. An anonymous survey was performed among 895 TTH and migraine sufferers who used the analgesic 400 mg ibuprofen/100 mg caffeine. NSP was relatively abundant among patients (42.4% for TTH; 39.2% for migraine), and associated with &gt;1 additional day with headache per month. Reported pain reduction was independent from NSP for TTH and migraine. More patients became pain-free at 2 h in migraine with NSP (42.9%) compared to migraine without NSP (32.2%), which is different from TTH with NSP (60.6%) and TTH without NSP (71.4%). For both, migraine and TTH, a recurrence of headache on the same day was more prevalent in those with concomitant NSP leading to a greater likelihood of taking a second dose of the analgesic. NSP frequently occurs together with TTH and migraine patients. In migraine, NSP seems to be associated with a better treatment response at 2 h. The more frequent recurrence of pain in those with concomitant NSP indicates that NSP makes both headache types worse. Further studies are needed to substantiate these effects.

Purpose: The aim of present study was to compare the treatment results of daily cisplatin (CDDP), weekly docetaxel (DOC) intra-arterial infusion chemotherapy combined with radiotherapy (DIACRT) regimen and weekly CDDP intra-arterial infusion chemotherapy combined with radiotherapy (WIACRT) for patients with tongue cancer. Materials and Methods: Between January 2007 and December 2016, a total of 11 patients treated with WIACRT and 45 patients treated with DIACRT were enrolled in present study. In DIACRT group, 25 patients had T2, 20 patients had T3. A total of 9 patients had T2 and 2 had T3 in WIACRT (p = NS). In DIACRT, the treatment schedule consisted of intra-arterial chemotherapy (DOC, total 60 mg/m²; CDDP, total 150 mg/m²) and daily concurrent radiotherapy (RT) (total, 60 Gy). In WIACRT, the treatment schedule consisted of intra-arterial chemotherapy (CDDP, total 360 mg/m²) and daily concurrent RT (total, 60 Gy). Results: The median follow-up periods for DIACRT and WIACRT were 61 and 66 months respectively. The 5-year local control (LC) and overall survival (OS) rate were 94.5% and 89.6% for DIACRT group, 60.6% and 63.6% for WIACRT group respectively. The LC rate and OS of DIACRT group were significantly higher than that of WIACRT group. As regards toxicities, no treatment-related deaths were observed during the follow-up periods both in two groups. Conclusions: DIACRT was found to be feasible and effective for patients with tongue cancer and could become a new treatment modality.

Multi-channel and multi-parameter near-infrared spectrometers (NIRS) have gradually become a new research direction and hot spot due to their ability to provide real-time, continuous, comprehensive indicators of multiple parameters. However, multi-channel and multi-parameter detection may lead to crosstalk between signals. There is still a lack of benchmarks on the evaluation of reliability, sensitivity, stability and response consistency of the NIRS instrument. In this study, a set of test methods (the ink drop test, multi-channel crosstalk test and multi-parameter crosstalk test) for analysis crosstalk and verifying the reliability of NIRS were conducted to test experimental verification on a multi-channel (8-channel), multi-parameter (4-parameter) NIRS instrument independently developed by our team. Results show that these tests can be used to analyze the signal crosstalk and verify the reliability, sensitivity, stability and response consistency in the NIRS instrument. This study contributes to the establishment of benchmarks for the NIRS instrument crosstalk and reliability testing. These novel tests have the potential to become the benchmark for the NIRS instrument reliability testing.

Although there are several access control systems in the literature for flexible policy management in multi-authority and multi-domain environments, achieving interoperability &amp; scalability, without relying on strong trust assumptions, is still an open challenge. We present HMBAC, a distributed fine-grained access control model for shared and dynamic multi-authority and multi-domain environments, along with Janus, a practical system for HMBAC policy enforcement. The proposed HMBAC model supports: (a) dynamic trust management between different authorities; (b) flexible access control policy enforcement, defined at domain and cross-domain level; (c) a global source of truth for all entities, supported by an immutable, audit-friendly mechanism. Janus implements the HMBAC model and relies on the effective fusion of two core components. First, a Hierarchical Multi-Blockchain architecture that acts as a single access point that cannot be bypassed by users or authorities. Second, a Multi-Authority Attribute Based Encryption protocol that supports flexible shared multi-owner encryption, where attribute keys from different authorities are combined to decrypt data distributedly stored in different authorities. Our approach was implemented using Hyperledger Fabric as the underlying blockchain, with the system components placed in Kubernetes Docker container pods. We experimentally validated the effectiveness and efficiency of Janus, while fully reproducible artifacts of both our implementation and our measurements are provided.

Previously, pseudomyogenic hemangioendothelioma (PMHE) is regarded as epithelioid sarcoma-like hemangioendothelioma due to significant histologic overlapping and diffuse cytokeratin expression since the first description in 1992. After considerable controversy and long-term debating, it is currently defined as a distinct intermediate malignant, rarely metastasizing neoplasm with vascular/endothelial differentiation in nature. PMHE is characterized by young age (typically < 40 years old) and extremity location (approximately ~80%) with t(7:19) SERPINE1-FOSB fusion as the most common molecular alteration. Here we reported a 59-year-old male presenting with multifocal lesions, including right temporalis muscle, right frontoparietal calvarium, right pterygoid muscles, and right mandibular condyle. Histologic examination of the lesion from right temporal mass revealed a multinodular biphasic lesion composed of sheets and fascicles of elongated spindle cells, and epithelioid small round to ovoid cells infiltrating into the adjacent skeletal muscle admixed with abundant neutrophilic infiltration. No rhabdomyoblast-like cells, prominent nuclear pleomorphism and mitosis were identified. IHC staining showed that the tumor cells were diffusely and strongly positive for FOSB, pan-cytokerain (AE1/AE3), CD31, ERG, and molecular testing further demonstrated a t(9:19) EGFL7::FOSB fusion mRNA. This constellation of morphological, IHC and molecular findings was consistent with the diagnosis of PMHE. This is the first reported case of multiple PMHEs with EGFL7::FOSB fusion in a patient aged more than 50 years old in the head and neck area. Since the vast majority of the differential diagnoses of PMHE are high-grade malignancies with aggressive clinical behavior and PMHE is rarely reported in the head and neck region, awareness of this tumor will avoid misdiagnosis and over-treatments of this entity.

Taxanes, particularly docetaxel (DTX), has been widely used for combination therapy of head and neck squamous cell carcinoma (HNSCC). For locally advanced unresectable HNSCC, DTX combined with cisplatin and 5-fluorouracil as a revolutionary treatment revealed an advantage in improvement of patient outcome. In addition. DTX plus immune check inhibitors (ICIs) showed low toxicity and increased response of patients with recurrent or metastatic HNSCC (R/M HNSCC). Accumulating data indicate that taxanes not only function as antimitotics but also impair diverse oncogenic signalings including angiogenesis, inflammatory response, ROS production, and apoptosis induction. However, despite an initial response, development of resistance remains a major obstacle to treatment response. Taxane resistance could result from intrinsic mechanisms such as enhanced DNA/RNA damage repair, increased drug efflux, and apoptosis inhibition, and extrinsic effects such as angiogenesis and interactions between tumor cells and immune cells. This review provides an overview of taxanes therapy applied in different stages of HNSCC and describe the mechanisms of taxane resistance in HNSCC. Through a detailed understanding the mechanisms of resistance may help developing the potential therapeutic methods and the effective combination strategies to overcome drug resistance.

This study aimed to investigate the influence of cranio-cervical position on the electromyographical activity of the core muscles during the prone plank exercise. Twenty healthy participants were enrolled in this study. Muscle activation was registered using surface electromyography (sEMG) in the rectus abdominis (RA), external oblique (EO), internal oblique (IO) and lumbar portion of erector spinae (LES). Three prone plank conditions were randomly evaluated, varying the position of the cranio-cervical segment during the prone plank performance (NEUTRAL, FLEXION and EXTENSION). sEMG signals of each individual muscle, Total Intensity (TI) and ratings of perceived exertion (RPE) were analysed with statistical significance set at P&lt;0.05. FLEXION revealed significantly higher TI values compared to NEUTRAL and EXTENSION (p = 0.000; effect size (ES) &gt; 0.90). The RA presented larger activation in FLEXION compared to the other variations (p &lt; 0.05; ES &gt;0.70). FLEXION elicited a greater response compared to NEUTRAL for both sides of EO when compared to EXTENSION, and also for both sides of IO compared to the other conditions. Both FLEXION and EXTENSION reported higher RPE values compared to NEUTRAL. Cranio-cervical segment position influenced the electromyographical activation of core musculature, showing highest values when performing prone plank in a cranio-cervical flexion.

Head and neck squamous cell carcinoma (HNSCC) takes the sixth place among the most common cancers in the world. Abnormal methylation can be one of the reasons for this cancer. The aim of this study was to investigate the DNA promotor methylation status of cancer-associated genes (ATM, APC, CDO1, RB1, TP53, WIF1) in patients with HNSCC. Bisulfite Conversion and Methylation-Sensitive High-Resolution Melting was used for analysis of the DNA methylation level of normal and tumor tissues in 44 patients. There were significant differences in DNA methylation level between patient’s tumor and normal tissues for CDO1 and WIF1 genes in all subjects and subgroups (p<0.05). In T3 subgroup there was significant correlation between CDO1 gene methylation and age in the normal tissue. The same correlation was detected also for the WIF1 gene methylation in tumor tissue samples in the subgroup with T3 and in normal tissue samples in the subgroup with T4 (p<0,05). In all genes no significant differences were found between the subgroups (T2, T3, T4 stage, primary/recurrent lesion, non-keratinizing/keratinizing SCC, age before/ after 50, smokers/non-smokers) of the patients. Thus, changes in the expression of the CDO1 and WIF1 genes can affect mechanisms of the occurrence and development of HNSCC.

