Reply to "Do not de-escalate oncology care in oropharyngeal cancer routinely"

Non peer reviewe

Complications in lymph node excision in the head and neck area

Background Although needle biopsy is widely used in work-up of lymphadenopathy, lymph node excision (LNE) is often required especially in lymphoma diagnostics. LNE is an invasive procedure, which carries a potential risk of complications. However, comprehensive studies evaluating the spectrum and occurrence of complications are lacking. Aims/Objectives This study addresses the role of preoperative needle biopsies in patients who underwent LNE. Furthermore, surgical complications related to LNE are analyzed. Materials and methods Altogether 321 patients, who underwent LNE in two-year period in 2018-19, and fulfilled our study criteria, were included. Patients' data were retrieved from the electronic patient records. Results The surgical complication rate was 5.9%. Most of the complications (n = 16; 84.2%) were categorized as minor (I-II) according to the Clavien-Dindo scale. The remaining three (15.8%), all hemorrhages, were categorized as major complications and required intervention. Preoperative needle biopsy might have avoided the need for LNE in some patients, which we discuss in this study. Conclusions and significance Surgical complications after LNE in the head and neck area are rare and mostly minor. Needle biopsy is often recommended preoperatively to avoid unnecessary operations and to refrain performing LNE for patients with non-lymphatic malignancy.Peer reviewe

International Society of Sports Nutrition Position Stand: Probiotics.

Position statement: The International Society of Sports Nutrition (ISSN) provides an objective and critical review of the mechanisms and use of probiotic supplementation to optimize the health, performance, and recovery of athletes. Based on the current available literature, the conclusions of the ISSN are as follows: 1)Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host (FAO/WHO).2)Probiotic administration has been linked to a multitude of health benefits, with gut and immune health being the most researched applications.3)Despite the existence of shared, core mechanisms for probiotic function, health benefits of probiotics are strain- and dose-dependent.4)Athletes have varying gut microbiota compositions that appear to reflect the activity level of the host in comparison to sedentary people, with the differences linked primarily to the volume of exercise and amount of protein consumption. Whether differences in gut microbiota composition affect probiotic efficacy is unknown.5)The main function of the gut is to digest food and absorb nutrients. In athletic populations, certain probiotics strains can increase absorption of key nutrients such as amino acids from protein, and affect the pharmacology and physiological properties of multiple food components.6)Immune depression in athletes worsens with excessive training load, psychological stress, disturbed sleep, and environmental extremes, all of which can contribute to an increased risk of respiratory tract infections. In certain situations, including exposure to crowds, foreign travel and poor hygiene at home, and training or competition venues, athletes' exposure to pathogens may be elevated leading to increased rates of infections. Approximately 70% of the immune system is located in the gut and probiotic supplementation has been shown to promote a healthy immune response. In an athletic population, specific probiotic strains can reduce the number of episodes, severity and duration of upper respiratory tract infections.7)Intense, prolonged exercise, especially in the heat, has been shown to increase gut permeability which potentially can result in systemic toxemia. Specific probiotic strains can improve the integrity of the gut-barrier function in athletes.8)Administration of selected anti-inflammatory probiotic strains have been linked to improved recovery from muscle-damaging exercise.9)The minimal effective dose and method of administration (potency per serving, single vs. split dose, delivery form) of a specific probiotic strain depends on validation studies for this particular strain. Products that contain probiotics must include the genus, species, and strain of each live microorganism on its label as well as the total estimated quantity of each probiotic strain at the end of the product's shelf life, as measured by colony forming units (CFU) or live cells.10)Preclinical and early human research has shown potential probiotic benefits relevant to an athletic population that include improved body composition and lean body mass, normalizing age-related declines in testosterone levels, reductions in cortisol levels indicating improved responses to a physical or mental stressor, reduction of exercise-induced lactate, and increased neurotransmitter synthesis, cognition and mood. However, these potential benefits require validation in more rigorous human studies and in an athletic population

