Dysphagia and QoL 3 Years After Treatment of Oropharyngeal Cancer With TORS or Radiotherapy.

OBJECTIVE(S): To investigate dysphagia and quality of life (QoL) outcomes 3 years after treatment of oropharyngeal cancer with either primary trans oral robotic surgery (TORS) or radiotherapy (RT). METHODS: A prospective cohort study conducted at the Copenhagen University Hospital. Endpoints were objective swallowing function, examined using fiberoptic endoscopic evaluation of swallowing (FEES) and video fluoroscopy (VF). QoL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core (EORTC QLQ-C30), Head & Neck Module (EORTC QLQ-HN35), and MD Anderson Dysphagia Inventory (MDADI). A comparison was made between 1-, and 3-year results. RESULTS: Forty-four patients were included prior to treatment, 31 treated with TORS and 13 with RT. One-year results for this cohort have previously been published (https://doi.org/10.1080/00016489.2020.1836395). Significant improvement on FEES in retention at the piriform sinus was noted in both groups. Patients treated with TORS had improved safety scores as well as dynamic imaging grade of swallowing toxicity (DIGEST) and efficiency scores, whereas patients treated with RT only had improvements in the latter two. Improvement in QoL scores was only noted for patients treated with TORS in composite MDADI scores. CONCLUSION: We found significant improvements in objective swallowing function from one to 3 years after treatment, particularly in patients treated with TORS. However, these improvements were not reflected as clinically meaningful improvements in QoL. LEVEL OF EVIDENCE: 3, cohort follow-up study Laryngoscope, 133:1893-1898, 2023.

Effect of transcutaneous electrical muscle stimulation on muscle volume in patients with septic shock.

OBJECTIVE: Intensive care unit admission is associated with muscle wasting and impaired physical function. We investigated the effect of early transcutaneous electrical muscle stimulation on quadriceps muscle volume in patients with septic shock. DESIGN: Randomized interventional study using a single-legged exercise design with the contralateral leg serving as a paired control. SETTING: A mixed 18-bed intensive care unit at a tertiary care university hospital. PATIENTS: Eight adult male intensive care unit patients with septic shock included within 72 hrs of diagnosis. INTERVENTIONS: After randomization of the quadriceps muscles, transcutaneous electrical muscle stimulation was applied on the intervention side for 7 consecutive days and for 60 mins per day. All patients underwent computed tomographic scans of both thighs immediately before and after the 7-day treatment period. The quadriceps muscle was manually delineated on the computed tomography slices, and muscle volumes were calculated after three-dimensional reconstruction. MEASUREMENTS AND MAIN RESULTS: Median age and Acute Physiology and Chronic Health Evaluation II score were 67 years (interquartile range, 64-72 years) and 25 (interquartile range, 20-29), respectively. During the 7-day study period, the volume of the quadriceps muscle on the control thigh decreased by 16% (4-21%, p=.03) corresponding to a rate of 2.3% per day. The volume of the stimulated muscle decreased by 20% (3-25%, p=.04) corresponding to a rate of 2.9% per day (p=.12 for the difference in decrease). There was no difference in muscle volume between the stimulated and nonstimulated thigh at baseline (p=.10) or at day 7 (p=.12). The charge delivered to the muscle tissue per training session (0.82 [0.66-1.18] coulomb) correlated with the maximum sequential organ failure assessment score. CONCLUSIONS: We observed a marked decrease in quadriceps volume within the first week of intensive care for septic shock. This loss of muscle mass was unaffected by transcutaneous electrical muscle stimulation applied for 60 mins per day for 7 days.

Long-term quality of life & functional outcomes after treatment of oropharyngeal cancer.

Functional and QoL outcomes were compared longitudinally in a cohort of patients treated for oropharyngeal squamous cell carcinoma (OPSCC) with primary transoral robotic surgery (TORS) or radiotherapy (RT). Forty-four patients undergoing primary TORS (n = 31) or RT (n = 13) for any stage OPSCC were included. Only low-stage disease was treated with TORS. Functional outcomes were: salivary flow rate, image-based swallowing function, and a self-reported 10-point scale comparing current swallowing function to baseline (CvB scale). QoL was assessed with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core (EORTC QLQ-C30), Head & Neck Module (EORTC QLQ-HN35), and MD Anderson Dysphagia Inventory (MDADI). Shoulder impairment was assessed with Neck Dissection Impairment Index (NDII) and Oxford Shoulder Score (OSS). In the RT group, salivary flow rates had significantly declined at 12-month follow-up, with the biggest declines in QoL subscale scores recorded in the RT group for dry mouth and sticky saliva. Swallowing function on imaging studies was overall good, with no severe dysphagia within 1 year although, both treatment groups showed significant deterioration relative to baseline at the 12-month follow-up with increased DIGEST scores and pharyngeal retention. Shoulder impairment was rare at 1 year in both groups. A comprehensive examination of this cohort treated for OPSCC showed overall good functional and QoL outcomes 1 year after treatment. However, persistent impairment was seen in both groups with regards to swallowing function. In the TORS group, at 12-months follow-up, the QoL questionnaires showed worse scores in only one subscale (sticky saliva).

