bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laryngeal Squamous Cell Carcinoma in 4256 Women: A Population‐Based Analysis of Gender's Prognostic Implications
Authors: Fritsch Smith Valerie A. 
Published: August 2013

Objectives:1) Describe a large series of female patients with laryngeal squamous cell carcinoma (SCC). 2) Determine if there are gender‐related differences in clinicopathologic factors, outcomes, and prognostic indicators.Methods:All cases of laryngeal SCC diagnosed between the years 2000‐2008 were extracted from the Surveillance Epidemiology and End Results database. Clinicopathologic data, disease‐specific survival (DSS), and prognostic factors were compared between genders using chi‐square, Kaplan‐Meier, and multivariable regression analysis.Results:Of 21,666 patients, 4,256 (19.6%) were female. Supraglottic tumors were predominant in females (61%) (vs. 64% glottic tumors in males; P < 0.001); and females with supraglottic SCC were less likely to present with locally‐advanced disease or nodal metastases (P < 0.001). Overall, female gender was independently associated with improved DSS (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.74‐0.89, P < 0.001). Further analysis stratified by age subgroups revealed that the favorable prognostic implications associated with female gender were limited to patients diagnosed at age<70y (P < 0.005). In this group, females carried a 27‐32% lower risk of SCC‐specific mortality on multivariable analysis (P < 0.005). Notably, the protective effective of female gender was lost after age at diagnosis exceeded 70y (P > 0.25). Prognostic factors were mostly similar within each gender subgroup; however, the negative prognostic implications of age were significantly greater in females. In fact, the risk of laryngeal SCC‐specific death nearly tripled per annum in females (2.9% vs. 1.6% in males, P < 0.01).Conclusions:There are significant gender‐related clinicopathologic differences in laryngeal SCC. Females diagnosed at age<70y have significantly better DSS than males; and mortality risk is highly attributable to age in women.
Lean Six Sigma Applied to Ultrasound of the Head and Neck: Changing Patient Management
Authors: Matt Bruce H. , Butler Penny D. , Woodward‐Hagg Heather K. , Kokoska Mimi S. 
Published: August 2013

Objectives:1) Confirm the positive value stream of office‐based ultrasound using Lean Six Sigma. 2) Demonstrate how ultrasound reduces time to diagnosis, costs, patient inconvenience and travel, exposure to ionizing radiation, intravenous contrast, and laboratory tests.Methods:A retrospective review of adults with head and neck lesions between 2009‐2012 at a veterans administration hospital was conducted. Affiliated interventions: Ultrasound evaluation of head and neck lesions. Outcome Measurements: Type of diagnostic tests, time to diagnosis, radiation exposure, episodes of patient travel, and final diagnosis. Independent variables: Age and gender of patient. Preliminary analyses: Value stream mapping prior to and after implementing office‐based ultrasound confirmed the time from consult request to final diagnosis of a head and neck lesion was reduced from a range of 49‐146 days, requiring 17 steps, to a range of 7‐29 days, requiring 9 steps.Results:Office‐based ultrasound for evaluation of head and neck lesions reduced costs, time to diagnosis, risks and inconvenience to patients, radiation exposure, and unnecessary laboratory and patient complaints, while increasing staff satisfaction. In addition, office‐based ultrasound also changed the clinical management of specific patients.Conclusions:Lean Six Sigma is used to reduce waste and optimize quality and accuracy in manufacturing. This is the first known application of Lean Six Sigma to office‐based ultrasound in the evaluation of head and neck lesions. The value of office‐based ultrasound to patients, healthcare systems, and healthcare teams is unquestionable.
Biomimetic Scaffolds Loaded with Adipose‐Derived Stem Cells and BMP‐2 Induce Healing of Mandibular Defects
Authors: Lee Matthew K. , DeConde Adam , Aghaloo Tara , Lee Min , Tetradis Sotirios , St. John Maie 
Published: August 2013

