Endoscopic transcanal approach to geniculate ganglion hemangioma and simultaneous facial nerve reinnervation: A case report

Hemangioma of the facial nerve (FN) is a very rare benign tumor whose origin is the vascular plexi that surround the nerve. The transpetrous, retrosigmoid, and middle cranial fossa (MCF) routes are the traditional and most widely used approaches to reach these lateral skull base neoformations. However, this very complex region can be reached through an exclusive transcanal endoscopic procedure in selected cases. One of these was a 42-year-old patient who had been presenting a worsening left FN paralysis (grade VI according to the House-Brackmann scale at the time of visit) for 22 months without a history of trauma or infection. Radiological studies showed a lesion in the region of the geniculate ganglion. A suprageniculate endoscopic approach was performed to remove the lesion, with the sacrifice of the FN and a simultaneous hypoglossal-facial anastomosis. The aim of this minimally invasive surgery is the complete excision of the disease, maintaining the hearing function intact and restoration of facial function, whenever possible, avoiding more invasive approaches

Tracheostomy in the COVID-19 pandemic

Purpose: The role of tracheostomy in COVID-19-related ARDS is unknown. Nowadays, there is no clear indication regarding the timing of tracheostomy in these patients. Methods: We describe our synergic experience between ENT and ICU Departments at University Hospital of Modena underlining some controversial aspects that would be worth discussing tracheostomies in these patients. During the last 2 weeks, we performed 28 tracheostomies on patients with ARDS due to COVID-19 infection who were treated with IMV. Results: No differences between percutaneous and surgical tracheostomy in terms of timing and no case of team virus infection. Conclusion: In our experience, tracheostomy should be performed only in selected patients within 7- and 14-day orotracheal intubation

Volatile anesthetic agent pollution in operating rooms in a large Roman hospital. A preliminary note

Gli autori riportano i risultati di un'indagine, effettuata in alcune sale operatorie di un nosocomio romano, per determinare le concentrazioni di agenti anestetici volatili e verificare la relazione tra i diversi sistemi di bonifica ambientale presenti ed il grado di inquinamento. Vengono discussi i risultati ed individuate le possibili soluzioni del problem

Curva di apprendimento nella scialoendoscopia diagnostica e interventistica per le patologie salivari ostruttive

La scialoendoscopia è un nuovo strumento diagnostico e chirurgico che offre l’opportunità di trattare alcune patologie delle ghiandole salivari con procedure non invasive e con risultati potenzialmente superiori alle precedenti tecniche. Come per tutte le nuove tecniche, per raggiungere rapidamente risultati paragonabili a quelli riportati in letteratura, è indispensabile un corretto programma di formazione che segua una graduale curva di apprendimento. Questo include un appropriato programma diagnostico, una corretta selezione dei pazienti e la conoscenza delle possibili insidie operatorie. Abbiamo eseguito uno studio retrospettivo confrontando le prime 141 procedure (74 parotidee e 67 sottomandibolari) eseguite con questa tecnica nel nostro Dipartimento dal 2009 al 2013 con analoghe esperienze riportate in letteratura. I pazienti sono stati divisi in 3 gruppi: Gruppo A (le prime 49 procedure effettuate), gruppo B (le successive 50), Gruppo C (le ultime 42 procedure effettuate). Fra i tre gruppi non sono state evidenziate differenze statisticamente significative nei tempi medi di durata delle procedure, nella percentuale di ricorrenza della sintomatologia dopo il trattamento, nel numero di pazienti che hanno necessitato di più trattamenti e nell’incidenza di complicanze minori. Non sono state riportate complicanze maggiori. Con l’acquisizione di una maggiore esperienza da parte dei chirurghi si è evidenziato un progressivo calo del numero di interventi eseguiti in anestesia generale rispetto a quelli in anestesia locale (51% vs 18% vs 14%). Solo in tre casi su 130 ghiandole trattate (2.3%) è stato necessario eseguire un’asportazione ghiandolare. Per i calcoli salivari è stato valutato il tipo di tecnica utilizzato per l’estrazione e la percentuale d’insuccesso che era analoga nei tre gruppi (13.6% vs 15% vs 15%). I nostri risultati non differiscono sostanzialmente da quelli riportati in letteratura. Abbiamo risolto la difficoltà iniziale nella cateterizzazione del dotto con esercizi chirurgici su cadavere o su teste di maiale. La mancanza di precisione degli strumenti diagnostici radiologici può essere migliorata autonomizzando il chirurgo nell’esecuzione delle ecografie pre e post-operatorie. Viene infine sottolineata l’opportunità di creare dei centri di scialoendoscopia con un bacino di utenza di circa 1 o 2 milioni di abitanti in modo da concentrare le patologie, far fronte agli elevati costi della strumentazione necessaria e poter guadagnare la necessaria esperienza nelle gestione delle varie tecniche chirurgiche

