Impact of alternative histopathology protocols in the dermatopathology laboratory: A prospective quality improvement study.

BACKGROUND: Histopathology protocols for processing dermatopathology specimens vary among laboratories. OBJECTIVE: To determine an optimal histopathology protocol to minimize cost and turnaround time (TAT) for biopsy specimens in a dermatopathology laboratory. METHODS: A prospective, 4-month study compared the mean cost and TAT of producing one versus two initial H&E slides, and zero versus three unstained slides that could be used for frequently used special or immunohistochemical (IHC) stains. RESULTS: For all cases, cost was lower for one versus two initial H&E slides, with an insignificant increase in TAT. Producing three vs zero unstained slides incurred higher cost, with no reduction in TAT. In a subset of cases in which frequently used special or IHC stains were performed, cost and TAT were optimized by producing one initial H&E and three unstained slides. CONCLUSION: A protocol of one initial H&E slide and zero unstained slides optimizes cost and TAT in our dermatopathology laboratory. Pigmented lesions and inflammatory dermatoses may benefit from the addition of unstained slides. Further study is needed to quantify this benefit and evaluate for other cases for which an alternative protocol is advantageous.

The role of the pediatric cutaneous and gut microbiomes in childhood disease: A review.

OBJECTIVE: Infancy and early childhood are crucial periods in the development of the human microbiome and shape the trajectory of microbial colonization, immune system development, and systemic disease. We review the development of the skin and gut microbiomes, their connection to the immune system, and their relevance to common pediatric pathologies. FINDINGS: Beginning after birth, and likely even in utero, colonization of the skin and the gut occur in parallel, influenced by external factors. This colonization, in turn, dictates maturation of the immune system and contributes to conditions from atopic dermatitis to sepsis. Emerging literature is identifying links between the gut and skin microbiomes. CONCLUSION: The gut and skin microbiomes are associated with pediatric disease states. Immune and microbial plasticity make this unique period an ideal target for intervention. Investigating the purposeful manipulation of the pediatric microbiome may lead to novel treatment and prevention strategies.

The effects of a 4-week mesocycle of barbell back squat or barbell hip thrust strength training upon isolated lumbar extension strength.

OBJECTIVES: Common exercises such as the barbell back squat (BBS) and barbell hip thrust (BHT) are perceived to provide a training stimulus to the lumbar extensors. However, to date there have been no empirical studies considering changes in lumbar extension strength as a result of BBS or BHT resistance training (RT) interventions. PURPOSE: To consider the effects of BBS and BHT RT programmes upon isolated lumbar extension (ILEX) strength. METHODS: Trained male subjects (n = 14; 22.07 ± 0.62 years; 179.31 ± 6.96 cm; 79.77 ± 13.81 kg) were randomised in to either BBS (n = 7) or BHT (n = 7) groups and performed two training sessions per week during a 4-week mesocycle using 80% of their 1RM. All subjects were tested pre- and post-intervention for BBS and BHT 1RM as well as isometric ILEX strength. RESULTS: Analyses revealed that both BBS and BHT groups significantly improved both their BBS and BHT 1RM, suggesting a degree of transferability. However, the BBS group improved their BBS 1RM to a greater degree than the BHT group (p = 0.050; ∼11.8 kg/10.2% vs. ∼8.6 kg/7.7%, respectively). And the BHT group improved their BHT 1RM to a greater degree than the BBS group (p = 0.034; ∼27.5 kg/24.8% vs. ∼20.3 kg/13.3%, respectively). Neither BBS nor BHT groups significantly improved their isometric ILEX strength. CONCLUSIONS: The present study supports the concept of specificity, particularly in relation to the movement mechanics between trunk extension (including pelvic rotation) and ILEX. Our data suggest that strength coaches, personal trainers, and trainees can self-select multi-joint lower-body trunk extension exercises based on preference or variety. However, evidence suggests that neither the BBS nor BHT exercises can meaningfully increase ILEX strength. Since strengthening these muscles might enhance physical and sporting performance we encourage strength coaches and personal trainers to prescribe ILEX exercise.

