bluuebunny/crossref_metadata_2025 huggingface dataset:
Oligometastatic status as predictor of survival in metastatic human papillomavirus‐positive oropharyngeal carcinoma
Authors: Albergotti William G. , Abberbock Shira , Mathews Fasil , Ferris Robert L. , Johnson Jonas T. , Duvvuri Umamaheswar , Kim Seungwon
Published: May 2018

Background

Oligometastasis is a good prognostic indicator when compared to widely metastatic disease in malignancies of other organ systems. We hypothesized that oligometastasis in human papillomavirus (HPV)‐positive oropharyngeal squamous cell carcinoma (SCC) would be associated with better overall survival.

Methods

This is a retrospective review of all HPV‐positive oropharyngeal SCC treated at one center with at least 1‐year of follow‐up. Patients were stratified into 2 cohorts: oligometastasis (1‐2 metastases, confined to 1 organ system) or polymetastasis (>2 metastases or multiple organ involvement) with cohorts compared for time to distant metastasis and overall survival after metastasis.

Results

Thirty‐eight of 506 patients (7.5%) developed metachronous distant metastasis; 12 developed oligometastasis and 26 developed polymetastasis. Median overall survival after oligometastasis was significantly longer than polymetastasis at 45 months (95% confidence interval [CI] 19 months ‐ not reached) and 10 months (95% CI 5‐24 months; P = .00028).

Conclusion

Oligometastasis in metastatic HPV‐positive oropharyngeal SCC portends a better prognosis than polymetastasis.
Treatment for T3 to T4a laryngeal cancer by open partial horizontal laryngectomies: Prognostic impact of different pathologic tumor subcategories
Authors: Succo Giovanni , Crosetti Erika , Bertolin Andy , Piazza Cesare , Molteni Gabriele , Cirillo Stefano , Petracchini Massimo , Tascone Martina , Sprio Andrea Elio , Berta Giovanni Nicolao , Peretti Giorgio , Presutti Livio , Rizzotto Giuseppe
Published: May 2018

Background

The purpose of this retrospective study was to identify subcategories in cT3 to cT4a supraglottic/glottic cancers, describing their different spreading patterns, and local and locoregional recurrence modes.

Methods

Four hundred eighty‐nine patients who underwent open partial horizontal laryngectomies (OPHLs) were retrospectively classified as: subcategory I (anterior pT3 with normal arytenoid mobility); subcategory II (posterior pT3 with impaired/absent mobility); subcategory III (anterior pT4 with normal mobility); and subcategory IV (posterior pT4 with impaired/absent mobility).

Results

Five‐year overall survival (OS), disease‐specific survival (DSS), disease‐free survival (DFS), locoregional, local control, freedom from laryngectomy, and laryngectomy‐free survival were significantly better in anterior tumors (subcategories I and III) when compared with the corresponding posterior ones (subcategories II and IV).

Conclusion

Anterior cT3 tumors are manageable by OPHL, and this approach could also be proposed in the treatment of early anterior cT4aN0. Despite promising results, OPHLs should be considered under investigation in posterior cT3 tumors due to clinical and biological behavior similar to cT4a tumors.
Helical intensity‐modulated radiotherapy with concurrent chemotherapy for oropharyngeal squamous cell carcinoma: A prospective investigation of acute swallowing and toxicity patterns
Authors: Moroney Laura B. , Helios Jennifer , Ward Elizabeth C. , Crombie Jane , Pelecanos Anita , Burns Clare L. , Spurgin Ann‐Louise , Blake Claire , Kenny Lizbeth , Chua Benjamin , Hughes Brett G. M.
Published: May 2018

Background

Conformal radiotherapy modalities may minimize treatment toxicities. The purpose of this study was to document the extent and timing of dysphagia and related toxicities during helical intensity‐modulated radiotherapy (IMRT) with chemotherapy for oropharyngeal squamous cell carcinoma (SCC).

Methods

We conducted a prospective study of 76 patients with oropharyngeal SCC undergoing helical IMRT with chemotherapy. Dysphagia and acute toxicity data were collected weekly during treatment and at 2, 4, and 12 weeks posttreatment using the Functional Oral Intake Scale, diet descriptors, and Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.

Results

Patients experienced maximum incidence of grade 3 dysphagia (61%), mucositis (30%), and thick saliva (38%), with grade 2 xerostomia (87%) and dysgeusia (97%). Only 14.5% were nil‐by‐mouth. Symptoms peaked in week 7 and improved thereafter. Grade 3 dysphagia was twice as common for T3 to T4 tumors compared with T2.

Conclusion

Results confirm that patients with oropharyngeal SCC undergoing helical IMRT with chemotherapy continue to experience incidences of acute toxicities comparable with other conformal techniques, and need supportive cares.
Marsupialization of mandibular cystic ameloblastoma: Retrospective study of 7 years
Authors: Yang Zinan , Liang Qian , Yang Le , Zheng Guang‐sen , Zhang Si‐en , Lao Xiao‐mei , Liang Yu‐jie , Liao Gui‐qing
Published: May 2018

Background

This retrospective study investigated the reduction rate and speed of shrinkage after marsupialization in mandibular cystic ameloblastoma and clarified whether marsupialization is appropriate for unicystic ameloblastoma and multicystic ameloblastoma.

Methods

Sixty‐three patients with mandibular cystic ameloblastoma were initially treated with marsupialization. Premarsupialization and postmarsupialization panoramic radiographs were reviewed for reduction rate and speed of shrinkage, and then were evaluated with age, sex, tumor location, and tumor type.

Results

The overall recurrence rate was 4.5% (2/44). The average reduction rate after marsupialization was 65.6%. No significant difference was found between unicystic ameloblastoma and multicystic ameloblastoma in reduction rate. The speed of shrinkage of unicystic ameloblastoma was significantly faster than that of multicystic ameloblastoma (P < .05). Similarly, patients with multicystic ameloblastoma had longer marsupialization periods than those with unicystic ameloblastoma (P < .05).

