bluuebunny/crossref_metadata_2025 huggingface dataset:
The Application of Epiglottic Laryngoplasty after Partial Laryngectomy
Authors: Qin Yong
Published: September 2014

Objectives:

Observe the applied value of epiglottis in laryngeal function reconstruction after partial laryngectomy.

Methods:

From April 1997 to December 2008, there were 295 patients with laryngeal carcinomas who were operated on in our department. There were 40 patients who had partial laryngectomy and laryngeal function was reconstructed using epiglottis with or without other materials. The 40 cases were followed up and the oncologic and functional results were retrospectively analyzed. We calculated the 3‐ and 5‐year tumor‐free survival rates and evaluated the rehabilitation of laryngeal function.

Results:

The 3‐ and 5‐year tumor‐free survival rates were 82.9% and 75.7%, respectively. All of the patients with supraglottic carcinoma had tumor‐free survival; in the 3 patients with subglottic carcinomas, only 1 patient had tumor‐free survival for 5 years; in the 34 patients with glottic carcinomas, 6 patients died, and 1 patient with local recurrence had a total laryngectomy. The total decannulation rate was 90%. Thirty‐nine patients rehabilitated normal peroral feeding. The mean time of removal of the nasogastric tube was 15.7 days. In the 40 cases, voice quality was good in 6 patients with a little hoarseness, 2 were worse, having only a whispered voice, and the others were moderate; the rate of vocal satisfaction was 95%.

Conclusions:

Using the epiglottis with or without other materials to reconstruct laryngeal function after partial laryngectomy is a useful alternative to total laryngectomy in laryngeal cancers, especially in selected advanced cases which improve the quality of life. The epiglottis is one of the ideal materials in laryngoplasty after partial laryngectomy.
Arrested Pneumatization of the Sphenoid: A Normal Variant Easily Mistaken for a Pathologic Entitity
Authors: Tummala Neelima , Waltonen Joshua D. , Clinger John D. , Lack Chris , Williams Dan
Published: September 2014

Objectives:

(1) Describe the radiologic findings of arrested pneumatization of the sphenoid sinus. (2) Recognize this benign developmental variant to prevent unnecessary surgical intervention.

Methods:

A case series. Between November 2012 to January 2014, 8 subjects presented with radiologic findings consistent with arrested pneumatization of the sphenoid bone, a benign developmental variant. In each case, review of imaging by a neuroradiologist confirmed this diagnosis using strict criteria. This series includes all cases encountered during routine clinical practice during this time period. Charts were reviewed for demographic, clinical, and radiologic data.

Results:

In all 8 cases, arrested pneumatization of the sphenoid sinus was an incidental finding. All subjects underwent computed tomography (CT) imaging as workup for a variety of otolaryngology‐related symptoms, including headache, hearing loss, facial trauma, and sinusitis. Two patients were referred after the finding of a sphenoid lesion was mistaken for a pathologic entity. Based on CT imaging, 7 subjects were recognized as having this benign developmental variant and were managed conservatively. One patient, whose imaging revealed what appeared to be an infiltrative, midline tumor of the sphenoid sinus, underwent surgical biopsy with benign results. Upon subsequent review of CT imaging at our institution, the lesion did appear to have features consistent with arrested pneumatization.

Conclusions:

Considering the frequency of identification of arrested pneumatization of the sphenoid, there is a paucity of information about this diagnosis within the otolaryngology literature. Familiarity with this entity may prevent additional costly workup or unnecessary surgical intervention.
Cancer of the Middle Ear: A Contemporary Review of the National Cancer Data Base, 1998‐2011
Authors: Nocon Cheryl C. , Liederbach Erik , Lapin Brittany , Gluth Michael B. , Shinners Michael J. , Bhayani Mihir K.
Published: September 2014

Objectives:

Middle ear cancer is a rare condition with limited data regarding incidence and outcomes. We used the National Cancer Data Base (NCDB) to describe the patient characteristics, treatment patterns, and outcomes of these uncommon malignancies.

Methods:

A total of 458 cancers coded as having the middle ear as their primary site were selected from the NCDB between 1998 and 2011 and analyzed using chi‐square tests and Cox regression.

Results:

Median age at diagnosis was 64 years (range, 18‐90 years) and most patients were white (79.7%). Histologic subtypes included squamous cell carcinoma (57.8%), adenocarcinoma (12.7%), other carcinoma (15.3%), and non‐carcinoma (14.2%). Of the 209 patients with documented tumor extension, 38.8%, 55.5%, and 5.7% had local, regional, and distant disease, respectively. Treatment included surgery alone (41.3%), surgery and adjuvant therapy (40.9%), and nonsurgical therapy alone (17.8%). In patients from 1998‐2006 with local and regional disease, the 5‐year survival rates were 52%, 27%, and 22% for these treatment groups, respectively. After risk‐adjustment, surgery alone had better survival compared with surgery and adjuvant therapy (hazard ratio [HR] =1.66, 95% confidence interval [CI] = 1.01, 2.73, P =. 045). Although not statistically significant, nonsurgical therapy trended toward worse survival (HR = 1.66, 95% CI = 0.95, 2.91, P =. 075).

