21.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Jan;34(1):73-78. doi: 10.13201/j.issn.1001-1781.2020.01.018.
[Misdiagnosis analysis: 120 patients with nasal extranodal NK/T cell lymphoma in head and neck].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective:The Clinicopathological characteristics and the reason of misdiagnosis about nasal extranodal NK/T cell lymphoma in head and neck（ENKTL） are analysised to raise awareness and reduce misdiagnosis. Method:One hundred and twenty patients with ENKTL, diagnosed pathologically in head and neck from May 2010 to April 2018, were analyzed retrospectively. All cases were divided into misdiagnosed group and non-misdiagnosed group according to whether there were misdiagnosis and mistreatment before diagnosis. The differences of clinicopathological characteristics between the two groups before and after diagnosis were compared. The differences of overall survival（OS） between the two groups after treatment were also compared. Result:The misdiagnosis rate of this study was 71.7%, and they were misdiagnosed as sinusitis, nasal polyps, upper respiratory tract infection and so on. On the whole, the 1-year OS, 3-year OS and 5-year OS were 77.8%, 65.9% and 49.3% respectively. There was no significant difference in sex, age, first symptom, initial site, B symptom, superficial lymph node enlargement and weight loss between two groups before diagnosis（P>0.05）, however, there were significant differences in relative specific signs, hospital grade and time from first visit to definite diagnosis（P<0.05）. The proportion of the high-level hospitals in the first visit hospital was significantly lower than that in the non-misdiagnosed group, while the time from the first visit to the final diagnosis was significantly longer than that in the non-misdiagnosed group. There was no significant difference in international prognostic index（IPI） score, expression of Ki-67, therapeutic schedule, chemotherapy regimen for patients receiving chemotherapy, and radiation dose for patients receiving radiotherapy after diagnosis between the two groups（P>0.05）, but there was a significant difference in the clinical stages of Ann Arbor between the two groups（P<0.05）. The clinical staging of the misdiagnosed group was later than that of the non-misdiagnosed group. The 1-year OS, 3-year OS and 5-year OS were 73.6%, 59.3% and 43.2% in the misdiagnosed group respectively, and 88.2%, 82.4% and 64.2% in the non-misdiagnosed group respectively. The overall survival rate in the misdiagnosis group was lower than that in the non-misdiagnosed group, and the overall survival time was lower than that in the non-misdiagnosed group. However, there was no significant difference in the overall survival rates between the early stage（Ⅰ and Ⅱ） and the advanced stage（Ⅲ and Ⅳ） of Ann Arbor（P>0.05）. Conclusion:The non-specific clinical and the complexity of pathological features of ENKTL in head and neck might cause misdiagnosis, which leads to prolonged time from first visit to definite diagnosis, thus results in disease progression, and ultimately may lead to decreased overall survival rate. To avoid the misdiagnosis and early diagnosis is very important.
Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.
KEYWORDS:
T cells; extranodal NK-T-cell; lymphoma; misdiagnose; natural killer cells
22.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Jan;34(1):70-72;78. doi: 10.13201/j.issn.1001-1781.2020.01.017.
[Analysis of transcanal endoscopic ear surgery for antrum cholesteatoma].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective:To report surgical techniques, outcomes, clinical experience and application key point of transcanal endoscopic ear surgery for tympanic antrum cholesteatoma. Method:Data from 27patients who underwent transcanal endoscopic ear surgery for tympanic antrum cholesteatoma were retrospectively analyzed. Removal of tympanic antrum cholesteatoma and tympanoplasty were individualized. Patients were followed up at postoperative 1, 3 and 6month. Result:There was no failure of tympanal and canal wall reconstruction. The mean preoperative air conduction threshold was（50.33±7.34） dB HL, compared to（29.59±5.56） dB HL postoperatively P=0.00）. The mean preoperative air-bone gap was（29.13±4.70） dB, compared to（12.25±4.98） dB postoperatively（P=0.00）. There was no complication, recurrence, residual tympanic antrum cholesteatoma or secondary surgery needed. Conclusion:Stand alone transcanal endoscopic ear surgery is a safe and effective for tympanic antrum cholesteatoma.
Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.
KEYWORDS:
endoscopic ear surgery; middle ear cholesteatoma; tympanic antrum
23.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Jan;34(1):64-69. doi: 10.13201/j.issn.1001-1781.2020.01.016.
[Knockout notch1 gene can enhanced radiosensitivity of nasopharyngeal carcinoma cells].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective:To investigate the effect of Notch1 gene on radiosensitivity of nasopharyngeal carcinoma cells and its molecular mechanism. Method:A Notch1-knockout CNE-2 cell line was constructed using CRISPR/Cas9 system, and the expression of Notch1 gene was detected by RT-PCR and Western blot. After treatment with different doses of radiation, the survival fraction （SF） of each group was calculated, and used the GraphPad Prism 6.0 software and the Linear quadratic model were used to calculate the fitted dose survival curve and the sensitivity enhancement ratio（SER）. Taking 6 Gy as radiation dose, the experiment was divided into four groups: Notch1（+） group, Notch1（-） group, IR+Notch1（+） group and IR+Notch1（-） group. CCK-8 assay was used to detect cell proliferation in each group. Annexin V-FITC/PI double staining assay was used to detect the changes of apoptosis in each group. The expression of H2AX, CyclinD1, Bax, Bcl-2 and GAPDH proteins were detected by Western blot. Result:The CNE-2 cell line with Notch1 gene knockout was successfully constructed. The clonogenic assay showed knockout of Notch1 enhanced the radiosensitivity of NPC cells. The CCK-8 assay showed that cell proliferation and cell viability were significantly reduced in the IR+Notch1（-） group compared with the IR+Notch1（+） group（P<0.05）. Annexin V-FITC/PI double staining assay showed that the IR+Notch1（-） group had the highest apoptosis rate compared with the other groups （P<0.05）. Western blotting demonstrated that the expression of γH2AX was significantly increased after irradiation of Notch1 nasopharyngeal carcinoma cells, the expression of Cyclin-D1 was increased, and the ratio of Bax:Bcl-2 was higher. Conclusion:Knockout of Notch1 signaling molecule can effectively improve the radiosensitivity of NPC cells cultured in vitro, which may be a potential target for radiosensitization of NPC.
Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.
KEYWORDS:
Cyclin D1; Notch1; knockout; nasopharyngeal carcinoma; radiosensitivity; γH2AX
24.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Jan;34(1):60-63. doi: 10.13201/j.issn.1001-1781.2020.01.015.
