RESUMEN
Subcutaneous emphysema is a relatively harmless finding which is pathognomonic for a mid-facial fracture in most cases. Increasing pressure will cause air to expand beyond the tissues. It is often caused by blowing one's nose, but can also result from intubation in cases of more severe trauma. Crepitus can be heard or felt subcutaneously upon palpitation. Two cases of patients presenting at an oral and maxillofacial unit with extensive emphysema in the head and neck region illustrate both a common and an unusual cause.
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Enfisema Subcutáneo , Humanos , Enfisema Subcutáneo/etiología , Enfisema Subcutáneo/diagnóstico , Masculino , Cuello , Femenino , Persona de Mediana Edad , Adulto , CabezaRESUMEN
Emergency front-of-neck access refers to all techniques that deliver oxygen into the airway lumen through the anterior neck structures and encompasses access both through the cricothyroid membrane and the tracheal wall. There has yet to be a universal agreement regarding the preferred technique. A surgical incision is currently the most common approach in prehospital and in-hospital care. This review intends to review and summarize the existing clinical, basic science, and societal guidelines for eFONA.
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Manejo de la Vía Aérea , Servicios Médicos de Urgencia , Cuello , Humanos , Cuello/cirugía , Manejo de la Vía Aérea/métodos , Servicios Médicos de Urgencia/métodos , Intubación Intratraqueal/métodos , TráqueaRESUMEN
BACKGROUND: The emergence of horizontal neck wrinkles is increasingly becoming a focal point for both cosmetic professionals and clients. Various treatment approaches must be considered to address this issue effectively, owing to its diverse underlying causes. The study explores the potential of utilizing the Endolift laser in conjunction with nanofat injection as a viable treatment option. METHODS: Twenty patients with horizontal neck wrinkles involved in the study. Ten patients underwent treatment with a combination of Endolift laser and nanofat injection and 10 patients treated with nanofat injection alone. The participants were monitored for 6 months post-treatment. Biometric measurements were utilized to assess outcomes, including changes in volume, depth, and area of the wrinkles, skin elasticity, as well as the diameter and density of the epidermis and dermis in the treated area. Skin improvement was evaluated by two independent dermatologists, who compared before and after photos in a blinded manner. Patient satisfaction levels were also documented. RESULTS: The Visioface analysis showed a notable decrease in neck wrinkle depth and area in both groups. However, the group receiving the combination treatment of Endolift laser and nanofat exhibited a significantly greater improvement compared to the group treated with nanofat alone. Skin ultrasonography results demonstrated an increase in thickness and density of the dermis and epidermis in both groups. Particularly, the group treated with Endolift laser-nanofat displayed significant enhancements in dermis and epidermis density and thickness when contrasted with the nanofat-only group. Analysis with Cutometer revealed a marked enhancement in skin elasticity in the Endolift-nanofat treated group in comparison to the nanofat-only treated group. Furthermore, in the Endolift-nanofat treated group, a substantial majority (90%) of patients exhibited improvement. Patient evaluations highlighted significant distinctions between the two groups, with 95% of patients in the Endolift-nanofat treated group demonstrating enhancement. CONCLUSION: Both methods notably enhance horizontal neck wrinkles; nevertheless, the combination of endolift laser and nanofat seems to be more efficient for treating horizontal neck wrinkles.
