Deep learning-based multimodal segmentation of oropharyngeal squamous cell carcinoma on CT and MRI using self-configuring nnU-Net.

PURPOSE: To evaluate deep learning-based segmentation models for oropharyngeal squamous cell carcinoma (OPSCC) using CT and MRI with nnU-Net. METHODS: This single-center retrospective study included 91 patients with OPSCC. The patients were grouped into the development (n = 56), test 1 (n = 13), and test 2 (n = 22) cohorts. In the development cohort, OPSCC was manually segmented on CT, MR, and co-registered CT-MR images, which served as the ground truth. The multimodal and multichannel input images were then trained using a self-configuring nnU-Net. For evaluation metrics, dice similarity coefficient (DSC) and mean Hausdorff distance (HD) were calculated for test cohorts. Pearson's correlation and Bland-Altman analyses were performed between ground truth and prediction volumes. Intraclass correlation coefficients (ICCs) of radiomic features were calculated for reproducibility assessment. RESULTS: All models achieved robust segmentation performances with DSC of 0.64 ± 0.33 (CT), 0.67 ± 0.27 (MR), and 0.65 ± 0.29 (CT-MR) in test cohort 1 and 0.57 ± 0.31 (CT), 0.77 ± 0.08 (MR), and 0.73 ± 0.18 (CT-MR) in test cohort 2. No significant differences were found in DSC among the models. HD of CT-MR (1.57 ± 1.06 mm) and MR models (1.36 ± 0.61 mm) were significantly lower than that of the CT model (3.48 ± 5.0 mm) (p = 0.037 and p = 0.014, respectively). The correlation coefficients between the ground truth and prediction volumes for CT, MR, and CT-MR models were 0.88, 0.93, and 0.9, respectively. MR models demonstrated excellent mean ICCs of radiomic features (0.91-0.93). CONCLUSION: The self-configuring nnU-Net demonstrated reliable and accurate segmentation of OPSCC on CT and MRI. The multimodal CT-MR model showed promising results for the simultaneous segmentation on CT and MRI. CLINICAL RELEVANCE STATEMENT: Deep learning-based automatic detection and segmentation of oropharyngeal squamous cell carcinoma on pre-treatment CT and MRI would facilitate radiologic response assessment and radiotherapy planning. KEY POINTS: • The nnU-Net framework produced a reliable and accurate segmentation of OPSCC on CT and MRI. • MR and CT-MR models showed higher DSC and lower Hausdorff distance than the CT model. • Correlation coefficients between the ground truth and predicted segmentation volumes were high in all the three models.

Efficacy and Safety of Precision Cryotherapy to Treat Seborrheic Dermatitis of the Scalp.

BACKGROUND: Recently, a new cryotherapy device that precisely controls skin temperature was developed. Precision cryotherapy (PC) can be a safe and alternative treatment modality for immune-related skin diseases that are difficult to treat by conventional cryotherapy because of serious adverse events. OBJECTIVE: To evaluate the efficacy and safety of PC in scalp seborrheic dermatitis (SD). METHODS: A single-arm, prospective trial was designed. Twenty-four patients with SD underwent 3 PC interventions 2 weeks apart. At the baseline, Week 6, and Week 8, overall improvements in Physician Global Assessment (PGA) and clinical severity scores were assessed. At each visit, the erythema index (EI) and transepidermal water loss were evaluated. The patients scored 9 subjective symptoms using a visual analog scale (VAS). RESULTS: The itch VAS score decreased by 50.4% at Week 8. Blinded investigators reported improvement of PGA scores from 2.86 ± 0.62 to 1.66 ± 0.61 and clinical severity scores from 4.55 ± 1.30 to 2.45 ± 1.37. The average EI decreased by 19.6% at Week 8 ( p < .05). CONCLUSION: This study not only demonstrated the efficacy and safety of PC in scalp SD but it also revealed insights for PC being a promising treatment modality in immune-related skin diseases.

Transcriptional Changes in Radiation-Induced Lung Injury: A Comparative Analysis of Two Radiation Doses for Preclinical Research.

