Component resolved allergen diagnosis allows for a precise evaluation of the sensitization profiles of patients sensitized to felines and canines. An accurate interpretation of these results allows better insi...
http://ift.tt/2fRMDkw
This study aims to address and assess possible factors associated with nausea and vomiting (NV) following oral and maxillofacial surgery.
A prospective study was carried out in the period from December 2013 to January 2016 targeting all attended cases in that period. For statistical analysis, Pearson chi-square and Fisher tests were used to verify association and ANOVA and Student's t tests to test for significant difference, p was defined as ≤0.05. The sample group consisted of 207 patients with an average age of 33.56 years (±13.23), and 70.5% of subjects were male.
Calculations based on the predictive model showed that a female patient with prior history of nausea and vomiting who used opioids and had intra-oral surgical access would have a 96% chance of experiencing a nausea and vomiting episode.
Other factors like age, being overweight, anesthesia, surgery duration, and duration of hospital stay also contribute so that these aspects must be paid careful attention prior to surgery to ensure a suitably orientated treatment that will avoid disturbances caused by post-operative nausea and vomiting.
The occurrence of post-operative nausea and vomiting after oral and maxillofacial surgery was found to be more higher incidence associated to female patients who used opioids, who had a prior history of NV, whose surgery involved intra-oral access, who were in the second or third decades of their lives, who have above average weight, and who have long anesthesia when undergoing surgery, resulting in a long hospital stays.
This study aims to address and assess possible factors associated with nausea and vomiting (NV) following oral and maxillofacial surgery.
A prospective study was carried out in the period from December 2013 to January 2016 targeting all attended cases in that period. For statistical analysis, Pearson chi-square and Fisher tests were used to verify association and ANOVA and Student’s t tests to test for significant difference, p was defined as ≤0.05. The sample group consisted of 207 patients with an average age of 33.56 years (±13.23), and 70.5% of subjects were male.
Calculations based on the predictive model showed that a female patient with prior history of nausea and vomiting who used opioids and had intra-oral surgical access would have a 96% chance of experiencing a nausea and vomiting episode.
Other factors like age, being overweight, anesthesia, surgery duration, and duration of hospital stay also contribute so that these aspects must be paid careful attention prior to surgery to ensure a suitably orientated treatment that will avoid disturbances caused by post-operative nausea and vomiting.
The occurrence of post-operative nausea and vomiting after oral and maxillofacial surgery was found to be more higher incidence associated to female patients who used opioids, who had a prior history of NV, whose surgery involved intra-oral access, who were in the second or third decades of their lives, who have above average weight, and who have long anesthesia when undergoing surgery, resulting in a long hospital stays.
The acute tendinitis of the longus colli muscle is an unusual diagnosis in the cases of acute dysphagia with cervical pain. Is a self-limiting condition caused by abnormal calcium hydroxyapatite deposition in the prevertebral space and can cause pharyngeal swelling with impaired swallow. It is absolutely critical to make the differential diagnosis with deep cervical infections in order to avoid invasive treatments.
Periodontally accelerated osteogenic orthodontics (PAOO) combines periodontal therapy with orthodontic therapy, which minimises treatment time. This study compared the effectiveness of a bovine-derived xenograft with that of bioactive glass when combined with PAOO for the treatment of adult patients with moderate crowding of the teeth.
In this prospective, single-masked clinical trial, 33 orthodontic patients (20 women, 13 men; mean age 21.2 ± 1.43 [18 − 27] years), were randomly allocated to one of three groups. Group 1 underwent a modified corticotomy technique on the labial side only, whereas group 2 was treated with the same technique combined with PAOO using a bovine-derived xenograft and group 3 was treated in the same way but combining PAOO with bioactive glass. The total treatment duration was recorded from the start of active orthodontic treatment, immediately after corticotomy, and at the time of debonding. Probing depth was evaluated clinically and bone density and root length were evaluated radiographically on the day of surgery (baseline, T1), post-treatment at debonding (T2), and 9 months post-treatment (T3).
The duration of orthodontic treatment was markedly reduced to an average of 11.4 ± 0.14 weeks in all groups. All probing depths were < 3 mm, the interdental papillae were well preserved, there was no loss of tooth vitality, and there was no evidence of significant apical root resorption at any time interval. All groups showed a decrease in mean bone density at T2 followed by an increase at T3. The net percentage change that occurred between baseline and 9 months post-treatment was significantly different between the three groups. Groups 2 and 3, where grafts were incorporated, demonstrated a statistically significant greater increase in bone density than group 1 at T3.
Combination of orthodontic treatment and periodontal surgery is an effective treatment for adult patients that decreases the duration of active treatment and reduces the risk of root resorption. Use of a bovine-derived xenograft with modified corticotomy provided superior benefits in terms of increased bone density than did the use of bioactive glass.
The study was retrospectively registered at ClinicalTrials.gov under Clinical Trial Registration Number: NCT02796911.
The present study aimed to elucidate the associations among self-rated oral health, clinical oral health status, oral health behaviors, subjective oral symptoms, and oral health-related quality of life (OHRQoL) in a group of Japanese university students.
Of 2051 participants, 2027 (98.83%) students received an optional oral examination and answered a questionnaire including items regarding age, sex, self-rated oral health, oral health behaviors, subjective oral symptoms, and OHRQoL [The Oral Health Impact Profile (OHIP)-14]. On oral examination, the decayed, missing, and filled teeth (DMFT) score, Community Periodontal Index (CPI), the percentage of teeth showing bleeding on probing (%BOP), and malocclusion were recorded. Structural equation modelling (SEM) analysis was used to test associations.
The mean score (± SD) of OHIP-14 was 1.92 ± 5.47. In the SEM analysis, the final model showed that self-rated oral health, oral pain, malocclusion, and the DMFT score were directly associated with the OHRQoL, and subjective symptoms of temporomandibular disorders (TMD) and recurrent aphthous stomatitis were both directly and indirectly associated (p < 0.05). CPI, %BOP, and oral health behaviors were excluded from the final model.
OHRQoL was associated with self-related oral health, subjective symptoms of TMD, oral pain and stomatitis, DMFT, and malocclusion in this group of Japanese university students.
The present study aimed to elucidate the associations among self-rated oral health, clinical oral health status, oral health behaviors, subjective oral symptoms, and oral health-related quality of life (OHRQoL) in a group of Japanese university students.
Of 2051 participants, 2027 (98.83%) students received an optional oral examination and answered a questionnaire including items regarding age, sex, self-rated oral health, oral health behaviors, subjective oral symptoms, and OHRQoL [The Oral Health Impact Profile (OHIP)-14]. On oral examination, the decayed, missing, and filled teeth (DMFT) score, Community Periodontal Index (CPI), the percentage of teeth showing bleeding on probing (%BOP), and malocclusion were recorded. Structural equation modelling (SEM) analysis was used to test associations.
The mean score (± SD) of OHIP-14 was 1.92 ± 5.47. In the SEM analysis, the final model showed that self-rated oral health, oral pain, malocclusion, and the DMFT score were directly associated with the OHRQoL, and subjective symptoms of temporomandibular disorders (TMD) and recurrent aphthous stomatitis were both directly and indirectly associated (p < 0.05). CPI, %BOP, and oral health behaviors were excluded from the final model.
OHRQoL was associated with self-related oral health, subjective symptoms of TMD, oral pain and stomatitis, DMFT, and malocclusion in this group of Japanese university students.
Periodontally accelerated osteogenic orthodontics (PAOO) combines periodontal therapy with orthodontic therapy, which minimises treatment time. This study compared the effectiveness of a bovine-derived xenograft with that of bioactive glass when combined with PAOO for the treatment of adult patients with moderate crowding of the teeth.
In this prospective, single-masked clinical trial, 33 orthodontic patients (20 women, 13 men; mean age 21.2 ± 1.43 [18 − 27] years), were randomly allocated to one of three groups. Group 1 underwent a modified corticotomy technique on the labial side only, whereas group 2 was treated with the same technique combined with PAOO using a bovine-derived xenograft and group 3 was treated in the same way but combining PAOO with bioactive glass. The total treatment duration was recorded from the start of active orthodontic treatment, immediately after corticotomy, and at the time of debonding. Probing depth was evaluated clinically and bone density and root length were evaluated radiographically on the day of surgery (baseline, T1), post-treatment at debonding (T2), and 9 months post-treatment (T3).
The duration of orthodontic treatment was markedly reduced to an average of 11.4 ± 0.14 weeks in all groups. All probing depths were < 3 mm, the interdental papillae were well preserved, there was no loss of tooth vitality, and there was no evidence of significant apical root resorption at any time interval. All groups showed a decrease in mean bone density at T2 followed by an increase at T3. The net percentage change that occurred between baseline and 9 months post-treatment was significantly different between the three groups. Groups 2 and 3, where grafts were incorporated, demonstrated a statistically significant greater increase in bone density than group 1 at T3.
