Improving head and neck sarcoma care: The impact of a specialized multidisciplinary team approach on diagnosis and patient outcomes.

OBJECTIVE: Globally, head & neck sarcoma care pathways remain unclear. In 2018, the London Sarcoma Service (LSS) set up a dedicated head and neck sarcoma (HNS) multidisciplinary team (MDT) with a clear objective to provide formal access to super-specialist expertise in diagnosis, treatment planning and management of HNS. The aim of the study is to provide first results of a dedicated HNS MDT. METHODS: All patients discussed between 2018 and 2022, in HNS MDT, with a new histologically confirmed HNS diagnosis were included in the study. Demographics, anatomic site, morphology, MDT recommendation, treatment details and outcomes were obtained from electronic patient records. RESULTS: A total of 337 patients were discussed in the HNS MDT of which 178 patients were included in the study, with a median age of 53 years(range 2-94); 67 % were soft tissue sarcomas(STS) and 33 % were bone sarcomas(BS), of which 43 % and 71 % were high grade, respectively. 55 % BS and 39 % STS underwent surgery. 9 % of BS and 7 % of STS received adjuvant Proton Beam therapy. With a median follow-up of 2.16 years, recurrence was observed in 12 %, distant metastasis in 6 % of patients and overall survival was 72 %. CONCLUSION: The HNS MDT provides expertise on diagnosis and multi-modality management of HNS. STS are more likely to be misdiagnosed. Atypical imaging characteristics should trigger a specialist referral. Adequate surgery at first presentation remains the mainstay of treatment and the strongest prognosticator of overall survival. Formation of an expert working group specific to HNS must work towards streamlining sarcoma care.

Trajectory of increased iceberg kill-off in West Antarctica's shallows.

Compared with low latitude coasts, many polar latitudes are still little impacted by intense and direct anthropogenic stressors. Climate forcing is now bringing rapid physical change to nearshore polar realms. In the shallow coastal waters adjacent to the United Kingdom's Rothera Research Station in the West Antarctic Peninsula (WAP), 225 seabed markers at 5-25 m depth have been surveyed and replaced every year from 2002-2023 (75 markers at each of 5, 10 and 25 m). This is one of the longest continuously running marine disturbance experiments in the world, in one of Earth's fastest changing environments. Different categories of sea ice are recorded (including when the sea surface freezes into fast ice) at Rothera since the 1980s, and losses of marine ice in both polar regions are one of the striking responses to a warming planet1. Five to ten years of seabed marker hit rate data (marker broken or moved) showed that reduced sea ice cover is correlated with disturbance and mortality on the seabed2,3.

Testing the Resilience, Physiological Plasticity and Mechanisms Underlying Upper Temperature Limits of Antarctic Marine Ectotherms.

Antarctic marine ectotherms live in the constant cold and are characterised by limited resilience to elevated temperature. Here we tested three of the central paradigms underlying this resilience. Firstly, we assessed the ability of eight species, from seven classes representing a range of functional groups, to survive, for 100 to 303 days, at temperatures 0 to 4 °C above previously calculated long-term temperature limits. Survivors were then tested for acclimation responses to acute warming and acclimatisation, in the field, was tested in the seastar Odontaster validus collected in different years, seasons and locations within Antarctica. Finally, we tested the importance of oxygen limitation in controlling upper thermal limits. We found that four of 11 species studied were able to survive for more than 245 days (245-303 days) at higher than previously recorded temperatures, between 6 and 10 °C. Only survivors of the anemone Urticinopsis antarctica did not acclimate CTmax and there was no evidence of acclimatisation in O. validus. We found species-specific effects of mild hyperoxia (30% oxygen) on survival duration, which was extended (two species), not changed (four species) or reduced (one species), re-enforcing that oxygen limitation is not universal in dictating thermal survival thresholds. Thermal sensitivity is clearly the product of multiple ecological and physiological capacities, and this diversity of response needs further investigation and interpretation to improve our ability to predict future patterns of biodiversity.

Detection of plastic, cellulosic micro-fragments and microfibers in Laternula elliptica from King George Island (Maritime Antarctica).

