bluuebunny/crossref_metadata_2025 huggingface dataset:
Presentation and Management of Neck Abscess: Have Things Changed over a 20‐Year Period?
Authors: Mazhar Kashif , Larro‐Popkin Ariel , Masood Kamil , Rice Dale H.
Published: August 2013

Objectives:

Our recent clinical experience with deep neck space infection indicated difference in the presentation, etiology, and bacteriology compared to previously published report from our institution. Hence we decided to evaluate 1) change in the presentation, physical examination, bacteriology, and empiric antibiotic therapy for patients with deep neck space abscess compared to previously published report and, 2) incidence of methicillin‐resistant Staphylococcus aureus (MRSA) related infection in our patient population.

Methods:

Institutional Review Board approved retrospective analysis of patients who underwent incision and drainage of neck abscess in the operating room between 2008‐2012 at LAC+USC Medical Center. Comparison was made with previously published historical data. Data analysis was done using SAS 9.1.

Results:

44 patients were included in the present study compared to 50 in previously published study. Compared to previously published report from our institution, there has been a statistically significant difference in 1) most common presenting symptom: dysphagia (64%) vs pain (76%); 2) location of neck abscess: parapharyngeal (54%) vs anterior triangle (28%); 3) etiology: upper respiratory tract infection (URI) (41%) vs intravenous drug abuse (IVDA) (28%); 4) higher prevalence of anaerobic bacteria (86%) vs 50%; 5) MRSA was present in only 1 (2%) patient; 6) Clindamycin was empiric antibiotic in 34 (77%) of the patients, with the need for change after culture report in 5 (11%) patients. Chi‐square p‐value was <0.05 for all comparisons.

Conclusions:

URI and odontogenic infections are now the major cause of neck abscesses compared to IVDA in previous report. Clindamycin is an appropriate empiric antibiotic. MRSA incidence is low.
The Cost and Inpatient Burden of Treating Mandible Fractures: A Nationwide Inpatient Sample Database Analysis
Authors: Pena Israel , Guy William M. , Zevallos Jose Pedro
Published: August 2013

Objectives:

At the conclusion of this presentation, the participants should be able to discuss the patient demographics, hospitalization characteristics, and costs associated with the treatment of mandible fractures. Study design: Cross‐sectional study.

Methods:

A cross‐sectional analysis using the 2009 Nationwide Inpatient Sample Database to identify patients hospitalized for isolated mandible fractures.

Results:

1481 patients were identified with isolated mandible fractures. The average age of patients was 31, and 93.5% were male. Forty‐six percent were White, 30% African‐American, 14% Hispanic, 9% other, and 1% Asian. Twelve percent of patients presented with a history of alcohol abuse, 7.2% drug abuse, and 7.7% mental illness. Forty percent were from the lowest median household income quartile, and 75% were uninsured or had Medicaid. Thirty‐nine percent of patients underwent surgery within 24 hours of admission, the average length of stay (LOS) was 2.95 days, and average cost of hospitalization was $35,804. Increased LOS was associated with alcohol abuse (3.7 vs. 2.9 days, p<0.001), drug use (4.7 vs. 2.8 days, p<0.001), mental illness (3.9 vs. 2.9 days, p=0.001), and age greater than 40 years (3.8 vs. 2.7 days, p<0.001). Increased total cost was associated with drug use ($56,600 vs. $34,391, p<0.001) and alcohol abuse ($42,343 vs. $34,943, p=0.011).

Conclusions:

Males, persons of low socioeconomic status, and African‐Americans comprise a disproportionately high percentage of mandible fracture patients treated nationally. Healthcare expenditures associated with the treatment of mandible fractures are higher for older patients, those with mental illness, and those with a history of substance abuse.
Representation of Women in Otolaryngology on Editorial Boards
Authors: Chaikhoutdinov Irina , Ghossaini Soha N. , Patel Hetal , Brodsky Linda S.
Published: August 2013

Objectives:

Investigate the involvement of women on the editorial boards of otolaryngology journals.

Methods:

Five journals were surveyed from 2006 through 2012. The number and position of women were tracked. Characteristics studied included ethnicity, board certification, geographic location, and academic rank using data extracted from publicly available sources. Journal impact was compared to board turnover and diversity.

Results:

Over the last 7 years, most journals increased their representation of women on editorial boards, with two displaying rates of 23.5% and 24.6% in 2012. Four journals increased their number of women with the highest percent of women and greatest board turnover associated with the greatest increases in impact. Of the 48 women noted to be on the editorial boards of these 5 journals, 9 (20%) are members of more than one board (2 on 3 boards, and 7 on 2 boards); of the 315 men, 67 (21%) were on more than one board, and 10 (3%) on more than two boards. Overall board turnover rates remain low; one journal had no turn over and also had the lowest percent of women. Women were more likely to be Asian than males (21% vs. 9%, P < 0.001) and were board certified fewer years (mean 19.7 vs. 25.3, P < 0.002). No differences in academic rank were noted.

Conclusions:

Between 2006 and 2012 proportionate rank of women on otolaryngology boards is noted. Their progression and strategies to achieve editor‐in‐chief positions are discussed.
Teaching and Assessing Microscopy Skills in Medical Students
Authors: Wong Stephanie Jung‐Ying , Devaiah Anand K.
Published: August 2013

Objectives:

Otolaryngology residents learn important skills as medical students, but typically not binocular microscopy. This study aims to 1) evaluate instructional methods teaching medical students binocular microscopy, 2) assess student ability to perform simulated clinical tasks, and 3) measure student feedback on this training.

