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To conduct a scoping review of the literature on psychological interventions directed to identify primary prevention strategies for depression among adult head and neck cancer (HNC) patients.Systematic searches were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review including relevant studies within the PubMed, PsycINFO, and EMBASE databases. Two authors independently screened the searches and reviewed the included articles according to the predetermined eligibility criteria based on the PICOS format. Studies included subjects with previous or current diagnosis of depression were excluded. The risk of bias assessment of these trials was conducted following the Cochrane tool for assessing the risk of bias in randomized trials. The search was repeated prior to submission to ensure all current articles meeting criteria were included.The search yielded 875 studies. The title and abstract screen, followed by the review of full texts identified five articles that met inclusion criteria. Four were randomized controlled trials (RCT) and the fifth was a non-randomized but controlled study. Different psychosocial interventions were used, including psycho-educational interventions, psychosocial counseling, and pharmacotherapy. All studies established the diagnosis of depression or screened for the diagnosis using standardized psychiatric assessment tools, either Diagnostic and Statistical Manual of Mental Disorders criteria or validated patient reported outcome measures. The average follow-up periods after intervention was 9.8 months. There was a significant decrease in the incidence of depression or depressive symptoms favoring the intervention group in three out of the five studies that were included.Psychological interventions identified thus far studying primary prevention of depression in HNC patients show promising results. However, the paucity of data and heterogeneity of the interventions challenges the ability to compare the prevention modalities and outcomes. Future well-designed RCTs with large sample sizes are recommended to better conclude a result of effectiveness.

Objective: Major postoperative adverse events (MPAEs) following head and neck surgery are not infrequent and lead to significant morbidity. The objective of this study was to ascertain which factors are most predictive of MPAEs in patients undergoing head and neck surgery. Methods: A cohort study was carried out based on data from patients registered in the National Surgical Quality Improvement Program (NSQIP) from 2006 to 2018. All patients undergoing non-ambulatory head and neck surgery based on Current Procedural Terminology codes were included. Perioperative factors were evaluated to predict MPAEs within 30-days of surgery. Age was classified as both a continuous and categorical variable. Retained factors were classified by attributable fraction and C-statistic. Multivariate regression and supervised machine learning models were used to quantify the contribution of age as a predictor of MPAEs. Results: A total of 43 701 operations were analyzed with 5106 (11.7%) MPAEs. The results of supervised machine learning indicated that prolonged surgeries, anemia, free tissue transfer, weight loss, wound classification, hypoalbuminemia, wound infection, tracheotomy (concurrent with index head and neck surgery), American Society of Anesthesia (ASA) class, and sex as most predictive of MPAEs. On multivariate regression, ASA class (21.3%), hypertension on medication (15.8%), prolonged operative time (15.3%), sex (13.1%), preoperative anemia (12.8%), and free tissue transfer (9%) had the largest attributable fractions associated with MPAEs. Age was independently associated with MPAEs with an attributable fraction ranging from 0.6% to 4.3% with poor predictive ability (C-statistic 0.60). Conclusion: Surgical, comorbid, and frailty-related factors were most predictive of short-term MPAEs following head and neck surgery. Age alone contributed a small attributable fraction and poor prediction of MPAEs. Level of evidence: 3

Background: Frey’s syndrome and facial asymmetry from loss of parotid tissue are long-term sequelae of parotid surgeries causing significant morbidity. Various techniques have been used to fill the parotidectomy defect, preserve facial contour symmetry, and prevent Frey’s syndrome. Free dermal-fat-fascial graft (DFFG) is one such technique; however, its use is largely undocumented in the literature. In this case series, we investigate the efficacy of free DFFG in reconstructing parotidectomy defects at 2 tertiary care centers. Materials and methods: Medical records of 54 patients who underwent primary parotidectomy and immediate reconstruction with autologous abdominal free DFFG by 2 surgeons in George Washington University Hospital and McGill University Health Centre between 2007 and 2019 were collected prospectively. Patients responded to 2 questionnaires addressing postoperative outcomes. Results: Fifty-four patients were included; 32 superficial parotidectomies and 22 total parotidectomies were performed for 39 benign and 15 malignant tumors. Thirty-seven patients could be reached. Out of 37 patients who responded to the first questionnaire, 59% (22) reported complete facial symmetry, 27% (10) reported mild hollowness, and 14% (5) reported mild fullness. None declared noticeable hollowness or fullness. While 81% (30) did not experience Frey’s syndrome, 5.4% (2) experienced mild symptoms without disability, and 13.5% (5) experienced debilitating symptoms. Out of 37 patients, 8 patients responded to a second questionnaire addressing the outcome of the abdominal graft donor site. In regard to the donor site, 87.5% (7) were satisfied or very satisfied from its cosmetic appearance, 75% (6) were not bothered by its cosmetic appearance, and 87.5% (7) had no discomfort at the graft donor site. Patients did not report any other symptom at the graft donor site. Conclusion: In this large series of total parotidectomies including malignant pathologies, autologous abdominal free DFFG effectively prevented Frey’s syndrome and preserved facial cosmesis in most patients.