Conclusions:

Patients with local and regional disease treated with surgery alone have the best survival, perhaps because of localized disease originating in the external auditory canal with minimal extension into the middle ear. Although the cases may be originating within the temporal bone, the true site of origin for middle ear cancers is ambiguous and a stricter coding system is needed.
Cervical Sympathetic Chain Schwannomas: A Global Systematic Review Provides Insight on Diagnosis, Treatment, and Outcomes
Authors: Setzen Gavin , Keefe Michael A. , Sharghi Leighla H. , Cho‐Reyes Soojin , Howie Benjamin A. , Navaie Maryam
Published: September 2014

Objectives:

Systematically evaluate the diagnosis, treatment, and outcomes of globally published cases of cervical sympathetic chain schwannomas (CSCS) to guide clinical decision making.

Methods:

Using Medline, EMBASE, and Cochrane databases, 89 CSCS case reports/series were identified from 1997 to 2013. Most cases were treated internationally (82%), predominantly in Asia (50%) and Europe (27%). Demographic, clinical, and outcomes data were extracted by 2 independent reviewers with high interrater reliability (k = 0.79). P <. 05 denoted statistical significance.

Results:

On average, patients were 42.6 years old (SD = 13.3) and had a 2 to 4‐cm (52.7%) or >4‐cm (43.2%) neck mass. Nearly 70% of cases were asymptomatic. Presurgical diagnosis relied heavily on computed tomography (63.4%), magnetic resonance imaging (MRI; 59.8%), or both (20%), supplemented by cytology (47.6%). US‐treated cases were significantly more likely to receive pre‐surgical MRI than internationally treated cases, but less likely to have cytology or histopathology (P <. 05). Presurgical diagnosis accuracy was only 11% as confirmed postsurgically. Extracapsular (complete) resection was more commonly performed than intracapsular resection (87.6%), irrespective of mass size and treatment country. Postsurgical adverse events (AEs) were more common with the extracapsular approach and when mass size was >4 cm. Reported AEs included Horner's syndrome (89.9%), First Bite syndrome (21.1%), or both (15.7%). AEs persisted in 81.1% of cases, with 28.8 months (SD = 27.1) average follow‐up time.

Conclusions:

Given the typical CSCS patient is young and asymptomatic, presurgical diagnostic accuracy is very low, and the likelihood of persistent postsurgical morbidity is high with aggressive extracapsular surgery, less invasive approaches to differentially manage CSCS are warranted.
Clinical Significance of Salivary CD44sol Levels in Laryngeal Carcinomas
Authors: Trapasso Serena , Aragona Teodoro , Franco Teresa , Allegra Eugenia
Published: September 2014

Objectives:

Describe our results about the clinical significance of salivary CD44sol levels in laryngeal carcinomas and analyze its emerging role as a diagnostic and prognostic factor.

Methods:

The study design was prospective. Patients with laryngeal cancer were selected and recruited at the Division of Otolaryngology, University of Catanzaro, from January to December 2012. Patients with benign head and neck disease were also included as a control group. For each patient, clinical‐anamnestic data were collected in a database. The data were recorded relating to any disease recurrence and locoregional or distant metastases detected during the follow‐up, every 3 months. The sampling of undiluted saliva was performed the day before surgery and during the follow‐up, every 3 months. Salivary CD44sol levels were determined using the enzyme‐linked immunosorbent assay method.

Results:

In patients with laryngeal carcinoma, salivary CD44sol levels were significantly higher than those in the control group (P <. 001). There is significant reduction in salivary CD44sol levels observed during the follow‐up at 3 and 6 months (P <. 04 and P <. 0002, respectively) when compared with those at the time of diagnosis of laryngeal cancer.

Conclusions:

In a previous study, we demonstrated that CD44sol can be an effective biological marker with useful application for early detection and screening in laryngeal cancer. The analysis of the obtained data shows that the Elisa CD44sol determination can represent a promising prognostic test.
Clinical Study of Surgical Resection for Pulmonary Metastasis of Head and Neck Cancer
Authors: Uwa Nobuhiro , Terada Tomonori , Sagawa Kosuke , Kida Kota , Sakagami Masafumi
Published: September 2014

Objectives:

Although chemotherapy is a common treatment for pulmonary metastasis of head and neck cancer, the prognosis is still poor. This study aimed to examine and evaluate the efficacy of surgical resection for pulmonary metastasis of head and neck cancer.

Methods:

A total of 15 patients who had undergone 19 resections were examined at our hospital between 2005 and 2012. The patients were followed up for at least 22 months after the surgery, or until their death, with a median period of 36 months. Among the 15 patients, 11 had squamous cell carcinoma, 3 had adenoid cystic carcinoma, and one had malignant melanoma.

Results:

Of the 19 resections, partial lung resection was performed in 13 cases, lobectomy in 4, and segmentectomy in 2. Video‐assisted thoracic surgery was performed in all cases. The mean surgical time, operative blood loss, and length of postoperative hospital stay were 104 minutes, 64 mL, and 7.8 days, respectively. Only 1 patient showed deterioration of the postoperative performance status. For patients with squamous cell carcinoma, the number of pulmonary metastases was 2 or less at the preoperative evaluation. The 3‐ and 5‐year disease‐specific survival rates after surgical resection in patients with squamous cell carcinoma were 54.6% and 20.5%, respectively. All patients with adenoid cystic carcinoma and malignant melanoma have survived to date.

Conclusions:

Lung surgical resection can be considered as one of the effective treatments for pulmonary metastasis of head and neck cancer to improve patient prognosis, with minimal invasion and complications.
A Double‐Blind, Randomized, Placebo‐Controlled Clinical Trial Evaluating Fibrin Sealant in Thyroidectomy Closure
Authors: Fuller Colin W. , Gillespie M. Boyd , Nguyen Shaun A. , Jones Taylor , Hornig Joshua D.
Published: September 2014

Objectives:

Evaluate the advantages and disadvantages of Evicel fibrin sealant when used in thyroid surgery closure, taking into account the following endpoints: postoperative drain output, time to drain removal, length of admission, and adverse events.

