Follicular Induction And CK20+ Merkel Cells Overlying Cutaneous Focal Mucinosis

Background

Cutaneous focal mucinosis (CFM), or focal dermal mucinosis, is a benign reactive process categorized as a primary mucinosis. Skin biopsy is essential for diagnosis, as the clinical appearance is often non‐specific. Follicular induction is a phenomenon whereby the epidermis is induced by an underlying process to form primitive or mature hair follicles, and is commonly seen overlying dermatofibromas. Follicular induction has been rarely described in CFM.

Methods

We performed a retrospective histologic review of lesions of CFM confirmed by skin biopsy from 2010 to 2015 in our department.

Results

We found that 11% (11/98) of CFM lesions demonstrated follicular induction. CK20 immunostaining was performed on 4 of these biopsies and highlighted an increased density of CK20+ Merkel cells within the basaloid epidermal proliferations.

Conclusions

As superficial basal cell carcinomas (BCC) often demonstrate a mucinous stroma around the basaloid islands, CFM with follicular induction may closely mimic a BCC histologically, particularly in superficial shave biopsies. Therefore, it is important that dermatopathologists be aware of this phenomenon. Furthermore, CK20+ staining within the basaloid epithelial proliferations may be helpful in differentiating CFM with follicular induction from a BCC.

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Double‐positive CD8/CD4 primary cutaneous acral T‐cell lymphoma

Primary cutaneous acral CD8⁺ T‐cell lymphoma (acral CD8⁺ TCL) is a rare, clinically indolent lymphoma that is classified as provisional entity in the 2016 revision of the WHO classification of tumors of hematopoietic and lymphoid tissue (1‐3).

This article is protected by copyright. All rights reserved.

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Double‐positive CD8/CD4 primary cutaneous acral T‐cell lymphoma

Primary cutaneous acral CD8⁺ T‐cell lymphoma (acral CD8⁺ TCL) is a rare, clinically indolent lymphoma that is classified as provisional entity in the 2016 revision of the WHO classification of tumors of hematopoietic and lymphoid tissue (1‐3).

This article is protected by copyright. All rights reserved.

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Follicular Induction And CK20+ Merkel Cells Overlying Cutaneous Focal Mucinosis

Background

Cutaneous focal mucinosis (CFM), or focal dermal mucinosis, is a benign reactive process categorized as a primary mucinosis. Skin biopsy is essential for diagnosis, as the clinical appearance is often non‐specific. Follicular induction is a phenomenon whereby the epidermis is induced by an underlying process to form primitive or mature hair follicles, and is commonly seen overlying dermatofibromas. Follicular induction has been rarely described in CFM.

Methods

We performed a retrospective histologic review of lesions of CFM confirmed by skin biopsy from 2010 to 2015 in our department.

Results

We found that 11% (11/98) of CFM lesions demonstrated follicular induction. CK20 immunostaining was performed on 4 of these biopsies and highlighted an increased density of CK20+ Merkel cells within the basaloid epidermal proliferations.

Conclusions

As superficial basal cell carcinomas (BCC) often demonstrate a mucinous stroma around the basaloid islands, CFM with follicular induction may closely mimic a BCC histologically, particularly in superficial shave biopsies. Therefore, it is important that dermatopathologists be aware of this phenomenon. Furthermore, CK20+ staining within the basaloid epithelial proliferations may be helpful in differentiating CFM with follicular induction from a BCC.

This article is protected by copyright. All rights reserved.

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Variation of degree of stenosis quantification using different energy level with dual energy CT scanner

Abstract

Purpose

To investigate the variation in the quantification of the carotid degree of stenosis (DoS) with a dual energy computed tomography (CT), using different energy levels during the image reconstruction.

Methods

In this retrospective study, 53 subjects (37 males; mean age 67 ± 11 years; age range 47–83 years) studied with a multi-energy CT scanner were included. Datasets were reconstructed on a dedicated workstation and from the CT raw data multiple datasets were generated at the following monochromatic energy levels: 66, 70, 77, and 86 kilo-electronvolt (keV). Two radiologists independently performed all measurements for quantification of the degree of stenosis. Wilcoxon test was used to test the differences between the Hounsifield unit (HU) values in the plaques at different keV.

Results

The Wilcoxon analysis showed a statistically significant difference (p = 0.001) in the DoS assessment among the different keVs selected. The Bland-Altman analysis showed that the DoS difference had a linear relation with the keV difference (the bigger is the difference in keV, the bigger is the variation in DoS) and that for different keVs, the difference in DoS is reduced with its increase.

Conclusion

A standardization in the use of the energy level during the image reconstruction should be considered.

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Variation of degree of stenosis quantification using different energy level with dual energy CT scanner

Abstract

Purpose

To investigate the variation in the quantification of the carotid degree of stenosis (DoS) with a dual energy computed tomography (CT), using different energy levels during the image reconstruction.

Methods

In this retrospective study, 53 subjects (37 males; mean age 67 ± 11 years; age range 47–83 years) studied with a multi-energy CT scanner were included. Datasets were reconstructed on a dedicated workstation and from the CT raw data multiple datasets were generated at the following monochromatic energy levels: 66, 70, 77, and 86 kilo-electronvolt (keV). Two radiologists independently performed all measurements for quantification of the degree of stenosis. Wilcoxon test was used to test the differences between the Hounsifield unit (HU) values in the plaques at different keV.

Results

The Wilcoxon analysis showed a statistically significant difference (p = 0.001) in the DoS assessment among the different keVs selected. The Bland-Altman analysis showed that the DoS difference had a linear relation with the keV difference (the bigger is the difference in keV, the bigger is the variation in DoS) and that for different keVs, the difference in DoS is reduced with its increase.

Conclusion

A standardization in the use of the energy level during the image reconstruction should be considered.

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The Relationship of Exhaled Nitric Oxide with Ethnicity and Gender in Rural Georgia YouthAuthors

Publication date: Available online 14 December 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Brian C. Reed, Jennifer L. Waller, Dennis R. Ownby, Martha S. Tingen

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Associations of urban greenness with asthma and respiratory symptoms in Mexican American children

Publication date: Available online 14 December 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Kamal Eldeirawi, Colin Kunzweiler, Shannon Zenk, Patricia Finn, Sharmilee Nyenhuis, Natalya Rosenberg, Victoria Persky

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The Relationship of Exhaled Nitric Oxide with Ethnicity and Gender in Rural Georgia YouthAuthors

Publication date: Available online 14 December 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Brian C. Reed, Jennifer L. Waller, Dennis R. Ownby, Martha S. Tingen

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Hydrogen gas restores exhausted CD8+ T cells in patients with advanced colorectal cancer to improve prognosis.

Hydrogen gas restores exhausted CD8+ T cells in patients with advanced colorectal cancer to improve prognosis. Oncol Rep. 2018 Nov 01;: Authors: Akagi J, Baba H Abstract Exhausted cluster of differentiation (CD)8+ T cells lose immunological activity due to mitochondrial dysfunction caused by peroxisome proliferator‑activated receptor γ coactivator 1α (PGC‑1α) inactivation, resulting in a poor prognosis in patients with cancer. As hydrogen gas was recently reported to activate PGC‑1α, the present study investigated whether it restores exhausted CD8+ T cells to improve prognosis in patients with stage IV colorectal cancer. A total of 55 patients with histologically and clinically diagnosed stage IV colorectal carcinoma were enrolled between July 2014 and J...

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CD47 Blockade Inhibits Tumor Progression through Promoting Phagocytosis of Tumor Cells by M2 Polarized Macrophages in Endometrial Cancer.

Authors: Gu S, Ni T, Wang J, Liu Y, Fan Q, Wang Y, Huang T, Chu Y, Sun X, Wang Y Abstract There are rapidly emerging efforts to explore tumor-associated macrophages (TAMs) as a tumor therapy target. Tumor cells express CD47, which can interact with the macrophages' SIRPα transmitting a "don't eat me" signal to macrophages. The expression of CD47 increases in various tumors to evade immune attack. However, the expression of CD47 in endometrial cancer (EC) and the role of CD47-SIRPα in the TAMs which mediate the progression of EC remain unclear. Our study shows that there are increased TAMs in EC which dominantly consist of M2 macrophages and contribute to the progression of EC. We confirm that CD47 is highly expressed in EC tissue using the TCGA database, qPCR, and flow cytometry....

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Modulation of Innate Immunity by G-CSF and Inflammatory Response by LBPK95A Improves the Outcome of Sepsis in a Rat Model.

Conclusion: Our results revealed that increasing innate immunity by G-CSF pretreatment and decreasing inflammatory responses using LBPK95A improved the survival rates in a rat sepsis model and could be a novel strategy to treat sepsis. PMID: 30525057 [PubMed - in process] (Source: Journal of Immunology Research)

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CD47 Blockade Inhibits Tumor Progression through Promoting Phagocytosis of Tumor Cells by M2 Polarized Macrophages in Endometrial Cancer.

Authors: Gu S, Ni T, Wang J, Liu Y, Fan Q, Wang Y, Huang T, Chu Y, Sun X, Wang Y Abstract There are rapidly emerging efforts to explore tumor-associated macrophages (TAMs) as a tumor therapy target. Tumor cells express CD47, which can interact with the macrophages' SIRPα transmitting a "don't eat me" signal to macrophages. The expression of CD47 increases in various tumors to evade immune attack. However, the expression of CD47 in endometrial cancer (EC) and the role of CD47-SIRPα in the TAMs which mediate the progression of EC remain unclear. Our study shows that there are increased TAMs in EC which dominantly consist of M2 macrophages and contribute to the progression of EC. We confirm that CD47 is highly expressed in EC tissue using the TCGA database, qPCR, and flow cytometry....

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Hydrogen gas restores exhausted CD8+ T cells in patients with advanced colorectal cancer to improve prognosis.

Hydrogen gas restores exhausted CD8+ T cells in patients with advanced colorectal cancer to improve prognosis. Oncol Rep. 2018 Nov 01;: Authors: Akagi J, Baba H Abstract Exhausted cluster of differentiation (CD)8+ T cells lose immunological activity due to mitochondrial dysfunction caused by peroxisome proliferator‑activated receptor γ coactivator 1α (PGC‑1α) inactivation, resulting in a poor prognosis in patients with cancer. As hydrogen gas was recently reported to activate PGC‑1α, the present study investigated whether it restores exhausted CD8+ T cells to improve prognosis in patients with stage IV colorectal cancer. A total of 55 patients with histologically and clinically diagnosed stage IV colorectal carcinoma were enrolled between July 2014 and J...

