Clinical practice guidelines on nutrition management in head and neck cancer: a systematic quality appraisal using the Appraisal of Guidelines for Research and Evaluation 2nd edition instrument.

OBJECTIVE: Several guidelines have been produced for the management of nutrition in patients with head and neck cancer. However, no systematic evaluation of the quality of these guidelines has been performed to date. METHOD: A comprehensive search was conducted up to August 2020. The quality of guidelines was assessed by four independent reviewers using the Appraisal of Guidelines for Research and Evaluation, 2nd edition. RESULTS: Nine guidelines were assessed for critical evaluation. Only two guidelines were classified as 'high quality'. The 'scope and purpose' domain achieved the highest mean score (75.5 ± 17.0 per cent), and the lowest domain mean score was 'applicability' (37.6 ± 23.0 per cent). CONCLUSION: These findings highlight the variability in the methodological quality of guidelines for the management of nutrition in head and neck cancer. These results may help to improve the reporting of future guidelines and guide the selection for use in clinical practice.

Infection after endoscopic ultrasound-guided aspiration of mediastinal cysts.

Foregut duplication cysts are rare congenital anomalies of enteric origin that arise during early embryonic development. They are usually incidentally found on routine imaging studies. The diagnosis can usually be made by computed tomography (CT) and endoscopic ultrasound (EUS) appearance. On CT, cyst attenuation values usually measure 0+/-20 Hounsfield units (HU). Higher HU is possible with hemorrhage, proteinaceous material or septations. At EUS, characteristic location and anechoic as well as hypoechoic but not necessarily anechoic appearance may be suggestive of a foregut duplication cyst. EUS-guided fine needle aspiration (FNA) has been thought to provide a safe, minimally invasive approach to establish the diagnosis. The purpose of this report is to highlight the potential for infectious risk of EUS-FNA for these cysts, and to suggest CT and EUS features that can suggest this diagnosis without FNA. Three patients who underwent EUS-FNA for diagnosis of incidental mediastinal lesions developed cyst infection despite accepted techniques including prophylactic antibiotics. Combined CT and EUS appearance may be sufficient in making this diagnosis without FNA. IV antibiotics may not be completely protective against infectious complications of FNA of mediastinal duplication cysts.

Alterations in AMPA receptor phosphorylation in the rat striatum following acute and repeated cocaine administration.

Protein phosphorylation is an important mechanism for the posttranslational modulation of ionotropic glutamate receptors and is subject to regulation by changing synaptic inputs. In this study, we investigated the regulation of alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) receptor GluR1 subunit phosphorylation by cocaine exposure in the rat dorsal striatum in vivo. We found that acute cocaine challenge followed by 6 days of repeated systemic injections of cocaine (20 mg/kg once daily) enhanced the sensitivity of the GluR1 subunit in its phosphorylation at serine 831 (Ser831) in the dorsal striatum. This enhancement of the sensitivity of Ser831 phosphorylation was reduced, at the receptor and ion channel level, by blocking (1) group I metabotropic glutamate receptors (mGluRs), (2) N-methyl-D-aspartate receptors, and (3) L-type voltage-operated Ca(2+) channels. Similar reduction of the enhancement was also induced, at the protein kinase level, by inhibiting (1) protein kinase C, (2) calcium/calmodulin-dependent protein kinases, and (3) c-Jun N-terminal kinases. In addition, inhibition of protein phosphatase 1/2A or calcineurin increased GluR1-Ser831 phosphorylation in the dorsal striatum of normal rats, whereas inhibition of these phosphatases did not further enhance the Ser831 phosphorylation in rats pretreated with 7 daily injections of cocaine. These data suggest that the phosphorylation of AMPA receptor GluR1 subunits at Ser831 is subject to upregulation by acute and repeated cocaine administration. Complex signaling integrations among glutamate receptors, Ca(2+) channels, protein kinases, and protein phosphatases participate in this upregulation.

Bovine pericardium for dural graft: clinical results in 22 patients.

