Management of failed inferior vena cava filter retrieval for complex cases: A case series.

The aim of this report is to describe our experience in managing cases of difficult inferior vena cava (IVC) filter retrieval with emphasis on different advanced retrieval techniques. We report three cases of difficult IVC filter retrieval at our institution. We included three patients age ranging from 42 to 72 years. Two of the cases were presenting with the lower limb deep vein thrombosis and one of the cases had pulmonary embolism and they all had Retrievable Celect Platinum IVC filter (Cook Medical, Bloomington, Ind.) inserted preoperatively. One case was managed conservatively after failing IVC filter retrieval using standard retrieval set, meaning the filter was left in place, one was successfully removed with advanced endovascular retrieval techniques, and one failing advanced endovascular retrieval and finally had it removed with open surgery. We reviewed the risk factors contributing to difficult IVC filter retrieval and discussed the different options for managing these cases including conservative management, endovascular treatment, and open surgery for retrievable type of IVC filter which can be placed permanently. Knowledge of these options will help us better understand conditions, leading to difficult IVC retrieval on insertion, hopefully to minimize the occurrence of these cases, and to better manage cases with difficult IVC filter retrieval to decide the best option for each patient after careful consideration and multidisciplinary discussion with surgeons and patients.

Use of Information and Communications Technology in Family Services and Its Perceived Benefits amid the COVID-19 Pandemic in Hong Kong-Jockey Club SMART Family-Link Project.

INTRODUCTION: We examined information and communications technology (ICT) use in family services and its perceived benefits and barriers amid the COVID-19 pandemic in Hong Kong. METHODS: We invited all family service social workers of 12 NGOs to complete an anonymous online questionnaire in May 2020 (Part A) and a management representative from each NGO to provide written feedback on ICT use in January 2021 (Part B). RESULTS: In Part A, of 255 respondents (response rate: 67.3%), perceived ICT use in conducting programmes, groups, casework and preventive family programmes showed net increases of 33.9-54.5%; perceived ICT use in different work processes showed net increases of 18.8-48.6%. The three most common perceived benefits were "providing another option to service users" (74.2%), "more convenient service" (60.2%) and "maintaining normal service" (59.7%). In Part B, 12 management representatives consistently reported positive impacts of ICT use on family services. They shared actionable strategies (e.g., ICT skill-related training) and concerns about data privacy and management. CONCLUSIONS: ICT use in family services markedly increased amid the COVID-19 pandemic in Hong Kong. It helped make the services more accessible especially when the pandemic restricted face-to-face services.

Iliocaval stenting for May-Thurner syndrome: Initial experience.

The aim of this report is to describe our experience in endovascular treatment of May-Thurner syndrome. We report three cases of iliocaval stenosis treated endovascularly at our institution. We included three patients age range from 41 to 85 years with two presenting with acute deep vein thrombosis and associated limb swelling and one with chronic lower limb symptoms. We reviewed the technical success, complications, and stent patency on follow-up, latter was monitored be serial imaging. The three cases of iliocaval stenosis were treated with endovascular stenting with follow-up imaging follow-up period ranged from 6 to 13 months (mean 5.6 months) with two out of the three cases maintaining stent patency. One case was complicated by intraprocedural reopening of previously venous bleed. Clinical symptoms resolved with no recurrence in two out of three cases. One case experienced symptomatic in-stent thrombosis following endovascular treatment. Endovascular treatment of iliocaval stenosis appears effective in immediate technical success. Periprocedural attention to anticoagulation and stent position are important in preventing in-stent restenosis.

Transvenous salvage of coil migration with intraprocedural pulmonary circulation protection and successful transvenous coil embolization for the treatment of giant high-flow renal arteriovenous fistula.

Transcatheter embolization is a well-established treatment for renal arteriovenous fistula (AVF) in selected cases. Transarterial approach has been the conventional route of access of the AVF. In large arteriovenous shunts, however, transarterial approach inherits the risk of distal migration of embolization material with subsequent pulmonary embolism. We report a case of giant high-flow renal arteriovenous fistula treated with coil embolization. Arterial approach was attempted with double catheter technique, however complicated with coil mass dislodgement. We have retrieved the coil mass via transvenous route with simultaneous pulmonary circulatory protection and subsequent successful transvenous coil embolization with complete obliteration of the AVF was performed.

Effects of a mouth-opening intervention with remote support on adherence, the maximum interincisal opening, and mandibular function of postoperative oral cancer patients: A randomized clinical trial.