Methods:

From June 2010 to January 2014, an institutional review board–approved prospective, randomized, double‐blind study of Evicel versus a saline control was conducted on 70 subjects receiving total thyroidectomy or hemithyroidectomy. Twenty‐eight received Evicel and 27 received saline; data from 15 subjects were eliminated due to protocol violations. The mean age was 50.3 (range, 21 to 73).

Results:

Comparisons of baseline characteristics, including age, sex, and type of surgery, revealed successful subject randomization. There was no significant difference in drain output between Evicel (median [interquartile range]: 96.3 mL [73.3‐139.3 mL]) and placebo (120.0 mL [68.8‐161.5 mL], P =. 334). Drain time (37.9 hours [25.2‐48.7 hours] vs 43.6 hours [37.6‐58.1 hours]) and hospital stay (45.5 hours [33.4‐53.8 hours] vs 50.9 hours [44.1‐69.4 hours]) were also shorter for Evicel, but again these differences were not significant (P =. 101 and. 526, respectively). For the subjects undergoing total thyroidectomy, there was a significant reduction in drain output (103.5 mL [80.0‐138.6 mL] vs 150.0 mL [120.0‐188.5 mL], P =. 035) and drain time (40.3 hours [26.2‐49.1 hours] vs 47.1 hours [42.0‐67.8 hours], P =. 035) with Evicel. Hospital stay in this subgroup was shorter with Evicel (50.3 hours [43.6‐54.9 hours] vs 59.4 hours [48.4‐70.6 hours]), but this result was not significant (P =. 246). No outcomes were significant in the hemithryoidectomy subgroup. Nine adverse events occurred in the Evicel group compared to 3 for placebo (P =. 101).

Conclusions:

Evicel sealant appears to be a safe, effective method to reduce serous drain output following total thyroidectomy but has a limited role in hemithyroidectomy due to low levels of baseline drain output.
Effect of Anesthesia on Morphoproteomic Expression Profile of Oral Cavity and Oropharyngeal Squamous Cell Carcinoma
Authors: Ferrell Jay , Cattano Davide , Brown Robert , Patel Chirag B. , Karni Ron J.
Published: September 2014

Objectives:

Head and neck squamous cell carcinoma (HNSCC) has an unfortunately high rate of recurrence. Recent evidence suggests that the type of anesthesia used during surgery may affect a tumor's molecular biology, thereby influencing its response to treatment. In this pilot study, we test the hypothesis that different forms of anesthesia will affect the differential expression of several pro‐survival cellular proteins in HNSCC utilizing morphoproteomic analysis.

Methods:

Between September 2013 and January 2014, 10 patients underwent surgical resection of previously untreated oral cavity and/or oropharyngeal SCCA. Preoperatively they were randomized to receive either sevoflurane (n = 5) or total intravenous anesthesia (n = 5). Immunohistochemistry of pre‐ and postprocedural tumor tissue was performed using the following markers: HIF‐1A, HIF‐2A, SIRT‐1, mTOR, FASn, COX‐2, c‐MET, pAKT, NFkB, and pp38. Morphoproteomic scoring by a blinded pathologist was then employed to evaluate for differences in expression between the 2 groups.

Results:

Differential expression of several proteins was observed between the 2 groups. Specifically, sevoflurane was associated with increased protein expression in postprocedural tissue. Moreover, correlative analysis demonstrated an association between increased expression of several markers and specific tumor features (eg, perineural invasion).

Conclusions:

While only preliminary, our results suggest that the form of anesthesia used during surgery may affect the molecular biology of HNSCC. This study represents one of the first to evaluate the effects of anesthesia on the molecular biology of HNSCC in vivo. However, larger, prospective studies are needed to better evaluate the effect of anesthesia on the postoperative outcomes of HNSCC.
Comprehensive Repair of the Nasal Valve in the Management of Obstructive Sleep Apnea
Authors: Shuaib Stefan W. , Stupak Howard D.
Published: September 2014

Objectives:

To analyze whether the nasal valve cartilage repositioning procedure described here results in a significant improvement in patients with obstructive sleep apnea (OSA).

Methods:

This is a prospective case series conducted at a university public hospital from 2011 to 2014. Adult patients who had OSA, nasal obstruction with valve collapse, and body mass index less than 30 were included in the study. All patients had a cartilage repositioning L‐strut septoplasty via full transfixion incision. Specifically, the septal dorsum is exposed, released from the upper lateral cartilages and bony septum, and repositioned in the midline and fixated to the nasal spine, thus restoring the L‐strut position. In addition, the nasal sidewalls were repaired using the Alar™ endonasal stent device to reposition the upper lateral and lower lateral cartilage after release into positions of increased overlap, thus increasing the diameter of the nasal valve. Preoperative and postoperative (3 months) polysomnograms were obtained. Statistical analysis using the paired t‐test was used to determine significance.

Results:

Fifteen patients were included in this study. Average apnea‐hypopnea index (AHI) scores preoperatively were 24. Postoperative AHI scores averaged to 13, a reduction of 54% (P =. 04). Only 3 out of 15 patients showed no improvement.

