Gynecology and Obstetrics

Uterus transplantation: advantages and disadvantages of a deceased donor

Analysis of the reproductive outcomes and the size of the unicornuate uterus measured by magnetic resonance imaging and their relationship Abstract Purpose To evaluate the relationship between the uterine size measured by pelvic magnetic resonance and reproductive outcome in women with a unicornuate uterus. Methods This was a retrospective study including 140 patients affiliated with unicornuate uterus diagnosed by the pelvic MR prior to their first pregnancy in the Obstetrics and Gynecology Hospital of Fudan University from April 2010 to December 2017. All the length of the unicornuate uterus were re-measured and recorded by skilled radiologists during the study period. We divided all the 140 participants with complete pelvic MR imaging into four groups by the best reproductive outcomes, which refers to Group 1 (primary infertility, n = 21), Group 2 ( < 24 weeks' gestation, n = 34), Group 3 (preterm delivery, 24–35 weeks' gestation, n = 13), Group 4 ( ≥ 35 weeks' gestation, n = 72), followed them up and then analyzed the data. Results Measurements of 140 patients with hemi-uteri were retrieved for analysis. The mean length of the uterine was 4.90  ± 0.56 cm. There were no significant differences in the uterine cavity length, cervical length, endometrial thickness and uterine wall thickness between the four groups while the uterine length (P = 0.001) was statistically significant. Women with uterine lengths  ≥  4.5 cm were more likely to experience full-term delivery compared with the other group (P = 0.001). Ordinal multiple logistic regression analysis showed that the uterine length [OR = 9.03 (95% CI: 2.90–28.13)] and uterine cavity length [OR = 0.32 (95% CI: 0.06–2.04)] were independent protective factors for better obstetric outcomes Conclusion The uterine length is a reliable prognostic factor for the gestational week of delivery and an appropriate antenatal surveillance factor of women with unicornuate uterus.

Compare two different usages of FRD for detecting high-grade cervical lesions and invasive cancer Abstract Objective To evaluate two usages of the folate receptor-mediated staining solution (FRD) for detecting high-grade cervical lesions and invasive cancer, and compared with cytology test (TCT) and human papillomavirus (HPV) testing. Methods FRD sampling and FRD direct staining methods were used for detecting high-grade cervical lesions and invasive cancer. As a comparison, TCT and HPV testing were also applied for screening high-grade cervical lesions and invasive cancer. The sensitivity and specificity of TCT, HPV testing, and staining results of FRD were analyzed by the SPSS software. Results In this study, 317 patients with biopsy were collected. The positive rate of FRD sampling method was 35.33% (112/317), and positive rate of FRD direct staining was 48.90% (155/317). Area under the curve (AUC) of TCT, HPV testing, FRD sampling and FRD direct staining were 0.53, 0.55, 0.58, and 0.75, respectively. The sensitivity of TCT, HPV, FRD sampling and FRD direct staining was 69.72%, 97.25%, 64.22% and 81.65%, respectively, and the specificity was 37.98%, 12.98%, 79.81% and 68.27%, respectively. Conclusion Compared with TCT and HPV testing, two usages of FRD methods have compatible sensitivity and high specificity to detect high-grade cervical lesions and invasive cancer. FRD direct staining may be comfortable for routine cervical cancer screening

Incisional hernias following open gynecological surgery: a population-based study Abstract Introduction Incisional hernia is a common and costly complication following abdominal surgery. The incidence of incisional hernia after gynecological surgery is not as well studied as that after general surgery. Materials and methods The Swedish National Quality Register for Gynecological Surgery (GynOp) collects preoperative, intraoperative, and postoperative information regarding gynecological surgery. Data were extracted from 2006 to 2014. The National Patient Register (NPR) contains physicians' data from both public and private hospitals. Univariate and multivariate Cox proportional hazard analyzes were performed on risk factors. Results Between 2006 and 2014, 39,312 women undergoing open surgery were registered in GynOp. The NPR recorded 526 patients who were diagnosed with or had undergone surgery for incisional hernia. The mean follow-up was 2.8 years. Five years after surgery the cumulative incidence of incisional hernias was 2.0% (95% confidence interval 1.8–2.2%). In multivariate Cox proportional hazard analysis obesity (BMI > 30), age > 60 years, midline incision, smoking, kidney, liver, and pulmonary disease were found to predict an increased risk for incisional hernias (all p < 0.05). Conclusions There is much to be gained if the patient can cease smoking and lose weight before undergoing abdominal surgery. The Pfannenstiel incision results in fewer incisional hernias and should be considered whenever possible.

Efficacy of a collagen-fibrin sealant patch (TachoSil®) as adjuvant treatment in the inguinofemoral lymphadenectomy for vulvar cancer: a double-blind randomized-controlled trial Abstract Purpose To evaluate the effect of a collagen-fibrin sealant patch (TachoSil®) in preventing postoperative complications after inguinofemoral lymphadenectomy for vulvar cancer. Methods Double-blind randomized-controlled trial on consecutive patients undergoing bilateral inguinofemoral lymphadenectomy for vulvar cancer. Intraoperatively, inguinofemoral areas were randomized: one was treated with TachoSil®, while the contralateral had standard closure without collagen-fibrin sealant patch. Surgical outcomes, amount of drainage volume, duration of drain placement, and any postoperative complication (vulvar wound dehiscence, inguinal wound dehiscence, cellulitis, lymphangitis, lymphoceles, and hematoma) were recorded. Leg measurements were taken preoperatively and during postoperative follow-up until 6 months to evaluate lymphedema. Results A total of 19 patients were enrolled and 38 inguinofemoral dissections were performed. There was no significant difference between the investigational and control arm in the amount of drainage volume (p = 0.976), and duration of drain placement (p = 0.793). The postoperative complications, excluding lymphedema, were 10/19 (53%) in investigational arm and 9/19 (47%) in control arm (p = 0.74). At the end of follow-up, the prevalence of grade 1 lymphedema was 44.4% and 50% in investigational and control arm, respectively (p = 0.744); grade 2 and 3 lymphedema had a prevalence of 33.3% in both arms (p = 1). Conclusion Application of TachoSil® does not seem to improve postoperative lymphorrhagia nor to reduce the incidence of postoperative complications in patients undergoing inguinofemoral lymphadenectomy for vulvar cancer. Considering this point, it would be useful to identify additional strategies in inguinofemoral dissection for the prevention of these complications.

The impact of EndoPredict ® on decision making with increasing oncological work experience: can overtreatment be avoided? Abstract Background Estimating distant recurrence risk in women with estrogen receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative early breast cancer is still challenging. EndoPredict® is a gene expression-based test predicting the likelihood of recurrent disease. We analyzed the difference in oncological decision making with and without the knowledge of gene expression tests. Patients and methods This is a retrospective analysis including patients diagnosed with hormone-receptor positive, Her2 negative breast cancer between 2011 and 2015 at the Municipal Breast Cancer Centre Cologne, Germany. All patients received an evaluation by EndoPredict®. An oncological tumor board (TB) with knowledge of these results served as a baseline (control group). This baseline was compared to the treatment decision (adjuvant chemotherapy yes vs. no) made by oncologists with different experience levels (less than 5 years, between 5 and 15 years, and more than 15 years) who were not provided the EndoPredict® scores. All clinicians had access to clinical as well to histopathological data. Results There was no significant difference between control group and the oncologists with different experience levels concerning a chemotherapy indication. A trend could be shown in the subgroup of nodal negative patients between the treatment recommendation and physicians with more than 15 years of experience (p = 0.088). A further trend could be demonstrated in the subgroup of patients with a low Ki67 index (≤ 14%) (p = 0.063) between physician with 5–10 years of clinical experience and official treatment recommendation. Conclusion It seems that inexperienced physicians may profit from the use of EndoPredict® to avoid an overtreatment. In nodal negative patients and patients with a low Ki67 index, undertreatment can be avoided with the use of EndoPredict® (borderline significance). Further prospective studies with larger study cohorts are needed to further validate this tool.

Tumor cell-specific Serpin A1 expression in vulvar squamous cell carcinoma Abstract Purpose The two main etiological factors for vulvar squamous cell carcinoma (vSCC) are the vulvar dermatosis lichen sclerosus (LS) and high-risk human papillomavirus (hrHPV). Serpin A1 (α1-antitrypsin) is a serine protease inhibitor, which plays a role in the tumorigenesis of various cancer types. The aim of the study was to evaluate the expressions of Serpin A1 in LS, premalignant vulvar lesions, and vSCC using immunohistochemistry (IHC) and serum analysis, and to compare Serpin A1 stainings to the tumor markers p53 and p16. Methods In total, 120 samples from 74 patients were studied with IHC for Serpin A1, p53 and p16: 18 normal vulvar skin, 53 LS, 9 premalignant vulvar lesions (dVIN/HSIL) and 40 vSCC samples. Serum concentrations of Serpin A1 were analyzed from 30 LS, 44 vSCC and 10 control patients. Expressions were compared to clinical data. Results Tumor cell-specific Serpin A1 overexpression was detected in 88% of vSCC samples, independent of the etiology. The intensity of Serpin A1 expression was significantly higher in vSCC than in healthy vulvar skin, LS, or premalignant vulvar lesions. Serpin A1 showed an association with p53 positivity. No difference in overall survival was found between Serpin A1-, p53-, or p16-positive vSCC patients. Serum concentrations of Serpin A1 were equal in the LS, vSCC, and control groups. Conclusion Tumor cell-specific Serpin A1 overexpression is a potential biomarker in vSCC.

