Impact of dysplasia at resection margin on oncologic outcome after curative resection of oral tongue squamous cell carcinoma: significance of high-grade dysplastic resection margin.

BACKGROUND: This study aimed to compare the oncologic outcomes among negative, close, positive, and dysplasia resection margins (RMs) with oral tongue squamous cell carcinoma (OSCC) and to investigate the impact of dysplastic RMs. METHODS: The 565 patients were retrospectively analyzed and divided into four groups according to RM. Dysplasia was classified into mild, moderate, and severe subgroups. RESULTS: RMs consisted of negative (62.1%), close (27.1%), positive (2.1%), and dysplastic (8.7%). In multivariate analysis, advanced T/N stages and positive RM were significant risk factors for overall survival, while dysplasia at the RM was not a significant risk factor for locoregional recurrence or overall survival. In subgroup analysis of patients with dysplastic margin, RM with severe dysplasia showed higher recurrence than mild and moderate dysplasia. CONCLUSIONS: Dysplastic RM was not a risk factor for recurrence and survival. Severe dysplasia RM should be carefully observed due to higher recurrence compared to other dysplasia RMs.

Heated debates on regulations of heated tobacco products in South Korea: the news valence, source and framing of relative risk/benefit.

BACKGROUND: We analyse news representations of the regulation of heated tobacco products (HTPs) in South Korea, the country where HTP use is among the highest in the world despite conflicts between the government and the HTP manufacturers. METHODS: We analysed a total of 571 print and TV news covering HTP regulations, published between 2017 and 2018, the time period when HTPs were introduced to the country and various regulations of HTPs were proposed and implemented. We assessed the prevalence and associations among specific types of HTP regulations that were discussed, valence towards regulation, sources, framing of the relative health risks/benefits of HTPs compared with conventional cigarettes. RESULTS: Taxation (55.2%) and warning labels (25.7%) were two regulation topics covered the most. Almost equal proportions of pro-regulation (2.5%) and anti-regulation valence (2.2%) were found in taxation-related news, while pro-regulation valence appeared more frequently for other restrictions, including warning labels (pro=9.5% vs anti=1.4%), marketing restrictions (pro=6.9% vs anti=0%) and integration of HTPs into smoke-free policies for cigarettes (pro=8.7% vs anti=0%). The government (59%), followed by the tobacco industry (39.4%), was the source cited most often across news stories while the presence of tobacco control advocates was low (4.9%). As for framing, there was no significant difference in the prevalence of stories mentioning reduced harm (31.7%) and equal or more harm (33.6%) of HTPs compared with cigarettes. CONCLUSIONS: We provide implications for governments and tobacco control advocates on building consensus for applying cigarette equivalent taxes and pictorial warning labels to HTPs.

News Media Presentations of Heated Tobacco Products (HTPs): A Content Analysis of Newspaper and Television News Coverage in South Korea.

Our content analysis of newspaper and television news stories in South Korea examines the quantity and nature of news about novel heated tobacco products (HTPs), which heat instead of burn tobacco and that manufacturers claim are less harmful than cigarettes. The amount of news coverage peaked when the government introduced new regulations, suggesting that HTP news was driven largely by new policies. Indeed, HTPs were more likely to be presented as a policy rather than a health issue. When it comes to news sources, government agencies and HTP manufacturers were referenced most often in the news. As for benefits of HTPs, news stories focused on reduced harm, greater social acceptability, and convenience, while discussions of drawbacks included potentially being equally or more harmful than cigarettes, the possibility of extensive future regulations, and HTPs' unknown health effects. Findings suggested that certain journalistic practices, such as relying heavily on established routine sources, focusing on the stories that could attract large audiences, and representing the perspectives of the publishers and the primary audiences, might have affected the nature of HTP discourse.

Deterioration of Hearing Due to Hearing Aids.

