bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Social Media in Medicine
Authors: Stern Wendy B. , Wei Julie L. , Chang Christopher Y. , Eisenberg Lee D. , Simon Lawrence M. 
Published: August 2013

Program Description:Social media has moved from an emerging technology to a mainstay of our patients’ lives. The panelists consist of speakers at the forefront of the social media field in otolaryngology in both academic and private arenas. This talk will demonstrate how social media has already been incorporated in the medical marketplace and future applications. We will discuss strategies for how physicians can incorporate this into their academic/private practices. Common pitfalls encountered in assimilating social media into your practice will be described. Additionally, we will discuss the inherent medico‐legal risk and ethical considerations associated with these endeavors.Educational Objectives:1) Discuss how social media affects medicine today. 2) Describe methods to use social media to help build/maintain your practice in an academic and private arena. 3) Apply the best uses of social media to interact with and educate your patients while being aware of the medico‐legal implications.
Consequences of Resident Case Unbundling on Future Billing Habits
Authors: Liebertz Daniel J. , Zuliani Giancarlo F 
Published: August 2013

Objectives:Recognize differences between CPT coding habits of otolaryngology residents compared to attending physicians, and analyze the possibility that resident case unbundling may affect future billing habits.Methods:A prospective survey was designed with four case scenarios reflecting four common procedures (septorhinoplasty, tympanomastoidectomy, thyroidectomy, and FESS) and presented to residents and staff physicians from Wayne State University. Respondents were asked to record up to 12 CPT codes for each procedure, per standard billing practices. Each procedure was accompanied by a list of all 17 categorized CPT codes found on the Accreditation Council for Graduate Medical Education (ACGME) Resident Case‐Log system. The survey results were then analyzed to determine the number of CPT codes entered per case per respondent.Results:Seventeen responses to the survey were recorded (14 residents, 3 attendings). Multivariate analysis comparing resident and attending responses was performed using GraphPad. Residents entered, on average, 12.86 codes in total for the 4 scenarios, attending physicians entered 8.67 (t‐test, p = 0.049). Further analysis, including comparison of individual scenarios and post‐graduate year, did not yield significant results; however, in all but one scenario resident response numbers were consistently elevated per procedure compared to attending physician responses.Conclusions:The practice of CPT code case unbundling in residency may affect future billing habits. Our small study indicates residents regularly over‐code routine surgical procedures compared to attending physician practices. An extension of the surveyed population will allow us to increase our data and hopefully establish wider conclusions.
Increased Expression Levels of Apoptosis Inhibitor BIRC5 Is Associated with Advanced Oropharyngeal Squamous Cell Carcinoma
Authors: Janus Jeffrey R. , Laborde Rebecca R. , Moore Eric J. , Olsen Kerry D. , Olsen Steven , Kasperbauer Jan L. , Smith David 
Published: August 2013

Objectives:1) Describe the role that BIRC5 and related activator genes (AURKB and CDCA8) play in various malignancies, and analyze the role that these genes play in oropharyngeal squamous cell carcinoma. 2) Implement innovative gene analysis technology (mRNA Seq) to determine gene expression and validate using established techniques (nCounter). 3) Analyze gene expression in the setting of human papillomavirus (HPV) status, smoking, and tumor stage.Methods:Tumor and adjacent normal oropharyngeal mucosal samples were obtained for validation studies from 24 patients undergoing surgical treatment of oropharyngeal squamous cell carcinoma (OPSCC) from 2010‐2012. Transcriptome data (mRNA‐Seq) were analyzed from patient matched tumor‐normal tissues. Transcript levels of target genes were validated using the nCounter system. Expression levels were correlated with tumor stage, HPV infection status, or smoking status.Results:A statistically significant overexpression was noted in all 3 target genes in tumor versus normal tissue. Statistically significant associations were present between expression levels of target genes and advanced tumor stage. No significant association was found between the 3 genes and etiologic subgroupings (HPV latent versus active infections or smoking status).Conclusions:BIRC5 and related activator genes (AURKB and CDCA8) have an established role in the development and progression of other cancers. Expression of these 3 gene targets is related to tumor stage in oropharyngeal SCC. The significant associations between the expression of these genes and tumor staging suggest that these genes may play a role in tumor progression independent of HPV viral expression patterns.
Learning Progression in the Use of Sialendoscopy for Sialolithiasis: Effect on Outcomes
Authors: Modest Mara C. , Galinat Lauren , Rabinowitz Mindy , Curry Joseph , Rosen David , Cognetti David M. 
Published: August 2013

