Σφακιανάκης Αλέξανδρος
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5 Άγιος Νικόλαος
Κρήτη 72100
00302841026182
00306932607174
alsfakia@gmail.com

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Κυριακή 13 Φεβρουαρίου 2022

Reconstruction following transoral robotic surgery for head and neck cancer: Systematic review

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Abstract

We performed a systematic review to characterize reconstructive modalities and postoperative surgical outcomes following TORS resection. A search of the PubMed, SCOPUS, and EMBASE databases was conducted to identify studies describing patients undergoing reconstruction of TORS defects. Twenty-six studies met inclusion criteria, consisting of 260 patients who underwent TORS resection followed by reconstruction. Twenty-one studies reported tumor classification information, with TORS performed for 44 (23.0%) T1, 86 (45.0%) T2, 33 (17.3%) T3, and 28 (14.7%) T4 tumors. Eighteen distinct reconstructive modalities were described in the studies identified, including nine unique free flap types. The most commonly performed reconstruction was the radial forearm free flap (RFFF), accounting for 121/260 (46.5%) of reconstructions performed. Reported surgical complications included 5 pharyngocutaneous fistulae, 13 hemorrhagic complications, 24 infectious complications, and 5 free flap failures . Our findings demonstrate favorable surgical outcomes but minimal quantitative functional data to compare reconstructive options following TORS.

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The effect of cosmetic surgery on mental self-image and life satisfaction in women undergoing breast augmentation: An intermediate role of evaluating the surgery as one of the most important life events

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J Plast Reconstr Aesthet Surg. 2022 Jan 21:S1748-6815(22)00033-X. doi: 10.1016/j.bjps.2022.01.018. Online ahead of print.

ABSTRACT

AIM: To estimate changes in self-perception and satisfaction in women undegoing breast augmentation surgery (BAS).

METHODS: Using a quasi-experimental questionnaire study design, we enrolled a cohort of BAS women treated at a private clinic during a 5-year interval. The primary predictor variable was treatment (before/after). The main outcome variables included effect of considering breast augmentation as one of the most important life events on self-image (BAOMILE), and subjective evaluation of physical appearance and life satisfaction. Other study variables were demographic data. The Mann-Whitney and the Wilcoxon signed-rank tests were used to compare the outcomes between before and after the surgery. The Spearman rank correlation and the Pearson chi-squared test were computed to analyze the relatio nships among variables.

RESULTS: The sample consisted of 53 subjects (52.3% married; 40.9% from medium-sized towns) with a mean age of 33.2 ± 6.4 years (range, 21-46). Life satisfaction was significantly increased after BAS in the whole cohort (preop., 7.83 vs. postop., 8.42; P = .003; 95% CI, -0.95 to -0.22) as well as in the BAOMILE subgroup (preop., 7.87 vs. postop., 8.56; P = .011; 95% CI, -1.20 to -0.17). Within the BAOMILE subgroup, there was a positive correlation between the appearance assessment and the number of positive traits before surgery (ρ = 0.63; P = .002; 95% CI, 0.27-0.83) and life satisfaction after surgery (ρ = 0.480; P = .03; 95% CI, 0.06-0.74).

CONCLUSIONS: The results of this study suggest that BAS improves self-perception and life satisfaction of the patients. The psychologist's role in understating patient's motivation for cosmetic surgery and the revision of their attitudes towards expected effects require further investigations.

PMID: 35140045 | DOI:10.1016/j.bjps.2022.01.018

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Revised donor site skin incision technique for a multivector functioning muscle transfer using the serratus anterior muscle for smile reanimation

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J Plast Reconstr Aesthet Surg. 2022 Jan 31:S1748-6815(22)00064-X. doi: 10.1016/j.bjps.2022.01.049. Online ahead of print.

NO ABSTRACT

PMID:35140039 | DOI:10.1016/j.bjps.2022.01.049

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Mitochondrial DHODH regulates hypoxia-inducible factor 1 expression in OTSCC

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Am J Cancer Res. 2022 Jan 15;12(1):48-67. eCollection 2022.

ABSTRACT

Oral tongue squamous cell carcinoma (OTSCC) was one of the most hypoxic tumors with unfavorable outcomes. Hypoxia-inducible factor-1 (HIF-1) signaling was associated with cancer proliferation, lymph node metastasis, angiogenesis and poor prognosis of OTSCC. Dihydroorotate dehydrogenase (DHODH) catalyzed the rate-limiting step in the de novo pyrimidine biosynthesis. The aim of the study was to explore the biological function of DHODH and investigate whether DHODH regulated HIF-1 signaling in OTSCC. Proliferation, migration and anoikis resistance were used to determine the function of DHODH. Western blot and luciferase activity assays were used to determine the regulatory role of DHODH on HIF-1. We found that increased DHODH expression was associated with advanced tumor stage and poorly differentiated tumor in head and neck cancer patients in The Cancer Genome Atlas (TC GA). DHODH enhanced the proliferation and aggressiveness of OTSCC. Moreover, DHODH prompted tumor growth and metastasis in vivo. DHODH promoted transcription, protein stability, and transactivation activity of HIF1A. DHODH-induced HIF1A upregulation in OTSCC can be reversed by reactive oxygen species (ROS) scavenger, indicating that DHODH enhanced HIF1A expression via ROS production. DHODH inhibitor suppressed DHODH-mediated ROS generation and HIF1A upregulation. Targeting DHODH using clinically available inhibitor, atovaquone, might provide a new strategy to treat OTSCC.