No Aujeszky's disease or PRRS in Finland

Although no outbreaks or typical, clinical signs indicating Aujeszky's disease (AD) or Porcine reproductive and respiratory syndrome (PRRS) have ever been reported in Finland, annual screenings for AD antibodies were started in 1993. It was estimated that increasing import of live animals and frozen meat is a threat to pig population. By constant evaluation of different swine herds it might be possible to detect and eradicate outbreaks before they become an epidemic and thus maintain the present, excellent disease status. Each year, blood samples have been randomly collected from 7% of breeding sows, from all slaughtered boars and 3 000 fattening pigs in every Finnish pig slaughtering abattoir. In addition, AD and PRRS antibody testing has been included in the Health Scheme of boar stations and elite breeding herds. The primary test methods were virus neutralisation for AD antibodies and enzyme-linked immunoassay (ELISA, IDEXX, France) for PRRS antibodies. Toxic and suspect samples have been retested with a serological AD ELISA (SVANOVA, Sweden) or with a PRRS immunoperoxidase monolayer assay (IPMA). Individuals from all pig categories, elite breeding sows and boars, breeding sows, fattening pigs, and even housed wild boars, tested for AD antibodies were seronegative. Similarly, no antibodies to PRRS virus were detected in random samples collected from slaughterhouses or elite breeding herds. The number of sera tested for AD varied from 12 000 to 15 000 per year and for PRRS from 2 000 to 3 000. Due to random sampling, 50% of Finnish pig herds have been annually included in the survey. Approximately 1% of samples were toxic for cultured cells in virus neutralisation test and have been assayed with ELISA with negative results. Some false positive PRRS antibody reactions (0.2%) have been obtained with the PRRS ELISA. In those cases the herd has been examined for clinical signs and new samples have been collected. The second testing has categorised the reactions as false positives. The majority of field cases with respiratory signs or abortions has been subjected to isolation tests for the AD or PRRS viruses. The isolation attempts in PK-15, Marc cell line or in primary macrophages have been negative. According to the results of annual surveys, Finland has been declared free of Aujeszky's disease. The disease free status has been confirmed by the EU Commission decision 94/961/EC. The results also strongly indicate that Finland is free of PRRS infection. The good disease situation is the result of several factors, which decrease the risk of infection. The pig husbandry in Finland is in the hands of small family farms rearing a medium of 50 breeding sows or rearing on fattening farms 200 pigs at a time. Infection risks increase in industrial pig production housing a large number of animals. Piggeries are located separately, the distance between facilities being more than 1 km. There are no pig dense areas, where herds more likely get infected. The top of the breeding pyramid, elite breeding herds and two boar stations, has a health scheme which includes measures for several infectious diseases. The epidemics can be stopped at an early stage. The annual serological survey has the same effect. The import of breeding animals is controlled by the Farmers Union. The use of testing and quarantine efficiently prevents the transmission of infections from abroad. Furthermore, Finland is separated from the neighbours by the Baltic Sea which is a natural barrier against the invasion of diseases

Comparison of intubation and tracheotomy in adult patients with acute epiglottitis or supraglottitis

Purpose In acute epiglottitis (AE) or acute supraglottitis (AS), the management of the airway is crucial. We hypothesized that tracheotomized patients recover faster than intubated patients do. Methods We retrospectively reviewed all adult AE and AS patients, who underwent intubation or tracheotomy between 2007 and 2018 in a tertiary care center. Patient demographics, treatment, and complications were analyzed. Results The cohort comprised 42 patients. The airway was secured with intubation in 50% and with tracheotomy in 50%. All intubated patients (n = 21) and three tracheotomized patients were treated in the intensive care unit (p <0.0001). Procedure-related complications were encountered in three intubated and eight tracheotomized patients (p = 0.892). Median overall treatment cost was 11.547 euro and 5.856 euro in the intubated and tracheotomized patient groups, respectively (p <0.001). The median duration of sick leave after discharge from hospital was 13 days in the tracheotomy group and 7 days in the intubation group (p = 0.097). Conclusion Tracheotomy resulted in a less expensive management in securing the airway in AE or AS, but tracheotomized patients had a trend towards more complications and longer sick leaves compared to intubated patients.Peer reviewe

Calculation of organ doses in x-ray examinations of premature babies

Lung disease represents one of the most life-threatening conditions in prematurely born children. In the evaluation of the neonatal chest, the primary and most important diagnostic study is the chest radiograph. Since prematurely born children are very sensitive to radiation, those radiographs may lead to a significant radiation detriment. Knowledge of the radiation dose is therefore necessary to justify the exposures. To calculate doses in the entire body and in specific organs, computational models of the human anatomy are needed. Using medical imaging techniques, voxel phantoms have been developed to achieve a representation as close as possible to the anatomical properties. In this study two voxel phantoms, representing prematurely born babies, were created from computed tomography- and magnetic resonance images: Phantom 1 (1910 g) and Phantom 2 (590 g). The two voxel phantoms were used in Monte Carlo calculations (MCNPX) to assess organ doses. The results were compared with the commercially available software package PCXMC in which the available mathematical phantoms can be downsized toward the prematurely born baby. The simple phantom-scaling method used in PCXMC seems to be sufficient to calculate doses for organs within the radiation field. However, one should be careful in specifying the irradiation geometry. Doses in organs that are wholly or partially outside the primary radiation field depend critically on the irradiation conditions and the phantom model.status: publishe

Sacrifice and extracranial reconstruction of the common or internal carotid artery in advanced head and neck carcinoma: Review and meta-analysis

Contains fulltext : 193460.pdf (publisher's version ) (Closed access)BACKGROUND: Sacrifice and reconstruction of the carotid artery in cases of head and neck carcinoma with invasion of the common or internal carotid artery is debated. METHODS: We conducted a systematic search of electronic databases and provide a review and meta-analysis. RESULTS: Of the 72 articles identified, 24 met the inclusion criteria resulting in the inclusion of 357 patients. The overall perioperative 30-day mortality was 3.6% (13/357). Permanent cerebrovascular complications occurred in 3.6% (13/357). Carotid blowout episodes were encountered in 1.4% (5/357). The meta-regression analysis showed a significant difference in 1-year overall survival between reports published from 1981-1999 (37.0%) and 2001-2016 (65.4%; P = .02). CONCLUSION: This review provides evidence that sacrifice with extracranial reconstruction of common or internal carotid artery in selected patients with head and neck carcinoma may improve survival with acceptable complication rates. However, all of the published literature is retrospective involving selected series and, therefore, precludes determining the absolute effectiveness of the surgery