bluuebunny/crossref_metadata_2025_split huggingface dataset:
Has Hypopharyngeal SCCa Survival Paralleled Laryngeal SCCa?
Authors: Newman John R. , Illing Elisa A. , Carroll William R. 
Published: February 2015

ObjectiveTo determine if: 1) the national trend of decreased survival of laryngeal cancer patients has also been seen in patients with squamous cell carcinoma of the hypopharynx, 2) to determine which subsets of hypopharyngeal cancer are most affected, and 3) to analyze factors that may contribute to survival.MethodThe Surveillance, Epidemiology and End Results (SEER) Database of the National Cancer Institute was analyzed for this study. Records of 6916 patients with squamous cell carcinoma (SCCa) of the hypopharynx between 1973 and 2003 were selected for review.ResultsOverall 5‐year survival rates for hypopharyngeal cancer have improved since 1973. Average survival of MO hypopharyngeal cancer patients was 83% in those diagnosed since 1990, compared to 75% before 1990 (P <. 0001). Since 2000, survival has averaged 86%. Since 1990, more patients have been treated with radiation only (1973‐89, 42.3% vs 1990‐2003, 49.9%) as opposed to combined surgical and radiation therapy (1973‐89, 43.6% vs 1990‐2003, 42.9%). Subsite analysis demonstrated that the majority of tumors (64%) originated in the pyriform sinus. The 5‐year survival for this subset of patients improved from 73% (1973‐89) to 82% (1990‐2003) (P <. 0002).ConclusionIn contrast to the decreased trends documented for laryngeal cancer, survival has improved in patients with squamous cell carcinoma of the hypopharynx over the past 2 decades. Primary therapy for these patients has largely been with radiation or radiation/surgery, with an increasing number of patients being treated with radiation alone.
Human Papilloma Virus in Laryngeal Squamous Cell Carcinoma
Authors: Clayburgh Daniel , Sauer David , Schindler Joshua S. 
Published: February 2015

Objective1) To determine the incidence of human papilloma virus (HPV) expression in laryngeal squamous cell carcinoma (SCC). 2) To determine the subtypes of HPV associated with laryngeal SCC.MethodBetween 2006 and 2011, most new diagnoses of laryngeal SCC at our institution were sent for HPV PCR. A retrospective review was conducted on these patients. The results of this test, patient history, and tumor characteristics were collected. Descriptive statistics and Student’s t test were performed.ResultsThirty patients with laryngeal SCC and an HPV PCR assay were identified. Three patients (10%) were positive for HPV. Subtypes 16, 31, and 59 were identified in these 3 patients. The HPV+ patients exhibited a trend towards less tobacco use (23 pack‐years versus 46 pack‐years in HPV– patients), although this was not statistically significant (P =. 18). There was no significant difference in age between HPV+ and HPV– patients (63.3 years vs 65.8 years, P =. 88).ConclusionAlthough not as common as in oropharyngeal SCC, a subset of laryngeal SCC is associated with HPV. Several subtypes of HPV may be found in this disease. Future prospective studies will be useful to more accurately determine the incidence of HPV in laryngeal SCC and its effects on disease outcomes.
Is Education Effective during Head and Neck Cancer Screenings?
Authors: Hapner Edie R. , Wise Justin C. , Bauer Kellie L. , Zhu Jiang Jason 
Published: February 2015

ObjectiveThis study measured the baseline knowledge of NASCAR fans regarding the risks, signs, and symptoms of head and neck cancer and examined the effectiveness of education efforts concerning head and neck cancer during a free, community‐based head and neck cancer screening.MethodAdults touring the midway during a NASCAR race were recruited for the study. A survey regarding knowledge on head and neck cancer (HNCA) was administered before and after HNCA screening which included education on risks, signs, and symptoms of such malignancies. Participants were surveyed again 3 months after the race.ResultsFour hundred seventy‐eight NASCAR fans participated in the study. Of these, 34% reported being a current smoker and 10% reported being a current user of smokeless tobacco. Of the 478 participants, 106 were contacted at the 3‐month follow up. A univariate ANOVA indicated knowledge of head and neck cancer changed significantly over time, F(2, 204) = 18.66, P <. 001, η2 =. 16. Specifically, knowledge assessed after the educational component was significantly higher than at baseline. At the 3‐month follow‐up, knowledge was significantly higher than baseline, but significantly lower than after exposure to the educational component.ConclusionParticipants demonstrated increased knowledge on the risks, signs, and symptoms of HNCA immediately following the educational session during the screening and at 3‐month follow‐up. While specific knowledge on HNCA was greater at the 3‐month follow‐up than baseline, it significantly diminished compared with post‐screening test results, suggesting poor long‐term knowledge retention.
Marginal Mandibular Nerve Palsy Incidence in Neck Dissection
Authors: Amin Nikul , Dixon Hannah , Gibbins Nicholas , Lew‐Gor Simione 
Published: February 2015

