Association between oral cavity cancer and metabolic syndrome

PURPOSE

Few studies have been conducted on the association between oral cavity cancer and metabolic diseases. This study aimed to investigate the relationship between oral cavity cancer and metabolic diseases.

METHODS

This cohort study used the database of the Korean National Health Insurance Service, which contains medical data of 97% of the Korean population. Oral cavity cancer occurred in a total of 2718 patients. Metabolic syndrome was defined according to IDF criteria. The Cox proportional hazard regression model was used.

RESULTS

The HR for oral cavity cancer in patients with metabolic syndrome was 1.113(95% CI 1.006-1.232), which was significantly higher than that in normal patients, especially in males (p = 0.0386). When the number of metabolic syndrome factors was ≥ 3, the HR of oral cavity cancer was 1.191(95% CI 1.026-1.383), which was significantly higher than that of 0 metabolic syndrome factors, especially in males (p = 0.0218). When the number of metabolic syndrome factors was ≥ 3, the HR for oral cavity cancer was 1.439(95% CI 1.066-1.942), which was significantly higher than that of 0 metabolic syndrome factors, especially in males aged < 50 years (p = 0.0173).

CONCLUSION

Metabolic syndrome increases the risk of oral cavity cancer only in males. In addition, the incidence of oral cavity cancer increased as the number of factors constituting metabolic syndrome increased, only in young males aged < 50 years. Thus, metabolic syndrome is an important risk factor for oral cavity cancer, particularly in young males.

Clinical significance of FAT1 gene mutation and mRNA expression in patients with head and neck squamous cell carcinoma

The FAT1 gene functions as a tumor suppressor or promoter and remains incompletely understood. We examined the clinical significance of FAT1 in head and neck squamous cell carcinoma (HNSCC) using four publicly available HNSCC cohorts and one HNSCC cohort enrolled at a tertiary medical center. We developed FAT1 signatures reflecting FAT1 mutations and mRNA expression using one cohort. Patients with HNSCC were classified into FAT1‐associated low risk (FAT1‐LR; n = 195) and FAT1‐associated high risk (FAT1‐HR; n = 371) subgroups. The five‐year overall survival and recurrence‐free survival rates were significantly lower in the FAT1‐HR subgroup than in the FAT1‐LR subgroup (P = 0.01 and 0.003, respectively). The clinical significance of FAT1 was validated using four independent cohorts. Cox proportional hazards models showed that the FAT1 signature was an independent prognostic factor for HNSCC patients. In addition, FAT1 signature was associated with the response to radiotherapy, advanced stage, and human papilloma virus (HPV) status in HNSCC patients. In conclusion, the FAT1 gene signature was associated with prognosis of HNSCC and may help to provide personalized treatments for HNSCC patients.

Pharyngeal reflux episodes in patients with suspected laryngopharyngeal reflux versus healthy subjects: a prospective cohort study

PURPOSE

This study aimed to analyze pharyngeal reflux episodes in patients with suspected LPR versus healthy subjects using 24-h MII-pH monitoring.

METHODS

One hundred twenty-one patients who visited our clinic with a chief complaint of LPR-related symptoms and underwent 24-h MII-pH monitoring were enrolled prospectively. Also, 27 healthy subjects were enrolled and underwent 24-h MII-pH monitoring during the same period. We analyzed sensitivity, specificity, and accuracy comprehensively to determine appropriate cut-off values of pharyngeal reflux episodes in 24-h MII-pH monitoring to diagnose patients with LPR.

RESULTS

Twenty-nine of 121 patients with suspected LPR showed no pharyngeal reflux episodes, while 92 showed more than one pharyngeal reflux event. In contrast, the 22 healthy subjects showed no pharyngeal reflux episodes, three showed one reflux event, and two showed two reflux events. A cut-off value of ≥ 1 showed best accuracy reflected by combined sensitivity and specificity values, while ≥ 2 demonstrated better specificity with slight loss of sensitivity and slightly lower overall accuracy, suggesting cut-off value of ≥ 1 pharyngeal reflux episodes is a good clinical indicator.

CONCLUSION

A cut-off value of ≥ 1 in pharyngeal reflux episodes on 24-h MII-pH monitoring in patients with suspected LPR might be an acceptable diagnostic tool for LPR.

Management of Laryngopharyngeal Reflux in Asia

OBJECTIVES

This study was conducted to investigate the current practices of Asian otolaryngologists for laryngopharyngeal reflux (LPR).

METHODS

An online survey about LPR was sent to 2,000 members of Asian otolaryngological societies, and a subgroup analysis was performed between Western and Eastern Asian otolaryngologists. The survey was conducted by the Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies.

