Oral cavity cancer management guidelines for low‐resource regions

Abstract

Background

The diagnosis and management of oral cavity cancer has been well described in developed countries, however, in regions with fewer medical resources, alternative methods may need to be used. We outline an approach to evaluation and treatment of oral cavity cancer in low‐resource areas.

Methods

Reviews of the Cochrane and Pubmed databases were performed and literature compiled. Expert opinions from the American and African Head and Neck Societies were also provided.

Results

Treatment guidelines for managing oral cavity cancer in low‐resource regions are outlined and the level of supporting evidence is defined.

Discussion

Successful treatment typically involves the use of upfront surgical resection of the primary lesion and any involved or at‐risk cervical lymph node basins, with adjuvant therapy based on the final pathology findings. In situations where services such as adjuvant therapy and/or appropriate reconstruction are not available, alternative approaches to treatment may be needed.

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Oral cavity cancer management guidelines for low‐resource regions

Abstract

Background

The diagnosis and management of oral cavity cancer has been well described in developed countries, however, in regions with fewer medical resources, alternative methods may need to be used. We outline an approach to evaluation and treatment of oral cavity cancer in low‐resource areas.

Methods

Reviews of the Cochrane and Pubmed databases were performed and literature compiled. Expert opinions from the American and African Head and Neck Societies were also provided.

Results

Treatment guidelines for managing oral cavity cancer in low‐resource regions are outlined and the level of supporting evidence is defined.

Discussion

Successful treatment typically involves the use of upfront surgical resection of the primary lesion and any involved or at‐risk cervical lymph node basins, with adjuvant therapy based on the final pathology findings. In situations where services such as adjuvant therapy and/or appropriate reconstruction are not available, alternative approaches to treatment may be needed.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2MsoMH2

Effect of antiangiogenic targeted chemotherapy on the osseointegration of titanium implants in rabbits

Patients with cancer have recently been treated with more advanced targeted chemotherapies that have greater specificity towards the cancer cells and fewer side effects. However, the periods of treatment take longer than those of traditional cytotoxic treatments. The aim of this study was to examine the effect of antiangiogenic targeted chemotherapy on the osseointegration of titanium implants. Fourteen white New Zealand rabbits were allocated randomly into two groups of seven: the placebo control group and the Avastin ® group. (Source: The British Journal of Oral and Maxillofacial Surgery)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TcrEKN

Effect of antiangiogenic targeted chemotherapy on the osseointegration of titanium implants in rabbits

Patients with cancer have recently been treated with more advanced targeted chemotherapies that have greater specificity towards the cancer cells and fewer side effects. However, the periods of treatment take longer than those of traditional cytotoxic treatments. The aim of this study was to examine the effect of antiangiogenic targeted chemotherapy on the osseointegration of titanium implants. Fourteen white New Zealand rabbits were allocated randomly into two groups of seven: the placebo control group and the Avastin ® group. (Source: The British Journal of Oral and Maxillofacial Surgery)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TcrEKN

Classifying cognitive impairment based on the spatial heterogeneity of cerebral blood flow images

Background

The spatial coefficient of variation (sCoV) of arterial spin‐labeled (ASL) MRI can index cerebral blood flow spatial heterogeneity. This metric reflects delayed blood delivery—seen as a hyperintense ASL signal juxtaposed by hypointense regions.

Purpose

To investigate the use of ASL‐sCoV in the classification of cognitively unimpaired (CU), mild cognitive impairment (MCI), and Alzheimer's disease (AD) cohorts.

Study Type

Prospective/cohort.

Population

Baseline ASL images from AD neuroimaging initiative dataset in three groups of CU, MCI, and AD (N = 258).

Field Strength/Sequence

Pulsed ASL (PICORE QT2) images were acquired on 3 T Siemens systems (TE/TR = 12/3400 msec, TI1/2 = 700/1900 msec).

Assessment

ASL‐sCoV was calculated in temporal, parietal, occipital, and frontal lobes as well as whole gray matter.

Statistical Tests

The primary analysis used an analysis of covariance to investigate sCoV and cognitive group (CU, MCI, AD) associations. We also evaluated the repeatability of sCoV by calculating within‐subject agreement in a subgroup of CU participants with a repeat ASL. The secondary analyses assessed ventricular volume, amyloid burden, glucose uptake, ASL‐sCoV, and regional CBF as cognitive group classifiers using logistic regression models and receiver operating characteristic analyses.

Results

We found that global and temporal lobe sCoV differed between cognitive groups (P = 0.006). Post‐hoc tests showed that temporal lobe sCoV was lower in CU than in MCI (Cohen's d = –0.36) or AD (Cohen's d = –1.36). We found that sCoV was moderately repeatable in CU (intersession intraclass correlation = 0.50; intrasession intraclass correlation = 0.88). Subsequent logistic regression analyses revealed that temporal lobe sCoV and amyloid uptake classified CU vs. MCI (P < 0.01; accuracy = 78%). Temporal lobe sCoV, amyloid, and glucose uptake classified CU vs. AD (P < 0.01; accuracy = 97%); glucose uptake significantly classified MCI vs. AD (P < 0.01; accuracy = 85%).

Data Conclusion

We showed that ASL spatial heterogeneity can be used alongside AD neuroimaging markers to distinguish cognitive groups, in particular, cognitively unimpaired from cognitively impaired individuals.

Level of Evidence: 2

Technical Efficacy: Stage 3

J. Magn. Reson. Imaging 2019.

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Resonate: Reflections and recommendations on implicit biases within the ISMRM

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2MlzHSC

Classifying cognitive impairment based on the spatial heterogeneity of cerebral blood flow images

Background

The spatial coefficient of variation (sCoV) of arterial spin‐labeled (ASL) MRI can index cerebral blood flow spatial heterogeneity. This metric reflects delayed blood delivery—seen as a hyperintense ASL signal juxtaposed by hypointense regions.

Purpose

To investigate the use of ASL‐sCoV in the classification of cognitively unimpaired (CU), mild cognitive impairment (MCI), and Alzheimer's disease (AD) cohorts.

Study Type

Prospective/cohort.

Population

Baseline ASL images from AD neuroimaging initiative dataset in three groups of CU, MCI, and AD (N = 258).

Field Strength/Sequence

Pulsed ASL (PICORE QT2) images were acquired on 3 T Siemens systems (TE/TR = 12/3400 msec, TI1/2 = 700/1900 msec).

Assessment

ASL‐sCoV was calculated in temporal, parietal, occipital, and frontal lobes as well as whole gray matter.

Statistical Tests

The primary analysis used an analysis of covariance to investigate sCoV and cognitive group (CU, MCI, AD) associations. We also evaluated the repeatability of sCoV by calculating within‐subject agreement in a subgroup of CU participants with a repeat ASL. The secondary analyses assessed ventricular volume, amyloid burden, glucose uptake, ASL‐sCoV, and regional CBF as cognitive group classifiers using logistic regression models and receiver operating characteristic analyses.

Results

We found that global and temporal lobe sCoV differed between cognitive groups (P = 0.006). Post‐hoc tests showed that temporal lobe sCoV was lower in CU than in MCI (Cohen's d = –0.36) or AD (Cohen's d = –1.36). We found that sCoV was moderately repeatable in CU (intersession intraclass correlation = 0.50; intrasession intraclass correlation = 0.88). Subsequent logistic regression analyses revealed that temporal lobe sCoV and amyloid uptake classified CU vs. MCI (P < 0.01; accuracy = 78%). Temporal lobe sCoV, amyloid, and glucose uptake classified CU vs. AD (P < 0.01; accuracy = 97%); glucose uptake significantly classified MCI vs. AD (P < 0.01; accuracy = 85%).

Data Conclusion

We showed that ASL spatial heterogeneity can be used alongside AD neuroimaging markers to distinguish cognitive groups, in particular, cognitively unimpaired from cognitively impaired individuals.

Level of Evidence: 2

Technical Efficacy: Stage 3

J. Magn. Reson. Imaging 2019.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sEnD5S

Resonate: Reflections and recommendations on implicit biases within the ISMRM

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Altered subsets and activities of B lymphocytes in polycystic ovary syndrome

We firstly demonstrate that CD19+ B cells play a critical role in the development of polycystic ovary syndrome (PCOS) and suggest that CD19+ B cells may be a potential therapeutic target for PCOS. (Source: Journal of Allergy and Clinical Immunology)

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Dilute bleach baths used for treatment of atopic dermatitis are not antimicrobial in vitro

Soaking in a dilute solution of household bleach (.005%) is not an effective antibacterial treatment despite its common use to suppress S. aureus colonization on the skin of patients with atopic dermatitis. (Source: Journal of Allergy and Clinical Immunology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2WbwHg7

Altered subsets and activities of B lymphocytes in polycystic ovary syndrome

We firstly demonstrate that CD19+ B cells play a critical role in the development of polycystic ovary syndrome (PCOS) and suggest that CD19+ B cells may be a potential therapeutic target for PCOS. (Source: Journal of Allergy and Clinical Immunology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2R2w6tu

Dilute bleach baths used for treatment of atopic dermatitis are not antimicrobial in vitro

Soaking in a dilute solution of household bleach (.005%) is not an effective antibacterial treatment despite its common use to suppress S. aureus colonization on the skin of patients with atopic dermatitis. (Source: Journal of Allergy and Clinical Immunology)

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A Philosophical Primer for Your First Global Anesthesia Experience

Abstract

Purpose of Review

There are few publications regarding practical important philosophical considerations to international anesthesia work. Most of the literature in this realm is aimed at trainees or are logistical recommendations.

Recent Findings

Clarity of mission can provide guidance and benchmarks for managing challenging situations that may unduly influence the overall experience of a global health trip. Much of that clarity can come from authentic exchanges with your colleagues from the under-resourced region in question.

Summary

We intend to provide a framework and some core principles for organizing thoughts and interactions before, during, and after your first global anesthesia experience.

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A Philosophical Primer for Your First Global Anesthesia Experience

Abstract

Purpose of Review

There are few publications regarding practical important philosophical considerations to international anesthesia work. Most of the literature in this realm is aimed at trainees or are logistical recommendations.