BACKGROUND: Bovine pericardium has widely been used for grafts in cardiac surgery and seems to have suitable properties for use as a dural graft. We report our experience of using locally processed bovine pericardium for dural grafts in 22 patients undergoing cranial operations. METHODS: 22 patients were analysed prospectively and followed-up for a maximum 3 years. All available records and information regarding the indication for grafting, graft size, complications and outcome were collected and analysed. RESULTS: Indications for grafting included neurosurgical, tumour, congenital and trauma patients. Outcomes were classified as good or excellent in 20 patients, whereas in two patients death was not related to surgical closure but more to malignant intracranial hypertension. In no patient was the dural graft a significant factor in the outcome. Bovine pericardium was found to be easily sutured and watertight using standard 4-0 silk suture. This material is relatively inexpensive compared to other non-synthetic grafts. CONCLUSION: In this clinical assessment, our bovine pericardium better known as Lyolemb was found to be an excellent dural graft material for local and eventual international consumption.

Two-phase helical CT for detection of early gastric carcinoma: importance of the mucosal phase for analysis of the abnormal mucosal layer.

PURPOSE: To evaluate the efficacy of two-phase dynamic helical computed tomography (CT), including the gastric mucosal phase, for detection of early gastric carcinoma with typical hyperattenuating and atypical nonhyperattenuating enhancement patterns. METHOD: Two-phase helical CT scanning was performed using the water-filling method as negative oral contrast material for 212 patients with proven adenocarcinoma on endoscopic biopsy. Two gastrointestinal radiologists prospectively analyzed the focal alterations of the inner hyperattenuating mucosal layer and the outer hypoattenuating layer before the information obtained at barium study and pathologic examination was available. The first, so-called mucosal phase was obtained at 38-45 seconds after the start of intravenous injection of contrast material for a total of 150 ml/sec at a rate of 4 ml/sec to obtain maximum enhancement of the inner mucosal layer. The second delayed phase was obtained at 3 minutes. RESULTS: Fifty-four cases of early gastric cancer were suspected on two-phase helical CT preoperatively. Postoperatively, 49 cases of early gastric cancer were pathologically confirmed. The detection rate for the typical hyperattenuating early gastric cancer, that is the type I enhancement pattern defined as the localized thickening of the inner hyperattenuating layer, using two-phase helical CT was 18% (9/49 patients). The type 2 enhancement pattern, defined as the focal interruption of the inner hyperattenuating mucosal layer without abnormal enhancement of the outer hypoattenuating layer on the mucosal phase, was seen in 15 cases. These were pathologically confirmed as early gastric cancer IIb + IIc (three patients), IIc (four patients), IIc + IIa (one patient), IIc + III (three patients), IIb + IIc (one patient), and advanced cancer (T2) lesions (three patients). The type 3 enhancement pattern was defined as the focal polypoid protrusion of the inner hyperattenuating layer without abnormal enhancement of the outer thickened hypoattenuating layer on the mucosal phase, and was seen in seven patients who were pathologically confirmed with early gastric cancer IIb + IIc (three patients), IIc + IIa (one patient), and IIc + lIb (three patients). The lesions became less distinct on the delayed phase. Five T2 advanced gastric cancers were falsely interpreted as early gastric cancer. The detection rate for early gastric cancer after considering type 2 and 3 atypical enhancement patterns was increased to 57% (28/49 patients). CONCLUSION: Helical CT with two-phase scan including the mucosal phase was efficient for identifying the enhancement patterns of early gastric cancer.

History, implementation, and current status of the National Spinal Cord Injury Database.

OBJECTIVE: To summarize a 25-year history of the Model Spinal Cord Injury Program and the coexistent National Spinal Cord Injury Database and provide the status of the Database with a discussion of the strengths and weaknesses. DESIGN: Inception cohort. SETTING: Model spinal cord injury systems throughout the United States. RESULTS: As of September 1998, the National Spinal Cord Injury Database included abbreviated registry records on 6,085 new patients, more complete initial injury and hospitalization records on 18,969 new patients, and 78,627 annual follow up records on those persons. Although stability and continuity of the Database has been a priority since it was started, some changes were needed to meet the changes in health care, health care policy, and new technology. CONCLUSION: This large database can now provide a wealth of information about short- and long-term outcomes, provide data on which future health care policies can be evaluated, and act as a source for answers to future research questions.

Recent demographic and injury trends in people served by the Model Spinal Cord Injury Care Systems.

