Stereotactic radiotherapy as planned boost after definitive radiotherapy for head and neck cancers: Systematic review

xlomafota13 shared this article with you from Inoreader Stereotactic radiotherapy as planned boost after definitive radiotherapy for head and neck cancers: Systematic review Via Head & Neck Abstract Management of locoregionally advanced head and neck cancers (HNCs) remains a challenge. Some groups have attempted to use stereotactic radiotherapy (SBRT) to deliver "boost" treatment following conventional radiotherapy to improve local control (LC) and overall survival (OS), while aiming for acceptable toxicities. Medline, EMBASE, and Cochrane Library databases were queried for SBRT as curative-intent planned boost in HNC after conventional radiotherapy. Individual studies were reviewed from inception until January 2021, extracting patient, treatment, and outcome data. Nine studies met inclusion criteria, representing 454 unique patients treated with curative intent across multiple head and neck sites with conventional radiotherapy. At 3 years, median LC was 92% (90%–98%), and median OS was 80% (75%–91%). Seven treatment-related grade 5 toxicities (1.5%) were reported. Despite acceptable LC and OS rates, there were severe treatment-related late toxicities. As such, SBRT boost should only be used in investigational settings until more data is available. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Oligometastatic adenoid cystic carcinoma: Correlating tumor burden and time to treatment with outcomes

xlomafota13 shared this article with you from Inoreader Oligometastatic adenoid cystic carcinoma: Correlating tumor burden and time to treatment with outcomes Via Head & Neck Abstract Background There is limited information on the management and outcomes of oligometastases (OM) in adenoid cystic carcinoma (ACC). Methods Retrospective study of 42 patients with metastatic ACC of the head and neck. Imaging studies were analyzed to identify patients with OM (1–5 lesions) at any point during follow-up. Results There was radiographic evidence of OM in 33/42 (79%) patients. Eighteen patients had OM when treated for metastases, with median overall survival (OS) of 36.0 versus 9.2 years for patients with polymetastases (6+ lesions, HR 0.38, 95%CI 0.14–0.89). Earlier locally ablative treatment, but not systemic treatment, of patients with OM predicted improved survival 3 years after metastasis (HR 0.15, 95%CI 0.02–0.63) and postponed systemic treatment by 80 more months (HR 0.22, 95%CI 0.07–0.71). Conclusions There is a considerable population of ACC patients with detectable oligometastases, and early locally ablative treatment of oligometastases may be associated with improved outcomes. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A multi-centred sequential trial comparing PEGASUS, an intervention to promote shared decision making about breast reconstruction with usual care

xlomafota13 shared this article with you from Inoreader A multi-centred sequential trial comparing PEGASUS, an intervention to promote shared decision making about breast reconstruction with usual care Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Nov 15:S1748-6815(21)00577-5. doi: 10.1016/j.bjps.2021.11.033. Online ahead of print. ABSTRACT Decision making about breast reconstruction (BR) is complex. The Patients' Expectations and Goals: Assisting Shared Understanding of Surgery (PEGASUS) intervention aims to support shared decision making by helping women and clinicians clarify and discuss their expectations around reconstructive surgery. We conducted a multi-centred sequential trial comparing PEGASUS (n = 52) with usual care (UC) (n = 86) in women considering reconstruction, who completed outcome measures at baseline, and 3, 6 and 12 months post-surgery. The primary outcome was BR-specific quality of life (Breast-Q) 6 months post-intervention. Secondary outcomes were health-related quality of life (EQ-5D-5L), capabilities (ICECAP-A) and decisional regret, compared using t-tests and Cohen's d. Comparative analyses revealed no significant diff erences between groups in Breast-Q scores at any time point, except for a favourable effect for UC on psychological well-being at 3 months (t = -2.41, p = .019, d= -0.59). Intervention participants reported significantly higher, therefore improved, ICECAP-A (t = -2.13, p = .037, d = -0.45) and EQ VAS (t = -2.28, p = .026, d = -0.49) scores at 12 months compared to UC. Decisional regret was significantly lower in the PEGASUS group compared to the UC group at 6 months (t =2.06, p = .044, d= -0.51), but this was not sustained at 12 months. In conclusion, the PEGASUS intervention offers some benefits to women considering BR. At times, women experienced less decisional regret, improved health-related quality of life and capability well-being. Findings are discussed in the light of fidelity testing and embedding PEGASUS into practice. PMID:34924325 | DOI:10.1016/j.bjps.2021.11.033 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pharyngo‐Esophageal Modulatory Swallow Responses to Bolus Volume and Viscosity Across Time

