Head and Neck Diseases by Alexandros G.Sfakianakis: 01/09/16

Σάββατο 9 Ιανουαρίου 2016

Auditory and visual 3D virtual reality therapy as a new treatment for chronic subjective tinnitus: results of a randomized controlled trial

Publication date: Available online 8 January 2016
Source:Hearing Research
Author(s): D. Malinvaud, A. Londero, R. Niarra, Ph Peignard, O. Warusfel, I. Viaud-Delmon, G. Chatellier, P. Bonfils
BackgroundSubjective tinnitus (ST) is a frequent audiologic condition that still requires effective treatment. This study aimed at evaluating two therapeutic approaches: Virtual Reality (VR) immersion in auditory and visual 3D environments and Cognitive Behaviour Therapy (CBT).Methodsthis open, randomized and therapeutic equivalence trial used bilateral testing of VR versus CBT. Adult patients displaying unilateral or predominantly unilateral ST, and fulfilling inclusion criteria were included after giving their written informed consent. We measured the different therapeutic effect by comparing the mean scores of validated questionnaires and visual analog scales, pre and post protocol. Equivalence was established if both strategies did not differ for more than a predetermined limit. We used univariate and multivariate analysis adjusted on baseline values to assess treatment efficacy. In addition of this trial, purely exploratory comparison to a waiting list group (WL) was provided.ResultsBetween August, 2009 and November, 2011, 148 of 162 screened patients were enrolled (VR n = 61, CBT n = 58, WL n = 29). These groups did not differ at baseline for demographic data. Three month after the end of the treatment, we didn't find any difference between VR and CBT groups either for tinnitus severity (p=0.99) or tinnitus handicap (p=0.36).ConclusionVR appears to be at least as effective as CBT in unilateral ST patients.

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Selective processing of auditory evoked responses with iterative-randomized stimulation and averaging: A strategy for evaluating the time-invariant assumption

Publication date: Available online 8 January 2016
Source:Hearing Research
Author(s): Joaquin T. Valderrama, Angel de la Torre, Carlos Medina, Jose C. Segura, A. Roger D. Thornton
The recording of auditory evoked potentials (AEPs) at fast rates allows the study of neural adaptation, improves accuracy in estimating hearing threshold and may help diagnosing certain pathologies. Stimulation sequences used to record AEPs at fast rates require to be designed with a certain jitter, i.e., not periodical. Some authors believe that stimuli from wide-jittered sequences may evoke auditory responses of different morphology, and therefore, the time-invariant assumption would not be accomplished. This paper describes a methodology that can be used to analyze the time-invariant assumption in jittered stimulation sequences. The proposed method [Split-IRSA] is based on an extended version of the iterative randomized stimulation and averaging (IRSA) technique, including selective processing of sweeps according to a predefined criterion. The fundamentals, the mathematical basis and relevant implementation guidelines of this technique are presented in this paper. The results of this study show that Split-IRSA presents an adequate performance and that both fast and slow mechanisms of adaptation influence the evoked-response morphology, thus both mechanisms should be considered when time-invariance is assumed. The significance of these findings is discussed.

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Can Superselective Intra-arterial Chemoradiotherapy replace surgery followed by radiation for advanced cancer of tongue and floor of mouth?

Publication date: Available online 8 January 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Wataru Kobayashi, Kosei Kukobota, Ryohei Ito, Hirotaka Sakaki, Hirosi Nakagawa, Beng Gwan Teh
PurposeThe purpose of this study was to compare quality of life (QoL) and survival rate after surgery with and without radiotherapy versus superselective intra-arterial chemoradiotherapy (SSIACRT) for advanced cancer of the tongue and floor of the mouth.Materials and MethodsPatients with stage III and IV squamous cell carcinoma (SCC) of the tongue and floor of the mouth treated between 2000 and 2013 were included in this study. Predictor variables were surgery without radiotherapy (S), surgery followed by radiotherapy (S+R), and SSIACRT. Outcome variables were QoL and survival rate. The University of Washington QoL questionnaire (UWQoL) was used for evaluation of QoL. Kaplan-Meier method was used to estimate the overall survival rate. UWQoL was analyzed by analysis of covariance and survival rate was analyzed by log-rank test statistically.ResultsSixty-two patients were eligible for this study. Thirteen patients were treated by S, 29 patients were treated by S+R, and 20 patients were treated by SSIACRT. SSIACRT had the best UWQoL scores among the three groups. The 5-year Kaplan-Meier disease-specific survival rate for these groups were 92.9, 62.9, and 83.2%, respectively, with no significant difference (p=0.20) revealed.ConclusionsThe QoL scores of SSIACRT were the best among the three groups in most domains. The superiority of QoL and survival rate in SSIACRT demonstrated that SSIACRT should be preferred in managing advanced cancer of the tongue and floor of the mouth. Introduction

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Recovery of Impaired Somatosensory Evoked Fields after Improvement of Tongue Sensory Deficits with Neurosurgical Reconstruction

Publication date: Available online 8 January 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Hitoshi Maezawa, Itaru Tojyo, Kazuya Yoshida, Shigeyuki Fujita
Somatosensory evoked fields (SEFs) induced by tongue stimulation can be useful as an objective parameter to assess sensory disturbances in the tongue. However, whether tongue SEFs can be useful as a clinical, objective follow-up assessment method of tongue sensation following oral surgery is unknown. Here we describe two cases in which tongue SEFs were successfully used in clinical assessment. Two patients with unilateral tongue sensory deficits caused by lingual nerve injury during lower third molar extraction were recruited. Both patients underwent surgery to repair the damaged nerve, and all tongue sensory evaluations were made once before and once after surgery. SEFs were recorded by stimulating the affected and unaffected sides of the tongue separately, and cortical activity was evaluated over the contralateral hemisphere. The unilaterality of the deficit was also assessed. In both patients, stimulation of the unaffected side evoked reproducible cortical responses pre- and post-surgery. Both patients also recovered some sensation following surgery, as pre-surgery stimulation of the affected side failed to evoke cortical activity, whereas post-surgery stimulation evoked cortical activity on both sides. Sensation was initially highly lateralized in both patients, but was restored to approximately normal in the post-surgery evaluation. Finally, both patients' rated their subjective tongue sensations on the affected side over 50% better after the surgical intervention. These cases indicate that tongue SEFs may have a clinical use as an objective parameter for assessing the course of tongue sensory recovery.

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Why Do Women Choose to Enter Academic Oral and Maxillofacial Surgery?

Publication date: Available online 9 January 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Antonia Kolokythas, Michael Miloro
PurposeTo determine why women chose to enter an academic career in oral and maxillofacial surgery (OMS).Materials and MethodsAn online questionnaire was developed and emailed to female ?OMS surgeons to assess the reasons why women choose to pursue an academic career, the perceived positive and negative features of academia for women, and proposed measures to increase the percentage of women choosing to specialize in OMS and pursue an academic career.Results31 female OMS surgeons completed the questionnaire; one additional participant accessed the survey but did not respond to any of the questions. There were 25 full-time academics and 6 part-time academics (50% time commitment or more). 72% of the responders were married, and of those 72% were married prior to entering academics. 47%% of the women had children, all during their academic tenure. Among the full time academicians with children, only 2 (7.7%) reported moderate difficulty finding the time for childbirth and maternity leave, while 3 out of the 5 part time academics with children, reported moderate or significant difficulty with childbirth and maternity leave. Factors associated with choosing and enjoying an academic career are involvement in resident-student teaching (78%), followed by colleague camaraderie and collaboration (65.6%), research potential (50%), time flexibility and not having to deal with excessive "business" practice issues (33%). The main reason for considering leaving an academic OMS career and/or amongst the least enjoyable aspects of being in academics were the potential for a higher income in private practice (56%). Less significant reasons for considering leaving an academic OMS career were a more flexible work schedule in the private sector and less institutional red tape (37.5%), independence/being in control, and more family time (22%), Engaging residents and students by female OMS, better mentorship from academic OMS and increase in the number of women serving in leadership positions in organized OMS, were identified as the most important measures to increase female involvement in academic OMS.ConclusionThis study shows that among the major motivating factors for choosing an academic career are: the involvement in resident-student teaching and colleague camaraderie and collaboration. Additional important factors for making this career choice were the research potential in academia, time flexibility and not having to deal with excessive "business" practice issues. The reasons that deter women from entering OMS as a specialty and choosing a full-time academic OMS career are not significantly related to childbirth and family life. The main reason for potentially considering leaving an academic OMS career and/or among the least enjoyable aspects of being in academics, were the potential for a higher income in private practice. Other reasons for potentially considering leaving an academic OMS career indicated by this study were the lack of institutional red tape as well as independence/being in control, and more family time. It appears that engaging female residents and students by female OMS, better mentorship by (both male and female) academic OMS and increasing the number of female surgeons who can serve as role models, may be beneficial in increasing the number of female OMS interested in an academic career.