ObjectiveThe marginal mandibular nerve (MMN), a branch of the facial nerve, is at risk of damage during neck dissections. The resulting asymmetry of the mouth can cause distress as well as physical problems (dental lip trauma and fluid spillage) and is often not appreciated preoperatively. The authors wished to: 1) ascertain the incidence of marginal mandibular nerve (MMN) palsy during neck dissections, and 2) correlate risk of nerve palsy with level of nodal clearance.MethodAll neck dissections undertaken at a tertiary referral head and neck oncology center from the last 2 years 1/1/10‐1/1/12 were examined. Data collected include type of neck dissection, levels cleared, and pre‐ and postoperative MMN function.ResultsWe collected data from 50 consecutive neck dissections. Seven of 50 (14%) patients had an MMN palsy postoperatively. Of these 100% were permanent. As expected, patients with level 1 clearance were those at highest risk of MMN palsy. The grade of the operating surgeon was not statistically significant.ConclusionThe incidence of MMN palsy in neck dissections is high. Despite being a recognized complication of neck dissection surgery, there are limited data regarding rates of MMN palsy or correlation with levels of nodal clearance. The authors suggest that preoperatively the patient should be alerted to the incidence of MMN plasy, especially if level I is to be included in the dissection.
Microfluidic Techniques to Assess Radiosensitivity of HNSCC
Authors: Carr Simon , Green Victoria , Stafford Nicholas , Greenman John 
Published: February 2015

ObjectiveThe ability to predict tumor radioresistance would avoid unnecessary treatment with associated side effects and negate salvage surgery. Microfluidic techniques can be exploited to replicate the in vivo tumor microenvironment.This study demonstrates how such technology can determine the response of HNSCC to radiotherapy in an individualistic manner.MethodTechnique optimized using rat liver maintained in microfluidic devices, perfused with media for <17 days. Radiotherapy treatment (10‐20Gy): single and fractionated doses. Effluent analyzed for urea, albumin, and lactate dehydrogenase (LDH, cell death indicator) to assess response. Nine HNSCC biopsies (T1‐T3) were analyzed for LDH release following radiotherapy (2‐30Gy).ResultsInitial cell death decreased reproducibly to minimal levels in all tissues between 12‐24 hours. Tissue remained viable for up to 17 days. Rat liver: 0‐2 hours after 20Gy radiotherapy (single dose), an LDH surge with concomitant decrease in urea and albumin was observed. The tissue partly disintegrated. 2 × 10Gy fractionated doses resulted in effects after the second fraction. The tissue remained intact. HNSCC biopsies: Tongue base (n = 3), larynx (n = 3), lymph node metastases (n = 2) 30Gy: Larynx responded. Tongue base (postradiotherapy recurrence) did not. 10Gy: Tongue base responded, not larynx or lymph nodes. No response in any tissues with <10Gy.ConclusionA model to assess tissue response to radiotherapy was successfully established using rat liver. Preliminary results with HNSCC samples have shown that a response to radiotherapy can be elicited at different doses using this technique. Correlation with histology and clinical response will further validate this technique as a predictive tool.
Outcomes in Oropharyngeal Cancer
Authors: Titoria Puneet , Carswell Andrew , Repanos Costa , Parmar Amit , Tierney Paul 
Published: February 2015

