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Monday, January 17, 2022

Marital status and survival in laryngeal squamous cell carcinoma patients: a multinomial propensity scores matched study

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Eur Arch Otorhinolaryngol. 2022 Jan 16. doi: 10.1007/s00405-022-07252-7. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore the correlation between the marital status and prognosis of patients with laryngeal squamous cell carcinoma (LSCC).

STUDY DESIGN: MPSM was adopted to minimize the maximum standardized average difference of the covariates among the four groups with different marital status.

SETTING: Multinomial propensity scores matching (MPSM) based on data from the surveillance, epidemiology, and end results (SEER) database.

METHODS: The Kaplan-Meier method and log-rank test were used to compare the survival outcomes of these groups with different marital status.

RESULTS: Totally, 16,981 LSCC patients (median [IQR] age 62 [55-69] years; 829 [76.41%] males) from 2004 to 2016 were included in this study. Among them, 9112 (53.66%) were married, 2708 (15.95%) divorced or separated, 1709 (10.06%) widowed, an d 3452 (20.33%) single. After MPSM, the weights make the characteristics of four groups with different marital status sufficient balance. The Kaplan-Meier method and log-rank test showed widowed patients may lead to the highest mortality rate while married patients have a higher survival rate than the other three groups. Single and divorced or separated patients had no significant difference in the survival rate. In addition, multivariate analysis by controlling for confounding factors showed that in male, well-differentiated, and early stage patients, compared with married, unmarried was an independent risk factor for CSS (P < 0.05).

CONCLUSION: Marital status showed a significant association with the survival status of LSCC patients. Importantly, the outcome of married patients was better, while widowed patients tended to have worse prognosis.

PMID:35034189 | DOI:10.1007/s00405-022-07252-7

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Prosthetic voice rehabilitation after laryngoesophagectomy: surgical and functional outcomes

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Eur Arch Otorhinolaryngol. 2022 Jan 16. doi: 10.1007/s00405-022-07251-8. Online ahead of print.

ABSTRACT

PURPOSE: Quality of Life (QoL) after extensive head and neck resections is of paramount importance, especially after pharyngolaryngectomy or pharyngolaryngoesophagectomy where complex digestive tract reconstruction is required (with gastric pull-up or colon transposition). Tracheodigestive puncture (TDP) is the only vocal restoration option in this group of patients. The aim of this study is to evaluate postoperative complications, vocal outcomes, voice-related and swallowing-related QoL after secondary TDP in this cohort of patients.

METHODS: A retrospective study was conducted in the tertiary referral center of Verona Hospital between June 2014 and June 2020. Patient demographics, clinical and surgical data were assessed. Speech objective and subjective evaluation was performed. QoL was assessed with Voice Handicap Index-10 (VHI-10) and M.D. Anderson Dysphagia Inventory (MDADI) questionnaires.

RESULTS: Seven patients met the inclusion criteria, but two had died before questionnaires were administered. No intraoperative complications were noted after TDP surgery. There were delayed complications in four cases (57.1%) and all were treated with restoration. Intelligible voice was restored in all patients. Maximum phonation time and maximal voice intensity recorded were 5.42 ± 3.27 s and 65.20 ± 5.45 dB, respectively. Acceptable average VHI-10 and MDADI scores were obtained in all patients.

CONCLUSIONS: Secondary TDP performed after gastric pull-up or colon transposition reconstructions are feasible and effective procedures. An intelligible voice was restored in all patients, with satisfactory patient-perceived voice-related and dysphagia-related quality-of-life outcomes.

PMID:35034188 | DOI:10.1007/s00405-022-07251-8

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Markers to sensibility and relapse on IMR-32 neuroblastoma cell line cultured in monolayer (2D) and neurosphere (3D) models cisplatin-treated

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Acta Histochem. 2022 Jan 13;124(2):151849. doi: 10.1016/j.acthis.2022.151849. Online ahead of print.