Objectives:Investigate the efficacy of biomimetic scaffolds, alone and in combination with osteogenic signaling factors and adipose‐derived stem cells (ASCs), to heal a critical‐sized segmental mandibular defect in a rat model.Study Design:Prospective study using an animal model.Methods:Adipose‐derived stem cells were isolated and cultured from the inguinal fat of green fluorescent protein (GFP)‐transgenic Lewis rats. Using 3D printing, biomimetic PLGA scaffolds were fabricated and impregnated with ASCs and/or bone morphogenic protein (BMP‐2). Critical‐sized 5‐mm segmental mandibular defects were created in adult Lewis rats and implanted with 1) blank PLGA scaffolds, 2) PLGA scaffolds seeded with ASCs, 3) PLGA scaffolds with BMP, 4) PLGA scaffolds with BMP and ASCs. Animals were sacrificed at 12 weeks, and bone healing was evaluated using microCT analysis.Results:A total of 28 rats underwent creation of segmental mandibular defects with implantation of biomimetic scaffolds. MicroCT analysis demonstrated no bridging of the segmental bony defect in rats implanted with blank scaffolds (control). Rats implanted with scaffolds containing ASCs, BMP‐2, and ASCs in combination with BMP‐2 demonstrated healing of critical‐sized segmental mandibular defects, as determined by microCT analysis.Conclusions:ASCs and BMP‐2, alone and in combination, demonstrate the ability to heal critical sized mandibular defects in rats. This has implications for future translational research in oromandibular reconstruction.
Multiportal Robotic Access to the Anterior Cranial Fossa: An Engineering and Surgical Feasibility Study
Authors: Bly Randall A. , Su David , Lendvay Thomas , Friedman Diana , Hannaford Blake , Ferreira Manuel , Moe Kris S. 
Published: August 2013

Objectives:Use of robotic surgical technology in skull base surgery has been limited due to the need for 3 non‐disruptive surgical portals; adequate working space between the large robotic arms; and the steep approach angle to the skull base. The objectives were to determine the minimum space requirements between robotic arms, systematically analyze surgical approach portals in a computer model, and assess task performance capability of the derived approaches.Methods:A computer analysis on 10 computed tomography scans computed approach trajectory angles and distances to specified skull base target locations for multiportal surgical approaches. The optimal combinations of portals were tested using the da Vinci and Raven robotic systems to perform tasks, both in dry lab and cadaver settings.Results:Two robotic tools required an angle of at least 20 degrees between them to function effectively at the skull base targets. In the computer analysis, the angle between two transnasal robotic tools was 14.7, and combining with transorbital portals yielded angles much larger (up to 46.0 degrees). Additionally, the skull base trajectory angle was improved by greater than 28 degrees.Conclusions:Computer analysis and cadaver testing demonstrated that the optimal multiportal combination to access sella and parasellar target locations was using 1 transnasal and 2 transorbital portals. This technique addresses the 2 major challenges of 1) the narrow funnel effect generated from portals in close proximity and 2) the steep angle of approach to the skull base, reported in studies evaluating transoral, transcervical, transmaxillary, and transhyoid portals.
Nonmedical Costs in Patients Receiving Oral Cancer Surgery: Interim Analysis from the COOLS Trial
Authors: Cromwell Ian , Cressman Sonya , Poh Catherine , Rosin Miriam P. , Durham Scott , Peacock Stuart 
Published: August 2013

Objectives:1) Describe the non‐medical financial burden experienced by early‐stage oral cancer patients. 2) Analyze constituent costs and discover relevant potential policy levers.Methods:The pan‐Canadian Optically‐guided Oral Lesions Surgical (COOLS) Trial is a multi‐center randomized controlled trial evaluating a novel surgical staging method for the treatment of early‐stage oral cancer. A survey of 209 participants collected data at baseline, 3 months, and 12 months after surgery on time taken away from work and expenses paid out of pocket.Results:Participants were generally able to return to work following surgery, albeit with a slight reduction in self‐reported ability to work. Very few patients needed to take time off work or changed their working status (ie, going on medical leave, retiring) following their surgery (n = 4; 10 weeks; range = 5 ‐ 146 days). A majority of trial participants reported out‐of‐pocket spending at baseline (n = 128; $64.55; 95% confidence interval [CI] $40 ‐ $88), 3 months (n = 108; $82.44; 95% CI $56 ‐ $109), and 12 months after surgery (n = 51; $65.01; 95% CI $13 ‐ $117). Most out of pocket expenses were non‐reimbursed travel costs.Conclusions:Oral cancer, when treated at an early stage, was not generally a barrier to returning to work in our participant sample. Moderate out‐of‐pocket expenditure was observed in a large number of patients, mostly related to travelling. Programs to defray the cost of travel may be helpful in many cases, but broader evidence is needed.
Observation of Patients with Oral Potentially Malignant Disorders Using Autofluorescence Imaging and Spectroscopy
Authors: Gillenwater Ann M. , Howe Jana M. , Mondrik Sharon , Schwarz Richard A. , King Travis J. , Bhattar Vijayashree , Richards‐Kortum Rebecca 
Published: August 2013