Effects of clarithromycin on inflammatory markers and clinical manifestations in postsurgical follow-up of patients with endometriosis: a double-blinded randomized placebo-controlled clinical trial Abstract Purpose Studies showed anti-inflammatory and immunomodulatory effects of macrolide antibiotics such as clarithromycin in endometriosis. Therefore, the present study aims to investigate the therapeutic efficacy of clarithromycin in patients with endometriosis. Methods This was a double-blinded randomized placebo-controlled trial conducted on endometriotic women during March 2016–2017 in Dena Hospital, Shiraz, Iran. Immediately after surgery, the patients were randomly divided into clarithromycin (real) (n = 120) and placebo group (n = 169). The real group received 500 mg of clarithromycin everyday for 6 months and the placebo group received the placebo. The serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), Erythrocyte sedimentation rate (ESR) and C-reactive protein as well as clinical symptoms at baseline and 3 and 6 months of post-surgery were compared within and between groups. Results The scores of dysmenorrhea, dyschezia, dyspareunia, and non-menstrual pain significantly decreased in both real and placebo groups compared with the baseline values. However, the real group showed greater reductions compared with the placebo group (p < 0.001). Similarly, the serum levels of CRP, TNF-α, and IL-10 decreased in both groups compared with the baseline values, but the real group showed greater reductions. Interestingly, the reductions in the clinical symptoms and serum levels did not significantly differ between the real and placebo groups. Moreover, the reductions in the studied variables showed no dependence on the time. Conclusion Clarithromycin may be an appropriate treatment in endometriotic patients. However, the non-significant differences between the real and placebo groups necessitate further studies on the therapeutic efficacy of clarithromycin.

Endoscopic surgery: talent or training? Abstract Purpose There are two groups of undergraduate students involved in endoscopic surgery with different degrees of experience: average and more experience. This study proves whether the subjective impression of the laparoscopic trainer is verifiable and which factors influence extreme talent. Methods 21 medical students of the eighth term of the University of Witten-Herdecke participated in the study. On their first course day, students got instructed in suturing and knot technique. They were then required to tie a maximum of five knots within 2 h. After a week, students repeated this procedure. Time used for tying knots was stopped. Results Regarding the time students used for their first knots, great differences were provable (7–8 min, average 23 min). However, an adaption of the knotting time was noticed at the end of the first course day. This was confirmed during the second course day. Neither acquired factors (music, sport, etc.) nor individual factors (visual acuity, handedness, etc.) had any impact on the time used for knotting. Merely, one advantage was seen with the first knots with the factors of playing the guitar and having a more than 10-h surgical previous experience. Knotting times leveled off at 95% to less than 10 min, though. Discussion Neither normally talented nor extremely talented junior surgeons could be noticed, and so could not the co-factors providing an advantage or disadvantage for surgery, respectively. All prospective surgeons can learn defined tasks (knots) by short interval training, and thus show similarly good results after a few repetitions.

Patients' perspectives towards malignant ascites: results of a prospective observational trial regarding expectations, characteristics and quality of life—a study of the North-Eastern-German Society of Gynecological Oncology Abstract Purpose Malignant ascites (MA) is a frequent and common symptom in (gyneco-) oncological patients. The present trial evaluated and assessed patients' characteristics, clinical features and the possible influence of MA on QoL measurements. Methods A prospective observational trial was conducted from Oct 2013 until Nov 2016. Therefore an interdisciplinary questionnaire was developed. Overall 250 patients with histological confirmed MA were included with different cancer entities (gynecological, gastrointestinal). The correlation of MA caused symptoms and QoL measurements was assessed using Kendall's tau b. Multivariable logistic regression models were applied to analyze the risks of symptoms or severe limitation in daily activities. Results 125 questionnaires could be analyzed. The majority of patients with MA had diagnosis of ovarian cancer (68.8%) and were under current cancer treatment (57.6%), mostly chemotherapy. Over 50% reported abdominal tension as major symptom, around 56% of the patients had MA when cancer was firstly diagnosed. Regression analysis showed that patients with MA above 2l were significantly more likely to be harmed in everyday activities. However, the age, gender, type of malignancy and the current treatment (chemotherapy vs. no chemotherapy) had no significant influence. Conclusion MA has a significantly impact on QoL measurements in cancer patients and might influence everyday activities including basic needs like eating, walking and body care. There is a high need for more information and education of patients with MA

Oral Oncology

https://www.sciencedirect.com/journal/oral-oncology/articles-in-press  

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Concurrent oropharyngeal squamous cell carcinomas in couples

Prashanth Panta, Mukund Seshadri

In Press, Corrected Proof, Available online 25 April 2019

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select article Tooth mobility: A plausible predictor of bony margins

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Tooth mobility: A plausible predictor of bony margins

Sameep S. Shetty, Vishal Rao, Akshay Kudpaje, Premalatha Shetty

In Press, Corrected Proof, Available online 24 April 2019

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select article Sanctuary site central nervous system relapse-refractory DLBCL responding to nivolumab and lenalidomide

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Sanctuary site central nervous system relapse-refractory DLBCL responding to nivolumab and lenalidomide

Irappa V. Madabhavi, Swaroop Revannasiddaiah, Malay S. Sarkar, Mitul G. Modi

In Press, Corrected Proof, Available online 19 April 2019

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Abstract

Abstract

Despite improvement in survival in diffuse large B-cell lymphoma (DLBCL) with the introduction of rituximab, central nervous system (CNS) relapse continues to represent a clinical challenge. In diffuse large B-cell lymphoma (DLBCL), the incidence of CNS relapse is only ∼5% in unselected cohorts. Immunotherapy is the treatment that either boosts the patient's own immune system or uses man-made versions of the normal parts of the immune system to kill lymphoma cells or slow their growth. We are presenting a thirty-eight year old man who, presented with neck nodes, axillary nodes, altered sensorium, abnormal body movements, unconsciousness, weight loss and, fever, with a past history of DLBCL in May 2008, treated with 6 cycles of CHOP and completed in November 2008. After 9 years in April 2018, the patient developed similar symptoms and treated with salvage chemotherapy with R-DHAP which was completed in September 2018. Post-treatment PET-CT showed partial metabolic response and we started external beam radiotherapy to initial bulky disease. After completion of radiotherapy, the patient was very reluctant for any type of therapy and went home. After one month he presented to us with persistent vomiting, abnormal body movements and, altered sensorium. On examination, his Glasgow Coma Scale (GCS) was E2V3M2 and he was admitted in Intensive Care Unit. The patient was managed with mannitol, dexamethasone, antiepileptics, antibiotics and other supportive care medicines. His brain magnetic resonance imaging (MRI) was showing multiple heterogeneously enhancing lesions with surrounding vasogenic oedema and his cerebrospinal fluid analysis was positive for malignant cells. He was managed with triple intrathecal chemotherapy with methotrexate 12 mg, Cytarabine 50 mg, and Hydrocortisone 50 mg along with other supportive care medicines, and after 4–5 days he regained consciousness and he was able to talk and understand verbal commands. In view of improvement in general condition and performance status, we started biweekly triple intra-thecal therapy, and Inj. Nivolumab 3 mg per kg q 2 weekly. From the second cycle, we started Lenalidomide 10 mg once a day for 21 days with 7 days gap along with 2 weekly nivolumab and biweekly triple IT chemotherapy. After one month his CSF analysis was negative for malignant cells. Now he is on regular treatment with weekly IT chemotherapy, 2 weekly nivolumab and 3 weeks on and one week off lenalidomide. After 2 months of treatment, his MRI Brain was showing. At the time of submission of this article, he has completed the fifth cycle of immunotherapy and two cycles of lenalidomide. He was able to manage his daily ADL and able to walk with a stick. The patient tolerated immunotherapy, triple IT therapy and lenalidomide very well without much intolerable side effects. Therefore, we concluded that nivolumab and lenalidomide was well tolerated and exhibited antitumor activity in extensively pretreated patients with relapsed or refractory sanctuary site CNS B- cell lymphomas. Additional studies of Nivolumab and lenalidomide in these diseases are ongoing.

select article Human papillomavirus (HPV) vaccine and HPV-related head and neck cancer: What's next?

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Human papillomavirus (HPV) vaccine and HPV-related head and neck cancer: What's next?

