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Medical Education Texts

Objective Skills Clinical Examination: Every Day in the Field of Practice

https://www.amazon.co.uk/Objective-Skills-Clinical-Examination-Practice/dp/1980880417

Assessing Competence in Medicine and Other Health Professions

https://www.crcpress.com/Assessing-Competence-in-Medicine-and-Other-Health-Professions/Violato/p/book/9781498785082

Sharp Foreign Bodies of the Aero-Digestive Tract: Endoscopic Removal by the ‘Kangaroo’ Technique

Abstract

Removal of sharp foreign bodies in the aero-digestive tract may inflict iatrogenic damage to the esophagus, trachea or other vital structures in case of impalement. We describe the 'Kangaroo' technique for safe and effective removal of sharp objects from the upper aero-digestive tracts. Index Case 1: 1-year old boy presented to us with an open (un)safety-pin lodged in the upper esophagus. The technique of removal of the pin by the Kangaroo technique, along-with the mechanics of en-pouching the (un)safety-pin has been described. Index Case 2: 8 years old boy presented with accidental aspiration of a razor blade. The removal of the blade from his trachea was executed by the Kangaroo technique. The Kangaroo technique is described for safe endoscopic extraction of sharp foreign body from the aero-digestive tract while protecting the surrounding tissues, to maintain control of the object during extraction and to avoid causing iatrogenic damage by enclosing the foreign body in a 'kangaroo pouch'. The advantages and limitations of the technique have been discussed. The Kangaroo technique is safe, effective and reproducible way to effect removal of sharp object from the aerodigestive tract while preventing iatrogenic injury to the surrounding organs.

http://bit.ly/2UPs8a5

Sharp Foreign Bodies of the Aero-Digestive Tract: Endoscopic Removal by the ‘Kangaroo’ Technique

Abstract

Removal of sharp foreign bodies in the aero-digestive tract may inflict iatrogenic damage to the esophagus, trachea or other vital structures in case of impalement. We describe the 'Kangaroo' technique for safe and effective removal of sharp objects from the upper aero-digestive tracts. Index Case 1: 1-year old boy presented to us with an open (un)safety-pin lodged in the upper esophagus. The technique of removal of the pin by the Kangaroo technique, along-with the mechanics of en-pouching the (un)safety-pin has been described. Index Case 2: 8 years old boy presented with accidental aspiration of a razor blade. The removal of the blade from his trachea was executed by the Kangaroo technique. The Kangaroo technique is described for safe endoscopic extraction of sharp foreign body from the aero-digestive tract while protecting the surrounding tissues, to maintain control of the object during extraction and to avoid causing iatrogenic damage by enclosing the foreign body in a 'kangaroo pouch'. The advantages and limitations of the technique have been discussed. The Kangaroo technique is safe, effective and reproducible way to effect removal of sharp object from the aerodigestive tract while preventing iatrogenic injury to the surrounding organs.

http://bit.ly/2UPs8a5

4 tips for airway management mastery

Successful airway management is the culmination of preparation, practice and technique mastery

http://bit.ly/2SyzAIW

Re: “Association Between Primary Hypothyroidism and Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis” by Mantovani et al. (Thyroid 2018;28:1270–1284)

Thyroid, Ahead of Print.


http://bit.ly/2WKe4jE

Metabolic Obesity Phenotypes and Thyroid Cancer Risk: A Cohort Study

Thyroid, Ahead of Print.


http://bit.ly/2RJkGLw

The Role of Sub-mental Ultrasonography in Diagnosing Obstructive Sleep Apnea and Its Correlation With Subjective Scales

Conditions:   Obstructive Sleep Apnea;   Diagnostic Imaging;   Ultrasound
Intervention:   Diagnostic Test: Sub-mental ultrasonography
Sponsor:   Bartin State Hospital
Recruiting

http://bit.ly/2TAvJZ4

Team-based Ergonomics Educational Model for Workplace WELLNESS Improvement: A Pilot Study

Conditions:   MSDs;   Muscle Pain
Intervention:   Behavioral: stretching exercises
Sponsor:   Milton S. Hershey Medical Center
Not yet recruiting

http://bit.ly/2BkSYzy

Validation of Smartphone App for Head and Neck Cancer Control and Patient Support

