Exploring the capabilities of modern cochlear implants : from electrophysiology to quality of life

Cochlear implants (CI) have proved to be a successful treatment for severely and profoundly deaf individuals. There is general agreement that the improvement of speech perception results has been due to ongoing development in CI electrode-array design, new speech processing strategies and by implanting patients with increasing amounts of residual hearing. However, although speech perception scores are very important indicators, there may be other outcomes that give essential information on the benefits of modern CI as outlined in this thesis. By assessing Quality of Life questionnaires and utilities before and after implantation, general health status and cost-utility were evaluated in pre- and postlingually deafened adult populations. In spite of the good results, it was realized that there was still room for improvement. Therefore, a high-rate speech processing strategy was investigated, which gave evidence of further improvement of speech perception performance (especially in noise), provided that the optimum number of electrodes was determined for each patient individually. These data suggested that objective individual parameter selection is obligatory to increase performance. For this purpose, we explored and used objective measures in an experimental and clinical setting to obtain basic knowledge about the electrode-nerve interface and, finally, to optimize individual implant functionAdvanced Bionic; Artu Biologicals; Atos Medical BV; Bayer HealthCare; Biolitec; EmiDaudiologische apparatuur; GlaxoSmithKline; Oticon; Schering-Plough, Stichting Atze Spoor Fonds; Veenhuis Medical AudioUBL - phd migration 201

SPECT/CT-guided lymph drainage mapping for the planning of unilateral elective nodal irradiation in head and neck squamous cell carcinoma

To investigate the feasibility of lymph drainage mapping (LDM) using SPECT/CT to help select head and neck cancer (HNSCC) patients for unilateral elective neck irradiation (ENI). Patients with lateralized HNSCC treated with radiotherapy routinely undergo bilateral ENI, despite the incidence of contralateral regional failure being relatively low even after unilateral ENI. We hypothesized that patients with a lateralized tumor without visible lymph drainage to the contralateral neck have an extremely low risk of contralateral involved nodes. Excluding the contralateral neck from elective irradiation will reduce radiation-induced toxicity and improve quality-of-life.Fifty-five patients with lateralized cT1-3N0-2bM0 HNSCC not crossing the midline underwent LDM. Radiolabeled Tc-99m-nanocolloid was injected in 4-5 depots around and in the primary tumor. Lymph drainage patterns were visualized using planar scintigraphy and SPECT/CT after 4 h. We report on the incidence of contralateral drainage, the location of draining areas, and the size of underlying nodes.Lymphatic drainage was successfully visualized in 54 patients (98%). In 11 patients (20%) with visible contralateral drainage, 14 draining areas (16 nodes; median volume 0.50 cc, diameter 8.0 mm) were identified. Neck levels with contralateral drainage were level II (88%), III (25%), and IV (13%). Contralateral drainage was significantly higher in T3 compared to T1-2 tumors (45 and 14%, respectively, P = 0.035).SPECT/CT-guided LDM is feasible and can be used to guide unilateral ENI in HNSCC patients in prospective studies. In addition, the anatomical confidence in visualization of contralateral drainage indicates a potential for ENI limited to draining levels alone.Biological, physical and clinical aspects of cancer treatment with ionising radiatio

Surgical outcomes of lymph node dissections for stage III melanoma after neoadjuvant systemic therapy are not inferior to upfront surgery

BackgroundNeoadjuvant systemic therapy has shown promising results in the treatment of high-risk stage III melanoma; however, the effects on surgery are currently unknown. This study aims to compare the surgical outcomes, in terms of postoperative complications, postoperative morbidity, duration of surgery and textbook outcomes, of patients with high-risk stage III melanoma who received neoadjuvant systemic therapy followed by lymph node dissection with patients who received an upfront lymph node dissection.MethodsIn this retrospective cohort study, patients with high-risk stage III melanoma treated with neoadjuvant anti-PD1 and anti-CTLA4 in the OpACIN (NCT02437279) and OpACIN-neo (NCT02977052) trial between October 2014 and August 2018 were included and compared to patients who received upfront surgery in the same time period.ResultsA total of 120 patients were included in this study, of whom 44 received neoadjuvant systemic therapy and 76 underwent upfront surgery. There was no significant difference in the overall rate of postoperative complications between the neoadjuvant group and the upfront surgery group (31.8% versus 36.8%, p = 0.578) and neither in rate of postoperative morbidity (seroma 56.8% versus 57.9%, p = 0.908) (lymphedema 22.7% versus 13.2%, p = 0.175). There was a non-significant difference towards a slightly longer duration of surgery after neoadjuvant immunotherapy (105 versus 90 min, p = 0.077). There were no differences in textbook outcomes (50% versus 49%, p = 0.889).ConclusionThis study shows that the surgical outcomes for patients who underwent a lymph node dissection after neoadjuvant systemic immunotherapy or underwent upfront lymph node dissection for high-risk stage III melanoma are comparable.Otorhinolaryngolog

