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Simple Summary: Synovial sarcoma in the head and neck region is rare, making up just 2–3% of sarcomas in that area. This anatomic location is challenging to treat due to its proximity to vital structures like the airways and cranial nerves. Studying this rare malignant tumor at an early, localized stage is important, as multidisciplinary treatments might improve survival outcomes. Therefore, this study aims to explore the survival outcomes of patients with localized head and neck synovial sarcomas. We find that radiation therapy is associated with improved local control of the tumor. While the role of perioperative chemotherapy is still debatable in synovial sarcoma patients, we observe that undergoing chemotherapy in addition to surgery and radiation can promote metastasis-free survival in patients with localized head and neck synovial sarcomas, especially when the tumor is ≥4 cm. By providing updated information on this rare cancer type, such findings may help improve treatment approaches and outcomes, benefiting both patients and the medical community. Background: this study aims to evaluate the survival outcomes of patients suffering from head and neck synovial sarcoma (HNSS), especially in relation to patients with a localized disease at diagnosis. Methods: this retrospective chart review includes 57 patients diagnosed with primary HNSS between 1981 and 2020 who presented with a localized disease at diagnosis. Overall survival (OS) from diagnosis, local recurrence-free survival (LRFS), and metastasis-free survival (MFS) from the end of the primary tumor treatment are estimated. The Kaplan–Meier method, the log-rank test, and the Cox proportional hazards regression are used. Results: the 5-year OS, LRFS, and MFS are estimated at 80.4% (95% CI: 66.6%, 88.9%), 67.7% (95% CI: 50.0%, 80.4%), and 50.6% (95% CI: 34.4%, 64.8), respectively. Compared to patients undergoing surgical resection alone, those receiving radiation therapy (RT) with surgery have better LRFS (HR: 0.03, 95% CI: 0.001, 0.57), and those undergoing neo/adjuvant chemotherapy with surgery and RT have better MFS (HR: 0.10, 95% CI: 0.01, 0.95). Moreover, among the patients with tumors ≥ 4 cm, those subject to neo/adjuvant chemotherapy have significantly better MFS (5-year MFS: 53.2%, 95% CI: 29.0%, 72.5%) than those treated with surgery and RT alone (5-year MFS: 20.0%, 95% CI: 0.8%, 58.2%) (LR-p = 0.003). Conclusions: overall, the prognosis of HNSS patients looks favorable. Perioperative RT significantly improves local control, and perioperative chemotherapy plays a vital role in delaying metastasis formation in patients with primary HNSS when diagnosed with a localized disease. Importantly, we recommend that systemic therapy should be considered for HNSS patients with tumors ≥ 4 cm. [ABSTRACT FROM AUTHOR]

INTRODUCTION Pediatric patients often receive vasoactive agents following cardiothoracic surgery or when in shock. The use of vasoactive agents varies between different settings and has largely changed because of anecdotal observations or small observational studies. Although vasoactive agents are frequently used, there are limited studies in pediatric populations comparing them to one another. The purpose of this systematic review is to quantify the comparative effects of epinephrine and dopamine while identifying gaps in knowledge. METHODS A systematic review of published manuscripts was completed to identify full-text manuscripts in English using PubMed, Embase, and Cochrane databases. Studies were included if they included clinical data using dopamine and epinephrine in different patients and included data for the same end points for patients receiving epinephrine or dopamine. RESULTS A total of 5 studies with 397 patients were included. Of the included patients, 187 received epinephrine and 210 received dopamine. The mean age for all the patients was 45 months. When all patient data were pooled, a significantly lower mortality was associated with epinephrine compared with dopamine (risk ratio, 0.74; 95% CI, 0.55-0.99). When only neonatal data were pooled, epinephrine was associated with a significantly higher average heart rate (10 bpm; 95% CI, 2.0-18.7) and a significantly lower average mean arterial blood pressure (-2.5 mm Hg; 95% CI, -4.6 to -0.4). CONCLUSION Limited data are available comparing dopamine to epinephrine in pediatric patients. The available data demonstrate an apparent mortality benefit associated with the use of epinephrine. [ABSTRACT FROM AUTHOR]

Byline: Satish. Khadilkar, Saurabh. Kamat, Riddhi. Patel Peripheral neuropathies are traditionally categorized into demyelinating or axonal. It has been proposed that dysfunction at nodal/paranodal region may be a key for [...]

