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Review: 'Deadpool' plays to Ryan Reynolds' snarky strengths
Charleston Gazette-Mail (subscription) When Wade discovers he has advanced-stage cancer, he undergoes an underground experimental treatment, in which his mutant genes are tortured into life by Francis (Ed Skrein) and his henchlady Angel Dust (Gina Carano). The treatment works, imbuing ... |
The endoplasmic reticulum (ER) stress response is a therapeutic target for pharmacologic intervention in cancer cells. We hypothesized that combining carfilzomib (CFZ), a proteasome inhibitor, and vorinostat (SAHA), a histone deacetylase (HDAC) inhibitor, would synergistically activate ER stress in non-small cell lung cancer (NSCLC) cell lines, resulting in enhanced anti-tumor activity.
Five NSCLC cell lines were treated with CFZ, SAHA, or the combination and cell proliferation measured using the MTT assay. Calcusyn software was utilized to determine the combination index as a measure of synergy. Cell viability and cytotoxicity were measured using trypan blue exclusion, CellTiter, and CytoTox assays. Western blot was used to measure markers of apoptosis, ER stress, and oxidative stress-related proteins. Reactive oxygen species (ROS) was measured using the fluorophore CM–H2DCFDA.
Synergistic activity was observed for all cell lines following 48 and 72 h of combined treatment. H520 and A549 cell lines were used to assess viability and apoptosis. In both cell lines, increased death and cleaved caspase-3 were observed following combination treatment as compared with single-agent treatments. Combination therapy was associated with upregulation of ER stress-regulated proteins including activating transcription factor 4, GRP78/BiP, and C/EBP homologous protein. Both cell lines also showed increased ROS and the oxidative stress-related protein, heat shock protein 70.
Combining proteasome inhibition with HDAC inhibition enhances ER stress, which may contribute to the synergistic anticancer activity observed in NSCLC cell lines. Further preclinical and clinical studies of CFZ + SAHA in NSCLC are warranted.
Several randomized clinical trials (RCTs) have demonstrated the efficacy of trastuzumab-based adjuvant therapy in HER2-positive breast cancer (BC). However, RCT patients may not invariably be representative of patients routinely seen in clinical practice (CP). To address this issue, we compared the clinical and tumor features of RCT and CP patients with HER2-positive BC.
From January to December 2012, 650 consecutive patients with HER2-positive early BC, treated in 36 different types of Italian healthcare facilities, were enrolled in this study. Age, treatment, tumor size (T), nodes (N), grade (G), estrogen receptor (ER) and progesterone receptor (PgR) status were prospectively collected in these CP patients. The same data were extracted from the main adjuvant trastuzumab RCTs and pooled using the random-effects model of DerSimonian and Laird. RCT and CP patients were compared by using the Cochran Q statistics.
Versus RCT patients, CP patients were more likely to be older than 50 years (65 vs. 49 %; p < 0.0001) and to have HR (ER and/or PgR)-positive (72 vs. 54 %; p < 0.0001) BC and less likely to have tumor >2 cm (T ≥ 2 cm 39 vs. 59 %; p < 0.0001), positive N (47 vs. 89 %; p < 0.0001) and a high G (61 vs. 67 %; p = 0.0241). CP patients more frequently received adjuvant endocrine therapy (70 vs. 57 %; p < 0.0003) and less frequently adjuvant chemotherapy (97 vs. 99.7 %; p < 0.0001).
Most tumor and clinical features differed significantly between CP and RCT patients. These data raise concerns about the applicability of RCT results to CP patients.
Colorectal cancer (CRC) is one of the most common cancers in the world. MicroRNAs play important roles in the progression of CRC. This study aimed to investigate the role of miR-206 and its novel mechanism in the invasion and metastasis of CRC.
Real-time RT-PCR or Western blotting was used to detect the expressions of miR-206, FMNL2 and c-MET in CRC cell lines and tissues. Luciferase reporter assays were conducted to detect the associations between miR-206 and 3′UTRs of FMNL2 and c-MET. A series of loss-of-function and gain-of-function assays were performed to evaluate the effect of miR-206 on the proliferation, invasion and metastasis of CRC cells.
miR-206 was significantly down-regulated in CRC tissues and correlated closely with differentiation, lymphatic metastasis and serosal invasion. miR-206 suppressed CRC cell proliferation by arresting CRC cells in the G1/G0 phase and accelerating apoptosis. miR-206 also inhibited cell invasion and lung metastasis in CRC cells. Mechanically, FMNL2 and c-MET were identified as direct targets of miR-206. And FMNL2 rescued the suppression of miR-206 in the proliferation and invasion of CRC cells.