Combination of orthodontic treatment and periodontal surgery is an effective treatment for adult patients that decreases the duration of active treatment and reduces the risk of root resorption. Use of a bovine-derived xenograft with modified corticotomy provided superior benefits in terms of increased bone density than did the use of bioactive glass.
The study was retrospectively registered at ClinicalTrials.gov under Clinical Trial Registration Number: NCT02796911.
Up to 30% of patients with laryngeal squamous cell carcinoma (SCC) present with recurrence after treatment. We analyzed factors associated with the risk of cancer recurrence and prognosis after recurrence.
A nationwide laryngeal SCC cohort from Finnish university hospitals during 2001 to 2005 with initial successful therapy (n = 316) was analyzed.
Laryngeal SCC recurred in 22% of patients. The median time to recurrence was 9 months, with 90% occurring within 36 months after treatment. The World Health Organization (WHO) performance status >0, neck metastasis at presentation, and nonsurgical treatment were independent prognostic factors for recurrence. Patients with local recurrence had a 5-year overall survival (OS) of 53% compared with 5% in patients with regional/distant recurrences. OS for glottic and nonglottic laryngeal SCC recurrence was 45% and 0%, respectively.
The type of treatment affected the risk of recurrence in this retrospective series. Local recurrences carried a chance for successful salvage treatment. Routine follow-up beyond 36 months remains controversial. © 2016 Wiley Periodicals, Inc. Head Neck, 2016
Up to 30% of patients with laryngeal squamous cell carcinoma (SCC) present with recurrence after treatment. We analyzed factors associated with the risk of cancer recurrence and prognosis after recurrence.
A nationwide laryngeal SCC cohort from Finnish university hospitals during 2001 to 2005 with initial successful therapy (n = 316) was analyzed.
Laryngeal SCC recurred in 22% of patients. The median time to recurrence was 9 months, with 90% occurring within 36 months after treatment. The World Health Organization (WHO) performance status >0, neck metastasis at presentation, and nonsurgical treatment were independent prognostic factors for recurrence. Patients with local recurrence had a 5-year overall survival (OS) of 53% compared with 5% in patients with regional/distant recurrences. OS for glottic and nonglottic laryngeal SCC recurrence was 45% and 0%, respectively.
The type of treatment affected the risk of recurrence in this retrospective series. Local recurrences carried a chance for successful salvage treatment. Routine follow-up beyond 36 months remains controversial. © 2016 Wiley Periodicals, Inc. Head Neck, 2016
Up to 30% of patients with laryngeal squamous cell carcinoma (SCC) present with recurrence after treatment. We analyzed factors associated with the risk of cancer recurrence and prognosis after recurrence.
A nationwide laryngeal SCC cohort from Finnish university hospitals during 2001 to 2005 with initial successful therapy (n = 316) was analyzed.
Laryngeal SCC recurred in 22% of patients. The median time to recurrence was 9 months, with 90% occurring within 36 months after treatment. The World Health Organization (WHO) performance status >0, neck metastasis at presentation, and nonsurgical treatment were independent prognostic factors for recurrence. Patients with local recurrence had a 5-year overall survival (OS) of 53% compared with 5% in patients with regional/distant recurrences. OS for glottic and nonglottic laryngeal SCC recurrence was 45% and 0%, respectively.
The type of treatment affected the risk of recurrence in this retrospective series. Local recurrences carried a chance for successful salvage treatment. Routine follow-up beyond 36 months remains controversial. © 2016 Wiley Periodicals, Inc. Head Neck, 2016
Background. Rhinosporidiosis is a common disease entity in tropical countries; however, it can be encountered in other parts of the world as well due to increasing medical tourism. It may mimic other more malignant and vigorous pathologies of the involved part. Case Report. We present a case of a 36-year-old male presenting with proptosis due to involvement of nasolacrimal duct which is rare. We will discuss typical CT and MRI features of the disease which were present in the case. Conclusion. For a surgeon and a radiologist, this is a necessary differential to be kept in mind for sinonasal masses. CT and MRI are invaluable investigations. However, FNAC is confirmatory. Both clinical and radiological aspects are required to reach correct diagnosis.
http://ift.tt/2g6dh76
Background. Rhinosporidiosis is a common disease entity in tropical countries; however, it can be encountered in other parts of the world as well due to increasing medical tourism. It may mimic other more malignant and vigorous pathologies of the involved part. Case Report. We present a case of a 36-year-old male presenting with proptosis due to involvement of nasolacrimal duct which is rare. We will discuss typical CT and MRI features of the disease which were present in the case. Conclusion. For a surgeon and a radiologist, this is a necessary differential to be kept in mind for sinonasal masses. CT and MRI are invaluable investigations. However, FNAC is confirmatory. Both clinical and radiological aspects are required to reach correct diagnosis.
http://ift.tt/2g6dh76
Background. Rhinosporidiosis is a common disease entity in tropical countries; however, it can be encountered in other parts of the world as well due to increasing medical tourism. It may mimic other more malignant and vigorous pathologies of the involved part. Case Report. We present a case of a 36-year-old male presenting with proptosis due to involvement of nasolacrimal duct which is rare. We will discuss typical CT and MRI features of the disease which were present in the case. Conclusion. For a surgeon and a radiologist, this is a necessary differential to be kept in mind for sinonasal masses. CT and MRI are invaluable investigations. However, FNAC is confirmatory. Both clinical and radiological aspects are required to reach correct diagnosis.
http://ift.tt/2g6dh76
Methicillin-Resistant Staphylococcus aureus in Foot Osteomyelitis.
Surg Infect (Larchmt). 2016 Nov 29;
Authors: Ashong CN, Raheem SA, Hunter AS, Mindru C, Barshes NR
Abstract
BACKGROUND: Conflicting studies exist regarding the impact of methicillin-resistant Staphylococcus aureus (MRSA) on increased time to wound healing, future need for surgical procedures, and likelihood of treatment failure in patients with diabetic foot osteomyelitis. The purpose of this study is to determine the overall significance of MRSA in predicting treatment failure in bone infections of the foot and to determine an appropriate pre-operative and empiric post-operative antibiotic regimen.
PATIENTS AND METHODS: Patients presenting with an initial episode of "probable" or "definite" foot osteomyelitis were included for review and analysis if the following criteria were met: (1) Osteomyelitis occurred in the foot (i.e., distal to the malleoli of the ankle); episodes occurring above the ankle were excluded. (2) Patients received either no antibiotics or only oral antibiotics for long-term treatment; episodes managed with long-term parenteral antibiotics were excluded. (3) The infection was managed initially with medical therapy or conservative surgical therapy; episodes managed with major (above-ankle) amputation as the initial treatment were excluded. The primary objective of this study was to assess whether episodes of foot osteomyelitis associated with MRSA resulted in treatment failure more frequently than not.
RESULTS: Of 178 episodes included in the study, 50 (28.1%) episodes had treatment failure. Median time-to-treatment failure was 60 days (range 7-598 days). In 28.1% (9/32 episodes) in which treatment failure occurred and 39.0% (41/105) episodes in which no treatment failure occurred, MRSA was present. The presence of MRSA was not significantly associated with treatment failure (p = 0.99).
CONCLUSIONS: The presence of MRSA in bone culture and whether antibiotic use had anti-MRSA activity was not associated with increased treatment failure of diabetic foot osteomyelitis in our institution. Empiric antibiotic coverage of MRSA may not be necessary for many patients presenting with foot osteomyelitis.
PMID: 27898266 [PubMed - as supplied by publisher]
Low-level laser therapy as an adjunct to conventional therapy in the treatment of diabetic foot ulcers.
Lasers Med Sci. 2016 Nov 29;
Authors: Mathur RK, Sahu K, Saraf S, Patheja P, Khan F, Gupta PK
Abstract
Foot ulcers are serious complications of diabetes mellitus (DM) and are known to be resistant to conventional treatment. This study was conducted to evaluate the efficacy of low-level laser therapy (LLLT) for the treatment of diabetic foot ulcers in a tertiary care centre (Department of Surgery, Mahatma Gandhi Memorial Medical College and Maharaja Yashwantrao Hospital, A.B. Road, Indore). A total of 30 patients with type 2 DM having Meggitt-Wagner grade I foot ulcers of more than 6 weeks duration with negative culture were studied. Patients were randomized into two groups of 15 each. Patients in study group received LLLT (660 ± 20 nm, 3 J/cm(2)) along with conventional therapy and those in control group were treated with conventional therapy alone. The primary outcome measure was the absolute and relative wound size reduction at 2 weeks compared to the baseline parameter. Percentage ulcer area reduction was 37 ± 9% in the LLLT group and 15 ± 5.4% in the control group (p < 0.001). For ∼75% of wounds of the treatment group, wound area reduction of 30-50% was observed. In contrast, for the control group, ∼80% of wounds showed a wound area reduction of <20% on day 15. Further, the wounds with initial wound area 1000-2000 mm(2) seems to have better final outcome than the groups with larger areas. The treated groups showed higher amount of granulation than the control group. The results suggest that LLLT is beneficial as an adjunct to conventional therapy in the treatment of diabetic foot ulcers.