Background: Because orthodontists work long hours and maintain a relationship with each patient for many years prior to the end of treatment, they may encounter unusually stressful situations. Materials and Methods: A self‑administered, anonymous survey was disseminated to orthodontic residents and practitioners in India. The survey includes 29 probable stressors. Result: Over 61% of respondents opined that these factors are the most stressful in orthodontic practice. [ABSTRACT FROM AUTHOR]

Background: Orthodontic correction of dentofacial abnormalities is a crucial component of oral health because it enhances overall oral health‑related quality of life, optimal function, periodontal health, and aesthetics. This study sought to determine whether otolaryngologists recommend patients to orthodontists, whether they are adequately knowledgeable about the fundamentals of orthodontics, and whether they check for orthodontic problems in their patients. Materials and Method: We conducted a survey study of otolaryngologists in Gujarat, India. Questionnaires were completed by 47 out of 60 otolaryngologists (response rate 78%). Results: In the assessment of the mouth breathers, a very low frequency of “always” examining the extra‑oral features (18%) was found. Reasons otolaryngologists referred patients to orthodontists varied from mouth breathing 48% (23/47) to face or teeth asymmetry 87% (41/47). In the multivariable analyses for the effect of gender, work sector, or years of experience in the decision for orthodontic referral, we could not identify any significant predictors. A low frequency of awareness of orthodontists’ role in obstructive sleep apnoea, 48% (23/47) was found. Conclusion: In conclusion, the survey of otolaryngologists in Gujarat, India, revealed areas for improvement in awareness and practices related to orthodontic issues, particularly in cases of mouth breathing. The study highlighted a low frequency of examination of extraoral features and variability in referral patterns, emphasizing potential gaps in knowledge. Additionally, a low awareness of orthodontists’ role in treating obstructive sleep apnea was identified. Targeted educational interventions are recommended to enhance interdisciplinary communication and collaboration between otolaryngologists and orthodontists, ultimately fostering a more comprehensive approach to patient care for individuals with dentofacial deformities in Gujarat and potentially influencing practices on a broader scale. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The purpose of this survey was to assess postgraduate students’ knowledge of orthodontic direct printed aligners and their opinions of the treatment modalities that can be used with them. Materials and Methods: 198 postgraduate learners were given a questionnaire consisting of 25 questions via Google Forms as part of this web‑based survey. Results: Compared to their male counterparts, women were more knowledgeable about direct printed aligners. Conclusion: The survey concluded that most postgraduate students have knowledge about direct printed aligners. Females are more aware about direct printed aligners than males. Orthodontists were the predominant source of knowledge regarding direct printed aligners. [ABSTRACT FROM AUTHOR]