Quality of life and voice outcome of patients treated with transoral CO2 laser microsurgery for early glottic carcinoma (T1-T2): a 2-year follow-up study

Purpose Longitudinal studies in laryngeal cancer can provide clinicians information about short-term and long-term functional outcomes, like quality of life (QoL) and voice outco

The Top One Percent and Exploitation Measures

With the Occupy Movement that recently took place on Wall Street and in other parts of the globe, a lot of attention has recently been given to growing income inequality. The 2008 United States financial crisis, the Great Recession, and the subsequent weak recovery have brought about a more serious focus on income inequality and the widening income gap between the top one percent and other groups. These events have brought about some social unrest and instability in American society perhaps not seen since the Great Depression. How much has the top 1 percent of households gained in terms of income versus the other 99 percent in the United States over the last 30 years or so? Mainstream economists and other social scientists point to various causes which have been mentioned in many scholarly and popular writings. All of these mainstream factors affecting inequality have been found to be statistically significant in one scholarly study or another. This research paper explores other major concepts to explain income inequality rather than to dispute the findings of other existing research efforts. The empirical findings of this paper support radical arguments that income accumulation of those at the top is not connected to the productivity of capital investment, but rather instead is connected to the declining incomes and exploitation of the rest of the US population despite the rising output per worker of the US workforce over the last 30 to 40 years

The best of both worlds: a hybrid approach for optimal pre- and intraoperative identification of sentinel lymph nodes

Imaging- and therapeutic targets in neoplastic and musculoskeletal inflammatory diseas

Voice outcome after unilateral ELS type III or bilateral type II resections for T1-T2 glottic carcinoma: Results after 1 year

Abstract Background: Voice outcome was assessed in patients with extended T1 and limited T2 glottic carcinoma, treated with a unilateral type III or a bilateral type II resection according to the European Laryngological Society (ELS) classification. Methods: Objective evaluation (acoustic and aerodynamic parameters), perceptual evaluation (GRBAS), and patients' self-assessment (voice handicap index [VHI]) were performed before and 1 year after treatment. Results were evaluated according to ELS resection type and the involvement of the anterior commissure. Results: The majority of voice parameters in all resection subgroups showed an improvement of the mean score 1 year postoperatively. Grade of dysphonia varied between 1.15 and 1.66 postoperatively and VHI score varied from 23.3 to 24.5. Conclusion: Voice outcome after ELS unilateral type III or a bilateral type II resection for extended T1 and limited T2 glottic carcinoma is good with mild to very moderate perceptive dysphonia and low self-reported voice impairment

Technologic (r)evolution leads to detection of more sentinel nodes in patients with melanoma in the head and neck region

Sentinel lymph node (SN) biopsy (SNB) has proven to be a valuable tool for staging melanoma patients. Since its introduction in the early 1990s, this procedure has undergone several technologic refinements, including the introduction of SPECT/CT, as well as radioguidance and fluorescence guidance. The purpose of the current study was to evaluate the effect of this technologic evolution on SNB in the head and neck region. The primary endpoint was the false-negative (FN) rate. Secondary endpoints were number of harvested SNs, overall operation time, operation time per harvested SN, and postoperative complications. Methods: A retrospective database was queried for cutaneous head and neck melanoma patients who underwent SNB at The Netherlands Cancer Institute between 1993 and 2016. The implementation of new detection techniques was divided into 4 groups: 1993-2005, with preoperative lymphoscintigraphy and intraoperative use of both a y-ray detection probe and patent blue (n = 30); 2006-2007, with addition of preoperative road maps based on SPECT/CT (n = 15); 2008-2009, with intraoperative use of a portable y-camera (n = 40); and 2010-2016, with addition of near-infrared fluorescence guidance (n = 192). Results: In total, 277 patients were included. At least 1 SN was identified in all patients. A tumor-positive SN was found in 59 patients (21.3%): 10 in group 1 (33.3%), 3 in group 2 (20.0%), 6 in group 3 (15.0%), and 40 in group 4 (20.8%). Regional recurrences in patients with tumor negative SNs resulted in an overall FN rate of 11.9% (group 1, 16.7%; group 2, 0%; group 3, 14.3%; group 4, 11.1%). The number of harvested nodes increased with advancing technologies (P = 0.003), whereas Breslow thickness and operation time per harvested SN decreased (P = 0.003 and P = 0.017, respectively). There was no significant difference in percentage of tumor-positive SNs, overall operation time, and complication rate between the different groups. Conclusion: The use of advanced detection technologies led to a higher number of identified SNs without an increase in overall operation time, possibly indicating an improved surgical efficiency. Operation time per harvested SN decreased; the average FN rate remained 11.9% and was unchanged over 23 y. There was no significant change in postoperative complication rate.Imaging- and therapeutic targets in neoplastic and musculoskeletal inflammatory diseas