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

Abstract

Background

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

Methods

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

Results

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

Conclusion

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

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Concomitant contact‐allergic reactions to iodopropynyl butylcarbamate and iodine

Background

Iodopropynyl butylcarbamate (IPBC) is a broad‐spectrum preservative for use in several product types, including cosmetics in which its concentrations have been limited by EU legislation because of concerns related to its iodine content and release, and risk of subsequent overdose.

Objectives

To report about concomitant patch‐test reactions observed with iodine and IPBC in patients sensitized to iodine‐containing antiseptics.

Patients

Between 2012 and 2018, 7 patients, six from Belgium and one from France, two suffering from acute dermatitis during surgical interventions, four from dermatitis due to wound treatment, and one from occupational dermatitis, were shown to be sensitized to iodine and/or povidone‐iodine (PVP‐I) which were considered relevant for their dermatitis. All patients were coincidentally also patch‐tested with IPBC.

Results

All patients presented positive patch‐test reactions to several other allergens, including IPBC. No relevance could be detected for IPBC.

Conclusions

We suspect that, notwithstanding the absence of firm evidence of IPBC being dehalogenated to produce free iodine in animals or in humans, the patch‐test reactions to IPBC in iodine‐allergic subjects were possibly caused by free iodine released from this preservative agent, thus underlining the EU restrictions regarding the use of this preservative in cosmetics.

This article is protected by copyright. All rights reserved.

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Concomitant contact‐allergic reactions to iodopropynyl butylcarbamate and iodine

Background

Iodopropynyl butylcarbamate (IPBC) is a broad‐spectrum preservative for use in several product types, including cosmetics in which its concentrations have been limited by EU legislation because of concerns related to its iodine content and release, and risk of subsequent overdose.

Objectives

To report about concomitant patch‐test reactions observed with iodine and IPBC in patients sensitized to iodine‐containing antiseptics.

Patients

Between 2012 and 2018, 7 patients, six from Belgium and one from France, two suffering from acute dermatitis during surgical interventions, four from dermatitis due to wound treatment, and one from occupational dermatitis, were shown to be sensitized to iodine and/or povidone‐iodine (PVP‐I) which were considered relevant for their dermatitis. All patients were coincidentally also patch‐tested with IPBC.

Results

All patients presented positive patch‐test reactions to several other allergens, including IPBC. No relevance could be detected for IPBC.

Conclusions

We suspect that, notwithstanding the absence of firm evidence of IPBC being dehalogenated to produce free iodine in animals or in humans, the patch‐test reactions to IPBC in iodine‐allergic subjects were possibly caused by free iodine released from this preservative agent, thus underlining the EU restrictions regarding the use of this preservative in cosmetics.

This article is protected by copyright. All rights reserved.

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Solitary and Multiple Epidermolytic Acanthoma: A Demographic and Clinical Study of 131 Cases

BACKGROUND

Epidermolytic acanthoma (EA) is a rare, benign acquired cutaneous keratosis displaying epidermolytic hyperkeratosis in more than 50% of its surface. Due to the sparsity of comprehensive studies, little is known on the patient demographics and clinical characteristics of this uncommon entity. We wish to comprehensively characterize the clinical and demographic features of EA and to differentiate it from its mimickers.

METHODS

We carried out a retrospectively review of 131 cases of EA, recorded clinical and histopathologic features and performed linear regression of yearly incidence rates to assess for possible under‐reporting of this entity.

RESULTS

EA affected both genders equally. We found 9.08 cases per 100,000 biopsy specimens per year and linear regression analysis demonstrated significant decreasing incidence rates. Analysis of the anatomical site distribution of EA lesions demonstrated a more frequent genital location in men (39.1% of cases in men, as compared to 11.3% for women). Contrary to previous studies, lesions were most frequently single (91.7%) and the mean age of presentation was 57.8 years.

CONCLUSION

The presented largest case series to‐date indicates that EA is likely an underdiagnosed entity and establishes the demographic and clinical features of EA.

