Prognostic value of the posterior cricoarytenoid muscle atrophy in computerized tomography scans for unilateral vocal fold paralysis recovery.

OBJECTIVES: To evaluate the prognostic value of the posterior cricoarytenoid (PCA) muscle atrophy observed on neck computed tomography (CT) in patients with unilateral vocal fold paralysis. METHODS: CT images of 87 subjects with unilateral vocal fold paralysis (UVFP) were evaluated to analyze the PCA muscle atrophy and to measure the severity of the PCA muscle atrophy in semi-quantitative manner. The grading of the PCA muscle atrophy was compared with the recruitment pattern of laryngeal electromyography (LEMG) and restoration of vocal fold movement. RESULTS: The PCA muscle was identifiable on CT in 73 subjects. Using the PCA muscle atrophy as an indicator of UVFP, we correctly predicted the paralysis in 69 (94.5%). Grade of the PCA muscle atrophy is significantly correlated with recruitment pattern of LEMG. If the positive result is defined as the PCA muscle showed moderate to severe degree of atrophy, we could predict the persistent UVFP in 88% of patients. CONCLUSIONS: PCA muscle atrophy identified on CT scan in patients with UVFP, is associated with low rates of return of mobility in the affected vocal fold.

Outcome of Cochlear Implantation in Prelingually Deafened Children According to Molecular Genetic Etiology.

OBJECTIVES: About 60% of Korean pediatric cochlear implantees could be genetically diagnosed (GD) and we previously reported that a substantial portion of undiagnosed cases by deafness gene panel sequencing were predicted to have a nongenetic or complex etiology. We aimed to compare the outcomes of cochlear implantation (CI) in GD and genetically undiagnosed (GUD) patients and attempted to determine CI outcomes according to etiology. DESIGN: Ninety-three pediatric cochlear implantees underwent molecular genetic testing. Fifty-seven patients carried pathogenic variants and 36 patients remained GUD after panel sequencing of 204 known or potential deafness genes (TRS-204). Among them, 55 cochlear implantees with reliable speech evaluation results with a follow-up of longer than 24 months were recruited. Longitudinal changes in the audiologic performance were compared between the GD (n = 31) and GUD (n = 24) groups. The GD group was subdivided into cochlear implantee with SLC26A4 mutations (group 1) and cochlear implantee with other genetic etiology (group 2), and the GUD group was subdivided into groups 3 and 4, that is, patients with or without inner ear anomaly, respectively. RESULTS: Group 1 related to SLC26A4 mutations had the highest categories of auditory perception scores among all groups pre- and postoperatively. Group 4 with inner ear anomaly had the lowest categories of auditory perception scores. At 24 months post-CI, the group 2 with another genetic etiology had significantly better outcomes than molecularly undiagnosed group 3, which had with the same condition as group 2 except that the candidate gene was not detected. This finding was recapitulated when we limited cases to those that underwent CI before 24 months of age to minimize age-related bias at implantation. Furthermore, on extending the follow-up to 36 months postoperatively, this tendency became more prominent. Additionally, our preliminary clinical data suggest a narrower sensitive window period for good CI outcomes for implantees with OTOF mutation rather than the GJB2 and other genes. CONCLUSIONS: Current molecular genetic testing including deafness panel sequencing helps to predict the 2-year follow-up outcomes after CI in prelingually deafened children. GD cochlear implantees show better functional outcomes after CI than undiagnosed cochlear implantees as determined by deafness panel sequencing, suggesting a genotype-functional outcome correlation. The genetic testing may provide a customized optimal window period in terms of CI timing for favorable outcome according to genetic etiology.

Is There Any Age Cutoff to Treat Elderly Patients with Head and Neck Cancer? Comparing with Septuagenarians and Octogenarians.

With the increase in life expectancy, age is no longer considered as a limitation for treatment. Nevertheless, the treatment of elderly patients with head and neck cancer (HNC) remains controversial. Here, we aimed to review our experience with the treatment for elderly patients, while particularly focusing on the differences among older old patients (septuagenarians vs. octogenarians). We retrospectively reviewed the records of 260 elderly patients who were assigned to 3 groups according to age: 70 years old ≤ group 1 < 75 years old, 75 years old ≤ group 2 < 80 years old, and group 3 ≥ 80 years old. The patients were assessed for comorbidities using the Adult Comorbidity Evaluation (ACE)-27, and the American Society of Anesthesia (ASA) physical status was also compared. Group 1, 2, and 3, consisted of 97, 102, and 61 patients, respectively. No significant difference in demographic data was noted among the groups. However, group 3 showed more comorbidities than groups 1 and 2. With regard to the initial treatment for HNC, radiation therapy (RT) was more frequently performed in group 3 than in groups 1 and 2. Among 7 patients of non-compliant to treatment in group 3, 6 patients had have performed RT. In group 3, a total of 18 patients underwent surgery, including microvascular free flap reconstruction and no significant difference in complications was observed postoperatively compared with group 1 and 2. Moreover, no significant difference was noted in overall survival between the groups, regardless of the treatment modality chosen. In conclusion, octogenarians with HNC should be more carefully managed than septuagenarians with HNC. Surgical treatment can be considered in octogenarians with HNC, if it can be tolerated.

