Feast or famine: How is global change affecting forage supply for Yellowstone's ungulate herds?

The ecological integrity of US national parks and other protected areas are under threat in the Anthropocene. For Yellowstone National Park (YNP), the impacts that global change has already had on the park's capacity to sustain its large migratory herds of wild ungulates is incompletely understood. Here we examine how two understudied components of global change, the historical increase in atmospheric CO2 and the spread of nonnative, invasive plant species, may have altered the capacity of YNP to provide forage for ungulates over the last 200-plus years. We performed two experiments: (1) a growth chamber study that determined the growth rates of important invasive and native YNP grasses that are forages for ungulates under preindustrial (280 ppm) versus modern (410 ppm) CO2 levels and (2) a field study that compared the effect of defoliation (clipping) on the shoot growth of invasive and native mesic grassland plants under ambient CO2 conditions in 2019. The growth chamber experiment revealed that modern CO2 increased the growth rates of both invasive and native grasses, and invasive grasses grew faster regardless of CO2 conditions. The field results showed a continuum of positive to negative responses of shoot growth to defoliation, with a subgroup of invasive species responding most positively. Altogether the results indicated that the historical increase in CO2 and the spread of invasive species, some of which were planted to provide forage for ungulates in the early and mid-1900s, have likely increased the capacity of forage production in YNP. However, rising CO2 has also resulted in regional warming and increased aridity in YNP, which will likely reduce grassland productivity. The challenge for global change biologists and park managers is to determine how competing components of global change have already affected and will increasingly affect forage dynamics and the sustainability of Yellowstone's iconic ungulate herds in the Anthropocene.

Osteoradionecrosis versus Cancer Recurrence: An Unresolved Clinical Dilemma.

INTRODUCTION: Osteoradionecrosis is a rare and debilitating risk of definitive chemoradiotherapy for head and neck squamous cell carcinoma. It is difficult to distinguish between osteoradionecrosis and recurrent or progressive disease, as clinical and radiologic features may be similar. Our aim was to compare the clinical presentation and radiologic features of osteonecrosis with those of recurrent or progressive cancer. METHODS: We conducted a single-center case series of 19 patients with head and neck squamous cell carcinoma diagnosed between 2011 and 2019 who subsequently developed clinical and/or radiological suspicion of osteoradionecrosis. The population was a referred sample from head and neck cancer physicians at Northwell Health Cancer Institute. Clinician notes and imaging reports were reviewed to assign a final diagnosis of either cancer, osteonecrosis, or indeterminate. RESULTS: No differences were found in the clinical presentation or radiologic features between groups. Median time between treatment and development of symptoms was longer in patients with a final diagnosis of osteoradionecrosis than recurrent or progressive disease (5 vs. 3 months), but this difference was not statistically significant. Radiation dose and type were not associated with diagnosis. Mean standard uptake value maximums on positron emission tomography/computed tomography were significantly higher in the cancer group (median 14.8 vs. 9.1, p < 0.0152). At 1 year after first suspicion of osteoradionecrosis, 100% of osteoradionecrosis patients were alive, versus 28.6% of cancer patients. DISCUSSION/CONCLUSION: There is significant overlap in clinical and radiologic features of osteoradionecrosis and cancer. Standard uptake maximums may be helpful in predicting diagnosis. Occurrence of symptoms within 6 months of completing chemoradiotherapy should raise the concern for malignancy.

Fast but steady: An integrated leaf-stem-root trait syndrome for woody forest invaders.

Successful control and prevention of biological invasions depend on identifying traits of non-native species that promote fitness advantages in competition with native species. Here, we show that, among 76 native and non-native woody plants of deciduous forests of North America, invaders express a unique functional syndrome that combines high metabolic rate with robust leaves of longer lifespan and a greater duration of annual carbon gain, behaviours enabled by seasonally plastic xylem structure and rapid production of thin roots. This trait combination was absent in all native species examined and suggests the success of forest invaders is driven by a novel resource-use strategy. Furthermore, two traits alone-annual leaf duration and nuclear DNA content-separated native and invasive species with 93% accuracy, supporting the use of functional traits in invader risk assessments. A trait syndrome reflecting both fast growth capacity and understorey persistence may be a key driver of forest invasions.

