bluuebunny/crossref_metadata_2025 huggingface dataset:
SLAM-inspired simultaneous localization of UAV and RF sources with unknown transmitted power
Authors: Dehghan Seyyed M. Mehdi , Moradi Hadi
Published: February 2015

In the unmanned aerial vehicle (UAV) based localization of slow-moving radio frequency (RF) sources with unknown transmitted strength of signal, such as a person with a cell phone in a search and rescue mission, the UAV navigation errors are significant sources of localization error. Although the use of a global positioning system (GPS) can reduce the UAV’s localization error significantly resulting in more accurate RF source localization, if the GPS signal is lost temporarily or permanently, the accuracy of the UAV-based localization decreases rapidly. In this paper, a simultaneous localization and mapping (SLAM)-inspired approach for simultaneous localization of UAV and RF sources (SLUS) is proposed. The proposed approach solves these two connected problems, i.e. the UAV localization and RF source localization, simultaneously to decrease the error of the UAV position estimation and the error of the RF source localization. In the proposed approach, beside the UAV position prediction, the RF source position prediction is also performed. Then the predicted states are augmented and the augmented predicted state information is corrected using range-ratio and bearing observations, i.e. RF source features, considering the unknown transmitted power. The proposed approach is simulated and the results show that the normal divergence of a target localization and the divergence of the UAV navigation in latitude and longitude channels have been eliminated using this approach. In other words, simultaneous localization of the UAV and RF sources uses the RF sources, as features in the environment, to aid the navigation system. Although the approach is similar to the mapping of RF sources in the environment, the created map would be useless after finding the RF sources. That is why SLUS has been used instead of SLAM. The main contributions of this work are: 1) performing simultaneous localization of a UAV and targets using RF signals, especially in a non-line of sight (NLOS) condition; 2) using difference of signal strength, i.e. differential received strength signal indicator (DRSSI), to eliminate the impact of unknown target signal power; and 3) simultaneous multi-target localization and tracking.
Finite-time attitude control for flexible spacecraft with unknown bounded disturbance
Authors: Zhong Chenxing , Guo Yu , Yu Zhen , Wang Lu , Chen Qingwei
Published: February 2015

This paper studies finite-time attitude control for a flexible spacecraft with unknown bounded disturbances. Aiming at reducing vibrations excited by attitude manoeuvring, we develop a new manoeuvre path by combining path planning with the input shaping technique. Also, based on terminal sliding mode and the exponential reaching law, we propose a modified fast non-singular finite-time control law, which can achieve rapid finite-time convergence in the reaching phase as well as in the sliding phase. Furthermore, we design a weighted homogeneous extended state observer to estimate and thus to attenuate the unknown bounded disturbances in finite time. Finite-time stability of the overall system is analysed via Lyapunov technique, and simulation results demonstrate the effectiveness and robustness of the proposed control scheme.
A Power Formula for the Mantel–Haenszel Test for Differential Item Functioning
Authors: Li Zhushan
Published: February 2015

The asymptotic power of the Mantel–Haenszel (MH) test for the differential item function (DIF) is derived. The formula describes the behavior of the power when the number of items is large, so that the measured latent trait can be considered as the matching variable in the MH test. As shown in the derived formula, the power is related to the sample size, effect size of DIF, the item response function (IRF), and the distribution of the latent trait in the reference and the focal groups. The formula provides an approximation of the power of the MH test in practice and thus provides a guideline for DIF detection in practice. It also suggests analytical explanations of the behavior of the MH test as observed in many previous simulation studies. Based on the formula, this study shows how to conduct the sample size calculation. The power of MH test under some practical models such as the two-parameter logistic (2PL) and three-parameter logistic (3PL) item response theory (IRT) models is discussed.
Revised Questionnaire to Assess Barriers to Adequate Nutrition in the Critically Ill
Authors: Cahill Naomi E. , Jiang Xuran , Heyland Daren K.
Published: February 2015

Background: The objective of this study was to revise and improve a questionnaire to assess barriers to providing adequate enteral nutrition (EN) in critically ill adults. Methods: Changes were made to the questionnaire based on feedback from previous respondents. The revised questionnaire, including 20 potential barriers, was pilot tested in 3 hospitals in North America. Nurses were asked to rate each item based on the degree to which it hinders the provision of EN in their intensive care unit (ICU). The acceptability of the revised questionnaire was evaluated using 5 open‐ended questions appended at the end of the questionnaire. Results: A total of 81 nurses completed the revised barriers questionnaire. A total of 72 of 73 (99%) respondents felt that the questionnaire was easy to understand, and 64 of 73 (88%) felt that the individual questions were clear. On average, respondents rated the degree to which potential barriers hindered the delivery of EN to the patient as “very little” or “a little.” Statistically significantly differences in mean responses were observed across the 3 ICUs for 8 of the 20 items. The indices of internal reliability were assessed to be acceptable. Conclusions: The revised questionnaire to assess barriers to EN seems acceptable and clinically sensible and now appears to comprehensively list all possible modifiable barriers to delivering EN. This questionnaire needs further study to determine whether measuring barriers with this questionnaire can translate into improved EN delivery to critically ill patients.
Is the Chronic Care Model Integrated Into Research Examining Culturally Competent Interventions for Ethnically Diverse Adults With Type 2 Diabetes Mellitus? A Review
Authors: Dauvrin Marie , Lorant Vincent , d’Hoore William
Published: February 2015