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Health insurance affects head and neck cancer treatment patterns and outcomes

Publication date: Available online 8 January 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Gino Inverso, Brandon A. Mahal, Ayal A. Aizer, R. Bruce Donoff, Sung-Kiang Chuang
PurposeThe purpose of this study is to examine the effect of insurance coverage on stage of presentation, treatment, and survival of head and neck cancer (HNC).Materials and MethodsA retrospective study was conducted utilizing the Surveillance, Epidemiology and End Results (SEER) program to identify patients diagnosed with HNC. The primary variable of interest was insurance analyzed as a dichotomous variable: Subjects were considered uninsured if they were classified as "uninsured" by SEER, while subjects were considered insured if they were defined by SEER as "any Medicaid", "insured", and "insured/no specifics". The outcomes of interest were cancer stage at presentation (M0 versus M1), receipt of definitive treatment, and head and neck cancer-specific mortality (HNCSM). Multivariable logistic regression modeled the association between insurance status and stage at presentation and receipt of definitive treatment, while HNCSM was modeled using Fine and Gray competing-risks. Sensitivity logistic regression analysis was used to determine whether observed interactions remained significant by insurance type (Privately insured, Medicaid, and uninsured).ResultsSubjects without medical insurance were more likely to present with metastatic cancer (Adjusted odds ratio [AOR] 1.60; P<0.001), more likely to not receive definitive treatment (AOR 1.64; P<0.001), and had a higher risk of HNCSM (AHR 1.20; P=0.002). Sensitivity analyses revealed that when stratifying results by insurance type, significant interactions remained for uninsured subjects and subjects with Medicaid.ConclusionUninsured patients and patients with Medicaid are more likely to present with metastatic disease, more likely to not be treated definitively, and are at a higher risk for HNCSM. The observed treatment gap between Medicaid and private insurance seen in the present study should serve as an immediate policy target for healthcare reform.

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Longitudinal contraction venoplasty in prevention of internal jugular vein thrombosis after free flap vascular anastomosis

Publication date: Available online 8 January 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Zhao-Jian Gong, Yan-rong Chen, Kai Wang, Sheng Zhang, Zhen-hu Ren, Han-Jiang Wu
PurposeThe vascular anastomosis of free flap with the internal jugular vein stump is prone to thrombosis, thus resulting in flap compromise or failure. This paper aims to explore the method of longitudinal contraction venoplasty in prevention of internal jugular vein stump thrombosis after free flap vascular anastomosis and its feasibility.Patients and MethodsA retrospective review was performed of 16 patients who underwent internal jugular vein resection due to cancer ablation and longitudinal contraction venoplasty to prevent internal jugular vein stump thrombosis after free flap vascular anastomosis from January 2013 through December 2014 in the Second Xiangya Hospital. The methods for longitudinal contraction venoplasty and its efficacy are reported.ResultsVenous anastomosis of all flaps was performed with the internal jugular vein stump, and single venous anastomosis was made in all cases. Postoperatively, all flaps survived completely, without vascular compromise. All the patients were followed for approximately 9 to 33 months, and they were satisfied with the esthetic and functional results of the donor and recipient sites after reconstruction.ConclusionsLongitudinal contraction venoplasty may be an effective new method for prevention of internal jugular vein thrombosis after free flap vascular anastomosis.

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Invasive fungal rhinosinusitis in adult patients: our experience in diagnosis and management

Publication date: Available online 9 January 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Fabio Pagella, Francesca De Bernardi, Daniela Dalla Gasperina, Alessandro Pusateri, Elina Matti, Irene Avato, Caterina Cavanna, Patrizia Zappasodi, Maurizio Bignami, Elena Bernardini, Paolo Antonio Grossi, Paolo Castelnuovo
BackgroundThis paper describes our experience in the management of acute and chronic invasive fungal rhinosinusitis (IFRS) in adults.MethodsMedical files of all patients aged >18 years treated in our institutions for IFRS from 2002 to 2013 were retrospectively reviewed.ResultsA total of 18 cases (10 acute and 8 chronic) were recorded. In acute form, haematological malignancies represented the principal comorbidity (100%), while in chronic form this was diabetes mellitus (87.5 %). All patients received systemic anti-fungal agents. Endoscopic sinus surgery was performed in 16/18 patients (88.9%). Among patients with an acute IFRS, 4/10 died of fungal infection (40%), on the other side 2/8 patients with chronic IFRS died of the evolution of the mycosis (25%).ConclusionsAcute and chronic IFRS are different entities: in acute form, prognosis is poor, so therapy should be promptly performed, although host immune status and evolution of the haematological disease are key factors for the outcome. In chronic form, a wide surgical excision of the disease is recommended in order to obtain a complete removal of fungal infection. In both forms, early clinical findings are non-specific and ambiguous, so diagnosis depends on a high index of suspicion, taking into account predisposing factors.

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Invasive fungal rhinosinusitis in adult patients: our experience in diagnosis and management

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Selective processing of auditory evoked responses with iterative-randomized stimulation and averaging: A strategy for evaluating the time-invariant assumption

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Selective processing of auditory evoked responses with iterative-randomized stimulation and averaging: A strategy for evaluating the time-invariant assumption

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Tuberkulose nimmt zu, und die Anforderungen steigen

Mehr Erkrankte
In Deutschland hat es auch im Jahr 2014 wieder mehr Tuberkulose-Patienten gegeben, berichtet das Robert Koch-Institut. Deswegen appellieren die Experten an Ärzte, sich für Diagnose und Therapie fit zu halten.

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Involvement of a Putative Bipartite Transit Peptide in Targeting Rice Pheophorbide a Oxygenase into Chloroplasts for Chlorophyll Degradation during Leaf Senescence

Publication date: Available online 8 January 2016
Source:Journal of Genetics and Genomics
Author(s): Qingjun Xie, Yan Liang, Jian Zhang, Huakun Zheng, Guojun Dong, Qian Qian, Jianru Zuo
Leaf senescence is one of the major factors contributing to the productivity and the grain quality in crops. The regulatory mechanism of leaf senescence remains largely unknown. Here, we report the identification and characterization of a rice early senescence 1 (eas1) mutant, which displayed an early leaf senescence phenotype, accompanying by dwarfism and the reduced tiller numbers, eventually leading to the reduction of grain yield. Map-based cloning revealed that the nuclear gene EAS1 encodes a pheophorbide a oxygenase (PaO), a key enzyme for chlorophyll breakdown. A highly conserved Thr residue of PaO was mutated into Ile in the eas1 mutant. Phylogenetic analysis indicates that PaO is an evolutionarily conserved protein, and EAS1 is 68% identical to the Arabidopsis ACCERLERATED CELL DEATH (ACD1) protein. Unlike ACD1 that contains a single transit peptide, EAS1 contains two putative transit peptides at its N-terminus, which are essential for its functionality, suggesting that targeting of EAS1 to the chloroplast is likely mediated by a putative bipartite transit peptide. Consistently, only a short version of EAS1 lacking the first putative transit peptide, but not the full-length EAS1, was capable of rescuing the Arabidopsis acd1 mutant phenotype. These results suggest that rice EAS1 represents a functional PaO, which is involved in chlorophyll degradation and may utilize a unique mechanism for its import into the chloroplast.