This article is protected by copyright. All rights reserved.

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Solitary and Multiple Epidermolytic Acanthoma: A Demographic and Clinical Study of 131 Cases

BACKGROUND

Epidermolytic acanthoma (EA) is a rare, benign acquired cutaneous keratosis displaying epidermolytic hyperkeratosis in more than 50% of its surface. Due to the sparsity of comprehensive studies, little is known on the patient demographics and clinical characteristics of this uncommon entity. We wish to comprehensively characterize the clinical and demographic features of EA and to differentiate it from its mimickers.

METHODS

We carried out a retrospectively review of 131 cases of EA, recorded clinical and histopathologic features and performed linear regression of yearly incidence rates to assess for possible under‐reporting of this entity.

RESULTS

EA affected both genders equally. We found 9.08 cases per 100,000 biopsy specimens per year and linear regression analysis demonstrated significant decreasing incidence rates. Analysis of the anatomical site distribution of EA lesions demonstrated a more frequent genital location in men (39.1% of cases in men, as compared to 11.3% for women). Contrary to previous studies, lesions were most frequently single (91.7%) and the mean age of presentation was 57.8 years.

CONCLUSION

The presented largest case series to‐date indicates that EA is likely an underdiagnosed entity and establishes the demographic and clinical features of EA.

This article is protected by copyright. All rights reserved.

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APT‐weighted MRI: Techniques, current neuro applications, and challenging issues

Amide proton transfer‐weighted (APTw) imaging is a molecular MRI technique that generates image contrast based predominantly on the amide protons in mobile cellular proteins and peptides that are endogenous in tissue. This technique, the most studied type of chemical exchange saturation transfer imaging, has been used successfully for imaging of protein content and pH, the latter being possible due to the strong dependence of the amide proton exchange rate on pH. In this article we briefly review the basic principles and recent technical advances of APTw imaging, which is showing promise clinically, especially for characterizing brain tumors and distinguishing recurrent tumor from treatment effects. Early applications of this approach to stroke, Alzheimer's disease, Parkinson's disease, multiple sclerosis, and traumatic brain injury are also illustrated. Finally, we outline the technical challenges for clinical APT‐based imaging and discuss several controversies regarding the origin of APTw imaging signals in vivo.

Level of Evidence: 3

Technical Efficacy Stage: 3

J. Magn. Reson. Imaging 2019.

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Diagnostic performance of diffusion‐weighted (DWI) and dynamic contrast‐enhanced (DCE) MRI for the differentiation of benign from malignant soft‐tissue tumors

Background

A wide range of specificity values for the differentiation of benign and malignant soft‐tissue tumors show the limitations of conventional MRI features. The data obtained by quantitative analysis of diffusion‐weighted image (DWI) and dynamic contrast‐enhanced (DCE) MRIs would provide more objective results, especially in terms of cellularity and perfusion.

Purpose

To evaluate the diagnostic efficacies of DWI and DCE MRI for the differentiation of malignant and benign soft‐tissue tumors.

Study Type

Retrospective.

Subjects

In all, 136 patients (68 females, 68 males; age range 18–86 years, mean age 57.2 years) with soft‐tissue tumors.

Field Strength/Sequence

3 T, DWI, DCE.

Assessment

Tumor sizes, margins, locations, the presence of involvement in bone or neurovascular bundle, peritumoral edema, heterogeneity, and tumor necrosis were investigated on conventional MR images. On DWIs, visual signal drops were assessed and ADC (apparent diffusion coefficient) values were measured. K^trans, K_ep, V_e, and iAUC values, and time–concentration curve (TCC) types were determined using DCE images.

Statistical Tests

The data were statistically analyzed to determine the abilities to differentiate benign and malignant tumors using the chi‐square test, two‐sample t‐test, and receiver operating characteristic (ROC) analysis.