Objectives:Evaluate how learning progression affects outcomes for the use of sialendoscopy for sialolithiasis.Methods:A retrospective chart review was conducted on 79 patients presenting with sialolithiasis between 2008 and 2012 who underwent sialendoscopy on 86 salivary glands at a tertiary medical center. Outcomes compared between the first 43 cases (40 patients) and second 43 cases (39 patients) included successful removal, surgical method, and any further need for intervention.Results:For the first 40 patients (group A), the mean age was 50.6 years (range, 21‐87), and 55.8% were male. For the second 39 patients (group B), the mean age was 50.8 (range, 15‐77), and 46.5% were male. Sialolithiasis was diagnosed based on physical exam or imaging. Mean stone size was similar in both groups: 8 versus 8.6mm, respectively. Where a stone was visualized, complete removal was accomplished in 88.6% of cases in group A versus 97.4% in Group B. Endoscopic removal occurred in 20.0% of the patients in group A, versus 35.9% in group B. A combined approach was used in 45.7% in group A versus 64.1% in group B. 34.3% in group A required gland removal versus 0.0% in group B (P = 0.005). Seventeen point nine percent of patients in group A needed further intervention (medical or surgical) versus 9.3% in group B.Conclusions:This study documents a clear learning curve for sialendoscopy for the management of sialolithiasis. With experience, the success of sialendoscopy increases, and there is a significant decrease in the number of gland excisions.
Lymphatic Mapping Patterns in Early Oral Squamous Cell Carcinoma
Authors: Farmer Roger W. , Civantos Francisco J. , Myers Jeffrey N. , Yarbrough Wendell G. , Siegel Barry A. , O'Leary Miriam A. , Zitsch Robert P. 
Published: August 2013

Objectives:Correlate location of sentinel nodes on lymphoscintigraphy versus sentinel lymph node biopsy (SLNB) and lymphatic metastases for T1 and T2 N0 oral cavity cancer.Methods:This was a prospective cooperative group trial of 140 patients with untreated T1 and T2 N0 oral cancers at academic medical centers. Interventions were lymphoscintigraphy, resection of the primary, SLNB, and immediate neck dissection. The outcome measures were location of sentinel nodes by lymphoscintigraphy versus SLNB, and location of metastases.Results:Lymph nodes located by lymphoscintigraphy and SLNB were found predominately in levels I through IV. There was heterogeneity in the number of the lymph nodes found at lymphoscintigraphy and at SLNB, which was significantly different in levels II and III (P < 0.0001). In 6 of 28 cases with bilateral drainage on imaging, SLNB detected only unilateral sentinel nodes. Sensitivity of lymphoscintigraphy in predicting the levels of sentinel nodes ranged from 42% to 63%, and specificity from 71% to 95%, for each level. Comparison of locations of nodal metastases to historical data showed fewer metastases to level I in our study (P = 0.0295). Metastases occurred predominantly in levels I, II, and III. In one case of a lateral tongue cancer, a contralateral node was the only positive node.Conclusions:Lymphatic drainage patterns and lymph node metastases involved predominantly levels I, II, and III. Lymphoscintigraphy is not very sensitive for predicting the levels of sentinel nodes. In levels II and III, the rate of detection of lymph nodes between the two modalities is significantly different.
A Novel Modular Polymer Platform for the Treatment of Head and Neck Squamous Cell Cancer
Authors: St. John Maie , Lin Yuan , Zhu Eric , Abemayor Elliot , Wu Ben 
Published: August 2013

Objectives:Evaluate the therapeutic efficacy of a novel modular polymer platform in the treatment of head and neck squamous cell carcinoma (HNSCC). 50% of HNSCC patients fail primary management, and salvage of the recurrent disease patient is of paramount importance.Methods:Study Design: In vivo study. Setting: Academic research laboratory. C3H/HeJ mice were randomized to receive implantation of 1) no polymer; 2) plain polymer; 3) plain polymer containing gene‐modified dendritic cells over‐expressing CCL21 (DC‐AdCCL21); and 4) plain polymer with concurrent daily CCL21 injections. Tumor size was measured until the mice were euthanized. At necropsy, the tumors were excised and weighed.Results:Our results using this novel polymer platform demonstrate a remarkable reduction in tumor growth. The dendritic cell CCL21 secreting polymer effectively reduced SCCVII/SF tumors in the C3H/HeJ mice by over 16‐fold (P < 0.01) as compared to control, plain polymer, and plain polymer + intratumoral CCL21 injection groups. We also demonstrate that we can effectively grow dendritic cells in the polymer that can actively secrete CCL21. Treatment with the dendritic cell CCL21 secreting polymer led to a marked reduction in tumor burden with extensive mononuclear cell infiltration of the tumors.Conclusions:Our promising results indicate that this polymer may represent a new therapeutic modality for patients with HNSCC. Our data provide a strong rationale for further evaluation of this DC‐AdCCL21 polymer in regulation of tumor immunity and genetic immunotherapy for HNSCC. Once this polymer platform is further optimized, we will plan for the ultimate validation in the context of a prospective trial in patients with unresectable advanced or recurrent HNSCC.
Outcome of Patients with Different MEN2A Germline Mutations
Authors: Tavares Marcos R. 
Published: August 2013