Introduction: The identification of some prognostic markers in head and neck cancers (HNC) is necessary for the stratification of the therapeutic approach with benefits in increasing treatment response rates and limiting the toxic side effects of treatments. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and pallets-to-lymphocyte ratio (PLR) are currently validated as cheap and accessible biomarkers in different types of solid tumors. The purpose of the study was to evaluate the possible biomarker value of NLR, PLR and MLR recorded pre-treatment (radiotherapy/chemotherapy) for prognostic purposes in HNC. Materials and methods: The study included 190 patients with HNC included in the oncology record in the oncology outpatient clinic of the Craiova County Emergency Hospital starting from January 2002 and deceased until December 2022. Among them, 40 patients treated multimodally in the Clinic were included in the study of Oncology of the Craiova County Emergency Hospital for which the pre-treatment value (chemotherapy/radiotherapy) of NLR, PLR and MLR could be calculated. Overall survival (OS) values were correlated with NLR, PLR and MLR. Results: Median values for NLR, PLR and MLR were 6.15 (1.24-69), 200.79 (61.3- 1775.0) and 0.53 (0.12-5.5) respectively. In the study, the mean values for NLR, PLR and MLR of 2.88, 142.97 and 0.36 respectively were obtained. Median OS in the study group was 11 months (1-120). Although a negative Pearson`s correlation, the relationship between your variables was only weak, values R =.07, p=.67; R=.02, p=.31 and R=07, p=.62 being related with NLR, PLR and MLR respectively correlation with overall survival (OS). The median values of NLR, PLR and MLR were calculated (1.53, 90.32 and 0.18 respectively) for HNC cases with pre-treatment values of NLR <2 and for HNC cases with NLR values ≥6 (23.5, 232.78 and 0.79 respectively). Median OS for cases with NLR<2 and NLR≥6 were 17.4 and 13 months, respectively. Conclusions: The negative correlations of NLR, PLR and MLR with OS reported in the study are in accordance with the data reported in the literature for locally advanced recurrent and metastatic HNSCC cases. The comparative analysis of the data in the group with NLR<2 and NLR≥6 highlights an advantage of 4.4 months in median OS in favor of the group with low values of NLR. Being cheap and accessible, these markers could change the therapeutic approach even in centers with limited resources. The role of borderline NLR values as a prognostic factor in HNSCC must also be defined. PLR and MLR are less evaluated as biomarkers but the study demonstrates their potential to be used as prognostic biomarkers, it remains to be clarified if their inclusion in multivariable models along with NLR would bring a benefit

Head and neck squamous cell carcinoma (HNSCC) is a type of cancer that arises from the epithelium lining of the oral cavity, hypopharynx, oropharynx, and larynx. Despite advancement of the current treatment to HNSCC, such as surgery, chemotherapy, and radiotherapy, the overall survival rate of HNSCC remains poor due to late diagnosis and acquired resistance to treatment. Natural products have been extensively explored as a safer and more acceptable alternative to current treatments, with numerous studies displaying their potential against HNSCC. This review highlights preclinical studies in the past 5 years involving natural products against HNSCC and explores the signalling pathways altered by these products. This review also addresses challenges and future directions of the use of natural products as chemotherapeutic and chemoprevention agents against HNSCC.

.Purpose: This paper presents a comparative analysis of state-of-the-art DIR algorithms in the context of head and neck squamous cell carcinoma (HNSCC) radiation therapy. Materials and Methods: We used a dataset of head and neck cancer patients within the Cancer Image Archive, which includes 31 patients with 3D CT image data from pre-treatment, mid-treatment, and post-treatment stages of radiotherapy. We applied DIR algorithms to two datasets, one for pre-treatment to mid-treatment registration and another for mid-treatment to post-treatment registration, by aligning one CT image to another CT image. To quantitatively analyze the patient data, we focused on the spinal cord, optic nerve, brain stem, cochlea, and PTV as the OAR datasets. To verify the DIR algorithm, we used two non-learning-based methods, SyN and NiftyReg, as well as three deep learning-based methods, Voxelmorph, Cyclemorph, and Transmorph. We trained a deep learning model by adjusting the ratio of the training dataset, validation dataset, and test dataset to 7:1:2. Results: The average DSCs of SyN and NiftyReg, the non-learning-based methods, were 0.74±0.06 and 0.70±0.12, respectively. The deep learning-based methods, Voxelmorph, Cyclemorph, and Transmorph, had average DSCs of 0.72±0.08, 0.68±0.11, and 0.69±0.13, respectively. The deep learning DIR algorithm produced transformed outputs of OAR/PTV in a shorter time than other models, including commercial and conventional mathematical algorithms (At Inference(sec/images), Voxelmorph: 0.36, Cyclemorph: 0.3, Transmorph: 5.1, SyN: 140, NiftyReg: 40.2). Conclusions: In conclusion, our study provides a comprehensive comparison of commercial DIR algorithms with traditional and deep learning-based DIR methods. Our results demonstrate that commercial DIR algorithms outperform traditional DIR methods in terms of accuracy and efficiency. However, we also show that deep learning-based DIR methods have the potential to achieve similar performance to commercial algorithms with proper training and optimization. Our findings suggest that both commercial and deep learning-based DIR methods have their respective advantages and limitations, and the choice of method should depend on the specific requirements of the clinical application. Overall, our study contributes to ongoing efforts to improve the accuracy and efficiency of DIR methods for better patient outcomes.

Objective: To investigate postacute laryngeal injuries and dysfunctions (PLID) in coronavirus disease 2019 (COVID-19) patients. Methods: Three independent investigators performed a systematic review of the current literature studying PLID in patients with a history of COVID-19. The review was performed according to PRISMA Statement. Epidemiological, clinical, hospitalization features, laryngeal diseases and voice outcomes were extracted from the included papers. Results: Eight papers met our inclusion criteria (393 patients) corresponding to 5 uncontrolled prospective and 3 retrospective studies. The most prevalent PLID were vocal fold dysmotility (65%), vocal fold edema (35%), laryngopharyngeal reflux (21%), and muscle tension dysphonia (21%). Posterior glottic stenosis (12%), granuloma (14%), and posterior glottic diastasis (12%) were the most common injuries. Most patients with PLID were obese and had a history of intensive care unit hospitalization, and orotracheal intubation. The delay between the discharge and the laryngology office consultation ranged from 51 to 122 days. The mean duration of intubation ranged from 10 to 34 days. Seventy-eight (49%) intubated patients were in prone position. The proportion of patients requiring surgical treatment ranged from 39% to 70% (mean=48%). There was an important heterogeneity between studies about inclusion, exclusion criteria and outcomes. Conclusion: COVID-19 appeared to be associated with PLID, especially in patients with a history of intubation. However, future controlled studies are needed to evaluate if intubated COVID-19 patients reported more frequently PLID than patients who were intubated for other conditions.

Understanding neck pain is an important societal issue. Kinematic data from sensors may help to gain insight on the pathophysiological mechanisms associated with neck pain through a quantitative sensorimotor assessment of one patient. The objective of this study was to evaluate the potential usefulness of artificial intelligence with several Machine Learning (ML) algorithms in assessing neck sensorimotor performance. Angular velocity and acceleration measured by an inertial sensor placed on the forehead during the DidRen laser test in thirty-eight acute and subacute non-specific neck pain (ANSP) patients were compared to forty-two healthy control participants (HCP). Seven supervised ML algorithms were chosen for the predictions. The most informative kinematic features were computed using Sequential Feature Selection methods. The best performing algorithm is the Linear Support Vector Machine with an accuracy of 82% and Area Under Curve of 84%. The best discriminative kinematic feature between ANSP patients and HCP is the first quartile of head pitch angular velocity. This study has shown that supervised ML algorithms could be used to classify ANSP patients and identify discriminatory kinematic features potentially useful for the clinicians in the assessment and monitoring of the neck sensorimotor performance in ANSP patients.

The problem of drug resistance in terms of antifungal therapy, unknown until a few years ago, is assuming increasing importance. Particularly in immunosuppressed patients and subject to chemotherapy and radiotherapy. In the last years the use of essential oils as approach to improving the effectiveness of antifungal agents and reducing the antibiotic resistant has been proposed. Our research aimed to evaluate the antifungal activity of Colombian essential oil of Ruta graveolens (REO) against clinical strains of Candida albicans, Candida parapsilopsis, C. glabrata and Candida tropicalis. The data obtained showed that Candida tropicalis and Candida albicans were most sensible strains showing minimum inhibitory concentrations (MIC) of 0.5 and 1.0 µg/ml of REO. The Time Kill Kinetics assay demonstrated that REO showed fungicide effect against C. tropicalis and fungistatic effect against C. albicans. In addition, the 40% of the biofilm formed by C. albicans was eradicated using 1% of REO after 1 hour of exposure.