Does the Muscle Action Duration Induce Different Regional Muscle Hypertrophy in Matched Resistance Training Protocols?

ABSTRACT: Diniz, RCR, Tourino, FD, Lacerda, LT, Martins-Costa, HC, Lanza, MB, Lima, FV, and Chagas, MH. Does the muscle action duration induce different regional muscle hypertrophy in matched resistance training protocols? J Strength Cond Res 36(9): 2371-2380, 2022-The manipulation of the muscle action duration (MAD) can influence the instantaneous torque along the range of motion, which can lead to adaptations of regional muscle hypertrophy. The aim of this study was to compare the effects of matched resistance training (RT) on the knee extension machine with different MAD in the cross-sectional area (CSA) responses within the quadriceps femoris (QF) and its muscles. Forty-four subjects were allocated into a control and 3 experimental groups. For a period of 10 weeks, subjects in the experimental groups performed the training protocols that were different only by the MAD: group 5c1e (5s concentric action [CON] and 1s eccentric action [ECC]; group 3c3e (3s CON and 3s ECC) and group 1c5e (1s CON and 5s ECC). Magnetic resonance imaging was performed (before and after the intervention) to determine the relative change (%) in CSA of the QF muscles along proximal (30%), middle (50%), and distal regions (70% distal of the femur). The change in CSA of the rectus femoris at the middle region are greater in 5c1e (6.8 ± 6.5%) and 1c5e (7.4 ± 6.0%) groups than 3c3e (3.4 ± 6.6%) and control groups (0.2 ± 1.8%). In addition, vastus lateralis at the distal region (5c1e = 15.9 ± 11.8%; 1c5e = 14.4 ± 10.0%) presenting greater increases in change of CSA than the others vastus only 5c1e (vastus lateralis [VI] = 5.0 ± 4.7%; vastus medialis [VM] = 4.2 ± 3.2%) and 1c5e groups (VI = 4.7 ± 3.6%; VM = 3.4 ± 3.1%). In conclusion, this study showed that matched RT protocols with different MAD resulted in different region-specific muscle hypertrophic across the individual muscles of QF.

Density-dependent plant growth drives grazer stimulation of aboveground net primary production in Yellowstone grasslands.

The mechanisms by which grazing animals influence aboveground net primary production (ANPP) in grasslands have long been an area of active research. The prevailing wisdom is that grazing can increase ANPP by increasing the availability of growth-limiting resources such as nitrogen and water, but recent theory suggests that the density-dependent growth of grassland vegetation can lead to grazer-stimulation of ANPP simply by removing shoot biomass and increasing relative growth rate (RGR). We compared the relative roles of resource availability and density-dependent growth in driving positive responses of ANPP to grazing in Yellowstone National Park. We measured the effects of clipping (50% simulated grazing intensity) and natural grazing on soil nitrogen availability, soil moisture, and shoot growth over 2 months in two grassland plant communities (mesic and dry) grazed primarily by bison. Clipping increased RGR by over 100% in both grassland types but had no effect on N availability or soil moisture during the same growth periods. Clipping stimulated ANPP only at mesic grassland, and the magnitude of this effect was strongly related to the initial plant biomass at the time of clipping relative to estimated peak biomass, supporting the density-dependent framework. Bison grazing had qualitatively similar effects on ANPP and RGR to clipping with no accompanying effects on N availability or soil moisture. Our results show how grazing can stimulate ANPP independent of a direct influence on resource availability simply by exploiting the dynamics of density-dependent plant growth.

Resistance training intervention performed with different muscle action durations influences the maximal dynamic strength without promoting joint-angle specific strength gains.

