The American Society of Anesthesiologists Physical status classification (ASA-PS) is a simple categorization of a patient's physiological status during the perioperative period. The role of ASA-PS in ...predicting operative risk and complications following tonsillectomy with or without adenoidectomy (T ± A) has not been studied. The objective of the study was to identify the association of the pre-operative ASA-PS with 30-day complication rates and adverse events following T ± A.
A retrospective analysis was performed using data from the American College of Surgeons' National Surgical Quality Improvement Program database (ACS NSQIP) of patients aged 16 years or older who underwent T ± A between 2005 and 2016. Patients were stratified into ASA-PS Classes I/II and III/IV. Patient demographics, preoperative comorbidities, pre-operative laboratory values, operation-specific variables, and postoperative outcomes in the 30-day period following surgery were compared between the two subsets of ASA-PS groups.
On multivariate analysis, patients with ASA class III and IV were more likely to experience an unplanned readmission (OR 1.39, 95 % CI 1.09–1.76; p = 0.007), overall complications (OR 1.49, 95 % CI 1.28–1.72; p < 0.001), major complications (OR 1.52, 95 % CI 1.31–1.77, p ≤ 0.001), reoperation (OR 1.33, 95 % CI 1.04–1.69; p = 0.022), and extended length of stay >1 day (OR 1.78, 95 % CI 1.41–2.25; p < 0.001) following a T ± A.
Higher ASA-PS classification is an independent predictor of complications following T ± A. Surgeons should aim to optimize the systemic medical conditions of ASA-PS classes III and IV patients prior to T ± A and implement post-operative management protocols specific to these patients to decrease morbidity, complications, and overall health care cost.
Although antiretroviral therapy (ART) successfully suppresses HIV-1 replication, ART-treated individuals must maintain therapy to avoid rebound from an integrated viral reservoir. Strategies to limit ...or clear this reservoir are urgently needed. Individuals infected for longer periods prior to ART appear to harbor more genetically diverse virus, but the roles of duration of infection and viral diversity in the humoral immune response remain to be studied. We aim to clarify a role, if any, for autologous and heterologous antibodies in multi-pronged approaches to clearing infection. To that end, we have characterized the breadths and potencies of antibody responses in individuals with varying durations of infection and HIV-1 envelope (
gene diversity as well as the sensitivity of their inducible virus reservoir to broadly neutralizing antibodies (bNAbs). Plasma was collected from 8 well-characterized HIV-1
males on ART with varied durations of active infection. HIV
from reservoir-derived outgrowth viruses were amplified and single genome sequenced in order to measure genetic diversity in each participant. IgG from plasma was analyzed for binding titers against gp41 and gp120 proteins, and for neutralizing titers against a global HIV-1 reference panel as well as autologous outgrowth viruses. The sensitivity to bNAbs of these same autologous viruses was measured. Overall, we observed that greater
diversity was associated with higher neutralizing titers against the global panel and also increased resistance to certain bNAbs. Despite the presence of robust anti-HIV-1 antibody titers, we did not observe potent neutralization against autologous viruses. In fact, 3 of 8 participants harbored viruses that were completely resistant to the highest tested concentration of autologous IgG. That this lack of neutralization was observed regardless of ART duration or viral diversity suggests that the inducible reservoir harbors 'escaped' viruses (that co-evolved with autologous antibody responses), rather than proviruses archived from earlier in infection. Finally, we observed that viruses resistant to autologous neutralization remained sensitive to bNAbs, especially CD4bs and MPER bNAbs. Overall, our data suggest that the inducible reservoir is relatively resistant to autologous antibodies and that individuals with limited virus variation in the
gene, such as those who start ART early in infection, are more likely to be sensitive to bNAb treatment.
Objective
Identify trends in swallowing outcomes in p16+ oropharyngeal squamous cell carcinoma following neoadjuvant chemotherapy+surgery (NAC+S) versus neoadjuvant chemotherapy+surgery+radiation ...(NAC+S+R).
Study Design
Cohort study.
Setting
Single academic institution.
Methods
Swallowing outcome was measured using a validated questionnaire, MD Anderson Dysphagia Inventory (MDADI). MDADI scores were compared between NAC+S and NAC+S+R groups in short‐term (<1 year), middle‐term (1‐3 years), and long‐term (>3 years). Clinical factors associated with MDADI scores were explored using a linear mixed model. Statistical significance was established at p < .05.
Results
Sixty‐seven patients met the inclusion criteria and were divided into 2 groups: NAC+S (57 85.1%) and NAC+S+R (10 14.9%). All patients had improved MDADI scores in the middle‐term compared to short‐term (NAC+S: score increase = 3.43, p = .002; NAC+S+R: score increase = 11.18, p = .044), long‐term compared to short‐term (NAC+S: score increase = 6.97, p < .001; NAC+S+R: score increase = 20.35, p < .001), and long‐term compared to middle‐term (NAC+S: score increase = 3.54, p = .043; NAC+S+R: score increase = 9.18, p = .026). NAC+S patients had better MDADI scores than NAC+S+R patients at short‐term (83.80 vs 71.26, p = .001). There was no significant difference in swallowing function in the middle‐term or long‐term.
Conclusion
Regardless of treatment type, swallowing will likely be improved in the middle‐term and long‐term compared to the short‐term. Patients treated with NAC+S+R will have worse short‐term swallowing function. However, in the middle‐term and long‐term, there is no significant difference in swallowing function between patients treated with NAC+S and NAC+S+R.
Sclerosing odontogenic carcinoma (SOC) is a rare intraosseous carcinoma of the jaw which was recently added to the World Health Organization classification of head and neck tumors. We report a case ...of SOC in the left maxilla of a 64-year-old who complained of several years of midface swelling, facial pain, and facial weakness. Imaging revealed an infiltrative mass and biopsy demonstrated fibrous dysplasia involved by a low-grade carcinoma, undeterminable origin. A partial maxillectomy was remarkable for scattered small, angulated nests and long, thin cords of cuboidal cells infiltrating a markedly sclerotic stroma. Bony changes consistent with fibrous dysplasia were again seen. Immunohistochemically, the epithelial cells were reactive for AE1/AE3 and p63, while negative for ERG and myogenin consistent with odontogenic carcinoma. The disease was not resectable, and the patient was treated with palliative immunotherapy. The diagnosis of SOC requires careful evaluation of clinical and pathologic features.
•Sclerosing odontogenic carcinoma (SOC) is a rare variant of odontogenic carcinoma.•SOC was added to WHO Classification of Head and Neck Tumors in 2017.•SOC exhibits a fibrous background, dispersed epithelial aggregates and cords.•Immunohistochemical staining of SOC often reveals muscle and perineural infiltration.•SOC clinicopathological findings are crucial for diagnosis, prognosis, and treatment.
PDF
