Search

Cervical cancer is a cancer caused by an infection derived from the Human Papillomavirus (HPV) that proliferates in the cervical mucosa. Cervical cancer ranks among the two highest incidences experienced by women, with 23.4% and an average death rate of 13.9%. Vascular endothelial growth factor (VEGF) is an important protein that plays a role in the pathology of angiogenesis in tumor growth and metastasis. Various efforts have been made to minimize mortality from cervical cancer, but they have caused side effects. Indonesia is rich in a diversity of flora that has the potential to be used as a natural medicine, for example, soursop leaves (Annona muricata). The study aimed to predict the compound extract of soursop leaves as a candidate drug for cervical cancer based on a silico approach. The prediction of phytochemical properties is made based on the five laws of Lipinski as seen from the values of absorption, distribution, and metabolism with Swiss ADME. The in-silico method was conducted with the assistance of computer devices, databases, and software like Autodock, PyRx, PyMol, and Discovery Studio. The target proteins used are VEGFR1 (PDB: 3HNG) and VEGFR-2 (PDB: 3VHE). The results showed that kaempferol, sativene, and thiazole-2,4(3H,5H)-dione, 5-benzylideno-3-[(ethylphenylamino)methyl] meet the five laws of Lipinski. The compound kaempferol has the lowest binding affinity, with a value of -8.5 kcal/mol on VEGFR-1 and -10.2 kcal/mol on VEGFR-2. On the other side, sunitib interactions with VEGFR-1 were -10.0 kcal/mol and -9.4 kcal/mol, respectively. Based on the results, can be concluded that kaempferol has a high potential to be a drug candidate for cervical cancer.

Stephanie M Cohen,1 S Travis Greathouse,2 Cyrus C Rabbani,3 Joseph O’Neil,4 Matthew A Kardatzke,5 Tasha E Hall,6 William E Bennett Jr,7 Ameet S Daftary,8 Bruce H Matt,3 Sunil S Tholpady1 1Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, 2Reid Health, Richmond, 3Department of Otolaryngology – Head and Neck Surgery, 4Section of Developmental Pediatrics, 5Section of Neonatal-Perinatal Medicine, Department of Pediatrics, 6Department of Orthodontics, 7Section of Children’s Health Services Research, Section of Pediatric and Adolescent Comparative Effectiveness Research, 8Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA Abstract: Robin sequence (RS) is a commonly encountered triad of micrognathia, glossoptosis, and airway obstruction, with or without a cleft palate. The management of airway obstruction is of paramount importance, and multiple reviews and retrospective series outline the diagnosis and treatment of RS. This article focuses on the multidisciplinary nature of RS and the specialists’ contributions and thought processes regarding the management of the RS child from birth to skeletal maturity. This review demonstrates that the care of these children extends far beyond the acute airway obstruction and that thorough monitoring and appropriate intervention are required to help them achieve optimal outcomes. Keywords: cleft palate, micrognathia, mandibular distraction, retrognathia, laryngomalacia

Nasal bone fractures are the most common type of facial injury and can pose significant long-term challenges if not diagnosed and treated correctly at the time of presentation, including, but not limited to, septal hematoma, infection, epistaxis, persistent nasal deformity, nasolacrimal injury, deviated septum, and even mental health issues as serious as post-traumatic stress disorder as persistent complications (1-4). Optimal management remains controversial and subjective based on the clinician's judgment, with many factors playing a role in the provider's decision, including the timing of treatment, the choice between foregoing treatment or choosing to undergo a closed or open reduction, and how to manage subsequent revision surgeries if necessary.