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Cuello , Envejecimiento de la Piel , Humanos , Femenino , Persona de Mediana Edad , Terapia Combinada/métodos , Adulto , Satisfacción del Paciente , Resultado del Tratamiento , Terapia por Láser/métodos , Terapia por Láser/instrumentación , Masculino , Tejido Adiposo/diagnóstico por imagen , Técnicas Cosméticas/instrumentaciónRESUMEN
Objective: To explore the risk factors of neck work-related musculoskeletal disorders (WMSDs) among automobile manufacturing enterprise workers, and construct the risk prediction model. Methods: In May 2022, a cluster convenience sampling method was used to selet all front-line workers from an automobile manufacturing factory in Xiangyang City as the research objects. And a questionnaire survey was conducted using the modified Musculoskeletal Disorders Questionnaire to analyze the occurrence and exposure to risk factors of neck WMSDs. Logistic regression was used to analyze the influencing factors of workers' neck WMSDs symptoms, and Nomogram column charts was used to construct the risk prediction model. The accuracy of the model was evaluated by the receiver operating characteristic (ROC) curve, the Bootstrap resampling method was used to verify the model, Hosmer-Lemeshow goodness of fit test was used to evaluate the model, and the Calibration curve was drawn. Results: A total of 1783 workers were surveyed, and the incidence of neck WMSDs symptoms was 24.8% (442/1783). Univariate logistic regression showed that age, female, smoking, working in uncomfortable postures, repetitive head movement, feeling constantly stressed at work, and completing conflicting tasks in work could increase the risk of neck WMSDs symptoms in automobile manufacturing enterprise workers (OR=1.37, 95%CI: 1.16-1.62; OR=2.85, 95%CI: 1.56-5.20; OR=1.50, 95%CI: 1.18-1.91; OR=1.18, 95%CI: 1.02-1.37; OR=1.34, 95%CI: 1.04-1.72; OR=1.62, 95%CI: 1.21-2.17; OR=1.48, 95%CI: 1.13-1.92; P<0.05). While adequate rest time could reduce the risk of neck WMSDs symptoms (OR=0.56, 95%CI: 0.52-0.86, P<0.05). The risk prediction model of neck WMSDs of workers in automobile manutacturing factory had good prediction efficiency, and the area under the ROC curve was 0.72 (95%CI: 0.70-0.75, P<0.001) . Conclusion: The occurrence of neck WMSDs symptoms of workers in automobile manufacturing factory is relatively high. The risk prediction model constructed in this study can play a certain auxiliary role in predicting neck WMSDs symptoms of workers in automobile manufacturing enterprise workers.
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Automóviles , Enfermedades Musculoesqueléticas , Enfermedades Profesionales , Humanos , Femenino , Enfermedades Musculoesqueléticas/epidemiología , Enfermedades Musculoesqueléticas/etiología , Masculino , Encuestas y Cuestionarios , Factores de Riesgo , Enfermedades Profesionales/epidemiología , Adulto , Modelos Logísticos , Cuello , Industria Manufacturera , Persona de Mediana Edad , Curva ROCRESUMEN
Objective: To describe cytologic findings from mandibular and superficial cervical lymph nodes in dogs with thyroid carcinoma and to determine prognostic factors associated with lymph node metastasis. Animals: A total of 71 client-owned dogs with confirmed thyroid carcinoma that had cytologic results from at least 1 mandibular or superficial cervical lymph node between 2010 and 2020. Procedure: Medical records from 2 referral veterinary hospitals were retrospectively reviewed. Cytology of lymph nodes was reviewed for presence of metastasis by diplomates of the American College of Veterinary Pathologists. Thyroid tumor diameter and volume, tumor fixation, bilateral location, vascular invasion, and stage were recorded to determine effects on nodal metastasis. Results: A total of 154 lymph nodes (104 mandibular and 50 superficial cervical lymph nodes) from 71 dogs were cytologically evaluated, and 1/154 (0.6%) and 2/154 (1.3%) lymph nodes were noted to be definitively metastatic or probably metastatic, respectively. Given the infrequent rate of nodal metastasis (1.9% or less), statistical analysis of potential prognostic variables was not completed. Conclusion and clinical relevance: Routine lymph node cytology of mandibular and superficial cervical lymph nodes appeared to be of low yield when assessing for metastasis of canine thyroid carcinomas. The medial retropharyngeal and deep cervical lymph nodes should continue to be evaluated as they appeared to have higher metastatic rates, based on historic reports. Additional studies are needed to determine prognostic factors associated with lymph node metastasis and effects on patient survival.
Résultats cytologiques dans les ganglions lymphatiques cervicaux mandibulaires et superficiels de chiens atteints d'un carcinome thyroïdien. Objectif: Décrire les résultats cytologiques obtenus des ganglions lymphatiques mandibulaires et cervicaux superficiels chez des chiens atteints d'un carcinome thyroïdien et déterminer les facteurs pronostiques associés aux métastases ganglionnaires. Animaux: Un total de 71 chiens appartenant à des clients atteints d'un carcinome thyroïdien confirmé avec des résultats cytologiques d'au moins un ganglion lymphatique cervical mandibulaire ou superficiel entre 2010 et 2020. Procédure: Les dossiers médicaux de 2 hôpitaux vétérinaires de référence ont été examinés rétrospectivement. La cytologie des ganglions lymphatiques a été examinée pour détecter la présence de métastases par des diplomates de l'American College of Veterinary Pathologists. Le diamètre et le volume de la tumeur thyroïdienne, la fixation de la tumeur, la localisation bilatérale, l'invasion vasculaire et le stade ont été notés pour déterminer les effets sur les métastases ganglionnaires. Résultats: Au total, 154 ganglions lymphatiques (104 ganglions lymphatiques mandibulaires et 50 ganglions lymphatiques cervicaux superficiels) provenant de 71 chiens ont été évalués par cytologie, et 1/154 (0,6 %) et 2/154 (1,3 %) ganglions lymphatiques ont été notés comme définitivement métastatiques ou probablement métastatiques, respectivement. Compte tenu du taux peu fréquent de métastases ganglionnaires (1,9 % ou moins), l'analyse statistique des variables pronostiques potentielles n'a pas été complétée. Conclusion et pertinence clinique: La cytologie de routine des ganglions lymphatiques mandibulaires et cervicaux superficiels semblait être de faible rendement lors de l'évaluation des possibilités de métastases des carcinomes thyroïdiens canins. Les ganglions lymphatiques rétropharyngés médiaux et cervicaux profonds doivent continuer à être évalués car ils semblent présenter des taux métastatiques plus élevés, sur la base des rapports historiques. Des études supplémentaires sont nécessaires pour déterminer les facteurs pronostiques associés aux métastases ganglionnaires et les effets sur la survie des patients.(Traduit par Dr Serge Messier).