Results

Seventy‐three cases were malignant and 63 benign. Age (mean ages of benign/malignant tumors, 51.75/61.86 years; P = 0.0002) and gender (F:M = 40:23 [benign], F:M = 28:45 [malignant], P = 0.003) influenced the distinction between benign and malignant. Sizes, margins, neurovascular bundle involvement, peritumoral edema, and heterogeneity of the tumors on conventional MR images and DCE parameters (K^trans, K_ep, V_e, and iAUC, and TCC plots) obtained from focal region of interest within a narrow volume of interest significantly differentiated benign and malignant lesions (all P < 0.0001, except V_e [P = 0.0004]). For DWI with ADC mapping, all ADC values and visually signal drops were also significant (P < 0.0001).

Data Conclusion

DWI and DCE‐MRI and derived variables were significantly helpful in discriminating benign and malignant soft‐tissue tumors complementary to conventional MRI.

Level of Evidence: 3

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2019.

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Risk factors of radiotherapy‐induced cerebral microbleeds and serial analysis of their size compared with white matter changes: A 7T MRI study in 113 adult patients with brain tumors

Background

Although radiation therapy (RT) contributes to survival benefit in many brain tumor patients, it has also been associated with long‐term brain injury. Cerebral microbleeds (CMBs) represent an important manifestation of radiation‐related injury.

Purpose

To characterize the change in size and number of CMBs over time and to evaluate their relationship to white matter structural integrity as measured using diffusion MRI indices.

Study Type

Longitudinal, retrospective, human cohort.

Population

In all, 113 brain tumor patients including patients treated with focal RT (n = 91, 80.5%) and a subset of nonirradiated controls (n = 22, 19.5%).

Field Strength/Sequence

Single and multiecho susceptibility‐weighted imaging (SWI) and multiband, shell, and direction diffusion tensor imaging (DTI) at 7 T.

Assessment

Patients were scanned either once or serially. CMBs were detected and quantified on SWI images using a semiautomated approach. Local and global fractional anisotropy (FA) were measured from DTI data for a subset of 35 patients.

Statistical Tests

Potential risk factors for CMB development were determined by multivariate linear regression and using linear mixed‐effect models. Longitudinal FA was quantitatively and qualitatively evaluated for trends.

Results

All patients scanned at 1 or more years post‐RT had CMBs. A history of multiple surgical resections was a risk factor for development of CMBs. The total number and volume of CMBs increased by 18% and 11% per year, respectively, although individual CMBs decreased in volume over time. Simultaneous to these microvascular changes, FA decreased by a median of 6.5% per year. While the majority of nonirradiated controls had no CMBs, four control patients presented with fewer than five CMBs.

Data Conclusion

Identifying patients who are at the greatest risk for CMB development, with its likely associated long‐term cognitive impairment, is an important step towards developing and piloting preventative and/or rehabilitative measures for patients undergoing RT.

Level of Evidence: 3

Technical Efficacy: Stage 4

J. Magn. Reson. Imaging 2018;47:1133–1138.

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APT‐weighted MRI: Techniques, current neuro applications, and challenging issues

Amide proton transfer‐weighted (APTw) imaging is a molecular MRI technique that generates image contrast based predominantly on the amide protons in mobile cellular proteins and peptides that are endogenous in tissue. This technique, the most studied type of chemical exchange saturation transfer imaging, has been used successfully for imaging of protein content and pH, the latter being possible due to the strong dependence of the amide proton exchange rate on pH. In this article we briefly review the basic principles and recent technical advances of APTw imaging, which is showing promise clinically, especially for characterizing brain tumors and distinguishing recurrent tumor from treatment effects. Early applications of this approach to stroke, Alzheimer's disease, Parkinson's disease, multiple sclerosis, and traumatic brain injury are also illustrated. Finally, we outline the technical challenges for clinical APT‐based imaging and discuss several controversies regarding the origin of APTw imaging signals in vivo.

