Κυριακή 1 Νοεμβρίου 2020

Functional Imaging to Predict Treatment Response in Head and Neck Cancer: How Close are We to Biologically Adaptive Radiotherapy?

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Functional Imaging to Predict Treatment Response in Head and Neck Cancer: How Close are We to Biologically Adaptive Radiotherapy?

Clin Oncol (R Coll Radiol). 2020 Oct 27;:

Authors: Paterson C, Hargreaves S, Rumley CN

Abstract
It is increasingly recognised that head and neck cancer represents a spectrum of disease with a differential response to standard treatments. Although prognostic factors are well established, they do not reliably predict response. The ability to predict response early during radiotherapy would allow adaptation of treatment: intensifying treatment for those not responding adequately or de-intensifying remaining therapy for those likely to achieve a complete response. Functional imaging offers such an opportunity. Changes in parameters obtained with functional magnetic resonance imaging or positron emission tomography-computed tomography during treatment have been found to be predictive of disease control in head and neck cancer. Although many questions remain unanswered regarding the optimal implementation of these techniques, current, maturing and future studies may provide the much-needed homogeneous cohorts with larger sample sizes and external validation of parameters. Wit h a stepwise and collaborative approach, we may be able to develop imaging biomarkers that allow us to deliver personalised, biologically adaptive radiotherapy for head and neck cancer.

PMID: 33127234 [PubMed - as supplied by publisher]

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Role of intracellular zinc in molecular and cellular function in allergic inflammatory diseases.

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Role of intracellular zinc in molecular and cellular function in allergic inflammatory diseases.

Allergol Int. 2020 Oct 27;:

Authors: Suzuki M, Suzuki T, Watanabe M, Hatakeyama S, Kimura S, Nakazono A, Honma A, Nakamaru Y, Vreugde S, Homma A

Abstract
Zinc is an essential micronutrient in human body and a vital cofactor for the function of numerous proteins encoded by the human genome. Zinc has a critical role in maintaining many biochemical and physiological processes at the molecular, cellular, and multiple organ and systemic levels. The alteration of zinc homeostasis causes dysfunction of many organs and systems. In the immune system, zinc regulates the differentiation, proliferation and function of inflammatory cells, including T cells, eosinophils, and B cells, by modifying several signaling pathways such as NFκB signaling pathways and TCR signals. An adequate zinc level is essential for proper immune responses and decreased zinc levels were reported in many allergic inflammatory diseases, including atopic dermatitis, bronchial asthma, and chronic rhinosinusitis. Decreased zinc levels often enhance inflammatory activation. On the other hand, the inflammatory conditions alter the intracellular homeostasis of zinc, oft en decreasing zinc levels. These findings implied that there could be a vicious cycle between zinc deficiency and inflammatory conditions. In this review, we present recent evidence on the involvement of zinc in atopic dermatitis, bronchial asthma, and chronic rhinosinusitis, with insights into the involvement of zinc in the underlying molecular and cellular mechanisms related to these allergic inflammatory diseases.

PMID: 33127267 [PubMed - as supplied by publisher]

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Respiratory muscle training in late-onset Pompe disease: Results of a sham-controlled clinical trial.

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Respiratory muscle training in late-onset Pompe disease: Results of a sham-controlled clinical trial.

Neuromuscul Disord. 2020 Sep 28;:

Authors: Jones HN, Kuchibhatla M, Crisp KD, Hobson-Webb LD, Case L, Batten MT, Marcus JA, Kravitz RM, Kishnani PS

Abstract
To address progressive respiratory muscle weakness in late-onset Pompe disease (LOPD), we developed a 12-week respiratory muscle training (RMT) program. In this exploratory, double-blind, randomized control trial, 22 adults with LOPD were randomized to RMT or sham-RMT. The primary outcome was maximum inspiratory pressure (MIP). Secondary and exploratory outcomes included maximum expiratory pressure (MEP), peak cough flow, diaphragm ultrasound, polysomnography, patient-reported outcomes, and measures of gross motor function. MIP increased 7.6 cmH2O (15.9) in the treatment group and 2.7 cmH2O (7.6) in the control group (P = 0.4670). MEP increased 14.0 cmH2O (25.9) in the treatment group and 0.0 cmH2O (12.0) in the control group (P = 0.1854). The only statistically significant differences in secondary/exploratory outcomes were improvements in time to climb 4 steps (P = 0.0346) and daytime sleepiness (P = 0.0160). The magnitude of changes in MIP and MEP in the tre atment group were consistent with our pilot findings but did not achieve statistical significance in comparison to controls. Explanations for this include inadequate power and baseline differences in subject characteristics between groups. Additionally, control group subjects appeared to exhibit an active response to sham-RMT and therefore sham-RMT may not be an optimal control condition for RMT in LOPD.

