Comparison of 2 Zero-Profile Implants in the Treatment of Single-Level Cervical Spondylotic Myelopathy: A Preliminary Clinical Study of Cervical Disc Arthroplasty versus Fusion.

Comparison of 2 Zero-Profile Implants in the Treatment of Single-Level Cervical Spondylotic Myelopathy: A Preliminary Clinical Study of Cervical Disc Arthroplasty versus Fusion.

PLoS One. 2016;11(7):e0159761

Authors: Shi S, Zheng S, Li XF, Yang LL, Liu ZD, Yuan W

Abstract
OBJECTIVES: Cervical disc arthroplasty (CDA) with Discover prosthesis or anterior cervical discectomy and fusion (ACDF) with Zero-P cage has been widely used in the treatment of cervical spondylotic myelopathy (CSM). However, little is known about the comparison of the 2 zero-profile implants in the treatment of single-level CSM. The aim was to compare the clinical outcomes and radiographic parameters of CDA with Discover prosthesis and ACDF with Zero-P cage for the treatment of single-level CSM.
METHODS: A total of 128 consecutive patients who underwent 1-level CDA with Discover prosthesis or ACDF with Zero-P cage for single-level CSM between September 2009 and December 2012 were included in this study. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score and Neck Disability Index (NDI). For radiographic assessment, the overall sagittal alignment (OSA), functional spinal unit (FSU) angle, and range of motion (ROM) at the index and adjacent levels were measured before and after surgery. Additionally, the complications were also recorded.
RESULTS: Both treatments significantly improved all clinical parameters (P < 0.05), without statistically relevant differences between the 2 groups. The OSA and FSU angle increased significantly in both groups (P <0.05). Compared with Zero-P group, ROMs at the index levels were well maintained in the Discover group (P < 0.05). However, there were no statistical differences in the ROMs of adjacent levels between the 2 groups (P > 0.05). Besides, no significant differences existed in dysphagia, subsidence, or adjacent disc degeneration between the 2 groups (P > 0.05). However, significant differences occurred in prosthesis migration in CDA group.
CONCLUSIONS: The results of this study showed that clinical outcomes and radiographic parameters were satisfactory and comparable with the 2 techniques. However, more attention to prosthesis migration of artificial cervical disc should be paid in the postoperative early-term follow-up.

PMID: 27441736 [PubMed - as supplied by publisher]

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Recurrent High-Grade Invasive Mucoepidermoid Carcinoma of Larynx: A Case Report and Review of the Literature.

Recurrent High-Grade Invasive Mucoepidermoid Carcinoma of Larynx: A Case Report and Review of the Literature.

Rare Tumors. 2016 Jun 28;8(2):6204

Authors: King W, Ko S, Miller D

Abstract
Recurrent invasive high-grade mucoepidermoid carcinoma of the larynx and hypopharynx is a rare occurrence. These tumors have been commonly associated with salivary gland tumors, most commonly the parotid gland. The patient usually presents with the following symptoms: hoarseness (if larynx is involved), or changes in voice character, sore throat, cough, odynophagia, dysphagia, otalgia, difficulty breathing, weight loss, lymphadenopathy. Here we present a case of a recurrent invasive high-grade mucoepidermoid carcinoma of larynx and hypopharynx. The patient was a 67-year-old male that originally presented in 2006. At that time he underwent a wide field laryngectomy, right thyroid lobectomy, and biopsy of the right digastric node. He was a clinical stage III, pT3N0M0. No adjuvant radiation therapy was given at that time. The patient remained asymptomatic until February 2014, when he presented with dysphagia and neck swelling. Positron emission tomography/computed tomography showed evidence of recurrence. The patient was treated with definitive intensity modulated radiation therapy (IMRT) with concurrent chemotherapy. Treatment for this disease is gathered by scattered case reports. If surgery is a possibility it is considered as first line therapy. Post-surgical radiation is then offered. However, in this case the recurrent tumor was located near the carotid artery, and thus surgery was not a possibility. Therefore, concurrent chemotherapy and radiation with IMRT and weekly cis-platinum was given. While the optimum combination of treatment has not yet been established because of the rarity of this cancer's location site, the current patient appeared to have an excellent response from the definitive IMRT and chemotherapy treatment.

PMID: 27441076 [PubMed]

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A survey of the enteral nutrition practices in patients with neurological disorders in the tertiary hospitals of China.

A survey of the enteral nutrition practices in patients with neurological disorders in the tertiary hospitals of China.

Asia Pac J Clin Nutr. 2016;25(3):521-8

Authors: Su YY, Gao DQ, Zeng XY, Sha RJ, Niu XY, Wang CQ, Zhou D, Jiang W, Cui F, Yang Y, Pan SY, Zhang X, Li LD, Gao L, Peng B, Zhong CL, Liu ZC, Li LH, Tan H, Lv PY

Abstract
BACKGROUND AND OBJECTIVES: With the development of enteral nutrition in patients with neurological disorders in China, related guidelines were published in 2011. The Chinese Society for Parenteral and Enteral Nutrition conducted a survey to evaluate the status quo of enteral nutrition practices in these patients.
METHODS AND STUDY DESIGN: This multicenter prospective investigation was conducted from April 2012 to April 2013 and involved 18 tertiary hospitals in China. The survey using standardized questionnaires sought information about the basic pro-tocols for enteral nutrition (devices and staffing) and specific information about patients with neurological condi-tions who received nutrition by way of enteral feeding.
RESULTS: In the 18 hospitals from 13 provinces, 83.3% pa-tients were configured with an enteral nutrition infusion pump, 77.8% had a percutaneous endoscopic gastrosto-my (PEG) device, and 88.9% had a clinical nutrition support group. Four hundred four patients participated in this survey (259 men, 145 women; mean age 61.3±14.7 years), 85.7% had suffered a stroke, 83.9% had impaired consciousness, and 98.0% had dysphagia. Of the 10 guidelines for enteral nutrition practices, setting the energy target, choosing the enteral nutrition tube, and monitoring the patient received unsatisfactory ratings were in poor compliance (56.2%, 30.0% and 38.9%, respectively); the remaining seven guidelines were in good compliance (each >75%).
CONCLUSION: The survey suggested that configuration of the enteral nutritional devices and staffing was adequate in China's tertiary hospitals. However, some associated practices had not yet reached the desired levels of competency, indicating a need for this to be understood and for improved training.

PMID: 27440686 [PubMed - in process]

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Predicting two-year longitudinal MD Anderson Dysphagia Inventory outcomes after intensity modulated radiotherapy for locoregionally advanced oropharyngeal carcinoma.

Predicting two-year longitudinal MD Anderson Dysphagia Inventory outcomes after intensity modulated radiotherapy for locoregionally advanced oropharyngeal carcinoma.

Laryngoscope. 2016 Jul 21;

Authors: Goepfert RP, Lewin JS, Barrow MP, Fuller CD, Lai SY, Song J, Hobbs BP, Gunn GB, Beadle BM, Rosenthal DI, Garden AS, Kies MS, Papadimitrakopoulou VA, Schwartz DL, Hutcheson KA

Abstract
OBJECTIVES/HYPOTHESIS: To determine the factors associated with longitudinal patient-reported dysphagia as measured by the MD Anderson Dysphagia Inventory (MDADI) in locoregionally advanced oropharyngeal carcinoma (OPC) survivors treated with split-field intensity modulated radiotherapy (IMRT).
STUDY DESIGN: Retrospective patient analysis.
METHODS: A retrospective analysis combined data from three single-institution clinical trials for stage III/IV head and neck carcinoma. According to trial protocols, patients had prospectively collected MDADI at baseline, 6, 12, and 24 months after treatment. OPC patients with baseline and at least one post-treatment MDADI were included. Longitudinal analysis was completed with multivariate linear mixed effects modeling.
RESULTS: There were 116 patients who met inclusion criteria. Mean baseline MDADI composite was 88.3, dropping to 73.8 at 6 months, and rising to 78.6 and 83.3 by 12 and 24 months, respectively (compared to baseline, all P < .0001). Tumor stage and smoking status were significant predictors of longitudinal MDADI composite scores. Patients with T1, T2, and T3 tumors had 15.9 (P = .0001), 10.9 (P = .0049), and 7.5 (P = .0615), respectively, higher mean MDADI composite than those with T4 tumors, and current smokers had a 9.4 (P = .0007) lower mean MDADI composite than never smokers.
CONCLUSIONS: Patients report clinically meaningful dysphagia early after split-field IMRT for locoregionally advanced OPC that remains apparent 6 months after treatment. MDADI scores recover slowly thereafter, but remain depressed at 24 months compared to baseline. Higher tumor stage and smoking status are important markers of patient-reported function through the course of treatment, suggesting these are important groups for heightened surveillance and more intensive interventions to optimize swallowing outcomes.
LEVEL OF EVIDENCE: 4 Laryngoscope, 2016.

PMID: 27440393 [PubMed - as supplied by publisher]

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Esophagitis in Adolescents.

Related Articles

Esophagitis in Adolescents.

Adolesc Med State Art Rev. 2016;27(1):1-18

Authors: Putnam PE

Abstract
Esophagitis is the end result of a variety of insults to epithelial homeostasis. Eosinophilic esophagitis is a manifestation of non-IgE-mediated food allergy that most commonly affects the esophagus of males who have other atopic phenomena. Reflux esophagitis reflects repeated exposure to acidic gastric contents because of failure of the normal protections afforded by the LES. Because certain histologic features can be present in either condition, endoscopic biopsy alone does not distinguish them. Their symptoms overlap, but the treatment options are very different, such that making a formal diagnosis by following consensus guidelines is essential. A treatment protocol designed to manage the inflammation by controlling the provocative factors (acid for GERD and food antigens for EoE) or suppressing the inflammation (ie, topical steroids for EoE) should result in normalization of the mucosa and resolution of symptoms. Eosinophilic esophagitis is a chronic condition that rarely remits spontaneously, so any therapeutic modality will need to be continued indefinitely.