RESULTS

Among approximately 1,600 Asian otolaryngologists, 146 completed the survey (62 from Western Asian countries, 84 from Eastern Asian countries). A substantial majority (73.3%) of the otolaryngologists considered LPR and gastroesophageal reflux disease to be different diseases. The symptoms thought to be closely related to LPR were coughing after lying down, throat clearing, and globus sensation. The findings thought to be closely related to LPR were posterior commissure granulations and hypertrophy, arytenoids, and laryngeal erythema. The respondents indicated that they mostly diagnosed LPR (70%) after an empirical therapeutic trial of proton pump inhibitors (PPIs). Although multichannel intraluminal impedance-pH (MII-pH) monitoring is a useful tool for diagnosing nonacid or mixed LPR, 78% of Asian otolaryngologists never or very rarely used MII-pH. Eastern Asian otolaryngologists more frequently used once-daily PPIs (64.3% vs. 45.2%, P=0.021), whereas Western Asian otolaryngologists preferred to use twice-daily PPIs (58.1% vs. 39.3%, P=0.025). The poor dietary habits of patients were considered to be the main reason for therapeutic failure by Asian otolaryngologists (53.8%). Only 48.6% of Asian otolaryngologists considered themselves to be adequately knowledgeable and skilled regarding LPR.

CONCLUSION

Significant differences exist between Western and Eastern Asian otolaryngologists in the diagnosis and treatment of LPR. Future consensus statements are needed to establish diagnostic criteria and therapeutic regimens.

Correlation of Nasal Fluid Biomarkers and Symptoms in Patients with Persistent Allergic Rhinitis

OBJECTIVES

This study investigated whether the biomarkers present in nasal fluid reflect the severity of symptoms in patients with persistent allergic rhinitis (PAR).

METHODS

We enrolled 29 PAR patients complaining of nasal symptoms and testing positive to skin prick test. Patients' total nasal symptom score (TNSS) was measured and their nasal lavage fluid (NALF) was collected. The levels of biomarkers including Clara cell protein 16 (CC16), tryptase, and interleukin 5 (IL-5) in NALF were determined via enzyme-linked immunosorbent assay (ELISA).

RESULTS

PAR patients were classified into persistent mild and persistent moderate-to-severe groups according to the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines. The CC16 alone was significantly negatively correlated with TNSS (P < .05). Further, the CC16 level was significantly lower in persistent moderate-to-severe group than persistent mild group of patients (P < .05).

CONCLUSIONS

The levels of CC16 alone among several NALF biomarkers showed an inverse correlation with symptoms of PAR patients.

Risk factors for transcervical incision and drainage of pediatric deep neck infections

OBJECTIVES

The aim of this study was to identify risk factors for transcervical approaches in the treatment of pediatric deep neck infections (DNIs).

METHODS

We performed a retrospective analysis of data from patients who were diagnosed with DNIs. All medical records were reviewed for demographic characteristics, presenting signs and symptoms, duration of symptoms, size of abscess, laboratory results, duration of intravenous (IV) antibiotic administration, duration of hospitalization, medical treatment, and type of surgical drainage (oral or transcervical approach). We divided 126 patients into three groups according to the approach used to treat the DNI: non-surgical, intraoral surgical and external transcervical surgical.

RESULTS

The average ages of the non-surgical, intraoral, and transcervical groups were 10.46±5.27, 12.75±4.82 and 5.54±5.15years, respectively. The transcervical approach was used to treat younger patients (p<0.001). Abscess size was significantly larger for the transcervical group compared to the other groups (5.72±8.93, 13.51±14.74, 18.36±16.05mm, non-surgical, intraoral, and transcervical group, respectively, p=0.009). The average duration of IV antibiotic administration for the transcervical group was 9.77±3.27days, which was significantly higher than those for the other groups (5.49±3.28 for non-surgical and 6.13±2.85 for intraoral, p<0.001). Multivariate analysis revealed that submandibular abscesses (Exp (B)=5.254, p=0.012) were the only significant risk factor for the transcervical approach in surgical treatment of DNIs.

CONCLUSION

Submandibular space abscesses were the only significant risk factor for the transcervical approach in the treatment of pediatric DNI patients.

LEVEL OF EVIDENCE

III.

Factors Affecting the Result of Intralesional Corticosteroid Injection in Patients With Oral Lichen Planus

Objectives

To examine the factors which affect the improvement or the recurrence of disease after intralesional steroid injection in patients with oral lichen planus (OLP).

Methods

Sixty-two patients diagnosed as OLP were treated with intralesion corticosteroid injection. To evaluate the objective severity of OLP, total severity score of OLP was assessed. To examine the factors affecting the therapeutic effect of intralesional steroid injection, factors were compared between the symptom-improved group and symptom-not-improved group. To assess the symptom of patients, patients filled in 10-cm visual analogue scale, along with an Oral Health Impact Profile-14.

