bluuebunny/crossref_metadata_2025 huggingface dataset:
A prospective crossover trial of botulinum toxin chemodenervation versus injection augmentation for essential voice tremor
Authors: Estes Christine , Sadoughi Babak , Coleman Rachel , Sarva Harini , Mauer Elizabeth , Sulica Lucian
Published: October 2017

Objectives/Hypothesis

Botulinum toxin chemodenervation (BTX) is used to treat essential voice tremor (EVT), but results are not uniformly satisfactory. This study sought to assess the comparative utility of injection augmentation (IA) for EVT.

Study Design

Prospective crossover treatment study.

Methods

Patients with EVT underwent BTX. After washout patients underwent IA. Multidimensional assessment carried out prior to and 30 days after each treatment included 1) videostroboscopy graded by the Vocal Tremor Scoring System (VTSS), 2) acoustic and aerodynamic assessment (cepstral peak prominence, cepstral spectral index of dysphonia, cepstral peak prominence fundamental frequency, airflow, peak air pressure and intensity, maximum phonation time, and amplitude/frequency of tremor), 3) audio‐perceptual assessment via Consensus Audio‐Perceptual Evaluation of Voice (CAPE‐V), and 4) patient self‐assessment via Voice Handicap Index‐10 (VHI‐10) and Percent of Normal Function (PNF) scale. Findings were analyzed via paired t tests and Wilcoxon rank sum tests.

Results

Seven patients (five female and two male; mean age 67 years old; range, 46–82 years old) participated. VTSS grading showed divergent outcomes for certain individual sites of tremor, but without significant differences. Airflow increased following BTX and decreased following IA, and VHI‐10 scores indicated slight improvement post‐BTX (26.29–23.57), and decline post‐IA (25.86–29.86), although differences were not significant. Only changes in audio‐perceptual ratings of loudness achieved significance, which decreased with BTX and increased with IA. Five patients chose to resume BTX; two elected long‐term IA. No findings supported patient preferences.

Conclusions

IA demonstrated no advantage over BTX in the treatment of EVT.

Level of Evidence

2b. Laryngoscope, 128:437–446, 2018
The effect of vocal fold augmentation on cough symptoms in the presence of glottic insufficiency
Authors: Litts Juliana K. , Fink Daniel S. , Clary Matthew S.
Published: October 2017

Objective

To determine the effect of injection augmentation of the vocal folds on chronic cough symptoms in patients with glottic insufficiency.

Methods

Medical records from 146 consecutive patients who underwent vocal fold injection augmentation by a fellowship‐trained laryngologist between 2013 and 2015 were reviewed. Twenty‐three patients (12 male) met inclusion criteria of a vocal fold augmentation injection, cough symptoms lasting more than 8 weeks, and glottic insufficiency as determined by shortened closed phase on stroboscopy. Exclusion criteria included lack of cough complaints, diagnosis of vocal fold immobility, previous history of vocal fold augmentation, and incomplete data sets. Data collected included age, gender, pre‐ and 1‐month postinjection Cough Severity Index (CSI) scores, location of injection (unilateral or bilateral), and patient statement of percent change in symptoms that was recorded at 1‐month postinjection visit.

Results

Paired t test indicated a significant decrease in CSI scores from pre‐ (m = 18.5) to 1‐month postinjection (m = 12.1) (P = 0.004). Eighteen patients (78.2%) reported a 50% or greater improvement in cough symptoms at the 1‐month postinjection visit.

Conclusion

Injection augmentation of the vocal folds in the presence of glottic insufficiency appears to improve cough symptoms, as was reported by CSI in patients who are refractory to other medical and behavioral treatments.

Level of Evidence

4. Laryngoscope, 128:1316–1319, 2018
Long‐term results of Amatsu tracheoesophageal shunt: Follow‐up of more than 5 years
Authors: Matsui Hidetoshi , Iwae Shigemichi , Hirayama Yuji , Yonezawa Koichiro , Shigeji Jun
Published: October 2017

Background/Objective

The Amatsu tracheoesophageal shunt (ATES) represents a nonprosthesis surgical option for voice restoration in laryngectomized patients. However, data regarding the long‐term efficacy of ATES are lacking.

Study Design

Retrospective, single‐institution study.

Methods

Between 2001 and 2010, 16 patients with laryngeal cancer underwent total laryngectomy with ATES at the Hyogo Cancer Center (Akashi, Hyogo, Japan). Of these, 11 achieved long‐term tracheoesophageal speech that was maintained for a follow‐up exceeding 5 years (range 75–161 months; median 95 months). All patients were male and ranged from 46 to 74 years of age at the time of ATES surgery.

Results

Of 11 eligible patients, eight were able to speak intelligibly with ATES at last follow‐up. Regarding aspiration, three patients experienced no leakage, and six experienced mild leakage of saliva without medical intervention at last follow‐up. Almost all patients maintained an unchanged degree of voice quality (9 of 11) and leakage (8 of 11).

Conclusion

The favorable voice restoration and low aspiration rates achieved in this study appear to support the long‐term efficacy of ATES.

Level of Evidence

4.Laryngoscope, 128:1395–1397, 2018
How reliably can computed tomography predict thyroid invasion prior to laryngectomy?
Authors: Harris Andrew S. , Passant Carl D. , Ingrams Duncan R.
Published: October 2017

Objectives/Hypothesis

There is little evidence to support the removal of thyroid tissue during total laryngectomy. Although oncological control of the tumor is the priority, thyroidectomy can lead to hypothyroidism and hypoparathyroidism. This study aimed to test the usefulness of preoperative computed tomography in predicting histological invasion of the thyroid.