The chronic care model (CCM) concerns both the medical and the cultural and linguistic needs of patients through the inclusion of cultural competence in the delivery system design. This literature review attempted to@@ identify the domains of the CCM culturally competent (CC) interventions that the adults from ethnic minorities suffering from type 2 diabetes mellitus report. We identified the CCM and the CC components in the relevant studies published between 2005 and 2014. Thirty-two studies were included. Thirty-one articles focused on self-management and 20 on community resources. Twenty-three interventions integrated cultural norms from the patients’ backgrounds. CC interventions reported the CCM at the individual level but need to address the organizational level more effectively. The scope of CC interventions should be expanded to transform health care organizations and systems.
Secondary Data Analysis as an Efficient and Effective Approach to Nursing Research
Authors: Dunn Susan L. , Arslanian-Engoren Cynthia , DeKoekkoek Tracy , Jadack Rosemary , Scott Linda D.
Published: February 2015

Meeting the expectation for scholarly productivity can be challenging for nursing faculty, especially in the absence of grant or other funding. Secondary data analysis is one strategy to address this challenge. The use of existing data to test new hypotheses or answer new research questions has several advantages. It typically takes less time and resources, is low risk to participants, and allows access to large data sets and longitudinal data. Despite these advantages, limitations do exist, including a lack of knowledge of the existence of rich data sets and how to obtain and evaluate the contents, insufficient or outdated data, and lack of funds to hire staff to assist with the work. Exemplars of secondary data analysis using public government and private data sets are presented along with the skills needed to conduct this type of analysis. Secondary data analysis is an efficient and effective approach to conducting nursing research.
Flexible OGD for Symptomatic Laryngopharyngeal Reflux?
Authors: Narayan Jeena , Mitchell‐Innes Alistair , Rockey Jason
Published: February 2015

Objective

1) To evaluate the flexible oesophagogastroduodenoscopy (FOGD) service offered by an ENT department in a university teaching hospital. 2) To determine whether FOGD has significant benefit in patients with LPR. 3) Is TNE (transnasal esophagoscopy) an alternative in this group of patients?

Method

Study designed as service evaluation of esophagogastroduodenoscopy performed by the otolaryngologist. Retrospective data were collected from the endoscopy and ENT departments over 2½ years. Included were esophagogastroduodenoscopy performed by an otolaryngologist for laryngopharyngeal reflux. Patients were on proton pump inhibitors (PPI), and some had speech therapy.

Results

Data will be analyzed with regard to presenting symptoms, endoscopy findings, management, and follow‐up. Outcomes were measured in terms of how many underwent the full procedure as defined by the JAG (Joint Advisory Group) guidelines; accuracy of records; and whether endoscopy findings guided treatment. Was symptom control achieved, and were other treatments required? Outcomes were compared with the literature. The majority of patients benefited in terms of symptom control from initial medical treatment. About 30% required further investigations and/or treatment. The local cost‐benefit of flexible esophagogastroduodenoscopy and the possibility of transnasal esophagoscopy as an alternative service are discussed.

Conclusion

This project will provide further insight into the flexible esophagogastroduodenoscopy service provided by the ENT team. It is anticipated that recommendations will be beneficial to stakeholders in improving the service to patients, and areas for future research will be identified.
New Healthcare Model: Citywide Care Management
Authors: Duncan Beth R.
Published: February 2015

Objective

Patient‐centered healthcare and its components of human interaction in an era of accountable healthcare and healthcare reform enables proactive preventive healthcare, saves millions in public funds, and decreases unnecessary emergency room (ER) visits; it comports with 2010 Accountable Care Act (ACA) mandates to establish patient‐centered medical homes (PCMH) and accountable care organizations (ACO) which limit diagnostic testing and some treatments and hold physicians accountable for care outcomes.

Method

The Camden Healthcare Coalition (CHCC) analyzed patient usage of ER resources and applied this to set up cost‐effective PCMHs and ACOs. Electronic medical record (EMR) data were shared with Camden hospitals and a profile of “super‐utilizers” was developed: 20% of patients generated 90% of costs; the top 1% of super‐utilizers made between 24 and 324 emergency room visits/five years; one patient was hospitalized 113 times in one year; 30 patients accounted for one‐third of Camden’s medical costs; and nearly $375 million in uncompensated care was provided.

Results

With a modest grant and state legislation, CHCC developed a PCMH without walls for super‐utilizers: Teaching and treatment teams led by nurse practitioners visited patients in shelters and on streets. There were 40% fewer monthly ER visits, 56% less charges; reimbursements increased 50% because of enrollment of super‐utilizers in insurance programs.

Conclusion

The CHCC model for proactive care for super‐utilizers provided better care—not withdrawal of care. Other cities could effectively share data and utilize the teams approach to healthcare management for super‐utilizers and other patient groups. Our model is now being considered nationally.
Failure in Oral or Oropharyngeal Cancer with Single‐Node Metastasis
Authors: Koh Yoon Woo , Lee Hyoung Shin , Kim Won Shik , Hong HyunJun , Lee So‐Yoon , Chung Hyun Pil , Choi Eun Chang
Published: February 2015

Objective

1) Analyze the oncologic results and related clinicopathologic factors of patients with oral and oropharyngeal squamous cell carcinoma (OOSCC) who presented as clinically single lymph node metastasis, nd underwent surgery. 2) To find out a rationale for optimal management in these selected cases.