Conclusion

Marsupialization is effective in reducing tumor size for both unicystic ameloblastoma and multicystic ameloblastoma. Marsupialization plus second‐stage curettage is recommended as the primary treatment for mandibular cystic ameloblastoma.
Pre‐diagnostic urinary 15‐F2t‐isoprostane level and liver cancer risk: Results from the Shanghai Women's and Men's Health Studies
Authors: Ma Xiao , Tan Yu‐Ting , Yang Yang , Gao Jing , Li Hong‐Lan , Zheng Wei , Lan Qing , Rothman Nathaniel , Shu Xiao‐Ou , Xiang Yong‐Bing
Published: May 2018

Oxidative stress has been hypothesized to affect cancer development via various mechanisms, but the evidence from human is limited and inconclusive. 15‐F2t‐isoprostane (15‐F2t‐IsoP) is an accurate marker of oxidative stress in humans. Recent studies showed that the evidence of urinary 15‐F2t‐IsoP level correlating cancer risk is conflicting. We conducted a case–control study nested within two population‐based cohort studies. Pre‐diagnosis urine samples, collected at cohort enrollment, from 363 incident liver cancer cases and 725 individually matched controls, were used to determine the level of 15‐F2t‐IsoP by enzyme‐linked immunosorbent assay. Conditional logistic regression model was used to estimate the odds ratio to measure the association between the urinary 15‐F2t‐IsoP level and liver cancer risk. We found that higher pre‐diagnostic urinary 15‐F2t‐IsoP level was associated with an increased liver cancer risk, with an adjusted OR in males (OR4th vs. 1st quartile = 8.84, 95% CI 2.74–28.60), which was significantly higher than those in females (OR4th vs. 1st quartile = 1.75, 95% CI 0.70–4.42). HBsAg carriers with higher 15‐F2t‐IsoP had a significantly increased liver cancer risk (ORfemale = 59.04, 95% CI 12.26, 284.30; ORmale = 92.55, 95% CI 34.83, 245.96) compared to non‐carriers with lower 15‐F2t‐IsoP. High urinary 15‐F2t‐IsoP level was associated with high liver cancer risk, suggesting that 15‐F2t‐IsoP may be a promising biomarker for liver cancer risk. The result suggests that people with sero‐positive HBsAg and higher level of 15‐F2t‐IsoP might be given a higher priority on future surveillance program of liver cancer.
A prospective analysis of circulating saturated and monounsaturated fatty acids and risk of non‐Hodgkin lymphoma
Authors: Chiu Yu‐Han , Bertrand Kimberly A. , Zhang Shumin , Laden Francine , Epstein Mara M. , Rosner Bernard A. , Chiuve Stephanie , Campos Hannia , Giovannucci Edward L. , Chavarro Jorge E. , Birmann Brenda M.
Published: May 2018

Circulating saturated (SFA) and monounsaturated fatty acids (MUFA), which are predominantly derived from endogenous metabolism, may influence non‐Hodgkin lymphoma (NHL) risk by modulating inflammation or lymphocyte membrane stability. However, few biomarker studies have evaluated NHL risk associated with these fats. We conducted a prospective study of 583 incident NHL cases and 583 individually matched controls with archived pre‐diagnosis red blood cell (RBC) specimens in the Nurses’ Health Study (NHS) and Health Professionals Follow‐Up Study (HPFS). RBC membrane fatty acid levels were measured using gas chromatography. Using multivariable logistic regression, we estimated odds ratios (OR) and 95% confidence intervals (CI) for risk of NHL and major NHL subtypes including T cell NHL (T‐NHL), B cell NHL (B‐NHL) and three individual B‐NHLs: chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), diffuse large B‐cell lymphoma (DLBCL) and follicular lymphoma. RBC SFA and MUFA levels were not associated with NHL risk overall. However, RBC very long chain SFA levels (VLCSFA; 20:0, 22:0, 23:0) were inversely associated with B‐NHLs other than CLL/SLL; ORs (95% CIs) per standard deviation (SD) increase in level were 0.81 (0.70, 0.95) for 20:0, 0.82 (0.70, 0.95) for 22:0 and 0.82 (0.70, 0.96) for 23:0 VLCSFA. Also, both VLCSFA and MUFA levels were inversely associated with T‐NHL [ORs (95% CIs) per SD: VLCSFA, 0.63 (0.40, 0.99); MUFA, 0.63 (0.40, 0.99)]. The findings of inverse associations for VLCSFAs with B‐NHLs other than CLL/SLL and for VLCSFA and MUFA with T‐NHL suggest an influence of fatty acid metabolism on lymphomagenesis.
Reuse of public, genome-wide, murine eosinophil expression data for hypotheses development
Authors: Grace Jillian O , Malik Astha , Reichman Hadar , Munitz Ariel , Barski Artem , Fulkerson Patricia C
Published: May 2018

The eosinophil (Eos) surface phenotype and activation state is altered after recruitment into tissues and after exposure to pro-inflammatory cytokines. In addition, distinct Eos functional subsets have been described, suggesting that tissue-specific responses for Eos contribute to organ homeostasis. Understanding the mechanisms by which Eos subsets achieve their tissue-specific identity is currently an unmet goal for the eosinophil research community. Publicly archived expression data can be used to answer original questions, test and generate new hypotheses, and serve as a launching point for experimental design. With these goals in mind, we investigated the effect of genetic background, culture methods, and tissue residency on murine Eos gene expression using publicly available, genome-wide expression data. Eos differentiated from cultures have a gene expression profile that is distinct from that of native homeostatic Eos; thus, researchers can repurpose published expression data to aid in selecting the appropriate culture method to study their gene of interest. In addition, we identified Eos lung- and gastrointestinal-specific transcriptomes, highlighting the profound effect of local tissue environment on gene expression in a terminally differentiated granulocyte even at homeostasis. Expanding the “toolbox” of Eos researchers to include public-data reuse can reduce redundancy, increase research efficiency, and lead to new biological insights.

