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Objective: Limited progress has occurred in treating operable human papillomavirus (HPV)-negative head and neck squamous cell carcinoma (HNSCC). Accessing timely care remains challenging in public health care systems, potentially resulting in disease progression before treatment initiation., Study Design: A prospective cohort of patients receiving neoadjuvant capecitabine (NC) was compared to stage-matched patients undergoing standard of care (SC)., Setting: This study was performed at 2 academic centers in Montreal, Canada., Methods: To ascertain the effect of 2 cycles of NC in operable HPV-negative HNSCC patients on clinical-to-pathologic stage migration. Comparison to an SC group was performed to site and TNM stage matched patients. Pathologic treatment response was measured using the modified Ryan score., Results: We compared 16 NC patients (11 oral cavity, 3 skin, 2 larynx) with 32 SC patients. Ten NC patients exhibited a pathologic response (1 complete, 3 major, 6 minor). Clinical-to-pathologic stage migration differed significantly between NC and SC groups: downstage (6 vs 1), upstage (3 vs 14), no change (7 vs 17, P = .0047). There was no severe treatment toxicity related to capecitabine. All patients in the NC group underwent surgery., Conclusion: NC followed by surgery demonstrates measurable pathologic response in HPV-negative HNSCC, suggesting potential utility in resource-limited health care settings., (© 2024 The Author(s). Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Objective: To ascertain the effect of curative-intent surgery on loss of independence (LOI) in patients with oral cavity squamous cell carcinoma (OCSCC)., Study Design: Retrospective observational study of patients diagnosed from 2014 to 2021., Setting: Single tertiary care academic center. Patients having undergone curative-intent surgical treatment for OCSCC from 2014 to 2021 in the cancer registry., Methods: LOI as the primary outcome was measured based on a combination of decrease in activities of daily living (ADLs) and/or decline in mobility during treatment. Descriptive statistics were used to compare baseline demographics and multivariable logistic regression was used to assess the association between LOI and perioperative variables of interest., Results: Of the 180 patients included in this study, 139 (79%) were fully independent in ADLs/instrumental ADLs prior to surgery. The average age of the cohort was 74 with 49% males. Thirty-seven (21%) experienced a decline in mobility or increased care needs following surgery, and 18 (10%) experienced an independent decline in functional status. Increasing age, osseous flap reconstruction, high Charlson Comorbidity Index, and major postoperative adverse events were associated with LOI. Fifty-five percent of patients with LOI had recovered to baseline within 7 months from surgery. LOI was associated with poor treatment tolerance (odds ratio: 4.77, 95% confidence interval: 1.87-12.2) while adjusting for multiple confounders., Conclusion: LOI is common in older adults undergoing curative-intent surgery for OCSCC and associated with poor treatment tolerance., (© 2024 The Authors. Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Background: The objective of this study was to examine the utility of postoperative radiation for low and intermediate grade cancers of the parotid and submandibular glands., Methods: The authors conducted a retrospective, Canadian-led, international, multi-institutional analysis of a patient cohort with low or intermediate grade salivary gland cancer of the parotid or submandibular gland who were treated from 2010 until 2020 with or without postoperative radiation therapy. A multivariable, marginal Cox proportional hazards regression analysis was performed to quantify the association between locoregional recurrence (LRR) and receipt of postoperative radiation therapy while accounting for patient-level factors and the clustering of patients by institution., Results: In total, 621 patients across 14 tertiary care centers were included in the study; of these, 309 patients (49.8%) received postoperative radiation therapy. Tumor histologies included 182 (29.3%) acinic cell carcinomas, 312 (50.2%) mucoepidermoid carcinomas, and 137 (20.5%) other low or intermediate grade primary salivary gland carcinomas. Kaplan-Meier LRR-free survival at 10 years was 89.0% (95% confidence interval [CI], 84.9%-93.3%). In multivariable Cox regression analysis, postoperative radiation therapy was independently associated with a lower hazard of LRR (adjusted hazard ratio, 0.53; 95% CI, 0.29-0.97). The multivariable model estimated that the marginal probability of LRR within 10 years was 15.4% without radiation and 8.8% with radiation. The number needed to treat was 16 patients (95% CI, 14-18 patients). Radiation therapy had no benefit in patients who had early stage, low-grade salivary gland cancer without evidence of nodal disease and negative margins., Conclusions: Postoperative radiation therapy may reduce LLR in some low and intermediate grade salivary gland cancers with adverse features, but it had no benefit in patients who had early stage, low-grade salivary gland cancer with negative margins., (© 2023 American Cancer Society.)