PMID:35141004 | PMC:PMC8822278

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Modulation of BRCA1 mediated DNA damage repair by deregulated ER-α signaling in breast cancers

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Am J Cancer Res. 2022 Jan 15;12(1):17-47. eCollection 2022.

ABSTRACT

BRCA1 mutation carriers have a greater risk of developing cancers in hormone-responsive tissues like breasts and ovaries. However, this tissue-specific incidence of BRCA1 related cancers remains elusive. The majority of the BRCA1 mutated breast cancers exhibit typical histopathological features of high-grade tumors, with basal epithelial phenotype, classified as triple-negative molecular subtype and have a higher percentage of DNA damage and chromosomal abnormality. Though there are many studies relating BRCA1 with ER-α (Estrogen receptor-α), it has not been reported whether E2 (Estrogen) -ER-α signaling can modulate the DNA repair activities of BRCA1. The present study analyzes whether deregulation of ER-α signaling, arising as a result of E2/ER-α deficiency, could impact the BRCA1 dependent DDR (DNA Damage Response) pathways, predominantly those of DNA-DSB (Dou ble Strand break) repair and oxidative damage response. We demonstrate that E2/E2-stimulated ER-α can augment BRCA1 mediated high fidelity repairs like HRR (Homologous Recombination Repair) and BER (Base Excision Repair) in breast cancer cells. Conversely, a condition of ER-α deficiency itself or any interruption in ligand-dependent ER-α transactivation resulted in delayed DNA damage repair, leading to persistent activation of γH2AX and retention of unrepaired DNA lesions, thereby triggering tumor progression. ER-α deficiency not only limited the HRR in cells but also facilitated the DSB repair through error prone pathways like NHEJ (Non Homologous End Joining). ER-α deficiency associated persistence of DNA lesions and reduced expression of DDR proteins were validated in human mammary tumors.

PMID:35141003 | PMC:PMC8822286

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ST3GAL2 knock-down decreases tumoral character of colorectal cancer cells in vitro and in vivo

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Am J Cancer Res. 2022 Jan 15;12(1):280-302. eCollection 2022.

ABSTRACT

Tumor cells have a modified glycosylation profile that promotes their evolution and/or their maintenance in the tumor. Sialylation is a type of glycosylation that is often altered in cancers. RNA-Seq database analysis revealed that the sialyltransferase gene ST3GAL2 is significantly overexpressed at all stages of colorectal cancer (CRC). ST3GAL2 sialylates both glycoproteins and glycolipids. The aim of this work was to investigate the involvement of ST3GAL2 in CRC. Using the HT29 tumor cell line derived from a stage II of CRC, we decreased the expression of ST3GAL2 by specific shRNA, and then characterized these cells by performing functional tests. We found that ST3GAL2 knock down (KD) significantly decreases tumor cell proliferation, cell migration and invasiveness properties in vitro. The cell cycle of these cells is affected with a ch ange in cell cycle distribution and an increase of cell apoptosis. The effect of ST3GAL2 KD was then studied in vivo, following xenografts into nude mice, in which the tumor progression was significantly reduced. This work demonstrates that ST3GAL2 is a major player in the behavior of colorectal tumor cells, by modifying the sialylation state of glycoproteins and glycolipids which remain to be specifically identified.

PMID:35141018 | PMC:PMC8822282

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Definitive radiation therapy and liver local therapy in de novo liver metastatic nasopharyngeal carcinoma: Large cohort study

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Abstract

Background

We aimed to evaluate patients suitable for definitive radiation therapy (DRT) and liver local therapy (LLT) in addition to palliative chemotherapy (PCT) among those with de novo liver metastatic nasopharyngeal carcinoma (lmNPC).

Methods

The overall survival (OS) and progression-free survival (PFS) rates were calculated and compared in 610 patients with lmNPC.

Results

Both the PCT+DRT and PCT+DRT+LLT groups had better survival outcomes than the PCT group. Among patients with complete response/partial response (CR/PR) after PCT, no significant differences in survival rates were observed between those treated with PCT+DRT and PCT+DRT+LLT (2-year PFS: 27.0% vs. 32.9%, p = 0.263). Among patients with progressive disease/stable disease (PD/SD) after PCT, significantly better survival rates were observed in patients treated with PCT+DRT+LLT.

