Ecology

Land use dictates diversity, density and regeneration of woody species in southwestern Mali, West Africa Abstract Despite the progression of land degradation and deforestation leading to vegetation fragmentation, most of the population in Mali are still strongly dependent on trees. The current study aimed at exploring how woody species diversity, density and regeneration varies with land use types (farmland, fallow and forest). The study also puts a particular focus on abundance, regeneration and distribution of Parkia biglobosa, a high value tree crop. Data were gathered through systematic vegetation surveys in 48 quadrat plots of 50 × 50 m distributed in three land use types. Ninety one woody species belonging to 72 genera and 30 families were recorded. Land use affected woody species regeneration, density and diversity and the structure of P. biglobosa. The highest mean number of species per plot was recorded in fallow (11.1 ± 1.5) and forest (10.8 ± 0.7) compared with farmland (6.9 ± 1.0). The most abundant regeneration individuals were recorded in the fallow (1998 ± 333 ha−1), followed by forest (1532 ± 167 ha−1) and farmland (897 ± 264 ha−1). For trees, the mean density of 99 ± 26 ind. ha−1 recorded in farmland is similar to fallow (156 ± 46 ha−1) but lower than forest (559 ± 133 ha−1). The lower Shannon's diversity index H′ was also observed in the farmland (1.3 ± 0.1) compared with fallows (1.7 ± 0.2) and forests (1.9 ± 0.1). Spatial distribution of regeneration individuals for each species obtained from Morisita's index showed aggregated patterns for most of the species while Canonical Correspondance Analysis showed more common species between fallow and forest. P. biglobosa trees growing in farmland had the greatest value (57.6 ± 7.0 cm) for collar diameter compared to that of forest (33.7 ± 4.6 cm) and fallow (31.2 ± 4.7 cm).

Reproductive period of a sub-montaneous tropical forest: estimation of seed availability for forest restoration in mount Masigit-Kareumbi, Indonesia Abstract The ability of local tree species (LTS) to produce seeds is an intrinsic factor that contributes to the success of forest restoration efforts through a natural regeneration process. The aim of this study was to investigate the reproductive period of LTS in order to estimate seed sources availability for the forest restoration process in the sub-montaneous forests. Twenty permanent plots (20 × 20 m) were identified at Mt. Masigit-Kareumbi. Observations regarding flowering and fruiting were conducted on 399 individual LTS (78 species, 29 families) that had a diameter at breast height of more than 10 cm. This activity was done every month: period I was from July 2015 to June 2016, and period II was from July 2016 to June 2017. The results showed that the number of flowering–fruiting trees in period I was higher than it had been in period II. Peak flowering–fruiting occurred in period I (30.1% of the total individuals), and the lowest flowering–fruiting occurred in period II (10.5% of total individuals). 242 individual trees (60.7%) in total, comprising 57 species (73.1%), were flowered–fruited. Most LTS had short durations of reproductive phases. The shortest flowering duration was 0.1–0.8 months (61.7%), the shortest flowering–fruiting duration was 0.1–0.5 months (80.0%), and the shortest fruiting duration was 0.1–1.0 months (59.4%). Flowers and fruits or seeds were always available all year round. To support seed availability for forest restoration, the best time for fruit or seed collection is December to January.

Butterfly diversity and effect of temperature and humidity gradients on butterfly assemblages in a sub-tropical urban landscape Abstract The butterfly assemblages of urban ecosystems of Delhi were studied for a period of one year to investigate their diversity. The objective of the study was to understand the dynamics of the butterfly assemblages with respect to changing temperature and humidity levels. We tested the hypothesis that the diversity of butterflies would differ significantly across sampling period owing to pronounced temperature and relative humidity differences throughout the year. The Pollard walk method was used for butterfly survey. Twelve months of intensive sampling at four study sites with 24 temporal replicates per site yielded 14,913 individuals belonging to 75 species. Butterfly community showed a biannual peak of species richness and abundance. The maximum diversity was recorded in the pre-monsoon period between the months of April and May unlike most other studies from India which have reported April–May as the months of lowest diversity. The lowest diversity was observed during winter. Previous studies have shown that tropical insect communities have higher diversity during high precipitation periods. In this study, we found an additional peak of diversity during the pre-monsoon in addition to the post-monsoon months. The study quantitatively assessed community assemblages between ecosystems across a temperature gradient evaluating potential conservation role of natural areas and parks in urban landscapes.

Spatial determination of soil variables using GIS method and their influence on microbial communities in the Eastern Ghats region Abstract The study deals with the spatial distribution of soil variables and their impact on soil microbial communities of Yercaud hills, Eastern Ghats of Tamil Nadu, India. A total of thirteen soil variables was recorded from the soil samples. The soil bacterial and fungal communities were enumerated and representatives were identified. The soil variables were plotted in spatial map using GIS and analyzed by Pearson correlation. PCA, cluster and MDS analysis were performed to recognize the drifts amongst the high linking soil variables and microbial communities. The pH, temperature, EC, organic matter, nitrogen, phosphorus, potassium, calcium, copper, zinc and magnesium were found to be positively significant with the soil microbial communities. It is suggested that the Yercaud hills possess highly fertile, undisturbed soil environment and microbes of novel biotechnological value.

Flowering pattern of Schizostachyum dullooa , a thin walled tropical bamboo and impact of flowering on regeneration of canopy trees in evergreen forest in North East India Abstract Schizostachyum dullooa is a semelparous, thin walled bamboo that grows in the moist forests of India, Bangladesh and Myanmar. The species has great potential in upliftment of socioeconomic conditions of the rural areas of North East India. The long flowering interval in S. dullooa has hindered documentation of its demography and its influence on regeneration of canopy trees. We hypothesized that mass flowering and death of S. dullooaopens a window of opportunity creating space for the regeneration of canopy tree seedlings. We studied the flowering pattern and seedling demography of this species between the years 2010 and 2015 in the Barak Valley, and evaluated if seedling abundance of canopy tree species increased after the flowering event. We followed five successive seedling cohorts to determine variation in survival of canopy tree seedlings, seedling attributes [i.e., maximum height (cm), diameter (cm) and density (individuals per 0.01 ha)]. At the local scale, mast flowering extended over 4 years in small patches of about 100 m2 where flowering and non-flowering culms were often mixed. At the landscape scale, sites with mast flowering stands were interspersed with sites that did not have flowering stands indicating spatially discontinuous flowering patterns. Mortality rate of bamboo seedlings was high during the first year. At the end of the study, 15–26% of the initial bamboo seedlings in each cohort survived and S. dullooa was able to re-colonize sites it previously occupied. Mass flowering significantly increased seedling density and growth of canopy trees compared to non-flowering sites. It is concluded that flowering and death of S. dullooa facilitates the regeneration of canopy trees, with implications for the structure and function of the forest ecosystem.

Towards the transformations of social-ecological systems for sustainable development

Community structure of gall-inducing insects associated with a tropical shrub: regional, local and individual patterns Abstract The organization of gall-inducing insect communities can be affected by environmental factors and host plant traits that may operate at different spatial scales. Using Copaifera oblongifolia (Fabaceae), we evaluated the organization of their associated gall-inducing insect species in different spatial scales considering the following hypotheses: (i) the community of gall-inducing insects will be different between different populations of C. oblongifolia; (ii) plant individuals with a greater number of neighbours (host plant density) will have a greater diversity of gall-inducing insects; (iii) and more structurally complex plants will support a greater diversity of gall-inducing insects. Data were collected from the three different populations of C. oblongifolia located in abandoned pastures of three different municipalities in northern Minas Gerais, Brazil. We recorded a total of 17,843 galls belonging to 15 different gall-inducing insect species associated to 60 C. oblongifolia plants sampled in the three populations (20 individuals per population). Abundance, richness and composition of gall-inducing insect species were different between the populations, suggesting that local environmental conditions influenced the gall-inducing insect community at a regional scale. Host plant density negatively affected the richness and abundance of gall-inducing insects per plant. Our data did not corroborate the hypothesis of resource concentration, perhaps due to the effect of resource dilution. The biomass of the host plant positively influenced the abundance of gall-inducing insects per plant. However, the interaction between plant density and biomass of the plant suggests that plants with greater structural complexity are more attacked by gall-inducing insects in plots with lower number of neighbours.

Invertebrates associated to Ponerine ants nests in two cocoa farming systems in the southeast of the state of Bahia, Brazil Abstract The fauna associated to nest belonging to nine species of three genera of Ponerinae ants were studied in two cacao agroforestry systems (Cabrua and Derruba Total) in southeast of the state of Bahia, Brazil. A total of 27 invertebrates orders comprising 87 recognized taxonomic units (RTU), were found associated to these nests. No differences were found in the abundances recorded in both agroforestry systems. The high values of the species richness and diversity of associated invertebrates were recorded to Neoponera verenae in both agroforestry systems, while the lowest value was recorded for the nest of Mayaponera constricta collected only in Cabruca. The most frequent groups were Collembola which was found in 95.8% of the reviewed nest, follow by Acari (94.7%), Hymenoptera (other ants species as well as parasitoids; 86.2%), Coleoptera (69.1%), Araneae (51%) and Symphyla (48.9%). Our study also shows the importance of Ponerinae ants' nests as safe habitats that are attractive to many invertebrate groups, and also the importance of the cacao agroforestry system to conservation of a range of invertebrates associated to the nests of these ants.

