Endoscopic resection of malignant sinonasal tumours: current trends and imaging workup

INTRODUCTION

Modern advances in endonasal endoscopic surgery have expanded its utility in the management of malignant sinonasal tumours, and the degree to which cases are eligible. Knowledge of the indications, inclusion and exclusion criteria and imaging workup that empowers judicious patient selection is essential. This article discusses the endoscopic resection of malignant sinonasal tumours.

CONCLUSION

Studies describing the impact of patient quality of life will surely affect the fate of endoscopic resection, but the current trend suggests that this technique stands to replace an open approach when outcomes are similar. Combined craniofacial/endoscopic and craniofacial-only approaches to sinonasal malignancy remain an important option in the management of complex disease.

Functionalization of quartz crystal microbalances with liposomes containing the N-hydroxysuccinimide ester of palmitic acid

We developed a fast and simple method to functionalize a quartz crystal microbalance (QCM) with liposomes composed of phosphatidylcholine lipid and the N-hydroxysuccinimide (NHS) ester of palmitic acid. The liposome was applied directly to a bare gold surface of a QCM to prepare the lipid bilayer presenting NHS groups on the surface. The whole functionalization process was completed within 1 h using stored lipid films. Streptavidin immobilization efficiency of the method was comparable to the 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC)/NHS chemical method, and the activity of the biotinylated antibody immobilized through the streptavidin was stably retained in repeated surface regeneration with the dissociation buffer.

Study of Microcellular Injection Molding with Expandable Thermoplastic Microsphere

Injection molding with expandable thermoplastic microspheres (ETM) containing blowing chemicals is capable of fabricating lightweight, dimensionally stable plastic parts while using less material. This paper presents the study of microcellular injection molding of low density polyethylene (LDPE), polypropylene (PP), and polystyrene (PS) parts with various ETM contents. It was found that the molded parts exhibit relatively better surface quality than conventional foamed parts. The microcellular morphology and cell density of the fractured cross-sectional surfaces were characterized using a scanning electron microscope (SEM). As reflected by the testing results, the cell microstructure – such as cell size, cell density, and a layered structure with a foamed core sandwiched by skin layers – play an important role in the weight reduction, surface quality, and mechanical properties. A smaller cell diameter and a thicker skin layer help to improve the surface quality and tensile properties of the injection molded parts with ETM. Finally, an appropriate ETM content has a positive effect on cell microstructure and weight reduction, whereas too high a concentration of microspheres adversely affects the tensile properties and surface quality.

Synergistic effects of A1896, T1653 and T1762/A1764 mutations in genotype c2 hepatitis B virus on development of hepatocellular carcinoma

The effects of genomic changes in hepatitis B virus (HBV) on the occurrence of hepatocellular carcinoma (HCC) are still unclear, especially in relation to the genotype of HBV. In this study, we examined the effects of genomic changes in HBV of genotype C2 on the development of HCC. A total of 318 patients with HBV-associated HCC and 234 patients with chronic hepatitis B (CHB) were studied. All of HCC cases were diagnosed histologically and treated with surgical resection. The whole of the X, S, basal core promoter (BCP) and precore regions of the viral genome from sera or liver tissues were sequenced. All subjects had HBV of genotype C2. The prevalence of the T1653 mutation in the X region and the A1896 mutation in the precore region of HBV was significantly higher in the HCC group than in the control CHB group (22% vs 11%, P = 0.003; 50% vs 23%, P < 0.001, respectively). Moreover, the T1762/A1764 mutations in the BCP region in combination with either T1653 or A1896 were more common in the HCC compared with the CHB group (BCP+X1653: 18% vs 11%, P = 0.05; BCP+PC, 40% vs 15%, P < 0.001, respectively). In multivariate analysis, T1653 and A1896 were revealed to be independent risk factors for HCC development. G1896A in the precore region and C1653T mutation in the X region of genotype C2 HBV are important risk factors for HCC development. Also, the A1762T/G1764A double mutation may act in synergy with C1653T to increase the risk of HCC in patients chronically infected with HBV genotype C2.

