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Objectives: Obliteration with cauterization of the internal opening of pyriform sinus fistulas, with or without marsupialization, has been a mainstay for preventing recurrence. However, this procedure predisposes patients to recurrence caused by the reopening of the cauterized orifice. We applied suture ligation to secure the closure of the internal orifice following cauterization and evaluated treatment Methods: A total of 42 patients were diagnosed with third or fourth branchial cleft anomaly with internal pyriform sinus fistula and treated either with cauterization or with cauterization and suture ligation, between January 2008 and December 2020. The medical records were reviewed to assess demographic characteristics, clinical presentations, diagnoses, surgical treatment, and outcomes. Treatment flow characteristics for intractable patients were analyzed. Results: The median age of onset was 9 years (range, 0-57 years). Neck swelling (n = 32, 76.2%) was commonly encountered symptom, and a history of neck infection was found in 27 patients (64.3%). After initial treatment, 11 cases (56.2%) recurred. Younger age (≤9 years) and thyroid involvement were associated with recurrence ( P = .034 and P = .046, respectively). Cauterization with suture ligation presented lower recurrence rate (19.2%) than cauterization only (37.5%, P = .037). Cauterization with suture ligation for recurrent cases (n = 11) showed 81.8% (9/11) of cure rate. Intractable fistulas (n = 2) from both groups were also salvaged by suture ligation. Conclusions: Suture ligation with cauterization for an internal orifice of branchial anomaly showed lower recurrence rate than cauterization only. This method was beneficial for refractory cases.

Additional file 1: Fig S1. Schematic representation of synthesized PEG-CZNPs and FITC conjugated PEG-CZNPs. A The process comprises two steps; (i) preparation of CZNPs based on non-hydrolytic sol-gel reaction in oleylamine; (ii) transfer of the as-synthesized CZNPs to aqueous phase by modifying with phospholipid-PEG. B FITC-conjugated phospholipid-PEG capped CZNPs were prepared with a thiourea linkage. C Analysis of Fourier transform infrared spectroscopy (FT-IR) spectra comparing the as synthesized PEG-CZNP and FITC conjugated PEG-CZNP with FITC. (a) PEG-CZNP, (b) FITC and (c) FITC conjugated PEG-CZNP. Fig. S2. Expression of key differentiation markers in human podocytes. A, B Representative confocal immunofluorescence microscopy images of podocin, nephrin and synaptopodin (green), with DAPI counterstaining (blue), in both undifferentiated and differentiated human podocytes. Fig. S3. Validation of ��-GLA knockdown efficiency by quantitative real-time RT-PCR analysis and immunoblotting. A, B Quantitative real-time RT-PCR and immunoblotting results showing the ��-GLA knockdown efficiency in HK-2 cells and human podocytes. Data values represent the mean �� SD; *P

(1) Background: Facial nerve resection with reconstruction helps achieve optimal outcomes in the treatment of facial nerve invasion (FNI) of parotid cancer. Preoperative imaging is crucial to predict facial nerve reconstruction. The radiological findings of CT or MRI may predict FNI in the parotid cancer even without facial paralysis. Methods: We retrospectively reviewed the records of 151 patients without facial nerve paralysis before surgery who had undergone tumor resection. Previously untreated parotid cancers were included. (2) Results: The median follow-up duration was 62 months (range: 24–120 months). The FNI (+) group (n = 30) showed a significantly worse 5-year overall survival compared with the FNI (−) group (75.5 vs. 93.9%; hazard ratio = 4.19; 95% confidence interval: 1.74–10.08; p = 0.001). The tumor margin, tumor size, presence in the anterolateral parotid region (area 3), retromandibular vein involvement, distance from the stylomastoid foramen to the upper tumor margin, and a high tumor grade were significant factors related to FNI in the univariate analysis. A spiculated tumor margin, the tumor size (2.2 cm), and presence in area 3 were factors predicting FNI in the logistic regression model (p = 0.020, 0.005, and 0.050, respectively; odds ratio: 4.02, 6.40, and 8.16, respectively). (3) Conclusions: The tumor size (≥2.2 cm), spiculated margin, and presence in area 3 as presented in CT and MRI may help clinicians preoperatively predict FNI in patients with parotid cancer and establish an appropriate surgical plan.