Fanconi anemia (FA) patients have an exacerbated risk of head and neck squamous cell carcinoma (HNSCC). Treatment is challenging as FA patients display enhanced toxicity to standard treatments, including radio/chemotherapy. Therefore better therapies as well as new disease models are urgently needed. We have used CRISPR/Cas9 editing tools in order to interrupt the human FANCA gene by the generation of insertions/deletions (indels) in exon 4 in two cancer cell lines from sporadic HNSCC having no mutation in FA-genes: CAL27 and CAL33 cells. Our approach allowed efficient editing, subsequent purification of single-cell clones, and Sanger sequencing validation at the edited locus. Clones having frameshift indels in homozygosis did not express FANCA protein and were selected for further analysis. When compared with parental CAL27 and CAL33, FANCA-mutant cell clones displayed a FA-phenotype as they i) are highly sensitive to DNA interstrand crosslink (ICL) agents such as mitomycin C (MMC) or cisplatin, ii) do not monoubiquitinate FANCD2 upon MMC treatment and therefore iii) do not form FANCD2 nuclear foci, and iv) they display increased chromosome fragility and G2 arrest after diepoxybutane (DEB) treatment. These FANCA-mutant clones display similar growth rates as their parental cells. Interestingly, mutant cells acquire phenotypes associated with more aggressive disease, such as increased migration in wound healing assays. Therefore, CAL27 and CAL33 cells with FANCA mutations are phenocopies of FA-HNSCC cells.

Patient derived model systems are important tools for studying novel anti-cancer therapies. Patient derived xenografts (PDXs) have gained favor over the last 10 years as newer mouse strains have improved the success rate of establishing PDXs from patient biopsies. PDXs can be engrafted from head and neck cancer (HNC) samples across a wide range of cancer stages, retain the genetic features of their human source, and can be treated with both chemotherapy and radiation, allowing for clinically relevant studies. Not only do PDXs allow for study of patient tissues in an in vivo model, they can also provide a renewable source of cancer cells for organoid cultures. Herein, we review the uses of HNC patient derived models for radiation research including approaches to establishing both orthotopic and heterotopic PDXs, approaches and potential pitfalls to delivering chemotherapy and radiation to these animal models, biological advantages and limitations, and alternatives to animal studies that still use patient-derived tissues.

EZH2 overexpression is associated with tumor proliferation, metastasis, and poor prognosis. Targeting and inhibiting EZH2 may be an effective therapeutic strategy for head and neck squamous cell carcinoma (HNSCC). We previously analyzed EZH2 mRNA expression in a well-characterized dataset of 230 (110 original and 120 validation cohorts) human head and neck cancer samples. This study aimed to investigate the effects of inhibiting EZH2, either via RNA interference or via pharmacotherapy, on HNSCC growth. EZH2 upregulation was significantly correlated with recurrence (P < 0.001) and the methylation index of tumor suppressor genes (P < 0.05). DNMT3A was significantly upregulated upon EZH2 upregulation (P = 0.043). Univariate analysis revealed that EZH2 upregulation was associated with poor disease-free survival (log-rank test, P < 0.001). In multivariate analysis, EZH2 upregulation was evaluated as a significant independent prognostic factor of disease-free survival (hazard ratio: 2.085, 95% confidence interval: 1.390–3.127; P < 0.001). Cells treated with RNA interference and DZNep, an EZH2 inhibitor, showed the most dramatic changes in expression, accompanied with a reduction in the growth and survival of FaDu cells. These findings suggest that EZH2 upregulation is correlated with tumor aggressiveness and adverse patient outcomes in HNSCC. Evaluation of EZH2 expression might help predict the prognosis of HNSCC patients.

The most common type of head and neck cancer (HNC) is head and neck squamous cell carcinoma (HNSCC). It describes a heterogenous neoplastic disease that arises from the mucosal epithelium of the of the upper respiratory system and the gastrointestinal tract. It is characterized by high morbidity and mortality, being is the eighth most common cancer worldwide, with 931,931 newly diagnosed cases and 467,125 deaths according to the latest Global Cancer Statistics (GLOBOCAN) data. Despite the use of modern low-invasive surgical techniques and application of promising new chemoradiotherapies or combination treatment, the frequency of recurrences and the five-year survival of these patients remains unsatisfactory. The microenvironment of head and neck cancer comprises various cells that regulate neoplastic expansion. It is believed that the mesenchymal stromal cells (MSCs) present in the tumour milieu play a key role in the modulation of tumour initiation, development and progression, in the regulation of cancer treatment response, survival rates, patient outcomes and long-term prognosis; they also influence the resistance to cisplatin-based chemotherapy, the gold standard for advanced HNSCC. MSCs, are multipotent, heterogeneous, mobile cells, which meet specific stemness criteria defined by the International Society for Cellular Therapy (ISCT). Although no MSC-specific markers exist, they can be recognized based on several others, such as CD73, CD90 and CD105, while lacking the presence of CD45, CD34, CD14 or CD11b, CD79α, or CD19 and HLA-DR antigens; they share phenotypic similarity with stromal cells and their capacity to differentiate into other cell types. In the tumour niche, MSC populations are characterized by cell quiescence, self-renewal capacity, low reactive oxygen species production and the acquisition of epithelial-to-mesenchymal transition properties, they may play a key role in the process of acquiring drug resistance, and thus treatment failure. MSCs must also demonstrate plastic adherence in vitro and be able to differentiate into specific mesodermal cell types after stimulation i.e., adipocytes, chondrocytes, and osteoblasts when cultured under well-defined conditions. The present narrative review examines the links between mesenchymal stromal/stem cells and HNC, as well as the different mechanisms involved in the development of resistance to current chemo- and radiotherapies in HNSCC. It provides an overview of the current literature, including key opinion-forming systematic reviews, as well as cross-sectional, longitudinal, prospective and interventional studies based on cell culture models in vitro, animal or in vivo models of HNSCC; it also examines the possibilities of pharmacological targeting of stemness-related chemoresistance in HNSCC. It describes promising new strategies to optimize chemoradiotherapy with the potential to personalize patient treatment approaches, and highlights future therapeutic perspectives in HNC. The data concerning tumour-associated MSCs is arranged according to increasing clinical credibility.

The oral microbiome, studied by sampling the saliva or oral rinse, has been long thought to have diagnostic capacity for head and neck cancers (HNC). However, previous reports on the HNC oral microbiome provide inconsistent results. The aim of this study is to consolidate these datasets and determine the oral microbial composition between HNC patients to healthy and premalignant individuals. We analyzed 16 published head and neck cancer (HNC) short-read 16S rRNA sequencing datasets, specifically targeting the V3V4, V4 and V4V5 regions. These datasets included saliva and oral rinse samples from donors with HNC, as well as from healthy and premalignant donors. Differences in diversities and microbial abundance were determined. HNC saliva displayed lower alpha diversity than healthy donors. In contrast, the opposite trend was observed for oral rinse samples. Beta diversity were largely similar across different patient types. Similar oral phyla were detected for all samples, but proportions were largely dependent on sample type (i.e. saliva or oral rinse) and primer set utilised for 16S rRNA sequencing. Neisseria, Leptotrichia and Megasphaera were elevated in healthy saliva, while Mycoplasma was elevated in HNC saliva. Oral rinse and saliva displayed similar enrichment for Fusobacterium, while Veillonella, Alloprevotella, and Campylobacter had conflicting results. The sparse partial least squares discriminant analysis model performed effectively in discriminating HNC from healthy or premalignant patients using V3V4 saliva (AUC = 0.888), and V3V4 oral rinse (AUC = 0.928), while poor discriminative capacity was observed for V4 saliva (AUC = 0.688). In conclusion, our meta-analysis highlighted the limitations of 16S rRNA sequencing, particularly due to variations across study batches, primer sets (i.e. V3V4, V4), and sample types. Hence, caution should be exercised when interpreting 16S rRNA sequencing results across studies, especially when different primer sets and sample types are used.

The External Occipital Protuberance (EOP) is a notable anatomical landmark connected to neck musculature. With the rise of tech neck syndrome due to prolonged smartphone use, concerns have emerged regarding its influence on EOP morphology. This study compares EEOP characteristics in contemporary individuals (aged 18-30 years) from Abruzzo with ancient skulls from the Opi necropolis (VII-Vth century BC) Methods: Four null hypotheses were tested concerning EEOP prevalence and severity: (1) no gender differences, (2) no differences between modern and ancient populations, (3) no gender-based variations in severity, and (4) no temporal differences in severity. Statistical analyses were conducted to assess the significance of these hypotheses. Results: The study found a higher prevalence of EEOP in modern individuals compared to ancient populations, with no significant gender differences in prevalence. However, severity of EEOP showed significant variation by gender and historical period, with modern individuals exhibiting greater severity. Conclusions: The observed increase in EEOP prevalence and severity in modern populations suggests a potential influence of tech neck posture associated with increased screen time. These findings underscore the need for further research into the effects of contemporary lifestyle factors on cranial morphology.