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Modulation of Innate Immunity by G-CSF and Inflammatory Response by LBPK95A Improves the Outcome of Sepsis in a Rat Model.

Conclusion: Our results revealed that increasing innate immunity by G-CSF pretreatment and decreasing inflammatory responses using LBPK95A improved the survival rates in a rat sepsis model and could be a novel strategy to treat sepsis. PMID: 30525057 [PubMed - in process] (Source: Journal of Immunology Research)

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Change in Lower Eyelid Position After Ptosis Repair in Patients With Unilateral Myogenic Versus Aponeurotic Blepharoptosiss

Purpose: To compare preoperative and postoperative lower eyelid scleral show in patients with unilateral myogenic (MP) and aponeurotic (AP) ptosis, analyze the factors correlated with them, and assess the rate of postoperative lower eyelid symmetry in both groups. Methods: Patients (older than 5 years old) with unilateral MP (58) and AP (20) were included from June 2015 to April 2017. Excluded were patients with previous eyelid surgery, strabismus, levator function of ≤3, and associated procedures. Margin reflex distance (MRD) 1 and 2 and levator function were measured by the same observer before and at least 6 months after the ptosis repair. Results: Lower scleral show was observed in 56.8% and 80% of MP and AP, respectively. Margin reflex distance 2 was significantly (r = −0.37, p = 0.002) associated with MRD1 in the MP group (multiple regression analysis). Both groups showed a significant improvement of MRD2, postoperatively resulting in symmetric MRD2 in 91.4% of MP and 80% of AP group. It was not changed in 43% of MP and 25% of AP group. Multiple regression analysis showed that preoperative MRD2 was the only significant factor associated with postoperative improvement of scleral show in the MP group. Conclusions: Lower scleral show was significantly improved after ptosis repair in both MP and AP. The more severe MP was significantly associated with more severe preoperative scleral show. Preoperative MRD2 was the only factor predicting postoperative improvement of scleral show in the MP. No factor was significantly associated with MRD2 in the AP group. Accepted for publication October 25, 2018. Supported by Iran University Eye Research Center which did not have any role in the design, execution, and presentation of results. The authors have no financial or conflicts of interest to disclose. Presented at annual meeting of European (Bucharest, September 14-15, 2018) and American (Chicago, October 25-26, 2018) Society of Ophthalmic Plastic and Reconstructive Surgery. Address correspondence and reprint requests to Mohsen Bahmani Kashkouli, M.D., Rassoul Akram Hospital, Sattarkhan Niayesh Street, Tehran 1455364, Iran. E-mail: mkashkouli2@gmanil.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Bony Orbital Volume Expansion in Thyroid Eye Disease

Purpose: To quantify changes to the bony orbital volume (BOV) in patients with thyroid eye disease (TED) relative to normal controls. Methods: In this case–control study, all patients affected with TED seen over a 2-year period were screened for study entry. Eligible participants were adults with clinical evidence of TED and CT scans of their orbits obtained during the course of their routine care. Exclusion criteria included the history of decompression surgery and/or medical or other ophthalmic conditions that could alter the orbital anatomy. The primary outcome was the measurement of the BOV. Secondary outcome measures included the relationships between BOV and muscle volume, fat volume, Hertel measurements, duration of the disease, and the occurrence of dysthyroid optic neuropathy in patients with TED. Three-dimensional reconstructions of the orbits were created to measure BOV, muscle volume, and fat volume. Results: A total of 100 participants were included in the study, contributing 200 orbits. This sample was comprised of 50 patients with TED (37 female, 13 male) and 50 controls (37 female and 13 male). There were no differences between the control and patient groups in age or sex. Of the patients with TED, 14 were diagnosed with dysthyroid optic neuropathy (15 orbits, 1 case was bilateral). The mean (standard deviation [SD]) clinical activity score for males was 4.1 (2.29) and 4.35 (2.63) for females. The mean (SD) BOV for males in the TED group was 28.62 ml (3.47), while that of the control group was 24.59 ml (2.19). This difference was significant (p

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Ocular Considerations in Face Transplantation: Report of 2 Cases and Review of the Literature

Purpose: Periorbital injuries are common in face transplantation (FT) candidates. It is therefore essential that the ophthalmologist play a central role in the multidisciplinary treatment of these patients. In this study, the authors perform a comprehensive review of all procedures involving periorbital components, provide an update for the ophthalmology community regarding the current state of the field, and present 2 cases. Methods: A comprehensive review of the literature for all FT procedures including periorbital components was performed. The authors also present 2 patients who received FT including periorbital components for extensive facial disfigurement. One patient sustained high-energy avulsive ballistic injury and underwent a total face, double jaw, and tongue transplant in 2012. The second patient received a total face, eyelids, ears, and skeletal subunits transplant for extensive facial burns in 2015. Results: Literature review demonstrated that 22 (54%) of the 41 patients undergoing FT received allografts containing periorbital components. Only 14 cases (64%) reported on the presence of ocular and periocular complications. The most common complications consisted of lower eyelid ectropion and lagophthalmos, and nearly all required revisional procedures. Both patients presented with significant periorbital scarring and demonstrated good visual acuity and aesthetic outcomes at postoperative follow up between 6 and 28 months. Conclusions: Face transplantation can address extensive facial and periorbital disfigurement with satisfactory functional and aesthetic outcomes. The majority of FT performed to date have included periorbital components, and postoperative ocular and periocular complications are common. It is critical for ophthalmologists to play a central role in the care of these patients. Accepted for publication November 7, 2018. The research was funded by New York University Langone Health, New York City, NY, and a grant from the Office of Naval Research, Arlington, VA (Grant N00014-10-1-0868). The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Eduardo D. Rodriguez, MD, DDS, Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, 305 E 33rd Street, New York, NY 10016. E-mail: eduardo.rodriguez@nyulangone.org © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Orbital Floor and Rim Reconstruction With a Titanium Orbital Implant and Acellular Dermis

Reconstruction of the orbital rim and floor following tumor excision is traditionally performed with bone grafts, vascularized grafts, or free flaps. The authors describe a case of an osteosarcoma of the maxillary sinus and a second case of an ossifying fibroma of the orbital floor, both of which required reconstruction of the orbital floor and rim. In both of these cases, reconstruction of the orbital floor and rim was performed with a titanium implant whose anterior portion was bent inferiorly to recreate the orbital rim. Acellular dermis was sutured over the anterior portion of the orbital implant to act as a barrier between the implant and the overlying eyelid tissues. Accepted for publication October 24, 2018. The authors have no financial or conflicts of interest to disclose. Meeting presentation: Spring ASOPRS 2018. Address correspondence and reprint requests to Ronald Mancini, M.D., F.A.C.S., Oculoplastic and Reconstructive Surgery, Department of Ophthalmology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390. E-mail: ronald.mancini@utsouthwestern.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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A Prospective Comparative Study Between Subcuticular and Sutureless Technique of Skin Closure Following External Dacryocystorhinostomy

Purpose: To compare the cosmetic outcome of the surgical scar of external dacryocystorhinostomy by the subcuticular versus sutureless technique. Methods: This was a prospective interventional randomized control study conducted at tertiary level hospital. Fifty patients of primary-acquired nasolacrimal duct obstruction were included in this study. The control group patients underwent the technique of wound closure in 2 layers, subcutaneous interrupted suture with 6-0 vicryl and superficial skin with 6-0 prolene continuous subcuticular sutures. In the case group, interrupted subcutaneous sutures with 6-0 vicryl with Steristrip for skin apposition was used. The surgical scars were assessed and graded by still photographs on a computer screen by 2 independent observers unaware of the surgical technique used at 2, 6 and 12 weeks postoperatively. Results: The mean scar assessment score by the 2 observers were 2.60 (0.57), 2.04 (0.64), and 1.16 (0.89) in control group and 2.02 (0.65), 1.44 (0.70), and 0.44 (0.61) in case group at 2, 6, and 12 weeks, respectively. Scar grades were analyzed using chi-square test between the 2 group and Wilcoxon signed rank test within the group. The difference between the 2 groups were found to be statistically significant at 2, 6, and 12 weeks (P

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Orbital Floor and Rim Reconstruction With a Titanium Orbital Implant and Acellular Dermis

Reconstruction of the orbital rim and floor following tumor excision is traditionally performed with bone grafts, vascularized grafts, or free flaps. The authors describe a case of an osteosarcoma of the maxillary sinus and a second case of an ossifying fibroma of the orbital floor, both of which required reconstruction of the orbital floor and rim. In both of these cases, reconstruction of the orbital floor and rim was performed with a titanium implant whose anterior portion was bent inferiorly to recreate the orbital rim. Acellular dermis was sutured over the anterior portion of the orbital implant to act as a barrier between the implant and the overlying eyelid tissues. Accepted for publication October 24, 2018. The authors have no financial or conflicts of interest to disclose. Meeting presentation: Spring ASOPRS 2018. Address correspondence and reprint requests to Ronald Mancini, M.D., F.A.C.S., Oculoplastic and Reconstructive Surgery, Department of Ophthalmology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390. E-mail: ronald.mancini@utsouthwestern.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Change in Lower Eyelid Position After Ptosis Repair in Patients With Unilateral Myogenic Versus Aponeurotic Blepharoptosiss

