How reliable is assessment of true vocal cord-arytenoid unit mobility in patients affected by laryngeal cancer? a multi-institutional study on 366 patients from the ARYFIX collaborative group.

PURPOSE: In clinical practice the assessment of the "vocal cord-arytenoid unit" (VCAU) mobility is crucial in the staging, prognosis, and choice of treatment of laryngeal squamous cell carcinoma (LSCC). The aim of the present study was to measure repeatability and reliability of clinical assessment of VCAU mobility and radiologic analysis of posterior laryngeal extension. METHODS: In this multi-institutional retrospective study, patients with LSCC-induced impairment of VCAU mobility who received curative treatment were included; pre-treatment endoscopy and contrast-enhanced imaging were collected and evaluated by raters. According to their evaluations, concordance, number of assigned categories, and inter- and intra-rater agreement were calculated. RESULTS: Twenty-two otorhinolaryngologists evaluated 366 videolaryngoscopies (total evaluations: 2170) and 6 radiologists evaluated 237 imaging studies (total evaluations: 477). The concordance of clinical rating was excellent in only 22.7% of cases. Overall, inter- and intra-rater agreement was weak. Supraglottic cancers and transoral endoscopy were associated with the lowest inter-observer reliability values. Radiologic inter-rater agreement was low and did not vary with imaging technique. Intra-rater reliability of radiologic evaluation was optimal. CONCLUSIONS: The current methods to assess VCAU mobility and posterior extension of LSCC are flawed by weak inter-observer agreement and reliability. Radiologic evaluation was characterized by very high intra-rater agreement, but weak inter-observer reliability. The relevance of VCAU mobility assessment in laryngeal oncology should be re-weighted. Patients affected by LSCC requiring imaging should be referred to dedicated radiologists with experience in head and neck oncology.

Pretreatment DWI with Histogram Analysis of the ADC in Predicting the Outcome of Advanced Oropharyngeal Cancer with Known Human Papillomavirus Status Treated with Chemoradiation.

BACKGROUND AND PURPOSE: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has increased in the period from the 1970s to 2004, due to increase of infection with human papilloma virus (HPV). This study aimed to examine the role of histogram analysis of the ADC in treatment response and survival prediction of patients with oropharyngeal squamous cell carcinoma and known human papillomavirus status. MATERIALS AND METHODS: This was a retrospective single-center study. Following inclusion and exclusion criteria, data for 59 patients affected by T2-T4 (according to the 8th edition of the AJCC Cancer Staging Manual) oropharyngeal squamous cell carcinoma were retrieved. Twenty-eight had human papillomavirus-positive oropharyngeal squamous cell carcinoma, while 31 had human papillomavirus-negative oropharyngeal squamous cell carcinoma. All patients underwent a pretreatment MR imaging. Histogram analysis of ADC maps obtained by DWI (b = 0-1000 mm/s2) was performed on the central section of all of tumors. The minimum follow-up period was 2 years. Histogram ADC parameters were associated with progression-free survival and overall survival. Univariable and multivariable Cox models were applied to the data; P values were corrected using the Benjamini-Hochberg method. RESULTS: At univariable analysis, both human papillomavirus status and mean ADC were associated with progression-free survival (hazard ratio = 0.267, P < .05, and hazard ratio = 1.0028, P ≤ .05, respectively), while only human papillomavirus status was associated with overall survival (hazard ratio = 0.213, P ≤ .05) before correction. At multivariable analysis, no parameter was included (in fact, human papillomavirus status lost significance after correction). If we separated the patients into 2 subgroups according to human papillomavirus status, ADC entropy was associated with overall survival in the human papillomavirus-negative group (hazard ratio = 4.846, P = .01). CONCLUSIONS: ADC and human papillomavirus status are related to progression-free survival in patients treated with chemoradiation for advanced oropharyngeal squamous cell carcinoma; however, this association seems to result from the strong association between ADC and human papillomavirus status.

Cheesemaking in highland pastures: Milk technological properties, cream, cheese and ricotta yields, milk nutrients recovery, and products composition.

Summer transhumance of dairy cows to high Alpine pastures is still practiced in many mountainous areas. It is important for many permanent dairy farms because the use of highland pastures increases milk production and high-priced typical local dairy products often boost farm income. As traditional cheese- and ricotta-making procedures in Alpine pastures are central to this dairy system, the objective of this study was to characterize the quality and efficiency of products and their relationships with the quality and availability of grass during the grazing season. The milk from 148 cows from 12 permanent farms reared on a temporary farm located in Alpine pastures was processed every 2wk during the summer (7 cheesemakings from late June to early September). During each processing, 11 dairy products (4 types of milk, 2 by-products, 3 fresh products, and 2 ripened cheeses) were sampled and analyzed. In addition, 8 samples of fresh forage from the pasture used by the cows were collected and analyzed. At the beginning of the pasture season the cows were at 233±90d in milk, 2.4±1.7 parities, and produced 23.6±5.7kg/d of milk. The milk yield decreased with the move from permanent to temporary farms and during the entire summer transhumance, but partly recovered after the cows returned to the permanent farms. Similar trends were observed for the daily yields of fat, protein, casein, lactose, and energy, as we found no large variations in the quality of the milk, with the exception of the first period of Alpine pasture. The somatic cell counts of milk increased during transhumance, but this resulted from a concentration of cells in a lower quantity of milk rather than an increase in the total number of cells ejected daily from the udder. We noted a quadratic trend in availability of forage (fresh and dry matter weight per hectare), with a maximum in late July. The quality of forage also varied during the summer with a worsening of chemical composition. The evening milk (before and after natural creaming), the whole morning milk, and the mixed vat milk had different chemical compositions, traditional coagulation properties, and curd-firming modeling parameters. These variations over the pasture season were similar to the residual variations with respect to chemical composition, and much lower with respect to coagulation and curd-firming traits. Much larger variations were noted in cream, cheese, and ricotta yields, as well as in nutrient recoveries in curd during the pasture season. The protein content of forage was correlated with some of the coagulation and curd-firming traits, the ether extract of forage was positively correlated with milk fat content and cheese yields, and fiber fractions of forage were unfavorably correlated with some of the chemical and technological traits. Traditional cheese- and ricotta-making procedures showed average cream, cheese, and ricotta yields of 6.3, 14.2, and 4.9%, respectively, and an overall recovery of almost 100% of milk fat, 88% of milk protein, and 60% of total milk solids.