Method

Study design: Retrospective. Year study conducted: 10 years. Disease studied: Oral or oral cavity carcinoma with clinically single lymph node metastasis. Subjects: 54 patients. Setting: Tertiary center. Outcome measurement: Patterns of treatment failure, related clinicopathologic factors.

Results

There was no metastasis in level V as clinical presentation, and only 1 case showed occult metastasis. Among the 15 cases (28%) of treatment failure, recurrence of lymph node metastasis was identified in only 1 case (1.9%). The most common cause of treatment failure or death was distant metastasis, which occurred in 10 patients (18.5%). Clinical (P =. 005) and pathologic (P =. 003) T stage were risk factors for the distant metastasis.

Conclusion

Nodal recurrence was rare, and distant metastasis was the main cause of failure and death with OOPSCC with single lymph node metastasis. While there is feasibility to save level V in these cases, distant metastasis should be considered in adjuvant therapy and follow up for patients with advanced T stage.
FAMM FLAP in Head and Neck Surgery
Authors: Gobel Yves , Valette Gerald , Abgral Ronan , Rousset Jean , Potard Gael , Marianowski Remi
Published: February 2015

Objective

Facial artery mucosa musclar (FAMM) flap is mainly used in head and neck oncologic surgery for primary reconstruction after resection in oral cavity and in surgical treatment of osteoradionecrosis of the mandible. Some benefits are ease of use, good vitality, and no aesthetic prejudice. Recently, robotic surgery has made removal of the flap inside the mouth cavity easier, thanks to a wider field of view and smaller surgical instruments.

Method

Retrospective study. Forty cases were analyzed in ENT and head and neck center of Brest University Hospital, between April 2007 and June 2011, in both indications primary reconstruction and surgical treatment of osteoradionecrosis. Complications such as infection, hematoma, necrosis, time within pedicle weaning, and resumption of feeding were studied.

Results

Eighteen cases for primary reconstruction and 22 cases for surgical treatment of osteoradionecrosis were analyzed. After radiotherapy, pedicle weaning was delayed (average of 11 more days) and enteral nutrition period lasted longer (average of 22 days vs 7 days). However, no infection and only 1 case of hematoma (2.5%) and 2 cases of necrosis (5%) were identified. Revision surgery for flap removal was necessary in 1 case (2.5%). After 1 month, oral feeding was possible in 35 cases (85%). Eighty percent of bad results occurred after radiotherapy.

Conclusion

Thanks to its reliability, the FAMM flap is a good solution in head and neck cancer surgery, even after radiotherapy. However, the size of this flap remains relatively small. For a medium size loss of substance, it is a good alternative between controlled wound healing and bigger flaps.
How Can Physicians Identify Dysphagia in Patients with Head and Neck Cancer?
Authors: Krisciunas Gintas P. , Langmore Susan E.
Published: February 2015

Objective

The investigators sought to determine the most sensitive indicator for identifying a swallowing problem in patients with HNC who are treated with radiotherapy—patient‐report of dysphagia or diet level consumed.

Method

Data were taken from 113 HNC patients. Prevalence of dysphagia was determined by patient report and diet level, then broken out by gender and age. A web‐based survey of clinical practice included 759 SLPs who work with HNC patients. Referral patterns and time of first intervention were queried.

Results

Over the first year, prevalence of dysphagia was 8% to 20% higher (worse) by diet restriction than by report of a swallowing problem. Men reported a worse swallowing problem and more diet restrictions than did women (P =. 057). Patients younger than 60 years reported worse diet levels and diet restrictions than did older patients (ns). The survey found that 70.6% of SLPs reported no institutional policy, with referrals made on a case by case basis. The prevalent trend (nearly 50%) was for patients to be referred only when a dysphagia presented.

Conclusion

Since most MDs do not refer to SLPs for dysphagia unless the patient reports a problem, it is critical to query the patient carefully. Patients tend to underreport a problem compared to diet level, thus physicians should ask specifically about diet in order to maximize sensitivity. A standardized diet scale is recommended.
Laryngeal Laser Resections with Frozen Section
Authors: Zahoor Tosief , Dawson Rebecca , Makura Zvorufura G. G.
Published: February 2015

Objective

To demonstrate that laryngeal laser resections can be done as day case procedures and the use of frozen section histology negates the need for second look surgery that is recommended by the UK consensus report. Demonstrate patient preference for choice of treatment and comparable outcomes for voice with laser resections.

Method

A retrospective study of patients who underwent laser resection for T1 and T2 laryngeal carcinoma from December 2002 to September 2009 with prospective analysis of functional outcomes and disease‐free survival. Suitable patients presenting to the Leeds Head & Neck Cancer Unit were offered a choice between radiotherapy and laser resection.

Results

A total of 60 patients underwent the procedure with greater than 42% patients over the age of 70 years. Ninety percent of patients had intraoperative frozen sections, with concordant histology with final histology in 96%. Forty‐two percent of patients had a repeat procedure on average at 10 months of which 36% were recurrence. The number of repeat procedures reduced as our experience for threshold for second look improved with experience. Greater than 50% patients had a single overnight stay for reasons mainly related to geography; a third of patients went home the same day. Greater than 85% of patients had voice that was acceptable or better.