Purpose: To compare preoperative and postoperative lower eyelid scleral show in patients with unilateral myogenic (MP) and aponeurotic (AP) ptosis, analyze the factors correlated with them, and assess the rate of postoperative lower eyelid symmetry in both groups. Methods: Patients (older than 5 years old) with unilateral MP (58) and AP (20) were included from June 2015 to April 2017. Excluded were patients with previous eyelid surgery, strabismus, levator function of ≤3, and associated procedures. Margin reflex distance (MRD) 1 and 2 and levator function were measured by the same observer before and at least 6 months after the ptosis repair. Results: Lower scleral show was observed in 56.8% and 80% of MP and AP, respectively. Margin reflex distance 2 was significantly (r = −0.37, p = 0.002) associated with MRD1 in the MP group (multiple regression analysis). Both groups showed a significant improvement of MRD2, postoperatively resulting in symmetric MRD2 in 91.4% of MP and 80% of AP group. It was not changed in 43% of MP and 25% of AP group. Multiple regression analysis showed that preoperative MRD2 was the only significant factor associated with postoperative improvement of scleral show in the MP group. Conclusions: Lower scleral show was significantly improved after ptosis repair in both MP and AP. The more severe MP was significantly associated with more severe preoperative scleral show. Preoperative MRD2 was the only factor predicting postoperative improvement of scleral show in the MP. No factor was significantly associated with MRD2 in the AP group. Accepted for publication October 25, 2018. Supported by Iran University Eye Research Center which did not have any role in the design, execution, and presentation of results. The authors have no financial or conflicts of interest to disclose. Presented at annual meeting of European (Bucharest, September 14-15, 2018) and American (Chicago, October 25-26, 2018) Society of Ophthalmic Plastic and Reconstructive Surgery. Address correspondence and reprint requests to Mohsen Bahmani Kashkouli, M.D., Rassoul Akram Hospital, Sattarkhan Niayesh Street, Tehran 1455364, Iran. E-mail: mkashkouli2@gmanil.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Ocular Considerations in Face Transplantation: Report of 2 Cases and Review of the Literature

Purpose: Periorbital injuries are common in face transplantation (FT) candidates. It is therefore essential that the ophthalmologist play a central role in the multidisciplinary treatment of these patients. In this study, the authors perform a comprehensive review of all procedures involving periorbital components, provide an update for the ophthalmology community regarding the current state of the field, and present 2 cases. Methods: A comprehensive review of the literature for all FT procedures including periorbital components was performed. The authors also present 2 patients who received FT including periorbital components for extensive facial disfigurement. One patient sustained high-energy avulsive ballistic injury and underwent a total face, double jaw, and tongue transplant in 2012. The second patient received a total face, eyelids, ears, and skeletal subunits transplant for extensive facial burns in 2015. Results: Literature review demonstrated that 22 (54%) of the 41 patients undergoing FT received allografts containing periorbital components. Only 14 cases (64%) reported on the presence of ocular and periocular complications. The most common complications consisted of lower eyelid ectropion and lagophthalmos, and nearly all required revisional procedures. Both patients presented with significant periorbital scarring and demonstrated good visual acuity and aesthetic outcomes at postoperative follow up between 6 and 28 months. Conclusions: Face transplantation can address extensive facial and periorbital disfigurement with satisfactory functional and aesthetic outcomes. The majority of FT performed to date have included periorbital components, and postoperative ocular and periocular complications are common. It is critical for ophthalmologists to play a central role in the care of these patients. Accepted for publication November 7, 2018. The research was funded by New York University Langone Health, New York City, NY, and a grant from the Office of Naval Research, Arlington, VA (Grant N00014-10-1-0868). The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Eduardo D. Rodriguez, MD, DDS, Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, 305 E 33rd Street, New York, NY 10016. E-mail: eduardo.rodriguez@nyulangone.org © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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A Prospective Comparative Study Between Subcuticular and Sutureless Technique of Skin Closure Following External Dacryocystorhinostomy

Purpose: To compare the cosmetic outcome of the surgical scar of external dacryocystorhinostomy by the subcuticular versus sutureless technique. Methods: This was a prospective interventional randomized control study conducted at tertiary level hospital. Fifty patients of primary-acquired nasolacrimal duct obstruction were included in this study. The control group patients underwent the technique of wound closure in 2 layers, subcutaneous interrupted suture with 6-0 vicryl and superficial skin with 6-0 prolene continuous subcuticular sutures. In the case group, interrupted subcutaneous sutures with 6-0 vicryl with Steristrip for skin apposition was used. The surgical scars were assessed and graded by still photographs on a computer screen by 2 independent observers unaware of the surgical technique used at 2, 6 and 12 weeks postoperatively. Results: The mean scar assessment score by the 2 observers were 2.60 (0.57), 2.04 (0.64), and 1.16 (0.89) in control group and 2.02 (0.65), 1.44 (0.70), and 0.44 (0.61) in case group at 2, 6, and 12 weeks, respectively. Scar grades were analyzed using chi-square test between the 2 group and Wilcoxon signed rank test within the group. The difference between the 2 groups were found to be statistically significant at 2, 6, and 12 weeks (P

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Bony Orbital Volume Expansion in Thyroid Eye Disease

Purpose: To quantify changes to the bony orbital volume (BOV) in patients with thyroid eye disease (TED) relative to normal controls. Methods: In this case–control study, all patients affected with TED seen over a 2-year period were screened for study entry. Eligible participants were adults with clinical evidence of TED and CT scans of their orbits obtained during the course of their routine care. Exclusion criteria included the history of decompression surgery and/or medical or other ophthalmic conditions that could alter the orbital anatomy. The primary outcome was the measurement of the BOV. Secondary outcome measures included the relationships between BOV and muscle volume, fat volume, Hertel measurements, duration of the disease, and the occurrence of dysthyroid optic neuropathy in patients with TED. Three-dimensional reconstructions of the orbits were created to measure BOV, muscle volume, and fat volume. Results: A total of 100 participants were included in the study, contributing 200 orbits. This sample was comprised of 50 patients with TED (37 female, 13 male) and 50 controls (37 female and 13 male). There were no differences between the control and patient groups in age or sex. Of the patients with TED, 14 were diagnosed with dysthyroid optic neuropathy (15 orbits, 1 case was bilateral). The mean (standard deviation [SD]) clinical activity score for males was 4.1 (2.29) and 4.35 (2.63) for females. The mean (SD) BOV for males in the TED group was 28.62 ml (3.47), while that of the control group was 24.59 ml (2.19). This difference was significant (p

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Human Papillomaviru Therapeutics Market, Share, Growth, Trends and Forecast to 2023: Market Study Report - TokeNexa

Human Papillomaviru Therapeutics Market, Share, Growth, Trends and Forecast to 2023: Market Study Report  TokeNexa

Global Human Papillomaviru Therapeutics Market Report focuses on the major drivers and restraints for the key players. These Research Report also provides ...

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Interpace Diagnostics Group Inc (IDXG) Receives Average Rating of “Buy” from Analysts - Fairfield Current

Interpace Diagnostics Group Inc (IDXG) Receives Average Rating of "Buy" from Analysts  Fairfield Current

Shares of Interpace Diagnostics Group Inc (NASDAQ:IDXG) have received a consensus rating of "Buy" from the seven analysts that are covering the company, ...

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Silent Cancer Therapeutics Market Forecast – Industry Value, Market Size, Top Companies and General Trends for 2018-2025 - LiveBitt

Silent Cancer Therapeutics Market Forecast – Industry Value, Market Size, Top Companies and General Trends for 2018-2025  LiveBitt

Global Silent Cancer Therapeutics Market report describes elements such as dominating companies, types, applications, classification, size, SWOT analysis, ...

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Human Papillomaviru Therapeutics Market, Share, Growth, Trends and Forecast to 2023: Market Study Report - TokeNexa

Human Papillomaviru Therapeutics Market, Share, Growth, Trends and Forecast to 2023: Market Study Report  TokeNexa

Global Human Papillomaviru Therapeutics Market Report focuses on the major drivers and restraints for the key players. These Research Report also provides ...

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Interpace Diagnostics Group Inc (IDXG) Receives Average Rating of “Buy” from Analysts - Fairfield Current

Interpace Diagnostics Group Inc (IDXG) Receives Average Rating of "Buy" from Analysts  Fairfield Current

Shares of Interpace Diagnostics Group Inc (NASDAQ:IDXG) have received a consensus rating of "Buy" from the seven analysts that are covering the company, ...

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Silent Cancer Therapeutics Market Forecast – Industry Value, Market Size, Top Companies and General Trends for 2018-2025 - LiveBitt

Silent Cancer Therapeutics Market Forecast – Industry Value, Market Size, Top Companies and General Trends for 2018-2025  LiveBitt

Global Silent Cancer Therapeutics Market report describes elements such as dominating companies, types, applications, classification, size, SWOT analysis, ...

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Mast Cell Granules: Modulating adaptive immune response remotely

(Source: Journal of Allergy and Clinical Immunology)

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Associations of urban greenness with asthma and respiratory symptoms in Mexican American children

Asthma is one of the most common childhood chronic conditions with approximately 19 million adults and seven million children affected in the United States alone. 1 The etiology of asthma and other allergic conditions is not fully understood, but environmental and lifestyle factors have been implicated in the inception of these conditions. In the United States, the prevalence of asthma and asthma related symptoms is disproportionately high in urban poor neighborhoods.2-4 Although this might be due partly to sociodemographic factors, studies have suggested that urbanization and its detrimental impact on the natural environment and lifestyle might increase the risk of respiratory conditions. (Source: Annals of Allergy, Asthma and Immunology)

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Effects of Intimate Partner Violence and Home Environment on Child Language Development in the First 3 Years of Life

ABSTRACT: Objective: Intimate partner violence (IPV) can adversely affect children's cognitive development, but links between IPV exposure and language development in the earliest years of life remain unknown. The present study examined the effects of IPV and the quality of the home environment on children's language development at age 3 years. Methods: In a prospective, 5-panel, longitudinal study of 79 mother-child dyads assessed prenatally to age 3 years, we examined standardized measures of receptive and expressive language development at age 3 years. Predictors and covariates included measures of IPV, characteristics of the home environment, maternal education, and maternal depression. Results: Regression analyses indicated a significant main effect of the home environment and maternal education on receptive language, with more supportive homes and more educated mothers at age 1 year linked to better child receptive language at age 3 years. Higher maternal education also significantly predicted better child expressive language at age 3 years. Early exposure to IPV had a direct adverse effect on children's expressive language development; however, interaction analyses indicated that this association was moderated by the quality of the home environment. Specifically, IPV adversely affected expressive language even when home quality was high, indicating that a supportive and stimulating home environment did not buffer effects of IPV on expressive language development. Conclusions: Intimate partner violence may adversely affect expressive language, even in positive home environments. Early language skill is an important predictor of later academic readiness and psychological development; therefore, children from at-risk home environments should be screened and monitored early for intervention. Address for reprints: Catherine C. Peterson, PhD, Department of Psychology, Eastern Michigan University, 361F Science Complex, Ypsilanti, MI 48197; e-mail: cpeter39@emich.edu. This study was funded by the American Psychoanalytic Association (waves 1–3), Psi Chi International Honor Society in Psychology (wave 4), the International Psychoanalytic Association (waves 4–5), and Eastern Michigan University (various waves through awarded faculty research fellowships). Portions of these findings were presented as a poster at the 2017 Society for Research in Child Development Biennial Conference. Disclosure: The authors declare no conflict of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jdbp.org). Received November , 2017 Accepted October , 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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A case of recurrent MOG antibody positive bilateral optic neuritis and anti-NMDAR encephalitis: Different biological evolution of the two associated antibodies