Study Design

Ambispective cohort study.

Methods

All patients undergoing total laryngectomy for squamous cell carcinoma at one center from 2006 to 2016 were included. Data were recorded prospectively as part of the patients' standard care, but were collated retrospectively, giving this study an ambispective design. The histology report for thyroid invasion was taken as the gold standard. The computed tomography report was categorized by invasion of tumor into intralaryngeal, laryngeal cartilage involvement, and extralaryngeal tissues.

Results

Seventy‐nine patients were included. Nine patients had thyroid involvement on histology, translating to an incidence of 11.29% in this population. The positive predictive value for cartilage involvement on computed tomography for thyroid invasion was 52.9% (95% confidence interval [CI]: 28.5%‐76.1%) and the negative predictive value was 100% (95% CI: 92.7%‐100%).The positive predictive value for extralaryngeal spread on computed tomography for thyroid involvement was 100% (95% CI: 62.9%‐100%), and the negative predictive value was also 100% (95% CI: 93.5%‐100%).

Conclusions

This study has shown that preoperative computed tomography is an effective method of ruling out thyroid gland invasion. The absence of extralaryngeal spread on computed tomography has been shown to be the most useful finding, with a high negative predictive value and a narrow 95% CI.

Level of Evidence

4. Laryngoscope, 128:1099–1102, 2018
Safety of outpatient thyroidectomy: Review of the American College of Surgeons National Surgical Quality Improvement Program
Authors: McLaughlin Eamon J. , Brant Jason A. , Bur Andres M. , Fischer John P. , Chen Jinbo , Cannady Steven B. , Chalian Ara A. , Newman Jason G.
Published: October 2017

Objectives/Hypothesis

To investigate national trends in admission status after thyroidectomy in the United States and to evaluate the factors associated with 30‐day unplanned readmission and reoperation.

Study Design

Retrospective review of American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP)

Methods

The ACS‐NSQIP database was queried for patients who underwent a partial or total thyroidectomy between 2005 and 2014. Outpatient surgery was defined as discharge on the day of surgery. Patient demographic information, unplanned hospital readmission, and reoperation were reviewed. Risk factors were identified using logistic regression modeling.

Results

A total of 76,604 cases met inclusion criteria as described above. There were 1,473 (1.9%) patients who underwent reoperation and 477 unplanned 30‐day readmissions (1.4%) for procedures performed since 2012. There was a significant positive trend in the percentage of thyroidectomy (partial and total) patients who underwent outpatient procedures by year of operation (P < .001). Outpatient procedures were not more likely to have unplanned readmissions or reoperations. Independent patient risk factors for unplanned readmission and reoperation included current dialysis, chronic steroid use, unintentional weight loss, American Society of Anesthesiologists class 3 to 4, and active bleeding disorders.

Conclusions

Over the past decade there has been a clear trend toward increasing outpatient thyroid surgery. Thyroidectomy performed as an outpatient was not found to be an independent risk factor for readmission or reoperation. Patients with serious medical comorbidities and active bleeding disorders are at increased risk of unplanned readmission or reoperation and should have their surgery performed on an inpatient basis.

Level of Evidence

2c. Laryngoscope, 128:1249–1254, 2018
Risk factors for salvage surgery failure in oral cavity squamous cell carcinoma
Authors: Matsuura Danielli , Valim Tiago Dias , Kulcsar Marco Aurélio Vamondes , Pinto Fábio Roberto , Brandão Lenine Garcia , Cernea Claudio Roberto , Matos Leandro Luongo
Published: October 2017

Objectives/Hypothesis

Locoregional recurrences of oral cavity squamous cell carcinoma (SCC) may be diagnosed during follow‐up of surgically treated patients. Nevertheless, few studies have investigated factors that impact salvage surgery failure and the mortality rates of these patients. The objectives were to identify predictive factors of salvage surgery failure and mortality in patients who undergo surgical treatment for recurrent oral cavity SCC and to compare the overall survival rates of these patients with those of patients who undergo only one surgical treatment.

Study Design

Retrospective cohort study.

Methods

Forty‐six patients submitted to salvage surgery for local or locoregional recurrence.

Results

The presence of lymph node metastasis and positive surgical margins at the salvage surgery time were the only independent factors associated with both recurrence rates (hazard ratio [HR]: 5.04 and 2.82, respectively) and mortality (HR: 3.51 and 3.24, respectively). When the overall survival rates of the 199 patients who only underwent one surgical treatment were compared to those of the 46 patients subjected to salvage surgery, a similarity was evident when patients who underwent salvage surgery did not have a new disease recurrence (70.7% vs. 54.7%, respectively; P = .158). Likewise, patients with new recurrences after salvage surgery and patients who received palliative treatment for relapsed disease had similar overall survival rates (0.6% vs. 0.0%, respectively; P = .475).

Conclusions

The presence of lymph node metastasis at the time of recurrence and positive surgical margins after the salvage surgery were associated with a worse overall survival rate in patients with oral cavity SCC relapse.