F. De Felice, A. Polimeni, V. Tombolini

In Press, Corrected Proof, Available online 5 April 2019

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Herbal Medicine

Acujoint™, a high efficient formulation with natural bioactives, exerts potent anti-arthritis effects in human osteoarthritis - A randomized clinical study Publication date: Available online 23 April 2019 Source: Journal of Herbal Medicine Author(s): Augustine Amalraj, Joby Jacob, Karthik Varma, Ajaikumar B. Kunnumakkara, Chandradhara Divya, Sreeraj Gopi Abstract The aim of the study was to evaluate the efficacy and safety of Acujoint™ - a supplement for articular cartilage degradation- in the treatment of patients with Osteoarthritis (OA) by comparing it with glucosamine and chondroitin formulation, which is a popular supplement used to treat OA. Acujoint™ is a health supplement prepared with extracts of 3-O-acetyl-11-keto-β-boswellic acid from Boswellia serrata, β-Caryophyllene from Piper nigrum, aqueous extract of Kaempferia galangal and Cureit™ - a bioavailable curcumin formulation- in a fixed ratio based on complete natural matrix, which has been used to treat osteoarthritis. A randomized, double blind, active controlled, single centre, clinical study was carried out using Acujoint™ during 90 days of treatment in 24 patients (1:1 ratio) with symptoms of moderate to mild OA along with combination of Glucosamine (1500 mg) and Chondroitin (1200 mg). The study shows that Acujoint™ can provide significant improvement in relieving the symptoms and the pain associated with active OA between the groups as well as within the groups. Active OA patients, who received Acujoint™ at 250 mg per day for a treatment period of 90 days, reported statistically significant changes/decreases in their clinical symptoms and pain. This was evident from significant changes in the total Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) score, pain score, functional ability score, visual analog scale (VAS) score and Lequesne functional index values at P < 0.05 level. Acujoint™ promises the beneficial effects for the treatment of human knee osteoarthritis by controlling inflammatory responses as well as the pain without any adverse effects. Graphical abstract

Antiplaque and antimicrobial efficacy of polyherbal mouth rinse among adult human volunteers – A short term randomized controlled trial Publication date: Available online 16 April 2019 Source: Journal of Herbal Medicine Author(s): BR Chandrashekar, Ramesh Nagarajappa, K Mruthunjaya, Suma Shekar, MS Girish, Rupesh Thakur Abstract Systematic evaluation of plant extracts and their combinations offers new insights into the development of innovative drugs from plants. The authors evaluated the antiplaque and antimicrobial efficacy of a polyherbal mouth rinse, using 0.2% chlorhexidine as positive and saline based mouth rinse as negative controls among adult human volunteers. Thirty eligible adult human volunteers were recruited and pre intervention prophylaxis was carried out to reduce their plaque scores to zero. Participants were randomly assigned to three different categories and given coded mouth rinse bottles containing either saline, a poly herbal mouth rinse containing Acacia nilotica, Murraya koenigii Linn Sprengel, Eucalyptus hybrid, and Psidium Guajava combined extracts at 1%, or 0.2% chlorhexidine. Participants were requested to use 10 ml of their assigned mouth rinse twice a day and refrain from oral hygiene practices for four days. On the fifth day following intervention, plaque buildup was assessed by a blinded investigator and supragingival plaque samples were collected. Unstimulated saliva samples were collected before and 60 minutes after mouth rinsing. Plaque samples were used in microbial assay, while saliva samples were used for assessing change in salivary pH. Post intervention plaque build-up, S. mutansand total viable counts were significantly higher in saline users compared to others, with no difference in salivary flow and pH. However, the difference between the polyherbal and chlorhexidine groups was not statistically significant. We conclude that the polyherbal mouth rinse merits further investigation as a potential alternative to chlorhexidine for preventing and controlling dental caries and plaque induced dental diseases.

Ethnopharmacological survey of plants used in the traditional treatment of pain conditions in Mali Publication date: Available online 11 April 2019 Source: Journal of Herbal Medicine Author(s): Ombeline Danton, Aimé Somboro, Baba Fofana, Drissa Diallo, Lassine Sidibé, Catherine Rubat-Coudert, Fabien Marchand, Alain Eschalier, Sylvie Ducki, Pierre Chalard Abstract Pain is among the major concerns of healthcare authorities across the world. It is complicated to diagnose, manage and treat. Current western treatments are successful to some extent in relieving pain; they provide minimum improvements in terms of physical and emotional functioning and are often accompanied by side effects. Finding new solutions in pain management has thus become a priority. Natural products have always been a huge source of new active principles; traditional medicine is thus a key to innovation. In Mali, traditional remedies are more popular than pharmaceutical drugs but this knowledge, verbally transferred from generation to generation is at risk as younger generations are not taking over. Thus, this study was designed to identify plants that are used traditionally in the South of Mali for the treatment of painful conditions. Data was collected by means of semi-structured face-to-face interviews with traditional healers (N = 108) in the regions of Bamako, Sikasso and Dioïla. Two quantitative ethnopharmacological indexes were calculated: Relative Frequency of Citation (RFC) and Fidelity Level (FL) when RFC > 0.10. A total of 66 plant species distributed across 29 families were recorded during this two-month survey. Stomach aches and external pains were the most cited pain conditions followed by body pains and pain due to diseases such as diabetes and sickle cell disease. Cassia sieberiana DC. (RFC = 0,22), Zanthoxylum zanthoxyloides (Lam.) Zepren. & Timler (0,13), Pericopsis laxiflora(Benth.) Meeuwen (0,11), Flueggea virosa (Roxb. ex Willd) Royle (0,08) and Sarcocephalus latifolius (Sm.) E.A.Bruce (0,08) were the most cited plants. This ethnopharmacological survey provides preliminary data for the discovery of new analgesic molecules. Graphical abstract

Plant use as a traditional method by women against vaginal discharge in western Anatolia, Turkey: A qualitative research study Publication date: Available online 10 April 2019 Source: Journal of Herbal Medicine Author(s): Zekiye Turan, Eylem Toker, Mehtap Omaç Sönmez, Fatma Kutlar Abstract Objective The aim of this research was to gain insight into the reasons why women useCyclamen coum. and how they use it, in addition to the symptoms being treated. Material and methods The study was carried out as a qualitative research. The first case was that of an inpatient with symptoms of vaginal infection who used Cyclamen coum. Snowball sampling was used for sample selection. Fifteen women were included in the research as users and proponents of this method. The questionnaire including socio-demographic attributes and an interview form were used to obtain in-depth information. After completion of interviews, raw research data were identified by a researcher, and these were then classified by three researchers in accordance with verified themes. This data was then reported using their interpretation. Results All participants applied the treatment by placing theCyclamen coum. tuber into the vagina for a period of three days. The positive results obtained from experiences of traditional methods increases the extent to which women adopt this method. Conclusion People should be informed regarding the possible potential adverse consequences of the use of traditional methods. Also, further research should be performed on women's health and widely applied traditional applications.

Clinical efficacy of a topical polyherbal formulation in the management of fluorouracil -associated hand-foot syndrome Publication date: Available online 9 April 2019 Source: Journal of Herbal Medicine Author(s): Elnaz Karimi, Behrooz Gharib, Nematollah Rostami, Latifeh Navidpour, Minoo Afshar Abstract Aim Hand foot syndrome (HFS) is a common side effect following administration of fluoropyrimidine drugs like capecitabine and 5-flourouracil in cancer patients. This syndrome is not life threatening. However, it is the main reason for dose reduction or temporary discontinuation of these drugs. The aim of this study was evaluating the efficacy of a standardized topical polyherbal hydrogel (E.gel) containing Calendula officinalis L., Matricaria recutita L.and Salvia officinalis L. for the management of Hand Foot Syndrome (HFS) in cancer patients following administration of fluoropyrimidine drugs. Methods In the present survey, 27 patients suffering from HFS were randomized to receive the E.gel and the placebo four times a day for 2 weeks. At the baseline and at the end of trial HFS grades were determined. Results No serious adverse events occurred. Among the patients who have completed the study, 71% had a significant improvement compared to the placebo (p-value = 0.039). In 5% of the patients no changes were observed in the treatment group, while the side effects had worsened in the placebo roup. Moreover, in 10% of the patients both treatment and placebo groups showed improvement and in 14% no changes were observed in both groups. Conclusion This study shows that patients receiving the polyherbal hydrogel experienced less complications and symptoms associated with HFS. In summary, it seems that the use of the prepared polyherbal hydrogel was beneficial for cancer patients administered fluorouracil-chemotherapeutic agents. Graphical; abstract

Treating Depression Naturally: How Flower Essences can Help Rebalance your Life. Chris Phillips. Floris Books, Edinburgh, 2017, pp., £12.99/$19.95. ISBN 978-178250-427-6. Publication date: Available online 4 April 2019 Source: Journal of Herbal Medicine Author(s): Graeme Tobyn

Bioactive metabolites of Ganoderma lucidum: Factors, mechanism and broad spectrum therapeutic potential Publication date: Available online 3 April 2019 Source: Journal of Herbal Medicine Author(s): Chetan Sharma, Neha Bhardwaj, Anupam Sharma, Hardeep Singh Tuli, Priya Batra, Vikas Beniwal, Girish Kumar Gupta, Anil K. Sharma Abstract Background The global interest in edible medicinal herbs for healthcare has significantly increased during the last few years.Ganoderma lucidum is a medicinal mushroom which is known to be a potential source of many therapeutic and pharmaceutical products with significant health importance. Methodology The available literature using PubMed, Scopus and Google Scholar database was thoroughly reviewed using the keywords Natural Products,Ganoderma, secondary metabolites and therapeutics. Thisnarrative review of all the relevant papers with significant citations leads the authors to greater insight into the potential therapeutic significance of Ganoderma lucidum. Results The presence of a wide array of secondary metabolites in this herb contributes to its pharmaceutical uses.G. lucidum is rich in polysaccharides (β-glucan,mannitol), alkaloids, and a group oftriterpenes (ganoderic acid). Many cellular mechanisms have been proposed to explain the mode of action of its active metabolites and their healthcare attributes including anticancer, antiviral, antioxidant and protective effects on liver and other secondary lymphoid organs. Conclusion This review illustrates the broad spectrum therapeutic potential of secondary metabolites derived fromGanoderma and supports our understanding of the main pharmacologically active compounds present in this fungus. Insight into the actions of its secondary metabolites could further pave a way for establishing G. lucidum, as a pharmacologically important product.