Background: Oropharyngeal squamous cell carcinoma (OPSCC) patients are burdened by the effect of the disease process and treatment toxicities on organs important in everyday activities, such as breathing, speaking, eating, and drinking. There is a rise in OPSCC due to human papilloma virus (HPV)-associated OPSCC, affecting younger and healthier patients and with a better overall prognosis. Emphasis must be shared between oncologic outcomes and the effects on quality of life. While there have been efforts to study global and physical quality of life, the impact on psychosocial quality of life has not yet been specifically reviewed. Methods: A scoping review methodology was employed to explore the emotional, social, and mental quality of life in OPSCC patients and determine the impact of HPV status or treatment modalities. Results: Eighty-seven full-text articles were evaluated for eligibility. Fifteen articles met final inclusion criteria. The majority of the studies were conducted in the United States (n = 10) and study methodology was divided between cross-sectional (n = 6), prospective (n = 5), and retrospective studies (n = 4). Four psychosocial quality of life themes were explored: the impact on mental health and emotional wellbeing, social wellbeing and function, stress, and relationship and sexual behavior. Eighteen different patient-reported outcome measures were used, including both general head and neck oncology questionnaires and symptom-specific surveys. Conclusion: There is a paucity of research regarding the effect of OPSCC on patients’ psychosocial quality of life. Learning more about this component of quality of life can guide outreach programs and multidisciplinary involvement in improving patient care.

Platinum and taxane-based neoadjuvant chemotherapy with surgery (NAC + S) is a novel de-intensified treatment modality that is currently under investigation.All patients treated for HPV positive OPSCC with NAC + S at a single institution between 2006 and 2020 were contacted to complete the University of Washington Quality of life questionnaire (UW-QOL) at least 2 years following the completion of treatment.The UW-QOL surveys were received from 25 of 48 eligible patients (52.1%). The mean follow-up time was 4.3 years (range 2.0-7.6 years). The overall mean score for the physical subscale was 92.4 (Standard deviation, SD = 10.9), and the social-emotional subscale was 91.1 (11.8). Compared to the normative cohort, the NAC + S cohort had a worse appearance (Mean scores Normative vs. NAC + S: 93 vs. 84.0, p = 0.009).NAC + S offers favorable long-term QOL, as evidenced by near-normal scores in most QOL domains.

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

International audience; Tunable diode laser absorption spectroscopy is used for recording the spectrally mixed profiles of argon 772.376 nm (2p 7-1s 5) and 772.421 nm (2p 2-1s 3) lines at different argon background pressures between 0.3 and 1 atmosphere. The absorbing atoms in the Ar*(1s 5) and Ar*(1s 3) metastable states are produced in a plane-to-plane dielectric barrier glow discharge operating at 20 kHz. The pressure broadening coefficient w and wavelength shift, s of the lines, deduced from the analysis of their variation versus pressure of recorded profiles, are w 1 =28.3±2.0 pm (14.2±1.0 GHz) and s 1 =11.5±0.8 pm (-5.8±0.4 GHz) for 772.376 nm line and w 2 =36.3±0.5 pm (18.2±0.3 GHz) and s 2 =12.8±0.7 pm (-6.4±0.4 GHz) for 772.4207 nm line, at 1 bar and 300 K. The progressive enhancement with argon pressure of the peak densities ratio [Ar*(1s 3)]/[Ar*(1s 5)], reaching 0.3 at 1 bar, reveals the importance of Arinduced collisions for the population transfer from resonant 1s 2 to the metastable 1s 3 state. Also, the time variation of Ar*(1s) densities indicates the presence of a weak excitation channel outside the discharge current pulse initiated by the breakdown. This channel results from the heating of electrons by the electric field seen by the gas in the DBD gap.