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Auditory and visual 3D virtual reality therapy as a new treatment for chronic subjective tinnitus: results of a randomized controlled trial

Reduction in Spread of Excitation from Current Focusing at Multiple Cochlear Locations in Cochlear Implant Users

Publication date: Available online 8 January 2016
Source:Hearing Research
Author(s): Monica Padilla, David M. Landsberger
Channel interaction from a broad spread of excitation is likely to be a limiting factor in performance by cochlear implant users. Although partial tripolar stimulation has been shown to reduce spread of excitation, the magnitude of the reduction is highly variable across subjects. Because the reduction in spread of excitation is typically only measured at one electrode for a given subject, the degree of variability across cochlear locations is unknown. The first goal of the present study was to determine if the reduction in spread of excitation observed from partial tripolar current focusing systematically varies across the cochlea. The second goal was to measure the variability in reduction of spread of excitation relative to monopolar stimulation across the cochlea. The third goal was to expand upon previous results that suggest that scaling of verbal descriptors can be used to predict the reduction in spread of excitation, by increasing the limited number of sites previously evaluated and verify the relationships remain with the larger dataset. The spread of excitation for monopolar and partial tripolar stimulation was measured at 5 cochlear locations using a psychophysical forward masking task. Results of the present study suggest that although partial tripolar stimulation typically reduces spread of excitation, the degree of reduction in spread of excitation was found to be highly variable and no effect of cochlear location was found. Additionally, subjective scaling of certain verbal descriptors (Clean/Dirty, Pure/Noisy) correlated with the reduction in spread of excitation suggesting sound quality scaling might be used as a quick clinical estimate of channels providing a reduction in spread of excitation. This quick scaling technique might help clinicians determine which patients would be most likely to benefit from a focused strategy.

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Selective processing of auditory evoked responses with iterative-randomized stimulation and averaging: A strategy for evaluating the time-invariant assumption

Auditory and visual 3D virtual reality therapy as a new treatment for chronic subjective tinnitus: results of a randomized controlled trial

Selective processing of auditory evoked responses with iterative-randomized stimulation and averaging: A strategy for evaluating the time-invariant assumption

Reduction in Spread of Excitation from Current Focusing at Multiple Cochlear Locations in Cochlear Implant Users

Publication date: Available online 8 January 2016
Source:Hearing Research
Author(s): Monica Padilla, David M. Landsberger
Channel interaction from a broad spread of excitation is likely to be a limiting factor in performance by cochlear implant users. Although partial tripolar stimulation has been shown to reduce spread of excitation, the magnitude of the reduction is highly variable across subjects. Because the reduction in spread of excitation is typically only measured at one electrode for a given subject, the degree of variability across cochlear locations is unknown. The first goal of the present study was to determine if the reduction in spread of excitation observed from partial tripolar current focusing systematically varies across the cochlea. The second goal was to measure the variability in reduction of spread of excitation relative to monopolar stimulation across the cochlea. The third goal was to expand upon previous results that suggest that scaling of verbal descriptors can be used to predict the reduction in spread of excitation, by increasing the limited number of sites previously evaluated and verify the relationships remain with the larger dataset. The spread of excitation for monopolar and partial tripolar stimulation was measured at 5 cochlear locations using a psychophysical forward masking task. Results of the present study suggest that although partial tripolar stimulation typically reduces spread of excitation, the degree of reduction in spread of excitation was found to be highly variable and no effect of cochlear location was found. Additionally, subjective scaling of certain verbal descriptors (Clean/Dirty, Pure/Noisy) correlated with the reduction in spread of excitation suggesting sound quality scaling might be used as a quick clinical estimate of channels providing a reduction in spread of excitation. This quick scaling technique might help clinicians determine which patients would be most likely to benefit from a focused strategy.

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Reduction in Spread of Excitation from Current Focusing at Multiple Cochlear Locations in Cochlear Implant Users

Publication date: Available online 8 January 2016
Source:Hearing Research
Author(s): Monica Padilla, David M. Landsberger
Channel interaction from a broad spread of excitation is likely to be a limiting factor in performance by cochlear implant users. Although partial tripolar stimulation has been shown to reduce spread of excitation, the magnitude of the reduction is highly variable across subjects. Because the reduction in spread of excitation is typically only measured at one electrode for a given subject, the degree of variability across cochlear locations is unknown. The first goal of the present study was to determine if the reduction in spread of excitation observed from partial tripolar current focusing systematically varies across the cochlea. The second goal was to measure the variability in reduction of spread of excitation relative to monopolar stimulation across the cochlea. The third goal was to expand upon previous results that suggest that scaling of verbal descriptors can be used to predict the reduction in spread of excitation, by increasing the limited number of sites previously evaluated and verify the relationships remain with the larger dataset. The spread of excitation for monopolar and partial tripolar stimulation was measured at 5 cochlear locations using a psychophysical forward masking task. Results of the present study suggest that although partial tripolar stimulation typically reduces spread of excitation, the degree of reduction in spread of excitation was found to be highly variable and no effect of cochlear location was found. Additionally, subjective scaling of certain verbal descriptors (Clean/Dirty, Pure/Noisy) correlated with the reduction in spread of excitation suggesting sound quality scaling might be used as a quick clinical estimate of channels providing a reduction in spread of excitation. This quick scaling technique might help clinicians determine which patients would be most likely to benefit from a focused strategy.

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Auditory and visual 3D virtual reality therapy as a new treatment for chronic subjective tinnitus: results of a randomized controlled trial

Breast Cancer in Lopburi, a Province in Central Thailand: Analysis of 2001-2010 Incidence and Future Trends.

Breast Cancer in Lopburi, a Province in Central Thailand: Analysis of 2001-2010 Incidence and Future Trends.

Asian Pac J Cancer Prev. 2015;16(18):8359-8364

Authors: Sangkittipaiboon S, Leklob A, Sriplung H, Bilheem S

Abstract
BACKGROUND: Thailand has come to an epidemiologic transition with decreasing infectious diseases and increasing burden of chronic conditions, including cancer. Breast cancer has the highest incidence rates among females throughout Thailand. This study aimed to identify the current burden and the future trends of breast cancer of Lopburi, a province in the Central Thailand.
MATERIALS AND METHODS: We used cancer incidence data from the Lopburi Cancer Registry to characterize and analyze the incidence of breast cancer in Central Thailand. With joinpoint and age-period-cohort analyses, the incidence of breast cancer in the province from 2001 to 2010 and project future trends from 2011 to 2030 was investigated.
RESULTS: Age-adjusted incidence rates of breast cancer in Lopburi increased from 23.4 to 34.3 cases per 100,000 female population during the period, equivalent to an annual percentage change of 4.3% per year. Both period and cohort effects played a role in shaping the increase in incidence. Joinpoint projection suggested that incidence rates would continue to increase in the future with incidence for women ages 50 years and above increasing at a higher rate than for women below the age of 50.
CONCLUSIONS: The current situation where early detection measures are being promoted could increase detection rates of the disease. Preparation of sufficient budget for treatment facilities and human resources, both in surgical and medical oncology, is essential for future medical care.