Recent Findings

Clarity of mission can provide guidance and benchmarks for managing challenging situations that may unduly influence the overall experience of a global health trip. Much of that clarity can come from authentic exchanges with your colleagues from the under-resourced region in question.

Summary

We intend to provide a framework and some core principles for organizing thoughts and interactions before, during, and after your first global anesthesia experience.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RYAvCo

Dilute bleach baths used for treatment of atopic dermatitis are not antimicrobial in vitro

Soaking in a dilute solution of household bleach (.005%) is not an effective antibacterial treatment despite its common use to suppress S. aureus colonization on the skin of patients with atopic dermatitis.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2T6w2Lc

Altered subsets and activities of B lymphocytes in polycystic ovary syndrome

We firstly demonstrate that CD19+ B cells play a critical role in the development of polycystic ovary syndrome (PCOS) and suggest that CD19+ B cells may be a potential therapeutic target for PCOS.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AVqnka

Dilute bleach baths used for treatment of atopic dermatitis are not antimicrobial in vitro

Soaking in a dilute solution of household bleach (.005%) is not an effective antibacterial treatment despite its common use to suppress S. aureus colonization on the skin of patients with atopic dermatitis.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2T6w2Lc

Altered subsets and activities of B lymphocytes in polycystic ovary syndrome

We firstly demonstrate that CD19+ B cells play a critical role in the development of polycystic ovary syndrome (PCOS) and suggest that CD19+ B cells may be a potential therapeutic target for PCOS.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AVqnka

Mechanism Study on Photocatalytic Inactivation for Salmonella typhimurium Bacteria by CuxO loaded Rhodium-Antimony co-doped TiO2 Nanorod

Photochem. Photobiol. Sci., 2019, Accepted Manuscript
DOI: 10.1039/C8PP00460A, Paper

Love Kumar Dhandole, Young-Seok Seo, Su-Gyeong Kim, Aerin Kim, Min Cho, Jum Suk Jang
This study presents the first report on the photocatalytic inactivation mechanism for Salmonella typhimurium pathogen by visible-light active Cu_xO loaded rhodium-antimony co-doped TiO₂ nanorod (Cu_xO/Rh-Sb-TiO₂ NR) under visible light irradiation...
The content of this RSS Feed (c) The Royal Society of Chemistry

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Mechanism Study on Photocatalytic Inactivation for Salmonella typhimurium Bacteria by CuxO loaded Rhodium-Antimony co-doped TiO2 Nanorod

Photochem. Photobiol. Sci., 2019, Accepted Manuscript
DOI: 10.1039/C8PP00460A, Paper

Love Kumar Dhandole, Young-Seok Seo, Su-Gyeong Kim, Aerin Kim, Min Cho, Jum Suk Jang
This study presents the first report on the photocatalytic inactivation mechanism for Salmonella typhimurium pathogen by visible-light active Cu_xO loaded rhodium-antimony co-doped TiO₂ nanorod (Cu_xO/Rh-Sb-TiO₂ NR) under visible light irradiation...
The content of this RSS Feed (c) The Royal Society of Chemistry

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Maxillary osteotomy complications in piezoelectric surgery compared to conventional surgical techniques: a systematic review

A systematic review was conducted to investigate the available evidence on maxillary complications related to piezoelectric and conventional surgery. Seven databases were searched. A total of 996 maxillary osteotomies were analysed, 864 performed with conventional tools and 132 with a piezoelectric device. One hundred and fifty-six complication events were reported. The complications, in descending order of overall prevalence, were as follows: neurosensory disturbance (64.7%), haemorrhage (8.3%), oroantral communication (7.7%), soft tissue injury (7.7%), tooth injury (5.1%), infection (3.2%), osteonecrosis (1.9%), and permanent nerve injury (1.3%).

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Maxillary osteotomy complications in piezoelectric surgery compared to conventional surgical techniques: a systematic review

A systematic review was conducted to investigate the available evidence on maxillary complications related to piezoelectric and conventional surgery. Seven databases were searched. A total of 996 maxillary osteotomies were analysed, 864 performed with conventional tools and 132 with a piezoelectric device. One hundred and fifty-six complication events were reported. The complications, in descending order of overall prevalence, were as follows: neurosensory disturbance (64.7%), haemorrhage (8.3%), oroantral communication (7.7%), soft tissue injury (7.7%), tooth injury (5.1%), infection (3.2%), osteonecrosis (1.9%), and permanent nerve injury (1.3%).

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2T4PJTC

Effect of antiangiogenic targeted chemotherapy on the osseointegration of titanium implants in rabbits

Patients with cancer have recently been treated with more advanced targeted chemotherapies that have greater specificity towards the cancer cells and fewer side effects. However, the periods of treatment take longer than those of traditional cytotoxic treatments. The aim of this study was to examine the effect of antiangiogenic targeted chemotherapy on the osseointegration of titanium implants. Fourteen white New Zealand rabbits were allocated randomly into two groups of seven: the placebo control group and the Avastin® group.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2R5zrYE

Effect of antiangiogenic targeted chemotherapy on the osseointegration of titanium implants in rabbits

Patients with cancer have recently been treated with more advanced targeted chemotherapies that have greater specificity towards the cancer cells and fewer side effects. However, the periods of treatment take longer than those of traditional cytotoxic treatments. The aim of this study was to examine the effect of antiangiogenic targeted chemotherapy on the osseointegration of titanium implants. Fourteen white New Zealand rabbits were allocated randomly into two groups of seven: the placebo control group and the Avastin® group.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2R5zrYE

Malignant paraganglioma presenting as a mandibular metastasis

Abstract

Background

Metastatic paragangliomas are rare neuroendocrine tumors. Bony metastases most commonly occur in the ribs, vertebrae, and pelvis. Few cases of mandibular metastases have been reported.

Methods

A 75‐year‐old female presented with a 6‐month history of an enlarging mandibular mass. A biopsy was consistent with a paraganglioma.

Results

Staging workup with ¹⁸F‐fluorodeoxyglucose positron emission tomography demonstrated 2 hypermetabolic intra‐abdominal lesions adjacent to the inferior vena cava. These were confirmed as paraganglioma by biopsy and presumed as the primary lesions. The patient underwent left segmental mandibulectomy and neck dissection with osteocutaneous fibula free tissue reconstruction.

Conclusion

A rare case of malignant paraganglioma presenting as a mandibular metastasis is described. Nuclear medicine studies for paraganglioma are reviewed.

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Primary vs secondary zygomatic implant placement in patients with head and neck cancer—A 10‐year prospective study

Abstract

Background

Zygomatic implants can provide excellent remote anchorage to support the prosthetic rehabilitation of patients treated for maxillary and midfacial tumors.

Methods

Patients who underwent zygomatic implant placement by the author between 2006 and 2016 as part of their oncology treatment were followed prospectively.

Results

Forty‐nine consecutively treated patients received 131 zygomatic implants of which 9 failed and were removed from 4 patients; 24 patients (49%) received radiotherapy either before or after implant insertion. The overall 12‐month survival estimate was 94% and the 60‐month estimate was 92%.

Conclusions

The use of zygomatic implants in the management of maxillary and midfacial malignancy is a predictable prosthetic treatment modality to support complex oral and facial prostheses. Their use with or without free tissue transfer can provide effective prosthetic rehabilitation with high implant survival irrespective of the timing of placement or the need for adjuvant radiotherapy.

Clinical Significance

Zygomatic Implants provide an excellent platform for the restoration of the dentition and facial structures affected by maxillary and midfacial malignant disease.

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Protocol driven outcomes in renal parathyroid surgery

Abstract

Background

Patients who require surgery for renal hyperparathyroidism represent a special population that is at high risk for postoperative complications. To optimize their treatment, we developed a multidisciplinary approach to the perioperative management of these patients undergoing parathyroidectomy.

Methods

The Augusta University endocrine surgery parathyroid database was interrogated to identify dialysis‐dependent patients undergoing parathyroidectomy from 2005 to 2015. Numerous clinical parameters were quantified. Patients were stratified into protocol patients and nonprotocol patients.

Results

A total of 42 patients undergoing renal parathyroidectomy who met the inclusion criteria were identified. Serious adverse events were nearly twice as common in the patients not treated on protocol. The length of stay was nearly 2 days shorter in the protocol group. Lowest calcium level and ionized calcium was higher in the protocol cohort despite a lower postoperative parathyroid hormone. The protocol group had fewer laboratory draws.

Conclusion

Implementation of a multidisciplinary renal hyperparathyroidism protocol has resulted in improved perioperative outcomes.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Dq0BG2

Malignant paraganglioma presenting as a mandibular metastasis

Abstract

Background

Metastatic paragangliomas are rare neuroendocrine tumors. Bony metastases most commonly occur in the ribs, vertebrae, and pelvis. Few cases of mandibular metastases have been reported.

Methods

A 75‐year‐old female presented with a 6‐month history of an enlarging mandibular mass. A biopsy was consistent with a paraganglioma.

Results

Staging workup with ¹⁸F‐fluorodeoxyglucose positron emission tomography demonstrated 2 hypermetabolic intra‐abdominal lesions adjacent to the inferior vena cava. These were confirmed as paraganglioma by biopsy and presumed as the primary lesions. The patient underwent left segmental mandibulectomy and neck dissection with osteocutaneous fibula free tissue reconstruction.

Conclusion

A rare case of malignant paraganglioma presenting as a mandibular metastasis is described. Nuclear medicine studies for paraganglioma are reviewed.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Dp8dsl

Primary vs secondary zygomatic implant placement in patients with head and neck cancer—A 10‐year prospective study

Abstract

Background

Zygomatic implants can provide excellent remote anchorage to support the prosthetic rehabilitation of patients treated for maxillary and midfacial tumors.

Methods

Patients who underwent zygomatic implant placement by the author between 2006 and 2016 as part of their oncology treatment were followed prospectively.

Results

Forty‐nine consecutively treated patients received 131 zygomatic implants of which 9 failed and were removed from 4 patients; 24 patients (49%) received radiotherapy either before or after implant insertion. The overall 12‐month survival estimate was 94% and the 60‐month estimate was 92%.

Conclusions

The use of zygomatic implants in the management of maxillary and midfacial malignancy is a predictable prosthetic treatment modality to support complex oral and facial prostheses. Their use with or without free tissue transfer can provide effective prosthetic rehabilitation with high implant survival irrespective of the timing of placement or the need for adjuvant radiotherapy.

