Interview with David A. Case: On force fields, biomolecular modeling, and NMR

Abstract

Prof. David Case is based in the Department of Chemistry and Chemical Biology at Rutgers University. In this interview he speaks about force field development and validation, predictive power of MD models, combining physics-based force fields with empirical scoring functions, MD modeling of disordered proteins and RNA, synergies between MD simulations and NMR measurements, and chemical shift calculations. The video of this interview is available on the YouTube site (URL https://www.youtube.com/watch?v=bumGM1CWA7Y).

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Editorial Board

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Contents

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Important ESTRO dates

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The world needs new knowledge

2017 was the first year of Radiotherapy & Oncology under my Editorship. It was a year of expansion and changing environment as new Editors joined the board and the Editorial Office was moved to Heidelberg. I am very grateful that Jens Overgaard continues to support the journal as Editor-in-Chief Emeritus and thus enabled the new editorial team to uphold Radiotherapy & Oncology as a leading scholarly journal dedicated to innovations and high-level research covering all aspects in radiation oncology for the benefit of our readers, authors, and cancer patients.

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Development and validation of an MRI-based model to predict response to chemoradiotherapy for rectal cancer

Publication date: Available online 31 January 2018
Source:Radiotherapy and Oncology
Author(s): Philippe Bulens, Alice Couwenberg, Karin Haustermans, Annelies Debucquoy, Vincent Vandecaveye, Marielle Philippens, Mu Zhou, Olivier Gevaert, Martijn Intven
Background and purposeTo safely implement organ preserving treatment strategies for patients with rectal cancer, well-considered selection of patients with favourable response is needed. In this study, we develop and validate an MRI-based response predicting model.MethodsA multivariate model using T2-volumetric and DWI parameters before and 6 weeks after chemoradiation (CRT) was developed using a cohort of 85 rectal cancer patients and validated in an external cohort of 55 patients that underwent preoperative CRT.ResultsTwenty-two patients (26%) achieved ypT0-1N0 response in the development cohort versus 13 patients (24%) in the validation cohort. Two T2-volumetric parameters (ΔVolume% and Sphere_post) and two DWI parameters (ADC_avg_post and ADCratio_avg) were retained in a model predicting (near-)complete response (ypT0-1N0). In the development cohort, this model had a good predictive performance (AUC = 0.89; 95% CI 0.80–0.98). Validation of the model in an external cohort resulted in a similar performance (AUC = 0.88 95% CI 0.79–0.98).ConclusionAn MRI-based prediction model of (near-)complete pathological response following CRT in rectal cancer patients, shows a high predictive performance in an external validation cohort. The clinically relevant features in the model make it an interesting tool for implementation of organ-preserving strategies in rectal cancer.



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A prospective study of the safety and efficacy of liver stereotactic body radiotherapy in patients with and without prior liver-directed therapy

Publication date: Available online 30 January 2018
Source:Radiotherapy and Oncology
Author(s): Dominic H. Moon, Andrew Z. Wang, Joel E. Tepper
Background and purposeTo evaluate the safety and efficacy of liver stereotactic body radiotherapy (SBRT), and examine potential factors impacting outcomes including prior liver-directed therapy.Materials and methodsPatients with ECOG 0–1, Child-Pugh Class A or B, and primary hepatocellular carcinoma (HCC) or liver metastases unsuitable for surgical resection or ablation were eligible for a prospective single arm trial. SBRT was delivered with a CyberKnife system to 45 Gy in 3 fractions with a predetermined dose de-escalation scheme. Adverse events, local control, and survival were assessed.ResultsA total of 30 patients were enrolled. Eleven patients (37%) had HCC and 19 (63%) patients had liver metastases. Fourteen patients (47%) had prior liver-directed therapies including nine with liver resection, seven with trans-arterial chemoembolization, and six with radiofrequency ablation. Cumulative grade 2 and 3 acute toxicity occurred in 47% and 7% of patients, respectively. Similar rates of ≥grade 2 acute toxicity were observed between patients who had prior liver-directed treatments and those who did not. At a median follow-up of 12.7 months, 1-year local control and overall survival were 81% and 62%, respectively. Prior liver-directed therapy did not affect local control or survival.ConclusionsLiver SBRT is a safe and effective treatment even in the setting of prior liver-directed surgical and ablative therapies.



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Palliative radiotherapy for locally advanced non-metastatic head and neck cancer: A survey of UK national practice

Publication date: Available online 30 January 2018
Source:Radiotherapy and Oncology
Author(s): Muhammad Shahid Iqbal, Charles Kelly, Josef Kovarik, Bojidar Goranov, Ghazia Shaikh, David Morgan, Werner Dobrowsky, Vinidh Paleri




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Clinical significance of soluble programmed cell death ligand-1 (sPD-L1) in hepatocellular carcinoma patients treated with radiotherapy

Publication date: Available online 30 January 2018
Source:Radiotherapy and Oncology
Author(s): Hyun Ju Kim, Sangjoon Park, Kyoung-Jin Kim, Jinsil Seong
PurposeTo investigate the clinical implications of the soluble programmed cell death-ligand 1 (sPD-L1) level in hepatocellular carcinoma (HCC) patients treated with radiotherapy (RT).Materials/methodsHCC patients treated with RT between June 2011 and March 2015 were prospectively recruited and sPD-L1 levels were measured using an enzyme-linked immunosorbent assay. Blood samples were obtained at the RT start, RT end, and 1-month follow-up. The associations of the sPD-L1 level with the clinical features and outcomes were analyzed.ResultsFifty-three patients with HCC were included. Thirty-four patients received conventional fractionated RT with hepatic arterial infusional chemotherapy, while 19 patients received stereotactic body radiotherapy (SBRT). The initial sPD-L1 level was significantly associated with stage, tumor size, portal vein tumor thrombosis, and venous invasion. The overall-survival was significantly poorer in patients with a higher level of initial sPD-L1 (≥1.315 pg/mL). A higher level of sPD-L1 at 1 month (≥12.9 pg/mL) was significantly related to early lung metastasis. The sPD-L1 level was significantly increased after RT and the change pattern of sPD-L1 was different between two RT schemes.ConclusionsThe level of sPD-L1 was associated with tumor aggressiveness and outcomes, suggesting its role as a possible predictive biomarker. The increases in sPD-L1 after RT suggests that combined treatment with RT and immune checkpoint inhibitors may be a promising therapeutic strategy in HCC.



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Review of the patient positioning reproducibility in head-and-neck radiotherapy using Statistical Process Control

Publication date: Available online 31 January 2018
Source:Radiotherapy and Oncology
Author(s): Sarah J. Moore, Patries M. Herst, Robert J.W. Louwe
Background and purposeA remarkable improvement in patient positioning was observed after the implementation of various process changes aiming to increase the consistency of patient positioning throughout the radiotherapy treatment chain. However, no tool was available to describe these changes over time in a standardised way. This study reports on the feasibility of Statistical Process Control (SPC) to highlight changes in patient positioning accuracy and facilitate correlation of these changes with the underlying process changes.Materials and methodsMetrics were designed to quantify the systematic and random patient deformation as input for the SPC charts. These metrics were based on data obtained from multiple local ROI matches for 191 patients who were treated for head-and-neck cancer during the period 2011–2016.ResultsSPC highlighted a significant improvement in patient positioning that coincided with multiple intentional process changes. The observed improvements could be described as a combination of a reduction in outliers and a systematic improvement in the patient positioning accuracy of all patients.ConclusionSPC is able to track changes in the reproducibility of patient positioning in head-and-neck radiation oncology, and distinguish between systematic and random process changes. Identification of process changes underlying these trends requires additional statistical analysis and seems only possible when the changes do not overlap in time.



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CNR 1/18, Societies’ Communications

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Thoracic Imaging of Non-Small Cell Lung Cancer Treated with Anti-Programmed-Death-Receptor-1 (PD-1) Therapy

Publication date: Available online 31 January 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Mark Hammer, Stephen Bagley, Charu Aggarwal, Joshua Bauml, Arun Nachiappan, Charles B. Simone, Corey Langer, Sharyn I. Katz
PurposeTreatment with anti-programmed-death-receptor-1 (PD1) therapeutics can lead to unconventional responses and side effect profiles due to their potentiating effects on the immune system. Here we evaluate the radiologic manifestations of anti-PD1 therapy in the chest in patients with non-small cell lung cancer (NSCLC) receiving anti-PD1 therapy.Materials and MethodsA retrospective review of real-world clinical practice was conducted of all the NSCLC patients receiving anti-PD1 therapy at our institution between 2013–2016. All patients without adequate clinical or radiologic follow-up data in the electronic medical records were excluded. Imaging examinations for all patients deemed by their thoracic oncologists to have radiologic pseudoprogression or therapy associated pneumonitis were reviewed by experienced thoracic radiologists.ResultsA total of 166 patients with NSCLC had available clinical and imaging data for retrospective review. Of these patients, 4 (2%) were considered to have radiologic pseudoprogression, 3 of which manifested as increased tumor size and 1 of which manifested with new lesions. A total of 5 patients (3%) were clinically deemed to have pneumonitis attributable to anti-PD1 therapy, 4 of which had radiologic manifestations on computed tomography (CT).ConclusionRadiologic pseudoprogression and drug-induced pneumonitis are uncommon but important manifestations of anti-PD1 therapy on thoracic imaging.