Publicly archived eosinophil genome-wide expression data can be used to answer original questions, generate new hypotheses, and serve as a launching point for experimental design.
Radiation therapy patient education using VERT: combination of technology with human care
Authors: Jimenez Yobelli A. , Lewis Sarah J.
Published: May 2018

The Virtual Environment for Radiotherapy Training (VERT) system is a recently available tool for radiation therapy education. The majority of research regarding VERT‐based education is focused on students, with a growing area of research being VERT's role in patient education. Because large differences in educational requirements exist between students and patients, focused resources and subsequent evaluations are necessary to provide solid justification for the unique benefits and challenges posed by VERT in a patient education context. This commentary article examines VERT's role in patient education, with a focus on salient visual features, VERT's ability to address some of the spatial challenges associated with RT patient education and how to combine technology with human care.
Antagonistic activities of volatiles produced by two Bacillus strains against Monilinia fructicola in peach fruit
Authors: Liu Chang , Yin Xiaohui , Wang Qingguo , Peng Yong , Ma Yurong , Liu Pei , Shi Jingying
Published: May 2018

BACKGROUND

Brown rot caused by Monilinia fructicola is one of most serious diseases of postharvest peach fruit. The objective of this study was to select effective antagonistic bacteria against Monilinia fructicola and evaluate the effects of these strains against brown rot.

RESULTS

Four bacterial strains producing inhibitory volatile gas against Monilinia fructicola were isolated from the peach rhizosphere soil. The volatiles produced by 12a (Bacillus vallismortis) and 14b (Bacillus altitudinis) showed considerable antagonistic activities. Monilinia fructicola showed 80.3% and 68.4% mycelial growth inhibition and cell damage in the presence of strains 12a and 14b, respectively. The inhibition rate of brown rot in peach fruit fumigated with the culture solution of 12a or 14b reached 77.1% and 50.0%, respectively. The volatile compounds produced by 12a and 14b were identified according to gas chromatographic–mass spectrometric analysis. Among them, 6‐methyl‐2‐heptanone and 2‐pentylfuran completely inhibited mycelial growth at 100 µL L−1 concentration. Cedrol showed strong inhibitory activity against mycelial growth at 100 µg L−1 and isodecyl methacrylate inhibited growth at high concentration. The inhibition rate of the 50 µL L−1 artificial mixture of these four volatiles was 59.3% in vitro.

CONCLUSION

These results indicate that the two antagonistic bacteria and some volatiles produced by them have potential value in controlling brown rot in harvested peach fruit. © 2018 Society of Chemical Industry
Postoperative prophylactic antibiotics for facial fractures: A systematic review and meta‐analysis
Authors: Habib Andy M. , Wong Alexander D. , Schreiner Geoffrey C. , Satti Komal F. , Riblet Natalie B. , Johnson Heather A. , Ossoff Jacob P.
Published: May 2018

Objective

Perioperative antibiotic prophylaxis in patients undergoing surgery for maxillofacial fractures is standard practice. However, the use of postoperative antibiotic prophylaxis remains controversial. This systematic review and meta‐analysis sought to evaluate the effect of postoperative antibiotic therapy on the incidence of surgical site infection (SSI) in patients with maxillofacial fractures.

Methods

MEDLINE, Embase, and the Cochrane Library were searched from inception through October 2017. Randomized controlled trials (RCTs) and cohort studies evaluating the efficacy of pre‐, peri‐, and postoperative antibiotic prophylaxis in preventing SSI in maxillofacial fractures were included. Data were extracted from studies using a standardized data collection form, with two reviewers independently performing extraction and quality assessment for each study. Risk ratios (RRs) for SSI were pooled using a random‐effects model.

Results

Among 2,150 potentially eligible citations, 13 studies met inclusion criteria and provided data to be included in a meta‐analysis. The addition of postoperative antibiotic prophylaxis to a standard preoperative and/or perioperative antibiotic regimen showed no significant difference in the risk of SSI (RR = 1.11 [95% CI: 0.86‐1.44], P > .1). There were also no differences in the risk of SSI when restricting the analysis to mandibular fractures (eight studies, RR = 1.22 [95% CI: 0.92‐1.62]) or open surgical techniques (eight studies, RR = 1.02 [95% CI: 0.62‐1.67]). A sensitivity analysis did not find any significant differences in risk when restricting to RCTs (seven trials, RR = 1.00 [95% CI: 0.61‐1.67]) or cohort studies (six studies, RR = 1.21 [95% CI: 0.89‐1.63]).

Conclusions

Our findings, along with the available evidence, does not support the routine use of postoperative antibiotic prophylaxis in patients with maxillofacial fractures. Avoiding the unnecessary use of antibiotic therapy in the postoperative period could have important implications for healthcare costs and patient outcomes. Laryngoscope, 129:82–95, 2019
Evaluation and treatment of pulsatile tinnitus associated with sigmoid sinus wall anomalies
Authors: Eisenman David J. , Raghavan Prashant , Hertzano Ronna , Morales Robert
Published: May 2018

Objective

Describe clinical and radiographic features of sigmoid sinus wall anomalies (SSWA) associated with pulsatile tinnitus (PT) and determine factors predictive of response to surgery.

Methods

Preoperative diagnostic imaging and treatment response were reviewed after surgical repair of 40 ears among 38 consecutive patients presenting with PT associated with SSWA who underwent transtemporal sinus wall reconstruction.