Limited value of novel pulmonary embolism biomarkers in patients with coronary atherosclerosis.

BACKGROUND: Recent research supports the efficacy of various plasma biomarkers in diagnosing pulmonary embolism (PE) including E-selectin, MMP-9, MPO, sVCAM-1, sICAM-1, adiponectin, hs-CRP and tPAI-1. OBJECTIVE: We hypothesized that these biomarkers, which are affected in both venous and arterial thromboembolic diseases, have a limited potential of diagnosing PE in patients with concomitant coronary atherosclerosis, as assessed from a low-dose CT scan of the thorax, compared to patients without atherosclerosis. METHODS: Consecutive patients suspected of PE were referred. All patients had a ventilation/perfusion single photon emission tomography (V/Q-SPECT), low-dose pulmonary CT, pulmonary multidetector computer tomography angiography, blood samples and ECG-gated cardiac CT performed the same day. RESULTS: A total of 69 patients were included, of which 28 (41%) had PE. In patients without coronary calcium, MMP-9 and tPAI-1 were significantly elevated (P<0·042 and P<0·049) in patients diagnosed with PE. From the receiver operating curves, we chose a cut-off value for MMP-9 at 164·4 ng l(-1) , which yielded sensitivity, specificity, positive and negative predictive values of 63%, 78%, 71% and 70%, respectively. With a chosen cut-off value for tPAI-1 at 56·3 ng l(-1) , the sensitivity, specificity, positive and negative predictive values were 88%, 89%, 88% and 89%, respectively. In patients with coronary calcium, none of the biomarkers could discriminate between PE and no PE. CONCLUSION: Plasma levels of tPAI-1 and MMP-9 are potentially useful in patients suspected of PE, however, not in the presence of the coronary atherosclerosis.

ANP, BNP and D-dimer predict right ventricular dysfunction in patients with acute pulmonary embolism.

BACKGROUND: The aim of this study was to predict right ventricular dysfunction (RVD) using plasma concentration of D-dimer, pro-atrial natriuretic peptide (pro-ANP), brain natriuretic peptide (BNP), endothelin-1 (ET-1) and cardiac troponin I (TNI) in patients with pulmonary embolism (PE). METHODS: Patients suspected of PE had a ventilation/perfusion-single-photon emission-tomography (V/Q-SPECT), pulmonary multidetector computer tomography (MDCT) angiography, blood samples and ECG-gated cardiac CT performed the same day. RESULTS: Pro-ANP, BNP and D-dimer are associated with significantly elevated levels in PE patients with RVD. ROC curves demonstrated that D-dimer, pro-ANP and BNP were accurate for detection of RVD. CONCLUSION: Because measurements of cardiac biomarkers are inexpensive and easily obtained they may prove useful in the clinical diagnosis of RVD. However because of the small sample size, the results need to be confirmed in larger studies.

Pulmonary hypertension in end-stage pulmonary sarcoidosis: therapeutic effect of sildenafil?

BACKGROUND: The objectives of this study were to assess the frequency and severity of pulmonary hypertension (PH) and the effect of sildenafil treatment in patients with recalcitrant pulmonary sarcoidosis. METHODS: This investigation was a single-center, retrospective study of all patients (n = 25) with end-stage pulmonary sarcoidosis referred for lung transplantation. Hemodynamic measurements were evaluated by right-side cardiac catheterization in 24 of 25 patients. Sildenafil treatment for patients with sarcoidosis-associated PH was introduced in April 2004. RESULTS: The study group of 24 patients (16 men, 8 women) had a median age of 45 (range 35 to 58) years, and duration of sarcoidosis of 11 (range 2 to 38) years. Mean pulmonary arterial pressure (MPAP) was median 36 (range 18 to 73) mm Hg. PH (MPAP >25 mm Hg) was present in 19 of 24 patients (79%). Sildenafil was administered to 12 of 13 patients at a dose of 150 (range 75 to 225) mg/day for 4 (range 1 to 12) months. Sildenafil treatment was associated with reductions in MPAP of -8 mm Hg (CI -1 to -15 mm Hg), and PVR -4.9 Wood units (CI -7.2 to -2.6 Wood units). Cardiac output and cardiac index also increased during treatment (p = 0.01, respectively). There were no consistent changes in 6-minute walk distance. CONCLUSIONS: Patients with severe pulmonary sarcoidosis have a high prevalence of PH. Sildenafil treatment was associated with significant improvements in hemodynamic parameters.