1.
Oral Cavity, Pharyngeal, and Laryngeal Cancer Prevention (PDQ®): Health Professional Version.
Authors
PDQ Screening and Prevention Editorial Board.Source
PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-.
2020 Feb 27.
2020 Feb 27.
Excerpt
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about oral cavity, oropharyngeal, nasopharyngeal, hypopharyngeal, and laryngeal cancer prevention. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions. This summary is reviewed regularly and updated as necessary by the PDQ Screening and Prevention Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
KEYWORDS:
lip and oral cavity cancer; oropharyngeal cancer; nasopharyngeal cancer; hypopharyngeal cancer; laryngeal cancer; head and neck squamous cell cancer; cancer prevention
Sections
2.
Oral Cavity, Pharyngeal, and Laryngeal Cancer Screening (PDQ®): Health Professional Version.
Authors
PDQ Screening and Prevention Editorial Board.Source
PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-.
2020 Feb 27.
2020 Feb 27.
Excerpt
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about oral cavity, oropharyngeal, nasopharyngeal, hypopharyngeal, and laryngeal cancer screening. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions. This summary is reviewed regularly and updated as necessary by the PDQ Screening and Prevention Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
KEYWORDS:
lip and oral cavity cancer; oropharyngeal cancer; nasopharyngeal cancer; hypopharyngeal cancer; laryngeal cancer; head and neck squamous cell cancer; disease screening
Sections
3.
Arch Craniofac Surg. 2020 Feb;21(1):69-72. doi: 10.7181/acfs.2019.00668. Epub 2020 Feb 20.
Flap reconstruction of soft tissue defect after resecting a huge hemangioma of the nose.
Abstract
Hemangioma is a benign vascular tumor that grows by endothelial cell hyperplasia. It occurs most frequently in the head and neck region. Nose reconstruction is tricky because of its unique threedimensional structure and different tissue components. We report a case of successful reconstruction of near-total nose defect using the paramedian forehead flap combined with a nasolabial flap, immediately after excision of nasal hemangioma. A 49-year-old male patient was presented with a huge mass at the nose. Preoperative magnetic resonance imaging showed prominent vascular channels extending to the forehead and cheek. Complete resection of the mass was performed, which resulted in an eccentric defect. The right paramedian forehead flap and the left nasolabial flap were designed and transferred to the defect. Flap division was performed 1 month later. The patient is satisfied with the overall appearance and did not develop any functional deficit.
KEYWORDS:
Hemangioma; Nasal surgical procedures; Nose neoplasms; Surgical flaps
4.
Arch Craniofac Surg. 2020 Feb;21(1):27-34. doi: 10.7181/acfs.2019.00738. Epub 2020 Feb 20.
Free-flap reconstruction in recurrent head and neck cancer: A retrospective review of 124 cases.
Abstract
BACKGROUND:
Free-flap reconstruction for recurrent head and neck cancer may be challenging depending on the previous treatments, those are, chemotherapy, radiotherapy, and surgery, including neck dissection or free tissue transfer. Specifically, the previous treatment could compromise the neck vessels, thereby making free-flap reconstruction more difficult. This study aimed to investigate the correlation between previous treatments and vascular compromise of the free flap.
METHODS:
In this retrospective study, 124 free-flap reconstructions in 116 patients for recurrent head and neck cancer between 1993 and 2017 were investigated. The demographic characteristics, previous treatments, flap choices, infections, recipient vessels, and vascular crises were evaluated.
RESULTS:
Of the 124 reconstruction cases, 10 had vascular crises. There were six revisions, totaling six flap failures. The success rate of free-flap reconstruction for recurrent cancer was 95.2%, which significantly differed from that for primary cancer (98.8%, p= 0.006). Moreover, in the recurrent cancer group, no correlation was found between previous treatments and vascular crises (p> 0.05). Increased rates of contralateral or uncommon anastomoses were found following neck dissection (p< 0.05).
CONCLUSION:
Previous neck dissection or radiotherapy could lead to scarring and tissue damage, which could in turn make microvascular reconstruction more challenging; however, the effect was not definite in this study. Approximately 60% of patients with previous neck dissection had compromised ipsilateral recipient vessels, which resulted in contralateral or uncommon anastomoses. In this study, free-flap reconstruction seems to be quite safe and preferable in patients with recurrent head and neck cancer based on the overall survival rate.
KEYWORDS:
Free tissue flaps; Head and neck neoplasms; Microsurgery; Neck dissection; Second neoplasms
5.
Oral Oncol. 2020 Feb 29;103:104617. doi: 10.1016/j.oraloncology.2020.104617. [Epub ahead of print]
Feasibility and efficacy of intraoperative neural monitoring in remote access robotic and endoscopic thyroidectomy.
Abstract
OBJECTIVES:
We performed this study to assess the feasibility and efficacy of intraoperative neural monitoring (IONM) in remote access robotic and endoscopic thyroidectomy.
MATERIALS AND METHODS:
We studied 104 consecutive patients (122 nerves at risk, NARs) who underwent robotic or endoscopic thyroidectomy via a postauricular facelift approach or transoral approach while performing intermittent IONM.
RESULTS:
IONM was successful in 86/104 patients (82.7%). The success rate was significantly lower in the first 15 cases using a transoral approach than in the subsequent cases (7/15 vs. 41/43, p < 0.001). The standard IONM procedure (obtaining V1/R1/R2/V2 signals) was performed on 32/42 NARs (76.2%) undergoing thyroidectomy via a facelift approach and 10/58 NARs (17.2%) undergoing thyroidectomy via a transoral approach (p < 0.001). Loss of signal occurred in 6/100 NARs in 86 patients receiving successful IONM. Of these 6 LOS, 5 were false positives, and 1 was a true positive. A false negative occurred in 1/100 NARs. The sensitivity, specificity, positive and negative predictive values of IONM were 50.0%, 94.9% 16.7% and 98.9%, respectively.
CONCLUSIONS:
The failure rate of IONM in remote access thyroidectomy is relatively high and following the standard IONM procedure is also relatively difficult. However, IONM is more helpful in confirming the recurrent laryngeal nerve (RLN) and predicting that it is functional in the limited working space available than it is in conventional thyroid surgery.
Copyright © 2020 Elsevier Ltd. All rights reserved.
KEYWORDS:
Endoscopic thyroidectomy; Intraoperative neuromonitoring; Recurrent laryngeal nerve injury; Remote access thyroidectomy; Robotic thyroidectomy
6.
Med Hypotheses. 2020 Feb 26;140:109648. doi: 10.1016/j.mehy.2020.109648. [Epub ahead of print]
From IBS to ME - The dysbiotic march hypothesis.
Abstract
Irritable bowel syndrome (IBS) is often associated with other unexplained complaints like chronic fatigue syndrome (CFS), fibromyalgia and myalgic encephalopathy (ME). The pathogenesis of the relationship is unknown. Intestinal dysbiosis may be a common abnormality, but based on 1100 consecutive IBS patients examined over a nine years period, we hypothesize that the development of the disease, often from IBS to ME, actually manifests a "dysbiotic march". In analogy with "the atopic march" in allergic diseases, we suggest "a dysbiotic march" in IBS; initiated by extensive use of antibiotics during childhood, often before school age. Various abdominal complaints including IBS may develop soon thereafter, while systemic symptom like CFS, fibromyalgia and ME may appear years later.
Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.
KEYWORDS:
Antibiotics; Candida albicans; Childhood; Chronic fatigue syndrome (CFS); Dysbiotic march; Fibromyalgia; Gut microbiota; Gut-brain axis; Intestinal dysbiosis; Irritable bowel syndrome (IBS); Lactobacilli; Myalgic encephalopathy (ME); Tryptophan metabolites
7.
Otolaryngol Head Neck Surg. 2020 Mar 3:194599820910126. doi: 10.1177/0194599820910126. [Epub ahead of print]
Appraising Otolaryngology-Head and Neck Surgery Clinical Practice Guidelines for Effective Dissemination and Implementation Design.
Abstract
OBJECTIVES:
Dissemination and implementation (D&I) science analyzes interventional strategies that aid in spreading scientific knowledge, adopting evidence into practice, and identifying barriers to maximize successful integration of science into practice. This study set out to critically appraise the published D&I strategies of the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Clinical Practice Guidelines (CPGs) and to introduce the theories of D&I science.