Exotic species as the main prey items of the Neotropical otter in the Atlantic Forest, southeastern Brazil Abstract In this work, the diet of Neotropical otter was characterized in four different hydrographic regions in the southern portion of the Central Atlantic Forest Ecological Corridor, in southeastern Brazil. This was done using scat analysis to determine whether diet composition and the proportion of food items vary between studied regions, and which factors may influence the eventual observed differences. A total of 581 scat samples was taken in the environment and identified prey based on the analysis of undigested structures (scales, bone fragments, exoskeleton) and comparison to the structures contained in a reference collection. All prey were described by large prey groups (classes), and fish and crustaceans were identified to the genus level. The frequency of occurrence for each prey item and the food niche breadth were calculated for each region and for the entire study area. Diet similarities between the regions were visualized by a cluster analysis followed by a Principal Coordinate Analysis from the normalized frequencies. The differences in the prey composition of otter diets were compared among the regions by PERMANOVA. Otters showed a predominantly piscivorous diet, in which exotic cichlids were the main prey. Crustaceans was the second most consumed group. The variations recorded for the otter diet were independent of the study region, which may be related to the food variability among rivers/sampled segments in each region, which in turn may be influenced by differences in habitat structures, including the composition of aquatic biota.

Accounting tropical forest carbon stock with synergistic use of space-borne ALOS PALSAR and COSMO-Skymed SAR sensors Abstract The objective of this study is to precisely quantify the forest aboveground biomass (AGB) and carbon stock in a tropical deciduous forest with synergistic use of space-borne L-band ALOS PALSAR and X-band COSMO-Skymed SAR data, along with field inventory data. AGB serves as a decisive parameter for preparing global decision making policy targeting the impact of reducing emissions from deforestation and forest degradation and climate change. The study proposed optimal regression models for assessing above-ground bole biomass over tropical deciduous mixed forests of Munger (Bihar, India) with synergistic use of ALOS PALSAR and COSMO-Skymed sigma nought images. Coefficient of determination (r2) of 0.89 and RMSE of 15.12 Mg ha−1 were calculated for the best fit integrated model. On validation, the integrated model produced a model accuracy of 78%, r2 = 0.89, RMSE = 16.64 Mg ha−1 and Willmott's index of agreement of 0.934. Resulting modeled AGB were converted to carbon and carbon dioxide equivalents using conversion factors. L-band showed higher accuracy in the estimation in comparison to X-band; but the estimation accuracy improved with the synergistic use of both X- and L-band SAR data. Hence, the study recommends the combined use of X- and L-band SAR with exceptional capabilities for improved assessment of tropical forest stand AGB and carbon with significant contribution towards operational forestry and policy making.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

European Journal of Cancer : read online free

https://ejc-113c.elsevierdigitaledition.com/II/index.html 

 

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Otolaryngology

https://www.sciencedirect.com/journal/american-journal-of-otolaryngology/articles-in-press 

Research articleAbstract only
Comparison of the effects of the temperature of intratympanic dexamethasone injections on vertigo
Nurdoğan Ata, Kayhan Öztürk, Bahri Gezgin
In Press, Accepted Manuscript, Available online 20 May 2019
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Abstract
Abstract
Objective
This study aimed to compare if vertigo improved in patients when the dexamethasone used in the intratympanic (IT) injection was applied at body temperature or at room temperature.

Methods
The study included 54 patients who had undergone intratympanic treatment due to sudden hearing loss and tinnitus. The IT injection was administered to all patients, 2 times with 1-day intervals. Two different IT injection techniques were used for each patient: injecting dexamethasone at room temperature and injecting it at body temperature. Patients were asked to report the vertigo they felt immediately, and at 15 min after the injection using the visual analogue scale (VAS) and the four-point categorical rating scale (CRS-4).

Results
The level of vertigo immediately after injection was lower when the dexamethasone was injected at body temperature rather that at room temperature for both the VAS and CRS-4 (p < 0.05). However, no statistical differences in the VAS and CRS-4 self-report values between the two methods were found 15 min after the injection (p > 0.05).

Conclusion
Vertigo due to IT decreases within minutes. When the IT drugs are administered at body temperature, temporal vertigo due to injection is lower than when they are administered at room temperature.

select article Craniofacial injuries related to motorized scooter use: A rising epidemic
Research articleAbstract only
Craniofacial injuries related to motorized scooter use: A rising epidemic
Amishav Bresler, Curtis Hanba, Peter Svider, Michael A. Carron, ... Boris Paskhover
In Press, Accepted Manuscript, Available online 20 May 2019
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Abstract
Abstract
Objectives
Over the last decade, there has been increased interest in utilizing motorized scooters for transportation. The limited regulation of this modernized vehicle raises numerous safety concerns. This analysis examines a national database to describe the yearly incidence of craniofacial injuries and patterns of injury related to motorized scooter use.

Methods
The Consumer Product Safety Commission's National Electronic Injury Surveillance system was queried for craniofacial injuries associated with motorized scooter use. Patient demographics, injury type, anatomic location, injury pattern, and helmet status were extracted for analysis.

Results
From 2008 to 2017, there were 990 recorded events for craniofacial injuries secondary to motorized scooters extrapolating to an estimated 32,001 emergency department (ED) visits. The annual incidence was noted to triple over that 10-year period. The majority of patients were male (62.1%) and the common age groups at presentation were young children 6–12 years old (33.3%), adolescents 13–18 years old (16.1%) and young adults 19–40 years old (18.0%). The most common injury pattern was a closed head injury (36.1%) followed by lacerations (20.5%). Facial fractures were only present in 5.2% of cases. In cases in which helmet use was recorded, 66% of the patients were not helmeted.

Conclusion
The incidence of motorized scooter related craniofacial trauma is rising, resulting in thousands of ED visits annually. Many patients are experiencing morbid traumatic injuries and may not be wearing appropriate protective equipment. This study highlights the importance of public awareness and policy to improve safety and primarily prevent craniofacial trauma.

select article Buteyko breathing technique for obstructive Eustachian tube dysfunction: Preliminary results from a randomized controlled trial
Research articleAbstract only
Buteyko breathing technique for obstructive Eustachian tube dysfunction: Preliminary results from a randomized controlled trial
Haicang Zeng, Xiaoxin Chen, Yaodong Xu, Yiqing Zheng, Hao Xiong
In Press, Accepted Manuscript, Available online 17 May 2019
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Abstract
Abstract
Purpose
To assess the effectiveness of Buteyko breathing technique in patients with obstructive Eustachian tube dysfunction (ETD).

Materials and methods
Fifty-one patients (77 ears) aged between 21 and 62 years were randomized to Buteyko breathing in conjunction with medical management (nasal steroid) group or medical management alone group. The Eustachian Tube Dysfunction Questionnaire (ETDQ-7) symptom scores, tympanogram, positive Valsalva maneuver were evaluated at baseline, 6-week and 12-week follow-up.

Results
Normalization of ETDQ-7 symptom scores at 6-week follow-up was observed in 30.0% (12/40) of the Buteyko breathing group versus 16.2% (6/37) of the controls (P > 0.05). At 12-week follow-up, the ratio rose to 50.0% (20/40) in the Buteyko breathing group and 24.3% (9/37) in the controls (P < 0.05). Tympanogram normalization at 12-week follow-up was observed in 53.6% (15/28) of the Buteyko breathing group versus 26.9% (7/26) of the controls (P < 0.05). The Buteyko breathing group showed slight improvement in positive Valsalva maneuver at 6- and 12-week follow-up (P > 0.05).

Conclusions
Our study shows that Buteyko breathing technique might be an effective adjunctive intervention in treatment of obstructive ETD, especially for those patients who are refractory to medical treatment and cannot afford Eustachian tube balloon dilation surgery.

select article Commentary on Surgical management of patients with Eagle syndrome
CorrespondenceNo access
Commentary on Surgical management of patients with Eagle syndrome
Zhengcai- Lou
In Press, Accepted Manuscript, Available online 17 May 2019
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select article Prognostic factors and survival for malignant conjunctival melanoma and squamous cell carcinoma over four decades
Research articleAbstract only
Prognostic factors and survival for malignant conjunctival melanoma and squamous cell carcinoma over four decades
Nicholas B. Abt, Jiawei Zhao, Yuru Huang, Allen O. Eghrari
In Press, Corrected Proof, Available online 15 May 2019
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Abstract
Abstract
Purpose
To determine the epidemiology and survival of primary conjunctival malignant neoplasms.