Objective: To evaluate 2-year follow-up swallowing function in patients with human papillomavirus-related oropharyngeal squamous cell carcinoma (HPV+ OPSCC) who completed neoadjuvant chemotherapy and transoral robotic surgery (NAC+S)., Study Design: Retrospective analysis of patients with OPSCC treated with NAC+S between 2010 and 2021., Setting: A single academic institution., Methods: This is a cross-sectional study of patient-reported swallowing function, assessed with the MD Anderson Dysphagia Inventory (MDADI) at least 2 years after completion of treatment. The inclusion criteria are patients with HPV+ OPSCC who underwent NAC+S at least 2 years ago. Those requiring adjuvant radiation or chemoradiation or experiencing relapse were excluded from the study., Results: Completed MDADIs were received from 37 patients at a median 3.8 years posttreatment (interquartile range, 2.0-8.6 years). Of those, 94.6% (n = 35) were male and 81.1% (n = 30) were White. The median age at OPSCC diagnosis was 59.0 years (interquartile range, 41-80 years). The most frequent primary subsite of OPSCC was the base of the tongue (n = 20, 54.1%), followed by the tonsils (n = 16, 43.2%). In addition, 75.7% (n = 28) had stage IVa disease (TNM seventh edition), and 29 (78.4%) had scores ≥80, classified as optimal function. When compared with patients who received bilateral neck dissection, patients who received unilateral neck dissection were associated with an age <65 years old ( P = .036) and lower clinical TNM stage ( P = .04), as well as higher composite, emotional, functional, and physical MDADI scores ( P = .017, .046, .013, and .05, respectively)., Conclusion: Patients with OPSCC who were treated with NAC+S achieved satisfactory long-term swallowing outcomes. Unilateral neck dissection was significantly associated with higher MDADI scores in this patient cohort.

Objectives: Human papillomavirus (HPV) has prompted a need to further investigate how this new biomarker changes the head and neck cancer (HNC) psychosocial landscape. This study aimed to: (a) characterize the sociodemographic, psychological, and social profiles of patients with HPV-positive versus -negative squamous cell carcinoma of the head and neck; and (b) identify how HPV status contributes to anxiety and depression (primary outcome), quality of life (QoL), and sexuality needs., Methods: We conducted a prospective longitudinal study of 146 patients newly diagnosed with oral, oropharyngeal, nasopharyngeal, and hypopharyngeal cancer. Seventy-nine patients were HPV-positive and 67 HPV-negative. Patients completed self-administered psychometric measures upon HNC and 3-month follow-up, and Structured Clinical Interviews for DSM Diagnoses., Results: Patients with HPV-negative tumors generally presented with higher anxiety and depression and lower QoL immediately post-HNC diagnosis (<2 weeks) compared to HPV-positive cancers. A Major Depressive Disorder (MDD) immediately post-HNC diagnosis negatively affected patients' anxiety and depression and QoL levels upon diagnosis only when the cancer was HPV-positive. Immediately posttreatment, HPV status was not associated with outcomes. A previous history of suicidal ideation, and upon cancer diagnosis cigarette smoking, anxiety and depression, and feeling close to one's partner were instead explanatory., Conclusion: While patients with HPV-positive HNC generally present with initially lower psychological distress, their vulnerability immediately posttreatment indicates an equal need for support. Head and neck clinics may need to better address MDD, anxiety and depression, a prior history of suicidal ideation, health behavior change, and quality of relationships., (© 2022 John Wiley & Sons Ltd.)