METHODS:
The 15 AAO-HNSF CPGs underwent appraisal by 2 independent reviewers using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. CPGs were rated over 23 key items in 6 domains. Each item was rated on a 7-point scale from 1 (strongly disagree) to 7 (strongly agree). CPGs were rated and quality assessments were performed. Intrarater reliability was assessed.
RESULTS:
The overall mean score of the CPGs was 85.2% (95% confidence interval, 83.4%-86.9%). Individual CPG mean scores ranged from 80.4% to 90.9%. Mean interrater reliability was strong. All domains of the AGREE II instrument, except the Applicability domain, scored a mean of 90.7% or better. D&I strategies within the CPGs, as calculated by the Applicability domain score, ranged from 22.9% to 77.1%.
DISCUSSION:
There is a paucity of published D&I strategies within the AAO-HNSF CPGs. Nesting a D&I framework, such as the Quality Improvement Framework, within CPGs would allow for identification of barriers to CPG adoption and evaluation of CPG-directed interventions.
IMPLICATIONS FOR PRACTICE:
A D&I framework within the AAO-HNSF CPGs would allow for objective measurement of the overall impact of CPGs on otolaryngology practices.
KEYWORDS:
PS/QI; clinical practice guidelines; dissemination; implementation
8.
Oncologist. 2020 Mar 3. doi: 10.1634/theoncologist.2019-0804. [Epub ahead of print]
Interventions Addressing Barriers to Delayed Cancer Diagnosis in Low- and Middle-Income Countries: A Systematic Review.
Abstract
BACKGROUND:
Delays to cancer diagnosis exist, resulting in worse survival outcomes for many cancers. Interventions targeting delays and barriers to cancer diagnosis and treatment have been investigated, but mostly in high-income countries. We conducted a systematic literature review to identify and characterize the interventions studied across cancers, within low- and middle-income countries (LMICs).
METHODS:
This systematic review forms part two of a wider study examining solutions to delays and barriers in cancer early diagnosis in LMICs. A comprehensive literature search was conducted on November 27, 2017, encompassing published studies from the preceding 15 years. We extracted study design, population, and intervention, and reported outcome measures from each study. Results were presented by target of interventions (general vs. health care professionals). A narrative synthesis was used to summarize intervention efficacy.
RESULTS:
Of 10,193 abstracts returned, 25 were included, consisting of studies across World Health Organization geographical regions, examining breast, cervix, childhood, prostate, head and neck, and gastric cancers. Altogether, 11 intervention studies targeted the general population, 12 targeted health care professionals, and 2 targeted both. The majority (17/25) of studies reported interventions focusing on patient and diagnosis-related barriers early in the cancer care pathway. Most studies reported knowledge score as primary outcome measure (17/25); few (6/25) reported on clinically relevant measures such as reducing disease stage at presentation or diagnostic time interval. Effectiveness of interventions was demonstrated for some cancers only.
CONCLUSION:
More interventions reporting clinically relevant measures and using standardized methods and outcomes are required to improve our ability to effectively improve cancer early diagnosis in LMICs.
IMPLICATIONS FOR PRACTICE:
Prior to this study, the extent of intervention literature in cancer early diagnosis in low- and middle-income countries had not been characterized. This study aimed to outline and characterize interventions across all cancer types and across all countries. This systematic review demonstrated that interventions have been investigated targeting both the general population and health care professionals. Furthermore, this review demonstrates that the majority of studies report knowledge as an outcome measure, rather than clinically significant measures that improve cancer-related outcomes, such as delay intervals or downstaging of disease. Future interventions should address clinically relevant measures to better assess efficacy of interventions.
© AlphaMed Press 2020.
KEYWORDS:
Barriers; Cancer; Delay interval; Early diagnosis; Interventions; Low- and middle-income countries
9.
Laryngoscope. 2020 Mar 3. doi: 10.1002/lary.28586. [Epub ahead of print]
Distinct Histopathology Characteristics in Empty Nose Syndrome.
Abstract
OBJECTIVES/HYPOTHESIS:
Empty nose syndrome (ENS) is a controversial disorder and the change of histopathology has never been discussed. This study aimed to conduct a structured histological review to improve the diagnosis and understanding of ENS. Further immunohistochemical staining of transient receptor potential channel melastatin 8 (TRPM8) was performed.
STUDY DESIGN:
A prospective case-control study in a tertiary medical center.
METHODS:
Consecutive patients with ENS who were diagnosed and received surgical intervention after failure of conservative management were included. Patients with benign pituitary gland tumor receiving transsphenoidal excision were enrolled as control group. Biopsy of inferior turbinate was obtained during surgery for histological review and immunohistochemical staining.
RESULTS:
Seventeen patients with ENS and six patients as a control group were established for structured histological review. Patients with ENS presented significantly more squamous metaplasia, a higher rate of submucosal fibrosis, and a lower submucosal gland number grading. Additionally, a unique histological change called goblet cell metaplasia was found in the ENS group. The respiratory epitheliums of ENS were mostly intact with preservation of ciliated cells and goblet cells. The ENS group had a significantly lower expression level of TRPM8.
CONCLUSIONS:
The nasal mucosa of ENS experienced some airway remodeling and thermoreceptors downregulation, which contribute to clinical symptoms. The distinct histology of ENS included preserved respiratory epithelium and goblet cell metaplasia, accompanying with characteristics similar to atrophic rhinitis. Biopsy of the inferior turbinate may help diagnose ENS.
LEVEL OF EVIDENCE:
4 Laryngoscope, 2020.
© 2020 The American Laryngological, Rhinological and Otological Society, Inc.
KEYWORDS:
Atrophic rhinitis, empty nose syndrome, histopathology, immunohistochemical stain, TRPM8
10.
Cerebellum. 2020 Mar 3. doi: 10.1007/s12311-020-01120-y. [Epub ahead of print]
The Pathophysiology and Clinical Manifestations of Spinocerebellar Ataxia Type 6.
Abstract
Spinocerebellar ataxias (SCA) constitute of a group of degenerative and progressive disorders that can be identified on a molecular and cellular basis. Along with histological changes, the clinical presentation of SCA differs between subtypes. In addition to basic cerebellar dysfunction symptoms, patients with SCA develop gait ataxia, dysphagia, dysarthria, oculomotor disturbances, pyramidal and extrapyramidal disease signs, rigidity, bradycardia, sensory deficits, and mild cognitive and executive function decline. MRI scans have confirmed reduction in mass of frontal, temporal, and parietal portions of the brain along with the cerebellar peduncles, brainstem, and cranial nerve III. Clinically, these damages manifest as decline in cognition and problems with speech, contemplation, and vision. This review article compares the most prevalent subtypes of SCA based on genetic background, pathogenesis, neurological manifestations, other presenting symptoms, and diagnostic workup. Further goals of research in this field should be directed towards a cure for SCA, which currently does not exist.
KEYWORDS:
Cognitive dysfunction; Deglutition disorders; Gait ataxia; Magnetic resonance imaging; Spinocerebellar ataxias; Trinucleotide repeat expansion
11.
Lifetime Data Anal. 2020 Mar 3. doi: 10.1007/s10985-020-09495-0. [Epub ahead of print]
Estimation of treatment effects and model diagnostics with two-way time-varying treatment switching: an application to a head and neck study.
Abstract
Treatment switching frequently occurs in clinical trials due to ethical reasons. Intent-to-treat analysis without adjusting for switching yields biased and inefficient estimates of the treatment effects. In this paper, we propose a class of semiparametric semi-competing risks transition survival models to accommodate two-way time-varying switching. Theoretical properties of the proposed method are examined. An efficient expectation-maximization algorithm is derived to obtain maximum likelihood estimates and model diagnostic tools. Existing software is used to implement the algorithm. Simulation studies are conducted to demonstrate the validity of the model. The proposed method is further applied to data from a clinical trial with patients having recurrent or metastatic squamous-cell carcinoma of head and neck.
KEYWORDS:
Expectation–maximization algorithm; Model diagnostics; Semi-competing risk; Survival model; Time-varying treatment switching
12.
Head Neck. 2020 Mar 3. doi: 10.1002/hed.26122. [Epub ahead of print]
Early oral hydration protects against pharyngocutaneous fistula after total laryngectomy or total pharyngolaryngectomy.