Methods
Retrospective analysis of primary malignant conjunctival neoplasms using Surveillance, Epidemiology, and End Results database from 1973 to 2012.

Results
Of 1661 cases, the most common neoplasms are squamous cell carcinoma (SCC) at 54.8% and melanoma at 38.8%. Mean diagnostic age for melanoma was 62.1 compared to 65.5 years for SCC (p = 0.002). 52.2% of melanoma are male versus 77.4% of SCC (p < 0.001). For SCC only age (HR: 1.09, 95% CI:1.04–1.14) is a predictor of survival. For melanoma, age (HR: 1.07, 95% CI: 1.05–1.10), male sex (HR: 2.04, 95% CI: 1.16–3.60), T4 tumors (HR: 3.38, 95% CI: 1.17–9.80) and N1 status (HR: 8.69, 95% CI: 2.75–27.42) are all survival predictors. The 5 and 10-year overall survival (OS) estimates are not significantly different between SCC and melanoma, with 70% and 50% respectively for SCC, and 71% and 50% respectively for melanoma. Median survival time is worse for blacks (52 months) compared to whites (118 months) and Asians/Native Americans/Pacific Islanders (145 months), however race was not found to be a significant prognostic factor in multivariate analysis. Five-year survival are similar between decades 1973–1982 (66.2%), 1983–1992 (69.2%), 1993–2002 (71.3%) and 2003–2012 (70.2%).

Conclusion
Age at diagnosis is a determinant of survival for both conjunctival SCC and melanoma. Male sex, T4 and N1 staging are also important prognostic factors for melanoma. With respect to overall survival, SCC and melanoma did not differ significantly.

select article Barometric pressure and the incidence of benign paroxysmal positional vertigo
Research articleAbstract only
Barometric pressure and the incidence of benign paroxysmal positional vertigo
Jonathan Korpon, Roy Sabo, Daniel H. Coelho
In Press, Accepted Manuscript, Available online 15 May 2019
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Abstract
Abstract
Objectives
To investigate the relationship between barometric pressure and the incidence of benign paroxysmal positional vertigo (BPPV).

Methods
181 patients diagnosed with classic BPPV seen between 2011 and 2016 were identified. Demographic information, data of onset, and date of presentation were recorded. Historical barometric data for each of the 60 months were recorded. In addition, monthly counts of other atmospheric, infectious, and allergic variables for that time period were recorded. Correlation analysis compared monthly incidence of BPPV with absolute and relative changes in atmospheric conditions.

Results
The incidence of BPPV onset demonstrated a statistically significant positive correlation with barometric pressure, where every one-unit increase in barometric pressure leads to an expected increase of 6.1 diagnoses (p = 0.0008). The correlation coefficient (r) between barometric pressure and BPPV diagnoses was 0.66 (95% CI 0.14–0.90) with a p-value of 0.0131. Other seasonal variables demonstrated correlation, though none as strong as barometric pressure.

Conclusions
Barometric pressure has been long been associated with conditions of the inner ear, though its relationship to the pathogenesis of BPPV has not been investigated. Monthly changes in barometric pressure, rather than the absolute value, may be responsible for the observed changes in incidence. These findings demonstrate a clear association between barometric pressure and BPPV that may help to explain both the etiology of BPPV and its possible connection to migraine-related conditions.

select article Thermal injury to common operating room materials by fiber optic light sources and endoscopes
Research articleAbstract only
Thermal injury to common operating room materials by fiber optic light sources and endoscopes
Earl Harley, Raluca Tavaluc, Navin Prasad
In Press, Accepted Manuscript, Available online 15 May 2019
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Abstract
Abstract
Purpose
To determine the thermal energy damage potential by heat sources, such as endoscopes and fiber optic light cables, in contact with materials commonly placed around an operating room (OR) table.

Materials and method
Injury by xenon and halogen light sources were tested by direct and indirect contact using fiber optic light bundle cables and scopes at light intensities between ranging from Standby to 100%. The scopes had diameters ranging from 2.7 mm to 10 mm and were set at varying angles. The materials tested were surgical drapes, cotton towels, child shirts, child pants, lap sponges, X-ray detectable sponges, and Mayo covers. The damage potential was determined qualitatively by presence of smoking or smell of burning.

Results
Permutations involving direct contact were able to cause thermal injury, while permutations involving indirect contact, endoscopes, or halogen lamp were not. The xenon light source with the fiber optic light cable created thermal injury at light intensities of 50%, 75%, and 100%. Time to injury increased as light intensity was decreased. Only the surgical drape, child shorts, and cotton towel showed evidence of burn injury.

Conclusions
This report supports the potential for thermal injury to the patient secondary to fiber optic light sources, although this potential may be limited in extent. The injury risk can be reduced by avoiding direct contact to materials overlying the patient, confirming standby mode or 25% light intensity, and maintaining the endoscope connected to the fiber optic cable at all times.

select article 3D-real IR MRI of Meniere's disease with partial endolymphatic hydrops
Research articleAbstract only
3D-real IR MRI of Meniere's disease with partial endolymphatic hydrops
Suming Shi, Feng Zhou, Wuqing Wang
In Press, Corrected Proof, Available online 15 May 2019
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Abstract
Abstract
Objectives
A three-dimensional inversion-recovery sequence with real reconstruction (3D-real IR) sequence 4 h after intravenous gadolinium injection (IV) has been used to visualize the endolymphatic hydrops (ELH) in Meniere's disease (MD). This study was designed to explore the pathology of MD with partial ELH.

Methods
We collected 338 patients with definite MD, all of whom underwent the IV method. Patients who were found to have partial ELH (vestibular or cochlear) were enrolled. The hearing thresholds of the enrolled patients were analyzed, the regions of interest of the cochlear perilymph and the cerebellum white matter were determined, and the signal intensity ratio in the former to the latter (CC ratio) for both sides in the patients was subsequently evaluated.

Results
Of the 338 collected patients with definite MD, 19 patients (5.6%) had unilateral vestibular ELH (N = 18) or cochlear ELH (N = 1), and 4 patients (1.2%) with bilateral ELH had contralateral cochlear ELH. The CC ratio of the affected side (1.44 ± 0.46) was higher than that of the unaffected side (1.15 ± 0.33, P < 0.05) in the 19 patients with unilateral ELH. Conversely, there was no difference between the ratio of the contralateral side (1.18 ± 0.16) and the unaffected side (P > 0.05) in the 4 patients with bilateral ELH.

Conclusions
Partial vestibular ELH was more common than partial cochlear ELH in MD. Moreover, vestibular ELH, rather than cochlear ELH, may correlate with the elevated contrast effect in the affected side, which may better reflect the pathologic mechanism of MD.

select article Plunging ranula with lingual nerve tether: Case report and literature review
Case reportAbstract only
Plunging ranula with lingual nerve tether: Case report and literature review
Krish Suresh, Allen L. Feng, Mark A. Varvares
In Press, Corrected Proof, Available online 15 May 2019
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Abstract
Abstract
Plunging ranulas are most often treated surgically; various surgical approaches may be necessary depending on the unique characteristics of each case. Here, we present the case of a plunging ranula noted on imaging to have a cordlike tether, which was revealed intraoperatively to be the lingual nerve. This case illustrates the importance of preoperative imaging for surgical planning, and when a transcervical approach may be the best choice for plunging ranulas.

select article Teaching nasal analysis to otolaryngology residents
Research articleAbstract only
Teaching nasal analysis to otolaryngology residents
Katie Geelan-Hansen, Douglas Farquhar, Gita Fleischman, J. Madison Clark, William W. Shockley
In Press, Accepted Manuscript, Available online 15 May 2019
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Abstract
Abstract
Purpose
This prospective cohort study was completed to evaluate a systematic approach for teaching nasal analysis to otolaryngology-head and neck surgery residents.

Methods
Residents from each post graduate year (PGY) were randomized to the control group or study group. Residents in the study group were given a 10-slide PowerPoint (Microsoft Corp) instruction on nasal analysis using the standard sequence of photographs and anatomic elements to describe in each view. All residents were given the standard sequence of photographs of 3 patients for assessment on nasal analysis. Then 12–14 weeks later all residents were re-evaluated using photographs of 3 new patients. The results were blinded and graded using an 18 point scale modified from a previous publication [1].

Results
Twenty otolaryngology-head and neck surgery residents completed the study. Analysis was performed with and without multivariate regression modeling to adjust for PGY, gender, and number of rhinoplasties performed. The study group had overall higher scores in both the initial and follow up assessment, specifically with subsite-specific dorsal deviation, tip projection, and nostril symmetry. Neither group obtained high scores in facial symmetry, skin thickness, tip shape and contour, and radix position at initial or re-assessment.