Invasive larynx or pharyngeal fungal infections are rare. We report an invasive fungal laryngopharyngitis patient who complained of a persistent sore throat after an allogenic bone marrow transplant and a haploidentical stem cell transplant. An antifungal gargle was used after finding necrotic changes extending from the right soft palate to the aryepiglottic fold. Biopsy and culture suggested a fungal infection with suspicious mucormycosis. Imaging showed the right oropharynx, supraglottis, and the parapharnygeal space were involved. After initiating liposomal amphotericin B for 4 days, wide excisional debridement, and a partial pharyngectomy with an anterolateral thigh free flap including the deep fascia were performed. Amphotericin B and posaconazole were used subsequently. Pathology assessment indicated invasive mucormycosis. There was no recurrence for 9 months. Mucormycosis is a fatal opportunistic infection often seen in immunocompromised patients. Rapid detection, radical resection, and reconstruction can save the patient from a life-threatening fungal infection of the laryngopharynx.

Objectives: Immediate facial nerve substitution or graft technique has been used for the repair of facial nerve defects occurring as a result of tumour dissection. However, some patients report unsatisfactory outcomes, such as difficulty in maintaining resting or smiling symmetry, due to persistent flaccid facial palsy. Here we evaluated the functional outcomes of transferring the masseteric branch of the trigeminal nerve to the facial nerve adjunct to facial nerve graft. Methods: We reviewed the medical records of seven patients who underwent facial reanimation surgery between 2014 and 2016. The patients were divided into two groups according to the type of facial reanimation surgery: group A, masseteric nerve innervation with interposition graft; group B, interposition graft only. The postoperative resting symmetry and dynamic movement were compared. Results: Facial contraction was first observed in group A at 4 months and in group B at 7.3 months. Most of the patients achieved reliable resting symmetry; however, one patient in group B exhibited unsatisfactory facial weakness on the affected side. Group A patients showed better dynamic movement than group B patients. Eye closure, oral excursion and oral continence were better in group A than in group B patients. Smile symmetry in both groups was similar due to hyperkinetic movement in group A patients and flaccidity in group B patients. Conclusions: Dual innervation of the masseteric branch of the trigeminal nerve improves the dynamic movement of paralysed facial muscles and shortens the recovery period in patients with iatrogenic facial palsy.

본 연구의 목적은 노동시간의 단축이 관광지출에 미치는 영향을 분석하는 것이다. 분석을 위해 거시경제 변수를 활용한 거시적 분석을 시도하였다. 소득과 근로시간을 하나의 상호작용항 변수로 처리하는 방법을 사용하였다. 분석결과, 숙박지출에 대한 회귀분석모형의 월평균노동시간이 1% 하락할 때, 숙박지출의 GDP(소득)에 대한 탄력성이 0.3406 포인트 상승하는 것으로 나타난다. 월평균노동시간이 1% 감소할 때 실질숙박지출은 약 8.4% 증가하는 것으로 나타났다. 외식지출에 대한 분석 결과는 월평균근로시간이 1% 하락할 때, 외식지출의 GDP에 대한 탄력성이 0.0688 포인트 상승하는 것으로 나타난다. 최근 실질GDP를 대입하여 계산하면, 월평균노동시간이 1% 하락할 때 외식지출은 약 2% 정도상승하는 것으로 나타난다. 한편, 여행 지출은 통계적으로도 유의하지 않은 것으로 나타났다. 이는 여행의 경우 단순한 근로시간의 감소보다는 연속되는 여가시간이 확보되어야 지출이 늘어날 수 있는 성격을 지니고 있기 때문일 것으로 사료된다. 이상의 분석으로 볼 때 여가시간 증가로 인한 여유로움은 소비에 대한 선호를 변화시켰다고 볼 수 있으며, 이로 인하여 숙박, 외식 등의 소비가 늘어날 수 있는 가능성이 증대되었다고 할 수 있다. 즉, 소비성향의 변화가 여가시간의 증가와 소비지출의 증가간의 관계를 설명하는 조절기능을 역할을 하는 것으로 해석할 수 있다.

