Transoral surgery for superficial head and neck cancer: National Multi‐Center Survey in Japan

Head and neck cancers, especially in hypopharynx and oropharynx, are often detected at advanced stage with poor prognosis. Narrow band imaging enables detection of superficial cancers and transoral surgery is performed with curative intent. However, pathological evaluation and real-world safety and clinical outcomes have not been clearly understood. The aim of this nationwide multicenter study was to investigate the safety and efficacy of transoral surgery for superficial head and neck cancer. We collected the patients with superficial head and neck squamous cell carcinoma who were treated by transoral surgery from 27 hospitals in Japan. Central pathology review was undertaken on all of the resected specimens. The primary objective was effectiveness of transoral surgery, and the secondary objective was safety including incidence and severity of adverse events. Among the 568 patients, a total of 662 lesions were primarily treated by 575 sessions of transoral surgery. The median tumor diameter was 12 mm (range 1–75) endoscopically. Among the lesions, 57.4% were diagnosed as squamous cell carcinoma in situ. The median procedure time was 48 minutes (range 2–357). Adverse events occurred in 12.7%. Life-threatening complications occurred in 0.5%, but there were no treatment-related deaths. During a median follow-up period of 46.1 months (range 1–113), the 3-year overall survival rate, relapse-free survival rate, cause-specific survival rate, and larynx-preservation survival rate were 88.1%, 84.4%, 99.6%, and 87.5%, respectively. Transoral surgery for superficial head and neck cancer offers effective minimally invasive treatment

Outer Membrane Vesicles of Porphyromonas gingivalis Elicit a Mucosal Immune Response

We previously reported that mutation of galE in Porphyromonas gingivalis has pleiotropic effects, including a truncated lipopolysaccharide (LPS) O-antigen and deglycosylation of the outer membrane protein OMP85 homolog. In the present study, further analysis of the galE mutant revealed that it produced little or no outer membrane vesicles (OMVs). Using three mouse antisera raised against whole cells of the P. gingivalis wild type strain, we performed ELISAs to examine the reactivity of these antisera with whole cells of the wild type or the galE mutant. All three antisera had significantly lower reactivity against the galE mutant compared to wild type. OMVs, but not LPS, retained the immunodominant determinant of P. gingivalis, as determined by ELISAs (with wild type LPS or OMVs as antigen) and absorption assays. In addition, we assessed the capacity of OMVs as a vaccine antigen by intranasal immunization to BALB/c mice. Synthetic double-stranded RNA polyriboinosinic polyribocytidylic acid [Poly (I∶C)], an agonist of Toll-like receptor 3 (TLR3), was used as the mucosal adjuvant. Vaccination with OMV elicited dramatically high levels of P. gingivalis-specific IgA in nasal washes and saliva, as well as serum IgG and IgA. In conclusion, the OMVs of P. gingivalis have an important role in mucosal immunogenicity as well as in antigenicity. We propose that P. gingivalis OMV is an intriguing immunogen for development of a periodontal disease vaccine

A pediatric case of multiple trauma with impending cardiac arrest due to hemorrhagic shock successfully treated with resuscitative thoracotomy: A case report

Abstract Background The effectiveness of resuscitative thoracotomy (RT) in pediatric patients with multiple trauma is limited. We present a pediatric case of multiple trauma successfully treated with RT. Case Presentation A 9‐year‐old boy was injured after falling down stairs. On arrival, his blood pressure was unmeasurable, and the carotid artery pulse was barely palpable. Sonographic assessment indicated intra‐abdominal hemorrhage. RT and aortic cross‐clamping were performed, and he received a blood transfusion, after which his circulatory status recovered. Laparotomy indicated an inferior mesenteric vein injury that was sutured. Ten hours after arrival, an acute epidural hematoma was observed and treated with an emergency craniotomy. The patient's condition remained stable and he was discharged on the 101st day. Conclusion RT may save the life of patients with multiple trauma, even pediatric patients, if performed in a timely manner, based on the diagnosis of hemorrhagic shock, along with rapid transfusion and hemostatic intervention

<i>P. gingivalis</i> antiserum cross-reacts strongly with OMVs, but not with LPS.

<p>(A) ELISA plates were coated with LPS and OMVs of <i>P. gingivalis</i>. <i>P. gingivalis</i>, antiserum-2 and pre-immune serum were used at dilutions of 1∶1,000. Sera reactivity was determined as the absorbance at 405 nm (mean ± SD) for triplicate assays after a 30-min incubation with alkaline phosphatase substrate. (B) To test whether antiserum-2 cross-reacts with OMVs or LPS, we absorbed the serum against LPS and OMVs and removed bound antibodies. ELISA results are expressed as absorbance at 405 nm (mean ± SD) after a 30-min incubation with alkaline phosphatase substrate.</p