Commentary on "Impurities in Hyaluronic Acid Facial Fillers? A Narrative Review on Nonanimal Cross-Linked Fillers" by Wollina et al.

A brief discussion in response to the article: Impurities in hyaluronic acid facial fillers? A narrative review on nonanimal cross-linked fillers.

Influenza vaccine format mediates distinct cellular and antibody responses in human immune organoids.

Highly effective vaccines elicit specific, robust, and durable adaptive immune responses. To advance informed vaccine design, it is critical that we understand the cellular dynamics underlying responses to different antigen formats. Here, we sought to understand how antigen-specific B and T cells were activated and participated in adaptive immune responses within the mucosal site. Using a human tonsil organoid model, we tracked the differentiation and kinetics of the adaptive immune response to influenza vaccine and virus modalities. Each antigen format elicited distinct B and T cell responses, including differences in their magnitude, diversity, phenotype, function, and breadth. These differences culminated in substantial changes in the corresponding antibody response. A major source of antigen format-related variability was the ability to recruit naive vs. memory B and T cells to the response. These findings have important implications for vaccine design and the generation of protective immune responses in the upper respiratory tract.

Lateral neck dissection for well-differentiated thyroid carcinoma: a systematic review.

OBJECTIVES/HYPOTHESIS: Management of the lateral neck in well-differentiated thyroid carcinoma (WDTC) remains a topic of ongoing debate. A systematic review was performed to determine if patients with WDTC who undergo lateral neck dissection (LND) have significantly different survival, recurrence, or procedure-related complication rates, as compared to those who do not. DATA SOURCES: A computerized search of MEDLINE from 1966 to October 2012 was performed, supplemented with manual searches. REVIEW METHODS: A priori criteria were used to evaluate 924 studies. Data extraction was performed by independent reviewers and focused on survival, recurrence, postoperative complications, study designs, and potential confounders. RESULTS: Forty-seven criterion-meeting studies included 24,153 participants. Stage-specific data were limited. The small volume of data specific to the N0 neck (n=3 studies, 6.3%) demonstrates no difference in disease-free survival (DFS) or recurrence with versus without LND. The data regarding the N+ neck (n=14 studies, 29.2%) were mixed with regard to the impact of LND on DFS and recurrence. The preponderance of data was reported in analyses of mixed or unreported nodal status (n=31 studies, 64.6%). Among these studies, the majority reported no difference in overall survival, DFS, disease-specific survival, or recurrence, but overall data were mixed and subject to confounding by indication and limitations in power. CONCLUSIONS: Data regarding the impact of LND on survival, recurrence, and postoperative complications are mixed. Routine prophylactic LND for WDTC does not have a clearly advantageous risk-to-benefit ratio.

Can the pathology of a thyroid nodule be determined by positron emission tomography uptake?

OBJECTIVES: To determine if standardized uptake values (SUV) on positron emission tomography (PET) are predictive of thyroid pathology and the significance of serial SUV measurements of thyroid nodules over time. STUDY DESIGN: Case series with chart review. SETTING: Academic health center. SUBJECTS: In total, 23,384 PET and PET/computed tomography (CT) scans were performed between December 2001 and April 2011. METHODS: Patients with incidental thyroid uptake were identified. SUV(max), age, sex, size of thyroid lesion, indication for PET scan, and cytology/pathology were collected. RESULTS: Incidental thyroid uptake was noted in 1309 PET scans (5.60%), focal uptake in 690 (2.95%), and diffuse uptake in 619 (2.65%). Complete data were available for 359 PET scans from 103 patients. Malignancy was identified in 28 patients (27%). Twenty-five of the 28 lesions (89%) were primary thyroid malignancies. A significant difference between malignant SUV(max) and benign SUV(max) was found (mean ± SD, 7.04 ± 7.88 for malignancies vs 3.85 ± 3.06 for benign tumors, P = .0292). Receiver operating characteristics curves were constructed on patients with PET data within 3 months of diagnosis and indicated that a SUV(max) of 4.2 differentiated maximally between benign and malignant lesions. Serial SUV uptake had no significant change over time. CONCLUSION: All thyroid nodules with focal uptake on (18)F-fluorodeoxyglucose-PET/CT should be considered at higher risk of malignancy than those discovered incidentally by other imaging modalities. Higher SUV(max) values are more indicative of malignant lesions. All lesions should be evaluated with ultrasonography ± fine-needle aspiration if no clinical contraindications exist. Size of the primary nodule does not influence SUV(max) uptake.

Impact on quality of life after mastoid obliteration.

OBJECTIVES/HYPOTHESIS: To understand the long-term impact on quality of life (QOL) in patients undergoing mastoid obliteration surgery for a chronically draining cavity, using the Glascow Benefit Inventory (GBI) QOL survey, and to correlate these findings to perceived changes in drainage and hearing. STUDY DESIGN: Retrospective chart review. METHODS: Adult patients undergoing mastoid obliteration and restoration of the middle ear space with cartilage reconstruction of the tympanic membrane, with at least 3-year follow-up, were contacted by phone to solicit participation. Those who agreed to participate were mailed the GBI and consent documents with a prepaid self-addressed envelope. RESULTS: Of 80 patients meeting the inclusion criteria, 37 were successfully contacted and agreed to participate, yielding 23 returned questionnaires. The vast majority (19 of 23; 83%) reported improved QOL after surgery, with the most positive effects seen on confidence and social situations, and patients experiencing less inconvenience, self-consciousness, and embarrassment. Eighty-three percent reported a perceived improvement in hearing; 74% reported an improvement in drainage. Over 90% would recommend the procedure to a family member. The average score on the GBI was 28.9, and a two-tailed one-sample t test showed that mastoid obliteration significantly improved QOL in our patients (t = 4.65, P < .001). There was a fairly good correlation between the perceived improvement in QOL with improvement in hearing and/or drainage. CONCLUSIONS: The GBI is a valuable tool for evaluating patient satisfaction after revision surgery for a draining cavity. This information is helpful in understanding the impact of a draining cavity on an individual's life and may be beneficial in preoperative selection and counseling.