We have previously introduced the potential of casein micelles (CM) as natural nanovehicles for hydrophobic nutraceuticals, e.g. vitamin D (VD) (E. Semo, E. Kesselman, D. Danino and Y. D. Livney, Food Hydrocolloids, 2007, 21, 936-942). The aims of the current study were to improve performance by adding an ultra-high-pressure homogenization step, and to evaluate the protection conferred by re-assembled CM (rCM) against VD thermal and oxidative degradation, and the bioavailability of VD(3) in rCM, by a clinical trial. Dynamic-light-scattering showed that VD(3)-rCM had a diameter of 91 ± 8 nm (average ± standard error). When VD(3) was encapsulated in rCM and subjected to thermal treatment (80 °C, 1 min), no significant loss was observed (P > 0.05), compared to 13 and 14% loss of VD(3) emulsified with Tween-80 (a synthetic emulsifier typically used for VD solubilization) and of unencapsulated VD(3) respectively (P < 0.05). VD(3) in rCM was also more stable during 28 d cold storage (∼40% loss) compared to Tween-80 emulsified (∼50% loss) or to un-encapsulated (∼70% loss) VD(3). Ultra-high-pressure homogenization of VD(3)-rCM (∼155 MPa) significantly enhanced vitamin stability, resulting in only ∼10% loss after 28 d of storage. Bioavailability of a single-dose of 50,000 international-units (IU) VD(3) encapsulated in rCM, in 1% fat milk, investigated in a randomized double blinded placebo controlled clinical study with 87 human volunteers, was at least as high as that using an aqueous Tween-80-emulsified VD(3) supplement. We conclude that ultra-high-pressure homogenization treated rCM protect VD(3) against heat- and storage-induced degradation, and VD(3) encapsulated in rCM is highly bioavailable.

Key Points Question Can molecular markers of cancer be extracted from tissue morphology as seen in hematoxylin-eosin–stained images? Findings In this diagnostic study of tissue microarray hematoxylin-eosin–stained images from 5356 patients with breast cancer, molecular biomarker expression was found to be significantly associated with tissue histomorphology. A deep learning model was able to predict estrogen receptor expression solely from hematoxylin-eosin–stained images with noninferior accuracy to standard immunohistochemistry. Meaning These results suggest that deep learning models may assist pathologists in molecular profiling of cancer with practically no added cost and time.

Pediatric skull base and craniofacial reconstruction presents a unique challenge since the potential benefits of therapy must be balanced against the cumulative impact of multimodality treatment on craniofacial growth, donor-site morbidity, and the potential for serious psychosocial issues. To suggest an algorithm for skull base reconstruction in children and adolescents after tumor resection. Comprehensive literature review and summary of our experience. We advocate soft-tissue reconstruction as the primary technique, reserving bony flaps for definitive procedures in survivors who have reached skeletal maturity. Free soft-tissue transfer in microvascular technique is the mainstay for reconstruction of large, three-dimensional defects, involving more than one anatomic region of the skull base, as well as defects involving an irradiated field. However, to reduce total operative time, intraoperative blood loss, postoperative hospital stay, and donor-site morbidity, locoregional flaps are better be considered the flap of first choice for skull base reconstruction in children and adolescents, as long as the flap is large enough to cover the defect. Our "workhorse" for dural reconstruction is the double-layer fascia lata. Advances in endoscopic surgery, image guidance, alloplastic grafts, and biomaterials have increased the armamentarium for reconstruction of small and mid-sized defects. Skull base reconstruction using locoregional flaps or free flaps may be safely performed in pediatrics. Although the general principles of skull base reconstruction are applicable to nearly all patients, the unique demands of skull base surgery in pediatrics merit special attention. Multidisciplinary care in experienced centers is of utmost importance.

Objectives/Hypothesis This study aimed to evaluate the long‐term swallowing performance following transoral robotic surgery (TORS) to the base of tongue (BOT) in the treatment of obstructive sleep apnea (OSA). Study Design Retrospective and prospective cohort study. Methods Data analysis of 39 patients who underwent BOT reduction via TORS to treat OSA at our center from September 2013 to April 2016. Long‐term swallowing functions were assessed using subjective self‐evaluated swallowing disturbances questionnaire (SDQ) and objective fiberoptic endoscopic evaluation of swallowing (FEES). Results Seven patients underwent TORS BOT reduction alone, whereas 32 had also uvulopalatoplasty ± tonsillectomy, with a surgical success rate of 71.4%. Mean time for swallowing evaluation was 27.4 ± 9.43 months. Twenty‐five patients completed the SDQ with an average score of 9.26 ± 10.05. In 32%, the SDQ was positive for dysphagia. In 10 out of 14 patients who underwent FEES, swallowing problems were noticed. The most common pathological findings were food residue in the vallecula followed by early spillage of food into the hypopharynx, penetration of solid food and liquid on the vocal folds surface, and aspiration. Conclusions BOT reduction via TORS has a negative effect on long‐term swallowing function. A self‐assessment questionnaire can help detect patients who suffer from swallowing impairment. Postoperative objective swallowing tests are essential not only in the immediate postoperative period but also during late routine follow‐up. Proper patient selection and detailed information about surgery and possible late‐swallowing effect are important factors before scheduling BOT reduction via TORS for OSA treatment. Level of Evidence 4 Laryngoscope, 129:422–428, 2019