Soft tissue necrosis in patients treated with transoral robotic surgery and postoperative radiotherapy: preliminary results

OBJECTIVE

Postoperative radiotherapy (PORT) is indicated in almost two-thirds of patients treated with transoral robotic surgery (TORS) for head and neck tumors. The aim of this study was to quantify the toxicity profile of patients treated with PORT after TORS in oropharyngeal and supraglottic laryngeal cancer focusing on soft tissue necrosis (STN).

METHODS

We retrospectively reviewed 28 patients. Acute and late toxicity were examined. Incidence and severity of STN were recorded.

RESULTS

No patient experienced acute grade 3 skin or mucosal toxicity; 1 patient had grade 3 dysphagia. At 12 months, no evaluated patient required enteral nutrition and 2 patients had tracheostomy. STN occurred in 4 (14%) patients: 3 out of 4 (75%) patients with STN had diabetes, whereas 6 out of 13 (25%) patients without STN had diabetes (p = 0.05).

CONCLUSION

We found an acceptable toxicity profile of PORT performed after a TORS procedure. Diabetes mellitus might be a risk factor for STN.

Clinical features and management of antrochoanal polyps in children: Cues from a clinical series of 58 patients

OBJECTIVE

To review the clinical features of pediatric patients affected by antrochoanal polyps (ACPs) and surgically treated at three University settings.

METHODS

Retrospective study. The present research includes the clinical data of subjects affected by ACPs, aged <18 years and referred to three ENT Departments, between January 1st 2003 and September 30th 2016. All patients underwent nasal endoscopy and sinonasal imaging; all subjects have been treated surgically.

RESULTS

Fifty-eight patients underwent functional endoscopic sinus surgery (FESS) for ACPs removal, under general anesthesia. There were no major intraoperative complications. Recurrence occurred in 12 cases (20.5%).

CONCLUSIONS

FESS was the first-choice treatment for APCs in the present series; our recurrence rate was similar to that of other reports available in literature. Recurrences of ACPs in children still represent a clinical challenge; it is likely that an improved comprehension of ACPs biology could help in better understanding the pathophysiology of this disease.

[Development of extracorporeal blood purification methods: Molecular Adsorbent Recirculating System (MARS) for hepatic and renal function replacement]

The Molecular Adsorbent Recirculating System (MARS) clears the blood from catabolites that either occur free in the plasma water (through dialysis), such as uremic toxins and ammonia, or are bound by albumin, such as hepatic toxins. The latter are transferred from the albumin in the blood to the albumin circulating in a closed loop where toxins are removed by adsorption on resins (charcoal and ion-exchange resin). The efficacy of this extracorporeal blood purification method in the treatment of acute or acute-on-chronic liver failure (also associated with renal failure) has been demonstrated in numerous studies. Fifty-one patients, 5 affected by acute liver failure and 46 by acute-onchronic liver failure (8 of them with additional renal failure) were treated with MARS. The results demonstrated that the method, which effectively removes ammonia, bilirubin, bile acids and uremic toxins, reduces the blood concentration of these molecules. It thereby improves the patient's clinical condition and biochemical parameters including cholinesterase, alkaline phosphatase and prothrombin activity, eliminating, in addition, the drug-refractory pruritus that is a very frequent symptom in cholestatic liver disease. These results agree with those reported in the literature concerning the efficacy of MARS in the replacement of the detoxifying function of kidneys and liver.

[Molecular Adsorbent Recirculating System in liver function replacement therapy]

The molecular adsorbent recirculating system (MARS) method removes from the blood catabolites either free in the plasma water such as uremic toxins and ammonia, taking advantage of dialysis or free albumin bound ones, like hepatic toxins, transferring them from the albumin in the blood to the albumin circulating in a closed loop where toxins are removed by adsorbtion on resins (charcoal and ion exchange resin). The efficacy of the method in removing the hepatic toxins either in the acute or in the acute on chronic liver failure is demonstrated in numerous studies. Based on these findings, 10 patients affected by acute on chronic liver failure were treated. The results demonstrated that the method, powerfully removing ammonia, bilirubin and bile acids (taken as method efficacy markers), reduced the blood concentrations of these molecules remarkably; allowing the elimination of the refractory pruritus (due to the lowering of plasma bile acid levels), an almost constant symptom in chronic liver diseases, especially with cholestasis, and improves other parameters (cholinesterase, alkaline phosphatase and prothrombin activity). These results agree with those reported in the literature concerning the efficacy of MARS in the replacement of the liver detoxifying function.