Objective: This study aimed to: (1) determine the contribution of pre-cancer psychosocial vulnerability as an independent predictor of anxiety disorder (AD) onset immediately post-treatment in patients diagnosed with a first occurrence of head and neck cancer (HNC), controlling for sociodemographics and medical variables; and (2) estimate prevalence of AD and identify trajectories from the moment of diagnosis to the immediate post-treatment (i.e., over a period of 3 months) in this population., Methods: Two-hundred twenty-four consecutive patients (participation rate = 72%) newly diagnosed with a primary HNC were assessed with a structured clinical interview for a mental disorder, validated psychometric measures, and medical chart reviews., Results: Twenty-five percent of patients presented a lifetime AD, 19.4% within 2 weeks of HNC diagnosis, and 16.6% immediately post-treatment; representing 26.7% of patients with AD at any timepoint from the moment of diagnosis to immediately post-treatment. Patients were more likely to present an AD immediately post-treatment when they: were diagnosed with advanced-stage cancer (OR = 3.40, p = 0.006), presented a upon cancer diagnosis AD (OR = 2.45, p = 0.008) and/or experienced childhood abuse (OR = 1.96, p = 0.03)., Conclusions: Several AD trajectories may arise when patients are diagnosed with primary HNC. Health professionals should address AD and screen for risk factors (i.e., advanced stage cancer, AD upon cancer diagnosis, history of childhood abuse) as early as possible to assure optimal mental health care in this vulnerable population., (© 2021 John Wiley & Sons Ltd.)

Purpose: To assess the effects of blip-up and -down echo planar imaging (EPI) acquisition designs, with different choices of phase-encoding directions (PEDs) on the reproducibility of diffusion MRI (dMRI)-derived metrics in the human brain., Methods: Diffusion MRI data in seven subjects were acquired five times, each with five different protocols. The base design included 64 diffusion directions acquired with anterior-posterior (AP) PED, the first and second protocols added reverse phase-encoded b = 0 s / mm 2 posterior-anterior (PA) PED images. The third one included 32 directions all with PED acquisitions with opposite polarity (AP and PA). The fourth protocol, also with 32 unique directions used four PEDs (AP, PA, right-left (RL), and left-right (LR)). The scan time was virtually identical for all protocols. The variability of diffusion MRI metrics for each subject and each protocol was computed across the different sessions., Results: The highest reproducibility for all dMRI metrics was obtained with protocol four (AP/PA-RL/LR, ie, four-way PED). Protocols that used only b = 0 s / mm 2 for distortion correction, which are the most widely used designs, had the lowest reproducibility., Conclusions: An acquisition design with four PEDs, including all DWIs in addition to b = 0 s / mm 2 images should be used to achieve high reproducibility in diffusion MRI studies., (Published 2020. This article is a U.S. Government work and is in the public domain in the USA. Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Purpose: We performed this review systematically to assess the effect of cold application at the heparin subcutaneous injection site on incidence and size of bruising, hematoma, and pain intensity., Design: A systematic review and meta-analysis were utilized as the study design., Data Sources: To retrieve the relevant randomized controlled trials (RCTs) published up to July 2019, the databases of PubMed, Scopus, Web of Science, ScienceDirect, Cochrane Library, Google Scholar, TRIP, and Elmnet.ir were searched., Review Methods: Those RCTs were selected in which the participants had received any type of heparin via subcutaneous injections at least once a day, as were those comparing the effect of cold application (i.e., moist or dry ice packs or vapocoolant spray) on injection sites with no interventions or placebos. The types of outcomes measured included pain intensity, bruising, and hematoma at injection sites. Furthermore, odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were employed to measure the pooled data., Results: A total of nine studies recruiting 896 patients with a mean age range of 37 to 62 years were ultimately included in this study. The findings revealed that eight studies had used low-molecular-weight heparin, but unfractionated heparin had been administered in one study. The quality of the studies was also assessed in seven domains. Overall, risk of bias in the included articles was low to moderate. Pooling data of six studies showed that the patients had experienced less pain intensity once cold had been applied at the heparin injection sites (MD = -1.67; 95% CI -3.03 to -0.31; p = .02; I 2 = 92%). Bruising had been correspondingly reported in eight and six studies in terms of size and incidence, respectively. In particular, the results had demonstrated no statistically significant difference between either group in terms of bruising size or incidence at 48 to 72 hr following heparin injection. Furthermore, hematoma incidence had been reported in two studies, and one trial had reported hematoma size only. The results had suggested that the patients had smaller hematomas (MD = -0.87; 95% CI -1.63 to -0.11; p = .03) and a lower incidence of hematomas (OR = 0.35; 95% CI 0.16 to 0.76; p = .008) in the cold application group 48 hr after injection., Conclusions: The results of this systematic review and meta-analysis showed that patients could experience less pain and fewer hematomas once the cold had been applied for 3 to 5 min at the injection sites before or after subcutaneous heparin administration. During this period, clinicians should also consider the patient's comfort; if some patients feel discomfort at the cold application site, the minimum possible time should be considered., Clinical Reverence: This study's results could be used as evidence for all hospitalized and outpatients who need to receive any form of heparin and may suffer from local complications of this medicine., (© 2020 Sigma Theta Tau International.)