[Clinical observation of nasal spray allergen blocker combined with antihistamines in treatment of allergic rhinitis children].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective:To investigate the clinical effect and safety of nasal spray allergen blocker combined with antihistamines in children with allergic rhinitis. Method:Eighty-four children with mild-severe allergic rhinitis were randomly divided into observation group（42 cases） and control group（42 cases）. Children in control group were treated with azelastine hydrochloride nasal spray, while children in observation group added with nasal spray allergen blocker on the basis of control group. Both groups were treated for 4 weeks. The changes of symptoms and signs integral in both groups were compared and analyzed after 1, 2 and 4 weeks treatment. And Clinical efficacy and adverse reactions between two groups were compared after treatment. Result:Among 4 weeks treatment, the symptoms and signs integral of the two groups showed a significant decreasing trend（P<0.01）. The reduction in the observation group was greater than that in the control group, there were statistical differences in the variation trends of symptoms and signs integral between the two groups（P<0.01, P<0.05）. And there were significant differences in symptoms and signs integral between the two groups（P<0.05）. The total effective rate of observation group（90.5%） was significantly higher than that of control group（64.3%）（P<0.05）. There was no statistically significant difference in the incidence of adverse reactions between the two groups（9.5%vs 4.8%, P>0.05）. Conclusion:The effect of nasal spray allergen blocker combined with antihistamines on allergic rhinitis children is remarkable. They can alleviate the symptoms and signs of allergic rhinitis with rapidity and safety.
Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.
KEYWORDS:
allergen blocker; azelastine hydrochloride; child; rhinitis, allergic
25.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Jan;34(1):53-56. doi: 10.13201/j.issn.1001-1781.2020.01.013.
[Effect of sublingual immunotherapy on patients with allergic rhinitis].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective:Study the efficacy of sublingual immunotherapy （SLIT） for monosensitized and polysensitized allergic rhinitis patients of different severity. Method:According to the results of intradermal experiments, 186 patients with AR who were treated with standardized dust mites SLIT for 2 years. These patients have been divided into mild monosensitized group and mild polysensitized group, moderate monosensitized group and moderate polysensitized group, severe monosensitized group and severe polysensitized group. Statistics and analysis of total nasal symptom score （TNSS）, total medication score （TMS） , visual analog scale （VAS） about before and after SLIT treatment. Result:Before SLIT treatment and after 2 years, the TNSS: Mild monosensitized group （5. 58±1. 68）（0. 58±0. 75）, mild polysensitized group（5. 34±1. 49）（0. 93±0. 75）;moderate monosensitized group （4. 68±1. 55）（0. 32±0. 63）, moderate polysensitized group（6. 26±1. 46）（0. 61±0. 67）,which have showed a statistically significant difference（P<0.05）,between the two groups have no significant difference （P>0.05）. Severe monosensitized group（6. 26±0. 73）（1. 16±1. 13）, severe polysensitized group（6. 49±1. 04）（1. 89±1. 07）, which have showed a statistically significant difference（P<0.05）, between the two groups have a statistically significant difference（P<0.05）. The VAS:Mild monosensitized group （6. 09±1. 23）（1. 52±1. 25）, mild polysensitized group（6. 21±0. 90）（1. 97±1. 18）,moderate monosensitized group（6. 12±0. 53）（1. 16±1. 03）, moderate polysensitized group（6. 65±1. 08）（1. 65±0. 98）,which have showed a statistically significant difference（P<0.05）,between the two groups have no significant difference （P>0.05）. Severe monosensitized group（6. 26±0. 73）（1. 16±1. 13）, severe polysensitized group（6. 49±1. 04）（1. 89±1. 07）, which have showed a statistically significant difference（P<0.05）, between the two groups have a statistically significant difference（P<0.05）. The TMS:These have showed a statistically significant difference（P<0.05）with same group,between all groups have no significant difference （P>0.05）. Conclusion:Dust mites under the SLIT are effective for monosensitized and polysensitized allergic patients. For patients with severe polysensitized , it is necessary to extend the treatment time （>2 years）.
Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.
KEYWORDS:
rhinitis, allergic; sublingual immunotherapy
26.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Jan;34(1):49-52. doi: 10.13201/j.issn.1001-1781.2020.01.012.
[Effectiveness of spirolactone on the treatment of laryngeal edema and complications after H-uvulopalatopharyngoplasty for patients with obstructive sleep apnea].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective:To determine whether taking spirolactone orally after H-UPPP may relieve laryngeal edema and complications for patients with obstructive sleep apnea（OSA）. Method:Fifty patients with OSA to undergo H-UPPP operation were randomly divided equally to the intervention group（taking spirolactone 20 mg orally twice a day for 7 days after H-UPPP） or the control group, all patients received conventional therapy after H-UPPP including anti-infection, hemostatic treatment, fluid replacement and expectorant by fogged absorption. The pharyngeal wound, diet, sleep and speaking pronunciation of all patients in each group were evaluated every other day in 7 days postoperation. The minimum oxygen saturation of blood（SaO2） during sleep at night each day and the period needed for staphyledema resolution of all patients were recorded and compared between each group. Result:Postoperatively, the intervention group had significantly slighter bleeding at wound site, better sleep and more legible speaking pronunciation than the control group after 3 days to 5 days（P<0.05）. The wound dehiscence of the intervention group was significantly slighter than the control group within 7 days after operation（P<0.05）. During 3 days to 7days after operation, the intervention group had a significantly better diet than the control group（P<0.05）. The average minimum SaO2during sleep at night in the intervention group was significantly higher than that in the control group from 3 days to 5 days post operation（P<0.05）. Period needed for staphyledema resolution in the intervention group（4.1±1.5） days was significantly shorter than that in the control group（5.9±1.8） days （P<0.05）. Conclusion:Taking spirolactone orally after H-UPPP may relieve laryngeal edema and complications for OSA patients, and it will also shorten the period needed for staphyledema resolution.
Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.
KEYWORDS:
H-uvulopalatopharyngoplasty; complications; laryngeal edema; sleep apnea, obstructive; spirolactone
27.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Jan;34(1):45-48. doi: 10.13201/j.issn.1001-1781.2020.01.011.
