Clinical approach and treatment of benign and malignant parotid masses, personal experience

Parotid gland tumours account for 80% of all salivary gland neoplasms, 20% of these are malignant, but in daily clinical practice most parotid masses are operated on before obtaining the final histological diagnosis. This clinical setting further complicates the critical point of parotid surgery, which is the management of the facial nerve. In the present study, data were evaluated referring to 540 patients who underwent parotidectomy for a mass which was discovered to be a benign (470 cases) or a malignant (70 cases) neoplasm, between November 1994 and December 2007, at our Institution. The most significant single parameter in this series of malignancies regarding disease specific survival was the clinical involvement of the facial nerve at diagnosis (p = 0.006). Also for this reason, as there is no evidence that liberal VIIth nerve sacrifice improves prognosis, when it is not clinically involved, every attempt is made to dissect and preserve it. At present, the most complicated situation concerning nerve preservation may be, on the other hand, recurrence of a benign tumour, in particular pleomorphic adenoma, which, in our series, has a higher incidence (8.3%) of permanent facial dysfunction, than surgery with nerve preservation for malignancy (3.7%)

Uncovering neurodevelopmental paths to Autism Spectrum Disorder through an integrated analysis of developmental measures and neural sensitivity to faces

Background: Autism Spectrum Disorder (ASD) is highly heterogeneous in etiology and manifestation. The neurobiological processes underlying ASD development are reflected in multiple features, from behavior and cognition to brain functioning. An integrated analysis of these features may optimize the identification of these processes. Methods: We examined cognitive and adaptive functioning, and ASD symptoms between 8 and 36 months in 161 infants at familial high-risk for ASD (HR) and 71 low-risk controls (LR), and neural sensitivity to eye-gaze at 8 months in a subsample of 140 HR and 61 LR. We used linked independent component analysis to extract patterns of variation across domains and development, and selected the patterns significantly associated with clinical classification at 36 months. Results: An early process at 8 months, indicating high levels of functioning and low levels of symptoms linked to higher attention to gaze shifts, was reduced in infants who developed ASD. A longitudinal process of increasing functioning and low levels of symptoms was reduced in infants who developed ASD, while another process suggesting a stagnation in cognitive functioning at 24 months was increased in infants who developed ASD. Limitations: Although results show a clear significant trend relating to clinical classification, there was substantial overlap between groups. Conclusions: We uncovered underlying processes acting together early in development and associated with clinical outcome. Results highlight the complexity of emerging ASD, which goes beyond the borders of clinical categories. Future work should integrate genetic data to investigate the specific genetic risks linked to these processes

Colombian essential oil of ruta graveolens against nosocomial antifungal resistant candida strains

Drug resistance in antifungal therapy, a problem unknown until a few years ago, is increasingly assuming importance especially in immunosuppressed patients and patients receiving chemotherapy and radiotherapy. In the past years, the use of essential oils as an approach to improve the effectiveness of antifungal agents and to reduce antifungal resistance levels has been proposed. Our research aimed to evaluate the antifungal activity of Colombian rue, Ruta graveolens, essential oil (REO) against clinical strains of Candida albicans, Candida parapsilopsis, Candida glabrata, and Candida tropicalis. Data obtained showed that C. tropicalis and C. albicans were the most sensitive strains showing minimum inhibitory concentrations (MIC) of 4.1 and 8.2 µg/mL of REO. Time–kill kinetics assay demonstrated that REO showed a fungicidal effect against C. tropicalis and a fungistatic effect against C. albicans. In addition, an amount of 40% of the biofilm formed by C. albicans was eradicated using 8.2 µg/mL of REO after 1 h of exposure. The synergistic effect of REO together with some antifungal compounds was also investigated. Fractional inhibitory concentration index (FICI) showed synergic effects of REO combined with amphotericin B. REO Lead a disruption in the cellular membrane integrity, consequently resulting in increased intracellular leakage of the macromolecules, thus confirming that the plasma membrane is a target of the mode of action of REO against C. albicans and C. tropicalis

IFN-\u3b3 and other serum cytokines in head and neck squamous cell carcinomas

Altered immune responses have been reported in head and neck cancer, and some of these responses have been associated with poor clinical outcomes. A multiple-array technology platform was used to simultaneously evaluate the levels of 25 cytokines. Pre-treatment serum levels were evaluated in 31 HNSCC patients and 6 healthy controls. The levels of 8 cytokines, specifically IL-1ra, IL-2, IL-5, IL-6, IL-8, IL-17, IFN-\u3b3 and IP-10, were significantly higher in patients than in controls. Among cancer patients we observed lower levels of IFN-\u3b3 and IL-7 in cases with nodal metastases compared to those with cN0 disease. We observed increases in the levels of some serum cytokines in HNSCC patients, as well as reductions in selected cytokines associated with regional progression. These findings provide an intriguing perspective on the development and validation of novel markers for follow-up evaluations and predictions of regional spreading in HNSCC patients

Patients With Voice Prosthesis Rehabilitation During the COVID-19 Pandemic: Analyzing the Effectiveness of Remote Triage and Management