Background and Aims: Curcumin has anti-inflammatory properties. The aim of this study was to evaluate the effect of curcumin on improvement of the disease activity in ulcerative colitis (UC)., Methods: In this randomized double-blind clinical trial, 70 patients with mild-to-moderate UC were randomly assigned to curcumin (1,500 mg/day) or placebo intake for 8 weeks. Disease clinical activity, quality of life, serum levels of tumor necrosis factor alpha (TNF-α), high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR) values, and complete blood count were measured., Results: Changes in Simple Clinical Colitis Activity Index score were significantly higher in the curcumin than the placebo group (-5.9 ± 2.08 vs. -2.1 ± 2.6; p = .001). The scores of Inflammatory Bowel Disease Questionnaire-9 and quality of life were significantly higher in the intervention group compared to the control group (p = .006). Furthermore, the curcumin supplementation reduced the serum hs-CRP concentration (-6.3 ± 13.6 vs. 3.7 ± 11.6 μg/ml; p = .01) and ESR levels significantly (-1.6 ± 2.7 vs. -0.09 ± 2.4 mm/hr; p = .02) in comparison with the control group. No significant changes were observed in the TNF-α levels of both groups., Conclusions: Consumption of the curcumin supplement, along with drug therapy, is associated with significant improvement of the clinical outcomes, quality of life, hs-CRP, and ESR in patients with mild-to-moderate UC., (© 2019 John Wiley & Sons, Ltd.)

Tensor-based morphometry (TBM) performed using T1-weighted images (T1WIs) is a well-established method for analyzing local morphological changes occurring in the brain due to normal aging and disease. However, in white matter regions that appear homogeneous on T1WIs, T1W-TBM may be inadequate for detecting changes that affect specific pathways. In these regions, diffusion tensor MRI (DTI) can identify white matter pathways on the basis of their different anisotropy and orientation. In this study, we propose performing TBM using deformation fields constructed using all scalar and directional information provided by the diffusion tensor (DTBM) with the goal of increasing sensitivity in detecting morphological abnormalities of specific white matter pathways. Previously, mostly fractional anisotropy (FA) has been used to drive registration in diffusion MRI-based TBM (FA-TBM). However, FA does not have the directional information that the tensors contain, therefore, the registration based on tensors provides better alignment of brain structures and better localization of volume change. We compare our DTBM method to both T1W-TBM and FA-TBM in investigating differences in brain morphology between patients with complicated hereditary spastic paraplegia of type 11 (SPG11) and a group of healthy controls. Effect size maps of T1W-TBM of SPG11 patients showed diffuse atrophy of white matter. However, DTBM indicated that atrophy was more localized, predominantly affecting several long-range pathways. The results of our study suggest that DTBM could be a powerful tool for detecting morphological changes of specific white matter pathways in normal brain development and aging, as well as in degenerative disorders., (© 2018 Wiley Periodicals, Inc.)