[Clinical analysis of missed diagnostic congenital cholesteatoma].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective:The clinical symptoms, imaging features and surgical treatment of congenital cholesteatoma are reported. Method:The clinical data of 20 patients with congenital cholesteatoma diagnosed and treated in our hospital from January 2016 to May 2018 were retrospectively analyzed, including the age of onset, clinical symptoms, signs, audiology, HRCT of temporal bone, surgical methods and so on. Result:In 20 patients with congenital cholesteatoma, the clinical manifestations were hearing loss in the affected ears, including 5 cases with ear fullness and 4 cases with tinnitus. There were 13 cases of local yellow-white shadow of tympanic membrane, 5 cases of normal tympanic membrane and 2 cases of tympanic membrane bombe. Pure tone audiometry showed conductive deafness in 14 cases and mixed deafness in 6 cases. CT scan of temporal bone showed that 15 cases had pneumatic type of mastoid, 4 cases had diploectic type and 1 case had sclerostic type. There were 15 cases of interspersed flocculent shadow and 5 cases of mass shadow. Among the 20 cases of chronic otitis media with cholesteatoma, 6 have cholesteatoma in epitympanum, 4 in tympanic cavity, 3 in tympanic cavity and epitympanum, 2 in mastoid and tympanic antrum, 1 in mastoid, tympanic antrum and tympanic cavity, 1 in tympanic antrum, tympanic cavity and petrous apex, 1 in tympanic cavity, hypotympanum, posterior tympanum and ostium tympanicum tubae auditivae, 1 in aditus ad antrum, epitympanum and posterior tympanum, 1 in tympanic cavity, epitympanum and posterior tympanum. Intact canal wall mastoidectomy and tympanoplasty were performed in 7 cases, open mastoidectomy and tympanoplasty in 5 cases, middle ear exploration and tympanoplasty in 4 cases, atticotomy with reconstruction and tympanoplasty in 3 cases and subtotal temporal bone resection in 1 case. Conclusion:For patients with intact tympanic membrane presenting with hearing loss, the tympanic membranes should be carefully examined, and thin-section CT and MRI of temporal bone should be performed in time to avoid missed diagnosis of congenital cholesteatoma. Once diagnosed, surgery should be performed as soon as possible.
Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.
KEYWORDS:
cholesteatoma; diagnosis; treatment
28.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Jan;34(1):41-44. doi: 10.13201/j.issn.1001-1781.2020.01.010.
[Comparative study on the EPLAD of profoundly deaf children with hearing aid fittings or cochlear implantations at the same age].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective:The purpose of the current study was to provide good clinical values for rehabilitation exercises and counseling of hearing impaired children by comparing the early prelingual auditory development（EPLAD） of children with hearing aid fittings or cochlear implantations at the same age. Method:Longitudinal evaluation of EPLAD, profoundly deaf children, who received hearing aid fittings or cochlear implantations at 2 years of age, were recruited in this study, and would be tested with Infant-toddler meaningful auditory integration scale（IT-MAIS） at 3, 6 and 12 months after intervention. One hundred and four children were recruited in this study and divided into two groups based on the types of devices: Cochlear implant group（CI group） and Hearing aid group（HA group）. Each child could be permitted to miss follow-up one time. Result:The IT-MAIS scores of children in both groups improved with increasing wear time. The scores in CI group showed a statistically significant improvement between each interval after switch-on（P=0.000）. However, there was just a statistical difference between overall scores at 3 and 12 months after fitting in HA group（P=0.042）. In addition, the IT-MAIS scores of the two groups were statistically significant at 6 and 12 months after switch-on/fitting（P=0.026, P=0.005）. Simultaneously, the mean overall score of children in CI group at 12 months after switch-on approached the average level of unaided peers with mild hearing loss. However, the mean score at 12 months after fitting was close to the average level of unaided peers with moderate hearing loss. Conclusion:Both of CI and HA could improve EPLAD of profoundly deaf children. However, the EPLAD of CI children could improve faster in the first year after switch-on. And the results would also provide more comprehensive clinical values for rehabilitation and counseling of hearing impaired children by comparing to normal and unaided hearing impaired children.
Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.
KEYWORDS:
cochlear implant; deafness; early prelingual auditory development; hearing aid; infant-toddler meaningful auditory integration scale
29.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Jan;34(1):36-40. doi: 10.13201/j.issn.1001-1781.2020.01.009.
[Distribution of allergens and associated risk factors of patients with allergic rhinitis in Qingdao area].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective:To analyze the distribution of allergens and the risk factors in patients with allergic rhinitis in Qingdao area. Method:Two hundred and sixteen patients diagnosed with allergic rhinitis and 49 healthy volunteers were admitted to the outpatient clinic of the Otolaryngology Department of the three branches of Qingdao University Affiliated Hospital in Qingdao from August 2018 to March 2019. A total of 271 patients（5-84 years old） were included in the epidemiological investigation. The study conducted a skin stinging test of inhalation allergens. In addition, the questionnaire of allergic disease and self-examination of dust mite allergy were carried out for each group of patients, and the results were analyzed and counted. Result:①In 216 patients with allergic rhinitis, the top six inhalation allergens were dust mites（55.0%）, house dust mites（46.1%）, tropical mites（21.8%）, dog hair（16.6%）, Artemisia halodendron（13.3%）, and German cockroaches（10.3%）. ②Inhalation allergens, the degree of positive of house dust mites and dust mites were mainly（+++）, the degree of positive of Artemisia halodendron were mainly（+++） and（++++）, and the degree of positive of other allergens were mainly（++）. ③There were statistically significant differences in the positive rates of inhalation allergens in different age groups, and the positive rates of inhalation allergens gradually decreased with age after adulthood. ④The single factor and multi-factor logical regression analysis all showed that the history of smoking, family history, age less than 18 years, and 18-40 years old were closely related to the occurrence of allergic rhinitis（P<0.05）. ⑤Using Spearson-related analysis and loess regression analysis, it was found that with the increase of dust mite self-examination score, the positive rate of dust mite increased significantly. Conclusion:The most important inhalation allergens of patients with allergic rhinitis in Qingdao area are dust mites, dog hair and artemisinin. The positive rate of inhalation allergens is influenced by age and there are certain rules in them. Smoking history, family history, age and other factors are risk factors for allergic rhinitis. The dust mite self-examination score can predict the occurrence of dust mite allergy.
Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.
KEYWORDS:
Logitic regression analysis; inhalation allergens; pethogenic factors; rhinitis, allergic
30.
Clin Otolaryngol. 2020 Feb 21. doi: 10.1111/coa.13515. [Epub ahead of print]
Ethmoidal drug-eluting stent therapy is not superior to nasal corticosteroid spray in the prevention of endoscopic sinus surgery: results from a randomized, clinical trial.
Abstract
OBJECTIVES:
To evaluate whether an ethmoidal drug-eluting stent (DES) (the Relieva StratusTM MicroFlow Spacer) could better prevent endoscopic sinus surgery (ESS) than standard non-invasive therapy using corticosteroid nasal spray in patients suffering from chronic rhinosinusitis (CRS).
DESIGN:
Prospective, randomised clinical trial.
SETTING:
Tertiary referral centre.