Condition:   Head Neck Cancer
Intervention:   Other: Virtual Coach
Sponsors:   Vibrent Health;   Stanford University;   Johns Hopkins University;   Massachusetts General Hospital
Not yet recruiting

http://bit.ly/2Tzwm5r

A Study of pING-hHER3FL Vaccine in Cancer Patients WITH ADVANCED MALIGNANCIES

Condition:   Advanced Cancer
Intervention:   Biological: pING-hHER3FL
Sponsor:   Herbert Lyerly
Not yet recruiting

http://bit.ly/2BkSRnC

Einführung der neuen Rubrik „OP-Techniken“

http://bit.ly/2GeaOYN

Hot Topic: Schilddrüse

http://bit.ly/2MTqKR0

Quality of life in Swedish children receiving grommets – An analysis of pre- and postoperative results based on a national quality register

Publication date: Available online 6 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Job van Brink, Marie Gisselsson-Solen

Abstract

Background

Otitis media with effusion (OME) and recurrent otitis media (rAOM) are two common diagnoses in childhood, both of which are treated with grommets, or ventilation tubes. It is known that affected children have a worse quality of life (QoL), and various questionnaires have been used to evaluate this. The national Swedish quality register for grommet insertions contains some QoL questions that have hitherto never been analysed.

Methods

Data from 2010 to 2016 was extracted from the register and analysed with regards to QoL questions, reasons for surgery, hearing levels and number of AOM episodes.

Results

Preoperative QoL data was available for 3835 children. Before surgery, most parents felt that the QoL of their children was negatively affected by the ear disease. Parents of children with OME were more likely to suspect that their child had a hearing loss (ORs 10.1 and 28.2 for suspecting a mild and severe hearing loss, respectively), but less likely to find that the ear disease affected the child's general wellbeing than did parents of children with rAOM (ORs 0.54 and 0.33 for somewhat and much affected, respectively). Many children underwent surgery despite not fulfilling the criteria for surgery as stipulated in the national guidelines. Those who did fulfil criteria, however, had a more severely affected QoL. A significant improvement was seen in individual QoL scores after surgery (p < 0.001). The degree of postoperative improvement in pure tone average correlated with the improvement in QoL (p < 0.001).

Conclusion

This is the first time that the QoL aspect has been analysed in the Swedish grommet register. Though the validity of the questions has not been proven, they provide valuable information. The relevance of the surgical criteria in national guidelines is illustrated by their correlation with the QoL questions, particularly for OME, and the postoperative improvement in QoL suggests parents find that their children benefit from surgery.

http://bit.ly/2Ddo5wX

Outcome Of Drug-Induced Sleep Endoscopy-Directed Surgery For Persistent Obstructive Sleep Apnea After Adenotonsillar Surgery

Publication date: Available online 6 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): E. Esteller, J.C. Villatoro, A. Agüero, E. Matiñó, R. Lopez, Aristimuño A, Nuñez V, M.A. Díaz-Herrera

Abstract

PURPOSE

Drug-induced sleep endoscopy (DISE) is suitable for evaluating persistent obstructive sleep apnea syndrome (OSAS) after adenotonsillar surgery as a means to guide surgical intervention, yet few studies demonstrate its usefulness in resolving the syndrome. We describe our experience of DISE-directed surgery in children with persistent OSAS by analysing objective and subjective outcomes of this treatment.

METHODS

Prospective study of 20 otherwise healthy 2-12 year-old children with OSAS persisting after adenotonsillar surgery. All patients underwent DISE-directed surgery and were followed up clinically and with a polysomnogram at 12±3 months.

RESULTS

All 20 children had an apnea-hypopnea index (AHI) score ≥1 (mean: 6.1±4.9) and 75% had AHI>3 before surgery. We performed a total of 14 total tonsillectomies (70%), 7 with associated pharyngoplasties; 5 radiofrequency turbinate reductions (25%); 7 radiofrequency lingual tonsil reductions (35%); and 10 revision adenoidectomies (50%). No surgery-related complications were observed. AHI scores at follow-up were significantly lower than AHI scores before surgery (1.895±1.11 vs 6.143±4.88; p<0.05) and, in 85% (n=17) of patients, AHI was below 3. There was a significant reduction in the number of children with AHI>3 in follow-up at 12±3 months (15%; n= 3) compared to before surgery (75%; n=15) (p<0.005).

