pinecone/core-2020-05-10-deduplication huggingface dataset:
Potential for promoting recurrent laryngeal nerve regeneration by remote delivery of viral gene therapy

Objectives/Hypothesis:  The aims of this study were to demonstrate the ability to enhance nerve regeneration by remote delivery of a viral vector to the crushed recurrent laryngeal nerve (RLN), to demonstrate the usefulness of a crushed RLN model to test the efficacy of viral gene therapy, and to discuss future potential applications of this approach.    Study Design:  Animal study.    Methods:  Adult Sprague‐Dawley rats were assigned to two groups. In the experimental group, an adeno‐associated viral (AAV) vector carrying a zinc‐finger transcription factor, which stimulates endogenous insulinlike growth factor I production (AAV2‐TO‐6876vp16), was injected into the crushed RLN. In the control group, an AAV vector carrying the gene for green fluorescent protein was injected into the crushed RLN. Unilateral RLN paralysis was confirmed endoscopically. At 1 week, laryngeal endoscopies were repeated and recorded. Larynges were cryosectioned in 15‐μm sections and processed for acetylcholine histochemistry (motor endplates) followed by neurofilament immunoperoxidase (nerve fibers). Percentage nerve‐endplate contact (PEC) was determined and compared. Vocal fold motion was evaluated by blinded reviewers using a visual analogue scale (VAS).    Results:  The difference between PEC on the crushed and uncrushed sides was statistically less in the experimental group (0.54 ± 0.18 vs. 0.30 ± 0.26,  P  = .0006). The VAS score at 1 week was significantly better in the experimental group ( P  = .002).    Conclusions:  AAV2‐TO‐6876vp16 demonstrated a neurotrophic effect when injected into the crushed RLN. The RLN offers a conduit for viral gene therapy to the brainstem that could be useful for the treatment of RLN injury or bulbar motor neuron disease
Bell's palsy : study design, prognosis and quality-of-life

Background: Bell’s palsy is an acute peripheral facial nerve dysfunction with
unknown etiology, causing weakness or paralysis of the mimic muscles of the face.
The disease can cause disfi gurement of the face, impair the ability to eat, drink and
speak, and seriously affect the patient’s quality of life. Physicians have searched
for tests or clinical signs that can predict the outcome of Bell’s palsy but none have
proven powerful enough. Studies also show several methodological differences and
interpretation of results is diffi cult. In addition, validated instruments measuring
quality of life aspects in these patients in Swedish have not been available.




Aims: To examine the effect of different analysis methods on a Bell’s palsy study,
to fi nd prognostic clinical signs for non-recovery in Bell’s palsy using the Sunnybrook
facial grading scale, and to translate and validate the Facial Disability Index
(FDI) and Facial Clinimetric Evaluation (FaCE) scale questionnaires in Swedish.




Data: Data for papers I-III were extracted from a prospective, controlled multicenter
study including 829 patients with Bell’s palsy. Patients were randomized to
treatment with prednisolone and/or valacyclovir or placebo. In paper IV, 93 patients
with stable peripheral facial palsy had their facial function assessed with House-
Brackmann and Sunnybrook scales and answered FDI and FaCE-scale questionnaires
on two occasions with a 2-week interval.




Results and conclusions: The choice of statistical method and defi nition of complete
recovery substantially infl uence the calculated rate of recovery. These results
emphasize the caution that must be exercised when interpreting clinical results in
reported Bell’s palsy studies. Early deterioration in Sunnybrook scores between
baseline and fi rst follow-up at days 11-17 is found to be a negative prognostic factor
for complete recovery at 12 months. Early prednisolone treatment reduces this
deterioration and improves outcome in patients with early deterioration. Sunnybrook
grading at 1 month can accurately predict non-recovery (Sunnybrook< 70)
at 12 months in Bell’s palsy. A prediction model and a simple-to-use risk curve for
identifying patients at risk for sequelae based on the Sunnybrook score at 1 month
are presented and both can be used in clinical practice. The Swedish versions of
the FDI and FaCE-scale show high reliability and validity, and the questionnaires
can be used for clinical evaluation and for studies on patients with peripheral facial
palsy in Sweden
TALK score: Development and validation of a prognostic model for predicting larynx preservation outcome