Level of Evidence

2b. Laryngoscope, 128:1113–1119, 2018
Maternal and obstetrical outcome in 35 cases of well‐differentiated thyroid carcinoma during pregnancy
Authors: Boucek Jan , de Haan Jorine , Halaska Michael J. , Plzak Jan , Van Calsteren Kristel , de Groot Christianne J. M. , Dahl Steffensen Karina , Fruscio Robert , Massolt Elske T. , Klaritsch Philipp , Zola Paolo , Amant Frédéric ,   on behalf of the International Network on Cancer, Infertility, and Pregnancy
Published: October 2017

Objectives/Hypothesis

Thyroid cancer, with 6% to 10% of cancer diagnoses, is one of the most common malignancies during pregnancy. Its treatment poses a risk for the pregnancy, as the thyroid gland plays a crucial role in the evolution of pregnancy. The aim of this study is to evaluate treatment of primary well‐differentiated thyroid carcinoma during pregnancy and fetal and maternal outcomes.

Study Design

This is an international cohort study.

Methods

Primary thyroid cancer patients were identified from the database of the International Network on Cancer, Infertility, and Pregnancy registration study. Data on histopathological characteristics, diagnostic and therapeutic interventions, outcome (obstetrical, neonatal, and maternal) and maternal follow‐up were analyzed.

Results

Thirty‐five patients with well‐differentiated thyroid carcinoma were eligible. All 35 patients underwent surgery, 29 (83%) of which during pregnancy. Procedures during pregnancy were mainly total thyroidectomies (n = 24). The median number of days between diagnosis and surgical treatment was different between the groups with surgery during and after pregnancy (27 vs. 139 days, P < .001). Both maternal and neonatal outcomes were uncomplicated, regardless of gestational age during surgery.

Conclusions

Well‐differentiated thyroid carcinoma diagnosed during pregnancy has a favorable outcome for both mother and child. Surgical management during pregnancy has no negative impact on the pregnancy regardless of the trimester at the time of surgery. However, the potential negative effects of thyroid surgery early in pregnancy demand management of these patients in an experienced multidisciplinary team to provide the best possible care for these patients and their unborn babies.

Level of Evidence

4. Laryngoscope, 128:1493–1500, 2018
Evidence against the mucosal traction theory in cholesteatoma
Authors: Pauna Henrique F. , Monsanto Rafael C. , Schachern Patricia , Paparella Michael M. , Chole Richard A. , Cureoglu Sebahattin
Published: October 2017

Objectives

To investigate the distribution of ciliated epithelium in the human middle ear and its potential role in the formation of cholesteatoma.

Study Design

Comparative human temporal bone study.

Methods

We selected temporal bones from 14 donors with a diagnosis of cholesteatoma, 15 with chronic otitis media without retraction pockets, 14 with chronic otitis media with retraction pockets, 14 with cystic fibrosis (CF), and 16 controls. We mapped the distribution of the ciliated cells in the mucosal lining of the middle ear and tympanic membrane using three‐dimensional reconstruction analysis, and counted the number of ciliated cells in the middle ear mucosa.

Results

Ciliated cells are extremely sparse in the epithelial lining of the lateral surface of the ossicles in the epitympanum and the medial surface of the tympanic membrane. Furthermore, there is a significant decrease in the number of ciliated cells in these areas in temporal bones with cholesteatoma, chronic otitis media, chronic otitis media with retraction pockets, and CF compared to controls. Ciliated cells most commonly are located at the hypotympanum and the Eustachian tube opening but not the tympanic membrane or epitympanum.

Conclusion

The paucity of ciliated epithelial cells on the medial side of the tympanic membrane and the lateral surface of the ossicles in the epitympanum in cases with cholesteatoma and/or chronic otitis media do not support the mucosal migration theory of cholesteatoma formation.

Level of Evidence

NA. Laryngoscope, 128:1663–1667, 2018
Evolving trends in sinus surgery: What is the impact of balloon sinus dilation?
Authors: Svider Peter F. , Darlin Spencer , Bobian Michael , Sekhsaria Vibhav , Harvey Richard J. , Gray Stacey T. , Baredes Soly , Folbe Adam J. , Eloy Jean Anderson
Published: October 2017

Objectives/Hypothesis

Balloon dilation (BD) represents a minimally invasive alternative to endoscopic sinus surgery (ESS). Although BD was introduced in 2006, distinct Current Procedural Terminology (CPT) codes were not available until 2011, making prior analysis of population‐based trends difficult. Our objectives were to evaluate these trends and compare any changes to the use of traditional ESS techniques. Geographic trends also were evaluated.

Methods

Medicare Part B national datasets encompassing procedures from 2011 to 2015 were obtained. ESS CPT codes (frontal sinusotomy, maxillary antrostomy with/without tissue removal, sphenoidotomy) and BD codes were searched to determine temporal trends in their use. Additionally, state carriers were individually evaluated for geographic trends.

Results

National use of BD increased greater than five‐fold (39,193 from 7,496 among Medicare patients), whereas the use of ESS increased by only 5.9%. This increase in BD was observed across all sites, including the sphenoid (7.0x), maxillary (5.1x), and frontal (4.7x) sinuses. In the most recent year for which data was available (2015), a significantly greater portion of sinus procedures in these sites utilized BD in the South (42.1%) compared to the Northeast (30.6%), West (29.5%), and Midwest (25.3%) regions (P < 0.0001).

Conclusion

The performance of BD has increased markedly in recent years. Because the use of ESS codes remain stable, observed BD trends are unlikely to be due simply to greater familiarity with newer CPT coding. The reasons for the striking increase in BD popularity are speculative and beyond the scope of this analysis, but further study may be needed.