PARTICIPANTS:
Sixty-three adult patients with ethmoidal involvement in cone beam computed tomography (CBCT) whose first-line medical treatment with topical corticosteroids had failed and who were candidates for ESS were randomised either to a DES group, which received triamcinolone acetonide stents (n=34), or to a topical intranasal corticosteroid group (n=29) that used optimally dosed triamcinolone acetonide nasal spray.
OUTCOME MEASURES:
Patients were followed up prospectively for six months and at 36 months. Freedom from ESS was the primary endpoint. Further, we identified those factors predicting ESS.
RESULTS:
At 6 months, ESS could be prevented in almost half of the patients in both groups (DES 13/28, 46.4%, nasal spray 14/29, 48.3%). At 36 months, 20/28 (71.4%) patients in the DES group and 18/29 (62.1%) in the nasal spray group had been operated. The differences were not statistically significant at either timepoint. Patients who smoked (14/19, 73.7% vs 16/38, 42.1%) were more likely to be operated at 6 months.
CONCLUSION:
ESS can be prevented using both therapies in the medium term in almost half of cases with neither therapy being statistically superior. This effect was somewhat diminished in the long term with a trend towards more patients being operated in the DES group. Considering the additional costs, the need for general anesthesia and the potential side effects associated with DES, its potential clinical role appears to be limited. Smoking was significantly associated with ESS.
This article is protected by copyright. All rights reserved.
KEYWORDS:
Chronic rhinosinusitis; Relieva Stratus Micro Flow Spacer; drug-eluting stent; endoscopic sinus surgery; ethmoiditis; nasal corticosteroids; smoking; steroid-eluting stent
31.
Clin Otolaryngol. 2020 Feb 22. doi: 10.1111/coa.13516. [Epub ahead of print]
W21Assessment of Bilateral Vocal Fold Immobility Prior to Selective Bilateral Laryngeal Reinnervation.
Abstract
Prior to selective bilateral laryngeal reinnervation there must be no inspiratory PCA laryngeal EMG activity. The only way to properly assess for cricoarytenoid joint ankylosis and interarytenoid synechiae is under deep paralysis. Use respiratory auscultation to confirm paradoxical inspiratory adduction versus purposeful adduction.
This article is protected by copyright. All rights reserved.
32.
Cancer Immunol Immunother. 2020 Feb 21. doi: 10.1007/s00262-020-02524-9. [Epub ahead of print]
Phosphorylated vimentin as an immunotherapeutic target against metastatic colorectal cancer.
Ohara M1,2, Ohara K1,3, Kumai T4,5,6, Ohkuri T7, Nagato T1, Hirata-Nozaki Y1,3, Kosaka A1, Nagata M1, Hayashi R1,3, Harabuchi S1,3, Yajima Y1, Oikawa K1, Harabuchi Y3, Sumi Y2, Furukawa H2, Kobayashi H1.
Abstract
Colorectal cancer (CRC) patients with metastatic lesions have low 5-year survival rates. During metastasis, cancer cells often obtain unique characteristics such as epithelial-mesenchymal transition (EMT). Vimentin a biomarker contributes to EMT by changing cell shape and motility. Since abnormal phosphorylation is a hallmark of malignancy, targeting phosphorylated vimentin is a feasible approach for the treatment of metastatic tumors while sparing non-tumor cells. Recent evidence has revealed that both CD8 cytotoxic T lymphocytes (CTLs) and also CD4 helper T lymphocytes (HTLs) can distinguish post-translationally modified antigens from normal antigens. Here, we showed that the expression of phosphorylated vimentin was upregulated in metastatic sites of CRC. We also showed that a chemotherapeutic reagent augmented the expression of phosphorylated vimentin. The novel phosphorylated helper peptide epitopes from vimentin could elicit a sufficient T cell response. Notably, precursor lymphocytes that specifically reacted to these phosphorylated vimentin-derived peptides were detected in CRC patients. These results suggest that immunotherapy targeting phosphorylated vimentin could be promising for metastatic CRC patients.
KEYWORDS:
CD4 T cell; Colorectal cancer; Epitope; Phosphorylation; Post-translational modification; Vimentin
33.
Mol Cancer Res. 2020 Feb 21. pii: molcanres.0726.2019. doi: 10.1158/1541-7786.MCR-19-0726. [Epub ahead of print]
Cdc42 mediates cancer cell chemotaxis in perineural invasion.
Chernichenko N1, Omelchenko T2, Deborde S1, Bakst R3, He S4, Chen CH1, Gusain L5, Vakiani E6, Katabi N7, Hall A8, Wong RJ9.
Abstract
Perineural invasion (PNI) is an ominous form of cancer progression along nerves associated with poor clinical outcome. Glial derived neurotrophic factor (GDNF) interacts with cancer cell RET receptors to enable PNI, but downstream events remain undefined. We demonstrate that GDNF leads to early activation of the GTPase Cdc42 in pancreatic cancer cells, but only delayed activation of RhoA and does not affect Rac1. Depletion of Cdc42 impairs pancreatic cancer cell chemotaxis towards GDNF and nerves. An siRNA library of guanine nucleotide exchange factors was screened to identify activators of Cdc42. ARHGEF7 (β-Pix) was required for Cdc42 activation and chemotaxis towards nerves, and also co-localizes with RET under GDNF stimulation. Cdc42 enables PNI in an in vitro dorsal root ganglia (DRG) co-culture model, and controls the directionality of migration but does not affect cell speed or cell viability. In contrast, Rac1 was necessary for cell speed but not directionality, while the RhoA was not necessary for either cell speed or directionality. Cdc42 was required for PNI in an in vivo murine sciatic nerve model. Depletion of Cdc42 significantly diminished the length of PNI, volume of PNI, and motor nerve paralysis resulting from PNI. Activated Cdc42 is expressed in human salivary ductal cancer cells invading nerves. These findings establish the GDNF-RET-β-Pix-Cdc42 pathway as a directional regulator of pancreatic cancer cell migration towards nerves, highlight the importance of directional migration in PNI, and offer novel targets for therapy. Implications: The GTPase Cdc42 drives directional migration of pancreatic cancer cells towards nerves.
Copyright ©2020, American Association for Cancer Research.
34.
J Clin Virol. 2020 Feb 11;125:104287. doi: 10.1016/j.jcv.2020.104287. [Epub ahead of print]
Viral shedding, and distribution of cytomegalovirus glycoprotein H (UL75), glycoprotein B (UL55), and glycoprotein N (UL73) genotypes in congenital cytomegalovirus infection.
Puhakka L1, Pati S2, Lappalainen M3, Lönnqvist T4, Niemensivu R5, Lindahl P6, Nieminen T7, Seuri R8, Nupponen I9, Boppana S10, Saxen H7.
