Objective Lymph nodes within the parotid gland (PG) are known as 1) an origin of Warthin’s tumors and 2) a metastatic focus of nearby cancers. This study aimed to investigate factors that provide the specific features. Methods Using histological sections from 28 human fetuses at approximately 15–31 weeks, we examined developing acini, ducts and lymph vessels (LVs) in the PG and compared the results with the other exocrine glands. Results In the PG at 15–16 weeks, developing acini were embedded in a meshwork of LVs that corresponds to a major lymphatic route from the posterolateral head to the jugular lymph sac. Moreover, lymphocyte aggregations (=initial lymph node) protruded into LVs and some aggregations surrounded acini and ducts. In contrast, without entering the exocrine pancreas, the LVs and aggregations extended along and beneath the peritoneum. The submandibular and lacrimal glands contained a few LVs and, the sublingual gland and pancreas did not. Interstitial tissues between acini were loose in the PG and lacrimal gland, whereas they were relatively tight in the submandibular and sublingual glands and tightest between clusters of the pancreatic acini and endocrine tissue. The entrapped parotid acini appeared to maintain the basal lamina but, after 26 weeks, lymphocytes contacted acinar cells. The encapsulation occurred much later than nodal development in all those exocrine glands. Conclusion The PG at 3–4 months of gestation was characterized by active lymph node development accelerated by the highest density of intraglandular LVs. These LVs might drain the physiological nuchal translucency in fetuses.
Infantile nystagmus syndrome (INS), formerly referred to as congenital nystagmus, typically presents in early infancy. We report a rare case in which nystagmus consistent with INS became clinically apparent after a vertigo attack during adolescence. A 17-year-old female developed acute rotational vertigo. Although the vertigo gradually subsided, she continued to perceive rightward visual motion. Five months later, she was referred to our institution because of persistent spontaneous and gaze-evoked nystagmus. There was no prior history or documentation of nystagmus. Examination revealed jerk-type horizontal nystagmus with a predominantly right-beating fast phase (slow-phase velocity [SPV] ~5°/s). Gaze testing showed direction-changing nystagmus, predominantly left-beating (SPV 10–30°/s), with a rightward null position. Horizontal smooth pursuit was saccadic, whereas vertical pursuit was preserved. Optokinetic testing demonstrated poor development and inversion of horizontal responses. Vestibular testing showed mild right-sided hypofunction. Over a 4-year follow-up, mild oscillopsia persisted, and ocular motor findings remained unchanged. This case suggests that a vertigo attack may have contributed to the clinical manifestation of latent INS in adolescence. Persistent characteristic ocular motor findings support the possibility that pre-existing but clinically silent INS may have become manifest following vestibular dysfunction.
Objective Papillary thyroid carcinoma (PTC) generally has an excellent prognosis; however, recurrence may occur over a wide range of postoperative periods, and factors associated with the timing of recurrence remain unclear. Previous studies have evaluated early or late recurrence using predefined time points or specific recurrence patterns. We aimed to evaluate the association between clinicopathological and treatment-related factors and the timing of recurrence across the entire postoperative period. Methods We retrospectively analyzed 69 patients with recurrent PTC among 677 patients who underwent initial surgery. Recurrence timing was defined as the postoperative month (POM), calculated from the date of initial surgery to the date when recurrence was first identified. We evaluated the distribution of POM and compared recurrence timing across clinicopathological and treatment-related subgroups. Cumulative recurrence curves were constructed, and differences in POM were assessed using the Mann–Whitney U test or Kruskal–Wallis test, as appropriate. Multivariable linear regression analysis was also performed to identify factors independently associated with recurrence timing. Results The median POM was 34 months (IQR, 13–73), with 71% of recurrences occurring within POM 60 (5 years), 25% between POM 60 and 120 (5–10 years), and 4.3% after POM 120 (>10 years). Most clinicopathological and treatment-related factors, including T classification, N classification, recurrence site, recurrence risk group, age, extent of thyroidectomy, and radioactive iodine treatment, were not significantly associated with recurrence timing. In contrast, multifocal tumors were associated with earlier recurrence than solitary tumors (median POM, 20 vs. 48 months; p = 0.015). Multivariable linear regression analysis also demonstrated that tumor multifocality was independently associated with a shorter time to recurrence. Conclusion Recurrence timing in PTC was highly variable and was difficult to predict using conventional clinicopathological and treatment-related factors. Tumor multifocality was associated with earlier recurrence, suggesting that patients with multifocal tumor may benefit from closer surveillance during the early postoperative period. However, late recurrence also occurred, including more than 10 years after surgery, indicating that long-term surveillance remains important. These findings may support a risk-adapted approach to postoperative surveillance, although the optimal intensity and duration of follow-up require further investigation.
