Modified Gugging Swallowing Screen: A New Bedside Evaluation Tool for Swallowing Function in Patients with Open Partial Laryngectomy before Oral Feeding: A Single-Centre Retrospective Study.

BACKGROUND: Dysphagia is a prevalent complication following partial laryngectomy. We aimed to introduce a novel bedside evaluation tool, the modified Gugging Swallowing Screen (GUSS), and evaluate its reliability and validity in patients with open partial laryngectomy before oral feeding. METHODS: We conducted a retrospective analysis of 120 patients with laryngeal cancer, including 40 hospitalized patients who underwent open partial laryngectomy. On the same day before oral feeding, we performed the modified GUSS, videofluoroscopic swallowing study (VFSS), and fiberoptic endoscopic evaluation of swallowing (FEES) to evaluate swallowing function. Two independent trained nurses assessed all patients for interrater reliability of modified GUSS. We compared the results of the modified GUSS with VFSS for predictive validity, and VFSS results for solid, semisolid, and liquid intake for content validity. RESULTS: The results of VFSS and FEES showed a strong correlation and consistency (rs = 0.952, p < 0.01; κ = 0.800 to 1.000, p < 0.01). The modified GUSS exhibited substantial to excellent interrater reliability across all classification categories (rs = 0.961, p < 0.01; κ = 0.600 to 1.000, p < 0.01) and demonstrated excellent consistency and predictive validity compared to VFSS (rs = -0.931, p < 0.01; κ = 0.800 to 1.000, p < 0.01). Content validity revealed that the risk of aspiration during solid intake was lower than that during semisolid intake (p < 0.01), and the risk of aspiration during semisolid intake was lower than that during liquid intake (p < 0.01), therefore confirming the subtest sequence of the modified GUSS. CONCLUSIONS: We successfully modified GUSS for patients with open partial laryngectomy. Moreover, the new bedside screening tool was validated as an effective tool for evaluating swallowing function and the risk of aspiration in patients with open partial laryngectomy before oral feeding.

Oral diet management for carcinoma at the base of tongue with radiotherapy and chemotherapy associated dysphagia: a case report.

Introduction: Tongue cancer is one of the common malignancy of the head and neck, and directly impacts chewing, swallowing, and other eating activities. Based on the evidence-based guidelines and clinical management, this paper presents nutrition management experience of a patient with tongue cancer who had a dysphagia and feeding reflux while undergoing radiotherapy and chemotherapy. Methods: Nutritional risk screening and comprehensive nutritional assessment were performed based on the patient's medical history, and personalized nutritional programs were developed under the guidance of the clinical pharmaceutical consensus of parenteral nutrition and nutritional treatment guidelines for patients with tumors during radiotherapy. For the management of oral feeding, the patient's swallowing function was evaluated to manage oral feeding. Thickening powders were used to improve the consistency of the patient's food, which successfully achieved oral feeding of the patient. Results: The patient finally ate five meals a day by mouth, and energy requirements were met using industrialized nutritional supplements, and homogenized food was added in between the meals. The energy provided by enteral nutrition can reached approximately 60-75%. The patient's weight and albumin levels had increased significantly at the time of discharge. Discussion: The nutritional management of patients with dysphagia should be jointly managed by clinicians, nurses, nutritionists, and family members to effectively improve the quality of life (QOL) and nutritional status of patients. To ensure adequate nutritional supply, appropriate swallowing training may delay the deterioration of the chewing function and improve the eating experience of such patients.

Prognostic prediction of head and neck squamous cell carcinoma: Construction of cuproptosis-related long non-coding RNA signature.

BACKGROUND: Recently, a new type of programmed cell death, cuproptosis, has been identified to play important role in the progression of tumors. We constructed a cuproptosis-related long non-coding RNA (lncRNA) signature to predict the prognostic significance for head and neck squamous cell carcinoma (HNSCC). METHODS: The risk model was developed based on differentially expressed lncRNAs associated with cuproptosis. Principal component analysis was used to assess the validity. The Kaplan-Meier curves were analyzed to compare the overall survival (OS), disease-specific survival (DSS), and progression-free survival (PFS) values. The multivariate and univariate Cox regression analyses were used to evaluate the prognostic efficiency. Furthermore, the functional enrichment, immune cell infiltration, tumor mutation burden (TMB), and sensitivity toward chemotherapy were also explored. RESULTS: Six cuproptosis-related lncRNAs (AL109936.2, CDKN2A-DT, AC090587.1, KLF3-AS1, AL133395.1, and LINC01063) were identified to construct the independent prognostic predictor for HNSCC. The area under the curve and C-index values obtained using the risk model were higher than the values corresponding to the clinical factors. Analysis of Kaplan-Meier curves indicated that the OS, PFS, and DSS time recorded for the patients in the low-risk group were higher than the corresponding values recorded for the patients belonging to the high-risk group. By functional enrichment analysis, we observed that differentially expressed genes were enriched in the immune response and tumor-associated pathways. The patients characterized by a low-risk score exhibited better immune cell infiltration than the patients belonging to the other group. We also observed that the sensitivity of the individuals belonging to the low-risk group to chemotherapeutic agents (cisplatin, docetaxel, and paclitaxel) was higher than the sensitivity of those in the other group. CONCLUSIONS: A cuproptosis-related lncRNA-based signature that functioned as an independent prognosis predictor for HNSCC patients was constructed. The chemosensitivity of individual patients can be potentially predicted using this signature.

Whole-course nutritional support therapy and indicators in head and neck cancer surgery.

BACKGROUND AND OBJECTIVES: This study investigated the effect of continuous perioperative nutritional support provided by a multidisciplinary team (MDT) to patients who underwent surgery for head and neck cancer (HNC). METHODS AND STUDY DESIGN: This study enrolled 99 patients with HNC and divided them into two groups: a management group (n=48), comprising patients who underwent surgery between August and December 2020 and received continuous perioperative nutritional support from the MDT; and a control group (n=51), comprising patients who underwent surgery between June and December 2017 and received routine nutritional guidance. Data on weight, nutritional indicators, and the prognostic nutritional index (PNI) were collected. We compared the changes in weight, nutritional indicators, PNI, Patient-Generated Subjective Global Assessment (PG-SGA) scores, and body composition. Factors influencing the PNI were analysed. RESULTS: The minimum weight, nutritional indicator, and PNI values observed postoperatively and at discharge were lower than those observed at admission. The serum nutritional index values observed at discharge and minimum PNI values observed postoperatively and at discharge were higher in the management group than in the control group. The PG-SGA score at 2 weeks postoperatively was higher than that on the day of surgery in the management group. The discharge PNI was influenced by management and age in these HNC surgical patients. In the management group, body composition data did not differ significantly between the preoperative and 1-, 2-, and 3-week postoperative time points. CONCLUSIONS: Continuous perioperative nutritional support by an MDT can improve the weight and serum nutritional index of patients receiving surgery for HNC and improve the PNI at discharge.