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Convolutional Neural Networks: The Possibilities are Almost Endless

Publication date: Available online 31 January 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Rebecca J. Mieloszyk, Puneet Bhargava




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The Tipping Point: Key Oncologic Imaging Findings Resulting in Critical Changes in the Management of Malignant Tumors of the Gastrointestinal Tract

Publication date: Available online 31 January 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Raul N. Uppot, Jonathan Wu, Ryan Nipp, Jennifer Wo, Motaz Qadan, Lipika Goyal
ObjectiveThe purpose of this article is to review tumor staging systems for gastrointestinal tumors including pancreatic adenocarcinoma, hepatocellular carcinoma, cholangiocarcinoma, gastric adenocarcinoma, small bowel adenocarcinoma, rectal carcinoma, and anal carcinoma and identify the key imaging findings ("tipping points") which change patient management based on changes in tumor staging.ConclusionFor all malignant gastrointestinal tumors, there are key imaging findings ("tipping points") including tumor size, tumor extension, lymphadenopathy, vascular invasion, and distant metastasis that dictate patient management and prognosis, based on changes in tumor stage. In interpreting these imaging studies, radiologists should be cognizant of these "tipping points" to guide patient management.



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The demographic features of concomitant facial fractures with closed head injuries in maricopa arizona

Publication date: Available online 31 January 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Malcolm Harris, Tara Brantley, Douglas Hammond, Sabah Kalamchi
Objectives:1. To investigate the demographic profile of American Native patients with concomitant facial fractures and closed head injuries (CHI).2. To explore the validation of the craniofacial crumble zone.Patients and MethodsThis is a retrospective observational case controlled study of 2131 maxillofacial fractures from 2010 to 2014 of which 173 (8%) had concomitant CHI.Results133 (77%) were males, mean age 40.6 years. Only 2.1% of the local population were Native Americans but represented 24% of the CHI patients and sustained assault injuries 4.6 times more than other groups (p-value <0.001) and 2.6 times more concussion (p-value <0.001). Other trauma comparisons were not significant. 86 (50%) of the 173 patient's blood alcohol levels exceeded 80mg/100mL, compared to 93% of the Native Americans.ConclusionsThe Native American patients had a highly significant predisposition to violence and road traffic accidents with maxillofacial and CHI. Their high blood alcohol levels also reflected longstanding serious sociological problems. This study is an invaluable model to investigate the relative ethnic/racial role of comminuted paranasal structures for the protection of the brain, that is the crumble zone.



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Differentiation between benign and malignant palatal tumors using conventional MRI: a retrospective analysis of 130 cases

Publication date: Available online 31 January 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Yingyan Zheng, Zebin Xiao, Hua Zhang, Dejun She, Xuehua Lin, Yu Lin, Dairong Cao
ObjectivesTo evaluate the discriminative value of conventional maganetic resonance imaging (MRI) between benign and malignant palatal tumors.Study DesignConventional MR imaging features of 130 patients with palatal tumors confirmed by histopathology were retrospectively reviewed. Clinical data and imaging findings were assessed between benign and malignant tumors and between benign and low-grade malignant salivary gland tumors. The variables that were significant in differentiating benign from malignant lesions were further identified using logistic regression analysis. Moreover, imaging features of each common palatal histologic entity were statistically analyzed with the rest of the tumors to define their typical imaging features.ResultsOlder age, partially-defined and ill-defined margins, and absence of a capsule were highly suggestive of malignant palatal tumors, especially ill-defined margins (β = 6.400). The precision in determining malignant palatal tumors achieved a sensitivity of 92.8% and a specificity of 85.6%. In addition, irregular shape, ill-defined margins, lack of a capsule, perineural spread, and invasion of surrounding structures were more frequently associated with low-grade malignant salivary gland tumors.ConclusionConventional MRI is useful for differentiating benign from malignant palatal tumors as well as benign salivary gland tumors from low-grade salivary gland malignancies.



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Diffusion Properties and 3D Architecture of Human Lower Leg Muscles Assessed with Ultra-High-Field-Strength Diffusion-Tensor MR Imaging and Tractography: Reproducibility and Sensitivity to Sex Difference and Intramuscular Variability.

Diffusion Properties and 3D Architecture of Human Lower Leg Muscles Assessed with Ultra-High-Field-Strength Diffusion-Tensor MR Imaging and Tractography: Reproducibility and Sensitivity to Sex Difference and Intramuscular Variability.

Radiology. 2018 Jan 30;:171330

Authors: Fouré A, Ogier AC, Le Troter A, Vilmen C, Feiweier T, Guye M, Gondin J, Besson P, Bendahan D

Abstract
Purpose To demonstrate the reproducibility of the diffusion properties and three-dimensional structural organization measurements of the lower leg muscles by using diffusion-tensor imaging (DTI) assessed with ultra-high-field-strength (7.0-T) magnetic resonance (MR) imaging and tractography of skeletal muscle fibers. On the basis of robust statistical mapping analyses, this study also aimed at determining the sensitivity of the measurements to sex difference and intramuscular variability. Materials and Methods All examinations were performed with ethical review board approval; written informed consent was obtained from all volunteers. Reproducibility of diffusion tensor indexes assessment including eigenvalues, mean diffusivity, and fractional anisotropy (FA) as well as muscle volume and architecture (ie, fiber length and pennation angle) were characterized in lower leg muscles (n = 8). Intramuscular variability and sex differences were characterized in young healthy men and women (n = 10 in each group). Student t test, statistical parametric mapping, correlation coefficients (Spearman rho and Pearson product-moment) and coefficient of variation (CV) were used for statistical data analysis. Results High reproducibility of measurements (mean CV ± standard deviation, 4.6% ± 3.8) was determined in diffusion properties and architectural parameters. Significant sex differences were detected in FA (4.2% in women for the entire lower leg; P = .001) and muscle volume (21.7% in men for the entire lower leg; P = .008), whereas architecture parameters were almost identical across sex. Additional differences were found independently of sex in diffusion properties and architecture along several muscles of the lower leg. Conclusion The high-spatial-resolution DTI assessed with 7.0-T MR imaging allows a reproducible assessment of structural organization of superficial and deep muscles, giving indirect information on muscle function. ©RSNA, 2018 Online supplemental material is available for this article.

PMID: 29381871 [PubMed - as supplied by publisher]

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Robotically Assisted Sonic Therapy as a Noninvasive Nonthermal Ablation Modality: Proof of Concept in a Porcine Liver Model.

Robotically Assisted Sonic Therapy as a Noninvasive Nonthermal Ablation Modality: Proof of Concept in a Porcine Liver Model.

Radiology. 2018 Jan 30;:171544

Authors: Smolock AR, Cristescu MM, Vlaisavljevich E, Gendron-Fitzpatrick A, Green C, Cannata J, Ziemlewicz TJ, Lee FT

Abstract
Purpose To determine the feasibility of creating a clinically relevant hepatic ablation (ie, an ablation zone capable of treating a 2-cm liver tumor) by using robotically assisted sonic therapy (RAST), a noninvasive and nonthermal focused ultrasound therapy based on histotripsy. Materials and Methods This study was approved by the institutional animal use and care committee. Ten female pigs were treated with RAST in a single session with a prescribed 3-cm spherical treatment region and immediately underwent abdominal magnetic resonance (MR) imaging. Three pigs (acute group) were sacrificed immediately following MR imaging. Seven pigs (chronic group) were survived for approximately 4 weeks and were reimaged with MR imaging immediately before sacrifice. Animals underwent necropsy and harvesting of the liver for histologic evaluation of the ablation zone. RAST ablations were performed with a 700-kHz therapy transducer. Student t tests were performed to compare prescribed versus achieved ablation diameter, difference of sphericity from 1, and change in ablation zone volume from acute to chronic imaging. Results Ablation zones had a sphericity index of 0.99 ± 0.01 (standard deviation) (P < .001 vs sphericity index of 1). Anteroposterior and transverse dimensions were not significantly different from prescribed (3.4 ± 0.7; P = .08 and 3.2 ± 0.8; P = .29, respectively). The craniocaudal dimension was significantly larger than prescribed (3.8 ± 1.1; P = .04), likely because of respiratory motion. The central ablation zone demonstrated complete cell destruction and a zone of partial necrosis. A fibrous capsule surrounded the ablation zone by 4 weeks. On 4-week follow-up images, ablation zone volumes decreased by 64% (P < .001). Conclusion RAST is capable of producing clinically relevant ablation zones in a noninvasive manner in a porcine model. © RSNA, 2018.

PMID: 29381870 [PubMed - as supplied by publisher]

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Natural Language-based Machine Learning Models for the Annotation of Clinical Radiology Reports.

Natural Language-based Machine Learning Models for the Annotation of Clinical Radiology Reports.