Anti-inflammatory action of YHQ by regulating 5-LOX/COX-2/NF-κB/MAPKs/Akt signaling pathways in RAW 264.7 macrophage cells Publication date: Available online 3 April 2019 Source: Journal of Herbal Medicine Author(s): Bao-Hui Cheng, Tian-Yong Hu, Li Ma, Wen-Hui Hu, Yan-Yan Chen, Xian-Hai Zeng, Hai-Liang Zhao, Zhi-Qiang Liu, Shu-Qi Qiu Abstract Yan-Hou-Qing (YHQ), a traditional Chinese medicine (TCM) formula including fifteen herbal medicines has been used for acute pharyngitis and cough treatment in Oriental medicine. However, anti-inflammatory activities of YHQ are poorly understood. The anti-inflammatory activities of YHQ were evaluated via enzyme-linked immunosorbent assay (ELISA), and the underlying mechanisms were further determined using western blot in lipopolysaccharide (LPS)-stimulated RAW 264.7 murine macrophage cells in vitro. Anti-inflammation study revealed that YHQ inhibits the release of prostaglandin E2 (PGE2) potently by suppressing the protein expression of cyclooxygenase-2 (COX-2) and leukotriene B4 (LTB4) by reducing arachidonate 5-lipoxygenase (5-LOX) in LPS-stimulated RAW 264.7 macrophages. Further study demonstrated that YHQ inhibits the production of the pro-inflammatory cytokines interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α in LPS-stimulated RAW 264.7 macrophages by attenuating the phosphorylation p65 subunit of nuclear factor-kappaB (NF-κB). The suppressive effects of YHQ on LPS-stimulated inflammatory cytokines and mediators can be attributed to the suppression of YHQ on the phosphorylation of Akt and c-Jun N-terminal kinases (JNK), extracellular signal-regulated kinase (ERK), and p38 MAPKs. This study suggested that YHQ can be a preventive and potent therapeutic candidate for the management of inflammatory-mediated immune disorders. Graphical abstract

Effect of Arctium lappa linne (Burdock) root tea consumption on lipid profile and blood pressure in patients with knee osteoarthritis Publication date: Available online 1 April 2019 Source: Journal of Herbal Medicine Author(s): Leila Maghsoumi-Norouzabad, Farideh Shishehbor, Reza Abed, Ahmad Zare Javid, Bina Eftekhar-Sadat, Beitollah Alipour Abstract Background Knee Osteoarthritis (OA) is a common disabling joint disorder worldwide. This study was designed to evaluate the effect of burdock root tea consumption on lipid profile and blood pressure in patients with OA. Methods In this randomized, single-blind, placebo-controlled clinical trial 36 patients (10 males and 26 females) aged 50–70 years old suffering from bilateral knee Osteoarthritis were randomly divided into intervention and control groups. The routine treatment was considered for all patients during the study. The intervention group received 3 cups / day of Burdock root tea (2 g tea bags steeped in 150 ml of boiled water for 10 min) and control group received only 3 cups / day of boiled water (150 ml) 30 min after meals (breakfast, lunch, and dinner) for 6 weeks. Blood lipid profile and blood pressure were assessed at baseline and 6 weeks post intervention. Results Total cholesterol (TC), LDL-C, TC/HDL-C, LDL-C/HDL-C ratios, systolic and diastolic blood pressure were significantly decreased post intervention. A significant increase in HDL-C level was observed in the intervention group. At the end of the study, there was a significant difference in LDL-C, HDL-C, TC/HDL-C, LDL-C/HDL-C ratios and diastolic blood pressure between two groups. Conclusions It is suggested that consumption of burdock root tea may improve lipid profile and blood pressure status in patients with knee OA. Further studies may need to confirm these effects.

Daily date vinegar consumption improves hyperlipidemia, β-carotenoid and inflammatory biomarkers in mildly hypercholesterolemic adults Publication date: Available online 18 March 2019 Source: Journal of Herbal Medicine Author(s): Zeshan Ali, Haile Ma, Asif Wali, Ishmael Ayim, Muhammad Nauman Sharif Abstract Dates are delicious fruits with a sweet taste and a fleshy consistency. Dates also have various bioactive components which have effects on different types of diseases. The objective of this study was to determine the effects of date vinegar made from date pulp and pits on the serum lipid profile and inflammatory biomarkers of mildly hypercholesterolemic adults. Seventy-six subjects with mildly raised total cholesterol and LDL cholesterol were enrolled. Participants ingested 30 mL of either date vinegar or placebo daily together with their normal diets. Plasma lipids, inflammatory biomarkers, carotenoids, potassium, folic acid, urea and creatinine were measured at baseline after 4 weeks and after treatment. These results suggest that the date vinegar improved several serum lipid profile parameters (mg/dL: Total Cholesterol (TC) 246.40 ± 14.7 to 197.60 ± 14.7, P = 0.001; Low density lipoprotein (LDL) 166.6 ± 11.8 to 109.8 ± 11.8, P = 0.001; Triglycerides (TG) 170.30 ± 16.54 to 161.20 ± 17.8, P = 0.002; High density lipoprotein (HDL) 41.7 ± 8.08 to 44.1 ± 8.05, P = 0.003) and inflammatory biomarkers (C-reactive protein (CRP) 7.05 ± 1.23 to 4.12 ± 0.04 mg/L, P = 0.001; nitric oxide (NO) 31.06 ± 0.47 to 27.01 ± 0.14 μmol/L, P = 0.002; tumor necrosis factor alpha (TNFα) 17.2 ± 2.8 to 13.6 ± 2.4 pg/mL, P = 0.001; fibrinogen 272.54 ± 22.6 to 238.31 ± 11.7 mg/dL, P = 0.014). The findings suggest that date vinegar improved the concentration of lipid and inflammatory biomarkers.

Otolaryngology

https://www.sciencedirect.com/journal/american-journal-of-otolaryngology/articles-in-press  

Research articleAbstract only

Practice patterns and knowledge among California pediatricians regarding human papillomavirus and its relation to head and neck cancer

Michael H. Berger, Yarah M. Haidar, Benjamin Bitner, Monica Trent, Tjoson Tjoa

In Press, Accepted Manuscript, Available online 25 April 2019

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Abstract

Abstract

Objective

To identify practice patterns regarding human papillomavirus (HPV) vaccination efforts and vaccination rates in context of head and neck cancer prevention, identify barriers to vaccination, and identify gaps in knowledge regarding the link between HPV and head and neck cancer in the pediatrician population.

Study design/Methods

A 27-question cross-sectional survey was distributed to members of the four California chapters of the American Academy of Pediatrics.

Results

Of the completed responses, 89.4% identified as "always" recommending the HPV vaccine to patients, but only 19.5% of pediatricians estimated that >75% of their eligible patients had completed the HPV vaccination series. 71.5% of respondents felt that further education about HPV's link to head and neck cancer them more comfortable discussing vaccination. Physicians who were in practice longer were less likely to respond that additional education about HPV and its link to head and neck cancer would make them more comfortable discussing vaccination with patients (p = 0.043). Physicians who were in practice longer were more likely to correctly respond that HPV type 16 is the most common strain linked to head and neck cancer (p = 0.021).

Conclusion

There is need to improve both the knowledge base and comfort level of pediatricians in counseling their patients during vaccine recommendations. Otolaryngologists have a critical role in providing education to physicians, trainees, and the general public in the effort to combat the epidemic of HPV-associated head and neck cancer.

select article The molecular differences between human papillomavirus-positive and -negative oropharyngeal squamous cell carcinoma: A bioinformatics study

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The molecular differences between human papillomavirus-positive and -negative oropharyngeal squamous cell carcinoma: A bioinformatics study

Jiaming Wang, Xiaoxi Xi, Wei Shang, Aneesha Archaya, ... Xianda Hu

In Press, Accepted Manuscript, Available online 23 April 2019

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Abstract

Abstract

Objective

To investigate the genetic and epigenetic differences between human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) and HPV-negative OPSCC.

Methods

Microarray data of HPV-positive and -negative OPSCC were retrieved from NCBI GEO datasets. Differentially expressed genes (DEGs) and differentially expressed miRNAs (DE-miRNAs) were identified by performing differential expression analysis. A functional enrichment analysis was performed to explore the biological processes and signaling pathways that DEGs and DE-miRNAs were involved in, respectively. A protein-protein interaction (PPI) network of DEGs was constructed to identify hub genes. miRNA-target network and miRNA-miRNA functional synergistic network were each constructed in order to identify risk-marker miRNAs. An miRNA-target-pathway network was constructed in order to explore the function of identified risk-marker miRNAs.

Results

Microarray data from 3 datasets (GSE39366, GSE40774, and GSE55550) was included and analyzed. The PPI network identified 3 hub genes (VCAM1, UBD, and RPA2). MiR-107 and miR-142-3p were found to play the most significant role in both the DE-miRNA-target network as well as in the miRNA-miRNA functional synergistic network. MiR-107 was involved in HPV-induced tumorigenesis by targeting many genes (CAV1, CDK6, MYB, and SERPINB5) and regulating the p53 signaling pathway, the PI3K-Akt signaling pathway, and the autophagy pathway. In addition, miR-142-3p was implicated in HPV-induced tumorigenesis by targeting the PPFIA1 gene and regulating transcriptional dysregulation and other cancerous pathways.