Abstract
BACKGROUND:
The objective of this study was to evaluate the impact of early oral hydration on the incidence of pharyngocutaneous fistula (PCF) after total laryngectomy (TL) or total pharyngolaryngectomy (TPL).
METHODS:
A prospective series of 25 patients operated on between October 2017 and March 2019 who received early oral hydration starting 2 days after surgery were compared to a retrospective cohort of 28 patients who did not receive any early oral hydration. These are two consecutive series including all operated patients.
RESULTS:
There was no significant difference between the two groups in terms of risk factors for PCF. In univariate and multivariate analysis, early oral hydration was significantly associated with a decreased risk of PCF: 50% vs 20% (odds ratio [OR], 0.25; 95% confidence interval [95% CI], 0.07-0.85; P = .03, vs OR, 0.24; 95% CI, 0.07-0.85; P = .02).
CONCLUSION:
Early oral hydration after TL or TPL reduces the risk of PCF.
© 2020 Wiley Periodicals, Inc.
KEYWORDS:
early oral hydration; incidence; pharyngocutaneous fistula; postlaryngectomy complications; protective factor
13.
Fundam Clin Pharmacol. 2020 Mar 3. doi: 10.1111/fcp.12552. [Epub ahead of print]
Platelet Function Defects and Sertraline-induced bleeding: a Case Report.
Abstract
A 71-year-old man is admitted for nose bleeds recurring for several days. His medical background shows in particular major depression for which he has been receiving sertraline for several years. The workup shows anemia, and no anomalies on head and neck CT angiography. However, further explorations suggest an acquired thrombopathy that could have contributed to the bleeding. During sertraline exposure, platelet functional exploration and platelet secretion were abnormal. Sertraline is often used as first line treatment of depression. Pharmacological data and spontaneous notifications suggest increased potential risk with sertraline. It appears necessary to pay attention to bleeding with sertraline use.
This article is protected by copyright. All rights reserved.
KEYWORDS:
Hemorrhage; Long Term Adverse Effects; Platelet Aggregation; Sertraline
14.
Allergy. 2020 Mar 3. doi: 10.1111/all.14257. [Epub ahead of print]
Stability of regulatory T cells in T helper 2-biased allergic airway diseases.
Abstract
Regulatory T (Treg) cells potentially suppress the deleterious activities of effector T cells and maintain a state of tolerance against antigens in the airway mucosa. A decrease in the number and function of Treg cells is observed in T helper 2 (Th2)-biased allergic airway diseases. However, adoptive transfer of naturally occurring Treg (tTreg) cells or peripherally derived Treg (pTreg) cells in asthmatic mouse models did not yield satisfactory results in any previous studies. Here, we review the recent progress in the identification and plasticity of tTreg and pTreg cells in Th2-biased airway diseases and summarize the factors affecting the stability and function of Treg cells. This review may serve as foundation for understanding the molecular mechanisms underlying the stability of tTreg and pTreg cells and development of effective strategies for treating allergic airway diseases.
This article is protected by copyright. All rights reserved.
KEYWORDS:
T helper 2; airway disease; peripherally derived regulatory T cell; thymus derived regulatory T cell
15.
Head Neck. 2020 Mar 2. doi: 10.1002/hed.26129. [Epub ahead of print]
Diagnostic accuracy of computed tomography and magnetic resonance imaging compared to surgical exploration for anterior skull base and medial orbital wall infiltration in advanced sinonasal tumors.
Abstract
BACKGROUND:
Knowledge of medial orbital wall (MOW) and anterior skull base (ASB) infiltration is of uttermost importance for staging and therapy planning of advanced sinonasal tumors.
METHODS:
We assessed the diagnostic performance of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) for MOW and ASB infiltration compared to intraoperative exploration.
RESULTS:
Both CT and MRI yielded higher diagnostic accuracy for MOW infiltration (Reader 1: 83.6% CT; 89.0% MRI, Reader 2: 91.8% CT, 93.2% MRI) than for ASB infiltration (Reader 1: 82.2% CT, 82.2% MRI, Reader 2: 67.7% CT, 67.7% MRI). Both modalities were equal to the gold standard, except for ASB assessment by Reader 2 with MRI. A postoperative change of T classification is common (Reader 1: 28.8%, Reader 2: 31.5%).
CONCLUSIONS:
CT and MRI are accurate methods for the assessment of MOW infiltration. ASB assessment is challenging and false-positive and false-negative findings are common with both methods, emphasizing the need for intraoperative exploration.
© 2020 Wiley Periodicals, Inc.
KEYWORDS:
CT; MRI; orbit; sinonasal; skull base; tumor
16.
Acad Emerg Med. 2020 Mar 2. doi: 10.1111/acem.13951. [Epub ahead of print]
Hospital Emergency Management Plan During the COVID-19 Epidemic.
Abstract
The confirmed and suspected cases of the 2019 novel coronavirus disease (COVID-19) have increased not only in Wuhan, Hubei Province but also China and the world. Enormous demand for handling the COVID-19 outbreak challenged both the healthcare personnel and medical supply system. In West China Hospital, Emergency Department (ED) undertook the mission of clinical reception, primary diagnosis, and interim treatment for the suspected cases of COVID-19.
This article is protected by copyright. All rights reserved.
KEYWORDS:
COVID-19; Emergency department; hospital management; personal protection equipment
17.
Head Neck Pathol. 2020 Mar 2. doi: 10.1007/s12105-019-01121-2. [Epub ahead of print]
Intraoperative Margin Assessment in Head and Neck Cancer: A Case of Misuse and Abuse?
Abstract
Surgical removal with negative margins is the preferred management of oral squamous cell carcinomas. This review summarizes statements by professional organizations and data supporting the specimen-driven approach to margin assessment. Practical aspects of the intraoperative margin assessment, as guided by gross examination, are presented. The most cost- and time-efficient method of intraoperative margin assessment depends on desired margin clearance and likelihood of other adverse histologic factors, such as extranodal extension, perineural invasion, which are likelier in advanced carcinomas. Intraoperative surgeon-pathologist communication can be improved by reporting to surgical team gross distances to all or selected closest margins, before choosing margins for microscopic frozen examination. Case specific mitigation strategies to minimize the negative impact of tumor-bed driven margin assessment or of suboptimal margin revision are proposed. Based on size, shape, histology, size of carcinoma at the margin, and orientation of the additional tissue, margin revision may be judged as adequate (conversion of a positive margin into a negative one), inadequate (positive margin remains positive), or indeterminate. The significance of anatomic subsite based labeling, radial margin sampling from the main resection specimen, and the relationship between the distance to closest margin and local control are highlighted. The modern definition of safe margin would account for other parameters, such as perineural invasion. An updated approach to resolution of frozen versus permanent sampling issues is outlined. Future studies are needed to design and validate risk models that would help to determine for individual patient what represents a safe margin and how to judge the quality of margin revision.
KEYWORDS:
Frozen; Gross examination; Margin; Oral cavity; Squamous cell carcinoma
18.
Head Neck Pathol. 2020 Mar 2. doi: 10.1007/s12105-020-01147-x. [Epub ahead of print]
The Microenvironment of Head and Neck Cancers: Papillomavirus Involvement and Potential Impact of Immunomodulatory Treatments.
Abstract
Cancer progression can be understood as the result of deregulation of tumors' immune microenvironments. Recent studies of the alterations of microenvironments highlight their significant influence on the prognosis of patients with head and neck squamous cell carcinoma (HNSCC). It is necessary to better characterize tumor-infiltrating lymphocytes by focusing, in particular, on the tumor escape mechanisms from immune surveillance. One of the best described tumor immune system evasion mechanisms is the expression of co-stimulation molecules that constitute so-called "immune checkpoints". These molecules regulate the immune response by either activating or inhibiting its effects. The programmed cell death 1 (PD-1) surface protein is an inhibitory co-stimulation molecule that induces exhaustion of activated T-lymphocytes (TLs, T cells) through binding with its ligands, PD-L1 and PD-L2. Half of HNSCCs exhibit PD-L1 expression with higher expression identified in human papillomavirus (HPV) positive tumors. Numerous studies have shown differences between the microenvironments of HPV+ and HPV- cancers. Notably, infiltrations of exhausted CD4+ PD1+ and CD8+ PD1+ T cells are far higher in the microenvironment of HPV+ tumors. The FDA has approved the use of molecules that target PD-1 for the treatment of HNSCC. The first results of clinical trials with anti-PD-1 blockers in HNSCC show improved patient survival, particularly long-term survival without recurrence. However, discordant results were sometimes observed, and improvements in defining cellular predictive markers are necessary. With the development of immunotherapies, pathologists play a role in the selection of patients who are eligible for specific treatments and assessment of their prognosis in greater detail. An automated, quantitative in situ imaging system that integrates both multispectral imaging and automated slide scanning could be developed in pathology laboratories. The evaluation of PD-L1 expression has only been used to stratify the administration of first-line immunotherapy. The validation of these tests and their routine interpretation is essential. No specific recommendation is adopted for HPV+ HNSCC.