Conclusions:

The comprehensive repair of the nasal valve including repair of the nasal sidewalls and septal L‐strut can significantly improve the severity of OSA for select patients. This is a fast and minimally invasive approach to consider in patients with OSA and nasal valve collapse.
Endotracheal Tube Displacement during Neck Extension in Thyroid Surgery
Authors: Sharma Sunil D. , Kumar Gaurav , Jovaisa Tomas , Kaddour Hesham
Published: September 2014

Objectives:

Evaluate how much the endotracheal tube moves on neck extension in patients undergoing elective thyroid surgery and whether this is affected by body mass index (BMI) or neck length.

Methods:

Prospective study of 20 patients undergoing thyroidectomy during a 4‐month period in 2013‐2014. Patient demographics, BMI, collar size, sterno‐mental distance, and sterno‐cricoid distance were recorded. The electromyography endotracheal tubes used in thyroid surgery were marked at 1 cm, and the distance was noted in the neutral and extended (30° as tolerated) neck positions.

Results:

The mean age of patients was 46.4 years (range 26‐68 years). There were 18 female and 2 male patients. The mean BMI was 28.2 (range, 20.1‐32.6) and mean sterno‐mental distance was 15.2 cm (range, 9.8‐20.4 cm). The mean upward displacement of the endotracheal tube during neck extension was 22.2 ± 7.6 mm. Patients with a larger BMI (>25) had a significantly smaller amount of tube displacement than patients with a smaller BMI (<25; 17.1 ± 7.3 mm vs 24.5 ± 8.1 mm, P =. 02) and patients with a smaller neck length (sterno‐mental <12 cm) had a significantly smaller amount of tube displacement than those with a larger neck length (sterno‐mental distance >12 cm; 18.2 ± 6.9 mm vs 24.6 ± 7.1 mm, P =. 04).

Conclusions:

Neck extension results in upward displacement of the endotracheal tube. The amount of displacement is significantly lower in patients with a larger BMI or shorter neck length, possibly due to the limitation of neck extension in these patients. This has particular relevance for thyroidectomy patients in whom accurate positioning of the tube is essential for nerve monitoring.
Factors Affecting the Likelihood of Undergoing Transoral Robotic Surgery for Head and Neck Cancer
Authors: Squires Lane D. , Steele Toby O. , Biron Vincent L. , Luu Quang K. , Farwell D. Gregory , Bewley Arnaud F.
Published: September 2014

Objectives:

Evaluate whether patient demographics and hospital characteristics are associated with a patient's likelihood of undergoing transoral robotic surgery (TORS) for head and neck cancer.

Methods:

A cross‐sectional analysis of 13,193 patients who were admitted to US hospitals in 2009 and 2011 with a primary diagnosis of head and neck cancer was performed using data from the Nationwide Inpatient Sample. A multinomial logistic regression model was used to calculate the likelihood of undergoing TORS based on age, sex, race, household income quartile, insurance status, hospital size, hospital region, and hospital teaching status.

Results:

A total of 181 patients underwent TORS for head and neck cancer in the years 2009 and 2011. With regard to demographic factors, Hispanic patients and those within the lowest 2 income quartiles were significantly less likely to undergo TORS when compared with white patients and those within the highest income quartile (odds ratio [ORs] 0.27 confidence interval [CI; 0.09‐0.80], 0.48 CI [0.29‐0.80], 0.54 CI [0.34‐0.87]). With regard to hospital characteristics, patients treated at hospitals in the northeast and south and those treated at nonteaching hospitals were significantly less likely to undergo TORS than those treated at hospitals in the west and those treated at teaching hospitals (ORs 0.48 CI [0.31‐0.73], 0.43 CI [0.28‐0.64], 0.27 [0.16‐0.44]). There were no significant differences found between patients of different age groups or patients treated at different sized hospitals.

Conclusions:

Racial, socioeconomic, and regional disparities exist in the availability of TORS to head and neck cancer patients.
Factors Influencing Sialocele or Salivary Fistula Formation Post‐parotidectomy
Authors: Britt Christopher J. , Stein Andrew P. , Hartig Gregory K.
Published: September 2014

Objectives:

Determine if the extent of parotidectomy or other patient or tumor characteristics influence the rate of sialocele or salivary fistula formation after parotidectomy.

Methods:

A retrospective chart review was performed for all patients who underwent parotidectomy at the University of Wisconsin from 1994 to 2013. Patients who developed a sialocele or salivary fistula at any time postoperatively were identified. Age, sex, area and size of defect, body mass index (BMI), and rate of malignancy were evaluated to assess any relationship to these complications.

Results:

A total of 771 patients underwent parotidectomy at our institution from 1994 to 2013. Of these, 75 (9.7%) developed a sialocele or salivary fistula. Sialoceles or salivary fistulas developed in 96% (72/75) within 1 month post‐parotidectomy, and none developed after 6 months. Age, sex, BMI, and histology were not associated with sialocele or salivary fistula formation. Extent of parotidectomy was quantified through assessment of surgical volume of tissue removed. The average volume of tissue removed was 37.8 cubic centimeters (cc) (range 0.2‐277 cc; 95% confidence interval [28.4 cc, 47.2 cc]). Sixty‐four patients (85.3%) underwent superficial parotidectomy, 7 (9.3%) underwent total parotidectomy, and extent of surgery was not documented in 4 patients (5.3%). 2 patients (2.7%) underwent revision surgery. Of patients who underwent superficial parotidectomy, 28 (43.8%) were complete superficial parotidectomy and 23 (35.9%) were partial inferior superficial parotidectomy.