PMID: 27363230 [PubMed - indexed for MEDLINE]

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[Case Report; A case of esophageal achalasia diagnosed with HRM].

Related Articles

[Case Report; A case of esophageal achalasia diagnosed with HRM].

Nihon Naika Gakkai Zasshi. 2016 Mar 10;105(3):525-31

Authors: Yamasaki T, Tomita T, Ohda Y, Oshima T, Fukui H, Watari J, Miwa H

PMID: 27319205 [PubMed - indexed for MEDLINE]

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125I Seed Permanent Implantation as a Palliative Treatment for Stage III and IV Hypopharyngeal Carcinoma.

125I Seed Permanent Implantation as a Palliative Treatment for Stage III and IV Hypopharyngeal Carcinoma.

Clin Exp Otorhinolaryngol. 2016 Jul 21;

Authors: Li L, Yang J, Li X, Wang X, Ren Y, Fei J, Xi Y, Sun R, Ma J

Abstract
Objectives: The aim of this study was to investigate the feasibility and safety of percutaneous 125I seed permanent implantation for advanced hypopharyngeal carcinoma from toxicity, tumor response, and short-term outcome.
Methods: 125I seeds implant procedures were performed under computed tomography for 34 patients with advanced hypopharyngeal carcinoma. We observed the local control rate, overall survival, and acute or late toxicity rate.
Results: In the 34 patients (stage III, n=6; stage IV, n=28), the sites of origin were pyriform sinus (n=29) and postcricoid area (n=5). All patients also received one to four cycles of chemotherapy after seed implantation. The post-plan showed that the actuarial D90 of 125I seeds ranged from 90 to 158 Gy (median, 127 Gy). The mean follow-up was 12.3 months (range, 3.4 to 43.2 months). The local control was 2.1-31.0 months with a median of 17.7 months (95% confidence interval [CI], 13.4 to 22.0 months). The 1-, 2-, and 3-year local controls were 65.3%, 28.6%, and 9.5% respectively. Twelve patients (35%) died of local recurrence, fourteen patients (41%) died of distant metastases, and three patients (9%) died of recurrence and metastases at the same time. Five patients (15%) still survived to follow-up. At the time of analysis, the median survival time was 12.5 months (95% CI, 9.5 to 15.4 months). The 1-, 2-, and 3-year overall survival rates were 55.2%, 20.3%, and 10.9%, respectively. Five patients (15%) experienced grade 3 toxic events and nine patients (26%) have experienced grade 2 toxic events.
Conclusion: This review shows relatively low toxicity for interstitial 125I seed implantation in the patients with advanced stage hypopharyngeal cancer. The high local control.
Results.: suggest that 125I seed brachytherapy implant as a salvage or palliative treatment for advanced hypopharyngeal carcinoma merit further investigation.

PMID: 27440132 [PubMed - as supplied by publisher]

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Update on Clinical Strategies in Hereditary Hemorrhagic Telangiectasia From an ENT Point of View.

Update on Clinical Strategies in Hereditary Hemorrhagic Telangiectasia From an ENT Point of View.

Clin Exp Otorhinolaryngol. 2016 Jul 21;

Authors: Wirsching KE, Kühnel TS

Abstract
Objectives: Hereditary hemorrhagic telangiectasia (HHT) is characterized by the presence of vascular malformations with an absence of capillaries between arteries and veins. One major manifestation site is the nasal mucous membrane where recurrent nosebleeds occur. Our clinical strategy to treat patients with HHT has the aim to reduce nasal bleeding long-term with minimal local and general side effects.
Methods: We describe staged diagnosis and therapy including individual medical treatments of 97 patients with HHT. The success of treatment is monitored with a systematic questionnaire.
Results: The neodymium-doped yttrium aluminium garnet (Nd:YAG) laser therapy remains standard treatment of choice with no major side effects despite the need for repeated treatment. In addition new treatment strategies like nasal occlusion, local drug therapy, and nasal septal splinting show initial success.
Conclusion: Improvement of the quality of life of HHT patients can be achieved by a multimodal concept. Several new treatment strategies like nasal septal splinting and nasal occlusion successfully expand the range of established.
Methods.: Further studies have to prove the safety and long-term effectiveness of the described individual medical treatments.

PMID: 27440131 [PubMed - as supplied by publisher]

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Swallowing and Aspiration: How Much Is Affected by the Number of Arytenoid Cartilages Remaining After Supracricoid Partial Laryngectomy?

Swallowing and Aspiration: How Much Is Affected by the Number of Arytenoid Cartilages Remaining After Supracricoid Partial Laryngectomy?

Clin Exp Otorhinolaryngol. 2016 Jul 21;

Authors: Kılıç C, Tunçel Ü, Kaya M, Cömert E, Özlügedik S

Abstract
Objectives: The aim of this study was to compare the effect of the presence of one or two arytenoids on early/late period swallowing-aspiration functions.
Methods: Supracricoid partial laryngectomy (SCPL) with the diagnosis of laryngeal cancer between 2012 and 2014 were retrospectively evaluated. The patients were categorized into two groups as follows: group I, patients who underwent SCPL with one arytenoid cartilage and group II, patients who underwent SCPL with two arytenoid cartilages. The time of decannulation and oral feeding onset, and swallowing-aspiration functions were evaluated and compared in the early nutritional period, first, and third months.
Results: There was no significant correlation between decannulation time and swallowing-aspiration. The aspiration rates in group I and group II were similar and there was no significant difference in oral feeding onset and aspiration grades in the first and third months between both groups.
Conclusion: We found similar oncological and functional outcomes in SCPL which protected one or two arytenoid cartilages. Therefore we suggest to be performed one arytenoid cartilage SCPL in selected patients who was advance stage and tumor volume over with larynx cancer.

PMID: 27440130 [PubMed - as supplied by publisher]

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Pathogenesis and Bone Resorption in Acquired Cholesteatoma: Current Knowledge and Future Prospectives.

Pathogenesis and Bone Resorption in Acquired Cholesteatoma: Current Knowledge and Future Prospectives.

Clin Exp Otorhinolaryngol. 2016 Jul 21;

Authors: Hamed MA, Nakata S, Sayed RH, Ueda H, Badawy BS, Nishimura Y, Kojima T, Iwata N, Ahmed AR, Dahy K, Kondo N, Suzuki K

Abstract
Cholesteatoma is a cystic non tumorous lesion of the temporal bone that has the ability to destroy nearby structures by its power to cause bone resorption and as a result, fatal complications prevail. We aimed to conduct a comprehensive review for pathogenesis of acquired cholesteatoma, bone resorption mechanisms, and offer a future vision of this serious disease. We have reviewed different theories for pathogenesis of acquired cholesteatoma including the most relevant and updated ones with special emphasis on the mechanisms of bone resorption through Medline/PubMed research using the keywords 'aetiopathogenesis, bone resorption, acquired cholesteatoma, temporal bone, and cytokines.' In order to strengthen our study, we searched the reference lists of identified reviews. Cholesteatoma is a subject of debate among otolaryngologists since it was prescribed firstly. Over many decades, several theories were postulated for aetiopathogenesis of cholesteatoma with a tendency to follow more than one theory to explain the proper nature of that disease. Until now, the mechanism of bone resorption has yet to be more clarified. In the last century, a leap has occurred in the field of biomolecular cholesteatoma research which improved our knowledge about its pathophysiology and bone destructive mechanism. However, surgery is still the only available treatment. We conclude that discovery of new therapeutic choices for cholesteatoma other than surgery by the use of anti-growth, anti-proliferative, apoptotic agents as well as medications that antagonize osteoclastogenesis should be the main concern in the future clinical and experimental research work. Also, searching for predictors of the aggressiveness of cholesteatoma can affect the timing of intervention and prevent occurrence of complications.

PMID: 27440129 [PubMed - as supplied by publisher]

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The Effectiveness of Budesonide Nasal Irrigation After Endoscopic Sinus Surgery in Chronic Rhinosinusitis With Asthma.

The Effectiveness of Budesonide Nasal Irrigation After Endoscopic Sinus Surgery in Chronic Rhinosinusitis With Asthma.

Clin Exp Otorhinolaryngol. 2016 Jul 21;

Authors: Kang TW, Chung JH, Cho SH, Lee SH, Kim KR, Jeong JH

Abstract
Objectives: Budesonide nasal irrigation was introduced recently for postoperative management of patients with chronic rhinosinusitis. The safety and therapeutic effectiveness of this procedure is becoming accepted by many physicians. The objective of this study was to evaluate the efficacy of postoperative steroid irrigation in patients with chronic rhinosinusitis and asthma.
Methods: This prospective study involved 12 chronic rhinosinusitis patients with nasal polyps and asthma who received oral steroid treatment for recurring or worsening disease. The 22-item Sinonasal Outcomes Test (SNOT-22) and Lund-Kennedy endoscopy scores were checked before nasal budesonide irrigation, and 1, 2, 4, and 6 months after irrigation. We also calculated the total amount of oral steroids and inhaled steroids in the 6 months before irrigation and the 6 months after it.
Results: The mean SNOT-22 score improved from 30.8±14.4 before irrigation to 14.2±8.7 after 6 months of irrigation (P=0.030). The endoscopy score also improved from 7.4±4.7 before irrigation to 2.2±2.7 after 6 months (P<0.001). The total amount of oral steroid was decreased from 397.8±97.6 mg over the 6 months before irrigation to 72.7± 99.7 mg over the 6 months after irrigation (P<0.001).
Conclusion: Nasal irrigation with budesonide is an effective postoperative treatment for chronic rhinosinusitis with asthma, which recurs frequently, reducing the oral steroid intake.