It is generally acknowledged that microplastic pollutants are prevalent in ocean waters and sediments across a range of tropical, temperate, subpolar, and polar regions. The waters surrounding King George Island are significantly impacted by human activities, particularly those related to scientific stations, fishing, and tourism. Organisms, such as Laternula elliptica, can be used as environmental monitors due to the likelihood that they will bioaccumulate pollutants. The goal of this study was to quantify and identify plastic and cellulosic micro-fragments and microfibers present in the soft body of clams (n = 21), collected from Fildes Bay near sewage and wastewater discharges. Plastic and cellulose microfragments and microfibers were counted, and their compositions were determined using FT-IR. All 21 individuals sampled contained fragments and fibers, with a total of 900 items detected (42.86 ± 25.36 mean ± SD items per individual), or 1.82 items g.wet mass-1. 58 % of items were cellulose and 22 % plastic. Considering the plastic polymer compositions, 28.57 % were polyethylene terephthalate (PET), 21.43 % acrylic, 14.29 % high-density polyethylene (HDPE), 14.29 % Polypropylene (PP), 7.14 % ultra-high drawn polyethylene filament (UHMWPE), 7.14 % polyester and 7.14 % Polyethylene. The quantities and prevalence of MP in L. elliptica were higher than those found in other Antarctic marine species, and even in bivalves from populated regions of the world. Our work assessed the pollution status of L. elliptica near an effluent of wastewater plants and found that 95 % of individuals displayed MP and 100 % microfibers that could impact their population.

Mucormycosis after CD19 chimeric antigen receptor T-cell therapy: results of a US Food and Drug Administration adverse events reporting system analysis and a review of the literature.

Chimeric antigen receptor (CAR) T-cell therapy leads to durable remissions in relapsed B-cell cancers, but treatment-associated immunocompromise leads to a substantial morbidity and mortality risk from atypical infection. Mucormycosis is an aggressive and invasive fungal infection with a mortality risk of 40-80% in patients with haematological malignancies. In this Grand Round, we report a case of mucormycosis in a 54-year-old patient undergoing CAR T-cell therapy who reached complete clinical control of Mucorales with combined aggressive surgical debridement, antifungal pharmacotherapy, and reversal of underlying risk factors, but with substantial morbidity from extensive oro-facial surgery affecting the patient's speech and swallowing. For broader context, we present our case alongside an US Food and Drugs Administration adverse events reporting database analysis and a review of the literature to fully evaluate the clinical burden of mucormycosis in patients treated with CAR T-cell therapy. We discuss epidemiology, clinical features, diagnostic tools, and current frameworks for treatment and prophylaxis. We did this analysis to promote increased vigilance for mucormycosis among physicians specialising in CAR T-cell therapy and microbiologists and to illustrate the importance of early initiation of therapy to effectively manage this condition. Mucormycosis prevention and early diagnosis, through targeted surveillance and mould prevention in patients at highest risk and Mucorales-specific screening assays, is likely to be key to improving outcomes in patients treated with CAR T-cell therapy.

Migration and other electrode complications following cochlear implantation.

OBJECTIVES: To investigate migration and other electrode-related complications in cochlear implant surgery. METHODS: Retrospective review of all patients (adult and paediatric) undergoing cochlear implantation at a tertiary referral centre in England, between April 2019 and December 2021. Split arrays and patients who did not have post-op imaging were excluded. RESULTS: Two hundred and ninety-nine cochlear implants were performed including 90% primary and 10% revision surgeries. Two hundred and forty-eight (86%) of electrodes implanted were straight arrays.Twenty-seven (9%) demonstrated suboptimal position on post-operative imaging. Three (11%) were true migration, 4 (15%) possible migration, 15 (56%) had two or less extra-cochlear electrodes, 3 (11%) expected partial insertion and 2 (7%) demonstrated tip fold-overs. Twenty (74%) of arrays within the suboptimal insertion group were in primary surgeries. Six patients required re-implantation. The most common reason for re-implantation was migration. DISCUSSION: Electrode migration after cochlear implantation may be more common than previously thought. We demonstrate rates of migration congruous with current literature; this is despite robust and varied fixation techniques. Notable in our series is that all true captured migrations were seen exclusively in straight arrays. The majority of patients in the possible and confirmed migration group had normal inner ear anatomy. CONCLUSION: Suboptimal electrode position following cochlear implant surgery is a recognized complication and can affect implant performance. Reporting may increase with more widespread use of sophisticated post-operative imaging. Use of a pre-curved electrode and routine use of appropriate fixation techniques may reduce migration rates.