PMID: 27896528 [PubMed - as supplied by publisher]
The microbiology of diabetic foot infections in patients recently treated with antibiotic therapy: A prospective study from India.
J Diabetes Complications. 2016 Nov 9;:
Authors: Rastogi A, Sukumar S, Hajela A, Mukherjee S, Dutta P, Bhadada SK, Bhansali A
Abstract
AIM: Clinicians often treat clinically infected diabetic foot ulcers without information from cultures of the wound. The results of wound cultures may also be affected by previous antibiotic therapy. Thus, we aimed to study the microbial isolates, and antimicrobial sensitivity of previously treated patients with a clinically infected DFU.
RESEARCH DESIGN AND METHODS: 293 consecutive patients with clinically infected DFU on prior antimicrobial treatment within the immediate past few days for a duration greater than one week were evaluated for microbial etiology, antibiotic sensitivity and final outcomes. Appropriate tissue samples i.e. purulent drainage, soft-tissue and/ or bone were obtained for aerobic/anaerobic cultures and antimicrobial sensitivities. 71 patients with missing prior antibiotic data were excluded.
RESULTS: 313 tissue samples obtained from 222 patients isolated 317 causative organisms. Most of the culture results from tissue specimens were mono-microbial (93.2%) compared to 37% in our previous cohort of 60 patients. Pseudomonas aeruginosa was the most common organism isolated on culture of bone (26.9%) or soft tissue (23.2%) specimen, respectively. Only 23% and 64% of P. aeruginosa isolates and 5.6% and 44% of Acinetobacter sp. were sensitive to quinolones and cephalosporins, respectively.
CONCLUSIONS: Clinically infected DFU recently treated with antibiotics have predominant monomicrobial and multi drug-resistant infection. Quinolones as an empirical antibiotic choice may not be appropriate in this setting.
PMID: 27894749 [PubMed - as supplied by publisher]
Recently much research has been conducted on early detection of cognitive and physical status deterioration in elderly adults. Primarily the focus is on gait analysis methodologies exploiting average speed, however this presents an issue when used for context aware applications. Additionally data capture tends to be in short bursts over a long period, allowing for localized temporal factors, such as short term injury, to potentially skew measurements. As such this work collects gait and trajectory IoT data from elderly adults in senior homes ("in the wild") over a sustained period of time (1 year). Density based clustering algorithms are then applied to the data to provide long-term insights into how the high density regions change over time. The data is collected, analyzed and made available by the indoor analytics client utilizing available processing resources and delivers the analytics outcome even when it is hosted in hardware with constrained resources. Promising results are obtained from the long-term study, suggesting that this form of evaluation has strong potential in the analysis of cognitive and physical status deterioration.
Lung cancer accounts for the highest fatalities amongst cancers worldwide. Within the frames of the Metaboli-Ca project, we explored the effects of non-small cell lung cancer (NSCLC) by utilizing next generation sequencing (NGS) technologies. Here, we update and expand our previous work; exploiting RNA sequencing data for the derivation of differentially expressed genes and alternatively spliced genes in cancer cells compared to the adjacent normal tissue and carry out functional analysis to discover the underlying molecular mechanisms altered in cancer cells. We used our established pipeline for quantitative analysis, which utilizes a range of state-of-the-art tools, and investigated the modifications performed in cancer cells. A significant number of 1449 genes were found as differentially expressed, while 368 genes as alternatively spliced. Focusing in alternative splicing events, a number of important molecular mechanisms emerged, such as proteasome functionality, stemness, and regulation of mitosis. Our analysis suggests several molecular players that could enhance the understanding of NSCLC pathophysiology.
Reirradiation with intensity-modulated radiotherapy for locally recurrent T3 to T4 nasopharyngeal carcinoma.
Head Neck. 2016 Nov 29;:
Authors: Chan OS, Sze HC, Lee MC, Chan LL, Chang AT, Lee SW, Hung WM, Lee AW, Ng WT
Abstract
BACKGROUND: The purpose of this study was to assess the efficacy and toxicities of reirradiation using intensity-modulated radiotherapy (IMRT) in patients with locally advanced recurrent nasopharyngeal carcinoma (NPC).
METHODS: Thirty-eight patients with consecutive rT3 to rT4 NPC treated between 2005 and 2013 were retrospectively analyzed.
RESULTS: The 3-year overall survival (OS), progression-free survival (PFS), and local control rate were 47.2%, 17.5%, and 44.3%, respectively. Gross target volume (GTV) D95 , GTV D50 , and age were all important prognostic factors for OS and PFS, but only GTV D95 was an important determinant for local control. A total of 73.7% patients experienced ≥1 grade 3 late toxicities and 3 patients died of massive epistaxis. Temporal lobe necrosis (TLN) developed sooner with a higher total biological equivalent dose.
CONCLUSION: Adequate tumor dose coverage was important for treating rT3 to rT4 NPC. Although late complications were common, treatment-related mortality was solely vascular in nature. Dose constraints of neurologic structures for reirradiation should be revised with the latest information on late toxicities. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.
PMID: 27898191 [PubMed - as supplied by publisher]
Reappraising hyalinizing clear cell carcinoma: A population-based study with molecular confirmation.
Head Neck. 2016 Nov 29;:
Authors: Hernandez-Prera JC, Kwan R, Tripodi J, Chiosea S, Cordon-Cardo C, Najfeld V, Demicco EG
Abstract
BACKGROUND: Hyalinizing clear cell carcinoma (HCCC) is a rare malignancy, characterized by EWSR1-ATF1 gene fusion, whose behavior is poorly understood, as it was for many years considered a diagnosis of exclusion.
METHODS: All available salivary gland carcinomas (n = 594) from our institution were reviewed. Diagnosis of HCCC was confirmed by fluorescence in situ hybridization (FISH) for EWSR1. Literature review was performed.
RESULTS: We found 15 patients with HCCCs (10 women, 5 men), 13 with EWSR1 rearrangement. Median age at diagnosis was 57 years (range, 31-87 years). Oral cavity (n = 9) and base of tongue (n = 4) were the most frequent primary sites. Combining our cases with those identified in literature review, the 10-year risk of local recurrence and locoregional nodal metastasis were 49% and 15%, respectively.
CONCLUSION: Molecularly confirmed HCCC accounted for 2.5% of salivary gland malignancies at our institution. HCCCs are indolent tumors with a propensity for locoregional recurrence. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.
PMID: 27898192 [PubMed - as supplied by publisher]
Cost-effectiveness of microsurgical reconstruction for head and neck defects after oncologic resection.
Head Neck. 2016 Nov 29;:
Authors: Gao LL, Basta M, Kanchwala SK, Serletti JM, Low DW, Wu LC
Abstract
BACKGROUND: Microvascular free tissue transfer has become the main technique used for head and neck reconstruction. We assessed the cost-effectiveness of free flap reconstruction for head and neck defects after oncologic resection for squamous cell carcinoma (SCC).
METHODS: We developed a Markov model of the cost, quality of life, survival, and incremental cost-effectiveness of reconstruction with free tissue transfer compared with locoregional flaps. Health state probabilities and quality of life scores were determined from literature. Costs were determined from institutional experience. Outcomes included quality-adjusted life years, costs, and incremental cost-effectiveness ratio.
RESULTS: Free flap reconstruction was more costly than pedicled flap but associated with greater quality of life with no survival benefit. A value <$50,000 per quality-adjusted life-year (QALY) was defined as cost-effective. The incremental cost-effectiveness for head and neck free flap reconstruction was below the threshold and, therefore, free flap reconstruction is cost-effective. Reconstruction was more cost-effective for patients with lower stage cancers: $4643 per QALY for stage I SCC, $8226 for stage II, $17,269 for stage III, and $23,324 for stage IV. Univariate sensitivity analysis showed the cost-effectiveness would remain <$50,000 for all stages of SCC for all variables except for QALY after locoregional reconstruction without complications.
CONCLUSION: Microsurgical head and neck reconstruction is cost-effective compared with locoregional flaps, even more so in patients with early-stage cancer. This finding supports the current practice of free flap head and neck reconstruction. Screening and early detection are important to optimize costs. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.
PMID: 27898195 [PubMed - as supplied by publisher]
Effects of Molsidomine on Retinopathy and Oxidative Stress Induced by Radiotheraphy in Rat Eyes.
Curr Eye Res. 2016 Nov 29;:1-7
Authors: Özer MA, Polat N, Özen S, Parlakpınar H, Ekici K, Polat A, Vardı N, Tanbek K, Yildiz A
Abstract
PURPOSE: To determine the role of Molsidomine in preventing radiation-induced retinopathy after head and neck region irradiation of rats with a single radiation dose of 15 Gy.