Conclusion

Laryngeal laser resection with frozen section is a valid technique for the treatment of T1 and T2 laryngeal cancer and offers many advantages over radiotherapy. We found that with good pathological support cure can be achieved in a single day case procedure and negates the need for routine second look surgery.
Laryngeal Organ Preservation Protocols: Are They Effective?
Authors: Peixoto Maria C. , Branquinho Francisco , Guimarães Arnaldo , Gonçalves Sara , Khouri Leila , Silva Regina
Published: February 2015

Objective

Understand the role of organ preservation protocol in locally advanced laryngeal carcinoma according to our experience and determine predictive factors.

Method

The study selected all patients treated between 2004 and 2009. During the study period, all patients began treatment with induction chemotherapy (3 cycles of cisplatin and 5‐fluoruracil in the majority of cases) followed by radiotherapy and concomitant or subsequent chemotherapy. The results were analyzed by clinical and image evaluation.

Results

The study included 40 patients, with mean age of 55 years (range, 38 to 72 years), mainly men. Smoke and alcohol were present in more than 50%, and 70.7% had no comorbidities. Hypopharynx was the most common place (65.8%). At the end of induction chemotherapy 34.2% of patients had an answer >80%. The overall survival is 59% at 3 years. The relapse rate was of 24.7% with an average of time of 8 months (4 to 56 months). No statistical differences were found between different groups of TMN staging system.

Conclusion

Different studies have shown that chemotherapy followed by radiotherapy is a valid alternative to surgery in locally advanced operable head and neck cancer, involving the larynx. Our study confirms these results. Local and cervical disease staging did not contribute as a predictive factor for survival or relapse.
Localized Amyloidosis of the Tongue: Mayo Clinic Experience
Authors: O’Reilly Ashley , Price Daniel , D’Souza Anita
Published: February 2015

Objective

1) Review Mayo Clinic Rochester experience of localized tongue amyloidosis from 1961 to 2011. 2) Evaluate the workup of patients with localized amyloidosis, particularly exclusion of systemic amyloidosis. 3) Understand treatment and outcomes for patients with localized tongue amyloidosis.

Method

We reviewed the medical records of patients presenting to the Mayo Clinic Rochester from 1963 to 2011 for evaluation of amyloidosis who were found to have localized tongue amyloidosis, with no systemic involvement. Patients were followed over time to assess for disease recurrence and progression to systemic amyloidosis.

Results

Between 1963 and 2011, 30 patients presented to the Mayo Clinic Rochester for evaluation of amyloidosis who underwent a tongue biopsy as part of the evaluation. Of these 30 patients, 2 were diagnosed with localized tongue amyloidosis with no systemic involvement. Both patients were treated with wide local excision of the lesion without complication. They have not had local recurrence and have not developed systemic amyloidosis.

Conclusion

Localized tongue amyloidosis remains an extremely rare finding, with only 5 other cases reported in the English literature. Thorough evaluation is required in order to exclude systemic involvement. Treatment involves wide local excision of the lesion. Patients are not at increased risk for recurrence or of developing systemic amyloidosis.
Low Vitamin D and Risk of Post‐thyroidectomy Hypocalcemia
Authors: Nhan Carol , Dolev Yalon , Mijovic Tamara , Rivera Juan A. , Mlynarek Alex M. , Kallai‐Sanfaçon Mary‐Ann , Payne Richard J.
Published: February 2015

Objective

1) Determine if low vitamin D reduces risk of post‐thyroidectomy hypocalcemia. 2) Verify if this is an independent effect.

Method

Retrospective study of 139 total thyroidectomy patients (October 2009‐October 2011) at a McGill University teaching hospital. Preoperative 25‐hydroxy‐vitamin D (25OHD), calcium, and PTH were measured. Patients were assessed for postoperative hypocalcemia. Low vitamin D (LVD) was defined as 25OHD ≤70 nmol/L (28 ng/mL) and optimal vitamin D (OVD) was defined as 25OHD >70 nmol/L (28 ng/mL).

Results

Hypocalcemia occurred in 3.2% (2 of 62) patients with LVD and 10.4% (8 of 77) patients with OVD (OR 0.2875, P =. 124). No patients with vitamin D deficiency (VDD), defined as 25OHD ≤35 nmol/L (14 ng/mL), developed hypocalcemia. Univariate analysis did not show age, sex, malignancy, presence of thyroiditis, number of preserved parathyroids, parathyroid autotransplantation, preoperative PTH, or preoperative calcium to be significantly predictive. Multivariate analysis confirmed no confounding factors in vitamin D analysis, but also did not show any independent risk factors. Fisher analysis comparing total versus completion thyroidectomy was marginally significant (P =. 064) for predicting hypocalcemia.

Conclusion

Transient hypocalcemia appears to occur less frequently in patients with VDD, however in our limited study we were unable to elucidate whether this was significant. Future study observing a larger population and excluding completion thyroidectomy patients may help to clarify whether VDD impacts risk for hypocalcemia.
Rhinoplasty in the Andean Patient
Authors: Villagra Eric J. , Perales Marcos‐Antonio Rodriguez
Published: February 2015

Objective

Rhinoplasty is one of the most frequently performed surgeries and sought after worldwide. There are different types of races, such as African, Mediterranean, Middle East, Asian, European, and Latin American. The standards of beauty have changed over time, and rhinologists should know the standard of beauty for each race. The Andean nose (part of Latin America) requires intense work; osteocartilaginous humps are generally rather prominent; the skin tends to be at the thick nasal tip and lower lateral cartilages with little or no basal medium, which requires in most cases the use of structural grafts and intensive management of membranous septum. It is important to know what characteristics must be preserved and what features should be modified. The Caucasian nose and even other Latin American noses differ greatly from the Andean (Peru, Ecuador, Bolivia) nose, and therefore, the management should be fully individualized in each case in order to provide realistic patient surgical options according to their anatomic characteristics. This presentation aims to make known some features of the Andean race, as well as some tips and tricks to better manage their patients.

