ObjectiveThe use of aspirin in patients undergoing open tracheostomy is an issue for which there is still no clear conclusion. This uncertainty leads surgeons to make decisions based on the risks and benefits of continuing versus discontinuing aspirin. Therefore, this study aims to investigate complications related to aspirin use. The primary outcome was bleeding complications, while other complications were secondary outcomes.MethodsThis was a retrospective study compiling data from patients who underwent open tracheostomy at the Department of Otolaryngology, Faculty of Medicine, Chulalongkorn university and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, between January 2019 and December 2023. Demographic data, medical conditions, indications for tracheostomy, surgeon characteristics, operative time, aspirin use status, and complications were reviewed.ResultsThere were 47 patients in total in this study: 15 patients in the aspirin continuation group and 32 patients in the aspirin discontinuation group. In the aspirin continuation group, there were no major or minor bleeding events. In the discontinuation group, there were two cases of major bleeding and two cases of minor bleeding (an incidence of 6.3% for each), although the differences observed were not statistically significant. There were no other complications that showed statistically significant differences between the two groups.ConclusionThis study has shown that low-dose aspirin (81 mg) does not increase the risk of bleeding or other complications in patients who undergo open tracheostomy. These results support that the continuation of aspirin may be safe in patients undergoing this procedure.

ObjectiveSimultaneous bilateral cochlear implantation has been shown to provide long-term benefits in children suffering from severe-to-profound hearing loss. However, very little research has been conducted on long-term benefits in Mandarin-speaking children. We aimed to (1) evaluate tone perception with simultaneous bilateral cochlear implants (CIs) compared to unilateral CIs; and (2) evaluate early auditory and speech skills.MethodsThe longitudinal study was comprised of 20 participants, 10 with unilateral and 10 with simultaneous bilateral CIs. Participants received a CI at a mean age of 1.3 (SD ± 0.2) years. The Mandarin Early Speech Perception test, auditory thresholds, and influence of environmental factors were measured pre-operatively and after 24 months. Categories of Auditory Performance (CAP), Speech Intelligibility Rating (SIR), and LittlEARS Auditory Questionnaire (LEAQ) were measured pre-operatively and after 6, 12, and 24 months.ResultsAfter 24 months of device use, tone perception scores tended to be higher in the bilateral CI group than in the unilateral group, although the difference did not reach statistical significance (p = 0.058). Over the 24-month follow-up period, CAP, SIR, and LEAQ scores showed significant improvements in both groups (all p < 0.05).ConclusionsTone perception and early auditory and speech skills in Mandarin-speaking children were better with simultaneous bilateral CI implantation compared to unilateral after 24 months of use.

Denture base materials made using three-dimensional printing (3D printing) have expanded in availability, contributing to the meteoric rise of this innovative dental technique. Despite 3D-printed denture resins having good biocompatibility and esthetics, achieving superior mechanics in these materials is still difficult. This study aimed to find out how adding calcium carbonate (CaCO3) nanoparticles to 3D-printed denture base resin affected its surface hardness, impact strength, and flexural strength. The ninety 3D printed samples were allocated into three groups following the amount of CaCO3 NPs added to the resin: one control group had no CaCO3, and two modified groups-one had 1.5 wt.%, and the other group had 2 wt.%. Surface hardness, impact, and flexural strength were the three test specifications used to further divide each group into three subgroups. Analysis was also conducted utilizing energy dispersive X-ray spectroscopy (EDX) and field emission scanning electron microscopy (FESEM). All data were statistically analyzed. The results verified that adding CaCO3 NPs to the 3D-printed denture resin significantly boosted its impact strength, flexural, and surface hardness (P value < 0.05). These findings indicate potential for developing a novel denture base constructed from 3D-printed nanocomposites with enhanced material properties.