Purpose: Early glottic cancer is a highly curable malignancy. Disease control is achieved by resec-tion or external beam radiation with similar long-term results according survival. Surgery is predominantly performed by transoral endoscopic approach, due to reduced complication rates when compared to open cordectomy. Open cordectomy might still be warranted in cases of inad-equate surgical accessibility. Aim of the present study was to compare endoscopic versus open approach in relation to complications and outcome in an up-to-date patient group. Methods: 219 patients underwent primary tumor resection in early glottic cancer (UICC stages I-II). 168 opera-tions were performed endoscopically, 51 operations were open transcervical cordectomies. We compared survival data with non-parametric methods and functional outcome according to need of tracheostomy, feeding tube and voice functional outcome following ELS protocol. Results: There were no significant differences in overall survival (OS). 2 years OS after endoscopic surgery was 90.5% vs 95.3% after transcervical resection. As expected, OS in T1b and T2 tumors was worse than in T1a tumors. We found a statistically significant difference in disease free survival (DFS) within the T1a and T1b/T2 group (Log rank test: p=0.006) but no relevant difference be-tween the two surgical modalities, even when the data was stratified by T-categories performing a Cox regression (hazard ratio 1.21, p=0.712). Patients who underwent open surgery had a sig-nificantly worse peri- and postoperative course with longer hospital stay, higher frequency of tracheotomies and longer need for nasogastric tubes. Functional results were comparable within the two patient groups while higher tumor size / stage was an unfavorable predictor for voice re-habilitation. Conclusion: Open cordectomy leads to more complications but offers comparable oncological and functional outcome when compared to transoral endoscopic approach in early glottic cancer. Open surgery therefore continues to be a valid treatment option when endoscopic resection is not possible.

Background: Previous investigations have found a correlation between abnormal curvatures and a variety of patient complaints such as cervical pain and disability. However, no study has shown that loss of the cervical curve is a direct result of exposure to a motor vehicle collision (MVC). This investigation presents a retrospective consecutive case series of patients with both a pre-injury cervical lateral radiograph (CLR) and a post-injury CLR after exposure to a MVC. Computer analysis of digitized vertebral body corners on CLRs was performed to investigate the possible alterations in the geometric alignment of the sagittal cervical curve. Methods: Three spine clinic records were reviewed, over a 2-year period, looking for patients where both an initial lateral cervical x-ray and an examination were performed prior to the patient being exposed to a MVC; afterwards an additional exam and radiographic analysis were required. A total of 41 patients met the inclusion criteria. Examination records of pain intensity on numerical pain rating scores (NPRS) and neck disability index (NDI), if available, were analyzed. The CLRs were digitized and modeled in the sagittal plane using curve fitting and the least squares error approach. Radiographic variables included total cervical curve (ARA C2-C7), Chamberlain’s line to horizontal (skull flexion), horizontal translation of C2 relative to C7, segmental translations (retrolisthesis and anterolisthesis), and circular modelling radii. Results: There were 15 males and 26 females with an age range of 8-65 years. Most participants were drivers (28) involved in rear end impacts (30). The pre-injury NPRS was 2.7 while the post injury was 5.0; p &lt; 0.001. The NDI was available on 24 /41 (58.5%) patients and was found to increase following exposure to the MVC: 15.7% to 32.8%, p &lt; 0.001. An altered cervical curvature was identified following exposure to MVC, characterized by an increase in radius of curvature and an approximate 8° reduction of lordosis from C2-C7; p &lt; 0.001. The mid cervical spine (C3-C5) showed the greatest curve reduction with localized mild kyphosis at these levels on average. Several participants developed segmental translations that approached the instability value of translation &gt; 3.5mm. Conclusions: Abnormalities of cervical lordosis occurred following exposure to a MVC. The average loss of cervical curvature was 8° from C2-C7, with mild flexion of the mid cervical segments. Snap through type or dynamic buckling during the MVC may explain our findings. The primary contribution of this study to the motor vehicle collision literature is that altered cervical lordosis may result from MVC exposures and the consequences of an altered cervical alignment, in turn, may lead to future pain, disability and decreased health-related quality of life.

This is a retrospective chart review of outcomes of maxillofacial microvascular free flap reconstructions in pediatric and adolescent patients. A single head and neck surgical team performed all the included 136 procedures. Demographic and surgical patient data were recorded. Type of transfer performed in each recipient site and major complications were analyzed. Relevant influencing factors, such as age, gender and etiology of defect were determined using the ANOVA test and χ² test of independence. Results indicate a 90% success rate. No significant relation was found between the incidence of total flap loss and patient age, etiology or graft source. The maxillary reconstructions showed a higher incidence of total flap loss compared to mandibular ones (11 vs. 3 cases). Despite the high success rate, the findings underline the necessity for further research to validate these observations and enhance surgical methods for pediatric and adolescent patients.

Introduction: Obstructive sleep apnea (OSA) is not only common in the general population but even more so in patients with tumors of the head and neck region. Untreated, it leads to reduced quality of life, increased daytime sleepiness, and other comorbidities. The aim of this study was to determine the difference in the occurrence of OSA in the patient population with head and neck tumors compared to the general population as represented by the Trend cohort of the Study of Health in Pomerania (SHIP) , and to assess the influence of tumor treatment. Methods: Between July 2018 and December 2021, preoperative polysomnography was conducted in 47 patients with histologically confirmed squamous cell carcinoma in the oropharynx, hypo-pharynx, or larynx. A follow-up polysomnography was performed in 23 patients 2-11 months af-ter completing treatment. The collected data was correlated with tumor treatment and tumor size. Results: Of the included patients, 43 were male and four were female. Age ranged from 54 to 90 years. The pretherapeutic measurement found no significant difference in the prevalence of a pathologically elevated apnea-hypopnea index (AHI) in our patients compared to the SHIP-Trend cohort. In the follow-up measurement after treatment completion, a significant deterioration in AHI was observed. Initially, 70 % of patients had an AHI > 5, after therapy this increased to 87 %. The effect was particularly pronounced in the group of patients with advanced tumor stages who had received primary chemoradiation. Conclusion: OSA is a relevant condition in patients with head and neck cancer. Tumor treatment can lead to an increased occurrence of sleep-related breathing disorders, especially in patients with advanced tumor stages undergoing primary chemoradiation. Additional studies are neces-sary to better understand the exact mechanism involved.

Background: Approximately 75% of all head and neck cancer patients are treated with radiotherapy (RT). RT to the oral cavity results in acute and late adverse events which can be severe and detrimental to a patient’s quality of life and function. The purpose of this study was to explore associations between RT dose to a defined oral cavity organ at risk (OAR) avoidance structure, provider and patient reported outcomes (PROs), opioid use, and hospitalization. Methods: This was a retrospective analysis of prospectively obtained outcomes using multivariable modeling. The study included 196 patients treated with RT involving the oral cavity for a head and neck tumor. A defined oral cavity OAR avoidance structure was used in all patients for RT treatment planning. Validated PROs were collected prospectively. Opioid use and hospitalization were abstracted electronically from medical records. Results: Multivariable modeling revealed the mean dose to the oral cavity OAR was significantly associated with opioid use (p=0.0082) and hospitalization (p=0.0356) during and within 30 days of completing RT. Conclusion: The findings of this study may be valuable in RT treatment planning for patients with tumors of the head and neck region to reduce the need for opioid use and hospitalization during treatment.

(1) Background: P-cadherin (CDH3) is a transmembrane protein that plays a crucial role in maintaining the structural integrity of epithelial tissue and homeostasis. Its role in carcinogenesis remains a subject of debate, as its behavior can vary depending on the molecular context and the specific tumor cell model under study. In this study, we explored the role of P-cadherin in head and neck squamous cell carcinoma (HNSCC) and the mechanism underlying its function. (2) Methods: We analyzed P-cadherin expression in HNSCC patients using The Cancer Genome Atlas (TCGA) database. For in vitro functional analysis, we conducted proliferation, migration, invasion, and western blot assays after either suppressing or overexpressing P-cadherin. For in vivo functional analysis, we utilized mouse xenograft models. (3) Results: P-cadherin was significantly overex-pressed in tumor samples compared to normal samples in the TCGA-HNSCC cohort. P-cadherin knockdown resulted in decreased proliferation, migration, and invasion compared to control cells, while P-cadherin overexpression increased cell proliferation and migration in HNSCC cells. We discovered that c-Met functioned as an upstream regulator of P-cadherin. Surprisingly, we found that P-cadherin knockdown increased the phosphorylation of c-Met and STAT3. Combining P-cadherin siRNA with the c-Met inhibitor SU11274 resulted in a more effective reduction in HNSCC cell growth, both in vitro and in vivo, compared to either treatment alone. (4) Conclusions: Our study uncovered a previously unknown aspect of P-cadherin-mediated c-Met regulation. The enhanced activation of c-Met/STAT3 following P-cadherin inhibition could be responsible for the survival of resistant tumor cells. Therefore, dual inhibition of P-cadherin and c-Met may be a potentially effective approach for treating HNSCC.

Introduction and objectives Obstructive sleep apnea (OSA) is defined as a cause of daytime sleepiness, as well as a clinical manifestation of sleep-disordered breathing. In the literature, there are numerous controversial studies regarding the etiology of this condition, but it is universally accepted that a significant role in its onset is played by the reduced activity of the upper airway muscles. Additionally, OSA has been associated with a series of comorbidities, such as type II diabetes, metabolic syndrome, cardiovascular and pulmonary conditions, as well as head and neck tumors, especially oropharyngeal and laryngeal tumors. The purpose of this review is to examine and demonstrate the prevalence of OSA in patients with associated pathologies, especially in patients with head and neck tumors, as well as the role of surgical and non-surgical therapeutic methods in improving the quality of life. Material and methods Taking into consideration the stated objective, a systematic analysis of the available literature was conducted, encompassing PubMed, Medline and Scopus databases. The evaluation was based on several keywords, including head and neck cancer, diabetes, diabetic, overlap syndrome, cardiovascular conditions, laryngeal neoplasm, radiotherapy, chemotherapy, as well as the concept of quality of life in laryngectomized patients and patients with OSA. Results Our results demonstrate the involvement of OSA in the presence of comorbidities and also, an increased incidence of OSA in patients with laryngeal cancer. It is important to note that surgical and post-surgical treatment can play a significant role in triggering OSA in these patients. Conclusions The clinician must recognize the increased prevalence of OSA in patients with head and neck cancer, as well as the coexistence of OSA with certain comorbidities. They should actively engage in early diagnosis and establish optimal treatment methods to improve the quality of life for patients with associated conditions such as head and neck tumors or cardiovascular pathology.