The present study investigated the effect of 10-week matched (range of motion, volume, intensity, rest, and repetition duration) training protocols with varying muscle action duration (MAD) on maximal voluntary isometric contraction (MVIC) test at eight different knee angles and one-repetition maximum (1RM) test after in seated knee extensor machine. Forty women were allocated into one control and three training groups with varying MAD: 5C1E (5s concentric action [CON] and 1s eccentric action [ECC]), 3C3E (3s CON and 3s ECC), and 1C5E (1s CON and 5s ECC). All training groups (5C1E, 3C3E, and 1C5E) showed a greater relative response in 1RM performance than the control group (0.1 ± 3.5%, p ≤ 0.05). The 1C5E group presented greater relative increases in the 1RM performance (22.1 ± 11.6%) compared to 5C1E (13.6 ± 9.2%; p ≤ 0.05) and 3C3E (14.1 ± 5.5%, p ≤ 0.05) groups. The training groups increased the MVIC performance more than the control group (p ≤ 0.05), although there were no significant differences between the training groups. This study demonstrated that isoinertial resistance training protocols with shorter CON MAD showed greater maximum dynamic strength performance response than matched training protocols with other MAD configurations. However, the configuration of MAD did not induce angle-specificity to increase the maximum isometric strength.

Identifying patterns of failure and secondary primary malignancies in HPV-related oropharyngeal squamous cell carcinomas.

Aim: To compare patterns and rates of recurrence in patients with oropharyngeal squamous cell carcinoma by human papilloma virus (HPV) status. Patients & methods: Retrospective chart review of 155 patients diagnosed with oropharyngeal squamous cell carcinoma between 2012 and 2014 at a single center. Results: Two-year recurrence-free survival was higher in patients with HPV-positive tumors compared with negative (85.2% [standard error = 0.03] versus 59.3% [standard error = 0.09]; p < .001) with the former proportionally less likely to have locoregional recurrence. HPV-positive patients had proportionally higher incidence of second primary malignancies outside of head, neck and lung compared with HPV-negative (74.2 vs 37.5%; p = 0.09). Conclusion: The differences in failure by HPV status indicates a need for modified surveillance guidelines. The differences in second primary malignancies patterns are interesting, warranting further evaluation in larger studies.

Functional Outcomes Regarding Facial Artery Musculomucosal Flap for Reconstruction of Partial Glossectomy Defects.

BACKGROUND: The surgical management and reconstruction after ablation of squamous cell carcinoma of the oral tongue and floor of mouth are quite challenging. If not reconstructed properly, the deficits resulting from the extirpation of even relatively small (T1 and T2) tumors of the tongue can impact speech and deglutition via tongue tethering and poor anterolateral mobility. Functional outcome studies regarding the utility of the pedicled facial artery musculamucosal (FAMM) flap for reconstruction of partial glossectomy defects are limited. METHODS: This is a retrospective single institutional study of patients who underwent FAMM flap reconstruction for oral cavity defects resulting from partial glossectomy (2009-2013). Follow-up data included postoperative complications, defect size, operative time, and subjective functional results (tongue mobility, speech, and swallowing capabilities).The MD Anderson Dysphagia Inventory and a limited self-assessment of speech were sent to all living patients in this initial tongue cancer cohort to assess aspects of functional status. RESULTS: Of the 21 patients studied in this initial FAMM flap cohort, 18 are currently living. The MD Anderson Dysphagia Inventory and a limited self-assessment survey of speech were sent to these individuals 6 months after treatment completion. Eight patients (44%) returned completed questionnaires. All of the respondents disagreed or strongly disagreed with the statement that they felt excluded from others because of their eating habits, 6 of the 8 of the respondents stated that they disagreed or strongly disagreed with the statement that they have to limit their food intake, and none felt that others were irritated by their eating habits. All felt that their speech was either good, very good, or excellent. No surveyed patient reported having job difficulty because of their speech. CONCLUSIONS: The FAMM flap is a reliable alternative for reconstruction of small oral tongue defects without functional deficits and a great alternative to free flap reconstruction of medium-sized defects. The encouragement of patient functional outcome studies and longitudinal follow-up studies need to be conducted in efforts to best tailor a reconstruction plan for patients with oral tongue cancers.