Abstract
BACKGROUND:
Children with congenital CMV infection (cCMV) shed virus in urine and saliva for prolonged periods of time. Outcome of cCMV varies from asymptomatic infection with no sequelae in most cases, to severe longterm morbidity. The factors associated with asymptomatic cCMV are not well defined. We evaluated the viral shedding in a cohort of infants with cCMV identified on newborn screening. In addition, we describe the distribution of viral genotypes in our cohort of asymptomatic infants and previous cohorts of cCMV children in the literature.
METHODS:
Study population consisted of 40 children with cCMV identified in screening of 19,868 infants, a prevalence of 2/1000. The viral shedding was evaluated at 3 and 18 months of age by real-time CMV-PCR of saliva and plasma, and CMV culture of urine. CMV positive saliva samples were analyzed for genotypes for CMV envelope glycoproteins gB (UL55), and gH (UL75) by genotype specific real-time PCR, and gN (UL73) by cloning and sequencing RESULTS: At 3 months age 40/40 saliva and urine samples, and 19/40 plasma samples were positive for CMV. At 18 months age all urine samples tested (33/33), 9/37 of saliva samples, and 2/34 plasma samples were positive for CMV. The genotype distribution did not differ from the published data CONCLUSIONS: The urinary virus shedding is more persistent than salivary shedding in children with cCMV. The genotype distribution was similar to previous literature and does not explain the low disease burden of cCMV in our population.
Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.
KEYWORDS:
Asymptomatic; Congenital CMV; Cytomegalovirus; Genotype; Screening; Symptomatic
35.
Int J Pediatr Otorhinolaryngol. 2020 Feb 9;133:109943. doi: 10.1016/j.ijporl.2020.109943. [Epub ahead of print]
Cost-effectiveness of polysomnography in the management of pediatric obstructive sleep apnea.
Abstract
OBJECTIVES:
At our institution, younger children require polysomnography (PSG) testing to confirm obstructive sleep apnea (OSA hereafter) before surgical intervention by adenotonsillectomy (T&A). Given that sleep studies can be costly, we investigated the cost-effectiveness of PSG as well as the possible role for symptom documentation in evaluation for T&A.
METHODS:
Pediatric patients age 1-3 years who received PSG testing between Jan. 2015 and Jan. 2016 who had not previously had T&A were identified for retrospective cost analysis. Cost data were obtained from institutional accountants. We defined a positive PSG as obstructive apnea-hypopnea index ≥1. Logistic regression analysis was used, and statistical significance was set a priori at p < 0.05. Sensitivities and specificities of symptom documentation screen for OSA were compared to gold standard, or PSG testing.
RESULTS:
Of the 176 children who received polysomnography testing, 140 (80%) had a positive PSG indicative of OSA. Seventy-one (51%) children with OSA underwent T&A within 1 year of PSG, and 10 (7%) eventually received T&A after 1 year from PSG date. Of the children whose PSG results were negative (n = 36), 14 (39%) still underwent T&A within 1 year (n = 7, 19%) or later (n = 7, 19%). Children with positive sleep studies were significantly more likely to receive T&A within one year of PSG (p = 0.0006) and at any time after PSG (p = 0.04). Hospital costs for T&A varied widely while PSG costs were fairly consistent. Using average institutional costs of T&A and PSG, the total cost of a T&A was 17.7× the cost of PSG testing. Using number of recorded symptoms to diagnose OSA instead of PSG testing yielded low specificities.
CONCLUSION:
Fifty-eight percent of patients with OSA and 39% of patients without OSA had a T&A within 1 year or later, although positive PSG was significantly associated with a higher likelihood of receiving T&A. Given costs at this institution and current decision-making practices, 147 PSGs would need to be done to account for the cost of one T&A, which in our cohort would occur after approximately 305 days.
Copyright © 2020 Elsevier B.V. All rights reserved.
KEYWORDS:
Adenotonsillectomy; Cost-effectiveness; Pediatric obstructive sleep apnea; Polysomnography; Tonsillectomy
36.
Acta Oncol. 2020 Feb 21:1-4. doi: 10.1080/0284186X.2020.1730005. [Epub ahead of print]
Treatment outcomes of patients with salivary duct carcinoma undergoing surgery and postoperative radiotherapy.
37.
Cancers (Basel). 2020 Feb 18;12(2). pii: E470. doi: 10.3390/cancers12020470.
Transcriptome Analysis Identifies ALCAM Overexpression as a Prognosis Biomarker in Laryngeal Squamous Cell Carcinoma.
Nicolau-Neto P1, de Souza-Santos PT2, Severo Ramundo M1, Valverde P3, Martins I3, Santos IC4, Dias F4, de Almeida Simão T5, Ribeiro Pinto LF1,5.
Abstract
BACKGROUND:
Laryngeal squamous cell carcinoma (LSCC) is one of the most incident tumors in the world, especially in developing countries, such as Brazil. Different from other tumors, LSCC prognosis did not improve during the past four decades. Therefore, the objective of this study was to develop biomarkers that can predict LSCC patient's prognosis.
RESULTS:
Transcriptome analysis pointed out 287 overexpressed genes in LSCC in comparison to adjacent mucosa. Among these, a gene-pattern signature was created with 24 genes associated with prognosis. The Bayesian clustering of both Brazil and The Cancer Genome Atlas (TCGA) data pointed out clusters of samples possessing significative differences in the prognosis, and the expression panel of three genes (ALCAM, GBP6, and ME1) was capable to distinguish patients with worse prognosis with an accuracy of 97%. Survival analyses with TCGA data highlighted ALCAM gene expression as an independent prognostic factor for LSCC. This was further confirmed through immunohistochemistry, using a validation set of Brazilian patients. ALCAM expression was not associated with prognosis for other head and neck tumor sites.
CONCLUSION:
ALCAM overexpression seems to be an independent prognosis biomarker for LSCC patients.
KEYWORDS:
ALCAM; laryngeal squamous cell carcinoma; prognostic biomarker; transcriptome analysis
38.
Molecules. 2020 Feb 18;25(4). pii: E901. doi: 10.3390/molecules25040901.
Moscatilin Induces Apoptosis in Human Head and Neck Squamous Cell Carcinoma Cells via JNK Signaling Pathway.