Objectives/Hypothesis:  To develop and validate a simple prognostic tool that would help predict larynx preservation outcome.    Study Design:  A retrospective review of 3 prospective studies.    Methods:  We reviewed consecutive chemotherapy/radiation protocols for patients (n = 170) with advanced, resectable, squamous cell, larynx, or pharynx cancer treated at Memorial Sloan‐Kettering Cancer Center from 1988 to 1995 with larynx preservation intent. The outcome was successful larynx preservation. Model validation used data from U. S. Department of Veterans Affairs larynx preservation study.    Results:  The developed model added one point for each poor prognostic covariate present (show in parentheses) and was given the acronym TALK: T stage (T4), albumin (<4 g/dL), maximum alcohol/liquor use (≥6 drinks/day or heavy drinking), and Karnofsky performance status (<80%). The 3‐year larynx preservation rates by TALK score were 65% (0), 41% (1–2), and 6% (3–4),  P  < .0001; on validation, the TALK 3–4 group was particularly well demarcated.    Conclusions:  The TALK score is an easily applied and valid tool that should assist treatment selection
Diagnostic modalities for distant metastasis in head and neck squamous cell carcinoma: Are we changing life expectancy?

Objectives/Hypothesis:   To determine if the various imaging modalities for distant metastasis (DM) diagnosis alters life expectancy in head and neck squamous cell carcinoma (HNSCC).     Study Design:   Retrospective.     Methods:   One hundred seventy patients (mean age, 59.1 years; male:female, 135:35) with HNSCC who developed DM were reviewed. The main outcome measures were the method of DM diagnosis and time from DM diagnosis to death while controlling for clinical parameters (age, gender, tobacco status, primary tumor site, initial TNM classification, number and site of DM, administration of palliative chemotherapy).     Results:   Tumor subsites were: 40 oral cavity, 75 oropharynx, 36 larynx, 10 hypopharynx, one nasopharynx, and eight unknown primary. Of the patients, 16.5% (28/170) had distant metastasis at presentation; the remaining 142 patients were diagnosed with DM at a median of 324 days from diagnosis. Although patients diagnosed with DM by positron‐emission tomography (PET) scan were more likely to have multiple DM sites ( P  = .0001), there were no differences in life expectancy in patients who were diagnosed with or without PET scan (median, 185 vs. 165 days,  P  = .833). There were no differences in life expectancy based on age, gender, site of primary tumor, or number/site of DM. The use of palliative chemotherapy resulted in a significantly longer life expectancy (median, 285 vs. 70 days;  P  = .001).     Conclusions:   Although a PET scan is more likely to diagnose multiple DM sites, there was no difference in life expectancy based on imaging modality. Patients who are symptomatic from their distant metastasis have a worse life expectancy, and palliative chemotherapy was able to increase life expectancy, even in patients who were symptomatic from the distant metastasis
Canal switch after canalith repositioning procedure for benign paroxysmal positional vertigo

Canal switch is a complication following canalith repositioning procedure (CRP) for posterior canal benign paroxysmal positional vertigo (BPPV). Instead of being returned to the utricle, the loose otoconia migrate into the superior or horizontal semicircular canal. Patients remain symptomatic, and treatment can be ineffective unless the switch is recognized and additional repositioning maneuvers directed toward the appropriate semicircular canal are performed. This report provides the first videographic documentation of canal switch involving conversion of unilateral posterior semicircular canal BPPV to geotropic horizontal canalithiasis. Laryngoscope, 201
Olfactory identification testing as a predictor of the development of Alzheimer's dementia: A systematic review