In a recent stereotactic body radiation therapy animal model, radiation pneumonitis and radiation pulmonary fibrosis were observed at around 2 and 6 weeks, respectively. However, the molecular signature of this model remains unclear. This study aimed to examine the molecular characteristics at these two stages using RNA-seq analysis. Transcriptomic profiling revealed distinct transcriptional patterns for each stage. Inflammatory response and immune cell activation were involved in both stages. Cell cycle processes and response to type II interferons were observed during the inflammation stage. Extracellular matrix organization and immunoglobulin production were noted during the fibrosis stage. To investigate the impact of a 10 Gy difference on fibrosis progression, doses of 45, 55, and 65 Gy were tested. A dose of 65 Gy was selected and compared with 75 Gy. The 65 Gy dose induced inflammation and fibrosis as well as the 75 Gy dose, but with reduced lung damage, fewer inflammatory cells, and decreased collagen deposition, particularly during the inflammation stage. Transcriptomic analysis revealed significant overlap, but differences were observed and clarified in Gene Ontology and KEGG pathway analysis, potentially influenced by changes in interferon-gamma-mediated lipid metabolism. This suggests the suitability of 65 Gy for future preclinical basic and pharmaceutical research connected with radiation-induced lung injury.

Are second primary head and neck cancers with previous hematological malignancy more aggressive than de novo head and neck cancers?

OBJECTIVES: Secondary solid tumors can occur after the treatment of hematological malignancies and are associated with a poor prognosis. We evaluated the survival outcomes of patients with second primary head and neck cancers according to the site of cancer origin, type of hematological malignancy, and age. MATERIALS AND METHODS: We enrolled all patients who underwent surgery for second primary head and neck cancer and were previously treated for hematological malignancy between 1997 and 2020. We analyzed the survival outcomes of patients with second primary head and neck cancer, and compared them with 3126 de novo head and neck cancer patients diagnosed during the same period at our hospital. RESULTS: The 5-year overall survival (OS) rate was significantly worse for second primary head and neck cancer patients than de novo cancer patients (52.0 % and 77.9 %, respectively; p = 0.04) and those results were similarly observed in second primary oral cavity cancer (33.3 % and 75.7 %, respectively; p < 0.01). Patients with myelodysplastic syndrome and acute myeloid leukemia showed significantly worse 5-year OS rate than those with other types of hematological malignancies (p = 0.036). Multivariate analysis showed that bone marrow transplantation (BMT) was a risk factor for the recurrence of head and neck cancers (odds ratio = 6.635, p = 0.042). CONCLUSION: Patients with second primary head and neck cancer, particularly of the oral cavity, had a worse prognosis than patients with de novo head and neck cancer. BMT predicts recurrence in second primary head and neck cancer patients.

Persistent subjective voice symptoms for two years after thyroidectomy.

BACKGROUND: Voice change after thyroidectomy is an important issue in thyroid surgery. However, little is known about long-term voice outcomes after thyroidectomy. This study investigates the long-term voice outcomes of thyroidectomy up to two years after surgery. Also, we analyzed the pattern of recovery through acoustic tests over time. METHODS: We reviewed data from 168 patients who underwent thyroidectomy between January 2020 and August 2020 at a single institution. The Thyroidectomy-related Voice and Symptom Questionnaire (TVSQ) score and acoustic voice analysis results were examined preoperatively and postoperative one, three, and six months, and one and two years after surgery. We divided patients into two groups based on the TVSQ score (≥15 or <15) at two years postoperatively. We investigated the difference of acoustic characteristics between the two groups and analyzed correlations between acoustic parameters and various clinical and surgical factors. RESULTS: Voice parameters tended to recover, but some parameters and TVSQ scores exhibited deterioration two years after surgery. In the subgroups, among the many clinicopathologic factors examined, voice abuse history including professional voice users (p = 0.014), greater extent of thyroidectomy and neck dissection (p = 0.019, p = 0.029), and high pitch voice (F0; p = 0.005, SFF; p = 0.016) were associated with high TVSQ score at two years. CONCLUSIONS: Patients frequently experience voice discomfort after thyroidectomy. After surgery, voice abuse history including professional voice users, greater extent of surgery, and higher pitch voice are associated with worse voice quality and increased risk of persistent voice symptoms over the long-term.

NXC736 Attenuates Radiation-Induced Lung Fibrosis via Regulating NLRP3/IL-1ß Signaling Pathway.

