Otolaryngologists’ Role in Redeployment During the COVID-19 Pandemic: A Commentary

As otolaryngologists, we identify as subspecialists and fellowship-trained surgeons and may even identify as “super-subspecialists.” The likelihood of being redeployed and drawing from knowledge learned during our postgraduate year 1 training seemed exceedingly unlikely until physician resources became scarce in some health care systems during the COVID-19 pandemic. More now than ever, it is evident that our broad training is valuable in helping patients and allowing the otolaryngologist to meaningfully contribute to the larger health care community, especially while the majority (70%-95%) of elective care is delayed. With our skill set, otolaryngologists are poised to support various aspects of hospital wards, intensive care units, emergency departments, and beyond

Reverse-Surge Planning During the COVID-19 Pandemic: A Cautionary Ramp-up for the Otolaryngologist

As the coronavirus disease 2019 (COVID-19) pandemic continues to evolve through the United States and other countries, differing rates of progression and decline are occurring based on varied population densities. While some health systems are reaching a steady state of new patient cases, others are seeing a leveling off or decline, allowing for restoration of normal practices. This “reverse-surge” planning and implementation process is a colossal undertaking for health systems trying to reacquire patient access and financial stability while preserving necessary resources and maintaining precautions for another potential surge. For the otolaryngologist, reverse-surge planning involves additional workflow adjustments in the outpatient and operating room settings given the abundance of COVID-19 virus in the upper aerodigestive tract. As the reverse-surge best practices are still under development, open communication between otolaryngology colleagues and health system leadership is paramount to optimize efficiency and maintain an adequate measure of safety for patients and our health care teams

Searching for molecular markers in head and neck squamous cell carcinomas (HNSCC) by statistical and bioinformatic analysis of larynx-derived SAGE libraries

Background: Head and neck squamous cell carcinoma (HNSCC) is one of the most common malignancies in humans. The average 5-year survival rate is one of the lowest among aggressive cancers, showing no significant improvement in recent years. When detected early, HNSCC has a good prognosis, but most patients present metastatic disease at the time of diagnosis, which significantly reduces survival rate. Despite extensive research, no molecular markers are currently available for diagnostic or prognostic purposes. Methods: Aiming to identify differentially-expressed genes involved in laryngeal squamous cell carcinoma (LSCC) development and progression, we generated individual Serial Analysis of Gene Expression (SAGE) libraries from a metastatic and non-metastatic larynx carcinoma, as well as from a normal larynx mucosa sample. Approximately 54,000 unique tags were sequenced in three libraries. Results: Statistical data analysis identified a subset of 1,216 differentially expressed tags between tumor and normal libraries, and 894 differentially expressed tags between metastatic and non-metastatic carcinomas. Three genes displaying differential regulation, one down-regulated (KRT31) and two up-regulated (BST2, MFAP2), as well as one with a non-significant differential expression pattern (GNA15) in our SAGE data were selected for real-time polymerase chain reaction (PCR) in a set of HNSCC samples. Consistent with our statistical analysis, quantitative PCR confirmed the upregulation of BST2 and MFAP2 and the downregulation of KRT31 when samples of HNSCC were compared to tumor-free surgical margins. As expected, GNA15 presented a non-significant differential expression pattern when tumor samples were compared to normal tissues. Conclusion: To the best of our knowledge, this is the first study reporting SAGE data in head and neck squamous cell tumors. Statistical analysis was effective in identifying differentially expressed genes reportedly involved in cancer development. The differential expression of a subset of genes was confirmed in additional larynx carcinoma samples and in carcinomas from a distinct head and neck subsite. This result suggests the existence of potential common biomarkers for prognosis and targeted-therapy development in this heterogeneous type of tumor.Fundação de Amparo a Pesquisa do Estado de São Paulo/FAPESP [05/51467-0]; [04/12054-9]; [07/50894-7]Ludwig Institute for Cancer ResearchConselho Nacional de Pesquisas/CNPqCoordenacao de Aperfeicoamento do Pessoal do Ensino Superior/CAPE

Genomic analysis of atypical fibroxanthoma

Atypical fibroxanthoma (AFX), is a rare type of skin cancer affecting older individuals with sun damaged skin. Since there is limited genomic information about AFX, our study seeks to improve the understanding of AFX through whole-exome and RNA sequencing of 8 matched tumor-normal samples. AFX is a highly mutated malignancy with recurrent mutations in a number of genes, including COL11A1, ERBB4, CSMD3, and FAT1. The majority of mutations identified were UV signature (C>T in dipyrimidines). We observed deletion of chromosomal segments on chr9p and chr13q, including tumor suppressor genes such as KANK1 and CDKN2A, but no gene fusions were found. Gene expression profiling revealed several biological pathways that are upregulated in AFX, including tumor associated macrophage response, GPCR signaling, and epithelial to mesenchymal transition (EMT). To further investigate the presence of EMT in AFX, we conducted a gene expression meta-analysis that incorporated RNA-seq data from dermal fibroblasts and keratinocytes. Ours is the first study to employ high throughput sequencing for molecular profiling of AFX. These data provide valuable insights to inform models of carcinogenesis and additional research towards tumor-directed therapy

A comprehensive overview of radioguided surgery using gamma detection probe technology

