Low compliance to post‐screening recommendations in a family‐based Helicobacter pylori screening and treatment program: A prospective cohort study

alexandrossfakianakis shared this article with you from Inoreader Low compliance to post‐screening recommendations in a family‐based Helicobacter pylori screening and treatment program: A prospective cohort study via Helicobacter Abstract Background Intra-family transmission is an important Helicobacter pylori (H. pylori) infection route. Family-based screening and treatment of H. pylori is a promising strategy. However, limited data are available on patient compliance with post-screening recommendations for such a strategy. Materials and Methods A prospective cohort study of families from six regions in Shandong, China, from July 2021 to February 2022 was conducted. Demographic characteristics, prior testing, and treatment for H. pylori, prior gastroscopy, symptoms, and family history were collected. Infection status of participants was determined using the 13C-urea breath test. Infected participants were recommended to undergo eradication treatment, confirmation testing, and gastroscopy per expert consensus. Participants were monitored for 6 months to record recommendation compliance in a real-world setting. Logistic regression models were used to analyze the factors influencing compliance with the recommendations. Results The study included 1173 individuals from 386 families with the overall infection rate of 36.7%. The recommendation compliance for eradication treatment, confirmation testing, and gastroscopy was 69.3% (271/391), 32.5% (88/271), and 6.1% (19/309), respectively. Factors that increased the risk of lower compliance were male sex (odds ratio [OR], 1.917, 95% confidence interval [CI], 1.233–2.981), and living in a non-urban area (OR, 1.954, 95% CI, 1.241–3.074), for treatment recommendations; having more than one infected family member (OR, 2.138, 95% CI, 1.237–3.698), and a lower family income (¥100,000–¥300,000 per year, OR, 7.247, 95% CI, 1.788–29.363; or <¥100,000 per year, OR, 7.294, 95% CI, 1.832–29.042), for confirmation testing recommendations; and being asymptomatic (OR, 3.009, 95% CI, 1.105–8.196), for gastroscopy recommendations. Conclusions Post-screening recommendation compliance for this family-based H. pylori screening and treatment program was unsatisfactory. Further studies focusing on pre-screening education are warranted to improve compliance. View on Web

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Outcomes for Organ Preservation with Chemoradiation Therapy for T4 Larynx and Hypopharynx Cancer

alexandrossfakianakis shared this article with you from Inoreader Outcomes for Organ Preservation with Chemoradiation Therapy for T4 Larynx and Hypopharynx Cancer via The Laryngoscope Limited data exists on the non-surgical management of stage T4 larynx and hypopharynx cancer patients who are not surgical candidates or refuse surgery. This study aims to investigate the clinical and functional outcomes of non-surgical management of T4 larynx and hypopharynx cancer patients. The outcomes reported in this study will provide guidance for those who have unresectable disease or refuse surgery for advanced laryngeal and hypopharyngeal cancer patients. Objective Limited data is available to guide non-surgical management of Stage T4 larynx and hypopharynx cancer patients who have inoperable disease or refuse surgery. We aim to review the nonoperative management of T4 laryngeal and hypopharyngeal cancer and report the long-term therapeutic and functional outcomes. Methods We reviewed the nonoperative management of T4 laryngeal (n = 44) and hypopharyngeal (n = 53) cancer from 1997 to 2015 and performed a univariate analysis (UVA). Results The 2-/5-year OS rates were 73%/38% for larynx patients and 52%/29% for hypopharynx patients. Locoregional failure (LRF) occurred in 25% and 19% of larynx and hypopharynx patients, respectively. On UVA of the larynx subset, N3 nodal status and non-intensity-modulated radiation therapy were negatively associated with OS; treatment with radiation therapy alone impacted disease-free survival; and age >70 was associated with LRF. On UVA of the hypopharynx subset, only T4b status significantly impacted OS. In the larynx and hypopharynx groups, 68% and 85% received a percutaneous endoscopic gastrostomy (PEG) tube and 32% and 40% received a tracheostomy tube, respectively. At the last follow-up visit, 66% of our larynx cohort had neither tracheostomy or PEG placed and 40% of our hypopharynx cohort had neither. Conclusion We report better than previously noted outcomes among T4 larynx and hypopharynx patients who have unresectable disease or refuse surgery. Level of Evidence Level 4 Laryngoscope, 2022 View on Web