Conclusions:

Sialocele is an uncommon complication post‐parotidectomy. Contrary to other studies, we observed that sialocele formation does not depend on amount of parotid tissue removed, site of parotidectomy, gender, age, BMI, or rate of malignancy.
Fluorescently Labeled Peptide Highlights Degenerated Facial Nerve Branches during Surgery
Authors: Hussain Timon , Mastrodimos Melina , Raju Sharat C. , Glasgow Heather L. , Whitney Michael , Nguyen Quyen T.
Published: September 2014

Objectives:

Nerve degeneration after transection decreases intraoperative visibility under white light (WL), complicating repair and increasing the risk of additional injury to surrounding tissue. We previously described F‐NP41, a fluorescently‐labeled peptide which highlights peripheral nerves following systemic injection. In this study, we analyzed whether F‐NP41 highlights degenerated nerves and evaluated the use of additional fluorescence guidance in delayed facial nerve repair procedures.

Methods:

Degenerated distal facial nerve branches were imaged under WL and with fluorescence after systemic F‐NP41 application 1, 2, 3, 6, and 9 months (n = 4 per time point) after main branch transection. Nerve to non‐nerve tissue contrast was compared. Facial nerve repair surgeries with a cable graft were performed 6 weeks after transection, using WL alone (n = 9) or additional fluorescence guidance (n = 10). Time to nerve identification and total operating time were measured; postoperative functional recovery was assessed weekly by quantitative measurement of whisker movement for 6 weeks.

Results:

Nerve to non‐nerve tissue contrast was increased >2‐fold using fluorescence imaging versus WL at all time points (P <. 001). Fluorescence guidance decreased time to intraoperative nerve stump identification by 39% (P <. 0001). Postoperative functional recovery was similar for both groups after 6 weeks, although the rate of recovery tended to be increased after surgery with fluorescence guidance.

Conclusions:

F‐NP41 significantly improves intraoperative visualization of degenerated nerves in mice up to nine months following injury compared with WL alone. The use of F‐NP41 decreases intraoperative time to nerve identification by nearly 40%, thus reducing operating time and potentially improving functional recovery.
Endonasal Septal Perforation Repair Using an Interpositional Porcine Dermal Collagen Implant
Authors: Amin Nikul , Syed Irfan , Hunter Benjamin , Roberts David N.
Published: September 2014

Objectives:

Describe our novel minimally invasive technique for closure of nasal septal perforations.

Methods:

We describe our experience in a series of patients from 2 London teaching hospitals treated using the same surgical technique. Closure of the defect was undertaken using one inferiorly based nasal floor mucosal flap and a contra‐lateral superiorly based vascularized septal mucosal flap. This was achieved by a closed endonasal approach with a porcine dermal collagen sheet interpositional graft (Permacol) placed on the more concave side of the perforation. The mucosal flaps are used to cover the repair and sutured in place.

Results:

Septal perforations of up to 2‐cm diameter were successfully repaired in greater than 90% of cases over a 36‐month follow‐up period.

Conclusions:

Our novel technique has proved effective in closure of septal perforations. Permacol is a durable graft, utilizing acellular cross‐linked collagen matrix, used commonly in abdominal hernia repair. We found Permacol to be a biocompatible graft with the ability to resist dessication if there is slow re‐epithelization or partial exposure, making it a robust and easy to use interpositional graft with no morbidity from graft harvesting. The use of local intranasal mucosal advancement flaps allows a minimally invasive approach without any external incisions or scars. Potential limitations are the size of the pedicled flaps for very large perforations, or the lengths of the flaps for very anterior defects. For the majority of septal perforations the authors feel this technique offers an effective minimally invasive option with low morbidity.
Free Flap Outcomes in Previously Irradiated Patients: A Meta‐analysis
Authors: Kennedy Aimee , Watson Sydeaka , Langerman Alexander
Published: September 2014

Objectives:

(1) Understand the types of complications affecting head and neck free flap reconstructions. (2) Compare the incidence of flap complications between patients with and without prior irradiation.

Methods:

Systematic review and meta‐analysis of all studies of head and neck free flap reconstructions between January 1993 and October 2013. Studies that included separate data for patients with and without prior irradiation were analyzed for differences in demographics, flap type, and complications using Poisson regression and odds ratios.

Results:

Fourteen studies encompassing 701 free flaps in irradiated patients and 328 free flaps in nonirradiated patients were included. The 2 groups were comparable in age (P =. 45), sex (P =. 45), and types of reconstructions. Postoperative complications such as complete flap failure (incidence rate ratio [95% confidence interval] 1.10 [0.59‐2.05]; P =. 74), fistula (1.93 [0.23‐16.19]; P =. 24), dehiscence (1.45 [0.70‐2.97]; P =. 15), infection (1.43 [0.37‐5.34]; P =. 46), vascular thrombosis (2.24 [0.20‐24.46]; P =. 27), hematoma (1.98 [0.312‐12.57]; P =. 27), partial flap loss (2.38 [0.334‐17.02]; P =. 18), and other complications including vascular compromise and hardware/bone exposure (1.33 [0.63‐2.78]; P =. 41) were not statistically different between the 2 groups. However, previously irradiated patients demonstrated a higher overall complication rate (46.3% vs 30.5%; 1.57 [1.02‐2.41]; P =. 001) when all complications were considered together.

