Cognitive changes in patients treated for Obstructive Sleep Apnea with upper airway stimulation, maxillomandibular advancement, or expansion sphincter pharyngoplasty

Introduction: Obstructive sleep apnea (OSA) is a prevalent diagnosis that has been shown to not only affect sleepiness, but daytime cognitive function — specifically attention, working memory, and executive function. CPAP treatment is troublesome for some patients and it is possible that superior treatment options, specifically novel surgical techniques, are available, though none have been evaluated for their long-term effects on neurocognition. We hypothesize that treating patients with upper airway stimulation surgery (UAS) UAS, maxillomandibular advancement surgery (MMA), and expansion sphincter pharyngoplasty surgery (ESP) for OSA produces a significant improvement in cognition from baseline. Methods: For inclusion in the study, two important criteria must be met: 1) a previous diagnosis of OSA 2) patients have failed CPAP. Exclusion criteria include pediatric population (\u3c18 years of age), and those without ability to complete the NIH Toolbox assessment on an iPad in English. Using the iPad-based NIH Toolbox assessment, the primary outcome of the study is to analyze the effect of UAS, MMA, and ESP treatment on three markers of cognition: the Processing Speed Test, the Inhibitory Control and Attention Test, and Sorting Working Memory Test (15 minutes total). Results: Data reported below is for one timepoint for nine patients receiving UAS: ▪ Age=53.8 ± 15.4 ▪ BMI=29.2 ± 4.2 ▪ Depression diagnosis:3/9 ▪ CCI \u3e 0: 5/9 ▪ Age-adjusted national percentiles: ▪ Processing speed: 61.4±43.7 ▪ Inhibitory Control and Attention Test: 59.1±32.3 ▪ Sorting Working Memory Test: 52.8±23.7 Discussion: The results of this study will give providers additional information in evaluating treatment options for patients with cognitive deficit related to OSA. The gold standard for assessing neurocognitive function is fMRI, as demonstrated by studies done showing improvement in CPAP patients. Success in this study may support further research using fMRI data to support the hypothesis of improvement in cognition

Accrual-Monitoring Practices for Various Disease Trials among AACI Member Cancer Centers

Progress in the management of rare diseases, including rare cancers, is dependent upon clinical trials; however, as many as 32% of rare-disease trials go uncompleted or unpublished due to insufficient accrual. Monitoring practices may differ between institutions. We sought to survey the regulatory standards for various trial types among major U.S. cancer centers. A 10-question survey was designed using Qualtrics assessment software. The survey was sent via email to an internal server of member institutions of the Association of American Cancer Institutes (AACI). Of 103 AACI centers, 31% completed the survey (n = 32). Respondents differed in their definitions of a rare disease, minimum expectations for rare tumor studies, and frequency of accrual monitoring by their institutional Protocol Review and Monitoring Committee. Seventy-three percent of respondents did not close trials based on low accrual. Strategies to optimize accrual included investigator incentives for high accrual and penalties for low accrual in 37% and 13% of respondents, respectively

Treatment Summaries for Head and Neck Cancer Survivors: Improving Patient Self Efficacy and Survivorship Care

Objective To determine if receiving treatment summaries enhances patient understanding and recall of cancer and treatment details, improves patient self efficacy, and serves as a useful patient tool after completion of head and neck (HNC) therapyhttps://jdc.jefferson.edu/patientsafetyposters/1115/thumbnail.jp

Preoperative Immunotherapy in the Multidisciplinary Management of Oral Cavity Cancer.

Despite advances in multimodal treatment for oral cavity squamous cell carcinoma, recurrence rates remain high, providing an opportunity for new therapeutic modalities that may improve oncologic outcomes. Much recent attention has been paid to the molecular interactions between the tumor cells with the adjacent peritumoral microenvironment, in which immunosuppressive molecular changes create a landscape that promotes tumor progression. The rationale for the introduction of immunotherapy is to reverse the balance of these immune interactions in a way that utilizes the host immune system to attack tumor cells. In the preoperative setting, immunotherapy has the advantage of priming the unresected tumor and the associated native immune infiltration, supercharging the adaptive anti-tumor immune response. It also provides the basis for scientific discovery where the molecular profile of responders can be interrogated to elucidate prognostic markers to aid in future patient selection. Preoperative immunotherapy is not without limitations. The risk of surgical delay due to immune adverse events must be carefully discussed by members of a multidisciplinary treatment team and patient selection will be critical. One day, the discovery of predictive biomarkers may allow for algorithms where pre-surgical immunotherapy decreases the size of surgical defect and impacts the intensity of adjuvant therapy leading to improved patient survival and decreased morbidity. With further study, immunotherapy could become a key component of future treatment algorithm

Free tissue transfer for skull base reconstruction - a review

Evolutions in skull base surgery and reconstructive technique have given surgeons the confidence to resect and repair increasingly advanced skull base pathologies. Free tissue transfer (FTT) provides a versatile option capable of addressing numerous simultaneous reconstructive goals. This review highlights some of the nuances, challenges, and considerations of performing FTT for skull base reconstruction in the anterior, central and lateral skull base. This review combines the expert opinion of the senior authors with those of the field at large as queried through PubMed searches regarding skull base reconstruction and FTT. Reconstructive goals include separation of intracranial from extracranial cavities, obliteration of dead space, and protection of vascular and neural structures. Atypical vascular pedicle management is commonly needed, especially for endonasal and central skull base resection. Virtual surgical planning may be beneficial for complex bony reconstruction. Familiarity with common complications such as cerebrospinal fluid leak, nasocutaneous fistula, and inferior flap displacement, as well as associations for their development, can help plan the reconstruction to minimize morbidity