Background: Rates of spontaneous cerebrospinal fluid leak (sCSF) repairs have increased in recent decades in line with increases in obesity rates., Objectives: To determine if the national rate of sCSF leak has continued to rise in recent years and to identify associated risk factors utilizing a comprehensive national database comprising most academic medical centers., Methods: A retrospective review from 2009 to 2018 was performed using the Vizient Clinical Database (CDB) of 105 leading academic medical centers in the United States. Patients who underwent CSF leak repair in the CDB database using ICD-9 and ICD-10 diagnostic and procedure codes. Patients with epidural hematomas over the same time frame were used as a control. National rates of craniotomy for sCSF leak repair each quarter were assessed and sCSF leak patient characteristics (age, gender, obesity, hypertension, diabetes) were calculated., Results: The rate of craniotomy for all sCSF leak repairs increased by 10.2% annually from 2009 to 2015 ( P < 0.0001). There was no statistically significant change in the rate of epidural hematomas over the same period. The rate of lateral sCSF leak repair increased on average by 10.4% annually from 2009 (218 cases/year) to 2018 (457 cases/year) ( P < 0.0001). A statistically significant increase was observed across all regions of the United States ( P ≤ 0.005). sCSF leak patients had an average (standard deviation) age of 55.0 (13.2) years and 67.2% were female. Obesity was the only demographic factors that increased significantly over time. Likely due to comorbid factors, Black patients comprise a disproportionately large percentage of lateral sCSF leak repair patients., Conclusions: The rate of craniotomy for spontaneous CSF leaks continues to rise by approximately 10% annually., Competing Interests: None declared., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of Otology & Neurotology, Inc.)

Objective: Temporal bone spontaneous cerebrospinal fluid (sCSF) leaks are characterized by defects in the tegmen along with calvarial thinning without associated thinning of the extracranial zygoma. The authors sought to determine the effect of age and race on calvarial, tegmen, and zygoma thickness., Study Design: Retrospective cohort study., Setting: Tertiary Referral Center., Patients: A total of 446 patients with high-resolution head computer tomography (CT) imaging from 2003 to 2018.Intervention(s): Calvarial, tegmen, and zygoma thicknesses were measured using 3D slicer.Main Outcome Measure(s): Effects of age and race on calvarium, tegmen, zygoma thickness., Results: Among all patients, increased age was associated with increased thickness of the calvarium [95% CI, 0.0002 to 0.007 mm/year, P < 0.05] and tegmen [95% CI, 0.00039 to 0.0075 mm/year, P = 0.03], but decreased thickness of the zygoma [95% CI, -0.013 to -0.005 mm/year, P < 0.001]. When compared to white patients, black patients had thicker mean [SD] calvaria (2.63 [0.61] versus 3.30 [0.79] mm; difference, 0.67 mm; [95% CI, 0.57 to 0.77]; Cohen d, 1.02), tegmen (0.73 [0.34] versus 0.92 [0.36] mm; difference 0.19 mm; [95% CI, 0.101 to 0.279]; Cohen d, 0.533) and zygoma (4.89 [0.81] versus 5.55 [0.91] mm; difference, 0.66 mm; [95% CI, 0.53 to 0.79]; Cohen d, 0.78)., Conclusions: Racial differences exist in calvarial and zygoma thickness. Aging generally leads to increased calvarium and tegmen thickness, suggesting that early onset of obesity and comorbid conditions known to thin the skull base may predispose patients to developing sCSF leaks by reversing the effects of age., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 by Mutaz B. Habal, MD.)