Effects of livestock grazing on grassland carbon storage and release override impacts associated with global climate change.

Predicting future carbon (C) dynamics in grassland ecosystems requires knowledge of how grazing and global climate change (e.g., warming, elevated CO2 , increased precipitation, drought, and N fertilization) interact to influence C storage and release. Here, we synthesized data from 223 grassland studies to quantify the individual and interactive effects of herbivores and climate change on ecosystem C pools and soil respiration (Rs). Our results showed that grazing overrode global climate change factors in regulating grassland C storage and release (i.e., Rs). Specifically, grazing significantly decreased aboveground plant C pool (APCP), belowground plant C pool (BPCP), soil C pool (SCP), and Rs by 19.1%, 6.4%, 3.1%, and 4.6%, respectively, while overall effects of all global climate change factors increased APCP, BPCP, and Rs by 6.5%, 15.3%, and 3.4% but had no significant effect on SCP. However, the combined effects of grazing with global climate change factors also significantly decreased APCP, SCP, and Rs by 4.0%, 4.7%, and 2.7%, respectively but had no effect on BPCP. Most of the interactions between grazing and global climate change factors on APCP, BPCP, SCP, and Rs were additive instead of synergistic or antagonistic. Our findings highlight the dominant effects of grazing on C storage and Rs when compared with the suite of global climate change factors. Therefore, incorporating the dominant effect of herbivore grazing into Earth System Models is necessary to accurately predict climate-grassland feedbacks in the Anthropocene.

Management of the neck after definitive chemoradiation in patients with HPV-associated oropharyngeal cancer: An institutional experience.

PURPOSE: To investigate the multidisciplinary management of patients with Human Papilloma Virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) and an incomplete nodal response on restaging PET/CT after definitive chemoradiation (CRT). MATERIALS AND METHODS: A retrospective chart review was performed of patients diagnosed with node-positive HPV-associated OPSCC from 2012 to 2017, who underwent definitive upfront CRT, and had an incomplete response on post-therapy PET/CT according to NCCN criteria. Post-CRT PET/CT results, management decisions, and clinical outcomes were recorded. RESULTS: Seventy-four patients with node-positive HPV-associated OPSCC were identified; 20 patients with incomplete neck response on PET/CT according to NCCN criteria were included in the final case series. Median follow-up time was 33 months. Patients were managed as follows: 8 underwent observation and surveillance imaging, 6 underwent ultrasound-guided fine needle aspiration (FNA), and 6 had immediate neck dissection. All the observed patients were disease-free at most recent follow-up. None of the patients who underwent immediate neck dissection had residual neck disease on pathological examination; two patients in this group ultimately developed metastatic disease. Among the 6 who underwent FNA, 1 individual had positive pathology, along with residual primary disease, for which the patient underwent salvage surgery. The 5 remaining individuals had negative FNA results, were subsequently observed, and remained free of disease. CONCLUSIONS: This institutional experience supports the notion of a high threshold for neck dissection in this low-risk population; only 1 of 20 patients with suspicious PET/CT findings had residual disease in the neck. Moreover, these patients should be managed by a multidisciplinary tumor board (MTB) since current algorithms do not universally include HPV status. Finally, the use of restaging PET/CT to guide management of the neck can be improved with changes in terminology and consideration of FDG-avidity at the primary site and on pre-therapy scans.

More of the same? In situ leaf and root decomposition rates do not vary between 80 native and nonnative deciduous forest species.