Level of Evidence

NA. Laryngoscope, 128:1299–1303, 2018
Online and call center referral for endocrine surgical pathology within institutions
Authors: Dhillon Vaninder K. , Al Khadem Mai G. , Tufano Ralph P. , Russell Jonathon O.
Published: October 2017

Objectives/Hypothesis

We hypothesized that self‐referred patients to academic centers will be equally distributed between general surgery and otolaryngology departments that perform thyroid surgery. We sought to quantify disparities in the assignment of these self‐referred patients who may reach an institution through call centers or online pathways.

Study design

Cross‐sectional survey.

Methods

Key words “thyroid surgery” and “thyroid cancer” were used along with the name of the Accreditation Council for Graduate Medical Education–listed otolaryngology program in both Google and Bing search engines. The top three search results for departments were reviewed, and a tally was given to general surgery (GS), otolaryngology–head and neck surgery (OLHNS), or neither. A multidisciplinary center with both GS and OLHNS was recorded as “equitable.” Telephone calls were tallied if they were directed to GS or OLHNS.

Results

Out of 400 program tallies, 117 (29.25%) patients were directed to GS and 50 (12.5%) were directed to OLHNS. An additional 181 (45.25%) were directed to neither group (“neither”) (P < .05). Fifty‐two (13%) of the patients were referred to multidisciplinary groups (“equitable”). A telephone call survey had 62 patients (62%) assigned to a general surgeon, as opposed to 38 (38%) for OLHNS (P < .05). Five institutions offered a multidisciplinary group when searching with Bing, and 11 were found by searching with Google.

Conclusions

There is not an equal distribution of self‐referred patients with thyroid surgical pathology. It may be important to increase the online presence of OLHNS surgeons who perform thyroid surgery at academic medical institutions. Multidisciplinary centers focused on thyroid and parathyroid surgical disease represents one model of assigning self‐referred patients.

Level of Evidence

NA Laryngoscope, 1977–1981, 2018
Toolbox of assessment tools of technical skills in otolaryngology–head and neck surgery: A systematic review
Authors: Labbé Mathilde , Young Meredith , Nguyen Lily H. P.
Published: October 2017

Objective

To support the development of programs of assessment of technical skills in the operating room (OR), we systematically reviewed the literature to identify assessment tools specific to otolaryngology–head and neck surgery (OTL‐HNS) core procedures and summarized their characteristics.

Methods

We systematically searched Embase, MEDLINE, PubMed, and Cochrane to identify and report on assessment tools that can be used to assess residents' technical surgical skills in the operating room for OTL‐HNS core procedures.

Results

Of the 736 unique titles retrieved, 16 articles met inclusion criteria, covering 11 different procedures (in otology, rhinology, laryngology, head and neck, and general otolaryngology). The tools were composed of a task‐specific checklist and/or global rating scale and were developed in the OR, on human cadavers, or in a simulation setting.

Conclusions

Our study reports on published tools for assessing technical skills for OTL‐HNS residents during core procedures conducted in the OR. These assessment tools could facilitate the provision of timely feedback to trainees including specific goals for improvement. However, the paucity of publications suggests little agreement on how to best perform work‐based direct‐observation assessment for core surgical procedures in OTL‐HNS. The sparsity of tools specific to OTL‐HNS may become a barrier to a fluid transition to competency‐based medical education. Laryngoscope, 128:1571–1575, 2018
Outcomes and reliability of the flow coupler in postoperative monitoring of head and neck free flaps
Authors: Fujiwara Rance J. T. , Dibble Jacqueline M. , Larson Scott V. , Pierce Matthew L. , Mehra Saral
Published: October 2017

Objectives/Hypothesis

To assess the accuracy and reliability of the flow coupler relative to the implantable arterial Doppler probe in postoperative monitoring of head and neck free flaps.

Study Design

Retrospective single‐institution study, April 2015 to March 2017.

Methods

Both the venous flow coupler and arterial Doppler were employed in 120 consecutive head and neck free flap cases. When Doppler signal loss occurred, flaps were evaluated by physical exam to determine whether signal loss was a true positive necessitating operating room takeback. Sensitivity, specificity, and false positive rate (FPR) were recorded for each device. Logistic regression was conducted to identify user trends over time.

Results

Eleven of 120 patients (9.2%) required takeback, 10 from venous thrombosis and one from arterial thrombosis. Permanent signal loss (PSL) occurred in the flow coupler in all takebacks; PSL occurred in the arterial Doppler only in the case of arterial thrombosis. Salvage rate was 9/11 (81.8%). For the flow coupler, sensitivity was 100%, specificity 86.4%, and FPR 13.6%. For the arterial probe, sensitivity was 9.1%, specificity 97.1%, and FPR 2.9%. A 4.1% decrease in false positives with each additional flow coupler use was observed.

Conclusions

Monitoring the vein via flow coupler has high sensitivity in identifying vascular compromise compared to the arterial probe, especially for venous thrombosis. There is moderate FPR; this decreases with increased usage and, when supplemented with physical examination, does not result in unnecessary takebacks. The flow coupler can be a valuable tool in postoperative monitoring of head and neck free flaps.

