bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fluorescence Imaging of Head and Neck Squamous Cell Carcinoma
Authors: Hauff Samantha J. , Raju Sharat C. , Orosco Ryan K. , Nashi Nadia , Savariar Elamprakash N. , Tsien Roger Y. , Nguyen Quyen T. 
Published: September 2014

Objectives:(1) Demonstrate that head and neck squamous cell carcinoma (HNSCC) can be fluorescently imaged using a matrix metalloproteinase (MMP)‐cleavable, ratiometric activatable cell‐penetrating peptide (RACPP). (2) Correlate extent of tumor involvement with fluorescent signal.Methods:Increased expression of MMP‐2 and MMP‐9 has been well documented in multiple cancers. We developed an injectable probe (RACPP) that exhibits ratiometric fluorescence (increased Cy5:Cy7 ratio) when cleaved by these proteinases. To examine the utility of MMP2,9‐cleavable RACPPs in HNSCC, mice were injected with 5 human HNSCC cell lines to establish orthotopic tongue xenografts (n = 22). Tumor‐bearing mice were imaged in‐vivo after intravenous RACPP injection. Fluorescent signal was correlated with histology by a blinded pathologist. Gelatinase zymography confirmed MMP‐2,9 activity in these xenografts. For ex‐vivo analysis of human HNSCC specimens, RACPP was applied to homogenized samples (n = 5), and fluorescence was measured on a microplate reader.Results:Orthotopic tongue HNSCC xenografts showed excellent ratiometric fluorescent labeling with MMP2,9‐cleavable RACPP (sensitivity = 95.4%, specificity = 95.0%). Signal intensity, as defined by ratiometric contrast, was greater in areas of higher tumor burden (P <. 03). Ex vivo human HNSCC specimens treated with MMP2,9‐cleavable RACPP also had increased signal intensity when compared to normal human fat (P =. 005).Conclusions:Fluorescent labeling with MMP2,9‐cleavable RACPP is an effective way to visualize HNSCC in‐vivo in a murine model, and signal intensity correlates with tumor burden. RACPPs have the potential to improve occult tumor identification and margin clearance in HNSCC. Ex‐vivo assays using biopsy specimens may help identify patients who will benefit from intraoperative RACPP use and may be useful in retrospective analyses.
Incidence of Postoperative Hypocalcemia following Total Thyroidectomy versus Completion Thyroidectomy
Authors: Merchavy Shlomo , Forest Veronique‐Isabelle , Marom Tal , Hier Michael P. , Mlynarek Alex M. , McHugh Tobial , Payne Richard J. 
Published: September 2014

Objectives:Study hypocalcemia incidence and trends over time following completion thyroidectomy (CT) versus total thyroidectomy (TT).Methods:A retrospective study comparing hypocalcemia and hypoparathyroidism incidence rates in all patients who underwent CT and in a random control group of TT at the McGill University Thyroid Cancer Centre, during the period of 2007 through 2012. Data were collected for demographic, clinical, and pathological characteristics.Results:There were 68 CT patients and 146 TT patients. Transient hypocalcemia occurred in 1 out of 68 (2%) and 18 out of 146 (12%) inpatients in the CT and TT groups, respectively. The rate of hypocalcemia was significantly lower in the CT group when compared with the TT group (P =. 02). In both groups, there were no cases of permanent hypocalcemia. In the CT group there were 12 (18%) patients with parathyroid gland or parathyroid tissue found in the surgical specimen, compared with 47 (32%) of patients in the TT group. There were no correlations between the postoperative hypocalcemia rates and the type of the thyroid disease or the numbers of parathyroid glands removed and found within the surgical specimen (P >. 05).Conclusions:In this study, the risk of transient hypocalcemia in patients undergoing CT was significantly lower than the rate of hypocalcemia in patients undergoing TT.
Intraoperative Tumor Imaging with Indocyanine Green in Head and Neck Cancer Patients
Authors: Chung Thomas K. , Kovar Joy , Bell Walter , Brandwein‐Gensler Margaret , Rosenthal Eben L. 
Published: September 2014