Results

Twenty‐three ears had isolated sigmoid sinus dehiscence, and 17 had diverticulum. The rates of transverse sinus stenosis (TSS) and empty sella, 66% and 32% respectively, were significantly higher than in historical controls (P = 0.02 and 0.001). Thirty‐six out of 40 subjects (90%) had complete resolution of their PT following surgery, including all those with a diverticulum. For subjects with dehiscence alone without diverticulum, a favorable response to surgery was strongly associated with the presence of TSS (P = 0.01) and empty sella (P = 0.02).

Conclusion

Sigmoid sinus diverticulum and dehiscence are a clinically important cause of PT. Women of childbearing age with an elevated body mass index (BMI) are commonly affected, and there is a high rate of associated TSS and empty sella. Transtemporal sinus wall reconstruction has a high rate of success in appropriately selected patients. Patients with isolated sinus wall dehiscence without diverticulum, TSS, or empty sella are less likely to respond to transtemporal sinus wall reconstruction. These data imply a multifactorial cause of PT in at least some patients with SSWA.

Level of Evidence: 4

Laryngoscope, 128:S1–S13, 2018
Study design and early result of a phase I study of SABR for early‐stage glottic cancer
Authors: Yu Tosol , Wee Chan Woo , Choi Noorie , Wu Hong‐Gyun , Kang Hyun‐Cheol , Park Jong Min , Kim Jung‐In , Kim Jin Ho , Kwon Tack‐Kyun , Chung Eun‐Jae
Published: May 2018

Objective

Avoidance of organs at risk has become possible with advances in image‐guided volumetric‐modulated arc therapy (VMAT) techniques. This study was designed to evaluate the safety and feasibility of stereotactic ablative radiotherapy (SABR) for early stage glottic cancer. This report presents the preliminary result of the first and second dose level.

Methods

Fraction size was increased from 3.5 gray (Gy) (total dose 59.5 Gy) to 9 Gy (total dose 45 Gy). Dose‐limiting toxicities were defined as grade 3 or higher treatment‐related toxicities. Voice outcome was assessed with electroglottography, and quality of life (QoL) was measured with the Head and Neck Cancer Inventory (HNCI).

Results

Seven patients received 59.5 Gy at 3.5 Gy per fraction as the first dose level, and five patients received 55 Gy at 5 Gy per fraction as the second dose level. None of the patients developed grade 3+ toxicity throughout a median follow‐up of 17.5 months (range, 1.7–30.6 months). One patient in the second dose level recurred in the primary site at 4 months after radiotherapy (RT) and received total laryngectomy. The rest of participants were disease‐free at locoregional and distant sites. Jitter, shimmer, mean phonation time, and noise‐to‐harmony ratio did not change significantly at 6 months after RT. HNCI scores between pretreatment and posttreatment were not significantly different (P = 0.221).

Conclusion

This study revealed acceptable toxicity, voice outcome, and QoL in patients treated with hypofractionated VMAT of 3.5 Gy and 5 Gy per fraction. This phase I study is currently ongoing with a dose of 55 Gy in 11 fractions and 45 Gy in five fractions.

Level of Evidence

2b. Laryngoscope, 2560–2565, 2018
Quantification of tissue‐engineered trachea performance with computational fluid dynamics
Authors: Eichaker Lauren , Li Chengyu , King Nakesha , Pepper Victoria , Best Cameron , Onwuka Ekene , Heuer Eric , Zhao Kai , Grischkan Jonathan , Breuer Christopher , Johnson Jed , Chiang Tendy
Published: May 2018

Objectives/Hypothesis

Current techniques for airway characterization include endoscopic or radiographic measurements that produce static, two‐dimensional descriptions. As pathology can be multilevel, irregularly shaped, and dynamic, minimal luminal area (MLA) may not provide the most comprehensive description or diagnostic metric. Our aim was to examine the utilization of computational fluid dynamics (CFD) for the purpose of defining airway stenosis using an ovine model of tissue‐engineered tracheal graft (TETG) implantation.

Study Design

Animal research model.

Methods

TETGs were implanted into sheep, and MLA was quantified with imaging and endoscopic measurements. Graft stenosis was managed with endoscopic dilation and stenting when indicated. Geometries of the TETG were reconstructed from three‐dimensional fluoroscopic images. CFD simulations were used to calculate peak flow velocity (PFV) and peak wall shear stress (PWSS). These metrics were compared to values derived from a quantitative respiratory symptom score.

Results

Elevated PFV and PWSS derived from CFD modeling correlated with increased respiratory symptoms. Immediate pre‐ and postimplantation CFD metrics were similar, and implanted sheep were asymptomatic. Respiratory symptoms improved with stenting, which maintained graft architecture similar to dilation procedures. With stenting, baseline PFV (0.33 m/s) and PWSS (0.006 Pa) were sustained for the remainder of the study. MLA measurements collected via bronchoscopy were also correlated with respiratory symptoms. PFV and PWSS found via CFD were correlated (R2 = 0.92 and 0.99, respectively) with respiratory symptoms compared to MLA (R2 = 0.61).

Conclusions

CFD is valid for informed interventions based on multilevel, complex airflow and airway characteristics. Furthermore, CFD may be used to evaluate TETG functionality.

Level of Evidence

NA. Laryngoscope, E273–E280, 2018
Treatment outcomes of patients with primary squamous cell carcinoma of the retromolar trigone
Authors: Rizvi Zain H. , Alonso Jose E. , Kuan Edward C. , St. John Maie A.
Published: May 2018

Objectives/Hypothesis

Squamous cell carcinoma of the retromolar trigone (RMT SCC) is a relatively uncommon primary site for oral cavity malignancy. However, given its proximity to the mandible and buccal mucosa, RMT SCC typically exhibits early invasion and generally presents at an advanced stage. Large‐sample studies are needed to assess the epidemiology and clinical outcomes of this tumor. Our aim was to describe the determinants of survival in patients with RMT SCC.

Study Design

Retrospective cohort study.