Invaders often have greater rates of production and produce more labile litter than natives. The increased litter quantity and quality of invaders should increase nutrient cycling through faster litter decomposition. However, the limited number of invasive species that have been included in decomposition studies has hindered the ability to generalize their impacts on decomposition rates. Further, previous decomposition studies have neglected roots. We measured litter traits and decomposition rates of leaves for 42 native and 36 nonnative woody species, and those of fine roots for 23 native and 25 nonnative species that occur in temperate deciduous forests throughout the Eastern USA. Among the leaf and root traits that differed between native and invasive species, only leaf nitrogen was significantly associated with decomposition rate. However, native and nonnative species did not differ systematically in leaf and root decomposition rates. We found that among the parameters measured, litter decomposer activity was driven by litter chemical quality rather than tissue density and structure. Our results indicate that litter decomposition rate per se is not a pathway by which forest woody invasive species affect North American temperate forest soil carbon and nutrient processes.

Fine-scale belowground species associations in temperate grassland.

Evaluating how belowground processes contribute to plant community dynamics is hampered by limited information on the spatial structure of root communities at the scale that plants interact belowground. In this study, roots were mapped to the nearest one mm and molecularly identified by species on vertical (0-15 cm deep) surfaces of soil blocks excavated from dry and mesic grasslands in Yellowstone National Park (YNP) to examine the spatial relationships among species at the scale that roots interact. Our results indicated that average interspecific root - root distances for the majority of species were within a distance (3 mm) that roots have been shown to compete for resources. Most species placed their roots at random, although low root numbers for many species probably led to overestimating the occurrence of random patterns. According to theory, we expected that most of the remaining species would segregate their root systems to avoid competition. Instead we found that more species aggregated than segregated from others. Based on previous investigations, we hypothesize that species aggregate to increase uptake of water, nitrogen and/or phosphorus made available by neighbouring roots, or as a consequence of a reduction in the pathogenicity of soil biota growing in multispecies mixtures. Our results indicate that YNP grassland root communities are organized as closely interdigitating networks of species that potentially can support strong interactions among many species combinations. Future root research should address the prevalence and functional consequences of species aggregation across plant communities.

Melanotic neuroectodermal tumor of infancy: a wolf in sheep's clothing.

INTRODUCTION: The melanotic neuroectodermal tumor of infancy (MNTI) is an exceptionally rare neoplasm. Despite their potential for local invasion, MNTI are considered benign neoplasms. Sporadic cases have been reported of MNTI acting in a malignant fashion; however, the majority of these tumors were of extragnathic origin. METHODS: A 2-month-old male presented with a rapidly expanding maxillary mass. The patient underwent excisional biopsy of the mass and a diagnosis of MNTI was returned. Tumor recurrence was appreciated postoperatively. Neoadjuvant chemotherapy was initiated to render it more amenable to surgical resection. Chemotherapy was suspended prematurely and the patient returned to the operating room for hemimaxillectomy. The postchemotherapy surgical pathology report demonstrated a unique mixed chemotherapy response. DISCUSSION: This report highlights the aggressive nature of gnathic MNTI, the importance of early diagnosis and definitive intervention, and the mixed clinical and histologic response of the lesion to neoadjuvant chemotherapy.

Predictive Factors for Preoperative Percutaneous Endoscopic Gastrostomy Placement: Novel Screening Tools for Head and Neck Reconstruction.

