Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2019 Sep 7;54(9):647-654. doi: 10.3760/cma.j.issn.1673-0860.2019.09.002.
[Lateral endoscopic transorbital approach to middle skull base: anatomical and surgical practice study].
[Article in Chinese; Abstract available in Chinese from the publisher]
Li J1, Guo SL2, Sun W1, Wang QM1, Wen YH1, Wei FQ1, Wen WP1.
Author information
1
Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Sun Yat-sen University, the Institute of Otorhinolaryngology of Sun Yat-sen University, Guangzhou Key Laboratory of Otorhinolaryngology Head and Neck Surgery, the First Affliaited Hospital of Sun Yat-sen University, Guangzhou 510080, China.
2
Department of Neurosurgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
Abstract
Objective: To investigate the anatomical and surgical approaches to middle cranial fossa through orbital lateral wall under endoscope. Methods: Cadaveric formalin fixed specimens and fresh colored silicone injected specimens were used for this study. All anatomic technical measurements were performed under 0° and 30° endoscope and infrared rays navigation. The surgical approach was designed with the bony opening on the lateral wall of orbit through which the lateral side of the middle cranial fossa could be directly entered under endoscope. One case of recurrent meningioma was performed through this surgical approach. SPSS 20.0 software was used for statistical analysis. Results: The approach can directly enter the middle cranial fossa and expose anatomic landmarks including superior orbital fissure, lateral side of cavernous sinus, foramen rotundum, foramen ovale, foramen spinosum, petrosal bone and others as well as Ⅱ, Ⅲ, Ⅳ, Ⅴ, Ⅵ cranial nerves under endoscope. The maximal bony opening through the lateral wall of orbit was measured, with a horizontal diameter of (1.38±0.68) cm, a vertical diameter of (2.02±0.32) cm, a depth of (1.44±0.42) cm from bony opening margin to the dura. The recurrent meningioma involving lateral side of the middle skull base was successfully removed by this surgical approach through lateral wall of orbit. Conclusion: Lateral transorbital endoscopic approach to the lateral side of middle skull base is a safe, feasible, and minimally invasive method, which allows surgeons to directly manipulate diseases involving this area with good visualization and minimal invasion under endoscope.

KEYWORDS:
Cavernous sinus; Dissection; Endoscope; Orbit; Skull base

PMID: 31550755 DOI: 10.3760/cma.j.issn.1673-0860.2019.09.002
[Indexed for MEDLINE]
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122.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2019 Sep 7;54(9):641-646. doi: 10.3760/cma.j.issn.1673-0860.2019.09.001.
[The application of Chinese version of anterior skull base questionnaire (ASBQ) in patients with anterior and middle skull base tumors].
[Article in Chinese; Abstract available in Chinese from the publisher]
Wei TT1, Wang ZL1, Qi Y1, Liu JQ1, Liu JF2, Wei HQ3, Ren X1.
Author information
1
Department of Otorhinolaryngology Head and Neck Surgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
2
Department of Otorhinolaryngology Head and Neck Surgery, China-Japan Friendship Hospital, Beijing 100029, China.
3
Department of Otorhinolaryngology Head and Neck Surgery, the First Hospital of China Medical University, Shenyang 110001, China.
Abstract
Objective: To develop the Chinese version of anterior skull base questionnaire(ASBQ) and to verify its application in patients with anterior and middle skull base tumors. Methods: The following steps were finished including getting the permission from the author of the original English scale, translating and back-translating, tentative test, discussing the consequence and cultural debugging. From October 2016 to December 2018, 51 patients with skull base tumors from Xuanwu Hospital and China-Japan Friendship Hospital were enrolled as an experimental group, aged from 24 to 70 years old, with 19 males and 32 females, which included 27 patients with anterior skull base tumor and 24 patients with middle skull base tumor. From December 2016 to January 2018, 46 healthy volunteers were selected as a control group, aged from 18 to 36 years old, including 26 females and 20 males. The subjects in the test group and the control group were rigorously tested with official manuscripts and judged whether the manuscript was applicable. The SPSS 22.0 statistical software was used to analyze the data of the test group, the anterior skull base group, the middle skull base group and the control group to evaluate the performance of the scale. Results: Both the rate of the recovery and efficiency in experimental group, anterior skull base group and middle skull base group were 100%, with the average time of completion of (8.7±3.2), (11.2±4.0) and (7.3±2.1) min, respectively in each group. The r value of test-retest reliability was 0.96, 0.99 and 0.97 in experimental group, anterior skull base group and middle skull base group, with the split-half reliability coefficient of 0.91, 0.90 and 0.96, with the entire scale Cronbach's coefficient of 0.91, 0.95 and 0.93, respectively. The content validity and the construct validity of the scale were good enough, and the criteria validity was-0.483,-0.509 and -0.489 in experimental group, anterior skull base group and middle skull base group. The scale could well distinguish the difference of the quality of life between the preoperative and postoperative patients in experimental group and the middle skull base group. The difference of the quality of life in anterior skull base group was not found between preoperative and postoperative patients. Conclusion: The Chinese version of ASBQ has good reliability and validity, which is suitable for a wide range of Chinese patients with anterior and middle skull base tumors to assess their quality of life.