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Enfermedades de los Perros , Ganglios Linfáticos , Metástasis Linfática , Neoplasias de la Tiroides , Animales , Perros , Neoplasias de la Tiroides/veterinaria , Neoplasias de la Tiroides/patología , Enfermedades de los Perros/patología , Ganglios Linfáticos/patología , Estudios Retrospectivos , Metástasis Linfática/patología , Masculino , Femenino , Cuello/patología , Mandíbula/patologíaRESUMEN
Not required for Clinical Vignette.
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Hormona de Crecimiento Humana , Micrognatismo , Humanos , Hormona de Crecimiento Humana/uso terapéutico , Masculino , Micrognatismo/tratamiento farmacológico , Deformidades Congénitas de la Mano/tratamiento farmacológico , Deformidades Congénitas de la Mano/genética , Resultado del Tratamiento , Anomalías Múltiples/tratamiento farmacológico , Anomalías Múltiples/genética , Discapacidad Intelectual/tratamiento farmacológico , Cuello/anomalías , Cara/anomalías , Proteínas Recombinantes/uso terapéuticoRESUMEN
Sensorimotor disturbances such as disturbed cervical joint position sense (JPS) and reduced reaction time and velocity in fast cervical movements have been demonstrated in people with neck pain. While these sensorimotor functions have been assessed mainly in movement science laboratories, new sensor technology enables objective assessments in the clinic. The aim was to investigate concurrent validity of a VR-based JPS test and a new cervical reaction acuity (CRA) test. Twenty participants, thirteen asymptomatic and seven with neck pain, participated in this cross-sectional study. The JPS test, including outcome measures of absolute error (AE), constant error (CE), and variable error (VE), and the CRA test, including outcome measures of reaction time and maximum velocity, were performed using a VR headset and compared to a gold standard optical motion capture system. The mean bias (assessed with the Bland-Altman method) between VR and the gold standard system ranged from 0.0° to 2.4° for the JPS test variables. For the CRA test, reaction times demonstrated a mean bias of -19.9 milliseconds (ms), and maximum velocity a mean bias of -6.5 degrees per seconds (°/s). The intraclass correlation coefficients (ICCs) between VR and gold standard were good to excellent (ICC 0.835-0.998) for the JPS test, and excellent (ICC 0.931-0.954) for reaction time and maximum velocity for the CRA test. The results show acceptable concurrent validity for the VR technology for assessment of JPS and CRA. A slightly larger bias was observed in JPS left rotation which should be considered in future research.
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Dolor de Cuello , Tiempo de Reacción , Humanos , Femenino , Adulto , Masculino , Estudios Transversales , Dolor de Cuello/fisiopatología , Dolor de Cuello/diagnóstico , Tiempo de Reacción/fisiología , Vértebras Cervicales/fisiología , Adulto Joven , Realidad Virtual , Rango del Movimiento Articular/fisiología , Propiocepción/fisiología , Movimiento/fisiología , Cuello/fisiología , Persona de Mediana EdadRESUMEN
The vast array of acute nontraumatic diseases encountered in the head and neck of pediatric patients can be intimidating for radiologists in training in a fast-paced emergency setting. Although there is some overlap of pediatric and adult diseases, congenital lesions and developmental variants are much more common in the pediatric population. Furthermore, the relative incidences of numerous infections and neoplasms differ between pediatric and adult populations. Young patients and/or those with developmental delays may have clinical histories that are difficult to elicit or nonspecific presentations, underscoring the importance of imaging in facilitating accurate and timely diagnoses. It is essential that radiologists caring for children be well versed in pediatric nontraumatic head and neck emergency imaging. The authors provide an on-call resource for radiology trainees, organized by anatomic location and highlighting key points, pearls, pitfalls, and mimics of many acute nontraumatic diseases in the pediatric head and neck. ©RSNA, 2024 Supplemental material is available for this article.
