Combined Techniques for Bilateral Maxillary and Nasal Reconstruction After Ablative Surgery for Adenoid Cystic Carcinoma

Indolent tumor growth up to large tumor masses and broad infiltration of surrounding tissue are the most typical characteristics of malignant tumors of the nasal cavity and paranasal sinuses. If surgery is a therapeutic option, extended resections and complex reconstruction modalities have to be taken into account. We present a combination of different reconstruction techniques to restore midface integrity after bilateral maxillectomy, including parts of the nasal skeleton, for adenoid cystic carcinoma. After obtaining tumor-free margins, reconstruction was performed using a microvascular double-flap technique to achieve a neo-maxilla and soft tissue lining of the oral cavity, dental implantology with prosthetic restoration and the insertion of a patient-specific implant for nasal re-shaping and stability. In cases of extended maxillary resection, a combination of different techniques can achieve sufficient functional and aesthetic rehabilitation, and restore quality of life. Further studies are warranted to evaluate the long-term stability of such complex reconstructions. However, local tumor control remains the highest priority and will be essential for years.

The Prognostic value of the Fibrinogen to pre-albumin ratio in malignant tumors of the digestive system: a systematic review and meta-analysis

Background In recent years, the Fibrinogen to pre-albumin ratio (FPR) has been reported in many studies to be significantly associated with the prognosis of various cancers. This systematic review and meta-analysis aimed to investigate the prognostic value of FPR in malignant tumors of the digestive system based on available evidence. Methods The relevant articles published before July 1, 2021, were systematically retrieved from electronic databases to evaluate the effect of Fibrinogen to pre-albumin ratio (FPR) on the prognosis of patients with malignant digestive system tumors and calculate the hazard ratio (HR) and the corresponding 95% confidence interval (CI). Result Thirteen articles, all from China, including 15 cohort studies and a total of 5116 cases, were included in this study. A high FPR was associated with poor overall survival (HR = 1.88, 95%CI 1.53–2.32, P < 0.001), recurrence-free survival (HR = 2.29, 95%CI 1.91–2.76, P < 0.001), progression-free survival (HR = 1.96, 95%CI: 1.33–2.90, P = 0.001), complications (HR = 1.78, 95%CI: 1.06–3.00, P = 0.029), disease-free survival (HR = 1.46, 95%CI: 1.08–1.97, P = 0.013) was significantly associated with cancer-specific survival (HR = 1.44, 95%CI: 1.15–1.79, P = 0.001). Even though intergroup differences were present, FPR was strongly associated with overall and relapse-free survival, and sensitivity analysis suggested that our results were stable. Conclusion FPR can be used as a valuable indicator to predict the prognosis of patients with malignant digestive system tumors.

Midface Resection And Reconstruction In Head And Neck Oncology: A 20 Years Single Institution Experience

Background: Midface tumors are relatively uncommon as midface comprises less than 1% of all malignant tumors and incorporate a distinct group of lesions, with a high variety of histological types and biological behavior. The purpose of the study is to present our experience in managing patients with advanced midface tumors for a 20-year period.Materials & Methods: From January 2000 to May 2020, we performed 72 excisions and reconstructions in 36 patients where their medical records were reviewed by the head and neck oncology clinic. The commonest anatomical site of the primary was the maxilla in 19 patients and bilaterally in 5 patients. In 15 patients there was an orbital and anterior fossa extension. In 6 patients there was a parotid and middle ear extension and in 1 patient there was a lip involvement.Results: Surgical resection included maxillectomy in the majority of the cases in combination with orbital exenteration or orbitectomy and anterior fossa resection. In 8 cases parotidectomy and mastoidectomy/ core petrosectomy was performed. One patient was subjected to total petrosectomy. Reconstruction was performed with radial forearm osteocutaneous free flap in 4 cases, latissimus with scapular bone flap in one case, lengthening temporalis myoplasty in 19 cases, rectus femoris in one case and anterolateral thigh flap in 5 cases in combination with temporalis and vastus lateralis in one case respectively and bilateral karapandzic flap in 1 case. The patients were followed-up from 2005 to 2020. To date, 23 patients (63.8%) are disease free with no recurrences of the disease and 4.4% of all patients presented disease recurrence during the follow-up period.Conclusions: In conclusion midface resections are safely performed with a combination of microvascular and dynamic reconstruction of the face offering our patients quality of life improvement.Level of Evidence: Level V, therapeutic study