Objectives:(1) Describe the effectiveness of indocyanine green (ICG) as an imaging agent for head and neck tumors. (2) Illustrate the potential of near‐infrared imaging for intraoperative visualization of cancers.Methods:Patients underwent intravenous administration of 7.5mg ICG during the surgical procedure. The SPY/LUNA (Novadaq) near‐infrared intraoperative imaging system was used prior to resection and the Pearl (LICOR) and Odyssey (LICOR) systems for ex‐vivo tumor imaging. Tumor‐to‐background ratio (TBR) was defined as tumor fluorescence divided by normal tissue fluorescence. Histologic analysis was performed with a head and neck cancer board‐certified pathologist.Results:Five patients were enrolled into this study between August and September 2013. Three patients had pharyngeal cancer, one had laryngeal cancer, and one had cutaneous cancer. TBR values of confirmed cancer tissue varied among patients (LUNA TBR 3‐9, Pearl TBR 3‐18). However, in 2 patients, areas of highest fluorescence were found to be absent of carcinoma on histological analysis. The epidermal portions of the cutaneous SCC lesion were highly fluorescent, but the tumor did not penetrate this layer in multiple sections. Histologic analysis of these tissues confirmed significant areas of acute and chronic inflammation at areas of high fluorescence intensity. Skin, mucosal surfaces, and perivascular areas were most prone to false‐positive high fluorescence.Conclusions:While intravenous ICG does accumulate in head and neck tumors sufficiently to distinguish them from normal tissue, it is not specific enough to serve as a tumor visualization agent. Targeted fluorescent probes will likely be needed for image‐guided surgery.
Locoregional Radiotherapy Combined with Systemic Chemotherapy Improves Survival of NPC Patients with Distant Metastases
Authors: Chen Ming‐Yuan 
Published: September 2014

Objectives:Systemic chemotherapy is the basic palliative treatment for metastatic nasopharyngeal carcinoma (mNPC) at diagnosis; however, the impact of locoregional radiotherapy (lrRT) targeting the primary and regional lymph nodes on the survival of mNPC patients remains unknown and will be evaluated here retrospectively.Methods:A total of 408 mNPC patients were included in this study. The mortality risks were compared between the untreated patients and the patients who underwent chemotherapy and lrRT delivered alone or in combination. Univariate and multivariate analyses were conducted. The contributions of independent factors were adjusted by other covariates with significant prognostic association (P <. 05).Results:Both lrRT and systemic chemotherapy were found to be significant independent prognostic factors of overall survival (OS). The group receiving lrRT alone exhibited similar mortality risk compared to the group who underwent systemic chemotherapy alone (multiadjusted hazard ratio [HR], 0.9; P =. 529) and 60% reduction compared to the untreated group (HR, 0.4; P =. 004), but a 130% increase compared to those who received the combination treatment of systemic chemotherapy and lrRT (HR, 2.3; P <. 001). In the subgroup of combination treatment (n = 176), induction chemotherapy and high‐dose lrRT (≥66 Gy) showed a significant lower mortality risk compared with the noninduction chemotherapy (HR, 0.5; P =. 007) and low‐dose radiation (<66 Gy) (HR, 0.4; P =. 001).Conclusions:Locoregional radiotherapy, particularly combined with systemic chemotherapy, was correlated with the improved survival of mNPC patients.
Human Papillomavirus among Veterans Treated for Oropharyngeal Squamous Cell Carcinoma
Authors: Gleysteen John P. , Carroll Sarah R. , Sullivan C. B. , Maggiore Ronald J. , Barnes Lynne , Gross Neil D. 
Published: September 2014

Objectives:The prevalence and significance of high‐risk oral human papillomavirus (HPV) among veterans treated for oropharyngeal squamous cell carcinoma (OPSCC) remains unknown. In this study, we aimed to (1) define the prevalence of HPV among veterans with OPSCC and (2) compare outcomes of veterans with OPSCC relative to high‐risk HPV status and other well‐known prognostic factors.Methods:Patients from a high‐volume Veterans Administra‐tion (VA) medical center with OPSCC were identified from 2001‐2006. Demographic, surgical, and pathological data were extracted from the electronic medical record. P16 immunohistochemistry testing was performed on archived pathological samples as a surrogate marker for HPV status. Outcomes were compared between HPV‐positive (+) and negative (–) patients using Kaplan‐Meier estimates.Results:Seventy‐six veteran patients with available tumor tissue and follow‐up data were included. All of the patients were male (100%) and the vast majority were ever smokers (89%). Most patients presented with advanced stage disease (61, 80%) and were treated nonsurgically (64, 84%). The overall prevalence of p16 positivity was 52 out of 76 (68%). Overall survival at 2 and 5 years was 60% and 38%, respectively, for the entire cohort. HPV+ veteran patients had significantly better survival at 2 years (58% vs 33%) and 5 years (40% vs 17%) than HPV– veteran patients (P =. 014).Conclusions:Using p16 as a surrogate marker, HPV is prevalent among veteran patients treated for OPSCC. Veteran patients with HPV‐associated OPSCC have improved survival relative to HPV‐negative patients. However, their prognosis remains poor compared to a nonveteran population.
Human Papillomavirus–Associated Head and Neck Cancer in Hong Kong
Authors: Yau Kay Chung J. , Lam Eddy Wai Hung , Ngai Chi Man , Ma Kwong Hon 
Published: September 2014