Guillain–Barré syndrome (GBS) is a life-threatening acute paralytic neuropathy characterized by rapidly progressive limb weakness and bilateral cranial nerve involvement. We report an early 70s male with no relevant medical history diagnosed with anti-GM3 IgG-positive GBS, who developed unilateral oculomotor nerve palsy and autonomic dysfunction during intravenous immunoglobulin (IVIG) therapy, with spontaneous symptom resolution following IVIG completion. Six-month follow-up assessments confirmed complete remission. This case reinforces the therapeutic value of IVIG in GBS patients with specific autoantibody profiles, even when complicated by transient neurological deterioration during treatment.

The brain–gut–bone axis refers to the interactions among the brain, gut, and bones, which were developed and refined by researchers across multiple fields. This axis was complex and dynamic, and influenced overall health through any possible intervention. This narrative review primarily focused on the regulation of bone metabolism through this axis mediated by serotonin (5-hydroxytryptamine (5-HT)) and mediators. Bone metabolism, influenced by various factors, was characterized by dynamic processes occurring within bone tissue, including bone formation and resorption. To enhance bone metabolism, it was essential to consider the brain–gut–bone axis, offering new insights in clinical research. This review examined the influence of the brain–gut–bone axis on bone metabolism and its underlying mechanisms.

Von Hippel-Lindau (VHL) disease is a rare inherited tumor syndrome characterized by the development of multiple neoplasms. The broad variability in clinical manifestations makes this entity susceptible to being overlooked during clinicpathological diagnosis. A female patient in her late 20s presented with multiple adrenal masses during a routine health check-up, with associated dizziness and palpitations lasting 1 month. Laboratory studies revealed plasma-free normetanephrine level of 2894.9 pg/ml. Abdominal contrast-enhanced computed tomography showed multiple lesions consisting of bilateral adrenal masses and retroperitoneal nodules. Postoperative pathological examination demonstrated the diagnosis of bilateral adrenal pheochromocytomas, retroperitoneal paraganglioma, and pancreatic neuroendocrine tumor. Molecular genetic testing detected a pathogenic germline mutation in the VHL gene (c.499C > T: p.R167 W). Subsequent brain magnetic resonance imaging revealed a hypervascular cerebellar nodule. Genetic and clinical findings confirmed a definitive diagnosis of VHL syndrome type 2B. The diverse manifestations of VHL syndrome often cause diagnostic delays. Analyzing this case alongside the literature highlights the need to suspect VHL in young patients with multiple tumors, for whom genetic testing is crucial for definitive diagnosis. While a single case cannot capture the full disease spectrum, it provides valuable clinical insight.

Chronic venous disease (CVD) of the lower extremities constitutes a progressive clinical entity that compromises venous hemodynamics, leading to structural and functional alterations predominantly due to venous reflux. With an estimated global prevalence of approximately 60%, CVD exerts a substantial negative impact on quality of life. Historically dismissed as merely aesthetic, the condition is now recognized for its symptomatic burden, which can considerably impair daily functioning and well-being.ObjectiveTo describe the epidemiological and clinical profile of patients with CVD treated at a university hospital and to identify demographic, clinical, and behavioral factors associated with disease severity according to the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification.MethodsA cross-sectional prospective study was conducted with 674 patients evaluated with CVD at the Angiology Teaching and Clinical Care Unit of Pedro Ernesto University Hospital. Demographic, clinical, and behavioral data were analyzed according to the CEAP classification using ordinal logistic regression to identify factors associated with disease severity.ResultsA predominance of female patients (78.9%) was observed, with a mean age of 56.5 years. The most frequently reported symptoms were leg pain (reported by 80.7% of patients), lower-limb edema (68.7%), and burning sensation (63.8%). Higher Body Mass Index (BMI) was significantly associated with advanced CEAP stages (P < .001), identifying obesity as a key modifiable risk factor.ConclusionHigher BMI was the only modifiable variable independently associated with advanced stages of CVD.