Methods:

Fifteen students were randomized into one of three training arms: 1) video instruction, 2) personal demonstration, and 3) combination of video and personal instruction. Time to complete two tasks was used to determine training effectiveness. Task 1: focus on an object in a cup; Task 2: focus and use alligator forceps to remove the object from the cup. For each subject, three trials were done for each task at three magnifications. Participants filled out pre‐ and post‐study questionnaires.

Results:

Groups were compared using one‐tail t‐tests. For Task 1, there was no significant difference between educational methods. For Task 2, those who received any video instruction were significantly faster at focusing than those who only received personal instruction (10.35s and 11.19s vs. 14.80s; P < 0.01 and P = 0.02). Those who had video and personal instruction were faster at the manual task than those receiving only personal instruction (17.58s vs. 23.02s; P = 0.04). Post‐training questionnaires showed greater interest in surgical specialties, particularly otolaryngology.

Conclusions:

Video instruction plus personal instruction enhances learning clinical microscopy. This may be extrapolated to other skills students and residents must learn. This training is perceived as positive by students and may be important in teaching, as well as in the residency selection process.
Three‐Dimensional, Virtual Technologies and Haptic Simulation Temporal Bone Surgical Training
Authors: Liu Chih‐Hsien , Fang Te‐Yung , Wang Pa‐Chun , Yeh Shih‐Ching
Published: August 2013

Objectives:

Simulation has become an important teaching format in medical education; it is especially useful to teach complex anatomy of temporal bone (TB). We developed a TB simulator consisting of 1) software with high resolution three‐dimensional (3D) TB volumetric images; 2) A haptic device from which the user can sense the force feedback and the sound of drilling. The aim of this study is to evaluate and compare the effectiveness of TB simulator in medical student teaching.

Methods:

A total of 18 rotating medical students were randomly assigned to the “simulation” (N = 13) or “traditional’ (N = 5) TB training groups. Both groups were oriented with TB anatomy and dissection procedures by slide presentation and didactic lecture. The simulation group practiced on the simulator to complete 1 session of TB dissection. Written examinations were given at day 0 and day 14. Using paired t‐test, the before‐after test scores were compared between simulation and traditional groups.

Results:

Both groups showed significant improvement in their comprehension to TB anatomy. The anatomy comprehension showed 10% improvement in traditional and 20% in simulation groups, respectively (P < 0.05) The written examination showed that the “simulation” group had significantly greater magnitude of improvement (40 vs. 20 points) than “traditional” group. (P < 0.05).

Conclusions:

The test results confirm that the 3D, virtual technology, and haptic simulator might be a worthwhile and superior substitute to traditional class‐based lecture in teaching TB anatomy.
Unexplained Recurrent Subcutaneous Emphysema of the Face, Neck, and Mediastinum in an Otherwise Healthy Adult
Authors: Rangarajan Sanjeet V. , Agrawal Amit
Published: August 2013

Objectives:

1) Understand the presentation and work‐up of a rare cause of recurrent, diffuse subcutaneous emphysema in the head and neck. 2) Apply the findings from this case report and related literature.

Methods:

We describe a case of a 23 year‐old man who presented to the Emergency Department at a tertiary care center complaining of an acute onset of diffuse swelling throughout his face, neck, and chest.

Results:

The full diagnostic work‐up for this patient included routine laboratory studies, computed tomography (CT) imaging of the head, neck, and chest, fluoroscopic esophagram, and prior esophagogastroduodenoscopy and bronchoscopy. Thoracic and otolaryngology consultations were sought. The patient demonstrated a leukocytosis and severe, diffuse subcutaneous emphysema throughout the face, neck, and mediastinum visible on CT imaging. The remaining work‐up was negative for organic causes. Several small, inconspicuous wounds were noticed on the patient's right cheek and buccal mucosa, consistent with self‐inflicted needle injuries. It was determined that the patient had intentionally created percutaneous facial and neck defects with a needle and expired against a closed glottis to create the observed symptoms. A psychiatry consultation was sought, and the patient was discharged shortly thereafter in stable condition. A review of the literature suggests that this factitious etiology of subcutaneous emphysema is quite rare and emphasizes the importance of the physical exam the consulting otolaryngologist may employ when evaluating new patients.

Conclusions:

Factitious subcutaneous emphysema in the United States is a rare, seldom reported finding in the otolaryngology literature but may be suspected when the patient has a prior history of psychiatric disorder or self‐harm and work‐up for organic causes is negative.
Analysis of the Effect of Metformin in the Treatment of Oral and Oropharyngeal Cancer
Authors: Seok Jungirl , Kim Hyo‐Sang , Kim Heejin , Hah J. Hun , Sung Myung‐Whun , Ahn Soon‐Hyun , Jeong Woo‐Jin
Published: August 2013

Objectives:

Patients with diabetes mellitus (DM) are at significantly higher risk for many forms of cancers. There have been studies about the effect of metformin in cancer, but few studies presented in head and neck cancer. In this study, we investigated the anti‐cancer effect of metformin in oral and oropharyngeal cancer.

Methods:

Patients with type II DM who were diagnosed with oral and oropharyngeal cancers and treated in our institution from 2004 through 2010 were enrolled. Medical records, imaging, and pathologic reports were reviewed retrospectively.

Results:

Of 2286 patients who were diagnosed with head and neck cancers in that period, 8.6% of patients had type II DM, and eventually 68 patients were enrolled. Half of them had history of using metformin, and mean age was 69.3 years. Metformin usage did not affect overall survival (P =. 359) and recurrence (P =. 538) in oral and oropharyngeal cancer patients. The same results were shown when patients limited in squamous cell carcinoma and early stage cancer.