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

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, 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 three months) in this population. Methods 224 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 (O.R.=3.40, , p=0.006), presented a upon cancer diagnosis AD (O.R.=2.45, p=0.008) and/or experienced childhood abuse (O.R.=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. This article is protected by copyright. All rights reserved.

Objective: Examine the association of Graves’ disease with the development of postoperative neck hematoma. Design: A cohort of patients participating in the Thyroid Procedure-Targeted Database of the National Surgical Quality Improvement Program from January 1, 2016 to December 31, 2018. Setting: A North American surgical cohort study. Methods: 17 906 patients who underwent thyroidectomy were included. Propensity score matching was performed to adjust for differences in baseline covariates. Multivariate logistic regression was used to ascertain the association between thyroidectomy for Graves’ disease and risk of postoperative adverse events within 30 days of surgery. The primary outcome was postoperative hematoma. Secondary outcomes were postoperative hypocalcemia and recurrent laryngeal nerve injury. Results: One-to-three propensity score matching yielded 1207 patients with mean age (SD) of 42.6 (14.9) years and 1017 (84.3%) female in the group with Graves’ disease and 3621 patients with mean age (SD) of 46.7 (15.0%) years and 2998 (82.8%) female in the group with indications other than Graves’ disease for thyroidectomy. The cumulative 30-day incidence of postoperative hematoma was 3.1% (38/1207) in the Graves’ disease group and 1.9% (70/3621) in other patients. The matched cohort showed that Graves’ disease was associated with higher odds of postoperative hematoma (OR 1.65, 95% CI 1.10-2.46) and hypocalcemia (OR 2.04, 95% CI 1.66-2.50) compared with other indications for thyroid surgery. There was no difference in recurrent laryngeal nerve injury among the 2 groups. Conclusions: Patients with Graves’ disease undergoing thyroidectomy are more likely to suffer from postoperative hematoma and hypocalcemia compared to patients undergoing surgery for other indications.

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

Background: Head and neck cancer (HNC) is the sixth most common cancer type worldwide, and despite decreases in the rates of Human Papillomavirus (HPV)-negative HNC, an alarming increase in HPV+ HNC is occurring. Circulating tumor (ct)DNA isolated from liquid biopsy has been shown to have clinical utility as a biomarker in cancer, with ctDNA levels and fragment size used to monitor treatment response. Methods: The aim of this study was to determine the presence of ctDNA in liquid biopsy (plasma and saliva) of HPV+ HNC patients to non-invasively monitor treatment response and disease progression. Blood and saliva samples were collected from 45 HPV+ HNC patients and 14 HPV-negative controls at the McGill University Health Centre before and/or after surgical resection. Samples were analyzed using droplet digital PCR (ddPCR) with primers and probes for HPV16/HPV18, the most common subtypes of HPV in HNC, accounting for 97% of cases in North America. Analysis was performed for all patients with confirmed follow-up scans and/or pathology. ctDNA levels were correlated with disease course as determined through imaging (>6 months post-sampling) and pathological examination. Results: ctDNA was detectable in 21/23 (91%) patients prior to treatment and 8/36 (22%) post treatment. In the two patients who were not positive for ctDNA prior to treatment, tumor tissue was found to be negative for HPV DNA despite being p16-positive by immunohistochemistry. Patients showed shifts in ctDNA fragment length in longitudinal samples following treatment. All post-treatment patients with no detectable ctDNA had no signs of recurrence/residual disease on follow-up imaging. In contrast, all 8 patients who tested positive for ctDNA post-treatment showed signs of recurrence on follow-up imaging. In our cohort, 14 patients had matched pre- and post-treatment samples and all showed major reductions in ctDNA post treatment compared to pre-treatment, with 12/14 patients having a complete loss of detectable ctDNA. Concordance between the presence of ctDNA in saliva and plasma was found in 86% of patients. ctDNA was only detected in one analyte in 6 patients (3 in plasma only and 3 in saliva only). Conclusion: HPV ctDNA was successfully detected in saliva and blood of patients with HPV-positive HNC, with a sensitivity of 92% for ctDNA prior to treatment, and a sensitivity of 100% when adjusted for tumor HPV status as opposed to p16 staining. The inclusion of both plasma and saliva in analysis increases the sensitivity of assays, with the use of both analytes allowing for the detection of ctDNA in patients with low plasma DNA levels and for patients who did not have salivary ctDNA, potentially due to inability to produce sufficient saliva or tumor location. The presence of ctDNA correlated with treatment response, indicating the potential of HPV ctDNA for monitoring tumor progression in HPV-positive HNC patients. Citation Format: Sarah Tadhg Ferrier, Anthony Zeitouni, Nader Sadeghi, Thupten Tsering, Julia V. Burnier. Characterizing treatment response in head and neck cancer through viral ctDNA quantification and fragment length [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3405.