Level of Evidence

4. Laryngoscope, 128:812–817, 2018
Clinical utility of 18F‐fluorodeoxyglucose/positron emission tomography in diagnosis of immunoglobulin G4–related sclerosing sialadenitis
Authors: Takano Kenichi , Yajima Ryoto , Kamekura Ryuta , Yamamoto Motohisa , Takahashi Hiroki , Yama Naoya , Hatakenaka Masamitsu , Himi Tetsuo
Published: October 2017

Objectives/Hypothesis

The aim of this study was to evaluate the utility of 18F‐fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for accurately diagnosing immunoglobulin G4‐related sclerosing sialadenitis (IgG4‐SS).

Study Design

Retrospective cohort study.

Methods

We reviewed the records of 64 patients with IgG4‐SS (35 male and 29 female patients) and 10 patients with clinically suspected IgG4‐SS. Pathological diagnoses of patients clinically suspected with IgG4‐SS included four cases of malignant lymphoma, one case of multicentric Castleman disease, one case of Sjögren's syndrome, and four cases of sialadenitis. All patients underwent submandibular gland (SMG) biopsies and baseline FDG‐PET/CT evaluation. Clinical, serological, pathological, and PET/CT findings were analyzed. We also investigated maximum standardized uptake values (SUVmax) in the salivary glands of 15 patients with malignant disease of the salivary glands during the same period.

Results

Increased FDG uptake in the SMG and parotid gland was found in 63 (98%) and 23 (35%) patients with IgG4‐SS, respectively. FDG uptake of the bilateral SMG and unilateral SMG was recorded in 57 patients (89%) and six patients (9%), respectively. Mean SUVmax in patients with malignant disease of the salivary glands was significantly higher than that in patients with IgG4‐SS (P = .035). We defined a positive test for IgG4‐SS diagnosis as high SMG FDG uptake and serum IgG4 level ≥135 mg/dL, resulting in a sensitivity, specificity, and accuracy of 96.9%, 90.0%, and 86.4%, respectively.

Conclusions

FDG‐PET/CT findings in combination with serological and clinical findings may have the capacity to diagnose IgG4‐SS and lead to less‐invasive biopsy procedures.

Level of Evidence

4. Laryngoscope, 128:1120–1125, 2018
Hydroxyurea therapy in UK children with sickle cell anaemia: A single‐centre experience
Authors: Phillips Kate , Healy Laura , Smith Louise , Keenan Russell
Published: October 2017

Introduction

Despite the demonstrated efficacy of hydroxyurea therapy, children with sickle cell anaemia in the UK are preferentially managed with supportive care or transfusion. Hydroxyurea is reserved for children with severe disease phenotype. This is in contrast to North America and other countries where hydroxyurea is widely used for children of all clinical phenotypes. The conservative UK practice may in part be due to concerns about toxicity, in particular marrow suppression with high doses, and growth in children.

Methods and results

We monitored 37 paediatric patients with sickle cell anaemia who were treated with hydroxyurea at a single UK treatment centre. Therapy was well tolerated and mild transient cytopenias were the only toxicity observed. Comparative analysis of patients receiving ≥26 mg/kg/day versus <26 mg/kg/day demonstrates increasing dose has a significant positive effect on foetal haemoglobin (Hb; 29.2% vs. 20.4%, P = 0.0151), mean cell volume (94.4 vs. 86.5, P = 0.0183) and reticulocyte count (99.66 × 109/l vs. 164.3 × 109/l, P = 0.0059). Marrow suppression was not a clinical problem with high‐dose treatment, Hb 92.25 g/l versus 91.81 g/l (ns), neutrophil count 3.3 × 109/l versus 4.8 × 109/l (ns) and platelet count 232.4 × 109/l versus 302.2 × 109/l (ns). Normal growth rates were maintained in all children. Good adherence to therapy was a significant factor in reducing hospitalisations.

Conclusion

This study demonstrates the effectiveness and safety in practice of high‐dose hydroxyurea as a disease‐modifying therapy, which we advocate for all children with sickle cell anaemia.
Inconsistency in classifying vascular anomalies: What's in a name?
Authors: Pahl Kristy S. , Kim Kyung , Sams Casey , Alvarez Hortensia , Smith Scott V. , Blatt Julie
Published: October 2017

Background

Vascular anomalies are a heterogeneous group of disorders seen in children and adults. A standard nomenclature for classification has been offered by the International Society for the Study of Vascular Anomalies. Its application is important for communication among the multiple specialties involved in the care of patients and for planning treatment, as well as for research and billing. We hypothesized that terminology still is not uniformly applied, and that this could have an impact on treatment.

Methods

We retrospectively reviewed the medical records of patients with nonbrain lesions from our institutional vascular anomalies database seen during 2010–2016 for whom at least one clinic visit, radiologic imaging report, and pathology report were available to compare diagnoses among and within disciplines, and treatment recommendations. Diagnoses and referral patterns by community healthcare providers were also reviewed.

Results

Of 400 patients seen during the targeted time interval, 35 had clinical, imaging, and pathology reports. Agreement in terminology from initial clinic notes with imaging and pathology reports was noted in only three cases (9%). “Hemangioma” was often misused; “lymphangioma” and “cystic hygroma” persist as diagnostic labels. Community healthcare providers referred vascular malformations with a diagnosis of “mass” or “hemangioma” in 17 of 18 cases where that information was available. Incomplete or mislabeling of vascular anomalies sometimes delayed referrals to appropriate clinics, though it did not have a major impact on treatment.

