bluuebunny/crossref_metadata_2025 huggingface dataset:
Malignant Lymphoma
Authors: Brierley James D. , Gospodarowicz Mary K. , Wittekind Christian
Published: February 2017

Paediatric malignant lymphomas have been classified. Non‐Hodgkin lymphoma is classified into Tier 1 and Tier 2.
Prognosis and Classification of Cancer
Authors: O'Sullivan Brian , Brierley James , Gospodarowicz Mary
Published: February 2017

Even in cancers where a substantial proportion of patients have a successful outcome, not all are cured. There is a need to address these disparities scientifically under a broad rubric that encompasses prognostic factor research. Within this domain exists an interdependent array of principles, definitions and data underpinning the complex nature of oncology outcome. These address clinical, biological, interventional and diagnostic dimensions that attempt to understand the reasons for treatment failure or success in individual or groups of patients. This field evolves continuously and can be expected to change with new knowledge and concepts. At the same time, systematic analysis, reporting and comparison of results requires adherence to agreed standards for nomenclature, taxonomy and classification. At present, no uniformly agreed classification exists for prognostic factors. A description of a framework proposed by the UICC is described to address clinical relevance in this evolving field that acknowledges numerous dimensions of factors related to the patient, tumour, and healthcare system, and is used in the disease‐site chapters of this Manual. Future enhancements can be anticipated through advances in protocols, standards, classification and terminology, combined with a general understanding of the needs for interpretation and implementation.
Cancer Informatics
Authors: Jaffray David A. , Hope Andrew , Dwivedi Prateek , Michaelson Terry , Dekker Andre
Published: February 2017

Information collection and knowledge synthesis are central to the practice of cancer medicine. The expert cancer clinician has been trained in these concepts and merges them with delivery of care to build hypotheses that ultimately lead to evidence and a change in practice. The volume and diversity of patient‐derived data, the complexity of modern cancer treatments and the development of information technology over the past two decades require the adoption of informatics strategies if the process of delivering care is to substantially contribute to improving outcomes. In this chapter, we have endeavoured to assemble a cross‐section of important elements of a cancer informatics strategy, ranging from the technology, to data models, to critical operational issues that need to be considered in designing an effective cancer informatics strategy. Finally, a section highlighting the rapidly changing frontier of cancer informatics is provided to stimulate further reading.
Principles of Systemic Therapy
Authors: Fey Martin F. , Aebi Stefan
Published: February 2017

Drugs have become an important tool to improve outcome in cancer. Cytotoxic agents often work best in combination rather than as single drugs. Drug combinations should exhibit better anticancer efficacy due to distinct mechanisms of action, yet different toxicity profiles. Some cancers are endocrine‐responsive, e.g. prostate cancer. Research into the molecular pathology of cancer has led to the development of small compounds inhibiting tyrosine kinase dependent pathways (‘‐nibs‘) and monoclonal antibodies binding to proteins on the cancer cell. Adjuvant cancer therapy reduces the risk or relapse and improves chances of cure, after removal of all detectable cancer. Neoadjuvant therapy improves the chances of radical tumour surgery or less mutilating surgery. In some cancers, such as the leukaemias, systemic treatment can be curative, whilst in many metastatic solid tumours, a realistic goal is palliation. When planning systemic cancer treatment, patient co‐morbidity must be taken into account, particularly in an elderly population.
Treatment in the Elderly
Authors: Aapro Matti S.
Published: February 2017

In 2020 20% of the world's population will be over the age of 65 years, and most of these persons will be in developing countries. Physiological decline of organ reserves and co‐morbidities which accelerate this decline and reduce the ability to cope with stress determine tolerability of cancer surgery, access to radiation and toxicity of chemotherapy as well as patient's life expectancy. Renal function is probably best evaluated with an MDRD formula. Elderly patients are at higher risk of cardiac complications in the short and longer term. Co‐morbidity (including diabetes and osteoporosis ) complicates many treatments. Supportive care plays a major role, and use of granulocyte‐colony stimulating factor is suggested more frequently than in younger patients. Quality of life and performance status maintenance may be more important than progression‐free survival or overall survival.
Oncology Emergencies
Authors: King Jonathan , Deming Dustin , Robins H. Ian
Published: February 2017

Patients with cancer are at risk for multiple life‐threatening complications both form their disease as well as treatment. The prepared physician needs to be able to recognize, evaluate and treat these oncological emergencies. This chapter describes the presentation, exam findings, diagnostics and treatment of patients with such conditions.
Colon and Rectum
Authors: Glynne‐Jones Rob , Brown Gina , Chau Ian , Moran Brendan J.
Published: February 2017

Colorectal cancer (CRC) is a disease predominantly of the developed world, which remains a major public health problem despite screening and preventive strategies. Surgery remains the mainstay of CRC treatment and cure, which is complicated by the location (a narrow bony pelvis) and proximity to the sphincter mechanism, increasing the difficulty of surgical access and risk of a permanent colostomy. Screening programmes have reduced mortality by removing precursor and early lesions, but morbidity and mortality remain high for advanced cases. Identification of inherited colorectal cancer is important. Diagnostic requirements include clinical assessment and imaging (CT, MRI, ultrasound), laboratory tests and tumour markers (carcinoembryonic antigen [CEA]). Accurate preoperative staging is vital to enable risk‐adapted optimal local and systemic management. Early rectal cancers are amenable to local excision. Total mesorectal excision (TME) achieves low rates of local recurrence (<10%) in Stage II and III rectal cancer. More locally‐advanced cancers require neoadjuvant chemoradiotherapy followed by radical resection. Adjuvant chemotherapy post surgery for rectal cancer is more controversial than in colon cancer. We describe risk factors, presentation, recommended diagnostic procedures and treatment of patients with cancers of the colon and rectum.
Bladder and Other Urothelium
Authors: Duchesne Gillian M. , Sengupta Shomik , Davis Ian D.
Published: February 2017

