Comparative Study Between Peristomal Patches in Patients with Definitive Tracheostomy

Introduction: To prevent or diminish pulmonary problems in laryngectomized patients, continuous use of a heat and moisture exchanger (HME) is recommended. Therefore, automatic speaking valves are also often combined with an HME to enable hands-free speech. In order to keep these devices in place, most commonly, peristomal patches are used. Objective: This prospective clinical 2 × 2 crossover study aims at assessing the added value of a new patch for HME application, the Provox StabiliBase OptiDerm (SBO). The device combines the stable and conical base of the Provox StabiliBase with the skin-friendlier hydrocolloid Provox OptiDerm (OD) patch. Methods: Thirty-two laryngectomized patients were included in this multicenter study. Participants were asked to compare SBO to OD, and to the patch they normally use. The primary outcome measure was patient preference. Results: Overall, 60% of the participants had preference for their normally used patch, 23% preferred the SBO and 17% indicated no preference. When comparing the SBO to the OD, 43% preferred the SBO, 40% the OD and 17% had no preference. Conclusion: Most patients preferred their normally used patch and SBO was favored by a subgroup. Provox StabiliBase OptiDerm seems to be a valuable addition to the existing patches and further increases patients' options for HME application

Meta-analysis of 701 published cases of sinonasal neuroendocrine carcinoma:The importance of differentiation grade in determining treatment strategy

AbstractThe aim of this meta-analysis was to provide treatment guidelines for sinonasal neuroendocrine carcinoma (SNC) by combining all available data in the literature.A literature search for all studies concerning SNC was performed against the MEDLINE and EMBASE databases. Available clinical data was normalized, pooled, and statistically analyzed.A total of 701 cases of SNC were available for analysis, comprising 127 well or moderately differentiated sinonasal neuroendocrine carcinomas (SNEC), 459 sinonasal undifferentiated carcinoma (SNUC) and 115 sinonasal small cell carcinoma (SmCC). Tumor type was the most important predictor of survival, with a 5-year disease-specific survival (DSS) of 70.2% for SNEC, 35.9% for SNUC and 46.1% for SmCC. Tumor stage on presentation was of limited value in predicting survival or response to treatment. Overall, the application of surgery yielded significantly better results (5-year DSS 52.2% versus 30.1%, p<0.001). In SNUC, radiotherapy was a beneficial supplement to surgery (5-year DSS 54.7% versus 15.7%, p=0.027), while radiotherapy as monotherapy performed poorly (5-year DSS 17.9%). Chemotherapy did not appear to contribute to survival.Based on these findings, we can conclude that the most important predictors of survival in SNC are differentiation grade and the associated choice of treatment modality. In contrast to other head and neck cancers, tumor staging appears of limited value in predicting survival or deciding on a treatment strategy. Surgery should be the cornerstone of treatment, supplemented by radiotherapy in poorly differentiated subtypes (SNUC, SmCC). Chemotherapy does not appear to contribute to survival

Comparing powder magnetization and transport critical current of Bi,Pb(2223) tapes

The magnetic field dependence of the critical current in (Bi,Pb)/sub 2/Sr/sub 2/Ca/sub 2/Cu/sub 3/O/sub 10+x/ tapes is compared with the magnetization response of isolated grains extracted from the tapes. Special attention is paid to the low-field behavior. The goal of the experiment is to test the widely-used hypothesis that current paths in these tapes contain both weak- and strong- linked branches, which in low field act in parallel. The data agree with this hypothesis; at temperatures above 50 K the powder magnetization drops off exponentially from the self-field to the irreversibility field, while the transport and magnetization currents in the intact tapes show an extra low-field component. Below 50 K the powder behavior becomes less straightforward, but the parallel-path picture in the tapes still holds

Strain effects in high temperature superconductors investigated with magneto-optical imaging

In order to determine the influence of intermediate deformation steps on the mechanical behavior of Bi-based tapes, the effect of longitudinal applied strain is investigated by means of magneto-optical imaging. The strain is applied in a helium flow-cryostat. Cracks appear soon after the critical current in Bi-based tapes is degraded. All filaments form multiple cracks that grow into tape-wide cracks, running from one filament to the next. The crack location is not caused by stress concentrations in the matrix, but by the mechanically weak colony boundaries. Because of the absence of intermediate rolling steps in the production of Bi/sub 2/Sr/sub 2/CaCu/sub 2/O/sub x/ tapes, a different crack structure is observed compared to Bi/sub 2/Sr/sub 2/Ca/sub 2/Cu/sub 3/O/sub x/ tapes. The relation between the critical current and the formation of cracks is studied. The degradation in critical current before the critical strain is reached may be caused by microcracks that remain undetected by magneto-optical imaging. The influence of strain on the microstructure of YBa/sub 2/Cu/sub 3/O/sub x/ coated conductors is also investigated with magneto-optical imaging. The formation of cracks is believed to be determined by the nickel substrate and related to the Ni-grain size