Radiology. 2018 Jan 30;:171093

Authors: Zech J, Pain M, Titano J, Badgeley M, Schefflein J, Su A, Costa A, Bederson J, Lehar J, Oermann EK

Abstract
Purpose To compare different methods for generating features from radiology reports and to develop a method to automatically identify findings in these reports. Materials and Methods In this study, 96 303 head computed tomography (CT) reports were obtained. The linguistic complexity of these reports was compared with that of alternative corpora. Head CT reports were preprocessed, and machine-analyzable features were constructed by using bag-of-words (BOW), word embedding, and Latent Dirichlet allocation-based approaches. Ultimately, 1004 head CT reports were manually labeled for findings of interest by physicians, and a subset of these were deemed critical findings. Lasso logistic regression was used to train models for physician-assigned labels on 602 of 1004 head CT reports (60%) using the constructed features, and the performance of these models was validated on a held-out 402 of 1004 reports (40%). Models were scored by area under the receiver operating characteristic curve (AUC), and aggregate AUC statistics were reported for (a) all labels, (b) critical labels, and (c) the presence of any critical finding in a report. Sensitivity, specificity, accuracy, and F1 score were reported for the best performing model's (a) predictions of all labels and (b) identification of reports containing critical findings. Results The best-performing model (BOW with unigrams, bigrams, and trigrams plus average word embeddings vector) had a held-out AUC of 0.966 for identifying the presence of any critical head CT finding and an average 0.957 AUC across all head CT findings. Sensitivity and specificity for identifying the presence of any critical finding were 92.59% (175 of 189) and 89.67% (191 of 213), respectively. Average sensitivity and specificity across all findings were 90.25% (1898 of 2103) and 91.72% (18 351 of 20 007), respectively. Simpler BOW methods achieved results competitive with those of more sophisticated approaches, with an average AUC for presence of any critical finding of 0.951 for unigram BOW versus 0.966 for the best-performing model. The Yule I of the head CT corpus was 34, markedly lower than that of the Reuters corpus (at 103) or I2B2 discharge summaries (at 271), indicating lower linguistic complexity. Conclusion Automated methods can be used to identify findings in radiology reports. The success of this approach benefits from the standardized language of these reports. With this method, a large labeled corpus can be generated for applications such as deep learning. © RSNA, 2018 Online supplemental material is available for this article.

PMID: 29381109 [PubMed - as supplied by publisher]

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Anatomical and histological study of the deep neck fasciae: does the alar fascia exist?

Anatomical and histological study of the deep neck fasciae: does the alar fascia exist?

Surg Radiol Anat. 2018 Jan 29;:

Authors: Gavid M, Dumollard JM, Habougit C, Lelonge Y, Bergandi F, Peoc'h M, Prades JM

Abstract
PURPOSE: The aim of this study was to determine whether the alar fascia is a distinct layer of the deep cervical neck fasciae. The present study also aimed to elucidate the anatomical limits of this fascia.
METHODS: Neck dissections of ten adult cadavers were performed, layer by layer, in the retropharyngeal region, under a powered operating microscope. Detailed dissections revealed the anatomical limits of the deep neck fasciae. Histological descriptions were also performed on large tissue samples collected from three cervical dissections.
RESULTS: In the ten dissections, three layers of fascia were identified and dissected in the retropharyngeal region: a visceral fascia, a prevertebral fascia and an alar fascia. The alar fascia appeared like a connecting band derivative of the visceral fascia, between both vascular sheaths. It fused completely with the visceral fascia anteriorly at the level of T2 and with the prevertebral fascia posteriorly at the level of C1. No sagittal connection between the visceral fascia and the prevertebral fascia was identified. The stained histological sections confirmed the presence of the visceral and prevertebral fasciae at the oropharyngeal level, with a third intermediate layer closely connected with the visceral fascia.
CONCLUSION: The alar fascia is a layer of the cervical neck fascia connected with the visceral fascia from C1 to T2 levels. The anatomical limits of this alar fascia and its relationships with the internal carotid artery are important in the surgical management and the prognosis of deep neck infections and retropharyngeal lymph node metastases.

PMID: 29380103 [PubMed - as supplied by publisher]

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Circumportal pancreas: prevalence, subtypes and vascular variations of 55 patients.

Circumportal pancreas: prevalence, subtypes and vascular variations of 55 patients.

Surg Radiol Anat. 2018 Jan 27;:

Authors: Yilmaz E, Celik A

Abstract
PURPOSE: To determine the frequency of circumportal pancreas (CP), and accompanying ductal and vascular anatomy variations.
METHODS: Thin-section multidetector computed tomography of 6813 consecutive patients was retrospectively reviewed. Two radiologists evaluated CP presence with consensus. Concomitant pancreatic ductal and vascular variations were recorded. The course of the pancreatic duct was classified according to the portal vein as anteportal and retroportal, and pancreas fusion level classified according to splenic vein as suprasplenic, infrasplenic and mixed type.
RESULTS: A total of 55 (0.8%) CP cases were detected. Six suprasplenic subtype cases were excluded from the classification, because the pancreatic ducts were not clearly distinguishable. Suprasplenic anteportal (45/49, 92%), infrasplenic anteportal (2/49, 4%), suprasplenic retroportal (1/49, 2%), and mixed anteportal subtypes (1/49, 2%) were detected. There were vascular variations in 16 cases (29%). 13/16 (81%) of vascular variations were detected on suprasplenic anteportal subtype. Most of them were replaced right hepatic artery from the superior mesenteric artery (n: 6).
CONCLUSIONS: CP is a rare but important pancreatic fusion anomaly. Suprasplenic anteportal CP is the most common subtype and other subtypes are very rare. Replaced right hepatic artery from the superior mesenteric artery is the most frequent vascular variation associated with CP. Identifying the CP and defining the pancreatic duct and vascular variations are important to prevent possible complications in patients undergoing pancreatic surgery.

PMID: 29380102 [PubMed - as supplied by publisher]

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MR arthrographic demonstration of an unusual multiplication anomaly concerning the glenohumeral ligaments.

MR arthrographic demonstration of an unusual multiplication anomaly concerning the glenohumeral ligaments.

Surg Radiol Anat. 2018 Jan 29;:

Authors: Ogul H

Abstract
The glenohumeral ligaments (GHLs), localized thickenings of the anterior joint capsule, are important passive stabilizers of the shoulder joint. A 29-year-old man was admitted for evaluation of left shoulder pain. The conventional magnetic resonance (MR) imaging showed a thickened anterior labroligamentous complex. MR arthrography revealed a multiplication anomaly of all the GHLs. The purpose of this study was to demonstrate the MR arthrography findings of this unusual anatomic variation of the GHLs.

PMID: 29380101 [PubMed - as supplied by publisher]

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Clinico-social factors to choose radioactive iodine dose in differentiated thyroid cancer patients: an Asian survey.

Clinico-social factors to choose radioactive iodine dose in differentiated thyroid cancer patients: an Asian survey.

Nucl Med Commun. 2018 Jan 29;:

Authors: Jabin Z, Kwon SY, Bom HS, Lin Y, Yang K, Inaki A, Dewi AR, Al-Ibraheem AN, Balooshi BA, San Luis TOL, Thyroid Study Group of the Asia Oceania Research Initiative Network (AORIN)

Abstract
OBJECTIVE: This survey was designed to investigate the practice of radioactive iodine (RAI) therapy and clinico-social factors related to RAI dose in differentiated thyroid cancer (DTC) patients among Asian countries.
MATERIALS AND METHODS: A survey questionnaire was mailed to Asian Nuclear Medicine physicians that addressed the infrastructure, general regulations on RAI therapy, adherence to recommendations, RAI dose selection, factors to elevate RAI dose, and follow-up protocols in DTC patients. Contrived RAI practice recommendations were based on key international guidelines.
RESULTS: A total of 38 institutes of 20 Asian countries were enrolled. Dose administration criterion was 30 mCi, but release criterion was variable (5-70 μSv/h). When the administered RAI dose was classified according to three risk stratifications, RAI dose distribution was variable, especially in the low-risk group. In this group, 14.0% of respondents preferred no ablation, 54.5% were treated with 0-30 mCi, 21.5% were treated with 30-50 mCi, and 10.0% were administered even higher doses of 80-100 mCi. The major factors that influenced the elevated RAI doses in the respondents included high serum thyroglobulin (Tg), inadequate information on lymph node involvement, and histopathology reporting. Although serum Tg measurement is included in most of the institutes as a follow-up tool, neck ultrasound was omitted in 25% and in another 25% a whole-body scan was not included.
CONCLUSION: Different RAI dose ranges are used in the low-risk group probably because the enrolled physicians consider RAI dose elevation on the basis of clinico-social factors beyond pre-existed guidelines. Our study may enable closer harmonization of RAI therapy practice in Asian countries.

PMID: 29381585 [PubMed - as supplied by publisher]

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Increased N6-Methyladenosine causes infertility is associated with FTO expression

Abstract

The N6-methyladenosine (m6A) modification plays a central role in epigenetic regulation of the mammalian transcriptome. m6A can be demethylated by the fat mass- and obesity-associated (FTO) protein and the α-ketoglutarate-dependent dioxygenase alkB homolog 5 (ALKBH5) protein. Much less is known about that whether m6A content is involved in POI (premature ovarian insufficiency) disease. In this case-controlled study, 69 POI and 53 tubal occlusion patients were recruited from the reproduction centers in our hospital. For the POI animal model experiment, ovarian tissue was obtained from ten POI and nine healthy mice. An m6A test kit was developed to determine the m6A content in the RNA, and qPCR and western blot were used to examine the mRNA and protein expression levels of FTO and ALKBH5. FACS was used to measure the levels of proliferation and apoptosis, and siRNA was used to establish FTO and ALKBH5 knockdown cell lines. Our results showed that the m6A content in the RNA from POI patients and POI mice was significantly higher than control groups and that POI was characterized by the content of m6A. The mRNA and protein expression levels of FTO were significantly lower in the POI patients than control group and were associated with a risk of POI. These data suggest that the decreased mRNA and protein expression levels of FTO may be responsible for the increase in m6A in POI, which may further increase the risk of complications of POI. High m6A should be investigated further as a novel potential biomarker of POI. This article is protected by copyright. All rights reserved

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Schwannoma of the Membranous Nasal Septum: a Clinical Report With Aesthetic Approach.

Schwannoma of the Membranous Nasal Septum: a Clinical Report With Aesthetic Approach.

