Durvalumab Treatment Patterns for Patients with Unresectable Stage III Non-Small Cell Lung Cancer in the Veterans Health Administration (VHA): A Nationwide, Real-World Study.

BACKGROUND: Durvalumab is approved for the treatment of adults with unresectable stage III non-small cell lung cancer (NSCLC) post-chemoradiotherapy (CRT). This real-world study describes patient characteristics and durvalumab treatment patterns (number of doses and therapy duration; treatment initiation delays, interruptions, discontinuations, and associated reasons) among VHA-treated patients. METHODS: This was a retrospective cohort study of adults with unresectable stage III NSCLC receiving durvalumab at the VHA between 1 January 2017 and 30 June 2020. Patient characteristics and treatment patterns were presented descriptively. RESULTS: A total of 935 patients were included (median age: 69 years; 95% males; 21% Blacks; 46% current smokers; 16% ECOG performance scores ≥ 2; 50% squamous histology). Durvalumab initiation was delayed in 39% of patients (n = 367). Among the 200 patients with recorded reasons, delays were mainly due to physician preference (20%) and CRT toxicity (11%). Overall, patients received a median (interquartile range) of 16 (7-24) doses of durvalumab over 9.0 (2.9-11.8) months. Treatment interruptions were experienced by 19% of patients (n = 180), with toxicity (7.8%) and social reasons (2.6%) being the most cited reasons. Early discontinuation occurred in 59% of patients (n = 551), largely due to disease progression (24.2%) and toxicity (18.2%). CONCLUSIONS: These real-world analyses corroborate PACIFIC study results in terms of the main reasons for treatment discontinuation in a VHA population with worse prognostic factors, including older age, predominantly male sex, and poorer performance score. One of the main reasons for durvalumab initiation delays, treatment interruptions, or discontinuations was due to toxicities. Patients could benefit from improved strategies to prevent, identify, and manage CRT and durvalumab toxicities timely and effectively.

Are There Differences in Opioid Prescriptions to Urban and Rural Patients by Oral and Maxillofacial Surgeons in Massachusetts From 2011 to 2021?

PURPOSE: Oral-maxillofacial surgeons (OMSs) are frequent prescribers of opioid analgesics. It remains unclear if prescription patterns differ for urban versus rural patients, given potential differences in access to and delivery of care. This study aimed to characterize urban-rural differences in opioid analgesic prescriptions to patients in Massachusetts by OMSs from 2011 to 2021. METHODS: This retrospective cohort study used the Massachusetts Prescription Monitoring Program database to identify Schedule II and III opioid prescriptions by providers with specialty of oral and maxillofacial surgery from 2011 to 2021. The primary predictor variable was patient geography (urban/rural) and secondary predictor was year (2011-2021). The primary outcome variable was milligram morphine equivalent (MME) per prescription. Secondary outcome variables were days' supply per prescription and number of prescriptions received per patient. Descriptive and linear regression statistics were performed to analyze differences in prescriptions to urban and rural patients each year and throughout the study period. RESULTS: The study data, which includes OMS opioid prescriptions (n = 1,057,412) in Massachusetts from 2011 to 2021, ranged annually between 63,678 and 116,000 prescriptions to between 58,000 and 100,000 unique patients. The cohorts each year ranged between 48 and 56% female with mean ages between 37 and 44 years. There were no differences in the mean number of patients per provider in urban and rural populations in any year. The study sample had a large majority of urban patients (>98%). MME per prescription, days' supply per prescription, and prescriptions received per patient were all generally similar between urban and rural patients each year, with the largest MME per prescription difference in 2019 (87.3 for rural to 73.9 for urban patients, P < .01). From 2011 to 2021, all patients had a steady decrease in MME per prescription (ß = -6.64, 95% confidence interval: -6.81, -6.48; R2 = 0.39) and day's supply per prescription (ß = -0.1, 95% confidence interval: -0.1, -0.09; R2 = 0.37). CONCLUSION: In Massachusetts, there were similar opioid prescribing patterns by oral and maxillofacial surgeons to urban and rural patients from 2011 to 2021. There has also been a steady decrease in the duration and total dosage of opioid prescriptions to all patients. These results are consistent with multiple statewide policies over the last several years aimed at curbing opioid overprescribing.