The concept of radioguided surgery, which was first developed some 60 years ago, involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has tremendously expanded and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma, and colorectal cancer, as well as the surgical management of parathyroid disease. The impact of radioguided surgery on the surgical management of cancer patients includes providing vital and real-time information to the surgeon regarding the location and extent of disease, as well as regarding the assessment of surgical resection margins. Additionally, it has allowed the surgeon to minimize the surgical invasiveness of many diagnostic and therapeutic procedures, while still maintaining maximum benefit to the cancer patient. In the current review, we have attempted to comprehensively evaluate the history, technical aspects, and clinical applications of radioguided surgery using gamma detection probe technology

Current potential and limitations of molecular diagnostic methods in head and neck cancer

Item does not contain fulltextTraditional diagnostic methods such as clinical assessment, histopathological examination and imaging techniques are limited in their capacity to provide information on prognosis and treatment choice of head and neck cancer. In recent years, molecular techniques have been developed that enabled us to get more insight into the molecular biological cellular pathways underlying tumor progression and metastasis. Correlation of these molecular changes with clinical events has been explored. However, consistently useful markers have not been identified yet, although many promising developments are in progress. It may be expected that in the near future, molecular markers will be useful for clinical purposes. In this paper, an overview will be given of the several molecular techniques that may have potential to be introduced in clinical practice in the management of head and neck squamous cell carcinoma.1 juni 201

A Tool for Assessing the Experience of Shared Reality: Validation of the German SR-t

Humans are highly motivated to achieve shared reality – common inner states (i.e., judgments, opinions, attitudes) with others about a target object. Scholarly interest in the phenomenon has been rapidly growing over the last decade, culminating in the development of a five-item self-report scale for Shared Reality about a Target (SR-T; Schmalbach et al., unpublished). The present study aims to validate the German version of the scale. Individuals can establish shared reality either by receiving social verification (i.e., agreement or confirmation from an interaction partner) or by aligning their inner state with that of their partner. To increase the scope of the present validation, we implemented both pathways of shared-reality creation in three studies (N = 522). Study 1 employed a social judgment task, in which participants assessed ambiguous social situations and received confirming (vs. disconfirming) feedback from their partner. Studies 2 and 3 build on the saying-is-believing paradigm, in which participants align their own evaluation of the target with their partner’s judgment. Based on an evaluatively ambiguous description, participants communicated about a target person and later recalled information about the target (Study 2). To further generalize the findings, message production was omitted from the paradigm in Study 3. Overall, the five-item model of the SR-T evinced good fit and reliability. In Study 1, the SR-T reflected experimentally induced differences in commonality of judgments– even when controlling for several related state measures, such as Inclusion of Other in the Self and Need Threat. In Studies 2 and 3, the SR-T predicted participants’ evaluative recall bias, which is an established, indirect index of communicators’ shared-reality creation. This effect was stronger when participants overtly communicated with their study partner, but it still emerged without overt communication. Across all studies, correlations with related constructs support the convergent validity of the SR-T. In sum, we recommend the use of the SR-T in research on interpersonal processes and communication

Analysing humanly generated random number sequences: A pattern-based approach

In a random number generation task, participants are asked to generate a random sequence of numbers, most typically the digits 1 to 9. Such number sequences are not mathematically random, and both extent and type of bias allow one to characterize the brain's “internal random number generator”. We assume that certain patterns and their variations will frequently occur in humanly generated random number sequences. Thus, we introduce a pattern-based analysis of random number sequences. Twenty healthy subjects randomly generated two sequences of 300 numbers each. Sequences were analysed to identify the patterns of numbers predominantly used by the subjects and to calculate the frequency of a specific pattern and its variations within the number sequence. This pattern analysis is based on the Damerau-Levenshtein distance, which counts the number of edit operations that are needed to convert one string into another. We built a model that predicts not only the next item in a humanly generated random number sequence based on the item′s immediate history, but also the deployment of patterns in another sequence generated by the same subject. When a history of seven items was computed, the mean correct prediction rate rose up to 27% (with an individual maximum of 46%, chance performance of 11%). Furthermore, we assumed that when predicting one subject′s sequence, predictions based on statistical information from the same subject should yield a higher success rate than predictions based on statistical information from a different subject. When provided with two sequences from the same subject and one from a different subject, an algorithm identifies the foreign sequence in up to 88% of the cases. In conclusion, the pattern-based analysis using the Levenshtein-Damarau distance is both able to predict humanly generated random number sequences and to identify person-specific information within a humanly generated random number sequence

Psychometric properties of an English short version of the Trier Inventory for chronic Stress

Background: Although a variety of instruments are available that capture stress experience, the assessment of chronic stress has been hindered by the lack of economical screening instruments. Recently, an English-language version of the Trier Inventory for Chronic Stress (TICS-EN) consisting of 57 items according to a systemic-requirement-resource model of health in nine subdomains of the chronic stress experience has been introduced. Methods: We constructed a new 9-item short version of the TICS covering all nine subdomains and evaluated it in two samples (total N = 685). We then used confirmatory factor analysis to check factorial validity. Results: This version showed a highly satisfactory model fit, was invariant across participant gender, demonstrated a very high correlation with the original TICS (r = .94), and showed a moderate correlation (r = .58) with a measure of perceived stress in the past month. Conclusions: Therefore, this theoretically driven instrument can be recommended as a short version of the TICS in English language