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Predicting Progression of Oral Lesions to Malignancy Using Machine Learning

alexandrossfakianakis shared this article with you from Inoreader Predicting Progression of Oral Lesions to Malignancy Using Machine Learning via The Laryngoscope Objective To use large-scale electronic health record (EHR) data to develop machine learning models predicting malignant transformation of oral lesions. Methods A multi-institutional health system database was used to identify a retrospective cohort of patients with biopsied oral lesions. The primary outcome was malignant transformation. Chart review and automated system database queries were used to identify a range of demographic, clinical, and pathologic variables. Machine learning was used to develop predictive models for progression to malignancy. Results There were 2192 patients with a biopsied oral lesion, of whom 1232 had biopsy proven oral dysplasia. There was malignant transformation in 34% of patients in the oral lesions dataset, and in 54% of patients in the dysplasia subset. Multiple machine learning-based models were trained on the data in two experiments, (a) including all patients with biopsied oral lesions and (b) including only patients with biopsy-proven dysplasia. In the first experiment, the best machine learning models predicted malignant transformation among the biopsied oral lesions with an area under the curve (AUC) of 86%. In the second experiment, the random forest model predicted malignant transformation among lesions with dysplasia with an AUC of 0.75. The most influential features were dysplasia grade and the presence of multiple lesions, with smaller influences from other features including anemia, histopathologic description of atypia, and other prior cancer history. Conclusion With diverse features from EHR data, machine learning approaches are feasible and allow for generation of models that predict which oral lesions are likely to progress to malignancy. Level of Evidence 3 Laryngoscope, 2022 View on Web

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Ingredients in the Visual Perception of Hypomobile Vocal Fold Motion Impairment

alexandrossfakianakis shared this article with you from Inoreader Ingredients in the Visual Perception of Hypomobile Vocal Fold Motion Impairment via The Laryngoscope In patients diagnosed with unilateral vocal fold hypomobility, semi-automated analysis of laryngoscopic videos revealed differences in the vocal fold angular velocity or range of motion between the two vocal folds in a substantial subset, but not a large majority, of the patients. Other visual cues in a laryngoscopic exam likely contribute to the perception of unilateral vocal fold hypomobility. Objectives The clinical determination of vocal fold (VF) hypomobility based on laryngoscopy is subjective. Previous studies point to VF motion anomaly as the most commonly reported factor in the diagnosis of hypomobility. This study tested the hypotheses that VF angular velocities and angular range of motion (ROM) differ between the two VFs in cases of unilateral VF hypomobility. Study Design Retrospective. Methods Semi-automated analysis of laryngoscopic videos of 18 subjects diagnosed with unilateral VF hypomobility and 13 subjects with normal VF mobility was performed to quantify/compare the VF angular velocity and ROM between the two VFs during /i/−sniff and laugh. Results In the hypomobile VF group, 7 out of 15 (47%) videos with /i/−sniff and 5 out of 8 (63%) with laugh had a statistically significant difference in the angular velocities between the VFs in either abduction or adduction. For VF ROM, 8 out of 15 (53%) /i/−sniff videos and 4 out of 8 (50%) with laughter had a statistically significant difference between VFs. In the group without the diagnosis of VF hypomobility, 9 out of 13 subjects (69%) had no difference in VF angular velocity and ROM during either /i/−sniff or laugh. Conclusions Differences in VF angular velocity or ROM are measurable in a substantial subset of subjects diagnosed with unilateral VF hypomobility. Clinicians' ability to gauge VF motion goes beyond what can be extracted from frame-by-frame analysis. Other visual cues, in addition to VF angular velocity and ROM, likely contribute to the perception of unilateral VF hypomobility. Level of Evidence 3 Laryngoscope, 2022 View on Web

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