This study revealed functional and mechanistic links between miR-206 and oncogene FMNL2 and c-MET in the progression of CRC. miR-206 functioned as a tumor suppressor in the progression of CRC by targeting FMNL2 and c-MET. Restoration of miR-206 expression may represent a promising therapeutic approach for targeting malignant CRC.
Histological vascular invasion (VI) by tumors is a risk factor for recurrence after surgical resection. However, VI features vary histologically. The aim of this study was to identify characteristic VI features that are associated with recurrence in squamous cell carcinoma (SCC) of the lung.
We enrolled 149 patients with pathological stage I primary lung SCC in this study and examined whether the presence, frequency, and size of VI were associated with recurrence. We also evaluated immunophenotypes of carcinoma cells and stromal cells within VI areas.
Of the 149 patients, 58 had tumors with VI. The presence of VI was significantly correlated with shorter recurrence-free survival (RFS) (P = 0.018). Although VI frequency was not associated with RFS, larger VI size (>425 µm) was significantly correlated with shorter RFS (P = 0.003). Carcinoma cells within larger VI areas expressed significantly higher levels of podoplanin, cancer stem cell marker (P = 0.039); higher numbers of CD34+ microvessels (P = 0.009), CD204+ macrophages (P = 0.026), and α-SMA+ myofibroblasts (P = 0.056) were present within larger VI areas than within smaller VI ones.
Our results indicate that larger VI areas are a predictor for recurrence in lung SCC; also, within the larger blood vessel, cancer stem cells and abundant stromal cells can create a more favorable microenvironment for tumor metastasis.
This review aims to summarize the evidence that Notch signaling is associated with prostate development, tumorigenesis and prostate tumor progression.
Studies in PubMed database were searched using the keywords of Notch signaling, prostate development and prostate cancer. Relevant literatures were identified and summarized.
The Notch pathway plays an important role in determining cell fate, proliferation, differentiation and apoptosis. Recent findings have highlighted the involvement of Notch signaling in prostate development and in the maintenance of adult prostate homeostasis. Aberrant Notch expression in tissues leads to dysregulation of Notch functions and promotes various neoplasms, including prostate cancer. High expression of Notch has been implicated in prostate cancer, and its expression increases with higher cancer grade. However, the precise role of Notch in prostate cancer has yet to be clearly defined. The roles of Notch either as an oncogene or tumor suppressor in prostate cancer hallmarks such as cell proliferation, apoptosis and anoikis, hypoxia, migration and invasion, angiogenesis as well as the correlation with metastasis are therefore discussed.
Notch signaling is a complicated signaling pathway in modulating prostate development and prostate cancer. Understanding and manipulating Notch signaling could therefore be of potential therapeutic value in combating prostate cancer.
Proton beam therapy (PBT), compared with conventional radiotherapy, can deliver high-dose radiation to a tumor, while minimizing doses delivered to surrounding normal tissues. The better dose distribution of PBT may contribute to the improvement in local control rate and reduction in late adverse events. We evaluated therapeutic results and toxicities of PBT combined with selective intra-arterial infusion chemotherapy (PBT-IACT) in patients with stage III–IVB squamous cell carcinoma of the tongue.
After 2 systemic chemotherapy courses and whole-neck irradiation (36 Gy in 20 fractions), we administered concurrent chemoradiotherapy comprising PBT for the primary tumor [28.6–33 Gy(RBE) in 13–15 fractions] and for the metastatic neck lymph node [33–39.6 Gy(RBE) in 15–18 fractions] with weekly retrograde intra-arterial chemotherapy by continuous infusion of cisplatin with sodium thiosulfate.
Between February 2009 and September 2012, 33 patients were enrolled. The median follow-up duration was 43 months. The 3-year overall survival, progression-free survival, local control rate, and regional control rate for the neck were 87.0, 74.1, 86.6, and 83.9 %, respectively. Major acute toxicities >grade 3 included mucositis in 26 cases (79 %), neutropenia in 17 cases (51 %), and dermatitis in 11 cases (33 %). Late grade 2 osteoradionecrosis was observed in 1 case (3 %).