Conclusions:

Metformin usage was not associated with favorable survival or recurrence outcomes in oral and oropharyngeal cancer patients. Subset analysis revealed possible association of metformin usage with pathology/stage. A large prospective cohort study is warranted to elucidate the effect of metformin usage on oral and oropharyngeal cancer.
Curcumin Analogue May Be Used as Therapeutic Agent for Head and Neck Cancer
Authors: Patel Ronica R. , Masood Rizwan , Sinha Uttam K. , Prakash G. K. Surya
Published: August 2013

Objectives:

Curcumin has shown anti‐proliferative effects in multiple cancers and is an inhibitor of NF‐kB. Downstream curcumin inhibits various genes which play an important role in tumor growth and metastasis. However, curcumin's effects are greatly diminished due to its poor solubility. This study compared the effect of curcumin against more soluble curcumin analogues on the cell proliferation and gene expression in head and neck cancer (HNC) cell lines.

Methods:

Two novel curcumin analogues were synthesized, 1‐flouro‐curcumin (CF1) and 2‐flouro‐curcumin (CF2), which have shown increased solubility compared to curcumin. Our lab developed three HNC cell lines: 351GFP, 351GFP G1, and 351GFP G2. 351GFP G1 and 351GFP G2 are more metastatic HNC cell lines. The effect of CF1 and CF2 was tested in these three cell lines on the cell growth and the inhibition of genes (IL8, MMP7, COX2, and epidermal growth factor receptor [EGFR]) which are important in growth and metastasis of HNC.

Results:

The IC50s of curcumin, CF1, and CF2 in the 351GFP G1 cell line are 7.38microM, 0.33microM, and 0.1microM, respectively. Curcumin analogues were 20‐80 times more potent than curcumin. Western Blot analysis showed that curcumin analogues blocked expression of IL8, MMP7, COX2, and EGFR. The analogues also showed several fold greater inhibition of these genes compared to curcumin in the HNC cell lines.

Conclusions:

Both curcumin analogues show greater anti‐proliferative effect than curcumin, inhibiting cell proliferation and expression of genes involved in HNC growth and metastasis. Because of their increased activity, curcumin analogues may be of potential benefit in future HNC therapies.
Dynamic Risk Stratification for Recurrence in Medullary Thyroid Cancer
Authors: Ho Allen S. , Palmer Frank L. , Shah Jatin P. , Tuttle R. Michael , Ganly Ian
Published: August 2013

Objectives:

Develop a dynamic postoperative risk stratification tool for medullary thyroid cancer (MTC) recurrence, based on patient, tumor and treatment characteristics.

Methods:

124 MTC patients who were treated entirely at Memorial Sloan‐Kettering Cancer Center between 1986‐2010 were identified. Immediate postoperative risk groups were defined as low, intermediate, and high based upon extent of extrathyroid extension, presence of regional or distant metastases and preoperative calcitonin level. Response to therapy categories were then defined as excellent, acceptable, and poor based upon 6‐month calcitonin level and presence of radiological structural disease. Overall risk groups based upon the immediate postoperative risk and the response to therapy category were then defined.

Results:

The median age was 55 years (range: 6‐88). Median follow‐up was 66 months (range: 1‐229). In the immediate postoperative risk groups, the 5‐year risk of structural recurrence for low, intermediate, and high risk groups was 5.9%, 24.9%, and 67.8% respectively (P < 0.001). For the overall risk groups, the 5‐year risk of structural recurrence for low, intermediate, and high risk groups was 3.2%, 24.0%, and 45.9% (P < 0.001). Low risk patients with poor responses increased their recurrence risk from 5.9% to 24.9%, while high risk patients with excellent responses reduced their recurrence risk from 67.8% to 24.9%.

Conclusions:

A clinically useful dynamic risk stratification tool to predict risk of recurrence in MTC patients over time is introduced. Its prognostic value may augment patient counseling on prognosis and help determine the frequency and extent of follow up investigations.
The Effect of Geography on Survival of Patients with Oral Cavity Squamous Cell Carcinoma
Authors: Zhang Han , Nguyen T. T. Jean , Jeffrey Caroline C. , Biron Vincent L. , O'Connell Daniel A. , Harris Jeffrey R. , Seikaly Hadi
Published: August 2013

Objectives:

Patients with oral cavity squamous cell carcinoma (OCSCC) residing in urban setting have traditionally improved survival. The main theory of the urban effect on survival is improved access to healthcare. We aimed to evaluate effects of residing in an urban setting on the survival of patients with OCSCC in a system with universal access to health care.

Methods:

This is a population based study set in the province of Alberta, Canada. Demographic, pathologic, treatment, and survival data was obtained from all patients diagnosed with OCSCC in the province of Alberta between 1998 and 2010. The overall and disease specific survival were calculated using Kaplan‐Meir and Cox‐Regression analysis. The log rank test was employed for comparisons between groups.

Results:

A total of 624 patients were included. There was no difference between patients residing in an Urban or rural setting in regards to, stage, demographics, and treatment paradigms. Urban patients benefitted from 5 and 10 year overall survival improvements (77.4%, P = 0.04) and early stage OCSCC (83.4%, P = 0.002).