Testing the physiological capacity of the mussel Mytilus chilensis to establish into the Southern Ocean.

The Southern Ocean and the Antarctic Circumpolar Current create environmental conditions that serve as an efficient barrier to prevent the colonization of non-native species (NNS) in the marine ecosystems of Antarctica. However, warming of the Southern Ocean and the increasing number of transport opportunities are reducing the physiological and physical barriers, increasing the chances of NNS arriving. The aim of this study was to determine the limits of survival of the juvenile mussels, M. chilensis, under current Antarctic conditions and those projected under climate change. These assessments were used to define the mussels potential for establishment in the Antarctic region. Experimental mussels were exposed to four treatments: -1.5 °C (Antarctic winter), 2 °C (Antarctic summer), 4 °C (Antarctic projected) and 8 °C (control) for 80 days and a combination of physiological and transcriptomics approaches were used to investigate mussel response. The molecular responses of mussels were congruent with the physiological results, revealing tolerance to Antarctic winter temperatures. However, a higher number of regulated differentially expressed gene (DEGs) were reported in mussels exposed to Antarctic winter temperatures (-1.5 °C). This tolerance was associated with the activation of the biological processes associated with apoptosis (up regulated) and both cell division and cilium assembly (down regulated). The reduced feeding rate and the negative scope for growth, for a large part of the exposure period at -1.5 °C, suggests that Antarctic winter temperatures represents an environmental barrier to M. chilensis from the Magellanic region settling in the Antarctic. Although M. chilensis are not robust to current Antarctica thermal conditions, future warming scenarios are likely to weaken these physiological barriers. These results strongly suggest that the West Antarctic Peninsula could become part of Mytilus distributional range, especially with dispersal aided by increasing maritime transport activity across the Southern Ocean.

Augmented reality presentation of the extracranial facial nerve: an innovation in parotid surgery.

Surgeons used to be unaware of the facial nerve's position during parotid surgery. Now, with special magnetic resonance imaging (MRI) sequences, it can be located and converted into a 3D model displayed on an augmented reality (AR) device for surgeons to study and manipulate. This study explores the accuracy and usefulness of the technique for the treatment of benign and malignant parotid tumours. A total of 20 patients with parotid tumours had 3-Tesla MRI scans, and their anatomical structures were segmented using Slicer software. The structures were imported into a Microsoft HoloLens 2® device, displayed in 3D, and shown to the patient for consent. Intraoperative video recording was used to record the position of the facial nerve in relation to the tumour. The predicted path of the nerve taken from the 3D model was combined with surgical observation and video recording in all cases. The imaging proved to have application in both benign and malignant disease. It also improved the process of informed patient consent. Three-dimensional MRI imaging of the facial nerve within the parotid gland and its display in a 3D model is an innovative technique for parotid surgery. Surgeons can now see the nerve's position and tailor their approach to each patient's tumour, providing personalised care. The technique eliminates the surgeon's blind spot and is a significant advantage in parotid surgery.

The Falkland Islands marine ecosystem: A review of the seasonal dynamics and trophic interactions across the food web.

The Falkland Islands marine environment host a mix of temperate and subantarctic species. This review synthesizes baseline information regarding ontogenetic migration patterns and trophic interactions in relation to oceanographic dynamics of the Falkland Shelf, which is useful to inform ecosystem modelling. Many species are strongly influenced by regional oceanographic dynamics that bring together different water masses, resulting in high primary production which supports high biomass in the rest of the food web. Further, many species, including those of commercial interest, show complex ontogenetic migrations that separate spawning, nursing, and feeding grounds spatially and temporally, producing food web connections across space and time. The oceanographic and biological dynamics may make the ecosystem vulnerable to climatic changes in temperature and shifts in the surrounding area. The Falkland marine ecosystem has been understudied and various functional groups, deep-sea habitats and inshore-offshore connections are poorly understood and should be priorities for further research.

The use of mixed reality in dentistry.