Methods

Retrospective, population‐based cohort study of patients in the Surveillance, Epidemiology, and End Results tumor registry who were diagnosed with RMT SCC from 1973 to 2012. Primary endpoints were overall survival (OS) and disease‐specific survival (DSS).

Results

A total of 4,022 cases of RMT SCC were identified. The mean age at diagnosis was 65 years. Thirty‐nine percent of cases presented with stage IV disease. The median OS by stages I to IV were 73.7, 52.4, 27.5, and 23.4 months, respectively (P < .05). Overall, 34.3% of patients underwent surgery, 23.5% received radiation therapy, and 34.1% had both surgical and radiation therapy. On multivariate analysis, advanced age, greater tumor size, and advanced stage were associated with worse OS and DSS (P < .05), surgery predicted improved OS and DSS (P < .05), and radiation therapy predicted improved OS only (P < .05).

Conclusions

RMT SCC is an aggressive malignancy that portends a poor prognosis, though early‐stage tumors (stages I and II) have significantly improved survival. Any surgical intervention independently predicted higher survival outcomes. There may be a role of dual modality approaches, particularly for larger tumors.

Level of Evidence

4 Laryngoscope, 128:2740–2744, 2018
Long‐term outcomes and prognosis in submandibular gland malignant tumors: A multicenter study
Authors: Lombardi Davide , Accorona Remo , Lambert Arnaud , Mercante Giuseppe , Coropciuc Ruxandra , Paderno Alberto , Lancini Davide , Spriano Giuseppe , Nicolai Piero , Vander Poorten Vincent
Published: May 2018

Objectives/Hypothesis

Submandibular gland tumors (SMGTs) are rare and characterized by heterogeneity in histologic profiles. The aim of the present study was to retrieve data on submandibular gland (SMG) malignancies and identify factors influencing survival.

Study Design

Retrospective study.

Methods

A multicenter, retrospective study on patients who underwent primary surgery for SMGTs at three referral centers was performed.

Results

Among 204 patients with SMGTs, 50 (24.5%) with SMG malignancies were analyzed in detail. Definitive pT status was: 21 (42%) pT1, 14 (28%) pT2, 10 (20%) pT3, and five (10%) pT4. Nodal metastases and perineural spread were diagnosed in 15 (30%) and 25 (50%) patients, respectively. High‐grade lesions were identified in 32 (64%) patients. Follow‐up status, available for 49 (98%) patients, was as follows: 23 (47%) patients were alive without disease, 11 (22.5%) died of disease, five (10.2%) alive with disease, and 10 (20.4%) died of other causes. Five‐ and 10‐year overall survival (OS), disease‐specific survival (DSS), and recurrence‐free survival (RFS) were 66.4% and 57.1%, 76.6% and 72.1%, 69.1% and 62.4%, respectively. At univariate analysis, OS, DSS, and RFS were influenced by pT status, pN status, and perineural spread. OS and RFS were also affected by the presence of facial palsy and pain. RFS was negatively influenced by positive margins. Multivariate analysis confirmed that OS, DSS, and RFS were independently affected by perineural spread, whereas nodal involvement influenced only RFS.

Conclusions

The malignancy rate of SMGTs is comparable to that reported for parotid tumors. Most patients presented with high‐grade lesions. pT status, pN status, and perineural spread significantly affected prognosis.

Level of Evidence

4 Laryngoscope, 128:2745–2750, 2018
A standardized, closed‐loop system for monitoring pediatric tracheostomy‐related adverse events
Authors: McKeon Mallory , Munhall Daphne , Walsh Brian K. , Nuss Roger , Rahbar Reza , Volk Mark , Watters Karen
Published: May 2018

Objectives/Hypothesis

Advancement in neonatal and pediatric intensive care has increased the need for chronic‐care interventions, including tracheostomy. It is well established that children with a tracheostomy are at a high risk for adverse events, many of which are preventable. Despite this, there is no standardized method of monitoring tracheostomy‐related adverse events (TRAEs). Our objective was to describe and assess a standardized, closed‐loop system for monitoring TRAEs.

Study Design

Prospective Study.

Methods

A specific tracheostomy‐related category was established within the adverse event reporting system in January 2015. Monthly TRAE reports were supplied to the multidisciplinary tracheostomy team (MDT) with descriptions of event type, severity, and preventability. The MDT reviewed events and discussed necessary follow‐up. The frequency of events was standardized by inpatient tracheostomy days (ITDs) using an automated monthly list. Adverse events were tracked using a control chart. Aggregated data were divided into biannual reports for analysis.

Results

Eighty‐five TRAEs were reported between January 2015 and June 2017, averaging 5.75 per 1,000 ITDs. Most common events include unplanned decannulation (50%) and improper use of tracheostomy supplies (21%). The frequency of all preventable events has decreased by 76% since the second half of 2015. During this timeframe, minor events have decreased, moderate events have maintained a frequency of less than one per 1,000 ITDs, and only one severe event occurred.

Conclusions

This standardized, closed‐loop reporting method, modeled after other successful intensive care unit reporting systems, accurately tracks TRAEs. We have observed a decrease in preventable TRAEs without a negative impact on rates of severe events. Results suggest improved quality of care for patients with tracheostomy.

Level of Evidence

4. Laryngoscope, 128:2419–2424, 2018
In search of a longitudinal animal model of evoked swallow function
Authors: Langerman Jared , Doukas Sotirios G. , Hasegawa Hisashi , Goodrich James , Lerner Michael , Sasaki Clarence
Published: May 2018

Background

A malfunction or impairment of swallow function can potentiate aspiration events and interfere with both quality of life and survival. Establishing an animal model for swallow research would provide a better understanding of its pathophysiology and would also allow for the development and validation of physiologically based clinical interventions to improve swallow function. Two requirements define the ideal model for longitudinal exploration: 1) identification of species similar to human in form and function; and 2) provision for reliable and reproducible evoked swallow under general anesthesia and one that would also support a longitudinal study design.