Abstract
Dendrobii Herba is an herbal medicine that uses the stems of Dendrobium species (Orchidacea). It has been traditionally used to treat fever, hydrodipsomania, stomach disorders, and amyotrophia. In our previous study, a bibenzyl compound, moscatilin, which is isolated from Dendrobii Herba, showed potent cytotoxicity against a FaDu human pharyngeal squamous carcinoma cell line. Prompted by this finding, we performed additional studies in FaDu cells to investigate the mechanism of action. Moscatilin induced FaDu cell death by using 5 μM of concentration and by mediating apoptosis, whereas cell proliferation following treatment with 1 μM of moscatilin was not suppressed to the same levels as by the anti-cancer agent, cisplatin. Apoptosis-related protein expression (cleaved caspase-8, cleaved caspase-7, cytochrome c, cleaved caspase-9, cleaved caspase-3, and poly (ADP-ribose) polymerase (PARP) was increased by treating with 5 μM of moscatilin. This suggests that moscatilin-mediated apoptosis is associated with the extrinsic and intrinsic apoptotic signaling pathways. In addition, moscatilin-induced apoptosis was mediated by the c-Jun N-terminal kinase (JNK) signaling pathway. Overall, this study identified additional biological activity of moscatilin derived from natural products and suggested its potential application as a chemotherapeutic agent for the management of head and neck squamous cell carcinoma.
KEYWORDS:
Dendrobium; FaDu; apoptosis; head and neck squamous cell carcinoma; moscatilin
39.
Cancers (Basel). 2020 Feb 18;12(2). pii: E467. doi: 10.3390/cancers12020467.
Dual PI3K/mTOR Inhibitor NVP-BEZ235 Enhances Radiosensitivity of Head and Neck Squamous Cell Carcinoma (HNSCC) Cell Lines Due to Suppressed Double-Strand Break (DSB) Repair by Non-Homologous End Joining.
Schötz U1, Balzer V1, Brandt FW1, Ziemann F1, Subtil FSB1, Rieckmann T2,3, Köcher S2, Engenhart-Cabillic R1, Dikomey E1,2, Wittig A1,4, Arenz A1.
Abstract
The PI3K/Akt/mTOR pathway is frequently altered in human papillomavirus (HPV)-positive and negative squamous cell carcinoma of the head and neck (HNSCC) and overstimulation is associated with poor prognosis. PI3K drives Akt activation and constitutive signaling acts pro-proliferative, supports cell survival, DNA repair, and contributes to radioresistance. Since the small molecule NVP-BEZ235 (BEZ235) is a potent dual inhibitor of this pathway, we were interested whether BEZ235 could be an efficient radiosensitizer. The 50 nM BEZ235 was found to abrogate endogenous and irradiation-induced phosphorylation of Akt (Ser473). The anti-proliferative capacity of the drug resulted in an increase in G1-phase cells. Repair of radiation-induced DNA double-strand breaks (DSBs) was strongly suppressed. Reduction in DSB repair was only apparent in G1- but not in G2-phase cells, suggesting that BEZ235 primarily affects non-homologous end joining. This finding was confirmed using a DSB repair reporter gene assay and could be attributed to an impaired phosphorylation of DNA-PKcs (S2056). Cellular radiosensitivity increased strongly after BEZ235 addition in all HNSCC cell lines used, especially when irradiated in the G0 or G1 phase. Our data indicate that targeting the PI3K/Akt/mTOR pathway by BEZ235 with concurrent radiotherapy may be considered an effective strategy for the treatment of HNSCC, regardless of the HPV and Akt status.
KEYWORDS:
Akt; BEZ235; DNA-PKcs; HNSCC; radiation; radioresistance; radiosensitizer
40.
Ann Oncol. 2019 May;30 Suppl 3:iii68. doi: 10.1093/annonc/mdz101.010. Epub 2020 Jan 8.
Compromised cancer-specific survival among under-insured Chinese patients with breast cancer: A prospective cohort study.
41.
Ann Oncol. 2019 May;30 Suppl 3:iii67-iii68. doi: 10.1093/annonc/mdz101.009. Epub 2020 Jan 8.
Second malignancies with breast cancer: An audit.
Srinivasalu VK1, Subramaniam N2, K S S3, V A3, Kolathu S3, D K VK4, Philip A5, Jose WM6, Kunheri B7, Pavithran K5.
42.
Ann Oncol. 2019 May;30 Suppl 3:iii14. doi: 10.1093/annonc/mdz095.041. Epub 2020 Jan 8.
Painting the global picture of HER2-testing for breast cancer. The ONCOLLEGE-001 survey study.
Altuna SC1, Lengyel C2, Trapani D3, Elfaham EM4, Hussain S5, Petrillo A6, El Bairi K7, Mazher SA8, Habeeb BS9, Khan SZ10.
43.
PLoS One. 2020 Feb 21;15(2):e0229311. doi: 10.1371/journal.pone.0229311. eCollection 2020.
The role of Glial cell derived neurotrophic factor in head and neck cancer.
Cao H1, He Q1, Eyben RV1, Bloomstein J1, Nambiar DK1, Viswanathan V1, Aggarwal S1, Kwok S2, Liang R2, Koong AJ2, Lewis JS Jr3, Kong C2, Xiao N4, Le QT1.
Abstract
Glial cell-derived neurotrophic factor (GDNF) is reported to promote the survival of neurons and salivary gland regeneration after radiation damage. This study investigated the effect of GDNF on cell migration, growth, and response to radiation in preclinical models of head and neck squamous cell carcinoma (HNSCC) and correlated GDNF expression to treatment outcomes in HNSCC patients. Our ultimate goal is to determine whether systemic administration of GDNF at high dose is safe for the management of hyposalivation or xerostomia in HNSCC patients. Three HPV-positive and three HPV-negative cell lines were examined for cell migration, growth, and clonogenic survival in vitro and tumor growth assay in vivo. Immunohistochemical staining of GDNF, its receptors GFRα1 and its co-receptor RET was performed on two independent HNSCC tissue microarrays (TMA) and correlated to treatment outcomes. Results showed that GDNF only enhanced cell migration in two HPV-positive cells at supra-physiologic doses, but not in HPV-negative cells. GDNF did not increase cell survival in the tested cell lines post-irradiation. Likewise, GDNF treatment affected neither tumor growth in vitro nor response to radiation in xenografts in two HPV-positive and two HPV-negative HNSCC models. High stromal expression of GDNF protein was associated with worse overall survival in HPV-negative HNSCC on multivariate analysis in a combined cohort of patients from Stanford University (n = 82) and Washington University (n = 189); however, the association between GDNF gene expression and worse survival was not confirmed in a separate group of HPV-negative HNSCC patients identified from the Cancer Genome Atlas (TCGA) database. Based on these data, we do not believe that GNDF is a safe systemic treatment to prevent or treat xerostomia in HNSCC and a local delivery approach such as intraglandular injection needs to be explored.
44.
PLoS One. 2020 Feb 21;15(2):e0229198. doi: 10.1371/journal.pone.0229198. eCollection 2020.