Bladder cancer is a common disease, although its epidemiology differs around the world. Environmental and behavioural factors are important in its aetiology. Significant differences in the biology of different types of non‐muscle‐invasive bladder urothelial cancer, or differences between upper and lower tract cancers, have now been recognized. Management involves multidisciplinary engagement in terms of diagnosis, treatment of non‐muscle‐invasive disease, consideration of options for local control of invasive disease, and management of locally‐advanced or metastatic cancer or cancers of non‐urothelial histology. Significant opportunities remain for improvement of management and controversies continue with respect to issues of surgery, radiation and medical management.
Testicular Germ Cell Tumours
Authors: Winter Christian , Lorch Anja , Bokemeyer Carsten , Schmidberger Heinz , Albers Peter
Published: February 2017

Testicular germ cell tumours (GCT) represent the most common solid malignancy of young men aged between 15 and 40 years. Histopathologically, testicular GCT are divided into two major groups: pure seminoma and non‐seminoma. The pathogenesis of GCT still remains largely unknown. In cases of GCT suspicion, a surgical exploration for histopathology, in most cases orchiectomy, is obligatory. After completion of diagnostic procedures, levels of serum tumour markers and the clinical stage should be defined. Patients with early‐stage GCT are treated by individualized risk stratification within a multidisciplinary approach. The individual management has to be balanced according to clinical features and the risk of short‐ and long‐term toxic effects. The treatment for metastatic tumours is based on risk stratification according to IGCCCG and is performed with cisplatin‐based combination chemotherapy and residual tumour resection in cases of residual tumour lesion. High‐dose chemotherapy represents a curative option for patients with first or subsequent relapses.
Nasopharynx
Authors: Lee Anne W.M. , Ng W.T. , Le Quynh‐Thu , Chan Anthony T.C. , Chan Jimmy Y.W. , Sze Henry C.K.
Published: February 2017

Nasopharyngeal carcinoma (NPC) is one of the most interesting cancers with a distinctly skewed distribution. The aetiology is multifactorial (genetic predisposition, Epstein‐Barr virus infection and environmental carcinogens). The most significant prognostic factors include TNM staging, tumour volume, EBV‐DNA copies, age and gender. Radiotherapy is the primary treatment modality, with the intensity‐modulated radiotherapy technique recommended. Addition of cisplatin‐based concurrent ± adjuvant chemotherapy is recommended for treatment of locoregionally advanced tumours. The current consensus and controversies in treatment strategy for different stages and areas for research will be presented.
Pituitary
Authors: Ferguson Sherise D. , McCutcheon Ian E.
Published: February 2017

Pituitary tumours are among the most common intracranial lesions. Primarily benign adenomas arising from the anterior pituitary gland, they manifest clinically via mass effect or secretion of a variety of hormones resulting in a spectrum of symptomatology. This chapter will focus on the diagnostic work‐up and clinical syndromes associated with pituitary adenomas and outline the treatment modalities available. It will also briefly cover carcinomas, a rare pituitary pathology with an exceptionally poor prognosis.
Fluorescent Nanomaterials for the Development of Latent Fingerprints in Forensic Sciences
Authors: Wang Meng , Li Ming , Yu Aoyang , Zhu Ye , Yang Mingying , Mao Chuanbin
Published: February 2017

This review presents an overview on the application of latent fingerprint development techniques in forensic sciences. At present, traditional developing methods such as powder dusting, cyanoacrylate fuming, chemical method, and small particle reagent method, have all been gradually compromised given their emerging drawbacks such as low contrast, sensitivity, and selectivity, as well as high toxicity. Recently, much attention has been paid to the use of fluorescent nanomaterials including quantum dots (QDs) and rare earth upconversion fluorescent nanomaterials (UCNMs) due to their unique optical and chemical properties. Thus, this review lays emphasis on latent fingerprint development based on QDs and UCNMs. Compared to latent fingerprint development by traditional methods, the new methods using fluorescent nanomaterials can achieve high contrast, sensitivity, and selectivity while showing reduced toxicity. Overall, this review provides a systematic overview on such methods.
In pursuit of neurophenotypes: The consequences of having autism and a big brain
Authors: Amaral David G. , Li Deana , Libero Lauren , Solomon Marjorie , Van de Water Judy , Mastergeorge Ann , Naigles Letitia , Rogers Sally , Wu Nordahl Christine
Published: February 2017