Objectives:1) Describe 2 noninvasive optical techniques, widefield autofluorescence imaging (AFI) and optical spectroscopy, that may be used in conjunction with conventional oral examination (COE) for long‐term surveillance of patients with oral potentially malignant disorders (OPMD). 2) Present images and spectra collected from patients with OPMD using AFI and spectroscopy over a 33‐month surveillance period, and compare results to clinical observations and patient outcomes over that time period.Methods:Patients undergoing routine follow‐up surveillance for OPMD were enrolled in a longitudinal optical imaging study. The patients were monitored over time with COE, AFI, and spectroscopy. AFI was used to observe natural tissue fluorescence over a 4‐5 cm field of view. Spectroscopy was used to obtain reflectance and fluorescence spectra from selected sites within the oral cavity. The images and spectra collected from these patients were evaluated for changes over time and compared to clinical observations and (where available) histopathology results.Results:During the 33‐month period from May 2010 to February 2013, more than 140 patients were enrolled in the study. To date, more than 1,000 optical measurements have been performed during more than 400 clinical surveillance visits. During the surveillance period 26 patients were judged clinically to have progressed from OPMD to cancer. Representative images and spectra from some of these patients will be presented.Conclusions:These results indicate the potential for simple optical techniques, when used in combination with COE, to assist clinicians in monitoring patients with OPMD for early detection of cancer.
Pathologic Discordance in Skull Base Tumors
Authors: Burgin Sarah , Peress Lilia , McKean Erin M. 
Published: August 2013

Objectives:A wide range of pathologies cause skull base tumors, which require accurate diagnosis for appropriate treatment. These lesions can be difficult to biopsy in the clinic due to patient intolerance and risk of bleeding, and in the operating room due to difficulty with access. The objective of this study was to analyze diagnostic accuracy among patients with skull base tumors referred to a tertiary care center.Methods:We retrospectively reviewed the records of patients referred to the University of Michigan Multidisciplinary Cranial Base program over a 2 year period (July 2010‐June 2012). We excluded patients referred for pituitary lesions, for internal auditory canal/cerebello‐pontine angle lesions, and without concern for tumors (encephaloceoles, CSF leaks, fractures). We collected data regarding biopsy prior to referral, histologic diagnosis by outside pathologists, diagnosis on review by University of Michigan pathologists, and final histologic diagnosis after repeat biopsy, resection, or both.Results:The records of 177 patients were reviewed. Fifty‐nine (59) patients had specimens which had been reviewed by both community pathologists and University of Michigan pathologists. There was some discrepancy in histologic diagnosis in 17/59 (28.8%) of the patients. The most frequent diagnosis with discordance was squamous cell carcinoma (5/17, 29%) and sinonasal undifferentiated carcinoma (2/17, 11.8%). No patient's diagnosis was changed from benign to malignant or vice‐versa.Conclusions:There is a high rate of discrepancy (28.8%) in the diagnosis of skull base tumors when reviewed by community pathologists compared to specialized pathologists at a tertiary care institution.
Comparison of Complication Rates with and without Arch Bar Use in Treatment of Mandible Fractures
Authors: Archer Kaete A. , Kopp Robert , Goyal Parul , Kellman Robert M. , Suryadevara Amar C. 
Published: August 2013

Objectives:1) Explain the pros and cons of using arch bars for mandible fracture stabilization. 2) Compare and contrast the outcomes of mandible fractures treated with and without arch bars.Methods:A retrospective review was performed of mandible fractures treated at a Level 1 trauma center between 2001 and 2011. Two‐hundred forty‐two patients met inclusion criteria. Patients were categorized into those treated with or without arch bars. Major complications were malocclusion, infection, and malunion. Independent variables of age, sex, trauma, and dental status were collected. Exclusion criteria included lack of follow‐up, greenstick fractures, mid‐facial fractures, and subcondylar fractures. Data were analyzed using Fisher's exact test.Results:Eighty‐four patients had one mandible fracture, and 158 patients had two fractures. Overall, patients treated with arch bars had a complication rate of 13%, and those treated without arch bars had a rate of 16%. This was statistically insignificant (P = 0.58). When separated by number of fractures, the differences remained insignificant (12% and 10% complication rates with and without arch bars in single fracture cases (P = 0.74); 14% and 19% in two fracture cases (P = 0.37)).Conclusions:The use of arch bars did not have a significant effect on major complications in this series. This trend was consistent for cases of one and two mandible fractures. These data suggest that many patients with mandible fractures may be safely treated without arch bars.
Predictors and Cost of Readmissions at an Academic Head and Neck Cancer Service
Authors: Dziegielewski Peter T. , Boyce Brian J. , Manning Amy , Agrawal Amit , Old Matthew O. , Ozer Enver , Teknos Theodoros N. 
Published: August 2013