Clinical Significance

Zygomatic Implants provide an excellent platform for the restoration of the dentition and facial structures affected by maxillary and midfacial malignant disease.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2U8zi8H

Protocol driven outcomes in renal parathyroid surgery

Abstract

Background

Patients who require surgery for renal hyperparathyroidism represent a special population that is at high risk for postoperative complications. To optimize their treatment, we developed a multidisciplinary approach to the perioperative management of these patients undergoing parathyroidectomy.

Methods

The Augusta University endocrine surgery parathyroid database was interrogated to identify dialysis‐dependent patients undergoing parathyroidectomy from 2005 to 2015. Numerous clinical parameters were quantified. Patients were stratified into protocol patients and nonprotocol patients.

Results

A total of 42 patients undergoing renal parathyroidectomy who met the inclusion criteria were identified. Serious adverse events were nearly twice as common in the patients not treated on protocol. The length of stay was nearly 2 days shorter in the protocol group. Lowest calcium level and ionized calcium was higher in the protocol cohort despite a lower postoperative parathyroid hormone. The protocol group had fewer laboratory draws.

Conclusion

Implementation of a multidisciplinary renal hyperparathyroidism protocol has resulted in improved perioperative outcomes.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Dq0BG2

World Workshop on Oral Medicine VII: Biomarkers predicting lymphoma in the salivary glands of patients with Sjögren's syndrome. A systematic review

Abstract

Objective

To conduct a systematic review of studies exploring potential biomarkers for development, course and efficacy of treatment of lymphomas in salivary glands of patients with Sjögren's syndrome.

Material and Methods

Eligible studies were identified through a comprehensive search of two databases, i.e. PubMed and EMBASE. Quality of included articles was assessed with the 'Quality In Prognosis Studies' (QUIPS) tool. The 'CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies' (CHARMS) was used to facilitate data extraction.

Results

Fifty‐eight studies met the inclusion criteria. Only one study assessed the progression of lymphoma. Moderate risk of bias was detected in 'outcome measurement', 'study participation' and 'study confounding' domains. Parotid gland enlargement, mixed monoclonal cryoglobulins and low C4 levels represented strongest predictors of lymphoma development. The role of histological biomarkers, and specifically germinal centers, remains controversial. Clinical and methodological heterogeneity across studies precluded conduct of a meta‐analysis.

Conclusions

Specific biomarkers in combination with clinical manifestations represent potential candidates for advancing precision medicine approaches to lymphoma prediction in patients with Sjögren's syndrome. Current focus has increasingly been on genetic and epigenetic markers as candidate predictors. Predictive accuracy of key biomarker candidates remains to be tested in well‐designed prospectively‐followed Sjögren's syndrome cohorts.

This article is protected by copyright. All rights reserved.

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World Workshop on Oral Medicine VII: Biomarkers predicting lymphoma in the salivary glands of patients with Sjögren's syndrome. A systematic review

Abstract

Objective

To conduct a systematic review of studies exploring potential biomarkers for development, course and efficacy of treatment of lymphomas in salivary glands of patients with Sjögren's syndrome.

Material and Methods

Eligible studies were identified through a comprehensive search of two databases, i.e. PubMed and EMBASE. Quality of included articles was assessed with the 'Quality In Prognosis Studies' (QUIPS) tool. The 'CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies' (CHARMS) was used to facilitate data extraction.

Results

Fifty‐eight studies met the inclusion criteria. Only one study assessed the progression of lymphoma. Moderate risk of bias was detected in 'outcome measurement', 'study participation' and 'study confounding' domains. Parotid gland enlargement, mixed monoclonal cryoglobulins and low C4 levels represented strongest predictors of lymphoma development. The role of histological biomarkers, and specifically germinal centers, remains controversial. Clinical and methodological heterogeneity across studies precluded conduct of a meta‐analysis.

Conclusions

Specific biomarkers in combination with clinical manifestations represent potential candidates for advancing precision medicine approaches to lymphoma prediction in patients with Sjögren's syndrome. Current focus has increasingly been on genetic and epigenetic markers as candidate predictors. Predictive accuracy of key biomarker candidates remains to be tested in well‐designed prospectively‐followed Sjögren's syndrome cohorts.

This article is protected by copyright. All rights reserved.

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Post-contrast T1-weighted spine 3T MRI in children using a golden-angle radial acquisition

Abstract

Purpose

MRI methods that have reduced sensitivity to motion are attractive in pediatric applications. In spine imaging, physiologic motion such as respiration and cerebrospinal fluid pulsation can hamper diagnostic image quality. We compare a 3D T1-weighted non-Cartesian radial acquisition with a conventional Cartesian 2D turbo-spin-echo (TSE) acquisition in axial post-contrast spine imaging at 3T.

Methods

Thirty-two patients (mean age 12.2 ± 5.3 years) scheduled for routine clinical spine exams with contrast were enrolled. Three pediatric neuroradiologists compared the two sequences and assessed the presence of motion, the conspicuity of nerve roots, and whether one of the sequences was preferred in visualizing pathology using Likert scales.

Results

The Fleiss' kappa statistic for inter-rater agreement was 0.29 (95% confidence interval, 0.15–0.43) for the presence of motion, 0.30 (0.21–0.38) for conspicuity, and 0.37 (0.19–0.55) for sequence preference. Radial images were less sensitive to motion than TSE (p < 0.01). Motion and consequent artifacts were present in all TSE cases, while it was absent in 51% of the radial cases. In depicting nerve roots, radial images were superior in the cervical (p < 0.05), thoracic (p < 0.01), and lumbar spines (p < 0.01). Lastly, in 28 of the 32 patients who demonstrated contrast-enhancing pathology, radial images were preferred in 51% of the cases, while both sequences were equally preferred in 41% of the cases.

Conclusion

We demonstrate the potential utility of radial MRI in post-contrast spine imaging. The free-breathing method is robust in generating diagnostic image quality and is superior in visualizing nerve roots and extramedullary metastases than traditional Cartesian TSE acquisitions.

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Amide proton transfer-weighted MRI in distinguishing high- and low-grade gliomas: a systematic review and meta-analysis

Abstract

Purpose

Grading of brain gliomas is of clinical importance, and noninvasive molecular imaging may help differentiate low- and high-grade gliomas. We aimed to evaluate the diagnostic performance of amide proton transfer-weighted (APTw) MRI for differentiating low- and high-grade gliomas on 3-T scanners.

Methods

A systematic literature search of Ovid-MEDLINE and EMBASE was performed up to March 28, 2018. Original articles evaluating the diagnostic performance of APTw MRI for differentiating low- and high-grade gliomas were selected. The pooled sensitivity and specificity were calculated using a bivariate random-effects model. A coupled forest plot and a hierarchical summary receiver operating characteristic curve were obtained. Heterogeneity was investigated using Higgins inconsistency index (I²) test. Meta-regression was performed.

Results

Ten original articles with a total of 353 patients were included. High-grade gliomas showed significantly higher APT signal intensity than low-grade gliomas. The pooled sensitivity and specificity for the diagnostic performance of APTw MRI for differentiating low-grade and high-grade gliomas were 88% (95% CI, 77–94%) and 91% (95% CI, 82–96%), respectively. Higgins I² statistic demonstrated heterogeneity in the sensitivity (I² = 68.17%), whereas no heterogeneity was noted in the specificity (I² = 44.84%). In meta-regression, RF saturation power was associated with study heterogeneity. Correlation coefficients between APT signal intensity and Ki-67 cellular proliferation index ranged from 0.430 to 0.597, indicating moderate correlation. All studies showed excellent interobserver agreement.

Conclusions

Although heterogeneous protocols were used, APTw MRI demonstrated excellent diagnostic performance for differentiating low- and high-grade gliomas. APTw MRI could be a reliable technique for glioma grading in clinical practice.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FGvEA1

Post-contrast T1-weighted spine 3T MRI in children using a golden-angle radial acquisition

Abstract

Purpose

MRI methods that have reduced sensitivity to motion are attractive in pediatric applications. In spine imaging, physiologic motion such as respiration and cerebrospinal fluid pulsation can hamper diagnostic image quality. We compare a 3D T1-weighted non-Cartesian radial acquisition with a conventional Cartesian 2D turbo-spin-echo (TSE) acquisition in axial post-contrast spine imaging at 3T.

Methods

Thirty-two patients (mean age 12.2 ± 5.3 years) scheduled for routine clinical spine exams with contrast were enrolled. Three pediatric neuroradiologists compared the two sequences and assessed the presence of motion, the conspicuity of nerve roots, and whether one of the sequences was preferred in visualizing pathology using Likert scales.

Results

The Fleiss' kappa statistic for inter-rater agreement was 0.29 (95% confidence interval, 0.15–0.43) for the presence of motion, 0.30 (0.21–0.38) for conspicuity, and 0.37 (0.19–0.55) for sequence preference. Radial images were less sensitive to motion than TSE (p < 0.01). Motion and consequent artifacts were present in all TSE cases, while it was absent in 51% of the radial cases. In depicting nerve roots, radial images were superior in the cervical (p < 0.05), thoracic (p < 0.01), and lumbar spines (p < 0.01). Lastly, in 28 of the 32 patients who demonstrated contrast-enhancing pathology, radial images were preferred in 51% of the cases, while both sequences were equally preferred in 41% of the cases.

Conclusion

We demonstrate the potential utility of radial MRI in post-contrast spine imaging. The free-breathing method is robust in generating diagnostic image quality and is superior in visualizing nerve roots and extramedullary metastases than traditional Cartesian TSE acquisitions.

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Amide proton transfer-weighted MRI in distinguishing high- and low-grade gliomas: a systematic review and meta-analysis

Abstract

Purpose

Grading of brain gliomas is of clinical importance, and noninvasive molecular imaging may help differentiate low- and high-grade gliomas. We aimed to evaluate the diagnostic performance of amide proton transfer-weighted (APTw) MRI for differentiating low- and high-grade gliomas on 3-T scanners.