A consensus has emerged that despite common core features, autism spectrum disorder (ASD) has multiple etiologies and various genetic and biological characteristics. The fact that there are likely to be subtypes of ASD has complicated attempts to develop effective therapies. The UC Davis MIND Institute Autism Phenome Project is a longitudinal, multidisciplinary analysis of children with autism and age‐matched typically developing controls; nearly 400 families are participating in this study. The overarching goal is to gather sufficient biological, medical, and behavioral data to allow definition of clinically meaningful subtypes of ASD. One reasonable hypothesis is that different subtypes of autism will demonstrate different patterns of altered brain organization or development i.e., different neurophenotypes. In this Commentary, we discuss one neurophenotype that is defined by megalencephaly, or having brain size that is large and disproportionate to body size. We have found that 15% of the boys with autism demonstrate this neurophenotype, though it is far less common in girls. We review behavioral and medical characteristics of the large‐brained group of boys with autism in comparison to those with typically sized brains. While brain size in typically developing individuals is positively correlated with cognitive function, the children with autism and larger brains have more severe disabilities and poorer prognosis. This research indicates that phenotyping in autism, like genotyping, requires a very substantial cohort of subjects. Moreover, since brain and behavior relationships may emerge at different times during development, this effort highlights the need for longitudinal analyses to carry out meaningful phenotyping. Autism Res 2017, 10: 711–722. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.
Outcomes of laparoscopic gastric bypass in a randomized clinical trial compared with a concurrent national database
Authors: Stenberg E , Szabo E , Ottosson J , Näslund I
Published: February 2017

Background

RCTs are the standard for assessing medical interventions, but they may not be feasible and their external validity is sometimes questioned. This study aimed to compare results from an RCT on mesenteric defect closure during laparoscopic gastric bypass with those from a national database containing data on the same procedure, to shed light on the external validity of the RCT.

Methods

Patients undergoing laparoscopic gastric bypass surgery within an RCT conducted between 1 May 2010 and 14 November 2011 were compared with those who underwent the same procedure in Sweden outside the RCT over the same time interval. Primary endpoints were severe complications within 30 days and surgery for small bowel obstruction within 4 years.

Results

Some 2507 patients in the RCT were compared with 8485 patients in the non-RCT group. There were no differences in severe complications within 30 days in the group without closure of the mesenteric defect (odds ratio (OR) for RCTversus non-RCT 0·94, 95 per cent c.i. 0·64 to 1·36; P = 0·728) or in the group with closure of the defect (OR 1·34, 0·96 to 1·86; P = 0·087). There were no differences between the RCT and non-RCT cohorts in reoperation rates for small bowel obstruction in the mesenteric defect non-closure (cumulative incidence 10·9 versus 9·4 per cent respectively; hazard ratio (HR) 1·20, 95 per cent c.i. 0·99 to 1·46; P = 0·065) and closure (cumulative incidence 5·7 versus 7·0 per cent; HR 0·82, 0·62 to 1·07; P = 0·137) groups. The relative risk for small bowel obstruction without mesenteric defect closure compared with closure was 1·91 in the RCT group and 1·39 in the non-RCT group.

Conclusion

The efficacy of mesenteric defect closure was similar in the RCT and national registry, providing evidence for the external validity of the RCT.
Local tumour progression after percutaneous ablation of colorectal liver metastases according to RAS mutation status
Authors: Odisio B C , Yamashita S , Huang S Y , Harmoush S , Kopetz S E , Ahrar K , Shin Chun Y , Conrad C , Aloia T A , Gupta S , Hicks M E , Vauthey J-N
Published: February 2017

Background

Percutaneous ablation is a common treatment for colorectal liver metastasis (CLM). However, the effect of rat sarcoma viral oncogene homologue (RAS) mutation on outcome after ablation of CLMs is unclear.

Methods

Patients who underwent image-guided percutaneous ablation of CLMs from 2004 to 2015 and had known RAS mutation status were analysed. Patients were evaluated for local tumour progression as observed on imaging of CLMs treated with ablation. Multivariable Cox regression analysis was performed to determine factors associated with local tumour progression-free survival.

Results

The study included 92 patients who underwent ablation of 137 CLMs. Thirty-six patients (39 per cent) had mutant RAS. Rates of local tumour progression were 14 per cent (8 of 56) for patients with wild-type RAS and 39 per cent (14 of 36) for patients with mutant RAS (P = 0·007). The actuarial 3-year local tumour progression-free survival rate after percutaneous ablation was worse in patients with mutant RAS than in those with wild-type RAS (35 versus 71 per cent respectively; P = 0·001). In multivariable analysis, negative predictors of local tumour progression-free survival were a minimum ablation margin of less than 5 mm (hazard ratio (HR) 2·48, 95 per cent c.i. 1·31 to 4·72; P = 0·006) and mutant RAS (HR 3·01, 1·60 to 5·77; P = 0·001).

Conclusion

Mutant RAS is associated with an earlier and higher rate of local tumour progression in patients undergoing ablation of CLMs.
Endovascular stroke treatment in a small‐volume stroke center
Authors: Behzadi Gry N. , Fjetland Lars , Advani Rajiv , Kurz Martin W. , Kurz Kathinka D.
Published: February 2017

Introduction

Our purpose was to evaluate the safety and efficacy of endovascular treatment (EVT) of stroke caused by large vessel occlusions (LVO) performed by general interventional radiologists in cooperation with stroke neurologists and neuroradiologists at a center with a limited annual number of procedures. We aimed to compare our results with those previously reported from larger stroke centers.

Patients and Methods

A total of 108 patients with acute stroke due to LVO treated with EVT were included. Outcome was measured using the modified Rankin scale (mRS) at 90 days. Efficacy was classified according to the modified thrombolysis in cerebral infarction (mTICI) scoring system. Safety was evaluated according to the incidence of procedural complications and symptomatic intracranial hemorrhage (sICH).