Introduction/Aims: Hyperexcitable peripheral nerve disorders (HPNDs) are rare. Although their clinical and laboratory features have been well studied, information on treatment and follow‐up is limited. The aim of this study is to explore the long‐term clinical, investigative, and therapeutic profile of patients with acquired HPNDs. Methods: This study retrospectively analyzed patients from a single tertiary care center with HPND (January 2012 to January 2022). Patients were recruited according to published inclusion and exclusion criteria. Details of clinical features, diagnostic tests, therapeutic interventions, and follow‐up were recorded. This study included patients with follow‐up of 2 or more years. Results: A total of 32 patients (M = 26, F = 6) were studied. The common clinical features included myokymia, neuropathic or shock‐like pain, cramps, sleep disturbances, encephalopathy, cerebellar ataxia, and seizures. A total of 81.25% of patients responded favorably to corticosteroids and membrane stabilizers. Among the nonresponders, five received intravenous immunoglobulin (IVIG), and one received plasma exchange (PLEX). Two patients required rituximab due to poor responses to the above treatments. The mean duration of response was 6 weeks (4–24 weeks) from the initiation of treatment. All patients had favorable outcomes, reaching clinical remission within 1–5 years from the initiation of treatment. Only two patients had relapses. Immunotherapy could be stopped in 78% of patients within 3 years and 100% by 5 years. Discussion: Chronic immunosuppression starting with corticosteroids is required for satisfactory outcomes of HPNDs. These disorders usually run a monophasic course, and relapses are uncommon. [ABSTRACT FROM AUTHOR]

Simple Summary: A urine drug test (UDT) is often used in the treatment of cancer pain to monitor compliance with opioid treatment. Two types of UDT are commonly for this purpose: the immunoassay test, and the mass spectrometry method. Only a few studies have examined the use of immunoassay UDT for cancer patients in palliative care clinics. In this study, we examined the frequency of immunoassay UDT abnormalities, and the factors associated with aberrant findings at a safety-net hospital palliative medicine clinic. Electronic medical records of 913 patients were reviewed. We found that 27% had aberrant UDT results; 35% of these were positive for cocaine. Non-Hispanic White race, history of illicit drug use, and history of marijuana use were associated with an aberrant finding. Despite limitations of immunoassay UDT, it could detect aberrant drug-taking behaviors in a significant number of patients. These findings support the utility of immunoassay UDT in clinical settings with less resources. Background: Few studies have examined the use of immunoassay urine drug testing of cancer patients in palliative care clinics. Objectives: We examined the frequency of immunoassay urine drug test (UDT) abnormalities and the factors associated with aberrancy at a safety-net hospital palliative medicine clinic. Methods: A retrospective review of the electronic medical records of consecutive eligible patients seen at the outpatient palliative medicine clinic in a resource-limited safety-net hospital system was conducted between 1 September 2015 and 31 December 2020. We collected longitudinal data on patient demographics, UDT findings, and potential predictors of aberrant results. Results: Of the 913 patients in the study, 500 (55%) underwent UDT testing, with 455 (50%) having the testing within the first three visits. Among those tested within the first three visits, 125 (27%) had aberrant UDT results; 44 (35%) of these 125 patients were positive for cocaine. In a multivariable regression model analysis of predictors for aberrant UDT within the first three visits, non-Hispanic White race (odds ratio (OR) = 2.13; 95% confidence interval (CI): 1.03–4.38; p = 0.04), history of illicit drug use (OR = 3.57; CI: 1.78–7.13; p < 0.001), and history of marijuana use (OR = 7.05; CI: 3.85–12.91; p < 0.001) were independent predictors of an aberrant UDT finding. Conclusion: Despite limitations of immunoassay UDT, it was able to detect aberrant drug-taking behaviors in a significant number of patients seen at a safety-net hospital palliative care clinic, including cocaine use. These findings support universal UDT monitoring and utility of immunoassay-based UDT in resource-limited settings. [ABSTRACT FROM AUTHOR]