Epidemiological and clinical characteristics of the outbreak of 2009 pandemic influenza A (H1N1) at a middle school in Luoyang, China

OBJECTIVES

To describe the epidemiological and clinical characteristics of 2009 H1N1 influenza, particularly the incubation period and the duration of symptoms, and to assess the public health response to this outbreak.

STUDY DESIGN

A retrospective cohort study was conducted among all students and employees in a middle school by telephone survey and laboratory inspection.

METHODS

Nasopharyngeal specimens were collected and tested, and real-time reverse transcriptase polymerase chain reaction testing was performed to confirm the viral infection. The epidemiological and clinical characteristics were obtained through a telephone survey, and the incubation period and the duration of symptoms associated with 2009 H1N1 influenza were estimated by parametric distribution.

RESULTS

In total, 253 cases of influenza-like illness were found among students and employees, and 79 of these cases were confirmed as H1N1 infection through laboratory inspection. The response rate for the telephone survey was 93.48% for the students (2586/2768) and 85.87% for the employees (158/184). The average attack rate was 9.22% (253/2744). The main reported symptoms were fever (100%), cough (74.68%), sore throat (59.49%), headache (56.96%) and myalgia/arthralgia (51.90%). No complications were reported and no deaths occurred. The confirmed and suspected cases had no associated travel history or contact with a confirmed or probable case. The estimated median incubation period was 1.6 days [95% confidence interval (CI) 1.2-2.3]. The duration of symptoms was 3-11 days, and the median duration of symptoms was 7.5 days (95% CI 4.5-10.5).

CONCLUSIONS

The results suggest that the outbreak of 2009 H1N1 influenza in this middle school was widespread but not severe. The natural history of 2009 H1N1 influenza virus appears to be similar to that of previously circulating pandemic and interpandemic influenza viruses. The public health response indicates that school closure could have a substantial impact on the spread of 2009 H1N1 influenza.

De novo autoimmune hepatitis in Korean children after liver transplantation: a single institution's experience

INTRODUCTION

De novo autoimmune hepatitis (AIH) after orthotopic liver transplantation (OLT) has been described as a new type of late graft dysfunction in children who have not undergone transplantation for previous autoimmune liver disease. The purpose of this study was to evaluate the clinical aspects of de novo AIH among children following OLT.

PATIENTS AND METHODS

Between January 1994 and May 2007, 149 children underwent OLT, including 1 with recurrent AIH who was excluded from this study, whereas 4 others developed de novo AIH (2.7%; n = 4/148). We analyzed the demographics, laboratory characteristics, and response to treatment of the 4 children with de novo AIH following OLT.

RESULTS

The 4 patients were all girls with a median interval after OLT to presentation of 6.5 years (range, 0.7-8.8 years). The median age when de novo AIH developed was 12.4 years (range, 8.7-17.3 years). All cases were detected by abnormal liver function tests, namely, increased aspartate aminotransferase (AST; median, 322 IU/L; range, 181-919 IU/L). One patient showed elevated immunoglobulin G. Three patients displayed positive antinuclear antibodies. All were seronegative for smooth muscle antibody and liver-kidney microsomal type 1 antibody. One patient showed anti-mitochondrial antibody. All patients were treated with steroids with or without azathioprine. The liver function tests in these 4 patients, improved by at least 50% during the first month of treatment, responding to steroid treatment with or without azathioprine.

CONCLUSION

In preadolescent or adolescent female patients with unexplained graft dysfunction after OLT, it is important to recognize de novo AIH rapidly and to develop an adequate diagnostic strategy, including evaluation of serum autoantibodies, immunoglobulin G, and liver biopsy.

P5-14-25: Disease Presentation, Treatment, and Outcome in Young and Elderly Women with Breast Cancer

Aim: To determine the influence of age on disease presentation, treatment, and outcome in breast cancer patients who are not routinely screened by mammography, women younger than 40 and women older than 69 years.