Conclusion
Nasal analysis is a complex task. A lecture on a systemic approach to facial analysis given to a group of residents, who performed significantly better on facial analysis cases than controls. Further research in providing feedback, periods of rehearsal or testing, or focused selected elements with serial exposure can be considered.

select article The prognostic effect of anatomic subsite in HPV-positive oropharyngeal squamous cell carcinoma
Research articleAbstract only
The prognostic effect of anatomic subsite in HPV-positive oropharyngeal squamous cell carcinoma
Tristan Tham, Michael Wotman, Ansley Roche, Dennis Kraus, Peter Costantino
In Press, Corrected Proof, Available online 15 May 2019
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Abstract
Abstract
Background
Since most HPV-associated disease occurs in the tonsillar-related areas (TRA) – palatine and lingual tonsils, the effect of HPV on survival in non-tonsillar oropharyngeal subsites (nTRA) is not well established. The objective of this study was to use a large population-based cohort to investigate the survival impact of HPV in nTRA subsites versus TRA subsites.

Methods
This SEER database study was conducted by stratifying the HPV-positive oropharyngeal cancer cohort into two primary groups, TRA and nTRA.

Results
HPV-positive squamous cell cancer was significantly more common in TRAs (73%) compared to nTRAs (31.2%, p < 0.001). After controlling for age, treatment, stage, race, and income, patients with HPV-positive disease in nTRAs had a worse cause-specific survival (CSS) than individuals with HPV-positive disease in TRAs (HR = 2.16, 95% CI 1.20–3.86, p = 0.01).

Conclusion
Patients with HPV-positive OPSCC in nTRAs had poorer survival outcomes compared to patients with HPV-positive OPSCC in TRAs.

select article Post-operative epiphora following the transcutaneous medial canthal incision
Research articleAbstract only
Post-operative epiphora following the transcutaneous medial canthal incision
Mark A. Prendes, John Mittel, Peter J. Timoney, Christopher J. Compton, ... H.B. Harold Lee
In Press, Corrected Proof, Available online 14 May 2019
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Abstract
Abstract
Purpose
The safety profile of the transcutaneous medial canthal incision for access to the medial orbit is assessed with a focus on the risk of post-operative iatrogenic epiphora.

Methods
A retrospective chart review of patients undergoing medial orbitotomy via the transcutaneous medial canthal incision was performed. Patients with a minimum of 3 months of follow-up were included and post-operative complications were assessed and characterized.

Results
One-hundred-fifty patients were included in the study. A total of 4 complications were identified, including one each of the following: nasolacrimal duct obstruction, hypertrophic scar, suture granuloma and soft tissue infection. Only the nasolacrimal duct obstruction required surgical intervention.

Discussion
Access to the medial orbit has been achieved through a variety of approaches, each with their own benefits and risk profile. The transcaruncular approach has increased in usage as a means to avoid a visible cutaneous scar and decrease the risk of iatrogenic epiphora, however, there are specific patients who may have relative contraindications to this approach. The current study demonstrates the low risk profile of the transcutaneous medial canthal incision, specifically the minimal risk of iatrogenic damage to the nasolacrimal outflow system. This approach is another useful tool which orbit surgeons should be familiar with to offer as an option to patients requiring medial orbitotomy.

select article Efficacy analysis of medical and surgical treatments in chronic kidney disease patients with secondary hyperparathyroidism
Research articleAbstract only
Efficacy analysis of medical and surgical treatments in chronic kidney disease patients with secondary hyperparathyroidism
Yajing Huang, Hao Wu, Yaqun Wu, Zhiyong Luo
In Press, Accepted Manuscript, Available online 14 May 2019
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Abstract
Abstract
Purpose
To investigate the effects of surgical and medical treatments on chronic kidney disease (CKD) patients with secondary hyperparathyroidism (SHPT).

Materials and methods
A total of 198 CKD patients with SHPT were identified at Tongji Hospital from January 2013 to June 2017.

Results
Surgical group (53 patients) received maintenance dialysis for 78.0 ± 4.9 months, while medical group (84 patients) for 62.0 ± 6.4 months. The serum intact parathyroid hormone (iPTH) in surgical group reduced apparently compared with medical group (P = 0.015) and maintained satisfied result during three years of follow-up (67.4 ± 7.4 pg/ml). The recurrence rate in surgical group was 7.5% and in medical group was 15.5% (P = 0.024). Beyond that, 5 (5.9%) patients suffered persistent hyperparathyroidism in medical group.

Conclusion
Although the progress of medical treatment is changing rapidly, surgical treatment is still an effective way to control serum iPTH and calcium chronically for SHPT patients. Complex SHPT patients can also receive satisfied effect by surgical treatment, without apparently increasing the risk of complications.

select article The case of the eyelid silicone granulomas
Case reportAbstract only
The case of the eyelid silicone granulomas
Jacqueline A. Wulu, Laura Garcia-Rodriguez, Andrey Prilutskiy, Jeffrey Spiegel
In Press, Accepted Manuscript, Available online 14 May 2019
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Abstract
Abstract
Foreign body granulomas can develop even several years after autologous fat or filler injection. In some instances the foreign body granulomas have been found at sites other than the original injection site. We present a case of a 48-year-old male with reported "hyaluronic acid fillers" injected into his upper and lower eyelids several years prior. He subsequently developed periorbital swelling with negative allergic and rheumatologic workup. The patient ultimately underwent a blepharoplasty for improvement of the swelling. Histopathology suggested silicone granulomas of the upper and lower eyelid. This case illustrates the importance of keeping foreign body granulomas on the differential for all patients with a history of facial dermal filler injections. Although hyaluronic acid is the most common dermal filler, providers should suspect the use of other dermal fillers including those not FDA approved particularly when common conservative treatment methods are not sufficient.

select article Herpes simplex virus of the nose masquerading as invasive fungal sinusitis: A pediatric case series
Case reportAbstract only
Herpes simplex virus of the nose masquerading as invasive fungal sinusitis: A pediatric case series
Neha A. Patel, Rachel Kessel, Gerald Zahtz
In Press, Corrected Proof, Available online 14 May 2019
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Abstract
Abstract
The management of invasive fungal sinusitis differs greatly from the management of herpes simplex virus (HSV) of the nose in immunocompromised patients. However, the diagnosis may be uncertain and a delay in treatment can lead to mortality. Here we describe the successful medical management of a series of immunocompromised pediatric patients with HSV lesions of the nose with the initial concern for invasive fungal sinusitis. The diagnosis of HSV herpes was supported by positive polymerase chain reaction (PCR) testing of the nasal lesion. To our knowledge, these are the first cases described in the pediatric literature, emphasizing the need to include this entity on the differential.

select article Heterogeneity in the clinical presentation, diagnosis, and treatment initiation of p16-positive oropharyngeal cancer
Research articleAbstract only
Heterogeneity in the clinical presentation, diagnosis, and treatment initiation of p16-positive oropharyngeal cancer
Anish Raman, Neilayan Sen, Ethan Ritz, Mary Jo Fidler, ... Samer Al-khudari
In Press, Accepted Manuscript, Available online 14 May 2019
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Abstract
Abstract
Background
Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) has a patient demographic, presentation, and clinical treatment response distinct from HPV-unassociated OPSCC. The heterogeneity in presentation and diagnosis within a patient population with HPV-positive OPSCC and its impact on times to presentation, diagnosis, and treatment have yet to be characterized.

Participants
Patients with biopsy-proven p16-positive OPSCC seen and/or treated at our institution between 2008 and 2018. Of 136 patients with OPSCC seen and/or treated at our institution, 101 met criteria for inclusion.

Methods
Patients were grouped by several parameters including presenting symptom category (asymptomatic neck mass, neck mass with primary-site symptoms, or primary-site symptoms without a neck mass), p16 status on fine-needle aspiration (FNA), and date of presentation. Median time intervals between presentation to imaging, biopsy, and treatment were compared within each parameter using the Kruskal-Wallis test with a significance level of 0.05.

Results
Sixty-five of the 101 study patients presented with a neck mass. Patients without a neck mass had a longer interval from presentation to imaging than patients with a neck mass (median 4 vs 0 days, p = 0.025). Initial FNA obtained on 61 patients was positive for p16 in 19 patients. Unknown or negative p16 status on FNA was associated with shorter intervals from initial imaging to treatment initiation (39 vs 46.5 days, p = 0.045). Patients presenting in the final three years had a longer interval from presentation to treatment initiation (55 vs 41 days, p = 0.024).

Conclusion
A neck mass is absent from the clinical picture of a substantial proportion of HPV-associated OPSCC patients. Primary-site symptom category and regional metastasis were not associated with differences in times to diagnosis or treatment initiation at this major referral center. The increased awareness and complexity of treatment decisions related to OPSCC may contribute to the delays in treatment initiation observed in patients with p16-positive FNAs and those who presented in more recent years.

select article Impact of metabolic syndrome on recovery of idiopathic sudden sensorineural hearing loss
Research articleAbstract only
Impact of metabolic syndrome on recovery of idiopathic sudden sensorineural hearing loss
Yilong Zhou, Shuyao Qiu, Dabo Liu
In Press, Corrected Proof, Available online 14 May 2019
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Abstract
Abstract
Purpose
Metabolic syndrome (MetS) was reported to a risk factor of developing idiopathic sudden sensorineural hearing loss (ISSNHL), but limited data exist on its effect on the recovery.