CONCLUSION

DISE-directed surgery for otherwise healthy children with persistent OSAS is a useful and safe technique to decide a therapeutic strategy and to obtain good objective and subjective results regarding resolution of the syndrome.

http://bit.ly/2SvgaVh

Receptive and productive speech and language abilities in hearing-impaired children with German as a second language

Publication date: Available online 6 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Annerose Keilmann, Barbara Friese, Vanessa Hoffmann

Abstract

Objectives

Many studies examining early bilingualism in migrant populations focus on the development of the first language. As language acquisition is closely related to the hearing development, there is a critical need to investigate language development in hearing-impaired children being raised bilingually who were fitted with cochlear implants and/or hearing aids. Therefore, this research project aimed to study the linguistic development of hearing-impaired children being raised with German as a second language who were provided with hearing aids or cochlear implants. Further, the language development of these children is compared with that of hearing-impaired children being raised in a monolingual environment and with normal-hearing children being raised bilingually.

Methods

In this prospective study, we analyzed data from 95 typically developing children with hearing loss (43 bilingual and 52 monolingual) aged 3;0 to 10;11 (years; months) on four language measures in German: receptive vocabulary, productive vocabulary, receptive grammar, productive grammar (sentence repetition). Additionally, 30 bilingual children with normal hearing were included in this study.

Results

44 children were provided with hearing aids in both ears; 34 used cochlear implants bilaterally and 17 were fitted bimodally. Statistical analysis showed that bilingual hearing-impaired children scored significantly poorer than monolingual hearing-impaired children.

Conclusion

Hearing-impaired children being raised bilingually should have speech and language examinations on a regular basis. An examination of both languages would be desirable in order to be able to fully assess speech and language acquisition.

http://bit.ly/2DcXfFm

Does influenza vaccination or RSV prophylaxis impact resource utilization for children after the diagnosis of airway disorders?

Publication date: Available online 6 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jeffrey Cheng, Congwen Zhao, Hui-Jie Li

Abstract

Objective

Quantify the rates influenza vaccination and RSV prophylaxis for children with airway stenosis and/or other disorders and assess impact on resource utilization.

Methods

This was a retrospective study with data extracted from Duke Enterprise Data Unified Content Explorer (DEDUCE) between January 1, 2006 and December 1, 2017. Children aged 18 years and younger with at least one diagnosis code for airway stenosis and/or disorders were included. The index date was defined as the first date of airway stenosis/disorders diagnosis. Each patient was followed for up to one year after the index date. Influenza vaccination or RSV prophylaxis documented within one year of index date were included. We defined emergency department (ED) visits and/or hospital admissions related to respiratory diagnoses as the primary outcome of increased resource utilization.

Results

A total of 2718 patients were included. In our institution, our results have indicated that there are fairly low vaccination documentation rates of influenza vaccination, RSV prophylaxis, or both provided to children with airway stenosis/disorders, 14.1% (389/2718), 1.1% (30/2718), and 0.6% (17/2718), respectively, within the first year after diagnosis. Around 5% (139/2718) and 10% (269/2718) experienced ED visits or hospitalizations related to respiratory issues within the first year after diagnosis, respectively. Among 139 and 269 patients with ED visits or hospitalizations, 34 (25%) and 54 (20%) had multiple visits, respectively. Very few patients had documented influenza vaccination (11/139, 0.4%) or RSV prophylaxis (5/269, 0.18%) before ED visits or hospitalization.

Conclusions

There is little available evidence at this time for strategies to prevent adverse events or complications in children with airway stenosis/disorders. In our institution, our results have indicated that there are fairly low documented rates of influenza vaccination, RSV prophylaxis, or both provided to children with airway stenosis/disorders in the first year after diagnosis. This is an area of significant clinical interest for potentially limiting adverse events and optimizing resource utilization for children with airway stenosis/disorders.

http://bit.ly/2SuMKqA

Genetic risk of FCRL3 and FCRL5 Polymorphisms in children with asthma and allergic rhinitis in a Chinese Han Population

Publication date: Available online 5 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Zheng Gu, Yang Shen, Xin-Ye Tang, Xia Ke, Hong-Bing Yao, Su-Ling Hong, Hou-Yong Kang

Abstract

Objectives

Asthma and allergic rhinitis (AR) frequently occur as comorbid diseases of the upper airways. Single-nucleotide polymorphisms (SNPs) in the FCRL3 and FCRL5 genes have recently been shown to be associated with various immune-related disorders. This study evaluated the association of FCRL3 and FCRL5 polymorphisms with asthma and allergic rhinitis (AR) in a Han Chinese population.