Methods: The records of 272 breast cancer patients who presented to the Emory University Department of Radiation Oncology between 1997 and 2010 were reviewed. We excluded women with inflammatory or Stage IV breast cancer and those diagnosed between the ages of 40 and 69. We compared presentation, staging, treatment, and outcomes in women younger than 40 with those older than 69. Results: The median age of the young and older patient groups were 31 (range 16–40) and 76 years (range 70–91), respectively. Young women more often presented with a symptomatic breast mass than older women whose cancers were more frequently detected on screening mammography (p&lt;.001). Young women were less likely than older women to present with significant co-morbidities including hypertension, diabetes, or cardiac disease (2% vs 76%, p&lt;.001). A higher proportion of young women had high grade (50% vs 25%), T2/T3 tumors (69% vs 26%), and node positive disease (50% vs 23%) (p&lt;.001 for all comparisons) than older women. Also, more young women had triple negative (25% vs 12.5%, p=.048) or HER2 positive breast cancers (34.4% vs. 18.3%, p=.02). Regarding treatment, older patients were less likely to undergo surgical axillary nodal staging (72% vs. 88%, p&lt;.04) or chemotherapy (23% vs 84%, p&lt;.001).

Among women treated with chemotherapy, older women more often received a non-anthracycline based regimen (82% vs 7% of young patients, p&lt;.001). Following neoadjuvant chemotherapy, significantly more young women had a complete pathological response (23% vs 13% in older women, p&lt;.03). Fifty-two percent of young women received mastectomy versus 14% of older women (p&lt;.001). In part due to their low rates of breast conserving surgery, younger women trended toward less radiation treatment (81% vs 90% in older women, p=.12). Among estrogen receptor positive patients, more young women received adjuvant endocrine therapy than older women (91.4% vs 72%, p=.05). The median follow-up period for the entire group was 38 months (range 1–160). At 3 years, young women were more likely to recur locoregionally (10% vs. 2%, p=.06) and distantly (16% vs 5%, p=.04) than older women, though both groups had comparable breast cancer-specific (96% vs 96%, p=0.2) and overall survival (96% vs 93%, p=.3). On multivariate analysis, old age was a significant predictor of poorer overall survival (p=.05), whereas initial tumor size and nodal status were independent predictors of breast cancer recurrence (p&lt;.05).

Discussion: Our data suggest that young women present with more advanced stage tumors than older patients and are subsequently treated with more aggressive surgery and systemic treatments, including chemotherapy and endocrine therapy. In spite of this, young women are more likely to develop breast cancer recurrence largely due to their higher T and N stages at diagnosis. Select women less than the age of 40 may benefit from screening and early detection of their breast cancers. Regardless, future studies aimed at developing better systemic treatments for younger breast cancer patients are warranted.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-14-25.

Case-cohort study to determine the value of therapeutic touch in preventing radiation dermatitis

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Background: Therapeutic touch (TT) is a noninvasive healing technique. There is evidence of value in various clinical areas, but not during radiotherapy (RT) for breast cancer. The TT Cohort was designed to assess the acceptability, compliance, and side effects of TT. The Control Cohort was used compare the impact of TT in preventing radiation dermatitis.

Methods: Early breast cancer patients scheduled to undergo post-conservative surgery RT were selected. TT was administered three times per week during RT. Feasibility was defined a priori as 15 of 17 patients completing all treatments. The effectiveness of TT was evaluated by the NCIC CTC V3 dermatitis scale and EORTC Cosmetic Rating. The quality of life (QOL), mood, and fatigue were assessed by EORTC QLQ C30, POMS, and BFI, respectively. These were assessed at baseline and weekly during treatment.

Results: 17 stage I/II breast were prospectively identified for the TT Cohort and 31 patients were prospectively assessed in the Control Cohort. Median age was 63 years (47-79). TT was considered feasible as all 17 patients completed treatment. In the TT Cohort, the worst grade of radiation dermatitis was grade II in 9 patients. One patient did not develop any dermatitis. Median time to develop the worst grade was 20 days. QOL, mood and energy, and fatigue levels were consistent with the previous published studies. In the Control Cohort, the worst grade of radiation dermatitis was grade III in 1 patient. The most common toxicity grade was II in 15 patients. Three patients did not develop any dermatitis. Median time to develop the worst grade was 29 days. There was no statistical difference in the overall cosmetic score and grade II/III toxicity. There was a statistically significant difference in skin pigmentation and edema.

Conclusions: This study represents the first evaluation of TT in patients with EBC using objective measures. TT is a feasible addition for the management of dermatitis to a tertiary clinic. TT neither improved overall cosmesis nor grade II/III toxicity.