Objectives/Hypothesis:  To evaluate the utility of olfactory identification tests as prognostic instruments for Alzheimer's dementia (AD).    Study Design:  Systematic review.    Methods:  In accordance with PRISMA guidelines, PubMed and Ovid MEDLINE, EMBASE, ISI Web of Science, PsycINFO, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched to determine the quality and quantity of longitudinal and cross‐sectional research on this topic.    Results:  Two prospective longitudinal cohort studies and 30 cross‐sectional studies met inclusion criteria. The prospective longitudinal studies evaluated subjects with or without mild cognitive impairment (MCI) while also using olfactory identification testing as part of a neurocognitive evaluation. The first study reported an increased risk of later onset of AD in subjects with baseline hyposmia, whereas the second study suggested a possible relationship between decreased olfaction in participants with MCI and conversion to AD but was inconclusive due to low follow‐up rates. Wide variability in the type of olfactory identification test used and the reporting of results precluded meta‐analysis. The cross‐sectional studies demonstrated a positive association between poorer performance on olfactory identification testing and AD.    Conclusions:  Although there is evidence suggesting an association between decreased olfaction and AD, rigorously designed longitudinal cohort studies are necessary to clarify the value of olfactory identification testing in predicting the onset of AD
Optical Imaging With a High-Resolution Microendoscope to Identify Cholesteatoma of the Middle Ear

Objectives/Hypothesis: High-resolution optical imaging is an imaging modality that allows visualization of structural
changes in epithelial tissue in real time. Our prior studies using contrast-enhanced microendoscopy to image squamous cell
carcinoma in the head and neck demonstrated that the contrast agent, proflavine, has high affinity for keratinized tissue.
Thus, high-resolution microendoscopy with proflavine provides a potential mechanism to identify ectopic keratin production,
such as that associated with cholesteatoma formation, and distinguish between uninvolved mucosa and residual keratin at
the time of surgery.
Study Design: Ex vivo imaging of histopathologically confirmed samples of cholesteatoma and uninvolved middle ear
epithelium.
Methods: Seven separate specimens collected from patients who underwent surgical treatment for cholesteatoma were
imaged ex vivo with the fiberoptic endoscope after surface staining with proflavine. Following imaging, the specimens were
submitted for hematoxylin and eosin staining to allow histopathological correlation.
Results: Cholesteatoma and surrounding middle ear epithelium have distinct imaging characteristics. Keratin-bearing
areas of cholesteatoma lack nuclei and appear as confluent hyperfluorescence, whereas nuclei are easily visualized in specimens
containing normal middle ear epithelium. Hyperfluorescence and loss of cellular detail is the imaging hallmark of keratin,
allowing for discrimination of cholesteatoma from normal middle ear epithelium.
Conclusions: This study demonstrates the feasibility of high-resolution optical imaging to discriminate cholesteatoma
from uninvolved middle ear mucosa based on the unique staining properties of keratin. Use of real-time imaging may facilitate
more complete extirpation of cholesteatoma by identifying areas of residual disease
The effect of cancer stage and treatment modality on quality of life in oropharyngeal cancer

Objectives/Hypothesis To examine changes in health-related quality of life among oropharyngeal cancer patients by stages and across treatment types among advanced cancer patients. Study Design Individual prospective cohort study. Methods All newly diagnosed patients with oropharyngeal cancer treated with curative intent were routinely assessed. The European Organization for Research and Treatment of Cancer (EORTC) both the Main Module quality-of-life questionnaire (QLQ-C30) and the Head and Neck Cancer (HNC) Module (QLQ-H\u26N35) were administered at diagnosis and 3, 6, and 12 months thereafter. Complete case analysis was used following assessment of missing data. The proportion of patients with clinically significant deterioration (changes of ≥10 points) from baseline were calculated for each follow-up time point and compared by stage (I/II vs. III/IV) and then treatment type (chemotherapy and radiotherapy [CRT] vs. surgery and postoperative radiotherapy [S\u26PORT]). Results Deterioration in most domains was most frequent for stage III/IV patients at 3 months (both modules), whereas stage I/II patients experienced this at 6 months (QLQ-C30) and 12 months (H\u26N35). Among stage III/IV patients, this happened at all time points for S\u26PORT patients (QLQ-C30) versus 12 months for CRT patients (H\u26N35). The number of patients reporting deterioration was lower for most domains at 12 months compared to earlier periods, although dry mouth remained a problem for most patients (60%-85% across treatment/stage groups). Conclusions Our preliminary findings suggest that general and disease-specific deterioration is of most concern for stage I/II patients at 6 and 12 months and at 3 months for advanced cancer patients. For stage III/IV patients receiving S\u26PORT, general deterioration remains a problem after diagnosis, whereas for CRT patients, disease-specific deterioration is of most concern at 12 months. Level of Evidence 4. Laryngoscope, 124:151-158, 201
Pharmacoeconomics of Cyclamen europaeum in the management of Acute Rhinosinusitis