Objective

We hypothesize that an anesthetized porcine model under dexmedetomidine‐based or ketamine‐based anesthesia will support a reproducible and stable evoked swallow response.

Methods

Seven neutered male Yorkshire pigs were anesthetized using combinations of dexmedetomidine‐based or ketamine‐based anesthesia for induction and maintenance of anesthesia during the experimental portion of our study. Single stimulation of iSLN or vagus nerve, bilateral simultaneous single stimulation of iSLN or vagus nerve, and stimulus trains applied to afferent nerves were performed.

Results

None of the seven pigs demonstrated evoked swallow events, both during inhalational anesthesia (1.0 MAC) or during post‐washout intravenous anesthesia (dexmedetomidine, ketamine/fentanyl or ketamine alone).

Conclusion

Our results support a high degree of organizational neurophysiologic complexity characterizing the swallow reflex and highlight the challenges and limitations of intraoperative study in survival models.

Level of Evidence

NA Laryngoscope, 2018
Guide design in virtual planning for scapular tip free flap reconstruction
Authors: Kass Jason I. , Prisman Eitan , Miles Brett A.
Published: May 2018

Background

Virtual surgical planning (VSP), intraoperative cutting guides and stereolithographic models, provides the head and neck reconstructive surgeon with powerful tools for complex reconstruction planning. Despite its use in fibular osteocutaneous reconstruction, application to the scapular tip has not been as widely reported.

Methods

From 2013 to 2014, four cases of either mandibular or maxillary reconstruction were completed with the scapular tip osseous free flap. All four cases underwent preoperative VSP with patient‐specific guide design.

Results

Patient‐specific guides were generated for scapular tip harvest. Guide placement was improved using a stabilizing flange and bracket design. With minimal disruption of the overlying periosteum a wedge osteotomy was successfully implemented in one case.

Conclusions

Unlike the fibula and iliac crest donor sites, the scapular tip has overlying muscle attachments that make intraoperative osteotomies challenging. Attention to key aspects of scapular anatomy, including the fibrous tip and extensive overlying muscle, permits effective guide design.

Level of evidence

4
Simultaneous labyrinthectomy and cochlear implantation in unilateral meniere's disease
Authors: Perkins Elizabeth , Rooth Meredith , Dillon Margaret , Brown Kevin
Published: May 2018

Objective

In a single‐institution, FDA‐approved IDE study, subjects with unilateral Meniere's disease and intractable vertigo underwent concurrent labyrinthectomy and cochlear implantation to determine speech perception, localization, and quality of life outcomes.

Methods

Three subjects with unilateral Meniere's disease with normal or near‐normal hearing in the contralateral ear underwent simultaneous labyrinthectomy and cochlear implantation. Sound localization, speech perception in noise and quiet, tinnitus handicap index, and quality of life measures were evaluated at 1, 3, and 6 months after implant activation.

Results

Sound localization testing demonstrated immediate benefit postimplantation with the cochlear implant (CI). RMS error with CI on was 22 degrees (±2) and with CI off was 63 (±15) at 6 months. Mean CI alone scores were 22% (±20) at 1 month and improved to 43% (±20) and 49% (±11) at the 3‐ and 6‐month intervals, respectively. AzBio sentences in babble (0 dB SNR) scores presented in the most challenging listening condition (S0NContra) were 28% (±20) at 1 month, 38% (±18) at 3 months, and 45% (±24) at 6 months. Tinnitus Handicap Inventory (THI) significantly improved from an average preoperative score of 42 (±26) to 0 at 6 months. Quality of life measures improved overall over the postimplantation follow‐up intervals.

Conclusions

Subjects with unilateral Meniere's Disease who underwent simultaneous labyrinthectomy and cochlear implantation experienced improvements in sound localization, speech understanding, tinnitus severity, and quality of life with device use. There was a trend for better performance over the postoperative intervals.

Level of Evidence

2b.
Lightweight, Highly Permeable, Biocompatible, and Antiadhesive Composite Meshes for Intraperitoneal Repairs
Authors: Hu Minhui , Lin Xidong , Huang Rongkang , Yang Keli , Liang Yeru , Zhang Xingcai , Wang Hui , Wu Dingcai
Published: May 2018

Ventral hernia is a public health issue and millions of meshes are used to repair abdominal wall defects every year. Polypropylene‐based composite meshes represent an important class of materials for intraperitoneal repair, but the meshes generally give rise to infection, seroma, migration, and adhesion, leading to severe consequence or even reoperation. Here, a facile and versatile one‐way fabrication of lightweight, highly permeable, and biocompatible composite meshes with superior antiadhesion properties is proposed by modifying polypropylene meshes with well‐defined polydopamine nanocoating. The resulting composite meshes are found to significantly enhance the biocompatibility and antiadhesion effect in rat model. The scalable production and excellent biomedical properties of composite meshes make them a promising candidate for future‐generation ventral hernia repair materials.
Treatment of restless legs syndrome: Evidence‐based review and implications for clinical practice (Revised 2017)§
Authors: Winkelmann Juliane , Allen Richard P. , Högl Birgit , Inoue Yuichi , Oertel Wolfgang , Salminen Aaro V. , Winkelman John W. , Trenkwalder Claudia , Sampaio Cristina
Published: May 2018