OBJECTIVE: The treatment of head and neck cancer has varying impact on postoperative recovery and return of swallowing function. The authors aim to establish screening tools to assist in preoperatively determining the need for gastrostomy tube placement. METHODS: The authors prospectively assessed all patients undergoing complex head and neck reconstructive surgery during a 1-year study period. Only patients tolerating an oral diet, without preoperative gastrostomies, were enrolled for study. Eight parameters were assessed including: body mass index (BMI), prealbumin, albumin, smoking history, comorbidities [including coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DM)], age, use of microvascular reconstruction, and type of defect. Two specific screening tools were assessed. In the first, a multivariate logistic regression model was employed to determine factor(s) that predict postoperative gastrostomy tube. In a second screening tool, the 8 parameters were scored between 0 to 1 points. The total score obtained for each patient was correlated with postoperative gastrostomy placement. RESULTS: Out of the 60 study patients enrolled in the study, 24 patients (40%) received a postoperative gastrostomy. In the logistic regression model, albumin level was the only factor that was significantly associated with need for postoperative gastrostomy (P < 0.0023). A score of 4 or greater was determined to have a sensitivity of 83% and specificity of 61% for postoperative gastrostomy. CONCLUSIONS: Patients with a score of 4 or more with this screening scoring system or those patients with an albumin level <3.5 g/dL were at high risk for postoperative feeding tube placement.

Clinical predictors of premature radiotherapy terminations in senior adults with oral cavity and laryngeal carcinoma.

INTRODUCTION: The underlying factors that contribute to early radiotherapy (RT) termination are understudied, especially in the era of hypofractionated treatment regimens. In this retrospective investigation, we examined the characteristics and causes of premature RT terminations in senior adults (>70 years old) with oral cavity (OC) and laryngeal carcinomas. METHODS: Hundred and eighty-eight patients treated with RT ± systemic therapy for OC and laryngeal cancer from 2017 to 2022 were identified. Premature termination was defined as completion of less than 95% of the prescribed RT. Logistic regression analysis was performed to examine factors predictive of premature termination, and survival was determined using the Kaplan-Meier method. RESULTS: Twenty patients (10.6%) experienced premature RT terminations. On regression analysis, ECOG score at initiation of RT was the only covariate studied to be independently associated with premature termination (OR 2.00, 95%CI: [1.21, 3.30], p = 0.007). Three-year overall survival (49.1% vs. 77.3%) was significantly reduced in the termination cohort (p < 0.0001). CONCLUSIONS: This analysis demonstrated over 1 in 10 patients had premature RT termination, which prognosticated inferior survival outcomes. Poor performance status may highlight patients at risk for premature termination and thus identify good candidates for hypofractionated protocols.

Rates of Occult Invasive Disease in Patients With Biopsy-Proven Oral Cavity Squamous Cell Carcinoma in Situ.

Importance: The likelihood that an oral cavity lesion harbors occult invasive disease after biopsy demonstrating carcinoma in situ (CIS) is unknown. While de-escalated treatment strategies may be appealing in the setting of CIS, knowing whether occult invasive disease may be present and its association with survival outcomes would lead to more informed management decisions. Objective: To evaluate rate of occult invasive disease and clinical outcomes in patients with oral cavity CIS. Design, Setting, and Participants: This was a retrospective population-based cohort study using the National Cancer Database and included adults with biopsy-proven oral cavity CIS as the first diagnosis of cancer between 2004 and 2020. Data were analyzed from October 10, 2022, to June 25, 2023. Exposures: Surgical resection vs no surgery. Main Outcomes and Measures: Analyses calculated the rate of occult invasive disease identified on resection of a biopsy-proven CIS lesion. Univariate and multivariate logistic regression with odds ratios and 95% CIs were used to identify significant demographic and clinical characteristics associated with risk of occult invasion (age, year of diagnosis, sex, race and ethnicity, oral cavity subsite, and comorbidity status). Kaplan-Meier curves for overall survival (OS) were calculated for both unresected and resected cohorts (stratified by presence of occult invasive disease). Results: A total of 1856 patients with oral cavity CIS were identified, with 122 who did not undergo surgery (median [range] age, 65 [26-90] years; 48 female individuals [39.3%] and 74 male individuals [60.7%]) and 1458 who underwent surgical resection and had documented pathology (median [range] age, 62 [21-90] years; 490 female individuals [33.6%] and 968 male individuals [66.4%]). Of the 1580 patients overall, 52 (3.3%) were Black; 39 (2.5%), Hispanic; 1365 (86.4%), White; and 124 (7.8%), other, not specified. Among those who proceeded with surgery with documented pathology, 408 patients (28.0%) were found to have occult invasive disease. Higher-risk features were present in 45 patients (11.0%) for final margin positivity, 16 patients (3.9%) for lymphovascular invasion, 13 patients (3.2%) for high-grade invasive disease, and 14 patients (3.4%) for nodal involvement. For those patients with occult disease, staging according to the American Joint Committee on Cancer's AJCC Cancer Staging Manual, eighth edition, was pT1 in 341 patients (83.6%), pT2 in 41 (10.0%), and pT3 or pT4 disease in 26 (6.4%). Factors associated with greater odds of occult invasive disease at resection were female sex, Black race, and alveolar ridge, vestibule, and retromolar subsite. With median 66-month follow-up, 5-year OS was 85.9% in patients who proceeded with surgical resection vs 59.7% in patients who did not undergo surgery (difference, 26.2%; 95% CI, 19.0%-33.4%). Conclusions and Relevance: This cohort study assessed the risk of concurrent occult invasion with biopsy-proven CIS of the oral cavity, demonstrating that 28.0% had invasive disease at resection. Reassuringly, even in the setting of occult invasion, high-risk disease features were rare, and 5-year OS was nearly 80% with resection. The findings support the practice of definitive resection if feasible following biopsy demonstrating oral cavity CIS.