KEYWORDS:
Quality of life; Scale; Skull base neoplasms

PMID: 31550754 DOI: 10.3760/cma.j.issn.1673-0860.2019.09.001
[Indexed for MEDLINE]
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123.
J Craniofac Surg. 2019 Jul;30(5):e454-e460. doi: 10.1097/SCS.0000000000005533.
Partial Adenoidectomy in Patients With Palatal Abnormalities.
Salna I1, Jervis-Bardy J2, Wabnitz D3, Rees G4, Psaltis A1,4, Johnson A2.
Author information
1
Department of Otolaryngology Head and Neck Surgery, The Queen Elizabeth Hospital, Adelaide, Australia.
2
Department of Otolaryngology Head and Neck Surgery, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR.
3
Department of Paediatric Otolaryngology Head and Neck Surgery, Women's & Children's Hospital, North Adelaide, South Australia.
4
Otolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, Australia.
Abstract
BACKGROUND:
Velopharyngeal insufficiency is a feared complication of adenoidectomies in patients with palatal abnormalities. Thus, the benefits of adenoidectomy in this population are less understood. The techniques of partial adenoidectomy aim to preserve velopharyngeal closure while sufficiently debulking the nasal airway to ameliorate obstruction and snoring.

METHODOLOGY:
Systematic review of online databases using a combination of search terms including "cleft palate," "submucosal cleft palate," "short palate," "adenoidectomy," "partial adenoidectomy," "subtotal adenoidectomy," and "powered adenoidectomy." Two independent reviewers assessed the eligibility of each study based on predefined inclusion criteria.

RESULTS:
From 323 studies identified, 8 were included. All were retrospective case series, except 1 prospective study. Study period ranged from 1.1 to 14 years (median 7.5 years). There were 172 patients with a cleft palate (n = 80), submucous cleft palate (n = 67) or another defined palatal abnormality [short soft palate (n = 14), bifid uvula (n = 4), questionable palatal mobility (n = 4) or incomplete CP (n = 3)] identified. Mean age was 5.5 years and just over half were male (58%). Nearly all patients showed improvement in nasal airway obstruction and snoring. The pooled risk for velopharyngeal insufficiency across all studies was 2 out of 122, which approximates to 1.6% of patients. There were very few complications.

CONCLUSION:
This is the first systematic review of partial adenoidectomy in patients with palatal abnormalities. Sub-total adenoidectomy in patients with submucosal cleft palate or repaired cleft palate appears to be a safe and efficacious procedure. There is; however, a need for prospective data collection using a standardized technique in large patient series required to properly assess outcomes.

PMID: 31299813 DOI: 10.1097/SCS.0000000000005533
[Indexed for MEDLINE]
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124.
J Craniofac Surg. 2019 Jul;30(5):e453-e454. doi: 10.1097/SCS.0000000000005532.
A Patient With a Protuberant Fibro-Osseous Lesion of the Temporal Bone.
Maroun CA1, Khalifeh I2, Faddoul DS3, Zaytoun G1, Moukarbel RV1.
Author information
1
Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center.
2
Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center.
3
American University of Beirut, Beirut, Lebanon.
Abstract
Protuberant fibro-osseous lesion of the temporal bone, otherwise known as "Bullough's lesion", is a rare, benign exophytic fibro-osseous tumor. In this brief report, we present a case of a 61-year-old woman with a history of a right-sided skull mass that had been increasing in size for approximately 6 years before presentation. Clinical, radiological and histological features are examined and discussed. We achieved excellent results with surgical resection, with no evidence of recurrence.

PMID: 31299812 DOI: 10.1097/SCS.0000000000005532
[Indexed for MEDLINE]
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Select item 31152465
125.
Cell Prolif. 2019 Sep;52(5):e12638. doi: 10.1111/cpr.12638. Epub 2019 May 31.
Jarid1b promotes epidermal differentiation by mediating the repression of Ship1 and activation of the AKT/Ovol1 pathway.
Sun X1, Li Z1, Niu Y1,2, Zhao L1, Huang Y1, Li Q3, Zhang S1, Chen T1, Fu T1, Yang T2, An X4, Jiang Y1, Zhang J1,5,6.
Author information
1
Department of Otolaryngology-Head and Neck Surgery, Key Laboratory, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.
2
Department of Biochemistry & Molecular Biology, Shanxi Medical University, Taiyuan, China.
3
Department of Andrology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.
4
Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
5
Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Qingdao, China.
6
Shandong College Collaborative Innovation Center of Digital Medicine in Clinical Treatment and Nutrition Health, Qingdao, China.
Abstract
OBJECTIVES:
Terminally differentiated stratified squamous epithelial cells play an important role in barrier protection of the skin. The integrity of epidermal cells is maintained by tight regulation of proliferation and differentiation. The aim of this study was to investigate the role of epigenetic regulator H3K4me3 and its demethylase Jarid1b in the control of epithelial cell differentiation.