Effects of a games-based physical education lesson on cognitive function in adolescents.

Despite the importance of physical education (PE) lessons for physical activity in adolescents, the acute cognitive responses to PE lessons have not been explored; a gap in the literature that this study addresses. Following familiarisation, 76 (39 female) adolescents (12.2 ± 0.4 y) completed two trials (60 min games-based PE lesson and 60 min academic lesson) separated by 7-d in a counterbalanced, crossover design. Attention, executive function, working memory, and perception were assessed 30 min before, immediately post, and 45 min post-lesson in both trials. Participants were split into high-and low-fit groups based on a gender-specific median split of distance run on the multi-stage fitness test. Furthermore, participants were split into high and low MVPA groups based on a gender-specific median split of MVPA time (time spent >64% HR max) during the PE lesson. Overall, a 60 min games-based PE lesson had no effect on perception, working memory, attention, or executive function in adolescents (all p > 0.05) unless MVPA time is high. The physical activity-cognition relationship was moderated by MVPA, as working memory improved post-PE lesson in adolescents who completed more MVPA during their PE lesson (time*trial*MVPA interaction, p < 0.05, partial η2 = 0.119). Furthermore, high-fit adolescents displayed superior cognitive function than their low-fit counterparts, across all domains of cognitive function (main effect of fitness, all p < 0.05, partial η2 0.014-0.121). This study provides novel evidence that MVPA time moderates the cognitive response to a games-based PE lesson; and emphasises that higher levels of fitness are beneficial for cognitive function in adolescents.

Associations of Self-Control with Physical Activity, Physical Fitness, and Adiposity in Adolescents.

The associations between self-control and objective measures of physical activity, physical fitness, and adiposity are yet to be explored in young people; this is a gap in the literature that the present study aimed to address. The study employed a cross-sectional design. A total of 101 young people participated in the study. Participants completed the Brief Self-Control Scale as a measure of trait self-control. Free-living physical activity was assessed using an ActiGraph GT3X + triaxial accelerometer, which was worn for 7 days. Participants also completed the 15-meter version of the multistage fitness test as a measure of physical fitness. For the assessment of adiposity, three criterion measures were used: body mass index (BMI), sum of skinfolds, and waist circumference. Data were analyzed using the glm function in the open access software R. Higher levels of trait self-control were associated with higher levels of physical fitness (measured by distance run on the multistage fitness test) and lower adiposity (BMI, waist circumference, and sum of skinfolds) in adolescents. There was a tendency for a positive association between self-control and time spent in vigorous physical activity, although this did not reach statistical significance. In a combined model, self-control was also associated with both physical fitness and waist circumference, with these effects independent of each other. These findings suggest that self-control is associated with healthy behaviors and characteristics in adolescents and is thus potentially an attractive target for future interventions aimed at increasing physical activity and physical fitness and reducing adiposity in this population.

Effect of 5-weeks participation in The Daily Mile on cognitive function, physical fitness, and body composition in children.

