The Association of Ethnicity and Oncologic Outcomes for Oral Cavity Squamous Cell Carcinoma (OSCC).

(1) Background: To compare oncologic outcomes of South Asian (SA) patients treated for oral squamous cell carcinoma (OSCC) to the general population. (2) Methods: Adult patients who underwent surgical resection of OSCC +/- adjuvant treatment between 2009 and 2022 (N = 697) at a regional cancer centre in Canada were included. SA patients, identified using a validated method, were compared to non-SA patients. Kaplan-Meier methods were used to compare the primary outcomes, disease-specific survival (DSS) and recurrence-free survival (RFS) across baseline univariate characteristics, including betel nut consumption. Median follow-up time was 36.4 months. Cox proportional hazard models were used to identify independent predictors of survival with significance set at p < 0.05. (3) Results: SA patients (9% of cohort, N = 64) were significantly younger and had lower rates of smoking and alcohol consumption compared to non-SA patients (p < 0.05). SA patients had a two-fold higher risk of recurrence and significantly worse disease-specific survival, even after adjusting for stage and high-risk features [RFS: HR 2.01 (1.28-3.14), DSS: HR 1.79 (1.12-2.88)]. The consumption of betel nut was not associated with outcomes. (4) Conclusions: SA patients had significantly worse oncologic outcomes, even after controlling for known predictors of poor prognosis. These findings are novel and can inform personalized treatment decisions and influence public health policies when managing patients with different ethnic backgrounds.

Concordance of traditional osteometric and volume-rendered MSCT interlandmark cranial measurements.

The statistical quantification of error and uncertainty is inherently intertwined with ascertaining the admissibility of forensic evidence in a court of law. In the forensic anthropological discipline, the robustness of any given standard should not only be evaluated according to its stated error but by the accuracy and precision of the raw data (measurements) from which they are derived. In the absence of Australian contemporary documented skeletal collections, medical scans (e.g. multislice computed tomography-MSCT) offer a source of contemporary population-specific data for the formulation of skeletal standards. As the acquisition of morphometric data from clinical MSCT scans is still relatively novel, the purpose of this study is to assess validity of the raw data that is being used to formulate Australian forensic standards. Six human crania were subjected to clinical MSCT at a slice thickness of 0.9 mm. Each cranium and its corresponding volume-rendered three-dimensional MSCT image were measured multiple times. Whether differences between MSCT and dry bone interlandmark measurements are negligible is statistically quantified; intra- and inter-observer measurement error is also assessed. We found that traditional bone measurements are more precise than their MSCT counterparts, although overall differences between the two data acquisition methods are negligible compared to sample variance. Cranial variation accounted on average for more than 20× the variance explained by MSCT vs. bone measurements. Similarly, although differences between operators were sometimes significant compared to intra-operator variance, they were negligible when compared to sample variance, which was on average 12× larger than that due to inter-operator differences.

Pivoted composite nasal septal flap for reconstruction of the nose.

Reconstruction of nasal tip support and internal lining after excision of nasal carcinoma is challenging. Since its original description by Menick in 1989, the outcomes of bipedicled septal pivot flap are rarely reported in the literature. Objective of this work is to review our results using the Septal pivoted flap in nasal reconstruction. It is a retrospective case series, Dalhousie University, Halifax, Nova Scotia. We studied six patients who underwent significant resection of the tip and dorsum of the nose for squamous or basal cell carcinoma. All involved nasal subunits were removed. Nasal reconstruction was subsequently performed using an inferiorly bipedicled pivoted composite nasal septal flap combined with a regional flap for skin coverage. The bipedicled SPF provided excellent support of the nasal tip in all six cases. All flaps in the cohort survived. Five patients had good mucosal lining from the septal flap alone and only one patient required a concurrent pericranial flap. Three patients experienced bleeding and required additional nasal packing. A bipedicled septal pivoted flap is exceptionally useful in providing a good tip support and well-vascularized nasal lining for reconstruction after major resection of the nasal tip. Bleeding is common and should be anticipated in the majority of patients.

Agroecological practices in combination with healthy diets can help meet EU food system policy targets.