PBT-IACT for stage III–IVB tongue cancer has an acceptable toxicity profile and showed good treatment results. This protocol should be considered as a treatment option for locally advanced tongue cancer.
The Glasgow Prognostic Score (GPS) and modified Glasgow Prognostic Score (mGPS) are shown to be reliable prognostic indexes in patients with operable and inoperable non-small cell lung cancer (NSCLC). Considering the difference between the two indexes lies in whether hypoalbuminemia without an elevated C-reactive protein (CRP) is associated with worse survival, this study aims to evaluate the prognostic performance of hypoalbuminemia in patients without an elevated CRP and to compare the prognostic value of GPS and mGPS in patients with operable and inoperable NSCLC.
The data of 2988 patients were retrospectively collected from the Shanghai Health Information Network. Univariate and multivariate Cox regression was performed to investigate the prognostic effect of albumin, CRP, GPS and mGPS. Restricted cubic spline was also performed to evaluate the relationship between albumin and hazard ratio. Kaplan–Meier survival curves were estimated and compared using the log-rank test. Additional discriminative ability of GPS and of mGPS was evaluated using the area under the curve and Harrell’s concordance index.
Hypoalbuminemia was associated with worse survival in both operable and inoperable patients without an elevated CRP. The Kaplan–Meier survival curve of hypoalbuminemic patients without an elevated CRP was more close to the curve of patients with an elevated CRP and a normal albumin than to the curve of patients with neither of these abnormalities. Multivariate analysis, AUC and C-index all indicated that GPS had a higher prognostic value than mGPS.
Hypoalbuminemia was associated with worse survival in patients with or without an elevated CRP. GPS was superior to mGPS in predicting survival in operable and inoperable NSCLC patients.
An 86-year-old man presented with severe pain in the upper abdomen along with fever. On physical examination, we found an arterial blood pressure of 84/43 mm Hg, a heart rate of 80 bpm and a temperature of 38.3°C. The abdomen was painful and peristalsis was absent. Empiric antibiotic therapy for sepsis was started with amoxicillin/clavulanate and gentamicin. CT scan of the abdomen revealed an emphysematous cholecystitis. Percutaneous ultrasound-guided cholecystostomy was applied. Bile cultures revealed Clostridium perfringens. Emphysematous cholecystitis is a life-threatening form of acute cholecystitis that occurs as a consequence of ischaemic injury to the gallbladder, followed by translocation of gas-forming bacteria (ie, C. perfringens, Escherichia coli, Klebsiella and Streptococci). The mortality associated with emphysematous cholecystitis is higher than in non-emphysematous cholecystitis (15% vs 4%). Therefore, early diagnosis with radiological imaging is of vital importance.
A lymphocoele or cystic hygroma is a benign lymphatic malformation that usually presents as a congenital mass in infancy. These masses are most common in the cervicofacial region and more rarely occur elsewhere in the body. Spontaneous, atraumatic presentation in adulthood is extremely rare. We present a case of a 59-year-old woman who presented with a fluctuant mass in the axilla, which was diagnosed as a lymphocoele. Initial management by ultrasound-guided aspiration of the cyst proved unsuccessful due to recurrence. Surgical excision of the cyst was then successfully performed and histological analysis proved the diagnosis. The incidence of adult-onset lymphocoele without a history of prior trauma or operation is rare. This case report adds to the literature and reviews the various management strategies that have been successfully employed.
The purposes of this work are to investigate the influence of breathing motion on the quality of delivered radiation therapy treatment for lung cancer patients, to study the effect of tumor volume movement and anatomy change (due to the breathing motion) on the dose distribution through a radiobiological analysis, and finally, to examine the influence of the deformable image registration (DIR) method used on the 4D dose accumulation.
The work is based on the 4D CT image sets and treatment plans of ten lung cancer patients. For each patient, the actual delivered dose was approximated through the development of the “4D” treatment plan, which was created by applying the plan of the average intensity projection (AIP) CT on the ten respiratory phases of the 4D CT dataset. Additionally, the “4D optimal” plan was created, which was based on the optimized plans of each of the 4D CT phases using the same beam setup and objectives as for the 4D AIP plan. Equal weights were used for the different phases, and for both the 4D and 4D optimal cases, the individual phase plans were exported from the treatment planning system (TPS) to the Velocity AI where the dose distributions were summed using DIR together with the extended deformable multipass (EXDMP) and deformable multipass (DMP) methods. A radiobiological analysis was performed based on the radiobiological parameters of the involved organs at risk (OARs) and planning target volume (PTV).