J Craniofac Surg. 2018 Jan 19;:

Authors: Kim YH, Lee JH, Park Y, Chung KJ

Abstract
Schwannoma is an uncommon tumor of nerve sheath that arises from any peripheral, cranial, or autonomic nerve. Only 4% of head and neck schwannomas originate from the sinonasal tract, and a finding of a schwannoma in the nasal septum is exceedingly rare. The authors experienced nasal septal schwannoma with the functional and aesthetic consideration of nasal contour. The authors present an open rhinoplasty approach for nasal septal schwannoma which has not been reported in the previous literature yet.

PMID: 29381644 [PubMed - as supplied by publisher]

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Giant Parapharyngeal Space Lipoma Extending to the Pterygoid Region (Anterior Skull Base).

Giant Parapharyngeal Space Lipoma Extending to the Pterygoid Region (Anterior Skull Base).

J Craniofac Surg. 2018 Jan 19;:

Authors: Hakeem AH, Hakeem IH, Budharapu A, Wani FJ

Abstract
Although lipoma is frequently seen in the head and neck region, but occurrence of the lipoma in the parapharyngeal space is rare. It is extremely rare for a parapharyngeal lipoma to extent to the pterygoid region (ie, anterior skull base). Management of giant parapharyngeal space lipoma with skull base extension and proximity to the vital neurovascular structures poses a challenge to surgeon. The authors report a patient with giant lipoma extending from the upper border of the clavicle to the pterygoid region. Complete excision was done using upper transverse cervical incision and pterygoid region was approached after removal of the ipsilateral submandibular gland. Surgery produced excellent cosmetic results with no functional impairment.

PMID: 29381623 [PubMed - as supplied by publisher]

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Morphometric Measurements of Bony Nasolacrimal Canal in Children.

Morphometric Measurements of Bony Nasolacrimal Canal in Children.

J Craniofac Surg. 2018 Jan 29;:

Authors: Ela AS, Cigdem KE, Karagoz Y, Yigit O, Longur ES

Abstract
OBJECTIVE: Morphology and dimensions of the bony nasolacrimal canal duct (BNLD) as a key factor in the development of primary acquired nasolacrimal duct obstruction. We aimed to obtain detailed morphometric analysis of BNLD in children without nasolacrimal duct pathology by using computed tomography and provide standard measurements by means of age which could be utilized in planning management or in invasive interventions.
METHODS: Picture Archiving Communication Systems database of our hospital's radiology department was searched for this retrospective study. Subjects were under 18 years of age who had undergone a paranasal, maxillofacial, or temporal bone high-resolution computed tomography scan in last 2 years with various indications. Those with fractures including facial bones and/or nasolacrimal canal or history of nasolacrimal duct pathology were excluded from the study. We measured the diameter, angle, and surface area of BNLD.
RESULTS: A total number of 136 subjects (86 boys, 50 girls) were included in the study. The average age was 7.3 ± 5.1 years. We documented statistically significantly positive correlation between all measured diameters and ages (P < 0.001), whereas there was a negative association between mean angle and age (P < 0.001). Mean angle is defined as the angle between BNLD and nasal floor. The surface area of BNLD was found to be significantly increasing depending on age (P < 0.001). However, we could not find any significant association between gender and measured parameters (P > 0.050).
CONCLUSION: Our study demonstrated that development of BNLD continues during childhood, regardless of gender.

PMID: 29381609 [PubMed - as supplied by publisher]

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A Practical Suggestion for Prepare Dorsal Onlay Graft.

A Practical Suggestion for Prepare Dorsal Onlay Graft.

J Craniofac Surg. 2018 Jan 29;:

Authors: Arslan F, Yildiz CA

Abstract
Nowadays, rhinoplasty is one of the most popular surgical procedures. Dorsal contour irregularities caused by various maneuvers, such as hump resection, are a major concern in patients who have undergone rhinoplasty. The most common graft used in this case is dorsal onlay graft which is made from sliced and crushed cartilage. Ear, nose and throat specialists usually use Swester table (mayo desk) for preparing the graft, if there is no other steril metal instrument. Crushed cartilage is done on a sterile gauze or on the tables' cover, as a result cartilage may be contaminated with particules from the tables' cover and sterile gauze.The authors recommend using the steril pack of a new sterilized surgical instrument opened on the table for the slicing or crushing process. In this way, the cartilage can be spared from contamination and the loss of some cartilage to the table during slicing or crushing can be prevented.

PMID: 29381602 [PubMed - as supplied by publisher]

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Risk of second primary malignancy in patients with sinonasal tumors: a population-based cohort study.

Risk of second primary malignancy in patients with sinonasal tumors: a population-based cohort study.

Int Forum Allergy Rhinol. 2018 Jan 30;:

Authors: Ganti A, Plitt MA, Kuan EC, Kuhar HN, Batra PS, Tajudeen BA

Abstract
BACKGROUND: The 5-year overall survival rate for patients with sinonasal cancers has remained around 50% for the last 3 decades. Prior studies on head and neck cancers have suggested that 1 reason for poor survival is the frequent development of second primary malignancies (SPMs). The purpose of this study is to assess overall and site-specific risks of SPM following treatment of sinonasal malignancy.
METHODS: A retrospective, population-based cohort study was performed on 2614 patients in the Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed with primary sinonasal malignancy between 1973 and 2014. Standardized incidence ratios (SIRs) and absolute excess risks (AERs) were calculated to assess risk of SPM relative to incidence in the general population.
RESULTS: A total of 422 (16.1%) patients with primary sinonasal malignancies developed a total of 480 SPMs. This cohort had a significantly higher frequency of SPMs than expected in the general population (SIR 1.32; 95% confidence interval [CI], 1.20 to 1.44; AER 53.41). Site-specific analyses of SIRs suggested highest risk of malignancy in the sinonasal tract (SIR 75.64; 95% CI, 53.53 to 103.83; AER 17.22), followed by bone, eye and orbit, oral cavity and pharynx, and lung and mediastinum.
CONCLUSION: Patients with history of sinonasal cancer are at significantly increased risk of developing an SPM. Careful monitoring for development of additional tumors may be warranted.

PMID: 29381260 [PubMed - as supplied by publisher]

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Airborne and food sensitization patterns in children and adults with eosinophilic esophagitis.

Airborne and food sensitization patterns in children and adults with eosinophilic esophagitis.

Int Forum Allergy Rhinol. 2018 Jan 30;:

Authors: He YT, Christos PJ, Reisacher WR

Abstract
BACKGROUND: The pathogenesis of eosinophilic esophagitis (EoE) is currently unknown, but evidence suggests that allergic sensitization to food and airborne allergens may play a key role. This retrospective study examines the rate of sensitization to both food and airborne allergens in EoE patients, and compares their sensitivity patterns to control groups.
METHODS: We identified 103 patients with a diagnosis of EoE via esophageal eosinophilia (≥15 eosinophils/high-power field [hpf]), who had undergone comprehensive food and/or airborne allergen testing through either skin or in vitro methods. Food and airborne allergen sensitization was defined as positive testing in at least 1 food subgroup (milk, peanut, tree nut, seafood/fish, soy, grain, egg) or airborne subgroup (tree, grass, weed, mite/cockroach, animal, mold), respectively. The same sensitization criterion was applied to allergic rhinitis (AR) patients, with and without a clinical suspicion of food allergy (FA), in order to create control groups.
RESULTS: Sensitization in the EoE group to at least 1 subgroup of food allergen and airborne allergen was seen in 77.1% (64/83) and 71.7% (38/53), respectively (p = 0.82). There were significant differences in sensitization between EoE and control groups for tree nut, soy, grain, and egg, but no differences noted in any of the other food or airborne allergen subgroups, even after accounting for age and gender.
CONCLUSION: EoE and control groups had similar airborne allergen sensitization patterns, yet dissimilar food allergen sensitization patterns, suggesting that specific allergens may play a more prominent role in the pathogenesis of EoE. The EoE group had a more uniform distribution pattern for food allergens, compared to controls.

PMID: 29381255 [PubMed - as supplied by publisher]

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Deprivation in relation to urgent suspicion of head and neck cancer referrals in Glasgow.

Deprivation in relation to urgent suspicion of head and neck cancer referrals in Glasgow.

Clin Otolaryngol. 2018 Jan 30;:

Authors: Zeitler M, Fingland P, TIkka T, Douglas C, Montgomery J

Abstract
AIM: To examine deprivation measured by the Scottish Index of Multiple Deprivation (SIMD) and its relation to urgent suspicion of head and neck cancer referrals. A secondary aim was to examine the symptomatology generating urgent suspicion of cancer (USOC) referrals by SIMD category.
METHODS: All "Urgent Suspicion of Cancer" referrals to the GGC ENT department over a one-year period, between 2015-16, were reviewed. Information was recorded anonymously and included demographics and red flag referral symptoms.
RESULTS: 1998 patients were assessed, 43.4% (n=867) were male. 171 (8.6%) patients had primary head and neck cancer. 61 patients had other types of cancer, giving an all cause cancer rate of 11.6%. 71.3% of primary HNC patients were male. The most common SIMD category observed was SIMD1, the most common SIMD category yielding a primary head and neck cancer diagnosis was SIMD1. Neck lump was the commonest symptom amongst all SIMD categories.
CONCLUSION: A link between deprivation and USOC referrals has been established. A difference in gender distribution between referrals and HNC was observed, more females are referred but a significantly higher number of HNC patients are males. Neck lump is a very strong referral indicator for HNC and intermittent hoarseness is not. The findings from this analysis could be used to refine local referral patterns and priority of referral. This article is protected by copyright. All rights reserved.