Agroecology has been proposed as a strategy to improve food system sustainability, but has also been criticised for using land inefficiently. We compared five explorative storylines, developed in a stakeholder process, for future food systems in the EU to 2050. We modelled a range of biophysical (e.g., land use and food production), environmental (e.g., greenhouse gas emissions) and social indicators, and potential for regional food self-sufficiency, and investigated the economic policy needed to reach these futures by 2050. Two contrasting storylines for upscaling agroecological practices emerged. In one, agroecology was implemented to produce high-value products serving high-income consumers through trade but, despite 40% of agricultural area being under organic management, only two out of eight EU environmental policy targets were met. As diets followed current trends in this storyline, there were few improvements in environmental indicators compared with the current situation, despite large-scale implementation of agroecological farming practices. This suggests that large-scale implementation of agroecological practices without concurrent changes on the demand side could aggravate existing environmental pressures. However, our second agroecological storyline showed that if large-scale diffusion of agroecological farming practices were implemented alongside drastic dietary change and waste reductions, major improvements on environmental indicators could be achieved and all relevant EU policy targets met. An alternative storyline comprising sustainable intensification in combination with dietary change and waste reductions was efficient in meeting targets related to climate, biodiversity, ammonia emissions, and use of antibiotics, but did not meet targets for reductions in pesticide and fertiliser use. These results confirm the importance of dietary change for food system climate change mitigation. Economic modelling showed a need for drastic changes in consumer preferences towards more plant-based, agroecological and local foods, and for improvements in technology, for these storylines to be realised, as very high taxes and tariffs would otherwise be needed.

The impact of close surgical margins on recurrence in oral squamous cell carcinoma.

BACKGROUND: Close margins influence treatment and outcome in patients with oral squamous cell carcinoma (OSCC). This study evaluates 187 cases of surgically treated OSCC regarding the impact of close margins on recurrence-free survival (RFS) and disease-specific survival (DSS). METHODS: Predictors of worsened outcome were identified using Kaplan-Meier analysis and multivariate Cox regression analysis. RESULTS: Tumour size [HR:1.70(0.95-3.08)], nodal status [HR:2.15(1.00-4.64)], presence of extracapsular spread (ECS) [HR:6.36(2.41-16.74)] and smoking history [HR:2.87(1.19-6.86)] were associated with worsened RFS. Similar factors were associated with worsened DSS. Close margins did not influence RFS or DSS. CONCLUSIONS: While most conventional risk factors for OSCC conferred a worsened outcome, close margins did not. One explanation for this would be that close margins (< 5 mm) are equivalent to clear margins and the cutoff definition for a close margin should be re-evaluated. Lack of standardized pathology could also reduce accuracy of reporting of close surgical margins.

Effect of Fluorescence Visualization-Guided Surgery on Local Recurrence of Oral Squamous Cell Carcinoma: A Randomized Clinical Trial.

Importance: High local recurrence rates with aggressive disease remain the main concern in oral cancer survival. Use of a translational device using fluorescence visualization (FV) approved by the US Food and Drug Administration and Health Canada, has shown a marked reduction in the 3-year local recurrence rate of high-grade oral lesions in a single-center observational study. Objective: To determine whether FV- guided surgery can improve local control rates in the treatment of in situ or T1 to T2 category oral squamous cell carcinoma (OSCC). Design, Setting, and Participants: A multicenter randomized clinical trial was conducted in a surgical setting. A total of 457 patients were enrolled between January 18, 2010, and April 30, 2015. Data analysis of the intention-to-treat population was performed from April 3, 2019, to March 20, 2020. Patients with histologically confirmed high-grade dysplasia/carcinoma in situ or T1 to T2 category OSCC were randomized to receive traditional peroral surgery or FV-guided surgery. Intervention: Fluorescence visualization during surgery. Main Outcomes and Measures: The primary outcome was local recurrence of OSCC. Secondary outcomes were failure of the first-pass margin, defined as a histologically confirmed positive margin for severe dysplasia or greater histologic change of the main specimen (ie, not the margins taken from the resection bed), regional or distant metastasis, and death due to disease. Results: Of the 457 patients enrolled in the study, 443 patients (264 [59.6%] men; mean [SD] age, 61.5 [13.3] years) completed the randomized treatment: 227 FV-guided and 216 non-FV guided surgery. The median follow-up was 52 (range, 0.29-90.8) months. In total, 45 patients (10.2%) experienced local recurrence. The 3-year local recurrence rate was 9.4% in the FV-guided group and 7.2% in the non-FV group (difference, 2.2%; 95% CI, -3.2% to 7.4%). Other similarities between the FV vs non-FV groups included failure of first-pass margin (68/227 [30.0%]) vs 65/216 [30.1%]), regional failure (39/227 [17.2%] vs 37/216 [17.1%]), disease-specific survival (23/227 [10.1%] vs 19/26 [8.8%]), and overall survival (41/227 [18.1%] vs 38/216 [17.6%]) were also similar between groups. No adverse events were judged to be related to the intervention. Conclusions and Relevance: In this randomized clinical trial, FV-guided surgery did not improve local control rates in the treatment of patients with in situ or T1 to T2 category oral cancer. Under a controlled environment, FV-guided surgery did not have an evident effect in reduction of local recurrence for localized OSCC. This result suggests that attention be directed to strategies other than improving definitions of nonapparent disease at clinical margins to identify the sources of local recurrence. Trial Registration: ClinicalTrial.gov Identifier: NCT01039298.