Using the complication-free tumor control probability (P +) index, non-negligible differences in P + were observed between the 4D and 4D optimal dose distributions as well as between the dose distributions that were generated with different DIR methods. The optimal P + values ranged from 9.4 to 98.8 % for the 4D case and from 17.1 to 99.1 % for the 4D optimal case. The clinical P + values ranged from 4.3 to 81.4 % for the 4D case using the EXDMP method and from 4.3 to 81.5 % for the DMP method. These differences emphasize the significance of using the proper DIR algorithm and its influence on the final dose distribution.
The radiobiological and dosimetric analyses showed the importance of taking into account the breathing motion during treatment planning. That was especially evident for smaller tumors and tumors with large motion extent. Also, the importance of choosing the proper DIR method was found to be great since it may lead to large differences in the accumulated 4D dose distribution.
Sensitivity of photosynthetic processes towards environmental stress is used as a bioanalytical tool to evaluate the responses of aquatic plants to a changing environment. In this paper, change of biomass density, chlorophyll a fluorescence and photosynthetic parameters during growth phases of two microalgae Chlorella vulgaris and Scenedesmus obliquus were studied. The photosynthetic growth behaviour changed significantly with cell age and algae species. During the exponential phase of growth, the photosynthesis capacity reached its maximum and decreased in ageing algal culture during stationary phase. In conclusion, the chlorophyll a fluorescence OJIP method and the derived fluorescence parameters would be an accurate method for obtaining information on maximum photosynthetic capacities and monitoring algal cell growth. This will contribute to more understanding, for example, of toxic actions of pollutants in microalgae test.
This work describes the effect of insecticide bifenthrin on Lactobacillus plantarum and Saccharomyces cerevisiae. Growths of used microorganisms in growth media supplemented with pesticide were studied. Determination of bacterial and yeast fermentation efficiency in wheat supplemented with bifenthrin was conducted. Additionally, investigation of bifenthrin dissipation during microbiological activity was performed. Experiments applying bifenthrin in different concentrations highlighted a negligible impact of the pesticide on the growth of L. plantarum and S. cerevisiae. This insecticide overall negatively affected the yeast fermentation of wheat, while its presence in wheat had a slight negative impact on lactic acid fermentation. The results of bifenthrin dissipation during lactic acid and yeast fermentations of wheat showed that activities of L. plantarum and S. cerevisiae caused lower pesticide reductions. Average bifenthrin residue reduction within samples fermented with L. plantarum was 5.4 % (maximum ~16 %), while within samples fermented with S. cerevisiae, it was 11.6 % (maximum ~17 %).
Features of Residual Dizziness after Canalith Repositioning Procedures for Benign Paroxysmal Positional Vertigo.
Otolaryngol Head Neck Surg. 2016 Feb 9;
Authors: Martellucci S, Pagliuca G, de Vincentiis M, Greco A, De Virgilio A, Nobili Benedetti FM, Gallipoli C, Rosato C, Clemenzi V, Gallo A
Abstract
OBJECTIVES: To assess factors related to residual dizziness (RD) in patients who underwent successful canalith repositioning procedures (CRPs) for benign paroxysmal positional vertigo (BPPV).
STUDY DESIGN: Prospective cohort study.
SETTING: Academic center.
SUBJECTS AND METHODS: Ninety-seven consecutive patients with BPPV of the posterior semicircular canal were initially enrolled. Diagnosis was assessed according to clinical history and bedside evaluation. All patients were treated with CRPs until nystagmus disappeared. Three days after the successful treatment, presence of RD was investigated. If RD was present, patients were monitored every 3 days until the symptoms disappeared. Subjects who required ≥4 CRPs or who failed to meet the follow-up visit were excluded. The Dizziness Handicap Inventory (DHI) was obtained from patients at the time of diagnosis and at every subsequent visit.
RESULTS: At the end of selection, 86 patients were included; 33 (38.36%) reported RD after successful treatment. A significant difference in the incidence of RD was observed in consideration of the age of the subjects (P = .0003) and the DHI score at the time of diagnosis (P < .001). A logistic regression analysis showed that the probability of RD occurrence increased with the increase of the emotional subdomain score of the DHI questionnaire.