Functional Outcomes of Single-Stage Facial Reanimation Surgery With Radical Parotidectomy.

OBJECTIVES: Facial nerve sacrifice during radical parotidectomy can impair quality of life. This study assessed the effectiveness of single-stage facial reanimation surgery performed concurrently with radical parotidectomy in restoring facial function. METHODS: A retrospective analysis was conducted on patients who underwent single-stage facial reanimation combined with radical parotidectomy. The techniques employed included selective reinnervation and orthodromic temporalis tendon transfer. Outcomes were evaluated using the modified House-Brackmann and Terzis grading systems, Emotrics facial assessment, and the Facial Disability Index (FDI). RESULTS: Among the 13 patients studied (median age, 54 years; 69% male), 10 underwent selective reinnervation. Of these, nine patients demonstrated improvement, achieving House-Brackmann grade III and Terzis grade 4 or 5. The other three patients underwent tendon transfer and achieved moderate functional outcomes. Emotrics analysis revealed balanced facial symmetry in the selective reinnervation group. Furthermore, FDI scores indicated satisfactory physical and social/well-being functions. CONCLUSION: Single-stage facial reanimation effectively restores facial function in patients undergoing radical parotidectomy. This approach offers meaningful benefits in the early recovery of facial function.

Prolonged Positional Downbeat Nystagmus in Benign Paroxysmal Positional Vertigo: A Case Report and Literature Review.

Purpose This study aimed to report an unusual case of benign paroxysmal positional vertigo (BPPV), who showed prolonged positional downbeat nystagmus without latency and was diagnosed with cupulolithiasis of the anterior canal (AC). We compared this case with one of typical AC-BPPV, and possible mechanisms underlying the atypical characteristics were discussed. Method Two patients diagnosed with AC-BPPV were reported. Positional testing using video-oculography goggles was performed, and outcomes were measured via medical records and analysis of videos of the nystagmus. Results Downbeat nystagmus was observed in the contralateral Dix-Hallpike test in both cases. The torsional component was subtle or absent, but motion was induced toward the affected ear. The two cases differed in latency and duration of vertigo, as well as habituation. The patient with atypical nystagmus showed little or no latency and longer duration. Moreover, there was no habituation on repeated tests. The nystagmus showed several differences from that of typical AC-BPPV. Conclusions Based on our case, AC-BPPV may induce various unusual clinical manifestations of nystagmus. Accurate diagnosis requires careful consideration of the patient's symptoms and the characteristics of the nystagmus. Supplemental Material https://doi.org/10.23641/asha.14265356.

Three-Dimensional Printed Design of Antibiotic-Releasing Esophageal Patches for Antimicrobial Activity Prevention.