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Urgencias Médicas , Cabeza , Cuello , Humanos , Niño , Cabeza/diagnóstico por imagen , Cabeza/anomalías , Cuello/diagnóstico por imagen , Diagnóstico DiferencialRESUMEN
STUDY OBJECTIVE: To evaluate the sensitivity and specificity of the combined Kushida morphometric model (KMM) and the oxygen desaturation index (ODI) for screening individuals with obstructive sleep apnea. METHODS: Diagnostic test study with adults >18 years, both sexes, polysomnography, body mass index, neck circumference and intraoral measurements. RESULTS: 144 patients were invited; of these, 75 met the exclusion criteria. 55 individuals presented AHI ≥5 ev/h and 14, an AHI <5 ev/h. Three AHI cut-off points were evaluated: AHI ≥5, ≥15, ≥30 ev/h. When adopting the cut-off point of AHI ≥5 ev/h, the KMM showed sensitivity (SE) = 60.0 %, specificity (SP) = 71.4 % and 95 % confidence interval of the area under the curve (95 % CI of AUC) = 0.655; the combination of KMM and ODI (KMM + ODI) revealed SE = 73.0 %, SP = 71.4 % (95 % CI of AUC = 0.779) and the ODI showed SE = 76.4 % and SP = 92.9 % (95 % CI of AUC = 0.815). At the cut-off point of AHI ≥15 ev/h, the KMM presented SE = 64.1 %, SP = 76.7 % (95 % CI of AUC = 0.735); the KMM + ODI showed SE = 82.1 %, SP = 83.3 % (95 % CI of AUC = 0.895); and the ODI presented SE = 76.9 %, SP = 100.0 % (95 % CI of AUC = 0.903). For the cut-off point of AHI ≥30 ev/h, the KMM showed SE = 56.0 %, SP = 77.2 % (95 % CI of AUC = 0.722); the KMM + ODI revealed SE = 92.0 %, SP = 79.5 % (95 % CI of AUC = 0.926); and the ODI showed SE = 92.0 %, SP = 90.9 % (95 % CI of AUC = 0.941). CONCLUSION: The combination of oxygen desaturation index and Kushida morphometric model improved the sensitivity and specificity of this model regardless of obstructive sleep apnea severity suggesting greater effectiveness in risk prediction.
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Índice de Masa Corporal , Polisomnografía , Sensibilidad y Especificidad , Apnea Obstructiva del Sueño , Humanos , Apnea Obstructiva del Sueño/diagnóstico , Femenino , Masculino , Persona de Mediana Edad , Adulto , Saturación de Oxígeno/fisiología , Tamizaje Masivo/métodos , Cuello/anatomía & histologíaRESUMEN
OBJECTIVE: Deep neck space infections (DNSI), caused by the spread of an odontogenic infection to the floor of the mouth and neck, are potentially life-threatening but preventable. We explored the total cost of illness (COI) for patients with DNSI of odontogenic origin. MATERIAL AND METHODS: Cross-sectional, register-based, multi-centre study of the health economics of DNSI treatment. Included were patients aged > 18 years who were treated in hospital for DNSI of odontogenic origin. Subjects were identified from the regional healthcare database VEGA based on the International Classification of Diseases (ICD) codes and surgical procedure codes. The cost per patient (CPP) values for the hospital care, prescription medications and sick leave were extracted. RESULTS: In total, 148 patients were included. The average length of the hospital stay was 6 days. Total COI was estimated as 15,400 EUR per patient and 2,280,000 EUR in total. Direct costs accounted for 93% of the COI, and indirect costs were 7%. CONCLUSION: The total COI for patients with DNSI of odontogenic origin was six-fold higher than the average COI for patients in otorhinolaryngology (ORL) care. Preventing DNSI will entail substantial cost savings for the specialised healthcare units and will have a significant impact on the patients.
