Thursday, December 2, 2021

Clinical features, molecular characteristics and surgical management of primary penile mucosal melanoma based on the European Association of Urology Penile Cancer Guidelines

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Penile mucosal melanoma is an aggressive and rare genital malignancy. The aim of the present study was to review the management and outcomes of a homogenous cohort of patients with histologically confirmed penile mucosal melanoma, at a single specialist centre. A retrospective review of an institutional database ident ified patients with penile mucosal melanoma over a 10-year period. Patient demographics, histopathological characteristics, type of primary surgery, recurrence, presence of metastatic disease and molecular markers were evaluated. The management of the patients was initially based on the European Association of Urology (EAU) penile cancer guidelines which are primarily for squamous cell carcinoma with inputs from a melanoma multidisciplinary team. Twelve patients with penile mucosal melanoma were analysed. Median [interquartile range (IQR)] age was 69.5 (67.25−81) years. The overall median follow-up (IQR) was 69.5 (20−114) months, while median follow-up for cancer-specific survival (CSS) was 11.5 (8−37) months. Location of primary tumour was glans penis (n = 7), urethra (n = 2) and inner prepuce (n = 3). The CSS at 1, 2 and 5 years after primary surgery was 33%, 16.7% and 0%, respectively. The recurrence-free survival at 1, 3 and 5 months after the primary surge ry was 90%, 67% and 56%, respectively. All patients with metastatic disease or with inguinal lymph node invasion at presentation, died within 25 months of the primary diagnosis. Management based on the modified EAU penile cancer guidelines still led to poor outcomes. We present a management diagram based on our experience. Received 6 June 2021 Accepted 18 September 2021 Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.melanomaresearch.com. Correspondence to Asif Muneer, MD, FRCS (Urol), Division of Surgery and Interventional Science, NIHR Biomedical Research Centre, University College London Hospital, University College London, 235 Euston Rd, London NW1 2BU, UK, Tel: +44 0203 447 9280; e-mail: asif.muneer@nhs.net Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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Evaluation of human acellular amniotic membrane for promoting anterior auricle reconstruction

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Long‐term hearing performance and soft tissue outcomes of the Baha® Attract system in patients with bilateral congenital microtia in a single centre

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Abstract

The Baha® Attract system can provide effective and stable hearing amplification for patients with microtia.

Concurrent surgeries of auricle reconstruction and Baha® Attract implantation do not result in more soft tissue complications.

The number of adverse events increased with the duration of implantation, even one year postoperatively.

Benign skin evolutions, including skin thinning and erythema at the implant side, are commonly seen in Baha® Attract users.

Implants are not necessarily removed when skin necrosis occurs in Baha® Attract users.

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Spheroids to organoids: Solid cancer models for anticancer drug discovery

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Bull Cancer. 2021 Nov 27:S0007-4551(21)00443-4. doi: 10.1016/j.bulcan.2021.09.019. Online ahead of print.

ABSTRACT

Cell culture is an important and necessary technology in oncology research. Currently, two-dimensional (2D) cell culture models are the most widely used, but they cannot reproduce the complexity and pathophysiology of tumors in vivo. This may be a major cause of the high rate of attrition of anticancer drugs entering clinical trials, the rate of new anticancer drugs entering the market being less than 5 %. One way to improve the success of new cancer drugs in the clinic is based on the use of three-dimensional (3D) cell culture models, more able to represent the complex environment and architecture of tumors. These 3D culture systems are also a powerful research tool for modeling the evolution of cancer from early stages to metastasis. Spheroids and organoids, the most adaptable models among 3D culture systems, are beginni ng to be used in pharmaceutical research and personalized medicine. In this article, we review the use of spheroids and organoids by highlighting their differences, discussing their impact on drug development, and looking at future challenges.

PMID:34848046 | DOI:10.1016/j.bulcan.2021.09.019

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The management of multimorphic cancer pain, from diagnosis to treatment

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Bull Cancer. 2021 Nov 27:S0007-4551(21)00395-7. doi: 10.1016/j.bulcan.2021.08.013. Online ahead of print.

ABSTRACT

Cancer pain remains a major public health issue. Despite progress in pain medicine thanks to the interest shown in early and timely supportive care, more than half the patients managed for cancer are in pain. One of the key factors in high quality multidisciplinary management throughout the care pathway is to assess more than just pain: it is necessary to assess the patient as a whole. Understanding the complexity of cancer pain - or the various types of pain - through the innovative multimorphic cancer pain model, effectively opens up new perspectives for a targeted, personalised, and multimodal approach. The subsequent treatment strategies, whether drug-based with opioids, or interventional, are codified by guidelines based on scientific evidence for the healthcare professionals and, ultimately, patients.