KEYWORDS:
HPV; Head and neck cancer; Immune checkpoint; Immunotherapy; PD-1; PD-L1; Papillomavirus
19.
Head Neck Pathol. 2020 Mar 2. doi: 10.1007/s12105-019-01117-y. [Epub ahead of print]
Human Papillomavirus Testing in Head and Neck Squamous Cell Carcinoma in 2020: Where Are We Now and Where Are We Going?
Abstract
High risk human papillomavirus (HPV) has transformed head and neck oncology in the past several decades. Now that we have recognized that HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) is a unique cancer type with distinct clinicopathologic features and favorable prognosis, it has become essential to test patients in routine practice. We have progressed greatly in our knowledge of this disease and gone, over the past two to three decades, from doing testing in highly variable amounts and methods to, now, with the help of national and international guidelines and patient staging requirements, to a situation where almost all patients with OPSCC are getting accurate classification through at least p16 immunohistochemistry. However, we are still struggling with how to accurately test specimens from cervical lymph nodes, and, in particular, on fine needle aspiration. In addition, many patients with non-oropharyngeal SCC are getting clinically unnecessary p16 and/or HPV-specific testing. The trends suggest progressive improvement in practices, but many practical questions still remain. On the horizon are myriad non-tissue-based tests, such as HPV serology and plasma DNA, DNA-based testing of fine needle aspirate fluid, computerized analysis of digitized pathology and radiology images, and machine learning from clinical and pathologic features, that may render pathologists largely obsolete for establishing HPV status for our patients' tumors. This review takes a brief look back in time to where we have been, then characterizes current practices in 2020 and lingering questions, and, finally, looks ahead into the possible future of HPV testing in patients with head and neck SCC.
KEYWORDS:
Classification; Guidelines; Human papillomavirus; In situ hybridization; Squamous cell carcinoma; Testing; p16
20.
World J Surg. 2020 Mar 2. doi: 10.1007/s00268-020-05451-z. [Epub ahead of print]
Authors' Reply: Relevance of Level IIb Neck Dissection in Patients with Head and Neck Squamous Cell Carcinomas.
Hosokawa S1, Mochizuki D2, Takahashi G2,3, Okamura J2,4, Imai A2, Ishikawa R2, Takizawa Y2, Yamatodani T2, Misawa K2, Mineta H2.
21.
J Natl Cancer Inst. 2020 Mar 3. pii: djaa014. doi: 10.1093/jnci/djaa014. [Epub ahead of print]
Trends in late mortality among adolescent and young adult (AYA) cancer survivors.
Abstract
BACKGROUND:
Over the past several decades, treatment of cancer in adolescents and young adults (AYAs) has evolved substantially, leading to steady improvements in estimated five-year survival at diagnosis. However, the impact on late mortality in this population is largely unexamined. We investigated temporal trends in mortality among five-year AYA cancer survivors.
METHODS:
The Surveillance, Epidemiology, and End Results database was used to identify AYAs (age 15-39) diagnosed with cancer during 1975-2011 who survived ≥5 years beyond diagnosis. Survival months were accrued from five years post-diagnosis until death or end of 2016. Cumulative mortality from all causes, the primary cancer, other cancers, and noncancer/nonexternal causes (i.e. excluding accidents, suicide, homicide) were estimated according to diagnosis era.
RESULTS:
Among 282,969 five-year AYA cancer survivors, five-year mortality (i.e. from 5 through 10 years post-diagnosis) from all causes decreased from 8.3% (95% CI: 8.0%-8.6%) among those diagnosed in 1975-1984 to 5.4% (95% CI: 5.3%-5.6%) among those diagnosed in 2005-2011. This was largely explained by decreases in mortality from the primary cancer (6.8% to 4.2%) between these periods. However, for specific cancer types, including colorectal, bone, sarcomas, cervical/uterine, and bladder, cumulative mortality curves demonstrated little improvement in primary cancer-mortality over time. Some reduction in late mortality from noncancer/nonexternal causes was apparent for Hodgkin lymphoma, leukemia, kidney cancer, head and neck cancers, and trachea, lung, and bronchus cancers.
CONCLUSION:
Over the past four decades, all-cause and cancer-specific mortality have decreased among five-year AYA cancer survivors overall, but several cancer types have not shared in these improvements.
© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.
22.
Jpn Dent Sci Rev. 2020 Dec;56(1):62-67. doi: 10.1016/j.jdsr.2020.02.001. Epub 2020 Feb 20.
Oral management strategies for radiotherapy of head and neck cancer.
Abstract
Radiotherapy, often with concomitant chemotherapy, has a significant role in the management of head and neck cancer, however, radiotherapy induces adverse events include oral mucositis, hyposalivation, loss of taste, dental caries, osteoradionecrosis, and trismus, all of which have an impact on patients' quality of life. Therefore, it is necessary to implement oral management strategies prior to the initiation of radiotherapy in patients with head and neck cancer. Since 2014, the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines) have enumerated the "Principles of Dental Evaluation and Management (DENT-A)" in the section on head and neck cancers, however, oral management was not explained in detail. Oral management has not been achieved a consensus protocol. The aim of this literature is to show that oral management strategy include removal infected teeth before the start of radiotherapy to prevent osteoradionecrosis, oral care for preventing severe oral mucositis to support patient complete radiotherapy during radiotherapy, and prevent of dental caries followed by osteoradionecrosis after radiotherapy.
© 2020 The Authors.
KEYWORDS:
Head and neck cancer; Oral management; Radiotherapy
23.
Cell Mol Biol Lett. 2020 Feb 24;25:8. doi: 10.1186/s11658-020-00204-1. eCollection 2020.
GNAS promotes inflammation-related hepatocellular carcinoma progression by promoting STAT3 activation.
Abstract
BACKGROUND:
Hepatocellular carcinoma (HCC) is still the most common cause of cancer-related mortality worldwide and accumulating studies report that HCC is frequently linked to chronic inflammation. G-protein alpha-subunit (GNAS)-activating mutations have recently been reported to form a rare subgroup of inflammatory liver tumors. In this study, we investigated the roles of GNAS in inflammation-related HCC progression and its underlying mechanism.
METHODS:
Lipopolysaccharides (LPS) and diethylnitrosamine were employed to stimulate HCC cells to an induced inflammatory response. qRT-PCR, immunohistochemistry and immunoblotting were performed to detect the expression of GNAS in HCC tissues and cell lines. Expression levels of proinflammatory cytokines were detected by qRT-PCR and ELISA. N6-methyladenosine (m6A) methylation of GNAS mRNA was detected by RNA-binding protein immunoprecipitation (RIP). Transcription factors activation profiling plate array was performed to investigate the underlying mechanism in GNAS promoting interleukin-6 (IL-6) expression in HCC cells. HCC cell invasion was determined by transwell assay in vitro, and tumorigenesis was assessed with a subcutaneous xenograft mouse model of HCC.
RESULTS:
We found that LPS stimulation promotes GNAS expression in HCC cells through increasing m6A methylation of GNAS mRNA. The high expression level of GNAS promotes LPS-induced HCC cell growth and invasion by interacting with signal transducer and activator of transcription 3 (STAT3). Furthermore, GNAS knockdown inhibits LPS induced-IL-6 expression in HCC cells by suppressing STAT3 activation. Moreover, we found that GNAS promotes LPS-induced STAT3 activation in HCC cells through inhibiting long non-coding RNA TPTEP1 interacting with STAT3. In addition, GNAS expression promotes HCC development in mice and is related to poor survival.