Methods

Seven single nucleotide polymorphisms (SNPs) of the FCRL3 and FCRL5 were genotyped in 300 asthmatic children, and 206 healthy unrelated individuals using PCR-restriction fragment length polymorphism (PCR-RFLP) assay. Genotyping was validated by direct sequencing.

Results

Our results showed that the frequencies of the rs6692977 CT genotype and T allele within FCRL5 were significantly higher in asthma with comorbid AR compared to healthy controls (Bonferroni-corrected p (Pc) = 3.75 × 10^-6; Pc = 0.006, respectively), whereas these of the CC genotype and C allele were significantly lower (Pc = 4.15 × 10^-5; Pc = 0.006, respectively). The frequencies of the rs7528684 A allele (Pc = 1.80 × 10^-3) and the rs10489678 G allele (Pc = 0.04) within FCRL3 were higher in asthma with comorbid AR than in controls. However, no differences in the tested genetic polymorphisms were detected between asthma and healthy individuals.

Conclusion

This study identified novel SNPs in FCRL3 and FCRL5 significantly associated with the risk for asthma with comorbid AR in the Chinese population. The genetic variants may play role in the development of the asthma phenotype in children with asthma.

http://bit.ly/2DgAWOQ

Evaluation of bone regeneration in a critical size cortical bone defect in rat mandible using microCT and histological analysis

Publication date: Available online 5 February 2019

Source: Archives of Oral Biology

Author(s): Cynthia G. Trejo-Iriarte, Janeth Serrano-Bello, Rocío Gutiérrez-Escalona, Crisóforo Mercado-Marques, Natalio García-Honduvilla, Julia Buján-Varela, Luis Alberto Medina

Abstract

Goal

Evaluate bone regeneration in a critical size bone defect model in the jaw of healthy rats as a function of gender and defect location.

Design

A series of microCT and histological studies were performed to evaluate the process of bone regeneration in rats with a mandibular critical size defect. Rats were placed in two groups according to gender and sorted in terms of bone defect location. Bone regeneration rate and hydroxyapatite concentration were assessed with microCT imaging at specific times after surgery. Histological analysis was also performed to evaluate bone regeneration.

Results

No more that 85% of bone regeneration was observed after 60 days, with a low rate constant (K) indicating a slow restoration of the defect. Assessment of microCT images showed partial closure of the defect in all cases, which was confirmed by histological analysis. Hydroxyapatite concentration values revealed that regenerated bone was not fully calcified. No statistically significant differences in terms of gender or defect location were found.

Conclusion

The defect model studied here, located in the jaw of healthy rats, shows potential as a preclinical critical size bone defect model to evaluate bone regeneration therapies in the fields of dentistry and maxillofacial surgery.

http://bit.ly/2DgwwaI

Tumor volume as a predictive parameter in the sequential therapy (induction chemotherapy) of head and neck squamous cell carcinomas

Abstract

Purpose

Tumor volume in locally advanced head and neck squamous cell carcinomas (LAHNSCC) treated by induction chemotherapy (ICT) and followed by radiochemotherapy (RCT) was measured. The presence of potential correlation of initial tumor volume and volume reduction after ICT and RCT with remission status, overall survival (OS) and disease-free survival (DFS) were investigated. Furthermore, reliability of approximation of the tumor volume relying on its diameter to manual three-dimensional measurement was assessed.

Methods

Data of patients with LAHNSCC treated by ICT consisting of docetaxel, cisplatin, and 5-fluorouracil (TPF) followed by definite RCT were retrospectively analyzed. The tumor volume was calculated slice-by-slice in contrast-enhanced CT or MRI before and after ICT as well as after complete treatment. The volume was compared to radiologic remission status, correlated with OS and DFS, and to volume estimation using tumor diameter.

Result

65 patients were included. Primary tumor volume did not correlate with complete remission rate (CR) after ICT and RCT, OS or DFS. The change in tumor volume between baseline imaging and post-RCT had a significant impact on OS (p = 0.026) and DFS (p = 0.028). The agreement between tumor volume and radiologic remission was 72.14%.

Conclusion

The initial tumor volume had no influence on CR, OS or DFS. A severe response to ICT did not predict a powerful RCT outcome. The change in tumor volume post-RCT had an impact on OS and DFS. Tumor volume estimation using its diameter seems to be a reliable method.

http://bit.ly/2GbQaZu

Pediatric otogenic lateral sinus thrombosis: focus on the prognostic role of contralateral venous drainage

http://bit.ly/2MThH2u

Diagnostik und Therapie von Riechstörungen

Zusammenfassung

Hintergrund

Dysosmien zählen zu den häufigsten Störungen/Erkrankungen im HNO-Fachgebiet, epidemiologische Daten fehlen weitgehend, und die Therapiestrategien sind unzureichend standardisiert.