Virtual screening for inhibitors of the human TSLP:TSLPR interaction

The pro-inflammatory cytokine thymic stromal lymphopoietin (TSLP) plays a pivotal role in the pathophysiology of various allergy disorders that are mediated by type 2 helper T cell (Th2) responses, such as asthma and atopic dermatitis. TSLP forms a ternary complex with the TSLP receptor (TSLPR) and the interleukin-7-receptor subunit alpha (IL-7Ra), thereby activating a signaling cascade that culminates in the release of pro-inflammatory mediators. In this study, we conducted an in silico characterization of the TSLP: TSLPR complex to investigate the drugability of this complex. Two commercially available fragment libraries were screened computationally for possible inhibitors and a selection of fragments was subsequently tested in vitro. The screening setup consisted of two orthogonal assays measuring TSLP binding to TSLPR: a BLI-based assay and a biochemical assay based on a TSLP: alkaline phosphatase fusion protein. Four fragments pertaining to diverse chemical classes were identified to reduce TSLP: TSLPR complex formation to less than 75% in millimolar concentrations. We have used unbiased molecular dynamics simulations to develop a Markov state model that characterized the binding pathway of the most interesting compound. This work provides a proof-ofprinciple for use of fragments in the inhibition of TSLP: TSLPR complexation

PDGFR\u3b2 and FGFR2 mediate endothelial cell differentiation capability of triple negative breast carcinoma cells

Triple negative breast cancer (TNBC) is a very aggressive subgroup of breast carcinoma, still lacking specific markers for an effective targeted therapy and with a poorer prognosis compared to other breast cancer subtypes. In this study we investigated the possibility that TNBC cells contribute to the establishment of tumor vascular network by the process known as vasculogenic mimicry, through endothelial cell differentiation. Vascular-like functional properties of breast cancer cell lines were investigated in vitro by tube formation assay and in vivo by confocal microscopy, immunofluorescence or immunohistochemistry on frozen tumor sections. TNBCs express endothelial markers and acquire the ability to form vascular-like channels in vitro and in vivo, both in xenograft models and in human specimens, generating blood lacunae surrounded by tumor cells. Notably this feature is significantly associated with reduced disease free survival. The impairment of the main pathways involved in vessel formation, by treatment with inhibitors (i.e. Sunitinib and Bevacizumab) or by siRNA-mediating silencing, allowed the identification of PDGFR\u3b2 and FGFR2 as relevant players in this phenomenon. Inhibition of these tyrosine kinase receptors negatively affects vascular lacunae formation and significantly inhibits TNBC growth in vivo. In summary, we demonstrated that TNBCs have the ability to form vascular-like channels in vitro and to generate blood lacunae lined by tumor cells in vivo. Moreover, this feature is associated with poor outcome, probably contributing to the aggressiveness of this breast cancer subgroup. Finally, PDGFR\u3b2 and FGFR2-mediated pathways, identified as relevant in mediating this characteristic, potentially represent valid targets for a specific therapy of this breast cancer subgroup

Salvage neck dissection for isolated neck recurrences in head and neck tumors: Intra and postoperative complications

Background and Objectives: The current evidence regarding complications after salvage neck dissection (ND) for isolated regional recurrences (IRRs) in head and neck cancers is poor. The aim of this study is to evaluate the incidence and differences in complication rates of salvage ND after primary surgery, radiotherapy, chemoradiotherapy, or combined treatments. Methods: This was a multicentric retrospective study on 64 patients who underwent salvage ND for IRR in three Italian institutes between 2008 and May 2020. Results: Complications were detected in 7 of the 34 patients (20.8%) and surgeons described difficult dissection in 20 patients (58.82%). Accidental vascular ligations or nervous injury during surgery were never detected. None of the variables analyzed were statistically significant in predicting the risk of complications, disease-free survival, or overall survival. Conclusions: IRR represents a rare entity among total relapses. The incidence of complications after salvage ND for IRR is higher than after primary surgery but at an acceptable rate in experienced hands. However, an adequate balance between functional and oncological outcomes is mandatory

Wound Healing Fluid Reflects the Inflammatory Nature and Aggressiveness of Breast Tumors

Wound healing fluid that originates from breast surgery increases the aggressiveness of cancer cells that remain after the surgery. We determined the effects of the extent of surgery and tumor-driven remodeling of the surrounding microenvironment on the ability of wound-healing to promote breast cancer progression. In our analysis of a panel of 34 cytokines, chemokines, and growth factors in wound healing fluid, obtained from 27 breast carcinoma patients after surgery, the levels of several small molecules were associated with the extent of cellular damage that was induced by surgery. In addition, the composition of the resulting wound healing fluid was associated with molecular features of the removed tumor. Specifically, IP-10, IL-6, G-CSF, osteopontin, MIP-1a, MIP-1b, and MCP1-MCAF were higher in more aggressive tumors. Altogether, our findings indicate that the release of factors that are induced by removal of the primary tumor and subsequent wound healing is influenced by the extent of damage due to surgery and the reactive stroma that is derived from the continuously evolving network of interactions between neoplastic cells and the microenvironment, based on the molecular characteristics of breast carcinoma cells