Objective. To carry out a pharmacoeconomic analysis of Cyclamen europaeum (CE) in the management of acute rhinosinusitis (ARS) in Spain using data from the PROSINUS study. Study Design. This was a prospective observational study to compare the effectiveness and cost-effectiveness between therapies including CE vs. other therapies in the management of ARS. Methods. The study was carried out as a secondary analysis of the PROSINUS, combining healthcare resource use, productivity loses, and health outcomes from the observational study with costs representative of the Spanish Health System. Results. CE given as monotherapy appears to be more effective (cure rate) than other monotherapies (15.3% higher, p<0.05) and combination (10.3% higher, p<0.05) therapies. The addition of CE to other single-drug or combination therapies showed a statistically significant improvement in terms of cure rates when adding CE to 2-drug combinations (93.9% vs. 76.5%; p<0.05), and no significant effect when added to combinations of three or more drugs (81.1% vs. 79.8; NS). CE based therapies generally showed lower indirect costs, although only the comparison of CE alone vs. other monotherapies, with a net cost savings of 101  per patient, reached statistical significance (331  vs. 432 , p<0.05). In addition, CE-based therapies show lower cost per cured patient in all comparisons except when CE was used in combination with three or more other drugs. Conclusions. The use of Cyclamen europaeum may be associated to better clinical outcomes at no additional cost for the healthcare system, respect to treatments commonly used for ARS in clinical practice
A novel in vivo model for evaluating functional restoration of a tissue-engineered salivary gland

Objectives/Hypothesis: To create a novel model for development of a tissue-engineered salivary gland from human salivary gland cells that retains progenitor cell markers useful for treatment of radiation-induced xerostomia. Study Design: A three-dimensional (3D) hyaluronic acid (HA)-based hydrogel scaffold was used to encapsulate primary human salivary gland cells and to obtain organized acini-like spheroids. Hydrogels were implanted into rat models, and cell viability and receptor expression were evaluated. Methods: A parotid gland surgical resection model for xenografting was developed. Salivary cells loaded in HA hydrogels formed spheroids and in vitro were implanted in the three-fourths resected parotid bed of athymic rats. Implants were removed after 1 week and analyzed for spheroid viability and phenotype retention. Results: Spheroids in 3D stained positive for HA receptors CD168/RHAMM and CD44, which is also a progenitor cell marker. The parotid gland three-fourths resection model was well-tolerated by rodent hosts, and the salivary cell/hydrogel scaffolds were adherent to the remaining parotid gland, with no obvious signs of inflammation. A majority of human cells in the extracted hydrogels demonstrated robust expression of CD44. Conclusions: A 3D HA-based hydrogel scaffold that supported long-term culture of salivary gland cells into organized spheroids was established. An in vivo salivary gland resection model was developed that allowed for integration of the 3D HA hydrogel scaffold with the existing glandular parenchyma. The expression of CD44 among salivary cultures may partially explain their regenerative potential, and the expression of CD168/RHAMM along with CD44 may aid the development of these 3D spheroids into regenerated salivary glands
Peripheral facial palsy caused by neoplastic meningitis.