Conclusions:

Head and neck free flap reconstruction in irradiated patients carries an increased risk of complications. The largest effect sizes were seen in risk of fistula, vascular thrombosis, hematoma, and partial flap loss, although these did not individually reach statistical significance. However, overall flap survival was similar in patients with and without radiation.
Towards gene therapy for EBV-associated posttransplant lymphoma with genetically modified EBV-specific cytotoxic T cells
Authors: Ricciardelli Ida , Blundell Michael Patrick , Brewin Jennifer , Thrasher Adrian , Pule Martin , Amrolia Persis J.
Published: September 2014

Key Points

EBV-CTLs resistant to calcineurin inhibitors mediate durable, potent antitumor responses despite immunosuppression in a murine model of PTLD. This approach improves immunotherapy efficacy with EBV-CTLs for PTLD after SOT and obviates need for immunosuppression withdrawal.
Impact of acute and chronic graft-versus-host disease on human B-cell generation and replication
Authors: Glauzy Salomé , Soret Juliette , Fournier Isabelle , Douay Corinne , Moins-Teisserenc Hélène , Peffault de Latour Régis , Maki Guitta , Robin Marie , Socié Gérard , Toubert Antoine , Clave Emmanuel
Published: September 2014

Key Points

B-cell neogenesis is decreased independently by both aGVHD and cGVHD. B cells during GVHD undergo a higher number of cell divisions related, in the chronic form, to a higher BAFF/CD19 ratio.
Multi-objective multi-item solid transportation problem with fuzzy inequality constraints
Authors: Chakraborty Dipankar , Jana Dipak Kumar , Roy Tapan Kumar
Published: September 2014

Zimmermann (Int. J. Gen. Syst. 2:209-215, 1976) first introduced the concept of fuzzy inequality in the field of linear programming problem (LPP). But this concept is hardly used in any real life applications of LPP. So, in this paper, a multi-objective multi-item solid transportation problem (MMSTP) with fuzzy inequality constraints is modeled. Representing different preferences of the decision maker for transportation, three different types of models are formulated and analyzed. Fuzzy inequality solid transportation problem is converted to parameter solid transportation problem by an appropriate choice of flexible index, and then the crisp solid transportation problem is solved by the algorithm (Cao in Optimal Models and Methods with Fuzzy Quantities, 2010) for decision values. Fuzzy interactive satisfied method (FISM), global criterion method (GCM) and convex combination method (CCM) are applied to derive optimal compromise solutions for MMSTP by using MatLab and Lingo-11.0. The models are illustrated with numerical examples and some sensitivity analysis is also presented.
Most women diagnosed with cervical cancer by a visual screening program in Tanzania completed treatment: evidence from a retrospective cohort study
Authors: Gard Andrew C , Soliman Amr S , Ngoma Twalib , Mwaiselage Julius , Kahesa Crispin , Chamberlain Robert M , Harlow Siobán D
Published: September 2014

Background

Visual inspection with acetic acid (VIA) to identify and treat pre-cancerous lesions is effective for cervical cancer prevention. Screening programs also facilitate screening and diagnosis of invasive cancers that must be referred for radiation therapy or chemotherapy. This study compared characteristics of women diagnosed with invasive cervical cancer by a VIA screening program who did and did not follow up for treatment and who did and did not complete treatment at the Ocean Road Cancer Institute (ORCI), Dar es Salaam, Tanzania.

Methods

We conducted a retrospective cohort study of ORCI screening referrals from the period November 2002 to June 2011. Women referred for treatment of invasive disease (n = 980) were identified from an existing database of all women attending the screening clinic during this period (n = 20,131) and matched to a dataset of all cervical cancer patients attending ORCI in this period (n = 8,240). Treatment information was abstracted from patient records of women who followed up. Records of a random sample (n = 333) of unscreened patients were reviewed for disease stage.

Results

Of the 980 women referred women, 829 (84.6%) sought treatment. Most of those women (82.8%) completed their prescribed radiation. Lower disease stage, having a skilled occupation, residence in Dar es Salaam, and younger age were independently associated with loss to follow-up. Higher disease stage, residence in Dar es Salaam, older age, and later year of first treatment appointment were independently associated with incomplete treatment among those who followed up. Significantly more screened women had stage 1 disease (14.0%) than unscreened women (7.8%).

Conclusions

Most women referred from the screening clinic completed treatment for their cancer at ORCI. Some of those lost to follow-up may have sought treatment elsewhere. In most cases, the screening clinic appears to facilitate diagnosis and treatment, rather than screening, for women with invasive cervical cancer.
Prediction of trapezius muscle activity and shoulder, head, neck, and torso postures during computer use: results of a field study
Authors: Bruno Garza Jennifer L , Eijckelhof Belinda HW , Huysmans Maaike A , Johnson Peter W , van Dieen Jaap H , Catalano Paul J , Katz Jeffrey N , van der Beek Allard J , Dennerlein Jack T
Published: September 2014

Background

Due to difficulties in performing direct measurements as an exposure assessment technique, evidence supporting an association between physical exposures such as neck and shoulder muscle activities and postures and musculoskeletal disorders during computer use is limited. Alternative exposure assessment techniques are needed.

Methods

We predicted the median and range of amplitude (90th-10thpercentiles) of trapezius muscle activity and the median and range of motion (90th-10thpercentiles) of shoulder, head, neck, and torso postures based on two sets of parameters: the distribution of keyboard/mouse/idle activities only (“task-based” predictions), and a comprehensive set of task, questionnaire, workstation, and anthropometric parameters (“expanded model” predictions). We compared the task-based and expanded model predictions based on R2values, root mean squared (RMS) errors, and relative RMS errors calculated compared to direct measurements.