We report the clinical association of myelin-oligodendrocyte-glycoprotein (MOG) IgG-associated encephalomyelitis (MOG-EM) and anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis. A 47-year old male presented to our hospital with right eye optic neuritis in February 2018. He had a history of recurrent bilateral optic neuritis since 2001 and in 2013 was treated of a anti-NMDAR encephalitis. He never had any CNS demyelination event besides optic neuritis. At the time of anti-NMDAR encephalitis both NMDAR and MOG antibodies were positive in serum and CSF. (Source: Journal of Neuroimmunology)

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Effects of Intimate Partner Violence and Home Environment on Child Language Development in the First 3 Years of Life

ABSTRACT: Objective: Intimate partner violence (IPV) can adversely affect children's cognitive development, but links between IPV exposure and language development in the earliest years of life remain unknown. The present study examined the effects of IPV and the quality of the home environment on children's language development at age 3 years. Methods: In a prospective, 5-panel, longitudinal study of 79 mother-child dyads assessed prenatally to age 3 years, we examined standardized measures of receptive and expressive language development at age 3 years. Predictors and covariates included measures of IPV, characteristics of the home environment, maternal education, and maternal depression. Results: Regression analyses indicated a significant main effect of the home environment and maternal education on receptive language, with more supportive homes and more educated mothers at age 1 year linked to better child receptive language at age 3 years. Higher maternal education also significantly predicted better child expressive language at age 3 years. Early exposure to IPV had a direct adverse effect on children's expressive language development; however, interaction analyses indicated that this association was moderated by the quality of the home environment. Specifically, IPV adversely affected expressive language even when home quality was high, indicating that a supportive and stimulating home environment did not buffer effects of IPV on expressive language development. Conclusions: Intimate partner violence may adversely affect expressive language, even in positive home environments. Early language skill is an important predictor of later academic readiness and psychological development; therefore, children from at-risk home environments should be screened and monitored early for intervention. Address for reprints: Catherine C. Peterson, PhD, Department of Psychology, Eastern Michigan University, 361F Science Complex, Ypsilanti, MI 48197; e-mail: cpeter39@emich.edu. This study was funded by the American Psychoanalytic Association (waves 1–3), Psi Chi International Honor Society in Psychology (wave 4), the International Psychoanalytic Association (waves 4–5), and Eastern Michigan University (various waves through awarded faculty research fellowships). Portions of these findings were presented as a poster at the 2017 Society for Research in Child Development Biennial Conference. Disclosure: The authors declare no conflict of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jdbp.org). Received November , 2017 Accepted October , 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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A case of recurrent MOG antibody positive bilateral optic neuritis and anti-NMDAR encephalitis: Different biological evolution of the two associated antibodies

We report the clinical association of myelin-oligodendrocyte-glycoprotein (MOG) IgG-associated encephalomyelitis (MOG-EM) and anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis. A 47-year old male presented to our hospital with right eye optic neuritis in February 2018. He had a history of recurrent bilateral optic neuritis since 2001 and in 2013 was treated of a anti-NMDAR encephalitis. He never had any CNS demyelination event besides optic neuritis. At the time of anti-NMDAR encephalitis both NMDAR and MOG antibodies were positive in serum and CSF. (Source: Journal of Neuroimmunology)

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The Relationship of Exhaled Nitric Oxide with Ethnicity and Gender in Rural Georgia YouthAuthors

Nitric oxide is produced by the human bronchial epithelium1 and is associated with airway eosinophilic inflammation seen in asthmatics and other airway diseases.2 Airway inflammation is a characteristic of asthma, along with airway hyper-responsiveness and airway obstruction. Inhaled corticosteroids (ICS) to treat the inflammation are a mainstay of asthma treatment. Measurement of exhaled nitric oxide (eNO) as a biomarker of eosinophilic inflammation is noninvasive, safe, reproducible, and easy to perform; however, the clinical value of measurements has been limited by imprecise reference ranges. (Source: Annals of Allergy, Asthma and Immunology)

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Mast Cell Granules: Modulating adaptive immune response remotely

(Source: Journal of Allergy and Clinical Immunology)

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Nonmelanoma skin cancer of the head and neck region in solid organ transplant recipients

Abstract

Background

Nonmelanoma skin cancers (NMSC) are the most common malignancies in solid organ recipients. We investigated the incidence, clinical features, and outcome of solid organ recipients with NMSC of the head and neck.

Methods

A retrospective chart review was conducted for solid organ recipients who were treated from 1992 to 2015 and who developed NMSC of the head and neck.

Results

Of 3339 organ recipients, 259 patients developed 697 head and neck NMSC. Squamous cell carcinoma was the most common malignancy (55%). The overall 5‐year and 10‐year survival was 68% and 45%. Kidney recipients had better survival outcome than other organ recipients (10 vs 7 years). Advanced‐stage cancers (10%), aggressive patterns of tumors (21%), and treatment with Prograf and Cellcept were associated with increased disease‐specific mortality.

Conclusion

Solid organ transplant increases the risk of NMSC of the head and neck. Aggressive tumors decrease patient survival and warrant more decisive and multidisciplinary approach.

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Compatibility of CO2 laser surgery and fluorescence detection in head and neck cancer cells

Abstract

Background

Surgical treatment of cancer requires tumor excision with emphasis on function preservation which is achieved in (early stage) laryngeal cancer by transoral carbon dioxide (CO₂) laser surgery. Whereas conventional laser surgery is restricted by the surgeon's visual recognition of tumor tissue, new approaches based on fluorescence‐guided surgery (FGS) improve the detection of the tumor and its margin. However, it is unclear whether fluorophores are compatible with high‐power laser application or whether precision is compromised by laser‐induced bleaching of the dye.

Methods

We applied topology‐controlled 3D laser resection of fluorescent tumors cell in vitro and laser‐induced autofluorescence analysis ex vivo.

Results

Laser‐induced bleaching of fluorescent dyes in the visible and near‐infrared light spectrum (650‐900 nm) ranges below the resolution range of operation microscopes. Furthermore, specific fluorescent signals in an FGS mouse model is 10⁴ higher than laser‐induced autofluorescence in mouse tissue.

Conclusion

Laser‐induced lateral photobleaching is negligible indicating a path forward for fluorescence‐guided laser surgery in head and neck cancer.

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Diagnostic value of computed tomography combined with ultrasonography in detecting cervical recurrence in patients with thyroid cancer

Abstract

Background

To determine the diagnostic role of CT added to ultrasound for the diagnosis of recurrent differentiated thyroid cancer (DTC) and to evaluate potential benefits for patients.

Methods

A total of 193 patients with recurrent DTC were retrospectively included. The diagnostic performances of ultrasound and combination of ultrasound and CT (ultrasound/CT) in detecting recurrence were compared. Benefits of CT were assessed based on the presence of any recurrence detected only with additional CT.

Results

In detecting cervical recurrence, ultrasound/CT showed higher sensitivity (P = .001) and lower specificity (P < .001) than ultrasound alone, overall resulting in higher area under the curve (P < .001). Seventy‐nine patients (40.9%) benefited from additional CT in detecting recurrence.

Conclusion

For reoperation of cervical recurrence in patients with DTC, addition of CT to ultrasound offers better surgical planning by enhancing detection of recurrent cancers that were overlooked with ultrasound alone.

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Letter to the Editor regarding “Carbon dioxide embolism during transoral robotic thyroidectomy: A case report”

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Factors associated with gastrostomy tube dependence following salvage total laryngectomy with microvascular free tissue transfer

Abstract

Background

Following salvage total laryngectomy (STL) with microvascular‐free tissue transfer (MFTT), patients are at high risk for swallowing dysfunction, but risk factors for persistent gastrostomy tube (G‐tube) dependence are unknown.

Methods

Retrospective review of 33 patients who underwent STL with MFTT.

Results

A total oral diet was achieved by 81% of patients with ≥6 months of postoperative follow‐up. Approximately 27% of patients were G‐tube dependent preoperatively with 67% achieving a total oral diet postoperatively. Factors associated with persistent G‐tube dependence included pT4 tumor, pN2+ status, more extensive pharyngectomy, and re‐irradiation. Strictures occurred in 30% of patients and were associated with more extensive pharyngectomy and tubed reconstruction.

Conclusions

For patients undergoing STL with MFTT, the majority of patients achieve a total oral diet regardless of their preoperative swallowing function. Advanced‐stage recurrent tumors and increased extent of pharyngectomy contribute to poorer swallowing outcomes.

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Serum matrix metalloproteinase 8 and tissue inhibitor of metalloproteinase 1: Potential markers for malignant transformation of recurrent respiratory papillomatosis and for prognosis of laryngeal cancer

Abstract

Background

Biomarkers that could predict malignant transformation of recurrent respiratory papillomatosis (RRP) would be useful in patient follow‐up. We investigated whether serum matrix metalloproteinase 8 (MMP‐8) and tissue inhibitor of metalloproteinase 1 (TIMP‐1) could predict malignant transformation of RRP and whether they associate with survival in laryngeal squamous cell carcinoma (LSCC) without preexisting RRP.

Methods

We analyzed serum MMP‐8 (S‐MMP‐8) and serum TIMP‐1 (s‐TIMP‐1) in 114 patients: 55 were treated for RRP and 59 for LSCC without preexisting RRP. Five patients with RRP developed LSCC during follow‐up.