xlomafota13 shared this article with you from Inoreader Pharyngo‐Esophageal Modulatory Swallow Responses to Bolus Volume and Viscosity Across Time Via The Laryngoscope Objectives/Hypothesis Modulation of the pharyngeal swallow to bolus volume and viscosity is important for safe swallowing and is commonly studied using high-resolution pharyngeal manometry (HRPM). Use of unidirectional pressure sensor technology may, however, introduce variability in swallow measures and a fixed bolus administration protocol may induce time and order effects. We aimed to overcome these limitations and to investigate the effect of time by repeating randomized measurements using circumferential pressure sensor technology. Study Design Sub-set analysis of data from the placebo arm of a randomized, repeated measures trial. Methods HRPM with impedance was recorded using a solid-state catheter with 36 circumferential pressure sensors and 18 impedance segments straddling from hypopharynx to stomach. Testing included triplicates of 5, 10, and 20 ml thin liquid and 10 ml thick liquid boluses, the order of the thin liquid boluses was randomized. The swallow challenges were repeated approximately 10 minutes after finishing the baseline measurement. Results We included 19 healthy adults (10/9 male/female; age 24.5 ± 4.1 year). Intrabolus pressure, all upper esophageal sphincter (UES) opening and relaxation metrics, and flow timing metrics increased with larger volumes. A thicker viscosity decreased UES relaxation time, UES basal pressure, and flow timing metrics, whereas UES opening extent increased. Pre-swallow UES basal pressure and post-swallow UES contractile integral decreased over time. Conclusion Using circumferential pressure sensor technology, the effects of volume and viscosity were largely consistent with previous reports. UES contractile pressures reduced over time. The growing body of literature offers a benchmark for recognizing aberrant pharyngo-esophageal motor responses. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Efficacy of Endoscopic Posterior Nasal Neurectomy in Treating Eosinophilic Chronic Rhinosinusitis

xlomafota13 shared this article with you from Inoreader Efficacy of Endoscopic Posterior Nasal Neurectomy in Treating Eosinophilic Chronic Rhinosinusitis Via O.R.L. Journal for oto-rhino-laryngology and its borderlands Objectives: Recent guidelines have revealed that eosinophilic chronic rhinosinusitis (ECRS) exhibits a strong tendency for recurrence after surgery and impairs quality of life. Neuropeptides play an important neuroimmunological role. The aim of this study was to determine the efficacy of posterior nasal neurectomy (PNN) for the treatment of ECRS by inhibiting type 2 cytokine expression. Methods: Forty-six patients were divided into group A and group B according to a ran dom number table. Group A underwent conventional functional endoscopic sinusitis surgery (FESS) combined with PNN, and group B underwent conventional FESS alone. The subjective and objective symptoms included a 10-cm visual analog scale (VAS), 22-item SinoNasal Outcome Test (SNOT-22) score, nasal speculum Lund-Kennedy score, and paranasal sinus computed tomography (CT) Lund-Mackay score at the 1-year postoperative follow-up. Results: Postoperative VAS (10.33 ± 2.18 vs. 8.38 ± 2.11, p #x3c; 0.01) and Lund-Kennedy score (1.95 ± 1.32 vs. 3.14 ± 1.35, p #x3c; 0.01) were significantly improved. The rhinorrhea score (1.76 ± 0.83 vs. 2.90 ± 1.14, p #x3c; 0.001) in the VAS and the discharge (0.43 ± 0.51, vs. 0.95 ± 0.67, p #x3c; 0.01) and edema (0.57 ± 0.60 vs. 0.95 ± 0.59, p #x3c; 0.05) scores in the Lund-Kennedy score were observed to have improved significantly in group A compared with those in group B. Conclusions: FESS combined with PNN suppresses edema symptoms, which might significantly decrease the surgical recurrence rate of ECRS in the long term. ORL View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Three-dimensional cell culture for the study of nasal polyps