Conclusion

Three genes (VCAM1, UBD, and RPA2), two miRNAs (miR-107 and miR-142-3p), and four pathways (p53, PI3K-Akt, autophagy, and transcription dysregulation in cancer) were identified to play critical roles in distinguishing HPV-positive OPSCC from HPV-negative OPSCC.

select article Vitamin D deficiency and its relationship to cancer stage in patients who underwent thyroidectomy for papillary thyroid carcinoma.

Research articleAbstract only

Vitamin D deficiency and its relationship to cancer stage in patients who underwent thyroidectomy for papillary thyroid carcinoma.

Anita Sulibhavi, Matthew L. Rohlfing, Scharukh M. Jalisi, David B. McAneny, ... J. Pieter Noordzij

In Press, Accepted Manuscript, Available online 22 April 2019

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Abstract

Abstract

Purpose

As imaging technology improves and more thyroid nodules and malignancies are identified, it is important to recognize factors associated with malignancy and poor prognosis. Vitamin D has proven useful as a prognostic tool for other cancers and may be similarly useful in thyroid cancer. This study explores the relationship of Vitamin D to papillary thyroid carcinoma stage while accounting for socioeconomic covariates.

Materials and methods

The medical records of all patients who underwent thyroidectomy at one institution between 2000 and 2015 were reviewed. Subjects with non-papillary thyroid cancer pathology, prior malignancy, and without Vitamin D levels were excluded. The remaining 334 patient records were examined for cancer stage, Vitamin D levels, Vitamin D deficiency listed in history, and demographic and comorbid factors.

Results

Vitamin D laboratory values showed no significant relationship to cancer stage (p = 0.871), but patients with Vitamin D deficiency documented in the medical record were more likely to have advanced disease (28.6% versus 14.7%; p = 0.028). The patients with documented Vitamin D deficiency also had lower 25-hydroxyvitamin D nadirs (21.5 ng/mL versus 26.5 ng/mL, p = 0.008) and were more likely to be on Vitamin D supplementation (92.6% versus 41.8%, p < 0.001).

Conclusions

The results suggest that Vitamin D deficiency may have value as a negative prognostic indicator in papillary thyroid cancer and that pre-operative laboratory evaluation may be less useful. This is important because Vitamin D deficiency is modifiable. While different racial subgroups had different rates of Vitamin D deficiency, neither race nor socioeconomic status showed correlation with cancer stage.

select article Failed larynx preservation and survival in patients with advanced larynx cancer

Research articleAbstract only

Failed larynx preservation and survival in patients with advanced larynx cancer

Cheryl C. Nocon, Jessica Yesensky, Gaurav S. Ajmani, Mihir K. Bhayani

In Press, Accepted Manuscript, Available online 22 April 2019

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Abstract

Abstract

Purpose

To evaluate the survival benefit of total laryngectomy (TL) after induction chemotherapy in locally advanced laryngeal cancer patients.

Materials and methods

This is a retrospective study utilizing the National Cancer Database, which captures >80% of newly diagnosed head and neck squamous cell carcinoma cases in the United States. We included patients diagnosed with advanced stage laryngeal squamous cell carcinoma between 2004 and 2013 (n = 5649) who received either TL (n = 4113; 72.8%) or induction chemotherapy followed by either radiation therapy (n = 1431) or TL (n = 105). Kaplan-Meier curves and Cox proportional hazards regression were used to evaluate overall survival. A Cox regression model was computed to examine how the prognostic impact of treatment differed by clinical stage.

Results

In multivariable analysis, when compared to patients receiving TL alone, those receiving induction chemotherapy followed by TL experienced no significant difference in survival (HR 0.85, 95% CI 0.63–1.13), while those receiving induction chemotherapy followed by radiation experienced poorer survival (HR 1.15, 95% CI 1.06–1.26). Induction chemotherapy followed by TL was associated with improved survival compared to induction chemotherapy and radiation (P = .042). Among patients with T4a tumors, TL (P < .001) and induction chemotherapy followed by TL (P = .002) were both associated with improved survival compared to induction chemotherapy and radiation. There were no survival differences between TL and induction chemotherapy followed by TL (HR 0.76, 95% CI 0.52–1.10).

Conclusions

Larynx preservation may be attempted without compromising survival in patients with locally advanced larynx cancer who fail induction chemotherapy and undergo TL.

select article Improving efficiency in epistaxis transfers in a large health system: Analyzing emergency department treatment variability as pretext for a clinical care pathway

Research articleAbstract only

Improving efficiency in epistaxis transfers in a large health system: Analyzing emergency department treatment variability as pretext for a clinical care pathway

Clare Richardson, Anish Abrol, Chelsea S. Hamill, Nicole Maronian, ... Brian D'Anza

In Press, Accepted Manuscript, Available online 16 April 2019

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Abstract

Abstract

Introduction

Epistaxis is a common condition with an estimated $100 million in health care costs annually. A significant portion of this stems from Emergency Department (ED) management and hospital transfers. Currently there is no data in the literature clearly depicting the differences in treatment of epistaxis between Emergency Medicine (EM) physicians and Otolaryngologists. Clinical care pathways (CCP) are a way to standardize care and increase efficiency. Our goal was to evaluate the variability in epistaxis management between EM and Otolaryngology physicians in order to determine the potential impact of a system wide clinical care pathway.

Materials and methods

A retrospective case study was conducted of all patients transferred between emergency departments for epistaxis over an 18-month period. Exclusion criteria comprised patients under 18 years old, recent sinonasal surgery, bleeding disorders, and recent facial trauma.

Results

73 patients met inclusion criteria. EM physicians used nasal cautery in 8%, absorbable packing in 1% and non-absorbable packing in 92% (with 33% being bilateral). In comparison, Otolaryngologists used nasal cautery in 37%, absorbable packing in 34%, and non-absorbable packing in 23%. Eighty percent of patients treated by an Otolaryngology physician required less invasive intervention than previously performed by EM physicians prior to transfer.

Conclusions

Epistaxis management varied significantly between Emergency Medicine and Otolaryngology physicians. Numerous patients were treated immediately with non-absorbable packing. On post-transfer Otolaryngology evaluation, many of these patients required less invasive interventions. This study highlights the variability of epistaxis treatment within our hospital system and warrants the need for a standardized care pathway.

select article Predicting transient hypocalcemia in patients with unplanned parathyroidectomy after thyroidectomy

Research articleAbstract only

Predicting transient hypocalcemia in patients with unplanned parathyroidectomy after thyroidectomy

Ramez Philips, Phillip Nulty, Nolan Seim, Yubo Tan, ... Garth Essig

In Press, Corrected Proof, Available online 16 April 2019

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Abstract

Abstract

Objective

To assess the utility of rapid parathyroid hormone (PTH) values in predicting transient post-operative hypocalcemia in patients with unplanned parathyroidectomy during total or completion thyroidectomy.

Methods

All patients who underwent total or completion thyroidectomy between January 2010 and January 2015 were reviewed. Incidences of post-operative hypocalcemia were compared in patients with and without unplanned parathyroidectomy. Unplanned parathyroidectomy was defined as intra-operative incidental or intentional parathyroidectomy. Logistic regression assessed for predictors of hypocalcemia and optimum amount of calcium supplementation.

Results

Thirty-eight (13.6%) patients had evidence of incidental parathyroidectomy and 39/280 (13.9%) patients had parathyroid autotransplantation intra-operatively. Central neck dissection and malignancy were identified as risk factors for unplanned parathyroidectomy (p = 0.001, p = 0.060). Patients with unplanned parathyroidectomy were more likely to have hypocalcemia (p = 0.002) and hypoparathyroidism (p < 0.0005). PTH value was the only significant predictor of hypocalcemia in these patients. In patients with a post-operative PTH of ≤15, initial calcium supplementation ≥ 1000 mg decreased the risk of hypocalcemia (p < 0.05).

Conclusion

Post-operative PTH value predicts hypocalcemia in patients undergoing total and completion thyroidectomy with unplanned parathyroidectomy. In patients with a post-operative PTH < 15, initial calcium supplementation with ≥1000 mg of elemental calcium is recommended.

select article Clinical practice patterns in laryngeal cancer and introduction of CT lung screening

Research articleAbstract only

Clinical practice patterns in laryngeal cancer and introduction of CT lung screening

Krzysztof Piersiala, Lee M. Akst, Alexander T. Hillel, Simon R. Best

In Press, Corrected Proof, Available online 12 April 2019

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Abstract

Abstract

Objectives

After the publication of large clinical trials, in January 2014 The U.S. Preventive Services Task Force (USPSTF) recommended annual lung cancer screening with low-dose CT in a well-defined group of high-risk smokers. A significant proportion of patients with laryngeal cancer (LC) meet the introduced criteria, and we hypothesized that clinical practice would change as a result of these evidence-based guidelines.

Methods

Retrospective chart review of patients diagnosed with LC and treated at Johns Hopkins Hospital who met USPSTF criteria for annual chest screening and were followed for at least 3 consecutive years in the years surrounding the introduction of screening guidelines (January 2010 to December 2017) was performed to identify those who had recommended screening CT chest.

Results

A total of 151 patients met the inclusion criteria of the study and were followed for a total of 746 patient-years. 184/332 (55%) patient-years in the pre-guidelines period and 246/414 (59%) in the post-guidelines period included at least one recommended chest imaging (CT or PET-CT; p = 0.27). 248/332 (75%) patient-years in the pre-guidelines period and 314/414 (76%) in the post-guidelines period included any radiological chest imaging (X-ray, CT or PET-CT; p = 0.72). Screening scans were ordered by OHNS (45%), Medical Oncology (31%), Radiation Oncology (8%), and primary care (14%) with 70% of patients missing at least one year of indicated screening.