Results

Elevated S‐MMP‐8 level in RRP was associated with malignant transformation (P = .01). Compared to patients with RRP, S‐MMP‐8 in patients with LSCC was significantly higher (P < .001). Increased S‐TIMP‐1 level in LSCC was associated with poor overall survival (P = .02) and recurrence‐free survival (P = .05).

Conclusion

In RRP, high S‐MMP‐8 may predict malignant transformation. In LSCC, elevated S‐TIMP‐1 is connected to poor survival.

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Role and regulation of proapoptotic Bax in oral squamous cell carcinoma and drug resistance

Abstract

Background

Bax, a proapoptotic protein but its regulation during oral cancer progression and resistance remains elusive.

Methods

A total of 127 samples including adjacent normal, primary tumor, and resistance to chemoradiation therapy (RCRT) samples from oral squamous cell carcinoma (OSCC) patients were used. The status of Bax was analyzed at DNA/mRNA/protein levels and the results were correlated with p53 and Akt expression in tissue samples/cisplatin‐resistant oral tongue SCC (SCC9/SCC4‐CisR) cell line.

Results

Frequent progressive decrease of Bax expression with infrequent promoter methylation, polymorphisms G(‐248)A, and mutations was observed in OSCC progression/resistance. Furthermore, by targeting Akt pathway, induction of Bax‐dependent cell death was observed and this was further enhanced with nimbolide treatment in SCC9/SCC4‐CisR cells.

Conclusion

Hence, the Bax gene alteration and its deregulation through p53/Akt pathway are important for OSCC progression and drug resistance. Akt Inhibitor VIII and nimbolide synergistically induce Bax, and it is therefore beneficial for chemosensitizing cisplatin‐resistant human OSCC.

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Population analysis of socioeconomic status and otolaryngologist distribution on head and neck cancer outcomes

Abstract

Background

The relationship between clinical outcomes and geographic determinants is not well known for head and neck cancer. Socioeconomic status (SES) factors and the distribution of health care resources might impact outcomes.

Methods

Head and neck cancer cases in the Surveillance, Epidemiology, and End Results (SEER) database were studied. Patient‐level prognostic factors were identified from the SEER, and county‐level factors were identified from the Area Health Resource File. Stage at presentation and observed survival were the outcomes of interest, with predictive factors identified by multivariate logistic and Cox proportional hazards regression.

Results

On multivariate analysis, tumor site, sex, race, marital status, rural residence, and county poverty level predicted stage at presentation. Sex, race, marital status, county‐level poverty, and number of otolaryngologists predicted observed survival.

Conclusion

Adverse county‐level SES predicted advanced cancer stage at presentation and diminished observed survival. SES was a stronger predictor of patient outcomes than rurality or number of otolaryngologists.

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Posttreatment surveillance PET/CT for HPV‐associated oropharyngeal cancer

Abstract

Background

Surveillance positron emission tomography‐computed tomography (PET/CT) is commonly used for treatment assessment of radiation therapy in head and neck cancer. However, human papillomavirus‐associated oropharyngeal squamous cell carcinoma (HPV+OPSCC) patients represent a unique subpopulation, for which the utility of surveillance PET/CT has not been well studied.

Methods

In this retrospective chart review comprising 233 HPV+OPSCC patients, we evaluated surveillance PET/CT for diagnostic accuracy, downstream clinical impact, and survival.

Results

Surveillance PET/CT demonstrated 100% negative predictive value and sensitivity, 59.9% specificity, and 13.4% positive predictive value. Surveillance PET/CT led to 90 imaging studies and 31 biopsies; 91.1% and 77.4% were negative for recurrence, respectively. Surveillance PET/CT led to meaningful salvage therapy in 1.6% of cases. PET/CT‐detected recurrences did not have improved survival compared to clinically detected recurrences.

Conclusion

For HPV+OPSCC patients, surveillance PET/CTs frequently lead to unnecessary testing and rarely to meaningful disease salvage. They have no demonstrated survival benefit and should be interpreted cautiously to prevent patient harm.

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Randomized phase II/III confirmatory treatment selection design with a change of survival end points: Statistical design of Radiation Therapy Oncology Group 1216

Abstract

Background

To confirm the treatment effects of concurrent cetuximab plus docetaxel observed in Radiation Therapy Oncology Group (RTOG) 0234 and single out the effect of cetuximab, we designed RTOG 1216, a randomized phase II/III study, which uses an intermediate end point to select the best regimen for definitive testing of survival benefit.

Methods

In phase II, the best regimen should demonstrate statistically significant efficacy against the control with predefined advantage over the competing arm regarding disease‐free survival (DFS). We evaluate operating characteristics of the randomized II/III group sequential design through simulations and numerical integrations under the null and various alternative hypotheses.

Results

Results show the randomized II/III design yields substantial savings on sample size and time with well‐controlled type I and type II error rates.

Conclusion

Overall, the proposed randomized II/III design has desirable properties that offer cost effectiveness, operational efficiency, and, most importantly, scientific innovation that can be considered for similar clinical research settings.

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HLA class II expression on tumor cells and low numbers of tumor‐associated macrophages predict clinical outcome in oropharyngeal cancer

Abstract

Background

Human papillomavirus (HPV)‐positive oropharyngeal squamous cell carcinoma (OPSCC) is a highly immunogenic tumor and differences in tumor microenvironment might contribute to the improved survival of HPV‐positive OPSCC patient.

Methods

A comprehensive multivariate analysis with clinical and immune variables (human leukocyte antigen [HLA] I/II, programmed death ligand 1 (PD‐L1), programmed death receptor 1 (PD1), T cells, and macrophages) was performed in 142 OPSCC patients.

Results

We found an inverse correlation between the expression of HLA class II molecules on tumor cells and CD68+ CD163+ tumor‐associated macrophages (TAMs). High HLA‐DP/DQ/DR expression and low number of TAMs were associated with longer disease‐specific survival and disease‐free survival (DFS). Furthermore, a new population of CD8+ FoxP3+ T cells was correlated with shorter DFS in multivariate analysis.

Conclusions

\We identified new prognostic markers for patients with oropharyngeal cancer, which can be used for selecting patients that can benefit from immunotherapy.

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Heterozygosity of p16 expression in an oral squamous cell carcinoma with associated loss of heterozygosity and copy number alterations

Abstract

Background

Oral field cancerization describes a multifocal development process involving many cells at once in response to prolong exposure to carcinogens. This case demonstrated differential p16 expression in different sections of the same HPV negative tumor on the floor of mouth in a patient with history of prolonged smoking.

Methods

Histological examination, presence of HPV infection and OncoScan analysis of DNA extracted from two well‐defined areas with different p16 expression profiles were performed.

Results

Histological and immunochemical analysis revealed the presence of a dual architectural pattern squamous cell carcinoma with a p16 negative and a p16 positive component. OncoScan analysis showed genetic changes that define field cancerization of the p16 negative tumor as revealed by mosaicism in both loss of heterozygosity and copy number alterations in cancer‐associated genes located on 3p, 7p, 9p 11q, and 17p.

Conclusion

These changes were indicative of field cancerization in response to tobacco exposure.

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HED‐17‐0417—AHNS series: Do you know your guidelines? A review of current knowledge on laryngeal cancer

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Postoperative volumetric modulated arc therapy for sinonasal cancer: Improved survival compared with 3D conformal radiation therapy

Abstract

Background

Prospective evaluation of the results of volumetric modulated arc therapy (VMAT) for sinonasal cancer compared to 3D conformal radiation therapy (3DCRT).

Materials and Methods

We prospectively evaluated 34 patients (pts) treated with postoperative VMAT with simultaneous integrated boost (SIB; RapidArc) from 2011 to 2015. These pts were retrospectively compared with 24 pts treated with 3DCRT from 2003 to 2011. The two sets were not significantly different on sex, mean age, tumor site, stage, histology. Efficacy and toxicity were evaluated.

Results

Median follow‐up was 45 months (range: 6‐143 months). Three‐year overall survival was 85.2% in VMAT‐SIB versus 65.2% in 3DCRT (P = .02). Three‐year local control was 81.2% in VMAT‐SIB versus 62.5% in 3DCRT (P = .04). There was a reduction of acute (<0.09) and late (0.03) ocular toxicity of grade ≥ 2 for pts with VMAT‐SIB.

Conclusion

VMAT significantly improved local control and overall survival in sinonasal cancer with lower rate of toxicity.

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Gland‐preserving surgery for salivary stones and the utility of sialendoscopes

Abstract

Background

Sialoendoscopy is the standard treatment for sialolithiasis; however, some patients may be unlikely to benefit from an endoscopic approach. This study assesses predictors of failure in the endoscopic management of sialoliths.

Methods

Patients treated for sialolithiasis from 2012 to 2017 at two centers were stratified into 3 groups: successful interventional sialendoscopy, incisional sialolithotomy, and gland excision. Patient, disease, and surgical factors were compared.

Results

Interventional sialendoscopy was attempted in 156 of 206 cases and successful for 42 (27%). Endoscopically retrieved calculi were smaller (4.96 mm) compared to incisional sialolithotomy (7.90 mm). Nonendoscopic approaches were required more often in submandibular cases 87% (P ≤ .005). Palpable stones were present in 74% of incisional sialolithotomies (P < .001). Submandibular location (OR 3.50, 1.53‐7.98), palpability (OR 2.74, 1.21‐6.18), CT localization (OR 3.05, 1.32‐7.10, P = .010), and increased diameter (OR 1.25, 1.09‐1.44) were predictive of incisional management.

Conclusion

Stone size/location, CT‐localization, and palpability were predictive of calculi that require an incisional approach. If these factors are recognized, the surgeon can consider proceeding directly to incisional sialolithotomy.

Level of evidence

III

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Translation and validation of the MD Anderson Dysphagia Inventory (MDADI) for Spanish‐speaking patients

Abstract

Background

The main objective of this study was to perform the adaptation and cultural translation and validation of the MD Anderson Dysphagia Inventory (MDADI) questionnaire for the Spanish language.