Pharyngoesophageal defects can cause exposure to various bacterial flora and severe inflammation. We fabricated a biodegradable polycaprolactone (PCL) patch composed of both thin film and three-dimensional (3D) printed lattice, and then investigated the efficacy of pharyngoesophageal reconstruction by using 3D printed antibiotic-releasing PCL patches that inhibited early inflammation by sustained tetracycline (TCN) release from both thin PCL films and printed rods implanted in esophageal partial defects. PCL was 3D printed in lattice form on a presolution casted PCL thin film at ∼100 µm resolution. TCN was loaded onto the PCL-printed patches by 3D printing a mixture of TCN and PCL particles melted at 100°C. TCN exhibited sustained release in vitro for over 1 month. After loading TCN, the patches showed decreased tensile strength and Young's modulus, and less than 20% TCN was slowly released from the 2.5% TCN-loaded PCL patches over 150 days. Cytotoxicity tests of extract solutions from patch samples demonstrated excellent in vitro cell compatibility. Antibiotic-releasing PCL patches were then transplanted into partial esophageal defects in rats. Microcomputed tomography analysis revealed no leak of orally injected contrast agent in the entire esophagus. Tissue remodeling was examined through histological responses of M1 and M2 macrophages. In particular, the 1% and 3% TCN patch groups exhibited significant muscle layer regeneration by desmin immunostaining. Further histological and immunofluorescence analyses revealed that the 1% and 3% TCN patch groups exhibited the best esophageal regeneration according to reepithelialization, neovascularization, and elastin texture around the implanted sites. Our antibiotic-releasing patch successfully consolidates the regenerative potential of esophageal muscle and mucosa and the antibacterial activity of TCN for 3D esophageal reconstruction. Impact statement Anastomosis site leakage and necrosis after pharyngoesophageal transplantation inevitably causes mortality because the mediastinum and neck compartments become contaminated. Herein, we present antibiotic-releasing pharyngoesophageal patch that prevents saliva leakage and has an antimicrobial effect. We have demonstrated antibiotic release profile and mechanical properties for esophageal transplantation. Upon esophageal transplantation of antibiotic-releasing polycaprolactone patches, antimicrobial effects and muscle regeneration around the graft sites were clearly identified in the group containing 1% and 3% of tetracycline. The esophageal graft led to the remarkable recovery throughout reepithelialization, neovascularization, and elastin texture of around the implanted sites. We believe that current system is capable of various applications that require antibacterial in vivo.

Ammonia Emission Sources Characteristics and Emission Factor Uncertainty at Liquefied Natural Gas Power Plants.

This study developed the NH3 emission factor for Liquefied Natural Gas (LNG) power facilities in Korea by analyzing the emission characteristics from two LNG power plants using methods such as uncertainty analysis. Also, comparing the differences in NH3 emission levels between the developed emission factors, which reflect the characteristics in Korea, and the U.S. Environmental Protection Agency (EPA) values currently applied in Korea. The estimation showed that the NH3 emission factor for the LNG power plants was 0.0054 ton NH3/106Nm3, which is approximately nine times less than the EPA NH3 emission factor of 0.051 ton NH3/106Nm3 for LNG fuels of the industrial energy combustion sector currently applied in national statistics in Korea. The Selective Catalytic Reduction (SCR) emission factor for LNG power plants was 0.0010 ton NH3/106Nm3, which is considerably lower than the EPA NH3 emission factor of 0.146 ton NH3/106Nm3 currently applied in national statistics in Korea for the LNG fuels of the industrial process sector. This indicated the need for developing an emission factor that incorporates the unique characteristics in Korea. The uncertainty range of the LNG stack NH3 emission factor developed in this study was ±10.91% at a 95% confidence level, while that of the SCR NH3 emission factor was -10% to +20% at a 95% confidence level, indicating a slightly higher uncertainty range than the LNG stack. At present, quantitative analysis of air pollutants is difficult because numerical values of the uncertainty are not available. However, quantitative analysis might be possible using the methods applied in this study to estimate uncertainty.

Accelerated elimination of human cancer cells by a CD40 agonist antibody combined with a PD-1 antagonist in CD4-depleted mice.

The elimination of residual microscopic cancer cells is important cancer treatment. The immunoediting theory describes the balance between the immune system and cancer cells. The current study investigated changes in the immune system during the elimination of cancer cells and evaluated the influence of cluster of differentiation (CD)4 or CD8 depletion. A human squamous cell cancer cell line (SNU1041) was injected in the lateral tongue of immunocompetent mice and the changes in the CD4, CD8, CD11b, CD19, CD40 and CD40 ligand (L) populations in the blood, lymph nodes and spleen were evaluated using flow cytometry, and changes in serum cytokine levels were evaluated using a magnetic bead panel. Cancer cell elimination was delayed by CD4 depletion but not by CD8 depletion. The CD8-depleted group indicated increased levels of CD40L, interferon-gamma, interleukin (IL)-10, IL-6, and tumor necrosis factor-α. It was concluded that CD4 served a crucial role in the elimination of human cancer cells. Furthermore, the efficacies of CD40 agonist and programmed cell death protein 1 (PD1) antagonist treatments were assessed in CD4-depleted mice. CD40 agonist treatment resulted in faster cancer cell elimination and increased cytokine excretion. In conclusion, CD4 or CD40L significantly influenced cancer elimination. CD40 agonist antibodies may be potent adjuvant agents that can be used in patients with reduced CD4 or CD40L expression.

Changes in immune markers in tumor-free lymph node and peripheral blood of malignant head and neck cancer patients.