MATERIALS AND METHODS: Male Wistar albino rats were randomly grouped into five as follows: (1) control group rats, which were applied through an intraperitoneal (i.p.) vehicle without radiotherapy (RT); (2) RT group rats received a single dose of 15 Gy irradiation and after daily 0.1 ml vehicle i.p. for 5 consecutive days; (3) molsidomine (MOL) group rats were treated for 5 consecutive days by i.p. with 4 mg/kg/day MOL; (4) irradiation plus MOL group (RT+MOL) rats received irradiation and after 10 days single daily i.p. dose of MOL for 5 consecutive days; and (5) MOL+RT group rats were treated for 5 consecutive days by i.p. with MOL before RT. At the end of the work the rats were sacrificed under high-dose anesthesia on the 16(th) day and then eye tissues were taken for histopathological, immunohistochemical (caspase-3), and biochemical analyses (superoxide dismutase [SOD], glutathione peroxidase [GSH], and malondialdehyde [MDA]).
RESULTS: RT significantly decreased both the content of GSH and the activity of SOD, and significantly increased the production of MDA level in the rat eyes. MOL treatment significantly increased the SOD and GSH levels and significantly decreased the MDA production (p < 0.0001). In addition, RT significantly increased the number of ganglion cells (GCs; p = 0.001), whereas especially pretreatment with MOL improved (p = 0.013). RT led to significant retinopathy formation, and MOL therapy protected the retina from radiation-induced retinopathy (p < 0.0001).
CONCLUSIONS: We suggest that MOL is a powerful antioxidant and free radical scavenger that prevents the rat eyes from radiation-induced retinopathy and oxidative stress.
PMID: 27897441 [PubMed - as supplied by publisher]
An update on larynx cancer.
CA Cancer J Clin. 2016 Nov 29;:
Authors: Steuer CE, El-Deiry M, Parks JR, Higgins KA, Saba NF
Abstract
Answer questions and earn CME/CNE Laryngeal cancer remains one of the most common tumors of the respiratory tract. Fortunately, significant advancements have been made over the past decade in the treatment of laryngeal cancer. Although surgery has been the historical mainstay for localized disease and still is an integral part of treatment, nonsurgical options like radiation and systemic therapy have emerged as viable options. In addition, in the metastatic setting, novel agents are showing promise for this patient population. The care for patients with laryngeal cancer continues to evolve and truly requires a multidisciplinary team-based approach. Unique morbidities, such as loss of natural voice, respiration, and airway protection during swallowing, are observed with this disease and require special consideration. CA Cancer J Clin 2016. © 2016 American Cancer Society.
PMID: 27898173 [PubMed - as supplied by publisher]
Human papillomavirus DNA detection in fine-needle aspirates as indicator of human papillomavirus-positive oropharyngeal squamous cell carcinoma: A prospective study.
Head Neck. 2016 Nov 29;:
Authors: Sivars L, Landin D, Haeggblom L, Tertipis N, Grün N, Bersani C, Marklund L, Ghaderi M, Näsman A, Ramqvist T, Nordfors C, Munck-Wikland E, Tani E, Dalianis T
Abstract
BACKGROUND: Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (SCC) has a better outcome than most head neck squamous cell carcinomas (HNSCCs) and an HPV-positive lymph node metastasis likely has an HPV-positive oropharyngeal SCC origin. Determining HPV-status in cervical lymph nodes by fine-needle aspiration cytology (FNAC) may be useful for diagnosis.
METHODS: FNACs from 66 patients with neck masses were prospectively examined for HPV DNA and HPV16 mRNA by a polymerase chain reaction (PCR)-based assay, and the data correlated to diagnosis and HPV-status obtained from histopathological specimens.
RESULTS: Aspirates from 17 of 66 patients, later diagnosed with HPV-positive oropharyngeal SCC, were HPV16 DNA-positive. HPV16 mRNA was detected in all cases with extractable RNA. All remaining FNACs, including 18 branchial cleft cysts, were HPV DNA-negative. HPV DNA status in the aspirates showed perfect concordance with corresponding biopsies.
CONCLUSION: HPV16 DNA detection in fine-needle aspirations from neck masses is reliable and HPV16 DNA in a metastasis is a strong indicator of an HPV-positive oropharyngeal SCC. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.
PMID: 27898186 [PubMed - as supplied by publisher]
Salivary biomarkers as tools for oral squamous cell carcinoma diagnosis: A systematic review.
Head Neck. 2016 Nov 29;:
Authors: Stuani VT, Rubira CM, Sant'Ana AC, Santos PS
Abstract
BACKGROUND: The oral squamous cell carcinoma (OSCC) survival rate is influenced by the fact that diagnoses occur mostly in late stages of the disease. Thus, there is a clear contribution in the early findings, making the use of minimally invasive techniques for diagnosis, such as analysis of salivary markers, interesting tools.
METHODS: A systematic review was performed with all studies that establish a comparison between the levels of saliva-based markers found in patients with OSCC compared with cancer-free individuals.
RESULTS: Twenty-eight studies were included. Of them, only 12 showed some caution with oral conditions before sample collection. A wide range of potential markers was evaluated; however, the comparison between studies was impaired because each marker was hardly explored by more than 1 article.
CONCLUSION: The lack of methodological criteria within studies and the absence of consensus on marker choice are obstacles for future researches. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.
PMID: 27898189 [PubMed - as supplied by publisher]
Primary Ewing's sarcoma of the sinonasal tract in adults: A challenging disease.
Head Neck. 2016 Nov 29;:
Authors: Lombardi D, Mattavelli D, Redaelli De Zinis LO, Accorona R, Morassi ML, Facchetti F, Ferrari V, Farina D, Bertulli R, Nicolai P
Abstract
BACKGROUND: Sinonasal localization of Ewing's sarcoma in adults is an exceedingly rare event.
METHODS: The clinical records of 5 patients with primary sinonasal Ewing's sarcoma treated from 1992 to 2012 were retrospectively analyzed. All pathologic slides were reviewed by 2 experienced pathologists. All patients underwent multimodality treatments.
RESULTS: Median age was 36 years (range, 25-52 years). At referral, 2 patients had the original diagnosis changed by review of the histologic slides. Tumors were classified as T4aN0M0 (4 patients) and T2N0M0 (1 patient). Median follow-up was 110 months (range, 70-139 months). Only 1 patient, who started treatment elsewhere based on an incorrect histologic diagnosis, experienced multiple recurrences and eventually died of widespread metastasis.
CONCLUSION: Correct pathologic diagnosis can have a crucial impact on treatment planning and outcome. Multimodality therapy is the key for long-term successful results. Because of the rarity of the tumor, referral to highly experienced care centers is strongly recommended. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.
PMID: 27898190 [PubMed - as supplied by publisher]
Effects of Intratympanic Dexamethasone on High-Dose Radiation Ototoxicity In Vivo.
Otol Neurotol. 2016 Nov 24;
Authors: Dinh CT, Chen S, Dinh J, Goncalves S, Bas E, Padgett K, Johnson P, Elsayyad N, Telischi F, Van De Water T
Abstract
BACKGROUND: Stereotactic radiosurgery for lateral skull base tumors can cause hearing loss when the cochleae are exposed to high doses of single-fraction radiation. Currently, there are no known nondosimetric preventative treatments for radiation-induced ototoxicity.
HYPOTHESIS: Intratympanic (IT) dexamethasone (DXM), a synthetic steroid, protects against radiation-induced auditory hair cell (HC) and hearing losses in rats in vivo.
METHODS: Seven rats received radiation (12 Gy) to both cochleae. In irradiated rats and six nonirradiated rats, IT DXM was randomized to one ear, while tympanic puncture without DXM was performed on the contralateral ear. Baseline and 4-week postradiation auditory-evoked potential tests were performed. The cochleae were processed for HC viability.
RESULTS: Cochleae exposed to radiation demonstrated more outer HC (OHC) loss in all turns than nonirradiated ears (p <0.05). OHCs were more susceptible to radiation injury than inner HCs in the middle and basal turns (p <0.05). In irradiated cochleae, there was a nonsignificant trend for less OHC loss with IT DXM in the basal turn when compared with placebo. IT DXM did not improve radiation-induced hearing threshold shifts; however, a high rate of tympanic membrane perforations occurred with irradiated ears which may contribute to this finding.
CONCLUSION: Radiation induced loss of OHCs in all turns of the cochlea. IT DXM reduced OHC loss in the basal turn of irradiated ears; however, this finding did not achieve statistical significance. Although IT DXM did not affect radiation-induced hearing threshold shifts in adult rats in vivo, this may be due to a high rate of tympanic membrane perforations.