Method

Transversal study from July 2006 to July 2012 (6 years). Six hundred rhinoplasty surgeries were performed.

Results

Andean rhinoplasty differs from conventional surgery and requires an individualized approach and management.

Conclusion

We present a new armamentarium for your practice to manage Andean patients (Ecuador, Peru, Bolivia) and perform a most succesful rhinoplastic surgery.
Management of Oral Ranula
Authors: Woo Hyun‐Jae , Chi Deok Hwan
Published: February 2015

Objective

Preferred treatment of oral ranulas remains controversial. We present our experience with ranulas at Gumi CHA Medical Center (GCMC) and review the literature.

Method

Retrospective review. From 2002 to 2010, 61 oral ranulas were treated at GCMC. Combining the GCMC series with the literature identified 271 cases for review.

Results

In the GCMC series, procedures for oral ranulas varied from ranula excision (9 cases, 32%), marsupialization (18 cases), combined ranula and sublingual gland excision (24 cases, 45%), sclerotherapy with OK‐432 (10 cases, 23%). Recurrences of ranula excision only, marsupialization, combined ranula and sublingual gland excision, and sclerotherapy were 5 cases (56%), 5 cases (28 %), 0 cases (0%), and 5 cases (50%), respectively. Sixty complications were identified from the literature. Recurrence was considered a complication and was most prevalent (68%). Nonrecurrent complications included tongue hypesthesia (12%), bleeding/hematoma (12%), postoperative infection (7%), and Wharton’s duct injury (2%). Procedures and associated complication rates were: ranula excision only (20%), marsupialization (20%), combined ranula and sublingual gland excision (13%), and sclerotherapy (57%).

Conclusion

Based on our review, definitive treatment yielding lowest recurrence and complication rates for oral ranulas is transoral excision of the ipsilateral sublingual gland and ranula.
Sandwich Graft Technique Repair of Nasal Septal Perforation
Authors: Shin Myungseok
Published: February 2015

Objective

The aim of this study was to examine the surgical technique of sandwich graft using inferior turbinate mucoperiosteal flap and auricular cartilage via open rhinoplasty approach for repair of nasalseptal perforation.

Method

Retrospective review of 7 patients operated from 2008 to 2010.

Results

Six of the 7 patients had a complete closure, and one patient achieved incomplete closure.

Conclusion

Sandwich graft of inferior turbinate mucoperiosteal flap and auricular cartilage via open rhinoplasty approach showed high success rate and relatively easy surgical technique.
Partial Laryngectomy versus Chemoradiotherapy
Authors: De Arriba Alvaro , Castro Alejandro , Bernaldez Ricardo , Del Palacio Antonio , Del Rio Laura , Sanchez‐Cuadrado Isabel , Gavilan Javier
Published: February 2015

Objective

Chemoradiation protocols for organ preservation has relegated surgery to salvage in many institutions. However, open partial laryngectomies and endoscopic procedures provide an option for function preservation. The aim of this study is to review the outcomes of T2‐T4 laryngeal and hypopharyngeal cancer patients treated with either partial laryngectomy or chemoradiotherapy.

Method

Retrospective review of patients with T2‐T4 laryngeal and hypopharyngeal squamous cell carcinoma treated with either partial laryngectomy or chemoradiotherapy between 2001 and 2009 at the authors’ institution. Primary endpoints were local control rate and laryngo‐esophageal dysfunction‐free local control (LEDFLC, patients without tracheostomy or feeding tube in the last contact).

Results

Surgical group: 47 patients, with 50% of locally advanced tumors (T3‐T4). Chemoradiotherapy group: 36 patients with 72% of locally advanced tumors. Median follow‐up was 49.5 months. Local control rate was statistically higher for the surgical group (84.3% vs 63.6%, P =. 021), although no differences in LEDLC were observed. When local control rate is analyzed by T stages, a significant difference is found for T2 (95.2% vs 70%, P =. 035) favoring surgical group, and a nonsignificant trend for T3‐T4 (72.7% vs 61.4%). A nonsignificant trend in overall survival, disease‐specific survival, and disease‐free survival favoring primary surgical treatment was found.

Conclusion

When properly indicated and performed, partial laryngectomy achieves similar function preservation outcomes to chemoradiation protocols. A noticeable better local control rate has been observed for the surgical group. These techniques should endure in the armamentarium of surgeons. Choosing the most appropriate treatment for each patient is the key for success.
Tissue Oximetry Free Flap Monitoring in the Head and Neck
Authors: Rabie Amr N. , Ibrahim Ahmed , Lin Samuel J.
Published: February 2015

Objective

To assess the effectiveness of continuous noninvasive tissue oximetry in free flap monitoring in head and neck reconstruction.

Method

In a retrospective case series, we report 5 patients over a period of 12 months who underwent head and neck reconstruction with free tissue transfer and postoperative monitoring using near‐infrared spectroscopy using the commercially available ViOptix Tissue Oximeter device (ViOptix, Fremont, California).

