The staging of gastritis with the olga system in the italian setting. histological features and gastric cancer risk

BACKGROUND: Recently OLGA (Operative Link on Gastritis Assessment) classification has been proposed to identify high-risk forms of gastritis that can evolve in gastric cancer (stages III and IV). Helicobacter pylori infection and age older than 40 have been considered as independent risk factor for high-risk OLGA stages

Idiopathic infratentorial superficial siderosis of the central nervous system: case report and review of literature

The superficial siderosis (SS) of the central nervous system (CNS) is a rare condition characterized by a wide range of neurological manifestations directly linked to an acquired iron-mediated neurodegeneration. First described more than 100 years ago, only recently SS has been divided into two distinct entities, according to the distribution of iron deposition in the CNS: cortical superficial siderosis (cSS) and infratentorial superficial siderosis (iSS). Here we describe an adult case of iSS, with detailed clinical and radiological features. Moreover, we extensively review the literature of SS, particularly focusing on the pathogenesis, clinical-radiological classification, diagnostic algorithm and treatment options of this rare condition

Stability of circulating miRNA in saliva: The influence of sample associated pre-analytical variables

Background and aims: Increasing evidence supports the practicability of salivary cell-free (cf) miRNA as liquid biopsy markers in cancers. Its successful translation in the clinical setting requires reproducible approaches for saliva manipulation, in order to control for pre-analytical variables influencing miRNA stability. This study aims to define the optimal conditions to maintain the integrity of saliva during collection, transport and processing with respect to cf-miRNA quantification. Materials and methods: Saliva was collected from 20 healthy subjects and 8 oral cancer patients. Two sampling methods were tested and different storage temperatures and times were evaluated. Salivary expression level of target miRNAs was quantified by qPCR. Comparison between group mean values at specific conditions were performed using paired t-tests. Agreement between measurements was evaluated using a Bland-Altman plot. Results: Different collection methods revealed comparable levels of salivary miR-484 and miR-106b-5p in both subject cohorts. MiRNAs were stable for up to 48 h at 4 °C in saliva supernatant, showing significant alteration after 96 h. Mid-term storage of supernatant at -20 °C decreased miRNA stability significantly compared to standard -80 °C. Conclusions: Cf-miRNA in saliva were slightly altered by collection methods and storage conditions, both in healthy and in pathological contexts, and remained stable for a period of time compatible with main clinical routine needs

Fasciocutaneous free flaps for reconstruction of hypopharyngeal defects

Different reconstructive options are available for defects following total laryngectomy (TL) and circumferential (CH) or partial hypopharyngectomy (PH). We evaluated the flap success, pharyngocutaneous fistula, and pharyngoesophageal stenosis rates in two groups of patients treated by different policies

Treatment and outcomes of minor salivary gland cancers of the larynx and trachea: a systematic review

Objectives: Malignant minor salivary glands carcinomas (MiSGC) of the larynx and trachea are rare tumours and published evidence is sparse. We conducted a systematic review to describe shareable treatment strategies and oncological outcomes of these neoplastic entities. Methods: Full text English manuscripts published from January 1st 2000 to December 14th 2022 were included. Data on demographics, treatments and outcomes were collected. A pooled analysis of 5-year overall survival (OS) was performed. Results: Seventeen articles and 365 patients met the inclusion criteria. The most common subsites involved were subglottic and distal trachea. Adenoid cystic carcinoma was, by far, the most frequent histotype. The first-choice treatment strategy was surgery (86.8%), while adjuvant treatments were delivered in 57.4% of patients. Only 12.9% were treated with definitive radiotherapy with/without chemotherapy. The mean follow-up was 68.3 months. One hundred nine (34.9%) deaths were recorded and 62.4% were cancer-related. Five-year OS ranged from 20% to 100% and, at pooled analysis, it was 83% (range, 78%-87%). Conclusions: In case of MiSGC of the larynx and trachea, surgery remains the mainstay of treatment. Adjuvant treatments are frequently delivered. Survival estimates are good overall, but highly heterogeneous

Artificial intelligence in clinical endoscopy: Insights in the field of videomics

Artificial intelligence is being increasingly seen as a useful tool in medicine. Specifically, these technologies have the objective to extract insights from complex datasets that cannot easily be analyzed by conventional statistical methods. While promising results have been obtained for various -omics datasets, radiological images, and histopathologic slides, analysis of videoendoscopic frames still represents a major challenge. In this context, videomics represents a burgeoning field wherein several methods of computer vision are systematically used to organize unstructured data from frames obtained during diagnostic videoendoscopy. Recent studies have focused on five broad tasks with increasing complexity: quality assessment of endoscopic images, classification of pathologic and nonpathologic frames, detection of lesions inside frames, segmentation of pathologic lesions, and in-depth characterization of neoplastic lesions. Herein, we present a broad overview of the field, with a focus on conceptual key points and future perspectives

Subglotična visokofrekventna jet ventilacija u kirurškom liječenju obostrane pareze glasnica nakon operacije štitne žlijezde