PMID: 27440128 [PubMed - as supplied by publisher]

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Brain train to combat brain drain; focus on exercise strategies that optimise neuroprotection

Abstract

The prevalence of cognitive decline and neurodegenerative diseases (e.g. stroke and dementia) is increasing. Numerous studies show that regular exercise has beneficial effects on brain health in clinical and non-clinical populations, yet adherence to public health exercise guidelines is notoriously poor. Recently, novel exercise strategies have been investigated to allow for more individualised and prescriptive approaches that target the key mechanistic pathways that allow exercise to mediate adaptation. This work exploring alternative approaches to the traditional model of exercise training has demonstrated exciting potential for positive health-related adaptations (especially for metabolic, muscle and cardiovascular function). However, few studies to date have focused on brain adaptations. The aim of this review is to summarise new and innovative interventions that have the potential to optimise exercise for improved brain health (i.e., brain structure and function). First, we will briefly summarise current understanding of the nature whereby positive effects of exercise deliver their influence on the brain (i.e., underlying mechanisms and factors affecting its delivery). We will then introduce the effects of exercise training on cognition and give examples of studies showing the beneficial effects of exercise in clinical populations. Finally, we will explore the adaptive roles of individual stressors that may induce greater health-related adaptations in the brain than exercise alone, including environmental stressors (hydrostatic stress, thermal stress and hypoxia), nutritional supplementation and cognitive loading. In summary, optimised interventions that target key mechanistic pathways linked to improved brain structure and function could ultimately protect against and/or ameliorate cognitive decline and neurodegenerative diseases.

This article is protected by copyright. All rights reserved

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Inter-eye comparison of retinal oximetry and vessel caliber between eyes with asymmetrical glaucoma severity in different glaucoma subtypes

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Editorial (Thematic Issue: Natural Leads in Drug Discovery against Metabolic Disorders and their Related Infectious Diseases).

Editorial (Thematic Issue: Natural Leads in Drug Discovery against Metabolic Disorders and their Related Infectious Diseases).

Curr Top Med Chem. 2016;16(23):2523-4

Authors: Scotti L, Singla RK, Scotti MT

PMID: 27439612 [PubMed - in process]

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Editorial (Thematic Issue: Novel Approaches to the Discovery of Selective and Targeted Anticancer Agents).

Editorial (Thematic Issue: Novel Approaches to the Discovery of Selective and Targeted Anticancer Agents).

Curr Top Med Chem. 2016;16(22):2431

Authors: Aly OM

PMID: 27439508 [PubMed - in process]

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Endometrial cancer and antidepressants: A nationwide population-based study.

Endometrial cancer and antidepressants: A nationwide population-based study.

Medicine (Baltimore). 2016 Jul;95(29):e4178

Authors: Lin CF, Chan HL, Hsieh YH, Liang HY, Chiu WC, Huang KY, Lee Y, McIntyre RS, Chen VC

Abstract
To our knowledge, the association between antidepressant exposure and endometrial cancer has not been previously explored. Herein, we aim to investigate the association between antidepressant prescription, including novel antidepressants, and the risk for endometrial cancer in a population-based study.Data for the analysis were derived from National Health Insurance Research Database. We identified 8392 cases with a diagnosis of endometrial cancer and 82,432 matched controls. A conditional logistic regression model was used, with adjusting for potentially confounding variables (e.g., comorbid psychiatric diseases, comorbid physical diseases, and other medications). Risk for endometrial cancer in the population-based study sample was categorized by, and assessed as a function of, antidepressant prescription and cumulative dosage.We report no association between endometrial cancer incidence and antidepressant prescription, including those prescribed either selective serotonin reuptake inhibitors (adjusted odds ratio [OR] = 0.98; 95% confidence interval [CI], 0.84-1.15) or serotonin norepinephrine reuptake inhibitors (adjusted OR = 1.14; 95% CI, 0.76-1.71). We also did not identify an association between higher cumulative doses of antidepressant prescription and endometrial cancer.There was no association between antidepressant prescription and endometrial cancer.

PMID: 27442640 [PubMed - as supplied by publisher]

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Learning in Complex Environments: The Effects of Background Speech on Early Word Learning.

Learning in Complex Environments: The Effects of Background Speech on Early Word Learning.

Child Dev. 2016 Jul 21;

Authors: McMillan BT, Saffran JR

Abstract
Although most studies of language learning take place in quiet laboratory settings, everyday language learning occurs under noisy conditions. The current research investigated the effects of background speech on word learning. Both younger (22- to 24-month-olds; n = 40) and older (28- to 30-month-olds; n = 40) toddlers successfully learned novel label-object pairings when target speech was 10 dB louder than background speech but not when the signal-to-noise ratio (SNR) was 5 dB. Toddlers (28- to 30-month-olds; n = 26) successfully learned novel words with a 5-dB SNR when they initially heard the labels embedded in fluent speech without background noise, before they were mapped to objects. The results point to both challenges and protective factors that may impact language learning in complex auditory environments.

PMID: 27441911 [PubMed - as supplied by publisher]

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Percutaneous bone-anchored hearing implant surgery: dermatome versus linear incision technique.

Percutaneous bone-anchored hearing implant surgery: dermatome versus linear incision technique.

Eur Arch Otorhinolaryngol. 2016 Jul 20;

Authors: Strijbos RM, Bom SJ, Zwerver S, Hol MK

Abstract
The objective of this historical cohort study is to identify if there are differences in soft tissue reactions and skin thickening between implantation of the percutaneous bone-anchored hearing implant (BAHI) using the dermatome or linear incision technique. All adult patients who received a BAHI between August 2005 and January 2013 were selected. One surgeon performed all procedures and only the dermatome and linear incision technique were used. A total of 132 patients/implants were included and significantly more patients with risk factors were seen in the linear incision cohort. A soft tissue reaction Holgers ≥1 was present in 18 patients (40.9 %) in the dermatome compared to 36 patients (40.9 %) in the linear incision group. A Holgers ≥2 was noticed in 9 (20.5 %) and 19 (21.6 %) patients, respectively. Skin thickening was described in 14 (31.8 %) and 11 patients (12.5 %) in, respectively, the dermatome and linear incision cohort, which was a significant difference (p = 0.001). Nevertheless, therapeutic interventions were effective. In conclusion, there was no significant difference in (adverse) soft tissue reactions; however, skin thickening was more present in the dermatome technique. In addition, significantly more patients with risk factors were allocated to the linear incision technique. Based on these results, the linear incision is advocated as preferred technique.

PMID: 27439945 [PubMed - as supplied by publisher]

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Histopathological and clinical expression of periodontal disease related to the systemic inflammatory response.

Histopathological and clinical expression of periodontal disease related to the systemic inflammatory response.

Histol Histopathol. 2016 Jul 21;:11803

Authors: Ionel A, Lucaciu O, Tăbăran F, Berce C, Toader S, Hurubeanu L, Bondor C, Câmpian RS

Abstract
Periodontal disease with its systemic implications is highly prevalent among the population, and this correlation could have an impact on the quality lives of many humans. The purpose of this study was to assess the clinical and histopathological changes of the periodontium correlated with the systemic inflammatory response in periodontal disease. An experimental study was performed on male Wistar rats which were subjected to a procedure of periodontitis induction through placing silk thread ligatures around the lower incisors, under general anesthesia. Clinically, the changes of the periodontal tissue induced by the periodontitis progression were daily assessed. Two blood samples were obtained from each animal, at baseline and on completion of the experiment. The plasma level of the cytokine IL-6 and haematological parameters such as leukocytes, neutrophils, lymphocytes, monocytes, and platelets were determined. After seven days the animals were sacrificed, and samples were prepared for histological evaluation. Clinical manifestations such as changes in the color, contour and consistency of the gingival tissue and the bleeding on probing were registered. Histopathological analysis showed an intense inflammatory cell infiltration, the presence of osteoclasts and an obvious bone resorption activity. A significant increase in IL-6 values during the progression of periodontitis in rats (p<0.001) was also observed. The results of this research demonstrated that the clinical and histological changes in the rat's periodontium are correlated with a notable systemic inflammatory response. Therefore, periodontitis control can be inserted as part of the programs of systemic disorders prevention, in clinical practice.

PMID: 27440198 [PubMed - as supplied by publisher]

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Debio 0617B Inhibits Growth of STAT3-Driven Solid Tumors through Combined Inhibition of JAK, SRC, and Class III/V Receptor Tyrosine Kinases.

Debio 0617B Inhibits Growth of STAT3-Driven Solid Tumors through Combined Inhibition of JAK, SRC, and Class III/V Receptor Tyrosine Kinases.