The metastatic disease is a complex and sequential process that involves the migration of tumor cells from the primary site to distant areas. This metastatic pathway is not always predictable. Therefore, this paper presents three rare cases of unusual metastases, due to their primary site: two metastases of a clear cell renal cell carcinoma, one gingival and one nasal, as well as a mandibular metastasis of a hepatocellular carcinoma. In all cases, an incisional biopsy was performed in order to sign out the diagnosis. After microscopical examination of morphological Hematoxylin and Eosin stained slides, for all cases, immunohistochemical reactions were performed to support the primary tumor site. Two cases had a previous histopathological diagnosis of a primary tumor, while for the third case, the metastatic lesion represented the first manifestation of the neoplastic disease, with an unfavorable prognosis.

The study of notable people as agents for increasing cancer awareness started just in the last decades of the 20th century. This study aimed to identify Pan-American notable people with head and neck cancer (HNC) and to assess HNC’s professional perspective on communicating stories of notable patients with HNC to promote prevention. Methods: This cross-sectional study was conducted by applying a RedCap questionnaire to oral medicinists, oral pathologists, head and neck surgeons, and clinical oncologists with experience in HNC research, education, or treatment in Pan-American countries. Additionally, a structured search was performed on PubMed, Scopus, EMBASE, Web of Science, LILACS, and gray literature Results: We identified 42 notable people from the United States, Brazil, Argentina, Mexico, El Salvador, Chile, Colombia, and Peru who were mainly actors, athletes, and musicians. Participants agreed that stories of notable patients with HNC can positively impact the population and promote prevention if communicated by the internet, social media, and television. Conclusion: In the Pan-American region, notable individuals who have suffered from HNC may be powerful advocates for increasing cancer awareness and promoting prevention strategies. The professionals involved in the study expressed a positive inclination towards using the stories of these notable HNC survivors as an effective prevention strategy.

Head and neck squamous cell carcinoma (HNSCC) arise from the mucosal epithelium in the oral cavity, pharynx, sino-nasal region, and larynx. Laryngeal squamous cell carcinoma (LSCC) represents one-third of all head and neck cancers. Dysregulated RNA-related pathways define an important molecular signature in this aggressive carcinoma. The Survival Motor Neuron (SMN) protein regulates fundamental aspects of the RNA metabolism but, curiously, its role in cancer is virtually unknown. For the first time, here we focus on SMN in cancer context. We conducted a pilot study in a total of 20 patients with LSCC where SMN was found overexpressed at both the protein and transcript levels. By a cellular model of human laryngeal carcinoma, we demonstrated that SMN impacts cancer-relevant behaviors and perturbs key players of cell migration, invasion, and adhesion. Furthermore, in LSCC we showed a physical interaction between SMN and the epidermal growth factor receptor (EGFR), whose overexpression is an important feature in these tumours. This study candidates SMN as novel therapeutic target in LSSC, and likely in the whole spectrum of HNSCC. Overall, we provide the first analysis of SMN in human cancer.

Objective: The combination of docetaxel (DTX) with Laser-Activated NanoTherapy (LANT), as a treatment for head and neck cancer (HNC) may enhance the therapeutic efficacy of lower doses of DTX, thereby minimizing the effective dosage, side effects and treatment times. Material and methods: Three HNSCC cell lines, Detroit 562, FaDu, and CAL 27, were treated with four combinations of DTX + LANT to evaluate DTX dose reduction and cell viability. Results: The 1 nM DTX + 5 nM LANT combination was the most effective treatment, increasing cell death over its corresponding DTX monotreatment with approximately 86.6%, 80.7%, and 92.1% cell death for Detroit 562, FaDu, and CAL 27, respectively. In Detroit 562, the 1 nM DTX + 5 nM LANT combination treatment resulted in the highest percentage of DTX dose reduction at 84.6%; in FaDu and CAL 27, the 0.5 nM DTX + 5 nM LANT combination treatment resulted in the highest percentage of DTX dose reduction at 78.2% and 82.4%, respectively. Conclusion: LANT may increase the therapeutic efficacy of DTX at significantly lower doses, which could improve patient outcomes.

Conformal radiotherapy is a primary treatment in head and neck cancer, which putative adverse effects depend on relatively low doses of radiation delivered to increased volumes of normal tissues. Systemic effects of such treatment include radiation-induced changes in serum lipid profile, yet dose- and volume-dependence of these changes remain to be established. Here we analyzed levels of choline-containing phospholipids in serum samples collected consecutively during the radiotherapy used as the only treatment modality. The LC-MS approach applied in the study enabled the detection and quantitation of 151 phospholipids, including (lyso)phosphatidylcholines and sphingomyelins. No statistically significant differences were found in the pre-treatment samples from patients with different location and stage of cancer. To compensate for potential differences between schemes of radiotherapy the biologically effective doses were calculated and used in the search of correlations with specific lipid levels. We found that the levels of several phospholipids depended on the maximum dose delivered to the gross tumor volume and total radiation energy absorbed by the patient’s body. Increased doses correlated with increased levels of sphingomyelins and reduced levels of phosphatidylcholines. Noteworthy, serum phospholipid levels were associated mainly with volumes of normal tissues irradiated with relatively low doses (i.e., total accumulated dose 20 Gy), which indicated the importance of such effects on the systemic response of the patient’s organism to IMRT.

Chemotherapy treatment based on Cisplatin (CDDP) is established as the drug of choice for head and neck squamous cell carcinoma (HNSCC). Malignant tumors respond to microenvironment alteration through a dynamic balance of mitochondrial fission and fusion. HNSCC is known to have hypoxic conditions, yet the effects and underlying mechanisms of hypoxia on chemosensitivity and mitochondrial dynamics remain unclear. We found that hypoxia promoted mitochondrial fission and CDDP sensitivity in HNSCC cells. Importantly, Mff was shown to be correlated with chemosensitivity in clinical samples of HNSCC that underwent a hypoxic condition. Hypoxia-inducible factor 1 α-subunit (HIF-1α) dramatically increased Mff transcriptional expression and directly bound to Mff. Hypoxia enhanced the release of reactive oxygen species (ROS) and upregulated the expression of Mff via HIF-1α in HNSCC cells. ROS depletion in HNSCC cells attenuated HIF-1α, Mff expression, and mitochondrial fission. Moreover, a knockdown of Mff suppressed hypoxia-induced mitochondrial fission and decreased CDDP chemosensitivity in vivo and in vitro. Our findings revealed that the hypoxia-induced release of ROS promoted mitochondrial fission and CDDP chemosensitivity via the regulation of HIF-1α/Mff in HNSCC cells, indicating that Mff may serve as a new biomarker to predict neoadjuvant chemosensitivity in HNSCC patients

On review of neuroscience literature extreme capsule considered as a whiter matter tract. Nevertheless it is not clear that extreme capsule itself is a association fiber pathway or is o bottleneck for passing other association fiber. By a systematic search with investigating anatomical position, dissection, connectivity and cognitive role of extreme capsule it can be argued that extreme capsule probably is a bottleneck for passing uncinated fasciculus (UF) and inferior fronto – occipital fasciculus(IFOF), And its different role of language processing is duo to different tract that passing it.

To define the optimistic multiple-granulation (OMG) supra interior operator and the OMG-supra closure operator associated with a set A in a multiple-granulation approximation space, we used the concepts of the OMG-lower set OL (A) and the OMG-upper set OU (A). These operators create an approximate topological space known as optimistic multiple-granulation supratopological spaces. OMG-supra-open and OMG-supra-closed approximation sets are also defined, followed by OMG-supra-continuous approximation and OMG-irresolute approximation.

The paper proposes TOPSIS method for solving multi-objective multi-level programming problem (MO-MLPP) with fuzzy parameters via fuzzy goal programming (FGP). At first, - cut method is used to transform the fuzzily described MO-MLPP into deterministic MO-MLPP. Then, for specific , we construct the membership functions of distance functions from positive ideal solution (PIS) and negative ideal solution (NIS) of all level decision makers (DMs). Thereafter, FGP based multi-objective decision model is established for each level DM for obtaining individual optimal solution. A possible relaxation on decisions for all DMs is taken into account for satisfactory solution. Subsequently, two FGP models are developed and compromise optimal solutions are found by minimizing the sum of negative deviational variables. To recognize the better compromise optimal solution, the concept of distance functions is utilized. Finally, a novel algorithm for MO-MLPP involving fuzzy parameters is provided and an illustrative example is solved to verify the proposed procedure.

We develop an interactive likelihood (ILH) for sequential Monte-Carlo (SMC) methods for image-based multiple target tracking applications. The purpose of the ILH is to improve tracking accuracy by reducing the need for data association. In addition, we integrate a recently developed deep neural network for pedestrian detection along with the ILH with a multi-Bernoulli filter. We evaluate the performance of the multi-Bernoulli filter with the ILH and the pedestrian detector in a number of publicly available datasets (2003 PETS INMOVE, AFL, and TUD-Stadtmitte) using standard, well-known multi-target tracking metrics (OSPA and CLEAR MOT). In all datasets, the ILH term increases the tracking accuracy of the multi-Bernoulli filter.