ABSTRACT

The complexity of different components of tumor stroma poses huge challenges for therapies targeting the neuroblastoma (NB) microenvironment. The present study aimed to evaluate platinum-based response in IMR-32 neuroblastoma cell line cultured in monolayer (2D) and neurosphere (3D) models. For this, we evaluated mRNA expression of heat shock proteins HSPA1A, HSPB1, TRAP1, HSPA1AL, HSPD1, and DNA damage repair gene ERCC1. After treatment, residual cells were grafted on CAM (chicken chorioallantoic membrane) to evaluate the growth capability and histological paraffin sections were made to assess Ki-67 and HER-2 proteins by immunofluorescence. Our results showed that cisplatin induces mRNA downregulation of Heat Shock Proteins and ERCC1 in IMR-32 cells cultured in 2D or 3D models. In addition, the cisplatin-treatment approach increased HER-2 expression in residual IMR-32 cells grafted on the CAM. Therefore, these insights provide many advances in neuroendocrine tumor biology and knowledge about cisplatin-response in neuroblastoma.

PMID:35033934 | DOI:10.1016/j.acthis.2022.151849

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Complications during Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in 5680 examinations

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Objective: To evaluate retrospectively the incidence of complications during Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in 5680 examinations. Patients and Methods: 5680 patients were evaluated at the Department of Otorhinolaryngology, Audiology and Phoniatrics of Pisa University Hospital between January 2014 and December 2018, involving both inpatients and outpatients. Most common comorbidities included neurological pathologies such as stroke (11.8%), neurodegenerative diseases (28.9%) and a history of previous head and neck surgery (24.6%). The evaluation was conducted by clinicians with experience in swallowing for a minimum of 10 years with the assistance of one or more speech language pathologists. Results: In all patients studied the endoscope insertion was tolerated and it was possible to visualize the pharyngo-laryngeal structures. Most patients reported discomfort In a minority of patients, complications were recorded, such as anterior epistaxis, posterior epistaxis, vasovagal crises and laryngospasm. Laryngospasm was recorded in patients affected by Amyotrophic Lateral Sclerosis (ALS). Multivariate binary logistic regression showed that discomfort, chronic gastrointestinal diseases, neurodegenerative diseases and brain tumors were risk factors associated with minor complications. Conclusions: FEES proved to be easy to perform, well tolerated by the patients and cost-effective. It can be performed at the patient's bedside and it is characterized by low rate of complications. As a matter o f fact, normally only discomfort, gagging and/or vomit are reported. Only rarely complications occur, such as anterior or posterior epistaxis episodes or vasovagal crises, but these are still easily managed. Exceptionally, more severe complications are reported: adverse drug reactions to substances such as blue dye (methylene blue) and local anesthetics (not used in our protocol), and laryngospasm.
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Frequency of success and complications of primary endoscopic third ventriculostomy in infants with obstructive hydrocephalous

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Pak J Med Sci. 2022 Jan-Feb;38(1):267-270. doi: 10.12669/pjms.38.1.4097.

ABSTRACT

OBJECTIVES: To determine the success rate and complications of primary endoscopic third ventri-culostomy (ETV) in infants with obstructive hydrocephalous.

METHODS: This case series was conducted at the Department of Neurosurgery, Medical and Teaching Institute, Lady Reading Hospital Peshawar from July 2016 to June 2018. All consecutive patients with age less than one year who underwent ETV for primary obstructive hydrocephalous, of both gender, were included in the study. The patients were followed up to six months after surgery. The data was entered in a specially designed Performa. Patients' data was analyzed using SPSS version 21.0.

RESULTS: We had total 21 patients with age less than one year during the study period. Male patients were 11 (52.4%). Success rate of ETV at six months of follow up was 12 (57.1%). Post-op complications observed were i n 9.52% (2/21) cases. One patient had cerebrospinal fluid CSF) leak and the other had significant bleed.

CONCLUSION: ETV is successful in 57.1% of infants with obstructive type of hydrocephalous. The post op complications in case of ETV are lower than Ventriculo-peritoneal shunts. Therefore, ETV can be offered to infants having obstructive hydrocephalous.