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Cuello , Humanos , Estudios Transversales , Masculino , Femenino , Persona de Mediana Edad , Adulto , Anciano , Costo de Enfermedad , Tiempo de Internación/economía , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Nonspecific neck pain (NSNP) is a well-established global burden affecting. It is also a common problem in Pakistan. The burden of neck pain is also increasing day by day due to poor work ergonomics, and increased use of computers and mobiles after the pandemic. An individual's poor posture is often associated with forward head posture (FHP). Limited evidence is available about the effects of neck stabilization (NSE) and dynamic exercises (NDE) for nonspecific neck pain particularly in patients with FHP. This aimed to compare the effects of NSE versus NDE among patients having NSNP with FHP in reducing pain, disability, forward head posture and improving neck range of motion. METHODS: It is a single-blinded randomized clinical trial with 60 patients aged 18-40 years, with moderate intensity NSNP for > 3 weeks and < 6 months along with FHP with a moderate disability on neck disability index (NDI) randomly assigned to the treatment groups. Group 1 was doing NSE and group 2 was doing NDE. Transcutaneous Electical Nerve Stimulation, cold packs, and stretching exercises were given to both groups. A total of 9 sessions (3 sessions/ week) were given to participants. NDI questionnaire, Visual analogue scale (VAS), goniometry, and plumb line measurement tool were used as baseline and assessment at the end of 3rd week. The data was analyzed on SPSS version 21. Descriptive analysis was performed. Independent t-test was used for between group comparison and paired t-test used for within group comparison. A p-value less than 0.05 was considered statistically significant. RESULTS: After treatment within-group analysis of both NSE and NDE showed significant (p < 0.001) improvement in pain on VAS, all ROMs of the neck including flexion, extension, left and right lateral flexion and left rotation, plumb line and NDI score with very large effect size. However, between-group analysis showed non-significant differences (p > 0.05) for post-treatment mean VAS, neck ROM, NDI and plumb line measurement. CONCLUSION: Between NSE and NDE, no one is more beneficial than another. Both are equally effective in alleviating pain, increasing ROM, decreasing functional disability, and improving forward head posture in patients with NSNP. TRIAL REGISTRATION: Registered trial at ClinicalTrials.gov Identifier: NCT05298631, 28/03/2022, prospectively registered.
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Terapia por Ejercicio , Dolor de Cuello , Dimensión del Dolor , Postura , Humanos , Dolor de Cuello/terapia , Dolor de Cuello/fisiopatología , Adulto , Femenino , Masculino , Método Simple Ciego , Terapia por Ejercicio/métodos , Adulto Joven , Rango del Movimiento Articular , Adolescente , Resultado del Tratamiento , Cabeza , Evaluación de la Discapacidad , Cuello/fisiopatologíaRESUMEN
The excessive use of electronic devices for prolonged periods has led to problems such as neck pain and pressure injury in sedentary people. If not detected and corrected early, these issues can cause serious risks to physical health. Detectors for generic objects cannot adequately capture such subtle neck behaviors, resulting in missed detections. In this paper, we explore a deep learning-based solution for detecting abnormal behavior of the neck and propose a model called NABNet that combines object detection based on YOLOv5s with pose estimation based on Lightweight OpenPose. NABNet extracts the detailed behavior characteristics of the neck from global to local and detects abnormal behavior by analyzing the angle of the data. We deployed NABNet on the cloud and edge devices to achieve remote monitoring and abnormal behavior alarms. Finally, we applied the resulting NABNet-based IoT system for abnormal behavior detection in order to evaluate its effectiveness. The experimental results show that our system can effectively detect abnormal neck behavior and raise alarms on the cloud platform, with the highest accuracy reaching 94.13%.
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Aprendizaje Profundo , Cuello , Humanos , Dolor de Cuello/diagnóstico , Internet de las Cosas , AlgoritmosRESUMEN
Accurate and precise rigid registration between head-neck computed tomography (CT) and cone-beam computed tomography (CBCT) images is crucial for correcting setup errors in image-guided radiotherapy (IGRT) for head and neck tumors. However, conventional registration methods that treat the head and neck as a single entity may not achieve the necessary accuracy for the head region, which is particularly sensitive to radiation in radiotherapy. We propose ACSwinNet, a deep learning-based method for head-neck CT-CBCT rigid registration, which aims to enhance the registration precision in the head region. Our approach integrates an anatomical constraint encoder with anatomical segmentations of tissues and organs to enhance the accuracy of rigid registration in the head region. We also employ a Swin Transformer-based network for registration in cases with large initial misalignment and a perceptual similarity metric network to address intensity discrepancies and artifacts between the CT and CBCT images. We validate the proposed method using a head-neck CT-CBCT dataset acquired from clinical patients. Compared with the conventional rigid method, our method exhibits lower target registration error (TRE) for landmarks in the head region (reduced from 2.14 ± 0.45 mm to 1.82 ± 0.39 mm), higher dice similarity coefficient (DSC) (increased from 0.743 ± 0.051 to 0.755 ± 0.053), and higher structural similarity index (increased from 0.854 ± 0.044 to 0.870 ± 0.043). Our proposed method effectively addresses the challenge of low registration accuracy in the head region, which has been a limitation of conventional methods. This demonstrates significant potential in improving the accuracy of IGRT for head and neck tumors.