Objective1) To assess outcomes, in terms of survival, quality of life (using EORTC CQOL and HN35), and swallowing in oropharyngeal cancer patients treated with transoral surgical techniques. 2) To compare these outcomes with those of patients treated with chemoradiotherapy.MethodThe study was conducted through 2011. Data were collated from the databases of 3 head and neck cancer units in the southwest of England. Patients diagnosed with oropharyngeal squamous cell carcinoma between 2006‐2008 were identified. Their medical records were reviewed and questionnaires looking in to the assessed outcome measures were sent.ResultsA total of 124 patients diagnosed with oropharyngeal squamous cell carcinoma during the years 2006‐2008 were identified. Of these 124 patients, 70 were still alive at the time of the study. Sixty‐three of 70 patients responded to the questionnaire. Notable findings included much reduced symptom scores for swallowing difficulties in those patients treated surgically compared to chemoradiation. The combined head and neck symptom scores for stage 3 and 4 disease was a median of 12 for the surgical group versus 27 for the chemoradiation group.ConclusionThese data add to the available evidence that suggests that patients treated with modern, minimally invasive, transoral surgical techniques may have improved quality of life and swallowing function compared to those treated with chemoradiotherapy.
Percutaneous Dilatational Tracheotomy in Non‐ICU Wards
Authors: Hain Moshe , Adi Nimrod , Polishuk Yael , Lahav Yonatan , Halperin Doron 
Published: February 2015

ObjectiveTo retrospectively assess the feasibility of bedside PDT in nonintensive care wards using a novel joint Otolaryngology‐Intensive Care Team model. A control group composed of patients that underwent PDT in the ICU was used to assess the relative complication rate and outcome.MethodA working protocol was constructed defining all stages of the process. All early and late complications were recorded. Other parameters analyzed were patient epidemiology, preprocedure morbidity, staff learning curve, duration of procedure, anesthetics administered, interval from ventilation to weaning, and interval to decannulation. Endpoints were hospital discharge, decannulation, and death.ResultsFrom September 2009 until July 2010 a total of 98 PDTs were performed; 48 PDTs were performed in the hospital wards, and 45 PDTs were performed in the ICU. No life‐threatening complications were encountered in the non‐ICU group and no significant difference in complication rate was observed between the 2 groups.ConclusionPercutaneous tracheotomy is an available, safe, low cost procedure which may be safely performed bedside in non‐ICU wards by a qualified team. This novel approach may greatly simplify the process of tracheotomy performance, eliminating much of the excess time, hassle, and cost without compromising safety and success rate.
Sentinel Node Biopsy in Cutaneous Squamous Cell Carcinoma
Authors: Hills Susannah E. , Raza Syed N. , McLean Scott A. 
Published: February 2015

ObjectiveIn cases of cutaneous squamous cell carcinoma (SCCa), early detection of regional metastases can greatly improve survival. The objective of this study is to explore the utility of sentinel lymph node biopsy (SLNB) for early detection of regional metastasis in patients with high‐risk cutaneous SCCa of the head and neck.MethodParticipants include patients with cutaneous SCCa of the head and neck with high‐risk prognostic features (size >2 cm, recurrence, depth >4‐5 mm, poor differentiation, perineural invasion, history of CLL/SLL/organ transplantation) but no nodal metastases. All patients underwent excision of the primary tumor with SLNB. Specimens were analyzed for evidence of regional metastases.ResultsPreliminary results include 19 patients who underwent excision of their tumor with SLNB, and 5 of 19 (26%) of these high‐risk patients developed regionally metastatic disease. SLNB demonstrated a sensitivity of 80%. There was a SLNB false omission rate of 20%. Of the 5 patients with regional metastases, 1 (20%) demonstrated perineural invasion, 3 (60%) demonstrated lymphatic invasion, 3 (60%) demonstrated vascular invasion, 4 (80%) demonstrated poor differentiation, and all 5 (100%) demonstrated depth >4 mm. One case of false omission occurred in a patient with CLL. All patients are currently living, and 2 (40%) have developed regional recurrence.ConclusionSLNB is capable of identifying early regional metastases in cutaneous SCCa. Preliminary data demonstrate that 26% of high‐risk patients developed regional metastases. SLNB effectively identified 80% of metastatic disease, with a 20% false omission rate. Regional metastasis was most strongly associated with lymphovascular invasion, poor differentiation, and depth >4 mm.
SMG Resection via Transoral vs Endoscopic RA approach
Authors: Hong HyunJun , Lee So‐Yoon , Kim Won Shik , Lee Hyoung Shin , Kim Se‐Heon , Choi Eun Chang , Koh Yoon Woo 
Published: February 2015