Methods

A total of 69 patients were diagnosed with head and neck cancer treated with surgery; radiotherapy and chemoradiotherapy were included. MDADI was translated and a feasibility, internal consistency, test‐retest reliability, and construct validity were assessed.

Results

The mean overall score of the MDADI was 51.9 (18‐85). Internal consistency for total score was 0.908. The overall score of intraclass correlation coefficient was 0.98 and kappa coefficient scores were almost perfect (test‐retest reliability). All domains of MDADI were significantly correlated with physical and mental domains of the SF‐12. Construct validity was also evaluated with food texture measures, and with TNM classification.

Conclusion

The translation and validation of the Spanish version of the MDADI was performed and can be considered an important patient‐reported outcomes tool for dysphagia‐related quality of life.

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Clinical significance and peculiarities of succinate dehydrogenase B and hypoxia inducible factor 1α expression in parasympathetic versus sympathetic paragangliomas

Abstract

Background

Succinate dehydrogenase subunit B (SDHB) immunohistochemistry was considered a valuable tool to identify patients with inherited paraganglioma/pheochromocytoma (PGL/PCC). However, previous studies jointly analyzed 2 related but clinically distinct entities, parasympathetic head and neck paragangliomas (HNPGLs) and sympathetic PCCs/PGLs. Additionally, a role for hypoxia inducible factor‐1α (HIF‐1α) as a biomarker for succinate dehydrogenase (SDHx)‐mutated tumors has not been studied. Here, we evaluated the utility of SDHB/HIF‐1α proteins in HNPGLs and PCCs/PGLs as clinically useful biomarkers.

Methods

The SDHB/succinate dehydrogenase subunit A (SDHA)/HIF‐1α immunohistochemistry analysis was performed in 158 genetically defined patients.

Results

Similarly to PCCs/PGLs, SDHB immune‐negativity correlated with SDHx‐mutations in HNPGLs (P < .0001). The HIF‐1α stabilization was associated with SDHx‐mutations in HNPGLs (P = .020), not in PCCs/PGLs (P = .319). However, 25% of SDHx‐HNPGLs lacked HIF‐1α positive cells.

Conclusion

As in PCCs/PGLs, SDHB immunohistochemistry in HNPGLs is a valuable method for identification of candidates for SDHx‐genetic testing. On the contrary, although SDHx mutations may favor HIF‐1α stabilization in HNPGLs, this is not a clinically useful biomarker.

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Contemporary management of primary parapharyngeal space tumors

Abstract

The parapharyngeal space is a complex anatomical area. Primary parapharyngeal tumors are rare tumors and 80% of them are benign. A variety of tumor types can develop in this location; most common are salivary gland neoplasm and neurogenic tumors. The management of these tumors has improved greatly owing to the developments in imaging techniques, surgery, and radiotherapy. Most tumors can be removed with a low rate of complications and recurrence. The transcervical approach is the most frequently used. In some cases, minimally invasive approaches may be used alone or in combination with a limited transcervical route, allowing large tumors to be removed by reducing morbidity of expanded approaches. An adequate knowledge of the anatomy and a careful surgical plan is essential to tailor management according to the patient and the tumor. The purpose of the present review was to update current aspects of knowledge related to this more challenging area of tumor occurrence.

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Heterozygosity of p16 expression in an oral squamous cell carcinoma with associated loss of heterozygosity and copy number alterations

Abstract

Background

Oral field cancerization describes a multifocal development process involving many cells at once in response to prolong exposure to carcinogens. This case demonstrated differential p16 expression in different sections of the same HPV negative tumor on the floor of mouth in a patient with history of prolonged smoking.

Methods

Histological examination, presence of HPV infection and OncoScan analysis of DNA extracted from two well‐defined areas with different p16 expression profiles were performed.

Results

Histological and immunochemical analysis revealed the presence of a dual architectural pattern squamous cell carcinoma with a p16 negative and a p16 positive component. OncoScan analysis showed genetic changes that define field cancerization of the p16 negative tumor as revealed by mosaicism in both loss of heterozygosity and copy number alterations in cancer‐associated genes located on 3p, 7p, 9p 11q, and 17p.

Conclusion

These changes were indicative of field cancerization in response to tobacco exposure.

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Clinical significance and peculiarities of succinate dehydrogenase B and hypoxia inducible factor 1α expression in parasympathetic versus sympathetic paragangliomas

Abstract

Background

Succinate dehydrogenase subunit B (SDHB) immunohistochemistry was considered a valuable tool to identify patients with inherited paraganglioma/pheochromocytoma (PGL/PCC). However, previous studies jointly analyzed 2 related but clinically distinct entities, parasympathetic head and neck paragangliomas (HNPGLs) and sympathetic PCCs/PGLs. Additionally, a role for hypoxia inducible factor‐1α (HIF‐1α) as a biomarker for succinate dehydrogenase (SDHx)‐mutated tumors has not been studied. Here, we evaluated the utility of SDHB/HIF‐1α proteins in HNPGLs and PCCs/PGLs as clinically useful biomarkers.

Methods

The SDHB/succinate dehydrogenase subunit A (SDHA)/HIF‐1α immunohistochemistry analysis was performed in 158 genetically defined patients.

Results

Similarly to PCCs/PGLs, SDHB immune‐negativity correlated with SDHx‐mutations in HNPGLs (P < .0001). The HIF‐1α stabilization was associated with SDHx‐mutations in HNPGLs (P = .020), not in PCCs/PGLs (P = .319). However, 25% of SDHx‐HNPGLs lacked HIF‐1α positive cells.

Conclusion

As in PCCs/PGLs, SDHB immunohistochemistry in HNPGLs is a valuable method for identification of candidates for SDHx‐genetic testing. On the contrary, although SDHx mutations may favor HIF‐1α stabilization in HNPGLs, this is not a clinically useful biomarker.

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Population analysis of socioeconomic status and otolaryngologist distribution on head and neck cancer outcomes

Abstract

Background

The relationship between clinical outcomes and geographic determinants is not well known for head and neck cancer. Socioeconomic status (SES) factors and the distribution of health care resources might impact outcomes.

Methods

Head and neck cancer cases in the Surveillance, Epidemiology, and End Results (SEER) database were studied. Patient‐level prognostic factors were identified from the SEER, and county‐level factors were identified from the Area Health Resource File. Stage at presentation and observed survival were the outcomes of interest, with predictive factors identified by multivariate logistic and Cox proportional hazards regression.

Results

On multivariate analysis, tumor site, sex, race, marital status, rural residence, and county poverty level predicted stage at presentation. Sex, race, marital status, county‐level poverty, and number of otolaryngologists predicted observed survival.

Conclusion

Adverse county‐level SES predicted advanced cancer stage at presentation and diminished observed survival. SES was a stronger predictor of patient outcomes than rurality or number of otolaryngologists.

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Nonmelanoma skin cancer of the head and neck region in solid organ transplant recipients

Abstract

Background

Nonmelanoma skin cancers (NMSC) are the most common malignancies in solid organ recipients. We investigated the incidence, clinical features, and outcome of solid organ recipients with NMSC of the head and neck.

Methods

A retrospective chart review was conducted for solid organ recipients who were treated from 1992 to 2015 and who developed NMSC of the head and neck.

Results

Of 3339 organ recipients, 259 patients developed 697 head and neck NMSC. Squamous cell carcinoma was the most common malignancy (55%). The overall 5‐year and 10‐year survival was 68% and 45%. Kidney recipients had better survival outcome than other organ recipients (10 vs 7 years). Advanced‐stage cancers (10%), aggressive patterns of tumors (21%), and treatment with Prograf and Cellcept were associated with increased disease‐specific mortality.

Conclusion

Solid organ transplant increases the risk of NMSC of the head and neck. Aggressive tumors decrease patient survival and warrant more decisive and multidisciplinary approach.

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HLA class II expression on tumor cells and low numbers of tumor‐associated macrophages predict clinical outcome in oropharyngeal cancer

Abstract

Background

Human papillomavirus (HPV)‐positive oropharyngeal squamous cell carcinoma (OPSCC) is a highly immunogenic tumor and differences in tumor microenvironment might contribute to the improved survival of HPV‐positive OPSCC patient.

Methods

A comprehensive multivariate analysis with clinical and immune variables (human leukocyte antigen [HLA] I/II, programmed death ligand 1 (PD‐L1), programmed death receptor 1 (PD1), T cells, and macrophages) was performed in 142 OPSCC patients.

Results

We found an inverse correlation between the expression of HLA class II molecules on tumor cells and CD68+ CD163+ tumor‐associated macrophages (TAMs). High HLA‐DP/DQ/DR expression and low number of TAMs were associated with longer disease‐specific survival and disease‐free survival (DFS). Furthermore, a new population of CD8+ FoxP3+ T cells was correlated with shorter DFS in multivariate analysis.

Conclusions

\We identified new prognostic markers for patients with oropharyngeal cancer, which can be used for selecting patients that can benefit from immunotherapy.

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Relationship between oral intake, patient perceived swallowing impairment, and objective videofluoroscopic measures of swallowing in patients with head and neck cancer

Abstract

Background

We aimed to: (1) examine relationships between the Functional Oral Intake Scale (FOIS), Eating Assessment Tool‐10 (EAT‐10), and objective measures of swallowing (Modified Barium Swallow Impairment Profile [MBSImP©] and penetration‐aspiration scale [PAS]) in patients with head and neck cancer, (2) compare outcomes between oral intake vs tube‐dependent patients, and (3) compare outcomes across time points.

Methods

A total of 58 patients with head and neck cancer completed the FOIS, EAT‐10, and underwent a standardized videofluoroscopy (VFSS). VFSS were analyzed using the PAS and MBSImP©. Nonparametric analyses were performed.

Results

A relationship between the FOIS and EAT‐10 (r = −0.46; P < .001) was revealed. No other associations were observed (P < .05). Feeding status did not impact PAS or MBSImP©; however, patients with head and neck cancer who were tube dependent demonstrated higher (worse) EAT‐10 scores (P = .01).

Conclusions

In this cohort, a relationship between patient‐perceived swallowing impairment and functional oral intake was revealed; however, no associations were observed between the FOIS and objective measures of swallowing impairment or swallowing safety.