PMID: 27898607 [PubMed - as supplied by publisher]
Modelling tumour volume variations in head and neck cancer: magnetic resonance imaging contribution for patients undergoing induction chemotherapy.
Acta Otorhinolaryngol Ital. 2016 Nov 29;:
Authors: Dinapoli N, Tartaglione T, Bussu F, Autorino R, Miccichè F, Sciandra M, Visconti E, Colosimo C, Paludetti G, Valentini V
Abstract
Primary tumour volume evaluation has predictive value for estimating survival outcomes. Using volumetric data acquired by MRI in patients undergoing induction chemotherapy (IC) these outcomes were estimated before the radiotherapy course in head and neck cancer (HNC) patients. MRI performed before and after IC in 36 locally advanced HNC patients were analysed to measure primary tumour volume. The two volumes were correlated using the linear-log ratio (LLR) between the volume in the first MRI and the volume in the second. Cox's proportional hazards models (CPHM) were defined for loco-regional control (LRC), disease-free survival (DFS) and overall survival (OS). Strict evaluation of the influence of volume delineation uncertainties on prediction of final outcomes has been defined. LLR showed good predictive value for all survival outcomes in CPHM. Predictive models for LRC and DFS at 24 months showed optimal discrimination and prediction capability. Evaluation of primary tumour volume variations in HNC after IC provides an example of modelling that can be easily used even for other adaptive treatment approaches. A complete assessment of uncertainties in covariates required for running models is a prerequisite to create reliable clinically models.
PMID: 27897274 [PubMed - as supplied by publisher]
Development and validation of a septoplasty training model using 3-dimensional printing technology.
Int Forum Allergy Rhinol. 2016 Nov 29;:
Authors: AlReefi MA, Nguyen LH, Mongeau LG, Haq BU, Boyanapalli S, Hafeez N, Cegarra-Escolano F, Tewfik MA
Abstract
BACKGROUND: Providing alternative training modalities may improve trainees' ability to perform septoplasty. Three-dimensional printing has been shown to be a powerful tool in surgical training. The objectives of this study were to explain the development of our 3-dimensional (3D) printed septoplasty training model, to assess its face and content validity, and to present evidence supporting its ability to distinguish between levels of surgical proficiency.
METHODS: Imaging data of a patient with a nasal septal deviation was selected for printing. Printing materials reproducing the mechanical properties of human tissues were selected based on literature review and prototype testing. Eight expert rhinologists, 6 senior residents, and 6 junior residents performed endoscopic septoplasties on the model and completed a postsimulation survey. Performance metrics in quality (final product analysis), efficiency (time), and safety (eg, perforation length, nares damage) were recorded and analyzed in a study-blind manner.
RESULTS: The model was judged to be anatomically correct and the steps performed realistic, with scores of 4.05 ± 0.82 and 4.2 ± 1, respectively, on a 5-point Likert scale. Ninety-two percent of residents desired the simulator to be integrated into their teaching curriculum. There was a significant difference (p < 0.05) between the expert, intermediate, and novice groups in time taken and nares cuts, whereas other performance metrics showed no significant difference.
CONCLUSION: To our knowledge, there are no other simulator training models for septoplasty. Our model incorporates 2 different materials mixed into the 3 relevant consistencies necessary to simulate septoplasty. Our findings provide evidence supporting the validity of the model.
PMID: 27897397 [PubMed - as supplied by publisher]
Effect of Spatial Orientation of the Horizontal Semicircular Canal on the Vestibulo-ocular Reflex.
Otol Neurotol. 2016 Nov 24;
Authors: Maxwell R, von Kirschbaum C, Jerin C, Lehnen N, Krause E, Gürkov R
Abstract
OBJECTIVE: To determine if an alignment of the horizontal semi-circular canal (hSCC) with the plane of rotation would enhance the vestibular-ocular reflex (VOR) gain result as it has been previously suggested.
STUDY DESIGN: Comparative study of a physiological vestibular function test in healthy subjects.
SETTING: Tertiary referral center for otology and neurotology.
PATIENTS: Twenty two healthy volunteers were recruited for this study. Their mean age was 25.6 years and the sex distribution was 14:8 (M:F). None of the subjects had a history of audiovestibular disorders.
INTERVENTION: The video Head Impulse Test (v-HIT) was performed with the hSCC in the conventional position (head upright, horizontal gaze) and also with the hSCC in-line with the earth horizontal.
MAIN OUTCOME MEASURES: depending on the alignment of the hSCC with the plane of head rotation.
RESULTS: There was no significant difference between the results, either for the VOR gain at 60 ms, or the regression slope gain, when the two alternative head positions were compared.
CONCLUSIONS: The data acquired in this study show that the VOR as measured by the v-HIT is not enhanced by aligning the plane of the hSCC with the plane of rotation during the testing procedure. Hence, we recommend that the positioning of the patient, with the head upright and a horizontal gaze direction should be routinely used in the clinical evaluation of the angular VOR by v-HIT.
PMID: 27898608 [PubMed - as supplied by publisher]
Initial Results of a Safety and Feasibility Study of Auditory Brainstem Implantation in Congenitally Deaf Children.
Otol Neurotol. 2016 Nov 24;
Authors: Wilkinson EP, Eisenberg LS, Krieger MD, Schwartz MS, Winter M, Glater JL, Martinez AS, Fisher LM, Shannon RV, Los Angeles Pediatric ABI Team
Abstract
OBJECTIVE: To determine the safety and feasibility of the auditory brainstem implant (ABI) in congenitally deaf children with cochlear aplasia and/or cochlear nerve deficiency.
STUDY DESIGN: Phase I feasibility clinical trial of surgery in 10 children, ages 2 to 5 years, over a 3-year period.
SETTING: Tertiary children's hospital and university-based pediatric speech/language/hearing center.
INTERVENTION(S): ABI implantation and postsurgical programming.
MAIN OUTCOME MEASURE(S): The primary outcome measure is the number and type of adverse events during ABI surgery and postsurgical follow-up, including behavioral mapping of the device. The secondary outcome measure is access to and early integration of sound.
RESULTS: To date, nine children are enrolled. Five children have successfully undergone ABI surgery and postoperative behavioral programming. Three children were screen failures, and one child is currently undergoing candidacy evaluation. Expected adverse events have been documented in three of the five children who received the ABI. One child experienced a cerebral spinal fluid leak, which resolved with lumbar drainage. One child demonstrated vestibular side effects during device programming, which resolved by deactivating one electrode. One child experienced postoperative vomiting resulting in an abdominal radiograph. Four children have completed their 1-year follow-up and have speech detection thresholds of 30 to 35 dB HL. Scores on the IT-MAIS/MAIS range from 8 to 31 (out of a total of 40), and the children are demonstrating some ability to discriminate between closed-sets words that differ by number of syllables (pattern perception).
CONCLUSION: ABI surgery and device activation seem to be safe and feasible in this preliminary cohort.
PMID: 27898605 [PubMed - as supplied by publisher]
Recommendations for Potassium-Titanyl-Phosphate Laser in the Treatment of Cholesteatoma.
J Int Adv Otol. 2016 Nov 28;:
Authors: le Nobel GJ, James AL
Abstract
Potassium-titanyl-phosphage (KTP) lasers possess many characteristics suitable for otologic surgery. The objective of this report is to provide recommendations on the use of KTP laser for cholesteatoma surgery based on a narrative review of currently available evidence. PubMed and the Cochrane Review of randomized control trials were searched for relevant publications on efficacy and adverse effects and relevant articles appraised by the authors using Oxford Centre for Evidence-based Medicine criteria for recommendations. The potential benefits of KTP laser in cholesteatoma surgery include reduced rates of residual cholesteatoma and improved hearing outcomes. Cholesteatoma may be more effectively removed using KTP laser than using mechanical dissection alone. Reduced rates of residual cholesteatoma have been reported with KTP laser with level 2 evidence. In addition, KTP laser may facilitate the removal of cholesteatoma without the risk of mechanical trauma. This potentially allows for improved postoperative hearing outcomes through a) minimizing cochlear trauma and reducing sensorineural hearing loss and b) reducing the need for disruption of an intact ossicular chain. Currently, level 4 evidence exists to support improved postoperative hearing outcomes with the use of KTP laser. KTP laser use appears to be safe in otologic surgery if appropriate guidelines are followed. Current evidence is sufficient to strongly recommend KTP laser use for the prevention of residual cholesteatoma (Grade B recommendation) and an option for KTP laser use for optimizing hearing outcomes (Grade C recommendation).
PMID: 27897130 [PubMed - as supplied by publisher]
Pattern of clefts and dental anomalies in six-year-old children: a retrospective observational study in western Norway.