PURPOSE: The purpose of the study was to investigate the effects of a mouth-opening intervention for postoperative trismus and remote support provided via telephone following hospital discharge for intervention adherence in patients with oral cancer. METHODS: The study is a parallel randomized trial. Patients admitted at a general hospital for oral cancer surgery were recruited and randomly assigned to either the experimental or the active control group. Both groups underwent a 12-week intervention program, including warm compress, masticatory muscle massage, and jaw exercise. Subjects in the experimental group received additional support via telephone following hospital discharge. Data on intervention adherence maximum interincisal opening and mandibular function impairment were collected at baseline, week 4, and week 12. RESULTS: Sixty subjects (30 in each group) that completed the study were included in the analysis. At week 12, the intervention practice time in the experimental group was 299.67 min (95% CI: 223.44-357.89) more than that of the active control group. From baseline to week 12, the change in maximum interincisal opening was 10.30 mm (95% CI: 8.22-12.37) greater in the experimental than in the active control group. The change in mandibular function impairment score was -0.36 (95% CI: -0.44 to -0.28) greater in the experimental than in the active control group. CONCLUSIONS: The study results support the effect of remote support via telephone for enhancing adherence to the intervention protocol, and the effect of the intervention program for alleviating trismus and mandibular function impairments in patients who receive curative surgery for oral cancer.

Global Proteomics-based Identification and Validation of Thymosin Beta-4 X-Linked as a Prognostic Marker for Head and Neck Squamous Cell Carcinoma.

Head and neck squamous cell carcinoma (HNSCC) represents a major health concern worldwide. We applied the matrix-assisted laser desorption/ionization (MALDI) imaging mass spectrometry (IMS) to analyze paired normal (N) and tumor (T) samples from head and neck squamous cell carcinoma as well as liquid chromatography with tandem mass spectrometry (LC-MS/MS) analysis in HNSCC cell lines to identify tumor-associated biomarkers. Our results showed a number of proteins found to be over-expressed in HNSCC. We identified thymosin beta-4 X-linked (TMSB4X) is one of the most significant candidate biomarkers. Higher TMSB4X expression in the tumor was found by N/T-paired HNSCC samples at both RNA and protein level. Overexpression of TMSB4X was found significantly associated with poor prognosis of overall survival (OS, P = 0.006) and recurrence-free survival (RFS, P = 0.013) in HNSCC patients. Silencing of TMSB4X expression in HNSCC cell line reduced the proliferation and invasion ability in vitro, as well as inhibited the cervical lymph node metastasis in vivo. Altogether, our global proteomics analysis identified that TMSB4X is a newly discovered biomarker in HNSCC whose functions resulted in enhanced proliferation and metastasis in vitro and in vivo. TMSB4X may be a potential therapeutic target for treating HNSCC patients.

Quality of life of breast and cervical cancer survivors.

BACKGROUND: Breast and cervical cancer are the most common cancers affecting women. The symptom distresses experienced by cancer survivors are critical factors influencing their quality of life (QOL). This study investigated the QOL of breast and cervical cancer survivors, their physical, psychological and social conditions. METHODS: The participants were older than 20 years, had been diagnosed with breast or cervical cancer for more than 2 years, and had completed their cancer treatment. The survey incorporated the QOL questionnaires developed by the European Organization of Research and Treatment for Cancer and a self-designed questionnaire. RESULTS: The mean age at diagnosis was 48.89 ± 8.53 years for the breast cancer survivors and 49.00 ± 10.30 years for the cervical cancer survivors. The corresponding QOL scores were 75.33 ± 20.25 and 75.56 ± 17.93. The factors influencing QOL of breast cancer survivors were household income, number of comorbidities, stage of cancer, type of cancer treatment and duration of illness, whereas the factor related to QOL of cervical cancer survivors was only household income. CONCLUSIONS: The QOL of the two groups was similar. Healthcare providers should demonstrate greater concern toward breast and cervical cancer survivors.

Hinokitiol Negatively Regulates Immune Responses through Cell Cycle Arrest in Concanavalin A-Activated Lymphocytes.

Autoimmune diseases are a group of chronic inflammatory diseases that arise from inappropriate inflammatory responses. Hinokitiol, isolated from the wood of Chamaecyparis taiwanensis, engages in multiple biological activities. Although hinokitiol has been reported to inhibit inflammation, its immunological regulation in lymphocytes remains incomplete. Thus, we determined the effects of hinokitiol on concanavalin A- (ConA-) stimulated T lymphocytes from the spleens of mice. In the present study, the MTT assay revealed that hinokitiol (1-5 µM) alone did not affect cell viability of lymphocytes, but at the concentration of 5 µM it could reduce ConA-stimulated T lymphocyte proliferation. Moreover, propidium iodide (PI) staining revealed that hinokitiol arrested cell cycle of T lymphocytes at the G0/G1 phase. Hinokitiol also reduced interferon gamma (IFN-γ) secretion from ConA-activated T lymphocytes, as detected by an ELISA assay. In addition, hinokitiol also downregulated cyclin D3, E2F1, and Cdk4 expression and upregulated p21 expression. These results revealed that hinokitiol may regulate immune responses. In conclusion, we for the first time demonstrated that hinokitiol upregulates p21 expression and attenuates IFN-γ secretion in ConA-stimulated T lymphocytes, thereby arresting cell cycle at the G0/G1 phase. In addition, our findings also indicated that hinokitiol may provide benefits to treating patients with autoimmune diseases.