Tunable diode laser absorption spectroscopy was used to record the space-and time-resolved number density of argon metastable atoms, Ar(1s3) (Paschen notation), in plane-to-plane dielectric barrier discharges (DBDs) operated in a Penning Ar–NH3 mixture at atmospheric pressure. In both low-frequency (LF 650 V, 50 kHz) discharges and dual LF–radiofrequency (RF 190 V, 5 MHz) discharges operated in α–γ mode, the density of Ar(1s3) revealed a single peak per half-period of the LF voltage, with rise and decay times in the sub-microsecond time scale. These results were compared to the predictions of a 1D fluid model based on continuity and momentum equations for electrons, argon ions (Ar+ and Ar2 +) and excited argon 1s atoms as well electron energy balance equation. Using the scheme commonly reported for Ar-based DBDs in the homogeneous regime, the Ar metastable kinetics exhibited much slower rise and decay times than the ones seen in the experiments. The model was improved by considering the fast creation of Ar2 * excimers through three-body reactions involving Ar(1s) atoms and the rapid loss of Ar2 * by vacuum ultraviolet light emission. In optically thin media for such photons, they can readily reach the dielectric barriers of the DBD electrodes and induce secondary electron emission. It is shown that Ar2 * and photoemission play a significant role not only on the Ar metastable kinetics, but also on the dominant ionization pathways and possible α–γ transition in dual frequency RF–LF discharges.

Robotic thyroidectomy has evolved from video-assisted endoscopic thyroidectomy (ET). The traditional open thyroidectomy is a highly effective surgical technique with minimal risks for recurrent laryngeal nerve injury or hypoparathyroidism. Endoscopic and robotic thyroidectomy techniques have been primarily developed to improve the cosmetic outcome. This is via either reducing the size of the incision in the neck as in original minimally invasive video-assisted thyroidectomy (MIVAT) or placing the incision in a remote and hence less or nonvisible area such as the axilla, chest, mouth, or the posterior neck. Remote access thyroidectomy via a robotic approach is more invasive as it involves more surgical dissection to gain access to the thyroid. Cosmetic gain needs to be considered in the context of risks and pitfalls as well as increased costs on operative resources and time. In this chapter, a review of the evolution of endoscopic and robotic thyroidectomy is provided along with the techniques involved. Strengths, limitations, and indications of the various approaches as well as risks and pitfalls are provided based on published literature.