The purpose of this study was to evaluate the impact of (MetS) and its components on recovery of patients with ISSNHL.

Material and methods
228 ISSNHL patients were divided into MetS group and Non-MetS group according to the diagnostic criteria of MetS, and demographic and clinical characteristics and hearing recovery were reviewed between two groups.

Results
In total, 86 (37.7%) patients in MetS group, and 142 (62.3%) patients in Non-MetS group. The rate of hypertension, diabetes mellitus, low HDL-C, high TG and obesity were significantly higher in the MetS group than those in the Non-MetS group (P < 0.05). The complete recovery rate and partial recovery rate were significantly lower in the MetS group than those in the Non-MetS group. According to the multivariate analysis, MetS was significantly associated with a poor prognosis; high initial hearing threshold and presence of diabetes mellitus were correlated with a poor prognosis (P < 0.05).

Conclusions
These results suggest that MetS has a negative impact on the hearing recovery of ISSNHL. High initial hearing threshold and diabetes mellitus were indictors of a poor prognosis of ISSNHL.

select article Impact of habitual marijuana and tobacco smoke on severity of chronic rhinosinusitis
Research articleAbstract only
Impact of habitual marijuana and tobacco smoke on severity of chronic rhinosinusitis
Osama G. Abdel-Naby Awad
In Press, Corrected Proof, Available online 14 May 2019
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Abstract
Abstract
Purpose
Health concerns around cannabis (marijuana) use have focused on the possible relationship with psychosis and lower airway health, however; the effect of cannabis smoking on upper airway health has received less attention. The aim of this study is to investigate difference between exclusive tobacco cigarettes smoking compared with tobacco plus cannabis smoking regarding severity of chronic rhinosinusitis (CRS).

Material and methods
A prospective cross-sectional study with two groups of CRS patients recruited (Group 1: tobacco cigarettes smokers; 100 patients and group 2: tobacco cigarettes smokers and also cannabis users; 100 patients). Recruitment occurred in a general practice in Egypt. Cannabis use was recorded by self-report. Severity of CRS was assessed and compared between 2 groups using SNOT-20 questionnaire, Lund-Mackay CT score and Lund-Kennedy (LK) endoscopy Score.

Results
Group 2 patients (tobacco plus cannabis smokers) had significantly higher mean of assessment cores (SNOT-20 (P = 0.005), Lund-Mackay CT score (P = 0.006) and Lund-Kennedy (LK) endoscopy Score (P = 0.005)). Group 2 patients also had significantly higher mean of facial pain/pressure, difficulty sleep, and wake at night, lack of sleep, wake up tired, fatigue, reduced productivity, reduced concentration, frustration/restless/irritable, sad and embarrassed compared to patients in group 1.

Conclusion
Adult patients who smoked tobacco cigarettes plus cannabis mixed with tobacco had greater health related quality of life burden and more severe CRS compared to patients who smoked tobacco cigarettes only.

select article Aberrant expressed long non-coding RNAs in laryngeal squamous-cell carcinoma
Research articleAbstract only
Aberrant expressed long non-coding RNAs in laryngeal squamous-cell carcinoma
Hu Li, Fu-Ling Wang, Wei Li, Yong-Hua Fei, ... Mei Zhang
In Press, Accepted Manuscript, Available online 9 May 2019
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Abstract
Abstract
Purpose
Laryngeal squamous-cell carcinoma (LSCC) is the second most common malignant tumor of head and neck squamous cell carcinoma. The study was aimed to identify key long non-coding RNAs (lncRNAs) biomarkers for LSCC.

Methods
Differentially expressed lncRNAs (DElncRNAs) and mRNAs (DEmRNAs) between LSCC and adjacent tissues were obtained based on The Cancer Genome Atlas. DElncRNA-DEmRNAs co-expression and DElncRNA-nearby-target DEmRNA interaction networks were constructed. Receiver operating characteristic and survival analysis were performed. A published dataset were as used to validate the result of bioinformatics analysis.

Results
We obtained 1103 DEmRNAs and 306 DElncRNAs between LSCC and adjacent tissues. A total of 338 DElncRNA-DEmRNA co-expression pairs and 229 DElncRNA-nearby-target DEmRNA pairs were obtained. Ten DElncRNAs and six DEmRNAs has great diagnostic value for LSCC. HOXB9 has potential prognostic value for LSCC. The results of GSE84957 validation were generally consistent with our results.

Conclusion
Our study provided clues for understanding the mechanism and developing potential biomarkers for LSCC.

select article Impact of payer status on survival in parotid malignancy
Research articleAbstract only
Impact of payer status on survival in parotid malignancy
Vanessa C. Stubbs, Karthik Rajasekaran, Jinbo Chen, Steven B. Cannady, ... Jason G. Newman
In Press, Corrected Proof, Available online 9 May 2019
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Abstract
Abstract
Objective
In the setting of current national healthcare reform, it becomes especially relevant to understand the current state of healthcare disparities with regards to insurance status. To determine the impact of payer status on survival in parotid malignancy, we utilized the National Cancer Database (NCDB).

Study design
Retrospective database review.

Setting
National Cancer Database (2004–2012).

Subjects and methods
The NCDB was queried for cases of primary malignancy of the parotid gland between 2004 and 2012. The impact of payer status on overall survival was evaluated, as well as the relationship of insurance status with patient and tumor variables.

Results
15,815 cases met inclusion criteria. A majority had private insurance (47.8%), followed by Medicare (40.9%), Medicaid (5.0%), uninsured (3.2%) and other government sources (1.3%). Medicare patients had the lowest 5 and 10-year survival rates (50.7% (95% CI [49.3–52.1]) and 27.8% (95% CI [25.0–30.9]), respectively). On multivariable analysis, uninsured, Medicare, and Medicaid patients had worse overall survival than the privately insured (HR 1.42, 95% CI [1.17–1.74]; HR 1.29, 95% CI [1.17–1.42]; HR 1.36, 95% CI [1.13–1.62], respectively). Uninsured and Medicaid patients were more likely than the privately insured to present with advanced stage disease, nodal metastasis and longer times to treatment following diagnosis.

Conclusion
In parotid malignancy, uninsured, Medicaid, and Medicare patients have worse survival outcomes compared to those with private insurance. Uninsured and Medicaid patients also present with more advanced stage disease and have increased wait times before definitive treatment is initiated.

 

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Clinical Nuclear Medicine

Minimal-Invasive Robot-Assisted Image-Guided Resection of Prostate-Specific Membrane Antigen–Positive Lymph Nodes in Recurrent Prostate Cancer With the rapid expansion of robot-assisted surgical procedures, the need for robot-compliant image guidance technologies has also increased. Examples hereof are the integrated firefly fluorescence camera, the drop-in ultrasound probe, and the recently introduced DROP-IN gamma probe. Combined with 68Ga–prostate-specific membrane antigen–(PSMA)–11 PET/CT (staging) and 99mTc-PSMA-I&S SPECT/CT (preoperative imaging), the latter DROP-IN gamma probe technology recently allowed us to perform the first clinical cases of robot-assisted PSMA-guided salvage surgery of lymphatic metastases. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Received for publication December 7, 2018; revision accepted March 3, 2019. Conflicts of interest and sources of funding: This research was supported by an NWO-TTW-VICI grant (TTW 16141). Material support was provided by Eurorad (Eurorad S.A., Eckbolsheim, France) supporting our study with a prototype DROP-IN gamma probe. None declared to all authors. Correspondence to: Fijs W. B. van Leeuwen, PhD, Interventional Molecular Imaging Laboratory, Department of Radiology, C2-S zone, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands. E-mail: F.W.B.van_Leeuwen@lumc.nl; or Tobias Maurer, MD, PhD, FEBU, Leitender Arzt, Universitätsklinikum Hamburg-Eppendorf, Martini-Klinik am UKE GmbH, Martinistraße 52 Gebäude Ost 46, 20246 Hamburg, Germany. E-mail: t.maurer@uke.de. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

FDG PET/CT in a Case of Bilateral Tuberculous Epididymo-orchitis Isolated genital tuberculosis is rare. We present a case of bilateral tuberculous epididymo-orchitis showing high FDG uptake on FDG PET/CT. In addition, the patient had a prostatic FDG-avid lesion, consistent with tuberculous prostatitis. This case indicates tuberculous epididymo-orchitis, especially in tuberculosis-endemic regions, should be considered as a differential diagnosis in patients with hypermetabolic epididymal or testicular lesions, including benign and malignant tumors, bacterial epididymo-orchitis, abscess, idiopathic granulomatous orchitis, and sarcoidosis. Received for publication March 4, 2019; revision accepted March 21, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Pengcheng Ran, MM, Department of Nuclear Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou 510120, Guangdong Province, China. E-mail: cmurpc@163.com. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