PMID: 26745085 [PubMed - as supplied by publisher]

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Breast Cancer in Lampang, a Province in Northern Thailand: Analysis of 1993-2012 Incidence Data and Future Trends.

Breast Cancer in Lampang, a Province in Northern Thailand: Analysis of 1993-2012 Incidence Data and Future Trends.

Asian Pac J Cancer Prev. 2015;16(18):8327-8333

Authors: Lalitwongsa S, Pongnikorn D, Daoprasert K, Sriplung H, Bilheem S

Abstract
BACKGROUND: The recent epidemiologic transition in Thailand, with decreasing incidence of infectious diseases along with increasing rates of chronic conditions, including cancer, is a serious problem for the country. Breast cancer has the highest incidence rates among females throughout Thailand. Lampang is a province in the upper part of Northern Thailand. A study was needed to identify the current burden, and the future trends of breast cancer in upper Northern Thai women.
MATERIALS AND METHODS: Here we used cancer incidence data from the Lampang Cancer Registry to characterize and analyze the local incidence of breast cancer. Joinpoint analysis, age period cohort model and Nordpred package were used to investigate the incidences of breast cancer in the province from 1993 to 2012 and to project future trends from 2013 to 2030.
RESULTS: Age-standardized incidence rates (world) of breast cancer in the upper parts of Northern Thailand increased from 16.7 to 26.3 cases per 100,000 female population which is equivalent to an annual percentage change of 2.0-2.8%, according to the method used. Linear drift effects played a role in shaping the increase of incidence. The three projection method suggested that incidence rates would continue to increase in the future with incidence for women aged 50 and above, increasing at a higher rate than for women below the age of 50.
CONCLUSIONS: The current early detection measures increase detection rates of early disease. Preparation of a budget for treatment facilities and human resources, both in surgical and medical oncology, is essential.

PMID: 26745080 [PubMed - as supplied by publisher]

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Transforming Cancer Prevention through Precision Medicine and Immune-oncology.

Transforming Cancer Prevention through Precision Medicine and Immune-oncology.

Cancer Prev Res (Phila). 2016 Jan;9(1):2-10

Authors: Kensler TW, Spira A, Garber JE, Szabo E, Lee JJ, Dong Z, Dannenberg AJ, Hait WN, Blackburn E, Davidson NE, Foti M, Lippman SM

Abstract
We have entered a transformative period in cancer prevention (including early detection). Remarkable progress in precision medicine and immune-oncology, driven by extraordinary recent advances in genome-wide sequencing, big-data analytics, blood-based technologies, and deep understanding of the tumor immune microenvironment (TME), has provided unprecedented possibilities to study the biology of premalignancy. The pace of research and discovery in precision medicine and immunoprevention has been astonishing and includes the following clinical firsts reported in 2015: driver mutations detected in circulating cell-free DNA in patients with premalignant lesions (lung); clonal hematopoiesis shown to be a premalignant state; molecular selection in chemoprevention randomized controlled trial (RCT; oral); striking efficacy in RCT of combination chemoprevention targeting signaling pathway alterations mechanistically linked to germline mutation (duodenum); molecular markers for early detection validated for lung cancer and showing promise for pancreatic, liver, and ovarian cancer. Identification of HPV as the essential cause of a major global cancer burden, including HPV16 as the single driver of an epidemic of oropharyngeal cancer in men, provides unique opportunities for the dissemination and implementation of public health interventions. Important to immunoprevention beyond viral vaccines, genetic drivers of premalignant progression were associated with increasing immunosuppressive TME; and Kras vaccine efficacy in pancreas genetically engineered mouse (GEM) model required an inhibitory adjuvant (Treg depletion). In addition to developing new (e.g., epigenetic) TME regulators, recent mechanistic studies of repurposed drugs (aspirin, metformin, and tamoxifen) have identified potent immune activity. Just as precision medicine and immune-oncology are revolutionizing cancer therapy, these approaches are transforming cancer prevention. Here, we set out a brief agenda for the immediate future of cancer prevention research (including a "Pre-Cancer Genome Atlas" or "PCGA"), which will involve the inter-related fields of precision medicine and immunoprevention - pivotal elements of a broader domain of personalized public health. Cancer Prev Res; 9(1); 2-10. ©2016 AACR.

PMID: 26744449 [PubMed - in process]

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A Disintegrin and Metalloproteinase Domain 17 Regulates Colorectal Cancer Stem Cells and Chemosensitivity Via Notch1 Signaling.

A Disintegrin and Metalloproteinase Domain 17 Regulates Colorectal Cancer Stem Cells and Chemosensitivity Via Notch1 Signaling.

Stem Cells Transl Med. 2016 Jan 7;

Authors: Wang R, Ye X, Bhattacharya R, Boulbes DR, Fan F, Xia L, Ellis LM

Abstract
: Evidence is accumulating for the role of cancer stem cells (CSCs) in mediating chemoresistance in patients with metastatic colorectal cancer (mCRC). A disintegrin and metalloproteinase domain 17 (ADAM17; also known as tumor necrosis factor-α-converting enzyme [TACE]) was shown to be overexpressed and to mediate cell proliferation and chemoresistance in CRC cells. However, its role in mediating the CSC phenotype in CRC has not been well-characterized. The objective of the present study was to determine whether ADAM17 regulates the CSC phenotype in CRC and to elucidate the downstream signaling mechanism that mediates cancer stem-ness. We treated established CRC cell lines and a newly established human CRC cell line HCP-1 with ADAM17-specific small interfering RNA (siRNA) or the synthetic peptide inhibitor TAPI-2. The effects of ADAM17 inhibition on the CSC phenotype and chemosensitivity to 5-fluorouracil (5-FU) in CRC cells were examined. siRNA knockdown and TAPI-2 decreased the protein levels of cleaved Notch1 (Notch1 intracellular domain) and HES-1 in CRC cells. A decrease in the CSC phenotype was determined by sphere formation and ALDEFLUOR assays. Moreover, TAPI-2 sensitized CRC cells to 5-FU by decreasing cell viability and the median lethal dose of 5-FU and increasing apoptosis. We also showed the cleavage and release of soluble Jagged-1 and -2 by ADAM17 in CRC cells. Our studies have elucidated a role of ADAM17 in regulating the CSC phenotype and chemoresistance in CRC cells. The use of drugs that inhibit ADAM17 activity might increase the therapeutic benefit to patients with mCRC and, potentially, those with other solid malignancies.
SIGNIFICANCE: The present study has demonstrated the role of A disintegrin and metalloproteinase domain 17 (ADAM17) in regulating cancer stem-ness and chemosensitivity in colorectal cancer (CRC) cells. In addition, a previously unknown cleavage of the Notch ligands Jagged-1 and -2 by ADAM17 in CRC cells is reported. These findings will have an impact on future studies of the regulation of cancer stem cells in CRC and, potentially, other cancer types.

PMID: 26744411 [PubMed - as supplied by publisher]

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MiR-125b Functions as a Tumor Suppressor and Enhances Chemosensitivity to Cisplatin in Osteosarcoma.

MiR-125b Functions as a Tumor Suppressor and Enhances Chemosensitivity to Cisplatin in Osteosarcoma.