Imaging studies of bacterial biofilms on cochlear implants-Bioactive glass (BAG) inhibits mature biofilm.
Kirchhoff L1, Arweiler-Harbeck D2, Arnolds J2, Hussain T2, Hansen S2, Bertram R3, Buer J1, Lang S2, Steinmann J1,3, Höing B2.
Abstract
The capability of Pseudomonas aeruginosa and Staphylococcus aureus to form biofilm on varying CI component materials differs in the presence and absence of bioactive glass (BAG). The application of BAG induces significant changes in biofilm morphology which can be visualized via scanning electron microscopy (SEM). Bacterial biofilm formation on medical devices, such as cochlear implants (CI), can lead to chronic infections. Interestingly, BAG of type S53P4 seems to be a promising tool for use in the reduction of biofilm development. Primarily, four bacterial species known to cause implant-related infections, P.aeruginosa (ATCC9027), S. aureus (ATCC6538), Staphylococcus epidermidis (ATCC12228) and Streptococcus pyogenes (ATCC19615) were analyzed regarding their capacity to form biofilm on CI components manufactured from three kinds of material: silicone, platinum and titanium. Subsequently, P. aeruginosa and S. aureus biofilms were visualized using scanning electron microscopy, comparing BAG-treated biofilm with non-treated biofilm. The four bacterial species presented biofilm-forming capabilities in a species and surface dependent manner. Metal CI components allowed for the greatest proliferation of biofilm. S. aureus and P. aeruginosa showed the highest rate of biofilm formation on polystyrene surfaces. For both species, SEM revealed altered biofilm morphology after treatment of S53P4 BAG. This study indicates that bacterial biofilm formation and structure on CI components is dependent on the surface composition, altering between metal and silicone surfaces. After application of BAG, changes in biofilm morphology on CI components were observed. These data highlight the impact of BAG on bacterial biofilm morphology.
45.
J Infect Dev Ctries. 2019 Oct 31;13(10):945-947. doi: 10.3855/jidc.11057.
Thyroid abscess due to Eikenella corrodens in a pediatric patient.
Abstract
Eikenella corrodens is one of the HACEK bacteria that is commensal microorganism of the oropharngeal flora. E. corrodens has been increasingly reported to cause pyogenic abscesses, especially in diabetic or immunocompromised adults. It is less frequently reported in immunocompotent children. Here, we report a deep neck infection, including the thyroid gland, in a previously healthy girl. E. corrodens was the only microorganism isolated in two different cultures. Antibiotic susceptibility is variable, in contrast to other oropharyngeal pathogens. Thus, to avoid delayed treatment, E. corrodens should always be considered in infections of the head and neck area.
Copyright (c) 2019 Deniz Aygun, Beste Akdeniz, Gokhan Aygun, Haluk Cokugras, Yildiz Camcioglu.
KEYWORDS:
Eikenella corrodens; child; thyroid abscess
46.
J Clin Oncol. 2020 Feb 21:JCO1901937. doi: 10.1200/JCO.19.01937. [Epub ahead of print]
Impaired Immune Health in Survivors of Diffuse Large B-Cell Lymphoma.
Abstract
PURPOSE:
Therapeutic advances for diffuse large B-cell lymphoma (DLBCL) have led to an increasing number of survivors. Both DLBCL and its treatments perturb the immune system, yet little is known about immune health during extended survivorship.
METHODS:
In this retrospective cohort study, we compared 21,690 survivors of DLBCL from the California Cancer Registry (CCR) to survivors of breast, prostate, head and neck, and melanoma cancers. We linked their CCR records to a statewide database documenting hospital, emergency room, and ambulatory surgery visits and investigated the incidence of autoimmune conditions, immune deficiencies, and infections 1-10 years after cancer diagnosis.
RESULTS:
We found elevated incidence rate ratios (IRRs) for many immune-related conditions in survivors of DLBCL compared with other cancer survivors, including significantly and consistently elevated IRRs for viral and fungal pneumonias (up to 10.8-fold), meningitis (up to 5.3-fold), as well as humoral deficiency (up to 17.6-fold) and autoimmune cytopenias (up to 12-fold). IRRs for most conditions remained high even in the late survivorship period (5-10 years after cancer diagnosis). The elevated risks could not be explained by exposure to chemotherapy, stem-cell transplantation, or rituximab, except for IRRs for humoral deficiency, which were consistently higher after the incorporation of rituximab into DLBCL treatments.
CONCLUSION:
To our knowledge, this is the largest cohort study with extended follow-up to demonstrate impaired immune health in survivors of DLBCL. The observed persistent, elevated risks for autoimmune diseases, immune deficiencies, and infectious conditions may reflect persistent immune dysregulation caused by lymphoma or treatment and may lead to excess morbidity and mortality during survivorship. Improved understanding of these risks could meaningfully improve long-term care of patients with DLBCL.
47.
JCO Glob Oncol. 2020 Feb;6:269-276. doi: 10.1200/JGO.19.00286.
Infrastructural Challenges Lead to Delay of Curative Radiotherapy in Nigeria.
Abstract
PURPOSE:
In low- and middle-income countries, there has been an exponential increase in cancer incidence. According to the International Atomic Energy Agency, the biggest gap in radiotherapy availability and need is in Nigeria, where each machine serves an estimated 25.7 million people. This study aimed to characterize the barriers to radiotherapy and to identify areas for intervention.
METHODS:
This was a cross-sectional study conducted at the University College Hospital in Ibadan, Nigeria, from June 2017 to August 2017. Demographic, sociocultural, and infrastructural factors relating to radiotherapy were collected through a questionnaire (N = 186). Ordinal logistic regression was used to identify the factors leading to delays in referral and delays in treatment initiation.
RESULTS:
Patients traveled from 20 of Nigeria's 36 states. The median age was 50 years (range, 19-79 years). The most common cancers treated were breast (37.5%), cervical (16.3%), head and neck (11.9%), and prostate (10.9%). In ordinal logistic regression, sociocultural factors, including the inability to pay (odds ratio [OR], 1.99; P = .034), a bad hospital experience (OR, 7.05; P = .001), and travel time (OR, 1.36; P = .001), increased the odds of referral delay to radiotherapy. In contrast, there was no significant relationship between time to treatment initiation and sociocultural factors including age, education, and inability to pay. Infrastructural barriers, including machine breakdown (OR, 2.92; P = .001), worker strikes (OR, 2.64; P = .001), and power outages (OR, 2.81; P = .022), increased the odds of treatment delay.