Conclusions:

OCSSC patients residing in an urban setting have improved survival. Factors other than access to health care seem to be causing this effect.
Endoscopic Evaluation of the Local Complications after Radiotherapy and Radiochemotherapy for Nasal Cavity, Nasopharynx Neoplasms
Authors: Kizler‐Sobczyk Krystyna , Sobczyk Grzegorz , Wójtowicz Piotr , Nowakowski Filip , Mazurek Maciej J. , Kawecki Andrzej , Krzeski Antoni
Published: August 2013

Objectives:

Determine complications of the radiotherapy or radiochemotherapy in patients with nasal cavity, pharynx and soft palate neoplasms in endoscopic examination.

Methods:

Out of 184 patients for nasal cavity, pharynx or soft palate neoplasm, 65 patients with previous surgical intervention were excluded from the study. Group of 119 patients (19‐87 years old) were evaluated endoscopically in the Head and Neck Cancer Department of the Memorial Cancer Center in Warsaw between 2000 and 2012. Follow up was from 30 days up to 12 years. 115 patients were treated for cancer, 1 for sarcoma and 3 for melanoma. Nasopharynx was a primary localization in 74 cases, nasal cavity in 9 cases, soft palate in 4 cases. In 32 cases there were metastases to the regional lymph nodes without the primary focus. 31 patients were treated by radiotherapy, and 88 by radiochemotherapy.

Results:

The following complications were diagnosed: 47 skin and mucosal reactions, 23 permanent nasal cavity obturations, 11 hearing impairments, 6 ear leakages, 2 tinnituses, 2 vision impairments, 2 trismuses, 2 obturations of nasolacrimal canal, 2 Eustachian tube obturations, 2 palatal movement impairments 1 case of mandible bone exposition. There were also 3 cases of tissue necrosis and one case of bleeding. There were 13 cancer recurrences treated by 3 salvage surgeries, 1 brachytherapy, and 3 palliative chemotherapies.

Conclusions:

The regular endoscopic examinations allows to control negative aspects associated with radiotheraphy or radiochemotherapy. Complications and recurrence can be diagnosed easily by non‐invasive, method. Endoscopic evaluation provide quick and precise assessment of treatment results.
Exome Sequencing Identifies Patterns of Disruptive Mutations in Oropharyngeal Squamous Cell Carcinoma
Authors: Janus Jeffrey R. , Laborde Rebecca R. , Olsen Steven , Olsen Kerry D. , Moore Eric J. , Kasperbauer Jan L. , Smith David
Published: August 2013

Objectives:

1) Describe the frequency of disruptive gene mutations in current or never smoking patients. 2) Analyze coding regions to identify tumor specific nonsense mutations in genes related to tumor development and critical signaling pathways.

Methods:

Tumor and adjacent normal oropharyngeal mucosal samples were obtained from 8 patients undergoing surgical treatment of oropharyngeal squamous cell carcinoma (OPSCC) from 2010‐2012 representing HPV positive current and never smoking groups. Next generation sequencing following exome enrichment was performed to identify various classes of variants from each sample. Comparative analysis was conducted using Genesifter from PerkinElmer.

Results:

A global analysis of all mutation types determined that tumor tissues from current smoking patients contain 20% more missense mutations than never smoking groups, resulting in an amino acid substitution. Current smoking patients have tumor specific nonsense mutations in coding regions enriched for tumor suppressor genes and displayed extensive evidence of identical mutation in tumor and adjacent normal tissue. Never smoking patients have a greater number of tumor specific mutations that enrich for genes related to immune system function.

Conclusions:

Gene mutations that result in truncated proteins are known to associate with cancer development. We have identified a panel of nonsense mutations in current smoking patients that represent tumor suppressor and cell cycle regulatory genes. This group also shows extensive evidence of field cancerization. Never smoking patients carry larger numbers of tumor specific mutations than enrich for genes related to immune system regulation. This may reflect the involvement of active HPV infection in this group.
Factors Associated with Hypothyroidism following Hemithyroidectomy: A Prospective Study
Authors: Chowsilpa Sanathorn , Tananuvat Rak
Published: August 2013

Objectives:

Analyze factors associated with hypothyroidism following hemithyroidectomy.

Methods:

Prospective study at Chiang Mai University Hospital, Thailand. Patients who were scheduled for a hemithyroidectomy between September 2010 and April 2012 were recruited for the study. Demographic data, pre‐ and post‐operative thyroid function tests, resected side, weight and pathological diagnosis of resected thyroids between the euthyroid and hypothyroid groups were analyzed.

Results:

Of 50 cases, 11 cases with documented malignancy, or who required a total thyroidectomy, or who were lost to follow up were excluded. Thirty‐nine cases included seven males and 32 females, age ranged from 19 to 71 years (46.9±13.8 years). The resected thyroids were from the left (25) and the right (14). The pathology reports were as follows: adenomatous goiter (67%), follicular adenoma (20%), colloid cyst (5%), chronic lymphocytic thyroiditis (3%), and others (5%). Eight cases (20.5%) had hypothyroidism postoperatively at eight to ten weeks. The pre‐operative thyroid‐stimulating hormone (TSH) level of the hypothyroid group was normal but significantly less than in the euthyroid group (P = 0.009). Age, gender, pre‐operative free T4 and free T3, weight and resected side showed no difference between the two groups.

Conclusions:

One‐fifth of the hemithyroidectomy patients developed hypothyroidism within eight to ten weeks post‐operatively. Clinicians should be aware of post‐operative hypothyroidism and provide prompt treatment, particularly in patients with a pre‐operative high normal TSH level.
Feasibility and Monitoring of a Free Myofascial Anterolateral Thigh Flap in Head and Neck Reconstruction
Authors: Plein Colleen T. , Cannady Steven B.
Published: August 2013

Objectives:

1) Explore the feasibility of a free anterolateral thigh myofascial flap as a reconstructive option in patients with large body habitus. 2) Present a prospective case series of patients in which this flap was successfully utilized for head and neck reconstruction. First introduced in China, the anterolateral thigh free flap is being increasingly used in head and neck reconstruction. However, patient body habitus, particularly in North American patients, can contribute to flap bulkiness and pose a significant surgical challenge.