Critical current versus strain research at the University of Twente

At the University of Twente a U-shaped spring has been used to investigate the mechanical properties of a large variety of superconducting tapes and wires. Several mechanisms are responsible for the degradation of critical current as a function of applied strain. A change in its intrinsic parameters causes a reversible critical current dependence in Nb3Sn. The critical current reaches a maximum at a wire-dependent tensile strain level, and decreases when this tensile strain is either released or further increased. In Bi-based tapes the critical current is virtually insensitive to tensile strain up to a sample-dependent irreversible strain limit. When this limit is exceeded, the critical current decreases steeply and irreversibly. This behaviour is attributed to microstructural damage to the filaments. This cracking of the filaments is verified by a magneto-optical strain experiment. Recent experiments suggest that in MgB2 the degradation of critical current is caused by a change in intrinsic properties and damage to the microstructure. Magneto-optical imaging can be used to investigate the influence of applied strain on the microstructure of MgB2, as is done successfully with Bi-based tapes. In all these conductors the thermal precompression of the filaments plays an important role. In Nb3Sn it determines the position of the maximum and in Bi-based and MgB2 conductors it is closely related to the irreversible strain limit

To what extent has the last two decades seen significant progress in the management of older patients with head and neck cancer?

Introduction: Life expectancy is rising and consequently also the number of older patients with head and neck cancer. Different treatment regimens are often applied for older patients. The aim of this study is to investigate how treatment patterns and survival rates have changed over the past 20 years in older patients with head and neck squamous cell carcinoma (HNSCC). Materials: Patient and tumour characteristics, treatment and 5-year survival data from the Netherlands Cancer Registry of patients aged >60 years diagnosed with HNSCC in 1990-1995 and 2010-2015 were compared using chi-square test and relative survival analysis. Results: Data of 14,114 patients were analyzed. Oral cavity cancer treatment did not change over time, while survival improved from 54% to 58% (p 1/4 0.03). Oropharyngeal and hypopharyngeal cancer treatment shifted towards non-surgical, with survival improving from 31% to 51% (p < 0.01) and 26% to 34% (p < 0.01), respectively. Laryngeal cancer treatment changed towards surgery in stage I and non-surgical treatment in stage III and IV disease. Survival in laryngeal cancer stage I remained stable and favorable at a relative survival rate of around 90%. Survival non-significantly changed from 54% to 49% for stage III disease and from 37% to 33% for disease. Conclusion: Relative survival increased for all head and neck cancer sites in older patients, except for laryngeal cancer. For oropharyngeal, hypopharyngeal and advanced laryngeal cancer, a shift towards non-surgical treatment modalities was observed. (c) 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY licens

The relation between hypoxia and proliferation biomarkers with radiosensitivity in locally advanced laryngeal cancer

Purpose: Treatment decision-making in advanced-stage laryngeal squamous cell carcinoma (LSCC) is difficult due to the high recurrence rates and the desire to preserve laryngeal functions. New predictive markers for radiosensitivity are needed to facilitate treatment choices. In early stage glottic LSCC treated with primary radiotherapy, expression of hypoxia (HIF-1α and CA-IX) and proliferation (Ki-67) tumour markers showed prognostic value for local control. The objective of this study is to examine the prognostic value of tumour markers for hypoxia and proliferation on locoregional recurrent disease and disease-specific mortality in a well-defined cohort of patients with locally advanced LSCC treated with primary, curatively intended radiotherapy.Methods: In pre-treatment biopsy tissues from a homogeneous cohort of 61 patients with advanced stage (T3–T4, M0) LSCC primarily treated with radiotherapy, expression of HIF-1α, CA-IX and Ki-67 was evaluated with immunohistochemistry. Demographic data (age and sex) and clinical data (T- and N-status) were retrospectively collected from the medical records. Cox regression analysis was performed to assess the relation between marker expression, demographic and clinical data, and locoregional recurrence and disease-specific mortality.Results: Patients with high expression of HIF-1α developed significantly more often a locoregional recurrence (39%) compared to patients with a low expression (21%) (p = 0.002). The expression of CA-IX and Ki-67 showed no association with locoregional recurrent disease. HIF-1α, CA-IX and Ki-67 were not significantly related to disease-specific mortality. Clinical N-status was an independent predictor of recurrent disease (p &lt; 0.001) and disease-specific mortality (p = 0.003). Age, sex and T-status were not related to locoregional recurrent disease or disease-specific mortality.Conclusion: HIF-1α overexpression and the presence of regional lymph node metastases at diagnosis were independent predictors of locoregional recurrent disease after primary treatment with curatively intended radiotherapy in patients with locally advanced LSCC.</p