Methods

A systematic literature search of Ovid-MEDLINE and EMBASE was performed up to March 28, 2018. Original articles evaluating the diagnostic performance of APTw MRI for differentiating low- and high-grade gliomas were selected. The pooled sensitivity and specificity were calculated using a bivariate random-effects model. A coupled forest plot and a hierarchical summary receiver operating characteristic curve were obtained. Heterogeneity was investigated using Higgins inconsistency index (I²) test. Meta-regression was performed.

Results

Ten original articles with a total of 353 patients were included. High-grade gliomas showed significantly higher APT signal intensity than low-grade gliomas. The pooled sensitivity and specificity for the diagnostic performance of APTw MRI for differentiating low-grade and high-grade gliomas were 88% (95% CI, 77–94%) and 91% (95% CI, 82–96%), respectively. Higgins I² statistic demonstrated heterogeneity in the sensitivity (I² = 68.17%), whereas no heterogeneity was noted in the specificity (I² = 44.84%). In meta-regression, RF saturation power was associated with study heterogeneity. Correlation coefficients between APT signal intensity and Ki-67 cellular proliferation index ranged from 0.430 to 0.597, indicating moderate correlation. All studies showed excellent interobserver agreement.

Conclusions

Although heterogeneous protocols were used, APTw MRI demonstrated excellent diagnostic performance for differentiating low- and high-grade gliomas. APTw MRI could be a reliable technique for glioma grading in clinical practice.

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Comparison of diagnostic accuracy for fistulae at ultrasound and voiding cystourethrogram in neonates with anorectal malformation

Abstract

Background

Recently, it has been reported that anorectal malformation with rectourethral fistula in male neonates can be managed by primary neonatal reconstruction without colostomy. To prevent urethral injury during anorectoplasty, the fistula's location is important. To date, the use of voiding cystourethrograms to determine the presence and location of fistulas in neonates with anorectal malformations has not been studied.

Objective

To compare the accuracy of ultrasound (US) and voiding cystourethrogram for determining the presence and location of fistulas in neonates with anorectal malformation.

Materials and methods

We included 21 male neonates with anorectal malformation with rectourethral fistula (n=16), rectovesical fistula (n=1) or no fistula (n=4) who underwent US and voiding cystourethrogram preoperatively on the day of surgery. Fistula imaging was classified into three grades (0–2), and grades 1–2 were considered fistula positive. We compared the imaging-based location of the fistula with surgical findings.

Results

US performed significantly better than voiding cystourethrogram for determining the presence of fistulas (area under the receiver operating characteristic curve, 0.90 vs. 0.71, respectively; P=0.044) (diagnostic accuracy 85.7%, 95% confidence interval [95% CI] 63.7–97.0% and 52.4%, 95% CI 29.8–74.3%, respectively). In cases with fistulas detected by either modality, the accuracy of locating the fistula by US was 50.0% (95% CI 24.7–75.3%) and by voiding cystourethrogram was 100% (95% CI: 59.0–100%).

Conclusion

US accurately detected, but did not accurately locate, fistulas in neonates with anorectal malformation. When planning primary neonatal reconstruction of anorectal malformation without colostomy, voiding cystourethrogram could provide additional information about fistula location.

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Comparison of diagnostic accuracy for fistulae at ultrasound and voiding cystourethrogram in neonates with anorectal malformation

Abstract

Background

Recently, it has been reported that anorectal malformation with rectourethral fistula in male neonates can be managed by primary neonatal reconstruction without colostomy. To prevent urethral injury during anorectoplasty, the fistula's location is important. To date, the use of voiding cystourethrograms to determine the presence and location of fistulas in neonates with anorectal malformations has not been studied.

Objective

To compare the accuracy of ultrasound (US) and voiding cystourethrogram for determining the presence and location of fistulas in neonates with anorectal malformation.

Materials and methods

We included 21 male neonates with anorectal malformation with rectourethral fistula (n=16), rectovesical fistula (n=1) or no fistula (n=4) who underwent US and voiding cystourethrogram preoperatively on the day of surgery. Fistula imaging was classified into three grades (0–2), and grades 1–2 were considered fistula positive. We compared the imaging-based location of the fistula with surgical findings.

Results

US performed significantly better than voiding cystourethrogram for determining the presence of fistulas (area under the receiver operating characteristic curve, 0.90 vs. 0.71, respectively; P=0.044) (diagnostic accuracy 85.7%, 95% confidence interval [95% CI] 63.7–97.0% and 52.4%, 95% CI 29.8–74.3%, respectively). In cases with fistulas detected by either modality, the accuracy of locating the fistula by US was 50.0% (95% CI 24.7–75.3%) and by voiding cystourethrogram was 100% (95% CI: 59.0–100%).

Conclusion

US accurately detected, but did not accurately locate, fistulas in neonates with anorectal malformation. When planning primary neonatal reconstruction of anorectal malformation without colostomy, voiding cystourethrogram could provide additional information about fistula location.

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Outcomes of salvage surgery for the oropharynx and larynx: a contemporary experience in a UK Cancer Centre

Abstract

Introduction

The purpose of this study was to review our recent experience of salvage surgery, comparing larynx and oropharynx recurrence patterns.

Methods

A single centre, retrospective review of salvage surgery for recurrent head and neck cancer including patients between 2008 and 2016.

Results

61 patients were identified, 36 underwent salvage laryngectomy and 25 received oropharyngeal resections. The median overall survival of oropharyngeal recurrent tumors was 26 months (95% CI 15–118 months) and for laryngeal tumors was 23 months (95% CI 11–38 months), p = 0.1008. There was a significant overall survival benefit in patients with negative resection margin. The median survival in the negative margin group was 38 months (95% CI 25–108 months) compared to the positive margin group, 9 months (95% CI 5–15 months), p < 0.0001.

Conclusion

Survival results following surgical salvage in the larynx and oropharynx appear to be similarly poor. Those patients with clear margins appear to have a significantly better prognosis.

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Outcomes of salvage surgery for the oropharynx and larynx: a contemporary experience in a UK Cancer Centre

Abstract

Introduction

The purpose of this study was to review our recent experience of salvage surgery, comparing larynx and oropharynx recurrence patterns.

Methods

A single centre, retrospective review of salvage surgery for recurrent head and neck cancer including patients between 2008 and 2016.

Results

61 patients were identified, 36 underwent salvage laryngectomy and 25 received oropharyngeal resections. The median overall survival of oropharyngeal recurrent tumors was 26 months (95% CI 15–118 months) and for laryngeal tumors was 23 months (95% CI 11–38 months), p = 0.1008. There was a significant overall survival benefit in patients with negative resection margin. The median survival in the negative margin group was 38 months (95% CI 25–108 months) compared to the positive margin group, 9 months (95% CI 5–15 months), p < 0.0001.

Conclusion

Survival results following surgical salvage in the larynx and oropharynx appear to be similarly poor. Those patients with clear margins appear to have a significantly better prognosis.

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The role of monocytes and macrophages in the dynamic permeability of the blood-perilymph barrier

Publication date: Available online 20 January 2019

Source: Hearing Research

Author(s): Keiko Hirose, Song-Zhe Li

Abstract

The blood-perilymph barrier serves a critical role by separating the components of blood from inner ear fluids, limiting traffic of cells, proteins and other solutes into the labyrinth, and allowing gas (O₂-CO₂) exchange. Inflammation produces changes in the blood-perilymph barrier resulting in increased vascular permeability. It is commonly thought that compromise of the blood-inner ear barrier would lead to hearing impairment through loss of the endocochlear potential (EP). In fact, the effect of increasing cochlear vascular permeability on hearing function and EP is poorly understood. We used a novel method to measure the integrity of the blood-perilymph barrier and demonstrated the effects of barrier compromise on ABR threshold and EP. We also investigated the contribution of CX3CR1 cochlear macrophages and CCR2 inflammatory monocytes to barrier function after systemic exposure to lipopolysaccharide (LPS). We found that systemic LPS induced a profound change in vascular permeability, which correlated with minimal change in ABR threshold and EP. Macrophage depletion using CX3CR1-DTR mice did not alter the baseline permeability of cochlear vessels and resulted in preservation of barrier function in LPS-treated animals. We conclude that cochlear macrophages are not required to maintain the barrier in normal mice and activated macrophages are a critical factor in breakdown of the barrier after LPS. CCR2 null mice demonstrated that LPS induction of barrier leakiness occurs in the absence of CCR2 expression. Thus, enhanced aminoglycoside ototoxicity after LPS can be linked to the expression of CCR2 in inflammatory monocytes, and not to preservation of the blood-perilymph barrier in CCR2 knockout mice.

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The role of monocytes and macrophages in the dynamic permeability of the blood-perilymph barrier

Publication date: Available online 20 January 2019

Source: Hearing Research

Author(s): Keiko Hirose, Song-Zhe Li

Abstract

The blood-perilymph barrier serves a critical role by separating the components of blood from inner ear fluids, limiting traffic of cells, proteins and other solutes into the labyrinth, and allowing gas (O₂-CO₂) exchange. Inflammation produces changes in the blood-perilymph barrier resulting in increased vascular permeability. It is commonly thought that compromise of the blood-inner ear barrier would lead to hearing impairment through loss of the endocochlear potential (EP). In fact, the effect of increasing cochlear vascular permeability on hearing function and EP is poorly understood. We used a novel method to measure the integrity of the blood-perilymph barrier and demonstrated the effects of barrier compromise on ABR threshold and EP. We also investigated the contribution of CX3CR1 cochlear macrophages and CCR2 inflammatory monocytes to barrier function after systemic exposure to lipopolysaccharide (LPS). We found that systemic LPS induced a profound change in vascular permeability, which correlated with minimal change in ABR threshold and EP. Macrophage depletion using CX3CR1-DTR mice did not alter the baseline permeability of cochlear vessels and resulted in preservation of barrier function in LPS-treated animals. We conclude that cochlear macrophages are not required to maintain the barrier in normal mice and activated macrophages are a critical factor in breakdown of the barrier after LPS. CCR2 null mice demonstrated that LPS induction of barrier leakiness occurs in the absence of CCR2 expression. Thus, enhanced aminoglycoside ototoxicity after LPS can be linked to the expression of CCR2 in inflammatory monocytes, and not to preservation of the blood-perilymph barrier in CCR2 knockout mice.