MATERIALS AND METHODS:
RT-qPCR, Western blotting and IHC were used to detect mRNA and protein levels. We analysed cell proliferation by CCK8 assay and cell migration by wound healing assay. ChIP was used to measure H3K4me3 enrichment. A chamber graft model was established for epidermal development.

RESULTS:
Our studies showed that H3K4me3 was decreased during epidermal differentiation. The H3K4me3 demethylase Jarid1b positively controlled epidermal cell differentiation in vitro and in vivo. Mechanistically, we found that Jarid1b substantially increased the expression of mesenchymal-epithelial transition (MET)-related genes, among which Ovol1 positively regulated differentiation gene expression. In addition, Ovol1 expression was repressed by PI3K-AKT pathway inhibitors and overexpression (O/E) of the PI3K-AKT pathway suppressor Ship1. Knockdown (KD) of Ship1 activated downstream PI3K-AKT pathway and enhanced Ovol1 expression in HaCaT. Importantly, we found that Jarid1b negatively regulated Ship1 expression, but not that of Pten, by directly binding to its promoter to modulate H3K4me3 enrichment.

CONCLUSION:
Our results identify an essential role of Jarid1b in the regulation of the Ship1/AKT/Ovol1 pathway to promote epithelial cell differentiation.

© 2019 The Authors. Cell Proliferation Published byJohn Wiley & Sons Ltd.

KEYWORDS:
Jarid1b; Ovol1; Ship1; differentiation; epidermis

PMID: 31152465 DOI: 10.1111/cpr.12638
[Indexed for MEDLINE]
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Select item 31095727
126.
J Surg Oncol. 2019 Aug;120(2):99-100. doi: 10.1002/jso.25493. Epub 2019 May 16.
Sentinel node biopsy for cancer of the oral cavity.
Wu JX1, Hanson M1, Shaha AR1.
Author information
1
Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York.
KEYWORDS:
cancer of the oral cavity; elective nodal dissection; sentinel node biopsy

Comment on
Sentinel lymph node biopsy for management of the N0 neck in oral cavity squamous cell carcinoma. [J Surg Oncol. 2019]
PMID: 31095727 DOI: 10.1002/jso.25493
[Indexed for MEDLINE]
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Select item 30921526
127.
Otolaryngol Head Neck Surg. 2019 Feb;160(2):206-212. doi: 10.1177/0194599818817758.
Plain Language Summary for Patients: Tonsillectomy in Children.
Finestone SA1, Giordano T2, Mitchell RB3, Walsh SA1, O'Connor SS4, Satterfield LM4.
Author information
1
1 Consumers United for Evidence-based Healthcare, Fredericton, New Brunswick, Canada.
2
2 The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
3
3 UT Southwestern Medical Center, Dallas, Texas, USA.
4
4 Department of Research and Quality, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA.
Abstract
This plain language summary for patients serves as an overview explaining tonsillectomy in children and to help patients, caregivers, and clinicians in their discussions about the reasons that a tonsillectomy may be needed, management options, and care related to the procedure. This summary applies to patients ages 1 through 18 years and is based on the 2019 "Clinical Practice Guideline: Tonsillectomy in Children (Update)." This evidence-based guideline mainly addresses the need for tonsillectomy based on breathing problems that take place during sleep and repeated sore throats or "tonsillitis." The guideline was developed to identify quality improvement opportunities in managing children under consideration for tonsillectomy and to create clear recommendations for clinicians to use in medical practice.

KEYWORDS:
child; plain language summary; polysomnography; sleep disordered breathing; tonsillectomy; tonsillitis

PMID: 30921526 DOI: 10.1177/0194599818817758
[Indexed for MEDLINE]
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Select item 30798738
128.
Otolaryngol Head Neck Surg. 2019 Jan;160(1):6-7. doi: 10.1177/0194599818815805.
Highlights from the Current Issue: January 2019.
Krouse JH1.
Author information
1
1 School of Medicine, University of Texas Rio Grande Valley, Edinburg, Texas, USA.
PMID: 30798738 DOI: 10.1177/0194599818815805
[Indexed for MEDLINE]
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129.
Lasers Med Sci. 2019 Sep;34(7):1433-1440. doi: 10.1007/s10103-019-02735-2. Epub 2019 Feb 14.
Voice improvement in patients with recurrent respiratory papillomatosis after combined treatment with cidofovir and CO2 laser surgery.
Jackowska J1, Wojnowski W2, Hashimoto A2, Małaczyńska B2, Piersiala K3, Świdziński P2, Wiskirska-Woźnica B2, Wierzbicka M1.
Author information
1
Department of Otolaryngology, Head and Neck Surgery Poznań University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznań, Poland.
2
Department of Phoniatrics and Audiology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznań, Poland.
3
Student Research Group at the Department of Otolaryngology, Head and Neck Surgery Poznań University of Medical Sciences, Przybyszewskiego Street 49, 60-355, Poznań, Poland. piersiala@hotmail.com.
Abstract
Mechanical debulking of laryngeal papillomas is associated with voice disorders due to impairment of the vocal fold's mucosa. Intraepithelial injection of cidofovir reduces damage to the laryngeal structures and thus improves vocal parameters. The aim of our study was to compare vocal quality before and after cidofovir and CO2 laser treatment by means of objective phoniatric parameters and to obtain evidence concerning voice outcomes. The vocal parameters of 42 patients with RRP were assessed before and after intralesional cidofovir and CO2 laser debulking treatment (Lumenis AcuPulse 40 CO2 laser, wavelength 10.6 μm; Lumenis Ltd., Yokneam, Israel). The laser was used in SuperPulse™ mode with power tailored on the target structures (average 7 W). The depth of tissue penetration was 1 mm with a single burst of energy lasting 0.3 ms. Most of the patients had previously undergone traditional surgery (1-105 procedures); in 7/42, the video stroboscopic examination revealed extensive scar tissue covering the mucosa of the vocal folds, limiting the mucosal wave. The significance level for all calculations was p < 0.05. Statistical analysis was performed using Statistica 10 by StatSoft Polska. The methodology included subjective voice evaluation (GRBAS), videostroboscopy, analysis of the acoustic laryngeal tone (MDVP), spectrographic analysis, and voice handicap index (VHI). The GRBAS scale during spontaneous conversation revealed better phonation results after cidofovir treatment in all 42 patients. Scars were not observed in the presented group. In the MDVP laryngeal tone analysis before surgery parameters defining the amplitude and frequency of laryngeal tone were significantly elevated compared to the state after surgery. After treatment, both jitter and shimmer were reduced in all subjects. Even more pronounced changes were observed in the spectrographic analysis. In all analyzed patients, there was a significant reduction in VHI scores showing improvement in voice self-assessment. A satisfactory improvement in voice quality was observed in all RRP patients treated with cidofovir and CO2 laser.

