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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. [ABSTRACT FROM AUTHOR]

Sarcopenia is an increasingly recognized biomarker associated with poorer outcomes. The objective of this study was to ascertain the effect of sarcopenia on treatment tolerance and short‐term toxicity in head and neck cancer (HNC). A systematic review was performed using multiple databases. An inverse‐variation, random‐effects model was used to perform the meta‐analysis to evaluate the effect of sarcopenia on severe treatment toxicity and poor treatment tolerance. Sixteen observational studies, including 3187 patients with HNC, were analyzed. The combined odds ratio (OR) for severe treatment toxicity and tolerance was 2.22 (95%CI 1.50–3.29) and 1.40 (95%CI 0.84–2.32), respectively. The effect of sarcopenia on short‐term severe treatment toxicity was similar with upfront surgery (OR 2.03, 95%CI 1.22–3.37) and definitive radiotherapy (OR 2.24, 95%CI 1.18–4.27) Patients with sarcopenia are more than twice as likely to suffer a short‐term treatment‐related toxicity when undergoing curative‐intent HNC treatment. [ABSTRACT FROM AUTHOR]

Background: We ascertain the role of a low cervical paraspinal skeletal muscle index (CPSMI) as a biomarker for poor treatment tolerance in patients with operable mucosal head and neck squamous cell carcinoma (HNSCC). Methods: A prospective cohort of patients with operable HNSCC requiring microvascular reconstruction was evaluated. Low CPSMI was calculated using preoperative CT neck imaging. Poor treatment tolerance, a composite measure of incomplete therapy or severe morbidity/mortality during treatment, was the primary outcome. Results: One hundred and twenty‐seven patients underwent extirpative surgery with a mean age was 60.5. Poor treatment tolerance occurred in 71 (56%) patients with 21 not completing recommended adjuvant therapy and 66 having severe treatment‐related morbidity. A low CPSMI was independently associated with poor treatment tolerance (OR 2.49, 95%CI 1.10–5.93) and delay to adjuvant therapy (OR 4.48, 95%CI 1.07–27.6) after adjusting for multiple confounders. Conclusion: Low CPSMI was independently associated with poor treatment tolerance in patients with operable HNSCC. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to ascertain the relationship between Bethesda category and molecular mutation of thyroid nodules in patients undergoing thyroidectomy. Design: A retrospective cohort of patients who underwent thyroidectomy following needle biopsy and molecular profile testing was performed. Setting: Two tertiary care academic hospitals. Participants: Consecutive patients with a dominant thyroid nodule who underwent both USFNA and molecular profile testing followed by thyroidectomy were included in the study. Main Outcome and Measures: The main outcome was postoperative diagnosis of thyroid cancer and aggressivity of disease based on histopathological variants, nodal metastasis or extra‐thyroidal extension. Associations between Bethesda category, molecular mutation and postoperative pathology was assessed using descriptive analysis and chi‐square testing. Results: Four hundred fifty‐one patients were included. 95.9% (93/97) of patients with a BRAFV600E mutation had a Bethesda category V or VI (p <.001), and all had confirmed thyroid cancer on postoperative pathology. Those with H, K or N RAS or EIF1AX mutations, gene expression profiling (GEP) or copy number alterations showed an association with Bethesda categories III and IV (p ≤.01). Those with no identified molecular mutation had a lower incidence of aggressive thyroid cancer compared to those with an identified mutation (12.6% vs. 44.3%, p <.01). Conclusion: BRAFV600E mutations were associated with thyroid cancer subtypes known to be more aggressive whereas RAS and EIF1AX mutations, copy number alterations, and GEP were related to Bethesda categories III and IV. These findings may help thyroid specialists better identify aggressive thyroid nodules associated with indeterminate Bethesda categories. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the quality of evidence of rhinology and rhinologic skull base surgery (RSBS) research and its evolution over the past decade. Study Design: Review article. Setting: We reviewed articles from 2007 to 2019 in 4 leading peer-reviewed otolaryngology journals and 3 rhinology-specific journals. Methods: The articles were reviewed and levels of evidence were assigned using the Oxford Centre for Evidence-Based Medicine 2011 guidelines. High quality was defined as level of evidence 1 or 2. Results: In total, 1835 articles were reviewed in this study spanning a 13-year period. Overall, the absolute number of RSBS publications increased significantly 22.6% per year, from 108 articles in 2007 to 481 in 2019 (P <.001; 95% CI, 7.9-37.2). In 2007, only 13 articles, or 15%, were high quality, and this grew to 146 articles, or 39%, in 2019. A 14.0% per year exponential increase in the number of high-quality publications was found to be statistically significant (P <.001; 95% CI, 7.2, 20.7). Overall, high-quality publications represented just 25.8% of RSBS articles overall. There was no significant difference in quality between rhinology-specific journals and general otolaryngology journals (χ2 = 3.1, P =.077). Conclusion: The number of overall publications and of high-quality RSBS publications has significantly increased over the past decade. However, the proportion of high-quality studies continues to represent a minority of total RSBS research. [ABSTRACT FROM AUTHOR]