ObjectiveCompare the efficacy and feasibility of alternative approaches: endoscopic resection via retro‐auricular (RA) approach and transoral (TO) approach for submandibular gland (SMG) resection.MethodRetrospective analysis of surgical outcomes. We performed 21 endoscopic resections of benign lesions of SMG via RA approach and 11 resections via TO approach since 2010. The following variables were assessed: age, gender, tumor size, histopathologic type, operation time, length of hospital stay, scar satisfaction, and complications.ResultsThere were no statistically significant differences in patient profiles, tumor size, and histopathologic type between 2 groups. The cosmetic result was generally excellent and all patients were satisfied with the outcomes. However, in the first endoscopic surgery which was done for a large tumor in SMG, temporary weakness in the marginal branch of facial nerve was observed. There was no permanent palsy. Five patients in TO approach group had complaints of limitations of movement of tongue and numbness for several days. Excision via TO approach had the benefit of length of hospital stay over RA approach. However, the operation time took longer in patients who had small space of mouth floor.ConclusionThese 2 alternative approaches have distinct advantages. 1) Endoscopic resection of SMG via RA approach can be indicated for small benign tumors, sialadenitis and invisible or hiding scar. 2) Transoral approach for those who do not want an external scar, or do not have relatively small space of floor of mouth due to mandibular hypoplasia or narrow width of mandible body.
Temporal retinal nerve fibre layer thinning in cluster headache patients detected by optical coherence tomography
Authors: Ewering Carina , Haşal Nazmiye , Alten Florian , Clemens Christoph R , Eter Nicole , Oberwahrenbrock Timm , Kadas Ella M , Zimmermann Hanna , Brandt Alexander U , Osada Nani , Paul Friedemann , Marziniak Martin 
Published: February 2015

Background The exact pathophysiology of cluster headache (CH) is still not fully clarified. Various studies confirmed changes in ocular blood flow during CH attacks. Furthermore, vasoconstricting medication influences blood supply to the eye. We investigated the retina of CH patients for structural retinal alterations with optical coherence tomography (OCT), and how these changes correlate to headache characteristics, oxygen use and impaired visual function. Methods Spectral domain OCT of 107 CH patients – 67 episodic, 35 chronic, five former chronic sufferers – were compared to OCT from 65 healthy individuals. Visual function tests with Sloan charts and a substantial ophthalmologic examination were engaged. Results Reduction of temporal and temporal-inferior retinal nerve fibre layer (RNFL) thickness was found in both eyes for CH patients with a predominant thinning on the headache side in the temporal-inferior area. Chronic CH patients revealed thinning of the macula compared to episodic suffers and healthy individuals. Bilateral thinning of temporal RNFL was also found in users of 100% oxygen compared to non-users and healthy controls. Visual function did not differ between patients and controls. Discussion Our OCT findings show a systemic effect causing temporal retinal thinning in both eyes of CH patients possibly due to attack-inherent or medication-induced frequent bilateral vessel diameter changes. The temporal retina with its thinly myelinated parvo-cellular axons and its more susceptible vessels for the vasoconstricting influence of oxygen inhalation seems to be predisposed for tissue damage-causing processes related to CH.
The Epidemiology and Health Care Burden of Tennis Elbow
Authors: Sanders Thomas L. , Maradit Kremers Hilal , Bryan Andrew J. , Ransom Jeanine E. , Smith Jay , Morrey Bernard F. 
Published: February 2015

Background: Lateral elbow tendinosis (epicondylitis) is a common condition both in primary care and specialty clinics. Purpose: To evaluate the natural history (ie, incidence, recurrence, and progression to surgery) of lateral elbow tendinosis in a large population. Study Design: Descriptive epidemiology study. Methods: The study population comprised a population-based incidence cohort of patients with new-onset lateral elbow tendinosis between January 1, 2000, and December 31, 2012. The medical records of a 10% random sample (n = 576) were reviewed to ascertain information on patient and disease characteristics, treatment modalities, recurrence, and progression to surgery. Age- and sex-specific incidence rates were calculated and adjusted to the 2010 US population. Results: The age- and sex-adjusted annual incidence of lateral elbow tendinosis decreased significantly over time from 4.5 per 1000 people in 2000 to 2.4 per 1000 in 2012 ( P < .001). The recurrence rate within 2 years was 8.5% and remained constant over time. The proportion of surgically treated cases within 2 years of diagnosis tripled over time, from 1.1% during the 2000-2002 time period to 3.2% after 2009 ( P < .00001). About 1 in 10 patients with persistent symptoms at 6 months required surgery. Conclusion: The decrease in incidence of lateral elbow tendinosis may represent changes in diagnosis patterns or a true decrease in disease incidence. Natural history data can be used to help guide patients and providers in determining the most appropriate course at a given time in the disease process. The study data suggest that patients without resolution after 6 months of onset may have a prolonged disease course and may need surgical intervention.
Circulating CXCR5+CD4+helper T cells in systemic lupus erythematosus patients share phenotypic properties with germinal center follicular helper T cells and promote antibody production
Authors: Zhang X , Lindwall E , Gauthier C , Lyman J , Spencer N , Alarakhia A , Fraser A , Ing S , Chen M , Webb-Detiege T , Zakem J , Davis W , Choi Y Sung , Quinet R 
Published: February 2015