Results

Mean age of the patients was 67.5 years. The median National Institutes of Health Stroke Scale (NIHSS) on hospital admission was 17. Successful revascularization was achieved in 76%. 39.4% experienced a good clinical outcome (mRS<3). Intraprocedural complications were seen in 7.4%. 7.4% suffered a sICH. 21.3% died within 3 months after EVT.

Discussion

The use of general interventional radiologists in EVT of LVO may be a possible approach for improving EVT coverage where availability of specialized neurointerventionalists is challenging. EVT for LVO stroke performed by general interventional radiologists in close cooperation with diagnostic neuroradiologists and stroke neurologists can be safe and efficacious despite the low number of annual procedures.
Androgen regulation of host defenses and response to inflammatory stimuli in the prostate gland
Authors: Quintar Amado A. , Maldonado Cristina A.
Published: February 2017

The prostate gland is a strictly androgen‐dependent organ which is also the main target of infectious and inflammatory diseases in the male reproductive tract. Host defenses and immunity of the gland have unique features to maintain a constant balance between response and tolerance to diverse antigens. In this context, the effects of reproductive hormones on the male tract are thus complex and have just started to be defined. From the classical description of “the prostatic antibacterial factor,” many host defense proteins with potent microbicidal and anti‐tumoral activities have been described in the organ. Indeed, it has been proposed a central role for resident cells, that is, epithelial and smooth muscle cells, in the prostatic response against injuries. However, these cells also represent the target of the inflammatory damage, leading to the development of a Proliferative Inflammatory Atrophy‐like process in the epithelium and a myofibroblastic‐like reactive stroma. Available data on androgen regulation of inflammation led to a model of the complex control, in which the final effect will depend on the tissue microenvironment, the cause of inflammation, and the levels of androgens among other factors. In this paper, we review the current scientific literature about the inflammatory process in the gland, the modulation of host defense proteins, and the influence of testosterone on the resolution of prostatitis.
A Non‐Precious‐Metal Catalyst Derived from a Cp2‐Co+‐PBI Composite for Cathodic Oxygen Reduction under Both Acidic and Alkaline Conditions
Authors: Zhu Hong , Sun Zhaonan , Chen Nanjun , Cao Hehuan , Chen Minglin , Li Ke , Cai Yezheng , Wang Fanghui
Published: February 2017

One major limitation for polymer electrolyte membrane fuel cells is the sluggish cathode kinetics. Development of efficient noble‐free catalysts is the key resolution to the problem of the oxygen reduction reaction (ORR) in both acid and alkaline solutions. Herein, we report a new type of efficient non‐precious‐metal catalyst for the ORR through the direct pyrolysis of poly[2,2′‐(1,1′‐cobaltocenium)‐5,5′‐dibenzimidazole]. The cobalt oxides were produced after pyrolysis at 900 °C (Cp2‐Co+‐PBI‐900, where PBI is polybenzimidazole). The obtained catalysts exhibit higher electrocatalytic activity and stability for the ORR under both alkaline and acidic conditions. Structural characterization manifested that Cp2‐Co+‐PBI‐800 had the highest graphitic N content and Cp2‐Co+‐PBI‐900 was also produced. In alkaline media, Cp2‐Co+‐PBI‐900 showed the highest ORR activity with onset potential of 998 mV (vs. RHE), which was only 22 mV higher than that of Pt/C under identical conditions. Besides, in acidic media, Cp2‐Co+‐PBI‐800 exhibited excellent ORR activity with an onset potential of 847 mV (vs. RHE) after leaching in 6 M HCl solution for 12 h. Both optimal catalysts displayed high durability, especially in acidic media. The half‐wave potential was also improved by 11 mV after 5000 CV scanning cycles in N2. The catalysts possessed diverse active sites in different working conditions. In acid conditions, cobalt acted as the promotor, whereas, in alkaline conditions, CoO was the activity site. Moreover, graphite N and pyridine N were the main activity sites in acid and alkaline conditions, respectively. PBI has a long‐chain and π‐conjugated system, indicating that the PBI precursor can be used as a non‐precious‐metal catalyst.
The prognostic role of sex, race, and human papillomavirus in oropharyngeal and nonoropharyngeal head and neck squamous cell cancer
Authors: Fakhry Carole , Westra William H. , Wang Steven J. , van Zante Annemieke , Zhang Yuehan , Rettig Eleni , Yin Linda X. , Ryan William R. , Ha Patrick K. , Wentz Alicia , Koch Wayne , Richmon Jeremy D. , Eisele David W. , D'Souza Gypsyamber
Published: February 2017

BACKGROUND

Human papillomavirus (HPV) is a well‐established prognostic marker for oropharyngeal squamous cell cancer (OPSCC). Because of the limited numbers of women and nonwhites in studies to date, sex and racial/ethnic differences in prognosis have not been well explored. In this study, survival differences were explored by the tumor HPV status among 1) patients with OPSCCs by sex and race and 2) patients with nonoropharyngeal (non‐OP) head and neck squamous cell cancers (HNSCCs).

METHODS

This retrospective, multi‐institution study included OPSCCs and non‐OP HNSCCs of the oral cavity, larynx, and nasopharynx diagnosed from 1995 to 2012. Race/ethnicity was categorized as white non‐Hispanic, black non‐Hispanic, Asian non‐Hispanic, and Hispanic of any race. Tumors were centrally tested for p16 overexpression and the presence of HPV by HPV16 DNA and high‐risk HPV E6/E7 messenger RNA in situ hybridization. Kaplan‐Meier and Cox proportional hazards models were used to evaluate overall survival (OS).