Can radiological changes in lymph node volume during treatment predict success of radiation therapy in patients with locally advanced head and neck squamous cell carcinoma?

BACKGROUND: Assessment of nodal response after radiotherapy (RT) for head and neck squamous cell carcinoma is difficult, as both CT and positron emission tomography scanning have limited predictive value for residual disease. We sought to measure changes in nodal volume during RT to determine whether such changes are predictive of nodal disease control. METHODS: Patients with locally advanced head and neck squamous cell carcinoma treated with 70 Gy of radical RT (±chemotherapy or anti-epidermal growth factor receptor (EGFR) antibodies) were eligible. Baseline pre-RT scans and cone-beam CT scans done at the outset of treatment and at weeks 3, 5 and 7 (cone-beam CTs # 1, 2, 3 and 4, respectively) were deformably coregistered, and 3D nodal volumes were measured. RESULTS: Thirty-eight eligible patients were identified. The main primary tumour site was oropharyngeal; most patients had stage IVa disease. Twenty-seven patients received concurrent platinum-based chemotherapy, 10 received only an EGFR inhibitor with RT and one received RT alone. Twelve patients had a failure in the neck. After week 1 of treatment, a 4% mean decrease in nodal volume was observed, increasing to 40% at week 7. Platinum-based chemotherapy achieved significantly greater decreases in nodal volume than EGFR inhibitors (44 vs. 25%; P = 0.026). Advanced tumour stage predicted neck failure (P = 0.002), but nodal volumes did not correlate with neck control. CONCLUSIONS: Changes in nodal volume are minimal initially during RT but accelerate during the latter weeks of therapy. This study suggests that chemotherapy achieves a greater decrease in nodal volume than EGFR inhibitors and that nodal changes do not predict disease control in the neck.

Trismus following treatment of head and neck cancer.

BACKGROUND: The aim of this preliminary study was to determine the prevalence of trismus in head and neck cancer patients treated with radiotherapy with or without concomitant chemotherapy and surgery. METHODS AND MATERIALS: Patients with malignant lesions in the head and neck treated with curative intent were comprehensively evaluated for trismus using subjective and objective measures. RESULTS: A large proportion of the 70 patients recruited demonstrated moderate to severe subjective trismus (45.7%). Similarly, the vast majority of patients showed slight to severe trismus (91.4%) according to objective secondary outcome measures. Of these patients, 21 (65.6%) were also treated with concurrent chemoradiotherapy. When the radiation field involved the pterygoid muscles, 30 (93.8%) patients reported subjective trismus. Similarly, bilateral pterygoid muscle inclusion resulted in 28 (87.5%) patients with trismus. CONCLUSIONS: Trismus is a significantly prevalent consequence of treatment for head and neck cancer. Predictive factors include treatment with concurrent chemoradiotherapy and bilateral inclusion of the structures of mastication in the high-dose radiotherapy volume.

Microvascular changes in radiation-induced oral mucositis.

BACKGROUND: Mucositis is one of the most debilitating side effects of head and neck cancer therapy and is currently believed to arise from an inflammatory cascade leading to cellular damage. However, no effective treatment has been identified despite extensive attempts with anti-inflammatory medications. OBJECTIVE: To compare real-time microvascular inflammatory changes with oral mucositis levels in patients undergoing radiotherapy or chemoradiotherapy for head and neck tumours. DESIGN: Prospective, longitudinal, cohort, observational study. SETTING: Regional cancer program. METHODS: Twenty patients with head and neck tumours were assessed on a weekly basis throughout the course of radiotherapy. Levels of mucositis were graded objectively using the Oral Mucositis Assessment Scale and subjectively using a patient symptom questionnaire. Video imaging of the sublingual microcirculation was obtained using orthogonal polarized spectral imaging to quantify inflammatory markers such as microcirculatory velocity, white blood cell margination, and extravasation. RESULTS: Despite very high levels of objective and subjective mucositis, inflammatory changes were not present in the microcirculation. CONCLUSIONS: Typical microvascular inflammatory changes are not demonstrated in radiation-induced mucositis. These findings contradict the currently proposed mechanism of mucosal damage and may therefore have important implications in the development of novel therapeutic interventions.