Objective: To describe a remote approach used with patients with voice prosthesis after laryngectomy during the COVID-19 pandemic and the resulting clinical outcomes in terms of voice prosthesis complications management, oncological monitoring, and psychophysical well-being. Study Design: Prospective cohort study. Setting: Otolaryngology Clinic of the University Polyclinic A. Gemelli, IRCCS Foundation. Subjects and Methods: All patients with voice prosthesis who underwent laryngectomy followed by our institute were offered enrollment. Patients who agreed to participate were interviewed to inquire about the nature of the need and to plan a video call with the appropriate clinician. Before and 1 week after the clinician’s call, patients were tested with the Hospital Anxiety and Depression Scale. Degrees of satisfaction were investigated with a visual analog scale. A comparison between those who accepted and refused telematic support was carried out to identify factors that influence patient interest in teleservice. Results: Video call service allowed us to reach 37 (50.68%) of 73 patients. In 23 (62.16%) of 37 cases, the video call was sufficient to manage the problem. In the remaining 14 cases (37.83%), an outpatient visit was necessary. Participants who refused telematic support had a significantly shorter time interval from the last ear, nose, and throat visit than patients who accepted (57.95 vs 96.14 days, P =.03). Video-called patients showed significantly decreased levels of anxiety and depression (mean Hospital Anxiety and Depression Scale total score pre– vs post–video call: 13.97 vs. 10.23, P <.0001) and reported high levels of satisfaction about the service. Conclusion: Remote approach may be a viable support in the management of patients with voice prosthesis rehabilitation

Modelling tumour volume variations in head and neck cancer: contribution of magnetic resonance imaging for patients undergoing induction chemotherapy

La valutazione del volume del tumore primitivo ha mostrato un valore predittivo per la stima dei risultati della sopravvivenza. Usando i dati volumetrici acquisiti con la Risonanza Magnetica (RM) nei pazienti sottoposti a chemioterapia di induzione (CI), tali risultati sono stati stimati nei pazienti con tumore del testa e collo, prima del trattamento radiante. Le immagini RM acquisite prima e dopo CI in 36 pazienti con tumore avanzato della testa e del collo sono state analizzate per valutarne il volume del tumore primitivo. I due volumi sono stati correlati utilizzando la regressione lineare locale tra i volume valutati nelle immagini della prima e quelli della seconda RM. Sono stati definiti i modelli di rischio proporzionale di COX per la valutazione del controllo locoregionale, la sopravvivenza libera da malattia e la sopravvivenza globale. La regressione lineare locale ha mostrato un buon valore predittivo per tutti i risultati di sopravvivenza nei modelli di rischio proporzionale di COX. I modelli predittivi per il controllo locoregionale di malattia e la sopravvivenza libera da malattia a 24 mesi ha mostrato una ottima discriminazione e capacità di previsione. La valutazione delle variazioni dei volumi dei tumori primitivi della testa e del collo dopo CI fornisce un esempio di modello che può essere facilmente utilizzato per altri approcci terapeutici. Una valutazione completa delle variabili nelle covariate è un prerequisito necessario per la creazione di modelli clinicamente attendibili

Ent cobra ontology: the covariates classification system proposed by the Head & Neck and Skin GEC-ESTRO Working Group for interdisciplinary standardized data collection in head and neck patient cohorts treated with interventional radiotherapy (brachytherapy)

Purpose: Clinical data collecting is expensive in terms of time and human resources. Data can be collected in different ways; therefore, performing multicentric research based on previously stored data is often difficult. The primary objective of the ENT COBRA (COnsortium for BRachytherapy data Analysis) ontology is to define a specific terminological system to standardized data collection for head and neck (H&N) cancer patients treated with interventional radiotherapy. Material and methods: ENT-COBRA is a consortium for standardized data collection for H&N patients treated with interventional radiotherapy. It is linked to H&N and Skin GEC-ESTRO Working Group and includes 11 centers from 6 countries. Its ontology was firstly defined by a multicentric working group, then evaluated by the consortium followed by a multi-professional technical commission involving a mathematician, an engineer, a physician with experience in data storage, a programmer, and a software expert. Results: Two hundred and forty variables were defined on 13 input forms. There are 3 levels, each offering a specific type of analysis: 1. Registry level (epidemiology analysis); 2. Procedures level (standard oncology analysis); 3. Research level (radiomics analysis). The ontology was approved by the consortium and technical commission; an ad-hoc software architecture (\u201cbroker\u201d) remaps the data present in already existing storage systems of the various centers according to the shared terminology system. The first data sharing was successfully performed using COBRA software and the ENT COBRA Ontology, automatically collecting data directly from 3 different hospital databases (L\ufcbeck, Navarra, and Rome) in November 2017. Conclusions: The COBRA Ontology is a good response to the multi-dimensional criticalities of data collection, retrieval, and usability. It allows to create a software for large multicentric databases with implementation of specific remapping functions wherever necessary. This approach is well-received by all involved parties, primarily because it does not change a single center\u2019s storing technologies, procedures, and habits