Machine learning to differentiate small round cell malignant tumors and non-small round cell malignant tumors of the nasal and paranasal sinuses using apparent diffusion coefficient values

Objective We used radiomics feature–based machine learning classifiers of apparent diffusion coefficient (ADC) maps to differentiate small round cell malignant tumors (SRCMTs) and non-SRCMTs of the nasal and paranasal sinuses. Materials A total of 267 features were extracted from each region of interest (ROI). Datasets were randomized into two sets, a training set (∼70%) and a test set (∼30%). We performed dimensional reductions using the Pearson correlation coefficient and feature selection analyses (analysis of variance [ANOVA], relief, recursive feature elimination [RFE]) and classifications using 10 machine learning classifiers. Results were evaluated with a leave-one-out cross-validation analysis. Results We compared the AUC for all the pipelines in the validation dataset using FeAture Explorer (FAE) software. The pipeline using RFE feature selection and Gaussian process classifier yielded the highest AUCs with ten features. When the “one-standard error” rule was used, FAE produced a simpler model with eight features, including Perc.01%, Perc.10%, Perc.90%, Perc.99%, S(1,0) SumAverg, S(5,5) AngScMom, S(5,5) Correlat, and WavEnLH_s-2. The AUCs of the training, validation, and test datasets achieved 0.995, 0.902, and 0.710, respectively. For ANOVA, the pipeline with the auto-encoder classifier yielded the highest AUC using only one feature, Perc.10% (training/validation/test datasets: 0.886/0.895/0.809, respectively). For the relief, the AUCs of the training, validation, and test datasets that used the LRLasso classifier using five features (Perc.01%, Perc.10%, S(4,4) Correlat, S(5,0) SumAverg, S(5,0) Contrast) were 0.892, 0.886, and 0.787, respectively. Compared with the RFE and relief, the results of all algorithms of ANOVA feature selection were more stable with the AUC values higher than 0.800. Conclusions We demonstrated the feasibility of combining artificial intelligence with the radiomics from ADC values in the differential diagnosis of SRCMTs and non-SRCMTs and the potential of this non-invasive approach for clinical applications. Key Points • The parameter with the best diagnostic performance in differentiating SRCMTs from non-SRCMTs was the Perc.10% ADC value. • Results of all the algorithms of ANOVA feature selection were more stable and the AUCs were higher than 0.800, as compared with RFE and relief. • The pipeline using RFE feature selection and Gaussian process classifier yielded the highest AUC.

The Emerging Role of Tissue-Resident Memory CD8+ T Lymphocytes in Human Digestive Tract Cancers

Malignant digestive tract tumors are a great threat to human public health. In addition to surgery, immunotherapy brings hope for the treatment of these tumors. Tissue-resident memory CD8+ T (Trm) cells are a focus of tumor immunology research and treatment due to their powerful cytotoxic effects, ability to directly kill epithelial-derived tumor cells, and overall impact on maintaining mucosal homeostasis and antitumor function in the digestive tract. They are a group of noncirculating immune cells expressing adhesion and migration molecules such as CD69, CD103, and CD49a that primarily reside on the barrier epithelium of nonlymphoid organs and respond rapidly to both viral and bacterial infection and tumorigenesis. This review highlights new research exploring the role of CD8+ Trm cells in a variety of digestive tract malignant tumors, including esophageal cancer, gastric cancer, colorectal cancer, and hepatocellular carcinoma. A summary of CD8+ Trm cell phenotypes and characteristics, tissue distribution, and antitumor functions in different tumor environments is provided, illustrating how these cells may be used in immunotherapies against digestive tract tumors.

