Computed tomography-based radiomic markers are independent prognosticators of survival in advanced laryngeal cancer: a pilot study.

OBJECTIVE: Advanced laryngeal cancers are clinically complex; there is a paucity of modern decision-making models to guide tumour-specific management. This pilot study aims to identify computed tomography-based radiomic features that may predict survival and enhance prognostication. METHODS: Pre-biopsy, contrast-enhanced computed tomography scans were assembled from a retrospective cohort (n = 72) with advanced laryngeal cancers (T3 and T4). The LIFEx software was used for radiomic feature extraction. Two features: shape compacity (irregularity of tumour volume) and grey-level zone length matrix - grey-level non-uniformity (tumour heterogeneity) were selected via least absolute shrinkage and selection operator-based Cox regression and explored for prognostic potential. RESULTS: A greater shape compacity (hazard ratio 2.89) and grey-level zone length matrix - grey-level non-uniformity (hazard ratio 1.64) were significantly associated with worse 5-year disease-specific survival (p < 0.05). Cox regression models yielded a superior C-index when incorporating radiomic features (0.759) versus clinicopathological variables alone (0.655). CONCLUSIONS: Two radiomic features were identified as independent prognostic biomarkers. A multi-centre prospective study is necessary for further exploration. Integrated radiomic models may refine the treatment of advanced laryngeal cancers.

Burden of chronic diseases associated with periodontal diseases: a retrospective cohort study using UK primary care data.

OBJECTIVES: To identify the association between periodontal diseases (gingivitis and periodontitis) and chronic diseases including cardiovascular disease, cardiometabolic disease, autoimmune disease and mental ill health. DESIGN: Retrospective cohort. SETTING: IQVIA Medical Research Data-UK between 1 January 1995 and 1 January 2019. PARTICIPANTS: 64 379 adult patients with a general practitioner recorded diagnosis of periodontal disease (exposed patients) were matched to 251 161 unexposed patients by age, sex, deprivation and registration date. MAIN OUTCOME MEASURES: Logistic regression models accounting for covariates of clinical importance were undertaken to estimate the adjusted OR (aOR) of having chronic diseases at baseline in the exposed compared with the unexposed group. Incidence rates for each outcome of interest were then provided followed by the calculation of adjusted HRs using cox regression modelling to describe the risk of outcome development in each group. RESULTS: The average age at cohort entry was 45 years and the median follow-up was 3.4 years. At study entry, the exposed cohort had an increased likelihood of having a diagnosis of cardiovascular disease (aOR 1.43; 95% CI 1.38 to 1.48), cardiometabolic disease (aOR 1.16; 95% CI 1.13 to 1.19), autoimmune disease (aOR 1.33; 95% CI 1.28 to 1.37) and mental ill health (aOR 1.79; 95% CI 1.75 to 1.83) compared with the unexposed group. During the follow-up of individuals without pre-existing outcomes of interest, the exposed group had an increased risk of developing cardiovascular disease (HR 1.18; 95% CI 1.13 to 1.23), cardiometabolic disease (HR 1.07; 95% CI 1.03 to 1.10), autoimmune disease (HR 1.33; 95% CI 1.26 to 1.40) and mental ill health (HR 1.37; 95% CI 1.33 to 1.42) compared with the unexposed group. CONCLUSIONS: In this cohort, periodontal diseases appeared to be associated with an increased risk of developing cardiovascular, cardiometabolic, autoimmune diseases and mental ill health. Periodontal diseases are very common; therefore, an increased risk of other chronic diseases represent a substantial public health burden.

The application of radiomics in laryngeal cancer.