The objective of the current review was to update the previous evidence‐based medicine review of treatments for restless legs syndrome published in 2008. All randomized, controlled trials (level I) with a high quality score published between January 2007 and January 2017 were reviewed. Forty new studies qualified for efficacy review. Pregabalin, gabapentin enacarbil, and oxycodone/naloxone, which did not appear in the previous review, have accrued data to be considered efficacious. Likewise, new data enable the modification of the level of efficacy for rotigotine from likely efficacious to efficacious. Intravenous ferric carboxymaltose and pneumatic compression devices are considered likely efficacious in idiopathic restless legs syndrome. Bupropion and clonidine were reviewed, but the lack of data determined a rating of insufficient evidence for efficacy. The following interventions continue to be considered efficacious as in 2008: levodopa, ropinirole, pramipexole, cabergoline, pergolide, and gabapentin. Bromocriptine, oxycodone, carbamazepine, and valproic acid are considered likely efficacious. Oral iron is nonefficacious in iron‐sufficient subjects, but its benefit for patients with low peripheral iron status has not been adequately evaluated. Restless legs syndrome augmentation has been identified as a significant long‐term treatment complication for pramipexole more than pregabalin and possibly for all dopaminergic agents more than α2δ ligands. Therefore, special monitoring for augmentation is required for all dopaminergic medications as well as tramadol. Other drugs also require special safety monitoring: cabergoline, pergolide, oxycodone, methadone, tramadol, carbamazepine, and valproic acid. Finally, we also highlighted gaps and needs for future clinical research and studies of restless legs syndrome. © 2018 International Parkinson and Movement Disorder Society
Distinct progression pattern of susceptibility MRI in the substantia nigra of Parkinson's patients
Authors: Du Guangwei , Lewis Mechelle M. , Sica Christopher , He Lu , Connor James R. , Kong Lan , Mailman Richard B. , Huang Xuemei
Published: May 2018

Background: Susceptibility MRI may capture Parkinson's disease‐related pathology. This study delineated longitudinal changes in different substantia nigra regions.

Methods: Seventy‐two PD patients and 62 controls were studied at both baseline and after 18 months with MRI. R2* and quantitative susceptibility mapping values from the substantia nigra pars compacta and substantia nigra pars reticulata were calculated. Mixed‐effects models compared controls with PD or PD subgroups having different disease durations: early (<1 year), middle (<5 years, middle‐stage PD), and late (>5 years, late‐stage PD). Pearson's correlation assessed associations between imaging and clinical measures.

Results: At baseline, R2* and quantitative susceptibility mapping were higher in both the substantia nigra pars compacta and substantia nigra pars reticulata in all PD patients (group effect, P ≤ 0.003). Longitudinally, the substantia nigra pars compacta R2* showed a faster increase in PD compared with controls (time × group, P = 0.002), whereas quantitative susceptibility mapping did not (P = 0.668). The substantia nigra pars reticulata R2* and quantitative susceptibility mapping did not differ between PD and controls (time × group, P ≥ 0.084), although both decreased longitudinally (time effect, P ≤ 0.004). Baseline substantia nigra pars compacta R2* was higher in all PD subgroups (group, P ≤ 0.006), but showed a significantly faster increase only in later‐stage PD (time × group, P < 0.0001) that correlated with changes in nonmotor symptoms (r = 0.746, P = 0.002). Baseline substantia nigra pars reticulata quantitative susceptibility mapping was higher in middle‐stage PD and later‐stage PD (group, P ≤ 0.002), but showed a longitudinal decrease (time × group, P = 0.004) only in later‐stage PD that correlated with changes in motor signs (r = 0.837, P < 0.001).

Conclusion: Susceptibility MRI revealed distinct patterns of PD progression in the substantia nigra pars compacta and substantia nigra pars reticulata. The different patterns are particularly clear in later‐stage patients. These findings may resolve past controversies and have implications in the pathophysiological processes during PD progression. © 2018 International Parkinson and Movement Disorder Society
Neuromelanin imaging and midbrain volumetry in progressive supranuclear palsy and Parkinson's disease
Authors: Taniguchi Daisuke , Hatano Taku , Kamagata Koji , Okuzumi Ayami , Oji Yutaka , Mori Akio , Hori Masaaki , Aoki Shigeki , Hattori Nobutaka
Published: May 2018

Background Nigral degeneration patterns differ between PSP and PD. However, the relationship between nigral degeneration and midbrain atrophy in PSP remains unclear.

Objective We analyzed differences and relationships between nigral degeneration and midbrain atrophy in PSP and PD.

Methods Neuromelanin‐sensitive MRI and midbrain volumetry were performed in 11 PSP patients, 24 PD patients, and 10 controls to measure the neuromelanin‐sensitive SNpc area and midbrain volume.

Results The neuromelanin‐sensitive SNpc area and midbrain volume were significantly smaller in PSP patients compared with PD patients and controls. Motor deficits were inversely correlated with neuromelanin‐sensitive SNpc area in PD, but not PSP patients. There was no significant correlation between neuromelanin‐sensitive SNpc area and midbrain volume in either disease group. Midbrain volumetry discriminated PSP from PD. Diagnostic accuracy was improved when neuromelanin‐sensitive MRI analysis was added.

Conclusions Neuromelanin‐sensitive MRI and midbrain volumetry may reflect the clinical and pathological characteristics of PSP and PD. Combining neuromelanin‐sensitive MRI and midbrain volumetry may be useful for differentiating PSP from PD. © 2018 International Parkinson and Movement Disorder Society
Sleep‐related motor and behavioral disorders: Recent advances and new entities
Authors: Breen David P. , Högl Birgit , Fasano Alfonso , Trenkwalder Claudia , Lang Anthony E.
Published: May 2018

Patients with sleep‐related motor and behavioral disorders present to a variety of subspecialty clinics (neurology, sleep medicine, respiratory medicine, psychiatry). Diagnosing these disorders can be difficult, and sometimes they have a significant impact on quality of life. Alongside a number of common and well‐recognized conditions, several new disease entities have been described in recent years that present with abnormal nocturnal motor phenomena (such as ADCY5‐associated disease and anti‐IgLON5 disease). Our understanding of the neural basis and prognostic significance of other sleep‐related disorders has also grown, particularly rapid eye movement sleep behavior disorder. This review (along with a collection of previously unpublished videos) is intended to aid in the recognition and treatment of these patients. The recent change in terminology from nocturnal frontal lobe epilepsy to sleep‐related hypermotor epilepsy is also discussed. © 2018 International Parkinson and Movement Disorder Society
Susceptibility MRI captures nigral pathology in patients with parkinsonian syndromes
Authors: Lewis Mechelle M. , Du Guangwei , Baccon Jennifer , Snyder Amanda M. , Murie Ben , Cooper Felicia , Stetter Christy , Kong Lan , Sica Christopher , Mailman Richard B. , Connor James R. , Huang Xuemei
Published: May 2018