Objective Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of autoantibodies. Recently, a specific highly activated T helper cell subset, follicular helper T (Tfh) cell, has emerged as a key immunoregulator of germinal center (GC) formation and high-affinity antibody production. To identify the pathophysiological role of Tfh cells in SLE patients, we compared the phenotypic and functional properties of circulating Tfh-like cells in lupus patients to GC-Tfh cells, and correlated the percentage of Tfh-like cells with autoantibody production and SLE disease activity. Methods Peripheral blood was collected from 29 lupus patients and 25 healthy controls. Tonsils were obtained surgically from non-SLE controls and used as a source of GC-Tfh cells. Tfh cells were defined by their signature surface markers (CXCR5, ICOS, CD57, PD-1 and BTLA) via flow cytometry. IL-21 expression levels from Tfh cells were measured by real-time PCR and intracellular staining. The function of Tfh cells was carried out by co-culture of Tfh cells and autologous B cells in vitro. IgG in the culture supernatant was detected by ELISA. Results The frequency of circulating Tfh-like cells was significantly increased in SLE patients compared to healthy controls ( p < 0.05). The Tfh-like cells not only display similar phenotypes and signature cytokines with GC-Tfh cells, but also are capable of driving B cells to differentiate into IgG-secreting plasma cells in vitro. In addition, the frequency of Tfh-like cells correlated positively with the percentage of circulating plasmablasts, levels of serum anti-dsDNA antibodies and ANA. Conclusion The accumulated circulating Tfh-like cells in lupus patients share phenotypic and functional properties with GC-Tfh cells. Tfh-like cells may serve as perpetuators in the pathogenesis of SLE by enhancing the self-reactive B cell clones to further differentiate into auto antibody-producing plasmablasts, and ultimately cause autoimmunity.
Predictive accuracy of novel risk factors and markers: A simulation study of the sensitivity of different performance measures for the Cox proportional hazards regression model
Authors: Austin Peter C , Pencinca Michael J , Steyerberg Ewout W 
Published: February 2015

Predicting outcomes that occur over time is important in clinical, population health, and health services research. We compared changes in different measures of performance when a novel risk factor or marker was added to an existing Cox proportional hazards regression model. We performed Monte Carlo simulations for common measures of performance: concordance indices ( c, including various extensions to survival outcomes), Royston’s D index, R2-type measures, and Chambless’ adaptation of the integrated discrimination improvement to survival outcomes. We found that the increase in performance due to the inclusion of a risk factor tended to decrease as the performance of the reference model increased. Moreover, the increase in performance increased as the hazard ratio or the prevalence of a binary risk factor increased. Finally, for the concordance indices and R2-type measures, the absolute increase in predictive accuracy due to the inclusion of a risk factor was greater when the observed event rate was higher (low censoring). Amongst the different concordance indices, Chambless and Diao’s c-statistic exhibited the greatest increase in predictive accuracy when a novel risk factor was added to an existing model. Amongst the different R2-type measures, O’Quigley et al.’s modification of Nagelkerke’s R2 index and Kent and O’Quigley’s [Formula: see text] displayed the greatest sensitivity to the addition of a novel risk factor or marker. These methods were then applied to a cohort of 8635 patients hospitalized with heart failure to examine the added benefit of a point-based scoring system for predicting mortality after initial adjustment with patient age alone.
Managing bipolar II disorder: some personal perspectives
Authors: Parker Gordon 
Published: February 2015

Objective: The aim is to overview a personal model for managing bipolar II disorder. Method: The model describes the author’s personal approach and observes the relative lack of an evidence base. Results: Key ‘macro’ and treatment component approaches are overviewed. Conclusions: It is suggested that bipolar II disorder is categorically distinct from bipolar I, in lacking any psychotic features during contrasting mood states and thus allowing that its management should not necessarily extrapolate strategies used to manage bipolar I disorder. If valid, in addition to there being less of a need to prescribe antipsychotic drugs, the differing mood stabilizers may have quite differing gradients of efficacy across the bipolar I and II disorders.