Methods:

In a prospective case series, feasibility and results using a myofascial anterolateral thigh free flap were studied, an option previously unpublished in the head and neck reconstructive literature. We present five cases of its successful use in a variety of reconstructive situations. It was utilized twice for hemiglossectomy, once for scalp reconstruction, and twice for skull base defects.

Results:

All five flaps survived. Primary monitoring was conducted routinely via needle prick of the myofascial flap or direct muscle inspection. No complications were encountered at the harvest or reconstructive site. The fascial flap was well vascularized and muscle remained viable, while atrophy occurred in follow up.

Conclusions:

The anterolateral thigh myofascial flap is a versatile composite tissue flap that allows the use of the anterolateral thigh site in patients with larger body habitus. It can be monitored using routine techniques with good reliability. This flap may have applications in cases where radial forearm or rectus may have been used but forearm or abdominal wall harvest morbidity is undesirable.
The Feasibility of Free Flap Surgery in Foreign Medical Missions
Authors: Rohde Sarah L. , Mannion Kyle , Zender Chad A. , Sinard Robert J.
Published: August 2013

Objectives:

Determine the feasibility and efficacy of microvascular free flap reconstruction of head and neck defects during foreign medical mission trips in the low resource setting.

Methods:

Retrospective review of foreign medical mission trips by a single tertiary care institution. Eight patients with benign tumors of the maxilla or mandible underwent microvascular free flap reconstruction of a head and neck defect following composite resection. Patient charts were reviewed for demographic data, reconstruction type, tumor location, pathology, length of stay, complications, and follow‐up.

Results:

Eight patients underwent free flap reconstruction during four trips taking place over the span of two years in three different hospitals in Kenya. Seventy‐five percent of patients were male and the average age was 26. Final pathology was benign in all patients. There were no flap failures. One patient had a small fistula managed with packing and secondary closure.

Conclusions:

Free flap reconstruction of head and neck defects is feasible in the foreign medical mission setting. Careful patient selection and diligent pre‐operative planning for supplies is necessary. Partnership with a local physician comfortable with the care of the patients in the post‐operative setting is extremely helpful.
Fine‐Needle Aspiration Cytology versus Direct Laryngoscopic Biopsy in Suspicious Laryngo‐Hypopharyngeal Masses
Authors: Parasuraman Lakshminarasimman , Singh Chirom A. , Sharma Suresh C. , Thakar Alok , Iyer Venkateswaran , Bhalla Ashu S.
Published: August 2013

Objectives:

Evaluate the feasibility and performance of ultrasound‐guided fine needle aspiration cytology (FNAC) of suspicious laryngo‐hypopharyngeal masses.

Methods:

Cross‐sectional study (2012‐2013). After routine clinical and radiological evaluation, patients with advanced laryngo‐hypopharyngeal masses were included in the study. Early lesions and vascular masses were excluded. In all patients, ultrasound guided FNACs were performed with a free‐hand technique by a single radiologist and direct laryngoscopic biopsies were done on the subsequent day.

Results:

A total of 10 patients met the criteria for the study. Nine patients were primary cases and one was recurrent. There were 8 males and 2 females in the age group of 40‐73 years. Ultrasound guided FNAC reported squamous cell carcinoma in 8 patients, atypical cells in one patient and the remaining one had inadequate specimen. There was no complication following the procedure. In direct laryngoscopic biopsies 8 patients were positive for squamous cell carcinoma and two were negative. Ultrasound guided FNACs in these two negative cases were positive for squamous cell carcinoma. One case was a recurrent tumor and in the other, direct laryngoscopic biopsies were done twice. Both the patients were inoperable due to advanced disease and palliative treatments were planned based on FNAC reports.

Conclusions:

Although biopsy under direct laryngoscopy remains the gold standard technique, ultrasound guided FNAC can be used to diagnose advanced laryngo hypopharyngeal lesions. It is simple, safe, cost effective, and done as an out‐patient procedure. It seems to be more beneficial in deep seated submucosal tumors.
Flexible CO2 Laser in the Head and Neck: Single Institution Outcomes for First 4 years
Authors: Lambert Aileen L. , Giddings Charles E. , Vaz Francis M. , O'Flynn Paul E.
Published: August 2013

Objectives:

Determine the surgical, oncological, and functional outcomes of patients treated with the flexible CO2 laser for head and neck lesions without robotic assistance.

Methods:

Retrospective case review of patients treated with the Omniguide® Flexible CO2 laser in the head and neck unit of a university teaching hospital.

Results:

21 patients underwent 24 procedures from January 2009 to January 2013. 15 procedures involved confirmed invasive carcinoma (T1 to T3). 5 patients underwent further surgery due to involved margins/early local recurrence. 6 month disease free survival was 77%. Other pathology included squamous papilloma, lymphoid hyperplasia, vascular lesions and severe dysplasia. Anatomic sites included larynx (n = 15), base of tongue (n = 8), and postnasal space (n = 1). One case required semi‐elective intraoperative tracheostomy, nasogastric tube and a 21 day stay. All other patients returned to oral intake prior to discharge (mean length of stay 1.5 days). No other airway complications were reported.