Objectives:Human papillomaviruses (HPV) are a well‐documented cause of a subset of head and neck cancer. Studies have shown the prevalence of HPV infection is around 7% in the general US population. Yet data from an Asian population and analysis from different head and neck subsites are sparse. In this retrospective case control study, we systematically reviewed data from subjects diagnosed with squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx in Chinese patients at Yan Chai Hospital.Methods:Surgical specimens or biopsies were prospectively sent for detection of HPV DNA by polymerase chain reaction and immunohistochemical staining for p16 and p53.Results:In the 110 specimens obtained, preliminary results showed the overall prevalence of HPV was 21%. HPV 16 accounted for the majority of HPV‐positive oropharyngeal squamous cell carcinoma (SCC; 85%) and laryngeal SCC (66%). Other oncogenic HPVs, apart from HPV16 and 18, were rarely detected in our series. In the multiple logistic regression analysis, HPV‐associated oropharyngeal and oral cavity patients showed better overall survival, but this was statistically insignificant for laryngeal and hypopharyngeal patients. HPV positive and negative patients showed no statistically significant difference in disease staging on presentation as well as treatment modalities.Conclusions:The prevalence of HPV associated head and neck cancer is much lower in Hong Kong Chinese. Our overall survival of HPV associated oropharyngeal and laryngeal cancer showed consistent favorable outcomes compared with those of other western countries.
Human Papillomavirus Infection and p53 Expression in Oral Squamous Cell Carcinoma
Authors: Ali Adnan M. , Awan Sohail M. , Pervez Shahid 
Published: September 2014

Objectives:Determine the human papillomavirus (HPV) infection and p53 protein expression in oral squamous cell carcinoma (OSCC) and their correlation with patient overall survival (OS) and disease‐free survival (DFS).Methods:HPV general and type specific 16 and 18 were investigated by means of PCR. P53 protein overexpression was investigated by means of immunohistochemistry. Results of HPV association and p53 overexpression were evaluated in relation to different clinicopathological parameters and survival.Results:Out of 140 patient samples HPV was detected in 95 (68%) cases, out of which 85 (90%) were associated with HPV16, 2 (2%) were associated with HPV 18, 2 (2%) were co‐infected (with HPV 16 and 18), and 6 (6%) were positive for HPV by the general primer and could not be type specified. HPV positive patients had comparatively prolonged OS when compared with HPV‐negative patients, but this difference was not statistically significant (P =. 97). Furthermore, overexpression of p53 protein was observed in 75 patients (54%) using a threshold of 10% stained tumor nuclei. Patients with p53 negative tumors had improved OS when compared with patients with p53 positive tumors. This difference was statistically significant (P =. 036) in univariate Cox regression analysis; however, it lost its worth in the multivariate analysis.Conclusions:Our study found a high prevalence of HPV (type 16) in OSCC of Pakistani patients with male sex showing significant correlation with HPV. However, we did not find a statistically significant favorable association between p53 overexpression, HPV, survival, and histologic variables.
Improving Oral Tongue Cancer Pathology Margins through Surgical Technique
Authors: Argo Jimmy L. , Pierson Brandon , Gillies Elizabeth M. , Anderson Michael , Vasan Nilesh R. 
Published: September 2014