KEYWORDS:
CO2 laser; Cidofovir; RRP; Vocal parameters; Voice quality

PMID: 30762194 DOI: 10.1007/s10103-019-02735-2
[Indexed for MEDLINE]
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Select item 30678995
130.
Oral Oncol. 2019 Mar;90:122. doi: 10.1016/j.oraloncology.2019.01.008. Epub 2019 Jan 22.
RE: Impact of radical treatments on survival in locally advanced T4a and T4b buccal mucosa cancers: Selected surgically treated T4b cancers have similar control rates as T4a.
Shetty SS1, Vishal Rao US2.
Author information
1
Health Care Global Enterprises Ltd, Bangalore 560027, India; Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, India(1). Electronic address: sameep.shetty@manipal.edu.
2
Head and Neck Oncology, Health Care Global Enterprises Ltd, Bangalore, India.
Comment on
Impact of radical treatments on survival in locally advanced T4a and T4b buccal mucosa cancers: Selected surgically treated T4b cancers have similar control rates as T4a. [Oral Oncol. 2018]
PMID: 30678995 DOI: 10.1016/j.oraloncology.2019.01.008
[Indexed for MEDLINE]
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Select item 30619373
131.
Front Immunol. 2018 Dec 21;9:3045. doi: 10.3389/fimmu.2018.03045. eCollection 2018.
Fas Signaling in Dendritic Cells Mediates Th2 Polarization in HDM-Induced Allergic Pulmonary Inflammation.
Han M1,2,3, Hu R2, Ma J2, Zhang B2, Chen C4, Li H1, Yang J3, Huang G2,4.
Author information
1
Department of Otolaryngology-Head and Neck Surgery, Center for Allergic and Inflammatory Diseases, Affiliated Eye and ENT Hospital, Fudan University, Shanghai, China.
2
Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
3
Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
4
Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical University, Dongguan, China.
Abstract
Fas-Fas ligand (FasL) signaling plays an important role in the development of allergic inflammation, but the cellular and molecular mechanisms are still not well known. By using the bone marrow-derived dendritic cell (BMDC) transfer-induced pulmonary inflammation model, we found that house dust mite (HDM)-stimulated FAS-deficient BMDCs induced higher Th2-mediated allergic inflammation, associated with increased mucus production and eosinophilic inflammation. Moreover, FAS-deficient BMDCs promoted Th2 cell differentiation upon HDM stimulation in vitro. Compared to wild-type BMDCs, the Fas-deficient BMDCs had increased ERK activity and decreased IL-12 production upon HDM stimulation. Inhibition of ERK activity could largely increase IL-12 production, consequently restored the increased Th2 cytokine expression of OT-II CD4+ T cells activated by Fas-deficient BMDCs. Thus, our results uncover an important role of DC-specific Fas signaling in Th2 differentiation and allergic inflammation, and modulation of Fas signaling in DCs may offer a useful strategy for the treatment of allergic inflammatory diseases.