The aim of the present study was to determine the effect of 5-weeks participation in The Daily Mile on cognitive function, physical fitness, and adiposity in primary school children. In a quasi-experimental study, one class from each school completed The Daily Mile (n = 44) or acted as a control group (n = 35). Baseline measures included cognitive function tests (Stroop test, Sternberg paradigm, Flanker task), physical fitness (multi-stage fitness test) and body composition (BMI percentile, waist:hip circumference, sum of skinfolds). The intervention group completed 5-weeks of The Daily Mile. Follow-up measurements were completed within 48-h of the last training session. Data were analysed via ANCOVA, examining between group differences at follow-up, controlling for baseline values. Response times on the complex Stroop test were faster at follow-up in the intervention group (Intervention: 1357 ms [1280-1400 ms]; Control: 1463 ms, [1410-1523 ms], d = 0.31, p = 0.048). There was no effect of The Daily Mile on the Sternberg paradigm or Flanker test. Physical fitness was greater at follow-up in the intervention group (Intervention: 880 m, [820-940 m]; Control: 740 m, [680-800 m], d = 0.39, p = 0.002). There was no effect of the intervention on adiposity. In conclusion, five-weeks of The Daily Mile enhanced inhibitory control and physical fitness in children, but did not affect working memory, attention, or adiposity.

Effect of two-weeks of school-based sprint training on physical fitness, risk factors for cardiometabolic diseases and cognitive function in adolescent girls: A randomized controlled pilot trial.

Background: School-based physical activity interventions are accessible to most adolescents and could enhance adolescent cardiometabolic health and cognition; yet the feasibility and success of school-based physical activity interventions is understudied. Methods: Sixteen adolescent girls (age: 11.7 ± 0.3 y; height: 1.58 ± 0.07 m; body mass: 45.5 ± 9.2 kg) were randomized to either an intervention (2-weeks sprint training; n = 8) or control group (continuation of regular physical activity levels; n = 8). Following familiarization, all participants completed baseline measurements including fasted and postprandial capillary blood samples, a battery of cognitive function tests (Stroop Test, Sternberg Paradigm and Flanker Task), and an assessment of physical fitness (20 m sprint and multi-stage fitness test). The intervention group completed 2-weeks progressive sprint training (3 sessions per week: week one 6 × 10 s sprints, week two 8 × 10 s sprints). Follow-up measurements were completed 48 h after the final sprint training session. Data were analyzed via ANCOVA to examine between group differences at follow-up whilst controlling for baseline score. Results: Accuracy in the intervention group during the three-item Sternberg paradigm was greater when compared with the control group (Intervention: 99.6 ± 1.1%; Control: 97.7 ± 2.2%, p = 0.046). BDNF concentration was also higher in the intervention group at follow-up than control group (Intervention: 39.12 ± 9.88 ng.ml-1; Control: 22.95 ± 9.13 ng.ml-1, p < 0.001). There were no differences at follow-up between the intervention and control group for measures of cardiometabolic health (fasted cytokine concentrations or postprandial glycaemic and insulinaemic responses) or on the Stroop Test or Flanker Task (all p > 0.05). However, the intervention group reported enjoying the sprint training and that they found the sessions valuable. Conclusion: Two-weeks sprint interval training in a school-setting enhanced working memory and increased concentrations of BDNF in adolescent girls. The intervention was deemed enjoyable and worthwhile by the adolescent girls and thus the longer-term implementation of such an intervention should be examined.

Physical fitness, physical activity and adiposity: associations with risk factors for cardiometabolic disease and cognitive function across adolescence.

