Objective
To provide a summary of the current frailty literature relating to head and neck cancer.
Data Sources
Ovid MEDLINE, PubMed, Google Scholar.
Methods
A comprehensive review of the literature ...was performed from 2000 to 2017 using key words frailty, elderly, geriatric, surgery, otolaryngology, head and neck cancer.
Results
The aging population has led to an increased diagnosis of head and neck cancer in elderly patients. The prevalence of comorbidities, disabilities, geriatric syndromes and social issues can make treatment planning and management in this population challenging. Chronological age alone may not be the optimal approach to guiding treatment decisions, as there is marked heterogeneity amongst this age group. Individualization of treatment can be achieved by assessing for the presence of frailty, which has growing evidence as an important marker of health status in geriatric oncology. Frailty is a complex geriatric syndrome characterized by a state of increased vulnerability to stressors and is associated with morbidity, mortality, and treatment toxicity. Screening for frailty may provide an efficient method to identify those who would benefit from further assessment or pretreatment optimization, and to provide prognostic information to assist clinicians and patients in formulating the most ideal treatment plan for the elderly individual with head and neck cancer.
Conclusions
Frailty has emerged as an important concept in geriatric oncology, with wide significance in head and neck cancer. Incorporating frailty assessments into clinical practice may provide otolaryngologists pertinent information regarding health status and outcomes leading to optimal care of the elderly cancer patient. Laryngoscope, 128:E416–E424, 2018
Pretreatment determination of extranodal extension (ENE) has significant clinical implications in human papillomavirus positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC). Unfortunately ...there is no gold‐standard imaging modality for radiological assessment of ENE in HPV+ OPSCC, leading to subjective assessments and complex decision making concerning ENE. A systematic review of diagnostic test accuracy was therefore undertaken, with five databases systemically searched to evaluate the diagnostic performance of an imaging modality for detection of ENE in HPV+ OPSCC. A meta‐analysis was conducted on four CT studies using a random‐effects model. While a narrative synthesis was provided for the studies using PET/CT and “CT and MRI.” Out of 1772 hits, six studies were included in the review. Meta‐analysis on four CT studies showed CT had an overall sensitivity of 77% and specificity of 60%. PET/CT had a sensitivity of 37.5% and specificity of 97%. “CT and MRI” had a sensitivity of 62% and specificity of 78%. Further diagnostic studies involving CT, PET/CT and MRI are ultimately required.
Introduction
Tonsillectomy is a frequently performed otolaryngological procedure and is associated with significant postoperative pain and bleeding. A number of studies have investigated methods to ...reduce pain and bleeding. Coblation and BiZact devices have both been claimed to have favourable pain outcomes following tonsillectomy. This study was designed to investigate these two techniques in a direct comparison of postoperative pain and bleeding.
Methods
In this single blinded, randomized control trial, 61 patients were randomly assigned to undergo tonsillectomy with either the BiZact or Coblation device. Pain scores were collected for 14 days postoperatively using a Visual Analogue Score scale. Secondary outcome data was collected for duration of surgery, intra‐operative bleeding, return to normal, and secondary bleeding rates.
Results
Coblation was found to have lower postoperative pain on day 1 (P < 0.05). BiZact was found to have lower postoperative pain on day 7 (P < 0.05) and day 11 (P < 0.05). Pain scores for other days were not significant. There was no significant difference in set‐up time, procedural time and return to normal activities. The BiZact group had a longer time to achieve haemostasis (P < 0.001) and greater intraoperative blood loss (P < 0.01). There was a trend towards more significant secondary bleeding in the BiZact arm, however, this study was not adequately powered to assess this finding.
Conclusion
Both Coblation and BiZact devices appear to provide a safe and effective method for tonsillectomy in adults. Reduced pain on day 1 may make Coblation more suitable for day‐case surgery.
Tonsillectomy is a frequently performed otolaryngological procedure and is associated with significant postoperative pain and bleeding. This study was designed to investigate Bizact and Coblation techniques in a direct comparison of postoperative pain and bleeding. Both Coblation and BiZact devices appear to provide a safe and effective method for tonsillectomy in adults.