Conclusions

An understanding of vascular anomalies as tumors or malformations is not uniform. Ongoing education will be needed to promote consensus terminology and facilitate referrals.
Dramatic response to nivolumab in xeroderma pigmentosum skin tumor
Authors: Chambon Fanny , Osdoit Sophie , Bagny Kelly , Moro Anne , Nguyen Jacqueline , Réguerre Yves
Published: October 2017

We report the case of a 6‐year‐old female with xeroderma pigmentosum (XP) who developed a nonoperable scalp tumor, treated with anti‐programmed cell death protein 1 (anti‐PD‐1) therapy (nivolumab). She presented with a sarcomatoid carcinoma of the scalp with bone lysis as well as vascular and meningeal contact. Nivolumab was initiated because it has emerged as a promising immunotherapy. We observed a dramatic tumor response with excellent tolerance. However, while on nivolumab therapy she developed two large skin melanomas and several squamous cell carcinomas, which have been resected. These results demonstrate that cancer immunotherapy in patients with XP can be impressive but complex and warrants further investigation.
Comparison of two cytoreductive regimens for αβ‐T‐cell‐depleted haploidentical HSCT in pediatric malignancies: Improved engraftment and outcome with TBI‐based regimen
Authors: Jacoby Elad , Varda‐Bloom Nira , Goldstein Gal , Hutt Daphna , Churi Chaim , Vernitsky Helly , Toren Amos , Bielorai Bella
Published: October 2017

Background

Graft manipulation using selective depletion of αβ‐T cells provides a source of haploidentical hematopoietic stem cell transplantation (haplo‐HSCT) enriched in effector cells. We report our experience implementing this haplo‐HSCT for high‐risk malignancies in pediatric patients focusing on the conditioning regimen.

Procedure

We performed a retrospective study of patients who underwent T‐cell receptor αβ‐depleted haplo‐HSCT for high‐risk pediatric malignancies.

Results

Eighteen patients underwent haplo‐HSCT using this method. The initial reduced‐toxicity chemotherapy‐based conditioning regimen was given to eight patients, and resulted in a high rate of graft rejections (six of eight patients). Thus, total body irradiation (TBI) based regimen was introduced in the following 10 patients and resulted in engraftment in all patients. Neutrophil and platelet engraftment were rapid (median time to engraft, 10 days and 12 days, respectively). Significant treatment‐related complications for both cohorts were all due to graft failure in patients receiving chemotherapy‐based conditioning, with a treatment‐related mortality rate of 17%. None of the patients developed hepatic sinusoidal‐obstruction syndrome, and no grade III–IV acute graft versus host disease (GVHD) was observed. The majority of patients were free of immunosuppression in the first 100 days post‐HSCT, and only two patients developed chronic GVHD. The cumulative incidence of relapse was 39%. Compared to patients conditioned with chemotherapy, patients conditioned with TBI had superior actuarial overall survival (66% vs. 37%, P = 0.05) and event‐free survival (61% vs. 33%, P = 0.04).

Conclusions

A TBI‐based conditioning for haplo‐HSCT using αβ‐T‐cell depletion for malignant diseases ensured engraftment and resulted in acceptable outcomes.
Triple therapy of vincristine, bleomycin and etoposide for children with Kaposi sarcoma: Results of a study in Malawian children
Authors: Macken Marita , Dale Helen , Moyo Dominic , Chakmata Eunice , Depani Sarita , Israels Trijn , Niyrenda Dalida , Bailey Simon , Chagaluka George , Molyneux Elizabeth M.
Published: October 2017

Background

Kaposi sarcoma (KS) is the most common paediatric cancer in human immunodeficiency virus (HIV) endemic countries of sub‐Saharan Africa, but there is little research on management and outcomes.

Methods

Children with KS at Queen Elizabeth Central Hospital, Blantyre, Malawi treated between August 2012 and March 2015 with six courses of vincristine, bleomycin and etoposide combination chemotherapy, including antiretroviral therapy (ART) if HIV infected, were studied and outcomes compared with previously reported results.

Findings

Fifty‐six children were included; 38 (68%) were male; and 48 (86%) were HIV positive, of whom 36 (77%) were on ART at diagnosis. Median age at diagnosis was 8 years (interquartile range [IQR] 3–12) and median follow‐up was 16.9 months (IQR 3.4–36.4). Quality of life improved in 45 (80%) children; the median Lansky Score increased from 80% pre‐treatment to 100% post‐treatment. Eighteen (32%) children had complete response to treatment. At 12 months, overall survival was 71% (95% confidence interval [CI] 56–82) and event‐free survival (event = death, loss to follow‐up or relapse) was 50% (95% CI 36–63). At 1 year, the risk of loss to follow‐up was 13.4%. In a previous, same‐site, randomized controlled study of vincristine monotherapy, vincristine and bleomycin, or oral etoposide, oral etoposide monotherapy had the best outcome with survival at 12 month of 66% (95% CI 46–80) and event‐free survival of 52% (95% CI 33–68); however, loss to follow‐up was not reported.

Conclusion

Overall survival, event‐free survival and quality of life appear to have improved with this three‐agent combination chemotherapy; however larger, randomized studies are needed to determine optimal management.
Cognitive outcomes among Latino survivors of childhood acute lymphoblastic leukemia and lymphoma: A cross‐sectional cohort study using culturally competent, performance‐based assessment
Authors: Bava Laura , Johns Alexis , Kayser Kimberly , Freyer David R.
Published: October 2017

Background

This study sought to characterize cognitive outcomes among Latino survivors of childhood acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LL).

