Evaluating Quality of Life and Functional Outcomes in Salvage Surgery for Head and Neck Cancer

Background: Unique challenges surround treatment for residual or recurrent head and neck squamous cell carcinoma (HNSCC). Of the limited treatment options for residual or recurrent HNSCC, salvage surgery is often the best option. However, salvage surgery can result in significant morbidity, affecting both quality of life (QoL) and functional outcomes. Few studies have examined QoL outcomes following salvage surgery in the setting of HNSCC. Objectives: To analyze head and neck related quality of life and functional outcomes in patients with head and neck cancer who underwent salvage surgery. Methods: In this IRB approved study, FACT-HN Version 4 was administered pre-operatively and 6 months post-operatively to patients undergoing salvage surgery for HNSCC between November 4, 2014 and April 27, 2020. Retrospective cohort analysis was performed on this population with major outcome being postoperative QoL score. Functional outcomes included postoperative tracheostomy and feeding tube status. QoL outcomes were compared with paired t-tests. Univariate logistic regression was used to determine characteristics associated with presence of permanent tracheostomy and feeding tube, defined as presence greater than 30 days. Results: Overall, 25 patients undergoing salvage surgery for HNSCC were included in this analysis. Primary tumor sites were larynx/hypopharynx (44.0%), oral cavity (24.0%), oropharynx (20.0%), salivary (4.0%), skin (4.0%), and unknown primary (4.0%). Salvage surgeries consisted of total laryngectomy (36.0%), definitive neck dissection (24.0%), mandibulectomy (16.0%), parotidectomy (8.0%), with total laryngectomy/total glossectomy, radical tonsillectomy, TORS base of tongue excision, and transoral laser laryngeal excision all comprising 4% of cases. Total QoL scores were not significantly different preoperatively to postoperatively (mean 108.7, 95% CI=97.7 to 119.7 vs. 103.8, 95% CI: 93.1 to 114.5; P=0.436, with maximum total score of 148). Patients with lower preoperative Emotional Well-Being (EWB) subscores demonstrated significantly worse EWB subscores postoperatively (postoperative mean: 17.0, 95% CI: 14.5 to 19.4 vs. 21.7, 95% CI: 20.0 to 23.4; P=0.002). Of patients who underwent tracheostomy tube placement, 53.8% (N=7/13) remained tracheostomy dependent long-term (\u3e30 d). Of patients who underwent feeding tube placement, 81.0% (N=17/21) remained feeding tube dependent long-term (\u3e30 d). Tracheostomy and feeding tubes remained in place with median durations of 3.02 months (range 0.16 to 20.55) and 10.13 months (range 0 to 24.89), respectively. All patients with T3/4 disease undergoing salvage surgery required long-term feeding tube (N=6). Conclusions: This study provides important information about quality of life and functional outcomes for patients undergoing salvage surgery for HNSCC. There is a high rate of long-term tracheostomy and feeding tube dependence following salvage surgery. While no difference was found in head and neck related quality of life total score and sub-scores at 6 months postoperatively, general emotional well-being preoperatively was most associated with general emotional well-being postoperatively. This information should be taken into consideration when counseling and managing patients with residual or recurrent HNSCC

Interference With Implanted Upper Airway Stimulation Device by Phones With Magnet Technology

Newer iPhone models with MagSafe magnetic technology can cause electromagnetic interference with the Inspire upper airway stimulator device (a surgical implant for the treatment of obstructive sleep apnea). Laryngoscope, 132:2513–2515, 202

Evaluating Quality of Life and Functional Outcomes in Salvage Surgery for Head and Neck Cancer