KEYWORDS:
Fas; Th2; allergic inflammation; dendritic cells; house dust mite

PMID: 30619373 PMCID: PMC6308134 DOI: 10.3389/fimmu.2018.03045
[Indexed for MEDLINE] Free PMC Article
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Select item 30619295
132.
Front Immunol. 2018 Dec 13;9:2935. doi: 10.3389/fimmu.2018.02935. eCollection 2018.
Clara Cell 10 kDa Protein Alleviates Murine Hepatitis Virus Strain 3-Induced Fulminant Hepatitis by Inhibiting Fibrinogen-Like Protein 2 Expression.
Yu H1, Liu Y2, Wang H1, Wan X1, Huang J1, Yan W1, Xi D1, Luo X3, Shen G4, Ning Q1.
Author information
1
Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
2
Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
3
Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
4
Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Abstract
Background: Fulminant hepatitis (FH) is a serious threat to human life, accompanied by massive and rapid necroinflammation. Kupffer cells, the major immune cell population involved in innate immune responses, are considered to be central for FH. Fibrinogen-like protein 2 (Fgl2) is a pro-coagulant protein that is substantially induced in macrophages upon viral infection, and Fgl2 depletion represses murine hepatitis virus strain 3 (MHV-3) infection. Clara cell 10 kDa (CC10) protein is a secretory protein with anti-inflammatory properties in allergic rhinitis and asthma. However, its mechanisms of action and pathogenic roles in other disease are still unclear. In this study, we aimed to determine the role of CC10 in FH and the regulation of Fgl2 by CC10. Methods: A mouse FH model was established by peritoneal injection of MHV-3. The mice received CC10 protein through tail vein injection before viral infection. Survival rate, liver function, liver histology, fibrin deposition, and necrosis were examined. The regulatory effect of CC10 on Fgl2 expression was investigated using THP-1 cells and mouse peritoneal macrophages in vitro. Results: In the mouse FH model induced by MHV-3, the survival rate increased from 0 to 12.5% in the CC10 group compared to that in the saline-only control group. Meanwhile, the levels of ALT and AST in serum were significantly decreased and liver damage was reduced. Furthermore, hepatic Fgl2, TNF-α, and IL-1β expression was obviously downregulated together with fibrin deposition, and hepatocyte apoptosis was reduced after administration of CC10 protein. In vitro, CC10 was found to significantly inhibit the expression of Fgl2 in IFN-γ-treated THP-1 cells and MHV-3-infected mouse peritoneal macrophages by western blot and real-time PCR. However, there was no direct interaction between CC10 and Fgl2 as shown by co-immunoprecipitation. Microarray investigations suggested that HMG-box transcription factor 1 (HBP1) was significantly low in CC10-treated and IFN-γ-primed THP-1 cells. HBP1-siRNA treatment abrogated the inhibitory effect of CC10 on Fgl2 expression in Human Umbilical Vein Endothelial cells (HUVECs). Conclusion:CC10 protects against MHV-3-induced FH via suppression of Fgl2 expression in macrophages. Such effects may be mediated by the transcription factor HBP1.

KEYWORDS:
CC10; Fgl2; MHV-3; hepatitis; macrophage

PMID: 30619295 PMCID: PMC6300492 DOI: 10.3389/fimmu.2018.02935
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Select item 30598049
133.
Otolaryngol Head Neck Surg. 2019 Feb;160(2):364-367. doi: 10.1177/0194599818816965. Epub 2019 Jan 1.
Initial Experience with 3-Dimensional Exoscope-Assisted Transmastoid and Lateral Skull Base Surgery.
Smith S1,2, Kozin ED1,2, Kanumuri VV1,2, Barber SR1,3, Backous D4, Flávio Nogueira J5, Lee DJ1,2.
Author information
1
1 Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.
2
2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.
3
3 Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA.
4
4 Proliance Surgeons, Seattle, Washington, USA.
5
5 Sinus & Oto Centro-Hospital Geral de Fortaleza, Rua Dr. José Furtado, Fortaleza, Brazil.
Abstract
Extracorporeal video microscopes, or "exoscopes," provide high-definition views of the operative field and are alternatives to the operating microscope or loupes for large-corridor surgical approaches. In this proof-of-concept study, we aim to determine the feasibility of 3-dimensional exoscopes as alternatives to operating microscopes in otology and neurotology, espeically in conjunction with endoscopes. Eleven consecutive cases were performed using 3-dimensional exoscopes in place of, or as adjuncts to, the operating microscope. The exoscope was the sole visualization tool in 7 cases, with 4 including the use of an endoscope or microscope. There were no perioperative complications. Potential subjective advantages include superior ergonomics, compact size, and an equal visual experience for surgeons and observers. Limitations include low lighting in small surgical corridors and pixilation at high magnification. Exoscopes are potentially viable alternatives to the microscope in otologic and neurotologic surgery.

KEYWORDS:
cochlear implant; exoscope; mastoid surgery; mastoidectomy; middle ear surgery