Simple Summary: Opioids are often used to treat cancer-related pain. Non-medical opioid use (NMOU) is a potential concern in all patients. Patient prescriber agreements (PPAs) have been recommended as a risk mitigation strategy. However, few studies have examined their use. The aim of our retrospective study was to assess how often PPAs were completed and how often cancer patients did not adhere to the PPA in a palliative care clinic. We found that 54% of patients had a PPA, and 10% were not adherent. PPAs were associated with younger age and alcohol use. Non-adherence was associated with males, being single, tobacco and alcohol use, contact with persons involved in criminal activity, opioid use for non-cancer pain, and higher pain score. PPA non-adherence occurred in a minority of patients, particularly those with NMOU risk factors. Our findings support the potential role of universal PPAs and systematic screening of NMOU risk factors. Patient prescriber agreements, also known as opioid contracts or opioid treatment agreements, have been recommended as a strategy for mitigating non-medical opioid use (NMOU). The purpose of our study was to characterize the proportion of patients with PPAs, the rate of non-adherence, and clinical predictors for PPA completion and non-adherence. This retrospective study covered consecutive cancer patients seen at a palliative care clinic at a safety net hospital between 1 September 2015 and 31 December 2019. We included patients 18 years or older with cancer diagnoses who received opioids. We collected patient characteristics at consultation and information regarding PPA. The primary purpose was to determine the frequency and predictors of patients with a PPA and non-adherence to PPAs. Descriptive statistics and multivariable logistic regression models were used for the analysis. The survey covered 905 patients having a mean age of 55 (range 18–93), of whom 474 (52%) were female, 423 (47%) were Hispanic, 603 (67%) were single, and 814 (90%) had advanced cancer. Of patients surveyed, 484 (54%) had a PPA, and 50 (10%) of these did not adhere to their PPA. In multivariable analysis, PPAs were associated with younger age (odds ratio [OR] 1.44; p = 0.02) and alcohol use (OR 1.72; p = 0.01). Non-adherence was associated with males (OR 3.66; p = 0.007), being single (OR 12.23; p = 0.003), tobacco (OR 3.34; p = 0.03) and alcohol use (OR 0.29; p = 0.02), contact with persons involved in criminal activity (OR 9.87; p < 0.001), use for non-malignant pain (OR 7.45; p = 0.006), and higher pain score (OR 1.2; p = 0.01). In summary, we found that PPA non-adherence occurred in a substantial minority of patients and was more likely in patients with known NMOU risk factors. These findings underscore the potential role of universal PPAs and systematic screening of NMOU risk factors to streamline care. [ABSTRACT FROM AUTHOR]

• Subacute combined degeneration is a demyelinating disorder of the cord localized to the dorsal columns, presenting primarily with sensory impairments in proprioception and vibration. • In MRI of the spinal cord, a T2 hyperintensity resembling an "inverted V" on the dorsal columns can be seen in subacute combined degeneration. • In patients where vitamin B12 deficiency is suspected, particularly in teens and young adults, conduct a thorough history of substance use including recreational nitrous oxide. • Nitrous oxide is an inhibitor of vitamin B12 metabolism and its use can cause symptoms of B12 deficiency. [ABSTRACT FROM AUTHOR]

The sun bear Helarctos malayanus is one of the most endangered ursids, and to date classification of sun bear populations has been based almost exclusively on geographic distribution and morphology. The very few molecular studies focussing on this species were limited in geographic scope. Using archival and non‐invasively collected sample material, we have added a substantial number of complete or near‐complete mitochondrial genome sequences from sun bears of several range countries of the species' distribution. We here report 32 new mitogenome sequences representing sun bears from Cambodia, Thailand, Peninsular Malaysia, Sumatra, and Borneo. Reconstruction of phylogenetic relationships revealed two matrilines that diverged ~295 thousand years ago: one restricted to portions of mainland Indochina (China, Cambodia, Thailand; "Mainland clade"), and one comprising bears from Borneo, Sumatra, Peninsular Malaysia but also Thailand ("Sunda clade"). Generally recent coalescence times in the mitochondrial phylogeny suggest that recent or historical demographic processes have resulted in a loss of mtDNA variation. Additionally, analysis of our data in conjunction with shorter mtDNA sequences revealed that the Bornean sun bear, classified as a distinct subspecies (H. m. euryspilus), does not harbor a distinctive matriline. Further molecular studies of H. malayanus are needed, which should ideally include data from nuclear loci. [ABSTRACT FROM AUTHOR]