In Vivo Accelerator-Based Boron Neutron Capture Therapy for Spontaneous Tumors in Large Animals: Case Series

(1) Background: accelerator-based neutron sources are a new frontier for BNCT but many technical issues remain. We aimed to study such issues and results in larger-animal BNCT (cats and dogs) with naturally occurring, malignant tumors in different locations as an intermediate step in translating current research into clinical practice. (2) Methods: 10 pet cats and dogs with incurable, malignant tumors that had no treatment alternatives were included in this study. A tandem accelerator with vacuum insulation was used as a neutron source. As a boron-containing agent, 10B-enriched sodium borocaptate (BSH) was used at a dose of 100 mg/kg. Animal condition as well as tumor progression/regression were monitored. (3) Results: regression of tumors in response to treatment, improvements in the overall clinical picture, and an increase in the estimated duration and quality of life were observed. Treatment-related toxicity was mild and reversible. (4) Conclusions: our study contributes to preparations for human BNCT clinical trials and suggests utility for veterinary oncology.

Circ_0000658 knockdown inhibits epithelial-mesenchymal transition in bladder cancer via miR-498-induced HMGA2 downregulation

Background Epithelial-mesenchymal transition (EMT) has been associated with the angiogenesis and oncogenic phenotypes of multiple malignant tumors including bladder cancer (BCa). Circular RNAs (circRNAs) are recognized as crucial regulators in the EMT. This study aims to illustrate the possible role of circular RNA_0000658 (circ_0000658) in BCa and the underlying molecular mechanism. Methods The expression of circ_0000658, microRNA (miR)-498, and high mobility group AT-hook 2 (HMGA2) was assessed in cancer and adjacent normal tissue collected from BCa patients and human BCa cell lines (MGH-U3, T24, 5637 and SW780). BCa cells were transduced with a series of overexpression or shRNA plasmids to clarify the function of circ_0000658 and miR-498 on the oncogenic phenotypes and EMT of BCa cells. Further, we established nude mice xenografted with BCa cells to validate the roles of circ_0000658 on tumor growth in vivo. Results Circ_0000658 was highly expressed in BCa tissue samples and cell lines, which indicated a poor prognosis of BCa patients. Circ_0000658 competitively bound to miR-498 and thus restricted miR-498 expression. Meanwhile, circ_0000658 weakened the binding of miR-498 to the target gene HMGA2 and upregulated the HMGA2 expression. Circ_0000658 elevation or miR-498 knockdown augmented oncogenic phenotypes and EMT of BCa cells, corresponding to a reduction in the expression of β-catenin and E-cadherin as well as an increase in the expression of N-cadherin, Slug, Snail, ZEB1 and Twist. Inhibition of HMGA2 reversed the effects of circ_0000658 overexpression on tumor growth in vivo. Conclusion Altogether, our study uncovered the tumor-promoting role of circ_0000658 in BCa via the miR-498/HMGA2 axis.

Accuracy of Mixed Reality Combined With Surgical Navigation Assisted Oral and Maxillofacial Tumor Resection

ObjectiveTo evaluate the feasibility and accuracy of mixed reality combined with surgical navigation in oral and maxillofacial tumor surgery.MethodsRetrospective analysis of data of seven patients with oral and maxillofacial tumors who underwent surgery between January 2019 and January 2021 using a combination of mixed reality and surgical navigation. Virtual surgical planning and navigation plan were based on preoperative CT datasets. Through IGT-Link port, mixed reality workstation was synchronized with surgical navigation, and surgical planning data were transferred to the mixed reality workstation. Osteotomy lines were marked with the aid of both surgical navigation and mixed reality images visualized through HoloLens. Frozen section examination was used to ensure negative surgical margins. Postoperative CT datasets were obtained 1 week after the surgery, and chromatographic analysis of virtual osteotomies and actual osteotomies was carried out. Patients received standard oncological postoperative follow-up.ResultsOf the seven patients, four had maxillary tumors and three had mandibular tumors. There were total of 13 osteotomy planes. Mean deviation between the planned osteotomy plane and the actual osteotomy plane was 1.68 ± 0.92 mm; the maximum deviation was 3.46 mm. Chromatographic analysis showed error of ≤3 mm for 80.16% of the points. Mean deviations of maxillary and mandibular osteotomy lines were approximate (1.60 ± 0.93 mm vs. 1.86 ± 0.93 mm). While five patients had benign tumors, two had malignant tumors. Mean deviations of osteotomy lines was comparable between patients with benign and malignant tumors (1.48 ± 0.74 mm vs. 2.18 ± 0.77 mm). Intraoperative frozen pathology confirmed negative resection margins in all cases. No tumor recurrence or complications occurred during mean follow-up of 15.7 months (range, 6-26 months).ConclusionThe combination of mixed reality technology and surgical navigation appears to be feasible, safe, and effective for tumor resection in the oral and maxillofacial region.