Radiation-induced lung fibrosis (RILF) is a common complication of radiotherapy in lung cancer. However, to date no effective treatment has been developed for this condition. NXC736 is a novel small-molecule compound that inhibits NLRP3, but its effect on RILF is unknown. NLRP3 activation is an important trigger for the development of RILF. Thus, we aimed to evaluate the therapeutic effect of NXC736 on lung fibrosis inhibition using a RILF animal model and to elucidate its molecular signaling pathway. The left lungs of mice were irradiated with a single dose of 75 Gy. We observed that NXC736 treatment inhibited collagen deposition and inflammatory cell infiltration in irradiated mouse lung tissues. The damaged lung volume, evaluated by magnetic resonance imaging, was lower in NXC736-treated mice than in irradiated mice. NXC736-treated mice exhibited significant changes in lung function parameters. NXC736 inhibited inflammasome activation by interfering with the NLRP3-ASC-cleaved caspase-1 interaction, thereby reducing the expression of IL-1ß and blocking the fibrotic pathway. In addition, NXC736 treatment reduced the expression of epithelial-mesenchymal transition markers such as α-SMA, vimentin, and twist by blocking the Smad 2,3,4 signaling pathway. These data suggested that NXC736 is a potent therapeutic agent against RILF.

The Role of Open Conservation Surgery in the Era of Minimally Invasive Surgery for Hypopharyngeal Cancer.

Background and Objectives: Total laryngectomy with partial pharyngectomy is traditionally the principal curative treatment for hypopharyngeal cancer; however, conservative surgical approaches that minimize functional disability are attracting increasing interest. Thus, we evaluated the appropriateness and oncological outcomes of open conservation surgery for such patients. Materials and Methods: We reviewed the medical records of 49 patients who underwent vertical hemipharyngolaryngectomy from 1998 to 2018 at a single institution. Results: Locoregional recurrences developed in 19 patients (38.8%) and distant metastases in 6 (12.2%). Histopathologically, paraglottic space invasion was apparent in 13 patients (26.5%), pre-epiglottic space invasion in 4 (8.2%), thyroid cartilage invasion in 9 (18.4%), thyroid gland invasion in 2, perineural invasion in 11 (22.4%), and lymphovascular invasion in 35 (71.4%). The 5-year overall survival of patients who underwent open conservation surgery was comparable to that of patients who underwent total laryngectomy with partial pharyngectomy (68.7% vs. 48.4%, p = 0.14). Pre-epiglottic space invasion significantly decreased the 5-year disease-free survival rate after open conservation surgery (69.7% vs. 17.9%, p = 0.01). Conclusions: We found that pre-epiglottic space invasion negatively impacted disease control after open conservation surgery, emphasizing the crucial role played by a preoperative evaluation during patient selection.

Efferocytosis and enhanced FPR2 expression following apoptotic cell instillation attenuate radiation-induced lung inflammation and fibrosis.

Lung inflammation and fibrosis are common side effects of radiotherapy that can lead to serious reduction in the quality of life of patients. However, no effective treatment is available, and the mechanisms underlying its pathophysiology are poorly understood. Irradiation increases formyl peptide receptor 2 (FPR2) expression in lung tissue, and FPR2 agonists are known to promote the uptake of apoptosis cells, referred to as efferocytosis that is a hallmark of the resolution of inflammation. Herein, in a mouse model of radiation-induced lung injury (RILI), efferocytosis was induced by injecting apoptotic cells into the lung through the trachea, and its correlation with FPR expression and the effect of efferocytosis and FPR expression on RILI were assessed. Interestingly, when apoptotic cells were injected into the lung, the radiation-induced increase in FPR2 expression was further amplified. In the mouse model of RILI, apoptotic cell instillation reduced the volume of the damaged lung and prevented the decrease in lung function. Additionally, the expression of inflammatory cytokines, fibrosis-related markers, and oxidative stress-related markers was reduced by apoptotic cell instillation. Co-administration of apoptotic Jurkat cells and WRW4, the FPR2 antagonist, reversed these effects. These findings suggest that efferocytosis induced by apoptotic cell instillation and enhanced FPR2 expression attenuate RILI, thereby alleviating lung inflammation and fibrosis.

Next-generation sequencing for typing human papillomaviruses and predicting multi-infections and their clinical symptoms.