Results

The use of near‐infrared spectroscopy (ViOptix) was successfully implemented in all 5 patients. Early experience with this technique in the head and neck demonstrates its feasibility in monitoring head and neck flaps, especially in areas where monitoring the skin paddle may be challenging for the observer. We report early success in using this device in postoperative monitoring.

Conclusion

Near infrared spectroscopy is a potential means of monitoring free tissue transfer in the head and neck. More research is needed to study the impact of using ViOptix in the early detection of free flap compromise and subsequent salvage and its impact on re‐exploration rates and overall flap survival rates.
Predictors of Neck Failure in T1/T2 ‐N0 Oral Tongue Squamous Cell Carcinoma
Authors: Moreno Mauricio A. , Cotrill Elizabeth , Vural Emre
Published: February 2015

Objective

The incidence of early squamous cell carcinoma of the oral tongue (SCCOT) is increasing, particularly among young patients. The development of loco‐regional recurrence is associated with poor survival. We sought to identify the predictors for nodal recurrence in early (T1/T2) SCCOT presenting with a radiologically N0 neck.

Method

Retrospective chart review of 50 consecutive patients primarily treated for T1/T2‐N0 SCCOT at an academic tertiary institution between 1998 and 2007. N0 status confirmed by preoperative contrasted neck CT in all cases.

Results

Twenty‐six men and 24 women with a median age of 61 years (range, 24‐90 years); 46% presented with a T1 and 54% with a T2. Depth of invasion >4 mm was present in 76%; positive margins in 8%; dysplasia at the margin 6%; perineural invasion 18%; and lymphovascular invasion 12%. Ipsilateral neck dissection was performed in 60% (20% microscopically positive) while adjuvant radiation was used in 32%. Twenty percent of the patients recurred in the neck, ipsilateral in all cases. It presented between 4 and 47 months and was associated with dysplasia at the margin (P =. 037) and local recurrence (P =. 002), while pathological T‐stage (pT2/pT1) trended (P =. 087).

Conclusion

Pathological T‐stage, field cancerization and development of local recurrence are predictors for regional failure in patients with early SCCOT. Neck recurrence appears to be primarily determined by biological behavior rather than treatment modality in this subset of patients.
Pre‐op Thyroglobulin and Sentinel Lymph Node Biopsy Outcomes
Authors: Maniakas Anastasios , Saliba Joe , Hier Michael P. , Mlynarek Alex M. , Caglar D. , Tamilia Michael , Payne Richard J.
Published: February 2015

Objective

1) To retrospectively assess the usefulness of preoperative thyroglobulin (Tg) levels in predicting sentinel lymph node (SLN) biopsy (SLNB) status. 2) To evaluate the correlation between preoperative Tg levels and the overall number of positive SLNs. 3) To compare primary tumor (T) classification in patients according to SLNB outcome.

Method

Data from patients operated for well‐differentiated thyroid carcinoma (WDTC) at the McGill University Thyroid Cancer Center were collected from January 2007 to January 2012. Statistical analyses were performed using a Mann‐Whitney‐Wilcoxon test, a Pearson correlation coefficient and a Pearson χ2 test.

Results

Preoperative Tg levels and SLNB results were available in 74 patients (51 negative and 23 positive SLNBs). Mean preoperative Tg levels for negative and positive SLNB groups were 105.2 and 85.9 ng/mL, respectively, yielding no statistically significant difference (P =. 143). Moreover, no statistically significant correlation was found between Tg levels and the number of positive SLNs (P =. 515). While 82.4% of patients with negative SLNBs had a T1 or T2 class WDTC, 82.6% of patients with positive SLNBs had a T3 or higher class, yielding a statistically significant difference between the 2 groups (P <. 001).

Conclusion

Preoperative Tg levels are not significantly different in patients with positive SLNBs as compared to negative SLNBs, and show no significant correlation with the number of positive SLNs. Thus, an elevated preoperative Tg is not a predictor of SLN status. Patients with positive SLNBs, however, have significantly worse T classifications.
Quality of Life of Head and Neck Cancer Patients in Ghana
Authors: Hills Susannah E. , Prince Mark E.
Published: February 2015

Objective

1) Investigate quality of life (QOL) of patients undergoing radiation therapy for head and neck cancer at KATH hospital in Ghana. 2) Compare QOL of these patients with a healthy Ghanaian population. 3) Compare QOL for Ghanian patients with QOL of head and neck cancer patients in the United States.

Method

Data collection is ongoing. We anticipate inclusion of 30 Ghanaian head and neck cancer patients, and 30 healthy Ghanaian controls. Participants complete the FACT‐H+N QOL Question‐naire. Data for patients in the United States are obtained from the FACIT database. Outcome measures include means, medians, standard deviations, and analysis of variance.

Results

Preliminary results demonstrate lower QOL scores among Ghanaian patients undergoing treatment compared with healthy controls (94.5 vs 111). Patients undergoing treatment also have lower scores for physical well‐being (22.5 vs 26.4), functional well‐being (14 vs 18.5), and head and neck–specific symptoms (20.5 vs 36.4). Ghanaians undergoing treatment had higher scores for emotional well‐being compared with healthy Ghanaians (22 vs 16.1). Initial comparison of the Ghanaian and American treatment groups revealed similar scores for physical well‐being (22.5 vs 18.9) and functional impairment (14 vs 15.3). However, the Ghanaian patients had higher scores for emotional well‐being (22 vs 16.8).