xlomafota13 shared this article with you from Inoreader Three-dimensional cell culture for the study of nasal polyps Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Nov 26:S1808-8694(21)00191-9. doi: 10.1016/j.bjorl.2021.11.001. Online ahead of print. ABSTRACT OBJECTIVES: Three-dimensional (3D) cell cultures have many applications such as stem cell biology research, new drug discovery, cancer, and Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). This disease is characterized by a significant impact on quality of life and productivity. The diversity of factors that act in the progression of CRSwNP point to the creation of a cell culture model that allows the integration of different cell types with extracellular matrix. This work aimed to create a cell culture model in 3 dimensions (spheroids) for the study of Nasal Polyposis. METHODS: Nasal polyp tissue from patients diagnosed with CRSwNP was mechanically dissociated using tweezers and a scalpel and the solution containing cells and small aggregates of nasal polyps was transferred to a Petri dish containing 5 mL of culture medium at the concentration of 106 cells/mL. RESULTS: The spheroids were cultivated for 20 days, fixed and analyzed using confocal microscopy. In a 3D culture environment, the spheroids were formed both by clustering cells and from small tissue fragments. In the cultures analyzed, the ciliary beat was present from the dissociation of the cells up to 20 days in culture. CONCLUSION: Our findings also point to these characteristics showing the environment generated in our study, the cells remained differentiated for a longer time and with ciliary beating. Thus, this work shows that nasal polyp-derived cells can be maintained in a 3D environment, enabling better strategies for understanding CRSwNP in situations similar to those found in vivo. LEVEL OF EVIDENCE: Laboratory studies. PMID:34924329 | DOI:10.1016/j.bjorl.2021.11.001 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A prospective pilot study on the effects of endoscopic sinus surgery on upper and lower airway performance

xlomafota13 shared this article with you from Inoreader A prospective pilot study on the effects of endoscopic sinus surgery on upper and lower airway performance Via Acta Otorhinolaryngol Ital Acta Otorhinolaryngol Ital. 2021 Dec;41(6):544-549. doi: 10.14639/0392-100X-N1361. ABSTRACT OBJECTIVE: The relationship between chronic rhinosinusitis, asthma and allergic rhinitis is well known, but only recently has the scientific community started to evaluate these as different manifestations of a common pathogenic phenomenon, considering them as a unified airway disease. METHODS: Twenty-two patients with chronic rhinosinusitis treated with endoscopic sinus surgery (ESS) were included in the study. Sino-nasal assessment questionnaire (SNAQ) investigating subjective evaluation of sino-nasal state was administered to patients, while objective evaluations included nasal endoscopy, sinonasal CT, skin prick tests, nasal cytology, spirometry, bronchodilator responsiveness testing and sputum eosinophil count. All tests were performed before surgery. Two months after surgery, SNAQ questionnaire, nasal endoscopy, spirometry and bronchodilator responsiveness testing were repeated. RESULTS: All patients had significant improvement of subjective status: mean SNAQ score decreased in all from 99.31 to 16.04. Mean Forced Expiratory Volume in the 1st second (FEV1) significantly improved after surgery from 3.23 to 3.45 L/s. CONCLUSIONS: ESS achieved a beneficial effect on upper and lower airway status in patients with chronic rhinosinusitis with or without lower airway diseases. PMID:34928265 | DOI:10.14639/0392-100X-N1361 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Management of cochlear fistula and the role of hearing: a five-case report