Atmospheric pressure plasmas in argon are of particular interest due to the production of highly excited and reactive species enabling numerous plasma-aided applications. In this contribution, we report on absolute optical emission and absorption spectroscopy of a radio frequency (RF) driven capacitively coupled argon glow discharge operated in a parallel-plate configuration. This enabled the study of all key parameters including electron density and temperature, gas temperature, and absolute densities of atoms in highly electronically excited states. Space and time-averaged electron density and temperature were determined from the measurement of the absolute intensity of the electron-atom bremsstrahlung in the visible range. Considering the non-Maxwellian electron energy distribution function, an electron temperature ( T e) of 2.1 eV and an electron density ( n e) of 1.1 × 10 19 m − 3 were obtained. The time-averaged and spatially resolved absolute densities of atoms in the metastable ( 1 s 5 and 1 s 3) and resonant ( 1 s 4 and 1 s 2) states of argon in the pure Ar and Ar/He mixture were obtained by broadband absorption spectroscopy. The 1 s 5 metastable atoms had the largest density near the sheath region with a maximum value of 8 × 10 17 m − 3, while all other 1s states had densities of at most 2 × 10 17 m − 3. The dominant production and loss mechanisms of these atoms were discussed, in particular, the role of radiation trapping. We conclude with comparison of the plasma properties of the argon RF glow discharges with the more common He equivalent and highlight their differences.

International audience; Vacuum ultraviolet-absorption spectroscopy (AS) and emission spectroscopy (ES) from delocalized probe plasma are implemented in the downstream chamber of a soft-etch industrial plasma reactor. A capacitively coupled plasma plasma, running in the upper compartment in He/NF$_3$/NH$_3$/H$_2$ mixtures at about 1 Torr, produces reactive species which flow through a shower head into a downstream chamber, where they can etch different μ-electronic materials: Si, SiO$_2$, SiN, etc. The ES reveals the presence of F atoms, while the dissociation rates of NF$_3$ and NH$_3$ are deduced from the AS, as well as the density of HF molecules, produced by chemical chain-reactions between dissociation products of NF$_3$, NH$_3$, and H$_2$. The variations of HF density as a function of the NH$_3$ flow rate suggest the possible formation of NH$_4$F molecules in the plasma

Background: Although the current gold standard for diagnosing thyroid nodule malignancy is ultrasound-guided fine-needle aspiration (FNA) cytology, about 20–25% of cytological evaluations are consi...

Background Molecular testing has been used for cytologically indeterminate thyroid nodules (Bethesda III and IV), where the risk of malignancy is 10–40%. However, to date, the role of molecular testing in cytologically suspicious or positive for malignancy (Bethesda V and VI) thyroid nodules has been controversial. The aim of this study was to determine whether patients who had molecular testing in Bethesda V and VI thyroid nodules had the optimal extent of surgery performed more often than patients who did not have molecular testing performed. Methods A retrospective chart review of 122 cases was performed: 101 patients from the McGill University teaching hospitals and 21 patients from the Hillel Yaffe Medical center, Technion University. Patients included in the study were those with Bethesda V or VI thyroid nodules who underwent molecular testing (ThyGenext® or ThyroseqV3®) (McGill n = 72, Hillel Yaffe n = 14). Patients with Bethesda V or VI thyroid nodules who did not undergo molecular testing were used as controls (McGill n = 29, Hillel Yaffe n = 7). Each case was reviewed in order to determine whether the patient had optimal surgery. This was defined as total thyroidectomy in the presence of either a positive lymph node, extrathyroidal extension, or an aggressive pathological variant of papillary thyroid carcinoma (tall cell, hobnail, columnar cell, diffuse sclerosing, and solid/trabecular) documented on the final pathology report. In all other cases, a lobectomy/hemi/subtotal thyroidectomy was considered as optimal surgery. Chi-squared testing was performed to compare groups. Results When molecular testing was done, 91.86% (79/86) of surgeries in the molecular testing group were optimal, compared to 61.11% (22/36) in the control group. At McGill University teaching hospitals and at Hillel Yaffe, 91.67% (66/72) and 92.86% (13/14) of surgeries in the intervention group were considered as optimal, respectively. This compares to 58.62% (17/29) at McGill and 71.43% (5/7) at Hillel Yaffe when molecular testing was not performed (p = .001, p = .186). Conclusions In this study, molecular testing in Bethesda V and VI thyroid tumors significantly improved the likelihood of optimal surgery. Therefore, molecular testing may have an important role in optimizing surgical procedures performed in the setting of Bethesda V and VI thyroid nodules. Prospective studies with larger sample sizes are required to further investigate this finding. Graphical abstract