During 2012–2018, the clandestine manufacture of new psychoactive substances (NPS) designed to circumvent substance control regulations increased exponentially worldwide, with concomitant increase in fatalities. This review focuses on three compound classes identified as synthetic opioids, synthetic amphetamines, and synthetic cannabinoids and highlights the medicinal chemistry precedents utilized by clandestine laboratories to develop new NPS with increased brain penetration, longer duration of action, and greater potency. Chemical approaches to illicit drug abuse treatment options, particularly for opioid use disorder, are also discussed. [ABSTRACT FROM AUTHOR]

Background: Neoadjuvant chemotherapy followed by surgery (NAC + S), a paradigm based on systemic escalation coupled with surgery‐based de‐escalation, is under investigation for treatment of HPV‐associated oropharynx cancer (OPC). Methods: Prospective cohort of patients with non‐metastatic, p16 positive OPC enrolled in a clinical trial of NAC + S was compared to a historic cohort of patients undergoing concurrent chemoradiation (CCRT) to compare disease‐free survival (DFS). Results: Fifty‐five patients were treated with NAC + S and 142 with CCRT. Stage‐matched patients undergoing CCRT had higher frequency of smoking and alcohol consumption. 5‐year DFS in the NAC + S group was 96.1% (95% CI 90.8‐100) compared to 67.6% (95% CI 50.7‐84.5) for CCRT (P =.01). At 12 months from treatment, 24.5% of patients undergoing CCRT and none of the patients in the NAC + S were feeding tube dependent (P <.0001). Conclusion: NAC + S may be a novel approach for HPV‐associated OPC as it provides lower feeding tube dependence and improved survival compared to stage‐matched patients undergoing CCRT. [ABSTRACT FROM AUTHOR]

[3H]Genipin was synthesized in a single step by Ir(I) catalyzed hydrogen isotope exchange. Conditions for selective exchange of the sp2 CH bond ortho to the methyl ester functionality were developed through deuterium modeling studies through a catalyst screen. Optimized conditions so obtained were then utilized with tritium gas to generate [3H]genipin at a specific activity of 18.5 Ci/mmol. Racemic [14C]genipin was prepared in eight steps in overall 5.4% radiochemical yield from potassium [14C]cyanide. [ABSTRACT FROM AUTHOR]