PMID: 30598049 DOI: 10.1177/0194599818816965
[Indexed for MEDLINE]
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Select item 30554855
134.
Oral Oncol. 2019 Mar;90:147-149. doi: 10.1016/j.oraloncology.2018.11.034. Epub 2018 Dec 13.
Regional recurrence rate of lymph-node-positive thyroid carcinoma after selective or comprehensive neck dissection.
Deng L1, Cao Y2, Lin J3.
Author information
1
Department of Oral and Maxillofacial Surgery, The Second Affiliated Hospital of Guizhou Medical Hospital, Kaili, China.
2
Department of Head and Neck Oncology, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, Section Three, Ren Min Nan Road, Chengdu 610041, China. Electronic address: yubin.cao@qq.com.
3
Department of Dental Anesthesiology, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, Section Three, Ren Min Nan Road, Chengdu 610041, China. Electronic address: 13558852310@163.com.
Comment on
Optimal extent of lateral neck dissection for well-differentiated thyroid carcinoma with metastatic lateral neck lymph nodes: A systematic review and meta-analysis. [Oral Oncol. 2018]
PMID: 30554855 DOI: 10.1016/j.oraloncology.2018.11.034
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Select item 30509151
135.
Otolaryngol Head Neck Surg. 2019 Feb;160(2):355-358. doi: 10.1177/0194599818815658. Epub 2018 Dec 4.
Expansion Hyoidthyroidpexy: Combined Hyoid Surgery Techniques for Obstructive Sleep Apnea: All in One.
Askar SM1, El-Anwar MW1, Awad A1.
Author information
1
1 Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt.
Abstract
We provide expansion hyoidthyroidpexy as a novel surgical procedure for obstructive sleep apnea (OSA) that could combine different techniques of hyoid bone surgery in 1 procedure. This case series included patients with OSA who had an apnea-hypopnea index (AHI) >15 and showed predominant lateral wall hypopharyngeal collapse. In 21 patients, the procedure was performed smoothly without technical difficulties or operative adverse events, resulting in lateral expansion of each horn of the hyoid bone by ≥1 cm without early or late complications. At 6 months postoperatively, both AHI and the mean lowest oxygen saturation level were significantly improved ( P < .0001). The new expansion hyoidthyroidpexy technique is a reliable, easy, and effective procedure with good surgical outcomes in patients with OSA. It is feasible to be employed in the protocol of multilevel surgery for OSA.

KEYWORDS:
expansion hyoidplasty; hyoidthyroidpexy; obstructive sleep apnea; polysomnography; sleep apnea

PMID: 30509151 DOI: 10.1177/0194599818815658
[Indexed for MEDLINE]
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Select item 30453863
136.
Otolaryngol Head Neck Surg. 2019 Feb;160(2):347-354. doi: 10.1177/0194599818813123. Epub 2018 Nov 20.
Comparing Outcomes of the Standard Technique of Endoscopic DCR with Its Modifications: A Retrospective Analysis.
Kumar S1, Mishra AK1, Sethi A1, Mallick A1, Maggon N1, Sharma H1, Gupta A1.
Author information
1
1 Department of Otorhinolaryngology-Head and Neck Surgery, Army College of Medical Sciences and Associated Base Hospital, Delhi Cantt, New Delhi, India.
Abstract
OBJECTIVE:
To compare the outcomes of various techniques of endoscopic dacryocystorhinostomy (DCR).

STUDY DESIGN:
Retrospective case record analysis.

SETTINGS:
Tertiary care referral center.

SUBJECT AND METHODS:
Retrospective analysis of case records was carried out pertaining to the period from January 1996 to September 2017 with respect to patients who had undergone endoscopic DCR with either the standard technique or one of its modifications. Case notes showing well-documented preoperative evaluation, operative details, postoperative assessment, and minimum 6-month follow-up were considered. The outcomes were measured on the basis of patients' postoperative symptoms, clinical examination, and sac-syringing results.

RESULTS:
A total of 423 patients were included in the study. Of these, 169 underwent standard endoscopic DCR; 87, endoscopic DCR with stent; 19, endoscopic DCR with mitomycin C; 62, powered DCR; 29, laser-assisted DCR; and 57, balloon DCR. There was no statistically significant difference in success rates, recurrences, or complications of various techniques at 3 or 6 months. Mean operating time was lowest for balloon DCR (mean ± SD, 27.1 ± 3.1 minutes), followed by standard endoscopic DCR (38.2 ± 3.6 minutes; P = .001).

CONCLUSION:
Standard endoscopic DCR and its more sophisticated modifications were equally effective and safe in managing distal nasolacrimal drainage obstruction. Balloon DCR, followed by standard endoscopic DCR, was significantly faster than other techniques.

KEYWORDS:
DCR; balloon DCR; chronic dacryocystitis; epiphora; mitomycin C

PMID: 30453863 DOI: 10.1177/0194599818813123
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137.
Otolaryngol Head Neck Surg. 2019 Feb;160(2):255-260. doi: 10.1177/0194599818813101. Epub 2018 Nov 20.
In-office versus Operating Room Sialendoscopy: Comparison of Outcomes, Patient Time Burden, and Charge Analysis.
Coniglio AJ1, Deal AM2, Bhate O3, Hackman TG1.
Author information
1
1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
2
2 Lineberger Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA.
3
3 School of Medicine, Boston University, Boston, Massachusetts, USA.
Abstract
OBJECTIVE:
To evaluate outcomes of in-office versus operating room (OR) sialendoscopy/sialolithotomy and to recognize the efficiency of outpatient salivary gland surgery with significant time and facility charge reductions.

STUDY DESIGN:
Case series with chart review.

SETTING:
State hospital OR and ambulatory clinic.