PMID:34848047 | DOI:10.1016/j.bulcan.2021.08.013

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New MAA: First-line nivolumab plus ipilimumab in unresectable malignant pleural mesothelioma

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Bull Cancer. 2021 Nov 27:S0007-4551(21)00437-9. doi: 10.1016/j.bulcan.2021.09.013. Online ahead of print.

NO ABSTRACT

PMID:34848048 | DOI:10.1016/j.bulcan.2021.09.013

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Evaluation of burned hand function after enzymatic debridement

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J Plast Reconstr Aesthet Surg. 2021 Oct 22:S1748-6815(21)00517-9. doi: 10.1016/j.bjps.2021.09.074. Online ahead of print.

ABSTRACT

Hand burns are common injuries that can result in long-term impairment of hand function. Enzymatic debridement (ED) prevents damage to the viable dermis due to the procedure's selectivity and has become an option for obtaining an accurate depth assessment and enabling wound re-epithelialization with less skin graft use. We conducted a prospective study from July 2015 to July 2018, which enrolled patients with deep partial-thickness hand burns and treated them with ED using bromelain. After a specified period, we assessed the patients' hand function, using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Michigan Hand Outcomes Questionnaire (MHOQ) to assess their disabilities and activities of daily life, respectively. We assessed the hand joint range of motion using a goniometer a nd assessed scar quality with the Vancouver Scar Scale (VSS). We analyzed 72 patients with 90 burned hands at 3 months and, at the final assessment, 69 patients with 86 burned hands. Fire was the most common cause of the burns. Bromelain allowed for early debridement (73.6% during the first 24 h). At the 3-month evaluation, the mean DASH and MHOQ scores were 2.35 and 97.9%, respectively, with a high inverse correlation between the 2 types of scores (Spearman's rho, -0.78; p < .001). The mean wrist flexion and extension were 85.7 and 80°, respectively, the mean metacarpophalangeal flexion was 88.3°, the proximal interphalangeal (PIP) flexion was 112.9°, and the thumb opposition was 77°. The mean VSS score was 2.87. At the final evaluation, with a minimum follow-up of 391 days, the mean DASH and MHOQ scores were 0.18 and 99.71%, respectively. ED with bromelain in deep partial-thickness hand burns resulted in normal values at 3 months and at over 1 year of follow-up, with comple te restoration of function and quality of life and good scar results.

PMID:34848129 | DOI:10.1016/j.bjps.2021.09.074

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CircAKT3 promotes cell proliferation, survival and glutamine metabolism of gastric cancer by activating SLC1A5 expression via targeting miR-515-5p

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Histol Histopathol. 2021 Dec 1:18401. doi: 10.14670/HH-18-401. Online ahead of print.

ABSTRACT

BACKGROUND: Gastric cancer (GC) is a common disorder in the population. Numerous studies have reported that the pathogenesis of GC is implicated in the dysregulation of circular RNAs (circRNAs). The aim of this study was to investigate the role and functional mechanism of circ_0000199 (circAKT3) in GC.

METHODS: The expression of circAKT3, miR-515-5p and solute carrier family 1 member 5 (SLC1A5) mRNA was measured by quantitative real-time PCR (qPCR). Cell proliferation was assessed by cell counting kit-8 (CCK-8) assay, colony formation assay and 5-ethynyl-2'-deoxyuridine (EdU) assay. Cell apoptosis was determined by flow cytometry assay and caspase 3/7 activity. The protein levels of glutaminase (GLS), proliferating cell nuclear antigen (PCNA) and cleaved-caspase3 were detected by western blot. The binding relationship between miR-515-5p and circAKT3 or SLC1A5 was verified by dual-luciferase reporter assay or RIP assay. The role of circAKT3 in vivo was investigated by establishing animal models. The abundance of Ki-67 and PCNA was detected by IHC assay.

RESULTS: The expression of circAKT3 in GC tissues and cells was enhanced. The knockdown of circAKT3 inhibited GC cell proliferation, survival and glutamine metabolism, as well as tumor growth in animal models. MiR-515-5p was a target of circAKT3, and miR-515-5p suppressed the expression of SLC1A5 by binding to SLC1A5 3'UTR. CircAKT3 relieved the inhibition of miR-515-5p on SLC1A5 expression by targeting miR-515-5p. The effects of circAKT3 knockdown were reversed by miR-515-5p depletion, and the effects of miR-515-5p restoration were abolished by SLC1A5 overexpression.