Objectives:Compare pathology margins of oral tongue cancer patients undergoing partial glossectomy between a novel surgical technique and conventional surgical resection. Describe the horizontal mattress surgical technique for partial glossectomy.Methods:Patients with oral tongue cancer underwent partial glossectomy using a new surgical technique by the senior author from February 2011 to July 2013 at a tertiary care medical center. A retrospective comparison cohort was selected from prior patients of the department with age, sex, and tumor stage matching. Anterior, posterior, and medial pathology margins were compared between the groups. Mean values were compared with the Student t test for normally distributed variables, and median values were compared with the Wilcoxon‐Mann‐Whitney test for variables which were not normally distributed. The horizontal mattress technique for partial glossectomy is described.Results:Ten patients underwent partial glossectomy with the new technique. The mean medial pathology margin was significantly greater in the novel technique group (1.40 cm, 0.88 cm, P <. 05; novel technique, conventional technique, P value). There were no significant differences in the median anterior margin (1.10 cm, 1.25 cm, P =. 79), mean posterior margin (1.47 cm, 1.13 cm, P =. 15), mean tumor size (1.91 cm, 1.71 cm, P =. 67), or tumor depth of invasion (0.65 cm, 0.80 cm, P =. 73).Conclusions:The new surgical technique using horizontal mattress sutures for dissection guidance and specimen orientation yielded significantly larger medial pathology margins compared to the traditional method. This study is limited by the retrospective nature of the comparison group. A prospective trial should be undertaken to confirm these results.
Oncologic Outcomes of Robotic Thyroidectomy: 5 Years’ Experience
Authors: Tae Kyung , Ji Yong Bae , Song Chang Myeon , Lee Seung Hwan , Park Chul Won 
Published: September 2014

Objectives:The feasibility and early surgical outcomes of robotic thyroidectomy have been reported. However, its oncologic outcomes are not well established. The aim of this study is to evaluate oncologic outcomes of robotic thyroidectomy compared with conventional thyroidectomy in differentiated thyroid carcinoma (DTC).Methods:We analyzed 925 DTC patients who underwent robotic thyroidectomy (204 cases) using a gasless unilateral axillo‐breast or axillary approach, or conventional open thyroidectomy (721 cases) with or without central neck dissection (CND) from October 2008 to December 2013. We excluded patients who underwent simultaneous lateral neck dissection or completion thyroidectomy and cases with recurrent cancer, other types of malignancy, or distant metastasis.Results:The male ratio and the mean age were significantly lower in the robotic group (P <. 001). The mean tumor size, minimal extrathyroidal extension, and stage did not differ between the 2 groups. The rate of total thyroidectomy was higher in the open group (P <. 001). The rate of CND and the mean number of lymph nodes removed in the central compartment was not different between the 2 groups. Operative time was significantly longer in the robotic group (P <. 001). Postoperative complications did not differ between the 2 groups, except transient hypoparathyroidism. Recurrence rate did not differ between the 2 groups after a mean follow‐up of 33 months (0 % vs 0.4% in the robotic vs open groups, P = 1.0).Conclusions:The oncologic outcome of robotic thyroidectomy in 5 years’ experience is comparable with conventional thyroidectomy in selected patients with DTC.
Optimal Interventions for Depression after Diagnosis of Head and Neck Cancer: A Systematic Review
Authors: Barber Brittany , Zhang Han , Mitchell Nicholas , O'Connell Daniel A. , Harris Jeffrey R. , Seikaly Hadi 
Published: September 2014

Objectives:Depression in head and neck cancer (HNC) patients is undertreated and under‐recognized, yet has been shown to be present in up to 40% of patients. The objective in this study was to perform a systematic review of the literature regarding the optimal psychologic intervention for HNC patients with depressive symptomatology.Methods:A systematic review. PubMed, Medline, and ENCASE were searched in December 2013 for studies examining psychologic interventions in head and neck cancer patients. Results were screened by 2 independent reviewers. The level of evidence for each study and intervention were evaluated using criteria put forth by the Agency for Healthcare Research and Quality US Preventative Services Task Force. Subsequent analysis was then planned according to the criteria in the Cochrane Handbook for Systematic Reviews.Results:Eleven studies met inclusion criteria. Three studies were rated “good” for internal validity and 6 for external validity. Psychologic education and cognitive behavior therapy were evaluated by 8 studies, and antidepressant use was examined by 2 studies. Support group therapy was examined by 1 study. Meta‐analysis was precluded by significant heterogeneity. Strongest evidence for successful treatment of depression was demonstrated by psycho‐education.Conclusions:Evidence for the optimal psychologic intervention for depression in HNC patients is limited by the small number of studies examining treatment types, lack of high level of evidence in research methodology, and poor comparability of studies. Future studies should target a standardized assessment and diagnosis as well as evaluation of treatment type.
Outcomes and Complications of Locally Advanced Sinonasal Malignancies Treated with Open and Endoscopic Resections
Authors: Trosman Samuel J. , Momin Suhael , Al‐Khudari Samer , Sindwani Raj , Adelstein David J. , Koyfman Shlomo A. , Burkey Brian B. 
Published: September 2014