SUBJECTS AND METHODS:
Retrospective review was performed of adult patients treated for inflammatory salivary diseases by a single surgeon from 2011 to 2016. The patients were divided into 2 groups based on procedure setting (office vs OR) and compared by various baseline features, including demographics, symptom onset and duration, stone size, symptomatic improvement, and recurrence. Patient time burden was compared via office procedure records and OR time charting from the electronic health record. Retrospective clinic and hospital charge sheets were tallied and similarly compared.

RESULTS:
The 2 cohorts (office, n = 111; OR, n = 96) were comparable in all demographics, including sialolith number and size (7.36 vs 6.69 mm, P = .45). Additional subgrouping was statistically similar. Both cohorts had similar postprocedure symptom improvement (97% vs 95.8%, P = .65) and recurrence rates (8.9% vs 14.5%, P = .22) independent of subgroup. Overall time burden for patients was 39 minutes in the office versus 277 minutes in the OR ( P ≤ .0001). Procedure and hospital charge data were tallied and compared (office, $719.21; OR, $13,956.14; P ≤ .0001).

CONCLUSION:
Bothcohorts were statistically similar in all features. There was significant reduction in patient time burden and health care charges with office-based procedures while maintaining similar symptom improvement and recurrence rates.

KEYWORDS:
charge analysis; in-office; sialendoscopy; sialoendoscopy; time

PMID: 30453822 DOI: 10.1177/0194599818813101
[Indexed for MEDLINE]
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138.
J Immunother Cancer. 2018 Nov 13;6(1):118. doi: 10.1186/s40425-018-0435-6.
Targeting myeloid-inflamed tumor with anti-CSF-1R antibody expands CD137+ effector T-cells in the murine model of pancreatic cancer.
Saung MT1,2,3,4, Muth S1,2,3,4, Ding D1,2,3,4, Thomas DL 2nd1,2,3,4, Blair AB2,5,3,4, Tsujikawa T6,7, Coussens L7,8, Jaffee EM1,2,9,3,4, Zheng L10,11,12,13,14,15.
Author information
1
Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
2
The Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
3
Pancreatic Cancer Precision Medicine Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
4
The Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
5
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
6
Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
7
Department of Cell, Developmental & Cancer Biology, Oregon Health and Science University, Portland, OR, USA.
8
Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA.
9
The Skip Viragh Center for Pancreatic Cancer Research and Clinical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
10
Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. lzheng6@jhmi.edu.
11
The Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA. lzheng6@jhmi.edu.
12
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. lzheng6@jhmi.edu.
13
The Skip Viragh Center for Pancreatic Cancer Research and Clinical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA. lzheng6@jhmi.edu.
14
Pancreatic Cancer Precision Medicine Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA. lzheng6@jhmi.edu.
15
The Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA. lzheng6@jhmi.edu.
Abstract
BACKGROUND:
The pancreatic cancer vaccine, GVAX, induces novel lymphoid aggregates in the otherwise immune quiescent pancreatic ductal adenocarcinoma (PDAC). GVAX also upregulates the PD-1/PD-L1 pathway, and a pre-clinical model demonstrated the anti-tumor effects of combination GVAX and anti-PD-1 antibody therapy (GVAX/αPD-1). Resistance to GVAX was associated with an immune-suppressive myeloid cell infiltration, which may limit further therapeutic gains of GVAX/αPD-1 therapy. The expression of CSF-1R, a receptor important for myeloid cell migration, differentiation and survival, and the effect of its therapeutic blockade in the context of GVAX in PDAC has not been investigated.

METHODS:
Lymphoid aggregates appreciated in 24 surgically resected PDAC from patients who received one dose of neoadjuvant GVAX were analyzed with multiplex immunohistochemistry. Flow cytometry analysis of tumor infiltrating T-cells in a murine model of PDAC was performed to investigate the therapeutic effects and mechanism of anti-CSF-1R/anti-PD-1/GVAX combination immunotherapy.

RESULTS:
High CSF-1R expression in resected PDAC from patients who received neoadjuvant GVAX was associated with a higher myeloid to lymphoid cell ratio (p < 0.05), which has been associated with poorer survival. This higher CSF-1R expression was associated with a higher intra-tumoral infiltration of immature dendritic cells (p < 0.05), but not mature dendritic cells (p = 0.132). In the pre-clinical murine model, administering anti-CSF-1R antibody prior to and after GVAX/αPD-1 ("pre/post-αCSF-1R + αPD-1 + GVAX") enhanced the survival rate compared to GVAX/αPD-1 dual therapy (p = 0.005), but administering anti-CSF-1R only before GVAX/αPD-1 did not (p = 0.41). The "pre/post-αCSF-1R + αPD-1 + GVAX" group also had higher intra-tumoral infiltration of PD-1 + CD8+ and PD-1 + CD4+ T-cells compared to αPD-1/GVAX (p < 0.001). Furthermore, this regimen increased the intra-tumoral infiltration of PD-1 + CD137 + CD8+, PD-1 + CD137 + CD4+ and PD-1 + OX40 + CD4+ T-cells (p < 0.001). These PD-1 + CD137 + CD8+ T-cells expressed high levels of interferon-γ (median 80-90%) in response to stimulation with CD3/CD28 activation beads, and this expression was higher than that of PD-1 + CD137-CD8+ T-cells (p < 0.001).