OBJECTIVES: A primary reason for the low adoption of hearing aids (HAs) among the large population with sensorineural hearing loss is the perception that these devices may negatively impact remaining hearing ability. Research addressing this issue has yielded conflicting results. This study examined the long-term effects of HAs on standard audiometric changes in individuals with sensorineural hearing loss. METHODS: We retrospectively analyzed patients who acquired unilateral HAs between 2015 and 2017 and demonstrated consistent use over a 5-year period. We examined demographics, medical comorbidities, audiometric data, and questionnaire results from the Hearing Handicap Inventory for the Elderly and the International Outcome Inventory for Hearing Aids. Additionally, we reviewed each patient's history of noise exposure and prior HA use. RESULTS: The study included 55 patients who used unilateral HAs, with a mean follow-up period of 5.32 years. Among them, 31 patients (56.4%) used the HA on the right side. Audiometric data from the aided side showed no significant difference from the unaided side in either the pre-fit pure-tone average of air conduction (AC) or word recognition score (WRS) (P =0.73 and P =0.11, respectively). Similarly, no significant differences were noted in the 5-year follow-up audiometry of AC and WRS (P=0.98 and P=0.07, respectively) or in the change from pre-fit to final audiometry for either parameter (AC, P=0.58; WRS, P=0.70). Eleven patients (20%) exhibited a deterioration in hearing (as measured by AC) of 5 dB or greater on the aided side compared with the unaided side, while 23 (53.5%) showed greater WRS deterioration on the aided side. No significant factors were found to contribute to the difference in hearing deterioration between groups for either AC or WRS. CONCLUSION: No significant factors were identified as contributing to hearing deterioration after prolonged HA use. Overall, the use of HAs did not adversely impact residual hearing.

Extra-Capsular Spread of Lymph Node Metastasis in Oral, Oropharyngeal and Hypopharyngeal Cancer: A Comparative Subsite Analysis.

BACKGROUND: The extra-capsular spread (ECS) of lymph node metastasis (LNM) is a hallmark of aggressive primary tumor phenotype in head and neck cancer (HNC); however, the factors influencing ECS are poorly understood. PATIENTS AND METHODS: This was a retrospective study, including 190 cases of oral tongue cancer (OTC), 148 cases of oropharyngeal cancer (OPC) (118 HPV-positive and 30 HPV-negative), and 100 cases of hypopharyngeal cancer (HPC). Tumor dimension, tumor biological variables (lymphovascular/perineural invasion and histologic grade), and LNM variables (LNM number and size) were analyzed according to the presence of ECS using multivariable logistic regression and receiver operating characteristic (ROC) curve analyses. RESULTS: LNM variables were significant factors for ECS in all subsites of HNC (p < 0.05), except HPV-positive OPC. In OTC, tumor dimensional variables were significantly related to ECS (p < 0.01). Meanwhile, in OPC and HPC, neither the primary tumor dimension nor the T status were significant factors for ECS occurrence. The predictability of ECS by ROC curve using multiple variables was 0.819 [95% confidence interval: 0.759-0.878] in OTC, 0.687 [0.559-0.815] in HPV-positive OPC, 0.823 [0.642-1.000] in HPV-negative OPC, and 0.907 [0.841-0.973] in HPC. CONCLUSION: LNM variables were correlated with ECS occurrence for most HNC subsites, and site-dependent primary tumor characteristics might contribute differentially to the ECS development of LNM in HNC.

Effect of within-endobag method during laparoscopic ovarian cystectomy of dermoid cyst: A retrospective study.

This study aimed to evaluate the effect of within-endobag cystectomy during and after laparoscopic ovarian cystectomy in patients with dermoid cysts. We retrospectively analyzed 84 patients with ovarian dermoid cysts who underwent laparoscopic ovarian cystectomy. In 30 patients, the affected ovary was placed in an endobag before cystectomy and cystectomy was performed within an endobag (within-endobag group), while the remaining 54 patients underwent standard cystectomy without this step (without-endobag group). After cystectomy, the cyst wall was placed in an endobag and was removed from the abdomen. Compared with the without-endobag group, the within-endobag group had a significantly lower rate of cyst content spillage (23.3% vs 72.2%, P < .001) and significantly shorter operation times when the cysts ruptured (23.4 ± 8.6 minutes vs 51.2 ± 28.6 minutes, P < .001). Whereas there was no significant difference in operation time in the absence of cyst rupture between 2 groups (21.2 ± 8.8 minutes vs 31.1 ± 17.4 minutes, P = .111). In patients with cyst rupture, according to the cyst size increase, the operation time was significantly prolonged without-endobag, whereas no significant prolongation was observed in within-endobag cystectomy. Except for operation time, there were no significant differences in cyst length, pain on the first day after surgery, hemoglobin loss, hospital stay, and inflammatory markers (C-reactive protein and white blood cell counts) in both ruptured and unruptured cases between the 2 groups. There were no postoperative complications in the within-endobag group, but 2 cases of perioperative complications occurred in the without-endobag group. No chemical peritonitis due to spillage of the cyst contents was observed in either group. Laparoscopic ovarian cystectomy performed within-endobag can reduce both the spillage rate of cyst contents and operation time regardless of cyst size in patients with ruptured cysts. Therefore, this technique is a good surgical option for the laparoscopic ovarian cystectomy of large dermoid ovarian cysts.