OBJECTIVE: To identify trends in the demographic and injury data of persons with spinal cord injury (SCI). DESIGN: Consecutive case series. SETTINGS: Model Spinal Cord Injury Care Systems throughout the United States. PATIENTS: A total of 25,054 persons admitted to a Model Spinal Cord Injury Care System within 365 days of injury between 1973 and 1998. RESULTS: Many trends and changes have been noted in the clinical features of patients who have been admitted to the Model SCI Care Systems. Average age at time of injury is rising; persons older than 60 comprise 11.5% of all persons enrolled in the National Database during the 1994-1998 period. Although the overall male-to-female ratio is greater than 4:1, the proportion of males has decreased significantly in recent years. Violence-related injuries have increased dramatically from 13.9% in 1973-1977 to 21.8% in 1994-1998. Since 1973, the proportions of injuries resulting from vehicular crashes and sports declined while injuries from falls increased. Injury continues to occur most commonly in the summer. When age, race, and gender are considered, violence is a more common cause of injury among individuals who are younger, male, or African American. Complete injuries were more common among younger individuals and among men than among older adults and women. CONCLUSION: Trends in the national database provide valuable data for tracking groups at risk for traumatic SCI.

Pulmonary nodules resected at video-assisted thoracoscopic surgery: etiology in 426 patients.

PURPOSE: To determine the etiology of pulmonary nodules resected at video-assisted thoracoscopic surgery (VATS) and establish the probabilities that single or multiple nodules resected at VATS represent malignancy in patients with or patients without known cancer. MATERIALS AND METHODS: Pathology reports from VATS performed between January 1995 and July 1997 were searched for data on gross specimens revealing pulmonary nodules 3 cm or smaller. Findings were correlated with clinical and histologic data. RESULTS: In 254 patients with one nodule resected at VATS, the nodules were malignant in 108 patients with and in 32 patients without known cancer (P < .03). Among 172 patients with multiple nodules resected, at least one nodule was malignant in 85 patients with and in 20 patients without known cancer (P > .05). Nodules larger than 1 cm were more likely to be malignant than were smaller nodules (P < .002). In patients with known malignancy, nodules smaller than 0.5 cm were more likely to be benign, whereas nodules larger than 0.5 cm but smaller than 1 cm were more likely to be malignant (P < .001). CONCLUSION: A single pulmonary nodule resected at VATS was more likely to be malignant in patients with known cancer. Nodules larger than 1 cm but smaller than 3 cm resected at VATS were more likely to be malignant. Nodules smaller than 0.5 cm were more likely to be benign.

The relationship between resting systolic blood pressure and cutaneous pain perception in cardiac patients with angina pectoris and controls.

In order to determine the influence of resting systolic blood pressure and stable angina on cutaneous pain perception, we studied 19 male cardiac patients with stable angina and 16 male controls. Pain perception was measured using a suprathreshold evaluation of pain intensity and pain unpleasantness to a series of thermal stimuli. We found that men with higher resting blood pressure had a decrease in the perception of pain intensity and pain unpleasantness. Similarly, we found that patients with stable angina perceived pain as less intense and unpleasant than controls. These differences in pain perception may be associated with different pain mechanisms: in the case of blood pressure, differences in opioid activity and baroreceptor-regulated pain systems; in the case of stable angina, patients may adapt to continued experiences of pain, altering internal frames of reference.

Association of systolic blood pressure at time of myocardial ischemia with angina pectoris during exercise testing.

In a sample of 306 patients with positive treadmill test results, we found that patients with silent ischemia had a higher systolic blood pressure at onset of ST depression than patients with painful ischemia. We conclude that systolic blood pressure at the time of ischemia influences the experience of angina during exercise in a manner consistent with acute activation of baroreceptors and resulting antinociception.

Mutations altering the mitochondrial-cytoplasmic distribution of Mod5p implicate the actin cytoskeleton and mRNA 3' ends and/or protein synthesis in mitochondrial delivery.