CONCLUSION:
Although delays caused by patient factors are reported extensively, patients overcame these barriers in the hopes of curative treatment. However, staff and equipment malfunctions prevented patients from receiving timely radiotherapy. Policies aimed at addressing machine maintenance, health care worker satisfaction, and the aging power grid in Nigeria must be implemented in the future to strengthen the health care system to care for patients with cancer.
48.
Cancer. 2020 Feb 21. doi: 10.1002/cncr.32742. [Epub ahead of print]
Intratumor heterogeneity could inform the use and type of postoperative adjuvant therapy in patients with head and neck squamous cell carcinoma.
Abstract
BACKGROUND:
After surgery for head and neck squamous cell carcinoma (HNSCC), decisions regarding adjuvant radiotherapy (RT) or chemoradiotherapy (CRT) are based on staging and the presence of high-risk pathology. Because higher mutant allele tumor heterogeneity (MATH; a measure of intratumor genetic heterogeneity) is associated with shorter overall survival (OS) in patients with HNSCC, the authors sought to determine whether MATH analysis might further inform these decisions.
METHODS:
Adjuvant therapy-associated relationships between MATH and OS were analyzed for 389 patients with HNSCC who were treated surgically. Data were obtained from The Cancer Genome Atlas and analyzed with Cox proportional hazards multiple regression accounting for 7 other patient characteristics.
RESULTS:
The relationship between MATH and OS differed with adjuvant therapy in a way that could inform therapy decisions. Adjuvant RT alone was found to provide substantial benefit for patients having high-MATH tumors (RT vs no adjuvant therapy: hazard ratio, 0.29 [95% CI, 0.17-0.51]) but no benefit for those having low-MATH tumors. In contrast, adjuvant CRT provided no benefit beyond that of adjuvant RT for patients with high-MATH tumors but substantially improved OS among patients with low-MATH tumors (CRT vs no adjuvant therapy: hazard ratio, 0.34 [95% CI, 0.15-0.78]).
CONCLUSIONS:
The results of the current analysis suggested that patients with HNSCC with high-MATH tumors who underwent surgical treatment could benefit from adjuvant RT, even when current clinical guidelines indicate otherwise. The addition of adjuvant chemotherapy for patients with high-MATH tumors would not be indicated. Adding chemotherapy might be necessary to radiosensitize low-MATH tumors to adjuvant RT. This potential predictive role of tumor MATH analysis should be evaluated in prospective clinical trials.
© 2020 American Cancer Society.
KEYWORDS:
adjuvant radiotherapy; cancer biomarkers; chemoradiotherapy; genetic variation; intratumor heterogeneity; neoplasm staging; proportional hazards models; squamous cell carcinoma of the head and neck; surgery; treatment resistance
49.
Laryngoscope. 2020 Feb 21. doi: 10.1002/lary.28546. [Epub ahead of print]
Treatment of Vestibular Migraine: A Systematic Review and Meta-analysis.
Abstract
OBJECTIVE:
To assess the efficacy of the various therapies used for the prevention of vestibular migraine (VM).
METHODS:
Primary studies were identified though PubMed, Scopus, PsycINFO, and Cochrane Library by two independent investigators for articles published through April 2019. The search identified randomized comparison or observational studies pertaining to vestibular migraine treatment. Meta-analysis was performed on pre- and posttreatment Dizziness Handicap Inventory, vertigo frequency, and percentage of perceived improvement.
RESULTS:
Literature search identified 13 studies that reported sufficient outcome measures to be included in the analysis. Patients with VM had a mean age of 43.3 years with female-to-male gender ratio of 2.1:1. Classes of therapeutic agents included antiepileptic drugs, calcium channel blockers, tricyclic antidepressants, β-blockers, serotonin and norepinephrine reuptake inhibitors, and vestibular rehabilitation. All treatment options that were analyzed demonstrated improvement in all of the outcome parameters, but due to significant heterogeneity and lack of standardized reporting on outcomes, establishment of preferred treatment modality could not be determined.
CONCLUSIONS:
Various treatment modalities have been evaluated for preventative treatment of VM. Physician familiarity, patient comorbidities, and the side-effect profiles of various interventions likely influence the selection of intervention. Future randomized controlled trials with restrictive inclusion criteria and generalizable standardized outcome measures will allow for more robust meta-analyses and for more evidence-based treatment of vestibular migraines. Laryngoscope, 2020.
© 2020 The American Laryngological, Rhinological and Otological Society, Inc.
KEYWORDS:
Vestibular migraine; dizziness; headache; migraine; treatment; vertigo
50.
Laryngoscope. 2020 Feb 21. doi: 10.1002/lary.28587. [Epub ahead of print]
The Geriatric Nutritional Risk Index as a Prognostic Factor in Patients with Advanced Head and Neck Cancer.
Nakayama M1, Gosho M2, Adachi M1, Ii R1, Matsumoto S1, Miyamoto H1, Hirose Y1, Nishimura B1, Tanaka S1, Wada T1, Tabuchi K1.
Abstract
OBJECTIVE:
The Geriatric Nutritional Risk Index (GNRI) is a simple and well-established nutritional assessment tool and is a significant prognostic factor in various cancers. However, the role of the GNRI in predicting clinical outcomes in patients with advanced head and neck cancer (AHNC) has not been investigated. The aim of the present study was to examine the association between the GNRI and prognosis in patients with AHNC.
STUDY DESIGN:
Retrospective cohort study.
METHODS:
Data collected between 2002 and 2013 from Tsukuba University Hospital were reviewed. The GNRI was calculated according to the equation, 1.489 × serum albumin (g/l) + 41.7 × (body weight/ideal body weight). Characteristics and prognosis were compared among three risk groups: high (GNRI <82); intermediate (GNRI 82-98); and normal (GNRI >98). The primary endpoint was overall survival.
RESULTS:
A total of 248 AHNC patients were enrolled, among whom 134 (54%) exhibited no nutritional risk, 53 (21%) had an intermediate risk for malnutrition, and 61 (25%) exhibited a high risk for malnutrition. Three-year survival rates according to the three-group GNRI scores for normal, intermediate, and high risk were 76.6%, 56.3%, and 19.5%, respectively. As the three-group GNRI score increased, the risk for mortality significantly increased (adjusted hazard ratio [HR] for intermediate to normal, 1.73 [95% CI, 1.02-2.92]; adjusted HR for high to normal, 4.31 [95% CI, 2.71-6.84]).
CONCLUSIONS:
The GNRI could be considered a useful prognostic factor in patients with AHNC.
LEVEL OF EVIDENCE:
4 Laryngoscope, 2020.
© 2020 The American Laryngological, Rhinological and Otological Society, Inc.
KEYWORDS:
Advanced head and neck cancer, GNRI, hazard ratio, overall survival, prognostic factor
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