A case report of mucinous cystadenoma with contralateral serous cystadenofibroma in identical twin.

Introduction: There are limited reports on ovarian neoplasm occurring among identical twins. Most previous reports showed ovarian teratoma found in both twins. Herein, we report for the first time a case of ovarian mucinous cystadenoma with contralateral serous cystadenofibroma found in twin siblings. Case report: One patient suffered from abdominal distension and the following computed tomography found ovarian mucinous cystadenoma. During the laparoscopy, another ovarian mass was found in the contralateral ovary. The histopathology revealed ovarian mucinous cystadenoma with contralateral serous cystadenofibroma. The twin sister had no symptoms but underwent gynecological screening. She also showed a similar finding, mucinous cystadenoma with serous cystadenofibroma on the contralateral ovary. Both patients underwent laparoscopic bilateral ovarian cystectomy. Conclusion: This is the first clinical report on left ovarian mucinous cystadenoma with right serous cystadenofibroma in twin siblings. Our cases support awareness of ovarian tumors in twin sisters.

One-Unit Osteotomy to Correct Deviated Bony Dorsum.

OBJECTIVES: A crooked nose is frequently caused by nasal bony vault deviation, and proper management of the bony vault is an integral part of rhinoplasty. Conventional osteotomy to correct a deviated nose favors simultaneous medial and lateral osteotomies, which allows the free independent movement of each nasal bone. However, patient satisfaction with deviated nose surgery is sometimes low. In the present study, we introduce a one-unit osteotomy procedure that combines bilateral and root osteotomies with unilateral triangular bony wedge resection to allow symmetry of both nasal bones. METHODS: Twenty consecutive patients who presented with bony vault deviation and underwent one-unit osteotomy were enrolled in this retrospective single-center study. The Nasal Obstruction Symptom Evaluation (NOSE) questionnaire was used to evaluate each patient's functional outcome. The angle of bony vault deviation before and after one-unit osteotomy was measured using a protractor and compared with the. RESULTS: of 14 patients who had undergone conventional osteotomy. The improvement in dorsal deviation was evaluated using facial photography preoperatively and 3 months postoperatively. RESULTS: NOSE values improved from 8.4±6.4 to 4.1±4.2 (P =0.021). The angle of bony vault deviation improved from 6.9°±2.2° to 2.1°±1.2° (P <0.001) in one-unit osteotomy and from 7.3°±4.0° to 2.7°±1.2° (P =0.001) in conventional osteotomy. The preoperative deviation angle improved by 70.3% in one-unit osteotomy compared with 56.6% in conventional osteotomy, which was a significant difference (P =0.033). The mean grade of the postoperative esthetic outcomes for the remaining deviation was 1.6±0.5, which was similar to that in the conventional osteotomy group. CONCLUSION: One-unit osteotomy is a relatively simple procedure that balances the width of both lateral walls by removing excessive bony fragments from the wider bony wall and providing better structural integrity. This technique improves functional outcomes and has equivalent esthetic. RESULTS: to those of the traditional procedure.

Improved Early Detection Models of Pharyngocutaneous Fistula after Total Laryngectomy.