Objective Tezepelumab, an anti-thymic stromal lymphopoietin monoclonal antibody, effectively reduced polyp size in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Tezepelumab also reduced the need for nasal polyp surgery and systemic corticosteroids (SCS) in the phase 3 WAYPOINT study across 10 countries (including Japan). This descriptive subgroup analysis evaluated the efficacy and safety of tezepelumab in Japanese patients enrolled in the WAYPOINT study; no formal statistical hypothesis testing was performed. Methods Adults with severe uncontrolled CRSwNP were randomized to receive subcutaneous tezepelumab 210 mg or placebo once every 4 weeks. Evaluations included coprimary endpoints (change from baseline to week 52 in total Nasal Polyp Score [NPS] and bi-weekly mean Nasal Congestion Score [NCS]), key secondary endpoints (loss of smell score, total score on the SinoNasal Outcome Test 22-item [SNOT-22], and Lund-Mackay sinus score, and the need for nasal polyp surgery, SCS, or both), and safety outcomes in the Japanese population. Results Of the 408 patients overall, 33 were enrolled in Japan (tezepelumab, n = 17; placebo, n = 16). In the Japanese population, tezepelumab showed numerically favorable reductions versus placebo at week 52 in total NPS (least squares mean change from baseline [95% confidence interval] −2.30 [−3.17, −1.44] vs −1.24 [−2.13, −0.35]) and bi-weekly mean NCS (−1.63 [−2.01, −1.25] vs −1.08 [−1.47, −0.69]). Loss of smell, SNOT-22, and Lund-Mackay scores also showed numerically favorable reductions from baseline with tezepelumab compared with placebo. No Japanese patients receiving tezepelumab required nasal polyp surgery or SCS. Safety was consistent with the overall study population. Conclusion In this exploratory subpopulation analysis, tezepelumab showed numerically favorable results compared with placebo across multiple endpoints and was well tolerated in Japanese patients with severe uncontrolled CRSwNP, with findings generally consistent with the overall WAYPOINT population.Clinical trial registration: NCT04851964 (Available at: https://clinicaltrials.gov/study/NCT04851964)
BACKGROUND:Communication confidence is increasingly recognised as a clinically crucial yet under-researched topic in aphasiology. It has been reported to be one of the most valuable treatment outcomes by stroke survivors. A scoping review of therapies targeting confidence in stroke survivors revealed a growing interest in this topic and identified outcome measures for confidence. However, there were limited studies, with small sample sizes, that explored communication confidence in stroke survivors with aphasia. Further evidence is needed regarding this topic. AIMS:This study aims to examine communication confidence in a comparatively larger and heterogeneous sample of people with post-stroke chronic aphasia. The research questions explore (1) relationships between measures of language, communication confidence, confidence after stroke and well-being and (2) stability of these measures over time and if changes align with self-perceptions. METHODOLOGY:Participants with chronic aphasia after stroke (i.e., 6 months or more) and interested in exploring their communication confidence were recruited to participate in online assessments. Assessments included a test-battery consisting of the 'Western Aphasia Battery-Revised-WAB-R', 'Confidence after Stroke Measure-CaSM', 'Communication Confidence Rating Scale for Aphasia-CCRSA' and 'ONS-4'. The test battery was administered at two separate time-points approximately 6-months apart. RESULTS:Twenty-seven participants were recruited for initial assessment and 18 were followed-up after 6 months. Aphasia severities varied from mild to very severe with a mean WAB-R aphasia quotient (AQ) of 74.4 (range from 9.1 to 98.2). Baseline measures indicated mean scores of 43.4/81 for the CaSM, 28.1/40 for the CCRSA and 25.9/40 for the ONS-4. Statistically significant correlations were found between confidence after stroke and well-being (r = 0.76, p < 0.001), communication confidence and confidence after stroke (r = 0.51, p = 0.006), and communication confidence and language skills (rs = 0.68, p < 0.001). Although language skills and communication confidence remained relatively stable over time, confidence after stroke (r = 0.61, p = 0.01) and well-being (r = 0.55, p = 0.02) significantly improved. CONCLUSION:The findings suggested stronger correlations between closer conceptual constructs (e.g., language and communication confidence, confidence and well-being). Improvements in confidence and well-being may have potential implications for rehabilitation approaches and may support the development of more holistic interventions for people with aphasia. This study also demonstrated the feasibility of conducting online, longitudinal research on stroke survivors. WHAT THIS PAPER ADDS:What is already known on the subject Communication confidence is a clinically crucial and valued topic for stroke survivors with aphasia. Previous research has explored relationships between aphasia and communication confidence in small samples of people with mild anomic aphasia or very severe aphasia. However, specific relationships between communication confidence and language skills, confidence after stroke and well-being in a wider range of aphasia types and severities are not yet well understood.What this paper adds to the existing knowledge Conceptually closer constructs had stronger correlations: significant correlations between language and communication confidence, confidence after stroke and communication confidence as well as confidence after stroke and well-being. Confidence and well-being seem to have improved over time while language and communication confidence remained stable. These findings offer refined perspectives on communication confidence and what might serve as potential intervention targets in chronic stages of aphasia. The study also demonstrated the feasibility of conducting online, longitudinal research on stroke survivors.What are the potential or actual clinical implications for this work? Targeting improved confidence and well-being after stroke when language skills have become more stable opens new avenues for therapeutic interventions.