Index modulation (IM) is one of the candidate technologies for the upcoming sixth-generation (6G) wireless communications networks. In this letter, we propose a space-time-modulated reconfigurable ...intelligent metasurface (RI-MTS) that is configured to implement various frequency-domain IM techniques in a multiple-input-multiple-output (MIMO) array configuration. Unlike prior works that mostly analyze the signal theory of general RI-MTS IM, we present novel electromagnetics-compliant designs of specific IMs such as subcarrier index modulation (SIM) and MIMO orthogonal frequency-domain modulation IM (MIMO-OFDM-IM). Our full-wave electromagnetic simulations and analytical computations establish the programmable ability of these transceivers to vary the reflection phase and generate frequency harmonics for IM. Our experiments for the bit error rate show that RI-MTS-based SIM and MIMO-OFDM-IM are lower than the conventional MIMO-OFDM.
Objectives
Customised acoustic therapy aims to moderate the neural pathways implicated in the pathophysiology of tinnitus. This study aimed to assess the efficacy of customised acoustic therapy ...administered via a web‐based treatment platform.
Design
Clinical trial with prospective recruitment. Fifty‐eight participants underwent 6 weeks of customised acoustic therapy.
Setting
Treatment was delivered for 2 h each day using a smartphone, tablet or computer. Treatment was integrated into usual daily activities.
Participants
Participants with subjective tinnitus were recruited through public and private otolaryngology clinics and electronic and print media.
Main Outcomes Measured
FiveQ, a novel 5 question tinnitus questionnaire, was measured at baseline and each week of treatment. Statistical analyses, including Wilcoxon, Mann–Whitney and mixed linear regression, were used to assess treatment efficacy and identify factors associated with treatment response.
Results
39/58 participants (67.2%) had an improvement in symptom severity scores, 4 had no change (6.9%) and 15 had a decline from baseline (25.9%). Mean FiveQ scores improved by 22.9% from 40.8 (SD = 21.4) at baseline to 31.5 (SD = 21.3) following 6 weeks of treatment (p < 0.001). With the exception of the slight tinnitus group, all other groups (from mild to catastrophic) demonstrated a treatment response. Participants with low frequency tinnitus (<2000 Hz) had a significantly greater treatment response (p < 0.001).
Conclusion
Customised acoustic therapy administered via a web‐based platform demonstrated encouraging efficacy. At least mild symptoms at baseline and low frequency tinnitus were associated with a greater treatment response. Customised acoustic therapy offers accessible and efficacious tinnitus treatment, however longer term clinical studies are required to confirm the observed initial benefit is maintained.
Objectives
Tinnitus is a complex and debilitating phenomenon with potentially significant implications on quality of life. New presentations can be resource and time intensive for clinicians. ...Validated comprehensive tinnitus questionnaires may lack practical utility in the high‐volume clinical setting. Concise, targeted questionnaires may offer an efficient alternative. This study aimed to assess the validity of the FiveQ, a novel five question construct designed to measure tinnitus severity. Convergent validity was assessed through correlating FiveQ against two comprehensive validated questionnaires, the Tinnitus Handicap Questionnaire (THQ) and Tinnitus Handicap Inventory (THI).
Design
Cross‐sectional study with prospective recruitment. The 117 voluntarily recruited participants completed the FiveQ, THI and THQ questionnaires. Results were comparatively analysed.
Setting
Recruitment was via electronic and print media, audiology clinics and public and private otolaryngology outpatient clinics. Surveys were completed electronically.
Participants
Members of the public aged over 18 with subjective tinnitus were invited to participate.
Main Outcome Measured
Analyses for establishing the content validity, construct validity, internal consistency, explorary factor analysis, and responsiveness of FiveQ was performed.
Results
FiveQ demonstrated a high positive correlation with both the THI (r = 0.773, p < .001) and THQ (r = 0.808, p < .001). Internal consistency for FiveQ reached an acceptable threshold (Cronbach's alpha 0.86). Exploratory factor analysis demonstrated that one latent factor underlies the five items of the FiveQ. FiveQ demonstrated better responsiveness than both the THI and THQ after a 6 week interval repeat measurement.