Mol Cancer Ther. 2016 Jul 20;

Authors: Murone M, Vaslin Chessex A, Attinger A, Ramachandra R, Shetty SJ, Daginakatte G, Sengupta S, Marappan S, Dhodheri S, Rigotti S, Bachhav Y, Brienza S, Traxler P, Lang M, Aguet M, Zoete V, Michielin O, Nicholas C, Johnson FM, Ramachandra M, McAllister A

Abstract
Tumor survival, metastases, chemoresistance, and escape from immune responses have been associated with inappropriate activation of Signal Transducer and Activator of Transcription 3 (STAT3) and/or STAT5 in various cancers, including solid tumors. Debio 0617B has been developed as a first-in-class kinase inhibitor with a unique profile targeting phospho-STAT3 (pSTAT3) and/or pSTAT5 in tumors through combined inhibition of JAK, SRC, ABL, and class III/V receptor tyrosine kinases. Debio 0617B showed dose-dependent inhibition of pSTAT3 in STAT3-activated carcinoma cell lines; Debio 0617B also showed potent antiproliferative activity in a panel of cancer cell lines and in patient-derived tumor xenografts tested in an in vitro clonogenic assay. Debio 0617B showed in vivo efficacy by inhibiting tumor growth in several mouse xenograft models. To increase in vivo efficacy and STAT3 inhibition, Debio 0617B was tested in combination with the epidermal growth factor receptor (EGFR) inhibitor erlotinib in a non-small cell lung cancer xenograft model. To evaluate the impact of in vivo STAT3 blockade on metastases, Debio 0617B was tested in an orthotopic tumor model. Measurement of primary tumor weight and metastatic counts in lung tissue demonstrated therapeutic efficacy of Debio 0617B in this model. These data show potent activity of Debio 0617B on a broad spectrum of STAT3-driven solid tumors and synergistic activity in combination with EGFR inhibition.

PMID: 27439479 [PubMed - as supplied by publisher]

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The use of magnetic resonance imaging in the evaluation of upper airway structures in paediatric obstructive sleep apnoea syndrome. A systematic review and meta-analysis.

The use of magnetic resonance imaging in the evaluation of upper airway structures in paediatric obstructive sleep apnoea syndrome. A systematic review and meta-analysis.

Dentomaxillofac Radiol. 2016 Jul 20;:20160136

Authors: Patini R, Arrica M, Di Stasio E, Gallenzi P, Cordaro M

Abstract
OBJECTIVE: A systematic review was conducted to assess the effectiveness of magnetic resonance imaging (MRI) in evaluating upper airway structures in children affected by obstructive sleep apnoea syndrome (OSAS).
METHODS: A literature search was performed in the CENTRAL, Web of Science, Scopus and PubMed databases from their inceptions to 31/03/2016, including available English published randomised controlled trials (RCT) and controlled clinical trials (CCT) assessing the use of MRI integrated with traditional polysomnography (PSG) among children up to 15 years of age affected by OSAS. The primary outcome was to evaluate the efficacy of MRI in analysing the upper airway total volume among healthy children compared to children affected by OSAS. Secondary outcomes were to compare the efficacy of MRI in analysing the upper airway cross-sectional area in the areas adjacent to the adenoids and tonsils, adenoid and tonsil volume, soft tissue and maxillofacial bone parameters in the same sample. Results were expressed using a random-effects model and mean differences (MD) with 95% confidence intervals (CI).
RESULTS: The search yielded 1,005 titles in total and using the selection process narrowed to three, which were all assessed as indicating an unclear level of risk of bias. The meta-analysis found evidence in MRI effectiveness to evaluate differences in the upper airway total volume between paediatric patients affected by OSAS, and non affected paediatric patients (MD -0.56 cm(3); 95% CI -1.05 to -0.07).
CONCLUSIONS: Basing on the current evidence, although MRI could be considered effective to evaluate upper airway structures in children affected by OSAS, PSG is still the golden standard and further studies are required to verify MRI reliability.

PMID: 27440304 [PubMed - as supplied by publisher]

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Systematic review: periprocedural hydration in the prevention of post-ERCP pancreatitis

Summary

Background

With an overall incidence of 3.5%, pancreatitis is the most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP). Periprocedural hydration may prevent post-ERCP pancreatitis by maintaining pancreatic microperfusion, thereby inhibiting the pancreatic inflammatory response. However, the evidence for periprocedural hydration as a preventive measure is unclear.

Aim

To conduct a systematic review to assess the evidence regarding periprocedural hydration as a preventive measure for post-ERCP pancreatitis.

Methods

We searched PubMed and EMBASE databases and adhered to the PRISMA guidelines. We included studies addressing periprocedural hydration as a preventive measure to reduce frequency and severity of post-ERCP pancreatitis. Study quality was assessed by using the MINORS and Cochrane Collaboration's tool.

Results

Six studies with a total of 1102 patients were included. Two randomised controlled trials reported a decreased incidence of post-ERCP pancreatitis after hydration: 0% vs. 17% (P = 0.016) and 5.3% vs. 22.7% (P = 0.002). A third trial and two case–controls studies did not report significant differences. Two retrospective studies found that patients with mild post-ERCP pancreatitis had received significantly more fluids during (mean 940 mL vs. 810 mL; P = 0.031) or after ERCP (median 2834 mL vs. 2044 mL; P < 0.02) compared to patients with moderate/severe disease. Adverse events of periprocedural hydration were not reported in any of the included studies. The different methodologies of the included studies precluded a formal data synthesis.

Conclusions

There is some evidence to suggest that hydration affords protection against post-ERCP pancreatitis, but study heterogeneity precludes firm conclusions. Adequately powered randomised trials are needed to evaluate the preventive effect of periprocedural hydration.

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High risk of post-infectious irritable bowel syndrome in patients with Clostridium difficile infection

Summary

Background

Infectious enteritis is a commonly identified risk factor for irritable bowel syndrome (IBS). The incidence of Clostridium difficile infection (CDI) is on the rise. However, there is limited information on post-infectious IBS (PI-IBS) development following CDI and the host- and infection-related risk factors are not known.

Aim

To determine the incidence and risk factors for PI-IBS following CDI.

Methods

A total of 684 cases of CDI identified from September 2012 to November 2013 were surveyed. Participants completed the Rome III IBS questionnaire and details on the CDI episode. Predictive modelling was done using logistic regression to evaluate risk factors for PI-IBS development.

Results

A total of 315 CDI cases responded (46% response rate) and 205 were at-risk (no pre-CDI IBS) for PI-IBS development. A total of 52/205 (25%) met the Rome III criteria for IBS ≥6 months following CDI. IBS-mixed was most common followed by IBS-diarrhoea. In comparison to those without subsequent PI-IBS, greater percentage of PI-IBS patients had CDI symptoms >7 days, nausea, vomiting, abdominal pain during CDI, anxiety and a higher BMI. Using logistic regression, CDI symptoms >7 days [Odds ratio (OR): 2.96, P = 0.01], current anxiety (OR: 1.33, P < 0.0001) and a higher BMI (OR: 1.08, P = 0.004) were independently associated with PI-IBS development; blood in the stool during CDI was protective (OR: 0.44, P = 0.06).

Conclusions

In this cohort study, new-onset IBS is common after CDI. Longer CDI duration, current anxiety and higher BMI are associated with the diagnosis of C. difficile PI-IBS. This chronic sequela should be considered during active management and follow-up of patients with CDI.

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News and Views-September 2016.

News and Views-September 2016.

Nucl Med Commun. 2016 Sep;37(9):999

Authors:

PMID: 27441400 [PubMed - as supplied by publisher]

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Accuracy of PET/MRI coregistration of cervical lesions.

Accuracy of PET/MRI coregistration of cervical lesions.

Nucl Med Commun. 2016 Sep;37(9):997-998

Authors: Vogel WV, Bloemers MC, van der Heide UA, Beets-Tan RG

PMID: 27441399 [PubMed - as supplied by publisher]

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Do probiotics have a role in the treatment of allergic rhinitis?: A comprehensive systematic review and meta analysis.

Do probiotics have a role in the treatment of allergic rhinitis?: A comprehensive systematic review and meta analysis.

Am J Rhinol Allergy. 2016 Jul 20;

Authors: Guvenc IA, Muluk NB, Mutlu FS, Eski E, Altintoprak N, Oktemer T, Cingi C

Abstract
OBJECTIVE: To investigate clinical evidence for the efficacy of probiotics in the treatment of allergic rhinitis (AR).
METHODS: A systematic search was conducted to review the results of all randomized, double-blind, placebo-controlled trials by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Primary outcome measurements were total nasal and ocular symptom scores (SS) and quality of life (QoL) questionnaires. Secondary outcome measurements were individual nasal SS and immunologic parameters.
RESULTS: Twenty-two randomized, double-blind, placebo-controlled studies were included. Seventeen trials showed significant benefit of probiotics clinically, whereas eight trials showed significant improvement in immunologic parameters compared with placebo. All five studies with Lactobacillus paracasei (LP) strains demonstrated clinically significant improvements compared with placebo. Probiotics showed significant reduction in nasal and ocular SS (standardized mean difference [SMD], -1.23, p < 0.001; and SMD, -1.84, p < 0.001; respectively), total, nasal, and ocular QoL scores compared with placebo (SMD, -1.84, p < 0.001; SMD, -2.30, p = 0.006; and SMD, -3.11, p = 0.005; respectively). Although heterogeneity was high, in subgroup analysis, SMD for total nasal and ocular symptoms with patients with seasonal AR and for nasal QoL scores for studies with LP-33 strain were significant and homogenous. Scores of nasal blockage, rhinorrhea, and nasal itching were significantly lower in the probiotic group compared with placebo. The meta-analysis studies SS the Japanese guidelines revealed a significant, homogenous SMD score of -0.34 for individual nasal SS, above the minimal important clinical difference value of 0.3. The T-helper 1 to T-helper 2 ratio was significantly lower in the probiotic group compared with placebo (SMD,-0.78; p = 0.045).
CONCLUSION: Despite high variability among the studies, synthesis of available data provided significant evidence of beneficial clinical and immunologic effects of probiotics in the treatment of AR, especially with seasonal AR and LP-33 strains. With the rising pool of studies, the most promising strains in specific allergies can be revealed and adjuvant therapy with probiotics can be recommended for the treatment of AR.