CONCLUSIONS:
Our findings for the first time indicate a tumor-promoting role of GNAS in inflammation-related HCC progression and provide a novel potential target for HCC therapy.
© The Author(s) 2020.
KEYWORDS:
G-protein alpha-subunit; Hepatocellular carcinoma; Interleukin-6; Lipopolysaccharides; Signal transducer and activator of transcription 3
24.
Sci Rep. 2020 Mar 2;10(1):3806. doi: 10.1038/s41598-020-60811-y.
Serum sHLA-G: Significant diagnostic biomarker with respect to therapy and immunosuppressive mediators in Head and Neck Squamous Cell Carcinoma.
Abstract
Head & Neck Squamous Cell Carcinoma is one of the highest mortality factors in the world due to the lack of potential biomarker for early detection of disease. There is an urgent need for molecular marker involved in disease progression which remains suppressed normally, required for specificity. HLA-G is highly expressed in cancers and creates immune-suppressive microenvironment. Cancerous cells secrete inflammatory cytokines like IL-10,IFN-γ which increase expression of immunosuppressive molecules, such as HLA-G. We evaluated sHLA-G protein level in serum of 120 HNSCC patients at diagnosis and after therapy and compared with 99 individuals by SPR, ELISA and determined its mRNA level by qRT-PCR. sHLA-G was correlated with serum IL-10 and IFN-γ of the patients. Significant elevated levels of sHLA-G were observed in patients (8.25 ± 1.74 ng/µl) than control (6.45 ± 1.31 ng/µl). Levels were declined in (8.09 ± 1.79 ng/µl to 6.64 ± 1.33 ng/µl) patients in response to therapy. sHLA-G levels with tumor burden (8.16 ± 1.91 to 6.63 ± 1.32 ng/µl), node (8.62 ± 1.45 to 6.66 ± 1.26 ng/µl), PDSCC (8.14 ± 0.62 to 5.65 ± 0.27 ng/µl) and oropharynx (7.90 ± 1.24 to 6.10 ± 1.33 ng/µl) showed a positive and significant response to therapy. Findings indicate that sHLA-G can be a potential diagnostic serum protein marker for HNSCC due to its suppressive function and over expression in diseased condition with the influence of cytokines.
25.
Sci Rep. 2020 Mar 2;10(1):3811. doi: 10.1038/s41598-020-60140-0.
Clustering of Largely Right-Censored Oropharyngeal Head and Neck Cancer Patients for Discriminative Groupings to Improve Outcome Prediction.
Tosado J1, Zdilar L2, Elhalawani H3, Elgohari B3, Vock DM4, Marai GE5, Fuller C3, Mohamed ASR3, Canahuate G2.
Abstract
Clustering is the task of identifying groups of similar subjects according to certain criteria. The AJCC staging system can be thought as a clustering mechanism that groups patients based on their disease stage. This grouping drives prognosis and influences treatment. The goal of this work is to evaluate the efficacy of machine learning algorithms to cluster the patients into discriminative groups to improve prognosis for overall survival (OS) and relapse free survival (RFS) outcomes. We apply clustering over a retrospectively collected data from 644 head and neck cancer patients including both clinical and radiomic features. In order to incorporate outcome information into the clustering process and deal with the large proportion of censored samples, the feature space was scaled using the regression coefficients fitted using a proxy dependent variable, martingale residuals, instead of follow-up time. Two clusters were identified and evaluated using cross validation. The Kaplan Meier (KM) curves between the two clusters differ significantly for OS and RFS (p-value < 0.0001). Moreover, there was a relative predictive improvement when using the cluster label in addition to the clinical features compared to using only clinical features where AUC increased by 5.7% and 13.0% for OS and RFS, respectively.
26.
J Nucl Med. 2020 Mar;61(3):375-396. doi: 10.2967/jnumed.119.240945.
Appropriate Use Criteria for Nuclear Medicine in the Evaluation and Treatment of Differentiated Thyroid Cancer.
Donohoe KJ1, Aloff J2, Avram AM3, Bennet KG3, Giovanella L4, Greenspan B5, Gulec S5, Hassan A5, Kloos RT6, Solórzano CC7, Stack BC Jr8, Tulchinsky M5, Tuttle RM9, Van Nostrand D5, Wexler JA10.
27.
Neoreviews. 2020 Mar;21(3):e213-e216. doi: 10.1542/neo.21-3-e213.
An Infant with Blue Spells During Feeding.
28.
Clin Neurophysiol. 2020 Feb 19. pii: S1388-2457(20)30056-0. doi: 10.1016/j.clinph.2020.02.003. [Epub ahead of print]
Corrigendum to "Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014-2018)" [Clin. Neurophysiol. 131 (2020) 474-528].
Lefaucheur JP1, Aleman A2, Baeken C3, Benninger DH4, Brunelin J5, Di Lazzaro V6, Filipović SR7, Grefkes C8, Hasan A9, Hummel FC10, Jääskeläinen SK11, Langguth B12, Leocani L13, Londero A14, Nardone R15, Nguyen JP16, Nyffeler T17, Oliveira-Maia AJ18, Oliviero A19, Padberg F9, Palm U20, Paulus W21, Poulet E22, Quartarone A23, Rachid F24, Rektorová I25, Rossi S26, Sahlsten H27, Schecklmann M12, Szekely D28, Ziemann U29.
Erratum for
29.
Am J Otolaryngol. 2020 Feb 21:102437. doi: 10.1016/j.amjoto.2020.102437. [Epub ahead of print]
Response to commentary.
30.
Am J Otolaryngol. 2020 Feb 24:102443. doi: 10.1016/j.amjoto.2020.102443. [Epub ahead of print]
Patient safety and the annulment of medical clearance exams for hearing aids: Are we "closing the book" too soon?
Abstract
PURPOSE:
To determine the utility of medical clearance exams by otolaryngologists prior to the distribution of hearing aids to patients with hearing loss.
MATERIAL AND METHODS:
Medical records of 313 consecutive hearing-impaired individuals seeking financial assistance for hearing aids from the Lions Hearing Center of Michigan and who presented for medical clearance exams between January 2014 and May 2017 were retrospectively analyzed. Separate determinations were made for each patient about (1) benefit from the exam and (2) avoidance of significant harm.
RESULTS:
Majority (64.2%; n = 201) of patients benefited from medical clearance exams. Furthermore, 5.4% of patients (n = 17) were found to have avoided significant harm due to administration of the medical clearance exam. Finally, 14.4% (n = 45) were offered alternative interventions over conventional hearing aids.
CONCLUSIONS:
Medical clearance exams are beneficial to a majority of patients with hearing loss prior to receiving hearing aids. With the impending arrival of over-the-counter hearing aids in the United States, special consideration should be placed on educating the general public about the importance of the medical evaluation prior to purchasing any type of hearing aid.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
Federal recommendations; Hearing aids; Medical clearance exam; Patient safety; Regulations
31.
Methods Enzymol. 2020;635:1-20. doi: 10.1016/bs.mie.2019.05.039. Epub 2019 Jul 2.
High-dimensional multiplexed immunohistochemical characterization of immune contexture in human cancers.
Banik G1, Betts CB2, Liudahl SM2, Sivagnanam S2, Kawashima R2, Cotechini T2, Larson W2, Goecks J3, Pai SI4, Clayburgh DR5, Tsujikawa T6, Coussens LM7.