Neck circumference (NC), neck circumference to height ratio (NHtR) and neck circumference to weight ratio (NWtR) appear to be good candidates for the non-invasive management of non-alcoholic fatty liver disease (NAFLD). This study aimed to evaluate the ability of routine variables to assess and manage NAFLD in participants with obesity and NAFLD included in a 2-year nutritional intervention program. Anthropometric measurements, biochemical variables and imaging techniques were performed at different study time-points (baseline, 6, 12 and 24 months). The nutritional intervention significantly improved all anthropometric measurements as well as the glucose profile and the hepatic enzymes. NC and neck ratios combined with ALT levels and HOMA-IR showed good prediction ability for the hepatic fat content and hepatic steatosis at all the study time-points in a ROC analysis. The prediction ability of the combination panels improved when the weight loss variable was also considered. NC and neck ratios are easy anthropometric measurements that in combination with routine biochemical variables (ALT and HOMA-IR) showed good prediction ability of NAFLD. More research studies are necessary to validate the utility of these simple and easy variables as surrogate markers of NAFLD since their application could improve the prevention and management of this prevalent disease.

Human papillomavirus (HPV), a DNA virus, causes one the most common sexually transmitted infections (STI), spreading through direct sexual contact to the anogenital and oropharyngeal regions. Although most infected individuals may be asymptomatic and naturally undergo viral clearance, in some individuals HPV causes carcinogenesis of the infected epithelia. HPV now accounts for over 70% of oropharyngeal carcinomas (OPC). More than 90% of these OPC are associated with HPV 16, one of the 14 high-risk subtypes. In recent years, HPV positive (HPV+) OPC has been one of the most rapidly rising cancers, by new cancer incidence rates, especially among men. The HPV driven OPCs present some unique infection driven cellular and molecular features, constituting distinct preventive, therapeutic and prognostic strategies, in contrast to HPV negative (HPV-) OPC. In this manuscript, we drive through the role of HPV, from a sexually transmitted infection to malignancy transformation landscape, while parsing through the significant immune response environment. In this comprehensive review we collate key literature around transmission and epidemiology of HPV, while addressing the current state of clinical management, diagnosis, prevention and screening strategies, that can help shed light on this critical area.

From the existing millions of fungal species only a few cause disease. In this study, we investigated invasive fungal infections in the head and neck over a 19-year period (2005 to 2024) at a large academic healthcare system. Among 413 cases, 336 were noninvasive, and 77 were invasive. The highest incidence of invasive infections occurred in the sinonasal cavities, with a 15-fold difference compared to other sites. Most infections affected adults over 40 years old. The most common organisms were Mucorales (51%), hyaline molds (29%), and Candida (11%). Risk factors included malignancy, transplant, diabetes, and illicit drug use. Mortality was high in patients with malignancy and/or transplant. Infections affecting the mandible were usually a complication of osteoradionecrosis and were associated with coinfection of Candida and Actinomyces. At other sites, infections were rare and were usually the result of penetrating injuries or immunosuppression. Treatment typically involved a combination of antifungals and surgical procedures.

This study aimed to demonstrate the potential role of Dual Energy CT in assessing Bone Mineral Density (BMD) in postmenopausal women. A retrospective study was conducted on 51 postmenopausal female patients who underwent DXA and DECT examinations for other clinical reasons. DECT images were acquired with spectral imaging using a 256-slice system. These images were processed and visualized using an HAP(fat) map. Statistical analysis was performed using the Bland-Altman method to assess agreement between DXA and DECT HAP(fat) measurements. Mean BMD, vertebral and femoral T-scores were obtained. For vertebral analysis, the Bland-Altman plot showed an inverse correlation (R2: -0.042; RMSE: 0.690) between T-scores and DECT HAP(fat) values for measurements from L1 to L4, while a good linear correlation (R2: 0.341; RMSE: 0.589) it was found for measurements at the femoral neck. In conclusion, we demonstrated the enhanced accuracy of BMD calculation through DECT, finding a statistically significant correlation only at the femoral neck where BMD results do not seem to be influenced by the overlap of the measurements on cortical and trabecular bone. This outcome could be beneficial in the future by reducing radiation exposure for patients already undergoing follow-up for chronic conditions.

Background: Metastatic tumors to the oro-facial tissues are rare, with an incidence ranging between 1% and 8% of all oral malignant tumors. Generally reported with a peak of incidence in the 5th–7th decades, but possibly occurring at any age, metastases may represent the first sign of an occult cancer or manifest in patient with an already known history of a primary carcinoma, mostly from the lungs, kidney, prostate, and colon-rectum in males, or uterus, breast, lung, and ovary in females. In the oro-facial tissues the sites mostly involved are the oral mucosa, gingiva/jawbones, tongue, and the salivary glands. Methods: A systemic Review of the literature on the oro-facial metastases from Renal Cell Carcinoma has been conducted by searching the most used databases, also focusing the attention on the Clear Cell histological variant, representing the most frequent one. Results: Among the 160 analyzed studies, 211 cases of oral metastases of renal cancer were found (148 in males, 70.1%; 63 in females, 29.8%), with an average age of 59.8 years. In almost 40% of cases, metastasis represented the first clinical manifestation of the primary tumor and 122 were histologically diagnosed as ccRCCs (57.8%). The tongue was involved in most of the cases (26% - 55 cases), followed by mandible (18.9% - 40 cases), gingiva (18.4% - 39 cases), maxilla (10.9% - 23 cases), parotid gland (10.4% - 22 cases), buccal mucosa (5.2% - 11 cases), lips (3.3% - 7 cases), hard palate (2.8% - 6 cases), soft palate, masticatory space and submandibular gland (0.9% - 2 cases), lymph nodes, tonsil and oral floor (0.4% - 1 case). Among the 122 ccRCCs (84 were males, 68.8 %; 38 females, 31.1%), with an average age of 60.8 years and representing in 33.6% the first clinical manifestation, the tongue remained the most involved site (25.4% - 31 cases), followed by the gingiva (17.2% - 21 cases), parotid gland (13,1% - 16 cases), mandibular bone (12.2% - 15 cases), maxillary bone (11.4% - 14 cases), buccal mucosa and lips (4.9% - 6 cases), hard palate (4% - 5 cases), submandibular gland and soft palate (1.6% - 2 cases), lymph nodes, tonsil, oral floor and masticatory space (0.8%. 1 case). The clinical presentation in soft tissues was represented by a fast-growing exophytic mass, sometimes accompanied by pain. Instead inn bone appeared as radiolucent lesions, with ill-defined borders and cortical erosion. Conclusions: Our data focus the attention on the incidence of Renal cancer Metastases in the oro-facial tissues. Their early identification surely represents a diagnostic challenge, especially when the clinical work-up is limited to the cervico-facial region. Nevertheless, early diagnosis and recently introduced adjuvant therapies may represent the key for better outcomes. Therefore, general guidelines about clinical and radiological identification of oro-facial potentially malignant lesions should be part of the cultural background of any dentists.

The incidence of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is rising in the West, but little is known in Asia. This study elucidated changes in the incidence and HPV-positive portion of OPSCC in Hong Kong. Data from population-based cancer registry were used to analyze the incidence of OPSCC in associate with other head and neck cancers. Archived tumour tissues were tested for HPV. From 1986 to 2020, there was a marked decrease in the incidence of nasopharyngeal and laryngeal cancers, but a persistent increase in OPSCC from 36 cases in 1986 to 116 cases in 2020. The average positive rate for high-risk HPV was 36.1% (112/310) among OPSCC diagnosed in 2010-2020. The HPV positive rate in recent years was significantly higher than earlier cases (tonsil SCC: 64.7% (55/85) in 2016-2020 vs. 40.4% (19/47) in 2010-2015, P = 0.007). Patients with HPV-positive tonsil cancers were significantly younger than those negative (mean [SD]: 58.9 [9.9] vs. 64.3 [13.3] years, P = 0.006), but no significant difference between genders. A persistent increase in the incidence of oropharyngeal cancer over the last few decades was observed in Hong Kong, which can be explained by the remarkable increase in HPV-positive tonsil cancers.

(1) Background: The goal of the study was to evaluate psychological tolerance and health-related quality of life (QOL) in head and neck (HN) cancer patients treated with definitive accelerated radiotherapy (DART); (2) Methods: Seventy-six recurrence-free patients eligible for the study, who were treated with DART in the CAIR-2 phase III clinical study (median of follow-up=47 months), completed EORTC QLQ-C30 with H&amp;N35 module, Hospital Anxiety and Depression Scale (HADS) and Visual–Analog Scales (VAS) of pain in HN and the neck / arm area.; (3) Results: The most dominating symptoms measured with QLQ-C30 were: fatigue (44/100), sleeplessness (39/100), financial problems (38/100) and pain (32/100). Within H&amp;N35 the highest scores were reported on the subscales of sticky saliva (60/100), mouth dryness (65/100) and increased intake of painkillers (50/100). Pain (VAS) was reported by 87% (HN area) and 78% (shoulder) of the patients, with a mean score of 3/10. One-third reported depressive mood (HADS≥15 points) with an average score of 12.5/42 p. The depressed group, who smoked more as compared to non-depressed before DART (96% vs 78%) and required steroids treatment (85% vs 58%) during DART, also scored significantly worse on 23 of 35 subscales of QLQ-C30 and H&amp;N35 and experienced more intense pain (VAS). Women, and less advanced patients scored better in several aspects of the quality of life; (4) Conclusions: Patients treated with DART struggle with low quality of life and persisting treatment-related symptoms including constant pain. HNC survivors, especially those, who are depressed, may require additional psychosocial, rehabilitation and medical intervention programs..