BACKGROUND: The cross-sectional associations between physical activity, physical fitness and adiposity with risk factors for cardiometabolic disease (particularly novel ones such as inflammatory cytokines) and cognitive function across the period of adolescence are not well understood. Additionally, novel physical activity metrics that summarise activity volume and intensity in a continuous manner have not been investigated in this context. Therefore, this study investigated the cross-sectional associations between physical activity, physical fitness and adiposity with risk factors for cardiometabolic disease and cognitive function. These associations were compared between younger and older adolescents. METHODS: Seventy younger (11-12y, 35 girls) and 43 older (14-15y, 27 girls) adolescents volunteered to take part in the study. Physical fitness (multi-stage fitness test, MSFT) and adiposity (waist circumference) were determined, followed 7d later by resting blood pressure, a fasted blood sample (glucose, plasma insulin, IL6, IL10, IL15 and IL-1ß concentrations) and a cognitive function test battery. Habitual physical activity was monitored via hip-worn accelerometers over this 7-d period and the average acceleration (activity volume), and intensity gradient (intensity distribution of activity) were determined. RESULTS: Average acceleration and intensity gradient were negatively associated with mean arterial blood pressure (ß = -0.75 mmHg, p = 0.021; ß = -10 mmHg, p = 0.006, respectively), and waist circumference was positively associated with IL-6 concentration (ß = 0.03%, p = 0.026), with stronger associations observed in older adolescents. Higher physical fitness (MSFT distance) was positively associated with anti-inflammatory IL-15 concentration (ß = 0.03%, p = 0.038) and faster response times on the incongruent Stroop task (ß = -1.43 ms, p = 0.025), the one-item level of the Sternberg paradigm (ß = -0.66 ms, p = 0.026) and the simple (ß = 0.43 ms, p = 0.032) and complex (ß = -2.43 ms, p = 0.020) levels of the visual search test, but these were not moderated by age group. CONCLUSIONS: The present study highlights the important role of physical activity (both the volume and intensity distribution) and physical fitness for cardio-metabolic health. Furthermore, the present study highlights the importance of physical fitness for a variety of cognitive function domains in adolescents, irrespective of age.

Agreement and equivalence of estimated physical activity behaviours, using ENMO- and counts-based processing methods, for wrist-worn accelerometers in adolescents.

The present study examined the agreement and equivalence between two physical activity processing methods. Data were obtained from 161 Hong-Kong adolescents (74 girls, age: 12.6 ± 1.7y). Participants wore an Actigraph GT3XBT on their non-dominant wrist for 7d. Time spent sedentary, and in light-(LPA), moderate-(MPA), vigorous-(VPA), and moderate-to-vigorous physical activity (MVPA) were calculated using different processing methods (proprietary counts and Euclidean Norm Minus One (ENMO)). Intraclass correlation coefficients (ICC) were used to examine absolute agreement (ICC2) and consistency (ICC3), and equivalence was assessed using pairwise equivalence tests. Using ENMO, sedentary time and VPA were higher, whereas all other behaviours were lower (compared to counts processing). Agreement ranged from poor (ICC2:0.42(Sedentary)) to moderate (ICC2:0.86(LPA)) and consistency ranged from moderate (ICC3:0.71(sedentary)) to good (ICC3:0.91(LPA)). Methods were not considered equivalent (all p > 0.05). Due to differences in the wear-time validation of processing methods, a sensitivity analyses (sub-sample with the same valid wear time for both methods (n = 56)), resulted in minimal change. Lack of agreement and equivalence between ENMO and counts processing methods suggests that the processing method significantly affects youth physical activity estimates.

Effect of adiposity and physical fitness on cardiometabolic risk factors in adolescents: A 2-year longitudinal study.

Although risk factors for cardiometabolic diseases begin to present in young people, the association between physical fitness and adiposity with traditional and novel risk factors for cardiometabolic diseases across adolescence remains relatively unknown. Following ethical approval, fifty-two adolescents (age 11.6 ± 0.6 years; 32 girls) were recruited for a 2-years longitudinal study. Adiposity was assessed based on sum of skinfolds, waist circumference and body mass index, and physical fitness as distance run on the multi-stage fitness test (MSFT). Risk factors for cardiometabolic diseases (pro- and anti-inflammatory cytokines, plasma insulin, Homeostatic Model Assessment of Insulin Resistance - HOMA-IR, blood pressure) were measured following an overnight fast. Relationships between independent and response variables were analysed using multi-level modelling (final combined models were created using the stepwise backward elimination method). Plasma insulin concentration and HOMA-IR were positively associated with adiposity and inversely associated with distance run on the MSFT (all p < 0.05). The final combined models for plasma insulin concentration and HOMA-IR contained main effects for age, skinfolds and distance run on the MSFT. Levels of the anti-inflammatory cytokine IL-10 were inversely related to the sum of skinfolds (p = 0.046), whereas there was a trend for levels of the pro-inflammatory cytokine TNF-α to be positively related to the sum of skinfolds (p = 0.056). Adiposity and physical fitness are important, independent, determinants of metabolic health in adolescents. Furthermore, adiposity influences levels of pro- and anti-inflammatory cytokines in adolescence, with greater adiposity associated with a poorer inflammatory profile. The present study demonstrates an independent effect of physical fitness on metabolic health longitudinally across adolescence. It is therefore recommended that future work develops therapeutic interventions that reduce adiposity and enhance physical fitness in adolescents, to promote lifelong health.