INTRODUCTION Unique challenges surround treatment for residual or recurrent head and neck squamous cell carcinoma (HNSCC). Of the limited treatment options for residual or recurrent HNSCC, salvage surgery is often the best option. However, salvage surgery can result in significant morbidity, affecting both quality of life (QoL) and functional outcomes. Few studies have examined QoL outcomes following salvage surgery in the setting of HNSCC. Our goal is to analyze the head and neck related quality of life, and functional outcomes in patients with head and neck cancer who underwent salvage surgery. METHODS In this study, FACT-HN Version 4 was administered pre-operatively and 6 months post-operatively to patients undergoing salvage surgery for HNSCC between November 4, 2014 and March 30, 2020. Retrospective cohort analysis was performed on this population with major outcome being postoperative QoL score. Functional outcomes included post-operative tracheostomy and feeding tube status. Simple logistic regression was used to determine characteristics associated with presence of permanent tracheostomy and feeding tube, defined as presence greater than 30 days. Chi-square fisher’s exact test was used to assess tumor characteristics with functional outcomes greater than 30 days. QoL outcomes were compared using paired t-tests and ANOVAs. RESULTS Overall, 39 patients undergoing salvage surgery for HNSCC and were included in this analysis. Salvage surgeries consisted of total laryngectomy (36.0%), definitive neck dissection (24.0%), mandibulectomy (16.0%), parotidectomy (8.0%), with total laryngectomy/total glossectomy, radical tonsillectomy, TORS base of tongue excision, and transoral laser laryngeal excision all comprising 4% of cases. Statistically significant differences between salvage and non-salvage patients were observed with alcohol use, with 5 (12.8%) salvage patients reporting no alcohol use, 10 (25.6%) reporting some, and 24 (61.5%) reporting abuse, when compared to 15 (17.7%), 39 (45.9%), and 31 (36.5%) in non-salvage patients, respectively. Preoperative scores for salvage patients were not found to be associated with functional outcomes of having a feeding tube and/or tracheostomy for more than 30 days. For non-salvage patients, the odds of having a tracheostomy more than 30 days decreases with higher pre-op HNCS score (p=0.0462). Of the patients with a feeding tube for more than 30 days, 52.14% do not have a secondary total laryngectomy versus 42.86%, 18% did not use systemic therapy while 81.82% did, and 57.14% had a neck dissection while 42.85% did not. Patients with tertiary total laryngectomy have higher Social Well-Being (SWB) postoperative scores (mean 27.33 vs 21.75) and higher Functional Well-Being (FWB) postoperative scores (mean 25.50 vs 17.39). Patients with salvage surgery and use of systemic therapy had lower HNCS post scores with means 19.39 vs 23.96 and 19.65 vs 26.82, respectively. Salvage patients also have a lower preoperative HNCS mean of 25.8 vs. 29.1. There is a statistically significant positive association between preoperative Physical Well-being (PWB) score and postoperative PWB score (correlation coefficient of 0.56), preoperative SWB score and postoperative SWB score (correlation coefficient of 0.56), and preoperative Emotional Well-Being (EWB) score and postoperative EWB score (correlation coefficient of 0.90) in salvage patients. In non-salvage patients, a similar positive correlation was found between preoperative and postoperative PWB (correlation coefficient of 0.51) and FWB (correlation coefficient of 0.64). Using a regression model we found that in salvage patients, for every one-point increase on preoperative PWB score, SWB score, and EWB score, the predicted postoperative score would be 0.63, 0.47, and 0.97 points higher, respectively. Similarly, in non-salvage patients, for every one-point increase in PWB, FWB, and HNCS pre-op score, the predicted postoperative was 0.86, 0.42, and 0.73 points higher, respectively. CONCLUSIONS This study provides important information about quality of life and functional outcomes for patients undergoing salvage surgery for HNSCC. There is a lower rate of long-term tracheostomy and feeding tube dependence in non-salvage patients when preoperative HNSC score was higher, and of the patients who had permanent feeding tube, a significant percent used secondary therapy and had a neck dissection. Patients who underwent salvage surgery had positive association between preoperative and postoperative social well-being, physical well-being and emotional well-being, with the preoperative value being a strong predictor for postoperative well-being. This information should be taken into consideration when counselling and managing patients with residual or recurrent HNSCC

CHEMIA_2_2009_0_1.pmd

Abstract. With the aim of improving the basic characteristics of Track Etched Membranes (TEMs), functionalization by graft copolymerization has been attempted in the present work. Thin films (25 μm) of poly(vinyl fluoride) (PVF) (Tedlar) were irradiated by swift heavy ions (110 MeV Si 8+ ). The irradiated films were chemically etched to form latent tracks. Atomic Force Microscopy (AFM) was used to ascertain the formation of latent tracks. Irradiation effects were studied using UVvisible spectroscopic techniques. The tracks were functionalized by gamma radiation induced grafting with 4-vinyl pyridine (4-VP). In order to anticipate the best grafting conditions, percentage of grafting was studied as a function of various reaction conditions such as (i) total dose, (ii) monomer concentration and (iii) amount of water. Maximum percentage of grafting (13.66 %) was obtained at a total dose of 57.024 kGy using 2 ml of 4-VP in 10 ml of water. The grafted films were characterized by FTIR technique

Outcomes and complications of primary rhegmatogenous retinal detachment repair with pars plana vitrectomy in young adults