PMID: 29380938 [PubMed - as supplied by publisher]

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A retrospective case control analysis of the efficacy of Gardasil® vaccination in 28 patients with recurrent respiratory papillomatosis of the larynx.

A retrospective case control analysis of the efficacy of Gardasil® vaccination in 28 patients with recurrent respiratory papillomatosis of the larynx.

Clin Otolaryngol. 2018 Jan 30;:

Authors: Milner TD, Harrison A, Montgomery J, MacGregor FB, Buchanan MA, MacKenzie K

Abstract
Recurrent respiratory papillomatosis (RRP) of the larynx represents a significant disease burden to patients and the healthcare system The use of HPV 6/11/16/18 vaccination (Gardasil® ) has previously been thought to impact on disease burden in patients with RRP. Gardasil® vaccination did not impact on the number of endolaryngeal surgical procedures required, the interval between procedures, or the number of patients who achieved disease remission in comparison to a control cohort. This study indicates Gardasil® vaccination does not appear to have any effect on disease burden in patients with RRP. The use of a control cohort profiles the natural progression of RRP. This article is protected by copyright. All rights reserved.

PMID: 29380936 [PubMed - as supplied by publisher]

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Type-specific persistence and clearance rates of HPV genotypes in the oral and oropharyngeal mucosa in an HIV/AIDS cohort.

Type-specific persistence and clearance rates of HPV genotypes in the oral and oropharyngeal mucosa in an HIV/AIDS cohort.

J Oral Pathol Med. 2018 Jan 30;:

Authors: Castillejos-García I, Ramírez-Amador V, Carrillo-García A, García-Carrancá A, Lizano M, Anaya-Saavedra G

Abstract
BACKGROUND: Oral high-risk human papillomavirus (HR-HPV) infections are frequent and persistent among HIV-positive population and are associated with an increased risk for head and neck cancer (HNC). In this study, we sought to determine the incidence, persistence, and clearance of HPV-infections in oral and oropharyngeal samples from HIV/AIDS subjects.
METHODS: A longitudinal, observational, and analytical study was performed with an ongoing cohort of HIV/AIDS subjects in Mexico City (September 2013-February 2015). The study was approved by institutional committees, and demographic and clinical data were registered. At the baseline and three-month visits, oral examinations and cytobrush samples were obtained. DNA was purified, quantified and used to detect an HPV-L1 gene fragment by nested-PCR, using MY09/MY11 and GP5+/GP6+ primers. HPV-DNA products were purified, sequenced, and typed according to HPV-databases. Risk factors were assessed, and a multivariate modelling approach was used to determine independent effects.
RESULTS: This study included 97 HIV/AIDS individuals (91% men [86.4% of which are men who have sex with men], median age: 36 years, 72.2% under HAART). From the baseline visit, HPV was observed in 55.7% (HR-HPV: 26.8%; HPV-18: 24.1%), with a higher HPV-positive samples for smokers (61.1 vs. 32.6%, p=0.005). The three-month overall HPV-incidence was 33.9%; type-specific HPV persistence was 33.3% (HR-HPV: 13.3%); and 13 of the 33 (39.4%) baseline HPV-positive individuals cleared the infection (HR-HPV: 53.8%).
CONCLUSIONS: Although HR-HPV persistence was low, and clearance of the infection was observed in most cases, a close follow-up is necessary, given the increase of HNC among HIV-subjects, particularly HPV-related cancer. This article is protected by copyright. All rights reserved.

PMID: 29380908 [PubMed - as supplied by publisher]

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Masseteric cooptation and crossfacial nerve grafting: Is it still applicable 22 months after the onset of facial palsy?

Masseteric cooptation and crossfacial nerve grafting: Is it still applicable 22 months after the onset of facial palsy?

Microsurgery. 2018 Jan 30;:

Authors: Bianchi B, Varazzani A, Pedrazzi G, Poddi V, Ferrari S, Brevi B, Ferri A

Abstract
BACKGROUND: Eighteen months is usually considered the cutoff time within which recovery of the mimic muscle remains possible using facial nerve cooptation. Few reports on the use of cooptation after this interval have appeared. Purpose of this study is to investigate the feasibility of this procedure also after 22 months.
METHODS: Six patients treated via crossfacial nerve grafting between healthy and paralyzed middle and middle-upper facial nerve branches and masseteric cooptation of the main trunk of the paralyzed facial nerve between 20 and 24 months after the onset of palsy were analyzed. Population consisted of two males and four females ages 8-42 years (mean 24 years). Facial palsy developed after acoustic neuroma resection in three patients, after the removal of a cerebellopontine angle astrocytoma in one, and as a consequence of Bell's palsy or cerebral hemorrhage in the other two (one each). House-Brackman and Sunnybrook clinical evaluation systems and FDI questionnaire were used to assess results.
RESULTS: House-Brackman scores changed from VI before the operation for all patients to II for two patients and III for four patients. Sunnybrook scores were 0-10 before the operation, but 62-84 at the last visit. Mean FDI scores moved from 24 to 38.5 meaning a statistical high significant improvement (P < .01).
CONCLUSIONS: Masseteric/crossfacial nerve grafting is feasible for patients with palsies 20-24 months in duration, affording satisfactory functional and esthetic results and a dramatic improvement in quality of life.

PMID: 29380892 [PubMed - as supplied by publisher]

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History of intranasal splints.

History of intranasal splints.

J Laryngol Otol. 2018 Jan 30;:1-4

Authors: Lau J, Elhassan HA, Singh N

Abstract
OBJECTIVE: Intranasal splints have long been utilised as a post-operative adjunct in septoplasty, intended to reduce the risk of adhesions and haematoma formation, and to maintain alignment during healing.
METHODS: A Medline literature review of the history and evolution of intranasal splint materials and designs was performed. Advantages and disadvantages of various splints are discussed.
RESULTS: Intranasal splints fashioned from X-ray film were first reported in 1955. Since then, a variety of materials have been utilised, including polyethylene coffee cup lids, samarium cobalt magnets and dental utility wax. Most contemporary splints are produced from silicon rubber or polytetrafluoroethylene (Teflon). Designs have varied in thickness, flexibility, shape, absorption and the inclusion of built-in airway tubes. Future directions in splint materials and designs are discussed.
CONCLUSION: Intranasal splints have steadily evolved since 1955, with numerous novel innovations. Despite their simplicity, they play an important role in nasal surgery and will continue to evolve over time.

PMID: 29380712 [PubMed - as supplied by publisher]

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EAACI Guidelines on Allergen Immunotherapy: Executive Statement.

EAACI Guidelines on Allergen Immunotherapy: Executive Statement.

Allergy. 2018 Jan 30;:

Authors: Muraro A, Roberts G, Halken S, Agache A, Angier L, Fernandez-Rivas M, Gerth van Wijk R, Jutel M, Lau S, Pajno G, Pfaar O, Ryan D, Sturm GJ, van Ree R, Varga EM, Bachert C, Calderon M, Canonica GW, Durham SR, Malling HJ, Wahn U, Sheikh A

Abstract
The allergist's community has recently celebrated 100 year of Allergen Immunotherapy (AIT). Unfortunately the implemention of this treatment is still impaired by some challenges. With the diversity of definitions, methodology and different allergen products used, research studies have produced conflicting outcomes. This has resulted in confusion about the benefits and risks of AIT amongst policymakers and professionals, as well as in the variable availability of AIT products, regulation and reimbursement policies globally. In 2015 EAACI initiated the AIT Guidelines project as part of the Presidential plan in order to settle the controversies. This article is protected by copyright. All rights reserved.

PMID: 29380390 [PubMed - as supplied by publisher]

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Medical Students' Exposure to the Humanities Correlates with Positive Personal Qualities and Reduced Burnout: A Multi-Institutional U.S. Survey.

Medical Students' Exposure to the Humanities Correlates with Positive Personal Qualities and Reduced Burnout: A Multi-Institutional U.S. Survey.

J Gen Intern Med. 2018 Jan 29;:

Authors: Mangione S, Chakraborti C, Staltari G, Harrison R, Tunkel AR, Liou KT, Cerceo E, Voeller M, Bedwell WL, Fletcher K, Kahn MJ

Abstract
BACKGROUND: Literature, music, theater, and visual arts play an uncertain and limited role in medical education. One of the arguments often advanced in favor of teaching the humanities refers to their capacity to foster traits that not only improve practice, but might also reduce physician burnout-an increasing scourge in today's medicine. Yet, research remains limited.
OBJECTIVE: To test the hypothesis that medical students with higher exposure to the humanities would report higher levels of positive physician qualities (e.g., wisdom, empathy, self-efficacy, emotional appraisal, spatial skills), while reporting lower levels of negative qualities that are detrimental to physician well-being (e.g., intolerance of ambiguity, physical fatigue, emotional exhaustion, and cognitive weariness).
DESIGN: An online survey.
PARTICIPANTS: All students enrolled at five U.S. medical schools during the 2014-2015 academic year were invited by email to take part in our online survey.
MAIN MEASURES: Students reported their exposure to the humanities (e.g., music, literature, theater, visual arts) and completed rating scales measuring selected personal qualities.
KEY RESULTS: In all, 739/3107 medical students completed the survey (23.8%). Regression analyses revealed that exposure to the humanities was significantly correlated with positive personal qualities, including empathy (p < 0.001), tolerance for ambiguity (p < 0.001), wisdom (p < 0.001), emotional appraisal (p = 0.01), self-efficacy (p = 0.02), and spatial skills (p = 0.02), while it was significantly and inversely correlated with some components of burnout (p = 0.01). Thus, all hypotheses were statistically significant, with effect sizes ranging from 0.2 to 0.59.
CONCLUSIONS: This study confirms the association between exposure to the humanities and both a higher level of students' positive qualities and a lower level of adverse traits. These findings may carry implications for medical school recruitment and curriculum design. "[Science and humanities are] twin berries on one stem, grievous damage has been done to both in regarding [them]... in any other light than complemental." (William Osler, Br Med J. 1919;2:1-7).