RESULTS

The study population included 239 patients with OPSCC and 621 patients with non‐OP HNSCC with a median follow‐up time of 3.5 years. After adjustments for the tumor HPV status, age, current tobacco use, and stage, the risk of death was lower for women versus men with OPSCC (adjusted hazard ratio, 0.55; P = .04). The results were similar with p16. In contrast, for non‐OP HNSCCs, HPV positivity, p16 positivity, and sex were not associated with OS.

CONCLUSIONS

For OPSCC, there are differences in survival by sex, even after the tumor HPV status has been taken into account. For non‐OP HNSCC, the HPV status and the p16 status are not of prognostic significance. Cancer 2017;123:1566–1575. © 2017 American Cancer Society.
Potential of immunotherapy for sarcoma
Authors: Hoffman Robert M. , Singh Arun S. , Eilber Fritz C.
Published: February 2017

This editorial examines Miwa et al's article entitled “Phase 1/2 Study of Immunotherapy With Dendritic Cells Pulsed With Autologous Tumor Lysate in Patients With Refractory Bone and Soft Tissue Sarcoma: A Safe Method for Inducing an Immunological Response but With Limited Effects on Clinical Outcomes,” which appears in the current issue of Cancer. The state of the art of autologous cancer vaccines is briefly reviewed, and suggestions for improved immunological therapy for sarcomas are discussed.

See also pages 1576‐84.
Use of an annular non‐sleeve photoreactor for photocatalytic dye degradation: Study of temperature and light intensity effects
Authors: Ung‐Medina F. , Caudillo‐Flores U. , Correa‐González J.C. , Maya‐Yescas R. , Chávez‐Parga Ma. del C. , Cortés J.A.
Published: February 2017

In this article an annular non‐sleeve photoreactor (ANSP) is used to assess the TiO2/UV‐A advanced oxidation process, using the dye Acid Blue 9 (AB9) as model molecule. Within this particular configuration, the borosilicate glass or quartz sleeve that isolates lamp is removed. This fact allows the use of fluorescent BLB lamp to be in direct contact with suspension, which implies a variation of light intensity as a function of suspension temperature, surrounding the lamp. The variation of light intensity was evaluated in the range from 10 to 60°C, and the rates of dye degradation and chemical oxygen demand were also evaluated in the same interval of temperatures. Results showed that light intensity exhibits a proportional increment with temperature until a maximum at 40°C is achieved, then a slight decrease is observed. The degradation profiles of AB9 followed a pseudo first‐order kinetic model; whereas, chemical oxygen demand was defined by a pseudo zero‐order kinetic model. All kinetic constants exhibit a higher correlation with light intensity rather than temperature. The figure‐of‐merit electrical energy per order (EEO) was used to assess the electrical efficiency of the ANSP, and suggest an optimal operation temperature at 40°C. The sleeve removal is a practical application that could change the paradigm on photocatalytic reactor design, since wastewater treatment can be readily performed in a wide range of temperatures. © 2017 American Institute of Chemical Engineers Environ Prog, 36: 1083–1088, 2017
Percutaneous probe stimulation for intraoperative neuromonitoring in total endoscopic thyroidectomy: A preliminary experience
Authors: Zhang Daqi , Li Fang , Wu Che‐Wei , Liu Xiaoli , Xin Jingwei , Chiang Feng‐Yu , Sun Hui
Published: February 2017

Background

The purpose of this study was to investigate the feasibility and value of using intraoperative neuromonitoring (IONM) performed via percutaneous probe stimulation during total endoscopic thyroidectomy.

Methods

This study prospectively enrolled a series of 132 consecutive patients with 156 recurrent laryngeal nerves (RLNs) at risk who received total endoscopic thyroidectomy performed via bilateral breast approach using standardized IONM. The stimulation probe was introduced into the working space by percutaneous puncture. During lateral thyroid dissection, the proximal RLN was periodically stimulated to monitor adverse electromyography (EMG) changes. Preoperative and postoperative vocal cord mobility was routinely examined with laryngofiberoscopy.

Results

All IONMs were successfully performed via percutaneous probe stimulation with no morbidity or scarring in the neck. Twelve nerves (7.7%) showed significant changes in EMG (amplitude reduction, 50% to 90% from baseline EMG) during the lateral thyroid dissection. Compression near the inferior thyroid artery (70%) and traction near the Berry's ligament (30%) were the most common causative mechanisms, and modification of the surgical maneuver resulted in partial recovery of the EMG changes (amplitude reduction, 10% to 80% before wound closure). Of the 12 nerves with adverse EMG changes (final amplitude reduction, 65% to 80%), 8 nerves showed temporary (3 months or less) vocal cord palsy. No cases of permanent vocal cord palsy occurred in this series.