Background: A paradigm shift has led to de‐escalation trials for the treatment of HPV‐positive oropharynx cancer (OPC). The objective of this study was to assess the ability of tumor volume reduction on imaging to predict pathological response to neoadjuvant chemotherapy in patients with HPV‐positive OPC. Methods: A prospective observational study of 54 patients with HPV‐positive OPC enrolled in a clinical trial of neoadjuvant chemotherapy followed by surgery was performed. Patients underwent three cycles of induction chemotherapy (cisplatin/docetaxel); prechemotherapy and postchemotherapy imaging were obtained. Receiver operating characteristic curves and logistic regression analyses were used. Results: The complete pathologic response (pCR) rate at primary and nodal sites were 72% and 57%, respectively. Tumor volume reduction of ≥90% following induction chemotherapy predicted pCR of the primary tumor. Conclusions: Neoadjuvant chemotherapy followed by definitive transoral surgery is a new paradigm worthy of further investigation and MRI is a reliable modality to assess preoperative response. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of current smoking status on 30-day postoperative adverse events in patients undergoing otologic surgery.Study Design: Retrospective cohort study.Setting: Database of the American College of Surgeons National Surgical Quality Improvement Program from 2006 to 2016.Subjects and Methods: Adult patients undergoing middle ear and mastoid surgery were included. Preoperative smoking status was determined, and adverse events within 30 days of surgery were recorded. Descriptive statistics were used to characterize the study sample. Multivariable logistic regression was performed to identify the association between sociodemographic and clinical variables and postoperative adverse events. Population-attributable fractions were then calculated.Results: A total of 10,684 patients who underwent otologic surgery were included, of whom 2036 (19.1%) were smokers. The most commonly performed surgery was tympanoplasty with and without ossicular chain reconstruction, followed by canal wall up tympanomastoidectomy. Adverse events occurred in 221 (2.1%) patients; the most common was superficial wound infections (n = 99, 0.9%). In smokers, the odds ratio for any adverse event was 1.97 (95% CI, 1.42-2.71). The odds ratios (95% CIs) for superficial wound infections, wound dehiscence, and 30-day readmission among smokers were 1.89 (1.32-2.86), 3.92 (1.26-11.60), and 1.84 (1.15-2.87), respectively. The population-attributable fraction for any adverse event in smokers was 15.5%.Conclusions: In patients undergoing otologic surgery, smokers are more likely than nonsmokers to have postoperative adverse events-in particular, wound infections, wound dehiscence, and readmission to hospital. [ABSTRACT FROM AUTHOR]

Background: We ascertain the association of postoperative infection on survival in patients with locoregionally advanced oral cavity squamous cell carcinoma (OCSCC). Methods: A retrospective study of patients with stage III/IVA OCSCC undergoing curative‐intent surgery was performed. Postoperative infection was considered within 30 days after surgery. Kaplan‐Meier survival curves were used to compare overall survival (OS) in patients with postoperative infection. Cox regression and propensity‐score matching were used to adjust for confounders. Results: Fifty‐four of 114 patients had a postoperative infection. The 5‐year OS in patients with a postoperative infection (24.1%) was lower than those without (65.2%; P < .0001). Postoperative infection was a negative predictor of OS after adjusting for patient, antibiotic, pathologic, and operative factors; the adjusted hazard ratio for OS was 2.54 (95% confidence interval, 1.27‐5.09). Conclusion: Postoperative infection is a strong negative predictor of OS in patients with OCSCC undergoing ablative surgery. [ABSTRACT FROM AUTHOR]

Abstract: Background: Hematologic markers, such as the neutrophil‐to‐lymphocyte ratio (NLR), characterize the inflammatory response to cancer and are associated with poorer survival in various malignancies. We evaluate the effect of pretreatment NLR on overall survival (OS) in patients with head and neck squamous cell carcinoma (HNSCC). Methods: Using multiple databases, a systematic search for articles evaluating the effect of NLR on OS in patients with HNSCC was performed. An inverse variation, random‐effects model was used to analyze the data. Results: A total of 24 of 241 articles, including 6479 patients, were analyzed. The combined hazard ratio for OS in patients with an elevated NLR (range 2.04‐5) was 1.78 (confidence interval [CI] 1.53‐2.07; P < .0001). The hazard ratios for site‐specific cancer: oral cavity 1.56 CI 1.23‐1.98 (P < .001), nasopharynx 1.66 CI 1.35‐2.04 (P < .001), larynx 1.55 CI 1.26‐1.92 (P < .001), and hypopharynx 2.36 CI 1.54‐3.61 (P < .001). Conclusion: An elevated NLR is predictive of poorer OS in patients with HNSCC. [ABSTRACT FROM AUTHOR]