PMID: 29380213 [PubMed - as supplied by publisher]

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Case series about ex vivo identification of squamous cell carcinomas by laser-induced autofluorescence and Fourier transform infrared spectroscopy.

Case series about ex vivo identification of squamous cell carcinomas by laser-induced autofluorescence and Fourier transform infrared spectroscopy.

Lasers Med Sci. 2018 Jan 29;:

Authors: Tozar T, Andrei IR, Costin R, Pirvulescu R, Pascu ML

Abstract
An ex vivo case series aimed at identification of normal laryngeal tissue from laryngeal epidermoid squamous keratinized carcinoma by measuring laser-induced autofluorescence (LIAF) and Fourier transform infrared-attenuated total reflectance (FTIR-ATR) spectra is presented. The case series results were obtained for paired samples extracted from three patients (exclusion: macroscopic changes of normal vocal cord observed during surgery; surgical intervention on vocal cord, treated only with chemotherapy or radiotherapy for carcinoma; inclusion: men, aged 57-68, non-smokers). For LIAF analysis, a 375-nm picosecond pulsed laser diode with 31 MHz pulse repetition rate, 100 ps full-time width at half-maximum, and average power 0.49 μW was used. LIAF and FTIR-ATR spectra show noticeable differences between normal and malignant tissues. LIAF spectra differed in shape of emitted band, peak position, and band relative intensity of the two kinds of samples, evidencing hypsochromic shift and mean fluorescence intensity decrease of (75.42 ± 3)% in malignant tissue with respect to the normal one. The lack of 1745 cm-1 band in FTIR-ATR spectra for malignant tissues could be considered an important indicative of the presence of this kind of tissue; moreover, it resulted a greater contribution of lipids and proteins in normal tissue and of collagen in malignant tissue. Penetration depth of the evanescent wave was about 2 μm at an angle of 42°. The two spectroscopic methods are complementary, are applicable for real-time measurements, and may enhance cancer detection and diagnostics. Results presented in this study evidence the potential of the two methods for future in vivo studies.

PMID: 29380083 [PubMed - as supplied by publisher]

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Olfactory and gustatory functions after free flap reconstruction and radiotherapy for oral and pharyngeal cancer: a prospective follow-up study.

Olfactory and gustatory functions after free flap reconstruction and radiotherapy for oral and pharyngeal cancer: a prospective follow-up study.

Eur Arch Otorhinolaryngol. 2018 Jan 27;:

Authors: Lilja M, Markkanen-Leppänen M, Viitasalo S, Saarilahti K, Lindford A, Lassus P, Mäkitie A

Abstract
BACKGROUND: The senses of smell and taste can be adversely affected by both tumour- and treatment-related factors amongst head and neck cancer patients. The consequences may negatively impact nutritional status as well as quality of life in this patient population.
PATIENTS AND METHODS: This prospective longitudinal follow-up study is consisted of 44 patients treated for oral cavity, oropharyngeal or hypopharyngeal cancer with tumour resection and microvascular free tissue transfer reconstruction at the Helsinki University Hospital, Helsinki, Finland. Thirty-nine (89%) of them also received radiotherapy. The senses of smell (odour detection, identification and threshold test) and taste (electrogustometry) and quality of life (UW-QOL) were evaluated preoperatively, and at 6 weeks, 3 months, 6 months and 12 months, postoperatively.
RESULTS: There were higher scores in the odour detection values in the 6-week and 3-month tests compared with preoperative values for the tumour side. Other detection scores did not differ statistically from the preoperative values neither in the tumour nor the contralateral side. However, in the odour identification test, all posttreatment values were statistically significantly higher than pretreatment ones. In the olfactory threshold test, no statistically significant differences were found between pre- and posttreatment values. Electrogustometry values for the taste on the tumour side were statistically significantly impaired at 6 weeks (p < 0.05) and at 3 months (p < 0.01) compared with the pretreatment results. They were also impaired at 6 months and at 12 months, although the differences were not statistically significant. The quality of life was impaired after treatment in this patient series. However, the correlation between quality of life and sense of taste was found only at one time point (3 months) and only with contralateral side measurements.
CONCLUSIONS: We conclude that in oral and pharyngeal cancer patients the postoperative taste problems are related to the impairment on the taste sensation in the tongue but not with the sense of smell. Moreover, the impairment in the quality of life is not clearly related to the impaired sense of taste.

PMID: 29380039 [PubMed - as supplied by publisher]

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IJMS, Vol. 19, Pages 419: HDAC Inhibition Improves the Sarcoendoplasmic Reticulum Ca2+-ATPase Activity in Cardiac Myocytes

IJMS, Vol. 19, Pages 419: HDAC Inhibition Improves the Sarcoendoplasmic Reticulum Ca2+-ATPase Activity in Cardiac Myocytes

International Journal of Molecular Sciences doi: 10.3390/ijms19020419

Authors: Viviana Meraviglia Leonardo Bocchi Roberta Sacchetto Maria Florio Benedetta Motta Corrado Corti Christian Weichenberger Monia Savi Yuri D’Elia Marcelo Rosato-Siri Silvia Suffredini Chiara Piubelli Giulio Pompilio Peter Pramstaller Francisco Domingues Donatella Stilli Alessandra Rossini

SERCA2a is the Ca2+ ATPase playing the major contribution in cardiomyocyte (CM) calcium removal. Its activity can be regulated by both modulatory proteins and several post-translational modifications. The aim of the present work was to investigate whether the function of SERCA2 can be modulated by treating CMs with the histone deacetylase (HDAC) inhibitor suberanilohydroxamic acid (SAHA). The incubation with SAHA (2.5 µM, 90 min) of CMs isolated from rat adult hearts resulted in an increase of SERCA2 acetylation level and improved ATPase activity. This was associated with a significant improvement of calcium transient recovery time and cell contractility. Previous reports have identified K464 as an acetylation site in human SERCA2. Mutants were generated where K464 was substituted with glutamine (Q) or arginine (R), mimicking constitutive acetylation or deacetylation, respectively. The K464Q mutation ameliorated ATPase activity and calcium transient recovery time, thus indicating that constitutive K464 acetylation has a positive impact on human SERCA2a (hSERCA2a) function. In conclusion, SAHA induced deacetylation inhibition had a positive impact on CM calcium handling, that, at least in part, was due to improved SERCA2 activity. This observation can provide the basis for the development of novel pharmacological approaches to ameliorate SERCA2 efficiency.

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IJMS, Vol. 19, Pages 418: Synthesis of a Cleaved Form of Osteopontin by THP-1 Cells and Its Alteration by Phorbol 12-Myristate 13-Acetate and BCG Infection

IJMS, Vol. 19, Pages 418: Synthesis of a Cleaved Form of Osteopontin by THP-1 Cells and Its Alteration by Phorbol 12-Myristate 13-Acetate and BCG Infection

International Journal of Molecular Sciences doi: 10.3390/ijms19020418

Authors: Gaowa Bai Hirotoshi Motoda Ryo Ozuru Haorile Chagan-Yasutan Toshio Hattori Takashi Matsuba

The protease-cleaved osteopontin (OPN) was proposed to enhance the migration of memory T cells to granulomas in tuberculosis. Various forms of OPN were identified in human monocytic THP-1 cells stimulated by phorbol 12-myristate 13-acetate (PMA). Antibodies O-17, 10A16 and 34E3, which recognize N-terminus, the C-half, and thrombin-cleaved site of OPN, respectively, all detected distinct bands on Western blots following PMA stimulation. Bands corresponding to 18 and 30 kD were detected by antibodies 34E3 and 10A16, indicating that OPN cleavage occurred by endogenous proteases in the PMA-stimulated THP-1 cells. In immune-fluorescence (IF) assay, 34E3 positive signals were detected in intracellular space of non-infected and bacillus Calmette-Guérin (BCG)-infected cells; however, 10A16 positive signals were confirmed in extracellular area in PMA-stimulated cells followed by BCG infection. Small amounts of full-length (FL) and thrombin-cleaved (Tr) OPN were detected by ELISA in the supernatants of non-PMA-stimulated cells, and increased levels of all forms, including undefined (Ud) OPN, in PMA-stimulated cells. ELISA showed a decrease in OPN synthesis during BCG infection. To our knowledge, this is the first report of OPN cleavage in THP-1 macrophages after PMA stimulation, and of enhanced cleavage induced by BCG infection.