PaTre: a method for paralogy trees construction

Genomes can be described as a collection of clusters, the gene families, whose members are called paralogs. Paralogs are genes that most probably share duplication history and show a significant similarity in their sequences, even if they perform slightly different biological function. Among the different mechanisms that have led to an increase of the genomic information during biological evolution, gene duplication is probably the most important. To better understand duplication events, the first step is to investigate the history of the gene families in order to detect which duplication events have taken place, and in which relative (partial) order. Here we present a method, called PaTre, that, given a gene family, attempts to construct the paralogy tree of the family. We will work under the hypothesis that every family member derives from a duplication process of another member. By the term paralogy tree, we mean a directed tree in which the root represents the most ancient paralog of the family and each oriented arc (a, b) represents the existence of a duplication event from the template gene a to its copy b. Notice that gene a survives the event and can serve as a template of more than one duplication event; in fact, there can be more than one arc leaving a. PaTre uses new algorithmic techniques motivated by the specific application at hand. The reliability of the inferential process has been tested by means of a simulator that implements different hypotheses on the duplication-with-modification paradigm and on three examples of different biological gene families, belonging either to lower and higher organisms.

Modification of the Interlayer Surface of Layered Copper(II) Hydroxide Acetate with Benzoate Groups: Submicrometer Fiber Generation

We report on the functionalization of layered copper(II) hydroxide acetate with benzoic acid. The grafting of benzoate groups is characterized by thermogravimetry/differential scanning calorimetry, Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy. The submicrometer fiber generation of the grafted material is clearly demonstrated through scanning electron microscopy. Copyright 2001 Academic Press.

ELDONET--European Light Dosimeter Network. Structure and functions of the ELDONET server

The European Light Dosimeter Network (ELDONET) project has been designed with the purpose of establishing an efficient system to monitor solar radiation in Europe, in as many as possible locations. This paper describes the structure of the server that collects and processes the data acquired by the different stations belonging to the network, and makes them freely available on the Internet to the scientific community. The server is able to receive data either via FTP from the Internet or via modem and to process them looking for errors or inconsistencies. Moreover, it automatically generates graphs, Web-pages and FTP archives. The server has been active for some years in testing mode and is now fully operative.

Phototaxis in the ciliated protozoan Ophryoglena flava: dose-effect curves and action spectrum determination

The sensitivity of positive phototactic orientation of cells of the ciliated protozoan Ophryoglena flava has been measured for white light, broad-band blue and red light, and narrow-band monochromatic light, using a laboratory-developed computer aided system. The white-light fluence rate-response curve shows that there is no negative phototaxis in the fluence rate range investigated (0-15 W/m2) and no adaptation phenomena; it is very well fitted by a hyperbolic function; the fluence rate curves under broad band blue and red light (full width at half maximum, FWHM= 100 nm) can be fitted by the same model. The saturation level is, within experimental errors, the same for the three curves, indicating that there are no chromaticity effects and that if there is more than one photoreceptor pigment, they act independently of each other. The fluence rate-response curves determined under narrow band monochromatic light (FWHM = 10 nm) can also be fitted by the same model and show, within experimental errors, the same saturation level. An action spectrum for positive phototaxis at 10-nm intervals has been calculated from fluence rate-response curves: it shows three maxima, at 420, 540 and 590 nm. This action spectrum is significantly different from the ones for photomotile responses in Blepharisma japonicum, Stentor coeruleus and Chlamydodon mnemosyne, whereas it resembles the ones of Paramecium bursaria and Fabrea salina.