Augmented reality (AR) was first described in the literature in the 1990s. It has been shown as a futuristic concept in television, film and media, and now in the twenty-first century has become a reality. AR is defined as an interactive experience of a real-world environment where the object that resides in the real world is enhanced by computer-generated perceptual information.Microsoft HoloLens is a mixed reality device which has the capability to provide a real-time, three-dimensional platform using multiple sensors and holographic processing to display information and even simulate a virtual world. With rapidly evolving technology and virtual learning on the increase, the HoloLens technology can be used as a vital tool for dental education and surgical planning. However, within dentistry at present, there is limited research regarding its benefits and potential.The authors would like to demonstrate the use of HoloLens in three common oral surgery procedures and how it can be used to distinguish anatomy and benefit surgical planning, aid in patient communication and play a role in dental education.

Autoimmune Vestibulopathy-A Case Series.

Autoimmune inner ear disease (AIED) is a rare clinical entity. Its pathogenicity, heterogenous clinical presentation in the context of secondary systemic autoimmune disease and optimal treatment avenues remain poorly understood. Vestibular impairment occurring in the context of AIED is rarely subject to detailed investigation given that the auditory symptoms and their responsiveness to immunosuppression are the focus of the few proposed diagnostic criteria for AIED. We present three cases of vestibulopathy occurring in the context of autoimmune inner ear conditions, including the first known report of autoimmune inner ear pathology arising with a temporal association to administration of the Pfizer-BioNTech SARS-CoV2 vaccination. We review the available literature pertinent to each case and summarise the key learning points, highlighting the variable presentation of vestibular impairment in AIED.

Benthic Biodiversity, Carbon Storage and the Potential for Increasing Negative Feedbacks on Climate Change in Shallow Waters of the Antarctic Peninsula.

The importance of cold-water blue carbon as biological carbon pumps that sequester carbon into ocean sediments is now being realised. Most polar blue carbon research to date has focussed on deep water, yet the highest productivity is in the shallows. This study measured the functional biodiversity and carbon standing stock accumulated by shallow-water (<25 m) benthic assemblages on both hard and soft substrata on the Antarctic Peninsula (WAP, 67° S). Soft substrata benthic assemblages (391 ± 499 t C km-2) contained 60% less carbon than hard substrata benthic assemblages (648 ± 909). In situ observations of substrata by SCUBA divers provided estimates of 59% hard (4700 km) and 12% soft (960 km) substrata on seasonally ice-free shores of the Antarctic Peninsula, giving an estimate of 253,000 t C at 20 m depth, with a sequestration potential of ~4500 t C year-1. Currently, 54% of the shoreline is permanently ice covered and so climate-mediated ice loss along the Peninsula is predicted to more than double this carbon sink. The steep fjordic shorelines make these assemblages a globally important pathway to sequestration, acting as one of the few negative (mitigating) feedbacks to climate change. The proposed WAP marine protected area could safeguard this ecosystem service, helping to tackle the climate and biodiversity crises.

Evolutionary constraints on physiology confound range shift predictions of two nacellid limpets.

Physiological comparisons are fundamental to quantitative assessments of the capacity of species to persist within their current distribution and to predict their rates of redistribution in response to climate change. Yet, the degree to which physiological traits are conserved through evolutionary history may fundamentally constrain the capacity for species to adapt and shift their geographic range. Taxa that straddle major climate transitions provide the opportunity to test the mechanisms underlying evolutionary constraints and how such constraints may influence range shift predictions. Here we focus on two abundant and shallow water nacellid limpets which have representative species on either side of the Polar front. We test the thermal thresholds of the Southern Patagonian limpet, Nacella deaurata and show that its optimal temperatures for growth (4 °C), activity (-1.2 to -0.2 °C) and survival (1 to 8 °C) are mismatched to its currently experienced annual sea surface temperature range (5.9 to 10 °C). Comparisons with the congeneric Antarctic limpet, N. concinna, reveal an evolutionary constraint on N. deaurata physiology, with overlapping thermal capacities, suggesting that a cold climate legacy has been maintained through the evolution of these species. These physiological assessments predict that the South American range of N. deaurata will likely decline with continued warming. It is, however, one of the first species with demonstrated physiological capacity to successfully colonize the cold Southern Ocean. With the expected increase in opportunities for transport within high southern latitudes, N. deaurata has the potential to establish and drive ecological change within the shallow Southern Ocean.

Climate Mitigation through Biological Conservation: Extensive and Valuable Blue Carbon Natural Capital in Tristan da Cunha's Giant Marine Protected Zone.