PMID: 33127291 [PubMed - as supplied by publisher]

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Mucinous cystadenocarcinoma of the oral tongue: malignant transformation from a mucinous cystadenoma?

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Mucinous cystadenocarcinoma of the oral tongue: malignant transformation from a mucinous cystadenoma?

BMJ Case Rep. 2020 Oct 30;13(10):

Authors: Dutra S, Rito M, Vilares M, Borges A

Abstract
Mucinous cystadenocarcinoma of minor salivary glands is an extremely rare entity that has only recently been described, with a few published cases in the English literature. A 42-year-old woman with a history of a surgically excised mucinous cystadenoma of the oral tongue, presented with a painful swelling in the oral tongue slowly growing for 1 month. On clinical examination, there was a firm, relatively well-circumscribed mass in the left posterior border of the mobile tongue. Subsequent MRI scan revealed a heterogeneous lesion composed of multiple cysts separated by contrast enhancing septa, in the posterior two-thirds of the left tongue. Imaging findings were similar to those of the previously resected mass, suggesting local relapse of the primary lesion. A complete surgical excision was performed and the histopathological examination revealed typical features of a low-grade mucinous cystadenocarcinoma of minor salivary glands.

PMID: 33127690 [PubMed - as supplied by publisher]

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Lemierre's syndrome: a forgotten life-threatening entity.

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Lemierre's syndrome: a forgotten life-threatening entity.

BMJ Case Rep. 2020 Oct 30;13(10):

Authors: Gama R, Sousa M, Castro F, Condé A

Abstract
Lemierre's syndrome is a very rare but potentially fatal condition. It mainly affects adolescents and young adult males, and usually arises as a serious complication of pharyngitis or peritonsillar abscess. It is characterised by the triad of internal jugular vein septic thrombophlebitis, septic emboli (mostly pulmonary) and the isolation of the agent 'Fusobacterium necrophorum' in sterile fluids. In this report, it is described a case in which the nonspecific and subtle clinic made the diagnosis difficult to reach. In fact, only the dissociation between flu-like symptoms and the presence of significant changes in the blood tests (suggestive of acute bacterial infection), led to the request for imaging tests, which proved to be essential for the final diagnosis and subsequent control of the disease. This case report aims to increase the awareness among Ear, Nose and Throat (ENT) residents, paediatricians and family doctors about the existence of this entity and its potential life-threatening nature.

PMID: 33127694 [PubMed - as supplied by publisher]

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Oropharyngeal Kimura's disease: a diagnostic dilemma and therapeutic challenge.

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Oropharyngeal Kimura's disease: a diagnostic dilemma and therapeutic challenge.

BMJ Case Rep. 2020 Oct 30;13(10):

Authors: Saravanam PK, Gajendran A, Dinakaran N, Jayaraman D

Abstract
Kimura's disease is a chronic inflammatory disorder involving subcutaneous tissue and locoregional lymph nodes of head and neck region, characterised by angiolymphoid proliferation. It is typically associated with peripheral eosinophilia, increased serum IgE and lymphadenopathy. Diagnosis is usually based on histopathological examination. Though various treatment modalities have been put forward, surgical management remains the first line of treatment, followed by systemic steroids application. This case report discusses the diagnostic dilemma and therapeutic management of a rare clinical presentation and management of oropharyngeal Kimura's disease in a young immunocompetent woman.

PMID: 33127696 [PubMed - as supplied by publisher]

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Transnasal endoscopic resection of Epstein-Barr virus-associated cavernous sinus tumour.

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Transnasal endoscopic resection of Epstein-Barr virus-associated cavernous sinus tumour.

BMJ Case Rep. 2020 Oct 30;13(10):

Authors: Yokoyama D, Horiguchi K, Higuchi Y, Hashiba J

Abstract
Epstein-Barr virus-associated smooth muscle tumour (EBV-SMT) is a rare disease occurring in immunosuppressed patients, such as those with AIDS, post-transplantation immunodeficiency and congenital immunodeficiency. Intracranial EBV-SMT after solid organ transplantation has been reported. However, intracranial lesions after bone marrow transplantation are extremely rare. We report the case of a 47-year-old man with a history of acute myeloid leukaemia and bone marrow transplantation. He had symptoms of trigeminal neuralgia, and MRI revealed a left cavernous sinus tumour. He started taking oral gabapentin, but his symptoms did not improve. We performed transnasal endoscopic surgery. Postoperative MRI showed complete removal of the cavernous sinus lesion. Pathological examination showed spindle-shaped cells positive for smooth muscle markers and EBV-encoded small RNA in situ hybridisation. EBV-SMT was pathologically diagnosed. His symptoms improved after surgery. No tumour recur rence was noted on follow-up MRI after 15 months without adjuvant radiation or chemotherapy.

PMID: 33127697 [PubMed - as supplied by publisher]

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