PMID: 27442711 [PubMed - as supplied by publisher]

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Effectiveness and Safety of Acitretin in Children with Plaque Psoriasis: A Multicenter Retrospective Analysis

Abstract

Background

Acitretin is licensed for and is most commonly used to treat psoriasis. Little information exists about its efficacy and safety in childhood and adolescent psoriasis.

Methods

Retrospective analysis of a group of children and adolescents (<17 years of age) with moderate to severe plaque psoriasis treated with acitretin between 2010 and 2014 at Italian dermatology clinics. Patients were identified through databases or registries.

Results

The study population consisted of 18 patients with a median age of 9.5 years at the start of therapy. The median maintenance dosage per day was 0.41 mg/kg. Eight patients (44.4%) achieved complete clearance or good improvement of their psoriasis, defined as improvement from baseline of 75% or more on the Psoriasis Area and Severity Index at week 16. Three had three or more courses of treatment with short disease-free intervals. In three patients, acitretin treatment was ongoing at the time of data collection. The mean total duration of treatment in responders was 22.7 months. One patient discontinued treatment because of arthralgia. The remaining nine patients (50%) discontinued treatment because it was ineffective. Mucocutaneous adverse effects occurred in all patients, but did not affect therapy maintenance.

Conclusions

In this retrospective case series, acitretin was a moderately effective, well-tolerated treatment in children with moderate to severe plaque psoriasis. Given the small number of patients, statements about long-term safety are not possible.

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5 Years has passed. RIP. Norway Explosion At Oslo And Shooting At Utoya

The 2011 Norway attacks, referred to in Norway as 22 July, were two sequential lone wolf terrorist attacks by xxx against the gov., the civilian pop., and a Workers' Youth League (AUF)-run summer camp. The attacks claimed a total of 77 lives.The first attack was a car bomb explosion in Oslo w.i. the executive gov. quarter of Norway. The bomb was made from a mix. of fertiliser and fuel oil, in the back of a van. The van was placed next to the tower block housing the office of P.M.Jens Stoltenberg. The explosion killed eight people, injured at least 209 people, twelve seriously. The second attack occurred less than two hours later at a summer camp on the island of Utøya in Tyrifjorden, The camp was organized by the AUF, the youth division of the ruling Norwegian Labour Party. XXX, dressed in a homemade police uniform and showing false ID, took a ferry to the island and opened fire at the participants, killing 68, injuring 110 people, 55 seriously, the 69th died 2 days later. From Wiki.

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[Books].

[Books].

G Chir. 2016 Jan-Feb;37(1):49-50

Authors: Di Matteo G

PMID: 27443000 [PubMed - as supplied by publisher]

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[Prof. Andrea Salvati].

[Prof. Andrea Salvati].

G Chir. 2016 Jan-Feb;37(1):5

Authors: Di Matteo G

PMID: 27442999 [PubMed - as supplied by publisher]

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5 Years has passed. RIP. Norway Explosion At Oslo And Shooting At Utoya

The 2011 Norway attacks, referred to in Norway as 22 July, were two sequential lone wolf terrorist attacks by xxx against the gov., the civilian pop., and a Workers' Youth League (AUF)-run summer camp. The attacks claimed a total of 77 lives.The first attack was a car bomb explosion in Oslo w.i. the executive gov. quarter of Norway. The bomb was made from a mix. of fertiliser and fuel oil, in the back of a van. The van was placed next to the tower block housing the office of P.M.Jens Stoltenberg. The explosion killed eight people, injured at least 209 people, twelve seriously. The second attack occurred less than two hours later at a summer camp on the island of Utøya in Tyrifjorden, The camp was organized by the AUF, the youth division of the ruling Norwegian Labour Party. XXX, dressed in a homemade police uniform and showing false ID, took a ferry to the island and opened fire at the participants, killing 68, injuring 110 people, 55 seriously, the 69th died 2 days later. From Wiki.

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The mitochondrial ubiquitin ligase plays an anti-apoptotic role in cardiomyocytes by regulating mitochondrial fission

Abstract

Apoptosis plays a critical role in the development of myocardial infarction. Cardiomyocytes are enriched with mitochondria and excessive mitochondrial fission can trigger cellular apoptosis. Recently, the mitochondrial ubiquitin ligase (MITOL), localized in the mitochondrial outer membrane, was reported to play an important role in the regulation of mitochondrial dynamics and apoptosis. However, the underlying mechanism of its action remains uncertain. The present study was aimed at uncovering the role of MITOL in the regulation of cardiomyocyte apoptosis. Our results showed that MITOL expression was up-regulated in cardiomyocytes in response to apoptotic stimulation. Mitochondrial ubiquitin ligase overexpression blocked dynamin-related protein 1 accumulation in the mitochondria, and attenuated the mitochondrial fission induced by hydrogen peroxide. Conversely, MITOL knockdown sensitized cardiomyocytes to undergo mitochondrial fission, resulting in subsequent apoptosis. These findings suggest that MITOL plays a protective role against apoptosis in cardiomyocytes, and may serve as a potential therapeutic target for apoptosis-related cardiac diseases.

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Efficient hardware implementation strategy for local normalization of fingerprint images

Abstract

Global techniques do not produce satisfying and definitive results for fingerprint image normalization due to the non-stationary nature of the image contents. Local normalization techniques are employed, which are a better alternative to deal with local image statistics. Conventional local normalization techniques involve pixelwise division by the local variance and thus have the potential to amplify unwanted noise structures, especially in low-activity background regions. To counter the background noise amplification, the research work presented here introduces a correction factor that, once multiplied with the output of the conventional normalization algorithm, will enhance only the feature region of the image while avoiding the background area entirely. In essence, its task is to provide the job of foreground segmentation. A modified local normalization has been proposed along with its efficient hardware structure. On the way to achieve real-time hardware implementation, certain important computationally efficient approximations are deployed. Test results show an improved speed for the hardware architecture while sustaining reasonable enhancement benchmarks.

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Elective Neck Dissection vs Observation in Early-Stage Squamous Cell Carcinoma of the Oral Tongue With No Clinically Apparent Lymph Node Metastasis in the Neck: A Systematic Review and Meta-analysis.

Elective Neck Dissection vs Observation in Early-Stage Squamous Cell Carcinoma of the Oral Tongue With No Clinically Apparent Lymph Node Metastasis in the Neck: A Systematic Review and Meta-analysis.

JAMA Otolaryngol Head Neck Surg. 2016 Jul 21;

Authors: Abu-Ghanem S, Yehuda M, Carmel NN, Leshno M, Abergel A, Gutfeld O, Fliss DM

Abstract
Importance: The elective management of no clinical or radiologic evidence of lymph node metastasis in the neck (cN0) in early stage T1-T2 oral tongue squamous cell carcinoma (OTSCC) has been the subject of much debate during the past 3 decades and continues to be controversial.
Objective: To systematically review the literature and carry out a meta-analysis of studies that compared elective neck dissection (END) with observation in patients with early-stage T1-T2 OTSCC and cN0 neck.
Data Sources: The MEDLINE, Scopus, Google scholar, and Cochrane databases were systematically searched for articles published between January 1, 1970, and June 1, 2015. Search terms used were squamous cell carcinoma, oral tongue, mobile tongue, T1, T2, early stage, elective neck dissection, no neck treatment, observation, wait and watch, node-negative neck, and N0 neck.
Study Selection: Controlled clinical trials, prospective and retrospective cohorts, case-control studies, and case series that compared END with observation in patients with early-stage T1-T2 OTSCC who had no clinical or radiologic evidence of lymph node metastasis to the neck were eligible for inclusion in this meta-analysis. All patients included had a histopathologic diagnosis of SCC and at least 6 months of follow-up. Regional (neck) nodal recurrence, overall survival (OS), and disease-specific survival (DSS) were tested.
Data Extraction and Synthesis: Four researchers independently extracted information on population characteristics, outcomes of interest, and study design. Discrepancies were resolved by consensus. Fixed effects were used to determine hazard ratios (HRs) and odds ratio (ORs) were used for studies including samples without substantial heterogeneity; random effects were evaluated for samples with significant heterogeneity.
Results: A total of 20 retrospective and 3 prospective randomized studies that met the inclusion criteria, with a total of 3244 patients, were included in the meta-analysis The results showed that END significantly reduced risk of regional recurrence (random-effects model: OR, 0.32; 95% CI, 0.22-0.46; P < .001) and improved DSS (fixed-effects model: HR, 0.49; 95% CI, 0.33-0.72; P < .001) compared with management by observation. However, END did not significantly improve OS (random-effects model: HR, 0.71; 95% CI, 0.41-1.22; P = .21).
Conclusions and Relevance: The findings of this systematic review and meta-analysis indicate that END can significantly reduce the rate of regional nodal recurrence and improve DSS in patients with cT1T2N0 OTSCC.

PMID: 27442962 [PubMed - as supplied by publisher]

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Free tissue transfer as a vascular source for the vessel-depleted neck.

Free tissue transfer as a vascular source for the vessel-depleted neck.

Head Neck. 2016 Jul 21;

Authors: Tsao CK, Loh CY, Barrera JM

Abstract
BACKGROUND: Reconstructing head and neck defects postoncologic resection can be challenging. This problem is further amplified when tackling the vessel-depleted or hostile neck. Free flaps still provide the gold standard of reconstructing such defects. However, with increasing reconstructions, recipient vessel options rapidly diminish. This article provides a technique and strategy in managing such difficult cases using previous free flap pedicles. It also highlights the importance of flap selection in paving the way for future successful reconstructions.
METHODS: We present a fifth sequential free flap reconstruction postoncologic buccal resection and mention the key steps taken to ensure the safe and successful reuse of previous free flap pedicles.
RESULTS: Intraoperative and postoperative photographs are clearly presented with a particular focus on the management of the recipient pedicle.
CONCLUSION: Adequate planning and strategic selection of free flaps with long pedicles can provide the necessary vascular sources needed for future successful free flap head and neck reconstructions. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27442917 [PubMed - as supplied by publisher]

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The Molecular Landscape of Recurrent and Metastatic Head and Neck Cancers: Insights From a Precision Oncology Sequencing Platform.