Does rest interval between unilateral exercise protocols influences on contralateral neuromuscular responses in untrained individuals?

INTRODUCTION: Effects on strength performance and muscle activation in the contralateral limb have been observed after training with the ipsilateral limb (IL). Cross fatigue effects in the contralateral limb (CL) can occur at intervals of up to 48 h after a training session performed with the ipsilateral limb. The objective of this study was to verify the effect of a training session in the ipsilateral limb, on the strength and activation of the muscles in the contralateral limb also submitted to the training protocol. METHODS: 10 untrained men (mean ± SD: age = 23.7 ± 4.9 years) performed unilateral knee extension with both limbs in equated protocols, in two conditions with different intervals between limbs - 20 min and 24 h. RESULTS: There were no differences in the comparison of the force produced between the pre x post interventions with the CL limb, as well as in the activation of the quadriceps during its performance. These results were similar for the two different intervals between the protocols. CONCLUSION: It was concluded that when the CL member performs the protocol after the IL, the responses in the CL depend mainly on the requirement imposed on the protocol performed by this member, without influence of the training protocol performed previously with the IL member.

Efficacy of ketamine mouthwash in the management of oral and pharyngeal toxicity associated with head and neck chemoradiotherapy: protocol for a phase II, Simon's two-stage trial.

INTRODUCTION: Curative intent treatment of head and neck cancer (HNC) is frequently radiation therapy over 7 weeks with concurrent chemotherapy. This regimen is effective but carries a burden of toxicity leading to severe pain and treatment breaks portending inferior outcomes. Conventional palliation methods include opioids, anticonvulsants and local anaesthetics. Breakthrough toxicities are nevertheless ubiquitous and present an urgent unmet need. Ketamine is an inexpensive drug with mechanisms of analgesia outside the opioid pathway including N-methyl-D-aspartate (NMDA) receptor antagonism and a pharmacologically unique property of opioid desensitisation. Systemic ketamine is validated in randomised controlled trials for efficacy in reducing pain and/or opioid burden in the oncologic setting. Literature supports peripherally administered ketamine for pain control without systemic toxicity. These data support our rationale of using ketamine mouthwash to decrease acute toxicity of curative treatment of HNC, the efficacy of which is our aim to elucidate. METHODS AND ANALYSIS: This is a phase II, Simon's two-stage trial. Patients have pathologically confirmed HNC and an intended regimen of 70 Gy of radiation with concurrent cisplatin. The protocol is initiated on diagnosis of grade 3 mucositis and consists of 2 weeks of 4 times daily (QID) ketamine mouthwash use. The primary endpoint is pain response defined as a combination of pain score and opioid use. 23 subjects will be enrolled in stage 1. If statistical criteria are met, 33 subjects will be enrolled in stage 2. Secondary endpoints include daily pain, daily opioid use, dysphagia at baseline and completion, nightly sleep quality, feeding tube placement and any unscheduled treatment breaks. ETHICS AND DISSEMINATION: All trial data will be stored in an Institutional Review Board (IRB) approved database. The protocol is registered under Northwell IRB registration number #22-0292 and U.S. Food and Drug Administration (FDA) Investigational New Drug (IND) approval has been granted under IND number 161609. Results are intended to be published in an open-source journal and further data, statistics and source documents are available on request. TRIAL REGISTRATION NUMBER: NCT05331131.