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Factors associated with gastrostomy tube dependence following salvage total laryngectomy with microvascular free tissue transfer

Abstract

Background

Following salvage total laryngectomy (STL) with microvascular‐free tissue transfer (MFTT), patients are at high risk for swallowing dysfunction, but risk factors for persistent gastrostomy tube (G‐tube) dependence are unknown.

Methods

Retrospective review of 33 patients who underwent STL with MFTT.

Results

A total oral diet was achieved by 81% of patients with ≥6 months of postoperative follow‐up. Approximately 27% of patients were G‐tube dependent preoperatively with 67% achieving a total oral diet postoperatively. Factors associated with persistent G‐tube dependence included pT4 tumor, pN2+ status, more extensive pharyngectomy, and re‐irradiation. Strictures occurred in 30% of patients and were associated with more extensive pharyngectomy and tubed reconstruction.

Conclusions

For patients undergoing STL with MFTT, the majority of patients achieve a total oral diet regardless of their preoperative swallowing function. Advanced‐stage recurrent tumors and increased extent of pharyngectomy contribute to poorer swallowing outcomes.

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HED‐17‐0417—AHNS series: Do you know your guidelines? A review of current knowledge on laryngeal cancer

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Diagnostic value of computed tomography combined with ultrasonography in detecting cervical recurrence in patients with thyroid cancer

Abstract

Background

To determine the diagnostic role of CT added to ultrasound for the diagnosis of recurrent differentiated thyroid cancer (DTC) and to evaluate potential benefits for patients.

Methods

A total of 193 patients with recurrent DTC were retrospectively included. The diagnostic performances of ultrasound and combination of ultrasound and CT (ultrasound/CT) in detecting recurrence were compared. Benefits of CT were assessed based on the presence of any recurrence detected only with additional CT.

Results

In detecting cervical recurrence, ultrasound/CT showed higher sensitivity (P = .001) and lower specificity (P < .001) than ultrasound alone, overall resulting in higher area under the curve (P < .001). Seventy‐nine patients (40.9%) benefited from additional CT in detecting recurrence.

Conclusion

For reoperation of cervical recurrence in patients with DTC, addition of CT to ultrasound offers better surgical planning by enhancing detection of recurrent cancers that were overlooked with ultrasound alone.

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Role and regulation of proapoptotic Bax in oral squamous cell carcinoma and drug resistance

Abstract

Background

Bax, a proapoptotic protein but its regulation during oral cancer progression and resistance remains elusive.

Methods

A total of 127 samples including adjacent normal, primary tumor, and resistance to chemoradiation therapy (RCRT) samples from oral squamous cell carcinoma (OSCC) patients were used. The status of Bax was analyzed at DNA/mRNA/protein levels and the results were correlated with p53 and Akt expression in tissue samples/cisplatin‐resistant oral tongue SCC (SCC9/SCC4‐CisR) cell line.

Results

Frequent progressive decrease of Bax expression with infrequent promoter methylation, polymorphisms G(‐248)A, and mutations was observed in OSCC progression/resistance. Furthermore, by targeting Akt pathway, induction of Bax‐dependent cell death was observed and this was further enhanced with nimbolide treatment in SCC9/SCC4‐CisR cells.

Conclusion

Hence, the Bax gene alteration and its deregulation through p53/Akt pathway are important for OSCC progression and drug resistance. Akt Inhibitor VIII and nimbolide synergistically induce Bax, and it is therefore beneficial for chemosensitizing cisplatin‐resistant human OSCC.

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Postoperative volumetric modulated arc therapy for sinonasal cancer: Improved survival compared with 3D conformal radiation therapy

Abstract

Background

Prospective evaluation of the results of volumetric modulated arc therapy (VMAT) for sinonasal cancer compared to 3D conformal radiation therapy (3DCRT).

Materials and Methods

We prospectively evaluated 34 patients (pts) treated with postoperative VMAT with simultaneous integrated boost (SIB; RapidArc) from 2011 to 2015. These pts were retrospectively compared with 24 pts treated with 3DCRT from 2003 to 2011. The two sets were not significantly different on sex, mean age, tumor site, stage, histology. Efficacy and toxicity were evaluated.

Results

Median follow‐up was 45 months (range: 6‐143 months). Three‐year overall survival was 85.2% in VMAT‐SIB versus 65.2% in 3DCRT (P = .02). Three‐year local control was 81.2% in VMAT‐SIB versus 62.5% in 3DCRT (P = .04). There was a reduction of acute (<0.09) and late (0.03) ocular toxicity of grade ≥ 2 for pts with VMAT‐SIB.

Conclusion

VMAT significantly improved local control and overall survival in sinonasal cancer with lower rate of toxicity.

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Kinetics of indocyanine green: Optimizing tumor to normal tissue fluorescence in image‐guided oral cancer surgery applications

Abstract

Background

The study aimed to define indocyanine green (ICG) kinetics to determine the optimal ICG dose and surgical time for near‐infrared fluorescence‐guided oral cancer surgery.

Methods

Spectrometer and grayscale digital imaging were used to quantify the ICG kinetics in 12 patients with oral cancer. The fluorescence intensity and signal‐to‐background ratio (SBR) of tumor and normal tissue were tested at 1, 6, and 24 hours after ICG injection.

Results

The greatest contrast in the fluorescence intensity between tumor and normal tissue was observed at 6 hours (P < .01), and of three dose groups (0.5, 0.75, and 1.0 mg/kg), 0.75 mg/kg showed the highest SBR (2.06 ± 0.23) after ICG injection.

Conclusions

Fluorescence quantification based on spectrometry and grayscale imaging could be effective in determining the optimal ICG dose and surgical time after ICG injection in this cohort of patients with oral cancer.

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Letter to the Editor regarding “Carbon dioxide embolism during transoral robotic thyroidectomy: A case report”

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Posttreatment surveillance PET/CT for HPV‐associated oropharyngeal cancer

Abstract

Background

Surveillance positron emission tomography‐computed tomography (PET/CT) is commonly used for treatment assessment of radiation therapy in head and neck cancer. However, human papillomavirus‐associated oropharyngeal squamous cell carcinoma (HPV+OPSCC) patients represent a unique subpopulation, for which the utility of surveillance PET/CT has not been well studied.

Methods

In this retrospective chart review comprising 233 HPV+OPSCC patients, we evaluated surveillance PET/CT for diagnostic accuracy, downstream clinical impact, and survival.

Results

Surveillance PET/CT demonstrated 100% negative predictive value and sensitivity, 59.9% specificity, and 13.4% positive predictive value. Surveillance PET/CT led to 90 imaging studies and 31 biopsies; 91.1% and 77.4% were negative for recurrence, respectively. Surveillance PET/CT led to meaningful salvage therapy in 1.6% of cases. PET/CT‐detected recurrences did not have improved survival compared to clinically detected recurrences.

Conclusion

For HPV+OPSCC patients, surveillance PET/CTs frequently lead to unnecessary testing and rarely to meaningful disease salvage. They have no demonstrated survival benefit and should be interpreted cautiously to prevent patient harm.

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Gland‐preserving surgery for salivary stones and the utility of sialendoscopes

Abstract

Background

Sialoendoscopy is the standard treatment for sialolithiasis; however, some patients may be unlikely to benefit from an endoscopic approach. This study assesses predictors of failure in the endoscopic management of sialoliths.

Methods

Patients treated for sialolithiasis from 2012 to 2017 at two centers were stratified into 3 groups: successful interventional sialendoscopy, incisional sialolithotomy, and gland excision. Patient, disease, and surgical factors were compared.

Results

Interventional sialendoscopy was attempted in 156 of 206 cases and successful for 42 (27%). Endoscopically retrieved calculi were smaller (4.96 mm) compared to incisional sialolithotomy (7.90 mm). Nonendoscopic approaches were required more often in submandibular cases 87% (P ≤ .005). Palpable stones were present in 74% of incisional sialolithotomies (P < .001). Submandibular location (OR 3.50, 1.53‐7.98), palpability (OR 2.74, 1.21‐6.18), CT localization (OR 3.05, 1.32‐7.10, P = .010), and increased diameter (OR 1.25, 1.09‐1.44) were predictive of incisional management.

Conclusion

Stone size/location, CT‐localization, and palpability were predictive of calculi that require an incisional approach. If these factors are recognized, the surgeon can consider proceeding directly to incisional sialolithotomy.

Level of evidence

III

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Translation and validation of the MD Anderson Dysphagia Inventory (MDADI) for Spanish‐speaking patients

Abstract

Background

The main objective of this study was to perform the adaptation and cultural translation and validation of the MD Anderson Dysphagia Inventory (MDADI) questionnaire for the Spanish language.

Methods

A total of 69 patients were diagnosed with head and neck cancer treated with surgery; radiotherapy and chemoradiotherapy were included. MDADI was translated and a feasibility, internal consistency, test‐retest reliability, and construct validity were assessed.

Results

The mean overall score of the MDADI was 51.9 (18‐85). Internal consistency for total score was 0.908. The overall score of intraclass correlation coefficient was 0.98 and kappa coefficient scores were almost perfect (test‐retest reliability). All domains of MDADI were significantly correlated with physical and mental domains of the SF‐12. Construct validity was also evaluated with food texture measures, and with TNM classification.

Conclusion

The translation and validation of the Spanish version of the MDADI was performed and can be considered an important patient‐reported outcomes tool for dysphagia‐related quality of life.

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Serum matrix metalloproteinase 8 and tissue inhibitor of metalloproteinase 1: Potential markers for malignant transformation of recurrent respiratory papillomatosis and for prognosis of laryngeal cancer

Abstract

Background

Biomarkers that could predict malignant transformation of recurrent respiratory papillomatosis (RRP) would be useful in patient follow‐up. We investigated whether serum matrix metalloproteinase 8 (MMP‐8) and tissue inhibitor of metalloproteinase 1 (TIMP‐1) could predict malignant transformation of RRP and whether they associate with survival in laryngeal squamous cell carcinoma (LSCC) without preexisting RRP.

Methods

We analyzed serum MMP‐8 (S‐MMP‐8) and serum TIMP‐1 (s‐TIMP‐1) in 114 patients: 55 were treated for RRP and 59 for LSCC without preexisting RRP. Five patients with RRP developed LSCC during follow‐up.