Procedure

In this cross‐sectional cohort study, Latino survivors of ALL (n = 57) and LL (n = 5) aged 6–16 years were pooled and evaluated using validated measures of cognitive, academic, and behavioral function and English language proficiency. Performance was compared with norms using single‐sample t‐tests.

Results

In this cohort (n = 62, 50% male), mean ages at diagnosis and testing were 4.5 and 10.8 years, respectively; mean time off treatment was 44.7 months. All participants spoke English and over half (57%) identified Spanish as the primary language in the home. Forty‐two families (68%) placed in the two lowest Hollingshead socioeconomic status categories. Participants were below average for working memory (P < 0.001). Overall, participants were in the average range, but significantly lower than published norms on domain‐specific measures of verbal comprehension (P < 0.001); perceptual reasoning (P = 0.033); processing speed (P = 0.003); visual memory (P < 0.001); visuomotor attention, scanning, and sequencing (P = 0.005); and reading comprehension (P = 0.001). Parents reported concerns with working memory (P < 0.001) and metacognition (P = 0.014).

Conclusions

Similar to other childhood ALL/LL survivors, overall cognitive function in this Latino sample was relatively preserved but selected deficits were observed. Routine cognitive screening is indicated in this population.
Synthesis and radical ring‐opening polymerization of vinylcyclopropanes derived from amino acids with hydrophobic moieties
Authors: Takahashi Naoya , Yamada Shuhei , Sudo Atsushi , Endo Takeshi
Published: October 2017

Six 1,1‐disubstituted vinylcyclopropanes (VCP) were synthesized from glycine and amino acids bearing hydrophobic moieties, l‐alanine, l‐valine, l‐leucine, l‐isoleucine, and l‐phenylalanine. These VCP derivatives efficiently underwent radical ring‐opening polymerization to afford the corresponding polymers bearing trans‐vinylene moiety in the main chains and the amino acid‐derived chiral moieties in the side chains. The polymers were film‐formable, and in the films of polymers bearing the glycine‐ and alanine‐derived side chains, presence of hydrogen bonding was confirmed by IR analysis. Thermogravimetric analysis of the polymers revealed that the temperatures of 5% weight loss were higher than 300 °C. Differential scanning calorimetry clarified that the polymers were amorphous ones showing glass transition temperatures in a range of 48–80 °C. © 2017 Wiley Periodicals, Inc. J. Polym. Sci., Part A: Polym. Chem. 2017, 55, 3996–4002
Synthesis and characterization of functional polyethylene with regularly distributed thioester pendants via ring‐opening metathesis polymerization
Authors: Song Shaofei , Zhang Zhen , Liu Xiaoyu , Fu Zhisheng , Xu Junting , Fan Zhiqiang
Published: October 2017

Four kinds of functional polyethylene carrying thioester pendants were synthesized via ring‐opening metathesis polymerization (ROMP) of alkyl cyclopent‐3‐enecarbothioate catalyzed by a ruthenium‐based commercial catalyst and subsequent hydrogenation of the ROMP products (alkyl = ethyl, n‐butyl, n‐octyl, or n‐dodecyl). In these polymers the pendant alkyl thioester groups are precisely distributed along the backbone on every five methylene carbons. Chain structure, molecular weight and molecular weight distribution of the polymers were characterized by 1H and 13C NMR, and GPC. The ROMP reactions all reached high monomer conversions, and hydrogenation of the ROMP products were exhaustive. Thermal transitions and side chain crystallization behaviors of the polymer were investigated and characterized by DSC and TGA. Glass transition temperature and melting temperature of these polymers were higher than the counterparts containing ester pendants. TGA analysis indicated that all the thioester‐containing polymers exhibited moderate thermal stability, and the sulfur‐containing polymers show slightly lower thermal stability than their counterparts without sulfur. The new family of functionalized polyethylenes could be used as models of ethylene‐thioacrylate copolymers, and find applications as novel functional materials. © 2017 Wiley Periodicals, Inc. J. Polym. Sci., Part A: Polym. Chem. 2017, 55, 4027–4036
Visible light‐emitting diode‐sensitive thioxanthone derivatives used in versatile photoinitiating systems for photopolymerizations
Authors: Wu Xingyu , Jin Ming , Malval Jean‐Pierre , Wan Decheng , Pu Hongting
Published: October 2017

Novel thioxanthone (TX) derivatives are used as versatile photoinitiators upon visible light‐emitting diode (LED; e.g., 405, 425, and 450 nm) exposure. The mechanisms for the photochemical generation of reactive species (i.e., cations and free radicals) produced from photoinitiating systems based on the photoinitiator and an iodonium salt, tris(trimethylsilyl)silane, or an amine, were studied by UV–vis spectroscopy, fluorescence, cyclic voltammetry, steady‐state photolysis, and electron spin resonance spin‐trapping techniques. The reactive species are particularly efficient for cationic, free radical, hybrid, and thiol‐ene photopolymerizations upon LED exposure. The optimized photoinitiating systems exhibit higher efficiency than those of reference systems (i.e., isopropyl TX‐based photoinitiating systems), especially in the visible range. According to their beneficial features, these photoinitiating systems have considerable potential in photocuring applications. © 2017 Wiley Periodicals, Inc. J. Polym. Sci., Part A: Polym. Chem. 2017, 55, 4037–4045
Cognitive profiles in childhood and adolescence differ between adult psychotic and affective symptoms: a prospective birth cohort study
Authors: Koike S. , Barnett J. , Jones P. B. , Richards M.
Published: October 2017

Background

Differences between verbal and non-verbal cognitive development from childhood to adulthood may differentiate between those with and without psychotic symptoms and affective symptoms in later life. However, there has been no study exploring this in a population-based cohort.