Objectives:Medullary thyroid carcinoma (MTC) behavior in MEN2 present variations, ranging from indolent MTC, in patients harboring intra‐cellular “weak mutations, to highly aggressive disease, with RET mutation in codons 634 or 918. We compared the outcomes among patients with different germline mutations.Methods:Retrospective chart review. Between January 2002 and December 2011, 67 MTC patients were operated at our institution: 26 (38.8%) sporadic and 41 (61.2%) carriers of MEN2A germline RET mutations. All patients were tested for RET hot spot mutations (exons 5, 8, 10, 11, 13, 16), pre‐ and postoperative calcitonin (Ct), carcinoembryonic antigen (CEA), parathyroid hormone, and calcium. They were also submitted to imaging studies (ultrasound, MRI, CT and scintigraphy). Follow‐up varied from 1 to 65 months (average 10.9 months). Patients were classified as cured when serum Ct concentration <2pg/mL in the last evaluation (Group A). Patients not cured were divided in two groups: Group B) Ct >2pg/mL and >40pg/mL and Group C) Ct>40pg/mL.Results:Nineteen patients (46.3%) were cured, most of them treated by prophylactic surgery. There was no difference according to the RET mutation. Preoperative calcitonin level ranged from 4.5 to 1367pg/mL (average 124.5) in group A from 9 to 180149 (average 124.5) in group B and from 98 to 8358 (average 2587) in group C. Fifteen patients (36.6%) presented postoperative hypoparathyroidism, not related to cure, although related to extended surgery. Younger patients who underwent prophylactic surgery had better prognosis (P = 0.02).Conclusions:Genetic test is the most important exam to perform in MTC patients. Outcome was better in younger patients treated by prophylactic surgery.
Pretreatment Interleukin‐6 Serum Levels Are Associated with Patient Survival for Oral Cavity Squamous Cell Carcinoma
Authors: Chang Kai‐Ping 
Published: August 2013

Objectives:Determine the role of serum interleukin‐6 concentration for oral cavity squamous cell carcinomas.Methods:Cohort study in a tertiary referral center. Two hundred thirty‐seven untreated patients, 125 healthy individuals, and 104 individuals with oral premalignant lesions were enrolled. Interleukin‐6 serum concentrations were measured by the enzyme‐linked immunosorbent assay.Results:Serum concentrations of interleukin‐6 were significantly higher in patients compared to the levels in healthy individuals and the subjects with oral premalignant lesions. Serum interleukin‐6 levels were significantly higher in patients with higher pT status (from pT1 to pT4, median values in pg/ml = 0, 0, 1.3, 5.0 respectively, with P < 0.001), higher pathological stages (from stage I to IV, median values = 0, 0, 1.3, 3.6 respectively, with P < 0.001), positive bone invasion (5.0 vs. 0, 1.4 vs. 0; P <0.001), and higher tumor depths (1.4 vs. 0; P 0.005). Patients with higher pre‐treatment levels of interleukin‐6 (>1.35 pg/mL, median level) had worse prognoses for 5‐year overall survival and disease‐specific survival despite treatment (75.7% vs. 54.9% and 79.1% vs. 59.8%; P = 0.001 and 0.003, respectively). Multivariate logistic regression analyses also indicated that higher interleukin‐6 serum levels were an independent prognostic factor for overall survival and disease‐free survival (adjusted hazard ratio = 2.417 and 2.364; P = 0.009 and 0.017, respectively).Conclusions:Our study revealed that serum interleukin‐6 levels were associated with increased tumor burden and aggressiveness of oral cavity squamous cell carcinomas and may be useful as a prognostic indicator after treatment.
Prophylactic versus Elective PEG Tube Placement in Head and Neck Cancer
Authors: Kramer Scott , Newcomb Matthew , Hessler Joshua , Siddiqui Farzan 
Published: August 2013