While plasma–liquid interactions have been an important focus in the plasma research community, the impact of the strong coupling between plasma and liquid on plasma properties and processes remains not fully understood. In this work, we report on the impact of the applied voltage, pulse width and liquid conductivity on the plasma morphology and the OH generation for a positive pulsed DC atmospheric pressure plasma jet with He–0.1% H2O mixture interacting with a liquid cathode. We adopted diagnostic techniques of fast imaging, 2D laser induced fluorescence of OH and Thomson scattering spectroscopy. We show that plasma instabilities and enhanced evaporation occur and have a significant impact on the OH generation. At elevated plasma energies, it is found that the plasma contracts due to a thermal instability through Ohmic heating and the contraction coincides with a depletion in the OH density in the core due to electron impact dissociation. For lower plasma energies, the instability is suppressed/delayed by the equivalent series resistor of the liquid electrode. An estimation of the energy flux from the plasma to the liquid shows that the energy flux of the ions released into the liquid by positive ion hydration is dominant, and significantly larger than the energy needed to evaporate sufficient amount of water to account for the measured H2O concentration increase near the plasma–liquid interface.

Objective We tested the hypothesis that a single-phase neck computed tomography (CT) is not inferior to multiphase neck CT (MPNCT), ultrasound, or nuclear medicine sestamibi scan in identifying parathyroid adenomas (PAs). Methods A total of 29 patients who had an MPNCT for the evaluation of a PA were identified; 11 patients met the inclusion criteria. During the 30-second arterial phase CT (APNCT), a normalized Hounsfield unit of suspected PA was compared to Hounsfield unit of a normal-appearing level I and a level II lymph node. A PA was defined as a lesion with a ratio of greater than 1.4 when compared to the level I and level II lymph node. This cutoff was determined based on the normalized ratios between level II and level I lymph nodes. Results of intraoperative parathyroid hormone assays and surgical pathology were used to validate the accuracy of this technique. Results The sensitivity of this method in APNCT is 90.9% whereas positive predictive value is 100%. The sensitivity or positive predictive value of ultrasound and nuclear medicine are 60% or 100% and 90% or 100%, respectively. Conclusion The sensitivity of APNCT is equivalent to that of MPNCT in identifying PA.

A micro-hollow cathode discharge (MHCD) operated in Ar/N2 gas mixture, working in the normal regime, was studied both experimentally and with a 0D (volume-averaged) model in this work. This source provides high electron densities (up to 1015 cm−3) at low injected power (1 W). To understand the mechanisms leading to the production of N atoms, the densities of electrons, N atoms and argon metastable atoms (Ar*) were monitored over a wide range of experimental conditions. Electrons, N atoms and Ar* densities were probed by means of optical emission spectroscopy, vacuum ultra violet Fourier transform spectroscopy and tunable diode laser absorption spectroscopy, respectively. Measurements showed that using a smaller hole diameter enables to work with less injected power, while increasing the power density inside the hole and, subsequently, increasing the densities of excited species. Varying the percentage of N2 in the gas mixture highlighted that, up to 80%, the density of N atoms increases although the dissociation rate drops. Looking at the processes involved in the production of N atoms with the help of the 0D model, we found that at very low N2 fraction, N atoms are mostly produced through dissociative electron-ion recombination. However, adding more N2 decreases drastically the electron density. The density of N atoms does not drop thanks to the contribution of Ar* atoms, which are the main species dissociating N2 between 5% and 55% of N2 in the gas mixture. A reasonable agreement is found between the experiments and the model results. This study shows that, with this MHCD, it is possible to significantly modify the production of N atoms when modifying the physical parameters, making it particularly relevant for applications requiring a N atoms source, such as nitride deposition.

Objectives/Hypothesis To determine the effect of preoperative parathyroid hormone (PTH) level on the extent of surgery and the accuracy of parathyroid imaging in primary hyperparathyroidism. Study Design Retrospective cohort. Methods Final diagnosis of single-gland adenoma and its location versus multigland disease was established in this retrospective cohort study. Positive predictive value, negative predictive value, and accuracy of imaging were analyzed in relation to preoperative PTH levels. Results Eighty-seven percent of the 218 patients enrolled in the study underwent unilateral targeted operation and had a 97.9% (95% confidence interval: 95.8%–100%) success rate. However, in patients with PTH