Conclusions:

Our experience using a CO2 phototonic bandgap laser fiber in head and neck disease without robotic assistance provides the first published oncological and functional outcomes for this new modality. Our data is representative of the diverse cases selected for this technique in our unit. Our 3 cases of T3 squamous cell carcinoma represent patients who declined laryngectomy. All other patients had anatomy which precluded accessing the lesions with a straight‐line CO2 laser. The cost per case is a significant factor (approximately GBP £500), but may be offset by reduced length of stay and improved morbidity compared with open resection.
Head and Neck Cancer Screenings in Suburban/Urban Populations in Michigan: Need for More Education
Authors: Ghanem Tamer A. H. , Jesse Michelle , Fei Naomi , Goldstein Eric , Rakitin Ilya , Shama Liat , Hall Francis
Published: August 2013

Objectives:

1) Assess self‐reported risk factors and knowledge gaps regarding head and neck cancer (HNC) risk factors in a multi‐ethnic urban versus suburban population. 2) Improve education regarding behavioral risk factors for HNC, including regarding the transmission of human papillomavirus (HPV).

Methods:

The current sample includes a total of 118 individuals who presented for free HNC screenings across urban and suburban sites. Ninety‐eight consented to complete behavioral risk questionnaires assessing for knowledge regarding HNC, ancestry, smoking/tobacco use, alcohol use, and sexual history.

Results:

Mean age was 56.63 years old (SD = 14.22, range 23 to 85), 60.2% female, predominantly African American (53.1%), Caucasian (42.7%), and other (4.1%). Those residing in an urban environment were more likely to be African American χ2(1, N = 98)=23.334, P < 0.001, have a history of treatment for some other cancer χ2(1, N=98)=6.063, P = 0.01, be a current smoker χ2(2, N=98)=5.885, P = 0.05, report more cumulative years consuming alcohol t(85)=2.050, P = 0.04, be willing to volunteer to promote awareness χ2(1, N=98)=4.866, P = 0.02, and feel the program increased their knowledge regarding HNC χ2(1, N=98)=4.726, P = 0.03, than those in a suburban environment.

Conclusions:

Free HNC screenings and related education are well received by a racially diverse urban population. HNC screenings should include evaluation of behavioral risk and specific knowledge associated with HNC.
HER2 and EGFR Gene Copy Number Alterations Are Predominant in High‐Grade Salivary Mucoepidermoid Carcinoma
Authors: Nakano Takafumi , Yamamoto Hidetaka , Hashimoto Kazuki , Yasumatsu Ryuji , Nakashima Torahiko , Oda Yoshinao , Komune Shizuo
Published: August 2013

Objectives:

Investigate the molecular mechanisms underlying the development of mucoepidermoid carcinoma (MEC).

Methods:

We investigated the MAML2 fusion status using reverse transcriptase‐polymerase chain reaction, and HER2 and epidermal growth factor receptor (EGFR) status using immunohistochemistry and chromogenic in‐situ hybridization in 31 cases.

Results:

MAML2 fusions were detected in 57.7% MECs analyzed, including 68.8% low‐grade, 50% intermediate‐grade and 33.3% high‐grade MECs. HER2 gene amplification was present in 14.3% MECs analyzed, including 25% intermediate‐grade and 42.9% high‐grade MECs. An increased EGFR gene copy number was detected in 14.3% MECs analyzed, and was correlated with both high tumor grade (P=0.0017) and worse outcome (P < 0.0001). Irrespective of MAML2 fusion status, all of 7 high‐grade MECs had an increased gene copy number of either HER2 or EGFR gene in a mutually exclusive manner, whereas such abnormalities were extremely rare in low‐ and intermediate‐grade MEC.

Conclusions:

These results suggest that HER2 or EGFR gene abnormality may play an important role in the development of high‐grade MEC, and also in the progression from MAML2 fusion‐positive low/intermediate‐grade to high‐grade in a subset of MEC. Furthermore, we suggest that high‐grade MEC consists of a heterogeneous group of tumors in terms of molecular pathogenesis in particular MAML2 fusion status.
High Risk HPV and Lymph Node Size in Single Node Metastasis of Oral Oropharyngeal Cancer
Authors: Kim Sang‐Yeon , Joo Young‐Hoon , Kim Chung‐Soo , Nam In‐Chul , Cho Kwang‐Jae , Kim Min‐Sik
Published: August 2013

Objectives:

Examine the relationship between high risk human papillomavirus (HPV) infection and lymph node size in patients with single node metastasis of oral and oropharyngeal carcinoma.

Methods:

The study included 48 subjects with squamous cell carcinoma,21 in the oral cavity and 27 in the oropharynx. High risk HPV in situ hybridization was performed to detect HPV infection. The pathologic N stages were 36 N1and 12 N2a.

Results:

The positive rate of high risk HPV in situ hybridization was 29% (14/48). There was a significant difference in the fraction positive high risk HPV between oral (9.5%) and oropharyngeal (44.4%) cancer (P = 0.008). The average diameter of positive lymph node was 20.7 ± 12.6 mm (range, 5‐54 mm). A significant positive correlation was found between high risk HPV status and lymph node size (P = 0.018). The mean lymph node diameter in cases with high risk HPV positive was 27.3 ± 13.1 mm, whereas in cases with high risk HPV negative was 18.0 ± 11.5 mm. Extracapsular spread was also significantly related to the lymph node size (P = 0.030). Patients with high risk HPV negativity (P = 0.043), advanced T stage (P = 0.009), or the presence of extracapsular spread (P = 0.038) had a significant adverse effect on 5‐year disease specific survival according to the Kaplan‐Meier survival curves.