Objectives:1) Evaluate nutritional outcomes of head and neck cancer patients treated with prophylactic versus elective percutaneous endogastric (PEG) tubes. 2) Analyze the length of PEG tube usage when placed prophylactically versus electively.Methods:This is a retrospective review of 83 subjects treated with cisplatinum‐based chemoradiotherapy (CRT) for head and neck cancer between 2007 and 2011, who received PEG tubes for nutritive support. Patients were eligible if their PEG tube was placed within six months of initiating CRT. Subjects were stratified according to when PEG tube placement occurred, whether before initiating CRT (prophylactic) or after (elective). Independent variables included age, gender, TNM stage, HPV tumor association, and CRT doses; outcome measures included weight change during radiation therapy, PEG tube duration, and survival.Results:Fifty‐four patients received prophylactic PEG tubes, whereas 29 patients received elective PEG tubes. There was no significant difference in age, gender TNM stage, HPV tumor association, or CRT doses between the groups. Weight loss was not significantly different between the groups (‐9.9% v. ‐10.0%, P = 0.96). Prophylactic patients had a longer duration of PEG tube usage than elective patients (mean 227 days v. 139 days, P <. 01). Additionally, a higher percentage of elective patients were alive at last follow‐up (100% v. 79.6%, P =. 03).Conclusions:Patients requiring on‐demand PEG tube placement may use their PEG tubes for a shorter duration than those receiving up‐front placement, without suffering worse nutritional outcomes.
Quantitative Assessment of Outcomes for Sialendoscopy in Patients with Radioiodine‐Induced Sialadenitis
Authors: Lai Stephen Y. , Acharya Varun , Kongkiatkamon Suchada , Farrah Sally , Roberts Dianna B. , Sterba Jennifer , Chambers Mark S. 
Published: August 2013

Objectives:Radioiodine (I131) is an effective adjuvant therapy following surgery in patients with high‐risk thyroid cancer. Unfortunately, radioiodine treatment may result in significant xerostomia and sialadenitis. We examined outcomes in patients treated for radioiodine‐induced sialadenitis with sialendoscopy.Methods:Data have been prospectively collected for all patients undergoing sialendoscopy at this institution. Findings of the procedure and the intervention details were recorded. Qualitative data were obtained through patient examination and use of standard quality of life questionnaires (eg, MDASI‐HN and Xerostomia Questionnaire). Quantitative data were obtained from patients who underwent sialometry.Results:Twenty‐six patients (23F/3M) with an average age of 46 yrs (range: 19‐57 yrs) underwent interventional sialendoscopy for radioiodine‐induced sialadenitis. Sialendoscopy was attempted on 62 glands (45 parotid and 17 submandibular glands). In 2 patients, sialendoscopy could not be completed successfully on submandibular glands. Papillary stenosis was seen in 10 (16%) of the glands treated. Six submandibular glands ducts (9.7%) required sialdochoplasty. Patients subjectively noted the following resolution of symptoms: partial resolution (18; 69.2%), complete resolution (6; 23.1%), no change (1; 3.8%), and worsening of symptoms (1; 3.8%). Preliminary statistical analysis of the sialometry data by Wilcoxon matched pairs test (nonparametric) showed that there was a statistically significant difference in saliva production at 6 months following sialendoscopy for unstimulated saliva production (P = 0.028) but not for stimulated saliva production (P = 0.50) as compared to baseline measurements in patients with subjective improvement.Conclusions:Sialendoscopy is an effective treatment option for the management of radioiodine‐induced sialadenitis.
Rapid Discharge after Transoral Robotic Surgery
Authors: Richmon Jeremy D. , Chan Jason Y. , Feng Allen 
Published: August 2013