Fragestellung

Erhebung der Ursachen von Riechstörungen und den angewendeten Behandlungsstrategien an HNO-Kliniken im deutschsprachigen Raum. Auswertung und Vergleich mit den Ergebnissen aus der Umfrage im Jahr 2000 und Durchführung einer Literaturanalyse zur Therapie von Riechstörungen.

Material und Methoden

Die Umfrage erfolgte 2010 mit einem zweiseitigen Fragebogen zu Riechstörungen, der an alle HNO-Kliniken im deutschsprachigen Raum verschickt wurde. Die Analyse schloss die Literatur aus PubMed, der Cochrane Library sowie themenrelevanten Leitlinien ein.

Ergebnisse

An HNO-Kliniken wurde die Diagnose Dysosmie seltener gestellt (Rückgang um 52 %) Die 3 am häufigsten genannten Therapieansätze waren Kortikosteroide (topisch und systemisch) und systemische Antibiotika. Bei sinunasalen Dysosmien zeigte sich in der Literaturanalyse ein kleiner bis mittlerer Effekt von topischen Steroiden.

Schlussfolgerung

Da eine Halbierung der Prävalenz von Riechstörungen unwahrscheinlich ist, beruht die geringere Patientenzahl möglicherweise auf einer kritischeren Diagnostik. Die Anwendung des Riechtrainings hat in den Kliniken stark zugenommen (von <6 % auf 29 %). Der Einsatz von topischen Steroiden bei der Behandlung von sinunasalen Dysosmien ist evidenzbasiert. Das Riechtraining stellt besonders bei postinfektiösen und posttraumatischen Riechstörungen eine sichere und effektive Therapieoption dar.

http://bit.ly/2GqfbQ2

Malformations of the lateral semicircular canal correlated with data from the audiogram

Abstract

Objectives

Lateral semicircular canal (LSCC) malformations  are one of the most common inner ear malformations. The purpose of this study is to analyze the prevalence and type of hearing losses associated with LSCC malformations, compared to a control group.

Materials and methods

We retrospectively included 109 patients (166 ears) presenting with a CT-confirmed LSCC malformation, compared to a control group (24 patients). The bony island surface and the width of the inner portion of the LSCC were measured to confirm the malformation. There results were correlated to audiogram data: sensorineural (SHNL), mixed (MHL) or conductive hearing loss (CHL) by an otologist.

Results

In the LSCC group, 60.9% of patients presented with an audiogram-confirmed hearing loss, especially SNHL (39.2%, n = 65) and MHL (12.7%, n = 21). Hearing was normal in 39.2% (n = 65) of the cases. Bilateral LSCC malformations (n = 57) were frequently associated with hearing loss (80.7%), SNHL in most of the cases (33.3%). Unilateral LSCC malformations were associated with hearing alterations (51.9%, n = 27), but we also observed a high rate (81%, n = 42) of contralateral abnormalities of the audiogram.

Conclusion

LSCC malformations are commonly associated with hearing loss (61%), especially SHNL (39%). The high rate (81%) of contralateral hearing disturbances in unilateral LSCC malformations should be taken into account in the patient's daily life to avoid triggering or exacerbating any hearing loss. Otologists and radiologists must cooperate to ensure that all malformations are correctly described on CT, especially to improve the patient's education regarding hearing preservation.

http://bit.ly/2HWEETz

Clinical relevance of human papillomavirus outside of oropharynx

Purpose of review The role of HPV in oropharyngeal cancer is well recognized. HPV DNA is also found in a fraction of head and neck tumors outside of oropharynx but its clinical importance is unknown. The purpose of this review is to sum up the present knowledge about the prevalence and possible impact of HPV presence in head and neck tumors in nonoropharyngeal sites. Recent findings The data demonstrating prevalence of HPV presence in tumors outside of oropharynx are inconsistent. However, it can be stated that it is substantially lower than in oropharynx. Most articles report the HPV DNA presence only but very few prove also the transcriptionally active viral presence. The fraction of really HPV-induced tumors is probably very small. The majority of literature shows no impact of HPV on prognosis in nonoropharyngeal locations. Also the role of high-risk HPV in malignant transformation of lesions potentially linked to malignancy like inverted papillomas, recurrent respiratory papillomatosis or laryngeal dysplasia was up to date not demonstrated. Summary Despite of the unknown role of HPV and lack of evidence regarding any clinical use of HPV knowledge in other than oropharyngeal tumors, further research is warranted. Correspondence to Jan Klozar, MD, Department of Otolaryngology Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol Prague, V Úvalu 84, 150 06 Praha 5, Czech Republic. Tel: +420 727971911; e-mail: jan.klozar@fnmotol.cz Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2RHfbwP