CONCLUSION: RD is a common self-limited disorder, more frequent in the elderly, which may occur after the physical treatment for BPPV. The DHI score at the time of BPPV diagnosis represents a useful tool to quantify the impact of this vestibular disorder on the quality of life and to estimate the risk of RD after CRPs.
PMID: 26861236 [PubMed - as supplied by publisher]
Novel Anatomic Characteristics of the Laryngeal Framework: A Computed Tomography Evaluation.
Otolaryngol Head Neck Surg. 2016 Feb 9;
Authors: Sagiv D, Eyal A, Mansour J, Nakache G, Wolf M, Primov-Fever A
Abstract
OBJECTIVE: The thyroid cartilage (TC) in men has a more prominent thyroid notch and a narrower interlaminae angle (ILA) as compared with women. Anatomy textbooks classically stipulate that the ILA is 90° in men and 120° in women. Our observation, based on thyroid chondroplasty operations, of a much narrower angle led to the current investigation.
STUDY DESIGN: Cohort imaging study.
SETTING: Tertiary academic referral center.
SUBJECTS AND METHODS: Computed tomography angiography neck images of adult patients were studied. The ILA was measured on 2 axial planes: at the level of the vocal processes (and the upper portion of thyroarytenoid muscles) and 5 mm superior and parallel to the former. The anterior projection of the TC and the vertical dimensions of the midline cricothyroid membrane (CTM) were also measured.
RESULTS: A total of 126 patients were included in the study. The average ILAs were 63.5°±20.6° and 93.3°±16.6° for men and women, respectively (P < 10(-14)), and were significantly narrower at the upper level in comparison with the vocal process level (P < 10(-7) for men, P = .004 for women). The anterior projection of the TC in men was more prominent as compared with women (P = .0003) and significantly correlated with the ILA (P = .0159). The length of the midline CTM was 11.1±2.3 mm in men and 10.3±1.7 mm in women (P = .0355).
CONCLUSIONS: The ILA is narrower than that reported in the classic anatomy textbooks. In male patients, the upper part of the TC becomes narrower and projects anteriorly like a "jug's spout." The mean vertical dimension of the midline CTM was 10 to 11 mm.
PMID: 26861235 [PubMed - as supplied by publisher]
Mucoepidermoid Carcinoma at the Mandibular Edentulous Ridge Mucosa: An Infrequent Location.
Otolaryngol Head Neck Surg. 2016 Feb 9;
Authors: Alberto PL
PMID: 26861234 [PubMed - as supplied by publisher]
Repair of Posterior Glottic Stenosis with the Modified Endoscopic Postcricoid Advancement Flap.
Otolaryngol Head Neck Surg. 2016 Feb 9;
Authors: Damrose EJ, Beswick DM
Abstract
Posterior glottic stenosis is a difficult clinical problem that frequently results in bilateral vocal fold immobility, dyspnea, and tracheostomy dependence. Charts were reviewed of all patients undergoing a modified endoscopic postcricoid advancement flap procedure for posterior glottic stenosis between October 1, 2003, and June 30, 2015. Age, sex, operative findings, complications, and outcomes were noted. Follow-up was available in 10 of 11 patients, 10 of whom were successfully decannulated. There were no complications. Regular diet was maintained in all patients. In patients with bilateral vocal fold immobility secondary to posterior glottis stenosis, endoscopic repair via endoscopic postcricoid advancement flap can restore full vocal fold motion and allow decannulation. In select patients with posterior glottic stenosis, repair via endoscopic postcricoid advancement flap should be considered in lieu of ablative methods, such as cordotomy, cordectomy, or arytenoidectomy.
PMID: 26861233 [PubMed - as supplied by publisher]
Application of Lean Sigma to the Audiology Clinic at a Large Academic Center.
Otolaryngol Head Neck Surg. 2016 Feb 9;
Authors: Huddle MG, Tirabassi A, Turner L, Lee E, Ries K, Lin SY
Abstract
OBJECTIVE: To apply Lean Sigma-a quality improvement strategy to eliminate waste and reduce variation and defects-to improve audiology scheduling and utilization in a large tertiary care referral center. The project goals included an increase in utilization rates of audiology block time and a reduction in appointment lead time.
STUDY DESIGN: Prospective quality improvement study.
SETTING: Academic tertiary care center.