International audience; A helicon-based plasma source is under development and exploration at CEA-IRFM to produce an efficient and dense magnetized plasma column. The final objective of this development is the extraction and acceleration of a blade-like negative ion beam in view of future neutral beam injector systems for fusion reactors. The extraction of a negative ion beam from a magnetized plasma column requires a specific topology of the magnetic confinement, which significantly impacts the plasma parameters and wave propagation along the column. The magnetic confinement under investigation is based on water-cooled internal coils implemented under vacuum along the source (column) axis; these coils are supplied with a high DC current (~1000 A), providing the axial magnetic field (B//~10 mT). Different diagnostics developed in academic laboratories, such as 3D B-dot probes, optical emission spectroscopy and Langmuir probes, have been used for plasma characterization. The paper reports the experimental results obtained under different operating conditions of this particular magnetic confinement.

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.

Background Acute invasive fungal infections of the head and neck secondary to tyrosine kinase inhibitors are rare and potentially life-threatening events. Case presentation We report a case of mucormycosis of the thyroid gland in a patient known for chronic lymphocytic leukemia receiving ibrutinib who presented with a rapidly growing thyroid nodule and dysphonia. An acute invasive fungal infection was identified on a core needle biopsy; mucormycosis was confirmed on culture. The patient was successfully treated with surgical debridement and long-term antifungal therapy. Conclusion Patients on ibrutinib may be at risk of acute invasive fungal infections of the head and neck.

There has been an increasing use of transoral robotic surgery (TORS) as studies have demonstrated its effectiveness for treating a variety of conditions. Postoperative complications of TORS include hemorrhage, tooth injury, dehydration, aspiration pneumonia, and prolonged percutaneous endoscopic gastrostomy (PEG) tube dependency. Dental injury has not been adequately discussed although it has been reported to be a common complication in multiple studies, with repair costs ranging from $700 to $3000 and average time spent to address the injury estimated to be 2.6 h. The incidence of this injury is likely due to the standard dental guard, which is not customizable to the patient’s teeth, therefore, not optimal for dental protection. Many alternative dental guards have been proposed to reduce the rate of dental injury. However, the previously presented alternatives are high cost, not time efficient, or have the potential for molding error rendering them less effective. We propose a guard that is cheap, time efficient, and effective in preventing dental injury. A retrospective study of 124 patients who underwent TORS over a period of 6 years with the proposed dental guard was conducted. No dental complications were observed in any of these cases. A cost analysis showed that this guard saved $4526.64 for our relatively small patient cohort. This guard can save money, time, and stress for both the patient and the surgeon, as well as reduce the number and severity of medico-legal claims related to perioperative dental injury.

The present study reports an economically attractive improvement in fertilizer, using lignin sulfonate as a waste product in the pulp and paper manufacturing process. Lignin sulfonate was extracted by precipitation with calcium hydroxide. To achieve hydrophobicity, some modifiers were tested, and oxalic acid successfully met the required purpose. FTIR analysis indicated the changes in the functional groups of acetylated lignin. Then, lignin sulfonate acetylated with oxalic acid was coated on urea through a fluidized bed column. The released amount of different concentrations of fertilizer in water and soil was measured. Sulfur-coated urea fertilizer was used to compare with the product. The results showed that acetylated lignin sulfonate coated urea could properly control urea release. The amount of released acetylated lignin sulfonate coated urea after 18 days was 79 %, while for sulfur-coated urea, 93 % was released after 11 days. To add, the power model could predict the release pattern of acetylated lignin sulfonate coated urea accurately.

Background The purpose of this study was to present our evaluation of the outcome of oropharyngeal cancer managed with neoadjuvant chemotherapy and transoral surgery (TOS) with neck dissection as definitive treatment. Methods This is a case series of 17 patients with advanced oropharyngeal cancer who were treated with neoadjuvant chemotherapy followed by TOS. The treatment details and oncologic outcome are reported. The volumetric response of the tumor to neoadjuvant chemotherapy is evaluated and validated by histopathology. Results Seventeen patients with TNM stages III and IV oropharyngeal cancer constitute this series for survival analysis. On a median and mean follow-up of 31 and 40 months, respectively, 16 of the 17 patients were alive without recurrence. Disease-specific survival (DSS) and overall survival (OS) at 3 years were 94.1%. Conclusion Adjuvant chemotherapy followed by TOS and neck dissection is a feasible and efficacious novel therapeutic approach for definitive management of moderately advanced oropharyngeal cancer, reserving radiotherapy (RT) for salvage or adverse features. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1837–1846, 2016

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.