Conclusions

The implementation of new lung cancer screening guidelines did not change clinical practice in the management of patients with LC and many patients do not receive recommended screening. Further study concerning potential barriers to effective evidence-based screening and coordination of care is warranted.

select article Wideband Tympanmetry Results of Bone Cement Ossiculoplasty

Research articleAbstract only

Wideband Tympanmetry Results of Bone Cement Ossiculoplasty

O. Yigit, S. Tokgoz-Yilmaz, E. Tahir, M.D. Bajin, ... L. Sennaroglu

In Press, Corrected Proof, Available online 12 April 2019

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Abstract

Abstract

Objective

We aim to investigate hearing sensitivity and wideband tympanometry results in bone cement ossiculoplasty cases in present study.

Study design

A prospective study.

Setting

Ossiculoplasty patients were grouped according to the anatomical location of bone cement application by surgery note. Ossiculoplasty and tympanoplasty patients were retrospectively invited to the clinic and evaluated. 30 bone cement ossiculoplasty cases as well as 30 Type I tympanoplasty cases (intact ossicular chain) and 30 healthy controls were included in the study and Wideband Tympanometry was performed. Tympanometric peak pressure, equivalent middle ear volume, static admittance, tympanogram width, resonance frequency, average wideband tympanometry and absorbance measurements were analyzed.

Results

A statistically significant improvement was observed in the hearing levels of all ossiculoplasty and type I tympanoplasty patients (p < 0.05). Bone cement ossiculoplasty groups demonstrated the remarkable differences than the type I tympanoplasty and control group in Wideband Tympanometry test parameters. In some parameters, malleus-stapes and manubriostapedioplasty groups demonstrated similarities to Type I tympanoplasty and control groups.

Conclusion

Bone cement is an effective application for ossiculoplasty. Wideband tympanometry is a promising method for the evaluation of the middle ear dynamics.

select article Intracapsular hemorrhage rates in non-fixated nylon sheet orbital implants for orbital fracture management

Research articleAbstract only

Intracapsular hemorrhage rates in non-fixated nylon sheet orbital implants for orbital fracture management

Mark A. Prendes, Brett Gudgel, Enoch B. Kassa, Amelia M. Todd, ... H.B. Harold Lee

In Press, Corrected Proof, Available online 9 April 2019

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Abstract

Abstract

Purpose

To examine the incidence of intracapsular hemorrhage in orbital fracture repair with non-fixated nylon sheet implants.

Methods

A retrospective chart review of 227 patients presenting from January 2013 to December 2016 for orbital fracture repair with nylon sheet implants.

Results

Of the 331 orbital fractures repaired over 4 years, a total of 227 met inclusion criteria. The average implant thickness was 0.38 mm and no implants were fixated. Four total implants (1.8%) were removed due to complications; one each secondary to exploration for ongoing postoperative diplopia, immediate post-operative orbital hemorrhage, a cystic mass anterior to the implant, and pain. There were no cases of intracapsular hemorrhage nor infection for any of the 227 patients over 4 years.

Conclusions

To the authors knowledge, this represents the largest case series to date to assess the rate of intracapsular hemorrhage in non-fixated nylon sheet orbital implants. In the 227 cases reviewed over a 4-year period, there were no cases of intracapsular hemorrhage. This suggests a much lower complication rate than previously reported.

Précis

A case series of 227 patients who underwent orbital fracture repair with non-fixated nylon sheet implants.

select article Atypical thyroglossal duct cyst with intra-laryngeal and para-glottic extension

Case reportAbstract only

Atypical thyroglossal duct cyst with intra-laryngeal and para-glottic extension

Adele Chin Wei Ng, Heng Wai Yuen, Xin Yong Huang

In Press, Accepted Manuscript, Available online 8 April 2019

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Abstract

Abstract

Thyroglossal duct cysts (TDC) are the most common congenital neck masses. Although they are anatomically closely related to the larynx, intra-laryngeal extension is very rare. We present a case, review the literature and discuss the challenges of intra-laryngeal TDC. A 55-year-old man presented with a neck mass associated with dysphagia. Computer Tomography neck scan showed a midline cyst extending to the pre-epiglottic space with partial obliteration of the right pyriform sinus and narrowing of the larynx. The cyst was excised en-bloc via Sistrunk procedure. Intra-laryngeal TDC are surgically challenging due to risk of perforation into the aerodigestive tract.

select article The etiology, pathogeneses, and treatment of objective tinnitus: Unique case series and literature review

Case reportAbstract only

The etiology, pathogeneses, and treatment of objective tinnitus: Unique case series and literature review

Parsa P. Salehi, David Kasle, Sina J. Torabi, Elias Michaelides, Douglas M. Hildrew

In Press, Corrected Proof, Available online 5 April 2019

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Abstract

Abstract

We present two unique cases of myoclonus-induced objective tinnitus (OT), along with a comprehensive literature review on the topic. Primary goals include: explore the relationship between palatal myoclonus (PM) and middle ear myoclonus (MEM), highlight the embryologic, neurologic, and anatomical relationship between the involved peri-tubular muscles, exemplify the first case of OT which documents video evidence demonstrating the link between objective tinnitus and eustachian tube movement. Also, we discuss available treatment interventions and why they often do not fully resolve patients' symptoms. Finally we introduce a novel way to objectively quantify the severity of OT. Ultimately, our series hopes to inform future diagnostic and treatment guidelines.

select article Expression of vimentin (VIM) and metastasis-associated 1 (MTA1) protein in laryngeal squamous cell carcinoma are associated with prognostic outcome of patients

Research articleAbstract only

Expression of vimentin (VIM) and metastasis-associated 1 (MTA1) protein in laryngeal squamous cell carcinoma are associated with prognostic outcome of patients

Sotirios Karamagkiolas, Ioannis Giotakis, Efthimios Kyrodimos, Evangelos I. Giotakis, ... Andreas M. Lazaris

In Press, Corrected Proof, Available online 3 April 2019

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Abstract

Abstract

Purpose

Laryngeal squamous cell carcinoma (LSCC), a common type of head and neck cancer, is associated with high rates of metastasis and recurrence. In this study, we investigated the potential combinatorial prognostic value of NOTCH1, Vimentin (VIM), and Metastasis-associated 1 (MTA1) protein in LSCC, using immunohistochemistry.

Materials and methods

Tissue specimens from 69 patients with LSCC were immunohistochemically evaluated for the protein expression of NOTCH1, VIM, and MTA1. Then, biostatistical analysis was performed, in order to assess the prognostic value of the expression of each one of these proteins.

Results

NOTCH1 expression status was not a significant prognosticator in LSCC, as shown in Kaplan-Meier survival analysis. On the contrary, both VIM and MTA1 seem to have an important prognostic potential, independently of TNM staging and histological grade of the tumor. In fact, positive VIM expression was shown to predict patients' relapse and poor outcome regarding patients' overall survival, in contrast with MTA1, the positive expression of which predicts higher disease-free survival (DFS) and overall survival (OS) rates in LSCC.

Conclusions

VIM and MTA1 constitute potential tumor biomarkers in LSCC and could be integrated into a multiparametric prognostic model. Undoubtedly, their prognostic value needs further validation in larger cohorts of LSCC patients.

select article Spontaneous cervical chyle fistula: A case report

Case reportAbstract only

Spontaneous cervical chyle fistula: A case report

Swathi Appachi, Joseph B. Meleca, Paul C. Bryson

In Press, Corrected Proof, Available online 2 April 2019

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Abstract

Abstract

Background

Cervical chylous fistulae are rare complications usually occurring from iatrogenic injury to the thoracic duct. There have been no reported cases of spontaneous chyle leaks in surgical naïve necks.

Methods

Case report.

Results

A 50 year-old female presented with progressive left neck swelling without fever, dyspnea, or dysphagia. Imaging demonstrated extensive infiltrative changes of the left neck with retropharyngeal fluid extending into strap musculature and the mediastinum. Flexible laryngoscopy revealed posterior pharyngeal wall edema. Differential diagnosis included abscess versus necrotizing fasciitis. Broad-spectrum antibiotics were initiated and she was taken to the OR for neck exploration. Intra-operatively, milky fluid was present around the carotid sheath and in the retropharyngeal space. Fluid analysis demonstrated chylomicrons and triglycerides >2400 mg/dL. Repeat imaging of the neck, chest, and abdomen did not reveal malignancy or obstructive masses. A lymphangiogram showed dilated lymphatic vessels near the cervical thoracic duct. On post-operative day four, the patient was taken back to the OR for thoracic duct ligation and biopsy of nearby tissue. Pathology demonstrated benign lymph nodes with dilated sinusoids. A low-fat diet was started and she was discharged home on hospital day nine. She has followed up regularly with no signs of recurrence.

Conclusion

A cervical chylous fistula usually results from iatrogenic injury to the thoracic duct. To our knowledge, this is the first reported case of a spontaneous cervical chyle leak.

select article Does cervical range of motion affect the outcomes of canalith repositioning procedures for posterior canal benign positional paroxysmal vertigo?

Research articleAbstract only

Does cervical range of motion affect the outcomes of canalith repositioning procedures for posterior canal benign positional paroxysmal vertigo?