64CuCl2 PET/CT in a Hyperfunctioning Parathyroid Gland We report a case of incidental 64CuCl2 uptake at PET/CT imaging in a 61-year-old man with a biochemical recurrence of prostate cancer. Parathyroid hormone was slightly elevated (92.4 pg/mL; reference range, 18.4–80.1 pg/mL); serum calcium was in reference range (9.5 mg/dL; reference range, 8.6–10.6 mg/dL), whereas serum phosphate was slightly low (2.6 mg/dL; reference range, 2.7–4.5 mg/dL). This case highlights the ability of 64CuCl2, similar to radiolabeled choline, to identify the presence of hyperfunctioning parathyroid glands in patients undergoing PET/CT examination. Received for publication January 12, 2019; revision accepted March 24, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Laura Evangelista, MD, PhD, Nuclear Medicine Unit, Veneto Institute of Oncology IOV–IRCCS, Via Gattamelata, 64 35128 Padova, Italy. E-mail: laura.evangelista@iov.veneto.it. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

18F-FACBC PET/MRI in Diagnostic Assessment and Neurosurgery of Gliomas Purpose This pilot study aimed to evaluate the amino acid tracer 18F-FACBC with simultaneous PET/MRI in diagnostic assessment and neurosurgery of gliomas. Materials and Methods Eleven patients with suspected primary or recurrent low- or high-grade glioma received an 18F-FACBC PET/MRI examination before surgery. PET and MRI were used for diagnostic assessment, and for guiding tumor resection and histopathological tissue sampling. PET uptake, tumor-to-background ratios (TBRs), time-activity curves, as well as PET and MRI tumor volumes were evaluated. The sensitivities of lesion detection and to detect glioma tissue were calculated for PET, MRI, and combined PET/MRI with histopathology (biopsies for final diagnosis and additional image-localized biopsies) as reference. Results Overall sensitivity for lesion detection was 54.5% (95% confidence interval [CI], 23.4–83.3) for PET, 45.5% (95% CI, 16.7–76.6) for contrast-enhanced MRI (MRICE), and 100% (95% CI, 71.5–100.0) for combined PET/MRI, with a significant difference between MRICE and combined PET/MRI (P = 0.031). TBRs increased with tumor grade (P = 0.004) and were stable from 10 minutes post injection. PET tumor volumes enclosed most of the MRICE volumes (>98%) and were generally larger (1.5–2.8 times) than the MRICE volumes. Based on image-localized biopsies, combined PET/MRI demonstrated higher concurrence with malignant findings at histopathology (89.5%) than MRICE (26.3%). Conclusions Low- versus high-grade glioma differentiation may be possible with 18F-FACBC using TBR. 18F-FACBC PET/MRI outperformed MRICE in lesion detection and in detection of glioma tissue. More research is required to evaluate 18F-FACBC properties, especially in grade II and III tumors, and for different subtypes of gliomas. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Received for publication January 23, 2019; revision accepted March 24, 2019. Conflicts of interest and sources of funding: This work was supported by the Norwegian National Advisory Unit for Ultrasound and Image Guided Therapy, St Olavs Hospital, Trondheim, Norway. The authors report no conflicts of interest. Correspondence to: Anna Karlberg, MSc, Department of Radiology and Nuclear Medicine, St Olavs Hospital, Olav Kyrres gt 17, N-7006 Trondheim, Norway. E-mail: annamka@stud.ntnu.no. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Compressed Central Zone Uptake on PSMA PET/CT—A Potential Pitfall in Interpretation The case of a 66-year-old man undergoing a staging PSMA PET/CT after a recent diagnosis of prostate carcinoma is presented. In addition to uptake within the prostate consistent with primary tumor activity, mild symmetrical and diffuse uptake is also noted within central zone. The appearance is not consistent with likely tumor activity. Comparison is made with histopathology after a radical prostatectomy, and no correlating tumor is noted in the region of central zone uptake. Increased PSMA uptake within the compressed central zone of the prostate may represent a potential pitfall in PSMA PET/CT imaging. Received for publication August 15, 2018; revision accepted March 24, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Rueben Ganeshalingam, MBBS, Nuclear Medicine, Royal North Shore Hospital, Reserve Rd, St Leonards, New South Wales, Australia 2065. E-mail: Rueben.ganeshalingam@health.nsw.gov.au. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Complete Metabolic Response Assessed by FDG PET/CT to FOLFIRI-Aflibercept in Second-Line Treatment of Metastatic Colorectal Cancer FOLFIRI-aflibercept chemotherapy is indicated in second-line treatment of metastatic colorectal cancer (mCRC) after progression under FOLFOX (±bevacizumab). Nevertheless, its proven therapeutic efficacy in clinical trials was based on partial responses. And to date, only 2 cases of complete response assessed by CT were reported in literature. We report a complete metabolic response assessed by FDG PET/CT in a 50-year-old woman with mCRC treated by FOLFIRI-aflibercept. This also confirms that FDG PET/CT is emerging as a useful approach for therapeutic assessment of targeted drugs in mCRC. Received for publication December 2, 2018; revision accepted March 26, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Karim Amrane, MD, Department of Oncology, University Hospital of Brest, 2 Ave Foch, 29609 Brest Cedex, France. E-mail: karim.amrane@chu-brest.fr. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

A Critical Assessment of the Linear No-Threshold Hypothesis: Its Validity and Applicability for Use in Risk Assessment and Radiation Protection The Society of Nuclear Medicine and Molecular Imaging convened a task group to examine the evidence for the risk of carcinogenesis from low-dose radiation exposure and to assess evidence in the scientific literature related to the overall validity of the linear no-threshold (LNT) hypothesis and its applicability for use in risk assessment and radiation protection. In the low-dose and dose-rate region, the group concluded that the LNT hypothesis is invalid as it is not supported by the available scientific evidence and, instead, is actually refuted by published epidemiology and radiation biology. The task group concluded that the evidence does not support the use of LNT either for risk assessment or radiation protection in the low-dose and dose-rate region. Received for publication February 20, 2019; revision accepted March 27, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Bennett S. Greenspan, MD, MS, 150 River Club Lane, North Augusta, SC 29841. E-mail: bengreenspan0708@gmail.com. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Predictive Value of 16α-[18F]-Fluoro-17β-Estradiol PET as a Biomarker of Progestin Therapy Resistance in Patients With Atypical Endometrial Hyperplasia and Low-Grade Endometrial Cancer For early-stage endometrial cancer patients who wish to preserve fertility, progestin treatment is effective. However, repeated endometrial curettage to evaluate treatment response may cause infertility. The clinical courses of 3 patients who were treated with fertility-sparing progestin treatment and underwent serial 18F-FES PET before and after treatment are presented. The SUVmean decreased greatly in patients with pathologically complete response (44.2%, 46.2%), whereas there was only a small change (22.5%) in the patient with pathologically stable disease who finally underwent hysterectomy. 18F-FES PET can be a noninvasive method to evaluate response to fertility-sparing progestin treatment. Received for publication November 14, 2018; revision accepted March 25, 2019. Conflicts of interest and sources of funding: This study was partly supported by grants-in-aid for scientific research from the Japan Society for the Promotion of Science (nos. 15H04981, 16K20181, and 16K10345). None declared to all authors. Correspondence to: Hideaki Tsuyoshi, MD, Department of Obstetrics and Gynecology, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan. E-mail: go242h@yahoo.co.jp. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

A Critical Assessment of the Linear No-Threshold Hypothesis: What Is the Evidence? The Linear No-Threshold (LNT) hypothesis regarding low-level radiation is based on expert opinion. As more experts critically evaluate the absence of convincing evidence supporting the LNT hypothesis, the more likely we will recognize that LNT may create more risk than it mitigates. Received for publication March 28, 2019; revision accepted March 29, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Patrick M. Colletti, MD, FACNM, FSNMMI, Keck School of Medicine of USC, 1500 San Pablo St, Los Angeles, CA 90033. E-mail: colletti@usc.edu. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Thyroid Cancer Brain Metastasis: Survival and Genomic Characteristics of a Large Tertiary Care Cohort Purpose Brain metastases (BMs) in patients with differentiated thyroid cancer (DTC) are rare but associated with poor prognosis. We examined risk factors for overall survival (OS) in this population and explored the pattern of genomic alterations. Methods Single-institution, retrospective review of all patients with DTC from January 2000 to November 2016 identified 79 patients for analysis. Multiple prognostic factors, including age, gender, distal metastasis (DM), diagnosis time, DM sites, BM diagnosis time, BM number and size, genomic sequencing data, craniectomy, external beam radiation therapy, and kinase inhibitor therapies, were evaluated. Univariate and multivariate analyses were performed. Results Median survival after BM was 18 months. One- and 3-year survival rates were 63% and 33%, respectively. Univariate analysis identified 4 covariates correlated with prolonged survival: time between DTC diagnosis and BM for less than 3 years (P = 0.01), time from initial DM diagnosis to BM for 22 months or less (P = 0.03), 3 BM sites or fewer (P = 0.002), and craniectomy (P = 0.05). Multivariate model revealed 3 variables associated with OS: DTC diagnosis to BM time of less than 3 years (P = 0.04), craniectomy (P = 0.06), and patients with fewer than 3 BM sites (P = 0.06). The majority of patients with BM had a telomerase reverse transcriptase promoter mutation, However, mutational status was not an independent predictor of survival. Conclusions For BM from DTC, time interval between DTC diagnosis and BM, number of BM sites, and craniectomy were independently associated with OS. Further studies are needed to define the role of genomic mutations in advanced cancer. Received for publication October 26, 2018; revision accepted March 30, 2019. J.R.O. and J.D.K., co–first authors, contributed equally to this work. Conflicts of interest and sources of funding: This study was supported by R01 CA201250-01A1 "124I-NaI PET: Building Block for Precision Medicine in Metastatic Thyroid Cancer" grant (to J.R.O., R.K.G., S.M.L.), as well as by the Center for Targeted Radioimmunotherapy and Diagnosis and the Ludwig Center for Title page 2 Cancer Immunotherapy. This research was also funded in part through the National Institutes of Health/National Cancer Institute Cancer Center Support grant P30 CA008748. The authors declare no conflict of interest. Correspondence to: Joseph R. Osborne, MD, PhD, Department of Radiology, New York–Presbyterian Weill Cornell Medical Center, 520 E 70th St, Starr-2, New York, NY 10021. E-mail: jro7001@med.cornell.edu. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Transplantation

