Safety and feasibility study of non-invasive robot-assisted high-intensity focused ultrasound therapy for the treatment of atherosclerotic plaques in the femoral artery: protocol for a pilot study.

INTRODUCTION: Peripheral arterial disease (PAD) is an atherosclerotic disease leading to stenosis and/or occlusion of the arterial circulation of the lower extremities. The currently available revascularisation methods have an acceptable initial success rate, but the long-term patency is limited, while surgical revascularisation is associated with a relatively high perioperative risk. This urges the need for development of less invasive and more effective treatment modalities. This protocol article describes a study investigating a new non-invasive technique that uses robot assisted high-intensity focused ultrasound (HIFU) to treat atherosclerosis in the femoral artery. METHODS AND ANALYSIS: A pilot study is currently performed in 15 symptomatic patients with PAD with a significant stenosis in the common femoral and/or proximal superficial femoral artery. All patients will be treated with the dual-mode ultrasound array system to deliver imaging-guided HIFU to the atherosclerotic plaque. Safety and feasibility are the primary objectives assessed by the technical feasibility of this therapy and the 30-day major complication rate as primary endpoints. Secondary endpoints are angiographic and clinical success and quality of life. ETHICS AND DISSEMINATION: Ethical approval for this study was obtained in 2019 from the Medical Ethics Committee of the University Medical Center Utrecht, the Netherlands. Data will be presented at national and international conferences and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NL7564.

Oral squamous cell carcinoma involving the maxillae: Factors affecting local recurrence and the value of salvage treatment for overall survival.

OBJECTIVE: To determine factors associated with local recurrence (LR) of oral squamous cell carcinoma involving the maxillae (MSCC) and overall survival (OS) after salvage treatment. SUBJECTS AND METHODS: Retrospective study of MSCC operated between 2000 and 2015. Kaplan-Meier survival and Cox regression were used for analysis of MSCC-associated clinical and histopathological factors. RESULTS: Ninety-five patients were included. LR occurred in 24% of patients. Vascular invasion significantly increased the risk of LR (hazard ratio 4.595, P = .003). Local salvage surgery, in the area of the original tumor, significantly prolonged OS, compared to palliative treatment (P = .001) and extensive salvage surgery (P = .013). Extensive salvage surgery, requiring resection of adjacent facial structures, did not prolong OS compared to palliative treatment (P = .186). CONCLUSIONS: MSCC with vascular invasion has higher risk of LR. Salvage surgery may prolong OS in small recurrences but might have dubious value for larger recurrences infiltrating adjacent facial structures.

Predicting individualized mortality probabilities for patients with squamous cell carcinoma of the maxilla: Novel models with clinical and histopathological predictors.

BACKGROUND: The aim of this article was to develop prediction models that calculate postoperative 2- and 5-year mortality probabilities of patients with squamous cell carcinoma of the maxilla (MSCC). METHODS: Data were collected from the medical records of patients who had been operated between 2000 and 2015 for MSCC. Potential clinical and histopathological predictors were identified. Confounding-(un)adjusted multivariate Cox and logistic regression models were computed with stepwise backward selection. Internal validation was performed to assess calibration and discriminatory ability. RESULTS: Ninety-five patients with MSCC were included. Two-year follow-up was complete, and 85 patients had 5-year follow-up. Age, neck treatment, surgical margins, bone invasion, spindle growth, and vasoinvasive growth were associated with mortality. Models were adjusted for confounding with Charlson's comorbidities index. C-indexes were .841 and .770 respectively, and .838 and .749 after bootstrapping. CONCLUSION: The MSCC-specific mortality probability can be calculated with new prediction models.

Esophageal Resection, Gastric Tube Reconstruction, and Omental Flap Coverage of Iatrogenic Aortoesophageal Fistula After Secondary Thoracic Stentgraft Infection: A Case Report.

Secondary stent graft infection is a life-threatening complication after thoracic endovascular aortic repair (TEVAR). There is no consensus on optimal treatment strategy, but combined antibiotic and surgical treatment is advocated. Two years after his TEVAR procedure, a 70-year-old patient was admitted to the hospital with a secondary periaortic abscess. At first, the abscess was managed with clindamycin and transesophageal drainage. The abscess would not dissipate, and an infected iatrogenic aortoesophageal fistula was formed, which was surgically treated with esophageal resection, gastric tube reconstruction, and omental flap coverage.

Cell-free nucleic acids in body fluids as biomarkers for the prediction and early detection of recurrent head and neck cancer: A systematic review of the literature.

Liquid biopsy is a minimally invasive detection method for molecular biomarkers in body fluids which may serve as a novel tool in management of head and neck cancer. The purpose of this systematic review is to outline the current status of liquid biopsy in head and neck squamous cell carcinoma (HNSCC) patients by systematically identifying and qualifying all published studies on the diagnostic or prognostic value of cell-free nucleic acids detection for posttreatment disease monitoring and/or disease outcome. A search was performed in PubMed, EMBASE, and Cochrane Library. Thirty articles met the inclusion criteria for further analysis. Study and patient characteristics, molecular analysis method and treatment or prognostic outcomes were extracted. Seventeen studies investigated circulating miRNAs in blood. Of these studies, 16 found statistically significant results for a total of 24 different candidate miRNAs for prognostication or treatment monitoring. The remaining studies investigated circulating tumor DNA by targeting somatic mutations, allelic imbalances, hypermethylation, or HPV-DNA. Of these studies, 2 found a statistically significant association between nucleic acid levels (tumor DNA targeted by allelic imbalances and HPV-DNA) in blood and/or saliva and prognostic outcome. One study found significantly different pre- and posttreatment levels of mitochondrial DNA in serum. Despite large differences among these studies in both design and results, individual results are promising and provide ground for more large-scale studies with standardized serial assessment of patient samples in the future.