Salvatore Martellucci, Giuseppe Attanasio, Massimo Ralli, Vincenzo Marcelli, ... Andrea Gallo

In Press, Corrected Proof, Available online 2 April 2019

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Abstract

Abstract

Purpose

Canalith repositioning procedure (CRP) for posterior canal benign positional paroxysmal vertigo (BPPV), also known as Epley maneuver, is a common procedure for the treatment of BPPV. This maneuver entails flexion, extension and rotation of the patient's neck. This study aims to investigate the impact of cervical range of motion (C-ROM) on CRP efficacy.

Materials and methods

The study included 47 patients with posterior canal BPPV treated by CRP. The procedure was considered successful if vertigo and nystagmus disappeared at the post-treatment evaluation. If CRP resulted ineffective, it was repeated up to three times per session. C-ROM was measured at BPPV diagnosis before treatment. Patients were followed up for 30 days.

Results

The first CRP was successful in 29 patients (61.7%), while it was ineffective in 18 patients (38.3%) requiring multiple repositioning maneuvers. Patients who needed two or more CRP showed lower C-ROM in extension (p = .003) and flexion (p = .042), and earlier recurrences (p = .006). Univariate regression analysis showed that lower cervical extension was significantly associated with the failure of the first CRP (OR: 0.899, 95% CI 0.831–0.973, p = .008).

Conclusions

Our data suggest that a reduced C-ROM can require multiple CRPs to successfully treat BPPV and increase the risk of early recurrences.

select article Total vs hemithyroidectomy for intermediate risk papillary thyroid cancer: A 23 year retrospective study in a tertiary center

Research articleAbstract only

Total vs hemithyroidectomy for intermediate risk papillary thyroid cancer: A 23 year retrospective study in a tertiary center

Kwan Pok Tsui, Wai Yin Kwan, Tam Lin Chow

In Press, Corrected Proof, Available online 2 April 2019

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Abstract

Abstract

Background

There is much debate in the literature over the extent of surgery for patients with intermediate risk papillary thyroid cancer. We herein report our results in a local tertiary hospital.

Method

We identify from our database patients with papillary thyroid cancer who underwent surgery in our hospital and were stratified to be of intermediate risk from the GAMES stratification system. Patients' demographic data, surgical and pathological details were recorded. Primary end points were disease specific survival (DSS) and recurrence free survival (RFS).

Results

From January 1993 to December 2016, 231 patients with papillary thyroid cancer underwent surgery of which 137 (59%) were of intermediate risk. 45 (33%) patients had hemithyroidectomy and 92 (67%) patients had total thyroidectomy. In the total thyroidectomy group, patients had a higher tumor (T) (p value = 0.009) and nodal (N) staging (p value = 0.001). They were also predicted to have a higher risk of recurrence according to the American Thyroid Association (ATA) classification (p value = 0.005). The 5 year DSS in both groups were 100%. The 5 year RFS in the total thyroidectomy and hemithyroidectomy groups were 92% and 100% respectively and were significantly different by the log rank test (p value = 0.02). The median follow up time was 54 months (range 4–276 months).

Conclusion

The 5 year survival in intermediate risk papillary thyroid cancer is favorable. Hemithyroidectomy is an acceptable choice of operation in intermediate risk patients with a better risk profile.

select article Translation and validation of the Parotidectomy Outcome Inventory 8 (POI-8) to Spanish

Research articleAbstract only

Translation and validation of the Parotidectomy Outcome Inventory 8 (POI-8) to Spanish

Carlos Miguel Chiesa-Estomba, Elizabeth Ninchritz, Teresa Rivera-Schmitz, Jose Angel González-García, ... Xabier Altuna-Mariezcurrena

In Press, Corrected Proof, Available online 2 April 2019

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Abstract

Abstract

Introduction

There are >400 million of native Spanish speakers around the world, being the second most spoken language in regard to the number of native speakers. For this reason, a valid questionnaire to access the quality of our patients after parotidectomy is necessary.

Material and methods

Validation and cross-cultural adaptation of the POI-8 questionnaire to the Spanish language. Internal consistency of Sp-POI 8 measured with Cronbach α.

Results

35 patients met the inclusion criteria during the mentioned period. Mean age was 59 ± 15,37 (Min: 18/Max: 87). 20 patients (57,1%) were male and 15 (42,9%) were female. Internal consistency with Cronbach α was 0.868. The intraclass correlation coefficient was 0.830 [CI] (95%: 0,791–925). Hypoesthesia was the most severely weighted problem (0,91) and xerostomia was the second (0,89). However, the high score was for fear of revision surgery (1,26).

Conclusion

The Spanish Language is the second most spoken language with regard to the number of native speakers and the Sp-POI 8 translation represents a valid option for the Spanish-speaking medical community, from which a large number of patients can benefit.

select article Sex-specific enlarged vestibular aqueduct morphology and audiometry

Research articleAbstract only

Sex-specific enlarged vestibular aqueduct morphology and audiometry

Jeremy Ruthberg, Mustafa S. Ascha, Armine Kocharyan, Amit Gupta, ... Todd D. Otteson

In Press, Accepted Manuscript, Available online 29 March 2019

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Abstract

Abstract

Objective

Enlargement of the vestibular aqueduct (EVA) is one of the most common congenital malformations in pediatric patients presenting with sensorineural or mixed hearing loss. The relationship between vestibular aqueduct (VA) morphology and hearing loss across sex is not well characterized. This study assesses VA morphology and frequency-specific hearing thresholds with sex as the primary predictor of interest.

Materials and methods

A retrospective, longitudinal, and repeated-measures study was used. 47 patients at an academic tertiary care center with hearing loss and a record of CT scan of the internal auditory canal were candidates, and included upon meeting EVA criteria after confirmatory measurements of vestibular aqueduct midpoint and operculum widths. Audiometric measures included pure-tone average and frequency-specific thresholds.

Results

Of the 47 patients (23 female and 24 male), 79 total ears were affected by EVA; the median age at diagnosis was 6.60 years. After comparing morphological measurements between sexes, ears from female patients were observed to have a greater average operculum width (3.25 vs. 2.70 mm for males, p = 0.006) and a greater average VA midpoint width (2.80 vs. 1.90 mm for males, p = 0.004). After adjusting for morphology, male patients' ears had pure-tone average thresholds 17.6 dB greater than female patients' ears (95% CI, 3.8 to 31.3 dB).

Conclusions

Though females seem to have greater enlargement of the vestibular aqueduct, this difference does not extend to hearing loss. Therefore, our results indicate that criteria for EVA diagnoses may benefit from re-evaluation. Further exploration into morphological and audiometric discrepancies across sex may help inform both clinician and patient expectations.

select article Clinical and audiometric outcomes of palisade cartilage myringoplasty under local anesthetic in an office setting

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Clinical and audiometric outcomes of palisade cartilage myringoplasty under local anesthetic in an office setting

Nael M. Shoman

In Press, Corrected Proof, Available online 29 March 2019

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Abstract

Abstract

Objective

Assess clinical and functional outcomes of a modified palisade cartilage-perichondrium graft myringoplasty under local in an office setting.

Study design

Retrospective case series.

Setting

Tertiary care facility.

Patients

Patients with a tympanic membrane perforation presenting between March 2013 and October 2017. Inclusion criteria included age ≥ 7 years, entire perforation margin visualized through a transcanal view, and the ability to lie supine for up to 45 min. Exclusion criteria included a conductive hearing loss larger than expected, and presence of active infection.

Intervention

In-office modified myringoplasty technique under local anesthesia without sedation.

Main outcome measures

Complete perforation closure rate and audiometric outcomes.

Results

250 patients underwent the procedure, of whom 13 had bilateral sequential procedures (total 263 ears). Of those, 197 were primary and 66 revision. Average age was 46.3 years. Perforation sizes were categorized as small (32), moderate (109), large (78), and subtotal (44). Complete perforation closure was evident in 219 of the 250 cases (88%). Preoperative mean air pure tone average (PTA) was 56.7 dB and mean bone PTA was 27.5 dB (pre-operative ABG 29.2 dB). AC-PTA significantly improved to 35.0 dB (p < 0.0001), and ABG to 9.6 dB (p < 0.0001). Only subtotal perforations showed a statistically significant negative relationship with outcome (p = 0.04).

Conclusion

The modified palisade cartilage-perichondrium graft myringoplasty under local anesthetic is a highly successful procedure well tolerated by adult and pediatric patients with variable perforation sizes. This may have significant potential patient benefits, as well as cost savings to the health care system.

select article Cricoarytenoid joint abscess associated with rheumatoid arthritis

Case reportAbstract only

Cricoarytenoid joint abscess associated with rheumatoid arthritis

Megan J. Foggia, Henry T. Hoffman

In Press, Corrected Proof, Available online 28 March 2019

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Abstract

Abstract

Cricoarytenoid joint arthritis is an uncommon manifestation of rheumatoid arthritis. We encountered a 68-year-old woman with rheumatoid arthritis who presented with odynophagia, dysphagia, and progressive shortness of breath. Examination findings showed diminished mobility of the left vocal cord and right arytenoid swelling associated with an immobile right vocal cord. Computed tomography (CT) imaging identified a ring-enhancing lesion of the right lateral cricoarytenoid joint. Microdirect laryngoscopy with drainage of the cricoarytenoid abscess and tracheotomy were performed. Development of a laterally based cricoarytenoid joint abscess is identified as a complication of chronic rheumatoid arthritis with successful management described.

select article Delayed laryngeal implant infection and laryngocutaneous fistula after medialization laryngoplasty

Case reportAbstract only

Delayed laryngeal implant infection and laryngocutaneous fistula after medialization laryngoplasty

Joseph B. Meleca, Paul C. Bryson

In Press, Corrected Proof, Available online 27 March 2019

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Abstract

Abstract

Background

Medialization laryngoplasty is a common procedure for voice rehabilitation in patients with unilateral vocal fold paralysis. Complications are uncommon and delayed infections involving implants are rare. We report a delayed infectious complication following an animal scratch resulting in a laryngocutaneous fistula.

