Importance of PET/CT in Initial Workup of Head and Neck Squamous Cell Carcinoma.

Objective: Assess the impact of positron emission tomography/computed tomography (PET/CT) on disease staging at presentation in patients with head and neck squamous cell carcinoma. Study Design: Retrospective cross-sectional review. Setting: Academic multicenter single institution (Geisinger Health System). Methods: All patients who had PET/CT imaging during workup for head and neck squamous cell carcinoma were included in the study. Pre- and post-PET/CT clinical staging were recorded. Statistical analyses were performed for patients with a change in clinical staging or detection of second primary malignancies on PET/CT. Results: A total of 292 patients were included in the study, 238 of whom underwent PET/CT imaging as part of their initial workup. Twenty-eight (11.9%) patients were clinically upstaged on PET/CT with 7 patients having treatment alterations based on imaging. Eighteen (7.6%) patients were found to have second primary malignancies on PET/CT. Conclusion: The current study further illustrates the importance of PET/CT in the workup of head and neck squamous cell carcinoma. Without the inclusion of PET/CT imaging, 19.3% of patients would have either been staged inappropriately or had second primary malignancies missed, again confirming the necessity of comprehensive functional imaging during the initial pretreatment workup.

Thyroid Abscess: A Case Series and Literature Review.

OBJECTIVE: In this retrospective case series, we chronicle six patients presenting with acute suppurative thyroiditis (AST) with progression to thyroid abscess in a single institution. METHODS: Patients ranged in age from 16 to 74 years of age. The most common presenting symptoms were progressive unilateral neck pain, swelling, and odynophagia. Other symptoms included hoarseness and systemic signs of infection. Diagnosis of thyroid abscess was made with a CT scan of the neck, fine needle aspiration, and/or incision and drainage (I&D). RESULTS: Management included antibiotic therapy, I&D, and thyroidectomy. All patients were successfully treated except for one who developed mediastinitis and died. CONCLUSION: A complete literature review was performed to determine etiologies, common findings, and management of similar cases.

Accurate Operative Time Prediction in Thyroid Surgery: A Rural Tertiary Care Facility Experience.

OBJECTIVE: To determine whether surgeons can estimate thyroid operative time more accurately than a system-generated average time estimate. METHODS: Four otolaryngologists at a single institution with extensive endocrine surgery experience were asked to predict their operative times for all eligible thyroid surgeries. These estimates were compared to system-generated operative time predications based on averaging the surgeon's previous 10 cases with the same Current Procedural Terminology code. The surgeon-generated estimations and system-generated estimations were then compared to each other and the actual operative time. RESULTS: A final sample of 73 cases was used for all analyses. Average age was 51 years old and the majority of patients were female. Surgeon-generated operative time estimates were significantly more accurate than system-generated estimates based on time averaging (P < .001). These findings were consistent across each surgeon individually and within each procedure type (hemithyroidectomy and total thyroidectomy). These findings had a power of over 99% based on mean differences. CONCLUSION: As the financial center of modern hospitals, an efficient operating room is integral to economic success. Improving the precision of operative time estimation reduces costly unplanned staff overtime, canceled cases, and underutilization. Our research at a rural tertiary care center shows that experienced thyroid surgeons can substantially reduce the error of estimating thyroid operative times by considering individual patient characteristics. Although no objective variables have so far been identified to correlate with thyroid operative time, surgeon-generated operative time estimation is significantly more accurate than a generic system approach of averaging previous operative times.

Novel tools for genetic manipulation of follicle stem cells in the Drosophila ovary reveal an integrin-dependent transition from quiescence to proliferation.

In many tissues, the presence of stem cells is inferred by the capacity of the tissue to maintain homeostasis and undergo repair after injury. Isolation of self-renewing cells with the ability to generate the full array of cells within a given tissue strongly supports this idea, but the identification and genetic manipulation of individual stem cells within their niche remain a challenge. Here we present novel methods for marking and genetically altering epithelial follicle stem cells (FSCs) within the Drosophila ovary. Using these new tools, we define a sequential multistep process that comprises transitioning of FSCs from quiescence to proliferation. We further demonstrate that integrins are cell-autonomously required within FSCs to provide directional signals that are necessary at each step of this process. These methods may be used to define precise roles for specific genes in the sequential events that occur during FSC division after a period of quiescence.

Ack kinase regulates CTP synthase filaments during Drosophila oogenesis.

The enzyme CTP synthase (CTPS) dynamically assembles into macromolecular filaments in bacteria, yeast, Drosophila, and mammalian cells, but the role of this morphological reorganization in regulating CTPS activity is controversial. During Drosophila oogenesis, CTPS filaments are transiently apparent in ovarian germline cells during a period of intense genomic endoreplication and stockpiling of ribosomal RNA. Here, we demonstrate that CTPS filaments are catalytically active and that their assembly is regulated by the non-receptor tyrosine kinase DAck, the Drosophila homologue of mammalian Ack1 (activated cdc42-associated kinase 1), which we find also localizes to CTPS filaments. Egg chambers from flies deficient in DAck or lacking DAck catalytic activity exhibit disrupted CTPS filament architecture and morphological defects that correlate with reduced fertility. Furthermore, ovaries from these flies exhibit reduced levels of total RNA, suggesting that DAck may regulate CTP synthase activity. These findings highlight an unexpected function for DAck and provide insight into a novel pathway for the developmental control of an essential metabolic pathway governing nucleotide biosynthesis.