Conclusion
FiveQ demonstrated high‐positive correlations with existing validated tinnitus questionnaires as well as acceptable internal consistency and factor analysis. The concise construct of FiveQ allows clinicians to efficiently estimate tinnitus severity, target treatment towards dominant symptoms and establish a reliable estimation of treatment response following interventions.
The role of polyploidy, particularly allopolyploidy, in plant diversification is a subject of debate. Whole-genome duplications precede the origins of many major clades (e.g., angiosperms, ...Brassicaceae, Poaceae), suggesting that polyploidy drives diversification. However, theoretical arguments and empirical studies suggest that polyploid lineages may actually have lower speciation rates and higher extinction rates than diploid lineages. We focus here on the grass tribe Andropogoneae, an economically and ecologically important group of C ₄ species with a high frequency of polyploids. A phylogeny was constructed for ca . 10% of the species of the clade, based on sequences of four concatenated low-copy nuclear loci. Genetic allopolyploidy was documented using the characteristic pattern of double-labeled gene trees. At least 32% of the species sampled are the result of genetic allopolyploidy and result from 28 distinct tetraploidy events plus an additional six hexaploidy events. This number is a minimum, and the actual frequency could be considerably higher. The parental genomes of most Andropogoneae polyploids diverged in the Late Miocene coincident with the expansion of the major C ₄ grasslands that dominate the earth today. The well-documented whole-genome duplication in Zea mays ssp. mays occurred after the divergence of Zea and Sorghum . We find no evidence that polyploidization is followed by an increase in net diversification rate; nonetheless, allopolyploidy itself is a major mode of speciation.
Significance Duplication of genomes following hybridization (allopolyploidy) is common among flowering plants, particularly in the grasses that cover vast areas of the world and provide food and fuel. Here, we find that genome duplication has occurred at a remarkable rate, accounting for at least a third of all speciation events in a group of about 1,200 species. Much of this genome duplication occurred during the expansion of the C ₄ grasslands in the Late Miocene. We find no evidence that allopolyploidy leads directly to a change in the net rate of diversification or correlates with the origin of novel morphological characters. However, as a mode of speciation, the frequency of allopolyploidization is surprisingly high.
Objective
To investigate the histological location and extent of perineural invasion (PNI) as prognostic factors.
Design
Retrospective review of medical records and histological analysis of 116 ...patients with oral squamous cell carcinoma (OSCC).
Setting
Two major public tertiary hospitals treating head and neck cancer, Royal Adelaide Hospital and Flinders Medical Centre, in South Australia.
Participants
Patients diagnosed with OSCC who underwent primary surgical treatment with curative intent at these two centres from January 1, 2005 through December 31, 2015.
Main Outcome Measures
The primary end points were disease‐free survival (DFS) and disease‐specific survival (DSS).
Results
The presence of PNI as a binary factor alone did not significantly influence the clinical outcomes. Extratumoural (ET) PNI as measured from the tumour edge was associated with worse DFS on multivariate analyses. Multifocal PNI was associated with worse DFS and DSS. DFS in multifocal PNI was worse irrespective of whether adjuvant therapy was administered.
Conclusions
The presence of multifocal and ET PNI in OSCC is associated with poor clinical outcomes. Patients with multifocal PNI were associated with worse DFS even with adjuvant therapy.
Background
Extracapsular spread (ECS) of lymph node metastases is associated with poor prognosis and is an indication for adjuvant chemoradiotherapy. Accurately identifying ECS using imaging may ...allow us to recommend primary chemoradiotherapy to avoid trimodality treatment. We investigated the accuracy of staging CT in diagnosing ECS in P16 + oropharyngeal squamous cell carcinoma (OPSCC).
Methods
Patients with pathologically determined cervical nodal metastases from P16 + OPSCC were included. Two blinded radiologists scored images to predict the presence of ECS in comparison to histopathology.
Results
Eighty patients with a total of 91 specimens were evaluated. Pathologic ECS was identified in 53.8% of the patients. Sensitivity and specificity of CT for the two observers were 56.5% and 60.9%, and 73.3% and 66.7%, respectively. The presence of perinodal stranding was found to be significantly associated with pathological ECS.
Conclusion
Computed tomography displays consistently high specificity, which may be used to rule out the presence of extracapsular spread in cervical nodal metastases of P16 + oropharyngeal squamous cell carcinoma.
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