Technol Cancer Res Treat. 2016 Jan 6;

Authors: Wang F, Yu D, Liu Z, Wang R, Xu Y, Cui H, Zhao T

Abstract
MicroRNAs are highly conserved noncoding RNA that negatively modulate protein expression at a posttranscriptional and/or translational level and are deeply involved in the pathogenesis of several types of cancers. To date, the potential microRNAs regulating the growth and progression of osteosarcoma are not fully identified yet. Previous reports have shown differentially expressed miR-125b in osteosarcoma. However, the role of miR-125b in human osteosarcoma has not been totally illuminated. In this study, we have shown that miR-125b was downregulated in human osteosarcoma tissues compared to the adjacent tissues and effects as a tumor suppressor in vitro. We found that stable overexpression of miR-125b in osteosarcoma cell lines U2OS and MG-63 inhibited cell proliferation, migration, and invasion. Our data also verified that Bcl-2 is the target of miR-125b. Meanwhile, we showed that Bcl-2 was inversely correlated with miR-125b in osteosarcoma tissues. More importantly, we proved that miR-125b increased the chemosensitivity of osteosarcoma cell lines to cisplatin by targeting Bcl-2. In conclusion, our data demonstrate that miR-125b is a tumor suppressor and support its potential application for the treatment of osteosarcoma in the future.

PMID: 26744308 [PubMed - as supplied by publisher]

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A commentary on the 2015 Canadian Clinical Practice Guidelines in glutamine supplementation to parenteral nutrition.

A commentary on the 2015 Canadian Clinical Practice Guidelines in glutamine supplementation to parenteral nutrition.

Crit Care. 2016;20(1):7

Authors: Leguina-Ruzzi A

Abstract
Glutamine is one of the conditionally essential free amino acids with multiple biological functions. Its supplementation to parenteral nutrition has been widely used for the management of complications in intensive care. However, controversial clinical reports have generated reluctance in the use of this pharmaco-nutrient. In this commentary, we address the impact of four studies that influenced the recommendations on glutamine supplementation by the Canadian Clinical Practice Guide 2015. Because of the importance of this guideline in clinical practice, we strongly believe that a more rigorous and critical evaluation is required to support recommendations in future guidelines.

PMID: 26743681 [PubMed - in process]

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Octreotide and Lanreotide in Gastroenteropancreatic Neuroendocrine Tumors.

Octreotide and Lanreotide in Gastroenteropancreatic Neuroendocrine Tumors.

Curr Oncol Rep. 2016 Jan;18(1):7

Authors: Pokuri VK, Fong MK, Iyer R

Abstract
Neuroendocrine tumors are heterogeneous, rare malignancies that arise most commonly in the gastrointestinal tract and pancreas. They often secrete vasoactive substances resulting in carcinoid syndrome and the tumor cells exclusively express somatostatin receptors. Octreotide and lanreotide are the two synthetic somatostatin analogs used for the control of carcinoid symptoms and tumor progression in advanced inoperable disease. Recent pivotal trials (PROMID and CLARINET studies) established their antitumor activity. We discuss the available data to support their use as symptom controlling and antiproliferative agents. This article also reviews the guidelines (National Comprehensive Cancer Network and North American Neuro Endocrine Tumor Society), cost-analysis (suggesting the cost-effectiveness of lanreotide autogel compared to higher doses of octreotide long acting release formulation in refractory patients), and future directions of somatostatin analogs in the management of patients refractory to conventional doses of octreotide and lanreotide.

PMID: 26743514 [PubMed - in process]

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Signaling and molecular basis of bone marrow niche angiogenesis in leukemia.

Signaling and molecular basis of bone marrow niche angiogenesis in leukemia.

Clin Transl Oncol. 2016 Jan 7;

Authors: Shirzad R, Shahrabi S, Ahmadzadeh A, Kampen KR, Shahjahani M, Saki N

Abstract
Angiogenesis, the process of blood vessel formation, is necessary for tissue survival in normal and pathologic conditions. Increased angiogenesis in BM niche is correlated with leukemia progression and resistance to treatment. Angiogenesis can interfere with disease progression and several angiogenic (such as vascular growth factors) as well as anti-angiogenic factors (i.e. angiostatin) can affect angiogenesis. Furthermore, miRs can affect the angiogenic process by inhibiting angiogenesis or increasing the expression of growth factors. Given the importance of angiogenesis in BM for maintenance of leukemic clones, recognition of angiogenic and anti-angiogenic factors and miRs as well as drug resistance mechanisms of leukemic blasts can improve the therapeutic strategies. We highlight the changes in angiogenic balance within the BM niche in different leukemia types. Moreover, we explored the pathways leading to drug resistance in relation to angiogenesis and attempted to assign interesting candidates for future research.

PMID: 26742939 [PubMed - as supplied by publisher]

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18F-FDG PET/CT and PET/MRI perform equally well in cancer patients: Evidence from studies in more than 2300 patients.

18F-FDG PET/CT and PET/MRI perform equally well in cancer patients: Evidence from studies in more than 2300 patients.

J Nucl Med. 2016 Jan 7;

Authors: Spick C, Herrmann K, Czernin J

Abstract
(18)F-FDG-PET/CT has become the reference standard in oncologic imaging against which the performance of other imaging modalities is measured. The promise of PET/MRI includes multi-parametric imaging to further improve diagnosis and phenotyping of cancer. Rather than focusing on these capabilities many investigators have however examined whether (18)F-FDG-PET combined with mostly anatomic MRI improves cancer staging and restaging. Following a description of PET/MRI designs, and a discussion of technical and operational issues we review the available literature to determine whether cancer assessments are improved with PET/MRI. The available data show that PET/MRI is feasible and performs equally well as PET/CT in most cancers. Diagnostic advantages may be achievable in prostate cancer and in bone metastases while disadvantages may exist in lung nodule assessments. We conclude that (18)F-FDG PET/MRI and PET/CT provide comparable diagnostic information when MRI is simply used to provide the anatomical framework. Thus, PET/MRI could be used in lieu of PET/CT if this approach becomes economically viable and if reasonable workflows can be established. Future studies should explore the multi-parametric potential of MRI.

PMID: 26742709 [PubMed - as supplied by publisher]

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Evaluating the pharmacokinetics and pharmacodynamics of everolimus for treating breast cancer.

Evaluating the pharmacokinetics and pharmacodynamics of everolimus for treating breast cancer.

Expert Opin Drug Metab Toxicol. 2015 May;11(5):823-34

Authors: Gombos A, Barthélémy P, Awada A

Abstract
INTRODUCTION: The aberrant activation of the phosphoinositide 3-kinase-Akt-mTOR signaling pathway is a common mechanism of resistance to endocrine therapy and human epidermal growth factor receptor 2 (HER2)-targeted treatments in breast cancer. Data from large clinical trials have shown that the combination of everolimus , an orally bioavailable mTOR inhibitor with exemestane improves outcome of metastatic breast cancer resistant to non-steroidal aromatase inhibitors. On the other hand, the addition of everolimus to trastuzumab in order to overcome resistance did not show meaningful clinical benefit in recent reported Phase III clinical trials. Everolimus has a favorable pharmacokinetic (PK) profile in early breast cancer studies. The association of endocrine therapy and HER2-targeted agents did not influence the main PK parameters of the drugs.
AREAS COVERED: This review article focuses on the biological rationale of using everolimus in breast cancer and on latest advances in the field of everolimus-based combinations with an emphasis on the PK and pharmacodynamic parameters of the drug throughout different studies.
EXPERT OPINION: Better identification of patients who sustain benefit or who are resistant to everolimus-based combinations in the treatment of advanced breast cancer remains an unmet need. New combination strategies based on the understanding of resistance mechanisms and intracellular feedback loops should be studied further in the future.

PMID: 25659402 [PubMed - indexed for MEDLINE]

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Pre-mRNA splicing in cancer: the relevance in oncogenesis, treatment and drug resistance.

Pre-mRNA splicing in cancer: the relevance in oncogenesis, treatment and drug resistance.