Introduction: Osteosarcomas of the jaw (OSJ) are rare tumors with a different behavior from osteosarcomas of other bones. This study aims to analyze the clinical, pathological, and therapeutic characteristics of this type of sarcoma. Methods: a retrospective observational study of cases diagnosed with OSJ registered at the “La Paz” University Hospital (Madrid). Results: Eight cases with a diagnosis of OSJ were obtained in a study period of 22 years (2000-2022). The mean age was 41 years. The distribution was 1:1 between the maxilla and mandible. Painful inflammation was the most frequent clinical manifestation. Conventional osteoblastic osteosarcoma was the most common. Survival at 5 years was 50%, while at 10 years, it decreased to 25%. Conclusions: OSJ differs from conventional osteosarcomas of long tubular bones. Surgery continues to be the mainstay of treatment; more studies are needed in which more standardized protocols can be proposed for adjuvant therapeutic management.

Radiomics involves the extraction of information from medical images not visible to the human eye. There is evidence these features can be used for treatment stratification and outcome prediction. However, there is much discussion about the reproducibility of results between different studies. This paper studies the reproducibility of CT texture features used in radiomics, comparing two feature extraction implementations namely Matlab toolkit and Pyradiomics when applied on independent datasets of CT scans of patients i) the open access RIDER dataset containing a set of repeat CT scans taken 15 minutes apart for 31 patients (RIDER Scan 1 and Scan 2 respectively) treated for lung cancer and ii) the open access HN1 dataset containing 137 patients treated for head and neck cancer. Gross tumor volume (GTV) manually outlined by an experienced observer available on both datasets was used. 43 common radiomics features available on Matlab and Pyradiomics were calculated using 2 intensity-level quantization methods with and without an intensity threshold. Cases were ranked for each feature for all combinations of quantization parameters and the Spearman’s rank coefficient, rs, calculated. Reproducibility was defined when a highly correlated feature in the RIDER dataset also correlated highly in the HN1 dataset and vice versa. 29 out of 43 reported stable features were found to be highly reproducible between Matlab and Pyradiomics implementations, having consistently high correlation in rank ordering for RIDER Scan 1 and RIDER Scan 2 (rs &gt; 0.8). 18/43 reported features were common in RIDER and HN1 datasets, suggesting they may be agnostic to disease site. Useful radiomics features should be selected based on reproducibility. This study identified a set of features that meet this requirement and validated the methodology for evaluating reproducibility between datasets.

Transcutaneous injection laryngoplasty is a well-known procedure for treating paralyzed vocal fold by injecting augmentation material into it. Hence, vocal fold localization plays a vital role in the preoperative planning as the fold location is required to determine the optimal injection route. In this communication, we propose a mirror environment based reinforcement learning (RL) algorithm for localizing the right and left vocal folds in preoperative neck CT. RL-based methods commonly showed noteworthy outcome in general anatomic landmark localization problem in the recent years. However, such methods suggest training individual agent for localizing each fold, though the right and left vocal folds are located in close proximity and have high feature-similarity. Utilizing the lateral symmetry between the right and left vocal folds, the proposed mirror environment allows for a single agent for localizing both the folds by treating the left fold as a flipped version of the right fold. Thus, localization of both folds can be trained using a single training session which utilizes the inter-fold correlation and avoids redundant feature learning. Experiment with 120 CT volumes showed improved localization performance and training efficiency of the proposed method compared with the standard RL method.

Background: In the present study, we assessed the feasibility and success outcomes of voice prosthesis (VP) changes when performed by speech-language pathologist (SLP). Methods: Patients treated with total laryngectomy (TL) from January 2020 to December 2020 were prospectively recruited from our medical center. Patients benefited from tracheoesophageal puncture. The VP changes were performed by the senior SLP and the following data were collected for each VP change: date of placement; change or removal; VP type and size; reason for change or removal; and use of a washer for periprosthetic leakage. A patient-reported outcome questionnaire including 6 items was proposed to patients at each VP change (Appendix 1). Items were assessed with a 10-point Likert-scale. Results: Fifty-two VP changes were performed by the senior SLP during the study period. The mean duration of the SLP consultation, including patient history, examination and VP change procedure was 20 min (range: 15-30). The median prosthesis lifetime was 88 days. The main reasons for VP changes were transprosthetic (N=34; 79%) and periprosthetic (N=7; 21%) leakages, respectively. SLP successfully performed all VP changes. He did not change one VP but used a periprosthetic silastic to stop the periprosthetic leakages. In two cases, SLP needed the surgeon examination to discuss about the following indication: implant mucosa inclusion and autologous fat injection. The patient satisfaction was high according to the speed and the quality of care by the SLP. Conclusion: The delegation of VP change from the otolaryngologist-head and neck sur-geon to the speech-language pathologist (SLP) may be done without significant complications. The delegation of VP change procedure to SLP may be interesting in some rural regions with otolaryngologist shortage.

β₂-m, β₂-microglobulin; CAF, cancer associated fibroblast; CSC, cancer stem cell; CTL, cytotoxic T lymphocyte; DC, dendritic cell; ECM, extracellular matrix; EGF-R, epidermal growth factor receptor; ER, endoplasmic reticulum; FDA, Food and Drug Administration; HLA, human leukocyte antigen; HNSCC, head and neck squamous cell carcinoma; HPV, human papilloma virus; ICP immune checkpoint; ICPi, immune checkpoint inhibitor; IFN, interferon; LMP, low molecular weight protein; mAb, monoclonal antibody; MDSC, myeloid-derived suppressor cell; mTOR, mammalian target of rapamycin; MSI, multispectral imaging; NK, natural killer; OS, overall survival; PBL, peripheral blood lymphocytes; PBMNC, peripheral blood mononuclear cells; PD1, programmed death receptor 1; PD-L1, programmed death ligand 1; PFS, progression-free survival; PI3K, phosphatidyl-linositol-3-kinase; R/M, recurrence and or metastatic; STAT, signal transducer and activator of transcription; TAA, tumor-associated antigen; TAM, tumor associated macrophages; TAP, transporter associated with antigen processing; TCR, T cell receptor; TIL, tumor-infiltrating lymphocyte; TLS, tertiary lymphoid structure; TME, tumor microenvironment; Treg, regulatory T cell; TSA, tumor-specific antigen; VEGF, vascular endothelial growth factor; VEGF-R, vascular endothelial growth factor receptor.

Background and objectives: Induction chemotherapy (ICT) before definitive chemoradiation (CRT) gives high response rates in LA-SCCHN. However, pre-ICT gross tumour volume (GTV) for radiotherapy (RT) planning is still recommended. As ¹⁸F-FDG PET/CT has an advantage of biological tumour information comparing to standard imaging methods, we aimed to evaluate the feasibility of ¹⁸F-FDG PET/CT-based post-ICT GTV delineation for RT planning in LA-SCCHN and to assess the prognostic value of PET parameters: maximum standardized uptake value (SUV_max), metabolic tumour volume (MTV) and total lesion glycolysis (TLG). Methods: 47 LA-SCCHN patients were treated with 3 cycles of ICT (docetaxel, cisplatin, and 5-fluorouracil) followed by CRT (70 Gy in 35 fractions with weekly cisplatin). Pre- and post-ICT PET/CT examinations were acquired. Planning CT was co-registered with post-ICT PET/CT and RT target volumes were contoured according to post-ICT PET. Post-ICT percentage decrease of SUV_max, MTV and TLG in primary tumour and metastatic regional lymphnodes (LN) was counted. Loco-regional failure patterns, 3-year progression free (PFS) and overall survival (OS) were evaluated. Results: 3-year PFS and OS rates for study population were 67% and 61% respectively. 31.9% of patients progressed loco-regionally. All progresses were localised in high-to-intermediate dose (60–70 Gy) RT volumes and none in low dose (50 Gy) volumes. Decrease of SUV_max ≥74% (p = 0.03), MTV ≥ 68% (p = 0.04), TLG ≥ 76% (p = 0.02) in primary tumour, and LN TLG decrease ≥74% (p = 0.03) were associated with PFS. Decrease of primary tumour SUV_max ≥ 74% (p = 0.04), MTV ≥ 69% (p = 0.04), TLG ≥ 74% (p = 0.02) and LN TLG ≥ 73% (p = 0.02) were prognostic factors for OS. Conclusions: According to our results, 18F-FDG PET/CT-based post-ICT GTV delineation is feasible strategy without negative impact on loco-regional control and survival. Percentage decrease of metabolic PET parameters SUV_max, MTV and TLG has a prognostic value in LA-SCCHN.

Vehicle logo detection plays a crucial role in various computer vision applications, such as vehicle classification and detection. In this research, we propose an improved vehicle logo detection method leveraging the MAMBA structure. The MAMBA structure integrates multiple attention mechanisms and bidirectional feature aggregation to enhance the discriminative power of the detection model. Specifically, we introduce the Multi-Head Attention for Multi-Scale Feature Fusion (MHAMFF) module to capture multi-scale contextual information effectively. Moreover, we incorporate the Bidirectional Aggregation Mechanism (BAM) to facilitate information exchange between different layers of the detection network. Experimental results on a benchmark dataset (VLD-45 dataset) demonstrate that our proposed method outperforms baseline models in terms of both detection accuracy and efficiency. Furthermore, extensive ablation studies validate the effectiveness of each component in the MAMBA structure. Overall, the proposed MAMBA-based vehicle logo detection approach shows promising potential for real-world applications in intelligent transportation systems.