Photodynamic therapy in head and neck cancer: indications, outcomes, and future prospects

Purpose of review To identify and review the recent literature on clinical applications, outcome, and new developments in photodynamic therapy (PDT) for the treatment of head and neck cancer. Recent findings Although PDT and surgery have a similar local control and recurrence rate, the gold standard of treatment for early-stage oral cavity cancer remains local surgery with, on indication, concurrent treatment of the neck. PDT proves its value in treatment of patients with field cancerization and patients with superficial recurrence after previous surgery and/or radiation, in whom surgical salvage would entail important morbidity. PDT is also promising as an adjuvant treatment after surgery in the presence of macroscopic or microscopic involved margins, in patients where reresection or reirradiation would imply an unacceptable risk. Recent progress in the field of PDT focuses on development and clinical application of new photosensitizing agents, photochemical internalization, and photoimmunotherapy. Summary The value of PDT in specific well-selected head and neck cancer clinical scenarios is well established. The basic research field is rapidly evolving and experimental findings are promising, maybe eventually leading to optimized results, less side-effects, and more indications. Correspondence to Vincent Vander Poorten, MD, PhD, MSc, Department of Otorhinolaryngology–Head and Neck Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. Tel: +32/16336340; e-mail: vincent.vanderpoorten@uzleuven.be Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2WJ9baQ

Medial femoral condyle free flap for head and neck reconstruction

Purpose of review The aim of this article is to review the literature on medial femoral condyle (MFC) free flap in head and neck reconstruction. Recent findings The MFC flap is a superb material for head and neck reconstruction, especially in smaller bony defects. As an alternative to fibular free flap, it presents many advantages. Combining the periosteal bone with skin and/or muscle paddle, the MFC flap is suitable for complex reconstructions with favorable healing process. Even though this flap has a longer history of orthopedic and traumatologic reconstructions, a number of cases in head and neck surgery have been recently reported. Summary The MFC flap has been successfully used to reconstruct various head and neck sites, from the orbit, maxilla, and mandible, to the laryngeal and tracheal scaffolds. Correspondence to Jacek Banaszewski, Department of Otolaryngology Head and Neck Surgery, Poznan University of Medical Sciences. Przybyszewskiego 49, 60355 Poznan, Poland. Tel: +48 61 8691387; e-mail: bananana@poczta.onet.pl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2RIpcKa

The effects of checkpoint inhibition on head and neck squamous cell carcinoma: A systematic review

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Mustafa Ghanizada, Kathrine Kronberg Jakobsen, Christian Grønhøj, Christian von Buchwald

Abstract

Background

Head and neck squamous cell carcinoma (HNSCC) is the sixth most frequent malignancy worldwide. Immunotherapy with checkpoint inhibitors such as anti-CTLA-4 anti-PD-l and anti-PD-L1 has shown promising results in treating patients with recurrent/metastatic HNSCC. We aimed to systematically review the literature on immunotherapy with checkpoint inhibitors as treatment for advanced HNSCC.

Methods

PubMed, EMBASE, Google Scholar, and the Cochrane Library were systematically searched with the purpose of identifying all studies addressing the effects of checkpoint inhibitors as treatment for HNSCC in human clinical trials. We assessed effects of the treatment with checkpoint inhibitors on overall survival (OS), progression-free survival (PFS), HPV-status, PD-L1-status, and adverse events.

Results

We identified eight studies (n = 1431 patients) with an OS ranging from 7.5 to 14.9 months in PD-1 checkpoint inhibition. Two studies (n = 541 patients) observed a significantly (p = 0.01) and (p = 0.007) longer OS with checkpoint inhibition compared to standard-treatment, platinum-based chemotherapy (7.5 versus 5.1 months and 14.9 months versus 10.7 months). Two studies (n = 411 patients) found an increased OS associated with PD-L1-postive patients compared to PD-L1-negative patients. The eight studies have heterogenous design with only three being randomized.