PMID:35035437 | PMC:PMC8713220 | DOI:10.12669/pjms.38.1.4097

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Inner ear MRI enhancement based on 3D‐real IR sequence in patients with Meniere's disease after intravenous gadolinium injection: comparison of different doses used and exploration of a appropriate dose

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Abstract

Objectives

Three-dimensional inversion-recovery sequence with real reconstruction (3D-real IR) magnetic resonance imaging (MRI) can detect endolymphatic hydrops of the inner ear. We aimed to explore a appropriate dose for intravenous gadolinium injection.

Design

Observational prospective study.

Setting

Tertiary referral center.

Participants

We collected 90 unilateral definite Meniere's disease patients.

Main outcome measures

All enrolled patients were divided into three groups randomly (patients in group A, B and C received gadolinium injection in 1/1.5/2 times doses, respectively). After 4 hours, inner ear MRI scans were applied.

Results

The signal intensities of B-affected ears and C-affected ears were significantly higher than A-affected ears (p < 0.05), however, no difference was found between B-affected ears and C-affected ears (p=0.267). The same conditions also appeared in the three unaffected-ear groups. Moreover, the signal intensities of affected-ear in group A, B and C were significantly higher than that of the corresponding unaffected-ear groups (p < 0.05). Besides, the subjective visual evaluation scores of group B and C were significantly better than that of group A (p < 0.05).

Conclusions

Intravenous injection of gadolinium in a single dose may be unbefitting for the inner ear imaging based on 3D-real IR MRI, both the applications of gadolinium in 1.5 times and double doses can have a good perilymphatic enhancement effect of inner ear. In order to minimize the use of dose for avoiding or mitigating the adverse reactions and renal damage, 1.5 times dose may be preferred in clinical practice.

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Development of advanced practice nursing in oncology and hematology-oncology

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Bull Cancer. 2022 Jan 13:S0007-4551(21)00570-1. doi: 10.1016/j.bulcan.2021.11.009. Online ahead of print.

ABSTRACT

BACKGROUND: Advanced practice nursing was introduced in France in 2018, in response to health needs. The first advanced practice nurses were graduated since 2019 and were trained in one among four medical areas including oncology and onco-hematology. The purpose of this article is to make an early assessment of the development of the profession of oncology Advanced Practice Nurse in France.

METHOD: An exploratory study was conducted. A sample of 44 onco-hematology IPA graduated in 2019 and 2020 was recruited from June 2021 to end of July 2021. The 44 participants completed a questionnaire, by phone interviews or self-administered.

RESULTS AND CONCLUSION: The distribution of the 44 participants concerns 12 of the 13 regions of metropolitan France. This profession shows an employability for 86% of the first gradu ates. These professionals practice in health care institutions and rather in oncology, 71% in the framework of an organizational protocol established with the oncologist. They appear to be well accepted by patients and oncology teams. Further studies on performance and quality indicators will make it possible to evaluate the added value of the oncology Advanced Practice Nurses in the cancer patient's pathway.

PMID:35034787 | DOI:10.1016/j.bulcan.2021.11.009

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How do we get around the barriers to integrating palliative care in oncology?

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Bull Cancer. 2022 Jan 13:S0007-4551(21)00684-6. doi: 10.1016/j.bulcan.2021.12.006. Online ahead of print.

ABSTRACT

Supported by numerous scientific publications showing its clinical benefits, early palliative care has become a gold standard in oncology since 2017, recommended for patients with advanced cancer by the major societies of oncology. Nevertheless, palliative care team integration is still too late in France and the intervention of palliative care teams in oncology is still often limited to the management of patients and their relatives at the end of life. First, we will look at the main obstacles: the lack of staff in palliative care teams and the complex functioning of palliative care identified beds; also, the difficulties of communication with the patient and his relatives for the introduction of palliative care. We will then discuss the prospects for development, moving from the concept of early palliative care (systemat ic from the advanced phase) to integrated palliative care (targeted to patients' needs). Standardization of the integrated palliative care pathway requires the description of referral criteria, screening modalities, different clinical missions, and collaboration modalities with oncologists. Palliative care and oncology teams, working together, can enable holistic medicine that focuses on the needs of patients and their loved ones, giving voice to their preferences and aiming to improve their quality of life.