Results

The expanded model predictions of the median and range of amplitude of trapezius muscle activity had consistently better R2values (range 0.40-0.55 compared to 0.00-0.06), RMS errors (range 2-3%MVC compared to 3-4%MVC), and relative RMS errors (range 10-14%MVC compared to 16-19%MVC) than the task-based predictions. The expanded model predictions of the median and range of amplitude of postures also had consistently better R2values (range 0.22-0.58 compared to 0.00-0.35), RMS errors (range 2–14 degrees compared to 3–22 degrees), and relative RMS errors (range 9–21 degrees compared to 13–42 degrees) than the task-based predictions.

Conclusions

The variation in physical exposures across users performing the same task is large, especially in comparison to the variation across tasks. Thus, expanded model predictions of physical exposures during computer use should be used rather than task-based predictions to improve exposure assessment for future epidemiological studies. Clinically, this finding also indicates that computer users will have differences in their physical exposures even when performing the same tasks.
The effect of two novel amino acid-coated magnetic nanoparticles on survival in vascular endothelial cells, bone marrow stromal cells, and macrophages
Authors: Wu Qinghua , Meng Ning , Zhang Yanru , Han Lei , Su Le , Zhao Jing , Zhang Shangli , Zhang Yun , Zhao Baoxiang , Miao Junying
Published: September 2014

Magnetic nanoparticles (MNPs) have been popularly used in many fields. Recently, many kinds of MNPs are modified as new absorbents, which have attracted considerable attention and are promising to be applied in waste water. In our previous study, we synthesized two novel MNPs surface-coated with glycine or lysine, which could efficiently remove many anionic and cationic dyes under severe conditions. It should be considered that MNP residues in water may exert some side effects on human health. In the present study, we evaluated the potential nanotoxicity of MNPs in human endothelial cells, macrophages, and rat bone marrow stromal cells. The results showed that the two kinds of nanoparticles were consistently absorbed into the cell cytoplasm. The concentration of MNPs@Gly that could distinctly decrease survival was 15 μg/ml in human umbilical vascular endothelial cells (HUVECs) or bone marrow stromal cells (BMSCs) and 10 μg/ml in macrophages. While the concentration of MNPs@Lys that obviously reduced viability was 15 μg/ml in HUVECs or macrophages and 50 μg/ml in BMSCs. Furthermore, cell nucleus staining and cell integrity assay indicated that the nanoparticles induced cell apoptosis, but not necrosis even at a high concentration. Altogether, these data suggest that the amino acid-coated magnetic nanoparticles exert relatively high cytotoxicity. By contrast, lysine-coated magnetic nanoparticles are more secure than glycine-coated magnetic nanoparticles.
Transmission mode switching for device-to-device communication aided by relay node
Authors: Ni Yiyang , Qiao Dan , Li Xiao , Jin Shi , Zhu Hongbo
Published: September 2014

In this paper, we investigate the strategy of transmission mode switching for device-to-device (D2D) communication in both single-cell scenario and multi-cell scenarios, which selects the transmission mode to guarantee the maximum ergodic achievable sum-rate among three transmission modes. We first introduce the basic operation principles of three communication transmission modes which are named as traditional cellular communication mode, direct D2D communication mode and two-way decode-and-forward (DF)-relayed D2D communication mode. Then we derive the corresponding expressions for the ergodic achievable sum-rates of each transmission mode, and get the crossing points of different transmission modes to attain maximum ergodic achievable sum-rate of the system. From the analytical results, we can see that the proper operating region of each transmission mode is related to different interference level and distance of the D2D users. Based on the analytical results, we obtain a reliable communication transmission mode switching strategy which guarantees the system to choose the mode with the maximum ergodic achievable sum-rate so as to improve the performance of D2D communication. Numerical results demonstrate that by applying mode switching, the ergodic achievable sum-rate of the system achieves a remarkable enhancement.
Enzymatic and acid conversion of new starches from improved orphan crops: prospects for renewable materials uses in food and non-food industries
Authors: Doué Ginette , Bédikou Micaël , Koua Gisèle , Mégnanou Rose-Monde , Niamké Sébastien
Published: September 2014

The enzymatic and acid hydrolysis have converted eight new starches into a range of chain lengths mainly including glucose, maltose, and maltodextrins as observed on TLC plates, irrespective to the starch variety and treatment. Results of the enzymatic hydrolysis have highlighted the possibility of the use of V4 and V64, which can be labelled as “dietary fibres”, to enhance the organoleptic qualities of foods and for fibre fortification of low-calorie products. Concerning V66 and V69, they have much relevant in food, textile and pharmaceutical applications. The acid hydrolysis showed that V73 is the best starch in the chemical industry for making environment-friendly products such as plastics. Because starch is a natural component that degrade quickly in normal composting condition, the whole studied starches could be advised for various utilizations in the food, textile, paper, biofuel, pharmaceutical and plastic industries for sustainable development.
Co-production of bioethanol and probiotic yeast biomass from agricultural feedstock: application of the rural biorefinery concept
Authors: Hull Claire M , Loveridge E Joel , Donnison Iain S , Kelly Diane E , Kelly Steven L
Published: August 2014