Effect of Differing Durations of High-Intensity Intermittent Activity on Cognitive Function in Adolescents.

Exercise duration may influence the acute effects on cognition. However, only one study to date has explored the dose-response relationship between exercise duration and cognition in adolescents. Thus, the purpose of this study was to investigate the effect of differing durations of high-intensity intermittent running on cognition in adolescents. Thirty-eight adolescents (23 girls) completed three trials separated by 7 d: 30 min exercise, 60 min exercise, and rest; in a randomised crossover design. The exercise was a modified version of the Loughborough Intermittent Shuttle Test (LIST), which elicited high-intensity intermittent exercise. Cognitive function tests (Stroop test, Sternberg paradigm, Flanker task) were completed 30 min pre, immediately post, and 45 min post exercise. Response times on the incongruent level of the Flanker task improved to a greater extent 45 min following the 30 min LIST, compared to rest (p = 0.009). Moreover, response times improved to a greater extent on the three-item level of Sternberg paradigm 45 min following the 30 min LIST, compared to the 60 min LIST (p = 0.002) and rest (p = 0.013), as well as on the five-item level 45 min following the 30 min LIST, compared to the 60 min LIST (p = 0.002). In conclusion, acute exercise enhanced subsequent cognition in adolescents, but overall, 30 min of high-intensity intermittent running is more favourable to adolescents' cognition, compared to 60 min.

Clinicopathologic differences and mortality among Latinos and non-Latino whites with gastric cancer at a majority-minority cancer center in South Texas.

BACKGROUND: Latino patients have a higher incidence of gastric cancer compared to non-Latino white patients nationwide, with greater disparities in South Texas. However, the impact of Latino ethnicity on mortality in gastric cancer is controversial. We evaluated clinicopathological characteristics and survival outcomes in Latino vs. non-Latino white patients at our National Cancer Institute (NCI)-designated cancer center and its affiliated hospital. METHODS: We conducted a retrospective chart review of Latino and non-Latino white patients diagnosed with gastric cancer who were seen at Mays Cancer Center at the University of Texas Health in San Antonio, Texas, from 2000-2018. Median overall survival (mOS) was estimated from Kaplan-Meier curves and groups were compared with the log-rank test. RESULTS: A total of 193 patients met inclusion criteria and 65% (n=126) were Latino. Median age for all patients was 61 years. Female patients represented almost 50% of Latinos vs. 36% of non-Latino whites. There were no differences in Eastern Cooperative Oncology Group (ECOG) performance status, primary tumor location, stage, Helicobacter pylori status, HER2 status, or histologic subtype at diagnosis. Median overall survival was 14 months (95% CI: 13-36) for Latinos vs. 33 months (95% CI: 14 to n/a) for non-Latino whites (P=0.36). CONCLUSIONS: Compared to non-Latino white patients, Latino patients with gastric cancer at a majority-minority cancer center in South Texas did not have significant differences in baseline clinicopathologic features or survival outcomes. Further prospective studies are needed to evaluate epidemiologic, pathogenetic, and molecular differences in gastric cancer in order to identify variables associated with treatment efficacy and survival.

Activity patterns of primary school children during participation in The Daily Mile.