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Tomografía Computarizada de Haz Cónico , Aprendizaje Profundo , Neoplasias de Cabeza y Cuello , Radioterapia Guiada por Imagen , Humanos , Radioterapia Guiada por Imagen/métodos , Tomografía Computarizada de Haz Cónico/métodos , Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Algoritmos , Cabeza/diagnóstico por imagen , Cuello/diagnóstico por imagenRESUMEN
Objective: To analyze the radiomic and clinical features extracted from 2D ultrasound images of thyroid tumors in patients with Hashimoto's thyroiditis (HT) combined with papillary thyroid carcinoma (PTC) using machine learning (ML) models, and to explore the diagnostic performance of the method in making preoperative noninvasive identification of cervical lymph node metastasis (LNM). Methods: A total of 528 patients with HT combined with PTC were enrolled and divided into two groups based on their pathological results of the presence or absence of LNM. The groups were subsequently designated the With LNM Group and the Without LNM Group. Three ultrasound doctors independently delineated the regions of interest and extracted radiomic features. Two modes, radiomic features and radiomics-clinical features, were used to construct random forest (RF), support vector machine (SVM), LightGBM, K-nearest neighbor (KNN), and XGBoost models. The performance of these five ML models in the two modes was evaluated by the receiver operating characteristic (ROC) curves on the test dataset, and SHapley Additive exPlanations (SHAP) was used for model visualization. Results: All five ML models showed good performance, with area under the ROC curve (AUC) ranging from 0.798 to 0.921. LightGBM and XGBoost demonstrated the best performance, outperforming the other models (P<0.05). The ML models constructed with radiomics-clinical features performed better than those constructed using only radiomic features (P<0.05). The SHAP visualization of the best-performing models indicated that the anteroposterior diameter, superoinferior diameter, original_shape_VoxelVolume, age, wavelet-LHL_firstorder_10Percentile, and left-to-right diameter had the most significant effect on the LightGBM model. On the other hand, the superoinferior diameter, anteroposterior diameter, left-to-right diameter, original_shape_VoxelVolume, original_firstorder_InterquartileRange, and age had the most significant effect on the XGBoost model. Conclusion: ML models based on radiomics and clinical features can accurately evaluate the cervical lymph node status in patients with HT combined with PTC. Among the 5 ML models, LightGBM and XGBoost demonstrate the best evaluation performance.
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Enfermedad de Hashimoto , Metástasis Linfática , Aprendizaje Automático , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides , Ultrasonografía , Humanos , Carcinoma Papilar/diagnóstico por imagen , Enfermedad de Hashimoto/complicaciones , Enfermedad de Hashimoto/diagnóstico por imagen , Ganglios Linfáticos/patología , Ganglios Linfáticos/diagnóstico por imagen , Cuello/diagnóstico por imagen , Radiómica , Curva ROC , Máquina de Vectores de Soporte , Cáncer Papilar Tiroideo/diagnóstico por imagen , Cáncer Papilar Tiroideo/patología , Cáncer Papilar Tiroideo/complicaciones , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/diagnóstico por imagen , Ultrasonografía/métodosRESUMEN
The human neck is a unique mechanical structure, highly flexible but fatigue prone. The rising prevalence of neck pain and chronic injuries has been attributed to increasing exposure to fatigue loading in activities such as prolonged sedentary work and overuse of electronic devices. However, a causal relationship between fatigue and musculoskeletal mechanical changes remains elusive. This work aimed to establish this relationship through a unique experiment design, inspired by a cantilever beam mechanical model of the neck, and an orchestrated deployment of advanced motion-force measurement technologies including dynamic stereo-radiographic imaging. As a group of 24 subjects performed sustained-till-exhaustion neck exertions in varied positions-neutral, extended, and flexed, their cervical spine musculoskeletal responses were measured. Data verified the occurrence of fatigue and revealed fatigue-induced neck deflection which increased cervical lordosis or kyphosis by 4-5° to 11°, depending on the neck position. This finding and its interpretations render a renewed understanding of muscle fatigue from a more unified motor control perspective as well as profound implications on neck pain and injury prevention.