NAT2 slow acetylation haplotypes are associated with the increased risk of betel quid-related oral and pharyngeal squamous cell carcinoma.

BACKGROUND: NAT2, the most important phase II metabolic enzyme for betel quid (BQ), might modify the risk of BQ-related oral and pharyngeal squamous cell carcinoma (OPSCC) in Taiwan. STUDY DESIGN: PCR-RFLP and TaqMan assay were conducted for genotyping of NAT2 in 172 OPSCC cases and 170 healthy controls who habitually chewed BQ. RESULTS: The genotypic and allelic type of T341C and C481T in NAT2 are associated with the risk of OPSCC. There were linear trends between increased risk of OPSCC and slowness of NAT2 acetylation haplotypes (P = .017), especially for young subjects (P < .001), light BQ chewers (P = .005), light smokers (P = .023), and alcohol drinkers (P = .001). The interactions on risk of OPSCC were found for NAT2 acetylation haplotypes with status of age, BQ chewing, and alcohol drinking. CONCLUSIONS: The NAT2 acetylation haplotypes might be genetic markers for risk of BQ-related OPSCC.

Pin1 overexpression is associated with poor differentiation and survival in oral squamous cell carcinoma.

Phosphorylation on certain Ser/Thr-Pro motifs is a major oncogenic mechanism. The conformation and function of phosphorylated Ser/Thr-Pro motifs are further regulated by the prolyl isomerase Pin1. Pin1 has been shown to be prevalently overexpressed in human breast cancer cell lines and cancer tissues and to play a critical role in the transformation of mammary epithelial cells by activating multiple oncogenic pathways. Pin1 expression was found to be an excellent independent prognostic marker in prostate cancer. However, little is known about Pin1 and its downstream targets beta-catenin and cyclin D1 expressions in human oral cancers. In the present study, we quantified Pin1 expression in 74 paired normal/tumor human oral cancer samples as well as oral cancer cell lines. Pin1 was overexpressed in oral squamous cell carcinoma (OSCC) and its level correlated with beta-catenin accumulation and cyclin D1 expression. Moreover, we examined Pin1 mRNA expression in OSCC and cancer cell lines by RT-PCR analysis. The results showed that there is concordance in the relationship between the Pin1 mRNA level and Pin1 protein expression. The up-regulation of Pin1 mRNA expression in tumor part when comparing with that in non-tumor part was in agreement with that of the Pin1 protein overexpressed in OSCC. In addition, we showed that the molecular and immunohistochemical profiles of Pin1 overexpression were associated with progression of OSCC. Taken together, these results indicate that Pin1 is a regulator of cyclin D1 expression in OSCC and might play a role in oral oncogenesis. The overexpression of Pin1 can be used as an indicator for pathological diagnosis of OSCC.

Implant placement immediately after the lateral approach of the trap door window procedure to create a maxillary sinus lift without bone grafting: a 2-year retrospective evaluation of 47 implants in 33 patients.

PURPOSE: The present study was undertaken to retrospectively evaluate the status of implants in patients subjected to a maxillary sinus lift and immediate implant placement without bone grafting. PATIENTS AND METHODS: Seventy-five implants were placed in 47 patients from 2000 to 2006. Lateral approach for the trap-door, open-window method for sinus lifting without placement of either autogenous bone grafts or allogeneic bone substitute was carried out. A 5-mm of the bone level was required in the alveolar ridge for all. All implants were placed synchronously with sinus lifting procedure. Patients underwent strict oral hygiene instruction, periodontal charting, presurgical/postsurgical panoramic radiographs, and postsurgical computed tomographic scan during the follow-up. The implant survival was defined when the prosthesis had been delivered and followed for 2 years without infection, pain, or more than 2-mm peri-implant bone loss. RESULTS: Thirty-three patients (23 males, 10 females) having an average age of 55 years old, with a total of 47 fixtures were followed for more than 2 years after prosthesis delivery. No patients developed sinusitis or other complications leading to loss of an implant subsequent to performance of the sinus lifting-combined immediate implant surgery. The 2-year survival of fixture was 100%. Increases in lifted sinus bone height ranged from 3 mm to 9 mm with an average of 4.5 mm. The peri-implant health was judged to be good with a peri-implant sulcus depth of 2.7 +/- 0.5 mm at 2-year follow-up. CONCLUSIONS: A good survival rate was observed in the immediate implant placement synchronously with the lateral approach for maxillary sinus lift without bone grafting.