Expert Opin Drug Metab Toxicol. 2015 May;11(5):673-89

Authors: Wojtuszkiewicz A, Assaraf YG, Maas MJ, Kaspers GJ, Jansen G, Cloos J

Abstract
INTRODUCTION: Aberrant pre-mRNA splicing in cancer is emerging as an important determinant of oncogenesis, response to treatment and anticancer drug resistance. At the same time, the spliceosome has become a target for a novel class of pre-clinical chemotherapeutics with a potential future application in cancer treatment. Taken together, these findings offer novel opportunities for the enhancement of the efficacy of cancer therapy.
AREAS COVERED: This review presents a comprehensive overview of the molecular mechanisms involved in splicing and current developments regarding splicing aberrations in relation to several aspects of cancer formation and therapy. Identified mutations in the various components of the spliceosome and their implications for cancer prognosis are delineated. Moreover, the contribution of abnormal splicing patterns as well as deregulated splicing factors to chemoresistance is discussed, along with novel splicing-based therapeutic approaches.
EXPERT OPINION: Significant progress has been made in deciphering the role of splicing factors in cancer including carcinogenesis and drug resistance. Splicing-based prognostic tools as well as therapeutic options hold great potential towards improvements in cancer therapy. However, gaining more in-depth molecular insight into the consequences of mutations in various components of the splicing machinery as well as of cellular effects of spliceosome inhibition is a prerequisite to establish the role of splicing in tumor progression and treatment options, respectively.

PMID: 25495223 [PubMed - indexed for MEDLINE]

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Closer to the edge - the value of intraoperative brain mapping.

Closer to the edge - the value of intraoperative brain mapping.

World Neurosurg. 2015 Dec 29;

Authors: Roser F, Liebsch M

PMID: 26743386 [PubMed - as supplied by publisher]

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Posterior Fossa Intra-axial Tumors in Adults.

Posterior Fossa Intra-axial Tumors in Adults.

World Neurosurg. 2015 Dec 29;

Authors: Grossman R, Ram Z

Abstract
BACKGROUND: The posterior fossa is the site of many types of tumors, and brain metastases are the most common malignancies in that location among adults. Other brain tumors, such as ependymomas, medulloblastomas and juvenile pilocytic astrocytomas, mostly occur during childhood and are relatively rare in the adult population. The majority of primary malignant brain tumors, such as gliomas and lymphomas, tend to be located in the supratentorial compartment.
METHODS: In this review we summarized the current data including prognostic factors and therapeutic management and molecular data of patients with intra-axial posterior fossa tumors in adults including ependymomas, medulloblastomas pilocytic astrocytomas in the "posterior fossa in adults.
RESULTS: We present the literature on intra-axial posterior fossa tumors in adults that relies mainly on limited retrospective clinical studies and employing a wide range of treatment approaches that were usually based on therapies developed specifically for children or for supratentorial brain tumors CONCLUSIONS: The clinical course and surgical outcome of adult patients with intra-axial brain tumors in the posterior fossa is summarized in this review. The prognostic factors and therapeutic management of patients with these tumors are controversial due to their rarity, their heterogeneity and the lack of sufficient data in the literature.

PMID: 26743385 [PubMed - as supplied by publisher]

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Predictors of Surgical Site Infection Following Craniotomy for Intracranial Neoplasms: An Analysis of Prospectively Collected Data in the ACS-NSQIP Database.

Predictors of Surgical Site Infection Following Craniotomy for Intracranial Neoplasms: An Analysis of Prospectively Collected Data in the ACS-NSQIP Database.

World Neurosurg. 2015 Dec 29;

Authors: McCutcheon BA, Ubl DS, Babu M, Maloney P, Murphy M, Kerezoudis P, Bydon M, Habermann EB, Parney I

Abstract
OVERVIEW: Patients with an intracranial neoplasm are at increased risk for surgical site infection (SSI) following craniotomy relative to patients receiving surgery for other disease processes.
METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant Use File (PUF) was queried from 2006-2013 for patients who received a resection for an intracranial neoplasm. Multivariable logistic regression analysis was used to identify risk factors associated with SSI.
RESULTS: A total of 12,021 patients met inclusion criteria. SSI occurred at a rate of 2.04%. SSI was significantly associated with increased rates of return to the operating room (56.1% vs. 4.0%, p<0.001) and prolonged postoperative lengths of stay greater than 30 days (5.3% vs. 1.3% p<0.001) on unadjusted bivariate analysis. On multivariable analysis, age (OR 0.991, 95% CI 0.982-0.999) and female gender (OR 0.697, 95% CI 0.538-0.902) were associated with a reduction in the odds of SSI. Preoperative wound infections (OR 3.833, 95% CI 1.834-8.0011), and operative times greater than 4 hours were associated with an increased odds of SSI (OR 1.891, 95% CI 1.298-2.756). Among cases with available chemotherapy data (n=3,504), recent chemotherapy (OR 3.007, 95% CI 1.460-6.196) was associated with an increased odds of SSI.
CONCLUSIONS: This study identified patient risk-factors that may assist clinical decision-making regarding patient risk stratification, timing of surgery, or preoperative antibiotic prophylaxis for patients with an intracranial neoplasm undergoing craniotomy.

PMID: 26743384 [PubMed - as supplied by publisher]

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Epilepsy: A Disruptive Force in History.

Epilepsy: A Disruptive Force in History.

World Neurosurg. 2015 Dec 29;

Authors: Grossman RG

PMID: 26743383 [PubMed - as supplied by publisher]

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Implant Site Infection and Bone Flap Osteomyelitis Associated with the NeuroPace Responsive Neurostimulation System.

Implant Site Infection and Bone Flap Osteomyelitis Associated with the NeuroPace Responsive Neurostimulation System.

World Neurosurg. 2015 Dec 29;

Authors: Wei Z, Wei Z, Gordon CR, Bergey GK, Sacks JM, Anderson WS

PMID: 26743382 [PubMed - as supplied by publisher]

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The difficulties and risks of Y-stent-assisted coiling: a comparison of first and second stenting procedures.

The difficulties and risks of Y-stent-assisted coiling: a comparison of first and second stenting procedures.

World Neurosurg. 2015 Dec 29;

Authors: Bang JS, Kim CH, Kwon BJ, Park SC, Kim Y

PMID: 26743381 [PubMed - as supplied by publisher]

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Cross-cultural adaptation of an Arabic version of the 10-item hearing handicap inventory.

Cross-cultural adaptation of an Arabic version of the 10-item hearing handicap inventory.

Int J Audiol. 2015 May;54(5):341-6

Authors: Weinstein BE, Rasheedy D, Taha HM, Fatouh FN

Abstract
OBJECTIVE: The purpose of this study was to translate and culturally adapt an Arabic version of the hearing handicap inventory for the elderly - screening (HHIE-S).
DESIGN: The HHIE-S was translated following cross-cultural adaptation guidelines, and pretested in 20 elderly patients with hearing impairment. Next, the adapted Arabic HHIE-S underwent psychometric evaluation. The results were confirmed by pure-tone audiometer (PTA) examination. The patients completed the HHIE-S again after one hour. The validation of the questionnaire using Cronbach's alpha (internal consistency), (construct validity), and intraclass correlation coefficients (repeatability) was performed.
STUDY SAMPLE: Twenty elderly subjects with hearing impairment were recruited for the pretesting stage, and 100 elderly subjects were recruited for the psychometric evaluation stage. Patients with acute illness, functional dependency, cognitive impairment, and previous users of hearing aids were excluded.
RESULTS: The adapted Arabic HHIE-S showed good internal consistency (α = 0.902). Construct validity was good, as high correlations were found between the scale and the PTA outcome (r = 0.688, p = 0.000). Repeatability was high (ICC = 0.986).
CONCLUSIONS: This study showed that the adapted Arabic HHIE-S is a valid and reliable questionnaire for the assessment of handicapping hearing impairment in Egyptian elderly patients.

PMID: 25735202 [PubMed - indexed for MEDLINE]

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Determinants of hearing-aid adoption and use among the elderly: a systematic review.