Human papillomavirus (HPV) has more than 100 different types, some of which are associated with cancer. The most common example is that of cervical cancer, which is associated with HPV16 and HPV18. Here, we performed next-generation sequencing (NGS) to type 2436 samples obtained from Korean women to elucidate the correlation between multiple infections, virus types, and cytology. NGS revealed that types 58, 56, and 16 were the most common in high-risk (HR) types, whereas types 90, 54, and 81 were the most common in low-risk (LR) types. The incidence of atypical squamous cells of undetermined significance (ASCUS) or high-grade squamous intraepithelial lesion (HSIL) was 11.45% in single-type cases and 27.17% in multiple infections by the two types of HPV. ASCUS or HSIL was 29.79% in only the HR type multiple infections and 29.81% in mixed high- and low-risk types of multiple infections, whereas it was 18.79% in LR type multiple infections (P ≤ 0.0001). Co-infection by LR-HPV and HR-HPV is therefore more likely to cause cell lesions. Collectively, these results show that the higher the incidence of multiple infections, the greater the frequency of cell lesions. Thus, to predict the clinical symptoms, it would be beneficial to confirm the HPV type and multiple infections using NGS, although this could be relatively expensive.

How Can We Predict the Recovery from Pitch Lowering After Thyroidectomy?

BACKGROUND: Some of patients are suffered from pitch lowering of voice after thyroidectomy. We sought to identify factors predictive of a recovery from lowered pitch voice after thyroid surgery. METHODS: We retrospectively reviewed the records of 133 patients who underwent total thyroidectomy to treat papillary carcinoma between January 2012 and February 2013. Of these, we enrolled 78 who exhibited a lower-pitched voice (SFF fall > 12 Hz) at 2 weeks post-operatively than pre-operatively and investigated pitch recovery after 3 months. We subclassified patients into recovery and non-recovery groups and compared videostroboscopic findings, acoustic voice data, and thyroidectomy-related voice questionnaire scores pre-operatively and 2, 8, and 12 weeks post-operatively. RESULTS: Vocal cord asymmetry on videostroboscopic examination at 2 weeks post-operatively (odds ratio 19.056, p = 0.001*) was more frequent in the non-recovery group. In acoustic analysis, mean pre-operative SFF was higher in the non-recovery group than the recovery group (190.9 ± 27.5 and 180.9 ±  24.6 Hz, respectively; p = 0.030*). Also, a reduction in the SFF of > 19.6 Hz, at 2 weeks post-operatively versus pre-operatively, predicted non-recovery of pitch-lowering in patients with reduced SFF within post-operative 3 months, with 72.0% sensitivity and 71.2% specificity. After 6 months of follow-up, no patient who exhibited an SFF fall > 19.6 Hz recovered to within 10 Hz of the pre-operative value. CONCLUSION: A reduction in the speaking fundamental frequency (SFF) > 19.6 Hz at 2 weeks post-operatively predicted persisting lowering of voice pitch after thyroidectomy among those with lower-pitched voices after surgery. Pre-operative high SFF and post-operative stroboscopic findings including vocal cord asymmetry at 2 weeks post-operatively also predicted persisting lowering of voice pitch for 3 months.

Soluble siglec-5 is a novel salivary biomarker for primary Sjogren's syndrome.

Despite advances in the understanding of the pathogenesis, disease-specific biomarkers have not been included in the classification criteria for Primary Sjogren's syndrome (pSS). Based on a microarray of peripheral blood mononuclear cells (PBMCs) from patients with primary Sjogren's syndrome (pSS), we aimed to investigate whether soluble sialic acid-binding immunoglobulin-like lectin (siglec)-5 in saliva might be a biomarker for pSS. The concentration of siglec-5 in saliva and sera was determined by ELISA. Clinical parameters related with pSS were obtained from pSS registry and correlation with salivary siglec-5 level was evaluated. Receiver operating curve (ROC) analysis was performed to determine cut off value. A separate validation cohort consisted of subjects with suspicious pSS was evaluated to determine the performance. The level of salivary siglec-5 was significantly higher in pSS patients (n = 170) compared with HCs (n = 25), non SS sicca patients (n = 78) or patients with systemic lupus erythematosus (SLE) (n = 43) (1346.8 [202.8-4280.0] pg/mL, 6.08 [0-134.0] pg/mL, 195 [0-947.5] pg/mL, and 0 [0-238.7] pg/mL, median [interquartile range], P < 0.001). Salivary siglec-5 level negatively correlated with salivary flow rate (spearman's rho: -0.420, P < 0.001), and positively correlated with ocular surface score (rho: 0.331, P < 0.001) and serum immunoglobulin G level (rho = 0.202, P = 0.008). In ROC analysis, area under the curve was 0.774[0.724-0.826]. With a cut off value of 400 pg/mL, sensitivity and specificity was 0.69 and 0.70 respectively. In validation cohort (45 pSS patients and 45 non SS sicca patients), sensitivity and specificity of siglec-5 was 64.4% and 77.8%, respectively. In conclusion, the level of soluble siglec-5 is significantly higher in the saliva from pSS patients, which reflects the severity of hyposalivation and ocular surface damage. This novel salivary biomarker may provide benefits for pSS diagnosis.