The Daily Mile is a popular physical activity initiative in primary schools, yet little is known regarding the activity patterns of children during The Daily Mile. Eighty children (10.4 ± 0.7 years) participated in The Daily Mile (20-min). Activity patterns were assessed using global positioning systems (total distance and age-specific speed zones), alongside heart rate. Cardiorespiratory fitness was assessed using the Multi-Stage Fitness Test. Participants covered a distance of 2511 ± 550 m during The Daily Mile, and heart rate was 163 ± 27 beats.min-1. Participants travelled the furthest distance, and were most intermittent, during the first 5 min (main effect of time, both p < 0.001). Boys ran further and their activity was more intermittent compared to girls (main effect of sex, both p < 0.001). Moreover, the highest fit children ran further than less fit children (main effect of fitness, p < 0.001). This study provides novel evidence of the nature of physical activity during The Daily Mile; demonstrating that children covered, on average, 1.5-miles and exercised at a moderate-to-vigorous intensity. Furthermore, boys covered a greater distance and were more intermittent than girls; whilst higher fit children ran further than lower fit children. In summary, The Daily Mile makes a valuable contribution to in-school physical activity targets in all children.

Effect of acute football activity and physical fitness on glycaemic and insulinaemic responses in adolescents.

The present study examined the metabolic responses to an acute bout of football and the overall and moderating role of physical fitness on these responses, in adolescents. Thirty-six adolescents (16 girls, 20 boys; 12.6±0.5 y) completed two trials (60-min football and 60-min seated rest) separated by 7-d. Capillary blood samples were taken at baseline (60-min prior to exercise/rest), immediately, 30- and 60-min post-exercise and 30-, 60- and 120-min following a standardised lunch (1.5-, 2- and 3-h post-exercise), for the determination of blood glucose and plasma insulin concentrations. The median split of distance covered on the multi-stage fitness test was used to define high- and low-fit groups. Overall plasma insulin tAUC following lunch was lower in high-fit participants compared to low-fit (high-fit: 3784.2±1653.1 pmol·L-1x120min, low-fit: 6457.3±3290.7 pmol·L-1x120min; p<0.001), although there was no acute effect of the football session (p>0.05). Football reduced blood glucose concentration 1-h post-exercise compared to control (exercise: 3.8±0.6 mmol·L-1, rest: 4.6±0.8 mmol·L-1; p<0.001), but this was similar for the high- and low-fit participants (p>0.05). Blood glucose tAUC was not affected by exercise or physical fitness (p>0.05). These data emphasise the importance of physical fitness for metabolic health in adolescents, as well as the utility of football as a popular form of games-based activity for improving glucose regulation.

Predictors of postprandial glycaemia, insulinaemia and insulin resistance in adolescents.

Postprandial glycaemia and insulinaemia are important risk factors for type 2 diabetes. The prevalence of insulin resistance in adolescents is increasing, but it is unknown how adolescent participant characteristics such as BMI, waist circumference, fitness and maturity offset may explain responses to a standard meal. The aim of the present study was to examine how such participant characteristics affect the postprandial glycaemic and insulinaemic responses to an ecologically valid mixed meal. Data from the control trials of three separate randomised, crossover experiments were pooled, resulting in a total of 108 participants (fifty-two boys, fifty-six girls; aged 12·5 (SD 0·6) years; BMI 19·05 (SD 2·66) kg/m2). A fasting blood sample was taken for the calculation of fasting insulin resistance, using the homoeostatic model assessment of insulin resistance (HOMA-IR). Further capillary blood samples were taken before and 30, 60 and 120 min after a standardised lunch, providing 1·5 g/kg body mass of carbohydrate, for the quantification of blood glucose and plasma insulin total AUC (tAUC). Hierarchical multiple linear regression demonstrated significant predictors for plasma insulin tAUC were waist circumference, physical fitness and HOMA-IR (F(3,98) = 36·78, P < 0·001, adjusted R2 = 0·515). The variance in blood glucose tAUC was not significantly explained by the predictors used (F(7,94) = 1·44, P = 0·198). Significant predictors for HOMA-IR were BMI and maturity offset (F(2,102) = 14·06, P < 0·001, adjusted R2 = 0·021). In summary, the key findings of the study are that waist circumference, followed by physical fitness, best explained the insulinaemic response to an ecologically valid standardised meal in adolescents. This has important behavioural consequences because these variables can be modified.