For several decades, providers have routinely restricted the diets of neutropenic cancer patients by eliminating foods that might harbor pathogenic microbes to reduce infection rates. These diets, known as neutropenic or low-bacteria diets, are prescribed across the country with little uniformity in the extent or content of prescription. These diets are difficult to follow and force patients to omit fresh fruits and vegetables and limit dairy and meat products from their diet. These dietary omissions compromise nutritional intake in patients who are already at high risk of malnutrition. Randomized trials have shown that these restrictive diets are not superior in preventing infections than more liberalized diets. Evidence shows that adherence to the Safe Food-Handling guidelines issued by the Food and Drug Administration, a mandate for all hospital kitchens, provides adequate protection against food-borne infection, precluding the need for the neutropenic diet. Thus, routine use of the neutropenic diet should be abandoned., (© 2018 Society of Hospital Medicine.)

Twin studies provide valuable insights into the analysis of genetic and environmental factors influencing human brain development. However, these findings may not generalize to singletons due to differences in pre- and postnatal environments. One would expect the effect of these differences to be greater during the early years of life. To address this concern, we compare longitudinal diffusion data of white matter regions for 26 singletons and 76 twins (monozygotic and dizygotic) from birth to 2 years of age. We use nonlinear mixed effect modeling where the temporal changes in the diffusion parameters are described by the Gompertz function. The Gompertz function describes growth trajectory in terms of intuitive parameters: asymptote, delay, and speed. We analyzed fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) for 21 regions of interest (ROIs). These ROIs included areas in the association, projection, and commissural fiber tracts. We did not find any differences in the diffusion parameters between monozygotic and dizygotic twins. In addition, FA and RD showed no developmental differences between singletons and twins for the regions analyzed. However, the delay parameter of the Gompertz function of AD for the anterior limb of the internal capsule and anterior corona radiata was significantly different between singletons and twins. Further analysis indicated that the differences are small, and twins "catch up" by the first few months of life. These results suggest that the effects of differences of pre- and postnatal environments between twins and singletons are minimal on white matter development and disappear early in life. Hum Brain Mapp 38:1009-1024, 2017. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Answer questions and earn CME/CNE The American Cancer Society Head and Neck Cancer Survivorship Care Guideline was developed to assist primary care clinicians and other health practitioners with the care of head and neck cancer survivors, including monitoring for recurrence, screening for second primary cancers, assessment and management of long-term and late effects, health promotion, and care coordination. A systematic review of the literature was conducted using PubMed through April 2015, and a multidisciplinary expert workgroup with expertise in primary care, dentistry, surgical oncology, medical oncology, radiation oncology, clinical psychology, speech-language pathology, physical medicine and rehabilitation, the patient perspective, and nursing was assembled. While the guideline is based on a systematic review of the current literature, most evidence is not sufficient to warrant a strong recommendation. Therefore, recommendations should be viewed as consensus-based management strategies for assisting patients with physical and psychosocial effects of head and neck cancer and its treatment. CA Cancer J Clin 2016;66:203-239. © 2016 American Cancer Society., (© 2016 American Cancer Society, Inc.)

Reconstruction of the soft plate after oncologic resection is complex owing to the palate's complex role in speech and swallow. This challenge becomes more complex as defects increase in size. Current management of soft plate reconstruction includes obturation as well as local or microvascular flaps. These methods, though, are limited by poor function and complexity. In regard to large subtotal central soft palate defects, we expand on previous descriptions of a tubed posterior pharyngeal constrictor flap to include a palatoglossal rotational flap that is facile and hardy and has a decreased recovery time. Furthermore, we present 2 representative cases, including 1 with previous radiation, in which our technique was utilized with successful closure of the defect and without subsequent breakdown., (© American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.)