Conclusion

Few clinical trials have investigated the treatment with checkpoint inhibition for HNSCC. Solely, two randomized studies comprising 240 patients treated with nivolumab (anti-PD-L) and 301 patients treated with pembrolizumab (anti-PD-L) showed a significantly prolonged survival in patients with recurrent/metastatic HNSCC compared with standard-treatment. There is a further need for randomized clinical trials investigating a putative role of checkpoint inhibition in the treatment of advanced HNSCC.

http://bit.ly/2MQls8I

Die subjektive Vertikalenwahrnehmung – ein wertvoller Parameter für die Bestimmung der peripher vestibulären Störung bei M. Menière in der chronischen Phase?

Zusammenfassung

Für die Vertikalitätswahrnehmung sind vornehmlich der Utrikulus und die zentrale Verarbeitung der weitergeleiteten Signale verantwortlich. Jedoch gibt es auch extrakranielle Rezeptoren, die einen nicht unwichtigen Anteil an der Wahrnehmung der Vertikalität haben. Mit der subjektiven visuellen Vertikale (SVV) für den Utrikulus und der subjektiven Rumpfvertikale (SRV) stehen Parameter zur Verfügung, die in ihrer Beeinflussbarkeit noch nicht vollständig verstanden sind. Es galt, die Bestimmung der SVV und SRV unter bestimmten Lagepositionen von Kopf und Rumpf und unter dem Einfluss des M. Menière (MM) als chronische vestibuläre Erkrankung zu überprüfen. In einer klinisch-prospektiven Studie wurden 26 Patienten mit MM und 39 gesunde Probanden rekrutiert. Es wurde mit der C‑SVV-Brille und mit dem dreidimensionalen Rumpfexkursionsstuhl untersucht und hierbei der Kopf und Rumpf unterschiedlich positioniert. Die SVV-Bestimmung zeigte sowohl bei Patienten mit MM als auch in der Kontrollgruppe bei gerader Kopfausrichtung eine signifikant geringere Abweichung als bei seitlicher Kopfneigung nach rechts und links. Wurde in der Kontrollgruppe der Rumpf ausgelenkt und der Kopf aber gerade gehalten, war die SVV signifikant genauer (rechts p = 0,015; links p = 0,003). Die SRV zeigte keine Beeinflussung durch das Vorhandensein eines unilateralen MM, während die SVV, wenn sie pathologische Werte zeigte, zur erkrankten Seite hin verkippt war. Die Ergebnisse unserer Studie unterstützen die Annahme, dass neben der SVV auch die SRV ein eigenständiger Parameter für die Vertikalitätswahrnehmung ist, die extrakraniellen Rezeptoren aber anderen Einflüssen unterliegen und durch eine hydropische peripher-vestibuläre Läsion nicht signifikant verändert werden.

http://bit.ly/2t60Y2R

Induction of squamous cell carcinoma after MAP3K8 overexpression in murine salivry gland epithelial cells

Abstract

Background

Salivary gland neoplasms are relatively rare and comprise only 1%‐4% of all human neoplasms. Salivary gland neoplasms also show an extremely wide range of morphological diversity. Currently, the genetic alterations and corresponding molecular mechanisms underlying salivary gland neoplasms development remain largely unknown.

Method

We generated an inducible Tet‐MAP3K8::MMTV‐rTA mouse model by crossing the MAP3K8 transgenic mice with MMTR‐rTA transgenic mice to express MAP3K8 in the salivary gland.

Results

MAP3K8 overexpression in the murine salivary glands of Tet‐MAP3K8::MMTR‐rTA transgenic mice induces tumorigenesis. Pathological investigations reveal partial fibrosis and adenosis of salivary glands, and foci of atypical squamoid cellular proliferation, which represent invasive squamous cell carcinoma (SCC).

Conclusion

MAP3K8 overexpression is associated with SCC development in murine salivary glands. It provides an in vivo framework for the understanding of molecular mechanisms underlying SCC development in the salivary glands and also for the development of a future therapeutic strategy targeting this tumor type.

http://bit.ly/2HWrtSB

Dysphagia optimized radiotherapy to reduce swallowing dysfunction severity in patients undergoing treatment for head and neck cancer: A systematized scoping review

Abstract

This study involved a systematized scoping review to coalesce current evidence on dysphagia outcomes achieved through active sparing of the swallowing structures in patients receiving radiotherapy for head and neck cancer.