Effect of football activity and physical fitness on information processing, inhibitory control and working memory in adolescents.

BACKGROUND: Whilst an acute bout of exercise has been shown to enhance subsequent cognition, including in adolescents, the effects of team games (of which Football is the most popular) has received little attention. Therefore, this study examined: the effect of an acute bout of outdoor Football activity on information processing, inhibitory control, working memory and circulating brain-derived neurotrophic factor (BDNF) in adolescents; the effect of physical fitness on cognition and; the moderating effect of physical fitness on the acute exercise responses. METHODS: Following familiarisation, 36 adolescents (16 girls) took part in two trials (60-min Football and 60-min seated rest) separated by 7-d in a counterbalanced, crossover design. Information processing and inhibitory control (Stroop Test), and working memory (Sternberg Paradigm) were assessed 30-min before exercise/rest and immediately, 45- and 90-min post-exercise/rest. Capillary blood samples were obtained before exercise/rest and up to 120-min post-exercise/rest. The median split of distance covered on the MSFT was used to divide the group into high- and low-fit groups. RESULTS: Performance on the cognitive function tasks was similar between Football and seated rest (trial*time interactions; all p > .05). However, the high-fit group had overall quicker response times on both levels of the Stroop Task and all three levels of the Sternberg Paradigm (main effect of fitness; all p < .001). Furthermore, the exercise-cognition relationship was moderated by physical fitness, with improvements in working memory response times seen post-exercise, only in the high-fit group (trial*time*fitness interaction, p < .05). Circulating BDNF was unaffected by the Football activity and physical fitness (p > .05). CONCLUSION: The present study shows that higher levels of physical fitness are beneficial for cognitive function and provides novel evidence that an ecologically valid, and popular, form of exercise is beneficial for working memory following exercise, in high-fit participants only.

Effect of Exercise Duration on Postprandial Glycaemic and Insulinaemic Responses in Adolescents.

High-intensity intermittent exercise (HIIE) is a potential intervention to manage hyperglycaemia and insulin resistance in adolescents. The aim of this study was to determine the optimum duration of HIIE to reduce postprandial glycaemic and insulinaemic responses in adolescents and the longevity of the response. Thirty-nine participants (12.4 ± 0.4 year) completed a 30- and 60-min exercise trial (Loughborough Intermittent Shuttle Test) and a rested control trial in a randomised crossover design. Capillary blood samples were taken at baseline, immediately and 1-h post-exercise; and 30, 60 and 120 min following a standardised lunch (day one) and a standardised breakfast 24-h post-exercise. Plasma insulin total area under the curve (tAUC) following lunch was lower following 60-min HIIE (21754 ± 16861 pmol·L-1 × 120 min, p = 0.032) and tended to be lower following 30-min HIIE (24273 ± 16131 pmol·L-1 × 120 min, p = 0.080), when compared with the resting condition (26931 ± 21634 pmol·L-1 × 120 min). Blood glucose concentration was lower 1-h post-exercise following 30-min HIIE (3.6 ± 0.6 mmol·L-1) when compared to resting (4.1 ± 0.9 mmol·L-1, p = 0.001). Blood glucose and plasma insulin concentration did not differ across trials on day two. Shorter bouts of HIIE (30-min), as well as a 60-min bout, reduced the postprandial insulinaemic response to lunch, an ecologically valid marker of insulin sensitivity. As the beneficial effects of HIIE were limited to 3 h post-exercise, adolescents are recommended to engage daily HIIE to enhance metabolic health.