Abstract
Biomarker assessments of tumor specimens is widely used in cancer research to audit tumor cell intrinsic as well as tumor cell extrinsic features including the diversity of immune, stromal, and mesenchymal cells. To comprehensively and quantitatively audit the tumor-immune microenvironment (TiME), we developed a novel multiplex immunohistochemistry (mIHC) platform and computational image processing workflow using a single formalin-fixed paraffin-embedded (FFPE) tissue section. Herein, we validated this platform using nine matched primary newly diagnosed and recurrent head and neck squamous cell carcinoma (HNSCC) sections sequentially subjected to immunodetection with a panel of 29 antibodies identifying malignant tumor cells, and 17 distinct leukocyte lineages and their functional states. Image cytometric analysis was applied to interpret chromogenic signals from digitally scanned and coregistered light microscopy-based images enabling identification and quantification of individual tumor cells, structural features, immune cell phenotypes and their functional state. In agreement with our previous study via a 12-plex imaging mIHC platform, myeloid-inflamed status in newly diagnosed primary tumors associated with significantly short progression free survival, independent of lymphoid-inflamed status. Spatial distribution of tumor and immune cell lineages in TiME was also examined and revealed statistically significant CD8+ T cell exclusion from tumor nests, whereas regulatory T cells and myeloid cells, when present in close proximity to tumor cells, highly associated with rapid cancer recurrence. These findings indicate presence of differential immune-spatial profiles in newly diagnosed and recurrent HNSCC, and establish the robustness of the 29-plex mIHC platform and associated analytics for quantitative analysis of single tissue sections revealing longitudinal TiME changes.
© 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
Cancer immunology; Histopathology; Immunohistochemistry; Multiplex imaging
32.
J Laryngol Otol. 2020 Mar 3:1-4. doi: 10.1017/S0022215120000420. [Epub ahead of print]
Use of the KTP laser in totally endoscopic cholesteatoma surgery.
Abstract
OBJECTIVE:
This paper reviews our experience of potassium titanyl phosphate (KTP) laser in transcanal totally endoscopic cholesteatoma surgery.
METHODS:
A prospective cohort study was conducted in a tertiary referral centre, involving a consecutive series of children with cholesteatoma who underwent totally endoscopic cholesteatoma surgery with a KTP laser.
RESULTS:
The patients' mean age was 10.5 years (range, 1.8-18 years). A KTP laser was used in 70 of the 83 cases (84 per cent). The laser was not used in 13 'clean' cases, in which disease was removed more easily. Residual disease was detected in five cases (6 per cent), of which the KTP laser had been used in four (5 per cent). No complications were associated with KTP laser use.
CONCLUSION:
The combination of KTP laser use with endoscopic visualisation is effective for minimising the risk of residual disease using a minimally invasive surgical approach. The thin, semi-flexible fibre carrier of the KTP laser is ideally suited to work alongside the endoscope within the narrow confines of the ear canal.
KEYWORDS:
Cholesteatoma; Endoscopic Ear Surgery; KTP Lasers
33.
Trials. 2020 Mar 2;21(1):237. doi: 10.1186/s13063-020-4171-0.
Study protocol for a randomized controlled trial: prophylactic swallowing exercises in head-and-neck cancer patients treated with (chemo)radiotherapy (PRESTO trial).
Baudelet M1,2,3, Van den Steen L4,5, Duprez F6,7, De Bodt M4,5,8, Deschuymer S9, Goeleven A10,11, Hutsebaut I12, Mariën S5, Meersschout S12, Nevens D4,13,14, Nuyts S9,15, Peeters M4,14,16, Specenier P4,5,14, Van den Brekel M17,18, van der Molen L17, Vandenbruaene C19, Vanderveken O4,5,14, Van Dinther J20, Van Laer C4,5,14, Vauterin T21, Verstraete H13,14, Van Nuffelen G4,5,8; Member of the Belgian PRESTO Group.
Abstract
BACKGROUND:
Dysphagia is a common and serious complication after (chemo)radiotherapy (CRT) for head-and-neck cancer (HNC) patients. Prophylactic swallowing exercises (PSE) can have a significantly positive effect on post-treatment swallowing function. However, low adherence rates are a key issue in undermining this positive effect. This current randomized trial will investigate the effect of adherence-improving measures on patients' swallowing function, adherence and quality of life (QOL).
METHODS:
This ongoing trial will explore the difference in adherence and swallowing-related outcome variables during and after PSE in HNC patients performing the same therapy schedule, receiving different delivery methods. One hundred and fifty patients treated in various hospitals will be divided into three groups. Group 1 performs PSE at home, group 2 practices at home with continuous counseling through an app and group 3 receives face-to-face therapy by a speech and language pathologist. The exercises consist of tongue-strengthening exercises and chin-tuck against resistance with effortful swallow. The Iowa Oral Performance Instrument and the Swallowing Exercise Aid are used for practicing. Patients are evaluated before, during and after treatment by means of strength measurements, swallowing and QOL questionnaires.
DISCUSSION:
Since low adherence rates undermine the positive impact of PSE on post-treatment swallowing function, there is need to develop an efficient PSE protocol maximizing adherence rates.
TRIAL REGISTRATION:
ISRCTN, ID: ISRCTN98243550. Registered retrospectively on 21 December 2018.
KEYWORDS:
(Chemo)radiotherapy; Adherence; Dysphagia; Head-and-neck cancer; Prophylactic swallowing exercises
34.
Cranio. 2020 Mar 2:1-10. doi: 10.1080/08869634.2020.1724458. [Epub ahead of print]
Botulinum toxin type A for controlling bruxism assessed with computerized occlusal analysis: A pilot study.
Abstract
Objective: To assess botulinum toxin-A (BTX-A) on mandibular movements and bite force (BF%) in bruxism.Methods: Ten bruxers were divided into 2 groups based on BF% imbalance (G1: >10%, G2: <10%). BTX-A 140U was total injected into the masseter and temporalis muscles. A T-Scan® recorded BF%, occlusion time (OT), right, left, and protrusive disclusion time (DT) before administering BTX-A, as well as 15, 45, 90, and 120 days after injection.Results: The Friedman and Wilcoxon tests found significant differences in BF% in G1 subjects at 15 days (p = 0.028 s), OT at 90 (p = 0.043 s), and 120 (p = 0.027 s) days, DTR at 90 (p = 0.046 s) and 120 (p = 0.028 s) days, DTL at 15 (p = 0.043 s) and 90 (p = 0.027 s) days, and DTP 45-90 days (p = 0.043 s).Conclusion: BTX-A induced BF% starting at 15 days post-injection and influenced lateralities later.
KEYWORDS:
Botulinum toxin type A; bruxism; computerized occlusal analysis (T-Scan®); temporal and masseter muscle
35.
Otolaryngol Head Neck Surg. 2020 Mar 3:194599820904055. doi: 10.1177/0194599820904055. [Epub ahead of print]
Surgical Treatment and Outcomes for Sinonasal and Skull Base Phosphaturic Mesenchymal Tumors.
Abstract
OBJECTIVE:
To describe our clinical experience with surgical treatments for sinonasal phosphaturic mesenchymal tumors diagnosed at our institution.
STUDY DESIGN:
Retrospective case series.
SETTING:
Affiliated Sixth People's Hospital, Shanghai Jiao Tong University.
SUBJECTS AND METHODS:
We retrospectively reviewed the medical records of 10 patients diagnosed with phosphaturic mesenchymal tumors associated with tumor-induced osteomalacia between December 2014 and October 2019.
RESULTS:
There were 4 men and 6 women with a disease course of 1 to 19 years. All patients exhibited hypophosphatemia and tumor-induced osteomalacia. The tumor was located in the sinonasal region, frontal bone, and temporal bone in 8 patients, 1 patient, and 1 patient, respectively. Technetium-99m octreotide scintigraphy was used for tumor localization in 4 cases. Six patients underwent endoscopic resection; the remaining 4 underwent unilateral transorbital anterior and posterior ethmoid artery ligation + endoscopic resection, endoscopic resection + skull base repair, internal carotid artery stenting + transcatheter arterial embolization + temporal bone tumor excision + adipose tissue plugging, and endoscopic resection + transfrontal craniotomy (n = 1 each). Two patients had a history of incomplete endoscopic resection. All patients achieved clinical remission and normalized biochemical indices after surgery. Only 1 patient developed recurrence and died of a brain hernia.
CONCLUSIONS:
A diagnosis of sinonasal phosphaturic mesenchymal tumors should be based on a combination of clinical, imaging, and pathological findings. Technetium-99m octreotide scintigraphy helps in locating the tumor. Complete surgical excision guarantees clinical remission, and preoperative transcatheter arterial embolization or feeding artery ligation may reduce intraoperative bleeding in cases of highly vascularized tumors.
KEYWORDS:
feeding artery ligation; hypophosphatemia; osteomalacia; scintigraphy; surgical excision
36.
Otolaryngol Head Neck Surg. 2020 Mar 3:194599820907882. doi: 10.1177/0194599820907882. [Epub ahead of print]
Treatment-Related Changes in Heart Rate Variability in Children with Sleep Apnea.