Carbon-rich habitats can provide powerful climate mitigation if meaningful protection is put in place. We attempted to quantify this around the Tristan da Cunha archipelago Marine Protected Area. Its shallows (<1000 m depth) are varied and productive. The 5.4 km2 of kelp stores ~60 tonnes of carbon (tC) and may export ~240 tC into surrounding depths. In deep-waters we analysed seabed data collected from three research cruises, including seabed mapping, camera imagery, seabed oceanography and benthic samples from mini-Agassiz trawl. Rich biological assemblages on seamounts significantly differed to the islands and carbon storage had complex drivers. We estimate ~2.3 million tC are stored in benthic biodiversity of waters <1000 m, which includes >0.22 million tC that can be sequestered (the proportion of the carbon captured that is expected to become buried in sediment or locked away in skeletal tissue for at least 100 years). Much of this carbon is captured by cold-water coral reefs as a mixture of inorganic (largely calcium carbonate) and organic compounds. As part of its 2020 Marine Protection Strategy, these deep-water reef systems are now protected by a full bottom-trawling ban throughout Tristan da Cunha and representative no take areas on its seamounts. This small United Kingdom Overseas Territory's reef systems represent approximately 0.8 Mt CO2 equivalent sequestered carbon; valued at >£24 Million GBP (at the UN shadow price of carbon). Annual productivity of this protected standing stock generates an estimated £3 million worth of sequestered carbon a year, making it an unrecognized and potentially major component of the economy of small island nations like Tristan da Cunha. Conservation of near intact habitats are expected to provide strong climate and biodiversity returns, which are exemplified by this MPA.

Utility of diffusion MRI characteristics of cervical lymph nodes as disease classifier between patients with head and neck squamous cell carcinoma and healthy volunteers.

Diffusion MRI characteristics assessed by apparent diffusion coefficient (ADC) histogram analysis in head and neck squamous cell carcinoma (HNSCC) have been reported as helpful in classifying tumours based on diffusion characteristics. There is little reported on HNSCC lymph nodes classification by diffusion characteristics. The aim of this study was to determine whether pretreatment nodal microstructural diffusion MRI characteristics can classify diseased nodes of patients with HNSCC from normal nodes of healthy volunteers. Seventy-nine patients with histologically confirmed HNSCC prior to chemoradiotherapy, and eight healthy volunteers, underwent diffusion-weighted (DW) MRI at a 1.5-T MR scanner. Two radiologists contoured lymph nodes on DW (b = 300 s/m2 ) images. ADC, distributed diffusion coefficient (DDC) and alpha (α) values were calculated by monoexponential and stretched exponential models. Histogram analysis metrics of drawn volume were compared between patients and volunteers using a Mann-Whitney test. The classification performance of each metric between the normal and diseased nodes was determined by receiver operating characteristic (ROC) analysis. Intraclass correlation coefficients determined interobserver reproducibility of each metric based on differently drawn ROIs by two radiologists. Sixty cancerous and 40 normal nodes were analysed. ADC histogram analysis revealed significant differences between patients and volunteers (p ≤0.0001 to 0.0046), presenting ADC distributions that were more skewed (1.49 for patients, 1.03 for volunteers; p = 0.0114) and 'peaked' (6.82 for patients, 4.20 for volunteers; p = 0.0021) in patients. Maximum ADC values exhibited the highest area under the curve ([AUC] 0.892). Significant differences were revealed between patients and volunteers for DDC and α value histogram metrics (p ≤0.0001 to 0.0044); the highest AUC were exhibited by maximum DDC (0.772) and the 25th percentile α value (0.761). Interobserver repeatability was excellent for mean ADC (ICC = 0.88) and the 25th percentile α value (ICC = 0.78), but poor for all other metrics. These results suggest that pretreatment microstructural diffusion MRI characteristics in lymph nodes, assessed by ADC and α value histogram analysis, can identify nodal disease.

Can Antarctica's shallow zoobenthos 'bounce back' from iceberg scouring impacts driven by climate change?