Classically skin defects are covered by split thickness skin grafts or by means of local or regional skin flaps. In the presented case series for the first time a bilayered, non-crossed-linked collagen matrix has been used in an off-label fashion in order to reconstruct facial skin defects following different types of skin cancer resection. The material is of porcine origin and consists of a spongy and a compact layer. The ratio of the two layers is 1:3 in favour of the spongy layer. The aim of the study was to investigate the potential of this matrix for skin regeneration as an alternative to the standard techniques of skin grafts or flaps. Six patients between 39 and 83 years old were included in the study based on a therapeutic trial. The collagen matrix was used in seven defects involving the nose, eyelid, forehead- and posterior scalp regions, and ranging from 1,2 to 6 cm in diameter. Two different head and neck surgeons at two different institutions performed the operations. Each used a different technique in covering the wound following surgery, i.e. with and without a latex-based sheet under the pressure dressing. In three cases cylindrical biopsies were taken after 14 days. In all cases the biomaterial application was performed without any complication and no adverse effects were observed. Clinically, the collagen matrix contributed to a tension-free skin regeneration, independent of the wound dressing used. The newly regenerated skin showed strong similarity to the adjacent normal tissue both in quality and colour. Histological analysis indicated that the spongy layer replaced the defective connective tissue, by providing stepwise integration into the surrounding implantation bed, while the compact layer was infiltrated by mononuclear cells and contributed to its epithelialization by means of a „conductive“process from the surrounding epithelial cells. The clinical and histological data demonstrate that the collagen bilayered matrix used in this series contributes to a „Guided-Integrative-Regeneration-Process“, which still needs to be further understood. The biomimetic nature of this material seems to contribute to physiological matrix remodelling, which probably involves other matricellular proteins essential for soft tissue regeneration. A deeper understanding of the mechanism, involved in the tissue integration of this material and its contribution to soft tissue regeneration based on the direct and indirect effect of matricellular proteins could open new therapeutic avenues for biomaterial-based soft tissue regeneration as an alternative to traditional flap-based plastic surgery.

To study dual frequency Townsend glow and radio frequency DBDs in an Ar/NH3 Penning mixture, different voltages are applied on each electrode of a plane/plane DBD. The one which has the higher amplitude and frequency, V H, determines the discharge regime. The other one, which has a lower amplitude and frequency, V L, is more similar to a bias voltage. V H frequency ranges from 50 kHz to 13.56 MHz and V L frequency from 1 kHz to 2 MHz. The amplitude of V L is always kept lower than the breakdown voltage. The discharge behavior is characterized by space and phase resolved optical emission spectroscopy and Fourier transform of the plasma induced light intensity. When the frequencies of two voltages are close to each other, V L higher than 150 V increases the discharge light intensity. In glow and Townsend discharges, this increase is attributed to the enhancement of the plasma density, due to the ions drift from the plasma bulk to the cathode, which produces a higher secondary electron emission. For the radiofrequency discharge, the enhancement of the light intensity is attributed to an enhancement of the positive space charge due to the higher voltage amplitude. When the frequencies of two voltages are very different, e.g. for V L between 1 and 100 kHz and a 5.5 MHz α-RF discharge, the behavior largely depends on V L amplitude. Above some low frequency (LF), the discharge tends to extinguish when V L amplitude is at its maximum. This is explained by a diminution of the plasma density resulting from the ion drift to the cathode due to V L. When V L is very high, it enhances the discharge intensity. This discharge amplification is associated with a transition from α to γ RF mode, which only occurs when the two voltages have the same polarity. Whatever the RF discharge mode, γ or α, the discharge is diffuse. To determine the interest of LF-RF dual frequency DBD for the PECVD, SiOx coatings, made with a single and a dual LF-RF frequency DBDs, are compared. It is concluded that the ɣ dual frequency removes OH functions from the material lattice and densifies the layer.