Acta Odontol Scand. 2016 Nov 29;:1-6
Authors: Sæle P, Østhus E, Ådalen S, Nasir EF, Mustafa M
Abstract
OBJECTIVES: Clefts of the lip and/or palate (CL/P) are the most common congenital disorders of the head and neck. In Norway, the incidence is 1.9/1000 live births. The aim of this study was to investigate the frequency and distribution of various types of clefts and dental anomalies in patients treated by the cleft lip and palate (CLP) team in Bergen, Norway.
MATERIAL AND METHODS: The material comprised the records of patients 6 years of age, examined by the CLP team in Bergen from spring 1993 to autumn 2012, incomplete records were excluded. The records of 989 patients were analysed, using frequencies and Chi-square test to compare differences in percentages between groups.
RESULTS: The gender distribution was 58.8% male and 41.2% female. Isolated cleft palate (CP) was the most common condition (39.5%). Clefts of the lip, jaw and palate (CLP) constituted (30%) of cases and (30.5%) had isolated cleft lip (CL). The frequencies of agenesis, supernumerary and peg-shaped teeth were (36.5%), (17.8%) and (7.5%), respectively. Over 50% of the study population were diagnosed with one or more malocclusion. Of the CLP patients, 61.4% had Angle Class III occlusion. Statistical analysis disclosed a positive association of agenesis with Class III occlusion (OR =1.8, p≤ 0.001).
CONCLUSIONS: The findings supported the hypothesis that the distribution of dental anomalies and occlusal disorders varied among patients with CL, CP and CLP. In patients with cleft, there is a twofold chance to get Class III malocclusion in the presence of agenesis.
PMID: 27897086 [PubMed - as supplied by publisher]
Complex Monteggia fracture in a 5 year old.
J Pediatr Orthop B. 2017 Jan;26(1):36-40
Authors: Clark TR, Merriott DS, Gonzales JA
Abstract
Monteggia fractures comprise a small subset of fractures in the pediatric population that are normally reduced nonoperatively. Complex Monteggia fractures can be more difficult to identify and require operative intervention. We describe a case of a Bado type I Monteggia fracture with a posteriorly dislocated radial head and neck fracture that has not been described before in the literature. The patient required advanced imaging because of ossification delays and led to an operative intervention to reduce the radial head and neck. This case exemplifies how irreducible Monteggia fractures may necessitate advanced imaging to determine blocks to a successful reduction.
PMID: 27898493 [PubMed - in process]
Prophylactic Feeding Tubes in Head and Neck Cancers #318.
J Palliat Med. 2016 Dec;19(12):1343-1344
Authors: Hardy S, Haas K, Vanston VJ, Angelo M
PMID: 27898295 [PubMed - in process]
Cost-effectiveness of microsurgical reconstruction for head and neck defects after oncologic resection.
Head Neck. 2016 Nov 29;:
Authors: Gao LL, Basta M, Kanchwala SK, Serletti JM, Low DW, Wu LC
Abstract
BACKGROUND: Microvascular free tissue transfer has become the main technique used for head and neck reconstruction. We assessed the cost-effectiveness of free flap reconstruction for head and neck defects after oncologic resection for squamous cell carcinoma (SCC).
METHODS: We developed a Markov model of the cost, quality of life, survival, and incremental cost-effectiveness of reconstruction with free tissue transfer compared with locoregional flaps. Health state probabilities and quality of life scores were determined from literature. Costs were determined from institutional experience. Outcomes included quality-adjusted life years, costs, and incremental cost-effectiveness ratio.
RESULTS: Free flap reconstruction was more costly than pedicled flap but associated with greater quality of life with no survival benefit. A value <$50,000 per quality-adjusted life-year (QALY) was defined as cost-effective. The incremental cost-effectiveness for head and neck free flap reconstruction was below the threshold and, therefore, free flap reconstruction is cost-effective. Reconstruction was more cost-effective for patients with lower stage cancers: $4643 per QALY for stage I SCC, $8226 for stage II, $17,269 for stage III, and $23,324 for stage IV. Univariate sensitivity analysis showed the cost-effectiveness would remain <$50,000 for all stages of SCC for all variables except for QALY after locoregional reconstruction without complications.
CONCLUSION: Microsurgical head and neck reconstruction is cost-effective compared with locoregional flaps, even more so in patients with early-stage cancer. This finding supports the current practice of free flap head and neck reconstruction. Screening and early detection are important to optimize costs. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.
PMID: 27898195 [PubMed - as supplied by publisher]
Effects of Intratympanic Dexamethasone on High-Dose Radiation Ototoxicity In Vivo.
Otol Neurotol. 2016 Nov 24;
Authors: Dinh CT, Chen S, Dinh J, Goncalves S, Bas E, Padgett K, Johnson P, Elsayyad N, Telischi F, Van De Water T
Abstract
BACKGROUND: Stereotactic radiosurgery for lateral skull base tumors can cause hearing loss when the cochleae are exposed to high doses of single-fraction radiation. Currently, there are no known nondosimetric preventative treatments for radiation-induced ototoxicity.
HYPOTHESIS: Intratympanic (IT) dexamethasone (DXM), a synthetic steroid, protects against radiation-induced auditory hair cell (HC) and hearing losses in rats in vivo.
METHODS: Seven rats received radiation (12 Gy) to both cochleae. In irradiated rats and six nonirradiated rats, IT DXM was randomized to one ear, while tympanic puncture without DXM was performed on the contralateral ear. Baseline and 4-week postradiation auditory-evoked potential tests were performed. The cochleae were processed for HC viability.
RESULTS: Cochleae exposed to radiation demonstrated more outer HC (OHC) loss in all turns than nonirradiated ears (p <0.05). OHCs were more susceptible to radiation injury than inner HCs in the middle and basal turns (p <0.05). In irradiated cochleae, there was a nonsignificant trend for less OHC loss with IT DXM in the basal turn when compared with placebo. IT DXM did not improve radiation-induced hearing threshold shifts; however, a high rate of tympanic membrane perforations occurred with irradiated ears which may contribute to this finding.
CONCLUSION: Radiation induced loss of OHCs in all turns of the cochlea. IT DXM reduced OHC loss in the basal turn of irradiated ears; however, this finding did not achieve statistical significance. Although IT DXM did not affect radiation-induced hearing threshold shifts in adult rats in vivo, this may be due to a high rate of tympanic membrane perforations.
PMID: 27898607 [PubMed - as supplied by publisher]
The effect of dexamethasone/cell-penetrating peptide nanoparticles on gene delivery for inner ear therapy.
Int J Nanomedicine. 2016;11:6123-6134
Authors: Yoon JY, Yang KJ, Park SN, Kim DK, Kim JD
Abstract
Dexamethasone (Dex)-loaded PHEA-g-C18-Arg8 (PCA) nanoparticles (PCA/Dex) were developed for the delivery of genes to determine the synergistic effect of Dex on gene expression. The cationic PCA nanoparticles were self-assembled to create cationic micelles containing an octadecylamine (C18) core with Dex and an arginine 8 (Arg8) peptide shell for electrostatic complexation with nucleic acids (connexin 26 [Cx26] siRNA, green fluorescent protein [GFP] DNA or brain-derived neurotrophic factor [BDNF] pDNA). The PCA/Dex nanoparticles conjugated with Arg8, a cell-penetrating peptide that enhances permeability through a round window membrane in the inner ear for gene delivery, exhibited high uptake efficiency in HEI-OC1 cells. This potential carrier co-delivering Dex and the gene into inner ear cells has a diameter of 120-140 nm and a zeta potential of 20-25 mV. Different types of genes were complexed with the Dex-loaded PCA nanoparticle (PCA/Dex/gene) for gene expression to induce additional anti-inflammatory effects. PCA/Dex showed mildly increased expression of GFP and lower mRNA expression of inflammatory cytokines (IL1b, IL12, and INFr) than did Dex-free PCA nanoparticles and Lipofectamine(®) reagent in HEI-OC1 cells. In addition, after loading Cx26 siRNA onto the surface of PCA/Dex, Cx26 gene expression was downregulated according to real-time polymerase chain reaction for 24 h, compared with that using Lipofectamine reagent. After loading BDNF DNA into PCA/Dex, increased expression of BDNF was observed for 30 h, and its signaling pathway resulted in an increase in phosphorylation of Akt, observed by Western blotting. Thus, Dex within PCA/Dex/gene nanoparticles created an anti-inflammatory effect and enhanced gene expression.
PMID: 27895484 [PubMed - in process]
PPARγ targeted oral cancer treatment and additional utility of genomics analytic techniques.
Laryngoscope. 2016 Nov 29;:
Authors: Handley N, Eide J, Taylor R, Wuertz B, Gaffney P, Ondrey F
Abstract
OBJECTIVE: Peroxisome proliferator-activated receptor γ (PPARγ) agonists have been shown to have anti-proliferative, anti-angiogenic, and proapoptotic effects, leading to interest in their use as cancer therapeutics. Pioglitazone, a U.S. Food and Drug Administration-approved type II diabetes medication and PPARγ agonist, may have a role in adjuvant head-and-neck squamous cell carcinoma treatment or prevention. Therefore, the purpose of this study was: 1) to treat oral cavity cancer cells with the PPARγ activator, pioglitazone, to analyze gene expression changes; and 2) to compare those changes with our preexisting genomic data for development of hypothesis-driven additional basic and clinical studies.