CONCLUSION: CircAKT3 promotes the malignant development of GC by activating SLC1A5 expression via targeting miR-515-5p.

PMID:34850965 | DOI:10.14670/HH-18-401

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Endoscopic transcanal attico-antrostomy versus endoscopic-assisted canal wall up mastoidectomy in management of localized cholesteatoma: a randomized clinical trial

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Eur Arch Otorhinolaryngol. 2021 Dec 1. doi: 10.1007/s00405-021-07200-x. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aims to compare results of endoscopic transcanal tympanoplasty with attico-antrostomy with endoscopic-assisted canal wall up mastoidectomy in treatment of cases of limited attic cholesteatoma.

MATERIALS AND METHODS: A prospective randomized single-blinded study involving 40 patients with limited attic cholesteatoma was conducted. Randomization of the patients into two groups was done; 20 patients are managed by endoscopic transcanal tympanoplasty with attico-antrostomy, while the other 20 patients are managed by endoscopic-assisted canal wall up mastoidectomy. Primary outcome is recidivism, while secondary outcomes include hearing results, operative time, pain score and associated complications.

RESULTS: Comparable recidivism rate was found in the two groups. The endoscopic-assisted canal wall up ma stoidectomy group was associated with significantly longer duration of surgery and higher postoperative pain score. There was no significant difference between both the groups regarding hearing results and associated complications.

CONCLUSION: In localized attic cholesteatoma cases, endoscopic transcanal tympanoplasty with attico-antrostomy is a time-saving less-invasive reliable technique with good eradication results.

CLINICAL TRIAL REGISTRY: ClinicalTrials.gov (NCT04959539) "retrospectively registered" at 12/7/2021.

PMID:34851451 | DOI:10.1007/s00405-021-07200-x

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Improving tissue characterization, differentiation and diagnosis in gynecology with the narrow-band imaging technique: A systematic review

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Exp Ther Med. 2022 Jan;23(1):36. doi: 10.3892/etm.2021.10958. Epub 2021 Nov 10.

ABSTRACT

Narrow-band imaging (NBI), an on-demand, real-time endoscopic imaging technique, was developed to enhance visualization of the mucosal vascular network and surface texture. The present article provides a systematic review of studies that assessed the use of NBI in gynecological endoscopy. The following electronic databases were searched: PubMed (1950-2020), Google Scholar (2004-2020) and Cochrane Library (2010-2020). In the initial search, 3,836 entries were identified, of which 31 were finally included in the systematic review. Of the selected studies, 10 (32%) were case reports, 19 (61.2%) were prospective studies and 2 (6.4%) were randomized controlled trials with control groups. The selected studies reported on the use of NBI in hysteroscopy, laparoscopy and colposcopy. It was revealed that NBI utilization in hysteroscopy increased the accuracy , sensitivity and specificity in detecting malignant and premalignant lesions. NBI improved the specificity and sensitivity in the detection of endometriotic lesions and cervical lesions. Conventional white light endoscopy in gynecology may be significantly improved by the use of NBI. Further studies with larger cohorts and improved design are required to achieve more reliable results. It is of special interest that utilization of this method requires apparatus which is expensive; concerns are the long training and experience of staff required and the long learning curve.

PMID:34849151 | PMC:PMC8613536 | DOI:10.3892/etm.2021.10958

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The omission of intentional primary site radiation following transoral robotic surgery in 59 patients: No local‐regional failures

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Abstract

Background

We assessed locoregional control with omission of intentional primary site radiation after transoral robotic surgery (TORS) and quantified nontargeted primary site dose.

Methods

Following Institutional Review Board (IRB) approval, patients treated with primary TORS resection for squamous cell carcinomas of the oropharynx were reviewed. Patients with cT1-2 tumors, >2 mm margins, in whom the surgeon resected the primary without revising specimen-driven margins, qualified for omission of primary site radiation.

Results

From 2014 to 2019, 112 patients met criteria. Fifty-nine (52%) patients did not receive radiation targeting the primary site; of whom, 22 received no radiation. In this group, there were no local failures; mean age was 58 years and median follow-up was 25 months. Thirty-seven patients received adjuvant radiation targeting the neck, mean bystander dose to the primary site was 28.8 Gy (range, 13.3–50.6 Gy).

Conclusion

In a 59 patient population, omission of radiation to the primary site after TORS resulted in no locoregional failures.

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