Objectively Monitoring Amyotrophic Lateral Sclerosis Patient Symptoms During Clinical Trials With Sensors: Observational Study.

BACKGROUND: Objective symptom monitoring of patients with Amyotrophic Lateral Sclerosis (ALS) has the potential to provide an important source of information to evaluate the impact of the disease on aspects of real-world functional capacity and activities of daily living in the home setting, providing useful objective outcome measures for clinical trials. OBJECTIVE: This study aimed to investigate the feasibility of a novel digital platform for remote data collection of multiple symptoms-physical activity, heart rate variability (HRV), and digital speech characteristics-in 25 patients with ALS in an observational clinical trial setting to explore the impact of the devices on patients' everyday life and to record tolerability related to the devices and study procedures over 48 weeks. METHODS: In this exploratory, noncontrolled, nondrug study, patients attended a clinical site visit every 3 months to perform activity reference tasks while wearing a sensor, to conduct digital speech tests and for conventional ALS monitoring. In addition, patients wore the sensor in their daily life for approximately 3 days every month for the duration of the study. RESULTS: The amount and quality of digital speech data captured at the clinical sites were as intended, and there were no significant issues. All the home monitoring sensor data available were propagated through the system and were received as expected. However, the amount and quality of physical activity home monitoring data were lower than anticipated. A total of 3 or more days (or partial days) of data were recorded for 65% of protocol time points, with no data collected for 24% of time points. At baseline, 24 of 25 patients provided data, reduced to 13 of 18 patients at Week 48. Lower-than-expected quality HRV data were obtained, likely because of poor contact between the sensor and the skin. In total, 6 of 25 patients had mild or moderate adverse events (AEs) in the skin and subcutaneous tissue disorders category because of skin irritation caused by the electrode patch. There were no reports of serious AEs or deaths. Most patients found the sensor comfortable, with no or minimal impact on daily activities. CONCLUSIONS: The platform can measure physical activity in patients with ALS in their home environment; patients used the equipment successfully, and it was generally well tolerated. The quantity of home monitoring physical activity data was lower than expected, although it was sufficient to allow investigation of novel physical activity end points. Good-quality in-clinic speech data were successfully captured for analysis. Future studies using objective patient monitoring approaches, combined with the most current technological advances, may be useful to elucidate novel digital biomarkers of disease progression.

Thyrotoxicosis Associated with a Hypopharyngeal Toxic Nodular Thyroid.

Ectopic thyroid is a rare developmental anomaly which may be either asymptomatic or present with thyroid dysfunction as well as pressure symptoms. Here we present a novel case of thyrotoxicosis associated with a hypopharyngeal multinodular thyroid in a female. Removal of the ectopic thyroid led to normalization of the thyroid status.

Skeletal age estimation in a contemporary Western Australian population using the Tanner-Whitehouse method.