Conclusion

Percutaneous probe stimulation is a simple, effective, and safe method of performing IONM in total endoscopic thyroidectomy when the operating space is limited. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1001–1007, 2017
Evaluation of hepatitis B reactivation among 62,920 veterans treated with oral hepatitis C antivirals
Authors: Belperio Pamela S. , Shahoumian Troy A. , Mole Larry A. , Backus Lisa I.
Published: February 2017

Reactivation of hepatitis B virus (HBV) has been reported in hepatitis C virus–infected individuals receiving direct‐acting antiviral (DAA) therapy. The overall risk among patients with current or prior HBV infection in the context of DAA treatment is unknown. The aim of this evaluation was to identify and characterize HBV reactivation among veterans treated with oral DAA therapy. This retrospective evaluation included 62,290 hepatitis C virus–infected veterans completing oral DAA treatment. Baseline HBV infection status for each veteran was identified from HBV laboratory data performed prior to DAA initiation. To assess for HBV reactivation and hepatitis we identified all hepatitis B surface antigen (HBsAg), HBV DNA, and alanine aminotransferase results obtained while on DAA treatment or 7 days after. HBV reactivation was defined as a >1000 IU/mL increase in HBV DNA or HBsAg detection in a person who was previously negative. Prior to DAA treatment 85.5% (53,784/62,920) had HBsAg testing and 0.70% (377/53,784) were positive; 84.6% (53,237/62,920) had a hepatitis B surface antibody test, of which 42.2% (22,479/53,237) were positive. In all, 9 of 62,290 patients treated with DAAs had evidence of HBV reactivation occurring while on DAA treatment. Eight occurred in patients known to be HBsAg‐positive, and 1 occurred in a patient known to be isolated hepatitis B core antibody–positive. Seventeen other patients had small increases in HBV DNA levels that did not qualify as HBV reactivation. Only 3 of the 9 patients identified with HBV reactivation in this cohort exhibited peak alanine aminotransferase elevations >2 times the upper limit of normal. Conclusion: HBV reactivation of varying severity, even in the setting of isolated hepatitis B core antibody, with or without accompanying hepatitis can occur—though the occurrence of accompanying severe hepatitis was rare. (Hepatology 2017;66:27–36).
N‐cadherin Regulation of Bone Growth and Homeostasis Is Osteolineage Stage–Specific
Authors: Fontana Francesca , Hickman‐Brecks Cynthia L , Salazar Valerie S , Revollo Leila , Abou‐Ezzi Grazia , Grimston Susan K , Jeong Sung Yeop , Watkins Marcus , Fortunato Manuela , Alippe Yael , Link Daniel C , Mbalaviele Gabriel , Civitelli Roberto
Published: February 2017

N‐cadherin inhibits osteogenic cell differentiation and canonical Wnt/β‐catenin signaling in vitro. However, in vivo both conditional Cdh2 ablation and overexpression in osteoblasts lead to low bone mass. We tested the hypothesis that N‐cadherin has different effects on osteolineage cells depending upon their differentiation stage. Embryonic conditional osteolineage Cdh2 deletion in mice results in defective growth, low bone mass, and reduced osteoprogenitor number. These abnormalities are prevented by delaying Cdh2 ablation until 1 month of age, thus targeting only committed and mature osteoblasts, suggesting they are the consequence of N‐cadherin deficiency in osteoprogenitors. Indeed, diaphyseal trabecularization actually increases when Cdh2 is ablated postnatally. The sclerostin‐insensitive Lrp5A214V mutant, associated with high bone mass, does not rescue the growth defect, but it overrides the low bone mass of embryonically Cdh2‐deleted mice, suggesting N‐cadherin interacts with Wnt signaling to control bone mass. Finally, bone accrual and β‐catenin accumulation after administration of an anti‐Dkk1 antibody are enhanced in N‐cadherin–deficient mice. Thus, although lack of N‐cadherin in embryonic and perinatal age is detrimental to bone growth and bone accrual, in adult mice loss of N‐cadherin in osteolineage cells favors bone formation. Hence, N‐cadherin inhibition may widen the therapeutic window of osteoanabolic agents. © 2017 American Society for Bone and Mineral Research.
Effects Of Hypoxia in Long‐Term In Vitro Expansion of Human Bone Marrow Derived Mesenchymal Stem Cells
Authors: Pezzi Annelise , Amorin Bruna , Laureano Álvaro , Valim Vanessa , Dahmer Alice , Zambonato Bruna , Sehn Filipe , Wilke Ianaê , Bruschi Lia , Silva Maria Aparecida Lima da , Filippi‐Chiela Eduardo , Silla Lucia
Published: February 2017

Mesenchymal stem cells (MSC) are considered multipotent stromal, non‐hematopoietic cells with properties of self‐renovation and differentiation. Optimal conditions for culture of MSC have been under investigation. The oxygen tension used for cultivation has been studied and appears to play an important role in biological behavior of mesenchymal cells. The aim is characterize MSC in hypoxia and normoxia conditions comparing their morphological and functional characteristics. Bone marrow‐derived mesenchymal stem cells obtained from 15 healthy donors and cultured. MSC obtained from each donor were separated into two cultivation conditions normoxia (21% O2) and hypoxia (three donors at 1%, three donors at 2%, five donors at 3%, and four donors at 4% O2) up to second passage. MSC were evaluated for proliferation, differentiation, immunophenotyping, size and cell complexity, oxidative stress, mitochondrial activity, and autophagy. Culture conditions applied did not seem to affect immunophenotypic features and cellular plasticity. However, cells subjected to hypoxia showed smaller size and greater cellular complexity, besides lower proliferation (P < 0.002). Furthermore, cells cultured in low O2 tension had lower mitochondrial activity (P < 0.03) and a reduced tendency to autophagy, although oxidative stress did not vary among groups (P < 0.39). Oxygen tension seems to be a key regulator of cellular adaptation in vitro, and metabolic effects underlying this variable remain undescribed. Heterogeneity or even lack of results on the impact of oxygen concentration used for expanding MSC highlights the need for further research, in order to optimize conditions of cultivation and expansion and achieve greater safety and therapeutic efficacy. J. Cell. Biochem. 118: 3072–3079, 2017. © 2017 Wiley Periodicals, Inc.
Pharyngeal Reconstruction After Laryngectomy
Authors: Applebaum Edward L. , Levine Howard L.
Published: February 2017