Lesion of the recurrent laryngeal nerves as a consequence of thyroid surgery results in bilateral vocal fold paralysis and respiratory obstruction. The initial treatment involves ensuring an adequate airway and it ranges from tracheostomy to endo-extralaryngeal laterofixating operations in general anesthesia. Subglottic high frequency jet ventilation (HFJV) is an alternative ventilatory approach in airway surgery. HFJV offers optimal endolaryngeal working conditions, immobility of vocal cords, adequate oxygenation and ventilation. The HFJV was prospectively studied in 20 consecutive female patients with bilateral vocal fold paralysis. Ventilation was performed as subglottic HFJV via jet catheter inserted through the vocal cord. Anesthesia was administered as total intravenous anesthesia. At the end of the procedure, the jet catheter was exchanged with LMA laryngeal mask until spontaneous breathing was established. Subglottic HFJV was used in 20 patients undergoing endo-extralaryngeal laterofixating operations with suspension microlaryngoscopy. The mean duration of surgery was 32.25 minutes, mean age 47.35 (SD 9.75) years, and mean body mass index 26.39 kg m-2 (SD 5.03). The mean arterial PaCO2 5 min before surgical procedure was 5.39 (SD 0.86) kPa, at 5 min of starting jet ventilation 6.19 (SD 0.91) kPa, and at the end of surgical procedure 5.93 (SD 0.99) kPa. There was significant correlation between PaCO2 obtained 5 min before starting jet ventilation and PaCO2 at 5 min of starting jet ventilation (p<0.05). No complications secondary to the ventilation technique were observed. No perioperative tracheotomy was necessary. It is concluded that subglottic HFJV is an easy and safe way to ventilate patients with bilateral vocal fold paralysis when endoscopic intervention is performed.Obostrana pareza glasnica s posljedičnom opstrukcijom dišnoga puta nastaje kao rezultat lezije rekurentnog laringealnog živca tijekom operacije štitne žlijezde. Inicijalni postupci kojima se osigurava dišni put kod ovih bolesnika uključuju različite endo-ekstralaringealne zahvate te samu traheotomiju, koji se izvode u općoj anesteziji. Subglotična visokofrekventna jet ventilacija (VFJV) je alternativna tehnika ventilacije koja se koristi u kirurgiji dišnog puta. Ova tehnika ventilacije pruža optimalne endolaringealne uvjete za kirurški rad. U ovoj prospektivnoj studiji VFJV se rabio kod 20 bolesnica s obostranom parezom glasnica. Subglotična VFJV je provedena preko jet katetera postavljenog između glasnica u totalnoj intravenskoj anesteziji. Na kraju operacije je jet kateter zamijenjen laringealnom maskom sve do uspostavljanja spontanog disanja. Tehnika subglotične VFJV je upotrijebljena kod 20 bolesnica podvrgnutih endo-ekstralaringealnoj laterofiksaciji u suspenzijskoj mikrolaringoskopiji. Srednje vrijeme kirurške intervencije je bilo 32,25 minuta, srednja dob bolesnica 47,35 (SD 9,75) godina i srednji indeks tjelesne mase 26,39 (SD 5,03) kg m-2. Srednja vrijednost PaCO2 5 minuta prije početka kirurške intervencije je bila 5,39 (SD 0,86) kPa, 5 minuta nakon primjene jet ventilacije 6,19 (SD 0,91) kPa, a na kraju kirurške intervencije 5,93 (SD 0,99) kPa. Uočena je značajna korelacija između vrijednosti PaCO2 dobivenih 5 minuta prije početka kirurške intervencije i 5 minuta nakon početka primjene jet ventilacije (p<0,05). Komplikacije vezane za primjenu VFJV nisu primijećene. Tijekom perioperacijskog razdoblja nije bilo potrebe za traheotomijom. U zaključku, subglotična VFJV je sigurna tehnika ventilacije koja se primjenjuje tijekom endoskopskih intervencija kod bolesnika s obostranom parezom glasnica

Thyroid cartilage infiltration in advanced laryngeal cancer: prognostic implications and predictive modelling

Objective: Detection of laryngeal cartilage invasion is of great importance in staging of laryngeal squamous cell carcinoma (LSCC). The role of prognosticators in locally advanced laryngeal cancer are still widely debated. This study aimed to assess the impact of volume of thyroid cartilage infiltration, as well as other histopathologic variables, on patient survival. Materials and methods: We retrospectively analysed 74 patients affected by pT4 LSCC and treated with total laryngectomy between 2005 and 2021 at the Department of Otorhinolaryngology - Head and Neck Surgery of the University of Brescia, Italy. We considered as potential prognosticators histological grade, perineural (PNI) and lympho-vascular invasion (LVI), thyroid cartilage infiltration, and pTN staging. Pre-operative CT or MRI were analysed to quantify the volume of cartilage infiltration using 3D Slicer software. Results: The 1-, 3-, and 5-year disease free survivals (DFS) were 76%, 66%, and 64%, respectively. Using machine learning models, we found that the volume of thyroid cartilage infiltration had high correlation with DFS. Patients with a higher volume (> 670 mm3) of infiltration had a worse prognosis compared to those with a lower volume. Conclusions: Our study confirms the essential role of LVI as prognosticator in advanced LSCC and, more innovatively, highlights the volume of thyroid cartilage infiltration as another promising prognostic factor