PMID:35034784 | DOI:10.1016/j.bulcan.2021.12.006

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Immunotherapy of head and neck cancer : Highlights of the ASCO and ESMO annual meetings 2021

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HNO. 2022 Jan 17. doi: 10.1007/s00106-021-01142-w. Online ahead of print.

ABSTRACT

BACKGROUND: This year's American Society of Clinical Oncology (ASCO) meeting included interesting data on first-line therapy of nasopharyngeal carcinomas with PD‑1 inhibitors and on checkpoint inhibition in various clinical constellations. At the European Society of Medical Oncology (ESMO) meeting, the results of the CheckMate-651 study were presented.

MATERIALS AND METHODS: All abstra cts and presentations from the ASCO and ESMO meetings 2021 on immunotherapy in head and neck cancer (HNSCC) were evaluated for their relevance. The most interesting studies are elaborated upon herein.

RESULTS: Studies on locally advanced HNSCC showed an improved response after neoadjuvant pembrolizumab administration. A second cycle did not improve the response rate, but the proportion of patients with a good response was almost doubled. The CheckRad CD8 study showed an improvement in progression-free survival by induction chemoimmunotherapy with tremelimumab and durvalumab followed by stratification according to the CD8 immune cell infiltrate. Two studies were presented on first-line treatment of recurrent/metastatic nasopharyngeal carcinomas. Chemoimmunotherapy showed a higher response rate and prolonged progression-free survival with a similar adverse event profile. In recurrent/metastatic HNSCC, the CheckMate 651 study showed an increased duration of response with nivoluma b and ipilimumab and higher response rates than pembrolizumab alone. The primary endpoints for overall survival were not achieved.

CONCLUSION: PD‑1 inhibition has great potential to change the therapeutic landscape for nasopharyngeal carcinomas in the future. In HNSCC, CD8 tumor infiltrate presents a promising predictive marker for selecting patients who can benefit from radioimmunotherapy. The combination of nivolumab and ipilimumab did not improve overall survival in palliative first-line therapy; thus, no change in the current standard is expected.

PMID:35037989 | DOI:10.1007/s00106-021-01142-w

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A Rare Cause of Secondary Otalgia

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A Rare Cause of Secondary Otalgia
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Evropi Forozidou, MD, Nikolaos Tsetsos, MD, MSc, Paraskevi Karamitsou, MD, MSc, ...
First Published January 17, 2022 Research Article
https://doi.org/10.1177/01455613221075226
Article information
Open AccessCreative Commons Attribution, Non Commercial 4.0 License
Significance Statement
Secondary otalgia is defined as pain felt in the ear although originating from a non-otologic source. The complex innervation of ear structures makes the identification of the responsible region a challenging procedure. The 2 most common causes of secondary otalgia are the temporomandibular joint dysfunction and dental infections. We present a rare case of secondary otalgia caused by a foreign body hidden deeply in the lateral surface of the tongue.

A 61-year-old male ironworker presented to our emergency Ear, Nose and Throat department complaining about left otalgia accompanied by difficulty in swallowing. Symptoms had started 1 week before in his work environment. The patient was prescribed a 5-day course of antibiotics with ciprofloxacin ear drops combined with painkillers by his family doctor without, however, any signs of improvement. His past medical history was otherwise normal.

A thorough clinical examination combined with otomicroscopy was unremarkable for any ear pathology. Fiberoptic nasolaryngoscopy and laboratory tests were also normal. Inspection of the oral cavity showed no signs of inflammation; however, a tender area on the left lateral surface of the tongue was noted. After careful observation, a tiny hole was recognized in the same area (Figure 1). An exploration of the area under local anesthesia was conducted and a metallic iron bar of approximately 1.5 cm in length was removed (Figure 2). Symptoms were completely subsided and the patient remained pain free at 1-week follow-up.

figure

Figure 1. Oral cavity inspection. Recognition of the painful area on the left lateral surface of the tongue.


figure

Figure 2. The extracted foreign body. A metallic iron bar.