Microbial biotechnology and biotransformations promise to diversify the scope of the biorefinery approach for the production of high-value products and biofuels from industrial, rural and municipal waste feedstocks. In addition to bio-based chemicals and metabolites, microbial biomass itself constitutes an obvious but overlooked by-product of existing biofermentation systems which warrants fuller attention. The probiotic yeast Saccharomyces boulardii is used to treat gastrointestinal disorders and marketed as a human health supplement. Despite its relatedness to S. cerevisiae that is employed widely in biotechnology, food and biofuel industries, the alternative applications of S. boulardii are not well studied. Using a biorefinery approach, we compared the bioethanol and biomass yields attainable from agriculturally-sourced grass juice using probiotic S. boulardii (strain MYA-769) and a commercial S. cerevisiae brewing strain (Turbo yeast). Maximum product yields for MYA-769 (39.18 [±2.42] mg ethanol mL−1 and 4.96 [±0.15] g dry weight L−1) compared closely to those of Turbo (37.43 [±1.99] mg mL−1 and 4.78 [±0.10] g L−1, respectively). Co-production, marketing and/or on-site utilisation of probiotic yeast biomass as a direct-fed microbial to improve livestock health represents a novel and viable prospect for rural biorefineries. Given emergent evidence to suggest that dietary yeast supplementations might also mitigate ruminant enteric methane emissions, the administration of probiotic yeast biomass could also offer an economically feasible way of reducing atmospheric CH4.
Discussing the deactivation of ICDs
Authors: Tagney Jenny
Published: September 2014

I am writing in response to Nicola Meldrum's (2007) excellent article in the May issue, exploring some of the many issues surrounding the deactivation of the shock component of implantable cardioverter defi brillators (ICDs) at the end of life. She quite rightly identifies that health professionals are poor at raising the subject with patients and that little is known about the subject in terms of research exploring patient preferences or health professionals' knowledge and confi dence in discussing such matters. If we relate their knowledge and confi dence in this area to that of discussing ICDs in general, a UK-based survey suggested that this was really quite poor (Tagney, 2004).
Silent at Heart: Using art to raise awareness
Authors: Nelson Sara , Lomba Mauricio
Published: September 2014

The 4th September marks the opening of an exhibition which aims to raise awareness of cardiac risk in the young. It includes artwork from professional artists as well as a number of talented A-level students. Sara Nelson and Mauricio Lomba tell us all about it.
Preventing contrast-induced nephropathy part 1: What is CIN?
Authors: O'Donovan Kate
Published: September 2014

Contrast agents are widely used in cardiology as part of diagnostic and interventional procedures such as angiography and percutaneous coronary intervention. Despite their usefulness, these contrast agents are also known to be nephrotoxic, and damage to the kidneys can occur as a result of their use.

Although the precise pathophysiology of contrast-induced nephropathy (CIN) remains unclear several risk factors have been identified that increase the likelihood of a patient developing it. This article, the first of two parts, outlines the general consensus on what puts a patient at risk of developing CIN.
ECG of the month
Authors: Regan Claire
Published: September 2014

Clare Regain presents an ECG for you to analyse. The answer is given on page 599
Research dissemination and knowledge translation
Authors: Flynn Maria , Quinn John
Published: September 2014

In the last part of a series on practical aspects of research, Maria Flynn and John Quinn outline the principles of research dissemination and knowledge translation and discuss some practical issues cardiac nurses will need to consider when planning their research dissemination strategies
District nurses and home carers 3: project evaluation
Authors: Redworth Fiona , Atkin Jackie , Jones-Tatum Lisa
Published: September 2014

This article, the last in a series of three, discusses the evaluation of a project established to provide a programme of education for social ser vices' home carers that focused on the development of skills relating to care work. This education was delivered by district nurses (DNs) to address a number of problems associated with the provision of personal care identified by the home carers and their DN colleagues. An action research framework was used to improve collaborative working between the staff of the two disciplines. The article outlines some of the key findings from the evaluation of the project in relation to the structure, the process and the outcome of the project. The project evaluation was mainly positive and this success can be partly attributed to the fact that an action research method was used to drive the project.
Urinary sheaths: assessment, prescription and evaluation
Authors: Doherty Willie
Published: September 2014

Urinary sheaths are a common solution to male urinary incontinence, but can be a source of much anxiety and discomfort if incorrectly fitted. This article discusses the process of assessment that must precede the prescription of a urinary sheath system. Assessment of bladder function and correct fitting and sizing are essential. The article also discusses the range of urinary sheath systems available, some of the problems that may arise in their use, and the processes of evaluation that should accompany use.
Recognising and managing atrial fibrillation in the community
Authors: Lee Geraldine , Campbell-Cole Carolyn
Published: September 2014

Atrial fibrillation (AF) is the most common cardiac arrhythmia and has greater prevalence in the increasing ageing population, with an estimated 10% of those over 80 years having AF. Symptoms associated with AF include palpitations, dizziness, shortness of breath and fatigue. Those presenting with these symptoms need to be investigated and the appropriate treatment should be initiated if AF is detected. For those with AF, there is a significant risk of stroke if patients are not adequately anti-coagulated. This article outlines methods for detecting AF in the community and provides an overview of current treatment options, including the newer anti-coagulant agents. The importance of assessing stroke risk and conveying this risk to those with AF is essential. Community health professionals play an important role in monitoring, treating and managing AF within the community setting and supporting and educating the patient in minimising the risk of serious thromboembolic complications such as stroke.
Caring for a patient with a short-term urinary catheter
Authors: Upton Caroline
Published: September 2014

February 2007 saw the publication by the Department of Health of the final guidelines on the best available evidence for the care of indwelling urinary catheters (Pratt et al, 2007). Since then, there has been a flurry of documents published by national organizations relating to this aspect of hospital care. With up to a quarter of all hospital-acquired infections occurring in patients with urinary catheters, this article outlines the key recommendations that will enable healthcare assistants to provide the highest standards of care for any patient who requires a catheter as part of their acute treatment during their hospital stay.