OBJECTIVES: Radiomics is the conversion of medical images into quantitative high-dimensional data. Laryngeal cancer, one of the most common head and neck cancers, has risen globally by 58.7%. CT, MRI and PET are acquired during the diagnostic process providing potential data for radiomic analysis and correlation with outcomes.This review aims to examine the applications of this technique to laryngeal cancer and the future considerations for translation into clinical practice. METHODS: A comprehensive systematic review-informed search of the MEDLINE and EMBASE databases was undertaken. Keywords "laryngeal cancer" OR "larynx" OR "larynx cancer" OR "head and neck cancer" were combined with "radiomic" OR "signature" OR "machine learning" OR "artificial intelligence". Additional articles were obtained from bibliographies using the "snowball method". RESULTS: The included studies (n = 15) demonstrated that radiomic features are significantly associated with various clinical outcomes (including stage, overall survival, treatment response, progression-free survival) and that predictive models incorporating radiomic features are superior to those that do not. Two studies demonstrated radiomics could improve laryngeal cancer staging whilst 12 studies affirmed its predictive capability for clinical outcomes. CONCLUSIONS: Radiomics has potential for improving multiple aspects of laryngeal cancer care; however, the heterogeneous cohorts and lack of data on laryngeal cancer exclusively inhibits firm conclusions. Large prospective well-designed studies in laryngeal cancer are required to progress this field. Furthermore, to implement radiomics into clinical practice, a unified research effort is required to standardise radiomics practice. ADVANCES IN KNOWLEDGE: This review has highlighted the value of radiomics in enhancing laryngeal cancer care (including staging, prognosis and predicting treatment response).

Silicone granuloma: a cause of cervical lymphadenopathy following breast implantation.

We report a case of a 54-year-old woman with saline-based breast implants who presented to the ear, nose and throat neck lump clinic with a 2-week history of bilateral neck lumps. She was found to have multiple palpable cervical lymph nodes bilaterally in levels IV and Vb. The ultrasonography demonstrated multiple lymph nodes with the snowstorm sign and a core biopsy confirmed a silicone granuloma (siliconoma). This granuloma was likely caused by bleeding gel from the silicone shell of her saline-based implants. This case demonstrates the importance of bleeding gel from saline-based implants, in the absence of implant rupture. Thus, head and neck specialists should consider siliconomas as a cause for cervical lymphadenopathy in patients with saline-based breast implants.

Is Surgical Training Prepared for the "Second Wave" of COVID-19? A Collaborative Perspective.

Restructuring of surgical services during the 'first wave' of the coronavirus-disease 2019 pandemic led to significant disruption in surgical learning opportunities provided to junior surgeons. Recent challenges faced by trainees have never been faced before. These include disruption to surgical opportunities available, completing assessments and attending educational events. With a 'second wave' now upon the United Kingdom it is vitally important we reflect upon the 'first wave' to ensure junior surgeons are able to achieve appropriate surgical case numbers, complete assessments and progress to the next stage of training. Alternate assessment methods in the United Kingdom need to be considered should the pandemic continue and clear information should be provided to surgical trainees regarding career progression. These are difficult times for surgical training and we need to endeavor that trainees are provided with opportunities similar to their predecessors albeit in difficult circumstances. This is to ensure the future standard of surgical patient care remains of the highest standard.

Paediatric Autoimmune Neuropsychiatric Disorder Associated with Group A Beta-Haemolytic Streptococcal Infection: An Indication for Tonsillectomy? A Review of the Literature.

Background. Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection (PANDAS) is the acute onset of neuropsychiatric symptoms following group A beta-haemolytic streptococcal infection. The aetiology remains elusive. However, with group A streptococcus being the most common bacterial cause of tonsillitis, surgical intervention in the form of tonsillectomy has often been considered as a potential therapy. Methods. A MEDLINE® search was undertaken using keywords "PANDAS" or "paediatric autoimmune neuropsychiatric disorders associated with streptococcus" combined with "tonsillectomy". Results. Six case reports and 3 case series met the inclusion criteria. Demesh et al. (case series) reported a dramatic reduction in neuropsychiatric symptom severity in the patient cohort undergoing tonsillectomy. Two case series suggest that there is no association between tonsillectomy and resolution of PANDAS. Conclusion. Due to the lack of uniform data and sporadic reports, tonsillectomy should be carefully adopted for the treatment of this disorder. In particular, tonsillectomies/adenoidectomies to alleviate neuropsychiatric symptoms should be avoided until more definitive evidence is at our disposal. This review highlights the importance of a potential collaborative prospective study.