Results

Symptoms improved in 50 patients (80.6%, symptom-improved group), but not in 12 patients (symptom-not-improved group). In a comparison between both group, OLP with lip involvement was the only variable which showed significant difference (P=0.008). Twenty-nine of 50 patients had recurrence of OLP (58%, recurrence group) and 21 of 50 patients did not have recurrence (42%, no-recurrence group). Statistically significant differences were not found between both groups.

Conclusion

This study suggested that patients suffering from OLP with lesion on the lip might not be effective in treating with intralesional corticosteroid injection.

Comparison of Characteristics According to Reflux Type in Patients With Laryngopharyngeal Reflux

OBJECTIVES

To analyze laryngopharyngeal reflux (LPR) as an acidic, nonacidic, or mixed type according to 24-hour multi-channel intraluminal impedance (MII) pH monitoring and the clinical characteristics of each type.

METHODS

Ninety patients were prospectively enrolled in this study. All patients underwent 24-hour MII pH monitoring as a diagnostic tool. Eighty-three patients were diagnosed with LPR. The patients were classified into three groups according to the pH of the hypopharyngeal probe: the acid reflux group, nonacid reflux group, and mixed reflux group. Subjective symptoms and objective findings were evaluated based on patients' responses to the Short Form 12 Survey (SF-12), LPR health-related quality of life (LPR-HRQOL), reflux symptom index, and reflux finding score.

RESULTS

The results of each group were compared. As a result, 34 patients were classified into the nonacid reflux group and 49 into the mixed reflux group. There were no patients classified as having acid reflux alone. There was no significant difference between the two groups when comparing the reflux symptom index, reflux finding score, LPR-HRQOL, or the mental component score of the SF-12. However, the physical component score of the SF-12 was higher in the nonacid reflux group (P=0.018). The DeMeester composite score (P=0.015) and total number of LPR events (P=0.001) were lower in the nonacid reflux group than in the mixed reflux group.

CONCLUSION

In conclusion, no LPR patient had only acid reflux. The nonacid reflux LPR patients showed similar clinical characteristics and findings compared to the mixed reflux group, but exhibited significantly fewer LPR episodes.

Clinicopathologic characteristics and pattern of central lymph node metastasis in papillary thyroid cancer located in the isthmus

OBJECTIVES/HYPOTHESIS

The aim of this study was to evaluate the clinicopathologic characteristics and pattern of lymph node (LN) metastasis in papillary thyroid cancer (PTC) located in the isthmus.

STUDY DESIGN

Retrospective cohort study.

METHODS

One hundred ninety consecutive patients with PTC who underwent total thyroidectomy and bilateral central neck dissection were analyzed. Preoperative ultrasonography was reviewed to identify PTC located in the isthmus. Clinicopathologic factors including age, sex, tumor size, extrathyroidal extension (ETE), margin, angiolymphatic invasion, and nodal metastasis were evaluated.

RESULTS

Of 190 PTC patients, 14 patients (7.3%) had a tumor located in the isthmus. The PTCs located in the isthmus were more likely to have ETE and central LN involvement. Furthermore, PTCs located in the isthmus had a higher frequency of metastasis to pretracheal and prelaryngeal LNs than those located in the lobes.

CONCLUSION

PTCs located in the isthmus were associated with ETE and more likely to involve the pretracheal and prelaryngeal LNs.

LEVEL OF EVIDENCE

4 Laryngoscope, 126:2419-2421, 2016.

Comparison of complications in stroke subjects undergoing early versus standard tracheostomy

BACKGROUND

Although the benefits of early tracheostomy have been discussed in numerous studies, it is still unclear whether it is safe to perform early tracheostomy on unstable stroke patients. The purpose of this study is to assess the influences of the timing of tracheostomy on the incidence of complications following surgical tracheostomy in stroke patients.

METHODS

We retrospectively performed chart reviews of 95 stroke subjects who underwent tracheostomy. In terms of timing, procedures performed within 7 d of intubation were categorized as early tracheostomy, and those performed after 7 d were categorized as standard tracheostomy. The incidence of complications following tracheostomy was compared between the two groups. The risk factors for complication were also investigated.

RESULTS

Among the 95 subjects, 59 (62.1%) received early tracheostomy and 36 (37.9%) received standard tracheostomy. The overall incidence of tracheostomy complications was 24.2%, and there was no significant difference in incidence between the two groups. A comparison of risk factors between the groups with and without complications revealed no significant differences in age, sex, body mass index, Glasgow coma scale score, stroke type, or history of underlying disease. However, activated partial thromboplastin time was significantly higher in the group with complication.

CONCLUSIONS

There was no significant difference in the incidence of complications in stroke subjects undergoing early versus standard tracheotomy.