Objectives:With healthcare reform nationally debated, surgeons are increasingly called upon to improve quality of care while lowering cost of delivery. Rate of hospital readmission within thirty days of discharge (RA30) is a quality measure monitored by CMS and will subject healthcare systems to fines if they fall outside of acceptable standards. Unfortunately, few benchmarks in head and neck surgery (HNS) exist. Our goal was to determine: 1) the rate and predictors of readmissions, and 2) a detailed cost breakdown of readmissions on an academic head and neck surgery service.Methods:A prospective‐cohort study at a tertiary‐care academic center was conducted. Six hundred and ninety‐four patients from 2011‐2012 underwent HNS procedures. Demographic, pathological, and follow‐up data were collected. Financial information for each admission was obtained from the hospital billing database. RA30 was the primary outcome. Multivariate analysis identified peri‐admission factors predictive of re‐admission. A cost analysis was performed.Results:C4QI cancer hospital‐readmission benchmarks for fiscal year 2011 were 17.29%. On the HNS service, 39 (5.6%) patients were re‐admitted to the hospital. Thirty‐six of 39 patients were admitted due to wound complications and 3/39 due to pneumonia (2) or C difficile (1) colitis. Predictors of re‐admission were age >65 years, advanced stage cancer, previous radiation therapy, multiple medical comorbidities, and high‐acuity procedures (P < 0.05). Median cost of readmission was $20,877.84 (range: $3,201.50‐$174,693.30). The highest source of readmission cost was the operating room.Conclusions:Readmission rates on a busy HNS service can be low, but costly. Knowing factors predictive of readmission may help create preventative and minimize excess costs.
Prognostic Factors for Survival in Human Papilloma Virus Positive Head and Neck Squamous Cell Carcinoma
Authors: Ahn Sun M. , Chan Jason Y. , Mydlarz Wojciech K. , Zhou Xian‐Chong , Richmon Jeremy D. , Agrawal Nishant 
Published: August 2013

Objectives:The TNM classification of human papillomavirus (HPV) associated tumors does not account for HPV/p16 status or that the cervical metastases tend to be cystic, which artifactually increases the size of the affected nodes. Our study objective was to review the outcomes of patients with HPV associated squamous cell carcinoma (SCC) of the oropharynx and unknown primary treated at our institution from 2008‐2011.Methods:A retrospective review of patients at our institution from 2008‐2011 identified 199 patients with p16 positive squamous cell carcinoma of unknown primary or of the oropharynx.Results:Of the 199 patients, 177 (89%) were males, 182 (92%) were Caucasian, 135 (68%) were ≤ 60 years old, 85 (43%) were non‐smokers, 187 (94%) arose from the oropharynx, 139 (70%) had T stage ≤2, 47 (24%) had N ≤1, and 20 (10.1%) were p16 positive but HPV DNA negative by in situ hybridization (ISH). On multivariate analysis of disease‐free survival (DFS), increased age (hazard ratio [HR] = 1.05 P = 0.02), ECOG status ≥1 (HR = 3.09 P = 0.002), T3/4 vs. T0/1/2 (HR 2.27 P = 0.02), N2C vs. N1/N0 (HR = 2.77 P = 0.02) and receiving induction chemotherapy versus definitive chemoradiotherapy (HR = 5.13 P = 0.02) were associated with worse DFS. p16 and HPV DNA positivity (HR 0.41 P = 0.03) was associated with improved DFS.Conclusions:Our data suggest that nodal size may not be as important as number of nodes in HPV positive disease. Furthermore, dual positivity of p16 and HPV DNA compared to p16 alone has a positive impact on prognosis suggesting a biologic difference between them.
Rapid Mandible Margins for Intraoperative Assessment
Authors: Taraska Allison K. , Royer Mark C. , Summerlin Don‐John , Moore Michael G. , Kokoska Mimi S. 
Published: August 2013