BACKGROUND: Immunoediting theory, which explains the balance between the host immunity and cancer cells, could suggest a new way to reduce the recurrence of cancer. This study aimed to compare changes in immune cells in tumor-free lymph node and peripheral blood according to their malignancy, disease status, and prognosis. METHODS: From October 2016 to August 2017, 26 malignant and 14 benign cases were enrolled, and the tumor-free lymph node and peripheral blood were harvested during the surgery. The proportions of cluster of differentiation 4 (CD4), CD8, CD19, CD33, CD40, and CD40 ligand (CD40L) expression and cytokine levels in the serum were compared between the malignant and benign patients. Furthermore, among the malignant group, the changes occurring due to the disease progression or recurrence were evaluated. RESULTS: In the malignant patients, a significantly decreased proportion of cells expressing CD8 and CD40 in the peripheral blood was observed compared to benign patients. In the advanced stage (stage III or IV) and in patients with extracapsular spread, significant decrease in CD33 cells in tumor-free lymph nodes could be observed. On performing a survival analysis based on the recurrence, patients with interferon-γ (IFNγ) level greater than 16 pg/mL exhibited significantly higher recurrence rate, and this higher level of IFNγ was associated with distant metastasis. CONCLUSIONS: Immune markers exhibiting clinical significance differ from each other based on the comparison between benign and malignant groups, between advanced and early cancer, and between recurrence and nonrecurrence. And this result suggests that research in the immune system is likely to have an important effect on future treatment.

Comparison of risk of malignancy in a subgroup with atypia of undetermined significance/follicular lesion of undetermined significance: A meta-analysis.

BACKGROUND: As heterogeneous findings are included in the atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) category, differing risks of malignancy in subgroups have been reported in several articles. METHODS: We performed a meta-analysis of full-text publications written in English found in the Embase and PubMed databases. RESULTS: The 4-tiered subgroup proportion meta-analysis showed that the 95% confidence interval (95% CI) of the risk of malignancy in the cellular atypia group did not overlap with the other 3 subgroups and demonstrated a significant difference. Two-tiered analysis using the cytologic and architectural atypia groups showed that cytologic atypia group had a 2.64-fold increase in the risk of malignancy compared with the architectural atypia group. CONCLUSION: The cytologic atypia had a significantly higher risk of malignancy than the architectural atypia group, and it should be considered as a separate category.

Differences in Clinical Features Between Subcategories of "Atypia/Follicular Lesion of Undetermined Significance".

Within the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), category III (atypia or follicular lesion of undetermined significance (AUS/FLUS)) comprises specimens with heterogeneous features and the need for subcategorization has been reported. We compared the clinical features of two subgroups from within the category of AUS/FLUS to determine precise guidelines for clinicians who explain the results of fine-needle aspiration (FNA) to patients. Retrospective review was performed including data from all patients who underwent FNA with results reported as AUS/FLUS at a single tertiary hospital from January 2010 to August 2014. The results of repeated FNA, core needle biopsy, and diagnostic surgery were analyzed. Of the 903 patients with results categorized as AUS/FLUS, 500 were subcategorized as cellular atypia and 160 as architectural atypia. On repeated biopsy, diagnostic results were obtained for 78.9% patients of the cellular atypia group, compared to only 54.3% of the architectural atypia group (p < 0.0001). The rate of neoplasm or malignancy was also significantly higher in the cellular atypia group compared to the architectural atypia group (51.8 vs. 25.2%, p < 0.0001, 48.2 vs. 14.2%, p < 0.0001). Therefore, clinicians can inform patients with architectural atypia that the risk of malignancy is low. However, the high rate of non-diagnostic results on repeated biopsy makes clinical decisions difficult. The data of the present study revealed the necessity of subcategorization of category III of TBSRTC in the future.

Effect of Celecoxib on Survival of Mobile Tongue Cancer.

AIM: The goal of the present study was to evaluate the effects of celecoxib on treatment outcomes of squamous cell carcinoma of the mobile tongue. PATIENTS AND METHODS: Among 158 patients who were diagnosed with mobile tongue cancer, 19 received celecoxib during the preoperative, postoperative, or post-recurrence phase. Differences in disease-specific survival (DSS) and recurrence-free survival (RFS) between patients who received celecoxib (study group) and those who did not (control group) were analyzed. RESULTS: For the entire cohort, DSS and RFS were not significantly different according to duration of celecoxib treatment (p=0.293 and 0.703, respectively). Among patients who received chemotherapy, DSS was significantly higher in the study group than in the control group (p=0.048), but RFS was not different between the two groups (p=0.117). CONCLUSION: When combined with chemotherapy, celecoxib may have a beneficial effect on the survival of patients with mobile tongue cancer.