Conclusions:

High risk HPV infection is significantly related to lymph node size in patients with single node metastasis of oral and oropharyngeal cancer.
HPV Status and TP53 Mutational Status as Prognostic Markers in Head and Neck Cancer
Authors: Tokumaru Yutaka
Published: August 2013

Objectives:

The mutation of TP53 is one of the most important genetic alterations in head and neck squamous cell carcinomas (HNSCCs). Human papillomavirus (HPV) is detected in a subset of HNSCCs. Several retrospective studies have shown that HNSCCs patients without TP53 mutations and HPV positive patients have significantly improved survival compared to other patients. We analyzed the HPV status and the TP53 mutations in the HNSCCs and examined the association with prognosis.

Methods:

A total of 67 patients with newly diagnosed stage III and IV squamous cell carcinoma of the head and neck which are all treated by chemoradiotherapy for organ preservation were enrolled in this study. TP53 mutations were analyzed using direct sequencing methods for exon 2 to 11. HPV detection and typing were analyzed by polymerase chain reaction (PCR) assay targeted to the E6 and E7 regions of the viral genome. TP53 mutational status and HPV status were compared with clinical outcome.

Results:

The high‐risk HPV was detected in 11 cases (16.4%) which were all oropharyngeal cancers. In addition, TP 53 mutation was detected in 41 cases (61.2%). The overall survival was good in order of an HPV‐positive group, TP53 wild type group and TP53 mutant group. Multivariate analysis revealed not only the T stage but also that this genetic classification correlated significantly to overall survival in HNSCCs.

Conclusions:

TP53 mutational status and HPV status are associated with prognosis and these genetic statuses are considered to be useful as molecular biomarkers for personalized treatment in HNSCCs.
A survey of rural primary school music education in Northeastern China
Authors: Sun Zuodong , Leung Bo Wah
Published: August 2013

China has been instituting national basic education curriculum reforms since 2001. This study provides an updated understanding of present-day, rural primary school music education in Northeastern China’s Tonghua region. A total of 126 rural primary music teachers and 674 students from 28 primary schools in the region were surveyed using a questionnaire. In addition, teachers were interviewed about the factors responsible for the current situation. The findings reveal that primary music education in the rural areas of North-east China is suffering from a number of problems including the inadequate provision of resources by local government, teachers’ lack of professionalism in terms of music education, and an inadequate understanding of the new curriculum reforms and rationales. The measures recommended to improve the current situation in the region may also provide insights that would prove useful for global consideration.
Ultrasound findings of subacute thyroiditis: a single institution retrospective review
Authors: Cappelli C , Pirola I , Gandossi E , Formenti AM , Agosti B , Castellano M
Published: August 2013

Background

High resolution ultrasonography features have also been described as having a useful supporting role in the diagnosis of subacute granulomatous thyroiditis (ST), and images are generally characterized by heterogeneous hypoechoic areas of the affected tissue with lack of flow on color Doppler US.

Purpose

To determine the sonographic features of subacute granulomatous thyroiditis.

Material and Methods

We reviewed the medical records of patients referred at the Endocrine and Metabolic Unit of our Institution between January 2010 and December 2011.

Results

A total of 7520 patients were evaluated in our department between January 2010 and December 2011. Among them, 22 (0.3%) patients had a diagnosis of ST (19 women and 3 men, 45.4 ± 9.7 year; range, 33–62 years). Ultrasound examination showed bilateral ST in 64% of patients. Thyroid volume was 13.2 ± 7.7 mL, without difference if ST was unilateral (13.2 ± 7.1 mL) or bilateral (13.9 ± 8.3 mL). On grayscale US, heterogeneous diffusely or focally marked hypoechoic areas, like “lava flow”, were found in all the lesions.

Conclusion

Our data confirm the high sensitivity of US in the diagnosis of ST: diffuse hypoechoic and confluent areas with the characteristic features like “lava flow”.
Dual-energy CT: clinical application in differentiating an adrenal adenoma from a metastasis
Authors: Shi Jiang Wei , Dai Hong Zhi , Shen Li , Xu Dong Feng
Published: August 2013

Background

Application of dual-energy CT in characterization of adrenal nodules has not been well evaluated.

Purpose

To evaluate the ability of dual-energy CT scan to differentiate an adrenal adenoma from a metastasis.

Material and Methods

Fifty-five patients presenting 63 adrenal nodules underwent dual-energy CT scan at tube voltages of 80 kVp and 140 kVp. Mean attenuation values were measured for every nodule at 80/140 kVp and at 40/100 keV. Mean attenuation value changes between 140 kVp and 80 kVp (MAVC140–80kVp) and mean attenuation value changes between 100 keV and 40 keV (MAVC100–40keV) were calculated.

Results

Of the 63 adrenal nodules available for analyses, 42 nodules were classified as adenoma (26 lipid-rich and 16 lipid-poor) and 21 were classified as metastases. MAVC140–80kVpand MAVC100–40keVof all adenomas (including lipid-poor and lipid-rich) were significantly higher than metastases ( P < 0.001). According to receiver-operating characteristic (ROC) curve analyses, areas under the ROC curve of MAVC140–80kVpand MAVC100–40keVfor diagnosing adrenal adenomas were both of 0.964. When the cut-off points were set at 2.42 HU and 6.95 HU for MAVC140–80kVpand MAVC100–40keV, the two parameters both had a sensitivity of 78.6% and a specificity of 100% in adenoma diagnosis.