The Molecular Landscape of Recurrent and Metastatic Head and Neck Cancers: Insights From a Precision Oncology Sequencing Platform.

JAMA Oncol. 2016 Jul 21;

Authors: Morris LG, Chandramohan R, West L, Zehir A, Chakravarty D, Pfister DG, Wong RJ, Lee NY, Sherman EJ, Baxi SS, Ganly I, Singh B, Shah JP, Shaha AR, Boyle JO, Patel SG, Roman BR, Barker CA, McBride SM, Chan TA, Dogan S, Hyman DM, Berger MF, Solit DB, Riaz N, Ho AL

Abstract
Importance: Recurrent and/or metastatic head and neck cancer is usually incurable. Implementation of precision oncology for these patients has been limited by incomplete understanding of the molecular alterations underlying advanced disease. At the same time, the molecular profiles of many rare head and neck cancer types are unknown. These significant gaps in knowledge need to be addressed to rationally devise new therapies.
Objective: To illuminate the distinct biology of recurrent and metastatic head and neck cancers and review implementation of precision oncology for patients with advanced disease.
Design, Setting, and Participants: After exclusions, 151 patients with advanced, treatment-resistant head and neck tumors, including squamous cell carcinoma (HNSCC), adenoid cystic carcinoma (ACC), and other salivary and cutaneous cancers, whose tumors were sequenced between January 2014 and July 2015 at Memorial Sloan Kettering were recruited. Next-generation sequencing of tumors as part of clinical care included high-depth (median 600×) exonic coverage of 410 cancer genes and whole-genome copy number analysis.
Interventions: Next-generation sequencing of tumors and matched normal DNA.
Main Outcomes and Measures: Feasibility, the frequency of actionable molecular alterations, the effect on decision making, and identification of alterations associated with recurrent and metastatic disease.
Results: Overall, 151 patients (95 men and 56 women; mean [range] age, 61.8 [17-100] years) were included in the study. Next-generation sequencing ultimately guided therapy in 21 of 151 patients (14%) (13 of 53 [25%] of patients with HNSCC) by refining diagnoses and matching patients to specific therapies, in some cases with dramatic responses on basket studies. Molecular alterations were potentially actionable in 28 of 135 patients (21%). The genetic profiles of recurrent and metastatic tumors were often distinct from primary tumors. Compared to primary human papillomavirus (HPV)-positive tumors, many recurrent and metastatic HPV-positive tumors exhibited a molecular profile more similar to HPV-negative tumors, including enriched frequencies of TP53 mutation (3 of 20 tumors [15%]), whole genome duplication (5 of 20 tumors [25%]), and 3p deletion (11 of 20 tumors [55%]). There were high rates of TERT promoter mutation in recurrent and metastatic HPV-negative HNSCC (13 of 30 tumors [43%]), cutaneous SCC (11 of 21 tumors [52%]), basal cell carcinoma (3 of 4 tumors [75%]), and ACC (5 of 36 tumors [14%]). Activating NOTCH1 mutations were enriched in metastatic ACCs (8 of 36 tumors [22%]).
Conclusions and Relevance: These findings reveal the molecular landscape of advanced disease and rare cancer subtypes, both predominant challenges in head and neck oncology. To understand the repertoire of targetable alterations in advanced cancers, it is necessary to sequence recurrent and metastatic tumors. These data are important first steps toward implementation of precision head and neck oncology.

PMID: 27442865 [PubMed - as supplied by publisher]

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Variables Associated With Communicative Participation After Head and Neck Cancer.

Variables Associated With Communicative Participation After Head and Neck Cancer.

JAMA Otolaryngol Head Neck Surg. 2016 Jul 21;

Authors: Bolt S, Eadie T, Yorkston K, Baylor C, Amtmann D

Abstract
Importance: For patients with head and neck cancer (HNC), communication difficulties often create substantial barriers in daily life, affecting a person's ability to return to work, establish or maintain relationships, or participate in everyday activities.
Objective: To examine variables significantly associated with communication in everyday activities, or communicative participation, in adult survivors of HNC.
Design, Setting, and Participants: In a cross-sectional study, from November 1, 2008, through March 18, 2011, participants completed questionnaires about specific experiences and symptoms associated with their health and communication. Seventeen variables were considered in association with communicative participation. Data were collected from adult survivors of HNC residing in a community. Participants completed questionnaires, in English, either online or using paper forms according to their preference. Participants were recruited through support groups, professional email lists, and professional contacts.
Main Outcomes and Measures: Communicative participation and predictor variables were measured using a variety of validated patient-report scales and demographic information. Multiple linear regression analysis was conducted with variables entered using a backward stepwise regression procedure. Variables with significant regression coefficients were retained in the model and reported as change in R2.
Results: One hundred ninety-seven adults (121 males and 76 females; mean age, 61.5 years) participated, all at least 6 months posttreatment of HNC with no additional medical conditions affecting speech. The final model contained 4 significant variables (R2 = 0.462): self-rated speech severity, cognitive function, laryngectomy status, and time since diagnosis. Better communicative participation was associated with less severe speech and cognitive problems; together, these 2 variables explained 42% of the variance in the model (self-rated speech severity, R2 = 0.227, and cognitive function, R2 = 0.193 [0.227 + 0.193 = 0.420 = 42%]). To a lesser extent, better communicative participation also was associated with not having undergone a total laryngectomy surgical procedure (R2 = 0.035) and longer time since diagnosis (R2 = 0.007); full model: R2 = 0.462, P < .001; regression coefficients [SE]: self-rated speech severity 0.551 [0.065], P < .001, R2 = 0.227; cognitive function 0.063 [0.011], P < .001, R2 = 0.193; laryngectomy status 0.285 [0.117], P = .02; and time since diagnosis 0.015 [0.006], P = .02.
Conclusions and Relevance: These results suggest that communicative participation in adults with HNC is associated with self-rated speech severity, cognitive function, whether or not a person has undergone total laryngectomy, and time since diagnosis. Clinicians can use these results to inform their practice in pretreatment counseling, patient education, and rehabilitation for survivors of HNC.

PMID: 27442853 [PubMed - as supplied by publisher]

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Combined CD44, c-MET, and EGFR expression in p16-positive and p16-negative head and neck squamous cell carcinomas.

Combined CD44, c-MET, and EGFR expression in p16-positive and p16-negative head and neck squamous cell carcinomas.

J Oral Pathol Med. 2016 Jul 21;

Authors: Baschnagel AM, Tonlaar N, Eskandari M, Kumar T, Williams L, Hanna A, Pruetz BL, Wilson GD

Abstract
PURPOSE/OBJECTIVE(S): To examine the association between CD44 and c-MET expression in relation to p16 and EGFR in patients with head and neck squamous cell carcinoma (HNSCC).
MATERIALS/METHODS: Immunohistochemical staining of CD44, p16, EGFR, and c-MET was performed on 105 locally advanced HNSCC patients treated with chemoradiation. CD44 expression was correlated with c-MET, EGFR, and p16, locoregional control (LRC), distant metastases (DM), disease-free survival (DFS) and overall survival (OS).
RESULTS: High CD44 expression was present in 33% of patients and was associated with non-oropharynx primaries (P < 0.001), high c-MET expression (P < 0.001), p16-negative (P < 0.001) and EGFR-positive tumors (P < 0.001). Fifty-seven percent of CD44 high expressing tumors had high c-MET expression compared to 21% of CD44 low expressing tumors (P < 0.001). High CD44 expression predicted for worse LRC (HR: 2.44; 95% CI: 1.16-5.13; P = 0.018), DFS (HR: 2.61; 95% CI: 1.46-4.67; P = 0.001), and OS (HR: 2.52; 95% CI: 1.30-4.92; P = 0.007) but not DM (P = 0.57) on univariate analysis. Patients with both high CD44 and c-MET expression had a poor prognosis with a 2-year DFS of 30% compared to 70% in the rest of the cohort (P = 0.003). On multivariable analysis, after adjusting for site, T-stage, smoking history, and EGFR status, high c-MET (P = 0.039) and negative p16 status (P = 0.034) predicted for worse DFS, while high CD44 expression did not (P = 0.43).
CONCLUSIONS: High CD44 expression is associated with high c-MET expression, p16-negative tumors, and EGFR-positive tumors. The combination of these markers predicts for poor prognosis in HNSCC patients treated with chemoradiation.

PMID: 27442811 [PubMed - as supplied by publisher]

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Extracranial schwannoma in the carotid space: A retrospective review of 91 cases.

Extracranial schwannoma in the carotid space: A retrospective review of 91 cases.