Various age estimation techniques have been utilised in Australia to evaluate the age of individuals who do not have documentation to determine legal majority/culpability. These age estimation techniques rely on the assessment of skeletal development as visualised in radiographs, CT scans, MRI or ultrasound modalities, and subsequent comparison to reference standards. These standards are not always population specific and are thus known to be less accurate when applied outside of the original reference sample, leading to potential ethical implications. Therefore, the present study aims to: (i) explore the variation in developmental trajectories between the established Tanner-Whitehouse (TW) age estimation standards and a Western Australian population; and (ii) develop specific hand-wrist age estimation standards for the latter population. The present study examines digital anterior-posterior hand-wrist radiographs of 360 individuals 0 to 24.9 years of age, equally represented by sex. Each radiograph was assessed using the RUS, Carpal and 20-bone methods of Tanner et al. The standard error of the estimate (SEE) was calculated for each method (range: ♀ SEE ±0.4-11.5 years; ♂ SEE ±0.9-10.1 years). The most accurate method was TW3 RUS for females and the TW2 Carpal system for males. The 50th centile skeletal maturity scores for each year age group were plotted against average chronological age to produce polynomial regression standards with a demonstrated accuracy of (♀ SEE ±0.09-3.46 years; ♂ SEE ±0.02-3.42 years) for females and males, respectively. The standards presented here can be used in future forensic investigations that require age estimation of hand-wrist bones in a Western Australian population, however, they are not appropriate for establishing age of majority (18 years), as skeletal maturity was attained on average earlier than 15 years of age in both sexes for all three systems examined.

Improving marine water quality by mussel farming: a profitable solution for Swedish society.

Eutrophication of coastal waters is a serious environmental problem with high costs for society globally. In eastern Skagerrak, reductions in eutrophication are planned through reduction of nitrogen inputs, but it is unclear how this can be achieved. One possible method is the cultivation of filter-feeding organisms, such as blue mussels, which remove nitrogen while generating seafood, fodder and agricultural fertilizer, thus recycling nutrients from sea to land. The expected effect of mussel farming on nitrogen cycling was modeled for the Gullmar Fjord on the Swedish west coast and it is shown that the net transport of nitrogen (sum of dissolved and particulate) at the fjord mouth was reduced by 20%. Existing commercial mussel farms already perform this service for free, but the benefits to society could be far greater. We suggest that rather than paying mussel farmers for their work that nutrient trading systems are introduced to improve coastal waters. In this context an alternative to nitrogen reduction in the sewage treatment plant in Lysekil community through mussel farming is presented. Accumulation of bio-toxins has been identified as the largest impediment to further expansion of commercial mussel farming in Sweden, but the problem seems to be manageable through new techniques and management strategies. On the basis of existing and potential regulations and payments, possible win-win solutions are suggested.

Digital radiography in space.

With the permanent habitation of the International Space Station, the planning of longer duration exploration missions, and the possibility of space tourism, it is likely that digital radiography will be needed in the future to support medical care in space. Ultrasound is currently the medical imaging modality of choice for spaceflight. Digital radiography in space is limited because of prohibitive launch costs (in the region of $20,000/kg) that severely restrict the volume, weight, and power requirements of medical care hardware. Technological increases in radiography, a predicted ten-fold decrease in future launch costs, and an increasing clinical need for definitive medical care in space will drive efforts to expand the ability to provide medical care in space including diagnostic imaging. Normal physiological responses to microgravity, in conjunction with the high-risk environment of spaceflight, increase the risk of injury and could imply an extended recovery period for common injuries. The advantages of gravity on Earth, such as the stabilization of patients undergoing radiography and the drainage of fluids, which provide radiographic contrast, are unavailable in space. This creates significant difficulties in patient immobilization and radiographic positioning. Gravity-dependent radiological signs, such as lipohemarthrosis in knee and shoulder trauma, air or fluid levels in pneumoperitoneum, pleural effusion, or bowel obstruction, and the apical pleural edge in pneumothorax become unavailable. Impaired healing processes such as delayed callus formation following fracture will have implications on imaging, and recovery time lines are unknown. The confined nature of spacecraft and the economic impossibility of launching lead-based personal protective equipment present significant challenges to crew radiation safety. A modified, free-floating radiographic C-arm device equipped with a digital detector and utilizing teleradiology support is proposed as a theoretical solution to help overcome many of these difficulties.