A method of pharyngeal reconstruction following laryngectomy is described. In 44 successive laryngectomies using this technique, no postoperative pharyngocutaneous fistulas occurred. Ten of the patients had received full courses of radiation therapy prior to the surgical procedure and had recurrent carcinomas. Other reports have noted that laryngectomy following full courses of “unplanned preoperative” radiation therapy is usually associated with a high incidence of postoperative pharyngeal fistula. The pharyngeal fistula problem, and the pharyngeal repair that was used in our series, are discussed. The pharynx was closed carefully in three layers with fine, absorbable sutures, and a submucosal inverting technique was used for the important mucous membrane closure. Tube feedings were used for two weeks after surgery. A high incidence of pharyngocutaneous fistula after laryngectomy in the irradiated patient can be prevented.
Dermatomyositis a Vocal and Swallowing Disease Entity
Authors: Metheny John A.
Published: February 2017

The otolaryngologist must consider the diagnosis of dermatomyositis when he examines patients who complain of hoarseness, dysphagia or have symptoms referable to the tongue or upper esophageal and laryngeal musculature. It is the rarest of the so‐called collagen diseases. There is a 50% mortality rate within the first two years but spontaneous remissions are seen.

Dermatomyositis is a collagen disease in which polymyositis with creatinuria and accompanying dermatitis and periorbital “heliotrope” edema are the distinguishing characteristics. No other collagen disease has such a strikingly consistent creatinuria.

Dermatomyositis may follow an acute infectious process or be related to a cancer process. Of dermatomyositis patients, 17% to 50% will demonstrate a malignant process. Treatment of the malignancy may be followed by remarkable improvement in the dermatomyositis.

The polymyositis usually causes dysphagia, dysphonia and tongue weakness. Laboratory tests are not of much help in diagnosis. Diagnoses depends upon muscle biopsy. Urine creatine is increased and creatinine is decreased. Lactic dehydrogenase, transaminase, aldolase and creatine phosphokinase with isoenzymes are increased secondary to the muscle degenerative process. Electromyography is helpful in determining biopsy site. Radiologic findings show diseased portions of the esophagus to gape (“the vallecular sign”) and bolus propulsion to be defective. Cinefluoroscopy and esophageal motility studies show absent esophageal motility.

Muscle biopsies show parenchymal and interstitial changes of nonspecific character and degree. Primarily, the disease must be differentiated from disseminated lupus erythematosus and scleroderma.

Prednisone is the drug of choice for treatment using a descending dosage scheduled according to the patient's objective improvement and serum enzyme studies. In resistant cases, immuno‐suppressive agents such as methotrexate have been effective. Other agents have been useful.

The etiology of the disease is unknown. Picornaviruses and other viruses have been implicated. Current knowledge considers dermatomyositis to be a disease in which an autoimmune response to an antigen causes muscle damage with specific cytotoxicity of muscle cells being produced by the action of lymphocytes and the release of lymphotoxin.
Experiences with Parieto‐Occipital Flaps in Hair Transplantation
Authors: KabaKer Sheldon
Published: February 2017

Parieto‐occipital flap operations were successfully performed on patients with hereditary or traumatic baldness. The indications for this procedure, the techniques of the operation, and the postoperative morbidity and complications are described.
The Thirty Degree Transposition Flap
Authors: Webster Richard C. , Davidson Terence M. , Smith Richard C.
Published: February 2017

The rhomboid and other 60° transposition flaps have theoretical and practical disadvantages for many applications. A better flap for these is one having an angulation of 30° at its distal end. When this 30° flap is combined with the M‐plasty, a versatile and cosmetically favorable repair is provided for many surface defects. In fact, over the years, it has become our most useful method of closure with flaps. Fundamentally, it allows sharing of tensions of closure better than does the rhomboid flap, produces less level disparities or protrusions than does any 60° flap, and its resulting scar length is only fractionally longer than that of the rhomboid flap.

Rhomboid and other 60° angle flaps have been exceedingly valuable tools to many surgeons; the 30° flap combined with M‐plasty should be significantly more useful.
Significance of Node Biopsy Before Definitive Treatment of Cervical Metastatic Carcinoma
Authors: McGuirt W. Fred , McCabe Brian F.
Published: February 2017

A survey was made of 714 radical neck dissections done alone or in combination with resection of a primary malignancy. Sixty‐four (8.9%) of the patients had had a cervical node biopsy before diagnosis and definitive treatment. The complications of wound necrosis, local cervical recurrence, and distant metastasis were significantly higher in those patients than in patients who had had no biopsy or who had had biopsy only at the time of definitive treatment.