Head Neck. 2016 Jul 21;

Authors: Zheng X, Guo K, Wang H, Li D, Wu Y, Ji Q, Shen Q, Sun T, Xiang J, Zeng W, Chen Y, Wang Z

Abstract
BACKGROUND: Schwannomas of the vagus nerve and cervical sympathetic nerve are rare; hence, only limited information exists regarding their diagnosis and clinical management.
METHODS: We conducted a retrospective review of the clinical features, imaging studies, and treatment results of patients with schwannoma of the vagus nerve and schwannoma of the sympathetic nerve.
RESULTS: Of 91 patients, 91% (n = 83) were preoperatively diagnosed with schwannoma tumors. Using the hyoid bone as an anatomic landmark, the location of the schwannoma of the vagus nerve in the carotid space was significantly different to the location of schwannoma of the sympathetic nerve (p = .003). Although 52 of the 76 patients followed up (68%) had postoperative nerve weaknesses, 13 patients (50%) and 14 patients (53.8%), respectively, fully recovered from schwannoma of the vagus nerve and schwannoma of the sympathetic nerve.
CONCLUSION: In the carotid space, schwannomas of the vagus nerve are usually located below the hyoid bone, whereas schwannomas of the sympathetic nerve more commonly arise from the suprahyoid compartment. Accurate preoperative diagnosis and the intracapsular enucleation surgical approach decreased the incidence of postoperative morbidity. © 2016 Wiley Periodicals, Head Neck, 2016.

PMID: 27442804 [PubMed - as supplied by publisher]

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The Effect of Donepezil on Arousal Threshold and Apnea Hypopnea Index: A Randomized, Double-blind Cross-over Study.

The Effect of Donepezil on Arousal Threshold and Apnea Hypopnea Index: A Randomized, Double-blind Cross-over Study.

Ann Am Thorac Soc. 2016 Jul 21;

Authors: Li Y, Owens RL, Sands S, Orr J, Moraes W, DeYoung P, Smales E, Jen R, Malhotra A

Abstract
RATIONALE: Obstructive sleep apnea (OSA) has multiple pathophysiological causes. A low respiratory arousal threshold (ArTh) and a high loop gain (unstable ventilatory control) can contribute to recurrent respiratory events in patients with OSA. Prior small studies have shown that donepezil, an acetylcholinesterase inhibitor, might improve OSA, but the mechanism is unknown.
OBJECTIVES: To determine whether a single dose of donepezil lowers the apnea hypopnea index (AHI) by modulating the ArTh or loop gain.
METHODS: In this randomized, double-blind cross-over trial, Forty-one OSA subjects underwent two polysomnograms with ArTh and loop gain evaluated, during which 10 mg of donepezil or placebo were administered.
MEASUREMENTS AND MAIN RESULTS: Compared to placebo, sleep efficiency (77.2 vs 71.9%; P=0.015) and total sleep time decreased with donepezil (372 vs 351min; P=0.004). No differences were found in AHI (51.8 vs 50.0 events/hr; P=0.576), or nadir SpO2 (80.3 vs 81.1%; P=0.241) between placebo and donepezil, respectively. ArTh was not significantly changed (-18.9 vs -18.0 cmH2O; P=0.394) with donepezil. As a whole group, loop gain (LG1, ventilatory response to a 1 cycle/min disturbance) did not change significantly (P=0.089).
CONCLUSIONS: A single dose of donepezil does not appear to affect the overall severity of OSA in this patient group, and no consistent effects on ArTh or loop gain were observed. Donepezil may have minor effects on sleep architecture. Clinical Trial registered with clinicaltrials.gov (NCT02264353).

PMID: 27442715 [PubMed - as supplied by publisher]

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Effect of Cognition on Quality of Life After Head and Neck Cancer Treatment.

Effect of Cognition on Quality of Life After Head and Neck Cancer Treatment.

JAMA Otolaryngol Head Neck Surg. 2016 Jul 21;

Authors: Okuyemi OT

PMID: 27442622 [PubMed - as supplied by publisher]

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Krüppel-Like Factor 12 Promotes Colorectal Cancer Growth through Early Growth Response Protein 1.

Krüppel-Like Factor 12 Promotes Colorectal Cancer Growth through Early Growth Response Protein 1.

PLoS One. 2016;11(7):e0159899

Authors: Kim SH, Park YY, Cho SN, Margalit O, Wang D, DuBois RN

Abstract
Krüppel-like factor 12 (KLF12) is a transcription factor that plays a role in normal kidney development and repression of decidualization. KLF12 is frequently elevated in esophageal adenocarcinoma and has been reported to promote gastric cancer progression. Here, we examined the role of KLF12 in colorectal cancer (CRC). Indeed, KLF12 promotes tumor growth by directly activating early growth response protein 1 (EGR1). The levels of KLF12 and EGR1 correlate synergistically with a poor prognosis. These results indicate that KLF12 likely plays an important role in CRC and could serve as a potential prognostic marker and therapeutic target.

PMID: 27442508 [PubMed - as supplied by publisher]

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Consensus statement: Long-term results of ABI in children with complex inner ear malformations and decision making between CI and ABI.

Consensus statement: Long-term results of ABI in children with complex inner ear malformations and decision making between CI and ABI.

Cochlear Implants Int. 2016 Jul 21;:0

Authors: Sennaroğlu L, Colletti V, Lenarz T, Manrique M, Laszig R, Rask-Andersen H, Göksu N, Offeciers E, Saeed S, Behr R, Bayazıt Y, Casselman J, Freeman S, Kileny P, Lee DJ, Shannon RV, Kameswaran M, Hagr A, Zarowski A, Schwartz MS, Bilginer B, Kishore A, Sennaroğlu G, Yücel E, Saraç S, Ataş A, Colletti L, O'Driscoll M, Moon IS, Gärtner L, Huarte A, Nyberg G, Mocan BÖ, Atay G, Bajin MD, Çınar BÇ, Batuk MÖ, Yaralı M, Aydınlı FE, Aslan F, Kirazlı MC, Özkan HB, Hans JM, Kosaner J, Polak M

PMID: 27442073 [PubMed - as supplied by publisher]

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Transoral and transnasal odontoidectomy complications: A systematic review and meta-analysis.

Transoral and transnasal odontoidectomy complications: A systematic review and meta-analysis.

Clin Neurol Neurosurg. 2016 Jul 11;148:121-129

Authors: Shriver MF, Kshettry VR, Sindwani R, Woodard T, Benzel EC, Recinos PF

Abstract
OBJECT: The craniovertebral junction (CVJ) is a complex region of the spine with unique anatomical and functional relationships. To alleviate symptoms associated with pathological processes involving the odontoid process, decompression is often required, including odontoidectomy. Accurate knowledge of the complication rates following the transoral and transnasal techniques is essential for both patients and surgeons.
METHODS: We conducted MEDLINE, Scopus and Web of Science database searches for studies reporting complications associated with the transoral and transnasal techniques for odontoidectomy. Case series presenting data for less than three patients were excluded. Rates of complication and clinical outcomes were calculated and subsequently analyzed using a fixed-effects model to assess statistical significance.
RESULTS: Of 1288 articles retrieved from MEDLINE, Scopus, and Web of Science, twenty-six met inclusion criteria. Transoral and transnasal procedures resulted in the following respective complication rates: arterial injury 1.9% and 0.0%, intraoperative CSF leak 0.3% and 30.0%, postoperative CSF leak 0.8% and 5.2%, 30-day mortality 2.9% and 4.4%, medical complications 13.9% and 28.6%, meningitis 1.0% and 4.0%, pharyngeal wound dehiscence 1.7% (transnasal not reported), pneumonia 10.3% (transnasal not reported), prolonged or re-intubation 5.6% and 6.0%, reoperation 2.5% and 5.1%, sepsis 1.9% and 7.7%, tracheostomy 10.8% and 3.4%, velopharyngeal insufficiency 3.3% and 6.4% and wound infection 3.3% and 1.9%. None of these differences were statistically significant, except for postoperative tracheostomy, which was significantly higher after transoral odontoidectomy 8.4% (95% CI 4.9% -11.9%) compared to transnasal odontoidectomy 0.8% (95% CI -1.0% -2.9%). Neurologic outcome was improved in 90.0% and worse in 0.9% of patients after transoral compared to 94.0% and 0.0% after transnasal odontoidectomy (p=0.30).
CONCLUSIONS: This work presents a systematic review of complications reported for transoral or transnasal odontoidectomy across a heterogeneous group of surgeons and patients. Due to inconsistent reporting, statistical significance was only achieved for postoperative tracheostomy, which was significantly higher in the transoral group. This investigation sets the framework for further discussions regarding odontoidectomy approach options and their associated complications during the informed consent process.

PMID: 27442001 [PubMed - as supplied by publisher]

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Natural Language Use and Couples' Adjustment to Head and Neck Cancer.

Natural Language Use and Couples' Adjustment to Head and Neck Cancer.

Health Psychol. 2016 Jul 21;

Authors: Badr H, Milbury K, Majeed N, Carmack CL, Ahmad Z, Gritz ER

Abstract
OBJECTIVE: This multimethod prospective study examined whether emotional disclosure and coping focus as conveyed through natural language use are associated with the psychological and marital adjustment of head and neck cancer patients and their spouses.
METHOD: One-hundred twenty-three patients (85% men; age X¯ = 56.8 years, SD = 10.4) and their spouses completed surveys prior to, following, and 4 months after engaging in a videotaped discussion about cancer in the laboratory. Linguistic inquiry and word count (LIWC) software assessed counts of positive/negative emotion words and first-person singular (I-talk), second person (you-talk), and first-person plural (we-talk) pronouns. Using a grounded theory approach, discussions were also analyzed to describe how emotion words and pronouns were used and what was being discussed.
RESULTS: Emotion words were most often used to disclose thoughts/feelings or uncertainty about the future, and to express gratitude or acknowledgment to one's partner. Although patients who disclosed more negative emotion during the discussion reported more positive mood following the discussion (p < .05), no significant associations between emotion word use and patient or spouse psychological and marital adjustment were found. Patients used significantly more I-talk than spouses and spouses used significantly more you-talk than patients (ps < .01). Patients and spouses reported more positive mood following the discussion when they used more we-talk. They also reported less distress at the 4-month follow-up when their partners used more we-talk during the discussion (p < .01).
CONCLUSION: Findings suggest that emotional disclosure may be less important to one's cancer adjustment than having a partner who one sees as instrumental to the coping process. (PsycINFO Database Record

PMID: 27441867 [PubMed - as supplied by publisher]

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Stereotactic Body Radiation Therapy for Recurrent Head and Neck Cancer.