Level of Evidence: 3

Technical Efficacy Stage: 3

J. Magn. Reson. Imaging 2019.

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Diagnostic performance of diffusion‐weighted (DWI) and dynamic contrast‐enhanced (DCE) MRI for the differentiation of benign from malignant soft‐tissue tumors

Background

A wide range of specificity values for the differentiation of benign and malignant soft‐tissue tumors show the limitations of conventional MRI features. The data obtained by quantitative analysis of diffusion‐weighted image (DWI) and dynamic contrast‐enhanced (DCE) MRIs would provide more objective results, especially in terms of cellularity and perfusion.

Purpose

To evaluate the diagnostic efficacies of DWI and DCE MRI for the differentiation of malignant and benign soft‐tissue tumors.

Study Type

Retrospective.

Subjects

In all, 136 patients (68 females, 68 males; age range 18–86 years, mean age 57.2 years) with soft‐tissue tumors.

Field Strength/Sequence

3 T, DWI, DCE.

Assessment

Tumor sizes, margins, locations, the presence of involvement in bone or neurovascular bundle, peritumoral edema, heterogeneity, and tumor necrosis were investigated on conventional MR images. On DWIs, visual signal drops were assessed and ADC (apparent diffusion coefficient) values were measured. K^trans, K_ep, V_e, and iAUC values, and time–concentration curve (TCC) types were determined using DCE images.

Statistical Tests

The data were statistically analyzed to determine the abilities to differentiate benign and malignant tumors using the chi‐square test, two‐sample t‐test, and receiver operating characteristic (ROC) analysis.

Results

Seventy‐three cases were malignant and 63 benign. Age (mean ages of benign/malignant tumors, 51.75/61.86 years; P = 0.0002) and gender (F:M = 40:23 [benign], F:M = 28:45 [malignant], P = 0.003) influenced the distinction between benign and malignant. Sizes, margins, neurovascular bundle involvement, peritumoral edema, and heterogeneity of the tumors on conventional MR images and DCE parameters (K^trans, K_ep, V_e, and iAUC, and TCC plots) obtained from focal region of interest within a narrow volume of interest significantly differentiated benign and malignant lesions (all P < 0.0001, except V_e [P = 0.0004]). For DWI with ADC mapping, all ADC values and visually signal drops were also significant (P < 0.0001).

Data Conclusion

DWI and DCE‐MRI and derived variables were significantly helpful in discriminating benign and malignant soft‐tissue tumors complementary to conventional MRI.

Level of Evidence: 3

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2019.

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Risk factors of radiotherapy‐induced cerebral microbleeds and serial analysis of their size compared with white matter changes: A 7T MRI study in 113 adult patients with brain tumors

Background

Although radiation therapy (RT) contributes to survival benefit in many brain tumor patients, it has also been associated with long‐term brain injury. Cerebral microbleeds (CMBs) represent an important manifestation of radiation‐related injury.

Purpose

To characterize the change in size and number of CMBs over time and to evaluate their relationship to white matter structural integrity as measured using diffusion MRI indices.

Study Type

Longitudinal, retrospective, human cohort.

Population

In all, 113 brain tumor patients including patients treated with focal RT (n = 91, 80.5%) and a subset of nonirradiated controls (n = 22, 19.5%).

Field Strength/Sequence

Single and multiecho susceptibility‐weighted imaging (SWI) and multiband, shell, and direction diffusion tensor imaging (DTI) at 7 T.

Assessment

Patients were scanned either once or serially. CMBs were detected and quantified on SWI images using a semiautomated approach. Local and global fractional anisotropy (FA) were measured from DTI data for a subset of 35 patients.

Statistical Tests

Potential risk factors for CMB development were determined by multivariate linear regression and using linear mixed‐effect models. Longitudinal FA was quantitatively and qualitatively evaluated for trends.