Covalent Grafting of Ethylene Glycol into the Zn-Al-CO(3) Layered Double Hydroxide

Zn-Al-CO(3) layered double hydroxide was synthesized at room temperature using a procedure reported elsewhere. After characterization, 0.5 g of the Zn-Al-CO(3) layered compound was reacted under air with 15 cm(3) of ethylene glycol at 80 degrees C for a period of 5 days. After washing with acetone and drying at 50 degrees C, the resulting white powder was characterized by X-ray powder diffraction, thermal analysis (simultaneous TG/DSC), elemental analysis (C, H, N, Al, and Zn content), and FTIR spectroscopy. All of the experimental data were consistent with the bidentade grafting of ethylene glycol into the interlayer surface of the Al-Zn double hydroxide. The stoichiometry obtained [Zn(0.66)Al(0.34)(OCH(2)CH(2)O)](OH)(0.34).0.4H(2)O] showed that all of the surface hydroxide groups were replaced by ethylene glycol through Al-(Zn)-O-C bonds. Carbonate could not be detected by FTIR, proving that OH(-) was probably the actual intercalated counteranion. Copyright 2000 Academic Press.

Phototactic orientation mechanism in the ciliate Fabrea salina, as inferred from numerical simulations

The marine ciliate Fabrea salina shows a clear positive phototaxis, but the mechanism by which a single cell is able to detect the direction of light and orient its swimming accordingly is still unknown. A simple model of phototaxis is that of a biased random walk, where the bias due to light can affect one or more of the parameters that characterize a random walk, i.e., the mean speed, the frequency distribution of the angles of directional changes and the frequency of directional changes. Since experimental evidence has shown no effect of light on the mean speed of Fabrea salina, we have excluded models depending on this parameter. We have, therefore, investigated the phototactic orientation of Fabrea salina by computer simulation of two simple models, the first where light affects the frequency distribution of the angles of directional changes (model M1) and the second where the light bias modifies the frequency of directional changes (model M2). Simulated M1 cells directly orient their swimming towards the direction of light, regardless of their current swimming orientation; simulated M2 cells, on the contrary, are unable to actively orient their motion, but remain locked along the light direction once they find it by chance. The simulations show that these two orientation models lead to different macroscopic behaviours of the simulated cell populations. By comparing the results of the simulations with the experimental ones, we have found that the phototactic behaviour of real cells is more similar to that of the M2 model.

Lactate versus bicarbonate on-line hemofiltration: a comparative study

In this study, 6 chronic anuric uremic patients underwent lactate hemofiltration (HF) with a substitution fluid, prepared in bags, for 3 months and bicarbonate HF, with continuous on-line preparation of the substitution fluid, for 3 months. We determined Na+, Cl-, K+, total calcium (Ca), ionized calcium (Ca2+), phosphate, intact parathormone (I-PTH), pH, PCO2, PO2, and HCO3- in plasma before, during, and after the treatment, as well as Ca, Ca2+, phosphate, and I-PTH in the ultrafiltrate. Moreover, heart rate (HR) and mean arterial pressure (MAP) were continually recorded during the procedure. Furthermore, the patients underwent echocardiographic study before and after the session. In comparison with lactate, bicarbonate HF caused a significant increase in HCO3- and a decrease in K+ plasma concentrations. This was detectable, with lower significance, even 44 h after the end of the treatment. At the end of the long interdialytic period (68 h after the end of the treatment), no significant difference was detectable. pH and PCO2 showed a significant but transient increase during HF. The other parameters investigated did not differ significantly between the two methods.

[Evaluation of bronchiectasia with AMBER and high-resolution computerized tomography. Prospective study of a group of 50 patients]

The authors compared the diagnostic value of AMBER and HRCT in the evaluation of bronchiectasis. A series of 50 patients with conventional X-ray findings suggestive of this condition (increased pulmonary markings, loss of pulmonary volume and segmental cysts) were submitted to HRCT. In all the patients with bronchiectasis (25/50), AMBER showed increased pulmonary markings in one or more localizations, while loss of pulmonary volume was observed in 22 cases and segmental cysts in 8. The positive predictive value (PPV) of these findings was 50% for increased markings, 59% for the loss of pulmonary volume, 64% for the association of the former two signs and finally 100% for segmental cysts. The false-positive cases were due to bronchial wall thickening and to areas of peribronchial fibrosis. On the basis of their findings, the authors conclude that, except for the finding of segmental cysts, AMBER does not allow the unquestionable diagnosis of bronchiectasis to be made due to its low PPV (64%) and that further studies with HRCT are therefore required.