Results

Elevated S‐MMP‐8 level in RRP was associated with malignant transformation (P = .01). Compared to patients with RRP, S‐MMP‐8 in patients with LSCC was significantly higher (P < .001). Increased S‐TIMP‐1 level in LSCC was associated with poor overall survival (P = .02) and recurrence‐free survival (P = .05).

Conclusion

In RRP, high S‐MMP‐8 may predict malignant transformation. In LSCC, elevated S‐TIMP‐1 is connected to poor survival.

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Compatibility of CO2 laser surgery and fluorescence detection in head and neck cancer cells

Abstract

Background

Surgical treatment of cancer requires tumor excision with emphasis on function preservation which is achieved in (early stage) laryngeal cancer by transoral carbon dioxide (CO₂) laser surgery. Whereas conventional laser surgery is restricted by the surgeon's visual recognition of tumor tissue, new approaches based on fluorescence‐guided surgery (FGS) improve the detection of the tumor and its margin. However, it is unclear whether fluorophores are compatible with high‐power laser application or whether precision is compromised by laser‐induced bleaching of the dye.

Methods

We applied topology‐controlled 3D laser resection of fluorescent tumors cell in vitro and laser‐induced autofluorescence analysis ex vivo.

Results

Laser‐induced bleaching of fluorescent dyes in the visible and near‐infrared light spectrum (650‐900 nm) ranges below the resolution range of operation microscopes. Furthermore, specific fluorescent signals in an FGS mouse model is 10⁴ higher than laser‐induced autofluorescence in mouse tissue.

Conclusion

Laser‐induced lateral photobleaching is negligible indicating a path forward for fluorescence‐guided laser surgery in head and neck cancer.

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Contemporary management of primary parapharyngeal space tumors

Abstract

The parapharyngeal space is a complex anatomical area. Primary parapharyngeal tumors are rare tumors and 80% of them are benign. A variety of tumor types can develop in this location; most common are salivary gland neoplasm and neurogenic tumors. The management of these tumors has improved greatly owing to the developments in imaging techniques, surgery, and radiotherapy. Most tumors can be removed with a low rate of complications and recurrence. The transcervical approach is the most frequently used. In some cases, minimally invasive approaches may be used alone or in combination with a limited transcervical route, allowing large tumors to be removed by reducing morbidity of expanded approaches. An adequate knowledge of the anatomy and a careful surgical plan is essential to tailor management according to the patient and the tumor. The purpose of the present review was to update current aspects of knowledge related to this more challenging area of tumor occurrence.

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Randomized phase II/III confirmatory treatment selection design with a change of survival end points: Statistical design of Radiation Therapy Oncology Group 1216

Abstract

Background

To confirm the treatment effects of concurrent cetuximab plus docetaxel observed in Radiation Therapy Oncology Group (RTOG) 0234 and single out the effect of cetuximab, we designed RTOG 1216, a randomized phase II/III study, which uses an intermediate end point to select the best regimen for definitive testing of survival benefit.

Methods

In phase II, the best regimen should demonstrate statistically significant efficacy against the control with predefined advantage over the competing arm regarding disease‐free survival (DFS). We evaluate operating characteristics of the randomized II/III group sequential design through simulations and numerical integrations under the null and various alternative hypotheses.

Results

Results show the randomized II/III design yields substantial savings on sample size and time with well‐controlled type I and type II error rates.

Conclusion

Overall, the proposed randomized II/III design has desirable properties that offer cost effectiveness, operational efficiency, and, most importantly, scientific innovation that can be considered for similar clinical research settings.

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Thyroid Cancer Drugs Market Growth Opportunities, Share & Competitive Landscape Report To 2026 - Coherent Chronicle

Thyroid Cancer Drugs Market Growth Opportunities, Share & Competitive Landscape Report To 2026  Coherent Chronicle

Thyroid Cancer Drugs Market Survival Strategies explore Economic Impact in International Industries Manufactures, Growth, Size, Share, Trends, Development ...

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Response Genetics (RGDXQ) and Lantheus (LNTH) Critical Contrast - Fairfield Current

Response Genetics (RGDXQ) and Lantheus (LNTH) Critical Contrast  Fairfield Current

Response Genetics (OTCMKTS:RGDXQ) and Lantheus (NASDAQ:LNTH) are both small-cap medical companies, but which is the superior business? We will ...

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NRAS Q61R and BRAF G466A Mutations in Atypical Melanocytic Lesions Newly Arising in Advanced Melanoma Patients Treated with Vemurafenib

Background

BRAF inhibition has improved overall survival in patients with BRAF mutant melanoma but this is associated with a range of known and predictable cutaneous side effects, including squamous cell carcinomas associated with RAS mutations.

Methods

We identified three severely dysplastic nevi, one atypical intraepidermal melanocytic proliferation, and four melanoma in situ lesions, newly arising in four patients undergoing treatment with vemurafenib. To characterize mutations in these atypical melanocytic lesions, we used a custom iPlex panel detecting 74 mutations in 13 genes known to play a role in melanoma pathogenesis.

Results

We identified an NRAS mutation at codon 61 (Q61R) and a rare BRAF exon 11 mutation (G466A) in atypical melanocytic lesions that arose in patients treated with vemurafenib.

Conclusions

There appears to be development or accelerated growth of atypical melanocytic lesions in the setting of BRAF inhibition. Our results underscore the need for careful surveillance for melanocytic lesions in patients on BRAF inhibitor therapy and shed light on potential mechanisms for melanoma pathogenesis in the context of BRAF pathway blockade. Further studies are warranted to demonstrate a causal relationship.

This article is protected by copyright. All rights reserved.

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HC Wainwright Reiterates $3.00 Price Target for Interpace Diagnostics Group (IDXG) - Baseball Daily News

HC Wainwright Reiterates $3.00 Price Target for Interpace Diagnostics Group (IDXG)  Baseball Daily News

Interpace Diagnostics Group (NASDAQ:IDXG) has been assigned a $3.00 price target by investment analysts at HC Wainwright in a report issued on Tuesday, ...

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Anaplastic Thyroid Cancer Market by Component, Delivery Mode, Type, End User – Global Forecast to 2026 - The Industry Chronicle

Anaplastic Thyroid Cancer Market by Component, Delivery Mode, Type, End User – Global Forecast to 2026  The Industry Chronicle

The qualitative research study conducted by Worldwide Market Reports Topic "Anaplastic Thyroid Cancer Market" provides primary Data, surveys, Scope of the.

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HC Wainwright Reiterates $3.00 Price Target for Interpace Diagnostics Group (IDXG) - Baseball Daily News

HC Wainwright Reiterates $3.00 Price Target for Interpace Diagnostics Group (IDXG)  Baseball Daily News

Interpace Diagnostics Group (NASDAQ:IDXG) has been assigned a $3.00 price target by investment analysts at HC Wainwright in a report issued on Tuesday, ...

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Response Genetics (RGDXQ) and Lantheus (LNTH) Critical Contrast - Fairfield Current

Response Genetics (RGDXQ) and Lantheus (LNTH) Critical Contrast  Fairfield Current

Response Genetics (OTCMKTS:RGDXQ) and Lantheus (NASDAQ:LNTH) are both small-cap medical companies, but which is the superior business? We will ...

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Thyroid Cancer Drugs Market Growth Opportunities, Share & Competitive Landscape Report To 2026 - Coherent Chronicle

Thyroid Cancer Drugs Market Growth Opportunities, Share & Competitive Landscape Report To 2026  Coherent Chronicle

Thyroid Cancer Drugs Market Survival Strategies explore Economic Impact in International Industries Manufactures, Growth, Size, Share, Trends, Development ...

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Anaplastic Thyroid Cancer Market by Component, Delivery Mode, Type, End User – Global Forecast to 2026 - The Industry Chronicle

Anaplastic Thyroid Cancer Market by Component, Delivery Mode, Type, End User – Global Forecast to 2026  The Industry Chronicle

The qualitative research study conducted by Worldwide Market Reports Topic "Anaplastic Thyroid Cancer Market" provides primary Data, surveys, Scope of the.

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NRAS Q61R and BRAF G466A Mutations in Atypical Melanocytic Lesions Newly Arising in Advanced Melanoma Patients Treated with Vemurafenib

Background

BRAF inhibition has improved overall survival in patients with BRAF mutant melanoma but this is associated with a range of known and predictable cutaneous side effects, including squamous cell carcinomas associated with RAS mutations.

Methods

We identified three severely dysplastic nevi, one atypical intraepidermal melanocytic proliferation, and four melanoma in situ lesions, newly arising in four patients undergoing treatment with vemurafenib. To characterize mutations in these atypical melanocytic lesions, we used a custom iPlex panel detecting 74 mutations in 13 genes known to play a role in melanoma pathogenesis.

Results

We identified an NRAS mutation at codon 61 (Q61R) and a rare BRAF exon 11 mutation (G466A) in atypical melanocytic lesions that arose in patients treated with vemurafenib.

Conclusions

There appears to be development or accelerated growth of atypical melanocytic lesions in the setting of BRAF inhibition. Our results underscore the need for careful surveillance for melanocytic lesions in patients on BRAF inhibitor therapy and shed light on potential mechanisms for melanoma pathogenesis in the context of BRAF pathway blockade. Further studies are warranted to demonstrate a causal relationship.

This article is protected by copyright. All rights reserved.

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The Unwound Cochlea: A Specific Imaging Marker of Branchio-Oto-Renal Syndrome [HEAD & NECK]

CONCLUSIONS: The unwound cochlea is a specific imaging marker of branchio-oto-renal syndrome. These findings further support the diagnostic accuracy and therefore the utility of temporal bone imaging in the diagnosis of this disorder. (Source: American Journal of Neuroradiology)

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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Hearing preservation after Gamma Knife radiosurgery for cerebellopontine angle meningiomas.

CONCLUSIONSGKRS for CPA meningiomas provides excellent hearing preservation in addition to high tumor control rate. Hearing outcome is better with CPA meningiomas than with VSs. Further long-term prospective studies on determinants of hearing outcome after GKRS for CPA meningiomas should be conducted. PMID: 30544298 [PubMed - in process] (Source: Journal of Neurosurgery)

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