Metastatic lymph node (LN) burden is one of the most important prognosticators in human solid cancers, but has rarely been examined in laryngeal and hypopharyngeal cancers (LHC). We evaluated the nodal factors predictive of recurrence and survival in patients with LHC. This study included 141 consecutive patients who underwent primary surgery and neck dissection for previously untreated LHC at our tertiary referral centre. Nodal factors included the presence of pathological LN metastasis, number of positive LNs, LN ratio, and extra-nodal extension (ENE). Our proposed N classification was analysed by recursive partitioning analysis and compared with the AJCC and other N classifications using the c-index. Univariate and multivariate Cox proportional hazard regression analyses were used to define significant predictors of post-treatment disease-free survival (DFS) and overall survival (OS). Of the 141 patients, 66 (46.8%) had positive LNs, and 27 (19.1%) had ENE. In multivariate analyses, the number of positive LNs was strongly associated with DFS and OS outcomes (P

Objective To determine whether radiologic extranodal extension (ENE) appearing on pretreatment CT and MRI could predict the prognosis in patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC). Materials and methods The study population was obtained from a historical cohort diagnosed with HPV-related OPSCC. A total of 134 OPSCC patients who had a metastatic lymph node on pretreatment CT or MRI were included, and radiologic ENE was evaluated by two experienced head and neck radiologists. Kaplan-Meier and multivariate Cox regression analyses were performed to evaluate the impact of radiologic ENE on progression-free survival (PFS). The diagnostic performance of CT and MRI for the diagnosis of ENE was also evaluated in patients who underwent neck dissection. Results Seventy patients (52.2%) showed radiologic ENE-positive findings. Although patients showing radiologic ENE had a worse 3-year PFS (83.7% vs. 95.3%, p = 0.023), the association between radiologic ENE and PFS was not statistically significant on multivariate analysis (p = 0.141; hazard ratio, 2.68; 95% confidence interval, 0.72-9.97). CT or MRI had a sensitivity of 62%, specificity of 77.8%, and accuracy of 71.9% for predicting pathologic ENE. Conclusion Radiologic ENE on CT or MRI did not predict poor PFS in patients with HPV-related OPSCC, although there was a trend towards worse PFS. Further studies are warranted to determine whether radiologic ENE is a useful imaging biomarker to risk-stratify patients with HPV-related OPSCC.

BACKGROUND Owing to the COVID-19 pandemic, social distancing has become mandatory. Wireless endoscopy in contactless examinations promises to protect health care workers and reduce viral spread. OBJECTIVE This study aimed to introduce a contactless endoscopic diagnosis system using a wireless endoscope resembling a mask. METHODS The Wi-Fi–based contactless mask endoscopy system comprises a disposable endoscope and a controller. First, the effective force applied by the tip during insertion was evaluated in a simple transoral model consisting of a force sensor on a simulated oropharynx wall. Second, the delay in video streaming was evaluated by comparing the frame rate and delays between a movement and its image over direct and Wi-Fi connections. Third, the system was applied to a detailed laryngopharyngeal tract phantom. RESULTS The smartphone-controlled wireless endoscopy system was successfully evaluated. The mean, maximum, and minimum collision forces against the wall of the transoral model were 296 mN (30 gf), 363 mN (37 gf), and 235 mN (24 gf), respectively. The delay resulting from the wireless connection was 0.72 seconds. Using the phantom, an inexperienced user took around 1 minute to orient the endoscope to a desired area via the app. CONCLUSIONS Device articulation does not pose a significant risk of laryngopharyngeal wall penetration, and latency does not significantly impede its use. Contactless wireless video streaming was successful within the access point range regardless of the presence of walls. The mask endoscope can be controlled and articulated wirelessly, minimizing contact between patients and device operators. By minimizing contact, the device can protect health care workers from infectious viruses like the coronavirus. CLINICALTRIAL