When 40 of the 64 patients were matched on the basis of age, sex, histological diagnosis, site and stage of the lesion and treatment protocol with 40 patients who had had no biopsy, this trend toward a higher complication rate when previous biopsy was done continued and was significantly higher for distant metastasis. The authors believe that these findings quantitatively confirm the accepted belief that, except for instances when no primary lesion can be found and the cervical mass must be biopsied for the purposes of diagnosis, such biopsy increases local complications and, by increasing the incidence of distant metastasis, decreases the chance for survival.
Temporal Arterial Ligation in Head and Neck Surgery with Absorbable Sutures
Authors: Fee Willard E. , Okamoto Eric , Spellman Michael , Ward Paul H.
Published: February 2017

Temporary arterial ligation is a useful concept in head and neck surgery for situations dealing with potential recurrent hemorrhage or recurrent vascular neoplasms. In this study, several absorbable sutures, including plain gut, chromic gut, and polyglycolic acid were used to ligate the common carotid artery in dogs. Arterial patency was followed by serial selective arteriograms. Only polyglycolic acid sutures proved to be a reliable material to achieve transient arterial occlusion.
Relationship between Laryngoceles and Laryngeal Carcinomas
Authors: Micheau Christian , Luboinski Bernard , Lanchi Patrice , Cachin Yves
Published: February 2017

Because X‐ray evaluation of the larynx is an unreliable method of detecting laryngoceles, a study based on the systematic measurement of the ventricular depth in surgical specimens was carried out to determine the frequency of laryngoceles and their relationship to laryngeal carcinomas. The frequency of laryngoceles was found to be about 2% in the normal larynx. The frequency in laryngeal cancer specimens was about 18%. This difference demonstrated the role of cancer in the genesis of laryngoceles. A close relationship between the ventricular diverticuli and the tumors was observed on microscopic examination in half of the laryngeal carcinomas associated with laryngoceles. These carcinomas can be considered to have developed on the laryngoceles. Depending upon the degree of tumor spread and the number of laryngoceles involved, different types of carcinoma developing in laryngoceles can be recognized. This particular form of tumor can be misinterpreted as an ulcerated vestibular tumor, in which case inappropriate treatment may be tried.
Results of Homografts in Middle Ear Surgery
Authors: Wehrs Roger E.
Published: February 2017

Anatomical and hearing results following the use of the homograft tympanic membrane and ossicles either in combination or separately are reported for the period 1968 through 1975. The study is divided into two parts, the first covering the primary years 1968 through 1971, and the latter covering the last four years, 1972 through 1975.

The original technique was to cover completely the homograft tympanic membrane with a canal skin graft. During the year 1969 new and different techniques were attempted. Unfortunately this resulted in a marked increase of graft failures; therefore, there was a prompt return to the original technique, which has been used without change throughout the study.

The graft take rate for the first four years which included 1969 was 92%. There was a slight increase to 96% during the second part of the study. The hearing results show a greater discrepancy for the two periods with 89% of the patients receiving a satisfactory hearing result during the last four years, compared to 77% for the earlier period.
Air Caloric Stimulation With Tympanic Membrane Perforation
Authors: Barber Hugh O. , Harmand William M. , Money Kenneth E.
Published: February 2017

Warm air caloric stimulation in an ear with tympanic membrane perforation or mastoidectomy cavity often causes contralateral nystagmus. Secondary nystagmus is common. Our evidence with squirrel monkeys and patients indicates that the primary “inversion” results from endolymph cooling due to evaporative cooling of the mucus lining the middle ear cavity, by the dry air stimulus. Disconjugate horizontal nystagmus was found in a patient with large eardrum perforation, after cold air caloric stimulation. The effect probably resulted from stimulation of the anterior or posterior vertical semicircular canal. Inverted or disconjugate caloric nystagmus after air stimulation is much more frequently due to tympanic membrane perforation, or moisture in the external ear, than to central nervous system disease.
Stapes Gusher And Klippel‐Feil Syndrome
Authors: Daniilidis J. , Maganaris T. , Dimitriadis A. , Iliades T. , Manolidis L.
Published: February 2017

The stapes gusher which is the most dramatic complication of stapedectomy arises from an abnormal communication between the subarchnoid and perilymphatic spaces. This congenital defect may be associated with other anomalies such as the Klippel‐Feil syndrome. Two cases of stapes gusher in patients with congenital fixation of the footplate are described. One of them was combined with Klippel‐Feil syndrome. The object of this paper is to emphasize the necessity of a complete preoperative examination of all cases of congenital footplate fixation.
Meibomian Gland Adenocarcinoma of the Eyelid with Neck Metastasis
Authors: Maniglia Anthony J.
Published: February 2017

Meibomian sebaceous gland adenocarcinoma of the eyelid is a rare lethal neoplasm. It accounts for less than 1% of all eyelid tumors. There are approximately 200 cases described in the literature. The incidence of regional metastases is 17–28%. Once metastases are present, only half of the patients survive five years.

Presented are two cases with neck node metastases. In one of the patients the primary lesion was initially treated with radiation therapy with an unsuccessful result. Subsequently full thickness, wide excision of the lower lid was required to control the primary. Eyelid oculoplastic reconstruction was performed using a nasolabial rotation skin flap lined with nasal septal composite graft (cartilage and mucosa).

Orbital exenteration was necessary to control the primary tumor in the other patient.

The regional metastases in both patients were treated with parotidectomy with preservation of the facial nerve, radical neck dissection and postoperative radiation therapy. One of the patients with poorly differentiated adenocarcinoma died due to brain metastasis.

I feel that combined treatment of radical surgery to the primary site, parotidectorny, radical neck dissection and planned postoperative radiation therapy may improve the fiveyear survival of patients with regional node metastases.