The Saccharomyces cerevisiae MOD5 gene encodes proteins that function in three subcellular locations: mitochondria, the cytoplasm, and nuclei (M. Boguta, L.A. Hunter, W.-C. Shen, E. C. Gillman, N. C. Martin, and A. K. Hopper, Mol. Cell. Biol. 14:2298-2306, 1994; E. C. Gillman, L. B. Slusher, N. C. Martin, and A. K. Hopper, Mol. Cell. Biol. 11:2382-2390, 1991). A mutant allele of MOD5 encoding a protein (Mod5p-I,KR6) located predominantly in mitochondria was constructed. Mutants defective in delivering Mod5p-I,KR6 to mitochondria were sought by selecting cells with increased cytosolic activity of this protein. Twenty-five mutants defining four complementation groups, mdp1, mdp2, mdp3, and mdp4, were found. They are unable to respire at 34 degrees C or to grow on glucose medium at 38 degrees C. Cell fractionation studies showed that mdp1, mdp2, and mdp3 mutants have an altered mitochondrial-cytoplasmic distribution of Mod5p. mdp2 can be suppressed by ACT1, the actin-encoding gene. The actin cytoskeleton organization is also aberrant in mdp2 cells. MDP2 is the same as VRP1 (S. F. H. Donnelly, M. J. Picklington, D. Pallotta, and E. Orr, Mol. Microbiol. 10:585-596, 1993). MDP3 is identical to PAN1, which encodes a protein that interacts with mRNA 3' ends and affects initiation of protein synthesis (A. B. Sachs and J. A. Deardoff, Cell 70:961-973, 1992). These results implicate the actin cytoskeleton and mRNA 3' ends and/or protein synthesis as being as important for protein distribution in S. cerevisiae as they are for distribution of cytosolic proteins in higher eukaryotes. This provides the potential to apply genetic and molecular approaches to study gene products and mechanisms involved in this type of protein distribution. The selection strategy also offers a new approach for identifying gene products involved in the distribution of proteins to their subscellular destinations.

Outcomes of post-spinal cord injury marriages.

The purpose of this study was to compare the divorce rate among persons who got married after spinal cord injury with that of the non-spinal cord-injured population of comparable age and gender and to identify factors associated with increased likelihood of divorce. The study included 622 persons enrolled in the National Spinal Cord Injury Statistical Center data set since 1973. These persons were followed between 1 and 15 years after their marriage (mean = 3.5 years). The status of each marriage was determined at the time of their most recent routine annual follow-up examination. Overall, 126 divorces occurred, whereas 74 were expected, based on 2,190 person-years of follow-up and age-sex-specific annual divorce rates for the United States population. Men and remarried persons had divorce rates 2.07 times and 1.80 times higher, respectively, than women and persons married for the first time. The divorce rate was 1.85 times higher among persons without college educations and was lower for persons with lumbosacral injuries than for persons with higher injury levels. In general, the impact of spinal cord injury appears to be almost as great on postinjury marriages as it is on preexisting marriages. However, this study yields descriptive rather than causal information. Other factors must be identified before a clinically useful model to predict persons at high risk for divorce can be developed.

A cross-sectional study of the relationship between age and current health status for persons with spinal cord injuries.

As life expectancies of persons with spinal cord injuries increase, this population is aging rapidly. This trend requires that increasing attention be given to the healthcare needs of older persons with spinal cord injury. Follow up data on 11,117 persons injured since 1973 were analyzed by current age at 15-year intervals. Mean time postinjury was 4.7 years. Several trends were observed when comparing persons currently in the 16-30 year age group with persons in the oldest age group (age 76+). The percentage of persons independent in selfcare decreased from 61.9% to 29.1%. Ventilator use increased from 1.7% to 4.3%. Nursing home residence increased from 1.4% to 22.2%. The percentage of persons rehospitalized during the most recent year increased from 26.5% to 33.7%. Age was an important predictor of health status, but time postinjury was less important, perhaps due to the study's short postinjury time frame. While few differences in health status were observed in individuals between 16 and 60 years of age, persons in the oldest two age groups demonstrated lower levels of health status than younger individuals.

Trends in spinal cord injury demographics and treatment outcomes between 1973 and 1986.

A study of the National Spinal Cord Injury Statistical Center database on 6,563 persons treated at Spinal Cord Injury Care Systems was conducted to detect demographic and treatment outcome trends over time. Data from the initial hospitalization and first two years postinjury were divided into four time periods based on injury year (1973 to 1977, 1978 to 1980, 1981 to 1983, 1984 to 1986). Between 1973 and 1986, mean age at injury increased, as did the percentage of nonwhites and the percentage of persons with quadriplegia, while the percentage of neurologically complete lesions decreased. There was an increase in long-term use of intermittent catheterization. Ventilator use during hospitalization also increased. Mean lengths of stay for acute care and rehabilitation decreased, although mean inflation-adjusted hospital charges increased. The percentage of persons rehospitalized during the second postinjury year decreased substantially. From 1973 to 1986, for persons admitted to the model system within 24 hours of injury, there was a 66% decrease in the risk of dying within the first two years postinjury. Overall, these data document changing demographics and treatment practices as well as an improved prognosis for persons with spinal cord injuries.