Conclusion

QOL of Ghanaian head and neck cancer patients is significantly worse than healthy controls. Patients are most affected by physical and functional impairments. Emotional well‐being is not worse for Ghanaians undergoing treatment. Ghanaian patients are similar to Americans in physical and functional well‐being. However, Ghanaian patients demonstrate greater sense of emotional well‐being.
Quality‐of‐Life Tools in Oral and Oropharyngeal Cancer
Authors: Moubayed Sami P. , Sampalis John S. , Christopoulos Apostolos
Published: February 2015

Objective

1) To identify and evaluate patient‐reported quality of life (QOL) questionnaires used in studies of oral and oropharyngeal cancer. 2) To provide information on the trends of use of each questionnaire according to language, country of origin, publication date, and type of treatment.

Method

Systematic review of the English‐language literature. A search using the Medical Subject Headings (MeSH) queries (“Oropharyngeal Neoplasms” OR “Mouth Neoplasms”) AND “Quality of Life” was carried out by using a publicly available MEDLINE interface (PubMed). A total of 371 articles were identified and reviewed. We identified all English‐language studies of oral or oropharyngeal cancer patients that measure QOL using a patient‐reported questionnaire. Exclusion criteria are review article, comment, non‐English‐language study, wrong disease, and absence of quality of life measure.

Results

Identified questionnaires will be summarized. Each instrument will be compared against the standards for health outcome instrument development and evaluation of the Scientific Advisory Committee of the Medical Outcomes Trust. Descriptive statistics regarding identified studies will be presented regarding questionnaire use by language, country of origin, publication date, and type of treatment.

Conclusion

Our results will help identify well‐researched areas in patient‐reported measures of QOL, and areas where more research is required. This is also the first study to objectively measure the number of studies that use each patient‐reported QOL questionnaire according to language, country of origin, publication date, and type of treatment. Such data is crucial in helping adequate questionnaire selection for evaluation of QOL.
Rare Malignant Parapharyngeal Tumors: Is There a Dilemma?
Authors: Panda Naresh K. , Gupta Karan , Verma Roshan , Ghoshal Sushmita , Bakshi Jaimanti , Vasishta Rakesh K.
Published: February 2015

Objective

To study the clinical, radiological, and histopathological characteristics along with the treatment outcome of 23 patients presenting with malignant parapharyngeal space tumors.

Method

Retrospective chart review between 2001 to 2010, at Department of Otolaryngology–Head and Neck Surgery, Chandigarh, India. Retrospective analysis of malignant parapharyngeal tumors from 2001 to 2010. Subjects: Twenty‐three patients. Interventions: Clinical, radiological, and histopathological characteristics. Outcome measures: Disease‐free survival at 1 year.

Results

Out of 23 cases, 17 were rare malignancies of the parapharyngeal space. Of these, 6 tumors arose de novo (sarcoma, squamous cell carcinoma, synovial sarcoma, fibrosarcoma, rhabdomyosarcoma, and leiomyosarcoma) and 3 were direct extension of deep lobe parotid tumor (undifferentiated carcinoma with neck metastasis). Other rare tumors were extra osseous chordoma of the parapharyngeal space (n = 1), malignant fibrous histiocytoma (n = 1), malignant ameloblastoma (n = 1), malignant melanoma extending to the infratemporal fossa (n = 1), malignant schwannoma (n = 1), malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation (triton tumor; n = 1), neurofibroma with atypia (n = 1), and extraosseus Ewing’s sarcoma (n = 1). Fourteen out of 23 (60.8%) patients are alive with no evidence of disease on variable follow up with mean follow up of 15 months.

Conclusion

Tumors of the parapharyngeal space are uncommon, comprising less than 1% of all head and neck neoplasms. Accurate diagnosis and management is challenging and requires a team approach. When the diagnosis is ambiguous, a complete surgical excision and histopathological examination should be the preferred approach for these rare tumors.
Recurrent Laryngeal Neurofibroma Unrelated to NF Type 1
Authors: Phillips Jeffrey , Gu Xin , Nathan Cherie‐Ann O.
Published: February 2015

Objective

Although rare, neurofibromas arising from the recurrent laryngeal nerve in neurofibromatosis type I patients have been cited in the literature. However, recurrent laryngeal neurofibromas unrelated to this inherited disorder have not been reported. We describe a new entity of a recurrent laryngeal neurofibroma arising at the level of the glottis.

Method

A case report and literature review is presented. A patient with progressive dysphonia, dysphagia, and mild dyspnea was referred to our cancer center in November 2011 for assessment. Flexible laryngoscopy revealed right vocal cord paresis and a submucosal mass causing medial displacement of the right arytenoid.

Results

CT imaging revealed a well‐defined, nonenhancing mass at the level of the posterior glottis. Transoral endoscopic surgical excision of the mass was performed. Pathology revealed a benign peripheral nerve sheath tumor consistent with a neurofibroma. The patient had resolution of his dyspnea and achieved significant improvement of his voice with a 6‐week course of speech therapy, despite postoperative right vocal cord paralysis.

Conclusion

Isolated neurofibromas of the recurrent laryngeal nerve, without the appearance of other characteristic features of von Recklinhausen disease have not been reported. Although benign, early recognition and surgical excision of these lesions is necessary to prevent airway obstruction, dysphagia, and aspiration.
Rhytidectomy in Parotidectomy
Authors: Piccioni Lucia O. , Sarandria Daniela , Pilolli Francesco , Bussi Mario
Published: February 2015

Objective

1) Describe our results in a different surgical approach to parotidectomy. 2) Establish the indications to this approach. 3) Establish the incidence of postoperative complications.