Objectives:1) Assess various rapid methods for processing mandible bone margins for histopathologic examination. 2) Determine the optimal method for intraoperative use.Methods:Multiple bone samples were collected from a fresh (<12 hours post‐mortem) human cadaveric mandible using a standard 3mm core bone biopsy trocar. The cored specimens were placed 30 minutes in 10% formalin (transport time) and then for 15‐75 minutes in 1 of 3 decalcifying solutions (Decal A, Calex, EDTA Decal). Controls were placed in 10% formalin. After each designated decalcification time period, specimens were cryosectioned or paraffin‐embedded and reviewed by a head and neck surgical pathologist blinded to the treatment groups. The specimens were assessed for overall quality, adequacy of decalcification, soft tissue quality, marrow quality, and presence of artifact.Results:Bone margin specimens collected with a 3mm core bone biopsy trocar and processed with all 3 decalcifying solutions for 15 minutes yielded acceptable quality and sufficient decalcification for histopathologic assessment. In addition, the trabecular, intact soft tissue and marrow were well‐preserved with good cellular architecture.Conclusions:Mandible bone margins can be rapidly processed for histologic evaluation using cored specimens with only 15 minutes of decalcification, allowing for intraoperative assessment of a bone margin. A prospective clinical trial of patients with cancer invasion in the mandibular bone to confirm cancer cells are identifiable with this rapid processing method is planned.
Recurrence Patterns for Head and Neck Squamous Cell Carcinoma Treated with Cetuximab versus Non‐cetuximab Therapy
Authors: Walgama Evan S. , Sumer Baran D. 
Published: August 2013

Objectives:The respective roles of platinum‐based chemotherapy and cetuximab therapy in the treatment of head and neck squamous cell carcinoma (HNSCC) have yet to be strictly defined. This study investigates the patterns of recurrence for patients with HNSCC treated with cetuximab versus non‐cetuximab therapies.Methods:Retrospective case‐control study at a tertiary academic practice. Patients with recurrent HNSCC that received primary non‐surgical therapy between 2006 and 2009 were retrospectively reviewed. Patients were stratified by treatment into 2 primary groups: 14 patients who received cetuximab plus radiotherapy and 30 patients who received non‐cetuximab radiotherapies. The 2 groups were compared, and the primary endpoint was the time to locoregional recurrence. Subgroup analysis was performed for the non‐cetuximab radiotherapy group.Results:Overall stage (P = 0.423), T stage (P = 0.190), smoking history (P =1.000), alcohol use (P = 0.498), and comorbidity based on ASA score (P = 1.000) were not significantly different between the 2 groups. Patients in the cetuximab group were on average older; 68.9 versus 61.3 years old (P = 0.049). Median time to recurrence for the cetuximab group was 5.3 ± 3 months versus 8.7 ±6 months for non‐cetuximab patients (P = 0.020); subgroup analysis showed 10.7 ± 7.3 months till recurrence for the concurrent chemoradiotherapy subgroup (P = 0.023). None of the patients in the cetuximab group were disease‐free for one year or longer.Conclusions:Patients with recurrent HNSCC treated primarily with cetuximab and radiotherapy alone have a significantly shorter time to recurrence than patients treated with conventional therapies.
Re‐irradiation versus Chemo‐reirradiation for Recurrent, Unresectable Head and Neck Cancer
Authors: Tay Kaijun , Loh Kwok‐Seng , Goh Boon‐Cher , Tham Ivan W.K. , Lim Chwee Ming 
Published: August 2013

Objectives:Both chemo‐reirradiation and reirradiation alone have been shown to be feasible treatment options for recurrent, unresectable head and neck cancer in an irradiated field. However, no randomized controlled studies have been performed to compare their efficacy. Our goal was to compare the survival and toxicity rates among patients treated with chemo‐reirradiation and reirradiation.Methods:A Pubmed search was performed using the search terms: re irradiation, previously irradiated, reirradiation, re‐irradiation and head and neck neoplasms[Mesh]. Two observers identified the full manuscripts which fulfilled the inclusion criteria: recurrent or second primary head and neck cancer, prior irradiation, no surgery, and no targeted therapy. Median overall survival (OS), 1‐year OS, and toxicity between reirradiation alone and chemo‐reirradiation groups were compared using Mann‐Whitney‐U test.Results:Of 473 papers identified, 15 papers were included: 11 papers (n = 567) reported median OS, and 13 papers (n = 601) reported 1‐year OS. Median age of the patients and radiation dosage delivered were similar between the groups. Average 1‐year OS was 44.1% (n = 214) in the reirradiation group and 47.2% (n = 387) in the chemo‐reirradiation group (P = 0.42). Average median OS was 12 months in the reirradiation group (n = 162) and 10.6 months in the chemo‐reirradiation group (n = 405) (P = 0.32). Average incidence of Grade‐3/4 Mucositis was 21.5% (n = 118) in the reirradiation group and 18.1% (n = 396) in the chemo‐reirradiation group (P =0.46). Chemotherapy‐related‐hematology toxicity was 24.2% (n = 353).Conclusions:This analysis involving more than 600 patients shows that, compared to reirradiation alone, chemo‐reirradiation has no discernable difference in OS or local toxicity but poses additional hematological toxicity. Optimal treatment remains to be defined.