BACKGROUND: Scleral buckling has been the standard for rhegmatogenous retinal detachment repair in young patients given the typical lack of posterior vitreous detachment, phakic status, and lower risk of proliferative vitreoretinopathy. In older patients, pars plana vitrectomy alone is typically used for rhegmatogenous retinal detachment repair. We report the outcomes and complications of pars plana vitrectomy for rhegmatogenous retinal detachment in young eyes. METHODS: Retrospective, single-center cohort study. Medical records of patients between 15 to 45 years of age undergoing primary pars plana vitrectomy for rhegmatogenous retinal detachment repair between 2010 and 2020 were carefully reviewed. All analyses were performed using the Kruskal-Wallis tests for numeric covariates between age groups. RESULTS: Eyes were stratified by age: 15-24 (group 1, n = 10), 25-34 (group 2, n = 14), and 35-45 (group 3, n = 38). The average number of surgeries were 1.9, 1.4, and 1.1 in groups 1, 2, and 3, respectively (p = 0.004). Single surgery success rates were 50%, 64%, and 92% in groups 1, 2 and 3, respectively (p = 0.005). Final reattachment rates were 80%, 93%, 100% in groups 1, 2, and 3, respectively (p = 0.568). Proliferative vitreoretinopathy developed in 50%, 7%, and 8% of eyes in groups 1, 2, and 3, respectively (p \u3c 0.001). CONCLUSION: While the final reattachment rates were excellent in all groups, the higher rates of proliferative vitreoretinopathy and lower single surgery success rate in younger patients may suggest that primary pars plana vitrectomy may not be the optimal repair method in these age groups

Genomic Landscape Highlights Molecular Mechanisms Involved in Silicate Solubilization, Stress Tolerance, and Potential Growth-Promoting Activity of Bacterium Enterobacter sp. LR6

Silicon (Si) is gaining widespread attention due to its prophylactic activity to protect plants under stress conditions. Despite Si’s abundance in the earth’s crust, most soils do not have enough soluble Si for plants to absorb. In the present study, a silicate-solubilizing bacterium, Enterobacter sp. LR6, was isolated from the rhizospheric soil of rice and subsequently characterized through whole-genome sequencing. The size of the LR6 genome is 5.2 Mb with a GC content of 54.9% and 5182 protein-coding genes. In taxogenomic terms, it is similar to E. hormaechei subsp. xiangfangensis based on average nucleotide identity (ANI) and digital DNA–DNA hybridization (dDDH). LR6 genomic data provided insight into potential genes involved in stress response, secondary metabolite production, and growth promotion. The LR6 genome contains two aquaporins, of which the aquaglyceroporin (GlpF) is responsible for the uptake of metalloids including arsenic (As) and antimony (Sb). The yeast survivability assay confirmed the metalloid transport activity of GlpF. As a biofertilizer, LR6 isolate has a great deal of tolerance to high temperatures (45 °C), salinity (7%), and acidic environments (pH 9). Most importantly, the present study provides an understanding of plant-growth-promoting activity of the silicate-solubilizing bacterium, its adaptation to various stresses, and its uptake of different metalloids including As, Ge, and Si

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Not AvailableSuccessful purification of multiple viruses from mixed infections remains a challenge. In this study, we investigated peste des petits ruminants virus (PPRV) and foot-and-mouth disease virus (FMDV) mixed infection in goats. Rather than in a single cell type, cytopathic effect (CPE) of the virus was observed in cocultured Vero/BHK-21 cells at 6th blind passage (BP). PPRV, but not FMDV could be purified from the virus mixture by plaque assay. Viral RNA (mixture) transfection in BHK-21 cells produced FMDV but not PPRV virions, a strategy which we have successfully employed for the first time to eliminate the negative-stranded RNA virus from the virus mixture. FMDV phenotypes, such as replication competent but noncytolytic, cytolytic but defective in plaque formation and, cytolytic but defective in both plaque formation and standard FMDV genome were observed respectively, at passage level BP8, BP15 and BP19 and hence complicated virus isolation in the cell culture system. Mixed infection was not found to induce any significant antigenic and genetic diversity in both PPRV and FMDV. Further, we for the first time demonstrated the viral interference between PPRV and FMDV. Prior transfection of PPRV RNA, but not Newcastle disease virus (NDV) and rotavirus RNA resulted in reduced FMDV replication in BHK-21 cells suggesting that the PPRV RNAinduced interference was specifically directed against FMDV. On long-termcoinfection of some acute pathogenic viruses (all possible combinations of PPRV, FMDV, NDV and buffalopox virus) in Vero cells, inmost cases, one of the coinfecting viruses was excluded at passage level 5 suggesting that the long-term coinfection may modify viral persistence. To the best of our knowledge, this is the first documented evidence describing a natural mixed infection of FMDV and PPRV. The study not only provides simple and reliable methodologies for isolation and purification of two epidemiologically and economically important groups of viruses, but could also help in establishing better guidelines for trading animals that could transmit further infections and epidemics in disease free nations.Not Availabl

An international pilot study of an Internet-based platform to facilitate clinical research in epilepsy: the EpiNet project.