Abstract
OBJECTIVE:
Heart rate variability (HRV), a noninvasive indicator of autonomic regulation of cardiac rhythm, may represent the physiologic burden of obstructive sleep apnea (OSA). We hypothesized that the treatment-related effects of OSA on HRV in children are causally attributable to the improvement in OSA severity.
STUDY DESIGN:
Secondary analysis of outcomes from the Childhood Adenotonsillectomy Trial (CHAT).
SETTING:
Analysis of database.
SUBJECTS AND METHODS:
Time- and frequency-domain HRV parameters along with polysomnographic (PSG) and demographic variables were obtained from the CHAT study, which compared early adenotonsillectomy (eAT) to watchful waiting (WW) in children with OSA. The relative contributions of PSG variables and covariates to each HRV parameter were quantified. The proportion of changes in HRV parameters causally attributable to changes in OSA severity, measured by the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI), was estimated.
RESULTS:
In total, 404 children aged 5 to 10 years were included. The median (interquartile range) age was 6 (3-9) years. The median body mass index percentile was 82 (53), 195 (48%) children were male, and 147 (36%) were African American. The average heart rate during PSG was the strongest independent predictor of each HRV parameter (P < .001). Although eAT resulted in statistically significant changes in the majority of HRV parameters, these effects were not causally attributable to treatment-related changes in AHI or ODI.
CONCLUSIONS:
The average heart rate strongly modulates HRV in children with OSA. Although eAT results in discernible changes in HRV, it appears to not be causally attributable to specific treatment-related changes in AHI or ODI.
KEYWORDS:
heart rate variability; pediatric obstructive sleep apnea; polysomnography
37.
Otolaryngol Head Neck Surg. 2020 Mar 3:194599820908596. doi: 10.1177/0194599820908596. [Epub ahead of print]
Knowledge Gaps among Patients and Providers in HPV-Related Oropharyngeal Cancer: A Systematic Review.
Abstract
OBJECTIVE:
To describe the level of knowledge of human papillomavirus (HPV) and HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) among the general population and health care providers.
DATA SOURCES:
Systematic search was performed on December 20, 2018, using MEDLINE (1966 to December 2018), EMBASE (1975 to December 2018), Web of Science (1900 to December 2018), and CENTRAL (1996 to December 2018) databases. English-language literature involving human subjects was used, and studies were limited to case series, case-control, cohort, and randomized controlled trial designs.
REVIEW METHODS:
Studies were included if they assessed knowledge of HPV and HPV-associated OPSCC. The primary outcome measure was the knowledge of HPV-associated OPSCC among the general population and with health care providers. Meta-analysis of proportions was attempted using random-effects model. The PRISMA guidelines were used for accuracy of reporting.
RESULTS:
Thirty-two studies were included with 17,288 participants. There was a high degree of heterogeneity preventing completion of a meta-analysis. Knowledge of HPV and HPV-associated OPSCC varied between the general population and health care providers. The proportion of the general population and health care providers with knowledge of HPV ranged from 16% to 75% and 21% to 84%, respectively. Knowledge of HPV-associated OPSCC was greater in health care providers and ranged from 22% to 100% compared with the general population, which ranged from 7% to 57%.
CONCLUSION:
There is a knowledge gap of HPV-associated OPSCC for both the general population and health care providers. Additional education may not only increase awareness but may also result in prevention and earlier detection.
KEYWORDS:
awareness; education; human papillomavirus; oropharyngeal squamous cell carcinoma
38.
Otolaryngol Head Neck Surg. 2020 Mar 3:194599820908202. doi: 10.1177/0194599820908202. [Epub ahead of print]
Cognitive and Quality of Life-Related Burdens of Illness in Pediatric Allergic Airway Disease.
Abstract
OBJECTIVE:
To analyze the prevalence of pediatric allergic airway disease (PAA) and recognize its impact on cognitive function, childhood activities, use of early intervention, and missed school days.
STUDY DESIGN:
Cross-sectional analysis of National Health Interview Survey (NHIS), 2014 to 2017.
SETTING:
US households.
SUBJECTS AND METHODS:
An NHIS survey of US children and responding caregivers was analyzed to determine the prevalence of PAA, including allergic rhinitis and allergic asthma. Associations were determined between the presence of PAA and activities limited by difficulty remembering, limitation in the amount of childhood play, use of special education/early intervention, and number of missed school days in the past 12 months. Multivariate analysis was used to adjust for age, sex, race, ethnicity, and income level.
RESULTS:
An estimated 11.1 million (10.6-11.6 million, 95% confidence interval) children (mean age, 9.9 years; 56.9% male) reported a diagnosis of PAA (15.1% [14.6-15.6%]). Children with PAA missed 4.0 (3.7-4.4) school days per year vs 2.2 (2.1-2.4) days for those without PAA (P < .001, adjusted). PAA was associated with limited daily activities due to difficulty with memory (odds ratio, 1.8 [1.2-2.9]), limitations in childhood play (3.2 [2.2-4.7]), and need for special education/early intervention services (1.6 [1.4-1.8]) after adjusting for age, sex, race, ethnicity, and income level.
CONCLUSION:
PAA is a common condition and is associated with declines in cognitive function and school attendance as well as increased use of special education/early intervention. Given the significant prevalence and burden of illness of PAA, further attention is needed to ensure timely diagnosis and treatment.
KEYWORDS:
functional outcomes; pediatric allergic airway disease; pediatric allergic asthma; pediatric allergic rhinitis; pediatric respiratory atopy
39.
Otolaryngol Head Neck Surg. 2020 Mar 3:194599820910115. doi: 10.1177/0194599820910115. [Epub ahead of print]
Tonsillectomy Outcomes among Children with Mental Health Disorders in the United States.
Abstract
OBJECTIVES:
Recent evidence suggests that children with mental health disorders are more likely to have postoperative complications. Our aim was to determine if mental health disorders affect postoperative complications after tonsillectomy with or without adenoidectomy (T&A).
SETTING:
Cross-sectional analysis of national databases.
SUBJECTS AND METHODS:
The 2006 to 2016 Kids Inpatient Database and the 2014 Nationwide Readmission Database were used to identify children (age <21 years) who underwent T&A. We compared children with mental health disorders (eg, autism, developmental delays, or mood disorders) to those without a mental health disorder. We contrasted gender, race, length of stay, complications, and 30-day readmissions.
RESULTS:
We estimated that 37,386 children underwent T&A, and there were 2138 (5.7%) diagnosed with a mental health disorder. Children with mental health disorders were older (6.0 vs 5.3 years, P < .001), more commonly males (64% vs 58%, P < .001), had a longer length of stay (3.4 days vs 2.3 days, P < .001), and had higher total charges even after controlling for length of stay ($19,000 vs $14,000, P < .001). Children with a mental health disorder were more likely to have a complication (odds ratio [OR] = 2.1; 95% confidence interval [CI], 1.7 to 3.4; P < .001) including intubation, mechanical ventilation, or both (OR = 3.3; 95% CI, 2.6 to 3.8; P < .001). The 30-day all-cause readmission rate was higher (12% vs 4.0%, P < .001).
CONCLUSION:
Children with mental health disorders, especially development delays, have more frequent complications, longer lengths of stay, and readmissions than children without mental health disorders. This information should be included in preoperative counseling.
KEYWORDS:
disparities; mental health; pediatric; tonsillectomy
40.
Otolaryngol Head Neck Surg. 2020 Mar 3:194599820907572. doi: 10.1177/0194599820907572. [Epub ahead of print]
Cochlear Implant Performance in Adult Patients with Absent Intraoperative Electrically Evoked Compound Action Potentials.
Abstract
OBJECTIVE:
To describe cochlear implant performance outcomes in adult patients in whom no intraoperative electrically evoked compound action potential (ECAP) responses were able to be obtained despite intracochlear electrode placement.
STUDY DESIGN:
Retrospective case review.
SETTING:
Academic tertiary center.
SUBJECTS AND METHODS:
Patients 18 years of age and older undergoing cochlear implantation between May 2010 and September 2018 with absent ECAP measurements intraoperatively with intracochlear electrode positioning were identified. Patient performance on sentence recognition testing using the Hearing in Noise Test (HINT) and AzBio at 6 to 12 months postoperatively was compared to preimplantation scores. Additional collected data included patient demographics, etiology of hearing loss, and preoperative pure-tone average (PTA) and word recognition scores (WRSs).