SUBJECTS: All patients scheduling audiology clinic visits July 2013 to July 2014.
METHODS: Value stream mapping was performed for the audiology scheduling process, and wasteful steps were identified for elimination. Interventions included a 2-week block release, audiology template revision, and reduction of underutilized blocks. Schedule utilization and lead time for new patient diagnostic audiogram were measured for 5 months postintervention and compared with 5 months preintervention. Overall, 2995 preintervention and 3714 postintervention booked appointments were analyzed.
RESULTS: Block utilization increased from 77% to 90% after intervention (P < .0001). Utilization of joint-with-provider visits increased from 39% to 67% (P < .0001). Booked appointments increased from 2995 to 3714, with joint-with-provider booked appointments increasing from 317 to 1193. Appointment lead time averaged 24 days postintervention, compared with 29 days preintervention (P = .06). Average monthly relative value units measured 13,321 preintervention and 14,778 postintervention (P = .09).
CONCLUSION: Lean Sigma techniques were successfully used to increase appointment block utilization and streamline scheduling practices.
PMID: 26861232 [PubMed - as supplied by publisher]
Definitive Surgical Therapy after Open Neck Biopsy for HPV-Related Oropharyngeal Cancer.
Otolaryngol Head Neck Surg. 2016 Feb 9;
Authors: Zenga J, Graboyes EM, Haughey BH, Paniello RC, Mehrad M, Lewis JS, Thorstad WL, Nussenbaum B, Rich JT
Abstract
OBJECTIVE: To determine the impact of prior open neck biopsy on the prognosis of patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) who are subsequently treated with a definitive surgical paradigm, including adjuvant therapy when indicated.
STUDY DESIGN: Retrospective cohort.
SETTING: Tertiary care university hospital.
SUBJECTS AND METHODS: Patients with open neck biopsies who were treated with definitive surgery, with or without adjuvant therapy, for HPV-related OPSCC between 1998 and 2012 were compared with a matched control group who did not undergo open neck biopsy. Outcomes were disease-free survival, overall survival, disease-specific survival, incidence of tumor deposit in dermal scar, patterns of recurrence, and neck dissection complications.
RESULTS: Forty-five patients who underwent open neck biopsy were compared with 90 matched controls. Tumor deposits in dermal scars from the prior open neck biopsy were found in 3 patients (7%) during completion neck dissection. Overall complications of the neck dissection were not significantly increased in the open biopsy group over matched controls (20% vs 12%, respectively; P > .05). Five-year Kaplan-Meier estimates for disease-free survival, overall survival, and disease-specific survival were not significantly different between the open biopsy and control groups (93% vs 91%, 98% vs 97%, 98% vs 99%, respectively; all P > .05). Recurrence rates were also not significantly different between groups.
CONCLUSIONS: Patients with HPV-related OPSCC who have undergone a prior open neck biopsy can be successfully treated with a definitive surgical paradigm. Although needle biopsy is preferable to establish a diagnosis, previous open neck biopsy does not affect prognosis in these patients.
PMID: 26861231 [PubMed - as supplied by publisher]
Head and Neck Paragangliomas: An Update on Evaluation and Management.
Otolaryngol Head Neck Surg. 2016 Feb 9;
Authors: Moore MG, Netterville JL, Mendenhall WM, Isaacson B, Nussenbaum B
Abstract
OBJECTIVE: Head and neck paragangliomas are a group of slow-growing hypervascular tumors associated with the paraganglion system. The approach to evaluate and treat these lesions has evolved over the last 2 decades. While radical surgery had been the traditional approach, improvements in diagnostic imaging as well as radiation therapy techniques have led to an emphasis on observation and nonsurgical therapy in many patients. This article reviews the contemporary approach to the workup and management of head and neck paragangliomas.
DATA SOURCE: Articles were identified from PubMed.
REVIEW METHODS: PubMed searches with the following keywords were performed: carotid body paraganglioma management, vagal paraganglioma management, jugulotympanic paraganglioma management, imaging of head and neck paragangliomas, head and neck paraganglioma embolization, paraganglioma radiation, head and neck paraganglioma management, observation of head and neck paragangliomas, bilateral carotid body paragangliomas, and genetics of paragangliomas. Review and original research articles available in the English language and published during or after 2009 were selected on the basis of their clinical relevance and scientific strength. Certain articles published prior to 2009 were also included if they provided background information that was relevant.
CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Workup and treatment of head and neck paragangliomas are changing. With more now known regarding the longitudinal behavior of these tumors, observation and nonsurgical therapy are indicated in many instances. For patients where surgery is the most appropriate option, improved diagnostic and perioperative techniques are allowing patients to tolerate resection, often with reduced morbidity.
PMID: 26861230 [PubMed - as supplied by publisher]
Organized Hematoma: An Analysis of 84 Cases with Emphasis on Difficult Prediction and Favorable Management.
Otolaryngol Head Neck Surg. 2016 Feb 9;
Authors: Pang W, Hu L, Wang H, Sha Y, Ma N, Wang S, Liu Q, Sun X, Wang D
Abstract
OBJECTIVE: To characterize features of organized hematoma (OH) that may cause considerable diagnostic difficulties.
STUDY DESIGN: Case series with chart review.
SETTING: Tertiary medical center.
SUBJECTS AND METHODS: Eighty-four patients with pathologically confirmed OH over a 10-year period were retrospectively reviewed for clinical features, imaging findings, pathologic characteristics, and treatment modalities.
RESULTS: This study included 39 males and 45 females who presented with frequent epistaxis and nasal obstruction. There were 62 (74%) patients >40 years old (mean, 50; range, 9-81). OH mainly originated in the maxillary sinus (n = 82) or nasal cavity (n = 2) unilaterally, and most were expansile masses (n = 73) that extended into nasal cavity (n = 71) or choanae (n = 17). Several lesions were locally aggressive and simulated a malignant process that involved the ethmoid sinus (n = 22), orbit (n = 11), pterygopalatine fossa (n = 16), infratemporal fossa (n = 9), cheek (n = 3), and hard palate (n = 3). Internal architecture on computed tomography (CT) scans showed OH with expansile remodeling of the maxillary wall (82.1%) and smooth bony destruction (70.2%), whereas T2-weighted magnetic resonance (MR) images showed inhomogeneity with a notable hypointense peripheral rim in all lesions. CT and MR contrast-enhanced images revealed patchy heterogeneous enhancement that could be interpreted according to histopathologic findings of hemorrhage and neovascularization. OH was successfully removed with endoscopic surgery, although 5 cases recurred.
CONCLUSIONS: OH can be successfully treated by endoscopic surgery. CT and MR examination provide characteristic findings for prediction and careful surgical planning.
PMID: 26861229 [PubMed - as supplied by publisher]
Effect of Radiofrequency Thermal Ablation Treatment on Nasal Ciliary Motility: A Study with Phase-Contrast Microscopy.
Otolaryngol Head Neck Surg. 2016 Feb 9;
Authors: Rosato C, Pagliuca G, Martellucci S, de Vincentiis M, Greco A, Fusconi M, De Virgilio A, Gallipoli C, Simonelli M, Gallo A
Abstract
OBJECTIVE: To investigate the efficacy of nasal ciliary motility after radiofrequency ablation treatment in patients with isolated inferior turbinate hypertrophy and to clarify how long until normal ciliary function is restored.
STUDY DESIGN: Prospective, single-group, pretest-posttest design.
SETTING: Academic tertiary care medical center.
SUBJECTS AND METHODS: This study involved 34 adult patients affected by nasal obstruction due to inferior turbinate hypertrophy who underwent radiofrequency ablation treatment between June and December 2014. Diagnosis was assessed according to clinical history, nasal endoscopy, and active anterior rhinomanometry. Cytologic samples were collected by nasal scraping before surgery and 1, 2, and 3 months after surgery. Ciliary motility was evaluated by nasal cytology with phase-contrast microscopy. Functional aspects of nasal mucosa were studied, with a focus on 3 parameters: (1) nasal mucociliary clearance, assessed by saccharin nasal transit time test; (2) percentage of ciliated cell motility, measured as the ratio between cells with motility and cells without motility; and (3) efficacy of ciliary motility, measured as the ratio between cells with valid motility and cells with hypovalid motility.
RESULTS: Ciliary motility and ciliary efficacy showed a significant reduction after 1 and 2 months from surgery, returning to normal values within 3 months. No significant changes in saccharin nasal transit time were recorded during the follow-up.
CONCLUSIONS: The outcomes of this study suggest that radiofrequency ablation treatment causes ciliary motility changes of nasal mucosa that are completely restored after at least 3 months after surgery. These cytologic abnormalities do not affect nasal functionality.