Methods

Case report.

Results

A 73-year-old female underwent a successful and uneventful medialization laryngoplasty for idiopathic unilateral vocal fold paralysis using a silastic implant. More than one year after surgery, she presented with an anterior neck infection following an animal scratch with CT neck findings of a left strap muscle abscess. After incision and drainage, cultures grew methicillin-resistant Staphylococcus aureus. Despite culture-directed antibiotic therapy, the neck continued to drain persistently. Laryngoscopy with stroboscopy revealed a medialized vocal fold with no obvious granulation tissue and normal mucosal pliability.

The patient underwent neck exploration revealing a laryngocutaneous fistula. Thus, both the fistulous tract and implant were removed. The wound was closed with a strap muscle advancement into the laryngoplasty window. One month after surgery and antibiotics, the patient had no signs of recurrent neck infection, with a well-healing wound and stroboscopic findings of complete glottic closure, symmetric vocal fold oscillation and acceptable phonation with mild supraglottic compression.

Conclusions

Delayed complications of medialization laryngoplasty are rarely reported. This case demonstrates a delayed infection of a laryngeal implant after an animal scratch requiring implant removal, local tissue reconstruction, and culture-directed antibiotic therapy.

Medical

Knowledge, attitude, and practice of breastfeeding: A comparative study of mothers in urban and rural communities of Lagos, Southwest Nigeria Mobolanle R Balogun, Oluchi A Okpalugo, Adedoyin O Ogunyemi, Adekemi O Sekoni Nigerian Medical Journal 2017 58(4):123-130 Background: Breastfeeding is a child survival intervention, which is effective in reducing child mortality. This study compared the knowledge, attitude, and practice of breastfeeding among mothers of under-five children in rural and urban communities of Lagos, Southwest Nigeria. Methods: This comparative cross-sectional study was conducted in Ikeja and Ikorodu, an urban and a rural local government area (LGA) of Lagos state, respectively. A total of 248 mothers of children under 5 years were selected from both areas using multistage sampling technique and subsequently interviewed. Data were analyzed using the Statistical Package for the Social Sciences version 20. Chi-squared test was used for urban and rural comparisons. Results: The respondents with good level of knowledge of breastfeeding in the urban and rural areas were 84.7% and 89.5%, respectively (P = 0.256). The overall positive attitude was 52.4% and 57.3% among the urban and rural respondents, respectively (P = 0.444). More than three-quarters (75.8%) of the respondents in the rural LGA and 43.5% of the urban respondents initiated breastfeeding immediately after birth (P < 0.001). Most of the rural respondents who had babies aged 0–24 months (46.8%) were currently breastfeeding their babies compared to 25.9% of their urban counterparts (P = 0.001). Furthermore, 79.8% of the rural respondents had practiced or were currently practicing exclusive breastfeeding (EBF) compared to 29.0% of the urban respondents (P < 0.001), with more urban women citing work resumption as reason for nonpractice of EBF (P = 0.010). The overall good practice was 16.1% and 69.4% among the urban and rural respondents, respectively (P < 0.001). Conclusion: Respondents' knowledge about breastfeeding was good, while their attitude was fair. The practice of breastfeeding among urban respondents was however low. Government and nongovernmental agencies should focus on programs that improve the attitude and breastfeeding practice of urban women.

Comparative assessment of some white blood cell and platelet parameters among normotensive and hypertensive subjects in Port Harcourt, Nigeria Chidinma Ijeoma Eziuzo, Bruno Chukwuemeka Chinko, Datonye Victor Dapper Nigerian Medical Journal 2017 58(4):131-137 Background: Reports comparing the values of white blood cells (WBCs) and platelet parameters among normotensive, newly diagnosed hypertensive, and known hypertensive participants in Nigeria are relatively scarce. This study sought to compare these hematologic parameters of normotensive and hypertensive participants in the Southeastern Nigeria. Materials and Methods: Fifty participants each of normotensive, newly diagnosed hypertensive, and known hypertensive and age- and sex-matched individuals were recruited into the study. Using an automated hematology analyzer, the following hematological parameters were determined in all participants: total WBC; neutrophil, lymphocyte and platelet counts; percentage value of neutrophil and lymphocytes; mean platelet volume (MPV); platelet distribution width; and total lymphocyte count. Results: Significantly higher total WBCs and (absolute) neutrophil counts and lower percentage lymphocyte were observed among known hypertensive male participants, whereas percentage neutrophil was significantly higher among known hypertensive female participants. Platelet count and MPV were significantly higher in hypertensive male participants compared to their normotensive counterparts. MPV was found to be significantly lower in hypertensive female participants compared to normotensive females. Conclusion: The present study reports significantly higher leukocytes, platelet counts, and MPV among hypertensive males and lower MPV among hypertensive females. Regular assessment of hematological parameters may perhaps be useful indicators of the prognosis of hypertension among the study population.

Sociodemographic factors affecting the quality of life of elderly persons attending the general outpatient clinics of a tertiary hospital, South-South Nigeria Uduak-Obong Morgan Morgan, Etiobong Akpan Etukumana, Festus Abasiubong Nigerian Medical Journal 2017 58(4):138-142 Background: In the last few decades, the evaluation of the quality of life (QoL) among older adults has become increasingly important in health as well as in social sciences. There has been growing emphasis on the need to understand what influences older people's QoL as it is argued to be of greater value than the traditional outcome measures, such as health status. Aim and Objective: The aim of this study was to determine the sociodemographic factors affecting the QoL of elderly patients attending the General Outpatient Clinics of the University of Uyo Teaching Hospital (UUTH), Uyo. Methodology: The study was a cross-sectional descriptive study. Three hundred and ten elderly persons attending the General Outpatient Clinics of the UUTH for medical conditions between July and September 2014 were consecutively recruited for the study. Details of sociodemographic information were taken, and QoL of respondents was assessed using the older persons' QoL questionnaire. Data were analyzed using the Statistical Package for Social Sciences-17.0, and the level of statistical significance was set at P < 0.05. Results: Of the three hundred and ten respondents recruited for the study, One hundred and seventy-seven (57.1%) were female and one hundred and thirty-three (42.9%) were male. The female-to-male ratio was 1.3:1. The age range of the respondents was between 60 and 90 years and the mean age (±standard deviation) was 67.4 (±6.6) years. Two hundred and thirty-two respondents (74.8%) had at least primary level of education and one hundred and sixty-one (51.9%) were married. The median monthly income was ₦ 25,500.00 with interquartile range of ₦ 10,000.00 to ₦ 50,000.00. From the study, 85.5% of the elderly reported an overall good QoL. High-income grade (P = 0.019), high social class (P = 0.036), and high level of education (P < 0.001) were the factors associated with good QoL in this study on univariate analysis. Conclusion: A high percentage of respondents reported an overall good QoL. High-income grade, high social class, and high level of education were the factors associated with good QoL.

Dysmenorrhea and its effects on school absenteeism and school activities among adolescents in selected secondary schools in Ibadan, Nigeria Damilola M Femi-Agboola, Olutoyin O Sekoni, Olayinka O Goodman Nigerian Medical Journal 2017 58(4):143-148 Background: Menstruation can be associated with dysmenorrhea that may affect daily activities. This study aimed to determine the prevalence of dysmenorrhea, effects on school activities, and associated school absenteeism among secondary school girls in Ibadan, Nigeria. Materials and Methods: This cross-sectional study was among 460 students from all girls' only secondary schools in Ibadan, Nigeria, using a cluster sampling method. Data were collected using questionnaires and focus group discussions. The severity of dysmenorrhea was categorized as mild, moderate, and severe. Data collected were analyzed using descriptive statistics and Chi-square tests performed to determine significant associations. Level of statistical significance was set at 5%. Results: Prevalence of dysmenorrhea and school absenteeism was 73% and 13.1%, with the severity of dysmenorrhea being 37.5%, 43.8%, and 18.8% for mild, moderate, and severe dysmenorrhea. Other school activities affected were as follows: class concentration, class participation, social, and sports activities (17.6%, 12.2%, 10.9%, and 4.6%). Main sources of medication for pain relief were family (15.8%) and self (13.7%). Age and duration of menstruation predicted dysmenorrhea (odds ratio [OR] =3.5, confidence interval [CI] = 1.2–9.7, P = 0.019), (OR = 1.7, CI = 1.1–2.6, P = 0.022), whereas severe dysmenorrhea predicted school absenteeism (OR = 4.2, CI = 1.7–9.9, P = 0.001). Respondents opined that analgesic drugs should be available in school to prevent school absenteeism. Conclusion: Prevalence of dysmenorrhea was high and severe dysmenorrhea played a role in school absenteeism. Health education should be provided to address the dangers of self-medication while drugs for pain relief should be available in schools.