Effects of an antiadhesive agent on functional recovery of the greater auricular nerve after parotidectomy: a double-blind randomized controlled trial.

PURPOSE: Periauricular sensory deficit occurs frequently after parotidectomy even in cases with preservation of the greater auricular nerve (GAN). This study was performed to evaluate the effects of antiadhesive agent in functional recovery of the GAN after parotidectomy. METHODS: Ninety-eight patients undergoing partial parotidectomy for benign parotid tumors were prospectively enrolled in this multicenter, double-blind randomized controlled study and randomly assigned to either the study or control group. Antiadhesive agent was applied in the study group. The results of sensory tests (tactile, heat, and cold sensitivity) and a questionnaire on quality of life (QoL) were acquired at postoperative 1, 8, and 24 weeks after surgery. Clinical parameters, and the results of the sensory tests and the questionnaire, were compared between the two groups. RESULTS: A total of 80 patients were finally enrolled. On sensory evaluation, tactile sensation and warm sensation in the ear lobule, and warm sensation in the mastoid area, showed significant improvement at 24 weeks postoperatively in the study group. There were no significant differences between the two groups on any questions in the QoL questionnaire, at any follow-up time point. CONCLUSIONS: Antiadhesive agents have some positive effects on functional recovery of the GAN after parotidectomy. Therefore, applying antiadhesive agents after parotidectomy can reduce discomfort in patients.

Application of Deep-Learning Methods to Bird Detection Using Unmanned Aerial Vehicle Imagery.

Wild birds are monitored with the important objectives of identifying their habitats and estimating the size of their populations. Especially in the case of migratory bird, they are significantly recorded during specific periods of time to forecast any possible spread of animal disease such as avian influenza. This study led to the construction of deep-learning-based object-detection models with the aid of aerial photographs collected by an unmanned aerial vehicle (UAV). The dataset containing the aerial photographs includes diverse images of birds in various bird habitats and in the vicinity of lakes and on farmland. In addition, aerial images of bird decoys are captured to achieve various bird patterns and more accurate bird information. Bird detection models such as Faster Region-based Convolutional Neural Network (R-CNN), Region-based Fully Convolutional Network (R-FCN), Single Shot MultiBox Detector (SSD), Retinanet, and You Only Look Once (YOLO) were created and the performance of all models was estimated by comparing their computing speed and average precision. The test results show Faster R-CNN to be the most accurate and YOLO to be the fastest among the models. The combined results demonstrate that the use of deep-learning-based detection methods in combination with UAV aerial imagery is fairly suitable for bird detection in various environments.

Do I sound dry? Comparative voice analysis of primary Sjögren's syndrome.

OBJECTIVES: Desiccation of the vocal tract can cause many voice problems. Therefore, we aimed to investigate whether patients with primary Sjögren's syndrome (pSS) with dry mouth have more voice-related problems than controls without the disease and to determine the factors affecting voice in pSS patients. METHODS: Patients with pSS and controls complaining of voice-related symptoms underwent acoustic analysis, aerodynamic study and stroboscopic analysis. They also completed the voice handicap index (VHI) questionnaire and perceptual voice analysis (GRBAS). Various disease-related parameters were obtained from pSS registry data. RESULTS: Fifty-five pSS patients and 52 controls were analysed. The subjects were all female, and mean age was 53.9 years. VHI score was significantly higher in the pSS patient group (median [interquartile range], 11 [3-30] vs. 5.5 [0- 15.75], p=0.014). However, the results of acoustic analysis aerodynamic study and stroboscopic findings were not different between the two groups. Disease-related parameters were available in 47 pSS patients. Correlation analysis revealed that jitter value positively correlated with ESSDAI (spearman's rho = 0.29, p=0.048) and patient global assessment (rho=0.3, p= 0.04). High VHI score was associated with low quality of life measured by EQ5D (rho=-0.493, p=0.0001). Of note, patients with longer disease duration (≥ 40 months) showed higher noise-to-harmonics ratio (NHR). CONCLUSIONS: Patients with pSS had higher VHI score, which was associated with low quality of life and longer disease duration was associated with increased noise in pSS patients. The likelihood of voice problems should be addressed with pSS patients, and vocal hygiene education will be important in those patients.