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Effects of Vaginal Seeding on Infants' Body Mass Index and Allergy Risk for Caesarean-delivered Children

Conditions:   Overweight and Obesity;   Allergy Intervention:   Procedure: Vaginal seeding Sponsors:   Peking University;   National Natural Science Foundation of China;   Liuyang Maternal and Child Health Care Hospital Recruiting (Source: ClinicalTrials.gov)

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Effects of Vaginal Seeding on Infants' Body Mass Index and Allergy Risk for Caesarean-delivered Children

Conditions:   Overweight and Obesity;   Allergy Intervention:   Procedure: Vaginal seeding Sponsors:   Peking University;   National Natural Science Foundation of China;   Liuyang Maternal and Child Health Care Hospital Recruiting (Source: ClinicalTrials.gov)

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Exploring the Use of ECochG Testing During Electrode Insertion in Cochlear Implant Surgery

Conditions:   Cochlear Implants;   Hearing Preservation Intervention:   Procedure: Electrocochlography Sponsors:   Cambridge University Hospitals NHS Foundation Trust;   University of Cambridge Recruiting (Source: ClinicalTrials.gov)

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Clinical Study of Minimally Invasive Ponto Surgical Technique (MIPS) - Design Iteration

Conditions:   Bone Conduction Deafness;   Unilateral Deafness;   Middle Ear Deafness;   Mixed Hearing Loss Intervention:   Device: Minimally Invasive Ponto Surgery Sponsor:   Oticon Medical Recruiting (Source: ClinicalTrials.gov)

MedWorm Message: If you are looking to buy something in the January Sales please visit TheJanuarySales.com for a directory of all the best sales in the UK. Any income gained via affiliate links keeps MedWorm running.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2W9leh1

Exploring the Use of ECochG Testing During Electrode Insertion in Cochlear Implant Surgery

Conditions:   Cochlear Implants;   Hearing Preservation Intervention:   Procedure: Electrocochlography Sponsors:   Cambridge University Hospitals NHS Foundation Trust;   University of Cambridge Recruiting (Source: ClinicalTrials.gov)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2R00t3T

Clinical Study of Minimally Invasive Ponto Surgical Technique (MIPS) - Design Iteration

Conditions:   Bone Conduction Deafness;   Unilateral Deafness;   Middle Ear Deafness;   Mixed Hearing Loss Intervention:   Device: Minimally Invasive Ponto Surgery Sponsor:   Oticon Medical Recruiting (Source: ClinicalTrials.gov)

MedWorm Message: If you are looking to buy something in the January Sales please visit TheJanuarySales.com for a directory of all the best sales in the UK. Any income gained via affiliate links keeps MedWorm running.

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Effects of treatment on anxiety levels among patients with benign paroxysmal positional vertigo

Abstract

Purpose

The association of vertigo with anxiety disorders is well known. Herein, we aimed to determine the relationship between pre-treatment and post-treatment anxiety levels, assessed with Beck anxiety inventory, with educational status among patients diagnosed with and treated for Benign paroxysmal positional vertigo (BPPV), and to evaluate the effect of treatment on the sub-parameters of the Beck anxiety inventory.

Methods

Our study included a total of 33 patients that presented to the otorhinolaryngology outpatient clinic with acute vertigo and were diagnosed to have posterior canal BPPV. Patients diagnosed with posterior BPPV were applied Beck anxiety inventory prior to the treatment as well as 1 week and 4 weeks after the treatment.

Results

Compared to the control group, statistically significant changes were observed in relation to pre-treatment and post-treatment inventory scores (p < 0.05). A comparison of the pre-treatment and post-treatment assessments revealed significant differences (p < 0.05). Improvements were observed in 48% (10/21) of the subparameters by the end of the first week at the earliest. Educational status had no significant effect on inventory scores (p > 0.05).

Conclusion

Anxiety-related subjective symptoms mostly started to improve 1 week after the treatment at the earliest, and symptoms showed persistence at a certain level even at the end of the first month. Inequalities between the patients' educational levels affect anxiety levels. It should be remembered that educational status should be considered when approaching patients.

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Correlation between the duration of locoregional control and survival in T1–T2 oropharyngeal cancer patients

Abstract

Purpose

To investigate the correlation between the time to locoregional recurrence and survival in T1–T2 oropharyngeal squamous-cell carcinoma (OPSCC) patients.

Methods

A retrospective, single-site study of patients with T1–T2 OPSCC treated with curative intent between 2000 and 2015 who had a locoregional recurrence without distant metastases. Patients without a disease-free interval (i.e., persistent macroscopic disease after the end of treatment and a time to locoregional recurrence of less than 3 months) were excluded. The endpoint considered was overall survival (OS).

Results

Out of 602 T1–T2 OPSCC patients, 121 patients had a locoregional recurrence and they were, hence, analyzed. All of the patients were heavy-smokers, with a consumption of more than 20 pack-years. The recurrence was local in 59.5%, regional in 27.3%, and both local and regional in 13.2% of the patients. The median time to locoregional recurrence and median OS was 15 months and 44 months, respectively. The time to locoregional recurrence was correlated with OS (p < 0.0001). In multivariate analyses, factors associated with survival were an initial N0–N2a versus N2b–N3 nodal staging and a 12-month threshold for the time to locoregional recurrence.

Conclusions

Locoregional control in T1–T2 OPSCC is not only a qualitative prognostic factor but also a quantitative prognostic factor of survival. A time to locoregional recurrence of less than 12 months was correlated with an unfavorable prognosis.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2S4LvOI

Effects of treatment on anxiety levels among patients with benign paroxysmal positional vertigo

Abstract

Purpose

The association of vertigo with anxiety disorders is well known. Herein, we aimed to determine the relationship between pre-treatment and post-treatment anxiety levels, assessed with Beck anxiety inventory, with educational status among patients diagnosed with and treated for Benign paroxysmal positional vertigo (BPPV), and to evaluate the effect of treatment on the sub-parameters of the Beck anxiety inventory.

Methods

Our study included a total of 33 patients that presented to the otorhinolaryngology outpatient clinic with acute vertigo and were diagnosed to have posterior canal BPPV. Patients diagnosed with posterior BPPV were applied Beck anxiety inventory prior to the treatment as well as 1 week and 4 weeks after the treatment.

Results

Compared to the control group, statistically significant changes were observed in relation to pre-treatment and post-treatment inventory scores (p < 0.05). A comparison of the pre-treatment and post-treatment assessments revealed significant differences (p < 0.05). Improvements were observed in 48% (10/21) of the subparameters by the end of the first week at the earliest. Educational status had no significant effect on inventory scores (p > 0.05).

Conclusion

Anxiety-related subjective symptoms mostly started to improve 1 week after the treatment at the earliest, and symptoms showed persistence at a certain level even at the end of the first month. Inequalities between the patients' educational levels affect anxiety levels. It should be remembered that educational status should be considered when approaching patients.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FLP31I

Correlation between the duration of locoregional control and survival in T1–T2 oropharyngeal cancer patients

Abstract

Purpose

To investigate the correlation between the time to locoregional recurrence and survival in T1–T2 oropharyngeal squamous-cell carcinoma (OPSCC) patients.

Methods

A retrospective, single-site study of patients with T1–T2 OPSCC treated with curative intent between 2000 and 2015 who had a locoregional recurrence without distant metastases. Patients without a disease-free interval (i.e., persistent macroscopic disease after the end of treatment and a time to locoregional recurrence of less than 3 months) were excluded. The endpoint considered was overall survival (OS).

Results

Out of 602 T1–T2 OPSCC patients, 121 patients had a locoregional recurrence and they were, hence, analyzed. All of the patients were heavy-smokers, with a consumption of more than 20 pack-years. The recurrence was local in 59.5%, regional in 27.3%, and both local and regional in 13.2% of the patients. The median time to locoregional recurrence and median OS was 15 months and 44 months, respectively. The time to locoregional recurrence was correlated with OS (p < 0.0001). In multivariate analyses, factors associated with survival were an initial N0–N2a versus N2b–N3 nodal staging and a 12-month threshold for the time to locoregional recurrence.

Conclusions

Locoregional control in T1–T2 OPSCC is not only a qualitative prognostic factor but also a quantitative prognostic factor of survival. A time to locoregional recurrence of less than 12 months was correlated with an unfavorable prognosis.

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Neuron density fundamentally relates to architecture and connectivity of the primate cerebral cortex

Publication date: Available online 21 January 2019

Source: NeuroImage

Author(s): Sarah F. Beul, Claus C. Hilgetag

Abstract

Studies of structural brain connectivity have revealed many intriguing features of complex cortical networks. To advance integrative theories of cortical organization, an understanding is required of how connectivity interrelates with other aspects of brain structure. Recent studies have suggested that interareal connectivity may be related to a variety of macroscopic as well as microscopic architectonic features of cortical areas. However, it is unclear how these features are inter-dependent and which of them most strongly and fundamentally relate to structural corticocortical connectivity. Here, we systematically investigated the relation of a range of microscopic and macroscopic architectonic features of cortical organization, namely layer III pyramidal cell soma cross section, dendritic synapse count, dendritic synapse density and dendritic tree size as well as area neuron density, to multiple properties of cortical connectivity, using a comprehensive, up-to-date structural connectome of the primate brain. Importantly, relationships were investigated by multi-variate analyses to account for the interrelations of features. Of all considered factors, the classical architectonic parameter of neuron density most strongly and consistently related to essential features of cortical connectivity (existence and laminar patterns of projections, area degree), and in conjoint analyses largely abolished effects of cellular morphological features. These results reveal neuron density as a central architectonic indicator of the primate cerebral cortex that is closely related to essential aspects of brain connectivity and is also highly indicative of further features of the architectonic organization of cortical areas such as the considered cellular morphological measures. Our findings integrate several aspects of cortical micro- and macroscopic organization, with implications for cortical development and function.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CJJJsD

Neuron density fundamentally relates to architecture and connectivity of the primate cerebral cortex

Publication date: Available online 21 January 2019

Source: NeuroImage

Author(s): Sarah F. Beul, Claus C. Hilgetag

Abstract

Studies of structural brain connectivity have revealed many intriguing features of complex cortical networks. To advance integrative theories of cortical organization, an understanding is required of how connectivity interrelates with other aspects of brain structure. Recent studies have suggested that interareal connectivity may be related to a variety of macroscopic as well as microscopic architectonic features of cortical areas. However, it is unclear how these features are inter-dependent and which of them most strongly and fundamentally relate to structural corticocortical connectivity. Here, we systematically investigated the relation of a range of microscopic and macroscopic architectonic features of cortical organization, namely layer III pyramidal cell soma cross section, dendritic synapse count, dendritic synapse density and dendritic tree size as well as area neuron density, to multiple properties of cortical connectivity, using a comprehensive, up-to-date structural connectome of the primate brain. Importantly, relationships were investigated by multi-variate analyses to account for the interrelations of features. Of all considered factors, the classical architectonic parameter of neuron density most strongly and consistently related to essential features of cortical connectivity (existence and laminar patterns of projections, area degree), and in conjoint analyses largely abolished effects of cellular morphological features. These results reveal neuron density as a central architectonic indicator of the primate cerebral cortex that is closely related to essential aspects of brain connectivity and is also highly indicative of further features of the architectonic organization of cortical areas such as the considered cellular morphological measures. Our findings integrate several aspects of cortical micro- and macroscopic organization, with implications for cortical development and function.