Determinants of hearing-aid adoption and use among the elderly: a systematic review.

Int J Audiol. 2015 May;54(5):291-300

Authors: Ng JH, Loke AY

Abstract
OBJECTIVE: While the benefits of hearing aids among older adults with presbycusis have been well documented, there is limited research on hearing-aid usage. The aim of this review is to synthesize current evidence to identify the determinants of hearing-aid adoption and use among the elderly.
DESIGN: Systematic review.
STUDY SAMPLE: Articles were identified through systematic searches in the Web of Science, Medline, CINAHL, and a manual search. Studies that explore the potential determinants of hearing-aid usage were to be included.
RESULTS: A total of twenty-two articles were reviewed. Four audiological determinants (the severity of hearing loss, the type of hearing aids, background noise acceptance, and insertion gain) and seven non-audiological determinants (self-perceived hearing problems, expectation, demographics, group consultation, support from significant others, self-perceived benefit, and satisfaction) were identified as affecting the adoption and use of hearing aids.
CONCLUSIONS: There is a need to explore the influence of significant others, health professionals, and user demographics on hearing rehabilitation for future research. The determinants identified in this review depicted the stage progression of the trans-theoretical model (TTM) in explaining an individual's readiness to hearing-aid usage.

PMID: 25640403 [PubMed - indexed for MEDLINE]

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Hearing aid and hearing assistance technology use in Aotearoa/New Zealand.

Hearing aid and hearing assistance technology use in Aotearoa/New Zealand.

Int J Audiol. 2015 May;54(5):308-15

Authors: Kelly-Campbell RJ, Lessoway K

Abstract
OBJECTIVE: The purpose of this study was to describe factors that are related to hearing aid and hearing assistance technology ownership and use in Aotearoa/New Zealand.
DESIGN: Adults with hearing impairment living in New Zealand were surveyed regarding health-related quality of life and device usage. Audiometric data (hearing sensitivity and speech in noise) were collected.
STUDY SAMPLE: Data were obtained from 123 adults with hearing impairment: 73 reported current hearing-aid use, 81 reported current hearing assistance technology use.
RESULTS: In both analyses, device users had more difficulty understanding speech in background noise, had poor hearing in both their better and worse hearing ears, and perceived more consequences of hearing impairment in their everyday lives (both emotionally and socially) than non-hearing-aid users. Discriminant analyses showed that the social consequences of hearing impairment and the better ear hearing best classified hearing aid users from non-users but social consequences and worse ear hearing best classified hearing assistance technology users from non-users.
CONCLUSIONS: Quality of life measurements and speech-in-noise assessments provide useful clinical information. Hearing-impaired adults in New Zealand who use hearing aids also tend to use hearing assistance technology, which has important clinical implications.

PMID: 25634777 [PubMed - indexed for MEDLINE]

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Impact of different sedation protocols and perioperative procedures on patients admitted to the intensive care unit after maxillofacial tumor surgery of the lower jaw: A retrospective study

Publication date: Available online 8 January 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Diana Lebherz-Eichinger, Bianca Tudor, Claus G. Krenn, Georg A. Roth, Rudolf Seemann
Maxillofacial tumor surgery often necessitates prolonged invasive ventilation to prevent blockage of the respiratory tract. To tolerate ventilation, continuously administered sedatives are recommended. Half-time of sedative or analgesic medication is an important characteristic by which narcotic drugs are chosen, due to the fact that weaning period increases with half-time. The aim of our study was to investigate whether a change in sedation regimen would affect the length of invasive ventilation or intensive care unit stay and medical costs. Additionally, the impact of various surgical procedures was analyzed. Data of 157 patients after mandibular surgery were retrospectively analyzed over 5 years in count regression models. Of those patients, 84 received a sedation regimen with sufentanil and midazolam and 73 with remifentanil and propofol. The impact of the surgical procedures (tracheostomy, tumor resection, neck dissection, length of operation) and the patient age and sex were analyzed with respect to length of ventilation and ICU days. Cost savings were calculated. Our data show that patients receiving remifentanil/propofol had fewer ventilation days (2.5 ± 2.5 versus 6.1 ± 4.6 days, P < 0.001) and were discharged earlier from the intensive care unit than patients receiving sufentanil/midazolam (5.1 ± 3.8 versus 9.2 ± 6.2 days, P < 0.001), leading to calculated cost savings of about 8,000 Euro per patient. Length of operation negatively influenced length of ICU stay (P < 0.001). In conclusion, short-acting drugs such as remifentanil/propofol, as well as tracheostoma and shortened surgery duration may reduce the postoperative need for invasive ventilation and length of intensive care unit stay.

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The Role of Mylohyoid Flap in the Treatment of Bisphosphonate Related Osteonecrosis of the Jaws

Publication date: Available online 8 January 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Thomas Mücke, Steffen Koerdt, Maximilian Jung, David A. Mitchell, Klaus-Dietrich Wolff, Marco Rainer Kesting, Denys John Loeffelbein
IntroductionSurgical treatment of Bisphosphonate Related Osteonecrosis of the Jaws (BRONJ) combines excision of adequate damaged bone and watertight coverage by appropriate vascularised tissue. Local tissues are preferred when possible. This study compares local mucoperiosteal flaps with mylohyoid flaps with special emphasis on their influence on wound healing.Material and MethodsA total of 195 patients with BRONJ in the mandible were included in this prospective study. The control group (n=169) were treated with a mucoperiosteal flap, whereas patients of the study group (n=26) received a mylohyoid flap.ResultsRecurrence of BRONJ was significantly reduced (p=0.023) as was extent of necrosis (p=0.001) in patients with mylohyoid flaps.DiscussionThis study demonstrates the importance of a sufficient mucosal coverage in surgical treatment of BRONJ. The mylohyoid flap provides an additional tissue coverage, which seems to account for the significantly reduced rate of disease recurrence.ConclusionThe vascularized mylohyoid flap is an important tool in the complex and challenging surgical care of BRONJ.

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Invasive fungal rhinosinusitis in adult patients: our experience in diagnosis and management

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Vestibular evoked myogenic potentials in patients with ankylosing spondylitis.

Vestibular evoked myogenic potentials in patients with ankylosing spondylitis.

Eur Arch Otorhinolaryngol. 2016 Jan 7;

Authors: Özgür A, Serdaroğlu Beyazal M, Terzi S, Coşkun ZÖ, Dursun E

Abstract
Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease with unknown etiology. Although sacroiliac joint involvement is the classic sign along with the formed immune mediators, it may result in immune-mediated inner ear disease and may cause damage to the audiovestibular system. Vestibular evoked myogenic potentials (VEMP) is a clinical reflex test used in the diagnosis of vestibular diseases and is performed by recording and evaluating the muscle potentials resulting from the stimulation of the vestibular system with different stimuli. The aim of this study is to evaluate the cervical VEMP test results in AS patients without vestibular symptoms. Thirty-three patients with AS and a control group of 30 healthy volunteers with similar demographic characteristics were evaluated in the study. VEMP wave latency, P13-N23 wave amplitude, and VEMP asymmetry ratio (VAR) values were compared between the groups. The relationship between clinical and laboratory findings of the AS patients and VEMP data were also investigated. Compared with healthy people, this study shows the response rate of patients with ankylosing spondylitis was reduced in the VEMP test, and P13-N23 wave amplitude showed a decrease in AS patients who had VEMP response (p < 0.001). There was no correlation between the clinical and laboratory findings and VEMP findings in patients with ankylosing spondylitis. The data obtained from this study suggest that AS may lead to decreased sensitivity of the vestibular system.

PMID: 26742904 [PubMed - as supplied by publisher]

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Effect of body posture on involuntary swallow in healthy volunteers.