Factors Predicting the Recovery of Unilateral Vocal Fold Paralysis After Thyroidectomy.

BACKGROUND: We used voice analysis and clinicopathological factors to explore the prognosis of unilateral vocal fold paralysis after thyroid surgery. METHODS: The medical records of 63 females who developed unilateral vocal fold paralysis after thyroidectomy were reviewed. All patients were divided into two groups: those who recovered from vocal fold paralysis and those who did not. We analyzed clinical parameters and voice analysis results in a search for correlations with recovery from paralysis. RESULTS: Of the 63 patients, 37 (58%) recovered from paralysis. A small tumor size, incomplete paralysis, the absence of arytenoid tilting, no compensatory movement of the normal side, lower postoperative shimmer, a higher postoperative maximum phonation time (MPT), and lower postoperative subglottic pressure correlated significantly with recovery from vocal fold paralysis. Multivariate analysis confirmed that the absence of compensatory movement of the normal side on videostroboscopy was independently prognostic. A postoperative MPT of 6.86 appeared to be optimal for prediction of recovery. Most patients recovered within 6 months, but those with incomplete paralysis recovered about 3 months earlier. At the 12-month follow-up, the thyroidectomy-related voice questionnaire scores had returned to preoperative values in only 12 patients (19.0%); 51 patients (81.0%) did not fully recover. CONCLUSION: Compensatory movement of the normal side evident on videostroboscopy was a poor prognostic factor. Voice analysis can be helpful in counseling vocal fold paralysis patients after thyroidectomy, and early intervention may be considered in patients who are expected to have a poor prognosis.

Clinicopathological factors influencing the outcomes of surgical treatment in patients with T4a hypopharyngeal cancer.

BACKGROUND: The purpose of this study was to determine prognostic factors influencing outcomes of surgical treatment in patients with T4a hypopharyngeal cancer. METHODS: The present study enrolled 93 patients diagnosed with T4a hypopharyngeal cancer who underwent primary surgery between January 2005 and December 2015 at six medical centers in Korea. Primary tumor sites included pyriform sinus in 71 patients, posterior pharyngeal wall in 14 patients, and postcricoid region in 8 patients. Seventy-two patients received postoperative radio(chemo)therapy. RESULTS: Five-year disease-free survival (DFS) and disease-specific survival (DSS) rates were 38% and 45%, respectively. In univariate analysis, 5-year DFS was found to have significant and positive correlations with margin involvement (p < 0.001) and extracapsular spread (p = 0.025). Multivariate analysis confirmed that margin involvement (hazard ratio (HR): 2.81; 95% confidence interval (CI): 1.49-5.30; p = 0.001) and extracapsular spread (HR: 2.08; 95% CI: 1.08-3.99; p = 0.028) were significant factors associated with 5-year DFS. In univariate analysis, cervical lymph node metastasis (p = 0.048), lymphovascular invasion (p = 0.041), extracapsular spread (p = 0.015), and esophageal invasion (p = 0.033) were significant factors associated with 5-year DSS. In multivariate analysis, extracapsular spread (HR: 2.98; 95% CI: 1.39-6.42; p = 0.005) and esophageal invasion (HR: 2.87; 95% CI: 1.38-5.98; p = 0.005) remained significant factors associated with 5-year DSS. CONCLUSION: Margin involvement and extracapsular spread are factors influencing recurrence while extracapsular spread and esophageal invasion are factors affecting survival in patients with T4a hypopharyngeal cancer treated by primary surgery.

Catalyzing Transdisciplinarity: A Systems Ethnography of Cancer-Obesity Comorbidity and Risk Coincidence.