The effect of in vitro fermentation on specific gravity and sedimentation measurements of forage particles.

Dry matter degradability (DMD), gas production (GP), functional specific gravity (FSG), volume of gas associated (GA), water-holding capacity (WHC), and sedimentation measurements of orchard-grass (OG) and alfalfa (AA) hays (ground through a 8-mm screen) were studied before and after in vitro incubation with ruminal fluid for 2, 4, 8, 24, 48, and 72 h. The DMD was higher for AA than for OG (P < .001), but GP did not differ. The FSG of unfermented OG and AA was .59 and .73, respectively (P < .01). During fermentation, the FSG of OG increased more than did that of AA (from .93 to 1.39 for OG and from .97 to 1.27 for AA after 2 and 72 h, respectively), and GA decreased more rapidly (from .94 to -.04 mL/g DM and from .74 to .15 mL/g DM, respectively). The DMD was positively correlated with FSG (r = .83; P < .001) and, therefore, negatively with GA (r = -.72; P < .01). The WHC increased similarly in the two forages with fermentation time. Unfermented and fermented samples were incubated in sedimentation columns filled with distilled water for 19, 37, 75, 150, and 300 s. After 300 s of sedimentation time, the unfermented AA and OG samples tended to float (91.1 and 72.7% of DM, respectively). In contrast, fermented samples tended to sediment (90.7 and 90.9% of DM, respectively). There were only small effects of forage species and fermentation time on sedimentation tendency. Correlations between sedimentation measurements and DMD and FSG were not significant, with the only exception of DM recovered in the lower section of sedimentation columns after 75 s, which was particularly correlated with DMD (P < .01) and FSG (P < .05). The results suggest that degradation rate of fibrous particles is related to changes in FSG and GA and, therefore, could influence ruminal transit. However, FSG was unable to predict accurately the sedimentation behavior of samples.

Effect of monensin on milk production and efficiency of dairy cows fed two diets differing in forage to concentrate ratios.

Four primiparous Holstein cows were gradually introduced, according to a Latin square design, to four diets obtained from the factorial combination of two forage to concentrate ratios (70:30 and 50:50) and two concentrations of monensin sodium (0 and 300 mg/d per cow). Addition of monensin tended to depress feed intake and milk fat content without affecting milk production and without interactions with forage to concentrate ratios. Ruminal propionate percentage was increased more by the addition of monensin to the low forage diet than by the addition of monensin to the high forage diet. Serum urea and concentrations of nonesterified fatty acids tended to decrease when monensin was added to the high forage diet but did not change when monensin was added to the low forage diet. The results suggested that monensin had moderate positive effects on efficiency of milk production and might have an antiketogenic effect with high forage diets.

Effect of slow-release somatotropin on the pattern of milk yield between and within injection intervals.

Thirty-six Alpine goats (10 primiparous and 26 multiparous) were used to study the milk yield response induced by recombinant bST administered in a sustained-delivery vehicle. Eighteen goats were injected with recombinant bST at 4-wk intervals from about 7 wk postpartum for 12 wk. Patterns of milk yield were highly affected by injection of recombinant bST. Milk yield of treated goats increased from day of injection, peaked between d 3 to 5 after treatment, and then decreased progressively. This pattern of response was well fitted by a curve containing two exponential terms: Yi = A x [exp(-k1di - exp(-k2di)], where Yi = daily relative response of treated goats to recombinant bST, computed as a deviation of least squares means of milk yield at day i (i = 0,..., 26) of the treatment interval from least squares means of milk yield at d 27 of the treatment interval; A = constant; k1 and k2 = response rate parameters; and di = day from treatment (i = 0,..., 27). Administration of recombinant bST also improved persistency of lactation, and the overall milk yield response to exogenous hormone was 300 g/d (13.9%) higher than the yield of untreated goats. This response was due to both the short-term response immediately after injection (53%) and the medium-term effect on lactation persistency.

Modeling response to slow-releasing somatotropin administered at 3- or 4-week intervals.

The purpose of this study was to develop a time-dependent model to account for the effects of recombinant bST in a slow-release formulation on short-term (between two consecutive injections) and long-term (baseline of the lactation curve) response of milk yield and composition. Observations on milk yield (n = 8234) and on milk composition (n = 1509) of 196 Holstein Friesian cows were recorded over 1 yr of trial. Treated cows were injected with somidobove at 3- or 4-wk intervals. Data were analyzed according to a model that included effect of treatment, parity, interaction, and the random effect of cow; two time-dependent covariables, obtained by the splitting of DIM, were included in the model to account for the effects of bST on short- and long-term responses of milk traits. Cyclical variations of milk yield, protein, and SCC content in the interval between two consecutive injections were detected. Recombinant bST administration also influenced the persistency of milk yield and protein content. Treatment of cows at 3- and 4-wk intervals increased yield by 20.6 and 12.6% over those of untreated cows. Nearly 60% of this increment was due to the short-term effect of bST. Milk composition response to bST was less noticeable.