Eligible publications between 2007 and 2017 were reviewed and synthesized regarding participant demographics, treatment regimens, swallowing structures chosen for optimization, dosimetric constraints, and dysphagia measures.

Nine prospective cohort studies were included. Key structures routinely spared included pharyngeal constrictor muscles (PCMs), glottic larynx (GL), supraglottic larynx (SGL), and esophageal inlet muscle.

Shorter enteral feeding times and reductions in Common Terminology Criteria for Adverse Event (CTCAE) grade 3 dysphagia toxicity were observed when dose to the larynx (GL and SGL) and PCMs was constrained to < 50 and < 60 Gy, respectively.

Emerging evidence supports "active" sparing of the swallowing structures at the time of radiotherapy planning to reduce dysphagia severity, with no compromise to planning target volumes and locoregional control rates.

http://bit.ly/2t7O04o

The role of organ‐ and function‐preserving radiotherapy in the treatment of adenoid cystic carcinoma of the larynx

Abstract

Background

To evaluate clinical outcome and functional larynx preservation after radiotherapy (RT) for adenoid cystic carcinoma (ACC) of the larynx.

Methods

Eleven patients with primary ACC of the larynx, who received RT definitely (n = 5/11) or postoperatively (n = 6/11), were analyzed regarding survival and treatment‐related toxicity with the focus on functional larynx preservation.

Results

Median follow‐up was 45 months. RT offered an excellent 5‐year local control (LC) rate of 100%. Eight of 11 patients were treated with a laryngeal preservation approach (LPA). At last follow‐up, only one of these eight patients developed a local recurrence requiring a total laryngectomy 11 years after treatment. Severe toxicity was uncommon, with only one patient with LPA, requiring a temporary tracheostomy during therapy.

Conclusions

RT is an effective treatment method for laryngeal ACC with excellent LC rates, preservation of the laryngeal function and voice formation, representing a valuable therapy alternative to total laryngectomy.

http://bit.ly/2HSy5kM

Patients' preferences concerning follow‐up after curative head and neck cancer treatment: A cross‐sectional pilot study

Abstract

Background

Evidence of the oncological benefit of scheduled follow‐up in head and neck squamous cell carcinoma is weak; symptom‐oriented self‐referral may be an alternative. Patients' preferences regarding follow‐up remain poorly investigated.

Methods

We conducted a cross‐sectional survey among patients undergoing follow‐up at a tertiary outpatient clinic, focusing on their preferences, correlating factors, fear of recurrence, and willingness for participation in a randomized trial on follow‐up.

Results

Of 101 patients, 89.1% preferred scheduled follow‐up to self‐referral, 57% favored fewer visits than the current standard, and 85.1% endorsed regular imaging. Recurrence or second primary was associated with preference of intensive follow‐up schedules (P = 0.02). There were trends for women and patients with high fear of recurrence score to favor intensive follow‐up. Two‐third of the participants declared willingness to participate in a randomized controlled trial.

Conclusions

Patients' preferences only partially correspond to current follow‐up guidelines. Recruitment for randomized controlled studies evaluating the value of follow‐up seems feasible.

http://bit.ly/2t4chbM

Implementation of submandibular gland transfer: A multi‐institutional study of feasibility and time to treatment

Abstract

Background

Submandibular gland transfer (SMGT) mitigates radiation‐induced xerostomia but has yet to be widely adopted. We evaluate the feasibility of incorporating SMGT at multiple academic institutions and report the incidence of treatment delay.

Methods

Forty‐nine patients were identified who underwent SMGT. Time points pertaining to diagnosis and key treatment events including SMGT, surgery, chemotherapy, and radiation were extracted. Treatment delay was defined as either >60 days from diagnosis to definitive therapy or >6 weeks between surgery and adjuvant therapy.

Results

Median time from diagnosis to primary treatment was 42 days (IQR, 32‐54). Median time from surgery to adjuvant therapy was 33 days (IQR, 28‐47). Delay in starting treatment was observed in 7/49 patients (14%). Six patients incurred a delay in postoperative radiation therapy (6/19; 32%).

Conclusions

With appropriate care coordination, SMGT can be implemented into a clinical pathway with a goal of decreasing radiation‐induced xerostomia without increasing treatment delays.

http://bit.ly/2HUaFeJ