Currently, purely deep learning-based agents struggle to make optimal decisions within a short timeframe in problems with a vast decision-making space. Human planning knowledge is required to assist agents in making better decisions. This manuscript proposes a novel knowledge-guided and data-driven decision-making framework, utilizing hierarchical task network as the carrier of knowledge, deep learning as the trainer for data, and the Monte Carlo Tree Search as the connector between hierarchical task network and deep learning. The experiments on the MiniRTS environment validated that the proposed framework in this manuscript can replace humans in collecting high-quality data, and it can train neural networks that perform equally well as the compared network even with only 20% of the available data, which provide a new direction for future research.

ObjectiveThe diagnosis of Ménière's disease (MD) and delayed endolymphatic hydrops (DEH) is challenging due to overlapping symptoms. This study aimed to retrospectively evaluate the diagnostic performance of gadolinium-enhanced delayed inner ear magnetic resonance imaging (MRI) for visualizing endolymphatic hydrops (EH) in patients with MD and DEH.MethodsThis retrospective study included 191 patients with unilateral MD (n = 164) or DEH (n = 27), stratified into definite MD (DMD, n = 129), probable MD (PMD, n = 35), and DEH subgroups. All patients underwent intratympanic administration of gadolinium followed by 3.0-T MRI using 3D-FLAIR and 3D-real-IR sequences. Clinical data, including pure-tone audiometry (PTA), speech recognition score (SRS), electrocochleography (ECochG), and caloric testing, were analyzed to assess correlations between EH and auditory-vestibular function.ResultsEH was detected in 85.2% (23/27) of clinically diagnosed DEH patients. Detection rates were 96.1% in DMD cases and 28.6% in PMD cases. There was no significant difference in cochlear or vestibular EH between the DMD and DEH groups. However, the DMD group exhibited a significantly higher incidence and severity of EH than the PMD group (P < 0.05). In DMD patients, the degree of EH was positively correlated with PTA, clinical stage, and disease course (P < 0.05), and negatively correlated with SRS (P < 0.05). The degree of vestibular EH was also positively correlated with caloric test abnormalities (Spearman's ρ = 0.350, P < 0.001).ConclusionGadolinium-enhanced delayed MRI of the inner ear provides objective evidence of EH and improves the diagnostic accuracy for MD and DEH. Its incorporation into standardized diagnostic protocols may further enhance clinical decision-making.

ObjectivesThis study aims to investigate the significance of tumor microenvironment (TME)-related genes and signal transduction pathways in head and neck cancer (HNC).MethodsGene expression and clinical data of HNC patients were obtained from the Cancer Genome Atlas (TCGA) database. Differentially expressed genes (DEGs) were screened through a multi-step filtration approach to obtain candidate predictors. The biological role of COL5A1 in HNC was verified through rigorous bioinformatic analysis, experimental validation using quantitative real-time PCR (qRT-PCR), immunohistochemical (IHC) analysis from HNC samples, and IHC data from the Human Protein Atlas (HPA) database.ResultsCOL5A1 was significantly upregulated in HNC tissues and cell lines. High COL5A1 expression was significantly associated with advanced tumor grade (P < .05) and shorter survival (TCGA: P < .001; GSE42743: P = .004). COL5A1 was an independent prognostic indicator (univariate analysis: HR = 1.324, P = .001; Multivariate analysis: HR = 1.326, P = .005). It was enriched in pathways related to tumor invasion and immune responses, and its expression was associated with decreased levels of CD8+ T cells and increased levels of macrophages and neutrophils. Spatial distribution analysis revealed higher expression at the tumor's leading edge (vs. tumor core: P < .001). COL5A1 expression is associated with tumor stage, with more pronounced expression in advanced-stage tumors.ConclusionCOL5A1 represented a novel potential prognostic indicator and therapeutic target in an HNC database sample, as its expression is closely linked to tumor progression, immune cell infiltration, and adverse clinical outcomes. These findings, primarily derived from squamous cell carcinoma-dominated cohorts, warrant further functional validation.