Backyard hazard: a case series of ingested grill brush bristles and a novel approach to extraction.

OBJECTIVES: To report a small case series of an unusual ingested foreign body and a new method for removal of tongue base foreign bodies. METHODS: Three patients were identified with wire bristle foreign bodies between 2009 and 2011 at our academic tertiary medical center. Their medical records were reviewed and are described in this report. RESULTS: Each patient presented to our medical center with progressive pain after ingestion of barbecued food. For 2 patients, the metallic bristle foreign body was imbedded within the lingual tonsil. In these 2 cases, radiofrequency plasma ablation (coblation) assisted partial lingual tonsillectomy was performed to identify the foreign body. In a third case, the foreign body presented as a complex deep space neck abscess and an open trans-cervical approach was required. CONCLUSION: While oropharyngeal and esophageal foreign bodies are common, there are only a few case reports describing this particular foreign body. The presentation of an imbedded wire grill brush bristle can be insidious. Persistent pain and foreign body sensation should be taken seriously in patients with a history of barbecue food ingestion. Intraoperatively, wire bristles can be difficult to localize and extract. Radiofrequency plasma assisted lingual tonsillectomy may be helpful for identifying and removing foreign bodies that are imbedded in the tongue base. Grill brushes should undergo stringent safety regulation, as ingested wire bristles are difficult to localize and remove and may cause significant morbidity.

Impact of Treatment Parameters on Racial Survival Differences in Oropharyngeal Cancer: National Cancer Database Study.

OBJECTIVE: To investigate how differences in treatment parameters account for survival differences between races of patients with oropharyngeal squamous cell carcinoma (OPSCC). STUDY DESIGN: Retrospective cohort study. SETTING: National Cancer Database. METHODS: Data of patients with OPSCC undergoing radiation therapy (RT) or concurrent chemoradiation therapy as primary treatment were obtained from the National Cancer Database from 2004 to 2016. We analyzed 4 treatment-related time intervals to determine their impact on survival between races when controlling for human papilloma virus (HPV) status. Cox proportional hazards models, stepwise logistic regressions, covariate adjustments, and propensity score matching were performed. RESULTS: A total of 3152 patients were identified (2877 White, 275 Black). In HPV- cases, Black patients with prolonged radiation duration had a significantly worse overall survival as compared with White patients (hazard ratio, 1.77; 95% CI, 1.03-3.05; P = .039). In a logistic regression model, the only covariate that was significantly associated with prolonged RT was facility type. When further adjusted for facility type, the survival difference between Black and White patients with HPV- status and prolonged RT times was no longer significant (hazard ratio, 1.55; 95% CI, 0.90-2.69; P = .116). CONCLUSIONS: There is a significant disparity in overall survival between Black and White patients with HPV- OPSCC when RT duration is prolonged. Clinicians should be aware of the negative impact of prolonged RT, especially in Black patients, so that they can attempt to decrease treatment-related time intervals. Facility type was also found to affect the outcomes of patients with OPSCC, and efforts should be made to improve patient access to well-equipped, high-volume facilities.