Narrow-Band Imaging in Transoral Laser Surgery for Early Glottic Cancer:A Randomized Controlled Trial

Objective: Assessing whether the additional use of narrow-band imaging (NBI) in transoral laser surgery (TOLS) for early laryngeal cancer improves clinical outcomes. Study Design: Randomized controlled trial, performed between September 2015 and November 2022. Setting: A tertiary referral hospital in The Netherlands. Methods: TOLS was carried out in 113 patients. The procedure was performed with white light imaging (WLI, n = 56) alone, or combined with NBI (n = 57). Patients received frequent follow-up laryngoscopy. Resection margin status, recurrence rate, and recurrence-free survival at 12 months, 18 months, and after study termination (maximum 86 months) were analyzed. Results: Thirty-one cases in the WLI group had a positive resection margin, versus 16 in the NBI group (p =.002). After 12 months, the recurrence-free survival was 92%: 87% for WLI versus 96% for NBI, p =.07. The recurrence rate was 7/56 (13%) for WLI, versus 2/57 (4%) for NBI, p =.09. After 18 months, the recurrence-free survival was 84% for WLI versus 96% for NBI, p =.02. The recurrence rate was 9/56 (16%) for WLI, versus 2/57 (4%) for NBI, p =.02. After study termination, the recurrence-free survival was 71% for WLI versus 83% for the NBI group (p =.08). The recurrence rate was 16/56 for WLI, versus 10/57 for NBI (p =.16). Conclusion: The additional use of NBI during TOLS significantly decreased the number of positive resection margins. Although not statistically significant at all time points, patients treated with NBI-supported TOLS showed a lower recurrence rate and better recurrence-free survival. Further studies in larger patient groups are needed to confirm these results.</p

Narrow-Band Imaging in Transoral Laser Surgery for Early Glottic Cancer:A Randomized Controlled Trial

Objective: Assessing whether the additional use of narrow-band imaging (NBI) in transoral laser surgery (TOLS) for early laryngeal cancer improves clinical outcomes. Study Design: Randomized controlled trial, performed between September 2015 and November 2022. Setting: A tertiary referral hospital in The Netherlands. Methods: TOLS was carried out in 113 patients. The procedure was performed with white light imaging (WLI, n = 56) alone, or combined with NBI (n = 57). Patients received frequent follow-up laryngoscopy. Resection margin status, recurrence rate, and recurrence-free survival at 12 months, 18 months, and after study termination (maximum 86 months) were analyzed. Results: Thirty-one cases in the WLI group had a positive resection margin, versus 16 in the NBI group (p =.002). After 12 months, the recurrence-free survival was 92%: 87% for WLI versus 96% for NBI, p =.07. The recurrence rate was 7/56 (13%) for WLI, versus 2/57 (4%) for NBI, p =.09. After 18 months, the recurrence-free survival was 84% for WLI versus 96% for NBI, p =.02. The recurrence rate was 9/56 (16%) for WLI, versus 2/57 (4%) for NBI, p =.02. After study termination, the recurrence-free survival was 71% for WLI versus 83% for the NBI group (p =.08). The recurrence rate was 16/56 for WLI, versus 10/57 for NBI (p =.16). Conclusion: The additional use of NBI during TOLS significantly decreased the number of positive resection margins. Although not statistically significant at all time points, patients treated with NBI-supported TOLS showed a lower recurrence rate and better recurrence-free survival. Further studies in larger patient groups are needed to confirm these results.</p

Evaluating Laryngopharyngeal Tumor Extension Using Narrow Band Imaging Versus Conventional White Light Imaging

OBJECTIVE/HYPOTHESIS: Comparing detection and extension of malignant tumors by flexible laryngoscopy in the outpatient setting with laryngoscopy under general anesthesia using both White Light Imaging (WLI) and Narrow Band Imaging (NBI). STUDY DESIGN: Prospective randomized controlled trial. METHODS: Two hundred and thirty-three patients with laryngeal and pharyngeal lesions underwent flexible and rigid laryngoscopy, with both WLI and NBI. Extension of malignant lesions (n = 132) was compared between both techniques in detail. RESULTS: Sensitivity of NBI during flexible endoscopy (92%), was comparable with that of WLI during rigid endoscopy (91%). The correlation of tumor extension between flexible and rigid laryngoscopy was high (rs = 0.852-0.893). The observed tumor extension was significantly larger when using NBI in both settings. The use of NBI during flexible laryngoscopy leads to upstaging (12%) and downstaging (2%) of the T classification. CONCLUSIONS: NBI during flexible laryngoscopy could be an alternative to WLI rigid endoscopy. NBI improves visualization of tumor extension and accuracy of T staging. LEVEL OF EVIDENCE: 3 Laryngoscope, 2021