RESULTS:
Intraoperative ECAP measurements were unable to be obtained in 15 cochlear implants performed on 14 patients out of 383 cochlear implant cases. Of the patients with absent ECAP measures, the mean ± SD age was 61.7 ± 15.7 years. Causes of hearing loss included congenital hearing loss, meningitis, autoimmune inner ear disease, otosclerosis, presbycusis, and Ménière's disease. The average preoperative PTA was 103.5 ± 17.0 dB. Twelve implanted ears had a WRS of 0% and 9 had a HINT score of 0% prior to surgery. The mean HINT score at 6 to 12 months postimplantation was 57.8% ± 37.8% and had improved by 42.6% ± 35.6% compared to the mean preimplantation HINT score (95% confidence interval, 22.0%-63.1%, P = .001, paired Student t test).
CONCLUSION:
There is a wide range of cochlear implant performance in patients with absent intraoperative ECAP measures ranging from sound awareness to HINT scores of 100%.
KEYWORDS:
cochlear implant; cochlear implant outcomes; electrically evoked compound action potential; intraoperative monitoring
41.
Otolaryngol Head Neck Surg. 2020 Mar 3:194599820906400. doi: 10.1177/0194599820906400. [Epub ahead of print]
Association Between Body Mass Index and Complications in Acoustic Neuroma Surgery.
Abstract
OBJECTIVES:
Elevated body mass index (BMI) is a risk factor for surgical complications, but data in acoustic neuroma surgery are conflicting and limited to small single-institution studies. This work evaluates associations between BMI and complications in surgery for acoustic neuroma (AN).
STUDY DESIGN:
Retrospective review.
SETTING:
Two tertiary otology referral institutions.
SUBJECTS AND METHODS:
Patients undergoing surgery for AN. Univariate and multivariate analysis of association between BMI and complications was performed using two-tailed t tests and binary logistic regression.
RESULTS:
BMI ranged from 18.0 kg/m2 to 63.9 kg/m2 with mean of 29.2 kg/m2 among 362 included patients. High BMI was associated with increased risk of cerebrospinal fluid (CSF) leak (p = 0.003) and need for revision surgery within 6 months (p = 0.03). CSF leak occurred in 11.6% of obese patients (BMI ≥ 30.0) and 5.1% of patients with BMI < 30.0. There was no association between BMI and post-operative intracranial hemorrhage, wound infection, or incomplete resection (p > 0.05). Multivariate analysis revealed BMI was associated with CSF leak (odds ratio 1.11 per BMI point, p = 0.002) and need for revision surgery (odds ratio 1.07 per BMI point, p = 0.02) independent of age, gender, tumor size, or surgical approach.
CONCLUSIONS:
The largest series to date investigating BMI in acoustic surgery is presented. Elevated BMI is strongly associated with CSF leak and need for revision surgery but not with other complications. Obese or overweight patients undergoing acoustic neuroma resection should be counseled of their increased risk of CSF leak.
KEYWORDS:
BMI; Neurotology; acoustic neuroma; cerebrospinal fluid leak; obesity
42.
Otolaryngol Head Neck Surg. 2020 Mar 3:194599820908860. doi: 10.1177/0194599820908860. [Epub ahead of print]
Variation in the Geographic Distribution of the Otolaryngology Workforce: A National Geospatial Analysis.
Gadkaree SK1,2,3, McCarty JC2,4, Siu J2,5, Shaye DA1, Deschler DG1, Varvares MA1, Jarman M2, Bergmark R2,3.
Abstract
OBJECTIVE:
To examine the current geographic distribution of otolaryngologists in the United States and the disparities in socioeconomic demographics at the county and hospital referral region (HRR) level.
STUDY DESIGN:
Cross-sectional study.
SETTING:
National cohort analysis including all otolaryngologists in the United States.
SUBJECTS AND METHODS:
All otolaryngologists board certified by the American Board of Otolaryngology-Head and Neck Surgery in the United States in 2018 were compared with overlaid demographic data from the 2010 United States Census Bureau by county and HRR. Associations between the density of otolaryngologists per population and socioeconomic characteristics were assessed and stratified by region.
RESULTS:
The average number of otolaryngologists was 3.6 (SD 9.6) per 100,000. On multivariable regression analysis, the density of otolaryngologists was positively associated with counties with the highest quartile of college education (1.8 providers per 100,000 [95% confidence interval [CI] 0.89, 2.90], P < .001) and income (2.1 providers per 100,000 [95% CI 1.03, 3.07], P = .01). Significant regional variation existed in access to otolaryngology care.
CONCLUSION:
There are significant areas with disparate densities of otolaryngologists in the United States. Lower socioeconomic status, more severe poverty, and a lower number of college graduates in a county correlated with reduced density of otolaryngologists.
KEYWORDS:
geographic disparities; geospatial analysis; otolaryngologist
43.
Cancers (Basel). 2020 Mar 1;12(3). pii: E572. doi: 10.3390/cancers12030572.
Development and Validation of a Clinically Relevant Workflow for MR-Guided Volumetric Arc Therapy in a Rabbit Model of Head and Neck Cancer.
Rajab Bolookat E1,2, Malhotra H2,3, Rich LJ1, Sexton S4, Curtin L4, Spernyak JA2,5, Singh AK3, Seshadri M1,2,6.
Abstract
There is increased interest in the use of magnetic resonance imaging (MRI) for guiding radiation therapy (RT) in the clinical setting. In this regard, preclinical studies can play an important role in understanding the added value of MRI in RT planning. In the present study, we developed and validated a clinically relevant integrated workflow for MRI-guided volumetric arc therapy (VMAT) in a VX2 rabbit neck tumor model of HNSCC. In addition to demonstrating safety and feasibility, we examined the therapeutic impact of MR-guided VMAT using a single high dose to obtain proof-of-concept and compared the response to conventional 2D-RT. Contrast-enhanced MRI (CE-MRI) provided excellent soft tissue contrast for accurate tumor segmentation for VMAT. Notably, MRI-guided RT enabled improved tumor targeting ability and minimal dose to organs at risk (OAR) compared to 2D-RT, which resulted in notable morbidity within a few weeks of RT. Our results highlight the value of integrating MRI into the workflow for VMAT for improved delineation of tumor anatomy and optimal treatment planning. The model combined with the multimodal imaging approach can serve as a valuable platform for the conduct of preclinical RT trials.
KEYWORDS:
HNSCC; Image-guided radiation therapy; MRI; VMAT
44.
Nutrients. 2020 Feb 29;12(3). pii: E665. doi: 10.3390/nu12030665.
A Review of Zinc-L-Carnosine and Its Positive Effects on Oral Mucositis, Taste Disorders, and Gastrointestinal Disorders.
Abstract
Zinc-L-carnosine (ZnC), also called polaprezinc known as PepZin GI™, is a chelated compound that contains L-carnosine and zinc. It is a relatively new molecule and has been associated with multiple health benefits. There are several studies that support ZnC's benefits in restoring the gastric lining, healing other parts of the gastrointestinal (GI) tract, improving taste disorders, improving GI disorders, and enhancing skin and liver. Oral mucositis is a common complication of cytotoxic radiotherapy and/or chemotherapy. It occurs in almost every person with head and neck cancer who receive radiotherapy. It is often overlooked because it is not considered life threatening. However, mucositis often leads to a decreased quality of life and cessation of treatment, ultimately decreasing positive outcomes. Therefore, solutions to address it should be considered. The primary mechanisms of action are thought to be localized and related to ZnC's anti-inflammatory and antioxidant functions. Therefore, the purpose of this review is to discuss the research related to ZnC and to explore its benefits, especially in the management of conditions related to damaged epithelial cells, such as oral mucositis. Evidence supports the safety and efficacy of ZnC for the maintenance, prevention, and treatment of the mucosal lining and other epithelial tissues. The research supports its use for gastric ulcers (approved in Japan) and conditions of the upper GI and suggests other applications, particularly for oral mucositis.
KEYWORDS:
carnosine; oral mucositis; taste disorders; zinc
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