CONCLUSIONS:
The conversion of exhausted PD-1+ T-cells to CD137+ activated effector T-cells may contribute to the anti-tumor effects of the anti-CSF-1R/anti-PD-1/GVAX combination therapy. Anti-CSF-1R antibody with anti-PD-1 antibody and GVAX have the potential be an effective therapeutic strategy for treatment of PDAC.

KEYWORDS:
CD137; CSF-1R; Cytotoxic T-cells; Dendritic cells; GVAX; Interferon-γ; Lymphoid aggregates; PD-1; Pancreatic ductal adenocarcinoma; Tumor associated macrophages

PMID: 30424804 PMCID: PMC6234697 DOI: 10.1186/s40425-018-0435-6
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139.
Sci Rep. 2018 Oct 30;8(1):15990. doi: 10.1038/s41598-018-34345-3.
Phosphoinositide 3-kinase-delta could be a biomarker for eosinophilic nasal polyps.
Kim JS1,2, Jeong JS3, Lee KB3, Kim SR3,2, Choe YH3, Kwon SH1,2, Cho SH4, Lee YC5,6.
Author information
1
Department of Otorhinolaryngology-Head and Neck Surgery, Chonbuk National University Medical School, Jeonju, South Korea.
2
Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, South Korea.
3
Department of Internal Medicine, Research Center for Pulmonary Disorders, Chonbuk National University Medical School, Jeonju, South Korea.
4
Division of Allergy and Immunology, Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
5
Department of Internal Medicine, Research Center for Pulmonary Disorders, Chonbuk National University Medical School, Jeonju, South Korea. leeyc@jbnu.ac.kr.
6
Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, South Korea. leeyc@jbnu.ac.kr.
Abstract
Nasal polyps (NP) cause diverse clinical symptoms of chronic rhinosinusitis (CRS). Chronic inflammation of sinonasal mucosa is known to be crucial in NP formation. We aimed to define the implications of phosphoinositide 3-kinase (PI3K)-δ in nasal inflammation associated with NP by analyzing NP tissue obtained from CRS patients. Results showed that expression of p110δ, a regulatory subunit of PI3K-δ, in NP tissue was increased compared to control tissue. Increased p110δ expression was closely correlated with more severe CRS features. Interestingly, p110δ expression was increased in eosinophilic NP, which are closely related to more complicated clinical courses of the disease. Furthermore, CRS patients possessing NP with higher p110δ expression displayed more eosinophils in NP tissue and blood, higher levels of IL-5 in NP tissue, and more severe features of the disease. Therefore, PI3K-δ may contribute to the formation of NP, especially eosinophilic NP associated with more severe clinical presentations and radiological features.

PMID: 30375439 PMCID: PMC6207677 DOI: 10.1038/s41598-018-34345-3
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140.
Otolaryngol Head Neck Surg. 2019 Feb;160(2):295-301. doi: 10.1177/0194599818804768. Epub 2018 Oct 23.
Prevalence of Minor Larynx Structural Alterations: Influence on the Concept of a Normal Vocal Fold.
Moraes BT1, De Biase NG2.
Author information
1
1 Department of Surgery, Federal University of Pernambuco, Recife/PE, Brazil.
2
2 Department of Otolaryngology-Head and Neck Surgery, Federal University of São Paulo, São Paulo/SP, Brazil.
Abstract
OBJECTIVE:
To determine the prevalence of minor structural alterations (MSA) in the vocal fold cover in a population submitted to extralaryngeal site surgery and to characterize them according to morphological and epidemiological parameters.

STUDY DESIGN:
This was a cross-sectional and observational study.

SETTING:
Tertiary referral medical center.

SUBJECTS AND METHODS:
A total of 147 patients underwent general anesthesia for extralaryngeal site surgery indicated for a procedure extraneous to the study and irrespective of the presence of vocal complaint. Next, detection and morphological characterization of MSAs in the vocal fold cover were performed by means of suspension microlaryngoscopy with laryngeal inspection and palpation without surgical intervention related to this procedure. The laryngeal findings were compared with variables from a clinical and demographic characteristics questionnaire given to these individuals.

RESULTS:
A 21.1% prevalence of MSAs was identified in the sample, which included a majority of individuals without vocal complaint (95.9%). Of these, 5.4% of individuals had laryngeal microdiaphragms, 16.3% sulcus vocalis, and 4.1% epidermoid cysts. No pouch sulcus or mucosal bridges were found. The identification of these alterations occurred mainly after 10 years of age, without effects of sex, vocal abuse, or upper airway conditions. The most common combination of MSAs was bilateral sulcus vocalis.

CONCLUSIONS:
The prevalence of MSAs in laryngeal coverage in this predominantly vocally asymptomatic population was 21.1%, with identification of sulcus vocalis, epidermoid cyst, and laryngeal microdiaphragm. Age was the only clinical or demographic characteristic associated with these alterations.

KEYWORDS:
anatomic variation; congenital abnormalities; laryngoscopy; larynx diseases; vocal fold

PMID: 30351192 DOI: 10.1177/0194599818804768