Short time treatment with high-efficiency paired filtration dialysis for chronic renal failure

With the aim of treating with short sessions even chronic uremic patients with cardiovascular instability, we have developed our previous findings about paired filtration dialysis (hemofiltration-hemodialysis in series) by a method we call high-efficiency paired filtration dialysis (HEPFD). We have treated with this method for 6 months 6 chronic anuric uremic patients previously treated for 6 months with hemofiltration (HF) because of their cardiovascular instability. By comparison with HF, HEPFD shows much higher clearances of small molecules with consequent significant decrease of their predialytic values, improvement of Kt/V value, lower beta 2-microglobulin clearance (its predialytic value remains unchanged), and the same tolerability. HEPFD allows short, efficient, and well-tolerated treatments even in patients with cardiovascular instability.

Plasma lipids and fatty acid levels in chronically uremic patients undergoing blood purification with different methods

Levels of plasma lipids and the fatty acid composition of major plasma lipid classes have been determined in chronically uremic patients before and after treatments with hemofiltration, high efficiency paired filtration dialysis, or acetate-free biofiltration. The major findings are a decrease of triglycerides and an increase of total free fatty acids (FFAs) at the end of the dialytic session--already reported in the literature--that do not appear to be strictly dependent on heparin administration. The changes in the plasma concentrations of selected saturated and polyunsaturated fatty acids, which may contribute to alteration of functional parameters in the cardiovascular system in dialyzed patients, are different in the various types of techniques.

[Computerized tomography as a diagnostic complement of standard radiograms in the evaluation of traumatic lesions of the carpal scaphoid. A study of 10 cases]

The authors investigated the value of direct coronal CT as a diagnostic complement to plain radiography in the assessment of post-traumatic scaphoid conditions. The series included 10 patients who were selected either for disagreement of clinical and radiological findings, the latter being negative (3 patients), or for better assessment of radiological findings, which had diagnosed bone lesions, in order to plan treatment (7 cases). CT provided additional information in 5 patients, demonstrating 2 nonunited fractures in the first group and 2 pseudoarthroses with no significant bone deformity and 1 osteonecrosis in the second group. These results, which proved essential to plan the subsequent treatment, show that CT has, at present, in specific cases, a definite role in evaluating post-traumatic scaphoid conditions, and stress the value of direct coronal images, which are both easy to interpret, being equivalent to radiographs in postero-anterior projection, and quick to perform.

Improvement of continuous arteriovenous hemofiltration (CAVH) and hemofiltration (HF) efficiency by adding hemoperfusion (HP)

Aiming to improve the efficiency of the blood purification convective methods either with spontaneous (CAVH) or with pump-assisted (HF) extracorporeal circulation we inserted after the hemofilter a cartridge containing 70 g of collodion-coated activated charcoal (CAC) microencapsulated, obtaining so hemofiltration and hemoperfusion in series (HF+HP). The obtained results show that in both methods HP addition gives a negligible increase of urea clearance and a practically null increase of phosphate clearance, whereas creatinine and uric acid clearances increase is remarkable especially, in percentage, with low blood flows (CAVH). In the HF+HP system we have also been studying B2-microglobulin (B2-M) clearance aiming at examining the possibility of increasing the removal of substances with higher molecular weight. We have been finding HP addition increases further on B2-M clearance already high in HF. Therefore we think HP addition to convective methods is an interesting step in the attempt to carry out highly efficient blood purification methods.

[Hemofiltration and hemoperfusion performed in series for the purpose of removing beta 2 microglobulin]

With the objective to develop most efficient method for Beta-2-microglobulin elimination, the authors, using extracorporeal circulation placed behind the haemofilter a capsule containing 70 g of collodion coated with activated medicinal charcoal. This combination was used in 3 haemofilters made from different membranes. The results showed polysulphon to be the highest efficiency membrane out of those tested for Beta-2 microglobulin elimination. In combination with haemoperfusion, its efficiency increases significantly. Even if haemoperfusion increases efficiency by considerable percentage, the Beta-2 microglobulin elimination using other types of membranes lasts long and the total clearance remains low.