Early detection of pharyngocutaneous fistula (PCF) after total laryngectomy (TL) could prevent severe complications such as major vessel rupture. We aimed to develop prediction models for detecting PCF in the early postoperative period. We retrospectively analyzed patients (N = 263) who received TL between 2004 and 2021. We collected clinical data for fever (>38.0 °C) and blood tests (WBC, CRP, albumin, Hb, neutrophils, lymphocytes) on postoperative days (POD) 3 and 7, and fistulography on POD 7. Clinical data were compared between fistula and no fistula groups, and significant factors were selected using machine learning. Using these clinical factors, we developed improved prediction models for PCF detection. Fistula occurred in 86 (32.7%) patients. Fever was significantly (p < 0.001) more common in the fistula group, and ratios (POD 7 to 3) of WBC, CRP, neutrophils, and neutrophils-to-lymphocytes (NLR) were significantly higher (all p ≤ 0.001) in the fistula group than in the no fistula group. Leakage on fistulography was more common in the fistula group (38.2%) than in the no fistula group (3.0%). The area under curve (AUC) of fistulography alone was 0.68, but predictive models using a combination of fistulography, WBC at POD 7, and neutrophil ratio (POD 7/POD 3) showed better diagnostic performance (AUC of 0.83). Our predictive models may detect PCF early and accurately, which could reduce fatal complications following PCF.

Impact of Pulmonary Function on Voice Outcomes After Injection Laryngoplasty for Unilateral Vocal Fold Paralysis.

OBJECTIVES: Pulmonary function is closely associated with voice quality especially in patients with voice disorder including unilateral vocal fold paralysis (UVFP). Injection laryngoplasty (IL) is the standard treatment for patients with UVFP. We investigated the subjective and objective voice outcomes according to pulmonary function test (PFT) before IL in patients with UVFP. METHOD: We retrospectively analyzed the patients who underwent IL for UVFP between 2004 and 2021 (N = 1201), and finally investigated 261 patients with PFT results before IL. The patients were classified into three groups according to results of PFT: normal (n = 189, 72%), mild (n = 40, 15%), and moderate (n = 32, 13%) obstructive pattern. Aspiration symptoms and subjective and objective voice parameters of voice handicap index (VHI), GRBAS score, maximal phonation time (MPT), Jitter, Shimmer, and noise to harmonic ratio (NHR) were compared between normal and abnormal (mild or moderate obstructive pattern) PFT groups. RESULTS: Age (68.0 ± 9.1 and 61.2 ± 12.6, respectively) was significantly higher and males were more common (84.7% and 57.7%, respectively) in abnormal PFT than in normal PFT. Aspiration showed significant improvement in all groups. The subjective and objective voice parameters significantly improved after IL in normal and mild obstruction groups, but MPT, Shimmer, and VHI did not significantly improve in the moderate obstruction group. The improvement in VHI-30 after IL was significantly higher in the normal group (20.0 ± 29.5) than in the mild (10.3 ± 32.8) or moderate (9.9 ± 33.2) obstruction group (P = 0.035). Improved amounts of MPT, Jitter, Shimmer, and NHR were not significantly different among the groups, but improvement of VHI was smallest in the moderate obstructive pattern group. CONCLUSION: Voice parameters showed significant improvement after IL in both normal and mild obstructive pattern groups, but MPT and VHI did not significantly improve in the moderate obstructive pattern group. In addition, patients with normal pulmonary function had marked improvement of subjective symptoms after IL in comparison with patients with abnormal pulmonary function.

Sentinel Lymph Node Biopsy Versus Elective Neck Dissection: Long-Term Oncologic Outcomes in Clinically Node-Negative Tongue Cancer.

OBJECTIVES: The aim of this study was to compare the long-term oncologic outcomes of sentinel lymph node biopsy (SLNB) versus elective neck dissection (END) in clinically node-negative (cN0) tongue cancer. METHODS: This was a retrospective cohort study of patients with cN0 tongue cancer from a single institution, including 91 patients in the SLNB group and 120 patients in the END group. RESULTS: The overall recurrence rate showed no significant difference between the two groups. The regional control rate was also comparable between the two groups (P=0.490). The 5-year recurrence-free survival (RFS) was slightly better in the SLNB group than in the END group (P=0.427). The 5-year overall survival (OS) rate was 89.9% in the SLNB group versus 91.9% in the END group (P=0.737). In a propensity-matched subgroup analysis, the type of neck management did not affect RFS or OS. CONCLUSION: SLNB showed non-inferior oncologic outcomes compared to END in patients with cN0 tongue squamous cell carcinoma.

Cancer Control Continuum in Korean American Community Newspapers: What Is the Association with Source Nationality-US vs. Korea?