Stereotactic Body Radiation Therapy for Recurrent Head and Neck Cancer.

Cancer J. 2016 Jul-Aug;22(4):302-306

Authors: Ling DC, Vargo JA, Heron DE

Abstract
Stereotactic body radiation therapy (SBRT) offers a promising opportunity for cure and/or palliation to patients with recurrent head and neck cancer whose comorbidities, performance status, and history of prior treatment may preclude many other salvage options. Stereotactic body radiation therapy appears to have a favorable response and toxicity profile compared with other nonoperative salvage options for recurrent head and neck cancer. However, the risk of severe toxicity remains, with carotid blowout syndrome a unique concern, although the incidence of this complication may be minimized with alternating-day fractionation. The short overall treatment time and low rates of acute toxicity make SBRT an optimal vehicle to integrate with novel systemic therapies, and several phase II studies have used concurrent cetuximab as a radiosensitizer with SBRT with promising results. Ongoing studies aim to evaluate the potential synergistic effect of SBRT with immune checkpoint inhibitors in recurrent head and neck cancer.

PMID: 27441751 [PubMed - as supplied by publisher]

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Patterns of Facial Fractures and Protective Device Use in Motor Vehicle Collisions From 2007 to 2012.

Patterns of Facial Fractures and Protective Device Use in Motor Vehicle Collisions From 2007 to 2012.

JAMA Facial Plast Surg. 2016 Jul 21;

Authors: Hyman DA, Saha S, Nayar HS, Doyle JF, Agarwal SK, Chaiet SR

Abstract
Importance: Facial fractures after motor vehicle collisions are a significant source of facial trauma in patients seen at trauma centers. With recent changes in use of seat belts and advances in airbag technology, new patterns in the incidence of facial fractures after motor vehicle collisions have yet to be quantified.
Objectives: To evaluate the incidence of facial fractures and assess the influence of protective device use in motor vehicle collisions in patients treated at trauma centers in the United States.
Design, Setting, and Participants: Using a data set from the National Trauma Data Bank, we retrospectively assessed facial fractures in motor vehicle collisions occurring from 2007 through 2012, reported by level I, II, III, and IV trauma centers. Data analysis was performed from March 13 to September 22, 2015.
Main Outcomes and Measures: We characterized the data set by subsite of facial injury using International Classification of Diseases, Ninth Revision codes including mandible, midface, and nasal fractures. We assessed the influence of variables such as age, sex, race/ethnicity, crash occupant (driver or passenger), use of protective device, and presence or suspicion of alcohol use.
Results: A total of 518 106 patients required assessment at a trauma center after a motor vehicle collision, with 56 422 (10.9%) experiencing at least 1 facial fracture. Nasal fracture was the most common facial fracture (5.6%), followed by midface (3.8%), other (3.2%), orbital (2.6%), mandible (2.2%), and panfacial fractures (0.8%). Of the subset sustaining at least 1 facial fracture, 5.8% had airbag protection only, 26.9% used a seat belt only, and 9.3% used both protective devices, while 57.6% used no protective device. Compared with no protective device, the use of an airbag alone significantly reduced the likelihood of facial fracture after a motor vehicle collision (odds ratio, 0.82; 95% CI, 0.79-0.86); use of a seat belt alone had a greater effect (odds ratio, 0.57; 95% CI, 0.56-0.58) and use of both devices provided the greatest odds reduction (odds ratio, 0.47; 95% CI, 0.45-0.48). Younger age, male sex, and alcohol use significantly increased the likelihood of facial fracture.
Conclusions and Relevance: For patients who presented to US trauma centers after motor vehicle collisions between 2007 and 2012, airbags, seat belts, and the combination of the 2 devices incrementally reduced the likelihood of facial fractures.
Level of Evidence: 3.

PMID: 27441732 [PubMed - as supplied by publisher]

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Prevalence, Severity, Exposures, and Treatment Patterns of Tinnitus in the United States.

Prevalence, Severity, Exposures, and Treatment Patterns of Tinnitus in the United States.

JAMA Otolaryngol Head Neck Surg. 2016 Jul 21;

Authors: Bhatt JM, Lin HW, Bhattacharyya N

Abstract
Importance: Tinnitus is a common problem for millions of individuals and can cause substantial negative effects on their quality of life. A large epidemiologic study of tinnitus and its management patterns in the US adult population is lacking.
Objectives: To quantify the epidemiologic features and effect of tinnitus and to analyze the management of tinnitus in the United States relative to the 2014 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) clinical practice guidelines.
Design, Methods, and Participants: This cross-sectional analysis of the representative 2007 National Health Interview Survey (raw data, 75 764 respondents) identified a weighted national sample of adults (age, ≥18 years) who reported tinnitus in the preceding 12 months. Data were collected in November 2014 at the University of California, Irvine, and Harvard Medical School.
Main Outcomes and Measures: In addition to quantifying prevalence, severity, duration, and regularity of tinnitus, specific data regarding noise exposure and tinnitus management patterns during health care visits were analyzed.
Results: Among an estimated (SE) 222.1 (3.4) million US adults, 21.4 (3.4) million (9.6% [0.3%]) experienced tinnitus in the past 12 months. Among those who reported tinnitus, 27% had symptoms for longer than 15 years, and 36% had nearly constant symptoms. Higher rates of tinnitus were reported in those with consistent exposure to loud noises at work (odds ratio, 3.3; 95% CI, 2.9-3.7) and during recreational time (odds ratio, 2.6; 95% CI, 2.3-2.9). Years of work-related noise exposure correlated with increasing prevalence of tinnitus (r = 0.13; 95% CI, 0.10-0.16). In terms of subjective severity, 7.2% reported their tinnitus as a big or a very big problem compared with 41.6% who reported it as a small problem. Only 49.4% had discussed their tinnitus with a physician, and medications were the most frequently discussed recommendation (45.4%). Other interventions, such as hearing aids (9.2%), wearable (2.6%) and nonwearable (2.3%) masking devices, and cognitive behavioral therapy (0.2%), were less frequently discussed.
Conclusions and Relevance: The prevalence of tinnitus in the United States is approximately 1 in 10 adults. Durations of occupational and leisure time noise exposures correlated with rates of tinnitus and are likely targetable risk factors. Management options suggested by the recently published AAO-HNSF guidelines were followed infrequently.

PMID: 27441392 [PubMed - as supplied by publisher]

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The use of the radial styloid in the extended osteocutaneous radial forearm free flap.

The use of the radial styloid in the extended osteocutaneous radial forearm free flap.

Plast Surg (Oakv). 2016;24(2):89-95

Authors: Matthews J, Ng W, Archibald S, Levis C

Abstract
BACKGROUND: The osteocutaneous radial forearm free flap (OC-RFFF) remains a useful tool in head and neck reconstruction; however, it can be challenging to harvest sufficient bone for large reconstructions. The extended OC-RFFF is a modification that involves harvest of the distal border of the radius to the tip of the styloid. This increases the length of the bone flap by 2 cm to 3 cm, and the inherent contour of the styloid can be used to reconstruct the anterior curvature of the mandible or maxilla without additional osteotomies that may reduce blood supply.
METHODS: The key steps in harvesting the extended OC-RFFF are described. Six patients with mandibular or maxillary defects underwent reconstruction with the extended OC-RFFF. Patient data including demographics, defect features, reconstruction details and outcomes were collected.
RESULTS: Of the six patients who underwent the extended OC-RFFF, four had mandibular reconstruction and two had maxillary reconstruction. Two patients underwent reconstruction for osteoradionecrosis and the remainder for malignant disease. The average patient age at the time of surgery was 64.5 years. The length of radius harvested ranged from 8 cm to 14 cm (mean 9.7 cm). Two of six patients required a single osteotomy of their bone flap. Donor site complications included partial skin graft loss in 50% and a radius fracture in two patients. Recipient site complications included one patient with intraoral plate exposure. There have been no cases of nonunion.
CONCLUSIONS: The extended OC-RFFF was a safe and reliable option for bony reconstruction in the head and neck.

PMID: 27441191 [PubMed]

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Multimodality Management of Trigeminal Schwannomas.

Multimodality Management of Trigeminal Schwannomas.

J Neurol Surg B Skull Base. 2016 Aug;77(4):371-8

Authors: Niranjan A, Barnett S, Anand V, Agazzi S

Abstract
Patients presenting with trigeminal schwannomas require multimodality management by a skull base surgical team that can offer expertise in both transcranial and transnasal approaches as well as radiosurgical and microsurgical strategies. Improvement in neurologic symptoms, preservation of cranial nerve function, and control of mass effect are the primary goals of management for trigeminal schwannomas. Complete surgical resection is the treatment of choice but may not be possible in all cases. Radiosurgery is an option as primary management for small- to moderate-sized tumors and can be used for postoperative residuals or recurrences. Planned surgical resection followed by SRS for residual tumor is an effective option for larger trigeminal schwannomas. The endoscopic resection is an excellent approach for patients with an extradural tumor or tumors isolated to the Meckel cave. A detailed analysis of a tumor and its surroundings based on high-quality imaging can help better estimate the expected outcome from each treatment. An expert skull base team should be able to provide precise counseling for each patient's situation for selecting the best option.

PMID: 27441164 [PubMed]

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