Method

From February 2008 until June 2011 we analyzed 84 successive cases of parotidectomy performed with a rhytidectomy in our department.

Results

In 73 cases a superficial parotidectomy was performed; in 9 cases a total parotidectomy, and in 2 cases the resection involved the skin overlying the lesion. The histology showed that most of the lesions were benign. The duration of surgery increased 20 minutes on average if compared to the usual Redon’s approach. We found 23 cases of salivary fistula, solved in 6 days on average. Only 1 patient had a postoperative hemorrhage and needed a surgical revision. Twelve patients developed a facial paralysis, but it resolved in all the cases 6 months later.

Conclusion

Rhytidectomy can be considered a useful surgical approach in benignant parotid lesions. It allows a good exposition of anatomic structures and does not show an increase of surgical complications
RON Is Associated with Tumor Progression in Head and Neck Squamous Cell Cancer
Authors: Yoon Tae Mi , Lee Dong Hoon , Lee Joon Kyoo , Lim Sang Chul
Published: February 2015

Objective

To investigate that the recepteur d’origine nantais (RON) expression is expressed in human head and neck squamous cell cancer (HNSCC) cells and to evaluate whether RON affects tumor cell behavior in head and neck cancer cell lines, thus serving as a target for molecular therapy in a preclinical model.

Method

The protein expression of RON by immunohistochemistry and western blot analysis was investigated in human head‐neck cancer tissues. To evaluate the impact of RON knock down on behavior of human head‐neck cancer cell lines, invasion and migration assays using small‐interfering RNA were performed. Western blot analysis was used to assess alteration in protein expression.

Results

RON positive immunoreactions were observed relative to adjacent mucosal tissue in all 28 cases, while 15 cases (53.6%) were over‐expressed. RON over‐expression was significantly associated with lymph node metastasis. RON protein expression was increased in cervical metastatic lymph node tissue by western blot analysis. Treatment of RON ligand, macrophage stimulating proetin (MSP) increased cell migration and invasion in human head‐neck cancer cell lines (SNU 1041, PCI 50). The knockdown of RON significantly suppressed tumor cell migration, invasion. The Erk, p38 phosphorylation was reduced by knockdown of RON in PCI 50.

Conclusion

RON expression might play an important role in the progression, especially lymphatic metastasis of head and neck squamous cell cancer. Further investigations are needed to assess the potential of RON‐directed molecular therapy in head and neck squamous cell cancer.
Synsepalum dulcificum and Varied Taste Occurring Postradiation Trial
Authors: Velargo Parker A. , Samant Sandeep
Published: February 2015

Objective

Postirradiation gustatory dysfunction (PIGD), which may cause malnutrition, is common in patients with head/neck cancer undergoing radiation therapy (XRT). Synsepalum dulcificum (miracle fruit) changes taste transduction mechanisms of certain substances. This investigation addresses whether S dulcificum can improve PIGD and result in weight augmentation in head/neck cancer patients.

Method

Sixteen patients meeting criteria were separated into 2 groups based on timing after XRT. In a double‐blind randomized fashion, patients were assigned miracle fruit or placebo. A series of taste batteries/questionnaires were performed. Patients were given a 1‐month supply of test substance. We measured pre‐ and posttrial weight.

Results

Fifty‐four percent of patients subjectively reported that sweet tastes were most adversely affected by XRT; however, objectively all patients correctly identified sweet tastes while 30% of patients answered sour tastes incorrectly. The majority of patients in both groups had a positive response to sour tastes with S dulcificum when compared to placebo (not statistically significant). Weight gain was slightly greater in both groups with S dulcificum when compared to placebo (not statistically significant). Inter‐group analyses did not yield significant differences.

Conclusion

In the treatment of PIGD, S dulcificum may be an effective treatment for patients with sour dysfunction but may not be effective in augmenting weight. It appears to work similarly in irradiation patients regardless of time after radiation. A larger N may help to obtain more significant findings.
Salivary Duct Carcinoma of the Accessory Parotid Gland
Authors: Funamura Jamie L. , Aouad Rony K. , Ramsamooj Rajen , Donald Paul J.
Published: February 2015

Objective

1) Present a rare case of salivary duct carcinoma of the accessory parotid gland (APG). 2) Understand the current prevalence, diagnosis, and management of benign and malignant tumors of the APG.

Method

This study includes a case presentation and literature review. The literature review included articles from October 1966 to January 2010 and included all cases of accessory parotid gland tumors in adults.

Results

One hundred and nineteen cases with 19 different tumor types were reported in the accessory parotid gland (APG). Pleomorphic adenoma and mucoepidermoid carcinoma represented 50% and 23%, respectively. There were no previously reported salivary duct carcinomas of the APG. Forty percent of APG neoplasms were malignant. This malignancy rate was comparable to previous studies reporting a higher rate of malignant tumors in the APG compared with 15% to 20% in parotid tumors. A standard parotidectomy remains the preferred approach with less risk to the facial nerve compared with direct cheek resection and transoral approaches.

Conclusion

Most tumor types that have been identified in the parotid gland have also been found in the APG, including this latest finding of salivary duct carcinoma in the accessory gland. The rate of malignant tumors of the APG appears to be higher than that of the main parotid gland.