Otalgia is a rather common symptom seen in the primary care setting with many diverse causes. Primary otalgia is related to clinical entities affecting the outer, middle, and inner ear.1 Inflections such as acute or chronic media otitis, external otitis, folliculitis, mastoiditis, and myringitis constitute the most common etiologic factors. Cerumen obstruction, ear neoplasms, and trauma may also be responsible for primary otalgia. The origin of primary otalgia is almost always easy to be established with otomicroscopy or radiographic imaging.2

On the other hand, when the cause of pain cannot be localized to the affected ear, it is referred to as secondary otalgia. There is a considerable overlap between the innervation of the ear and the related areas in the head and neck. Innervation of the ear structures comprises multiple lower cranial, upper cervical, and peripheral nerves. They innervate the spine, skull base, salivary glands, pharynx, larynx, oral cavity, orbits, face, paranasal sinuses, and deep neck spaces. The most common causes of secondary otalgia are temporomandibular joint syndrome and dental infections. Additionally, other potential causes of otalgia are Bell's palsy, salivary gland disorders, pharyngitis, tonsillitis, oral disorders, and cervical osteoarthritis.2,3

Clinicians should be aware that otalgia could be the primary symptom of a head and neck malignancy. Therefore, a thorough clinical examination of the whole head and neck area is imperative to exclude neoplasms.3,4

Inflammation, trauma, and neoplasms of the tongue often cause secondary otalgia via the trigeminal (CN V) and the glossopharyngeal nerve (CN IX).

The third branch of the trigeminal, the mandibular nerve (V3), is a mixed nerve. The auriculotemporal nerve is a branch of the V3 that provides sensation to the anterosuperior pinna, anterior external auditory canal, and the anterior lateral aspect of the tympanic membrane. Other branches include the lingual, buccal, and inferior alveolar nerves that provide sensory innervation to the oral cavity, the floor of the mouth, and the anterior two-thirds of the tongue.5

The glossopharyngeal nerve (CN IX) directly innervates the inner surface of the tympanic membrane as well as the middle ear cavity through sensory fibers of the tympanic nerve (Jacobson nerve). It also provides mixed innervation to the posterior third of the tongue.6 Secondary otalgia may be caused from anywhere along the course of this nerve. In cases that thorough clinical investigation fails to establish the source of otalgia, a computed tomography or magnetic resonance imaging studies should be considered to define the diagnosis.5

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs
Nikolaos Tsetsos https://orcid.org/0000-0003-1884-6824

Konstantinos Garefis https://orcid.org/0000-0003-3905-5650

Alexandros Poutoglidis https://orcid.org/0000-0002-4591-8347

References
1. Neilan, RE, Roland, PS. Otalgia. Med Clin North Am. 2010;94:96171.
Google Scholar | Crossref
2. Norris, CD, Koontz, NA. Secondary Otalgia: Referred Pain Pathways and Pathologies. AJNR Am J Neuroradiol. 2020;41(12):2188-2198.
Google Scholar | Crossref | Medline
3. Earwood, JS, Rogers, TS, Rathjen, NA. Ear pain: diagnosing common and uncommon causes. Am Fam Physician. 2018;97(1):20-27.
Google Scholar | Medline
4. Charlett, SD, Coatesworth, AP. Referred otalgia: a structured approach to diagnosis and treatment. Am J Med Sci Med. 2017;5(3):56-61.
Google Scholar
5. Scarbrough, TJ, Day, TA, Williams, TE, et al. Referred otalgia in head and neck cancer: a unifying schema. Am J Clin Oncol. 2003;26:e157-e162.
Google Scholar | Crossref | Medline
6. Naraev, BG, Linthicum, FH. Traumatic neuroma of the tympanic (Jacobson's) nerve as a possible cause of otalgia. Otolaryngol Head Neck Surg. 2008;138:735-737.
Google Scholar | SAGE Journals
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Ear, Nose & Throat Journal
ISSN: 0145-5613
Online ISSN: 1942-7522
Copyright © 2022 by SAGE Publications

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Ear Nose Throat J. 2022 Jan 17:1455613221075226. doi: 10.1177/01455613221075226. Online ahead of print.

NO ABSTRACT

PMID:35037504 | DOI:10.1177/01455613221075226

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