Expectantly waiting: a survey of thyroid surgery wait times among Canadian otolaryngologists.

BACKGROUND: Our objective is to highlight discrepancies between actual wait times and perceived appropriate wait times for various thyroid pathologies among Otolaryngology-Head and Neck Surgeons in Canada; and to identify specific diagnoses/pathologies where wait times could be improved. METHODS: A questionnaire was distributed to all practicing CSO-HNS members. Questions focused on actual wait times for initial consults and surgery within individual practices, in the setting of various thyroid pathologies. Respondents were also asked to state wait times that they felt were appropriate for each scenario. Wilcoxon signed-rank tests were performed to determine statistically significant differences between actual and appropriate wait times. RESULTS: For most scenarios, the actual wait times were significantly longer than most physicians felt were appropriate; these scenarios included time to initial consult for undiagnosed nodules, time to surgery for confirmed malignancies, and time to completion thyroidectomy for surgically confirmed malignancies. CONCLUSIONS: Wait times for thyroid consults and surgeries in Canada are longer than physicians feel are appropriate. The authors hope that this survey may spur a move towards a national consensus on appropriate wait times for the treatment of thyroid pathology.

Survival when treating adenoid cystic carcinoma of the external auditory canal: quantitative assessment of case reports.

BACKGROUND: Adenoid cystic carcinoma (ACC) of the external auditory canal is a rare neoplastic condition. The purpose of this study was to conduct a quantitative review of case reports to assess the efficacy of treatment options and assess prognostic factors. METHODS: Cases were identified using PubMed. Kaplan-Meier curves were used to plot overall and disease-free survival. The log-rank test was used to compare survival curves in the univariate analysis for perineural invasion, margin status, and specific treatment modalities. A Cox proportional hazard model was used for multivariate analysis. RESULTS: Sixty-six cases were identified. The univariate analysis suggests an increased overall (p = .03) and disease-free (p = .03) survival for those treated with parotidectomies, whereas temporal bone resection decreased survival (p = .07). There was no overall or disease-free survival advantage using radiation (p = .8). Positive margins decreased both overall (p = .05) and disease-free survival (p = .02). Perineural invasion was not significant. The multivariate analysis confirmed the findings for parotidectomies (p = .02) and temporal bone resections (p = .01). CONCLUSIONS: Although the short-term survival for ACC is high, the risk of metastasis and poor long-term survival is high. In addition to local excision with negative margins, the surgeon should perform a parotidectomy.

Transoral laser microsurgery versus radiation therapy for early glottic cancer in Canada: cost analysis.

OBJECTIVE: There is debate over whether radiation therapy or transoral laser microsurgery (TLM) is the superior treatment for early glottic cancer. Both offer similar cure rates and posttherapy quality of life. One factor that could decide the optimum therapy is cost. Several studies in Europe and the United States show that TLM is the most cost-effective treatment. The goal of this study was to conduct the first cost analysis in Canada on the treatment of early glottic cancer comparing radiation therapy and TLM. DESIGN AND METHODS: The study was conducted retrospectively. TLM and radiation therapy were broken down into individual components, and then the price for each component was summed. SETTING: The study was conducted at the Queen Elizabeth II Health Science Centre in Halifax, Nova Scotia. MAIN OUTCOME MEASURES: The main outcome measure was total cost. RESULTS: It was found that radiation therapy was approximately four times more expensive than TLM. CONCLUSIONS: This study suggests that TLM should be the preferred treatment option for treating early glottic cancer in Canada as it is the most economical and has been shown in previous studies to be as effective as radiation therapy in both cure rates and quality of life.

Incidence of adenoid cystic carcinoma in nova scotia: 30-year population-based epidemiologic study.