Objectives:(1) Compare outcomes of patients with sinonasal malignancies (SNM) treated with an open resection to patients treated with an exclusively endoscopic or endoscopic‐assisted approach. (2) Analyze the differences in surgical complications, length of hospital stay, and margin status between open and endoscopic approaches.Methods:A retrospective review was performed on 102 patients with a pathologically diagnosed T3 or T4 SNM treated definitively at a tertiary care academic center from 1995 to 2012. Oncologic outcomes were determined.Results:Of the 102 patients, 29 presented with T3 disease while 73 presented with T4 disease. The most common histologic subtype was squamous cell carcinoma (56.9%). Fifty‐three patients (52.0%) underwent open resection while 26 (25.5%) underwent an endoscopic or endoscopic‐assisted resection. The 5‐ and 10‐year disease‐specific survival (DSS) for the 2 surgically treated groups was 67.6% and 65.2%, respectively. There was no significant difference between patients treated with open resection and patients treated with endoscopic resection in overall survival (P =. 98) or DSS (P =. 15). There was no significant difference between the groups with regard to length of stay (median for both = 5 days, P =. 39) or margin status (P =. 42). The endoscopic surgery group had significantly more cerebrospinal fluid (CSF) leaks than the open surgery group (42% vs 6%, P <. 001).Conclusions:Endoscopic and endoscopic‐assisted resection of locally advanced SNM in the appropriately selected patient results in similar long‐term oncologic control as open resection. There may be a higher rate of CSF leaks during endoscopic resections that contributes to hospital stays similar to those after open resections.
Gradual Approach to Refinement of the Nasal Tip: Surgical Results
Authors: Carvalho Thiago B. , Thomazi Emerson , Leutz Rafael P. , Souza Rafael P. S. F. , Molina Fernando D. , Piatto Vania B. , Maniglia Jose V. 
Published: September 2014

Objectives:The complexity of the nasal tip structure and the impact of surgical holder maneuvers makes prediction of the final outcome very difficult. Therefore, no technique alone is enough to correct the numerous anatomic presentations adequately being the preoperative planning, the basis of rhinoplasty. This study's aim is to present results of rhinoplasty, by gradual surgical approach to nasal tip definition based on anatomic features, and evaluate the degree of satisfaction of patients after the surgical procedure.Methods:A retrospective historical cohort study of the medical charts of 533 patients of both sexes who underwent rhinoplasty from January 2005 to January 2012. Cases were allocated into 7 groups: (1) no surgery on nasal tip, (2) interdomal breakup, (3) cephalic trim, (4) domal suture, (5) shield‐shaped graft, (6) vertical dome division, and (7) replacement of lower lateral cartilages.Results:Group 4 was the most prevalent. The satisfaction rate was 96%, and revision surgery occurred in 4% of cases.Conclusions:The protocol used allowed the association of the gradual surgical approach to nasal tip definition with the nasal anatomic characteristics, high rate of satisfaction with the surgical outcome, and low rate of revision.
Pedicled Parathyroid Autotransposition in Surgical Management of Secondary Hyperparathyroidism
Authors: Shokri Tom , Sadeghi Nader 
Published: September 2014

Objectives:In this study, we report a new, less invasive surgical technique in managing preserved parathyroid tissue in patients with secondary hyperparathyroidism who undergo bilateral parathyroid exploration and excision of all 4 parathyroid glands. We report this technique in 4 patients and evaluate their postoperative parathyroid hormone (PTH) levels as a marker to evaluate efficacy.Methods:All 4 glands were first exposed. Superior glands are not possible to transpose and were excised while the inferior glands were mobilized on their pedicles. Once identified, the inferior glands were kept intact until it was determined which gland can be best preserved on its vascular pedicle with adequate length for transposition. This gland was then mobilized through an incision made in the strap muscles, placing it superficial and ventral to the muscles. The majority of the hyperplastic gland was then resected distal to its vascular pedicle. The portion of the gland that was preserved was secured over the strap muscle, making it easily accessible for future exploration and debulking if needed and avoiding a second operative site in the forearm.Results:Rapid intraoperative PTH assay confirmed adequate removal of hypersecreting parathyroids and was indicative of a curative outcome. All patients exhibited a greater than 90% initial reduction in the PTH level from their baseline and a sustained decrease in postoperative PTH levels well below their preoperative baselines at one month. The percentage mean reduction in PTH at longest follow‐up was 94.57%. Importantly, none of the patients exhibited postoperative PTH levels indicative of hypoparathyroidism.Conclusions:None provided.