Effectively addressing wicked health problems, that is, those arising from complex multifactorial biological and socio-economic causes, requires transdisciplinary action. However, a significant body of research points toward substantial difficulties in cultivating transdisciplinary collaboration. Accordingly, this article presents the results of a study that adapts Systems Ethnography and Qualitative Modeling (SEQM) in response to wicked health problems. SEQM protocols were designed to catalyze transdisciplinary responses to national defense concerns. We adapted these protocols to address cancer-obesity comorbidity and risk coincidence. In so doing, we conducted participant-observations and interviews with a diverse range of health care providers, community health educators, and health advocacy professionals who target either cancer or obesity. We then convened a transdisciplinary conference designed to catalyze a coordinated response. The findings offer productive insights into effective ways of catalyzing transdisciplinarity in addressing wicked health problems action and demonstrate the promise of SEQM for continued use in health care contexts.

Female sex, central lymph node metastasis and dissection are causes of globus symptom after thyroidectomy.

Globus symptoms are not uncommon after an uncomplicated thyroidectomy. However, their associated factors and etiology have not been investigated. We investigated the etiology and factors related to globus symptoms after thyroidectomy. The medical records of 289 patients who underwent thyroidectomy and completed a voice analysis, psychiatric screening, and voice-related questionnaires before and 1 month after the surgery were reviewed. Patients were excluded if they had globus symptoms before surgery or scored high on the psychiatric questionnaire. The selected patients were divided into two groups according to development of globus symptoms after surgery. Clinicopathological parameters and results of the voice analysis and voice-related questionnaires were compared between the two groups. A total of 157 patients were enrolled, and more than half (80/155, 51 %) showed development of globus symptoms 1 month after thyroidectomy. Female patients [hazard ratio (HR), 2.605; P = 0.010], patients who had central lymph node metastasis (HR, 3.533; P = 0.001), and patients who underwent central neck dissection (HR, 3.652; P = 0.014) had a higher probability of developing globus symptoms. Patients who developed globus symptoms scored higher on the voice-related questionnaire, and had a greater decrease in speaking fundamental frequency (P < 0.001). Globus symptoms developed after 1 month in more than half of patients who underwent thyroidectomy. Female sex and central lymph node metastasis and dissection increased the possibility of developing the symptoms.

Exploring cultural differences in women's body weight perception: The impact of self-construal on perceived overweight and engagement in health activities.

We examined the cultural influence on perceived body weight and the level of health practices at a national and individual level. At a national level, we found that Japanese women (n = 80) overestimate body weight more than Korean (n = 82) and American (n = 63) women. At an individual level, individuals with interdependent self-construal were more prone to overestimate weight than those with independent self-construal (N = 182; American women). Based on the data, we identify that the relationship is mediated by self-criticism, and, importantly, it is self-criticism rather than perceived overweight that predicts the level of health activities. Health practitioners and campaign designers across cultures are recommended to concentrate on promoting positive body esteem instead of encouraging engagement in corrective health behaviors for weight loss.

Prognostic Significance of Lymph Node Density in Patients with Hypopharyngeal Squamous Cell Carcinoma.

BACKGROUND: Lymph node density (LND) is more useful than the TNM classification in predicting survival after surgery for many cancers. The purpose of this study was to clarify independent prognostic factors for hypopharyngeal squamous cell carcinoma (HPSCC) and broaden the staging system to improve its predictive value. METHODS: The present study included 105 patients with HPSCC treated with hypophagectomy and neck dissection between 1993 and 2014. RESULTS: The median LND in patients with HPSCC was 0.060 (range 0.026-0.620). We found a significant difference in LND values between patients with and without recurrence (0.063 vs. 0.030, respectively; p = 0.001). The cutoff value of LND for recurrence was 0.055, with a sensitivity of 68% and specificity of 71%. Cervical lymph node metastasis, advanced pathologic T stage, lymphovascular invasion, LND ≥0.055, and extracapsular spread had significant adverse effects on 5-year overall and disease-specific survival in a univariate analysis. Multivariate analysis confirmed a significant association between 5-year overall survival and LND ≥0.055 [hazard ratio (HR) 2.19; 95% confidence interval (CI) 1.06-4.51; p = 0.035] and extracapsular spread (HR 2.47; 95% CI 1.09-5.61; p = 0.030). Furthermore, LND ≥0.055 (HR 2.30; 95% CI 1.07-4.93; p = 0.034) and extracapsular spread (HR 2.95; 95% CI 1.20-7.29; p = 0.019) were associated with 5-year, disease-specific survival. CONCLUSIONS: The median LND cutoff values ≥0.055 are associated with a greater risk of recurrence and survival in patients with HPSCC.