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Textile‐induced Vulvar and Perianal Dermatitis

We present a case of chronic vulvar and perianal pruritus that highlights the importance of patch testing for textile allergens in working up cases of chronic anogenital pruritus.

This article is protected by copyright. All rights reserved.

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Allergic reaction to a green tattoo with nickel as a possible allergen

A 40‐year‐old woman visited the allergology department because of a 10‐year‐old tattoo on her right lower leg itching for 4 years, specifically, in the green part. The other tattoo areas, red and black, were asymptomatic. There were no triggering factors, and she had no further relevant medical history. On physical examination, we observed excoriations on the lower right leg, mainly in the green tattooed area (Figure 1).

This article is protected by copyright. All rights reserved.

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Piroxicam‐induced fixed drug eruption: cross‐reactivity to meloxicam

Background

Non‐steroidal anti‐inflammatory drugs are a main cause of fixed drug eruption (FDE). A few cases of piroxicam‐induced FDE have been reported, however, the cross‐reactivity among oxicams has been rarely evaluated.

Objectives

To describe a series of patients with piroxicam‐induced FDE mostly confirmed by a positive patch test in whom cross‐reactivity to meloxicam has been assessed.

Methods

We included all cases of piroxicam‐induced FDE, diagnosed in the department of pharmacovigilance of Monastir. Patch tests for piroxicam and meloxicam were performed in the involved skin according to the ENDA recommendations. Oral provocation test (OPT) was performed for patients with negative skin tests.

Results

Seven patients were included in this study. FDE was multiple for five patients and solitary for two. Bullous eruption was noticed in two cases. Lesional patch tests for piroxicam were positive in six patients. To assess cross‐reactivity to meloxicam, this was patch tested. The test was positive in only one patient. An OPT with meloxicam was positive in two patients with negative patch test.

Conclusion

Meloxicam is not a safe alternative in piroxicam‐induced FDE, and OPT can confirm tolerance before prescribing this drug as a safer alternative.

This article is protected by copyright. All rights reserved.

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ALLERGIC CONTACT DERMATITIS PROBABLY DUE TO LATANOPROST DURING TREATMENT FOR ALOPECIA AREATA

Latanoprost is a phenyl‐substituted analogue of prostaglandin F2α used to treat glaucoma (1). Recently, it has been shown to stimulate eyelash hypertrichosis and therefore it has been proposed as a possible treatment for alopecia (2). Despite the extensive use of the drug in ophthalmology, allergic contact dermatitis (ACD) due to latanoprost has rarely been reported in glaucoma patients (3‐6). We report a case of ACD very probably due to latanoprost used for the treatment of alopecia areata in a woman.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2T7cwxW

Textile‐induced Vulvar and Perianal Dermatitis

We present a case of chronic vulvar and perianal pruritus that highlights the importance of patch testing for textile allergens in working up cases of chronic anogenital pruritus.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AUiT0L

Allergic reaction to a green tattoo with nickel as a possible allergen

A 40‐year‐old woman visited the allergology department because of a 10‐year‐old tattoo on her right lower leg itching for 4 years, specifically, in the green part. The other tattoo areas, red and black, were asymptomatic. There were no triggering factors, and she had no further relevant medical history. On physical examination, we observed excoriations on the lower right leg, mainly in the green tattooed area (Figure 1).

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2T4xspx

Piroxicam‐induced fixed drug eruption: cross‐reactivity to meloxicam

Background

Non‐steroidal anti‐inflammatory drugs are a main cause of fixed drug eruption (FDE). A few cases of piroxicam‐induced FDE have been reported, however, the cross‐reactivity among oxicams has been rarely evaluated.

Objectives

To describe a series of patients with piroxicam‐induced FDE mostly confirmed by a positive patch test in whom cross‐reactivity to meloxicam has been assessed.

Methods

We included all cases of piroxicam‐induced FDE, diagnosed in the department of pharmacovigilance of Monastir. Patch tests for piroxicam and meloxicam were performed in the involved skin according to the ENDA recommendations. Oral provocation test (OPT) was performed for patients with negative skin tests.

Results

Seven patients were included in this study. FDE was multiple for five patients and solitary for two. Bullous eruption was noticed in two cases. Lesional patch tests for piroxicam were positive in six patients. To assess cross‐reactivity to meloxicam, this was patch tested. The test was positive in only one patient. An OPT with meloxicam was positive in two patients with negative patch test.

Conclusion

Meloxicam is not a safe alternative in piroxicam‐induced FDE, and OPT can confirm tolerance before prescribing this drug as a safer alternative.

This article is protected by copyright. All rights reserved.

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ALLERGIC CONTACT DERMATITIS PROBABLY DUE TO LATANOPROST DURING TREATMENT FOR ALOPECIA AREATA

Latanoprost is a phenyl‐substituted analogue of prostaglandin F2α used to treat glaucoma (1). Recently, it has been shown to stimulate eyelash hypertrichosis and therefore it has been proposed as a possible treatment for alopecia (2). Despite the extensive use of the drug in ophthalmology, allergic contact dermatitis (ACD) due to latanoprost has rarely been reported in glaucoma patients (3‐6). We report a case of ACD very probably due to latanoprost used for the treatment of alopecia areata in a woman.

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Pediatric skull base surgery: Encephaloceles and cerebrospinal fluid leaks

Publication date: Available online 21 January 2019

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Jacob G. Eide, Patrick Walz, Tord D. Alden, Jeffrey C. Rastatter

In recent years, endoscopic endonasal approaches to the pediatric skull base have become an increasingly popular method for treatment of a variety of malignant and benign lesions. These approaches have largely evolved from experience in adult patients and can be an excellent alternative to open procedures in carefully selected patients. Pediatric encephaloceles can be addressed via open craniotomy, transpalatal, and endoscopic endonasal methods. The surgical approach should be dictated by the anatomy of the patient as well as the size and location of the encephalocele in question. Pediatric cerebrospinal fluid leaks can occur due to iatrogenic causes during skull base resections or sinus surgery, as well as from traumatic injury. Multiple options for repair of cerebrospinal fluid leaks exist, but endoscopic nasoseptal flaps are among the most commonly utilized reconstruction options.

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Locoregional flaps in pediatric anterior skull base surgery

Publication date: Available online 21 January 2019

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Christopher Pool, Neerav Goyal, Jessyka G. Lighthall

Management of skull base defects involves the separation of the cranial cavity from the nasal cavity in order to prevent cerebrospinal fluid leak, pneumocephalus, and intracranial infection. The size and location of the defect as well as donor tissue available will determine the type of reconstruction. Reconstruction options include free tissue grafts, locoregional flaps, and microvascular free flaps. In children, the size of potential flaps must be considered as well as the length of the pedicle, as often these differ in children. This article will discuss numerous reconstructive options, focusing on locoregional flaps in skull base reconstruction. In addition to outlining the surgical technique for each type, we will review considerations in pediatric patients for each reconstructive option.

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Surgical management of clival chordomas in children

Publication date: Available online 21 January 2019

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Carl H. Snyderman, Paul A. Gardner, Elizabeth C. Tyler-Kabara

Objective: Describe the surgical management of clival chordomas in the pediatric population, with an emphasis on techniques of endoscopic endonasal surgery.

Finding: Endoscopic endonasal approaches to the clivus provide access from posterior clinoids to foramen magnum. The clivus is divided into thirds (superior, middle, and inferior), each with corresponding vascular and neural structures. The abducens nerve is at greatest risk for injury due to spread of tumor within the interdural space to Dorello's canal. Despite decreased pneumatization of the sinuses in pediatric patients, the same techniques can be applied to this population. The contralateral transmaxillary approach enhances the ability to achieve a gross total resection when tumor extends laterally into the petrous apex. A multi-layer reconstruction with vascularized tissue minimizes the risk of cerebrospinal fluid leak.

Conclusion: Endoscopic endonasal surgery can be safely applied to the pediatric population and provides the best opportunity for complete surgical excision for most tumors.

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Pediatric skull base surgery: Encephaloceles and cerebrospinal fluid leaks

Publication date: Available online 21 January 2019

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Jacob G. Eide, Patrick Walz, Tord D. Alden, Jeffrey C. Rastatter

In recent years, endoscopic endonasal approaches to the pediatric skull base have become an increasingly popular method for treatment of a variety of malignant and benign lesions. These approaches have largely evolved from experience in adult patients and can be an excellent alternative to open procedures in carefully selected patients. Pediatric encephaloceles can be addressed via open craniotomy, transpalatal, and endoscopic endonasal methods. The surgical approach should be dictated by the anatomy of the patient as well as the size and location of the encephalocele in question. Pediatric cerebrospinal fluid leaks can occur due to iatrogenic causes during skull base resections or sinus surgery, as well as from traumatic injury. Multiple options for repair of cerebrospinal fluid leaks exist, but endoscopic nasoseptal flaps are among the most commonly utilized reconstruction options.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2S2vPLu

Locoregional flaps in pediatric anterior skull base surgery

Publication date: Available online 21 January 2019

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Christopher Pool, Neerav Goyal, Jessyka G. Lighthall

Management of skull base defects involves the separation of the cranial cavity from the nasal cavity in order to prevent cerebrospinal fluid leak, pneumocephalus, and intracranial infection. The size and location of the defect as well as donor tissue available will determine the type of reconstruction. Reconstruction options include free tissue grafts, locoregional flaps, and microvascular free flaps. In children, the size of potential flaps must be considered as well as the length of the pedicle, as often these differ in children. This article will discuss numerous reconstructive options, focusing on locoregional flaps in skull base reconstruction. In addition to outlining the surgical technique for each type, we will review considerations in pediatric patients for each reconstructive option.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2HqEp2E

Surgical management of clival chordomas in children

Publication date: Available online 21 January 2019

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Carl H. Snyderman, Paul A. Gardner, Elizabeth C. Tyler-Kabara

Objective: Describe the surgical management of clival chordomas in the pediatric population, with an emphasis on techniques of endoscopic endonasal surgery.