Effect of body posture on involuntary swallow in healthy volunteers.

Physiol Behav. 2015 Dec 29;

Authors: Shiino Y, Sakai S, Takeishi R, Hayashi H, Watanabe M, Tsujimura T, Magara J, Ito K, Tsukada T, Inoue M

Abstract
Clinically, reclining posture has been reported to reduce risk of aspiration. However, during involuntary swallow in reclining posture, changes in orofacial and pharyngeal movement before and during pharyngeal swallow should be considered. Further, the mechanisms underlying the effect of body posture on involuntary swallow remain unclear. The aim of the present study was to determine the effect of body posture on activity patterns of the suprahyoid muscles and on patterns of bolus transport during a natural involuntary swallow. Thirteen healthy male adults participated in a water infusion test and a chewing test. In the water infusion test, thickened water was delivered into the pharynx at a very slow rate until the first involuntary swallow was evoked. In the chewing test, subjects were asked to eat 10 g of gruel rice. In both tests, the recording was performed at four body postures between upright and supine positions. Results showed that reclining changed the location of the bolus head at the start of swallow and prolonged onset latency of the swallowing initiation. Muscle burst duration and whiteout time measured by videoendoscopy significantly increased with body reclining and prolongation of the falling time. In the chewing test, reclining changed the location of the bolus head at the start of swallow, and the frequency of bolus residue after the first swallow increased. Duration and area of EMG burst and whiteout time significantly increased with body reclining. These data suggest that body reclining may result in prolongation of pharyngeal swallow during involuntary swallow.

PMID: 26742532 [PubMed - as supplied by publisher]

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Interpreting pre-operative mastoid computed tomography images: comparison between operating surgeon, radiologist and operative findings.

Interpreting pre-operative mastoid computed tomography images: comparison between operating surgeon, radiologist and operative findings.

J Laryngol Otol. 2016 Jan;130(1):32-37

Authors: Badran K, Ansari S, Al Sam R, Al Husami Y, Iyer A

Abstract
OBJECTIVES: This study aimed to compare the interpretations of temporal bone computed tomography scans by an otologist and a radiologist with a special interest in temporal bone imaging. It also aimed to determine the usefulness of this imaging modality.
METHODS: A head and neck radiologist and an otologist separately reported pre-operative computed tomography images using a structured proforma. The reports were then compared with operative findings to determine their accuracy and differences in interpretations.
RESULTS: Forty-eight patients who underwent pre-operative computed tomography scans in a 30-month period were identified. Six patients were excluded because complete operative findings had not been recorded. Positive and negative predictive values and accuracy of the anatomical and pathological findings were calculated for 42 patients by both reporters. The accuracy was found to be less than 80 per cent, except for identification of the tegmen and lateral semicircular canal erosion. Overall, there was no significant difference in interpretations of computed tomography scans between reporters. There was a slight difference in interpretation for tympanic membrane retraction, facial canal erosion and lateral semicircular canal fistula and/or erosion.
CONCLUSION: Pre-operative computed tomography scanning of the temporal bone is useful for predicting anatomy for surgical planning in patients with chronic otitis media, but its reliability remains questionable.

PMID: 26745138 [PubMed - as supplied by publisher]

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Topical aural antibiotic use in the UK - time for a change of policy?

Topical aural antibiotic use in the UK - time for a change of policy?

J Laryngol Otol. 2016 Jan;130(1):1

Authors: Youngs R, Fisher E, Hussain M, Fishman J

PMID: 26745137 [PubMed - as supplied by publisher]

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Dose–effect relationship and risk factors for vaginal stenosis after definitive radio(chemo)therapy with image-guided brachytherapy for locally advanced cervical cancer in the EMBRACE study

Publication date: Available online 9 January 2016
Source:Radiotherapy and Oncology
Author(s): Kathrin Kirchheiner, Remi A. Nout, Jacob C. Lindegaard, Christine Haie-Meder, Umesh Mahantshetty, Barbara Segedin, Ina M. Jürgenliemk-Schulz, Peter J. Hoskin, Bhavana Rai, Wolfgang Dörr, Christian Kirisits, Søren M. Bentzen, Richard Pötter, Kari Tanderup
Background/purposeTo identify risk factors for vaginal stenosis and to establish a dose–effect relationship for image-guided brachytherapy in locally advanced cervical cancer.Materials/MethodsPatients from the ongoing EMBRACE study with prospectively assessed morbidity (CTCAEv3.0) at baseline and at least one follow-up were selected. Patient-, disease- and treatment characteristics were tested as risk factors for vaginal stenosis G⩾2 in univariate and multivariable analyses (Cox proportional hazards model) and a dose–effect curve was deduced from the estimates. The ICRU rectum point was used to derive the recto-vaginal reference point dose.ResultsIn 630 patients included (median follow-up 24months), 2-year actuarial estimate for vaginal stenosis G⩾2 was 21%. Recto-vaginal reference point dose (HR=1.025, p=0.029), external beam radiotherapy (EBRT) dose >45Gy/25 fractions (HR=1.770, p=0.056) and tumor extension in the vagina (HR=2.259, p⩽0.001) were risk factors for vaginal stenosis, adjusted for center reporting effects. Based on the model curve, the risk was 20% at 65Gy, 27% at 75Gy and 34% at 85Gy (recto-vaginal reference point dose).ConclusionKeeping the EBRT dose at 45Gy/25 fractions and decreasing the dose contribution of brachytherapy to the vagina decrease the risk of stenosis. A planning aim of ⩽65Gy EQD2 (EBRT+brachytherapy dose) to the recto-vaginal reference point is therefore proposed.

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Effect of polypharmacy and potentially inappropriate medications on treatment and posttreatment courses in elderly patients with head and neck cancer.

Effect of polypharmacy and potentially inappropriate medications on treatment and posttreatment courses in elderly patients with head and neck cancer.

J Cancer Res Clin Oncol. 2016 Jan 7;

Authors: Park JW, Roh JL, Lee SW, Kim SB, Choi SH, Nam SY, Kim SY

Abstract
PURPOSE: The use of excessive and inappropriate medications is a common problem in elderly populations. The use of polypharmacy (PP) and potentially inappropriate medication (PIM) may affect treatment-related morbidities in elderly cancer patients, which has rarely been studied in patients with head and neck cancer (HNC). Here, we evaluate the effects of PP and PIM on treatment and posttreatment courses in elderly HNC patients.
METHODS: This study included 229 elderly HNC patients who underwent definitive treatment. Medications were carefully recorded, and the prevalences of PP and PIM are reported. We evaluated the associations between PP, PIM, treatment, and posttreatment course in terms of comorbidities, treatment-related toxicity, prolonged hospitalization, and posttreatment noncancer health events.
RESULTS: The prevalences of PP and PIM in our elderly HNC patients were 29.3 and 24.0 %, respectively, and frequently described PIMs include aspirin (12.2 %), calcium channel blockers (4.8 %), benzodiazepines (4.3 %), and nonsteroidal anti-inflammatory drugs (3.9 %). PP and PIM were not significantly associated with treatment-related toxicity, but were associated with modestly increased prolonged hospitalization [odds ratio [OR] 2.30 (95 % confidence interval 0.89-5.95); P = 0.080] and noncancer health events [OR 1.81 (0.99-3.31); P = 0.052], respectively. Among high-risk medications, benzodiazepine [OR 5.09 (1.21-21.5); P = 0.015] and calcium channel blockers [OR 5.69 (1.07-33.25); P = 0.031) were significantly associated with prolonged hospitalization.
CONCLUSIONS: Neither PP nor PIM are significantly associated with treatment-related toxicity in elderly HNC patients, but these are associated with modest increases in prolonged hospitalization and noncancer health events.

PMID: 26744323 [PubMed - as supplied by publisher]

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