Basaloid Squamous Cell Carcinoma of the Larynx: A National Cancer Database Analysis.

OBJECTIVE: Basaloid squamous cell histology is a rare variant that accounts for about 2% of all head and neck squamous cell laryngeal carcinomas. The purpose of this study was to examine overall survival rates of patients according to treatment, stage, and laryngeal subsite. STUDY DESIGN: Retrospective analysis. SETTING: National Cancer Database (NCDB). SUBJECTS AND METHODS: The NCDB was queried for patients with basaloid squamous cell carcinoma (BSCC) who were treated from 2004 to 2014. Five-year overall survival rates were determined by the Kaplan-Meier method. Univariate and multivariate analysis was used to identify factors correlated with 5-year overall survival. RESULTS: The NCDB identified 440 patients meeting inclusion criteria. Median follow-up time was 31.2 months. On univariate analysis, the treatment modalities assessed (surgery alone, surgery with radiotherapy, surgery with chemoradiotherapy, radiotherapy, chemoradiotherapy) did not differ in their survival benefit. On multivariate analysis, only chemoradiotherapy (hazard ratio, 0.587; 95% CI, 0.37-0.93; P = .022) was associated with improved survival. All treatment modalities performed similarly between stage I and II tumors ( P = .340) and stage III and IV tumors ( P = .154). CONCLUSION: This study represents the largest laryngeal BSCC series to date. We found that chemoradiotherapy was associated with improved 5-year overall survival of laryngeal BSCC on multivariate analysis.

Use of Short Message Service and Smartphone Applications in the Management of Surgical Patients: A Systematic Review.

BACKGROUND: Mobile health and telemedicine are rapidly evolving fields used to provide healthcare remotely to patients. For surgical patients, telemedicine can improve patient education and remote monitoring of postoperative symptoms. We performed a systematic review of studies involving the use of short message service (SMS) and mobile application-based interventions in surgical patients to evaluate the advantages and disadvantages of each system, as well as of mobile interventions as a whole. MATERIALS AND METHODS: Major electronic databases were searched using relevant keywords from inception until November 2016. Studies involving SMS or mobile application-based communication protocols involving at least 25 preoperative or postoperative patients were included. Studies of systems involving communication exclusively between healthcare professionals were excluded. RESULTS: A total of 2,492 unique studies were identified through keyword search. After applying inclusion and exclusion criteria, 15 studies were included in this review. Intervention modalities were SMS (8 studies), mobile application (4), combined SMS and application (1), automated phone call (1), and electronic transmission of pictures to the physician (1). Intervention methods were symptom monitoring (7), patient education (2), protocol adherence reminders (4), and combined symptom monitoring and protocol adherence reminders (2). Both mobile applications and SMS-based interventions increased adherence to medications and protocols and improved clinic attendance. Lower readmission rates and emergency room visits were reported. Satisfaction with automated communication systems was high for both patients and physicians. CONCLUSIONS: Mobile interventions provide a sophisticated yet simple tool to improve perioperative healthcare. Future considerations to address include usage fatigue and Health Insurance Portability and Accountability Act compliance concerns.

The Influence of Mitral Annuloplasty on Left Ventricular Flow Dynamics.

BACKGROUND: Mitral valve (MV) repair using annuloplasty rings is the preferred method of treatment for MV regurgitation, but the impact of annuloplasty ring placement on left ventricular intraventricular flow has not been studied. METHODS: Annuloplasty rings of varying sizes were placed in 5 healthy sheep (intercommissural ring sizes were 24, 26, 28, 30, and 32 mm), and three-dimensional phase contrast magnetic resonance imaging (4D flow MRI) was performed before and 1 week after ring placement. RESULTS: Normal diastolic flow consisted of diastolic intraventricular vortices that naturally unwound during systole. Postsurgical intraventricular flow was highly disturbed in all sheep, and the disturbance was greatest for undersized rings. Ring size was highly correlated with the diastolic inflow angle (Pearson's r = -0.62, p < 0.1, 95% confidence interval: -0.92 to 0.14). There was a mean angle increase of mean diastolic inflow angle increase of 12.3 degrees (< 30 mm, p < 0.01, 95% confidence interval: 4.8 to 19.6) for rings less than 30 mm. There was an inverse relationship between peak velocity and annuloplasty ring area (Pearson's r = -0.80, p < 0.05, 95% confidence interval: -0.96 to -0.2). Transmitral pressure gradients increased significantly from baseline 0.73 ± 0.18 mm Hg to after annuloplasty 2.31 ± 1.04 mm Hg (p < 0.05). CONCLUSIONS: Mitral valve annuloplasty ring placement disturbs normal left ventricular intraventricular flow patterns, and the degree of disturbance is closely associated with annuloplasty ring size.