Background: Despite the usually favorable prognosis of well-differentiated thyroid cancer (WDTC) following appropriate treatment, advanced T-staged WDTCs are associated with poor prognosis. This study focused on identifying the driver genes of locally advanced WDTC by analyzing the TCGA cohort.Methods: We analyzed data on 501 patients with WDTC from the TCGA cohort. Patients were classified into two subgroups of pathological T4 stage or T1-3 stage (Cluster1 and Cluster2, respectively). The mRNA expression differences between subgroups were compared for several genes in the TCGA cohorts.Results: Cluster1 included 23 patients with pathological T4 classification (Papillary=21/Follicular=2) and Cluster2 included 478 patients (Papillary=371/Follicular=100/Others=7). The Cluster1 subgroup showed worse overall survival than the Cluster2 subgroup (p < 0.05). The two subgroups were analyzed for 34 genes reported in previous studies. Known genetic thyroid cancer alterations, including BRAF, RAS, RET, and ALK, were not different in the two subgroups. In Cluster1, MET, SERPINA1, TIMP1, PROS1, FN1, CDKN2A, and CDKN2B were significantly elevated, while TG, DNAH9, TFF3, CRABP1, TPO, JAK2, KIT, KDR, and NFE2L2 were significantly lower compared with the Cluster2 (all, p < 0.05). A TERT, EIF1AX, and ATM showed significantly frequent somatic mutations in Cluster1 compared to Cluster2. We also identified seven pathways related to the 16 genetic markers.Conclusions: Locally advanced WDTC presented 16 genetic alterations compared to less aggressive thyroid cancers. Somatic mutations associated with local invasion transformation were identified. Genetic profiles associated with locally advanced WDTC have prognostic significance, but these findings must be validated to further understand the pathway.

Background Currently, high-speed digital imaging (HSDI), especially endoscopic HSDI, is routinely used for the diagnosis of vocal cord disorders. However, endoscopic HSDI devices are usually large and costly, which limits access to patients in underdeveloped countries and in regions with inadequate medical infrastructure. Modern smartphones have sufficient functionality to process the complex calculations that are required for processing high-resolution images and videos with a high frame rate. Recently, several attempts have been made to integrate medical endoscopes with smartphones to make them more accessible to people in underdeveloped countries. Objective This study aims to develop a smartphone adaptor for endoscopes, which enables smartphone-based vocal cord imaging, to demonstrate the feasibility of performing high-speed vocal cord imaging via the high-speed imaging functions of a high-performance smartphone camera, and to determine the acceptability of the smartphone-based high-speed vocal cord imaging system for clinical applications in developing countries. Methods A customized smartphone adaptor optical relay was designed for clinical endoscopy using selective laser melting–based 3D printing. A standard laryngoscope was attached to the smartphone adaptor to acquire high-speed vocal cord endoscopic images. Only existing basic functions of the smartphone camera were used for HSDI of the vocal cords. Extracted still frames were observed for qualitative glottal volume and shape. For image processing, segmented glottal and vocal cord areas were calculated from whole HSDI frames to characterize the amplitude of the vibrations on each side of the glottis, including the frequency, edge length, glottal areas, base cord, and lateral phase differences over the acquisition time. The device was incorporated into a preclinical videokymography diagnosis routine to compare functionality. Results Smartphone-based HSDI with the smartphone-endoscope adaptor could achieve 940 frames per second and a resolution of 1280 by 720 frames, which corresponds to the detection of 3 to 8 frames per vocal cycle at double the spatial resolution of existing devices. The device was used to image the vocal cords of 4 volunteers: 1 healthy individual and 3 patients with vocal cord paralysis, chronic laryngitis, or vocal cord polyps. The resultant image stacks were sufficient for most diagnostic purposes. The cost of the device including the smartphone was lower than that of existing HSDI devices. The image processing and analytics demonstrated the successful calculation of relevant diagnostic variables from the acquired images. Patients with vocal pathologies were easily differentiable in the quantitative data. Conclusions A smartphone-based HSDI endoscope system can function as a point-of-care clinical diagnostic device. The resulting analysis is of higher quality than that accessible by videostroboscopy and promises comparable quality and greater accessibility than HSDI. In particular, this system is suitable for use as an accessible diagnostic tool in underdeveloped areas with inadequate medical service infrastructure.