INTRODUCTION: Adenoid cystic carcinoma (ACC) of the head and neck is a rare malignancy of salivary gland origin. Few epidemiologic studies exist assessing the incidence of this tumour. The purpose of the current study was to determine the incidence of ACC of the head and neck in Nova Scotia. Furthermore, we assessed survival outcomes based on presentation sites. METHODS: Nova Scotia is an ideal geographic location in which to conduct retrospective case reviews as there are centralized tertiary care centres and minimal population migration. Furthermore, there is an externally and internally validated cancer registry housed in Cancer Care Nova Scotia. Records at Cancer Care Nova Scotia were retrospectively reviewed to identify all reported cases of ACC since 1979. Age-adjusted incidence rates were calculated standardized to the 2001 Canadian population. Survival curves were plotted to allow assessment of overall survival. A log-rank test was used to compare survival curves for age (> 65 and < 65 years old) and presentation sites. RESULTS: One hundred thirty cases of ACC were identified, with 110 presenting as primary tumours in head and neck sites. The mean (standard error) age-adjusted incidence of ACC in Nova Scotia is 4.5 (0.6) cases per 1 000,000. The incidence did not change significantly over time. The most common site of presentation was the minor salivary glands (40%), followed by the submandibular gland (18.2%) and the parotid gland (17.3%). There was no significant difference for overall and disease-free survival between nonsalivary, major salivary, and minor salivary tumours (p = .97). Significant reductions in survival were found for those diagnosed at > 65 years of age (p < .014) and those with a sinus presentation (p < .005). Sixteen percent of all head and neck cancer patients experienced a distant metastasis of their primary tumour. CONCLUSION: ACC of the head and neck is a rare neoplastic condition that most commonly affects the minor and major salivary glands. Although short-term survival is high, nearly half of all patients will develop metastasis or die of complications of local recurrences.

Nitrogen in the Baltic Sea--policy implications of stock effects.

We develop an optimal control model for cost-effective management of pollution, including two state variables, pollution stock and ecosystem quality. We apply it to Baltic Sea pollution by nitrogen leachates from agriculture. We present a sophisticated, non-linear model of leaching abatement costs, and a simple model of nitrogen stocks. We find that significant abatement is achievable at reasonable cost, despite the countervailing effects of existing agricultural policies such as price supports. Successful abatement should lead to lower nitrogen stocks in the sea in 5 years or less. However, the rate of ecosystem recovery is less certain. The results are highly dependent on the rate of self-cleaning of the Baltic Sea, and less so on the discount rate. Choice of target has a radical effect on the abatement path chosen. Cost-effectiveness demands such a choice, and should therefore be used with care when stock effects are present.

Stable isotope analyses and demographic responses counter prospects of planktivory by Caridina (Decapoda: Atyidae) in Lake Victoria.

Caridina nilotica, a freshwater atyid prawn, is a vital component of the Lake Victoria ecosystem. Despite its important role in the food web leading to Nile perch, the diet of Caridina is not well understood. Caridina freshly collected from the inshore littoral and offshore plankton of Lake Victoria were cultured individually under laboratory conditions on (A) decomposing hydrophytes, (B) living hydrophytes, (C) planktonic algae, (D) zooplankton and (E) 35- microm filtered lake water (a 'starvation' control). Inter-moult intervals (IMI, days), size-standardized moult intervals (MI, days mm(-1)), per moult growth increments (PMI, mm) and survivorship (%) were monitored daily for up to 5 weeks. Significant effects of both food type and shrimp source on MI were revealed by ANOVA. MI increased progressively from treatment A to D, and was shorter in offshore than littoral shrimps. Food influence on IMI was confirmed by ANCOVA. PMI values were close to the limits of detection, but were generally in line with MI responses. PMI values were marginal in treatments A and B, and negligible or negative in treatments D and especially E. Survivorship values, although confounded by non-dietary factors, were generally consistent with dietary influences on MI, although values obtained for treatment E were inconsistently high for true starvation. Disparate responses between inshore and offshore shrimps hint at possible ecotypic differentiation, or perhaps the existence of cryptic species. Stable isotope analyses (SIA, delta13C and delta15N signatures) of cultured shrimps were further consistent with their utilization of food type A but not D. SIA signatures of feral shrimps maintained in situ in enclosure bags with three separate potential fresh hydrophyte food sources (Vossia cuspidata, Cyperus papyrus, and Eichhornia crassipes) reflected Caridina's probable dietary reliance on decomposed organic matter with accompanying bacterial exudates. Collections of feral shrimps from various locations yielded parallel SIA results. No support for zooplanktivory by shrimps occupying either inshore littoral/benthic or offshore planktonic habitats is provided by the delta15N signatures obtained from our data, which support Caridina's primary role as a detritivore.