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IJMS, Vol. 19, Pages 420: Expansion of Sphingosine Kinase and Sphingosine-1-Phosphate Receptor Function in Normal and Cancer Cells: From Membrane Restructuring to Mediation of Estrogen Signaling and Stem Cell Programming

IJMS, Vol. 19, Pages 420: Expansion of Sphingosine Kinase and Sphingosine-1-Phosphate Receptor Function in Normal and Cancer Cells: From Membrane Restructuring to Mediation of Estrogen Signaling and Stem Cell Programming

International Journal of Molecular Sciences doi: 10.3390/ijms19020420

Authors: Olga Sukocheva

Sphingolipids, sphingolipid metabolizing enzymes, and their receptors network are being recognized as part of the signaling mechanisms, which govern breast cancer cell growth, migration, and survival during chemotherapy treatment. Approximately 70% of breast cancers are estrogen receptor (ER) positive and, thus, rely on estrogen signaling. Estrogen activates an intracellular network composed of many cytoplasmic and nuclear mediators. Some estrogen effects can be mediated by sphingolipids. Estrogen activates sphingosine kinase 1 (SphK1) and amplifies the intracellular concentration of sphingosine-1-phosphate (S1P) in breast cancer cells during stimulation of proliferation and survival. Specifically, Estrogen activates S1P receptors (S1PR) and induces growth factor receptor transactivation. SphK, S1P, and S1PR expression are causally associated with endocrine resistance and progression to advanced tumor stages in ER-positive breast cancers in vivo. Recently, the network of SphK/S1PR was shown to promote the development of ER-negative cancers and breast cancer stem cells, as well as stimulating angiogenesis. Novel findings confirm and broaden our knowledge about the cross-talk between sphingolipids and estrogen network in normal and malignant cells. Current S1PRs therapeutic inhibition was indicated as a promising chemotherapy approach in non-responsive and advanced malignancies. Considering that sphingolipid signaling has a prominent role in terminally differentiated cells, the impact should be considered when designing specific SphK/S1PR inhibitors. This study analyzes the dynamic of the transformation of sphingolipid axis during a transition from normal to pathological condition on the level of the whole organism. The sphingolipid-based mediation and facilitation of global effects of estrogen were critically accented as a bridging mechanism that should be explored in cancer prevention.

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Getting ready for REDD+: Recognition and Donor-country Project Development Dynamics in Central Africa

Gretchen M Walters, Melis Ece

Conservation and Society 2017 15(4):451-464

REDD+ (Reducing Emissions, Deforestation and forest Degradation+) is a United Nations Framework Convention for Climate Change (UNFCCC) process through which governments reduce the impacts of climate change through forest conservation in a results-based payments scheme. Distinct from international negotiations about the REDD+ framework under the UNFCCC, there are also REDD+ projects that help governments to set up the institutional architecture, plans and strategies to implement REDD+. These capacity-building projects, in the first phase of 'REDD+ readiness', involve negotiations among national and international actors in which recognition and authority claims are used by participants to influence project-level negotiations. This study analyses the project development negotiations in a World Bank-led REDD+ capacity building regional project, involving six Central African countries between 2008 and 2011. It explores how the project created a 'negotiation table' constituted of national and regional institutions recognised by the donors and governments, and how this political space, influenced by global, regional and national political agendas led to 'instances' of recognition and misrecognition – in which some negotiating parties' claims of representation were acknowledge and affirmed, while others' claims were not. Focusing on Cameroon and Gabon, this article analyses how negotiations shaped full participation by Cameroon and only partial engagement by Gabon.

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Facipulation and Elite Formation: Community Resource Management in Southwestern Ghana

Manali Baruah

Conservation and Society 2017 15(4):371-383

Despite their stated commitment to democratic processes, the Government of Ghana and international authorities presume the accountability and ability of NGOs to represent local interests in forest resource management. This article scrutinises elite formation and elite capture through the case of a Community Resource Management Area (CREMA) in western Ghana. NGOs and the forestry department promotes commercial tree planting on farmlands at this CREMA site. This article shows how institutional mandates, technical and managerial priorities are used by higher-level authorities to rationalise the omission of accountability and representation in CREMA activities. Disregard for democratic processes thus centralise decision making and render political processes apolitical at the cost of effective local participation and control over forest resources. Also, the legal and administrative framework of the CREMA tended to empower the traditional elites. In addition, the recognition of a local NGO by state authorities to oversee natural resource management infringed upon the CREMA's mandate and encouraged the formation of new elites. Further, the higher-level authorities' promotion of tree-tenure privatisation reduced public engagement by enclosing and thus discounting the public forest domain. The combination of these factors compromise the accountability and equitable sharing of benefits in CREMAs. Nevertheless, the CREMAs have been endorsed by the government as an innovative institutional structure for implementing REDD+ projects in Ghana.

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Disempowering Democracy: Local Representation in Community and Carbon Forestry in Africa

Melis Ece, James Murombedzi, Jesse Ribot

Conservation and Society 2017 15(4):357-370

All major agencies intervening in community-based and carbon forestry – such as international development agencies, conservation institutions, and national governments – state that their interventions must engage local participation in decision making. All say they aim to represent local people in the design and implementation of their interventions. In practice, decision-making processes are rarely 'free', barely 'prior' poorly 'informative' and seldom seek any form of democratic 'consent' or even 'consultation'. Through case studies of representation processes in forestry programs in the Congo Basin region, Ghana, Kenya, Nigeria, Senegal and Uganda, this special issue shows how forestry interventions weaken local democracy. We show that participatory and 'free, prior and informed consent' processes rarely reflect local needs and aspirations, they are rarely democratic and they do not permit participants to make significant decisions – such as whether or how the project will take place. The intervening agents' choices of local partners are based on expedience, naïve notions of who can speak for local people, anti-government and pro-market ideologies informed by a comfort with expert rule. Although elected local governments are present in all cases in this special issue, they are systematically circumvented. Instead, project committees, non-governmental organizations, customary authorities, and local forestry department offices are recognized as 'representatives' while technical project objectives are favored over democratic representation.

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Feigning Democracy: Performing Representation in the UN-REDD Funded Nigeria-REDD Programme

Emmanuel O Nuesiri

Conservation and Society 2017 15(4):384-399

Reducing Emissions from Deforestation and forest Degradation plus the sustainable management of forest and enhancement of carbon stocks (REDD+) is a global climate change mitigation initiative. The United Nations REDD Programme (UN-REDD) is training governments in developing countries, including Nigeria, to implement REDD+. To protect local people, UN-REDD has developed social safeguards including a commitment to strengthen local democracy to prevent an elite capture of REDD+ benefits. This study examines local participation and representation in the UN-REDD international policy board and in the national-level design process for the Nigeria-REDD proposal, to see if practices are congruent with the UN-REDD commitment to local democracy. It is based on research in Nigeria in 2012 and 2013, and finds that local representation in the UN-REDD policy board and in Nigeria-REDD is not substantive. Participation is merely symbolic. For example, elected local government authorities, who ostensibly represent rural people, are neither present in the UN-REDD board nor were they invited to the participatory forums that vetted the Nigeria-REDD. They were excluded because they were politically weak. However, UN-REDD approved the Nigeria-REDD proposal without a strategy to include or strengthen elected local governments. The study concludes with recommendations to help the UN-REDD strengthen elected local government authority in Nigeria in support of democratic local representation.

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Conflict to Coexistence: Human – Leopard Interactions in a Plantation Landscape in Anamalai Hills, India

Swati Sidhu, Ganesh Raghunathan, Divya Mudappa, TR Shankar Raman

Conservation and Society 2017 15(4):474-482

When leopards are found in human-dominated landscapes, conflicts may arise due to attacks on people or livestock loss or when people retaliate following real and perceived threats. In the plantation landscape of the Valparai plateau, we studied incidents of injury and loss of life of people and livestock over time (15 – 25 y) and carried out questionnaire surveys in 29 plantation colonies and eight tribal villages to study correlates of livestock depredation, people's perception of leopards, and preferred management options for human – leopard interactions. Leopards were implicated in an average of 1.3 (± 0.4 SE) incidents/year (1990 – 2014) involving humans and 3.6 (± 0.8 SE) incidents/year (1999 – 2014) involving livestock, with no statistically significant increasing trend over time. Most incidents of injury or loss of life involved young children or unattended livestock, and occurred between afternoon and night. At the colony level, livestock depredation was positively related to the number of livestock, but decreased with the distance from protected area and number of residents. Half the respondents reported seeing a leopard in a neutral situation, under conditions that resulted in no harm. All tribal and 52% of estate respondents had neutral perceptions of leopards and most (81.9%, n = 161 respondents) indicated changing their own behaviour as a preferred option to manage negative interactions with leopards, rather than capture or removal of leopards. Perception was unrelated to livestock depredation, but tended to be more negative when human attacks had occurred in a colony. A combination of measures including safety precautions for adults and children at night, better livestock herding and cattle-sheds, and building on people's neutral perception and tolerance can mitigate negative interactions and support continued human – leopard coexistence.

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Choices have Consequences: REDD+ and Local Democracy in Kenya

Susan Chomba

Conservation and Society 2017 15(4):400-413

The extent to which the United Nations Reduced Emissions from Deforestation and forest Degradation programme (REDD+) addresses critical issues of governance is hotly contested. This article focuses on the local institutions chosen as partners by a prominent REDD+ project in Kenya and the implications of this choice for local democracy. The REDD+ project briefly partnered with state-appointed local authorities to represent local interests, bypassing elected ones. Shortly after, the state-appointed authorities were abandoned in favour of 'project-created' carbon committees and civil society organisations. The choice to recognise some institutions while excluding others, was justified by the levels of downward accountability and of corruption, and arguments that state-sanctioned institutions were overburdened and inefficient. However, the article contends that this preference for carbon committees and civil society organisations over state-sanctioned institutions, and particularly the aversion to democratically elected ones, was not conducive for long-term strengthening of local democracy. The analysis pinpoints a tension between setting up parallel models of authority that can act as exemplars of democratic practice, while undermining democratically elected institutions that, in Kenya, are struggling to exercise newly devolved powers. Explicit strategies are required to enable learning from parallel governance models and for their migration into mainstream local governance structures, if local democracy is to be strengthened rather than undermined.