Objectives:1) Analyze the Johns Hopkins’ experience of rapid discharge after transoral robotic surgery (TORS). 2) Describe those factors that allow for rapid discharge and those which require longer postoperative hospitalization following TORS.Methods:All transoral robotic surgery (TORS) cases performed by the senior author were retrospectively reviewed. Length of hospitalization (LOH) was the primary outcome measurement. LOH was analyzed in regards to disease process, stage, performance of other concurrent procedures (ie neck dissection, percutaneous endoscopic gastrostomy [PEG] placement), age, gender, co‐morbidities, and intra‐operative complications. Secondary outcome measures included postoperative complications, tracheotomy and PEG dependency rates, and need for re‐admission to hospital.Results:Seventy‐eight cases from October 2009 through February 2013 were included for analysis. The average LOH was 1.2 days. LOH was found to be significantly longer in patients with obstructive sleep apnea undergoing lingual tonsillectomy than in oncologic patients. All patients were discharged home on a per oral diet. No patients had a tracheotomy or PEG tube at 6 months postoperatively. The postoperative complication rate was 5% and was independent of the LOH.Conclusions:TORS has seen tremendous growth in the last few years for the treatment of oropharyngeal carcinoma and obstructive sleep apnea (OSA). To date, there have been no formal recommendations regarding postoperative management of these patients. We demonstrate that rapid discharge after undergoing TORS is safe, well‐tolerated, has a low complication rate, and does not result in hospital re‐admission. However, patients with OSA required longer hospitalizations. This further supports the cost‐effectiveness of TORS over other treatment paradigms for oropharyngeal cancer.
Sialendoscopy Outcomes: A Study of over 100 North American Patients for Benign Salivary Gland Disorders
Authors: Modest Mara C. , Galinat Lauren , Rabinowitz Mindy , Curry Joseph , Rosen David , Cognetti David M. 
Published: August 2013

Objectives:Evaluate our institution's experience with diagnostic and therapeutic sialendoscopy in the management of nonneoplastic salivary gland disorders.Methods:At a tertiary medical center, a retrospective chart review was conducted of 105 patients with recurrent sialadenitis between 2008‐2012 with sialendoscopy performed on 130 glands. Outcomes measured included cause, stone size and location, surgical method, and any further need for intervention.Results:The mean age of presentation was 49 (range, 15‐77), and 45% were male. Reasons for recurrent sialadenitis included sialolithiasis (75), history of radioactive iodine/radiation (10), Sjogrens Syndrome (2), stricture (6), and anatomical obstruction (7). Ten patients had a history of prior transoral intervention, and two had a history of gland removal on the affected side. In patients with sialolithiasis (n = 75), the mean stone size was 8.6 mm if originating from the submandibular gland (n = 44, range, 1‐25mm), and 4.4 mm if originating from the parotid (n = 9, range, 2‐7mm). Complete stone removal was accomplished in 92% of cases on first attempt with the stone visualized. In 33.8% of the patients, the stone was removed endoscopically, while a combined approach was required in 50.7%. 15.5% required submandibular or parotid gland removal. 17.8% of patients required further intervention (medical or surgical) following their procedure.Conclusions:Sialendoscopy demonstrates great potential in the management of recurrent sialadenitis and minimizes the need for gland excision in that setting. Further investigation and adoption of sialendoscopy is warranted.
Transoral Robotic versus Open Surgical Approaches to Oropharyngeal Squamous Cell Carcinoma by Human Papillomavirus Status
Authors: Ford Samuel E. , Brandwein‐Gensler Margaret , Carroll William R. , Rosenthal Eben L. , Magnuson J. Scott 
Published: August 2013

Objectives:1) Investigate oncologic survival outcomes. 2) Analyze the impact of human papillomavirus (HPV) status on prognosis in patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with transoral robotic (TORS) vs. open surgery.Methods:Retrospective case‐control study of 130 total patients treated for primary OPSCC with either TORS or open surgery and appropriate adjuvant therapy between October 2004 and March 2012 at the University of Alabama at Birmingham Hospital (tertiary care referral center). Cases and controls were matched based on TNM staging. Recurrence‐free survival was used to evaluate the impact of human papillomavirus‐mediated carcinogenesis and surgical intervention on prognosis. Kaplan‐Meier, chi‐square, and t‐test analyses were used.Results:Patients treated with transoral robotic surgery survived more frequently (94% and 89% at 1 and 3 years, respectively) than for those treated with open surgery (85% and 72% at 1 and 3 years, correspondingly) (Breslow P = 0.035). Patients with HPV‐positive cancers treated with either TORS or open approaches and patients with HPV‐negative tumors treated with TORS all survived at similar rates. Patients with HPV‐negative OPSCCs treated with open surgical approaches, however, survived without recurrence less frequently at 1 and 3 year rates of 58% and 25%, respectively (P = 0.001 and 0.001 vs. HPV‐positive TORS, respectively; P = 0.008 and 0.001 vs. HPV‐positive non‐TORS, respectively).Conclusions:These data suggest that TORS is at least equivalent to, if not better than, open surgical approaches to OPSCC in providing recurrence‐free survival at one‐ and three‐year post‐operative intervals to patients regardless of HPV status.