Finding: Endoscopic endonasal approaches to the clivus provide access from posterior clinoids to foramen magnum. The clivus is divided into thirds (superior, middle, and inferior), each with corresponding vascular and neural structures. The abducens nerve is at greatest risk for injury due to spread of tumor within the interdural space to Dorello's canal. Despite decreased pneumatization of the sinuses in pediatric patients, the same techniques can be applied to this population. The contralateral transmaxillary approach enhances the ability to achieve a gross total resection when tumor extends laterally into the petrous apex. A multi-layer reconstruction with vascularized tissue minimizes the risk of cerebrospinal fluid leak.

Conclusion: Endoscopic endonasal surgery can be safely applied to the pediatric population and provides the best opportunity for complete surgical excision for most tumors.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RWXTjA

Alcohol use, psychiatric disorders and gambling behaviors: A multi-sample study testing causal relationships via the co-twin control design

Publication date: Available online 21 January 2019

Source: Addictive Behaviors

Author(s): Spencer B. Huggett, Evan Winiger, Robin P. Corley, John K. Hewitt, Michael C. Stallings

Abstract

Human laboratory studies and twin research investigating relationships between alcohol use/pathology and gambling generally have yielded contradictory results, sometimes suggesting causal relationships and common genetic risk factors. 2860 individuals (mean age: 25.60, s.d = 3.21, 50.62% female) from separate clinical (n = 636) and community based (twin) samples (n = 2224) were used to assess associations between past year alcohol use and frequency of past year gambling behaviors (gambling frequency). After adjustment for demographic and psychiatric covariates, individual-level analyses detected that increased alcohol use was associated with more frequent gambling behaviors in twin and clinical samples. Co-twin control models were then used to test potential causal (direct) relationships between alcohol use and gambling frequency. Controlling for all covariates and shared genetic/environmental factors, we found increased alcohol use directly predicted more frequent gambling behaviors (consistent with causality). Our study also suggests shared genetic and/or environmental risk factors contribute to the association between increased alcohol use and frequent gambling behavior, a finding that may be more pronounced in males. The present study helps bridge the gap between twin research and human laboratory studies on gambling and alcohol use and corroborates findings across community and clinical samples. Overall, our findings support both common risk factors between alcohol use and gambling as well as a direct relationship between alcohol use and gambling frequency. Recognizing these dual processes could prove useful for gambling-related prevention/intervention programs.

Graphical abstract

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Alcohol use, psychiatric disorders and gambling behaviors: A multi-sample study testing causal relationships via the co-twin control design

Publication date: Available online 21 January 2019

Source: Addictive Behaviors

Author(s): Spencer B. Huggett, Evan Winiger, Robin P. Corley, John K. Hewitt, Michael C. Stallings

Abstract

Human laboratory studies and twin research investigating relationships between alcohol use/pathology and gambling generally have yielded contradictory results, sometimes suggesting causal relationships and common genetic risk factors. 2860 individuals (mean age: 25.60, s.d = 3.21, 50.62% female) from separate clinical (n = 636) and community based (twin) samples (n = 2224) were used to assess associations between past year alcohol use and frequency of past year gambling behaviors (gambling frequency). After adjustment for demographic and psychiatric covariates, individual-level analyses detected that increased alcohol use was associated with more frequent gambling behaviors in twin and clinical samples. Co-twin control models were then used to test potential causal (direct) relationships between alcohol use and gambling frequency. Controlling for all covariates and shared genetic/environmental factors, we found increased alcohol use directly predicted more frequent gambling behaviors (consistent with causality). Our study also suggests shared genetic and/or environmental risk factors contribute to the association between increased alcohol use and frequent gambling behavior, a finding that may be more pronounced in males. The present study helps bridge the gap between twin research and human laboratory studies on gambling and alcohol use and corroborates findings across community and clinical samples. Overall, our findings support both common risk factors between alcohol use and gambling as well as a direct relationship between alcohol use and gambling frequency. Recognizing these dual processes could prove useful for gambling-related prevention/intervention programs.

Graphical abstract

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The Liverpool Peritonsillar abscess Score (LPS): Development of a predictive score through a prospective multi‐centre observational study

Abstract

Objectives

While uncommon in the population at large, peritonsillar abscess (PTA) is a common subject of ENT referrals. Missed or uncertain diagnosis is a source of concern for non‐specialist referrers. In line with the NHS England Second Sepsis Action Plan, we aimed to develop a predictive score for the presence of PTA. This would help to improve non‐specialist colleagues' diagnostic certainty as well as to support ENT surgeons' triage of these referrals.

Design

Prospective, multi‐centre observational study.

Setting

Primary and secondary care.

Participants

Patients >16 years with symptoms of sore throat.

Data

We prospectively collected comprehensive data on patient demographics, symptoms and clinical status. We documented whether the patient had aspiration‐proven PTA or not. We performed binary logistic regression analysis, iterative development of a predictive score which we validated internally.

Results

100 patients were included (46 PTA and 54 tonsillitis). Five variables added significantly to the logistic regression model: unilateral sore throat; trismus; male gender; pharyngeal voice change; uvular deviation. Using the odds ratio outputs, we developed the Liverpool Peritonsillar abscess Score (LPS) iteratively.

We validated the latest (third) iteration of the LPS internally (ie on the same sample), yielding sensitivity 96%; specificity 85%; positive predictive value 85% and negative predictive value 96%. Area under the receiver operating characteristics (AUROC) curve was 0.970.

Conclusions

We have developed the first predictive score for PTA based on symptoms and signs that do not require the user to have specialist experience. Its high negative predictive value may be particularly helpful to non‐specialist colleagues.

This article is protected by copyright. All rights reserved.

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Nipple leiomyoma: a rare neoplasm with a broad spectrum of histologic appearances

Cutaneous leiomyomas are rare benign smooth muscle tumors. These lesions are differentiated based on their cell of origin and are sub‐classified as pilar leiomyoma, angioleiomyoma, and genital leiomyoma. Nipple leiomyomas are the least common genital leiomyoma, arising from the dartoic muscle cell of the nipple. Histologic examination of the lesion is necessary for definitive diagnosis, and these uncommon tumors can pose a diagnostic challenge. We describe herein a series of six nipple leiomyomas with a spectrum of histologic appearances.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2QZzLbD

The Liverpool Peritonsillar abscess Score (LPS): Development of a predictive score through a prospective multi‐centre observational study

Abstract

Objectives

While uncommon in the population at large, peritonsillar abscess (PTA) is a common subject of ENT referrals. Missed or uncertain diagnosis is a source of concern for non‐specialist referrers. In line with the NHS England Second Sepsis Action Plan, we aimed to develop a predictive score for the presence of PTA. This would help to improve non‐specialist colleagues' diagnostic certainty as well as to support ENT surgeons' triage of these referrals.

Design

Prospective, multi‐centre observational study.

Setting

Primary and secondary care.

Participants

Patients >16 years with symptoms of sore throat.

Data

We prospectively collected comprehensive data on patient demographics, symptoms and clinical status. We documented whether the patient had aspiration‐proven PTA or not. We performed binary logistic regression analysis, iterative development of a predictive score which we validated internally.

Results

100 patients were included (46 PTA and 54 tonsillitis). Five variables added significantly to the logistic regression model: unilateral sore throat; trismus; male gender; pharyngeal voice change; uvular deviation. Using the odds ratio outputs, we developed the Liverpool Peritonsillar abscess Score (LPS) iteratively.

We validated the latest (third) iteration of the LPS internally (ie on the same sample), yielding sensitivity 96%; specificity 85%; positive predictive value 85% and negative predictive value 96%. Area under the receiver operating characteristics (AUROC) curve was 0.970.

Conclusions

We have developed the first predictive score for PTA based on symptoms and signs that do not require the user to have specialist experience. Its high negative predictive value may be particularly helpful to non‐specialist colleagues.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FNMbBe

Nipple leiomyoma: a rare neoplasm with a broad spectrum of histologic appearances

Cutaneous leiomyomas are rare benign smooth muscle tumors. These lesions are differentiated based on their cell of origin and are sub‐classified as pilar leiomyoma, angioleiomyoma, and genital leiomyoma. Nipple leiomyomas are the least common genital leiomyoma, arising from the dartoic muscle cell of the nipple. Histologic examination of the lesion is necessary for definitive diagnosis, and these uncommon tumors can pose a diagnostic challenge. We describe herein a series of six nipple leiomyomas with a spectrum of histologic appearances.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2QZzLbD

High‐density surface electromyography: A visualization method of laryngeal muscle activity

Objectives/Hypothesis

Laryngeal muscle activation is a complex and dynamic process. Current evaluation methods include needle and surface electromyography (sEMG). Limitations of needle electromyography include patient discomfort, interpretive complexity, and limited duration of recording. sEMG demonstrates interpretive challenges given loss of spatial selectivity. Application of high‐density sEMG (HD sEMG) arrays were evaluated for potential to compensate for spatial selectivity loss while retaining benefits of noninvasive monitoring.

Study Design

Basic science.

Methods

Ten adults performed phonatory tasks while a 20‐channel array recorded spatiotemporal data of the anterior neck. Data were processed to provide average spectral power of each electrode. Comparison was made between rest, low‐, and high‐pitch phonation. Two‐dimensional (2D) spectral energy maps were created to evaluate use in gross identification of muscle location.