Results

All patients scanned at 1 or more years post‐RT had CMBs. A history of multiple surgical resections was a risk factor for development of CMBs. The total number and volume of CMBs increased by 18% and 11% per year, respectively, although individual CMBs decreased in volume over time. Simultaneous to these microvascular changes, FA decreased by a median of 6.5% per year. While the majority of nonirradiated controls had no CMBs, four control patients presented with fewer than five CMBs.

Data Conclusion

Identifying patients who are at the greatest risk for CMB development, with its likely associated long‐term cognitive impairment, is an important step towards developing and piloting preventative and/or rehabilitative measures for patients undergoing RT.

Level of Evidence: 3

Technical Efficacy: Stage 4

J. Magn. Reson. Imaging 2018;47:1133–1138.

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

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

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

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

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

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

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

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

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A Randomized Experiment of Malaria Diagnostic Testing and Conditional Subsidies to Target ACTs in the Retail Sector: the TESTsmART Trial Aim 1

Conditions:   Malaria;   Febrile Illness Interventions:   Other: Conditional ACT subsidy, Arm 1 levels;   Other: Conditional ACT subsidy, Arm 2 levels;   Other: Conditional ACT subsidy, Arm 3 levels;   Other: Conditional ACT subsidy, Arm 4 levels Sponsors:   Duke University;   National Institute of Allergy and Infectious Diseases (NIAID);   Moi University;   Clinton Health Access Initiative, Nigeria Not yet recruiting (Source: ClinicalTrials.gov)

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

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

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A Randomized Experiment of Malaria Diagnostic Testing and Conditional Subsidies to Target ACTs in the Retail Sector: the TESTsmART Trial Aim 1

Conditions:   Malaria;   Febrile Illness Interventions:   Other: Conditional ACT subsidy, Arm 1 levels;   Other: Conditional ACT subsidy, Arm 2 levels;   Other: Conditional ACT subsidy, Arm 3 levels;   Other: Conditional ACT subsidy, Arm 4 levels Sponsors:   Duke University;   National Institute of Allergy and Infectious Diseases (NIAID);   Moi University;   Clinton Health Access Initiative, Nigeria Not yet recruiting (Source: ClinicalTrials.gov)

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

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

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MP‐AzeFlu provides rapid and effective allergic rhinitis control: results of a non‐interventional study in Denmark

Background

Allergic rhinitis (AR) control is a priority in the European Union (EU), and Allergic Rhinitis and its Impact on Asthma (ARIA) has endorsed a visual analogue scale (VAS) as the new language of AR control. This study evaluated the effectiveness of MP‐AzeFlu (Dymista®, antihistamine [azelastine], and intranasal corticosteroid [fluticasone propionate]) using a VAS in real‐life clinical practice in Denmark.

Methods

The multicenter, prospective, non‐interventional study included 170 patients (≥12 years) with ARIA‐defined moderate‐to‐severe AR prescribed MP‐AzeFlu. Patients assessed symptom severity using a VAS (0 to 100 mm) on days 0, 1, 3, and 7 and after ∼14 days of MP‐AzeFlu use. On day 3, patients assessed their disease as well controlled, partly controlled, or uncontrolled. Proportions of patients achieving VAS score cutoffs (well‐controlled, partly controlled) were also calculated.

Results

MP‐AzeFlu reduced mean ± standard deviation VAS score from 67.1 ± 19.3 mm at baseline to 28.4 ± 23.7 mm on the last day, a reduction of 38.8 ± 27.3 mm. At day 3, 85.6% of patients considered their symptoms to be partly or well controlled. Effectiveness was consistent across disease severity, phenotype (seasonal, perennial, or combined AR), and patient age. Respectively, 28.2%, 44.2%, 61.6%, and 71.4% of patients achieved ≤38 mm well‐controlled VAS score cutoff on days 1, 3, and 7, and the last day.

Conclusion

MP‐AzeFlu provided effective, rapid, and sustained symptom control in a real‐life setting among patients from Denmark. These results align with EU and ARIA objectives and support the effectiveness of MP‐AzeFlu for the treatment of AR in real life.

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