All coastal systems experience disturbances and many across the planet are under unprecedented threat from an intensification of a variety of stressors. The West Antarctic Peninsula is a hotspot of physical climate change and has experienced a dramatic loss of sea-ice and glaciers in recent years. Among other things, sea-ice immobilizes icebergs, reducing collisions between icebergs and the seabed, thus decreasing ice-scouring. Ice disturbance drives patchiness in successional stages across seabed assemblages in Antarctica's shallows, making this an ideal system to understand the ecosystem resilience to increasing disturbance with climate change. We monitored a shallow benthic ecosystem before, during and after a 3-year pulse of catastrophic ice-scouring events and show that such systems can return, or bounce back, to previous states within 10 years. Our long-term data series show that recovery can happen more rapidly than expected, when disturbances abate, even in highly sensitive cold, polar environments.

Climatic change drives dynamic source-sink relationships in marine species with high dispersal potential.

While there is now strong evidence that many factors can shape dispersal, the mechanisms influencing connectivity patterns are species-specific and remain largely unknown for many species with a high dispersal potential. The rock lobsters Jasus tristani and Jasus paulensis have a long pelagic larval duration (up to 20 months) and inhabit seamounts and islands in the southern Atlantic and Indian Oceans, respectively. We used a multidisciplinary approach to assess the genetic relationships between J. tristani and J. paulensis, investigate historic and contemporary gene flow, and inform fisheries management. Using 17,256 neutral single nucleotide polymorphisms we found low but significant genetic differentiation. We show that patterns of connectivity changed over time in accordance with climatic fluctuations. Historic migration estimates showed stronger connectivity from the Indian to the Atlantic Ocean (influenced by the Agulhas Leakage). In contrast, the individual-based model coupled with contemporary migration estimates inferred from genetic data showed stronger inter-ocean connectivity in the opposite direction from the Atlantic to the Indian Ocean driven by the Subtropical Front. We suggest that the J. tristani and J. paulensis historical distribution might have extended further north (when water temperatures were lower) resulting in larval dispersal between the ocean basis being more influenced by the Agulhas Leakage than the Subtropical Front. As water temperatures in the region increase in accordance with anthropogenic climate change, a southern shift in the distribution range of J. tristani and J. paulensis could further reduce larval transport from the Indian to the Atlantic Ocean, adding complexity to fisheries management.

COVID-19-related thyroiditis: A novel disease entity?

The literature on COVID-19-related thyroid complications has accumulated over the past year or so as the pandemic has accelerated throughout the world. In particular, several recent case reports have been published describing a possible correlation between COVID-19 disease and subacute thyroiditis (SAT). In this review, we briefly present one of our own patients and review the current published literature in this area up to January 2021, including analyses of major series of thyroid function tests in patients with significant COVID-19 infection. We conclude that while the great majority of patients with severe COVID-19 infection may show manifestations of the sick euthyroid syndrome, clinicians should be aware of the possibility of SAT, especially in the early weeks and months following even mild COVID-19 infection.

Fish heating tolerance scales similarly across individual physiology and populations.

Extrapolating patterns from individuals to populations informs climate vulnerability models, yet biological responses to warming are uncertain at both levels. Here we contrast data on the heating tolerances of fishes from laboratory experiments with abundance patterns of wild populations. We find that heating tolerances in terms of individual physiologies in the lab and abundance in the wild decline with increasing temperature at the same rate. However, at a given acclimation temperature or optimum temperature, tropical individuals and populations have broader heating tolerances than temperate ones. These congruent relationships implicate a tight coupling between physiological and demographic processes underpinning macroecological patterns, and identify vulnerability in both temperate and tropical species.

1 °C warming increases spatial competition frequency and complexity in Antarctic marine macrofauna.

Environmental conditions of the Southern Ocean around Antarctica have varied little for >5 million years but are now changing. Here, we investigated how warming affects competition for space. Little considered in the polar regions, this is a critical component of biodiversity response. Change in competition in response to environment forcing might be detectable earlier than individual species presence/absence or performance measures (e.g. growth). Examination of fauna on artificial substrata in Antarctica's shallows at ambient or warmed temperature found that, mid-century predicted 1°C warming (throughout the year or just summer-only), increased the probability of individuals encountering spatial competition, as well as density and complexity of such interactions. 2°C, late century predicted warming, increased variance in the probability and density of competition, but overall, competition did not significantly differ from ambient (control) levels. In summary only 1°C warming increased probability, density and complexity of spatial competition, which seems to be summer-only driven.