The frontal sinus outflow pathway is complex and can be influenced by the configuration of the uncinate process (UP). The UP can attach superior to the lamina papyracea, skull base, and middle turbinate. The factors associated with superior attachment remain unclear. This study analyzed the relationships between different types of superior UP attachment and characteristics of the surrounding structures including the agger nasi cell, skull base, and middle turbinate. This retrospective study utilized computed tomography images of 836 sides with identifiable sinus structure from 434 Taiwanese patients. Types of superior UP attachment, height of the ethmoid cribriform plate, prevalence of agger nasi cell, and degree of pneumatization of the middle turbinate were analyzed. In the current study, neither the presence of an agger nasi cell nor height of the cribriform plate had significant relationship with superior UP attachment type. However, UP attachment type was statistically significantly associated with pneumatized middle turbinate (PMT) type (p < 0.01). The PMT group had a higher incidence of UP attachment to the middle turbinate (38%) than the non-PMT group (18%). In the extensive PMT group, the incidence of UP attachment to the middle turbinate was high to 49%. In conclusion, superior UP attachment to the middle turbinate was associated with pneumatization of the middle turbinate. The UP has a greater tendency to attach to the middle turbinate in cases with more PMT.

In recent years, the incidence of thyroid cancer has been increasing globally, with papillary thyroid cancer (PTCa) being the most prevalent pathological type, accounting for approximately 80% of all cases. Although PTCa has been regarded to be slow growing and has a good prognosis, in some cases, PTCa can be aggressive and progress despite surgery and radioactive iodine treatment. In addition, most cancer treatment drugs have been shown to be cytotoxic and nonspecific to cancer cells, as they also affect normal cells and consequently cause harm to the body. Therefore, searching for new targets and therapies is required. Herein, we explored a bioinformatics analysis to identify important theranostic markers for THCA. Interestingly, we identified that the DPP4/CTNNB1/MET gene signature was overexpressed in PTCa, which, according to our analysis, is associated with immuno-invasive phenotypes, cancer progression, metastasis, resistance, and unfavorable clinical outcomes of thyroid cancer cohorts. Since most cancer drugs were shown to exhibit cytotoxicity and to be nonspecific, herein, we evaluated the anticancer effects of the antidiabetic drug sitagliptin, which was recently shown to possess anticancer activities, and is well tolerated and effective. Interestingly, our in silico molecular docking results exhibited putative binding affinities of sitagliptin with DPP4/CTNNB1/MET signatures, even higher than standard inhibitors of these genes. This suggests that sitagliptin is a potential THCA therapeutic, worthy of further investigation both in vitro and in vivo and in clinical settings.

A 68-year-old male presented to our emergency department with progressive dyspnea on exertion and hoarseness. Tracing his past history, he had received Co-60 radiotherapy for laryngeal cancer 20 years ago. On physical examination, there was dark desquamation over his neck and discharging wound over the anterior thyroid cartilage region ( Figure 1) with stridor breathing sound. Flexible fiberoptic laryngoscope revealed poor movement of bilateral vocal folds with narrowed glottic airway (Figure 2). Computed tomography (CT) demonstrated fragmentation of the thyroid cartilage with gas bubble around it (Figure 3). The diagnosis was delayed radionecrosis of the larynx. After admission, the patient received tracheostomy. No recurrent laryngeal cancer was found. The exertional dyspnea improved after the surgery and he was discharged under stable condition.Radiation therapies have been the organ preservation treatment for early-stage cancer of larynx for over 20 years. However, radiotherapy could induce several complications such as laryngeal edema, skin damage, and even cartilage necrosis. 1 The arytenoid cartilages are involved most frequently that lead to incomplete abduction or adduction of vocal folds. 2 Therefore, the patients who had laryngeal radionecrosis would present the symptoms with dysphagia, hoarseness, and airway obstruction. Most of laryngeal radionecrosis present with these symptoms within 1 year of radiotherapy; however, delayed presentations have been reported up to 50 years after treatment. 3 The diagnosis of radiation necrosis is made on clinical presentation and CT is an useful diagnostic tool, which demonstrate the destruction of cartilage. The treatment depends on the

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