PMID: 26861228 [PubMed - as supplied by publisher]
Readability and Understandability of Online Vocal Cord Paralysis Materials.
Otolaryngol Head Neck Surg. 2016 Feb 9;
Authors: Balakrishnan V, Chandy Z, Hseih A, Bui TL, Verma SP
Abstract
OBJECTIVE: Patients use several online resources to learn about vocal cord paralysis (VCP). The objective of this study was to assess the readability and understandability of online VCP patient education materials (PEMs), with readability assessments and the Patient Education Materials Evaluation Tool (PEMAT), respectively. The relationship between readability and understandability was then analyzed.
STUDY DESIGN AND SETTING: Descriptive and correlational design.
METHOD: Online PEMs were identified by performing a Google search with the term "vocal cord paralysis." After scientific webpages, news articles, and information for medical professionals were excluded, 29 articles from the first 50 search results were considered. Readability analysis was performed with 6 formulas. Four individuals with different educational backgrounds conducted understandability analysis with the PEMAT. Fleiss's Kappa interrater reliability analysis determined consistency among raters. Correlation between readability and understandability was determined with Pearson's correlation test.
RESULTS: The reading level of the reviewed articles ranged from grades 9 to 17. Understandability ranged from 29% to 82%. Correlation analysis demonstrated a strong negative correlation between materials' readability and understandability (r = -0.462, P < .05).
CONCLUSION: Online PEMs pertaining to VCP are written above the recommended reading levels. Overall, materials written at lower grade levels are more understandable. However, articles of identical grade levels had varying levels of understandability. The PEMAT may provide a more critical evaluation of the quality of a PEM when compared with readability formulas. Both readability and understandability should be used to evaluate PEMs.
PMID: 26861227 [PubMed - as supplied by publisher]
Cognitive functioning is linked to cardiac mortality and morbidity, but the mechanisms underlying this relationship are unclear.
To examine the relationship between pre-operative cognitive functioning and post-operative inflammatory and neuroendocrine responses in patients undergoing coronary artery bypass graft (CABG) surgery.
One-hundred ninety-three outpatients were screened to assess their cognitive function using the Montreal Cognitive Assessment (MoCA) on average 30 days prior to CABG surgery and provided blood samples for the measurement of interleukin (IL)-6 and C-reactive protein (CRP) and saliva samples for the measurement of diurnal cortisol. Participants were followed-up 4–8 days following surgery for the repeat measurement of IL-6 and CRP and 60 days after surgery for the measurement of diurnal salivary cortisol.
Patients with low cognitive function (MoCA < 26) prior to surgery reached higher IL-6 concentrations in the days after surgery (β = −0.212, p = 0.021) and had greater cortisol output across the day 2 months after surgery (β = −0.179, p = 0.044).
Low cognitive functioning is associated with a more negative pattern of biological response to surgery, indicative of poorer physical recovery. These pathways may contribute to the links between cognitive function and cardiovascular pathology.
Despite health and economic burdens associated with overweight and obesity, long-term weight loss intervention efforts have been largely unsuccessful. Observations that weight status tends to cluster in social groups, and findings showing “ripple” effects of weight change within social clusters, raise questions about the impact of social relationships on weight loss.
Through a reanalysis of data from a randomized weight loss intervention, this study compared dyadic dynamics in intervention participants and in-home partners.
Over the course of 18 months, data was collected from 201 pairs enrolled in either behavioral weight loss treatment (BWL) or treatment including partners and providing items to facilitate healthy choices at home (BWL + H). Using a dyadic growth curve model, covariance between baseline BMI, BMI change trajectories, and starting BMI and BMI trajectory for both the self and the other were examined.
There were strong indicators of dependence in the data. Baseline BMI was positively correlated for both treatment groups. In the BWL + H condition, BMI change trajectories were positively correlated. In the BWL condition, this reversed: Change trajectories were negatively correlated. Additionally, partner BMI and primary participant BMI change were positively correlated, indicating that a heavier partner at baseline related to less weight loss.
Social relationships exert a significant influence on weight loss outcomes. Depending on the intervention group, these influences may help (BWL + H) or hinder (BWL). It may be that home intervention changed social support and interaction in important ways and that these effects could be effectively harnessed to implement more effective interventions (NCT00200330).
 Chicago Tribune |
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