Method

The sample was drawn from the MRC National Survey of Health and Development, and consisted of 2384 study members with self-reported psychotic experiences and affective symptoms at the age of 53 years, and with complete cognitive data at the ages of 8 and 15 years. The association between verbal and non-verbal cognition at age 8 years and relative developmental lag from age 8 to 15 years, and both adult outcomes were tested with the covariates adjusted, and mutually adjusted for verbal and non-verbal cognition.

Results

Those with psychotic experiences [thought interference (n = 433), strange experience (n = 296), hallucination (n = 88)] had lower cognition at both the ages of 8 and 15 years in both verbal and non-verbal domains. After mutual adjustment, lower verbal cognition at age 8 years and greater verbal developmental lag were associated with higher likelihood of psychotic experiences within individuals, whereas there was no association between non-verbal cognition and any psychotic experience. In contrast, those with case-level affective symptoms (n = 453) had lower non-verbal cognition at age 15 years, and greater developmental lag in the non-verbal domain. After adjustment, lower non-verbal cognition at age 8 years and greater non-verbal developmental lag were associated with higher risk of case-level affective symptoms within individuals.

Conclusions

These results suggest that cognitive profiles in childhood and adolescence differentiate psychiatric disease spectra.
A multi-species chemotaxis system: Lyapunov functionals, duality, critical mass
Authors: KAVALLARIS N. I. , RICCIARDI T. , ZECCA G.
Published: October 2017

We introduce a multi-species chemotaxis type system admitting an arbitrarily large number of population species, all of which are attracted versus repelled by a single chemical substance. The production versus destruction rates of the chemotactic substance by the species is described by a probability measure. For such a model, we investigate the variational structures, in particular, we prove the existence of Lyapunov functionals, we establish duality properties as well as a logarithmic Hardy–Littlewood–Sobolev type inequality for the associated free energy. The latter inequality provides the optimal critical value for the conserved total population mass.
Development of the PHAST model: generating standard public health services data and evidence for decision-making
Authors: Bekemeier Betty , Park Seungeun
Published: October 2017

Objective

Standardized data regarding the distribution, quality, reach, and variation in public health services provided at the community level and in wide use across states and communities do not exist. This leaves a major gap in our nation’s understanding of the value of prevention activities and, in particular, the contributions of our government public health agencies charged with assuring community health promotion and protection. Public health and community leaders, therefore, are eager for accessible and comparable data regarding preventive services that can inform policy decisions about where to invest resources.

Methods

We used literature review and a practice-based approach, employing an iterative process to identify factors that facilitate data provision among public health practitioners.

Results

This paper describes the model, systematically developed by our research team and with input from practice partners, that guides our process toward maximizing the uptake and integration of these standardized measures into state and local data collection systems.

Discussion

The model we developed, using a dissemination and implementation science framework, is intended to foster greater interest in and accountability for data collection around local health department services and to facilitate spatial exploration and statistical analysis of local health department service distribution, change, and performance.

Conclusion

Our model is the first of its kind to thoroughly develop a means to guide research and practice in realizing the National Academy of Medicine’s recommendation for developing systems to measure and track state and local public health system contributions to population health.
Digital Goods Are Valued Less Than Physical Goods
Authors: Atasoy Ozgun , Morewedge Carey K
Published: October 2017

Digital goods are, in many cases, substantive innovations relative to their physical counterparts. Yet, in five experiments, people ascribed less value to digital than to physical versions of the same good. Research participants paid more for, were willing to pay more for, and were more likely to purchase physical goods than equivalent digital goods, including souvenir photographs, books (fiction and nonfiction), and films. Participants valued physical goods more than digital goods whether their value was elicited in an incentive compatible pay-what-you-want paradigm, with willingness to pay, or with purchase intention. Greater capacity for physical than digital goods to garner an association with the self (i.e., psychological ownership) underlies the greater value ascribed to physical goods. Differences in psychological ownership for physical and digital goods mediated the difference in their value. Experimentally manipulating antecedents and consequents of psychological ownership (i.e., expected ownership, identity relevance, perceived control) bounded this effect, and moderated the mediating role of psychological ownership. The findings show how features of objects influence their capacity to garner psychological ownership before they are acquired, and provide theoretical and practical insights for the marketing, psychology, and economics of digital and physical goods.
Biliary Strongyloides stercoralis With Cholecystitis and Extensive Portal Vein Thrombosis
Authors: Filkins Laura M , Gaston David C , Mathison Blaine , Smith Timothy , Couturier Marc Roger , Murphy Ryan D , Ciarkowski Claire , Hanson Kimberly E , Cariello Paloma F
Published: October 2017

We report the rare finding of Strongyloides stercoralis rhabditiform larvae in biliary fluid, here associated with cholecystitis and near total portal vein thrombosis. The role of S. stercoralis leading to atypical clinical presentations and difficulty diagnosing strongyloidiasis in such patients with appropriate geographic exposure is discussed.