[Objectives/Hypothesis]To describe the clinical presentation of peripheral facial palsy caused by neoplastic meningitis. [Study Design]Retrospective case series. [Methods]Retrospective review, including accompanying symptoms and magnetic resonance imaging (MRI) findings. Results]Between January and December 2011, six patients were diagnosed with peripheral facial palsy caused by neoplastic meningitis. The patient age at presentation ranged from 56 to 77 years. The tumor origins were as follows: malignant lymphoma (n = 3), lung cancer (n = 2), and kidney cancer (n = 1). In three patients, sudden sensorineural hearing loss accompanied the facial palsy. Three patients were judged to be tumor-free at the onset of the facial palsy. In two patients, the malignancy was not diagnosed at the onset of facial palsy and hearing loss. Only one patient was diagnosed as having a tumor at the onset of the facial palsy. On the MRI, a mass lesion was detected in the internal auditory canals (IAC) of four patients; one had a solitary IAC tumor. In this patient, the diagnosis required a histopathological study using a translabyrinthine approach. In the other two patients, the facial nerve was enhanced with gadolinium, but it was difficult to differentiate the observed condition from Bell's palsy. In these patients, repeated cytological studies led to the correct diagnoses. [Conclusions]The clinical symptoms and MRI findings of peripheral facial palsy caused by neoplastic meningitis sometimes mimic those of benign facial palsy
Effect of AST on age-associated changes of vocal folds in a rat model.

[Objectives/Hypothesis]Reactive oxygen species (ROS) are associated with aging. Astaxanthin (AST) is a strong antioxidant and has been reported to prevent various ROS-induced diseases. In the current study, we investigated the effect of AST on age-associated histological and mRNA changes of vocal folds. [Study Design]Prospective animal experiment with control. [Methods]Six-month-old Sprague-Dawley rats were fed on a normal powder diet with 0.01% (w/w) AST (aged AST-treated group) or without AST (aged sham-treated group). After 12 months of feeding, the larynges were harvested for histology, immunohistochemical detection of 4-hydroxy-2-nonenal (4-HNE), and quantitative real-time polymerase chain reaction for basic fibroblast growth factor (bFGF) and hepatocyte growth factor (HGF). Thirteen-week-old rats were used as a young control group (young group). [Results]The expression of 4-HNE, an oxidative stress marker, significantly increased in the two aged groups compared with the young group. Histological examination showed that the deposition of hyaluronic acid in the lamina propria (LP) was significantly reduced in the aged sham-treated group compared with the young group, but no significant difference was observed between the aged AST-treated group and the young group. There were no significant differences in the mRNA expression of bFGF and HGF between the aged AST-treated group and the young group, although the expression of these genes was significantly reduced in the aged sham-treated group as compared with the young group. [Conclusions]These results suggest that AST has the potential to attenuate age-associated changes of vocal folds
Preoperative clinical predictors of difficult laryngeal exposure for microlaryngoscopy: The laryngoscore.

To identify a clinical predictor score for difficult laryngeal exposure (DLE) during operative microlaryngoscopy.Prospective cohort study in two academic institutions.We evaluated 319 patients before microlaryngoscopy for benign and malignant glottic diseases by a standardized preoperative assessment protocol (Laryngoscore) that included 11 parameters: interincisors gap (IIG), thyro-mental distance, upper jaw dental status, trismus, mandibular prognathism, macroglossia, micrognathia, degree of neck flexion-extension, history of previous open-neck and/or radiotherapy, Mallampati's modified score, and body mass index (BMI). Each parameter was assessed to obtain a total score. Patients were divided into five classes according to the anterior commissure (AC) visualization: class 0, complete AC visualization with large-bore laryngoscopes in the Boyce-Jackson position; class I, as class 0 with external laryngeal counterpressure; class II, as class I in the flexion-flexion position; class III, as class II using small-bore laryngoscopes; and class IV, impossible AC visualization.Class 0-I-II (good/acceptable laryngeal exposure) presented a median score < 6. This value was chosen as cutoff for distinguishing favorable versus difficult/impossible laryngeal exposures. When the Laryngoscore was < 6, good laryngeal exposure was observed in 94\% of patients, whereas when ≥ 6, DLE was encountered in 40\%. When considering a Laryngoscore of ≥ 9, 67\% of patients had a DLE. At univariate analysis, IIG, upper jaw dental status, macroglossia, micrognathia, degree of neck flexion-extension, and BMI statistically impacted on DLE (P < 0.05).The Laryngoscore is a good predictor of DLE and assists in selecting the ideal candidates for operative microlaryngoscopy.2b. Laryngoscope, 124:2561-2567, 2014