Results

Three phonatory tasks yielded spectral power measures across the HD sEMG array. Each electrode within the array demonstrated unique power values across all subjects (P < .001). Comparison of each electrode to itself across phonatory tasks yielded differences in all subjects during rest versus low versus high, rest versus low, and rest versus high and in 9/10 subjects (P < .001) for low versus high phonation. Symmetry of HD sEMG signal was noted. Review of 2D coronal energy maps allowed for gross identification of cricothyroid muscle amidst anterior strap musculature.

Conclusions

HD sEMG can be used to identify differences in anterior neck muscle activity between rest, low‐, and high‐pitch phonation. HD sEMG of the anterior neck holds potential to enhance diagnostic and therapeutic monitoring for pathologies of laryngeal function.

Level of Evidence

NA Laryngoscope, 2019

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Endoscopic Sinus Surgery for Type‐2 CRS wNP: An Endotype‐Based Retrospective Study

Objectives

Nasal polyps are often characterized by type 2 inflammation and disease recurrence. We developed a new surgical technique, referred to as reboot approach, which aims to maximally remove all sinus mucosa and allow healthy re‐epithelialization from the preserved nasal mucosa. We here review type 2 endotype chronic rhinosinusitis with nasal polyps (CRSwNP) patients who underwent classical mucosa‐sparing endoscopic sinus surgery (ESS) or the reboot approach.

Methods

Retrospective case‐control study of 50 consecutive CRSwNP patients who underwent endoscopic sinus surgery between 2015 and 2017, either as a classical non‐reboot ESS (n = 20); a partial reboot approach removing the mucosa of the ethmoidal, sphenoidal, and maxillary sinuses (n = 18); or a complete reboot approach including Draf III and removal of all frontal sinus mucosa (n = 12). Polyp recurrence over the follow‐up period of 2 years served as the primary outcome.

Results

All patients demonstrated a type 2 inflammation of the mucosal tissue harvested during surgery. In the classical approach group (n = 20), nine patients relapsed within 2 years (45%); in the partial reboot group, three out of 18 patients (17%) relapsed; and in the full reboot group one out of 12 patients (8%) relapsed. The relapse rates were significantly different between the non‐reboot and the reboot groups (P = 0.02) but also between all treatment groups (P = 0.038).

Conclusion

Complete removal of diseased mucosa from the paranasal sinuses (reboot approach) significantly reduces the recurrence of nasal polyps for 30 months postoperatively compared to the current mucosa‐sparing approach in type 2 inflammatory CRSwNP.

Level of Evidence

3b. Laryngoscope, 2019

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Improving decision making in larynx cancer by developing a decision aid: A mixed methods approach

Objective

Patients diagnosed with advanced larynx cancer face a decisional process in which they can choose between radiotherapy, chemoradiotherapy, or a total laryngectomy with adjuvant radiotherapy. Clinicians do not always agree on the best clinical treatment, making the decisional process for patients a complex problem.

Methods

Guided by the International Patient Decision Aid (PDA) Standards, we followed three developmental phases for which we held semi‐structured in‐depth interviews with patients and physicians, thinking‐out‐loud sessions, and a study‐specific questionnaire. Audio‐recorded interviews were verbatim transcribed, thematically coded, and analyzed. Phase 1 consisted of an evaluation of the decisional needs and the regular counseling process; phase 2 tested the comprehensibility and usability of the PDA; and phase 3 beta tested the feasibility of the PDA.

Results

Patients and doctors agreed on the need for development of a PDA. Major revisions were conducted after phase 1 to improve the readability and replace the majority of text with video animations. Patients and physicians considered the PDA to be a major improvement to the current counseling process.

Conclusion

This study describes the development of a comprehensible and easy‐to‐use online patient decision aid for advanced larynx cancer, which was found satisfactory by patients and physicians (available on www.treatmentchoice.info). The outcome of the interviews underscores the need for better patient counseling. The feasibility and satisfaction among newly diagnosed patients as well as doctors will need to be proven. To this end, we started a multicenter trial evaluating the PDA in clinical practice (ClinicalTrials.gov Identifier: NCT03292341).

Level of Evidence

NA. Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2W7btQI

High‐density surface electromyography: A visualization method of laryngeal muscle activity

Objectives/Hypothesis

Laryngeal muscle activation is a complex and dynamic process. Current evaluation methods include needle and surface electromyography (sEMG). Limitations of needle electromyography include patient discomfort, interpretive complexity, and limited duration of recording. sEMG demonstrates interpretive challenges given loss of spatial selectivity. Application of high‐density sEMG (HD sEMG) arrays were evaluated for potential to compensate for spatial selectivity loss while retaining benefits of noninvasive monitoring.

Study Design

Basic science.

Methods

Ten adults performed phonatory tasks while a 20‐channel array recorded spatiotemporal data of the anterior neck. Data were processed to provide average spectral power of each electrode. Comparison was made between rest, low‐, and high‐pitch phonation. Two‐dimensional (2D) spectral energy maps were created to evaluate use in gross identification of muscle location.

Results

Three phonatory tasks yielded spectral power measures across the HD sEMG array. Each electrode within the array demonstrated unique power values across all subjects (P < .001). Comparison of each electrode to itself across phonatory tasks yielded differences in all subjects during rest versus low versus high, rest versus low, and rest versus high and in 9/10 subjects (P < .001) for low versus high phonation. Symmetry of HD sEMG signal was noted. Review of 2D coronal energy maps allowed for gross identification of cricothyroid muscle amidst anterior strap musculature.

Conclusions

HD sEMG can be used to identify differences in anterior neck muscle activity between rest, low‐, and high‐pitch phonation. HD sEMG of the anterior neck holds potential to enhance diagnostic and therapeutic monitoring for pathologies of laryngeal function.

Level of Evidence

NA Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2W5rarA

Endoscopic Sinus Surgery for Type‐2 CRS wNP: An Endotype‐Based Retrospective Study

Objectives

Nasal polyps are often characterized by type 2 inflammation and disease recurrence. We developed a new surgical technique, referred to as reboot approach, which aims to maximally remove all sinus mucosa and allow healthy re‐epithelialization from the preserved nasal mucosa. We here review type 2 endotype chronic rhinosinusitis with nasal polyps (CRSwNP) patients who underwent classical mucosa‐sparing endoscopic sinus surgery (ESS) or the reboot approach.

Methods

Retrospective case‐control study of 50 consecutive CRSwNP patients who underwent endoscopic sinus surgery between 2015 and 2017, either as a classical non‐reboot ESS (n = 20); a partial reboot approach removing the mucosa of the ethmoidal, sphenoidal, and maxillary sinuses (n = 18); or a complete reboot approach including Draf III and removal of all frontal sinus mucosa (n = 12). Polyp recurrence over the follow‐up period of 2 years served as the primary outcome.

Results

All patients demonstrated a type 2 inflammation of the mucosal tissue harvested during surgery. In the classical approach group (n = 20), nine patients relapsed within 2 years (45%); in the partial reboot group, three out of 18 patients (17%) relapsed; and in the full reboot group one out of 12 patients (8%) relapsed. The relapse rates were significantly different between the non‐reboot and the reboot groups (P = 0.02) but also between all treatment groups (P = 0.038).

Conclusion

Complete removal of diseased mucosa from the paranasal sinuses (reboot approach) significantly reduces the recurrence of nasal polyps for 30 months postoperatively compared to the current mucosa‐sparing approach in type 2 inflammatory CRSwNP.

Level of Evidence

3b. Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2R26JrQ

Improving decision making in larynx cancer by developing a decision aid: A mixed methods approach

Objective

Patients diagnosed with advanced larynx cancer face a decisional process in which they can choose between radiotherapy, chemoradiotherapy, or a total laryngectomy with adjuvant radiotherapy. Clinicians do not always agree on the best clinical treatment, making the decisional process for patients a complex problem.

Methods

Guided by the International Patient Decision Aid (PDA) Standards, we followed three developmental phases for which we held semi‐structured in‐depth interviews with patients and physicians, thinking‐out‐loud sessions, and a study‐specific questionnaire. Audio‐recorded interviews were verbatim transcribed, thematically coded, and analyzed. Phase 1 consisted of an evaluation of the decisional needs and the regular counseling process; phase 2 tested the comprehensibility and usability of the PDA; and phase 3 beta tested the feasibility of the PDA.

Results

Patients and doctors agreed on the need for development of a PDA. Major revisions were conducted after phase 1 to improve the readability and replace the majority of text with video animations. Patients and physicians considered the PDA to be a major improvement to the current counseling process.

Conclusion

This study describes the development of a comprehensible and easy‐to‐use online patient decision aid for advanced larynx cancer, which was found satisfactory by patients and physicians (available on www.treatmentchoice.info). The outcome of the interviews underscores the need for better patient counseling. The feasibility and satisfaction among newly diagnosed patients as well as doctors will need to be proven. To this end, we started a multicenter trial evaluating the PDA in clinical practice (ClinicalTrials.gov Identifier: NCT03292341).

Level of Evidence

NA. Laryngoscope, 2019

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Preoperative low skeletal muscle mass as a risk factor for pharyngocutaneous fistula and decreased overall survival in patients undergoing total laryngectomy

Abstract

Background

Low skeletal muscle mass (SMM) is associated with postoperative complications, prolonged hospital stay, and short overall survival (OS) in surgical oncology. We aimed to investigate this association in patients undergoing total laryngectomy (TL).

Methods

A retrospective study was performed of patients undergoing TL. SMM was measured using CT or MRI scans at the level of the third cervical vertebra (C3).

Results

In all, 235 patients were included. Low SMM was observed in 109 patients (46.4%). Patients with low SMM had more pharyngocutaneous fistulas (PCFs) than patients with normal SMM (34.9% vs 20.6%; P = .02) and prolonged hospital stay (median, 17 vs 14 days; P < .001). In multivariate analysis, low SMM (hazards ratio, 1.849; 95% confidence interval, 1.202‐2.843) and high N stage were significant prognosticators of decreased OS.

Conclusion

Low SMM is associated with PCF and prolonged hospital stay in patients undergoing TL. Low SMM is an independent prognostic factor for shorter OS.

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