Large-scale crowd phenomena are complex to model because the behaviour of pedestrians needs to be described at both strategic, tactical, and operational levels and is impacted by the density of the crowd. Microscopic models manage to mimic the dynamics at low densities, whereas mesoscopic models achieve better performances in dense situations. This paper proposes and evaluates a novel agent-based architecture to enable agents to dynamically change their operational model based on local density. The ability to combine microscopic and mesoscopic models for multi-scale simulation is studied through a use case of pedestrians at the Festival of Lights, Lyon, France. Pedestrian outflow data is extracted from video recordings of exiting crowds at the festival. The hybrid model is calibrated and validated using a genetic algorithm that optimizes the match between simulated and observed outflow data. Additionally, a local sensitivity analysis is then conducted to identify the most sensitive parameters in the model. Finally, the performance of the hybrid model is compared to different models in terms of density map and computation time. The results demonstrate that the hybrid model has the capacity to effectively simulate pedestrians across varied density scenarios while optimizing computational performance compared to other models.

One of the most important applications in the wireless sensor networks (WSN) is to classify mobile targets in the monitoring area. In this paper, a multi-DBN weighted voting classification algorithm is proposed on the basis of the Deep Belief Network (DBN) classifier and combined with the idea of voting method, which is implemented on the nodes of the WSN monitoring system by means of "upper training, lower transplantation" appraoch. The performance of the algorithm is verified by using real-world experimental data, and the results show that the proposed method has a higher accuracy in classifying the target signal features, achieving an average classification accuracy of 84.63% across four different types of moving targets. The experiment reveals that the multi-DBN weighted voting algorithm enhances the target classification accuracy by approximately 5% in comparison to the single DBN classifier, but the memory and computation time required for the algorithm to run are also increased at the same time. Compared to the FFNN classifier, which exhibited the highest classification accuracy among the four selected methods, the algorithm achieves an improvement of approximately 8.8% in classification accuracy. However, it incurs greater time overhead to run.

Unmanned Aerial Vehicles (UAVs) image object detection has great application value in military and civilian fields. However, the objects in the captured images from UAVs have problems of large scale variation, complex backgrounds, and a large proportion of small objects. To resolve these problems, a multi-scale object detector based on coordinate and global information aggregation is proposed, named CGMDet. Firstly, a Coordinate and Global Information Aggregation Module (CGAM) is designed by aggregating local, coordinate, and global information, which can obtain features with richer context information. Secondly, a Multi-Feature Fusion Pyramid Network (MF-FPN) is proposed, which can better fuse features of different scales and obtain features containing more context information through repeated use of feature maps, to better detect multi-scale targets. Moreover, more location information of low-level feature maps is integrated to improve the detection results of small targets. Furthermore, we modified the bounding box regression loss of the model to make the model more accurately regress the bounding box and faster convergence. Finally, the proposed CGMDet was tested on VisDrone and UAVDT datasets and mAP0.5 of 50.9% and 48% was obtained, respectively. At the same time, our detector achieved the best results compared to other detectors.

Rapid assessment of maize yields in smallholder farming system is important to understand its spatial and temporal variability and for timely agronomic decision-support. Imageries acquired with unmanned air vehicles (UAV) offer opportunity to assess agronomic variables at field scale, however, it is not clear if this can be translated into reliable yield assessment on smallholder farms where field conditions, maize genotypes, and management practices vary within short distances. In this study, we assessed the predictability of maize grain yield using UAV-derived vegetation indices (VI), with(out) biophysical variables, in smallholder farms. High-resolution images were acquired with UAV-borne multispectral sensor at 4 and 8 weeks after sowing (WAS) on 31 farmers’ managed fields (FMFs) and 12 nearby Nutrient Omission Trials (NOT), all distributed across 5 locations within the core maize region of Nigeria. The NOTs included non-fertilized and fertilized plots (with and without micronutrients), sown with open-pollinated or hybrid maize genotypes. Acquired multispectral images were post-processed into several three (s) vegetation indices (VIs), normalized difference vegetation index (NDVI), normalized difference red-edge (NDRE), green-normalized difference vegetation index (GNDVI). Biophysical variables, plant height (Ht) and percent canopy cover (CC), were measured with the georeferenced plot locations recorded. In the NOTs, the nutrient status, not genotype, influenced the grain yield variability and outcome. The maximum grain yield observed in NOTs was 9.3 tha^-1, compared to 5.4 tha^-1 in FMF. Without accounting for between- and within-field variations, there was no relationship between UAV-derived VIs and grain yield at 4WAS (r<0.02, P>0.1), but significant correlations were observed at 8WAS (r≤0.3; p<0.001). Ht was positively correlated with grain yield at 4WAS (r=0.5, R²=0.25, p<0.001), and more strongly at 8WAS (r=0.7, R²=0.55, p<0.001), while relationship between CC and yield was only significant at 8WAS. By accounting for within- and between-field variations in NOTs and FMF (separately) through linear mixed-effects modeling, predictability of grain yield from UAV-derived VIs was generally (R²≤0.24), however, the inclusion of ground-measured biophysical variable (mainly Ht) improved the explained yield variability (R² ≥0.62, RMSEP≤0.35) in NOTs but not in FMF. We conclude that yield prediction with UAV-acquired imageries (before harvest) is more reliable under controlled experimental conditions (NOTs), than in actual farmer-managed fields where various confounding agronomic factors can amplify noise-signal within the vegetation canopy.

In this work, we show that a late fusion approach to multi-modality in sign language recognition improves the overall ability of the model in comparison to the singular approaches of Computer Vision (88.14%) and Leap Motion data classification (72.73%). With a large synchronous dataset of 18 BSL gestures collected from multiple subjects, two deep neural networks are benchmarked and compared to derive a best topology for each. The Vision model is implemented by a CNN and optimised MLP and the Leap Motion model is implemented by an evolutionary optimised deep MLP topology search. Next, the two best networks are fused for synchronised processing which results in a better overall result (94.44%) since complementary features are learnt in addition to the original task. The hypothesis is further supported by application of the three models to a set of completely unseen data where a multi-modality approach achieves the best results relative to the single sensor method. When transfer learning with the weights trained via BSL, all three models outperform standard random weight distribution when classifying ASL, and the best model overall for ASL classification was the transfer learning multi-modality approach which scored 82.55% accuracy.

Objective: To describe technique of platelet rich plasma injection into the olfactory cleft in patients with long-term COVID-19 olfactory dysfunction. Methods: The technique starts with the blood extraction and the isolation of PRP through a 10-min centrifugation (4,200 rpm). The supernatant was injected in nasal regions with a 27-G needle after a local anesthesia with Xylocain 10% spray. The injection was performed through a 0° rigid optic. Precisely, several points of 0.2–0.5 mL were performed in the nasal septum in regard of the head of the middle turbine, and in the head of the middle turbine in both sides. Clinical, psychophysical and pain outcomes were evaluated pre- to post-injection. Results: A 22-year-old female with 24-month post-COVID-19 anosmia was recruited for the injection of PRP. The olfactory cleft endoscopic scale score was 0 and the threshold, discrimination and identification scores were 1, 8 and 0, respectively. The Olfactory Disorder Questionnaire score was 51. The patient benefited from the injection of 2.2 mL of PRP in nasal regions, which was done without complication. The procedure pain level was 2/10, while the local anesthesia with xylocaine 10% was judged as the most annoyance step with a score of 3/10. At 2-month post-injection, the TDI scores reached 16, 16, and 16 (48), while the Olfactory Disorder Questionnaire was 73. The patient described its recovery as very rapid, lasting 3-4 days, and occurring 3-week post-injection. Conclusion: The injection of PRP into the olfactory cleft is a safe and easiness new approach that may improve the recovery of smell sense.

Odontogenic infections are infections of the orofacial structures arising from dental disease. Despite its preventability, it exerts a significant burden on healthcare infrastructure worldwide. Our study explored the various different microbiological, social, and epidemiological characteristics of 103 cases of odontogenic infections at our regional center which demonstrated specific predilections for the young and middle-aged, those with diabetes mellitus, African American/Black and Hispanic ethnicities, posterior teeth, left-sided dentition, and male gender. However, nuances and exceptions to these trends were also seen with specific groups that may complicate treatment.

Cyclic STAT3 decoy (CS3D) is a second-generation, double-stranded oligodeoxynucleotide (ODN) that mimics a genomic response element for signal transducer and activator of transcription 3 (STAT3), an oncogenic transcription factor. CS3D competitively inhibits STAT3 binding to target gene promoters, resulting in decreased expression of proteins that promote cellular proliferation and survival. Previous studies have demonstrated antitumor activity of CS3D in preclinical models of solid tumors. However, prior to entering human clinical trials, the efficiency of generating the CS3D molecule and its stability in biological fluids should be determined. CS3D is synthesized as a single-stranded ODN and must have its free ends ligated to generate the final cyclic form. In this study, we report a ligation efficiency of nearly 95 percent. The ligated CS3D demonstrated a half-life of 7.9 hours in human serum, indicating adequate stability for intravenous delivery. These results provide requisite biochemical characterization of CS3D that will inform upcoming clinical trials.