Effects of a novel herbal formulation JSK on acute spinal cord injury in rats.

PURPOSE: Acute spinal cord injury (SCI) triggers multiple cellular and molecular pathways; therapy aimed at only one pathway is unlikely to succeed. Anecdotal reports indicate that a novel herbal formulation (JSK-Ji-Sui-Kang) may enhance recovery in humans with SCI. We investigated whether JSK's therapeutic effects could be verified in a well-established SCI model in rats. METHODS: Therapeutic effects of JSK were tested using a standard behavioral assessment, histological, immunochemical and microarray analysis. Phytochemical fingerprinting of JSK was performed using high performance liquid chromatography coupled with photodiode array detection and electrospray ionization-mass spectrometry. JSK or vehicle was gavaged to rats 24 hours after SCI and daily thereafter for 3 weeks. RESULTS: Locomotor function significantly improved (n = 12; p < 0.05), tissue damage was reduced (p < 0.01; n = 6) and more axons and myelin were observed in JSK-treated compared with vehicle control animals. JSK significantly enhanced expression of neuroglobin, vascular endothelial growth factor and growth-associated protein 43, and reduced the expression of caspase 3, cyclooxygenase-2, RhoA (p < 0.05; n = 6) and fibrinogen (p < 0.01; n = 6). RNA microarray indicated that JSK altered transcription of genes involved in ischemic and inflammatory/immune responses and apoptosis (p < 0.05; n = 3). CONCLUSIONS: JSK appears to target multiple biochemical and cellular pathways to enhance functional recovery and improve outcomes of SCI. The results provide a basis for further investigation of JSK's effects following SCI.

Occipitocervical fusion in an infant with atlantooccipital dislocation.

BACKGROUND: For children who survive traumatic atlantooccipital dislocation (AOD), early surgical stabilization and arthrodesis of the occipitoatlantoaxial complex is typically performed. Because of the unique and crowded anatomy of the occipitocervical junction, the creation of a fusion construct that is both safe and biomechanically sound is extremely challenging, especially in infants. We present a technical report of a patient with infantile type I AOD with gross instability, who underwent surgical stabilization consisting of occiput to C2 arthrodesis using autologous rib, augmented with bone morphogenic protein 2 (BMP-2), Mersilene suture, and Ethibond suture as "cross-connectors." CASE DESCRIPTION: The patient is a 12-month-old female infant who was involved in a high-speed motor vehicle accident and sustained a type I AOD. Definitive surgical stabilization consisting of arthrodesis from the occiput to C2 using autologous rib augmented with BMP-2, Mersilene suture, and Ethibond suture as cross-connectors was performed. There were no intraoperative complications. A follow-up cervical spine computed tomography obtained 12 weeks postoperatively demonstrated excellent occipitocervical alignment, with evidence of modest bony fusion from the occiput to C2. Neurologic examination demonstrated modest, but progressive, improvement, with partial resolution of bilateral sixth nerve palsies, and improvement in upper- and lower-extremity muscle strength and tone. CONCLUSION: Significant surgical challenges exist regarding occipitocervical fusion in infants with AOD and gross instability. This case report illustrates the successful application of BMP-2-augmented occipitocervical fusion using autologous rib, in combination with Mersilene and Ethibond suture, in the treatment of an infant with type I AOD with gross instability.

Enteric glia mediate neuronal outgrowth through release of neurotrophic factors.

Previous studies have shown that transplanted enteric glia enhance axonal regeneration, reduce tissue damage, and promote functional recovery following spinal cord injury. However, the mechanisms by which enteric glia mediate these beneficial effects are unknown. Neurotrophic factors can promote neuronal differentiation, survival and neurite extension. We hypothesized that enteric glia may exert their protective effects against spinal cord injury partially through the secretion of neurotrophic factors. In the present study, we demonstrated that primary enteric glia cells release nerve growth factor, brain-derived neurotrophic factor and glial cell line-derived neurotrophic factor over time with their concentrations reaching approximately 250, 100 and 50 pg/mL of culture medium respectively after 48 hours. The biological relevance of this secretion was assessed by incubating dissociated dorsal root ganglion neuronal cultures in enteric glia-conditioned medium with and/or without neutralizing antibodies to each of these proteins and evaluating the differences in neurite growth. We discovered that conditioned medium enhances neurite outgrowth in dorsal root ganglion neurons. Even though there was no detectable amount of neurotrophin-3 secretion using ELISA analysis, the neurite outgrowth effect can be attenuated by the antibody-mediated neutralization of each of the aforementioned neurotrophic factors. Therefore, enteric glia secrete nerve growth factor, brain-derived neurotrophic factor, glial cell line-derived neurotrophic factor and neurotrophin-3 into their surrounding environment in concentrations that can cause a biological effect.