The study proposes a non-isolated three-phase integrated battery charger (IBC) based on electric vehicle drivetrains that have two permanent magnet synchronous motors with shafts coupled via a torque coupler. The windings of both machines are used as input filter inductances after reconfiguration and connected to a three-phase grid in charging mode. Their existing traction inverters are operated as a three-phase charger that controls the charging power from the grid. The total torque produced on the shaft during operation is analysed and a strategy to eliminate it is proposed. The strategy not only maintains a zero-average torque but also eliminates the pulsating torque component on the shaft during operation. The topology allows conversion of the existing drive to an IBC through minor reconfiguration and provides an opportunity to reduce the effective THD injection into the grid via interleaving for machines with low winding inductance. A power balancing control is also proposed to reduce the second harmonic on the DC power output due to machine non-ideality. Simulation and experimental results validate that the topology can be used as both a battery charger and as a distributed resource, while the resultant torque on the shaft remains eliminated by the proposed strategy. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Despite the transition to competency-based education in surgery, few standardized assessment tools exist in otolaryngology training. In particular, myringotomy and tympanostomy tube insertion (M+T) is a common surgical procedure with few validated assessment tools available. Our objectives were to develop an objective structured assessment of operative skills in M+T and to provide validity evidence for the developed assessment tool within otolaryngology training.Study Design: Prospective study involving the evaluation of an assessment tool.Methods: Through consultation with a panel of experts in otolaryngology and medical education we developed a Task-Specific Checklist and Global Rating Scale for M+T. Postgraduate year 2 junior residents, postgraduate year 3 senior residents, and attending otolaryngologists were video recorded performing M+T at a tertiary care pediatric hospital. The videos were subsequently reviewed and independently evaluated by three blinded raters from an unaffiliated academic institution.Results: The average score of junior residents, senior residents, and attending otolaryngologists using the Task-Specific Checklist was 21.7/30 (±7.1), 26.3/30 (±3.5), and 27.3/30 (±6.2), respectively (P = .04). For the Global Rating Scale, the scores for junior residents, senior residents, and attending surgeons were 27.7/50 (±11.2), 34.5/50 (±9.5), and 45.1/50 (±4.6), respectively (P < .001). The inter-rater and intrarater reliability were both above 0.88.Conclusions: The Task-Specific Checklist and Global Rating Scale for M+T appear reliable, with validity evidence supporting their use in otolaryngology training.Level Of Evidence: NA Laryngoscope, 126:2140-2146, 2016. [ABSTRACT FROM AUTHOR]

Objective: Hypocalcemia following thyroidectomy often prolongs hospital stay and is potentially life-threatening. The objective of this study is to determine whether the season when thyroidectomy is performed is associated with postoperative hypocalcemia.Study Design: Retrospective case series of patients undergoing thyroid surgery from 2009 to 2015.Setting: Tertiary care academic institution in Montreal, Canada.Subjects and Methods: A consecutive sample of 823 patients undergoing thyroidectomy by a single high-volume otolaryngologist for a suspected or confirmed thyroid malignancy. Patient demographics, procedure type, calcium and vitamin D supplementation, and seasonal rate of hypocalcemia postthyroidectomy were calculated and compared.Results: Average seasonal rates of postthyroidectomy hypocalcemia in the winter, spring, summer, and autumn were, respectively, 8.3% (8 of 216), 7.3% (12 of 165), 1.5% (3 of 201), and 3.5% (8 of 228; P < .005). Patients operated in the winter were 5.6 times more likely to develop hypocalcemia as compared with those in the summer (P < .01; 95% confidence interval: 1.7-18.7). In a multiple regression analysis factoring in season when surgery was performed, procedure type, and preoperative vitamin D/calcium supplementation, surgery occurring in the winter predicted a hypocalcemia event (correlation coefficient [SE]: 0.72 [0.024], P = .026; 0.006 [0.025], P = .81; 0.004 [0.019], P = .82, respectively).Conclusion: In this study, patients undergoing thyroidectomy in the winter months were more likely to develop postoperative hypocalcemia when compared with those operated in the summer. Further studies are needed to understand the role of vitamin D in the observed seasonal difference in hypocalcemia rates. [ABSTRACT FROM AUTHOR]

Inverted papillomas are tumors of the sinonasal tract with a propensity to recur. Raman spectroscopy can potentially identify inverted papillomas from other tissue based on biochemical signatures. A pilot study comparing Raman spectroscopy to histopathology for 3 types of sinonasal tissue was performed. Spectral data of biopsies from patients with normal sinonasal mucosa, chronic rhinosinusitis, and inverted papillomas are compared to histopathology using principal component analysis and linear discriminant analysis after data preprocessing. A total of 18 normal, 15 chronic rhinosinusitis, and 18 inverted papilloma specimens were evaluated. The model distinguished normal sinonasal mucosa, chronic rhinosinusitis, and inverted papilloma tissue with an overall accuracy of 90.2% (95% confidence interval, 0.86-0.94). In conclusion, Raman spectroscopy can distinguish inverted papilloma, normal sinonasal mucosa, and chronically rhinosinusitis tissue with acceptable accuracy. [ABSTRACT FROM AUTHOR]