STUDY DESIGN: Prospective in vitro.
METHODS: We utilized microarray technology, as well as OCPlus (Bioconductor open source software) and Ingenuity Pathway Analysis (Qiagen, Redwood City, CA), to analyze differential gene expression in tumor and pioglitazone-treated tumor cells on a genome-wide level to demonstrate the feasibility of such an approach and determine appropriate sample size for future investigations.
RESULTS: We found that approximately 35 samples are required to adequately power future studies. We next discovered that pioglitazone significantly affects Inducible T-Cell Costimulator (iCOS)-Ligand for the T-cell-specific cell surface receptor ICOS (iCOSL) and type II diabetes mellitus pathways as a putative anti-cancer mechanism.
CONCLUSION: Genome-wide analysis is possible for the exploration of differential pathway modulation and rapid hypothesis generation. Both inflammation and type II diabetes pathways were significantly altered and therefore might provide unique hypothesis-driven pharmacodynamic parameters for future in vitro or in vivo studies utilizing thiazolidinediones. These techniques could be applied to microarray or other high throughput data from a variety of hypothesis-generating research scenarios in otolaryngology (e.g., middle ear proteomics, sinus microbiome studies).
LEVEL OF EVIDENCE: NA. Laryngoscope, 2016.
PMID: 27896820 [PubMed - as supplied by publisher]
Salivary biomarkers as tools for oral squamous cell carcinoma diagnosis: A systematic review.
Head Neck. 2016 Nov 29;:
Authors: Stuani VT, Rubira CM, Sant'Ana AC, Santos PS
Abstract
BACKGROUND: The oral squamous cell carcinoma (OSCC) survival rate is influenced by the fact that diagnoses occur mostly in late stages of the disease. Thus, there is a clear contribution in the early findings, making the use of minimally invasive techniques for diagnosis, such as analysis of salivary markers, interesting tools.
METHODS: A systematic review was performed with all studies that establish a comparison between the levels of saliva-based markers found in patients with OSCC compared with cancer-free individuals.
RESULTS: Twenty-eight studies were included. Of them, only 12 showed some caution with oral conditions before sample collection. A wide range of potential markers was evaluated; however, the comparison between studies was impaired because each marker was hardly explored by more than 1 article.
CONCLUSION: The lack of methodological criteria within studies and the absence of consensus on marker choice are obstacles for future researches. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.
PMID: 27898189 [PubMed - as supplied by publisher]
Primary Ewing's sarcoma of the sinonasal tract in adults: A challenging disease.
Head Neck. 2016 Nov 29;:
Authors: Lombardi D, Mattavelli D, Redaelli De Zinis LO, Accorona R, Morassi ML, Facchetti F, Ferrari V, Farina D, Bertulli R, Nicolai P
Abstract
BACKGROUND: Sinonasal localization of Ewing's sarcoma in adults is an exceedingly rare event.
METHODS: The clinical records of 5 patients with primary sinonasal Ewing's sarcoma treated from 1992 to 2012 were retrospectively analyzed. All pathologic slides were reviewed by 2 experienced pathologists. All patients underwent multimodality treatments.
RESULTS: Median age was 36 years (range, 25-52 years). At referral, 2 patients had the original diagnosis changed by review of the histologic slides. Tumors were classified as T4aN0M0 (4 patients) and T2N0M0 (1 patient). Median follow-up was 110 months (range, 70-139 months). Only 1 patient, who started treatment elsewhere based on an incorrect histologic diagnosis, experienced multiple recurrences and eventually died of widespread metastasis.
CONCLUSION: Correct pathologic diagnosis can have a crucial impact on treatment planning and outcome. Multimodality therapy is the key for long-term successful results. Because of the rarity of the tumor, referral to highly experienced care centers is strongly recommended. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.
PMID: 27898190 [PubMed - as supplied by publisher]
Reirradiation with intensity-modulated radiotherapy for locally recurrent T3 to T4 nasopharyngeal carcinoma.
Head Neck. 2016 Nov 29;:
Authors: Chan OS, Sze HC, Lee MC, Chan LL, Chang AT, Lee SW, Hung WM, Lee AW, Ng WT
Abstract
BACKGROUND: The purpose of this study was to assess the efficacy and toxicities of reirradiation using intensity-modulated radiotherapy (IMRT) in patients with locally advanced recurrent nasopharyngeal carcinoma (NPC).
METHODS: Thirty-eight patients with consecutive rT3 to rT4 NPC treated between 2005 and 2013 were retrospectively analyzed.
RESULTS: The 3-year overall survival (OS), progression-free survival (PFS), and local control rate were 47.2%, 17.5%, and 44.3%, respectively. Gross target volume (GTV) D95 , GTV D50 , and age were all important prognostic factors for OS and PFS, but only GTV D95 was an important determinant for local control. A total of 73.7% patients experienced ≥1 grade 3 late toxicities and 3 patients died of massive epistaxis. Temporal lobe necrosis (TLN) developed sooner with a higher total biological equivalent dose.
CONCLUSION: Adequate tumor dose coverage was important for treating rT3 to rT4 NPC. Although late complications were common, treatment-related mortality was solely vascular in nature. Dose constraints of neurologic structures for reirradiation should be revised with the latest information on late toxicities. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.
PMID: 27898191 [PubMed - as supplied by publisher]
Reappraising hyalinizing clear cell carcinoma: A population-based study with molecular confirmation.
Head Neck. 2016 Nov 29;:
Authors: Hernandez-Prera JC, Kwan R, Tripodi J, Chiosea S, Cordon-Cardo C, Najfeld V, Demicco EG
Abstract
BACKGROUND: Hyalinizing clear cell carcinoma (HCCC) is a rare malignancy, characterized by EWSR1-ATF1 gene fusion, whose behavior is poorly understood, as it was for many years considered a diagnosis of exclusion.
METHODS: All available salivary gland carcinomas (n = 594) from our institution were reviewed. Diagnosis of HCCC was confirmed by fluorescence in situ hybridization (FISH) for EWSR1. Literature review was performed.
RESULTS: We found 15 patients with HCCCs (10 women, 5 men), 13 with EWSR1 rearrangement. Median age at diagnosis was 57 years (range, 31-87 years). Oral cavity (n = 9) and base of tongue (n = 4) were the most frequent primary sites. Combining our cases with those identified in literature review, the 10-year risk of local recurrence and locoregional nodal metastasis were 49% and 15%, respectively.
CONCLUSION: Molecularly confirmed HCCC accounted for 2.5% of salivary gland malignancies at our institution. HCCCs are indolent tumors with a propensity for locoregional recurrence. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.
PMID: 27898192 [PubMed - as supplied by publisher]
Microdosimetric Measurements in Gamma and neutron Fields with a Tissue Equivalent Proportional Counter Based on a Gas Electron Multiplier.
Radiat Prot Dosimetry. 2016 Nov 23;
Authors: De Nardo L, Dal Corso F, Pegoraro M
Abstract
A multi-element tissue-equivalent proportional counter (TEPC), based on a single gas electron multiplier (GEM) foil of standard geometry, has been constructed with 16 cylindrical sensitives volumes. In this article, the design of this novel counter is described and first microdosimetric measurements are presented. To study the response of the GEM-TEPC to both low and high linear energy transfer radiation fields, the microdosimetric spectra due to a (137)Cs gamma-ray source and to fast neutrons from (7)Li(d,n)(8)Be reaction have been measured using pure propane gas at low pressure, in order to simulate a tissue site of about 1 µm equivalent size. The comparison with spectra measured with a spherical TEPC and with a mini-TEPC demonstrates promising properties for application of the GEM-TEPC for microdosimetric applications.
PMID: 27881795 [PubMed - as supplied by publisher]
Toward More Efficient Surveillance of Barrett's Esophagus: Identification and Exclusion of Patients at Low Risk of Cancer.
World J Surg. 2016 Nov 23;
Authors: Lindblad M, Bright T, Schloithe A, Mayne GC, Chen G, Bull J, Bampton PA, Fraser RJ, Gatenby PA, Gordon LG, Watson DI
Abstract
BACKGROUND: Endoscopic surveillance of Barrett's esophagus (BE) is probably not cost-effective. A sub-population with BE at increased risk of high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) who could be targeted for cost-effective surveillance was sought.
METHODS: The outcome for BE surveillance from 2003 to 2012 in a structured program was reviewed. Incidence rates and incidence rate ratios for developing HGD or EAC were calculated. Risk stratification identified individuals who could be considered for exclusion from surveillance. A health-state transition Markov cohort model evaluated the cost-effectiveness of focusing on higher-risk individuals.