The Involvement of miRNAs in Pituitary Adenomas Pathogenesis and the Clinical Implications

Pituitary adenomas (PAs) account for the top three primary intracranial tumors in terms of total incidence rate. PAs can cause severe endocrine disorders and even malignant features, such as invasion, metastasis, and recurrence. Therefore, the early diagnosis and accurate prognosis would be greatly beneficial for clinical treatment of PAs. MicroRNAs (miRNAs) are small, protein-noncoding RNAs that regulate gene expression posttranscriptionally. They regulate essential physiological processes, including proliferation, growth, and apoptosis, and also they involve in the invasion and metastasis of malignant tumors. At the tissue level, differential miRNA expression in endocrine malignancies including PAs has been reported. When miRNAs have been successfully detected in various biofluids and cell-free environments, their important roles as potential screening or prognostic biomarkers have been extensively investigated. The current work reviews recent studies on the emerging roles of miRNAs in PAs and the clinical significance.

Analysis of death causes of residents in poverty-stricken Areas in 2020: take Liangshan Yi Autonomous Prefecture in China as an example

Background Continuous surveillance of death can measure health status of the population, reflect social development of a region, thus promote health service development in the region and improve the health level of local residents. Liangshan Yi Autonomous Prefecture was a poverty-stricken region in Sichuan province, China. While at the end of 2020, as the announcement of its last seven former severely impoverished counties had shaken off poverty, Liangshan declared victory against poverty. Since it is well known that the mortality and cause of death structure will undergo some undesirable changes as the economy develops, this study aimed to reveal the distribution of deaths, as well as analyze the latest mortality and death causes distribution characteristics in Liangshan in 2020, so as to provide references for the decision-making on health policies and the distribution of health resources in global poverty-stricken areas. Methods Liangshan carried out the investigation on underreporting deaths among population in its 11 counties in 2018, and combined with the partially available data from underreporting deaths investigation data in 2020 and the field experience, we have estimated the underreporting rates of death in 2020 using capture-recapture (CRC) method. The crude mortality rate, age-standardized mortality rate, proportion and rank of the death causes, potential years of life lost (PYLL), average years of life lost (AYLL), potential years of life lost rate (PYLLR), standardized potential years of life lost (SPYLL), premature mortality from non-communicable diseases (premature NCD mortality), life expectancy and cause-eliminated life expectancy were estimated and corrected. Results In 2020, Liangshan reported a total of 16,850 deaths, with a crude mortality rate of 608.75/100,000 and an age-standardized mortality rate of 633.50/100,000. Male mortality was higher than female mortality, while 0-year-old mortality of men was lower than women’s. The former severely impoverished counties’ age-standardized mortality and 0-year-old mortality were higher than those of the non-impoverished counties. The main cause of death spectrum was noncommunicable diseases (NCDs), and the premature NCD mortality of four major NCDs were 14.26% for the overall population, 19.16% for men and 9.27% for women. In the overall population, the top five death causes were heart diseases (112.07/100,000), respiratory diseases (105.85/100,000), cerebrovascular diseases (87.03/100,000), malignant tumors (73.92/100,000) and injury (43.89/100,000). Injury (64,216.78 person years), malignant tumors (41,478.33 person years) and heart diseases (29,647.83 person years) had the greatest burden on residents in Liangshan, and at the same time, the burden of most death causes on men were greater than those on women. The life expectancy was 76.25 years for overall population, 72.92 years for men and 80.17 years for women, respectively, all higher than the global level (73.3, 70.8 and 75.9 years). Conclusions Taking Liangshan in China as an example, this study analyzed the latest death situation in poverty-stricken areas, and proposed suggestions on the formulation of health policies in other poverty-stricken areas both at home and abroad.