There are numerous medicinal chemistry reports in the literature describing the pharmacological properties of thousands of narcotics, stimulants, hallucinogens, sedative-hypnotic drugs, cannabinoids, and other psychoactive substances as well as synthetic methods for their preparations. This information, while essential for the advancement of science, has been used by clandestine chemists to manufacture and market an endless variety of analogs of so-called designer drugs. In this review, we describe how clandestine chemists used the principles of medicinal chemistry to design molecules, referred to as designer drugs, that elicit the effects of opioids, amphetamine and analogs, cannabinoids, and phencyclidine analogs while circumventing the law. [ABSTRACT FROM AUTHOR]

Objectives: (1) Review the rate of postoperative hypocalcemia in patients undergoing thyroidectomy in the summer and winter. (2) Identify the association between the season when surgery was completed and the risk of postoperative hypocalcemia. Methods: A retrospective chart review of 436 patients undergoing thyroidectomy at the McGill University Thyroid Cancer Centre from 2006 to 2014 was performed. Patients undergoing total or completion thyroidectomy in the winter months (December to February) and summer months (July to September) were included in the study. Parathyroid hormone (PTH) and serum corrected calcium were recorded according to the McGill post‐thyroidectomy protocol. Preoperative PTH and 25‐hydroxyvitamin D (25‐OHD) were measured. Hypocalcemia was defined as a corrected calcium level <1.9 mmol/L. Results: The rate of postoperative hypocalcemia was 8% for patients operated on in the winter and 1.8% for those in the summer (P =. 01). Patients undergoing surgery in the winter were 4.3 times more likely to develop postoperative hypocalcemia than those in the summer (P =. 01, 95% confidence interval [1.5 to 1 5]). Surgery during the summer months showed a higher preoperative 25‐OHD level (P =. 04). Preoperative PTH levels were significantly greater in the winter months as compared with the summer (5 pmol/L and 4.5 pmol/L, respectively; P =. 01). Patients with 25‐OHD deficiency (≤70nmol/L) were not found to have a higher rate of postoperative hypocalcemia (5.2% and 13.8%, respectively; P =. 22). Conclusions: In this study, patients undergoing thyroidectomy during the winter months were 4.3 times more likely to develop postoperative hypocalcemia when compared with patients operated in the summer. [ABSTRACT FROM AUTHOR]

Objectives: (1) Evaluate the anatomic variability of the distance between the internal carotid arteries (ICA) at the paraclival, intracavernous, and paraclinoid segments in normal variants and in patients with sellar or parasellar lesions. (2) Identify clinicopathologic factors associated with a reduced intercarotid distance (ICD) and identify subgroups at higher risk for ICA injury during endoscopic skull base surgery. Methods: A retrospective case‐control study was performed at an academic tertiary care center. The smallest distance between the ICAs at the paraclival, intracavernous. and paraclinoid segments on coronal T2‐weighted magnetic resonance imaging was measured in patients with sellar or parasellar tumors and in nontumor controls. Factors such as demographic profiles, cephalometric measurements, tumor dimensions, and sphenoid configuration were assessed as potential predictors of the ICD. Results: In total, 154 cases and 34 controls were analyzed. Patients with growth hormone (GH) secreting adenomas had a markedly reduced ICD at the paraclival segment as compared to controls (1.59 cm and 1.77 cm, respectively; P =. 02; 95% confidence interval [CI] [0.03‐0.32]). The paraclinoid ICD was reduced in patients with a planum sphenoidale meningioma (1.09 cm and 1.33 cm, respectively; P =. 04; 95% CI [0.01‐0.45]). The transverse dimension of pituitary adenomas was linearly correlated to the ICD (P <. 001). No narrowing of the ICD was associated with sphenoid configuration or cephalometric measurements. Conclusions: Patients with a GH secreting adenoma or planum sphenoidale meningioma had a reduced ICD. Identifying these populations can help surgeons recognize constraints imposed by a reduced ICD to endoscopic access of the skull base and avoid inadvertent ICA injury. [ABSTRACT FROM AUTHOR]