Prior research suggests that cancer information obtained from Korean American community media, which are the primary health information sources among the population, does not connect to Korean Americans' increased cancer knowledge or cancer protective/detective behavior. We aim to identify the reason by analyzing cancer type, cancer control continuum, and cancer topic presented in Korean American community newspapers. The nationality of news source, US and Korea, and its association with the cancer coverage were examined. We found that among articles that cited any source, nearly one third used a source from Korea. The source nationality was associated with cancer coverage. In particular, cancer risk factors and screening were more likely to be discussed when a US source was cited as compared to when no source was cited. Korean sources were never or rarely observed in articles focusing on a few cancer sites (e.g., breast and prostate, which Korean Americans have higher risks compared to native Koreans), cancer preventive behaviors (diet, physical activity, no smoking), and specific cancer detection methods (mammogram, pap-smear). We suggest Korean American media to reflect the cancer priority and information needs among Korean Americans, which are varied from native Koreans, and to acknowledge the differences in cancer prevention and detection guidelines between the U.S. and Korean healthcare system. Also, the U.S. government should disseminate cancer screening and prevention guidelines, customized to racial/ethnic groups' cancer prevalence and communication preference.

Rheological alteration of erythrocytes exposed to carbon nanotubes.

Single-walled carbon nanotubes (SWNTs) have been increasingly used in a variety of biomedical applications, such as in vivo delivery of drugs and tumor imaging. Potential exposure of SWNTs to human red blood cells (RBCs) may cause serious toxicity including alteration of mechanical properties of cells. The present study investigated the cellular response to exposure of SWNTs with measuring rheological characteristics of RBCs, including hemolysis, deformability, aggregation, and morphological changes. RBCs were exposed to two different dispersion-state samples (i.e. individual SWNTs and bundled SWNTs) in chitosan hydroxyphenyl acetamide (CHPA) solutions. The concentrations of SWNTs were carefully chosen to avoid any hemorheological alterations due to hemolysis. Rheological characteristics were measured using microfluidic-laser diffractometry and aggregometry. Our results show that the bundled SWNTs had higher hemolytic activity than did the individual SWNTs. RBC aggregation apparently decreased as the concentration of SWNTs or incubation time increased. Additionally, bundled SWNTs caused significant alterations in the shape and fusion of RBCs. In conclusion, bundled SWNTs were found to be more toxic than individual SWNTs. These results provide important insights into the interactions between RBCs and SWNTs and will facilitate assessment of the risk of nanomaterial toxicity of blood.

Haemocompatibility evaluation of silica nanomaterials using hemorheological measurements.

Silica nanomaterials (NMs) are widely used in semiconductor, agriculture, cosmetics, and biomedical applications, in addition to other industries. We investigated the toxic effect of silica NMs on rheological characteristics of human red blood cells (RBCs), including hemolysis, deformability, aggregation, and morphological changes. Red blood cells were exposed to silica nanoparticles (d =∼200 nm) or silica nanowires (d =∼200 nm, l = 1µm or 10µm) at a range of concentrations and incubation times. Rheological characteristics were measured using microfluidic-laser diffractometry and aggregometry. Overall, at a concentration greater than 12.5 µg/ml, the hemolytic activity was shown to be in the order of nanoparticles, short nanowires, and long nanowires. Elongation index (EI) values were insignificant in the RBCs exposed to each of the silica NMs at a concentration of 12.5 µg/ml. Aggregation index (AI) values decreased in the short silica nanowires at a concentration of 12.5 µg/ml compared to other silica NMs. Therefore, the safe concentration of silica NMs for toxicity, in this study, was considered less than 12.5 µg/ml. These hemorheological results provided insight into the interaction between RBCs and silica NMs; they will also help assess the risk of NMs' toxicity in the blood.

Osmotic deformability of erythrocytes at various shear stresses.

Red blood cell (RBC) deformability is greatly affected by the osmolality, and maximum deformability, which is determined as maximal elongation index (EI(max)), is usually observed in isotonic conditions at high shear stresses (>20 Pa). Therefore, we examined osmotic RBC deformability over a range of shear stresses (0.5-20 Pa). We found that the RBC deformability at low shear stresses (1-3 Pa) was maximum in hypotonic conditions (225-250 mOsm/kg H2O), which is slightly lower than the normal range of osmolality in plasma (290-310 mOsm/kg H2O). The phenomenon that O(max) (the osmolality at EI(max)) is dependent on applied shear stress could play an important role in microcirculation in which osmolality varies widely.