xlomafota13 shared this article with you from Inoreader Management of cochlear fistula and the role of hearing: a five-case report Via Acta Otorhinolaryngol Ital Acta Otorhinolaryngol Ital. 2021 Dec;41(6):558-565. doi: 10.14639/0392-100X-N1237. ABSTRACT OBJECTIVE: Cochlear fistula (CF) is a rare finding, usually associated with extensive middle ear cholesteatoma. There is agreement on the fact that removing the cholesteatoma matrix on a CF exposes the ear to a high risk of sensorineural hearing loss or dead ear. The aim of the study is to describe the presentation, possible treatment strategies and related outcomes for patients with CF in chronic otitis media (COM). METHODS: The study considers a retrospective case series of patients with CF diagnosis supported by CT-scan and intraoperative/otoscopic evidence. RESULTS: Five cases of CF were identified, 4 associated with cholesteatoma and 1 associated with non-cholesteatomatous COM. Two patients presenting with anacusis underwent a subtotal petrosectomy. Two patients with useful hearing underwent a radical mastoidectomy in order to preserve the cholesteatoma matrix on the promontorium. One patient with good hearing and COM was treated conservatively. CONCLUSIONS: Conservative management should be considered for rare cases of CF in COM with residual hearing. Matrix preservation through radical/modified radical mastoidectomy is strongly advised in the presence of useful preoperative bone conduction. Subtotal petrosectomy should be considered the preferred option in presence of cholesteatoma with preoperative profound hearing loss. PMID:34928267 | DOI:10.14639/0392-100X-N1237 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Composite Extranodal Natural Killer (NK)/T-cell Lymphoma and Chronic Lymphocytic Leukemia in Nasal Cavity: A Rare Case

xlomafota13 shared this article with you from Inoreader Composite Extranodal Natural Killer (NK)/T-cell Lymphoma and Chronic Lymphocytic Leukemia in Nasal Cavity: A Rare Case Via ear nose throat Ear Nose Throat J. 2021 Dec 20:1455613211066688. doi: 10.1177/01455613211066688. Online ahead of print. NO ABSTRACT PMID:34928717 | DOI:10.1177/01455613211066688 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effects of background noise on auditory response characteristics of primary auditory cortex neurons in awake mice

xlomafota13 shared this article with you from Inoreader Effects of background noise on auditory response characteristics of primary auditory cortex neurons in awake mice Via cortical auditory Nan Fang Yi Ke Da Xue Xue Bao. 2021 Nov 20;41(11):1672-1679. doi: 10.12122/j.issn.1673-4254.2021.11.11. ABSTRACT OBJECTIVE: To study the effects of different continuous background noises on auditory response characteristics of primary auditory cortex (A1) neurons in awake mice. METHODS: We performed in vivo cell-attached recordings in layer 4 neurons of the A1 of awake mice to investigate how continuous background noises of different levels affected the intensity tuning, frequency tuning and time characteristics of individual A1 neurons. According to the intensity tuning characteristics and types of stimulation, 44 neurons were devided into 4 groups: monotonic-intensity group (20 monotonic neurons), nonmonotonic-intensity group (6 nonmonotonic neurons), monotonic-frequency group (25 monotonic neurons) and monotonic-latency group (15 monotonic neurons). RESULTS: The A1 neurons only had transient spike response within 10 to 40 ms af ter the onset of continuous wild-band noise stimulation. The noise intensity had no significant effects on the background firing rates of the A1 neurons (P>0.05). The increase of background noise resulted in a significant linear elevation of the intensity threshold of monotonic and nonmonotonic neurons for tone-evoked response (R2>0.90, P < 0.05). No significant difference was observed in the slopes of threshold changes between monotonic and nonmonotonic neurons (P>0.05). The best intensity of nonmonotonic neurons increased along with the intensity of the background noise, and the variation of the best intensity was positively correlated with the change of the threshold of the same neuron (r=0.944, P < 0.001). The frequency response bandwidth and the firing rate of the A1 neurons decreased as the noise intensity increased (P < 0.001), but the best frequency almost remained unchanged (P < 0.001). The increase of background noise intensity resulted in an increased first spike latency of the neurons to the same tone stimulus (P < 0.05) without affecting the time accuracy of the first action potential (P>0.05). CONCLUSION: The acoustic response threshold of the A1 neurons increases linearly with the increase of background noise intensity. An increased background noise leads to compressed frequency band-width, a decreased firing rate and a prolonged spike latency, but the frequency selectivity and the time accuracy of auditory response to the same noise remain stable. PMID:34916193 | DOI:10.12122/j.issn.1673-4254.2021.11.11 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.