Background: Parkinsonisms are neurodegenerative disorders characterized pathologically by α‐synuclein‐positive (e.g., PD, diffuse Lewy body disease, and MSA) and/or tau‐positive (e.g., PSP, cortical basal degeneration) pathology. Using R2* and quantitative susceptibility mapping, susceptibility changes have been reported in the midbrain of living parkinsonian patients, although the exact underlying pathology of these alterations is unknown.

Objective: The current study investigated the pathological correlates of these susceptibility MRI measures.

Methods: In vivo MRIs (T1‐ and T2‐weighted, and T2*) and pathology were obtained from 14 subjects enrolled in an NINDS PD Biomarker Program (PDBP). We assessed R2* and quantitative susceptibility mapping values in the SN, semiquantitative α‐synuclein, tau, and iron values, as well as neuronal and glial counts. Data were analyzed using age‐adjusted Spearman correlations.

Results: R2* was associated significantly with nigral α‐synuclein (r = 0.746; P = 0.003). Quantitative susceptibility mapping correlated significantly with Perls' (r = 0.758; P = 0.003), but not with other pathological measurements. Neither measurement correlated with tau or glial cell counts (r ≤ 0.11; P ≥ 0.129).

Conclusions: Susceptibility MRI measurements capture nigral pathologies associated with parkinsonian syndromes. Whereas quantitative susceptibility mapping is more sensitive to iron, R2* may reflect pathological aspects of the disorders beyond iron such as α‐synuclein. They may be invaluable tools in diagnosing differential parkinsonian syndromes, and tracking in living patients the dynamic changes associated with the pathological progression of these disorders. © 2018 International Parkinson and Movement Disorder Society
Full sequencing and haplotype analysis of MAPT in Parkinson's disease and rapid eye movement sleep behavior disorder
Authors: Li Jiao , Ruskey Jennifer A. , Arnulf Isabelle , Dauvilliers Yves , Hu Michele T.M. , Högl Birgit , Leblond Claire S. , Zhou Sirui , Ambalavanan Amirthagowri , Ross Jay P. , Bourassa Cynthia V. , Spiegelman Dan , Laurent Sandra B , Stefani Ambra , Charley Monaca Christelle , Cochen De Cock Valérie , Boivin Michel , Ferini‐Strambi Luigi , Plazzi Giuseppe , Antelmi Elena , Young Peter , Heidbreder Anna , Labbe Catherine , Ferman Tanis J. , Dion Patrick A. , Fan Dongsheng , Desautels Alex , Gagnon Jean‐François , Dupré Nicolas , Fon Edward A. , Montplaisir Jacques Y. , Boeve Bradley F. , Postuma Ronald B. , Rouleau Guy A. , Ross Owen A. , Gan‐Or Ziv
Published: May 2018

Background: MAPT haplotypes are associated with PD, but their association with rapid eye movement sleep behavior disorder is unclear.

Objective: To study the role of MAPT variants in rapid eye movement sleep behavior disorder.

Methods: Two cohorts were included: (A) PD (n = 600), rapid eye movement sleep behavior disorder (n = 613) patients, and controls (n = 981); (B) dementia with Lewy bodies patients with rapid eye movement sleep behavior disorder (n = 271) and controls (n = 950). MAPT‐associated variants and the entire coding sequence of MAPT were analyzed. Age‐, sex‐, and ethnicity‐adjusted analyses were performed to examine the association between MAPT, PD, and rapid eye movement sleep behavior disorder.

Results: MAPT‐H2 variants were associated with PD (odds ratios: 0.62‐0.65; P = 0.010‐0.019), but not with rapid eye movement sleep behavior disorder. In PD, the H1 haplotype odds ratio was 1.60 (95% confidence interval: 1.12‐2.28; P = 0.009), and the H2 odds ratio was 0.68 (95% confidence interval: 0.48‐0.96; P = 0.03). The H2/H1 haplotypes were not associated with rapid eye movement sleep behavior disorder.

Conclusions: Our results confirm the protective effect of the MAPT‐H2 haplotype in PD, and define its components. Furthermore, our results suggest that MAPT does not play a major role in rapid eye movement sleep behavior disorder, emphasizing different genetic background than in PD in this locus. © 2018 International Parkinson and Movement Disorder Society
Design Strategy of Multi‐electron Transfer Catalysts Based on a Bioinformatic Analysis of Oxygen Evolution and Reduction Enzymes
Authors: Ooka Hideshi , Hashimoto Kazuhito , Nakamura Ryuhei
Published: May 2018

Understanding the design strategy of photosynthetic and respiratory enzymes is important to develop efficient artificial catalysts for oxygen evolution and reduction reactions. Here, based on a bioinformatic analysis of cyanobacterial oxygen evolution and reduction enzymes (photosystem II: PS II and cytochrome c oxidase: COX, respectively), the gene encoding the catalytic D1 subunit of PS II was found to be expressed individually across 38 phylogenetically diverse strains, which is in contrast to the operon structure of the genes encoding major COX subunits. Selective synthesis of the D1 subunit minimizes the repair cost of PS II, which allows compensation for its instability by lowering the turnover number required to generate a net positive energy yield. The different bioenergetics observed between PS II and COX suggest that in addition to the catalytic activity rationalized by the Sabatier principle, stability factors have also provided a major influence on the design strategy of biological multi‐electron transfer enzymes.