Conclusion

Unique energy spectrum information provided by dual-energy CT scan displays a high capacity to distinguish adrenal adenoma from metastasis.
What makes music emotionally significant? Exploring the underlying mechanisms
Authors: Juslin Patrik N. , Harmat László , Eerola Tuomas
Published: August 2013

A common approach to study emotional reactions to music is to attempt to obtain direct links between musical surface features such as tempo and a listener’s response. However, such an analysis ultimately fails to explain why emotions are aroused in the listener. In this article, we propose an alternative approach, which seeks to explain musical emotions in terms of a set of underlying mechanisms that are activated by different types of information in musical events. We illustrate this approach by reporting a listening experiment, which manipulated a piece of music to activate four mechanisms: brain stem reflex; emotional contagion; episodic memory; and musical expectancy. The musical excerpts were played to 20 listeners, who were asked to rate their felt emotions on 12 scales. Pulse rate, skin conductance, and facial expressions were also measured. Results indicated that target mechanisms were activated and aroused emotions largely as predicted by a multi-mechanism framework.
Characterization of atmospheric plasma as a surface preparation process for the bonding of space composite materials
Authors: Zaldivar Rafael J , Steckel Gary L , Nokes James P , Morgan Brent A , Kim Hyun I
Published: August 2013

There is a growing interest in the use of atmospheric plasma treatment techniques for the surface preparation of fiber-reinforced composite hardware before bonding. In this article, we will discuss the effects of atmospheric plasma treatment on the chemical and physical properties of two types of composites (cyanate ester and epoxy) and the resultant mechanical properties. Atomic force microscopy and X-ray photoelectron spectroscopy were used to investigate the surface morphology and chemistry of the treated composites and were correlated to lap shear bond strengths. We observed a strong correlation between the increases in lap shear strength with the surface carboxyl concentration of the composite after treatment as verified by X-ray photoelectron spectroscopy. Changes in surface roughness appeared to be secondary in nature. As a result, we have separated the mechanical contributions caused by etching-induced surface roughness from chemical contributions due to formation of specific reactive surface functional groups. The mechanical and chemical mechanisms that govern surface properties and contribute to the observed enhanced bonding will be discussed.
Nanofluids as a potential solution for Minimum Quantity Lubrication: A review
Authors: Srikant RR , Prasad MMS , Amrita M , Sitaramaraju AV , Krishna P Vamsi
Published: August 2013

Several studies are being carried out to curtail the heat generated in machining. Among the various alternatives available, cutting fluids remain to be the choice. However, the various limitations of the cutting fluids restrict their application. Hence, different techniques are being explored to replace the use of cutting fluids, minimum quantity lubrication being one of them. This present article tries to review the available literature and examine nanofluids as potential candidates for minimum quantity lubrication.
A novel hybrid fuzzy nonlinear weighted goal programming for optimising interior acoustics level in car cabin
Authors: Nopiah Zulkifli Mohd , Junoh Ahmad Kadri , Ariffin Ahmad Kamal
Published: August 2013

The factors that are normally considered by customers for comfortable driving upon purchasing a car are acoustical comfort and exposed vibration. Keeping this in mind, the level of noise annoyance in reference to the vehicle acoustical comfort index is proposed. This index can be categorized by five states which are generally used in the computation that involve acoustical levels in the car cabin. This study is carried out in order to improve this index by classifying and categorizing these five states using the fuzzy set theory approach. Besides, identified sources of vibration are usually linked with engine transmission and tire-road interaction. This study includes the observation on the effects of the vibration due to tire interaction with the road, as well as the pattern of the trends toward the experienced noise against the engine speed [rpm] at both stationary and non-stationary positions. A combination of fuzzy set theory and nonlinear programming has been employed to develop a multi-objective model of hybrid fuzzy nonlinear weighted goal programming. This developed model adopts the results that have been provided in order to optimize the acoustics level by referring to the vibration level which is required at a certain value of the engine speed [rpm]. The proposed model has a significant impact towards a better environment, in the perspective of acoustics – a key factor in vehicle manufacturing process.
Book Review: Development Professionals in Northern Thailand: Hope, Politics and Practice
Authors: Forsyth Tim
Published: August 2013

McKinnon, Katharine. 2011: Development Professionals in Northern Thailand: Hope, Politics and Practice. Singapore and Copenhagen: National University of Singapore Press and Nordic Institute of Asian Studies. x + 235 pp. $34 paperback. ISBN: 978 9971 69 522 4.
Affect, Black Rage, and False Alternatives in the Hip-Hop Nation
Authors: McCann Bryan J.
Published: August 2013

This essay looks to the work of iconic rap artist Tupac Shakur to illuminate the role of Black rage as a common denominator between rap’s most conscious and gangsta iterations. Specifically, by theorizing Black rage as the founding affective impulse of the hip-hop nation, critics can identify common affective threads across the genre and spy emancipatory potential in hip-hop’s most jarring excesses, as surely as its more lucidly political iterations. I argue that theorizing Black rage through the lens of affect avoids many of the essentialist entanglements associated with earlier scholarship on the concept. The essay also challenges communication scholars to emphasize the emancipatory potential that underlies affective investments through the sociohistorical contextualization thereof.
A Model of Sustainable Distributed Service Delivery in Organizations With Compassion-Based Missions
Authors: Manz Charles C. , Skaggs Bruce C. , Pearce Craig L. , Wassenaar Christina L.
Published: August 2013

This article examines the potential for offering sustainable compassion-based service. Organizations with compassion-based service missions face difficult challenges in addressing acute client needs with limited resources. We posit that distributed service delivery (i.e., clients serving themselves and one another) can result in more long-term compassion-based service when supported by shared and self-leadership. A model of sustainable distributed service delivery is presented and propositions are provided to help guide future research.