RESULTS: During 2067 person-years of follow-up of 640 patients, 17 individuals progressed to HGD or EAC (annual IR 0.8%). Individuals with columnar-lined esophagus (CLE) ≥2 cm had an annual IR of 1.2% and >8-fold increased relative risk of HGD or EAC, compared to CLE <2 cm [IR-0.14% (IRR 8.6, 95% CIs 4.5-12.8)]. Limiting the surveillance cohort after the first endoscopy to individuals with CLE ≥2 cm, or dysplasia, followed by a further restriction after the second endoscopy-exclusion of patients without intestinal metaplasia-removed 296 (46%) patients, and 767 (37%) person-years from surveillance. Limiting surveillance to the remaining individuals reduced the incremental cost-effectiveness ratio from US$60,858 to US$33,807 per quality-adjusted life year (QALY). Further restrictions were tested but failed to improve cost-effectiveness.
CONCLUSIONS: Based on stratification of risk, the number of patients requiring surveillance can be reduced by at least a third. At a willingness-to-pay threshold of US$50,000 per QALY, surveillance of higher-risk individuals becomes cost-effective.
PMID: 27882416 [PubMed - as supplied by publisher]
First Map of Residential Indoor Radon Measurements in Azerbaijan.
Radiat Prot Dosimetry. 2016 Nov 23;
Authors: Hoffmann M, Aliyev CS, Feyzullayev AA, Baghirli RJ, Veliyeva FF, Pampuri L, Valsangiacomo C, Tollefsen T, Cinelli G
Abstract
This article describes results of the first measurements of indoor radon concentrations in Azerbaijan, including description of the methodology and the mathematical and statistical processing of the results obtained. Measured radon concentrations varied considerably: from almost radon-free houses to around 1100 Bq m(-3) However, only ~7% of the total number of measurements exceeded the maximum permissible concentrations. Based on these data, maps of the distribution of volumetric activity and elevated indoor radon concentrations in Azerbaijan were created. These maps reflect a mosaic character of distribution of radon and enhanced values that are confined to seismically active areas at the intersection of an active West Caspian fault with sub-latitudinal faults along the Great and Lesser Caucasus and the Talysh mountains. Spatial correlation of radon and temperature behavior is also described. The data gathered on residential indoor radon have been integrated into the European Indoor Radon Map.
PMID: 27881794 [PubMed - as supplied by publisher]
[Circadian rhythm : Influence on Epworth Sleepiness Scale score].
HNO. 2016 Nov 23;
Authors: Herzog M, Bedorf A, Rohrmeier C, Kühnel T, Herzog B, Bremert T, Plontke S, Plößl S
Abstract
BACKGROUND: The Epworth Sleepiness Scale (ESS) is frequently used to determine daytime sleepiness in patients with sleep-disordered breathing. It is still unclear whether different levels of alertness induced by the circadian rhythm influence ESS score.
OBJECTIVE: The aim of this study is to investigate the influence of circadian rhythm-dependent alertness on ESS performance.
MATERIALS AND METHODS: In a monocentric prospective noninterventional observation study, 97 patients with suspected sleep-disordered breathing were investigated with respect to daytime sleepiness in temporal relationship to polysomnographic examination and treatment. The Karolinska Sleepiness Scale (KSS) and the Stanford Sleepiness Scale (SSS) served as references for the detection of present sleepiness at three different measurement times (morning, noon, evening), prior to and following a diagnostic polysomnography night as well as after a continuous positive airway pressure (CPAP) titration night (9 measurements in total). The KSS, SSS, and ESS were performed at these times in a randomized order.
RESULTS: The KSS and SSS scores revealed a circadian rhythm-dependent curve with increased sleepiness at noon and in the evening. Following a diagnostic polysomnography night, the scores were increased compared to the measurements prior to the night. After the CPAP titration night, sleepiness in the morning was reduced. KSS and SSS reflect the changes in alertness induced by the circadian rhythm. The ESS score war neither altered by the intra-daily nor by the inter-daily changes in the level of alertness.
CONCLUSION: According to the present data, the ESS serves as a reliable instrument to detect the level of daytime sleepiness independently of the circadian rhythm-dependent level of alertness.
PMID: 27882399 [PubMed - as supplied by publisher]
When considering supine position and REM dependence, many studies refer to the traditional definition in which obstructive sleep apnea (OSA) severity is at least doubled in the corresponding position/sleep stage (Cartwright index). The lack of consideration of the time spent in that particular sleep situation can lead to clinical bias.
Two cohorts of patients with at least moderate OSA were analyzed retrospectively for anthropometric associations and correlations with OSA severity. One group consisted of 48 patients diagnosed using a polygraph, and the other group of 222 patients underwent polysomnography. First, the conventional Cartwright index was used, and a modified index was later applied to integrate the relative time component for REM sleep and the supine position.
Less than a fifth of the patients fulfilled the classic conditions for supine position or REM sleep dependency. There were no definitive cut-offs in the classic or modified Cartwright index with regard to daytime sleepiness. Both indices show there was a correlation between OSA severity and being overweight.
The modified Cartwright index allowed us to identify borderline cases that were characterized by a very low or high amount of time spent in the supine position or REM sleep situation. Therapy effects that could have been biased only by varying amounts of time spent in the supine position could be better controlled for. Future studies will possibly include various other ratios besides the previously accepted 2:1 ratio when different statistical parameters are considered, such as the reduction of OSA severity or therapy adherence.
When considering supine position and REM dependence, many studies refer to the traditional definition in which obstructive sleep apnea (OSA) severity is at least doubled in the corresponding position/sleep stage (Cartwright index). The lack of consideration of the time spent in that particular sleep situation can lead to clinical bias.
Two cohorts of patients with at least moderate OSA were analyzed retrospectively for anthropometric associations and correlations with OSA severity. One group consisted of 48 patients diagnosed using a polygraph, and the other group of 222 patients underwent polysomnography. First, the conventional Cartwright index was used, and a modified index was later applied to integrate the relative time component for REM sleep and the supine position.
Less than a fifth of the patients fulfilled the classic conditions for supine position or REM sleep dependency. There were no definitive cut-offs in the classic or modified Cartwright index with regard to daytime sleepiness. Both indices show there was a correlation between OSA severity and being overweight.
The modified Cartwright index allowed us to identify borderline cases that were characterized by a very low or high amount of time spent in the supine position or REM sleep situation. Therapy effects that could have been biased only by varying amounts of time spent in the supine position could be better controlled for. Future studies will possibly include various other ratios besides the previously accepted 2:1 ratio when different statistical parameters are considered, such as the reduction of OSA severity or therapy adherence.
Adrenal Injuries: Historical Facts and Modern Truths.
World J Surg. 2016 Nov 23;
Authors: DiGiacomo JC, Angus LD, Coffield E
Abstract
BACKGROUND: Prior to the advent of whole body computed tomography, injuries of the adrenal gland were almost exclusively identified on postmortem examinations and were associated with severe injury. Recent literature has continued to identify an association between adrenal injuries and high ISS. The purpose of this study was to assess the influence of adrenal trauma on ISS and mortality while controlling for potential confounding factors.
METHODS: A 15-year retrospective review for all adrenal gland injuries from a Level 1 Trauma Center's Trauma Registry was performed. Based on the characteristics of that patient population, the same Trauma Registry was then queried for case-matched patients, and the two groups compared to assess the influence of adrenal gland injuries on mortality.
RESULTS: Seventy-two patients with adrenal injuries were identified and compared to 1026 case-matched patients. The adrenal gland injury was not a contributing factor in any of the study group mortalities. The mean ISS for the adrenal gland injured group was higher than the overall Registry ISS (18.7 vs 10.6) but almost identical to the ISS of patients case matched for abdominal injuries.
CONCLUSION: Case-matched analysis based on multiple clinical variables demonstrates that the ISS of patients with adrenal gland injuries were similar to the ISS of patients with other injuries to the abdominal region and were in fact associated with a 0.02% decrease in mortality.
PMID: 27882417 [PubMed - as supplied by publisher]
Summer music and arts festivals as hot spots for measles transmission: experience from England and Wales, June to October 2016.
Euro Surveill. 2016 Nov 3;21(44):
Authors: le Polain de Waroux O, Saliba V, Cottrell S, Young N, Perry M, Bukasa A, Ramsay M, Brown K, Amirthalingam G
Abstract
We report 52 cases of measles linked to music and arts festivals in England and Wales, between mid-June and mid-October 2016. Nearly half were aged 15 to 19 years. Several individuals who acquired measles at one festival subsequently attended another festival while infectious, resulting in multiple interlinked outbreaks. Transmission within festivals resulted in a geographical spread of cases nationally as well as internationally, which presents particular challenges for measles control.
PMID: 27881230 [PubMed - in process]