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Fatiga Muscular , Dolor de Cuello , Cuello , Humanos , Masculino , Adulto , Femenino , Fatiga Muscular/fisiología , Dolor de Cuello/fisiopatología , Dolor de Cuello/etiología , Vértebras Cervicales/diagnóstico por imagen , Fenómenos Biomecánicos , Músculos del Cuello/fisiología , Rango del Movimiento Articular , Adulto Joven , Lordosis/fisiopatologíaRESUMEN
Genes encoding subunits of SWI/SNF (BAF) chromatin remodeling complexes are mutated in nearly 25% of cancers. To gain insight into the mechanisms by which SWI/SNF mutations drive cancer, we contributed ten rhabdoid tumor (RT) cell lines mutant for SWI/SNF subunit SMARCB1 to a genome-scale CRISPR-Cas9 depletion screen performed across 896 cell lines. We identify PHF6 as specifically essential for RT cell survival and demonstrate that dependency on Phf6 extends to Smarcb1-deficient cancers in vivo. As mutations in either SWI/SNF or PHF6 can cause the neurodevelopmental disorder Coffin-Siris syndrome, our findings of a dependency suggest a previously unrecognized functional link. We demonstrate that PHF6 co-localizes with SWI/SNF complexes at promoters, where it is essential for maintenance of an active chromatin state. We show that in the absence of SMARCB1, PHF6 loss disrupts the recruitment and stability of residual SWI/SNF complex members, collectively resulting in the loss of active chromatin at promoters and stalling of RNA Polymerase II progression. Our work establishes a mechanistic basis for the shared syndromic features of SWI/SNF and PHF6 mutations in CSS and the basis for selective dependency on PHF6 in SMARCB1-mutant cancers.
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Micrognatismo , Regiones Promotoras Genéticas , Proteínas Represoras , Tumor Rabdoide , Proteína SMARCB1 , Factores de Transcripción , Animales , Humanos , Masculino , Ratones , Anomalías Múltiples , Línea Celular Tumoral , Cromatina/metabolismo , Ensamble y Desensamble de Cromatina , Proteínas Cromosómicas no Histona/metabolismo , Proteínas Cromosómicas no Histona/genética , Sistemas CRISPR-Cas , Cara/anomalías , Deformidades Congénitas del Pie/genética , Deformidades Congénitas del Pie/metabolismo , Deformidades Congénitas de la Mano , Discapacidad Intelectual/genética , Discapacidad Intelectual/metabolismo , Micrognatismo/genética , Micrognatismo/metabolismo , Mutación , Cuello/anomalías , Regiones Promotoras Genéticas/genética , Proteínas Represoras/metabolismo , Proteínas Represoras/genética , Tumor Rabdoide/genética , Tumor Rabdoide/metabolismo , Tumor Rabdoide/patología , Proteína SMARCB1/metabolismo , Proteína SMARCB1/genética , Factores de Transcripción/metabolismo , Factores de Transcripción/genética , Transcripción GenéticaRESUMEN
INTRODUCTION/OBJECTIVES: Neck lumps are a common presentation to primary care services. The aetiology of posterior neck lumps is poorly explored in the literature, and therefore remain a concern to patients and clinicians. This often results in an urgent referral for ultrasound assessment. The authors of this study sought to evaluate the aetiology of posterior neck lumps from a radiological perspective, to assess whether ultrasound can be used as a useful adjunct, rather than a first-line urgent investigation. METHODS: A retrospective case series was carried out, examining all primary care referred ultrasound studies for assessment of posterior neck lumps, performed at a single institution in Essex, United Kingdom, over a period of over 10 years dating between 2nd February 2012 to 8th November 2022. Data was collected on: patient age at the time of study, patient sex, whether the lump was single or multiple as palpated and documented by the primary care physician, size of the lump to the nearest 0.5 cm as documented on ultrasound using the longest dimension, sonographic diagnosis and any follow up imaging (not limited to ultrasound). RESULTS: A total of 623 neck ultrasounds were performed on 615 adults. Of the overall radiological diagnoses made from the 623 scans, 555 (89.09%) scans were benign, 63 (10.11%) scans had no lump found on sonography, and 3 (0.48%) scans showed malignancy. In the remaining 2 (0.32%) scans, the lump was deemed indeterminate. The most common aetiologies for benign lumps were due to: normal lymph nodes (n = 263; 42.21%), lipomas (n = 152; 24.39%), and benign dermal cysts (n = 105; 16.85%). All 3 malignant cases had co-existing anterior and posterior neck lumps. CONCLUSIONS: Given that the overwhelming majority of posterior neck lumps in our study had benign findings, we propose that patients with solitary or even multiple posterior neck lumps alone, regardless of size can either be investigated routinely or can be reassured depending on other clinical examination characteristics. Patients who have the presence of co-existing anterior and posterior neck palpable neck lumps justifies urgent or 2-week wait radiological investigation.