Benign Temporomandibular Joint Lesions Presenting as Masses in the External Auditory Canal.

OBJECTIVE: Describe benign lesions arising from the temporomandibular joint (TMJ) that presented as masses in the external auditory canal (EAC). STUDY DESIGN: Retrospective case series of two academic medical centers. PATIENTS: Six patients with lesions emanating from the TMJ that presented as EAC masses. Lesions included pigmented villonodular synovitis (PVNS), nodular fasciitis, foramen of Huschke herniation with salivary fistula, fibroepithelial polyp, superficial angiomyxoma, and giant cell tumor (GCT). INTERVENTION: Surgical resection. MAIN OUTCOME MEASURES: Tumor control, TMJ function, and hearing. RESULTS: All patients presented with hearing loss, TMJ pain, and otalgia. Three patients with EAC occluding masses developed entrapment cholesteatoma between the mass and tympanic membrane. Following surgical resection, four patients were free of disease. The patient with PVNS has a stable remnant at 3 years follow up and the patient with giant cell tumor is under active surveillance. Hearing improved in three patients, remained stable in one patient, and worsened in two patients. All had resolution of their TMJ and ear pain. CONCLUSIONS: EAC masses of uncertain origin should be imaged preoperatively to exclude lesions best not biopsied (e.g., encephalocele, facial nerve schwannoma, paraganglioma). In the differential of EAC masses, lesions emanating from the TMJ need to be considered, especially for those based anteriorly. Understanding the extent of TMJ involvement is crucial for surgical planning which optimizes outcome. Goals for therapy are to control the underlying disease process, restore patency of the EAC, improve hearing, and preserve function of TMJ.

Endoscopic Resection of Skull Base Teratoma in Klippel-Feil Syndrome through Use of Combined Ultrasonic and Bipolar Diathermy Platforms.

Klippel-Feil syndrome (KFS) is associated with numerous craniofacial abnormalities but rarely with skull base tumor formation. We report an unusual and dramatic case of a symptomatic, mature skull base teratoma in an adult patient with KFS, with extension through the basisphenoid to obstruct the nasopharynx. This benign lesion was associated with midline palatal and cerebral defects, most notably pituitary and vertebrobasilar arteriolar duplications. A multidisciplinary workup and a complete endoscopic, transnasal surgical approach between otolaryngology and neurosurgery were undertaken. Out of concern for vascular control of the fibrofatty dense tumor stalk at the skull base and need for complete teratoma resection, we successfully employed a tissue resection tool with combined ultrasonic and bipolar diathermy to the tumor pedicle at the sphenoid/clivus junction. No CSF leak or major hemorrhage was noted using this endonasal approach, and no concerning postoperative sequelae were encountered. The patient continues to do well now 3 years after tumor extirpation, with resolution of all preoperative symptoms and absence of teratoma recurrence. KFS, teratoma biology, endocrine gland duplication, and the complex considerations required for successfully addressing this type of advanced skull base pathology are all reviewed herein.

Contemporary mandibular reconstruction.

PURPOSE OF REVIEW: Multiple disease processes, including neoplasia, trauma, and medication side-effects, necessitate segmental resection and subsequent reconstruction of the mandible. As surgical techniques have advanced, several technologies have been developed with the potential to significantly transform a surgeon's approach to the restoration of mandibular continuity. The purpose of this review is to highlight many of these relatively newer tools and discuss their evolving role in mandibular reconstruction. RECENT FINDINGS: Several contemporary studies have documented the application of different approaches and modifications to mandibular reconstruction - including computer-aided design or computer-aided modeling, contemporary plating systems, osseointegrated implants, and various modifications to existing osseocutaneous free tissue transfer options - and have reported relatively high success rates. SUMMARY: In discussing these reports, we present a survey of current and developing technologies in the field of mandibular reconstruction and aim to provide sufficient context for the gradual integration of these techniques into practice.