Defining a willingness-to-transplant threshold in an era of organ scarcity: Simultaneous liver-kidney transplant as a case example Background: Organ scarcity continues in solid organ transplantation, such that the availability of organs limits the number of people able to benefit from transplantation. Medical advancements in managing end-stage organ disease have led to an increasing demand for multi-organ transplant, wherein a patient with multi-organ disease receives more than one organ from the same donor. Current allocation schemes give priority to multi-organ recipients over single-organ transplant recipients, which raises ethical questions regarding equity and utility. Methods: We use simultaneous liver-kidney (SLK) transplant, a type of multi-organ transplant, as a case study to examine the tension between equity and utility in multi-organ allocation. We adapt the health economics willingness-to-pay threshold to a solid organ transplant setting by coining a new metric: the willingness-to-transplant (WTT) threshold. Results: We demonstrate how the WTT threshold can be used to evaluate different SLK allocation strategies by synthesizing utility and equity perspectives. Conclusions: We submit that this new framework enables us to distill the question of SLK allocation down to: what is the minimum amount of benefit we require from a deceased donor kidney to allocate it for a particular indication? Addressing the above question will prove helpful to devising a rational system of SLK allocation and is applicable to other transplant settings. Disclosure: The authors declare no conflict of interest. Findings in this manuscript were partly reported in abstract form at the National Kidney Foundation Young Investigator Forum in April, 2017 and American Transplant Congress in May, 2017. Funding: Research reported here was supported by the John M. Sobrato Gift Fund (J.C.T.) and National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number K24DK092336 (W.R.K.) and K24 DK085446 (G.M.C.). Corresponding Author: Xingxing S. Cheng xscheng@stanford.edu, 777 Welch Road, Suite DE Palo Alto, CA, USA 94304 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Letermovir as Salvage Therapy for CMV Infection in Transplant Recipients BACKGROUND: Letermovir, a new viral terminase complex inhibitor, has been approved for the prevention of cytomegalovirus (CMV) infection in hematopoietic stem cell transplant patients. However, data on the efficacy and safety of letermovir for the treatment of CMV infection in transplant recipients remain scarce. METHODS: We performed a single-center retrospective study of stem cell and organ transplant recipients who received letermovir for the treatment of CMV infection from November 2017 to October 2018. RESULTS: Six patients were included and five were evaluable. All received letermovir in the context of a refractory or resistant CMV infection including asymptomatic CMV viremia (n=3), CMV syndrome (n=1) and CMV pneumonitis and colitis (n=1). The three asymptomatic patients experienced a decrease of the viral load to less than 200 IU/mL after letermovir therapy. One patient displayed a partial viral load response (2 log of viral load reduction) but a good clinical response, and one who received a suboptimal dose of letermovir experienced an increase of viremia. There were no treatment-related adverse effects. CONCLUSION: We demonstrate mixed efficacy in patients with refractory CMV infection suggesting that letermovir may be a useful therapeutic adjunct, potentially in combination with other antivirals. * denotes joint senior authorship DISCLOSURES: AH has received clinical trials grants from Merck, Shire, Roche, Qiagen, and Astellas. DK has received clinical trials grant from Roche, Shire, Qiagen, Oxford Immunotec and honoraria from Merck, Shire. PP, JT, AV, SH, VHF have no relevant disclosures. FUNDING: None Corresponding Author: Atul Humar MD MSc FRCPC, University Health Network, Toronto, Ontario, Canada M5G 2N2, Atul.humar@uhn.ca Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Changes of T-cell immunity over a lifetime T cell immunity undergoes a complex and continuous remodeling with aging. Understanding those dynamics is essential in refining immunosuppression. Aging is linked to phenotypic and metabolic changes in T-cell immunity, many resulting into impaired function and compromised effectiveness. Those changes may impact clinical immunosuppression with evidences suggesting age-specific efficacies of some (CNI and mTORi) but not necessarily all immunosuppressants. Metabolic changes of T cells with aging have only recently been appreciated and may provide novel ways of immunosuppression. Here, we provide an update on changes of T-cell immunity in aging. Disclosure: The authors declare no conflicts of interest. Funding: This work was supported by National Institutes of Health grants R56/R01AG039449. Y.N. was supported by the Chinese Scholarship Council (201606370196) and Central South University. K.M and R.M. were supported by the Osaka Medical Foundation. J.I was supported by the Biomedical Education Program and The German Academic Exchange Service. Address correspondence to: Stefan G. Tullius MD, PhD, 75 Francis St, 02115, Boston, MA. Stullius@bwh.harvard.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Living Donor Liver Transplant for Alcoholic Liver Disease: Data from the Adult to Adult Living Donor Liver Transplantation Study (A2ALL) Background: Alcoholic liver disease (ALD) accounts for 15-30% of transplants performed in the United States and Europe, however the data on living donor liver transplantation (LDLT) for ALD remains sparse. The purpose of this study was to examine the outcomes following LDLT for ALD using data from the Adult to Adult Living Donor Liver Transplantation Study (A2ALL), which represents the largest Western experience with adult to adult LDLT. Methods: A retrospective review of A2ALL data collected between 1998-2014 was performed. Patients were excluded if they received a deceased donor liver transplant. Demographic data, post-operative outcomes and complications, graft and patient survival, and predictors of graft and patient survival were assessed. Results: Of the 1065 patients who underwent LDLT during the study time period, 168 (15.8%) were transplanted for a diagnosis of ALD. Comparing patients who underwent transplant for ALD with those who were transplanted for other etiologies of liver disease, there was no significant difference in graft survival at one (88% vs. 84%), five (76% vs. 74%), or ten years following transplant (55% vs. 61%, p=0.29). Similarly, there was no difference in patient survival at one (94% vs. 91%), five (83% vs. 79%), or ten years following transplant (61% vs. 66%, p=0.32). Conclusions: LDLT for ALD results in excellent one, five, and ten-year graft and patient survival. Patients with ALD and impaired renal function have a higher risk of graft loss and death. These findings support the notion that early LDLT for patients with ALD may help optimize outcomes. Disclosures: the authors declare no conflicts of interest Funding: Supported in part by the UCSF Liver Center (P30 DK026743). Corresponding Author: Dr. Nancy L. Ascher, MD, PhD, Professor of Surgery , Division of Transplant, University of California, San Francisco, Box 0780, 505 Parnassus Avenue, M884, San Francisco, CA 94117, Phone: (415) 353- 8615, Fax: (415) 353-8974, Email: nancy.ascher@ucsf.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Living Donor Liver Transplant in Alcohol-related Liver Disease: An Option Whose Time has Come No abstract available

Restoring activity of pig brain cells after death does not invalidate the determination ofdeath by neurologic criteria or undermine the propriety of organ donation after death No abstract available