Purpose: To present the results of treating combined lower eyelid laxity, retraction and midface descent secondary to facial nerve weakness with a hybrid surgical procedure., Materials and Methods: A retrospective analysis of patients from January 2015 to January 2017 who underwent a hybrid surgical technique for the treatment of corneal exposure secondary to facial nerve paresis with a single surgeon was performed. Age, gender, and presence of exposure symptoms were recorded pre-operatively. Outcomes assessed included improvement of lower eyelid laxity and position, operative complications, and post-operative symptomatic relief., Results: A total of 11 patients underwent unilateral eyelid surgery. All patients had symptomatic relief and good functional outcomes defined as improvement in eyelid laxity, lower eyelid position, and objective corneal exposure. No cases required reoperation during an average follow up of 174.5 days., Conclusions: Combining portions of a tarsorrhaphy and lateral wedge resection technique is a simple and effective procedure to improve lower eyelid position and limit corneal exposure secondary to facial nerve paresis., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Importance: Spontaneous cerebrospinal fluid leaks (sCSF-L) of the temporal bone are associated with obesity, calvarial thinning, and obstructive sleep apnea (OSA), and the incidence has doubled in the past decade. It is currently unknown if OSA is independently associated with skull thinning., Objective: To determine if patients with OSA have thinner skulls than patients without OSA., Design, Setting, and Participants: A retrospective cohort study of patients who underwent a level 1 polysomnogram (PSG) and also had high-resolution computed tomographic (CT) imaging of the head from January 2010 to March 2017 at Indiana University was carried out. Patients with moderate to severe OSA (apnea-hypopnea index [AHI]≥25/h) and without OSA (AHI<5/h) were matched for age and body mass index (BMI, calculated as weight in kilograms divided by height in meters squared)., Interventions: Measurement of calvarial thickness, extracranial zygoma thickness, skull base height and tegmen dehiscence (>4 mm) when blinded to OSA status., Main Outcomes and Measures: Primary outcomes were calvarial, skull base, and zygoma thickness differences between patients with OSA vs those without OSA., Results: A total of 22 933 patients had a PSG and 1012 also had head CT imaging. Of the 1012 patients with both PSG and CT, the mean (SD) age was 50.8 (16.2) years and 624 (61.7%) were women. Those patients with moderate to severe OSA (56) and without OSA (58) were matched for mean (SD) age (50.3 [6.5] vs 49.8 [6.1] years]) and BMI (37.4 [8.1] vs 38.6 [6.8]). Patients with OSA had thinner mean (SD) calvaria (2.73 [0.67] vs 2.47 [0.52] mm; difference, -0.26 mm; 95% CI, -0.49 to -0.04; Cohen d, 0.44) and thinner skull bases (5.03 [1.40] vs 4.32 [1.28] mm; difference, -0.71; 95% CI, -1.23 to -0.19; Cohen d, 0.53). The mean (SD) extracranial zygoma thickness was the same (4.92 [0.87] vs 4.84 [0.84] mm; difference, -0.07 mm; 95% CI, -0.39 to 0.24). The tegmen mastoideum was dehiscent in nearly twice as many patients with OSA as those without (37% vs 20%; difference, 17%; 95% CI, 0.4-32)., Conclusions and Relevance: Obstructive sleep apnea was independently associated with intracranial bone (calvaria and skull base) thinning and not with extracranial (zygoma) thinning. These findings support a possible role of OSA in the pathophysiologic development of sCSF-L.

Purpose: Computed tomographic (CT) imaging was used to determine the displacement of stranded seeds between day 0 and day 30 following prostate seed implants. Post-plan dosimetry was used to assess the dosimetric consequence of strand displacement., Methods and Materials: Between March 2006 and December 2009, 86 prostate seed implant patients had day 0 and day 30 post-plan CT imaging. Migrated strands were first identified by inspection of day 0 and day 30 scans. The exact distance of displacement was measured using 3-dimensional fusion software. Post-plan dosimetric analysis was performed using CMS software., Results: Of the 1550 strands placed, 23 strands exhibited substantial movement and these displacements occurred in 21 of the 86 cases. The measured distance of strand movement ranged from 0.31 cm to 3.44 cm, with mean displacement of 2.75 cm. Of the displaced strands, 15 strands moved away from the implant center while 8 strands moved toward the implant center. A comparison of changes in dosimetric parameters between day 0 and day 30 revealed expected increases in D90 related to resolution of prostate edema. When cases of strand displacement were compared with cases without displacement, there were no differences in D90 or V100 at day 0. At day 30, however, statistically significant decreases in D90 (96.8% vs 89.5%; P = .0061) and V100 (85.9% vs 82.2%; P = .046) were noted for cases with strand displacement. When the data were analyzed by looking at the change in dosimetric parameters over time for each individual case (eg, comparing the difference in D90 from day 0 to day 30 per patient) there was a trend toward decrease in D90 with displacement of the strands but this did not achieve statistical significance (P = .09)., Conclusions: Stranded seeds show unexpected spatial instability in the craniocaudal dimension. Strand displacement may occur in approximately 1.5% of stranded sources placed and about 25% of cases. One may expect mean decreases in D90 and V100 of about 7% and 3%, respectively, among cases exhibiting strand migration in the first month following seed implant. Resolution of prostate edema during the same time period accounts for an approximately 30% increase in D90 and V100., (Copyright © 2012 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)