We created an epilepsy patient database that can be accessed via the Internet by neurologists from anywhere in the world. The database was designed to enroll and follow large cohorts of patients with specific epilepsy syndromes, and to facilitate recruitment of patients for investigator-initiated clinical trials. The EpiNet database records physician-derived information regarding seizure type and frequency, epilepsy syndrome, etiology, drug history, and investigations. It can be accessed from any country by approved investigators via a secure, password-protected Website. All data are encrypted. The database is for both research and clinical purposes. Investigators were invited to register any patient with epilepsy, but were particularly encouraged to register patients when uncertain of the optimal management. Participation required approval from investigators' ethics committees and institutional review boards, and all patients or their caregiver provided written informed consent. Patients were not enrolled in clinical trials in this pilot study. The international pilot study recruited patients from September 2010 to November 2011. Sixty-four investigators or research assistants from 25 centers in 13 countries registered 1,050 patients. Patients with a wide range of epilepsy syndromes and etiologies were registered. Patients' ages ranged from 2 weeks to 90 years. The Website was successfully used by doctors working in different health systems. The pilot study confirmed that this low-cost, collaborative approach to research has great potential. Large, multicenter cohort studies will commence in 2012, and randomized clinical trials are being planned. All epileptologists are invited to join this project

Complexities in Isolation and Purification of Multiple Viruses from Mixed Viral Infections: Viral Interference, Persistence and Exclusion.

Successful purification of multiple viruses from mixed infections remains a challenge. In this study, we investigated peste des petits ruminants virus (PPRV) and foot-and-mouth disease virus (FMDV) mixed infection in goats. Rather than in a single cell type, cytopathic effect (CPE) of the virus was observed in cocultured Vero/BHK-21 cells at 6th blind passage (BP). PPRV, but not FMDV could be purified from the virus mixture by plaque assay. Viral RNA (mixture) transfection in BHK-21 cells produced FMDV but not PPRV virions, a strategy which we have successfully employed for the first time to eliminate the negative-stranded RNA virus from the virus mixture. FMDV phenotypes, such as replication competent but noncytolytic, cytolytic but defective in plaque formation and, cytolytic but defective in both plaque formation and standard FMDV genome were observed respectively, at passage level BP8, BP15 and BP19 and hence complicated virus isolation in the cell culture system. Mixed infection was not found to induce any significant antigenic and genetic diversity in both PPRV and FMDV. Further, we for the first time demonstrated the viral interference between PPRV and FMDV. Prior transfection of PPRV RNA, but not Newcastle disease virus (NDV) and rotavirus RNA resulted in reduced FMDV replication in BHK-21 cells suggesting that the PPRV RNA-induced interference was specifically directed against FMDV. On long-term coinfection of some acute pathogenic viruses (all possible combinations of PPRV, FMDV, NDV and buffalopox virus) in Vero cells, in most cases, one of the coinfecting viruses was excluded at passage level 5 suggesting that the long-term coinfection may modify viral persistence. To the best of our knowledge, this is the first documented evidence describing a natural mixed infection of FMDV and PPRV. The study not only provides simple and reliable methodologies for isolation and purification of two epidemiologically and economically important groups of viruses, but could also help in establishing better guidelines for trading animals that could transmit further infections and epidemics in disease free nations

Copersistence of FMDV/PPRV in cocultured BHK-21/Vero cells.

<p>Confluent monolayers of cocultured BHK-21/Vero cells or single cell types (Vero or BHK-21 cells) were infected, in triplicates (12 well cell culture plate), with 100 μl of the cell culture supernatant (BP15) for 2 h followed by washing with PBS and addition of fresh media. Virus release in the infected cell culture supernatant (cocultured BHK/Vero cells) at indicated time points was quantified by determining TCID₅₀ (a). Infected cell culture supernatants from Vero (b) and BHK-21 (c) cells at indicated time points were tested for PPRV and FMDV-specific genomes by qRT-PCR. The viral RNA levels, expressed as threshold cycle (CT) values, were analyzed to determine relative fold change in RNA copy number over 2 hpi. Error bars indicate SD. Statistical analysis was conducted with Student’s <i>t</i> test (*** = P<0.001).</p