DEVELOPMENT AND PRELIMINARY EVALUATION OF IRD-1-2-3: AN ANIMATED VIDEO TO INFORM TRANSPLANT CANDIDATES ABOUT INCREASED RISK DONOR KIDNEYS Background: Current educational interventions about increased risk donors (IRDs) are less effective in improving knowledge among African American (AA) kidney transplant candidates compared to other races. We aimed to develop an IRD educational animated video culturally responsive to AAs and conduct feasibility testing. Methods: Between 5/1/18-6/25/18 we iteratively refined a culturally targeted video for AAs with input from multiple stakeholders. We then conducted a one group pre post study between 6/28/18-10/29/18 with 40 kidney transplant candidates to assess the feasibility and acceptability of the video to improve participant knowledge and obtain feedback about IRD understanding, self-efficacy, and willingness. A mixed population was chosen to obtain race-specific acceptability data and efficacy estimates to inform a larger study. Results: Three themes emerged and informed video development; misattribution of IRD to kidney quality, IRD terminology as a barrier to meaningful understanding, and variable reactions to a 1:1000 risk estimate. The study cohort was 50% AA. Median IRD knowledge increased from 5 to 7.5 (p=0.001) overall and from 5 to 7 (p<0.001) among AAs. The frequency of positive responses increased pre post video for understanding of (23% vs. 83%, p<0.001), self-efficacy to decide about (38% vs. 70%, p<0.001) and willingness to accept IRD kidneys (25% vs 72%, p<0.001). Over 90% of participants provided positive ratings on each of 6 acceptability items. Conclusion: A culturally responsive IRD educational video was developed in collaboration with key stakeholders. Quantitative results indicate the video was acceptable and promising to impact IRD knowledge among AA and non-AA kidney transplant candidates. Authorship: LK and MCL participated in research design, data collection and analysis, manuscript preparation and editing. MM and TF participated in analysis and editing. RC and BD participated in editing. Disclosure: The authors declare no conflict of interest. Funding: The work reported in this paper was supported by Research for Health in Erie County, Inc. Corresponding Author: Michael D Cobler-Lichter BS1, M.D. Candidate, Class of 2021, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, 955 Main Street, Buffalo, NY 14203, Tel: 716-481-7805 EMAIL: mcoblerl@buffalo.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Area under trough concentrations of tacrolimus as a predictor of progressive renal impairment after liver transplantation. Background: Tacrolimus minimization is usually restricted to patients with pre-transplant renal impairment and this strategy could result into worse renal outcomes after liver transplantation (LT). Methods: A consecutive cohort of 455 LT patients receiving tacrolimus-based immunosuppression was studied (2008-2013). Cumulative exposure to tacrolimus was calculated as the area under curve of trough concentrations (AUCtc). Patients were stratified as tacrolimus minimization, conventional or high exposure according to thresholds based in the COMMIT consensus. Estimated glomerular filtration rates (eGFR) were assessed by the MDRD-4 formula up to 5 years post-LT. Results: Seventy patients (15.4%) had pre-transplant eGFR<60 ml/min, which was associated with increased mortality rates, particularly within the first 5 years post-LT (31.4% vs 17.5%; Breslow p= 0.010). After LT, there was an abrupt eGFR decline within the first 3 months (median 18.6 ml/min; p<0.001), further decreasing up to 12 months (additional 3 ml/min), without any improvement thereafter. According to AUCtc, 33.7% of patients received tacrolimus minimization, 44.8% conventional exposure and 21.5% high exposure. Conventional/high exposure to tacrolimus resulted in a more pronounced eGFR decline within the first 3 months as compared with minimization (23.3ml/min vs 9.5ml/min; p<0.001). This gap was even higher in patients with initially preserved renal function. Tacrolimus AUCtc was an independent predictor of eGFR decline within the first 3 months after controlling for potential confounders. Conclusions: AUCtc is a surrogate of cumulative exposure to tacrolimus and may be helpful for routine dose adjustments. Tacrolimus minimization should be universally attempted after LT in order to preserve renal function. Disclosure: The authors of the present manuscript have no conflict of interest to disclose as described by the Transplantation Journal. Funding: The present study was investigator-driven and it is free from any industry sponsorship. Marta Guerrero is a recipient of a research grant awarded by the Asociación Española para el Estudio del Hígado (AEEH). * Corresponding author. ** These authors had equal contribution to the manuscript and are joint senior authors. Correspondence information: Manuel Rodríguez-Perálvarez, MD, PhD. Hospital Universitario Reina Sofía. Avda/ Menéndez Pidal s/n; Postal Code 14004; Córdoba, Spain. E-mail: ropeml@hotmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

MHC-mismatched Allotransplantation of Induced Pluripotent Stem Cell-Derived Cardiomyocyte Sheets to Improve Cardiac Function in A Primate Ischemic Cardiomyopathy Model Background: Although allogeneic induced pluripotent stem cell (iPSC)-derived cardiomyocytes (CMs) exhibit potential in cardiomyogenesis for heart failure, whether major histocompatibility complex (MHC) -matched allogenic iPSC implantation (MMAI) minimizes immune rejection for cell survival or functional recovery remains unknown. We herein explored whether MMAI with an iPSC-CM sheet is stable for a longer period and therapeutically more effective than MHC-mismatched AI in a primate ischemic cardiomyopathy model. Methods: Green fluorescent protein (GFP)-transfected iPSC-CM sheets, derived from cynomolgus macaques with homozygous MHC haplotypes ''HT1'', were transplanted on the left ventricle (LV), generated by ligating the left anterior descending (LAD) artery for 2 weeks in an ischemic model with or without heterozygous HT1 as MMAI and MHC-mismatched AI. Sham models were made by opening chest at 14 days after LAD ligation without any treatment. Results: Stereomicroscopy revealed that at 4 months post transplantation, GFP intensity was higher in the MMAI group than in the MHC-mismatched AI group and the sham group. Immunohistochemistry staining revealed that host immune reaction with CD3-positive cells was stronger in MHC-mismatched AI than in MMAI at 3 months. Cardiac function improved both in MMAI and MHC-mismatched AI at 1 month after transplantation and was preserved until 6 months, whereas in the sham group, functional deterioration progressed over time. Conclusion: Although MHC-homo-iPSCs are preferred to avoid immune rejection, MHC-mismatched iPSC-CMs can also induce comparable cardiac functional recovery at late follow-up, suggesting that MHC-mismatched iPSC-based cardiac regenerative therapy with immunosuppressants is a feasible option for treating heart failure in clinical settings. Authorship: NK performed all the experiments, collected and/or assembled all the data, wrote the manuscript, and prepared the figures. SM provided financial support and helped to set up all the experiments and contributed to data analysis and interpretation. SF, TK, AK, SY, AH and KT helped data analysis and interpretation. SE provided study materials. KM, TW and JH contributed to the analysis of cardiac perfusion in experimental animals by positron emission tomography scanning. YS is the corresponding author and conceived and designed the study and provided financial support. Disclosure: The authors declare no conflicts of interest. Funding: This work was supported by the Japan Science and Technology Agency as a part of the project, Center for the Development of Myocardial Regenerative Treatments Using iPS Cells. Corresponding Author: Yoshiki Sawa, MD, PhD, Yamadaoka, 2-2, Suita-city, Osaka 565-0087, Japan. Tel: +81-6-6879-3154, Fax: +81-6-6879-3159, E-mail: sawa-p@surg1.med.osaka-u.ac.jp6 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Liver Transplantation Using Uncontrolled Donors After Circulatory Death: A 10-Year Single-Center Experience Background. One method for increasing the donor pool for orthotopic liver transplantations (OLTs) is to use uncontrolled donations after circulatory death (uDCDs). Methods. From January 2006 to December 2016, we performed 75 OLTs using uDCD livers. The control group comprised a sample of 265 OLTs using livers of donations after brain death (DBDs). A comparative study was performed. Results. Of 256 potential uDCD donors cannulated, 75 (29.3%) livers were accepted for OLT. The amount of hemoderivatives transfused was significantly higher in the uDCD group. The rate of primary nonfunction was also significantly higher (p = 0.031) in uDCD recipients (8%) than in DBD recipients (1.5%). The overall rate of biliary complications was significantly higher (p = 0.001) in uDCD recipients (23 cases, 30.6%) than DBD recipients (28 cases, 10.6%). In the uDCD group, 1-, 3-, and 5-year patient survival rates were 82.7%, 73%, and 71.5%, respectively; in the DBD group, they were 89%, 83.7%, and 78.8%, respectively (p = 0.180). In the uDCD group, 1-, 3- and 5-year graft survival rates were 73.3%, 65.1%, and 63.6%, respectively; in the DBD group, they were 87.1%, 81.9%, and 76.5%, respectively (p = 0.013). Multivariate analysis showed that independent risk factors for patient and graft survival were intraoperative transfusion of more than six units of packed red blood cell concentrates and recipients who were older than 60 years. Conclusions. Although graft survival is significantly lower using uDCD livers, 5-year patient survival in recipients of DBD and uDCD livers is similar. After careful selection, the livers of uDCD can be selectively used for OLT. Disclosure: The authors declare no conflicts of interest. The authors declare no applicable funding. 3Presented this research as oral communication at the 27th International Congress of The Transplantation Society (2018) held in Madrid, Spain. *Corresponding Author: Carlos Jiménez-Romero PhD, FACS. Prof. of Surgery. Unit of HPB Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, 4ª Planta, Ctra. Andalucía Km 5.4, 28041, Madrid, Spain. Phone: +34 91 3908294. Fax: +34 91 519271. E-mail: carlos.jimenez@inforboe.es Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Alexandros Sfakianakis
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