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Representation through Privatisation: Regionalisation of Forest Governance in Tambacounda, Senegal

Melis Ece

Conservation and Society 2017 15(4):439-450

Government officials, development agents and scholars showcase Senegal's 1996 regionalization reforms as a step towards the deepening of decentralisation. Yet this article shows that the reforms narrowed down local democracy via neoliberal processes. The reforms defined the regional councils as development intermediaries, to serve as a space for the negotiation of public-private partnership contracts between local governments and business interests. Focusing on Tambacounda Region of Senegal, the article analyses the effects of the reforms on forest governance at regional and rural-community scales. First, using two project case studies, it illustrates the use of forest management plans and project-based environmental committees in enabling privatisation of rural community forest governance at the expense of democratic processes. Second, it examines how the intermediary role of the regional council compromised its ability to represent the substantive interests of base-level rural communities and helped instrumentalise the council to promote different privatisation alternatives offered by 'community-based' projects. This role was facilitated by a public-private development agency of the council. The discursive analysis of a regional council meeting illustrates that rather than offering a deliberative and participatory forum, council meetings were used to make representation claims about the 'local people' and to push a market-based neoliberal rationality.

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Theorising Derecognition of Local Government Authorities as Political Injustice: The Effects of Technical Claims in Senegal's Forestry

Papa Faye

Conservation and Society 2017 15(4):414-425

Most developing-country governments have 'recognised' elected local governments (ELGs) by transferring to them the authority (e.g. rights and resources) over the forests within their jurisdiction. In practice, however, Forest Services are 'derecognising' ELGs – taking back these decentralised powers. This article shows that 'derecognition' is effectively a new 'recognition' dynamic in decentralised forest management in Senegal, in which Forestry officials and agents derecognise ELGs drawing upon technical claims. It also theorises derecognition as political injustice by demonstrating how the technical claims, although used in support of sustainable forest governance, cause political injustice through the following observed derecognition outcomes: 1) circumvention of ELGs that deprives them of the means to be responsive to local people (and thus disables them as democratic institutions); 2) subordination of the new participatory organisations created to receive the powers taken from ELGs to instrumental objectives of central forestry authorities; and 3) progressive privatisation of the forests that diminishes the democratic public domain.

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Tourism Taxation, Politics and Territorialisation in Tanzania's Wildlife Management

Emmanuel Sulle, Holti Banka

Conservation and Society 2017 15(4):465-473

Tourism activities occurring on communal lands such as Wildlife Management Areas (WMAs) are increasing in Tanzania. This is the result of natural resources governance reforms aimed to empower communities to manage and benefit directly from resources found in their jurisdictions. This article explores the impacts of taxes imposed on tourism activities occurring on communal lands and the emerging politics of resource and revenue sharing among WMA member villages. In the process, we use empirical data gathered from two WMAs in northern Tanzania between 2006 and 2016. We find that while the current high tax rates on tourism businesses occurring at the grassroots level reduce revenue earned by communities, the main challenge facing the studied WMAs is the model of revenue sharing among WMA member villages. Currently, as the result of WMA regulations, villages which had prior arrangement with tour operators in their land have suffered revenue losses as they have to share revenue equally with other members of the WMA. We argue that the current tax regime coupled with the contested cost and benefit sharing model not only lower returns to grassroots communities--which in turn discourage their much needed participation in conservation-tourism initiatives--but also generate new forms of struggles over resource control.

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Climbing the Ladder of Participation: Symbolic or Substantive Representation in Preparing Uganda for REDD+?

Robert Mbeche

Conservation and Society 2017 15(4):426-438

The United Nations (UN) and World Bank programme for Reducing Emissions from Deforestation and forest Deforestation (REDD) plus improving forest governance (REDD+) promotes carbon-emission reductions and sustainable forest management. The World Bank and the UN require developing countries to prepare for REDD+ via a consultation process with input from indigenous and forest-dependent peoples. This article focuses on stakeholder consultations carried out under the Ugandan REDD+ preparation process, examining whether these fulfill the conditions necessary for substantive local democratic representation. The article shows that even though REDD+ claims to be democratic and participatory, the Uganda program allows the input of only a few selected stakeholders – mainly the government actors and a limited number of NGOs. Further, despite claiming to be democratic and participatory, the program privileges REDD+'s programmatic goals over democratic procedures. In this context, the REDD+ consultations serve largely to—1) 'educate' the participants to secure their support in implementing the 'technical' aspects of the programme, 2) help the government to legitimise its REDD+ strategy; and 3) speed up the implementation of the REDD+ programme despite the lack of substantive representation.

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Democracy in the Woods

Dan Brockington

Conservation and Society 2017 15(4):483-484



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HIV Reactivation after Partial Protection by Neutralizing Antibodies

Publication date: Available online 30 January 2018
Source:Trends in Immunology
Author(s): Matthew S. Parsons, Deborah Cromer, Miles P. Davenport, Stephen J. Kent
It is widely thought that generating broadly neutralizing anti-HIV antibodies (BnAbs) will protect humans against HIV, given promising data from in vitro experiments and in vivo macaque studies. The primary action of BnAbs is preventing cell-free virus from entering cells. Recent in vitro and macaque data suggest that BnAbs are less potent against cell-associated virus exposure. We speculate that BnAb-based suppression of HIV transmission, particularly if mediated by cell–cell transmission, may result in some exposed subjects carrying a form of latent (or ‘occult’) HIV infection. Such largely hidden HIV infections may subsequently reactivate when BnAb levels decline. This concept has implications for the achievement of long-term sterilizing immunity to HIV.



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Avoiding blame and liability is vital to learning from errors and engineering a safer NHS

Hadiza Bawa-Garba, a trainee paediatrician who was convicted of manslaughter over the death of Jack Adcock, a 6 year old boy, was struck off the UK medical register last week after a High Court...

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Moving to accountable care in the NHS

How will UK accountable care organisations differ from those in the US?In the US, accountable care organisations (ACOs) were formed under Barack Obama’s health reforms by groups of healthcare...

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Sixty seconds on . . . the Presidents Club

Is this some seedy dive frequented by Donald Trump?It’s seedy, but has nothing to do with the president of the United States. It’s an annual men only fundraising dinner, attended by City grandees and...

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ERP components and behavior in the auditory equiprobable go/no-go task: Inhibition in young adults

Abstract

Previous research suggests that young adults do not need active and effortful inhibition to successfully complete the auditory equiprobable go/no-go task, a view that was incorporated into Barry and De Blasio's sequential processing schema for this task. However, recent evidence in children suggests that view could be incorrect. The present research aims to clarify the functionality of the N2 and P3 subcomponents within the proposed schema, assessing the role of inhibition in this task. To optimize the quantification of the N2 and P3 subcomponents, separate temporal PCAs were applied to the go/no-go ERP data from 40 young adults. Correlations were then used to link subcomponent amplitudes with performance outcomes, informing a functional interpretation of each subcomponent. Larger N2b and P3a amplitudes were each linked to fewer commission errors. N2c amplitude also increased with intraindividual reaction time variability, but no performance outcomes were associated with P3b. These findings link the young adult N2b and P3a with inhibition in the auditory equiprobable task, confirming the importance of control for successful nontarget processing in that paradigm. The functionality of N2c and P3b remain unclear from our results. However, these outcomes improve our understanding of cognitive processing in equiprobable tasks, and contribute to an improved conceptualization of the sequential processing schema.

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Endometriosis in a Man as a Rare Source of Abdominal Pain: A Case Report and Review of the Literature

Endometriosis occurs when a tissue resembling endometrial glands and stroma grows in ectopic sites, commonly causing infertility and pain. This condition is most often seen in women of reproductive age, involving pelvic sites such as the ovaries, broad ligaments, uterosacral ligaments, and posterior cul-de-sac. Very rarely, endometriosis has also been found in the lower genitourinary tract of men. A 40-year-old man presented to his primary care physician with abdominal pain. Further imaging discovered a midline mass. Surgical removal of the mass and histological investigations led to the diagnosis of endometriosis. There are multiple theories on the etiology of both female and male endometriosis. The prevailing risk factor proposed in previous cases of male endometriosis is prolonged exposure to estrogen therapy. Should endometriosis become symptomatic, cessation of estrogen therapy and careful surgical intervention may successfully relieve the associated symptoms.

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The Role of PET/CT with 18 F-FDG in the Assessment of Therapeutic Response of Head and Neck Cancer

Abstract

Purpose of Review

To make a brief review on the pre-treatment evaluation of head and neck squamous cell carcinoma (HNSCC) with positron emission tomography/computed tomography with 18F-Fluoro-deoxy-glucose (¹⁸F-FDG PET/CT) and to discuss the use of this method after treatment, with emphasis on the evaluation of therapeutic response.

Recent Findings

The ¹⁸F-FDG PET/CT pre-treatment evaluation is recommended at III–IV staging to determine metastasis foci. At post-evaluation, the use of ¹⁸F-FDG PET/CT is very important to confirm the therapeutic response based on its high negative predictive value (NPV), mostly when it is made after 12 weeks the last radiotherapy dose. Specific imaging criteria aid in the detection of active tumor lesions. Moreover, the ¹⁸F-FDG PET/CT can determine early failure treatment and overall survival and progression-free survival. Recently, the ¹⁸F-FDG PET/CT surveillance was showed an important tool to follow up HNSCC patients with stage N2 or N3 disease.

Summary

The ¹⁸F-FDG PET/CT is essential in the management of HNSCC, mainly at post-treatment evaluation. Its findings can determine a complementary therapy or even avoid an aggressive and unnecessary approach. So, careful analysis using imaging interpretation criteria has been central to an accurate assessment of HNSCC patients.

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