Asunto(s)
Cuello , Ultrasonografía , Humanos , Ultrasonografía/métodos , Estudios Retrospectivos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Cuello/diagnóstico por imagen , Anciano , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Adulto Joven , Reino Unido , Anciano de 80 o más Años , Adolescente , Atención Primaria de SaludRESUMEN
Objective:To investigate the clinical features, imaging findings, pathological phenotype, treatment and prognosis of unicentric Castleman disease in the children's neck, in order to improve the understanding of CD among Otolaryngology Head and Neck Surgery. Methods:Retrospective cross-sectional, observational study was undertaken in Kunming Children's Hospital, from the archival data between January July 2015 and June 2020. Only 6 cases of CD were identified after studying the histomorphological characteristics and neck mass diagnosed. The imaging and pathological features were summarized and the pathogenesis was discussed. Results:Among the 6 cases of Castleman disease, five were male and one was female. Histopathology: Five cases were hyaline vascular subtype, one was mixed type. The uniform clinicopathologic features seen in all hyaline vascular subtype of CD included atrophic germinal centre with lymphocyte depletion, concentric rings of small lymphocytes, increased vascularity and predominance of high endothelial vessels in interfollicular region. Twinning, in which two or more germinal centers are combined and surrounded by lymphocytes in the mantle zone was observed in two cases with lollipop pattern at the same time. All the cases underwent complete surgical resection, the median follow-up time was 48 monthsï¼26, 84ï¼, both of them had good prognosis. Conclusion:Most cases of unicentric type CD in children are diagnosed late, which is clinical showed by painless lymphadenopathy. The most common pathological type is hyaline vascular. The overall prognosis of surgical treatment was good.
Asunto(s)
Enfermedad de Castleman , Cuello , Humanos , Enfermedad de Castleman/patología , Masculino , Femenino , Niño , Estudios Retrospectivos , Estudios Transversales , Pronóstico , Adolescente , Centro Germinal/patología , PreescolarRESUMEN
Objective:To explore the clinical characteristics of sarcoidosis of head and neck symptoms, and to summarize the diagnosis and treatment experience. Methods:A retrospective study was conducted on patients with nodular disease with main symptoms in the head and neck who visited Henan Provincial People's Hospital from January 2020 to August 2023. The clinical data including symptom characteristics, pathological characteristics, treatment methods, and prognosis were analyzed. Results:A total of 14 patients were included, with 4 malesï¼28.6%ï¼ and 10 femalesï¼71.4%ï¼, age ranged from 11 to 71 years, with an average age ofï¼52.0±15.8ï¼ years. The lesions were located in the parotid gland in 2 cases and the neck in 12 cases. Twelve cases underwent neck mass resection surgery, and 2 cases underwent ultrasound-guided core biopsy of parotid gland tumor and postoperative pathological diagnosis was confirmed in all cases. Four cases received steroid treatment postoperatively, and showed good prognosis with reduced lesion size after 3 months. Three cases did not take medication and the lesions continued to persist, causing discomfort. Seven cases did not take medication postoperatively, and the lesions expanded with multi-organ progression. Conclusion:Patients with head and neck sarcoidosis are rare in clinical practice, and it is prone to misdiagnosis and missed diagnosis. Steroid therapy can achieve good therapeutic effects.
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Cuello , Sarcoidosis , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto , Sarcoidosis/diagnóstico , Anciano , Niño , Adolescente , Cabeza , Adulto Joven , Pronóstico , Glándula Parótida/patologíaRESUMEN
Acne keloidalis nuchae (AKN) is a rare chronic inflammatory condition most commonly treated medically but in severe, treatment-refractory cases, surgery can be a better solution. In this case report, we present a patient with severe refractory AKN, treated with excision and direct split-thickness skin grafting in combination with negative pressure wound therapy. The patient achieved a satisfactory cosmetic and functional result within a relatively short healing period of six weeks.