Conclusions

DRT might benefit patients with lmNPC regardless of the tumor response after PCT. For patients with CR/PR, LLT might not be needed. For patients with PD/SD, LLT might improve survival outcomes.

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Trends in Subglottic Stenosis Management: Resource Utilization and Pediatric Otolaryngology Training

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Objectives/Hypothesis

The role for endoscopic management in children with subglottic stenosis (SGS) has grown, but there are no data on resource utilization or the impact on surgical training in pediatric otolaryngology. This study hypothesizes that this shift has increased resource utilization and has impacted surgical training by shifting the focus toward more endoscopic techniques.

Study Design

Retrospective database review.

Methods

The Kids' Inpatient Database for 2003, 2006, 2009, and 2012 was queried for admissions with the diagnosis of SGS. Surgical caseload was studied using the Accreditation Council for Graduate Medical Education Accreditation data system for 2010 to 2017.

Results

Admissions with SGS remained constant between 2003 and 2012. Hospital charges per admission did not change between 2003 and 2009 but increased in 2012. Tracheostomy decreased from 10.5% of admissions in 2003 to 6.8% in 2012. The percentage requiring repair of the larynx did not change; other operations on the larynx increased from 4.5% in 2003 to 11.6% in 2012. The median number of laryngoplasties performed per trainee decreased from 14 to nine between 2010 and 2017, whereas the number of laryngoscopy with intervention procedures increased from 34 to 56.

Conclusions

The evolution of SGS management appears to have led to a decrease in tracheostomy and an increase in certain procedures that may include endoscopic procedures. Recently, there has been a shift in airway surgical training, with trainees logging less open laryngotracheoplasty and more interventional laryngoscopy. Although these trends cannot be directly linked, the changes in trainee surgical experience may be justified by the decrease in larger open procedures and associated resource utilization.

Level of Evidence

2c Laryngoscope, 132:S1–S9, 2022

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Nasal reconstruction with local flaps versus grafts: Long term perspectives

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J Plast Reconstr Aesthet Surg. 2022 Feb 1:S1748-6815(22)00025-0. doi: 10.1016/j.bjps.2022.01.010. Online ahead of print.

NO ABSTRACT

PMID:35144904 | DOI:10.1016/j.bjps.2022.01.010

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Bacterial meningitis due to the Streptococcus mitis group in children with cerebrospinal fluid leak

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IDCases. 2022 Jan 13;27:e01406. doi: 10.1016/j.idcr.2022.e01406. eCollection 2022.

ABSTRACT

The Streptococcus mitis group constitutes a part of the oral flora in humans and has been reported to cause infective endocarditis, brain abscesses, sepsis, pneumonia, and peritonitis. However, the S. mitis group rarely causes meningitis in children. We experienced a case of bacterial meningitis due to the S. mitis group in a 14-year-old girl with Gorham-Stout disease undergoing treatment with sirolimus for skull base osteolysis and cerebrospinal fluid (CSF) leak. Antibiotic treatment was initiated with linezolid and levofloxacin due to allergies against β-lactam antibiotics. On the third treatment day, antibiotics were switched to penicillin G according to CSF culture results, which were positive for penicillin-susceptible S. mitis group. Antibiotic therapy was successfully completed after 14 days without any neurological sequelae. There have apparently been no reports of S. mitis meningitis in pediatric patients with skull base osteolysis and CSF leak as in our case. Our findings suggest that clinicians should be aware of the possibility of S. mitis meningitis for patients with skull base osteolysis and/or CSF leakage.

PMID:35145856 | PMC:PMC8801995 | DOI:10.1016/j. idcr.2022.e01406

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Human telomerase reverse transcriptase protein expression is associated with survival in patients with oral squamous cell carcinoma

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Int J Clin Exp Pathol. 2022 Jan 15;15(1):29-37. eCollection 2022.

ABSTRACT

Despite improvements in diagnosis and treatment, the 5-year survival of oral squamous cell carcinoma (OSCC), no matter the location, remains low, averaging 50%. Telomerase is expressed in 85% of malignancies and may play an important role in human carcinogenesis. Its catalytic component is human telomerase reverse transcriptase (hTERT), which has been thought, but not proven, to be involved in survival with OSCC. We investigated whether hTERT protein was a prognostic factor in OSCC by evaluating its association with clinicopathologic findings and OSCC survival. We found that in comparison to patients with high hTERT expression, patients with low hTERT expression survived significantly longer, including a longer 5-year overall survival. In addition, overall survival was significantly correlated to hTERT expression and the histologic grade and N status of the tumo r. Disease-free survival was significantly related to hTERT expression, the histologic grade and N status of the tumor, and mode of invasion. These results suggest that hTERT protein is involved in cervical lymph node metastasis, that its levels may be increased during carcinogenesis, and that it may influence tumor invasion. We believe that this study is the first to demonstrate that OSCC with high hTERT expression carries a worse prognosis than cases with low hTERT expression.

PMID:35145581 | PMC:PMC8822205

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